{"id":65190,"date":"2024-12-27T14:27:50","date_gmt":"2024-12-27T14:27:50","guid":{"rendered":"https:\/\/medsbase.com\/?post_type=product&p=65190"},"modified":"2026-05-01T10:49:17","modified_gmt":"2026-05-01T10:49:17","slug":"artvigil","status":"publish","type":"product","link":"https:\/\/medsbase.com\/cs\/product\/artvigil\/","title":{"rendered":"Artvigil"},"content":{"rendered":"


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\u26a1 Rychl\u00e1 odpov\u011b\u010f \u2014 Co je Artvigil 150 mg?<\/h3>\n

Artvigil 150 mg<\/strong> obsahuje armodafinil<\/strong> jako peror\u00e1ln\u00ed tableta od HAB Pharma \u2014 eugeroikum podporuj\u00edc\u00ed bd\u011blost<\/strong> \u2014 \u010dist\u00fd R<\/em>-enantiomer modafinilu, rafinovan\u00fd z racemick\u00e9 sm\u011bsi pro plynulej\u0161\u00ed prodlou\u017eenou bd\u011blost s ni\u017e\u0161\u00edm po\u010d\u00e1te\u010dn\u00edm \u201cp\u0159est\u0159elen\u00edm\u201d. Schv\u00e1leno FDA pro l\u00e9\u010dbu nadm\u011brn\u00e9 denn\u00ed spavosti spojen\u00e9 s narkolepsi\u00ed<\/strong>, poruchy sp\u00e1nku p\u0159i sm\u011bnn\u00e9m provozu (SWSD)<\/strong>, a rezidu\u00e1ln\u00ed spavosti u l\u00e9\u010den\u00e9 obstruk\u010dn\u00ed sp\u00e1nkov\u00e9 apnoe (OSA)<\/strong>. N\u00e1stup \u00fa\u010dinku: 1-2 hodiny po peror\u00e1ln\u00edm pod\u00e1n\u00ed nala\u010dno<\/strong> (pomalej\u0161\u00ed n\u00e1stup ne\u017e u modafinilu kv\u016fli absenci S-enantiomeru). Maxim\u00e1ln\u00ed plazmatick\u00e1 koncentrace za 2-3 hodiny.<\/strong> Doba trv\u00e1n\u00ed \u00fa\u010dinku na bd\u011blost: 12-15 hodin<\/strong> pro d\u00e1vku 150 mg. 150 mg jednou denn\u011b r\u00e1no<\/strong> je standardn\u00ed d\u00e1vka pro narkolepsii a zbytkovou ospalost u OSA. Pro poruchu sp\u00e1nku p\u0159i sm\u011bnn\u00e9m provozu u\u017eijte 150 mg 1 hodinu p\u0159ed za\u010d\u00e1tkem sm\u011bny. 250 mg se n\u011bkdy pou\u017e\u00edv\u00e1 u pacient\u016f, kte\u0159\u00ed nedostate\u010dn\u011b reaguj\u00ed na 150 mg; tato d\u00e1vka je schv\u00e1lena FDA pro narkolepsii a SWSD. Pod dohledem specialisty.<\/strong> L\u00e1tka \u0159\u00edzen\u00e1 podle seznamu IV (US DEA); za\u0159azen\u00ed do seznam\u016f se mezin\u00e1rodn\u011b li\u0161\u00ed. D\u016eLE\u017dIT\u00c9: Armodafinil je induktor CYP3A4, kter\u00fd sni\u017euje \u00fa\u010dinnost hormon\u00e1ln\u00ed antikoncepce<\/strong> \u2014 \u017eeny v reproduk\u010dn\u00edm v\u011bku MUS\u00cd pou\u017e\u00edvat nehormon\u00e1ln\u00ed z\u00e1lo\u017en\u00ed antikoncepci (kondomy, m\u011bd\u011bn\u00e9 t\u011bl\u00edsko nebo abstinenci) b\u011bhem l\u00e9\u010dby a po dobu 1 m\u011bs\u00edce po posledn\u00ed d\u00e1vce<\/strong>. . \u010cast\u00e9 ne\u017e\u00e1douc\u00ed \u00fa\u010dinky: bolest hlavy, nevolnost, nespavost p\u0159i pozdn\u00edm pod\u00e1n\u00ed. P\u0158ERU\u0160TE okam\u017eit\u011b a vyhledejte neodkladnou l\u00e9ka\u0159skou pomoc, pokud se objev\u00ed jak\u00e1koli vyr\u00e1\u017eka<\/strong> \u2014 byly hl\u00e1\u0161eny vz\u00e1cn\u00e9, ale z\u00e1va\u017en\u00e9 reakce jako Stevens-Johnson\u016fv syndrom (SJS), toxick\u00e1 epiderm\u00e1ln\u00ed nekrol\u00fdza (TEN) a DRESS.<\/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 Artvigil 150 mg?<\/h2>\n

Artvigil 150 mg<\/strong> je peror\u00e1ln\u00ed armodafinil 150 mg<\/strong> od HAB Pharma<\/strong>, dod\u00e1v\u00e1no v balen\u00edch po 30 \/ 60 \/ 90 \/ 200 \/ 400 \/ 800 tablet\u00e1ch. Armodafinil je l\u00e1tka podporuj\u00edc\u00ed bd\u011blost, kter\u00e1 byla poprv\u00e9 schv\u00e1lena FDA v roce 2007 (zna\u010dka Nuvigil) jako \u010dist\u00e1 R-enantiomern\u00ed forma modafinilu. Schv\u00e1len\u00e9 indikace jsou shodn\u00e9 s modafinilem: narkolepsie, porucha sp\u00e1nku p\u0159i sm\u011bnn\u00e9m provozu a zbytkov\u00e1 ospalost u l\u00e9\u010den\u00e9 OSA.<\/p>\n

Armodafinil je \u010dist\u00fd R-enantiomer modafinilu<\/strong>. Racemick\u00fd modafinil je 50\/50 sm\u011bs R- a S-modafinilu; R-enantiomer m\u00e1 polo\u010das p\u0159ibli\u017en\u011b 15 hodin a zp\u016fsobuje v\u011bt\u0161inu klinick\u00e9ho \u00fa\u010dinku na bd\u011blost, zat\u00edmco S-enantiomer se vylu\u010duje za 3-4 hodiny a p\u0159isp\u00edv\u00e1 k \u010dasn\u00e9mu \u201cprvn\u00edmu vrcholu\u201d, kter\u00fd n\u011bkte\u0159\u00ed pacienti za\u017e\u00edvaj\u00ed u racemick\u00e9ho modafinilu. Odstran\u011bn\u00edm S-enantiomeru poskytuje armodafinil \u010dist\u0161\u00ed, vyrovnan\u011bj\u0161\u00ed a d\u00e9le trvaj\u00edc\u00ed \u00fa\u010dinek na bd\u011blost<\/strong> ne\u017e modafinil p\u0159i stejn\u00e9 d\u00e1vce.<\/p>\n

Pokud chcete rychlej\u0161\u00ed n\u00e1stup \u00fa\u010dinku<\/strong> (30-60 minut) a jste ochotni akceptovat v\u00fdrazn\u011bj\u0161\u00ed \u010dasn\u00fd vrchol, pod\u00edvejte se na na\u0161i Modvigil 200 mg<\/strong><\/a> str\u00e1nku \u2014 stejn\u00fd v\u00fdrobce HAB Pharma, racemick\u00fd modafinil nam\u00edsto \u010dist\u00e9ho armodafinilu.<\/p>\n

Jak funguje Armodafinil?<\/h2>\n

P\u0159esn\u00fd mechanismus bd\u011blosti armodafinilu nen\u00ed pln\u011b objasn\u011bn, ale modulace v\u00edce syst\u00e9m\u016f je nyn\u00ed dob\u0159e pops\u00e1na:<\/p>\n

    \n
  • Slab\u00e1 inhibice dopaminov\u00e9ho transport\u00e9ru (DAT)<\/strong> \u2014 armodafinil se v\u00e1\u017ee na DAT s relativn\u011b n\u00edzkou afinitou ve srovn\u00e1n\u00ed s klasick\u00fdmi stimulanty (amfetamin, methylfenid\u00e1t). To m\u00edrn\u011b zvy\u0161uje extracelul\u00e1rn\u00ed dopamin v nucleus accumbens, striatu a prefront\u00e1ln\u00ed k\u016f\u0159e. Slab\u0161\u00ed vazba je d\u016fvodem mnohem ni\u017e\u0161\u00edho potenci\u00e1lu zneu\u017eit\u00ed oproti amfetamin\u016fm.<\/li>\n
  • Aktivace histaminergn\u00edho syst\u00e9mu<\/strong> \u2014 armodafinil aktivuje j\u00e1dro tuberomamill\u00e1rn\u00ed oblasti<\/strong> (centrum mozku produkuj\u00edc\u00ed histamin), co\u017e zvy\u0161uje uvol\u0148ov\u00e1n\u00ed histaminu v hypotalamu a k\u016f\u0159e. Histamin je kl\u00ed\u010dov\u00fd neurotransmiter podporuj\u00edc\u00ed bd\u011blost a tato dr\u00e1ha je \u00fast\u0159edn\u00ed pro \u00fa\u010dinek trval\u00e9 bd\u011blosti.<\/li>\n
  • Stimulace syst\u00e9mu orexin\/hypokretin<\/strong> \u2014 armodafinil aktivuje neurony uvol\u0148uj\u00edc\u00ed orexin v later\u00e1ln\u00edm hypotalamu. Nedostatek orexinu je z\u00e1kladn\u00ed p\u0159\u00ed\u010dinou narkolepsie typu 1; armodafinil \u010d\u00e1ste\u010dn\u011b kompenzuje tento deficit.<\/li>\n
  • Noradrenergn\u00ed \u00fa\u010dinek<\/strong> \u2014 m\u00edrn\u00e1 inhibice norepinefrinov\u00e9ho transport\u00e9ru ve ventrolater\u00e1ln\u00edm preoptick\u00e9m j\u00e1dru, co\u017e podporuje bd\u011blost.<\/li>\n
  • Selektivn\u00ed pro obvody bd\u011blosti, nikoli odm\u011bny<\/strong> \u2014 na rozd\u00edl od stimulant\u016f t\u0159\u00eddy amfetamin\u016f armodafinil ve v\u011bt\u0161in\u011b u\u017eivatel\u016f p\u0159i terapeutick\u00fdch d\u00e1vk\u00e1ch nevyvol\u00e1v\u00e1 v\u00fdraznou euforii ani posiluj\u00edc\u00ed \u00fa\u010dinky. Tato selektivita je z\u00e1kladem jeho za\u0159azen\u00ed do kategorie Schedule IV (nikoli Schedule II).<\/li>\n
  • Metabolismus<\/strong> \u2014 jatern\u00ed, prim\u00e1rn\u011b prost\u0159ednictv\u00edm CYP3A4 a vedlej\u0161\u00edmi cestami CYP2C19. Armodafinil je s\u00e1m o sob\u011b induktor CYP3A4<\/strong> (to je mechanismus stoj\u00edc\u00ed za interakc\u00ed s antikoncepc\u00ed) a slab\u00fd inhibitor CYP2C19<\/strong>.<\/li>\n
  • Ren\u00e1ln\u00ed vylu\u010dov\u00e1n\u00ed<\/strong> \u2014 p\u0159ev\u00e1\u017en\u011b jako neaktivn\u00ed metabolity; <10% nezm\u011bn\u011bn\u00e9ho l\u00e9\u010diva.<\/li>\n<\/ul>\n

    Armodafinil nesni\u017euje biologickou pot\u0159ebu sp\u00e1nku.<\/strong> Potla\u010duje subjektivn\u00ed pro\u017e\u00edv\u00e1n\u00ed ospalosti b\u011bhem sv\u00e9 doby \u00fa\u010dinku, ale sp\u00e1nkov\u00fd dluh se hromad\u00ed norm\u00e1ln\u011b. Chronick\u00e9 u\u017e\u00edv\u00e1n\u00ed bez dostate\u010dn\u00e9ho no\u010dn\u00edho sp\u00e1nku (7-8 hodin pro v\u011bt\u0161inu dosp\u011bl\u00fdch) je \u0161kodliv\u00e9 a \u010dasem se projev\u00ed jako kognitivn\u00ed, imunitn\u00ed, kardiovaskul\u00e1rn\u00ed a metabolick\u00e9 zhor\u0161en\u00ed.<\/p>\n

    Kdy se Artvigil pou\u017e\u00edv\u00e1<\/h2>\n

    Indikace schv\u00e1len\u00e9 FDA<\/h3>\n
      \n
    • Narkolepsie<\/strong> \u2014 prim\u00e1rn\u00ed indikace schv\u00e1len\u00e1 FDA. Artvigil sni\u017euje nadm\u011brnou denn\u00ed spavost, zlep\u0161uje bd\u011blost podle objektivn\u00edch (test udr\u017een\u00ed bd\u011blosti, MWT) a subjektivn\u00edch (Epworthsk\u00e1 \u0161k\u00e1la spavosti) m\u011b\u0159en\u00ed. Ne ne<\/em> nel\u00e9\u010d\u00ed kataplexii; u narkolepsie s kataplexi\u00ed se Artvigil kombinuje s sodnou sol\u00ed oxyb\u00e1tu, pitolisantem nebo SSRI.<\/li>\n
    • Porucha sp\u00e1nku p\u0159i sm\u011bnn\u00e9m provozu (SWSD)<\/strong> \u2014 nadm\u011brn\u00e1 spavost b\u011bhem no\u010dn\u00ed sm\u011bny. Artvigil je schv\u00e1len FDA pro SWSD; d\u00e1vka se u\u017e\u00edv\u00e1 1 hodinu p\u0159ed za\u010d\u00e1tkem sm\u011bny.<\/li>\n
    • Zbytkov\u00e1 spavost u l\u00e9\u010den\u00e9 obstruk\u010dn\u00ed sp\u00e1nkov\u00e9 apnoe<\/strong> \u2014 u pacient\u016f dodr\u017euj\u00edc\u00edch CPAP\/BiPAP s p\u0159etrv\u00e1vaj\u00edc\u00ed nadm\u011brnou denn\u00ed spavost\u00ed navzdory optim\u00e1ln\u00ed l\u00e9\u010db\u011b d\u00fdchac\u00edch cest. Artvigil je dopl\u0148kem, NEN\u00c1HRADOU za CPAP.<\/li>\n<\/ul>\n

      Mimolabeln\u00ed klinick\u00e9 pou\u017eit\u00ed<\/h3>\n
        \n
      • ADHD<\/strong> \u2014 n\u011bkter\u00e9 randomizovan\u00e9 studie podporuj\u00ed pou\u017eit\u00ed armodafinilu u dosp\u011bl\u00fdch s ADHD. Nen\u00ed schv\u00e1len FDA pro tuto indikaci u dosp\u011bl\u00fdch ani d\u011bt\u00ed a FDA v\u00fdslovn\u011b varovala p\u0159ed pou\u017eit\u00edm u d\u011bt\u00ed po hl\u00e1\u0161en\u00ed p\u0159\u00edpad\u016f SJS u d\u011bt\u00ed.<\/li>\n
      • \u00danava p\u0159i roztrou\u0161en\u00e9 skler\u00f3ze<\/strong> \u2014 existuj\u00ed ur\u010dit\u00e9 d\u016fkazy o prosp\u011b\u0161nosti; \u010dasto se pou\u017e\u00edv\u00e1 off-label na specializovan\u00fdch RS klinik\u00e1ch.<\/li>\n
      • Augmentace p\u0159i depresi<\/strong> \u2014 mal\u00e9 kontrolovan\u00e9 studie podporuj\u00ed p\u0159id\u00e1n\u00ed armodafinilu k antidepresiv\u016fm u l\u00e9\u010debn\u011b rezistentn\u00ed deprese s v\u00fdraznou \u00fanavou.<\/li>\n
      • \u00danava spojen\u00e1 s rakovinou, \u00fanava po chemoterapii<\/strong> \u2014 m\u00edrn\u00fd benefit ve specializovan\u00fdch onkologick\u00fdch za\u0159\u00edzen\u00edch.<\/li>\n
      • Denn\u00ed ospalost u Parkinsonovy choroby<\/strong> \u2014 pou\u017e\u00edv\u00e1 se specificky pro EDS spojenou s Parkinsonovou chorobou.<\/li>\n
      • Jet lag a \u00fanava z dlouh\u00fdch let\u016f<\/strong> \u2014 ob\u010dasn\u00e9 kr\u00e1tkodob\u00e9 u\u017eit\u00ed; nejedn\u00e1 se o rutinn\u00ed ani prim\u00e1rn\u00ed indikaci.<\/li>\n<\/ul>\n

        Nevhodn\u00e9 pou\u017eit\u00ed<\/h3>\n

        Artvigil je ne<\/strong> vhodn\u00fd pro:<\/p>\n

          \n
        • B\u011b\u017en\u00e1 \u00fanava nebo vy\u010derp\u00e1n\u00ed<\/strong> bez diagnostikovan\u00e9 z\u00e1kladn\u00ed poruchy sp\u00e1nku. Spr\u00e1vn\u00e1 sp\u00e1nkov\u00e1 hygiena, dostate\u010dn\u00fd no\u010dn\u00ed sp\u00e1nek a vy\u0161et\u0159en\u00ed z\u00e1kladn\u00ed p\u0159\u00ed\u010diny (an\u00e9mie, onemocn\u011bn\u00ed \u0161t\u00edtn\u00e9 \u017el\u00e1zy, deprese, sp\u00e1nkov\u00e1 apnoe) jsou na prvn\u00edm m\u00edst\u011b.<\/li>\n
        • Obecn\u00e9 \u201ckognitivn\u00ed zlep\u0161en\u00ed\u201d nebo studijn\u00ed pom\u016fcka<\/strong> u zdrav\u00fdch lid\u00ed bez diagn\u00f3zy poruchy sp\u00e1nku nebo ADHD. A\u010dkoli je v tomto pou\u017eit\u00ed popul\u00e1rn\u00ed, jde o off-label u\u017eit\u00ed, nekontrolovan\u00e9 a nese skute\u010dn\u00e1 (by\u0165 vz\u00e1cn\u00e1) rizika v\u010detn\u011b SJS, psychiatrick\u00fdch reakc\u00ed a z\u00e1vislosti p\u0159i denn\u00edm dlouhodob\u00e9m u\u017e\u00edv\u00e1n\u00ed.<\/li>\n
        • N\u00e1hrada za dostate\u010dn\u00fd sp\u00e1nek<\/strong> \u2014 nenahrazuje biologick\u00e9 regenera\u010dn\u00ed funkce sp\u00e1nku.<\/li>\n
        • D\u011btsk\u00e9 poruchy sp\u00e1nku<\/strong> \u2014 u\u017eit\u00ed u d\u011bt\u00ed nen\u00ed schv\u00e1leno FDA a je v\u00fdslovn\u011b varov\u00e1no kv\u016fli hl\u00e1\u0161en\u00fdm p\u0159\u00edpad\u016fm SJS.<\/li>\n
        • \u00dabytek hmotnosti<\/strong> \u2014 navzdory m\u00edrn\u00fdm \u00fa\u010dink\u016fm na potla\u010den\u00ed chuti k j\u00eddlu u n\u011bkter\u00fdch u\u017eivatel\u016f toto nen\u00ed vhodn\u00e1 indikace.<\/li>\n<\/ul>\n

          Artvigil D\u00e1vkov\u00e1n\u00ed a Jak U\u017e\u00edvat<\/h2>\n

          Standardn\u00ed d\u00e1vkov\u00e1n\u00ed<\/h3>\n
            \n
          • Narkolepsie nebo p\u0159etrv\u00e1vaj\u00edc\u00ed ospalost u OSA:<\/strong> 150 mg jednou denn\u011b r\u00e1no, u\u017e\u00edvan\u00e9 nala\u010dno nebo s lehkou sn\u00eddan\u00ed.<\/li>\n
          • Porucha sp\u00e1nku p\u0159i sm\u011bnn\u00e9m provozu:<\/strong> 150 mg u\u017e\u00edvan\u00e9 p\u0159ibli\u017en\u011b 1 hodinu p\u0159ed za\u010d\u00e1tkem no\u010dn\u00ed sm\u011bny.<\/li>\n
          • Pacienti star\u0161\u00ed 65 let:<\/strong> zv\u00e1\u017eit za\u010d\u00e1tek s polovi\u010dn\u00ed d\u00e1vkou (75 mg jednou denn\u011b r\u00e1no, u\u017e\u00edvan\u00e9 nala\u010dno nebo s lehkou sn\u00eddan\u00ed).<\/li>\n
          • T\u011b\u017ek\u00e9 po\u0161kozen\u00ed jater:<\/strong> sni\u017ete d\u00e1vku o 50% (ekvivalent 75 mg).<\/li>\n
          • T\u011b\u017ek\u00e9 ren\u00e1ln\u00ed po\u0161kozen\u00ed:<\/strong> \u00faprava d\u00e1vkov\u00e1n\u00ed nen\u00ed form\u00e1ln\u011b stanovena; pou\u017e\u00edvejte opatrn\u011b a pe\u010dliv\u011b sledujte.<\/li>\n<\/ul>\n

            Vy\u0161\u0161\u00ed d\u00e1vky a titrace<\/h3>\n

            150 mg u\u017e\u00edvan\u00e9 p\u0159ibli\u017en\u011b 1 hodinu p\u0159ed za\u010d\u00e1tkem no\u010dn\u00ed sm\u011bny. 150 mg tablet je dod\u00e1v\u00e1no pouze \u2014 pou\u017eijte alternativn\u00ed denn\u00ed d\u00e1vkov\u00e1n\u00ed nebo rozd\u011blte-li t\u0159eba.<\/strong> 150 mg u\u017e\u00edvan\u00e9 p\u0159ibli\u017en\u011b 1 hodinu p\u0159ed za\u010d\u00e1tkem no\u010dn\u00ed sm\u011bny, ale s hlad\u0161\u00edm \u010dasov\u00fdm profilem (del\u0161\u00ed doba trv\u00e1n\u00ed, ni\u017e\u0161\u00ed \u010dasov\u00fd vrchol). N\u011bkte\u0159\u00ed pacienti s t\u011b\u017ekou narkolepsi\u00ed nebo SWSD odpov\u00eddaj\u00ed adekv\u00e1tn\u011b pouze 250 mg denn\u011b<\/strong> \u2014 kontrolovan\u00e9 studie prok\u00e1zaly, \u017ee tento p\u0159\u00edpravek nen\u00ed v pr\u016fm\u011bru nad\u0159azen\u00fd, ale m\u016f\u017ee prosp\u011bt jednotliv\u00fdm pacient\u016fm. D\u011blen\u00ed d\u00e1vky (r\u00e1no + v poledne) je v\u00fdhodn\u011bj\u0161\u00ed ne\u017e jedna v\u011bt\u0161\u00ed rann\u00ed d\u00e1vka, proto\u017ee sni\u017euje riziko naru\u0161en\u00ed ve\u010dern\u00edho sp\u00e1nku.<\/p>\n

            Pravidla na\u010dasov\u00e1n\u00ed<\/h3>\n
              \n
            • U\u017e\u00edvejte r\u00e1no<\/strong> \u2014 armodafinil u\u017eit\u00fd po 9. hodin\u011b r\u00e1no \u010dasto naru\u0161uje sp\u00e1nek toho sam\u00e9ho ve\u010dera. U\u017e\u00edvejte co nejd\u0159\u00edve po probuzen\u00ed.<\/li>\n
            • Neu\u017e\u00edvejte pozd\u011b b\u011bhem dne<\/strong> ani pokud pl\u00e1nujete z\u016fstat vzh\u016fru. Sp\u00e1nkov\u00fd dluh se hromad\u00ed, a\u0165 u\u017e si to uv\u011bdomujete nebo ne.<\/li>\n
            • U\u017e\u00edvejte s j\u00eddlem nebo nala\u010dno<\/strong> \u2014 j\u00eddlo odd\u00e1l\u00ed n\u00e1stup \u00fa\u010dinku o 1-2 hodiny, ale nesni\u017euje celkovou expozici. P\u016fst urychluje n\u00e1stup \u00fa\u010dinku.<\/li>\n
            • Nedr\u0165te a ned\u011blte tablety, pokud to nen\u00ed p\u0159edeps\u00e1no<\/strong> \u2014 tyto tablety nejsou ur\u010deny k d\u011blen\u00ed v l\u00e9k\u00e1rn\u00e1ch. Pokud je pot\u0159eba ni\u017e\u0161\u00ed d\u00e1vka, pora\u010fte se s l\u00e9ka\u0159em o tablet\u011b s vhodnou silou.<\/li>\n
            • Nekombinujte s jin\u00fdmi stimulanty<\/strong> (amfetaminy, methylfenid\u00e1t, vysok\u00e9 d\u00e1vky kofeinu) bez l\u00e9ka\u0159sk\u00e9ho dohledu \u2014 zvy\u0161uje se riziko kardiovaskul\u00e1rn\u00edch a psychiatrick\u00fdch \u00fa\u010dink\u016f.<\/li>\n<\/ul>\n

              D\u00e9lka l\u00e9\u010dby<\/h3>\n

              P\u0159i narkolepsii je Artvigil typicky dlouhodob\u00e1 denn\u00ed l\u00e9\u010dba<\/strong>, u\u017e\u00edv\u00e1n dlouhodob\u011b podle klinick\u00e9 pot\u0159eby. P\u0159i pr\u00e1ci na sm\u011bny se u\u017e\u00edv\u00e1 po dobu trv\u00e1n\u00ed tohoto re\u017eimu; po ukon\u010den\u00ed nen\u00ed nutn\u00e9 d\u00e1vkov\u00e1n\u00ed postupn\u011b sni\u017eovat. P\u0159i obstruk\u010dn\u00ed sp\u00e1nkov\u00e9 apnoi je dopl\u0148kem k l\u00e9\u010db\u011b d\u00fdchac\u00edch cest; pokud tato l\u00e9\u010dba normalizuje ospalost, lze Artvigil vysadit. P\u0159i mimol\u00e9ka\u0159sk\u00e9m nebo ob\u010dasn\u00e9m u\u017e\u00edv\u00e1n\u00ed by m\u011bl b\u00fdt u\u017e\u00edv\u00e1n st\u0159\u00eddm\u011b a pouze pod l\u00e9ka\u0159sk\u00fdm dohledem.<\/p>\n

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

              \u010cast\u00e9 (>5 % u\u017eivatel\u016f)<\/h3>\n
                \n
              • Bolest hlavy<\/strong> \u2014 nej\u010dast\u011bj\u0161\u00ed; obvykle m\u00edrn\u00e9, \u010dasto reaguje na hydrataci a paracetamol<\/li>\n
              • Nevolnost<\/strong>, m\u00edrn\u00e9 za\u017e\u00edvac\u00ed pot\u00ed\u017ee<\/li>\n
              • Nespavost nebo opo\u017ed\u011bn\u00fd n\u00e1stup sp\u00e1nku<\/strong> \u2014 pokud je d\u00e1vkov\u00e1n\u00ed p\u0159\u00edli\u0161 pozdn\u00ed<\/li>\n
              • \u00dazkost, nervozita<\/strong> \u2014 zejm\u00e9na v prvn\u00edm t\u00fddnu<\/li>\n
              • Z\u00e1vrat\u011b<\/strong><\/li>\n
              • Sucho v \u00fastech, sn\u00ed\u017een\u00e1 chu\u0165 k j\u00eddlu<\/strong><\/li>\n
              • Rinitida, faryngitida<\/strong> \u2014 hl\u00e1\u0161eno v klinick\u00fdch studi\u00edch<\/li>\n<\/ul>\n

                M\u00e9n\u011b \u010dast\u00e9 (1-5 %)<\/h3>\n
                  \n
                • Palpitace, tachykardie, m\u00edrn\u00e1 hypertenze \u2014 sledujte krevn\u00ed tlak, zejm\u00e9na p\u0159i p\u0159edchoz\u00edm kardiovaskul\u00e1rn\u00edm onemocn\u011bn\u00ed<\/li>\n
                • Pr\u016fjem, dyspepsie<\/li>\n
                • Bolest na hrudi (obvykle nekardi\u00e1ln\u00edho p\u016fvodu) \u2014 vyhodno\u0165te jakoukoli p\u0159etrv\u00e1vaj\u00edc\u00ed nebo n\u00e1mahovou bolest na hrudi<\/li>\n
                • Bolesti zad, muskuloskelet\u00e1ln\u00ed bolesti<\/li>\n
                • Parest\u00e9zie<\/li>\n<\/ul>\n

                  Vz\u00e1cn\u00e9, ale z\u00e1va\u017en\u00e9 \u2014 OKAM\u017dIT\u011a P\u0158ERU\u0160TE l\u00e9\u010dbu a vyhledejte neodkladnou l\u00e9ka\u0159skou pomoc<\/h3>\n
                    \n
                  • Z\u00e1va\u017en\u00e9 ko\u017en\u00ed reakce<\/strong> \u2014 Stevens-Johnsonova syndromu (SJS)<\/strong>, toxick\u00e9 epiderm\u00e1ln\u00ed nekrol\u00fdzy (TEN)<\/strong>, l\u00e9kov\u00e1 reakce s eozinofili\u00ed a syst\u00e9mov\u00fdmi p\u0159\u00edznaky (DRESS)<\/strong>. Tyto reakce jsou vz\u00e1cn\u00e9 (odhaduje se 1 z ~5 000 u\u017eivatel\u016f), ale mohou b\u00fdt fat\u00e1ln\u00ed. P\u0159\u00edznaky: jak\u00e1koli vyr\u00e1\u017eka, hore\u010dka, pocit podobn\u00fd ch\u0159ipce, puch\u00fd\u0159e, posti\u017een\u00ed sliznic (\u00fasta, o\u010di, genit\u00e1lie). P\u0159i jak\u00e9koli vyr\u00e1\u017ece okam\u017eit\u011b p\u0159eru\u0161te pod\u00e1v\u00e1n\u00ed l\u00e9ku a vyhledejte neodkladnou l\u00e9ka\u0159skou pomoc<\/strong> \u2014 ne\u010dekejte, zda se stav zhor\u0161\u00ed. FDA v\u00fdslovn\u011b varovala p\u0159ed pou\u017eit\u00edm u d\u011bt\u00ed kv\u016fli p\u0159\u00edpad\u016fm SJS u d\u011bt\u00ed.<\/li>\n
                  • Z\u00e1va\u017en\u00e9 psychiatrick\u00e9 reakce<\/strong> \u2014 m\u00e1nie, hypom\u00e1nie, psych\u00f3za, sebevra\u017eedn\u00e9 my\u0161lenky, agrese<\/strong>. Vy\u0161\u0161\u00ed riziko u pacient\u016f s anamn\u00e9zou bipol\u00e1rn\u00ed poruchy, psych\u00f3zy nebo p\u0159edchoz\u00edch podobn\u00fdch reakc\u00ed na stimulanty.<\/li>\n
                  • Angioed\u00e9m<\/strong> nebo anafylaxe \u2014 vz\u00e1cn\u00e9.<\/li>\n
                  • Z\u00e1va\u017en\u00e9 kardiovaskul\u00e1rn\u00ed p\u0159\u00edhody<\/strong> (arytmie, infarkt myokardu) \u2014 vz\u00e1cn\u00e9 p\u0159i terapeutick\u00fdch d\u00e1vk\u00e1ch; vy\u0161\u0161\u00ed riziko u pacient\u016f s preexistuj\u00edc\u00edm struktur\u00e1ln\u00edm onemocn\u011bn\u00edm srdce, t\u011b\u017ekou hypertenz\u00ed nebo v kombinaci s jin\u00fdmi stimulanty.<\/li>\n<\/ul>\n

                    Kontraindikace a varov\u00e1n\u00ed<\/h2>\n
                      \n
                    • Zn\u00e1m\u00e1 p\u0159ecitliv\u011blost na armodafinil, druh\u00fd enantiomer (modafinil) nebo jakoukoli pomocnou l\u00e1tku<\/li>\n
                    • Anamn\u00e9za z\u00e1va\u017en\u00e9 ko\u017en\u00ed reakce<\/strong> (SJS, TEN, DRESS) s armodafinilem nebo modafinilem\/armodafinilem \u2014 absolutn\u00ed<\/li>\n
                    • Anamn\u00e9za m\u00e1nie, psych\u00f3zy nebo t\u011b\u017ek\u00e9 bipol\u00e1rn\u00ed poruchy<\/strong> \u2014 relativn\u00ed kontraindikace; rozhodnut\u00ed specialisty<\/li>\n
                    • Nestabiln\u00ed angina pectoris, ned\u00e1vn\u00fd infarkt myokardu<\/strong>, t\u011b\u017ek\u00e1 nekontrolovan\u00e1 hypertenze, t\u011b\u017ek\u00e1 hypertrofie lev\u00e9 komory, prolaps mitr\u00e1ln\u00ed chlopn\u011b s bolest\u00ed na hrudi vyvolanou stimulanty \u2014 vyvarujte se nebo rozhodnut\u00ed kardiologa<\/li>\n
                    • T\u011bhotenstv\u00ed (kategorie C)<\/strong> \u2014 teratogenn\u00ed v pokusech na hlodavc\u00edch; lidsk\u00e9 kazuistiky nazna\u010duj\u00ed zv\u00fd\u0161en\u00e9 riziko vrozen\u00fdch srde\u010dn\u00edch vad a hypospadie. Vyvarujte se v t\u011bhotenstv\u00ed<\/strong>. B\u011bhem l\u00e9\u010dby a 1 m\u011bs\u00edc po posledn\u00ed d\u00e1vce je povinn\u00e1 \u00fa\u010dinn\u00e1 nehormon\u00e1ln\u00ed antikoncepce (viz n\u00ed\u017ee).<\/li>\n
                    • Kojen\u00ed<\/strong> \u2014 omezen\u00e1 data; vylu\u010dov\u00e1no do ml\u00e9ka hlodavc\u016f; obecn\u011b se vyh\u00fdb\u00e1 p\u0159i kojen\u00ed<\/li>\n
                    • Pou\u017eit\u00ed u d\u011bt\u00ed<\/strong> \u2014 neschv\u00e1leno FDA; specificky varov\u00e1no kv\u016fli p\u0159\u00edpad\u016fm SJS u d\u011bt\u00ed v postmarketingov\u00e9m sledov\u00e1n\u00ed 2006-2007<\/li>\n
                    • T\u011b\u017ek\u00e9 jatern\u00ed po\u0161kozen\u00ed<\/strong> \u2014 sn\u00ed\u017eit d\u00e1vku o 50 %<\/li>\n
                    • Historie poruchy u\u017e\u00edv\u00e1n\u00ed n\u00e1vykov\u00fdch l\u00e1tek, zejm\u00e9na stimulant\u016f<\/strong> \u2014 pou\u017e\u00edvat opatrn\u011b pod dohledem; potenci\u00e1l zneu\u017eit\u00ed je n\u00edzk\u00fd, ale nenulov\u00fd<\/li>\n<\/ul>\n

                      Kritick\u00e1 interakce \u2014 Hormon\u00e1ln\u00ed antikoncepce<\/h2>\n
                      \n\u26a0 KRITICK\u00c9:<\/strong> Armodafinil je induktor CYP3A4<\/strong> kter\u00e1 v\u00fdznamn\u011b sni\u017euje \u00fa\u010dinnost hormon\u00e1ln\u00ed antikoncepce<\/strong> \u2014 kombinovan\u00e9 peror\u00e1ln\u00ed antikoncepce, progestinov\u00e9 pilulky, kombinovan\u00e9 hormon\u00e1ln\u00ed n\u00e1plasti, vagin\u00e1ln\u00ed krou\u017eky, hormon\u00e1ln\u00ed nitrod\u011blo\u017en\u00ed t\u011bl\u00edska (Mirena, Skyla, Liletta, Kyleena), antikoncep\u010dn\u00ed implant\u00e1ty (Nexplanon) a hormon\u00e1ln\u00ed nouzov\u00e1 antikoncepce (Plan B, ella).\n<\/div>\n

                      \u017deny v reproduk\u010dn\u00edm v\u011bku mus\u00ed pou\u017e\u00edvat nehormon\u00e1ln\u00ed z\u00e1lo\u017en\u00ed antikoncepci<\/strong> b\u011bhem l\u00e9\u010dby p\u0159\u00edpravkem Artvigil a po dobu nejm\u00e9n\u011b 1 m\u011bs\u00edce po posledn\u00ed d\u00e1vce<\/strong> (pro zaji\u0161t\u011bn\u00ed \u00fapln\u00e9ho vymizen\u00ed indukce CYP3A4):<\/p>\n

                        \n
                      • Kondomy (mu\u017esk\u00e9 nebo \u017eensk\u00e9)<\/strong> \u2014 nejjednodu\u0161\u0161\u00ed spolehliv\u00e1 z\u00e1loha<\/li>\n
                      • M\u011bd\u011bn\u00e9 nitrod\u011blo\u017en\u00ed t\u011bl\u00edsko (ParaGard, m\u011bd\u011bn\u00e9 T)<\/strong> \u2014 nehormon\u00e1ln\u00ed, nen\u00ed ovlivn\u011bno indukc\u00ed CYP3A4<\/li>\n
                      • Abstinence<\/strong><\/li>\n
                      • Chirurgick\u00e1 sterilizace (podv\u00e1z\u00e1n\u00ed vejcovod\u016f, vasektomie u partnera)<\/li>\n<\/ul>\n

                        Hormon\u00e1ln\u00ed antikoncepce samotn\u00e1 NEN\u00cd p\u0159i u\u017e\u00edv\u00e1n\u00ed armodafinilu spolehliv\u00e1.<\/strong> Tato interakce ji\u017e zp\u016fsobila skute\u010dn\u00e9 selh\u00e1n\u00ed antikoncepce a nepl\u00e1novan\u00e1 t\u011bhotenstv\u00ed; vzhledem k riziku t\u011bhotenstv\u00ed p\u0159i u\u017e\u00edv\u00e1n\u00ed armodafinilu jde o obzvl\u00e1\u0161t\u011b z\u00e1va\u017en\u00e9 situace. Pokud se b\u011bhem l\u00e9\u010dby objev\u00ed p\u0159\u00edznaky t\u011bhotenstv\u00ed, okam\u017eit\u011b prove\u010fte test.<\/p>\n

                        Interakce s dal\u0161\u00edmi l\u00e9ky<\/h2>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
                        T\u0159\u00edda l\u00e9\u010div<\/th>\n\u00da\u010dinek<\/th>\n<\/tr>\n<\/thead>\n
                        Jin\u00e9 stimulanty<\/strong> (amfetaminy, methylfenid\u00e1t, vysok\u00e9 d\u00e1vky kofeinu, kokain)<\/td>\nAditivn\u00ed kardiovaskul\u00e1rn\u00ed (tachykardie, hypertenze) a psychiatrick\u00e9 (\u00fazkost, m\u00e1nie) \u00fa\u010dinky. Vyhn\u011bte se nebo kombinujte pouze pod odborn\u00fdm dohledem.<\/td>\n<\/tr>\n
                        MAOI<\/strong><\/td>\nVyhn\u011bte se \u2014 riziko hypertenzn\u00ed krize<\/td>\n<\/tr>\n
                        Warfarin<\/strong><\/td>\nM\u00edrn\u00e1 inhibice CYP2C9 \u2014 v prvn\u00edch 2-4 t\u00fddnech u\u017e\u00edv\u00e1n\u00ed armodafinilu \u010dast\u011bji monitorujte INR<\/td>\n<\/tr>\n
                        Cyklosporin, takrolimus, sirolimus<\/strong><\/td>\nSn\u00ed\u017een\u00e9 hladiny v d\u016fsledku indukce CYP3A4 \u2014 nezbytn\u00e9 monitorov\u00e1n\u00ed po transplantaci<\/td>\n<\/tr>\n
                        Prote\u00e1zov\u00e9 inhibitory (HIV)<\/strong>, mnoho antiepileptik<\/td>\nObousm\u011brn\u00e9 \u00fa\u010dinky prost\u0159ednictv\u00edm CYP3A4; vy\u017eaduje odborn\u00e9 poradenstv\u00ed<\/td>\n<\/tr>\n
                        Tricyklick\u00e1 antidepresiva<\/strong><\/td>\nMo\u017en\u00e9 zv\u00fd\u0161en\u00ed \u00fa\u010dinku inhibic\u00ed CYP2C19; klinicky sledujte<\/td>\n<\/tr>\n
                        SSRI\/SNRI<\/strong><\/td>\nObecn\u011b zvl\u00e1dnuteln\u00e9; sledujte serotoninergn\u00ed ne\u017e\u00e1douc\u00ed \u00fa\u010dinky<\/td>\n<\/tr>\n
                        Fenytoin, karbamazepin, fenobarbital<\/strong><\/td>\nSn\u00ed\u017een\u00ed hladin armodafinilu indukc\u00ed CYP3A4 \u2014 m\u016f\u017ee b\u00fdt nutn\u00e9 zv\u00fd\u0161it d\u00e1vku<\/td>\n<\/tr>\n
                        Klopidogrel<\/strong><\/td>\nSn\u00ed\u017een\u00e1 aktivace inhibic\u00ed CYP2C19 \u2014 mo\u017en\u00e9 sn\u00ed\u017een\u00ed antiagrega\u010dn\u00edho \u00fa\u010dinku<\/td>\n<\/tr>\n
                        Alkohol<\/strong><\/td>\nAlkohol m\u016f\u017ee odd\u00e1lit nebo maskovat pocit ospalosti. B\u011bhem u\u017e\u00edv\u00e1n\u00ed armodafinilu se vyhn\u011bte nadm\u011brn\u00e9 konzumaci alkoholu.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

                        Artvigil vs jin\u00e9 zna\u010dky armodafinilu<\/h2>\n

                        Artvigil je jedn\u00edm z n\u011bkolika generick\u00fdch p\u0159\u00edpravk\u016f armodafinilu 150 mg. V\u0161echny obsahuj\u00ed stejnou \u00fa\u010dinnou l\u00e1tku ve stejn\u00e9 s\u00edle; praktick\u00e9 rozd\u00edly jsou v reputaci v\u00fdrobce, slo\u017een\u00ed pomocn\u00fdch l\u00e1tek a cen\u011b.<\/p>\n\n\n\n\n\n\n\n\n
                        Zna\u010dka<\/th>\nPozn\u00e1mky<\/th>\n<\/tr>\n<\/thead>\n
                        Artvigil (HAB Pharma)<\/strong><\/td>\nGenerick\u00fd armodafinil 150 mg. Stejn\u00fd obsah \u00fa\u010dinn\u00e9 l\u00e1tky jako Waklert a Nuvigil; preferov\u00e1n u\u017eivateli hledaj\u00edc\u00edmi cenov\u011b v\u00fdhodn\u00fd R-enantiomer.<\/td>\n<\/tr>\n
                        Waklert (Sun Pharma)<\/td>\nDal\u0161\u00ed v\u00fdznamn\u00fd generick\u00fd armodafinil. Stejn\u00e1 \u00fa\u010dinn\u00e1 l\u00e1tka, m\u00edrn\u011b odli\u0161n\u00e9 slo\u017een\u00ed pomocn\u00fdch l\u00e1tek.<\/td>\n<\/tr>\n
                        Armodapro (Healing Pharma)<\/td>\nT\u0159et\u00ed v\u00fdznamn\u00fd generick\u00fd armodafinil. Ekvivalentn\u00ed obsah \u00fa\u010dinn\u00e9 l\u00e1tky.<\/td>\n<\/tr>\n
                        Nuvigil (Teva \/ Cephalon)<\/td>\nOrigin\u00e1ln\u00ed zna\u010dkov\u00fd armodafinil, schv\u00e1len\u00fd FDA v roce 2007. Stejn\u00e1 \u00fa\u010dinn\u00e1 l\u00e1tka. V\u00fdrazn\u011b vy\u0161\u0161\u00ed maloobchodn\u00ed cena.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

                        Proto\u017ee v\u0161echny tablety armodafinilu 150 mg obsahuj\u00ed stejnou \u00fa\u010dinnou l\u00e1tku, klinick\u00fd efekt je identick\u00fd. Individu\u00e1ln\u00ed zpr\u00e1vy o tom, \u017ee \u201ctato zna\u010dka p\u016fsob\u00ed jinak ne\u017e ta zna\u010dka\u201d, t\u00e9m\u011b\u0159 v\u017edy odr\u00e1\u017eej\u00ed variabilitu \u0161ar\u017ee, citlivost na pomocn\u00e9 l\u00e1tky nebo o\u010dek\u00e1v\u00e1n\u00ed sp\u00ed\u0161e ne\u017e farmakologick\u00fd rozd\u00edl. Pokud m\u00e1te prok\u00e1zanou p\u0159ecitliv\u011blost na konkr\u00e9tn\u00ed pomocnou l\u00e1tku, stoj\u00ed za to ji sledovat \u2014 jinak je volba zna\u010dky ot\u00e1zkou n\u00e1klad\u016f a dostupnosti.<\/p>\n

                        Armodafinil vs Modafinil \u2014 Kter\u00fd si vybrat?<\/h2>\n

                        Farmakologick\u00e9 rozd\u00edly mezi armodafinilem a modafinilem jsou nepatrn\u00e9; tyto dva l\u00e9ky jsou \u010dasto zam\u011bniteln\u00e9 pro stejn\u00e9 klinick\u00e9 indikace. Praktick\u00e9 rozd\u00edly, kter\u00e9 ovliv\u0148uj\u00ed volbu:<\/p>\n