Pharmacodynamics and pharmacokinetics
Diclofenac sodium is characterized as an anti-inflammatory, antiplatelet, analgesic and antipyretic agent. It has a non-selective inhibitory effect on COX-1 and COX-2, reduces the content of prostaglandins at the site of inflammation, and also interferes with the metabolism of arachidonic acid. For rheumatic diseases, this substance helps reduce swelling of the joints, pain, and the severity of morning stiffness. This significantly improves the functional state of the joints.
Pyridoxine hydrochloride normalizes the functioning of the nervous system. It serves as a coenzyme for important enzymes found in nerve tissues. In addition, it takes part in the biosynthesis of many neurotransmitters.
Thiamine hydrochloride, entering the human body, is converted into cocarboxylase. It is a coenzyme for many enzymes. It is an important component of metabolic processes in the body. Actively participates in the processes of nervous excitation at synapses.
Cyanocobalamin is a means for stabilizing hematopoiesis and maturation of red blood cells, which takes part in many biochemical reactions necessary for the normal functioning of the body. It also has a beneficial effect on processes occurring in the nervous system. Coenzyme forms of this substance are needed for cell renewal and growth.
The combination of B vitamins found in Neurodiclovit (pyridoxine, thiamine, cyanocobalamin) potentiates the analgesic properties of diclofenac.
Diclofenac is characterized by rapid and complete absorption upon entering the body. However, food intake slows down this process by 1-4 hours, and also reduces the maximum concentration of the active component by 40%. After taking the capsules orally, the maximum concentration of this substance is achieved in the body after 2-3 hours. It is linearly dependent on the amount of the administered dose.
The degree of bioavailability of the drug is 50%. Strong connection with blood plasma proteins. The half-life of elimination from synovial fluid is approximately 4-5 hours. The maximum concentration in synovial fluid is reached approximately 3 hours later than in plasma.
50% of the active component is broken down in the liver. Metabolic processes occur after hydroxylation and conjugation with glucuronic acid. The enzyme system P450 CYP2C9 is involved in the breakdown of Neurodiclovit. 65% of the drug is excreted through the kidneys in the form of metabolites, less than 1% - unchanged. The remaining part is excreted through bile, also in the form of metabolites.
Systemic clearance – 350 ml/min. The plasma half-life is 2 hours. Diclofenac may pass into breast milk.
The B vitamins included in the preparation are water-soluble. Absorption of pyridoxine and thiamine occurs in the upper part of the small intestine. This process largely depends on the dosage. In the body, they are broken down in the liver and excreted mainly through the kidneys. Only about 9% is excreted unchanged. At higher doses, the excretion of pyridoxine and thiamine through the intestines increases.
The absorption of cyanocobalamin largely depends on the presence of intrinsic factor in the stomach and upper small intestine. Transportation of this substance is determined by transcobalamin. After breakdown in the liver, it is excreted primarily in bile. Only about 6-30% of cyanocobalamin is excreted through the liver.
Pharmacological properties of the drug Neurodiclovit
Pharmacodynamics . Neurodiclovit is a combination drug containing diclofenac sodium and vitamins B1, B6 and B12. B vitamins function as coenzymes in metabolism, in particular in nervous tissue, which enhances the analgesic effect of diclofenac. Like other NSAIDs, dilofenac inhibits the activity of the COX enzyme, which is involved in the formation of prostaglandins from arachidonic acid. Diclofenac also inhibits the activity of the enzyme lipoxygenase. The analgesic, anti-inflammatory and antipyretic effect of diclofenac is due to inhibition of prostaglandin synthesis. Pharmacokinetics. After oral administration, dliclofenac is well and completely absorbed from the gastrointestinal tract. Bioavailability is not affected by concomitant food intake. The maximum concentration in the blood plasma is achieved 1–2 hours after administration (when taken on an empty stomach, it is achieved faster than when taking the drug with food). The therapeutic concentration of the drug in blood plasma is 0.7–2.0 mg/l. Almost 99% of diclofenac is bound to plasma proteins, mainly albumin. The half-life of diclofenac from blood plasma is about 2 hours. The total systemic clearance of diclofenac from blood plasma is about 250 ml/min. Approximately 60% of the administered dose of the drug is excreted by the kidneys in the form of active metabolites; ≤1% of diclofenac is excreted unchanged. About 30% of the drug dose is excreted in the form of metabolites in bile and feces. Impaired renal function does not cause accumulation of the active substance due to increased excretion in the bile. Absorption, metabolism and excretion of the drug do not depend on the patient's age. The vitamins included in the drug are absorbed in the intestine thanks to active and passive transport mechanisms. Distribution and excretion are similar to those for vitamins obtained from food.
Contraindications
The medicine should not be taken in case of hypersensitivity to its components, bleeding from the gastrointestinal tract, bronchial asthma with polyposis of the nasal mucosa, hemostasis disorders, pregnancy , breastfeeding , hematopoiesis disorders, intracranial bleeding, erosive and ulcerative lesions of the gastrointestinal tract (especially during exacerbation). In addition, it is not recommended to give this drug to patients in childhood.
Neurodiclovit is prescribed with caution for congestive heart failure, anemia , coronary heart disease , bronchial asthma , liver or kidney failure , diabetes mellitus , inflammatory bowel diseases, inducible porphyria , alcoholism, diverticulitis , arterial hypertension , systemic connective tissue diseases, edema syndrome, old age . It is also necessary to carefully monitor the patient's condition if the drug is prescribed after extensive surgery.
Side effects
The use of capsules may be accompanied by the following side effects:
- gastrointestinal tract and liver: increased levels of liver enzymes, abdominal pain , diarrhea , constipation , bleeding in the gastrointestinal tract, feeling of bloating, nausea, flatulence , peptic ulcer (complications are possible);
- sense organs: tinnitus;
- genitourinary system: oliguria , fluid retention, interstitial nephritis , nephrotic syndrome , acute renal failure , proteinuria , papillary necrosis , hematuria , azotemia ;
- nervous system: the appearance of dizziness , headache ;
- skin: rash, itching ;
- immune system and hematopoietic organs: agranulocytosis , worsening infectious processes, leukopenia , anemia , eosinophilia , thrombocytopenia , thrombocytopenic purpura .
In addition, in rare cases, disorders such as vomiting, melena, esophageal damage, liver necrosis , dry mucous membranes, hepatorenal syndrome , colitis , jaundice , aphthous stomatitis , hepatitis , cirrhosis , changes in appetite, the gastrointestinal tract and liver .
Rarely, the central nervous system may also cause sleep disturbance , depression , aseptic meningitis , general weakness, nightmares, drowsiness , irritability, convulsions, disorientation, and increased anxiety. From the skin: alopecia , increased photosensitivity, eczema , toxic dermatitis , erythema multiforme , urticaria , Lyell's syndrome , pinpoint hemorrhages.
Very rarely, side effects such as increased blood pressure, blurred vision, taste disturbance, scotoma , diplopia , hearing impairment, laryngeal edema, cough, bronchospasm , pneumonitis , extrasystole , myocardial infarction , congestive heart failure , pain in the chest, anaphylactoid reactions are noted. , swelling of the lips and tongue, anaphylactic shock , allergic vasculitis .
Side effects of the drug Neurodiclovit
The drug is usually well tolerated, although in some cases the following side effects may develop: gastrointestinal disorders (epigastric pain, anorexia, hiccups, nausea, diarrhea, hidden bleeding), headache, dizziness, fatigue, tinnitus, eczema , skin rash, itching, sodium and water retention in the body, peripheral edema (mainly in patients with hypertension (arterial hypertension)); uncommon - gastrointestinal ulcers with severe bleeding and perforation, anemia, insomnia, anxiety, irritability, allergic reactions (bronchospasm, urticaria, anaphylactic/anaphylactoid systemic reactions), acute renal failure (isolated cases), nephrotic syndrome, hematuria, isolated cases of hepatitis (jaundice, increased level of transaminases in the blood serum), hematopoietic disorders (leukopenia, thrombocytopenia, aplastic anemia, pancytopenia, thrombocytopenic purpura, agranulocytosis, hemolytic anemia); rarely - reversible alopecia, Stevens-Johnson syndrome, Lyell's syndrome, Hebra's disease, seizures, visual impairment (blurred vision, diplopia), hearing impairment, interstitial nephritis, papillary necrosis.
Instructions for use of Neurodiclovit (Method and dosage)
For those who have been prescribed Neurodiclovit, the instructions for use recommend swallowing the capsules whole during meals, with sufficient liquid. Dosages may vary depending on the severity of the disease. On average, the dose is designed to take 1-3 capsules per day, that is, about 100 mg of diclofenac.
Instructions for use of Neurodiclovit indicate that adult patients are usually prescribed 2-3 capsules per day to begin the course. But the maximum dosage should not exceed three capsules. Maintenance dose – 1 capsule 1-2 times during the day.
Elderly patients should use this drug with caution.
Children over the age of 14 years can be prescribed Neurodiclovit, but its maximum dosage should not exceed 1 capsule 2 times a day.
The duration of the course is determined by a specialist.
Introduction
The problem of back pain caused by degenerative lesions of the spine and surrounding tissues is extremely relevant due to its high prevalence.
According to the results of numerous epidemiological studies, up to half of the adult population experiences back pain over the course of one year [4]. The maximum incidence is recorded among people of working age - the most socially active population, which causes high material losses. It has been established that recurrent back pain lasting more than 3 days is periodically noted by about 20% of the adult population. The frequency, duration and intensity of exacerbations may vary depending on the nature and severity of physical activity, the age of the population, dietary habits and a number of other factors. From 1991 to 2008, the incidence of diseases of the musculoskeletal system and connective tissue in Moscow increased by 23.4% and amounted to more than 2000 cases per 100 thousand adult population. Therefore, the development of new methods for diagnosing and conservative treatment of back pain is very important [1]. Typically, back pain is a benign, self-limiting condition; In more than half of patients, the pain syndrome regresses under the influence of treatment within a period of several days to several weeks. However, it is extremely rare that an episode of back pain occurs only once during a lifetime—in the vast majority of patients, the pain recurs. In a significant proportion of patients, the pain becomes chronic, which can cause long-term disability or permanent disability. Among the factors contributing to the chronicity of the pain syndrome, in addition to the characteristics of the structural lesion (severe arthrosis, large herniated intervertebral disc), psychological and social factors should be noted, such as a tendency to depressive reactions, low level of education, etc. [8]. Prevention of chronic pain syndrome in a significant proportion of patients can be ensured by early pain relief.
Depending on the causes of back pain, they are divided into primary (nonspecific) and secondary (specific). The main cause of primary pain syndrome in most cases is degenerative-dystrophic changes in the spine with damage to large and small (facet) joints, osteochondrosis directly involving intervertebral discs in the pathological process, secondary changes in the tendon-ligamentous apparatus, adjacent muscles and fascia with irritation of pain receptors ( nociceptors). Much less often, pain is associated with secondary damage to the spinal roots and spinal nerves. In practical conditions, it is not always possible to establish a single cause of pain, which is usually caused by a combination of a number of factors. It must be borne in mind that the intensity of the pain syndrome does not always correspond to the severity of degenerative changes in the spine and soft tissues. Often, even fairly large herniations of intervertebral discs, like Schmorl’s hernias, are only markers of osteochondrosis, without causing clinically significant compression of neural structures [8].
When developing treatment tactics for a patient with back pain, it is important to exclude the secondary nature of the pain syndrome. Differential diagnosis should be made with somatic diseases that can manifest themselves as pain syndromes similar in clinical picture (renal pathology, gynecological pathology, etc.). In case of persistent pain syndrome, which is difficult to relieve with standard painkillers, primary or metastatic neoplasms, inflammatory or traumatic lesions of the skeletal system, osteoporosis, and some other pathological conditions should be excluded.
Taking into account the pathogenetic features of the occurrence of back pain, the general principles of pain therapy (taking into account the data of evidence-based medicine), the main directions of providing assistance to patients with nonspecific back pain can be considered the earliest and complete elimination of acute pain syndrome, the fastest motor activation of the patient, which promotes regression symptoms and reduces the risk of pain becoming chronic. Timely initiation of rehabilitation significantly reduces the risk of developing chronic pain. In this situation, it is difficult to overestimate the role of explanatory therapy, which ensures that the patient correctly understands his condition. A reliable guideline for expanding physical activity is reducing the intensity of pain. Increasing the patient's mobility should not aggravate the pain.
To eliminate pain, analgesics (paracetamol) and non-steroidal anti-inflammatory drugs (NSAIDs) are currently most widely used [9]. It is believed that for mild pain the use of NSAIDs is indicated, for moderate pain - NSAIDs in combination with non-opioid analgesics, for severe pain - the use of opioid analgesics, local anesthesia and NSAIDs.
The analgesic properties of NSAIDs are due to the weakening of prostaglandin synthesis through inhibition of cyclooxygenase (COX): tissue or constitutional (COX-1) and inducible (COX-2). Both COX isoforms are produced in both peripheral tissues and CNS cells. The analgesic effect of COX inhibitors is ensured by the indispensable involvement of not only peripheral, but also central mechanisms. One of the most popular and widely used drugs in the NSAID group today is diclofenac.
However, despite the fairly high effectiveness of NSAID drugs, the search continues for adjuvant agents that increase it, making it possible to achieve an analgesic effect using lower doses of drugs and, accordingly, a lower risk of side effects.
Currently, considerable experience has been accumulated in the simultaneous use of NSAIDs and a combination of B vitamins, which is due to their active participation in the metabolism of nervous tissue. It is well known that vitamins act as coenzymes in a wide range of biochemical reactions. Thiamine (vitamin B1) is involved in the processes of decarboxylation of pyruvate and the metabolism of α-ketoglutaric acid in the Krebs cycle, and takes part in protein synthesizing processes. In addition, thiamine is able to switch glucose metabolism to the pentose phosphate pathway, which ensures the energy needs of the cell and creates reserves of substrates for the synthesis of nucleic acids. Pyridoxine (vitamin B6) functions as a coenzyme in the reactions of decarboxylation and transamination of amino acids in the tissues of the central and peripheral nervous system. Cyanocobalamin (vitamin B12), metabolized into a cofactor - cobamide, is part of numerous enzymes, in particular reductase, which reduces folic acid to tetrahydrofolic acid. Participates in the transfer of methyl and other one-carbon fragments, being necessary for the formation of deoxyribose and DNA, creatine, methionine - a donor of methyl groups, in the synthesis of lipotropic factor - choline, in the conversion of methylmalonic acid into succinic acid, which is part of myelin, etc.
B vitamins prescribed in combination have the ability to potentiate each other’s effects and stimulate reparative and regenerative processes in nervous tissue due to complex neuroprotective and neurometabolic effects.
In clinical practice, B vitamins have been used for a long time as adjuvant agents in the complex treatment of pain syndromes caused, in particular, by vertebrogenic pathology. The basis for the use of B vitamins in patients with pain syndromes were the results of experimental studies. In particular, in an animal (rats) model of nociceptive pain syndrome, a combination of thiamine chloride, pyridoxine and cyanocobalamin demonstrated the ability to significantly reduce the severity of pain [11].
Based on information about the wide range of biochemical effects of these vitamins in the body, it has been suggested that the elimination (or significant reduction) of nociceptive pain syndrome may be due to both the suppression of the synthesis of inflammatory mediators and the difficulty of their interaction with receptors [6]. Features of the interaction between the receptor apparatus and vitamins, as well as other potential mechanisms of their analgesic action, are discussed in a recently published review [2]. Vitamin B complex has also been demonstrated to enhance the effects of norepinephrine and serotonin, mediators of antinociceptive systems in the central nervous system. In addition, the experiment revealed suppression of nociceptive responses not only in the dorsal horn, but also in the optic thalamus.
The results of experimental studies have been largely confirmed by clinical experience. Today, there are a lot of publications devoted to studying the effectiveness of B vitamins in the complex treatment of patients with back pain syndromes. Due to the widespread use of diclofenac in clinical practice, the possibility of its administration with a B complex of vitamins is of significant interest. Clinical studies have confirmed the effectiveness of this combination [10, 13, 14]. Subsequently, in a double-blind randomized study, it was found that the simultaneous administration of a vitamin B complex and diclofenac to patients with acute back pain was significantly more effective than diclofenac alone [12]. Positive results were obtained in the treatment of not only musculoskeletal pain syndromes with this combination, but also some types of neuropathic pain [7].
Taking into account the above, it is of significant interest to study the effectiveness of the drug Neurodiclovit, one capsule of which contains 50.0 mg of diclofenac sodium, 50.0 mg of thiamine hydrochloride, 50.0 mg of pyridoxine hydrochloride and 0.25 mg of cyanocobalamin, in the treatment of patients with pain syndromes caused by degenerative lesions of the spine.
Some domestic experience has been accumulated in the use of the drug Neurodiclovit in this category of patients. Thus, as a result of observation of a group of 50 patients suffering from dorsalgia, it was found that with two-week use, Neurodiclovit significantly reduces the severity of back pain and improves the vital functions of patients [3]. The drug is well tolerated - no serious adverse events were observed in patients receiving it. According to the authors of the study, an analysis of the results of using Neurodiclovit in patients suffering from dorsalgia confirmed the favorable profile of the effectiveness and safety of the drug, which gives grounds to recommend its use in this category of patients.
Last year, a domestic study was completed to study the clinical effectiveness, tolerability and safety of Neurodiclovit in outpatient neurological practice in patients with acute pain syndrome due to a herniated intervertebral disc.
Material and methods
The design of the study was prospective, comparative, randomized and open. It included 60 patients observed by the district neurological departments of Moscow with acute pain syndrome caused by a herniated intervertebral disc [1].
Criteria for inclusion in the study:
- age from 45 to 75 years;
- intervertebral disc herniation verified by computer or magnetic resonance imaging in accordance with diagnostic criteria according to ICD-10;
- the duration of the pain syndrome is no more than 5 days;
- pain intensity of at least 7 points on the VAS scale;
- the invariability of the patient’s usual environment and situation during the study period;
- patient consent to participate in a clinical trial.
Accordingly, the exclusion criteria were:
- the presence of epilepsy or severe mental illness (schizophrenia, mental retardation), leading to the inability of patients to take pills or navigate for research purposes;
- severe, decompensated or unstable somatic diseases (any disease or condition that threatens the patient’s life or worsens the patient’s prognosis);
- neoplasms of any localization;
- peptic ulcer of the stomach or duodenum;
- simultaneous use of anticoagulants;
- serious deviations in the values of laboratory parameters requiring further examination of the patient;
- alcoholism or drug addiction;
- established pregnancy, natural feeding.
If the patient was already receiving a course of treatment with a drug with a similar mechanism of action, it was discontinued, after which the patient was included in the study.
Forty patients received the drug Neurodiclovit, 1 capsule 2 times a day for 14 days; the comparison group consisted of 20 patients who received diclofenac 50 mg 2 times a day for 14 days. All patients included in the study underwent a clinical neurological examination, assessment of the intensity of pain using a visual analogue pain scale (VAS), assessment of the severity of anxiety and depression using the Beck scale, assessment of the state using the Global Clinical Impression (GCI) scale, assessment by functional status self-assessment scale (SAN). The main characteristics of the clinical groups are presented in Table. 1.
. Characteristics of patients.
Along with assessing the effectiveness of the treatment, the tolerability and safety of the drug were studied. To assess safety and tolerability, adverse events were recorded at each scheduled visit. The effectiveness of the study drug was assessed based on the results of the dynamics of the Beck scale, VAS, GCI, SAN, and clinical neurological examination.
results
Of the 60 patients initially included in the study, all patients completed the full course of treatment. The therapeutic effect of varying severity was observed in 38 (95%) patients in the group of patients treated with Neurodiclovit, and in 16 (80%) in the group of patients treated with Diclofenac. The improvement noted by patients was a decrease in the intensity of pain in the lumbar spine and an increase in motor activity. In both study groups, pain decreased by the 3rd day of treatment, and at the end of the course of therapy, all patients noted significant improvement.
Analysis of the VAS data allowed us to establish a significant decrease in the average total score two weeks after the start of treatment in both groups compared to the initial values, however, a more pronounced decrease was noted in the group of patients treated with Neurodiclovit. Before treatment, the average values in the group of patients receiving Neurodiclovit were 7.00 ± 0.16 points, and in the Diclofenac group – 7.60 ± 0.09 points.
After two weeks of treatment, VAS scores decreased to 2.0 ± 0.3 and 3.9 ± 0.3 points, respectively. It is important to note that a more pronounced decrease in the average total score on the VAS scale was noted already on the 3rd day of treatment in the group of patients receiving Neurodiclovit (up to 5.3 ± 0.3 points versus 6.1 ± 0.4 in the group Diclofenac; Fig. 1).
At the time of inclusion in the study, mild depressive symptoms were detected in 24 (60%) patients in the group receiving Neurodiclovit and in 10 (50%) in the comparison group, as evidenced by indicators on the Beck scale; in the remaining patients, no signs of depression were detected. At the end of the course of treatment, mild depressive symptoms were detected in 5 patients of the main group and in 6 patients of the comparison group (Fig. 2).
By the end of the second week of treatment, most patients showed an improvement in general well-being and mood; motor activity expanded; trends towards normalization of night sleep in the form of easier falling asleep have been identified; performance has increased. These changes took place in both groups, but positive dynamics were recorded to a greater extent among patients receiving Neurodiclovit. This trend is clearly confirmed by the dynamics of changes in the average total indicators on the SAN scale. Before treatment, in the main group of patients the indicators were 3.30 ± 0.09 points, while in the comparison group – 3.13 ± 0.17. At the end of the study (after two weeks of treatment), these indicators were 4.60 ± 0.06 and 4.00 ± 0.17 points, respectively. The final improvement in values on the SAN scale was +1.3 points for the group of patients receiving Neurodiclovit, and only +0.87 points for patients in the comparison group.
When analyzing the effectiveness of treatment in accordance with the GCI scale, the initial level on the subscale “severity of the disease” on the 3rd day of treatment in the main group and the comparison group was 5.4 ± 0.17 and 5.2 ± 0.13 points, respectively, and on 14th day of treatment – 2.5 ± 0.08 and 3.5 ± 0.12, respectively. Thus, the results obtained indicate a significant decrease in the average total score in both groups compared to the baseline, but a more significant effect was achieved in the group of patients receiving Neurodiclovit. On the “improvement of condition” subscale, the average total score at the end of the course of treatment in the main group was 1.7 ± 0.2 points, in the comparison group – 2.6 ± 0.09 points, i.e. a more significant improvement was noted in the group of patients , receiving Neurodiclovit (Fig. 3).
Taking into account the results of the analysis of the dynamics of the average total indicators on the anxiety and depression scales (Beck), VAS, GCI, SAN and neurological examination data, improvement after 3 days of treatment with Neurodiclovit was noted in 75% of patients (25% without changes) versus 65% (35% without changes) in the Diclofenac group. On the 14th day of treatment, improvement was observed in the vast majority of patients receiving Neurodiclovit (95%) and in 80% of patients in the Diclofenac group. Thus, after 2 weeks of treatment, improvement during treatment with Neurodiclovit was observed 15% more often.
During the study, all adverse events that occurred while taking the drugs were recorded (Table 2).
. Undesirable side effects.
The severity of adverse side effects ranged from mild to moderate. No serious side effects were recorded.
The tolerability of Neurodiclovit and Diclofenac by patients was assessed as follows: excellent - 87.5 and 80.0%, good - 5.0 and 0%, satisfactory - 7.5 and 20.0%, respectively. Thus, the safety and tolerability of the drug Neurodiclovit were higher than that of the drug Diclofenac.
Conclusion
The results of the study demonstrated that the drug Neurodiclovit is an effective treatment for patients with acute pain syndrome caused by degenerative-inflammatory lesions of the spine. A pronounced therapeutic effect is observed already by the third day of therapy with Neurodiclovit. The main advantages of Neurodiclovit are high efficiency, safety and good tolerability. Available data confirm that the combination of diclofenac and B vitamins in one capsule of Neurodiclovit in therapeutic dosages provides a potentiated analgesic effect - earlier and more complete elimination of pain compared to diclofenac alone. Considering the better tolerability, higher efficacy and safety of the drug Neurodiclovit compared to the drug Diclofenac, we consider it advisable to recommend the use of Neurodiclovit as a first-line drug in the treatment of patients with acute pain syndrome caused by degenerative lesions of the spine, including when long-term therapy is necessary.
Information about the authors: Pavel Rudolfovich Kamchatnov – Doctor of Medical Sciences, Professor, State Educational Institution of Higher Professional Education, Russian State Medical University. Email; Boyko Alexey Nikolaevich – Doctor of Medical Sciences, Professor, State Educational Institution of Higher Professional Education, Russian State Medical University. Tel.,; Batysheva Tatyana Timofeevna – Doctor of Medical Sciences, Professor, Chief Physician of Rehabilitation Clinic No. 7. Tel.,; Elena Vladimirovna Kostenko – Candidate of Medical Sciences, Associate Professor, Deputy. Chief physician of the rehabilitation treatment clinic No. 7. Tel.,; Pivovarchik Elena Mikhailovna – doctor at the rehabilitation treatment clinic No. 7. Tel.,; Ganzhula Pavel Aleksandrovich – Candidate of Medical Sciences, CDC No. 1 South-Western Administrative District. Tel. 8 (495) 336-6733; Ismailov Anvar Magomedovich – chief physician of city clinic No. 120 of the North-East Administrative District. Tel.; Lisinker Lidiya Nikolaevna – doctor at city clinic No. 157 of the Northern Administrative District. Tel.; Alexandra Alekseevna Khozova – doctor at city clinic No. 158 ZAO. Tel.; Otcheskaya Olga Vasilievna – doctor at city clinic No. 159 of the South-Western Administrative District. Tel.
Overdose
When taking the drug in increased dosages, the following symptoms may be observed: vomiting, headache , clouding of consciousness, dizziness , shortness of breath . Patients in childhood may experience myoclonic convulsions , abdominal pain , liver and kidney dysfunction, nausea, and bleeding.
Treatment includes gastric lavage, forced diuresis, and activated charcoal . Therapy is symptomatic. Hemodialysis is almost ineffective.
Special instructions for the use of the drug Neurodiclovit
The drug should not be used in the third trimester of pregnancy and during breastfeeding. During the 1st–2nd trimester of pregnancy, the drug can be used only according to strict indications in the minimum effective dose. It is not recommended for use in children under 14 years of age due to the high content of the active ingredient in the capsules. During long-term treatment with Neurodiclovit, it is recommended to monitor the peripheral blood picture, functional indicators of the liver and kidneys, and also conduct a stool test for occult blood. Patients with gastric and duodenal ulcers, a history of dyspeptic symptoms, severe liver disease, kidney disease, heart failure and hypertension (arterial hypertension) should be under strict medical supervision. The drug should be used with caution in patients with asthma, hay fever, nasal polyposis and chronic infectious diseases of the respiratory tract. Although no negative effect on the ability to drive vehicles or operate machinery was noted when taking the drug, it cannot be ruled out that the reaction rate may be reduced due to the negative effect of diclofenac on the central nervous system (dizziness, fatigue).
Interaction
Prescribing this medication may cause an increase in:
- lithium level when combined with lithium preparations;
- severity of adverse reactions when using other NSAIDs;
- the likelihood of bleeding in the gastrointestinal tract in combination with glucocorticoids;
- the effectiveness of potassium-sparing diuretics and drugs that inhibit platelet ;
- concentrations and toxicity of methotrexate .
In addition, the effectiveness of Neurodiclovit is reduced when interacting with loop diuretics and antihypertensive drugs. The concentration of its active substance (diclofenac) also decreases when combined with acetylsalicylic acid . The absorption of cyanocobalamin is reduced when taken with Colchicine , neomycin , PAS and antidiabetic drugs such as Biguanidine .
Neurodiclovit should not be used simultaneously with Levodopa , as it can dull the severity of its antiparkinsonian effect. In addition, it may reduce the antihypertensive effect of diuretics or antihypertensive drugs. So this combination is prescribed with caution. In this case, it is imperative to control blood pressure. In addition, it is necessary to consume a sufficient amount of fluid, and at the beginning and after completion of the course, monitoring of kidney function is necessary, as nephrotoxicity may occur.
serotonin reuptake inhibitors, the risk of bleeding from the gastrointestinal tract increases.
The dosage of hypoglycemic drugs while using Neurodiclovit should be carefully monitored.
Combination with colestipol or cholestyramine reduces the degree of absorption of diclofenac by approximately 30-60%. So between taking these medications it is necessary to take an interval of several hours. In addition, the concentration of diclofenac can be reduced by some drugs that stimulate enzymes ( Rifampicin , phenytoin , Carbamazepine , St. John's wort ).
It should also be taken into account that thiamine is inactivated by 5-fluorouracil, and antacids, in turn, reduce the degree of its absorption. Loop diuretics can inhibit tubular reabsorption of thiamine and, with a long course of treatment, reduce its concentration.
Analogues of Neurodiclovit
Level 4 ATC code matches:
Voltaren
Rapten
Zerodol
Dickloberl Retard
Dikloberl N 75
Dicloberl
Ketanov
Dolak
Panoxen
Ketorolac
Naklofen Duo
Naklofen
Olfen-100
Olfen-75
Nizilat
Fanigan
Aertal
Methindol retard
Ortofen
In pharmacies you can find the following analogues of Neurodiclovit:
- Blokium B12
- Bol-Ran
- Dilocaine
- Diclofenac
- Dolex
- Maxigesik
- Olfen-75
- Fanigan
- Flamidez
- Tsinepar
Why tablets offered as analogues of this remedy help in each specific case is best checked with your doctor.
Neurodiclovit price, where to buy
The price of Neurodiclovit, on average, is about 380 rubles for a package containing 30 capsules. In Ukraine, the cost of this product is about 160 hryvnia. It is worth noting that the price of Neurodiclovit is lower than many of its analogues.
- Online pharmacies in RussiaRussia
- Online pharmacies in UkraineUkraine
LuxPharma* special offer
- Neurodiclovit caps.
30pcs 1280 rub. order
ZdravCity
- Neurodiclovit capsules 30 pcs. Lannacher Heilmittel
RUB 382 order
Pharmacy Dialogue
- Neurodiclovit capsules No. 30 Lannacher
RUB 388 order
show more
Pharmacy24
- Neurodiclovit No. 30 capsules G.L Pharma GmbH, Austria
159 UAH.order
