ANTIANEMIC MEANS — the pharmaceuticals promoting increase in amount of hemoglobin and erythrocytes and applied to treatment of anemias.
There is no standard classification of P. of page. Distinguish P. the pages normalizing formation of erythrocytes and hemoglobin, and the drugs interfering destruction of erythrocytes.
The page normalizing formation of erythrocytes and hemoglobin carry iron preparations to P. (see. Iron , drugs), appointed for completion of deficit of this element at some types of anemias, and also the substances necessary for a normal hemopoiesis (so-called stimulators of an erythrogenesis). From the iron preparations intended for peroral uses as P. villages use tablets of Haemostimulinum (see), Blo's tablets, Ferrocalum, orferon (a ferroglitsina sulfate), ferrous sulfate. Ferrous sulfate is also a part of a number of the combined drugs, to the Crimea belong Ferroplexum (gland sulfate with ascorbic to - that), Conferonum (gland sulfate with dioktidil-sodium succinate), etc. From iron preparations apply to parenteral administration ferbitol, ferrum-lek and some other drugs.
As stimulators of an erythrogenesis use some vitamin drugs — cyanocobalamine (see), folic acid (see), pyridoxine (see), and also anabolic steroids (see), salts lity (see) and drugs cobalt (see), napr, Coamidum (see). Usually carry to group P. of the page interfering the increased destruction of erythrocytes Prednisolonum (see), Triamcinolonum (see), dexamethasone (see) and other drugs of glucocorticoids, immunodepressive substances (see), napr, Mercaptopurinum (see), Azathioprinum, Cyclophosphanum (see), Chlorbutinum (see), etc., and also some derivatives of aminoquinoline, e.g. Chingaminum (see) and plaquenil, having immunodepressive properties.
Iron preparations in modern medical practice apply hl. obr. for treatment of iron deficiency anemias. Therapy of such anemias is recommended to be begun with purpose of the ferriferous drugs intended for oral administration. At the choice of drugs of this group preference is given to those compounds of iron which provide the most bystry daily gain of amount of hemoglobin and erythrocytes and do not cause at the same time the expressed side effects. It is necessary to appoint iron preparations for parenteral administration when iron preparations for oral administration are contraindicated: at diseases of a stomach and intestines (e.g., at a peptic ulcer, a syndrome of the broken absorption, coloenterites, etc.), intolerance or lack of effect of introduction of iron preparations inside.
At treatment iron of scarce anemias iron preparations for oral administration success is defined by purpose of the most effective dose of drug and duration of the carried-out therapy (see. Iron deficiency anemia ). In an initiation of treatment these drugs are appointed in low doses for clarification of their portability. In the absence of reaction to introduction of trial doses of drugs the dose is increased to the most reasonable, edges is defined by quantity soaked up from went. - kish. a path of iron and ability of marrow to utilize it. Though these indicators are individual, it is possible to proceed from the following general patterns. It is normal soaked up apprx. 7 — 10% of the iron entered inside, at exhaustion of its stocks (a prelatentny and latent iron deficiency state) — to 17%, and at iron deficiency anemias — to 25%. The maximum quantity of the iron included in erythroblasts and used for synthesis of hemoglobin makes apprx. 25 — 30 mg a day. Increase in a daily dose of iron preparation of St. 200 mg (in terms of elementary iron) considerably increases the frequency and expressiveness of side reactions. In this regard it is the most reasonable to appoint 100 — 200 mg of iron a day. Such dose completely provides the need of an organism for the iron necessary for recovery of amount of hemoglobin. At good tolerance of drug its quantity can be increased to 300 mg of elementary iron, but at the same time the recovery rate of level of hemoglobin does not increase though the general duration of treatment is reduced.
The general duration of treatment of patients with iron deficiency anemias is defined by time necessary for normalization of amount of hemoglobin, level of serumal iron and recovery of its stocks in an organism. At the same time time necessary for recovery of reserves of iron makes about 2 — 3 months. In this regard after normalization of a hemoglobin content treatment needs to be continued apprx. 2 months. In case of proceeding hron, the blood loss which is the reason of deficit of iron, terms of treatment should be increased. At the same time iron preparations after the termination of a basic course of treatment appoint in maintenance doses (50 — 100 mg a day). The greatest to lay down. the combined drugs containing ferrous sulfate and organic to - you or sugar have effect and the smallest expressed side effect. Ferriferous drugs of the prolonged action, napr are perspective, ferrogradumt, an erifer, feospan, etc. which in smaller doses and at the best portability allow to achieve bigger utilization of iron. For increase in efficiency of usual ferriferous drugs it is reasonable to appoint them fractional doses (in 4 — 5 receptions).
At emergence of signs of intolerance of ferriferous drugs (lack of appetite, nausea, vomiting, diarrhea, allergic reactions) treatment it is necessary to stop or reduce a dose of drug for a while. If it does not help, it is recommended to replace drug. In case of intolerance of all of available connections of the doctor of iron for oral administration it is necessary to appoint iron preparations for parenteral administration.
The amount of drug necessary for all course of treatment, in each case calculate taking into account the content in drug of elementary iron and degree of anemia (according to special instructions to drugs). Usually the level of hemoglobin is recovered within 15 — 30 days.
Iron preparations for parenteral administration can cause emergence of metal taste in a mouth, reddening of integuments, spasms, an acute anaphylaxis. In this regard at use of such drugs it is also necessary to be careful and prior to treatment to define individual sensitivity of the patient to the appointed drug by introduction it in small (trial) doses.
Vitamin drugs — cyanocobalamine and folic to - they are apply at megaloblastny anemias (see. Pernicious anemia ). These vitamins are necessary for normal biosynthesis of the purine and pirimidinovy bases. At their deficit normal formation of DNA and RNA, and also the proteins coded by them is broken that is shown by development of an erythrogenesis of megaloblastny type. These drugs quickly normalize a hemoglobin content. Co-administration of cyanocobalamine and folic to - you is reasonable only at the combined deficit of these vitamins that meets seldom. In this regard at megaloblastny anemias it is recommended to begin treatment with purpose of cyanocobalamine. To lay down in certain cases. the effect of cyanocobalamine amplifies at simultaneous use of glucocorticoids. It is caused, apparently, by the fact that glucocorticoids suppress products of antibodies to covering cells of a mucous membrane of a stomach or an internal factor of Kasl (see. Kasla factors ) and by that eliminate one of the reasons of development of deficit of cyanocobalamine.
At separate types zhelezorefrakterny anemias (see), developing owing to disturbance of synthesis gem to lay down. effect render a pyridoxine and pyridoxal phosphate (see). Use of these drugs at iron scarce anemias is unjustified.
As stimulators of erythropoietic potentialities of marrow at hypoplastic anemias use Prednisolonum and other drugs of glucocorticoids, androgens, anabolic steroids, a growth hormone (somatotropic hormone), Coamidum, drugs of lithium. Lech. the effect of glucocorticoids at such anemias develops usually during 1 — 2 week. In the absence of effect of glucocorticoids in these terms further use of drugs of this group is inexpedient. The mechanism of action of glucocorticoids at hypoplastic anemias explain them with the stimulating influence on an exit of erythrocytes from depot, prolongation of their circulation in blood, and also effect of drugs on the committed stem cells.
Androgens and anabolic steroids render to lay down. action at anemias due to strengthening of products of endogenous erythropoetin, and also due to direct action on eritropoetinreagiruyushchy cells. It is noted that synthetic androgens (oxymetabosoms, flyuoksimetalon) affect an erythrogenesis, than natural androgens more actively.
Coamidum has antianemic effect, increasing products of erythropoetin kidneys, and drugs of lithium, apparently, due to increase in development of a koloniystimuliruyushchy factor and influence on the maintenance of tsAMF.
At the hemolitic anemias developing as a result of autoimmune processes use hl. obr. the drugs having immunodepressive properties. Most quickly and effectively at such anemias glucocorticoids work. At absence to lay down. effect of glucocorticoids and a splenectomy it is reasonable to apply immunodepressants from group of tsitostatik (Mercaptopurinum, Azathioprinum, Chlorbutinum, Cyclophosphanum); they are applied under control of indicators of peripheral blood and functions of a liver. For the supporting immunodepressive therapy it is possible to use derivatives of aminoquinoline, napr, Chingaminum and plaquenil (see. Hemolitic anemia ).
Use of replacement therapy at anemias in modern medical practice has limited value and is most justified at and - and hypoplastic anemias (see).
Bibliography: Iron scarce states, under the editorship of V. N. Chernigovsky and M. M. Shcherba, L., 1975; Idelson JI. I. Hypochromia anemias, M., 1981, bibliogr.; Idelson L. I., D and d-kovsky N. A. and Ermilchen-k about G. V. Hemolitic anemias, M., 1975, bibliogr.; Clinical pharmacology, under the editorship of V. V. Zakusov, M., 1978; M and sh to about in with to and y M. D. Pharmaceuticals, p.1 — 2, M., 1977; The Guide to hematology, under the editorship of A. I. Vorobyov and 10. I. Loriye, page 355, M., 1979; Iron deficiency, ed. by L. Hallberg a. o., L. — N. Y., 1970; Iron metabolism and its disorders, ed. by H. Kief, .Amsterdam a. o., 1975.
And. H. Bokarev, V. I. Yershov.