臨牀消化器内科 Vol.13 No.13(4)


特集名 消化管治療薬の使い方 --その根拠と問題点
題名 ムスカリン受容体拮抗薬(抗コリン薬も含む)
発刊年月 1998年 12月
著者 谷 礼夫 東海大学医学部内科
著者 三輪 剛 東海大学医学部内科
【 要旨 】 ムスカリン受容体拮抗薬とは,ムスカリン受容体(副交感神経支配臓器や中枢神経・神経節に存在するアセチルコリンの受容体)に対するアセチルコリンの作用を遮断する薬物である.臨床的には副交感神経遮断薬を意味し,消化管領域では副交感神経過緊張による消化管の運動や分泌の亢進がみられる疾患ないし病態,すなわち胃腸の平滑筋痙攣による腹痛,消化性潰瘍,過敏性腸症候群などに対して使用される.しかし他のムスカリン受容体にも作用して,それが副作用になるので,投与量に注意しなければならない.抗潰瘍薬としては最近,壁細胞に比較的選択的に作用し,平滑筋臓器や心臓に対して影響の少ないピレンゼピンが開発され,使用されている.
Theme Direction of the Prescription for Gastrointestinal Tract
Title Muscarinic Receptor Antagonists
Author Norio Tani Department of Internal Medicine, Tokai University School of Medicine
Author Takeshi Miwa Department of Internal Medicine, Tokai University School of Medicine
[ Summary ] Muscarinic receptor antagonists block the action of acetylcholine against muscarinic receptors which exist in the viscera, controlled by parasympathetic nerves, the central nervous system and ganglions. Clinically, they are seen to be drugs which produce parasympatholytic actions. In the area of the digestive tract they are used for diseases or pathologic states related to hypersecretion a/o hyperanakinesis due to hyperfunction of parasympathetic nerves, such as abdominal pain induced by spasm of the smooth muscles of the gastrointestinal tract, peptic ulcer, irritable bowel syndrome, etc. However, we must beware of overdosage because they display several adverse effects by acting against other muscarinic receptors, e.g. visual disturbances, an increase of intraocular pressure, thirst, palpitations, tachycardia, or dysuria. They were first used for treatment peptic ulcers with the expectation of acid-inhibitory action, but this action cannot be displayed well because of the dose-limitations in order to reduce adverse effects. Recently pirenzepine, which was developed as a drug to selectively antagonize the muscarinic receptors of the central nervous system and ganglions, has been used in place of the usual muscarinic receptor antagonists because it has been shown to display a relatively high affinity for parietal cells with a low affinity for smooth muscles and the heart.
戻る