Neuromax

Neuromax is a medicine containing a complex of vitamins – thiamine with pyridoxine or cyanocobalamin.

Indications Neuromax

It is used for neurological pathologies of various origins: neuralgia with neuritis (for example, the retrobulbar form of the disease), radiculopathy, various polyneuropathies (for example, alcoholic or diabetic varieties) and lesions affecting the facial nerves.

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Release form

The pharmaceutical element is released in injection liquid - in ampoules of 2 ml, 5 or 10 ampoules inside a cell plate. In a pack - 2 plates for 5 ampoules or 1 plate for 10 ampoules.

Pharmacodynamics

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

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

Thiamine diphosphate, being a coenzyme, participates in the metabolism of carbohydrates, which are important elements of the metabolism of nervous tissues and affect the conduction of neural impulses within synapses. Deficiency of thiamine within tissues causes the accumulation of metabolic elements (primarily pyruvic and 2-hydroxypropanoic acid), which causes the development of various pathologies and disorders in the functioning of the nervous system.

Phosphorylated pyridoxine (PALP) is a coenzyme of some enzymes that interact in the systemic non-oxidative metabolism of amino acids. By decarboxylation, they help form amines with physiological activity (for example, histamine with tyramine, adrenaline and dopamine with serotonin). During its transamination, catabolic and anabolic metabolic processes develop (for example, AST with ALT and γ-aminobutyric acid). In addition, the element participates in the breakdown 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 for the development of cellular metabolism processes. It affects hematopoiesis (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 administered parenterally, thiamine is distributed within the body. About 1 mg of the substance is broken down daily. Metabolic components are excreted in the urine. Dephosphorylation processes occur within the kidneys. The biological half-life of thiamine is 0.35 hours. Cumulation of the element does not develop due to limited fat dissolution.

Pyridoxine undergoes phosphorylation and oxidation to PALP. In the blood plasma, this component and pyridoxal are synthesized with albumin. The translocating form is pyridoxal. To overcome the cell walls, PALP synthesized with albumin undergoes hydrolysis with the participation of alkaline phosphatase, which converts it into pyridoxal.

Cyanocobalamin during parenteral use forms transport combinations of proteins, quickly absorbed by the bone marrow together with the liver and other organs of the proliferative type. The element penetrates into the bile and participates in the circulation inside the liver with the intestine. Cyanocobalamin is able to overcome the placenta.

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Dosing and administration

The substance is administered parenterally.

Before using a medication that contains lidocaine, it is necessary to perform a skin test to determine the possible presence of personal intolerance to the drug - this is indicated by redness and swelling in the injection area.

In acute episodes of the disease, therapy begins with the use of 2 ml of the substance (intramuscularly) once a day until acute manifestations disappear. Subsequently, the medication is administered at a dosage of 2 ml per injection, 2-3 times a week. The therapeutic cycle should be at least 1 month.

The injection is performed into the area of the outer upper quadrant of the gluteal muscle.

To continue treatment, as well as to prevent relapse or as a maintenance course, Neuromax should be taken orally – in tablets.

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Use Neuromax during pregnancy

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

Contraindications

Main contraindications:

• severe sensitivity to the components of the drug;
• acute form of cardiac conduction disorder;
• Heart failure in the decompensation stage, which has an acute expression.

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 gastric pH values).

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

Contraindications associated with lidocaine:

• severe sensitivity to lidocaine or other amide substances that have a local anesthetic effect;
• history of epileptic seizures caused by lidocaine;
• severe stage of bradycardia;
• severely reduced blood pressure;
• cardiogenic shock;
• having a severe stage of CHF intensity (2-3 degrees);
• SSSU;
• WPW syndrome;
• MAC syndrome;
• AV block of 2nd or 3rd degree;
• hypovolemia;
• myasthenia or porphyria;
• severe stages of kidney or liver dysfunction.

Side effects Neuromax

With prolonged daily use (over 0.5-1 year) in doses of 50 mg of pyridoxine, sensory polyneuropathy, a feeling of malaise, headaches, nervous excitement and dizziness may occur.

Other side effects include:

• digestive disorders: gastrointestinal disorders, including abdominal pain, vomiting, increased gastric pH, nausea and diarrhea;
• immune manifestations: signs of intolerance (respiratory disorders, epidermal rashes, Quincke's edema and anaphylaxis) or hyperhidrosis;
• epidermal lesions: acne, itching, exfoliative dermatitis of a generalized nature and urticaria;
• disorders of the cardiovascular system: arrhythmia, transverse heart block, 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 nervous system: CNS excitation (as a result of the introduction of large doses), headaches, a feeling of confusion or anxiety, as well as drowsiness, sleep disorders, loss of consciousness or dizziness and comatose state. In persons with severe intolerance, tremor with paresthesia, a feeling of euphoria, trismus with convulsions and motor anxiety are observed;
• damage to the visual organs: curable blindness, conjunctivitis, nystagmus, and in addition diplopia, photophobia and the appearance of “flies” in the eyes;
• disorders of the auditory organs: tinnitus, hearing impairment and hyperacusis;
• problems with the respiratory system: runny nose, dyspnea, as well as respiratory arrest or suppression;
• other disorders: feeling of numbness in the extremities, cold or heat, severe weakness, motor block, swelling, sensory disturbances and malignant hyperthermia;
• systemic lesions: symptoms at the injection site.

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

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Overdose

Thiamine has a wide range of medicinal activity. When used in large doses (over 10 g), it has curare-like properties, inhibiting the conductivity of neural impulses.

Pyridoxine has an extremely weak toxic effect. However, when using large doses of this component (more than 1 g per day) for several months, neurotoxicity may develop.

Ataxia with neuropathies, as well as cerebral seizures with changes in EEG readings, sensory disturbances, and in addition (sometimes) seborrheic dermatitis and hypochromic anemia appear when using more than 2000 mg per day.

When using cyanocobalamin parenterally (rarely, orally) in large doses, signs of allergy, epidermal lesions of an eczematous nature, and acne of a benign nature are observed.

Long-term use of high doses of Neuromax may disrupt the activity of liver enzymes, leading to hypercoagulation or heart pain.

To eliminate these disorders, symptomatic measures are carried out.

In case of lidocaine overdose, the following symptoms may appear: decreased blood pressure, psychomotor agitation, visual disturbance, dizziness, as well as a feeling of general weakness, collapse, comatose state and tonic-clonic seizures; AV block, CNS depression and respiratory arrest may also occur. The first signs of poisoning in a healthy person develop when blood levels of lidocaine are greater than 0.006 mg/kg, and seizures appear at values of 0.01 mg/kg.

To eliminate these manifestations, it is necessary to cancel the administration of drugs, conduct oxygen therapy, and also prescribe the use of anticonvulsants, vasoconstrictors (mesaton or norepinephrine), and in addition, anticholinergics in case of bradycardia (atropine in a dose of 0.5-1 mg). Intubation, artificial ventilation, and resuscitation procedures can be performed. Dialysis sessions will be ineffective.

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Interactions with other drugs

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

Loop diuretics (for example, furosemide), which slow tubular reabsorption, can increase the excretion of thiamine during long-term treatment, which results in a decrease in its levels.

It is prohibited to combine the drug with levodopa, because pyridoxine can weaken its antiparkinsonian activity.

Combination with substances that have an antagonistic effect relative to pyridoxine (including penicillamine with isoniazid, cycloserine or hydralazine) and oral contraception may increase the need for pyridoxine.

Consumption of beverages containing sulfites (such as wine) increases thiamine degradation.

Lidocaine potentiates the inhibitory effect of anesthetic substances (hexobarbital, as well as sodium thiopental intravenously) on the respiratory center, as well as the effect of sedatives and hypnotics; it also reduces the cardiotonic activity of digitoxin. Combination with sedatives or hypnotics can potentiate the inhibitory effect on the central nervous system.

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

Adrenergic blockers (including nadolol and propranolol) inhibit intrahepatic metabolic processes of lidocaine, potentiate its effect (including toxic) and increase the likelihood of a decrease in blood pressure and the occurrence of bradycardia.

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

Mexiletine with norepinephrine potentiate the toxic properties of lidocaine (reduce its clearance rate).

Glucagon with isadrine increases the clearance values of lidocaine.

Midazolam with cimetidine increase plasma lidocaine values. The first moderately increases blood lidocaine values, and the second displaces the substance from protein synthesis and inhibits its liver inactivation, which increases the likelihood of potentiating the side effects of lidocaine.

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

Antiarrhythmic drugs (including verapamil with ajmaline, amiodarone with disopyramide, and quinidine) and anticonvulsants (hydantoin derivatives) potentiate cardiodepressant activity. When combined with amiodarone, seizures may occur.

Novocainamide with novocaine, when administered together with lidocaine, can provoke hallucinations and excitation of central nervous system activity.

Aminazine, nortriptyline, MAOIs, imipramine with amitriptyline and bupivacaine in combination with lidocaine lead to an increased likelihood of a decrease in blood pressure and prolong the local anesthetic effect of the latter.

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

Prenylamine increases the likelihood of ventricular tachycardia.

Propafenone may prolong the effects and increase the intensity of adverse symptoms associated with the central nervous system.

When combined with rifampicin, blood levels of lidocaine may decrease.

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

Administration with procainamide may cause hallucinations.

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

When combined with digitalis glycosides and against the background of poisoning, lidocaine can potentiate the severity of AV block.

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

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

β-blockers combined with lidocaine inhibit its intrahepatic metabolism, potentiate the effect (also toxic) and increase the likelihood of a decrease in blood pressure values and the occurrence of bradycardia. With such combinations, the dosage of lidocaine must be reduced.

Loop or thiazide diuretics, as well as acetazolamide, when combined with lidocaine, cause hypokalemia, due to which the effect of the latter is weakened.

Anticoagulants (including dalteparin with heparin, ardeparin with warfarin, and enoxaparin with danaparoid) combined with lidocaine increase the risk of bleeding.

When lidocaine is combined with drugs that block neuromuscular transmission, the effect of the latter is enhanced because they reduce the conductivity of neural impulses.

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Storage conditions

Neuromax must be stored in a place closed to children. Temperature marks – within the range of 2-8°C.

Shelf life

Neuromax can be used for a period of 24 months from the date of release of the pharmaceutical product.

Application for children

Neuromax is not used in pediatrics.

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Analogues

The analogs of the drug are Milgamma, Neurobeks with Neovitam, Neurobion and Neurorubin with Neuromultivit and Nerviplex.

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