. . . . . . . . "4.5\tInterakce s\u00A0jin\u00FDmi l\u00E9\u010Div\u00FD p\u0159\u00EDpravky a jin\u00E9 formy interakce"@cs . . . . . "Farmakokinetick\u00E9 a farmakodynamick\u00E9 studie se ziprasidonem a jin\u00FDmi l\u00E9\u010Div\u00FDmi p\u0159\u00EDpravky, kter\u00E9 prodlu\u017Euj\u00ED QT interval, nebyly prov\u00E1d\u011Bny. Aditivn\u00ED efekt ziprasidonu a t\u011Bchto l\u00E9k\u016F nem\u016F\u017Ee b\u00FDt vylou\u010Den, proto by ziprasidon nem\u011Bl b\u00FDt sou\u010Dasn\u011B pod\u00E1v\u00E1n s\u00A0l\u00E9ky prodlu\u017Euj\u00EDc\u00EDmi QT interval, jako jsou antiarytmika t\u0159\u00EDd IA a III, oxid arsenit\u00FD, halofantrin, levacetylmethadol, mesoridazin, thioridazin, pimozid, sparfloxacin, gatifloxacin, moxifloxacin, dolasetron mesyl\u00E1t, meflochin, sertindol nebo cisaprid (viz bod 4.3).\nL\u00E9ky ovliv\u0148uj\u00EDc\u00ED centr\u00E1ln\u00ED nervovou soustavu/alkohol\nVzhledem k prim\u00E1rn\u00EDm \u00FA\u010Dink\u016Fm ziprasidonu je nezbytn\u00E1 opatrnost p\u0159i u\u017Eit\u00ED v kombinaci s jin\u00FDmi l\u00E9ky s \u00FA\u010Dinkem na centr\u00E1ln\u00ED nervovou soustavu a alkoholem.\nVliv ziprasidonu na jin\u00E9 l\u00E9ky\nV\u0161echny studie interakc\u00ED se prov\u00E1d\u011Bly s peror\u00E1ln\u00EDm ziprasidonem. \nIn vivo studie s\u00A0dextromethorfanem neprok\u00E1zala v\u00FDznamnou inhibici CYP2D6 p\u0159i plazmatick\u00FDch koncentrac\u00EDch ni\u017E\u0161\u00EDch o 50%, ne\u017E kter\u00E9 byly zji\u0161t\u011Bny po pod\u00E1n\u00ED 40 mg ziprasidonu 2x denn\u011B. In vitro data nazna\u010Duj\u00ED, \u017Ee ziprasidon by mohl b\u00FDt m\u00EDrn\u00FDm inhibitorem CYP2D6 a CYP3A4. Je nicm\u00E9n\u011B nepravd\u011Bpodobn\u00E9, \u017Ee by ziprasidon klinicky v\u00FDznamn\u011B ovliv\u0148oval farmakokinetiku l\u00E9\u010Div\u00FDch p\u0159\u00EDpravk\u016F metabolizovan\u00FDch izoformami cytochromu P450.\nPeror\u00E1ln\u00ED kontraceptiva - pod\u00E1n\u00ED ziprasidonu nem\u011Blo za n\u00E1sledek \u017E\u00E1dn\u00E9 v\u00FDznamn\u00E9 zm\u011Bny farmakokinetiky estrogenu (ethinylestradiolu, substr\u00E1tu CYP3A4) nebo slo\u017Eek progesteronu.\nLithium - sou\u010Dasn\u00E9 pod\u00E1v\u00E1n\u00ED ziprasidonu nem\u011Blo \u017E\u00E1dn\u00FD vliv na farmakokinetiku lithia.\nVliv jin\u00FDch l\u00E9k\u016F na ziprasidon\nKetokonazol (400 mg/den), siln\u00FD inhibitor CYP3A4, zv\u00FD\u0161il s\u00E9rov\u00E9 koncentrace ziprasidonu o <40%. S\u00E9rov\u00E9 koncentrace S-methyl-dihydroziprasidonu a ziprasidon-sulfoxidu byly p\u0159i o\u010Dek\u00E1van\u00E9m Tmax ziprasidonu zv\u00FD\u0161eny o 55% resp. o 8%. Dal\u0161\u00ED prodlou\u017Een\u00ED QTc nebylo pozorov\u00E1no. Zm\u011Bny ve farmakokinetice v\u00A0d\u016Fsledku sou\u010Dasn\u00E9ho pod\u00E1n\u00ED se siln\u00FDmi inhibitory CYP3A4 se nezdaj\u00ED b\u00FDt klinicky v\u00FDznamn\u00E9, nen\u00ED proto vy\u017Eadov\u00E1na \u00FAprava d\u00E1vky.\nL\u00E9\u010Dba karbamazepinem v d\u00E1vce 200 mg 2x denn\u011B po dobu 21 dn\u016F zp\u016Fsobovala sn\u00ED\u017Een\u00ED hladiny ziprasidonu o p\u0159ibli\u017En\u011B 35%. \nAntacida - opakovan\u00E9 d\u00E1vky antacid obsahuj\u00EDc\u00EDch aluminium a magnesium nebo cimetidin nem\u011Bly klinicky v\u00FDznamn\u00FD \u00FA\u010Dinek na farmakokinetiku ziprasidonu u nasycen\u00FDch pacient\u016F.\nSerotonergn\u00ED l\u00E9\u010Div\u00E9 p\u0159\u00EDpravky\nObjevily se jednotliv\u00E9 p\u0159\u00EDpady serotoninov\u00E9ho syndromu, kter\u00FD se do\u010Dasn\u011B objevil p\u0159i u\u017E\u00EDv\u00E1n\u00ED ziprasidonu v\u00A0kombinaci s\u00A0jin\u00FDmi serotonergn\u00EDmi l\u00E9\u010Div\u00FDmi p\u0159\u00EDpravky, jako jsou l\u00E9ky ze skupiny SSRI (viz bod 5.1). Serotoninov\u00FD syndrom je charakterizov\u00E1n zmatenost\u00ED, agitovanost\u00ED, hore\u010Dkou, pocen\u00EDm, ataxi\u00ED, hyperreflexi\u00ED, myoklonem a pr\u016Fjmem (viz bod 4.8).\nVazba na b\u00EDlkoviny\nZiprasidon se siln\u011B v\u00E1\u017Ee na plazmatick\u00E9 proteiny. Vazba ziprasidonu na plazmatick\u00E9 proteiny in vitro nebyla ovlivn\u011Bna ani warfarinem ani propanololem, co\u017E jsou 2 l\u00E9ky siln\u011B se v\u00E1zaj\u00EDc\u00ED na plazmatick\u00E9 proteiny, ani ziprasidon neovliv\u0148oval vazbu t\u011Bchto l\u00E9k\u016F v\u00A0plazm\u011B u \u010Dlov\u011Bka. Proto je potenci\u00E1l l\u00E9kov\u00FDch interakc\u00ED se ziprasidonem z\u00A0d\u016Fvodu vyt\u011Bsn\u011Bn\u00ED nepravd\u011Bpodobn\u00FD.\n"@cs . . . . "004.005" .