{"id":57155,"date":"2024-02-27T17:26:20","date_gmt":"2024-02-27T17:26:20","guid":{"rendered":"https:\/\/medsname.com\/amifru\/"},"modified":"2026-05-01T10:49:13","modified_gmt":"2026-05-01T10:49:13","slug":"amifru","status":"publish","type":"product","link":"https:\/\/medsbase.com\/cs\/product\/amifru\/","title":{"rendered":"Amifru"},"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 Amifru?<\/h3>\n<p style=\"margin:0;\"><strong>Amifru<\/strong> je <strong>40\/5 mg fixn\u00ed kombinace tablety<\/strong> z <strong>furosemid (frusemid)<\/strong> \u2014 kli\u010dkov\u00e9 diuretikum \u2014 a <strong>amilorid<\/strong> \u2014 \u0161et\u0159\u00edc\u00ed drasl\u00edk diuretikum \u2014 od Sun Pharma. Kombinace se pou\u017e\u00edv\u00e1, kdy\u017e je pot\u0159eba kli\u010dkov\u00e9 diuretikum, ale <strong>hypokal\u00e9mie je probl\u00e9m<\/strong> \u2014 amilorid blokuje ztr\u00e1tu drasl\u00edku v dist\u00e1ln\u00edch tubulech zp\u016fsobenou aktivac\u00ed aldosteronu, \u010d\u00edm\u017e vyva\u017euje \u00fabytek drasl\u00edku zp\u016fsoben\u00fd sod\u00edkovou z\u00e1t\u011b\u017e\u00ed furosemidu. B\u011b\u017en\u00e9 pou\u017eit\u00ed: hypertenze s otoky, chronick\u00e9 srde\u010dn\u00ed selh\u00e1n\u00ed s tendenc\u00ed k hypokal\u00e9mii, jatern\u00ed ascites, kde spironolakton s\u00e1m o sob\u011b neposkytuje dostate\u010dn\u00e9 \u0161et\u0159en\u00ed drasl\u00edku. Typick\u00e9 d\u00e1vkov\u00e1n\u00ed: jedna tableta jednou denn\u011b r\u00e1no (n\u011bkte\u0159\u00ed pacienti vy\u017eaduj\u00ed dvakr\u00e1t denn\u011b). <strong>Absolutn\u011b kontraindikov\u00e1no p\u0159i anurii, hyperkal\u00e9mii &gt;5,5, t\u011b\u017ek\u00e9 CKD (eGFR &lt;30) a Addisonov\u011b chorob\u011b<\/strong>. Monitorujte drasl\u00edk, sod\u00edk a kreatinin p\u0159i zah\u00e1jen\u00ed l\u00e9\u010dby a pravideln\u011b pot\u00e9.<\/p>\n<\/div>\n<div class=\"medsbase-trust-strip\" style=\"background:#f4f8fb;border:1px solid #d8e3eb;padding:12px 16px;margin:16px 0;border-radius:4px;font-size:14px;\">\n<strong>Co 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 <a href=\"https:\/\/medsbase.com\/cs\/reviews\/\">recenz\u00ed z\u00e1kazn\u00edk\u016f<\/a>\n<\/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 Amifru?<\/h2>\n<p>Amifru je peror\u00e1ln\u00ed tableta s fixn\u00ed kombinac\u00ed obsahuj\u00edc\u00ed <strong>furosemid (frusemid)<\/strong> a <strong>amilorid<\/strong> v jedn\u00e9 tablet\u011b (typick\u00fd pom\u011br 40 mg furosemidu + 5 mg amiloridu na tabletu). V\u00fdrobce Sun Pharma, dod\u00e1v\u00e1no v balen\u00ed 30-180 tablet.<\/p>\n<p>Furosemid je referen\u010dn\u00ed kli\u010dkov\u00e9 diuretikum, zaveden\u00e9 v roce 1964 jako Lasix. Amilorid je \u0161et\u0159\u00edc\u00ed drasl\u00edk diuretikum p\u016fsob\u00edc\u00ed na epiteli\u00e1ln\u00ed sod\u00edkov\u00fd kan\u00e1l (ENaC) v dist\u00e1ln\u00edm tubulu \u2014 zaveden\u00fd spole\u010dnost\u00ed MSD v roce 1967 speci\u00e1ln\u011b pro kompenzaci ztr\u00e1ty drasl\u00edku zp\u016fsoben\u00e9 thiazidov\u00fdmi a kli\u010dkov\u00fdmi diuretiky.<\/p>\n<h2 class=\"wp-block-heading\">Pro\u010d kombinovat furosemid s amiloridem?<\/h2>\n<p>Kli\u010dkov\u00e1 diuretika dod\u00e1vaj\u00ed do dist\u00e1ln\u00edho tubulu velk\u00e9 mno\u017estv\u00ed sod\u00edku. Aldosteron pak stimuluje zp\u011btn\u00e9 vst\u0159eb\u00e1v\u00e1n\u00ed sod\u00edku v dist\u00e1ln\u00edm tubulu v\u00fdm\u011bnou za vylu\u010dov\u00e1n\u00ed drasl\u00edku \u2014 klasick\u00fd mechanismus hypokal\u00e9mie vyvolan\u00e9 kli\u010dkov\u00fdmi diuretiky. Dv\u011b protistrategie:<\/p>\n<ul>\n<li><strong>Blokovat mineralokortikoidn\u00ed receptor<\/strong> (spironolakton, eplerenon) \u2014 zabra\u0148uje signalizaci aldosteronu.<\/li>\n<li><strong>P\u0159\u00edmo blokovat epiteli\u00e1ln\u00ed sod\u00edkov\u00fd kan\u00e1l<\/strong> (amilorid, triamteren) \u2014 p\u016fsob\u00ed na \u00farovni pod aldosteronem, tak\u017ee funguje bez ohledu na to, zda je aldosteron zv\u00fd\u0161en\u00fd \u010di nikoliv.<\/li>\n<\/ul>\n<p>Amilorid je preferov\u00e1n p\u0159ed spironolaktonem, kdy\u017e:<\/p>\n<ul>\n<li>Pacient vyvinul gynekomastii nebo mastalgii p\u0159i u\u017e\u00edv\u00e1n\u00ed spironolaktonu<\/li>\n<li>Eplerenon (selektivn\u00ed antagonista MR) nen\u00ed dostupn\u00fd nebo je finan\u010dn\u011b nedostupn\u00fd<\/li>\n<li>Je pot\u0159eba rychl\u00fd \u0161et\u0159\u00edc\u00ed \u00fa\u010dinek na drasl\u00edk \u2014 amilorid p\u016fsob\u00ed b\u011bhem hodin, spironolakton pot\u0159ebuje 24-72 hodin<\/li>\n<li>Pacient nesn\u00e1\u0161\u00ed antiandrogenn\u00ed \u00fa\u010dinky spironolaktonu<\/li>\n<\/ul>\n<p>Amifru je zvl\u00e1\u0161t\u011b u\u017eite\u010dn\u00fd p\u0159i <strong>jatern\u00ed ascites<\/strong> (kde jsou ztr\u00e1ty drasl\u00edku \u010dasto v\u00fdrazn\u00e9), <strong>pacienti s chronick\u00fdm srde\u010dn\u00edm selh\u00e1n\u00edm a labiln\u00edm drasl\u00edkem<\/strong>, a <strong>pacienti, kte\u0159\u00ed pot\u0159ebuj\u00ed rychl\u00fd \u00fa\u010dinek kli\u010dkov\u00e9ho diuretika bez poklesu drasl\u00edku<\/strong>.<\/p>\n<h2 class=\"wp-block-heading\">D\u00e1vkov\u00e1n\u00ed &amp; Titrace<\/h2>\n<p><strong>Standardn\u00ed d\u00e1vka:<\/strong> jedna tableta 40\/5 mg jednou denn\u011b r\u00e1no.<\/p>\n<p><strong>Titrace:<\/strong> <\/p>\n<ul>\n<li>Srde\u010dn\u00ed selh\u00e1n\u00ed nebo otoky nekontrolovan\u00e9 jednou tabletou: zv\u00fd\u0161it na dv\u011b tablety denn\u011b nebo p\u0159idat rozd\u011blenou d\u00e1vku r\u00e1no a \u010dasn\u011b odpoledne (vyvarujte se ve\u010dern\u00edch d\u00e1vek \u2013 nokturie).<\/li>\n<li>Cirhotick\u00fd ascites: \u010dasto kombinov\u00e1n se spironolaktonem 100-200 mg pro \u00fapln\u00e9 blokov\u00e1n\u00ed aldosteronu.<\/li>\n<li>Hypertenze: d\u00e1vkov\u00e1n\u00ed jako v\u00fd\u0161e; v\u011bt\u0161ina hypertonik\u016f nepot\u0159ebuje kombinace s kli\u010dkov\u00fdmi diuretiky \u2013 pokud TK z\u016fst\u00e1v\u00e1 nekontrolovan\u00fd na kombinaci ACEi\/ARB + CCB + thiazid, p\u0159ejd\u011bte na spironolakton (PATHWAY-2) sp\u00ed\u0161e ne\u017e na kombinaci s kli\u010dkov\u00fdm diuretikem, pokud ren\u00e1ln\u00ed funkce ne\u010din\u00ed thiazid ne\u00fa\u010dinn\u00fdm.<\/li>\n<\/ul>\n<p><strong>Monitorovac\u00ed pl\u00e1n:<\/strong><\/p>\n<ul>\n<li><strong>Vstupn\u00ed vy\u0161et\u0159en\u00ed:<\/strong> mo\u010dovina, drasl\u00edk, sod\u00edk, kreatinin, eGFR. TK, denn\u00ed v\u00e1ha (p\u0159i srde\u010dn\u00edm selh\u00e1n\u00ed), s\u00e9rov\u00fd ur\u00e1t, gluk\u00f3za.<\/li>\n<li><strong>1-2 t\u00fddny po zah\u00e1jen\u00ed nebo zm\u011bn\u011b d\u00e1vky:<\/strong> opakovat U&amp;E. Sledujte jak hypokal\u00e9mii (pokud je amilorid nedostate\u010dn\u011b d\u00e1vkov\u00e1n), tak hyperkal\u00e9mii (pokud je aktivn\u00ed kombinace amilorid\/ACEi\/ARB).<\/li>\n<li><strong>4-6 t\u00fddn\u016f:<\/strong> kontrola TK; opakovat kompletn\u00ed panel.<\/li>\n<li><strong>Pr\u016fb\u011b\u017en\u00e9:<\/strong> ka\u017ed\u00e9 3-6 m\u011bs\u00edc\u016f, nebo \u010dast\u011bji u CKD nebo nestabiln\u00edho HF.<\/li>\n<li><strong>P\u0159eru\u0161te a vy\u0161et\u0159ete:<\/strong> drasl\u00edk 5,5, sod\u00edk 30%, dnav\u00fd z\u00e1chvat, p\u0159etrv\u00e1vaj\u00edc\u00ed z\u00e1vrat\u011b nebo postur\u00e1ln\u00ed p\u0159\u00edznaky.<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Vedlej\u0161\u00ed \u00fa\u010dinky<\/h2>\n<p><strong>\u010cast\u00e9 (&gt;1 %):<\/strong><\/p>\n<ul>\n<li>Zv\u00fd\u0161en\u00fd v\u00fddej mo\u010di, zejm\u00e9na v prvn\u00edch 1-2 hodin\u00e1ch po pod\u00e1n\u00ed<\/li>\n<li>Postur\u00e1ln\u00ed z\u00e1vrat\u011b (p\u0159ed\u00e1vkov\u00e1n\u00ed diuretiky)<\/li>\n<li>Posuny elektrolyt\u016f \u2014 hyponatr\u00e9mie, hypomagnez\u00e9mie. Drasl\u00edk obvykle stabiln\u00ed, ale hyperkal\u00e9mie mo\u017en\u00e1 p\u0159i nep\u0159im\u011b\u0159en\u011b vysok\u00e9 d\u00e1vce amiloridu nebo p\u0159i kombinaci s ACEi\/ARB.<\/li>\n<li>Hyperurik\u00e9mie a dnav\u00fd z\u00e1chvat<\/li>\n<li>M\u00edrn\u00e1 hyperglyk\u00e9mie<\/li>\n<li>Vyr\u00e1\u017eka (p\u0159ecitliv\u011blost na sulfonamidy m\u016f\u017ee postihnout ob\u011b slo\u017eky)<\/li>\n<li>\u00danava, svalov\u00e9 k\u0159e\u010de<\/li>\n<\/ul>\n<p><strong>Nep\u0159\u00edli\u0161 \u010dast\u00e9, ale klinicky v\u00fdznamn\u00e9:<\/strong><\/p>\n<ul>\n<li><strong>T\u011b\u017ek\u00e1 hyperkal\u00e9mie<\/strong> \u2014 hlavn\u00ed riziko p\u0159i kombinaci amiloridu s ACEi, ARB, dopl\u0148ky drasl\u00edku nebo u CKD<\/li>\n<li><strong>T\u011b\u017ek\u00e1 hyponatr\u00e9mie<\/strong> \u2014 \u010dast\u011bj\u0161\u00ed u star\u0161\u00edch \u017een na n\u00edzkosoln\u00fdch diet\u00e1ch<\/li>\n<li><strong>Akutn\u00ed po\u0161kozen\u00ed ledvin<\/strong> \u2014 zejm\u00e9na p\u0159i kombinovan\u00e9 terapii NSAID + ACEi\/ARB (tzv. \u201ctriple whammy\u201d)<\/li>\n<li><strong>Ototoxicita<\/strong> p\u0159i vysok\u00fdch intraven\u00f3zn\u00edch d\u00e1vk\u00e1ch furosemidu (neplat\u00ed pro standardn\u00ed peror\u00e1ln\u00ed d\u00e1vky)<\/li>\n<li><strong>Pankreatitida<\/strong> (vz\u00e1cn\u00fd \u00fa\u010dinek t\u0159\u00eddy kli\u010dkov\u00fdch\/thiazidov\u00fdch diuretik)<\/li>\n<li><strong>Cholestatick\u00e1 \u017eloutenka<\/strong> (vz\u00e1cn\u00e9)<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Kontraindikace<\/h2>\n<ul>\n<li><strong>Hyperkal\u00e9mie &gt;5,5 mmol\/l v\u00fdchoz\u00ed<\/strong> \u2014 amilorid zhor\u0161\u00ed<\/li>\n<li><strong>T\u011b\u017ek\u00e9 ren\u00e1ln\u00ed posti\u017een\u00ed (eGFR &lt;30)<\/strong><\/li>\n<li><strong>Anurie<\/strong><\/li>\n<li><strong>Addisonova choroba<\/strong> (prim\u00e1rn\u00ed adren\u00e1ln\u00ed insuficience) \u2014 riziko hyperkal\u00e9mie<\/li>\n<li><strong>Sou\u010dasn\u00e9 pod\u00e1v\u00e1n\u00ed dopl\u0148k\u016f drasl\u00edku<\/strong> (pokud nen\u00ed pod pe\u010dliv\u00fdm dohledem)<\/li>\n<li><strong>Sou\u010dasn\u00e9 pod\u00e1v\u00e1n\u00ed dal\u0161\u00edho diuretika \u0161et\u0159\u00edc\u00edho drasl\u00edk<\/strong> (spironolakton, eplerenon, triamteren) \u2014 aditivn\u00ed hyperkal\u00e9mie<\/li>\n<li><strong>P\u0159ecitliv\u011blost na sulfonamidy<\/strong> (pro slo\u017eku furosemidu)<\/li>\n<li><strong>T\u011b\u017ek\u00e9 jatern\u00ed po\u0161kozen\u00ed s jatern\u00ed encefalopati\u00ed<\/strong> \u2014 riziko vyvol\u00e1n\u00ed k\u00f3matu v d\u016fsledku posunu elektrolyt\u016f<\/li>\n<li><strong>T\u011b\u017ek\u00e1 dehydratace a preren\u00e1ln\u00ed azot\u00e9mie<\/strong><\/li>\n<li><strong>p\u0159i vstupn\u00edm vy\u0161et\u0159en\u00ed \u2014 zhor\u0161\u00ed se<\/strong> p\u0159i v\u00fdchoz\u00edm vy\u0161et\u0159en\u00ed<\/li>\n<\/ul>\n<p><strong>T\u011bhotenstv\u00ed:<\/strong> obecn\u011b se nedoporu\u010duje. Kli\u010dkov\u00e1 diuretika proch\u00e1zej\u00ed placentou; \u00fadaje o amiloridu v t\u011bhotenstv\u00ed jsou omezen\u00e9. Pou\u017e\u00edvejte pouze pro p\u0159esv\u011bd\u010div\u00e9 indikace (plicn\u00ed ed\u00e9m) pod odborn\u00fdm dohledem.<\/p>\n<h2 class=\"wp-block-heading\">Interakce s l\u00e9\u010divy<\/h2>\n<ul>\n<li><strong>ACE inhibitory, ARB, aliskiren<\/strong> \u2014 <strong>aditivn\u00ed hyperkal\u00e9mie<\/strong>. Kombinace je n\u011bkdy nutn\u00e1 u srde\u010dn\u00edho selh\u00e1n\u00ed, ale vy\u017eaduje pe\u010dliv\u00e9 monitorov\u00e1n\u00ed (K+ po 1 t\u00fddnu, 1 m\u011bs\u00edci, pot\u00e9 ka\u017ed\u00e9 3 m\u011bs\u00edce). Vyhn\u011bte se p\u0159i eGFR &lt;45.<\/li>\n<li><strong>Dopl\u0148ky drasl\u00edku, n\u00e1hrady soli, dal\u0161\u00ed diuretika \u0161et\u0159\u00edc\u00ed drasl\u00edk<\/strong> \u2014 riziko hyperkal\u00e9mie. Obecn\u011b nekombinujte.<\/li>\n<li><strong>Lithium \u2014 KRITICK\u00c9.<\/strong> Slo\u017eka furosemidu sni\u017euje clearance lithia; p\u0159i nevyhnuteln\u00e9 kombinaci monitorujte hladiny t\u00fddn\u011b prvn\u00ed m\u011bs\u00edc a sni\u017ete d\u00e1vku lithia o 25-50%.<\/li>\n<li><strong>NSAID<\/strong> \u2014 sni\u017euje diuretick\u00fd \u00fa\u010dinek; v\u00fdrazn\u011b zvy\u0161uje riziko akutn\u00edho po\u0161kozen\u00ed ledvin (AKI) v kombinaci s ACEi\/ARB (trojit\u00fd efekt).<\/li>\n<li><strong>Digoxin<\/strong> \u2014 pe\u010dliv\u011b sledujte hladinu drasl\u00edku; hypokal\u00e9mie vyvol\u00e1v\u00e1 toxicitu digoxinu; monitorujte hladiny digoxinu.<\/li>\n<li><strong>Aminoglykosidov\u00e1 antibiotika (gentamicin, amikacin)<\/strong> \u2014 aditivn\u00ed ototoxicita s furosemidem p\u0159i vysok\u00fdch intraven\u00f3zn\u00edch d\u00e1vk\u00e1ch.<\/li>\n<li><strong>Kortikosteroidy, amfotericin B<\/strong> \u2014 aditivn\u00ed poruchy elektrolyt\u016f.<\/li>\n<li><strong>Cholestyramin \/ colestipol<\/strong> \u2014 sni\u017euje absorpci furosemidu o 50%. Odd\u011blte pod\u00e1v\u00e1n\u00ed o 4 hodiny.<\/li>\n<li><strong>Alkohol<\/strong> \u2014 aditivn\u00ed ortostatick\u00e1 hypotenze.<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Skladov\u00e1n\u00ed<\/h2>\n<p>Skladujte Amifru p\u0159i teplot\u011b pod 25\u00b0C v p\u016fvodn\u00edm blistru. Uchov\u00e1vejte mimo dosah d\u011bt\u00ed.<\/p>\n<h2 id=\"faqs\">\u010casto kladen\u00e9 dotazy<\/h2>\n<h3 class=\"wp-block-heading\">Pro\u010d bych si m\u011bl(a) vybrat Amifru m\u00edsto \u010dist\u00e9ho furosemidu?<\/h3>\n<p>T\u0159i situace. Za prv\u00e9, pokud jste p\u0159i u\u017e\u00edv\u00e1n\u00ed samotn\u00e9ho furosemidu dostali hypokal\u00e9mii a chcete <strong>vestav\u011bnou \u0161et\u0159\u00edc\u00ed slo\u017eku drasl\u00edku.<\/strong> bez p\u0159id\u00e1n\u00ed samostatn\u00e9 tablety spironolaktonu. Za druh\u00e9, pokud jste u v\u00e1s vznikla gynekomastie nebo bolest prs\u016f p\u0159i u\u017e\u00edv\u00e1n\u00ed spironolaktonu a pot\u0159ebujete nesteroidn\u00ed alternativu. Za t\u0159et\u00ed, pokud <strong>rychl\u00fd \u0161et\u0159\u00edc\u00ed \u00fa\u010dinek na drasl\u00edk<\/strong> je pot\u0159eba \u2014 amilorid p\u016fsob\u00ed b\u011bhem hodin, zat\u00edmco spironolakton pot\u0159ebuje 24\u201372 hodin prost\u0159ednictv\u00edm sv\u00fdch aktivn\u00edch metabolit\u016f.<\/p>\n<h3 class=\"wp-block-heading\">Kdy bych m\u011bl u\u017e\u00edvat Amifru?<\/h3>\n<p>R\u00e1no, s j\u00eddlem nebo bez. Diuretick\u00fd \u00fa\u010dinek vrchol\u00ed 1\u20132 hodiny po pod\u00e1n\u00ed a ve\u010der je v\u011bt\u0161inou pry\u010d. Ve\u010dern\u00ed d\u00e1vkov\u00e1n\u00ed zp\u016fsobuje nokturii a naru\u0161uje sp\u00e1nek.<\/p>\n<h3 class=\"wp-block-heading\">M\u016f\u017eu u\u017e\u00edvat Amifru s ACE inhibitorem nebo ARB?<\/h3>\n<p>Ano, s monitorov\u00e1n\u00edm. Kombinace amiloridu + ACE inhibitoru (nebo + ARB) v\u00fdznamn\u011b zvy\u0161uje hladinu drasl\u00edku a m\u011bla by se vyhnout u pokro\u010dil\u00e9ho CKD (eGFR 5,0. Pokud se kombinuje, kontrolujte drasl\u00edk za 1 t\u00fdden, 1 m\u011bs\u00edc a ka\u017ed\u00e9 3 m\u011bs\u00edce. Mnoho pacient\u016f v t\u00e9to situaci l\u00e9pe toleruje samotn\u00e9 kli\u010dkov\u00e9 diuretikum + ACEi\/ARB (bez amiloridu) a v p\u0159\u00edpad\u011b pot\u0159eby p\u0159ij\u00edm\u00e1 dopln\u011bk drasl\u00edku.<\/p>\n<h3 class=\"wp-block-heading\">Je Amifru l\u00e9kem prvn\u00ed volby na krevn\u00ed tlak?<\/h3>\n<p>Ne. Kombinace kli\u010dkov\u00fdch diuretik jsou ur\u010deny pro specifick\u00e9 indikace \u2014 hypertenzi s otoky nebo pokro\u010dil\u00fdm CKD, chronick\u00fdm srde\u010dn\u00edm selh\u00e1n\u00edm nebo cirhotickou ascites. U standardn\u00ed hypertenze za\u010dn\u011bte s ARB nebo ACE inhibitorem, p\u0159idejte blok\u00e1tor kalciov\u00fdch kan\u00e1l\u016f nebo thiazid a p\u0159ejd\u011bte na spironolakton (studie PATHWAY-2) p\u0159ed kombinac\u00ed s kli\u010dkov\u00fdm diuretikem.<\/p>\n<h3 class=\"wp-block-heading\">Ztrat\u00edm nebo z\u00edsk\u00e1m drasl\u00edk p\u0159i u\u017e\u00edv\u00e1n\u00ed Amifru?<\/h3>\n<p>Kombinace je navr\u017eena tak, aby byla <strong>neutr\u00e1ln\u00ed k drasl\u00edku<\/strong> \u2014 furosemid ztr\u00e1c\u00ed drasl\u00edk, amilorid jej \u0161et\u0159\u00ed a v\u00fdsledn\u00fd efekt je obvykle stabiln\u00ed hladina drasl\u00edku. Mal\u00fd po\u010det pacient\u016f se m\u016f\u017ee posunout jedn\u00edm nebo druh\u00fdm sm\u011brem v z\u00e1vislosti na strav\u011b, funkci ledvin a sou\u010dasn\u00fdch l\u00e9c\u00edch (ACEi\/ARB zvy\u0161uj\u00ed drasl\u00edk; kortikosteroidy jej sni\u017euj\u00ed). Zkontrolujte drasl\u00edk na za\u010d\u00e1tku a za 1\u20132 t\u00fddny, abyste vid\u011bli, kter\u00fdm sm\u011brem se posouv\u00e1te.<\/p>\n<h3 class=\"wp-block-heading\">M\u00e1m dnu \u2014 m\u016f\u017eu u\u017e\u00edvat Amifru?<\/h3>\n<p>S opatrnost\u00ed. Slo\u017eka furosemidu m\u016f\u017ee zv\u00fd\u0161it s\u00e9rovou kyselinu mo\u010dovou a vyvolat z\u00e1chvaty dny. Pokud je dna aktivn\u00ed, \u0159e\u0161te dnu terapi\u00ed sni\u017euj\u00edc\u00ed hladinu ur\u00e1t\u016f (allopurinolem) sp\u00ed\u0161e ne\u017e \u00fapln\u00fdm vysazen\u00edm Amifru \u2014 z\u00e1kladn\u00ed indikace (srde\u010dn\u00ed selh\u00e1n\u00ed, otoky, pokro\u010dil\u00e9 CKD) obvykle nelze zvl\u00e1dnout bez kli\u010dkov\u00e9ho diuretika.<\/p>\n<h3 class=\"wp-block-heading\">Mohu u\u017e\u00edvat ibuprofen s Amifru?<\/h3>\n<p>Chronick\u00e9 u\u017e\u00edv\u00e1n\u00ed NSAID je rizikov\u00e9 v kombinaci s jak\u00fdmkoli kli\u010dkov\u00fdm diuretikem \u2014 sni\u017euj\u00ed diuretick\u00fd \u00fa\u010dinek a v\u00fdrazn\u011b zvy\u0161uj\u00ed riziko akutn\u00edho po\u0161kozen\u00ed ledvin (AKI) v kombinaci s ACE inhibitorem nebo ARB. P\u0159i chronick\u00e9 bolesti up\u0159ednost\u0148ujte paracetamol.<\/p>\n<h3 class=\"wp-block-heading\">Co kdy\u017e vynech\u00e1m d\u00e1vku?<\/h3>\n<p>U\u017eijte d\u00e1vku, jakmile si vzpomenete, pokud nen\u00ed t\u00e9m\u011b\u0159 \u010das na dal\u0161\u00ed d\u00e1vku \u2014 v tom p\u0159\u00edpad\u011b vynechejte zapomenutou d\u00e1vku. Neduplikujte d\u00e1vky. Jedna vynechan\u00e1 d\u00e1vka p\u0159i chronick\u00e9m srde\u010dn\u00edm selh\u00e1n\u00ed m\u016f\u017ee v\u00e9st k hromad\u011bn\u00ed tekutin; n\u00e1sleduj\u00edc\u00ed den kontrolujte hmotnost.<\/p>\n<h3 class=\"wp-block-heading\">Mohu u\u017e\u00edvat Amifru v t\u011bhotenstv\u00ed?<\/h3>\n<p>Rutinn\u011b se nedoporu\u010duje. Kli\u010dkov\u00e1 diuretika prostupuj\u00ed placentou a \u00fadaje o amiloridu v t\u011bhotenstv\u00ed jsou omezen\u00e9. Pou\u017e\u00edvejte pouze p\u0159i z\u00e1va\u017en\u00fdch indikac\u00edch (plicn\u00ed ed\u00e9m, rezistentn\u00ed srde\u010dn\u00ed selh\u00e1n\u00ed) pod odborn\u00fdm dohledem.<\/p>\n<h3 class=\"wp-block-heading\">Kde lze koupit Amifru online?<\/h3>\n<p>Amifru (40\/5 mg furosemid + amilorid, 30-180 tablet) m\u016f\u017eete koupit na MedsBase s diskr\u00e9tn\u00edm balen\u00edm a celosv\u011btovou dopravou.<\/p>\n<h2 class=\"wp-block-heading\">Souvisej\u00edc\u00ed antihypertenziva a diuretika na MedsBase<\/h2>\n<ul>\n<li><a href=\"https:\/\/medsbase.com\/cs\/aldactone\/\">Aldactone \u2014 Spironolakton 25 mg (antagonista aldosteronu)<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/amlode\/\">Amlode \u2014 Amlodipin 5\/10 mg (BKK)<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/aquazide\/\">Aquazide \u2014 Hydrochlorothiazid (HCTZ) thiazid<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/hyros\/\">Hyros \u2014 Hydrochlorothiazid (HCTZ)<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/losar\/\">Losar \u2014 Losartan (ARB v kombinaci s diuretiky)<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/ramcor\/\">Ramcor \u2014 Ramipril (ACE inhibitor jako partner pro diuretikum)<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/high-blood-pressure-medication\/\"><strong>Prohl\u00e9dnout v\u0161echny l\u00e9ky na vysok\u00fd krevn\u00ed tlak<\/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 p\u00e9\u010di kvalifikovan\u00e9ho zdravotnick\u00e9ho pracovn\u00edka. Hypertenze, srde\u010dn\u00ed selh\u00e1n\u00ed a arytmie vy\u017eaduj\u00ed diagn\u00f3zu, monitorov\u00e1n\u00ed a individu\u00e1ln\u00ed d\u00e1vkov\u00e1n\u00ed l\u00e9ka\u0159em \u2014 v\u017edy u\u017e\u00edvejte betablok\u00e1tory pod l\u00e9ka\u0159sk\u00fdm dohledem.<\/div>\n<p><!-- medsbase-related-alts-v1 --><\/p>\n<h3 class=\"wp-block-heading\">Souvisej\u00edc\u00ed alternativy<\/h3>\n<p>Dal\u0161\u00ed produkty v <strong>Chronick\u00e1 onemocn\u011bn\u00ed<\/strong> kter\u00e9 z\u00e1kazn\u00edci tak\u00e9 prohl\u00ed\u017eej\u00ed:<\/p>\n<ul>\n<li><a href=\"https:\/\/medsbase.com\/cs\/allegra\/\">Allegra<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/ritocom\/\">Ritocom<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/telmaheal\/\">Telmaheal<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/lox-10-spray\/\">Lox 10% Spray<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/predniheal\/\">Predniheal<\/a><\/li>\n<\/ul>","protected":false},"excerpt":{"rendered":"<p>Amifru je fixn\u00ed kombinace furosemidu 40 mg a amiloridu 5 mg od spole\u010dnosti Sun Pharma \u2014 spojuje kli\u010dkov\u00e9 diuretikum s \u0161et\u0159\u00edc\u00edm drasl\u00edk \u010dinidlem p\u016fsob\u00edc\u00edm na ENaC. Navr\u017eeno k prevenci hypokal\u00e9mie vyvolan\u00e9 kli\u010dkov\u00fdmi diuretiky bez nutnosti p\u0159id\u00e1n\u00ed spironolaktonu. Preferov\u00e1no, kdy\u017e je spironolakton kontraindikov\u00e1n kv\u016fli gynekomastii nebo kdy\u017e je pot\u0159eba rychl\u00fd \u0161et\u0159\u00edc\u00ed drasl\u00edk efekt (hodiny, ne dny). Pou\u017eit\u00ed: srde\u010dn\u00ed selh\u00e1n\u00ed s labiln\u00edm drasl\u00edkem, jatern\u00ed ascites, otoky p\u0159i CKD.<\/p>","protected":false},"featured_media":57156,"comment_status":"open","ping_status":"open","template":"","meta":[],"product_brand":[],"product_cat":[3141,3223,3260,3356],"product_tag":[4244,4245,4239],"class_list":{"0":"post-57155","1":"product","2":"type-product","3":"status-publish","4":"has-post-thumbnail","6":"product_cat-category-overview","7":"product_cat-chronic-conditions","8":"product_cat-heart-blood-pressure","9":"product_cat-high-blood-pressure-medication","10":"product_tag-amifru","11":"product_tag-amiloride","12":"product_tag-frusemide","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\/57155","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=57155"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/media\/57156"}],"wp:attachment":[{"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/media?parent=57155"}],"wp:term":[{"taxonomy":"product_brand","embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_brand?post=57155"},{"taxonomy":"product_cat","embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_cat?post=57155"},{"taxonomy":"product_tag","embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_tag?post=57155"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}