{"id":53698,"date":"2023-09-20T09:49:34","date_gmt":"2023-09-20T09:49:34","guid":{"rendered":"https:\/\/medsname.com\/vorier\/"},"modified":"2026-04-30T10:25:10","modified_gmt":"2026-04-30T10:25:10","slug":"vorier","status":"publish","type":"product","link":"https:\/\/medsbase.com\/cs\/product\/vorier\/","title":{"rendered":"Vorier"},"content":{"rendered":"<p><!-- medsbase-tldr-answer --><\/p>\n<div style=\"background:#fff8e1;border-left:4px solid #f5a623;padding:14px 20px;margin:18px 0;border-radius:6px;\">\n<h3 style=\"margin-top:0;\">\ud83d\udca1 Rychl\u00e1 odpov\u011b\u010f<\/h3>\n<p style=\"margin-bottom:0;\">Vorier je vorikonazol 200 mg peror\u00e1ln\u00ed tableta \u2014 druh\u00e1 generace triazol\u016f a <strong>l\u00e9\u010dba prvn\u00ed volby u invazivn\u00ed aspergil\u00f3zy<\/strong>. Tak\u00e9 p\u016fsob\u00ed proti Candid\u011b (v\u010detn\u011b n\u011bkter\u00fdch kmen\u016f rezistentn\u00edch na flukonazol), Scedosporiu, Fusariu. Specializovan\u00fd l\u00e9k zahajovan\u00fd v nemocni\u010dn\u00edm prost\u0159ed\u00ed \u2014 vy\u017eaduje se TDM (koncentrace v doln\u00ed hranici 1\u20135,5 mg\/l), povinn\u00e9 vstupn\u00ed vy\u0161et\u0159en\u00ed u oftalmologa (\u010dast\u00e9 poruchy zraku) a \u010dast\u00e9 monitorov\u00e1n\u00ed jatern\u00edch funkc\u00ed. Velmi slo\u017eit\u00e1 farmakokinetika: neline\u00e1rn\u00ed (polymorfismus CYP2C19), siln\u00fd inhibitor CYP3A4, fotosenzitivita \u2192 riziko rakoviny k\u016f\u017ee p\u0159i dlouhodob\u00e9m u\u017e\u00edv\u00e1n\u00ed.<\/p>\n<\/div>\n<div class=\"medsbase-trust-strip\" style=\"background:#f5f5f5;border:1px solid #e1e1e1;padding:18px 22px;margin:24px 0;border-radius:8px;display:flex;flex-wrap:wrap;justify-content:space-around;gap:16px;align-items:center;font-size:0.95em;\">\n<div style=\"text-align:center;flex:1;min-width:140px;\">\ud83c\udfed<br \/><strong>WHO-GMP<\/strong><br \/>certifikovan\u00fd v\u00fdrobce<\/div>\n<p class=\"medsbase-reship-line\" style=\"font-size:14px;color:#444;margin:8px 0 18px;\">\ud83d\udce6 Ka\u017ed\u00e1 objedn\u00e1vka je pokryta na\u0161\u00ed <a href=\"https:\/\/medsbase.com\/cs\/medsbase-re-shipment-assurance-policy\/\"><strong>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<h3>Pro\u010d objedn\u00e1vat z MedsBase<\/h3>\n<p>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<div style=\"text-align:center;flex:1;min-width:140px;\">\ud83d\udce6<br \/><strong>Diskr\u00e9tn\u00ed balen\u00ed<\/strong><br \/>oby\u010dejn\u00e1 ob\u00e1lka<\/div>\n<div style=\"text-align:center;flex:1;min-width:140px;\">\ud83c\udf0d<br \/><strong>Dod\u00e1n\u00ed po cel\u00e9m sv\u011bt\u011b<\/strong><br \/>do v\u011bt\u0161iny zem\u00ed<\/div>\n<div style=\"text-align:center;flex:1;min-width:140px;\">\u2b50<br \/><strong>1 400+ z\u00e1kazn\u00edk\u016f<\/strong><br \/><a href=\"https:\/\/medsbase.com\/cs\/reviews\/\">\u010d\u00edst recenze<\/a><\/div>\n<\/div>\n<h2>\ud83d\udd12 Pro\u010d objedn\u00e1vat Vorier z MedsBase<\/h2>\n<ul>\n<li><strong>v\u00fdrobce certifikovan\u00e9ho WHO-GMP<\/strong> \u2014 dod\u00e1v\u00e1no z regulovan\u00e9ho za\u0159\u00edzen\u00ed, kompletn\u00ed balen\u00ed s \u010d\u00edslem \u0161ar\u017ee a datem expirace.<\/li>\n<li><strong>Diskr\u00e9tn\u00ed balen\u00ed<\/strong> \u2014 oby\u010dejn\u00e1 ob\u00e1lka, bez uveden\u00ed n\u00e1zvu l\u00e9ku na vn\u011bj\u0161\u00ed stran\u011b.<\/li>\n<li><strong>Dod\u00e1n\u00ed po cel\u00e9m sv\u011bt\u011b<\/strong> do v\u011bt\u0161iny zem\u00ed s <a href=\"https:\/\/medsbase.com\/cs\/medsbase-re-shipment-assurance-policy\/\">Reshipment Assurance<\/a>.<\/li>\n<li><strong>V\u011brnostn\u00ed body<\/strong> \u2014 1 bod za ka\u017ed\u00fd utracen\u00fd 1$ (neplat\u00ed pro peptidy\/dopravu); 100 bod\u016f = 5$ sleva na dal\u0161\u00ed objedn\u00e1vku.<\/li>\n<\/ul>\n<h2 id=\"uses\">Pou\u017eit\u00ed a indikace<\/h2>\n<p>Vorier (voriconazol 200 mg, Glenmark) je specializovan\u00e9 antimykotikum \u2014 l\u00e9k prvn\u00ed volby u invazivn\u00ed aspergil\u00f3zy (toto potvrdila studie Herbrecht 2002 publikovan\u00e1 v NEJM) a mo\u017enost l\u00e9\u010dby u invazivn\u00ed kandid\u00f3zy, infekc\u00ed zp\u016fsoben\u00fdch Scedosporium a Fusarium, j\u00edcnov\u00e9 kandid\u00f3zy rezistentn\u00ed na flukonazol a febriln\u00ed neutropenie u vybran\u00fdch p\u0159\u00edpad\u016f. <strong>Nen\u00ed l\u00e9kem prvn\u00ed volby u vagin\u00e1ln\u00ed nebo or\u00e1ln\u00ed kandid\u00f3zy ani u onychomyk\u00f3zy<\/strong> \u2014 u t\u011bchto stav\u016f pou\u017eijte flukonazol nebo terbinafin.<\/p>\n<table style=\"width:100%;border-collapse:collapse;margin:14px 0;font-size:0.95em;\">\n<thead>\n<tr style=\"background:#2c7cb0;color:#fff;\">\n<th style=\"padding:8px;text-align:left;border:1px solid #ccc;\">Indikace<\/th>\n<th style=\"padding:8px;text-align:left;border:1px solid #ccc;\">Typick\u00e9 d\u00e1vkov\u00e1n\u00ed<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"background:#fff;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">Invazivn\u00ed aspergil\u00f3za<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">\u00davodn\u00ed d\u00e1vka 6 mg\/kg ka\u017ed\u00fdch 12 hodin po dobu 24 hodin, pot\u00e9 4 mg\/kg ka\u017ed\u00fdch 12 hodin IV; nebo peror\u00e1ln\u011b 200 mg ka\u017ed\u00fdch 12 hodin (\u2265 40 kg) \/ 100 mg ka\u017ed\u00fdch 12 hodin (&lt; 40 kg)<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">Kandid\u00e9mie (u pacient\u016f bez neutropenie)<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Stejn\u00e9 d\u00e1vkov\u00e1n\u00ed \u2014 minim\u00e1ln\u011b 14 dn\u00ed po prvn\u00edm negativn\u00edm hemokultu\u0159e<\/td>\n<\/tr>\n<tr style=\"background:#fff;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">J\u00edcnov\u00e1 kandid\u00f3za (rezistentn\u00ed na flukonazol)<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">200 mg ka\u017ed\u00fdch 12 hodin po dobu 14\u201321 dn\u00ed<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">Infekce zp\u016fsoben\u00e1 Scedosporium \/ Fusarium<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">200 mg ka\u017ed\u00fdch 12 hodin, d\u00e9lka pod\u00e1v\u00e1n\u00ed podle odpov\u011bdi<\/td>\n<\/tr>\n<tr style=\"background:#fff;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">Empirick\u00e1 terapie u febriln\u00ed neutropenie<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">200 mg ka\u017ed\u00fdch 12 hodin<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2 id=\"how-to-take\">Jak u\u017e\u00edvat<\/h2>\n<ul>\n<li>U\u017e\u00edvejte 1 hodinu p\u0159ed j\u00eddlem nebo 1 hodinu po j\u00eddle \u2014 potrava sni\u017euje absorpci p\u0159ibli\u017en\u011b o 22 %.<\/li>\n<li>Polykejte cel\u00e9 s vodou.<\/li>\n<li>Nasycovac\u00ed d\u00e1vka je kl\u00ed\u010dov\u00e1 \u2014 bez n\u00ed se ust\u00e1len\u00e9ho stavu dos\u00e1hne za 5\u20137 dn\u00ed.<\/li>\n<li>Terapeutick\u00e9 monitorov\u00e1n\u00ed l\u00e9\u010div (koncentrace v minimu 1\u20135,5 mg\/l) v den 5\u20137 a po zm\u011bn\u011b d\u00e1vky.<\/li>\n<\/ul>\n<h2 id=\"mechanism\">Jak to funguje<\/h2>\n<p>Vorikonazol inhibuje houbov\u00fd CYP51 s vy\u0161\u0161\u00ed afinitou ne\u017e flukonazol, \u010d\u00edm\u017e roz\u0161i\u0159uje spektrum \u00fa\u010dinku na Aspergillus a v\u011bt\u0161inu nealbicans kandid. Farmakokinetika je u dosp\u011bl\u00fdch neline\u00e1rn\u00ed \u2014 mal\u00e9 zm\u011bny d\u00e1vky zp\u016fsobuj\u00ed velk\u00e9 zm\u011bny koncentrace. Polymorfismus CYP2C19: pomal\u00ed metaboliz\u00e1to\u0159i (15 % v\u00fdchodn\u00edch Asiat\u016f, 3 % b\u011bloch\u016f) maj\u00ed 4\u00d7 vy\u0161\u0161\u00ed hladiny; ultra-rychl\u00ed metaboliz\u00e1to\u0159i nemus\u00ed dos\u00e1hnout terapeutick\u00fdch hladin. <strong>Proto je TDM povinn\u00e9.<\/strong><\/p>\n<h2 id=\"side-effects\">Ne\u017e\u00e1douc\u00ed \u00fa\u010dinky &amp; monitorov\u00e1n\u00ed<\/h2>\n<table style=\"width:100%;border-collapse:collapse;margin:14px 0;font-size:0.95em;\">\n<thead>\n<tr style=\"background:#2c7cb0;color:#fff;\">\n<th style=\"padding:8px;text-align:left;border:1px solid #ccc;\">Frekvence<\/th>\n<th style=\"padding:8px;text-align:left;border:1px solid #ccc;\">\u00da\u010dinky<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"background:#fff;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">Velmi \u010dast\u00e9<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\"><strong>Poruchy zraku<\/strong> \u2014 rozmazan\u00e9 vid\u011bn\u00ed, fotopsie, zm\u011bn\u011bn\u00e9 vn\u00edm\u00e1n\u00ed barev (~30 %, zejm\u00e9na v prvn\u00edm t\u00fddnu, reverzibiln\u00ed)<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">B\u011b\u017en\u00e9<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Vyr\u00e1\u017eka, nevolnost, zvracen\u00ed, bolesti b\u0159icha, pr\u016fjem, perifern\u00ed ed\u00e9m, hore\u010dka, zv\u00fd\u0161en\u00e9 jatern\u00ed testy<\/td>\n<\/tr>\n<tr style=\"background:#fff;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">M\u00e9n\u011b \u010dast\u00e9<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Fotosensitivita \/ fototoxicita, halucinace, zmatenost, hypokal\u00e9mie<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">Vz\u00e1cn\u00e9, ale z\u00e1va\u017en\u00e9<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Hepatotoxicita (v\u010detn\u011b fat\u00e1ln\u00ed hepatitidy), prodlou\u017een\u00ed QT intervalu \/ torsade de pointes, SJS\/TEN, periostitida (dlouhodob\u011b \u2014 akumulace fluoridu), spinocelul\u00e1rn\u00ed karcinom k\u016f\u017ee (dlouhodob\u00e1 fotosenzitivita)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<div style=\"background:#fff3f3;border-left:4px solid #d9534f;padding:14px 20px;margin:20px 0;border-radius:6px;\"><strong>Varov\u00e1n\u00ed p\u0159ed rakovinou k\u016f\u017ee<\/strong><\/p>\n<div>Voriconazol vyvol\u00e1v\u00e1 z\u00e1va\u017enou fotosenzitivitu a je spojov\u00e1n se spinocelul\u00e1rn\u00edm karcinomem p\u0159i dlouhodob\u00e9 terapii (v\u011bt\u0161ina p\u0159\u00edpad\u016f &gt; 6 m\u011bs\u00edc\u016f kontinu\u00e1ln\u00edho u\u017e\u00edv\u00e1n\u00ed). Pacienti na dlouhodob\u00e9 l\u00e9\u010db\u011b voriconazolem mus\u00ed denn\u011b pou\u017e\u00edvat \u0161irokospektr\u00e1ln\u00ed opalovac\u00ed kr\u00e9m s SPF 50+, vyh\u00fdbat se p\u0159\u00edm\u00e9mu slunci a podstupovat ka\u017edoro\u010dn\u00ed dermatologick\u00e9 vy\u0161et\u0159en\u00ed. Jak\u00e1koli nov\u00e1 ko\u017en\u00ed l\u00e9ze na slunci exponovan\u00e9 oblasti = okam\u017eit\u00e9 doporu\u010den\u00ed k dermatologovi.<\/div>\n<\/div>\n<h2 id=\"interactions\">L\u00e9kov\u00e9 interakce \u2014 rozs\u00e1hl\u00e9<\/h2>\n<p>Voriconazol je metabolizov\u00e1n CYP2C19, CYP2C9, CYP3A4 \u2014 a s\u00e1m je siln\u00fdm inhibitorem v\u0161ech t\u0159\u00ed. Hlavn\u00ed obavy:<\/p>\n<table style=\"width:100%;border-collapse:collapse;margin:14px 0;font-size:0.95em;\">\n<thead>\n<tr style=\"background:#2c7cb0;color:#fff;\">\n<th style=\"padding:8px;text-align:left;border:1px solid #ccc;\">L\u00e9k<\/th>\n<th style=\"padding:8px;text-align:left;border:1px solid #ccc;\">\u00da\u010dinek<\/th>\n<th style=\"padding:8px;text-align:left;border:1px solid #ccc;\">\u00da\u010dinek<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"background:#fff;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">Rifampicin \/ rifabutin \/ karbamazepin \/ fenobarbital<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Siln\u00e1 indukce \u2192 nedetekovateln\u00e1 hladina voriconazolu<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Kontraindikov\u00e1no<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">T\u0159ezalka te\u010dkovan\u00e1<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Stejn\u00fd induk\u010dn\u00ed efekt<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Kontraindikov\u00e1no<\/td>\n<\/tr>\n<tr style=\"background:#fff;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">Sirolimus<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">8\u00d7 n\u00e1r\u016fst \u2014 z\u00e1va\u017en\u00e1 toxicita<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Kontraindikov\u00e1no<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">Pimozid \/ chinidin \/ terfenadin \/ cisaprid<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Prodlou\u017een\u00ed QT intervalu<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Kontraindikov\u00e1no<\/td>\n<\/tr>\n<tr style=\"background:#fff;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">Alkaloidy n\u00e1melu<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Vazokonstrikce \u2192 ergotismus<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Kontraindikov\u00e1no<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">Tacrolimus \/ cyklosporin<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">2\u20133\u00d7 n\u00e1r\u016fst<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Sni\u017ete d\u00e1vku; monitorujte spodn\u00ed hladinu<\/td>\n<\/tr>\n<tr style=\"background:#fff;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">Warfarin<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Vzestup INR<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Pe\u010dliv\u011b monitorujte INR<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">Statiny (simvastatin, atorvastatin)<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Riziko rabdomyol\u00fdzy<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Ukon\u010dit nebo p\u0159ej\u00edt na pravastatin<\/td>\n<\/tr>\n<tr style=\"background:#fff;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">Fenytoin<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Bidirek\u010dn\u00ed interakce \u2014 hladiny vorikonazolu klesaj\u00ed, hladiny fenytoinu stoupaj\u00ed<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Vyvarujte se; pokud je nutn\u00e9 pou\u017e\u00edt, zvy\u0161te d\u00e1vku vorikonazolu o 100 % a monitorujte hladiny fenytoinu<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">Omeprazol \/ esomeprazol<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Hladiny PPI stoupaj\u00ed; m\u00edrn\u00fd \u00fa\u010dinek na vorikonazol<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Sni\u017ete d\u00e1vku PPI na polovinu<\/td>\n<\/tr>\n<tr style=\"background:#fff;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">Metadon, opioidy<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Zv\u00fd\u0161en\u00e1 CNS deprese<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Sni\u017ete d\u00e1vku opioidu<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2 id=\"monitoring\">Povinn\u00e9 monitorov\u00e1n\u00ed<\/h2>\n<ul>\n<li><strong>Terapeutick\u00e9 monitorov\u00e1n\u00ed hladin l\u00e9\u010div<\/strong> \u2014 stanovte rezidu\u00e1ln\u00ed plazmatickou hladinu v den 5\u20137 a po ka\u017ed\u00e9 zm\u011bn\u011b d\u00e1vky. C\u00edlov\u00e1 hladina 1,0\u20135,5 mg\/l (n\u011bkter\u00e9 laborato\u0159e 2,0\u20135,5 pro invazivn\u00ed aspergil\u00f3zu).<\/li>\n<li><strong>Funkce jater<\/strong> \u2014 z\u00e1kladn\u00ed vy\u0161et\u0159en\u00ed, pot\u00e9 t\u00fddn\u011b po dobu 2\u20134 t\u00fddn\u016f, n\u00e1sledn\u011b m\u011bs\u00ed\u010dn\u011b b\u011bhem terapie.<\/li>\n<li><strong>Zrakov\u00e1 funkce<\/strong> \u2014 z\u00e1kladn\u00ed oftalmologick\u00e9 vy\u0161et\u0159en\u00ed, pokud se p\u0159edpokl\u00e1d\u00e1 terapie &gt; 28 dn\u00ed.<\/li>\n<li><strong>Funkce ledvin<\/strong> \u2014 IV forma obsahuje cyklodextrin; vyvarujte se p\u0159i ClCr &lt; 50, pokud p\u0159\u00ednos jasn\u011b nep\u0159ev\u00e1\u017e\u00ed riziko (peror\u00e1ln\u00ed forma je v po\u0159\u00e1dku).<\/li>\n<li><strong>K\u016f\u017ee \/ dermatologie<\/strong> \u2014 ro\u010dn\u00ed kontrola p\u0159i dlouhodob\u00e9 terapii.<\/li>\n<\/ul>\n<h2 id=\"contraindications\">Kontraindikace<\/h2>\n<ul>\n<li>Sou\u010dasn\u00e9 pod\u00e1v\u00e1n\u00ed rifampicinu, rifabutinu, karbamazepinu, fenobarbitalu, t\u0159ezalky te\u010dkovan\u00e9.<\/li>\n<li>Sou\u010dasn\u00e9 pod\u00e1v\u00e1n\u00ed pimozidu, chinidinu, terfenadinu, cisapridu, alkaloid\u016f n\u00e1melu, sirolimu.<\/li>\n<li>T\u011bhotenstv\u00ed (teratogenita).<\/li>\n<li>T\u011b\u017ek\u00e9 jatern\u00ed po\u0161kozen\u00ed.<\/li>\n<li>P\u0159ecitliv\u011blost na jin\u00e9 azoly.<\/li>\n<\/ul>\n<h2 id=\"pregnancy\">T\u011bhotenstv\u00ed a kojen\u00ed<\/h2>\n<p>Vorikonazol je teratogenn\u00ed u zv\u00ed\u0159at a kontraindikov\u00e1n v t\u011bhotenstv\u00ed krom\u011b \u017eivot ohro\u017euj\u00edc\u00edch syst\u00e9mov\u00fdch myk\u00f3z. Je nutn\u00e1 \u00fa\u010dinn\u00e1 antikoncepce. Vylu\u010dov\u00e1n\u00ed do mate\u0159sk\u00e9ho ml\u00e9ka nen\u00ed zn\u00e1mo \u2014 b\u011bhem kojen\u00ed jsou preferov\u00e1ny alternativy.<\/p>\n<h2 id=\"faqs\">\u010casto kladen\u00e9 dotazy<\/h2>\n<h3>Vid\u00edm z\u00e1blesky sv\u011btla, kdy\u017e u\u017e\u00edv\u00e1m vorikonazol \u2014 je to norm\u00e1ln\u00ed?<\/h3>\n<p>Ano \u2014 poruchy zraku (fotopsie, rozmazan\u00e9 vid\u011bn\u00ed, zm\u011bn\u011bn\u00e9 vn\u00edm\u00e1n\u00ed barev) se vyskytuj\u00ed u ~30 % pacient\u016f, obvykle b\u011bhem prvn\u00edch 2 hodin po pod\u00e1n\u00ed a b\u011bhem dn\u016f a\u017e t\u00fddn\u016f vymiz\u00ed i p\u0159i pokra\u010duj\u00edc\u00ed terapii. Ne\u0159i\u010fte v noci, dokud nen\u00ed \u00fa\u010dinek jasn\u00fd. Pokud jsou p\u0159\u00edznaky z\u00e1va\u017en\u00e9 nebo p\u0159etrv\u00e1vaj\u00edc\u00ed, po\u017e\u00e1dejte o TDM \u2014 vysok\u00e9 hladiny l\u00e9ku zhor\u0161uj\u00ed p\u0159\u00edznaky.<\/p>\n<h3>Pro\u010d se v\u0161ichni tolik zaj\u00edmaj\u00ed o m\u016fj CYP2C19 status?<\/h3>\n<p>Vorikonazol je metabolizov\u00e1n enzymem CYP2C19. Pomal\u00ed metaboliz\u00e1to\u0159i (15 % osob asijsk\u00e9ho p\u016fvodu, 3 % b\u011bloch\u016f) maj\u00ed 4\u00d7 vy\u0161\u0161\u00ed expozici p\u0159i standardn\u00edch d\u00e1vk\u00e1ch \u2192 toxicita. Ultra-rychl\u00ed metaboliz\u00e1to\u0159i nemus\u00ed dos\u00e1hnout terapeutick\u00fdch hladin \u2192 selh\u00e1n\u00ed l\u00e9\u010dby. Farmakogenetick\u00e9 testov\u00e1n\u00ed nebo prost\u00e9 monitorov\u00e1n\u00ed hladin l\u00e9ku (TDM) mezi 5.\u20137. dnem tento probl\u00e9m \u0159e\u0161\u00ed.<\/p>\n<h3>M\u016f\u017eu p\u0159ej\u00edt z intraven\u00f3zn\u00edho na peror\u00e1ln\u00ed vorikonazol?<\/h3>\n<p>Ano \u2014 jakmile je pacient stabiln\u00ed a toleruje peror\u00e1ln\u00ed pod\u00e1n\u00ed. Peror\u00e1ln\u00ed biologick\u00e1 dostupnost je u dosp\u011bl\u00fdch ~96 %, tak\u017ee d\u00e1vka z\u016fst\u00e1v\u00e1 stejn\u00e1 (200 mg ka\u017ed\u00fdch 12 hodin pro dosp\u011bl\u00e9 \u2265 40 kg).<\/p>\n<h3>Jak\u00fd opalovac\u00ed kr\u00e9m bych m\u011bl pou\u017e\u00edvat?<\/h3>\n<p>Minim\u00e1ln\u011b \u0161irokospektr\u00e1ln\u00ed SPF 50+, denn\u011b, v\u010detn\u011b zamra\u010den\u00fdch dn\u016f. P\u0159i pobytu venku nan\u00e1\u0161ejte ka\u017ed\u00e9 2 hodiny. P\u0159i del\u0161\u00edm pobytu na slunci noste od\u011bv s UV ochranou. Zcela se vyhn\u011bte sol\u00e1ri\u00edm.<\/p>\n<h3>Co jsou \u2018periostitida\u2019 a \u2018toxicita fluoridu\u2019?<\/h3>\n<p>Vorikonazol obsahuje fluorid. Dlouhodob\u00e1 terapie (m\u011bs\u00edce) m\u016f\u017ee zp\u016fsobit bolestivou periostitidu se zv\u00fd\u0161enou alkalickou fosfat\u00e1zou a hladinou fluoridu v s\u00e9ru. Kostn\u00ed scan prok\u00e1\u017ee zv\u00fd\u0161enou akumulaci. Stav se uprav\u00ed po vysazen\u00ed l\u00e9ku. Nov\u00e9 nevysv\u011btliteln\u00e9 bolesti kost\u00ed p\u0159i dlouhodob\u00e9 terapii \u2014 vy\u0161et\u0159te ALP a fluorid v s\u00e9ru.<\/p>\n<h3>Je vorikonazol to sam\u00e9 co Vfend?<\/h3>\n<p>Ano \u2014 Vfend je p\u016fvodn\u00ed zna\u010dka od Pfizeru. Vorier obsahuje stejnou \u00fa\u010dinnou l\u00e1tku, vyr\u00e1b\u011bnou spole\u010dnost\u00ed Glenmark podle WHO-GMP. Bioekvivalentn\u00ed.<\/p>\n<h3>Pro\u010d m\u016fj specialista na onychomyk\u00f3zu nepou\u017e\u00edv\u00e1 vorikonazol?<\/h3>\n<p>Vorikonazol je vyhrazen pro invazivn\u00ed syst\u00e9mov\u00e9 myk\u00f3zy. U dermatofytov\u00fdch infekc\u00ed neht\u016f (b\u011b\u017en\u00e1 p\u0159\u00ed\u010dina) je prvn\u00ed volbou terbinafin 250 mg\/den po dobu 12 t\u00fddn\u016f \u2014 vy\u0161\u0161\u00ed \u00fasp\u011b\u0161nost l\u00e9\u010dby, m\u00e9n\u011b interakc\u00ed, v\u00fdrazn\u011b levn\u011bj\u0161\u00ed. Vorikonazol by se pou\u017eil pouze u neobvykl\u00fdch pl\u00edsn\u00ed (Scedosporium, Fusarium) potvrzen\u00fdch kulturou.<\/p>\n<h3>Co kdy\u017e m\u00e1m p\u0159i u\u017e\u00edv\u00e1n\u00ed vorikonazolu hepatitidu?<\/h3>\n<p>P\u0159eru\u0161te vorikonazol, pokud AST\/ALT &gt; 5\u00d7 ULN, nebo jak\u00fdkoli vzestup + p\u0159\u00edznaky (\u017eloutenka, tmav\u00e1 mo\u010d, bolest v prav\u00e9m pod\u017eeb\u0159\u00ed). P\u0159echod na alternativu (kaspofungin\/mikafungin\/amfotericin B\/posakonazol\/isavukonazol podle indikace). N\u011bkdy je mo\u017en\u00e9 op\u011btovn\u00e9 pod\u00e1v\u00e1n\u00ed v ni\u017e\u0161\u00ed d\u00e1vce s pe\u010dliv\u00fdm monitorov\u00e1n\u00edm.<\/p>\n<h3>M\u016f\u017eu u\u017e\u00edvat vorikonazol s PPI?<\/h3>\n<p>Vorikonazol inhibuje CYP2C19, \u010d\u00edm\u017e zvy\u0161uje hladiny omeprazolu a esomeprazolu p\u0159ibli\u017en\u011b 2\u00d7. P\u0159i pokra\u010dov\u00e1n\u00ed l\u00e9\u010dby sni\u017ete d\u00e1vku PPI na polovinu. Pantoprazol a rabeprazol jsou m\u00e9n\u011b ovlivn\u011bny. Tato interakce v\u00fdznamn\u011b nem\u011bn\u00ed hladiny vorikonazolu.<\/p>\n<h3>Co je TDM a pro\u010d se zpo\u010d\u00e1tku prov\u00e1d\u00ed ka\u017ed\u00fd t\u00fdden?<\/h3>\n<p>Terapeutick\u00e9 monitorov\u00e1n\u00ed l\u00e9\u010div \u2014 m\u011b\u0159en\u00ed minim\u00e1ln\u00ed hladiny vorikonazolu v plazm\u011b. C\u00edlov\u00e1 hladina 1\u20135,5 mg\/l. Pod 1 mg\/l: riziko selh\u00e1n\u00ed l\u00e9\u010dby. Nad 5,5 mg\/l: hepatotoxicita, encefalopatie, zrakov\u00e9 pot\u00ed\u017ee. Polymorfismus CYP2C19 zp\u016fsobuje nep\u0159edv\u00eddatelnou d\u00e1vkovou odpov\u011b\u010f, proto je TDM nezbytn\u00fd u invazivn\u00ed aspergil\u00f3zy.<\/p>\n<h2 id=\"storage\">Skladov\u00e1n\u00ed<\/h2>\n<p>Tablety skladujte p\u0159i 15\u201330 \u00b0C v p\u016fvodn\u00edm obalu. Chra\u0148te p\u0159ed sv\u011btlem. Nepou\u017e\u00edvejte po uplynut\u00ed doby pou\u017eitelnosti. Uchov\u00e1vejte mimo dosah d\u011bt\u00ed.<\/p>\n<p><!-- medsbase-related-alts-v1 --><\/p>\n<h2>Dal\u0161\u00ed antifung\u00e1ln\u00ed l\u00e9ky, kter\u00e9 by v\u00e1s mohly zaj\u00edmat<\/h2>\n<p>Vorikonazol je specializovan\u00e1 terapie. N\u00ed\u017ee uveden\u00e9 p\u0159\u00edpravky obsahuj\u00ed stejnou molekulu od r\u016fzn\u00fdch v\u00fdrobc\u016f, plus l\u00e9ky prvn\u00ed volby pro b\u011b\u017en\u00e9 indikace, kde je vorikonazol zbyte\u010dn\u011b siln\u00fd.<\/p>\n<ul>\n<li><a href=\"https:\/\/medsbase.com\/cs\/zocon\/\"><strong>Zocon (fluconazol 150 mg)<\/strong><\/a> \u2014 Prvn\u00ed volba u ne-Aspergillus kandid\u00f3zy; dob\u0159e sn\u00e1\u0161en.<\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/sporanox-capsule\/\"><strong>Sporanox (itraconazol 100 mg)<\/strong><\/a> \u2014 U dimorfn\u00edch myk\u00f3z a ne-Aspergillus pl\u00edsn\u00ed.<\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/zimig\/\"><strong>Zimig (terbinafin 250 mg)<\/strong><\/a> \u2014 Dermatofytn\u00ed infekce neht\u016f\/k\u016f\u017ee (ne invazivn\u00ed pl\u00edsn\u011b).<\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/clocip\/\"><strong>Clocip (clotrimazol 1%)<\/strong><\/a> \u2014 Lok\u00e1ln\u00ed l\u00e9\u010dba kandid\u00f3zy, dermatofytn\u00ed tinea.<\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/loceryl-nail-liq\/\"><strong>Loceryl (amorolfin 5%)<\/strong><\/a> \u2014 Topick\u00fd lak na nehty pro m\u00edrnou onychomyk\u00f3zu.<\/li>\n<\/ul>\n<div style=\"background:#fff3f3;border-left:4px solid #d9534f;padding:12px 18px;margin:24px 0;font-size:0.95em;\"><strong>Zdravotn\u00ed prohl\u00e1\u0161en\u00ed.<\/strong> Tato str\u00e1nka obsahuje informace o produktu pro dosp\u011bl\u00e9, kte\u0159\u00ed si objedn\u00e1vaj\u00ed antifung\u00e1ln\u00ed l\u00e9ky pro osobn\u00ed pot\u0159ebu. Nenahrazuje individu\u00e1ln\u00ed l\u00e9ka\u0159skou radu. Proberte vhodn\u00e9 antifung\u00e1ln\u00ed l\u00e9\u010divo, d\u00e1vkov\u00e1n\u00ed a d\u00e9lku l\u00e9\u010dby s kvalifikovan\u00fdm l\u00e9ka\u0159em \u2013 zejm\u00e9na pokud m\u00e1te onemocn\u011bn\u00ed jater, jste t\u011bhotn\u00e1 nebo koj\u00edte, u\u017e\u00edv\u00e1te warfarin, statiny, imunosupresiva nebo m\u00e1te pl\u00eds\u0148ovou infekci neht\u016f, kter\u00e1 m\u016f\u017ee b\u00fdt jinou diagn\u00f3zou (psori\u00e1za, lichen planus, trauma).<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"<h5>\u2705 Rychl\u00e1 \u00faleva od pl\u00eds\u0148ov\u00e9 infekce<br \/>\n\u2705 Efektivn\u00ed eradikace pl\u00edsn\u00ed<br \/>\n\u2705 Odborn\u011b posouzeno a d\u016fv\u011bryhodn\u00e9<br \/>\n\u2705 Dob\u0159e sn\u00e1\u0161en\u00e9, b\u011b\u017en\u00e9 \u00fa\u010dinky<br \/>\n\u2705 Pohodln\u00e9 d\u00e1vkov\u00e1n\u00ed<\/h5>\n<p><span style=\"color: #999999;\">Vorier obsahuje vorikonazol<\/span><\/p>","protected":false},"featured_media":53699,"comment_status":"open","ping_status":"open","template":"","meta":[],"product_brand":[],"product_cat":[3501,3141,3504,3342],"product_tag":[],"class_list":{"0":"post-53698","1":"product","2":"type-product","3":"status-publish","4":"has-post-thumbnail","6":"product_cat-anti-fungal","7":"product_cat-category-overview","8":"product_cat-fungal-infection-treatment","9":"product_cat-general-health","11":"first","12":"outofstock","13":"shipping-taxable","14":"purchasable","15":"product-type-variable","16":"has-default-attributes"},"acf":[],"_links":{"self":[{"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product\/53698","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=53698"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/media\/53699"}],"wp:attachment":[{"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/media?parent=53698"}],"wp:term":[{"taxonomy":"product_brand","embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_brand?post=53698"},{"taxonomy":"product_cat","embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_cat?post=53698"},{"taxonomy":"product_tag","embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_tag?post=53698"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}