. . "Intravaskul\u00E1rn\u00ED objemov\u00E1 deplece \nSymptomatick\u00E1 hypotenze, zvl\u00E1\u0161t\u011B po prvn\u00ED d\u00E1vce, se m\u016F\u017Ee vyskytnout u pacient\u016F s nedostatkem tekutin a/nebo sod\u00EDku v d\u016Fsledku siln\u00E9 l\u00E9\u010Dby diuretiky, dietn\u00EDho omezen\u00ED p\u0159\u00EDjmu soli, pr\u016Fjmu nebo zvracen\u00ED. Tyto stavy je t\u0159eba p\u0159ed pod\u00E1n\u00EDm olmesartan medoxomilu upravit. \nJin\u00E9 stavy se stimulac\u00ED syst\u00E9mu renin-angiotenzin-aldosteron \nU pacient\u016F, jejich\u017E tonus c\u00E9v a funkce ledvin z\u00E1vis\u00ED p\u0159edev\u0161\u00EDm na aktivit\u011B syst\u00E9mu renin-angiotenzin-aldosteron (nap\u0159. pacient\u016F se z\u00E1va\u017En\u00FDm m\u011Bstnav\u00FDm srde\u010Dn\u00EDm selh\u00E1n\u00EDm nebo onemocn\u011Bn\u00EDm ledvin, v\u010Detn\u011B sten\u00F3zy ren\u00E1ln\u00ED arterie), b\u00FDv\u00E1 l\u00E9\u010Dba jin\u00FDmi l\u00E9ky, kter\u00E9 ovliv\u0148uj\u00ED tento syst\u00E9m, spojena s akutn\u00ED hypotenz\u00ED, azotemi\u00ED, oliguri\u00ED nebo vz\u00E1cn\u011B akutn\u00EDm selh\u00E1n\u00EDm ledvin. Mo\u017Enost vzniku obdobn\u00FDch reakc\u00ED nelze vylou\u010Dit ani u antagonist\u016F receptor\u016F pro angiotenzin II.\nRenovaskul\u00E1rn\u00ED hypertenze \nPacienti s bilater\u00E1ln\u00ED sten\u00F3zou ren\u00E1ln\u00ED arterie nebo sten\u00F3zou arterie z\u00E1sobuj\u00EDc\u00ED jednu funguj\u00EDc\u00ED ledvinu jsou ve zv\u00FD\u0161en\u00E9 m\u00ED\u0159e ohro\u017Eeni z\u00E1va\u017Enou hypotenz\u00ED a nedostate\u010Dnost\u00ED ledvin, pokud jsou l\u00E9\u010Deni p\u0159\u00EDpravky ovliv\u0148uj\u00EDc\u00EDmi syst\u00E9m renin-angiotenzin-aldosteron. \nPo\u0161kozen\u00ED ledvin a transplantace ledvin \nPokud olmesartan medoxomil u\u017E\u00EDvaj\u00ED pacienti s naru\u0161en\u00FDmi funkcemi ledvin, doporu\u010Duje se sledovat pravideln\u011B hladiny drasl\u00EDku v s\u00E9ru a hladinu kreatininu. Pod\u00E1v\u00E1n\u00ED olmesartan medoxomilu se nedoporu\u010Duje pacient\u016Fm se z\u00E1va\u017En\u00FDm po\u0161kozen\u00EDm ledvin (clerance kreatininu < 20 ml/min) (viz body 4.2, 5.2). Zku\u0161enosti s pod\u00E1v\u00E1n\u00EDm olmesartan medoxomilu pacient\u016Fm po ned\u00E1vn\u00E9 transplantaci ledvin nebo pacient\u016Fm s termin\u00E1ln\u00EDm st\u00E1diem po\u0161kozen\u00ED ledvin (tj. clearance kreatininu < 12 ml/min) nejsou. \nPo\u0161kozen\u00ED jater \nZku\u0161enosti s pod\u00E1v\u00E1n\u00EDm pacient\u016Fm se z\u00E1va\u017En\u00FDm po\u0161kozen\u00EDm jater nejsou, a proto se pod\u00E1v\u00E1n\u00ED olmesartan medoxomilu t\u011Bmto pacient\u016Fm nedoporu\u010Duje (d\u00E1vkovac\u00ED doporu\u010Den\u00ED pro pacienty s lehk\u00FDm nebo st\u0159edn\u011B z\u00E1va\u017En\u00FDm po\u0161kozen\u00EDm jater viz bod 4.2).\nHyperkal\u00E9mie \nU\u017E\u00EDv\u00E1n\u00ED l\u00E9\u010Div\u00FDch p\u0159\u00EDpravk\u016F, kter\u00E9 ovliv\u0148uj\u00ED syst\u00E9m renin-angiotenzin-aldosteron, by mohlo zp\u016Fsobit hyperkal\u00E9mii. \nRiziko, \u017Ee by hyperkal\u00E9mie mohla b\u00FDt fat\u00E1ln\u00ED, je zv\u00FD\u0161eno u star\u0161\u00EDch pacient\u016F, u pacient\u016F s ren\u00E1ln\u00ED insuficienc\u00ED a u pacient\u016F s diabetem, u pacient\u016F sou\u010Dasn\u011B l\u00E9\u010Den\u00FDch jin\u00FDmi p\u0159\u00EDpravky, kter\u00E9 by mohly zvy\u0161ovat hladinu drasl\u00EDku a/nebo u pacient\u016F s p\u0159idru\u017Een\u00FDmi obt\u00ED\u017Eemi. \nP\u0159ed zva\u017Eov\u00E1n\u00EDm sou\u010Dasn\u00E9ho u\u017E\u00EDv\u00E1n\u00ED p\u0159\u00EDpravk\u016F ovliv\u0148uj\u00EDc\u00EDch syst\u00E9m renin-angiotenzin-aldosteron je t\u0159eba zv\u00E1\u017Eit pom\u011Br mezi p\u0159\u00EDnosem a rizikem a jin\u00E9 alternativy l\u00E9\u010Dby. Hlavn\u00EDmi rizikov\u00FDmi faktory hyperkal\u00E9mie, kter\u00E9 je t\u0159eba vz\u00EDt v \u00FAvahu, jsou: \n-\tDiabetes, po\u0161kozen\u00ED ledvin, v\u011Bk (nad 70 let). \n-\tKombinace s jedn\u00EDm nebo v\u00EDce jin\u00FDmi l\u00E9\u010Div\u00FDmi p\u0159\u00EDpravky ovliv\u0148uj\u00EDc\u00EDmi syst\u00E9m renin-angiotenzin-aldosteron a/nebo dopl\u0148ky drasl\u00EDku. N\u011Bkter\u00E9 l\u00E9\u010Div\u00E9 p\u0159\u00EDpravky nebo terapeutick\u00E9 t\u0159\u00EDdy l\u00E9\u010Div\u00FDch p\u0159\u00EDpravk\u016F by mohly vyvolat hyperkal\u00E9mii: n\u00E1hrady sol\u00ED obsahuj\u00EDc\u00ED drasl\u00EDk, kalium \u0161et\u0159\u00EDc\u00ED diuretika, ACE inhibitory, antagonist\u00E9 angiotensinu II, nesteroidn\u00ED protiz\u00E1n\u011Btliv\u00E9 l\u00E9ky (v\u010Detn\u011B selektivn\u00EDch inhibitor\u016F COX-2), heparin, imunosupresn\u00ED l\u00E1tky jako cyklosporin nebo takrolimus, trimetoprim. \n-\tP\u0159idru\u017Een\u00E9 obt\u00ED\u017Ee, p\u0159edev\u0161\u00EDm dehydratace, akutn\u00ED srde\u010Dn\u00ED dekompenzace, metabolick\u00E1 acid\u00F3za, zhor\u0161en\u00ED funkce ledvin, n\u00E1hl\u00E9 zhor\u0161en\u00ED stavu ledvin (nap\u0159. infek\u010Dn\u00ED onemocn\u011Bn\u00ED), rozklad bun\u011Bk (nap\u0159. akutn\u00ED ischemie kon\u010Detin, rhabdomyol\u00FDza, rozs\u00E1hl\u00E9 trauma). \nU ohro\u017Een\u00FDch pacient\u016F se doporu\u010Duje pe\u010Dliv\u00E9 sledov\u00E1n\u00ED drasl\u00EDku v s\u00E9ru (viz bod 4.5). \nLithium \nStejn\u011B jako u jin\u00FDch antagonist\u016F receptor\u016F pro angiotenzin II, sou\u010Dasn\u00E9 u\u017E\u00EDv\u00E1n\u00ED olmesartan medoxomilu a lithia se nedoporu\u010Duje (viz bod 4.5). \nSten\u00F3za aort\u00E1ln\u00ED nebo mitr\u00E1ln\u00ED chlopn\u011B; obstruk\u010Dn\u00ED hypertrofick\u00E1 kardiomyopatie \nStejn\u011B jako u jin\u00FDch l\u00E1tek p\u016Fsob\u00EDc\u00EDch vazodilataci, zvl\u00E1\u0161tn\u00ED opatrnost je vhodn\u00E1 u pacient\u016F se sten\u00F3zou aort\u00E1ln\u00ED nebo mitr\u00E1ln\u00ED chlopn\u011B nebo obstruk\u010Dn\u00ED hypertrofickou kardiomyopati\u00ED.\nPrim\u00E1rn\u00ED aldosteronismus \nPacienti s prim\u00E1rn\u00EDm aldosteronismem obecn\u011B neodpov\u00EDdaj\u00ED na antihypertenziva p\u016Fsob\u00EDc\u00ED inhibici syst\u00E9mu renin-angiotenzin-aldosteron. Proto se pou\u017E\u00EDv\u00E1n\u00ED olmesartan medoxomilu u t\u011Bchto pacient\u016F nedoporu\u010Duje. \nEtnick\u00E9 rozd\u00EDly \nStejn\u011B jako u v\u0161ech ostatn\u00EDch antagonist\u016F angiotenzinu II, antihypertenzn\u00ED \u00FA\u010Dinek olmesartan medoxomilu je pon\u011Bkud ni\u017E\u0161\u00ED u \u010Derno\u0161sk\u00E9 populace ne\u017E u jin\u00FDch pacient\u016F. Je to pravd\u011Bpodobn\u011B zp\u016Fsobeno vy\u0161\u0161\u00ED prevalenc\u00ED stav\u016F s n\u00EDzkou hladinou reninu u \u010Derno\u0161sk\u00FDch pacient\u016F trp\u00EDc\u00EDch hypertenz\u00ED. \nT\u011Bhotenstv\u00ED \nU\u017E\u00EDv\u00E1n\u00ED antagonist\u016F angiotenzinu II nesm\u00ED b\u00FDt zahajov\u00E1no b\u011Bhem t\u011Bhotenstv\u00ED. Pokud nen\u00ED pokra\u010Dov\u00E1n\u00ED l\u00E9\u010Dby antagonisty angiotenzinu II pova\u017Eov\u00E1no za nezbytn\u00E9, pacientky pl\u00E1nuj\u00EDc\u00ED t\u011Bhotenstv\u00ED mus\u00ED b\u00FDt p\u0159evedeny na alternativn\u00ED antihypertenziva, kter\u00E1 maj\u00ED pro u\u017E\u00EDv\u00E1n\u00ED v t\u011Bhotenstv\u00ED stanoven bezpe\u010Dnostn\u00ED profil. Pokud pacientka ot\u011Bhotn\u00ED, l\u00E9\u010Dba antagonisty angiotenzinu II mus\u00ED b\u00FDt okam\u017Eit\u011B ukon\u010Dena, a je-li to vhodn\u00E9, mus\u00ED b\u00FDt zah\u00E1jena alternativn\u00ED l\u00E9\u010Dba (viz body 4.3 a 4.6). \nJin\u00E9 \nStejn\u011B jako u jin\u00FDch antihypertenziv, nadm\u011Brn\u00FD pokles krevn\u00EDho tlaku u pacient\u016F s ischemickou chorobou srde\u010Dn\u00ED nebo ischemickou cerebrovaskul\u00E1rn\u00ED chorobou by mohl vy\u00FAstit v infarkt myokardu nebo c\u00E9vn\u00ED mozkovou p\u0159\u00EDhodu.\nTento l\u00E9\u010Div\u00FD p\u0159\u00EDpravek obsahuje laktosu. Pacienti s vz\u00E1cnou vrozenou intoleranc\u00ED galaktosy, vrozen\u00FDm nedostatkem lakt\u00E1zy nebo malabsorpc\u00ED glukosy-galaktosy nesm\u00ED tento p\u0159\u00EDpravek u\u017E\u00EDvat.\n"@cs . . . . . . . . . . . . . . . . . . . . . "004.004" . . "4.4\tZvl\u00E1\u0161tn\u00ED upozorn\u011Bn\u00ED a opat\u0159en\u00ED pro pou\u017Eit\u00ED"@cs .