Vnitřní lékařství 2/2020

FARMAKOLOGICKÝ PROFIL Pioglitazon | 125 / Vnitř Lék 2020; 66(2): 121–125 / VNITŘNÍ LÉKAŘSTVÍ www.casopisvnitrnilekarstvi.cz účinky, které souvisí s poklesem inzulinové rezistence. Pioglitazon navíc působí příznivě na vývoj nealkoholové jaterní steatózy/fibrózy, oddaluje přechod prediabetu do diabetu a zřejmě i pozitivně ovlivňuje diabetické onemocnění ledvin (3). Objevují se také informace, které ukazují na jeho možnou roli v prevenci zhoršení kognitivních funkcí diabetiků (38, 39). Vhodným kandidátem pro léčbu pioglitazonem je nemocný, u něhož převládá podíl inzulinové rezistence na rozvoji hyperglykemie, a který má patrné také další projevy metabolického syndromu. Důležitým faktorem úspěšnosti léčby je jeho včasné podání (co nejdříve po metforminu). Nežádoucí účinky pioglitazonu jsou předvídatelné a lze je mini- malizovat respektováním kontraindikací. Některým z nich se můžeme vyhnout pozvolnou titrací, optimálním dávkováním pioglitazonu a mo- nitorováním pacientů. Váhový přírůstek a retenci tekutin lze příznivě ovlivnit simultánní léčbou některými dalšími antidiabetiky (metfor- minem, glifloziny, agonisty GLP-1 receptorů, jež navíc mohou přinést další pokles KV rizika), případně přidáním diuretika. V neposlední řadě je nutné zvážit i ekonomickou stránku léčby, která se nyní díky dostupnosti několika generických preparátů jeví, ve srovnání s novějšími antidiabe- tiky, jako poměrně výhodná. Do určité míry to koresponduje i s limitací preskripčního omezení pro předpis pioglitazonu z prostředků veřejného zdravotního pojištění, na rozdíl od některých ekonomicky náročnějších antidiabetik je možné léčbu zahájit i při HbA 1c < 60 mmol/mol. Podpořeno MZ ČR – RVO (FNOL, 00098892) a IGA_LF_2020_005. LITERATURA 1. Emerging Risk Factors Collaboration, Sarwar N, Gao P, Seshasai SR, et al. Diabetes melli- tus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta- -analysis of 102 prospective studies. 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