{"id":59339,"date":"2024-02-28T05:53:18","date_gmt":"2024-02-28T05:53:18","guid":{"rendered":"https:\/\/medsname.com\/silectone\/"},"modified":"2026-05-01T10:49:15","modified_gmt":"2026-05-01T10:49:15","slug":"silectone","status":"publish","type":"product","link":"https:\/\/medsbase.com\/cs\/product\/silectone\/","title":{"rendered":"Silectone"},"content":{"rendered":"

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\u26a1 Rychl\u00e1 odpov\u011b\u010f \u2014 Co je Silectone?<\/h3>\n

Silectone<\/strong> je Tableta spironolaktonu 25 \/ 50 mg<\/strong> od spole\u010dnosti Sun Pharma \u2014 antagonista mineralokortikoidn\u00edho receptoru (antagonista aldosteronu)<\/strong> kter\u00fd p\u016fsob\u00ed na mineralokortikoidn\u00ed receptor (MR) v hlavn\u00edch bu\u0148k\u00e1ch kortik\u00e1ln\u00edho sb\u011brn\u00e9ho kan\u00e1lku<\/strong>. Spironolakton byl uveden spole\u010dnost\u00ed G.D. Searle v roce 1959 \u2014 navr\u017een jako syntetick\u00fd steroid k antagonizaci \u00fa\u010dinku aldosteronu na dist\u00e1ln\u00edm tubulu p\u0159i retenci sod\u00edku a exkreci drasl\u00edku. Prvn\u00ed antagonista MR; z\u016fst\u00e1v\u00e1 referen\u010dn\u00ed l\u00e1tkou navzdory dostupnosti selektivn\u011bj\u0161\u00edho eplerenonu. Polo\u010das 1,4 hodiny (mate\u0159sk\u00e1 l\u00e1tka); 16-24 hodin (aktivn\u00ed metabolity canrenon a 7-\u03b1-thiomethylspirolakton); n\u00e1stup \u00fa\u010dinku 24-48 hodin (vy\u017eaduje \u010das pro projeven\u00ed antagonismu receptor\u016f na tk\u00e1\u0148ov\u00e9 \u00farovni); vrchol \u00fa\u010dinku za 2-3 dny; trv\u00e1n\u00ed 2-3 dny po vysazen\u00ed. Hlavn\u00ed indikace: srde\u010dn\u00ed selh\u00e1n\u00ed se sn\u00ed\u017eenou ejek\u010dn\u00ed frakc\u00ed (HF-REF), prim\u00e1rn\u00ed hyperaldosteronismus, rezistentn\u00ed hypertenze, jatern\u00ed ascites, adjuvantn\u00ed l\u00e9\u010dba hirsutismu a PCOS<\/strong>. Typick\u00e9 d\u00e1vkov\u00e1n\u00ed: Rezistentn\u00ed hypertenze<\/strong> (TK nekontrolovan\u00fd na ACEi\/ARB + CCB + thiazid): 25-50 mg jednou denn\u011b \u2014 d\u016fkaz z PATHWAY-2. Spironolakton p\u0159ekon\u00e1v\u00e1 bisoprolol a doxazosin jako \u010dtvrt\u00e1 l\u00e1tka u rezistentn\u00ed hypertenze. Nen\u00ed l\u00e9kem prvn\u00ed volby p\u0159i hypertenzi.<\/strong> Prim\u00e1rn\u00ed hyperaldosteronismus (Conn\u016fv syndrom):<\/strong> 50-400 mg\/den dokud se normalizuje drasl\u00edk a TK, pot\u00e9 udr\u017eovac\u00ed d\u00e1vka 25-100 mg. Kl\u00ed\u010dov\u00e9 kontraindikace: viz \u00fapln\u00fd seznam n\u00ed\u017ee. Monitorujte elektrolyty, kreatinin a gluk\u00f3zu. Nekombinujte s lithiem<\/strong> (thiazidov\u00e1\/smy\u010dkov\u00e1 diuretika mohou vyvolat toxicitu lithia). U\u017eit\u00ed v t\u011bhotenstv\u00ed je p\u0159\u00edpad od p\u0159\u00edpadu<\/strong> (viz pozn\u00e1mka k t\u011bhotenstv\u00ed). U v\u011bt\u0161iny hypertonik\u016f funguj\u00ed diuretika nejl\u00e9pe jako druh\u00fd nebo t\u0159et\u00ed l\u00e9k<\/strong> \u2014 obvykle v kombinaci s ARB, ACE inhibitorem nebo blok\u00e1torem kalciov\u00fdch kan\u00e1l\u016f sp\u00ed\u0161e ne\u017e samostatn\u011b.<\/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

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

Co je Silectone?<\/h2>\n

Silectone je peror\u00e1ln\u00ed tableta spironolaktonu 25 \/ 50 mg od spole\u010dnosti Sun Pharma, dod\u00e1van\u00e1 v balen\u00ed po 30-180 tablet\u00e1ch. Spironolakton byl uveden spole\u010dnost\u00ed G.D. Searle v roce 1959 \u2014 navr\u017een jako syntetick\u00fd steroid k antagonizaci \u00fa\u010dinku aldosteronu na dist\u00e1ln\u00ed tubuly, konkr\u00e9tn\u011b na zadr\u017eov\u00e1n\u00ed sod\u00edku a vylu\u010dov\u00e1n\u00ed drasl\u00edku. Prvn\u00ed antagonista MR; z\u016fst\u00e1v\u00e1 referen\u010dn\u00edm l\u00e9\u010divem navzdory dostupnosti selektivn\u011bj\u0161\u00edho eplerenonu.<\/p>\n

Jak spironolakton funguje<\/h2>\n

Spironolakton inhibuje mineralokortikoidn\u00ed receptor (MR) v hlavn\u00edch bu\u0148k\u00e1ch kortik\u00e1ln\u00edho sb\u011brn\u00e9ho kan\u00e1lku<\/strong>. N\u00e1sledn\u00e9 \u00fa\u010dinky:<\/p>\n

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  • Blokuje aldosteron na mineralokortikoidn\u00edm receptoru<\/strong> v hlavn\u00edch bu\u0148k\u00e1ch kortik\u00e1ln\u00edho sb\u011brn\u00e9ho kan\u00e1lku<\/li>\n
  • Sn\u00ed\u017een\u00e1 reabsorpce sod\u00edku, sn\u00ed\u017een\u00e1 sekrece drasl\u00edku<\/strong> \u2014 m\u00edrn\u00e1 natriur\u00e9za se zadr\u017eov\u00e1n\u00edm drasl\u00edku (\u0161et\u0159\u00edc\u00ed drasl\u00edk)<\/li>\n
  • Protifibrotick\u00fd a anti-remodela\u010dn\u00ed \u00fa\u010dinek na myokard<\/strong> \u2014 aldosteron vyvol\u00e1v\u00e1 srde\u010dn\u00ed fibr\u00f3zu nez\u00e1visle na sv\u00e9m \u00fa\u010dinku zadr\u017eov\u00e1n\u00ed soli; blokov\u00e1n\u00ed receptoru fibr\u00f3zu sni\u017euje. Toto je hlavn\u00ed mechanismus sn\u00ed\u017een\u00ed mortality u HF-REF (RALES).<\/li>\n
  • Antiandrogenn\u00ed \u00fa\u010dinek<\/strong> \u2014 zk\u0159\u00ed\u017een\u00e1 reaktivita s androgenn\u00edmi a progesteronov\u00fdmi receptory zp\u016fsobuje gynekomastii a menstrua\u010dn\u00ed nepravidelnosti jako t\u0159\u00eddn\u00ed ne\u017e\u00e1douc\u00ed \u00fa\u010dinky; stejn\u00e1 aktivita vysv\u011btluje jeho pou\u017eit\u00ed off-label u hirsutismu a PCOS.<\/li>\n
  • Pozdn\u00ed n\u00e1stup\/\u00fatlum \u00fa\u010dinku<\/strong> (24-72 hodin v ka\u017ed\u00e9m sm\u011bru) \u2014 farmakologie receptor\u016f plus dlouhodob\u011b p\u016fsob\u00edc\u00ed aktivn\u00ed metabolity (canrenon)<\/li>\n
  • \u00da\u010dinn\u00fd u rezistentn\u00ed hypertenze<\/strong> (PATHWAY-2) \u2014 p\u016fsob\u00ed na subpopulaci hypertonik\u016f se skryt\u00fdm nadbytkem aldosteronu<\/li>\n<\/ul>\n

    Schv\u00e1len\u00e9 a v\u011bdecky podlo\u017een\u00e9 indikace<\/h2>\n
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    • Srde\u010dn\u00ed selh\u00e1n\u00ed se sn\u00ed\u017eenou ejek\u010dn\u00ed frakc\u00ed (HF-REF), prim\u00e1rn\u00ed hyperaldosteronismus, rezistentn\u00ed hypertenze, cirhotick\u00e1 ascites, adjuvantn\u00ed l\u00e9\u010dba hirsutismu a PCOS<\/strong> \u2014 prim\u00e1rn\u00ed indikace<\/li>\n
    • Srde\u010dn\u00ed selh\u00e1n\u00ed se sn\u00ed\u017eenou ejek\u010dn\u00ed frakc\u00ed (EF \u226435%)<\/strong> \u2014 d\u016fkazy z studie RALES, 25\u201350 mg denn\u011b<\/li>\n
    • Prim\u00e1rn\u00ed hyperaldosteronismus (Conn\u016fv syndrom)<\/strong> \u2014 definitivn\u00ed l\u00e9\u010dba oboustrann\u00e9 adren\u00e1ln\u00ed hyperplazie; p\u0159echodn\u00e1 terapie p\u0159ed operac\u00ed jednostrann\u00e9ho adenomu<\/li>\n
    • Rezistentn\u00ed hypertenze<\/strong> \u2014 d\u016fkazy ze studie PATHWAY-2; \u010dtvrt\u00e1 volba po ACEi\/ARB + CCB + thiazidu<\/li>\n
    • Jatern\u00ed ascites<\/strong> \u2014 diuretikum prvn\u00ed volby u cirh\u00f3zy (kli\u010dkov\u00e1 diuretika p\u0159id\u00e1na p\u0159i nedostate\u010dn\u00e9 odpov\u011bdi)<\/li>\n
    • Hirsutismus, akn\u00e9 spojen\u00e9 s PCOS, \u017eensk\u00fd typ vypad\u00e1v\u00e1n\u00ed vlas\u016f<\/strong> \u2014 off-label antiandrogenn\u00ed terapie<\/li>\n
    • Stav po IM s dysfunkc\u00ed LK<\/strong> \u2014 preferov\u00e1n eplerenon (specifick\u00e9 pro studii EPHESUS)<\/li>\n<\/ul>\n

      Kl\u00ed\u010dov\u00e9 d\u016fkazy z klinick\u00fdch studi\u00ed:<\/strong> RALES (1999)<\/strong> \u2014 p\u0159elomov\u00e1 studie se spironolaktonem 25\u201350 mg u t\u011b\u017ek\u00e9ho HF-REF; 30% sn\u00ed\u017een\u00ed celkov\u00e9 mortality. Stanovila antagonismus aldosteronu jako standardn\u00ed terapii HF-REF. EPHESUS<\/strong> a EMPHASIS-HF<\/strong> roz\u0161\u00ed\u0159eno na eplerenon. PATHWAY-2 (2015)<\/strong> \u2014 spironolacton 25-50 mg byl nej\u00fa\u010dinn\u011bj\u0161\u00edm \u010dtvrt\u00fdm l\u00e9kem u rezistentn\u00ed hypertenze ve srovn\u00e1n\u00ed s bisoprololem nebo doxazosinem. TOPCAT<\/strong> \u2014 m\u00edrn\u00fd benefit u srde\u010dn\u00edho selh\u00e1n\u00ed s zachovanou ejek\u010dn\u00ed frakc\u00ed (HF-PEF); sign\u00e1l siln\u011bj\u0161\u00ed v americk\u00e9 v\u011btvi ne\u017e v rusk\u00e9 (kontroverzn\u00ed).<\/p>\n

      D\u00e1vkov\u00e1n\u00ed Silectone<\/h2>\n

      D\u00e1vka pro srdce:<\/strong> Rezistentn\u00ed hypertenze<\/strong> (TK nekontrolovan\u00fd na ACEi\/ARB + CCB + thiazid): 25-50 mg jednou denn\u011b \u2014 d\u016fkaz z PATHWAY-2. Spironolakton p\u0159ekon\u00e1v\u00e1 bisoprolol a doxazosin jako \u010dtvrt\u00e1 l\u00e1tka u rezistentn\u00ed hypertenze. Nen\u00ed l\u00e9kem prvn\u00ed volby p\u0159i hypertenzi.<\/strong> Prim\u00e1rn\u00ed hyperaldosteronismus (Conn\u016fv syndrom):<\/strong> 50-400 mg\/den, dokud se neuprav\u00ed drasl\u00edk a krevn\u00ed tlak, pot\u00e9 udr\u017eovac\u00ed d\u00e1vka 25-100 mg.<\/p>\n

      Dal\u0161\u00ed indikace:<\/strong> Srde\u010dn\u00ed selh\u00e1n\u00ed se sn\u00ed\u017eenou ejek\u010dn\u00ed frakc\u00ed (EF \u226435%):<\/strong> 12,5-25 mg jednou denn\u011b; c\u00edlem je 25-50 mg, pokud je tolerov\u00e1no (studie RALES). Cirhotick\u00fd ascites:<\/strong> 50-400 mg\/den, obvykle s furosemidem 20-160 mg (pom\u011br 1:2,5); c\u00edlem je \u00fabytek hmotnosti 0,5 kg\/den. Hirsutismus \/ PCOS \/ akn\u00e9 (u \u017een):<\/strong> 50-200 mg\/den \u2014 potla\u010duje androgenem stimulovan\u00fd r\u016fst ochlupen\u00ed a akn\u00e9 b\u011bhem 3-6 m\u011bs\u00edc\u016f (mimo indikaci, ale dob\u0159e zaveden\u00e9).<\/p>\n

      Pod\u00e1v\u00e1n\u00ed:<\/strong> jednou denn\u011b (nebo dvakr\u00e1t denn\u011b u vysok\u00fdch d\u00e1vek kli\u010dkov\u00fdch diuretik p\u0159i srde\u010dn\u00edm selh\u00e1n\u00ed), r\u00e1no. Ve\u010dern\u00ed pod\u00e1v\u00e1n\u00ed zp\u016fsobuje nykturii a m\u011blo by b\u00fdt pokud mo\u017eno vynech\u00e1no. U\u017e\u00edvejte ve stejnou denn\u00ed dobu. Potrava v\u00fdznamn\u011b neovliv\u0148uje vst\u0159eb\u00e1v\u00e1n\u00ed \u017e\u00e1dn\u00e9ho z t\u011bchto diuretik.<\/p>\n

      Monitorovac\u00ed pl\u00e1n:<\/strong><\/p>\n

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      • Vstupn\u00ed vy\u0161et\u0159en\u00ed:<\/strong> mo\u010dovina, elektrolyty (zejm\u00e9na drasl\u00edk a sod\u00edk), kreatinin, eGFR, gluk\u00f3za, s\u00e9rov\u00fd ur\u00e1t. Dom\u00e1c\u00ed nebo klinick\u00e9 m\u011b\u0159en\u00ed TK a denn\u00ed v\u00e1ha u pacient\u016f se srde\u010dn\u00edm selh\u00e1n\u00edm.<\/li>\n
      • 1-2 t\u00fddny po zah\u00e1jen\u00ed nebo zm\u011bn\u011b d\u00e1vky:<\/strong> opakujte U&E a kreatinin. O\u010dek\u00e1vejte m\u00edrn\u00e9 zm\u011bny elektrolyt\u016f; vy\u0161et\u0159te v\u00fdrazn\u00e9 odchylky.<\/li>\n
      • 4-6 t\u00fddn\u016f:<\/strong> Kontrola krevn\u00edho tlaku a kompletn\u00ed metabolick\u00fd panel.<\/li>\n
      • Pr\u016fb\u011b\u017en\u00e9:<\/strong> Ro\u010dn\u00ed vy\u0161et\u0159en\u00ed U&E, ur\u00e1t\u016f, gluk\u00f3zy a lipidov\u00e9ho panelu po stabilizaci. \u010cast\u011bj\u0161\u00ed u CKD, srde\u010dn\u00edho selh\u00e1n\u00ed nebo p\u0159i kombinovan\u00e9 terapii.<\/li>\n
      • P\u0159eru\u0161it l\u00e9\u010dbu nebo sn\u00ed\u017eit d\u00e1vkov\u00e1n\u00ed p\u0159i:<\/strong> sod\u00edk 5,5, vzestup kreatininu >30%, nov\u00e1 dna, p\u0159\u00edznaky t\u011b\u017ek\u00e9 dehydratace.<\/li>\n<\/ul>\n

        Ukon\u010den\u00ed l\u00e9\u010dby:<\/strong> \u017d\u00e1dn\u00fd abstinen\u010dn\u00ed syndrom, ale n\u00e1hl\u00e9 vysazen\u00ed m\u016f\u017ee zp\u016fsobit rebound retenci tekutin u pacient\u016f se srde\u010dn\u00edm selh\u00e1n\u00edm na chronick\u00e9 vysok\u00e9 d\u00e1vce kli\u010dkov\u00fdch diuretik \u2014 pokud mo\u017eno postupn\u011b sni\u017eovat a monitorovat hmotnost.<\/p>\n