TOP 13 analogues of the drug Neurodiclovit: list of substitutes similar in composition

Pharmacodynamics and pharmacokinetics

Diclofenac sodium is characterized as an anti-inflammatory, antiplatelet, analgesic and antipyretic agent. It has a non-selective inhibitory effect on COX-1 and COX-2, reduces the content of prostaglandins at the site of inflammation, and also interferes with the metabolism of arachidonic acid. For rheumatic diseases, this substance helps reduce swelling of the joints, pain, and the severity of morning stiffness. This significantly improves the functional state of the joints.

Pyridoxine hydrochloride normalizes the functioning of the nervous system. It serves as a coenzyme for important enzymes found in nerve tissues. In addition, it takes part in the biosynthesis of many neurotransmitters.

Thiamine hydrochloride, entering the human body, is converted into cocarboxylase. It is a coenzyme for many enzymes. It is an important component of metabolic processes in the body. Actively participates in the processes of nervous excitation at synapses.

Cyanocobalamin is a means for stabilizing hematopoiesis and maturation of red blood cells, which takes part in many biochemical reactions necessary for the normal functioning of the body. It also has a beneficial effect on processes occurring in the nervous system. Coenzyme forms of this substance are needed for cell renewal and growth.

The combination of B vitamins found in Neurodiclovit (pyridoxine, thiamine, cyanocobalamin) potentiates the analgesic properties of diclofenac.

Diclofenac is characterized by rapid and complete absorption upon entering the body. However, food intake slows down this process by 1-4 hours, and also reduces the maximum concentration of the active component by 40%. After taking the capsules orally, the maximum concentration of this substance is achieved in the body after 2-3 hours. It is linearly dependent on the amount of the administered dose.

The degree of bioavailability of the drug is 50%. Strong connection with blood plasma proteins. The half-life of elimination from synovial fluid is approximately 4-5 hours. The maximum concentration in synovial fluid is reached approximately 3 hours later than in plasma.

50% of the active component is broken down in the liver. Metabolic processes occur after hydroxylation and conjugation with glucuronic acid. The enzyme system P450 CYP2C9 is involved in the breakdown of Neurodiclovit. 65% of the drug is excreted through the kidneys in the form of metabolites, less than 1% - unchanged. The remaining part is excreted through bile, also in the form of metabolites.

Systemic clearance – 350 ml/min. The plasma half-life is 2 hours. Diclofenac may pass into breast milk.

The B vitamins included in the preparation are water-soluble. Absorption of pyridoxine and thiamine occurs in the upper part of the small intestine. This process largely depends on the dosage. In the body, they are broken down in the liver and excreted mainly through the kidneys. Only about 9% is excreted unchanged. At higher doses, the excretion of pyridoxine and thiamine through the intestines increases.

The absorption of cyanocobalamin largely depends on the presence of intrinsic factor in the stomach and upper small intestine. Transportation of this substance is determined by transcobalamin. After breakdown in the liver, it is excreted primarily in bile. Only about 6-30% of cyanocobalamin is excreted through the liver.

Introduction

The problem of back pain caused by degenerative lesions of the spine and surrounding tissues is extremely relevant due to its high prevalence.
According to the results of numerous epidemiological studies, up to half of the adult population experiences back pain over the course of one year [4]. The maximum incidence is recorded among people of working age - the most socially active population, which causes high material losses. It has been established that recurrent back pain lasting more than 3 days is periodically noted by about 20% of the adult population. The frequency, duration and intensity of exacerbations may vary depending on the nature and severity of physical activity, the age of the population, dietary habits and a number of other factors. From 1991 to 2008, the incidence of diseases of the musculoskeletal system and connective tissue in Moscow increased by 23.4% and amounted to more than 2000 cases per 100 thousand adult population. Therefore, the development of new methods for diagnosing and conservative treatment of back pain is very important [1]. Typically, back pain is a benign, self-limiting condition; In more than half of patients, the pain syndrome regresses under the influence of treatment within a period of several days to several weeks. However, it is extremely rare that an episode of back pain occurs only once during a lifetime—in the vast majority of patients, the pain recurs. In a significant proportion of patients, the pain becomes chronic, which can cause long-term disability or permanent disability. Among the factors contributing to the chronicity of the pain syndrome, in addition to the characteristics of the structural lesion (severe arthrosis, large herniated intervertebral disc), psychological and social factors should be noted, such as a tendency to depressive reactions, low level of education, etc. [8]. Prevention of chronic pain syndrome in a significant proportion of patients can be ensured by early pain relief.

Depending on the causes of back pain, they are divided into primary (nonspecific) and secondary (specific). The main cause of primary pain syndrome in most cases is degenerative-dystrophic changes in the spine with damage to large and small (facet) joints, osteochondrosis directly involving intervertebral discs in the pathological process, secondary changes in the tendon-ligamentous apparatus, adjacent muscles and fascia with irritation of pain receptors ( nociceptors). Much less often, pain is associated with secondary damage to the spinal roots and spinal nerves. In practical conditions, it is not always possible to establish a single cause of pain, which is usually caused by a combination of a number of factors. It must be borne in mind that the intensity of the pain syndrome does not always correspond to the severity of degenerative changes in the spine and soft tissues. Often, even fairly large herniations of intervertebral discs, like Schmorl’s hernias, are only markers of osteochondrosis, without causing clinically significant compression of neural structures [8].

When developing treatment tactics for a patient with back pain, it is important to exclude the secondary nature of the pain syndrome. Differential diagnosis should be made with somatic diseases that can manifest themselves as pain syndromes similar in clinical picture (renal pathology, gynecological pathology, etc.). In case of persistent pain syndrome, which is difficult to relieve with standard painkillers, primary or metastatic neoplasms, inflammatory or traumatic lesions of the skeletal system, osteoporosis, and some other pathological conditions should be excluded.

Taking into account the pathogenetic features of the occurrence of back pain, the general principles of pain therapy (taking into account the data of evidence-based medicine), the main directions of providing assistance to patients with nonspecific back pain can be considered the earliest and complete elimination of acute pain syndrome, the fastest motor activation of the patient, which promotes regression symptoms and reduces the risk of pain becoming chronic. Timely initiation of rehabilitation significantly reduces the risk of developing chronic pain. In this situation, it is difficult to overestimate the role of explanatory therapy, which ensures that the patient correctly understands his condition. A reliable guideline for expanding physical activity is reducing the intensity of pain. Increasing the patient's mobility should not aggravate the pain.

To eliminate pain, analgesics (paracetamol) and non-steroidal anti-inflammatory drugs (NSAIDs) are currently most widely used [9]. It is believed that for mild pain the use of NSAIDs is indicated, for moderate pain - NSAIDs in combination with non-opioid analgesics, for severe pain - the use of opioid analgesics, local anesthesia and NSAIDs.

The analgesic properties of NSAIDs are due to the weakening of prostaglandin synthesis through inhibition of cyclooxygenase (COX): tissue or constitutional (COX-1) and inducible (COX-2). Both COX isoforms are produced in both peripheral tissues and CNS cells. The analgesic effect of COX inhibitors is ensured by the indispensable involvement of not only peripheral, but also central mechanisms. One of the most popular and widely used drugs in the NSAID group today is diclofenac.

However, despite the fairly high effectiveness of NSAID drugs, the search continues for adjuvant agents that increase it, making it possible to achieve an analgesic effect using lower doses of drugs and, accordingly, a lower risk of side effects.

Currently, considerable experience has been accumulated in the simultaneous use of NSAIDs and a combination of B vitamins, which is due to their active participation in the metabolism of nervous tissue. It is well known that vitamins act as coenzymes in a wide range of biochemical reactions. Thiamine (vitamin B1) is involved in the processes of decarboxylation of pyruvate and the metabolism of α-ketoglutaric acid in the Krebs cycle, and takes part in protein synthesizing processes. In addition, thiamine is able to switch glucose metabolism to the pentose phosphate pathway, which ensures the energy needs of the cell and creates reserves of substrates for the synthesis of nucleic acids. Pyridoxine (vitamin B6) functions as a coenzyme in the reactions of decarboxylation and transamination of amino acids in the tissues of the central and peripheral nervous system. Cyanocobalamin (vitamin B12), metabolized into a cofactor - cobamide, is part of numerous enzymes, in particular reductase, which reduces folic acid to tetrahydrofolic acid. Participates in the transfer of methyl and other one-carbon fragments, being necessary for the formation of deoxyribose and DNA, creatine, methionine - a donor of methyl groups, in the synthesis of lipotropic factor - choline, in the conversion of methylmalonic acid into succinic acid, which is part of myelin, etc.

B vitamins prescribed in combination have the ability to potentiate each other’s effects and stimulate reparative and regenerative processes in nervous tissue due to complex neuroprotective and neurometabolic effects.

In clinical practice, B vitamins have been used for a long time as adjuvant agents in the complex treatment of pain syndromes caused, in particular, by vertebrogenic pathology. The basis for the use of B vitamins in patients with pain syndromes were the results of experimental studies. In particular, in an animal (rats) model of nociceptive pain syndrome, a combination of thiamine chloride, pyridoxine and cyanocobalamin demonstrated the ability to significantly reduce the severity of pain [11].

Based on information about the wide range of biochemical effects of these vitamins in the body, it has been suggested that the elimination (or significant reduction) of nociceptive pain syndrome may be due to both the suppression of the synthesis of inflammatory mediators and the difficulty of their interaction with receptors [6]. Features of the interaction between the receptor apparatus and vitamins, as well as other potential mechanisms of their analgesic action, are discussed in a recently published review [2]. Vitamin B complex has also been demonstrated to enhance the effects of norepinephrine and serotonin, mediators of antinociceptive systems in the central nervous system. In addition, the experiment revealed suppression of nociceptive responses not only in the dorsal horn, but also in the optic thalamus.

The results of experimental studies have been largely confirmed by clinical experience. Today, there are a lot of publications devoted to studying the effectiveness of B vitamins in the complex treatment of patients with back pain syndromes. Due to the widespread use of diclofenac in clinical practice, the possibility of its administration with a B complex of vitamins is of significant interest. Clinical studies have confirmed the effectiveness of this combination [10, 13, 14]. Subsequently, in a double-blind randomized study, it was found that the simultaneous administration of a vitamin B complex and diclofenac to patients with acute back pain was significantly more effective than diclofenac alone [12]. Positive results were obtained in the treatment of not only musculoskeletal pain syndromes with this combination, but also some types of neuropathic pain [7].

Taking into account the above, it is of significant interest to study the effectiveness of the drug Neurodiclovit, one capsule of which contains 50.0 mg of diclofenac sodium, 50.0 mg of thiamine hydrochloride, 50.0 mg of pyridoxine hydrochloride and 0.25 mg of cyanocobalamin, in the treatment of patients with pain syndromes caused by degenerative lesions of the spine.

Some domestic experience has been accumulated in the use of the drug Neurodiclovit in this category of patients. Thus, as a result of observation of a group of 50 patients suffering from dorsalgia, it was found that with two-week use, Neurodiclovit significantly reduces the severity of back pain and improves the vital functions of patients [3]. The drug is well tolerated - no serious adverse events were observed in patients receiving it. According to the authors of the study, an analysis of the results of using Neurodiclovit in patients suffering from dorsalgia confirmed the favorable profile of the effectiveness and safety of the drug, which gives grounds to recommend its use in this category of patients.

Last year, a domestic study was completed to study the clinical effectiveness, tolerability and safety of Neurodiclovit in outpatient neurological practice in patients with acute pain syndrome due to a herniated intervertebral disc.

Material and methods

The design of the study was prospective, comparative, randomized and open. It included 60 patients observed by the district neurological departments of Moscow with acute pain syndrome caused by a herniated intervertebral disc [1].

Criteria for inclusion in the study:

• age from 45 to 75 years;
• intervertebral disc herniation verified by computer or magnetic resonance imaging in accordance with diagnostic criteria according to ICD-10;
• the duration of the pain syndrome is no more than 5 days;
• pain intensity of at least 7 points on the VAS scale;
• the invariability of the patient’s usual environment and situation during the study period;
• patient consent to participate in a clinical trial.

Accordingly, the exclusion criteria were:

• the presence of epilepsy or severe mental illness (schizophrenia, mental retardation), leading to the inability of patients to take pills or navigate for research purposes;
• severe, decompensated or unstable somatic diseases (any disease or condition that threatens the patient’s life or worsens the patient’s prognosis);
• neoplasms of any localization;
• peptic ulcer of the stomach or duodenum;
• simultaneous use of anticoagulants;
• serious deviations in the values ​​of laboratory parameters requiring further examination of the patient;
• alcoholism or drug addiction;
• established pregnancy, natural feeding.

If the patient was already receiving a course of treatment with a drug with a similar mechanism of action, it was discontinued, after which the patient was included in the study.

Forty patients received the drug Neurodiclovit, 1 capsule 2 times a day for 14 days; the comparison group consisted of 20 patients who received diclofenac 50 mg 2 times a day for 14 days. All patients included in the study underwent a clinical neurological examination, assessment of the intensity of pain using a visual analogue pain scale (VAS), assessment of the severity of anxiety and depression using the Beck scale, assessment of the state using the Global Clinical Impression (GCI) scale, assessment by functional status self-assessment scale (SAN). The main characteristics of the clinical groups are presented in Table. 1.

. Characteristics of patients.

Along with assessing the effectiveness of the treatment, the tolerability and safety of the drug were studied. To assess safety and tolerability, adverse events were recorded at each scheduled visit. The effectiveness of the study drug was assessed based on the results of the dynamics of the Beck scale, VAS, GCI, SAN, and clinical neurological examination.

results

Of the 60 patients initially included in the study, all patients completed the full course of treatment. The therapeutic effect of varying severity was observed in 38 (95%) patients in the group of patients treated with Neurodiclovit, and in 16 (80%) in the group of patients treated with Diclofenac. The improvement noted by patients was a decrease in the intensity of pain in the lumbar spine and an increase in motor activity. In both study groups, pain decreased by the 3rd day of treatment, and at the end of the course of therapy, all patients noted significant improvement.

Analysis of the VAS data allowed us to establish a significant decrease in the average total score two weeks after the start of treatment in both groups compared to the initial values, however, a more pronounced decrease was noted in the group of patients treated with Neurodiclovit. Before treatment, the average values ​​in the group of patients receiving Neurodiclovit were 7.00 ± 0.16 points, and in the Diclofenac group – 7.60 ± 0.09 points.

After two weeks of treatment, VAS scores decreased to 2.0 ± 0.3 and 3.9 ± 0.3 points, respectively. It is important to note that a more pronounced decrease in the average total score on the VAS scale was noted already on the 3rd day of treatment in the group of patients receiving Neurodiclovit (up to 5.3 ± 0.3 points versus 6.1 ± 0.4 in the group Diclofenac; Fig. 1).

At the time of inclusion in the study, mild depressive symptoms were detected in 24 (60%) patients in the group receiving Neurodiclovit and in 10 (50%) in the comparison group, as evidenced by indicators on the Beck scale; in the remaining patients, no signs of depression were detected. At the end of the course of treatment, mild depressive symptoms were detected in 5 patients of the main group and in 6 patients of the comparison group (Fig. 2).

By the end of the second week of treatment, most patients showed an improvement in general well-being and mood; motor activity expanded; trends towards normalization of night sleep in the form of easier falling asleep have been identified; performance has increased. These changes took place in both groups, but positive dynamics were recorded to a greater extent among patients receiving Neurodiclovit. This trend is clearly confirmed by the dynamics of changes in the average total indicators on the SAN scale. Before treatment, in the main group of patients the indicators were 3.30 ± 0.09 points, while in the comparison group – 3.13 ± 0.17. At the end of the study (after two weeks of treatment), these indicators were 4.60 ± 0.06 and 4.00 ± 0.17 points, respectively. The final improvement in values ​​on the SAN scale was +1.3 points for the group of patients receiving Neurodiclovit, and only +0.87 points for patients in the comparison group.

When analyzing the effectiveness of treatment in accordance with the GCI scale, the initial level on the subscale “severity of the disease” on the 3rd day of treatment in the main group and the comparison group was 5.4 ± 0.17 and 5.2 ± 0.13 points, respectively, and on 14th day of treatment – ​​2.5 ± 0.08 and 3.5 ± 0.12, respectively. Thus, the results obtained indicate a significant decrease in the average total score in both groups compared to the baseline, but a more significant effect was achieved in the group of patients receiving Neurodiclovit. On the “improvement of condition” subscale, the average total score at the end of the course of treatment in the main group was 1.7 ± 0.2 points, in the comparison group – 2.6 ± 0.09 points, i.e. a more significant improvement was noted in the group of patients , receiving Neurodiclovit (Fig. 3).

Taking into account the results of the analysis of the dynamics of the average total indicators on the anxiety and depression scales (Beck), VAS, GCI, SAN and neurological examination data, improvement after 3 days of treatment with Neurodiclovit was noted in 75% of patients (25% without changes) versus 65% (35% without changes) in the Diclofenac group. On the 14th day of treatment, improvement was observed in the vast majority of patients receiving Neurodiclovit (95%) and in 80% of patients in the Diclofenac group. Thus, after 2 weeks of treatment, improvement during treatment with Neurodiclovit was observed 15% more often.

During the study, all adverse events that occurred while taking the drugs were recorded (Table 2).

. Undesirable side effects.

The severity of adverse side effects ranged from mild to moderate. No serious side effects were recorded.

The tolerability of Neurodiclovit and Diclofenac by patients was assessed as follows: excellent - 87.5 and 80.0%, good - 5.0 and 0%, satisfactory - 7.5 and 20.0%, respectively. Thus, the safety and tolerability of the drug Neurodiclovit were higher than that of the drug Diclofenac.

Conclusion

The results of the study demonstrated that the drug Neurodiclovit is an effective treatment for patients with acute pain syndrome caused by degenerative-inflammatory lesions of the spine. A pronounced therapeutic effect is observed already by the third day of therapy with Neurodiclovit. The main advantages of Neurodiclovit are high efficiency, safety and good tolerability. Available data confirm that the combination of diclofenac and B vitamins in one capsule of Neurodiclovit in therapeutic dosages provides a potentiated analgesic effect - earlier and more complete elimination of pain compared to diclofenac alone. Considering the better tolerability, higher efficacy and safety of the drug Neurodiclovit compared to the drug Diclofenac, we consider it advisable to recommend the use of Neurodiclovit as a first-line drug in the treatment of patients with acute pain syndrome caused by degenerative lesions of the spine, including when long-term therapy is necessary.

Information about the authors: Pavel Rudolfovich Kamchatnov – Doctor of Medical Sciences, Professor, State Educational Institution of Higher Professional Education, Russian State Medical University. Email; Boyko Alexey Nikolaevich – Doctor of Medical Sciences, Professor, State Educational Institution of Higher Professional Education, Russian State Medical University. Tel.,; Batysheva Tatyana Timofeevna – Doctor of Medical Sciences, Professor, Chief Physician of Rehabilitation Clinic No. 7. Tel.,; Elena Vladimirovna Kostenko – Candidate of Medical Sciences, Associate Professor, Deputy. Chief physician of the rehabilitation treatment clinic No. 7. Tel.,; Pivovarchik Elena Mikhailovna – doctor at the rehabilitation treatment clinic No. 7. Tel.,; Ganzhula Pavel Aleksandrovich – Candidate of Medical Sciences, CDC No. 1 South-Western Administrative District. Tel. 8 (495) 336-6733; Ismailov Anvar Magomedovich – chief physician of city clinic No. 120 of the North-East Administrative District. Tel.; Lisinker Lidiya Nikolaevna – doctor at city clinic No. 157 of the Northern Administrative District. Tel.; Alexandra Alekseevna Khozova – doctor at city clinic No. 158 ZAO. Tel.; Otcheskaya Olga Vasilievna – doctor at city clinic No. 159 of the South-Western Administrative District. Tel.

Contraindications

The medicine should not be taken in case of hypersensitivity to its components, bleeding from the gastrointestinal tract, bronchial asthma with polyposis of the nasal mucosa, hemostasis disorders, pregnancy , breastfeeding , hematopoiesis disorders, intracranial bleeding, erosive and ulcerative lesions of the gastrointestinal tract (especially during exacerbation). In addition, it is not recommended to give this drug to patients in childhood.

Neurodiclovit is prescribed with caution for congestive heart failure, anemia , coronary heart disease , bronchial asthma , liver or kidney failure , diabetes mellitus , inflammatory bowel diseases, inducible porphyria , alcoholism, diverticulitis , arterial hypertension , systemic connective tissue diseases, edema syndrome, old age . It is also necessary to carefully monitor the patient's condition if the drug is prescribed after extensive surgery.

Substitutes based on ketorolac

Among the non-steroidal drugs aimed at relieving inflammation and developed on the basis of acetic acid derivatives, one can highlight drugs with ketorolac. The effect of this substance is as close as possible to diclofenac.

Ketanov

An effective non-narcotic analgesic produced by the Indian company Ranbaxy Laboratories Limited. Used to relieve pain syndromes of moderate and severe severity of various origins. It also has anti-inflammatory properties and moderately reduces fever, while it does not depress respiration, does not affect receptors, does not cause dependence or sedation, and is comparable in pain relief effectiveness to morphine. It is used once and in treatment courses of 5-7 days.

As an active substance, unlike Neurodiclovit, this drug uses another derivative of acetic acid, which also belongs to the group of non-steroidal anti-inflammatory drugs - ketorolac tromethamine.

Description of the drug

Available in two forms:

1. Tablets (10 mg) with a characteristic engraving on one side.
2. A solution for intramuscular injection of a slightly yellowish color (ampoules of 1 ml).

Use is contraindicated in the following cases:

• increased sensitivity to components;
• asthmatic manifestations;
• ulcers;
• hemophilia;
• renal and liver failure;
• strokes;
• bleeding;
• period of pregnancy and breastfeeding;
• children under 16 years of age.

Ketorolac

Ketorolac is produced in Russia and Belarus in the form of tablets, as well as a solution for intramuscular and intravenous administration. The active component ketorolac tromethamine helps relieve pain and inflammation, thereby lowering the temperature caused by inflammatory processes. Particularly effective in postoperative therapy.

Doses are selected in proportion to the intensity of pain within the range of 15-30 mg every 4-6 hours, the course of treatment is no more than 5 days. An overdose can lead to ulcerative lesions of the gastrointestinal tract, interruptions in kidney function, and loss of consciousness.

Side effects

The use of capsules may be accompanied by the following side effects:

• gastrointestinal tract and liver: increased levels of liver enzymes, abdominal pain , diarrhea , constipation , bleeding in the gastrointestinal tract, feeling of bloating, nausea, flatulence , peptic ulcer (complications are possible);
• sense organs: tinnitus;
• genitourinary system: oliguria , fluid retention, interstitial nephritis , nephrotic syndrome , acute renal failure , proteinuria , papillary necrosis , hematuria , azotemia ;
• nervous system: the appearance of dizziness , headache ;
• skin: rash, itching ;
• immune system and hematopoietic organs: agranulocytosis , worsening infectious processes, leukopenia , anemia , eosinophilia , thrombocytopenia , thrombocytopenic purpura .

In addition, in rare cases, disorders such as vomiting, melena, esophageal damage, liver necrosis , dry mucous membranes, hepatorenal syndrome , colitis , jaundice , aphthous stomatitis , hepatitis , cirrhosis , changes in appetite, the gastrointestinal tract and liver .

Rarely, the central nervous system may also cause sleep disturbance , depression , aseptic meningitis , general weakness, nightmares, drowsiness , irritability, convulsions, disorientation, and increased anxiety. From the skin: alopecia , increased photosensitivity, eczema , toxic dermatitis , erythema multiforme , urticaria , Lyell's syndrome , pinpoint hemorrhages.

Very rarely, side effects such as increased blood pressure, blurred vision, taste disturbance, scotoma , diplopia , hearing impairment, laryngeal edema, cough, bronchospasm , pneumonitis , extrasystole , myocardial infarction , congestive heart failure , pain in the chest, anaphylactoid reactions are noted. , swelling of the lips and tongue, anaphylactic shock , allergic vasculitis .

Characteristics of common analogues based on diclofenac

Analogues of Neurodiclovit with the same complex composition of vitamins and NSAIDs are not produced. Substitutes with diclofenac cover only a certain part of the therapeutic indications, so it is important to correctly select the most effective and suitable drug from a broad drug group.

Blokium B12

Manufactured in Argentina by Casasco Laboratory A.P.T.T. the Neurodiclovit analogue is not a complete analogue of the drug; it contains only one B vitamin. It belongs to non-steroidal anti-inflammatory and antirheumatic drugs that affect the human musculoskeletal system. It includes:

• diclofenac potassium;
• betamethasone;
• cyanocobalamin, vitamin B12.

Mechanism of action of diclofenac

Blockium B12 tablets are effective for quickly relieving pain and swelling of various etiologies:

• traumatic (after fractures, sprains, bruises, surgery);
• gynecological (for dysmenorrhea, menstruation, adnexitis);
• rheumatic and neurological;
• colds and ENT diseases.

The drug is available in tablet form. Contraindicated in children under 14 years of age, with allergies to components, intolerance to non-steroidal drugs, duodenal and gastric ulcers, renal failure, diseases of the cardiovascular system, diabetes, osteoporosis, in the second half of pregnancy and lactation.

Bol-Ran

Combined analgesic, antipyretic and anti-inflammatory drug made in India. Contains 50 mg diclofenac and 500 mg paracetamol. Effectively reduces pain and high temperature, eliminates joint stiffness when moving, and relieves inflammatory processes. It has a short half-life of its components from the body.

It is administered orally, daily doses should not exceed 4 tablets, the optimal period of administration is 5 days. May cause side effects such as sensory disturbances, convulsions, headaches, sleep disturbances and even loss of consciousness.

In addition, stomach pain, nausea and vomiting, flatulence, and sometimes gastrointestinal bleeding may appear. Excessive doses or long-term use can also cause anemia, edema, provoke a hypertensive crisis, bronchospasm, acute renal failure

The drug is contraindicated in children under 14 years of age, people with hypersensitivity to paracetamol and diclofenac, patients with peptic ulcers or impaired kidney and liver function. While taking the drug, it is better to avoid driving a car or doing work that requires special care and caution. Treatment of pregnant and lactating women with this drug is strictly prohibited.

Diklak

The German drug (Salutas Pharma GmbH) belongs to the group of antirheumatic, anti-inflammatory, decongestant and analgesic drugs; it has only one active substance - diclofenac as a derivative of phenylacetic acid.

Available as 50 mg enteric tablets, modified-release tablets (75 mg, 150 mg) or injection solution in ampoules of 3 and 25 mg. The effect of the drug appears on average 2-3 hours after taking the tablet and 10-20 minutes in the case of intramuscular administration.

Significant relief is noted after 1-2 weeks of use of the remedy in patients with diseases:

• gout;
• rheumatoid arthritis;
• tendinitis;
• periarthritis;
• bursitis;
• joint injuries;
• postoperative pain.

Gout

The drug has the same side effects and contraindications as the main group of non-steroidal anti-inflammatory and anti-rheumatoid drugs.

Dilocaine

Produced in Ukraine pharmaceutical. In addition to diclofenac, it contains lidocaine hydrochloride. Available only in 2 ml injection ampoules. It has analgesic, anti-inflammatory and antipyretic effects. The presence of lidocaine significantly reduces pain symptoms at the injection site. Absorbed when administered intramuscularly within 10-20 minutes.

Prescribed strictly according to prescription for the following diseases:

• exacerbation of rheumatism;
• various types of neuralgia;
• arthritis of various origins;
• hepatic and renal colic;
• thrombophlebitis and other diseases accompanied by pain and fever.

Rheumatism

Dilocaine relieves pain for 3-5 days, without causing serious side effects, except for individual intolerance to the components of the drug. The drug is contraindicated for children and elderly people. Other contraindications for use include:

• peptic ulcers;
• pregnancy and breastfeeding;
• asthma;
• blood diseases;
• heart and kidney failure.

Diclofenac

Non-steroidal anti-inflammatory drug, produced in Serbia-Russia. The composition includes one active component - diclofenac. It is used to relieve pain in the following branches of medicine:

• surgery;
• gynecology;
• oncology;
• neurology;
• sports medicine;
• traumatology;
• urology;
• ophthalmology.

Properties of Diclofenac

The medication is available in two variations:

1. Enteric-coated tablets 50 mg;
2. Extended-release film-coated tablets, 100 mg.

Treatment with the drug is carried out for a limited time. It has been established that long-term use of the drug can cause cardiovascular diseases, including heart attacks. There are also abnormalities in the nervous system (drowsiness, dizziness, memory loss, disorientation, mental disorders, etc.). The drug also affects the state of the sensory organs. Deterioration of vision, hearing, and taste may be impaired.

Instructions for use of Neurodiclovit (Method and dosage)

For those who have been prescribed Neurodiclovit, the instructions for use recommend swallowing the capsules whole during meals, with sufficient liquid. Dosages may vary depending on the severity of the disease. On average, the dose is designed to take 1-3 capsules per day, that is, about 100 mg of diclofenac.

Instructions for use of Neurodiclovit indicate that adult patients are usually prescribed 2-3 capsules per day to begin the course. But the maximum dosage should not exceed three capsules. Maintenance dose – 1 capsule 1-2 times during the day.

Elderly patients should use this drug with caution.

Children over the age of 14 years can be prescribed Neurodiclovit, but its maximum dosage should not exceed 1 capsule 2 times a day.

The duration of the course is determined by a specialist.

Overdose

When taking the drug in increased dosages, the following symptoms may be observed: vomiting, headache , clouding of consciousness, dizziness , shortness of breath . Patients in childhood may experience myoclonic convulsions , abdominal pain , liver and kidney dysfunction, nausea, and bleeding.

Treatment includes gastric lavage, forced diuresis, and activated charcoal . Therapy is symptomatic. Hemodialysis is almost ineffective.

Interaction

Prescribing this medication may cause an increase in:

• lithium level when combined with lithium preparations;
• severity of adverse reactions when using other NSAIDs;
• the likelihood of bleeding in the gastrointestinal tract in combination with glucocorticoids;
• the effectiveness of potassium-sparing diuretics and drugs that inhibit platelet ;
• concentrations and toxicity of methotrexate .

In addition, the effectiveness of Neurodiclovit is reduced when interacting with loop diuretics and antihypertensive drugs. The concentration of its active substance (diclofenac) also decreases when combined with acetylsalicylic acid . The absorption of cyanocobalamin is reduced when taken with Colchicine , neomycin , PAS and antidiabetic drugs such as Biguanidine .

Neurodiclovit should not be used simultaneously with Levodopa , as it can dull the severity of its antiparkinsonian effect. In addition, it may reduce the antihypertensive effect of diuretics or antihypertensive drugs. So this combination is prescribed with caution. In this case, it is imperative to control blood pressure. In addition, it is necessary to consume a sufficient amount of fluid, and at the beginning and after completion of the course, monitoring of kidney function is necessary, as nephrotoxicity may occur.

serotonin reuptake inhibitors, the risk of bleeding from the gastrointestinal tract increases.

The dosage of hypoglycemic drugs while using Neurodiclovit should be carefully monitored.

Combination with colestipol or cholestyramine reduces the degree of absorption of diclofenac by approximately 30-60%. So between taking these medications it is necessary to take an interval of several hours. In addition, the concentration of diclofenac can be reduced by some drugs that stimulate enzymes ( Rifampicin , phenytoin , Carbamazepine , St. John's wort ).

It should also be taken into account that thiamine is inactivated by 5-fluorouracil, and antacids, in turn, reduce the degree of its absorption. Loop diuretics can inhibit tubular reabsorption of thiamine and, with a long course of treatment, reduce its concentration.

Neurodiclovit capsules No. 30 (30 pieces) - Instructions

Dosage form

Capsules, 30 pieces per pack.

Compound

Active ingredient: 1 capsule contains diclofenac sodium 50 mg, thiamine hydrochloride (vitamin 1) 50 mg, pyridoxine hydrochloride (vitamin 6) 50 mg, cyanocobalamin (vitamin 12) 0.25 mg.

Excipients: povidone, methacrylate copolymer (type A) 30% dispersion, triethyl citrate, talc, red iron oxide (E172), yellow iron oxide (E172), titanium dioxide, gelatin.

Pharmacological group

Diclofenac, combinations.

Pharmacological properties

Pharmacodynamics. Neurodiclovit is a combination of diclofenac and neurotropic vitamins B1, B6 and B12. Like other non-steroidal anti-inflammatory drugs, diclofenac inhibits the enzyme cyclooxygenase, which converts arachidonic acid into prostaglandins. Diclofenac also inhibits the enzyme lipoxygenase. The analgesic, anti-inflammatory and antipyretic effects of diclofenac are due to inhibition of prostaglandin synthesis.

B vitamins function as coenzymes in metabolism and in particular in neurology, which has a positive effect on the analgesic effect of diclofenac sodium.

Pharmacokinetics. After oral administration, diclofenac is well and completely absorbed from the gastrointestinal tract. Bioavailability is independent of food intake. The maximum concentration in blood plasma is achieved 1-2 hours after administration (faster on an empty stomach than after a meal). The vitamins contained in the drug are absorbed in the intestines through active and passive mechanisms. Distribution and excretion are similar to vitamins taken with food. After oral administration of diclofenac, half the concentration of the drug was found in plasma that was found after parenteral administration of the same dose. Therapeutic plasma concentration is approximately 0.7-2.0 mg/L. Almost 99% of diclofenac is bound to plasma proteins, mainly albumin.

About 60% of the dose taken is excreted by the kidneys in the form of active metabolites; less than 1% of diclofenac is excreted unchanged. About 30% of the drug dose is excreted in the form of metabolites through bile and feces. The half-life of diclofenac from plasma is approximately 2:00. The total systemic clearance of diclofenac from plasma is approximately 250 ml/min.

Impaired renal function does not cause accumulation of the active substance due to increased bile excretion. Absorption, metabolism and excretion of the drug do not depend on age.

Indications for use

Inflammatory and degenerative forms of rheumatic diseases:

• chronic polyarthritis;
• ankylosing spondylitis (ankylosing spondylitis)
• arthrosis
• spondyloarthritis,
• acute gouty arthritis
• extra-articular rheumatism of soft tissues
• neuritis and neuralgia, such as cervical syndrome, lumbago, sciatica.

Directions for use and doses

Capsules should be swallowed whole with sufficient liquid during meals.

Depending on the severity of the disease, the recommended dose is 1-3 capsules per day, which is equivalent to 50-150 mg of diclofenac, respectively.

Adults. For initial therapy, the dose of the drug is 2-3 capsules per day. Maintenance dose - 1 capsule 1-2 times a day. The maximum daily dose should not exceed 3 capsules.

Children over 14 years old. The maximum daily dose is 1 capsule 2 times a day.

The duration of treatment is determined by the doctor.

Elderly patients. Although the pharmacokinetics of diclofenac do not depend on age, the dose should be adjusted with caution in elderly patients.

The drug should be used in the most effective doses for the shortest period of time, taking into account the treatment goal for each individual patient.

Children. It is not recommended for the treatment of children under 14 years of age due to the high content of the active substance in the capsule.

Contraindications

• Hypersensitivity to the components of the drug.
• Stomach or duodenal ulcer.
• Porphyria, hemorrhagic diathesis, hematopoiesis disorder.
• Crohn's disease, ulcerative colitis.
• Severe heart failure.
• The drug is contraindicated in patients whose asthma attacks, skin reactions or acute rhinitis are provoked by taking acetylsalicylic acid or other drugs that inhibit prostaglandin synthesis.
• Severe renal and liver failure.
• Gastrointestinal bleeding or perforation.
• Erythremia, erythrocytosis, thromboembolism.
• Allergic diseases.
• Congestive heart failure (NYHA II-IV).
• Coronary heart disease in patients with angina pectoris and postmyocardial infarction.
• Cerebrovascular diseases in patients who have had a stroke or have episodes of transient ischemic attacks.
• Peripheral arterial diseases.
• Treatment of PERIOPERATIVE pain during coronary artery bypass grafting (or use of a heart-lung machine).

Interaction with other drugs and other types of interactions

Co-administration of Neurodiclovit and other drugs may cause an increase or decrease in effectiveness.

Increase:

• plasma levels of lithium and digoxin,
• risk of gastrointestinal bleeding with concomitant therapy with GCS,
• side effects of other non-steroidal anti-inflammatory drugs,
• effectiveness of potassium-sparing diuretics (control of potassium levels),
• the effectiveness of drugs that inhibit platelet aggregation,
• level and toxicity of methotrexate. Prescription of non-steroidal anti-inflammatory drugs less than 24 hours before or after treatment with methotrexate should be avoided.

Decrease:

• effectiveness of diclofenac with furosemide and other loop diuretics,
• effectiveness of diclofenac as an antihypertensive agent,
• mutual decrease in the concentrations of diclofenac and acetylsalicylic acid in the blood serum,
• absorption of vitamin B 12 when used together with colchicine, PAS, neomycin and antidiabetic agents such as biguanidine.

Concomitant use with levodopa is contraindicated, since vitamin B6 may reduce the antiparkinsonian effect of levodopa.

Like other NSAIDs, concomitant use with diuretics or antihypertensive drugs (for example, beta-calcium channel blockers, angiotensin-converting enzyme inhibitors) may reduce their antihypertensive effect. Therefore, a combination of such drugs should be prescribed with caution, and patients (especially elderly) should periodically monitor blood pressure. Patients should drink sufficient amounts of water, and renal function should be periodically monitored after initiation and completion of concomitant therapy, particularly when using diuretics and ACE inhibitors due to the increased risk of nephrotoxicity. Concomitant use of systemic NSAIDs and selective serotonin reuptake inhibitors may increase the risk of gastrointestinal bleeding.

The simultaneous use of diclofenac and antidiabetic drugs is possible, but the effectiveness of the latter does not change. However, there are isolated reports of the development in such cases of both hypoglycemia and hyperglycemia, which necessitated the need to change the dose of glucose-lowering drugs during the use of diclofenac. For this reason, it is recommended to monitor blood glucose levels during therapy. The simultaneous use of diclofenac and colestipol or cholestyramine reduces the absorption of diclofenac by approximately 30% and 60%, respectively. The drugs should be taken at intervals of several hours. Enzyme-stimulating drugs, such as rifampicin, carbamazepine, phenytoin, St. John's wort (Hypericum perforatum) and others, can theoretically reduce diclofenac plasma concentrations. The effect of NSAIDs on the synthesis of prostaglandins in the kidneys may enhance the nephrotoxicity of cyclosporine. There are isolated reports of the development of seizures in patients receiving concomitant quinolone derivatives and NSAIDs.

The action of thiamine is inactivated by 5-fluorouracil, since the latter competitively inhibits the phosphorylation of thiamine to thiamine pyrophosphate.

Antacids reduce the absorption of thiamine. Loop diuretics, such as furosemide, which inhibit tubular reabsorption, may increase thiamine excretion and thus decrease thiamine levels with long-term therapy.

Concomitant use with pyridoxine antagonists (for example, isoniazid, hydralazine, penicillamine or cycloserine), oral contraceptives may increase the need for vitamin B6.

Features of application

The occurrence of side effects can be reduced by using the minimum effective dose for the shortest time necessary to control the symptom.

The drug should be used with caution in patients with asthma, hay fever, swelling of the nasal mucosa (nasal polyps) or chronic infectious diseases of the respiratory tract.

Patients with a history of high blood pressure and/or heart failure require appropriate monitoring and consultation, as fluid retention and edema have been reported with NSAID treatment.

In patients with inadequately controlled hypertension, decompensated heart failure, pre-existing ischemic heart disease, peripheral arterial vascular disease and/or cerebrovascular disease, diclofenac should be prescribed after careful consideration. Similar factors should also be taken into account before starting the drug if the patient is prone to cardiovascular diseases (eg hypertension, hyperlipidemia, diabetes mellitus, smoking).

Clinical studies and epidemiological data show that the use of diclofenac, especially in high doses (150 mg per day) and for a long period, may be accompanied by a slight increase in the risk of arterial thrombotic complications (myocardial infarction or attack).

During long-term treatment with Neurodiclovit, it is recommended to monitor peripheral blood counts, liver and kidney function.

Patients with gastric and duodenal ulcers, a history of dyspeptic symptoms and patients with severe liver disease, kidney disease, heart failure or arterial hypertension require careful medical monitoring.

All NSAIDs are characterized by the following adverse reactions, such as gastrointestinal bleeding, ulcers and perforations, which can be fatal and occur during treatment, against the background of warning symptoms or in the absence of them, as well as in patients with a history of serious gastrointestinal events. In general, such phenomena are most dangerous for elderly patients. In some cases, when these complications develop in patients taking diclofenac, the drug should be discontinued.

Severe, even fatal, skin reactions, including exfoliative dermatitis, Stevens-Johnson syndrome and toxic epidermal necrolysis, have been very rarely reported in association with the use of NSAIDs, including diclofenac. The highest risk of these reactions exists at the beginning of therapy, and the development of these reactions is observed in most cases in the first month of treatment. The drug should be discontinued at the first appearance of skin rash, mucosal ulcers or any other manifestations of hypersensitivity.

Diclofenac, due to its pharmacodynamic properties, can mask symptoms characteristic of infectious and inflammatory diseases.

With the introduction of vitamin 12, the clinical picture, as well as laboratory tests for funicular myelosis or pernicious anemia, may lose their specificity.

Drinking alcohol and black tea reduces the absorption of thiamine. Drinking drinks containing sulfites (such as wine) increases the degradation of thiamine.

Patients with neoplasms, with the exception of cases accompanied by megaloblastic anemia and vitamin B12 deficiency, should not use the drug.

The drug is used for angina pectoris.

Diclofenac should only be prescribed to patients with significant risk factors for cardiovascular events (eg hypertension, hyperlipidemia, diabetes mellitus, smoking) after careful clinical assessment. Since the cardiovascular risks of diclofenac may increase with increasing dose and duration of treatment, it should be administered for the shortest possible period and at the most effective dose. Patients' needs for diclofenac for symptom relief and response to therapy should be periodically reviewed. Use with caution in patients over 65 years of age.

The ability to influence the reaction rate when driving vehicles or other mechanisms

Although no negative effects on the ability to drive vehicles or operate machinery were observed, it cannot be ruled out that reactivity may worsen due to the negative effect of diclofenac on the central nervous system (dizziness, fatigue).

Use during pregnancy or breastfeeding

Due to the lack of clinical data, the simultaneous use of vitamins B1, B6 and B12 is not recommended during pregnancy and lactation.

Overdose

Symptoms of diclofenac overdose and intoxication are an increase in the frequency of side effects from the gastrointestinal tract and central nervous system. Features of application.

In case of severe diclofenac poisoning, the development of acute renal failure and liver damage is possible.

Vitamin B1: has a wide therapeutic range. After oral administration, no symptoms were detected. Very high doses (more than 10 g) exhibit a curare-like effect, suppressing the conduction of nerve impulses.

Vitamin B 6: shows very low toxicity. Long-term intake (more than 6-12 months) in doses of more than 50 mg of vitamin B 6 daily can lead to peripheral sensory neuropathy. Excessive use of vitamin 6 in doses of more than 1 g per day for several months can lead to neurotoxic effects. Neuropathies with ataxia and sensory disorders, cerebral spasms with EEG changes, as well as in some cases hypsochromic anemia and seborrheic dermatitis have been described after administration of more than 2 g per day.

Vitamin B 12: after parenteral administration (in rare cases, after oral administration) above recommended doses of the drug, allergic reactions, eczematous skin disorders and a benign form of acne were observed. With long-term use in high doses, disturbances in the activity of liver enzymes, pain in the heart, and hypercoagulation are possible.

Adverse reactions

From the cardiovascular system: heart failure, arterial hypertension, edema, tachycardia, palpitations, chest pain, myocardial infarction, vasculitis.

Blood disorders: hematopoietic disorders (leukopenia, thrombocytopenia, aplastic anemia, panmyelopathy, purpura, agranulocytosis, hemolytic anemia).

From the nervous system: headache, nausea, drowsiness, convulsions, dizziness, paresthesia, memory impairment, anxiety, tremor, aseptic meningitis, taste disorder (distortion), cerebral circulation disorders, touch disorders.

Visual impairment: visual impairment (blurred image, double vision).

Hearing impairment: tinnitus, hearing loss.

From the gastrointestinal tract: pain in the epigastric region; anorexia; hiccups; nausea; stomach upset; gastrointestinal bleeding gastrointestinal ulcers accompanied by severe bleeding; perforation and anemia; vomiting diarrhea dyspepsia flatulence gastritis; colitis (including hemorrhagic colitis and exacerbation of ulcerative colitis or Crohn's disease), constipation, stomatitis; glossitis; esophageal disorders, increased acidity of gastric juice, diaphragm-like intestinal strictures; pancreatitis.

From the kidneys and urinary tract: renal failure, nephrotic syndrome, hematuria, acute renal failure, interstitial nephritis, papillary necrosis, proteinuria.

From the skin and subcutaneous tissues: rash, redness, itching, alopecia, erythema of various types, exfoliative dermatitis, photosensitivity.

From the immune system: allergic reactions such as bronchospasm, urticaria, anaphylactic/anaphylactoid reactions, Stevens-Johnson syndrome, Lyell's syndrome, angioedema.

From the digestive system: hepatitis, including fulminant hepatitis, jaundice, increased levels of transaminases, in isolated cases acute.

Mental disorders: insomnia, hyperarousal, irritability, disorientation, depression, nightmares, psychotic disorders, malaise.

General disorders: sodium and water retention in the body, peripheral edema, increased sweating, asthma, pneumonitis.

Clinical trial and epidemiological data indicate an increased risk of thrombotic complications (eg myocardial infarction or stroke) associated with the use of diclofenac, particularly at high therapeutic doses (150 mg per day) and for long periods of time.

Best before date

2 years.

Storage conditions

Store in a dry place, protected from light and out of reach of children, at a temperature not exceeding 25 ° C.

Vacation category

On prescription.

Analogues of Neurodiclovit

Level 4 ATC code matches:
Voltaren

Rapten

Zerodol

Dickloberl Retard

Dikloberl N 75

Dicloberl

Ketanov

Dolak

Panoxen

Ketorolac

Naklofen Duo

Naklofen

Olfen-100

Olfen-75

Nizilat

Fanigan

Aertal

Methindol retard

Ortofen

In pharmacies you can find the following analogues of Neurodiclovit:

• Blokium B12
• Bol-Ran
• Dilocaine
• Diclofenac
• Dolex
• Maxigesik
• Olfen-75
• Fanigan
• Flamidez
• Tsinepar

Why tablets offered as analogues of this remedy help in each specific case is best checked with your doctor.

Neurodiclovit price, where to buy

The price of Neurodiclovit, on average, is about 380 rubles for a package containing 30 capsules. In Ukraine, the cost of this product is about 160 hryvnia. It is worth noting that the price of Neurodiclovit is lower than many of its analogues.

• Online pharmacies in RussiaRussia
• Online pharmacies in UkraineUkraine

LuxPharma* special offer

• Neurodiclovit caps.
  30pcs 1280 rub. order

ZdravCity

• Neurodiclovit capsules 30 pcs. Lannacher Heilmittel

  RUB 367 order

Pharmacy Dialogue

• Neurodiclovit capsules No. 30 Lannacher

  RUB 385 order

show more

Pharmacy24

• Neurodiclovit No. 30 capsules G.L Pharma GmbH, Austria
  159 UAH.order

Prices for the drug and its main analogues, average in Russia

Recently, many analogues of Neurodiclovit capsules have appeared on the pharmaceutical market; prices for them fluctuate both in different regions and in different pharmacy chains, but on average analogues can be purchased 2 or more times cheaper.
Among them, analogues with partial composition and similar therapeutic effect are most often offered, such as tablets Ketorlak, Diclofenac, Bol-Ran, Ketorol, Diclaca, Dilocain, Ketanov, Aertala, Diklovit, Doloxen, Fanigan, Ortofen, Flamidez, Voltaren; Naklofen Duo capsules and others.

In each specific case of disease, the doctor can select several analogues of Neurodiclovit to relieve pain syndromes and alleviate the patient’s condition in different price groups.