Endoxan (cyklofosfamid 50 mg)<\/a><\/li>\n<\/ul>\n\u010casto kladen\u00e9 dotazy<\/h2>\nPro\u010d je Siromus za\u0159azen mezi protin\u00e1dorov\u00e9 l\u00e9ky?<\/h3>\n
Sirolimus je prim\u00e1rn\u011b imunosupresivum pro transplantace. mTOR dr\u00e1ha je zapojena do mnoha typ\u016f rakoviny a strukturn\u011b p\u0159\u00edbuzn\u00fd everolimus m\u00e1 schv\u00e1len\u00ed FDA pro n\u011bkolik onkologick\u00fdch indikac\u00ed, ale sirolimus s\u00e1m o sob\u011b nen\u00ed standardn\u00edm protin\u00e1dorov\u00fdm l\u00e9kem. Sou\u010dasn\u00e9 za\u0159azen\u00ed do kategorie se zd\u00e1 b\u00fdt historick\u00fdm taxonomick\u00fdm probl\u00e9mem.<\/p>\n
Siromus versus takrolimus \u2014 kter\u00fd je lep\u0161\u00ed?<\/h3>\n
Maj\u00ed r\u016fzn\u00e9 mechanismy \u00fa\u010dinku (mTOR vs kalcineurin), r\u016fzn\u00e9 profily vedlej\u0161\u00edch \u00fa\u010dink\u016f a r\u016fzn\u00e9 role. Tacrolimus je standardn\u00ed z\u00e1kladn\u00ed l\u00e9k pro \u010dasnou indukci a udr\u017eovac\u00ed l\u00e9\u010dbu po transplantaci. Sirolimus se obvykle zav\u00e1d\u00ed 2\u20134 m\u011bs\u00edce po transplantaci, \u010dasto nahrazuje nebo sni\u017euje d\u00e1vku tacrolimu, zejm\u00e9na u pacient\u016f s nefrotoxicitou zp\u016fsobenou inhibitorem kalcineurinu. Nejsou zam\u011bniteln\u00e9.<\/p>\n
Siromus versus everolimus?<\/h3>\n
Everolimus je analog sirolimu s hydroxyethylovou modifikac\u00ed, kter\u00e1 zaji\u0161\u0165uje krat\u0161\u00ed polo\u010das (28 vs 60 hodin), co\u017e umo\u017e\u0148uje d\u00e1vkov\u00e1n\u00ed dvakr\u00e1t denn\u011b a rychlej\u0161\u00ed \u00fapravu d\u00e1vky. Everolimus m\u00e1 v\u00edce schv\u00e1len\u00fdch indikac\u00ed (HR+ HER2- karcinom prsu s exemestanem, pokro\u010dil\u00fd ren\u00e1ln\u00ed karcinom, neuroendokrinn\u00ed n\u00e1dory, SEGA, TSC-AML, l\u00e9kov\u011b eluuj\u00edc\u00ed stenty). Sirolimus je mate\u0159sk\u00e1 slou\u010denina a st\u00e1le se \u0161iroce pou\u017e\u00edv\u00e1 v udr\u017eovac\u00ed l\u00e9\u010db\u011b po transplantaci a u LAM.<\/p>\n
Zv\u00fd\u0161\u00ed Siromus m\u00e9 riziko rakoviny?<\/h3>\n
Dlouhodob\u00e1 imunosuprese jak\u00fdmkoli p\u0159\u00edpravkem (sirolimus, tacrolimus, cyklosporin, mykofenol\u00e1t) zvy\u0161uje celo\u017eivotn\u00ed riziko ko\u017en\u00edch n\u00e1dor\u016f, posttransplanta\u010dn\u00edho lymfoproliferativn\u00edho onemocn\u011bn\u00ed a n\u011bkolika dal\u0161\u00edch malignit. T\u0159\u00edda inhibitor\u016f mTOR m\u016f\u017ee m\u00edt ni\u017e\u0161\u00edm<\/em> ni\u017e\u0161\u00ed riziko ko\u017en\u00edch n\u00e1dor\u016f ne\u017e inhibitory kalcineurinu podle \u00fadaj\u016f z transplanta\u010dn\u00edch kohort \u2014 n\u011bkter\u00e1 centra p\u0159ev\u00e1d\u011bj\u00ed pacienty s mnoho\u010detn\u00fdmi ko\u017en\u00edmi n\u00e1dory na sirolimus. Ro\u010dn\u00ed vy\u0161et\u0159en\u00ed cel\u00e9ho t\u011bla + denn\u00ed pou\u017e\u00edv\u00e1n\u00ed SPF 50+ je standard bez ohledu na re\u017eim.<\/p>\nPro\u010d pot\u0159ebuji krevn\u00ed test na sirolimus?<\/h3>\n
Sirolimus m\u00e1 \u00fazk\u00e9 terapeutick\u00e9 okno. Pod c\u00edlovou hladinou riskujete odm\u00edtnut\u00ed transplant\u00e1tu; nad c\u00edlovou hladinou riskujete pneumonitidu, t\u011b\u017ekou hyperlipidemii, infekci a dal\u0161\u00ed toxicitu. Standardn\u00edm monitorovac\u00edm vzorkem je 24hodinov\u00e1 p\u0159edd\u00e1vkov\u00e1 hladina v pln\u00e9 krvi. C\u00edle se li\u0161\u00ed podle indikace a re\u017eimu \u2014 v\u00e1\u0161 transplanta\u010dn\u00ed t\u00fdm stanov\u00ed v\u00e1\u0161 c\u00edl.<\/p>\n
M\u016f\u017eu podstoupit operaci p\u0159i u\u017e\u00edv\u00e1n\u00ed Siromusu?<\/h3>\n
Sirolimus naru\u0161uje hojen\u00ed ran inhibic\u00ed proliferace fibroblast\u016f a endoteli\u00e1ln\u00edch bun\u011bk prost\u0159ednictv\u00edm mTOR. P\u0159i pl\u00e1novan\u00fdch operac\u00edch se sirolimus obvykle vysazuje 2\u20134 t\u00fddny p\u0159ed v\u00fdkonem a obnovuje po dobr\u00e9m zahojen\u00ed r\u00e1ny (obvykle 2\u20134 t\u00fddny po operaci). P\u0159i nouzov\u00fdch operac\u00edch se sirolimus okam\u017eit\u011b vysad\u00ed a pod veden\u00edm transplanta\u010dn\u00edho t\u00fdmu se nahrad\u00ed re\u017eimem zalo\u017een\u00fdm na inhibitoru kalcineurinu.<\/p>\n
Pro\u010d mus\u00edm Siromus u\u017e\u00edvat pravideln\u011b, a\u0165 u\u017e s j\u00eddlem nebo bez?<\/h3>\n
Vysokotu\u010dn\u00e1 strava zvy\u0161uje AUC sirolimu asi o 35 % a vrcholovou koncentraci asi o 65 %. Pokud st\u0159\u00edd\u00e1te d\u00e1vkov\u00e1n\u00ed nala\u010dno a po j\u00eddle, va\u0161e hladiny p\u0159ed d\u00e1vkou se stanou nep\u0159edv\u00eddateln\u00e9. Zvolte si rutinu (v\u011bt\u0161ina lid\u00ed preferuje konzistentn\u00ed d\u00e1vkov\u00e1n\u00ed nala\u010dno, proto\u017ee je snaz\u0161\u00ed ji dodr\u017eovat) a dr\u017ete se j\u00ed.<\/p>\n
Jsou Rapacan a Siromus stejn\u00e9 jako Rapamune?<\/h3>\n
Ano \u2014 Rapacan, Siromus a Rapamune jsou v\u0161echny sirolimus 1 mg. Rapamune je p\u016fvodn\u00ed zna\u010dka od Wyeth\/Pfizer. Rapacan a Siromus jsou bioekvivalentn\u00ed generick\u00e9 verze od r\u016fzn\u00fdch v\u00fdrobc\u016f.<\/p>\n
Co je LAM?<\/h3>\n
Lymfangioleiomyomat\u00f3za je vz\u00e1cn\u00e9 progresivn\u00ed cystick\u00e9 plicn\u00ed onemocn\u011bn\u00ed, kter\u00e9 postihuje t\u00e9m\u011b\u0159 v\u00fdhradn\u011b \u017eeny a je \u010dasto spojeno s tuber\u00f3zn\u00ed skler\u00f3zou. Inhibice mTOR pomoc\u00ed sirolimu stabilizuje plicn\u00ed funkci (FEV1) u LAM \u2014 studie MILES vedla ke schv\u00e1len\u00ed FDA v roce 2015. LAM je diagnostikov\u00e1no a l\u00e9\u010deno ve specializovan\u00fdch centrech.<\/p>\n
M\u016f\u017eu p\u00edt alkohol p\u0159i u\u017e\u00edv\u00e1n\u00ed Siromusu?<\/h3>\n
Nejsou zn\u00e1my specifick\u00e9 interakce s alkoholem. M\u00edrn\u00e1 konzumace je obecn\u011b p\u0159ijateln\u00e1, ale alkohol zhor\u0161uje hyperlipidemii (b\u011b\u017en\u00fd vedlej\u0161\u00ed \u00fa\u010dinek sirolimu) a m\u016f\u017ee ovliv\u0148ovat jatern\u00ed metabolismus. Pokud m\u00e1te transplantovan\u00e1 j\u00e1tra nebo jin\u00e9 jatern\u00ed onemocn\u011bn\u00ed, je alkohol kontraindikov\u00e1n.<\/p>\n
Zdravotn\u00ed upozorn\u011bn\u00ed:<\/strong> Tato produktov\u00e1 str\u00e1nka slou\u017e\u00ed pro vzd\u011bl\u00e1vac\u00ed \u00fa\u010dely a nenahrazuje l\u00e9ka\u0159skou pomoc. Imunosupresiva mohou zp\u016fsobit \u017eivot ohro\u017euj\u00edc\u00ed infekce, malignity a vrozen\u00e9 vady. Pou\u017e\u00edvejte pouze pod odborn\u00fdm dohledem s vhodn\u00fdm monitorov\u00e1n\u00edm.<\/p>","protected":false},"excerpt":{"rendered":"\u2705 Imunosupresivn\u00ed l\u00e9k
\n\u2705 Zabr\u00e1n\u00ed odm\u00edtnut\u00ed org\u00e1nu
\n\u2705 L\u00e9\u010dba lymfangioleiomyomat\u00f3zy
\n\u2705 Sni\u017euje po\u0161kozen\u00ed ledvin
\n\u2705 Kontroluje revmatoidn\u00ed artritidu<\/p>","protected":false},"featured_media":53495,"comment_status":"open","ping_status":"open","template":"","meta":[],"product_brand":[],"product_cat":[3595,3141,3223],"product_tag":[],"class_list":{"0":"post-53494","1":"product","2":"type-product","3":"status-publish","4":"has-post-thumbnail","6":"product_cat-anti-cancer-medication","7":"product_cat-category-overview","8":"product_cat-chronic-conditions","10":"first","11":"instock","12":"shipping-taxable","13":"purchasable","14":"product-type-variable","15":"has-default-attributes"},"acf":[],"_links":{"self":[{"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product\/53494","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product"}],"about":[{"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/types\/product"}],"replies":[{"embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/comments?post=53494"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/media\/53495"}],"wp:attachment":[{"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/media?parent=53494"}],"wp:term":[{"taxonomy":"product_brand","embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_brand?post=53494"},{"taxonomy":"product_cat","embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_cat?post=53494"},{"taxonomy":"product_tag","embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_tag?post=53494"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}