{"id":55737,"date":"2024-02-07T05:38:29","date_gmt":"2024-02-07T05:38:29","guid":{"rendered":"https:\/\/medsname.com\/azoran\/"},"modified":"2026-04-30T10:24:45","modified_gmt":"2026-04-30T10:24:45","slug":"azoran","status":"publish","type":"product","link":"https:\/\/medsbase.com\/cs\/product\/azoran\/","title":{"rendered":"Azoran"},"content":{"rendered":"<p><!-- medsbase-tldr-answer --><\/p>\n<div style=\"background:#fff8e1;border-left:4px solid #f5a623;padding:18px 22px;margin:0 0 24px 0;border-radius:4px;\">\n<h3 class=\"wp-block-heading\" style=\"margin:0 0 8px 0;font-size:16px;font-weight:700;\">\u26a1 Rychl\u00e1 odpov\u011b\u010f \u2014 Co je Azoran?<\/h3>\n<p style=\"margin:0;\"><strong>Azoran<\/strong> je peror\u00e1ln\u00ed tableta od RPG Life Sciences obsahuj\u00edc\u00ed <strong>azathioprin 50 mg<\/strong> \u2014 klasick\u00fd <strong>purin-antagonistick\u00fd imunosupresivum<\/strong> metabolizovan\u00fd in vivo na <strong>6-merkaptopurin<\/strong>. Pou\u017e\u00edv\u00e1 se k prevenci odm\u00edtnut\u00ed transplantovan\u00e9ho org\u00e1nu a k l\u00e9\u010db\u011b \u0161irok\u00e9ho spektra autoimunitn\u00edch a z\u00e1n\u011btliv\u00fdch onemocn\u011bn\u00ed (revmatoidn\u00ed artritida, lupus, z\u00e1n\u011btliv\u00e1 st\u0159evn\u00ed onemocn\u011bn\u00ed, autoimunitn\u00ed hepatitida, myasthenia gravis, vaskulitida, pemfigus). Standardn\u00ed d\u00e1vka pro dosp\u011bl\u00e9: <strong>1\u20133 mg\/kg jednou denn\u011b<\/strong>, d\u00e1vkov\u00e1n\u00ed se zvy\u0161uje pomalu. <strong>P\u0159ed prvn\u00edm pod\u00e1n\u00edm je povinn\u00e9 genetick\u00e9 testov\u00e1n\u00ed TPMT (a ide\u00e1ln\u011b tak\u00e9 NUDT15) nebo stanoven\u00ed enzymatick\u00e9 aktivity<\/strong> \u2014 pacienti s n\u00edzkou nebo chyb\u011bj\u00edc\u00ed aktivitou TPMT vyv\u00edjej\u00ed p\u0159i standardn\u00edch d\u00e1vk\u00e1ch katastrofickou, \u017eivot ohro\u017euj\u00edc\u00ed myelosupresi. N\u00e1stup je pomal\u00fd \u2014 <strong>8\u201316 t\u00fddn\u016f<\/strong> pro steroid-\u0161et\u0159\u00edc\u00ed efekt. Dlouhodob\u00e1 rizika zahrnuj\u00ed infekce, \u00fatlum kostn\u00ed d\u0159en\u011b, hepatotoxicitu a m\u00edrn\u011b zv\u00fd\u0161en\u00e9 riziko lymfomu a nemelanomov\u00e9ho ko\u017en\u00edho karcinomu.<\/p>\n<\/div>\n<p><!-- medsbase-specialist-strip --><\/p>\n<div style=\"background:#fff3f3;border-left:4px solid #d9534f;padding:16px 20px;margin:0 0 24px 0;border-radius:4px;font-size:14px;\"><strong>\u2695 L\u00e9k vy\u017eaduj\u00edc\u00ed odborn\u00fd dohled \u2014 nutn\u00fd klinick\u00fd dohled.<\/strong> Toto je z\u00e1va\u017en\u00fd imunomodula\u010dn\u00ed l\u00e9k se specifick\u00fdmi po\u017eadavky na p\u0159edl\u00e9\u010debn\u00e9 vy\u0161et\u0159en\u00ed, \u010dern\u00fdmi v\u00fdstrahami a povinn\u00fdm laboratorn\u00edm monitorov\u00e1n\u00edm. M\u011bl by b\u00fdt p\u0159edepisov\u00e1n a sledov\u00e1n revmatologem, gastroenterologem, dermatologem nebo jin\u00fdm odborn\u00edkem zku\u0161en\u00fdm s jeho u\u017e\u00edv\u00e1n\u00edm. Ne <strong>ne<\/strong> p\u0159edepisujte si ho sami, neupravujte d\u00e1vku ani neza\u010d\u00ednejte\/nep\u0159est\u00e1vejte bez pokyn\u016f p\u0159edepisuj\u00edc\u00edho l\u00e9ka\u0159e. V\u017edy poskytn\u011bte sv\u00e9mu o\u0161et\u0159uj\u00edc\u00edmu l\u00e9ka\u0159i aktu\u00e1ln\u00ed p\u0159edpis p\u0159ed objedn\u00e1n\u00edm z MedsBase.<\/div>\n<div class=\"medsbase-trust-strip\" style=\"background:#f4f6f8;border:1px solid #e1e4e8;border-radius:4px;padding:14px 18px;margin:18px 0;display:flex;flex-wrap:wrap;gap:14px;font-size:0.95em;\"><span>\u2705 <strong>WHO-GMP certifikov\u00e1no<\/strong> v\u00fdrobce<\/span><span>\ud83d\udce6 <strong>Diskr\u00e9tn\u00ed balen\u00ed<\/strong><\/span><span>\ud83c\udf0d <strong>Dod\u00e1n\u00ed po cel\u00e9m sv\u011bt\u011b<\/strong><\/span><span>\ud83d\udcac <a href=\"\/cs\/reviews\/\">1,400+ recenz\u00ed z\u00e1kazn\u00edk\u016f<\/a><\/span><\/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<h2 class=\"wp-block-heading\">Co je Azoran?<\/h2>\n<p>Azoran je peror\u00e1ln\u00ed tableta vyr\u00e1b\u011bn\u00e1 spole\u010dnost\u00ed RPG Life Sciences obsahuj\u00edc\u00ed <strong>azathioprin 50 mg<\/strong>. Azathioprin je prol\u00e9\u010divo \u2014 po vst\u0159eb\u00e1n\u00ed je p\u0159em\u011bn\u011bn (neenzymaticky a pomoc\u00ed glutathion-S-transfer\u00e1zy) na <strong>6-mercaptopurin (6-MP)<\/strong>, kter\u00fd je d\u00e1le metabolizov\u00e1n na aktivn\u00ed thioguaninov\u00e9 nukleotidy, kter\u00e9 se za\u010dle\u0148uj\u00ed do DNA a blokuj\u00ed synt\u00e9zu purin\u016f v rychle se d\u011bl\u00edc\u00edch bu\u0148k\u00e1ch, zejm\u00e9na lymfocytech.<\/p>\n<p>Azoran je zna\u010dkov\u00fd generick\u00fd azathioprin od RPG Life Sciences \u2014 jeden z nejstar\u0161\u00edch imunosupresivn\u00edch l\u00e9k\u016f st\u00e1le pou\u017e\u00edvan\u00fdch v rutinn\u00ed klinick\u00e9 praxi a klasick\u00fd steroid-\u0161et\u0159\u00edc\u00ed prost\u0159edek u IBD, SLE, autoimunitn\u00ed hepatitidy, myasthenia gravis a udr\u017eovac\u00ed terapie po transplantaci pevn\u00fdch org\u00e1n\u016f. Azathioprin se klinicky pou\u017e\u00edv\u00e1 od 60. let 20. stolet\u00ed a z\u016fst\u00e1v\u00e1 jedn\u00edm ze z\u00e1kladn\u00edch steroid-\u0161et\u0159\u00edc\u00edch imunosupresiv \u2014 pro udr\u017eovac\u00ed terapii po transplantaci org\u00e1n\u016f a \u0161irok\u00e9 spektrum autoimunitn\u00edch onemocn\u011bn\u00ed. Jeho hlavn\u00ed role jsou bu\u010f jako prim\u00e1rn\u00ed imunosupresivum (u lehk\u00fdch a\u017e st\u0159edn\u011b z\u00e1va\u017en\u00fdch onemocn\u011bn\u00ed) nebo jako <strong>steroid-\u0161et\u0159\u00edc\u00ed l\u00e1tka<\/strong> (p\u0159idan\u00e1 k kortikosteroidn\u00ed terapii, aby umo\u017enila sn\u00ed\u017een\u00ed d\u00e1vky steroid\u016f p\u0159i zachov\u00e1n\u00ed kontroly onemocn\u011bn\u00ed).<\/p>\n<h2 class=\"wp-block-heading\">Jak Azoran funguje?<\/h2>\n<p>Azathioprin p\u016fsob\u00ed na \u00farovni DNA v d\u011bl\u00edc\u00edch se imunitn\u00edch bu\u0148k\u00e1ch:<\/p>\n<ul>\n<li><strong>P\u0159em\u011bna pro-l\u00e9ku<\/strong> \u2014 azathioprin se \u0161t\u011bp\u00ed na 6-MP b\u011bhem n\u011bkolika hodin po po\u017eit\u00ed.<\/li>\n<li><strong>T\u0159\u00edcestn\u00fd metabolismus 6-MP<\/strong>:<\/li>\n<ul>\n<li><em>Cesta HGPRT<\/em> \u2192 6-thioguaninov\u00e9 nukleotidy (6-TGN), hlavn\u00ed aktivn\u00ed metabolit. 6-TGN se za\u010dle\u0148uje do DNA a naru\u0161uje synt\u00e9zu purin\u016f v lymfocytech.<\/li>\n<li><em>Cesta TPMT<\/em> \u2192 6-methyl-merkaptopurin, v\u011bt\u0161inou neaktivn\u00ed. Pacienti s n\u00edzkou aktivitou TPMT p\u0159esm\u011bruj\u00ed v\u00edce 6-MP do aktivn\u00ed cesty 6-TGN \u2014 co\u017e vede k v\u00fdrazn\u00e9 myelosupresi p\u0159i b\u011b\u017en\u00fdch d\u00e1vk\u00e1ch.<\/li>\n<li><em>Cesta xanthinoxid\u00e1zy<\/em> \u2192 neaktivn\u00ed thiourikov\u00e1 kyselina. Tuto cestu blokuje <strong>allopurinol<\/strong> \u2014 co\u017e vysv\u011btluje, pro\u010d kombinace alopurinolu a standardn\u00ed d\u00e1vky azathioprinu je potenci\u00e1ln\u011b smrteln\u00e1.<\/li>\n<\/ul>\n<li><strong>Selektivita v\u016f\u010di lymfocyt\u016fm<\/strong> \u2014 T- a B-bu\u0148ky jsou obzvl\u00e1\u0161t\u011b citliv\u00e9, proto\u017ee z\u00e1vis\u00ed na <em>de novo<\/em> cest\u011b synt\u00e9zy purin\u016f sp\u00ed\u0161e ne\u017e na z\u00e1chran\u011b.<\/li>\n<\/ul>\n<p>N\u00e1stup klinick\u00e9ho \u00fa\u010dinku: <strong>8\u201316 t\u00fddn\u016f<\/strong> u v\u011bt\u0161iny autoimunitn\u00edch onemocn\u011bn\u00ed. Azathioprin nen\u00ed l\u00e9k s rychl\u00fdm n\u00e1stupem \u00fa\u010dinku \u2014 obvykle je nutn\u00e9 kortikosteroidn\u00ed kryt\u00ed b\u011bhem prvn\u00edch 2\u20133 m\u011bs\u00edc\u016f, ne\u017e azathioprin za\u010dne pln\u011b p\u016fsobit.<\/p>\n<h2 class=\"wp-block-heading\">Pou\u017eit\u00ed a indikace<\/h2>\n<ul>\n<li><strong>Transplantace pevn\u00fdch org\u00e1n\u016f<\/strong> \u2014 udr\u017eovac\u00ed imunosuprese po transplantaci ledvin, jater nebo srdce (nyn\u00ed m\u00e9n\u011b \u010dast\u00e9 \u2014 mykofenol\u00e1t je v modern\u00edch protokolech v\u011bt\u0161inou nahradil)<\/li>\n<li><strong>Z\u00e1n\u011btliv\u00e1 onemocn\u011bn\u00ed st\u0159ev<\/strong> \u2014 udr\u017eovac\u00ed l\u00e9\u010dba \u0161et\u0159\u00edc\u00ed kortikosteroidy u Crohnovy choroby a ulcer\u00f3zn\u00ed kolitidy<\/li>\n<li><strong>Revmatoidn\u00ed artritida<\/strong> \u2014 pro pacienty, kte\u0159\u00ed nesn\u00e1\u0161ej\u00ed metotrex\u00e1t nebo biologickou l\u00e9\u010dbu<\/li>\n<li><strong>Syst\u00e9mov\u00fd lupus erythematodes (SLE)<\/strong> \u2014 v\u010detn\u011b udr\u017eovac\u00ed l\u00e9\u010dby po induk\u010dn\u00ed terapii lupusov\u00e9 nefritidy<\/li>\n<li><strong>Autoimunitn\u00ed hepatitida<\/strong> \u2014 standardn\u00ed udr\u017eovac\u00ed l\u00e9\u010dba v kombinaci s (nebo jako n\u00e1hrada za) n\u00edzk\u00e9 d\u00e1vky prednisolonu<\/li>\n<li><strong>Myasthenia gravis<\/strong> \u2014 dlouhodob\u00e1 l\u00e9\u010dba \u0161et\u0159\u00edc\u00ed kortikosteroidy<\/li>\n<li><strong>ANCA-asociovan\u00e1 vaskulitida<\/strong> \u2014 udr\u017eov\u00e1n\u00ed remise po induk\u010dn\u00ed terapii<\/li>\n<li><strong>Pemphigus vulgaris a bul\u00f3zn\u00ed pemfigoid<\/strong> \u2014 \u0161et\u0159\u00edc\u00ed l\u00e9\u010dba kortikosteroidy u chronick\u00e9ho onemocn\u011bn\u00ed<\/li>\n<li><strong>Atopick\u00e1 dermatitida<\/strong> \u2014 z\u00e1va\u017en\u00e9 refraktern\u00ed p\u0159\u00edpady<\/li>\n<li><strong>Roztrou\u0161en\u00e1 skler\u00f3za (relabuj\u00edc\u00ed-remituj\u00edc\u00ed forma)<\/strong> \u2014 p\u0159\u00edle\u017eitostn\u00e9 u\u017eit\u00ed tam, kde nejsou dostupn\u00e9 chorobu modifikuj\u00edc\u00ed terapie<\/li>\n<\/ul>\n<p>Azoran je <strong>ne<\/strong> ur\u010den pro: nediagnostikovanou bolest kloub\u016f, prvn\u00ed linii l\u00e9\u010dby v\u011bt\u0161iny autoimunitn\u00edch onemocn\u011bn\u00ed, pokud jsou dostupn\u00e9 rychleji p\u016fsob\u00edc\u00ed nebo \u00fa\u010dinn\u011bj\u0161\u00ed alternativy, nebo pro pacienty, kte\u0159\u00ed nepodstoupili testov\u00e1n\u00ed TPMT a z\u00e1kladn\u00ed krevn\u00ed testy.<\/p>\n<h2 class=\"wp-block-heading\">P\u0159ed zah\u00e1jen\u00edm l\u00e9\u010dby Azoranem \u2014 povinn\u00e9 vy\u0161et\u0159en\u00ed<\/h2>\n<p>Azathioprin pat\u0159\u00ed mezi n\u011bkolik b\u011b\u017en\u011b u\u017e\u00edvan\u00fdch l\u00e9k\u016f, u kter\u00fdch je farmakogenetick\u00e9 testov\u00e1n\u00ed p\u0159ed pod\u00e1n\u00edm prvn\u00ed d\u00e1vky standardem p\u00e9\u010de. Jeho vynech\u00e1n\u00ed riskuje fat\u00e1ln\u00ed selh\u00e1n\u00ed kostn\u00ed d\u0159en\u011b.<\/p>\n<ul>\n<li><strong>Genotyp TPMT nebo test enzymatick\u00e9 aktivity<\/strong> \u2014 identifikuje p\u0159ibli\u017en\u011b 1 z 300 pacient\u016f evropsk\u00e9ho p\u016fvodu s nulovou aktivitou TPMT (homozygotn\u00ed varianta) a p\u0159ibli\u017en\u011b 10 % pacient\u016f se sn\u00ed\u017eenou aktivitou (heterozygotn\u00ed). Nulov\u00e1 aktivita TPMT znamen\u00e1, \u017ee standardn\u00ed d\u00e1vka zp\u016fsob\u00ed katastrof\u00e1ln\u00ed myelosupresi b\u011bhem n\u011bkolika t\u00fddn\u016f.<\/li>\n<li><strong>Genotyp NUDT15 (pokud je dostupn\u00fd)<\/strong> \u2014 zvl\u00e1\u0161t\u011b d\u016fle\u017eit\u00fd u pacient\u016f asijsk\u00e9ho, hisp\u00e1nsk\u00e9ho a africk\u00e9ho p\u016fvodu, kde varianty NUDT15 zp\u016fsobuj\u00ed podobn\u00e9 riziko myelosuprese nez\u00e1visle na stavu TPMT.<\/li>\n<li><strong>Kompletn\u00ed krevn\u00ed obraz<\/strong> \u2014 v\u00fdchoz\u00ed hodnoty; neza\u010d\u00ednat, pokud ANC &lt; 1,5 nebo trombocyty &lt; 100.<\/li>\n<li><strong>Jatern\u00ed testy<\/strong> \u2014 v\u00fdchoz\u00ed ALT, AST, ALP, bilirubin. Odlo\u017eit, pokud v\u00fdrazn\u011b abnorm\u00e1ln\u00ed.<\/li>\n<li><strong>Funkce ledvin<\/strong> \u2014 azathioprin je \u010d\u00e1ste\u010dn\u011b vylu\u010dov\u00e1n neaktivn\u00edmi metabolity mo\u010d\u00ed; p\u0159i t\u011b\u017ek\u00e9m ren\u00e1ln\u00edm posti\u017een\u00ed m\u016f\u017ee b\u00fdt nutn\u00e1 \u00faprava d\u00e1vky.<\/li>\n<li><strong>Screening hepatitidy B \/ C a HIV<\/strong> \u2014 zabra\u0148uje reaktivaci chronick\u00e9 virov\u00e9 hepatitidy a identifikuje koinfekci vy\u017eaduj\u00edc\u00ed specializovanou p\u00e9\u010di.<\/li>\n<li><strong>Screening latentn\u00ed TBC<\/strong> \u2014 QuantiFERON nebo TST; l\u00e9\u010dit latentn\u00ed TBC p\u0159ed zah\u00e1jen\u00edm dlouhodob\u00e9 imunosuprese.<\/li>\n<li><strong>Stav varicella-zoster<\/strong> \u2014 s\u00e9ronegativn\u00ed pacienti by m\u011bli obdr\u017eet vakc\u00ednu proti plan\u00fdm ne\u0161tovic\u00edm (\u017eivou) P\u0158ED zah\u00e1jen\u00edm l\u00e9\u010dby azathioprinem \u2014 \u017eiv\u00e9 vakc\u00edny jsou kontraindikov\u00e1ny po zah\u00e1jen\u00ed l\u00e9\u010dby.<\/li>\n<li><strong>T\u011bhotensk\u00fd test<\/strong> u \u017een v reproduk\u010dn\u00edm v\u011bku; nutn\u00e1 diskuse o antikoncepci.<\/li>\n<li><strong>P\u0159ehled o\u010dkov\u00e1n\u00ed<\/strong> \u2014 aktualizovat ne\u017eiv\u00e9 vakc\u00edny (ch\u0159ipka, pneumokokov\u00e9, COVID-19, Shingrix, HPV). \u017div\u00e9 vakc\u00edny jsou b\u011bhem l\u00e9\u010dby kontraindikov\u00e1ny.<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">D\u00e1vkov\u00e1n\u00ed p\u0159\u00edpravku Azoran a zp\u016fsob u\u017e\u00edv\u00e1n\u00ed<\/h2>\n<p>Azoran je dod\u00e1v\u00e1n v <strong>50 mg<\/strong>. D\u00e1vkov\u00e1n\u00ed je zalo\u017eeno na hmotnosti a pe\u010dliv\u011b titrov\u00e1no.<\/p>\n<ul>\n<li><strong>Standardn\u00ed d\u00e1vkov\u00e1n\u00ed pro dosp\u011bl\u00e9:<\/strong> 1\u20133 mg\/kg t\u011blesn\u00e9 hmotnosti 1\u00d7 denn\u011b.<\/li>\n<li><strong>Za\u010dn\u011bte n\u00edzkou d\u00e1vkou:<\/strong> obvykle 50 mg 1\u00d7 denn\u011b po dobu 1\u20132 t\u00fddn\u016f s kontrolou krevn\u00edho obrazu v 1. a 2. t\u00fddnu; n\u00e1sledn\u011b zv\u00fd\u0161it na c\u00edlovou d\u00e1vku, pokud jsou krevn\u00ed hodnoty stabiln\u00ed.<\/li>\n<li><strong>Udr\u017eovac\u00ed l\u00e9\u010dba autoimunitn\u00edch onemocn\u011bn\u00ed:<\/strong> obvykle 1\u20132,5 mg\/kg\/den.<\/li>\n<li><strong>Udr\u017eovac\u00ed l\u00e9\u010dba po transplantaci:<\/strong> 1\u20133 mg\/kg\/den v z\u00e1vislosti na re\u017eimu.<\/li>\n<li><strong>Pacienti s heterozygotn\u00edm TPMT nebo st\u0159edn\u00ed aktivitou:<\/strong> sn\u00ed\u017eit po\u010d\u00e1te\u010dn\u00ed d\u00e1vku na 50 % (0,5\u20131,5 mg\/kg\/den).<\/li>\n<li><strong>TPMT homozygotn\u011b deficitn\u00ed nebo NUDT15 deficitn\u00ed:<\/strong> azathioprin je kontraindikov\u00e1n (nebo pou\u017eijte &lt; 10 % standardn\u00ed d\u00e1vky pod odborn\u00fdm dohledem s intenzivn\u00edm monitorov\u00e1n\u00edm).<\/li>\n<li><strong>Porucha funkce ledvin:<\/strong> sni\u017ete d\u00e1vku p\u0159i t\u011b\u017ek\u00e9m po\u0161kozen\u00ed; vyhn\u011bte se pou\u017eit\u00ed u ESRD bez odborn\u00e9ho veden\u00ed.<\/li>\n<li><strong>S j\u00eddlem:<\/strong> u\u017e\u00edvejte s j\u00eddlem nebo po j\u00eddle, abyste sn\u00ed\u017eili nevolnost.<\/li>\n<\/ul>\n<h3 class=\"wp-block-heading\">Jak spr\u00e1vn\u011b u\u017e\u00edvat Azoran<\/h3>\n<ol>\n<li><strong>Nikdy neza\u010d\u00ednejte bez testov\u00e1n\u00ed TPMT<\/strong> (a NUDT15, kde je dostupn\u00e9). Toto je nejd\u016fle\u017eit\u011bj\u0161\u00ed bezpe\u010dnostn\u00ed krok.<\/li>\n<li><strong>Polykejte tablety cel\u00e9 s vodou, s j\u00eddlem.<\/strong> Nedr\u0165te a ne\u017ev\u00fdkejte \u2013 azathioprin je cytotoxick\u00fd l\u00e9k a prach m\u016f\u017ee b\u00fdt \u0161kodliv\u00fd pro pe\u010dovatele. Po manipulaci si umyjte ruce.<\/li>\n<li><strong>Jednou denn\u011b ve stejnou dobu<\/strong> \u2013 obvykle s ve\u010de\u0159\u00ed, aby se sn\u00ed\u017eila p\u0159\u00edpadn\u00e1 nevolnost b\u011bhem dne.<\/li>\n<li><strong>CBC a LFT v t\u00fddnech 1, 2, 4, 8, 12, pot\u00e9 ka\u017ed\u00e9 3 m\u011bs\u00edce<\/strong> na dobu neur\u010ditou. Jak\u00fdkoli pokles WBC pod 3,0 nebo neutrofil\u016f pod 1,5 vy\u017eaduje odborn\u00e9 posouzen\u00ed a obvykle sn\u00ed\u017een\u00ed d\u00e1vky nebo p\u0159eru\u0161en\u00ed.<\/li>\n<li><strong>Nevynech\u00e1vejte monitorovac\u00ed odb\u011bry krve<\/strong> \u2014 opo\u017ed\u011bn\u00e1 myelosuprese se m\u016f\u017ee objevit a\u017e po m\u011bs\u00edc\u00edch nebo letech l\u00e9\u010dby, zejm\u00e9na p\u0159i nasazen\u00ed nov\u00fdch l\u00e9k\u016f (alopurinol je klasick\u00fd spou\u0161t\u011b\u010d).<\/li>\n<li><strong>Denn\u011b pou\u017e\u00edvejte \u0161irokospektr\u00e1ln\u00ed opalovac\u00ed kr\u00e9m s SPF 50<\/strong>. Azathioprin v\u00fdrazn\u011b zvy\u0161uje riziko nemelanomov\u00fdch ko\u017en\u00edch n\u00e1dor\u016f \u2014 u sv\u011btlej\u0161\u00edch pacient\u016f nebo p\u0159i dlouhodob\u00e9 l\u00e9\u010db\u011b je nutn\u00e1 ro\u010dn\u00ed kontrola u dermatologa.<\/li>\n<li><strong>Okam\u017eit\u011b nahlaste jakoukoli bolest v krku, nevysv\u011btlitelnou hore\u010dku, mod\u0159iny, krv\u00e1cen\u00ed, afty nebo silnou \u00fanavu<\/strong> \u2014 m\u016f\u017ee to b\u00fdt prvn\u00ed zn\u00e1mka \u00fatlumu kostn\u00ed d\u0159en\u011b.<\/li>\n<li><strong>Informujte ka\u017ed\u00e9ho p\u0159edepisuj\u00edc\u00edho l\u00e9ka\u0159e<\/strong> \u017ee u\u017e\u00edv\u00e1te azathioprin \u2014 zejm\u00e9na p\u0159ed nasazen\u00edm jak\u00e9hokoli nov\u00e9ho l\u00e9ku za\u010d\u00ednaj\u00edc\u00edho na \u201calopurinol\u201d nebo jak\u00e9koli terapie sni\u017euj\u00edc\u00ed hladinu kyseliny mo\u010dov\u00e9.<\/li>\n<li><strong>Vyhn\u011bte se \u017eiv\u00fdm vakc\u00edn\u00e1m<\/strong> b\u011bhem l\u00e9\u010dby a po dobu nejm\u00e9n\u011b 3 m\u011bs\u00edc\u016f po jej\u00edm ukon\u010den\u00ed.<\/li>\n<li><strong>Pl\u00e1nujte t\u011bhotenstv\u00ed p\u0159edem s p\u0159edepisuj\u00edc\u00edm l\u00e9ka\u0159em<\/strong> \u2014 azathioprin je obecn\u011b pova\u017eov\u00e1n za kompatibiln\u00ed s t\u011bhotenstv\u00edm p\u0159i mate\u0159sk\u00fdch indikac\u00edch (na rozd\u00edl od mykofenol\u00e1tu), ale rozhodnut\u00ed je individu\u00e1ln\u00ed.<\/li>\n<\/ol>\n<h2 class=\"wp-block-heading\">Vedlej\u0161\u00ed \u00fa\u010dinky p\u0159\u00edpravku Azoran<\/h2>\n<p><strong>B\u011b\u017en\u00e9 (prvn\u00edch 4\u20138 t\u00fddn\u016f):<\/strong><\/p>\n<ul>\n<li>Nevolnost, zvracen\u00ed, bolesti b\u0159icha (obvykle ustoup\u00ed; nejhor\u0161\u00ed v prvn\u00edm m\u011bs\u00edci)<\/li>\n<li>Pr\u016fjem<\/li>\n<li>\u00danava<\/li>\n<li>Bolest hlavy<\/li>\n<li>M\u00edrn\u00e9 \u0159\u00eddnut\u00ed vlas\u016f<\/li>\n<li>M\u00edrn\u011b zv\u00fd\u0161en\u00e9 jatern\u00ed enzymy (ALT, AST)<\/li>\n<\/ul>\n<p><strong>M\u00e9n\u011b \u010dast\u00e9, ale d\u016fle\u017eit\u00e9:<\/strong><\/p>\n<ul>\n<li><strong>Myelosuprese<\/strong> \u2014 leukopenie, neutropenie, trombocytopenie, an\u00e9mie. Obvykle z\u00e1visl\u00e9 na d\u00e1vce a reverzibiln\u00ed.<\/li>\n<li><strong>Hypersenzitivn\u00ed reakce<\/strong> \u2014 hore\u010dka, vyr\u00e1\u017eka, bolesti kloub\u016f, n\u011bkdy hypotenze, typicky v prvn\u00edch 4 t\u00fddnech. Vymiz\u00ed po vysazen\u00ed a obvykle se opakuje p\u0159i op\u011btovn\u00e9m pod\u00e1n\u00ed.<\/li>\n<li><strong>Hepatotoxicita<\/strong> \u2014 m\u00edrn\u00e9 zv\u00fd\u0161en\u00ed ALT je b\u011b\u017en\u00e9; cholestatick\u00e1 hepatitida a veno-okluzivn\u00ed onemocn\u011bn\u00ed jsou vz\u00e1cn\u00e9, ale z\u00e1va\u017en\u00e9.<\/li>\n<li><strong>Pankreatitida<\/strong> \u2014 idiosynkratick\u00e9, \u010dast\u011bj\u0161\u00ed u pacient\u016f s IBD. Trvale vysadit, pokud k n\u011bmu dojde.<\/li>\n<li>Afty<\/li>\n<li>Zv\u00fd\u0161en\u00e9 riziko infekc\u00ed \u2014 bakteri\u00e1ln\u00edch, virov\u00fdch (zejm\u00e9na herpes zoster), pl\u00eds\u0148ov\u00fdch, parazit\u00e1rn\u00edch<\/li>\n<\/ul>\n<p><strong>Vz\u00e1cn\u00e9, ale z\u00e1va\u017en\u00e9 \u2014 vy\u017eaduje neodkladn\u00e9 vy\u0161et\u0159en\u00ed:<\/strong><\/p>\n<ul>\n<li><strong>Z\u00e1va\u017en\u00e1 \u017eivot ohro\u017euj\u00edc\u00ed myelosuprese<\/strong> \u2014 pacienti s deficitem TPMT, sou\u010dasn\u00e9 pod\u00e1v\u00e1n\u00ed alopurinolu nebo vysok\u00e9 d\u00e1vky. N\u00e1hl\u00e1 bolest v krku, hore\u010dka, mod\u0159iny, krv\u00e1cen\u00ed nebo siln\u00e1 \u00fanava jsou varovn\u00fdmi sign\u00e1ly.<\/li>\n<li><strong>Lymfom<\/strong> \u2014 posttransplanta\u010dn\u00ed lymfoproliferativn\u00ed onemocn\u011bn\u00ed (PTLD); hepatosplenick\u00fd T-bun\u011b\u010dn\u00fd lymfom (vz\u00e1cn\u00e9, ale \u010dasto fat\u00e1ln\u00ed; vy\u0161\u0161\u00ed riziko u mlad\u00fdch mu\u017e\u016f s IBD l\u00e9\u010den\u00fdch kombinac\u00ed azathioprin + TNF inhibitor)<\/li>\n<li><strong>Nemelanomov\u00fd ko\u017en\u00ed karcinom<\/strong> \u2014 v\u00fdznamn\u011b zv\u00fd\u0161en\u00e9 p\u0159i dlouhodob\u00e9m u\u017e\u00edv\u00e1n\u00ed, zejm\u00e9na u pacient\u016f se sv\u011btlou plet\u00ed a kumulativn\u00ed expozic\u00ed slune\u010dn\u00edmu z\u00e1\u0159en\u00ed<\/li>\n<li><strong>Progresivn\u00ed multifok\u00e1ln\u00ed leukoencefalopatie (PML)<\/strong> \u2014 vz\u00e1cn\u00e9, ale hl\u00e1\u0161en\u00e9, typicky u siln\u011b imunosuprimovan\u00fdch pacient\u016f<\/li>\n<li><strong>Reaktivace hepatitidy B nebo p\u00e1sov\u00e9ho oparu<\/strong>, diseminovan\u00e1 herpes infekce, oportunn\u00ed infekce<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Varov\u00e1n\u00ed a opat\u0159en\u00ed<\/h2>\n<ul>\n<li><strong>Aktivn\u00ed z\u00e1va\u017en\u00e1 infekce<\/strong> \u2014 neza\u010d\u00ednat; p\u0159eru\u0161it b\u011bhem febriln\u00edho onemocn\u011bn\u00ed.<\/li>\n<li><strong>Anamn\u00e9za nebo aktivn\u00ed malignita (krom\u011b l\u00e9\u010den\u00e9ho nemelanomov\u00e9ho ko\u017en\u00edho karcinomu)<\/strong> \u2014 relativn\u00ed kontraindikace; rozhodnut\u00ed specialisty.<\/li>\n<li><strong>Mlad\u00ed mu\u017ei s IBD<\/strong> \u2014 specifick\u00e9 (vz\u00e1cn\u00e9) riziko hepatosplenick\u00e9ho T-bun\u011b\u010dn\u00e9ho lymfomu, zejm\u00e9na p\u0159i kombinaci azathioprinu s TNF inhibitorem. Diskutovat alternativy monoterapie.<\/li>\n<li><strong>Chronick\u00e1 hepatitida B nebo C<\/strong> \u2014 riziko virov\u00e9 reaktivace; vhodn\u00e9 zajistit antivirovou terapii (entekavir nebo tenofovir pro HBV) tam, kde je to vhodn\u00e9.<\/li>\n<li><strong>Latentn\u00ed TBC<\/strong> \u2014 l\u00e9\u010dit p\u0159ed zah\u00e1jen\u00edm dlouhodob\u00e9 imunosuprese.<\/li>\n<li><strong>T\u011bhotenstv\u00ed<\/strong> \u2014 azathioprin je obecn\u011b pova\u017eov\u00e1n za kompatibiln\u00ed s t\u011bhotenstv\u00edm u mate\u0159sk\u00fdch autoimunitn\u00edch onemocn\u011bn\u00ed (na rozd\u00edl od mykofenol\u00e1tu, kter\u00fd je absolutn\u011b kontraindikov\u00e1n). Pokra\u010dov\u00e1n\u00ed v t\u011bhotenstv\u00ed by m\u011blo b\u00fdt spole\u010dn\u00e9 rozhodnut\u00ed s odborn\u00fdm vstupem; nel\u00e9\u010den\u00e9 aktivn\u00ed autoimunitn\u00ed onemocn\u011bn\u00ed \u010dasto p\u0159edstavuje vy\u0161\u0161\u00ed riziko pro plod ne\u017e l\u00e9k. Otcov\u00e9 u\u017e\u00edvaj\u00edc\u00ed azathioprin v dob\u011b po\u010det\u00ed: neexistuj\u00ed siln\u00e9 d\u016fkazy o teratogenit\u011b.<\/li>\n<li><strong>Kojen\u00ed<\/strong> \u2014 mal\u00e9 mno\u017estv\u00ed metabolit\u016f p\u0159ech\u00e1z\u00ed do mate\u0159sk\u00e9ho ml\u00e9ka, ale klinick\u00e9 zku\u0161enosti nazna\u010duj\u00ed n\u00edzk\u00e9 riziko pro kojence; obecn\u011b pova\u017eov\u00e1no za p\u0159ijateln\u00e9 s monitorov\u00e1n\u00edm kojence.<\/li>\n<li><strong>D\u011bti<\/strong> \u2014 pou\u017e\u00edv\u00e1 se u d\u011btsk\u00fdch pacient\u016f s IBD, transplantac\u00ed a autoimunitn\u00ed hepatitidou. Stejn\u00e9 farmakogenetick\u00e9 testov\u00e1n\u00ed je vy\u017eadov\u00e1no.<\/li>\n<li><strong>\u017div\u00e9 vakc\u00edny jsou b\u011bhem l\u00e9\u010dby kontraindikov\u00e1ny<\/strong>. Inaktivovan\u00e9 vakc\u00edny jsou v po\u0159\u00e1dku. Napl\u00e1nujte si vakc\u00ednu Shingrix a cestovn\u00ed vakc\u00edny p\u0159ed zah\u00e1jen\u00edm l\u00e9\u010dby.<\/li>\n<li><strong>Vystaven\u00ed slunci<\/strong> \u2014 denn\u011b \u0161irokospektr\u00e1ln\u00ed SPF 50; ro\u010dn\u00ed dermatologick\u00e1 kontrola pro pacienty se sv\u011btlou plet\u00ed a ty na dlouhodob\u00e9 l\u00e9\u010db\u011b.<\/li>\n<li><strong>Manipulace t\u011bhotn\u00fdmi nebo koj\u00edc\u00edmi pe\u010dovateli<\/strong> \u2014 azathioprin je klasifikov\u00e1n jako cytotoxick\u00fd l\u00e9k. P\u0159i v\u00fddeji rozl\u00e1man\u00fdch nebo rozdrcen\u00fdch tablet pou\u017e\u00edvejte rukavice; po manipulaci si umyjte ruce.<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Kontraindikace \u2014 Kdo by NEM\u011aL u\u017e\u00edvat Azoran<\/h2>\n<ul>\n<li>Zn\u00e1m\u00e1 p\u0159ecitliv\u011blost na azathioprin, 6-merkaptopurin nebo jakoukoli pomocnou l\u00e1tku tablety<\/li>\n<li>\u00dapln\u00fd deficit TPMT nebo NUDT15 (homozygotn\u00ed varianta) \u2014 pou\u017eijte jinou t\u0159\u00eddu l\u00e9k\u016f<\/li>\n<li>T\u011b\u017ek\u00e1 aktivn\u00ed infekce (bakteri\u00e1ln\u00ed, virov\u00e1, pl\u00eds\u0148ov\u00e1, mykobakteri\u00e1ln\u00ed)<\/li>\n<li>Aktivn\u00ed nel\u00e9\u010den\u00e1 hepatitida B nebo C bez antivirov\u00e9 ochrany<\/li>\n<li>T\u011b\u017ek\u00e9 jatern\u00ed onemocn\u011bn\u00ed (dekompenzovan\u00e1 cirh\u00f3za)<\/li>\n<li>P\u0159edchoz\u00ed pankreatitida indukovan\u00e1 azathioprinem (absolutn\u00ed kontraindikace k op\u011btovn\u00e9mu pod\u00e1n\u00ed)<\/li>\n<li>T\u011b\u017ek\u00e1 myelosuprese v\u00fdchoz\u00edho stavu (ANC &lt; 1,0, trombocyty &lt; 75, Hb &lt; 8 g\/dl)<\/li>\n<li>Pl\u00e1nov\u00e1n\u00ed t\u011bhotenstv\u00ed, kdy nebyla zv\u00e1\u017eena alternativa mykofenol\u00e1tu nebo metotrex\u00e1tu (rozhodnut\u00ed specialisty)<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Interakce s l\u00e9\u010divy<\/h2>\n<table style=\"border-collapse:collapse;width:100%;margin:12px 0;\">\n<thead>\n<tr style=\"background:#2c7cb0;color:#fff;\">\n<th style=\"padding:10px;border:1px solid #ddd;text-align:left;\">Kombinujte s<\/th>\n<th style=\"padding:10px;border:1px solid #ddd;text-align:left;\">\u00da\u010dinek<\/th>\n<th style=\"padding:10px;border:1px solid #ddd;text-align:left;\">Co d\u011blat<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\"><strong>Allopurinol, febuxostat<\/strong> (sni\u017euj\u00edc\u00ed hladinu ur\u00e1t\u016f)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\"><strong>\u017divot ohro\u017euj\u00edc\u00ed myelosuprese<\/strong> \u2014 xantinoxid\u00e1za je blokov\u00e1na, 6-MP se hromad\u00ed v aktivn\u00ed cytotoxick\u00e9 dr\u00e1ze. Hl\u00e1\u0161ena \u00famrt\u00ed.<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\"><strong>Sn\u00ed\u017eit d\u00e1vku azathioprinu na 25\u201333 % standardn\u00ed d\u00e1vky A sledovat CBC t\u00fddn\u011b po dobu 4 t\u00fddn\u016f.<\/strong> Alternativa: p\u0159ej\u00edt na l\u00e9\u010dbu dny ne-XO l\u00e1tkou (lesinurad, urikosurika).<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Aminosalicyl\u00e1ty (mesalazin, sulfasalazin, olsalazin)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Inhibice TPMT \u2014 m\u00edrn\u011b zv\u00fd\u0161en\u00e9 riziko myelosuprese<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">B\u011b\u017en\u00e1 kombinace u IBD. \u010cast\u011bji monitorujte krevn\u00ed obraz.<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Warfarin<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Azathioprin m\u016f\u017ee sn\u00ed\u017eit \u00fa\u010dinek warfarinu (mechanismus nejasn\u00fd)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Pe\u010dliv\u011b sledujte INR p\u0159i zah\u00e1jen\u00ed nebo ukon\u010den\u00ed l\u00e9\u010dby azathioprinem.<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">ACE inhibitory, ARB<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Aditivn\u00ed riziko an\u00e9mie<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Sledujte hladinu Hb.<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Co-trimoxazol (trimethoprim-sulfamethoxazol)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Aditivn\u00ed myelosuprese<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">\u010casto pou\u017e\u00edv\u00e1n k profylaxi Pneumocystis u t\u011b\u017ece imunosuprimovan\u00fdch pacient\u016f \u2014 monitorujte krevn\u00ed obraz.<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Ribavirin (l\u00e9\u010dba hepatitidy C)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">T\u011b\u017ek\u00e1 myelosuprese zp\u016fsoben\u00e1 inhibic\u00ed inosinmonofosf\u00e1tdehydrogen\u00e1zy<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\"><strong>Vyhn\u011bte se kombinaci.<\/strong> Pokud mo\u017eno dokon\u010dete l\u00e9\u010dbu HCV p\u0159ed zah\u00e1jen\u00edm l\u00e9\u010dby azathioprinem.<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">TNF inhibitory (infliximab, adalimumab, certolizumab)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Standardn\u00ed kombinace u IBD; m\u00edrn\u011b zv\u00fd\u0161en\u00e9 riziko lymfomu, zejm\u00e9na u mlad\u00fdch mu\u017e\u016f (hepatosplenick\u00fd T-bun\u011b\u010dn\u00fd lymfom)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Zva\u017ete p\u0159\u00ednos (kontrolu IBD) vs. riziko vzniku vz\u00e1cn\u00e9ho lymfomu. Po stabilizaci zva\u017ete monoterapii.<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">\u017div\u00e9 vakc\u00edny (MMR, plan\u00e9 ne\u0161tovice, \u017elut\u00e1 zimnice, BCG, Zostavax, \u017eiv\u00e1 nosn\u00ed ch\u0159ipka)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Riziko diseminovan\u00e9 infekce vakcina\u010dn\u00edm kmenem<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\"><strong>Kontraindikov\u00e1no b\u011bhem l\u00e9\u010dby<\/strong> a po dobu 3 m\u011bs\u00edc\u016f po ukon\u010den\u00ed l\u00e9\u010dby.<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Kortikosteroidy<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Aditivn\u00ed imunosuprese (zam\u00fd\u0161len\u00e1 kombinace)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Standardn\u011b \u2014 azathioprin se b\u011b\u017en\u011b pou\u017e\u00edv\u00e1 jako \u0161et\u0159\u00edc\u00ed l\u00e9k ke kortikosteroid\u016fm.<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Dal\u0161\u00ed imunosupresiva (MMF, cyklosporin, takrolimus, inhibitory JAK, biologika)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Zv\u00fd\u0161en\u00e9 riziko infekc\u00ed a malignit<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Pouze v pe\u010dliv\u011b monitorovan\u00fdch transplanta\u010dn\u00edch nebo specializovan\u00fdch kontextech.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2 class=\"wp-block-heading\">Pokyny k uchov\u00e1v\u00e1n\u00ed<\/h2>\n<ul>\n<li>Skladujte p\u0159i pokojov\u00e9 teplot\u011b, <strong>pod 25\u00b0C<\/strong>, v p\u016fvodn\u00edm blistru, chr\u00e1n\u011bno p\u0159ed sv\u011btlem a vlhkost\u00ed.<\/li>\n<li>Uchov\u00e1vejte mimo dosah d\u011bt\u00ed \u2014 azathioprin je cytotoxick\u00fd a nebezpe\u010dn\u00fd p\u0159i po\u017eit\u00ed d\u00edt\u011btem nebo zv\u00ed\u0159etem.<\/li>\n<li>Nepou\u017e\u00edvejte po uplynut\u00ed data expirace uveden\u00e9ho na obalu.<\/li>\n<li>Nepou\u017eit\u00e9 tablety vra\u0165te do l\u00e9k\u00e1rny jako cytotoxick\u00fd odpad \u2014 nevyhazujte do dom\u00e1c\u00edho odpadu ani nesplachujte.<\/li>\n<li>Po manipulaci si umyjte ruce. O\u0161et\u0159uj\u00edc\u00ed osoby by m\u011bly pou\u017e\u00edvat rukavice p\u0159i manipulaci s rozbit\u00fdmi tabletami, zejm\u00e9na pokud jsou t\u011bhotn\u00e9 nebo koj\u00ed.<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Souvisej\u00edc\u00ed alternativy na MedsBase<\/h2>\n<p>Dal\u0161\u00ed l\u00e9ky pou\u017e\u00edvan\u00e9 v protiz\u00e1n\u011btliv\u00e9 a autoimunitn\u00ed p\u00e9\u010di skladem vedle tohoto produktu:<\/p>\n<ul>\n<li><a href=\"https:\/\/medsbase.com\/cs\/barinat\/\"><strong>Barinat (baricitinib 2 \/ 4 mg) \u2014 inhibitor JAK1\/2 pro RA<\/strong><\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/tofe\/\"><strong>Tofe (tofacitinib 5 mg) \u2014 inhibitor JAK1\/3 pro RA, UC, PsA<\/strong><\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/lefuheal\/\"><strong>Lefuheal (leflunomid) \u2014 peror\u00e1ln\u00ed DMARD pro revmatoidn\u00ed artritidu<\/strong><\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/conimune-me\/\"><strong>Conimune ME (cyklosporin) \u2014 inhibitor kalcineurinu<\/strong><\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/wysolone\/\"><strong>Wysolone (prednisolon 5 \/ 10 \/ 20 mg) \u2014 peror\u00e1ln\u00ed kortikosteroid<\/strong><\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/medrol\/\"><strong>Medrol (methylprednisolon 4 \/ 8 \/ 16 mg) \u2014 peror\u00e1ln\u00ed kortikosteroid<\/strong><\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/predniheal\/\"><strong>Predniheal (prednisolon) \u2014 peror\u00e1ln\u00ed kortikosteroid<\/strong><\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/hisone\/\"><strong>Hisone (hydrokortizon) \u2014 fyziologick\u00e1 n\u00e1hradn\u00ed terapie steroidy<\/strong><\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/budez-cr\/\"><strong>Budez CR (budesonid) \u2014 st\u0159evn\u011b p\u016fsob\u00edc\u00ed kortikosteroid pro Crohnovu chorobu<\/strong><\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/kenacort\/\"><strong>Kenacort (triamcinolon) \u2014 syst\u00e9mov\u00fd kortikosteroid<\/strong><\/a><\/li>\n<\/ul>\n<p>Prozkoumejte celou <a href=\"https:\/\/medsbase.com\/cs\/anti-inflammatory-autoimmune-care\/\">Protiz\u00e1n\u011btliv\u00e1 a autoimunitn\u00ed p\u00e9\u010de<\/a> kategorie.<\/p>\n<h2 id=\"faqs\">\u010casto kladen\u00e9 dotazy<\/h2>\n<h3 class=\"wp-block-heading\">Pro\u010d pot\u0159ebuji testov\u00e1n\u00ed TPMT p\u0159ed zah\u00e1jen\u00edm u\u017e\u00edv\u00e1n\u00ed Azoranu?<\/h3>\n<p>Thiopurin-methyltransfer\u00e1za (TPMT) je enzym, kter\u00fd detoxifikuje aktivn\u00ed metabolit azathioprinu. P\u0159ibli\u017en\u011b 1 z 300 lid\u00ed evropsk\u00e9ho p\u016fvodu nem\u00e1 v\u016fbec \u017e\u00e1dnou funk\u010dn\u00ed TPMT (homozygotn\u00ed deficit) a asi 10 % m\u00e1 sn\u00ed\u017eenou aktivitu (heterozygotn\u00ed). P\u0159i standardn\u00ed d\u00e1vce u pacienta s deficitem TPMT dojde b\u011bhem n\u011bkolika t\u00fddn\u016f k z\u00e1va\u017en\u00e9, \u017eivot ohro\u017euj\u00edc\u00ed supresi kostn\u00ed d\u0159en\u011b. Testov\u00e1n\u00ed TPMT \u2014 bu\u010f genotypov\u00e9, nebo test enzymatick\u00e9 aktivity \u2014 identifikuje tyto pacienty je\u0161t\u011b p\u0159ed pod\u00e1n\u00edm prvn\u00ed tablety. Testov\u00e1n\u00ed NUDT15 je nav\u00edc d\u016fle\u017eit\u00e9 pro pacienty asijsk\u00e9ho, hisp\u00e1nsk\u00e9ho a africk\u00e9ho p\u016fvodu, kte\u0159\u00ed maj\u00ed jinou vysoce rizikovou variantu.<\/p>\n<h3 class=\"wp-block-heading\">Kdy za\u010dne Azoran \u00fa\u010dinkovat?<\/h3>\n<p>Azathioprin p\u016fsob\u00ed pomalu. Klinick\u00fd \u00fa\u010dinek se projev\u00ed <strong>8\u201316 t\u00fddn\u016f<\/strong> b\u011bhem t\u00e9to induk\u010dn\u00ed f\u00e1ze obvykle z\u016fst\u00e1v\u00e1te na kortikosteroidech nebo jin\u00e9m rychle p\u016fsob\u00edc\u00edm l\u00e9ku pro kontrolu onemocn\u011bn\u00ed. Neo\u010dek\u00e1vejte, \u017ee se budete c\u00edtit l\u00e9pe b\u011bhem prvn\u00edch 4 t\u00fddn\u016f \u2014 a nep\u0159est\u00e1vejte u\u017e\u00edvat azathioprin, proto\u017ee se v\u00e1m zd\u00e1, \u017ee \u201cnefunguje\u201d b\u011bhem prvn\u00edho m\u011bs\u00edce.<\/p>\n<h3 class=\"wp-block-heading\">Pro\u010d je alopurinol v kombinaci s Azoranem tak nebezpe\u010dn\u00fd?<\/h3>\n<p>Alopurinol blokuje xanthinoxid\u00e1zu, jeden ze t\u0159\u00ed enzym\u016f, kter\u00e9 metabolizuj\u00ed 6-MP (aktivn\u00ed forma azathioprinu). P\u0159i blok\u00e1d\u011b xanthinoxid\u00e1zy je v\u00edce 6-MP p\u0159esm\u011brov\u00e1no do aktivn\u00ed cytotoxick\u00e9 dr\u00e1hy \u2014 hladiny prudce stoupaj\u00ed a m\u016f\u017ee n\u00e1sledovat z\u00e1va\u017en\u00e9 selh\u00e1n\u00ed kostn\u00ed d\u0159en\u011b b\u011bhem n\u011bkolika t\u00fddn\u016f. Pokud u\u017e\u00edv\u00e1te azathioprin a pot\u0159ebujete terapii sni\u017euj\u00edc\u00ed hladinu ur\u00e1t\u016f, bu\u010f (a) sni\u017ete d\u00e1vku azathioprinu na 25\u201333 % obvykl\u00e9 d\u00e1vky A sledujte CBC t\u00fddn\u011b, (b) p\u0159ejd\u011bte na l\u00e9k sni\u017euj\u00edc\u00ed hladinu ur\u00e1t\u016f, kter\u00fd neblokuje XO (lesinurad, probenecid), nebo (c) do\u010dasn\u011b p\u0159eru\u0161te u\u017e\u00edv\u00e1n\u00ed azathioprinu. Toto je nejnebezpe\u010dn\u011bj\u0161\u00ed interakce s azathioprinem.<\/p>\n<h3 class=\"wp-block-heading\">Jak\u00e9 krevn\u00ed testy pot\u0159ebuji p\u0159i u\u017e\u00edv\u00e1n\u00ed Azoranu?<\/h3>\n<p>Kompletn\u00ed krevn\u00ed obraz a jatern\u00ed testy v t\u00fddnech 1, 2, 4, 8, 12, pot\u00e9 ka\u017ed\u00e9 3 m\u011bs\u00edce neomezen\u011b dlouho. \u010cast\u011bj\u0161\u00ed kontroly (t\u00fddn\u011b po dobu 4 t\u00fddn\u016f) p\u0159i zah\u00e1jen\u00ed jak\u00e9hokoli nov\u00e9ho l\u00e9ku, zejm\u00e9na alopurinolu nebo kotrimoxazolu. Jak\u00fdkoli pokles WBC pod 3,0 \u00d7 10\u2079\/l nebo ANC pod 1,5, nebo jak\u00e9koli zv\u00fd\u0161en\u00ed ALT nad 3\u00d7 horn\u00ed hranici norm\u00e1lu vy\u017eaduje p\u0159ezkoum\u00e1n\u00ed l\u00e9ka\u0159em a obvykle sn\u00ed\u017een\u00ed d\u00e1vky nebo p\u0159eru\u0161en\u00ed l\u00e9\u010dby.<\/p>\n<h3 class=\"wp-block-heading\">Mohu ot\u011bhotn\u011bt p\u0159i u\u017e\u00edv\u00e1n\u00ed Azoranu?<\/h3>\n<p>Azathioprin je obecn\u011b pova\u017eov\u00e1n za kompatibiln\u00ed s t\u011bhotenstv\u00edm u mate\u0159sk\u00fdch autoimunitn\u00edch onemocn\u011bn\u00ed \u2014 l\u00e9k p\u0159ech\u00e1z\u00ed do plodu, ale j\u00e1tra ran\u00e9ho plodu postr\u00e1daj\u00ed enzymy pot\u0159ebn\u00e9 k jeho aktivaci na 6-TGN, tak\u017ee expozice plodu aktivn\u00ed form\u011b je omezen\u00e1. To se v\u00fdrazn\u011b li\u0161\u00ed od mykofenol\u00e1tu, kter\u00fd je siln\u011b teratogenn\u00ed a v t\u011bhotenstv\u00ed absolutn\u011b kontraindikov\u00e1n. Mnoho revmatolog\u016f, specialist\u016f na IBD a transplanta\u010dn\u00edch l\u00e9ka\u0159\u016f pokra\u010duje v pod\u00e1v\u00e1n\u00ed azathioprinu b\u011bhem t\u011bhotenstv\u00ed, proto\u017ee rizika nekontrolovan\u00e9ho mate\u0159sk\u00e9ho onemocn\u011bn\u00ed p\u0159eva\u017euj\u00ed nad riziky l\u00e9ku. Proberte to se sv\u00fdm specialistou alespo\u0148 3 m\u011bs\u00edce p\u0159ed pl\u00e1novan\u00fdm po\u010det\u00edm. \u00da\u010dinn\u00e1 antikoncepce nen\u00ed povinn\u00e1, ale spole\u010dn\u00e1 rozhodovac\u00ed praxe ano.<\/p>\n<h3 class=\"wp-block-heading\">Pro\u010d jsem n\u00e1chyln\u011bj\u0161\u00ed k infekc\u00edm a rakovin\u011b k\u016f\u017ee p\u0159i u\u017e\u00edv\u00e1n\u00ed Azoranu?<\/h3>\n<p>Azathioprin obecn\u011b potla\u010duje lymfocyty, tak\u017ee va\u0161e schopnost reagovat na bakteri\u00e1ln\u00ed, virov\u00e9 a pl\u00eds\u0148ov\u00e9 infekce je sn\u00ed\u017eena \u2014 zejm\u00e9na reaktivace herpes zoster. Tak\u00e9 specificky naru\u0161uje opravu DNA v UV po\u0161kozen\u00fdch ko\u017en\u00edch bu\u0148k\u00e1ch, co\u017e v\u00fdrazn\u011b zvy\u0161uje riziko spinocelul\u00e1rn\u00edho a bazocelul\u00e1rn\u00edho karcinomu k\u016f\u017ee (obvykle se objevuje po 5+ letech l\u00e9\u010dby). Denn\u00ed ochrana SPF 50, ochrann\u00e9 oble\u010den\u00ed proti slunci, vyh\u00fdb\u00e1n\u00ed se sol\u00e1ri\u00edm a ka\u017edoro\u010dn\u00ed dermatologick\u00e1 prohl\u00eddka toto riziko v\u00fdznamn\u011b sni\u017euj\u00ed.<\/p>\n<h3 class=\"wp-block-heading\">Co m\u00e1m d\u011blat, kdy\u017e p\u0159i u\u017e\u00edv\u00e1n\u00ed Azoranu dostanu silnou bolest v krku nebo hore\u010dku?<\/h3>\n<p>Okam\u017eit\u011b p\u0159esta\u0148te u\u017e\u00edvat Azoran a nechte si urgentn\u011b ud\u011blat kompletn\u00ed krevn\u00ed obraz. Nevysv\u011btliteln\u00e1 hore\u010dka, siln\u00e1 bolest v krku, afty, neobvykl\u00e9 mod\u0159iny, krv\u00e1cen\u00ed d\u00e1sn\u00ed nebo extr\u00e9mn\u00ed \u00fanava jsou varovn\u00e9 p\u0159\u00edznaky \u00fatlumu kostn\u00ed d\u0159en\u011b nebo z\u00e1va\u017en\u00e9 infekce. Kter\u00fdkoli z t\u011bchto p\u0159\u00edznak\u016f u pacienta u\u017e\u00edvaj\u00edc\u00edho azathioprin je pova\u017eov\u00e1n za nouzov\u00fd stav, dokud norm\u00e1ln\u00ed CBC neprok\u00e1\u017ee opak. Azathioprin obnovte pouze po konzultaci s p\u0159edepisuj\u00edc\u00edm l\u00e9ka\u0159em.<\/p>\n<h3 class=\"wp-block-heading\">Mohu dostat \u017eiv\u00e9 vakc\u00edny p\u0159i u\u017e\u00edv\u00e1n\u00ed Azoranu?<\/h3>\n<p>Ne. \u017div\u00e9 vakc\u00edny \u2014 MMR, varicella, \u017elut\u00e1 zimnice, BCG, \u017eiv\u00e1 vakc\u00edna proti p\u00e1sov\u00e9mu oparu Zostavax, \u017eiv\u00e1 nosn\u00ed ch\u0159ipka \u2014 jsou b\u011bhem l\u00e9\u010dby azathioprinem a po dobu 3 m\u011bs\u00edc\u016f po jeho ukon\u010den\u00ed kontraindikov\u00e1ny. Napl\u00e1nujte si v\u0161echny tyto vakc\u00edny p\u0159ed zah\u00e1jen\u00edm l\u00e9\u010dby. <strong>Neaktivovan\u00e9 vakc\u00edny jsou v po\u0159\u00e1dku a doporu\u010duj\u00ed se<\/strong>: ka\u017edoro\u010dn\u00ed o\u010dkov\u00e1n\u00ed proti ch\u0159ipce, pneumokokov\u00e9, COVID-19, rekombinantn\u00ed Shingrix, HPV. Rekombinantn\u00ed Shingrix (nikoli star\u0161\u00ed \u017eiv\u00fd Zostavax) je spr\u00e1vn\u00e1 vakc\u00edna proti p\u00e1sov\u00e9mu oparu pro osoby s imunosupresivn\u00ed l\u00e9\u010dbou.<\/p>\n<h3 class=\"wp-block-heading\">Jak dlouho budu u\u017e\u00edvat Azoran?<\/h3>\n<p>U v\u011bt\u0161iny autoimunitn\u00edch a z\u00e1n\u011btliv\u00fdch onemocn\u011bn\u00ed je azathioprin dlouhodobou udr\u017eovac\u00ed l\u00e9\u010dbou \u2014 \u010dasto 2\u201310 let, n\u011bkdy i neomezen\u011b, v z\u00e1vislosti na kontrole onemocn\u011bn\u00ed a alternativn\u00edch mo\u017enostech. U transplanta\u010dn\u00edch indikac\u00ed je to do\u017eivotn\u011b. V\u00e1\u0161 specialista bude pravideln\u011b p\u0159ezkoum\u00e1vat, zda je pokra\u010dov\u00e1n\u00ed st\u00e1le nutn\u00e9. Nikdy nep\u0159est\u00e1vejte u\u017e\u00edvat azathioprin n\u00e1hle bez konzultace s odborn\u00edkem \u2014 vzplanut\u00ed onemocn\u011bn\u00ed je \u010dast\u00e9 a m\u016f\u017ee b\u00fdt z\u00e1va\u017en\u00e9.<\/p>\n<h3 class=\"wp-block-heading\">Pro\u010d objedn\u00e1vat z MedsBase<\/h3>\n<p>Azoran je dod\u00e1v\u00e1n v\u00fdrobcem certifikovan\u00fdm WHO-GMP s plnou dokumentac\u00ed COA. Dod\u00e1v\u00e1me po cel\u00e9m sv\u011bt\u011b v nen\u00e1padn\u00e9m obalu a ka\u017ed\u00e1 objedn\u00e1vka je pokryta na\u0161\u00ed <a href=\"\/cs\/medsbase-re-shipment-assurance-policy\/\">Z\u00e1rukou op\u011btovn\u00e9ho odesl\u00e1n\u00ed<\/a>. V\u00e1\u0161 popis transakce p\u0159i platb\u011b kartou zobrazuje regulovan\u00e9ho zpracovatele plateb (regulovan\u00e9ho zpracovatele plateb kartou), nikdy \u201cMedsBase\u201d nebo n\u00e1zev l\u00e9ku.<\/p>\n<p><!-- medsbase-related-alts-v1 --><\/p>\n<h3 class=\"wp-block-heading\">Dal\u0161\u00ed protiz\u00e1n\u011btliv\u00e9 a autoimunitn\u00ed l\u00e9ky<\/h3>\n<p>Pokud Azoran nevyhovuje va\u0161\u00ed situaci, jsou v t\u00e9to kategorii k dispozici n\u00e1sleduj\u00edc\u00ed mo\u017enosti:<\/p>\n<ul>\n<li><a href=\"https:\/\/medsbase.com\/cs\/lefuheal\/\">Lefuheal (Leflunomid 10\/20 mg) \u2014 inhibitor synt\u00e9zy pyrimidin\u016f<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/conimune-me\/\">Conimune ME (Cyklosporin 25\/50\/100 mg) \u2014 inhibitor kalcineurinu<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/barinat\/\">Barinat (Baricitinib 2\/4 mg) \u2014 selektivn\u00ed inhibitor JAK1\/JAK2<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/tofe\/\">Tofe (Tofacitinib 5 mg) \u2014 pan-JAK inhibitor<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/wysolone\/\">Wysolone (Prednisolon 5\/10\/20 mg) \u2014 p\u0159echodn\u00e9 kortikosteroidy<\/a><\/li>\n<\/ul>","protected":false},"excerpt":{"rendered":"<p>\u2705 Modulace imunitn\u00edho syst\u00e9mu<br \/>\n\u2705 Sni\u017euje z\u00e1n\u011bt<br \/>\n\u2705 Zabr\u00e1n\u00ed odm\u00edtnut\u00ed org\u00e1nu<br \/>\n\u2705 L\u00e9\u010d\u00ed autoimunitn\u00ed onemocn\u011bn\u00ed<br \/>\n\u2705 Dlouhodob\u00e1 p\u00e9\u010de<\/p>\n<p>Azoran obsahuje azathioprin.<\/p>","protected":false},"featured_media":55738,"comment_status":"open","ping_status":"open","template":"","meta":[],"product_brand":[],"product_cat":[3897,3141,3223],"product_tag":[3973,3974],"class_list":{"0":"post-55737","1":"product","2":"type-product","3":"status-publish","4":"has-post-thumbnail","6":"product_cat-anti-inflammatory-autoimmune-care","7":"product_cat-category-overview","8":"product_cat-chronic-conditions","9":"product_tag-azathioprine","10":"product_tag-azoran","12":"first","13":"instock","14":"shipping-taxable","15":"purchasable","16":"product-type-variable","17":"has-default-attributes"},"acf":[],"_links":{"self":[{"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product\/55737","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=55737"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/media\/55738"}],"wp:attachment":[{"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/media?parent=55737"}],"wp:term":[{"taxonomy":"product_brand","embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_brand?post=55737"},{"taxonomy":"product_cat","embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_cat?post=55737"},{"taxonomy":"product_tag","embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_tag?post=55737"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}