pmedpharmФармация и фармакологияPharmacy & Pharmacology2307-92662413-2241Pyatigorsk Medical and Pharmaceutical Institute - branch of Volgograd State Medical Univer10.19163/2307-9266-2024-12-1-74-88pmedpharm-1452Research ArticleОБЗОРЫREVIEWПрименение габапентина для терапии нейропатической боли: взгляд с позиций доказательной медициныUse of gabapentin for neuropathic pain therapy: A view from perspective of evidence-based medicinehttps://orcid.org/0000-0001-7729-2169БутрановаО. И.ButranovaO. I.

кандидат медицинских наук, доцент, доцент кафедры общей и  клинической фармакологии Медицинского института ФГАОУ «Российский университет дружбы народов имени Патриса Лумумбы».

117198, Россия, г. Москва, ул. Миклухо-Маклая, д. 6

Candidate of Sciences  (Medicine), Associated Professor of the Department of General and Clinical Pharmacology of the Medical Institute of Patrice Lumumba Peoples’ Friendship University.

6, Miklukho-Maklay Str., Moscow, Russia, 117198.

butranovaolga@mail.ruhttps://orcid.org/0000-0002-6348-6867ЗыряновС. К.ZyryanovS. K.

доктор медицинских наук, профессор, заведующий кафедрой общей и клинической фармакологии ФГАОУ «Российский университет дружбы народов имени Патриса Лумумбы»; заместитель главного врача ГБУЗ «Городская клиническая больница № 24 Департамента здравоохранения города Москвы».

117198, Россия, г. Москва, ул. Миклухо-Маклая, д. 6.

127015, Россия, г. Москва, ул. Писцовая, д. 10.

Doctor of Sciences  (Medicine), Professor, Head of the Department of General and Clinical Pharmacology of the Medical Institute of Patrice Lumumba Peoples’ Friendship University; Deputy Chief Medical Officer of City Clinical Hospital No. 24 of the Moscow City Health Department. 

6, Miklukho-Maklay Str., Moscow, Russia, 117198.

10, Pistsovaya St., Moscow, Russia, 127015.

zyryanov_sk@rudn.universityФедеральное государственное автономное образовательное учреждение высшего образования «Российский университет дружбы народов имени Патриса Лумумбы»РоссияPatrice Lumumba Peoples’ Friendship UniversityRussian Federation1. Федеральное государственное автономное образовательное учреждение высшего образования «Российский университет дружбы народов имени Патриса Лумумбы». 2. Государственное бюджетное учреждение города Москвы «Городская клиническая больница № 24 Департамента здравоохранения города Москвы».Россия1. Patrice Lumumba Peoples’ Friendship University. 2. Clinical Hospital No. 24 of the Moscow City Health Department.Russian Federation2024090520241217488Copyright © Бутранова О.И., Зырянов С.К., 20242024Бутранова О.И., Зырянов С.К.Butranova O.I., Zyryanov S.K.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.pharmpharm.ru/jour/article/view/1452Цель

Цель. Провести анализ литературных источников на предмет фармакодинамических и фармакокинетических особенностей габапентина, позволяющих использовать его у пациентов с нейропатической болью, а также сравнительную оценку его эффективности и безопасности при применении в различных дозах.

Материалы и методы

Материалы и методы. В качестве поисковых ресурсов были использованы базы данных PubMed, Google Scholar, EMBASE, научно-информационная сеть ResearchGate и elibrary.ru. В качестве ключевых слов для поиска использовали «габапентин»», «механизм действия», «мишени габапентина», «фармакодинамика габапентина», «фармакокинетика», «фармакокинетические параметры», «нейропатическая боль», «рандомизированные клинические исследования». Глубина поиска составила 26 лет (с 1998 по 2024 гг.). В результате настоящий обзор составили 87 источников литературы.

Результаты

Результаты. Нейропатическая боль (НБ) является одним из наиболее распространенных видов хронической боли, характеризующимся высокой распространенностью среди лиц трудоспособного возраста. Эффективная фармакотерапия, направленная на устранение болевого синдрома, является ключевым инструментом повышения качества жизни и сохранения работоспособности пациентов. Гетерогенность этиологических факторов, вовлечённых в генез НБ, указывает на необходимость использования препаратов, анальгетический эффект которых основан на ослаблении передачи болевых импульсов в ЦНС. В клинических исследованиях габапентин продемонстрировал эффективность в отношении снижения выраженности боли у пациентов с постгерпетической НБ, болевой диабетической нейропатией и многими другими состояниями, сопровождающимися НБ. Доза габапентина  300 мг/сут является начальной в терапии НБ и требует дальнейшей медленной титрации в зависимости от ответа пациента на терапию и переносимости препарата, в особенности у пациентов пожилого и старческого возраста, а также пациентов с нарушенной функцией почек. Согласно опубликованным данным, наиболее выраженный анальгетический эффект достигается у пациентов на фоне применения габапентина в дозе 3600 мг/сут.

Заключение

Заключение. Габапентин является препаратом выбора при ведении пациентов с НБ различной этиологии и интенсивности. Удовлетворительный профиль безопасности и фармакодинамические эффекты позволяют габапентину, несмотря на длительную историю его использования, оставаться актуальным препаратом, применяемым врачами широкого круга специальностей для фармакотерапии пациентов с НБ.

The aim of the study was to analyze the literature sources for pharmacodynamic and pharmacokinetic features of gabapentin, providing its use in patients with neuropathic pain, as well as a comparative evaluation of its efficacy and safety when used in different doses.

Materials and methods

Materials and methods. PubMed, Google Scholar, EMBASE, ResearchGate scientific information network and elibrary.ru databases were used as search resources. The keywords used for the search were “gabapentin”, “mechanism of action”, “gabapentin targets”, “gabapentin pharmacodynamics”, “pharmacokinetics”, “pharmacokinetic parameters”, “neuropathic pain”, and “randomized clinical trials”. The depth of the search was 26 years (from 1998 to 2024). This review resulted in 87 literature sources.

Results

Results. Neuropathic pain (NeP) is one of the most common types of chronic pain, characterized by a high prevalence among people of the working age. Effective pharmacotherapy aimed at eliminating the pain syndrome is a key tool for improving the quality of life and preserving the work capacity of patients. Heterogeneity of etiologic factors involved in the genesis of NeP indicates the need to use drugs the analgesic effect of which is based on weakening the transmission of pain impulses in the CNS. In clinical trials, gabapentin has demonstrated efficacy in reducing the severity of pain in patients with postherpetic NeP, painful diabetic neuropathy and many other conditions accompanied by NeP. The dose of gabapentin 300 mg/day is the initial dose in the therapy of NeP and requires a further slow titration depending on the patient’s response to therapy and tolerability of the drug, especially in elderly and senile patients, as well as in patients with an impaired renal function. According to the published data, the most pronounced analgesic effect is achieved in the patients against the background of the gabapentin administration at a dose of 3600 mg/day.

Conclusion

Conclusion. Gabapentin is the drug of choice in the management of patients with NeP of different etiology and intensity. A satisfactory safety profile and pharmacodynamic effects make gabapentin possible, despite the long history of its use, to remain a relevant drug used by a wide range of physicians, specialties, for pharmacotherapy of NeP patients.

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The authors declare that there are no conflicts of interest present.