Все это происходит на фоне экономической ситуации, когда правительства стемятся урезать затраты на медицинскую помощь, взваливая тем самым на плечи потребителей все более тяжкое бремя расходов на лекарства



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Ненадлежащее использование анальгетиков может вызывать серьезные и иногда летальные побочные эффекты. Проблемой во всем мире является почечные заболевания или почечная недостаточность, вызванные анальгетиками. Там, где проводились хорошо поставленные исследования, можно было провести связь между значительной частью пациентов, которым была заменена почка или которые находились на диализе, и использованием анальгетиков. В 1987 г. в Австралии эта цифра составляла 13%; в 1986 г. в Германии она была равна 16.8%; в 1988 г. в Бельгии - 18% [107]. Будет серьезной ошибкой считать, что продукт "безопасен" только потому, что он отпускается без рецепта.

Дело еще более осложняет озадачивающая масса анальгетиков на рынке многих стран; причем все они рекламируются как более эффективные, более быстродействующие, или более безопасные в купировании боли. Как уже отмечалось, для многих из них эти утверждения научно не подтверждаются. В отношении некоторых продуктов данные ясно говорят о том, что риск перевешивает любую предполагаемую пользу. Настало время рационализировать подход к лечению боли.



Рекомендации к действию


  1. Все анальгетики следует ограничить препаратами с одним ингредиентом (за исключением буферного аспирина, или комбинации парацетамола с антидотом метонином).

  2. Все анальгетики, содержащие декстропропоксифен, глафенин, фенацетин или производные пиразолона, должны быть немедленно изъяты с рынка.

  3. У всех анальгетиков на упаковке должно указываться воспроизведенное (непатентованное) наименование продукта, а также максимальные пределы дозировки, особенно в случае с парацетамолом.



Источники


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  2. Grichnik, K.P. and Ferrante, P.M., "The difference between acute and chronic pain", Mount Sinai Journal of Medicine, Vol 58, No 3, May 1991, pp217-20.

  3. Holland, A.J.A., Jackson, S.H.D. and Turner, P., "A survey of analgesic drug utilization within and between clinical units in a health district", International Journal of Clinical Pharmacology, Therapy and Toxicology, Vol 26, No 9, 1988, pp465-7.

  4. Greenwald, H.P., "Interethnic differences in pain perception", Pain, Vol 44, 1991, pp157-63.

  5. Po, A.L.W., Non-Prescription Drugs, Oxford, Blackwell Scientific, (2nd edn) 1990, p9.

  6. According to a 1989 report, Accelerated Growth in Pain Management Markets: Forecasts of Pharmaceuticals, Devices and Alternative Treatments, by the Market Intelligence Research Company, reported in: Anon., "New Publications", Scrip, No 1483, 26 Jan 1990, p4.

  7. According to a 1991 Frost and Sullivan report, The European Market for Pain Management Products - Pharmaceutical: Pain Control Devices & Alternative Medicines, reported in: Anon., "European pain relief market set to rise", Scrip, No 1587, 1 Feb 1991, p27.

  8. Laurence, D.R. and Bennett, P.N., Clinical Pharmacology, Edinburg, Churhill Livingstone, (6th edn), 1987, p301.

  9. Ibid, p302.

  10. Acs, G. and Drazner, E., "The incidence of postoperative pain and analgesic usage in children", Journal of Dentistry for Children, Jan-Feb 1992, pp48-52.

  11. Liebeskind, J.C., "Pain can kill". Pain, Vol 44, 1991, pp3-4.

  12. Grichnik and Ferrante, op cit, pp217-20.

  13. Laurence and Bennett, op cit, p303.

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  15. Maunuksela, E-L. and Oikkola, K.T., "Pediatnc pain management" International Anesthesiology Clinics, Vol 29, No 2, May 1991, pp37-55 (However, pain resulting from chronic diseases or surgery does demand sensitive and often prophylactic therapy as children typically do not request analgesics as adults do.).

  16. Grichnik and Ferrante, op cit, pp217-20.

  17. Lebovits, A.H., "Chronic pain: the multidisciplinary approach", International Anesthesiology Clinics, Vol 29, No 1, 1991, pp1-7.

  18. Ibid; Turk, D.C. and Rudy, Т.Е., "Neglected topics in the treatment of chronic pain patients - relapse, non-compliance, and adherence enhancement", Pain, Vol 44, 1991, pp5-28.

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  33. Henry, op cit, p77.

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  38. Parish, op cit, p192.

  39. BMA and the Royal Pharmaceutical Society of Great Britain, op cit, p18.

  40. Ibid, p161.

  41. Laurence and Bennett, op cit, p307.

  42. Po, op cit, p535.

  43. Gilman, et al, p629.

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  52. Wall and Melzack, op cit, p507.

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  54. Graedon,J. and Graedon, Т., Graedon’s Best Medicine: from herbal remedies to high-tech Rx breakthrough, New York, Bantam Books, 1991, p79.

  55. BMA and the Royal Pharmaceutical Society of Great Britain, op cit, p159.

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  58. MaLAM letter to Nicholas, March 1990.

  59. Wall and Melzack (eds), op cit, p507.

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  61. Parish, op cit, p195.

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  65. BMA and the Royal Pharmaceutical Society of Great Britain, op cit, p18.

  66. Sandier, D.P. and Weinberg, C.R., "Analgesic use and chronic renal disease", New England Journal of Medicine, Vol 321, No 16, 19 Oct 1989, pp1126-7.

  67. Burk, R.F., "N-acetylcysteine in the treatment of acetaminophen overdose", New England Journal of Medicine, Vol 320, No 21, 25 May 1989, p1418.

  68. AMA, op cit, p75.

  69. Gilman, et al, op cit, pp665-6.

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  72. Reynolds, J.E.F. (ed.), Martindale: The Extra Pharmacopoeia, London, The Pharmaceutical Press, (29th edn) 1989, p1321.

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  75. Anon., "Glafenine withdrawn in Belgium", Scrip, No 1581, 11 Jan 1991, p34. In 1991, glafenine was marketed in 78 countries, according to an article in The Lancet (Vol 339, 8 Feb 1992, p357).

  76. Offerhaus, op cit, pp1853-57.

  77. Dukes, M.N.G. and Beeley, L. (eds), Side Effects of Drugs Annual 12, Amsterdam, Elsevier, 1988, p90.

  78. Offerhaus, op cit, pp1853-57.

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  80. Herxheimer, A., "Belgium: Withdrawal of glafenine", Lancet, Vol 337, No 8733, 12 January 1191, p102.

  81. BUKO Pharma-Kampegne, Hoechst: A Cause of Illness?, Bielefeld, BUKO Pharma-Kampange, 1987, pp21-2

  82. MaLAM letter to Roussel, June 1990.

  83. Anon., Scrip, No 1581, op cit, p34.

  84. Anon., "Glafenine withdrawal recommended", Scrip, No 1685, 22 Jan 1992, p23.

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  86. Anon., "Glafenine: voluntary withdrawal", WHO Drug Information, Vol 6, No 2, 1992, p57.

  87. Sanberg, P. and Krema, R.M.T., Over-the-counter Drugs: harmless or hazardous?, London, Burke Publishing, 1988, p49.

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  89. Sandier, D.P., Smith, J.C., et al, "Analgesic use and chronic renal disease", New England Journal of Medicine, Vol 320, No 19, 11 May 1989, pp1238-43.

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  91. Graedon.J., The People's Pharmacy-2, New York, Avon Books, 1980, p41.

  92. United Nations, op cit, p77.

  93. Ibid, pp76-8; Anon., "FRG voluntary phenacetin withrawals", Scrip, No 1081, 3 Mar 1986, p3; Consumers' Association of Penang, Drugs and the Third World: Phenacetin risks, benefits and marketing in Malaysia, Penang, CAP, 1986, p4.

  94. Gilman, et all, op cit, pp654-5.

  95. Anon., "Hoechst in 1987 and 1988", Scrip, 23 Mar 1988, p14.

  96. Anon., "Good growth for Hoechst Pharma", Scrip, No 1702, 20 Mar 1992, pp8-9.

  97. Reynolds, op cit, p15.

  98. Laurence and Bennett, op cit, p168.

  99. Fuellgraff, G. and Palm, D. (eds), Pharmakotherapie - Klinische Pharmakologie, (6th edn), Stuttgart, Gustav Fischer Verlag, 1986, p194.

  100. AMA, Drug Evaluations, (2nd edn), Chicago, 1973, pp262-7.

  101. AMA Drug Evaluations, (3rd edn), Chicago, 1977, p341.

  102. United Nations, op cit, p62.

  103. United Nations, op cit, p115.

  104. United Nations, op cit, pp62-3.

  105. United Nations, op cit, p89.

  106. United Nations, op cit, p90.

  107. Bennett and DeBroe, op cit, pp.1269-71.





ЭНДРЮ ЧЕТЛИ. ПРОБЛЕМНЫЕ ЛЕКАРСТВА

ЭНДРЮ ЧЕТЛИ. ПРОБЛЕМНЫЕ ЛЕКАРСТВА




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