三叉神经痛药物疗法的最新进展。

IF 3.4 2区 医学 Q2 CLINICAL NEUROLOGY Expert Review of Neurotherapeutics Pub Date : 2024-08-01 Epub Date: 2024-06-13 DOI:10.1080/14737175.2024.2365946
Joseph V Pergolizzi, Jo Ann LeQuang, Salah N El-Tallawy, Morgan Wagner, Rania S Ahmed, Giustino Varrassi
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引用次数: 0

摘要

简介三叉神经痛是一种罕见的疾病,卡马西平或奥卡西平可有效治疗这种疾病,但这些老药会产生剂量依赖性不良反应,并可能限制治疗效果。第三代抗惊厥药、治疗偏头痛的新型降钙素基因相关肽阻断剂以及氯胺酮和大麻素等老药可能是有前景的辅助药物或单一治疗选择:本文讨论了新药及其假定的作用机制、安全性和疗效。支持这些药物治疗三叉神经痛的有力临床证据还很少。虽然偏头痛和三叉神经痛是两种不同的疾病,但两者具有相似性,本文也考虑了新的偏头痛药物。近年来,还没有针对三叉神经痛这一特定适应症的新药上市:在实际临床实践中,约有一半的三叉神经痛患者服用一种以上的药物进行预防,联合疗法可能是最佳方法。联合疗法可以降低卡马西平或奥卡西平的剂量,从而减少潜在不良反应的数量和严重程度,但必须考虑药代动力学药物间相互作用的可能性。三叉神经痛的药物治疗包括急性或终止治疗(通常在医院进行)和长期预防治疗(通常使用口服药物)。
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An update on pharmacotherapy for trigeminal neuralgia.

Introduction: Trigeminal neuralgia is a rare condition that can be effectively treated by carbamazepine or oxcarbazepine but these older drugs are associated with dose-dependent and potentially treatment-limiting adverse effects. Third-generation anticonvulsants, new calcitonin gene-related peptide blockers for migraine, and older drugs such as ketamine and cannabinoids may be promising adjuvants or monotherapeutic options.

Areas covered: The new drugs, their presumed mechanisms of action, safety and efficacy are discussed herein. There is a paucity of robust clinical evidence in support of these drugs for trigeminal neuralgia. New migraine agents are considered as well although migraines and trigeminal neuralgia are distinct, albeit similar, conditions. No new drugs have been released to market in recent years with the specific indication of trigeminal neuralgia.

Expert opinion: In real-world clinical practice, about half of trigeminal neuralgia patients take more than one agent for prevention and combination therapy may be the optimal approach. Combination therapy might allow for lower doses of carbamazepine or oxcarbazepine, thus reducing the number and severity of potential adverse events but the potential for pharmacokinetic drug-drug interactions must be considered. Drug therapy for trigeminal neuralgia involves acute or abortive treatments, often administered in hospital versus long-term preventive therapy, usually involving oral agents.

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来源期刊
Expert Review of Neurotherapeutics
Expert Review of Neurotherapeutics Medicine-Neurology (clinical)
CiteScore
7.00
自引率
2.30%
发文量
61
审稿时长
4-8 weeks
期刊介绍: Expert Review of Neurotherapeutics (ISSN 1473-7175) provides expert reviews on the use of drugs and medicines in clinical neurology and neuropsychiatry. Coverage includes disease management, new medicines and drugs in neurology, therapeutic indications, diagnostics, medical treatment guidelines and neurological diseases such as stroke, epilepsy, Alzheimer''s and Parkinson''s. Comprehensive coverage in each review is complemented by the unique Expert Review format and includes the following sections: Expert Opinion - a personal view of the data presented in the article, a discussion on the developments that are likely to be important in the future, and the avenues of research likely to become exciting as further studies yield more detailed results Article Highlights – an executive summary of the author’s most critical points
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