{"id":58241,"date":"2024-02-27T18:24:42","date_gmt":"2024-02-27T18:24:42","guid":{"rendered":"https:\/\/medsname.com\/cosart-h\/"},"modified":"2026-05-01T10:49:14","modified_gmt":"2026-05-01T10:49:14","slug":"cosart-h","status":"publish","type":"product","link":"https:\/\/medsbase.com\/cs\/product\/cosart-h\/","title":{"rendered":"Cosart H"},"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 \u2013 Co je Cosart H?<\/h3>\n<p style=\"margin:0;\"><strong>Cosart H<\/strong> je <strong>Fixn\u00ed kombinace 50\/12,5 mg<\/strong> losartanu 50 mg a <strong>hydrochlorothiazid<\/strong> od spole\u010dnosti Abbott Healthcare \u2013 <strong>kombinace antihypertenziv 2. volby<\/strong> pro pacienty, jejich\u017e krevn\u00ed tlak nen\u00ed kontrolov\u00e1n <a href=\"https:\/\/medsbase.com\/cs\/losar\/\">Losar<\/a> (monoterapie losartanu) samotn\u00e1. P\u0159id\u00e1n\u00ed thiazidov\u00e9ho diuretika obvykle p\u0159in\u00e1\u0161\u00ed dal\u0161\u00ed <strong>pokles systolick\u00e9ho tlaku o 5-10 mmHg<\/strong> ve srovn\u00e1n\u00ed s monoterapi\u00ed ARB. Ob\u011b slo\u017eky p\u016fsob\u00ed prost\u0159ednictv\u00edm <strong>komplement\u00e1rn\u00edch mechanism\u016f<\/strong> (ARB blokuje receptor pro angiotensin-II; HCTZ odstra\u0148uje sod\u00edk a vyvol\u00e1v\u00e1 m\u00edrnou volumovou kontrakci) a maj\u00ed <strong>vz\u00e1jemn\u011b vyva\u017euj\u00edc\u00ed profily vedlej\u0161\u00edch \u00fa\u010dink\u016f<\/strong> \u2014 HCTZ sni\u017euje hladinu drasl\u00edku, zat\u00edmco ARB ji m\u00e1 tendenci zvy\u0161ovat, tak\u017ee kombinace je m\u00e9n\u011b pravd\u011bpodobn\u00e1 p\u0159i vzniku hypokal\u00e9mie nebo hyperkal\u00e9mie ne\u017e ka\u017ed\u00fd l\u00e9k samostatn\u011b v ekvivalentn\u00edch d\u00e1vk\u00e1ch. Obvykl\u00e9 d\u00e1vkov\u00e1n\u00ed: jedna tableta jednou denn\u011b. <strong>Absolutn\u011b kontraindikov\u00e1n v t\u011bhotenstv\u00ed<\/strong> (ob\u011b slo\u017eky), <strong>anurie nebo t\u011b\u017ek\u00e9 ren\u00e1ln\u00ed posti\u017een\u00ed (eGFR &lt;30)<\/strong>, <strong>p\u0159ecitliv\u011blost na thiazidy (sulfonamidy)<\/strong>, a <strong>symptomatick\u00e1 hyponatr\u00e9mie<\/strong>. Monitorujte drasl\u00edk, sod\u00edk, ur\u00e1ty a kreatinin b\u011bhem l\u00e9\u010dby.<\/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 Cosart H?<\/h2>\n<p>Cosart H je fixn\u00ed kombinace v jedn\u00e9 tablet\u011b obsahuj\u00edc\u00ed <strong>losartan 50 mg<\/strong> a <strong>hydrochlorothiazid (HCTZ)<\/strong> v jedn\u00e9 tablet\u011b, vyr\u00e1b\u011bn\u00e1 spole\u010dnost\u00ed Abbott Healthcare a dod\u00e1van\u00e1 v balen\u00edch po 30\u2013180 tablet\u00e1ch. Kombinuje dv\u011b l\u00e9kov\u00e9 t\u0159\u00eddy prvn\u00ed volby v pom\u011bru vhodn\u00e9m pro v\u011bt\u0161inu pacient\u016f, u kter\u00fdch monoterapie ARB ji\u017e nesta\u010d\u00ed. Losartan je <strong>Prvn\u00ed ARB schv\u00e1len\u00fd pro klinick\u00e9 pou\u017eit\u00ed<\/strong> (DuPont Merck 1995; p\u016fvodn\u00ed zna\u010dka Cozaar). Polo\u010das ~2 hodiny pro mate\u0159skou l\u00e1tku a 6-9 hodin pro aktivn\u00ed metabolit E-3174 (generovan\u00fd CYP2C9 a CYP3A4).<\/p>\n<p>Hydrochlorothiazid (HCTZ) je thiazidov\u00e9 diuretikum zaveden\u00e9 v roce 1959 (MSD jako HydroDiuril). St\u00e1le pat\u0159\u00ed mezi nej\u010dast\u011bji p\u0159edepisovan\u00e1 antihypertenziva na sv\u011bt\u011b a je <strong>\u010dtvrtou t\u0159\u00eddou doporu\u010denou v guidelines<\/strong> pro hypertenzi vedle ARB, ACE inhibitor\u016f a blok\u00e1tor\u016f kalciov\u00fdch kan\u00e1l\u016f.<\/p>\n<h2 class=\"wp-block-heading\">Pro\u010d kombinovat ARB s thiazidem?<\/h2>\n<p>Hypertenze je jen z\u0159\u00eddka kontrolov\u00e1na jedin\u00fdm l\u00e9kem v c\u00edlov\u00e9 d\u00e1vce. Studie jako ALLHAT, ACCOMPLISH a ASCOT prok\u00e1zaly, \u017ee <strong>v\u011bt\u0161ina hypertonik\u016f pot\u0159ebuje dva nebo t\u0159i l\u00e9ky z r\u016fzn\u00fdch t\u0159\u00edd<\/strong> k dosa\u017een\u00ed c\u00edlov\u00fdch hodnot krevn\u00edho tlaku dle doporu\u010den\u00ed (&lt;140\/90 u v\u011bt\u0161iny dosp\u011bl\u00fdch, &lt;130\/80 u diabetik\u016f a pacient\u016f s CKD). Kombinace ARB + thiazid je jednou ze t\u0159\u00ed v\u011bdecky podlo\u017een\u00fdch dvoul\u00e9kov\u00fdch kombinac\u00ed (dal\u0161\u00ed dv\u011b jsou ARB + CCB a CCB + thiazid).<\/p>\n<p>Dv\u011b slo\u017eky p\u0159\u00edpravku Cosart H se vz\u00e1jemn\u011b dopl\u0148uj\u00ed v <strong>\u010dty\u0159ech farmakologick\u00fdch os\u00e1ch<\/strong>:<\/p>\n<ul>\n<li><strong>Dopl\u0148kov\u00e9 mechanismy sni\u017eov\u00e1n\u00ed krevn\u00edho tlaku.<\/strong> ARB blokuje vazokonstrikci a aldosteronem \u0159\u00edzenou retenci sod\u00edku; HCTZ sni\u017euje celkov\u00fd obsah sod\u00edku v t\u011ble a zp\u016fsobuje m\u00edrnou volumovou kontrakci. Aditivn\u00ed pokles krevn\u00edho tlaku (typicky o 5-10 mmHg systolick\u00e9ho tlaku nav\u00edc oproti monoterapii ARB).<\/li>\n<li><strong>RAAS kontra-regulace.<\/strong> Thiazidy aktivuj\u00ed syst\u00e9m renin-angiotenzin-aldosteron jako kompenza\u010dn\u00ed odpov\u011b\u010f na ztr\u00e1tu sod\u00edku \u2014 to obvykle tlum\u00ed jejich \u00fa\u010dinek. Blokov\u00e1n\u00ed AT<sub>1<\/sub> receptoru pomoc\u00ed ARB <strong>zabra\u0148uje t\u00e9to kompenza\u010dn\u00ed aktivaci<\/strong> a odemyk\u00e1 pln\u00fd antihypertenzn\u00ed \u00fa\u010dinek thiazidu.<\/li>\n<li><strong>Bilance drasl\u00edku.<\/strong> HCTZ ztr\u00e1c\u00ed drasl\u00edk p\u0159es dist\u00e1ln\u00ed tubulus (klasick\u00e9 riziko hypokal\u00e9mie). ARB zvy\u0161uj\u00ed hladinu drasl\u00edku blokov\u00e1n\u00edm aldosteronem zprost\u0159edkovan\u00e9 exkrece drasl\u00edku. Kombinace proto udr\u017euje fyziologi\u010dt\u011bj\u0161\u00ed hladinu drasl\u00edku ne\u017e ka\u017ed\u00fd l\u00e9k samostatn\u011b \u2014 klinicky se to projevuje m\u00e9n\u011b epizodami hypokal\u00e9mie p\u0159i kombinovan\u00e9 terapii s kli\u010dkov\u00fdmi diuretiky a m\u00e9n\u011b klinicky v\u00fdznamn\u00fdmi hyperkalemiemi ne\u017e u monoterapie ARB.<\/li>\n<li><strong>Kontra-regulace volumov\u00e9 aktivace.<\/strong> Vazodilatace vyvolan\u00e1 ARB m\u016f\u017ee u pacient\u016f citliv\u00fdch na s\u016fl vyvolat retenci sod\u00edku (klasick\u00e1 p\u0159\u00ed\u010dina \u201cztracen\u00e9\u201d odpov\u011bdi na krevn\u00ed tlak po t\u00fddnech l\u00e9\u010dby). Natriur\u00e9za zp\u016fsoben\u00e1 HCTZ tuto reten\u010dn\u00ed smy\u010dku p\u0159eru\u0161uje.<\/li>\n<\/ul>\n<p>Losartan je <strong>unik\u00e1tn\u011b urikosurick\u00fd mezi ARB<\/strong> \u2014 sni\u017euje s\u00e9rovou hladinu kyseliny mo\u010dov\u00e9 inhibic\u00ed transport\u00e9ru URAT1 v proxim\u00e1ln\u00edm tubulu. To je klinicky v\u00fdznamn\u00e9 v t\u00e9to kombinaci, proto\u017ee <strong>HCTZ zvy\u0161uje s\u00e9rovou hladinu kyseliny mo\u010dov\u00e9<\/strong> konkurenc\u00ed o stejnou vylu\u010dovac\u00ed cestu. Kombinace losartan-HCTZ je proto <strong>preferovanou kombinac\u00ed ARB+thiazid pro pacienty s dnou, hyperurik\u00e9mi\u00ed nebo citliv\u00e9 na thiazidem indukovan\u00e9 zv\u00fd\u0161en\u00ed hladiny ur\u00e1t\u016f<\/strong>.<\/p>\n<p><strong>D\u016fkazy pro ARB+HCTZ:<\/strong> The <strong>studie LIFE (2002)<\/strong> pou\u017eila losartan s p\u0159id\u00e1n\u00edm HCTZ jako aktivn\u00ed rameno, prokazuj\u00edc\u00ed 13% sn\u00ed\u017een\u00ed rizika c\u00e9vn\u00ed mozkov\u00e9 p\u0159\u00edhody, kardiovaskul\u00e1rn\u00ed smrti a infarktu myokardu ve srovn\u00e1n\u00ed s terapi\u00ed zalo\u017eenou na atenololu u hypertonik\u016f s hypertrofi\u00ed lev\u00e9 komory. RENAAL (2001) prok\u00e1zal renoprotekci u diabetick\u00e9 nefropatie 2. typu.<\/p>\n<h2 class=\"wp-block-heading\">D\u00e1vkov\u00e1n\u00ed &amp; Titrace<\/h2>\n<p><strong>Standardn\u00ed d\u00e1vka:<\/strong> jedna tableta 50\/12,5 mg jednou denn\u011b, obvykle r\u00e1no (HCTZ zp\u016fsobuje m\u00edrnou diur\u00e9zu; ve\u010dern\u00ed d\u00e1vkov\u00e1n\u00ed m\u016f\u017ee naru\u0161it sp\u00e1nek no\u010dn\u00edm mo\u010den\u00edm).<\/p>\n<p><strong>Kdy za\u010d\u00edt u\u017e\u00edvat Cosart H:<\/strong><\/p>\n<ul>\n<li>TK nekontrolovan\u00fd na monoterapii losartanem 50 mg po 4-6 t\u00fddnech v c\u00edlov\u00e9 d\u00e1vce<\/li>\n<li>Hypertenze 2. stupn\u011b (\u2265160\/100) jako po\u010d\u00e1te\u010dn\u00ed kombinace \u2014 zah\u00e1jen\u00ed dvou l\u00e9k\u016f z r\u016fzn\u00fdch t\u0159\u00edd je preferov\u00e1no p\u0159ed titrac\u00ed jednoho l\u00e9ku u t\u011b\u017ek\u00e9 hypertenze dle doporu\u010den\u00ed AHA\/ACC<\/li>\n<li>P\u0159echod z kombinace ACE inhibitor\/HCTZ, pokud ACE inhibitor zp\u016fsobil ka\u0161el<\/li>\n<\/ul>\n<p><strong>Titrace:<\/strong> Pokud TK z\u016fst\u00e1v\u00e1 nekontrolovan\u00fd po 4-6 t\u00fddnech na po\u010d\u00e1te\u010dn\u00ed FDC, lze nahradit tabletou s vy\u0161\u0161\u00ed silou (v\u011bt\u0161ina v\u00fdrobc\u016f nab\u00edz\u00ed kombinace 50\/12,5, 100\/12,5, 80\/12,5, 160\/12,5 a 160\/25 p\u0159\u00edslu\u0161n\u00e9ho ARB s HCTZ). P\u0159\u00edpadn\u011b p\u0159idat t\u0159et\u00ed t\u0159\u00eddu \u2014 typicky <a href=\"https:\/\/medsbase.com\/cs\/amlode\/\">blok\u00e1tor kalciov\u00fdch kan\u00e1l\u016f (amlodipin)<\/a>.<\/p>\n<p><strong>Monitorovac\u00ed pl\u00e1n:<\/strong><\/p>\n<ul>\n<li><strong>Vstupn\u00ed vy\u0161et\u0159en\u00ed:<\/strong> mo\u010dovina, elektrolyty (sod\u00edk, drasl\u00edk), kreatinin, eGFR, s\u00e9rov\u00fd ur\u00e1t, glyk\u00e9mie nala\u010dno, lipidy. Dom\u00e1c\u00ed nebo ambulantn\u00ed m\u011b\u0159en\u00ed TK.<\/li>\n<li><strong>1-2 t\u00fddny po zah\u00e1jen\u00ed nebo zm\u011bn\u011b d\u00e1vky:<\/strong> opakovat U&amp;E. O\u010dek\u00e1vejte m\u00edrn\u00fd vzestup kreatininu (a\u017e 30 % je p\u0159ijateln\u00e9), m\u00edrn\u00fd pokles sod\u00edku (1\u20133 mmol), m\u00edrn\u00fd vzestup ur\u00e1t\u016f (\u010d\u00e1ste\u010dn\u011b kompenzov\u00e1no u p\u0159\u00edpravk\u016f obsahuj\u00edc\u00edch losartan). Drasl\u00edk obvykle stabiln\u00ed v norm\u00e1ln\u00edm rozmez\u00ed.<\/li>\n<li><strong>4-6 t\u00fddn\u016f:<\/strong> kontrola TK k posouzen\u00ed odpov\u011bdi; opakovat U&amp;E p\u0159i jak\u00e9koli poru\u0161e elektrolyt\u016f v d\u0159\u00edv\u011bj\u0161\u00edm \u010dasov\u00e9m bod\u011b.<\/li>\n<li><strong>Pr\u016fb\u011b\u017en\u00e9:<\/strong> ro\u010dn\u00ed U&amp;E, ur\u00e1ty, gluk\u00f3za a lipidy po stabilizaci. Dom\u00e1c\u00ed m\u011b\u0159en\u00ed TK dvakr\u00e1t t\u00fddn\u011b.<\/li>\n<li><strong>P\u0159eru\u0161te a vy\u0161et\u0159ete:<\/strong> symptomatick\u00e1 hyponatr\u00e9mie (zmatenost, nauzea, letargie; s\u00e9rov\u00fd Na &lt;130), drasl\u00edk 5,5, vzestup kreatininu &gt;30 %, nov\u00e1 nebo zhor\u0161uj\u00edc\u00ed se dna, hypersenzitivn\u00ed vyr\u00e1\u017eka.<\/li>\n<\/ul>\n<p><strong>Ukon\u010den\u00ed l\u00e9\u010dby:<\/strong> \u017e\u00e1dn\u00fd abstinen\u010dn\u00ed syndrom, ale n\u00e1hl\u00e9 vysazen\u00ed zp\u016fsob\u00ed postupn\u00fd n\u00e1vrat TK b\u011bhem dn\u016f. Postupn\u00e9 vysazen\u00ed nahrazen\u00edm kombinac\u00ed s ni\u017e\u0161\u00ed silou nebo n\u00e1vrat k monoterapii ARB pod kontrolou TK.<\/p>\n<h2 class=\"wp-block-heading\">Vedlej\u0161\u00ed \u00fa\u010dinky<\/h2>\n<p>Vedlej\u0161\u00ed \u00fa\u010dinky se p\u0159ekr\u00fdvaj\u00ed s \u00fa\u010dinky obou slo\u017eek l\u00e9ku. Kombinace je obvykle <strong>l\u00e9pe sn\u00e1\u0161ena<\/strong> ne\u017e kter\u00e1koli slo\u017eka v maxim\u00e1ln\u00ed d\u00e1vce monoterapie, proto\u017ee d\u00e1vky pou\u017e\u00edvan\u00e9 v fixn\u00edch kombinac\u00edch jsou ni\u017e\u0161\u00ed ne\u017e \u0161pi\u010dkov\u00e9 d\u00e1vky monoterapie.<\/p>\n<p><strong>\u010cast\u00e9 (&gt;1 % u\u017eivatel\u016f):<\/strong><\/p>\n<ul>\n<li>Z\u00e1vrat\u011b, ortostatick\u00e1 hypotenze (obvykle m\u00edrn\u00e1; \u010dast\u011bj\u0161\u00ed v prvn\u00edch 1\u20132 t\u00fddnech)<\/li>\n<li>M\u00edrn\u00e1 diur\u00e9za \u2014 zv\u00fd\u0161en\u00e9 mo\u010den\u00ed v prvn\u00edch dnech, obvykle se uprav\u00ed s vyrovn\u00e1n\u00edm objemu<\/li>\n<li>M\u00edrn\u00e1 hyponatr\u00e9mie nebo hypokal\u00e9mie u n\u00e1chyln\u00fdch pacient\u016f<\/li>\n<li>O\u010dek\u00e1van\u00fd m\u00edrn\u00fd vzestup kreatininu (a\u017e 30 %)<\/li>\n<li>\u00danava, bolest hlavy, nazofaryngitida<\/li>\n<li>Hyperurik\u00e9mie (typicky asymptomatick\u00e1; vz\u00e1cn\u011b vyvol\u00e1 dnu \u2014 m\u00e9n\u011b pravd\u011bpodobn\u00e9 u kombinac\u00ed s losartanem)<\/li>\n<li>Fotosenzitivn\u00ed vyr\u00e1\u017eka (souvisej\u00edc\u00ed s thiazidy)<\/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 hyponatr\u00e9mie<\/strong> \u2014 nejvy\u0161\u0161\u00ed riziko u star\u0161\u00edch \u017een na n\u00edzkosoln\u00fdch diet\u00e1ch, se srde\u010dn\u00edm selh\u00e1n\u00edm nebo n\u00e1chyln\u00fdch k SIADH. P\u0159i nov\u011b vznikl\u00fdch stavech zmatenosti, nevolnosti nebo p\u00e1dech vy\u0161et\u0159ete s\u00e9rov\u00fd sod\u00edk.<\/li>\n<li><strong>Vyvol\u00e1n\u00ed akutn\u00ed dny<\/strong> \u2014 pravd\u011bpodobn\u011bj\u0161\u00ed u kombinace valsartan+HCTZ nebo telmisartan+HCTZ ne\u017e losartan+HCTZ. P\u0159i opakovan\u00fdch p\u0159\u00edpadech p\u0159ejd\u011bte na kombinaci s losartanem.<\/li>\n<li><strong>Metabolick\u00e1 porucha<\/strong> \u2014 zhor\u0161en\u00e1 gluk\u00f3zov\u00e1 tolerance (pr\u016fm\u011brn\u00fd vzestup hladiny gluk\u00f3zy nala\u010dno o 5-8 mg\/dL), m\u00edrn\u00e9 zv\u00fd\u0161en\u00ed LDL a triglycerid\u016f. Telmisartan to \u010d\u00e1ste\u010dn\u011b kompenzuje d\u00edky aktivit\u011b PPAR-\u03b3.<\/li>\n<li><strong>Angioed\u00e9m<\/strong> \u2014 ni\u017e\u0161\u00ed v\u00fdskyt ne\u017e u ACE inhibitor\u016f, ale mo\u017en\u00fd. Okam\u017eit\u011b vysa\u010fte; nahra\u010fte ne-RAAS l\u00e9\u010divem.<\/li>\n<li><strong>Akutn\u00ed po\u0161kozen\u00ed ledvin p\u0159i hypovolemick\u00fdch stavech nebo bilater\u00e1ln\u00ed sten\u00f3ze ren\u00e1ln\u00ed arterie<\/strong><\/li>\n<li><strong>Pankreatitida<\/strong> \u2014 vz\u00e1cn\u00fd ne\u017e\u00e1douc\u00ed \u00fa\u010dinek t\u0159\u00eddy thiazid\u016f; p\u0159i jak\u00e9koli bolesti v nadb\u0159i\u0161ku se vzestupem lip\u00e1zy okam\u017eit\u011b vysa\u010fte.<\/li>\n<li><strong>Akutn\u00ed myopie a uzav\u0159en\u00fd \u00fahel glaukomu<\/strong> \u2014 vz\u00e1cn\u00e1 reakce t\u0159\u00eddy sulfonamid\u016f, typicky b\u011bhem hodin a\u017e dn\u016f po zah\u00e1jen\u00ed nov\u00e9ho sulfonamidu. P\u0159i n\u00e1hl\u00e9 bolesti oka nebo zm\u011bn\u011b vid\u011bn\u00ed okam\u017eit\u011b vysa\u010fte a vyhledejte neodkladn\u00e9 oftalmologick\u00e9 vy\u0161et\u0159en\u00ed.<\/li>\n<li><strong>Trombocytopenie, leukopenie<\/strong> \u2014 vz\u00e1cn\u00e9 reakce thiazidov\u00e9 t\u0159\u00eddy<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Kontraindikace<\/h2>\n<ul>\n<li><strong>T\u011bhotenstv\u00ed \u2014 ABSOLUTN\u00cd kontraindikace ve v\u0161ech trimestrech.<\/strong> Ob\u011b slo\u017eky: ARB zp\u016fsobuj\u00ed fet\u00e1ln\u00ed ren\u00e1ln\u00ed agenezi, oligohydramnion, plicn\u00ed hypoplazii; HCTZ p\u0159ech\u00e1z\u00ed placentou a m\u016f\u017ee zp\u016fsobit fet\u00e1ln\u00ed nebo neonat\u00e1ln\u00ed \u017eloutenku a trombocytopenii. P\u0159epn\u011bte na <a href=\"https:\/\/medsbase.com\/cs\/labebet\/\">labetalol<\/a>, methyldopu nebo nifedipin.<\/li>\n<li><strong>Anurie nebo t\u011b\u017ek\u00e9 ren\u00e1ln\u00ed posti\u017een\u00ed<\/strong> (eGFR &lt;30 ml\/min\/1,73 m\u00b2) \u2014 HCTZ ztr\u00e1c\u00ed \u00fa\u010dinnost p\u0159i n\u00edzk\u00e9 GFR a ARB zvy\u0161uje riziko AKI<sup>2<\/sup>P\u0159ecitliv\u011blost na thiazidy nebo sulfonamidy<\/li>\n<li><strong>Symptomatick\u00e1 hyponatr\u00e9mie (Na &lt;130)<\/strong><\/li>\n<li><strong>p\u0159i vstupn\u00edm vy\u0161et\u0159en\u00ed \u2014 zhor\u0161\u00ed se<\/strong> Symptomatick\u00e1 hypokal\u00e9mie (K &lt;3,0)<\/li>\n<li><strong>nebo hypomagnez\u00e9mie p\u0159i vstupn\u00edm vy\u0161et\u0159en\u00ed \u2014 nejprve korigujte<\/strong> \u2014 HCTZ zvy\u0161uje kalcium sn\u00ed\u017een\u00edm ren\u00e1ln\u00ed exkrece<\/li>\n<li><strong>Hyperkalc\u00e9mie<\/strong> (Child-Pugh C) \u2014 riziko vyvol\u00e1n\u00ed jatern\u00ed encefalopatie prost\u0159ednictv\u00edm posunu elektrolyt\u016f<\/li>\n<li><strong>T\u011b\u017ek\u00e9 jatern\u00ed po\u0161kozen\u00ed<\/strong> Anamn\u00e9za angioed\u00e9mu s jak\u00fdmkoli ACE inhibitorem nebo ARB<\/li>\n<li><strong>(do 4 t\u00fddn\u016f; dlouhodob\u00e9 opatrn\u00e9 u\u017e\u00edv\u00e1n\u00ed je \u010dasto p\u0159ijateln\u00e9 pod odborn\u00fdm dohledem)<\/strong> (within 4 weeks; longer-term cautious use often acceptable under specialist advice)<\/li>\n<li><strong>Bilater\u00e1ln\u00ed sten\u00f3za ren\u00e1ln\u00edch tepen<\/strong><\/li>\n<li><strong>Sou\u010dasn\u00e9 pod\u00e1v\u00e1n\u00ed sacubitrilu\/valsartanu (Entresto)<\/strong> \u2014 vy\u017eaduje 36hodinovou vyplachovac\u00ed pauzu<\/li>\n<li><strong>Sou\u010dasn\u00e9 pod\u00e1v\u00e1n\u00ed aliskirenu u diabetu nebo CKD<\/strong> (po\u0161kozen\u00ed ALTITUDE)<\/li>\n<li><strong>Sou\u010dasn\u00e9 pod\u00e1v\u00e1n\u00ed ACE inhibitoru<\/strong> \u2014 po\u0161kozen\u00ed ONTARGET bez p\u0159\u00ednosu<\/li>\n<\/ul>\n<p><strong>Kojen\u00ed:<\/strong> HCTZ se vylu\u010duje do ml\u00e9ka a m\u016f\u017ee potla\u010dovat laktaci p\u0159i vy\u0161\u0161\u00edch d\u00e1vk\u00e1ch; obecn\u011b se vyh\u00fdb\u00e1 v prvn\u00edch t\u00fddnech po porodu p\u0159ed\u010dasn\u011b narozen\u00e9ho d\u00edt\u011bte. Preferuj\u00ed se alternativn\u00ed antihypertenziva (propranolol, nifedipin), pokud je to mo\u017en\u00e9.<\/p>\n<h2 class=\"wp-block-heading\">Interakce s l\u00e9\u010divy<\/h2>\n<ul>\n<li><strong>Lithium \u2014 KRITICK\u00c1 INTERAKCE.<\/strong> Thiazidy sni\u017euj\u00ed ren\u00e1ln\u00ed clearance lithia a mohou vyvolat toxicitu lithia. Pokud je to mo\u017en\u00e9, kombinaci se vyhn\u011bte; pokud je to nevyhnuteln\u00e9, monitorujte hladiny lithia t\u00fddn\u011b po prvn\u00ed m\u011bs\u00edc a sni\u017ete d\u00e1vku lithia o 25\u201350 %.<\/li>\n<li><strong>NSAID \u2014 riziko \u201ctrojit\u00e9ho \u00faderu\u201d.<\/strong> ARB + diuretikum + NSAID = vysok\u00e9 riziko AKI p\u0159i hypovol\u00e9mii nebo sou\u010dasn\u00e9m onemocn\u011bn\u00ed (infekce, dehydratace). Omezte NSAID na ob\u010dasn\u00e9 kr\u00e1tkodob\u00e9 u\u017e\u00edv\u00e1n\u00ed; preferuje se paracetamol.<\/li>\n<li><strong>Dopl\u0148ky drasl\u00edku, \u0161et\u0159\u00edc\u00ed diuretika (spironolakton, eplerenon, amilorid)<\/strong> \u2014 hyperkal\u00e9mie navzdory ztr\u00e1t\u011b drasl\u00edku zp\u016fsoben\u00e9 HCTZ. Pe\u010dliv\u011b monitorujte.<\/li>\n<li><strong>Digoxin<\/strong> \u2014 hypokal\u00e9mie vyvolan\u00e1 HCTZ zvy\u0161uje toxicitu digoxinu. Monitorujte hladiny drasl\u00edku a digoxinu.<\/li>\n<li><strong>Peror\u00e1ln\u00ed kortikosteroidy<\/strong> \u2014 aditivn\u00ed hypokal\u00e9mie a retence tekutin (\u010d\u00e1ste\u010dn\u011b kompenzuj\u00edc\u00ed \u00fa\u010dinek thiazid\u016f)<\/li>\n<li><strong>Amfotericin B, stimula\u010dn\u00ed laxativa<\/strong> \u2014 riziko aditivn\u00ed hypokal\u00e9mie<\/li>\n<li><strong>Peror\u00e1ln\u00ed antidiabetika, inzulin<\/strong> \u2014 thiazidy zhor\u0161uj\u00ed gluk\u00f3zovou toleranci; u diabetik\u016f m\u016f\u017ee HbA1c vzr\u016fst o 0,1\u20130,3 %. M\u00e9n\u011b v\u00fdrazn\u00fd probl\u00e9m u kombinace telmisartan+HCTZ ne\u017e u jin\u00fdch kombinac\u00ed ARB+HCTZ (PPAR-\u03b3 aktivita telmisartanu \u010d\u00e1ste\u010dn\u011b kompenzuje \u00fa\u010dinek thiazid\u016f).<\/li>\n<li><strong>Cholestyramin \/ colestipol<\/strong> \u2014 sni\u017euj\u00ed absorpci HCTZ o 40\u201385 %. Pod\u00e1vejte s odstupem 4 hodin.<\/li>\n<li><strong>Alkohol<\/strong> \u2014 aditivn\u00ed ortostatick\u00e1 hypotenze, zejm\u00e9na p\u0159i titraci d\u00e1vky<\/li>\n<li><strong>Fluconazol, rifampicin<\/strong> \u2014 ovliv\u0148uj\u00ed CYP2C9\/3A4 aktivaci losartanu na metabolit E-3174; mohou zm\u011bnit \u00fa\u010dinek na TK<\/li>\n<li><strong>Jin\u00e9 ACE inhibitory, jin\u00e9 ARB, aliskiren<\/strong> \u2014 nekombinovat<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Cosart H vs. monoterapie ARB \u2013 Kdy p\u0159ej\u00edt na vy\u0161\u0161\u00ed stupe\u0148<\/h2>\n<p>Cosart H je <strong>l\u00e9k 2. volby<\/strong>, nikoli prvn\u00ed volby. U nov\u011b diagnostikovan\u00e9 hypertenze bez komplikac\u00ed:<\/p>\n<ol>\n<li><strong>Start<\/strong> s <a href=\"https:\/\/medsbase.com\/cs\/losar\/\">Losar<\/a> (monoterapie losartanem) (nebo blok\u00e1tor kalciov\u00fdch kan\u00e1l\u016f; nebo ACE inhibitor, pokud nen\u00ed anamn\u00e9za ACEi-ka\u0161le)<\/li>\n<li><strong>Titrovat<\/strong> na c\u00edlovou d\u00e1vku b\u011bhem 4-6 t\u00fddn\u016f<\/li>\n<li><strong>Pokud TK st\u00e1le nekontrolov\u00e1n<\/strong>, p\u0159ejd\u011bte na Cosart H (ARB + thiazid) <strong>nebo<\/strong> p\u0159idat blok\u00e1tor kalciov\u00fdch kan\u00e1l\u016f (ARB + BKK). Ob\u011b kombinace jsou podlo\u017eeny d\u016fkazy.<\/li>\n<li><strong>Pokud TK st\u00e1le nekontrolov\u00e1n po 4-6 t\u00fddnech na kombinaci<\/strong>, p\u0159ej\u00edt na trojkombinaci: ARB + BKK + thiazid<\/li>\n<li><strong>Po trojkombinaci<\/strong>, p\u0159idat spironolakton (d\u016fkazy z studie PATHWAY-2 pro rezistentn\u00ed hypertenzi) nebo odeslat ke specialistovi (sten\u00f3za ren\u00e1ln\u00ed tepny, prim\u00e1rn\u00ed hyperaldosteronismus, feochromocytom)<\/li>\n<\/ol>\n<p>Pacienti s nekomplikovanou hypertenz\u00ed 2. stupn\u011b (\u2265160\/100) mohou rozumn\u011b za\u010d\u00edt p\u0159\u00edmo s Cosart H \u2014 sou\u010dasn\u00e9 pokyny AHA\/ACC up\u0159ednost\u0148uj\u00ed \u010dasn\u00e9 zah\u00e1jen\u00ed dvoul\u00e9kov\u00e9 terapie u t\u011b\u017ek\u00e9 hypertenze p\u0159ed postupn\u00fdm zvy\u0161ov\u00e1n\u00edm d\u00e1vky jednoho l\u00e9ku.<\/p>\n<h2 class=\"wp-block-heading\">Skladov\u00e1n\u00ed<\/h2>\n<p>Skladujte Cosart H 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\">Je Cosart H l\u00e9kem prvn\u00ed volby na krevn\u00ed tlak?<\/h3>\n<p>Ne \u2014 fixn\u00ed kombinace ARB\/thiazid nejsou <strong>l\u00e9ky druh\u00e9 volby<\/strong>. Standardn\u00ed postup je za\u010d\u00edt s monoterapi\u00ed ARB (<a href=\"https:\/\/medsbase.com\/cs\/losar\/\">Losar<\/a> (monoterapie losartanem), titrujte na c\u00edlovou d\u00e1vku a p\u0159ejd\u011bte na Cosart H pouze pokud nen\u00ed krevn\u00ed tlak kontrolov\u00e1n po 4-6 t\u00fddnech. V\u00fdjimka: hypertenze 2. stupn\u011b (\u2265160\/100) m\u016f\u017ee rozumn\u011b za\u010d\u00edt p\u0159\u00edmo dvoul\u00e9kovou terapi\u00ed dle pokyn\u016f AHA\/ACC.<\/p>\n<h3 class=\"wp-block-heading\">Kdy m\u00e1m u\u017e\u00edvat Cosart H \u2014 r\u00e1no nebo ve\u010der?<\/h3>\n<p><strong>R\u00e1no<\/strong> je v\u00fdchoz\u00ed volba. Slo\u017eka HCTZ je diuretikum \u2014 zvy\u0161uje tvorbu mo\u010di po dobu 2-4 hodin po pod\u00e1n\u00ed. Ve\u010dern\u00ed pod\u00e1n\u00ed m\u016f\u017ee naru\u0161it sp\u00e1nek no\u010dn\u00edm mo\u010den\u00edm. N\u011bkter\u00fdm pacient\u016fm s no\u010dn\u00ed hypertenz\u00ed (nedostate\u010dn\u00fd no\u010dn\u00ed pokles tlaku, chronick\u00e9 onemocn\u011bn\u00ed ledvin) m\u016f\u017ee b\u00fdt doporu\u010deno p\u0159ej\u00edt na ve\u010dern\u00ed pod\u00e1n\u00ed k ovlivn\u011bn\u00ed rann\u00edho krevn\u00edho tlaku; konzultujte se sv\u00fdm l\u00e9ka\u0159em.<\/p>\n<h3 class=\"wp-block-heading\">O kolik v\u011bt\u0161\u00ed pokles krevn\u00edho tlaku mohu o\u010dek\u00e1vat oproti <a href=\"https:\/\/medsbase.com\/cs\/losar\/\">Losar<\/a> (monoterapie losartanem) samotn\u00fd?<\/h3>\n<p>P\u0159ibli\u017en\u011b <strong>v pr\u016fm\u011bru o 5-10 mmHg systolick\u00e9ho a 3-6 mmHg diastolick\u00e9ho tlaku nav\u00edc<\/strong> v pr\u016fm\u011bru, m\u011b\u0159eno 4-6 t\u00fddn\u016f po zah\u00e1jen\u00ed u\u017e\u00edv\u00e1n\u00ed Cosart H. Aditivn\u00ed efekt vznik\u00e1 blok\u00e1dou kompenza\u010dn\u00ed aktivace RAAS, kter\u00e1 norm\u00e1ln\u011b oslabuje \u00fa\u010dinek thiazidov\u00e9 monoterapie; tato blok\u00e1da uvol\u0148uje pln\u00fd \u00fa\u010dinek HCTZ.<\/p>\n<h3 class=\"wp-block-heading\">M\u00e1m norm\u00e1ln\u00ed drasl\u00edk p\u0159i u\u017e\u00edv\u00e1n\u00ed ARB \u2014 poklesne p\u0159i u\u017e\u00edv\u00e1n\u00ed Cosart H?<\/h3>\n<p>Obvykle z\u016fst\u00e1v\u00e1 v norm\u00e1ln\u00edm rozmez\u00ed. Ztr\u00e1ta drasl\u00edku zp\u016fsoben\u00e1 thiazidy je <strong>\u010d\u00e1ste\u010dn\u011b kompenzov\u00e1na tendenc\u00ed ARB zvy\u0161ovat drasl\u00edk<\/strong>. Mal\u00fd po\u010det pacient\u016f skute\u010dn\u011b vyvine hypokal\u00e9mii \u2014 z\u00e1kladn\u00ed a kontroln\u00ed vy\u0161et\u0159en\u00ed elektrolyt\u016f po 1-2 t\u00fddnech je rutinn\u00ed. Pokud drasl\u00edk klesne pod 3,5, p\u0159idejte strategii \u0161et\u0159\u00edc\u00ed drasl\u00edk (eplerenon, dietu bohatou na drasl\u00edk nebo p\u0159\u00edle\u017eitostn\u011b dopln\u011bn\u00ed drasl\u00edku) sp\u00ed\u0161e ne\u017e vysazen\u00ed Cosart H.<\/p>\n<h3 class=\"wp-block-heading\">M\u016f\u017ee Cosart H zv\u00fd\u0161it moji hladinu kyseliny mo\u010dov\u00e9 nebo vyvolat dnu?<\/h3>\n<p>Losartan jedine\u010dn\u011b <strong>sni\u017euje<\/strong> sni\u017euje s\u00e9rovou kyselinu mo\u010dovou inhibic\u00ed URAT1 v proxim\u00e1ln\u00edm tubulu, co\u017e <strong>\u010d\u00e1ste\u010dn\u011b kompenzuje<\/strong> \u00fa\u010dinek HCTZ na zv\u00fd\u0161en\u00ed ur\u00e1t\u016f. Losartan + HCTZ je <strong>preferovan\u00e1 kombinace ARB+thiazid pro pacienty s dnou nebo hyperurik\u00e9mi\u00ed<\/strong>. Nov\u011b vznikl\u00e1 dna p\u0159i u\u017e\u00edv\u00e1n\u00ed Cosart H je neobvykl\u00e1, ale mo\u017en\u00e1 u vysoce rizikov\u00fdch pacient\u016f (chronick\u00e9 onemocn\u011bn\u00ed ledvin, mu\u017ei, konzumace alkoholu, obezita).<\/p>\n<h3 class=\"wp-block-heading\">M\u00e1m diabetes 2. typu \u2014 je Cosart H bezpe\u010dn\u00fd?<\/h3>\n<p>Ano, ale m\u011bjte na pam\u011bti, \u017ee <strong>thiazidy m\u00edrn\u011b zhor\u0161uj\u00ed gluk\u00f3zovou toleranci<\/strong> (pr\u016fm\u011brn\u00fd vzestup hladiny gluk\u00f3zy nala\u010dno o 5-8 mg\/dL, vzestup HbA1c o 0,1-0,3%). V\u00fdhoda sn\u00ed\u017een\u00ed krevn\u00edho tlaku p\u0159eva\u017euje nad t\u00edmto \u00fa\u010dinkem u v\u011bt\u0161iny diabetik\u016f a lep\u0161\u00ed kontrola krevn\u00edho tlaku sni\u017euje komplikace ledvin a o\u010d\u00ed u diabetik\u016f v\u00edce, ne\u017e vzestup gluk\u00f3zy zvy\u0161uje. Monitorujte HbA1c ro\u010dn\u011b. Pokud se kontrola diabetu p\u0159i u\u017e\u00edv\u00e1n\u00ed Cosart H zhor\u0161\u00ed, pora\u010fte se o p\u0159echodu na <a href=\"https:\/\/medsbase.com\/cs\/telma-h\/\">Telma H<\/a> (telmisartan + HCTZ), kter\u00fd m\u00e1 \u010d\u00e1ste\u010dnou metabolicky protektivn\u00ed aktivitu.<\/p>\n<h3 class=\"wp-block-heading\">Mohu u\u017e\u00edvat ibuprofen s Cosart H?<\/h3>\n<p>Ob\u010dasn\u00e9 kr\u00e1tkodob\u00e9 u\u017e\u00edv\u00e1n\u00ed je obvykle v po\u0159\u00e1dku. <strong>Chronick\u00e9 denn\u00ed u\u017e\u00edv\u00e1n\u00ed NSAID<\/strong> (ibuprofen, diklofenak, naproxen) je rizikov\u00e9 v kombinaci s jak\u00fdmkoli ARB + diuretikem \u2014 tzv. \u201ctrojit\u00e1 r\u00e1na\u201d (ARB + diuretikum + NSAID) m\u016f\u017ee vyvolat akutn\u00ed po\u0161kozen\u00ed ledvin p\u0159i dehydrataci, infekci nebo operaci. P\u0159i chronick\u00e9 bolesti u\u017e\u00edvejte paracetamol; p\u0159i z\u00e1n\u011btu proberte alternativy se sv\u00fdm l\u00e9ka\u0159em.<\/p>\n<h3 class=\"wp-block-heading\">Mohu u\u017e\u00edvat Cosart H v t\u011bhotenstv\u00ed?<\/h3>\n<p><strong>Ne \u2014 absolutn\u011b kontraindikov\u00e1no.<\/strong> Ob\u011b slo\u017eky jsou teratogenn\u00ed: ARB zp\u016fsobuje fet\u00e1ln\u00ed ren\u00e1ln\u00ed agenezi a oligohydramnion; HCTZ proch\u00e1z\u00ed placentou a m\u016f\u017ee zp\u016fsobit fet\u00e1ln\u00ed nebo novorozeneckou \u017eloutenku a trombocytopenii. \u017deny v reproduk\u010dn\u00edm v\u011bku by m\u011bly pou\u017e\u00edvat spolehlivou antikoncepci. Pro ty, kter\u00e9 pl\u00e1nuj\u00ed t\u011bhotenstv\u00ed, p\u0159ejd\u011bte na <a href=\"https:\/\/medsbase.com\/cs\/labebet\/\">labetalol<\/a>, methyldopu nebo nifedipin <strong>p\u0159ed po\u010det\u00edm<\/strong>.<\/p>\n<h3 class=\"wp-block-heading\">Budu muset \u010dast\u011bji mo\u010dit v noci p\u0159i u\u017e\u00edv\u00e1n\u00ed Cosart H?<\/h3>\n<p>Obvykle ne, pokud tabletu u\u017e\u00edv\u00e1te r\u00e1no. Diuretick\u00fd \u00fa\u010dinek vrchol\u00ed 2-4 hodiny po pod\u00e1n\u00ed a ve\u010der je v\u011bt\u0161inou ji\u017e pry\u010d. Pacienti, kte\u0159\u00ed p\u0159ejdou na ve\u010dern\u00ed d\u00e1vkov\u00e1n\u00ed, \u010dasto poci\u0165uj\u00ed nokturii; n\u00e1vrat k rann\u00edmu d\u00e1vkov\u00e1n\u00ed tento probl\u00e9m vy\u0159e\u0161\u00ed b\u011bhem 1-3 dn\u016f.<\/p>\n<h3 class=\"wp-block-heading\">Co kdy\u017e vynech\u00e1m d\u00e1vku?<\/h3>\n<p>Vezm\u011bte si ji, jakmile si vzpomenete, pokud to nen\u00ed n\u011bkolik hodin p\u0159ed dal\u0161\u00ed d\u00e1vkou \u2014 v tom p\u0159\u00edpad\u011b vynechejte vynechanou d\u00e1vku a pokra\u010dujte v obvykl\u00e9m re\u017eimu. Ned\u00e1vejte si dvojitou d\u00e1vku. Jedna vynechan\u00e1 d\u00e1vka nem\u00e1 v\u00fdznamn\u00fd vliv na kontrolu krevn\u00edho tlaku. Pokud vynech\u00e1te v\u00edce ne\u017e 2 dny, v\u00e1\u0161 krevn\u00ed tlak za\u010dne op\u011bt stoupat; pokra\u010dujte v obvykl\u00e9 d\u00e1vce (nen\u00ed t\u0159eba zvy\u0161ovat).<\/p>\n<h3 class=\"wp-block-heading\">Kde si mohu koupit Cosart H online?<\/h3>\n<p>M\u016f\u017eete si koupit Cosart H (50\/12,5 mg losartan + HCTZ, 30-180 tablet) na MedsBase s diskr\u00e9tn\u00edm balen\u00edm a celosv\u011btovou dopravou.<\/p>\n<h2 class=\"wp-block-heading\">Souvisej\u00edc\u00ed antihypertenziva na MedsBase<\/h2>\n<ul>\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\/losar\/\">Losar \u2014 Losartan 25\/50 mg (monoterapie)<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/olmesar\/\">Olmesar \u2014 Olmesartan 20\/40 mg (monoterapie)<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/olmezest-am\/\">Olmezest AM \u2014 Olmesartan + Amlodipine<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/ramcor\/\">Ramcor \u2014 Ramipril (alternativa ACE inhibitoru)<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/telmaheal\/\">Telmaheal \u2014 Telmisartan 20\/40\/80 mg (monoterapie)<\/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\/crocin-advance\/\">Crocin Advance<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/asthafen\/\">Asthafen<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/letroheal\/\">Letroheal<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/verpin\/\">Verpin<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/wysolone\/\">Wysolone<\/a><\/li>\n<\/ul>","protected":false},"excerpt":{"rendered":"<p>Cosart H je fixn\u00ed kombinace losartanu 50 mg + HCTZ 12,5 mg od spole\u010dnosti Abbott \u2013 kombinace antihypertenziv druh\u00e9ho kroku pro pacienty, u kter\u00fdch monoterapie losartanem nedos\u00e1hla c\u00edlov\u00fdch hodnot. Losartan je mezi blok\u00e1tory receptoru pro angiotensin II unik\u00e1tn\u00ed sv\u00fdm urikosurick\u00fdm \u00fa\u010dinkem, kter\u00fd \u010d\u00e1ste\u010dn\u011b kompenzuje zvy\u0161ov\u00e1n\u00ed hladiny ur\u00e1t\u016f HCTZ \u2013 jde o preferovanou kombinaci ARB+thiazid u hypertenze s dnou nebo hyperurik\u00e9mi\u00ed. Tato kombinace byla pou\u017eita ve studii LIFE.<\/p>","protected":false},"featured_media":58242,"comment_status":"open","ping_status":"open","template":"","meta":[],"product_brand":[],"product_cat":[3141,3223,3342,3260,3356],"product_tag":[4450,3401,4447],"class_list":{"0":"post-58241","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-general-health","9":"product_cat-heart-blood-pressure","10":"product_cat-high-blood-pressure-medication","11":"product_tag-cosart-h","12":"product_tag-hydrochlorothiazide","13":"product_tag-losartan-potassium","15":"first","16":"instock","17":"shipping-taxable","18":"purchasable","19":"product-type-variable","20":"has-default-attributes"},"acf":[],"_links":{"self":[{"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product\/58241","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=58241"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/media\/58242"}],"wp:attachment":[{"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/media?parent=58241"}],"wp:term":[{"taxonomy":"product_brand","embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_brand?post=58241"},{"taxonomy":"product_cat","embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_cat?post=58241"},{"taxonomy":"product_tag","embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_tag?post=58241"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}