RU2334509C2 - Application of atypical neuroleptic eglonyl and antidepressant - selective inhibitor of serotonid re-uptake trittico when treating eczema - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: eczema is suggested to be treated using atypical neuroleptic eglonyl (i.e. sulpiride) and antidepressant - selective inhibitor of serotonin re-uptake trittico (i.e. trazodone).

EFFECT: essentially increased remission for longer than a year and elimination of treatment complications.

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Description

The invention relates to medicine, in particular to dermatovenerology, and can be used in the treatment of eczema.

Known methods of treating eczema with the use of sedatives and antipsychotics (preparations of bromine, valerian, thioridazine) to normalize the psycho-emotional state and sleep [Eczema // Guide for the treatment of skin diseases / A.L. Mashkillayson. Ed. A.L. Mashkillayson. - M., 1990. - S.262-277].

The disadvantages of these methods are: 1 - low treatment effectiveness due to the non-selective effect of these drugs not taking into account the spectrum of neurotic disorders; 2 - the risk of complications (drowsiness, the phenomenon of "bromism", extrapyramidal disorders, allergic reactions, toxic retinopathy, etc.); 3 - long duration of treatment and frequent relapses of the disease.

The purpose of the invention is to increase efficiency, eliminate complications of treatment, reduce the duration of treatment and reduce the frequency of relapse of the disease by normalizing mental reactions and the state of the autonomic nervous system of patients with eczema.

The goal is achieved by the use of the atypical antagonist Eglonil and the antidepressant, a selective trittico serotonin reuptake inhibitor.

The atypical antipsychotic eglonyl (sulpiride) has a wide spectrum of action: antipsychotic, antidepressant, analgesic and antiemetic properties. Unlike typical antipsychotics (chlorpromazine, thioridazine), eglonil is characterized as a drug with a “regulatory” effect on the central nervous system, in which moderate antipsychotic activity is combined with some antidepressant and stimulating properties. For this reason, eglonyl has no such side effects as drowsiness, antipsychotic syndrome, depression, lowering blood pressure, allergic reactions, dyspepsia, jaundice, agranulocytosis. Eglonil is generally well tolerated. However, pyramidal disorders, agitation, increased blood pressure, menstrual irregularities can be observed. When using small therapeutic doses, these effects are not observed.

The selective serotonin reuptake inhibitor trittiko (trazodone) belongs to a new generation of antidepressants. Unlike non-selective monoamine reuptake inhibitors (tricyclic - amitriptyline, imipramine, etc. and tetracyclic - maprotiline, mianserin, etc.) it does not have anticholinergic activity. For this reason, the selective serotonin reuptake inhibitor has no side effects associated with the effect on the autonomic nervous system, such as orthostatic hypotension, tachycardia, constipation, urinary retention, etc., which accompany the use of non-selective antidepressants. Side effects that occur when taking trittiko - drowsiness, headache, dizziness, insomnia, lowering blood pressure, are relatively rare and pass with a decrease in dose. When using small therapeutic doses, these effects are not observed. [Katzung B.G. Basic and clinical pharmacology: In 2 vol. T. 1 / Per. from English - M. - St. Petersburg: Binom - Nevsky Dialect, 1998. - S.550-557; Kukes V.G. Clinical Pharmacology: Uch. / Scientific. ed. A.Z. Baychurina. - 2nd ed., Revised. and. add. - M: MEOTA MEDICINE, 1999. - S.447-460; Mashkovsky M.D. Medicines: In 2 tons. T.1. - 14th ed. - M .: New wave, 2002. - S.55-119].

The method is implemented as follows. Patients with eczema are prescribed a combined intake of eglonil and trittiko. The drugs are used in minimal therapeutic doses according to the following scheme: tab. eglonil 100 mg in the morning and 100 mg in the evening, tab. trittico 150 mg at bedtime. The duration of administration of eglonil 30 days, trittiko - 60 days.

We conducted a comparative assessment of the effectiveness of the treatment of patients with eczema according to the standard scheme (sedatives, antihistamines, desensitizers, mast cell membrane stabilizers, immunomodulators, angioprotectors, physiotherapy, external drugs in accordance with the process stage) and with the help of complex therapy, including eglonil and trittiko. For this, the following groups of patients were formed: group 1 — patients with eczema, whose therapy included eglonil and trittiko (trazodone) (n = 19); Group 2 - eczema patients who received conventional therapy (n = 20). The effectiveness of complex therapy was assessed by the dynamics of the clinical picture - the dermatological index of the scale of symptoms (DISS), the psychological state of patients, the state of the autonomic nervous system.

In patients who received standard treatment, compared with the group receiving complex treatment, a slower decrease in ESD was noted during the first three weeks. In addition, in the group of patients treated with complex treatment, a decrease in DIC by 80.0% occurred 7 days earlier, which corresponds to the clinical assessment of "significant improvement" than in the standard treatment group (table 1).

The dynamics of DICC patients with eczema during treatment

Table 1 Index Gr. Before treatment 7 day of treatment 14 day treatment 21 days of treatment 28 day of treatment DISC one 21.6 ± 0.8 15.3 ± 2.2 * 10.8 ± 2.4 ** 4.2 ± 1.3 ** 2.1 ± 1.1 * 2 20.3 ± 0.7 18.5 ± 2.2 15.7 ± 2.4 9.5 ± 2.3 5.3 ± 2.1 Note: a significant difference between the groups: * - p <0.05; ** - p <0.01, *** - p <0.001.

During treatment, there was a positive dynamics in the psychological state of patients with eczema in both groups. Additionally, a more pronounced positive dynamics of the psychological state in the group of patients receiving complex treatment was noted. So after 7 days, situational anxiety, the number of somatic complaints decreased, the level of attentiveness and mood increased; after the course of treatment, the level of depression, the number of somatic complaints significantly decreased, and the level of vivacity and mood increased. In the group of patients receiving standard therapy, after treatment, there was an increased level of depression, personal anxiety, and a reduced level of vigor compared to the group of healthy individuals (p <0.05) (tables 2, 3).

The dynamics of the psychological state of patients with eczema (group 1) during treatment (M ± m)

table 2 Indicator Units rev. Patients with eczema (group 2) (n = 19) Healthy (n = 30) Before treatment 7 day of treatment After treatment Pep point 3.9 ± 0.3 # ** 4.2 ± 0.2 * 5.1 ± 0.3 5.3 ± 0.2 Interest point 4.8 ± 0.2 * 4.8 ± 0.2 5.1 ± 0.2 5.2 ± 0.3 Mindfulness point 4.9 ± 0.1 * 5.9 ± 0.2 6.1 ± 0.2 6.1 ± 0.2 Mood point 4.0 ± 0.2 ** 4.8 ± 0.1 * 5.7 ± 0.1 5.8 ± 0.1 Feeling well point 5.1 ± 0.2 * 5.3 ± 0.2 * 6.1 ± 0.2 6.3 ± 0.2 Calm point 4.6 ± 0.2 * 4.8 ± 0.3 * 5.6 ± 0.3 5.7 ± 0.1 Confidence point 5.2 ± 0.3 * 5.5 ± 0.2 * 6.4 ± 0.2 6.3 ± 0.2 Psychological comfort point 33.5 ± 0.9 * 35.7 ± 1.3 * 39.9 ± 1.2 40.7 ± 0.6 Complaints qty 2.9 ± 0.4 # *** 2.4 ± 0.4 * 1.5 ± 0.4 1.4 ± 0.2 Situational anxiety point 45.2 ± 1.3 # * 42.1 ± 1.5 41.2 ± 1.3 40.5 ± 0.7 Personal anxiety point 51.1 ± 1.2 # ** 45.8 ± 1.1 * 42.3 ± 1.2 42.5 ± 0.5 Depression scale point 50.7 ± 1.3 # ** 50.3 ± 1.2 * 42.4 ± 1.1 41.2 ± 1.5

The dynamics of the psychological state of patients with eczema (group 2) during treatment (M ± m)

Table 3 Indicator Units rev. Patients with eczema (group 4) (n = 20) Healthy (n = 30) Before treatment 7 day of treatment After treatment Pep point 3.8 ± 0.2 # ** 3.9 ± 0.2 # ** 4.2 ± 0.3 * 5.3 ± 0.2 Interest point 4.7 ± 0.2 * 4.9 ± 0.2 * 5.0 ± 0.2 5.2 ± 0.3 Mindfulness point 4.8 ± 0.1 * 5.1 ± 0.3 * 5.9 ± 0.2 6.1 ± 0.2 Mood point 4.1 ± 0.2 ** 4.3 ± 0.1 ** 5.0 ± 0.1 5.8 ± 0.1 Feeling well point 5.0 ± 0.2 * 5.1 ± 0.2 * 6.0 ± 0.2 6.3 ± 0.2 Calm point 4.7 ± 0.2 * 4.8 ± 0.3 * 5.2 ± 0.3 5.7 ± 0.1 Confidence point 5.1 ± 0.3 * 5.3 ± 0.2 * 6.0 ± 0.2 6.3 ± 0.2 Psychological comfort point 33.7 ± 0.9 * 33.9 ± 1.2 * 37.3 ± 1.4 40.7 ± 0.6 Complaints qty 2.8 ± 0.4 # *** 2.7 ± 0.3 # ** 1.9 ± 0.4 1.4 ± 0.2 Situational anxiety point 45.4 ± 1.4 # * 44.3 ± 1.7 # * 42.5 ± 1.2 40.5 ± 0.7 Personal anxiety point 51.4 ± 1.3 # ** 46.8 ± 1.2 # ** 45.8 ± 1.1 * 42.5 ± 0.5 Depression scale point 50.8 ± 1.3 # ** 51.2 ± 1.2 # ** 48.2 ± 1.3 * 41.2 ± 1.5 Note: a significant difference between the groups: * - p <0.05; ** - p <0.01, *** - p <0.001

During treatment, there is a positive dynamics of the state of the autonomic nervous system of patients with eczema in both groups, but more pronounced in the group of patients receiving complex treatment. After 7 days and after treatment, the indicators of variational pulsometry, spectral analysis of the heart rhythm caused by the skin autonomic potential significantly change. The nature of these changes indicates the normalization of the state of the autonomic nervous system - a decrease in increased central ergotropic and humoral influences and parasympathetic activity (tables 4 and 5).

Dynamics of physiological parameters of patients with eczema (group 1) during treatment (M ± m)

Table 4 Indicator Units rev. Patients with eczema (group 3) (n = 19) Healthy (n = 30) Before treatment 7 day of treatment After treatment Sdnn ms 48.7 ± 5.4 * 52.3 ± 3.2 * 56.7 ± 3.1 59.8 ± 5.3 AMo % 29.6 ± 4.2 ** 37.9 ± 4.0 * 43.9 ± 4.13 46.0 ± 4.0 IWR cu 102.7 ± 12.7 ** 111.3 ± 6.4 * 142.4 ± 6.3 148.2 ± 29.1 IN cu 66.1 ± 10.3 *** 94.2 ± 4.1 # ** 127.3 ± 4.2 131.0 ± 10.0 HF f. n e. 50.2 ± 5.8 # ** 44.7 ± 3.6 # * 33.1 ± 3.7 * 29.0 ± 3.0 Heart rate about. beats / m 90.3 ± 2.6 ** 90.5 ± 2.4 ** 86.4 ± 2.4 * 75.2 ± 2.5 GARDEN about Hg 110.5 ± 4.3 ** 104.8 ± 2.3 * 101.2 ± 2.4 97.8 ± 1.6 TR to. ms 3838.5 ± 871.4 * 3018.7 ± 434.7 2809.3 ± 436.5 2304.1 ± 371.4 Vlf to. % 44.3 ± 4.1 ** 38.2 ± 1.2 * 31.4 ± 1.1 28.1 ± 3.1 Lf to. % 41.1 ± 3.5 * 36.1 ± 3.3 * 33.8 ± 3.4 31.4 ± 2.7 S1 p. from 0.94 ± 0.06 ** 0.78 ± 0.05 * 0.75 ± 0.05 * 0.63 ± 0.06 A2 p. mV 1.78 ± 0.17 *** 1.88 ± 0.06 * 2.47 ± 0.07 * 3.16 ± 0.24 S2 p. from 1.13 ± 0.08 * 1.19 ± 0.15 * 1.31 ± 0.14 * 1.41 ± 0.10

Dynamics of physiological parameters of patients with eczema (group 2) during treatment (M ± m)

Table 5 Indicator Units rev. Patients with eczema (group 4) (n = 20) Healthy (n = 30) Before treatment 7 day of treatment After treatment Sdnn ms 48.8 ± 5.5 * 49.8 ± 3.2 * 50.1 ± 3.2 * 59.8 ± 5.3 AMo % 29.8 ± 4.1 ** 31.2 ± 4.3 # ** 36.1 ± 4.1 # * 46.0 ± 4.0 IWR cu 102.9 ± 12.8 ** 116.2 ± 6.8 *** 130.4 ± 6.2 * 148.2 ± 29.1 IN cu 66.0 ± 10.4 *** 75.1 ± 4.5 # *** 98.1 ± 4.1 # ** 131.0 ± 10.0 HP f. not. 50.3 ± 5.9 # ** 45.1 ± 3.2 # * 39.2 ± 3.4 # * 29.0 ± 3.0 Heart rate about. beats / m 90.1 ± 2.5 ** 89.1 ± 2.7 ** 88.2 ± 2.4 * 75.2 ± 2.5 GARDEN about. Hg 110.4 ± 4.4 ** 108.2 ± 2.3 ** 106.8 ± 2.4 * 97.8 ± 1.6 TR to. ms 3840.1 ± 875.8 * 3403.4 ± 442.1 * 3101.6 ± 432 * 2304.1 ± 371.4 VLF to. % 44.4 ± 4.0 ** 42.8 ± 1.3 * 38.4 ± 1.3 * 28.1 ± 3.1 LF to. % 41.2 ± 3.4 * 38.7 ± 3.2 * 34.3 ± 3.2 31.4 ± 2.7 S1 p. from 0.95 ± 0.07 ** 0.94 ± 0.07 ** 0.87 ± 0.07 * 0.63 ± 0.06 A2 p. mV 1.79 ± 0.18 *** 1.80 ± 0.18 *** 1.91 ± 0.16 ** 3.1b ± 0.24 S2 p. from 1.14 ± 0.09 * 1.16 ± 0.16 * 1.22 ± 0.15 * 1.41 ± 0.10 Note: a significant difference between the groups: * - p <0.05; ** - p <0.01, *** - p <0.001.

Thus, as a result of complex treatment of patients with eczema using eglonil and trittiko, the treatment time is reduced by 7 days, the normalization of the psychological state and vegetative imbalance is reduced by 14 days. In the long-term period, remission for more than a year in the group receiving complex treatment was observed in 82.4% of patients, with the standard treatment regimen - in 49.3% (p <0.05). In addition to the indicated advantages of the proposed treatment method in the form of increasing effectiveness, eliminating treatment complications, decreasing treatment duration and reducing the recurrence rate of the disease, it is necessary to take into account the improvement in the quality of life of patients due to the restoration of the psychophysiological state.

Claims (1)

The use of an atypical antagonist of eglonil and an antidepressant, a selective serotonin trittico reuptake inhibitor in the treatment of eczema.