Shikh EV, Khaytovich ED, Perkov AV. Clinical and pharmacological approaches to the choice of a drug for a tension-type headache relief. Terapevticheskii Arkhiv (Ter. Arkh). 2021; 93 (8): 862–868.
DOI: 10.26442/00403660.2021.08.200920
Клинико-фармакологические подходы к выбору препарата для купирования головной боли напряжения
Shikh EV, Khaytovich ED, Perkov AV. Clinical and pharmacological approaches to the choice of a drug for a tension-type headache relief. Terapevticheskii Arkhiv (Ter. Arkh). 2021; 93 (8): 862–868.
DOI: 10.26442/00403660.2021.08.200920
В статье рассмотрены клинико-фармакологические подходы к выбору препарата с оптимальным профилем эффективность/безопасность, обеспечивающим необходимый анальгетический эффект требуемой продолжительности при головной боли напряжения. Цель. Провести сравнительный анализ фармакодинамических и фармакокинетических параметров ибупрофена и парацетамола в составе фиксированной комбинации и в виде монотерапии при головной боли напряжения. Материалы и методы. Сравнительный тест кинетики растворения; Сравнительный анализ фармакокинетических параметров по базе данных PubMed/MEDLINE. Результаты. Медиана Tmax ибупрофена 75 мин при применении в составе фиксированной комбинации и при монотерапии. Медиана Tmax парацетамола 30 мин для фиксированной комбинации и 40 мин для монотерапии. У пациентов, получавших фиксированную комбинацию, концентрация ибупрофена в плазме крови через 10 мин – 6,64 мкг/мЛ-1; через 20 мин – 16,81 мкг/мЛ-1, в то время как при приеме в той же дозе в виде монотерапии соответственно 0,58 и 9,00 мкг/мЛ-1. Средние концентрации парацетамола в плазме крови через 10 и 20 мин у пациентов, получавших фиксированную комбинацию, составили 5,43 и 14,54 мкг/мЛ-1 соответственно по сравнению со значениями 0,33 и 9,19 мкг/мЛ-1 для монотерапии парацетамолом. Тест кинетики растворения препарата Парацитолгин: через 5 мин в раствор в системе с рН 1,2 перешло 20% парацетамола; в системе с рН 4,5 – 36,4%; в системе с рН 6,8 – 33,5%; через 10 мин соответственно 68,5, 98,0 и 89,6%. Через 15 мин во всех системах отмечено практически полное растворение: соответственно 98,5, 98,8 и 100,5%. Обсуждение. Применение фиксированной комбинации ибупрофена и парацетамола дает возможность усилить анальгетический эффект в результате аддитивного действия за счет центральных механизмов. В фиксированной комбинации с ибупрофеном существенно повышается скорость растворения и всасывания парацетамола, что обеспечивает более быстрое начало аналгезии.
Заключение. Фиксированная комбинация ибупрофена и парацетамола обеспечивает более быструю и выраженную аналгезию при сравнительно более низкой дозе каждого анальгетика.
The article goes to describe clinical and pharmacological approaches to choosing a drug with an optimal efficacy/safety profile, providing the necessary analgesic effect in tension-type headache. TRPV1 brain receptors are considered the main action point of the mediator. Aim. The purpose of this study is a comparative analysis of the pharmacodynamic and pharmacokinetic parameters of ibuprofen and paracetamol as a part of fixed dose combination and as monotherapy in tension – type headaches. Materials and methods. Comparative dissolution kinetics test; Comparative analysis of pharmacokinetic parameters using the PubMed/MEDLINE database. Results. The median Tmax of ibuprofen as a part of a fixed-dose combination and as a monotherapy is 75 minutes. The median Tmax of paracetamol is 30 min when taken in a fixed dose combination and 40 min as a monotherapy. In patients who received the fixed dose combination, the concentration of ibuprofen in the blood plasma after 10 minutes – 6.64 μg/ml-1; after 20 minutes – 16.81 μg/ml-1, while when taken in the same dose in as a monotherapy, respectively, 0.58 and 9.00 μg/ml-1. The mean plasma concentrations of paracetamol after 10 and 20 minutes in patients receiving the fixed combination were 5.43 and 14.54 μg/ml-1, respectively, compared with 0.33 and 9.19 μg/ml-1 for paracetamol as monotherapy. dissolution kinetics test of the Paracytolgin: after 5 minutes, 20% of paracetamol passed into the solution in a system with a pH of 1.2; in a system with a pH of 4.5 – 36.4%; in a system with a pH of 6.8 – 33.5%; after 10 minutes, respectively 68.5, 98.0 and 89.6%. After 15 minutes, almost complete dissolution was noted in all systems: 98.5, 98.8 and 100.5%, respectively. Discussion. The combination of ibuprofen and paracetamol makes it possible to enhance the analgesic effect as a result of additive action by the help of central mechanisms. The fixed dose combination of ibuprofen and paracetamol significantly increases the rate of absorption of paracetamol, which has potential therapeutic benefits in terms of a faster analgesia’s onset. Conclusion. The fixed dose combination of ibuprofen and paracetamol provides faster and long-term anaesthesia with a comparatively lower dosage of each analgesic.
1. Steiner TJ, World Headache Alliance. Lifting the burden: The global campaign against headache. Lancet Neurol. 2004;3(4):204-5. DOI:10.1016/S1474-4422(04)00703-3
2. Stovner Lj, Hagen K, Jensen R, et al. The global burden of headache: a documentation of headache prevalence and disability worldwide, Cephalalgia. 2007;27(3):193-210. DOI:10.1111/j.1468-2982.2007.01288.x
3. Oshinaike O, Ojo O, Okubadejo N, et al. Primary headache disorders at a tertiary health facility in Lagos, Nigeria: prevalence and consultation patterns. Biomed Res Int. 2014;2014:782915. DOI:10.1155/2014/782915
4. Rasmussen BK. Epidemiology of headache. Cephalalgia. 2001;21(7):774-7. DOI:10.1177/033310240102100708
5. Lyngberg AC, Rasmussen BK, Jørgensen T, et al. Incidence of primary headache: a Danish epidemiologic follow-up study. Am J Epidemiol. 2005;161(11):1066-73. DOI:10.1093/aje/kwi139
6. Cristofolini A, Dalla Serra P, Scherillo G, et al. The prevalence of headache in a population of health care workers and the effects on productivity costs. Med Lav. 2008;99(1):8-15. PMID: 18254535
7. GBD 2016 Headache Collaborators. Global, regional, and national burden of migraine and tension-type headache, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2018;17(11):954-76. DOI:10.1016/S1474-4422(18)30322-3
8. Saylor D, Steiner TJ. The Global Burden of Headache. Semin Neurol. 2018;38(2):182-90. DOI: 10.1055/s-0038-1646946
9. Atkinson H, Stanescu, I, Beasley, et al. A pharmacokinetic analysis of a novel fixed dose oral combination of paracetamol and ibuprofen, with emphasis on food effect. J Bioequiv Availab. 2015;7:150-4. DOI:10.4172/jbb.1000230
10. Tanner T, Aspley S, Munn A, et al. The pharmacokinetic profile of a novel fixed-dose combination tablet of ibuprofen and paracetamol. BMC Clin Pharmacol. 2010;10:10. DOI:10.1186/1472-6904-10-10
11. Anderson BJ, Fanzca FJFICM. Paracetamol (Acetaminophen): mechanisms of action. Pediatric Anesthesia. 2008;18:915-92. DOI:10.1111/j.1460-9592.2008.02764.x
12. Högestätt ED, Bo Jönsson AG, Ermund A, et al. Conversion of acetaminophen to the bioactive N-acylphenolamine AM404 via fatty acid amide hydrolase-dependent arachidonic acid conjugation in the nervous system.
J Biol Chem. 2005;280(36):31405-12. DOI:10.1074/jbc.M501489200
13. Beltramo M, Stella N, Calignano A, et al. Functional role of high-affinity anandamide transport, as revealed by selective inhibition. Science. 1997;277(5329):1094-7. DOI:10.1126/science.277.5329.1094
14. De Gregorio D, McLaughlin RJ, Posa L, et al. Cannabidiol modulates serotonergic transmission and reverses both allodynia and anxiety-like behavior in a model of neuropathic pain. Pain. 2019;160(1):136-50. DOI:10.1097/j.pain.0000000000001386
15. Maione S, Starowicz K, Cristino L, et al. Functional interaction between TRPV1 and mu-opioid receptors in the descending antinociceptive pathway activates glutamate transmission and induces analgesia.
J Neurophysiology. 2009;101(5):2411-22. DOI:10.1152/jn.91225.2008
16. Roberts LA, MacDonald JC, Connor M. Anandamide is a partial agonist at native vanilloid receptors in acutely isolated mouse trigeminal sensory neurons. Br J Pharmacol. 2002;137(4):421-8. DOI:10.1038/sj.bjp.0704904
17. Jennings EA, Vaughan CW, Roberts LA, Christie MJ. The actions of anandamide on rat superficial medullary dorsal horn neurons in vitro.
J Physiol. 2003;548:121-9. DOI:10.1113/jphysiol.2002.035063
18. Mallet C, Barrière DA, Ermund A, et al. TRPV1 in Brain Is Involved in Acetaminophen-Induced Antinociception, PLoS One. 2010;5(9):e12748.
DOI:10.1371/journal.pone.0012748
19. Ohashi N, Sasaki M, Ohashi M, et al. Tranexamic acid evokes pain by modulating neuronal excitability in the spinal dorsal horn. Sci Rep. 2015;5:13458. DOI:10.1038/srep13458
20. Yang K, Kumamoto E, Furue H, et al. Capsaicin induces a slow inward current which is not mediated by substance P in substantia gelatinosa neurons of the rat spinal cord. Neuropharmacology. 2000;39(11):2185-94. DOI:10.1016/s0028-3908(00)00031-9
21. Borsani E, Labanca M, Bianchi R, Rodella LF. AM404 decreases Fos-immunoreactivity in the spinal cord in a model of inflammatory pain. Brain Res. 2007;1152:87-94. DOI:10.1016/j.brainres.2007.03.071
22. Moore RA, Derry S, Aldington D, Wiffen PJ. Single dose oral analgesics for acute postoperative pain in adults – an overview of Cochrane reviews. Cochrane Database Syst Rev. 2015;2015(9):CD008659. DOI:10.1002/14651858.CD008659.pub3
23. Rabbie R, Derry S, Moore RA. Ibuprofen with or without an antiemetic for acute migraine headaches in adults. Cochrane Database Syst Rev. 2013;2013(4):CD008039. DOI:10.1002/14651858.CD008039.pub3
24. Moore AR, Derry S, Straube S, et al. Faster, higher, stronger? Evidence for formulation and efficacy for ibuprofen in acute pain. Pain. 2014;155(1):14-21. DOI:10.1016/j.pain.2013.08.013
25. Schou S, Nielsen H, Nattestad A. Analgesic dose-response relationship of ibuprofen 50, 100, 200, and 400 mg after surgical removal of third molars: a single-dose, randomized, placebo-controlled, and double-blind study of 304 patients. J Clin Pharmacol. 1998;38(5):447-54. DOI:10.1002/j.1552-4604.1998.tb04452.x
26. Beaver WT. Review of the analgesic efficacy of ibuprofen. Int J Clin Pract (Suppl.). 2003;135:13-7. PMID: 12723741
27. Derry S, Wiffen PJ, Moore RA, Bendtsen L. Ibuprofen for acute treatment of episodic tension-type headache in adults. Cochrane Database Syst Rev. 2015;2015(7):CD011474. DOI:10.1002/14651858.CD011474.pub2
28. Ахмадеева Л.Р., Азимова Ю.Э., Каракулова Ю.В., и др. Клинические рекомендации по диагностике и лечению головной боли напряжения. РМЖ. 2016;7:411-9 [Akhmadeeva LR, Azimova UE, Karakulova UV, et al. Clinical practice guidelines for the diagnosis and treatment of tension headache. Russian Medical Journal. 2016;7:411-9 (in Russian)].
29. Diener H-C, Messoud A, Ritter S, et al. Guidelines of the International Headache Society for controlled trials of acute treatment of migraine attacks in adults: fourth edition. Cephalalgia. 2019;39:687-710. DOI:10.1177/0333102419828967
30. Derry CJ, Derry S, Moore RA. Single dose oral ibuprofen plus paracetamol (acetaminophen) for acute postoperative pain. Cochrane Database Syst Rev. 2013;Issue 6:CD010210. DOI:10.1002/14651858.CD010210.pub2
31. Sniezek PJ, Brodland DG, Zitelli JA. A randomized controlled trial comparing acetaminophen, acetaminophen and ibuprofen, and acetaminophen and codeine for postoperative pain relief after Mohs surgery and cutaneous reconstruction. Dermatol Surg. 2011;37(7):1007-13. DOI:10.1111/j.1524-4725.2011.02022.x
32. Mehlisch DR, Aspley S, Daniels SE, Bandy DP. Comparison of the analgesic efficacy of concurrent ibuprofen and paracetamol with ibuprofen or paracetamol alone in the management of moderate to severe acute postoperative dental pain in adolescents and adults: a randomized, double-blind, placebo-controlled, parallel-group, single-dose, two-center, modified factorial study. Clin Ther. 2010;32(5):882-95. DOI:10.1016/j.clinthera.2010.04.022
33. Wright CE, Antal EJ, Gillespie WR, Albert KS. Ibuprofen and acetaminophen kinetics when taken concurrently. Clin Pharmacol Ther. 1983;34(5):707-10. DOI:10.1038/clpt.1983.237
34. Anderson BJ, Holford NH, Woollard GA, et al. Perioperative pharmacodynamics of acetaminophen analgesia in children. Anesthesiology. 1999;90(2):411-21.
DOI:10.1097/00000542-199902000-00014
35. Oksuz E, Yasar S, Erten R, et al. Comparison of effects of high and low dose paracetamol treatment and toxicity on brain and liver in rats. North Clin Istanb. 2020;7(6):541-50. DOI:10.14744/nci.2020.54926
36. Raffa RB. Pharmacology of oral combination analgesics: rational therapy for pain. J Clin Pharm Ther. 2001;26(4):257-64. DOI:10.1046/j.1365-2710.2001.00355.x
________________________________________________
1. Steiner TJ, World Headache Alliance. Lifting the burden: The global campaign against headache. Lancet Neurol. 2004;3(4):204-5. DOI:10.1016/S1474-4422(04)00703-3
2. Stovner Lj, Hagen K, Jensen R, et al. The global burden of headache: a documentation of headache prevalence and disability worldwide, Cephalalgia. 2007;27(3):193-210. DOI:10.1111/j.1468-2982.2007.01288.x
3. Oshinaike O, Ojo O, Okubadejo N, et al. Primary headache disorders at a tertiary health facility in Lagos, Nigeria: prevalence and consultation patterns. Biomed Res Int. 2014;2014:782915. DOI:10.1155/2014/782915
4. Rasmussen BK. Epidemiology of headache. Cephalalgia. 2001;21(7):774-7. DOI:10.1177/033310240102100708
5. Lyngberg AC, Rasmussen BK, Jørgensen T, et al. Incidence of primary headache: a Danish epidemiologic follow-up study. Am J Epidemiol. 2005;161(11):1066-73. DOI:10.1093/aje/kwi139
6. Cristofolini A, Dalla Serra P, Scherillo G, et al. The prevalence of headache in a population of health care workers and the effects on productivity costs. Med Lav. 2008;99(1):8-15. PMID: 18254535
7. GBD 2016 Headache Collaborators. Global, regional, and national burden of migraine and tension-type headache, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2018;17(11):954-76. DOI:10.1016/S1474-4422(18)30322-3
8. Saylor D, Steiner TJ. The Global Burden of Headache. Semin Neurol. 2018;38(2):182-90. DOI: 10.1055/s-0038-1646946
9. Atkinson H, Stanescu, I, Beasley, et al. A pharmacokinetic analysis of a novel fixed dose oral combination of paracetamol and ibuprofen, with emphasis on food effect. J Bioequiv Availab. 2015;7:150-4. DOI:10.4172/jbb.1000230
10. Tanner T, Aspley S, Munn A, et al. The pharmacokinetic profile of a novel fixed-dose combination tablet of ibuprofen and paracetamol. BMC Clin Pharmacol. 2010;10:10. DOI:10.1186/1472-6904-10-10
11. Anderson BJ, Fanzca FJFICM. Paracetamol (Acetaminophen): mechanisms of action. Pediatric Anesthesia. 2008;18:915-92. DOI:10.1111/j.1460-9592.2008.02764.x
12. Högestätt ED, Bo Jönsson AG, Ermund A, et al. Conversion of acetaminophen to the bioactive N-acylphenolamine AM404 via fatty acid amide hydrolase-dependent arachidonic acid conjugation in the nervous system.
J Biol Chem. 2005;280(36):31405-12. DOI:10.1074/jbc.M501489200
13. Beltramo M, Stella N, Calignano A, et al. Functional role of high-affinity anandamide transport, as revealed by selective inhibition. Science. 1997;277(5329):1094-7. DOI:10.1126/science.277.5329.1094
14. De Gregorio D, McLaughlin RJ, Posa L, et al. Cannabidiol modulates serotonergic transmission and reverses both allodynia and anxiety-like behavior in a model of neuropathic pain. Pain. 2019;160(1):136-50. DOI:10.1097/j.pain.0000000000001386
15. Maione S, Starowicz K, Cristino L, et al. Functional interaction between TRPV1 and mu-opioid receptors in the descending antinociceptive pathway activates glutamate transmission and induces analgesia.
J Neurophysiology. 2009;101(5):2411-22. DOI:10.1152/jn.91225.2008
16. Roberts LA, MacDonald JC, Connor M. Anandamide is a partial agonist at native vanilloid receptors in acutely isolated mouse trigeminal sensory neurons. Br J Pharmacol. 2002;137(4):421-8. DOI:10.1038/sj.bjp.0704904
17. Jennings EA, Vaughan CW, Roberts LA, Christie MJ. The actions of anandamide on rat superficial medullary dorsal horn neurons in vitro.
J Physiol. 2003;548:121-9. DOI:10.1113/jphysiol.2002.035063
18. Mallet C, Barrière DA, Ermund A, et al. TRPV1 in Brain Is Involved in Acetaminophen-Induced Antinociception, PLoS One. 2010;5(9):e12748.
DOI:10.1371/journal.pone.0012748
19. Ohashi N, Sasaki M, Ohashi M, et al. Tranexamic acid evokes pain by modulating neuronal excitability in the spinal dorsal horn. Sci Rep. 2015;5:13458. DOI:10.1038/srep13458
20. Yang K, Kumamoto E, Furue H, et al. Capsaicin induces a slow inward current which is not mediated by substance P in substantia gelatinosa neurons of the rat spinal cord. Neuropharmacology. 2000;39(11):2185-94. DOI:10.1016/s0028-3908(00)00031-9
21. Borsani E, Labanca M, Bianchi R, Rodella LF. AM404 decreases Fos-immunoreactivity in the spinal cord in a model of inflammatory pain. Brain Res. 2007;1152:87-94. DOI:10.1016/j.brainres.2007.03.071
22. Moore RA, Derry S, Aldington D, Wiffen PJ. Single dose oral analgesics for acute postoperative pain in adults – an overview of Cochrane reviews. Cochrane Database Syst Rev. 2015;2015(9):CD008659. DOI:10.1002/14651858.CD008659.pub3
23. Rabbie R, Derry S, Moore RA. Ibuprofen with or without an antiemetic for acute migraine headaches in adults. Cochrane Database Syst Rev. 2013;2013(4):CD008039. DOI:10.1002/14651858.CD008039.pub3
24. Moore AR, Derry S, Straube S, et al. Faster, higher, stronger? Evidence for formulation and efficacy for ibuprofen in acute pain. Pain. 2014;155(1):14-21. DOI:10.1016/j.pain.2013.08.013
25. Schou S, Nielsen H, Nattestad A. Analgesic dose-response relationship of ibuprofen 50, 100, 200, and 400 mg after surgical removal of third molars: a single-dose, randomized, placebo-controlled, and double-blind study of 304 patients. J Clin Pharmacol. 1998;38(5):447-54. DOI:10.1002/j.1552-4604.1998.tb04452.x
26. Beaver WT. Review of the analgesic efficacy of ibuprofen. Int J Clin Pract (Suppl.). 2003;135:13-7. PMID: 12723741
27. Derry S, Wiffen PJ, Moore RA, Bendtsen L. Ibuprofen for acute treatment of episodic tension-type headache in adults. Cochrane Database Syst Rev. 2015;2015(7):CD011474. DOI:10.1002/14651858.CD011474.pub2
28. Akhmadeeva LR, Azimova UE, Karakulova UV, et al. Clinical practice guidelines for the diagnosis and treatment of tension headache. Russian Medical Journal. 2016;7:411-9 (in Russian)
29. Diener H-C, Messoud A, Ritter S, et al. Guidelines of the International Headache Society for controlled trials of acute treatment of migraine attacks in adults: fourth edition. Cephalalgia. 2019;39:687-710. DOI:10.1177/0333102419828967
30. Derry CJ, Derry S, Moore RA. Single dose oral ibuprofen plus paracetamol (acetaminophen) for acute postoperative pain. Cochrane Database Syst Rev. 2013;Issue 6:CD010210. DOI:10.1002/14651858.CD010210.pub2
31. Sniezek PJ, Brodland DG, Zitelli JA. A randomized controlled trial comparing acetaminophen, acetaminophen and ibuprofen, and acetaminophen and codeine for postoperative pain relief after Mohs surgery and cutaneous reconstruction. Dermatol Surg. 2011;37(7):1007-13. DOI:10.1111/j.1524-4725.2011.02022.x
32. Mehlisch DR, Aspley S, Daniels SE, Bandy DP. Comparison of the analgesic efficacy of concurrent ibuprofen and paracetamol with ibuprofen or paracetamol alone in the management of moderate to severe acute postoperative dental pain in adolescents and adults: a randomized, double-blind, placebo-controlled, parallel-group, single-dose, two-center, modified factorial study. Clin Ther. 2010;32(5):882-95. DOI:10.1016/j.clinthera.2010.04.022
33. Wright CE, Antal EJ, Gillespie WR, Albert KS. Ibuprofen and acetaminophen kinetics when taken concurrently. Clin Pharmacol Ther. 1983;34(5):707-10. DOI:10.1038/clpt.1983.237
34. Anderson BJ, Holford NH, Woollard GA, et al. Perioperative pharmacodynamics of acetaminophen analgesia in children. Anesthesiology. 1999;90(2):411-21.
DOI:10.1097/00000542-199902000-00014
35. Oksuz E, Yasar S, Erten R, et al. Comparison of effects of high and low dose paracetamol treatment and toxicity on brain and liver in rats. North Clin Istanb. 2020;7(6):541-50. DOI:10.14744/nci.2020.54926
36. Raffa RB. Pharmacology of oral combination analgesics: rational therapy for pain. J Clin Pharm Ther. 2001;26(4):257-64. DOI:10.1046/j.1365-2710.2001.00355.x
Авторы
Е.В. Ших*, Е.Д. Хайтович, А.В. Перков
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*chih@mail.ru
________________________________________________
Evgeniya V. Shikh*, Evgeniy D. Khaytovich, Aleksandr V. Perkov
Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*chih@mail.ru