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Выбор анальгетика при боли в спине сквозь призму лекарственной безопасности и коморбидности: в фокусе – флупиртин
Выбор анальгетика при боли в спине сквозь призму лекарственной безопасности и коморбидности: в фокусе – флупиртин
Трухан Д.И. Выбор анальгетика при боли в спине сквозь призму лекарственной безопасности и коморбидности: в фокусе – флупиртин. Consilium Medicum. 2017; 19 (9): 80–87. DOI: 10.26442/2075-1753_19.9.80-87
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Аннотация
Боль в спине (дорсалгия) беспокоит в разные периоды жизни подавляющее большинство людей, занимая по распространенности 2-е место после простудных заболеваний. Наиболее популярным классом лекарств, применяемых в качестве анальгетиков при дегенеративных или воспалительных заболеваниях опорно-двигательного аппарата, являются нестероидные противовоспалительные препараты (НПВП). Однако с приемом НПВП ассоциируется целый спектр различных осложнений. Лекарственная безопасность и коморбидность тесно переплетаются при использовании НПВП. В представленном обзоре проанализированы отечественные и зарубежные исследования флупиртина для лечения болевого синдрома. Флупиртин выгодно отличается от НПВП и опиоидных анальгетиков сочетанием болеутоляющего и миорелаксирующего свойств, отсутствием лекарственных взаимодействий и серьезных побочных эффектов, что позволяет использовать препарат для лечения болевого синдрома у пациентов с коморбидной соматической патологией.
Ключевые слова: боль в спине, лекарственная безопасность, коморбидность, нестероидные противовоспалительные препараты, флупиртин, Нолодатак.
Key words: dorsalgia, drug safety, comorbidity, nonsteroidal anti-inflammatory drugs, flupirtine, Nolodatak.
Ключевые слова: боль в спине, лекарственная безопасность, коморбидность, нестероидные противовоспалительные препараты, флупиртин, Нолодатак.
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Key words: dorsalgia, drug safety, comorbidity, nonsteroidal anti-inflammatory drugs, flupirtine, Nolodatak.
Полный текст
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60. Jakob R, Krieglstein J. Influence of flupirtine on a G-protein coupled inwardly rectifying potassium current in hippocampal neurons. Br J Pharmacol 1997; 122: 1333–8.
61. Kornhuber J, Bleich S, Wiltfang J et al. Flupirtine shows functional NMDA receptor antagonism by enhancing Mg+ block via activation of voltage independent potassium channels. J Neural Transm 1999; 106 (9–10): 857–67.
62. Wörz R, Müller-Schwefe G, Stroehmann I et al. Back pain: Guidelines for drug therapy. Fortschr Med 2000; 142 (5): 27–33.
63. Szelenyi I. Flupirtine, a re-discovered drug, revisited. Inflamm Res 2013 Mar; 62 (3): 251–8.
64. Wörz R, Bolten W, Heller B et al. Flupirtine in comparison with chlormezanone in chronic musculoskeletal back pain. Results of a multicenter randomized double-blind study. Fortschr Med 1996; 114 (35–36): 500–4.
65. Perovic S, Pialoglou P, Schroder HC et al. Flupirtine increases the levels of glutathione and Bc1–2 in hNT (human Ntera/D1) neurons: mode of action of the drug-mediated anti-apoptotic effect. Eur J Pharmacol 1996; 317 (1): 157–64.
66. Klawe C, Maschke M. Flupirtine: pharmacology and clinical applications of a nonopioid analgesic and potentially neuroprotective compound. Expert Opin Pharmacother 2009; 10 (9): 1495–500.
67. Devulder J. Flupirtine in pain management: pharmacological properties and clinical use. CNS Drugs 2010; 24 (10): 867–81.
68. Raffa RB, Pergolizzi JV Jr. The evolving understanding of the analgesic mechanism of action of flupirtine. J Clin Pharm Ther 2012; 37 (1): 4–6.
69. Mueller-Schwefe G. Flupirtine in acute and chronic pain associated with muscle tenseness. Results of a postmarket surveillance study. Fortschr Med Orig 2003; 121 (1): 11–8.
70. Ringe JD et al. Analgesic Efficacy of Flupirtine in Primary Care of Patients with Osteoporosis Related Pain. A multivariate analysis. Arzneimittelforschung 2003; 53 (7): 496–502.
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78. Li C, Ni J, Wang Z et al. Analgesic efficacy and tolerability of flupirtine vs. tramadol in patients with subacute low back pain: a double-blind multicentre trial. Curr Med Res Opin 2008; 24 (12): 3523–30.
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59. Ueberall MА, Mueller-Schwefe GН, Terhaag B. Efficacy and tolerability of flupirtine in subacute / chronic musculoskeletal pain – results of a patient level, pooled reanalysis of randomized, doubleblind, controlled trials. Int J Clin Pharmacol Ther 2011; 49: 637–47.
60. Jakob R, Krieglstein J. Influence of flupirtine on a G-protein coupled inwardly rectifying potassium current in hippocampal neurons. Br J Pharmacol 1997; 122: 1333–8.
61. Kornhuber J, Bleich S, Wiltfang J et al. Flupirtine shows functional NMDA receptor antagonism by enhancing Mg+ block via activation of voltage independent potassium channels. J Neural Transm 1999; 106 (9–10): 857–67.
62. Wörz R, Müller-Schwefe G, Stroehmann I et al. Back pain: Guidelines for drug therapy. Fortschr Med 2000; 142 (5): 27–33.
63. Szelenyi I. Flupirtine, a re-discovered drug, revisited. Inflamm Res 2013 Mar; 62 (3): 251–8.
64. Wörz R, Bolten W, Heller B et al. Flupirtine in comparison with chlormezanone in chronic musculoskeletal back pain. Results of a multicenter randomized double-blind study. Fortschr Med 1996; 114 (35–36): 500–4.
65. Perovic S, Pialoglou P, Schroder HC et al. Flupirtine increases the levels of glutathione and Bc1–2 in hNT (human Ntera/D1) neurons: mode of action of the drug-mediated anti-apoptotic effect. Eur J Pharmacol 1996; 317 (1): 157–64.
66. Klawe C, Maschke M. Flupirtine: pharmacology and clinical applications of a nonopioid analgesic and potentially neuroprotective compound. Expert Opin Pharmacother 2009; 10 (9): 1495–500.
67. Devulder J. Flupirtine in pain management: pharmacological properties and clinical use. CNS Drugs 2010; 24 (10): 867–81.
68. Raffa RB, Pergolizzi JV Jr. The evolving understanding of the analgesic mechanism of action of flupirtine. J Clin Pharm Ther 2012; 37 (1): 4–6.
69. Mueller-Schwefe G. Flupirtine in acute and chronic pain associated with muscle tenseness. Results of a postmarket surveillance study. Fortschr Med Orig 2003; 121 (1): 11–8.
70. Ringe JD et al. Analgesic Efficacy of Flupirtine in Primary Care of Patients with Osteoporosis Related Pain. A multivariate analysis. Arzneimittelforschung 2003; 53 (7): 496–502.
71. Levin Ia.I., Strygin K.N., Dobrovolskaia L.E. Katadolon v lechenii boli v spine. Lechenie nervnykh boleznei. 2005; 6 (3): 12–7. [in Russian]
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73. Erdes Sh., Galushko E., Zotkin E. i dr. Effektivnost katadolona (flupirtina) u patsientov s boliami v nizhnei chasti spiny. Vrach. 2007; 5: 56–9. [in Russian]
74. Alekseev V.V., Rachin A.P., Podchufarova E.V. Flupirtin (Katadolon) – nestandartnyi podkhod v terapii boli. Nevrol. i revmatologiia. 2009; 2: 50–3. [in Russian]
75. Danilov A.B., Nikolaeva N.S. Effektivnost novoi formy flupirtina (Katadolona forte) v lechenii ostroi boli v spine. Managepain. 2013; 1: 44–8. [in Russian]
76. Yadav G, Behera SS, Das SK et al. Role of flupirtine as a preemptive analgesic in patients undergoing laparoscopic cholecystectomy. J Anaesthesiol Clin Pharmacol 2015; 31 (2): 169–73.
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62. Wörz R, Müller-Schwefe G, Stroehmann I et al. Back pain: Guidelines for drug therapy. Fortschr Med 2000; 142 (5): 27–33.
63. Szelenyi I. Flupirtine, a re-discovered drug, revisited. Inflamm Res 2013 Mar; 62 (3): 251–8.
64. Wörz R, Bolten W, Heller B et al. Flupirtine in comparison with chlormezanone in chronic musculoskeletal back pain. Results of a multicenter randomized double-blind study. Fortschr Med 1996; 114 (35–36): 500–4.
65. Perovic S, Pialoglou P, Schroder HC et al. Flupirtine increases the levels of glutathione and Bc1–2 in hNT (human Ntera/D1) neurons: mode of action of the drug-mediated anti-apoptotic effect. Eur J Pharmacol 1996; 317 (1): 157–64.
66. Klawe C, Maschke M. Flupirtine: pharmacology and clinical applications of a nonopioid analgesic and potentially neuroprotective compound. Expert Opin Pharmacother 2009; 10 (9): 1495–500.
67. Devulder J. Flupirtine in pain management: pharmacological properties and clinical use. CNS Drugs 2010; 24 (10): 867–81.
68. Raffa RB, Pergolizzi JV Jr. The evolving understanding of the analgesic mechanism of action of flupirtine. J Clin Pharm Ther 2012; 37 (1): 4–6.
69. Mueller-Schwefe G. Flupirtine in acute and chronic pain associated with muscle tenseness. Results of a postmarket surveillance study. Fortschr Med Orig 2003; 121 (1): 11–8.
70. Ringe JD et al. Analgesic Efficacy of Flupirtine in Primary Care of Patients with Osteoporosis Related Pain. A multivariate analysis. Arzneimittelforschung 2003; 53 (7): 496–502.
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77. Ueberall MA, Essner U, Müller-Schwefe GH. 2-week efficacy and tolerability of flupirtine MR and diclofenac in patients with acute low/back pain-results of a post-hoc subgroup analysis of patient-level data from four non-interventional studies. MMW Fortschr Med 2013; 155 (Suppl. 4): 115–23.
78. Li C, Ni J, Wang Z et al. Analgesic efficacy and tolerability of flupirtine vs. tramadol in patients with subacute low back pain: a double-blind multicentre trial. Curr Med Res Opin 2008; 24 (12): 3523–30.
79. Uberall MA, Mueller-Schwefe GH, Terhaag B. Efficacy and safety of flupirtine modified release for the management of moderate to severe chronic low back pain: results of SUPREME, a prospective randomized, double-blind, placebo- and active-controlled parallel-group phase IV study. Curr Med Res Opin 2012; 28 (10): 1617–34.
80. Рачин А.П. Десять доказательств успешного применения флупиртина (катадолона) при болях в нижней части спины. Лечение нервных болезней. 2007; 2: 35–9. / Rachin A.P. Desiat dokazatelstv uspeshnogo primeneniia flupirtina (katadolona) pri boliakh v nizhnei chasti spiny. Lechenie nervnykh boleznei. 2007; 2: 35–9. [in Russian]
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83. Harish S, Bhuvana K, Bengalorkar GM, Kumar T. Flupirtine: Clinical pharmacology. J Anaesth Clin Pharmacol 2012; 28: 172–7.
84. Treudler R, Pohle K, Simon JC. Flupirtine is a safe alternative drug in patients with hypersensitivity to NSAIDs. Eur J Clin Pharmacol 2011; 67 (9): 961–3.
85. Flupirtine (флупиртин). URL: https://www.vidal.ru/drugs/molecule/1338 / Flupirtine (flupirtin). URL: https://www.vidal.ru/drugs/molecule/1338 [in Russian]
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60. Jakob R, Krieglstein J. Influence of flupirtine on a G-protein coupled inwardly rectifying potassium current in hippocampal neurons. Br J Pharmacol 1997; 122: 1333–8.
61. Kornhuber J, Bleich S, Wiltfang J et al. Flupirtine shows functional NMDA receptor antagonism by enhancing Mg+ block via activation of voltage independent potassium channels. J Neural Transm 1999; 106 (9–10): 857–67.
62. Wörz R, Müller-Schwefe G, Stroehmann I et al. Back pain: Guidelines for drug therapy. Fortschr Med 2000; 142 (5): 27–33.
63. Szelenyi I. Flupirtine, a re-discovered drug, revisited. Inflamm Res 2013 Mar; 62 (3): 251–8.
64. Wörz R, Bolten W, Heller B et al. Flupirtine in comparison with chlormezanone in chronic musculoskeletal back pain. Results of a multicenter randomized double-blind study. Fortschr Med 1996; 114 (35–36): 500–4.
65. Perovic S, Pialoglou P, Schroder HC et al. Flupirtine increases the levels of glutathione and Bc1–2 in hNT (human Ntera/D1) neurons: mode of action of the drug-mediated anti-apoptotic effect. Eur J Pharmacol 1996; 317 (1): 157–64.
66. Klawe C, Maschke M. Flupirtine: pharmacology and clinical applications of a nonopioid analgesic and potentially neuroprotective compound. Expert Opin Pharmacother 2009; 10 (9): 1495–500.
67. Devulder J. Flupirtine in pain management: pharmacological properties and clinical use. CNS Drugs 2010; 24 (10): 867–81.
68. Raffa RB, Pergolizzi JV Jr. The evolving understanding of the analgesic mechanism of action of flupirtine. J Clin Pharm Ther 2012; 37 (1): 4–6.
69. Mueller-Schwefe G. Flupirtine in acute and chronic pain associated with muscle tenseness. Results of a postmarket surveillance study. Fortschr Med Orig 2003; 121 (1): 11–8.
70. Ringe JD et al. Analgesic Efficacy of Flupirtine in Primary Care of Patients with Osteoporosis Related Pain. A multivariate analysis. Arzneimittelforschung 2003; 53 (7): 496–502.
71. Levin Ia.I., Strygin K.N., Dobrovolskaia L.E. Katadolon v lechenii boli v spine. Lechenie nervnykh boleznei. 2005; 6 (3): 12–7. [in Russian]
72. Kamchatnov P.R., Batysheva T.T., Ganzhula P.A. i dr. Primenenie katadolona u bolnykh so spondilogennoi dorsalgiei. Zhurn. nevrologii i psikhiatrii im. S.S.Korsakova. 2006; 106 (11): 46–8. [in Russian]
73. Erdes Sh., Galushko E., Zotkin E. i dr. Effektivnost katadolona (flupirtina) u patsientov s boliami v nizhnei chasti spiny. Vrach. 2007; 5: 56–9. [in Russian]
74. Alekseev V.V., Rachin A.P., Podchufarova E.V. Flupirtin (Katadolon) – nestandartnyi podkhod v terapii boli. Nevrol. i revmatologiia. 2009; 2: 50–3. [in Russian]
75. Danilov A.B., Nikolaeva N.S. Effektivnost novoi formy flupirtina (Katadolona forte) v lechenii ostroi boli v spine. Managepain. 2013; 1: 44–8. [in Russian]
76. Yadav G, Behera SS, Das SK et al. Role of flupirtine as a preemptive analgesic in patients undergoing laparoscopic cholecystectomy. J Anaesthesiol Clin Pharmacol 2015; 31 (2): 169–73.
77. Ueberall MA, Essner U, Müller-Schwefe GH. 2-week efficacy and tolerability of flupirtine MR and diclofenac in patients with acute low/back pain-results of a post-hoc subgroup analysis of patient-level data from four non-interventional studies. MMW Fortschr Med 2013; 155 (Suppl. 4): 115–23.
78. Li C, Ni J, Wang Z et al. Analgesic efficacy and tolerability of flupirtine vs. tramadol in patients with subacute low back pain: a double-blind multicentre trial. Curr Med Res Opin 2008; 24 (12): 3523–30.
79. Uberall MA, Mueller-Schwefe GH, Terhaag B. Efficacy and safety of flupirtine modified release for the management of moderate to severe chronic low back pain: results of SUPREME, a prospective randomized, double-blind, placebo- and active-controlled parallel-group phase IV study. Curr Med Res Opin 2012; 28 (10): 1617–34.
80. Rachin A.P. Desiat dokazatelstv uspeshnogo primeneniia flupirtina (katadolona) pri boliakh v nizhnei chasti spiny. Lechenie nervnykh boleznei. 2007; 2: 35–9. [in Russian]
81. Restrictions in the use of flupirtine-containing medicines – CMDh endorses PRAC recommendation. Press release. 28/06/2013. URL: http://www.ema.europa.eu/ema/ index.jsp curl=pages/news_and_events/news/2013/06/news_detail_001831.jsp&mid=WC0b01ac058004d5c1
82. Restrictions in the use of flupirtine-containing medicines. 13 September 2013. EMA/563900/ 2013. URL: http://www.ema.europa.eu/docs/en_GB/document_library/ Referrals_document/Flupirtine-containing_medicines/European_Commission_final_decision/ WC500155310.pdf
83. Harish S, Bhuvana K, Bengalorkar GM, Kumar T. Flupirtine: Clinical pharmacology. J Anaesth Clin Pharmacol 2012; 28: 172–7.
84. Treudler R, Pohle K, Simon JC. Flupirtine is a safe alternative drug in patients with hypersensitivity to NSAIDs. Eur J Clin Pharmacol 2011; 67 (9): 961–3.
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Авторы
Д.И.Трухан
ФГБОУ ВО «Омский государственный медицинский университет» Минздрава России. 644099, Россия, Омск, ул. Ленина, д. 12
dmitry_trukhan@mail.ru
Omsk State Medical University of the Ministry of Health of the Russian Federation. 644099, Russian Federation, Omsk, ul. Lenina, d. 12
dmitry_trukhan@mail.ru
ФГБОУ ВО «Омский государственный медицинский университет» Минздрава России. 644099, Россия, Омск, ул. Ленина, д. 12
dmitry_trukhan@mail.ru
________________________________________________
Omsk State Medical University of the Ministry of Health of the Russian Federation. 644099, Russian Federation, Omsk, ul. Lenina, d. 12
dmitry_trukhan@mail.ru
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