Does Mexidol increase or decrease blood pressure, when should you take it?

Mexidol is approved for wide medical use and is indicated for the treatment of acute cerebrovascular accidents, dyscirculatory encephalopathy, vegetative-vascular dystonia, atherosclerotic disorders of brain function, neurotic and neurosis-like disorders with anxiety, for the relief of withdrawal syndrome in alcoholism, for the treatment of acute intoxication with neuroleptics and a number of other diseases . Mexidol is a new type of drug, both in mechanism and in the spectrum of pharmacological action and has significant advantages over known neuropsychotropic drugs.

MECHANISM OF ACTION

Mexidol has an original mechanism of action, the fundamental difference of which from the mechanism of action of traditional neuropsychotropic drugs is its lack of specific binding to known receptors. Mexidol is an inhibitor of free radical processes, lipid peroxidation, it activates superoxide dismutase, affects the physicochemical properties of the membrane, increases the content of polar lipid fractions (phosphotidylserine and phosphotidylinositol, etc.) in the membrane, reduces the cholesterol/phospholipid ratio, reduces the viscosity of lipid layer and increases the fluidity of the membrane, activates the energy-synthesizing functions of mitochondria and improves energy metabolism in the cell and, thus, protects the cell apparatus and the structure of their membranes.

The change in the functional activity of the biological membrane caused by Mexidol leads to conformational changes in the protein macromolecules of synaptic membranes, as a result of which Mexidol has a modulating effect on the activity of membrane-bound enzymes, ion channels and receptor complexes, in particular, benzodiazepine, GABA, acetylcholine, enhancing their ability to bind to ligands, increasing the activity of neurotransmitters and the activation of synaptic processes.

Along with this, Mexidol has a pronounced lipid-lowering effect, reduces the level of total cholesterol and low-density lipoproteins and increases high-density lipoproteins.

Thus, the mechanism of action of Mexidol is determined primarily by its antioxidant properties, the ability to stabilize cell biomembranes, activate the energy-synthesizing functions of mitochondria, modulate the functioning of receptor complexes and the passage of ionic currents, enhance the binding of endogenous substances, improve synaptic transmission and the interconnection of brain structures. Thanks to this mechanism of action, Mexidol influences the key basic links in the pathogenesis of various diseases, has a wide range of effects, extremely few side effects and low toxicity, and has the ability to potentiate the action of other centrally active substances, especially those that act as direct receptor agonists.

PHARMACODYNAMICS

Mexidol, unlike well-known drugs, has a wide range of pharmacological effects, realized at least at two levels - neuronal and vascular.

It has cerebroprotective, anti-alcohol, nootropic, antihypoxic, tranquilizing, anticonvulsant, antiparkinsonian, anti-stress, vegetotropic effects. In addition, it has the ability to improve cerebral circulation, inhibit platelet aggregation, reduce total cholesterol levels, and have an anti-atherosclerotic effect. The therapeutic effects of Mexidol are detected in the dose range from 10 to 300 mg/kg.

Mexidol increases the body's resistance to various extreme damaging factors, such as sleep disturbance, conflict situations, stress, brain injury, electric shock, physical activity, hypoxia, ischemia, and various intoxications, including ethanol.

Mexidol has a pronounced tranquilizing and anti-stress effect, the ability to eliminate anxiety, fear, tension, restlessness, in particular in conflict situations. When administered parenterally, it has a similar depth of effect to diazepam (Seduxen) and alprazolam (Xanax). Anti-stress effect

Mexidol is expressed in the normalization of post-aggressive behavior, somatovegetative indicators, restoration of sleep-wake cycles and impaired learning and memory processes, reduction of stomach ulcers, reduction of dystrophic, morphological changes that occur after stress in various structures of the brain and in the myocardium.

Mexidol has a distinct anticonvulsant effect, influencing both primary generalized seizures, caused primarily by the administration of GABAergic substances, and the epileptiform activity of the brain with a chronic epileptogenic focus.

The nootropic properties of Mexidol are expressed in the ability to improve learning and memory, promote the preservation of a memorable trace and counteract the process of extinction of acquired skills and reflexes. Mexidol has a pronounced anti-amnestic effect, eliminating memory impairment caused by various influences (electric shock, brain injury, sleep deprivation, administration of scopolamine, ethanol, benzodiazepines, etc.).

Mexidol has a clear antihypoxic and antiischemic effect, which is expressed in the ability of the drug to increase life expectancy and the number of surviving animals under various hypoxic conditions: hypobaric hypoxia, hypoxia with hypercapnia in a hermetic volume and hemic hypoxia. In terms of antihypoxic activity, Mexidol is significantly superior to pyritinol and piracetam, which at doses of 300 and even 500 mg/kg have weak antihypoxic activity under conditions of acute hypobaric hypoxia and hypoxia with hypercapnia. In addition, Mexidol has a pronounced antihypoxic effect on the myocardium in experiments on an isolated, perforated, contracting heart. According to the mechanism for the implementation of these effects, Mexidol is an antihypoxant with a direct energizing effect, the effect of which is associated with the influence on the endogenous respiration of mitochondria, with the activation of the energy-synthesizing function of mitochondria. The antihypoxic effect of Mexidol is due not only to its own antioxidant properties, but also to its constituent succinate, which, under hypoxic conditions, entering the intracellular space, can be oxidized by the respiratory chain.

Mexidol has a pronounced anti-alcohol effect. It eliminates the neurological and neurotoxic manifestations of acute alcohol intoxication caused by a single injection of high doses of ethanol, and also restores behavioral disorders of the vegetative and emotional status, deterioration of cognitive functions, learning and memory processes caused by long-term (5 months) administration of ethanol and its withdrawal, and prevents accumulation of lipofuscin in the brain of alcoholized animals.

Mexidol has a pronounced geroprotective effect, has a clear corrective effect on learning and memory processes impaired during aging, improving the process of fixation, storage and reproduction of information, helps restore emotional and vegetative status, reduces manifestations of neurological deficits, reduces the level of aging markers - lipofuscin - in the brain and blood , malonaldehyde, cholesterol. The mechanism of the geroprotective action of Mexidol is associated with its antioxidant properties, the ability to inhibit lipid peroxidation processes, its direct membranotropic effect, the ability to restore ultrastructural changes in the granular endoplasmic reticulum and mitochondria, and modulate the functioning of receptor complexes. Mexidol has an antiatherogenic effect. The drug inhibits the humoral manifestations of atheroarteriosclerosis: reduces hyperlipidemia, prevents the activation of lipid peroxidation, increases the activity of the antioxidant system, prevents the development of pathological changes in the vascular wall and reduces the degree of damage to the aorta.

Mexidol reduces the content of atherogenic lipoproteins and triglycerides, increases the level of high-density lipoproteins in the blood serum, and prevents deficiency of highly unsaturated phospholipids.

Mexidol not only causes regression of atherosclerotic changes in the main arteries and restores lipid homeostasis, but also corrects disturbances in the regulatory and microcirculatory systems, which is expressed in the fact that there is no structure of arterioles and precapillaries, and their diameter differs little from the control, only focal ones are determined in venules aggregates, and complete elimination of spasm of afferent microvessels is observed.

In addition, 2-ethyl-6-methyl-3-hydroxypyridine derivatives, which include Mexidol, suppress platelet aggregation caused by collagen, thrombin, ADP and arachidonic acid, inhibit platelet cyclic nucleotide phosphodiesterase, and also protect blood cells during mechanical injury . In particular, stabilizing resistance of erythrocyte membranes to hemolysis is observed and the process of hematopoiesis (restoration of the number of erythrocytes) after acute blood loss or chemical hemolysis is accelerated.

The hepatoprotective effect of Mexidol was established in three models of acute toxic liver damage, in which hepatocyte cytolysis syndrome was caused by various hepatotoxins.

In conditions of liver damage caused by carbon tetrachloride, Mexidol reduces areas of liver tissue necrosis and the volume of fatty degeneration of hepatocytes, normalizes the energy balance of hepatocytes, and has a protective effect on the nuclear and cytoplasmic pool of nucleic acids. In case of alcoholic liver damage, the effect of Mexidol is expressed in a decrease in the number of hepatocytes with lysis of nuclei and chromatin, acceleration of restoration of the total genome of hepatocytes and an increase in the content of nucleic acids in the liver tissue and nuclei of hepatocytes. 3-hydroxypyridine derivatives have a protective effect against the toxic effect on the liver of the strong hepatotropic carcinogen diethylnitrosoamine (DENA), since they form complexes with cytochrome P-450 and thereby prevent its complex formation with DENA.

Mexidol has a pronounced ability to have a potentiating effect on the effects of other neuropsychotropic drugs. Under the influence of Mexidol, the effect of tranquilizing, neuroleptic, antidepressant, hypnotics and anticonvulsants is enhanced, which makes it possible to reduce their doses and reduce side effects. In particular, when Mexidol is combined with carbamazepine, the dose of the anticonvulsant can be reduced by 2 times without reducing its therapeutic effect. The combined use of Mexidol with carbamazepine allows for adequate pathogenetic therapy of partial epilepsy, reduces the side effects of carbamazepine with long-term use without reducing its therapeutic effectiveness, and thereby optimizes the treatment of patients with epilepsy.

Side effects and toxicity

A significant advantage of Mexidol is that it has minor side effects and low toxicity. When studying the side effects of Mexidol, it was found that even in the upper range of therapeutic doses it has neither a depressing nor a stimulating effect on spontaneous motor activity, does not change the coordination of movements, the exploratory behavior of animals, rectal temperature, corneal and pineal reflexes, and does not cause drowsiness . The drug maintains the adequacy of the animals' response to the stimuli provoking the test, and simple reflexes are not impaired. With an increase in the average therapeutic dose by 4-5.5 times, Mexidol does not have a muscle relaxant effect. Along with this, Mexidol, even in extremely high doses, does not impair memory and does not cause amnesia, but, on the contrary, has an anti-amnestic effect in case of memory impairment.

Mexidol does not have a negative effect on the liver, but on the contrary, has a hepatoprotective effect. The drug does not change the heart rate, does not change blood pressure, ECG, hemodynamics and breathing rhythm, does not cause changes in the composition of the blood, skin color and mucous membranes, urination, bowel movements and salivation.

Side effects

Mexidol is expressed mainly in inhibition of motor activity and impaired coordination of movements and begins to appear in individual animals when doses are increased to 300 mg/kg and higher when administered intraperitoneally and in doses of 400 mg/kg and higher when Mexidol is administered orally.

Long-term administration

Mexidol (2-3 months) does not cause a decrease in its therapeutic effect or the appearance of additional undesirable manifestations. After stopping long-term administration of Mexidol, no withdrawal syndrome is observed.

Acute toxicity

Mexidol was determined by recording the death of animals 24 hours after administration of the drug.
The lethal dose of Mexidol, causing the death of 50% of animals (LD50) is 820 (625 - 1025) mg/kg for rats and 475 (365 -617) mg/kg for mice, and when administered orally - more than 3000 mg/kg in rats and 2010 (1608 - 2513) mg/kg in mice. A study of the chronic toxicity
of Mexidol with long-term oral and parenteral use in experimental animals did not reveal significant changes in the organs and tissues of the body.

A comparison of effective therapeutic doses of Mexidol with doses that cause side effects (sedation, incoordination, LD50) or toxic, lethal doses (LD50) shows the significant therapeutic breadth of Mexidol. The therapeutic index calculated from the LD50/ED50 ratio is 6.2, and from the LD50/ED50 ratio is 16.4, which indicates the harmlessness and safety of the drug.

PHARMACOKINETICS AND METABOLISM

Mexidol has high bioavailability. When administered parenterally to rats, it is rapidly absorbed from the abdominal cavity with a half-absorption period of 0.94 hours and maximum concentrations in plasma are reached after 3 hours, and in the brain and liver of animals - after 2-3 hours. A study of the binding ability of the membranes of the endoplasmic reticulum of the liver and brain of rats with Mexidol showed that the substance is determined in significant quantities in the membranes for 72 hours, which indicates the membranotropic properties of Mexidol. After intravenous administration of Mexidol to rabbits, the substance is eliminated from the blood plasma bioexponentially and can be determined according to theoretical calculations in fairly high concentrations for 6-12 hours. The high lipophilicity of Mexidol, its ability to bind to blood plasma proteins and endoplasmic reticulum membranes suggest the formation of tissue and blood depots of Mexidol in the body of animals.

An analysis of the pharmacokinetic parameters of Mexidol in patients in the clinic showed that, both with single and course use, the concentration of Mexidol in the blood increases quite quickly, reaching a maximum after an average of 0.58 hours. At the same time, Mexidol is quickly eliminated from the blood and after 4 hours it is practically not registered. The pharmacokinetic profiles of the drug did not differ significantly between single and chronic administration. A study of the excretion of Mexidol in the urine showed that it is excreted both unchanged and in the form of a glucuronoconjugate, which constitutes a significant amount. When studying the metabolism of Mexidol in rats, 5 metabolites were identified.

Metabolite I is phosphate (at the hydroxy group) of 3-hydroxypyridine, the formation of which occurs in the liver. In the blood, under the influence of alkaline phosphatase, 3-hydroxypyridine phosphate is split into phosphoric acid and 3-hydroxypyridine.

Metabolite II - 2-methyl-6-methyl-3-hydroxypyridine - is formed in large quantities and is found in the urine on the first and second days after Mexidol administration; this metabolite has a spectrum of pharmacological activity close to Mexidol.

Metabolite III - 6-methyl-3-hydroxypyridine is contained and excreted in large quantities in the urine.

Metabolite IV is a glucuronic conjugate with 2-ethyl-6-methyl-3-hydroxypyridine.

Metabolite V is a glucuronic conjugate with 2-ethyl-6-methyl-3-hydroxypyridine phosphate.

APPLICATION OF MEXIDOL IN NEUROLOGY AND PSYCHIATRY

Mexidol is an effective means of anti-ischemic protection of the brain in cerebral strokes. The drug has a pronounced therapeutic effect in patients with acute cerebrovascular accidents, including patients with ischemic and hemorrhagic stroke located in the circulation zone of the internal carotid artery and its branches, as well as in the vertebrobasilar system. Mexidol, as a rule, is administered to patients in the first hours of admission to the clinic intravenously in a stream or intravenously drip and intramuscularly, in doses of 50 mg. up to 400 mg. once, from 50 mg. up to 900 mg. per day with a frequency of administration of 3. The duration of action of the drug is about 4 hours. During the same time, the drug is detected in the blood of patients. One of the most significant manifestations of the effect of Mexidol when included in the complex therapy of cerebral stroke is a significant decrease in the daily mortality of patients in the acute period of stroke, as well as a tendency to an overall decrease in mortality in this disease. In the acute period of cerebral stroke, the mortality rate of patients was -31.5% for those taking Mexidol, and -52.5% without it; The bed days also decreased significantly: 38.2±2.7 with Mexidol and 45.2±4.0 days without Mexidol (B.A. Spasennikov). When using Mexidol in the treatment of cerebral stroke, first of all, a more rapid regression of neurological symptoms, assessed on the Matthew scale, is observed. Thus, in patients who were in serious condition at the time of admission to the clinic, the Matthew index at the end of the acute period (21 days) was 51.5 ± 2.1, and after treatment with Mexidol it significantly increased to 59.7 ± 1.0. When treating patients with Mexidol, the dynamics of improvement in motor functions, revealed when using the ADL index, was also indicative. So, after 21 days this indicator was 76.6±3.1 in patients using Mexidol, and in the group of patients without using Mexidol it was 63.2±4.6 (the difference is significant at P

Echopulsography of intracranial arteries and veins after intravenous administration of Mexidol showed that already 30 minutes after the injection and for 4-6 hours, there is an increase in the amplitude (on average by 25.5%) of pulse oscillations of the cerebral vessels and the outflow of blood into the cerebral veins is facilitated. Under the influence of Mexidol, an increase in linear and volumetric blood flow is observed in the extracranial sections of the main arteries of the head, which is recorded within 6 hours after administration of the drug.

Registration of rheoencephalography after a course of treatment with Mexidol revealed normalization of waveforms in 67% of patients, and improvement in venous outflow in 38%. There is an increase in pulse blood supply in the external carotid artery system and in the vertebrobasilar system, with its initially low level, and normalization of the tone of small arteries and veins in both vascular systems. Mexidol causes normalization of the EEG of patients with DE, which is expressed in an increase in the total power of the spectrum due to the alpha and beta ranges without a significant change in the slow wave part of the spectrum. In patients receiving Mexidol, the increased content of hemoglobin and leukocytes decreases, blood viscosity decreases, cholesterol levels decrease, and the lecithin-cholesterol ratio increases.

Thus, Mexidol has a pronounced therapeutic effect in patients with dyscirculatory encephalopathy of stages 1, 2 and 3. Under the influence of Mexidol, remission or regression of neurological syndromic deficit is observed. As a result of treatment with Mexidol, 64% of patients showed a marked improvement in their condition, 32% had a moderate improvement, 20% had a slight improvement, and 16% had no effect. A comparison of the clinical effectiveness of Mexidol and known drugs showed that the index of overall effectiveness in the treatment of DE was 2.05 for Mexidol. for Cavinton, Trental and Sermion -2.1, Arsdergin -1.8. Mexidol is effective in patients with vegetative-vascular dystopia with symptoms of autonomic crises of a sympatho-adrenal nature, in whom improvement occurred within 5-14 days after the start of treatment. The intensity and frequency of headaches decreased, vasoactive imbalance and excitability decreased, and sleep improved. In 13% of patients, vegetative crises completely stopped and did not reappear over the next 2-3 months. Mexidol has a positive effect in patients with mental pathology of late age, especially with atherosclerotic dementia, in whom Mexidol was administered intramuscularly (patients received 100 mg for the first 5 days, and 300 mg daily for the remaining days, course - 3 weeks). Mexidol had a positive effect on memory, especially on current events, improved concentration, learning instructions, caused a decrease in headaches and symptoms of anxiety and depression. The degree of dysarthria and tearfulness in patients decreased. In some patients, dizziness completely disappeared, a confident gait appeared, and asthenia decreased. In some patients with initial manifestations of the senile-atrophic process and in patients with atherosclerotic dementia, after treatment with Mexidol, there is an increase in activity and an improvement in mood in the head. Thus, the use of Mexidol improves intellectual-mnestic activity in patients with age-related organic weakening processes, mainly in patients with atherosclerotic dementia, helping to improve concentration, follow instructions, memory for the present, reduce headaches, dizziness, tearfulness, dysarthria, and increase activity .

Mexidol has a pronounced positive effect in the treatment of chronic neuroleptic syndrome with symptoms of tardive dyskinesia and subacute neuroleptic syndrome. Before treatment with Mexidol, all patients received active therapy for neuroleptic syndrome with the drugs cyclodol, norparkin, midantan, tiapride, cerucal, tremblex, detoxification therapy with intravenous administration of nootropil, vitamins B and C, which was assessed as ineffective.

Mexidol had a pronounced antiparkinsonian and vegetotropic effect in these patients who were difficult to treat. The effect of Mexidol began to manifest itself already from the 2-3rd day of therapy and consisted of a decrease in the severity of oral-lingual hyperkinesis, which completely disappeared by the 7-14th day of treatment, then, under the influence of the drug, a decrease in limb tremor, stiffness, hypokinesia and hypomimia was noted, it improved, became more confident, free gait of patients, which ceased to be shuffling and mincing. The phenomena of orthogatism and dizziness decreased and disappeared, there was a tendency to normalize blood pressure with drug-induced hypotension, and Mexidol had no effect on normal blood pressure, weakness, lethargy, and dizziness decreased. The antiparkinsonian effect of Mexidol persisted for another 3-5 days after its discontinuation. Mexidol also has the ability to overcome the body's resistance to the effects of psychotropic drugs. Mexidol for this pathology was used at a dose of 300-500 mg per day with a treatment duration of 2-4 weeks. The effect of Mexidol began to appear already on the 3rd day of administration. Patients noted an improvement in the appearance, color and turgor of the skin, appetite, a decrease in lethargy, weakness, dizziness, dry mouth, and they became less lethargic. Against the background of Mexidol, it was possible to increase the doses of antidepressants and antipsychotics by 1.5-2 times without the occurrence of side effects. In a number of cases, the administration of previously ineffective drugs against the background of Mexidol made it possible to overcome the body's resistance and caused a significant decrease in depressive disorders and improvement in condition. In neurotic and neurosis-like conditions, Mexidol has a distinct tranquilizing effect, combined with a vegeto-normalizing effect. The therapeutic effect of Mexidol was most fully manifested in patients with neuroses and organic damage to the central nervous system with asthenic and astheno-vegetative disorders. The drug was effective and well tolerated by elderly patients. In 6 patients with asthenic disorders, the reverse development of anxiety and emotional tension against the background of Mexidol was accompanied by a peculiar activation with an increase in the background mood, a reduction in asthenic symptoms themselves. The tranquilizing effect of Mexidol is comparable in power to the effect of uxepam. Mexidol has a positive effect on sleep, restoring its duration and depth. The effect of Mexidol appears after 3-7 days of therapy. According to its spectrum of action, Mexidol can be classified as a daytime tranquilizer, which is effective both in hospital and outpatient settings, as well as in the elderly.

Mexidol has shown high effectiveness in the treatment of alcohol withdrawal syndrome with somato-neurological and mental symptoms. The dose of Mexidol was 100-400 mg per day intramuscularly with a course duration of 5-7 days (against the background of conventional detoxification agents). Mexidol is an effective remedy for the rapid relief of alcohol withdrawal syndrome with a wide range of effects, both on its psychopathological components and on vegetative-vascular manifestations.

The effect of Mexidol is observed within 1-1.5 hours after administration of the drug, and a persistent improvement in the condition occurs after 2-3 days. Patients experience a feeling of enlightenment, clarity in the head, headaches disappear, the process of concentration and comprehension when reading literature improves, anxiety, unaccountable fear, internal tension decrease, relaxation and a comfortable state appear, nightmares disappear, hypnotic hallucinations disappear, dreams become alcohol-free topics, sleep disorders disappear. Patients note the appearance of vigor and activity. Along with this, under the influence of Mexidol, alcohol motivation was significantly suppressed. Side effects. Comparison with cerebroprotective and psychotropic drugs. Mexidol is well tolerated by patients and causes only isolated side effects, which quickly disappear on their own or when the drug is discontinued.

Of the hundreds of patients treated with Mexidol, side effects occurred in exceptional cases. Two patients with discirculatory encephalopathy experienced nausea and dizziness a few minutes after the intramuscular injection of Mexidol, which went away on their own. Two patients with alcoholism experienced bitterness and dry mouth, dizziness, and weakness, which quickly disappeared when the drug was discontinued. In three patients with resistant depression combined with manifestations of chronic neuroleptic syndrome, after the first two or three injections a slight drowsiness appeared, which then disappeared on its own. One patient with neurosis, at the beginning of therapy, had a pinpoint rash on the skin of the forearms, not accompanied by itching and peeling, which self-reduced within three days with continued therapy. The insignificance of side effects makes Mexidol stand out among the known neuroprotective, nootropic and tranquilizing agents. The arsenal of drugs used in modern medicine that improve cerebral circulation and are used in injection form is quite limited and includes pentoxifylline (Trental), vinpocetine (Cavinton), nicergoline (Sermion), dihydroergotoxin (Redergan). Cinnarizine (stugeron), flunarizine, nimodipine are used in the form of tablets and capsules. A significant drawback of these known drugs, which in many cases limits their use, is the significant number and frequency of side effects. Pentoxifylline (trental) causes headache, dizziness, tachycardia, facial flushing, palpitations, angina pectoris, arterial hypotension, nervousness, drowsiness or insomnia, bleeding from the vessels of the skin and mucous membranes, urticaria, skin rashes, itching, nausea, vomiting, a feeling of heaviness in the epigastrium, increased fragility of nails, changes in body weight, swelling, and in case of an overdose of the drug, convulsions, loss of consciousness, and fever may occur. In this regard, contraindications to the use of trental are acute myocardial infarction, massive bleeding, cerebral hemorrhage, retinal hemorrhage, severe atherosclerotic damage to the blood vessels of the brain and heart, severe heart rhythm disturbances, pregnancy, lactation. Characteristic side effects of vinpocetine (Cavinton) are a decrease in blood pressure and tachycardia, and contraindications to the use of the drug are coronary heart disease and severe forms of arrhythmias. Nicergoline (sermion) causes arterial hypotension, dizziness, a feeling of heat and flushing, drowsiness and sleep disturbance. Side effects of dihydroergotoxin (redergin) are nausea, vomiting, a feeling of heaviness in the stomach, loss of appetite, blurred vision, hyperemia of the nasal mucosa, skin rash, orthostatic hypotension, and contraindications to the use of the drug are severe coronary heart disease, severe bradycardia and arterial hypotension .

Thus, all drugs currently used to treat cerebrovascular accidents are associated with significant side effects. In conditions of oxygen and energy deficiency that occurs with cerebrovascular lesions of the brain, Mexidol, which has a normalizing effect on cerebral metabolism, on fine neurochemical regulation and has minimal side effects, is of particular value. Cerebroprotective therapy with Mexidol differs from traditional effects on homeostasis and hemodynamics in its safety of use, the possibility of long-term use, and the ability to influence various levels and types of neurological and mental disorders. In contrast to traditional drugs, Mexidol does not cause a decrease in blood pressure, hemodynamic or ECG disturbances, and does not affect the heart rate. The positive effects of Mexidol in comparison with well-known drugs are its therapeutic effect on vasomotor instability, reduction of autonomic dysfunction, reduction of tachycardia, hyperemia, sweating, etc. In addition, Mexidol has a restorative effect on the functions of the motor sphere, improving coordination of movements and reducing psychomotor agitation, improves sleep, eliminates nervousness. Thus, having a high therapeutic effect, Mexidol does not have the side effects characteristic of other neuroprotective drugs. In contrast to sodium hydroxybutyrate and seduxen, Mexidol does not change the rhythm and frequency of breathing, i.e. does not cause the cardiorespiratory depression inherent in these drugs.

In contrast to noopropic drugs, when using Mexidol, there is no activating effect, sleep disturbances or increased convulsive readiness. In addition, Mexidol is significantly more effective than piracetam (nootropil). In comparison with benzodiazepine tranquilizers (seduxen, elenium, oxazepam, lorazepam, phenazepam, etc.), Mexidol does not have a muscle relaxant effect even in doses exceeding the average therapeutic anxiolytic dose by 4-5.5 times and does not cause such manifestations as impaired coordination movements, decreased muscle tone and muscle strength. Mexidol, in contrast to anxiolytics, does not have a sedative or amnesic effect, but, on the contrary, has a positive effect on memory, especially in conditions of impaired cognitive functions. With long-term administration of Mexidol and cessation of its use, there are no signs of withdrawal syndrome characteristic of benzodiazepine tranquilizers. Thus, Mexidol is a selective tranquilizer of “daytime” action, in which the anxiolytic and anti-stress effects are carried out without the layering of sedative, muscle relaxant and amnesic effects.

Possessing a high therapeutic effect, Mexidol does not cause side effects characteristic of known neuroprotective, nootropic and tranquilizing drugs, which indicates its safety and significantly expands the possibilities of use.

Directions for use and doses

Mexidol is prescribed intravenously (stream or drip), intramuscularly and orally. When administered intravenously, the drug should be diluted with water for injection or in physiological sodium chloride solution. For infusion administration, physiological NaCl solution should be used. Mexidol is administered in a stream over 1.5-3.0 minutes, and dropwise at a rate of 80-120 drops per minute. The duration of treatment and the daily dose of the drug depend on the nosology of the disease and the severity of the patient’s condition. For the treatment of acute cerebrovascular accident, Mexidol is prescribed intravenously by drip of 400 mg (8 ml) in isotonic sodium chloride solution (100-150 ml) twice a day for the first 15 days in intensive care or a specialized neurological department (maximum daily dose 1600 mg) . Then 400 mg (8 ml) 1 time per day intravenously in physiological NaCl solution daily for 15 days.

In the future, it is recommended to administer Mexidol intramuscularly at a dose of 200 mg (4 ml) once a day for 10-15 days. In subsequent complex drug therapy, it is advisable to include a tablet form of the drug, 0.25-0.5 g/day for 4-6 weeks. The daily dose is distributed into 2-3 doses during the day.

For the treatment of dyscirculatory encephalopathy (both against the background of cerebral atherosclerosis and against the background of hypertension):