Системные и топические назальные деконгестанты широко используются в оториноларингологии для лечения острого риносинусита и в качестве вспомогательных средств при лечении определенных форм хронического риносинусита. Назальные деконгестанты способствуют быстрому улучшению носового дыхания, в продаже легко доступны, что может привести к их неадекватному использованию и развитию побочных эффектов. В статье представлены обзор литературы по назальным деконгестантам, их механизмам действия, побочным эффектам от данной терапии. Даны рекомендации по снижению рисков развития негативного влияния при системной и местной терапии сосудосуживающими средствами.
Systemic and topical nasal decongestants are widely used in otorhinolaryngology for the treatment of acute rhinosinusitis and as aids in the treatment of certain forms of chronic rhinosinusitis. Nasal decongestants contribute to rapid improvement in nasal breathing, and commercially are readily available, – this availability can lead to an inappropriate use and development of side effects. The article presents an overview of the literature on nasal decongestants, their mechanisms of action, side effects of this therapy. The recommendations on the development of risk reduction in the negative impact of systemic and local therapy vasoconstrictor.
Key words: nasal decongestants, dexpanthenol, drug-induced rhinitis, side effects.
1. Карпищенко С.А., Колесникова О.М., Шумилова Н.А. Ирригационная терапия при ринитах. Consilium Medicum. Педиатрия (Прил). 2015; 3: 42–5. / Karpishchenko S.A., Kolesnikova O.M., Shumilova N.A. Irrigatsionnaia terapiia pri rinitakh. Consilium Medicum. Pediatrics (Suppl.). 2015; 3: 42–5. [in Russian]
2. Reinecke S, Tschaikin M. Investigation of the effect of oxymetazoline on the duration of rhinitis. Results of a placebo-controlled double blind study in patients with acute rhinitis. MMW Fortschr Med 2005; 6 (Iss. 147, Suppl. 3): 113–8.
3. Malm L, Anggard L. Vasoconstrictors. In: N.Mygind, R.M.Naclerio, eds. Allergic and non-allergic rhinitis. Clinical aspects. Copenhagen: Munksgaard, 1993; p. 95–100.
4. Food and Drug Administration. Establishment of a monograph for OTC cold, cough, allergy, bronchodilator and antiasthmatic drug products. Federal Register 1976; 41: 38399–400. Available at: http://www.fda.gov/OHRMS/Dockets/98fr/76-22710.PDF. Accessed December 8, 2005.
5. Kernan WN, Viscoli CM, Brass LM et al. Phenylpropanolamine and the risk of hemorrhagic stroke. N Engl J Med 2000; 343: 1826–32.
6. Bickerman HA. Physiologic and pharmacologic studies on nasal airway resistance (RN). Presented at a conference sponsored by the Scientific Development Committee of the Proprietary Association. Washington, DC. December 8, 1971.
7. McLaurin JW, Shipman WF, Rosedale RJr. Oral decongestants: a double blind comparison study of the effectiveness of four sympathomimetic drugs: objective and subjective. Laryngoscope 1961; 71: 54–67.
8. Hengstmann JH, Goronzy J. Pharmacokinetics of 3H-phenylephrine in man. Eur J Clin Pharmacol 1982;21: 335–41.
9. Hendeles L, Hatton RC. Oral phenylephrine: An ineffective replacement for pseudoephedrine? J Allergy Clin Immunol 2006; 118 (1): 279–80.
10. Cohen BM. Clinical and physiologic ‘‘significance’’ in drug-induced changes in nasal flow/resistance. Eur J Clin Pharmacol 1972; 5: 81–6.
11. Gelotte CK, Zimmerman BA. Pharmacokinetics, Safety, and Cardiovascular Tolerability of Phenylephrine HCl 10, 20, and 30 mg After a Single Oral Administration in Healthy Volunteers. Clin Drug Investig 2015; 35: 547–58.
12. Kanfer I, Dowse R, Vuma V. Pharmacokinetics of oral decongestants. Pharmacotherapy 1993; 13: 116S–28S.
13. Loose I, Winkel M. Clinical, double-blind, placebo-controlled study investi-gating the combination of acetylsalicylic acid and pseudoephedrine for thesymptomatic treatment of nasal congestion associated with common cold. Arzneimittelforschung 2004; 54: 513–21.
14. Eccles R, Jawad MS, Jawad SS et al. Efficacy and safety of single and multipledoses of pseudoephedrine in the treatment of nasal congestion associated withcommon cold. Am J Rhinol 2005; 19: 25–31.
15. Laccourreye O, Wernerb A, Giroudcet J-P et al. Benefits, limits and danger of ephedrine and pseudoephedrine as nasal decongestants. Eur Ann Otorhinolaryngol, Head Neck Dis 2015; 132; 31–4.
16. Sutrisna В, Frerichs RR, Reingold AL. Randomised, controlled trial of effectiveness of ampicillin in mild acute respiratory infections in Indonesian children. Lancet 1991; 338 (8765): 471.
17. Caenen M, Hamels K, Deron P, Clement P. Comparison of decongestive capacity of xylometazoline and pseudoephedrine with rhinomanometry and MRI. Rhinology 2005; 43 (3): 205–9.
18. Knipping S, Holzhausen HJ, Riederer A, Bloching M. Ultrastructural changes in human nasal mucosa in rhinitis medicamentosa. HNO 2006; 54 (10): 742–8.
19. Passali D, Salerni L, Passali G et al. Nasal decongestants in the treatment of chronic nasal obstruction: efficacy and safety of use. Expert Opin Drug Saf 2006; 5 (6): 783–90. DOI:10.1517/14740338.5.6.783
20. Lacroix J. Adrenergic and nonadrenergic mechanisms in sympathetic vascular control of the nasal mucosa. Acta Physiol Scand Suppl; 1989; 581: 1–63.
21. Graf P. Rhinitis medicamentosa: a review of causes and treatment. Treat Respir Med 2005; 4 (1): 21–9. DOI:10.2165/00151829-200504010-00003
22. Richards R, Cavill R. Electron microscopic study of the effect of benzalkonium chloride and edeta disodium on the cell envelope of Pseudomonas aeruginosa. J Pharm Sci 1976; 65: 76–80. DOI:10.1002/jps.2600650115
23. Graf P, Hallen H. Effect on the nasal mucosaof long-term treatment with oxymetasoline, bensalconium chloride, and placebo nasal sprays. Laryngoscope 1996; 106 (1): 605–9.
24. Mahieu LM, Rooman RP, Goossens E. Imidazoline intoxication in children. Eur J Pediatr 1993; 152 (11): 944–6.
25. Bucaretchi F, Dragosavac S, Vieira RJ. Acute exposure to imidazoline derivatives in children. J Pediatr (Rio J). 2003; 79 (6): 519–24.
26. Alvarez-Pitti J, Rodríguez-Varela A, Morales-Carpi C et al. Naphazoline intoxication in children. Eur J Pediatr 2006; 165 (11): 815–621.
27. Eskiizmir G, Hirçin Z, Ozyurt B, Unlü H. A comparative analysis of the decongestive effect of oxymetazoline and xylometazoline in healthy subjects. Eur J Clin Pharmacol 2011; 67 (1): 19–23. DOI: 10.1007/s00228-010-0941-z.
28. Ryan RE. Vasomotor rhinitis medicamentosa viewed histologically. Mayo Clin Proc 1947; 22: 113–7.
29. Talaat M, Belal A, Aziz T et al. Rhinitis medicamentosa: electron microscopic study. J Laryngol Otol 1981; 95: 125–31.
30. Suh SH, Chon KM, Min YG et al. Effects of topical nasal decongestants on histology of nasal respiratory mucosa in rabbits. Acta Otolaryngol 1995; 115: 664–71.
31. Morris S, Eccles R, Martez SJ et al. An evaluation of nasal response following different treatment regimens of oxymetazoline with references to rebound congestion. Am J Rhinol 1997; 11: 109–15.
32. Vaidyanathan S, Williamson P, Clearie K et al. Fluticasone reverses oxymetazoline-induced tachyphylaxis of response and rebound congestion. Am J Respir Crit Care Med 2010; 182: 19–24.
33. Завалий А.А., Кубышкин А.В. Патогенетическое значение исследования функционального состояния мукоцилиарной транспортной системы для совершенствования диагностики риносинуситов. Folia Otorhinolaryngologiae et Pathologiae Respiratoriae. 2016. 22 (1): 38–47. / Zavalii A.A., Kubyshkin A.V. Patogeneticheskoe znachenie issledovaniia funktsional'nogo sostoianiia mukotsiliarnoi transportnoi sistemy dlia sovershenstvovaniia diagnostiki rinosinusitov. Folia Otorhinolaryngologiae et Pathologiae Respiratoriae. 2016. 22 (1): 38–47. [in Russian]
34. Petruson B, Hansson HA. Function and structure of the nasal mucosa after 6 weeks use of nose drops. Acta Otolaryngol (Stockh) 1982; 94: 563–9.
35. Petruson B. Treatment with xylometazoline (Otrivin) nosedrops over a six-week period. Rhinology 1981; 19: 167–72.
36. Hahn C, Böhm M, Allekotte S et al. Tolerability and effects on quality of life of liposomal nasal spray treatment compared to nasal ointment containing dexpanthenol or isotonic NaCl spray in patients with rhinitis sicca. Eur Arch Otorhinolaryngol 2013; 270 (9): 2465–72.
37. Sonnemann U, Scherner O, Werkhäuser N. Treatment of rhinitis sicca anterior with ectoine containing nasal spray. J Allergy (Cairo) 2014; 2014: 273219. DOI: 10.1155/2014/273219.
38. Tantilipikorn P, Tunsuriyawong P, Jareoncharsri P et al. A randomized, prospective, double-blind study of the efficacy of dexpanthenol nasal spray on the postoperative treatment of patients with chronic rhinosinusitis after endoscopic sinus surgery. J Med Assoc Thai 2012; 95 (1): 58–63.
39. Gouteva I, Shah-Hosseini K, Meiser P. Clinical efficacy of a spray containing hyaluronic Acid and dexpanthenol after surgery in the nasal cavity (septoplasty, simple ethmoid sinus surgery, and turbinate surgery) J Allergy (Cairo) 2014; 2014: 635490. DOI: 10.1155/2014/635490.
40. Klöcker N, Rudolph P, Verse T. Evaluation of protective and therapeutic effects of dexpanthenol on nasal decongestants and preservatives: results of cytotoxic studies in vitro. Am J Rhinol 2004; 18 (5): 315–20.
41. Kehrl W et al. 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.
42. 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.
________________________________________________
1. Karpishchenko S.A., Kolesnikova O.M., Shumilova N.A. Irrigatsionnaia terapiia pri rinitakh. Consilium Medicum. Pediatrics (Suppl.). 2015; 3: 42–5. [in Russian]
2. Reinecke S, Tschaikin M. Investigation of the effect of oxymetazoline on the duration of rhinitis. Results of a placebo-controlled double blind study in patients with acute rhinitis. MMW Fortschr Med 2005; 6 (Iss. 147, Suppl. 3): 113–8.
3. Malm L, Anggard L. Vasoconstrictors. In: N.Mygind, R.M.Naclerio, eds. Allergic and non-allergic rhinitis. Clinical aspects. Copenhagen: Munksgaard, 1993; p. 95–100.
4. Food and Drug Administration. Establishment of a monograph for OTC cold, cough, allergy, bronchodilator and antiasthmatic drug products. Federal Register 1976; 41: 38399–400. Available at: http://www.fda.gov/OHRMS/Dockets/98fr/76-22710.PDF. Accessed December 8, 2005.
5. Kernan WN, Viscoli CM, Brass LM et al. Phenylpropanolamine and the risk of hemorrhagic stroke. N Engl J Med 2000; 343: 1826–32.
6. Bickerman HA. Physiologic and pharmacologic studies on nasal airway resistance (RN). Presented at a conference sponsored by the Scientific Development Committee of the Proprietary Association. Washington, DC. December 8, 1971.
7. McLaurin JW, Shipman WF, Rosedale RJr. Oral decongestants: a double blind comparison study of the effectiveness of four sympathomimetic drugs: objective and subjective. Laryngoscope 1961; 71: 54–67.
8. Hengstmann JH, Goronzy J. Pharmacokinetics of 3H-phenylephrine in man. Eur J Clin Pharmacol 1982;21: 335–41.
9. Hendeles L, Hatton RC. Oral phenylephrine: An ineffective replacement for pseudoephedrine? J Allergy Clin Immunol 2006; 118 (1): 279–80.
10. Cohen BM. Clinical and physiologic ‘‘significance’’ in drug-induced changes in nasal flow/resistance. Eur J Clin Pharmacol 1972; 5: 81–6.
11. Gelotte CK, Zimmerman BA. Pharmacokinetics, Safety, and Cardiovascular Tolerability of Phenylephrine HCl 10, 20, and 30 mg After a Single Oral Administration in Healthy Volunteers. Clin Drug Investig 2015; 35: 547–58.
12. Kanfer I, Dowse R, Vuma V. Pharmacokinetics of oral decongestants. Pharmacotherapy 1993; 13: 116S–28S.
13. Loose I, Winkel M. Clinical, double-blind, placebo-controlled study investi-gating the combination of acetylsalicylic acid and pseudoephedrine for thesymptomatic treatment of nasal congestion associated with common cold. Arzneimittelforschung 2004; 54: 513–21.
14. Eccles R, Jawad MS, Jawad SS et al. Efficacy and safety of single and multipledoses of pseudoephedrine in the treatment of nasal congestion associated withcommon cold. Am J Rhinol 2005; 19: 25–31.
15. Laccourreye O, Wernerb A, Giroudcet J-P et al. Benefits, limits and danger of ephedrine and pseudoephedrine as nasal decongestants. Eur Ann Otorhinolaryngol, Head Neck Dis 2015; 132; 31–4.
16. Sutrisna В, Frerichs RR, Reingold AL. Randomised, controlled trial of effectiveness of ampicillin in mild acute respiratory infections in Indonesian children. Lancet 1991; 338 (8765): 471.
17. Caenen M, Hamels K, Deron P, Clement P. Comparison of decongestive capacity of xylometazoline and pseudoephedrine with rhinomanometry and MRI. Rhinology 2005; 43 (3): 205–9.
18. Knipping S, Holzhausen HJ, Riederer A, Bloching M. Ultrastructural changes in human nasal mucosa in rhinitis medicamentosa. HNO 2006; 54 (10): 742–8.
19. Passali D, Salerni L, Passali G et al. Nasal decongestants in the treatment of chronic nasal obstruction: efficacy and safety of use. Expert Opin Drug Saf 2006; 5 (6): 783–90. DOI:10.1517/14740338.5.6.783
20. Lacroix J. Adrenergic and nonadrenergic mechanisms in sympathetic vascular control of the nasal mucosa. Acta Physiol Scand Suppl; 1989; 581: 1–63.
21. Graf P. Rhinitis medicamentosa: a review of causes and treatment. Treat Respir Med 2005; 4 (1): 21–9. DOI:10.2165/00151829-200504010-00003
22. Richards R, Cavill R. Electron microscopic study of the effect of benzalkonium chloride and edeta disodium on the cell envelope of Pseudomonas aeruginosa. J Pharm Sci 1976; 65: 76–80. DOI:10.1002/jps.2600650115
23. Graf P, Hallen H. Effect on the nasal mucosaof long-term treatment with oxymetasoline, bensalconium chloride, and placebo nasal sprays. Laryngoscope 1996; 106 (1): 605–9.
24. Mahieu LM, Rooman RP, Goossens E. Imidazoline intoxication in children. Eur J Pediatr 1993; 152 (11): 944–6.
25. Bucaretchi F, Dragosavac S, Vieira RJ. Acute exposure to imidazoline derivatives in children. J Pediatr (Rio J). 2003; 79 (6): 519–24.
26. Alvarez-Pitti J, Rodríguez-Varela A, Morales-Carpi C et al. Naphazoline intoxication in children. Eur J Pediatr 2006; 165 (11): 815–621.
27. Eskiizmir G, Hirçin Z, Ozyurt B, Unlü H. A comparative analysis of the decongestive effect of oxymetazoline and xylometazoline in healthy subjects. Eur J Clin Pharmacol 2011; 67 (1): 19–23. DOI: 10.1007/s00228-010-0941-z.
28. Ryan RE. Vasomotor rhinitis medicamentosa viewed histologically. Mayo Clin Proc 1947; 22: 113–7.
29. Talaat M, Belal A, Aziz T et al. Rhinitis medicamentosa: electron microscopic study. J Laryngol Otol 1981; 95: 125–31.
30. Suh SH, Chon KM, Min YG et al. Effects of topical nasal decongestants on histology of nasal respiratory mucosa in rabbits. Acta Otolaryngol 1995; 115: 664–71.
31. Morris S, Eccles R, Martez SJ et al. An evaluation of nasal response following different treatment regimens of oxymetazoline with references to rebound congestion. Am J Rhinol 1997; 11: 109–15.
32. Vaidyanathan S, Williamson P, Clearie K et al. Fluticasone reverses oxymetazoline-induced tachyphylaxis of response and rebound congestion. Am J Respir Crit Care Med 2010; 182: 19–24.
33. Zavalii A.A., Kubyshkin A.V. Patogeneticheskoe znachenie issledovaniia funktsional'nogo sostoianiia mukotsiliarnoi transportnoi sistemy dlia sovershenstvovaniia diagnostiki rinosinusitov. Folia Otorhinolaryngologiae et Pathologiae Respiratoriae. 2016. 22 (1): 38–47. [in Russian]
34. Petruson B, Hansson HA. Function and structure of the nasal mucosa after 6 weeks use of nose drops. Acta Otolaryngol (Stockh) 1982; 94: 563–9.
35. Petruson B. Treatment with xylometazoline (Otrivin) nosedrops over a six-week period. Rhinology 1981; 19: 167–72.
36. Hahn C, Böhm M, Allekotte S et al. Tolerability and effects on quality of life of liposomal nasal spray treatment compared to nasal ointment containing dexpanthenol or isotonic NaCl spray in patients with rhinitis sicca. Eur Arch Otorhinolaryngol 2013; 270 (9): 2465–72.
37. Sonnemann U, Scherner O, Werkhäuser N. Treatment of rhinitis sicca anterior with ectoine containing nasal spray. J Allergy (Cairo) 2014; 2014: 273219. DOI: 10.1155/2014/273219.
38. Tantilipikorn P, Tunsuriyawong P, Jareoncharsri P et al. A randomized, prospective, double-blind study of the efficacy of dexpanthenol nasal spray on the postoperative treatment of patients with chronic rhinosinusitis after endoscopic sinus surgery. J Med Assoc Thai 2012; 95 (1): 58–63.
39. Gouteva I, Shah-Hosseini K, Meiser P. Clinical efficacy of a spray containing hyaluronic Acid and dexpanthenol after surgery in the nasal cavity (septoplasty, simple ethmoid sinus surgery, and turbinate surgery) J Allergy (Cairo) 2014; 2014: 635490. DOI: 10.1155/2014/635490.
40. Klöcker N, Rudolph P, Verse T. Evaluation of protective and therapeutic effects of dexpanthenol on nasal decongestants and preservatives: results of cytotoxic studies in vitro. Am J Rhinol 2004; 18 (5): 315–20.
41. Kehrl W et al. 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.
42. 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.
Авторы
С.А.Карпищенко, О.М.Колесникова*
ФГБОУ ВО Первый Санкт-Петербургский государственный медицинский университет им. акад. И.П.Павлова Минздрава России. 197022, Россия, Санкт-Петербург, ул. Льва Толстого, д. 6/8
*olga_lozo@mail.ru
________________________________________________
S.A.Karpishchenko, O.M.Kolesnikova*
I.P.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
*olga_lozo@mail.ru