RU2185849C2 - Preparation for treating opium abstinential syndrome - Google Patents

Abstract

FIELD: medicine, narcology. SUBSTANCE: the present preparation is a combination of dalargin and clopheline in treating opium abstinential syndrome. The suggested composition leads to lower amount of side effects and complications of pharmacotherapy and decreased terms of therapy being 3-5 d. EFFECT: higher efficiency.

Description

 The invention relates to medicine, in particular to narcology, and can be used for the treatment of acute opiate withdrawal syndrome of varying severity.

 The use of methadone for the treatment of opium withdrawal syndrome is known [1]. The use of methadone reduces the duration of withdrawal symptoms and its severity. As a rule, from the third day from the start of methadone pain in the joints, muscles, the behavior normalizes, the craving for the drug decreases, and sleep is restored. The disadvantage of this tool is the possibility of developing mental and physical dependence on the drug.

 A known standard for the treatment of acute opiate withdrawal syndrome, recommended by the Ministry of Health of the Russian Federation [2]. The treatment regimen consists of specific pharmacotherapy (clonidine, tiapride, tramadol); tranquilizers and sleeping pills (diazepam, nitrazepam, oxazepam, phenazepam); drugs that suppress addiction to drugs, behavior correctors (chlorpromazine, levopromazine, clozapine, thioridazine, pericyazine, chlorprotixen, perphenazine, sulpiride, haloperidol, trifluperazine); anticonvulsants (carbamazepine); analeptics (niketamide, sulfocamphocaine); antiarrhythmic drugs (propranolol); drugs that affect the processes of tissue metabolism (essentials), cardiotropic drugs (strophanthin, digoxin); potassium preparations (potassium, magnesium aspartate); analgesics (metamizole sodium); plasma substituting and detoxification solutions (sodium chloride, chlorosol, trisol); sugars (glucose solution 5%); preparations of calcium, potassium (calcium chloride 10%, potassium, magnesium aspartate). It should be noted that the authors recommend a choice of drugs and doses depending on the condition of the patient and the severity of a particular syndrome, with a treatment duration of 10-12 days.

 The disadvantages of this treatment regimen are the appointment of a combination of antipsychotics, tranquilizers, sleeping pills and anticonvulsants, which makes it impossible to use methods of psychotherapy against the background of the treatment. In addition, the antipsychotics and tranquilizers used in the described treatment regimen have side effects, which are manifested in possible cardio depression, impaired microcirculation, in limiting the patient’s mobility, a sharp decrease in mood, weakness, and a decrease in thinking and memory processes. Tramadol is a narcotic analgesic and can cause dependence. Polyprohmazia of this scheme can lead to sensitization of the patient and various allergic manifestations and complications.

The tasks that are solved by the invention are:
- improving the quality of treatment of opium withdrawal syndrome due to the lack of psychoactive drugs (antipsychotics, tranquilizers, anticonvulsants, sleeping pills) in the proposed treatment regimen and the possibility of active psychotherapy against the background of a comfortable general condition and the possibility of active perception of information,
- reduction in the number of side effects and complications of pharmacotherapy;
- reducing the treatment time for acute opiate withdrawal symptoms to 3-5 days.

 For this, a tool is proposed that is a combination of dalargin and clonidine in dosages and methods of administration, corresponding to the instructions for these drugs. The specific dosage of drugs for each patient depends on the characteristics of the pathological process.

 It is known to use dalargin as an antiulcer and antihypertensive drug. In addition, it has an antisecretory effect (suppression of gastric secretion). Promotes activation of reparative processes and accelerates the healing of gastrointestinal mucosal defects (Radar Drug Encyclopedia. Eighth Edition, revised and enlarged. / Ed. Krylov / M.: “Radar-2001”, 2000-1504 p.). Dalargin is indicated for peptic ulcer of the stomach and duodenum, obliterating atherosclerosis and endarteritis of the vessels of the lower extremities, alcoholism. Dosage and administration: in / m, 1-2 mg, 2 times a day, in / in 1 time per day, 1 mg in 5-10 ml of isotonic sodium chloride solution. The highest daily dose of 5 mg.

 The pharmacological effect of clonidine (synonym: clonidine) is hypotensive and sedative (see ibid.). It stimulates alpha 2-adrenergic receptors, lowers the tone of the vasomotor center of the medulla oblongata and reduces impulse in the sympathetic link of the peripheral nervous system at a presynaptic level.

 Indications: hypertensive crises, arterial hypertension, acute myocardial infarction, primary open-angle glaucoma with high and medium intraocular pressure, withdrawal symptoms of opium addiction (as part of complex therapy). Method of application: inside, parenteral, drops in the eye. Doses and treatment regimens are individual.

 Clinical example 1: Patient Sh-tsev B.C., 17 years old, was hospitalized from June 1 to June 10, 1999 with a diagnosis of active dependence on opioids, withdrawal syndrome. The patient was admitted to the hospital with complaints characteristic of withdrawal symptoms of opium addiction: weakness, general discomfort, pain in the muscles of the lower extremities, low mood. From the anamnesis it was found that the patient has been using raw opium of artisanal production by intravenous injection since November 1998. An active dependence has formed, with a daily dose of 3.0 dry matter in 2 divided doses. 2-3 tablets of diphenhydramine are added to the solution. Has experience using heroin.

 On admission, an examination was performed: a general blood test, a general urine test (without deviations from the norm). A biochemical blood test revealed an increase in ALT activity to 4.0 mmol / l • h and ACT to 2.5 mmol / l • h. Toxicochemical analysis of urine revealed codeine. A blood test for RW and HIV is negative.

 Upon admission, a medication regimen was prescribed for the treatment of withdrawal symptoms using clonidine and dalargin, consisting of: clonidine 0.45 mg / day per os, dalargin 4 mg / day IM 1 mg. Against the background of the treatment, a rapid and complete relief of the manifestations of withdrawal symptoms was noted. Immediately after the first injection of dalargin, the disappearance of the pain syndrome, a decrease in general discomfort, and an increase in mood were noted. When studying central hemodynamics using tetrapolar rheography according to Tishchenko, the initially low indicators of the cardiac index, stroke volume, and minute volume of blood circulation increased by an average of 20-25%. The initially significantly increased (by 30%) total peripheral resistance in response to dalargin injection decreased to normal values. Normalization of sleep was noted on the 2nd day from the start of treatment. During the day, the patient had an even mood, the disappearance of drug addiction and irritability. All withdrawal symptoms were stopped within 3 days of treatment. After the completion of the drug treatment regimen, withdrawal was not observed. Also, the patient did not have manifestations of post-withdrawal syndrome in the form of depression, insomnia and decreased mood. Complications and side effects during the treatment of the proposed tool was not observed. the patient was discharged from the hospital on the 10th day in satisfactory condition with a disposition to completely refuse from drug use. Recommendations are given for further mental and social rehabilitation.

 Clinical example 2: Patient I-ev KP, 17 years old, was hospitalized from 05.05 to 05.25.1999 with a diagnosis of active dependence on opioids, withdrawal syndrome. The patient was admitted to the hospital with complaints typical of withdrawal symptoms of opium addiction: weakness, general discomfort, pain in the muscles of the lower extremities and lumbar region, decreased mood, irritability, and insomnia. From the anamnesis it was found that the patient uses heroin by intravenous injection for a year and a half. An active dependence was formed with a daily dose of 0.1 g in 2 divided doses.

 On admission, an examination was performed: a general blood test, a general urine test (without deviations from the norm). Toxicochemical analysis of urine revealed codeine. A blood test for RW and HIV is negative.

 Upon admission, a medication regimen was prescribed for the treatment of withdrawal symptoms using clonidine and dalargin, consisting of: clonidine 0.45 mg / day per os, dalargin 5 mg / day IM 1 mg. Against the background of the treatment, a rapid and complete relief of the manifestations of withdrawal symptoms was noted. Immediately after the first injection of dalargin, the disappearance of the pain syndrome, a decrease in general discomfort, and an increase in mood were noted. When studying central hemodynamics using tetrapolar rheography according to Tishchenko, the initially low indicators of cardiac index, stroke volume, and minute volume of blood circulation increased by an average of 25%. The initially significantly increased (by 20%) total peripheral resistance in response to the use of the combined treatment regimen decreased to normal values. Normalization of sleep was noted on the 5th day from the start of treatment. The patient had an even mood, the disappearance of drug addiction and irritability. The phenomena of withdrawal symptoms were stopped within 5 days of treatment. After the completion of the drug treatment regimen, withdrawal was not observed. The patient did not complain of mood decline, depression, and insomnia. Complications and side effects when using the proposed tool is not marked. The patient was discharged from the hospital on the 20th day in a satisfactory condition with a disposition to completely refuse to use drugs. There is a remission of the disease within 6 months.

 Thus, the proposed combination of drugs allows you to effectively and quickly stop the manifestations of opium withdrawal symptoms, prepare the patient for active psychotherapy and reduce the number of complications of pharmacotherapy.

Sources of information
1. Vitensky BC, Kherson B, G., Dvoryak S.V., Glushkov V.A. Addiction in adolescents. - Kiev: Health, 1989.- P.156.

 2. Appendix to the order of the Ministry of Health of Russia dated 04.22.98 140. Standards (protocol models) for the diagnosis and treatment of drug addicts. S.21-22.

 3. Radar Encyclopedia of drugs. The eighth edition, revised and supplemented / Gl.red. Krylov. M .: "RLS-2001", 2000-1504 p.

Claims (1)

 A treatment for opium withdrawal symptoms, which is a combination of dalargin and clonidine.