According to the World Health Organization, half of all drugs available on the global pharmaceutical market are sometimes used for indications that are not included in the instruction for use. This method of therapy has the term “off-label use” which means the use “out of instruction”. Today, off-label drugs are also prescribed for cancer treatment. For example, a drug developed to treat one type of tumor can sometimes be used to treat other types of cancer. The treatment of certain types of pain with tricyclic antidepressants is also an example of the off-label drugs used in oncology. An example of an off-label prescription is anxiolytic medicine lorazepam, which can be used off-label as an antiemetic in cancer patients. Low doses of naltrexone are applied to treat cancer and autoimmune diseases. A retrospective analysis of modern oncotherapy indicates that oncologists often use off-label drugs in combination therapy, especially in the treatment of patients with concomitant diseases, in case of progressive development of the tumor, or to reduce the toxicity and cost of treatment components. American oncologists are of the opinion that if all the drugs prescribed by the International Recommendations failed in the treatment of cancer, doctors can prescribe off-label medications, but only if their effectiveness and safety are clearly established. The problem of the off-label use of drugs in oncology has not yet been studied in detail, however, this direction has certain promising prospects.
Diseases of the musculoskeletal system are quite common diseases. Moreover, the use of pharmacotherapy may not always be effective, which is associated with a large number of side effects of modern non-steroidal anti-inflammatory drugs (NSAIDs). The way out of the situation can be the use of carboxytherapy (CO2 therapy), which has a complex of pharmacological effects: analgesic, anti-inflammatory, antispasmodic, antihypoxic and antioxidant.These CO2 effects are used to eliminate the symptom complex associated with pain, inflammation, ischemia, hypoxia, and joint stiffness. The use of carboxytherapy in orthopedics is primarily aimed at eliminating pain in various diseases of the spine, joints, muscles in the back, neck, thighs, knees and other organs. The main target of the action of carboxytherapy in diseases of the musculoskeletal system are Zakharyin – Geda zones, trigger points, myofibralgia zones and acupuncture points.When CO2 affects these zones and points, vasodilation, muscle relaxation and increased tissue oxygenation reflexively occur, which leads to a decrease in inflammation, pain and other functional disorders in the joints and muscles. Due to the polypathopathogenetic pharmacodynamics of CO2, carboxytherapy is often used for post-traumatic and inflammatory conditions of joints, arthrosis, and other acute and chronic joint pathologies of various etiologies.In addition, with combined pharmacotherapy of these diseases, carboxytherapy reduces the duration of NSAIDs and other drugs, reduces their dosage, which reduces the risk of side effects and increases the effectiveness of CO2 therapy.
Назначение препаратов -непростая задача для педиатров, так как ассортимент выбора лекарств в педиатрии на 2/3 меньше, чем у взрослых больных.Цель работы -проанализировать данные научной литературы об опыте применения лекарств off-label в мировой педиатрии.Материалы и методы. Библиосемантический анализ, обзор литературы, статистический анализ.Результаты. На основе проведенного анализа установлено, что одна из наиболее важных причин назначения лекарств off-label «вне инструкции» детям -отсутствие стандартных, лицензированных и безопасных терапевтических вариантов клинических испытаний лекарств при некоторых заболеваниях или состояниях у детей. Приведены возможные подходы к решению проблем «off-lable use» лекарств в медицине и здравоохранении.Выводы. Ситуацию использования лекарств off-label у детей можно улучшить благодаря сообщениям врачей о педиатрическом опыте с различными лекарствами off-label в виде научных статей, обсуждений на научных конференциях, с высокой степенью доказательности. Принимая решение о назначении лекарств off-label ребенку, врачи должны быть уверены, что это единственный правильный шаг при условии наличия национального формуляра и национального перечня основных лекарственных средств.
Determination of dependence of the efficiency and toxicity of drugs on the time of day or season is one of the most promising areas of modern experimental and clinical pharmacology. The aim of the study. Aim is to identify features of daily rhythms of silymarin influence on the state of antioxidant/prooxidant and cytolytic processes (the leading link in the implementation of hepatoprotective activity) with paracetamol in rats under conditions of acute toxic liver damage. Materials and methods. Chronopharmacological action features of silymarin were studied by use of the generic drug "Karsil" as an example (Sopharma, Bulgaria) with paracetamol in rats under conditions of acute toxic liver damage. The state of the processes of POL-AOS was evaluated by the content of TBA-active products (TBA-AP), the content of recovered glutathione, the activity of SOD, catalase in hepatocytes, and the cytolytic processes by the activity of ALT in serum. Results. There was established a certain chronoarchitectonics of the rhythms of the antioxidant protection system and the activity of the processes of peroxidation in rats under physiological conditions, which was not disturbed by paracetamol on the background of acute liver damage (with the exception of level of acrophase catalase activity). The same dynamics and commonality of rhythms occurred on the background of the use of silymarin. The maximum display of silymarin hepatoprotective activity was observed under conditions of its use in the morning (09.00) and in the evening (21.00). Conclusions. The use of silymarin during periods of maximal display of its hepatoprotective activity, in the morning (09.00) and in the evening (21.00) may be the way to increase its bioavailability. Chronopharmacological features of silymarin activity have been established and should be taken into account when to conduct its further chronopharmacological studies.
An experimental study of a new combined ointment with ethony for treatment of wounds was carried out and its advantages were established compared with the similar drugs Inflarax (LLC FC "Health"), Levomekol (ZAO SPC "Borshchagovsky HFZ") and Oflokain-Darnitsa® (ZAO FF "Darnitsa"), having the same indications for use as a new ointment. The osmotic activity of ointment with ethony was studied by the method of kinetics of water absorption in in vitro experiments. The antimicrobial effect of ointment with ethony relative to standard and hospital strains of microorganisms by diffusion in agar in the modification of wells was determined: S. aureus ATCC 25923, E. coli ATCC 25922, P. aeruginosa ATCC 27853, B. subtilis ATCC 6633, P. vulgaris ATCC 4636, C. albicans ATCC 885/653, S. aureus 23, E. coli 15, P. aeruginosa 39, P. vulgaris 59, K. pneumoniae 6. The anti-inflammatory activity of ointment with ethony was established in a model of non-allergic contact dermatitis caused by turpentine. The results of experimental studies indicate the high efficiency of the proposed combined composition of the ointment with ethony due to the optimal combination of the components of the ointment base and active substances. It was established that the ointment with ethony showed a pronounced and prolonged osmotic activity, which contributes to the complete penetration and release of the active substances of the ointment in the tissue. An ointment with ethony revealed a wide spectrum of antimicrobial activity with respect to standard and hospital strains: with respect to C. albicans ATCC 885/653 and K. pneumoniae 6, this ointment was superior in activity to all comparison drugs. The ointment with ethony showed a pronounced anti-inflammatory effect, superior to the comparison drugs in effectiveness. Thus, due to the presence of a wide spectrum of pharmacological activity, ethony ointment can be recommended for the treatment of wounds with severe exudation in the first phase of the wound process, for wounds infected with mixed bacterial and fungal microflora, and for the prevention of their complications, as well as in complex therapy of the skin inflammatory processes.
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