Milgamma for hernia of the lumbar spine: helps or not

Among the many vitamins there are neurotropic, or B vitamins. They are necessary for the normal functioning of the central and peripheral nervous system. Their prescription as part of complex therapy in our country is the standard for the treatment of neuralgia, radiculitis, sciatica, and acute back pain.

One of the characteristic representatives of combined drugs of group B is Milgamma, which is actively used for protrusions and hernias, for example, of the lumbar spine. How justified is the use of this drug and other vitamins in general? Is there a therapeutic effect from prescribing vitamins? If so, how long should you take this drug to improve your well-being if you have a hernia in the lumbar spine?

Hernia on MRI.

Mechanism of action of Milgamma

Milgamma is not one drug, but a set of three vitamins that are classified as neurotropic. Without them, normal functioning of the nervous system is impossible. These are B1, or thiamine, B6, or pyridoxine, and B12, or cyanocobalamin. Additionally, the complex drug contains 20 mg of local anesthetic - lidocaine, which makes intramuscular injection of vitamins painless. All these vitamins, from the manufacturer’s point of view, have a beneficial effect on inflammation, increase blood flow, and improve the metabolism of nervous tissue. Vitamins B1 and B6 potentiate each other, and cyanocobalamin takes part in the synthesis of the nerve sheath, consisting of myelin. After intramuscular injection, vitamins quickly enter the bloodstream and are distributed throughout the body.

Indications for use of Milgamma

The drug is indicated not for separate, independent treatment (monotherapy), but as part of the so-called complex therapy. This means that separate use of Milgamma may be useless. Does this mean that this drug “does not work”? You will find the answer to this question at the end of the article. Naturally, the official indications are neurological pathology.

In addition to neuralgia, neuritis, plexitis and polyneuropathies of various origins, Milgamma is indicated for nocturnal muscle cramps, and especially in old age. Since compression radiculopathy with protrusions and hernias occurs with symptoms of inflammation, the clinic of “lumbago” or lumbago with an aggravated hernia can, to a first approximation, be considered a clinic of neuritis. Therefore, the drug is indicated from this point of view for the relief of pain symptoms, as well as sensory and motor disorders in the presence of a clinically significant hernia, for example, the cervical spine.

Component composition of Milgamma

The instructions specify that each form of the drug contains its own ingredients. The component composition is presented:

pyrodoxine and thiamine hydrochloride;
cyanocobalamin;
lidocaine hydrochloride;
phenylcarbinol;
potassium hexacyanoferrate;
caustic soda;
food additive E452;
sterile water.

The tableted components are presented:

benfotiamine;
pyridoxine hydrochloride;
Silicii dioxydum colloidale;
croscarmellose sodium;
food additive E460;
povidone K 30;
partial long-chain glycerides;
talcum powder

The medicine Milgamma is made in 3 types: tablets, solution, dragees.

It contains subgroup B vitamins, the medicine is used for therapy:

NS diseases – with inflammation and degenerative processes, impaired conduction of impulses;
pathologies of the musculoskeletal system - the medication suppresses discomfort, improves local blood circulation, stabilizes the functioning of the hematopoietic organs.

Lidocaine, which is included in the composition, anesthetizes at the local level.

Instructions for use for hernia

There are no special features in the use of Milgamma for intervertebral hernia. The drug is administered as usual, deep intramuscularly. The official instructions recommend that in case of severe pain syndrome, administer 2 milliliters of the drug daily for 5 or 10 days. Then it is advisable to switch to the drug Milgamma compositum for oral administration. It is distinguished by the absence of vitamin B12. The second option is to continue giving injections (shots), but not daily, but every other day. The general course can last 2-3 weeks.

Adverse reactions

Non-standard responses of the body in response to Milgamma therapy occur in exceptional cases. Patients may experience:

with allergy symptoms - obsessive itching, redness in certain areas of the skin, dermatological rash;
attacks of dizziness, disturbances in clarity of consciousness;
changes in heart rhythm, fast or slow heartbeat;
vomiting, acne, active work of sweat glands, convulsive syndrome.

With intravenous injections, local irritation may occur at the entry point. Systemic reactions occur when an overdose of a drug or rapid administration of a solution occurs.

The occurrence of any side effects, including those not described, requires consultation with your doctor. After studying the problem, the specialist will change the treatment regimen and prescribe a safer medicine.

Contraindications and side effects, overdose

Contraindications for taking Milgamma, in addition to increased individual sensitivity, are pregnancy, lactation and childhood, severe forms of cardiovascular failure. The most common side defect was allergic reactions, in the form of skin rash. “Rarely” means no more often than one patient in a thousand. Also in some cases, dizziness, tachycardia, vomiting, as well as increased sweating and convulsions were noted. Sometimes local irritation may occur at the injection site of the drug.

You should also take into account some features of the administration of vitamins. The drug is incompatible with phenobarbital, riboflavin, as well as some citrates and carbonates. Milgamma weakens the effects of levodopa. If a patient is diagnosed with Parkinson's disease and is being treated with levodopa, then this must be taken into account. There may be an interaction with penicillamine or the anti-tuberculosis antibiotic isoniazid. Since the drug contains the local anesthetic lidocaine, if the patient uses norepinephrine together with Milgamma, this may adversely affect cardiac activity.

Compound

Active ingredients: thiamine hydrochloride - 100 mg;
pyridoxine hydrochloride - 100 mg; cyanocobalamin - 1 mg; lidocaine hydrochloride - 20 mg Excipients: benzyl alcohol - 40 mg; sodium polyphosphate - 20 mg; potassium hexacyanoferrate - 0.2 mg; sodium hydroxide - 12 mg; water for injection - up to 2 ml.

Description of the dosage form

Dragee

pharmachologic effect

Pharmacological action - metabolic, neuroprotective, analgesic.

Pharmacodynamics

Neurotropic B vitamins have a beneficial effect on inflammatory and degenerative diseases of the nerves and musculoskeletal system. Thiamine plays a key role in carbohydrate metabolism, as well as in the Krebs cycle with subsequent participation in the synthesis of thiamine pyrophosphate and ATP. Pyridoxine is involved in protein metabolism and partially in the metabolism of carbohydrates and fats. The physiological function of both vitamins is to potentiate each other’s action, manifested in a positive effect on the nervous and neuromuscular systems. Cyanocobalamin is involved in the synthesis of the myelin sheath, reduces pain associated with damage to the peripheral nervous system, and stimulates nucleic acid metabolism through the activation of folic acid. Lidocaine is a local anesthetic that causes all types of local anesthesia: terminal, infiltration, conduction.

Pharmacokinetics

After intravenous administration, thiamine is quickly absorbed from the injection site and enters the blood (484 ng/ml after 15 minutes on the first day of administration of a 50 mg dose) and is distributed unevenly in the body with its content in leukocytes - 15%, erythrocytes - 75% and in plasma - 10%. Due to the lack of significant reserves of the vitamin in the body, it must be supplied to the body daily. Thiamine penetrates the blood-brain and placental barriers and is found in breast milk. Thiamine is excreted in the urine in the alpha phase after 0.15 hours, in the beta phase after 1 hour and in the terminal phase within 2 days. The main metabolites are: thiaminecarboxylic acid, pyramine and some unknown metabolites. Of all the vitamins, thiamine is stored in the body in the smallest quantities. The adult human body contains about 30 mg of thiamine in the form of thiamine pyrophosphate (80%), thiamine triphosphate (10%) and the rest in the form of thiamine monophosphate.

After intramuscular injection, pyridoxine is quickly absorbed into the bloodstream and distributed in the body, acting as a coenzyme after phosphorylation of the CH2OH group at the 5th position. About 80% of the vitamin binds to blood plasma proteins. Pyridoxine is distributed throughout the body, crosses the placenta and is found in breast milk, deposited in the liver and oxidized to 4-pyridoxine acid, which is excreted in the urine a maximum of 2–5 hours after absorption. The human body contains 40–150 mg of vitamin B6 and its daily elimination rate is about 1.7–3.6 mg with a replacement rate of 2.2–2.4%.

Indications of the drug Milgamma®

As a pathogenetic and symptomatic agent as part of complex therapy for diseases and syndromes of the nervous system of various origins:

neuralgia;
neuritis;
facial nerve paresis;
retrobulbar neuritis;
ganglionitis (including herpes zoster);
plexopathy;
neuropathy;
polyneuropathy (including diabetic, alcoholic);
night muscle cramps, especially in older age groups;
neurological manifestations of spinal osteochondrosis: radiculopathy, lumbar ischialgia, muscular-tonic syndromes.

Contraindications

increased individual sensitivity to the components of the drug;
decompensated heart failure;
period of pregnancy and breastfeeding;
childhood.

Use during pregnancy and breastfeeding

The use of the drug is contraindicated during pregnancy and breastfeeding (see “Contraindications”).

Side effects

The frequency of adverse reactions is given in accordance with the WHO classification: very often (more than 1/10); often (less than 1/10, but more than 1/100); uncommon (less than 1/100, but more than 1/1000); rare (less than 1/1000, but more than 1/10000); very rare (less than 1/10,000), including isolated cases (symptoms occur with unknown frequency).

From the immune system: rarely - allergic reactions (skin rash, difficulty breathing, anaphylactic shock, Quincke's edema).

From the nervous system: in some cases - dizziness, confusion.

From the CCC: very rarely - tachycardia; in some cases - bradycardia, arrhythmia.

From the gastrointestinal tract: in some cases - vomiting.

From the skin and subcutaneous tissues: very rarely - increased sweating, acne, itching, urticaria.

On the part of the musculoskeletal and connective tissue: in some cases - convulsions.

General disorders and disorders at the injection site: in some cases, irritation may occur at the injection site; systemic reactions are possible with rapid administration or with an overdose.

If any of these side effects worsen or any other side effects not listed in the instructions appear, you should inform your doctor.

Interaction

Thiamine completely decomposes in solutions containing sulfites. And as a result, thiamine breakdown products inactivate the effect of other vitamins. Thiamine is incompatible with oxidizing and reducing compounds, incl. iodides, carbonates, acetates, tannic acid, ammonium iron citrate, phenobarbital, riboflavin, benzylpenicillin, dextrose, disulfites. Copper accelerates the breakdown of thiamine; in addition, thiamine loses its effectiveness when pH values increase above 3.

Therapeutic doses of pyridoxine weaken the effect of levodopa (the antiparkinsonian effect of levodopa is reduced) when taken simultaneously. Interactions with cycloserine, penicillamine, and isoniazid are also observed. With parenteral use of lidocaine, in the case of additional use of norepinephrine and epinephrine, side effects on the heart may increase. Interaction with sulfonamides is also observed.

Cyanocobalamin is incompatible with heavy metal salts. Riboflavin also has a destructive effect, especially when simultaneously exposed to light; nicotinamide accelerates photolysis, while antioxidants have an inhibitory effect.

Directions for use and doses

V/m (deep).

In cases of severe pain, in order to quickly achieve a high level of the drug in the blood, it is advisable to start treatment with 2 ml daily for 5–10 days. Subsequently, after the pain syndrome subsides and in mild forms of the disease, they switch to either therapy with a dosage form for oral administration (for example, the drug Milgamma® compositum), or to more rare injections (2-3 times intravenous over 2-3 weeks) with possible continuation of drug therapy oral form. Weekly monitoring of therapy by a physician is recommended.

It is recommended to switch to therapy with an oral dosage form as soon as possible.

Overdose

Treatment: drug withdrawal, symptomatic therapy.

special instructions

In case of accidental intravenous administration, the patient should be observed by a doctor or hospitalized depending on the severity of symptoms.

Impact on the ability to drive a car or perform work that requires increased speed of physical and mental reactions. There is no information on warnings regarding the use of the drug by vehicle drivers and persons working with potentially dangerous mechanisms.

Manufacturer

Marketing authorization holder: Verwag Pharma GmbH and Co. KG, Calverstraße 7, 71034 Böblingen, Germany.

Manufacturer: Solyufarm Pharmazoitische Erzeugnisse GmbH, Industrstrasse 3, 34212, Melsungen, Germany.

Representation/organization accepting complaints: Representative office of Verwag Pharma GmbH & Co. KG in the Russian Federation.

117587, Moscow, Varshavskoe highway, 125 Zh, bldg. 6.

Tel..

Conditions for dispensing from pharmacies

On prescription.

Storage conditions for the drug Milgamma®

In a place protected from light, at a temperature not exceeding 15 °C.

Keep out of the reach of children.

Shelf life of the drug Milgamma®

2 years.

Do not use after the expiration date stated on the package.

Drug analogues

Milgamma is produced by the German company Ferwag-Pharma, it is produced in ampoules of 2 milliliters, used only intramuscularly, there are three packaging options - 5 ampoules, 10 and 25. Accordingly, the medicine can be designed for a long course of treatment. The cost of the most popular package - 10 ampoules - ranges from 405 to 730 rubles.

Milgamma is a popular drug in the CIS countries, and it has quite a lot of imitators. These include:

Binavit;
Vitaxon;
the more famous and widely used Kombilipen;
Compligam B;
Larigama.

Binavit is a domestic drug produced by the Armavir biofactory with a price for a similar package of 239 rubles. Combilipen is a drug from Pharmstandard, with an average cost of 270 rubles. Compligam B is produced by the domestic company Sotex, with an average cost of 250 rubles, and Larigama is produced by the Russian company Grotex LLC, and its cost is approximately 260 rubles per package.

Attention. There is also the drug Milgamma compositum, which has a slightly different effect. Firstly, it contains only one vitamin B6, and benfotiamine, a derivative of vitamin B1, and secondly, it is available in tablets and is more expensive, that is, it does not have a form for parenteral administration.

There is also the drug Milgamma compositum, which has a slightly different effect. Firstly, it contains only vitamin B6 and benfotiamine, a derivative of vitamin B1, and secondly, it is available in tablets and dragees, it does not have a form for parenteral administration. Accordingly, the drug Milgamma can be considered more effective because it contains vitamin B12, or cyanocobalamin.

A deficiency of this vitamin can lead to a neurological disorder such as sensory or posterior columnar ataxia. In this case, the pathways of the joint-muscular sense lying in the posterior columns of the spinal cord are affected. They carry proprioceptive sensitivity, or muscle-joint sense, to the brain for analysis. Thanks to the work of this analyzer, we can be aware in complete darkness where our limbs are, and when walking on a flat surface in the dark, we do not fall, because we know how our legs are rearranged and where our torso is. With posterior columnar ataxia, this sensation is blurred or lost altogether. Therefore, one of the characteristic clinical symptoms will be a fall, or an unsteady gait of patients at night, for example, when getting up to go to the toilet. The patient should walk in good light to see the position of his legs.

If such symptoms are present, it is very likely that there is a deficiency of vitamin B 12, since sensitive ataxia is a characteristic sign of deep pernicious anemia.

Reviews about Milgamma

There are numerous reviews about Milgamma, which are left by both patients who have undergone such treatment and specialists. Reviews note that intramuscular injections are quite painful, and sometimes there is irritation at the site where the injection was administered. But more often a positive effect is described in the treatment of neuralgia , neuritis and other diseases that were noted after the patient was given injections of Milgamma. Reviews from doctors contain information that during treatment, patients must lead a correct lifestyle and follow all recommendations, since the remedy only eliminates the symptoms, but not the cause of the disease.

The effectiveness of the drug in complex therapy is also often noted, for which not only this drug is prescribed, but also other drugs. For example, a good effect can be obtained if Movalis and Milgamma are prescribed simultaneously. Movalis is a non-steroidal anti-inflammatory drug that has a pronounced positive effect on diseases of the musculoskeletal system.

Drug interactions Milgamma solution

Thiamine completely disintegrates when interacting with solutions containing sulfates. Other vitamins can be inactivated in the presence of vitamin B1 breakdown products. Therapeutic doses of vitamin B6 may weaken the effect of levodopa. Incompatibility. Pyridoxine is incompatible with drugs containing levodopa, since simultaneous use increases the peripheral decarboxylation of the latter and thus reduces its antiparkinsonian effect. Thiamine is incompatible with oxidizing and reducing compounds: mercuric chloride, iodide, carbonate, acetate, tannic acid, ammonium iron citrate, as well as sodium phenobarbital, riboflavin, benzylpenicillin, glucose and metabisulfite, since it is inactivated in their presence. Copper accelerates the breakdown of thiamine; in addition, thiamine loses its activity when pH increases to 3. Vitamin B12 is incompatible with heavy metal salts.

Milgamma price, where to buy

The price of Milgamma injections No. 5 is on average 400 rubles. The price of Milgamma in ampoules injections No. 10 is from 600 to 700 rubles. The price of Milgamma injections (pack of 25 pieces) averages 1,500 rubles. You can buy Milgamma in Moscow (tablets, 30 pcs.) for an average of 700 rubles.

The cost of ampoules in Ukraine is about 150 hryvnia per pack of 5 pieces. How much the medicine costs in different packages should be found out at the specific point of sale. The drug in tablets (30 pieces) can be bought for an average of 350 hryvnia.

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

ZdravCity

Milgamma solution for intramuscular injection.
2ml 5 pcs. Vervag Pharma/Solupharm GmbH RUB 345 order

Pharmacy Dialogue

Milgamma ampoules 2ml No. 25Worwag pharma
RUB 1,927 order
Milgamma ampoules 2ml No. 10Worwag pharma
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Pharmacy24

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Milgamma ampoule Milgamma injection solution ampoules 2ml No. 5 Germany, Woerwag Pharma
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