Papaverine Hydrochloride

☝ 点击上方 一键预约 ☝   最新最热的医药健康新闻政策 本共识以规范临床用药行为、促进合理用药为工作目标，对纳入《目录》中的奥美拉唑、人血白蛋白、左氧氟沙星、法莫替丁等30种药品中常见的超说明书用药情况进行评估，明确临床应用条件和原则，以利于加强合理用药监管，促进临床合理用药水平持续提高。 01 质子泵抑制剂 推荐意见1：治疗伴胃黏膜糜烂和（或）以反酸、上腹痛等症状为主的慢性胃炎。证据质量：B；推荐等级：强推荐。 《中国慢性胃炎共识意见(2017年，上海)》推荐有胃黏膜糜烂和(或)以上腹痛和上腹烧灼感等症状为主的慢性胃炎患者，可根据病情或症状严重程度选用胃黏膜保护剂、抗酸剂、H2受体抑制剂或PPIs(推荐等级：强；证据质量：A)。包括奥美拉唑、艾司奥美拉唑、雷贝拉唑、兰索拉唑、泮托拉唑和艾普拉唑等在内的PPIs抑酸作用强而持久，可根据病情或症状严重程度选用。 《质子泵抑制剂优化应用专家共识》中建议有黏膜糜烂和(或)酸相关症状的慢性胃炎患者，可根据病情酌情选用PPIs，推荐常规剂量每日1次PPIs，疗程4～6周(推荐等级：强；证据质量：B)。 推荐意见2：以上腹痛、灼烧感为主要症状的功能性消化不良 本条中：奥美拉唑说明书有消化不良适应症，其他PPI（证据质量：艾司奥美拉唑A，兰索拉唑A，雷贝拉唑A，泮托拉唑B；推荐等级：强推荐）。 推荐意见3：用于长期治疗病理性胃酸分泌过多症（如卓-艾综合征）（证据质量：艾司奥美拉唑A；推荐等级：强推荐）。其他PPIs说明书有卓-艾综合征的适应症。 推荐意见4：与抗菌药物联合，根除Hp感染 （证据质量：兰索拉唑A；推荐等级：强推荐）。其他PPIs说明书中有该适应症。 推荐意见5：与阿莫西林联合，大剂量二联方案根除Hp感染 （证据质量：艾司奥美拉唑A，雷贝拉唑A；推荐等级：强推荐）。 《2022中国幽门螺杆菌感染治疗指南》中提出铋剂四联方案和大剂量双联方案均可用于Hp感染初次和再次根除治疗(弱推荐，低质量)，大剂量阿莫西林(≥3g·d-1，如每次1g、tid，或每次0．75 g、qid)联合PPIs，如艾司奥美拉唑或雷贝拉唑(双倍标准剂量，bid；或标准剂量，qid)。 《2017ACG临床指南：幽门螺杆菌感染的治疗》中也建议大剂量二联方案(PPIs和阿莫西林联合使用14d)可作为挽救方案，PPIs(标准剂量或双倍剂量，tid或qid)+阿莫西林(1g，tid或0.75g，qid)。 推荐意见6：用于治疗GERD相关的咽喉反流性疾病患者（证据质量：奥美拉唑B、兰索拉唑B、艾司奥美拉唑B、雷贝拉唑B；推荐等级：强推荐）。 《咽喉反流性疾病诊断与治疗专家共识》提出药物治疗是治疗LPＲD的主要方法，包括PPIs、钾离子竞争性酸拮抗剂、H2受体阻断剂、促胃肠动力药和胃黏膜保护剂等(中等质量证据，强推荐)。 推荐意见7：用于治疗儿童Hp感染 （证据质量：奥美拉唑A，艾司奥美拉唑B；推荐等级：强推荐）。 推荐意见8：儿童胃食管反流病 （所有PPIs证据质量：A；推荐等级：强推荐）。 推荐意见9：儿童功能性消化不良 （证据质量：奥美拉唑C；推荐等级：弱推荐）。 推荐意见10：儿童消化道出血 （证据质量：奥美拉唑C；推荐等级：弱推荐）。 推荐意见11：儿童消化性溃疡 （证据质量：奥美拉唑B；推荐等级：强推荐）。 02 抗菌药物 推荐意见12：头孢他啶用于治疗类鼻疽 （证据质量：A级；推荐等级：强推荐）。 推荐意见13：美罗培南用于感染诱发的老年多器官功能障碍综合征的经验性抗感染治疗 （证据质量：B级；推荐等级：强推荐）。 推荐意见14： （1）左氧氟沙星用于感染性腹泻的经验性治疗 （证据质量：B；推荐等级：强推荐）。 （2）利福平耐药、异烟肼耐药或异烟肼和利福平耐药结核病治疗的长程治疗 （证据质量：B；推荐等级：强推荐）。 （3）高危的粒细胞缺乏患者的感染预防 （证据质量：A；推荐等级：强推荐）。 （4）Hp感染初次和再次根除治疗的四联方案 （证据质量：B；推荐等级：强推荐）。 03 糖皮质激素 推荐意见15：雾化吸入布地奈德可作为慢性阻塞性肺疾病急性加重住院患者的全身性糖皮质激素的替代治疗（证据质量：A；推荐等级：强推荐）。 推荐意见16：雾化吸入布地奈德在某些特定人群中可在支气管舒张剂基础上联合治疗慢阻肺急性加重的住院患者（证据质量：B；推荐等级：强推荐）。 推荐意见17：患新型冠状病毒感染（COVID-19）的儿童，若合并急性喉炎或喉气管炎者，可给予布地奈德2mg雾化吸入（证据质量：A；推荐等级：强推荐）。 推荐意见18：患COVID-19的儿童，若存在喘息、肺部哮鸣音：可在综合治疗的基础上加用布地奈德2mg雾化吸入（证据质量：A；推荐等级：强推荐）。 推荐意见19：患COVID-19的高风险人群（老年人及合并有并发症人群）可使用吸入布地奈德进行治疗（证据质量：B；推荐等级：强推荐）。 推荐意见20：COVID-19患者在发病早期可使用吸入布地奈德进行治疗（证据质量：B；推荐等级：强推荐）。 推荐意见21：吸入布地奈德可用于治疗成人和青少年患者非哮喘性嗜酸性支气管炎引起慢性咳嗽（证据质量：B；推荐等级：强推荐）。 推荐意见22：雾化布地奈德（2mg）用于严重儿童喉炎患者的辅助治疗（证据质量：B；推荐等级：强推荐）。 推荐意见23：用于儿童急性鼻窦炎的辅助治疗（证据质量：B；推荐等级：强推荐）。 推荐意见24：布地奈德可用于合并相关疾病的ICU患者有气道炎症时机械通气雾化吸入治疗（证据质量：D；推荐等级：弱推荐）。 推荐意见25：布地奈德雾化吸入可用于肺部手术围术期缓解气道炎症，加快手术康复（证据质量：D；推荐等级：弱推荐）。 04 其他临床治疗药物 推荐意见26：罂粟碱用于男子勃起功能障碍的替代治疗（证据质量：B级；推荐等级：弱推荐） 推荐意见27：罂粟碱用于治疗急性肠系膜缺血（证据质量：B级；推荐等级：强推荐） 推荐意见28：前列地尔用于勃起功能障碍的诊断和治疗（证据质量：A；推荐等级：强推荐）。 推荐意见29：前列地尔用于治疗糖尿病足（证据质量：A；推荐等级：强推荐）。 推荐意见30：法莫替丁用于治疗以上腹痛、烧灼感为主要症状的功能性消化不良（证据质量：A；推荐等级：强推荐）。 推荐意见31：法莫替丁用于治疗伴胃黏膜糜烂和（或）以反酸、上腹痛等症状为主的慢性胃炎（证据质量：B；推荐等级：强推荐）。 《中国慢性胃炎共识意见(2017年，上海)》推荐有胃黏膜糜烂和(或)以上腹痛和上腹烧灼感等症状为主的慢性胃炎患者，可根据病情或症状严重程度选用胃黏膜保护剂、抗酸剂、H2受体拮抗剂或PPIs(推荐等级：强；证据质量：高)。 推荐意见32：人血白蛋白用于卵巢过度刺激综合征（证据质量：A；推荐等级：强推荐）。 推荐意见33：人血白蛋白用于预防成人腹腔穿刺大量放液后的循环功能障碍（证据质量：A；推荐等级：强推荐）。 推荐意见34：人血白蛋白用于联合抗菌药物减少自发性细菌性腹膜炎后的肾损害（证据质量：B；推荐等级：强推荐）。 推荐意见35：人血白蛋白用于肝脏功能衰竭患者人工肝支持系统（证据质量：B；推荐等级：强推荐） (来源： 医药 ZS 公众号）   药闻康策 新媒体矩阵微信公众号 点击下方  一键关注 【免责声明】 1.“药闻康策”部分文章信息来源于网络转载是出于传递更多信息之目的，并不意味着赞同其观点或证实其内容的真实性。如对内容有疑议，请及时与我司联系。2.“药闻康策”致力于提供合理、准确、完整的资讯信息，但不保证信息的合理性、准确性和完整性，且不对因信息的不合理、不准确或遗漏导致的任何损失或损害承担责任。3.“药闻康策”所有信息仅供参考，不做任何商业交易或医疗服务的根据，如自行使用“药闻康策”内容发生偏差，我司不承担任何责任，包括但不限于法律责任，赔偿责任。 欢迎转发分享、点赞、点在看

Traditional large pharmaceutical companies Hengrui Pharmaceutical and Stone Pharmaceutical Group, which have made remarkable achievements in research and development and business expansion, experienced a significant decline in profitability in the third quarter of 2024 when there was no fault in the innovative drug product line. In the face of competition from biotechnology companies, these two large pharmaceutical companies have achieved the revival of innovation transformation, especially Hengrui Pharmaceutical, which has been approved for the listing of 17 Class A new drugs in China, and ranks among the top three domestic listed drugs in the same target. The 12 innovative pharmacological products approved since 2021 should be in the market growth and climb stage. However, Hengrui Pharmaceutical's revenue in the third quarter of 2024 was 6.589 billion yuan, up 13% year-on-year, down 13% quarter-on-quarter, and the net profit attributable to the parent company was 1.188 billion yuan, up 1.91% year-on-year. If we take into account the capitalization of R&D expenditure of about $126 million, there is actually negative growth. What the hell happened? Hengrui Pharmaceutical's operation and research and development have not made mistakes, and there is no need to reflect. However, even with efforts and efforts, the results are still not satisfactory and there may still be certain problems. The traditional big pharma model of relying on domestic demand may have reached its limits. Although each innovative drug of Hengrui Pharmaceutical ranks among the top three in China, it faces fierce competition from small and medium-sized pharmaceutical companies in each segment, and there is no absolute leading advantage. Although Hengrui has a commercialized portfolio of 17 innovative drugs, its peak sales and life cycle are decisively influenced by the level of payment. Hengrui does not yet have a drug with annual sales of $1 billion, and there is no hope in the short term. Lack of peak sales, the number to gather, essentially did not leave the generic drug stage to win the model of quantity, earn hard money, and eventually may be a dream in ten years, in place. Based on Zbrutinib's sales in 2024, once you have a drug with annual sales of $2 billion, all domestic competitors will no longer matter, and you need to consider a higher level of issues. Geopolitical uncertainty looms, but innovation and internationalization are still the only way for traditional large pharmaceutical companies. Hengrui Pharmaceutical suddenly announced plans to secondary listing in Hong Kong, it seems to have the intention of breaking the game. As of the third quarter of 2024, Hengrui Pharmaceutical is in the New Drug application (NDA) stage or has been listed in the first class of new drugs and second class of new drugs summary. Innovative drugs bear social benefits and public welfare responsibilities in the domestic market. According to Galaxy Securities, according to the sales data of the world's top 25 best-selling drugs in 2021, assuming that the drug price level in the United States is 100%, the average drug price in the United Kingdom, the European Union and Japan is about 20%-25% of the United States, and the price system of innovative drugs in China is relatively low, and the average drug price is 10% of the United States. Innovative drugs benefit from positive externalities in the domestic market, including engineer dividends and clinical resource advantages. Considering the difference in payment environment, the reasonable conversion ratio of pharmacoeconomics in the United States and China may be about 1/7, while the actual rate is as low as 1/10, and the difference between them is the subsidy provided by innovative drugs to the positive externalities of the domestic market. In the 2024 medical insurance negotiations, a total of 162 general-name drugs participated in the negotiation/bidding, including 117 kinds outside the medical insurance list and 45 kinds in the list, with a passing rate of less than 50% in the expert review process, compared with 74.2% in 2022 and 63.8% in 2023. The average decline in new health insurance negotiations over the years: 59% in 2016, 44% in 2017, 57% in 2018, 61% in 2019, 51% in 2020, 62% in 2021, 60% in 2022, and 61.7% in 2023. The 2024 decline is about to be revealed. From a more macro perspective, on November 18, the Ministry of Finance announced the general public budget expenditure for the period from January to October 2024, and the health expenditure was 1,652.1 billion yuan, down 8.5% year-on-year, the largest decline among the 10 major expenditure subjects. Hengrui has not yet shaken off the shadow of centralized purchasing. Since the implementation of the ninth batch of national centralized procurement of products involving carpofungin acetate for injection from March 2024, sales in the first half of 2024 decreased by 279 million yuan compared with the same period last year; Among the products involved in local centralized procurement, the sales of ioformol injection, sevoflurane for inhalation and papaverine hydrochloride injection in the first half of 2024 decreased by 276 million yuan year-on-year. Three major generic drugs with sales of more than 1 billion yuan (Lomefloxacin/Lodisloxacin/Butorphanol) are still facing potential centralized procurement risks. In the third quarter of 2024, the net profit attributable to the parent company was 758 million yuan, down 50% year-on-year and 46% quarter-on-quarter, showing a cliff-like decline. Among the seven business lines, the anti-tumor therapy segment was the most competitive and saw the most severe decline in performance, with revenue in the third quarter and the first nine months down 31.2 percent and 17.6 percent year-on-year, respectively. This is mainly due to the price reduction of the two products, Jinyouli (PEGylated recombinant human granulocyte stimulating factor injection) and Dometic (Doxorubicin hydrochloride liposome injection), by about 58% and 23% respectively in the centralized drug procurement of the Beijing-Tianjin-Hebei "3+N" alliance. Revenue in the cardiovascular treatment field in the third quarter decreased by 26.7% year-on-year, mainly due to the fact that Xuanning (levoamlodipine maleate tablets and disperse tablets) was not selected for the eighth batch of national centralized procurement in 2023, resulting in a greater impact on its sales in hospitals that strictly implement the centralized procurement policy, especially the decline in the second quarter and the third quarter was more significant. In the third quarter, the revenue of the nervous system treatment field decreased by 15.8% year-on-year. The core product of Embip was mainly due to the strict control of the top drugs in the hospital in the environment of strict control of medical costs, resulting in a relatively large decline in sales.