{"id":56730,"date":"2024-02-27T17:05:50","date_gmt":"2024-02-27T17:05:50","guid":{"rendered":"https:\/\/medsname.com\/crema-gel\/"},"modified":"2026-04-30T10:24:35","modified_gmt":"2026-04-30T10:24:35","slug":"crema-gel","status":"publish","type":"product","link":"https:\/\/medsbase.com\/cs\/product\/crema-gel\/","title":{"rendered":"Crema Gel"},"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 Crema Gel?<\/h3>\n<p style=\"margin:0;\"><strong>Crema Gel<\/strong> je <strong>topick\u00fd diltiazem 2% w\/w<\/strong> (30 g tuba) \u2014 blok\u00e1tor kalciov\u00fdch kan\u00e1l\u016f ur\u010den\u00fd pro <strong>chronickou an\u00e1ln\u00ed fisuru<\/strong>. Aplikuje se dvakr\u00e1t a\u017e t\u0159ikr\u00e1t denn\u011b do an\u00e1ln\u00edho kan\u00e1lu, uvol\u0148uje vnit\u0159n\u00ed an\u00e1ln\u00ed sv\u011bra\u010d, sni\u017euje klidov\u00fd an\u00e1ln\u00ed tlak a zlep\u0161uje pr\u016ftok krve k b\u00e1zi fisury, co\u017e umo\u017e\u0148uje hojen\u00ed bez chirurgick\u00e9ho z\u00e1kroku. \u00dasp\u011b\u0161nost hojen\u00ed je 65\u201375 % b\u011bhem 6\u20138 t\u00fddn\u016f. Je preferovan\u00fdm topick\u00fdm prost\u0159edkem oproti <strong>nitroglycerinu (GTN)<\/strong> , proto\u017ee zp\u016fsobuje mnohem m\u00e9n\u011b bolest\u00ed hlavy. Vyrobeno v souladu s normami WHO-GMP.<\/p>\n<\/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<div style=\"background:#f4f8fb;border-left:4px solid #2c7cb0;padding:14px 18px;margin:18px 0;border-radius:4px;\"><strong>\ud83d\udca1 Prvn\u00ed volba u chronick\u00e9 an\u00e1ln\u00ed fisury (dle ASCRS 2017).<\/strong> Diltiazem 2 % a nifedipin 0,3 % jsou oba \u00fa\u010dinn\u00e9 topick\u00e9 blok\u00e1tory kalciov\u00fdch kan\u00e1l\u016f (CCB) pro l\u00e9\u010dbu an\u00e1ln\u00ed fisury. Diltiazem je v modern\u00edch protokolech preferov\u00e1n kv\u016fli men\u0161\u00edmu v\u00fdskytu bolest\u00ed hlavy ve srovn\u00e1n\u00ed s 0,2% mast\u00ed GTN. Injekce botulotoxinu a later\u00e1ln\u00ed intern\u00ed sfinkterotomie jsou l\u00e9\u010dbou druh\u00e9\/t\u0159et\u00ed linie.<\/div>\n<h3 class=\"wp-block-heading\">Pro\u010d objedn\u00e1vat z MedsBase<\/h3>\n<p>Crema Gel je dod\u00e1v\u00e1n z <strong>v\u00fdrobce certifikovan\u00e9ho WHO-GMP<\/strong>. Ka\u017ed\u00e1 objedn\u00e1vka je diskr\u00e9tn\u011b zas\u00edl\u00e1na po cel\u00e9m sv\u011bt\u011b a je pokryta na\u0161\u00ed <a href=\"https:\/\/medsbase.com\/cs\/medsbase-re-shipment-assurance-policy\/\">Z\u00e1rukou op\u011btovn\u00e9ho odesl\u00e1n\u00ed<\/a> \u2014 pokud nedoraz\u00ed do 20 pracovn\u00edch dn\u016f, p\u0159epos\u00edl\u00e1me zdarma. Topick\u00fd diltiazem je preferov\u00e1n p\u0159ed mast\u00ed GTN kv\u016fli v\u00fdrazn\u011b ni\u017e\u0161\u00edmu v\u00fdskytu bolest\u00ed hlavy (5\u201315 % oproti 35\u201350 % u GTN) p\u0159i zachov\u00e1n\u00ed podobn\u00e9 \u00fa\u010dinnosti hojen\u00ed.<\/p>\n<h2 class=\"wp-block-heading\">Mechanismus \u00fa\u010dinku<\/h2>\n<p>Diltiazem je nedihydropyridinov\u00fd blok\u00e1tor kalciov\u00fdch kan\u00e1l\u016f. P\u0159i topick\u00e9 aplikaci v an\u00e1ln\u00edm kan\u00e1lu uvol\u0148uje vnit\u0159n\u00ed an\u00e1ln\u00ed sv\u011bra\u010d (hladk\u00e9 svalstvo), \u010d\u00edm\u017e sni\u017euje klidov\u00fd an\u00e1ln\u00ed tlak (hlavn\u00ed faktor bolesti a isch\u00e9mie fisury) a zlep\u0161uje kapil\u00e1rn\u00ed perfuzi sliznice zadn\u00ed st\u0159edn\u00ed \u010d\u00e1ry. Ni\u017e\u0161\u00ed tlak sv\u011bra\u010de umo\u017e\u0148uje hojen\u00ed fisury. Syst\u00e9mov\u00e1 absorpce z 2% topick\u00e9 p\u0159\u00edpravky je minim\u00e1ln\u00ed (~10 %), tak\u017ee syst\u00e9mov\u00e9 \u00fa\u010dinky CCB (n\u00edzk\u00fd krevn\u00ed tlak, bradykardie, otoky nohou) jsou p\u0159i standardn\u00edch d\u00e1vk\u00e1ch zanedbateln\u00e9.<\/p>\n<h2 class=\"wp-block-heading\">Indikace<\/h2>\n<ul>\n<li>Chronick\u00e1 an\u00e1ln\u00ed fisura (definovan\u00e1 jako trvaj\u00edc\u00ed &gt; 6 t\u00fddn\u016f)<\/li>\n<li>Akutn\u00ed an\u00e1ln\u00ed fisura, kter\u00e1 se nezhojila sedac\u00edmi koupelemi, vl\u00e1kninou a topickou analgezi\u00ed<\/li>\n<li>Bolestiv\u00fd spasmus sv\u011bra\u010de po hemoroidektomii (mimo schv\u00e1len\u00e9 indikace)<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Jak se p\u0159ihl\u00e1sit<\/h2>\n<ol>\n<li>Umyjte si ruce; na ukazov\u00e1\u010dek lze pou\u017e\u00edt prstov\u00fd n\u00e1vlek nebo rukavici, pokud je to preferov\u00e1no.<\/li>\n<li>Vytla\u010dte mno\u017estv\u00ed velikosti hr\u00e1\u0161ku na kone\u010dek prstu.<\/li>\n<li>Zave\u010fte ~1 cm do an\u00e1ln\u00edho kan\u00e1lu a rozet\u0159ete v oblasti fisury; nebo aplikujte na okraj fisury, pokud je vnit\u0159n\u00ed aplikace p\u0159\u00edli\u0161 nep\u0159\u00edjemn\u00e1.<\/li>\n<li>Aplikujte 2\u20133\u00d7 denn\u011b, ide\u00e1ln\u011b po stolici a sedac\u00ed koupeli.<\/li>\n<li>Pokra\u010dujte po dobu 6\u20138 t\u00fddn\u016f. P\u0159esta\u0148te, jakmile se fisura zahoj\u00ed (bez bolesti a krv\u00e1cen\u00ed) po dobu alespo\u0148 1\u20132 t\u00fddn\u016f.<\/li>\n<\/ol>\n<h2 class=\"wp-block-heading\">Vedlej\u0161\u00ed \u00fa\u010dinky<\/h2>\n<ul>\n<li>Lok\u00e1ln\u00ed: sv\u011bd\u011bn\u00ed, p\u00e1len\u00ed, kontaktn\u00ed dermatitida (5\u201310 %)<\/li>\n<li>Syst\u00e9mov\u00e9 (vz\u00e1cn\u00e9): bolest hlavy (5\u201315 % \u2013 v\u00fdrazn\u011b m\u00e9n\u011b ne\u017e u GTN), z\u00e1vrat\u011b, palpitace<\/li>\n<li>Opatrnost u srde\u010dn\u00edho bloku (vz\u00e1cn\u00e9 u topick\u00e9 aplikace), t\u011b\u017ek\u00e9 hypotenze<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Pomocn\u00e9 prost\u0159edky \u2014 bez nich gel neuzdrav\u00ed fisuru<\/h2>\n<ul>\n<li><strong>Vysokovl\u00e1knit\u00e1 strava:<\/strong> 25\u201335 g\/den z psyllia, zeleniny, ovoce, celozrnn\u00fdch obilovin.<\/li>\n<li><strong>Dostate\u010dn\u00fd p\u0159\u00edjem vody<\/strong> (2 l\/den).<\/li>\n<li><strong>Sedac\u00ed koupele<\/strong> 10\u201315 minut po ka\u017ed\u00e9 stolici.<\/li>\n<li><strong>Zm\u011bk\u010dova\u010d stolice<\/strong> (PEG, laktul\u00f3za) pokud p\u0159etrv\u00e1v\u00e1 tuh\u00e1 stolice.<\/li>\n<li><strong>Nesna\u017eit se n\u00e1sil\u00edm, neproj\u00ed\u017ed\u011bt telefonem na toalet\u011b.<\/strong><\/li>\n<\/ul>\n<h2 id=\"faqs\">\u010casto kladen\u00e9 dotazy<\/h2>\n<h3 class=\"wp-block-heading\">Jak dlouho to trv\u00e1, ne\u017e za\u010dne \u00fa\u010dinkovat?<\/h3>\n<p>Bolest \u010dasto ustupuje b\u011bhem 1\u20132 t\u00fddn\u016f. \u00dapln\u00e9 zahojen\u00ed fisury trv\u00e1 6\u20138 t\u00fddn\u016f. Pokra\u010dujte v aplikaci alespo\u0148 2 t\u00fddny po vymizen\u00ed p\u0159\u00edznak\u016f, abyste p\u0159ede\u0161li recidiv\u011b.<\/p>\n<h3 class=\"wp-block-heading\">Pro\u010d to bol\u00ed p\u0159i aplikaci?<\/h3>\n<p>Samotn\u00fd gel nebol\u00ed, ale oblast fisury ano. Aplikace po sedac\u00ed koupeli uvoln\u00ed sv\u011bra\u010d a sn\u00ed\u017e\u00ed bolest p\u0159i nan\u00e1\u0161en\u00ed. Lok\u00e1ln\u00ed anestetikum (lidokain 2% gel) p\u0159ed aplikac\u00ed diltiazemu m\u016f\u017ee pomoci v prvn\u00edm t\u00fddnu.<\/p>\n<h3 class=\"wp-block-heading\">Mohu jej pou\u017e\u00edvat spolu s GTN mast\u00ed?<\/h3>\n<p>Ne \u2013 oba jsou vazodilat\u00e1tory a jejich kombinace zvy\u0161uje riziko hypotenze a siln\u00fdch bolest\u00ed hlavy, ani\u017e by zlep\u0161ila hojen\u00ed.<\/p>\n<h3 class=\"wp-block-heading\">Co kdy\u017e se nehoj\u00ed za 8 t\u00fddn\u016f?<\/h3>\n<p>Doporu\u010dte pacienta ke kolorekt\u00e1ln\u00edmu chirurgovi. Mo\u017enosti zahrnuj\u00ed vy\u0161\u0161\u00ed koncentraci, p\u0159echod na topick\u00fd nifedipin, injekci botulotoxinu nebo later\u00e1ln\u00ed intern\u00ed sfinkterotomii (zlat\u00fd standard chirurgick\u00e9 l\u00e9\u010dby, 95% \u00fasp\u011b\u0161nost, ale ~5% riziko dlouhodob\u00e9 inkontinence).<\/p>\n<h3 class=\"wp-block-heading\">Je bezpe\u010dn\u00fd v t\u011bhotenstv\u00ed?<\/h3>\n<p>Omezen\u00e1 data. Topick\u00e1 absorpce je mal\u00e1, ale doporu\u010duje se opatrnost. Nejprve vyzkou\u0161ejte sedac\u00ed koupele, vl\u00e1kninu, laktul\u00f3zu a lok\u00e1ln\u00ed anestetikum. Proberte s p\u0159edepisuj\u00edc\u00edm l\u00e9ka\u0159em v t\u011bhotenstv\u00ed.<\/p>\n<h3 class=\"wp-block-heading\">Mohu m\u00edt pohlavn\u00ed styk p\u0159i jeho pou\u017e\u00edv\u00e1n\u00ed?<\/h3>\n<p>Gel se m\u016f\u017ee p\u0159i an\u00e1ln\u00edm styku p\u0159en\u00e9st na partnera a zp\u016fsobit m\u00edrn\u00e9 lok\u00e1ln\u00ed \u00fa\u010dinky. Po\u010dkejte alespo\u0148 1\u20132 hodiny po aplikaci nebo pou\u017eijte bari\u00e9rovou ochranu.<\/p>\n<h3 class=\"wp-block-heading\">Pro\u010d si m\u016fj partner st\u011b\u017euje na bolest hlavy?<\/h3>\n<p>P\u0159enosn\u00fd topick\u00fd CCB m\u016f\u017ee zp\u016fsobit m\u00edrnou bolest hlavy. D\u016fkladn\u011b si umyjte ruce a perian\u00e1ln\u00ed oblast p\u0159ed intimn\u00edm kontaktem.<\/p>\n<h3 class=\"wp-block-heading\">Bude se prop\u00edrat na spodn\u00ed pr\u00e1dlo?<\/h3>\n<p>M\u016f\u017ee doj\u00edt k p\u0159enosu tenk\u00e9ho mastn\u00e9ho filmu. B\u011bhem prvn\u00edch 30 minut po aplikaci pou\u017eijte vlo\u017eku.<\/p>\n<h3 class=\"wp-block-heading\">Skladov\u00e1n\u00ed<\/h3>\n<p>Skladujte p\u0159i teplot\u011b pod 25\u00b0C, neuchov\u00e1vejte v chladni\u010dce. Uchov\u00e1vejte tubu pevn\u011b uzav\u0159enou. Zlikvidujte 4 t\u00fddny po prvn\u00edm otev\u0159en\u00ed.<\/p>\n<h3 class=\"wp-block-heading\">Co kdy\u017e vynech\u00e1m d\u00e1vku?<\/h3>\n<p>Aplikujte, kdy\u017e si vzpomenete, a pokra\u010dujte v pl\u00e1nu. Vynech\u00e1n\u00ed jedn\u00e9 nebo dvou d\u00e1vek nezp\u016fsob\u00ed ztr\u00e1tu l\u00e9\u010debn\u00e9ho \u00fa\u010dinku \u2013 d\u016fle\u017eit\u00e1 je pravidelnost v pr\u016fb\u011bhu t\u00fddn\u016f.<\/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\/anovate\/\">Anovate \u2013 kr\u00e9m s beklometazonem, fenylefrinem a lidokainem<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/movicol-sachets\/\">Movicol \u2013 osmotick\u00e9 proj\u00edmadlo s PEG<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/duphalac\/\">Duphalac \u2013 laktul\u00f3za<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/cremalax\/\">Cremalax \u2013 bisakodyl<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/dulcolax\/\">Dulcolax \u2013 bisakodyl<\/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>\n<div style=\"background:#fff3f3;border-left:4px solid #d9534f;padding:16px 20px;margin:24px 0;border-radius:4px;\"><strong>\u2695 L\u00e9ka\u0159sk\u00e9 upozorn\u011bn\u00ed.<\/strong> Tato str\u00e1nka slou\u017e\u00ed pouze pro informa\u010dn\u00ed \u00fa\u010dely a nenahrazuje l\u00e9ka\u0159skou pomoc kvalifikovan\u00e9ho zdravotnick\u00e9ho pracovn\u00edka. P\u0159etrv\u00e1vaj\u00edc\u00ed rekt\u00e1ln\u00ed krv\u00e1cen\u00ed, zm\u011bna ve vyprazd\u0148ov\u00e1n\u00ed, \u00fabytek hmotnosti nebo fisura, kter\u00e1 se nehoj\u00ed b\u011bhem 6\u20138 t\u00fddn\u016f, vy\u017eaduj\u00ed vy\u0161et\u0159en\u00ed u kolorekt\u00e1ln\u00edho specialisty k vylou\u010den\u00ed z\u00e1n\u011btliv\u00e9ho st\u0159evn\u00edho onemocn\u011bn\u00ed, infekce (HIV, syfilis) nebo malignity.<\/div>","protected":false},"excerpt":{"rendered":"<p>Crema Gel (Diltiazem 2% topick\u00fd, 30 g tuba) \u2014 blok\u00e1tor kalciov\u00fdch kan\u00e1l\u016f pro chronickou an\u00e1ln\u00ed fisuru. Ni\u017e\u0161\u00ed v\u00fdskyt bolest\u00ed hlavy ne\u017e u nitroglycerinov\u00e9 masti. V\u00fdrobce certifikovan\u00fd WHO-GMP. Celosv\u011btov\u00e1 doprava z MedsBase.<\/p>","protected":false},"featured_media":56731,"comment_status":"open","ping_status":"open","template":"","meta":[],"product_brand":[],"product_cat":[3141,3542,3342],"product_tag":[4162,3360],"class_list":{"0":"post-56730","1":"product","2":"type-product","3":"status-publish","4":"has-post-thumbnail","6":"product_cat-category-overview","7":"product_cat-gastro-health","8":"product_cat-general-health","9":"product_tag-crema-gel","10":"product_tag-diltiazem","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\/56730","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=56730"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/media\/56731"}],"wp:attachment":[{"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/media?parent=56730"}],"wp:term":[{"taxonomy":"product_brand","embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_brand?post=56730"},{"taxonomy":"product_cat","embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_cat?post=56730"},{"taxonomy":"product_tag","embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_tag?post=56730"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}