Milgamma solution, 2ml No. 5

Milgamma solution, 2ml No. 5; 'As a pathogenetic and symptomatic agent in the complex therapy of diseases and syndromes of the nervous system of various origins: neuralgia, neuritis, paresis of the facial nerve, retrobulbar neuritis, ganglionitis (including shingles), plexopathy, neuropathy, polyneuropathy (diabetic, alcoholic, etc.), nocturnal muscle cramps, especially in older age groups, neurological manifestations of osteochondrosis of the spine: radiculopathy, lumboishalgia, muscle-tonic syndromes.

Injections are performed deeply intramuscularly. In cases of severe pain syndrome, in order to quickly achieve a high level of the drug in the blood, it is advisable to start treatment with 2.0 ml daily for 5-10 days. In the future, after the pain syndrome subsides and in milder forms of the disease, they are subsequently transferred either to therapy with a dosage form for oral administration (for example, the drug MilgammaЃ compositum), or to more rare injections (2-3 times a week for 2-3 weeks) with the possible continuation of therapy with an oral dosage form (for example, MilgammaЃ compositum). It is recommended that the therapy be monitored weekly by a physician. It is recommended to switch to therapy with an oral dosage form (for example, MilgammaЃ compositum) as soon as possible.

2 ml of solution for intramuscular administration contains:

active ingredients: thiamine hydrochloride 100.0 mg, pyridoxine hydrochloride 100.0 mg, cyanocobalamin 1.0 mg, lidocaine hydrochloride 20.0 mg;

excipients: benzyl alcohol 40.0 mg, sodium polyphosphate 20 mg, potassium hexacyanoferrate 0.20 mg, sodium hydroxide 12.0 mg, water for injection up to 2 ml.

The period of pregnancy and breastfeeding (see the section 'Use during pregnancy and during breastfeeding'). Children's age. Decompensated heart failure. Increased individual sensitivity to the components of the drug.

Pharmacodynamics:

The neurotropic B vitamins have a beneficial effect on inflammatory and degenerative diseases of the nerves and locomotor system. Promotes increased blood flow and improves the functioning of the nervous system. Thiamine plays a key role in the metabolism of carbohydrates, as well as in the Krebs cycle with subsequent participation in the synthesis of TPP (thiamine pyrophosphate) and ATP (adenosine triphosphate). Pyridoxine is involved in protein metabolism, and partly in the metabolism of carbohydrates and fats. The physiological function of both vitamins is to potentiate the action of each other, which manifests itself in a positive effect on the nervous, neuromuscular and cardiovascular systems. When vitamin B6 is deficient, widespread deficiency conditions are quickly reversed after administration of these vitamins. Cyanocobalamin is involved in the synthesis of the myelin sheath, stimulates hematopoiesis,reduces pain associated with damage to the peripheral nervous system, stimulates nucleic acid metabolism through the activation of folic acid. Lidocaine is a local anesthetic that causes all types of local anesthesia: terminal, infiltration, conduction.

Pharmacokinetics:

After intramuscular administration, thiamine is rapidly absorbed from the injection site and enters the bloodstream (484 ng / ml after 15 minutes on the first day of administration of a dose of 50 mg) and is unevenly distributed in the body with its content in leukocytes 15%, erythrocytes 75% and in plasma 10 %. Due to the lack of significant reserves of vitamin in the body, it must be ingested daily. Thiamine crosses the blood-brain and placental barriers and is found in breast milk. Thiamine is excreted in the urine in the alpha phase after 0.15 hours, in the beta phase after 1 hour and in the terminal phase within 2 days. The main metabolites are thiamincarboxylic acid, pyramine and some unknown metabolites. Of all vitamins, thiamine is stored in the body in the smallest amount.The body of an adult contains about 30 mg of thiamine in the form of 80% thiamine pyrophosphate, 10% thiamine triphosphate and the rest in the form of thiamine monophosphate. After intramuscular injection, pyridoxine is rapidly absorbed into the bloodstream and distributed in the body, acting as a coenzyme after phosphorylation of the CH2OH group in the 5th position. About 80% of the vitamin binds to blood plasma proteins. Pyridoxine is distributed throughout the body and crosses the placenta and is found in breast milk, deposited in the liver and oxidized to 4-pyridoxine acid, which is excreted in the urine, a maximum of 2 to 5 hours after absorption. The human body contains 40 - 150 mg of vitamin B6 and its daily elimination rate is about 1.7 - 3.6 mg with a replenishment rate of 2.2 - 2.4%.10% thiamine triphosphate and the rest as thiamine monophosphate. After intramuscular injection, pyridoxine is rapidly absorbed into the bloodstream and distributed in the body, acting as a coenzyme after phosphorylation of the CH2OH group in the 5th position. About 80% of the vitamin binds to blood plasma proteins. Pyridoxine is distributed throughout the body and crosses the placenta and is found in breast milk, deposited in the liver and oxidized to 4-pyridoxine acid, which is excreted in the urine, a maximum of 2 to 5 hours after absorption. The human body contains 40 - 150 mg of vitamin B6 and its daily elimination rate is about 1.7 - 3.6 mg with a replenishment rate of 2.2 - 2.4%.10% thiamine triphosphate and the rest as thiamine monophosphate. After intramuscular injection, pyridoxine is rapidly absorbed into the bloodstream and distributed in the body, acting as a coenzyme after phosphorylation of the CH2OH group in the 5th position. About 80% of the vitamin binds to blood plasma proteins. Pyridoxine is distributed throughout the body and crosses the placenta and is found in breast milk, deposited in the liver and oxidized to 4-pyridoxine acid, which is excreted in the urine, a maximum of 2 to 5 hours after absorption. The human body contains 40 - 150 mg of vitamin B6 and its daily elimination rate is about 1.7 - 3.6 mg with a replenishment rate of 2.2 - 2.4%.After intramuscular injection, pyridoxine is rapidly absorbed into the bloodstream and distributed in the body, acting as a coenzyme after phosphorylation of the CH2OH group in the 5th position. About 80% of the vitamin binds to blood plasma proteins. Pyridoxine is distributed throughout the body and crosses the placenta and is found in breast milk, deposited in the liver and oxidized to 4-pyridoxine acid, which is excreted in the urine, a maximum of 2 to 5 hours after absorption. The human body contains 40 - 150 mg of vitamin B6 and its daily elimination rate is about 1.7 - 3.6 mg with a replenishment rate of 2.2 - 2.4%.After intramuscular injection, pyridoxine is rapidly absorbed into the bloodstream and distributed in the body, acting as a coenzyme after phosphorylation of the CH2OH group in the 5th position. About 80% of the vitamin binds to blood plasma proteins. Pyridoxine is distributed throughout the body and crosses the placenta and is found in breast milk, deposited in the liver and oxidized to 4-pyridoxine acid, which is excreted in the urine, a maximum of 2 to 5 hours after absorption. The human body contains 40 - 150 mg of vitamin B6 and its daily elimination rate is about 1.7 - 3.6 mg with a replenishment rate of 2.2 - 2.4%.Pyridoxine is distributed throughout the body and crosses the placenta and is found in breast milk, deposited in the liver and oxidized to 4-pyridoxine acid, which is excreted in the urine, a maximum of 2 to 5 hours after absorption. The human body contains 40 - 150 mg of vitamin B6 and its daily elimination rate is about 1.7 - 3.6 mg with a replenishment rate of 2.2 - 2.4%.Pyridoxine is distributed throughout the body and crosses the placenta and is found in breast milk, deposited in the liver and oxidized to 4-pyridoxine acid, which is excreted in the urine, a maximum of 2 to 5 hours after absorption. The human body contains 40 - 150 mg of vitamin B6 and its daily elimination rate is about 1.7 - 3.6 mg with a replenishment rate of 2.2 - 2.4%.

Application during pregnancy and during breastfeeding:

use of the drug is contraindicated during pregnancy and breastfeeding (see section 'Contraindications').

Side effects:

from the immune system: rare: allergic reactions (skin rash, shortness of breath, anaphylactic shock, Quincke's edema); from the nervous system: in some cases: dizziness, confusion; on the part of the cardiovascular system: very rare: tachycardia; in some cases: bradycardia, arrhythmia; from the gastrointestinal tract: in some cases: vomiting; on the part of the skin and subcutaneous tissues: very rare: increased sweating, acne, itching, urticaria; from the musculoskeletal and connective tissue: in some cases: convulsions; general disorders and disorders at the injection site: in some cases: irritation may occur at the injection site; systemic reactions are possible with rapid administration or overdose. If any of the side effects indicated in the instructions are aggravated,or if you notice any other side effects not listed in the instructions, tell your doctor.Overdose:

Overdose treatment consists in discontinuation of the drug and symptomatic therapy.

Interaction with other medicinal products:

Thiamine breaks down completely in solutions containing sulfites. And as a consequence, the decay products of thiamine inactivate the actions of other vitamins. Thiamine is incompatible with oxidizing and reducing compounds, including: iodides, carbonates, acetates, tannic acid, ammonium iron citrate, phenobarbital, riboflavin, benzylpenicillin, dextrose, disulfites, etc. Copper accelerates the destruction of thiamine; in addition, thiamine loses its effectiveness with increasing pH values ??(over 3). Therapeutic doses of pyridoxine weaken the effect of levodopa (the antiparkinsonian effect of levodopa is reduced) while taking it. Interaction with cycloserine, penicillamine, isoniazid is also observed.With parenteral use of lidocaine, in the case of additional use of norepinephrine and epinephrine, an increase in side effects on the heart is possible. Interaction with sulfonamides is also observed. Cyanocobalamin is incompatible with heavy metal salts. Riboflavin also has a destructive effect, especially when exposed to light at the same time; nicotinamide accelerates photolysis, while antioxidants have an inhibitory effect.

Special instructions:

In case of accidental intravenous administration, the patient should be observed by a doctor or should be hospitalized depending on the severity of the symptoms. The ability to influence the reaction rate when driving or using other mechanisms. There is no information on the warning regarding the use of the drug by vehicle drivers and persons working with potentially dangerous machinery.