Cerepro 250 mg-ml 4 ml 5 pcs solution for intravenous and intramuscular administration

pharmachologic effect

Manufacturer: Veropharm, Russia
Release form: capsules, solution for IM or IV administration

Active ingredient: choline alfoscerate

Cerepro is a central anticholinergic stimulant. It has a positive effect on blood flow in the affected area of ​​the brain, enhances metabolic processes in the central nervous system, and also activates the reticular formation. The drug normalizes the spatiotemporal characteristics of brain activity. After completing a course of therapy, a patient with vascular pathologies in this area experiences stabilization of behavioral and cognitive reactions.

Cerepro does not have a negative effect on the reproductive cycle, which is important for women, and does not have a teratogenic effect. The product is not a mutagen. It has a high percentage of absorption. Excreted by the lungs, kidneys, and intestines.

Cerebrovascular diseases and their most severe forms—acute cerebrovascular accidents (ACVA)—are the most important medical and social problem [3, 12]. Vascular diseases of the brain have taken 2nd place in Russia (after cardiovascular diseases) among all causes of death in the population [2, 12]. Registry data show that about 450,000 strokes occur annually in Russia, with a mortality rate reaching 35% [2]. In Moscow alone, the number of patients with ischemic stroke was 26,608 in 2009, 28,653 in 2010. During the period from 1990 to 2010, there was an increase in the mortality rate from cerebrovascular diseases by 18.5% [2]. Among diseases of the nervous system that lead to permanent disability, cerebrovascular disorders occupy 1st place [2, 3, 12]. This dictates the need to strengthen efforts to prevent strokes and chronic progressive vascular diseases of the brain.

In the pathogenesis of vascular lesions of the brain, the leading role is given to the processes of ischemia, excitotoxicity and apoptosis, excessive activation of the glutamatergic system on the one hand, insufficient activity of the cholinergic and GABAergic systems on the other [3, 4, 11]. Based on the characteristics of pathogenesis, pharmacological agents that affect neurotransmitter systems have been widely used in the treatment of patients with acute and chronic vascular diseases of the brain. Considerable experience has been accumulated in influencing dopaminergic (L-DOPA drugs), glutamatergic (racetams, memantine), GABAergic and cholinergic receptor formations. It must be said that the cholinergic system, widely represented in various parts of the central nervous system (CNS), closely interacting with dopamine, GABA and glutamatergic systems, ensures spontaneous activity, emotional behavior, memory and volitional acts. In this regard, the effect on the cholinergic apparatus has always been one of the important tasks in the treatment of cerebrovascular diseases [1, 3, 4, 8-10].

Among the drugs with a central cholinomimetic effect is choline alfoscerate. By participating in the synthesis of acetylcholine, the drug has a positive effect on neurotransmission. Glycerophosphate contained in choline alphoscerate is a precursor of membrane phospholipids and myelin, therefore the drug improves membrane plasticity, receptor function and synaptic transmission. While taking it, an increase in blood flow and metabolic processes in the central nervous system is shown. Choline alfoscerate activates the reticular formation and helps normalize the spatiotemporal characteristics of spontaneous bioelectrical activity of the brain. In general, choline alfoscerate has a distinct nootropic effect, has a neuroprotective effect, activating an effect on brain structures, improves cognitive functions, attention, memorization and reproduction of information [1, 6, 7].

Choline alfoscerate preparations are currently effectively used in the treatment of a number of neurological and borderline psychiatric diseases: chronic cerebral ischemia, cognitive impairment of various etiologies, consequences of traumatic brain injuries, asthenia and chronic fatigue syndrome [5-7].

The purpose of this study was to evaluate the clinical efficacy and tolerability of the drug choline alfoscerate, Cerepro, in the treatment of patients with cerebrovascular diseases in an outpatient setting.

Material and methods

The study included 90 patients aged from 45 to 80 years (average - 62.34±5.7 years) with chronic progressive vascular diseases of the brain, undergoing rehabilitation in the district neurological departments of Moscow. Of these, 60 (66.7%) patients suffered a cerebral infarction, the remaining 30 (33.3%) patients were diagnosed with chronic cerebral ischemia (CHI).

The exclusion criteria from the study were: the presence of severe motor, speech, and cognitive deficits; severe, decompensated or unstable somatic diseases; tumors of various localizations; endogenous mental illnesses.

During a neurological examination, the majority of patients revealed coordination (77.7%), sensory (64.4%) and motor disorders in the form of moderate hemiparesis (34.0%). Elements of motor aphasia were noted in 10 patients, sensory aphasia in 2, mixed aphasia in 3. Cognitive changes were observed in 62 (68.9%) patients with an average score on the MMSE scale of 24.7±0.5 points.

Arterial hypertension was observed in more than half of the patients - in 57 (63.3%), coronary heart disease was detected in 30 (33.3%). 24 (26.7%) patients had other concomitant somatic diseases: urolithiasis, chronic cholecystitis, chronic gastritis, chronic bronchitis, spastic colitis, chronic pyelonephritis.

Of the patients who suffered a stroke, 24 (40.0%) suffered a heart attack in the territory of the right middle cerebral artery, 28 (46.7%) of the left middle cerebral artery, and 8 (13.3%) patients in the vertebrobasilar territory. The duration of the stroke ranged from 60 to 274 days (on average 158±10.6 days); patients predominated (71.2%) with a history of acute stroke of 4-6 months.

Using computer (CT) or magnetic resonance (MRI) imaging of the brain, signs of a heart attack were recorded in 57 (63.3%) of the examined patients; in 26 (28.9%) patients, multiple foci of vascular origin were identified in the brain substance , phenomena of leukoaraiosis and hydrocephalus. In 7 patients, no changes were detected during neuroimaging.

All patients, along with basic drugs (antihypertensives, antiplatelet agents or anticoagulants, hypocholesterolemic drugs), were prescribed intravenous drip administration of Cerepro 1000 mg per day per 200 ml of saline solution for 10 days (with a 2-day break on Saturday and Sunday) followed by oral administration the drug in a daily dose of 1200 mg (1 capsule 3 times a day) for 6 weeks. During the study, the use of other nootropic and neurometabolic drugs was prohibited.

To differentiate the effectiveness of therapy, all patients included in the study were divided into 2 groups: group 1 consisted of 60 patients in the recovery period of ischemic stroke; 2nd - 30 patients with CCI. In terms of age and gender composition and a number of clinical characteristics, the groups were statistically homogeneous and comparable.

To assess the effectiveness of therapy, the dynamics of neurological symptoms was studied. Additional methods were also used: scoring the subjective severity of neurological symptoms; brief scale for assessing higher mental functions MMSE (Mini-Mental State Examination); methodology for rapid assessment of well-being, activity and mood (SAM); Hamilton Depression Scale; Clinical Global Impression (CGI) scale; scoring of the tolerability and effectiveness of the drug (0-5 points). Neurological status, state of mental functions according to the MMSE scale, subjective severity of neurological symptoms (in points), indicators using the SAN method and the Hamilton test were assessed before the start of therapy (1st visit), after 10 days of parenteral administration of the drug (2nd visit) and after completion of the treatment course (3rd visit). Patients were assessed using the CGI scale at visits 1 and 3. The severity of the therapeutic response and drug tolerability were determined within each group.

The results were entered into the patient’s individual protocol and further statistically processed using Excel, Epi and Statistica 6.0 programs. The significance of the differences was determined using the parametric method (Student's t-test) and nonparametric statistics (criterion &khgr;2). Differences were considered statistically significant at p<0.05.

results

In patients of group 1 who suffered a stroke, when assessing the neurological status after completing the course of treatment with Cerepro, a decrease in the degree of paresis and regression of sensory disorders were noted, but these changes did not reach the level of statistical significance. At the same time, there was a significant (p = 0.036) decrease in the severity of coordination disorders.

A statistically significant (p<0.05) improvement was observed when assessing mental functions on the MMSE scale. Initially, disturbances in orientation, perception, speech, writing and reading in the examined patients using the MMSE scale corresponded to mild dementia (average score - 23.8±0.65). During Cerepro therapy, the overall test score increased, reaching the level of mild cognitive impairment by the end of the study - 25.0±0.81 points.

Subjectively, all examined patients noted a decrease in affective tone, up to the development in some cases of depressive manifestations, and somatovegetative and cerebrasthenic disorders were identified. Along with a decreased background mood, depression, internal tension, restlessness, and anxiety, most patients also showed a decrease in the productivity and focus of intellectual activity, impaired concentration of active attention, and a low level of activity and motivation. The use of the SAN technique made it possible to state a significant (p<0.05) decrease in the severity of emotional and autonomic disorders in patients in this group after 8 weeks of Cerepro therapy.

Upon admission to treatment, 41 (68.3%) patients showed depressive symptoms on the Hamilton scale; in the remaining patients they did not reach the clinically defined level. By the time of completion of therapy with the drug Cerepro, mild depressive symptoms on the Hamilton scale were detected in only 46.6% of patients; the remaining patients did not present any complaints from the depressive register during testing. However, there was no statistically significant change in the Hamilton Depression Scale score in this group of patients by the end of the study.

When assessed on the CGI scale, regression of objective signs of cognitive and focal impairments was revealed: the total score increased in the study group from the level of moderate deficit to mild.

The use of a score for the subjective severity of neurological symptoms made it possible to state a significant (p<0.05) decrease in the degree of emotional disorders in patients of group 1. At the 1st visit, most patients presented asthenic complaints of severe general weakness, fatigue, and impaired concentration. After 8 weeks of therapy with Cerepro, a significant proportion (p<0.05) of patients noted a decrease in asthenia and fatigue. A significant (p <0.05) effect of Cerepro on somatovegetative manifestations was also found - the intensity of headache and the severity of dizziness (Table 1).

In patients of group 2 with CCI, a study of the neurological status revealed a gradual regression of sensory and coordination disorders, but the severity of the changes did not reach the level of statistical significance.

When assessing the neuropsychological status at the end of treatment with Cerepro, a statistically significant improvement was observed in most parameters of the MMSE scale. The positive effect of the drug was established in terms of attention, memory and counting (p<0.05). The total score of the MMSE scale at the time of completion of the study corresponded to the level of mild cognitive impairment - 27.1±0.8 (at the 1st visit - 25.0±0.66 points, p<0.05).

By the end of the course of treatment with Cerepro, all patients in this group showed a general improvement in well-being, increased daily activity, and improved mood. A significant (p<0.05) improvement in indicators of well-being, activity and mood on the SAN scale, a decrease in the severity of asthenic manifestations, an increase in affective tone and the level of daily activity were recorded.

Before the start of the study, depressive symptoms of varying severity when assessed on the Hamilton scale were identified in 18 (60%) patients. By the end of the study, positive changes on the Hamilton scale were noted in 13 patients. In 4 cases, after 2 months of therapy with Cerepro, only slight or minimal improvement was noted, and in 1 case, depressive disorder remained stable in its manifestations. There were no significant differences in the average group score on this scale before and after treatment.

After 8 weeks of therapy with Cerepro, the score on the CGI scale changed significantly (p<0.05) - the total score for the severity of disorders decreased to the level of mild severity.

Improvement in the condition of patients in group 2 with CCI was also observed on the scale of subjective disorders. After 8 weeks of using Cerepro, patients noted positive changes in well-being, a decrease in the severity of depression, general weakness, and fatigue. Statistically significant (p<0.05) changes concerned memory indicators, asthenic manifestations and dizziness (Table 2).

A comparative analysis of the dynamics of the neurological status in patients of the 1st and 2nd groups showed a decrease in the degree of paresis in patients of the 1st group and a gradual regression of sensory and coordination disorders in patients of both groups by the 8th week of Cerepro therapy, however, no significant differences were observed between groups . Upon completion of the course of treatment, an increase in the total score on the MMSE scale was revealed in patients of both groups to the level of mild cognitive impairment. Similarly, there was an increase in scores on three components of the SAN scale (well-being, activity, mood) with a simultaneous decrease in the severity of depression on the Hamilton scale and a decrease in the severity of disorders on the CGI scale. There were no statistically significant differences in the results of the study of cognitive and psychoemotional status in patients of both groups (Table 3).

By the time the study was completed, overall therapeutic efficacy of varying severity was observed in all patients included in the study (100%), including a very good result in 15 (16.7%), good in 64 (71.1%) and satisfactory - in 11 (12.2%). In a comparative analysis by group, clinical effectiveness turned out to be higher in the treatment of patients in group 1 due to a significant reduction in the degree of coordination and cognitive disorders (Table 4).

There were no statistically significant differences in the tolerability of the drug in patients of both groups. In most cases - in 69 (76.7%) patients - tolerability was rated as good or very good (see Table 4). No significant side effects in the form of deterioration in somatic condition and mental status were registered in the studied patients. In 5 patients (5.5%, 4 patients of the 1st group and 1 patient of the 2nd group) during intravenous drip administration of the drug, headache and an increase in blood pressure above the adaptation figures were noted. Slower intravenous administration of the drug over 1 hour neutralized the increase in blood pressure.

When taking Cerepro orally, 8 patients (8.8%, 3 patients of group 1 and 5 patients of group 2) experienced headache (2 cases) and nausea (2 cases) in the first 2 weeks of taking the drug. These complaints did not require additional treatment or discontinuation of the drug. Another 3 patients experienced anxiety and agitation while taking Cerepro; 1 patient complained of sleep disturbances and difficulty falling asleep. In these cases, it was recommended to take the drug before 18 hours; specific therapy was not prescribed.

Among the variety of pharmacological agents used in neurological practice, one of the most popular in the treatment of vascular diseases of the brain are cholinergic drugs, in particular choline alfoscerate. The effectiveness of the drug in the treatment of acute and chronic cerebral circulatory failure, post-traumatic and toxic encephalopathy, degenerative diseases of the central nervous system, and complex therapy of Alzheimer's type dementia has been confirmed in many studies [5-7].

The present study revealed a distinct nootropic effect of choline alfoscerate (Cerepro). Cognitive functions significantly improved with the use of the drug: attention, memorization and reproduction of information. A reliable complex effect of Cerepro on asthenic syndrome and low mood was also revealed. However, no significant effect of the drug on focal neurological symptoms in patients with vascular diseases of the brain was found. A clinically significant reduction in cognitive and emotional disorders, along with an improvement in the well-being of patients, was evident by the 8th week of continuous use of the drug. There were no serious complications or side effects that required additional measures during treatment with Cerepro.

Thus, the study demonstrated the effectiveness of Cerepro in the treatment of patients with vascular diseases of the brain, including during the recovery period of ischemic stroke. The drug can be recommended for use in complex therapy of patients with vascular diseases of the brain at the stage of outpatient rehabilitation.

Indications for use of Cerepro

Prescribed to patients with the following disorders and pathologies:

1. Traumatic brain injury (acute phase, recovery period).
2. Ischemic and hemorrhagic stroke.
3. Psychoorganic syndrome, which is diagnosed in patients as a result of degenerative and involutional changes in the brain.
4. Circulatory failure in the brain in the chronic stage.
5. Cognitive type disorders.
6. Pseudomelancholia in patients of the elderly age group.

Helpful information! Before starting the course, you must consult with your doctor. Do not ignore existing restrictions and precautions. Self-prescription and use can lead to irreversible consequences.

Comparison of safety of Cerepr and Cereton

The safety of a drug includes many factors.

Moreover, in Cerepra it is quite similar to Cereton. It is important where the drug is metabolized: drugs are excreted from the body either unchanged or in the form of products of their biochemical transformations. Metabolism occurs spontaneously, but most often involves major organs such as the liver, kidneys, lungs, skin, brain and others. When assessing metabolism in Cerepra, as well as in Cereton, we look at which organ is the metabolizing organ and how critical the effect on it is.

The risk-benefit ratio is when the prescription of a drug is undesirable, but justified under certain conditions and circumstances, with the obligatory observance of caution in use. At the same time, Cerepra does not have any risks when used, just like Cereton.

Also, when calculating safety, it is taken into account whether only allergic reactions occur or possible dysfunction of the main organs. In other matters, as well as the reversibility of the consequences of using Cerepr and Cereton.

Cerepro - instructions for use

According to the instructions for use, the dosage of Cerepro and the number of doses are adjusted by a specialist depending on the diagnosis. To achieve stabilization and improvement of the condition, it is necessary to adhere to all recommendations and prescriptions of the doctor.

If the patient has an acute condition, then it is necessary to administer the drug intravenously or intramuscularly (1 g per day). In all other cases, the patient is allowed to take 400 mg tablets no more than three times a day. The duration of the course is from three months to six months.

How to take Cerepro: before or after meals

Cerepro is recommended to be taken 30-45 minutes before meals. If it was not possible to take the tablet before meals, you are allowed to do so after 60–90 minutes. During the course, it is not necessary to additionally prescribe to the patient medications that protect the mucous surface of the gastrointestinal tract.

Effect on the heart, hormonal levels, muscle tone

During a clinical study, a group of patients with transient ischemic attack or ischemic stroke received choline alfoscerate in a therapeutic dosage intramuscularly, then orally. From 19 to 21% of subjects showed a significant improvement in their general condition.

Healthy subjects in another group took choline alphoscerate before strength training. 45 minutes after administration, they performed a series of physical exercises. When bench pressing a barbell, an increase in strength indicators by 14% was noted.

A study of the effect of choline alfoscerate on the synthesis of somatotropin showed that the highest levels of growth hormone were recorded an hour after taking the drug. Within two hours, the concentration of the hormone in the blood returned to normal.

Analogues of Cerepro

The pharmacy offers a range of Cerepro substitutes, both domestic and foreign. Analogs differ from each other in the form of release, the company, and most importantly, the cost. The choice of medications from this group should be made exclusively by a doctor, since self-therapy can lead to destabilization of the condition.

Prices for analogues of the drug Cerepro

The price is influenced by factors such as release form, packaging, manufacturer, and dosage of the active ingredient.

Cerepro or Gliatilin – which is better and more effective?

Manufacturer: SI ES SI LTD, Italy
Release form: capsules, injection solution

Active ingredient: choline alfoscerate

Gliatilin is an analogue of foreign-made Cerepro injections. A prescription drug that has a positive effect on the transmission of nerve impulses, improves blood flow, and enhances metabolic processes in the brain. It also helps restore consciousness after injury to this area. Used as a preventive and corrective agent. Quickly and almost completely absorbed. The benefit accumulates in the brain, lungs and liver.

This analogue of Cerepro is prescribed to patients with the following disorders:

• TBI in the acute period with damage to the table part;
• chronic cerebrovascular insufficiency;
• dementia syndrome;
• cerebral infarction;
• pseudomelancholia in elderly patients.

Reviews from doctors about the presented medications are positive, since they are effective for these disorders and do not differ in the active ingredient or pharmacology.

Application of Cerepro, mechanisms of action of choline alfoscerate on the human central nervous system

Regular intake of choline alfoscerate increases the accumulation of inositol phosphate in nerve tissues, while the main antagonist of muscarinic-type cholinergic receptors, atropine, does not block the process. The reaction is due to stimulation of phospholipid synthesis5.

Studies have shown that choline alfoscerate improves calcium release in the hippocampus and is involved in the formation of inositol phosphate (due to its effect on the corresponding receptors). These processes and reactions, which are not characteristic of choline, are also presumably associated with effects on phospholipid metabolism.

A number of experiments have revealed that choline alfoscerate increases the concentration of dopamine in the frontal cortex and cerebellum, which was not observed when taking choline in other forms6. It is likely that the release of dopamine is due to the fact that choline alphoscerate interacts with cell membranes. The net effect is an increase in the number of dopamine transporters.

In these same areas - the frontal cortex and cerebellum - when taking choline alfoscerate, the concentration of serotonin increases. The level of acetylcholine itself also increases, but it is unknown whether this effect affects the entire brain or just certain areas.

The target effects were studied in brains with artificial amnesia modeled using scopolamine, a cholinergic toxin. Taking choline alfoscerate completely suppressed the negative effects of scopolamine and eliminated amnesia7, and its effectiveness exceeded that of aniracetam and idebenone, a synthetic analogue of coenzyme Q10. Potentially, choline alfoscerate may protect the brain from cholinergic toxins8.

Presumably, choline alfoscerate may have a neuroprotective effect, like any substances and preparations containing choline in one form or another. This is due, among other things, to the activation of nicotinic cholinergic receptors, which suppress the neurotoxicity of other substances.

Cerepro or Ceraxon - which is better?

Manufacturer: TAKEDA PHARMACEUTICALS, Spain
Release form: solution for oral administration and injection

Active ingredient: citicoline

Ceraxon is a foreign analogue that is cheaper than Cerepro. A prescription nootropic drug that restores damaged brain cells. If the patient is diagnosed with an acute stage, then the active component reduces the number of affected tissues in the brain and helps improve cholinergic transmission.

It is also worth noting that the drug reduces the recovery period and the severity of neurological symptoms. The drug is used to treat cognitive disorders. It is effective in the treatment of sensory and motor neurological disorders of various etiologies.

Most often, the Cerepro analog Ceraxon is prescribed to patients with ischemic and hemorrhagic stroke, traumatic brain injury, cognitive and behavioral disorders, as well as degenerative and vascular pathologies of the brain.

Reviews from doctors are positive, as they help to cope with these disorders and return the patient to normal life.

Cerepro or Cereton - which is better and more effective, what is the difference

Manufacturer: SOTEX, Russia
Release form: capsules, injection solution

Active ingredient: choline alfoscerate

Cereton is an analogue of Cerepro in 400 mg capsules. This is a prescription nootropic substitute that is a centrally acting cholinomimetic. The product improves blood circulation, enhances metabolic processes in the central nervous system, and also activates the reticular formation.

Cereton is prescribed for TBI in the acute and recovery period, for hemorrhagic stroke, cognitive disorders, psychoorganic syndrome, dementia, encephalopathy, pseudomelancholia in elderly patients. The product is no different and has the same effectiveness for these disorders.

GABAergic neurotransmission, influence on cognitive activity

Choline alfoscerate interacts with the noradrenergic system, stimulating the release of GABA - gamma-aminobutyric acid, which is the main inhibitory neurotransmitter of the central nervous system9. GABA release in some studies reached 130% of baseline values ​​within 150 minutes after administration of choline alfoscerate. Presumably, the release of GABA occurs through alpha-1 adrenergic receptors.

In one study, choline alfoscerate taken along with caffeine increased reaction time and attention in patients under acute stress. The substance stimulates memory and cognitive activity through the activation of protein kinase C, which is responsible for the formation of memory, including long-term memory10. 1 hour after oral administration of choline alfoscerate, stimulation of protein kinase C translocation reaches peak values ​​and levels off after 5 hours.

Many studies of choline alfoscerate as a cognitive stimulant involve patients suffering from Alzheimer's disease. Since this pathology is mediated by an increase in the rate of phospholipid degradation, its development increases the need for choline11. This process is called autocannibalism - when the body receives acetylcholine from phospholipids containing choline. Damage to cell membranes is also believed to occur.

Choline alfoscerate can repair damaged membranes. In experiments where one group of patients took choline alfoscerate and the other a placebo, the first group experienced improvements in behavioral, verbal symptoms and memory after 90 days of use. With a degenerative nature of the pathology, the overall improvement was 10-26%, with a vascular nature - 8-30%12.

Cerepro or Cerebrolysin - which is better, what is the difference

Manufacturer: EVER NEURO, Austria
Release form: injection solution

Active ingredient: Cerebrolysin concentrate

Cerebrolysin is an imported analogue of Cerepro in ampoules, a prescription nootropic drug. It has a complex composition that does not allow pharmacokinetic analysis. Prescribed to adults for the following disorders:

• Alzheimer's disease;
• dementia syndrome;
• cerebrovascular insufficiency;
• cerebral infarction;
• endogenous depression;
• damage to the spinal cord and brain.

The analogue is also recommended for children with developmental delays, hyperactivity, and attention deficit.

What nootropic drugs are prescribed to older people and for what purpose?

Indications for prescribing nootropics to older people are the following conditions: • Alzheimer's disease. • Syndromes of confused consciousness and fragmented thinking. • Pick's disease. • Disorientation in space and time. • Confusion and instability of attention. • Emotional imbalance. • Anxiety disorder. • Illusory perception. • Memory problems. • Sleep disorders. • Motor overexcitation or retardation.

In addition, nootropics can also be prescribed for preventive purposes to slow down age-related changes in the neuropsychic sphere associated with cerebrovascular accidents, weakening of memory and cognitive abilities. Among the nootropic drugs used for older people, the most common and popular are: • Cavinton, the active ingredient of which is vinpocetine. Its main therapeutic effect is aimed at improving cerebral circulation by reducing blood viscosity and, accordingly, improving the supply of oxygen to the brain. It is characterized by a targeted selective effect on the affected area of ​​the brain, so this nootropic drug is especially effective in the treatment and rehabilitation after stroke, vascular dementia and cerebrovascular accidents. It is also used in the treatment of vascular and retinal lesions and Meniere's disease. Side effects may include nausea, heartburn, weakness, headache and tachycardia, which is a disadvantage of the drug and a contraindication for its use in case of heart rhythm disturbances (arrhythmias). • Encephabol – stimulates metabolic processes in the brain by accelerating the utilization of glucose, normalizes blood circulation in areas affected by ischemia, and helps restore the functions of the nervous system. Other therapeutic effects include improved memory, increased mental activity and overall central nervous system tone. It helps well in overcoming the negative consequences of encephalitis, as well as in the treatment of cerebroasthenic syndrome and mental retardation in children. The downside is the ability to cause allergic reactions in people sensitive to pyritinol, as well as the high price.

• Phenibut is a drug that combines nootropic and tranquilizing effects. Which manifests itself in a decrease in the excitability of the nervous system, a decrease in anxiety and fear. The drug prolongs the duration of action and enhances the effect of sleeping pills. With long-term use, it increases physical and intellectual capabilities, normalizes sleep, and improves memory. Effective in the complex treatment of withdrawal syndrome in alcoholism. The downside is the possibility of withdrawal syndrome after completing the course of the drug.

• Picamilon is a nootropic drug popular among doctors and patients, which has several effects: a psychostimulant, a tranquilizer and an antioxidant. Improves metabolic processes and blood supply to brain tissue, reduces the intensity of headaches, relieves anxiety and nervous tension, and also increases a person’s physical and intellectual capabilities. Has a positive effect on the restoration of motor and speech functions after stroke and toxic lesions of the brain. In older people, it has a good effect in the complex treatment of migraines, cerebrovascular accidents, and retinal diseases. Side effects include the possibility of developing an allergic response to this drug.

The use of nootropics in older people should be treated very carefully, taking into account the depth of age-related changes, possible side effects, prevailing symptoms, the presence of concomitant diseases and the general condition of the body. Only a specialist can objectively evaluate all these aspects and correctly prescribe treatment using nootropics. Prescribing these drugs to your elderly relatives yourself is extremely undesirable and unsafe for their health.

Cerepro or Mexidol - which is better?

Manufacturer: VECTORFARMA, Russia
Release form: tablets, injection solution

Active ingredient: ethylmethylhydroxypyridine succinate

Mexidol is a prescription, nootropic, antioxidant drug that differs in pharmacology. The product has antihypoxic, stress-protective, anticonvulsant, and antioxidant properties. Russian tablets can increase the patient’s body’s resistance to negative factors. If you don’t know what you can replace Cerepro in tablets with, then use Mexidol.

This cheap analogue of the drug Cerepro increases the content of dopamine in the brain, and also improves metabolic processes and blood flow, and reduces platelet production. The product has hypolipidemic and antitoxic properties. Has an extended list of indications:

• acute disturbances of cerebral blood flow;
• Mild TBI, elimination of the consequences of injury;
• encephalopathy of various origins;
• VSD;
• cognitive disorders of atherosclerotic origin;
• IHD;
• withdrawal syndrome in patients dependent on alcoholic beverages;
• acute intoxication with antipsychotic drugs;
• asthenic disorders;
• the presence of constant stress factors.