The basis of the therapeutic effect of the drug Cerebrolysin®.

pharmachologic effect

The drug is a stimulator of neurometabolic processes (has a nootropic effect).

Deproteinized hydrolyzate of pig brain substance stimulates cell differentiation processes, improves the functional state of nervous system cells and activates protection and renewal mechanisms.

Animal experiments have shown that the biologically active amino acids and peptides have a direct effect on neuronal and synaptic plasticity, which in turn helps improve higher brain functions .

Pharmacological properties of the drug Cerebrolysin

Pharmacodynamics. Proteolytic peptide fraction obtained from pig brain stimulates differentiation and improves the function of nerve cells, activates protection and recovery mechanisms. Animal experiments have demonstrated that Cerebrolysin has a direct effect on neuronal and synaptic plasticity, which contributes to improved cognitive function. In experiments with models of cerebral ischemia, Cerebrolysin reduced infarct volume, prevented the formation of edema, stabilized microcirculation, normalized neurological and cognitive impairment, and doubled survival rates. Positive results were also obtained during experiments with models of Alzheimer's disease. In addition to its direct effect on neurons, Cerebrolysin significantly increased the amount of glucose transporter (GLUT-1) in the BBB, thus optimizing the critical energy deficit observed in this disease. Quantitative analysis of the EEG of healthy volunteers and patients with vascular dementia showed a significant dose-dependent increase in neuronal activity (increase in the frequencies of α- and β-rhythms) after 4 weeks of treatment with Cerebrolysin. Regardless of the cause of the disease in neurodegenerative dementia of the Alzheimer's type or in vascular dementia, after treatment with Cerebrolysin, patients objectively improved cognitive function and the ability to self-care. Clinically noticeable improvement in the patients' condition was observed after 2 weeks of treatment with Cerebrolysin and intensified with continued therapy. A positive effect after treatment with Cerebrolysin was noted in 60–70% of patients, regardless of the type of dementia. In the case of senile dementia of the Alzheimer's type, the improvement in the clinical condition of patients persisted even after the end of active therapy. This was especially true for the increase in the activity of patients in everyday life, as a result of which the need for outside help and supervision decreases. Due to its neurotrophic activity (similar to the action of nerve growth factor, glial and ciliary neurotrophic factors, insulin-like factor types I and II), Cerebrolysin can significantly slow down, and in some cases stop, the progression of neurodegenerative processes in the brain. Pharmacokinetics. Since the proteolytic peptide fraction obtained from pig brain contains biologically active peptides similar or identical to those produced endogenously, it is not yet possible to directly measure the pharmacokinetic parameters of Cerebrolysin. Indirect pharmacokinetic data were obtained from studying the pharmacodynamic profile of Cerebrolysin. After a single administration, the neurotrophic activity of Cerebrolysin in the blood plasma is detected for almost 24 hours. The components of the drug can cross the BBB. Experimental studies of chronic toxicity and use of the drug in clinical practice did not reveal any signs of carcinogenicity of Cerebrolysin. Peptides with a large molecular weight that have antigenic potential are removed from the drug during the manufacturing process. Cerebrolysin does not promote the formation of antibodies or the occurrence of anaphylactic reactions, does not stimulate histamine receptors and does not cause hemagglutination of red blood cells.

Pharmacodynamics and pharmacokinetics

As a result of studies using models of cerebral ischemia, it was possible to establish that the use of the drug allows:

• reduce heart attack ;
• prevent the development of edema ;
• stabilize microcirculation;
• normalize cognitive and neurological disorders ;
• double survival rates.

Based on studies using models of Alzheimer's disease , the following conclusion was made: in addition to the fact that the drug has a direct effect on neurons , it also helps to increase the number of molecules that transport glucose across the BBB (blood-brain barrier), and as a result, compensates for critical energy deficiency in the body.

A quantitative analysis of the encephalograms of healthy people and patients diagnosed with vascular dementia showed that with the use of the drug Cerebrolysin:

• neuronal activity increases significantly (activity indicators are dose-dependent);
• higher brain functions are objectively improved ;
• the ability to self-care and perform everyday tasks increases (as a result, the patient needs less outside care);

The drug has neurotrophic activity , which can significantly slow down, and in some cases stop, the progression of neurodegenerative processes .

During the experiments, it was revealed that Cerebrolysin does not provoke the formation of antibodies or the development of anaphylactic reactions, does not affect the immune system , does not stimulate histamine receptors and does not affect the hemagglutination of red blood cells .

Since the proteolytic peptide fraction obtained from porcine brain includes short biologically active peptides similar or identical to those produced in the body, it is not possible to conduct an accurate pharmacokinetic analysis of the drug.

Based on data on the pharmacodynamics of the drug, it was concluded that after a single administration of the drug, the neurotrophic activity of the hydrolyzate in the blood plasma is determined within 24 hours.

Cerebrolysin components have the ability to penetrate the BBB . Preclinical studies in vivo made it possible to establish identical pharmacodynamic effects of the drug on the central nervous system when administered into the ventricles of the brain and when administered peripherally. These studies provide indirect confirmation of Cerebrolysin's ability to cross cell membranes of the BBB .

The basis of the therapeutic effect of the drug Cerebrolysin®.

We present to your attention a review of the speech of Professor O.A. Gromova (Moscow), dedicated to the description of the properties of Cerebrolysin® and the characteristics of its components, which was presented at the “Neurological Readings”, Salzburg, June 18, 2009.

The clinical history of Cerebrolysin® and the high validity of its use are confirmed by modern experimental and clinical studies. According to evidence, Cerebrolysin® is advisable for use in the treatment of stroke (evidence category A); for mental retardation in children, ADHD, dementia of various origins, Alzheimer's disease (evidence category B).

Cerebrolysin®: history of discovery, implementation, clinical experience

The idea of ​​​​creating a drug from brain hydrolysates belongs to the chairman of the Society of Neurologists of Austria, professor at the University of Salzburg Gerhard Harrer. In 1954-1956. The first publications appeared on the clinical use of brain hydrolysates for narcolepsy and hyperglycemic coma.

In 1975, pharmacological studies of the bioavailability of these hydrolysates (GLP) were carried out, and the first clinical trials of the drug Cerebrolysin® were organized, during which its neuroprotective properties were demonstrated.

In 1990, thanks to large-scale trials in clinics in Austria, Germany, Japan, and Russia, the neurotrophic effect of Cerebrolysin® and its effectiveness in ischemic and degenerative diseases of the brain were proven.

1995-2005 marked a new breakthrough in the study of the molecular mechanisms of action of Cerebrolysin®. Randomized placebo-controlled trials have supported the expansion of the clinical use of this drug.

Since 1980, the technology for producing Cerebrolysin® has changed - a more sensitive method of controlling the composition began to be used, which ensured an increased degree of purification of the drug and a transition to a new qualitative level of its production. Today Cerebrolysin® is a high-tech drug produced in compliance with all necessary modern standards, including GMP and GLP.

Mechanisms of action of Cerebrolysin®

Cerebrolysin® is a naturally balanced blend of peptides and amino acids. The drug, obtained from the cerebral cortex of pigs through specialized processing, includes peptides with low molecular weight (up to 10 thousand daltons) and a set of basic amino acids. These oligopeptides have effects similar to those of neurotrophic factors. It is generally accepted that, thanks to a unique natural set of active substances, Cerebrolysin® acts on various “targets” of neuronal structures and, accordingly, corrects various parts of the pathological process in the brain. As a result of the complex interaction of the complex of factors included in Cerebrolysin® with neuronal structures, neurotrophic stimulation of various cell populations of the central and peripheral nervous system can be achieved.

The study of neurotrophic growth factors has been ongoing for several decades. Thus, over the past fifty years, nerve growth factor (NGF, NGF), brain-derived neurotrophic factor (BDNF), neutrophins 3 and 4/5 (NT-3, NT-4/5), glial factor (GDNF), ciliary factor (CNTF). These neuropeptides play an important role in the growth and maintenance of the vital activity of cells of the central and peripheral nervous system, provide retro- and antegrade transport of mature molecules to the axon and local synthesis in adjacent cells.

Cerebrolysin® has an organ-specific multimodal effect on the brain, providing:

• metabolic regulation – increases the efficiency of aerobic energy metabolism of the brain, improves intracellular protein synthesis in the developing and aging brain;
• neuroprotection – protects neurons from the damaging effects of lactic acidosis, prevents the formation of free radicals, increases survival and prevents the death of neurons under conditions of hypoxia and ischemia, reduces the damaging neurotoxic effect of glutamate and other excitatory amino acids;
• functional neuromodulation – has a positive effect in cases of cognitive impairment, on the processes of memorizing and reproducing information, activates the process of mental activity, improves mood, promotes the formation of positive emotions, thus exerting a modeling influence on behavior;
• neurotrophic activity: Cerebrolysin® is the only nootropic peptidergic drug with proven neurotrophic activity, similar to the action of natural neuronal growth factors, but manifested under conditions of peripheral administration.

Composition of Cerebrolysin®, features of components

All effects of Cerebrolysin® are realized thanks to its constituent amino acids, polypeptides, trace elements and vitamins.

It should be recalled that polypeptides, which make up 15% of the drug, are polymers created from amino acid residues; The conventional boundary between polypeptides and proteins lies in the region of molecular weight 6000 Da. Many hormones are polypeptides in their chemical nature. Regulatory peptides are fragments of targeted protein cleavage, evolutionarily ancient information transmitters, widespread in the body and playing an important role in a number of physiological processes. Returning to neuroprotection and neurotrophism, we emphasize that brain peptides (neuropeptides) function in the body longer than “classical” neurotransmitters (adenosine, acetylcholine, γ-aminobutyric acid, histamine, glutamic acid, dopamine, norepinephrine, serotonin, glycine ), and are less specific for the receptor proteins to which they bind. Neuropeptides are transported by the cerebrospinal fluid current and diffuse through the intercellular fluid, affecting brain regions remote from the site of their synthesis.

Cerebrolysin® is claimed to contain peptides up to 10,000 Da. However, literature data (Ciphergen, 2004) and research by a group of Russian scientists led by Professor O.A. Gromova show that 70% of them have a molecular weight of up to 3500 Da, 90% - up to 5800 Da. As a result of an in-depth study of the drug using immunoblotting and electron microscopy, no functionally active pro-oncogenes, nucleic acids and protein compounds of the amyloid class, including prions, were identified in Cerebrolysin®.

Thus, due to the low molecular weight, the components of Cerebrolysin® freely penetrate the blood-brain barrier and are distributed in the central nervous system according to the demand for certain areas in neuropeptides and other substances included in the drug.

The most important result of the study was the discovery of oligopeptides vital for brain neurochemistry in Cerebrolysin® samples. The tripeptide thyroliberin with the amino acid sequence Glu-His-Pro, an antagonist of opioid activity, has been identified in Cerebrolysin®. The main function of the oligopeptide is to enhance the secretion of thyrotropin by the anterior pituitary gland, as well as stimulate the growth hormone, corticotropin. The tripeptide glutathione Glu-Cis-Gly (GSH) has been isolated from Cerebrolysin®, the most important function of which is participation in redox reactions; used as an oxygen donor and acceptor and is necessary for the functioning of a large number of enzymes. An enkephalin motif with the amino acid sequence Tyr-Gly-Gly-Phe was isolated from Cerebrolysin® samples purified from lipids. The ability of enkephalins, together with other peptides, to regulate pain sensitivity, sexual behavior, satisfaction motivation, and adaptation processes has been proven. The enkephalin motif, when combined with leucine (H-Tyr-Gly-Gly-Phe-Leu-OH) and methionine (H-Tyr-Gly-Gly-Phe-Met-OH), forms peptides with high affinity for δ- and μ -morphine (opioid) type receptors; It was they who first provided the basis for the introduction of the term “neuropeptides”.

The vitamins that make up Cerebrolysin® are varied: B vitamins (B1, B2, B6, B12, folic acid), ascorbic acid, tocopherol, retinol. The brain is a unique biosubstrate that has a high concentration of vitamins compared to other organs, therefore the introduction of external vitamins in the form of the drug Cerebrolysin® is justified for various pathological conditions of the brain. However, vitamins are unstable compounds; they are easily destroyed by high temperature, light and other external influences. When studying Cerebrolysin®, it was found that its vitamin composition is balanced, the vitamins are in the drug in sufficient therapeutic concentrations. This study proves that the production process of Cerebrolysin® is as gentle as possible, high-tech and allows you to preserve a number of vitamins in active form in the final solution.

A few words need to be said about the advisability of introducing vitamins in a complex preparation. It is known that the trophic activity of the natural association of vitamins and the concomitant effect of vitamin isoforms is higher than the single effect. In addition, the supply of vitamins in the microenvironment of essential microelements in Cerebrolysin® increases their metabolic activity.

Micro- and macroelements included in Cerebrolysin® (K, Na, Mg, Ca, P, Si, Cu, Co, Fe, Mn, Cr, Li, Se, Zn, Sn, etc., 68 elements in total) play a critical role in the functioning of a number of enzymes. Among the antioxidant metalloenzymes, for example, superoxide dismutase (SOD), is directly included in Cerebrolysin®, and its activity is tens of times higher than that of other popular neuroprotectors used in clinical practice.

Thus, Cerebrolysin® has a unique elemental and bioligand composition: neuropeptides, amino acids Thanks to its optimal composition, Cerebrolysin® exhibits clinical effectiveness in a wide range of pathological conditions of the nervous system, not only of vascular origin, but also of toxic, neurodegenerative and infectious origin, which contributes to a more rapid restoration of the patient’s neurological functions and his social adaptation.

Research on Cerebrolysin® continues, and it is expected that new interesting data will be published in the near future, which will allow us to more deeply reveal the composition of the drug and the versatility of its clinical action.

Indications for use of Cerebrolysin

Indications for the use of Cerebrolysin are:

• organic lesions, metabolic disorders and degenerative diseases of the NS (especially Alzheimer's disease );
• complications that developed as a result of a stroke ;
• brain injuries and their consequences (conditions after neurosurgery, concussions and closed head injuries);
• delayed mental development in children;
• mental disorders that are accompanied by memory impairment, absent-mindedness , etc.

Side effects

In rare cases, Cerebrolysin injections can provoke:

• loss of appetite;
• depressive states;
• apathy;
• general weakness;
• arterial hypo- or hypertension;
• pulmonary hyperventilation syndrome;
• the appearance of shortness of breath;
• chest pain;
• increased fatigue;
• the appearance of flu-like symptoms.

Sometimes the therapeutic effect can be accompanied by agitation - strong emotional arousal with manifestations of aggression, confusion, and insomnia.

Too rapid administration of the drug can cause disorders of the nervous system, skin and subcutaneous tissues: dizziness , tremor , drowsiness , headache , sensation of heat , increased sweating, itching and redness of the skin, skin rashes (including the appearance of maculopapular rash ), urticaria .

In isolated cases the following were noted:

• hypersensitivity reactions or allergic reactions, angioedema , anaphylactic shock , chills and fever ;
• generalized epileptic seizures ;
• increased seizure activity;
• sensation of your own heartbeat, tachycardia , heart pain, arrhythmia (similar symptoms occurred when the drug was administered too quickly);
• dyspepsia;
• nausea and vomiting ;
• constipation or diarrhea ;
• reactions at the injection site (erythema, burning, local inflammatory reactions);
• painful sensations in the neck, back (in its lower part), and limbs.

Since the drug is often used to treat elderly people, some of the side effects that occurred during clinical trials may not have a cause-and-effect relationship with taking Cerebrolysin (most of them occur in this category of patients not only during the use of the drug).

Some of the identified side effects occurred with equal frequency in both patients treated with the drug and in patients taking placebo (changes in blood pressure, tremor, nausea, lethargy, dizziness, shortness of breath, tremor, diarrhea).

Side effects of the drug Cerebrolysin

Listed below are undesirable effects and reactions noted during clinical trials and post-marketing observations, regardless of the presence of a causal relationship with therapy with Cerebrolysin (the drug is used to treat mainly elderly people, and these symptoms are often observed in this category of patients). From the immune system Rarely (≤1/10,000) - hypersensitivity reactions or allergic reactions, anaphylactic shock, angioedema, fever, chills. Mental disorders Rare (1/10000 - ≤1/1000) - in isolated cases, the therapeutic effect was accompanied by agitation with manifestations of aggression, confusion, insomnia, depression, apathy. From the side of the central nervous system Rarely (1/10000 - ≤ 1/1000) - with rapid administration, dizziness, tremor, and headache are possible. Very rarely (≤ 1/10000) - grand mal seizures, convulsions. From the cardiovascular system Rarely (1/10000 - ≤1/1000) - arterial hypertension, arterial hypotension. Very rarely (≤1/10000) - with rapid administration, possible sensations of palpitations, arrhythmia, pain in the heart. From the respiratory system Rarely (1/10000 - ≤1/1000) - hyperventilation, shortness of breath, chest pain. From the gastrointestinal tract Rarely (1/10000 - ≤1/1000) - loss of appetite. Very rarely (≤1/10000) - dyspepsia, constipation, nausea, vomiting. From the skin and subcutaneous tissues Rarely (1/10000 - ≤1/1000) - with rapid administration, possible sensation of heat, increased sweating, itching, possible maculopapular rash, urticaria, redness of the skin. General reactions and local reactions Rarely (1/10000 - ≤1/1000) - increased fatigue, flu-like symptoms. Very rarely (≤1/10000) - local inflammatory reactions, erythema and burning at the injection site, pain in the neck, limbs, lower back.

Cerebrolysin injections, instructions for use (Method and dosage)

The drug is intended for intravenous and intramuscular administration.

IV Cerebrolysin is administered in its pure form in a dose of 5 to 10 ml. If the patient is indicated for a dose of 10 to 50 ml (the maximum allowable dose), it is recommended to administer the solution exclusively by slow intravenous infusion after preliminary dilution to 100 ml with one of the standard solutions: Ringer's solution, isotonic NaCl solution, 5% glucose solution.

According to the instructions for use of Cerebrolysin, when diluted at room temperature and in a place unprotected from sunlight, the drug remains physically and chemically stable throughout the day, however, from a microbiological point of view, the solution for infusion should be administered immediately after preparation.

The duration of the course of treatment, as a rule, is from 10 to 20 days (daily administration of the drug is assumed).

A one-time administration of the maximum dose of the drug (50 ml) is allowed, but course use of Cerebrolysin is considered more effective.

Of fundamental importance for achieving the clinical effect of therapy is the use of dosages of the drug that are adequate to the diagnosis, as well as the correct choice of the method of its administration.

Recommended daily doses:

• from 5 to 30 ml - for degradation of cognitive function, organic pathologies and metabolic disorders of the brain;
• from 10 to 50 ml - to eliminate the consequences of a stroke;
• from 10 to 50 ml - for the treatment of brain injuries and their consequences.

For neurological diseases in children, injections with the administration of 1 to 2 ml of solution to the patient are indicated.

The recommended dose for children under six months of age is 0.1 ml per kilogram of body weight. The maximum daily dose for patients of this age category should not exceed 2 ml.

The effectiveness of treatment increases with each repeated course. Treatment is usually continued until there is a significant improvement in the patient's condition.

When conducting an initial course, the number of administrations can be reduced to 2 or 3 times a week. An interval should be maintained between repeated courses, the duration of which should be no less than the duration of the previous course of treatment.

The manufacturer does not produce the drug in tablet form, so it is pointless to look for instructions for Cerebrolysin tablets.

Cerebrolysin

CEREBROLYSIN (Cerebrolysinum). Protein-free hydrolyzate of brain matter. Contains amino acids (85%) and low molecular weight peptides (15%). Available: in ampoules of 1; 5 and 10 ml in packs of 5; 10 and 50 ampoules. Pharmacological action: Cerebrolysin is a concentrate containing low molecular weight biologically active neuropeptides (the molecular weight of which does not exceed 10,000 daltons), which penetrate the BBB and directly enter nerve cells. The drug has a unique organ-specific multimodal effect on the brain, which is manifested in the ability of Cerebrolysin for metabolic regulation, functional neuromodulation and neurotrophic activity, and to provide a neuroprotective effect. Metabolic regulation: Cerebrolysin increases the efficiency of aerobic energy metabolism in the brain and improves intracellular protein synthesis in the developing and aging brain. Neuroprotective effect: the drug protects neurons from the damaging effects of lactic acidosis, prevents the formation of free radicals and reduces the concentration of lipid peroxidation products in the ischemia-reperfusion model, increases survival and prevents the death of neurons under conditions of hypoxia and ischemia, reduces the damaging neurotoxic effect of excitatory amino acids (glutamate); suppresses apoptosis through inhibition of palpain and caspaase. Neurotrophic and neuroimmunotrophic activity: Cerebrolysin is the only nootropic peptidergic drug with proven neuron-specific neurotrophic activity, similar to the action of natural neuronal growth factors, but unlike them, manifests itself under conditions of peripheral administration. Cerebrolysin stimulates the formation of synapses, sprouting dendrites and prevents the activation of microglial cells and the induction of astrogliosis. Functional neuromodulation: the drug has a positive effect in cases of cognitive dysfunction, improves concentration, memorization processes and information reproduction associated with short-term memory, increases the ability to acquire and retain skills, activates the process of mental activity, improves mood, promotes the formation of positive emotions, providing, thus, a modulating effect on behavior. Pharmacokinetics The complex composition of Cerebrolysin, the active fraction of which consists of a balanced and stable mixture of biologically active neuropeptides with a total polyfunctional effect, does not allow for conventional pharmacokinetic analysis of individual components. Indications: ischemic stroke; – chronic cerebrovascular pathology; – traumatic brain injury (the degree of brain damage can be checked using computer electroencephalography); – mental retardation in children; – disorders associated with attention deficit in children; – dementia syndromes of various origins; - Alzheimer's disease; – endogenous depression, resistant to antidepressants. Dosage regimen The drug is used only parenterally in the form of intramuscular injections (1-5 ml) or intravenous drip infusions (10-60 ml). Doses and duration of treatment depend on the nature and severity of the disease, as well as the age of the patient. The standard duration of the course of injections is 4 weeks (minimum 5 injections per week, if possible - daily). In acute conditions (ischemic stroke, traumatic brain injury, complications after neurosurgical operations), Cerebrolysin is recommended to be administered intravenously by drip, daily, in a daily dose of 10-60 ml (in 100-250 ml of saline) for 60-90 minutes. Course duration is 10-25 days. In the residual period of stroke and traumatic brain injury, the drug is prescribed intravenously at 5-10 ml/day for 20-30 days. For psychoorganic syndrome and depression, the drug is prescribed as an intravenous infusion in a daily dose of 5-10 ml for 20-25 and 10-15 days, respectively. In neuropediatric practice - 1-2 ml (up to 1 ml per 10 kg of body weight) intramuscularly, daily, for 1 month, repeating the course 2-3 times a year. For Alzheimer's disease, dementia of vascular and combined origins, the recommended doses are 20-30 ml in 100-200 ml of saline. The course of treatment is 20 infusions. Side effects Rare: slight increase in body temperature (with increased individual sensitivity to the drug and in the case of a very high rate of intravenous infusion). Contraindications – acute renal failure; – status epilepticus. Pregnancy and lactation Cerebrolysin should be used with caution in the first trimester of pregnancy. Special instructions The drug should be prescribed with caution for allergic diathesis and grand mal seizures. Overdose Currently, no cases of overdose of Cerebrolysin have been reported. Drug interactions With the simultaneous use of Cerebrolysin and antidepressants, the effect of the latter may be enhanced. Conditions and periods of storage The drug should be stored in a place protected from light at a temperature not exceeding 25°C. The shelf life of the drug in ampoules is 5 years. The shelf life of the drug in vials is 4 years. The drug is available with a prescription.

Interaction

The drug is incompatible:

• with drugs that can change its pH (5.0-8.0);
• lipid-containing drugs.

Cerebrolysin can be used with balanced solutions of amino acids , with vitamins , and drugs for the treatment of diseases of the heart and vascular system ; however, it is contraindicated to mix these drugs in one infusion bottle.

It is recommended to pay special attention to the potential pharmacological effects when used concomitantly with monoamine oxidase inhibitors (MAOIs) or antidepressants .

special instructions

The drug is prescribed with caution to patients with allergic (exudative-catarrhal) diathesis .

evidence that the drug may increase the load on the kidneys ; however, it should not be administered to patients with severe forms of renal failure .

Clinical studies did not reveal any effect of the drug on the ability to engage in activities requiring attentiveness and speed of psychomotor reactions, as well as on the ability to drive a vehicle.

However, in some cases, the possibility of developing undesirable side reactions from the mental sphere and the nervous system cannot be excluded, which in turn may temporarily impair the ability to drive a car and operate machinery.

The drug should be taken from an ampoule or vial immediately before injection or infusion. In this case, only a one-time set of solution from an ampoule or bottle is allowed.

If sediment or foreign impurities appear in the solution, as well as if the color of the solution changes, it is prohibited to use it. Under normal conditions, the color of the liquid is amber.

Special instructions for the use of Cerebrolysin

Prescribe Cerebrolysin with caution to patients with allergic diathesis, status epilepticus and grand mal attacks, since treatment with Cerebrolysin may increase the frequency of attacks. Caution must be exercised when prescribing the drug to patients with severe renal impairment. Cerebrolysin should not be prescribed to patients with severe renal impairment. Influence on reaction speed when driving vehicles or operating other mechanisms. Does not affect. Use during pregnancy or breastfeeding. Animal studies have not shown reproductive toxicity of the drug. However, there is no data on the effect of the drug on human reproductive function. Cerebrolysin can be used only after a careful assessment of the balance between the expected benefit to the mother and the potential risk to the fetus/child. While using the drug, breastfeeding should be stopped. Children. The drug is used in pediatric practice if there are justified indications.

Analogs of Cerebrolysin

Level 4 ATX code matches:
Bravinton

Acefen

Carnicetine

Pyracesin

Nooclerin

Semax

Piracetam

Olatropil

Fezam

Vinpocetine

Cerebrocurin

Cavinton Forte

Calcium hopantenate

Glutamic acid

Cephabol

Olanzapine

Cerebrolysate

Pramistar

Sidnocarb

Vinpotropil

Analogues of Cerebrolysin in ampoules are the drugs Amylonosar , Bravinton , Vinpocetine , Cavinton , Cortexin , Piracetam , Lucetam , Nootropil , Piracetam Bufus , Piracetam-Vial , Picamilon , Ceraxon , Cerebrolysate , Escotropil , Vinpotropil , Cellex , Thiocetam .

The drug also has analogues in tablets: Amylonosar , Acefen , Vero-Vinpocetine , Vinpotropil , Vinpocetine , Vincetine , Ginkgo Biloba , Glycine , Idebenone , Gopantam , Cavinton , Calcium hopanthenate , Ginkoum , Carnicetine , Combitropil , Lucetam , Memotropil , Neuromet , Noben , NooKam , Noopept , Nootropil , Pantogam , Picamilon , Pikogam , Piracezin , Omaron , Piracetam , Pyriditol , Telektol , Pantocalcin , Phezam , Phenotropil , Encephabol , Korsavin , Celestab , Carniteps .

Cheaper analogs of Cerebrolysin are Cerebrolysate , Glycine , Nootropil , Cinnazarin , Instenon .

During pregnancy (and lactation)

Studies conducted on animals did not reveal the toxic effect of the drug on the reproductive system. However, there is currently no data on how Cerebrolysin can affect human reproductive function.

In this regard, it is prescribed to pregnant women only in cases where there is no alternative to therapy using Cerebrolysin. If it is necessary to undergo a course of treatment with the drug during lactation, it is necessary to decide on stopping breastfeeding.

Reviews of Cerebrolysin

As with any other drug, reviews from doctors and patients about Cerebrolysin can be found very different. Moreover, many foreign experts consider it an expensive dummy with unproven effectiveness. At the same time, our doctors prescribe the drug quite often, and patients - if you believe the reviews left - are often satisfied with the achieved treatment results.

For children, injections are effective when necessary to eliminate the consequences of birth trauma , in case of perinatal pathology of the central nervous system , to reduce tension in the nervous system . In addition, the drug stimulates brain and speech development in children who have been diagnosed with delayed speech development .

At the same time, many mothers note that the effectiveness of the drug directly depends on the correct selection of the dose and duration of treatment. Some believe that Cerebrolysin works well in high dosages and in combination with a complex of physiotherapeutic measures.

According to parents whose children were treated with the drug, especially pronounced progress in children is observed if therapy was started before one year.

A number of negative reviews about Cerebrolysin for children are due to the fact that the injections are quite painful, expensive and have contraindications.

Reviews from adults about the drug are quite contradictory. On forums where people discuss certain medications, many positive reviews have been left about Cerebrolysin as an effective and time-tested remedy.

Some patients say they did not notice the expected effect. However, the instructions for Cerebrolysin warn that the greatest clinical effectiveness is observed after not one, but several courses of treatment.

Cerebrolysin price, where to buy

Price of Cerebrolysin in Russia

Prices for Cerebrolysin injections on the Russian pharmaceutical market are as follows:

• ampoules 1 ml No. 10 - 660 rubles;
• ampoules 2 ml No. 10 - 910 rubles;
• ampoules 5 ml No. 5 - 970 rubles;
• ampoules 10 ml No. 10 - 1350 rubles.

There is no point in looking for the price of Cerebrolysin in tablets, since the drug is available exclusively in solution form.

Price of Cerebrolysin ampoules in Ukraine

The cost of ampoules of 1 ml No. 10 is 200 UAH, you can buy ampoules of 5 ml No. 5 for about 330 UAH. Ampoules of 10 ml No. 5 in Ukrainian pharmacies cost an average of 540 UAH.

• Online pharmacies in RussiaRussia
• Online pharmacies in UkraineUkraine
• Online pharmacies in KazakhstanKazakhstan

LuxPharma* special offer

• Phytocerebrolysin F (Phytocerebrolysin) 500 mg caps.
  N40 RUR 1,570 order
• Cerebrolysin amp. 1ml No. 10

  2680 rub. order

ZdravCity

• Cerebrolysin solution for in. 10ml 5 pcs EVER Neuro Pharma GmbH

  RUB 1,442 order

• Cerebrolysin solution for in. 5ml 5 pcs EVER Pharma Jena GmbH/Hameln Pharmaceuticals GmbH

  RUB 1,049 order

• Cerebrolysin solution for in. 2ml 10 pcs EVER Neuro Pharma GmbH

  RUB 1,039 order

• Cerebrolysin solution for in. 20ml 5 pcs EVER Neuro Pharma GmbH

  RUB 3,207 order

Pharmacy Dialogue

• Cerebrolysin (amp. 2ml No. 10)EVER Neuro Pharma

  RUB 1,034 order

• Cerebrolysin (amp. 5 ml No. 5)EVER Neuro Pharma

  RUB 1,027 order

• Cerebrolysin ampoules 10ml No. 5EVER Neuro Pharma

  RUB 1,431 order

• Cerebrolysin (solution d.in.5ml No. 5) EVER Pharma Jena GmbH/EVER Neuro Pharma GmbH

  RUB 1,066 order

• Cerebrolysin (d.in. solution 10ml No. 5) EVER Pharma Jena GmbH/EVER Neuro Pharma GmbH

  RUB 1,512 order

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Pharmacy24

• Cerebrolysin 5 ml N5 solution for injection
  715 UAH. order
• Cerebrolysin 10 ml N5 injection solution

  1147 UAH. order

• Cerebrolysin 430.4 mg 2 ml No. 10 injection solution Ever Neuro Pharma GmbH., Austria

  678 UAH. order

• Cerebrolysin 20 ml N5 injection solution Ever Neuro Pharma GmbH., Austria

  2025 UAH. order

PaniPharmacy

• Cerebrolysin ampoule Cerebrolysin solution for injection 20ml No. 5 Austria, EVER Neuro Pharma

  1979 UAH order

• Cerebrolysin ampoule Cerebrolysin solution for injection 2ml No. 10 Austria, EVER Neuro Pharma

  684 UAH. order

• Cerebrolysin ampoule Cerebrolysin solution for injection 10ml No. 5 Austria, EVER Neuro Pharma

  1175 UAH. order

• Cerebrolysin ampoule Cerebrolysin solution for injection 5ml No. 5 Austria, EVER Neuro Pharma

  745 UAH. order

• Cerebrolysin ampoule Cerebrolysin solution for injection 1ml No. 10 Austria, EVER Neuro Pharma

  673 UAH. order

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Release form, composition and packaging

Injection

yellowish-brown, transparent.

* molecular weight not more than 10,000 daltons.

Excipients:

sodium hydroxide, water d/i.

• 1 ml - brown glass ampoules (10) - contour cell packaging (1) - cardboard packs.
• 2 ml - brown glass ampoules (10) - contour cell packaging (1) - cardboard packs.
• 5 ml - brown glass ampoules (5) - contour cell packaging (1) - cardboard packs.
• 10 ml - brown glass ampoules (5) - contour cell packaging (1) - cardboard packs.
• 20 ml - brown glass ampoules (5) - contour cell packaging (1) - cardboard packs.
• 30 ml - brown glass bottles (1) - cardboard packs.
• 30 ml - brown glass bottles (5) - cardboard packs.