Piemērotu zāļu formu pieejamība Latvijā cilvēkiem ar disfāgiju.
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Date
2023
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Disfāgija ir izplatīta dažādās vecuma grupās. Pētījumi liecina, ka tā skar katru divdesmit piekto pieaugušo ASV. Rīšanas traucējumi var būt radušies saistībā ar zāļu lietošanu, slimību vai izmaiņām novecojot. Tā ietekmē pacientu dzīves kvalitāti un medikamentu lietošanu. Cietās zāļu formas ir izplatītākās zāļu tirgū, bet ne visi cilvēki tās spēj viegli norīt. Disfāgijas pacienti reti uzdrošinās runāt ar ārstu par grūtībām norīt zāles, tāpēc bieži šī problēma paliek noklusēta un neatrisināta. Pētījuma mērķis bija noskaidrot, vai cilvēkiem ar rīšanas traucējumiem Latvijā ir pieejamas piemērotas zāļu formas galvenajās zāļu anatomiskajās grupās pēc zāļu patēriņa.
Tika veikta “Zāļu patēriņš Latvijā” 2021. gada statistikas analīze, lai identificētu 3 Latvijā patērētākās zāļu anatomiskās grupas. Tika analizēts arī “Latvijas Zāļu Reģistrs”, lai izvērtētu zāļu formu daudzveidību un pieejamību identificētajām patērētākajām zāļu vielām. Tika noskaidrots, kurām no zāļu vielām ir pieejama/s alternatīva cietai zāļu formai. Tika veikta arī medikamentu lietošanas instrukciju izpēte, lai spriestu par zāļu formu modificēšanas iespējām.
Gremošanas trakta un vielmaiņas grupā patērētākās zāļu vielas bija holekalciferols, omeprazols, pantoprazols, metformīns, gliklazīds un glimepirīds. No tām tikai holekalciferolam ir pieejamas 2 veidu alternatīvas zāļu formas – košļājamās tabletes un pilieni iekšķīgai lietošanai. Savukārt, ar omeprazola kapsulām pašam pacientam ir iespējams veikt modifikāciju, lai atvieglotu norīšanu. Gliklazīds ir pieejams tikai ilgstošas darbības tablešu veidā, kam nav pieļaujama modificēšana, bet dažas metformīna vai glimepirīda saturošas tabletes ir paredzēts dalīt.
Kardiovaskulārajā grupā patērētākās zāļu vielas bija statīni, AKEI un BB. Zāļu pieejamība Latvijā cilvēkiem, kam ir kardiovaskulāra saslimšana un disfāgija, ir ierobežota, jo pieejama tikai 1 alternatīva zāļu forma 1 aktīvajai vielai – mutē disperģējamās tabletes tieši perindoprilam.
Vislabākā situācija ar alternatīvu zāļu formu pieejamību ir nervu sistēmas grupā, jo Latvijā ir pieejamas mutē disperģējamās tabletes olanzapīnam, betahistīnam, mirtazapīnam un haloperidola pilieni iekšķīgai lietošanai.
Tika secināts, ka Latvijā ir ierobežota zāļu pieejamība disfāgijas pacientiem tajās zāļu grupās, kas tiek patērētas vairāk. Ir pieejamas dažas mutē disperģējamās tabletes un šķīdumi iekšķīgai lietošanai noteiktām zāļu vielām. Kā cieto zāļu formu alternatīva disfāgijas pacientiem ir apsverama zāļu pagatavošana ekstemporāli, ja nav pieejamu rūpnieciski ražotu alternatīvu. Pacientiem būtu jāzin par pārvarēšanas stratēģijām, lai atvieglotu zāļu norīšanu, piemēram, lielāka ūdens malka uzdzeršana, ķermeņa stāvokļa maiņa, zāļu formas maiņa, palīgierīces izmantošana, kā arī zāļu formas modificēšana, ja tas ir pieļaujams. Veselības aprūpes speciālistiem ir jāvērš pacientu uzmanība uz zāļu formām, kas nav paredzētas modificēšanai.
Dysphagia is widespread among all ages. Studies show that 1 of 25 adults in USA face it. Swallowing difficulties may be caused by drug use, aging or disease. It impairs quality of life and use of medication. Solid dosage forms are more popular in the drug market than others, but not all people can easily swallow them. Dysphagia patients rarely talk to their doctor about difficulties swallowing medication. So this problem often stays unspoken and unsolved. The purpose of this study was to find out if people with swallowing difficulties in Latvia have available appropriate dosage forms in anatomical groups of drugs which are consumed the most. Analysis of “Statistics on Medicines Consumption in Latvia in 2021” was performed to determine 3 most commonly consumed anatomical groups of drugs. “Medicinal product register of Latvia” was analyzed to evaluate multiplicity of available dosage forms for identified most consumed active substances. Active substances for which there are alternatives to solid dosage forms were researched. Package leaflets were looked at to estimate the possibilities of modifying dosage forms. In alimentary tract and metabolism group most consumed active substances were cholecalciferol, omeprazole, pantoprazole, metformin, gliclazide and glimepiride. From these only cholecalciferol is available in 2 different alternative dosage forms – chewable tablets and drops for internal use. Omeprazole capsules can be modified by the patient. Gliclazide is available only as extended release tablets for which modifications are not acceptable. Some metformine and some glimepiride containing tablets can be divided. In the cardiovascular group most commonly consumed active substances in Latvia were statins, ACEI and BB. Availability of medication in Latvia for those who have cardiovascular illness and dysphagia is limited because there is only 1 alternative dosage form for 1 of the active substances – orodispersible tablets for perindopril. The best situation concerning availability of solid dosage form alternatives is in the nervous system medication group because orodispersible tablets for olanzapine, mirtazapine, betahistine and haloperidol solution for internal use are available in Latvia. It was concluded that there is limited availability of drugs in Latvia for dysphagia patients in groups of drugs which are consumed most commonly. Orodispersible tablets and solutions for internal use are available for certain active substances. Extemporaneusly compounded medicines can be used as an alternative of solid dosage forms for dysphagia patients if industrial made alternatives are not available. Patients should know about coping strategies that use to ease swallowing of medication. Like, drinking a larger sip of water, changing body position, changing dosage form, using medical device, as well as modification of dosage form if it is acceptable. Health care professionals should pay patient’s attention to dosage forms which should not be modified.
Dysphagia is widespread among all ages. Studies show that 1 of 25 adults in USA face it. Swallowing difficulties may be caused by drug use, aging or disease. It impairs quality of life and use of medication. Solid dosage forms are more popular in the drug market than others, but not all people can easily swallow them. Dysphagia patients rarely talk to their doctor about difficulties swallowing medication. So this problem often stays unspoken and unsolved. The purpose of this study was to find out if people with swallowing difficulties in Latvia have available appropriate dosage forms in anatomical groups of drugs which are consumed the most. Analysis of “Statistics on Medicines Consumption in Latvia in 2021” was performed to determine 3 most commonly consumed anatomical groups of drugs. “Medicinal product register of Latvia” was analyzed to evaluate multiplicity of available dosage forms for identified most consumed active substances. Active substances for which there are alternatives to solid dosage forms were researched. Package leaflets were looked at to estimate the possibilities of modifying dosage forms. In alimentary tract and metabolism group most consumed active substances were cholecalciferol, omeprazole, pantoprazole, metformin, gliclazide and glimepiride. From these only cholecalciferol is available in 2 different alternative dosage forms – chewable tablets and drops for internal use. Omeprazole capsules can be modified by the patient. Gliclazide is available only as extended release tablets for which modifications are not acceptable. Some metformine and some glimepiride containing tablets can be divided. In the cardiovascular group most commonly consumed active substances in Latvia were statins, ACEI and BB. Availability of medication in Latvia for those who have cardiovascular illness and dysphagia is limited because there is only 1 alternative dosage form for 1 of the active substances – orodispersible tablets for perindopril. The best situation concerning availability of solid dosage form alternatives is in the nervous system medication group because orodispersible tablets for olanzapine, mirtazapine, betahistine and haloperidol solution for internal use are available in Latvia. It was concluded that there is limited availability of drugs in Latvia for dysphagia patients in groups of drugs which are consumed most commonly. Orodispersible tablets and solutions for internal use are available for certain active substances. Extemporaneusly compounded medicines can be used as an alternative of solid dosage forms for dysphagia patients if industrial made alternatives are not available. Patients should know about coping strategies that use to ease swallowing of medication. Like, drinking a larger sip of water, changing body position, changing dosage form, using medical device, as well as modification of dosage form if it is acceptable. Health care professionals should pay patient’s attention to dosage forms which should not be modified.
Description
Farmācija
Pharmacy
Veselības aprūpe
Health Care
Pharmacy
Veselības aprūpe
Health Care
Keywords
Disfāgija, rīšanas traucējumi, zāļu formas modificēšana, ekstemporālās zāles, zāļu pieejamība., Dysphagia; difficulties swallowing; modification of dosage form, extemporaneous compounding, availability of drugs.