{"id":66707,"date":"2025-05-01T13:49:54","date_gmt":"2025-05-01T13:49:54","guid":{"rendered":"https:\/\/medsbase.com\/?post_type=product&#038;p=66707"},"modified":"2026-04-30T10:23:27","modified_gmt":"2026-04-30T10:23:27","slug":"tofe","status":"publish","type":"product","link":"https:\/\/medsbase.com\/cs\/product\/tofe\/","title":{"rendered":"Tofe"},"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 Tofe?<\/h3>\n<p style=\"margin:0;\"><strong>Tofe<\/strong> je peror\u00e1ln\u00ed tableta od spole\u010dnosti Intas Pharmaceuticals obsahuj\u00edc\u00ed <strong>tofacitinib<\/strong> \u2014 peror\u00e1ln\u00ed <strong>inhibitor Janus kin\u00e1zy (JAK)<\/strong> kter\u00fd blokuje intracelul\u00e1rn\u00ed cytokinovou signalizaci p\u0159es JAK1 a JAK3 (s \u010d\u00e1ste\u010dnou aktivitou JAK2). Dostupn\u00e9 v d\u00e1vkov\u00e1n\u00ed <strong>5 mg<\/strong>. Standardn\u00ed d\u00e1vka: <strong>5 mg dvakr\u00e1t denn\u011b (nebo 11 mg jednou denn\u011b v prodlou\u017een\u00e9 form\u011b)<\/strong>. Pou\u017e\u00edv\u00e1 se na <strong>st\u0159edn\u011b t\u011b\u017ek\u00e9 a\u017e t\u011b\u017ek\u00e9 revmatoidn\u00ed artritidy<\/strong> a n\u011bkolik dal\u0161\u00edch autoimunitn\u00edch stav\u016f po selh\u00e1n\u00ed konven\u010dn\u00edch DMARDs. <strong>Nese \u010dern\u00e9 varov\u00e1n\u00ed FDA<\/strong> pro z\u00e1va\u017en\u00e9 infekce, z\u00e1va\u017en\u00e9 ne\u017e\u00e1douc\u00ed kardiovaskul\u00e1rn\u00ed p\u0159\u00edhody (MACE), tromb\u00f3zu a malignitu \u2014 zejm\u00e9na u pacient\u016f nad 50 let s alespo\u0148 jedn\u00edm kardiovaskul\u00e1rn\u00edm rizikov\u00fdm faktorem. <strong>Povinn\u00e9 p\u0159edl\u00e9\u010debn\u00e9 vy\u0161et\u0159en\u00ed: latentn\u00ed TBC, hepatitida B, hepatitida C, CBC s diferenci\u00e1lem, jatern\u00ed testy, lipidov\u00fd panel a status varicella-zoster.<\/strong> Nen\u00ed l\u00e9kem prvn\u00ed volby \u2014 vyhrazeno pro pacienty, u kter\u00fdch selhal methotrex\u00e1t nebo biologick\u00e9 DMARDs.<\/p>\n<\/div>\n<p><!-- medsbase-specialist-strip --><\/p>\n<div style=\"background:#fff3f3;border-left:4px solid #d9534f;padding:16px 20px;margin:0 0 24px 0;border-radius:4px;font-size:14px;\"><strong>\u2695 L\u00e9k vy\u017eaduj\u00edc\u00ed odborn\u00fd dohled \u2014 nutn\u00fd klinick\u00fd dohled.<\/strong> Toto je z\u00e1va\u017en\u00fd imunomodula\u010dn\u00ed l\u00e9k se specifick\u00fdmi po\u017eadavky na p\u0159edl\u00e9\u010debn\u00e9 vy\u0161et\u0159en\u00ed, \u010dern\u00fdmi v\u00fdstrahami a povinn\u00fdm laboratorn\u00edm monitorov\u00e1n\u00edm. M\u011bl by b\u00fdt p\u0159edepisov\u00e1n a sledov\u00e1n revmatologem, gastroenterologem, dermatologem nebo jin\u00fdm odborn\u00edkem zku\u0161en\u00fdm s jeho u\u017e\u00edv\u00e1n\u00edm. Ne <strong>ne<\/strong> p\u0159edepisujte si ho sami, neupravujte d\u00e1vku ani neza\u010d\u00ednejte\/nep\u0159est\u00e1vejte bez pokyn\u016f p\u0159edepisuj\u00edc\u00edho l\u00e9ka\u0159e. V\u017edy poskytn\u011bte sv\u00e9mu o\u0161et\u0159uj\u00edc\u00edmu l\u00e9ka\u0159i aktu\u00e1ln\u00ed p\u0159edpis p\u0159ed objedn\u00e1n\u00edm z MedsBase.<\/div>\n<div class=\"medsbase-trust-strip\" style=\"background:#f4f6f8;border:1px solid #e1e4e8;border-radius:4px;padding:14px 18px;margin:18px 0;display:flex;flex-wrap:wrap;gap:14px;font-size:0.95em;\"><span>\u2705 <strong>WHO-GMP certifikov\u00e1no<\/strong> v\u00fdrobce<\/span><span>\ud83d\udce6 <strong>Diskr\u00e9tn\u00ed balen\u00ed<\/strong><\/span><span>\ud83c\udf0d <strong>Dod\u00e1n\u00ed po cel\u00e9m sv\u011bt\u011b<\/strong><\/span><span>\ud83d\udcac <a href=\"\/cs\/reviews\/\">1,400+ recenz\u00ed z\u00e1kazn\u00edk\u016f<\/a><\/span><\/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 Tofe?<\/h2>\n<p>Tofe je peror\u00e1ln\u00ed tableta vyr\u00e1b\u011bn\u00e1 spole\u010dnost\u00ed Intas Pharmaceuticals obsahuj\u00edc\u00ed <strong>tofacitinib<\/strong>, malou molekulu <strong>inhibitor Janus kin\u00e1zy (JAK)<\/strong>. Inhibitory JAK jsou nov\u011bj\u0161\u00ed t\u0159\u00eddou c\u00edlen\u00fdch syntetick\u00fdch chorobu modifikuj\u00edc\u00edch antirevmatik (tsDMARDs), kter\u00e9 blokuj\u00ed intracelul\u00e1rn\u00ed sign\u00e1ln\u00ed kask\u00e1du spu\u0161t\u011bnou vazbou z\u00e1n\u011btliv\u00fdch cytokin\u016f na jejich receptory na imunitn\u00edch bu\u0148k\u00e1ch.<\/p>\n<p>Tofe je generick\u00fd tofacitinib od Intasu \u2014 prvn\u00ed schv\u00e1len\u00fd peror\u00e1ln\u00ed inhibitor JAK (Xeljanz, Pfizer) s nej\u0161ir\u0161\u00edmi regula\u010dn\u00edmi indikacemi ve sv\u00e9 t\u0159\u00edd\u011b: revmatoidn\u00ed artritida, psoriatick\u00e1 artritida, ankylozuj\u00edc\u00ed spondylitida, ulcer\u00f3zn\u00ed kolitida a polyartikul\u00e1rn\u00ed juveniln\u00ed idiopatick\u00e1 artritida. Na rozd\u00edl od star\u0161\u00edch injek\u010dn\u00edch biologik (inhibitor\u016f TNF, inhibitor\u016f IL-6) se tofacitinib u\u017e\u00edv\u00e1 jako tableta, m\u00e1 rychl\u00fd n\u00e1stup \u00fa\u010dinku (klinick\u00e9 zlep\u0161en\u00ed do 2\u20134 t\u00fddn\u016f) a p\u016fsob\u00ed na jin\u00e9 molekul\u00e1rn\u00ed dr\u00e1ze \u2014 co\u017e z n\u011bj \u010din\u00ed u\u017eite\u010dnou mo\u017enost pro pacienty, u kter\u00fdch selhala konven\u010dn\u00ed DMARDs nebo jedna \u010di v\u00edce biologik. Kl\u00ed\u010dov\u00e9 studie: ORAL Standard, ORAL Scan, ORAL Start (revmatoidn\u00ed artritida), OCTAVE Induction\/Sustain (ulcer\u00f3zn\u00ed kolitida) a OPAL Broaden\/Beyond (psoriatick\u00e1 artritida).<\/p>\n<h2 class=\"wp-block-heading\">Jak Tofe funguje?<\/h2>\n<p>Mnoho z\u00e1n\u011btliv\u00fdch cytokin\u016f (IL-6, IFN-\u03b3, GM-CSF, IL-2, IL-4, IL-15, IL-21 a dal\u0161\u00ed) signalizuje uvnit\u0159 bun\u011bk aktivac\u00ed <strong>JAK-STAT dr\u00e1hy<\/strong>. Kdy\u017e cytokin nav\u00e1\u017ee sv\u016fj receptor, JAK enzymy fosforyluj\u00ed STAT proteiny, kter\u00e9 se pak p\u0159esunou do j\u00e1dra a zapnou geny, kter\u00e9 spou\u0161t\u011bj\u00ed z\u00e1n\u011bt, aktivaci T-bun\u011bk a proliferaci synovie.<\/p>\n<ul>\n<li><strong>Tofacitinib blokuje JAK1 a JAK3 (s \u010d\u00e1ste\u010dnou aktivitou JAK2)<\/strong> uvnit\u0159 bu\u0148ky, \u010d\u00edm\u017e sou\u010dasn\u011b p\u0159eru\u0161uje signalizaci pro v\u00edce z\u00e1n\u011btliv\u00fdch cytokin\u016f.<\/li>\n<li><strong>\u0160irok\u00fd \u00fa\u010dinek na cytokinovou signalizaci<\/strong> \u2014 proto\u017ee v\u00edce cytokinov\u00fdch receptor\u016f vyu\u017e\u00edv\u00e1 JAK1\/JAK2\/JAK3\/TYK2 v r\u016fzn\u00fdch kombinac\u00edch, jedin\u00fd inhibitor JAK tlum\u00ed mnoho z\u00e1n\u011btliv\u00fdch drah najednou. To p\u0159in\u00e1\u0161\u00ed rychl\u00fd klinick\u00fd benefit, ale tak\u00e9 vysv\u011btluje sign\u00e1ly zv\u00fd\u0161en\u00e9ho rizika infekc\u00ed a malignit.<\/li>\n<li><strong>Reverzibiln\u00ed inhibice<\/strong> \u2014 \u00fa\u010dinky ustupuj\u00ed do 1\u20132 dn\u016f po vysazen\u00ed l\u00e9ku. U\u017eite\u010dn\u00e9 p\u0159ed chirurgick\u00fdm z\u00e1krokem nebo b\u011bhem infekce.<\/li>\n<\/ul>\n<p>N\u00e1stup symptomatick\u00e9ho zlep\u0161en\u00ed: \u00faleva od bolesti kloub\u016f ji\u017e za <strong>2\u20134 t\u00fddn\u016f<\/strong>; vrchol klinick\u00e9 odpov\u011bdi nast\u00e1v\u00e1 za 3\u20136 m\u011bs\u00edc\u016f. Zpomalen\u00ed radiografick\u00e9ho po\u0161kozen\u00ed kloub\u016f vy\u017eaduje 12 m\u011bs\u00edc\u016f pravideln\u00e9ho u\u017e\u00edv\u00e1n\u00ed, aby bylo prokazateln\u00e9.<\/p>\n<h2 class=\"wp-block-heading\">Pou\u017eit\u00ed a indikace<\/h2>\n<ul>\n<li><strong>St\u0159edn\u011b t\u011b\u017ek\u00e1 a\u017e t\u011b\u017ek\u00e1 revmatoidn\u00ed artritida<\/strong> \u2014 po nedostate\u010dn\u00e9 odpov\u011bdi na metotrex\u00e1t nebo jin\u00e9 DMARDs<\/li>\n<li><strong>St\u0159edn\u011b t\u011b\u017ek\u00e1 a\u017e t\u011b\u017ek\u00e1 ulcer\u00f3zn\u00ed kolitida<\/strong> \u2014 po selh\u00e1n\u00ed konven\u010dn\u00ed a biologick\u00e9 l\u00e9\u010dby<\/li>\n<li><strong>Psoriatick\u00e1 artritida<\/strong> \u2014 po nedostate\u010dn\u00e9 odpov\u011bdi na DMARDs<\/li>\n<li><strong>Ankylozuj\u00edc\u00ed spondylitida<\/strong> \u2014 po nedostate\u010dn\u00e9 odpov\u011bdi na inhibitory TNF<\/li>\n<li><strong>Polyartikul\u00e1rn\u00ed juveniln\u00ed idiopatick\u00e1 artritida<\/strong> (v\u011bk 2+)<\/li>\n<\/ul>\n<p>Tofe je <strong>ne<\/strong> l\u00e9\u010dbou prvn\u00ed volby u \u017e\u00e1dn\u00e9ho z t\u011bchto stav\u016f. Je vyhrazen pro pacienty, u kter\u00fdch selhala (nebo kte\u0159\u00ed nesnesou) <strong>methotrex\u00e1t<\/strong> a podle sou\u010dasn\u00fdch doporu\u010den\u00ed FDA ide\u00e1ln\u011b tak\u00e9 <strong>inhibitor TNF<\/strong> p\u0159ed zah\u00e1jen\u00edm l\u00e9\u010dby inhibitorem JAK \u2014 zejm\u00e9na u pacient\u016f star\u0161\u00edch 50 let s jedn\u00edm nebo v\u00edce kardiovaskul\u00e1rn\u00edmi rizikov\u00fdmi faktory, kde studie ORAL Surveillance prok\u00e1zala vy\u0161\u0161\u00ed v\u00fdskyt MACE a malignit ve srovn\u00e1n\u00ed s TNFi.<\/p>\n<h2 class=\"wp-block-heading\">P\u0159ed zah\u00e1jen\u00edm l\u00e9\u010dby p\u0159\u00edpravkem Tofe \u2014 povinn\u00e9 vy\u0161et\u0159en\u00ed<\/h2>\n<p>Ka\u017ed\u00fd pacient mus\u00ed p\u0159ed pod\u00e1n\u00edm prvn\u00ed d\u00e1vky absolvovat tato vy\u0161et\u0159en\u00ed. Jejich vynech\u00e1n\u00ed je nej\u010dast\u011bj\u0161\u00ed p\u0159\u00ed\u010dinou z\u00e1va\u017en\u00fdch ne\u017e\u00e1douc\u00edch \u00fa\u010dink\u016f u inhibitor\u016f JAK.<\/p>\n<ul>\n<li><strong>Vy\u0161et\u0159en\u00ed na latentn\u00ed tuberkul\u00f3zu<\/strong> \u2014 test QuantiFERON-TB Gold nebo T-SPOT (preferovan\u00fd) nebo tuberkulinov\u00fd ko\u017en\u00ed test. Inhibice JAK reaktivuje latentn\u00ed TB p\u0159ibli\u017en\u011b u 1 % pacient\u016f. P\u0159i pozitivn\u00edm v\u00fdsledku dokon\u010dit alespo\u0148 1 m\u011bs\u00edc l\u00e9\u010dby isoniazidem (nebo ekvivalentem) p\u0159ed zah\u00e1jen\u00edm l\u00e9\u010dby.<\/li>\n<li><strong>Hepatitida B<\/strong> \u2014 HBsAg, anti-HBc, anti-HBs. U chronick\u00e9 HBV pozitivity je nutn\u00fd dohled hepatologa a antivirov\u00e1 profylaxe (entecavir nebo tenofovir) po dobu l\u00e9\u010dby inhibitorem JAK.<\/li>\n<li><strong>Hepatitida C<\/strong> \u2014 anti-HCV, p\u0159i pozitivn\u00edm v\u00fdsledku potvrdit HCV RNA. P\u0159i p\u0159\u00edtomnosti HCV nejprve l\u00e9\u010dit HCV.<\/li>\n<li><strong>HIV status<\/strong> \u2014 nen\u00ed absolutn\u00ed kontraindikac\u00ed, ale vy\u017eaduje konzultaci se specialistou.<\/li>\n<li><strong>Kompletn\u00ed krevn\u00ed obraz s diferenci\u00e1lem<\/strong> \u2014 neza\u010d\u00ednejte, pokud ANC &lt; 1,0 \u00d7 10\u2079\/l, ALC &lt; 0,5 \u00d7 10\u2079\/l nebo hemoglobin &lt; 9 g\/dl.<\/li>\n<li><strong>Funkce jater<\/strong> \u2014 neza\u010d\u00ednejte, pokud ALT\/AST &gt; 3\u00d7 horn\u00ed hranice norm\u00e1lu.<\/li>\n<li><strong>Funkce ledvin<\/strong> \u2014 eGFR ur\u010duje d\u00e1vkov\u00e1n\u00ed.<\/li>\n<li><strong>Lipidov\u00fd panel<\/strong> \u2014 z\u00e1kladn\u00ed hodnoty celkov\u00e9ho cholesterolu, LDL, HDL, triglycerid\u016f. Inhibitory JAK zvy\u0161uj\u00ed lipidy; opakujte za 8 t\u00fddn\u016f a pot\u00e9 ro\u010dn\u011b.<\/li>\n<li><strong>T\u011bhotensk\u00fd test<\/strong> u \u017een v reproduk\u010dn\u00edm v\u011bku. B\u011bhem l\u00e9\u010dby a p\u0159ibli\u017en\u011b 1 t\u00fdden po posledn\u00ed d\u00e1vce je nutn\u00e1 \u00fa\u010dinn\u00e1 antikoncepce.<\/li>\n<li><strong>Stav varicella-zoster<\/strong> \u2014 anamn\u00e9za plan\u00fdch ne\u0161tovic nebo s\u00e9rologie VZV. Pokud je s\u00e9rologie negativn\u00ed, o\u010dkujte vakc\u00ednou proti plan\u00fdm ne\u0161tovic\u00edm alespo\u0148 4 t\u00fddny p\u0159ed zah\u00e1jen\u00edm l\u00e9\u010dby JAK inhibitory.<\/li>\n<li><strong>P\u0159ehled o\u010dkov\u00e1n\u00ed<\/strong> \u2014 aktualizujte v\u0161echny <em>inaktivovan\u00e9<\/em> vakc\u00edny (proti ch\u0159ipce, pneumokok\u016fm, COVID-19, HPV, p\u00e1sov\u00e9mu oparu rekombinantn\u00ed Shingrix). <strong>\u017div\u00e9 vakc\u00edny jsou b\u011bhem l\u00e9\u010dby kontraindikov\u00e1ny<\/strong> \u2014 podat alespo\u0148 4 t\u00fddny p\u0159ed zah\u00e1jen\u00edm.<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">D\u00e1vkov\u00e1n\u00ed p\u0159\u00edpravku Tofe a zp\u016fsob u\u017e\u00edv\u00e1n\u00ed<\/h2>\n<p>Tofe je dod\u00e1v\u00e1n v <strong>5 mg<\/strong>. D\u00e1vkov\u00e1n\u00ed z\u00e1vis\u00ed na indikaci, ren\u00e1ln\u00ed funkci a sou\u010dasn\u011b u\u017e\u00edvan\u00fdch l\u00e9c\u00edch.<\/p>\n<ul>\n<li><strong>Revmatoidn\u00ed artritida, psoriatick\u00e1 artritida, ankylozuj\u00edc\u00ed spondylitida:<\/strong> 5 mg dvakr\u00e1t denn\u011b NEBO 11 mg s prodlou\u017een\u00fdm uvol\u0148ov\u00e1n\u00edm jednou denn\u011b<\/li>\n<li><strong>Indukce ulcer\u00f3zn\u00ed kolitidy (8 t\u00fddn\u016f):<\/strong> 10 mg dvakr\u00e1t denn\u011b; po dosa\u017een\u00ed remise sn\u00ed\u017eit na 5 mg dvakr\u00e1t denn\u011b jako udr\u017eovac\u00ed d\u00e1vku<\/li>\n<li><strong>Polyartikul\u00e1rn\u00ed juveniln\u00ed idiopatick\u00e1 artritida (hmotnost \u2265 40 kg):<\/strong> 5 mg dvakr\u00e1t denn\u011b<\/li>\n<li><strong>\u00daprava d\u00e1vkov\u00e1n\u00ed p\u0159i ren\u00e1ln\u00edm posti\u017een\u00ed:<\/strong> st\u0159edn\u011b t\u011b\u017ek\u00e9 a\u017e t\u011b\u017ek\u00e9 (eGFR &lt; 60 ml\/min) \u2192 5 mg JEDNOU denn\u011b; nedoporu\u010duje se p\u0159i eGFR &lt; 15<\/li>\n<li><strong>\u00daprava d\u00e1vkov\u00e1n\u00ed p\u0159i jatern\u00edm posti\u017een\u00ed:<\/strong> st\u0159edn\u011b t\u011b\u017ek\u00e9 (Child-Pugh B) \u2192 5 mg JEDNOU denn\u011b; vyvarovat se u t\u011b\u017ek\u00e9ho posti\u017een\u00ed<\/li>\n<li><strong>U\u017e\u00edv\u00e1n\u00ed s j\u00eddlem nebo nala\u010dno:<\/strong> lze u\u017e\u00edvat ob\u011bma zp\u016fsoby; u\u017e\u00edvejte v\u017edy ve stejnou dobu ka\u017ed\u00fd den<\/li>\n<\/ul>\n<h3 class=\"wp-block-heading\">Jak spr\u00e1vn\u011b u\u017e\u00edvat Tofe<\/h3>\n<ol>\n<li><strong>Nezahajujte l\u00e9\u010dbu bez p\u0159edchoz\u00edch vy\u0161et\u0159en\u00ed uveden\u00fdch v\u00fd\u0161e.<\/strong> Ka\u017ed\u00e9 vynechan\u00e9 vy\u0161et\u0159en\u00ed zvy\u0161uje riziko z\u00e1va\u017en\u00e9 p\u0159\u00edhody.<\/li>\n<li><strong>Tabletu polykejte celou a zapijte vodou<\/strong> \u2014 nedrtit, ned\u011blit ani ne\u017ev\u00fdkat. Tofacitinib s okam\u017eit\u00fdm uvol\u0148ov\u00e1n\u00edm lze rozd\u011blit, pokud je opat\u0159en r\u00fdhou; tablety s prodlou\u017een\u00fdm uvol\u0148ov\u00e1n\u00edm 11 mg se mus\u00ed polykat cel\u00e9.<\/li>\n<li><strong>Ve stejnou dobu ka\u017ed\u00fd den.<\/strong> D\u016fle\u017eit\u011bj\u0161\u00ed ne\u017e \u010dasov\u00e1n\u00ed vzhledem k j\u00eddlu je pravidelnost.<\/li>\n<li><strong>Pokud je d\u00e1vka vynech\u00e1na<\/strong>, u\u017eijte l\u00e9k co nejd\u0159\u00edve, jak si vzpomenete, je\u0161t\u011b ten sam\u00fd den. Pokud je \u010das na dal\u0161\u00ed pl\u00e1novanou d\u00e1vku, vynechejte tu zapomenutou \u2013 ned\u00e1vejte dvojn\u00e1sobnou d\u00e1vku.<\/li>\n<li><strong>Pauza p\u0159i infekc\u00edch<\/strong> \u2014 p\u0159eru\u0161te u\u017e\u00edv\u00e1n\u00ed Tofe p\u0159i prvn\u00edch zn\u00e1mk\u00e1ch z\u00e1va\u017en\u00e9 infekce (vysok\u00e1 hore\u010dka, produktivn\u00ed ka\u0161el, pyelonefritida, celulitida, p\u00e1sov\u00fd opar). Pokra\u010dujte a\u017e po vyl\u00e9\u010den\u00ed infekce a po konzultaci s p\u0159edepisuj\u00edc\u00edm l\u00e9ka\u0159em.<\/li>\n<li><strong>Pauza p\u0159ed pl\u00e1novanou operac\u00ed.<\/strong> P\u0159eru\u0161te 3\u20137 dn\u00ed (5 polo\u010das\u016f) p\u0159ed v\u011bt\u0161\u00edm chirurgick\u00fdm z\u00e1krokem; obnovte za 1\u20132 t\u00fddny po z\u00e1kroku, a\u017e se zahoj\u00ed r\u00e1na a nebude p\u0159\u00edtomna infekce.<\/li>\n<li><strong>Pr\u016fb\u011b\u017en\u00e9 laboratorn\u00ed sledov\u00e1n\u00ed<\/strong> \u2013 CBC + jatern\u00ed testy v <strong>t\u00fddnech 4, 8, 12<\/strong>, pot\u00e9 ka\u017ed\u00e9 3 m\u011bs\u00edce. Lipidov\u00fd profil p\u0159i <strong>8. t\u00fdden<\/strong>, pot\u00e9 ka\u017edoro\u010dn\u011b. Nevynechejte tyto testy.<\/li>\n<li><strong>Okam\u017eit\u011b nahlaste jak\u00fdkoli nov\u00fd ka\u0161el, hore\u010dku, no\u010dn\u00ed pocen\u00ed, nevysv\u011btliteln\u00fd \u00fabytek hmotnosti, bolest na hrudi, otoky nohou, citlivost l\u00fdtek nebo du\u0161nost<\/strong> \u2014 mohou signalizovat z\u00e1va\u017enou infekci, MACE nebo tromb\u00f3zu.<\/li>\n<li><strong>Vyhn\u011bte se \u017eiv\u00fdm vakc\u00edn\u00e1m.<\/strong> Inaktivovan\u00e9 vakc\u00edny jsou v po\u0159\u00e1dku a doporu\u010duj\u00ed se (ch\u0159ipka, pneumokokov\u00e1, Shingrix).<\/li>\n<li><strong>Denn\u00ed ochrana SPF 50 proti slunci<\/strong> \u2014 Inhibitory JAK zvy\u0161uj\u00ed riziko nemelanomov\u00e9ho karcinomu k\u016f\u017ee. Ro\u010dn\u00ed dermatologick\u00e1 kontrola je vhodn\u00e1 u pacient\u016f se sv\u011btlou plet\u00ed, p\u0159edchoz\u00edm v\u00fdskytem ko\u017en\u00edho n\u00e1doru nebo p\u0159i terapii trvaj\u00edc\u00ed d\u00e9le ne\u017e 12 m\u011bs\u00edc\u016f.<\/li>\n<\/ol>\n<h2 class=\"wp-block-heading\">Vedlej\u0161\u00ed \u00fa\u010dinky Tofe<\/h2>\n<div style=\"background:#fff3f3;border-left:4px solid #d9534f;padding:14px 18px;margin:12px 0;border-radius:4px;font-size:14px;\"><strong>\u26a0\ufe0f FDA Black-Box varov\u00e1n\u00ed.<\/strong> Na z\u00e1klad\u011b studie ORAL Surveillance (2021), kter\u00e1 srovn\u00e1vala tofacitinib s inhibitory TNF u pacient\u016f s revmatoidn\u00ed artritidou ve v\u011bku 50+ s alespo\u0148 jedn\u00edm kardiovaskul\u00e1rn\u00edm rizikov\u00fdm faktorem \u2014 a extrapolov\u00e1no na celou t\u0159\u00eddu inhibitor\u016f JAK:<\/p>\n<ul style=\"margin:8px 0 0 0;\">\n<li><strong>Z\u00e1va\u017en\u00e9 infekce<\/strong> \u2014 bakteri\u00e1ln\u00ed, pl\u00eds\u0148ov\u00e9, virov\u00e9, mykobakteri\u00e1ln\u00ed (v\u010detn\u011b reaktivace TBC), oportunn\u00ed<\/li>\n<li><strong>Z\u00e1va\u017en\u00e9 kardiovaskul\u00e1rn\u00ed p\u0159\u00edhody (MACE)<\/strong> \u2014 infarkt myokardu, c\u00e9vn\u00ed mozkov\u00e1 p\u0159\u00edhoda, kardiovaskul\u00e1rn\u00ed \u00famrt\u00ed, ve vy\u0161\u0161\u00ed m\u00ed\u0159e ne\u017e u inhibitor\u016f TNF u vysoce rizikov\u00e9 populace<\/li>\n<li><strong>Tromb\u00f3za<\/strong> \u2014 hlubok\u00e1 \u017eiln\u00ed tromb\u00f3za, plicn\u00ed embolie, arteri\u00e1ln\u00ed tromb\u00f3za<\/li>\n<li><strong>Malignita<\/strong> \u2014 lymfom, karcinom plic (zejm\u00e9na u sou\u010dasn\u00fdch\/b\u00fdval\u00fdch ku\u0159\u00e1k\u016f), nemelanomov\u00e9 ko\u017en\u00ed n\u00e1dory<\/li>\n<li><strong>\u00damrtnost<\/strong> \u2014 celkov\u00e1 \u00famrtnost byla \u010d\u00edseln\u011b vy\u0161\u0161\u00ed u tofacitinibu ve srovn\u00e1n\u00ed s TNFi ve vysoce rizikov\u00e9 kohort\u011b<\/li>\n<\/ul>\n<p style=\"margin:8px 0 0 0;\">Podle sou\u010dasn\u00e9ho ozna\u010den\u00ed FDA vyhra\u010fte inhibitory JAK pro pacienty s nedostate\u010dnou odpov\u011bd\u00ed nebo intoleranc\u00ed k jednomu nebo v\u00edce inhibitor\u016fm TNF, pokud nejsou vhodn\u00e9 alternativy.<\/p>\n<\/div>\n<p><strong>\u010cast\u00e9 vedlej\u0161\u00ed \u00fa\u010dinky:<\/strong><\/p>\n<ul>\n<li>Infekce horn\u00edch cest d\u00fdchac\u00edch, nazofaryngitida, sinusitida<\/li>\n<li>Nevolnost, pr\u016fjem<\/li>\n<li>Bolest hlavy<\/li>\n<li>Vyr\u00e1\u017eka, akn\u00e9<\/li>\n<li>Herpes simplex a <strong>herpes zoster (p\u00e1sov\u00fd opar) reaktivace<\/strong> \u2014 v\u00fdrazn\u011b vy\u0161\u0161\u00ed v\u00fdskyt ne\u017e v b\u011b\u017en\u00e9 populaci, zejm\u00e9na u asijsk\u00fdch populac\u00ed<\/li>\n<li>Zv\u00fd\u0161en\u00fd LDL, HDL a celkov\u00fd cholesterol<\/li>\n<li>Zv\u00fd\u0161en\u00e9 ALT\/AST a kreatinkin\u00e1za<\/li>\n<li>Lymfopenie, neutropenie, an\u00e9mie<\/li>\n<\/ul>\n<p><strong>M\u00e9n\u011b \u010dast\u00e9, ale d\u016fle\u017eit\u00e9:<\/strong><\/p>\n<ul>\n<li>Pneumonie (bakteri\u00e1ln\u00ed a oportunn\u00ed v\u010detn\u011b <em>Pneumocystis<\/em>)<\/li>\n<li>Celulitida, infekce mo\u010dov\u00fdch cest, divertikulitida (vy\u0161\u0161\u00ed riziko perforace u tofacitinibu u star\u0161\u00edch pacient\u016f)<\/li>\n<li>Reaktivace hepatitidy B<\/li>\n<li>Interstici\u00e1ln\u00ed plicn\u00ed onemocn\u011bn\u00ed<\/li>\n<li>Gastrointestin\u00e1ln\u00ed perforace (zejm\u00e9na p\u0159i sou\u010dasn\u00e9m u\u017e\u00edv\u00e1n\u00ed NSAID nebo kortikosteroid\u016f)<\/li>\n<\/ul>\n<p><strong>Vz\u00e1cn\u00e9, ale z\u00e1va\u017en\u00e9 \u2014 okam\u017eit\u011b vyhledejte l\u00e9ka\u0159skou pomoc:<\/strong><\/p>\n<ul>\n<li>Aktivn\u00ed TBC nebo diseminovan\u00e1 pl\u00eds\u0148ov\u00e1 infekce (hore\u010dka, no\u010dn\u00ed pocen\u00ed, produktivn\u00ed ka\u0161el, \u00fabytek hmotnosti)<\/li>\n<li>Infarkt myokardu, c\u00e9vn\u00ed mozkov\u00e1 p\u0159\u00edhoda (bolest na hrudi, bolest pa\u017ee nebo \u010delisti, n\u00e1hl\u00e1 jednostrann\u00e1 slabost, pokles \u00fastn\u00edho koutku)<\/li>\n<li>Hlubok\u00e1 \u017eiln\u00ed tromb\u00f3za \/ plicn\u00ed embolie (jednostrann\u00fd otok l\u00fdtka s citlivost\u00ed na pohmat, n\u00e1hl\u00e1 du\u0161nost, pleuritick\u00e1 bolest na hrudi)<\/li>\n<li>Diseminovan\u00fd herpes zoster, encefalitida<\/li>\n<li>Nov\u00e1 lymfadenopatie nebo nevysv\u011btlen\u00fd \u00fabytek hmotnosti (mo\u017en\u00fd lymfom)<\/li>\n<li>Z\u00e1va\u017en\u00e1 ko\u017en\u00ed reakce (SJS, TEN, DRESS)<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Varov\u00e1n\u00ed a opat\u0159en\u00ed<\/h2>\n<ul>\n<li><strong>V\u011bk 65+ a\/nebo sou\u010dasn\u00ed\/b\u00fdval\u00ed ku\u0159\u00e1ci<\/strong> \u2014 v\u00fdrazn\u011b vy\u0161\u0161\u00ed riziko MACE, malignit a mortality. Pou\u017e\u00edvejte pouze v p\u0159\u00edpad\u011b, \u017ee alternativy (inhibitory TNF, inhibitory IL-6) nejsou vhodn\u00e9; preferujte nejni\u017e\u0161\u00ed \u00fa\u010dinnou d\u00e1vku.<\/li>\n<li><strong>Anamn\u00e9za IM, CMP, VTE, aktivn\u00ed malignity nebo lymfoproliferativn\u00edho onemocn\u011bn\u00ed<\/strong> \u2014 relativn\u00ed nebo absolutn\u00ed kontraindikace; rozhodnut\u00ed specialisty.<\/li>\n<li><strong>Aktivn\u00ed z\u00e1va\u017en\u00e1 infekce<\/strong> \u2014 nezahajovat. P\u0159eru\u0161it b\u011bhem febriln\u00edho onemocn\u011bn\u00ed.<\/li>\n<li><strong>Reaktivace herpes zoster<\/strong> \u2014 zvl\u00e1\u0161t\u011b \u010dast\u00e9. O\u010dkovat rekombinantn\u00ed vakc\u00ednou proti p\u00e1sov\u00e9mu oparu (Shingrix) alespo\u0148 4 t\u00fddny p\u0159ed zah\u00e1jen\u00edm l\u00e9\u010dby, pokud je v\u011bk \u2265 50 let nebo jinak indikov\u00e1n.<\/li>\n<li><strong>Chronick\u00e9\/opakovan\u00e9 infekce, trval\u00e9 kat\u00e9try, ned\u00e1vn\u00e1 intrakrani\u00e1ln\u00ed\/intraabdomin\u00e1ln\u00ed chirurgie<\/strong> \u2014 individu\u00e1ln\u00ed posouzen\u00ed rizik a p\u0159\u00ednos\u016f; konzultace specialisty.<\/li>\n<li><strong>Lymfopenie, neutropenie, an\u00e9mie<\/strong> \u2014 p\u0159eru\u0161it p\u0159i ALC &lt; 0,5, ANC &lt; 1,0 nebo Hb &lt; 8 g\/dL. Obnovit l\u00e9\u010dbu ni\u017e\u0161\u00ed d\u00e1vkou po zotaven\u00ed.<\/li>\n<li><strong>Zv\u00fd\u0161en\u00ed lipid\u016f<\/strong> \u2014 l\u00e9\u010dba podle kardiovaskul\u00e1rn\u00edho rizika; statiny v\u00fdznamn\u011b neinteraguj\u00ed s tofacitinibem.<\/li>\n<li><strong>Divertikul\u00e1rn\u00ed onemocn\u011bn\u00ed<\/strong> \u2014 vy\u0161\u0161\u00ed riziko perforace st\u0159eva, zejm\u00e9na u star\u0161\u00edch pacient\u016f u\u017e\u00edvaj\u00edc\u00edch tofacitinib s sou\u010dasn\u00fdm pod\u00e1v\u00e1n\u00edm NSAID nebo kortikosteroid\u016f.<\/li>\n<li><strong>T\u011bhotenstv\u00ed a kojen\u00ed<\/strong> \u2014 vyvarovat se. Nutn\u00e1 \u00fa\u010dinn\u00e1 antikoncepce b\u011bhem l\u00e9\u010dby a alespo\u0148 1 t\u00fdden po posledn\u00ed d\u00e1vce. Nedoporu\u010duje se b\u011bhem kojen\u00ed.<\/li>\n<li><strong>Pou\u017eit\u00ed u d\u011bt\u00ed<\/strong> \u2014 tofacitinib je schv\u00e1len pro polyartikul\u00e1rn\u00ed JIA od v\u011bku 2 let.<\/li>\n<li><strong>\u017div\u00e9 vakc\u00edny<\/strong> \u2014 kontraindikov\u00e1n b\u011bhem l\u00e9\u010dby. Pokud je pot\u0159eba \u017eiv\u00e1 vakc\u00edna (\u017elut\u00e1 zimnice, posiluj\u00edc\u00ed d\u00e1vka MMR, plan\u00e9 ne\u0161tovice, \u017eiv\u00e1 p\u00e1sov\u00e1 opar Zostavax, \u017eiv\u00e1 nosn\u00ed ch\u0159ipka), podat nejm\u00e9n\u011b 4 t\u00fddny p\u0159ed zah\u00e1jen\u00edm l\u00e9\u010dby a po\u010dkat 1\u20132 t\u00fddny po vysazen\u00ed l\u00e9ku p\u0159ed op\u011btovn\u00fdm zah\u00e1jen\u00edm.<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Kontraindikace \u2014 Kdo by NEM\u011aL u\u017e\u00edvat Tofe<\/h2>\n<ul>\n<li>Zn\u00e1m\u00e1 p\u0159ecitliv\u011blost na tofacitinib nebo jakoukoli pomocnou l\u00e1tku tablety<\/li>\n<li>Aktivn\u00ed z\u00e1va\u017en\u00e1 infekce (bakteri\u00e1ln\u00ed, virov\u00e1, pl\u00eds\u0148ov\u00e1, mykobakteri\u00e1ln\u00ed \u2014 v\u010detn\u011b aktivn\u00ed TBC)<\/li>\n<li>Nel\u00e9\u010den\u00e1 chronick\u00e1 hepatitida B<\/li>\n<li>T\u011b\u017ek\u00e9 jatern\u00ed po\u0161kozen\u00ed (Child-Pugh C)<\/li>\n<li>T\u011b\u017ek\u00e9 po\u0161kozen\u00ed ledvin (eGFR &lt; 15 ml\/min)<\/li>\n<li>T\u011b\u017ek\u00e1 lymfopenie (ALC &lt; 0,5), neutropenie (ANC &lt; 1,0) nebo an\u00e9mie (Hb &lt; 8 g\/dl)<\/li>\n<li>T\u011bhotenstv\u00ed<\/li>\n<li>Ned\u00e1vn\u00e1 z\u00e1va\u017en\u00e1 MACE (infarkt myokardu, c\u00e9vn\u00ed mozkov\u00e1 p\u0159\u00edhoda) v posledn\u00edch 6 m\u011bs\u00edc\u00edch<\/li>\n<li>Aktivn\u00ed malignita (krom\u011b l\u00e9\u010den\u00e9ho nemelanomov\u00e9ho karcinomu k\u016f\u017ee)<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Interakce s l\u00e9\u010divy<\/h2>\n<table style=\"border-collapse:collapse;width:100%;margin:12px 0;\">\n<thead>\n<tr style=\"background:#2c7cb0;color:#fff;\">\n<th style=\"padding:10px;border:1px solid #ddd;text-align:left;\">Kombinujte s<\/th>\n<th style=\"padding:10px;border:1px solid #ddd;text-align:left;\">\u00da\u010dinek<\/th>\n<th style=\"padding:10px;border:1px solid #ddd;text-align:left;\">Co d\u011blat<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Siln\u00e9 inhibitory CYP3A4 (ketokonazol, ritonavir, klarithromycin)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Zv\u00fd\u0161en\u00ed hladiny tofacitinibu ~2\u00d7<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Sni\u017ete d\u00e1vku na polovinu (5 mg jednou denn\u011b pro RA; 5 mg 2\u00d7 denn\u011b pro indukci UC).<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">St\u0159edn\u00ed CYP3A4 + siln\u00fd CYP2C19 kombinovan\u011b (flukonazol)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Zv\u00fd\u0161en\u00ed hladiny tofacitinibu<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Sni\u017ete d\u00e1vku tofacitinibu jako u siln\u00fdch inhibitor\u016f 3A4.<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Siln\u00e9 induktory CYP3A4 (rifampicin, karbamazepin, fenytoin, t\u0159ezalka te\u010dkovan\u00e1)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Sn\u00ed\u017een\u00ed hladiny tofacitinibu \u2014 mo\u017en\u00e1 ztr\u00e1ta \u00fa\u010dinnosti<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Pokud je to mo\u017en\u00e9, kombinaci se vyhn\u011bte; zva\u017ete alternativn\u00ed tsDMARD.<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Jin\u00e9 biologick\u00e9 DMARDs (adalimumab, etanercept, infliximab, tocilizumab, rituximab, abatacept)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Aditivn\u00ed imunosuprese \u2014 vysok\u00e9 riziko z\u00e1va\u017en\u00e9 infekce<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\"><strong>Nekombinovat.<\/strong> Ponechte dostate\u010dn\u00fd odstup p\u0159ed p\u0159echodem na jin\u00fd l\u00e9k.<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Dal\u0161\u00ed inhibitory JAK (upadacitinib, filgotinib)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Kumulativn\u00ed toxicita bez dal\u0161\u00edho p\u0159\u00ednosu<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Pou\u017e\u00edvejte pouze jeden inhibitor JAK sou\u010dasn\u011b.<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Siln\u00e1 imunosupresiva (azathioprin, cyklosporin, takrolimus, mykofenol\u00e1t) mimo transplantologii<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Kumulativn\u00ed riziko infekce a lymfomu<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Vyhn\u011bte se pou\u017eit\u00ed mimo transplanta\u010dn\u00ed indikace. U transplantovan\u00fdch pacient\u016f rozhodne specialista.<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">\u017div\u00e9 vakc\u00edny (MMR, plan\u00e9 ne\u0161tovice, p\u00e1sov\u00fd opar, \u017eiv\u00e1 nosn\u00ed ch\u0159ipka, \u017elut\u00e1 zimnice, BCG)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Riziko diseminovan\u00e9 infekce vakcin\u00e1ln\u00edm kmenem<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\"><strong>Kontraindikov\u00e1no b\u011bhem l\u00e9\u010dby.<\/strong> P\u0159ed zah\u00e1jen\u00edm pod\u00e1v\u00e1n\u00ed po\u010dkejte alespo\u0148 4 t\u00fddny nebo po ukon\u010den\u00ed l\u00e9\u010dby vy\u010dkejte 1\u20132 t\u00fddny.<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">NSAID a sou\u010dasn\u011b pod\u00e1van\u00e9 kortikosteroidy<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Zv\u00fd\u0161en\u00e9 riziko perforace GIT (zejm\u00e9na tofacitinib + vy\u0161\u0161\u00ed v\u011bk + divertikul\u00e1rn\u00ed onemocn\u011bn\u00ed)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Pou\u017e\u00edvejte nejni\u017e\u0161\u00ed \u00fa\u010dinnou d\u00e1vku obou p\u0159\u00edpravk\u016f; vyvarujte se dlouhodob\u00e9 kombinace.<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Metotrex\u00e1t (n\u00edzk\u00e1 d\u00e1vka, t\u00fddenn\u00ed pod\u00e1v\u00e1n\u00ed)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Standardn\u00ed kombinace u RA \u2014 \u017e\u00e1dn\u00e1 farmakokinetick\u00e1 interakce<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Pokra\u010dujte v pod\u00e1v\u00e1n\u00ed metotrex\u00e1tu jako z\u00e1kladn\u00edho DMARD; spole\u010dn\u011b monitorujte CBC a jatern\u00ed testy.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2 class=\"wp-block-heading\">Pokyny k uchov\u00e1v\u00e1n\u00ed<\/h2>\n<ul>\n<li>Skladujte p\u0159i pokojov\u00e9 teplot\u011b, <strong>pod 30 \u00b0C<\/strong>, v p\u016fvodn\u00edm blistru.<\/li>\n<li>Chra\u0148te p\u0159ed sv\u011btlem a vlhkost\u00ed. Neskladujte v koupeln\u011b.<\/li>\n<li>Uchov\u00e1vejte mimo dosah d\u011bt\u00ed \u2014 n\u00e1hodn\u00e9 po\u017eit\u00ed m\u016f\u017ee zp\u016fsobit t\u011b\u017ekou imunosupresi.<\/li>\n<li>Nepou\u017e\u00edvejte po uplynut\u00ed data expirace uveden\u00e9ho na obalu.<\/li>\n<li>Nepou\u017eit\u00e9 tablety vra\u0165te do l\u00e9k\u00e1rny k likvidaci \u2014 nevyhazujte do odpadu ani do dom\u00e1c\u00edho odpadu.<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Souvisej\u00edc\u00ed alternativy na MedsBase<\/h2>\n<p>Dal\u0161\u00ed l\u00e9ky pou\u017e\u00edvan\u00e9 v protiz\u00e1n\u011btliv\u00e9 a autoimunitn\u00ed p\u00e9\u010di skladem vedle tohoto produktu:<\/p>\n<ul>\n<li><a href=\"https:\/\/medsbase.com\/cs\/barinat\/\"><strong>Barinat (baricitinib 2 \/ 4 mg) \u2014 inhibitor JAK1\/2 pro RA<\/strong><\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/azoran\/\"><strong>Azoran (azathioprin 50 mg) \u2014 klasick\u00e9 imunosupresivum DMARD<\/strong><\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/lefuheal\/\"><strong>Lefuheal (leflunomid) \u2014 peror\u00e1ln\u00ed DMARD pro revmatoidn\u00ed artritidu<\/strong><\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/conimune-me\/\"><strong>Conimune ME (cyklosporin) \u2014 inhibitor kalcineurinu<\/strong><\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/wysolone\/\"><strong>Wysolone (prednisolon 5 \/ 10 \/ 20 mg) \u2014 peror\u00e1ln\u00ed kortikosteroid<\/strong><\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/medrol\/\"><strong>Medrol (methylprednisolon 4 \/ 8 \/ 16 mg) \u2014 peror\u00e1ln\u00ed kortikosteroid<\/strong><\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/predniheal\/\"><strong>Predniheal (prednisolon) \u2014 peror\u00e1ln\u00ed kortikosteroid<\/strong><\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/hisone\/\"><strong>Hisone (hydrokortizon) \u2014 fyziologick\u00e1 n\u00e1hradn\u00ed terapie steroidy<\/strong><\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/budez-cr\/\"><strong>Budez CR (budesonid) \u2014 st\u0159evn\u011b p\u016fsob\u00edc\u00ed kortikosteroid pro Crohnovu chorobu<\/strong><\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/kenacort\/\"><strong>Kenacort (triamcinolon) \u2014 syst\u00e9mov\u00fd kortikosteroid<\/strong><\/a><\/li>\n<\/ul>\n<p>Prozkoumejte celou <a href=\"https:\/\/medsbase.com\/cs\/anti-inflammatory-autoimmune-care\/\">Protiz\u00e1n\u011btliv\u00e1 a autoimunitn\u00ed p\u00e9\u010de<\/a> kategorie.<\/p>\n<h2 id=\"faqs\">\u010casto kladen\u00e9 dotazy<\/h2>\n<h3 class=\"wp-block-heading\">Kdy za\u010dnu c\u00edtit \u00fa\u010dinek Tofe?<\/h3>\n<p>Bolesti kloub\u016f a rann\u00ed ztuhlost obvykle ustupuj\u00ed do <strong>2\u20134 t\u00fddn\u016f<\/strong>. Vrchol klinick\u00e9 odpov\u011bdi nast\u00e1v\u00e1 za 3\u20136 m\u011bs\u00edc\u016f. Pokud nedojde k v\u00fdznamn\u00e9mu zlep\u0161en\u00ed do 12\u201316 t\u00fddn\u016f p\u0159i adekv\u00e1tn\u00ed d\u00e1vce, v\u011bt\u0161ina revmatolog\u016f by zv\u00e1\u017eila p\u0159echod na alternativn\u00ed c\u00edlenou terapii nam\u00edsto pokra\u010dov\u00e1n\u00ed neur\u010dit\u011b dlouho.<\/p>\n<h3 class=\"wp-block-heading\">Pro\u010d pot\u0159ebuji testov\u00e1n\u00ed na tuberkul\u00f3zu a hepatitidu B p\u0159ed zah\u00e1jen\u00edm u\u017e\u00edv\u00e1n\u00ed Tofe?<\/h3>\n<p>Inhibitory JAK reaktivuj\u00ed sp\u00edc\u00ed infekce. Latentn\u00ed TBC se reaktivuje u ~1 % pacient\u016f a chronick\u00e1 hepatitida B m\u016f\u017ee reaktivovat explozivn\u011b. Jedin\u00fd zp\u016fsob, jak tomu zabr\u00e1nit, je prov\u00e9st screening p\u0159ed prvn\u00ed d\u00e1vkou a l\u00e9\u010dit (nebo podat antivirovou profylaxi) ka\u017ed\u00e9ho, kdo m\u00e1 pozitivn\u00ed test. Vynech\u00e1n\u00ed t\u011bchto test\u016f je nej\u010dast\u011bj\u0161\u00ed p\u0159\u00ed\u010dinou z\u00e1va\u017en\u00fdch komplikac\u00ed p\u0159i l\u00e9\u010db\u011b inhibitory JAK, kter\u00fdm lze p\u0159edej\u00edt.<\/p>\n<h3 class=\"wp-block-heading\">Pro\u010d existuje \u010dern\u00e1 v\u00fdstra\u017en\u00e1 tabulka u p\u0159\u00edpravku Tofe?<\/h3>\n<p>FDA p\u0159idalo t\u0159\u00eddn\u00ed \u010dern\u00e9 varov\u00e1n\u00ed v z\u00e1\u0159\u00ed 2021 pot\u00e9, co <strong>ORAL Surveillance<\/strong> studie uk\u00e1zala, \u017ee tofacitinib v d\u00e1vk\u00e1ch schv\u00e1len\u00fdch pro revmatoidn\u00ed artritidu zp\u016fsobuje v\u00edce z\u00e1va\u017en\u00fdch ne\u017e\u00e1douc\u00edch kardiovaskul\u00e1rn\u00edch p\u0159\u00edhod (infarkt, mrtvice, kardiovaskul\u00e1rn\u00ed \u00famrt\u00ed), v\u00edce malignit (zejm\u00e9na rakovinu plic u ku\u0159\u00e1k\u016f), v\u00edce krevn\u00edch sra\u017eenin a vy\u0161\u0161\u00ed celkovou \u00famrtnost ne\u017e inhibitory TNF \u2014 konkr\u00e9tn\u011b u pacient\u016f s RA ve v\u011bku 50+ s alespo\u0148 jedn\u00edm kardiovaskul\u00e1rn\u00edm rizikov\u00fdm faktorem. Varov\u00e1n\u00ed bylo roz\u0161\u00ed\u0159eno na celou t\u0159\u00eddu inhibitor\u016f JAK. Aktu\u00e1ln\u00ed doporu\u010den\u00ed FDA: inhibitory JAK by m\u011bly b\u00fdt vyhrazeny pro pacienty, u kter\u00fdch selhala nebo nen\u00ed mo\u017en\u00e1 l\u00e9\u010dba inhibitorem TNF.<\/p>\n<h3 class=\"wp-block-heading\">Je Tofe bezpe\u010dn\u00fd p\u0159i dlouhodob\u00e9m u\u017e\u00edv\u00e1n\u00ed?<\/h3>\n<p>Dlouhodob\u00e1 data (a\u017e 9,5 let u\u017e\u00edv\u00e1n\u00ed tofacitinibu) ukazuj\u00ed, \u017ee v\u00fdskyt kardiovaskul\u00e1rn\u00edch p\u0159\u00edhod a malignit u standardn\u011b rizikov\u00fdch pacient\u016f z\u016fst\u00e1v\u00e1 bl\u00edzk\u00fd v\u00fdskytu v b\u011b\u017en\u00e9 populaci. Sign\u00e1l ze studie ORAL Surveillance se soust\u0159ed\u00ed p\u0159edev\u0161\u00edm na star\u0161\u00ed pacienty s p\u0159edchoz\u00edmi kardiovaskul\u00e1rn\u00edmi rizikov\u00fdmi faktory. U jinak zdrav\u00fdch mlad\u0161\u00edch pacient\u016f s revmatoidn\u00ed artritidou je dlouhodob\u00e9 u\u017e\u00edv\u00e1n\u00ed tofacitinibu rozumnou volbou \u2014 av\u0161ak ro\u010dn\u00ed kontroly k\u016f\u017ee, monitorov\u00e1n\u00ed lipid\u016f, krevn\u00edho obrazu a p\u0159ehled o\u010dkov\u00e1n\u00ed z\u016fst\u00e1vaj\u00ed nezbytn\u00e9.<\/p>\n<h3 class=\"wp-block-heading\">M\u016f\u017eu dostat p\u00e1sov\u00fd opar z Tofe?<\/h3>\n<p>Reaktivace latentn\u00edho viru varicella-zoster (p\u00e1sov\u00fd opar) je v\u00fdrazn\u011b \u010dast\u011bj\u0161\u00ed u inhibitor\u016f JAK ne\u017e u inhibitor\u016f TNF nebo v b\u011b\u017en\u00e9 populaci \u2014 v\u00fdskyt je 2\u20135\u00d7 vy\u0161\u0161\u00ed, p\u0159i\u010dem\u017e asij\u0161t\u00ed pacienti jsou nejv\u00edce ohro\u017eeni. Pokud je v\u00e1m 50 let nebo v\u00edce, nebo jste imunokompromitovan\u00ed, nechte se o\u010dkovat rekombinantn\u00ed vakc\u00ednou proti p\u00e1sov\u00e9mu oparu (Shingrix, dv\u011b d\u00e1vky) alespo\u0148 4 t\u00fddny p\u0159ed zah\u00e1jen\u00edm u\u017e\u00edv\u00e1n\u00ed Tofe. \u017div\u00e1 atenuovan\u00e1 vakc\u00edna proti p\u00e1sov\u00e9mu oparu (Zostavax) je kontraindikov\u00e1na p\u0159i terapii JAK inhibitory.<\/p>\n<h3 class=\"wp-block-heading\">M\u016f\u017ee se Tofe kombinovat s methotrex\u00e1tem?<\/h3>\n<p>Ano \u2014 methotrex\u00e1t je standardn\u00ed z\u00e1kladn\u00ed DMARD pou\u017e\u00edvan\u00fd spolu s tofacitinibem u revmatoidn\u00ed artritidy a kombinovan\u00e1 terapie dosahuje lep\u0161\u00edch v\u00fdsledk\u016f ne\u017e samotn\u00fd tofacitinib ve v\u011bt\u0161in\u011b studi\u00ed. Neexistuje farmakokinetick\u00e1 interakce. Pravideln\u011b monitorujte krevn\u00ed obraz a jatern\u00ed testy u obou l\u00e9k\u016f. Inhibitory JAK mus\u00ed <strong>ne<\/strong> b\u00fdt kombinov\u00e1ny s biologick\u00fdmi DMARD (TNFi, IL-6i, rituximab, abatacept) \u2014 riziko infekce je nep\u0159ijateln\u00e9.<\/p>\n<h3 class=\"wp-block-heading\">Co t\u011bhotenstv\u00ed a kojen\u00ed?<\/h3>\n<p>Tofacitinib je <strong>nedoporu\u010duje se<\/strong> v t\u011bhotenstv\u00ed \u2014 \u00fadaje ze zv\u00ed\u0159ec\u00edch studi\u00ed ukazuj\u00ed skelet\u00e1ln\u00ed a viscer\u00e1ln\u00ed teratogenitu a lidsk\u00e1 data jsou nedostate\u010dn\u00e1. Pou\u017e\u00edvejte \u00fa\u010dinnou antikoncepci b\u011bhem l\u00e9\u010dby a alespo\u0148 1 t\u00fdden po posledn\u00ed d\u00e1vce. Nepou\u017e\u00edvejte b\u011bhem kojen\u00ed \u2014 o\u010dek\u00e1v\u00e1 se, \u017ee tofacitinib p\u0159ech\u00e1z\u00ed do mate\u0159sk\u00e9ho ml\u00e9ka a m\u016f\u017ee ovlivnit d\u00edt\u011b. Pl\u00e1nujte t\u011bhotenstv\u00ed v konzultaci s revmatologem \u2014 p\u0159eveden\u00ed na t\u011bhotenstv\u00ed kompatibiln\u00ed DMARD (hydroxychlorochin, certolizumab, sulfasalazin) p\u0159ed po\u010det\u00edm.<\/p>\n<h3 class=\"wp-block-heading\">M\u00e1m p\u0159estat u\u017e\u00edvat Tofe, pokud dostanu nachlazen\u00ed nebo ch\u0159ipku?<\/h3>\n<p>P\u0159i m\u00edrn\u00e9m infek\u010dn\u00edm onemocn\u011bn\u00ed horn\u00edch cest d\u00fdchac\u00edch bez hore\u010dky l\u00e9k pokra\u010dujte v u\u017e\u00edv\u00e1n\u00ed a sledujte sv\u016fj stav. U z\u00e1va\u017en\u011bj\u0161\u00edch infekc\u00ed \u2014 hore\u010dka \u2265 38\u00b0C, produktivn\u00ed ka\u0161el, p\u0159\u00edznaky pyelonefritidy, celulitida, v\u00fdsev p\u00e1sov\u00e9ho oparu, podez\u0159en\u00ed na z\u00e1pal plic nebo COVID-19 vy\u017eaduj\u00edc\u00ed l\u00e9\u010dbu \u2014 Tofe okam\u017eit\u011b vysa\u010fte a kontaktujte p\u0159edepisuj\u00edc\u00edho l\u00e9ka\u0159e. Obnovte u\u017e\u00edv\u00e1n\u00ed a\u017e po \u00fapln\u00e9m vyl\u00e9\u010den\u00ed infekce. Toto pravidlo \u201cpauzy b\u011bhem infekce\u201d je nejd\u016fle\u017eit\u011bj\u0161\u00ed samostatn\u011b zvl\u00e1dnutelnou dovednost\u00ed p\u0159i l\u00e9\u010db\u011b JAK inhibitory.<\/p>\n<h3 class=\"wp-block-heading\">Jak\u00e9 laboratorn\u00ed testy pot\u0159ebuji a jak \u010dasto?<\/h3>\n<p>Standardn\u00ed monitorov\u00e1n\u00ed po zah\u00e1jen\u00ed u\u017e\u00edv\u00e1n\u00ed Tofe: <strong>Krevn\u00ed obraz s diferenci\u00e1lem a jatern\u00ed testy ve 4., 8. a 12. t\u00fddnu, pot\u00e9 ka\u017ed\u00e9 3 m\u011bs\u00edce.<\/strong> <strong>Lipidov\u00fd profil v 8. t\u00fddnu, pot\u00e9 ro\u010dn\u011b.<\/strong> <strong>Funkce ledvin ka\u017ed\u00e9 3\u20136 m\u011bs\u00edc\u016f.<\/strong> Ro\u010dn\u00ed dermatologick\u00e9 vy\u0161et\u0159en\u00ed je vhodn\u00e9 u pacient\u016f se sv\u011btlou plet\u00ed, s anamn\u00e9zou ko\u017en\u00edho karcinomu nebo po 12 m\u011bs\u00edc\u00edch l\u00e9\u010dby. Pokles lymfocyt\u016f pod 0,5 \u00d7 10\u2079\/l, neutrofil\u016f pod 1,0 nebo vzestup ALT nad 3\u00d7 horn\u00ed hranici normy vy\u017eaduj\u00ed p\u0159eru\u0161en\u00ed l\u00e9\u010dby do normalizace hodnot.<\/p>\n<h3 class=\"wp-block-heading\">Pro\u010d objedn\u00e1vat z MedsBase<\/h3>\n<p>Tofe je dod\u00e1v\u00e1n v\u00fdrobcem certifikovan\u00fdm WHO-GMP s kompletn\u00ed dokumentac\u00ed COA. Zas\u00edl\u00e1me po cel\u00e9m sv\u011bt\u011b v nen\u00e1padn\u00e9m obalu a ka\u017ed\u00e1 objedn\u00e1vka je pokryta na\u0161\u00edm <a href=\"\/cs\/medsbase-re-shipment-assurance-policy\/\">Z\u00e1rukou op\u011btovn\u00e9ho odesl\u00e1n\u00ed<\/a>. V\u00e1\u0161 popis transakce p\u0159i platb\u011b kartou zobrazuje regulovan\u00e9ho zpracovatele plateb (regulovan\u00e9ho zpracovatele plateb kartou), nikdy \u201cMedsBase\u201d nebo n\u00e1zev l\u00e9ku.<\/p>\n<p><!-- medsbase-related-alts-v1 --><\/p>\n<h3 class=\"wp-block-heading\">Dal\u0161\u00ed protiz\u00e1n\u011btliv\u00e9 a autoimunitn\u00ed l\u00e9ky<\/h3>\n<p>Pokud Tofe nevyhovuje va\u0161\u00ed situaci, v t\u00e9to kategorii jsou k dispozici n\u00e1sleduj\u00edc\u00ed alternativy:<\/p>\n<ul>\n<li><a href=\"https:\/\/medsbase.com\/cs\/barinat\/\">Barinat (Baricitinib 2\/4 mg, Cipla) \u2014 selektivn\u00ed inhibitor JAK1\/JAK2<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/wysolone\/\">Wysolone (Prednisolon 5\/10\/20 mg, Wyeth) \u2014 p\u0159echodn\u00fd kortikosteroid p\u0159i vzplanut\u00ed<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/kenacort\/\">Kenacort (Triamcinolon 4 mg, Abbott) \u2014 peror\u00e1ln\u00ed kortikosteroid<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/azoran\/\">Azoran (Azathioprin 50 mg, RPG) \u2013 purinov\u00fd antimetabolit<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/conimune-me\/\">Conimune ME (Cyklosporin 25\/50\/100 mg) \u2014 inhibitor kalcineurinu<\/a><\/li>\n<\/ul>","protected":false},"excerpt":{"rendered":"<p>\u2705 Sni\u017euje z\u00e1n\u011bt kloub\u016f<br \/>\n\u2705 Zlep\u0161uje fyzickou funkci<br \/>\n\u2705 Ulevuje od revmatoidn\u00ed bolesti<br \/>\n\u2705 Zpomaluje progresi onemocn\u011bn\u00ed<br \/>\n\u2705 Zlep\u0161uje denn\u00ed pohyblivost<\/p>\n<p><strong>Tofe<\/strong> obsahuje <strong>Tofacitinib<\/strong> 5 mg.<\/p>","protected":false},"featured_media":66708,"comment_status":"open","ping_status":"closed","template":"","meta":[],"product_brand":[],"product_cat":[3897,3141,3223],"product_tag":[5359,5358],"class_list":{"0":"post-66707","1":"product","2":"type-product","3":"status-publish","4":"has-post-thumbnail","6":"product_cat-anti-inflammatory-autoimmune-care","7":"product_cat-category-overview","8":"product_cat-chronic-conditions","9":"product_tag-tofacitinib","10":"product_tag-tofe","12":"first","13":"instock","14":"shipping-taxable","15":"purchasable","16":"product-type-variable","17":"has-default-attributes"},"acf":[],"_links":{"self":[{"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product\/66707","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=66707"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/media\/66708"}],"wp:attachment":[{"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/media?parent=66707"}],"wp:term":[{"taxonomy":"product_brand","embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_brand?post=66707"},{"taxonomy":"product_cat","embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_cat?post=66707"},{"taxonomy":"product_tag","embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_tag?post=66707"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}