{"id":60518,"date":"2024-02-28T06:52:47","date_gmt":"2024-02-28T06:52:47","guid":{"rendered":"https:\/\/medsname.com\/assurans\/"},"modified":"2026-05-01T10:49:16","modified_gmt":"2026-05-01T10:49:16","slug":"assurans","status":"publish","type":"product","link":"https:\/\/medsbase.com\/cs\/product\/assurans\/","title":{"rendered":"Assurans"},"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 Assurans?<\/h3>\n<p style=\"margin:0;\"><strong>Assurans 20 mg<\/strong> obsahuje <strong>sildenafil citr\u00e1t<\/strong> jako peror\u00e1ln\u00ed tableta od spole\u010dnosti Cipla. V t\u00e9to d\u00e1vce a d\u00e1vkovac\u00edm re\u017eimu je Assurans schv\u00e1len FDA pro l\u00e9\u010dbu <strong>plicn\u00ed arteri\u00e1ln\u00ed hypertenze (PAH, WHO skupina 1)<\/strong> \u2014 z\u00e1va\u017en\u00e9ho progresivn\u00edho c\u00e9vn\u00edho onemocn\u011bn\u00ed plicn\u00edch tepen. Mezin\u00e1rodn\u011b ekvivalentn\u00ed p\u0159\u00edpravku <strong>Revatio<\/strong> (Pfizer), zna\u010dkov\u00e9 formulaci sildenafilu pro PAH. <strong>D\u00e1vkov\u00e1n\u00ed: 20 mg peror\u00e1ln\u011b T\u0158IKR\u00c1T DENN\u011a (ka\u017ed\u00fdch 6-8 hodin)<\/strong> \u2014 toto NEN\u00cd re\u017eim pro on-demand l\u00e9\u010dbu erektiln\u00ed dysfunkce. Sni\u017euje tlak v plicn\u00edch tepn\u00e1ch, zlep\u0161uje v\u00fdkonnost (vzd\u00e1lenost u\u0161lou za 6 minut) a redukuje funk\u010dn\u00ed t\u0159\u00eddu WHO. <strong>Pouze na rozhodnut\u00ed specialisty (klinika pro plicn\u00ed hypertenzi)<\/strong> \u2014 PAH je vz\u00e1cn\u00e9 progresivn\u00ed onemocn\u011bn\u00ed vy\u017eaduj\u00edc\u00ed specializovanou odbornou p\u00e9\u010di. <strong>Absolutn\u00ed kontraindikace:<\/strong> dusi\u010dnany v jak\u00e9koli form\u011b, riociguat (dal\u0161\u00ed l\u00e9k na PAH). \u010cast\u00e9 ne\u017e\u00e1douc\u00ed \u00fa\u010dinky: bolest hlavy, n\u00e1valy horka, epistaxe (krv\u00e1cen\u00ed z nosu), pr\u016fjem, bolest zad\/kon\u010detin. <strong>P\u0159i d\u00e1vkov\u00e1n\u00ed 20 mg t\u0159ikr\u00e1t denn\u011b se Assurans NEPREDEPISUJE pro erektiln\u00ed dysfunkci<\/strong> \u2014 sildenafil pro ED pou\u017e\u00edv\u00e1 vy\u0161\u0161\u00ed on-demand d\u00e1vky (50-100 mg) pod\u00e1van\u00e9 jednou p\u0159ed aktivitou.<\/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 Assurans 20 mg?<\/h2>\n<p>Assurans 20 mg je peror\u00e1ln\u00ed <strong>sildenafil citrate 20 mg<\/strong> od <strong>Cipla<\/strong>, dod\u00e1van\u00e9 v balen\u00edch po 30 \/ 60 \/ 90 \/ 180 tablet\u00e1ch. Assurans je or\u00e1ln\u00ed tableta sildenafil citrate 20 mg od spole\u010dnosti Cipla, schv\u00e1len\u00e1 pro l\u00e9\u010dbu plicn\u00ed arteri\u00e1ln\u00ed hypertenze (PAH). Od v\u00fdrobce, jeho\u017e respira\u010dn\u00ed a kardiovaskul\u00e1rn\u00ed l\u00e9ky vyu\u017e\u00edvaj\u00ed WHO a mezin\u00e1rodn\u00ed programy p\u00e9\u010de o plicn\u00ed onemocn\u011bn\u00ed, je Assurans generick\u00fdm ekvivalentem p\u0159\u00edpravku <strong>Revatio<\/strong>. D\u00e1vka 20 mg je specifick\u00e1 formulace schv\u00e1len\u00e1 pro plicn\u00ed arteri\u00e1ln\u00ed hypertenzi (PAH) \u2014 odli\u0161n\u00e1 od d\u00e1vek 25 \/ 50 \/ 100 mg schv\u00e1len\u00fdch pro l\u00e9\u010dbu erektiln\u00ed dysfunkce u mu\u017e\u016f.<\/p>\n<p>Sildenafil byl p\u016fvodn\u011b vyvinut v 80. letech jako kandid\u00e1t na plicn\u00ed vazodilat\u00e1tor; jeho vedlej\u0161\u00ed \u00fa\u010dinky na erektiln\u00ed funkci byly pozorov\u00e1ny v ran\u00fdch studi\u00edch hypertenze a vedly k jeho schv\u00e1len\u00ed FDA v roce 1998 jako Viagra pro ED. V\u00fdvoj pro plicn\u00ed hypertenzi pokra\u010doval paraleln\u011b a sildenafil byl samostatn\u011b schv\u00e1len FDA pro PAH v roce 2005 pod obchodn\u00edm n\u00e1zvem <strong>Revatio<\/strong> (Pfizer). Assurans je generick\u00fd bioekvivalent p\u0159\u00edpravku Revatio, se stejnou \u00fa\u010dinnou l\u00e1tkou a d\u00e1vkou pro indikaci PAH.<\/p>\n<div style=\"background:#fff9e6;border-left:4px solid #f5a623;padding:16px 20px;margin:18px 0;border-radius:4px;\">\n<strong>\u26a0 Vy\u017eaduje se rozhodnut\u00ed specialisty.<\/strong> Plicn\u00ed arteri\u00e1ln\u00ed hypertenze je vz\u00e1cn\u00e9, progresivn\u00ed, \u017eivot ohro\u017euj\u00edc\u00ed onemocn\u011bn\u00ed, kter\u00e9 vy\u017eaduje <strong>specializovanou p\u00e9\u010di v plicn\u00ed hypertenzn\u00ed klinice<\/strong>. Diagn\u00f3za vy\u017eaduje katetrizaci prav\u00e9ho srdce (mPAP \u2265 20 mmHg v klidu, PAWP \u2264 15 mmHg, PVR &gt; 2 Woodovy jednotky podle sou\u010dasn\u00fdch krit\u00e9ri\u00ed ESC\/ERS). L\u00e9\u010dba je postupn\u011b eskalov\u00e1na prost\u0159ednictv\u00edm inhibitor\u016f PDE5, antagonist\u016f endotelinov\u00fdch receptor\u016f (bosentan, macitentan, ambrisentan), prostanoid\u016f (epoprostenol, treprostinil, iloprost) a stimul\u00e1tor\u016f solubiln\u00ed guanyl\u00e1tcykl\u00e1zy (riociguat) pod odborn\u00fdm dohledem. <strong>Assurans nen\u00ed vhodn\u00fd pro samol\u00e9\u010dbu nevysv\u011btlen\u00e9 du\u0161nosti.<\/strong><\/div>\n<h2 class=\"wp-block-heading\">Jak Assurans funguje u PAH<\/h2>\n<p>Plicn\u00ed arteri\u00e1ln\u00ed hypertenze je zp\u016fsobena patologick\u00fdm p\u0159estavbou, vazokonstrikc\u00ed a in-situ tromb\u00f3zou mal\u00fdch plicn\u00edch tepen. <strong>drasl\u00edk (NO) \u2192 cGMP dr\u00e1ha<\/strong> je u PAH naru\u0161ena \u2014 produkce endoteli\u00e1ln\u00edho NO je sn\u00ed\u017eena a obrat cGMP je zv\u00fd\u0161en.<\/p>\n<ul>\n<li>Sildenafil je <strong>selektivn\u00ed inhibitor fosfodiester\u00e1zy typu 5 (PDE5)<\/strong>. PDE5 je hojn\u011b exprimov\u00e1n v hladk\u00e9m svalstvu plicn\u00edch c\u00e9v.<\/li>\n<li>T\u00edm, \u017ee sildenafil inhibuje PDE5 <strong>prodlou\u017e\u00ed vazodilata\u010dn\u00ed \u00fa\u010dinek cGMP<\/strong> na hladk\u00e9 svalstvo plicn\u00edch tepen, \u010d\u00edm\u017e sni\u017euje plicn\u00ed vaskul\u00e1rn\u00ed rezistenci a tlak v plicn\u00edch tepn\u00e1ch.<\/li>\n<li>\u00da\u010dinky na v\u00fdkonnost p\u0159i cvi\u010den\u00ed, funk\u010dn\u00ed t\u0159\u00eddu WHO a hemodynamick\u00e9 parametry jsou dob\u0159e prok\u00e1z\u00e1ny \u2014 <strong>studie SUPER-1<\/strong> (Gali\u00e8 et al., NEJM 2005) byla kl\u00ed\u010dovou studi\u00ed, kter\u00e1 zajistila Revatiu schv\u00e1len\u00ed FDA. Vzd\u00e1lenost u\u0161lou za 6 minut se zlep\u0161ila v pr\u016fm\u011bru o 45 metr\u016f oproti placebu po 12 t\u00fddnech u\u017e\u00edv\u00e1n\u00ed 20 mg TID.<\/li>\n<li>Polo\u010das rozpadu &amp;approx; 4 hodiny, proto <strong>je nutn\u00e9 pod\u00e1v\u00e1n\u00ed t\u0159ikr\u00e1t denn\u011b<\/strong> k udr\u017een\u00ed stabiln\u00ed hladiny v plazm\u011b.<\/li>\n<li>Metabolizov\u00e1n p\u0159edev\u0161\u00edm CYP3A4 (hlavn\u00ed) a CYP2C9 (vedlej\u0161\u00ed).<\/li>\n<\/ul>\n<p><strong>Sildenafil u PAH NEl\u00e9\u010d\u00ed onemocn\u011bn\u00ed<\/strong> \u2014 jde o symptomatickou a hemodynamickou l\u00e9\u010dbu, kter\u00e1 zpomaluje progresi a zlep\u0161uje kvalitu \u017eivota. Mnoho pacient\u016f na monoterapii inhibitory PDE5 progreduje a vy\u017eaduje dopl\u0148kovou l\u00e9\u010dbu antagonisty endotelinov\u00fdch receptor\u016f a\/nebo prostanoidy. L\u00e9\u010debn\u00fd pl\u00e1n \u0159\u00edd\u00ed specialista na PAH.<\/p>\n<h2 class=\"wp-block-heading\">Kdy se pou\u017e\u00edv\u00e1 Assurans<\/h2>\n<h3 class=\"wp-block-heading\">Indikace schv\u00e1len\u00e9 FDA \/ EMA<\/h3>\n<ul>\n<li><strong>Plicn\u00ed arteri\u00e1ln\u00ed hypertenze (PAH, WHO skupina 1)<\/strong> u dosp\u011bl\u00fdch \u2014 prim\u00e1rn\u00ed indikace. Zahrnuje idiopatickou PAH, d\u011bdi\u010dnou PAH, PAH vyvolanou l\u00e9ky\/toxiny, PAH asociovanou s onemocn\u011bn\u00edm pojivov\u00e9 tk\u00e1n\u011b (syst\u00e9mov\u00e1 skler\u00f3za, sm\u00ed\u0161en\u00e9 onemocn\u011bn\u00ed pojivov\u00e9 tk\u00e1n\u011b, lupus, revmatoidn\u00ed artritida), PAH asociovanou s vrozenou srde\u010dn\u00ed vadou a PAH asociovanou s HIV infekc\u00ed.<\/li>\n<li><strong>D\u011btsk\u00e1 PAH<\/strong> (v\u011bk 1-17) \u2014 schv\u00e1leno FDA v roce 2012 s opatrnost\u00ed na z\u00e1klad\u011b <em>STARTS-2<\/em> pozorov\u00e1n\u00ed z klinick\u00e9ho hodnocen\u00ed. Pou\u017e\u00edvejte pouze v odborn\u00fdch d\u011btsk\u00fdch PAH klinik\u00e1ch s ohledem na sign\u00e1l d\u00e1vkov\u011b z\u00e1visl\u00e9 mortality pozorovan\u00fd u vy\u0161\u0161\u00edch pediatrick\u00fdch d\u00e1vek (viz FDA Drug Safety Communication, 2012 a 2014).<\/li>\n<\/ul>\n<h3 class=\"wp-block-heading\">Mimolabelov\u00e9 \/ odborn\u00e9 pou\u017eit\u00ed<\/h3>\n<ul>\n<li><strong>Vysokohorsk\u00fd plicn\u00ed ed\u00e9m (HAPE)<\/strong> prevence a l\u00e9\u010dba \u2014 pou\u017eit\u00ed v horsk\u00e9 medic\u00edn\u011b<\/li>\n<li><strong>Perzistuj\u00edc\u00ed plicn\u00ed hypertenze novorozenc\u016f (PPHN)<\/strong> \u2014 prost\u0159ed\u00ed neonat\u00e1ln\u00ed intenzivn\u00ed p\u00e9\u010de<\/li>\n<li><strong>PAH asociovan\u00e1 s onemocn\u011bn\u00edm lev\u00e9ho srdce (WHO skupina 2)<\/strong> \u2014 obecn\u011b se NEDOPORU\u010cUJE; d\u016fkazy nazna\u010duj\u00ed \u0161kodlivost nebo \u017e\u00e1dn\u00fd benefit<\/li>\n<li><strong>T\u011b\u017ek\u00fd Raynaud\u016fv fenom\u00e9n a digit\u00e1ln\u00ed ulcerace<\/strong> u syst\u00e9mov\u00e9 skler\u00f3zy \u2014 rozhodnut\u00ed revmatologick\u00e9ho specialisty<\/li>\n<\/ul>\n<h3 class=\"wp-block-heading\">Nevhodn\u00e9 pou\u017eit\u00ed<\/h3>\n<ul>\n<li><strong>Erektiln\u00ed dysfunkce<\/strong> \u2014 d\u00e1vkov\u00e1n\u00ed 20 mg t\u0159ikr\u00e1t denn\u011b nen\u00ed vhodn\u00e9 pro ED. ED vy\u017eaduje vy\u0161\u0161\u00ed jednor\u00e1zov\u00e9 d\u00e1vky (50-100 mg). Pacienti hledaj\u00edc\u00ed sildenafil pro ED by m\u011bli pou\u017e\u00edvat specializovan\u00fd produkt s d\u00e1vkou 50-100 mg, jako je <a href=\"https:\/\/medsbase.com\/cs\/cenforce\/\"><strong>Cenforce<\/strong><\/a> nebo <a href=\"https:\/\/medsbase.com\/cs\/caverta\/\"><strong>Caverta<\/strong><\/a> \u2014 nejedn\u00e1 se o produkt 20 mg pro PAH.<\/li>\n<li><strong>Nevysv\u011btliteln\u00e1 du\u0161nost nebo \u00fanava<\/strong> \u2014 vy\u017eaduje diagnostick\u00e9 vy\u0161et\u0159en\u00ed (echokardiogram, pravostrann\u00e1 katetrizace, kardiopulmon\u00e1ln\u00ed z\u00e1t\u011b\u017eov\u00fd test) k ur\u010den\u00ed p\u0159\u00ed\u010diny; PAH je pouze jedna z mnoha mo\u017enost\u00ed.<\/li>\n<li><strong>Levosrde\u010dn\u00ed selh\u00e1n\u00ed (HFpEF nebo HFrEF)<\/strong> bez potvrzen\u00e9 PAH \u2014 sildenafil NEN\u00cd indikov\u00e1n a m\u016f\u017ee b\u00fdt \u0161kodliv\u00fd.<\/li>\n<li><strong>Chronick\u00e1 obstruk\u010dn\u00ed plicn\u00ed nemoc (COPD)<\/strong> \u2014 nen\u00ed indikov\u00e1n pro plicn\u00ed hypertenzi sekund\u00e1rn\u00ed k CHOPN (WHO skupina 3).<\/li>\n<li><strong>Plicn\u00ed hypertenze spojen\u00e1 se sp\u00e1nkovou apnoe<\/strong> \u2014 nejprve l\u00e9\u010dit sp\u00e1nkovou apnoe (CPAP\/BiPAP); sildenafil nen\u00ed prim\u00e1rn\u00ed l\u00e9\u010dba.<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">D\u00e1vkov\u00e1n\u00ed Assurans a zp\u016fsob u\u017e\u00edv\u00e1n\u00ed<\/h2>\n<h3 class=\"wp-block-heading\">Standardn\u00ed d\u00e1vka pro dosp\u011bl\u00e9<\/h3>\n<ul>\n<li><strong>20 mg \u00fastn\u011b t\u0159ikr\u00e1t denn\u011b<\/strong>, p\u0159ibli\u017en\u011b 4\u20136 hodin od sebe (nap\u0159. 08:00, 14:00, 20:00)<\/li>\n<li><strong>U\u017e\u00edvejte s j\u00eddlem nebo nala\u010dno<\/strong> \u2014 j\u00eddlo zpomal\u00ed vst\u0159eb\u00e1v\u00e1n\u00ed asi o 1 hodinu, ale nesni\u017euje celkovou expozici<\/li>\n<li><strong>Tabletu spolkn\u011bte celou a zapijte vodou<\/strong>. Nedrtit ani ned\u011blit.<\/li>\n<li><strong>D\u016fslednost je z\u00e1sadn\u00ed<\/strong> \u2014 vynech\u00e1n\u00ed d\u00e1vek zp\u016fsobuje mezery v plicn\u00ed vazodilataci. Nastavte si p\u0159ipom\u00ednky.<\/li>\n<li><strong>Pokud je d\u00e1vka vynech\u00e1na<\/strong>, u\u017eijte ji, jakmile si vzpomenete, pokud nen\u00ed bl\u00edzko dal\u0161\u00ed pl\u00e1novan\u00e9 d\u00e1vky \u2013 v takov\u00e9m p\u0159\u00edpad\u011b vynechanou d\u00e1vku vynechejte a nikdy ned\u00e1vejte dvojn\u00e1sobnou d\u00e1vku.<\/li>\n<\/ul>\n<h3 class=\"wp-block-heading\">Vy\u0161\u0161\u00ed d\u00e1vky a titrace<\/h3>\n<p>A\u010dkoli byla u dosp\u011bl\u00fdch s PAH studov\u00e1na d\u00e1vka 80 mg t\u0159ikr\u00e1t denn\u011b, dodate\u010dn\u00fd benefit oproti 20 mg TID je minim\u00e1ln\u00ed a vedlej\u0161\u00ed \u00fa\u010dinky v\u00fdrazn\u011b nar\u016fstaj\u00ed. Sou\u010dasn\u00e9 sm\u011brnice ESC\/ERS a CHEST pro PAH doporu\u010duj\u00ed <strong>20 mg TID jako standardn\u00ed d\u00e1vku pro dosp\u011bl\u00e9<\/strong>. Vy\u0161\u0161\u00ed d\u00e1vky jsou vyhrazeny pro speci\u00e1ln\u00ed p\u0159\u00edpady.<\/p>\n<h3 class=\"wp-block-heading\">\u00daprava d\u00e1vkov\u00e1n\u00ed<\/h3>\n<ul>\n<li><strong>T\u011b\u017ek\u00e9 jatern\u00ed po\u0161kozen\u00ed<\/strong> (Child-Pugh C): zah\u00e1jit s ni\u017e\u0161\u00ed d\u00e1vkou; konzultace s hepatologem<\/li>\n<li><strong>T\u011b\u017ek\u00e9 po\u0161kozen\u00ed ledvin<\/strong> (CrCl &lt; 30 mL\/min): clearance je sn\u00ed\u017eena; zah\u00e1jit opatrn\u011b<\/li>\n<li><strong>Sou\u010dasn\u00e9 u\u017e\u00edv\u00e1n\u00ed siln\u00fdch inhibitor\u016f CYP3A4<\/strong> (ritonavir, ketokonazol, itrakonazol, klarithromycin, nefazodon): nutn\u00e1 redukce d\u00e1vky nebo vyhnut\u00ed se \u2014 odborn\u00e9 veden\u00ed<\/li>\n<li><strong>Senio\u0159i (&gt;65 let)<\/strong>: b\u011b\u017en\u00e1 \u00faprava d\u00e1vky nen\u00ed nutn\u00e1, ale sledujte vedlej\u0161\u00ed \u00fa\u010dinky a interakce l\u00e9k\u016f<\/li>\n<\/ul>\n<h3 class=\"wp-block-heading\">D\u011btsk\u00e1 d\u00e1vka (pouze pro odborn\u00e9 pou\u017eit\u00ed)<\/h3>\n<p>FDA-schv\u00e1len\u00e9 d\u011btsk\u00e9 d\u00e1vky pro PAH u d\u011bt\u00ed 1-17 let jsou <strong>10 mg t\u0159ikr\u00e1t denn\u011b<\/strong> pro t\u011blesnou hmotnost \u2264 20 kg, nebo <strong>20 mg t\u0159ikr\u00e1t denn\u011b<\/strong> pro t\u011blesnou hmotnost &gt; 20 kg. Nicm\u00e9n\u011b, FDA Drug Safety Communication z roku 2012 v\u00fdslovn\u011b varovala p\u0159ed vy\u0161\u0161\u00edmi ne\u017e doporu\u010den\u00fdmi d\u00e1vkami u d\u011bt\u00ed v d\u016fsledku <em>STARTS-2<\/em> sign\u00e1lu zv\u00fd\u0161en\u00e9 mortality p\u0159i d\u00e1vk\u00e1ch 40\/80 mg TID u d\u011bt\u00ed. <strong>Pou\u017eit\u00ed u d\u011bt\u00ed by m\u011blo b\u00fdt omezeno na specializovan\u00e9 d\u011btsk\u00e9 PAH kliniky<\/strong>.<\/p>\n<h2 class=\"wp-block-heading\">Vedlej\u0161\u00ed \u00fa\u010dinky<\/h2>\n<h3 class=\"wp-block-heading\">B\u011b\u017en\u00e9 (&gt;10 %)<\/h3>\n<ul>\n<li>Bolest hlavy (m\u00edrn\u00e1 a\u017e st\u0159edn\u00ed \u2014 \u010dasto ustoup\u00ed po 1-2 t\u00fddnech)<\/li>\n<li>Z\u010derven\u00e1n\u00ed obli\u010deje<\/li>\n<li>Dyspepsie, za\u017e\u00edvac\u00ed pot\u00ed\u017ee<\/li>\n<\/ul>\n<h3 class=\"wp-block-heading\">M\u00e9n\u011b \u010dast\u00e9 (1-10%)<\/h3>\n<ul>\n<li>Epistaxe (krv\u00e1cen\u00ed z nosu) \u2014 uzn\u00e1van\u00fd vedlej\u0161\u00ed \u00fa\u010dinek PAH-sildenafilu; vyhledejte kontrolu p\u0159i opakovan\u00e9m\/z\u00e1va\u017en\u00e9m v\u00fdskytu<\/li>\n<li>Pr\u016fjem<\/li>\n<li>Bolesti zad, bolesti kon\u010detin, myalgie<\/li>\n<li>Ucpan\u00fd nos<\/li>\n<li>Poruchy zraku (modr\u00fd n\u00e1dech vid\u011bn\u00ed, citlivost na sv\u011btlo)<\/li>\n<li>Z\u00e1vrat\u011b<\/li>\n<li>Nespavost<\/li>\n<li>Du\u0161nost (a\u010dkoli to je \u010dasto sp\u00ed\u0161e p\u0159\u00edznak PAH ne\u017e vedlej\u0161\u00ed \u00fa\u010dinek l\u00e9ku; rozli\u0161en\u00ed vy\u017eaduje specialistu)<\/li>\n<\/ul>\n<h3 class=\"wp-block-heading\">Vz\u00e1cn\u00e9, ale z\u00e1va\u017en\u00e9 \u2014 vyhledejte neodkladnou l\u00e9ka\u0159skou pomoc<\/h3>\n<ul>\n<li><strong>N\u00e1hl\u00e1 ztr\u00e1ta zraku<\/strong> (neartritick\u00e1 ischemick\u00e1 optick\u00e1 neuropatie, NAION)<\/li>\n<li><strong>N\u00e1hl\u00e1 ztr\u00e1ta sluchu<\/strong><\/li>\n<li><strong>T\u011b\u017ek\u00e1 hypotenze<\/strong>, zejm\u00e9na p\u0159i sou\u010dasn\u00e9m u\u017e\u00edv\u00e1n\u00ed nitr\u00e1t\u016f nebo alfa-blok\u00e1tor\u016f<\/li>\n<li><strong>Zhor\u0161en\u00ed plicn\u00ed vaskul\u00e1rn\u00ed obstruk\u010dn\u00ed choroby<\/strong> u pacient\u016f se subklinickou PVOD (vz\u00e1cn\u00e9)<\/li>\n<li>Stevens-Johnson\u016fv syndrom (velmi vz\u00e1cn\u00fd)<\/li>\n<li>Prodlou\u017een\u00e1 priapismus (erekce &gt;4 hodiny) u mu\u017esk\u00fdch pacient\u016f \u2014 urgentn\u00ed urologick\u00e9 vy\u0161et\u0159en\u00ed<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Kontraindikace a varov\u00e1n\u00ed<\/h2>\n<ul>\n<li><strong>Dusi\u010dnany v jak\u00e9koli form\u011b<\/strong> (nitroglycerin, isosorbidmono\/dinitr\u00e1t, amylnitrit \u201cpoppers\u201d) \u2014 ABSOLUTN\u00cd kontraindikace; t\u011b\u017ek\u00e1 hypotenze a smrt<\/li>\n<li><strong>Riociguat<\/strong> (dal\u0161\u00ed l\u00e9k na PAH, stimul\u00e1tor solubiln\u00ed guanyl\u00e1tcykl\u00e1zy) \u2014 ABSOLUTN\u00cd kontraindikace; oba l\u00e9ky zvy\u0161uj\u00ed cGMP, co\u017e vede k t\u011b\u017ek\u00e9 hypotenzi<\/li>\n<li><strong>Plicn\u00ed venookluzivn\u00ed choroba (PVOD)<\/strong> \u2014 sildenafil m\u016f\u017ee zhor\u0161it plicn\u00ed ed\u00e9m<\/li>\n<li><strong>T\u011b\u017ek\u00e9 jatern\u00ed po\u0161kozen\u00ed<\/strong> \u2014 rozhodnut\u00ed specialisty<\/li>\n<li><strong>T\u011b\u017ek\u00e1 hypotenze<\/strong> (v\u00fdchoz\u00ed TK &lt; 90 mmHg) \u2014 relativn\u00ed kontraindikace<\/li>\n<li><strong>Ned\u00e1vn\u00e1 c\u00e9vn\u00ed mozkov\u00e1 p\u0159\u00edhoda nebo infarkt myokardu<\/strong> (do 6 m\u011bs\u00edc\u016f)<\/li>\n<li><strong>D\u011bdi\u010dn\u00e1 retinitis pigmentosa<\/strong> nebo anamn\u00e9za NAION<\/li>\n<li><strong>Zn\u00e1m\u00e1 p\u0159ecitliv\u011blost<\/strong> k sildenafilu<\/li>\n<li><strong>T\u011bhotenstv\u00ed (kategorie B)<\/strong> \u2014 \u00fadaje ze studi\u00ed na zv\u00ed\u0159atech jsou uklid\u0148uj\u00edc\u00ed, ale \u00fadaje u lid\u00ed jsou omezen\u00e9. Samotn\u00e1 PAH je relativn\u00ed kontraindikac\u00ed t\u011bhotenstv\u00ed kv\u016fli velmi vysok\u00e9 mate\u0159sk\u00e9 mortalit\u011b (&gt;30% historicky, ~15% p\u0159i modern\u00ed p\u00e9\u010di). Rozhodnut\u00ed specialisty na maternofet\u00e1ln\u00ed medic\u00ednu + PAH kliniky.<\/li>\n<li><strong>Pediatrick\u00e9 pou\u017eit\u00ed ve vysok\u00fdch d\u00e1vk\u00e1ch<\/strong> \u2014 FDA varovala po sign\u00e1lu mortality ve studii STARTS-2; dodr\u017eujte d\u00e1vkov\u00e1n\u00ed dle doporu\u010den\u00ed<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Interakce s l\u00e9\u010divy<\/h2>\n<table style=\"width:100%;border-collapse:collapse;margin:14px 0;\">\n<thead>\n<tr style=\"background:#2c7cb0;color:#fff;\">\n<th style=\"padding:10px;border:1px solid #ddd;text-align:left;\">L\u00e9k\/t\u0159\u00edda<\/th>\n<th style=\"padding:10px;border:1px solid #ddd;text-align:left;\">\u00da\u010dinek<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\"><strong>Nitr\u00e1ty<\/strong> (nitroglycerin, isosorbidmono\/dinitr\u00e1t, amylnitrit)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">ABSOLUTN\u00cd kontraindikace \u2014 t\u011b\u017ek\u00e1 hypotenze, smrt<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:10px;border:1px solid #ddd;\"><strong>Riociguat<\/strong> (Adempas, stimul\u00e1tor sGC pro CTEPH\/PAH)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">ABSOLUTN\u00cd kontraindikace \u2014 aditivn\u00ed hypotenze prost\u0159ednictv\u00edm cGMP<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\"><strong>Jin\u00e9 inhibitory PDE5<\/strong> (tadalafil, vardenafil, avanafil)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Nekombinovat \u2013 \u017e\u00e1dn\u00fd dal\u0161\u00ed benefit, kumulativn\u00ed vedlej\u0161\u00ed \u00fa\u010dinky<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:10px;border:1px solid #ddd;\"><strong>Antagonist\u00e9 endothelinov\u00fdch receptor\u016f<\/strong> (bosentan, macitentan, ambrisentan)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">\u010casto kombinov\u00e1ny u PAH \u2013 pod odborn\u00fdm dohledem. Bosentan sni\u017euje expozici sildenafilu indukc\u00ed CYP3A4; m\u016f\u017ee b\u00fdt nutn\u00e1 \u00faprava d\u00e1vkov\u00e1n\u00ed.<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\"><strong>Analoga prostacyklinu<\/strong> (epoprostenol, treprostinil, iloprost, selexipag)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">\u010casto kombinov\u00e1ny u PAH \u2013 pod odborn\u00fdm dohledem<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:10px;border:1px solid #ddd;\"><strong>Siln\u00e9 inhibitory CYP3A4<\/strong> (ritonavir, ketokonazol, itrakonazol, klarithromycin)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Hladiny sildenafilu v\u00fdrazn\u011b stoupaj\u00ed \u2013 sn\u00ed\u017een\u00ed d\u00e1vky nebo vynech\u00e1n\u00ed<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\"><strong>Induktory CYP3A4<\/strong> (rifampin, karbamazepin, fenytoin, t\u0159ezalka te\u010dkovan\u00e1)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Hladiny sildenafilu klesaj\u00ed \u2013 m\u016f\u017ee sn\u00ed\u017eit \u00fa\u010dinnost<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:10px;border:1px solid #ddd;\"><strong>Alfa-blok\u00e1tory<\/strong> (doxazosin, tamsulosin, prazosin)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Kumulativn\u00ed hypotenze \u2013 odd\u011blen\u00e9 d\u00e1vkov\u00e1n\u00ed nebo odborn\u00e9 poradenstv\u00ed<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\"><strong>Antikoagulancia \/ antiagregancia<\/strong> (warfarin, DOAC, aspirin, klopidogrel)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Sildenafil zvy\u0161uje riziko krv\u00e1cen\u00ed z nosu; sledujte pacienta pe\u010dliv\u011bji<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:10px;border:1px solid #ddd;\"><strong>Grapefruitov\u00e1 \u0161\u0165\u00e1va<\/strong><\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Inhibuje CYP3A4 \u2014 zvy\u0161uje hladiny sildenafilu; vyvarujte se pravideln\u00e9ho u\u017e\u00edv\u00e1n\u00ed<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2 class=\"wp-block-heading\">Skladov\u00e1n\u00ed<\/h2>\n<p>Skladujte Assurans p\u0159i teplot\u011b ni\u017e\u0161\u00ed ne\u017e 25\u00b0C v p\u016fvodn\u00edm blistru, mimo p\u0159\u00edm\u00e9 slune\u010dn\u00ed sv\u011btlo a vlhkost. Uchov\u00e1vejte mimo dosah d\u011bt\u00ed. Pou\u017e\u00edvejte do data exspirace uveden\u00e9ho na obalu.<\/p>\n<h2 id=\"faqs\">\u010casto kladen\u00e9 dotazy<\/h2>\n<h3 class=\"wp-block-heading\">Je Assurans tot\u00e9\u017e co Viagra?<\/h3>\n<p>\u00da\u010dinn\u00e1 l\u00e1tka je stejn\u00e1 (sildenafil-citr\u00e1t), ale s\u00edla (20 mg), d\u00e1vkovac\u00ed re\u017eim (t\u0159ikr\u00e1t denn\u011b, kontinu\u00e1ln\u011b) a schv\u00e1len\u00e1 indikace (plicn\u00ed arteri\u00e1ln\u00ed hypertenze) se zcela li\u0161\u00ed od Viagry pro erektiln\u00ed dysfunkci. Assurans je generick\u00fd ekvivalent <strong>Revatio<\/strong> (Pfizerova PAH verze sildenafilu), nikoli Viagry. Tyto dva p\u0159\u00edpravky nelze zam\u011b\u0148ovat.<\/p>\n<h3 class=\"wp-block-heading\">Mohu pou\u017e\u00edvat Assurans na erektiln\u00ed dysfunkci?<\/h3>\n<p>P\u0159i d\u00e1vce 20 mg je Assurans pod obvyklou po\u010d\u00e1te\u010dn\u00ed d\u00e1vkou 50 mg pro ED. U\u017eit\u00ed t\u0159\u00ed 20mg tablet najednou (celkem 60 mg) je farmakologicky podobn\u00e9 d\u00e1vce 50 mg pro ED, ale jde o neschv\u00e1len\u00e9, nekontrolovan\u00e9 u\u017eit\u00ed mimo ur\u010den\u00fd \u00fa\u010del p\u0159\u00edpravku. Pro erektiln\u00ed dysfunkci pou\u017e\u00edvejte specializovan\u00fd p\u0159\u00edpravek s d\u00e1vkou 50 nebo 100 mg, jako je <a href=\"https:\/\/medsbase.com\/cs\/cenforce\/\">Cenforce<\/a>, <a href=\"https:\/\/medsbase.com\/cs\/caverta\/\">Caverta<\/a>, nebo <a href=\"https:\/\/medsbase.com\/cs\/penegra\/\">Penegra<\/a>. Nepou\u017e\u00edvejte sv\u016fj PAH l\u00e9k na ED bez odborn\u00e9ho dohledu \u2014 vynech\u00e1v\u00e1n\u00ed d\u00e1vek PAH l\u00e9ku pro jejich pou\u017eit\u00ed na ED je \u0161kodliv\u00e9.<\/p>\n<h3 class=\"wp-block-heading\">Pro\u010d t\u0159ikr\u00e1t denn\u011b? Mohu u\u017e\u00edvat jednou denn\u011b?<\/h3>\n<p>Sildenafil m\u00e1 polo\u010das v plazm\u011b asi 4 hodiny. Jednor\u00e1zov\u00e9 denn\u00ed d\u00e1vkov\u00e1n\u00ed vytv\u00e1\u0159\u00ed velk\u00e9 poklesy, kdy je \u00fa\u010dinek inhibice PDE5 na plicn\u00ed c\u00e9vn\u00ed \u0159e\u010di\u0161t\u011b t\u00e9m\u011b\u0159 nulov\u00fd. T\u0159ikr\u00e1t denn\u00ed d\u00e1vkov\u00e1n\u00ed udr\u017euje stabiln\u00ed hladinu pot\u0159ebnou pro kontinu\u00e1ln\u00ed sn\u00ed\u017een\u00ed plicn\u00edho tlaku u PAH. Zm\u011bna na jedno nebo dv\u011b denn\u00ed d\u00e1vky sni\u017euje \u00fa\u010dinnost. Tadalafil (Adcirca) s mnohem del\u0161\u00edm polo\u010dasem je mo\u017enost\u00ed pro jednodenn\u00ed d\u00e1vkov\u00e1n\u00ed PDE5 inhibitoru u PAH \u2014 pora\u010fte se se sv\u00fdm plicn\u00edm hypertenzn\u00edm centrem, pokud je dodr\u017eov\u00e1n\u00ed TID d\u00e1vkov\u00e1n\u00ed obt\u00ed\u017en\u00e9.<\/p>\n<h3 class=\"wp-block-heading\">Jak rychle se budu c\u00edtit l\u00e9pe?<\/h3>\n<p>Subjektivn\u00ed zlep\u0161en\u00ed tolerance z\u00e1t\u011b\u017ee a du\u0161nosti se \u010dasto objevuje po 4-8 t\u00fddnech pravideln\u00e9 l\u00e9\u010dby. Objektivn\u00ed zlep\u0161en\u00ed v 6-minutov\u00e9m testu ch\u016fze obvykle trv\u00e1 12 t\u00fddn\u016f v klinick\u00fdch studi\u00edch. Hemodynamick\u00e9 zlep\u0161en\u00ed (pravostrann\u00e1 katetrizace srdce) lze posoudit za 12-24 t\u00fddn\u016f. PAH je chronick\u00e9 onemocn\u011bn\u00ed \u2014 nep\u0159eru\u0161ujte u\u017e\u00edv\u00e1n\u00ed Assuransu na z\u00e1klad\u011b \u201cdobr\u00e9ho\u201d nebo \u201c\u0161patn\u00e9ho\u201d dne \u2014 pravideln\u00e1 dlouhodob\u00e1 l\u00e9\u010dba je t\u00edm, co zpomaluje progresi onemocn\u011bn\u00ed.<\/p>\n<h3 class=\"wp-block-heading\">Co kdy\u017e zapomenu d\u00e1vku?<\/h3>\n<p>Vynechanou d\u00e1vku u\u017eijte, jakmile si vzpomenete, pokud to nen\u00ed m\u00e9n\u011b ne\u017e 2 hodiny p\u0159ed dal\u0161\u00ed pl\u00e1novanou d\u00e1vkou \u2014 v tom p\u0159\u00edpad\u011b vynechanou d\u00e1vku p\u0159esko\u010dte a pokra\u010dujte v obvykl\u00e9m sch\u00e9matu. <strong>Nikdy neu\u017e\u00edvejte dvojn\u00e1sobnou d\u00e1vku<\/strong>. D\u016fslednost je d\u016fle\u017eit\u00e1; pou\u017eijte bud\u00edk na telefonu nebo organiz\u00e9r na l\u00e9ky.<\/p>\n<h3 class=\"wp-block-heading\">Mohu u\u017e\u00edvat Assurans spolu s dal\u0161\u00edmi l\u00e9ky na plicn\u00ed arteri\u00e1ln\u00ed hypertenzi (PAH)?<\/h3>\n<p>PAH se b\u011b\u017en\u011b l\u00e9\u010d\u00ed kombinovanou terapi\u00ed \u2014 sildenafil\/tadalafil plus antagonista endotelinov\u00e9ho receptoru (bosentan, macitentan, ambrisentan), s p\u0159id\u00e1n\u00edm prostanoidu (epoprostenol, treprostinil, iloprost) u pokro\u010dil\u00e9ho onemocn\u011bn\u00ed. Tyto kombinace jsou standardn\u00ed a \u0159\u00edzen\u00e9 specialistou. ABSOLUTN\u00cd v\u00fdjimkou je <strong>riociguat (Adempas)<\/strong>, dal\u0161\u00ed stimul\u00e1tor solubiln\u00ed guanyl\u00e1tcykl\u00e1zy \u2014 ten se NIKDY nesm\u00ed kombinovat se sildenafilem. Tyto volby \u0159\u00edd\u00ed v\u00e1\u0161 specialista na PAH.<\/p>\n<h3 class=\"wp-block-heading\">Mohu u\u017e\u00edvat Assurans b\u011bhem t\u011bhotenstv\u00ed?<\/h3>\n<p>Toto je rozhodnut\u00ed specialisty. Plicn\u00ed arteri\u00e1ln\u00ed hypertenze v t\u011bhotenstv\u00ed je spojena s velmi vysokou mate\u0159skou \u00famrtnost\u00ed (asi 15 % p\u0159i sou\u010dasn\u00e9 p\u00e9\u010di) a t\u011bhotenstv\u00ed se obecn\u011b nedoporu\u010duje u \u017een s PAH. Pokud k t\u011bhotenstv\u00ed dojde, sildenafil se n\u011bkdy pokra\u010duje pod spole\u010dn\u00fdm dohledem PAH kliniky a medic\u00edny matky a plodu \u2014 data kategorie B jsou uklid\u0148uj\u00edc\u00ed vzhledem k v\u00fdsledk\u016fm studi\u00ed na zv\u00ed\u0159atech s omezenou lidskou zku\u0161enost\u00ed. Bez odborn\u00e9ho vstupu nep\u0159est\u00e1vejte ani neza\u010d\u00ednejte s l\u00e9\u010dbou.<\/p>\n<h3 class=\"wp-block-heading\">M\u016f\u017ee m\u00e9 d\u00edt\u011b u\u017e\u00edvat Assurans pro d\u011btskou PAH?<\/h3>\n<p>D\u011btsk\u00e1 PAH je indikac\u00ed schv\u00e1lenou FDA p\u0159i d\u00e1vkov\u00e1n\u00ed podle hmotnosti (10 mg TID pro \u226420 kg, 20 mg TID pro &gt;20 kg). Nicm\u00e9n\u011b, FDA Drug Safety Communication z roku 2012 varovala p\u0159ed vy\u0161\u0161\u00edmi ne\u017e doporu\u010den\u00fdmi d\u00e1vkami pro d\u011bti po <em>STARTS-2<\/em> sign\u00e1lu \u00famrtnosti v klinick\u00e9 studii p\u0159i d\u00e1vk\u00e1ch 40-80 mg TID u d\u011bt\u00ed. <strong>Pou\u017eit\u00ed u d\u011bt\u00ed mus\u00ed prob\u00edhat na specializovan\u00e9 pediatrick\u00e9 klinice pro plicn\u00ed arteri\u00e1ln\u00ed hypertenzi (PAH)<\/strong>, v r\u00e1mci doporu\u010den\u00fdch d\u00e1vek FDA zalo\u017een\u00fdch na hmotnosti, s pe\u010dliv\u00fdm monitorov\u00e1n\u00edm.<\/p>\n<h3 class=\"wp-block-heading\">Co m\u00e1m d\u011blat, pokud se u m\u011b objev\u00ed krv\u00e1cen\u00ed z nosu?<\/h3>\n<p>M\u00edrn\u00e9, ob\u010dasn\u00e9 krv\u00e1cen\u00ed z nosu je zn\u00e1m\u00fdm vedlej\u0161\u00edm \u00fa\u010dinkem sildenafilu p\u0159i PAH \u2014 zvl\u00e1d\u00e1 se zvlh\u010dov\u00e1n\u00edm, vyh\u00fdb\u00e1n\u00edm se \u0161kr\u00e1b\u00e1n\u00ed v nose a voln\u011b prodejn\u00fdmi nosn\u00edmi spreji s fyziologick\u00fdm roztokem. <strong>Vyhledejte neodkladnou l\u00e9ka\u0159skou pomoc p\u0159i: opakovan\u00e9m krv\u00e1cen\u00ed z nosu (n\u011bkolikr\u00e1t t\u00fddn\u011b), krv\u00e1cen\u00ed trvaj\u00edc\u00edm &gt;15 minut i p\u0159es stla\u010den\u00ed nebo p\u0159i velk\u00e9m objemu krv\u00e1cen\u00ed.<\/strong> Pokud u\u017e\u00edv\u00e1te warfarin nebo p\u0159\u00edm\u00e9 or\u00e1ln\u00ed antikoagulans spolu s Assuransem, m\u016f\u017ee b\u00fdt nutn\u00e9 do\u010dasn\u011b upravit d\u00e1vkov\u00e1n\u00ed antikoagulans b\u011bhem aktivn\u00edho krv\u00e1cen\u00ed.<\/p>\n<h3 class=\"wp-block-heading\">Kde si mohu objednat Assurans online?<\/h3>\n<p>Assurans 20 mg m\u016f\u017eete objednat na MedsBase v balen\u00edch po 30\/60\/90\/180 tablet\u00e1ch. Objedn\u00e1vky se zas\u00edlaj\u00ed po cel\u00e9m sv\u011bt\u011b s diskr\u00e9tn\u00edm balen\u00edm. Assurans je ve v\u0161ech jurisdikc\u00edch pod odborn\u00fdm dohledem; m\u011bli byste m\u00edt potvrzenou diagn\u00f3zu PAH a b\u00fdt pod dohledem specializovan\u00e9 kliniky pro plicn\u00ed hypertenzi.<\/p>\n<h2 class=\"wp-block-heading\">Souvisej\u00edc\u00ed produkty na MedsBase<\/h2>\n<ul>\n<li><a href=\"https:\/\/medsbase.com\/cs\/cenforce\/\"><strong>Cenforce<\/strong><\/a> \u2014 sildenafil 25-200 mg pro erektiln\u00ed dysfunkci (jin\u00e1 indikace, jin\u00e9 d\u00e1vkov\u00e1n\u00ed)<\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/caverta\/\"><strong>Caverta<\/strong><\/a> \u2014 sildenafil 50\/100 mg pro ED<\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/penegra\/\"><strong>Penegra<\/strong><\/a> \u2014 sildenafil 100 mg pro ED<\/li>\n<\/ul>\n<p>Prohl\u00e9dn\u011bte si celou <a href=\"https:\/\/medsbase.com\/cs\/sildenafil\/\"><strong>kategorii Sildenafil<\/strong><\/a> pro v\u0161echny produkty se sildenafilem na MedsBase.<\/p>\n<p>U\u017eite\u010dn\u00e9 \u010dten\u00ed: <a href=\"https:\/\/medsbase.com\/cs\/reviews\/\">Recenze z\u00e1kazn\u00edk\u016f MedsBase<\/a>.<\/p>\n<div style=\"background:#fff3f3;border-left:4px solid #d9534f;padding:16px 20px;margin:24px 0;border-radius:4px;\">\n<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 radu kvalifikovan\u00e9ho specialisty na plicn\u00ed hypertenzi. Plicn\u00ed arteri\u00e1ln\u00ed hypertenze je vz\u00e1cn\u00e9, progresivn\u00ed, \u017eivot ohro\u017euj\u00edc\u00ed onemocn\u011bn\u00ed, kter\u00e9 vy\u017eaduje odbornou diagnostiku (v\u010detn\u011b katetrizace prav\u00e9ho srdce) a specializovanou p\u00e9\u010di na PAH klinice. Samol\u00e9\u010dba nevysv\u011btliteln\u00e9 du\u0161nosti sildenafilem je nebezpe\u010dn\u00e1 a nevhodn\u00e1. MedsBase neposkytuje diagnostiku, p\u0159edpis ani klinick\u00e1 doporu\u010den\u00ed.\n<\/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>Mu\u017esk\u00e9 zdrav\u00ed<\/strong> kter\u00e9 z\u00e1kazn\u00edci tak\u00e9 prohl\u00ed\u017eej\u00ed:<\/p>\n<ul>\n<li><a href=\"https:\/\/medsbase.com\/cs\/tadarise-oral-jelly\/\">Tadarise Oral Jelly<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/vigamax\/\">Vigamax<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/malegra-fxt-plus\/\">Malegra FXT Plus<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/filagra-oral-jelly\/\">Filagra Oral Jelly<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/himcolin-gel\/\">Himcolin Gel<\/a><\/li>\n<\/ul>","protected":false},"excerpt":{"rendered":"<p>\u2705 L\u00e9\u010d\u00ed plicn\u00ed hypertenzi<br \/>\n\u2705 Zlep\u0161uje toleranci z\u00e1t\u011b\u017ee<br \/>\n\u2705 Roz\u0161i\u0159uje krevn\u00ed c\u00e9vy<br \/>\n\u2705 Sni\u017euje tlak v plicnici<br \/>\n\u2705 Zlep\u0161uje dod\u00e1vku kysl\u00edku<\/p>\n<p>Assurans obsahuje Sildenafil.<\/p>","protected":false},"featured_media":60519,"comment_status":"open","ping_status":"closed","template":"","meta":[],"product_brand":[],"product_cat":[3141,3143,3142,3151],"product_tag":[4877,5645,5862,5637,5863,5864,3153,5861],"class_list":{"0":"post-60518","1":"product","2":"type-product","3":"status-publish","4":"has-post-thumbnail","6":"product_cat-category-overview","7":"product_cat-erectile-dysfunction","8":"product_cat-mens-health","9":"product_cat-sildenafil","10":"product_tag-assurans","11":"product_tag-cipla","12":"product_tag-pah","13":"product_tag-pde5-inhibitor","14":"product_tag-pulmonary-arterial-hypertension","15":"product_tag-revatio-generic","16":"product_tag-sildenafil","17":"product_tag-sildenafil-20-mg","19":"first","20":"instock","21":"shipping-taxable","22":"purchasable","23":"product-type-variable","24":"has-default-attributes"},"acf":[],"_links":{"self":[{"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product\/60518","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=60518"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/media\/60519"}],"wp:attachment":[{"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/media?parent=60518"}],"wp:term":[{"taxonomy":"product_brand","embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_brand?post=60518"},{"taxonomy":"product_cat","embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_cat?post=60518"},{"taxonomy":"product_tag","embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_tag?post=60518"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}