{"id":55914,"date":"2024-02-07T05:45:25","date_gmt":"2024-02-07T05:45:25","guid":{"rendered":"https:\/\/medsname.com\/budez-cr\/"},"modified":"2026-04-30T10:24:42","modified_gmt":"2026-04-30T10:24:42","slug":"budez-cr","status":"publish","type":"product","link":"https:\/\/medsbase.com\/cs\/product\/budez-cr\/","title":{"rendered":"Budez CR"},"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 Budez CR?<\/h3>\n<p style=\"margin:0;\"><strong>Budez CR<\/strong> je <strong>kontrolovan\u011b uvol\u0148ovan\u00e1 peror\u00e1ln\u00ed tobolka<\/strong> od spole\u010dnosti Sun Pharma obsahuj\u00edc\u00ed <strong>budesonid 3 mg<\/strong> \u2014 siln\u00fd syntetick\u00fd <strong>glukokortikoid<\/strong> formulov\u00e1n s pH- a \u010dasov\u011b z\u00e1visl\u00fdm uvol\u0148ov\u00e1n\u00edm, kter\u00e9 dod\u00e1v\u00e1 \u00fa\u010dinnou l\u00e1tku p\u0159\u00edmo do termin\u00e1ln\u00edho ilea a vzestupn\u00e9ho tra\u010dn\u00edku. Budesonid m\u00e1 <strong>~90% metabolismus prvn\u00edho pr\u016fchodu j\u00e1try<\/strong>, tak\u017ee i p\u0159es to, \u017ee je na tk\u00e1\u0148ov\u00e9 \u00farovni siln\u00fdm glukokortikoidem, je jeho <strong>syst\u00e9mov\u00e1 expozice ~10% ve srovn\u00e1n\u00ed s ekvivalentn\u00ed protiz\u00e1n\u011btlivou d\u00e1vkou prednisolonu<\/strong> \u2014 co\u017e vede k m\u00e9n\u011b Cushingoidn\u00edm p\u0159\u00edznak\u016fm, men\u0161\u00edmu potla\u010den\u00ed osy HPA a men\u0161\u00ed ztr\u00e1t\u011b kostn\u00ed hmoty. Pou\u017e\u00edv\u00e1 se u <strong>m\u00edrn\u00e9 a\u017e st\u0159edn\u011b aktivn\u00ed Crohnovy choroby<\/strong> postihuj\u00edc\u00ed termin\u00e1ln\u00ed ileum nebo vzestupn\u00fd tra\u010dn\u00edk, <strong>mikroskopick\u00e9 kolitidy<\/strong> (kolagen\u00f3zn\u00ed a lymfocyt\u00e1rn\u00ed) a off-label u <strong>autoimunitn\u00ed hepatitidy<\/strong>. Standardn\u00ed d\u00e1vka pro dosp\u011bl\u00e9: <strong>9 mg jednou denn\u011b r\u00e1no po dobu 8\u201310 t\u00fddn\u016f<\/strong>, pot\u00e9 postupn\u011b sni\u017eovat d\u00e1vku. Syst\u00e9mov\u00e9 ne\u017e\u00e1douc\u00ed \u00fa\u010dinky steroid\u016f se st\u00e1le vyskytuj\u00ed \u2014 zejm\u00e9na p\u0159i dlouhodob\u00e9m u\u017e\u00edv\u00e1n\u00ed, zv\u00fd\u0161en\u00ed d\u00e1vky nebo p\u0159i sou\u010dasn\u00e9m pod\u00e1v\u00e1n\u00ed siln\u00fdch inhibitor\u016f CYP3A4 (nap\u0159. ketokonazol, ritonavir, klarithromycin, grapefruitov\u00fd d\u017eus).<\/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>\u26a0\ufe0f L\u00e9k pod dohledem specialisty.<\/strong> Budesonid CR je lok\u00e1ln\u011b p\u016fsob\u00edc\u00ed glukokortikoid \u2014 syst\u00e9mov\u011b bezpe\u010dn\u011bj\u0161\u00ed ne\u017e prednisolon, ale st\u00e1le se jedn\u00e1 o steroid. Pou\u017e\u00edvejte pouze pod dohledem gastroenterologa: l\u00e9\u010dba je \u010dasov\u011b omezen\u00e1 (obvykle 8\u201310 t\u00fddn\u016f), po v\u00edce ne\u017e 2 t\u00fddnech u\u017e\u00edv\u00e1n\u00ed nep\u0159eru\u0161ujte n\u00e1hle (je nutn\u00e1 obnova osy HPA) a vyhn\u011bte se sou\u010dasn\u00e9mu pod\u00e1v\u00e1n\u00ed siln\u00fdch inhibitor\u016f CYP3A4 (ketokonazol, ritonavir, klarithromycin, grapefruitov\u00fd d\u017eus), kter\u00e9 mohou zv\u00fd\u0161it syst\u00e9movou expozici 4\u20138kr\u00e1t. M\u00edrn\u00e1 a\u017e st\u0159edn\u011b t\u011b\u017ek\u00e1 ile\u00e1ln\u00ed\/pravostrann\u00e1 Crohnova choroba a mikroskopick\u00e1 kolitida jsou ov\u011b\u0159en\u00e9 indikace.<\/div>\n<div class=\"medsbase-trust-strip\" style=\"background:#f5f6f8;border:1px solid #e1e4e8;border-radius:6px;padding:14px 18px;margin:24px 0;font-size:14px;\"><strong>Pro\u010d objedn\u00e1vat z MedsBase:<\/strong> \u2714 <strong>v\u00fdrobce certifikovan\u00e9ho WHO-GMP<\/strong> \u2714 Diskr\u00e9tn\u00ed balen\u00ed \u2714 Celosv\u011btov\u00e1 doprava \u2714 <a href=\"https:\/\/medsbase.com\/cs\/reviews\/\">Ov\u011b\u0159en\u00e9 recenze z\u00e1kazn\u00edk\u016f (1 400+ z\u00e1kazn\u00edk\u016f)<\/a><\/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 Budez CR?<\/h2>\n<p>Budez CR je <strong>kontrolovan\u011b uvol\u0148ovan\u00e1 (CR) peror\u00e1ln\u00ed tobolka<\/strong> vyr\u00e1b\u011bn\u00e1 spole\u010dnost\u00ed Sun Pharma obsahuj\u00edc\u00ed <strong>budesonid 3 mg<\/strong>. Budesonid je glukokortikoid druh\u00e9 generace, kter\u00fd je p\u0159ibli\u017en\u011b 15\u00d7 \u00fa\u010dinn\u011bj\u0161\u00ed ne\u017e hydrokortizon a 5\u00d7 \u00fa\u010dinn\u011bj\u0161\u00ed ne\u017e prednisolon <em>na tk\u00e1\u0148ov\u00e9 \u00farovni<\/em> \u2014 ale jedine\u010dn\u00e9 je, \u017ee asi 90% absorbovan\u00e9ho l\u00e9\u010diva je inaktivov\u00e1no p\u0159i prvn\u00edm pr\u016fchodu j\u00e1try.<\/p>\n<p>Budez CR je generick\u00fd ekvivalent spole\u010dnosti Sun Pharma k p\u0159\u00edpravk\u016fm Entocort EC \/ Uceris \u2014 kontrolovan\u011b uvol\u0148ovan\u00e1 peror\u00e1ln\u00ed tobolka budesonidu, kter\u00e1 je navr\u017eena tak, aby uvol\u0148ovala aktivn\u00ed l\u00e9\u010divo v termin\u00e1ln\u00edm ileu a vzestupn\u00e9m tra\u010dn\u00edku. Na tomto webu je to jedin\u00fd st\u0159evn\u011b c\u00edlen\u00fd kortikosteroid, kter\u00fd m\u00e1me skladem, a je preferovan\u00fdm kortikosteroidem prvn\u00ed volby pro ileocek\u00e1ln\u00ed Crohnovu chorobu a mikroskopickou kolitidu. CR povlak je navr\u017een tak, aby se rozpou\u0161t\u011bl p\u0159i pH &gt; 5,5 (termin\u00e1ln\u00ed ileum a prav\u00fd tra\u010dn\u00edk) sp\u00ed\u0161e ne\u017e v \u017ealudku nebo dvan\u00e1ctn\u00edku, tak\u017ee l\u00e9\u010divo je uvol\u0148ov\u00e1no p\u0159esn\u011b tam, kde je z\u00e1n\u011bt nej\u010dast\u011bji aktivn\u00ed u ileocek\u00e1ln\u00ed Crohnovy choroby a mikroskopick\u00e9 kolitidy. Toto tk\u00e1\u0148ov\u011b c\u00edlen\u00e9 pod\u00e1n\u00ed plus t\u00e9m\u011b\u0159 \u00fapln\u00fd jatern\u00ed prvopr\u016fchodov\u00fd metabolismus je to, co d\u011bl\u00e1 Budez CR <strong>preferovan\u00fdm kortikosteroidem<\/strong> pro gastroenterology l\u00e9\u010d\u00edc\u00ed ileocek\u00e1ln\u00ed Crohnovu chorobu v roce 2026 \u2014 dosahuje podobn\u00fdch remisn\u00edch v\u00fdsledk\u016f jako prednisolon u t\u00e9to podskupiny s p\u0159ibli\u017en\u011b polovi\u010dn\u00ed syst\u00e9movou z\u00e1t\u011b\u017e\u00ed vedlej\u0161\u00edch \u00fa\u010dink\u016f steroid\u016f.<\/p>\n<h2 class=\"wp-block-heading\">Jak Budez CR funguje?<\/h2>\n<p>Budez CR dosahuje st\u0159evn\u011b selektivn\u00edho protiz\u00e1n\u011btliv\u00e9ho \u00fa\u010dinku t\u0159emi mechanismy:<\/p>\n<ul>\n<li><strong>C\u00edlen\u00e9 uvol\u0148ov\u00e1n\u00ed ve st\u0159ev\u011b<\/strong> \u2014 tobolka CR vyu\u017e\u00edv\u00e1 pH-dependentn\u00ed kopolymer kyseliny methakrylov\u00e9, kter\u00fd z\u016fst\u00e1v\u00e1 neporu\u0161en\u00fd v \u017ealudku a proxim\u00e1ln\u00edm tenk\u00e9m st\u0159ev\u011b, pot\u00e9 se rozpou\u0161t\u00ed p\u0159i pH 5,5 a vy\u0161\u0161\u00edm v dist\u00e1ln\u00edm tenk\u00e9m st\u0159ev\u011b a proxim\u00e1ln\u00edm tra\u010dn\u00edku. Vrcholov\u00e1 lok\u00e1ln\u00ed koncentrace je v termin\u00e1ln\u00edm ileu a vzestupn\u00e9m tra\u010dn\u00edku \u2014 p\u0159esn\u011b v m\u00edstech posti\u017een\u00ed u ileocek\u00e1ln\u00ed Crohnovy choroby a mnoha p\u0159\u00edpad\u016f mikroskopick\u00e9 kolitidy.<\/li>\n<li><strong>Vysok\u00fd jatern\u00ed first-pass metabolismus (~90 %)<\/strong> \u2014 absorbovan\u00fd budesonid je rychle metabolizov\u00e1n CYP3A4 v j\u00e1trech na dva neaktivn\u00ed metabolity (6\u03b2-hydroxy-budesonid a 16\u03b1-hydroxy-prednisolon). Pouze ~10 % absorbovan\u00e9 d\u00e1vky se dost\u00e1v\u00e1 do syst\u00e9mov\u00e9ho ob\u011bhu, co\u017e vede k v\u00fdrazn\u011b ni\u017e\u0161\u00ed syst\u00e9mov\u00e9 steroidn\u00ed z\u00e1t\u011b\u017ei ne\u017e u ekvivalentn\u00ed protiz\u00e1n\u011btliv\u00e9 d\u00e1vky prednisolonu.<\/li>\n<li><strong>Standardn\u00ed p\u016fsoben\u00ed na glukokortikoidn\u00ed receptory v c\u00edlov\u00e9 tk\u00e1ni<\/strong> \u2014 ve st\u0159evn\u00ed sliznici budesonid v\u00e1\u017ee intracelul\u00e1rn\u00ed glukokortikoidn\u00ed receptory, potla\u010duje transkrip\u010dn\u00ed faktory NF-\u03baB a AP-1, sni\u017euje proz\u00e1n\u011btliv\u00e9 cytokiny (TNF-\u03b1, IL-1, IL-6, IL-8), inhibuje migraci leukocyt\u016f do sliznice a stabilizuje funkci epiteli\u00e1ln\u00ed bari\u00e9ry.<\/li>\n<\/ul>\n<p>Klinick\u00fd n\u00e1stup \u00fa\u010dinku: symptomatick\u00e9 zlep\u0161en\u00ed za 2\u20134 t\u00fddny; m\u00edra steroid-free remise je srovnateln\u00e1 s konven\u010dn\u00edm prednisolonem (studie zalo\u017een\u00e9 na CDAI, Campieri 1997, Thomsen 1998) u ileocek\u00e1ln\u00ed podskupiny Crohnovy choroby.<\/p>\n<h2 class=\"wp-block-heading\">Pou\u017eit\u00ed a indikace<\/h2>\n<ul>\n<li><strong>Lehk\u00e1 a\u017e st\u0159edn\u011b t\u011b\u017ek\u00e1 aktivn\u00ed Crohnova choroba<\/strong> postihuj\u00edc\u00ed <strong>termin\u00e1ln\u00ed ileum a\/nebo vzestupn\u00fd tra\u010dn\u00edk<\/strong> \u2014 kortikosteroid prvn\u00ed volby pro tuto anatomickou distribuci. M\u00e9n\u011b \u00fa\u010dinn\u00fd u proxim\u00e1ln\u00edho tenk\u00e9ho st\u0159eva nebo rozs\u00e1hl\u00e9ho posti\u017een\u00ed tra\u010dn\u00edku u Crohnovy choroby.<\/li>\n<li><strong>Mikroskopick\u00e1 kolitida<\/strong> \u2014 jak kolagen\u00f3zn\u00ed, tak lymfocyt\u00e1rn\u00ed kolitida. L\u00e9\u010dba prvn\u00ed volby; ~80 % klinick\u00fdch remis\u00ed do 6\u20138 t\u00fddn\u016f. Po indukci je \u010dasto nutn\u00e1 udr\u017eovac\u00ed l\u00e9\u010dba ni\u017e\u0161\u00ed d\u00e1vkou (3\u20136 mg\/den) k prevenci relapsu.<\/li>\n<li><strong>Autoimunitn\u00ed hepatitida<\/strong> (mimo schv\u00e1len\u00e9 indikace) \u2014 jako alternativa k prednisolonu u necirhotick\u00fdch pacient\u016f, kde ~90 % first-pass metabolismu poskytuje v\u011bt\u0161inu protiz\u00e1n\u011btliv\u00e9ho \u00fa\u010dinku v j\u00e1trech bez syst\u00e9mov\u00fdch steroidn\u00edch ne\u017e\u00e1douc\u00edch \u00fa\u010dink\u016f. Kontraindikov\u00e1no u cirh\u00f3zy, proto\u017ee portosyst\u00e9mov\u00e9 zkraty obch\u00e1zej\u00ed first-pass metabolismus.<\/li>\n<li><strong>Eosinofiln\u00ed ezofagitida<\/strong> (mimo indikaci, preferuje se or\u00e1ln\u011b dispergovateln\u00fd budesonid) \u2014 nikoli CR formulace.<\/li>\n<li><strong>Udr\u017eov\u00e1n\u00ed remise u Crohnovy choroby<\/strong> \u2014 6 mg\/den po dobu 3\u201312 m\u011bs\u00edc\u016f se n\u011bkdy pou\u017e\u00edv\u00e1, a\u010dkoli d\u016fkazy pro dlouhodob\u00e9 udr\u017eov\u00e1n\u00ed jsou omezen\u00e9.<\/li>\n<\/ul>\n<p>Budez CR je <strong>ne<\/strong> indikov\u00e1n pro: t\u011b\u017ekou Crohnovu chorobu, rozs\u00e1hlou ulcer\u00f3zn\u00ed kolitidu (pou\u017eijte prednisolon nebo 5-ASA), Crohnovu chorobu omezenou na \u017ealudek nebo proxim\u00e1ln\u00ed tenk\u00e9 st\u0159evo, perian\u00e1ln\u00ed Crohnovu chorobu (vy\u017eaduje syst\u00e9movou terapii), nebo pro obecn\u00e9 protiz\u00e1n\u011btliv\u00e9 pou\u017eit\u00ed (astma, revmatoidn\u00ed artritida, dermatologie \u2014 pou\u017eijte jin\u00e9 steroidn\u00ed formulace).<\/p>\n<h2 class=\"wp-block-heading\">D\u00e1vkov\u00e1n\u00ed Budez CR a zp\u016fsob u\u017e\u00edv\u00e1n\u00ed<\/h2>\n<p>Budez CR je dod\u00e1v\u00e1n v <strong>3 mg<\/strong> kontrolovan\u00e9m uvol\u0148ov\u00e1n\u00ed per kapsle.<\/p>\n<ul>\n<li><strong>Indukce u aktivn\u00ed Crohnovy choroby:<\/strong> 9 mg (3 kapsle) jednou denn\u011b r\u00e1no po dobu 8\u201310 t\u00fddn\u016f.<\/li>\n<li><strong>Postupn\u00e9 sni\u017eov\u00e1n\u00ed d\u00e1vky:<\/strong> sni\u017ete na 6 mg denn\u011b po dobu 2 t\u00fddn\u016f, pot\u00e9 3 mg denn\u011b po dobu 2 t\u00fddn\u016f, pot\u00e9 ukon\u010dete. N\u00e1hl\u00e9 ukon\u010den\u00ed po 8+ t\u00fddnech p\u0159i 9 mg\/den m\u016f\u017ee odhalit supresi HPA osy.<\/li>\n<li><strong>Indukce u mikroskopick\u00e9 kolitidy:<\/strong> 9 mg jednou denn\u011b po dobu 6\u20138 t\u00fddn\u016f; postupn\u011b sni\u017eujte d\u00e1vku.<\/li>\n<li><strong>\u00dadr\u017eba mikroskopick\u00e9 kolitidy:<\/strong> 3\u20136 mg jednou denn\u011b (\u010dasto celo\u017eivotn\u011b u chronick\u00fdch relaps\u016f).<\/li>\n<li><strong>\u00dadr\u017eba Crohnovy choroby (p\u0159i pou\u017eit\u00ed):<\/strong> 6 mg jednou denn\u011b po dobu 3\u201312 m\u011bs\u00edc\u016f; pokud mo\u017eno omezit pou\u017eit\u00ed nad 12 m\u011bs\u00edc\u016f.<\/li>\n<li><strong>Autoimunitn\u00ed hepatitida (mimo indikaci):<\/strong> 9 mg\/den pro indukci, sn\u00ed\u017eit na 3\u20136 mg\/den; pouze pod odborn\u00fdm dohledem; NEPOU\u017d\u00cdVAT u pacient\u016f s cirh\u00f3zou.<\/li>\n<li><strong>Porucha funkce ledvin:<\/strong> bez \u00fapravy d\u00e1vky.<\/li>\n<li><strong>Porucha funkce jater:<\/strong> pou\u017e\u00edvat opatrn\u011b; metabolismus prvn\u00edho pr\u016fchodu je naru\u0161en, tak\u017ee syst\u00e9mov\u00e1 expozice v\u00fdrazn\u011b stoup\u00e1. Vyvarujte se u t\u011b\u017ek\u00e9ho jatern\u00edho onemocn\u011bn\u00ed\/cirh\u00f3zy.<\/li>\n<\/ul>\n<h3 class=\"wp-block-heading\">Jak spr\u00e1vn\u011b u\u017e\u00edvat Budez CR<\/h3>\n<ol>\n<li><strong>Polykejte cel\u00e9 s sklenic\u00ed vody r\u00e1no.<\/strong> Nerozma\u010dk\u00e1vejte, ne\u017ev\u00fdkejte ani neotev\u00edrejte tobolky \u2014 rozdrcen\u00ed zni\u010d\u00ed kontrolovan\u011b uvol\u0148uj\u00edc\u00ed povlak, co\u017e by uvolnilo l\u00e9\u010divo v \u017ealudku a v\u00fdrazn\u011b sn\u00ed\u017eilo jeho selektivn\u00ed \u00fa\u010dinek ve st\u0159ev\u011b, zat\u00edmco by zv\u00fd\u0161ilo syst\u00e9movou absorpci.<\/li>\n<li><strong>U\u017e\u00edvejte nejm\u00e9n\u011b 30 minut p\u0159ed sn\u00eddan\u00ed.<\/strong> Rann\u00ed d\u00e1vkov\u00e1n\u00ed napodobuje fyziologick\u00fd rytmus kortizolu a minimalizuje potla\u010den\u00ed osy HPA.<\/li>\n<li><strong>B\u011bhem l\u00e9\u010dby se zcela vyhn\u011bte grapefruitu a grapefruitov\u00e9 \u0161\u0165\u00e1v\u011b.<\/strong> Grapefruit inhibuje st\u0159evn\u00ed CYP3A4, co\u017e zvy\u0161uje syst\u00e9mov\u00e9 hladiny budesonidu p\u0159ibli\u017en\u011b 2\u20133\u00d7 a dramaticky zvy\u0161uje syst\u00e9mov\u00e9 ne\u017e\u00e1douc\u00ed \u00fa\u010dinky steroid\u016f.<\/li>\n<li><strong>Po 8 t\u00fddnech nebo d\u00e9le u\u017e\u00edv\u00e1n\u00ed 9 mg\/den nep\u0159est\u00e1vejte n\u00e1hle.<\/strong> A\u010dkoli je syst\u00e9mov\u00e1 expozice ni\u017e\u0161\u00ed ne\u017e u prednisolonu, m\u016f\u017ee st\u00e1le doj\u00edt k potla\u010den\u00ed osy HPA. Postupn\u011b sni\u017eujte d\u00e1vku, jak je pops\u00e1no v\u00fd\u0161e.<\/li>\n<li><strong>M\u011bjte u sebe steroidn\u00ed kartu<\/strong> Pokud u\u017e\u00edv\u00e1te l\u00e9k d\u00e9le ne\u017e 8 t\u00fddn\u016f, informujte anesteziology, l\u00e9ka\u0159e pohotovostn\u00ed p\u00e9\u010de a ka\u017ed\u00e9ho nov\u00e9ho p\u0159edepisuj\u00edc\u00edho l\u00e9ka\u0159e o sou\u010dasn\u00e9m u\u017e\u00edv\u00e1n\u00ed budesonidu \u2014 b\u011bhem v\u011bt\u0161\u00edch operac\u00ed nebo v\u00e1\u017en\u00fdch onemocn\u011bn\u00ed m\u016f\u017ee b\u00fdt nutn\u00e1 stresov\u00e1 d\u00e1vka steroid\u016f.<\/li>\n<li><strong>Ochrana kost\u00ed<\/strong> P\u0159i l\u00e9\u010db\u011b del\u0161\u00ed ne\u017e 3 m\u011bs\u00edce je vhodn\u00e9 dopl\u0148ovat v\u00e1pn\u00edk a vitamin D. Riziko \u00fabytku kostn\u00ed hmoty je v\u00fdrazn\u011b ni\u017e\u0161\u00ed ne\u017e u prednisolonu, ale nen\u00ed nulov\u00e9; zva\u017ete DEXA vy\u0161et\u0159en\u00ed po 12 m\u011bs\u00edc\u00edch nep\u0159etr\u017eit\u00e9ho u\u017e\u00edv\u00e1n\u00ed.<\/li>\n<li><strong>Pravideln\u011b sledujte syst\u00e9mov\u00e9 ne\u017e\u00e1douc\u00ed \u00fa\u010dinky steroid\u016f<\/strong> p\u0159i ka\u017ed\u00e9 kontrole \u2014 p\u0159ib\u00fdv\u00e1n\u00ed na v\u00e1ze, otoky obli\u010deje, zm\u011bny n\u00e1lady, akn\u00e9, zv\u00fd\u0161en\u00e1 hladina gluk\u00f3zy v krvi, rozmazan\u00e9 vid\u011bn\u00ed (p\u0159i dlouhodob\u00e9m u\u017e\u00edv\u00e1n\u00ed mo\u017en\u00fd \u0161ed\u00fd z\u00e1kal\/glaukom).<\/li>\n<li><strong>Okam\u017eit\u011b nahlaste jakoukoli novou hore\u010dku, produktivn\u00ed ka\u0161el nebo nehoj\u00edc\u00ed se ko\u017en\u00ed l\u00e9zi<\/strong> \u2014 imunosuprese vyvolan\u00e1 steroidy je re\u00e1ln\u00e1 i p\u0159i u\u017e\u00edv\u00e1n\u00ed budesonidu.<\/li>\n<li><strong>Vyhn\u011bte se \u017eiv\u00fdm vakc\u00edn\u00e1m<\/strong> b\u011bhem induk\u010dn\u00ed f\u00e1ze 9 mg\/den. P\u0159i udr\u017eovac\u00ed d\u00e1vce 3\u20136 mg\/den jsou \u017eiv\u00e9 vakc\u00edny obvykle p\u0159ijateln\u00e9, ale konzultujte s p\u0159edepisuj\u00edc\u00edm l\u00e9ka\u0159em. Inaktivovan\u00e9 vakc\u00edny (ka\u017edoro\u010dn\u00ed ch\u0159ipka, pneumokokov\u00e1, COVID-19, Shingrix) jsou v po\u0159\u00e1dku a doporu\u010den\u00e9.<\/li>\n<li><strong>Nekombinovat se syst\u00e9mov\u00fdmi kortikosteroidy<\/strong> (nap\u0159. peror\u00e1ln\u00ed prednisolon) krom\u011b p\u0159\u00edpad\u016f pod odborn\u00fdm dohledem \u2014 syst\u00e9mov\u00e9 ne\u017e\u00e1douc\u00ed \u00fa\u010dinky se pak s\u010d\u00edtaj\u00ed.<\/li>\n<\/ol>\n<h2 class=\"wp-block-heading\">Ne\u017e\u00e1douc\u00ed \u00fa\u010dinky Budez CR<\/h2>\n<p>Syst\u00e9mov\u00e9 ne\u017e\u00e1douc\u00ed \u00fa\u010dinky steroid\u016f se vyskytuj\u00ed, ale jsou v\u00fdrazn\u011b m\u00e9n\u011b \u010dast\u00e9 a m\u00e9n\u011b z\u00e1va\u017en\u00e9 ne\u017e u ekvivalentn\u00edch protiz\u00e1n\u011btliv\u00fdch d\u00e1vek prednisolonu. P\u0159\u00edm\u00e9 srovn\u00e1vac\u00ed studie ukazuj\u00ed p\u0159ibli\u017en\u011b 50% syst\u00e9mov\u00e9 z\u00e1t\u011b\u017ee ne\u017e\u00e1douc\u00edch \u00fa\u010dink\u016f oproti konven\u010dn\u00edm steroid\u016fm.<\/p>\n<p><strong>\u010cast\u00e9:<\/strong><\/p>\n<ul>\n<li>Bolest hlavy<\/li>\n<li>Nevolnost<\/li>\n<li>\u00danava<\/li>\n<li>Dyspepsie<\/li>\n<li>M\u00edrn\u00e9 otoky obli\u010deje (\u201cm\u011bs\u00ed\u010dn\u00ed obli\u010dej\u201d) u men\u0161iny pacient\u016f, obvykle m\u00e9n\u011b v\u00fdrazn\u00e9 ne\u017e u prednisolonu<\/li>\n<li>Akn\u00e9<\/li>\n<li>Zm\u011bny n\u00e1lady (m\u00edrn\u00e9 povzbuzen\u00ed, ob\u010das nespavost)<\/li>\n<li>M\u00edrn\u00fd p\u0159\u00edr\u016fstek hmotnosti<\/li>\n<li>M\u00edrn\u00e9 zv\u00fd\u0161en\u00ed hladiny gluk\u00f3zy (m\u00e9n\u011b ne\u017e u prednisolonu)<\/li>\n<\/ul>\n<p><strong>M\u00e9n\u011b \u010dast\u00e9, ale d\u016fle\u017eit\u00e9:<\/strong><\/p>\n<ul>\n<li>Potla\u010den\u00ed osy HPA p\u0159i dlouhodob\u00e9m pod\u00e1v\u00e1n\u00ed 9 mg\/den<\/li>\n<li>Zv\u00fd\u0161en\u00fd krevn\u00ed tlak (m\u00e9n\u011b ne\u017e u prednisolonu)<\/li>\n<li>Zv\u00fd\u0161en\u00e1 n\u00e1chylnost k infekc\u00edm (kandid\u00f3za, infekce horn\u00edch cest d\u00fdchac\u00edch, ob\u010das oportunn\u00ed infekce)<\/li>\n<li>\u0160ed\u00fd z\u00e1kal, zadn\u00ed subkapsul\u00e1rn\u00ed (dlouhodob\u00e9 u\u017e\u00edv\u00e1n\u00ed)<\/li>\n<li>Zv\u00fd\u0161en\u00fd nitroo\u010dn\u00ed tlak a glaukom<\/li>\n<li>\u00dabytek kostn\u00ed hmoty (m\u00e9n\u011b ne\u017e u prednisolonu, ale m\u011b\u0159iteln\u00fd)<\/li>\n<li>Svalov\u00e1 slabost (steroidn\u00ed myopatie, vz\u00e1cn\u00e1 p\u0159i d\u00e1vk\u00e1ch budesonidu)<\/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>Adren\u00e1ln\u00ed krize b\u011bhem\/po vysazen\u00ed (hypotenze, t\u011b\u017ek\u00e1 slabost, nevolnost, zmatenost)<\/li>\n<li>Z\u00e1va\u017en\u00e1 infekce (zejm\u00e9na p\u0159i dlouhodob\u00e9m u\u017e\u00edv\u00e1n\u00ed)<\/li>\n<li>Z\u00e1va\u017en\u00e1 psychiatrick\u00e1 reakce<\/li>\n<li>N\u00e1hl\u00e1 zm\u011bna zraku<\/li>\n<li>Bolest ky\u010dle nebo kolena (mo\u017en\u00e1 avaskul\u00e1rn\u00ed nekr\u00f3za, vz\u00e1cn\u00e1)<\/li>\n<li>Anafylaxe na pomocn\u00e9 l\u00e1tky v kapsl\u00edch (velmi vz\u00e1cn\u00e1)<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Varov\u00e1n\u00ed a opat\u0159en\u00ed<\/h2>\n<ul>\n<li><strong>Aktivn\u00ed nel\u00e9\u010den\u00e1 infekce<\/strong> \u2014 neza\u010d\u00ednejte. Budesonid maskuje p\u0159\u00edznaky infekce m\u00e9n\u011b ne\u017e syst\u00e9mov\u00e9 steroidy, ale st\u00e1le v\u00fdznamn\u011b.<\/li>\n<li><strong>Latentn\u00ed TBC nebo hepatitida B<\/strong> \u2014 prov\u00e9st screening p\u0159ed zah\u00e1jen\u00edm dlouhodob\u00e9 imunosupresivn\u00ed l\u00e9\u010dby. M\u00e9n\u011b kritick\u00e9 ne\u017e u biologik nebo inhibitor\u016f JAK, ale st\u00e1le indikov\u00e1no p\u0159i u\u017e\u00edv\u00e1n\u00ed d\u00e9le ne\u017e 3 m\u011bs\u00edce.<\/li>\n<li><strong>Cirh\u00f3za \/ t\u011b\u017ek\u00e9 jatern\u00ed po\u0161kozen\u00ed<\/strong> \u2014 pou\u017e\u00edvat s opatrnost\u00ed nebo se vyvarovat. Portosyst\u00e9mov\u00e9 zkraty obch\u00e1zej\u00ed metabolismus prvn\u00edho pr\u016fchodu, co\u017e dramaticky zvy\u0161uje syst\u00e9movou expozici.<\/li>\n<li><strong>Diabetes<\/strong> \u2014 o\u010dek\u00e1vejte m\u00edrn\u00e9 zv\u00fd\u0161en\u00ed hladiny gluk\u00f3zy v krvi; podle pot\u0159eby upravte d\u00e1vkov\u00e1n\u00ed peror\u00e1ln\u00edch hypoglykemik nebo inzul\u00ednu (m\u00e9n\u011b agresivn\u00ed \u00faprava ne\u017e u prednisolonu).<\/li>\n<li><strong>Hypertenze, srde\u010dn\u00ed selh\u00e1n\u00ed<\/strong> \u2014 monitorujte krevn\u00ed tlak; men\u0161\u00ed retence tekutin ne\u017e u prednisolonu, ale ne zanedbateln\u00e1.<\/li>\n<li><strong>T\u011bhotenstv\u00ed a kojen\u00ed<\/strong> \u2014 budesonid je pova\u017eov\u00e1n za jeden z preferovan\u00fdch kortikosteroid\u016f v t\u011bhotenstv\u00ed u IBD d\u00edky sv\u00e9 n\u00edzk\u00e9 syst\u00e9mov\u00e9 biologick\u00e9 dostupnosti. Pokra\u010dov\u00e1n\u00ed nebo zah\u00e1jen\u00ed l\u00e9\u010dby v t\u011bhotenstv\u00ed je \u010dasto vhodn\u00e9 p\u0159i aktivn\u00edm onemocn\u011bn\u00ed; rozhodnut\u00ed specialisty. Kompatibiln\u00ed s kojen\u00edm (minim\u00e1ln\u00ed p\u0159estup do ml\u00e9ka).<\/li>\n<li><strong>Riziko osteopor\u00f3zy<\/strong> \u2014 ni\u017e\u0161\u00ed ne\u017e u prednisolonu. P\u0159i dlouhodob\u00e9 l\u00e9\u010db\u011b (&gt; 3 m\u011bs\u00edce) je vhodn\u00e9 doplnit v\u00e1pn\u00edk a vitamin D; DEXA po 12 m\u011bs\u00edc\u00edch.<\/li>\n<li><strong>D\u011bti<\/strong> \u2014 budesonid CR se pou\u017e\u00edv\u00e1 u d\u011btsk\u00fdch IBD s odpov\u00eddaj\u00edc\u00ed \u00fapravou d\u00e1vkov\u00e1n\u00ed; sledujte r\u016fst.<\/li>\n<li><strong>Anestezie \/ velk\u00fd chirurgick\u00fd v\u00fdkon \/ t\u011b\u017ek\u00e9 onemocn\u011bn\u00ed<\/strong> \u2014 m\u016f\u017ee b\u00fdt nutn\u00e9 pod\u00e1n\u00ed stresov\u00fdch d\u00e1vek hydrokortizonu p\u0159i dlouhodob\u00e9 l\u00e9\u010db\u011b. Informujte anesteziology a l\u00e9ka\u0159e urgentn\u00ed p\u00e9\u010de o u\u017e\u00edv\u00e1n\u00ed budesonidu.<\/li>\n<li><strong>\u017div\u00e9 vakc\u00edny<\/strong> \u2014 vyvarujte se p\u0159i induk\u010dn\u00edch d\u00e1vk\u00e1ch 9 mg\/den; obvykle p\u0159ijateln\u00e9 p\u0159i udr\u017eovac\u00edch d\u00e1vk\u00e1ch 3\u20136 mg\/den, ale konzultujte s p\u0159edepisuj\u00edc\u00edm l\u00e9ka\u0159em. Inaktivovan\u00e9 vakc\u00edny jsou v po\u0159\u00e1dku.<\/li>\n<li><strong>Grapefruit, siln\u00e9 inhibitory CYP3A4<\/strong> \u2014 dramaticky zvy\u0161uj\u00ed syst\u00e9mov\u00e9 hladiny budesonidu. Pokud mo\u017eno se kombinaci vyhn\u011bte; pokud je nevyhnuteln\u00e1, sni\u017ete d\u00e1vku na polovinu a monitorujte.<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Kontraindikace \u2014 Kdo by NEM\u011aL u\u017e\u00edvat Budez CR<\/h2>\n<ul>\n<li>Zn\u00e1m\u00e1 p\u0159ecitliv\u011blost na budesonid nebo jakoukoli pomocnou l\u00e1tku tobolky<\/li>\n<li>Aktivn\u00ed syst\u00e9mov\u00e1 pl\u00eds\u0148ov\u00e1 infekce (bez antimykotick\u00e9 l\u00e9\u010dby)<\/li>\n<li>Nel\u00e9\u010den\u00e1 aktivn\u00ed TBC, hepatitida B nebo jin\u00e1 z\u00e1va\u017en\u00e1 infekce<\/li>\n<li>Cirh\u00f3za (pro indikaci autoimunitn\u00ed hepatitidy; u IBD indikac\u00ed zv\u00e1\u017eit p\u0159i pokro\u010dil\u00e9 cirh\u00f3ze)<\/li>\n<li>T\u011b\u017ek\u00e1 nekontrolovan\u00e1 cukrovka, hypertenze, srde\u010dn\u00ed selh\u00e1n\u00ed nebo psychiatrick\u00e9 onemocn\u011bn\u00ed (relativn\u00ed kontraindikace)<\/li>\n<li>Ned\u00e1vn\u00e9 pod\u00e1n\u00ed \u017eiv\u00e9 vakc\u00edny v imunosupresivn\u00edch d\u00e1vk\u00e1ch<\/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>Grapefruitov\u00e1 \u0161\u0165\u00e1va<\/strong> a siln\u00e9 inhibitory CYP3A4 (ketokonazol, itrakonazol, klarithromycin, ritonavir, kobicistat, nefazodon)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">V\u00fdrazn\u011b sni\u017euj\u00ed metabolismus prvn\u00edho pr\u016fchodu \u2014 syst\u00e9mov\u00e1 hladina budesonidu stoup\u00e1 2\u20138\u00d7, co\u017e vede k syst\u00e9mov\u00fdm steroidn\u00edm \u00fa\u010dink\u016fm podobn\u00fdm prednisolonu<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\"><strong>Vyhn\u011bte se kombinaci.<\/strong> Pokud je kombinace nevyhnuteln\u00e1, sn\u00ed\u017eit d\u00e1vku na polovinu a pe\u010dliv\u011b monitorovat p\u0159\u00edznaky Cushingova syndromu, suprese HPA osy a zv\u00fd\u0161en\u00ed TK\/gluk\u00f3zy.<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">M\u00edrn\u00e9 inhibitory CYP3A4 (erytromycin, diltiazem, flukonazol)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">M\u00edrn\u011b zvy\u0161uj\u00ed syst\u00e9movou hladinu budesonidu<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Monitorovat syst\u00e9mov\u00e9 steroidn\u00ed \u00fa\u010dinky; u dlouhodob\u00e9 kombinace zv\u00e1\u017eit sn\u00ed\u017een\u00ed d\u00e1vky.<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Siln\u00ed induktory CYP3A4 (rifampicin, fenytoin, karbamazepin, t\u0159ezalka te\u010dkovan\u00e1)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Sni\u017euj\u00ed syst\u00e9movou hladinu budesonidu \u2014 mo\u017en\u00e9 zhor\u0161en\u00ed kontroly onemocn\u011bn\u00ed<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">M\u016f\u017ee b\u00fdt nutn\u00e1 vy\u0161\u0161\u00ed d\u00e1vka nebo alternativn\u00ed kortikosteroid; konzultace specialisty.<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Cholestyramin a dal\u0161\u00ed sekvestranty \u017elu\u010dov\u00fdch kyselin<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">M\u016f\u017ee sn\u00ed\u017eit vst\u0159eb\u00e1v\u00e1n\u00ed budesonidu ze st\u0159evn\u00edho lumen<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Odd\u011blte d\u00e1vky o 4\u20136 hodin.<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">NSAID (ibuprofen, diklofenak, naproxen)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Aditivn\u00ed riziko ulcerace a krv\u00e1cen\u00ed v GI traktu; NSAID mohou tak\u00e9 zhor\u0161it aktivitu IBD<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Pokud mo\u017eno se vyhn\u011bte; pokud je to nevyhnuteln\u00e9, p\u0159edepi\u0161te sou\u010dasn\u011b PPI.<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Syst\u00e9mov\u00e9 kortikosteroidy (prednisolon, methylprednisolon, dexamethason)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Aditivn\u00ed syst\u00e9mov\u00e1 expozice steroid\u016fm<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Vyhn\u011bte se rutinn\u00ed kombinaci; rozhodnut\u00ed specialisty.<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Dal\u0161\u00ed imunosupresiva (azathioprin, methotrex\u00e1t, biologika, inhibitory JAK)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Aditivn\u00ed imunosuprese (zam\u00fd\u0161len\u00e1 kombinace u IBD)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">\u010cast\u00e9 a \u010dasto nutn\u00e9; monitorujte infekce a vedlej\u0161\u00ed \u00fa\u010dinky steroid\u016f.<\/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;\">Teoretick\u00e9 riziko diseminovan\u00e9 infekce vakc\u00ednov\u00fdm kmenem p\u0159i induk\u010dn\u00edch d\u00e1vk\u00e1ch<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Vyhn\u011bte se b\u011bhem indukce 9 mg\/den; zva\u017ete p\u0159ijatelnost p\u0159i udr\u017eovac\u00ed d\u00e1vce 3\u20136 mg\/den pod odborn\u00fdm dohledem.<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">L\u00e9ky na diabetes<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">M\u00edrn\u00e9 zv\u00fd\u0161en\u00ed gluk\u00f3zy \u2014 m\u00e9n\u011b ne\u017e u prednisolonu<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Sledujte hladinu gluk\u00f3zy v krvi; m\u016f\u017ee b\u00fdt nutn\u00e1 men\u0161\u00ed \u00faprava d\u00e1vky.<\/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>Neskladujte v koupeln\u011b \u2014 vlhkost m\u016f\u017ee naru\u0161it \u0159\u00edzen\u00e9 uvol\u0148ov\u00e1n\u00ed povlaku.<\/li>\n<li>Uchov\u00e1vejte mimo dosah d\u011bt\u00ed.<\/li>\n<li>Nepou\u017e\u00edvejte po uplynut\u00ed data expirace uveden\u00e9ho na obalu.<\/li>\n<li>Nepou\u017eit\u00e9 tobolky vra\u0165te do l\u00e9k\u00e1rny k likvidaci.<\/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\/azoran\/\"><strong>Azoran (azathioprin 50 mg) \u2014 klasick\u00e9 imunosupresivum DMARD<\/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\/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\">Jak se Budez CR li\u0161\u00ed od prednisolonu nebo methylprednisolonu?<\/h3>\n<p>T\u0159i z\u00e1sadn\u00ed rozd\u00edly. (1) <strong>Um\u00edst\u011bn\u00ed:<\/strong> \u0159\u00edzen\u00e9 uvol\u0148ov\u00e1n\u00ed povlaku dod\u00e1v\u00e1 l\u00e9k do termin\u00e1ln\u00edho ilea a prav\u00e9 \u010d\u00e1sti tlust\u00e9ho st\u0159eva, tak\u017ee l\u00e9\u010d\u00ed z\u00e1n\u011bt p\u0159esn\u011b tam, kde se vyskytuje ileocek\u00e1ln\u00ed Crohnova choroba a mikroskopick\u00e1 kolitida. (2) <strong>Syst\u00e9mov\u00e1 expozice:<\/strong> ~90% absorbovan\u00e9ho budesonidu je inaktivov\u00e1no p\u0159i prvn\u00edm pr\u016fchodu j\u00e1try, tak\u017ee syst\u00e9mov\u00e9 steroidn\u00ed vedlej\u0161\u00ed \u00fa\u010dinky jsou p\u0159ibli\u017en\u011b polovi\u010dn\u00ed co do \u010detnosti a z\u00e1va\u017enosti ve srovn\u00e1n\u00ed s ekvivalentn\u00ed protiz\u00e1n\u011btlivou d\u00e1vkou prednisolonu. (3) <strong>Indikace:<\/strong> budesonid CR je specifick\u00fd pro st\u0159evn\u00ed onemocn\u011bn\u00ed \u2014 nepou\u017e\u00edv\u00e1 se pro astma, revmatoidn\u00ed artritidu, lupus ani obecn\u00e9 protiz\u00e1n\u011btliv\u00e9 \u00fa\u010dely. Pro tyto \u00fa\u010dely pou\u017eijte Wysolone (prednisolon) nebo Medrol (methylprednisolon).<\/p>\n<h3 class=\"wp-block-heading\">Pro\u010d je grapefruitov\u00e1 \u0161\u0165\u00e1va takov\u00fd probl\u00e9m s Budez CR?<\/h3>\n<p>Grapefruitov\u00e1 \u0161\u0165\u00e1va nevratn\u011b inhibuje st\u0159evn\u00ed CYP3A4 \u2014 enzym, kter\u00fd inaktivuje absorbovan\u00fd budesonid d\u0159\u00edve, ne\u017e se dostane do syst\u00e9mov\u00e9ho ob\u011bhu. P\u0159i konzumaci grapefruitu mohou syst\u00e9mov\u00e9 hladiny budesonidu vzr\u016fst 2\u20138\u00d7, co\u017e vede k prednisolonov\u00fdm Cushingoidn\u00edm vedlej\u0161\u00edm \u00fa\u010dink\u016fm (m\u011bs\u00ed\u010dkovit\u00fd obli\u010dej, p\u0159ib\u00fdv\u00e1n\u00ed na v\u00e1ze, zm\u011bny n\u00e1lady, zv\u00fd\u0161en\u00e1 hladina gluk\u00f3zy v krvi, potla\u010den\u00ed HPA). B\u011bhem l\u00e9\u010dby se zcela vyhn\u011bte grapefruitu a grapefruitov\u00e9 \u0161\u0165\u00e1v\u011b. Stejn\u00fd probl\u00e9m plat\u00ed pro siln\u00e9 inhibitory CYP3A4 (ketokonazol, klarithromycin, ritonavir).<\/p>\n<h3 class=\"wp-block-heading\">Kdy poc\u00edt\u00edm \u00fa\u010dinek Budez CR?<\/h3>\n<p>Symptomatick\u00e9 zlep\u0161en\u00ed u Crohnovy choroby obvykle za\u010d\u00edn\u00e1 po 2\u20134 t\u00fddnech p\u0159i induk\u010dn\u00ed d\u00e1vce 9 mg\/den, p\u0159i\u010dem\u017e v\u011bt\u0161ina pacient\u016f dos\u00e1hne klinick\u00e9 remise do 8 t\u00fddn\u016f. Mikroskopick\u00e1 kolitida obvykle reaguje rychleji \u2014 pr\u016fjem se \u010dasto zlep\u0161\u00ed b\u011bhem 1\u20132 t\u00fddn\u016f. Pokud nedojde k v\u00fdznamn\u00e9mu zlep\u0161en\u00ed do 4 t\u00fddn\u016f u mikroskopick\u00e9 kolitidy nebo do 8 t\u00fddn\u016f u Crohnovy choroby, m\u011bl by p\u0159edepisuj\u00edc\u00ed l\u00e9ka\u0159 p\u0159ezkoumat diagn\u00f3zu nebo l\u00e9\u010debn\u00fd pl\u00e1n.<\/p>\n<h3 class=\"wp-block-heading\">Mohu u\u017e\u00edvat Budez CR dlouhodob\u011b?<\/h3>\n<p>Pro <strong>mikroskopick\u00e9 kolitidy<\/strong>, ano \u2014 mnoho pacient\u016f vy\u017eaduje dlouhodobou udr\u017eovac\u00ed l\u00e9\u010dbu v d\u00e1vce 3\u20136 mg\/den, aby z\u016fstali v remisi, n\u011bkdy i po n\u011bkolik let. U <strong>Crohnovy choroby<\/strong>, dlouhodob\u00e9 u\u017e\u00edv\u00e1n\u00ed d\u00e9le ne\u017e 12 m\u011bs\u00edc\u016f se nedoporu\u010duje \u2014 po indukci remise je preferov\u00e1na udr\u017eovac\u00ed l\u00e9\u010dba \u0161et\u0159\u00edc\u00ed steroidy s azathioprinem, methotrex\u00e1tem nebo biologikem. U <strong>autoimunitn\u00ed hepatitidy<\/strong>, dlouhodob\u00e9 u\u017e\u00edv\u00e1n\u00ed je standardem u pacient\u016f bez cirh\u00f3zy. Dlouhodob\u00e9 u\u017e\u00edv\u00e1n\u00ed budesonidu st\u00e1le nese m\u00edrn\u00e9 riziko suprese HPA osy, \u00fabytku kostn\u00ed hmoty, \u0161ed\u00e9ho z\u00e1kalu a glaukomu \u2014 podle toho monitorujte.<\/p>\n<h3 class=\"wp-block-heading\">Je Budez CR bezpe\u010dn\u00fd v t\u011bhotenstv\u00ed a p\u0159i kojen\u00ed?<\/h3>\n<p>Ano \u2014 budesonid je jedn\u00edm z <strong>preferovan\u00fdch kortikosteroid\u016f v t\u011bhotenstv\u00ed<\/strong> pro aktivn\u00ed IBD, proto\u017ee jeho n\u00edzk\u00e1 syst\u00e9mov\u00e1 biologick\u00e1 dostupnost minimalizuje expozici plodu. Pokra\u010dov\u00e1n\u00ed nebo zah\u00e1jen\u00ed l\u00e9\u010dby b\u011bhem t\u011bhotenstv\u00ed je vhodn\u00e9 pro aktivn\u00ed onemocn\u011bn\u00ed vy\u017eaduj\u00edc\u00ed steroidn\u00ed terapii. Kompatibiln\u00ed s kojen\u00edm; p\u0159estup do ml\u00e9ka je minim\u00e1ln\u00ed. Proberte s gastroenterologem a porodn\u00edkem b\u011bhem pl\u00e1nov\u00e1n\u00ed t\u011bhotenstv\u00ed.<\/p>\n<h3 class=\"wp-block-heading\">Mus\u00edm st\u00e1le nosit steroidn\u00ed kartu p\u0159i u\u017e\u00edv\u00e1n\u00ed Budez CR?<\/h3>\n<p>Ano, pokud jste l\u00e9\u010deni d\u00e9le ne\u017e 8 t\u00fddn\u016f v d\u00e1vce 9 mg\/den. K supresi HPA osy st\u00e1le m\u016f\u017ee doj\u00edt, zejm\u00e9na pokud je l\u00e9k kombinov\u00e1n s inhibitorem CYP3A4 nebo pokud se konzumuje grapefruit. Steroidn\u00ed karta upozor\u0148uje pohotovostn\u00ed l\u00e9ka\u0159e a anesteziology na va\u0161i expozici steroid\u016fm a mo\u017enou pot\u0159ebu stresov\u00e9 d\u00e1vky hydrokortizonu b\u011bhem z\u00e1va\u017en\u00e9ho onemocn\u011bn\u00ed, traumatu nebo operace.<\/p>\n<h3 class=\"wp-block-heading\">Mohu pou\u017e\u00edt Budez CR pro ulcer\u00f3zn\u00ed kolitidu?<\/h3>\n<p>Budesonid CR NEN\u00cd vhodn\u00fd pro typickou dist\u00e1ln\u00ed ulcer\u00f3zn\u00ed kolitidu, proto\u017ee CR kapsle uvol\u0148uje l\u00e9k v termin\u00e1ln\u00edm ileu a vzestupn\u00e9m tra\u010dn\u00edku \u2014 co\u017e je <em>v\u00fd\u0161e<\/em> u v\u011bt\u0161iny aktivit UC onemocn\u011bn\u00ed. Pro UC je preferov\u00e1n bu\u010f budesonid MMX (odli\u0161n\u00e1 formulace speci\u00e1ln\u011b navr\u017een\u00e1 pro \u00fapln\u00e9 uvoln\u011bn\u00ed v tlust\u00e9m st\u0159ev\u011b) nebo konven\u010dn\u00ed prednisolon. Mikroskopick\u00e1 kolitida \u2014 co\u017e je odli\u0161n\u00e9 onemocn\u011bn\u00ed navzdory n\u00e1zvu \u201ckolitida\u201d \u2014 <em>je<\/em> reaguj\u00edc\u00ed na Budez CR.<\/p>\n<h3 class=\"wp-block-heading\">Pro\u010d nepou\u017e\u00edvat pouze prednisolon, pokud je levn\u011bj\u0161\u00ed a funguje?<\/h3>\n<p>Prednisolon dosahuje podobn\u00fdch remisn\u00edch v\u00fdsledk\u016f u m\u00edrn\u00e9 a\u017e st\u0159edn\u011b t\u011b\u017ek\u00e9 Crohnovy choroby, ale s p\u0159ibli\u017en\u011b dvojn\u00e1sobnou z\u00e1t\u011b\u017e\u00ed syst\u00e9mov\u00fdch steroidn\u00edch vedlej\u0161\u00edch \u00fa\u010dink\u016f: v\u00edce Cushingoidn\u00edch rys\u016f, v\u00edce poruch n\u00e1lady, v\u00edce potla\u010den\u00ed HPA osy, v\u00edce \u00fabytku kostn\u00ed hmoty, v\u011bt\u0161\u00ed riziko nespavosti, diabetu a hypertenze. Sm\u011brnice (ECCO, ACG) uv\u00e1d\u011bj\u00ed budesonid CR jako preferovan\u00fd kortikosteroid pro ileocek\u00e1ln\u00ed Crohnovu chorobu pr\u00e1v\u011b proto, \u017ee dosahuje stejn\u00e9ho \u00fa\u010dinku na st\u0159evn\u00ed tk\u00e1\u0148 s men\u0161\u00edmi syst\u00e9mov\u00fdmi d\u016fsledky. Pro rozs\u00e1hlou Crohnovu chorobu nebo t\u011b\u017ek\u00e9 onemocn\u011bn\u00ed z\u016fst\u00e1v\u00e1 prednisolon prvn\u00ed volbou, proto\u017ee je pot\u0159eba jeho syst\u00e9mov\u00fd \u00fa\u010dinek.<\/p>\n<h3 class=\"wp-block-heading\">Co kdy\u017e Budez CR nevyvol\u00e1 remisi u m\u00e9 Crohnovy choroby?<\/h3>\n<p>Nereagov\u00e1n\u00ed na steroidy nebo z\u00e1vislost na steroidech je indikac\u00ed k eskalaci terapie. Mo\u017enosti zahrnuj\u00ed (a) p\u0159echod na prednisolon pro v\u011bt\u0161\u00ed syst\u00e9mov\u00fd \u00fa\u010dinek, (b) zah\u00e1jen\u00ed udr\u017eovac\u00ed l\u00e9\u010dby DMARD \u0161et\u0159\u00edc\u00ed steroidy (azathioprin p\u0159es <a href=\"https:\/\/medsbase.com\/cs\/azoran\/\">Azoran<\/a>, methotrex\u00e1t), nebo (c) zah\u00e1jen\u00ed biologick\u00e9 l\u00e9\u010dby (anti-TNF, anti-integrin, inhibitor IL-23) v z\u00e1vislosti na vzoru onemocn\u011bn\u00ed a z\u00e1va\u017enosti. Vstup specialisty gastroenterologa je nezbytn\u00fd, jakmile budesonid sel\u017ee.<\/p>\n<p><!-- medsbase-related-alts-v1 --><\/p>\n<h3 class=\"wp-block-heading\">Dal\u0161\u00ed l\u00e9ky na za\u017e\u00edvac\u00ed pot\u00ed\u017ee<\/h3>\n<ul>\n<li><a href=\"https:\/\/medsbase.com\/cs\/asacol\/\">Asacol \u2014 Mesalazin 400 mg DR (remise UC)<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/mesacol\/\">Mesacol \u2014 Mesalazin 400 mg DR<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/saaz\/\">Saaz \u2014 Sulfasalazin 500 mg (UC + Crohnova choroba)<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/pentasa-suppositories\/\">Pentasa \u010d\u00edpky \u2014 Mesalazin 1 g (dist\u00e1ln\u00ed ulcer\u00f3zn\u00ed kolitida)<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/rifagut\/\">Rifagut \u2014 Rifaximin 400\/550 mg (st\u0159evn\u011b selektivn\u00ed)<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/gastro-health\/\"><strong>Prohl\u00e9dnout v\u0161echny l\u00e9ky na za\u017e\u00edvac\u00ed pot\u00ed\u017ee<\/strong><\/a><\/li>\n<\/ul>","protected":false},"excerpt":{"rendered":"<p>\u2705 L\u00e9\u010d\u00ed z\u00e1n\u011btliv\u00e1 st\u0159evn\u00ed onemocn\u011bn\u00ed<br \/>\n\u2705 Sni\u017euje p\u0159\u00edznaky Crohnovy choroby<br \/>\n\u2705 Kontroluje ulcer\u00f3zn\u00ed kolitidu<br \/>\n\u2705 Minimalizuje z\u00e1n\u011bt tr\u00e1vic\u00edho traktu<br \/>\n\u2705 Ulevuje od bolesti b\u0159icha<\/p>\n<p>Budez CR obsahuje Budesonid.<\/p>","protected":false},"featured_media":55915,"comment_status":"open","ping_status":"open","template":"","meta":[],"product_brand":[],"product_cat":[3897,3141,3223,3542,3342],"product_tag":[3700,4011],"class_list":{"0":"post-55914","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_cat-gastro-health","10":"product_cat-general-health","11":"product_tag-budesonide","12":"product_tag-budez-cr","14":"first","15":"instock","16":"shipping-taxable","17":"purchasable","18":"product-type-variable","19":"has-default-attributes"},"acf":[],"_links":{"self":[{"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product\/55914","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=55914"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/media\/55915"}],"wp:attachment":[{"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/media?parent=55914"}],"wp:term":[{"taxonomy":"product_brand","embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_brand?post=55914"},{"taxonomy":"product_cat","embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_cat?post=55914"},{"taxonomy":"product_tag","embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_tag?post=55914"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}