{"id":58433,"date":"2024-02-27T18:35:26","date_gmt":"2024-02-27T18:35:26","guid":{"rendered":"https:\/\/medsname.com\/monolith\/"},"modified":"2026-04-30T10:24:14","modified_gmt":"2026-04-30T10:24:14","slug":"monolith","status":"publish","type":"product","link":"https:\/\/medsbase.com\/cs\/product\/monolith\/","title":{"rendered":"Monolith"},"content":{"rendered":"

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

Monolith (Lithium karbon\u00e1t 300 mg, s okam\u017eit\u00fdm uvol\u0148ov\u00e1n\u00edm) je zlat\u00fd standard stabiliz\u00e1toru n\u00e1lady pro bipol\u00e1rn\u00ed poruchu. Jedin\u00fd stabiliz\u00e1tor n\u00e1lady s reprodukovateln\u00fdmi d\u016fkazy o sn\u00ed\u017een\u00ed m\u00edry sebevra\u017ed. \u00dazk\u00fd terapeutick\u00fd index \u2014 povinn\u00e9 monitorov\u00e1n\u00ed hladin v s\u00e9ru.<\/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

Monolith 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\u00edm 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 Monolith a jak funguje<\/h2>\n

Monolith je tableta s okam\u017eit\u00fdm uvol\u0148ov\u00e1n\u00edm lithia karbon\u00e1tu dod\u00e1van\u00e1 spole\u010dnost\u00ed Cipla. Dostupn\u00e9 s\u00edly: 300 mg<\/strong>. Lithium je monovalentn\u00ed kationt, kter\u00fd se pou\u017e\u00edv\u00e1 p\u0159i bipol\u00e1rn\u00ed poru\u0161e ji\u017e p\u0159es 70 let (Cade, 1949). Jeho mechanismus je multimod\u00e1ln\u00ed: inhibice inositolmonofosfat\u00e1zy (IMP\u00e1zy), inhibice GSK-3\u03b2, modulace glutam\u00e1tergn\u00edho p\u0159enosu a \u00fa\u010dinky na geny cirkadi\u00e1nn\u00edch hodin. Klinick\u00fd p\u0159\u00ednos: profylaxe proti manick\u00fdm i depresivn\u00edm epizod\u00e1m, augmentace antidepresiv a reprodukovateln\u00e9 sn\u00ed\u017een\u00ed m\u00edry sebevra\u017ed (~60 % v dlouhodob\u00fdch studi\u00edch).<\/p>\n

\n\u00dazk\u00fd terapeutick\u00fd index \u2014 povinn\u00e9 monitorov\u00e1n\u00ed hladin<\/strong><\/p>\n

Terapeutick\u00e9 rozmez\u00ed: 0,6\u20131,2 mEq\/l<\/strong> pro udr\u017eovac\u00ed l\u00e9\u010dbu (akutn\u00ed m\u00e1nie a\u017e do 1,2). Toxicita za\u010d\u00edn\u00e1 p\u0159i 1,5 mEq\/l<\/strong>; t\u011b\u017ek\u00e1 toxicita (zmatenost, k\u0159e\u010de, selh\u00e1n\u00ed ledvin, smrt) p\u0159i 2,0+ mEq\/l<\/strong>. Kontrola hladiny: 12 hodin po pod\u00e1n\u00ed v minim\u00e1ln\u00ed koncentraci. Pl\u00e1n: 5\u20137 dn\u00ed po ka\u017ed\u00e9 zm\u011bn\u011b d\u00e1vky, pot\u00e9 ka\u017ed\u00fdch 6 m\u011bs\u00edc\u016f p\u0159i stabiln\u00edm stavu. Nav\u00edc v\u00fdchoz\u00ed a 6m\u011bs\u00ed\u010dn\u00ed TSH, kreatinin\/eGFR, v\u00e1pn\u00edk.<\/p>\n<\/div>\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>\nC\u00edlov\u00e1 hladina<\/th>\n<\/tr>\n<\/thead>\n
Bipol\u00e1rn\u00ed m\u00e1nie (akutn\u00ed)<\/td>\n600\u2013900 mg\/den v rozd\u011blen\u00fdch d\u00e1vk\u00e1ch<\/td>\n900\u20131800 mg\/den<\/td>\n0,8\u20131,2 mEq\/l<\/td>\n<\/tr>\n
Bipol\u00e1rn\u00ed udr\u017eovac\u00ed l\u00e9\u010dba<\/td>\n\u2014<\/td>\n600\u20131200 mg\/den<\/td>\n0,6\u20131,0 mEq\/l<\/td>\n<\/tr>\n
Bipol\u00e1rn\u00ed deprese \/ unipol\u00e1rn\u00ed augmentace<\/td>\n\u2014<\/td>\n600\u2013900 mg\/den<\/td>\n0,4\u20130,8 mEq\/l<\/td>\n<\/tr>\n
Star\u0161\u00ed pacienti \/ ren\u00e1ln\u00ed posti\u017een\u00ed<\/td>\n150\u2013300 mg\/den<\/td>\npodle hladiny<\/td>\n0,4\u20130,8 mEq\/l<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

XR formulace se d\u00e1vkuj\u00ed jednou nebo dvakr\u00e1t denn\u011b (vyrovnan\u011bj\u0161\u00ed k\u0159ivka hladin, ni\u017e\u0161\u00ed vrchol vedlej\u0161\u00edch \u00fa\u010dink\u016f). IR formulace se obvykle d\u00e1vkuj\u00ed 2\u20133\u00d7 denn\u011b.<\/p>\n

D\u016fle\u017eit\u00e9 bezpe\u010dnostn\u00ed aspekty<\/h2>\n
\nLedviny \u2014 chronick\u00e1 interstici\u00e1ln\u00ed nefritida p\u0159i dlouhodob\u00e9m u\u017e\u00edv\u00e1n\u00ed<\/strong><\/p>\n

Po 10\u201320 letech l\u00e9\u010dby lithiem se u p\u0159ibli\u017en\u011b 20 % pacient\u016f rozvine chronick\u00e1 interstici\u00e1ln\u00ed nefritida s progresivn\u00edm poklesem eGFR. Povinn\u00e9 stanoven\u00ed kreatininu\/eGFR na za\u010d\u00e1tku, po 3 m\u011bs\u00edc\u00edch, 6 m\u011bs\u00edc\u00edch a pot\u00e9 ka\u017ed\u00fdch 6 m\u011bs\u00edc\u016f. P\u0159eru\u0161it nebo sn\u00ed\u017eit d\u00e1vku, pokud eGFR klesne pod 60 s jinak nevysv\u011btlitelnou progres\u00ed.<\/p>\n<\/div>\n

\n\u0160t\u00edtn\u00e1 \u017el\u00e1za \u2014 hypotyre\u00f3za (\u010dast\u00e1) a hypertyre\u00f3za (vz\u00e1cn\u00e1)<\/strong><\/p>\n

Lithium se koncentruje ve \u0161t\u00edtn\u00e9 \u017el\u00e1ze a inhibuje uvol\u0148ov\u00e1n\u00ed hormon\u016f. Hypotyre\u00f3za se rozvine u 20\u201330 % dlouhodob\u00fdch u\u017eivatel\u016f; povinn\u00e9 stanoven\u00ed TSH na za\u010d\u00e1tku, po 3 m\u011bs\u00edc\u00edch, 6 m\u011bs\u00edc\u00edch a pot\u00e9 ka\u017ed\u00fdch 6 m\u011bs\u00edc\u016f. P\u0159i p\u0159\u00edznac\u00edch p\u0159idat levothyroxin \u2014 obvykle nen\u00ed nutn\u00e9 lithium vysadit.<\/p>\n<\/div>\n

\nP\u0159\u00ed\u0161t\u00edtn\u00e1 t\u011bl\u00edska a v\u00e1pn\u00edk<\/strong><\/p>\n

Lithium m\u016f\u017ee zp\u016fsobit m\u00edrnou hyperparatyre\u00f3zu s hyperkalc\u00e9mi\u00ed. Kontrolovat hladinu v\u00e1pn\u00edku na za\u010d\u00e1tku a ka\u017ed\u00fdch 6 m\u011bs\u00edc\u016f.<\/p>\n<\/div>\n

\nL\u00e9ky vyvolan\u00e1 toxicita lithia \u2014 dehydratace, NSAID, ACE inhibitory, thiazidy<\/strong><\/p>\n

V\u011bt\u0161ina p\u0159\u00edpad\u016f toxicity lithia v klinick\u00e9 praxi poch\u00e1z\u00ed od pacient\u016f se stabiln\u00ed d\u00e1vkou, u kter\u00fdch do\u0161lo k poklesu clearance lithia z d\u016fvodu: (1) dehydratace (pr\u016fjem a zvracen\u00ed, hore\u010dka, hork\u00e9 po\u010das\u00ed, intenzivn\u00ed cvi\u010den\u00ed bez n\u00e1hrady tekutin); (2) zah\u00e1jen\u00ed l\u00e9\u010dby NSAID; (3) zah\u00e1jen\u00ed l\u00e9\u010dby ACE inhibitorem nebo ARB; (4) zah\u00e1jen\u00ed l\u00e9\u010dby thiazidov\u00fdm diuretikem; (5) n\u00e1hl\u00e9ho p\u0159echodu na dietu s n\u00edzk\u00fdm obsahem sod\u00edku. V\u00fdslovn\u011b pou\u010dte pacienty o ka\u017ed\u00e9m z t\u011bchto faktor\u016f. P\u0159i pr\u016fjmu a zvracen\u00ed p\u0159eru\u0161te pod\u00e1v\u00e1n\u00ed lithia na 24\u201348 hodin a po \u00fastupu p\u0159\u00edznak\u016f zkontrolujte hladinu.<\/p>\n<\/div>\n

\nT\u011bhotenstv\u00ed \u2014 Ebsteinova anom\u00e1lie + riziko v prvn\u00edm trimestru<\/strong><\/p>\n

Lithium bylo historicky spojov\u00e1no s v\u00fdvojov\u00fdmi vadami srdce (zejm\u00e9na Ebsteinovou anom\u00e1li\u00ed trikuspid\u00e1ln\u00ed chlopn\u011b) p\u0159i expozici v prvn\u00edm trimestru. Modern\u00ed studie nazna\u010duj\u00ed, \u017ee absolutn\u00ed riziko je mal\u00e9, ale re\u00e1ln\u00e9 (p\u0159ibli\u017en\u011b 1,2\u20137 %). Ide\u00e1ln\u011b p\u0159ejd\u011bte na jinou l\u00e9\u010dbu p\u0159ed ot\u011bhotn\u011bn\u00edm; pokud to nen\u00ed mo\u017en\u00e9, prove\u010fte fet\u00e1ln\u00ed echokardiografii ve 20. t\u00fddnu. Lithium v pozdn\u00edm t\u011bhotenstv\u00ed a po porodu je obecn\u011b bezpe\u010dn\u011bj\u0161\u00ed ne\u017e v prvn\u00edm trimestru. Lithium p\u0159ech\u00e1z\u00ed do mate\u0159sk\u00e9ho ml\u00e9ka ve v\u00fdznamn\u00e9m mno\u017estv\u00ed \u2014 obvykle se b\u011bhem kojen\u00ed vyh\u00fdb\u00e1me jeho pod\u00e1v\u00e1n\u00ed.<\/p>\n<\/div>\n

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