The best new generation drugs for the blood vessels of the head

What nootropic drugs are considered the most famous and widely used in medical practice? What nootropics are commonly used for children, the elderly, for psychoneurological disorders and healthy individuals to stimulate mental activity? We addressed these questions to the Chief Doctor of the Multidisciplinary Medical Center, psychiatrist, psychiatrist-narcologist and psychotherapist Vladislav Sipovich.

Who may need vascular medications?

In early childhood, changes in blood flow in the brain are a consequence of perinatal encephalopathy, birth trauma, hypoxia during childbirth, and pressure drop during cesarean section. If a treatment plan is drawn up correctly, the child’s condition will normalize within 2-3 years. If the baby has cerebral palsy and other serious diseases, he will have to take vascular medications for the rest of his life.

School-age children grow quickly, and vascular medications may be needed due to the increased workload.

In adults, cerebral circulatory disorders are even more common - due to heart disease, osteochondrosis, ischemia, thrombosis, injuries, and operations.

In older people, the blood vessels of the brain suffer from atherosclerosis - blockage of the arteries with plaques. All of these categories of patients have indications for taking vascular drugs.

Improving blood circulation in the brain - physical activity and exercise

Physical inactivity (lack of physical activity) can be caused by many factors - from sedentary work to basic laziness. It has a number of negative consequences, including problems with the cardiovascular and respiratory systems, bones33,34.

In the context of cerebral circulation, lack of physical activity is associated with an increased risk of blood clots35 and deterioration of the conductive capacity of gray matter (a major component of the central nervous system)36. Therefore, anyone who leads a sedentary lifestyle is recommended to take regular walks, run every night, practice Nordic walking, or workout in the gym.

Research shows that regular physical exercise has a beneficial effect on blood flow throughout the body, including the brain37,38. There are special sets of exercises to improve blood circulation in the brain, and there are also specialized programs implemented in the presence of certain pathologies.

A set of exercises to improve blood circulation in the brain:

– Take a sitting position, looking straight ahead, turn your head 45 degrees to one side, then to the other.

– Slowly rotate your head in a circle, first to the right, then to the left.

– Tilt your head up so that your chin points to the ceiling. Then lower your head to your chest and touch your chin to your chest.

– Bend to the right and left towards your shoulders so that your ear touches your shoulder. The shoulders are motionless.

– Looking straight ahead, stretch your head forward as much as possible, return it to its original position and pull it back as far as possible.

The entire complex is performed as slowly and carefully as possible. The purpose of exercises to improve blood circulation in the brain is to relax the muscles that compress the blood vessels and normalize blood flow. Each movement is performed 10-15 times; for sedentary work, it is recommended to perform the complex 2-3 times during the day at approximately equal intervals.

Exercises to improve blood circulation in the brain with cervical osteochondrosis include neck rotations, lateral flexions, rotation, retractions, and stretching of the trapezius muscle. The figure below shows an example of such a complex.

There are many specialized complexes of medical gymnastics to improve blood circulation in the brain in case of osteochondrosis of various joints39,40. It is unacceptable to perform these exercises on your own; they are performed only under the supervision of a specialist, or as directed and after consulting a doctor.

Calcium channel blockers

These medications are among the most popular among neurologists and therapists. Due to a decrease in the amount of calcium in cell membranes, the vascular walls relax, their lumen expands, and blood flow increases. The amount of nutrients and oxygen reaching the brain also increases. The tone of the veins does not change, which is important for maintaining normal venous outflow. There are a number of proven drugs, as well as new generation drugs.

Which ones are better to choose? The list of the most popular is given in the table.

Generation	Name of medicine	Group
First	Verapamil	Phenylalkylamine derivatives
First	Nifedipine	Dihydropyridine derivatives
First	Diazem	Benzothiazepine derivatives
Second	Isradipin	Benzofurazanil derivatives
Second	Plendil	Dihydropyridine derivatives

Currently, third-generation drugs are being developed that have even fewer side effects and contraindications. The above remedies can also treat arterial hypertension. Vasodilators are contraindicated during pregnancy and lactation.

Modern ideas about nootropic drugs

Drugs that affect the processes of neuroplasticity of the central nervous system occupy one of the leading positions in the treatment of vascular diseases of the brain. Currently, some researchers (E. I. Gusev, 1992, 2000, 2005; V. I. Skvortsova, 2000, 2003, 2004; N. V. Vereshchagin, 2001; Z. A. Suslina, 2003; etc.) They believe that the reorganization of neuronal processes is a combination of a number of mechanisms, including the functioning of previously inactive pathways, sprouting of fibers of surviving cells with the formation of new synapses, and activation of neuronal circuits. It is known that one of the universal components of the pathogenesis of damage to nervous tissue is trophic dysregulation, leading to biochemical and functional dedifferentiation of neurons with the initiation of a cascade of pathobiochemical reactions (V. I. Skvortsova, 2001; T. L. Deckwirth et al., 1993; RS Freeman, 1994).

Traditionally, angioneurology uses a number of drugs that affect plastic, neurotransmitter, neuroprotective and integrative processes in the brain. Among them, nootropic drugs occupy a special place.

Nootropic drugs are drugs that have an activating effect on cerebral metabolism and higher mental functions. They are characterized by a metabolic and neurotrophic effect, which determines the processes of improving redox reactions, reducing the aggressive effect of lipid peroxidation (LPO) products, and a positive effect on neurotransmission. In addition, these drugs have a vasoactive and mild antiplatelet effect - they reduce platelet aggregation, reduce the adhesion of erythrocytes to the endothelial surface, and reduce blood viscosity.

The group of drugs that nootropic drugs make up is developing very dynamically both in Russia and abroad. About 60 leading pharmaceutical companies in various countries are developing new drugs. According to the Pharmaprojects Yearbook, in 1995, 132 nootropic drugs were in various stages of research, clinical study and introduction to the market, of which 79 were in preclinical research, 34 were in various stages of clinical study, and 19 were at the stage of registration and introduction into the market. market.

The term “nootropics” (from the Greek “noos” - thinking and “tropos” - striving) was first used in 1972 by Cornelia Guirgea to describe the effect of piracetam from the Belgian company UCB.

Subsequently, this term also began to be used to refer to drugs with different chemical structures that can improve cognitive functions. The classification of these drugs is difficult due to the lack of clear criteria for dividing drugs into those that have and/or do not have a nootropic effect. Currently, there are several classes of nootropic drugs.

Pyrrolidone derivatives (piracetam, lucetam, phenotropil).
Dimethylaminoethanol derivatives (demanol, deanol aceglumate).
Pyridoxine derivatives (encephabol, pyritinol).
Derivatives of γ-aminobutyric acid (GABA) (aminalone, picamilon, phenibut, gammalon).
Ginkgo biloba derivatives (tanakan, bilobil).
Drugs that act on N-methyl-D-aspartate (NMDA) receptors (akatinol memantine).
Drugs with tropism for cholinergic structures (gliatilin).
Preparations of animal origin (Cerebrolysin, Cortexin, Actovegin).
Mixed-action drugs (instenon).

As a result of numerous clinical and experimental studies, the main mechanisms of action of nootropic drugs have been determined.

Accelerating the penetration of glucose through the blood-brain barrier and increasing its absorption by brain cells, especially in the cerebral cortex.
Strengthening the conduction of cholinergic impulses in the central nervous system (CNS).
Increased synthesis of phospholipids and proteins in nerve cells and red blood cells (stabilization of cell membranes), normalization of the liquid properties of membranes.
Inhibition of lysosomal enzymes and scavenging of free radicals.
Activation of cerebral microcirculation by improving the deformability of erythrocytes and preventing platelet aggregation.
Improved cortical-subcortical interaction.
Normalization of neurotransmitter disorders.
Activating effect on higher mental functions (memory, learning ability, etc.).
Improving reparative processes in case of brain damage of various origins.

Due to these properties, a group of nootropic drugs is often called neurometabolic cerebroprotectors, which indicates a common property for drugs in this group - to stimulate metabolic processes in nervous tissue, optimizing the level of metabolism. According to the severity of their effect on the central nervous system, nootropics can be arranged in the following sequence: phenibut–aminalone–pantogam–picamilon–piracetam–pyritinol–meclofenoxate.

Phenibut has the most pronounced depressive effect, meclofenoxate has the most distinct psychostimulant properties. The “pioneer” of nootropic therapy is piracetam.

Piracetam has a chemical structure similar to GABA and is considered a derivative of this amino acid, but it is not converted into GABA in the body and the GABA content in the brain does not increase after its use. But in relatively large doses and with repeated administration, the drug can enhance GABAergic inhibitory processes.

There are two main directions of action of piracetam: neuroprotective and vascular. Piracetam promotes the oxidative breakdown of glucose through the pentose phosphate shunt, increasing the metabolism of adenosine triphosphate (ATP), as well as the level of cyclic adenosine monophosphate (cAMP). The functioning of this shunt is associated with the formation of substances that neutralize free radicals and prevent membrane lipid peroxidation. The drug stimulates the activity of adenylate kinase, ensuring anaerobic metabolism without the formation of lactate. After administration of the drug in patients with acute ischemic stroke, glucose metabolism, local cerebral blood flow, extraction coefficient and local oxygen metabolism increase in the affected area and the surrounding functionally inactive zone. Piracetam interacts with the neurotransmitter system, exerting a modulating effect on cholinergic and aminacidergic (aspartate, glutamate) neurotransmission, which is especially important since disorders of synaptic transmission involving acetylcholine and glutamate cause “age-related” changes in memory and other cognitive functions. The drug also stimulates interhemispheric information exchange, which underlies the restoration of speech functions lost after a stroke. The effect of piracetam on the vestibular system is described due to its effect on the mechanisms of signal transmission from sources of visual and proprioceptive sensitivity or its effect on the vestibular nucleus in the brain stem. The vascular effect of the drug is due to a decrease in platelet aggregation, an increase in the deformability of erythrocytes, a decrease in the adhesion of erythrocytes to the endothelial surface, and a decrease in the viscosity of plasma and whole blood. Reducing vasospasm without a vasodilator effect and hypotension makes it possible to have a positive effect on cerebral circulation, not accompanied by a change in general hemodynamics. A peculiarity of piracetam is that its pharmacological effect is manifested only under conditions of prolonged repeated administration of the drug in sufficiently high doses.

Phenotropil (chemical name: N-carbamoyl-methyl-4-phenyl-2-pyrrolidone) is a derivative of pyrrolidone, has a pronounced antiamnestic effect, has an activating effect on the integrative activity of the brain, promotes memory consolidation, increases the resistance of brain tissue to hypoxia and toxic effects . It is characterized by anticonvulsant and anxiolytic effects.

Phenotropil is used with caution in patients with severe organic damage to the liver and kidneys, severe forms of arterial hypertension in patients with atherosclerosis, as well as in those who have previously suffered panic attacks, anxiety or acute psychotic states, especially with psychomotor agitation, due to the possibility of exacerbation of anxiety, panic, hallucinations and delirium.

With excessive psycho-emotional exhaustion against the background of chronic stress and fatigue, chronic insomnia, a single dose of phenotropil on the first day can cause a sharp need for sleep. Such patients on an outpatient basis should be advised to start a course of taking the drug on non-working days.

The group of neuroamino acid drugs includes a number of well-known drugs.

Aminalon 's chemical structure is GABA, which is the most important mediator of inhibition in the central nervous system and is also involved in the energy supply of the brain. In terms of clinical effectiveness, the drug is inferior to piracetam, but unlike it does not provide clear stimulating effects. Under the influence of GABA, the effectiveness of inhibitory GABAergic processes increases.

Picamilon (nicotinoyl-γ-aminobutyric acid) combines the properties of GABA and nicotinic acid, which has vasoactive properties, and affects the processes of tissue respiration. The drug is capable of exerting both neurometabolic and vascular effects: it reduces vascular resistance, increases the linear and volumetric velocity of cerebral blood flow, and improves microcirculation. Picamilon has moderate anxiolytic activity and helps restore mental and physical performance in case of overwork.

Phenibut is a derivative of GABA and phenylethylamine and has nootropic and tranquilizing activity. The drug reduces the manifestations of asthenia and vasovegetative symptoms (headache, feeling of heaviness in the head), irritability, emotional lability, and increases mental performance.

Pantogam (hopantenic acid) is the most mildly acting metabolic cerebroprotector with a minimally pronounced stimulating effect on the central nervous system. The metabolic activity of the drug is presumably due to the replacement of the p-alanine fragment in the pantothenic acid molecule with GABA. The drug improves energy metabolism in the brain, affects the oxidative processes of the tricarboxylic acid cycle, which plays a significant role in ensuring various types of metabolism in the cell, including energy.

Glycine is an inhibitory neurotransmitter and a regulator of metabolic processes in the brain; it has a sedative and antidepressant effect. The glycine site is a structural region of the NMDA receptor that is important for memory processes; its activation underlies the long-term potentiation of hippocampal neurons and, consequently, the strengthening of synaptic transmission. Glycine, as an agonist of the glycine site, has an improving effect on memory both in experiment and in humans (V. I. Skvortsova, 2000). The drug is also effective as an adjuvant for epileptic seizures.

Glutamic acid is a neurotransmitter amino acid that stimulates the transmission of excitation at synapses in the central nervous system. The drug normalizes metabolic processes, stimulates oxidative processes, promotes the neutralization and removal of ammonia from the body, and increases resistance to hypoxia.

Pyritinol consists of two pyridoxine molecules connected by a disulfide bridge. The main coenzyme form of pyridoxine is pyridoxal phosphate, which, along with various other functions, is involved in the metabolism of GABA. The only enzyme for the synthesis of GABA, glutamate decarboxylase, is a pyridoxal-dependent enzyme, which may determine the ability of the drug to stimulate the formation of GABA. The action of pyritinol ensures more economical utilization of energy substrates and the subsequent expenditure of energy for the synthesis of macromolecular compounds (ATP, ribonucleic acid). The drug enhances the transport of glucose across the blood-brain barrier, increases its utilization in conditions when oxygen consumption by tissues is reduced, accelerates the oxidation of glucose, reduces the excess formation of lactic and acetic acids in brain tissue, increases the resistance of brain tissue to hypoxia, has the ability to stabilize cell membranes and improve them functional state.

Encephabol is a pyritinol derivative that increases the density and sensitivity of receptors and normalizes neuroplasticity. The drug has a neuroprotective effect, stimulates learning processes, improves memory, memorization and concentration. Encephabol stabilizes the cell membranes of neurons by inhibiting lysosomal enzymes and preventing the formation of free radicals, improves the rheological properties of blood, increases the conformational ability of red blood cells, increasing the ATP content in their membrane. For adults, the average daily dose is 600 mg for 6–8 weeks. The drug is effective for the treatment of cognitive impairment in menopausal patients.

Choline alfoscerate (gliatilin) has a cholinomimetic effect, stimulating predominantly central cholinergic receptors. In the body it is broken down into choline and glycerophosphate. Provides the synthesis of acetylcholine and phosphatidylcholine of neuronal membranes, improves the functions of receptors and membranes in cholinergic neurons. The drug activates cerebral blood flow, stimulates the metabolism of the central nervous system, and stimulates the reticular formation. Improves mood, stimulates mental activity, improves concentration, the ability to remember and reproduce received information, optimizes cognitive and behavioral reactions, and eliminates apathy.

Ginkgo biloba extract (bilobil, memoplant, tanakan) is a standardized herbal preparation that affects metabolic processes in cells, rheological properties of blood, and microcirculation. The drug improves cerebral circulation, supply the brain with oxygen and glucose, normalizes metabolic processes, has an antihypoxic effect, prevents the formation of free radicals and normalizes the LPO of cell membranes. Ginkgo biloba affects the release, reuptake, catabolism of neurotransmitters (norepinephrine, dopamine, acetylcholine) and their ability to bind to membrane receptors. The drug normalizes the vascular system, stimulates the production of endothelium-dependent relaxing factor, dilates small arteries, increases the tone of veins, reduces the permeability of the vascular wall, has an anti-edematous effect, stabilizes platelet and erythrocyte membranes, and has antiplatelet properties.

Actovegin is a modern drug that is a deproteinized extract of the blood of young calves. Its main effect is aimed at improving the utilization of oxygen and glucose. Under its influence, the diffusion of oxygen in neuronal structures significantly improves, which makes it possible to reduce the severity of secondary trophic disorders. There is also stabilization of cerebral and peripheral microcirculation against the background of improved aerobic energy exchange of vascular walls and the release of prostacyclin and nitric oxide. The resulting vasodilation and decrease in peripheral resistance are secondary to the activation of oxygen metabolism of the vascular walls (A. I. Fedin, S. A. Rumyantseva, 2002). There is evidence of the positive effect of Actovegin on patients with various forms of dementia, including vascular origin. The pace and quality of mental activity in patients may improve during treatment as the duration of drug use increases (W. Jansen, 2002).

Of significant interest are combination drugs that affect various parts of the pathogenetic process. An example of a successful combination is instenon.

Instenon is a combined drug with neuroprotective action, including a vasoactive agent from the group of purine derivatives, a substance that affects the state of the ascending reticular formation and cortical-subcortical relationships, and, finally, an activator of tissue respiration processes under hypoxic conditions (S. A. Rumyantseva, 2002; B V. Kovalchuk, 2002).

The three components of instenon (etophylline, hexobendine, etamivan) jointly affect various parts of the pathogenesis of ischemic brain damage.

Etophylline is a vasoactive component of the purine series that activates myocardial metabolism with an increase in stroke volume. The transition from a hypokinetic type of blood circulation to a normokinetic one is accompanied by an increase in cerebral blood flow. Important components of the action of etophylline are an increase in renal blood flow and, as a consequence, dehydration and diuretic effects.

Etamivan has a nootropic effect, directly affecting memory processes, attention, mental and physical performance as a result of increased activity of the reticular formation of the brain.

Hexobendine selectively stimulates metabolism by increasing the utilization of oxygen and glucose, due to increased anaerobic glycolysis and pentose cycles. At the same time, the physiological mechanisms of autoregulation of cerebral and systemic blood flow are stabilized.

The variety of drugs with combined action used in angioneurology (Cavinton, Instenon, Sermion, Vasobral, Fezam, etc.) requires clear recommendations for use by general practitioners. Taking into account the literature data and the results of our own research, additional indications for prescribing this group of drugs have been identified:

vegetative-trophic disorders;
concomitant peripheral circulatory disorders (retinopathy and angiopathy in diabetes mellitus, atherosclerosis, arterial hypertension);
cochleovestibular disorders;
asthenodepressive disorders;
prevention of chronic cerebral ischemia after a stroke.

Nootropic drugs can be used both in patients with various pathologies of the central nervous system, and in healthy people during fatigue, natural aging, and also in extreme situations.

Indications for prescribing nootropic drugs:

acute cerebrovascular accidents;
traumatic brain injury;
comatose states;
chronic cerebral ischemia;
vascular dementia;
hypertensive and atherosclerotic encephalopathy;
asthenic syndromes;
autonomic dystonia syndrome;
consequences of perinatal encephalopathy;
delayed mental development in children;
attention deficit hyperactivity disorder.

In recent years, the list of indications for the use of drugs has expanded significantly, but the complexity and multicomponent nature of cerebral metabolic disorders, as well as the limitation of extrapolation of experimental data into clinical practice, lead to ambiguity of opinions about neuroprotective and metabolically active therapy. Undoubtedly, this direction is one of the key, the most promising and at the same time the most difficult. Cerebrovascular diseases cause significant damage to the health of the population, as a result of which the percentage of disability and mortality increases. In recent decades, the arsenal of drugs used to treat these diseases has expanded significantly. Every year, new drugs with indirect nootropic effects enter the pharmacological market. Differentiated therapy for vascular diseases of the brain requires knowledge of the etiology, pathogenesis, and mechanisms of pharmacological action of certain drugs. A special place is occupied by the safety of medicines. In addition, a practicing doctor often has to decide the question: “price–quality–clinical effectiveness.” Life expectancy is constantly increasing, with the fastest growing portion of the general population being people over 65 years of age. Consequently, we can expect that the incidence of diseases associated with age, such as dementia and others, will increase significantly, and nootropic drugs will be more and more in demand. Currently, 15 drugs classified as nootropics are registered in Russia. The range of domestic nootropic drugs is significantly smaller than on the foreign medicine market; in other words, they are often not enough to meet the needs of medical practice in our country.

Understanding the mechanism of action of drugs on the body expands the range of possibilities for drug therapy for various clinical syndromes and diseases. The optimal choice of a nootropic drug is facilitated by the doctor’s correct understanding of pharmacokinetics and pharmacodynamics, which is necessary to determine a rational single and daily dose of the drug used. It should be noted that in order to determine the general patterns of treatment, an individual approach to each patient is necessary, taking into account age, gender, medical history, concomitant diseases, metabolic characteristics and hemodynamics. The effectiveness of the drug is determined from the standpoint of evidence-based medicine and is expressed in reducing the clinical manifestations of the disease and improving the patient’s quality of life. Currently, a new strategy in the use of drugs that have a neuroprotective effect is clearly visible. This is, on the one hand, optimally high doses of the drug (piracetam, Actovegin, Tanakan) and, on the other hand, the widespread introduction of forte forms (Instenon, Cavinton). However, it is necessary to observe the following rule: early initiation and long course (up to 3–4 months) of therapy. Modern medicine makes it possible to combine two or more drugs. For example, Actovegin - Instenon, Actovegin - Piracetam, Piracetam - Gliatilin, etc. The final judgment on the effectiveness of the chosen treatment and the need for its correction can be made if there is no therapeutic effect after 2-3 courses lasting at least 3 months. You should not refuse the chosen drug unless its dose has been increased to an individual maximum and well tolerated. If there is no positive response to treatment or side effects occur, it is recommended to replace the selected medication with a drug of a different class. In case of insufficient effectiveness, but good tolerability of the drug substance, a second drug belonging to a different class can be added to it. This combination can provide a more pronounced therapeutic effect with a lower likelihood of side effects, since lower doses are used during therapy.

Thus, nootropic drugs, due to various mechanisms of therapeutic action, can be used in the treatment of neurological patients. The Russian pharmaceutical market offers drugs with varying degrees of effectiveness and tolerability. Therefore, the choice of a particular drug should be based on the results of clinical studies and the personal experience of the doctor.

M. V. Putilina , Doctor of Medical Sciences, Professor of Russian State Medical University, Moscow

Antioxidants and antihypoxants

Such medications are always prescribed as part of complex therapy to improve cerebral vascular function. They quickly eliminate the symptoms of oxygen starvation and help strengthen vascular walls. Here is a list of the best medicines:

Actovegin
(630 rubles). Activates tissue metabolism, eliminates hypoxia, optimizes trophism and recovery processes. The drug is obtained from the blood of animals, therefore, in addition to allergies, it has a small number of side effects.
Mexidol
(470 rubles). It is one of the best antihypoxants, membrane protectors, and nootropics. The medicine is administered intramuscularly or taken in tablet form. It increases the body's resistance to various damaging factors. With long-term use, the medicine somewhat thins the blood and reduces the accumulation of lipids, lowering cholesterol.
Emoxipin
(250 rubles). Antioxidant, stabilizer of cell membranes, reduces vascular permeability. Has a retinoprotective effect. Most often prescribed if cerebral disorders affect the condition of the retina.
Glycine
(40 rubles). This amino acid is a natural brain metabolite, a neurotransmitter, that helps regulate metabolism in brain tissue.

Complamin, Glutamic acid, Picamilon and other antihypoxic and antioxidant agents also improve the functioning of cerebral vessels.

Stroke and rehabilitation

Stroke is an acute disease that is associated with circulatory disorders and is manifested by such symptoms from the nervous system as:

motor, speech, sensory, coordination, visual and other disorders;
general cerebral disorders: changes in consciousness, headache, vomiting for more than 24 hours;
death in a short period of time.

There are 2 main forms of stroke:

ischemic (when some part of the brain stops receiving oxygen for various reasons, for example, blockage of the lumen of a vessel with a blood clot);
hemorrhagic (when a vessel ruptures, blood permeates the brain tissue and non-traumatic damage or subarachnoid hemorrhage occurs).

Rehabilitation after a stroke begins as early as possible. An integrated approach to treatment combines drug therapy, physiotherapy, and training to restore lost functions. There are 3 main areas in pharmacotherapy:

prevention of relapse, that is, repeated stroke. Typically, 1 in 10 people will have another stroke in the first year;
treatment of individual symptoms;
pathogenetic treatment.

Vitamins and minerals

The next group of vasodilator drugs for the brain are vitamin supplements that are urgently needed for the normal functioning of blood vessels. Most often, patients are recommended drugs based on nicotinic acid in injections.

The medicine improves the metabolism of nitrogenous substances and carbohydrates, dilates blood vessels, and reduces cholesterol. Nicotinic acid also improves blood microcirculation in the brain and replenishes vitamin B3 deficiency.

The main preparations with vitamins are Nicotinamide, Niacinamide, Nicotinic acid in ampoules.

Rutin is another remedy that strengthens blood vessels. Troxerutin and Ascorutin are made on its basis; they are prescribed against the fragility of small capillaries, to reduce the permeability of vascular walls, as an antioxidant.

Also, patients with vascular diseases are recommended to regularly take tablets with retinol, tocopherol, potassium, selenium, and silicon. For osteochondrosis of the neck and other diseases of the spine, a complex of B vitamins - Neuromultivit, Compligam, Milgamma - is always introduced into the course of therapy.

Angiovitis

The first domestic drug created for the correction and treatment of hyperhomocysteinemia. Contains specially selected therapeutic doses of vitamins B6, B12 and folic acid (vitamin B9). It has angioprotective properties, promotes structural and functional normalization of the inner wall (endothelium) of blood vessels.

ANGIOVIT® was developed by the pharmaceutical industry together with a group of leading Russian scientists under the leadership of Corresponding Member of the Russian Academy of Medical Sciences, Doctor of Medical Sciences, Professor Z.S. Barkagan.

ANGIOVIT® is available in tablets coated with a protective coating. The main active ingredients of the drug are:

vitamin B9 (folic acid) – 5 mg
vitamin B6 (pyridoxine hydrochloride) – 4 mg
vitamin B12 (cyanocobalamin) – 0.006 mg

ANGIOVIT® has undergone preclinical and clinical testing and is recommended for use in therapy, cardiology, obstetrics and gynecology.

Nootropics

These medications do not act directly on blood vessels, but they improve overall metabolism in tissues, stabilize neurocyte membranes, increase tissue resistance to oxygen starvation, thereby optimizing blood supply to the brain. Nootropics are prescribed even to children, they are indicated for most elderly people, and are used in the complex treatment of osteochondrosis, atherosclerosis, hypertension, the consequences of cerebral palsy, etc.

The cheapest and most accessible are racetams - Piracetam, Nootropil, Lucetam, Phenotropil and others.

The latest generation of drugs includes Cortexin, which is a complex of polypeptides from the animal cerebral cortex. The medicine is injected into the muscle; it is available only in injection form. Price for 10 ampoules - 1300 rubles.

Patients are also given the following injections:

Cerebrolysin;
Vinpocetine;
Cavinton;
Telektol;
Bravinton.

Many nootropics have a positive effect on blood composition - they prevent platelets from sticking together, improving blood microcirculation by increasing its fluidity. This helps to avoid thrombosis and other serious complications of vascular pathologies.

Symptomatic picture of vascular diseases

Strong and healthy blood vessels are the key to smooth functioning of the heart. Proper contraction and expansion of the vessel walls ensures continuous transport of blood.

Loss of flexibility and blockage of blood vessels lead to oxygen starvation

If the vessels lose their original elasticity, become too dense or fragile, various pathologies form:

vegetative-vascular dystonia;
migraine;
stroke, atherosclerosis;
vascular aneurysms;
ischemia;
hypertension.

Problems with the vascular system can be recognized by the following signs:

insomnia;
frequent dizziness;
numbness of the limbs;
memory impairment;
decreased mental activity;
cyanosis;
tachycardia and heart pain;
dyspnea;
depression;
fainting.

When disturbances in the functioning of blood vessels appear due to osteochondrosis or spinal injury, the patient will complain of severe dizziness, migraines and constant weakness.

Frequent headaches can signal vascular diseases in the body

At the first symptoms indicating a malfunction in the body, you must immediately make an appointment with your doctor. He will order a full examination of the body, collect anamnesis and prescribe appropriate vascular medications.

Medicines for atherosclerosis

If a person is diagnosed with atherosclerosis, treatment with folk remedies or so-called vascular cleansing is not always enough. Atherosclerosis of cerebral vessels is a very serious disease; without treatment it leads to stroke.

The following will help improve blood circulation in this pathology:

Statins
- Rosuvastatin, Atorvastatin, Lovastatin. Many people have to take these medications for several years; they normalize cholesterol levels and prevent it from depositing in the blood vessels. Unfortunately, statins have a bad effect on the liver and other internal organs and can cause a number of side effects.
Fibrates
- Fenofibrate, Clofibrate. They increase “good” cholesterol while reducing “bad” cholesterol. The course usually lasts up to 2 months, then take a break.
Other means - bile acid sequestrants
. These medications are Cholestyramine and Cholestipol. They bind the cholesterol present in the intestines and remove it, preventing it from being absorbed.

In mild cases of atherosclerosis, it is enough to take Omega-3 acids, which strengthen the walls of blood vessels and prevent the disease from progressing.

What is VSD

Vegetovascular dystonia (VSD), or neurocirculatory syndrome, is a functional disorder of the autonomic nervous system, in which a complex of symptoms appears that are not characteristic of a specific disease. Examination of patients with suspected VSD most often does not reveal changes in the structure of internal organs, but may show deviations in their function at the border of normal.

Autonomic dysfunction cannot be called a full-fledged disease; this diagnosis is not included in the International Classification of Diseases (ICD-10). But therapists, cardiologists and neurologists continue to make this diagnosis to patients in whom the examination did not reveal any disorders, and complaints of poor health continue.

It is believed that manifestations of pathology arise due to disturbances in the coordination of the two structures of the autonomic nervous system. It consists of the sympathetic and parasympathetic systems, which differ in their effects on the body. The activator of sympathy is the hormone adrenaline, so it performs the following functions:

increases the number of heart contractions;
increases blood pressure;
stimulates the release of glucose into the blood;
dilates the arteries of the brain, lungs and heart;
reduces saliva secretion;
suppresses peristalsis of the digestive tract;
dilates the bronchi and enhances gas exchange;
enlarges pupils;
causes spasm of the sphincters of the bladder and digestive tract.

These reactions are necessary to protect the body in a dangerous situation, to activate it to escape. The parasympathetic nervous system works in the opposite direction. It reduces blood pressure, accelerates peristalsis of the intestines and urinary organs, and constricts the pupils and bronchi. The parasympathetic activator is the substance acetylcholine. It slows down the heartbeat, reduces blood glucose levels and relaxes all the sphincters in the body.

Autonomic dystonia occurs when the sympathetic or parasympathetic system is activated spontaneously, for no apparent reason. Therefore, a person suddenly has an increased heartbeat while at rest, his blood pressure rises, and he is worried about anxiety.

But often vegetative-vascular dystonia is a precursor to serious diseases. Having arisen at a young age without treatment, after a few years it leads to the formation of arterial hypertension, heart disease, digestive tract and hormonal disorders.

Other drugs

Often a person experiences vascular spasms (when taking vasoconstrictor medications, hypertension, smoking, etc.). In this case, antispasmodics will help improve blood flow - No-shpa, Revalgin, Drotaverine, Papaverine. Doctors also prescribe as vascular agents:

antiplatelet agents (thin the blood) - Warfarin, Heparin, Aspirin;
medicines with ginkgo biloba (increase blood supply to the brain) - Tanakan, Gingikum, Bilobil.

You cannot select treatment regimens on your own - it is important to make prescriptions taking into account the exact indications and type of disease, to know the contraindications, side effects and effectiveness of the active substances.

Antiplatelet agents and anticoagulants

Anticoagulants are special pharmacological drugs that inhibit coagulation processes (clumping of blood cells). They treat diseases associated with thrombosis, such as stroke and heart attack. Natural anticoagulants include:

Heparin;
Dicumarol;
Hirudin.

These medications help prevent vein thrombosis, prevent thromboembolism, and reduce the risk of heart attack. In addition, they treat peripheral vascular diseases. Their principle of action is based on the inhibition of vitamin K and activation of antithrombin III.

Antiplatelet agents are drugs that prevent blood cells from sticking together, thereby preventing the formation of blood clots.

Antiplatelet drugs are prescribed to people who are at risk of developing blood clots

This category of medicines includes:

vitamin E;
products containing the Ginkgo Biloba plant (Bilobil, Ginos);
Aspirin, Aspirin Cardio, Acecardol are drugs with acetylsalicylic acid as an active ingredient.

Antiplatelet agents are found in large quantities in ginger, pomegranates, onions, papaya, ginseng, soy, and fish oil. However, these vegetables and fruits should be consumed under the supervision of a specialist.

The best drugs for the blood vessels of the head

It is possible to resume the stable operation of the processes occurring in the organs of the central nervous system if you follow the exact instructions for natural medicinal products and modern vasodilating drugs.

Actovegin
. Promotes oxygen saturation of tissues and organs, has an antioxidant effect, restores blood flow, and prevents the onset of ischemic stroke. Daily dosage: 1-3 capsules before meals 3 times. Intravenous administration involves 10-15 ml of the drug in combination with a 0.9% NaCl solution or 5% dextrose.
Vasobral
. Vasodilating drug. Reduces the permeability of the vascular wall, restores cerebral circulation, increases mental activity, reflex excitability of the spinal cord and increases the activity and stability of the brain. Eliminates attention, memory and vestibular complications. Prescribed 0.5 - 1 tablet in the morning and evening. In the form of a solution, it is recommended to take 2-4 ml twice a day.
Ceraxon
. The nootropic active ingredient promotes the restoration of cells and damaged tissues. Reduces the effects of memory loss, improves attention and thinking. For traumatic brain injuries and heart failure, it reduces the duration of associated symptoms. In the acute ischemic period, intravenous administration of 1000 ml is recommended.

What nootropics (list of drugs and their characteristics) are widely used in pediatrics?

First of all, I would like to remind you that nootropics in pediatrics have fairly clear indications for use. These are, first of all, the following conditions: • Prevention and treatment of child retardation in mental, motor and speech (after 3 years) development. • Stimulation of central nervous system functions associated with the processes of learning, concentration, memorization and reproduction of information. • Organic damage to the central nervous system as a result of neuroinfections, traumatic brain injuries, genetic diseases. • Cerebral palsy. • Urinary disorders of neurogenic nature. • Stuttering. • Complex therapy of epilepsy. • Neurotic conditions and asthenia (obsessive-compulsive disorder) • ADHD – attention deficit hyperactivity disorder. Most often, children are prescribed nootropics from the list of so-called true nootropics, which primarily affect the mnestic (memory) and cognitive (cognitive) abilities of a person of any age. These are nootropic drugs such as: • Racetams. • Neuropeptides. • Cholinergic nootropics. • Neuroprotectors. • Activators of amino acids and GABA (gamma-aminobutyric acid). • Antioxidants. Of the Racetams, the most significant and widespread is Piracetam - a drug used by doctors for almost 50 years and being the founder of nootropic drugs, the list of which is constantly expanding and updated. Known under the commercial name nootropil. In children, it is especially effective as a stimulator of speech development, and also helps well with cerebral palsy and mental retardation, during rehabilitation after TBI and GM intoxication, and helps increase learning ability. Available in a wide variety of pharmacological forms - tablets, granules, capsules, syrups, solutions for parenteral administration. Peculiarities of use: not recommended for use in the afternoon.

In childhood, drugs such as: • Cortexin, which is considered the best for children 1 year of life, are also often prescribed. It can be used starting from the first birthday. It has a positive effect on the nervous system, including the peripheral one, counteracts toxic effects, improves blood circulation, and is used in the complex treatment of epilepsy. In addition, cortexin improves memory, increases resistance to stress and is effective when taken by children with developmental delays (psychomotor and speech). Quite popular among students, especially during sessions, to improve memory and assimilate large amounts of information. Cortexin also has positive reviews from parents and pediatricians; it is quite safe, but quite expensive. Available in the form of a lyophilisate (powder dried at sub-zero temperatures). • Semax 0.1% solution is the safest and is produced in the form of nasal drops convenient for use in children. It has virtually no side effects, except for rare and minor irritation of the mucous membrane. It belongs to the peptide series of nootropics and has a positive effect on attention, learning and perception. In addition, it helps restore and adapt the nervous system after anesthesia. In pediatrics, it has proven itself well in the treatment of brain dysfunction in children over 5 years of age. The advantages of Semax include high safety and a convenient release form for use. A relative disadvantage is the need to store the drug in the refrigerator at a temperature not exceeding 8 degrees.

• Cerebrolysin, which is a neuropeptide of animal origin (a concentrate of peptides from the brain of pigs or cattle. It is actively used as an activator of neural metabolism, helps to increase concentration and reduce hyperactivity. Its disadvantage is that it is a relatively expensive drug and is produced only in in the form of injection solutions, and the plus is that this is one of the most effective nootropics for developmental delays in children.Side effects are rare and boil down to individual allergic reactions to the components of the drug, insomnia and, extremely rarely, arrhythmias.

For delayed speech development (DSD), the following nootropics are also effective: • GABA analogues and derivatives (Picamilon, Pantogam), which normalize the conduction of nerve impulses and improve glucose utilization and oxygen consumption in neurons. Being inhibitory mediators, they are effective for hyperactivity and increased excitability of the central nervous system. • Pyritinol drugs (Encephabol, Cerebol), which have a neuroprotective (stabilization of membranes and inhibition of the production of free radicals that destroy the structure of cells) and antihypoxic effects. • Ceraxon is a stimulant of central nervous system activity, containing citicoline, which is responsible for restoring neuronal membranes and their energy supply, as well as reducing the amount of intercellular fluid in the brain and thus providing an anti-edematous effect. It is recommended not only for mental retardation with symptoms of inhibition, but also for autism. To summarize the answer to this question, I would like to say that the choice of nootropic drugs, the list of which, taking into account the new generation drugs, includes more than a hundred items, remains with the pediatrician. Under no circumstances should you prescribe nootropics on your own, even based on the indications indicated in the instructions. Of course, nootropics are quite safe drugs that have a positive effect on the nervous system, but each of them has its own preferential effect and is aimed at different processes in the nervous tissue. By independently prescribing CNS activators to a small patient with hyperactivity, parents can get increased activity and increased excitability in their child, leading him to a nervous breakdown and treatment by a child psychiatrist. To prevent such excesses, the vast majority of nootropics are sold in pharmacies only with a doctor’s prescription. Some of them can be purchased without a prescription, but their list is quite limited. I will dwell on them in more detail at the end of the interview.

Injections for cerebral vessels

The following vascular drugs are often used for injection:

Vinpocetine, Cavinton and Bravinton are alkaloid derivatives
. They help normalize the nutrition of nerve cells and also significantly improve blood flow. These are new generation drugs to improve cerebral circulation.
Nicotinic acid, Nikoshpan are derivatives of nicotinic acid
. This type of product can be purchased at a pharmacy only with a prescription written by a doctor.
Drotaverine (No-shpa)
. As a rule, this drug is prescribed in the form of tablets. However, it is sometimes also used in injectable form. This drug is considered harmless, inexpensive, and has the fewest contraindications.
Nootropic drug, Piracetam
. Such drugs can improve brain nutrition and relieve spasms. They are often taken by older people as a preventative against dementia.
Eufillin
. This medicine has a vasodilating effect and also has a beneficial effect on oxygen supply to the brain. It is contraindicated for diseases of the gastrointestinal tract, glaucoma, and for problems related to blood pressure.

Drugs to normalize blood flow in the brain

Pharmacological agents designed specifically to improve blood flow in the brain are divided into 3 groups:

Myotropic. The active elements of this group affect the smooth muscles of the walls of blood vessels, thereby reducing its tone. Myotropic drugs include Eufillin with Dibazol.
Neurotropic. Medicines have a direct effect on the nerve endings of cells (Reserpine, Validol).
Nitrates. This group includes the properties of the above-described products. This includes Nitroglycerin with Nitrosorbitol.

Eufillin is one of the most common drugs for the treatment of vascular diseases

The composition of the drug and its effect may also differ. Based on this, the following groups can be distinguished.

Calcium blockers

This type of medication contains active ingredients that affect the substance that causes impaired vascular flexibility. These include calcium ions, which strengthen the walls. Since the medications are intended to normalize cerebral circulation, they are not used to treat heart disease. There are three generations of calcium blockers. First generation drugs contain three main active ingredients:

verapamil (Finoptin);
nifedipine (Corlipin, Nifedipine);
diltiazem (Diazem).

Nimodipine, Clentiazem, Tiapamil belong to the second generation. The improved third generation includes drugs such as Amlodipine, Norvasc.

Norvasc is a modern remedy characterized by fast action and long-lasting effect after treatment.

The main difference between third-generation drugs and their predecessors is their high prolonged action and low number of side effects.

Heart remedies

This category of drugs improves oxygen saturation of the brain and normalizes the functioning of coronary vessels. As a rule, these preparations are made from plants: lily of the valley, adonis. Pharmacological names of cardiac drugs are Cardiovalen, Adoniside.

Products containing nicotinic acid

Enduratin, Nicotinic acid.

Nicotinic acid helps lower blood cholesterol, thereby reducing the risk of plaque formation

Nicotinic acid acts even on small capillaries. Treatment of large vessels with this drug does not give positive results. When taking medications from this group, it should be taken into account that acid has a negative effect on the liver. It is necessary to strictly adhere to the dosage prescribed by the doctor.

Preparations made from plants

Medicines have virtually no contraindications or serious side effects. They are prescribed to improve blood flow in the brain and also eliminate spasms. Herbal preparations are classified into two categories:

Ginkgo Biloba extract (Tanakan, Bilobil);
with plant alkaloids (Vinpocetine, Cavinton).

Drugs intended to expand the lumen between the walls of blood vessels should absolutely not be taken without prior consultation with a doctor. An incorrectly selected dosage can lead to an increase in heart rate, which is fraught with serious consequences.

Drugs for cervical osteochondrosis

Osteochondrosis is a disease accompanied by pain in the spine that interferes with everyday activities. The use of non-steroidal anti-inflammatory drugs for osteochondrosis helps alleviate the health condition: they eliminate the inflammatory process in the tissues of the spine, thereby relieving pain. But not all anti-inflammatory drugs are equally effective and safe for the body.

Diclofenac
. Included in the anti-inflammatory drugs Voltaren, Ortofen, Diclak, Flotak, Diclobene. The analgesic and anti-inflammatory effects are equally well expressed. It inhibits both forms of the COX enzyme, but to a greater extent COX-2, so drugs with Diclofenac are less likely to cause gastrointestinal lesions than other first-generation NSAIDs.
Ibuprofen
. Preparations with ibuprofen (Dolgit, Nurofen, Ibalgin, Solpaflex) have a pronounced analgesic effect, the anti-inflammatory effect is somewhat weaker. Clinical studies have shown that the incidence of adverse reactions after taking therapeutic doses is the lowest among all non-selective NSAIDs.
Indomethacin
. One of the oldest representatives of the group of non-steroidal drugs. It has proven itself as a powerful analgesic and anti-inflammatory agent for osteochondrosis and other rheumatic diseases. But taking this drug is unsafe in terms of the development of serious complications of the gastrointestinal tract, central nervous system, heart failure and has many contraindications. It is used only occasionally for unbearable pain.

Homeopathy

The action of drugs from the homeopathic group is based on the transfer to the body of the beneficial properties of herbal medicines.

Homeopathic medicines do not have an immediate effect, but they have virtually no contraindications or side effects

Drugs are selected based on the individual characteristics of the patient and his diseases. As a rule, homeopathic remedies need to be taken for a long period. For atherosclerosis, drugs such as Cerebralic and Edas-138 have a beneficial effect. They help improve memory and brain activity.

Traditional methods of treatment

Today, home medical treatment methods are not inferior to modern methods of treatment, so many people prefer to be treated and prevent dystonia on their own, using the gifts of nature. Herbalists suggest treating narrowed blood vessels in the brain with effective herbal infusions.

You need to take a couple of particles, divided equally: burdock root, eleutherococcus fruits, mint and birch leaves, marsh cudweed, kidney tea. Pour half a liter of hot water over the entire mixture and leave for 30 minutes. For the best effect, you need to drink one hundred ml of liquid three times per 24 hours.
Mix St. John's wort, chamomile, immortelle, birch buds and add a few glasses of hot water. We divide the collection in half and drink it twice every day with a small spoon of honey and bay leaf oil.
We take clover, 5 parts of wormwood, a couple of pieces of myrtle, one piece of marjoram and half a share of parsley seeds. A liter of hot water is added to three large spoons of the product. Let the broth sit for a couple of hours, drink 1 fourth cup every few hours.
Boil the mixture with pine needles, onion peels and rose hips, and let it sit. We drink half a liter a day for 3 months, dividing the portion into morning, lunch and evening.
Take one large spoon with chopped burdock rhizome, fill it with half a liter of water and leave it in a thermos for infusion. We drink 100 ml in the morning for 3 months.

Before using traditional recipes, you should consult your doctor.

Groups of tools to improve brain function

Piracetam was the world's first nootropic. It was developed back in 1963 as a replacement for psychostimulants, benefiting from the absence of side effects. This substance became the founder of the racetam group, which improves memory.

In the nootropics category you can also find:

correctors of cerebral circulatory disorders;
dimethylaminoethanol derivatives, which help absorb oxygen and improve thinking skills;
derivatives of pyridoxine (vitamin B6), normalizing metabolism in neurons and stabilizing the functioning of the central nervous system;
neuropeptides that promote the formation of long-term memory.

Neuroprotectors are sometimes identified with nootropics, but there is a difference between them. Neuroprotectors are drugs of mixed action. They have a wider range of effects.

Diagnostics

If complaints arise about spasms of blood vessels in the arms and legs, diagnosis begins with a visual examination. The doctor pays attention to the appearance of the skin, its color and condition. Next, he performs manipulations with flexion and extension of the limbs so that the patient reports the degree of pain.

Special diagnostic methods are used:

oscillography (determination of pressure in blood vessels);
measuring temperature in various parts of the limbs;
rheography (determining changes in tissue resistance);
radioisotope study (determining the filling of blood vessels);
capillary study;
angiography (detection of the degree of narrowing of the vessel and the size of the affected area);
Ultrasound duplex scanning.

Symptoms

With angiospastic syndrome, prolonged spasm of the vessels of the extremities occurs. Such patients react acutely to cold air. There is a feeling of coldness in the upper and lower extremities, the color of the skin changes, and numbness is felt. Spasm of the blood vessels in the hand leads to tremor. People with angiospastic syndrome take longer to warm up. Sometimes, with prolonged exposure to low temperatures, atrophic processes develop.

Obliterating atherosclerosis occurs due to thickening of the walls of blood vessels due to fat deposition. Atherosclerotic plaques form, narrowing of the lumen of blood vessels occurs, up to their blocking in certain areas. This does not allow blood to enter the tissues, they do not receive the necessary nutrients.

Symptoms of arterial insufficiency:

pain in the legs that occurs when walking, which goes away after rest;
the pain has a constraining, squeezing character;
limitation of leg mobility;
thickening of nails;
hair loss or slow hair growth;
feeling of coldness, tingling, numbness in the legs;
ulcerative lesions on the skin;
lameness.

With spasm of the blood vessels in the legs, the pain is localized in the lower part of the limbs, in the calves. When large blood vessels are blocked, discomfort occurs in the thighs and buttocks. It becomes difficult for patients to walk, run, or climb stairs. With atherosclerosis in the later stages, even painkillers do not help patients cope with pain.

With obliterating endarteritis, damage to small vessels occurs. This occurs due to autoimmune processes and leads to the proliferation of connective tissue. The disease develops quickly. The main symptoms of vascular spasm in the legs during endarteritis:

leg fatigue;
lameness;
sensation of burning and coldness in the fingers of the lower extremities;
increased sensitivity, pallor or cyanosis of the skin;
convulsions;
deterioration of hair and nail growth;
ulcerative lesions.

With the onset of obliterating endarteritis, patients notice an increase in symptoms after walking a distance of about 200 meters. Over time, this figure decreases; it is difficult for a person to walk more than 60 meters.

If you have diabetes, there is a risk of vascular damage to the upper and lower extremities (microangiopathy). As a result, ischemia occurs, that is, oxygen starvation of tissues.

New generation vascular drugs for the brain