safetyriskБезопасность и риск фармакотерапииSafety and Risk of Pharmacotherapy2312-78212619-1164Federal State Budgetary Institution ‘Scientific Centre for Expert Evaluation of Medicinal Products’ of the Ministry of Health of the Russian Federation (FSBI ‘SCEEMP’)10.30895/2312-7821-2020-8-4-205-210safetyrisk-201Research ArticleОБЗОРЫREVIEWSНежелательные реакции в полости рта, ассоциированные с приемом низких доз метотрексатаAdverse Oral Reactions Associated with Low Doses of Methotrexatehttps://orcid.org/0000-0001-7826-9657ИзможероваН. В.IzmozherovaN. V.

Изможерова Надежда Владимировна, доктор медицинских наук, доцент.ул. Репина, д. 3, Екатеринбург, 620028

Nadezhda V. Izmozherova, Dr. Sci. (Med.), Associate Professor.3 Repina St., Ekaterinburg 620028

nadezhda_izm@mail.ruhttps://orcid.org/0000-0001-6216-2468ПоповА. А.PopovA. A.

Попов Артем Анатольевич, доктор медицинских наук, доцент.ул. Репина, д. 3, Екатеринбург, 620028

Artem A. Popov, Dr. Sci. (Med.), Associate Professor.3 Repina St., Ekaterinburg 620028

art_popov@mail.ruhttps://orcid.org/0000-0003-1223-5790ГайсинаЕ. Ф.GaysinaE. F.

Гайсина Елена Фахаргалеевна, кандидат медицинских наук, доцент.ул. Репина, д. 3, Екатеринбург, 620028

Elena F. Gaysina, Cand. Sci. (Med.), Associate Professor.3 Repina St., Ekaterinburg 620028

egaisina68@mail.ruhttps://orcid.org/0000-0001-9208-9417ДобринскаяМ. Н.DobrinskayaM. N.

Добринская Мария Николаевна, кандидат медицинских наук, доцент.ул. Репина, д. 3, Екатеринбург, 620028

Maria N. Dobrinskaya, Cand. Sci. (Med.), Associate Professor.3 Repina St., Ekaterinburg 620028

maria-nd@mail.ruhttps://orcid.org/0000-0001-7907-2629БахтинВ. М.BakhtinV. M.

Бахтин Виктор Михайлович.ул. Репина, д. 3, Екатеринбург, 620028

Viktor M. Bakhtin.3 Repina St., Ekaterinburg 620028

https://orcid.org/0000-0003-2679-020XШатуноваМ. К.ShatunovaM. K.

Шатунова Мария Константиновна.ул. Репина, д. 3, Екатеринбург, 620028

Maria K. Shatunova.3 Repina St., Ekaterinburg 620028

11031955@e1.ruhttps://orcid.org/0000-0002-3421-5590ЗахватошинаА. М.ZakhvatoshinaA. M.

Захватошина Анна Михайловна.ул. Репина, д. 3, Екатеринбург, 620028

Anna M. Zakhvatoshina.3 Repina St., Ekaterinburg 620028

annza345643@mail.ruУральский государственный медицинский университет Министерства здравоохранения Российской ФедерацииРоссияUral State Medical UniversityRussian Federation20201012202084205210Copyright © Изможерова Н.В., Попов А.А., Гайсина Е.Ф., Добринская М.Н., Бахтин В.М., Шатунова М.К., Захватошина А.М., 20202020Изможерова Н.В., Попов А.А., Гайсина Е.Ф., Добринская М.Н., Бахтин В.М., Шатунова М.К., Захватошина А.М.Izmozherova N.V., Popov A.A., Gaysina E.F., Dobrinskaya M.N., Bakhtin V.M., Shatunova M.K., Zakhvatoshina A.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.risksafety.ru/jour/article/view/201

Врачи различных специальностей в своей практике часто встречаются с нежелательными реакциями при применении лекарственных средств. Метотрексат может вызывать нежелательные реакции в полости рта, прежде всего эрозивно-язвенные поражения. Цель работы: анализ данных научной литературы о распространенности, патофизиологических механизмах, факторах риска развития поражений слизистой оболочки полости рта, ассоциированных с применением низких доз метотрексата, профилактике и лечении этих повреждений. Показано, что наиболее частыми нежелательными реакциями, возникающими в полости рта при применении низких доз метотрексата, являются длительно незаживающие болезненные участки некроза слизистой оболочки полости рта, часто неправильной формы (в том числе афты, язвы). Спектр гистопатологических изменений варьирует от неспецифического изъязвления до лихеноидных реакций. Лечение поражений полости рта, индуцированных применением низких доз метотрексата, заключается в прекращении приема препарата или снижении его дозы. При необходимости назначают прием фолиевой кислоты, местную симптоматическую терапию. Для своевременного выявления нежелательных реакций и проведения эффективной терапии практикующим врачам следует знать о возможности развития поражений слизистой оболочки полости рта, ассоциированных с применением метотрексата, а также об особенностях фармакокинетики и фармакодинамики препарата, способствующих их возникновению.

Doctors of various medical specialties often encounter adverse drug reactions in their clinical practice. Methotrexate (MTX) can cause adverse reactions in the oral cavity, primarily erosions and ulcerations. The aim of the study was to analyse scientific literature on the prevalence, pathophysiological mechanisms, risk factors for oral lesions associated with low doses of MTX, their prevention and treatment. It was demonstrated that the most frequent oral adverse reactions associated with low doses of MTX are hard-to-heal painful necrotic and often irregularly shaped lesions of the oral mucosa (including aphthae and ulcers). The spectrum of histopathological changes ranges from nonspecific ulcerations to lichenoid reactions. Treatment of oral lesions induced by low doses of MTX consists in drug withdrawal or dose tapering. Folic acid and local symptomatic therapy can also be used, if necessary. Practitioners should be aware of the potential development of MTX-induced oral lesions, and specific aspects of the drug pharmacokinetics and pharmacodynamics in order to be able to ensure timely detection of adverse reactions and their effective treatment.

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The authors declare that there are no conflicts of interest present.