One of the components of the complex treatment of inflammation of the pancreas is drug therapy, and timely effective medications for pancreatitis play a key role in stopping the pathological process and preserving the functions of the entire gastro-entero-pancreatic endocrine system.
Because acute and chronic pancreatitis have some etiological and morphological differences, and their clinical manifestations may vary depending on the degree of impairment of the secretory functions of the gland, there are certain problems with choosing the right therapeutic tactics and applying pharmacological agents.
Treatment of pancreatitis with medications
It should be borne in mind that acute pancreatitis refers to urgent conditions, and its treatment is carried out only in a clinical hospital, where patients, in most cases, are urgently hospitalized by an ambulance. In severe conditions, which occurs in 20-25% of patients, a condition close to abdominal pain may be observed, and in case of vomiting caused by a sudden loss of fluid - and hypovolemia.
Therefore, drugs for acute pancreatitis, in the first place, should relieve acute pain, accompanied by nausea, vomiting, increased heart rate and blood pressure drop, and restore the water-electrolyte balance in the body. Pain is stopped by the parenteral administration of analgesics (Novocaine with glucose, Analgin, Ketanov) or antispasmodic drugs: No-shpi, Papaverina hydrochloride, Platifillin hydroartyrate, Metacin or Ganglefen hydrochloride.
At the same time, fluid recovery and hemodynamic stabilization are carried out: a dropper is often put on pancreatitis with saline, glucose and other components that support the work of various systems and organs. Syndrome of systemic inflammatory response, sepsis and multiple organ failure develop in severe acute pancreatitis in patients because activated pancreatic enzymes digest the membranes of its own cells.
Therefore, intensive care measures are combined with the prevention of infection of the affected pancreatic tissue or the fight against an already existing bacterial infection, and antibiotics (most often Amoxiclav or third generation cephalosporins) are used to solve this problem in gastroenterology. On the features of their use in pediatric gastroenterology, see - Acute pancreatitis in children
Another task is to suppress secretory functions of the gland in order not only to limit its load as much as possible, but also to stop the irreversible destruction of cells leading to pancreatonecrosis. For this, there are drugs that inhibit the synthesis of pancreatic enzymes. Their main names are:
- Aprotinin (synonyms - Contrikal, Gordoks, Traskolan);
- Octreotide (Octridium, Octretex, Sandostatin, Seraclast).
As a rule, they are used only in acute pancreatitis in adults. More about them - more.
Medications for chronic pancreatitis
The most important item, which includes the scheme of treatment of pancreatitis with drugs, is to inhibit the functional activity of the pancreas, that is, to lower the production of its enzymes. It is generally recognized that the cells of the parenchyma of the gland are damaged by the proteases it synthesizes, and damage is initiated in acinar cells after premature intracellular activation of digestive enzymes.
In the chronic form of the disease, Pirenzepine (Gastrotsepin) or Prifinium bromide (Riabal) can be used to reduce the production of proteolytic enzymes. Also, these medications are prescribed for exacerbation of pancreatitis: if the patient is hospitalized - Pyrenzepine is used parenterally.
With chronic inflammation and damage to the secretory cells of the pancreas, a state of deficiency in digestive pancreatic enzymes is associated. To cover it, gastroenterologists prescribe enzyme preparations containing proteases (digesting proteins), amylase (for hydrolysis of complex carbohydrates) and lipase (so that the body can metabolize fats). These include Pancreatin, which has many trade names: Pancitrate, Pangrol, Pancreasim, Penzital, Mikrazim, Creon, Mezim, Gastenorm forte, Vestal, Hermitage, etc. In addition to pancreatitis, indications for the use of enzymes include problems with the digestive system of various etiologies, dyspepsia , meteorism, cystic fibrosis, nutritional errors.
In order to suppress the production of hydrochloric acid in the stomach, the increased production of which activates the synthesis of pancreatic juice, preparations of three more pharmacological groups are introduced into the scheme of treatment of chronic pancreatitis :
- antisecretory H2-antihistamines: Ranitidine (Ranigast, Acyloc, Zantac, etc.) or Famotidine (Pepsidine, Kwamatel, Gastrosidine);
- inhibitors of the enzyme hydrogen-potassium ATPase (proton pump): Omepraspal (Omez, Gastrozol, Primez), Rabeprazole or Lansoprol (Lanzol, Clatinol, etc.);
- antatsidy with hydroxides of aluminum and magnesium - Almagel (Alumag, Gastracid, Maaloks), neutralizing acid in the stomach.
The mechanism of action, the form of the release, the method of administration and dose, and other pharmacological characteristics of the preparations of these three groups are described in detail in the material - Tablets from stomach ulcers
About what medicines are needed for pancreatitis in children, and about the features of their use in childhood read in the publication - Treatment of chronic pancreatitis
And the drugs for pancreatitis, which inhibit the production of pancreatic enzymes (aprotinin, Octreotide, Pirenzepine, Prinfonia bromide) and the deficiencies that fill them later (Pancreatin), are discussed in detail below.