Neuromax

Neuromax is a medicine containing a vitamin complex - thiamine with pyridoxine or cyanocobalamin.

Indications Neuromax

It is used in patients with various genesis of neurological pathologies: neuralgia with neuritis (for example, the retrobulbar form of the disease), radiculopathy, various polyneuropathies (for example, alcohol or diabetic varieties) and damage affecting the facial nerves.

[1], [2], [3], [4]

Release form

The release of the pharmaceutical element is made in the injection fluid - in ampoules with a volume of 2 ml, 5 or 10 ampoules inside the cell plate. In a pack - 2 plates on 5 ampoules or 1 plate on 10 ampoules.

Pharmacodynamics

Neurotrophic effects B-vitamins have a positive effect on degenerative or inflammatory lesions of the motor system and nerves. They are used to eliminate the deficiency of elements, and in large portions have analgesic properties, improve blood circulation processes and stabilize the function of the NA with hematopoietic activity.

Thiamine is an extremely important component for the body. It undergoes phosphorylation, thus forming the bioactive elements thiamine diphosphate (cocarboxylase), as well as thiamine triphosphate (TTP).

Thiamine diphosphate, being a coenzyme, is involved in the metabolism of carbohydrates, which are important elements of the nervous tissue metabolism, and affect the conduction of neural impulses inside synapses. The deficiency of thiamine inside the tissues causes the accumulation of metabolic elements (primarily pyruvic and 2-hydroxypropanoic acid), which causes a variety of pathologies and disturbances in the functioning of the NA.

Phosphorylated pyridoxine (PALP) is a coenzyme of certain enzymes that interact with the systemic non-oxidative exchange of amino acids. By decarboxylation, they help the formation of physiologically active amines (for example, histamine with tyramine, adrenaline and dopamine with serotonin). During its transamination, catabolic and anabolic metabolic processes develop (for example, AsAt with ALT and γ-aminobutyric acid). In addition, the element is involved in carrying out the cleavage and binding of amino acids. Pyridoxine affects 4 different tryptophan metabolic processes. During hemoglobin binding, pyridoxine catalyzes the formation of α-amino-β-ketoadinic acid.

Cyanocobalamin is required in the development of cellular metabolism. It affects the hematopoietic activity (exogenous antianemic factor), and in addition it participates in the formation of choline, methionine with nucleic acids and creatinine, and also has an analgesic effect.

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Pharmacokinetics

When used parenterally, thiamine is distributed inside the body. About 1 mg of substance disintegrates daily. Metabolic components are excreted in the urine. Dephosphorylation processes take place inside the kidneys. The biological half-life of thiamine is 0.35 hours. Element cumulation does not develop due to limited fat dissolving.

Pyridoxine is phosphorylated and oxidized to PALP. Inside the blood plasma, this component and pyridoxal are synthesized with albumin. Pyridoxal acts as a moveable form. To overcome the cell walls, PALP, synthesized with albumin, undergoes hydrolysis with the participation of alkaline phosphatase, which converts it to pyridoxal.

Cyanocobalamin during parenteral use forms transport combinations of proteins that are rapidly absorbed by the bone marrow along with the liver and the rest of the proliferative type of organs. The element enters the bile and is involved in the circulation inside the liver with intestines. Cyanocobalamin is able to cross the placenta.

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Dosing and administration

The substance is administered parenterally.

Before using the drug, a component of which is lidocaine, it is necessary to perform a skin test to determine the possible presence of personal intolerance regarding drugs — redness and swelling in the injection area indicate this.

In acute episodes of the disease, therapy begins with the use of 2 ml of the substance (i / m method) 1 times a day, until the acute manifestations disappear. In the future, the drug is administered in a dosage of 2 ml for 1 injection, 2-3 times per week. The therapeutic cycle should be at least 1 month.

The injection is carried out in the area of the outer upper quadrant of the muscles of the buttocks.

To continue the treatment, as well as to prevent relapse or in the form of a supportive course, Neuromax should be taken orally - in tablets.

[8]

Use Neuromax during pregnancy

During lactation and pregnancy, the daily requirement for receiving pyridoxine is a maximum of 25 mg. Inside the ampoule of the drug contains 0.1 g of pyridoxine, which is why it is forbidden to prescribe it during these periods.

Contraindications

The main contraindications:

• strong sensitivity to the elements of the drug;
• acute form of cardiac conduction disorder;
• SN in the stage of decompensation, with acute severity.

Thiamine should not be prescribed if you are allergic to it.

Pyridoxine is not used in acute stages of ulcers affecting the gastrointestinal tract (because the element can increase the values of gastric pH).

Cyanocobalamin is not prescribed to people with erythrocytosis, erythremia or thromboembolism.

Contraindications associated with lidocaine:

• strong sensitivity to lidocaine or other amide substances that have a local anesthetic effect;
• a history of seizures of an epileptic nature due to lidocaine;
• severe stage of bradycardia;
• severely reduced blood pressure;
• cardiogenic shock;
• having a severe stage of CHF intensity (grade 2–3);
• SSSU;
• WPW syndrome;
• MAS syndrome;
• AV-blockade, with 2nd or 3rd degree;
• gossip;
• myasthenia gravis or porphyria;
• severe stages of kidney or liver disorders.

Side effects Neuromax

With prolonged daily use (over 0.5-1-1 years) in portions of 50 mg of pyridoxine, the appearance of sensory polyneuropathy, feelings of indisposition, headaches, nervous agitation and dizziness may occur.

Among other adverse symptoms:

• digestive disorders: gastrointestinal disorders, including pain in the abdominal zone, vomiting, increased gastric pH, nausea and diarrhea;
• immune manifestations: signs of intolerance (respiratory disorders, epidermal rashes, angioedema and anaphylaxis) or hyperhidrosis;
• epidermal lesions: acne, pruritus, exfoliative form of generalized dermatitis and urticaria;
• disorders of the CVS function: arrhythmia, cardiac blockade of the transverse nature, tachycardia, cardiac arrest, bradycardia, dilation of peripheral vessels, inhibition of cardiac conduction, collapse, heart pain and an increase or decrease in blood pressure;
• Disorders of the NA: CNS arousal (as a result of the introduction of large portions), headaches, a feeling of confusion or anxiety, as well as drowsiness, sleep disturbance, loss of consciousness or dizziness and coma. In individuals with severe intolerance, there is tremor with paresthesias, a feeling of euphoria, trismus with convulsions, and anxiety of the motor nature;
• lesions of the visual organs: curable blindness, conjunctivitis, nystagmus, and in addition diplopia, photophobia and the appearance of "fly" in the eyes;
• hearing impairment: ear noise, hearing impairment and hyperacusis;
• problems with the function of the respiratory system: runny nose, dyspnea, as well as respiratory arrest or suppression;
• other disorders: numbness of the limbs, cold or heat, severe weakness, motor blockage, swelling, sensitivity disorders and hyperthermia of a malignant nature;
• systemic lesions: symptoms in the injection area.

If the parenteral injection rate is too high, systemic signs may appear in the form of convulsions.

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Overdose

Thiamine has a wide spectrum of drug activity. When using large dosages (over 10 g), it has curare-like properties, inhibiting the conductivity of neural impulses.

Pyridoxine has a very weak toxic effect. But when using large portions of this component (above 1 g per day) for several months, neurotoxicity may develop.

Ataxia with neuropathies, as well as cerebral seizures with altered EEG readings, sensitivity disorders, and besides (sometimes) a seborrheic form of dermatitis and a hypochromic variety of anemia appear when using more than 2000 mg per day.

With parenteral administration (occasionally with oral administration) of cyanocobalamin in large portions, signs of allergy, eczematous lesions of an eczematous nature and acne, having a benign form, are noted.

Prolonged use of high dosages of Neuromax may disrupt the activity of liver enzymes, leading to hypercoagulation or heart pain.

Symptomatic measures are taken to eliminate these disorders.

With an overdose of lidocaine, the following signs may appear: a decrease in blood pressure, psychomotor agitation, visual disturbance, dizziness, and also a feeling of general weakness, collapse, coma, and convulsions of tonic-clonic type; AV blockade, CNS suppression and respiratory arrest can also occur. The first signs of poisoning in a healthy person develop with blood levels of lidocaine, which are more than 0.006 mg / kg, and convulsions appear at values of 0.01 mg / kg.

To remove these manifestations, you must cancel the introduction of drugs, oxygen therapy, and also appoint the use of anticonvulsants, vasoconstrictors (mezaton or norepinephrine), and in addition to anticholinergics in the case of bradycardia (atropine in a portion of 0.5-1 mg). Intubation, mechanical ventilation can be performed, and in addition, resuscitation procedures. Dialysis sessions will be ineffective.

[9],

Interactions with other drugs

The properties of thiamine under the influence of 5-fluorouracil are inactivated, because the latter competitively slows down the process of phosphorylation of the vitamin into the element thiamine pyrophosphate.

Diuretic loopback character (for example, furosemide), slowing down the reabsorption of tubules, during prolonged treatment can increase the excretion of thiamine, which reduces its performance.

It is forbidden to combine the drug with levodopa, because pyridoxine is able to weaken its anti-Parkinsonian activity.

Combination with substances that have an antagonistic effect on pyridoxine (among those penicillamine with isoniazid, cycloserine or hydralazine), and oral contraception may increase the need to receive pyridoxine.

Drinking beverages that contain sulfites (for example, wines) increases thiamine degradation.

Lidocaine potentiates the overwhelming effect on the respiratory center of anesthetic substances (hexobarbital, as well as sodium thiopental in / in the way), and also the effect of sedatives and hypnotics; it also reduces the cardiotonic activity of digitoxin. Combining with sedatives or sleeping pills can potentiate the overwhelming effect on the central nervous system.

Ethyl alcohol potentiates the inhibitory effect of lidocaine on respiratory activity.

Adrenergic blockers (among them nadolol with propranolol) inhibit the intrahepatic metabolic processes of lidocaine, potentiate its influence (also toxic) and increase the likelihood of a decrease in blood pressure and the appearance of bradycardia.

Curariform drugs can increase muscle relaxation (even paralysis of the respiratory muscles is possible).

Meksiletin with norepinephrine potentiate the toxic properties of lidocaine (reduce its level of clearance).

Glucagon with izadrina increase the values of lidocaine clearance.

Midazolam with cimetidine increase plasma lidocaine values. The first moderately increases the blood values of lidocaine, and the second displaces the substance from protein synthesis and inhibits its hepatic inactivation, which increases the probability of potentiation of the side properties of lidocaine.

Barbiturates (among them phenytoin with phenobarbital) and anticonvulsants when combined with lidocaine can increase the rate of liver metabolism of the latter, reduce its blood values and potentiate the cardiodepressive effect.

Antiarrhythmic drugs (among them verapamil with amainalin, amiodarone with disopyramide and quinidine) and anticonvulsants (derivatives of hydantoin) potentiate cardiac depressive activity. When combined with amiodarone, seizures may occur.

Novocainamide with novocaine, when administered together with lidocaine, can provoke hallucinations and stimulation of CNS activity.

Aminazine, nortriptyline, MAOI, imipramine with amitriptyline and bupivacaine in combination with lidocaine increase the likelihood of lowering blood pressure and prolong the local anesthetic effect of the latter.

Opioid analgesics (for example, morphine), administered with lidocaine, potentiate their analgesic effect, but also increases the suppression of respiratory processes.

Prenylamine increases the likelihood of ventricular tachycardia.

Propafenone can prolong exposure and increase the intensity of negative symptoms associated with the central nervous system.

When combined with rifampicin, the blood lidocaine index may decrease.

When combined with polymyxin type B, respiratory activity must be monitored.

Introduction with procainamide can provoke hallucinations.

The use of lidocaine and SG causes a weakening of the cardiotonic effect of the latter.

When combined with the glycosides of digitalis and against the background of poisoning, lidocaine is able to potentiate the severity of AV-blockade.

Vasoconstrictors (this includes methoxamine with epinephrine and phenylephrine), administered with lidocaine, inhibit the absorption of the latter and lengthen its effect.

Guanethidine and trimetafan with guanadrel and mecamylamine, used in epidural or spinal anesthesia, increase the likelihood of bradycardia and a strong decrease in blood pressure.

Combined with lidocaine β-adrenergic blockers inhibit its intrahepatic metabolism, potentiate the effect (also toxic) and increase the likelihood of lower blood pressure values and the occurrence of bradycardia. With such combinations, the dosage of lidocaine is required to be reduced.

A diuretic or thiazide diuretic, as well as acetazolamide, when combined with lidocaine, cause hypokalemia, due to which the influence of the latter is weakened.

Anticoagulants (among them dalteparin with heparin, ardeparin with warfarin and enoxaparin with danaparoid), combined with lidocaine, increase the likelihood of bleeding.

When combining lidocaine with drugs that block neuromuscular transmission, the influence of the latter increases, because they reduce the conductivity of neural impulses.

[10], [11]

Storage conditions

Neuromax should be kept in a place that is closed to children. Temperature marks - within the range of 2-8 ° C.

Shelf life

Neuromax can be used for a 24-month period from the date of issue of the pharmaceutical agent.

Application for children

Neuromax is not used in pediatrics.

[12], [13], [14]

Analogs

Analogues of the drug are the substances Milgamma, Neurobex with Neovitam, Neyrobion and Neyrorubin with Neyromultivit and Nerviplex.

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