Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.
Декскетопрофен: возможности применения в неврологии
Пилипович А.А. Декскетопрофен: возможности применения в неврологии. Consilium Medicum. 2018; 20 (9): 71–75. DOI: 10.26442/2075-1753_2018.9.71-75
________________________________________________
Pilipovich A.A. Dexketoprofen: therapeutic potential in neurology. Consilium Medicum. 2018; 20 (9): 71–75. DOI: 10.26442/2075-1753_2018.9.71-75
Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.
Аннотация
На сегодняшний день основой терапии острого болевого синдрома любой степени выраженности остаются нестероидные противовоспалительные препараты (НПВП). В практике клинического невролога наиболее часто НПВП используются для лечения заболеваний опорно-двигательного аппарата и купирования головных болей. Задача заключается в том, чтобы правильно выбрать препарат для пациента, учитывая все показания и противопоказания, адекватно подобрать дозу или комбинацию нескольких анальгетиков. При этом желательно использовать препарат с максимальной скоростью развития противоболевого эффекта и минимальным риском осложнений со стороны желудочно-кишечного тракта без ущерба для эффективности. Одним из таких представителей группы НПВП является декскетопрофена трометамол – правовращающий изомер кетопрофена. Препарат обладает высокой степенью очистки от R(-)-кетопрофена (99,9%), имеет улучшенные физико-химические свойства. В статье разбираются механизмы его действия, приводятся данные клинических исследований, демонстрирующие анальгетическую эффективность и переносимость декскетопрофена трометамола (препарат Дексалгин®) по основному показанию к применению препарата в неврологии – скелетно-мышечные боли, а также головные боли мигренозного характера.
Ключевые слова: боль в спине, скелетно-мышечные боли, декскетопрофена трометамол, Дексалгин, мигрень.
Ключевые слова: боль в спине, скелетно-мышечные боли, декскетопрофена трометамол, Дексалгин, мигрень.
________________________________________________
At present non-steroid anti-inflammatory drugs (NSAID) remain the basis for acute pain syndrome of any intensity treatment. In clinical neurologysts' practice NSAID are mostly used in musculoskeletal system disorders treatment and for headaches abortion. The concern is to choose a right medication for the patient considering all indications and contraindications, to determine an adequate dosage or a combination of several analgetic drugs. In the meantime it is recommended to use medications with maximal rate of analgesic effect development and minimal risk of adverse effects in gastrointestinal tract development without loss of effectiveness. Dexketoprofen trometamol, a dextrarotatory isomer of ketoprophen, is one of these medications from NSAID group. The drug is highly purified from R(-)-ketoprophen (99.9%), and has improved physico-chemical properties. The article describes its mechanisms of action, and presents clinical studies results that demonstrate dexketoprofen trometamol (Dexalgin®) analgetic effectiveness and tolerance with the primary indication for use in neurology in musculoskeletal pain and migrainous headaches treatment.
Key words: back pain, musculoskeletal pain, dexketoprofen trometamol, Dexalgin, migraine.
Полный текст
Список литературы
1. Алексеев В.В., Баринов А.Н., Кукушкин М.Л. и др. Боль. Руководство для врачей и студентов. Под ред. Н.Н.Яхно. М.: Медпресс-информ, 2009. / Alekseev V.V., Bari- nov A.N., Kukushkin M.L. i dr. Bol. Rukovodstvo dlya vrachej i studentov. Pod red. N.N.Yahno. M.: Medpress-inform, 2009. [in Russian]
2. Рябоконь И.В. Современный взгляд на лечение боли в спине. Справочник поликлинического врача. 2009; 3: 78–81. / Ryabokon I.V. Sovremennyj vzglyad na lechenie boli v spine. Handbook for Practitioners Doctors. 2009; 3: 78–81. [in Russian]
3. Mauleon D, Artigas R, Garcнa ML, Carganico G. Preclinical and clinical development of dexketoprofen. Drugs 1996; 52 (Suppl. 5): 24–45.
4. Barbanoj MJ, Gich I, Artigas R et al. Pharmacokinetics of dexketoprofen trometamol in healthy volunteers after single and repeated oral doses. Drugs 1998; 52 (Suppl. 5): 24–45.
5. McEwen J, De Luca M, Casini A et al. The effect of food and an antacid on the bioavailability of dexketoprofen trometamol. J Clin Pharmacol 1998; 38 (Suppl. 12): 33S–40S.
6. Карнеев А.Н. Практика лечения боли в спине. Consilium Medicum. 2017; 19 (2.2. Неврология и Ревматология): 32–6. / Karneev A.N. The practice of treating back pain. Consilium Medicum. 2017; 19 (2.2. Neurology and Rheumatology): 32–6. [in Russian]
7. Moore RA, Barden J. Systematic review of dexketoprofen in acute and chronic pain. BMC Clin Pharmacol 2008; 8: 11.
8. Zippel H, Wagenitz A. Comparison of the efficacy and safety of intravenously administered dexketoprofen trometamol and ketoprofen in the management of pain after orthopaedic surgery: A multicentre, double-blind, randomised, parallelgroup clinical trial. Clin Drug Investig 2006; 26: 517–28.
9. Zapata A, Cegarra F, Artigas R, Keller F. Dexketoprofen vs tramadol: randomised double-blind trial in patients with postoperative pain. British J Clin Pharmacol 2000; 223: abs 870.
10. Hanna MH, Elliott KM, Stuart-Taylor ME et al. Comparative study of analgesic efficacy and morphine-sparing effect of intramuscular dexketoprofen trometamol with ketoprofen or placebo after major orthopaedic surgery. Br J Clin Pharmacol 2003; 55: 126–133.
11. Jackson ID, Heidemann BH, Wilson J et al. Doubleblind, randomized, placebo-controlled trial comparing rofecoxib with dexketoprofen trometamol in surgical dentistry. Br J Anaesth 2004; 92: 675–80.
12. McGurk M, Robinson P, Rajayogeswaran V et al. Clinical comparison of dexketoprofen trometamol, ketoprofen, and placebo in postoperative dental pain. J Clin Pharmacol 1998; 38 (Suppl. 12): 46S–54S.
12. McGurk M, Robinson P, Rajayogeswaran V et al. Clinical comparison of dexketoprofen trometamol, ketoprofen, and placebo in postoperative dental pain. J Clin Pharmacol 1998; 38 (Suppl. 12): 46S–54S.
13. Munoz G, Berini L, Sanchez S et al. Preoperative dexketoprofen trometamol for the prevention of postoperative dental pain: a randomised double-blind clinical trial. Method Find Exp Clin Pharmacol 1998; 20 (Suppl A): 69.
14. Sanchez-Carpena J, Dominguez-Hervella F, Garcia I et al; Dexketoprofen Renal Colic Study Group. Comparison of intravenous dexketoprofen and dipyrone in acute renal colic. Eur J Clin Pharmacol 2007; 63 (8): 751–60.
15. Zippel H, Wagenitz A. A multicentre, randomised, double-blind study comparing the efficacy and tolerability of intramuscular dexketoprofen versus diclofenac in the symptomatic treatment of acute low back pain. Clin Drug Investig 2007; 27: 533–43.
16. Metscher B, Kubler U, Jahnel-Kracht H. Dexketoprofen-trometamol and tramadol in acute lumbago. Fortschr Med Orig 2001; 118: 147–51.
17. Marenco JL, Pérez M, Navarro FJ et al. A multicentre, randomised, double-blind study to compare the efficacy and tolerability of dexketoprofen trometamol versus diclofenac in the symptomatic treatment of knee osteoarthritis. Clin Drug Invest 2000; 19: 247–56.
18. Ezcurdia M, Cortejoso FJ, Lanzon R et al. Comparison of the efficacy and tolerability of dexketoprofen and ketoprofen in the treatment of primary dysmenorrhea. J Clin Pharmacol 1998; 38 (Suppl. 12): 65S–73S.
19. Rodriguez MJ, Contreras D, Galvez R et al. Double-blind evaluation of short-term analgesic efficacy of orally administered dexketoprofen trometamol and ketorolac in bone cancer pain. Pain 2003; 104: 103–10.
20. Leman P, Kapadia Y, Herington J. Randomised controlled trial of the onset of analgesic efficacy of dexketoprofen and diclofenac in lower limb injury. Emerg Med J 2003; 20: 511–3.
19. Rodriguez MJ, Contreras D, Galvez R et al. Double-blind evaluation of short-term analgesic efficacy of orally administered dexketoprofen trometamol and ketorolac in bone cancer pain. Pain 2003; 104: 103–10.
20. Leman P, Kapadia Y, Herington J. Randomised controlled trial of the onset of analgesic efficacy of dexketoprofen and diclofenac in lower limb injury. Emerg Med J 2003; 20: 511–3.
21. Beltra’n J et al. Comparison of Dexketoprofen trometamol and ketoprofen in the treatment of osteoartritis of the knee. J Clin Pharmacol 1998; 38: 74S–80S.
22. Capriai A, Mas M, Bertoloti M et al. Intramuscular dexketoprofen trometamol in acute lower back pain. 10th World Congress on Pain, IASP, California, 2002; p. 108–12.
23. Metscher B, Kubler U et al. Dexketoprofen-trometamol and tramadol in acute lumbago. Fortschr Med Orig 2001; 118 (4): 147–51.
24. Подчуфарова Е.В. Опыт применения препарата Дексалгин® при лечении острых скелетно-мышечных болевых синдромов. Эффективная фармакотерапия. Неврология и Психиатрия. 2012; 2: 34–9. / Podchufarova E.V. Opyt primeneniya preparata Deksalgin® pri lechenii ostryh skeletno-myshechnyh bolevyh sindromov. Effektivnaya farmakoterapiya. Nevrologiya i Psihiatriya. 2012; 2: 34–9. [in Russian]
25. Меркулов Ю.А., Меркулова Д.М., Крыжановский Г.Н. Эффективность дексалгина на вертеброгенные и невертеброгенные механизмы дизрегуляции при болях в спине. Журн. неврологии и психиатрии им. С.С.Корсакова. 2006; 106 (5): 20–4. / Merkulov Yu.A., Merkulova D.M., Kryzhanovskij G.N. Effektivnost deksalgina na vertebrogennye i nevertebrogennye mehanizmy dizregulyacii pri bolyah v spine. Zhurn. nevrologii i psihiatrii im. S.S.Korsakova. 2006; 106 (5): 20–4. [in Russian]
26. Соловьева Э.Ю., Карнеев А.Н., Федин А.И. Сочетанное применение дексалгина и нимесила в стадии обострения дорсопатии. Врач. 2007; 3: 67–71. / Soloveva E.Yu., Karneev A.N., Fedin A.I. Sochetannoe primenenie deksalgina i nimesila v stadii obostreniya dorsopatii. Vrach. 2007; 3: 67–71. [in Russian]
27. Подчуфарова Е.В., Яхно Н.Н. Боли в спине и конечностях. В кн.: Болезни нервной системы. Руководство для врачей. Под ред. Н.Н.Яхно. Т. 2. М., 2005; с. 306–31. / Podchufarova E.V., Yahno N.N. Boli v spine i konechnostyah. V kn.: Bolezni nervnoj sistemy. Rukovodstvo dlya vrachej. Pod red. N.N.Yahno. T. 2. M., 2005; s. 306–31. [in Russian]
28. Krymchantowski AV, Jevoux CC. The experience of combining agents, specially triptans and non steroidal anti-inflammatory drugs, for the acute treatment of migraine – a review. Recent Pat CNS Drug Discov 2007; 2: 141–4.
29. Tullo V, Valguarnera F, Barbanti P et al. Comparison of frovatriptan plus dexketoprofen (25 mg or 37.5 mg) with frovatriptan alone in the treatment of migraine attacks with or without aura: A randomized study. Cephalalgia 2014; 34: 434–45.
30. Allais G, Rolando S, Schiapparelli P et al. Frovatriptan plus dexketoprofen in the treatment of menstrually related migraine. An open study. Neurol Sci 2013; 34 (Suppl. 1): S179–S181.
31. Elkind AH and MacGregor EA. Frovatriptan for the acute treatment of migraine and prevention of predictable menstrual migraine. Expert Rev Neurother 2008; 8: 723–36.
32. Allais G, Bussone G, Tullo V et al. Frovatriptan 2.5 mg plus dexketoprofen (25 mg or 37.5 mg) in menstrually related migraine. Subanalysis from a double-blind, randomized trial. Cephalalgia 2015; 35 (1): 45–50.
________________________________________________
1. Alekseev V.V., Bari- nov A.N., Kukushkin M.L. i dr. Bol. Rukovodstvo dlya vrachej i studentov. Pod red. N.N.Yahno. M.: Medpress-inform, 2009. [in Russian]
2. Ryabokon I.V. Sovremennyj vzglyad na lechenie boli v spine. Handbook for Practitioners Doctors. 2009; 3: 78–81. [in Russian] 3. Mauleon D, Artigas R, Garcнa ML, Carganico G. Preclinical and clinical development of dexketoprofen. Drugs 1996; 52 (Suppl. 5): 24–45.
4. Barbanoj MJ, Gich I, Artigas R et al. Pharmacokinetics of dexketoprofen trometamol in healthy volunteers after single and repeated oral doses. Drugs 1998; 52 (Suppl. 5): 24–45.
5. McEwen J, De Luca M, Casini A et al. The effect of food and an antacid on the bioavailability of dexketoprofen trometamol. J Clin Pharmacol 1998; 38 (Suppl. 12): 33S–40S.
6. Karneev A.N. The practice of treating back pain. Consilium Medicum. 2017; 19 (2.2. Neurology and Rheumatology): 32–6. [in Russian]
7. Moore RA, Barden J. Systematic review of dexketoprofen in acute and chronic pain. BMC Clin Pharmacol 2008; 8: 11.
8. Zippel H, Wagenitz A. Comparison of the efficacy and safety of intravenously administered dexketoprofen trometamol and ketoprofen in the management of pain after orthopaedic surgery: A multicentre, double-blind, randomised, parallelgroup clinical trial. Clin Drug Investig 2006; 26: 517–28.
9. Zapata A, Cegarra F, Artigas R, Keller F. Dexketoprofen vs tramadol: randomised double-blind trial in patients with postoperative pain. British J Clin Pharmacol 2000; 223: abs 870.
10. Hanna MH, Elliott KM, Stuart-Taylor ME et al. Comparative study of analgesic efficacy and morphine-sparing effect of intramuscular dexketoprofen trometamol with ketoprofen or placebo after major orthopaedic surgery. Br J Clin Pharmacol 2003; 55: 126–133.
11. Jackson ID, Heidemann BH, Wilson J et al. Doubleblind, randomized, placebo-controlled trial comparing rofecoxib with dexketoprofen trometamol in surgical dentistry. Br J Anaesth 2004; 92: 675–80.
12. McGurk M, Robinson P, Rajayogeswaran V et al. Clinical comparison of dexketoprofen trometamol, ketoprofen, and placebo in postoperative dental pain. J Clin Pharmacol 1998; 38 (Suppl. 12): 46S–54S.
13. Munoz G, Berini L, Sanchez S et al. Preoperative dexketoprofen trometamol for the prevention of postoperative dental pain: a randomised double-blind clinical trial. Method Find Exp Clin Pharmacol 1998; 20 (Suppl A): 69.
14. Sanchez-Carpena J, Dominguez-Hervella F, Garcia I et al; Dexketoprofen Renal Colic Study Group. Comparison of intravenous dexketoprofen and dipyrone in acute renal colic. Eur J Clin Pharmacol 2007; 63 (8): 751–60.
15. Zippel H, Wagenitz A. A multicentre, randomised, double-blind study comparing the efficacy and tolerability of intramuscular dexketoprofen versus diclofenac in the symptomatic treatment of acute low back pain. Clin Drug Investig 2007; 27: 533–43.
16. Metscher B, Kubler U, Jahnel-Kracht H. Dexketoprofen-trometamol and tramadol in acute lumbago. Fortschr Med Orig 2001; 118: 147–51.
17. Marenco JL, Pérez M, Navarro FJ et al. A multicentre, randomised, double-blind study to compare the efficacy and tolerability of dexketoprofen trometamol versus diclofenac in the symptomatic treatment of knee osteoarthritis. Clin Drug Invest 2000; 19: 247–56.
18. Ezcurdia M, Cortejoso FJ, Lanzon R et al. Comparison of the efficacy and tolerability of dexketoprofen and ketoprofen in the treatment of primary dysmenorrhea. J Clin Pharmacol 1998; 38 (Suppl. 12): 65S–73S.
19. Rodriguez MJ, Contreras D, Galvez R et al. Double-blind evaluation of short-term analgesic efficacy of orally administered dexketoprofen trometamol and ketorolac in bone cancer pain. Pain 2003; 104: 103–10.
20. Leman P, Kapadia Y, Herington J. Randomised controlled trial of the onset of analgesic efficacy of dexketoprofen and diclofenac in lower limb injury. Emerg Med J 2003; 20: 511–3.
21. Beltra’n J et al. Comparison of Dexketoprofen trometamol and ketoprofen in the treatment of osteoartritis of the knee. J Clin Pharmacol 1998; 38: 74S–80S.
22. Capriai A, Mas M, Bertoloti M et al. Intramuscular dexketoprofen trometamol in acute lower back pain. 10th World Congress on Pain, IASP, California, 2002; p. 108–12.
23. Metscher B, Kubler U et al. Dexketoprofen-trometamol and tramadol in acute lumbago. Fortschr Med Orig 2001; 118 (4): 147–51.
24. Podchufarova E.V. Opyt primeneniya preparata Deksalgin® pri lechenii ostryh skeletno-myshechnyh bolevyh sindromov. Effektivnaya farmakoterapiya. Nevrologiya i Psihiatriya. 2012; 2: 34–9. [in Russian]
25. Merkulov Yu.A., Merkulova D.M., Kryzhanovskij G.N. Effektivnost deksalgina na vertebrogennye i nevertebrogennye mehanizmy dizregulyacii pri bolyah v spine. Zhurn. nevrologii i psihiatrii im. S.S.Korsakova. 2006; 106 (5): 20–4. [in Russian]
26. Soloveva E.Yu., Karneev A.N., Fedin A.I. Sochetannoe primenenie deksalgina i nimesila v stadii obostreniya dorsopatii. Vrach. 2007; 3: 67–71. [in Russian]
27. Podchufarova E.V., Yahno N.N. Boli v spine i konechnostyah. V kn.: Bolezni nervnoj sistemy. Rukovodstvo dlya vrachej. Pod red. N.N.Yahno. T. 2. M., 2005; s. 306–31. [in Russian]
28. Krymchantowski AV, Jevoux CC. The experience of combining agents, specially triptans and non steroidal anti-inflammatory drugs, for the acute treatment of migraine – a review. Recent Pat CNS Drug Discov 2007; 2: 141–4.
29. Tullo V, Valguarnera F, Barbanti P et al. Comparison of frovatriptan plus dexketoprofen (25 mg or 37.5 mg) with frovatriptan alone in the treatment of migraine attacks with or without aura: A randomized study. Cephalalgia 2014; 34: 434–45.
30. Allais G, Rolando S, Schiapparelli P et al. Frovatriptan plus dexketoprofen in the treatment of menstrually related migraine. An open study. Neurol Sci 2013; 34 (Suppl. 1): S179–S181.
31. Elkind AH and MacGregor EA. Frovatriptan for the acute treatment of migraine and prevention of predictable menstrual migraine. Expert Rev Neurother 2008; 8: 723–36.
32. Allais G, Bussone G, Tullo V et al. Frovatriptan 2.5 mg plus dexketoprofen (25 mg or 37.5 mg) in menstrually related migraine. Subanalysis from a double-blind, randomized trial. Cephalalgia 2015; 35 (1): 45–50.
Авторы
А.А.Пилипович
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М.Сеченова» Минздрава России. 119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2
aapilipovich@mail.ru
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М.Сеченова» Минздрава России. 119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2
aapilipovich@mail.ru
________________________________________________
A.A.Pilipovich
I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation. 119991, Russian Federation, Moscow, ul. Trubetskaia, d. 8, str. 2
aapilipovich@mail.ru
Цель портала OmniDoctor – предоставление профессиональной информации врачам, провизорам и фармацевтам.