{"id":56255,"date":"2024-02-07T05:58:35","date_gmt":"2024-02-07T05:58:35","guid":{"rendered":"https:\/\/medsname.com\/skizoril\/"},"modified":"2026-04-30T10:24:39","modified_gmt":"2026-04-30T10:24:39","slug":"skizoril","status":"publish","type":"product","link":"https:\/\/medsbase.com\/cs\/product\/skizoril\/","title":{"rendered":"Skizoril"},"content":{"rendered":"

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

Skizoril (Clozapin 25 \/ 50 \/ 100 mg) je nej\u00fa\u010dinn\u011bj\u0161\u00ed antipsychotikum pro l\u00e9\u010dbu rezistentn\u00ed schizofrenie, ale s nejn\u00e1ro\u010dn\u011bj\u0161\u00edm monitorovac\u00edm re\u017eimem v modern\u00ed psychiatrii. Povinn\u00fd t\u00fddenn\u00ed krevn\u00ed obraz po prvn\u00edch 18 t\u00fddn\u016f kv\u016fli riziku agranulocyt\u00f3zy. Pouze pro odborn\u00e9 zah\u00e1jen\u00ed l\u00e9\u010dby.<\/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

Skizoril na MedsBase je dod\u00e1v\u00e1n p\u0159\u00edmo od v\u00fdrobce certifikovan\u00e9ho WHO-GMP v jednoduch\u00e9m, diskr\u00e9tn\u00edm balen\u00ed. Ka\u017ed\u00e1 objedn\u00e1vka je pokryta na\u0161\u00ed Z\u00e1rukou op\u011btovn\u00e9ho odesl\u00e1n\u00ed<\/a> \u2014 20pracovn\u00edchdenn\u00ed lh\u016fta pro doru\u010den\u00ed, nebo v\u00e1m z\u00e1silku zdarma p\u0159epo\u0161leme \u2014 a oprav\u0148uje v\u00e1s k \u00fa\u010dasti v na\u0161em v\u011brnostn\u00edm programu<\/a>. Dod\u00e1v\u00e1me do v\u011bt\u0161iny zem\u00ed po cel\u00e9m sv\u011bt\u011b.<\/p>\n

Co je Skizoril a jak funguje<\/h2>\n

Skizoril je tableta klopapinu dod\u00e1van\u00e1 spole\u010dnost\u00ed Sun Pharma. Dostupn\u00e9 s\u00edly: 25 \/ 50 \/ 100 mg<\/strong>. Klopazin je nej\u00fa\u010dinn\u011bj\u0161\u00ed antipsychotikum, kter\u00e9 bylo kdy vyvinuto pro l\u00e9\u010dbu rezistentn\u00ed schizofrenie (CATIE f\u00e1ze 2, 2006; CUtLASS 1, 2006). Je tak\u00e9 jedin\u00fdm antipsychotikem s reprodukovateln\u00fdmi d\u016fkazy o sn\u00ed\u017een\u00ed m\u00edry sebevra\u017ed u schizofrenie (InterSePT, 2003). Mechanismus je \u0161irok\u00fd: slab\u00e1 antagonie D2 (n\u00edzk\u00fd v\u00fdskyt EPS, n\u00edzk\u00fd v\u00fdskyt TD), siln\u00e1 antagonie 5-HT2A a D4, siln\u00e1 blok\u00e1da \u03b11 a H1 a siln\u00e1 antagonie M1\/M3. Navzdory sv\u00e9 \u00fa\u010dinnosti je klopazin vyhrazen pro l\u00e9\u010dbu rezistentn\u00edch onemocn\u011bn\u00ed kv\u016fli vysok\u00e9 z\u00e1t\u011b\u017ei monitorov\u00e1n\u00ed.<\/p>\n

Indikace a d\u00e1vkov\u00e1n\u00ed<\/h2>\n\n\n\n\n\n\n\n\n
Indikace<\/th>\nPo\u010d\u00e1te\u010dn\u00ed d\u00e1vka<\/th>\nC\u00edlov\u00e1 d\u00e1vka<\/th>\nMaxim\u00e1ln\u00ed d\u00e1vka<\/th>\n<\/tr>\n<\/thead>\n
Rezistentn\u00ed schizofrenie<\/td>\n12,5 mg HS den 1, pot\u00e9 25 mg BID, pot\u00e9 zv\u00fd\u0161en\u00ed o 25\u201350 mg\/den<\/td>\n300\u2013450 mg\/den v rozd\u011blen\u00fdch d\u00e1vk\u00e1ch<\/td>\n900 mg<\/td>\n<\/tr>\n
Schizofrenie se suicid\u00e1ln\u00edmi tendencemi<\/td>\nstejn\u00e9 jako v\u00fd\u0161e<\/td>\nstejn\u00e9<\/td>\nstejn\u00e9<\/td>\n<\/tr>\n
Rezistentn\u00ed bipol\u00e1rn\u00ed porucha (mimo indikaci)<\/td>\n12,5 mg HS<\/td>\n200\u2013500 mg\/den<\/td>\ndle sn\u00e1\u0161enlivosti<\/td>\n<\/tr>\n
Star\u0161\u00ed dosp\u011bl\u00ed<\/td>\n12,5 mg OD<\/td>\n50\u2013200 mg\/den<\/td>\ndle sn\u00e1\u0161enlivosti<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Pomal\u00e1 titrace je povinn\u00e1 \u2014 rychl\u00e1 titrace zp\u016fsobuje t\u011b\u017ekou ortost\u00e1zu a z\u00e1chvaty. Pravidlo \u201cpoklesu d\u00e1vky\u201d: pokud pacient vynech\u00e1 \u2265 2 dny klopazinu, za\u010dn\u011bte znovu od n\u00edzk\u00e9 d\u00e1vky a znovu titrujte.<\/p>\n

D\u016fle\u017eit\u00e9 bezpe\u010dnostn\u00ed aspekty<\/h2>\n
\nPovinn\u00e9 monitorov\u00e1n\u00ed krevn\u00edho obrazu \u2014 agranulocyt\u00f3za<\/strong><\/p>\n

Klozapin zp\u016fsobuje klinicky v\u00fdznamnou neutropenii p\u0159ibli\u017en\u011b u 3 % pacient\u016f a t\u011b\u017ekou agranulocyt\u00f3zu (ANC < 500) p\u0159ibli\u017en\u011b u 0,8 %. Riziko je nejvy\u0161\u0161\u00ed v prvn\u00edch 18 t\u00fddnech, ale nikdy nen\u00ed nulov\u00e9. Povinn\u00fd harmonogram krevn\u00edho obrazu:<\/strong> v\u00fdchoz\u00ed hodnoty \u2192 t\u00fddn\u011b \u00d7 18 t\u00fddn\u016f \u2192 ka\u017ed\u00e9 2 t\u00fddny \u00d7 t\u00fddny 19\u201352 \u2192 m\u011bs\u00ed\u010dn\u011b pot\u00e9. Okam\u017eit\u011b p\u0159eru\u0161te, pokud ANC klesne pod stanoven\u00e9 hranice (li\u0161\u00ed se podle registru: obvykle < 1500 \u017elut\u00e1, < 1000 \u010derven\u00e1). V\u011bt\u0161ina zem\u00ed vy\u017eaduje n\u00e1rodn\u00ed registr klozapinu, kter\u00fd mus\u00ed p\u0159ed ka\u017ed\u00fdm vyd\u00e1n\u00edm zkontrolovat p\u0159edepisuj\u00edc\u00ed l\u00e9ka\u0159 a l\u00e9k\u00e1rna.<\/p>\n<\/div>\n

\nMyokarditida a kardiomyopatie<\/strong><\/p>\n

Klozapin zp\u016fsobuje myokarditidu (zejm\u00e9na v prvn\u00edch 4 t\u00fddnech) a dilata\u010dn\u00ed kardiomyopatii (m\u011bs\u00edce a\u017e roky pozd\u011bji). St\u00e1le \u010dast\u011bji se doporu\u010duje v\u00fdchoz\u00ed EKG, troponin, CRP a echokardiogram. Okam\u017eit\u011b p\u0159eru\u0161te p\u0159i nevysv\u011btliteln\u00e9 bolesti na hrudi, du\u0161nosti, hore\u010dce, palpitac\u00edch nebo nevysv\u011btliteln\u00e9 tachykardii v prvn\u00edch 6\u20138 t\u00fddnech.<\/p>\n<\/div>\n

\nZ\u00e1chvaty (z\u00e1visl\u00e9 na d\u00e1vce)<\/strong><\/p>\n

~1 % p\u0159i 300 mg\/den; ~5 % p\u0159i 600+ mg\/den. P\u0159i vysok\u00fdch d\u00e1vk\u00e1ch klozapinu se p\u0159id\u00e1v\u00e1 antikonvulzivn\u00ed kryt\u00ed (\u010dasto valpro\u00e1t). Vyhn\u011bte se l\u00e9k\u016fm, kter\u00e9 sni\u017euj\u00ed pr\u00e1h z\u00e1chvat\u016f (bupropion, tramadol).<\/p>\n<\/div>\n

\nT\u011b\u017ek\u00e1 z\u00e1cpa \/ ileus<\/strong><\/p>\n

Siln\u00fd M1\/M3 anticholinergn\u00ed \u00fa\u010dinek zp\u016fsobuje t\u011b\u017ekou z\u00e1cpu a vz\u00e1cn\u00e9 p\u0159\u00edpady ileu, megakolonu a nekr\u00f3zy st\u0159ev (klozapinem indukovan\u00e1 gastrointestin\u00e1ln\u00ed hypomotilita, CIGH). \u00damrtnost na CIGH m\u016f\u017ee p\u0159ekro\u010dit \u00famrtnost na agranulocyt\u00f3zu. Aktivn\u00ed management st\u0159evn\u00ed motility od zah\u00e1jen\u00ed l\u00e9\u010dby.<\/p>\n<\/div>\n

\nVysok\u00e1 metabolick\u00e1 z\u00e1t\u011b\u017e<\/strong><\/p>\n

Klozapin zp\u016fsobuje nejv\u011bt\u0161\u00ed p\u0159\u00edr\u016fstek hmotnosti a metabolick\u00fd syndrom ze v\u0161ech antipsychotik \u2014 podobn\u011b jako olanzapin. Povinn\u00e9 sledov\u00e1n\u00ed hmotnosti, hladiny gluk\u00f3zy nala\u010dno a lipid\u016f nala\u010dno.<\/p>\n<\/div>\n

\nSialorea<\/strong><\/p>\n

V\u011bt\u0161ina pacient\u016f slin\u00ed, zejm\u00e9na v noci. Paradoxn\u00ed (anticholinergn\u00ed \u00fa\u010dinek by m\u011bl slin\u011bn\u00ed sn\u00ed\u017eit; klozapin paradoxn\u011b stimuluje M4 receptory ve slinn\u00fdch \u017el\u00e1z\u00e1ch). \u0158e\u0161en\u00ed: topick\u00e9 atropinov\u00e9 kapky nebo klonidin.<\/p>\n<\/div>\n

\u010cast\u00e9 ne\u017e\u00e1douc\u00ed \u00fa\u010dinky<\/h2>\n