Contraindications and side effects of milgamma. Possible manifestations of side effects

Such an ailment is considered the primary process in the disease of the nervous system, as well as a pathology that negatively affects other organs and tissues.

Milgamma is considered a unique remedy, because it contains vitamins that are important for a person and, in particular, for his nervous system.

In addition to the directed action in the treatment of the nervous system, the drug helps to cope with other diseases, for example, to cure arthrosis, arthritis, rheumatism. The vitamins that the drug contains are considered neurotropic, so Milgamma is often prescribed by neurosurgeons and neuropathologists.

Compound

2 ml of solution for injection deep into the muscles contains thiamine, pyridoxine, cyanocobalamin, lidocaine. As auxiliary components, the drug contains alcohol, sodium, potassium, water. The basis of the drug in the form of tablets is pyridoxine, benfotiamine. Auxiliary components - sucrose, titanium dioxide, talc, povidone.

Release form

Milgamma can be bought in ampoules for injection into the muscles, and in the form of tablets for oral administration. The solution is colored pink, transparent. Available in brown glass ampoules of 2 ml. There are 5 or 10 ampoules in a carton package, which are packed in a blister with individual cells.

Tablets are round, white, odorless. The package contains a blister with a dragee of 15 pieces. Each box may contain 2 or 4 tablets in cartons.

pharmachologic effect

Milgamma is one of the few drugs that, depending on the form of release, are prescribed for various ailments. It should be remembered that this drug is combined and its basis consists of B vitamins. Vitamin B1 plays an important role in protein and carbohydrate metabolism, in addition, it is indispensable in the process of fat metabolism. First of all, this vitamin is a good antioxidant, has a beneficial effect on nerve impulses, relieves pain due to the fact that it affects the process of transmission of excitation of nerve impulses.

Vitamin B6 is the main substance in the proper formation of enzymes that are necessary for the normal functioning of nerve impulses in tissues. In addition, the vitamin contributes to the production of essential amino acids, removes excess ammonia accumulated in the tissues, and also helps to form adrenaline, dopamine, and histamine. Milgamma in various forms of release affects the human body in different ways.

Tablets are prescribed in order to speed up the recovery process in nerve tissues. Vitamin B1 and vitamin B6 accelerate each other's work. A solution for injection into the muscles relieves inflammation and eliminates other diseases associated with inflammation of the nervous tissue. In addition, it is prescribed if a person suffers from diseases of the musculoskeletal system. In general, the drug normalizes the functioning of the entire nervous system.

The medicine also contains vitamin B12, it is just the main substance that helps to form the myelin sheath, relieves pain that occurs with diseases of the nervous system. Lidocaine in solution is a good anesthetic, it is he who quickly eliminates pain, this is the effect that the patient needs in the first minutes in diseases associated with peripheral nerve damage.

Pharmacodynamics and pharmacokinetics

After the Milgamma tablet has been taken, active absorption of benfotiamine occurs. Its maximum concentration in blood plasma is observed after one hour. Benfotiamine is able to accumulate several times faster in cells, unlike the liquid form of thiamine. After the drug has been injected into the patient's muscle, the active substances are absorbed into the blood in a matter of minutes.

Twenty minutes after administration, a high concentration of thiamine in erythrocytes (80%) is observed, only 15% of the substance is noted in plasma. Thiamine easily passes to the fetus through the placenta, and also penetrates into the mother's milk. The pyridoxine contained in the preparation easily enters the general bloodstream through the muscles, is distributed evenly throughout it, and enters the brain. Pyridoxine is able to bind to plasma proteins (85%). Thiamine is excreted by the kidneys in the urine two hours after complete absorption.

Milgamma injections and their side effects

Milgamma is prescribed to patients with various neuralgic diseases. In any form, the drug can be used if a person is constantly tormented by neuralgia, neuritis.

In addition, Milgamma injections have long helped to cure nerve paresis of the facial region. Doctors often prescribe a medicine, since it contains a large concentration of B vitamins that help with polyneuropathy, and the drug actively fights against alcoholic and diabetic polyneuropathy. Tablets are more often prescribed if a person suffers from myalgia, neuralgia, from herpes zoster.

In medicine, Milgamma is also known as an effective tool that helps to cope with many pathologies of the nervous system, which most often occur due to a deficiency of vitamins B1 and B6. Injections are effective in such diseases when the tablet form of the drug is powerless. The patient may be disturbed by diseases such as neuropathy, plexopathy.

In addition, the drug in ampoule form is prescribed for ganglionitis, in the case when a person is disturbed by muscle cramps at night. The drug is effective for osteochondrosis, sciatica, often it is Milgamma that is the only salvation for the patient when he develops a muscular-tonic syndrome.

Contraindications

Milgamma should not be prescribed to patients who suffer from heart failure during pregnancy and breastfeeding. The remedy is contraindicated in the case when there is intolerance to B vitamins or any other component that is part of the Milgamma preparation. Injections for children are not prescribed until the child reaches the age of 14 years.

Side effects

Often the drug is well tolerated by patients, but in some cases you need to be prepared for the fact that Milgama will cause some side effects that can affect the work of absolutely any organ.

Milgamma can cause allergies if it is not noticed on time, a person may experience anaphylactic shock or Quincke's edema may occur. The drug in some cases leads to a malfunction of the nervous system, which is manifested by dizziness. In a patient from the drug, cardiac activity may be disturbed, namely, tachycardia or arrhythmia may begin. In rare cases, Milgamma leads to nausea, vomiting, convulsions.

Milgamma: instructions for use

Most often, Milgamma for diseased joints in tablet form is prescribed to patients for a three-time intake of one tablet. It is allowed to be treated with the drug for no more than one month.

Solution for injections and injections

The solution is intended for deep injection into the muscles. For pain in the joints, the drug is prescribed 2 ml twice a day for ten days. In all cases when you have to use the drug Milgamma, the instructions should be studied, as it indicates the correct dosage. Despite this, the exact dosage can only be established by the attending physician.

What else is it used for and how?

Milgamma is used for neuralgia, myalgia, for this the drug is prescribed in the form of tablets, if the disease is mild. Tablets are taken twice a day.

Injections are prescribed if neuralgia occurs more often and headaches are acute. The injections are injected into the muscle once a day for ten days. In diabetic polyneuropathy, Milgamma is prescribed in injections, twice a day, 2 ml. The course is set by the doctor, usually it does not exceed two weeks.

Overdose

An overdose of the drug can occur if you enter a dose higher than prescribed by the doctor. In this case, nausea, vomiting, convulsions, dizziness, allergies, swelling of the mucosa may occur. Rarely, patients had tachycardia, arrhythmia, increased heart rate, decreased blood pressure. So that the patient does not suffer from an overdose of Milgamma, the instruction indicates the permitted dosage. If such reactions occur, symptomatic treatment should be carried out. In the future, the correct doses are easily tolerated by patients.

Interaction

If you take the drug at the same time as the drug, which will contain sulfite, in this case, thiamine, which is part of Milgamma, will completely collapse and will not have the desired effect. In addition, thiamine cannot be combined with such compounds that have an acidic environment, namely with iodinated preparations, with agents that contain iron, riboflavin. Copper also contributes to the destruction of thiamine.

Medicine Milgamma: special instructions

Milgamma can be purchased at pharmacies in ampoules, only with a prescription from a specialist. Tablets can be purchased without providing a prescription from a doctor.

Storage conditions

The drug contains a special vitamin complex, so it can be stored at a temperature of 15 degrees. It is unacceptable to get direct sunlight to the drug, in addition, it must be stored in a closed place where children cannot penetrate.

Best before date

Milgamma medicine is stored for no more than two years. Before you buy the drug, you need to pay attention to the storage conditions, as well as the date of manufacture.

special instructions

If the patient needs to administer the drug intramuscularly, a healthcare professional should be present, as in this case, adverse reactions may occur more quickly. It is necessary to ensure the correct administration and dosage of the drug. Milgamma medicine can be used while driving, as it does not affect mental ability. With caution, Milgamma should be prescribed in complex treatment with drugs that have cycloserine in their composition. In addition, vitamin B12 is not compatible with salts of heavy metals.

Milgamma drug and its analogues

There are analogues of the drug that can be used for Milgamma intolerance.

Trigamma - vitamins belonging to the neurotropic group of drugs that relieve the inflammatory process, anesthetize with diseases of the motor system, with inflamed nerves, and also eliminate pain in the head of various etiologies. The tool has some contraindications, with respect to chronic diseases, it can rarely cause allergies.

Neuromax is a remedy similar to vitamin B1. The drug is prescribed for degenerative diseases of the nerves and motor system. The product contains an analgesic substance that can quickly eliminate pain, improve blood circulation and restore the functioning of the nervous system. In particular, the drug is able to eliminate myalgia, neuritis, neuralgia, motor nerve paralysis in combination with other drugs. In addition, Neuromax is used before surgery in the nasal region to eliminate swelling of the mucous tissue.

Neurobion - the drug contains neurotropic vitamins, namely thiamine, pyridoxine. The drug is prescribed in combination with other drugs to achieve the best effect. Neurobion eliminates sciatica, neuralgia, relieves pain in the lower back, in the neck, treats plexitis, herpes, and is effective for nerve damage in the face.

Vitakson - the remedy has a good therapeutic effect in inflammatory diseases of the optic nerve, neuralgia of a different nature, in addition, the drug has long been used for back diseases, arthritis, nephritis, it relieves headaches and neck pains. The active vitamin complex treats the diseases that have arisen. The medicine has practically no side effects, so it can be prescribed to pregnant women.

children

Milgamma is contraindicated in children until they have reached the age of 14 years.

During pregnancy and lactation

The components of the drug are able to quickly penetrate into the mother's milk, and also get to the fetus through the placenta. Therefore, the drug Milgamma is not prescribed to pregnant women.

Reviews

Svetlana, Yekaterinburg “I took Milgamma, I had neuralgia, I finished taking pills a week ago, the result is good, as expected. Previously, every year, exclusively in the fall or spring, I suffered from headaches, constantly tormented by spasms of blood vessels. No painkillers helped me, no matter how much I tried them. Since the doctor prescribed just such a drug, I saw a white light. In addition, my back stopped pulling at night, my body got stronger as a whole. I will advise everyone to Milgamma, only after consulting a doctor. ”

Irina, Tula “My husband constantly complains of back pain, all because he has to work sitting most of the time at work. We tried all ointments, creams, gels, including warming ones, nothing helped. After that, I decided to find the drug myself, on the Internet I came across Milgamma, we decided to try it, and it helped us. As the doctor later told us that we were taking a risk, but fortunately, it turned out to be exactly the drug that we needed. ”

Kirill, Ufa “My grandfather suffers from pain in the cervical region, the doctor immediately told us to inject Milgama, because analgesics will not help in our case. They pierced her for a week, the result is excellent, thanks to the doctor for discovering this wonderful remedy for us. ”

Price where to buy

If Milgamma injections are needed, then you will have to pay about 300 rubles for them, a package of 25 pieces will cost from 900 to 1000 rubles. The drug Milgamma in the form of ampoules costs about 400 rubles. The cost of tablets in the amount of 30 pieces is approximately 700 rubles.

Milgamma is a fairly common drug that helps to cope with many diseases associated with the nervous system. It should be remembered that this remedy is only suitable for complex treatment, since the composition contains only an analgesic substance and vitamins.

Despite the fact that the drug is tolerated quite easily, it should be used only as directed by a doctor. Sometimes vitamins can cause allergic reactions, while the medicine is canceled and its analogue is prescribed.

Remember that self-medication is dangerous for your health! Be sure to consult with your doctor! The information on the site is presented for informational purposes only and does not claim to be reference and medical accuracy, is not a guide to action.

Milgamma instructions for use, contraindications, side effects, reviews

Vitamin B complex.

Active substance of the drug: comb. drug

ATX encoding: A11DB

CFG: Vitamin B Complex

Registration number: P No. 012551/02

Date of registration: 03.11.06

The owner of the reg. Honorary: WORWAG PHARMA GmbH & Co. KG

Milgamma release form, drug packaging and composition.

The solution for i / m administration is transparent, red.

pyridoxine hydrochloride (vit. B6)

cyanocobalamin hydrochloride (vit. B12)

Excipients: benzyl alcohol, sodium polyphosphate, potassium hexacyanoferrate, sodium hydroxide, water for injections.

2 ml - dark glass ampoules (5) - packs of cardboard.

The description of the drug is based on the officially approved instructions for use.

Pharmacological action of Milgamma

Complex of vitamins of group B. Neurotropic vitamins of group B have a beneficial effect on inflammatory and degenerative diseases of the nerves and the musculoskeletal system. Promote increased blood flow and improve the functioning of the nervous system.

Thiamine (vitamin B1) 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 (vitamin B6) is involved in protein metabolism and, in part, in the metabolism of carbohydrates and fats.

The physiological function of both vitamins is to potentiate each other's action, which manifests itself in a positive effect on the neuromuscular and cardiovascular systems. In vitamin B6 deficiency, widespread deficiencies are quickly reversed after administration of these vitamins.

Cyanocobalamin (vitamin B12) is involved in the synthesis of the myelin sheath, stimulates hematopoiesis, reduces pain associated with damage to the peripheral nervous system, stimulates nucleic metabolism through the activation of folic acid.

Lidocaine is a local anesthetic that causes all types of local anesthesia (terminal, infiltration, conduction).

Pharmacokinetics of the drug.

After i / m administration, thiamine is rapidly absorbed and enters the bloodstream. The concentration of thiamine is 484 ng / ml 15 minutes after the administration of the drug at a dose of 50 mg (on the 1st day of administration).

After intramuscular administration, pyridoxine is rapidly absorbed into the systemic circulation and distributed in the body, acting as a coenzyme after phosphorylation of the CH2OH group in the 5th position.

Thiamine is unevenly distributed in the body. The content of thiamine in leukocytes is 15%, in erythrocytes - 75% and in plasma - 10%. Due to the lack of significant reserves of the vitamin in the body, it must be ingested daily. Thiamine passes through the BBB and the placental barrier and is found in breast milk.

Pyridoxine is distributed throughout the body, crosses the placental barrier and is found in breast milk. The body contains mg of vitamin B6, its daily elimination rate is about 1.7-3.6 mg with a replenishment rate of 2.2-2.4%.

Metabolism and excretion

The main metabolites of thiamine are thiamine carboxylic acid, pyramine and some unknown metabolites. Of all the vitamins, thiamine is stored in the body in the smallest quantities. The adult human body contains about 30 mg of thiamine as 80% thiamine pyrophosphate, 10% thiamine triphosphate, and the rest as thiamine monophosphate. Thiamine is excreted in the urine, T1 / 2 -phase - 0.15 h, -phase - 1 h and terminal phase - within 2 days.

Pyridoxine is deposited in the liver and oxidized to 4-pyridoxic acid, which is excreted in the urine, a maximum of 2-5 hours after absorption.

Indications for use:

As a pathogenetic and symptomatic agent in the complex therapy of diseases and syndromes of the nervous system of various origins:

Paresis of the facial nerve;

Ganglionitis (including shingles);

Polyneuropathy (diabetic, alcoholic);

Nocturnal muscle cramps, especially in older age groups;

Neurological manifestations of osteochondrosis of the spine;

Dosage and method of application of the drug.

In cases of severe pain syndrome, it is advisable to start treatment with an intramuscular injection of the drug at a dose of 2 ml daily for 5-10 days, with a transition to either oral administration or a more rare administration (2-3 times a week for 2-3 days). 3 weeks) with possible continuation of oral dosage form therapy.

The drug is injected deep into the / m.

Side effects of Milgamma:

Allergic reactions: itching, urticaria, shortness of breath, Quincke's edema, anaphylactic shock.

Other: in some cases - increased sweating, tachycardia, acne.

Contraindications to the drug:

Decompensated heart failure;

Children's age (due to lack of data);

Increased individual sensitivity to the components of the drug.

Use during pregnancy and lactation.

Special instructions for the use of Milgamma.

Drug overdose:

In cases of very rapid administration of the drug, dizziness, arrhythmia, convulsions may occur, they can also be symptoms of an overdose.

Treatment: carry out symptomatic therapy.

Interaction of Milgamma with other drugs.

Thiamine is completely destroyed in solutions containing sulfites.

Other vitamins are inactivated in the presence of breakdown products of the B vitamins.

Levodopa reduces the effect of pyridoxine.

Possible interaction of the drug with cycloserine, D-penicillamine, epinephrine, norepinephrine, sulfonamides, which leads to a decrease in the effect of pyridoxine.

Thiamine is incompatible with oxidizing agents, mercuric chloride, iodide, carbonate, acetate, tannic acid, iron ammonium citrate, as well as phenobarbital, riboflavin, benzylpenicillin, dextrose and metabisulphite.

Copper accelerates the breakdown of thiamine.

Thiamine loses its effect with increasing pH values ​​(more than 3).

Conditions of sale in pharmacies.

The drug is dispensed by prescription.

Terms of storage conditions of the drug Milgamma.

The drug should be stored in a place protected from light, out of the reach of children, at a temperature not exceeding 15°C. Shelf life - 2 years.

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Maalox - an updated description of the drug, you can see the pharmacological action, side effects, dosage of the drug Maalox. .

The material is published for informational purposes only and under no circumstances can be considered a substitute for medical advice from a specialist in a medical institution. The site administration is not responsible for the results of using the posted information. For diagnostics and treatment, as well as prescribing medications and determining the scheme for taking them, we recommend that you contact your doctor.

"Milgamma": indications, contraindications, reviews of the drug

Indications for use

The drug "Milgamma" is intended for the treatment of various neurological diseases, including those caused by a proven deficiency of B vitamins. In particular, the drug is indicated for neuralgia, myalgia, paresis of the facial nerve, radiculitis and neuritis, including optic neuritis, nocturnal muscle cramps.

Instructions for use "Milgamma"

Intramuscular injections with a dosage of 2 ml are done 1 time per day. The drug should be injected into the muscle slowly and as deeply as possible. In case of severe pain syndrome, injections are made daily, for maintenance therapy - every other day. The course of treatment consists of 5-10 injections.

Contraindications and side effects

Treatment with the drug is contraindicated in decompensated heart failure, as well as during pregnancy, lactation and under the age of 16 years. In addition, a contraindication to taking this remedy is the individual intolerance of its components.

Reviews

The drug is effective in the treatment of osteochondrosis, neuralgia and radiculitis. It eliminates discomfort, restores mobility of joints and muscles, relieves spasms, improves blood circulation.

Milgamma

Description current as of 09/25/2014

• Latin name: Milgamma
• ATX code: A11DB
• Active ingredient: INN: Pyridoxine + Thiamine + Cyanocobalamin + Lidocaine (Pyridoxine + Thiamine + Cyanocobalamin + Lidocaine)
• Manufacturer: Worwag Pharma GmbH & Co. KG (Germany)

Compound

The composition of Milgamma in the form of a solution for intramuscular injection includes several active substances. In particular, the composition of the ampoules includes: pyridoxine hydrochloride, thiamine hydrochloride, cyanocobalamin, lidocaine hydrochloride.

Also, Milgamma injections contain additional substances: benzyl alcohol, potassium hexacyanoferrate, sodium hydroxide, sodium polyphosphate, water for injection.

Vitamins in tablets contain benfotiamine, pyridoxine hydrochloride, and they also contain anhydrous colloidal silicon dioxide, croscarmellose sodium, microcrystalline cellulose, talc, povidone K30, partial long-chain glycerides.

Release form

The medicine is available in the form of a solution (Milgamma injections for intramuscular injection), as well as in the form of tablets and dragees.

Vitamins in the form of a solution are contained in 2 ml ampoules. The ampoules are made of brown hydrolytic glass, each with a label and a white dot. The package contains 5 or 10 ampoules.

Film-coated tablets are packed in packs of 30 or 60 pcs.

Milgamma Compositum dragees are also produced - biconvex, round, white. The dragee is contained in a blister pack of 15 pieces. There can be 2 or 4 blisters in a cardboard pack.

pharmachologic effect

Milgamma medicine contains neurotropic vitamins that belong to group B. The drug is used in a therapeutic dose for diseases of the nerves, nervous tissue, in which patients have a violation of nerve conduction or inflammatory and degenerative phenomena.

The drug Milgamma is also prescribed for people with diseases of the musculoskeletal system. The use of a preparation containing large doses of vitamin B relieves sharp pain, activates microcirculation processes, improves hematopoiesis and the functioning of the nervous system.

Vitamin B1 (thiamine), entering the body, through phosphorylation turns into cocarboxylase and thiamine triphosphate. In turn, cocarboxylase takes part in the processes of carbohydrate metabolism, normalizing the functions of the nervous tissue and nerves and improving the conductivity in the nerves. If there is a deficiency of vitamin B1 in the body, then incompletely oxidized products of carbohydrate metabolism can accumulate in the tissues, provoking a variety of pathological conditions.

When determining which is better - injections or Milgamma tablets, it should be taken into account that instead of thiamine chloride, the tablets contain benfotiamine, a fat-soluble derivative of thiamine.

Vitamin B6 (pyridoxine) is phosphorylated when it enters the body. The products of its metabolism are involved in the decarboxylation of amino acids, as a result of which physiologically active mediators are produced in the body - adrenaline, histamine, tyramine, dopamine, serotonin. In addition, vitamin B6 affects the metabolism of tryptophan.

Vitamins B1 and B6 provide potentiation of each other's influence, therefore Milgamma vitamins in injections and tablets have a pronounced beneficial effect on the health of patients with diseases of the nerves and the musculoskeletal system.

Vitamin B12 (cyanocobalamin) has an antianemic effect, activates the synthesis of nucleic acids, choline, creatinine, methionine. Takes part in metabolic processes in cells. The substance reduces pain, manifested as a result of damage to the peripheral NS, activates nucleic acid metabolism.

Pharmacokinetics and pharmacodynamics

Abstract shows that after intramuscular injection, thiamine is rapidly absorbed and enters the bloodstream. Distributed unevenly throughout the body. Since there are no significant reserves of thiamine in the body, it must be supplied every day. The substance can cross the blood-brain and placental barriers. Excreted through the kidneys. Thiamine, compared with other vitamins, is stored in the body in the smallest quantities.

Pyridoxine, after the solution has been injected intramuscularly, quickly enters the bloodstream and is distributed throughout the body. Approximately 80% of the vitamin binds to plasma proteins. The substance is able to penetrate the placenta, enters the mother's milk. Later it is oxidized to 4-pyridoxic acid, which is excreted through the kidneys after 2-5 hours.

Cyanocobalamin, getting into the human blood, binds to proteins, resulting in the formation of a transport complex. Further, in this form, it is absorbed by the liver tissue. It also accumulates in the bone marrow. After cyanocobalamin is excreted in the bile into the intestine, it can be reabsorbed.

Indications for use Milgamma

The solution and tablets are prescribed as part of the complex treatment of diseases and syndromes of the nervous system of different origin.

The following indications for the use of Milgamma are determined:

Also, there are indications for the use of injections in people suffering from night cramps, neurological symptoms of osteochondrosis of the spine. From what the drug helps as part of complex therapy, and from what Milgamma injections are prescribed more, you can learn more from your doctor.

Contraindications for Milgamma

Contraindications to the use of the drug are as follows:

• high level of sensitivity to its components;
• decompensated heart failure.

Also, contraindications to injections and tablets are pregnancy, lactation time and the child's age of the patient.

Side effects

Side effects of Milgamma appear, as a rule, in rare cases.

In particular, the following side effects are rarely possible:

Sometimes after the patient is given Milgamma IV, he may experience irritation at the site where the solution was injected. The manifestation of systemic reactions can be observed only with very rapid administration or in case of overdose.

If any other side effects appear or the negative effects described above are aggravated, you should immediately tell a specialist about this, who will give recommendations on how to prick the ampoules, or replace the drug.

Application instruction of Milgamma (Way and dosage)

If the patient is prescribed Milgamma injections, the instructions for use should be carefully followed. Initially, the drug is injected deep into the muscle, 2 ml once a day for 5-10 days. If injections are intended for maintenance treatment, then 2 ml is administered 2-3 times a week. You can also take the drug in the form of tablets for maintenance therapy (1 tablet daily).

Instructions for the use of Milgamma indicate that ampoules or tablets should be used to quickly eliminate the pain syndrome (1 tablet three times a day). Treatment can last about one month. The doctor should monitor the patient's health status weekly. Experts advise as soon as possible to switch to the internal administration of the drug. It should be noted that Milgamma candles are not available.

The course of treatment with injections can last longer only as prescribed by the doctor. How often you can inject injections, and what form of release is preferable in each case, you should also ask your doctor.

Overdose

If an overdose of the drug is noted, the patient may experience those symptoms that are described as side effects. In such cases, symptomatic therapy is used.

Interaction

If vitamin B1 is mixed with sulfate solutions, then it completely decomposes.

Inactivation of thiamine (benfotiamine) is noted in the presence of acetates, mercury chloride, iodides, carbonates, riboflavin, tannic acid, iron ammonium citrate, penicillin, metabisulphite.

Pyridoxine in therapeutic doses can reduce the effect of levodopa, so it is not used with levodopa and drugs containing it. There is also an interaction with penicillamine, cycloserine, isoniazid.

Cyanocobalamin is inactivated in the presence of salts of heavy metals. Riboflavin also has a destructive effect on it, especially with parallel exposure to light.

Terms of sale

In the pharmacy, tablets and Milgamma in ampoules can be purchased by prescription.

Storage conditions

The agent must be protected from light, stored at a temperature not exceeding 15 ° C. Keep out of reach of children.

Best before date

Shelf life 2 years.

special instructions

If the solution was accidentally administered intravenously, the patient must be provided with medical supervision and symptomatic treatment of adverse events.

There is no data on the effect on the ability to drive vehicles and work with precise mechanisms.

Wikipedia indicates that in veterinary practice, the remedy can be used for dogs and other animals. However, it should be noted that such use of injections is possible only after a clear prescription from a veterinarian.

Milgamma's analogs

If a substitution for a drug is required, the possibility of using similar drugs for treatment that have a similar effect on the body can be considered. How to replace the remedy is determined only by a doctor who will select the optimal analogues of Milgamma in injections and tablets. You can pick up both imported and Russian counterparts. To date, the following preparations-analogues of Milgamma are known: Neuromultivit, Binavit, Triovit, Pikovit, etc. The most optimal substitute is the analog of Combilipen, which is similar in composition, as well as Neuromultivit. The price of Milgamma analogues is, as a rule, somewhat lower.

Which is better: Milgamma or Combilipen?

Kombilipen is also a complex vitamin drug, which includes vitamins of group B. The drug is prescribed as part of complex therapy for patients with neurological diseases. These are similar products, only they have a different manufacturer, and Kombilipen can be purchased at a lower price.

Neuromultivit or Milgamma: which is better?

The composition of these drugs is similar, but Neuromultivit does not have lidocaine among the components. Neuromultivit, unlike Milgamma, is prescribed for the treatment of children. Why each of the drugs is prescribed, the attending specialist will explain in more detail.

children

The drug is prescribed to adolescents only from the age of 16.

With alcohol

Milgamma is prescribed after alcohol intoxication in order to restore the body. At the same time, alcohol and Milgamma, both in injections and in tablets, should not be used. Despite the fact that the compatibility with alcohol of this drug is not described in the official instructions, such a combination completely neutralizes the positive effect of using the drug. Also, a number of side effects can provoke the combination of alcohol and lidocaine: these are headache, drowsiness, anxiety.

During pregnancy and lactation

During pregnancy, as well as during feeding, Milgamma is not prescribed to women, since there is not enough information about the effect of its components on the fetus during pregnancy and during breastfeeding.

Vitamin B complex

Active ingredients

Lidocaine- a local anesthetic that causes all types of local anesthesia: terminal, infiltration, conduction.

Pharmacokinetics

After the / m introduction thiamine it is rapidly absorbed from the injection site and enters the blood (484 ng / ml after 15 minutes on the first day of administration at a dose of 50 mg) and is distributed unevenly in the body - with its content in leukocytes 15%, erythrocytes 75% and in plasma 10%. Due to the lack of significant reserves of the vitamin in the body, it must be ingested daily. Thiamine crosses the BBB and the placental barrier and is found in breast milk. Thiamine is excreted in the urine in the α-phase after 0.15 hours, in the β-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 quantities. The body of an adult contains about 30 mg of thiamine in the form of 80% thiamine pyrophosphate, 10% thiamine triphosphate, and the rest as thiamine monophosphate.

After IM injection pyridoxine it is quickly absorbed into the bloodstream and distributed in the body, acting as a coenzyme after phosphorylation of the CH 2 OH group in the 5th position. About 80% of the vitamin binds to plasma proteins. Pyridoxine is distributed throughout the body, crosses the placental barrier, is found in breast milk, is 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 B 6 , its daily elimination rate is about 1.7-3.6 mg with a replenishment rate of 2.2-2.4%.

Indications

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 and others);

- nocturnal muscle cramps, especially in older age groups;

- neurological manifestations of osteochondrosis of the spine: radiculopathy, lumboischalgia, muscular-tonic syndromes.

Contraindications

- pregnancy;

- the period of breastfeeding;

- childhood;

- decompensated heart failure;

- increased individual sensitivity to the components of the drug.

Dosage

Injections are performed deep in / m.

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 ml daily for 5-10 days. In the future, after the pain syndrome subsides and in mild forms of the disease, they switch either to therapy with an oral dosage form (for example, drug), or to more rare injections (2-3 times a week for 2-3 weeks) with the possible continuation of drug therapy oral form (for example, Milgamma compositum).

The transition to therapy with an oral dosage form (for example, Milgamma compositum) is recommended to be carried out as soon as possible.

Side effects

The frequency of occurrence of adverse reactions is given in accordance with the WHO classification: very often (more than 1 in 10 treated), often (less than 1 in 10, but more than 1 in 100 treated), infrequent (less than 1 in 100 but more than 1 in 1,000 treated), rare (less than 1 in 1,000 but more than 1 in 10,000 treated), very rare (less than 1 in 10,000, including isolated cases) , in some cases - the symptoms appear with an unknown frequency.

From the immune system: rarely - allergic reactions (skin rash, shortness of breath, anaphylactic shock, Quincke's edema).

From the nervous system: in some cases - dizziness, confusion.

From the side of the cardiovascular system: very rarely - tachycardia; in some cases - bradycardia, arrhythmia.

From the gastrointestinal tract: in some cases - vomiting.

From the skin and subcutaneous tissues: very rarely - increased sweating, acne, itching, urticaria.

From the musculoskeletal system: 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 any other side effects not indicated in the instructions are noted, the patient should inform the doctor about this.

Overdose

Treatment of overdose consists in drug withdrawal and symptomatic therapy.

drug interaction

Thiamine completely decomposes in solutions containing sulfites, as a result, the decomposition products of thiamine inactivate the action of other vitamins.

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

Copper accelerates the destruction of thiamine; in addition, thiamine loses its effectiveness with increasing pH values ​​(more than 3).

Therapeutic doses of pyridoxine weaken the effect of levodopa (the antiparkinsonian effect of levodopa is reduced) when taken simultaneously. Interaction with cycloserine, penicillamine, isoniazid is also observed.

With parenteral use of lidocaine, in the case of the 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 salts of heavy metals. Riboflavin also has a destructive effect, especially when exposed to light simultaneously; nicotinamide accelerates photolysis, while antioxidants have an inhibitory effect.

Terms of dispensing from pharmacies

Released by prescription.

Terms and conditions of storage

The drug should be stored in a place protected from light, out of the reach of children at a temperature of 2 ° to 8 ° C; do not freeze. Shelf life - 3 years. Do not use after the expiration date.

Milgamma is a complex preparation containing vitamins of group B. The drug is available in various forms, both for oral use and in solution for injection. The main purpose of the drug is therapy for neurological pathologies, accompanied by a violation of the conduction of impulses in the nerve tissue. The effectiveness of the drug in the complex therapy of diseases and pathologies of the musculoskeletal system is due to the effect of B vitamins on inflammatory and degenerative processes and the relief of pain. Instructions for use Milgamma describes general recommendations for doses, frequency and duration of treatment, so the drug is taken only after consulting a doctor in accordance with an individual prescription.

Milgamma release forms

On the market, the drug is present in two forms: dragee tablets and injection solution. The injectable form is considered to be preferable due to its rapid penetration into the bloodstream and increased efficiency of absorption and action while eliminating the processing factors of the drug components in the digestive tract.
Milgamma Compositum in the form of a dragee for oral administration and an injection solution have differences in the composition of the drug.

Compositions of dosage forms and features of pharmacological action

The complex active substance is B vitamins. Both dosage forms include pyridoxine (B6), which enhances metabolic processes in organs and tissues, improves the conduction of nerve impulses and affects the production of hemoglobin. The combination of pyridoxine and other representatives of group B affects the formation of hormones such as serotonin, histamine and adrenaline.
Thiamine (B1) provides regulation of the energy resource of tissues and cells, affects the process of converting carbohydrates. In tablet form, B1 is included as benfotiamine.
The injection solution is enriched with cyanocobalamin, vitamin B12. It affects the severity of pain, providing a moderate pain-suppressing effect, and reduces the risk of developing anemia.
Milgamma injections provide a pronounced local analgesic effect due to the presence of lidocaine, an analgesic that quickly relieves pain. The use of lidocaine helps restore motor functions damaged due to a neurological disease or pathology of the musculoskeletal system.

When is Milgamma prescribed?

The drug is prescribed, as a rule, as part of complex therapy to reduce the severity of inflammation and reduce pain when diagnosing the following pathologies and diseases:

• neuralgia, neuritis;
• lesions of nervous tissues of non-inflammatory etiology;
• paresis of the facial nerves, accompanied by a violation of the motor functions of facial muscles;
• convulsive syndrome;
• multiple lesions of peripheral nerve endings;
• plexopathies;
• retrobulbar neuritis;
• inflammation of the nerve ganglia;

It is also used for the phenomenon of night cramps of the calf muscle. When indicated, it can be included in the treatment of diseases provoked by the herpes virus.

Instructions for use: doses and duration of treatment courses

Dosages, methods of administration and course of therapy depend both on the individual characteristics of the patient and on the form of the drug.

Milgamma in solution for injection

Distinguish between the use of medication for the relief of acute attacks and in the course of therapy. To relieve pain, a single dose of 2 ml (one ampoule) is prescribed intramuscularly. The duration of therapy for acute attacks depends on the patient's condition, injections are performed daily until a stable condition is reached.
Supportive treatment is carried out at a dose of 2 ml per injection every other day.

Tablet form of the drug

Milgamma in tablets and dragees is used in general courses and maintenance therapy against the background of a stable patient's condition without pronounced and acute attacks. The course of admission is 30 days, 1 tablet per day.
With an exacerbation of the disease and the impossibility of using the injection form, the dosage is up to 3 tablets per day. Take 1 tablet at regular intervals.

Contraindications and side effects of the drug

The main contraindications include heart failure in the decompensated stage, conduction disorders of the heart muscle, as well as individual sensitivity to the components of the drug.
Milgamma in both forms is contraindicated for children under 16 years of age due to the increased vitamin content compared to the age norm. The use of this drug in childhood can lead to hypervitaminosis and the appearance of abnormalities in the functioning of organs and systems.
The use of Milgamma during the gestational period and lactation is not contraindicated, however, it is not recommended by the manufacturers due to the lack of data on testing the composition on this group of recipients.
With caution, a medication is prescribed while taking other drugs and vitamin complexes containing pyridoxine, thiamine, cyanocobalamin due to the risk of overdose.

Possible Side Effects

The likelihood of side effects is extremely low, but the possibility of increased individual sensitivity to the composition of the drug cannot be ruled out. Most often, with the manifestation of side effects, reactions from the skin are noted: itching, rash, urticaria. With the injection method of administering the drug, local reactions are possible, as a rule, due to an excessively high injection rate of the solution or violations of aseptic requirements.
The following types of side effects are less common:

• from the digestive tract - nausea, vomiting;
• on the part of the skin and mucous membranes - a feeling of dryness, peeling, mainly there are complaints about the skin of the lips, face;
• oppressed breathing;
• increased drowsiness, episodes of confusion;
• violations of the rhythm of the heartbeat;
• convulsive syndrome;
• increased sweating;
• anaphylactic shock.

Any side effects when taking the drug - an occasion for immediate medical attention.
Normally, the drug does not adversely affect the reaction rate and mental functions, which allows it to be used when driving a car and in work that requires increased concentration.

Prices for different forms of the drug

The average cost of a drug in pharmacies:

• tablets No. 30 - 700 rubles;
• dragee No. 60 - 1200 rubles;
• solution for injection, 5 ampoules of 2 ml - 300 rubles;
• solution for injection, 25 ampoules of 2 ml - 1200 rubles.

Analogues and substitute drugs

There are many structural analogs containing B vitamins. If necessary, you can use Binavit, Kombipilen, as well as individual B vitamins and lidocaine. It is important to consult a doctor before replacing the drug, since not all analogues contain the same amount of components, and substitution with a set of vitamins requires compliance with the rules for introducing different active substances to ensure the desired therapeutic effect.

Milgamma: instructions for use and reviews

Latin name: Milgamma

ATX code: A11EX

Active substance: pyridoxine + cyanocobalamin + thiamine + lidocaine (pyridoxine + cyanocobalamin + thiamine + lidocaine)

Manufacturer: Worwag Pharma GmbH & Co. KG (Germany)

Description and photo update: 02.05.2018

Milgamma is a neurotropic complex of B vitamins.

Release form and composition

Dosage forms of Milgamma:

• Solution for intramuscular (i / m) administration: a clear red liquid (2 ml each in dark glass ampoules, 5 pcs. in a blister pack, in a carton pack of 1, 2 or 5 packs; in cardboard pallets: 5 pcs. ., in a cardboard bundle 1 or 5 pallets, or 10 pieces, in a cardboard bundle 1 pallet);
• Dragee (15 pieces in a blister pack, in a carton box 2 or 4 packs).

• 1 ml of solution: thiamine hydrochloride (B1) - 50 mg, pyridoxine hydrochloride (B6) - 50 mg, cyanocobalamin (B12) - 0.5 mg, lidocaine hydrochloride - 10 mg;
• 1 dragee: benfotiamine - 100 mg, pyridoxine hydrochloride - 100 mg.

Auxiliary components:

• Solution: benzyl alcohol, sodium polyphosphate, potassium hexacyanoferrate, sodium hydroxide, water for injection;
• Dragee: aerosil, calcium carbonate, titanium dioxide, microcrystalline cellulose, sodium carboxymethylcellulose, povidone, shellac, fatty acid glycerides, sucrose, acacia powder, polyethylene glycol-6000, corn starch, glycerol, glycol wax, tween-80, talc.

Pharmacological properties

Pharmacodynamics

Neurotropic B vitamins have a positive effect on degenerative and inflammatory diseases of the musculoskeletal system and nerves, activating blood flow and improving the functioning of the nervous system.

Thiamine is one of the most important elements in the process of carbohydrate metabolism, as well as in the Krebs cycle, with subsequent participation in the synthesis of adenosine triphosphate and thiamine pyrophosphate.

Pyridoxine is involved in protein metabolism and is partially involved in fat and carbohydrate metabolism. The physiological function of thiamine and pyridoxine is to enhance each other's action, which is expressed in a beneficial effect on the cardiovascular, neuromuscular and nervous systems. The lack of vitamin B 6 leads to the development of widespread deficiency states, which are stopped as soon as possible after the administration of thiamine and pyridoxine.

Cyanocobalamin plays an important role in the synthesis of the myelin sheath, enhances nucleic acid metabolism through the activation of folic acid, reduces the severity of pain caused by damage to the peripheral nervous system, and is a stimulant of hematopoiesis.

Lidocaine is a local anesthetic that causes all types of local anesthesia: conduction, infiltration, terminal.

Pharmacokinetics

When administered intramuscularly, thiamine is rapidly absorbed from the injection site and enters the bloodstream. Its concentration is 484 ng / ml and is reached 15 minutes after a dose of 50 mg on the first day of treatment. Thiamine is distributed unevenly in the body: 75% of the administered dose is found in erythrocytes, 15% in leukocytes, and 10% in blood plasma. Due to the lack of vitamin reserves in the body, it is necessary to ensure its daily intake in the body.

Thiamine crosses the placental and blood-brain barriers and is found in breast milk. Excretion of the substance is carried out in the urine after 0.15 hours in the alpha phase, after 1 hour - in the beta phase, for 2 days - in the terminal phase. Major thiamine metabolites include pyramine, thiamine carboxylic acid, and some unknown metabolites. Of all the vitamins, thiamine accumulates in the body in the smallest concentrations. The body of an adult contains approximately 30 mg of thiamine, 80% of which is in the form of thiamine pyrophosphate, 10% is in the form of thiamine triphosphate, and 10% is in the form of thiamine monophosphate.

After intramuscular administration, pyridoxine is rapidly absorbed into the blood and distributed in the body, playing the role of a coenzyme after its CH 2 OH group is phosphorylated in the 5th position. The vitamin binds to plasma proteins by about 80%. Pyridoxine is distributed throughout the body and crosses the placental barrier, and is also determined in breast milk. The substance accumulates in the liver and is oxidized to 4-pyridoxic acid, which is excreted through the kidneys within 2-5 hours after absorption. The human body contains 4-150 mg of vitamin B 6, its daily elimination rate is approximately 1.7-3.6 mg with a replenishment rate of 2.2-2.4%.

Indications for use

• Neuritis, neuralgia;
• Polyneuropathy, including alcoholic and diabetic;
• Retrobulbar neuritis;
• Ganglionitis, including herpes zoster;
• Neurological manifestations of osteochondrosis of the spine: radiculopathy, lumboischialgia, muscular-tonic syndromes;
• Paresis of the facial nerve.

In addition, the use of Milgamma is shown:

• Solution: as part of the complex therapy of plexopathy, neuropathy, muscle nocturnal cramps (more often in elderly patients);
• Dragee: symptomatic therapy of myalgia, systemic neurological diseases caused by a confirmed deficiency of vitamins B1 and B6.

Contraindications

• The period of pregnancy and breastfeeding;
• Hypersensitivity to the components of the drug.

In addition, the use of Milgamma is contraindicated:

• Solution: the presence of decompensated heart failure, childhood;
• Dragee: heart failure in the stage of decompensation.

Instructions for use Milgamma: method and dosage

The solution is intended for injection. Milgamma injections are done deep intramuscularly. Recommended dosage for severe pain syndrome: 2 ml 1 time per day, course of treatment - 5-10 days. After the removal of acute pain or in mild forms of the disease, the drug is prescribed 2-3 times a week for 2-3 weeks. Treatment should be carried out under weekly medical supervision. The use of the solution should be prescribed for the shortest possible period, followed by the transfer of the patient to taking the drug inside.

Dragee Milgamma is taken orally with a sufficient amount of liquid. Recommended dosage: 1 tablet 1-3 times a day, course of treatment - 1 month.

Side effects

Allergic reactions are not excluded: rarely - shortness of breath, urticaria, skin rash, Quincke's edema, anaphylactic shock.

In addition, Milgamma injections can cause side effects:

• Cardiovascular system: very rarely - tachycardia; in some cases - arrhythmia, bradycardia;
• Nervous system: in some cases - confusion, dizziness;
• Digestive system: in some cases - vomiting;
• Musculoskeletal system: in some cases - convulsions;
• Dermatological reactions: very rarely - itching, increased sweating, acne;
• Local and systemic reactions: in some cases - irritation at the injection site; overdose or rapid administration - increased manifestation of systemic reactions.

Against the background of the treatment of Milgamma dragees, the development of undesirable reactions is possible:

• Cardiovascular system: in some cases - tachycardia;
• Other: in some cases - increased sweating, acne.

Overdose

With a diagnosed overdose of Milgamma, the drug is immediately canceled and symptomatic therapy is prescribed. Its symptoms usually include a sharp increase in the severity of side effects.

special instructions

In case of accidental intravenous administration of a solution, the patient should immediately be examined by a doctor and, depending on the patient's condition, prescribe appropriate therapy or decide on his hospitalization.

Dragee should be used with caution in combination with cycloserine, D-penicillamine.

There is no information on the effect of Milgamma on the patient's ability to drive vehicles and mechanisms.

Application in childhood

Children's age is a contraindication to the appointment of Milgamma.

drug interaction

According to the instructions, Milgamma in therapeutic doses reduces the antiparkinsonian effect of levodopa, this is due to an increase in its peripheral decarboxylation under the influence of pyridoxine. The drug interacts with penicillamine, cycloserine, isoniazid.

The drug interaction of the solution is due to its combined composition.

Due to the content of thiamine, Milgamma solution cannot be combined with reducing and oxidizing compounds, including carbonates, iodides, acetates, ammonium iron citrate, tannic acid, phenobarbital, benzylpenicillin, riboflavin, dextrose, disulfites. Completely destroyed in solutions of sulfites, the decomposition products of thiamine reduce the activity of other vitamins. The effectiveness of thiamine is lost at a pH of more than 3, and copper also helps to accelerate the processes of its destruction.

With the simultaneous use of epinephrine and norepinephrine, the presence of lidocaine in the solution may cause an increase in side effects from the heart. Interaction with sulfonamides has also been noted.

Due to the presence of cyanocobalamin, the Milgamma solution cannot be combined with salts of heavy metals, riboflavin (especially with simultaneous exposure to light).

Antioxidants slow down the clinical effect of the drug, the action of nicotinamide accelerates photolysis.

Analogues

Analogues of Milgamma are: Vitakson, Vitagamma, Kombilipen, Compligam B, Neuromultivit, Binavit, Triovit, Pikovit.

Terms and conditions of storage

Keep out of the reach of children at a temperature:

• Solution: up to 15°C in a place protected from light;
• Dragee: up to 25°C.

Shelf life: solution - 2 years, dragee - 5 years.