{"id":60667,"date":"2024-02-28T07:01:42","date_gmt":"2024-02-28T07:01:42","guid":{"rendered":"https:\/\/medsname.com\/macralfate-suspension\/"},"modified":"2026-05-01T10:49:16","modified_gmt":"2026-05-01T10:49:16","slug":"macralfate-suspension","status":"publish","type":"product","link":"https:\/\/medsbase.com\/cs\/product\/macralfate-suspension\/","title":{"rendered":"Macralfate Suspension"},"content":{"rendered":"

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

Macralfate Suspension<\/strong> obsahuje sucralfate 1 g na 10 mL<\/strong> v 200 mL lahvi, od v\u00fdrobce certifikovan\u00e9ho WHO-GMP. Sucralfate je mukoprotektivum<\/strong>, nikoli l\u00e9k potla\u010duj\u00edc\u00ed kyselinu \u2014 jde o komplex hlin\u00edku-sachar\u00f3zy-octasulf\u00e1tu, kter\u00fd se v kysel\u00e9m prost\u0159ed\u00ed \u017ealudku polymerizuje na visk\u00f3zn\u00ed, p\u0159ilnavou pastu a selektivn\u011b se v\u00e1\u017ee na povrch v\u0159ed\u016f a eroz\u00ed, \u010d\u00edm\u017e vytv\u00e1\u0159\u00ed fyzickou ochrannou bari\u00e9ru na 6\u20138 hodin. Standardn\u00ed d\u00e1vka pro dosp\u011bl\u00e9:<\/strong> 10 mL (1 g) \u010dty\u0159ikr\u00e1t denn\u011b nala\u010dno \u2014 jednu hodinu p\u0159ed j\u00eddlem a p\u0159ed span\u00edm \u2014 po dobu 4\u20138 t\u00fddn\u016f. U\u017eite\u010dn\u00e9 pro hojen\u00ed peptick\u00fdch v\u0159ed\u016f, bili\u00e1rn\u00ed refluxn\u00ed gastritidu, profylaxi v\u0159ed\u016f zp\u016fsoben\u00fdch NSAID, radia\u010dn\u00ed ezofagitidu a chemoterapi\u00ed indukovanou or\u00e1ln\u00ed mukozitidu (mimo indikaci). Kritick\u00e9 pravidlo na\u010dasov\u00e1n\u00ed:<\/strong> sucralfate v\u00e1\u017ee mnoho dal\u0161\u00edch l\u00e9k\u016f a sni\u017euje jejich vst\u0159eb\u00e1v\u00e1n\u00ed \u2014 odd\u011blte pod\u00e1n\u00ed sucralfatu od v\u0161ech ostatn\u00edch peror\u00e1ln\u00edch l\u00e9k\u016f alespo\u0148 o 2 hodiny.<\/strong>. Vyvarujte se pod\u00e1v\u00e1n\u00ed u dialyzovan\u00fdch pacient\u016f (kumulace hlin\u00edku).<\/p>\n<\/div>\n

\nCo z\u00edsk\u00e1te s MedsBase:<\/strong> V\u00fdrobce certifikovan\u00fd WHO-GMP \u00b7 Diskr\u00e9tn\u00ed balen\u00ed \u00b7 Celosv\u011btov\u00e1 doprava \u00b7 V\u00edce ne\u017e 1 400 ov\u011b\u0159en\u00fdch recenz\u00ed z\u00e1kazn\u00edk\u016f<\/a>\n<\/div>\n

\ud83d\udce6 Ka\u017ed\u00e1 objedn\u00e1vka je pokryta na\u0161\u00ed Z\u00e1rukou op\u011btovn\u00e9ho odesl\u00e1n\u00ed<\/strong><\/a> \u2014 pokud va\u0161e z\u00e1silka nedoraz\u00ed do 20 pracovn\u00edch dn\u016f, p\u0159epos\u00edl\u00e1me ji.<\/p>\n

Pro\u010d objedn\u00e1vat z MedsBase<\/h3>\n

Na\u0161e generick\u00e9 l\u00e9ky poch\u00e1zej\u00ed od v\u00fdrobc\u016f certifikovan\u00fdch WHO-GMP a jsou expedov\u00e1ny po cel\u00e9m sv\u011bt\u011b v diskr\u00e9tn\u00edm, nen\u00e1padn\u00e9m balen\u00ed \u2013 na vn\u011bj\u0161\u00ed stran\u011b bal\u00edku nen\u00ed uveden n\u00e1zev l\u00e9ku. Platby kartou jsou sm\u011brov\u00e1ny prost\u0159ednictv\u00edm regulovan\u00e9ho procesoru (popisky na v\u00fdpisu zahrnuj\u00ed regulovan\u00e9ho procesora plateb kartou \u2013 nikdy \u201cMedsBase\u201d nebo n\u00e1zev l\u00e9ku). P\u0159ij\u00edm\u00e1me tak\u00e9 kryptom\u011bny a bankovn\u00ed p\u0159evody SEPA. Ka\u017ed\u00e1 objedn\u00e1vka je zaji\u0161t\u011bna na\u0161\u00ed politikou p\u0159eposl\u00e1n\u00ed.<\/p>\n

Co je Macralfate<\/h2>\n

Macralfate Suspension je peror\u00e1ln\u00ed suspenze sucralf\u00e1tu<\/strong> \u2014 z\u00e1kladn\u00ed hlin\u00edkov\u00e1 s\u016fl sachar\u00f3zy oktasulf\u00e1tu. Ka\u017ed\u00fdch 10 ml obsahuje 1 g sucralf\u00e1tu; 200ml lahvi\u010dka tedy poskytuje 20 d\u00e1vek. Sucralf\u00e1t je neobvykl\u00fd l\u00e9k, proto\u017ee se neabsorbuje<\/strong> v \u017e\u00e1dn\u00e9m klinicky v\u00fdznamn\u00e9m mno\u017estv\u00ed \u2014 p\u016fsob\u00ed v\u00fdhradn\u011b lok\u00e1ln\u011b v lumen st\u0159eva.<\/p>\n

Jak Macralfate funguje (mechanismus)<\/h2>\n

V kysel\u00e9m prost\u0159ed\u00ed \u017ealudku (pH < 4) doch\u00e1z\u00ed u sucralf\u00e1tu k protonaci a polymeraci<\/strong> do visk\u00f3zn\u00ed, lepkav\u00e9, negativn\u011b nabit\u00e9 pasty. V\u0159edy a eroze odhaluj\u00ed na sv\u00e9m povrchu pozitivn\u011b nabit\u00e9 proteiny (zejm\u00e9na albumin a fibrinogen), ke kter\u00fdm se negativn\u011b nabit\u00fd polymer sukralf\u00e1tu selektivn\u011b v\u00e1\u017ee. V\u00fdsledkem je fyzick\u00e1 adhezivn\u00ed ochrann\u00e1 vrstva na povrchu v\u0159edu, kter\u00e1 vydr\u017e\u00ed 6\u20138 hodin a odol\u00e1v\u00e1 kyselin\u00e1m, pepsinu a erozi \u017elu\u010dov\u00fdmi solemi. Sukralf\u00e1t tak\u00e9 stimuluje m\u00edstn\u00ed sekreci prostaglandin\u016f a hydrogenuhli\u010ditanu na slizni\u010dn\u00edm povrchu, zvy\u0161uje vazbu epiderm\u00e1ln\u00edho r\u016fstov\u00e9ho faktoru a sni\u017euje aktivitu pepsinu. Nesni\u017euje sekreci \u017ealude\u010dn\u00ed kyseliny<\/strong> \u2014 pokud pot\u0159ebujete tak\u00e9 potla\u010den\u00ed kyseliny (co\u017e v\u011bt\u0161ina pacient\u016f s peptick\u00fdm v\u0159edem pot\u0159ebuje), p\u0159id\u00e1 se PPI nebo H2<\/sub> antagonista.<\/p>\n

Proto\u017ee sukralf\u00e1t pot\u0159ebuje kysel\u00e9 prost\u0159ed\u00ed k polymerizaci, neu\u017e\u00edvejte jej spole\u010dn\u011b s PPI nebo H2<\/sub> antagonistou \u2014 odd\u011blte je alespo\u0148 o 30\u201360 minut (nejprve sukralf\u00e1t, pot\u00e9 kyselinu potla\u010duj\u00edc\u00ed l\u00e9k po j\u00eddle funguje dob\u0159e).<\/p>\n

Indikace \u2014 Co Macralfate l\u00e9\u010d\u00ed<\/h2>\n

1. Peptick\u00e1 v\u0159edov\u00e1 choroba \u2014 \u017ealude\u010dn\u00ed a duoden\u00e1ln\u00ed<\/h3>\n

Sukralf\u00e1t hoj\u00ed duoden\u00e1ln\u00ed v\u0159edy za 4 t\u00fddny a \u017ealude\u010dn\u00ed v\u0159edy za 8 t\u00fddn\u016f p\u0159i d\u00e1vkov\u00e1n\u00ed 1 g \u010dty\u0159ikr\u00e1t denn\u011b. M\u00edra hojen\u00ed je srovnateln\u00e1 s H2<\/sub> antagonisty; PPI jsou \u00fa\u010dinn\u011bj\u0161\u00ed a rychlej\u0161\u00ed, ale sukralf\u00e1t je u\u017eite\u010dn\u00fd tam, kde je PPI kontraindikov\u00e1n nebo kde pacient preferuje nesyst\u00e9movou variantu.<\/p>\n

2. Bili\u00e1rn\u00ed refluxn\u00ed gastritida<\/h3>\n

Kdy\u017e nen\u00ed probl\u00e9mem \u017ealude\u010dn\u00ed kyselina (bili\u00e1rn\u00ed reflux po gastrektomii, po cholecystektomii), PPI p\u0159in\u00e1\u0161ej\u00ed mal\u00fd u\u017eitek. Mechanick\u00e1 slizni\u010dn\u00ed vrstva sukralf\u00e1tu pom\u00e1h\u00e1 v tomto p\u0159\u00edpad\u011b a je jednou z m\u00e1la kyselinou souvisej\u00edc\u00edch terapi\u00ed s definovanou v\u00fdklenkovou indikac\u00ed.<\/p>\n

3. NSAID asociovan\u00e1 gastritida a profylaxe v\u0159ed\u016f<\/h3>\n

U pacient\u016f s ni\u017e\u0161\u00edm rizikem na chronick\u00e9 terapii NSAID m\u016f\u017ee sukralf\u00e1t sn\u00ed\u017eit rozvoj gastritidy a v\u0159ed\u016f. PPI jsou \u00fa\u010dinn\u011bj\u0161\u00ed a jsou prvn\u00ed volbou u pacient\u016f s vy\u0161\u0161\u00edm rizikem.<\/p>\n

4. Radia\u010dn\u00ed ezofagitida a proktitida<\/h3>\n

Sucralf\u00e1tov\u00e1 suspenze sni\u017euje bolest a urychluje hojen\u00ed p\u0159i radia\u010dn\u00ed ezofagitid\u011b (l\u00e9\u010dba n\u00e1dor\u016f hlavy a krku) a radia\u010dn\u00ed proktitid\u011b (p\u00e1nevn\u00ed radiace). Suspenzi lze spolknout jako ochrann\u00fd povlak j\u00edcnu nebo pou\u017e\u00edt jako reten\u010dn\u00ed klyst\u00fdr p\u0159i proktitid\u011b.<\/p>\n

5. Chemoterapi\u00ed indukovan\u00e1 or\u00e1ln\u00ed mukozitida (mimo schv\u00e1len\u00e9 indikace)<\/h3>\n

Sucralf\u00e1tov\u00e1 suspenze pou\u017e\u00edvan\u00e1 jako \u00fastn\u00ed v\u00fdplach a vyplivnut\u00ed nebo v\u00fdplach a spolknut\u00ed sni\u017euje bolest a z\u00e1va\u017enost v\u0159ed\u016f p\u0159i mukozitid\u011b zp\u016fsoben\u00e9 chemoterapi\u00ed. D\u016fkazy jsou omezen\u00e9, ale podp\u016frn\u00e9.<\/p>\n

6. Profylaxe stresov\u00fdch v\u0159ed\u016f (vybran\u00e9 populace na JIP)<\/h3>\n

N\u011bkter\u00e9 postupy na JIP se vr\u00e1tily k pou\u017e\u00edv\u00e1n\u00ed sucralf\u00e1tu nebo H2<\/sub> antagonist\u016f pro profylaxi stresov\u00fdch v\u0159ed\u016f u vybran\u00fdch ventilovan\u00fdch pacient\u016f, proto\u017ee PPI zvy\u0161uj\u00ed riziko ventila\u010dn\u00ed pneumonie a C. difficile<\/em> m\u00edry. Rozhodnut\u00ed specialisty intenzivn\u00ed p\u00e9\u010de.<\/p>\n

7. Refraktern\u00ed GERD \u2014 dopln\u011bk k PPI<\/h3>\n

P\u0159i refraktern\u00edm refluxu navzdory optimalizovan\u00e9 terapii PPI m\u016f\u017ee p\u0159id\u00e1n\u00ed sucralf\u00e1tov\u00e9 suspenze p\u0159in\u00e9st symptomatick\u00e9 zlep\u0161en\u00ed fyzick\u00fdm pokryt\u00edm erodovan\u00e9ho dist\u00e1ln\u00edho j\u00edcnu. U\u017e\u00edvejte t\u011bsn\u011b p\u0159ed span\u00edm jako ochrannou d\u00e1vku.<\/p>\n

D\u00e1vkov\u00e1n\u00ed<\/h2>\n\n\n\n\n\n\n\n\n\n\n
Indikace<\/th>\nD\u00e1vka<\/th>\nD\u00e9lka<\/th>\n<\/tr>\n<\/thead>\n
Hojen\u00ed peptick\u00e9ho v\u0159edu<\/td>\n10 ml (1 g) \u010dty\u0159ikr\u00e1t denn\u011b nala\u010dno<\/td>\n4\u20138 t\u00fddn\u016f<\/td>\n<\/tr>\n
\u00dadr\u017eba peptick\u00e9ho v\u0159edu<\/td>\n10 ml dvakr\u00e1t denn\u011b nala\u010dno<\/td>\npodle pot\u0159eby<\/td>\n<\/tr>\n
Profylaxe NSAID<\/td>\n10 ml dvakr\u00e1t denn\u011b<\/td>\npo dobu l\u00e9\u010dby NSAID<\/td>\n<\/tr>\n
Radia\u010dn\u00ed ezofagitida<\/td>\n10 mL \u010dty\u0159ikr\u00e1t denn\u011b, pomalu polykat<\/td>\ndoba trv\u00e1n\u00ed radiace + 2 t\u00fddny<\/td>\n<\/tr>\n
Radia\u010dn\u00ed proktitida<\/td>\n10 mL reten\u010dn\u00ed klyst\u00fdr 2\u00d7 denn\u011b<\/td>\npod veden\u00edm specialisty<\/td>\n<\/tr>\n
Or\u00e1ln\u00ed mukozitida (mimo schv\u00e1len\u00e9 indikace)<\/td>\n10 mL vypl\u00e1chnout a vyplivnout \u010dty\u0159ikr\u00e1t denn\u011b<\/td>\n2\u20134 t\u00fddn\u016f<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

U\u017e\u00edvejte nala\u010dno<\/strong> \u2014 jednu hodinu p\u0159ed j\u00eddlem a p\u0159ed span\u00edm, \u010dty\u0159ikr\u00e1t denn\u011b. L\u00e9k pot\u0159ebuje kysel\u00e9 prost\u0159ed\u00ed k polymerizaci; j\u00eddlo a antacida sni\u017euj\u00ed jeho \u00fa\u010dinnost. P\u0159ed ka\u017edou d\u00e1vkou lahvi\u010dku dob\u0159e prot\u0159epejte.<\/p>\n

KRITICK\u00c9: Pravidlo na\u010dasov\u00e1n\u00ed l\u00e9ku<\/h2>\n
Sukralf\u00e1t mus\u00ed b\u00fdt u\u017e\u00edv\u00e1n s odstupem alespo\u0148 2 hodin od jak\u00e9hokoli jin\u00e9ho peror\u00e1ln\u00edho l\u00e9ku.<\/strong> Sukralf\u00e1t v\u00e1\u017ee v tr\u00e1vic\u00edm traktu mnoho l\u00e9k\u016f a v\u00fdrazn\u011b sni\u017euje jejich vst\u0159eb\u00e1v\u00e1n\u00ed. Mezi l\u00e9ky, jejich\u017e vst\u0159eb\u00e1v\u00e1n\u00ed je sn\u00ed\u017eeno, pat\u0159\u00ed: levothyroxin, digoxin, warfarin, fenytoin, theofylin, ketokonazol, fluorochinolony (ciprofloxacin, levofloxacin, moxifloxacin), tetracykliny (doxycyklin), peror\u00e1ln\u00ed \u017eelezo, vitamin K, kyselina listov\u00e1<\/strong>, a mnoho dal\u0161\u00edch. Praktick\u00fd re\u017eim: u\u017e\u00edvejte sukralf\u00e1t jednu hodinu p\u0159ed j\u00eddlem (a p\u0159ed span\u00edm) a v\u0161echny ostatn\u00ed peror\u00e1ln\u00ed l\u00e9ky bu\u010f spole\u010dn\u011b s<\/em> s j\u00eddlem nebo alespo\u0148 2 hodiny od sukralf\u00e1tu. Pokud je v\u00e1\u0161 seznam l\u00e9k\u016f slo\u017eit\u00fd, p\u0159ed zah\u00e1jen\u00edm l\u00e9\u010dby si s l\u00e9k\u00e1rn\u00edkem vypracujte denn\u00ed \u010dasov\u00fd rozvrh.<\/div>\n

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

Sukralf\u00e1t je v\u00fdjime\u010dn\u011b dob\u0159e sn\u00e1\u0161en, proto\u017ee se neabsorbuje.<\/p>\n

\u010cast\u00e9 (1\u20135 %):<\/strong><\/p>\n

    \n
  • Z\u00e1cpa (nej\u010dast\u011bj\u0161\u00ed vedlej\u0161\u00ed \u00fa\u010dinek; vyskytuje se u ~2 % u\u017eivatel\u016f)<\/li>\n
  • Sucho v \u00fastech<\/li>\n
  • M\u00edrn\u00e1 nevolnost<\/li>\n
  • Kovov\u00e1 chu\u0165<\/li>\n<\/ul>\n

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

      \n
    • Toxicita hlin\u00edku<\/strong> u dialyzovan\u00fdch pacient\u016f a p\u0159i t\u011b\u017ek\u00e9m chronick\u00e9m onemocn\u011bn\u00ed ledvin \u2014 sukralf\u00e1t je hlin\u00edkov\u00e1 s\u016fl; navzdory minim\u00e1ln\u00ed absorpci m\u016f\u017ee akumulace p\u0159i chronick\u00e9m onemocn\u011bn\u00ed ledvin zp\u016fsobit encefalopatii, osteomalacii a mikrocyt\u00e1rn\u00ed an\u00e9mii. Vyhn\u011bte se u dialyzovan\u00fdch pacient\u016f<\/strong>.<\/li>\n
    • Hypofosfat\u00e9mie (vz\u00e1cn\u00e9, p\u0159i dlouhodob\u00e9m u\u017e\u00edv\u00e1n\u00ed)<\/li>\n
    • Tvorba bezo\u00e1r\u016f v \u017ealudku (velmi vz\u00e1cn\u00e9; hl\u00e1\u0161eno u pacient\u016f na JIP na enter\u00e1ln\u00ed v\u00fd\u017eiv\u011b)<\/li>\n
    • P\u0159ecitliv\u011blostn\u00ed vyr\u00e1\u017eka<\/li>\n<\/ul>\n

      L\u00e9kov\u00e9 interakce mimo pravidlo \u010dasov\u00e9ho odstupu<\/h2>\n

      Sukralf\u00e1t nem\u00e1 \u017e\u00e1dn\u00e9 enzymem zprost\u0159edkovan\u00e9 l\u00e9kov\u00e9 interakce. V\u0161echny klinicky v\u00fdznamn\u00e9 interakce jsou v\u00e1zan\u00e9 na absorpci<\/strong> a \u0159e\u0161\u00ed se odd\u011blen\u00edm d\u00e1vek o 2 hodiny. \u00dapln\u00fd seznam l\u00e9k\u016f, jejich\u017e absorpce je sukralf\u00e1tem naru\u0161ena, je p\u0159\u00edli\u0161 dlouh\u00fd na to, aby byl vyjmenov\u00e1n \u2014 bezpe\u010dn\u00e9 pravidlo je: u\u017e\u00edvejte v\u0161echny ostatn\u00ed peror\u00e1ln\u00ed l\u00e9ky nejm\u00e9n\u011b 2 hodiny p\u0159ed nebo po pod\u00e1n\u00ed sukralf\u00e1tu.<\/strong><\/p>\n

      Kontraindikace a upozorn\u011bn\u00ed<\/h2>\n