{"id":51115,"date":"2023-09-20T09:17:46","date_gmt":"2023-09-20T09:17:46","guid":{"rendered":"https:\/\/medsname.com\/synthivan\/"},"modified":"2026-04-30T16:19:00","modified_gmt":"2026-04-30T16:19:00","slug":"synthivan","status":"publish","type":"product","link":"https:\/\/medsbase.com\/ro\/product\/synthivan\/","title":{"rendered":"Synthivan"},"content":{"rendered":"<div class=\"medsbase-tldr-answer\" style=\"background:#fff8e1;border-left:4px solid #f5a623;padding:14px 18px;margin:18px 0;border-radius:4px;\">\n<h3 style=\"margin-top:0;\">R\u0103spuns rapid<\/h3>\n<p style=\"margin-bottom:0;\"><strong>Synthivan<\/strong> \u2014 Atazanavir + Ritonavir 300 + 100 mg (produc\u0103tor certificat WHO-GMP). Atazanavir 300 mg + ritonavir 100 mg booster \u2014 regim PI o dat\u0103 pe zi cu dou\u0103 NRTI. Hiperbilirubinemia indirect\u0103 reversibil\u0103 este cosmetic\u0103. Incompatibil cu IPP.<\/p>\n<\/div>\n<div class=\"medsbase-trust-strip\" style=\"background:#f7f7f7;border-left:4px solid #2c7cb0;padding:14px 18px;margin:18px 0;border-radius:4px;\">\n<p style=\"margin:0 0 6px 0;\"><strong>Ce beneficii ofer\u0103 MedsBase:<\/strong><\/p>\n<ul style=\"margin:6px 0 0 22px;padding:0;list-style:disc;\">\n<li>produc\u0103tor certificat WHO-GMP<\/li>\n<li>Ambalaj discret \u00een plic simplu<\/li>\n<li>Livrare \u00een toat\u0103 lumea<\/li>\n<li>Evaluat de peste 1.400 de clien\u021bi (<a href=\"https:\/\/medsbase.com\/ro\/reviews\/\">cite\u0219te recenziile<\/a>)<\/li>\n<\/ul>\n<\/div>\n<p class=\"medsbase-reship-line\" style=\"background:#eef7ee;border-left:4px solid #4caf50;padding:10px 14px;margin:14px 0;border-radius:3px;\">\ud83d\udce6 <strong>Garan\u021bia de retransmitere:<\/strong> dac\u0103 comanda dvs. nu a ajuns \u00een 20 de zile lucr\u0103toare de la expediere, o retransmitem f\u0103r\u0103 costuri suplimentare. <a href=\"https:\/\/medsbase.com\/ro\/medsbase-re-shipment-assurance-policy\/\">Cite\u0219te politica<\/a>.<\/p>\n<h3>De ce s\u0103 comanzi de la MedsBase<\/h3>\n<p>Synthivan este expediat de la un produc\u0103tor certificat WHO-GMP \u00een ambalaj neutru, facturat printr-un procesator de pl\u0103\u021bi reglementat (descrierea extrasului de cont men\u021bioneaz\u0103 un procesator de pl\u0103\u021bi reglementat \u2014 niciodat\u0103 MedsBase sau nume de medicamente). Fiecare comand\u0103 beneficiaz\u0103 de Garan\u021bia noastr\u0103 de Reexpediere \u00een 20 de zile lucr\u0103toare.<\/p>\n<div style=\"background:#fff3f3;border-left:4px solid #d9534f;padding:12px 16px;margin:14px 0;border-radius:3px;\"><strong>Conformitate \u0219i rezisten\u021b\u0103<\/strong><br \/>PI au o barier\u0103 genetic\u0103 relativ mai ridicat\u0103 la rezisten\u021b\u0103 dec\u00e2t NNRTI, dar necesit\u0103 \u00een continuare o conformitate &gt;95%. \u00centotdeauna combinate cu doi NRTI (de obicei TDF\/FTC sau ABC\/3TC) pentru un regim complet. PI\/r se refer\u0103 la PI boostat cu ritonavir \u2014 ritonavirul este administrat \u00een doze mici (100 mg) ca inhibitor CYP3A4 pentru a cre\u0219te nivelurile PI partener.<\/div>\n<h2>Cum func\u021bioneaz\u0103 inhibitorii de proteaz\u0103<\/h2>\n<p>Proteaza HIV cleaveaz\u0103 poliproteina gag-pol \u00een proteine virale mature \u0219i func\u021bionale. F\u0103r\u0103 proteaz\u0103, HIV produce virioni imaturi neinfec\u021bio\u0219i. PI se leag\u0103 de situsul activ al proteazei \u0219i blocheaz\u0103 cleavarea.<\/p>\n<p>Terapia modern\u0103 cu PI folose\u0219te aproape \u00eentotdeauna ritonavir sau cobicistat ca booster farmacocinetic \u2014 ace\u0219ti inhibitori CYP3A4 cresc nivelurile PI partener (atazanavir, darunavir, lopinavir) \u0219i permit administrarea o dat\u0103 pe zi.<\/p>\n<h2>Efecte adverse specifice clasei<\/h2>\n<ul>\n<li><strong>GI:<\/strong> diaree, grea\u021b\u0103, dureri abdominale (\u00een special lopinavir\/r \u2014 cel mai predispus la diaree)<\/li>\n<li><strong>Metabolic:<\/strong> dislipidemie, rezisten\u021b\u0103 la insulin\u0103, lipodistrofie (mai pu\u021bin pronun\u021bate la PI mai noi darunavir, atazanavir dec\u00e2t la lopinavirul mai vechi)<\/li>\n<li><strong>Hepatice:<\/strong> cre\u0219teri ale enzimelor hepatice; precau\u021bie \u00een co-infec\u021bia HBV\/HCV<\/li>\n<li><strong>Cardiovascular:<\/strong> mic\u0103 asociere cu riscul de IM (PI vechi); PI noi mai pu\u021bin afecta\u021bi<\/li>\n<li><strong>Specific Atazanavir:<\/strong> hiperbilirubinemie indirect\u0103 reversibil\u0103 (icter Gilbert-like \u2014 cosmetic, nu hepatotoxic), nefrolitiaza, colelitiaza<\/li>\n<li><strong>Specific Darunavir:<\/strong> erup\u021bie cutanat\u0103 (asociat\u0103 sulfonamide), hepatit\u0103<\/li>\n<\/ul>\n<h2>Interac\u021biuni medicamentoase importante<\/h2>\n<ul>\n<li><strong>Substrate puternice CYP3A4 cu indice terapeutic \u00eengust \u2014 contraindica\u021bii absolute:<\/strong> simvastatin\u0103, lovastatin\u0103 (utiliza\u021bi pravastatin\u0103\/fluvastatin\u0103\/pitavastatin\u0103 \u00een schimb); alcaloizi ai ergotului; pimozid\u0103; midazolam\/triazolam (oral); rifampicin\u0103; St John\u2019s wort; cisaprid\u0103.<\/li>\n<li><strong>Inhibitori ai pompei de protoni (IPP):<\/strong> reduc absorb\u021bia atazanavirului \u2014 separa\u021bi cu \u226512 ore SAU evita\u021bi. Problem\u0103 mai mic\u0103 cu darunavir, lopinavir.<\/li>\n<li><strong>Rifampicin\u0103:<\/strong> scade nivelurile IP &gt;75% \u2014 utiliza\u021bi rifabutin\u0103 \u00een schimb, cu ajustarea dozei de IP.<\/li>\n<li><strong>Contracep\u021bia hormonal\u0103:<\/strong> unele IP reduc etinilestradiolul \u2014 utiliza\u021bi contracep\u021bie de barier\u0103 sau alternativ\u0103.<\/li>\n<li><strong>DAAs anti-VHC:<\/strong> verifica\u021bi \u00eentotdeauna baza de date actual\u0103 Liverpool HIV-DDI \u00eenainte de a combina terapia HIV + VHC.<\/li>\n<\/ul>\n<h2 id=\"faqs\">\u00centreb\u0103ri frecvente<\/h2>\n<h3>De ce este utilizat ritonavirul ca booster?<\/h3>\n<p>Ritonavirul \u00een doze mici (100 mg) inhib\u0103 CYP3A4, cresc\u00e2nd nivelurile PI-ului asociat (atazanavir, darunavir, lopinavir). Acest lucru permite administrarea o dat\u0103 pe zi \u0219i o povar\u0103 mai mic\u0103 a num\u0103rului de comprimate. Cobicistatul este o alternativ\u0103 de booster (f\u0103r\u0103 activitate antiviral\u0103, doar inhibi\u021bie CYP).<\/p>\n<h3>Va vindeca regimul HIV?<\/h3>\n<p>Nu \u2014 terapia antiretroviral\u0103 (ART) suprim\u0103 replicarea viral\u0103 pe via\u021b\u0103. Oprirea ART permite revenirea viral\u0103 \u00een c\u00e2teva s\u0103pt\u0103m\u00e2ni. Cu terapia consecvent\u0103 \u0219i \u00eenc\u0103rc\u0103tur\u0103 viral\u0103 nedetectabil\u0103, speran\u021ba de via\u021b\u0103 se apropie de cea a persoanelor HIV-negative (U=U).<\/p>\n<h3>Ce fac dac\u0103 uit o doz\u0103?<\/h3>\n<p>Lua\u021bi c\u00e2nd v\u0103 aminti\u021bi dac\u0103 \u00eent\u00e2rzia\u021bi 6 ore, omite\u021bi \u0219i relua\u021bi programul normal \u2014 nu lua\u021bi o dobl\u0103 doz\u0103. Dozele ratate repetate risc\u0103 dezvoltarea rezisten\u021bei.<\/p>\n<h3>Managementul efectelor secundare?<\/h3>\n<p>Diarhea este cea mai frecvent\u0103 \u2014 de obicei se amelioraz\u0103 \u00een 4-6 s\u0103pt\u0103m\u00e2ni; se poate folosi loperamid\u0103. Modific\u0103rile lipidice pot necesita un statin (evita\u021bi simvastatin\/lovastatin \u2014 folosi\u021bi atorvastatin \u00een doze mici, rosuvastatin sau pitavastatin). Icterusul la atazanavir este cosmetic \u0219i nu este hepatotoxic \u2014 nu este nevoie de schimbare.<\/p>\n<h3>C\u00e2nd ar trebui s\u0103-l iau?<\/h3>\n<p>Majoritatea PI-urilor boostate se iau cu m\u00e2ncare (\u00eembun\u0103t\u0103\u021be\u0219te absorb\u021bia \u0219i tolerabilitatea). Atazanavir\/r necesit\u0103 un stomac acid \u2014 evita\u021bi IPP; antagoni\u0219tii H2 sunt OK cu separare temporal\u0103. Darunavir\/r \u0219i lopinavir\/r sunt mai pu\u021bin sensibili la pH.<\/p>\n<h3>Interac\u021biuni medicamentoase?<\/h3>\n<p>Clasa major\u0103 \u2014 dezv\u0103lui\u021bi \u00eentotdeauna toate medicamentele. PI-urile sunt inhibitori puternici ai CYP3A4. Statinele, rifampicina, ergotaminele, contraceptivele orale, anticonvulsivantele, antifungicele \u0219i multe medicamente psihiatrice necesit\u0103 ajustare sau substitu\u021bie. Folosi\u021bi baza de date Liverpool HIV-DDI (hiv-druginteractions.org).<\/p>\n<h3>Coinfec\u021bie cu HBV?<\/h3>\n<p>Regimurile bazate pe IP nu trateaz\u0103 HBV. Coloana vertebral\u0103 NRTI (TDF + FTC sau 3TC) trateaz\u0103 at\u00e2t HIV c\u00e2t \u0219i HBV \u2014 p\u0103stra\u021bi aceast\u0103 combina\u021bie dac\u0103 exist\u0103 coinfec\u021bie cu HBV. \u00centreruperea brusc\u0103 poate agrava HBV.<\/p>\n<h3>Sarcin\u0103?<\/h3>\n<p>Atazanavir\/r \u0219i darunavir\/r au cele mai multe date despre sarcin\u0103 \u0219i sunt frecvent utilizate. Lopinavir\/r este de asemenea acceptabil. PI-urile poten\u021bate cu cobicistat sunt \u00een general evitate \u00een timpul sarcinii din cauza nivelurilor reduse \u00een trimestrul 2\/3.<\/p>\n<h3>C\u00e2nd sunt preferate PI-urile?<\/h3>\n<p>PI-urile sunt de linia a doua conform ghidurilor moderne (inhibitorii de integraz\u0103 sunt de prim\u0103 linie). PI-urile r\u0103m\u00e2n utile pentru: pacien\u021bii pre-trata\u021bi cu rezisten\u021b\u0103 la INSTI, pacien\u021bii cu afec\u021biuni ale SNC (penetrarea \u00een LCR este variabil\u0103 dar util\u0103), HIV-2 (unde INSTI-urile func\u021bioneaz\u0103 dar c\u0103ile de rezisten\u021b\u0103 difer\u0103) \u0219i sarcin\u0103 \u00een unele contexte.<\/p>\n<h3>Ce spune\u021bi despre riscul cardiovascular?<\/h3>\n<p>PI-urile mai vechi (lopinavir, indinavir) au un exces mic absolut de IM. PI-urile mai noi (atazanavir, darunavir) mai pu\u021bin. Gestiona\u021bi factorii de risc CV tradi\u021bionali (fumat, TA, lipide, greutate, exerci\u021biu) \u2014 ace\u0219tia domin\u0103 asupra efectului modest al PI-urilor.<\/p>\n<p><!-- medsbase-related-alts-v1 --><\/p>\n<h2>Alte medicamente HIV \u0219i antivirale<\/h2>\n<ul>\n<li><a href=\"https:\/\/medsbase.com\/ro\/trioday\/\">Trioday<\/a> \u2014 TDF + 3TC + EFV \u2014 regim cu o singur\u0103 tablet\u0103 de la Cipla<\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/triomune\/\">Triomune<\/a> \u2014 d4T + 3TC + NVP \u2014 regim mai vechi 3-\u00een-1 (pe baz\u0103 de stavudin\u0103)<\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/zepdon\/\">Zepdon<\/a> \u2014 raltegravir 400 mg \u2014 inhibitor de integraz\u0103<\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/abamune-l\/\">Abamune L<\/a> \u2014 abacavir + lamivudin\u0103 \u2014 alternativ\u0103 pentru scheletul NRTI<\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/tenvir-l\/\">Tenvir L<\/a> \u2014 tenofovir + lamivudine \u2014 alternativ\u0103 de baz\u0103 NRTI<\/li>\n<\/ul>\n<div style=\"background:#fff3f3;border-left:4px solid #d9534f;padding:12px 16px;margin:18px 0;border-radius:3px;font-size:.95em;\"><strong>Disclaimer medical:<\/strong> Tratamentul HIV este o terapie complex\u0103 \u0219i pe termen lung. Alegerea medicamentului depinde de genotip, teste de rezisten\u021b\u0103, comorbidit\u0103\u021bi \u0219i istoricul tratamentelor anterioare. Discuta\u021bi orice modificare a regimenului cu un specialist \u00een HIV. Este necesar\u0103 o conformitate &gt;95% pentru a preveni rezisten\u021ba. Testa\u021bi pentru HBV \u00eenainte de a \u00eencepe orice regimen care con\u021bine tenofovir, lamivudin\u0103 sau emtricitabin\u0103 \u2014 \u00eentreruperea poate provoca o exacerbare sever\u0103 a HBV la pacien\u021bii cu infec\u021bie mixt\u0103.<\/div>","protected":false},"excerpt":{"rendered":"<p>Synthivan (Atazanavir 300 mg + Ritonavir 100 mg) \u2014 inhibitor de proteaz\u0103 boostat \u00een combina\u021bie fix\u0103 pentru HIV. Administrare oral\u0103 o dat\u0103 pe zi. Hiperbilirubinemia indirect\u0103 reversibil\u0103 este cosmetic\u0103. Incompatibil cu IPP.<\/p>","protected":false},"featured_media":51116,"comment_status":"open","ping_status":"open","template":"","meta":[],"product_brand":[],"product_cat":[3141,3223,3304],"product_tag":[],"class_list":{"0":"post-51115","1":"product","2":"type-product","3":"status-publish","4":"has-post-thumbnail","6":"product_cat-category-overview","7":"product_cat-chronic-conditions","8":"product_cat-hiv-medication","10":"first","11":"outofstock","12":"shipping-taxable","13":"purchasable","14":"product-type-variable","15":"has-default-attributes"},"acf":[],"_links":{"self":[{"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/product\/51115","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/product"}],"about":[{"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/types\/product"}],"replies":[{"embeddable":true,"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/comments?post=51115"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/media\/51116"}],"wp:attachment":[{"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/media?parent=51115"}],"wp:term":[{"taxonomy":"product_brand","embeddable":true,"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/product_brand?post=51115"},{"taxonomy":"product_cat","embeddable":true,"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/product_cat?post=51115"},{"taxonomy":"product_tag","embeddable":true,"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/product_tag?post=51115"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}