Neuromultivit solution 2ml ampoules, 5pcs

Composition

Solution for intramuscular use.

1 ampoule contains:

active ingredients:

thiamine hydrochloride 100.00 mg

pyridoxine hydrochloride 100.00 mg

cyanocobalamin 1.00 mg

excipients:

diethanolamine 5.0 mg

water for injection up to 2.0 ml

Pharmacological action

Pharmacological action is determined by the properties of 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.

Neurotropic B vitamins have a beneficial effect on inflammatory and degenerative diseases of the nerves and motor system. They promote increased blood flow and improve the functioning of the nervous system.

Thiamine is a cofactor of enzymes that transfer 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 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.

The drug quickly replenishes the deficiency of these vitamins.

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

Pharmacokinetics:

After intramuscular use, thiamine is rapidly absorbed from the injection site and enters the blood (484 ng / ml after 15 minutes on the first day of use of a 50 mg dose) and is distributed unevenly in the body with its content in white blood cells of 15%, red blood cells of 75% and plasma of 10%.

Thiamine penetrates the blood-brain and placental barriers and is found in human 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: thiaminecarboxylic acid, pyramine, and some unknown metabolites. Of all the vitamins, thiamine is stored in the body in the smallest amounts. The adult body 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 use, pyridoxine is rapidly absorbed into the bloodstream and distributed in the body, acting as a coenzyme after phosphorylation of the CH2 group, IT forms metabolically active pyridoxal phosphate in the 5th position. About 80% of the vitamin binds to 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-pyridoxic 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 parenteral use, cyanocobalamin forms complexes with the transport protein transcobalamin, which are rapidly absorbed by the liver, bone marrow, and other organs. Cyanocobalamin is excreted in the bile and participates in the intestinal-hepatic circulation. Penetrates through the placenta.

Indications

In the treatment of these neurological diseases associated with deficiency of vitamins of group b:

– neuropathy (diabetic, alcoholic);

– intercostal neuralgia;

– neuralgia of the trigeminal nerve

– the facial nerve neuritis;

– radicular syndrome caused by degenerative changes of the spine;

cervical syndrome;

– shoulder syndrome;

lumbar syndrome;

– lumboischialgia.

Contraindications

-Hypersensitivity to the active or auxiliary substances of the drug;

– severe and acute forms of decompensated chronic heart failure (CHF);

– pregnancy and lactation;

– childhood.

Side effects

The following concepts and frequencies apply: very common (≥1/10), (often (≥1/100, <1/10); infrequent (≥1/1000, <1/100); rare (≥1/10000, <1/1000); very rare (

From the immune system:

rarely:  allergic reactions (urticaria, pruritus, angioedema, difficulty breathing, anaphylactic shock).

From the gastrointestinal tract:

in some cases:  nausea, vomiting.

From the cardiovascular system:

in some cases:  tachycardia, increased sweating.

Skin and subcutaneous tissue disorders:

Very rarely:  increased sweating, acne.

Nervous system disorders:

Very rarely:  dizziness, confusion.

General disorders and disorders at the injection site:

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

Interaction

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, including: iodides, carbonates, acetates, tannic acid, ammonium iron citrate, phenobarbital, raboflavin, benzylpenicillin, dextrose, disulfites.

Copper accelerates the breakdown of thiamine; in addition, thiamine loses its effectiveness when pH values increase (more than 3).

Therapeutic doses of vitamin B6 may reduce the effect of levodopa when taken concomitantly.

Interaction with cyclosporine, penicillamine, isoniazid, epinephrine, norepinephrine, and 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.

How to take, course of use and dosage

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.

Weekly medical monitoring is recommended.

It is recommended to switch to oral use of Neuromultivit in the dosage form of film-coated tablets as soon as possible.

Intravenous use is not allowed.

Overdose

Symptoms of overdose:

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

Treatment:

symptomatic.

Special instructions

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

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

Influence on the ability to drive vehicles and mechanisms:

There is no information about warnings regarding the use of the drug Neuromultivit by drivers of vehicles and persons working with potentially dangerous mechanisms.

Form of production

Transparent liquid of red color, with a characteristic smell.

Active ingredient

Pyridoxine, Thiamine, Cyanocobalamin

Conditions of release from pharmacies

By prescription

Dosage form

solution for injection

Indications

Trigeminal Neuralgia, Lumbago, Sciatica, Polyneuropathy, Neuritis