| Abstract | Cilj istraživanja
Cilj specijalističkog rada je analizirati farmaceutske oblike antimigrenika i njihove kliničke
aspekte. Od kliničkih aspekata navedene su terapijske indikacije, doziranje i način primjene,
kontraindikacije, interakcije, nuspojave, farmakodinamička i farmakokinetička svojstva
antimigrenika. U radu su prikazani farmaceutski oblici antimigrenika odobrenih na području
Europe i SAD-a te oblici koji su u fazi istraživanja i razvoja. Osim upotrebe farmakoterapije u
liječenju migrene ističe se primjena nefarmakoloških metoda kako u akutnoj tako i u
preventivnoj terapiji. Istaknuta je važnost kolaborativne prakse te uloge farmaceuta u
upravljanju migrenom kao najdostupnijeg dionika zdravstvenog sustava.
Materijal i metode
Za izradu ovog specijalističkog rada koristili su se relevantni stručni i znanstveni članci s
najnovijim saznanjima o suvremenim farmaceutskim oblicima antimigrenika. Relevantni članci
pretraživani su prema temi istraživanja od općih prema specijaliziranim te su proučavani na
analitički i kritički način. Izdvojeni su najvažniji rezultati, rasprave i zaključci koji su prikazani
ovim specijalističkim radom. Na temelju proučavanih članaka izvedena su vlastita razmatranja
proučavane problematike koja su dio rasprave. U svrhu pisanja specijalističkog rada, literatura
je pretraživana putem baze podataka PubMed, Hrčak, ScieceDirect, Frontiers te na mrežnim
stranicama regulatornih tijela (HALMED, HZZO, EMA, FDA).
Rezultati
Prema trećem izdanju Međunarodne klasifikacije glavobolja (ICHD-3) migrena se razvrstava u
skupinu primarnih glavobolja, a dijeli se na migrenu bez aure i migrenu s aurom. Migrena
pripada u jednu od najčešćih neuroloških bolesti. Migrena može biti epizodna ili kronična
prema učestalosti pojavljivanja.
Farmakoterapija migrene dijeli se na akutnu i preventivnu. U liječenju migrene koriste se
nespecifični i specifični lijekovi. Specifični lijekovi za liječenje migrene oblikovani su u razne
farmaceutske oblike i doze te pokazuju različita farmakološka svojstva. Odabir terapije za
liječenje migrene treba biti individualan.
Specifični lijekovi za akutno liječenje migrene su triptani i ditani (selektivni antagonisti
serotoninskih (5-hidroksitriptamin) receptora), gepanti (antagonisti receptora peptida
povezanog s kalcitoninskim genom (engl. calcitonin gene-related peptide, CGRP)) te alkaloidi
ražene glavice. Najčešće se primjenjuju oralnim putem (tableta, raspadljiva tableta za usta,
oralni liofilizat, raspadljivi film za usta) te u manjoj mjeri intranazalno (sprej za nos - otopina,
suspenzija, prašak) i supkutano (injekcija).
Specifično preventivno liječenje epizodne i kronične migrene provodi se monoklonskim
protutijelima na CGRP i CGRP receptor, koji se primjenjuju supkutano ili intravenski te
antagonistima CGRP-a, gepantima, koji se primjenjuju oralnim putem (tableta, oralni liofilizat).
Korištenje nefarmakoloških metoda liječenja migrene dovodi do smanjenja pojavnosti
migrene, povećanog učinka preventivne i akutne terapije te do izbjegavanja ili smanjenja
nuspojava primijenjenih lijekova.
Provođenjem kolaborativne prakse u koju je uključen javni ljekarnik, kao najdostupniji
zdravstveni djelatnik, povećava se adherencija bolesnika prema terapiji te postiže bolja
kvaliteta života bolesnika s migrenom. Uloga javnog ljekarnika je edukacija i savjetovanje
bolesnika o farmakološkim i nefarmakološkim metodama liječenja migrene. Provođenjem
ljekarničke skrbi, ljekarnici mogu pomoći u poboljšanju ishoda liječenja migrene.
Zaključak
Za uspjeh liječenja migrene potrebna je individualizacija terapije. Odabir antimigrenika treba
biti prema kliničkoj slici migrene bolesnika, kompetenciji za administraciju antimigrenika te
komorbiditetima.
Upravljanje migrenom je učinkovitije upotrebom antimigrenika s pouzdanom učinkovitošću, u
prikladnom farmaceutskom obliku i s odgovarajućim farmakološkim svojstvima.
Primjenom nefarmakoloških metoda te promjenom nepodržavajućeg načina života mogu se
poboljšati ishodi liječenja migrene te povećati aktivna uloga bolesnika u samom liječenju.
Nefarmakološke metode mogu se primijeniti samostalno te u kombinaciji s akutnom ili
preventivnom terapijom migrene.
Migrena predstavlja javnozdravstveni i socioekonomski problem. Za uspjeh terapije migrene
važna je kolaborativna praksa specijalista neurologa, liječnika opće medicine, javnog ljekarnika
te aktivno sudjelovanje bolesnika u upravljanju migrenom. Cilj je postizanje boljeg terapijskog
ishoda liječenja migrene te posredno smanjenje javnozdravstvenog i socioekonomskog
opterećenja. Ljekarničkim savjetovanjem bolesnika o pravilnoj i pravodobnoj primjeni
antimigrenika može se izbjeći glavobolja uzrokovana prekomjernom upotrebom lijekova te
posljedice koje nosi takav način samoliječenja.
Mogućnost izbora prikladnog farmaceutskom oblika antimigerenika s odgovarajućim kliničkim
aspektima unaprjeđuje zdravstvenu skrb za bolesnika s migrenom, racionalnu upotrebu
lijekova te postizanje boljih farmakoterapijskih učinaka antimigrenika. |
| Abstract (english) | Objectives
The goal of the expert thesis is to analyze the pharmaceutical forms of antimigraine drugs and
their clinical aspects. Among the clinical aspects, therapeutic indications, dosage and method
of administration, contraindications, interactions, side effects, pharmacodynamic and
pharmacokinetic properties of antimigraine drugs are listed. The paper presents the
pharmaceutical forms of antimigraines approved in Europe and the USA, as well as the forms
that are in the research and development phase. In addition to the use of pharmacotherapy
in the treatment of migraine, the use of non-pharmacological methods in both acute and
preventive therapy stands out. The importance of collaborative practice and the role of
pharmacists in the management of migraine as the most accessible stakeholder in the health
care system were emphasized.
Materials and methods
Relevant professional and scientific articles with the latest knowledge about modern
pharmaceutical forms of antimigraine were used for the preparation of this specialist work.
Relevant articles were searched according to the research topic from general to specialized
and were studied in an analytical and critical way. The most important results, discussions and
conclusions presented in this specialist work have been highlighted. On the basis of the
studied articles, their own considerations of the studied issue were performed, which are part
of the discussion. For the purpose of writing a specialist paper, the literature was searched
through the databases PubMed, Hrčak, ScieceDirect, Frontiers and on the websites of
regulatory bodies (HALMED, HZZO, EMA, FDA).
Results
According to the third edition of the International Classification of Headache Disorders (ICHD3), migraine is classified in the group of primary headaches, divided into migraine without aura
and migraine with aura. Migraine belongs to one of the most common neurological diseases.
Migraine can be episodic or chronic according to the frequency of occurrence.
Pharmacotherapy of migraine is divided into acute and preventive. In the treatment of
migraine, non-specific and specific drugs are used. Specific drugs for the treatment of migraine
are formulated in various pharmaceutical forms and dosages and show different
pharmacological properties. The choice of therapy for the treatment of migraine should be
individual.
Specific drugs for the acute treatment of migraine are triptans and ditans (selective serotonin
(5-hydroxytryptamine) receptor antagonists), gepants (calcitonin gene-related peptide (CGRP)
receptor antagonists) and ryegrass alkaloids. They are most often administered orally (tablet,
disintegrating oral tablet, oral lyophilizate, disintegrating oral film) and to a lesser extent
intranasally (nasal spray – solution, suspension, powder) and subcutaneously (injection).
Specific preventive treatment of episodic and chronic migraine is carried out with monoclonal
antibodies to CGRP and CGRP receptor, which are administered subcutaneously or
intravenously, and CGRP antagonists, gepants, which are administered orally (tablet, oral
lyophilisate).
The use of non-pharmacological methods of migraine treatment leads to a reduction in the
incidence of migraine, an increased effect of preventive and acute therapy, and the avoidance
or reduction of side effects of the drugs used.
By implementing a collaborative practice in which the public pharmacist is involved, as the
most accessible healthcare professional, the patient's adherence to therapy increases and the
quality of life of migraine patients is improved. The role of the public pharmacist is to educate
and advise patients on pharmacological and non-pharmacological methods of migraine
treatment. By implementing pharmacy care, pharmacists can help improve migraine
treatment outcomes.
Conclusion
The success of migraine treatment requires individualization of therapy. The choice of
antimigraine should be based on the clinical picture of the patient's migraine, the competence
for antimigraine administration and comorbidities.
Migraine management is more effective by using antimigraine drugs with reliable efficacy, in
a suitable pharmaceutical form and with appropriate pharmacological properties.
By applying non-pharmacological methods and changing an unsupportive lifestyle, the
outcomes of migraine treatment can be improved and the patient's active role in the
treatment itself can be increased. Non-pharmacological methods can be applied
independently and in combination with acute or preventive migraine therapy.
Migraine represents a public health and socioeconomic problem. For the success of migraine
therapy, the collaborative practice of specialist neurologists, general practitioners, public
pharmacists and the active participation of patients in migraine management is important.
The goal is to achieve a better therapeutic outcome of migraine treatment and indirectly
reduce the public health and socioeconomic burden. By advising patients at the pharmacy on
the correct and timely use of antimigraine drugs, headaches caused by overuse of drugs and
the consequences of such self-medication can be avoided.
The possibility of choosing a suitable pharmaceutical form of antimigraine drug with
appropriate clinical aspects improves health care for patients with migraine, the rational use
of drugs and the achievement of better pharmacotherapeutic effects of antimigraine drugs. |
