Hunter Pain Specialists, Broadmeadow, NSW, Australia.
Genesis Research Services, Broadmeadow, NSW, Australia.
Pain. 2023 Jan 1;164(1):3-13. doi: 10.1097/j.pain.0000000000002693. Epub 2022 May 17.
Ambroxol is a multifaceted drug with primarily mucoactive and secretolytic actions, along with anti-inflammatory, antioxidant, and local anaesthetic properties. It has a long history of use in the treatment of respiratory tract diseases and has shown to be efficacious in relieving sore throat. In more recent years, ambroxol has gained interest for its potential usefulness in treating neuropathic pain. Research into this area has been slow, despite clear preclinical evidence to support its primary analgesic mechanism of action-blockade of voltage-gated sodium (Na v ) channels in sensory neurons. Ambroxol is a commercially available inhibitor of Na v 1.8, a crucial player in the pathophysiology of neuropathic pain, and Na v 1.7, a particularly exciting target for the treatment of chronic pain. In this review, we discuss the analgesic mechanisms of action of ambroxol, as well as proposed synergistic properties, followed by the preclinical and clinical results of its use in the treatment of persistent pain and neuropathic pain symptoms, including trigeminal neuralgia, fibromyalgia, and complex regional pain syndrome. With its well-established safety profile, extensive preclinical and clinical drug data, and early evidence of clinical effectiveness, ambroxol is an old drug worthy of further investigation for repurposing. As a patent-expired drug, a push is needed to progress the drug to clinical trials for neuropathic pain. We encourage the pharmaceutical industry to look at patented drug formulations and take an active role in bringing an optimized version for neuropathic pain to market.
氨溴索是一种具有多种作用的药物，主要具有黏液活性和分泌溶解作用，同时具有抗炎、抗氧化和局部麻醉作用。它在治疗呼吸道疾病方面有着悠久的历史，并且已被证明在缓解喉咙痛方面非常有效。近年来，氨溴索因其在治疗神经病理性疼痛方面的潜在用途而受到关注。尽管有明确的临床前证据支持其主要的镇痛作用机制——阻断感觉神经元中的电压门控钠（Na v ）通道，但该领域的研究进展缓慢。氨溴索是一种商业上可获得的 Na v 1.8 抑制剂，Na v 1.8 是神经病理性疼痛病理生理学中的关键参与者，也是治疗慢性疼痛的一个特别令人兴奋的靶点。在这篇综述中，我们讨论了氨溴索的镇痛作用机制，以及提出的协同作用，然后讨论了其在治疗持续性疼痛和神经病理性疼痛症状（包括三叉神经痛、纤维肌痛和复杂性区域疼痛综合征）中的临床前和临床结果。氨溴索具有良好的安全性、广泛的临床前和临床药物数据以及早期的临床疗效证据，作为一种已过期专利的药物，值得进一步研究以重新定位用途。作为一种已过期专利的药物，需要推动该药物进入神经病理性疼痛的临床试验。我们鼓励制药行业研究已获专利的药物配方，并在将优化版本用于治疗神经病理性疼痛方面发挥积极作用。
