FrancophonIA/ELRC3.0 huggingface dataset:
English: In general etoposide can cause fetal harm when administered to pregnant women.
Croatian: Etopozid općenito može imati štetne posljedice po fetus kad se daje trudnicama.
English: For this reason, it is critical that the advantages of the oral administration route are carefully weighed against the disadvantages of larger within-patient variability in exposure after oral administration.
Croatian: Zbog toga je ključno da se pažljivo odvagnu prednosti peroralne primjene naspram nedostataka uzrokovanih većom varijabilnošću u izloženosti unutar pojedinog bolesnika nakon peroralne primjene.
English: How to store VEPESID and associated names Contents of the pack and other information
Croatian: Kako čuvati VEPESID i pridružena imena Sadržaj pakiranja i druge informacije
English: What you need to know before you take VEPESID and associated names
Croatian: Što morate znati prije nego počnete uzimati VEPESID i pridružena imena
English: Syncope, face oedema, swelling face, tongue oedema and swelling tongue can also occur with etoposide.
Croatian: Sinkopa, edemi lica, oticanje lica, edem jezika i oticanje jezika također se mogu pojaviti s etopozidom.
English: Live vaccines are contraindicated in immunosuppressed patients (see section 4.3).
Croatian: Primjena živih cjepiva je kontraindicirana u imunosuprimiranih bolesnika (vidjeti dio 4.3).
English: VEPESID and associated names should not be used during pregnancy unless the clinical condition of the woman requires treatment with etoposide.
Croatian: VEPESID i pridružena imena ne smije se primjenjivati u trudnoći osim ako kliničko stanje žene ne zahtijeva liječenje etopozidom.
English: Hepatobiliary disorders very common hepatotoxicity not known alanine aminotransferase increased, alkaline phosphatase increased, aspartate amino transferase increased, bilirubin increased
Croatian: Poremećaji jetre i žuči vrlo često hepatotoksičnost nepoznato povišena alanin aminotransferaza, povišena alkalna fosfataza, povišena aspartat aminotransferaza, povišen bilirubin
English: even if their signs of illness are the same as yours.
Croatian: Može im naškoditi, čak i ako su njihovi znakovi bolesti jednaki Vašima..
English: Prior use of cisplatin may also result in a decrease of etoposide total body clearance in children.
Croatian: Prethodna primjena cisplatina također može izazvati smanjeni ukupni tjelesni klirens etopozida u djece.
English: [See Annex I - To be completed nationally] This leaflet was last revised in <{MM/YYYY}> <{month YYYY}>.
Croatian: - Ispunjava država članica] Ova uputa je zadnji puta revidirana u <{MM/GGGG}> <{mjesec GGGG}>.
English: Non-Hodgkin's lymphoma
Croatian: Non-Hodgkinov limfom
English: Anaphylactic reactions manifested by chills, fever, tachycardia, bronchospasm, dyspnoea, and hypotension which can be fatal can occur with the initial dose of etoposide.
Croatian: Anafilaktičke reakcije koje se manifestiraju zimicom, vrućicom, tahikardijom, bronhospazmom, dispnejom i hipotenzijom i mogu biti smrtonosne, mogu se pojaviti uz početnu dozu etopozida.
English: Reinstitution of VEPESID and associated names therapy should be carried out with caution, and with adequate consideration of the further need for the drug and close attention to possible recurrence of toxicity.
Croatian: Ponovno uvođenje VEPESIDA i pridruženih imena treba provoditi oprezno i uz odgovarajuće razmatranje dalje potrebe za lijekom te oprez zbog moguće ponovne pojave toksičnosti.
English: • nausea and vomiting
Croatian: • mučnina i povraćanje
English: Annex III Product information
Croatian: Prilog III Informacije o lijeku
English: As etoposide may decrease male fertility, preservation of sperm may be considered for the purpose of later fatherhood (see section 4.6).
Croatian: Budući da etopozid može smanjiti plodnost muškaraca, treba razmotriti pohranu sperme u svrhu kasnijeg očinstva (vidjeti dio 4.6).
English: Women of childbearing potential have to use effective contraception during and up to 6 months after treatment.
Croatian: Žene u reproduktivnoj dobi moraju koristiti učinkovitu kontracepciju tijekom i do 6 mjeseci nakon liječenja.
English: Prior or concurrent use of other drugs with similar myelosuppressant action as etoposide may be expected to have additive or synergetic effects (see section 4.4).
Croatian: Može se očekivati da će prethodna ili istodobna primjena drugih lijekova sa sličnim mijelosupresivnim djelovanjem kao etopozid imati aditivne ili sinergijske učinke (vidjeti dio 4.4).
English: This abnormality has also been seen in patients developing secondary leukaemia after being treated with chemotherapy regimens not containing epipodophyllotoxins and in leukaemia occurring de novo.
Croatian: Ova abnormalnost također je primijećena u bolesnika kod kojih je došlo do razvoja sekundarne leukemije nakon liječenja kemoterapijskim režimima koji ne sadrže epipodofilotoksine i kod novonastale leukemije.
English: Etoposide is mutagenic in mammalian cells.
Croatian: Etopozid je mutagen u stanicama sisavaca.
English: Myelosuppression (see section 4.4) with fatal outcome has been reported following administration of etoposide.
Croatian: Mijelosupresija (vidjeti dio 4.4) sa smrtnim ishodom prijavljena je nakon primjene etopozida.
English: Total body clearance values range from 33 to 48 mL/min or 16 to 36 mL/min/m2 and, like the terminal elimination half-life, are independent of dose over a range 100 to 600 mg/m2.
Croatian: Vrijednosti ukupnog tjelesnog klirensa kreću se u rasponu od 33 do 48 ml/min ili od 16 do 36 ml/min/m2 te, kao i terminalni poluvijek eliminacije, ne ovise o dozi u rasponu od 100 do 600 mg/m2.
English: Severe myelosuppression with resulting infection or haemorrhage may occur.
Croatian: Može doći do teške mijelosupresije s posljedičnom infekcijom ili krvarenjem.
English: Immune system disorders rare anaphylactic reactions not known angioedema, bronchospasm Metabolism and nutrition disorders not known tumour lysis syndrome
Croatian: Poremećaji imunološkog sustava rijetko anafilaktičke reakcije nepoznato angioedem, bronhospazam Poremećaji metabolizma i prehrane nepoznato sindrom lize tumora
English: An alternative dosing of 50 mg/m body surface area taken each day for 2 to 3 weeks is sometimes used.
Croatian: Ponekad se koristi alternativno doza od 50 mg/m 2 površine tijela koja se uzima svakodnevno tijekom 2 do 3 tjedna.
English: Given the mutagenic potential of etoposide, an effective contraceptive is required for both male and female patients during treatment and up to 6 months after ending treatment (see section 4.4).
Croatian: S obzirom na mutageni potencijal etopozida, potrebna je učinkovita kontracepcija i kod muških i kod ženskih bolesnika tijekom liječenja i do 6 mjeseci nakon završetka liječenja (vidjeti dio 4.4).
English: Unbound fraction of etoposide correlates significantly with bilirubin in cancer patients.
Croatian: Nevezana frakcija etopozida značajno korelira s bilirubinom kod bolesnika s rakom.
English: There is no evidence of a hepatic first-pass effect for etoposide.
Croatian: Nema dokaza o učinku prvog prolaza etopozida kroz jetru.
English: Respiratory, thoracic and mediastinal disorders rare interstitial pneumonitis, pulmonary fibrosis
Croatian: Poremećaji dišnog sustava, prsišta i sredoprsja rijetko intersticijski pneumonitis, plućna fibroza
English: In patients with creatinine clearance less than 15 mL/min and on dialysis further dose reduction is likely to be required as etoposide clearance is further reduced in these patients.
Croatian: Kod bolesnika s klirensom kreatinina nižim od 15 ml/min i koji su na dijalizi, vjerojatno će biti potrebno dodatno sniženje doze jer kod tih bolesnika dolazi do daljnjeg sniženja klirensa etopozida.
English: Safety and effectiveness of VEPESID and associated names in paediatric patients has not been systematically studied.
Croatian: Sigurnost i djelotvornost VEPESIDA i pridruženih imena nije sustavno ispitivana u pedijatrijskih bolesnika.
English: The name of this medicine is VEPESID and associated names.
Croatian: Naziv ovog lijeka je VEPESID i pridružena imena.
English: Nervous system disorders common dizziness uncommon neuropathy peripheral rare cortical blindness transient, neurotoxicities (e.g., somnolence and fatigue), optic neuritis, seizure**
Croatian: Poremećaji živčanog sustava često omaglica manje često periferna neuropatija rijetko prolazna kortikalna sljepoća, neurotoksičnosti (npr., somnolencija i umor), optički neuritis, napadaj**
English: Within-patient variability in exposure (i.e. between cycles) is larger with oral administration than after intravenous administration (see section 4.4 and 5.2).
Croatian: Varijabilnost u izloženosti unutar pojedinog bolesnika (tj. između ciklusa) je veća kod peroralne primjene nego kod intravenske primjene (vidjeti dio 4.4 i 5.2).
English: Secondary leukaemia
Croatian: Sekundarna leukemija
English: • tingling or numbness in hands and feet Rare side effects (affecting between 1 in 1,000 and 1 in 10,000 people)
Croatian: • trnci ili utrnulost šaka i stopala Rijetke nuspojave (mogu se javiti kod između 1 na 1000 i 1 na 10 000 osoba)
English: Small cell lung cancer
Croatian: Rak pluća malih stanica
English: Physicians should be aware of the possible occurrence of an anaphylactic reaction with VEPESID and associated names, manifested by chills, pyrexia, tachycardia, bronchospasm, dyspnoea and hypotension, which can be fatal.
Croatian: Liječnici moraju biti svjesni mogućnosti nastupa anafilaktičke reakcije na VEPESID i pridružena imena, čiji su znakovi zimica, vrućica, tahikardija, bronhospazam, dispneja i hipotenzija, koja može imati smrtni ishod.
English: What VEPESID and associated names is and what it is used for
Croatian: Što je VEPESID i pridružena imena i za što se koristi
English: This medicinal product is authorised in the Member States of the EEA under the following names:
Croatian: Ovaj lijek je odobren u zemljama članicama EGP-a pod sljedećim nazivima: [Vidjeti Prilog I.
English: Etoposide shows low penetration into the CSF.
Croatian: Etopozid slabo prodire u CSF.
English: Leucopenia and severe leucopenia (less than 1,000 cells/mm 91% and 3 to 17%, respectively, for etoposide.
Croatian: Leukopenija i teška leukopenija (manje od 1000 stanica/mm3) zabilježene su kod 60 do 91%, odnosno 3 do 17% bolesnika, za etopozid.
English: A 100 mg oral dose would be comparable to a 75 mg intravenous dose; a 400 mg oral dose would be comparable to a 200 mg intravenous dose.
Croatian: Peroralna doza od 100 mg usporediva je s intravenskom dozom od 75 mg; peroralna doza od 400 mg usporediva je s intravenskom dozom od 200 mg.
English: Hodgkin's lymphoma
Croatian: Hodgkinov limfom
English: In addition the dose should be adjusted in case of occurrence of fever, infections, or at a thrombocyte count below 25,000 cells/mm3, which is not caused by the disease.
Croatian: Osim toga, dozu treba prilagoditi kod pojave vrućice, infekcija ili ako je broj trombocita manji od 25 000 stanica/mm3, što nije uzrokovano bolešću.
English: An inverse relationship between plasma albumin levels and etoposide renal clearance is found in children.
Croatian: Obrnuti odnos između razina albumina u plazmi i bubrežnog klirensa etopozida utvrđen je kod djece.
English: - The other ingredients are: citric acid, anhydrous (E330), glycerol (85 per cent) (E422), macrogol 400 (E1521) and water.
Croatian: - Drugi sastojci su: citratna kiselina, bezvodna (E330), glicerol (85 postotni) (E422), makrogol 400 (E1521) i voda.
English: What VEPESID and associated names is and what it is used for What you need to know before you take VEPESID and associated names How to take VEPESID and associated names Possible side effects
Croatian: Što je VEPESID i pridružena imena i za što se koristi Što morate znati prije nego počnete uzimati VEPESID i pridružena imena
English: Skin and subcutaneous tissue disorders very common alopecia, pigmentation common pruritus, rash, urticaria rare radiation recall dermatitis, StevensJohnsons syndrome, toxic epidermal necrolysis
Croatian: Poremećaji kože i potkožnog tkiva vrlo često alopecija, pigmentacija često pruritus, osip, urtikarija rijetko odzivna radijacijska upalna reakcija (engl. radiation recall), Stevens-Johnsonov sindrom, toksična epidermalna nekroliza
English: Patients being treated with VEPESID and associated names must be observed for myelosuppression carefully and frequently both during and after therapy.
Croatian: Bolesnike koji se liječe VEPESIDOM i pridruženim imenima mora se pažljivo i često kontrolirati i tijekom i nakon liječenja zbog moguće mijelosupresije.
English: Gastrointestinal disorders very common abdominal pain, anorexia, constipation,
Croatian: Poremećaji probavnog sustava vrlo često bolovi u abdomenu, anoreksija,
English: In adult cancer patients with liver dysfunction, total body clearance of etoposide is not reduced.
Croatian: U odraslih onkoloških bolesnika s oštećenom funkcijom jetre, ukupni tjelesni klirens etopozida nije smanjen.
English: Doses subsequent to initial dose should be adjusted if neutrophil count less than 500 cells/mm occurs for more than 5 days or is associated with fever or infection, if platelet count less than 25,000 cells/mm occurs, if any grade 3 or 4 toxicity develops or if renal clearance is less than 50 ml/min.
Croatian: Doze koje se primjenjuju nakon početne doze treba prilagoditi ako je broj neutrofila manji od 500 stanica/mm3 tijekom više od 5 dana ili je povezan s vrućicom ili infekcijom, ako broj trombocita padne na manje od 25 000 stanica/mm3 ili ako se razvije toksičnost 3. ili 4. stupnja ili ako je bubrežni klirens manji od 50 ml/min.
English: Effects of other drugs on the pharmacokinetics of etoposide
Croatian: Učinci drugih lijekova na farmakokinetiku etopozida
English: Etoposide has been shown to cause metaphasearrest in chick fibroblasts.
Croatian: Pokazalo se da etopozid izaziva zastoj diobe pilećih fibroblasta u metafazi.
English: SPECIAL STORAGE CONDITIONS [To be completed nationally]
Croatian: POSEBNI UVJETI ČUVANJA [Ispunjava država članica]
English: - if you are taking phenylbutazone, sodium salicylate, or aspirin.
Croatian: - ako uzimate fenilbutazon, natrijev salicilat ili aspirin. - ako uzimate antracikline (skupinu lijekova koji se koriste u liječenju raka).
English: The following haematological parameters should be measured at the start of therapy and prior to each subsequent dose of VEPESID and associated names: platelet count, haemoglobin, white blood cell count and differential.
Croatian: Na početku terapije i prije svake sljedeće doze VEPESIDA i pridruženih imena treba izmjeriti sljedeće hematološke parametre: broj trombocita, hemoglobin, broj leukocita i diferencijalnu krvnu sliku.
English: VEPESID and associated names capsules contain sodium propyl parahydroxybenzoate and sodium ethyl parahydroxybenzoate which may cause allergic reactions (possibly delayed).
Croatian: Kapsule VEPESIDA i pridruženih imena sadrže natrijev propilparahidroksibenzoat i natrijev etilparahidroksibenzat koji mogu uzrokovati alergijske reakcije (moguće i odgođene).
English: Anaemia, leucopenia, and thrombocytopenia were observed in rats and mice, while dogs had mild reversible deterioration of liver and kidney functions.
Croatian: Kod štakora i miševa zapažena je anemija, leukopenija i trombocitopenija, dok su psi imali blago reverzibilno propadanje jetrene i bubrežne funkcije.
English: Tumour lysis syndrome (sometimes fatal) has been reported following the use of etoposide in association with other chemotherapeutic drugs (see section 4.4).
Croatian: Sindrom lize tumora (ponekad sa smrtnim ishodom) zabilježen je nakon primjene etopozida s drugim kemoterapeuticima (vidjeti dio 4.4).
English: Patients with impaired renal function receiving etoposide have exhibited reduced total body clearance, increased AUC and higher steady state volume of distribution (see section 4.2).
Croatian: Pokazalo se da bolesnici s oštećenjem funkcije bubrega koji primaju etopozid imaju smanjeni ukupni tjelesni klirens, povećani AUC i veći volumen distribucije u stanju dinamičke ravnoteže (vidjeti dio
English: The mean renal clearance of etoposide is 7 to 10 mL/min/m2 or about 35% of the total body clearance over a dose range of 80 to 600 mg/m2.
Croatian: Srednji bubrežni klirens etopozida je 7 do 10 ml/min/m2 ili oko 35% ukupnog tjelesnog klirensa u rasponu doze od 80 do 600 mg/m2.
English: VEPESID and associated names capsules should only be administered and monitored under the supervision of a qualified physician experienced in the use of anti-neoplastic medicinal products (see section 4.4).
Croatian: Liječenje kapsulama VEPESID i pridružena imena smije se započeti i provoditi samo pod nadzorom kvalificiranog liječnika iskusnog u primjeni antineoplastičnih lijekova (vidjeti dio 4.4).
English: Follow up doses should be adjusted in case of occurrence of grade 3 or 4 toxicities or if renal creatinine clearance is below 50 ml/min.
Croatian: Daljnje doze treba prilagoditi u slučaju pojave toksičnosti 3. ili 4. stupnja ili ako su vrijednosti bubrežnog klirensa kreatinina manje od 50 ml/min.
English: • difficulty breathing
Croatian: • otežano disanje
English: • temporary blindness
Croatian: • privremena sljepoća
English: Given the mutagenic potential of etoposide, an effective contraception is required for both male and female patients during treatment and up to 6 months after ending treatment.
Croatian: S obzirom na mutageni potencijal etopozida, potrebna je učinkovita kontracepcija i muških i ženskih bolesnika tijekom liječenja i do 6 mjeseci nakon završetka liječenja.
English: Total body clearance and the terminal elimination half-life are independent of dose over a range 100 to 600 mg/m2.
Croatian: Vrijednosti ukupnog tjelesnog klirensa i terminalnog poluvijeka eliminacije ne ovise o dozi u rasponu od 100 do 600 mg/m2.
English: In a study of the effects of other therapeutic agents on in vitro binding of 14C etoposide to human serum proteins, only phenylbutazone, sodium salicylate, and aspirin displaced protein-bound etoposide at concentrations generally achieved in vivo (see section 4.5).
Croatian: C etopozida za proteine u ljudskom serumu, samo su fenilbutazon, natrijev salicilat i aspirin istisnuli etopozid vezan za proteine pri koncentracijama koje se općenito postižu in vivo (vidjeti dio 4.5).
English: Low serum albumin is associated with increased exposure to etoposide.
Croatian: Niska koncentracija albumina u serumu povezana je s većom izloženošću etopozidu.
English: • skin problems such as itching or rash Uncommon side effects (affecting between 1 in 100 and 1 in 1000 people)
Croatian: • problemi s kožom poput svrbeža ili osipa Manje česte pojave (mogu se javiti kod između 1 na 100 i 1 na 1000 osoba)
English: Within-patient variability in exposure (i.e. between cycles) is larger with oral administration than after intravenous administration.
Croatian: Varijabilnost u izloženosti unutar pojedinog bolesnika (tj. između ciklusa) je veća kod peroralne primjene nego kod intravenske primjene.
English: The doses after the initial dose should be adjusted if neutrophil count is below 500 cells/mm for more than 5 days.
Croatian: Doze nakon početne doze treba prilagoditi ako je broj neutrofila manji od 500 stanica/mm3 tijekom više od 5 dana.
English: nausea and vomiting common diarrhoea, mucositis (including stomatitis and esophagitis)
Croatian: konstipacija, mučnina i povraćanje često proljev, mukozitis (uključujući stomatitis i ezofagitis)
English: Contains sodium ethyl parahydroxybenzoate and sodium propyl parahydroxybenzoate (see leaflet for further information).
Croatian: Sadrži natrijev etilparahidroksibeznoat i natrijev propilparahidroksibenzoat (vidjeti uputu o lijeku za dodatne informacije).
English: VEPESID and associated names should be terminated immediately, followed by the administration of pressor agents, corticosteroids, antihistamines, or volume expanders at the discretion of the physician.
Croatian: Odmah treba prekinuti primjenu VEPESIDA i pridruženih imena i nakon toga primijeniti presorne lijekove, kortikosteroide, antihistaminike ili ekspandere volumena, prema odluci liječnika.
English: Granulocyte and platelet nadirs tend to occur about 10 to 14 days after administration of etoposide depending on the way of administration and treatment scheme.
Croatian: Najniže vrijednosti broja granulocita i trombocita javljaju se za 10 do 14 dana nakon primjene etopozida, ovisno o putu primjene i terapijskoj shemi.
English: Other medicines and VEPESID and associated names
Croatian: Drugi lijekovi i VEPESID i pridružena imena
English: Do not take VEPESID and associated names
Croatian: Nemojte uzimati VEPESID i pridružena imena
English: Date of latest renewal: {DD month YYYY}> [To be completed nationally]
Croatian: Datum prvog odobrenja: <{DD mjesec GGGG}> Datum zadnje obnove: <{DD mjesec GGGG}>
English: Neutropenia and thrombocytopenia
Croatian: Neutropenija i trombocitopenija
English: The capsule shell contain gelatin (E441), glycerol (85 per cent) (E422), red iron oxide (E172), sodium ethyl parahydroxybenzoate (E215), sodium propyl parahydroxybenzoate (E217) and titanium dioxide (E171).
Croatian: Kapsula sadrži želatinu (E441), glicerol (85 postotni) (E422), crveni željezov oksid (E172), natrijev etilparahidroksibenzoat (E215), natrijev propilparahidroksibenzoat (E217) i titanijev dioksid (E171).
English: Etoposide, therefore, is cleared by both renal and nonrenal processes, ie, metabolism and biliary excretion.
Croatian: Etopozid se, stoga, eliminira kako putem bubrega, tako i nebubrežnim procesima, tj. metabolizmom i izlučivanjem putem žuči.
English: If you have any further questions on the use of this medicine, ask your Doctor or Pharmacist.
Croatian: U slučaju bilo kakvih pitanja u vezi s primjenom ovog lijeka, obratite se liječniku ili ljekarniku.
English: There is the potential for serious adverse reactions in nursing infants from VEPESID and associated names.
Croatian: Postoji mogućnost ozbiljnih nuspojava VEPESIDA i pridruženih imena kod dojenčadi.
English: - if you are taking phenytoin or any other medicines used to treat epilepsy.
Croatian: - ako uzimate fenitoin ili druge lijekove za liječenje epilepsije. - ako uzimate varfarin (lijek koji se koristi za sprječavanje zgrušavanja krvi).
English: Patients should not begin a new cycle of treatment with VEPESID and associated names if the neutrophil count is less than 1,500 cells/mm or the platelet count is less than 100,000 cells/mm unless caused by malignant disease.
Croatian: Bolesnici ne smiju započinjati novi ciklus liječenja VEPESIDOM i pridruženim imenima ako je broj neutrofila manji od 1500 stanica/mm3 ili ako je broj trombocita manji od 100 000 stanica/mm3, osim ako je to uzrokovano malignom bolešću.
English: - If you are breast-feeding or planning to breast-feed.
Croatian: - ako dojite ili planirate dojiti
English: INFORMATION IN BRAILLE [To be completed nationally]
Croatian: 16. PODACI NA BRAILLEOVOM PISMU [Ispunjava država članica]
English: Chronic toxicity
Croatian: Kronična toksičnost
English: Blood and lymphatic system disorders very common anaemia , leucopenia, myelosuppression*, neutropenia, thrombocytopenia
Croatian: Poremećaji krvi i limfnog sustava vrlo često anemija, leukopenija, mijelosupresija*, neutropenija, trombocitopenija
English: The usual dose of VEPESID and associated names administered orally is 100 to 200 mg/m2/day on days 1 to 5 or 200 mg/m2/day on days 1, 3 and 5 every 3 to 4 weeks.
Croatian: Uobičajena doza VEPESIDA i pridruženih imena kod peroralne primjene je 100 do 200 mg/m2/dan od 1. do 5. dana ili 200 mg/m2/dan primijenjeno 1., 3. i 5. dana svaka 3 do 4 tjedna.
English: Cardiac disorders common arrythmia, myocardial infarction
Croatian: Srčani poremećaji često aritmija, infarkt miokarda
English: Etoposide is excreted in human milk.
Croatian: Etopozid se izlučuje u majčinom mlijeku kod ljudi.
English: Each capsule contains etoposide 50 mg or 100 mg as the active ingredient.
Croatian: Jedna kapsula sadrži 50 mg ili 100 mg etopozida kao djelatnu tvar.
English: Within-patient variability
Croatian: Varijabilnost unutar pojedinog bolesnika