{"id":52171,"date":"2023-09-20T09:30:00","date_gmt":"2023-09-20T09:30:00","guid":{"rendered":"https:\/\/medsname.com\/topamac\/"},"modified":"2026-05-01T10:49:12","modified_gmt":"2026-05-01T10:49:12","slug":"topamac","status":"publish","type":"product","link":"https:\/\/medsbase.com\/cs\/product\/topamac\/","title":{"rendered":"Topamac"},"content":{"rendered":"

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\u26a1 Rychl\u00e1 odpov\u011b\u010f \u2014 Topamac \u2014 topiramate 25 mg \/ 50 mg<\/h3>\n

Topamac je topiramate 25 mg \/ 50 mg US$2.27\/tablet<\/strong> US$2.09\/tablet US$228.00<\/strong>. \u26a1 Rychl\u00e1 odpov\u011b\u010f \u2014 Topamac \u2014 topiramate 25 mg \/ 50 mg.<\/p>\n<\/div>\n

\nCo z\u00edsk\u00e1te s MedsBase:<\/strong> V\u00fdrobce certifikovan\u00fd WHO-GMP \u00b7 Diskr\u00e9tn\u00ed balen\u00ed \u00b7 Celosv\u011btov\u00e1 doprava \u00b7 V\u00edce ne\u017e 1 400 ov\u011b\u0159en\u00fdch recenz\u00ed z\u00e1kazn\u00edk\u016f<\/a>\n<\/div>\n

\ud83d\udce6 Ka\u017ed\u00e1 objedn\u00e1vka je pokryta na\u0161\u00ed Z\u00e1rukou op\u011btovn\u00e9ho odesl\u00e1n\u00ed<\/strong><\/a> \u2014 pokud va\u0161e z\u00e1silka nedoraz\u00ed do 20 pracovn\u00edch dn\u016f, p\u0159epos\u00edl\u00e1me ji.<\/p>\n

Pro\u010d objedn\u00e1vat z MedsBase<\/h3>\n

Na\u0161e generick\u00e9 l\u00e9ky poch\u00e1zej\u00ed od v\u00fdrobc\u016f certifikovan\u00fdch WHO-GMP a jsou expedov\u00e1ny po cel\u00e9m sv\u011bt\u011b v diskr\u00e9tn\u00edm, nen\u00e1padn\u00e9m balen\u00ed \u2013 na vn\u011bj\u0161\u00ed stran\u011b bal\u00edku nen\u00ed uveden n\u00e1zev l\u00e9ku. Platby kartou jsou sm\u011brov\u00e1ny prost\u0159ednictv\u00edm regulovan\u00e9ho procesoru (popisky na v\u00fdpisu zahrnuj\u00ed regulovan\u00e9ho procesora plateb kartou \u2013 nikdy \u201cMedsBase\u201d nebo n\u00e1zev l\u00e9ku). P\u0159ij\u00edm\u00e1me tak\u00e9 kryptom\u011bny a bankovn\u00ed p\u0159evody SEPA. Ka\u017ed\u00e1 objedn\u00e1vka je zaji\u0161t\u011bna na\u0161\u00ed politikou p\u0159eposl\u00e1n\u00ed.<\/p>\n

Topamac je topiramate 25 mg \/ 50 mg<\/h2>\n

US$2.27\/tablet US$2.09\/tablet<\/strong> US$228.00 parci\u00e1ln\u00ed a generalizovan\u00e9 tonicko-klonick\u00e9 z\u00e1chvaty<\/strong> (monoterapie nebo adjuvantn\u00ed l\u00e9\u010dba) a pro profylaxe migr\u00e9ny<\/strong>. Mimo schv\u00e1len\u00e9 indikace existuj\u00ed d\u016fkazy pro pou\u017eit\u00ed u poruchy u\u017e\u00edv\u00e1n\u00ed alkoholu, z\u00e1chvatovit\u00e9 p\u0159ej\u00edd\u00e1n\u00ed, idiopatick\u00e1 intrakrani\u00e1ln\u00ed hypertenze, esenci\u00e1ln\u00ed tremor a bipol\u00e1rn\u00ed porucha<\/strong> \u2014 nejpevn\u011bj\u0161\u00ed d\u016fkazy mimo schv\u00e1len\u00e9 indikace jsou pro poruchu u\u017e\u00edv\u00e1n\u00ed alkoholu (Johnson 2007).<\/p>\n

Jak topiramat p\u016fsob\u00ed<\/h2>\n

Topiramat m\u00e1 n\u011bkolik vz\u00e1jemn\u011b se dopl\u0148uj\u00edc\u00edch \u00fa\u010dink\u016f v CNS:<\/p>\n

    \n
  • Blok\u00e1da sod\u00edkov\u00fdch kan\u00e1l\u016f<\/strong> \u2014 sni\u017euje neuron\u00e1ln\u00ed excitabilitu (antikonvulzivn\u00ed \u00fa\u010dinek)<\/li>\n
  • Potenciace GABA-A<\/strong> na nebenzodiazepinov\u00e9m vazebn\u00e9m m\u00edst\u011b \u2014 zvy\u0161uje inhibi\u010dn\u00ed tonus<\/li>\n
  • Antagonismus glutam\u00e1tov\u00fdch AMPA\/kain\u00e1tov\u00fdch receptor\u016f<\/strong> \u2014 sni\u017euje excita\u010dn\u00ed neurotransmisi; pova\u017euje se za hlavn\u00ed mechanismus \u00fa\u010dinku u poruchy u\u017e\u00edv\u00e1n\u00ed alkoholu<\/li>\n
  • Inhibice karboanhydr\u00e1zy<\/strong> \u2014 vysv\u011btluje vedlej\u0161\u00ed \u00fa\u010dinky v podob\u011b metabolick\u00e9 acid\u00f3zy, tvorby ledvinov\u00fdch kamen\u016f a \u00fabytku hmotnosti<\/li>\n
  • Modulace nap\u011b\u0165ov\u011b \u0159\u00edzen\u00fdch kalciov\u00fdch kan\u00e1l\u016f<\/strong><\/li>\n<\/ul>\n

    Kombinace antagonismu glutam\u00e1tov\u00fdch AMPA receptor\u016f a zes\u00edlen\u00ed GABA-A se pova\u017euje za mechanismus, kter\u00fd tlum\u00ed dopaminergn\u00ed odm\u011bnov\u00e9 okruhy \u0159\u00edd\u00edc\u00ed chu\u0165 na alkohol a z\u00e1chvatovit\u00e9 p\u0159ej\u00edd\u00e1n\u00ed \u2014 stejnou dr\u00e1hu, na kterou naltrexon p\u016fsob\u00ed p\u0159es opioidn\u00ed receptory.<\/p>\n

    Jak se Topamac u\u017e\u00edv\u00e1<\/h2>\n

    Pomal\u00e1 titrace je z\u00e1sadn\u00ed \u2014 rychl\u00e9 zvy\u0161ov\u00e1n\u00ed d\u00e1vek zp\u016fsobuje nep\u0159ijateln\u00e9 kognitivn\u00ed vedlej\u0161\u00ed \u00fa\u010dinky (fenom\u00e9n \u201ctopa-dopa\u201d: obt\u00ed\u017ee s hled\u00e1n\u00edm slov, zpomalen\u00e9 my\u0161len\u00ed, zmatenost). Standardn\u00ed 8t\u00fddenn\u00ed titrace:<\/p>\n\n\n\n\n\n\n\n\n\n\n
    T\u00fdden<\/th>\nRann\u00ed d\u00e1vka<\/th>\nVe\u010dern\u00ed d\u00e1vka<\/th>\nCelkov\u00e1 denn\u00ed d\u00e1vka<\/th>\n<\/tr>\n<\/thead>\n
    1<\/td>\n\u2014<\/td>\n25 mg<\/td>\n25 mg<\/td>\n<\/tr>\n
    2<\/td>\n25 mg<\/td>\n25 mg<\/td>\n50 mg<\/td>\n<\/tr>\n
    3<\/td>\n25 mg<\/td>\n50 mg<\/td>\n75 mg<\/td>\n<\/tr>\n
    4<\/td>\n50 mg<\/td>\n50 mg<\/td>\n100 mg<\/td>\n<\/tr>\n
    5\u20138<\/td>\nzvy\u0161ovat o 25 mg\/t\u00fdden<\/td>\nzvy\u0161ovat o 25 mg\/t\u00fdden<\/td>\na\u017e 200 mg\/den<\/td>\n<\/tr>\n
    Udr\u017eovac\u00ed d\u00e1vka<\/td>\nli\u0161\u00ed se<\/td>\nli\u0161\u00ed se<\/td>\nli\u0161\u00ed se podle indikace (viz n\u00ed\u017ee)<\/strong><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n\n\n\n\n\n
    Indikace<\/th>\nC\u00edlov\u00e1 udr\u017eovac\u00ed d\u00e1vka<\/th>\nPozn\u00e1mky<\/th>\n<\/tr>\n<\/thead>\n
    Profylaxe migr\u00e9ny<\/td>\n50\u2013100 mg\/den ve dvou d\u00edl\u010d\u00edch d\u00e1vk\u00e1ch<\/td>\n\u010casto \u00fa\u010dinn\u00e9 p\u0159i 100 mg; vy\u0161\u0161\u00ed d\u00e1vky zvy\u0161uj\u00ed v\u00fdskyt ne\u017e\u00e1douc\u00edch \u00fa\u010dink\u016f bez v\u00fdrazn\u011bj\u0161\u00edho p\u0159\u00ednosu<\/td>\n<\/tr>\n
    Epilepsie u dosp\u011bl\u00fdch (adjuvans)<\/td>\n200\u2013400 mg\/den ve dvou d\u00edl\u010d\u00edch d\u00e1vk\u00e1ch<\/td>\nObvykl\u00e1 udr\u017eovac\u00ed d\u00e1vka; n\u011bkte\u0159\u00ed pacienti sn\u00e1\u0161ej\u00ed a\u017e 1 600 mg\/den<\/td>\n<\/tr>\n
    Alkoholov\u00e1 z\u00e1vislost (mimo indikaci)<\/td>\nTitrov\u00e1no na 200\u2013300 mg\/den<\/td>\nMimo schv\u00e1len\u00e9 indikace<\/strong> \u2014 Studie Johnson 2007 pou\u017e\u00edvala c\u00edl 300 mg; ni\u017e\u0161\u00ed d\u00e1vky (100\u2013150 mg) mohou b\u00fdt n\u011bkdy \u00fa\u010dinn\u00e9 s men\u0161\u00edmi kognitivn\u00edmi vedlej\u0161\u00edmi \u00fa\u010dinky<\/td>\n<\/tr>\n
    Porucha p\u0159\u00edjmu potravy s epizodami p\u0159ej\u00edd\u00e1n\u00ed (mimo schv\u00e1len\u00e9 indikace)<\/td>\n200\u2013400 mg\/den<\/td>\nMimo schv\u00e1len\u00e9 indikace; FDA schv\u00e1lila kombinaci fentermin+topiram\u00e1t pro sn\u00ed\u017een\u00ed hmotnosti<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    U\u017e\u00edvejte s j\u00eddlem nebo nala\u010dno. Dostate\u010dn\u00e1 hydratace v\u00fdrazn\u011b sni\u017euje riziko ledvinov\u00fdch kamen\u016f (c\u00edlit na > 2 l vody denn\u011b). Po dosa\u017een\u00ed udr\u017eovac\u00ed d\u00e1vky se l\u00e9\u010dba obvykle pokra\u010duje alespo\u0148 6\u201312 m\u011bs\u00edc\u016f u AUD, u chronick\u00e9 profylaxe z\u00e1chvat\u016f nebo migr\u00e9ny neomezen\u011b.<\/p>\n

    \u00daprava d\u00e1vky p\u0159i ren\u00e1ln\u00ed insuficienci<\/h2>\n\n\n\n\n\n\n\n\n
    eGFR (mL\/min\/1,73 m\u00b2)<\/th>\n\u00daprava<\/th>\n<\/tr>\n<\/thead>\n
    > 70<\/td>\nStandardn\u00ed<\/td>\n<\/tr>\n
    30\u201370<\/td>\nSn\u00ed\u017eit o 50 %<\/strong>; titrovat pomaleji<\/td>\n<\/tr>\n
    < 30<\/td>\nSn\u00ed\u017eit o 50 %, pe\u010dliv\u011b monitorovat<\/td>\n<\/tr>\n
    Hemodial\u00fdza<\/td>\nDoplnkov\u00e1 d\u00e1vka po dial\u00fdze (v\u00fdznamn\u011b eliminov\u00e1na)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    Vedlej\u0161\u00ed \u00fa\u010dinky (pomal\u00e1 titrace je kl\u00ed\u010dem k toleranci)<\/h2>\n
      \n
    • Zpomalen\u00ed kognitivn\u00edch funkc\u00ed, obt\u00ed\u017ee s vybavov\u00e1n\u00edm slov (\u201ctopa-dopa\u201d)<\/strong> \u2014 limituj\u00edc\u00ed vedlej\u0161\u00ed \u00fa\u010dinek; sni\u017euje se pomalej\u0161\u00ed titrac\u00ed a ni\u017e\u0161\u00ed c\u00edlovou d\u00e1vkou<\/li>\n
    • Parest\u00e9zie<\/strong> (brn\u011bn\u00ed v prstech a rtech) \u2014 velmi \u010dast\u00e9, obvykle m\u00edrn\u00e9; sn\u00ed\u017een\u00e9 dietou bohatou na drasl\u00edk<\/li>\n
    • \u00dabytek hmotnosti<\/strong> \u2014 konzistentn\u00ed a v\u00fdznamn\u00fd (pr\u016fm\u011brn\u011b ~5 % t\u011blesn\u00e9 hmotnosti); obvykle \u017e\u00e1douc\u00ed, ale m\u016f\u017ee b\u00fdt problematick\u00fd u pacient\u016f s n\u00edzk\u00fdm BMI<\/li>\n
    • Nefroliti\u00e1za (ledvinov\u00e9 kameny)<\/strong> \u2014 riziko ~1,5 %; inhibice karbonick\u00e9 anhydr\u00e1zy zvy\u0161uje pH mo\u010di a sni\u017euje citr\u00e1ty. Riziko sn\u00ed\u017eeno dostate\u010dnou hydratac\u00ed; vyvarujte se u pacient\u016f s anamn\u00e9zou kamen\u016f, pokud existuj\u00ed jin\u00e9 mo\u017enosti<\/li>\n
    • Akutn\u00ed glaukom s uzav\u0159en\u00fdm \u00fahlem<\/strong> \u2014 vz\u00e1cn\u00fd, ale z\u00e1va\u017en\u00fd o\u010dn\u00ed stav, obvykle b\u011bhem prvn\u00edho m\u011bs\u00edce; bolest o\u010d\u00ed, rozmazan\u00e9 vid\u011bn\u00ed, zarudl\u00e9 oko = p\u0159eru\u0161it l\u00e9\u010dbu a okam\u017eit\u011b vyhledat o\u010dn\u00ed vy\u0161et\u0159en\u00ed<\/li>\n
    • Metabolick\u00e1 acid\u00f3za<\/strong> (n\u00edzk\u00fd bikarbon\u00e1t) \u2014 u v\u011bt\u0161iny m\u00edrn\u00e1 a asymptomatick\u00e1; zkontrolovat v\u00fdchoz\u00ed a pravideln\u00e9 hladiny bikarbon\u00e1tu<\/li>\n
    • Oligohidr\u00f3za a hypertermie<\/strong> \u2014 sn\u00ed\u017een\u00e9 pocen\u00ed, hlavn\u011b u d\u011bt\u00ed; opatrnost v hork\u00e9m podneb\u00ed<\/li>\n
    • Poruchy n\u00e1lady, deprese, sebevra\u017eedn\u00e9 my\u0161lenky \u2014 spole\u010dn\u00fd znak u antikonvulziv; monitorovat<\/li>\n
    • Anorexie, poruchy chuti (sycen\u00e9 n\u00e1poje chutnaj\u00ed nev\u00fdrazn\u011b \u2014 klasick\u00fd a reverzibiln\u00ed \u00fa\u010dinek)<\/li>\n<\/ul>\n
      Riziko v t\u011bhotenstv\u00ed.<\/strong> Topiram\u00e1t je spojen s 2\u20133\u00d7 vy\u0161\u0161\u00edm rizikem roz\u0161t\u011bp\u016f patra a rtu<\/strong> (roz\u0161t\u011bp rtu\/patra) p\u0159i u\u017e\u00edv\u00e1n\u00ed v prvn\u00edm trimestru a s ni\u017e\u0161\u00ed porodn\u00ed hmotnost\u00ed. \u017deny v reproduk\u010dn\u00edm v\u011bku pot\u0159ebuj\u00ed \u00fa\u010dinnou antikoncepci<\/strong> \u2014 topiram\u00e1t v d\u00e1vce > 200 mg\/den sni\u017euje \u00fa\u010dinnost hormon\u00e1ln\u00ed antikoncepce indukc\u00ed CYP3A4, proto je vhodn\u00e1 pilulka s vy\u0161\u0161\u00edm obsahem estrogenu, nitrod\u011blo\u017en\u00ed t\u011bl\u00edsko nebo bari\u00e9rov\u00e1 metoda. P\u0159i pl\u00e1nov\u00e1n\u00ed t\u011bhotenstv\u00ed p\u0159ej\u00edt na alternativn\u00ed antikonvulzivum (lamotrigin, levetiracetam) p\u0159ed po\u010det\u00edm. Antiepileptic Drug Pregnancy Registry nad\u00e1le sleduje v\u00fdsledky.<\/div>\n

      Interakce l\u00e9k\u016f<\/h2>\n\n\n\n\n\n\n\n\n\n\n\n\n\n
      L\u00e9k\/t\u0159\u00edda<\/th>\n\u00da\u010dinek<\/th>\n\u00da\u010dinek<\/th>\n<\/tr>\n<\/thead>\n
      Hormon\u00e1ln\u00ed antikoncepce (kombinovan\u00e1)<\/td>\nSn\u00ed\u017een\u00e1 \u00fa\u010dinnost p\u0159i d\u00e1vce topiram\u00e1tu > 200 mg\/den<\/td>\nPou\u017e\u00edvejte pilulku s vy\u0161\u0161\u00edm obsahem estrogenu, nitrod\u011blo\u017en\u00ed t\u011bl\u00edsko nebo bari\u00e9rovou ochranu<\/td>\n<\/tr>\n
      Karbamazepin<\/td>\nSni\u017euje hladinu topiram\u00e1tu (indukce CYP3A4)<\/td>\nM\u016f\u017ee b\u00fdt pot\u0159eba vy\u0161\u0161\u00ed d\u00e1vka topiram\u00e1tu<\/td>\n<\/tr>\n
      Fenytoin<\/td>\nSni\u017euje hladinu topiram\u00e1tu; m\u00edrn\u011b zvy\u0161uje hladinu fenytoinu<\/td>\nMonitorujte hladiny<\/td>\n<\/tr>\n
      Jin\u00e9 inhibitory karboanhydr\u00e1zy (acetazolamid, zonisamid, diklorfenamid)<\/td>\nKumulativn\u00ed riziko metabolick\u00e9 acid\u00f3zy a tvorby kamen\u016f<\/td>\nVyvarujte se kombinace<\/td>\n<\/tr>\n
      Lithium<\/td>\nProm\u011bnliv\u00e9 zm\u011bny hladin lithia<\/td>\n\u010cast\u011bj\u0161\u00ed monitorov\u00e1n\u00ed lithia po zm\u011bn\u011b d\u00e1vkov\u00e1n\u00ed<\/td>\n<\/tr>\n
      Valpro\u00e1t<\/td>\nOba mohou zp\u016fsobit hyperamonemickou encefalopatii<\/td>\nOpatrnost; p\u0159i zmatenosti vy\u0161et\u0159it amoniak<\/td>\n<\/tr>\n
      Alkohol<\/td>\nKognitivn\u00ed poruchy se s\u010d\u00edtaj\u00ed; alkohol zesiluje \u00fa\u010dinek topiram\u00e1tu na \u0159\u00edzen\u00ed<\/td>\nPora\u010fte pacientovi<\/td>\n<\/tr>\n
      Metformin<\/td>\nOba zvy\u0161uj\u00ed lakt\u00e1t; teoretick\u00e9 riziko kumulativn\u00ed lakt\u00e1tov\u00e9 acid\u00f3zy<\/td>\nMonitorov\u00e1n\u00ed; obvykle bezpe\u010dn\u00e9<\/td>\n<\/tr>\n
      Hydrochlorothiazid<\/td>\nZvy\u0161uje hladinu topiram\u00e1tu<\/td>\nMonitorujte vedlej\u0161\u00ed \u00fa\u010dinky<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

      Kontraindikace a speci\u00e1ln\u00ed populace<\/h2>\n