{"id":53837,"date":"2023-09-20T09:51:34","date_gmt":"2023-09-20T09:51:34","guid":{"rendered":"https:\/\/medsname.com\/dapsone-tablets\/"},"modified":"2026-05-01T10:49:12","modified_gmt":"2026-05-01T10:49:12","slug":"dapsone-tablets","status":"publish","type":"product","link":"https:\/\/medsbase.com\/cs\/product\/dapsone-tablets\/","title":{"rendered":"Dapson tablety"},"content":{"rendered":"

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\u26a1 Rychl\u00e1 odpov\u011b\u010f \u2014 Co jsou tablety Dapsone?<\/h3>\n

Dapson tablety<\/strong> obsahuje dapson (4,4\u2032-diaminodifenylsulfon, DDS) 100 mg<\/strong> \u2014 antibakteri\u00e1ln\u00ed a protiz\u00e1n\u011btliv\u00e9 l\u00e9\u010divo ze skupiny sulfon\u016f od spole\u010dnosti Abbott India. Dapson je za\u0159azen na Modelov\u00fd seznam z\u00e1kladn\u00edch l\u00e9\u010div WHO jako kl\u00ed\u010dov\u00fd prvek multidrogov\u00e9 terapie (MDT) pro lepru (Hansenovu chorobu)<\/strong>; je tak\u00e9 prvn\u00ed volbou pro dermatitis herpetiformis (ko\u017en\u00ed projev celiakie)<\/strong>, a \u0161iroce se pou\u017e\u00edv\u00e1 jako profylaxe PCP druh\u00e9 volby<\/strong> (u pacient\u016f s HIV\/imunokompromitovan\u00fdch alergick\u00fdch na kotrimoxazol), a mimo indikaci pro t\u011b\u017ek\u00e9 z\u00e1n\u011btliv\u00e9 akn\u00e9 (acne fulminans, hidradenitis suppurativa)<\/strong>. Standardn\u00ed d\u00e1vkov\u00e1n\u00ed:<\/strong> Lepra MDT \u2014 100 mg\/den (multibacil\u00e1rn\u00ed 12 m\u011bs\u00edc\u016f; paucibacil\u00e1rn\u00ed 6 m\u011bs\u00edc\u016f). Dermatitis herpetiformis \u2014 50-300 mg\/den titrov\u00e1no podle kontroly p\u0159\u00edznak\u016f. Profylaxe PCP \u2014 100 mg\/den. KL\u00cd\u010cOV\u00c9 bezpe\u010dnostn\u00ed kroky p\u0159ed zah\u00e1jen\u00edm:<\/strong> testovat na deficit G6PD<\/strong> (d\u00e1vkov\u011b z\u00e1visl\u00e1 t\u011b\u017ek\u00e1 hemol\u00fdza p\u0159i deficitu); prov\u00e9st v\u00fdchoz\u00ed vy\u0161et\u0159en\u00ed FBC, po\u010det retikulocyt\u016f, methemoglobin a jatern\u00ed testy<\/strong>; pou\u010dte pacienta o syndromu p\u0159ecitliv\u011blosti na dapson (DHS), kter\u00fd m\u016f\u017ee b\u00fdt fat\u00e1ln\u00ed b\u011bhem prvn\u00edch 6 t\u00fddn\u016f. Dapson je ve v\u011bt\u0161in\u011b kontext\u016f vyhrazen pro odborn\u00fd dohled<\/strong> \u2014 nejedn\u00e1 se o l\u00e9k k samol\u00e9\u010db\u011b.<\/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

Co jsou tablety Dapson?<\/h2>\n

Tablety Dapson jsou peror\u00e1ln\u00ed p\u0159\u00edpravek obsahuj\u00edc\u00ed dapson (DDS) 100 mg<\/strong> vyroben\u00fd spole\u010dnost\u00ed Abbott India, dod\u00e1van\u00fd v balen\u00edch po 1000 \/ 2000 \/ 3000 tablet\u00e1ch. Velk\u00e9 balen\u00ed odr\u00e1\u017e\u00ed prim\u00e1rn\u00ed pou\u017eit\u00ed dapsonu v programech WHO pro l\u00e9\u010dbu lepry MDT<\/strong> (12m\u011bs\u00ed\u010dn\u00ed l\u00e9\u010dba multibacil\u00e1rn\u00edho onemocn\u011bn\u00ed, l\u00e9\u010dba velk\u00fdch skupin pacient\u016f) a v chronick\u00e9 dermatologii (dermatitis herpetiformis, hidradenitis suppurativa, lupusov\u00e9 dermat\u00f3zy), kde l\u00e9\u010dba m\u016f\u017ee pokra\u010dovat roky.<\/p>\n

Dapson je v klinick\u00e9m pou\u017eit\u00ed nep\u0159etr\u017eit\u011b od roku 1937 (zaveden pro streptokokov\u00e9 infekce Domagkem), p\u0159eorientov\u00e1n na l\u00e9\u010dbu lepry Fagetem v roce 1941 a z\u016fst\u00e1v\u00e1 z\u00e1kladem dermatologick\u00e9 a infek\u010dn\u00ed farmakologie t\u00e9m\u011b\u0159 o stolet\u00ed pozd\u011bji.<\/p>\n

Jak Dapson funguje?<\/h2>\n

Dapson m\u00e1 dva odli\u0161n\u00e9 mechanismy<\/strong> kter\u00e9 vysv\u011btluj\u00ed jeho velmi \u0161irok\u00e9 spektrum indikac\u00ed:<\/p>\n

    \n
  • Antibakteri\u00e1ln\u00ed \u00fa\u010dinek<\/strong> \u2014 kompetitivn\u00ed inhibice bakteri\u00e1ln\u00ed dihydroptero\u00e1t synt\u00e1zy (stejn\u00fd enzymov\u00fd c\u00edl jako sulfonamidy), blokuje synt\u00e9zu fol\u00e1tu a r\u016fst bakteri\u00ed. Aktivn\u00ed proti Mycobacterium leprae<\/em>, Plasmodium falciparum<\/em> (v kombinaci s proguanilem se historicky pou\u017e\u00edval k profylaxi mal\u00e1rie), a Pneumocystis jirovecii<\/em>.<\/li>\n
  • Protiz\u00e1n\u011btliv\u00fd \u00fa\u010dinek<\/strong> \u2014 inhibuje chemotaxi neutrofil\u016f a myeloperoxid\u00e1zovou \/ hypochloritovou dr\u00e1hu. Toto je mechanismus, d\u00edky kter\u00e9mu je dapson \u00fa\u010dinn\u00fd u neutrofiln\u00edch dermat\u00f3z (dermatitis herpetiformis, hidradenitis suppurativa, pyoderma gangrenosum, leukocytoklastick\u00e1 vaskulitida, bul\u00f3zn\u00ed pemfigoid).<\/li>\n<\/ul>\n

    Dapson je dob\u0159e absorbov\u00e1n peror\u00e1ln\u011b (vrchol 2-8 hodin), vysoce v\u00e1z\u00e1n na b\u00edlkoviny, metabolizov\u00e1n v j\u00e1trech na N-acetyl-dapson (nez\u00e1visle na CYP) a dapson-hydroxylamin (CYP2C9\/CYP2C19\/CYP3A4). Hydroxylaminov\u00fd metabolit zp\u016fsobuje hematologick\u00e9 ne\u017e\u00e1douc\u00ed \u00fa\u010dinky (hemol\u00fdza, methemoglobin\u00e9mie). Polo\u010das ~30 hodin umo\u017e\u0148uje pod\u00e1v\u00e1n\u00ed jednou denn\u011b.<\/p>\n

    Indikace & Standardn\u00ed re\u017eimy<\/h2>\n\n\n\n\n\n\n\n\n\n\n\n
    Indikace<\/th>\nStandardn\u00ed d\u00e1vka pro dosp\u011bl\u00e9<\/th>\nD\u00e9lka<\/th>\n<\/tr>\n<\/thead>\n
    Multibacil\u00e1rn\u00ed lepra (MB-MDT)<\/strong><\/td>\n100 mg\/den + rifampicin 600 mg m\u011bs\u00ed\u010dn\u011b + clofazimin 50 mg\/den & 300 mg m\u011bs\u00ed\u010dn\u011b<\/td>\n12 m\u011bs\u00edc\u016f<\/td>\n<\/tr>\n
    Paucibacil\u00e1rn\u00ed lepra (PB-MDT)<\/strong><\/td>\n100 mg\/den + rifampicin 600 mg m\u011bs\u00ed\u010dn\u011b + clofazimin 50 mg\/den & 300 mg m\u011bs\u00ed\u010dn\u011b (WHO aktualizace 2018)<\/td>\n6 m\u011bs\u00edc\u016f<\/td>\n<\/tr>\n
    Dermatitis herpetiformis<\/strong><\/td>\n50 mg\/den jako po\u010d\u00e1te\u010dn\u00ed d\u00e1vka, zvy\u0161ovat o 25-50 mg ka\u017ed\u00fdch 1-2 t\u00fddny; obvykl\u00e1 udr\u017eovac\u00ed d\u00e1vka 50-200 mg\/den; max. 300 mg\/den<\/td>\nRoky (spolu s bezlepkovou dietou, kter\u00e1 je l\u00e9\u010dbou s kurativn\u00edm \u00fa\u010dinkem)<\/td>\n<\/tr>\n
    Profylaxe PCP (HIV\/imunokompromitovan\u00ed)<\/strong><\/td>\n100 mg\/den NEBO 50 mg dvakr\u00e1t denn\u011b (druh\u00e1 volba po kotrimoxazolu)<\/td>\nA\u017e do CD4 >200 po dobu 3+ m\u011bs\u00edc\u016f<\/td>\n<\/tr>\n
    Hidradenitis suppurativa (mimo indikaci)<\/strong><\/td>\n50-200 mg\/den<\/td>\n3-12 m\u011bs\u00edc\u016f zku\u0161ebn\u00ed l\u00e9\u010dba<\/td>\n<\/tr>\n
    T\u011b\u017ek\u00fd acne fulminans (mimo indikaci)<\/strong><\/td>\n50-150 mg\/den, obvykle v kombinaci s peror\u00e1ln\u00edm steroidn\u00edm terapeutick\u00fdm sch\u00e9matem<\/td>\nT\u00fddny a\u017e m\u011bs\u00edce<\/td>\n<\/tr>\n
    Bul\u00f3zn\u00ed pemfigoid, pyoderma gangrenosum, leukocytoklastick\u00e1 vaskulitida (mimo indikaci)<\/strong><\/td>\n50-200 mg\/den, \u010dasto v kombinaci s kortikosteroidy<\/td>\nM\u011bs\u00edce<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    U\u017e\u00edvejte s j\u00eddlem ke sn\u00ed\u017een\u00ed gastrointestin\u00e1ln\u00edch pot\u00ed\u017e\u00ed. Standardn\u00ed je jednodenn\u00ed d\u00e1vkov\u00e1n\u00ed.<\/p>\n

    KRITICK\u00c9: P\u0159edl\u00e9\u010debn\u00e9 vy\u0161et\u0159en\u00ed<\/h2>\n
    \n\u26a0\ufe0f Screening deficitu G6PD p\u0159ed prvn\u00ed d\u00e1vkou.<\/strong> V\u0161ichni pacienti by m\u011bli b\u00fdt testov\u00e1ni na deficit gluk\u00f3za-6-fosf\u00e1t dehydrogen\u00e1zy (G6PD)<\/strong> p\u0159ed zah\u00e1jen\u00edm l\u00e9\u010dby dapsonem. Pacienti s deficitem G6PD vystaven\u00ed dapsonu mohou vyvinout t\u011b\u017ekou oxida\u010dn\u00ed hemol\u00fdzu<\/strong> \u2014 potenci\u00e1ln\u011b \u017eivot ohro\u017euj\u00edc\u00ed, zejm\u00e9na u pacient\u016f s africkou (A\u2212) variantou, st\u0159edomo\u0159skou variantou nebo kantonovskou variantou. Deficit G6PD postihuje p\u0159ibli\u017en\u011b 4,9 % sv\u011btov\u00e9 populace, s region\u00e1ln\u00ed prevalenc\u00ed a\u017e 35 % v n\u011bkter\u00fdch st\u0159edomo\u0159sk\u00fdch, africk\u00fdch a asijsk\u00fdch populac\u00edch.\n<\/div>\n

    Povinn\u00e9 vstupn\u00ed testy p\u0159ed zah\u00e1jen\u00edm l\u00e9\u010dby dapsonem:<\/strong><\/p>\n

      \n
    • Kvantitativn\u00ed nebo kvalitativn\u00ed test G6PD<\/li>\n
    • Kompletn\u00ed krevn\u00ed obraz (KKS)<\/li>\n
    • Po\u010det retikulocyt\u016f<\/li>\n
    • Hladina methemoglobinu (pokud je k dispozici)<\/li>\n
    • Jatern\u00ed testy (LFTs)<\/li>\n
    • Ren\u00e1ln\u00ed funkce (kreatinin, eGFR)<\/li>\n<\/ul>\n

      Monitorov\u00e1n\u00ed b\u011bhem l\u00e9\u010dby:<\/strong> Kompletn\u00ed krevn\u00ed obraz a retikulocyty t\u00fddn\u011b prvn\u00ed m\u011bs\u00edc, pot\u00e9 m\u011bs\u00ed\u010dn\u011b po dobu 6 m\u011bs\u00edc\u016f, n\u00e1sledn\u011b \u010dtvrtletn\u011b. Jatern\u00ed testy m\u011bs\u00ed\u010dn\u011b po dobu 3 m\u011bs\u00edc\u016f, pot\u00e9 \u010dtvrtletn\u011b. Methemoglobin v p\u0159\u00edpad\u011b rozvoje cyan\u00f3zy nebo du\u0161nosti.<\/p>\n

      Vedlej\u0161\u00ed \u00fa\u010dinky<\/h2>\n

      \u010cast\u00e9 (1 z 10 nebo v\u00edce):<\/strong><\/p>\n

        \n
      • M\u00edrn\u00e1 d\u00e1vkov\u011b z\u00e1visl\u00e1 hemol\u00fdza<\/strong> (pokles hemoglobinu je o\u010dek\u00e1v\u00e1n i u pacient\u016f s norm\u00e1ln\u00ed G6PD; obvykle 1-2 g\/dL)<\/li>\n
      • Methemoglobinemie<\/strong> \u2014 obvykle subklinick\u00e1; klinick\u00e9 projevy (cyan\u00f3za, du\u0161nost, bolest hlavy) p\u0159i hladin\u00e1ch >15-20%<\/li>\n
      • Nevolnost, b\u0159i\u0161n\u00ed diskomfort, nechutenstv\u00ed<\/li>\n
      • Bolest hlavy, z\u00e1vrat\u011b<\/li>\n
      • Nespavost<\/li>\n
      • M\u00edrn\u00e1 vyr\u00e1\u017eka<\/li>\n<\/ul>\n

        M\u00e9n\u011b \u010dast\u00e9, ale z\u00e1va\u017en\u00e9:<\/strong><\/p>\n

          \n
        • Dapsonov\u00fd hypersenzitivn\u00ed syndrom (DHS)<\/strong> \u2014 viz samostatn\u00e1 sekce n\u00ed\u017ee<\/li>\n
        • T\u011b\u017ek\u00e1 hemol\u00fdza<\/strong> u nediagnostikovan\u00e9ho deficitu G6PD \u2014 m\u016f\u017ee b\u00fdt fat\u00e1ln\u00ed<\/li>\n
        • Agranulocyt\u00f3za<\/strong> \u2014 vz\u00e1cn\u00fd, ale \u017eivot ohro\u017euj\u00edc\u00ed; typicky v prvn\u00edch 3 m\u011bs\u00edc\u00edch<\/li>\n
        • Aplastick\u00e1 an\u00e9mie, trombocytopenie<\/li>\n
        • Perifern\u00ed neuropatie (motorick\u00e1 nebo senzorick\u00e1; \u010dasto \u010d\u00e1ste\u010dn\u011b reverzibiln\u00ed)<\/li>\n
        • Hepatitida, cholestatick\u00e1 \u017eloutenka<\/li>\n
        • Toxick\u00e1 psych\u00f3za, deprese<\/li>\n
        • Stevens-Johnson\u016fv syndrom \/ toxick\u00e1 epiderm\u00e1ln\u00ed nekrol\u00fdza (vz\u00e1cn\u00e9, ale popsan\u00e9)<\/li>\n
        • \u201cDapsonov\u00e1 pl\u00edce\u201d \u2014 eozinofiln\u00ed pneumonitida (vz\u00e1cn\u00e9)<\/li>\n<\/ul>\n

          Dapsonov\u00fd hypersenzitivn\u00ed syndrom (DHS)<\/h2>\n

          DHS je nejob\u00e1van\u011bj\u0161\u00ed komplikac\u00ed l\u00e9\u010dby dapsonem.<\/strong> Jedn\u00e1 se o opo\u017ed\u011bnou hypersenzitivn\u00ed reakci (podobnou DRESS), kter\u00e1 se vyskytuje u 0,5\u20133 % u\u017eivatel\u016f dapsonu, typicky 2\u20138 t\u00fddn\u016f po zah\u00e1jen\u00ed l\u00e9\u010dby<\/strong>. Mortalita \u010din\u00ed p\u0159ibli\u017en\u011b 10 %, pokud nen\u00ed stav v\u010das rozpozn\u00e1n a l\u00e9\u010den.<\/p>\n

          Klasick\u00e1 tri\u00e1da:<\/strong><\/p>\n

            \n
          • Hore\u010dka<\/strong> (\u010dasto prvn\u00ed p\u0159\u00edznak)<\/li>\n
          • Ko\u017en\u00ed vyr\u00e1\u017eka<\/strong> \u2014 morbilliformn\u00ed, kop\u0159ivkov\u00e1, exfoliativn\u00ed nebo pln\u00e9 spektrum SJS\/TEN<\/li>\n
          • Posti\u017een\u00ed vnit\u0159n\u00edch org\u00e1n\u016f<\/strong> \u2014 lymfadenopatie, hepatitida (\u010dasto hlavn\u00ed p\u0159\u00ed\u010dina \u00famrt\u00ed), interstici\u00e1ln\u00ed nefritida, eozinofilie, atypick\u00e1 lymfocyt\u00f3za<\/li>\n<\/ul>\n

            Genetick\u00e9 riziko:<\/strong> alela HLA-B*13:01<\/em> v\u00fdrazn\u011b zvy\u0161uje riziko DHS. P\u0159ed l\u00e9\u010dbou se nyn\u00ed doporu\u010duje screening HLA-B*13:01 u pacient\u016f asijsk\u00e9ho p\u016fvodu (zejm\u00e9na \u010d\u00ednsk\u00e9ho, korejsk\u00e9ho, indon\u00e9sk\u00e9ho, thajsk\u00e9ho), kde je frekvence alely 5-15%. Pacienti s pozitivn\u00ed alelou by nem\u011bli dost\u00e1vat dapson.<\/p>\n

            Rozpozn\u00e1n\u00ed a zvl\u00e1d\u00e1n\u00ed:<\/strong> jak\u00e1koliv nov\u00e1 hore\u010dka nebo vyr\u00e1\u017eka v prvn\u00edch 8 t\u00fddnech l\u00e9\u010dby dapsonem by m\u011bla b\u00fdt pova\u017eov\u00e1na za DHS, dokud se neprok\u00e1\u017ee opak. Okam\u017eit\u011b ukon\u010dete pod\u00e1v\u00e1n\u00ed dapsonu<\/strong>, neodkladn\u011b prove\u010fte FBC + jatern\u00ed testy, odka\u017ete na pohotovostn\u00ed p\u00e9\u010di. L\u00e9\u010dba: vysok\u00e9 d\u00e1vky syst\u00e9mov\u00fdch kortikosteroid\u016f, podp\u016frn\u00e1 p\u00e9\u010de, monitorov\u00e1n\u00ed selh\u00e1n\u00ed jater.<\/p>\n

            Kontraindikace a varov\u00e1n\u00ed<\/h2>\n
              \n
            • Dokumentovan\u00fd deficit G6PD<\/strong> (nebo netestov\u00e1no u populac\u00ed s vysokou prevalenc\u00ed) \u2014 absolutn\u00ed kontraindikace, pokud p\u0159\u00ednos jednozna\u010dn\u011b nep\u0159ev\u00e1\u017e\u00ed riziko pod odborn\u00fdm dohledem<\/li>\n
            • Pacienti pozitivn\u00ed na HLA-B*13:01<\/strong> (pokud testov\u00e1no)<\/li>\n
            • P\u0159ecitliv\u011blost na dapson nebo sulfonamidy<\/li>\n
            • T\u011b\u017ek\u00e1 an\u00e9mie<\/li>\n
            • T\u011b\u017ek\u00e9 kardiopulmon\u00e1ln\u00ed onemocn\u011bn\u00ed (\u0161patn\u00e1 tolerance methemoglobin\u00e9mie)<\/li>\n
            • V\u00fdznamn\u00e9 po\u0161kozen\u00ed jater<\/li>\n
            • Porfyrie<\/li>\n
            • P\u0159ecitliv\u011blost na metabolity dapsonu nebo na sulfonamidy (z\u0159\u00eddka hl\u00e1\u0161en\u00e1 zk\u0159\u00ed\u017een\u00e1 reaktivita)<\/li>\n<\/ul>\n

              T\u011bhotenstv\u00ed:<\/strong> dapson byl pou\u017e\u00edv\u00e1n v t\u011bhotenstv\u00ed u lepry a dermatitis herpetiformis bez d\u016fkaz\u016f o v\u00fdznamn\u00e9 teratogenit\u011b. Fet\u00e1ln\u00ed hemol\u00fdza je mo\u017en\u00e1, pokud je plod deficitn\u00ed na G6PD. Pou\u017e\u00edvejte pouze v p\u0159\u00edpad\u011b, \u017ee p\u0159\u00ednos jasn\u011b p\u0159ev\u00e1\u017e\u00ed riziko a za odborn\u00e9ho poradenstv\u00ed v oboru porodnictv\u00ed a dermatologie\/infek\u010dn\u00edho l\u00e9ka\u0159stv\u00ed.<\/p>\n

              Kojen\u00ed:<\/strong> dapson se vylu\u010duje do mate\u0159sk\u00e9ho ml\u00e9ka; riziko hemol\u00fdzy u kojenc\u016f s deficitem G6PD. Je nutn\u00e9 odborn\u00e9 poradenstv\u00ed.<\/p>\n

              Interakce s l\u00e9\u010divy<\/h2>\n