{"id":60454,"date":"2024-02-28T06:49:25","date_gmt":"2024-02-28T06:49:25","guid":{"rendered":"https:\/\/medsname.com\/r-cin\/"},"modified":"2026-05-01T10:49:16","modified_gmt":"2026-05-01T10:49:16","slug":"r-cin","status":"publish","type":"product","link":"https:\/\/medsbase.com\/cs\/product\/r-cin\/","title":{"rendered":"R-Cin"},"content":{"rendered":"

<\/p>\n

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

R-Cin<\/strong> obsahuje rifampicin (300 mg \/ 450 mg \/ 600 mg tobolky)<\/strong> od v\u00fdrobce certifikovan\u00e9ho WHO-GMP (vyr\u00e1b\u00ed spole\u010dnost Cipla) \u2014 baktericidn\u00ed antituberkulotikum, kter\u00e9 inhibuje bakteri\u00e1ln\u00ed DNA-dependentn\u00ed RNA polymer\u00e1zu. Standardn\u00ed d\u00e1vka pro dosp\u011bl\u00e9 p\u0159i aktivn\u00ed TB:<\/strong> 10 mg\/kg jednou denn\u011b (obvykle 450 mg pro 38\u201355 kg, 600 mg pro > 55 kg) nala\u010dno<\/strong> \u2014 jednu hodinu p\u0159ed j\u00eddlem nebo dv\u011b hodiny po j\u00eddle. Rifampicin se p\u0159i l\u00e9\u010db\u011b aktivn\u00ed TB nikdy nepou\u017e\u00edv\u00e1 samostatn\u011b<\/strong>; v\u017edy se kombinuje s isoniazidem, pyrazinamidem a ethambutolem (4-l\u00e9kov\u00fd re\u017eim RIPE) po prvn\u00ed dva m\u011bs\u00edce, pot\u00e9 pokra\u010duje s isoniazidem dal\u0161\u00ed \u010dty\u0159i m\u011bs\u00edce. Samostatn\u00fd rifampicin m\u00e1 definovan\u00e9 pou\u017eit\u00ed p\u0159i latentn\u00ed TB infekci (4m\u011bs\u00ed\u010dn\u00ed monoterapie), lep\u0159e, profylaxi meningokokov\u00fdch kontakt\u016f, infekc\u00edch kost\u00ed\/kloub\u016f MRSA a brucel\u00f3ze<\/strong>. O\u010dek\u00e1vejte oran\u017eovo-\u010derven\u00e9 zabarven\u00ed mo\u010di, potu, slz a slin<\/strong> (ne\u0161kodn\u00e9, ale trvale barv\u00ed m\u011bkk\u00e9 kontaktn\u00ed \u010do\u010dky). Rifampicin je velmi siln\u00fd induktor CYP3A4\/2C9\/2C19<\/strong> a sni\u017euje \u00fa\u010dinnost des\u00edtek l\u00e9k\u016f v\u010detn\u011b peror\u00e1ln\u00edch kontraceptiv, warfarinu, DOAC, statin\u016f, methadonu, imunosupresiv, antiretrovirotik a mnoha dal\u0161\u00edch.<\/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

Kritick\u00e9 bezpe\u010dnostn\u00ed upozorn\u011bn\u00ed \u2014 samotn\u00fd rifampicin nen\u00ed l\u00e9\u010dbou aktivn\u00ed tuberkul\u00f3zy.<\/strong> Aktivn\u00ed plicn\u00ed nebo mimoplicn\u00ed TB vy\u017eaduje kombinovanou terapii. Standardn\u00ed re\u017eim doporu\u010den\u00fd WHO je 2 m\u011bs\u00edce intenzivn\u00ed f\u00e1ze RIPE<\/strong> (rifampicin + isoniazid + pyrazinamid + ethambutol) n\u00e1sledovan\u00e9 4 m\u011bs\u00edce pokra\u010dovac\u00ed f\u00e1ze RH<\/strong> (rifampicin + isoniazid). Pou\u017eit\u00ed rifampicinu jako jedin\u00e9ho \u010dinidla u aktivn\u00ed TB zp\u016fsobuje rychl\u00e9 vzniknut\u00ed rezistence na rifampicin<\/strong>, selh\u00e1n\u00ed l\u00e9\u010dby, prodlou\u017eenou infek\u010dnost a rozvoj multirezistentn\u00ed TB (MDR-TB). Jedno\u010dinidlov\u00fd R-Cin je vhodn\u00fd pouze<\/strong> p\u0159i p\u0159edeps\u00e1n\u00ed pro: (a) pokra\u010dov\u00e1n\u00ed prob\u00edhaj\u00edc\u00edho kombinovan\u00e9ho re\u017eimu pod dohledem, (b) latentn\u00ed infekci TB (4m\u011bs\u00ed\u010dn\u00ed monoterapie rifampicinem \u2014 re\u017eim 4R), (c) jednu z definovan\u00fdch indikac\u00ed mimo TB uveden\u00fdch n\u00ed\u017ee. Pokud m\u00e1te podez\u0159en\u00ed nebo potvrzenou aktivn\u00ed TB, pot\u0159ebujete plnou kombinovanou terapii pod odborn\u00fdm dohledem \u2014 nel\u00e9\u010dte pouze rifampicinem.<\/div>\n

Co je R-Cin (Rifampicin)<\/h2>\n

R-Cin je zna\u010dka spole\u010dnosti Cipla pro rifampicinem<\/strong>, polosyntetick\u00e9 rifamycinov\u00e9 antibiotikum zaveden\u00e9 koncem 60. let 20. stolet\u00ed a za\u0159azen\u00e9 na Modelov\u00fd seznam z\u00e1kladn\u00edch l\u00e9\u010div WHO. Ka\u017ed\u00e1 nepr\u016fhledn\u00e1 \u010derveno-v\u00ednov\u00e1 tobolka obsahuje 300 mg, 450 mg nebo 600 mg rifampicinu. Rifampicin je \u00fa\u010dinn\u00fd baktericidn\u00ed<\/strong> proti Mycobacterium tuberculosis<\/em>, M. leprae<\/em>, a \u0159ad\u011b stafylokok\u016f, neisseri\u00ed a dal\u0161\u00edch intracelul\u00e1rn\u00edch patogen\u016f. Je to nejd\u016fle\u017eit\u011bj\u0161\u00ed steriliza\u010dn\u00ed l\u00e9k v modern\u00ed kr\u00e1tkodob\u00e9 terapii TB \u2014 jedin\u00e9 \u010dinidlo, kter\u00e9 v 70. letech 20. stolet\u00ed umo\u017enilo zkr\u00e1tit dobu l\u00e9\u010dby z 18\u201324 m\u011bs\u00edc\u016f na 6 m\u011bs\u00edc\u016f.<\/p>\n

Jak R-Cin funguje (mechanismus \u00fa\u010dinku)<\/h2>\n

Rifampicin se v\u00e1\u017ee na \u03b2-podjednotku bakteri\u00e1ln\u00ed DNA-dependentn\u00ed RNA polymer\u00e1zy, \u010d\u00edm\u017e blokuje iniciaci transkripce RNA. Na sav\u010d\u00ed RNA polymer\u00e1zy nep\u016fsob\u00ed, proto\u017ee jejich struktura se li\u0161\u00ed v oblasti vazebn\u00e9ho m\u00edsta pro rifampicin. L\u00e9k pronik\u00e1 do hostitelsk\u00fdch bun\u011bk, granulom\u016f, abscesov\u00fdch dutin a mozkom\u00ed\u0161n\u00edho moku p\u0159i z\u00e1n\u011btu mening\u016f \u2013 proto je tak d\u016fle\u017eit\u00fd proti intracelul\u00e1rn\u00edm a odd\u011blovac\u00edm infekc\u00edm. Rezistence vznik\u00e1 bodov\u00fdmi mutacemi v genu rpoB<\/em> k\u00f3duj\u00edc\u00edm \u03b2-podjednotku polymer\u00e1zy; proto mus\u00ed b\u00fdt rifampicin v\u017edy kombinov\u00e1n s alespo\u0148 jedn\u00edm dal\u0161\u00edm \u00fa\u010dinn\u00fdm \u010dinidlem<\/strong> p\u0159i l\u00e9\u010db\u011b organism\u016f s vysokou bakteri\u00e1ln\u00ed n\u00e1lo\u017e\u00ed (jako je aktivn\u00ed TBC).<\/p>\n

Indikace \u2013 co R-Cin l\u00e9\u010d\u00ed<\/h2>\n

1. Aktivn\u00ed tuberkul\u00f3za (pouze v kombinovan\u00e9 terapii)<\/h3>\n

Rifampicin je z\u00e1kladem 6m\u011bs\u00ed\u010dn\u00edho kr\u00e1tkodob\u00e9ho re\u017eimu WHO pro l\u00e9ky citlivou plicn\u00ed a mimoplicn\u00ed TBC:<\/p>\n\n\n\n\n\n\n
F\u00e1ze<\/th>\nD\u00e9lka<\/th>\nL\u00e9ky<\/th>\n<\/tr>\n<\/thead>\n
Intenzivn\u00ed<\/td>\n2 m\u011bs\u00edce<\/td>\nRifampicin + Isoniazid + Pyrazinamid + Ethambutol (RIPE)<\/td>\n<\/tr>\n
Pokra\u010dovac\u00ed<\/td>\n4 m\u011bs\u00edce<\/td>\nRifampicin + Isoniazid (RH)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Minim\u00e1ln\u00ed celkov\u00e1 doba l\u00e9\u010dby je 6 m\u011bs\u00edc\u016f. Del\u0161\u00ed re\u017eimy (9\u201312 m\u011bs\u00edc\u016f) se pou\u017e\u00edvaj\u00ed pro TBC meningitidu, kostn\u00ed\/kloubn\u00ed TBC a diseminovan\u00e9 onemocn\u011bn\u00ed. L\u00e9\u010dba mus\u00ed b\u00fdt kontrolov\u00e1na \u2013 p\u0159\u00edmo sledovan\u00e1 terapie (DOT) je doporu\u010dena ve v\u011bt\u0161in\u011b n\u00e1rodn\u00edch program\u016f k zaji\u0161t\u011bn\u00ed adherence a prevenci vzniku MDR-TBC.<\/p>\n

2. Latentn\u00ed tuberkul\u00f3zn\u00ed infekce (LTBI)<\/h3>\n

U pacient\u016f s pozitivn\u00edm tuberkulinov\u00fdm testem nebo testem na uvoln\u011bn\u00ed interferonu-gama, ale bez aktivn\u00edho onemocn\u011bn\u00ed, se pod\u00e1v\u00e1 \u010dty\u0159m\u011bs\u00ed\u010dn\u00ed monoterapie rifampicinem<\/strong> p\u0159i d\u00e1vce 10 mg\/kg\/den (4R re\u017eim) je jednou z preferovan\u00fdch mo\u017enost\u00ed WHO. Studie NEJM z roku 2017 od Menzies et al. prok\u00e1zala, \u017ee 4R re\u017eim nen\u00ed hor\u0161\u00ed ne\u017e 9 m\u011bs\u00edc\u016f isoniazidu a m\u011bl v\u00fdrazn\u011b m\u00e9n\u011b p\u0159\u00edpad\u016f hepatotoxicity, ni\u017e\u0161\u00ed m\u00edru p\u0159eru\u0161en\u00ed l\u00e9\u010dby a lep\u0161\u00ed m\u00edru dokon\u010den\u00ed. Toto je jedin\u00e1 standardn\u00ed situace, kdy je rifampicin spr\u00e1vn\u011b pou\u017e\u00edv\u00e1n jako jedin\u00fd l\u00e9k p\u0159i tuberkul\u00f3zn\u00ed infekci.<\/p>\n

3. Lepra (multibacil\u00e1rn\u00ed v\u00edce\u010detn\u00e1 l\u00e9\u010dba)<\/h3>\n

WHO re\u017eim v\u00edce\u010detn\u00e9 l\u00e9\u010dby pro multibacil\u00e1rn\u00ed lepru je m\u011bs\u00ed\u010dn\u00ed rifampicin 600 mg + m\u011bs\u00ed\u010dn\u00ed klofazimin 300 mg + denn\u00ed klofazimin 50 mg + denn\u00ed dapson 100 mg po dobu 12 m\u011bs\u00edc\u016f. Rifampicin je nejrychleji baktericidn\u00ed l\u00e1tka proti M. leprae<\/em> \u2014 jedin\u00e1 d\u00e1vka 600 mg zabije v\u00edce ne\u017e 99 % \u017eivotaschopn\u00fdch organism\u016f.<\/p>\n

4. Profylaxe meningokokov\u00e9ho onemocn\u011bn\u00ed<\/h3>\n

Bl\u00edzc\u00ed kontakty potvrzen\u00e9ho p\u0159\u00edpadu meningokokov\u00e9ho onemocn\u011bn\u00ed mohou u\u017e\u00edvat rifampicin 600 mg dvakr\u00e1t denn\u011b po dobu 2 dn\u016f (dosp\u011bl\u00ed; u d\u011bt\u00ed upraveno podle hmotnosti) k eradikaci nosohltanov\u00e9ho nosi\u010dstv\u00ed. Ciprofloxacin 500 mg v jedn\u00e9 d\u00e1vce nebo ceftriaxon 250 mg IM v jedn\u00e9 d\u00e1vce jsou stejn\u011b p\u0159ijateln\u00e9 alternativy, zejm\u00e9na kdy\u017e by rifampicin interagoval s prob\u00edhaj\u00edc\u00ed medikac\u00ed.<\/p>\n

5. Stafylokokov\u00e9 infekce kost\u00ed, kloub\u016f a protetick\u00fdch za\u0159\u00edzen\u00ed<\/h3>\n

Rifampicin se p\u0159id\u00e1v\u00e1 k vankomycinu, daptomycinu nebo beta-laktam\u016fm u z\u00e1va\u017en\u00fdch stafylokokov\u00fdch infekc\u00ed zahrnuj\u00edc\u00edch biofilm \u2014 zejm\u00e9na infekce protetick\u00fdch kloub\u016f a infek\u010dn\u00ed endokarditidu na protetick\u00fdch chlopn\u00edch. Rifampicin pronik\u00e1 do biofilmu, kam v\u011bt\u0161ina antibiotik nedos\u00e1hne. V\u017edy mus\u00ed b\u00fdt kombinov\u00e1n, aby se p\u0159ede\u0161lo rychl\u00e9mu vzniku rezistence.<\/p>\n

6. Brucel\u00f3za<\/h3>\n

Rifampicin 600\u2013900 mg\/den v kombinaci s doxycyklinem 100 mg dvakr\u00e1t denn\u011b po dobu 6 t\u00fddn\u016f je jedn\u00edm ze standardn\u00edch re\u017eim\u016f WHO pro nekomplikovanou brucel\u00f3zu. Aminoglykosid (streptomycin nebo gentamicin) se p\u0159id\u00e1v\u00e1 p\u0159i spondylitid\u011b nebo endokarditid\u011b.<\/p>\n

D\u00e1vkov\u00e1n\u00ed<\/h2>\n\n\n\n\n\n\n\n\n\n\n
Indikace<\/th>\nD\u00e1vkov\u00e1n\u00ed pro dosp\u011bl\u00e9<\/th>\nD\u011btsk\u00e1 d\u00e1vka<\/th>\n<\/tr>\n<\/thead>\n
Aktivn\u00ed TBC (v kombinaci)<\/td>\n10 mg\/kg jednou denn\u011b, max. 600 mg
 \u2022 38\u201355 kg \u2192 450 mg
 \u2022 > 55 kg \u2192 600 mg<\/td>\n		15 mg\/kg jednou denn\u011b, max. 600 mg<\/td>\n<\/tr>\n
Latentn\u00ed TB (4R)<\/td>\n10 mg\/kg jednou denn\u011b po dobu 4 m\u011bs\u00edc\u016f<\/td>\n15 mg\/kg jednou denn\u011b po dobu 4 m\u011bs\u00edc\u016f<\/td>\n<\/tr>\n
Lepra (multibacil\u00e1rn\u00ed)<\/td>\n600 mg jednou m\u011bs\u00ed\u010dn\u011b \u00d7 12 m\u011bs\u00edc\u016f<\/td>\n10 mg\/kg jednou m\u011bs\u00ed\u010dn\u011b<\/td>\n<\/tr>\n
Profylaxe meningokokov\u00e9 infekce<\/td>\n600 mg dvakr\u00e1t denn\u011b po dobu 2 dn\u016f<\/td>\n10 mg\/kg dvakr\u00e1t denn\u011b \u00d7 2 dny (max. 600 mg\/d\u00e1vka)<\/td>\n<\/tr>\n
Infekce kost\u00ed\/kloub\u016f\/za\u0159\u00edzen\u00ed na prot\u00e9zu<\/td>\n300\u2013600 mg dvakr\u00e1t denn\u011b, v kombinaci<\/td>\nVedeno specialistou<\/td>\n<\/tr>\n
Infekce veden\u00e1 specialistou<\/td>\nBrucel\u00f3za (s doxycyklinem)<\/td>\n600\u2013900 mg jednou denn\u011b po dobu 6 t\u00fddn\u016f<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Vy\u017eaduje se monitorov\u00e1n\u00ed funkce jater<\/strong> jednu hodinu p\u0159ed j\u00eddlem nebo dv\u011b hodiny po j\u00eddle. J\u00eddlo (zejm\u00e9na tu\u010dn\u00e1 j\u00eddla) sni\u017euje absorpci o ~30%. Tobolky polykejte cel\u00e9 a zapijte vodou; nel\u00e1mejte je ani neotv\u00edrejte.<\/p>\n

Povinn\u00e9 monitorov\u00e1n\u00ed<\/h2>\n
Vy\u017eaduje se monitorov\u00e1n\u00ed funkce jater.<\/strong> P\u0159ed zah\u00e1jen\u00edm l\u00e9\u010dby zkontrolujte v\u00fdchoz\u00ed hodnoty ALT, AST, bilirubinu a alkalick\u00e9 fosfat\u00e1zy; opakujte za 2 t\u00fddny, pot\u00e9 m\u011bs\u00ed\u010dn\u011b b\u011bhem l\u00e9\u010dby. P\u0159eru\u0161te pod\u00e1v\u00e1n\u00ed rifampicinu a doprovodn\u00fdch l\u00e9k\u016f (zejm\u00e9na isoniazidu a pyrazinamidu) a vyhledejte l\u00e9ka\u0159skou pomoc, pokud se objev\u00ed: neustupuj\u00edc\u00ed nevolnost nebo zvracen\u00ed, ztr\u00e1ta chuti k j\u00eddlu, \u017eloutenka (ze\u017eloutnut\u00ed k\u016f\u017ee nebo o\u010dn\u00edho b\u011blma), tmav\u00e1 mo\u010d, sv\u011btl\u00e1 stolice nebo bolest b\u0159icha v prav\u00e9m horn\u00edm kvadrantu. P\u0159eru\u0161te l\u00e9\u010dbu, pokud ALT > 3\u00d7 ULN s p\u0159\u00edznaky nebo > 5\u00d7 ULN bez p\u0159\u00edznak\u016f.<\/div>\n

Dal\u0161\u00ed monitorov\u00e1n\u00ed v z\u00e1vislosti na re\u017eimu: kompletn\u00ed krevn\u00ed obraz (rifampicin m\u016f\u017ee zp\u016fsobit trombocytopenii a vz\u00e1cnou hemolytickou an\u00e9mii), urea\/kreatinin, n\u00e1t\u011br\/kultivace sputa (u aktivn\u00ed TBC \u2014 konverze ve 2. m\u011bs\u00edci je hlavn\u00edm ukazatelem \u00fa\u010dinnosti), HIV status (koinfekce TBC\/HIV m\u011bn\u00ed re\u017eim).<\/p>\n

Vedlej\u0161\u00ed \u00fa\u010dinky<\/h2>\n

Vy\u017eaduje se monitorov\u00e1n\u00ed funkce jater<\/strong><\/p>\n

    \n
  • Oran\u017eovo-\u010derven\u00e9 zbarven\u00ed mo\u010di, potu, slz, slin (v\u017edy \u2014 potvrzuje vst\u0159eb\u00e1v\u00e1n\u00ed; trvale barv\u00ed m\u011bkk\u00e9 kontaktn\u00ed \u010do\u010dky)<\/li>\n
  • Nevolnost, nechutenstv\u00ed, b\u0159i\u0161n\u00ed diskomfort \u2014 ustupuj\u00ed b\u011bhem prvn\u00edch 1\u20132 t\u00fddn\u016f<\/li>\n
  • Vy\u017eaduje se monitorov\u00e1n\u00ed funkce jater<\/li>\n<\/ul>\n

    M\u00e9n\u011b \u010dast\u00e9, ale d\u016fle\u017eit\u00e9:<\/strong><\/p>\n

      \n
    • L\u00e9ky vyvolan\u00e1 hepatitida (5\u201310 % pacient\u016f m\u00e1 asymptomatick\u00e9 zv\u00fd\u0161en\u00ed transamin\u00e1z; ~1 % rozvine klinickou hepatitidu \u2014 riziko je vy\u0161\u0161\u00ed u star\u0161\u00edch pacient\u016f, konzument\u016f alkoholu, nosi\u010d\u016f hepatitidy B\/C a p\u0159i kombinaci s isoniazidem + pyrazinamidem)<\/li>\n
    • Ch\u0159ipkov\u00fd syndrom \u2014 hore\u010dka, zimnice, bolest hlavy, myalgie \u2014 zejm\u00e9na p\u0159i p\u0159eru\u0161ovan\u00e9m d\u00e1vkov\u00e1n\u00ed (dvakr\u00e1t nebo t\u0159ikr\u00e1t t\u00fddn\u011b) nebo po op\u011btovn\u00e9m zah\u00e1jen\u00ed l\u00e9\u010dby<\/li>\n
    • Trombocytopenie, hemolytick\u00e1 an\u00e9mie, eosinofilie (vz\u00e1cn\u00e9; imunitn\u011b zprost\u0159edkovan\u00e9; p\u0159eru\u0161it pod\u00e1v\u00e1n\u00ed l\u00e9ku)<\/li>\n
    • Akutn\u00ed po\u0161kozen\u00ed ledvin (vz\u00e1cn\u00e9; obvykle p\u0159i p\u0159eru\u0161ovan\u00e9m d\u00e1vkov\u00e1n\u00ed)<\/li>\n
    • P\u0159ecitliv\u011blostn\u00ed vyr\u00e1\u017eka, kop\u0159ivka, angioed\u00e9m, anafylaxe (vz\u00e1cn\u00e9; trval\u00e1 kontraindikace)<\/li>\n
    • Stevens-Johnson\u016fv syndrom \/ toxick\u00e1 epiderm\u00e1ln\u00ed nekrol\u00fdza (velmi vz\u00e1cn\u00e9; trval\u00e1 kontraindikace)<\/li>\n<\/ul>\n

      Interakce s l\u00e9\u010divy<\/h2>\n
      Varov\u00e1n\u00ed p\u0159ed l\u00e9kov\u00fdmi interakcemi \u2014 rifampicin je jedn\u00edm z nejsiln\u011bj\u0161\u00edch induktor\u016f CYP enzym\u016f v klinick\u00e9 praxi.<\/strong> Indukuje CYP3A4, CYP2C9, CYP2C19, CYP1A2, CYP2B6, P-glykoprotein a mnoho enzym\u016f f\u00e1ze II konjugace. Plazmatick\u00e9 koncentrace sou\u010dasn\u011b pod\u00e1van\u00fdch l\u00e9k\u016f mohou klesnout o 50\u201390 %, s n\u00e1stupem b\u011bhem 1\u20132 t\u00fddn\u016f a p\u0159etrv\u00e1v\u00e1n\u00edm 2\u20134 t\u00fddny po vysazen\u00ed rifampicinu. P\u0159ed zah\u00e1jen\u00edm l\u00e9\u010dby rifampicinem informujte sv\u00e9ho p\u0159edepisuj\u00edc\u00edho l\u00e9ka\u0159e o v\u0161ech l\u00e9c\u00edch, dopl\u0148c\u00edch stravy a bylinn\u00fdch p\u0159\u00edpravc\u00edch, kter\u00e9 u\u017e\u00edv\u00e1te.<\/strong> N\u00ed\u017ee uveden\u00e1 tabulka interakc\u00ed pokr\u00fdv\u00e1 hlavn\u00ed t\u0159\u00eddy; pro l\u00e9ky neuveden\u00e9 v seznamu se pora\u010fte s l\u00e9k\u00e1rn\u00edkem.<\/div>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
      T\u0159\u00edda l\u00e9k\u016f \/ p\u0159\u00edklady<\/th>\nInterakce s rifampicinem<\/th>\nCo d\u011blat<\/th>\n<\/tr>\n<\/thead>\n
      Kombinovan\u00e9 \/ pouze progestogenn\u00ed peror\u00e1ln\u00ed antikoncepce, n\u00e1plast, krou\u017eek, implant\u00e1t<\/td>\nV\u00fdznamn\u00e1 ztr\u00e1ta \u00fa\u010dinnosti<\/td>\nPou\u017e\u00edvejte bari\u00e9rovou antikoncepci (kondomy) nebo m\u011bd\u011bn\u00e9 nitrod\u011blo\u017en\u00ed t\u011bl\u00edsko po celou dobu a 4 t\u00fddny po ukon\u010den\u00ed l\u00e9\u010dby<\/td>\n<\/tr>\n
      Warfarin<\/td>\nINR prudce kles\u00e1; riziko tromb\u00f3zy<\/td>\nMonitorujte INR t\u00fddn\u011b; o\u010dek\u00e1vejte pot\u0159ebu 2\u20133n\u00e1sobn\u00e9ho zv\u00fd\u0161en\u00ed d\u00e1vky; kontrolujte t\u00fddn\u011b po dobu 4 t\u00fddn\u016f po vysazen\u00ed rifampicinu<\/td>\n<\/tr>\n
      DOAC (apixaban, rivaroxaban, dabigatran, edoxaban)<\/td>\nHladiny v\u0161ech DOAC v\u00fdrazn\u011b klesaj\u00ed<\/td>\nP\u0159echod na warfarin (nebo LMWH) po dobu l\u00e9\u010dby rifampicinem<\/td>\n<\/tr>\n
      Statiny (simvastatin, atorvastatin, lovastatin)<\/td>\nPlazmatick\u00e9 hladiny sn\u00ed\u017eeny > 50 %<\/td>\nP\u0159echod na fluvastatin, rosuvastatin nebo pravastatin (m\u00e9n\u011b ovlivn\u011bn\u00e9); konzultujte s p\u0159edepisuj\u00edc\u00edm l\u00e9ka\u0159em<\/td>\n<\/tr>\n
      Inhibitory HIV prote\u00e1zy (lopinavir, atazanavir, darunavir)<\/td>\nHladiny PI kolabuj\u00ed; selh\u00e1n\u00ed ART<\/td>\nVym\u011b\u0148te rifampicin za rifabutin<\/strong> nebo zm\u011bnit re\u017eim ART \u2014 nutn\u00fd odborn\u00fd posudek<\/td>\n<\/tr>\n
      HIV NNRTIs (efavirenz OK; nevirapine sn\u00ed\u017een\u00fd)<\/td>\nProm\u011bnliv\u00e9<\/td>\nART na b\u00e1zi efavirenzu je obecn\u011b kompatibiln\u00ed s rifampicinem<\/td>\n<\/tr>\n
      Dolutegravir, raltegravir<\/td>\nSn\u00ed\u017een\u00e9 hladiny<\/td>\nDolutegravir 50 mg dvakr\u00e1t denn\u011b<\/strong> s rifampicinem; raltegravir 800 mg dvakr\u00e1t denn\u011b<\/td>\n<\/tr>\n
      Metadon<\/td>\nVysazen\u00ed b\u011bhem n\u011bkolika dn\u00ed<\/td>\nZv\u00fd\u0161it d\u00e1vku methadonu o 50\u2013100 % s monitorov\u00e1n\u00edm; varovat pacienta p\u0159ed zah\u00e1jen\u00edm l\u00e9\u010dby rifampicinem<\/td>\n<\/tr>\n
      Tacrolimus, cyklosporin, sirolimus, everolimus<\/td>\nPokles hladin v minimu; riziko odm\u00edtnut\u00ed transplant\u00e1tu<\/td>\nKonzultace s transplanta\u010dn\u00edm t\u00fdmem p\u0159ed zah\u00e1jen\u00edm l\u00e9\u010dby rifampicinem<\/td>\n<\/tr>\n
      Fenytoin, karbamazepin<\/td>\nPokles hladin antikonvulziv; riziko z\u00e1chvat\u016f<\/td>\nMonitorovat hladiny; \u010dasto je nutn\u00e9 zv\u00fd\u0161it d\u00e1vku<\/td>\n<\/tr>\n
      Kortikosteroidy (prednisolon, dexamethason)<\/td>\nClearance steroid\u016f se p\u0159ibli\u017en\u011b zdvojn\u00e1sob\u00ed<\/td>\nZv\u00fd\u0161it d\u00e1vku steroid\u016f p\u0159i l\u00e9\u010db\u011b Addisonovy choroby, astmatu nebo autoimunitn\u00edho vzplanut\u00ed<\/td>\n<\/tr>\n
      Itrakonazol, ketokonazol, vorikonazol<\/td>\nHladiny antimykotik v\u00fdrazn\u011b klesaj\u00ed<\/td>\nVyhn\u011bte se kombinaci \u2014 zva\u017ete flukonazol (m\u00e9n\u011b ovlivn\u011bn\u00fd) nebo amfotericin<\/td>\n<\/tr>\n
      Sulfonylmo\u010doviny (gliklazid, glimepirid, glipizid)<\/td>\nGlykemick\u00e1 kontrola se zhor\u0161uje<\/td>\nMonitorujte hladinu gluk\u00f3zy v krvi; upravte d\u00e1vkov\u00e1n\u00ed podle pot\u0159eby<\/td>\n<\/tr>\n
      Levothyroxin<\/td>\nZv\u00fd\u0161en\u00e1 clearance; TSH stoup\u00e1<\/td>\nZkontrolujte TSH za 6 t\u00fddn\u016f; o\u010dek\u00e1vejte zv\u00fd\u0161en\u00ed d\u00e1vky levothyroxinu<\/td>\n<\/tr>\n
      Theofylin, betablok\u00e1tory (metabolizovan\u00e9), opioidy (kodein, oxykodon)<\/td>\nSn\u00ed\u017een\u00fd \u00fa\u010dinek<\/td>\nKlinick\u00e9 sledov\u00e1n\u00ed; titrujte podle \u00fa\u010dinku<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

      Tento v\u00fd\u010det nen\u00ed vy\u010derp\u00e1vaj\u00edc\u00ed. V\u017edy nechte l\u00e9k\u00e1rn\u00edka nebo l\u00e9ka\u0159e zkontrolovat v\u0161echny sou\u010dasn\u011b u\u017e\u00edvan\u00e9 l\u00e9ky a dopl\u0148ky \u2014 v\u010detn\u011b voln\u011b prodejn\u00fdch analgetik, bylinn\u00fdch p\u0159\u00edpravk\u016f a dopl\u0148kov\u00fdch l\u00e9\u010div.<\/p>\n

      Kontraindikace a upozorn\u011bn\u00ed<\/h2>\n
        \n
      • Zn\u00e1m\u00e1 p\u0159ecitliv\u011blost na rifampicin nebo jak\u00fdkoli rifamycin (rifabutin, rifapentin)<\/li>\n
      • Akutn\u00ed jatern\u00ed onemocn\u011bn\u00ed, prok\u00e1zan\u00e1 \u017eloutenka nebo chronick\u00e9 jatern\u00ed onemocn\u011bn\u00ed s v\u00fdznamn\u00fdm po\u0161kozen\u00edm funkce<\/li>\n
      • Sou\u010dasn\u00e9 pod\u00e1v\u00e1n\u00ed saquinaviru + ritonaviru (z\u00e1va\u017en\u00e1 hepatotoxicita)<\/li>\n
      • Porfyrie (rifampicin m\u016f\u017ee vyvolat akutn\u00ed ataky)<\/li>\n<\/ul>\n

        Pou\u017e\u00edvejte s opatrnost\u00ed u: poruchy u\u017e\u00edv\u00e1n\u00ed alkoholu, chronick\u00e9 hepatitidy B nebo C, podv\u00fd\u017eivy (nedostatek vitaminu K \u2192 riziko krv\u00e1cen\u00ed), star\u0161\u00edch osob, anamn\u00e9zy l\u00e9ky vyvolan\u00e9 hepatitidy. M\u016f\u017ee se zhor\u0161it kontrola diabetu; pot\u0159eba inzul\u00ednu \u010dasto stoup\u00e1.<\/p>\n

        T\u011bhotenstv\u00ed, kojen\u00ed a d\u011bti<\/h2>\n

        Rifampicin je sou\u010d\u00e1st\u00ed standardn\u00edho WHO re\u017eimu pro l\u00e9\u010dbu TBC pou\u017e\u00edvan\u00e9ho v t\u011bhotenstv\u00ed \u2014 rizika nel\u00e9\u010den\u00e9 aktivn\u00ed TBC pro matku a plod v\u00fdrazn\u011b p\u0159eva\u017euj\u00ed nad velmi mal\u00fdm teoretick\u00fdm rizikem l\u00e9ku. Vitamin K 10 mg peror\u00e1ln\u011b denn\u011b se p\u0159id\u00e1v\u00e1 v posledn\u00edch 4 t\u00fddnech t\u011bhotenstv\u00ed ke sn\u00ed\u017een\u00ed rizika novorozeneck\u00e9ho krv\u00e1cen\u00ed. Kompatibiln\u00ed s kojen\u00edm (mal\u00e9 mno\u017estv\u00ed v ml\u00e9ce; nedostate\u010dn\u00e9 k l\u00e9\u010db\u011b d\u00edt\u011bte a nedostate\u010dn\u00e9 k po\u0161kozen\u00ed). U d\u011bt\u00ed se pou\u017e\u00edv\u00e1 v d\u00e1vce 15 mg\/kg\/den p\u0159i aktivn\u00ed TBC a 10 mg\/kg jako jednor\u00e1zov\u00e1 d\u00e1vka pro meningokokovou profylaxi.<\/p>\n

        Skladov\u00e1n\u00ed<\/h2>\n

        Skladujte p\u0159i 15\u201330 \u00b0C v p\u016fvodn\u00edm blistru nebo lahvi\u010dce, chr\u00e1n\u011bn\u00e9 p\u0159ed vlhkost\u00ed a p\u0159\u00edm\u00fdm slune\u010dn\u00edm z\u00e1\u0159en\u00edm. Tobolky jsou citliv\u00e9 na teplo \u2014 nep\u0159esyp\u00e1vejte je dlouhodob\u011b do organiz\u00e9ru na l\u00e9ky. Uchov\u00e1vejte mimo dosah d\u011bt\u00ed. Nepou\u017eit\u00e9 nebo pro\u0161l\u00e9 tobolky likvidujte prost\u0159ednictv\u00edm l\u00e9k\u00e1rensk\u00e9ho zp\u011btn\u00e9ho odb\u011bru.<\/p>\n

        \u010casto kladen\u00e9 dotazy<\/h2>\n

        Mohu l\u00e9\u010dit aktivn\u00ed tuberkul\u00f3zu pouze R-Cinem?<\/h3>\n

        Ne \u2014 nikdy. Monoterapie rifampicinem u aktivn\u00ed TBC zp\u016fsobuje rychl\u00fd rozvoj rezistence a selh\u00e1n\u00ed l\u00e9\u010dby. Aktivn\u00ed TBC se l\u00e9\u010d\u00ed 4-l\u00e9kov\u00fdm RIPE re\u017eimem (rifampicin + isoniazid + pyrazinamid + ethambutol) po dobu 2 m\u011bs\u00edc\u016f, pot\u00e9 4 m\u011bs\u00edce rifampicin + isoniazid. Monoterapie rifampicinem je vhodn\u00e1 pouze pro latentn\u00ed TBC infekci, lepru, meningokokovou profylaxi, n\u011bkter\u00e9 infekce MRSA a brucel\u00f3zu \u2014 v\u0161e pod l\u00e9ka\u0159sk\u00fdm dohledem.<\/p>\n

        Pro\u010d rifampicin barv\u00ed mo\u010d, pot a slzy do oran\u017eovo\u010dervena?<\/h3>\n

        Rifampicin a jeho metabolity jsou intenzivn\u011b \u010derveno-oran\u017eov\u00e9 pigmenty vylu\u010dovan\u00e9 v\u0161emi t\u011bln\u00edmi tekutinami. Zbarven\u00ed je ne\u0161kodn\u00e9 a potvrzuje, \u017ee l\u00e9k je vst\u0159eb\u00e1v\u00e1n. M\u016f\u017ee trvale zabarvit m\u011bkk\u00e9 kontaktn\u00ed \u010do\u010dky, sv\u011btl\u00e9 oble\u010den\u00ed p\u0159i pocen\u00ed a lo\u017en\u00ed pr\u00e1dlo. B\u011bhem terapie p\u0159ejd\u011bte na br\u00fdle nebo jednodenn\u00ed kontaktn\u00ed \u010do\u010dky a upozorn\u011bte sv\u00e9ho zubn\u00edho l\u00e9ka\u0159e (m\u016f\u017ee do\u010dasn\u011b zabarvit korunky a zubn\u00ed n\u00e1hrady).<\/p>\n

        Jak by se m\u011bl R-Cin u\u017e\u00edvat \u2014 s j\u00eddlem nebo nala\u010dno?<\/h3>\n

        U\u017e\u00edvejte R-Cin na nala\u010dno<\/strong>: jednu hodinu p\u0159ed j\u00eddlem nebo dv\u011b hodiny po j\u00eddle. J\u00eddlo \u2014 zejm\u00e9na tu\u010dn\u00e1 j\u00eddla \u2014 sni\u017euje biologickou dostupnost rifampicinu p\u0159ibli\u017en\u011b o 30 %, co\u017e m\u016f\u017ee sn\u00ed\u017eit hladiny v krvi pod terapeutick\u00e9 rozmez\u00ed. Pokud pod\u00e1n\u00ed nala\u010dno zp\u016fsobuje nesnesiteln\u00e9 nevolnosti, mal\u00e1 lehk\u00e1 sva\u010dina (nap\u0159. p\u00e1r suchar\u016f) je lep\u0161\u00ed ne\u017e vynech\u00e1n\u00ed d\u00e1vky nebo zvracen\u00ed. U\u017e\u00edvejte celou denn\u00ed d\u00e1vku najednou, nerozd\u011blenou.<\/p>\n

        M\u016f\u017ee rifampicin zp\u016fsobit, \u017ee moje antikoncep\u010dn\u00ed pilulka p\u0159estane fungovat?<\/h3>\n

        Ano. Rifampicin sni\u017euje hladiny ethinylestradiolu a progestogen\u016f indukc\u00ed jatern\u00edch enzym\u016f; kombinovan\u00e9 a \u010dist\u011b progestogenn\u00ed pilulky, n\u00e1plast, vagin\u00e1ln\u00ed krou\u017eek a progestogenn\u00ed implant\u00e1ty jsou v\u0161echny nespolehliv\u00e9 b\u011bhem l\u00e9\u010dby rifampicinem a po dobu alespo\u0148 4 t\u00fddn\u016f<\/strong> po jej\u00edm ukon\u010den\u00ed. Pou\u017e\u00edvejte bari\u00e9rovou antikoncepci (kondomy)<\/strong> nebo nehormon\u00e1ln\u00ed metodu (m\u011bd\u011bn\u00e9 nitrod\u011blo\u017en\u00ed t\u011bl\u00edsko) po celou dobu. Depotn\u00ed injekce (DMPA) a nitrod\u011blo\u017en\u00ed syst\u00e9m s levonorgestrelem jsou pova\u017eov\u00e1ny za neovlivn\u011bn\u00e9.<\/p>\n

        Mohu p\u00edt alkohol p\u0159i u\u017e\u00edv\u00e1n\u00ed R-Cinu?<\/h3>\n

        Vyhn\u011bte se alkoholu nebo jej p\u0159\u00edsn\u011b omezte. Rifampicin i doprovodn\u00fd l\u00e9k isoniazid jsou hepatotoxick\u00e9 a alkohol v\u00fdrazn\u011b zvy\u0161uje riziko l\u00e9ky vyvolan\u00e9 hepatitidy \u2014 jeden z hlavn\u00edch d\u016fvod\u016f, pro\u010d mus\u00ed b\u00fdt l\u00e9\u010dba TBC p\u0159eru\u0161ena. Denn\u00ed konzumace alkoholu je relativn\u00ed kontraindikac\u00ed standardn\u00edch re\u017eim\u016f; informujte sv\u00e9ho l\u00e9ka\u0159e p\u0159ed zah\u00e1jen\u00edm l\u00e9\u010dby.<\/p>\n

        Jak\u00e9 krevn\u00ed testy bych m\u011bl m\u00edt b\u011bhem l\u00e9\u010dby rifampicinem?<\/h3>\n

        V\u00fdchoz\u00ed p\u0159ed zah\u00e1jen\u00edm: jatern\u00ed testy (ALT, AST, bilirubin, alkalick\u00e1 fosfat\u00e1za), kompletn\u00ed krevn\u00ed obraz, mo\u010dovina\/kreatinin. Opakujte jatern\u00ed testy za 2 t\u00fddny, pot\u00e9 m\u011bs\u00ed\u010dn\u011b po celou dobu l\u00e9\u010dby \u2014 nebo d\u0159\u00edve, pokud se objev\u00ed nevolnost, \u017eloutenka, tmav\u00e1 mo\u010d nebo bolest v prav\u00e9m pod\u017eeb\u0159\u00ed. P\u0159eru\u0161te u\u017e\u00edv\u00e1n\u00ed rifampicinu (a isoniazidu) a kontaktujte sv\u00e9ho l\u00e9ka\u0159e, pokud ALT p\u0159ekro\u010d\u00ed trojn\u00e1sobek horn\u00ed hranice normy s p\u0159\u00edznaky nebo p\u011btin\u00e1sobek bez p\u0159\u00edznak\u016f.<\/p>\n

        Je R-Cin bezpe\u010dn\u00fd v t\u011bhotenstv\u00ed a p\u0159i kojen\u00ed?<\/h3>\n

        Aktivn\u00ed TBC v t\u011bhotenstv\u00ed je nebezpe\u010dn\u00e1 pro matku i plod a rifampicin je jedn\u00edm z l\u00e9k\u016f pova\u017eovan\u00fdch za bezpe\u010dn\u00e9 v t\u011bhotenstv\u00ed \u2014 WHO a v\u011bt\u0161ina n\u00e1rodn\u00edch program\u016f pro TBC jej doporu\u010duje jako sou\u010d\u00e1st standardn\u00edho re\u017eimu. Vitamin K (10 mg or\u00e1ln\u011b denn\u011b) se p\u0159id\u00e1v\u00e1 v posledn\u00edch 4 t\u00fddnech t\u011bhotenstv\u00ed ke sn\u00ed\u017een\u00ed rizika novorozeneck\u00e9ho krv\u00e1cen\u00ed. Rifampicin p\u0159ech\u00e1z\u00ed do mate\u0159sk\u00e9ho ml\u00e9ka v mal\u00e9m mno\u017estv\u00ed, ale je slu\u010diteln\u00fd s kojen\u00edm. V\u0161echna rozhodnut\u00ed by m\u011bla b\u00fdt u\u010din\u011bna ve spolupr\u00e1ci s porodn\u00edkem a specialistou na TBC.<\/p>\n

        Jak\u00fd je rozd\u00edl mezi rifampicinem a rifaximinem?<\/h3>\n

        Oba pat\u0159\u00ed do t\u0159\u00eddy rifamycin\u016f, ale klinicky se velmi li\u0161\u00ed. Rifampicin<\/strong> je dob\u0159e syst\u00e9mov\u011b absorbov\u00e1n, pou\u017e\u00edv\u00e1 se pro tuberkul\u00f3zu, lepru a z\u00e1va\u017en\u00e9 bakteri\u00e1ln\u00ed infekce a je v\u00fdznamn\u00fdm induktorem CYP enzym\u016f. Rifaximin<\/strong> je prakticky neabsorbovateln\u00fd, z\u016fst\u00e1v\u00e1 ve st\u0159ev\u011b a pou\u017e\u00edv\u00e1 se pro cestovatelsk\u00fd pr\u016fjem, jatern\u00ed encefalopatii a IBS-D \u2014 m\u00e1 minim\u00e1ln\u00ed syst\u00e9mov\u00e9 vedlej\u0161\u00ed \u00fa\u010dinky a minim\u00e1ln\u00ed l\u00e9kov\u00e9 interakce. Nejsou zam\u011bniteln\u00e9.<\/p>\n

        Jsem na antiretrovirov\u00e9 terapii pro HIV \u2014 mohu st\u00e1le u\u017e\u00edvat rifampicin?<\/h3>\n

        Toto vy\u017eaduje odborn\u00fd posudek. Rifampicin v\u00fdrazn\u011b sni\u017euje hladiny inhibitor\u016f HIV prote\u00e1zy a n\u011bkolika nenukleosidov\u00fdch inhibitor\u016f reverzn\u00ed transkript\u00e1zy v krvi, co\u017e riskuje selh\u00e1n\u00ed ART a rezistenci HIV. B\u011b\u017en\u00e1 \u0159e\u0161en\u00ed: nahradit rifampicin rifabutin<\/strong> (m\u00e9n\u011b potentn\u00edm induktorem), zvolit re\u017eim ART kompatibiln\u00ed s rifampicinem (re\u017eimy zalo\u017een\u00e9 na efavirenzu nebo dolutegraviru s dvojitou denn\u00ed d\u00e1vkou), nebo na\u010dasovat l\u00e9\u010dbu. Nikdy neza\u010d\u00ednejte s rifampicinem bez konzultace s l\u00e9ka\u0159em specializuj\u00edc\u00edm se na HIV.<\/p>\n

        Jak se skladuje R-Cin?<\/h3>\n

        Skladujte p\u0159i 15\u201330 \u00b0C v p\u016fvodn\u00edm obalu, chr\u00e1n\u011bn\u00e9 p\u0159ed vlhkost\u00ed, teplem a p\u0159\u00edm\u00fdm slune\u010dn\u00edm z\u00e1\u0159en\u00edm. Uchov\u00e1vejte mimo dosah d\u011bt\u00ed \u2014 p\u0159ed\u00e1vkov\u00e1n\u00ed rifampicinem zp\u016fsobuje \u010derven\u00e9 zabarven\u00ed k\u016f\u017ee a z\u00e1va\u017enou hepatotoxicitu. Pro\u0161l\u00e9 nebo nepou\u017eit\u00e9 l\u00e9ky likvidujte prost\u0159ednictv\u00edm l\u00e9k\u00e1rensk\u00e9ho zp\u011btn\u00e9ho odb\u011bru, nikoliv dom\u00e1c\u00edm odpadem.<\/p>\n

        Zdravotn\u00ed upozorn\u011bn\u00ed:<\/strong> Informace na t\u00e9to str\u00e1nce jsou ur\u010deny pro dosp\u011bl\u00e9 pod l\u00e9ka\u0159sk\u00fdm dohledem. Aktivn\u00ed tuberkul\u00f3za je z\u00e1va\u017en\u00e9, hl\u00e1\u0161en\u00edm povinn\u00e9 infek\u010dn\u00ed onemocn\u011bn\u00ed, kter\u00e9 vy\u017eaduje kombinovanou antibiotickou terapii, odborn\u00fd dohled specialisty, trasov\u00e1n\u00ed kontakt\u016f a v mnoha jurisdikc\u00edch p\u0159\u00edmo kontrolovanou l\u00e9\u010dbu. Nel\u00e9\u010dte aktivn\u00ed tuberkul\u00f3zu sami. Jak\u00e9koli zm\u011bny v anti-tuberkul\u00f3zn\u00edch l\u00e9c\u00edch, d\u00e1vkov\u00e1n\u00ed nebo pl\u00e1novan\u00e9 ukon\u010den\u00ed l\u00e9\u010dby proberte s kvalifikovan\u00fdm l\u00e9ka\u0159em. Pokud se u v\u00e1s objev\u00ed \u017eloutenka, tmav\u00e1 mo\u010d, siln\u00e1 bolest b\u0159icha, n\u00e1hl\u00e1 zm\u011bna zraku nebo ztr\u00e1ta rozli\u0161en\u00ed \u010derven\u00e9 a zelen\u00e9 barvy, siln\u00e1 vyr\u00e1\u017eka nebo p\u0159\u00edznaky z\u00e1va\u017en\u00e9 alergick\u00e9 reakce, okam\u017eit\u011b vyhledejte l\u00e9ka\u0159skou pomoc.<\/div>\n

        <\/p>\n

        Souvisej\u00edc\u00ed alternativy<\/h3>\n

        Dal\u0161\u00ed produkty v Chronick\u00e1 onemocn\u011bn\u00ed<\/strong> kter\u00e9 z\u00e1kazn\u00edci tak\u00e9 prohl\u00ed\u017eej\u00ed:<\/p>\n