Usporedba metadona i buprenorfina u terapiji ovisnosti o opioidima u Hrvatskoj

master's thesis

• Title (english): Comparison of methadone and buprenorphine in opioid dependence therapy in Croatia
• Author: Damjan Grđan
• Mentor: Lidija Bach-Rojecky (mentor)
• Committee member: Lidija Bach-Rojecky (predsjednik povjerenstva)
• Committee member: Renata Jurišić Grubešić (član povjerenstva)
• Committee member: Maja Ortner Hadžiabdić (član povjerenstva)
• Granter: University of Zagreb; Faculty of Pharmacy and Biochemistry; (Department of pharmacology); Zagreb
• Defense date and country: 2020-09-09, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Pharmacy; Pharmacy

Abstract

Ovisnost o heroinu i sintetskim opioidima veliki je javnozdravstveni problem, kako u svijetu, tako i u Hrvatskoj. Jedan od pristupa liječenju ovisnosti o heroinu uključuje primjenu sintetskih opioida metadona ili buprenorfina u okviru supstitucijske terapije. Metadon je potpuni agonist opioidnih receptora, te kao takav ostvaruje opioidne učinke, no njegova farmakokinetska svojstva kao što su visok postotak vezanja za proteine plazme i dugo, ali vrlo različito poluvrijeme eliminacije zbog interindividualnih varijacija u brzini i stupnju biotransformacije čine ga lijekom s nepredvidivim farmakološkim učincima te većim rizikom od nuspojava u odnosu na buprenorfin. Buprenorfin je parcijalni agonist opioidnih receptora, a ta farmakodinamska posebnost omogućuje mu da vezanjem na opioidne receptore uzrokuje slabiji opioidni odgovor popraćen manjim rizikom od predoziranja i neželjenih učinaka. Njegova sigurnost, za razliku od metadona, posebno u kombinaciji s opioidnim antagonistom naloksonom, omogućuje provođenje terapije i izvan medicinskih ustanova. Unatoč brojnim farmakološkim prednostima koje buprenorfin ima nad metadonom, potonji i dalje ostaje prva opcija u pozamašnom broju slučajeva terapije heroinske ovisnosti. Razlozi tome leže u njegovoj značajno dužoj uporabi u ovoj indikaciji, velikom broju pacijenata koji su terapiju započeli metadonom te ne žele primjenjivati drugi lijek, u stavu liječnika koji imaju veće povjerenje u metadon, te u njegovoj nižoj cijeni. Metadon je također zbog svoje dugotrajne uporabe lijek izbora u trudnica ovisnih o heroinu.

Abstract (english)

Heroin and synthetic opioid addiction is a major public health problem, both in the world and in Croatia. Opioid substitution treatment with methadone and buprenorphine is used in heroin addiction. Methadone is a full opioid receptor agonist and as such produces full opioid effects, but its pharmacokinetic properties such as high plasma protein binding, and long but very different elimination half-lives due to interindividual variations in rate and degree of biotransformation make it a drug with unpredictable pharmacological effects and a higher risk of side effects compared to buprenorphine. Buprenorphine is a partial opioid receptor agonist and this pharmacodynamic specificity allows it to bind to opioid receptors and produce a weaker opioid response accompanied by a lower risk of overdose and fewer side effects. Its greater safety, especially in combination with opioid antagonist naloxone, allows the therapy to be carried out outside medical institutions. Despite the numerous pharmacological advantages that buprenorphine has over methadone, the latter still remains the first option in a large number of cases of heroin addiction therapy. The reasons for this lie in its significantly longer use in this indication, the large number of patients who started therapy with methadone and do not want to use another drug, the attitude of doctors who have more confidence in methadone and its lower cost. Methadone is also, due to its long term use, the drug of choice in pregnant women addicted to heroin.

• Keywords: ovisnost; opioidi; heroin; metadon; buprenorfin; liječenje ovisnosti; supstitucijska terapija
• Keywords (english): addiction; opioids; heroin; methadone; buprenorphine; addiction treatment; substitution treatment
• Language: croatian
• URN:NBN: urn:nbn:hr:163:990880
• Study programme: Title: Pharmacy; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: magistar/magistra farmacije (magistar/magistra farmacije)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2021-04-29 15:36:35