Combilipen, Meloxicam and Mydocalm - how the drugs act on the body and features of combined use

Sometimes Meloxicam and Combilipen must be taken together according to the treatment regimen. These drugs are prescribed for various diseases, but before starting therapy it is recommended to read the instructions. In some cases, combined use is contraindicated.

Composition and properties

The drugs have different compositions and properties.

• It is better to familiarize yourself with these data before starting treatment.

Meloxicam

This medicine belongs to the category of non-steroidal anti-inflammatory drugs. It has another name - Movalis. Part of the oxicam group. It has an anti-inflammatory, antipyretic and analgesic effect on the body.

The principle of action of the drug is to inhibit the synthesis of prostaglandins located at the site of inflammation. The medicine contains the following components:

• meloxicam - active ingredient (10 mg/1ml);
• glycine;
• sodium chloride;
• meglumine;
• poloxamer;
• sodium hydroxide solution;
• water d/i.

Available in the form of a solution for intramuscular administration.

Combilipen

Combilipen belongs to the category of vitamin combination medicines. Thanks to the many vitamins included in the composition, it has a number of effects on the body:

• improves nerve conduction;
• facilitates the synthesis of substances that enter the nerve sheath;
• creates conditions for the exchange of pteroylglutamic acid.

The medicine contains several main active ingredients: thiamine hydrochloride, pyridoxine hydrochloride, cyanocobalamin, lidocaine hydrochloride. Auxiliary components include:

• benzyl alcohol;
• sodium hydroxide;
• potassium hexacyanoferrate;
• water d/i.

The medicine is available in the form of a pinkish-red solution, which is intended for intramuscular injection.

Effects of drug combinations

1. In tandem, these drugs provide rapid elimination of the inflammatory process and also provide an analgesic effect.

1. If you give injections together, the effect will be noticeable already in the first days of treatment.

Features of joint use

If medications are administered simultaneously, the course of treatment is significantly shortened. Therapy can last from 10 to 14 days.

Before treatment, it is necessary to take into account possible side effects that occur during joint administration. The most common are:

• attacks of dizziness and confusion;
• heart failure;
• disorders in the gastrointestinal tract;
• convulsions.

Allergic reactions may also occur in the form of skin rashes with redness and itching.

If side effects occur, you should monitor them for their development.

If the condition worsens, it is necessary to stop treatment and seek help from a doctor.

Is it possible to inject everything together?

The injections can be done together. Indications for this are:

• pathologies of the spine accompanied by pain;
• osteochondrosis;
• injuries;
• dorsalgia.

Despite the fact that doctors recommend giving injections together and both medications have good compatibility, there are a number of contraindications. It is better to avoid injections for the following diseases and conditions:

1. Pregnancy and lactation in women.
2. Diseases of the cardiovascular system.
3. Kidney and liver failure.
4. Increased tendency to bleed.
5. Inflammatory processes localized in parts of the intestine.

It is also not recommended to start treatment if you are hypersensitive to the components included in the composition. In some cases, Meloxicam can be replaced with a similar drug called Mydocalm.

Medicines can be purchased at a pharmacy with a prescription from your doctor.

Compatibility of Meloxicam and Combilipen

Various medications are used to treat diseases of the spine and peripheral nervous system, including Meloxicam and Combilipen. Their combination allows you to quickly alleviate the patient’s condition by reducing pain and relieving inflammation.

Meloxicam and Combilipen are used to treat diseases of the spine and peripheral nervous system.

Meloxicam is used as an antipyretic, anti-inflammatory and analgesic drug.

B vitamins not only reduce inflammation, but also improve the trophism of nervous tissue. This allows for faster pain relief and provides a more lasting therapeutic effect.

Meloxicam

Non-steroidal anti-inflammatory drug from the oxicam group. Recommended for the treatment of joint diseases accompanied by pain: rheumatoid arthritis, acute arthritis, spondylitis, chronic polyarthritis. Helps eliminate pain due to osteochondrosis and radiculitis.

It is characterized by a minimal number of side effects, which most often manifest themselves in the gastrointestinal tract.

The main active ingredient is meloxicam. Available in the form of tablets and ampoules with injection solution.

Complex vitamin preparation, which includes:

1. Thiamine (B1).
2. Pyridoxine (B6).
3. Cyanocobalamin (B12).

Combilipen is included in the treatment regimen for pathologies of the spine, neuritis of the facial nerve, intercostal neuralgia, cervicobrachial and lumbar syndrome.

The composition is supplemented with an anesthetic - lidocaine, which anesthetizes the injection site and improves the absorption of components due to vasodilation. The drug is included in the treatment regimen for pain caused by pathologies of the spine, neuritis of the facial nerve, intercostal neuralgia, cervico-brachial and lumbar syndrome, lumboischialgia.

Can I take it together?

The drugs are highly compatible. When used simultaneously, they provide rapid pain relief and relieve inflammation, thereby shortening the course of treatment.

Indications for joint use

The following conditions are the basis for the simultaneous use of drugs:

1. Neuralgia associated with damage to the spine: osteochondrosis, trauma, ankyposis spondipoarthritis.
2. Mono- and polyneuropathies of various origins: dorsalgia, plexopathies, lumbago, radicular pain syndrome due to degenerative changes in the spinal column.

Contraindications for taking Meloxicam and Combilipen

The use of Meloxicam and Combilipen is not recommended in case of individual intolerance to the active substance and other components included in their composition, as well as under 18 years of age. The combination of drugs is not used for the following conditions and disorders:

1. Pregnancy and during breastfeeding.
2. Acute and chronic heart failure.
3. Kidney and liver failure.
4. Tendency to bleed.
5. Erosive and ulcerative lesions of the stomach and duodenum, inflammation of the intestines.

Increased caution in using a combination of drugs is necessary for the following conditions:

1. For bronchial asthma, recurrent polyposis of the nose and paranasal sinuses.
2. For angioedema or urticaria caused by the use of acetylsalicylic acid or other non-steroidal anti-inflammatory drugs.

In the form of injections, the drugs are used in short courses. Each drug is administered separately; mixing them in one syringe is prohibited.

Since the drugs are available in the form of tablets and solution for injection, during the first 3 days they are administered in the form of injections.

The doctor should determine the dosage depending on the intensity of the pain syndrome and the severity of inflammation.

Back pain and its treatment with Mydocalm

T.T.
Batysheva Polyclinic for Rehabilitation No. 7, Moscow
B

Back pain, or dorsalgia, can be a symptom of various diseases. Back pain is one of the most common complaints in general medical practice [2,5].

Main causes of back pain

Back pain is most often caused by spinal osteochondrosis - degenerative damage to the cartilage of the intervertebral disc and reactive changes in the adjacent vertebral bodies. Damage to the intervertebral disc occurs as a result of repeated injuries (heavy lifting, excessive static and dynamic load, falls, etc.) and age-related degenerative changes. The nucleus pulposus, the central part of the disc, dries out and partially loses its shock-absorbing function. The fibrous ring, located along the periphery of the disc, becomes thinner, cracks form in it, towards which the nucleus pulposus moves, forming a protrusion (prolapse), and if the fibrous ring ruptures, a hernia. In the affected spinal segment, relative instability of the spine occurs, osteophytes of the vertebral bodies develop (spondylosis), and ligaments and intervertebral joints are damaged (spondyloarthrosis). Herniated intervertebral discs most often occur in the lower lumbar discs, less often in the lower cervical and upper lumbar discs, and extremely rarely in the thoracic discs. Disc herniations in the vertebral body (Schmorl's hernias) are not clinically significant; disc herniations in the posterior and posterolateral direction can cause compression of the spinal root (radiculopathy), spinal cord (myelopathy at the cervical level) or their vessels. In addition to compression syndromes, reflex (muscular-tonic) syndromes are possible, which are caused by impulses from receptors in response to changes in the discs, ligaments and joints of the spine.

Reflex syndromes of spinal osteochondrosis occur throughout life in almost every person

, compression develop much less frequently. Reflex muscle tension initially has a protective nature, since it leads to immobilization of the affected segment, but later becomes a factor maintaining pain.

Another common cause of back and limb pain is myofascial pain.

caused by the formation of so-called trigger zones in the muscles and/or associated fascia. Trigger zones arise under the influence of muscle tension and often against the background of spinal osteochondrosis. When exposed to them - stretching, compression, palpation - pain occurs, which determines the diagnosis.

Back pain may be the only symptom of a spinal cord tumor, syringomyelia and other spinal cord diseases. It occurs with destruction of the vertebrae and damage to the nerve roots due to infectious processes (tuberculous spondylitis, spinal epidural abscess), with neoplasms (primary and metastatic tumors of the spine, myeloma), dysmetabolic disorders (osteoporosis, hyperparathyroidism, Paget's disease). Back pain can be a consequence of a fracture of the spine, its congenital or acquired deformities (scoliosis and others), spinal stenosis, displacement of the vertebral bodies (spondylolisthesis), ankylosing spondylitis.

Back pain is possible with various somatic diseases (heart, stomach, pancreas, kidneys, pelvic organs, etc.) through the mechanism of referred pain.

Examination and diagnosis for back pain

Any back pain cannot be attributed to “osteochondrosis” - a condition that is detected by X-ray examination in most middle-aged and elderly people.

To establish the cause of back pain, a thorough examination of the patient is necessary, including clarification of complaints, medical history, somatic and neurological examination, as well as additional studies.

When collecting complaints and medical history, it is necessary to find out:

• localization and irradiation of pain;
• dependence of pain on body position and movement in the spine;
• previous injuries and diseases (malignant neoplasms and others);
• emotional state, reasons for simulation or aggravation.

A somatic examination is aimed at identifying malignant neoplasms, infectious processes and somatic diseases that may manifest as back pain.
During a neurological examination, it is necessary to assess the emotional state of the patient, determine whether there are paresis, sensitivity disorders, loss of reflexes, examine the mobility of the spine, the range of movements of the limbs, and determine local pain in the back and leg. Additional research:

1) radiography of the spine in several projections,

2) general blood test,

3) biochemical blood test (calcium, creatinine, phosphates, glucose, etc.),

4) if indicated - computed x-ray tomography (CT) or magnetic resonance imaging (MRI) of the spine.

Diagnosis of reflex and compression complications of osteochondrosis

based on clinical data.

For lumbago

(lumbar lumbago) is characterized by a sharp, shooting pain in the lower back, which usually develops during physical activity (lifting heavy objects, etc.) or awkward movement.
The patient often freezes in an uncomfortable position, and an attempt to move leads to increased pain. The examination reveals muscular-tonic syndrome: tension of the back muscles, usually scoliosis, flattening of the lumbar lordosis, severe limitation of mobility in the lumbar spine. Lumbodynia
(back pain) and
lumboischialgia
(pain in the back and along the back of the leg) are characterized by pain that occurs after physical activity, awkward movement or hypothermia . The pain is aching in nature and intensifies with movements in the spine, certain postures, and walking. The examination reveals muscular-tonic syndrome without paresis, sensitivity disorders and loss of reflexes.

Radiculopathy

lumbar and first sacral roots are manifested by acute shooting pain in the lower back and leg. When examining a patient, in addition to muscular-tonic syndrome, sensitive, reflex and, less often, motor disorders are detected in the area of ​​the affected root. The fifth lumbar (L5) and first sacral (S1) roots are most often affected, less often the fourth lumbar root and very rarely the upper lumbar roots.

For cervicalgia

(neck pain) and
cervicobrachialgia
(pain in the neck and arm) are characterized by pain that occurs after physical activity or awkward movement of the neck. There is an increase in pain when moving the neck or, conversely, during a prolonged monotonous position (in a car or on an airplane, after sleeping on a dense high pillow, etc.). The examination reveals muscular-tonic syndrome: tension of the neck muscles, limitation of movements in the cervical spine. Radiculopathies of the lower cervical roots are much less common than reflex syndromes, and are manifested, in addition to muscular-tonic syndrome, by sensory, reflex and/or motor disorders in the area of ​​innervation of the affected root.

In the thoracic region, reflex and compression syndromes of osteochondrosis are much less common than in the lumbar and cervical regions. They manifest themselves as back pain and loss of sensitivity in the area of ​​the affected roots.

X-rays of the spine are used mainly to exclude congenital anomalies and deformities, inflammatory diseases (spondylitis), primary and metastatic tumors. X-ray CT or MRI can identify a disc herniation, determine its size and location, and also detect spinal canal stenosis.

Diagnosis of myofascial pain

is based on clinical data and requires the exclusion of other possible causes of pain. Myofascial pain is manifested by muscle tension and the presence of trigger points in them, which are identified through manual examination of the muscles. An active trigger point is a constant source of pain that increases with palpation in the muscle; a latent trigger point causes pain only when palpated. For each muscle there is an independent myofascial syndrome, with a characteristic localization of pain when the trigger zone is irritated, spreading beyond the projection of the muscle to the skin surface. There are no symptoms of damage to the peripheral nervous system, except in cases where tense muscles compress the nerve trunk. In the absence of supporting factors, myofascial pain can go away spontaneously if the muscle is left to rest for several days.

For spinal cord tumors, syringomyelia and other spinal cord diseases

back pain is often combined with other neurological disorders; muscle-tonic syndrome is usually absent. The diagnosis is made using CT or MRI of the spine.

With destructive lesions of the spine

(tuberculous spondylitis, primary tumor or metastasis to the spine, osteoporosis, hyperparathyroidism), spinal fracture, congenital or acquired deformities, spondyloarthritis deformans, local pain is often observed, the diagnosis is established based on the results of an x-ray and/or CT or MRI of the spine.

For somatic diseases

referred back pain is usually combined with other manifestations of the disease; it is not accompanied by tension in the back muscles and usually does not intensify with movements in the spine.

Treatment of back pain

Treatment of back pain is based on treatment of the underlying disease. Below we will talk about treatment for the most common causes of back pain - reflex and compression complications of osteochondrosis and myofascial pain.

Treatment of reflex syndromes and radiculopathies due to osteochondrosis

In the acute period, it is based on rest, avoidance of sharp bends and painful poses. In the acute period, it is better to carry out treatment at home, without forcing the patient to visit the clinic for injections or physical therapy, the benefits of which are much less than the harm associated with the high probability of increased pain due to premature excessive activation. They recommend bed rest for several days until the sharp pain subsides, a hard bed (a shield under the mattress), taking analgesics, non-steroidal anti-inflammatory drugs and muscle relaxants. If movement is necessary, you should wear a neck or lumbar corset (fixing belt). You can use physiotherapeutic pain-relieving procedures, rubbing ointments, compresses with a 30-50% solution of dimexide and novocaine, novocaine and hydrocortisone blockades. When pain subsides, a gradual increase in physical activity and muscle strengthening exercises are recommended.

In the chronic course of reflex syndromes and radiculopathies, physiotherapeutic treatment, non-steroidal anti-inflammatory drugs and muscle relaxants, manual therapy, reflexology, and spa treatment can be effective.

Surgical treatment (removal of a herniated disc) is necessary in those rare cases when compression of the spinal cord or cauda equina roots occurs. Surgical treatment is also indicated for discogenic radiculopathy, accompanied by severe paresis, and in case of long-term (more than 3-4 months) lack of effect from conservative treatment and the presence of a large disc herniation.

To prevent exacerbations of osteochondrosis, it is recommended to avoid provoking factors (lifting large loads, carrying a heavy bag in one hand, hypothermia, etc.) and regularly engage in therapeutic exercises.

For myofascial pain

it is necessary to give the muscle rest for several days. As treatment, you can use muscle stretching exercises (post-isometric relaxation), taking muscle relaxants, physiotherapy, reflexology or local injection of anesthetics into trigger zones, compresses with dimexide and anesthetics.

Application of Mydocalm for dorsalgia

Mydocalm is a centrally acting muscle relaxant that has been widely used for 30 years in the treatment of reflex and compression complications of degenerative changes in the spine (osteochondrosis, spondylosis, spondyloarthrosis) and myofascial pain.

The tonic muscle tension that occurs during these conditions can not only cause pain in itself, but also cause deformation and limitation of the mobility of the spine, as well as compression of the nerve trunks and vessels passing nearby. For the treatment of these conditions, in addition to non-steroidal anti-inflammatory drugs, analgesics, physiotherapy and therapeutic exercises, the use of muscle relaxants, which can break the vicious circle of pain caused by tension in the muscles of the back and limbs, is theoretically justified.

The effectiveness and safety of the use of Mydocalm for painful muscular-tonic syndrome of predominantly vertebrogenic origin was assessed in 110 patients aged 20 to 75 years in a double-blind, placebo-controlled study (3). In eight research centers, patients were randomized to receive Mydocalm at a dose of 300 mg per day or placebo in combination with physiotherapy and rehabilitation for 21 days.

In both groups, patients with long-term (more than 3 months) pain syndrome predominated. There were no differences in the patient groups in terms of treatment and physical therapy received. 10 patients in the Mydocalm group and 9 patients in the placebo group used non-steroidal anti-inflammatory drugs. Physiotherapy included therapeutic exercises, massage, hydrotherapy, electrotherapy and other procedures, which were standardized as much as possible in both groups.

Treatment results were assessed on days 4, 7, 10 and 21 of treatment. The pain threshold of pressure, measured using a special device (Pressure Tolerance Meter) at 16 symmetrical points of the torso and limbs, was chosen as the main criterion for the effectiveness of treatment. Patients subjectively assessed their condition based on pain intensity, sensation of muscle tension and spinal mobility in 4 degrees of severity: none, slight, moderate and severe. The physiotherapist also assessed muscle tension and spinal mobility according to 4 degrees of severity: none, slight, moderate and severe. At the end of treatment, the investigator and patient provided an overall assessment of the effectiveness and tolerability of the drug. Before the start of treatment and at the end of it, a detailed clinical and laboratory examination was carried out, including an ECG, blood pressure measurement, and a biochemical blood test for 16 indicators.

The results of the study showed that the use of Mydocalm significantly reduced painful muscle spasms more than placebo.

, measured objectively using a special device. The difference between the treatment and placebo groups was noted already on day 4, it gradually increased and became statistically significant on days 10 and 21 of treatment, which were chosen as endpoints for evidence-based comparison. These days, a positive effect was noted in the majority of patients and, to a certain extent, was caused by concomitant physiotherapy, however, as the comparison results show, it was significantly higher in the active treatment group, which confirms the effectiveness of Mydocalm as a means of treating painful muscular-tonic syndromes.

Analysis of the subjective assessment of the results of treatment given by patients after its completion (21 days) showed that in the group of patients receiving Mydocalm, a very good assessment of the treatment was significantly more common.

Lack of effectiveness, on the contrary, was significantly more often noted by patients in the placebo group. In general, by the end of treatment, the overall effectiveness rating was significantly higher in the group receiving Mydocalm than in the placebo group.

Analysis of the subjective assessment of the results of treatment given by patients after its completion (after 21 days) showed no significant differences in the tolerability of Mydocalm and placebo. The vast majority of patients had good tolerability of Mydocalm. During the entire study period, 4 patients from the placebo group and only 3 patients from the Mydocalm group stopped treatment.

ECG, biochemical and hematological parameters also did not differ in the group of patients taking Mydocalm and the placebo group.

Thus, the results of a double-blind, placebo-controlled study indicate the effectiveness and safety of Mydocalm.

at a dose of 300 mg per day for painful muscular-tonic syndromes. It is important to note that more than half (62%) of the patients included in the study were receiving other types of therapy before the start of the study, and the majority of them (68%) did not experience improvement. This indicates the effectiveness of Mydocalm in the treatment of painful muscular-tonic syndromes resistant to therapy.

A number of other studies have also noted that in case of vertebrogenic muscular-tonic syndrome, the addition of Mydocalm at a dose of 150–450 mg/day to standard therapy (non-steroidal anti-inflammatory drugs, analgesics, physiotherapy, therapeutic exercises) leads to a more rapid regression of pain, muscle tension and improving spinal mobility, without being accompanied by any side effects. In one of these studies [1], it was shown that in case of vertebrogenic pain syndrome, intramuscular administration of 100 mg Mydocalm reduces pain after 1.5 hours, and treatment with Mydocalm for a week at 200 mg/day intramuscularly, and then for 2 weeks, 450 mg/day orally has a significant advantage over standard therapy. At the same time, treatment with Mydocalm not only reduces pain, but also relieves anxiety, increases mental performance and is accompanied by an improvement in the functional state of the peripheral nervous system according to electroneuromyography.

In case of vertebrogenic muscular-tonic syndromes, the advantages of Mydocalm, in addition to its effective muscle relaxant and analgesic effect, are the absence of side effects and good interaction with non-steroidal anti-inflammatory drugs, which in many cases makes it possible to reduce the dose of the latter and, as a result, weaken or even completely eliminate their side effects without reducing effectiveness treatment.

An important advantage of Mydocalm over other muscle relaxants is the absence of sedation and muscle weakness

when receiving it. This benefit has recently been rigorously demonstrated in a double-blind, placebo-controlled study [4]. The study included 72 healthy volunteers (36 men and 36 women) aged 19 to 27 years (mean age 21.7 years). It lasted for 8 days, during which volunteers randomized to receive 150 or 450 mg of Mydocalm per day in three divided doses or placebo, also in three divided doses. Neuropsychological studies were carried out in the morning on the first and last (eighth) days of the study before, 1.5 hours, 4 hours and 6 hours after taking Mydocalm or placebo. They included a study of simple reaction speed, psychomotor coordination (eye, hand and foot movements), and a study of Welzel color scales.

The results of the study did not show any significant differences in the rate of reactions before, 1.5 hours, 4 hours and 6 hours after taking Mydocalm at a dose of 50 or 150 mg or placebo. Comparison of reaction rates before the start of the study and on the 8th day also did not show significant differences. The results of changes in the reaction rate in the group taking Mydocalm at a maximum dose of 450 mg/day and the placebo group were the same.

The results of the study show that taking Mydocalm in a daily dose of both 150 mg and 450 mg does not cause any sedation or slowdown in the time of motor reactions in comparison with placebo. This indicates that Mydocalm is well tolerated and can be prescribed in cases where the patient continues to drive a car or his other activities require maintaining quick reactions and attention.

Thus, the key to successful treatment of back pain is an accurate diagnosis of its cause, since dorsalgia can be a symptom of various diseases.
In many cases, back pain is caused by painful muscle spasms due to degenerative changes in the spine or myofascial syndrome. In such cases, Mydocalm is effective and safe for its treatment, which can be used in combination with various medications, physiotherapy and therapeutic exercises. Literature:
1. Avakyan G.N., Chukanova E.I., Nikonov A.A. The use of mydocalm in the relief of vertebrogenic pain syndromes // Journal. neurol. and psychiatrist. – 2000. – No. 5. – P. 26–31.

2. Diseases of the nervous system. Guide for doctors. Edited by N.N. Yakhno, D.R. Shtulman. – M., 2001, volume 1.

3. Pratzel HG, Alken R.-G., Ramm S. Efficacy and tolerance of repeated doses of tolperisone hydrochloride in the treatment of painful reflex muscle spasm: results of a prospective placebo-controlled double-blind trial // Pain. – 1996. – Vol. 67. – P. 417–425

4. Dulin J., Kovacs L., Ramm S. et al. Evaluation of sedative effects of single and repeated doses of 50 mg and 150 mg tolperisone hydrochloride. Results of a prospective, randomized, double-blind, placebo-controlled trial // Pharmacopsychiat. – 1998. – Vol. 31. – P. 137–142.

5. Victor M., Ropper AH // Adams and Victor's principles of Neurology. New York. 2001

Meloxicam combilipen mydocalm can be injected all together

Osteochondrosis, arthrosis, intervertebral hernia, muscle spasms - many people face these pathologies. To get rid of pain, various medications are used, including in combination.

In this case, the combined use of drugs such as Combilipen, Meloxicam and Mydocalm can help.

To get rid of pain due to osteochondrosis, arthrosis, and muscle spasms, drugs such as Combilipen, Meloxicam and Mydocalm are used.

Effect of the drug Combilipen

Combilipen is a complex vitamin preparation that includes an anesthetic.

• vitamin B1 (thiamine), which has a beneficial effect on the functioning of the heart muscle and central nervous system;
• vitamin B6 (pyridoxine) – it takes part in the regulation of the central and peripheral nervous system;
• vitamin B12 (cyanocobalamin), necessary to replenish the insufficient amount of myelin and nucleotides;
• lidocaine, which has a local anesthetic effect.

Action of the drug Meloxicam

Meloxicam (Movalis) is a non-steroidal anti-inflammatory drug from the oxicam group. It has antipyretic, anti-inflammatory and analgesic effects.

Action of the drug Mydocalm

Mydocalm also belongs to the group of nonsteroidal anti-inflammatory drugs (NSAIDs), which are widely used in medicine. The active ingredient of the drug is tolperisone hydrochloride.

It has a muscle relaxant, vasodilator and anesthetic effect, and also helps improve blood circulation in the affected tissues.

Mydocalm is prescribed primarily for pain relief due to muscle spasms, arthrosis, and osteochondrosis.

Mydocalm is prescribed primarily for pain relief due to muscle spasms, arthrosis, and osteochondrosis.

Joint effect

Despite the fact that all drugs belong to different pharmacological groups, when used together, their effect is greatly enhanced. Thanks to this, the therapeutic effect occurs faster, and the time until complete recovery is reduced. This eliminates the occurrence of side effects that occur with long-term use of medications.

Indications for simultaneous use

The combined use of these drugs is recommended for the following pathologies:

• osteochondrosis;
• herniated discs;
• pinched nerves;
• muscle spasms;
• spondylitis;
• spondyloarthrosis;
• ankylosing spondylitis;
• lumbago;
• intercostal neuralgia.

Contraindications

It is not recommended to use these medications together if the patient has:

• individual intolerance to drug components;
• tendency to allergic reactions;
• chronic heart failure;
• erosive and ulcerative lesions of the stomach and duodenum;
• inflammatory bowel diseases;
• severe liver and kidney failure;
• pregnancy and lactation;
• age up to 12 months.

Meloxicam should not be taken if you are hypersensitive to any of the drug components.

How to take Combilipen, Meloxicam and Mydocalm?

Most often, when used together, the drugs are administered daily as intramuscular injections. It is not recommended to mix them in one syringe. The average duration of injection therapy is at least 5 days.

Over the next 7-10 days, you must take these medications in tablet form until your condition improves.

However, depending on the pathology and the characteristics of its course, the dosage may vary, so it is better to trust the advice of specialists.

Treatment of neuropathic pain syndromes in the practice of a neurologist

N.V. TARAROSCHENKO, Head of the Neurological Department of the Central City Hospital No. 14 of Donetsk

Patients with a variety of pain types are encountered in our practice every day. How important it is for a doctor, after examining a patient, to clearly determine the genesis of pain, because the choice of correct and adequate treatment sometimes depends on this.

A neurologist, like no one else, should know well what pain is and what types of pain exist.

Pain is an unpleasant sensation and emotional experience associated with actual or potential tissue damage or described in terms of such damage.

All pain sensations are divided into two large types: nociceptive (or somatogenic) and neuropathic (or neurogenic).

Nociceptive (somatogenic) is pain caused by the influence of any factor (mechanical trauma, burn, inflammation, etc.) on peripheral pain receptors when all parts of the nervous system are intact.

Neuropathic (neurogenic) is pain that occurs with organic damage or dysfunction of various parts of the nervous system, both peripheral and central, at any level, from the peripheral nerves to the cerebral cortex.

Nociceptive pain is more often acute, and neuropathic pain is chronic.

In certain cases, there is a combination of nociceptive and neuropathic components of pain (with compression radiculopathies).

The most common situations in which neuropathic pain occurs are:

• Diabetic neuropathy (DN) - 86%.
• Postherpetic neuralgia (PHN) - 3%.
• Trigeminal neuralgia (TN) - 1%.
• Oncological neuropathic pain - 6%.
• Neuropathy in HIV - 3%.
• Complex regional pain syndrome (CRPS), previously referred to as reflex sympathetic dystrophy, is local pain with swelling, trophic disorders and osteoporosis - 1%.

Examples of neuropathic pain:

• For diabetic and alcoholic polyneuropathy (up to 25-45%).
• Postherpetic neuralgia (in old age, this complication occurs in 70% of cases of herpes zoster).
• Complex regional pain syndrome (local pain with swelling, trophic disorders and osteoporosis), which was previously designated as reflex sympathetic dystrophy. A striking example of CRPS, which is quite common in industrial regions of Ukraine, is vibration disease.
• Trigeminal neuralgia.
• Phantom pain.
• Post-stroke central pain.
• Pain syndrome in multiple sclerosis, syringomyelia, spinal cord lesions.

Frequency of neuropathic pain:

• in the population - about 1.5%;
• for diabetic polyneuropathy - up to 45%;
• with multiple sclerosis - up to 28%;
• with syringomyelia - up to 75%;
• for cerebral stroke - up to 8%;
• with nerve injury - up to 5%.

Among all patients with neuropathic pain, about 50% are patients with diabetic polyneuropathy. Unfortunately, pain in these patients is often interpreted as vascular or vertebrogenic, which leads to inadequate therapeutic measures.

A feature of neuropathic pain is its association with specific sensory disorders:

• allodynia;
• hyperesthesia;
• hyperalgesia;
• hyperpathy;
• neuralgia.

Allodynia is the occurrence of pain in response to a stimulus that does not normally cause pain. In such cases, patients experience severe pain at the slightest touch, sometimes even when the wind blows. There are temperature and mechanical allodynia. Mechanical allodynia is divided into static, which occurs when pressure is applied to a fixed point on the skin, and dynamic, which occurs with moving stimuli, for example, when the skin is slightly irritated with a brush or finger.

With hyperalgesia, sensitivity to a painful stimulus is significantly higher than expected normally.

In hyperpathy, the subjective response to both painful and non-painful stimuli is excessive and often persists for a long time after the irritation has ceased.

Neuralgia (trigeminal, postherpetic) are a typical example of neuropathic pain.

Spontaneous pain occurs in the apparent absence of any external influence; As a rule, it has a burning, stabbing character.

Paresthesia - sensations of tickling, painless tingling or other similar ones.

Dysesthesias are conditions in which the sensations caused by paresthesias cause pain.

Neuropathic pain occurs as a result of impaired interaction between nociceptive and antinociceptive systems due to their damage or dysfunction at various levels of the nervous system. The role of peripheral nerves, roots, dorsal horn of the spinal cord, pain neurotransmitters, glutamate receptors, sodium and calcium channels has been most studied.

Possible mechanisms of pain include spontaneous ectopic activity of damaged axons, sensitization of pain receptors, abnormal interactions of peripheral sensory fibers, and hypersensitivity to catecholamines.

Central sensitization of a group of spinal cord neurons results from neuronal plasticity activated by primary afferent stimulation. This process is considered decisive in the formation of neuropathic pain syndrome and leads to the development of allodynia and hyperpathia.

Voltage-dependent calcium N channels are located in the superficial plate of the dorsal horn of the spinal cord and are involved in the formation of neuropathic pain. It is believed that the α2δ subunit, which is part of all voltage-dependent calcium channels, is the target for the antiallodynic action of gabapentin.

Treatment methods for neuropathic pain can be divided into two large groups: non-drug and medicinal.

Non-drug methods that enhance the activity of antinociceptive systems:

• acupuncture;
• transcutaneous electrical nerve stimulation;
• spinal cord stimulation;
• physiotherapy;
• biofeedback;
• psychotherapy;
• less often, blockades and neurosurgical treatment methods (destruction of the zone of entry of the dorsal root), blocking the flow of afferent nociceptive afferentation.

Medicinal:

• local anesthetics;
• opioid drugs;
• central muscle relaxants;
• antiarrhythmic drugs;
• antidepressants;
• anticonvulsants.

Simple analgesics (paracetamol, aspirin) and non-steroidal anti-inflammatory drugs (diclofenac, indomethacin, etc.) are ineffective for neuropathic pain and are not used for its treatment. This is due to the fact that the main mechanisms of neuropathic pain are not inflammatory processes, but neuronal and receptor disorders, peripheral and central sensitization.

Local anesthetics:

• lidocaine 5% cream or patch (Versatis) is used to block peripheral nociceptors;
• Perineural injections of corticosteroids or combinations of corticosteroids and local anesthetics can be used to treat pain from mononeuropathies and neuromas.

Central muscle relaxants:

• tolperisone (mydocalm);
• baclofen;
• tizanidine (sirdalud).

Often these drugs alone cannot adequately relieve neuropathic pain syndrome, but in combination with drugs from the group of anticonvulsants they enhance the effect of the latter.

Opioid analgesics:

• morphine;
• codeine;
• oxycodone;
• tramadol;
• dextromethorphan;
• methodon.

Experience shows that the use of the above medications is justified only in the case of neuropathic pain in cancer. In our department, we practically do not use opioid analgesics due to their toxicity, a large number of side effects, and addiction to drugs in this group.

Antidepressants. Previously, most often for neuropathic pain, many neurologists, including my colleagues and I, widely used tricyclic antidepressants, for example, the well-known amitriptyline, both alone and in combination with anticonvulsants (for example, carbamazepines). As experience and many authors of publications have shown, the use of tricyclic antidepressants is currently irrelevant, since they cause adverse reactions associated with anticholinergic effects, orthostatic hypotension and cardiac arrhythmias. Contraindications to the use of tricyclic anticonvulsants are:

• cardiac conduction disorders;
• congestive heart failure;
• seizure disorders;
• urinary retention;
• liver failure.

A relative contraindication is orthostatic symptoms.

At present, there is still insufficient clinical experience in the use of antidepressants from other groups in the treatment of neuropathic pain syndromes, either alone or in combination with the same anticonvulsants.

Anticonvulsants

Carbamazepine has been and is very often used for the treatment of neuropathic pain. However, when using it, a number of problems arise:

• difficulty in dose titration;
• aplastic anemia (!) and necessary monitoring of liver function;
• many side effects (drowsiness, dizziness, gait disturbance, nausea, vomiting, visual disturbances);
• interaction with many drugs metabolized in the liver.

In general, antiepileptic drugs can be effective in cases where other drugs do not provide benefit or are contraindicated, so further study of new generation anticonvulsants in the treatment of pain is justified.

The emergence of a new drug, gabapentin (Tebantin), has opened up new prospects in the treatment of neuropathic pain and many other chronic pain syndromes. The point of application of Tebantin is the voltage-dependent calcium N-channels located in the superficial plate of the posterior horn, which explains the anti-allodynic effect of Tebantin.

The advantages of Tebantin are:

• excellent pharmacokinetic profile: not metabolized, does not bind to plasma proteins, excreted by the kidneys, easily penetrates the BBB;
• no need to monitor drug concentrations in the blood;
• mild side effect profile (sedation and dizziness may occur).

Tebantin does not interact with:

• with GABA-A receptors;
• GABA-B receptors
• benzodiazepine receptors;
• glycine receptors;
• adrenergic receptors;
• cholinergic receptors.

In addition, Tebantine does not bind to plasma proteins, is not metabolized, does not affect liver enzymes, and drugs that affect the activity of liver enzymes do not affect the pharmacokinetics of Tebantine.

The favorable pharmacokinetic profile of Tebantine makes this drug a good choice for the treatment of elderly patients receiving polypharmacotherapy and ensures a high level of safety of the drug.

Compared to carbamazepines, Tebantine is well tolerated, including by older people; sometimes with its use we observed side effects (dizziness, drowsiness, nausea), but it must be said that they were mild or moderate and were transient.

Tebantin was used in the practice of our department for various types of neuropathic pain:

• for diabetic and alcoholic polyneuropathy;
• complex regional pain syndrome (vibration disease);
• postherpetic neuralgia;
• metastatic lesions of the spine;
• radiculopathy;
• postlaminectomy syndrome.

Benefits of Tebantin in the treatment of neuropathic pain:

• safety;
• low potential for interaction with other drugs;
• good tolerance;
• drug of choice for the elderly on polypharmacotherapy;
• convenient to use;
• proven effectiveness;
• wide availability.

In our practice, we did not increase the dose of the drug at a rapid pace. If on the second day, when the patient takes 600 mg of Tebantin per day in two doses, a positive effect is achieved and the pain syndrome is relieved, then there is no need to increase the dose further. This can and should be done, judging by our experience, if a given dose does not have the desired effect or when pain returns. Thus, titration should be gradual and there is no need to significantly increase the dose of Tebantine if a positive effect is obtained already on the second or third day of using the drug, that is, when taking 600-900 mg of Tebantine per day. The average daily doses of Tebantin, which made it possible to relieve neuropathic pain, ranged from 900 to 1500 mg.

We did not observe any signs of serious interaction between Tebantine and other drugs.

However, you should refrain from using it in combination with alcohol, tranquilizers, antihistamines, barbiturates, anticonvulsants, sleeping pills, muscle relaxants, and drugs.

The combination of Tebantine with lidocaine or antidepressants enhances its effect. Therefore, it makes sense to combine it with the Versatis patch containing lidocaine, with tolperisone (mydocalm), the molecule of which has a lidocaine-like effect, thus, the administration of mydocalm at a dose of 300-450 mg per day potentiates the effect of Tebantine in the treatment of neuropathic pain syndromes.

The plasma concentration of Tebantine reaches its peak 2-3 hours after administration.

The dosing interval should not exceed 12 hours.

Bioavailability is 60%.

Food intake does not affect the pharmacokinetics of gabapentin.

Antacids reduce the concentration of gabapentin in the blood, so it is recommended to take it no earlier than 2 hours after taking antacids. The drug is excreted primarily by the kidneys and is not metabolized in the liver.

If renal function is impaired, the dose of gabapentin is selected taking into account creatinine clearance.

Let's look at examples of the use of Tebantin in the treatment of neuropathic pain syndromes

Peripheral polyneuropathy

• The recommended maximum dose is 1800-2400 mg/day (we obtained an effect at average doses of 1200-1800 mg/day).
• Treatment begins with a dose of 300 mg/day, which is increased to the recommended dose during the first week.
• The course of treatment is 2-4 months.

Postherpetic neuralgia

• The dose of Tebantin is 1800-3600 mg/day (initial 300 mg). In the practice of our department, an effect was obtained at an average dosage of 1500-2400 mg/day.
• Treatment is continued for 2-4 months.

Pain in multiple sclerosis (according to literature)

• The initial dose of the drug was 300 mg/day.
• It is increased to 900 mg/day or more for 3 weeks.
• The average dose is 900 mg/day (from 600 to 2400 mg/day).
• Treatment is continued for 2-4 months.

Trigeminal neuralgia

In many studies, gabapentin was effective in patients with trigeminal neuralgia that did not respond to treatment with other drugs (carbamazepine, phenytoin, valproate, amitriptyline, intravenous methylprednisolone, various nonsteroidal anti-inflammatory drugs). In most cases, complete pain relief was observed. We used Tebantin for trigeminal neuralgia at a daily dose of 1500-2400 mg, which allowed us to achieve a positive effect.

Complex regional pain syndrome

Tebantin at a dose of 900-1500 mg caused a significant reduction in pain, improved well-being, a decrease in the severity of hyperpathia, allodynia, hyperalgesia and normalization of the color of the skin of the limb in patients with complex regional pain syndrome. The recommended duration of treatment is 2-3 months.

Lower back pain

• Tebantin is used for 4 weeks.
• Pain intensity decreases by an average of 46%.
• However, most patients were able to stop taking one or more medications that they were taking before starting gabapentin treatment.
• Gabapentin is used for back pain according to the standard regimen in the presence of a neuropathic component (compression lesions).
• An average Tebantin dose of 900-1500 mg/day was sufficient to relieve or significantly reduce pain in compressive discogenic radiculopathy. In this case, the combination of Tebantin with mydocalm at a dose of 300-450 mg/day is justified and has a potentiated effect.

Of course, if a patient has a disc herniation on MRI with sequestration, compression of the root and dural sac, and in the clinic there is severe pain and radicular syndrome, then it is much more appropriate not to titrate the dose of Tebantin, but to refer such a patient to a neurosurgeon as quickly and timely as possible.

Carpal tunnel syndrome (according to literature)

Gabapentin has been successfully used to treat neuropathic pain in various mononeuropathies and tunnel syndromes.

Its effectiveness was confirmed in a comparative study with carbamazepine in patients with carpal tunnel syndrome who, for various reasons, were refused surgical treatment.

Migraine (according to literature)

In patients with migraine, it is recommended to start treatment with a dose of 300 mg, which is increased to 2400 mg over 2 weeks, and continue therapy for 6 weeks. When using gabapentin, headaches occurred significantly less often, and their intensity on the visual analogue scale decreased. In addition, a decrease in the severity of associated symptoms was noted - nausea, photophobia, etc. The effectiveness of gabapentin was also noted in many studies in patients with migraine, accompanied and not accompanied by aura, transformed migraine, cluster headache, as well as chronic daily headache, refractory to other medicines.

Thus, the modern approach to the treatment of neuropathic pain is the use of Tebantin in complex therapy:

• Solving the main treatment problems:

  reduction of the initial level and exacerbations of pain;

• improving quality of life.

Clearly, there is no panacea. But the positive experience gained in using Tebantin in the treatment of neuropathic pain syndromes helps the practical neurologist in treating patients with neuropathic pain syndromes, which are often difficult to treat and quite problematic.

Literature 1. Pain syndromes in neurological practice / Ed. A.M. Veina. - M., 2001. 2. Davydov O.S., Danilov A.B. Principles and algorithms for the treatment of neuropathic pain // Russian Medical Journal. — T. 16, special issue “Pain syndrome.” — From 11-16. 3. Danilov A.B. Gabapentin in the treatment of neuropathic pain // Klin. pharmacology and therapy. - 2004. - T. 13, No. 14. - P. 57-60. 4. Danilov A.B., Davydov O.S. Neuropathic pain. - M.: Borges, 2007. 5. Kukushkin M.L. Neurogenic (neuropathic) pain // Medical Bulletin. - 2005. - No. 32.

Meloxicam and combilipen - can they be taken at the same time (compatibility)

The combined use of Meloxicam and Kombilipen gives good results in the treatment of pathologies associated with damage to the peripheral nervous system. Their use can quickly reduce the inflammatory process and eliminate unpleasant symptoms.

The combined use of Meloxicam and Kombilipen gives good results in the treatment of pathologies associated with damage to the peripheral nervous system.

Properties of drugs

The combined effect of drugs is due to the therapeutic effect of the active components included in them.

Meloxicam

The medicine belongs to the group of non-steroidal anti-inflammatory drugs. It does not allow the synthesis of the substance responsible for the development of the inflammatory process. The product has pronounced antipyretic, anti-edematous and analgesic properties.

Under its influence, the temperature decreases, pain, swelling and inflammation are eliminated.

Meloxicam has pronounced antipyretic, anti-edematous and analgesic properties.

Combilipen

The drug contains B vitamins, which enhance each other’s effects.

Their simultaneous use allows you to achieve numerous positive changes in the patient’s condition:

• nerve conduction improves;
• metabolic processes are enhanced;
• the body's protective properties increase;
• bone growth and muscle functionality are stimulated;
• inflammation and pain are reduced.

Additionally, the vitamin complex includes lidocaine, which has analgesic and anti-inflammatory properties.

Treatment regimen with a combination of Meloxicam and Combilipen

Osteochondrosis is a disease that causes problems with the normal functioning of the joints. This disease most often affects the spinal column. Such changes in the joints occur gradually. A sedentary lifestyle, excess weight, problems with the cardiovascular system - all this directly affects the risk of developing osteochondrosis.

Degradation of joint joints in the human body is a common age-related process, but to slow it down it is worth engaging in physical activity. If the disease could not be prevented, then Meloxicam and Combilipen can be used to treat it.

Combination of drugs

Treatment of osteochondrosis takes place in two stages: elimination of painful syndromes, then improvement of nutrition of the bone formations of the spine. To begin with, the doctor must ease or eliminate the patient’s attacks of pain, relieve inflammation that has arisen due to improper functioning of the diseased joints. For this purpose, anti-inflammatory drugs for osteochondrosis such as Meloxicam are used.

Meloxicam

Meloxicam is one of the most effective drugs on the market. Its development has become one of the key points in the treatment of osteochondrosis, varicose veins and most rheumatic pathologies. Meloxicam was also produced much cheaper than many of its analogues. The effectiveness of the drug has been proven by experiments and studies.

The tablets contain substances such as:

• Meloxicam
• Sodium citrate
• Aerosil
• Lactose
• Cellulose
• Magnesium stearate
• Starch

Injection ampoules for osteochondrosis consist of the following substances:

• Meloxicam
• Sodium chloride
• Saline
• Glycine
• Poloxamer 188
• Glycofurol

When ingested, it has an analgesic, antipyretic, and anti-inflammatory effect. Affects inflammation in the joint. This makes it easier to tolerate diseases of the musculoskeletal system.

Meloxicam is 90% absorbed within 6 hours after administration. All residual substances are eliminated from the body naturally within a few days. This puts some strain on the gastrointestinal tract (GIT), liver, and kidneys. Therefore, while taking Meloxicam you need to limit yourself to alcohol, fatty foods and other harmful substances.

After the symptoms have eased, the attending physician should begin to normalize the blood supply to the vertebrae affected by osteochondrosis. For this, a medicine such as Combilipen can be used.

Combilipen

Combilipen is a complex of B vitamins. This drug is prescribed everywhere for diseases of the motor system, neuroses, liver diseases, and other ailments associated with a lack of vitamins of this group.

The main active ingredients of Combilipen are:

• Thiamine hydrochloride. Vitamin B solution Nourishes the body's cells, improves blood supply and overall tone of all body systems.
• Pyridoxine hydrochloride. Vitamin B solution is necessary for the normal functioning of the central nervous system (CNS). Helps improve impulse transmission, braking and excitation systems. Participates in the formation and transmission of substances such as catecholamines and sphingosine. These components are necessary for the synthesis of new parts of the nervous system.
• Cyanocobalamin. Vitamin B Activates the regeneration of damaged cells and is involved in the synthesis of many substances that are necessary for the normal functioning of the human body.
• Lidocaine. It has a rapid analgesic effect and improves blood flow, which facilitates the absorption of all components of Combilipen.

Auxiliary components of Kombilipen:

• Alcohol
• Saline
• Sodium tripolyphosphate
• Sodium hydroxide
• Hexacyanoferrate

In pharmacies you can find a tablet version of Kombilipen. Taking vitamins in this form leads to a low percentage of absorption. Most of the beneficial components of the drug are destroyed in the aggressive environment of the stomach.

Meloxicam or Mydocalm: which is better? Can I take it together? - new from the world of medicine

Due to the commonality of some indications for use and the similarity of names, many believe that mydocalm and meloxicam are the same medicine. However, they are not analogues at all. The difference between them lies in the mechanism of action and scope of application.

Pharmacological properties

• Meloxicam is an anti-inflammatory drug that exerts its effect by inhibiting the formation and release of substances that trigger inflammatory changes in tissues (swelling, pain, increased blood flow, increased local temperature).
• Mydocalm is a muscle relaxant, that is, a drug that relaxes skeletal muscles. The mechanism of action is based on blocking the transmission of impulses along nerve fibers. In addition, the medicine has a weak vasodilator effect.

Meloxicam

• arthritis and arthrosis (inflammation and destruction of cartilage in joints);
• Ankylosing spondylitis (impaired vertebral mobility);
• pain syndrome in joint and spinal pathologies.

Mydocalm

• persistent tension of the trunk muscles due to disorders of the brain and spinal cord;
• muscle spasm in diseases of the musculoskeletal system;
• recovery period after orthopedic surgery;
• narrowing of blood vessels of various origins (cholesterol deposition, thrombosis, etc.).

Contraindications

Meloxicam

• hypersensitivity to the components of the drug;
• the period of bearing a child and breastfeeding;
• age less than 15 years;
• erosions and ulcers of any part of the digestive system;
• any bleeding;
• inflammation of intestinal structures;
• severe disorders of the kidneys, liver, heart;
• a combination of bronchial asthma, nasal polyps and aspirin intolerance.

Mydocalm

• hypersensitivity to the drug;
• childbearing and breastfeeding;
• the child's age is less than 3 years;
• myasthenia gravis (pathological muscle weakness).

Meloxicam

• nausea, vomiting, stool upset;
• ulceration in the digestive tract;
• decrease in the concentration of all blood cells;
• bronchospasm;
• dizziness, headaches;
• disorientation, drowsiness;
• swelling;
• increase in pressure, heart rate;
• visual impairment;
• allergic reactions.

Mydocalm

• weakness;
• headache;
• nausea, abdominal pain;
• decreased blood pressure;
• allergies.

Meloxicam or Mydocalm, which is better?

It is not entirely correct to compare these drugs, since they belong to different pharmaceutical groups and serve different purposes.

Since meloxicam has a number of serious contraindications for use and often causes undesirable side reactions, in the presence of skeletal muscle spasm it is necessary to limit oneself to taking mydocalm.

It does not have an anti-inflammatory effect, but indirectly helps reduce pain by relaxing muscles. In the absence of muscle spasm (uncomplicated arthritis and arthrosis, ankylosing spondylitis, etc.), taking mydocalm is not advisable.

Mydocalm and Meloxicam: compatibility

With pathology of the musculoskeletal system, the question often arises: is it possible in certain cases to take mydocalm and meloxicam together. If there are appropriate indications, taking these medications together is not only possible, but also necessary:

• diseases of the spine (osteochondrosis, herniated intervertebral discs, injuries), accompanied by muscle spasms;
• pathology of large joints (hip, shoulder) in combination with tension in the surrounding muscles;
• condition after operations on the joints and spine.

Many people are interested in the question of whether it is possible to give injections of mydocalm and meloxicam at the same time. This is quite possible, as is the joint use of tablet forms.

Dose adjustment in this case is not necessary, however, it should be borne in mind that when combined with these drugs, you need to be especially careful when engaging in potentially hazardous activities that require increased concentration.

Mydocalm, Combilipen, Meloxicam

These three drugs are often prescribed together to treat spinal disorders accompanied by the following symptoms:

• back pain;
• back muscle tension;
• signs of damage to nerve fibers (numbness, pain, weakness in the limbs).

In such a situation, prescribing medications is completely justified. Meloxicam will suppress the inflammatory reaction and reduce pain, mydocalm will relieve muscle spasms, and combilipen, containing a B complex of vitamins, will restore damaged nerve tissue.

Mydocalm and Meloxicam: compatibility

With pathology of the musculoskeletal system, the question often arises: is it possible in certain cases to take mydocalm and meloxicam together. If there are appropriate indications, taking these medications together is not only possible, but also necessary:

• diseases of the spine (osteochondrosis, herniated intervertebral discs, injuries), accompanied by muscle spasms;
• pathology of large joints (hip, shoulder) in combination with tension in the surrounding muscles;
• condition after operations on the joints and spine.

Many people are interested in the question of whether it is possible to give injections of mydocalm and meloxicam at the same time. This is quite possible, as is the joint use of tablet forms. Dose adjustment in this case is not necessary, however, it should be borne in mind that when combined with these drugs, you need to be especially careful when engaging in potentially hazardous activities that require increased concentration.