Niesteroidowe leki przeciwzapalne (NLPZ), do których należy ketoprofen, wykazują działanie nie tylko przeciwzapalne, ale także przeciwbólowe i przeciwgorączkowe. Niestety ich mechanizm działania jest także odpowiedzialny za wiele efektów niepożądanych i groźnych dla życia, zwłaszcza przy ich nadużywaniu. Jak działa ketoprofen? Dlaczego powinniśmy być ostrożni, stosując go?

Mechanizm działania niesteroidowych leków przeciwzapalnych

Za wiele niepokojących zjawisk, toczących się w naszym organizmie, takich jak stany podgorączkowe, gorączka, stany zapalne czy dolegliwości bólowe, odpowiadają prostaglandyny. Ich synteza zachodzi pod wpływem enzymów nazywanych cyklooksygenazami. W dużym skrócie, leki z grupy niesteroidowych leków przeciwzapalnych, w tym ketoprofen, hamują czynność cyklooksygenaz, co skutkuje spadkiem stężenia prostaglandyn i redukcją niepokojących objawów. [1][2][3]

Dopiero pod koniec XX wieku naukowcy odkryli, że w naszym organizmie występuję dwie formy enzymu cyklooksygenazy: COX-1 i COX-2. Okazało się też, że tę pierwszą możemy znaleźć w niektórych tkankach naszego organizmu konstytutywnie, czyli przez cały czas, niezależnie od tego, czy toczy się w nich proces zapalny. Uczestniczy ona w syntezie prostaglandyn w żołądku, nerkach czy w płytkach krwi, a hamowanie jej czynności przez leki z grupy niesteroidowych leków przeciwzapalnych prowadzi do wystąpienia nie działań leczniczych, a tych niepożądanych, o czym nieco więcej można dowiedzieć się w kolejnych akapitach. [1][2][3]

Enzymem związanym z indukcją procesów zapalnych i gorączki jest natomiast COX-2, który ujawnia się w organizmie właśnie w sytuacjach, kiedy jego praca jest zaburzona, np. przez ból czy stany zapalne. [1][2][3]

Działania niepożądane związane ze stosowaniem niesteroidowych leków przeciwzapalnych

Większość działań niepożądanych występujących podczas stosowania NLPZ-ów jest taka sama jak przy przyjmowaniu każdego innego leku. Chodzi przede wszystkim o dolegliwości żołądkowo-jelitowe, takie jak nudności czy wymioty, i alergiczne reakcje skórne. [1][2]

Jednak jak już wspomniano, występują też pewne działania niepożądane związane ze stosowaniem niesteroidowych leków przeciwzapalnych, które są spowodowane hamowaniem aktywności enzymu COX-1. Prostaglandyny w żołądku chronią np. jego śluzówkę, stanowiąc niejako barierę ochronną. W przypadku przyjmowania NLPZ-ów, zwłaszcza w większych dawkach i przez okres dłuższy niż kilka dni, dochodzi do hamowania COX-1 i w konsekwencji – produkcji prostaglandyn w żołądku. Wówczas zwiększa się ryzyko występowania nadżerek, owrzodzeń oraz groźnych dla życia perforacji i krwawień z przewodu pokarmowego. Prostaglandyny regulują także m.in. pracę nerek. W przypadku hamowania COX-1 i zmniejszenia ich stężenia dochodzi do zaburzeń pracy tych narządów, co skutkuje retencją jonów sodu i co za tym idzie – wody w organizmie, a to z kolei powoduje obrzęki i wzrost wartości ciśnienia tętniczego. [1][2][3]

Rodzaje niesteroidowych leków przeciwzapalnych

Większość stosowanych powszechnie NLPZ-ów wykazuje podobną aktywność hamującą w stosunku do obu izoform enzymu COX: COX-1 i COX-2. Można tu wymienić popularne leki takie jak diklofenak, ibuprofen czy ketoprofen. Są to oczywiście leki ogólnie uznawane za bezpieczne i skuteczne. Przyjmują je pacjenci z bólami głowy, bólami związanymi ze stanami zapalnymi stawów czy tkanek okołostawowych, bólami ran pooperacyjnych. Trzeba się jednak liczyć z tym, że ich stosowanie przez dłuższy czas lub nadużywanie może prowadzić do wystąpienia działań niepożądanych. [1][2][3][4]

Istnieje także podgrupa niesteroidowych leków przeciwzapalnych, które wykazują się zwiększoną selektywnością wobec enzymu COX-2. Są to tzw. koksyby, np. celekoksyb czy parekoksyb. W przypadku ich stosowania ryzyko wystąpienia charakterystycznych działań niepożądanych jest mniejsze, ale wciąż istnieje, ponieważ w niewielkim stopniu również oddziałują one na COX-1. [1][3]

Bibliografia:

[1] Pod red. Buczko W., Mutschler – Farmakologia i toksykologia, wyd. Elsevier Urban&Partner, Wrocław 2013, s: 246-262.
[2] https://bazalekow.mp.pl/leki/doctor_subst.html?id=444 – data dostępu: 07.12.2017.
[3] https://www.mp.pl/bol/wytyczne/90989,racjonalne-stosowanie-niesteroidowych-lekow-przeciwzapalnych-w-terapii-bolu – data dostępu: 07.12.2017.
[4] Sarzi-Puttini P. et al., Pain and ketoprofen: what is its role in clinical practice?, Reumatismo. 2010 Jul-Sep;62(3):172-88.

4 580 thoughts on “Jak działa ketoprofen?”
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