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Вред и польза назальных деконгестантов: пути снижения рисков
Вред и польза назальных деконгестантов: пути снижения рисков
Поляков Д.П. Вред и польза назальных деконгестантов: пути снижения рисков. Consilium Medicum. 2015; 17 (11): 94–98. DOI:10.26442/2075-1753_2015.11.94-98
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Аннотация
Назальные деконгестанты остаются одними из самых часто назначаемых средств при большинстве заболеваний полости носа и смежных анатомических областей. Несмотря на высокую эффективность, их применение сопряжено с рядом побочных эффектов и нежелательных явлений (цито- и цилиотоксическое действие, системные симпатомиметические эффекты, эффект «рикошета», медикаментозный ринит). Одним из способов снижения риска описанных эффектов является использование комбинированных препаратов, включающих α2-адреномиметики и декспантенол. В статье приводится обзор исследований по оценке эффективности подобной комбинированной терапии и других способов минимизации побочных эффектов местных сосудосуживающих средств.
Ключевые слова: назальные деконгестанты, сосудосуживающие препараты, декспантенол, ксилометазолин.
Ключевые слова: назальные деконгестанты, сосудосуживающие препараты, декспантенол, ксилометазолин.
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Nasal decongestants are still one of the most frequently prescribed drugs in different pathology of the nose and the nearest anatomical regions. Despite of they high effectiveness there are many side effects (cito- and ciliotoxity, systemic sympathomimetic effects, reboud-effect, rhinitis medicamentosa). One of the ways to decrease the side effects is the use of combined medication included alpha-2-adrenomymetics and dexpanthenol. The paper is the review of clinical trails on the effectiveness of such a combined therapy and other methods to minimize the side effects of nasal decongestants.
Key words: nasal decongestants, vasoconstrictors, dexpanthenol, xylometazoline.
Key words: nasal decongestants, vasoconstrictors, dexpanthenol, xylometazoline.
Полный текст
Список литературы
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2. Naclerio RM, Bachert C, Baraniuk JN. Pathophysiology of nasal congestion. Int J Gen Med 2010; 3: 47–57.
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9. Coleman C, Moore M. Decongestants and antihistamines for acute otitis media in children. Cochrane Database Syst Rev 2008; 3: CD001727.
10. Griffin G, Flynn CA. Antihistamines and/or decongestants for otitis media with effusion (OME) in children. Cochrane Database Syst Rev 2011; 9: CD003423.
11. Hofmann T, Wolf G, Koidl B. In vitro studies of the effect of vasoconstrictor nose drops on ciliary epithelium of human nasal mucosa. Laryngorhinootologie 1995; 74 (9): 564–7.
12. Mickenhagen A, Siefer O, Neugebauer P, Stennert E. The influence of different alpha-sympathomimetic drugs and benzalkoniumchlorid on the ciliary beat frequency of in vitro cultured human nasal mucosa cells. Laryngorhinootologie 2008; 87 (1): 30–8.
13. Graf P, Hallen H. Effect on the nasal mucosaof long-term treatment with oxymetasoline, bensalconium chloride, and placebo nasal sprays. Laryngoscope 1996; 106 (5. Pt 1): 605–9.
14. Knipping S, Holzhausen HJ, Riederer A, Bloching M. Ultrastructural changes in human nasal mucosa in rhinitis medicamentosa. HNO 2006; 54 (10): 742–8.
15. Кунельская Н.Л., Царапкин Г.Ю., Артемьев М.Е. и др. Консервативное лечение химического повреждения. Медицинский совет. 2013; 3: 63–4. / Kunel'skaia N.L., Tsarapkin G.Iu., Artem'ev M.E. i dr. Konservativnoe lechenie khimicheskogo povrezhdeniia. Meditsinskii sovet. 2013; 3: 63–4. [in Russian]
16. Proctor DW, Adams GK. Physiology and pharmacology of nasal function and mucous secretion. Pharmacol Ther Bull 1976; 2: 493–509.
17. Montalban J, Ibanez L, Rodriguez C et al. Cerebral infarction after excessive use of nasal decongestants. J Neurol Neurosurg Psychiatry 1989; 52: 541–3.
18. Wenzel S, Sagowski C, Laux G et al. Course and therapy of intoxication with imidazoline derivate naphazoline. Int J Pediatr Otorhinolaryngol 2004; 68 (7): 979–83.
19. Калашникова О.В., Челпаченко О.Е. Клинико-лабораторная характеристика отравлений топическими деконгестантами у детей. Вестн. ОГУ. 2013; 9 (158): 96–9. / Kalashnikova O.V., Chelpachenko O.E. Kliniko-laboratornaia kharakteristika otravlenii topicheskimi dekongestantami u detei. Vestn. OGU. 2013; 9 (158): 96–9. [in Russian]
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21. Hosemann W, Wigand ME, Göde U et al. Normal wound healing of the paranasal sinuses: clinical and experimental investigations. Eur Arch Otorhinolaryngol 1991; 248 (7): 390–4.
22. Verse T, Klöcker N, Riedel F et al. Dexpanthenol nasal spray in comparison to dexpanthenol nasal ointment. A prospective, randomised, open, cross-over study to compare nasal mucociliary clearance. HNO 2004; 52 (7): 611–5.
23. Klocker N, Verse T, Rudolph P. The protective effect of dexpanthenol in nasal sprays and ciliary-toxic studies in vitro. Laryngorhinootologie 2003; 82 (3): 177–82.
24. Klocker N, Rudolph P, Verse T. Evaluation of protective and therapeutic effect of dexpanthenol on nasal decongestants and preservatives: results of cytotoxic studies in vitro. Am J Rhinol 2004; 18 (5): 315–20.
25. Kehrl W, Sonnemann U, Dethlefsen U. Advance in therapy of acute rhinitis – comparison of efficacy and safety of xylometazoline in combination xylometazoline-dexpanthenol in patients with acute rhinitis. Laryngorhinootologie 2003; 82 (4): 266–71.
26. Jagade Mahan V, Langade Deepak G, Pophale Rupesh R, Prabhu Arun. Oxymetazolyn and dexpanthenol in nasal congestion. Indian J Otolaryngol Head Neck Surg. 2008; 60: 393–7.
27. Kehrl W, Sonnemann U. Dexpanthenol nasal spray as an effective therapeutic principle for treatment of rhinitis sicca anterior. Laryngorhinootologie 1998; 77 (9): 506–12.
28. Kehrl W, Sonnemann U. Improving wound healing after nose surgery by combined flvinistration of xylometazoline and dexpanthenol. Laryngorhinootologie 2000; 79 (3): 151–4.
2. Naclerio RM, Bachert C, Baraniuk JN. Pathophysiology of nasal congestion. Int J Gen Med 2010; 3: 47–57.
3. Lopatin A.S. Nazal'nye dekongestanty: starye preparaty i novye formy. Doktor.ru. 2011; 6 (65): 17–23. [in Russian]
4. http://www.imshealth.com
5. Bénard-Laribière A, Jové J, Lassalle R et al. Drug use in French children: a population-based study. Arch Dis Child 2015. pii: archdischild-2014-307224
6. http://glav-otolar/documents
7. Lopatin A.S. Rinit. M.: Litterra, 2010. [in Russian]
8. Shaikh N, Wald ER. Decongestants, antihistamines and nasal irrigation for acute sinusitis in children. Cochrane Database Syst Rev 2014; 10: CD007909.
9. Coleman C, Moore M. Decongestants and antihistamines for acute otitis media in children. Cochrane Database Syst Rev 2008; 3: CD001727.
10. Griffin G, Flynn CA. Antihistamines and/or decongestants for otitis media with effusion (OME) in children. Cochrane Database Syst Rev 2011; 9: CD003423.
11. Hofmann T, Wolf G, Koidl B. In vitro studies of the effect of vasoconstrictor nose drops on ciliary epithelium of human nasal mucosa. Laryngorhinootologie 1995; 74 (9): 564–7.
12. Mickenhagen A, Siefer O, Neugebauer P, Stennert E. The influence of different alpha-sympathomimetic drugs and benzalkoniumchlorid on the ciliary beat frequency of in vitro cultured human nasal mucosa cells. Laryngorhinootologie 2008; 87 (1): 30–8.
13. Graf P, Hallen H. Effect on the nasal mucosaof long-term treatment with oxymetasoline, bensalconium chloride, and placebo nasal sprays. Laryngoscope 1996; 106 (5. Pt 1): 605–9.
14. Knipping S, Holzhausen HJ, Riederer A, Bloching M. Ultrastructural changes in human nasal mucosa in rhinitis medicamentosa. HNO 2006; 54 (10): 742–8.
15. Kunel'skaia N.L., Tsarapkin G.Iu., Artem'ev M.E. i dr. Konservativnoe lechenie khimicheskogo povrezhdeniia. Meditsinskii sovet. 2013; 3: 63–4. [in Russian]
16. Proctor DW, Adams GK. Physiology and pharmacology of nasal function and mucous secretion. Pharmacol Ther Bull 1976; 2: 493–509.
17. Montalban J, Ibanez L, Rodriguez C et al. Cerebral infarction after excessive use of nasal decongestants. J Neurol Neurosurg Psychiatry 1989; 52: 541–3.
18. Wenzel S, Sagowski C, Laux G et al. Course and therapy of intoxication with imidazoline derivate naphazoline. Int J Pediatr Otorhinolaryngol 2004; 68 (7): 979–83.
19. Kalashnikova O.V., Chelpachenko O.E. Kliniko-laboratornaia kharakteristika otravlenii topicheskimi dekongestantami u detei. Vestn. OGU. 2013; 9 (158): 96–9. [in Russian]
20. Hosemann W, Göde U, Länger F, Wigand ME. Experimental studies of wound healing in the paranasal sinuses. II. Spontaneous wound healing and drug effects in a standardized wound model. HNO 1991; 39 (2): 48–54.
21. Hosemann W, Wigand ME, Göde U et al. Normal wound healing of the paranasal sinuses: clinical and experimental investigations. Eur Arch Otorhinolaryngol 1991; 248 (7): 390–4.
22. Verse T, Klöcker N, Riedel F et al. Dexpanthenol nasal spray in comparison to dexpanthenol nasal ointment. A prospective, randomised, open, cross-over study to compare nasal mucociliary clearance. HNO 2004; 52 (7): 611–5.
23. Klocker N, Verse T, Rudolph P. The protective effect of dexpanthenol in nasal sprays and ciliary-toxic studies in vitro. Laryngorhinootologie 2003; 82 (3): 177–82.
24. Klocker N, Rudolph P, Verse T. Evaluation of protective and therapeutic effect of dexpanthenol on nasal decongestants and preservatives: results of cytotoxic studies in vitro. Am J Rhinol 2004; 18 (5): 315–20.
25. Kehrl W, Sonnemann U, Dethlefsen U. Advance in therapy of acute rhinitis – comparison of efficacy and safety of xylometazoline in combination xylometazoline-dexpanthenol in patients with acute rhinitis. Laryngorhinootologie 2003; 82 (4): 266–71.
26. Jagade Mahan V, Langade Deepak G, Pophale Rupesh R, Prabhu Arun. Oxymetazolyn and dexpanthenol in nasal congestion. Indian J Otolaryngol Head Neck Surg. 2008; 60: 393–7.
27. Kehrl W, Sonnemann U. Dexpanthenol nasal spray as an effective therapeutic principle for treatment of rhinitis sicca anterior. Laryngorhinootologie 1998; 77 (9): 506–12.
28. Kehrl W, Sonnemann U. Improving wound healing after nose surgery by combined flvinistration of xylometazoline and dexpanthenol. Laryngorhinootologie 2000; 79 (3): 151–4.
2. Naclerio RM, Bachert C, Baraniuk JN. Pathophysiology of nasal congestion. Int J Gen Med 2010; 3: 47–57.
3. Лопатин А.С. Назальные деконгестанты: старые препараты и новые формы. Доктор.ру. 2011; 6 (65): 17–23. / Lopatin A.S. Nazal'nye dekongestanty: starye preparaty i novye formy. Doktor.ru. 2011; 6 (65): 17–23. [in Russian]
4. http://www.imshealth.com
5. Bénard-Laribière A, Jové J, Lassalle R et al. Drug use in French children: a population-based study. Arch Dis Child 2015. pii: archdischild-2014-307224
6. http://glav-otolar/documents
7. Лопатин А.С. Ринит. М.: Литтерра, 2010. / Lopatin A.S. Rinit. M.: Litterra, 2010. [in Russian]
8. Shaikh N, Wald ER. Decongestants, antihistamines and nasal irrigation for acute sinusitis in children. Cochrane Database Syst Rev 2014; 10: CD007909.
9. Coleman C, Moore M. Decongestants and antihistamines for acute otitis media in children. Cochrane Database Syst Rev 2008; 3: CD001727.
10. Griffin G, Flynn CA. Antihistamines and/or decongestants for otitis media with effusion (OME) in children. Cochrane Database Syst Rev 2011; 9: CD003423.
11. Hofmann T, Wolf G, Koidl B. In vitro studies of the effect of vasoconstrictor nose drops on ciliary epithelium of human nasal mucosa. Laryngorhinootologie 1995; 74 (9): 564–7.
12. Mickenhagen A, Siefer O, Neugebauer P, Stennert E. The influence of different alpha-sympathomimetic drugs and benzalkoniumchlorid on the ciliary beat frequency of in vitro cultured human nasal mucosa cells. Laryngorhinootologie 2008; 87 (1): 30–8.
13. Graf P, Hallen H. Effect on the nasal mucosaof long-term treatment with oxymetasoline, bensalconium chloride, and placebo nasal sprays. Laryngoscope 1996; 106 (5. Pt 1): 605–9.
14. Knipping S, Holzhausen HJ, Riederer A, Bloching M. Ultrastructural changes in human nasal mucosa in rhinitis medicamentosa. HNO 2006; 54 (10): 742–8.
15. Кунельская Н.Л., Царапкин Г.Ю., Артемьев М.Е. и др. Консервативное лечение химического повреждения. Медицинский совет. 2013; 3: 63–4. / Kunel'skaia N.L., Tsarapkin G.Iu., Artem'ev M.E. i dr. Konservativnoe lechenie khimicheskogo povrezhdeniia. Meditsinskii sovet. 2013; 3: 63–4. [in Russian]
16. Proctor DW, Adams GK. Physiology and pharmacology of nasal function and mucous secretion. Pharmacol Ther Bull 1976; 2: 493–509.
17. Montalban J, Ibanez L, Rodriguez C et al. Cerebral infarction after excessive use of nasal decongestants. J Neurol Neurosurg Psychiatry 1989; 52: 541–3.
18. Wenzel S, Sagowski C, Laux G et al. Course and therapy of intoxication with imidazoline derivate naphazoline. Int J Pediatr Otorhinolaryngol 2004; 68 (7): 979–83.
19. Калашникова О.В., Челпаченко О.Е. Клинико-лабораторная характеристика отравлений топическими деконгестантами у детей. Вестн. ОГУ. 2013; 9 (158): 96–9. / Kalashnikova O.V., Chelpachenko O.E. Kliniko-laboratornaia kharakteristika otravlenii topicheskimi dekongestantami u detei. Vestn. OGU. 2013; 9 (158): 96–9. [in Russian]
20. Hosemann W, Göde U, Länger F, Wigand ME. Experimental studies of wound healing in the paranasal sinuses. II. Spontaneous wound healing and drug effects in a standardized wound model. HNO 1991; 39 (2): 48–54.
21. Hosemann W, Wigand ME, Göde U et al. Normal wound healing of the paranasal sinuses: clinical and experimental investigations. Eur Arch Otorhinolaryngol 1991; 248 (7): 390–4.
22. Verse T, Klöcker N, Riedel F et al. Dexpanthenol nasal spray in comparison to dexpanthenol nasal ointment. A prospective, randomised, open, cross-over study to compare nasal mucociliary clearance. HNO 2004; 52 (7): 611–5.
23. Klocker N, Verse T, Rudolph P. The protective effect of dexpanthenol in nasal sprays and ciliary-toxic studies in vitro. Laryngorhinootologie 2003; 82 (3): 177–82.
24. Klocker N, Rudolph P, Verse T. Evaluation of protective and therapeutic effect of dexpanthenol on nasal decongestants and preservatives: results of cytotoxic studies in vitro. Am J Rhinol 2004; 18 (5): 315–20.
25. Kehrl W, Sonnemann U, Dethlefsen U. Advance in therapy of acute rhinitis – comparison of efficacy and safety of xylometazoline in combination xylometazoline-dexpanthenol in patients with acute rhinitis. Laryngorhinootologie 2003; 82 (4): 266–71.
26. Jagade Mahan V, Langade Deepak G, Pophale Rupesh R, Prabhu Arun. Oxymetazolyn and dexpanthenol in nasal congestion. Indian J Otolaryngol Head Neck Surg. 2008; 60: 393–7.
27. Kehrl W, Sonnemann U. Dexpanthenol nasal spray as an effective therapeutic principle for treatment of rhinitis sicca anterior. Laryngorhinootologie 1998; 77 (9): 506–12.
28. Kehrl W, Sonnemann U. Improving wound healing after nose surgery by combined flvinistration of xylometazoline and dexpanthenol. Laryngorhinootologie 2000; 79 (3): 151–4.
________________________________________________
2. Naclerio RM, Bachert C, Baraniuk JN. Pathophysiology of nasal congestion. Int J Gen Med 2010; 3: 47–57.
3. Lopatin A.S. Nazal'nye dekongestanty: starye preparaty i novye formy. Doktor.ru. 2011; 6 (65): 17–23. [in Russian]
4. http://www.imshealth.com
5. Bénard-Laribière A, Jové J, Lassalle R et al. Drug use in French children: a population-based study. Arch Dis Child 2015. pii: archdischild-2014-307224
6. http://glav-otolar/documents
7. Lopatin A.S. Rinit. M.: Litterra, 2010. [in Russian]
8. Shaikh N, Wald ER. Decongestants, antihistamines and nasal irrigation for acute sinusitis in children. Cochrane Database Syst Rev 2014; 10: CD007909.
9. Coleman C, Moore M. Decongestants and antihistamines for acute otitis media in children. Cochrane Database Syst Rev 2008; 3: CD001727.
10. Griffin G, Flynn CA. Antihistamines and/or decongestants for otitis media with effusion (OME) in children. Cochrane Database Syst Rev 2011; 9: CD003423.
11. Hofmann T, Wolf G, Koidl B. In vitro studies of the effect of vasoconstrictor nose drops on ciliary epithelium of human nasal mucosa. Laryngorhinootologie 1995; 74 (9): 564–7.
12. Mickenhagen A, Siefer O, Neugebauer P, Stennert E. The influence of different alpha-sympathomimetic drugs and benzalkoniumchlorid on the ciliary beat frequency of in vitro cultured human nasal mucosa cells. Laryngorhinootologie 2008; 87 (1): 30–8.
13. Graf P, Hallen H. Effect on the nasal mucosaof long-term treatment with oxymetasoline, bensalconium chloride, and placebo nasal sprays. Laryngoscope 1996; 106 (5. Pt 1): 605–9.
14. Knipping S, Holzhausen HJ, Riederer A, Bloching M. Ultrastructural changes in human nasal mucosa in rhinitis medicamentosa. HNO 2006; 54 (10): 742–8.
15. Kunel'skaia N.L., Tsarapkin G.Iu., Artem'ev M.E. i dr. Konservativnoe lechenie khimicheskogo povrezhdeniia. Meditsinskii sovet. 2013; 3: 63–4. [in Russian]
16. Proctor DW, Adams GK. Physiology and pharmacology of nasal function and mucous secretion. Pharmacol Ther Bull 1976; 2: 493–509.
17. Montalban J, Ibanez L, Rodriguez C et al. Cerebral infarction after excessive use of nasal decongestants. J Neurol Neurosurg Psychiatry 1989; 52: 541–3.
18. Wenzel S, Sagowski C, Laux G et al. Course and therapy of intoxication with imidazoline derivate naphazoline. Int J Pediatr Otorhinolaryngol 2004; 68 (7): 979–83.
19. Kalashnikova O.V., Chelpachenko O.E. Kliniko-laboratornaia kharakteristika otravlenii topicheskimi dekongestantami u detei. Vestn. OGU. 2013; 9 (158): 96–9. [in Russian]
20. Hosemann W, Göde U, Länger F, Wigand ME. Experimental studies of wound healing in the paranasal sinuses. II. Spontaneous wound healing and drug effects in a standardized wound model. HNO 1991; 39 (2): 48–54.
21. Hosemann W, Wigand ME, Göde U et al. Normal wound healing of the paranasal sinuses: clinical and experimental investigations. Eur Arch Otorhinolaryngol 1991; 248 (7): 390–4.
22. Verse T, Klöcker N, Riedel F et al. Dexpanthenol nasal spray in comparison to dexpanthenol nasal ointment. A prospective, randomised, open, cross-over study to compare nasal mucociliary clearance. HNO 2004; 52 (7): 611–5.
23. Klocker N, Verse T, Rudolph P. The protective effect of dexpanthenol in nasal sprays and ciliary-toxic studies in vitro. Laryngorhinootologie 2003; 82 (3): 177–82.
24. Klocker N, Rudolph P, Verse T. Evaluation of protective and therapeutic effect of dexpanthenol on nasal decongestants and preservatives: results of cytotoxic studies in vitro. Am J Rhinol 2004; 18 (5): 315–20.
25. Kehrl W, Sonnemann U, Dethlefsen U. Advance in therapy of acute rhinitis – comparison of efficacy and safety of xylometazoline in combination xylometazoline-dexpanthenol in patients with acute rhinitis. Laryngorhinootologie 2003; 82 (4): 266–71.
26. Jagade Mahan V, Langade Deepak G, Pophale Rupesh R, Prabhu Arun. Oxymetazolyn and dexpanthenol in nasal congestion. Indian J Otolaryngol Head Neck Surg. 2008; 60: 393–7.
27. Kehrl W, Sonnemann U. Dexpanthenol nasal spray as an effective therapeutic principle for treatment of rhinitis sicca anterior. Laryngorhinootologie 1998; 77 (9): 506–12.
28. Kehrl W, Sonnemann U. Improving wound healing after nose surgery by combined flvinistration of xylometazoline and dexpanthenol. Laryngorhinootologie 2000; 79 (3): 151–4.
Авторы
Д.П.Поляков
ФГБУ Научно-клинический центр оториноларингологии ФМБА России. 123182, Россия, Москва, Волоколамское ш., д. 30, корп. 2
child.lor@yandex.ru
ФГБУ Научно-клинический центр оториноларингологии ФМБА России. 123182, Россия, Москва, Волоколамское ш., д. 30, корп. 2
child.lor@yandex.ru
________________________________________________
D.P.Polyakov
Research and Clinical Center of Otorhinolaryngology. 123182, Russian Federation, Moscow, Volokolamskoe sh., d. 30, korp. 2
child.lor@yandex.ru
Research and Clinical Center of Otorhinolaryngology. 123182, Russian Federation, Moscow, Volokolamskoe sh., d. 30, korp. 2
child.lor@yandex.ru
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