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Dostupnost Léčiv Pro Trávicí Trakt a Metabolická Onemocnění: Kouzlo

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Dostupnost Léčiv Pro Trávicí Trakt a Metabolická Onemocnění: Kouzlo aktuálně Léky a právo ročník 27 | číslo 3/2017 Dostupnost léčiv pro trávicí trakt a metabolická onemocnění: kouzlo rovnováhy MVDr. Veronika Valdová Arete‑Zoe, LLC Souhrn Valdová V. Dostupnost léčiv pro trávicí trakt a metabolická onemocnění: kouzlo rovnováhy. Remedia 2017; 27: 250–256. V atC skupině a je možno nalézt přípravky pro léčbu v oblasti trávicího traktu a metabolických chorob. Z 34 léčiv považovaných Světovou zdravotnickou organizací za nepostradatelná jich v České republice chybí devět. některé skupiny léčiv, jako např. léčiva pro funkční poruchy trávicího systému, jsou zastoupeny jen velmi spoře. Řada nezbytných léčiv je zastoupena jen minimálním počtem registrací. nedostatek léčiv ve světě se týká především steril- ních injekčních přípravků, včetně komponent pro parenterální výživu. Dále chybějí některá důležitá léčiva uváděná ve standardních postupech napří- klad pro léčbu infekcí H. pylori a Cl. difficile. Posouzení přiměřenosti zastoupení jednotlivých indikačních podskupin je již otázkou pro klinické specialisty. anabolika a léky proti obezitě zasluhují zvláštní pozornost, a to z důvodu jejich popularity na černém trhu. V České republice jsou tato léčiva „k mání“ velmi snadno i navzdory rozsáhlé regulaci. Klíčová slova: léčiva pro trávicí trakt – nepostradatelná léčiva – dostupnost léčiv – nedostatek léčiv. Summary Valdova V. Availability of medicines used for alimentary tract and metabolic diseases treatment. Remedia 2017; 27: 250–256. the group a of the atC classification contains products for the treatment of alimentary tract and metabolic diseases. Of the 34 drugs considered essen- tial by the World Health Organization, 9 are not available in the Czech Republic. Some subgroups, such as drugs for treatment of functional disorders of BLOK GASTROENTEROLOGIE gastrointestinal tract, are represented very sparsely. numerous other indispensable drugs are represented only by a very limited number of registrations. Worlwide shortage of drugs pertains mainly to sterile injectable drugs, including components for parenteral nutrition. Furthermore, some important medicines listed in current guidelines, for example drugs used for treatment of H. pylori, and Cl. difficile infections, are unavailable as well. appropriate- ness of individual indication subgroups representation shloud be assessed by clinical specialists. anabolic steroids and anti‑obesity medications deserve special attention due to their popularity on the black market. these drugs are easily available in the Czech Republic despite their strict regulation. Key words: drugs for alimentary system diseases treatment – essential medicines – availability of medicines – shortage of drugs. Ve skupině léčiv pro trávicí systém jsou me zejména antacida, antagonisty hista‑ Zácpa a průjmy v České republice nejvíce zastoupena hypo‑ minových receptorů H2 a inhibitory Léky proti zácpě jsou zastoupeny počet‑ glykemika, rychle účinkující inzulin a ome‑ protonové pumpy (PPI). Fixní kombina‑ ně, některé podskupiny, jako jsou zejména prazol. Na seznamu nepostradatelných léčiv ce pro eradikaci H. pylori jsou součástí změkčovadla, zhutňovadla, enémy (střevní Světové zdravotnické organizace (World standardních léčebných postupů, v ČR nálevy) či antagonisté opioidních recep‑ Health Organization, WHO), která nejsou je však nenajdeme. Například Torontská torů, bychom však na trhu hledali mar‑ v České republice k dispozici vůbec, figuru‑ konvence (2016) a Americká akademie ně. Kontaktních a osmotických laxativ je je devět léčivých látek. Řada dalších léčiv je gastroenterologů [1] doporučují specific‑ v ČR dostatek. Střevní antibiotika jsou k dispozici v minimálním počtu 1–2 regis‑ ké kombinace PPI, bismutu a antibiotik nezbytná k léčbě závažných infekcí, jako trace, což ohrožuje dostupnost v případech [2]. Světová zdravotnická organizace uvá‑ je například Clostridium difficile. V ČR výpadku. Dále chybějí důležité léky, které dí jako nepostradatelné pouze ranitidin je zastoupen pouze fidaxomicin a rifaxi‑ sice nejsou na seznamu WHO, najdeme je a omeprazol. min. Evropská společnost pro klinickou však ve standardních léčebných postupech. mikrobiologii [5] a Society for Healthcare Tytéž léčivé látky je sice možno najít i pod Funkční poruchy trávicího Epidemiology of America (SHEA) [6] do‑ jinými kódy, vždy je však třeba brát v úvahu, traktu poručují léčbu metronidazolem, případně o jakou lékovou formu se jedná. Dostupnost Mezi léčiva určená pro funkční poruchy vankomycinem nebo fidaxomicinem. léčivých přípravků pro skupinu léčiv označe‑ trávicího traktu (A03) patří zejména syn‑ nou dle Anatomicko‑terapeuticko‑chemic‑ tetická anticholinergika a spasmolytika. Antidiabetika ké (ATC) klasifikace léčiv jako Trávicí trakt Tato skupina je velmi rozsáhlá a různoro‑ Antidiabetika představují velmi bohatou a metabolismus souhrnně předkládá tabul- dá, v České republice je však až na výjimky a různorodou skupinu. Inzuliny a jejich ka 1. Česká republika není jedinou zemí, kte‑ zastoupena velmi spoře. analoga (A10A) jsou rozděleny dle rychlosti rá se potýká s nedostupností některých léčiv. Znepokojující je relativní nedostatek a délky účinku. K perorálním hypoglyke‑ Celosvětově jsou nejproblematičtějšími star‑ antiemetik (A04), která jsou nezbytná při mikům řadíme lék první volby metformin ší generické přípravky, obzvláště injekce a in‑ léčbě onkologických onemocnění. Dopo‑ a deriváty sulfonylurey, a dále již omezeně fuze a komponenty pro parenterální výživu. ručení pro různé chemoterapeutické pro‑ používané thiazolidindiony [7] a inhibi‑ tokoly rozebírají léčebné postupy Ameri‑ tory dipeptidylpeptidázy 4 (DPP‑4) [8,9]. Nemoci žaludku can Society of Clinical Oncology (ASCO) Některé nové kategorie léčiv (inhibitory Ve skupině A02 (Léčiva k terapii onemoc‑ [3] a Multinational Association of Suppor‑ DPP‑4, analoga GLP‑1, inhibitory SGLT2 nění spojených s poruchou acidity) najde‑ tive Care in Cancer (MASCC) [4]. [10]) ve standardních léčebných postupech 250 Dostupnost léčiv pro trávicí trakt a metabolická onemocnění: kouzlo rovnováhy aktuálně ročník 27 | číslo 3/2017 Léky a právo TAB. 1 Přehled léčiv dle atC klasifikace léčiv s vyznačením zástupců účinných látek ATC Název Příklady léčiv REG OBCH Nepostradatelná léčiva a01 StOMatOlOGICkÉ PŘÍPRaVkY aa Léky k profylaxi zubního kazu fluorid sodný, olaflur 11 4 n/a chlorhexidin, amfotericin B, polynoxylin, aB Antiinfektiva a antiseptika (lokální) 4 1 neomycin AC Kortikosteroidy pro lokální léčbu triamcinolon, dexametazon 0 0 Ostatní přípravky k místnímu použití epinefrin, benzydamin, amlexanox, aD 33 16 v ústní dutině kyselina salicylová a02a antaCIDa 2+ a Sloučeniny hořčíku uhličitan, oxid, peroxid Mg 0 0 n/a B Sloučeniny hliníku aloglutamol, algeldrát 0 0 BLOK GASTROENTEROLOGIE 2+ C Sloučeniny vápníku uhličitan, křemičitan Ca 0 0 Kombinace a komplexní sloučeniny D kombinace, magaldrát, almagát, hydrotalcit 29 12 hliníku, vápníku a hořčíku F Antacida a prostředky proti plynatosti madalgrát s antiflatulencii 0 0 G Antacida a spasmolytika antacida se spasmolytiky 0 0 H Antacida s obsahem sody jedlá soda 0 0 X Ostatní kombinace antacid kombinace 0 0 a02B lÉČIVa k tERaPII PEPtICkÉHO VŘEDu a REFluXnÍ CHOROBY J ÍCnu Ba Antagonisté receptoru H2 cimetidin, ranitidin, famotidin 27 18 ranitidin BB Prostaglandiny misoprostol, enprostil 0 0 BC Inhibitory protonové pumpy omeprazol, pantoprazol, lansoprazol, esomeprazol 1508 94 omeprazol Kombinace pro eradikaci BD inhibitor protonové pumpy + AMX, TET, MTZ a CLR 2 0 Helicobacter pylori Ostatní přípravky k léčbě žaludečních BX karbenoxolon, sukralfát, pirenzepin, proglumin 52 9 vředů Ostatní léčiva pro poruchy kyselosti X ostatní 0 0 žaludku a03 lÉČIVa k tERaPII FunkČnÍCH PORuCH tRáVICÍHO tRaktu Léčiva pro funkční choroby trávicího piperidolát, benzilon, papaverin, a 18 5 systému penthienát atropin, skopolamin B Rulík a jeho deriváty atropin, butylskopolamin, metyltropin, fentonium 7 4 butylbromid Spasmolytika v kombinaci isopropamid, clidinium, C 0 0 s psycholeptiky otilonium + psycholeptikum D Spasmolytika v kombinaci s analgetiky tropenzilon, trospium, pitofenon + analgetikum 5 3 Spasmolytika a anticholinergika E kombinace s jinými léčivy 1 1 v kombinaci F Propulziva metoklopramid, cisaprid, domperidon, alizaprid 62 10 metoklopramid a04 antIEMEtIka ondansetron, tropisetron, dolasetron, aa Antagonisté serotoninu (5HT3) 150 24 ondansetron palonosetron aD Jiná antiemetika skopolamin, chlorobutanol, nabilon, rolapitant 16 3 skopolamin hydrobromid a05 lÉČIVa k tERaPII OnEMOCněnÍ J atER a ŽluČOVÝCH CESt kys. cholová, obeticholová, ursodeoxycholová, aa Žlučové kyseliny 26 5 chenodeoxycholová aB Přípravky pro léčbu žlučových cest nikotinyl metylamid 0 0 aX Ostatní léčiva na žlučové cesty piprozolin, hymekromon, cyklobutyrol 4 3 n/a Ba Léčba chorob jater arginin glutamát, silymarin, citiolon, epomediol 29 12 Kombinace léčiv na žlučové cesty C kombinace 0 0 a lipotropik Dostupnost léčiv pro trávicí trakt a metabolická onemocnění: kouzlo rovnováhy 251 aktuálně Léky a právo ročník 27 | číslo 3/2017 ATC Název Příklady léčiv REG OBCH Nepostradatelná léčiva a06 PŘÍPRaVkY PROtI ZáCPě aa Změkčující laxativa dokusát sodný, tekutý parafín 0 0 dokusát sodný bisakodyl, dantron, pikosulfát sodný, senna, aB Kontaktní laxativa 79 26 senna ricinový olej AC Laxativa zhutňující hmotu lněné semínko, etulóza, metylcelulóza 0 0 aD Osmoticky účinkující laxativa laktulóza, laktitol, makrogol 115 15 laktulóza aG Enémy bisakodyl, glycerol, sorbitol 2 0 Antagonisté periferních opioidních aH alvimopan, naloxegol, naloxon, metylnatrexon 18 0 receptorů
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