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Дилтиазем при фибрилляции предсердий: эффективность, безопасность, лекарствосберегающие свойства
Дилтиазем при фибрилляции предсердий: эффективность, безопасность, лекарствосберегающие свойства
Бельдиев С.Н. Дилтиазем при фибрилляции предсердий: эффективность, безопасность, лекарствосберегающие свойства. Consilium Medicum. 2015; 17 (10): 45–49. DOI: 10.26442/2075-1753_2015.10.45-48
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Аннотация
В статье обсуждается современный алгоритм выбора лекарственных средств для контроля частоты сердечных сокращений при фибрилляции предсердий. Показано, что его использование в клинической практике может приводить к избыточному назначению дигоксина и b-адреноблокаторов по сравнению с недигидропиридиновыми АК. Представлен модифицированный алгоритм, расширяющий показания к применению дилтиазема. Обосновывается целесообразность комбинированного применения дилтиазема с апиксабаном для снижения затрат на антикоагулянтную терапию.
Ключевые слова: фибрилляция предсердий, дилтиазем, b-адреноблокаторы, дигоксин, апиксабан.
Ключевые слова: фибрилляция предсердий, дилтиазем, b-адреноблокаторы, дигоксин, апиксабан.
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The article discusses current algorithm for choice of drugs for rate control in atrial fibrillation. It is shown that algorithm use in clinical practice may lead to excessive prescribing of digoxin and b-blockers compared to non-dihydropyridine calcium antagonists. A modified algorithm is proposed to extend indications for use of diltiazem. A rationale is provided for diltiazem-apixaban combination to reduce the cost of anticoagulation therapy.
Key words: atrial fibrillation, diltiazem, b-blockers, digoxin, apixaban.
Key words: atrial fibrillation, diltiazem, b-blockers, digoxin, apixaban.
Полный текст
Список литературы
1. Национальные рекомендации по диагностике и лечению фибрилляции предсердий. 2012. http://www.scardio.ru/content/Guidelines/FP_rkj_13.pdf / Natsional'nye rekomendatsii po diagnostike i lecheniiu fibrilliatsii predserdii. 2012. http://www.scardio.ru/content/Guidelines/FP_rkj_13.pdf [in Russian]
2. Vaughan-Sarrazin MS, Mazur A, Chrischilles E, Cram P. Trends in the pharmacologic management of atrial fibrillation: Data from the Veterans Affairs health system. Am Heart J 2014; 168 (1): 53–9.e1.
3. Lip GY, Laroche C, Dan GA et al. A prospective survey in European Society of Cardiology member countries of atrial fibrillation management: baseline results of EURObservational Research Programme Atrial Fibrillation (EORP-AF) Pilot General Registry. Europace 2014; 16: 308–19.
4. Kotecha D, Holmes J, Krum H et al. on behalf of the Beta-Blockers in Heart Failure Collaborative Group. Efficacy of b blockers in patients with heart failure plus atrial fibrillation: an individual-patient data meta-analysis. Lancet 2014; 384: 2235–43.
5. Farshi R, Kistner D, Sarma JS et al. Ventricular rate control in chronic atrial fibrillation during daily activity and programmed exercise: a crossover open-label study of five drug regimens. J Am Coll Cardiol 1999; 33: 304–10.
6. Rathore SS, Curtis JP, Wang Y et al. Association of serum digoxin concentration and outcomes in patients with heart failure. JAMA 2003; 289: 871–8.
7. Khan SS, Gheorghiade M. Digoxin use in atrial fibrillation: a critical reappraisal. Lancet 2015; 385: 2330–2.
8. Bauman JL, DiDomenico RJ, Viana M, Fitch M. A method of determining the dose of digoxin for heart failure in the modern era. Arch Intern Med 2006; 166: 2539–45.
9. Bangalore S, Makani H, Radford M et al. Clinical outcomes with b-blockers for myocardial infarction: a meta-analysis of randomized trials. Am J Med 2014; 127: 939–53.
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11. Hansson L, Hedner T, Lund-Johansen P et al. Randomised trial of effects of calcium antagonists compared with diuretics and beta-blockers on cardiovascular morbidity and mortality in hypertension: the Nordic Diltiazem (NORDIL) study. Lancet 2000; 356: 359–65.
12. Skanes AC, Healey JS, Cairns JA et al. Focused 2012 update of the Canadian Cardiovascular Society atrial fibrillation guidelines: recommendations for stroke prevention and rate/rhythm control. Can J Cardiol 2012; 28: 125–36.
13. Ulimoen SR, Enger S, Carlson J et al. Comparison of four single-drug regimens on ventricular rate and arrhythmia-related symptoms in patients with permanent atrial fibrillation. Am J Cardiol 2013; 111: 225–30.
14. Ulimoen SR, Enger S, Pripp AH et al. Calcium channel blockers improve exercise capacity and reduce N-terminal Pro-B-type natriuretic peptide levels compared with beta-blockers in patients with permanent atrial fibrillation. Eur Heart J 2014; 35: 517–24.
15. National Clinical Guideline Centre (UK). Atrial fibrillation: The management of atrial fibrillation. London: National Institute for Health and Care Excellence (UK), 2014. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0068959/pdf/TOC.pdf
16. Frost CE, Byon W, Song Y et al. Effect of ketoconazole and diltiazem on the pharmacokinetics of apixaban, an oral direct factor Xa inhibitor. Br J Clin Pharmacol 2015; 79: 838–46.
17. Food and Drug Administration. ELIQUIS (apixaban) tablets for oral use. http://www.accessdata.fda.gov/drugsatfda_docs/label/2014/202155s006lbl.pdf
18. Food and Drug Administration: Center for drug evaluation and research. Apixaban (Eliquis): clinical pharmacology and biopharmaceutical review. http://www.accessdata.fda.gov/drugsatfda_docs/nda/2012/202155Orig1s000ClinPharmR.pdf
19. ФАРМ-индекс – российский фармпортал, цены в аптеках, наличие лекарств на рынке. http://www.pharmindex.ru / FARM-indeks – rossiiskii farmportal, tseny v aptekakh, nalichie lekarstv na rynke. http://www.pharmindex.ru [in Russian]
20. Martin JE, Daoud AJ, Schroeder TJ, First MR. The clinical and economic potential of cyclosporin drug interactions. Pharmacoeconomics 1999; 15: 317–37.
2. Vaughan-Sarrazin MS, Mazur A, Chrischilles E, Cram P. Trends in the pharmacologic management of atrial fibrillation: Data from the Veterans Affairs health system. Am Heart J 2014; 168 (1): 53–9.e1.
3. Lip GY, Laroche C, Dan GA et al. A prospective survey in European Society of Cardiology member countries of atrial fibrillation management: baseline results of EURObservational Research Programme Atrial Fibrillation (EORP-AF) Pilot General Registry. Europace 2014; 16: 308–19.
4. Kotecha D, Holmes J, Krum H et al. on behalf of the Beta-Blockers in Heart Failure Collaborative Group. Efficacy of b blockers in patients with heart failure plus atrial fibrillation: an individual-patient data meta-analysis. Lancet 2014; 384: 2235–43.
5. Farshi R, Kistner D, Sarma JS et al. Ventricular rate control in chronic atrial fibrillation during daily activity and programmed exercise: a crossover open-label study of five drug regimens. J Am Coll Cardiol 1999; 33: 304–10.
6. Rathore SS, Curtis JP, Wang Y et al. Association of serum digoxin concentration and outcomes in patients with heart failure. JAMA 2003; 289: 871–8.
7. Khan SS, Gheorghiade M. Digoxin use in atrial fibrillation: a critical reappraisal. Lancet 2015; 385: 2330–2.
8. Bauman JL, DiDomenico RJ, Viana M, Fitch M. A method of determining the dose of digoxin for heart failure in the modern era. Arch Intern Med 2006; 166: 2539–45.
9. Bangalore S, Makani H, Radford M et al. Clinical outcomes with b-blockers for myocardial infarction: a meta-analysis of randomized trials. Am J Med 2014; 127: 939–53.
10. Messerli FH, Hansen JF, Gibson RS et al. Heart rate-lowering calcium antagonists in hypertensive post-myocardial infarction patients. J Hypertens 2001; 19: 977–82.
11. Hansson L, Hedner T, Lund-Johansen P et al. Randomised trial of effects of calcium antagonists compared with diuretics and beta-blockers on cardiovascular morbidity and mortality in hypertension: the Nordic Diltiazem (NORDIL) study. Lancet 2000; 356: 359–65.
12. Skanes AC, Healey JS, Cairns JA et al. Focused 2012 update of the Canadian Cardiovascular Society atrial fibrillation guidelines: recommendations for stroke prevention and rate/rhythm control. Can J Cardiol 2012; 28: 125–36.
13. Ulimoen SR, Enger S, Carlson J et al. Comparison of four single-drug regimens on ventricular rate and arrhythmia-related symptoms in patients with permanent atrial fibrillation. Am J Cardiol 2013; 111: 225–30.
14. Ulimoen SR, Enger S, Pripp AH et al. Calcium channel blockers improve exercise capacity and reduce N-terminal Pro-B-type natriuretic peptide levels compared with beta-blockers in patients with permanent atrial fibrillation. Eur Heart J 2014; 35: 517–24.
15. National Clinical Guideline Centre (UK). Atrial fibrillation: The management of atrial fibrillation. London: National Institute for Health and Care Excellence (UK), 2014. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0068959/pdf/TOC.pdf
16. Frost CE, Byon W, Song Y et al. Effect of ketoconazole and diltiazem on the pharmacokinetics of apixaban, an oral direct factor Xa inhibitor. Br J Clin Pharmacol 2015; 79: 838–46.
17. Food and Drug Administration. ELIQUIS (apixaban) tablets for oral use. http://www.accessdata.fda.gov/drugsatfda_docs/label/2014/202155s006lbl.pdf
18. Food and Drug Administration: Center for drug evaluation and research. Apixaban (Eliquis): clinical pharmacology and biopharmaceutical review. http://www.accessdata.fda.gov/drugsatfda_docs/nda/2012/202155Orig1s000ClinPharmR.pdf
19. FARM-indeks – rossiiskii farmportal, tseny v aptekakh, nalichie lekarstv na rynke. http://www.pharmindex.ru [in Russian]
20. Martin JE, Daoud AJ, Schroeder TJ, First MR. The clinical and economic potential of cyclosporin drug interactions. Pharmacoeconomics 1999; 15: 317–37.
2. Vaughan-Sarrazin MS, Mazur A, Chrischilles E, Cram P. Trends in the pharmacologic management of atrial fibrillation: Data from the Veterans Affairs health system. Am Heart J 2014; 168 (1): 53–9.e1.
3. Lip GY, Laroche C, Dan GA et al. A prospective survey in European Society of Cardiology member countries of atrial fibrillation management: baseline results of EURObservational Research Programme Atrial Fibrillation (EORP-AF) Pilot General Registry. Europace 2014; 16: 308–19.
4. Kotecha D, Holmes J, Krum H et al. on behalf of the Beta-Blockers in Heart Failure Collaborative Group. Efficacy of b blockers in patients with heart failure plus atrial fibrillation: an individual-patient data meta-analysis. Lancet 2014; 384: 2235–43.
5. Farshi R, Kistner D, Sarma JS et al. Ventricular rate control in chronic atrial fibrillation during daily activity and programmed exercise: a crossover open-label study of five drug regimens. J Am Coll Cardiol 1999; 33: 304–10.
6. Rathore SS, Curtis JP, Wang Y et al. Association of serum digoxin concentration and outcomes in patients with heart failure. JAMA 2003; 289: 871–8.
7. Khan SS, Gheorghiade M. Digoxin use in atrial fibrillation: a critical reappraisal. Lancet 2015; 385: 2330–2.
8. Bauman JL, DiDomenico RJ, Viana M, Fitch M. A method of determining the dose of digoxin for heart failure in the modern era. Arch Intern Med 2006; 166: 2539–45.
9. Bangalore S, Makani H, Radford M et al. Clinical outcomes with b-blockers for myocardial infarction: a meta-analysis of randomized trials. Am J Med 2014; 127: 939–53.
10. Messerli FH, Hansen JF, Gibson RS et al. Heart rate-lowering calcium antagonists in hypertensive post-myocardial infarction patients. J Hypertens 2001; 19: 977–82.
11. Hansson L, Hedner T, Lund-Johansen P et al. Randomised trial of effects of calcium antagonists compared with diuretics and beta-blockers on cardiovascular morbidity and mortality in hypertension: the Nordic Diltiazem (NORDIL) study. Lancet 2000; 356: 359–65.
12. Skanes AC, Healey JS, Cairns JA et al. Focused 2012 update of the Canadian Cardiovascular Society atrial fibrillation guidelines: recommendations for stroke prevention and rate/rhythm control. Can J Cardiol 2012; 28: 125–36.
13. Ulimoen SR, Enger S, Carlson J et al. Comparison of four single-drug regimens on ventricular rate and arrhythmia-related symptoms in patients with permanent atrial fibrillation. Am J Cardiol 2013; 111: 225–30.
14. Ulimoen SR, Enger S, Pripp AH et al. Calcium channel blockers improve exercise capacity and reduce N-terminal Pro-B-type natriuretic peptide levels compared with beta-blockers in patients with permanent atrial fibrillation. Eur Heart J 2014; 35: 517–24.
15. National Clinical Guideline Centre (UK). Atrial fibrillation: The management of atrial fibrillation. London: National Institute for Health and Care Excellence (UK), 2014. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0068959/pdf/TOC.pdf
16. Frost CE, Byon W, Song Y et al. Effect of ketoconazole and diltiazem on the pharmacokinetics of apixaban, an oral direct factor Xa inhibitor. Br J Clin Pharmacol 2015; 79: 838–46.
17. Food and Drug Administration. ELIQUIS (apixaban) tablets for oral use. http://www.accessdata.fda.gov/drugsatfda_docs/label/2014/202155s006lbl.pdf
18. Food and Drug Administration: Center for drug evaluation and research. Apixaban (Eliquis): clinical pharmacology and biopharmaceutical review. http://www.accessdata.fda.gov/drugsatfda_docs/nda/2012/202155Orig1s000ClinPharmR.pdf
19. ФАРМ-индекс – российский фармпортал, цены в аптеках, наличие лекарств на рынке. http://www.pharmindex.ru / FARM-indeks – rossiiskii farmportal, tseny v aptekakh, nalichie lekarstv na rynke. http://www.pharmindex.ru [in Russian]
20. Martin JE, Daoud AJ, Schroeder TJ, First MR. The clinical and economic potential of cyclosporin drug interactions. Pharmacoeconomics 1999; 15: 317–37.
________________________________________________
2. Vaughan-Sarrazin MS, Mazur A, Chrischilles E, Cram P. Trends in the pharmacologic management of atrial fibrillation: Data from the Veterans Affairs health system. Am Heart J 2014; 168 (1): 53–9.e1.
3. Lip GY, Laroche C, Dan GA et al. A prospective survey in European Society of Cardiology member countries of atrial fibrillation management: baseline results of EURObservational Research Programme Atrial Fibrillation (EORP-AF) Pilot General Registry. Europace 2014; 16: 308–19.
4. Kotecha D, Holmes J, Krum H et al. on behalf of the Beta-Blockers in Heart Failure Collaborative Group. Efficacy of b blockers in patients with heart failure plus atrial fibrillation: an individual-patient data meta-analysis. Lancet 2014; 384: 2235–43.
5. Farshi R, Kistner D, Sarma JS et al. Ventricular rate control in chronic atrial fibrillation during daily activity and programmed exercise: a crossover open-label study of five drug regimens. J Am Coll Cardiol 1999; 33: 304–10.
6. Rathore SS, Curtis JP, Wang Y et al. Association of serum digoxin concentration and outcomes in patients with heart failure. JAMA 2003; 289: 871–8.
7. Khan SS, Gheorghiade M. Digoxin use in atrial fibrillation: a critical reappraisal. Lancet 2015; 385: 2330–2.
8. Bauman JL, DiDomenico RJ, Viana M, Fitch M. A method of determining the dose of digoxin for heart failure in the modern era. Arch Intern Med 2006; 166: 2539–45.
9. Bangalore S, Makani H, Radford M et al. Clinical outcomes with b-blockers for myocardial infarction: a meta-analysis of randomized trials. Am J Med 2014; 127: 939–53.
10. Messerli FH, Hansen JF, Gibson RS et al. Heart rate-lowering calcium antagonists in hypertensive post-myocardial infarction patients. J Hypertens 2001; 19: 977–82.
11. Hansson L, Hedner T, Lund-Johansen P et al. Randomised trial of effects of calcium antagonists compared with diuretics and beta-blockers on cardiovascular morbidity and mortality in hypertension: the Nordic Diltiazem (NORDIL) study. Lancet 2000; 356: 359–65.
12. Skanes AC, Healey JS, Cairns JA et al. Focused 2012 update of the Canadian Cardiovascular Society atrial fibrillation guidelines: recommendations for stroke prevention and rate/rhythm control. Can J Cardiol 2012; 28: 125–36.
13. Ulimoen SR, Enger S, Carlson J et al. Comparison of four single-drug regimens on ventricular rate and arrhythmia-related symptoms in patients with permanent atrial fibrillation. Am J Cardiol 2013; 111: 225–30.
14. Ulimoen SR, Enger S, Pripp AH et al. Calcium channel blockers improve exercise capacity and reduce N-terminal Pro-B-type natriuretic peptide levels compared with beta-blockers in patients with permanent atrial fibrillation. Eur Heart J 2014; 35: 517–24.
15. National Clinical Guideline Centre (UK). Atrial fibrillation: The management of atrial fibrillation. London: National Institute for Health and Care Excellence (UK), 2014. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0068959/pdf/TOC.pdf
16. Frost CE, Byon W, Song Y et al. Effect of ketoconazole and diltiazem on the pharmacokinetics of apixaban, an oral direct factor Xa inhibitor. Br J Clin Pharmacol 2015; 79: 838–46.
17. Food and Drug Administration. ELIQUIS (apixaban) tablets for oral use. http://www.accessdata.fda.gov/drugsatfda_docs/label/2014/202155s006lbl.pdf
18. Food and Drug Administration: Center for drug evaluation and research. Apixaban (Eliquis): clinical pharmacology and biopharmaceutical review. http://www.accessdata.fda.gov/drugsatfda_docs/nda/2012/202155Orig1s000ClinPharmR.pdf
19. FARM-indeks – rossiiskii farmportal, tseny v aptekakh, nalichie lekarstv na rynke. http://www.pharmindex.ru [in Russian]
20. Martin JE, Daoud AJ, Schroeder TJ, First MR. The clinical and economic potential of cyclosporin drug interactions. Pharmacoeconomics 1999; 15: 317–37.
Авторы
С.Н.Бельдиев
ГБОУ ВПО Тверской государственный медицинский университет Минздрава России. 170100, Россия, Тверь, ул. Советская, д. 4
beldiev@yandex.ru
ГБОУ ВПО Тверской государственный медицинский университет Минздрава России. 170100, Россия, Тверь, ул. Советская, д. 4
beldiev@yandex.ru
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S.N.Beldiev
Tver State Medical University of the Ministry of Health of the Russian Federation. 170100, Russian Federation, Tver, ul. Sovetskaja, d. 4
sbeldiev@yandex.ru
Tver State Medical University of the Ministry of Health of the Russian Federation. 170100, Russian Federation, Tver, ul. Sovetskaja, d. 4
sbeldiev@yandex.ru
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