Inhibitory cholinesterazy i memantyna: racjonalne wybory czy intuicja? Artykuł przeglądowy

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Tomasz Sobów
Monika Ponichtera-Kasprzykowska
Krzysztof Pękala

Abstrakt

Objawowe preparaty do leczenia otępienia w chorobie Alzheimera: inhibitory cholinesterazy (IChE) i memantyna, są dostępne od wielu lat i traktowane przez lekarzy jako dobrze znane (lekarze oceniają siebie jako doświadczonych w ich stosowaniu), przez przemysł farmaceutyczny zaś jako środki dojrzałe i niewymagające istotnych działań promocyjnych czy edukacyjnych. W badaniach klinicznych potwierdzono ich umiarkowaną skuteczność w zakresie wpływu na funkcje poznawcze, objawy behawioralne oraz funkcjonowanie chorych. Kontrowersyjne pozostaje natomiast to, czy leki te wpływają na naturalny przebieg procesu neurozwyrodnieniowego. W artykule omówiono kliniczne zastosowania IChE i memantyny oraz obecne zalecenia dotyczące ich wyboru w codziennej praktyce klinicznej. Uwzględniono ponadto aktualne rekomendacje dotyczące zasad zamiany terapii (na inny inhibitor) oraz konieczne środki ostrożności (przeciwwskazania, interakcje lekowe).

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