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Современные анальгетики. Стремимся к эффективности и безопасности
Современные анальгетики. Стремимся к эффективности и безопасности
Амелин А.В. Современные анальгетики. Стремимся к эффективности и безопасности. Consilium Medicum. 2015; 17 (2): 34–35. DOI: 10.26442/2075-1753_2015.2.34-35
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Аннотация
Нестероидные противовоспалительные препараты (НПВП), метамизол (Анальгин), парацетамол (ацетаминофен), флупиртин, антиконвульсанты, антидепрессанты, местные анестетики широко применяются для лечения разных патогенетических вариантов боли. Выбирая средство для лечения боли, следует принимать во внимание наличие сопутствующих заболеваний желудочно-кишечного тракта, сердечно-сосудистой системы и т.д. В настоящее время для практикующего врача предлагается «балансирование» между гастроэнтерологической и кардиоваскулярной безопасностью НПВП или поиск препаратов вне этого класса. Флупиртин является ярким подтверждением осознанного выбора анальгетика в зависимости от особенностей клинической ситуации.
Ключевые слова: анальгетики, нестероидные противовоспалительные препараты, флупиртин.
Ключевые слова: анальгетики, нестероидные противовоспалительные препараты, флупиртин.
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Nonsteroidal anti-inflammatory drugs (NSAIDs), such as metamizole (Analgin), paracetamol (acetaminophen), flupirtine, anticonvulsants, antidepressants and local anesthetics are widely used for the treatment of different pathogenetic types of pain. Means for selecting a pain treatment should take into account the presence of concomitant diseases of the gastrointestinal tract, the cardiovascular system, etc. Currently, the medical practitioner is required to «balance» between gastroenterology and cardiovascular safety of NSAIDs or search for drugs outside of this class. Flupirtine is a proof of informed choice of analgesic depending on the particular clinical situation.
Key words: analgesics, nonsteroidal anti-inflammatory drugs, flupirtine.
Key words: analgesics, nonsteroidal anti-inflammatory drugs, flupirtine.
Полный текст
Список литературы
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2. Klinicheskaia farmakologiia nesteroidnykh protivovospalitel’nykh sredstv. Pod red. Iu.D.Ignatova, V.G.Kukesa, V.I.Mazurova. M.: GEOTAR-Meditsina, 2010. [in Russian]
3. Hochman J, Shah N. What Price Pain Relief? Circulation 2006; 113: 2868–70.
4. Hermann M. Cardiovascular risk associated with nonsteroidal anti-inflammatory drugs. Curr Rheumatol Rep 2009; 11 (1): 31–5.
5. Aw T-J, Haas S, Liew D. Meta-analysis of cyclooxygenase-2 inhibitors and their effects on blood pressure. Arch Intern Med 2005; 165: 490–6.
6. Wang P, Avorn J, Brookhart M et al. Effects of noncardiovascular comorbidities on anti-hypertensive use in elderly hypertensives. Hypertension 2005; 46 (2): 273–9.
7. Trelle S, Reichenbach S, Wandel S et al. Cardiovascular safety of non-steroidal anti-inflammatory drugs: a network metaanalysis. BMJ 2011; 342: 7086.
8. McGettigan P, Henry D. Cardiovascular risk with non-steroidal anti-inflammatory drugs: systematic review of population-based controlled observational studies. PLoS Med 2011; 8: e1001098.
9. Coxib and traditional NSAID Trialists (CNT) Collaboration, Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet 2013; 382: 769–79.
10. Karateev A.E. Primenenie paratsetamola prilechenii ostroi i khronicheskoi boli: sravnitel’naia effektivnost’ i bezopasnost’. Rus. med. zhurn. 2010; 18 (25): 1477–88. [in Russian]
11. Revmatologiia. Natsional’noe rukovodstvo. Pod red. E.L.Nasonova, V.A.Nasonovoi. M.: GEOTAR-Media, 2008. [in Russian]
12. Zhang W, Doherty M, Arden N et al. EULAR evidence based recommendations for the management of hip osteoarthritis: report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 2005; 64 (4): 655–66.
13. Jordan K, Arden N, Doherty M et al. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis 2003; 62 (12): 1145–55.
14. Mastronardi P et al. Analgesic Activity of Flupirtine Maleate: a Controlled Double-blind Study with Diclofenac Sodium in Orthopaedics. J Intern Med Res 1988; 16: 338–48.
15. Ringe JD et al. Analgesic Efficacy of Flupirtine in Primary Care of Patients with Osteoporosis Related Pain. A multivariateanalysis. Arzneim Forsch 2003; 53 (7): 496–502.
16. Million R et al. Clinical trial of flupirtine maleate in patients with migraine. Curr Med Res Opin 1984; 9: 204–12.
17. McMahon FG et al. Clinical experience with flupirtine in the U.S. Postgrad Med J 1987; 63: 81–5.
18. Moore RA et al. Comparison of flupirtine maleate and dihydrocodeine in patients following surgery. Br J Anaesth 1983; 55: 429–32.
19. Sebening H, Schnelle H, Plominski R, Klein G. Einflubvon Flupirtin auf Hamodynamik und Blutgasegesunder Probanden. Kardio 1991; 9: 55–62.
20. Riethmuller-Winzen H. Evaluation of renal tolerance of flupirtine (Retrospective evaluation). ASTA Medica Report No. D-09998/7500000125
21. Herrmann WM. Final report: Investigation of the long-term tolerability of the analgesic flupirtine in patients who require analgesics regularly over long periods of time. Open study over 12 months, single blind subsequent observation period of 14 days (including an «Additional evaluation about a group of very old patients >80 years») Degussa-Report No. D-09998/75 057 C 52
22. Turner P, Warrington SJ. Comparison of flupirtine and indomethacin effects on furosemide-induced diuresis. Degussa-Report No. D-09998/75 068
23. Riethmuller-Winzen H. Evaluation of renal tolerance of flupirtine (Retrospective evaluation). ASTA Medica Report No. D-09998/7500000127
24. Johnston A, Warrington SJ, Turner P, Riethmuller-Winzen H. Comparison of flupirtine and indomethacin on furosemide-induced diuresis. Postgrad Med J 1987; 63 (3): 959–61.
25. Meyer U, Nowak H. Wirksamkeit und Vertraglichkeiteines Mono-Analgetikums. Z Allg Med 1986; 62: 486–8.
26. Nowak H. Klinische Untersuchung von Katadolon®. Studiezur Untersuchung der Wirkungubermehrere Tage. Degussa-Report No D 9998 76 043
2. Клиническая фармакология нестероидных противовоспалительных средств. Под ред. Ю.Д.Игнатова, В.Г.Кукеса, В.И.Мазурова. М.: ГЭОТАР-Медицина, 2010. / Klinicheskaia farmakologiia nesteroidnykh protivovospalitel’nykh sredstv. Pod red. Iu.D.Ignatova, V.G.Kukesa, V.I.Mazurova. M.: GEOTAR-Meditsina, 2010. [in Russian]
3. Hochman J, Shah N. What Price Pain Relief? Circulation 2006; 113: 2868–70.
4. Hermann M. Cardiovascular risk associated with nonsteroidal anti-inflammatory drugs. Curr Rheumatol Rep 2009; 11 (1): 31–5.
5. Aw T-J, Haas S, Liew D. Meta-analysis of cyclooxygenase-2 inhibitors and their effects on blood pressure. Arch Intern Med 2005; 165: 490–6.
6. Wang P, Avorn J, Brookhart M et al. Effects of noncardiovascular comorbidities on anti-hypertensive use in elderly hypertensives. Hypertension 2005; 46 (2): 273–9.
7. Trelle S, Reichenbach S, Wandel S et al. Cardiovascular safety of non-steroidal anti-inflammatory drugs: a network metaanalysis. BMJ 2011; 342: 7086.
8. McGettigan P, Henry D. Cardiovascular risk with non-steroidal anti-inflammatory drugs: systematic review of population-based controlled observational studies. PLoS Med 2011; 8: e1001098.
9. Coxib and traditional NSAID Trialists (CNT) Collaboration, Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet 2013; 382: 769–79.
10. Каратеев А.Е. Применение парацетамола при лечении острой и хронической боли: сравнительная эффективность и безопасность. Рус. мед. журн. 2010; 18 (25): 1477–88. / Karateev A.E. Primenenie paratsetamola prilechenii ostroi i khronicheskoi boli: sravnitel’naia effektivnost’ i bezopasnost’. Rus. med. zhurn. 2010; 18 (25): 1477–88. [in Russian]
11. Ревматология. Национальное руководство. Под ред. Е.Л.Насонова, В.А.Насоновой. М.: ГЭОТАР-Медиа, 2008. / Revmatologiia. Natsional’noe rukovodstvo. Pod red. E.L.Nasonova, V.A.Nasonovoi. M.: GEOTAR-Media, 2008. [in Russian]
12. Zhang W, Doherty M, Arden N et al. EULAR evidence based recommendations for the management of hip osteoarthritis: report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 2005; 64 (4): 655–66.
13. Jordan K, Arden N, Doherty M et al. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis 2003; 62 (12): 1145–55.
14. Mastronardi P et al. Analgesic Activity of Flupirtine Maleate: a Controlled Double-blind Study with Diclofenac Sodium in Orthopaedics. J Intern Med Res 1988; 16: 338–48.
15. Ringe JD et al. Analgesic Efficacy of Flupirtine in Primary Care of Patients with Osteoporosis Related Pain. A multivariateanalysis. Arzneim Forsch 2003; 53 (7): 496–502.
16. Million R et al. Clinical trial of flupirtine maleate in patients with migraine. Curr Med Res Opin 1984; 9: 204–12.
17. McMahon FG et al. Clinical experience with flupirtine in the U.S. Postgrad Med J 1987; 63: 81–5.
18. Moore RA et al. Comparison of flupirtine maleate and dihydrocodeine in patients following surgery. Br J Anaesth 1983; 55: 429–32.
19. Sebening H, Schnelle H, Plominski R, Klein G. Einflubvon Flupirtin auf Hamodynamik und Blutgasegesunder Probanden. Kardio 1991; 9: 55–62.
20. Riethmuller-Winzen H. Evaluation of renal tolerance of flupirtine (Retrospective evaluation). ASTA Medica Report No. D-09998/7500000125
21. Herrmann WM. Final report: Investigation of the long-term tolerability of the analgesic flupirtine in patients who require analgesics regularly over long periods of time. Open study over 12 months, single blind subsequent observation period of 14 days (including an «Additional evaluation about a group of very old patients >80 years») Degussa-Report No. D-09998/75 057 C 52
22. Turner P, Warrington SJ. Comparison of flupirtine and indomethacin effects on furosemide-induced diuresis. Degussa-Report No. D-09998/75 068
23. Riethmuller-Winzen H. Evaluation of renal tolerance of flupirtine (Retrospective evaluation). ASTA Medica Report No. D-09998/7500000127
24. Johnston A, Warrington SJ, Turner P, Riethmuller-Winzen H. Comparison of flupirtine and indomethacin on furosemide-induced diuresis. Postgrad Med J 1987; 63 (3): 959–61.
25. Meyer U, Nowak H. Wirksamkeit und Vertraglichkeiteines Mono-Analgetikums. Z Allg Med 1986; 62: 486–8.
26. Nowak H. Klinische Untersuchung von Katadolon®. Studiezur Untersuchung der Wirkungubermehrere Tage. Degussa-Report No D 9998 76 043
________________________________________________
2. Klinicheskaia farmakologiia nesteroidnykh protivovospalitel’nykh sredstv. Pod red. Iu.D.Ignatova, V.G.Kukesa, V.I.Mazurova. M.: GEOTAR-Meditsina, 2010. [in Russian]
3. Hochman J, Shah N. What Price Pain Relief? Circulation 2006; 113: 2868–70.
4. Hermann M. Cardiovascular risk associated with nonsteroidal anti-inflammatory drugs. Curr Rheumatol Rep 2009; 11 (1): 31–5.
5. Aw T-J, Haas S, Liew D. Meta-analysis of cyclooxygenase-2 inhibitors and their effects on blood pressure. Arch Intern Med 2005; 165: 490–6.
6. Wang P, Avorn J, Brookhart M et al. Effects of noncardiovascular comorbidities on anti-hypertensive use in elderly hypertensives. Hypertension 2005; 46 (2): 273–9.
7. Trelle S, Reichenbach S, Wandel S et al. Cardiovascular safety of non-steroidal anti-inflammatory drugs: a network metaanalysis. BMJ 2011; 342: 7086.
8. McGettigan P, Henry D. Cardiovascular risk with non-steroidal anti-inflammatory drugs: systematic review of population-based controlled observational studies. PLoS Med 2011; 8: e1001098.
9. Coxib and traditional NSAID Trialists (CNT) Collaboration, Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet 2013; 382: 769–79.
10. Karateev A.E. Primenenie paratsetamola prilechenii ostroi i khronicheskoi boli: sravnitel’naia effektivnost’ i bezopasnost’. Rus. med. zhurn. 2010; 18 (25): 1477–88. [in Russian]
11. Revmatologiia. Natsional’noe rukovodstvo. Pod red. E.L.Nasonova, V.A.Nasonovoi. M.: GEOTAR-Media, 2008. [in Russian]
12. Zhang W, Doherty M, Arden N et al. EULAR evidence based recommendations for the management of hip osteoarthritis: report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 2005; 64 (4): 655–66.
13. Jordan K, Arden N, Doherty M et al. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis 2003; 62 (12): 1145–55.
14. Mastronardi P et al. Analgesic Activity of Flupirtine Maleate: a Controlled Double-blind Study with Diclofenac Sodium in Orthopaedics. J Intern Med Res 1988; 16: 338–48.
15. Ringe JD et al. Analgesic Efficacy of Flupirtine in Primary Care of Patients with Osteoporosis Related Pain. A multivariateanalysis. Arzneim Forsch 2003; 53 (7): 496–502.
16. Million R et al. Clinical trial of flupirtine maleate in patients with migraine. Curr Med Res Opin 1984; 9: 204–12.
17. McMahon FG et al. Clinical experience with flupirtine in the U.S. Postgrad Med J 1987; 63: 81–5.
18. Moore RA et al. Comparison of flupirtine maleate and dihydrocodeine in patients following surgery. Br J Anaesth 1983; 55: 429–32.
19. Sebening H, Schnelle H, Plominski R, Klein G. Einflubvon Flupirtin auf Hamodynamik und Blutgasegesunder Probanden. Kardio 1991; 9: 55–62.
20. Riethmuller-Winzen H. Evaluation of renal tolerance of flupirtine (Retrospective evaluation). ASTA Medica Report No. D-09998/7500000125
21. Herrmann WM. Final report: Investigation of the long-term tolerability of the analgesic flupirtine in patients who require analgesics regularly over long periods of time. Open study over 12 months, single blind subsequent observation period of 14 days (including an «Additional evaluation about a group of very old patients >80 years») Degussa-Report No. D-09998/75 057 C 52
22. Turner P, Warrington SJ. Comparison of flupirtine and indomethacin effects on furosemide-induced diuresis. Degussa-Report No. D-09998/75 068
23. Riethmuller-Winzen H. Evaluation of renal tolerance of flupirtine (Retrospective evaluation). ASTA Medica Report No. D-09998/7500000127
24. Johnston A, Warrington SJ, Turner P, Riethmuller-Winzen H. Comparison of flupirtine and indomethacin on furosemide-induced diuresis. Postgrad Med J 1987; 63 (3): 959–61.
25. Meyer U, Nowak H. Wirksamkeit und Vertraglichkeiteines Mono-Analgetikums. Z Allg Med 1986; 62: 486–8.
26. Nowak H. Klinische Untersuchung von Katadolon®. Studiezur Untersuchung der Wirkungubermehrere Tage. Degussa-Report No D 9998 76 043
Авторы
А.В.Амелин
ГБОУ ВПО Первый Санкт-Петербургский медицинский университет им. акад. И.П.Павлова Минздрава России. 197022, Россия, Санкт-Петербург, ул. Льва Толстого, д. 6/8
avamelin@mail.ru
ГБОУ ВПО Первый Санкт-Петербургский медицинский университет им. акад. И.П.Павлова Минздрава России. 197022, Россия, Санкт-Петербург, ул. Льва Толстого, д. 6/8
avamelin@mail.ru
________________________________________________
A.V.Amelin
I.M.Pavlov First Saint Petersburg State Medical University of the Ministry of Health of the Russian Federation. 197022, Russian Federation, Saint Petersburg, ul. L'va Tolstogo, d. 6/8
avamelin@mail.ru
I.M.Pavlov First Saint Petersburg State Medical University of the Ministry of Health of the Russian Federation. 197022, Russian Federation, Saint Petersburg, ul. L'va Tolstogo, d. 6/8
avamelin@mail.ru
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