Milgamma - what is it and what is it used for? Milgamma is a combination drug that contains B vitamins: B1 (thiamine), vitamin B6 (pyridoxine) and vitamin B12 (cyanocobalamin).
This vitamin complex saturates the body with essential elements, improves the functioning of the nervous system and supporting apparatus, has an effective therapeutic effect, and is a powerful analgesic for attacks of acute pain.
Milgamma has an effective effect on pinching, damage and inflammation of nerve endings. So, it is successfully taken for diseases such as:
- neuropathy;
- neuralgia;
- facial nerve paresis;
- radicular syndromes;
- retrobulbar neuritis.
Due to its unique ability to saturate the human body with essential vitamins, Milgamma is recommended by specialists as an auxiliary drug in the treatment of diseases of internal organs (arthrosis, vertebral hernia, gout, inflammation of the pancreas, etc.)
Due to stressful situations that accompany modern man, natural degenerative processes occurring in the body, possible physical activity and injuries, changes in the structure of the myelin sheaths of nerve endings occur, which leads to pain. The Milgamma vitamin complex helps get rid of pain.
pharmachologic effect
Milgamma Compositum tablets are a complex of B vitamins. The active ingredients of the drug - benfotiamine and pyridoxine hydrochloride - alleviate the patient’s condition with inflammatory and degenerative diseases of the nerves, as well as the musculoskeletal system. Milgamma tablets activate blood flow and improve the functions of the nervous system.
Benfotiamine is a substance that plays an important role in carbohydrate metabolism. Pyridoxine is involved in the body's metabolism of protein; it is also partially involved in the metabolism of fats and carbohydrates. Benfotiamine and pyridoxine in high doses act as an analgesic due to the participation of benfotiamine in the synthesis of serotonin . A regenerating effect is also noted: under the influence of the drug, the myelin sheath of the nerves is restored.
What is it prescribed for?
Milgamma contains B vitamins.
B vitamins are fat-soluble substances that play a major role in the cellular metabolism of the body and are involved in all vital processes. The group of vitamins B includes the main components of the drug Milgamma - vitamin B1 (thiamine), B6 (pyridoxine) and B12 (cyanocobalamin). Each of the components of the Milgamma vitamin complex plays its own important role.
Vitamin B1 (thiamine)
Thiamine (B1) is responsible for normalizing carbohydrate metabolism in internal organs (liver, brain and living tissues). In addition, it is involved in the production of fatty acids and optimizes amino acid metabolism. An important function of thiamine is that it effectively reduces inflammation of the skin and improves the condition of the mucous membranes. Thiamine is involved in hematopoiesis and in the process of cell division, preventing the aging process of the body.
Thiamine is prescribed by specialists in the following cases:
- with liver disease;
- if the endocrine system is disrupted (consequences of obesity, diabetes);
- for eczema, psoriasis, pyoderma;
- in case of malfunction of the kidneys, brain and central nervous system;
- for gastritis, ulcers, pancreatitis and other gastrointestinal diseases.
Vitamin B6 (pyridoxine)
Pyridoxine (B6) is a water-soluble element that regulates metabolic processes and normalizes blood circulation. Pyridoxine is involved in the synthesis of molecules and the breakdown of carbohydrates. In addition, vitamin B6 reduces the risk of obesity, diabetes and the development of cardiovascular diseases. The level of cholesterol in the human body depends on the amount of vitamin B6. The role of vitamin B6 is indispensable in the synthesis of new red blood cells, i.e. this component is actively involved in the restoration of hematopoietic function. Like the other vitamins of the Milgamma complex, vitamin B6 affects the strengthening of the human immune system. In addition, a sufficient amount of pyridoxine protects against depression, relieves anxiety, and ensures calm.
Vitamin B6 is prescribed:
- patients with atherosclerosis, anemia and diabetes;
- pregnant women with toxicosis;
- teenagers with problems with improper functioning of the sebaceous glands.
Vitamin B12 (cyanocobalamin)
Cyanocobalamin (B12) helps accelerate the breakdown of proteins, fats and carbohydrates. Responsible for the synthesis of leukocytes, which are involved in protecting living tissues from foreign elements. Reduces cholesterol levels in the human body. Vitamin B12 helps normalize sleep and optimize the production of melatonin, the sufficient amount of which determines the sleep-wake cycle.
Indications for the use of cyanocobalamin are as follows:
- radiculitis;
- cirrhosis of the liver;
- polyneuritis;
- skin diseases (dermatitis, psoriasis);
- radiation sickness;
- bone injuries;
- acute and chronic hepatitis;
- bone injuries;
- radiculitis and others.
Pharmacokinetics and pharmacodynamics
Benfotiamine is a fat-soluble derivative of vitamin B1 (thiamine). In the body, this substance is phosphorylated into thiamine diphosphate and thiamine triphosphate, which are biologically active coenzymes. The main part of benfotiamine is absorbed in the duodenum, the rest of it is absorbed in the small intestine.
Pyridoxine is converted into pyridoxal phosphate. This enzyme affects the non-oxidative metabolism of amino acids. It takes part in the production of physiologically active amines. It is mainly absorbed in the upper parts of the digestive tract through the process of passive diffusion.
Both active substances are excreted mainly through the kidneys. The half-life of benfotiamine from the blood is 3.6 hours, the half-life of pyridoxine is 2-5 hours.
Compound
The composition of Milgamma in the form of a solution for intramuscular administration includes several active substances. In particular, the ampoules contain: pyridoxine hydrochloride , thiamine hydrochloride , cyanocobalamin and lidocaine hydrochloride .
Also, Milgamma injections contain additional substances: benzyl alcohol, potassium hexacyanoferrate, sodium hydroxide, sodium polyphosphate, water for injection.
Vitamins in tablets contain benfotiamine , pyridoxine hydrochloride , and also contain anhydrous colloidal silicon dioxide, croscarmellose sodium, microcrystalline cellulose, talc, povidone K30, and partial long-chain glycerides.
Indications for use
The following indications for the use of Milgamma Compositum as part of complex treatment are determined:
- neuritis;
- retrobulbar neuritis;
- neuralgia;
- ganglionitis;
- facial nerve paresis;
- plexopathy;
- polyneuropathy , neuropathy ;
- lumboischialgia;
- radiculopathy.
There are also indications for the use of this drug in people who regularly suffer from night cramps (primarily older people) and muscle-tonic syndromes. For what else the drug is prescribed, the doctor determines individually.
The effectiveness of Milgamma for prosopalgia of herpetic origin
The article discusses the generally accepted tactics of managing patients with herpetic lesions of the genu ganglion of the facial nerve (Ramsay-Hunt syndrome), accompanied by pain.
Using the example of the drug Milgamma, the place and significance of the combination of B vitamins in the complex therapy of such patients is analyzed.
The results of our own observations are presented, in which a positive result was obtained when using B vitamins in the treatment of facial pain syndromes.
Table. Dynamics of pain (compared to pain intensity before treatment, taken as 100%) according to VAS
Rice. 1. Dynamics of pain assessment according to VAS during the entire course of treatment
Rice. 2. The effectiveness of therapy according to subjective assessment of patients in the main group (Milgamma)
Rice. 3. The effectiveness of therapy according to subjective assessment of patients in the control group
Chronic pain in neurology
Chronic pain is one of the most pressing problems in neurological practice. The International Association for the Study of Pain defines chronic pain as “…pain that continues beyond the normal healing period.” In practice, this period can take from several weeks to several months. Chronic pain can also include recurring pain conditions (neuralgia, headaches of various origins, etc.). The point, however, is not so much a matter of temporal differences as of qualitatively different neurophysiological, psychological and clinical features.
The main difference is that acute pain is always a symptom of an underlying disease, while chronic pain can transform into an independent nosology. Consequently, therapeutic tactics for eliminating acute and chronic pain have significant features. Chronic pain in its pathophysiological basis may have a pathological process in the somatic sphere and/or primary or secondary dysfunction of the peripheral or central nervous system, it can also be caused by psychological factors [1].
The pathogenesis of chronic pain is multilevel and includes peripheral, central, combined peripheral-central and psychological mechanisms. By peripheral mechanisms we mean constant irritation of nociceptors of internal organs, blood vessels, the musculoskeletal system, the nerves themselves (nociceptors nervi nervorum), etc. The term “nociceptive pain” is used as a synonym for peripheral pain. Peripheral and central mechanisms, along with the participation of the peripheral component, suggest dysfunction of the central nociceptive and antinociceptive systems of the spinal and cerebral level associated with it (and/or caused by it). At the same time, long-term pain of peripheral origin can be the cause of dysfunction of central mechanisms, which necessitates the need for the most effective elimination of peripheral pain [2].
Relevance of the problem of treatment of facial pain
Pain in the facial area is one of the most pressing and socially significant problems in modern medicine, faced not only by neurologists, but also by general practitioners, in particular family doctors. All currently known diseases of the orofacial region and their clinical manifestations are combined into a group of neurodental diseases - clinically heterogeneous conditions, largely related to the pathological nature of the functioning of nociceptive mechanisms [3, 4].
One of the most common forms of pain syndromes in the craniofacial region is prosopalgia. This particularly intense, severe pain, which brings severe suffering to patients, often becomes the cause of temporary or permanent loss of ability to work. Pain becomes an active psychotraumatic factor, often leading to the development in patients of various mental disorders, predominantly of a neurosis-like nature, and in some cases leading to suicide [5].
The prevalence of prosopalgia, the complexity and persistence of dysfunction, sometimes accompanied by long-term disability, determine the medical significance of prosopalgia. Significant economic losses to society from the incidence of paroxysmal prosopalgia, in particular trigeminal neuralgia, and the difficulties of their adequate diagnosis, therapy and prevention determine not only the clinical, but also the socio-economic significance of the disease.
The variety of factors causing facial pain and the diversity of their clinical manifestations served as the basis for the creation of numerous classifications of prosopalgia. Sometimes facial pain contains a vegetative component (unclear localization, burning sensation), which can accompany somatic pain or be the leading one in the clinical picture. Prosopalgia can be caused by diseases of the nervous system, ENT organs, eyes, dentofacial system, etc. That is why the treatment of such patients is a joint task of doctors of different specialties, primarily neurologists, neurosurgeons and dentists.
Neurostomatologists are trying to develop optimal diagnostic, treatment and rehabilitation treatment regimens for patients with paroxysmal prosopalgia [6]. The maximum clinical effect is achieved by selecting the optimal combination of medicinal and non-medicinal agents for each individual patient.
Features of the treatment of prosopalgia of herpetic origin
The problem of treating facial pain syndrome, in particular its non-paroxysmal forms, is a fairly frequently discussed topic in the literature on neurostomatology, which once again emphasizes its relevance. This is due to the fact that this syndrome is often characterized by sufficient persistence and duration of the pain syndrome, which entails the development of psycho-emotional disorders; It is also important to take into account the fact that it mainly affects the working-age population and that the consequence of this syndrome is a pronounced decrease in the quality of life. North American neurologist Ramsay Hunt described ganglion ganglion neuralgia of the facial nerve due to herpetic infection in 1907. The disease is characterized by pain in the ear canal, herpetic rashes in the ear area and moderate paresis of the facial nerve. At the same time, damage to the VII, IX and X pairs of cranial nerves or the I, II cervical roots is possible. In this regard, four variants of the course of the disease are distinguished:
- herpetic eruptions without neurological manifestations (Hunt I);
- their combination with paresis of the facial nerve (Hunt II);
- combination of the above symptoms with hearing loss (Hunt III);
- a combination of manifestations of Hunt III and vestibular disorders (Hunt IV).
The acute period of Hunt syndrome is characterized by the presence of intoxication phenomena characteristic of the viral etiology of the disease. Usually on the 2-3rd day of the disease, herpetic rashes appear in the area of the external auditory canal and the auricle; rashes are possible on the anterior 2/3 of the tongue on the ipsilateral side. Along with moderately expressed motor disturbances of the facial muscles (which regress in a short time), pain appears that has a deep-seated nature. Subsequently, after regression of the period of intoxication (no malaise, drying out of crusts, etc.), pain is the leading symptom [7].
Considering the fact that the genesis of prosopalgia is herpetic in nature, the “standard” mistake in the treatment of this disease is the prescription of antiviral drugs, which are relevant exclusively during the period of virus replication in the blood. In this regard, patients must be hospitalized in an infectious diseases hospital. Often, after the acute period has resolved, patients are transferred to a specialized neurological (neurostomatological) department to continue treatment of the consequences of a viral infection of the facial nerve ganglion. One should take into account the fact that the herpes simplex virus is a tumor marker, therefore, if there are objective signs of this infection (paraclinical research methods, laboratory data, etc.), it is necessary to conduct research to exclude or confirm cancer. The classic treatment regimen for postherpetic prosopalgia includes the following:
- antidepressants (amitriptyline);
- anticonvulsants (gabapentin (Gabagamma));
- neuroleptics (thioridazine, chlorprothixene);
- sedatives (diazepam);
- sodium oxybate;
- agents that improve peripheral blood circulation (pentoxifylline, aminophylline, nicotinic acid);
- anticholinesterase drugs in the presence of moderate prosoparesis (ipidacrine);
- physiotherapy, transcranial magnetic stimulation, laser therapy, reflexology;
- neurotropic B vitamins (Milgamma, Milgamma compositum).
B vitamins in the treatment of pain syndromes
Interest in the widespread use of a combination of B vitamins for pain came from practice [8, 9]. Since the 1950s in many countries they began to be used as analgesics. In domestic practice, B vitamins are used very widely. Based on clinical experience, we can confidently state that parenteral use of a combination of thiamine, pyridoxine and cyanocobalamin effectively relieves pain syndromes, normalizes reflex reactions, and eliminates sensitivity disorders. With the advent of synthetic vitamins, it became possible to combine in one dose of the drug the amount of vitamins that a person could get from food throughout the year. In such pharmacological doses, vitamins are considered as drugs. It is well known that B vitamins are neurotropic drugs and significantly affect processes in the nervous system (metabolism, metabolism of mediators, transmission of excitation) [10, 11].
Currently, B vitamins have gained particular popularity in the treatment of a number of diseases characterized by pain, including pain in the facial area. Active work is underway to study the mechanism of the analgesic effect of B vitamins. There is already convincing evidence of their analgesic effect in neuropathic pain, especially caused by the herpes virus. It has been shown that the B complex of vitamins enhances the effect of norepinephrine and serotonin, the main antinociceptive mediators, and is also capable of enhancing analgesic effects when used simultaneously with anticonvulsants. That is why, for pain syndromes of various localizations, including in the face, doctors often resort to the use of vitamins of this group, both as monotherapy and in combination with other drugs. There is a sufficient number of studies that have noted clinical improvement with the use of B vitamins in patients with pain of various localizations [12, 13].
However, many questions remain regarding the use of a combination of B vitamins in the treatment of facial pain syndromes. For example, what is the mechanism of analgesic action, how quickly the effect occurs and how long it lasts [14–16]. In order to study the effectiveness of B vitamins in combination with standard therapy in the treatment of pain in patients with herpetic lesions of the genu ganglion of the facial nerve, as well as to determine the time of onset of the analgesic effect, we conducted a clinical study.
Materials and research methods
The study involved 12 patients suffering from persistent prosopalgia of herpetic origin with damage to the VII pair of cranial nerves. The average age of the patients was 47.8 ± 5.3 years, the average duration of the disease was 4.3 ± 1.2 months. The inclusion criterion was pain with an intensity of at least 5 points on the visual analog pain scale (VAS). Exclusion criteria were:
- inappropriate behavior of the patient;
- intolerance to B vitamins;
- peptic ulcer with symptoms of dyspepsia;
- presence of cancer;
- presence of disease from the ENT organs.
A clinical and neurological analysis was used, which assessed the location, intensity of pain, the nature of sensory disorders according to VAS (average pain intensity according to VAS was 5.86 points), as well as subjective assessment of the effectiveness of therapy by study participants. Each patient was informed about the purpose of taking the drug and possible side effects of therapy. The main group consisted of 6 patients (4 women and 2 men), who, along with standard therapy, received the drug Milgamma 2.0 ml intramuscularly during the patients' hospital stay (the average number of bed days was 16.4 days).
Each Milgamma ampoule contains 100 mg of thiamine hydrochloride, 100 mg of pyridoxine hydrochloride, 1000 mcg of cyanocobalamin and 20 mg of lidocaine and has a small volume of only 2 ml, which makes injections virtually painless. The difference between Milgamma and other vitamin preparations is that it is the first neurotropic complex that appeared in Russia 16 years ago, and the most studied drug. The control group consisted of 6 patients (3 women and 3 men) who took standard therapy and did not differ significantly from the main group in terms of disease duration, age and pain intensity according to VAS. Pain intensity was assessed every other day throughout the entire stay of patients in the hospital. The dynamics of pain regression were also assessed.
Results and its discussion
The pain syndrome is represented predominantly by a neuropathic component. To assess the dynamics of prosopalgia, an analysis of changes in the VAS score as a percentage was carried out in relation to the initial intensity of the pain syndrome, taken as 100%. The dynamics of pain regression during the entire course of treatment in the study groups are presented in the table. By the 8th day of treatment, a clinically significant reduction in pain for patients (> 30%) was achieved in the main group. In the control group, positive dynamics were also noted, but less pronounced than in the Milgamma group. The dynamics of VAS scores throughout the course are presented in Figure 1.
The intensity of pain according to VAS in the compared groups before treatment did not differ significantly. In the main group, while taking Milgamma, a statistically significant decrease in the intensity of pain syndrome was noted starting from the second day of therapy and its subsequent highly reliable decrease throughout the entire course of therapy (p
- the pain persisted;
- pain has decreased significantly;
- the pain has decreased slightly.
The results of determining the effectiveness of therapy according to the subjective assessment of patients in the main and control groups are presented in Figures 2, 3. In general, following the results of 16-day treatment, a significant decrease in the severity of prosopalgia was noted by 75% of patients in the main group (versus 62% in the control group). Taking into account the clinical features of the course of the disease (persistence of the pain syndrome, the dominant neuropathic component), in the test groups, pain persisted in 10% of patients in the main group and 15% in the control group. There were no side effects observed in patients during the entire study.
conclusions
The results obtained in our work confirmed the effectiveness and safety of using a combination of standard therapy in combination with the combined neurotropic complex Milgamma in the treatment of postherpetic prosopalgia. This combination can be recommended for high intensity prosopalgia of herpetic origin and on an outpatient basis in combination with the most beneficial options for traditionally used therapy.
Thus, taking into account new experimental data, it can be expected that the combination of anticonvulsants and neurotropic B vitamins will play an important role in the treatment of facial pain syndromes. It is quite possible that the predominant use of the combination of “anticonvulsant + B vitamins” can reduce the length of stay of patients in the hospital and can be recommended for long-term outpatient use.
Side effects
Milgamma Compositum tablets, like Milgamma injections, can cause some side effects, which, as a rule, appear only in rare cases. The following manifestations are possible:
- urticaria , skin itching , difficulty breathing, angioedema , anaphylactic shock ;
- tachycardia;
- reactions associated with high sensitivity ;
- heavy sweating, acne ;
- headache ; _
- nausea.
If any of these side effects occur, you should immediately inform your doctor.
With alcohol
Milgamma is prescribed after alcohol intoxication in order to restore the body. At the same time, alcohol and Milgamma, both in injections and tablets, should not be consumed.
Despite the fact that the compatibility of this medicine with alcohol is not described in the official instructions, such a combination completely neutralizes the positive effect of using the drug. Also, a number of side effects can be caused by combining alcohol and lidocaine , such as headache , drowsiness , and anxiety .
Instructions for use Milgamma Compositum (Method and dosage)
When taken orally, tablets should be taken with plenty of liquid.
If the patient is prescribed Milgamma tablets, the instructions for use include taking 1 tablet per day. In acute diseases, the dose may be increased: 1 tablet three times a day. At this dosage, treatment can be carried out for no more than 4 weeks, after which the doctor decides to reduce the dose, since taking vitamin B6 in large quantities increases the likelihood of developing neuropathy. In general, the course of therapy lasts no more than two months.
Interaction
If vitamin B1 is mixed with sulfate solutions, it completely disintegrates.
Inactivation of thiamine (benfotiamine) is noted in the presence of acetates, mercury chloride, iodides, carbonates, Riboflavin , tannic acid, ferric ammonium citrate, Penicillin , metabisulfite.
Pyridoxine in therapeutic doses can reduce the effect of levodopa, therefore it is not used with levodopa and medications containing it. There is also interaction with Penicillamine , Cycloserine , Isoniazid .
Cyanocobalamin is inactivated in the presence of heavy metal salts. Riboflavin also has a destructive effect on it, especially with parallel exposure to light.
Overdose
An overdose of vitamin B6 may cause neurotoxic effects. When treated with large doses of this vitamin for more than six months, neuropathy may develop. polyneuropathy may occur , which is accompanied by ataxia. Taking large doses of medication may cause convulsions. An overdose of benfotiamine when taken orally is unlikely.
After taking high doses of pyridoxine, induce vomiting and then take activated charcoal . However, such measures are effective only in the first 30 minutes. In more serious cases, you should immediately contact a specialist.
Reviews from patients and doctors about Milgamma
By analyzing the totality of the complex of vitamins that make up Milgamma, you can understand the benefits this drug brings to the human body. It is the B vitamins that have a positive effect on the overall strengthening of the immune system and have a powerful therapeutic effect in the treatment of diseases of the central nervous system and musculoskeletal system. Thanks to the use of Milgamma, specialists achieve quick relief from acute pain; the treatment brings a long-term positive effect. In addition, experts recommend taking Milgamma vitamins for various diseases of internal organs, since this replenishes the elements and nutrients that a weakened body lacks.
Analogues of Milgamma Compositum
Level 4 ATX code matches:
Neurobex Forte
Neurobex
Milgamma
Neurorubin
Neurobion
Combilipen
Analogs of Milgamma Copositum tablets are medications that contain the same components. Such medications are Milgamma , as well as Combilipen , Neuromultivit , Triovit , etc. The price of analogues depends on the number of tablets in the package, manufacturer, etc.
Milgamma Compositum price, where to buy
Price of Milgamma Compositum tablets 30 pcs. ranges from 550 to 650 rubles. Buy dragees in a pack of 60 pieces in Moscow. possible at a price of 1000 to 1200 rubles. The price of Milgamma Compositum in St. Petersburg is similar. You can find out how much the tablets cost at specific points of sale. Milgamma injections cost an average of 450 rubles (10 ampoules).
- Online pharmacies in RussiaRussia
ZdravCity
- Milgamma compositum tab.
p/o 30 pcs. Vervag Pharma/Mauermann-Artsneimittel 679 rub. order
Release form
The medicine is available in the form of a solution (Milgamma injections for intramuscular administration), as well as in the form of tablets and dragees.
- Vitamins in the form of a solution are contained in 2 ml ampoules. The ampoules are made of brown hydrolytic glass, each of them has a label and a white dot. The package contains 5 or 10 ampoules.
- Film-coated tablets are packaged in 30 or 60 pcs.
- Milgamma Compositum pellets are also produced - biconvex, round in shape, white. The dragee is contained in a blister pack of 15 pieces. There may be 2 or 4 blisters in a cardboard pack.