{"id":55994,"date":"2024-02-07T05:48:54","date_gmt":"2024-02-07T05:48:54","guid":{"rendered":"https:\/\/medsname.com\/syndopa-cr\/"},"modified":"2026-05-01T10:49:13","modified_gmt":"2026-05-01T10:49:13","slug":"syndopa-cr","status":"publish","type":"product","link":"https:\/\/medsbase.com\/cs\/product\/syndopa-cr\/","title":{"rendered":"Syndopa CR"},"content":{"rendered":"

<\/p>\n

\n

\u26a1 Rychl\u00e1 odpov\u011b\u010f<\/h3>\n

Syndopa CR<\/strong> je kombinovan\u00e1 tableta s \u0159\u00edzen\u00fdm uvol\u0148ov\u00e1n\u00edm levodopy + karbidopy<\/strong> (125 mg (100 mg levodopy + 25 mg karbidopy, s \u0159\u00edzen\u00fdm uvol\u0148ov\u00e1n\u00edm)) \u2014 z\u00e1kladn\u00ed l\u00e9\u010dba pro Parkinsonova choroba<\/strong>. Levodopa se v mozku p\u0159em\u011b\u0148uje na dopamin, aby nahradila to, co ji\u017e po\u0161kozen\u00e9 nigr\u00e1ln\u00ed neurony nedok\u00e1\u017eou produkovat; karbidopa blokuje tuto p\u0159em\u011bnu mimo mozek, tak\u017ee v\u00edce levodopy se dostane do centr\u00e1ln\u00edho nervov\u00e9ho syst\u00e9mu s men\u0161\u00edmi vedlej\u0161\u00edmi \u00fa\u010dinky (nevolnost, zvracen\u00ed, pokles krevn\u00edho tlaku p\u0159i zm\u011bn\u011b polohy). Formulace CR sni\u017euje \u201cvyvanut\u00ed \u00fa\u010dinku\u201d mezi d\u00e1vkami a je zvl\u00e1\u0161t\u011b u\u017eite\u010dn\u00e1 p\u0159ed span\u00edm pro zvl\u00e1dnut\u00ed no\u010dn\u00ed ztuhlosti a rann\u00ed akineze. Biologick\u00e1 dostupnost CR je asi 70\u201375 % oproti IR, tak\u017ee \u00fa\u010dinn\u00e1 d\u00e1vka je m\u00edrn\u011b ni\u017e\u0161\u00ed ne\u017e u IR \u2014 r\u00e1no se \u010dasto p\u0159id\u00e1v\u00e1 \u201cdo\u010di\u0161\u0165uj\u00edc\u00ed\u201d d\u00e1vka IR pro rychl\u00e9 zvl\u00e1dnut\u00ed rann\u00ed akineze. Kritick\u00e9:<\/strong> nikdy nep\u0159eru\u0161ujte levodopu n\u00e1hle \u2014 riziko neuroleptick\u00e9ho malign\u00edho syndromu<\/em>. D\u00e1vkov\u00e1n\u00ed mus\u00ed b\u00fdt postupn\u011b sni\u017eov\u00e1no.<\/p>\n<\/div>\n

\nCo z\u00edsk\u00e1te s MedsBase:<\/strong> V\u00fdrobce certifikovan\u00fd WHO-GMP \u00b7 Diskr\u00e9tn\u00ed balen\u00ed \u00b7 Celosv\u011btov\u00e1 doprava \u00b7 V\u00edce ne\u017e 1 400 ov\u011b\u0159en\u00fdch recenz\u00ed z\u00e1kazn\u00edk\u016f<\/a>\n<\/div>\n

\ud83d\udce6 Ka\u017ed\u00e1 objedn\u00e1vka je pokryta na\u0161\u00ed Z\u00e1rukou op\u011btovn\u00e9ho odesl\u00e1n\u00ed<\/strong><\/a> \u2014 pokud va\u0161e z\u00e1silka nedoraz\u00ed do 20 pracovn\u00edch dn\u016f, p\u0159epos\u00edl\u00e1me ji.<\/p>\n

Pro\u010d objedn\u00e1vat z MedsBase<\/h3>\n

Na\u0161e generick\u00e9 l\u00e9ky poch\u00e1zej\u00ed od v\u00fdrobc\u016f certifikovan\u00fdch WHO-GMP a jsou expedov\u00e1ny po cel\u00e9m sv\u011bt\u011b v diskr\u00e9tn\u00edm, nen\u00e1padn\u00e9m balen\u00ed \u2013 na vn\u011bj\u0161\u00ed stran\u011b bal\u00edku nen\u00ed uveden n\u00e1zev l\u00e9ku. Platby kartou jsou sm\u011brov\u00e1ny prost\u0159ednictv\u00edm regulovan\u00e9ho procesoru (popisky na v\u00fdpisu zahrnuj\u00ed regulovan\u00e9ho procesora plateb kartou \u2013 nikdy \u201cMedsBase\u201d nebo n\u00e1zev l\u00e9ku). P\u0159ij\u00edm\u00e1me tak\u00e9 kryptom\u011bny a bankovn\u00ed p\u0159evody SEPA. Ka\u017ed\u00e1 objedn\u00e1vka je zaji\u0161t\u011bna na\u0161\u00ed politikou p\u0159eposl\u00e1n\u00ed.<\/p>\n

Co je Syndopa CR?<\/h2>\n

Syndopa CR je peror\u00e1ln\u00ed tableta obsahuj\u00edc\u00ed levodopa + karbidopa 125 mg (100 mg levodopy + 25 mg karbidopy, s \u0159\u00edzen\u00fdm uvol\u0148ov\u00e1n\u00edm)<\/strong> v s \u0159\u00edzen\u00fdm uvol\u0148ov\u00e1n\u00edm<\/strong> formulace. Tato kombinace je z\u00e1kladem l\u00e9\u010dby Parkinsonovy choroby od 70. let 20. stolet\u00ed a z\u016fst\u00e1v\u00e1 nej\u00fa\u010dinn\u011bj\u0161\u00ed jednotlivou l\u00e9\u010dbou motorick\u00fdch p\u0159\u00edznak\u016f (bradykineze, rigidita, tremor). P\u016fvodn\u011b byla uv\u00e1d\u011bna na trh pod n\u00e1zvem Sinemet<\/strong> \/ Sinemet CR<\/strong>. Syndopa CR je vyr\u00e1b\u011bna ve WHO-GMP certifikovan\u00e9m za\u0159\u00edzen\u00ed a je bioekvivalentn\u00ed origin\u00e1ln\u00ed zna\u010dce ve stejn\u00e9 s\u00edle.<\/p>\n

Jak Syndopa CR funguje?<\/h2>\n

Parkinsonova choroba je d\u016fsledkem postupn\u00e9ho \u00fabytku neuron\u016f produkuj\u00edc\u00edch dopamin v substantia nigra<\/em>. Levodopa<\/strong> je bezprost\u0159edn\u00edm biochemick\u00fdm prekurzorem dopaminu; na rozd\u00edl od samotn\u00e9ho dopaminu p\u0159ekon\u00e1v\u00e1 hematoencefalickou bari\u00e9ru. Jakmile se dostane do mozku, p\u0159e\u017e\u00edvaj\u00edc\u00ed neurony jej dekarboxyluj\u00ed na dopamin, \u010d\u00edm\u017e obnovuj\u00ed synaptick\u00e9 hladiny dopaminu a zlep\u0161uj\u00ed motorickou kontrolu.<\/p>\n

Probl\u00e9m: kdy\u017e je levodopa pod\u00e1v\u00e1na samotn\u00e1, >95 % se p\u0159em\u011bn\u00ed na dopamin v perifern\u00edch tk\u00e1n\u00edch, ne\u017e dos\u00e1hne mozku \u2014 co\u017e zp\u016fsobuje silnou nevolnost, zvracen\u00ed a ortostatickou hypotenzi a nut\u00ed pou\u017eit\u00ed vysok\u00fdch d\u00e1vek. Carbidopa<\/strong> je perifern\u00ed inhibitor aromatick\u00fdch-aminokyselin dekarboxyl\u00e1zy. Sama nep\u0159ekon\u00e1v\u00e1 hematoencefalickou bari\u00e9ru, ale blokuje rozklad levodopy v perifern\u00edch tk\u00e1n\u00edch. V\u00fdsledek: 4\u20135kr\u00e1t ni\u017e\u0161\u00ed d\u00e1vka levodopy pot\u0159ebn\u00e1 pro stejn\u00fd \u00fa\u010dinek v mozku a mnohem m\u00e9n\u011b gastrointestin\u00e1ln\u00edch\/kardiovaskul\u00e1rn\u00edch vedlej\u0161\u00edch \u00fa\u010dink\u016f.<\/p>\n

The s \u0159\u00edzen\u00fdm uvol\u0148ov\u00e1n\u00edm<\/strong> matrix zpomaluje rozpou\u0161t\u011bn\u00ed tablety, tak\u017ee levodopa se vst\u0159eb\u00e1v\u00e1 po dobu 4\u20136 hodin nam\u00edsto 1\u20132. To vyrovn\u00e1v\u00e1 hladiny v plazm\u011b a pom\u00e1h\u00e1 sn\u00ed\u017eit vymizen\u00ed \u00fa\u010dinku na konci d\u00e1vky<\/em> u pacient\u016f s motorick\u00fdmi fluktuacemi. Kompromis: biologick\u00e1 dostupnost je asi 70\u201375 % ve srovn\u00e1n\u00ed s tabletami s okam\u017eit\u00fdm uvol\u0148ov\u00e1n\u00edm (IR), tak\u017ee efektivn\u00ed d\u00e1vka je m\u00edrn\u011b ni\u017e\u0161\u00ed; j\u00eddlo (zejm\u00e9na b\u00edlkoviny) d\u00e1le oddaluje absorpci. Mnoho pacient\u016f pou\u017e\u00edv\u00e1 kombinaci \u2014 d\u00e1vku IR r\u00e1no pro rychl\u00fd n\u00e1stup \u00fa\u010dinku, pot\u00e9 CR pro plynul\u00fd \u00fa\u010dinek b\u011bhem dne a v p\u0159\u00edpad\u011b pot\u0159eby dopl\u0148kovou d\u00e1vku IR p\u0159ed span\u00edm.<\/p>\n

Pro koho je Syndopa CR vhodn\u00e1?<\/h2>\n

Syndopa CR je vhodn\u00e1 pro dosp\u011bl\u00e9 s idiopatickou Parkinsonovou chorobou, kte\u0159\u00ed pot\u0159ebuj\u00ed symptomatickou \u00falevu od motorick\u00fdch p\u0159\u00edznak\u016f, v\u010detn\u011b:<\/p>\n

    \n
  • Nov\u011b diagnostikovan\u00fdch pacient\u016f, u kter\u00fdch p\u0159\u00edznaky naru\u0161uj\u00ed ka\u017edodenn\u00ed fungov\u00e1n\u00ed (zejm\u00e9na star\u0161\u00edch pacient\u016f \u2014 u mlad\u0161\u00edch pacient\u016f neurologov\u00e9 \u010dasto za\u010d\u00ednaj\u00ed s dopaminov\u00fdm agonistou nebo inhibitorem MAO-B, aby odd\u00e1lili dyskineze souvisej\u00edc\u00ed s levodopou).<\/li>\n
  • Pacienti na agonistech dopaminu nebo inhibitory MAO-B, u kter\u00fdch do\u0161lo k progresi p\u0159\u00edznak\u016f a nyn\u00ed pot\u0159ebuj\u00ed dal\u0161\u00ed motorick\u00fd benefit.<\/li>\n
  • Pacient\u016f, u kter\u00fdch se projevuje vymizen\u00ed \u00fa\u010dinku na konci d\u00e1vky\u201c<\/strong> u standardn\u00edho levodopy s okam\u017eit\u00fdm uvol\u0148ov\u00e1n\u00edm \u2014 kontrolovan\u00e1 uvol\u0148ovac\u00ed matrice prodlu\u017euje dobu \u00fa\u010dinku.<\/li>\n
  • Pacient\u016f s no\u010dn\u00edmi p\u0159\u00edznaky<\/strong> \u2014 ve\u010dern\u00ed d\u00e1vka CR m\u016f\u017ee sn\u00ed\u017eit no\u010dn\u00ed ztuhlost a rann\u00ed akinezi.<\/li>\n
  • N\u011bkte\u0159\u00ed pacienti s parkinsonismem z jin\u00fdch p\u0159\u00ed\u010din (postencefalitick\u00fd, intoxikace manganem, n\u011bkter\u00e9 atypick\u00e9 syndromy) \u2014 pod odborn\u00fdm dohledem, s v\u011bdom\u00edm, \u017ee odpov\u011b\u010f je obvykle m\u00e9n\u011b v\u00fdrazn\u00e1 ne\u017e u idiopatick\u00e9 PD.<\/li>\n<\/ul>\n

    Nevhodn\u00e9 pro:<\/strong> pacienti s uzav\u0159en\u00fdm \u00fahlem glaukomu, podez\u0159en\u00edm na melanom nebo nediagnostikovanou ko\u017en\u00ed l\u00e9z\u00ed, t\u011b\u017ekou psychotickou poruchou nebo sou\u010dasn\u00fdm u\u017e\u00edv\u00e1n\u00edm neselektivn\u00edho inhibitoru MAO (do 14 dn\u016f).<\/p>\n

    D\u00e1vkov\u00e1n\u00ed a pod\u00e1v\u00e1n\u00ed<\/h2>\n\n\n\n\n\n\n\n\n
    F\u00e1ze<\/th>\nD\u00e1vkovac\u00ed sch\u00e9ma<\/th>\nPozn\u00e1mky<\/th>\n<\/tr>\n<\/thead>\n
    P\u0159echod z IR na CR<\/td>\nP\u0159idejte 10\u201330 % k celkov\u00e9 denn\u00ed d\u00e1vce levodopy; redistribuujte ji v pr\u016fb\u011bhu 4\u20138 hodin.<\/td>\nCR m\u00e1 biologickou dostupnost ~75 %<\/td>\n<\/tr>\n
    Typick\u00e9 d\u00e1vkov\u00e1n\u00ed<\/td>\n125 mg ka\u017ed\u00e9 4\u20138 hodin; 1\u20132 tablety na d\u00e1vku<\/td>\nPlus IR pro rann\u00ed d\u00e1vku, pokud je pot\u0159eba<\/td>\n<\/tr>\n
    Ve\u010dern\u00ed d\u00e1vka<\/td>\n125 mg nebo 250 mg p\u0159ed span\u00edm<\/td>\nSni\u017euje rann\u00ed ztuhlost<\/td>\n<\/tr>\n
    Polykejte cel\u00e9<\/td>\nNedrtit ani ned\u011blit (n\u011bkter\u00e9 CR formulace s r\u00fdhou lze rozd\u011blit na poloviny; zkontrolujte tabletu)<\/td>\nRozdrcen\u00ed ni\u010d\u00ed matrici<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    Syndopa CR je s \u0159\u00edzen\u00fdm uvol\u0148ov\u00e1n\u00edm<\/strong> formulace: n\u00e1stup \u00fa\u010dinku je pomalej\u0161\u00ed (45\u201390 minut vs 30 u IR), vrchol je ni\u017e\u0161\u00ed a pozd\u011bj\u0161\u00ed, \u00fa\u010dinek trv\u00e1 d\u00e9le (5\u20137 hodin na d\u00e1vku vs 3\u20135). D\u00edky tomu je vhodn\u00e1 pro udr\u017een\u00ed stabiln\u00ed hladiny v plazm\u011b b\u011bhem dne a p\u0159es noc, ale m\u00e9n\u011b vhodn\u00e1 pro rann\u00ed d\u00e1vku, kde je prioritou rychl\u00fd n\u00e1stup \u00fa\u010dinku \u2013 mnoho pokro\u010dil\u00fdch pacient\u016f pou\u017e\u00edv\u00e1 IR pro prvn\u00ed d\u00e1vku a CR pro zbytek dne. Ide\u00e1ln\u011b u\u017e\u00edvejte 30 minut p\u0159ed j\u00eddlem, pokud je to mo\u017en\u00e9; j\u00eddlo (zejm\u00e9na b\u00edlkoviny) zpomaluje a sni\u017euje vst\u0159eb\u00e1v\u00e1n\u00ed.<\/p>\n

    U\u017e\u00edvat s j\u00eddlem obsahuj\u00edc\u00edm b\u00edlkoviny nebo bez?<\/strong> Levodopa sout\u011b\u017e\u00ed o absorpci s dietn\u00edmi aminokyselinami (velk\u00e9 neutr\u00e1ln\u00ed aminokyseliny \u2014 LNAA \u2014 z b\u00edlkovinn\u00fdch j\u00eddel). U v\u011bt\u0161iny pacient\u016f v ran\u00fdch letech nen\u00ed tato konkurence v\u00fdznamn\u00e1; u\u017e\u00edvejte s j\u00eddlem, pokud je probl\u00e9m nevolnost. U pacient\u016f s motorick\u00fdmi fluktuacemi<\/strong>, u\u017e\u00edvejte levodopu 30 minut p\u0159ed<\/strong> j\u00eddlem obsahuj\u00edc\u00edm b\u00edlkoviny (nebo 1 hodinu po) pro maximalizaci absorpce. N\u011bkte\u0159\u00ed odborn\u00edci doporu\u010duj\u00ed sn\u00eddani\/ob\u011bd s n\u00edzk\u00fdm obsahem b\u00edlkovin a p\u0159esunout v\u011bt\u0161inu b\u00edlkovin na ve\u010de\u0159i.<\/div>\n

    Dlouhodob\u00e9 probl\u00e9my: Motorick\u00e9 fluktuace a dyskineze<\/h2>\n

    Po 5\u201310 letech l\u00e9\u010dby levodopou se u mnoha pacient\u016f rozvinou:<\/p>\n

      \n
    • Vymizen\u00ed \u00fa\u010dinku<\/strong> \u2014 ka\u017ed\u00e1 d\u00e1vka p\u016fsob\u00ed krat\u0161\u00ed dobu; p\u0159\u00edznaky se vracej\u00ed p\u0159ed dal\u0161\u00ed d\u00e1vkou. \u0158e\u0161\u00ed se krat\u0161\u00edmi intervaly mezi d\u00e1vkami, p\u0159id\u00e1n\u00edm inhibitoru COMT (entakapon) nebo inhibitoru MAO-B (rasagilin, safinamid).<\/li>\n
    • Fenom\u00e9n on\u2013off<\/strong> \u2014 n\u00e1hl\u00e9 nep\u0159edv\u00eddateln\u00e9 p\u0159echody mezi pohybliv\u00fdm (\u201con\u201d) a ztuhl\u00fdm (\u201coff\u201d) stavem.<\/li>\n
    • Dyskineze<\/strong> \u2014 mimovoln\u00ed kroutiv\u00e9 nebo krouciv\u00e9 pohyby p\u0159i maxim\u00e1ln\u00ed koncentraci levodopy. \u0158e\u0161\u00ed se sn\u00ed\u017een\u00edm jednotliv\u00fdch d\u00e1vek, p\u0159id\u00e1n\u00edm amantadinu nebo zm\u011bnou l\u00e9kov\u00e9 formy.<\/li>\n
    • Zamrznut\u00ed ch\u016fze<\/strong> \u2014 kr\u00e1tkodob\u00e1 neschopnost za\u010d\u00edt nebo pokra\u010dovat v ch\u016fzi. M\u00e9n\u011b citliv\u00e9 na medikaci; fyzioterapeutick\u00e9 strategie (vizu\u00e1ln\u00ed podn\u011bty, rytmick\u00e1 hudba) \u010dasto pom\u00e1haj\u00ed v\u00edce.<\/li>\n<\/ul>\n

      Tyto probl\u00e9my je snaz\u0161\u00ed odd\u00e1lit, ne\u017e je l\u00e9\u010dit, jakmile se objev\u00ed \u2014 jeden z d\u016fvod\u016f, pro\u010d se u mlad\u0161\u00edch pacient\u016f n\u011bkdy za\u010d\u00edn\u00e1 s dopaminov\u00fdmi agonisty nebo inhibitory MAO-B.<\/p>\n

      B\u011b\u017en\u00e9 ne\u017e\u00e1douc\u00ed \u00fa\u010dinky<\/h2>\n

      Na za\u010d\u00e1tku l\u00e9\u010dby:<\/strong> nevolnost, zvracen\u00ed, nechutenstv\u00ed, ortostatick\u00e1 hypotenze, z\u00e1vrat\u011b, sucho v \u00fastech. V\u011bt\u0161ina p\u0159\u00edznak\u016f ustoup\u00ed do 2\u20134 t\u00fddn\u016f. U\u017e\u00edv\u00e1n\u00ed s j\u00eddlem nebo domperidonem pom\u00e1h\u00e1.<\/p>\n

      P\u0159i dlouhodob\u00e9m u\u017e\u00edv\u00e1n\u00ed:<\/strong> dyskineze (mimovoln\u00ed pohyby p\u0159i maxim\u00e1ln\u00ed d\u00e1vce), motorick\u00e9 fluktuace (vymizen\u00ed \u00fa\u010dinku, fenom\u00e9n on\u2013off), halucinace, \u017eiv\u00e9 sny, poruchy impulzivn\u00ed kontroly (m\u00e9n\u011b \u010dast\u00e9 ne\u017e u dopaminov\u00fdch agonist\u016f), nespavost, n\u00e1hl\u00fd n\u00e1stup sp\u00e1nku, ne\u0161kodn\u00e9 \u010dervenohn\u011bd\u00e9 zabarven\u00ed mo\u010di a potu.<\/p>\n

      M\u00e9n\u011b \u010dast\u00e9:<\/strong> zmatenost, paranoia, deprese, m\u00e1nie, gambling\/hypersexualita, neuroleptick\u00fd malign\u00ed syndrom p\u0159i n\u00e1hl\u00e9m vysazen\u00ed.<\/p>\n

      \u26a0 Nikdy nevysazujte levodopu n\u00e1hle<\/strong> N\u00e1hl\u00e9 vysazen\u00ed m\u016f\u017ee vyvolat neuroleptick\u00fd malign\u00ed syndrom<\/em>: vysokou hore\u010dku, svalovou rigiditu, autonomn\u00ed nestabilitu, zv\u00fd\u0161enou hladinu CK a poruchu v\u011bdom\u00ed. Jedn\u00e1 se o l\u00e9ka\u0159skou pohotovost. Pokud mus\u00edte levodopa vysadit \u2014 kv\u016fli operaci, hospitalizaci, v\u00e1\u017en\u00e9mu onemocn\u011bn\u00ed \u2014 m\u011blo by to b\u00fdt pl\u00e1nov\u00e1no a postupn\u011b sni\u017eov\u00e1no ve spolupr\u00e1ci s neurologem. Pokud jej nem\u016f\u017eete z jak\u00e9hokoli d\u016fvodu u\u017e\u00edvat peror\u00e1ln\u011b, okam\u017eit\u011b kontaktujte sv\u016fj t\u00fdm ohledn\u011b transderm\u00e1ln\u00edho rotigotinu nebo apomorfinov\u00e9ho m\u016fstku.<\/div>\n

      Interakce s l\u00e9ky a potravinami<\/h2>\n