{"id":60062,"date":"2024-02-28T06:31:39","date_gmt":"2024-02-28T06:31:39","guid":{"rendered":"https:\/\/medsname.com\/dilantin\/"},"modified":"2026-05-01T10:49:15","modified_gmt":"2026-05-01T10:49:15","slug":"dilantin","status":"publish","type":"product","link":"https:\/\/medsbase.com\/cs\/product\/dilantin\/","title":{"rendered":"Dilantin"},"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 Dilantin?<\/h3>\n<p style=\"margin:0;\"><strong>Dilantin<\/strong> je peror\u00e1ln\u00ed <strong>fenytoin sodn\u00fd<\/strong> (100 mg) kapsle s prodlou\u017een\u00fdm uvol\u0148ov\u00e1n\u00edm \u2014 antikonvulzivum prvn\u00ed generace <strong>hydantoinov\u00e9 antikonvulzivum<\/strong> pou\u017e\u00edv\u00e1 se k <strong>tonicko-klonick\u00e9 (grand mal) z\u00e1chvaty<\/strong>, <strong>komplexn\u00ed parci\u00e1ln\u00ed z\u00e1chvaty<\/strong>, a <strong>prevence z\u00e1chvat\u016f po neurochirurgick\u00e9m z\u00e1kroku<\/strong>. P\u016fsob\u00ed blok\u00e1dou nap\u011b\u0165ov\u011b \u0159\u00edzen\u00fdch sod\u00edkov\u00fdch kan\u00e1l\u016f v neuronech, stabilizuje inaktivovan\u00fd stav a zabra\u0148uje opakovan\u00e9mu v\u00fdboji. Obvykl\u00e1 d\u00e1vka pro dosp\u011bl\u00e9: <strong>300\u2013400 mg\/den<\/strong> v 1\u20132 rozd\u011blen\u00fdch d\u00e1vk\u00e1ch (forma s prodlou\u017een\u00fdm uvol\u0148ov\u00e1n\u00edm umo\u017e\u0148uje pod\u00e1v\u00e1n\u00ed jednou denn\u011b). Terapeutick\u00e9 rozmez\u00ed: <strong>10\u201320 \u00b5g\/mL<\/strong> \u2014 vy\u017eaduje monitorov\u00e1n\u00ed kv\u016fli <strong>neline\u00e1rn\u00ed (satura\u010dn\u00ed) farmakokinetice<\/strong>. \u010cast\u00e9 vedlej\u0161\u00ed \u00fa\u010dinky: gingiv\u00e1ln\u00ed hyperplazie, ataxie, nystagmus, hirsutismus, zhrub\u011bn\u00ed obli\u010dejov\u00fdch rys\u016f. \u010cetn\u00e9 l\u00e9kov\u00e9 interakce prost\u0159ednictv\u00edm indukce CYP2C9\/2C19.<\/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 Dilantin?<\/h2>\n<p>Dilantin jsou peror\u00e1ln\u00ed tobolky s prodlou\u017een\u00fdm uvol\u0148ov\u00e1n\u00edm obsahuj\u00edc\u00ed <strong>fenytoin sodn\u00fd 100 mg<\/strong>. Fenytoin je jedn\u00edm z nejstar\u0161\u00edch a nejpou\u017e\u00edvan\u011bj\u0161\u00edch antikonvulziv, kter\u00e9 se v klinick\u00e9 praxi nep\u0159etr\u017eit\u011b pou\u017e\u00edv\u00e1 od <strong>1938<\/strong> \u2014 co\u017e z n\u011bj \u010din\u00ed jeden z nejl\u00e9pe prostudovan\u00fdch l\u00e9k\u016f v medic\u00edn\u011b.<\/p>\n<p>Fenytoin stabilizuje neuron\u00e1ln\u00ed membr\u00e1ny blokov\u00e1n\u00edm nap\u011b\u0165ov\u011b \u0159\u00edzen\u00fdch sod\u00edkov\u00fdch kan\u00e1l\u016f, \u010d\u00edm\u017e zabra\u0148uje opakovan\u00e9mu v\u00fdboji, kter\u00fd je z\u00e1kladem \u0161\u00ed\u0159en\u00ed z\u00e1chvat\u016f. Je na <strong>Modelov\u00fd seznam z\u00e1kladn\u00edch l\u00e9\u010div WHO<\/strong> a z\u016fst\u00e1v\u00e1 prvn\u00ed volbou pro <strong>tonicko-klonick\u00e9<\/strong> a <strong>fok\u00e1ln\u00edm z\u00e1chvat\u016fm<\/strong>.  z\u00e1chvaty. Dilantin je p\u016fvodn\u00ed zna\u010dka vyvinut\u00e1 spole\u010dnost\u00ed Parke-Davis (nyn\u00ed Pfizer) a je referen\u010dn\u00edm standardem pro v\u0161echny generick\u00e9 p\u0159\u00edpravky fenytoinu.<\/p>\n<p>Fenytoin je mezi antikonvulzivy unik\u00e1tn\u00ed svou <strong>kinetikou nult\u00e9ho \u0159\u00e1du (satura\u010dn\u00ed)<\/strong> v terapeutick\u00fdch d\u00e1vk\u00e1ch: mal\u00e9 zm\u011bny d\u00e1vkov\u00e1n\u00ed mohou zp\u016fsobit nep\u0159im\u011b\u0159en\u011b velk\u00e9 zm\u011bny hladin v krvi. Proto je <strong>monitorov\u00e1n\u00ed hladin l\u00e9ku (TDM)<\/strong> u fenytoinu povinn\u00e9 \u2014 tato vlastnost z n\u011bj \u010din\u00ed n\u00e1ro\u010dn\u011bj\u0161\u00ed l\u00e9k na p\u0159edepisov\u00e1n\u00ed ne\u017e nov\u011bj\u0161\u00ed p\u0159\u00edpravky, ale z\u00e1rove\u0148 nejl\u00e9pe nastaviteln\u00fd p\u0159i pou\u017eit\u00ed zku\u0161en\u00fdmi kliniky.<\/p>\n<h2 class=\"wp-block-heading\">Jak funguje Dilantin (Fenytoin)?<\/h2>\n<p>Fenytoin blokuje <strong>na nap\u011b\u0165ov\u011b \u0159\u00edzen\u00e9 sod\u00edkov\u00e9 kan\u00e1ly<\/strong> preferen\u010dn\u00ed vazbou na jejich inaktivovan\u00fd stav. T\u00edm prodlu\u017euje refraktern\u00ed obdob\u00ed neuron\u016f a zabra\u0148uje rychl\u00e9mu opakovan\u00e9mu v\u00fdboji, kter\u00fd stoj\u00ed za \u0161\u00ed\u0159en\u00edm z\u00e1chvat\u016f. Na rozd\u00edl od nov\u011bj\u0161\u00edch antikonvulziv p\u016fsob\u00edc\u00edch na v\u00edce c\u00edl\u016f je fenytoin relativn\u011b selektivn\u00edm blok\u00e1torem sod\u00edkov\u00fdch kan\u00e1l\u016f.<\/p>\n<p>Kriticky, fenytoin vykazuje <strong>neline\u00e1rn\u00ed (nulov\u00e9ho \u0159\u00e1du, saturabiln\u00ed) farmakokinetiku<\/strong> popsanou Michaelis-Mentenovou rovnic\u00ed. To znamen\u00e1, \u017ee mal\u00e9 zv\u00fd\u0161en\u00ed d\u00e1vek bl\u00edzko saturace m\u016f\u017ee zp\u016fsobit <strong>nep\u0159im\u011b\u0159en\u011b velk\u00fd<\/strong> vzestup hladin v krvi, co\u017e \u010din\u00ed monitorov\u00e1n\u00ed hladin l\u00e9ku nezbytn\u00fdm.<\/p>\n<h2 class=\"wp-block-heading\">Indikace<\/h2>\n<ul>\n<li><strong>Generalizovan\u00e9 tonicko-klonick\u00e9 (grand mal) z\u00e1chvaty<\/strong><\/li>\n<li><strong>Komplexn\u00ed parci\u00e1ln\u00ed (fok\u00e1ln\u00ed) z\u00e1chvaty<\/strong><\/li>\n<li><strong>Status epilepticus<\/strong> (IV nasycovac\u00ed d\u00e1vka \u2014 ne tato peror\u00e1ln\u00ed forma)<\/li>\n<li><strong>Profylaxe z\u00e1chvat\u016f po neurochirurgick\u00e9m v\u00fdkonu\/\u00farazu mozku<\/strong><\/li>\n<li>Neuralgie trigeminu (druh\u00e1 volba, off-label)<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">D\u00e1vkov\u00e1n\u00ed a terapeutick\u00fd monitoring l\u00e9k\u016f<\/h2>\n<table style=\"width:100%;border-collapse:collapse;margin:0 0 24px 0;\">\n<thead>\n<tr style=\"background:#2c7cb0;color:#fff;\">\n<th style=\"padding:10px 14px;text-align:left;\">Parametr<\/th>\n<th style=\"padding:10px 14px;text-align:left;\">Hodnota<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td style=\"padding:10px 14px;\">Obvykl\u00e1 d\u00e1vka pro dosp\u011bl\u00e9<\/td>\n<td style=\"padding:10px 14px;\">300\u2013400 mg\/den (jednou denn\u011b nebo rozd\u011blen\u011b)<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:10px 14px;\">Nasycovac\u00ed d\u00e1vka (je-li pot\u0159eba)<\/td>\n<td style=\"padding:10px 14px;\">1 000 mg rozd\u011bleno do 3 d\u00e1vek za 24 hodin (or\u00e1ln\u00ed nasycen\u00ed)<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px 14px;\">Terapeutick\u00e9 rozmez\u00ed (celkov\u00e9)<\/td>\n<td style=\"padding:10px 14px;\">10\u201320 \u00b5g\/mL<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:10px 14px;\">Voln\u00e1 (nev\u00e1zan\u00e1) hladina<\/td>\n<td style=\"padding:10px 14px;\">1\u20132 \u00b5g\/mL (kontrolovat p\u0159i hypoalbumin\u00e9mii, selh\u00e1n\u00ed ledvin)<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px 14px;\">\u00dapravy d\u00e1vkov\u00e1n\u00ed<\/td>\n<td style=\"padding:10px 14px;\">Pouze po 25\u201350 mg (neline\u00e1rn\u00ed kinetika)<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:10px 14px;\">Doba do ust\u00e1len\u00ed koncentrace<\/td>\n<td style=\"padding:10px 14px;\">5\u201314 dn\u00ed (del\u0161\u00ed p\u0159i vy\u0161\u0161\u00edch d\u00e1vk\u00e1ch)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><strong>D\u016fle\u017eit\u00e9:<\/strong> Kapsle s prodlou\u017een\u00fdm uvol\u0148ov\u00e1n\u00edm (Dilantin Kapseals) se mus\u00ed polykat cel\u00e9, ne \u017ev\u00fdkat ani drtit. Generick\u00e9 p\u0159\u00edpravky s prodlou\u017een\u00fdm uvol\u0148ov\u00e1n\u00edm fenytoinu nejsou v\u017edy zam\u011bniteln\u00e9 s origin\u00e1ln\u00edm p\u0159\u00edpravkem \u2014 konzultujte zm\u011bnu se sv\u00fdm l\u00e9ka\u0159em.<\/p>\n<h2 class=\"wp-block-heading\">Vedlej\u0161\u00ed \u00fa\u010dinky<\/h2>\n<p><strong>\u010cast\u00e9:<\/strong> gingiv\u00e1ln\u00ed hyperplazie (nadm\u011brn\u00fd r\u016fst d\u00e1sn\u00ed, a\u017e u 50 % dlouhodob\u00fdch u\u017eivatel\u016f), nystagmus, ataxie, zhor\u0161en\u00e1 artikulace, ospalost, hirsutismus, akn\u00e9, hrubnut\u00ed rys\u016f obli\u010deje.<\/p>\n<p><strong>P\u0159\u00edznaky toxicity souvisej\u00edc\u00ed s d\u00e1vkou (v po\u0159ad\u00ed v\u00fdskytu):<\/strong><\/p>\n<table style=\"width:100%;border-collapse:collapse;margin:0 0 24px 0;\">\n<thead>\n<tr style=\"background:#2c7cb0;color:#fff;\">\n<th style=\"padding:10px 14px;\">Hladina v s\u00e9ru<\/th>\n<th style=\"padding:10px 14px;\">P\u0159\u00edznaky<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td style=\"padding:10px 14px;\">&gt;20 \u00b5g\/mL<\/td>\n<td style=\"padding:10px 14px;\">Nystagmus<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:10px 14px;\">&gt;30 \u00b5g\/mL<\/td>\n<td style=\"padding:10px 14px;\">Ataxie, zhor\u0161en\u00e1 artikulace<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px 14px;\">&gt;40 \u00b5g\/mL<\/td>\n<td style=\"padding:10px 14px;\">Zmatenost, letargie<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:10px 14px;\">&gt;50 \u00b5g\/ml<\/td>\n<td style=\"padding:10px 14px;\">K\u0159e\u010de (paradoxn\u00ed), k\u00f3ma<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><strong>Z\u00e1va\u017en\u00e9\/dlouhodob\u00e9:<\/strong> osteomalacie (naru\u0161en\u00ed metabolismu vitaminu D), megaloblastick\u00e1 an\u00e9mie (vy\u010derp\u00e1n\u00ed fol\u00e1t\u016f), Stevens-Johnson\u016fv syndrom\/TEN (vz\u00e1cn\u00e9 \u2013 vy\u0161\u0161\u00ed riziko u nosi\u010d\u016f HLA-B*1502, \u010dast\u00e9 v jihov\u00fdchodn\u00ed Asii), hepatotoxicita, syndrom fialov\u00e9 rukavice (extravazace p\u0159i IV pod\u00e1n\u00ed \u2013 nevztahuje se na peror\u00e1ln\u00ed u\u017eit\u00ed), cerebel\u00e1rn\u00ed atrofie (chronick\u00e9 supraterapeutick\u00e9 hladiny).<\/p>\n<h2 class=\"wp-block-heading\">Varov\u00e1n\u00ed a opat\u0159en\u00ed<\/h2>\n<ul>\n<li><strong>Terapeutick\u00fd monitoring l\u00e9k\u016f je povinn\u00fd.<\/strong> C\u00edlov\u00e1 hladina celkov\u00e9ho fenytoinu: 10\u201320 \u00b5g\/ml (voln\u00fd fenytoin: 1\u20132 \u00b5g\/ml). Nulov\u00e1 kinetika znamen\u00e1, \u017ee i mal\u00e9 zv\u00fd\u0161en\u00ed d\u00e1vky (nap\u0159. z 300 na 330 mg\/den) m\u016f\u017ee posunout hladiny do toxick\u00e9ho rozmez\u00ed. Hladiny kontrolujte 7\u201310 dn\u00ed po jak\u00e9koli zm\u011bn\u011b d\u00e1vky.<\/li>\n<li><strong>Sebevra\u017eedn\u00e9 chov\u00e1n\u00ed \u2013 varov\u00e1n\u00ed t\u0159\u00eddy.<\/strong> V\u0161echna antikonvulziva nesou varov\u00e1n\u00ed FDA ohledn\u011b zv\u00fd\u0161en\u00e9ho rizika sebevra\u017eedn\u00fdch my\u0161lenek. Sledujte n\u00e1ladu, zejm\u00e9na v prvn\u00edch 3 m\u011bs\u00edc\u00edch.<\/li>\n<li><strong>Z\u00e1va\u017en\u00e9 ko\u017en\u00ed ne\u017e\u00e1douc\u00ed reakce (SCARs).<\/strong> Fenytoin nese riziko <strong>Stevens-Johnsonova syndromu (SJS)<\/strong> a <strong>toxick\u00e9 epiderm\u00e1ln\u00ed nekrol\u00fdzy (TEN)<\/strong>, zejm\u00e9na u pacient\u016f s <strong>HLA-B*15:02<\/strong> (b\u011b\u017en\u00e9 u populace jihov\u00fdchodn\u00ed Asie). P\u0159ed zah\u00e1jen\u00edm l\u00e9\u010dby fenytoinem u rizikov\u00fdch populac\u00ed prove\u010fte screening na HLA-B*15:02.<\/li>\n<li><strong>DRESS syndrom.<\/strong> L\u00e9kov\u00e1 reakce s eozinofili\u00ed a syst\u00e9mov\u00fdmi p\u0159\u00edznaky \u2014 n\u00e1stup obvykle 2\u20138 t\u00fddn\u016f po zah\u00e1jen\u00ed l\u00e9\u010dby. Projevuje se hore\u010dkou, vyr\u00e1\u017ekou, lymfadenopati\u00ed a posti\u017een\u00edm org\u00e1n\u016f (j\u00e1tra, ledviny). Okam\u017eit\u011b ukon\u010dete pod\u00e1v\u00e1n\u00ed.<\/li>\n<li><strong>Gingiv\u00e1ln\u00ed hyperplazie.<\/strong> Vyskytuje se u ~50 % chronick\u00fdch u\u017eivatel\u016f. Pe\u010dliv\u00e1 \u00fastn\u00ed hygiena sni\u017euje z\u00e1va\u017enost. U mlad\u00fdch pacient\u016f s kosmetick\u00fdmi obavami zva\u017ete alternativn\u00ed l\u00e9\u010diva.<\/li>\n<li><strong>Hepatotoxicita.<\/strong> Vz\u00e1cn\u00e9, ale m\u016f\u017ee b\u00fdt z\u00e1va\u017en\u00e9, zejm\u00e9na u DRESS. Sledujte jatern\u00ed testy, pokud se objev\u00ed hore\u010dka nebo vyr\u00e1\u017eka.<\/li>\n<li><strong>T\u011bhotenstv\u00ed \u2014 kategorie D.<\/strong> Fenytoin je teratogenn\u00ed (fet\u00e1ln\u00ed hydantoinov\u00fd syndrom: kraniofaci\u00e1ln\u00ed anom\u00e1lie, anom\u00e1lie neht\u016f a prst\u016f, r\u016fstov\u00e9 omezen\u00ed). Pou\u017e\u00edvejte pouze, pokud \u017e\u00e1dn\u00e1 alternativa nekontroluje z\u00e1chvaty. Fol\u00e1t 5 mg\/den od p\u0159edpo\u010detn\u00edho obdob\u00ed. Vitamin K 10 mg\/den v posledn\u00edm m\u011bs\u00edci (fenytoin vy\u010derp\u00e1v\u00e1 fet\u00e1ln\u00ed vitamin K \u2192 neonat\u00e1ln\u00ed krv\u00e1cen\u00ed).<\/li>\n<li><strong>Osteopor\u00f3za.<\/strong> Dlouhodob\u00e9 u\u017e\u00edv\u00e1n\u00ed fenytoinu indukuje CYP enzymy metabolizuj\u00edc\u00ed vitamin D, co\u017e vede k osteomalacii. Dopl\u0148ujte vitamin D v d\u00e1vce 1 000\u20132 000 IU\/den a monitorujte pomoc\u00ed DEXA sken\u016f.<\/li>\n<li><strong>Enter\u00e1ln\u00ed v\u00fd\u017eiva.<\/strong> Pod\u00e1v\u00e1n\u00ed v\u00fd\u017eivy sondou sni\u017euje absorpci fenytoinu a\u017e o 70%. V\u00fd\u017eivu p\u0159eru\u0161te 2 hodiny p\u0159ed a po pod\u00e1n\u00ed d\u00e1vky.<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Kontraindikace \u2013 Kdo by NEM\u011aL u\u017e\u00edvat Dilantin<\/h2>\n<ul>\n<li>Zn\u00e1m\u00e1 p\u0159ecitliv\u011blost na fenytoin, jin\u00e9 hydantoiny nebo jakoukoli pomocnou l\u00e1tku<\/li>\n<li>Sou\u010dasn\u00e9 u\u017e\u00edv\u00e1n\u00ed <strong>delavirdinu<\/strong> (HIV NNRTI \u2013 fenytoin sni\u017euje hladiny delavirdinu na subterapeutick\u00e9)<\/li>\n<li>Sinusov\u00e1 bradykardie, sinoatri\u00e1ln\u00ed blok, AV blok druh\u00e9ho\/t\u0159et\u00edho stupn\u011b, Adams-Stokes\u016fv syndrom<\/li>\n<li>Pacienti pozitivn\u00ed na <strong>HLA-B*15:02<\/strong> (pokud neexistuje alternativa a p\u0159\u00ednos jasn\u011b p\u0159eva\u017euje riziko SJS\/TEN)<\/li>\n<li>Porfyrie<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Interakce s l\u00e9\u010divy<\/h2>\n<p>Fenytoin je sou\u010dasn\u011b <strong>substr\u00e1tem<\/strong> a <strong>induktorem<\/strong> CYP2C9, CYP2C19 a CYP3A4, co\u017e z n\u011bj \u010din\u00ed jeden z antikonvulziv nejn\u00e1chyln\u011bj\u0161\u00edch k interakc\u00edm:<\/p>\n<ul>\n<li><strong>L\u00e9ky, kter\u00e9 zvy\u0161uj\u00ed hladinu fenytoinu:<\/strong> flukonazol, isoniazid, omeprazol, amiodaron, fluoxetin, valpro\u00e1t, trimetoprim<\/li>\n<li><strong>L\u00e9ky, jejich\u017e hladinu fenytoin sni\u017euje:<\/strong> warfarin (paradoxn\u011b: fenytoin nejprve vyt\u011bsn\u00ed, pot\u00e9 indukuje metabolismus), or\u00e1ln\u00ed antikoncepce, cyklosporin, dexamethason, theofylin, doxycyklin, lamotrigin, karbamazepin, metadon<\/li>\n<li><strong>Enter\u00e1ln\u00ed v\u00fd\u017eiva:<\/strong> Kontinu\u00e1ln\u00ed pod\u00e1v\u00e1n\u00ed sondou sni\u017euje absorpci fenytoinu - p\u0159eru\u0161te v\u00fd\u017eivu 2 hodiny p\u0159ed a po pod\u00e1n\u00ed d\u00e1vky<\/li>\n<li><strong>Alkohol:<\/strong> Dlouhodob\u00e9 u\u017e\u00edv\u00e1n\u00ed indukuje metabolismus (ni\u017e\u0161\u00ed hladiny); akutn\u00ed intoxikace metabolismus inhibuje (vy\u0161\u0161\u00ed hladiny)<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Pokyny k uchov\u00e1v\u00e1n\u00ed<\/h2>\n<ul>\n<li>Skladujte p\u0159i pokojov\u00e9 teplot\u011b, <strong>15\u201330\u00b0C<\/strong>. Chra\u0148te p\u0159ed vlhkost\u00ed a sv\u011btlem.<\/li>\n<li>Tobolky uchov\u00e1vejte v p\u016fvodn\u00edm blistrov\u00e9m balen\u00ed a\u017e do pou\u017eit\u00ed.<\/li>\n<li>Neskladujte v koupeln\u011b.<\/li>\n<li>Uchov\u00e1vejte mimo dosah d\u011bt\u00ed - p\u0159ed\u00e1vkov\u00e1n\u00ed fenytoinem je l\u00e9ka\u0159sk\u00e1 pohotovost (nystagmus \u2192 ataxie \u2192 k\u00f3ma).<\/li>\n<li>Nepou\u017e\u00edvejte po uplynut\u00ed data expirace.<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Souvisej\u00edc\u00ed kategorie na MedsBase<\/h2>\n<ul>\n<li><a href=\"https:\/\/medsbase.com\/cs\/neurological-conditions-and-epilepsy\/\">Prohl\u00e9dn\u011bte si v\u0161echny neurologick\u00e9 a antiepileptick\u00e9 l\u00e9ky<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/pain-relief-medication\/\">Proch\u00e1zet l\u00e9ky na \u00falevu od bolesti<\/a><\/li>\n<\/ul>\n<h2 id=\"faqs\">\u010casto kladen\u00e9 dotazy<\/h2>\n<h3 class=\"wp-block-heading\">K \u010demu se pou\u017e\u00edv\u00e1 Dilantin?<\/h3>\n<p>Dilantin obsahuje <strong>fenytoin 100 mg<\/strong> a pou\u017e\u00edv\u00e1 se k l\u00e9\u010db\u011b a prevenci <strong>tonicko-klonick\u00fdch a komplexn\u00edch parci\u00e1ln\u00edch z\u00e1chvat\u016f<\/strong> p\u0159i epilepsii a k prevenci z\u00e1chvat\u016f po mozkov\u00e9 operaci nebo \u00farazu hlavy.<\/p>\n<h3 class=\"wp-block-heading\">Pro\u010d je nutn\u00e9 monitorovat hladinu fenytoinu v krvi?<\/h3>\n<p>Fenytoin m\u00e1 <strong>neline\u00e1rn\u00ed farmakokinetiku<\/strong> \u2014 enzymov\u00fd syst\u00e9m, kter\u00fd jej metabolizuje, se p\u0159i terapeutick\u00fdch d\u00e1vk\u00e1ch saturuje. Mal\u00e9 zv\u00fd\u0161en\u00ed d\u00e1vky (nap\u0159. z 300 na 350 mg) m\u016f\u017ee zp\u016fsobit nep\u0159im\u011b\u0159en\u011b velk\u00fd skok v hladin\u011b v krvi, z terapeutick\u00e9 na toxickou. Pravideln\u00e9 monitorov\u00e1n\u00ed udr\u017euje hladinu v <strong>terapeutick\u00e9m rozmez\u00ed 10\u201320 \u00b5g\/ml<\/strong>.<\/p>\n<h3 class=\"wp-block-heading\">Co je gingiv\u00e1ln\u00ed hyperplazie a lze j\u00ed p\u0159edej\u00edt?<\/h3>\n<p>Gingiv\u00e1ln\u00ed hyperplazie je nadm\u011brn\u00fd r\u016fst d\u00e1sn\u00ed, vyskytuj\u00edc\u00ed se a\u017e u <strong>50%<\/strong> pacient\u016f dlouhodob\u011b u\u017e\u00edvaj\u00edc\u00edch fenytoin. Dobr\u00e1 \u00fastn\u00ed hygiena (pravideln\u00e9 \u010di\u0161t\u011bn\u00ed zub\u016f, pou\u017e\u00edv\u00e1n\u00ed zubn\u00ed nit\u011b, zubn\u00ed prohl\u00eddky) sni\u017euje z\u00e1va\u017enost, ale neodstra\u0148uje ji \u00fapln\u011b. P\u0159echod na jin\u00fd antikonvulzivum je definitivn\u00edm \u0159e\u0161en\u00edm, kdy\u017e se zm\u011bny d\u00e1sn\u00ed stanou problematick\u00fdmi.<\/p>\n<h3 class=\"wp-block-heading\">Mohu p\u0159ej\u00edt mezi origin\u00e1ln\u00edm a generick\u00fdm fenytoinem?<\/h3>\n<p>Prodlou\u017een\u00e9 uvol\u0148ov\u00e1n\u00ed fenytoinu se m\u016f\u017ee li\u0161it v absorp\u010dn\u00edch charakteristik\u00e1ch mezi v\u00fdrobci. N\u011bkter\u00e9 sm\u011brnice doporu\u010duj\u00ed <strong>nep\u0159ech\u00e1zet<\/strong> mezi origin\u00e1ln\u00edmi a generick\u00fdmi l\u00e9ky bez monitorov\u00e1n\u00ed hladin, proto\u017ee i mal\u00e9 zm\u011bny v biologick\u00e9 dostupnosti mohou posunout hladiny mimo \u00fazk\u00e9 terapeutick\u00e9 okno.<\/p>\n<h3 class=\"wp-block-heading\">Pro\u010d by se fenytoin m\u011bl vyvarovat u absence z\u00e1chvat\u016f?<\/h3>\n<p>Fenytoin (a karbamazepin) m\u016f\u017ee <strong>zhor\u0161ovat absence (petit mal) z\u00e1chvaty<\/strong> zm\u011bnou thalamokortik\u00e1ln\u00edch rytm\u016f. L\u00e9ky prvn\u00ed volby pro absence z\u00e1chvat\u016f jsou ethosuximid, valpro\u00e1t nebo lamotrigin.<\/p>\n<h3 class=\"wp-block-heading\">Ovliv\u0148uje fenytoin zdrav\u00ed kost\u00ed?<\/h3>\n<p>Ano \u2014 dlouhodob\u00e9 u\u017e\u00edv\u00e1n\u00ed fenytoinu indukuje CYP enzymy, kter\u00e9 urychluj\u00ed metabolismus vitaminu D, co\u017e vede k <strong>osteomalacii a zv\u00fd\u0161en\u00e9mu riziku zlomenin<\/strong>. Pacienti dlouhodob\u011b u\u017e\u00edvaj\u00edc\u00ed fenytoin by m\u011bli u\u017e\u00edvat dopl\u0148ky vitaminu D a v\u00e1pn\u00edku a podstupovat pravideln\u00e9 vy\u0161et\u0159en\u00ed hustoty kost\u00ed.<\/p>\n<h3 class=\"wp-block-heading\">Je Dilantin bezpe\u010dn\u00fd b\u011bhem t\u011bhotenstv\u00ed?<\/h3>\n<p>Fenytoin je zn\u00e1m\u00fd <strong>teratogen<\/strong> (fet\u00e1ln\u00ed hydantoinov\u00fd syndrom: r\u016fstov\u00e1 retardace, kraniofaci\u00e1ln\u00ed abnormality, defekty kon\u010detin). M\u011bl by b\u00fdt nahrazen bezpe\u010dn\u011bj\u0161\u00edm antikonvulzivem (lamotriginem nebo levetiracetamem) p\u0159ed po\u010det\u00edm, pokud je to mo\u017en\u00e9. Pokud mus\u00ed b\u00fdt fenytoin nad\u00e1le u\u017e\u00edv\u00e1n, je nezbytn\u00e1 suplementace vysok\u00fdmi d\u00e1vkami fol\u00e1tu a odborn\u00fd monitoring.<\/p>\n<h3 class=\"wp-block-heading\">Co m\u00e1m d\u011blat, kdy\u017e vynech\u00e1m d\u00e1vku Dilantinu?<\/h3>\n<p>Vezm\u011bte si l\u00e9k, jakmile si vzpomenete. Pokud je \u010das bl\u00edzko dal\u0161\u00ed pl\u00e1novan\u00e9 d\u00e1vky, vynechejte vynechanou d\u00e1vku. Nikdy ned\u00e1vejte dvojn\u00e1sobnou d\u00e1vku \u2013 kv\u016fli neline\u00e1rn\u00ed kinetice m\u016f\u017ee zdvojn\u00e1soben\u00ed d\u00e1vky zv\u00fd\u0161it hladinu do toxick\u00e9ho rozmez\u00ed.<\/p>\n<h3 class=\"wp-block-heading\">Pro\u010d je u fenytoinu zm\u00edn\u011bn test HLA-B*1502?<\/h3>\n<p>The <strong>HLA-B*1502<\/strong> alel (b\u011b\u017en\u00fd v populac\u00edch jihov\u00fdchodn\u00ed Asie) je siln\u011b spojov\u00e1n s fenytoinem a karbamazepinem vyvolan\u00fdm <strong>Stevens-Johnsonov\u00fdm syndromem (SJS) a toxickou epiderm\u00e1ln\u00ed nekrol\u00fdzou (TEN)<\/strong> \u2013 potenci\u00e1ln\u011b fat\u00e1ln\u00edmi ko\u017en\u00edmi reakcemi. Testov\u00e1n\u00ed se doporu\u010duje p\u0159ed zah\u00e1jen\u00edm l\u00e9\u010dby fenytoinem u rizikov\u00fdch populac\u00ed.<\/p>\n<h3 class=\"wp-block-heading\">Mohu u\u017e\u00edvat antacida s Dilantinem?<\/h3>\n<p>Antacida obsahuj\u00edc\u00ed v\u00e1pn\u00edk a hlin\u00edk mohou sn\u00ed\u017eit absorpci fenytoinu. U\u017e\u00edvejte je s odstupem <strong>alespo\u0148 2 hodiny<\/strong>.<\/p>\n<h3 class=\"wp-block-heading\">Je Dilantin stejn\u00fd jako Epanutin?<\/h3>\n<p>Oba obsahuj\u00ed fenytoin. Dilantin a Epanutin jsou obchodn\u00ed n\u00e1zvy pou\u017e\u00edvan\u00e9 v r\u016fzn\u00fdch trz\u00edch. Tento produkt pou\u017e\u00edv\u00e1 n\u00e1zev Dilantin a obsahuje stejnou formulaci 100 mg fenytoinu sodn\u00e9ho.<\/p>\n<div style=\"background:#fff3f3;border-left:4px solid #d9534f;padding:16px 20px;margin:24px 0;border-radius:4px;font-size:13px;\"><strong>Zdravotn\u00ed upozorn\u011bn\u00ed:<\/strong> Tato str\u00e1nka slou\u017e\u00ed pouze pro informa\u010dn\u00ed \u00fa\u010dely a nenahrazuje odbornou l\u00e9ka\u0159skou pomoc. P\u0159ed zah\u00e1jen\u00edm, zm\u011bnou nebo ukon\u010den\u00edm jak\u00e9hokoli l\u00e9ku se v\u017edy pora\u010fte s kvalifikovan\u00fdm zdravotnick\u00fdm pracovn\u00edkem. D\u00e1vkov\u00e1n\u00ed odpov\u00edd\u00e1 \u00fadaj\u016fm v\u00fdrobce a publikovan\u00fdm klinick\u00fdm doporu\u010den\u00edm \u2014 individu\u00e1ln\u00ed pot\u0159eby se mohou li\u0161it.<\/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\/lefuheal\/\">Lefuheal<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/reactin-sr\/\">Reactin SR<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/anaridex\/\">Anaridex<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/gravitor\/\">Gravitor<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/erythego-gel\/\">Erythego Gel<\/a><\/li>\n<\/ul>","protected":false},"excerpt":{"rendered":"<p>\u2705 Kontrola z\u00e1chvat\u016f<br \/>\n\u2705 Zabra\u0148uje k\u0159e\u010d\u00edm<br \/>\n\u2705 L\u00e9\u010d\u00ed epilepsii<br \/>\n\u2705 Stabilizuje mozkovou aktivitu<br \/>\n\u2705 Sni\u017euje frekvenci z\u00e1chvat\u016f<\/p>\n<p>Dilantin obsahuje Phenytoin.<\/p>","protected":false},"featured_media":60063,"comment_status":"open","ping_status":"open","template":"","meta":[],"product_brand":[],"product_cat":[3141,3223,3468],"product_tag":[4793,4794],"class_list":{"0":"post-60062","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-neurological-conditions-and-epilepsy","9":"product_tag-dilantin","10":"product_tag-phenytoin","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\/60062","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=60062"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/media\/60063"}],"wp:attachment":[{"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/media?parent=60062"}],"wp:term":[{"taxonomy":"product_brand","embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_brand?post=60062"},{"taxonomy":"product_cat","embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_cat?post=60062"},{"taxonomy":"product_tag","embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_tag?post=60062"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}