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Рецепт. 2019; : 119-126

Антилейкотриеновые препараты в клинической практике

Артишевский С. Н.

Аннотация

В работе описаны пути метаболизма арахидоновой кислоты и синтеза основных медиаторов воспаления. Особенно подробно рассмотрен 5-липооксигеназный путь с образованием лейкотриенов. Представлена их классификация, биологическая роль в организме, а также специфические рецепторы, которые опосредуют механизмы влияния. Изложены подходы по устранению действия лейкотриенов на организм и доложена современная классификация антилейкотриеновых препаратов. Касаясь фармакокинетики и фармакодинамики монтелука- ста и зафирлукаста, указаны особенности их назначения в зависимости от возраста и наличия сопутствующей патологии. В соответствии с международными рекомендациями приведены показания и противопоказания к назначению данных препаратов, а также аспекты их использования при бронхиальной астме, аллергическом рините и крапивнице в зависимости от степени тяжести процесса и в комбинации с другими препаратами (топическими глюкокортикостероидами и антигистаминными), особенно при продолжительных курсах терапии. Отдельно рассмотрена патогенетическая эффективность назначения монтелукаста при аспириновой бронхиальной астме и непереносимости нестероидных противовоспалительных препаратов. Кроме того, мотивировано длительное использование монтелукаста и зафирлукаста при хронических гиперпластических процессах (полипозах, аденоидитах, синуситах) в верхних дыхательных путях.

Список литературы

1. Vasilevskii I.V. (2014) Ispol’zovanie montelukasta (Singlona) - novaya strategiya lecheniya allergicheskih zabolevanii [The use of montelukast (Singlon) - the new strategy of allergic diseases treatment]. Klinicheskaya praktika i zdorov’e [Clinical practice and health], no 6, pp. 52-67.

2. Vasilevskii I.V., Skep’yan E.N. (2011) Ispol’zovanie singulyara - novaya strategiya lecheniya allergicheskogo rinita [The use of Singular - the new strategy of allergic rhinitis treatment]. ARS- medica [ARS-medica], no 3, pp.159-172.

3. Knyazheskaya N.P. (2013) Antagonisti leikotrienovih retseptorov - protivovospalitel’nie preparati dlya lecheniya bronhial’noi astmi [Leukotriene receptor antagonists - anti-inflammatory drugs for treatment of bronchial asthma]. Consilium Medicum [Consilium Medicum], vol. 11, pp. 13-16.

4. Mizernitskii YU.L. (2014) Antileikotrienovie preparati v terapii bronhial’noi astmi u detei [Antileukotriene drugs in bronchial asthma therapy in children]. Meditsinskii sovet [Medical council], no 14, pp. 46-49.

5. RevyakinaV.A.(2014) Sovremenniepodhodikterapiibol’nihbronhial’noiastmoi[]. Prakticheskaya pul’monologiya [], no 1, pp. 83-87.

6. Ryazantsev S.V., Krivolapov A.A., Krivolapova L.I. (2015) Novie vozmozhnosti v lechenii allergicheskogo rinita [New opportunities in allergic rhinitis treatment]. Meditsinskii sovet [Medical council], no 4, pp. 26-29.

7. Barnes N. (2000) Effects of antileukotrienes in the treatment of asthma. Ibid, vol. 161, p. 73-76.

8. Barnes P. (2000) New directions in allergic diseases: mechanism-based anti-inflammatory therapies. J. Allergy Clin Immunol, vol. 106, p. 5-16.

9. Scadding G.W., Scadding G.K. (2010) Recent advances in antileukotriene therapy. Curr. Opin Allergy Clin Immunol, vol. 10 (4), p. 370-376.

10. Visitsunthorn N., Chirdjirapong V., Santadilog S. et all. (2011) The effect of montelukast on bronchial hyperreactivity and lung function in asthmatic children aged 6-13 years. Asian Pac J Allergy Immunol., vol. 29 (2), p. 127-133.

11. Wahn U., Dass S.B. (2008) Review of recent results of montelukast use as a monotherapy in children with mild asthma. Clin. Tber, vol. 30, p. 1026-1035.

12. Wenzel S.E. (2008) Antileukotriene Therapy in Asthma. ed. Mosby. Imprint Elsevier, p. 1619-1629.

Recipe. 2019; : 119-126

Antileukotriene Drugs Medicines in Clinical Practice

Artishevskij S. .

Abstract

The paper describes the ways of arachidonic acid metabolism and synthesis of the main inflammatory mediators. The 5-lipoxygenase pathway with the formation of leukotrienes is considered in particular in detail. Their classification, biological role in an organism, and also specific receptors which mediate mechanisms of influence are presented. The suggested approaches to eliminate the actions of leukotrienes on the body and reported to the modern classification antileukotriene drugs. Concerning the pharmacokinetics and pharmacodynamics of montelukast and zafirlukast, the features of their administration depending on the age and the presence of comorbidities are indicated. In accordance with international recommendations, the indications and contraindications to the appointment of these drugs, as well as aspects of their use in bronchial asthma, allergic rhinitis and urticaria, depending on the severity of the process and in combination with other drugs (topical glucocorticosteroids and antihistamines), especially with long-term courses of therapy aregiven. The pathogenetic efficacy of montelukast administration in aspirin bronchial asthma and intolerance to non-steroidal anti-inflammatory drugs is considered separately. In addition, the long- term use of montelukast and zafirlukast in chronic hyperplastic processes (polyposis, adenoiditis, sinusitis) in the upper respiratory tract is motivated.
References

1. Vasilevskii I.V. (2014) Ispol’zovanie montelukasta (Singlona) - novaya strategiya lecheniya allergicheskih zabolevanii [The use of montelukast (Singlon) - the new strategy of allergic diseases treatment]. Klinicheskaya praktika i zdorov’e [Clinical practice and health], no 6, pp. 52-67.

2. Vasilevskii I.V., Skep’yan E.N. (2011) Ispol’zovanie singulyara - novaya strategiya lecheniya allergicheskogo rinita [The use of Singular - the new strategy of allergic rhinitis treatment]. ARS- medica [ARS-medica], no 3, pp.159-172.

3. Knyazheskaya N.P. (2013) Antagonisti leikotrienovih retseptorov - protivovospalitel’nie preparati dlya lecheniya bronhial’noi astmi [Leukotriene receptor antagonists - anti-inflammatory drugs for treatment of bronchial asthma]. Consilium Medicum [Consilium Medicum], vol. 11, pp. 13-16.

4. Mizernitskii YU.L. (2014) Antileikotrienovie preparati v terapii bronhial’noi astmi u detei [Antileukotriene drugs in bronchial asthma therapy in children]. Meditsinskii sovet [Medical council], no 14, pp. 46-49.

5. RevyakinaV.A.(2014) Sovremenniepodhodikterapiibol’nihbronhial’noiastmoi[]. Prakticheskaya pul’monologiya [], no 1, pp. 83-87.

6. Ryazantsev S.V., Krivolapov A.A., Krivolapova L.I. (2015) Novie vozmozhnosti v lechenii allergicheskogo rinita [New opportunities in allergic rhinitis treatment]. Meditsinskii sovet [Medical council], no 4, pp. 26-29.

7. Barnes N. (2000) Effects of antileukotrienes in the treatment of asthma. Ibid, vol. 161, p. 73-76.

8. Barnes P. (2000) New directions in allergic diseases: mechanism-based anti-inflammatory therapies. J. Allergy Clin Immunol, vol. 106, p. 5-16.

9. Scadding G.W., Scadding G.K. (2010) Recent advances in antileukotriene therapy. Curr. Opin Allergy Clin Immunol, vol. 10 (4), p. 370-376.

10. Visitsunthorn N., Chirdjirapong V., Santadilog S. et all. (2011) The effect of montelukast on bronchial hyperreactivity and lung function in asthmatic children aged 6-13 years. Asian Pac J Allergy Immunol., vol. 29 (2), p. 127-133.

11. Wahn U., Dass S.B. (2008) Review of recent results of montelukast use as a monotherapy in children with mild asthma. Clin. Tber, vol. 30, p. 1026-1035.

12. Wenzel S.E. (2008) Antileukotriene Therapy in Asthma. ed. Mosby. Imprint Elsevier, p. 1619-1629.