What is alpha-lipoic acid, how is it useful, who is it indicated and contraindicated, how to take it?

What is Alpha Lipoic Acid

ALA is an organosulfur substance that belongs to the category of conditional vitamins (that is, similar in action, but not considered a vitamin). Alpha lipoic acid has antioxidant properties and is a cofactor for many important reactions. The substance takes part in the metabolism of carbohydrates, blood formation, and strengthens nerve cells. The substance may be known by other names: vitamin N or thioctic acid.

For the consumer, there are no differences between lipoic, alpha-lipoic and thioctic acid. These are all names for the same substance. In the food and dietary supplement industry, the name most often used is alpha lipoic acid.

Biological role of ALA

The main effect of alpha lipoic acid is to inhibit oxidative stress in cells. This is extremely important for preventing the negative effects of free radicals, maintaining health and maintaining a youthful body. The main benefits of alpha lipoic acid in the body:

• Improving the functioning of the cardiovascular, endocrine and other systems;
• Protecting nerve tissue from stress;
• Improved elimination of toxins and metabolic by-products from the body;
• Improving the utilization of fat cells;
• Improves liver function.

In general, alpha-lipoic acid has many indications for use; the substance has a positive effect on almost all tissues, organs and systems. The range of uses of vitamin N ranges from simply increasing energy to supporting the body in diabetes or liver damage. The substance is also used in cosmetology; it is included in many creams for skin rejuvenation, eliminating age spots, and smoothing wrinkles. Although topical use of alpha lipoic acid has minimal effect compared to obtaining the compound from food or supplements.

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4. Miquel, J. Can antioxidant diet supplementation protect against age-related mitochondrial damage? Ann NY Acad Sci 959:508-516, 2002.
5. Sytze Van Dam, P. Oxidative stress and diabetic neuropathy: pathophysiological mechanisms and treatment perspectives. Diabetes Metab Res Rev 18:176-184, 2002.
6. Sen, S. K. Update on thiol status and supplements in physical exercise. Can J Appl Physiol 26 Suppl:S4-12, 2001.
7. Greene, E.L., B.A. Nelson, K.A. Robinson, M.G. Buse. alpha-Lipoic acid prevents the development of glucose-induced insulin resistance in 3T3-L1 adipocytes and accelerates the decline in immunoreactive insulin during cell incubation. Metabolism 50:1063–1069, 2001.
8. Khanna, S., M. Atalay, D. E. Laaksonen, M. Gul, S. Roy, S. K. Sen. Alpha-lipoic acid supplementation: tissue glutathione homeostj at rest and after exercise. J Appl Physiol 86:1191–1196, 1999.
9. Schmidt, M. C, E. W. Askew, D. E. Roberts, R. L. Prior, W. Ensign, Jr., R. E. Hesslink, Jr. Oxidative stress in humans training in a cold, moderate altitude environment and their response to a phytochemical antioxidant supplement. Wilderness Environ Med 13:94-105, 2002
10. Petersen Shay K, Moreau RF, Smith EJ, Hagen TM. Is alpha-lipoic acid a scavenger of reactive oxygen species in vivo? Evidence for its initiation of stress signaling pathways that promote endogenous antioxidant capacity. IUBMB Life. 2008 Jun;60(6):362-7. Review. PMID: 18409172

Who should take alpha lipoic acid?

Taking ALA is divided into two categories - for a specific purpose and for general health promotion. Doctors and nutritionists identify a number of main indications for the use of vitamin N:

• To prevent age-related changes - the most widespread indication that affects almost all aspects of health: from strengthening the immune system to reducing the risk of developing cancer;
• For endocrine disorders, to increase the synthesis of thyroid hormones;
• Improving memory, reducing the risk of Alzheimer's disease;
• Gastrointestinal disorders and diseases - the substance normalizes digestion, improves liver function;
• While taking medications or in any cases where a hepatoprotective effect is necessary;
• For central nervous system disorders, insomnia, depression and other psycho-emotional disorders;
• For rejuvenation of skin and other tissues;
• Strengthening the cardiovascular system, preventing heart attack and other diseases;
• To support the body with diabetes, reduce the risk of developing concomitant diseases.

The use of ALA for weight loss

Alpha lipoic acid is often prescribed for weight loss. It is not a direct fat burner, but can help accelerate weight loss during dieting and active physical activity. Reduction of body fat mass occurs due to:

• Decreased appetite and the ability to better tolerate hunger;
• Acceleration of metabolic processes, better consumption of calories by the body;
• Increased sensitivity to insulin;
• Improves liver function, prevents fatty hepatosis.

The use of alpha lipoic acid in sports

In sports, alpha lipoic acid is used not only for weight loss. The substance increases protein synthesis, which directly affects muscle growth and recovery. This makes alpha lipoic acid effective in any discipline: strength, aerobic, cyclic and other sports.

Another important effect due to which ALA is highly valued in sports (especially in strength sports) is its antioxidant effect. Any physical activity is stressful for the body, and when it accumulates, various malfunctions in the body can occur. Reducing oxidative stress can enhance not only physical regeneration, but also enhance the restorative abilities of the central nervous system and endocrine systems. The use of ALA allows you to train more often without loss of efficiency, maintain muscle volume, strength, and endurance levels.

Application

It is recommended to use lipoic acid, as well as B vitamins: for atherosclerosis, polyneuritis, liver pathology, for various poisonings, to stabilize cholesterol levels in the blood, to rid the body of toxins, to speed up metabolism.

The instructions for the drug recommend its use in cases such as: progression of type II diabetes mellitus and diabetic polyneuropathy in cases of alcoholic polyneuropathy in the treatment of liver pathologies (cirrhosis, fatty degeneration, hepatitis, intoxication) diseases of the nervous system in the treatment of tumor pathologies in the treatment of hyperlipidemia

Reviews after drug therapy say that it is very effective, provided that all standards and recommendations for use are followed.

Lipoic acid for weight loss

Lipoic acid does not provoke getting rid of extra pounds on its own; this happens by lowering blood sugar levels and reducing hunger. A person begins to control the size of portions consumed and thereby lose weight.

Reducing hunger helps you survive while dieting, which of course helps you lose weight.

Stabilizing blood sugar levels improves fat metabolism - stabilizes the general condition, improves well-being, and promotes weight loss.

Thioctic acid also helps the body completely burn consumed carbohydrates, which prevents the accumulation of excess fat. This effect may only contribute slightly to weight loss.

Lipoic acid is able to bind and remove toxins, which helps you lose extra pounds faster and makes the process easier. This means that by itself it does not cause weight loss. But its effects can help you lose weight if you follow a diet and exercise. To do this, it is recommended to take thioctic acid in the form of dietary supplements, supplementing L-carnitine and B vitamins.

Those who pursue the goal of losing weight are recommended to take 12-15 mg of the drug 2-3 times a day after meals, before and after exercise. The maximum allowable amount is 100 mg of lipoic acid per day. The duration of taking thioctic acid for weight loss is 2-3 weeks. Patients are satisfied with the result, because... In addition to an ideal figure, they strengthen the immune system and feel an unprecedented surge of vital energy.

What foods contain lipoic acid?

In addition to dietary supplements, it is part of the following products: beef liver, kidneys and heart, red meat green vegetables, including leafy ones, especially spinach potatoes tomatoes beans brewer's yeast rice bran mushrooms dairy products nod carrots bell peppers eggs Other vegetables and fruits content this substance is much lower.

Where to buy lipoic acid

You can buy the drug in tablets in pharmacies. Lipoic acid is sold without a prescription, in a package of 50 tablets of 50 mg. The second name is thioacetic acid. There are also dietary supplements with alpha-lipoic acid, but their price is much higher. The difference is in the place of production of the drug. In addition, another form of the drug is used - purified. But its effectiveness is no less than that of a pharmaceutical drug. Alpha lipoic acid is found in sports nutrition. It is usually used along with L-carnitine because it helps burn fat. The effect of such drugs is much stronger because they are specifically designed to reduce fat deposits and increase muscle mass. Their cost is very high.

Possible contraindications and side effects

Despite the huge range of positive effects, alpha lipoic acid has a number of contraindications. Therefore, you should not be negligent in taking the supplement and exceed the dosage on your own.

It is recommended to discontinue or temporarily limit intake of the supplement in the following cases:

• For peptic ulcers or inflammatory phenomena in the gastrointestinal tract;
• With iron deficiency;
• For decompensated diabetes mellitus;
• For acute bronchitis;
• While breastfeeding.

In some cases, negative effects may occur only at the beginning of the course; this is an individual reaction and increased sensitivity to the substance. In this case, doctors may temporarily lower the dosage to ease the adjustment period. The compound itself is not dangerous to the body and can cause side effects only with a severe overdose.

It is strictly forbidden to drink alpha lipoic acid in combination with any alcohol. When combined with ethanol, the risks of any side effects increase greatly.

Benefit

The beneficial properties of lipoic acid are still being studied. To date, it has been found that this is a powerful antioxidant that slows down the aging process in the body and suppresses the formation of free radicals. It is able to penetrate every cell of the body and protect them from radical damage and, as a result, from various pathologies. The substance enhances the antioxidant effect of vitamin C, E and coenzyme Q10. Thanks to this property, lipoate has a beneficial effect on the body:

Preparations with lipoic acid are prescribed to people with diabetes. It has been proven that the substance reduces the need of body cells for glucose and increases their susceptibility to it. It also helps maintain normal blood glucose levels.

Athletes and people who frequently exercise take this drug as it improves metabolism and helps build muscle mass. When combined with intense training, lipoate helps you burn fat faster and release more energy, thereby helping you achieve your desired shape.

If you don’t want to build up muscles, but want to reduce volume and lose weight, then you should take the drug according to a certain regimen, which should be prescribed by your doctor. Due to the fact that lipoate improves metabolism, it is able to increase the digestibility of carbohydrates and prevent them from being deposited in excess fat on the body.

Lipoic acid is important in the treatment of liver diseases. It is prescribed for viral hepatitis B and C, cirrhosis and fatty liver, liver failure, non-alcoholic steatohepatitis. The drug improves the functioning of the organ, inhibits the development of fibrosis and malignant tumors, thanks to its antioxidant properties, normalizes fat metabolism in liver cells and stops inflammatory processes.

Lipoate improves body tone and prevents the development of many aging diseases, including Parkinson's, Alzheimer's, dementia, etc. The drug is prescribed for chronic fatigue, stress, decreased memory and attention. The drug is also able to prevent glaucoma and cataracts, which develop mainly in old age.

The substance is able to bind heavy metal salts and remove them from the body. Therefore, its use is prescribed for severe intoxication of the body, including alcohol and drugs.

Lipoic acid is similar in effect and structure to vitamin B, so it is often prescribed for diseases of the nervous system and cardiovascular pathologies. It helps normalize blood pressure, improve vascular permeability, and eliminate numbness in the limbs.

Harm

There is no need to think that this antioxidant will not cause any harm to the body. If you take the drug incorrectly or use it excessively, the following side effects are possible:

Heartburn, stomach or intestinal upsets, nausea, skin rash, itchy skin; in severe cases, anaphylactic shock is possible.

A sharp drop in blood glucose levels. Therefore, persons suffering from diabetes should under no circumstances violate the drug dosage regimen and take it only under the supervision of a doctor.

Lipoate reduces the effectiveness of chemotherapy, so it is not recommended to combine them.

If you have problems with the thyroid gland and hormonal imbalance, you should use the substance with caution, as it can negatively affect hormonal levels.

Long-term use of the drug for peptic ulcers and gastritis can aggravate the problem. Also, for any other chronic diseases, long-term use is agreed with the doctor.

How to take ALA

Manufacturers often indicate on the packaging how to properly take alpha lipoic acid. Typically, a serving should be washed down with plain water 30 minutes before a meal. When combined with food, juices, dairy drinks or other liquids, the bioavailability of the substance will be significantly reduced. Therefore, it is optimal to drink ALA with a portion of plain water at room temperature.

Daily dosages vary, from 50 to 400 mg. This is a standard therapeutic and maintenance dosage in which the substance can be used on an ongoing basis. For therapeutic purposes, the daily dose usually increases, depending on the diagnosis. In this case, the substance can be taken in dosages from 600 to 1800 mg/day. High dosages are indicated mainly for severe forms of diabetes mellitus and other acute conditions. In sports, the daily intake of the substance is usually 500-800 mg.

Best Alpha Lipoic Acid Supplements

Almost all major manufacturers make ALA supplements. Some of the best alpha lipoic acid supplements include:

• Alpha Lipoic Acid from NOW is the optimal choice in terms of quality, price and bioavailability. The manufacturer produces up to 10 variations with different dosages and packaging. The most profitable packaging is considered to be 120 capsules, with dosages of 600 mg. This is the standard daily value for most uses;
• Alpha Lipoic Acid California Gold Nutrition is NOW's main competitor. It is of the same high quality; some forms of release have a more favorable price. It is also recommended to pack with 120 capsules of 600 mg per package;
• Doctor's Best Alpha-Lipoic Acid is one of the most beneficial options for therapeutic use. Each capsule contains 150 mg of the substance;
• Natrol's Alpha Lipoic Acid is the best supplement for diabetics or when you need a slow release and gradual absorption of the substance. ALA from this manufacturer is distinguished by a slow release system, which ensures a long and gradual release of the substance into the blood. Another benefit is 600 mg per tablet;
• Solgar's Alpha Lipoic Acid is simply a good supplement from one of the world's most famous brands. It has high quality, but loses to competitors in terms of price;
• Life Extension's Super R-Lipoic Acid is the most expensive, low-dose supplement available. A package of 60 capsules of 240 mg costs almost twice as much as analogues of 120 capsules of 600 mg. However, its main advantage is the highest bioavailability, which is achieved through the use of a special form.

Thioctic acid: antioxidant therapy for neurological diseases

The use of thioctic acid in medical practice is largely associated with the development of ideas about “oxidative stress” and lipid peroxidation as a fairly universal pathogenetic mechanism of cell and tissue damage [24]. The antioxidant effect of thioctic acid is due to the presence of two thiol groups in the molecule (hence the prefix “thio”), as well as the ability to bind free radicals and free tissue iron (preventing its participation in lipid peroxidation) [10]. Thioctic acid not only has independent antioxidant potential, but also provides powerful support for the work of other antioxidant units in the body [23]. In this regard, its protective effect is closely related to homeostasis in the glutathione and ubiquinone system [8]. The production of reactive oxygen species increases significantly with inflammation, immunological disorders, hypoxia, hyperoxia, exposure to drugs, radiation, and antioxidant deficiency.

Thioctic acid is one of the most powerful antioxidants used in the treatment of diabetic neuropathy [2, 25]. Thioctic acid is a coenzyme of key enzymes in the Krebs cycle, which explains its effectiveness. An additional advantage in the mechanism of action of thioctic acid is its clearly documented effect of glucose utilization [15]. The high efficiency and pathogenetic effect of thioctic acid have been proven by numerous experimental and clinical studies. The adequate and rational use of thioctic acid preparations is based on the results of numerous studies (ALADIN I, ALADIN II, ALADIN III, ORPIL, NATHAN, DECAN, SYDNEY), which tested the dose, frequency of administration and course duration (Table 1).

A multicenter, randomized, double-blind study (SYDNEY II) assessed the effectiveness of thioctic acid in the treatment of patients with diabetic polyneuropathy (DPN) [1, 3]. The study was conducted from 2004 to 2006, it involved 87 patients with diabetes mellitus (DM) of type 1 and 2, who were undergoing inpatient (National Healthcare Institution Central Clinical Hospital No. 1 of JSC Russian Railways) and outpatient treatment (Department endocrinology of the State Educational Institution of Additional Professional Education of the Russian Medical Academy of Postgraduate Education (Roszdrav). The SYDNEY study concluded that intravenous alpha lipoic acid for 3 weeks. causes a significant reduction in neuropathic symptoms and neurological objective symptoms that are painful for patients. Considering the dose-dependent effect of side effects, the optimal dosage is 600 mg of thioctic acid. The authors concluded: as a result of a comprehensive clinical and neurophysiological study of patients with type 1 and type 2 diabetes, it was noted that the earliest EMG indicator of sensory nerve damage in diabetes is a decrease in the action potential. Pain reduction occurred from the 2nd week. taking thioctic acid at a dose of 1800 mg/day, from the 4th week. reception - at a dose of 1200 mg and only by the 5th week. - while taking 600 mg of thioctic acid [3]. In patients with DPN (n=24) participating in the study, using thioctic acid at a dose of 1800 mg/day for 3 weeks. neuropathic symptoms and neurological deficits decreased; the incidence of side effects was comparable to the placebo group [29].

In medical practice, a number of thioctic acid preparations are used for therapeutic purposes, which are represented by its three main salts: ethylenediamine, trometamol and megluminic [12]. One of the drugs whose active substance is thioctic (alpha-lipoic) acid is Thiogamma® (pharmaceutical (Germany)). Thiogamma® is a meglumine salt of alpha-lipoic acid, polyethylene glycol is used as a solubilizer, their advantages are to suppress the formation of free radicals, improve the energy metabolism of neurons, and restore impaired endoneurial blood flow. The drug is available in the form of tablets containing 600 mg of the drug, a solution for intravenous infusion in bottles containing 600 mg of the drug in the form of meglumine salt, and ampoules. Meglumine (N-methyl-D-glucamine) is known to be used as a stabilizer in many pharmaceutical products [12]. Meglumine is also used to reduce the toxicity of gadolinium in magnetic resonance contrast media. It is used as the antimonate meglumine to treat leishmaniasis. It was demonstrated that in the experiment, mice accepted a dose of up to 1 g/kg when administered intraperitoneally without side effects. There is only one report of the development of an anaphylactic reaction in a patient with osteoid osteoma after the use of gadoteric and gadopentetic acid during an MRI study. No descriptions of other negative effects of meglumine could be found. Thus, we can conclude that of all the stabilizers used for the manufacture of dosage forms of thioctic acid, meglumine is the least toxic.

Instructions for use of the drug Thiogamma® were approved on 04/15/1999 by the State Pharmacological Committee of the Ministry of Health of Russia, re-registration on 05/24/2010 (for tablet forms), 02/29/2012 (for injection forms) [19]. The drug is prescribed 1 r./day 300–600 mg, taken without chewing, with a small amount of liquid. According to the ALADIN I study [28], the effect of alpha-lipoic acid on positive neuropathic symptoms at doses of 600 and 1200 mg is practically the same. In a clinical study of 3 weeks of intravenous alpha-lipoic acid, side effects (headache, nausea, vomiting) were more common with 1200 mg (32.6%) than with 600 mg (19.8%) with placebo. (20.7%) [28]. It was concluded that a dosage of 600 mg of alpha-lipoic acid is optimal both from the point of view of clinical effectiveness and taking into account the possibility of developing side effects.

The clinical use of thioctic (alpha-lipoic) acid (in particular, Thiogamma®) is based on the many biochemical and physiological effects of this substance [6]. The main mechanisms of action of Thiogamma®, according to those set out in the Methodological Recommendations of V.V. Gorodetsky (2004) [8], can be presented as follows:

• influence on energy metabolism, glucose and lipid metabolism (participation in the oxidative decarboxylation of keto acids) with activation of the Krebs cycle; increased uptake and utilization of glucose by the cell and oxygen consumption; increase in basal metabolism; normalization of gluconeogenesis and ketogenesis; inhibition of cholesterol formation;
• cytoprotective effect: increased antioxidant activity (direct and indirect through the vitamin C/E, cystine/cysteine ​​and glutathione systems); stabilization of mitochondrial membranes;
• influence on the reactivity of the body: stimulation of the reticuloendothelial system; immunotropic effect; anti-inflammatory and analgesic activity (associated with antioxidant effects);
• neurotropic effects: stimulation of axon growth, positive effect on axonal transport, reduction of the harmful effects of free radicals on nerve cells, normalization of abnormal glucose supply to the nerve, prevention and reduction of nerve damage in experimental diabetes;
• hepatoprotective effect: accumulation of glycogen in the liver, inhibition of lipid accumulation in the liver (in some pathological conditions), increased activity of a number of enzymes, improvement of the functional activity of the liver;
• detoxification effect (FOS, lead, arsenic, mercury, sublimate, cyanides, phenothiazides, etc.).

The main indications for the use of the drug Thiogamma® in the treatment of diseases accompanied by neurological symptoms are focused on diabetic and alcoholic polyneuropathy [18]. Currently, thioctic (alpha-lipoic) acid, in particular Thiogamma®, is the most effective agent in the treatment of peripheral polyneuropathy, which has been confirmed by large-scale multicenter long-term studies, such as the ALADIN Study (Alpha-Lipoic Acid in Diabetic Neuropathy) [16]. However, the antioxidant activity of thioctic acid is used in many areas of medicine [10] (Table 2).

Thioctic (alpha-lipoic) acid is a powerful lipophilic antioxidant and is rightfully considered the “gold standard” for the pathogenetic treatment of diabetic polyneuropathy (DPN) [8]. A number of studies have shown that the use of alpha-lipoic acid at a dose of 600 mg/day intravenously or orally for 3 weeks. up to 6 months reduces to a clinically significant extent the main symptoms of DPN, including pain, paresthesia and numbness. It is known that the cause of a 50–70% decrease in the rate of insulin-dependent transmembrane glucose transport in diabetes is oxidative stress. The basis for treating DPN with thioctic (alpha-lipoic) acid drugs is the fact that in diabetes there is a deficiency of alpha-lipoic acid, and alpha-lipoic acid (which has a powerful antioxidant effect), in turn, increases the bioavailability of glucose in insulin-dependent and non-insulin-dependent tissues , increases the absorption of glucose by peripheral nerves to normal levels, and also promotes an increase in endoneurial glucose reserves, which has a beneficial effect on the restoration of energy metabolism of nerves. It is believed that the administration of thioctic acid is advisable for insulin-resistant forms of diabetes [10]. In this case, it is considered optimal to prescribe an intravenous drip of alpha-lipoic acid solution at the beginning of treatment for 3 weeks. (15 droppers) followed by taking 600 mg of the drug in tablet form (1 r./day 30–40 minutes before meals) for 1–2 months. [8].

The effectiveness of Thiogamma® in DPN has been convincingly demonstrated in many clinical studies. At the Sofia Medical University (Bulgaria), T. Tankova et al. (2000) conducted a randomized, open, placebo-controlled study [7–9] to evaluate the effectiveness of the drug Thiogamma® using a 2-stage prescription regimen: after a period of intravenous infusions, the drug was administered orally. A constant dose of 600 mg/day was used, intravenous administration was carried out for 10 days, oral administration for another 50 days. A pronounced clinical effect appears after the first 10 days of therapy. When compared with the control group, in patients receiving Thiogamma®, the intensity of spontaneous pain in the legs decreased by 40%, and vibration sensitivity, which was significantly reduced before treatment and determined in various areas of the foot, increased by 35%. By the end of the course of therapy, positive dynamics were noted in reducing the severity of pain according to VAS and increasing vibration sensitivity. Positive dynamics of indicators characterizing the severity of damage to the autonomic nervous system were also obtained: over 60 days of therapy, manifestations of autonomic neuropathy decreased by 40% and the drop in systolic blood pressure during an orthostatic test decreased by 2.5 times, which indicates an improvement in the function of the autonomic nervous system.

As part of another monocenter, randomized, double-blind, placebo-controlled study, 120 patients with type 1 and type 2 diabetes were examined, of which 60 received placebo and 60 received alpha-lipoic acid (at a dose of 600 mg in 225 ml of saline at a time of intravenous drip administration 30–40 min) [1]. We studied the effect of this drug on the clinical manifestations of DPN, electromyographic (EMG) indicators, indicators of quantitative sensory and autonomic testing in 60 patients with type 1 and type 2 diabetes. The duration of the study was 4 weeks. Positive neuropathic symptoms were chosen as the main criterion for the clinical effectiveness of the study drug due to the fact that they primarily disrupt the patient’s quality of life. An improvement in the distal latency indicator in an EMG study indicates that the main unpleasant sensations (pain, burning, numbness, paresthesia), which worsen the patient’s quality of life, decreased during alpha-lipic acid therapy due to improved peripheral nerve function. Thus, the drug has been shown to be highly effective in relation to most of the studied indicators of the condition of peripheral nerves. It was concluded that thiocotic (alpha-lipoic) acid preparations can be successfully used in the treatment of symptomatic DPN.

In a study by I. I. Matveeva et al. [13], conducted in the “Diabetic Foot” office of the Izhevsk Endocrinology Center, examined 126 patients with newly diagnosed type 2 diabetes (screening), who were prescribed the drug thioctic acid intravenously for 10 days at a dose of 600 mg, subsequently in tablets of 600 mg. mg daily for 8–10 weeks. Based on the results of the study, it was concluded that the drug thioctic acid is highly effective in the treatment of distal DPN, clinical symptoms and the condition of peripheral nerves improve, oxidative stress and insulin resistance decrease.

In another study [14], 50 patients with diabetic and hypothyroid distal symmetric sensorimotor polyneuropathy were prescribed the drug Thiogamma®, first at a dose of 600 mg (equivalent to 1167.70 meglumine salt of alpha-lipoic acid) intravenously, drip for 10 days, 1 injection per day , the injection rate was no more than 50 mg/min. It is also important to note that a distinctive feature of the drug Thiogamma® is the release form, which allows the drug to be administered intravenously, by drip, without requiring prior dilution. Then, for 30 days, patients took Thiogamma® 600 mg in the morning and on an empty stomach. During the study, the author came to the conclusion that among all forms of DPN, the greatest effect of using the drug Thiogamma® was noted in the treatment of acute sensory polyneuropathy and radiculoplexopathy; in the treatment of progressive sensorimotor polyneuropathy, the use of Thiogamma® also showed a statistically significant therapeutic result. In relation to hypothyroid polyneuropathy, Thiogamma® showed high efficiency, in particular for reducing and eliminating pain, however, the positive dynamics during treatment with Thiogamma® clearly correlated with adequate replacement therapy with thyroid hormones.

In a study by E. Yu. Komelyagina et al. (2006) [11] presented the results of a comparison of the effectiveness of two options for treating DPN with thioctic acid drugs: option 1 - oral administration of 1800 mg/day (600 mg 3 times/day) for 4 weeks. (n=15) and 2nd option - oral administration of 600 mg/day for 3 months. (n=15). The study showed that in both modes of use, the drug thioctic acid provides a significant reduction in the severity of neuropathic complaints in patients with diabetes with a satisfactory level of compensation for carbohydrate metabolism. Based on the results of the study, the authors came to the conclusion: “... the choice of treatment regimen for DPN using thioctic acid drugs is individual and depends on the specific situation: in case of severe pain symptoms, a shorter course with a high dosage of the drug (1800 mg/day for 4 weeks. ), with unexpressed symptoms - a longer course with a lower daily dosage (600 mg/day for 3 months)...".

The range of use of drugs containing thioctic acid, both as monotherapy and as part of complex therapy, is constantly expanding. In a comparative open randomized study [5], conducted at the Department of Occupational Diseases of the St. Petersburg State Medical Academy named after. I. I. Mechnikov, evaluated the effectiveness of the drug, the active substance of which is thioctic acid, in the complex treatment of manifestations of vibration disease (syndrome of vegetative-sensory polyneuropathy of the extremities, angiodystonic syndrome). Use at a dosage of 600 mg daily as part of complex therapy for 21 days significantly reduces the frequency of subjective complaints of patients, leads to a persistent reduction in relapses of pain in the extremities, a decrease in the frequency of attacks of vasospasms, enhancing the effect of therapy in general. Thus, the effectiveness of this drug has been shown in relation to vascular tone, blood filling and venous outflow, which, according to the authors, causes the development of anti-inflammatory, anti-edematous, analgesic effects and contributes to the normalization of homeostasis.

Research by M. Senoglu et al. (2009) [27] showed the effectiveness of alpha-lipoic acid against such clinical symptoms as pain, paresthesia, hypoesthesia in patients with compressive radiculopathy due to discoradicular conflict. The results of this study correlate with a study in which M. Ranieri et al. (2009) [26] assessed the effectiveness of the additional use of a combination of alpha-lipoic and gamma-linolenic acid in a 6-week rehabilitation program for patients with discogenic radiculopathy when compared with a similar group of patients receiving only a rehabilitation program. A case of effective use of the drug thioctic acid (600 mg/day for 1 month) as part of complex therapy in a patient with stage III Lyme disease (neuroborreliosis, changes in the central nervous system, damage to the cranial nerve, peripheral polyneuropathy due to neuroborreliosis) is described [4].

Employees of the Clinic of Neurology and Neurosurgery of the Medical Faculty of the Russian State Medical University (now Russian National Research Medical University) E. I. Chukanova et al. (2001–2014) [20–22] a number of studies were conducted to evaluate the effectiveness of the use of thioctic acid in the treatment of patients with discirculatory encephalopathy (DE) and when prescribed in complex pathogenetic therapy of vascular cognitive impairment. Based on the example of a study of 49 patients with DE, it was shown [20] that when prescribing thioctic acid in a dosage regimen of 600 mg 2 times / day for 7 days, switching to 600 mg 1 time / day for 53 days orally in 30 min before meals allows you to achieve a positive effect by the 7th day of treatment (at a dose of 1200 mg/day); when the dose is reduced to 600 mg/day (from the 8th day of treatment), the positive effect of the drug on the dynamics of the neurological status is maintained and is most pronounced by 60th day. Positive dynamics were noted in the neurological and neuropsychological status of patients with DE. Based on the results of the study, it was concluded that thioctic acid is effective not only in the treatment of patients with DE with elevated glucose levels, but also in patients with cerebrovascular insufficiency without diabetes [20]. In a study of a group of 128 patients with DE [21], a pharmacoeconomic analysis of the effectiveness of treatment with thioctic acid was conducted in patients with different stages of chronic cerebral vascular insufficiency. The drug thioctic acid was prescribed orally at a daily dose of 600 mg 2 times/day for 7 days, switching to 600 mg 1 time/day for 23 days 30 minutes before meals. The study established: in patients with stage I DE. — regression of asthenic syndrome, vestibular ataxia, axial reflexes; in patients with stage II DE. — increasing the effectiveness of influencing the indicators of the “movement” scale, ataxia, pseudobulbar syndrome; in patients with stage III DE. — a positive effect on the indicators of the “movement” scale, ataxia (frontal and cerebellar), pseudobulbar syndrome, which persisted until the 12th month. observations, and also showed a statistically significant effect on the dynamics of the amyostatic syndrome score. The authors of the study concluded that treatment with thioctic acid in patients with DE leads to significant clinical improvement, reduces the risk of strokes during the course of the disease and reduces the percentage of disease progression in patients with stage I and II DE. A small percentage of side effects were noted. Thioctic acid is well tolerated by patients, including patients of older age groups. Thioctic acid therapy is preferable from an economic point of view compared to the cost of treatment of patients in the control group who received antihypertensive and antithrombotic therapy, which is associated with its high effectiveness in influencing the risk of TIA, stroke and progression of DE.

Conclusion

The data available today allow us to recommend that a doctor prescribe the drug Thiogamma® in the treatment of patients with neuropathy of somatogenic origin. The developed scheme of 2-stage administration of the drug Thiogamma® is successfully used with a high degree of efficiency: intravenous infusions of the finished solution of the drug Thiogamma® for 10 days (in bottles of 50 mg of solution for infusion of 12 mg/ml, which is equivalent to 600 mg of thioctic acid, with the time of intravenous drip administration for 30–40 minutes) followed by administration of the tablet form of the drug (600 mg/day) for 50 days. From the point of view of clinical effectiveness and taking into account the possibility of side effects, a dosage of thioctic (alpha-lipoic) acid of 600 mg/day is optimal. Individual approach to the dosage regimen: for severe pain symptoms - a shorter course with a high dosage of the drug (1800 mg/day for 4 weeks), for less severe symptoms - a longer course with a lower daily dosage (600 mg/day for 3 months).

It is important to note that a distinctive feature of the drug Thiogamma® is its release form, which allows the drug to be administered intravenously, by drip, without requiring prior dilution.

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