Neuromultivit injection solution, 2ml # 5

In the complex therapy of the following neurological diseases, accompanied by a deficiency of B vitamins:

• polyneuropathy (diabetic, alcoholic);

• intercostal neuralgia;

• trigeminal neuralgia;

• neuritis of the facial nerve;

• radicular syndrome caused by degenerative changes in the spine;

• cervical syndrome;

• shoulder-scapular syndrome;

• lumbar syndrome;

• lumboishalgia.

With severe pain syndrome, treatment begins with intramuscular injection (deep) of 2 ml of the drug, daily, for 5-10 days and then, with the transition to more rare injections (2-3 times a week) for 2-3 weeks.

It is recommended to carry out weekly medical supervision.

It is recommended to switch to taking the drug Neuromultivit as early as possible in the dosage form of film-coated tablets.

I / O introduction is not allowed.

thiamine hydrochloride 100 mg

pyridoxine hydrochloride 100 mg

cyanocobalamin 1 mg

Excipients : diethanolamine - 5 mg, water d / i - up to 2 ml.

• severe and acute forms of decompensated chronic heart failure;

• pregnancy;

• breastfeeding period;

• childhood;

• hypersensitivity to active or auxiliary substances of the drug.

pharmachologic effect

The pharmacological action is determined by the properties of the vitamins that make up the drug. The drug contains vitamins B1 (thiamine), B6 ??(pyridoxine) and B12 (cyanocobalamin), the deficiency of which can lead to neurological disorders, mainly from the peripheral nervous system.

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 is a cofactor of enzymes that carry two-carbon groups in decarboxylation reactions, plays a key role in carbohydrate metabolism, as well as in the Krebs cycle, with subsequent participation in the synthesis of TPP (thiamine pyrophosphate) and ATP (adenosine triphosphate).

Pyridoxine is a transaminase cofactor, is involved in protein metabolism, and partially 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.

The drug quickly compensates for the deficiency of these vitamins.

Cyanocobalamin is a cofactor in the transfer reactions of one-carbon groups, participates in the synthesis of the myelin sheath, stimulates hematopoiesis, reduces pain associated with damage to the peripheral nervous system, and stimulates nucleic acid metabolism through the activation of folic acid.

Pharmacokinetics

Thiamine

After i / m administration, thiamine is rapidly absorbed from the injection site and enters the bloodstream (484 ng / ml after 15 minutes on the first day of a 50 mg dose) and is distributed unevenly in the body when it is contained in leukocytes 15%, erythrocytes 75% and in plasma 10%. 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 the 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.

Pyridoxine

After i / m administration, 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, it forms metabolically active pyridoxal phosphate. About 80% of the vitamin binds to blood plasma proteins. Pyridoxine is distributed throughout the body, crosses the placental barrier 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 2-5 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 at a replenishment rate of 2.2-2.4%.

Cyanocobalamin

After parenteral administration, cyanocobalamin forms complexes with the transport protein transcobalamin, which are rapidly absorbed by the liver, bone marrow and other organs. Cyanocobalamin is excreted in bile and takes part in the intestinal-hepatic circulation. Penetrates the placental barrier.

Indications of the drug Neuromultivit

In the complex therapy of the following neurological diseases, accompanied by a deficiency of B vitamins:

• polyneuropathy (diabetic, alcoholic);

• intercostal neuralgia;

• trigeminal neuralgia;

• neuritis of the facial nerve;

• radicular syndrome caused by degenerative changes in the spine;

• cervical syndrome;

• shoulder-scapular syndrome;

• lumbar syndrome;

• lumboishalgia.

Dosage regimen

With severe pain syndrome, treatment begins with intramuscular injection (deep) of 2 ml of the drug, daily, for 5-10 days and then, with the transition to more rare injections (2-3 times a week) for 2-3 weeks.

It is recommended to carry out weekly medical supervision.

It is recommended to switch to taking the drug Neuromultivit as early as possible in the dosage form of film-coated tablets.

I / O introduction is not allowed.

Side effect

The following concepts and frequencies are used: very often (? 1/10), often (? 1/100, <1/10), infrequently (? 1/1000, <1/100), rarely (? 1/10 000, < 1/1000), very rare (<1/10 000) and the frequency is unknown (cannot be estimated from the available data).

From the immune system: rarely - allergic reactions (urticaria, itching, angioedema, shortness of breath, anaphylactic shock).

From the digestive system: in some cases - nausea, vomiting.

From the side of the cardiovascular system: in some cases - tachycardia.

Skin and subcutaneous tissue disorders: very rarely - increased sweating, acne.

From the side of the nervous system: very rarely - dizziness, confusion.

Others: in some cases - irritation may occur at the injection site; with rapid introduction (for example, due to unintentional intravascular injection or injection into tissues with a rich blood supply) or if the dose is exceeded, systemic reactions may develop - confusion, vomiting, bradycardia, arrhythmia, dizziness, convulsions.

Contraindications for use

• severe and acute forms of decompensated chronic heart failure;

• pregnancy;

• breastfeeding period;

• childhood;

• hypersensitivity to active or auxiliary substances of the drug.

Application during pregnancy and lactation

The use of the drug during pregnancy and during breastfeeding is contraindicated.

Application in children

The use of the drug in childhood is contraindicated.

special instructions

The drug should be injected exclusively intramuscularly and should not be allowed to enter the vascular bed.

In case of unintentional intravenous administration, it is necessary to carry out medical supervision (for example, in a stationary setting), depending on the severity of the symptoms that have arisen.

Influence on the ability to drive vehicles and use mechanisms

There is no information on the warning regarding the use of the drug Neuromultivit by vehicle drivers and persons working with potentially dangerous machinery.

Overdose

Symptoms: confusion, vomiting, bradycardia, arrhythmia, dizziness, convulsions.

Treatment: symptomatic therapy.

Drug interactions

In the presence of sulfite-containing solutions, thiamine completely decomposes.

In the presence of degradation products of vitamin B1, other vitamins can be inactivated.

Thiamine is incompatible with oxidizing and reducing compounds, incl. iodides, carbonates, acetates, tannic acid, ammonium iron citrate, phenobarbital, riboflavin, benzylpenicillin, dextrose, disulfites.

Copper accelerates the breakdown of thiamine; in addition, thiamine loses its effectiveness with increasing pH values ??(over 3).

Therapeutic doses of vitamin B6 can reduce the effects of levodopa when taken concomitantly.

Interaction with cyclosporine, penicillamine, isoniazid, epinephrine, norepinephrine, sulfonamides is possible.

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.

Storage conditions of the drug Neuromultivit

The drug should be stored out of the reach of children at a temperature of 2 ? C to 8 ? C.