Dlitel'no deystvuyushchie proizvodnye digidropiridina pri lechenii koronarnoy bolezni serdtsa: rol' prolongirovannoy lekarstvennoy formy nifedipina


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Нифедипин – блокатор кальциевых каналов из группы производных дигидропиридина – используется в клинической практике с середины 1970-х годов. За этот срок хорошо охарактеризованы его преимущества и недостатки. Установлено, что основным эффектом этого лекарственного средства является артериолярная вазодилатация, выраженность которой зависит от концентрации и скорости нарастания действующего вещества в крови. Короткодействующие препараты нифедипина способны вызвать быстрое и достаточно выраженное снижение артериального давления (АД), что приводит к активации симпатической нервной системы через барорефлекс [1,2]. В итоге возникает тахикардия и повышается потребность миокарда в кислороде. Кроме того, из-за дилатации артериол, примыкающих к зоне ишемии миокарда, возможно возникновение феномена коронарного обкрадывания. Очевидно, что для больных коронарной болезнью сердца (КБС) все эти эффекты крайне нежелательны. Преодолеть указанный недостаток позволяет использование длительно действующих производных дигидропиридина или лекарственных форм нифедипина пролонгированного действия с замедленным высвобождением действующего вещества. Последние обеспечивают постепенное поступление в кровоток и меньшую пиковую концентрацию нифедипина в крови, которая поддерживается на протяжении суток, что предотвращает активацию симпатической нервной системы через барорефлекс. Одним из таких лекарственных средств является желудочно-кишечная (гастроинтестинальная) терапевтическая система нифедипина (нифедипин ГИТС). При этом в клинической практике следует учитывать, что доступные для применения препараты нифедипина, рекомендуемые для приема 1 раз в сутки, различаются по характеру взаимодействия с пищей, особенностям высвобождения действующего вещества и профилю его концентрации в крови. Соответственно, они могут по-разному воздействовать на 24-часовой профиль АД и частоту сердечных сокращений (ЧСС). Поэтому пока не будет продемонстрирована эквивалентность длительно действующих препаратов нифедипина по этим показателям, делать предположения о сходстве их клинического эффекта нельзя.

About the authors

I. S Yavelov

ГКБ №29, Москва

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