Хронічний панкреатит (ХП) – це запальне захворювання, що прогресує і призводить до незворотного пошкодження підшлункової залози, спричиняючи екзокринну та ендокринну недостатність. Оптимізація фармакотерапії ХП є критичним питанням через зростання поширеності захворювання та необхідність економічно ефективних та науково обґрунтованих стратегій лікування. Використання ABC/VED-аналізу надає можливість класифікувати та пріоритезувати ліки на основі їхньої клінічної значущості та економічної доцільності.
Мета. Автори дослідження мали на меті оптимізувати фармакотерапію хронічного панкреатиту із застосуванням ABC/VED-аналізу в контексті маркетингових та фармакоекономічних досліджень.
Методи. Дослідження охоплювало комплексний огляд нормативних документів, клінічних рекомендацій та фармакоекономічних оцінок. Було проведене багатопрофільне експертне опитування за участю 50 медичних працівників, включно з гастроентерологами, хірургами, ендокринологами, лікарями загальної практики та фармацевтами. ABC-аналіз застосовували для класифікації ліків на основі їхнього внеску у вартість, тоді як VED-аналіз класифікував препарати на життєво важливі (V), необхідні Україна та бажані (D) групи. У дослідженні також оцінювали нормативно-правову базу для фармакотерапії ХП на національному та міжнародному рівнях.
Результати. Дослідження виявило невідповідності між національними та міжнародними нормативно-правовими документами щодо фармакотерапії ХП. Серед 30 проаналізованих лікарських засобів п’ять препаратів (Іміпенем + Циластатин, Меропенем, Метронідазол, Цефотаксим, Ципрофлоксацин) були віднесені до всіх чотирьох регуляторних документів. ABC- аналіз засвідчив, що 82.21% загальних витрат були виділені на препарати категорії А, 15.54% - категорії B та 2.25% - категорії C. VED-аналіз виявив, що 43% препаратів були класифіковані як життєво необхідні, тоді як 57% були необхідними, при цьому жоден препарат не вважався необов’язковим. Комбінована матриця ABC/VED показала, що препарати категорії A/V мали
найбільшу частку витрат (41.54%), що підкреслює їх пріоритетність у лікуванні ХП.
Висновки. Застосування ABC/VED-аналізу у фармакотерапії ХП дає змогу структуровано та економічно обґрунтовано підійти до вибору ліків. Дослідження виявило регуляторні розбіжності, які можуть вплинути на доступність ліків та ефективність лікування. Результати дослідження надають рекомендації на основі доказів щодо оптимізації фармакотерапії ХП, забезпечуючи відповідність як міжнародним стандартам, так і національній політиці охорони здоров’я. Подальші дослідження повинні бути зосереджені на інтеграції фармакоекономічних оцінок у клінічне ухвалення рішень та на відповідному оновленні національних протоколів лікування.
Ключові слова: хронічний панкреатит, фармакотерапія, ABC-аналіз, VED-аналіз, регулювання лікарських засобів, фармакоекономіка.

Introduction 
Tuberculosis (TB) remains one of the leading  causes of death from infectious diseases in the world. The 
situation is complicated by the increasing prevalence of multidrug-resistant forms of the pathogen Mycobacterium 
tuberculosis against the background of covid, post-covid, long-covid disorders, which requires improving 
approaches to pharmacotherapy according to the requirements of ICD-11. According to the World Health 
Organization, more than ten million new cases of tuberculosis are registered in the world annually, while 
about one million three hundred thousand patients die [15]. Standard treatment of active tuberculosis, 
recommended by the World Health Organization, involves the use of a combination of at least three or four anti
tuberculosis drugs. This approach allows you to effectively combat the bacterial load, reduce the risk of developing drug resistance, shorten the duration of therapy, and reduce the frequency of relapses of the disease [6]. 
Fixed-dose combination drugs, which contain several active pharmaceutical ingredients in one dosage form, are designed to increase patient adherence to treatment and prevent dosing errors. These drugs are particularly relevant in countries with high tuberculosis incidence rates, where non-adherence to treatment regimens is common. Numerous studies have shown that fixed-dose combination drugs provide efficacy and safety comparable to single drugs, and reduce the risk of drug resistance [7, 8]. However, the use of fixed-dose combination 
drugs has certain limitations. Among patients with human immunodeficiency virus co-infection, pharmacokinetic 
interactions between anti-tuberculosis and antiretroviral drugs are possible. This can lead to changes in the 
concentration of active substances in the blood, reduced treatment efficacy, or increased toxicity [9]. In addition, 
the use of fixed-dose combination drugs may be inappropriate in cases of individual intolerance to one of 
the components or if dosage adjustment is necessary for a particular patient. Thus, despite the advantages of fixed-dose combination anti-tuberculosis drugs, their use requires an individual approach and constant monitoring of the effectiveness and safety of therapy. The rational use of such drugs in national tuberculosis control programs is a key factor in the successful control of this global health problem [10]. Overcoming multidrug-resistant tuberculosis is a challenging task, as the bacteria that cause this infection can develop resistance to standard anti-TB drugs. However, combination antimycobacterial chemotherapy remains the mainstay of treatment. It involves the use of at least three anti-TB drugs to which the bacteria are still susceptible, and the duration of treatment is at least 6 months [11, 12]. The main principles of anti-TB chemotherapy are: 
• Combination use of anti-TB drugs: The use of several drugs simultaneously reduces the risk of the development 
of resistance of TB bacteria to one of the drugs. 
• Use of standard drug combinations: Certain combinations of anti-TB drugs are defined as standard and 
are used to treat patients with new cases of TB and relapses of the disease. 
• Monitoring by healthcare professionals: Healthcare professionals should ensure that patients take their 
medications correctly and adhere to their treatment regimen. 
• Avoid adding one anti-TB drug after treatment failure: If a patient does not respond to treatment, adding another anti-TB drug to the regimen may lead to further failure. In addition, antimicrobial therapy is administered 
under the supervision of healthcare professionals, which allows for monitoring of drug use and prevention of 
potential complications. 
Regarding the convenience of taking medications, the development of combination drugs that contain the 
active pharmaceutical ingredients necessary for pharmacotherapy can help patients to facilitate their treatment regimen, improve adherence to the therapy protocol, and ensure the quality of the drugs [12]. Overall, the fight against multidrug-resistant tuberculosis requires a comprehensive approach, active collaboration between healthcare professionals and patients, as well as continuous improvement of anti-TB strategies and the development of new drugs to treat this dangerous infection. The purpose of the study was to conduct a content 
analysis of the modern range of combined anti-tuberculosis drugs registered on the pharmaceutical market of Ukraine, considering the current requirements of domestic legislation in the field of healthcare. Particular attention is paid to the study of the clinical feasibility of using fixeddose combination drugs in the pharmacotherapy of 
tuberculosis in accordance with the provisions of the sixteenth edition of the State Formulary of Medicines, 
approved by the Order of the Ministry of Health of Ukraine dated March 12, 2024 No. 418 “On Approval and 
Implementation of the Sixteenth Edition of the State Formulary of Medicines”. The work also analyzed current 
scientific sources on the effectiveness, safety, and impact of combined anti-tuberculosis pharmacotherapy on 
reducing the level of chemoresistance and increasing patient adherence to treatment.   
Materials and methods The study is of a content analysis nature and is based on a comprehensive study of open information sources related to combined anti-tuberculosis drugs. The main information resources were: scientific publications from professional domestic and international medical and pharmaceutical journals, official documents of the World Health Organization, analytical materials of international initiatives to combat tuberculosis, as well as current regulatory legal acts of Ukraine in the field of health care. The analysis of the range of combined anti
tuberculosis drugs registered in Ukraine was carried out using data from the State Register of Medicines of Ukraine. Particular attention was paid to drugs included in the sixteenth edition of the State Formulary of Medicines, approved by the Order of the Ministry of Health of Ukraine dated March 12, 2024 No. 418 “On Approval and Implementation of the Sixteenth Edition of the State Formulary of Medicines”. International non-proprietary names of active pharmaceutical ingredients, trade names of medicines, release forms, dosages, as well as their availability in state reimbursement programs were studied. In the process of research, methods of content 
analysis of scientific literature, comparative analysis of regulatory sources, classification method, as well as 
elements of a statistical approach for quantitative assessment of the presence of combined drugs on the 
pharmaceutical market of Ukraine, previous studies of foreign and domestic scientists in the direction of content 
analysis, quality of drugs [13-20] were applied. Special attention was paid to comparing data on the advantages and disadvantages of combination therapy in the context of international and national clinical guidelines, [21-23]. 
The research of the article is a fragment of research works of Private Scientific Institution "Scientific 
and Research University of Medical and Pharmaceutical Law" and Danylo Halytsky Lviv National Medical 
University on the topic "Diagnosis, treatment, pharmacotherapy of inflammatory, traumatic and onco
thoracic pathology using instrumental methods" (state registration number 0125U000071, implementation period 
2025-2031); Lviv Medical Institute on the topic of "Improving the system of circulation of drugs during 
pharmacotherapy on the basis of evidentiary and forensic pharmacy, organization, technology, biopharmacy and 
pharmaceutical law" (state registration 0120U105348, implementation period 2021-2026); Private Scientific Institution "Scientific and Research University of Medical and Pharmaceutical Law" on the topic “Multidisciplinary research of post-traumatic stress disorders during war among patients (primarily combatants)” (state registration number 0124U002540, implementation period 2024-2028). 

Abstract. For the first time in Ukraine, our team successfully  applied  extracorporeal  blood hyperthermia (EBH) within a closed-loop circuit to manage inflammatory conditions of the lungs and pleura. Controlled warming of autologous blood to 38°C and its subsequent reinfusion produced rapid, clinically  significant  reductions  in  exudative pleurisy,  pleural  empyema,  and  paracancerous inflammatory  lesions.  Earlier,  EBH  had  been 
incorporated  into  U.S.  military  field  protocols between  2003  and  2007,  and  it  is  now  formally 
included  in  therapeutic  guidelines  across  the United  States,  Canada,  New  Zealand,  multiple European nations, and several African healthcare systems.  Our  findings  corroborate  international data  showing  that  mild  systemic  hyperthermia enhances  phagocytic  activity,  improves microcirculation  within  the  pleural  cavity,  and accelerates  resorption  of  inflammatory  exudate while  maintaining  a  favorable  safety  profile.  No severe adverse events or hemodynamic instabilities were observed during or after the procedures in our 
cohort.  Beyond  its  direct  anti-inflammatory impact, EBH may potentiate antibiotic penetration into pleural tissues, offering a valuable adjunct in the  era  of  rising  antimicrobial  resistance.  Future multicenter  trials  with  larger  patient  populations and  comparative  cost-effectiveness  analyses  are warranted  to  refine  treatment  parameters  and confirm  long-term  benefits  of  this  promising modality. 
Keywords:  inflammatory  pulmonary  pathology, treatment, extracorporeal blood hyperthermia

Introduction 
In  the  previous  study,  a  pharmacoeconomic  analysis  of codeine medicines was conducted using the ABC 
and VED methods [1]. Antitussive  drugs  play  an  important role in the treatment of respiratory diseases accompanied by cough. A special  niche  among  such  drugs  is  occupied  by  codeine medicines. Codeine is a semisynthetic opioid that has been used in medicine for more than a century. Codeine has a unique mechanism of action: it affects the cough center in the medulla oblongata, suppressing the cough reflex, which makes it indispensable in the treatment of dry, debilitating cough. However, along with proven effectiveness, codeine 
medicines  have  several  features  that  affect  their  use  in clinical practice [2-7]. Globally,  codeine  medicines  are  the  subject  of significant attention from regulatory authorities due to the risk  of  addiction,  abuse,  and  side  effects.  In  many countries, their circulation is strictly controlled, including restrictions  on  access  to  non-prescription  drugs  and  the establishment  of  quotas  for  production  and  sales.  In Ukraine,  this  problem  is  also  relevant,  as  codeine  abuse among  the  population  leads  to  social  and  medical complications, in particular the development of addiction and  side  effects.  At  the  same  time,  such  drugs  remain 
important  in  pharmacotherapy  due  to  their  high effectiveness [8-10]. Regulatory  aspects  of  the  use  of  codeine medicines in Ukraine deserve special attention. On the one hand,  there  is  a  need  to  ensure  the  availability  of  these drugs for patients who really need them. On the other hand, it is important to minimize the risks of uncontrolled use. As of today, Ukraine has introduced strict restrictions on the dispensing of codeine medicines - they are available only by prescription. In addition,  work is ongoing to improve the regulatory framework for their circulation, which meets international standards [11-13]. The epidemiological situation also affects the use of  codeine  medicines.  The  increase  in  the  number  of diseases  accompanied  by  cough,  such  as  influenza, COVID-19  and  other  acute  respiratory  infections, increases the demand for antitussives. At the same time, the pandemic has highlighted weaknesses in the supply chain of  medicines,  including  codeine  medicines,  in  particular problems  with  organization,  storage,  and  availability  for end users [14, 15]. 
Codeine abuse is a significant problem, especially among young people. Cases of using codeine medicines for 
non-medical purposes, such as achieving a euphoric effect, pose serious health risks and require active action by the state  and  the  medical  community.  In  this  context, preventive measures aimed at raising public awareness of the  dangers  of  abuse  and  strengthening  control  over  the circulation of such medicines are important [16, 17]. From  a  marketing  point  of  view,  codeine medicines  have  a  stable  demand  on  the  pharmaceutical 
market  of  Ukraine.  However,  competition  between manufacturers forces them to look for new ways to attract 
consumers,  through  the  introduction  of  new  forms  of release,  increasing  the  availability  of  information  about medicines and ensuring high product quality. At the same time, pharmaceutical companies face challenges related to regulatory restrictions and the need for transparency of the entire production and sales process [18, 19]. No less important are the forecasts for the further use  of  codeine  medicines  in  Ukraine.  It  is  expected  that 
regulatory policy will become stricter, especially regarding circulation  control  and  prescription  dispensing.  At  the same  time,  there  is  a  trend  in  the  world  to  search  for alternatives to codeine, synthetic or herbal remedies that provide similar efficacy, but have a lower risk of addiction [20]. The study utilized the following registries: European Convention  on  Drug  Control,  1986.  Council  of  Europe, International  Convention  on  Narcotic  Drugs  and Psychotropic Substances, 1988. UN, WHO Drug Control System, World Health Organization, 2019, and Convention on Narcotic Drugs, 1961. UN. Thus,  antitussive  codeine  medicines  remain  an 
important component of pharmacotherapy, but their use is accompanied by several challenges. The relevance of this issue is due not only to medical aspects, but also to social, economic,  and  regulatory  factors.  Further  study  of  these medicines  will  contribute  to  improving  their  use, increasing the safety and effectiveness of treatment. 
 Purpose of the study 
The  purpose  of  this  article  is  to  study  the  features  of codeine  medicines  and  analyze  their  role  in  modern medicine. The article aims to: 
1.  Describe the clinical and pharmacological properties of codeine – to reveal the mechanism of its action, antitussive, analgesic  effects,  and  explain  how  these  properties contribute to the treatment of various diseases. 
2.  Consider the features of the composition and forms of release of codeine medicines – to demonstrate the diversity of  medicines,  their  combinations  with  other  active substances,  as  well  as  the  advantages  of  each  form  in different clinical situations. 
3.  Analyze the codeine medicines market in Ukraine – to provide an idea of the main manufacturers, and to study the development trends of this segment of the pharmaceutical market. 
4.  Assess  the  regulatory  aspects  of  the  circulation  of codeine  medicines  –  to  study  the  rules  of  registration, release and control that operate on the Ukrainian market, and to compare them with international standards. 
5.  Warn about the risks of abuse – emphasize the danger of  developing  addiction  if  recommendations  are  not followed and consider measures that help minimize such risks. This article is aimed at comprehensively highlighting the role of codeine medicines in pharmacotherapy, as well as providing recommendations for their rational and safe use.  

Materials and methods 
The following materials and methods were used to conduct this study: 
Research materials 
1. Codeine medicines registration data Information  from  the  State  Register  of  Medicines  of Ukraine, containing information about codeine medicines, their  composition,  release  forms,  manufacturers,  and 
registration dates. 
Current pharmacopoeial and regulatory documents related to  the  production,  circulation,  and  control  of  codeine medicines. 
2. Scientific literature Publications  on  pharmacology,  toxicology  and  clinical medicine related to the use of codeine. Analytical reviews and studies devoted to the  medicines market in Ukraine and the world. 
The following databases were used in the study: 
State Register of Medicines State Formulary of Medicines ATC/DDD  Index  2024,  WHO  Collaborating  Centre  for Drug Statistics Methodology ATC/DDD  Index  2023,  WHO  Collaborating  Centre  for Drug Statistics Methodology ATC classification, Compendium Review of the pharmaceutical market of Ukraine Analytical reviews of the market – Weekly APTEKA Analysis of the pharmaceutical market in Ukraine, 2023 – Pro-Consulting Pharmaceutical market of Ukraine – analytical review Pharmacies of the world – 2023: digital initiatives and their impact on the pharmaceutical market Global pharmaceutical industry outlook, 2023 and beyond Global use of medicines: status and trends Pharmaceutical market – Pharmaceutical Encyclopedia World forecasts and trends – Weekly APTEKA 
Research methods 
1.  Analytical  method.  The  composition  of  codeine medicines,  their  release  forms  and  compliance  with 
modern pharmacopoeial requirements were analyzed. The features  of  combinations  of  codeine  with  other  active substances were studied. 
2.  Statistical method. Data processing was carried out on the number of registered codeine medicines in Ukraine, the dynamics of their sales and popularity among patients and doctors. 
3.  Comparative analysis. Regulatory requirements for the circulation  of  codeine  medicines  in  Ukraine  were 
compared  with  international  standards.  Differences  in release  forms  and  dosages  of  medicines  in  different markets were studied. 
4.  Documentary analysis of scientific sources. A critical analysis  of  scientific  works  was  conducted  that  consider the  effectiveness,  safety,  and  risks  of  the  use  of  codeine medicines. 
5.  Expert  assessment.  The  conclusions  of  practicing physicians,  pharmacologists  and  regulatory  specialists 
were involved to assess the safety of use and prospects for the development of the codeine medicines market. 
Research limitations The  study  is  based  on  available  public  sources  and statistical data. Limitations may include incomplete data on unofficial  consumption  of  codeine  medicines  or unavailability  of  information  on  clinical  trials  in  private companies. The  use  of  the  above  methods  allowed  to  provide  a comprehensive  approach  to  the  analysis  of  codeine medicines, their role in medicine and the pharmaceutical market of Ukraine. The research of the article is a fragment of research works of  Private  Scientific  Institution  "Scientific  and  Research University  of  Medical  and  Pharmaceutical  Law"  and Danylo Halytsky Lviv National Medical University on the topic  "Diagnosis,  treatment,  pharmacotherapy  of inflammatory,  traumatic  and  onco-thoracic  pathology using  instrumental  methods"  (state  registration  number 0125U000071,  implementation  period  2025-2031);  Lviv Medical Institute on the topic of "Improving the system of circulation of drugs during pharmacotherapy on the basis of  evidentiary  and  forensic  pharmacy,  organization, technology, biopharmacy and pharmaceutical law" (state registration number 0120U105348, implementation period 2021-2026);  Private  Scientific  Institution  "Scientific  and Research University of Medical and Pharmaceutical Law" on the topic “Multidisciplinary research of post-traumatic stress  disorders  during  war  among  patients  (primarily 
combatants)”  (state  registration  number  0124U002540, implementation period 2024-2028). 

Results and discussion 
1. Description of the pharmacological properties of codeine Codeine is an alkaloid of the opium poppy, which belongs to the group of semi-synthetic opioids. It is widely used in medicine as an analgesic, antitussive and  weak  sedative. The main pharmacological properties of codeine include: Anesthetic action Codeine  interacts  with  μ-opioid  receptors  in  the  central nervous  system,  which  reduces  the  transmission  of  pain impulses.  Its  analgesic  effect  is  weaker  than  that  of morphine, but sufficient to relieve moderate pain. Antitussive effect 
Codeine  suppresses  the  cough  reflex  by  acting  on  the cough centers in the medulla oblongata. Due to this, it is used in the treatment of unproductive cough, especially in cases where the symptom is debilitating for the patient. Weak sedative effect Codeine has a sedative effect, which is due to its effect on the central nervous system. In small doses, it rarely causes severe  drowsiness,  which  allows  its  use  in  outpatient practice. 

Abstract. The healthcare sector is faced with the need to find new innovative and multidisciplinary approaches  for  the  prevention  and  treatment  of Covid, post-Covid, long-Covid, chronic, comorbid disorders. The results of 30 years of experience in the  use  of  halotherapy  in  the  treatment  of pulmonary pathology indicate that the authors of the article have established the optimal level of use of  halotherapy  in  pathological  pulmonary 
processes.  At  the  same  time,  clinical  experience provides evidence for the optimal method of using 
the halotherapy method in pulmonary nosologies. The  method  of  using  salt  therapy  in  exudative 
pleurisy, in fibrinous pleurisy, in fibrotic processes in  the  lungs  has  been  theoretically  substantiated, 
developed, and implemented in clinical practice. It has  been  proven  that  halotherapy  is  an  effective 
treatment  method  for  bronchial  asthma,  chronic obstructive  pulmonary diseases,  acute  respiratory 
viral infections, fibrinous and exudative pleurisy. The therapeutic effect of this method is observed only when using halogenerators with the ability to grind salt in the range of 1-5 microns. Halotherapy sessions  in  patients  with  bronchial  asthma  with mild  and  moderate  severity  lead  to  the development  of  nonspecific hyposensitization, which  in  turn  provides  long-term  remission  of attacks  and  reduces  the  need  for 
glucocorticosteroid  drugs.  Halotherapy  has  a confirmed immunomodulatory effect and activates local and T-cell immunity. It requires further study of  the  experience  of  halotherapy,  conducting marketing, pharmacoeconomic  and  comparative analysis. 
Keywords:  halotherapy,  pulmonary  pathologies, thoracic  pathology,  bronchial  asthma,  fibrinous 
pleurisy, post-covid syndrome, patient.