Vinpocetine, concentrate 5 mg/ml 5 ml 10 pcs
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ATC: N.06.B.X.18 Vinpocetine
Pharmacodynamics:
The mechanism of action of Vinpocetine is composed of several elements: it improves cerebral blood flow and metabolism and has beneficial effects on blood rheological properties.
The neuroprotective effect is realized by reducing the adverse cytotoxic effects of excitatory amino acids. It blocks Na- and Ca2+-channels and NMDA- and AMRA-receptors. Selectively inhibits Ca2+-calmodulin-dependent cGMP-phosphodiesterase. Increases serotonin and noradrenaline metabolism in the brain, stimulates noradrenergic neurotransmitter system and has antioxidant effect.
It improves microcirculation in the brain by inhibiting platelet aggregation, decreasing pathologically elevated blood viscosity, increasing erythrocyte deformability and inhibiting adenosine reuptake; it promotes oxygen transfer to cells by reducing the affinity of red blood cells for it.
It selectively increases cerebral blood flow by reducing cerebral vascular resistance without significant effect on systemic circulatory parameters (blood pressure (BP), cardiac output, heart rate, total peripheral vascular resistance); does not cause “stealing” effect.
Distribution
Distribution of radioactively labeled vinpocetine, when administered to rats, the greatest radioactivity was found in the liver and gastrointestinal tract. The maximum concentration in tissues was noted 2-4 h after administration. Concentrations in the brain did not exceed those found in blood.
In humans the binding to plasma proteins is 66%. Bioavailability is about 7%. The volume of distribution is 246.7±88.5 L, indicating high tissue binding. Total clearance (66.7 l/h) exceeds hepatic blood flow rate (50 l/h), indicating extrahepatic metabolism.
Metabolism
The main metabolite is apovincamic acid (AVC), which is 25-30% of the parent compound. The area under the “concentration-time” curve of AVC after oral administration is twice that of intravenous administration of vinpocetine. Thus, vinpocetine is subject to a pronounced “first pass” effect through the liver.
Other metabolites include: hydroxyvinpocetine, hydroxy-AVC, AVC-dioxyglycinate and their conjugates (sulfates and (or) glucuronides). Excretion of unchanged vinpocetine is low (a few percent).
In patients with hepatic or renal dysfunction, no dose adjustment is required because vinpocetine does not cumulate.
Excretion
When repeatedly administered in doses of 5 and 10 mg, vinpocetine exhibits linear pharmacokinetics, with equilibrium plasma concentrations of 1.2±0.27 and 2.1±0.33 ng/mL, respectively. The elimination half-life in humans is 4.83±1.29 h. In studies with radioactively labeled vinpocetine, renal and intestinal excretion was found to be 60:40%.
In rats and dogs a high concentration is found in bile, but significant enterohepatic recirculation was noted.
Pharmacokinetics in special patient groups
As vinpocetine is primarily intended to treat the elderly, the slower distribution and metabolism as well as excretion in this age group must be considered, especially with long-term use. According to the results of clinical studies it was found that the kinetics of vinpocetine in the elderly is not significantly different from the young, there is no cumulation.
With impaired liver and renal function no cumulation is noted, which allows for long-term therapy.
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Indications
Neurology: transient ischemic attack, symptomatic therapy of the consequences of ischemic stroke, vascular vertebrobasilar insufficiency, vascular dementia, atherosclerosis of cerebral vessels, post-traumatic, hypertensive encephalopathy.
Ophthalmology: chronic vascular diseases of the retina and choroid.
Otology: perceptual hearing loss, Meniere’s disease, tinnitus, vascular or toxic (including drug-induced) hearing impairment.
Active ingredient
Composition
One ampoule contains:
the active ingredient:
vinpocetine – 5 mg;
excipients:
ascorbic acid – 0.5 mg,
benzyl alcohol – 10 mg,
sodium disulfite (sodium metabisulfite) – 1 mg,
How to take, the dosage
The drug is intended for intravenous drip infusion only, administer slowly (infusion rate should not exceed 80 drops/minute).
Intravenous administration of the undiluted drug is not allowed. The infusion solution should be administered within 3 hours after preparation!
To prepare the infusion, 0.9% sodium chloride solution or solutions containing dextrose may be used.
The initial daily dose is 20 mg in 500 ml of infusion solution. Depending on tolerance, within 2-3 days the dose may be increased to no more than 1 mg/kg/day. The average duration of treatment is 10-14 days.
The average daily dose at a body weight of 70 kg is 50 mg.
In case of liver or kidney disease no dose adjustment is required.
When the course of parenteral administration is completed, the drug is switched to oral administration (10 mg 3 times daily). The dose should be gradually reduced before withdrawing the drug.
Interaction
Methyldopa may increase the hypotensive effect of vinpocetine, therefore systematic BP control is required with their concomitant use.
Despite the lack of clinical data, concomitant use with agents affecting the central nervous system, anticoagulants and antiarrhythmic agents should be used with caution.
Vinpocetine solution is pharmaceutically incompatible with heparin and solutions containing amino acids.
Special Instructions
The drug should be used with caution in intracranial hypertension, when concomitant use with antiarrhythmic drugs, as well as in prolonged QT interval syndrome or concomitant use with drugs prolonging the QT interval. ECG monitoring should be performed in case of prolonged QT interval syndrome or concomitant use of QT interval prolonging drugs.
There have been no studies on the effect on driving ability. Caution should be exercised when driving vehicles and operating moving machinery if adverse reactions from the nervous system occur.
Synopsis
Contraindications
Acute phase of hemorrhagic stroke, severe coronary heart disease, severe heart rhythm disturbances.
Hypersensitivity to vinpocetine or other components of the drug.
Pregnancy, lactation period.
Children under 18 years of age (due to lack of clinical trial data).
Side effects
Adverse reactions are classified according to their frequency of occurrence: very common (â¥1/10), common (â¥1/100, <1/10), infrequent (â¥1/1000, <1/100), rare (â¥1/10000, <1/1000), very rare (<1/10000), frequency unknown (due to insufficient data).
Blood and lymphatic system disorders: rare – thrombocytopenia, erythrocyte agglutination; very rare – anemia.
Immune system disorders: very rare – hypersensitivity.
Metabolism and nutrition disorders: rarely – hypercholesterolemia, diabetes, decreased appetite, very rarely – anorexia.
Mental disorders: infrequent – euphoria; rare – anxiety; very rare – depression, sleep disorders.
Nervous system disorders: rarely – headache, dizziness, hemiparesis, somnolence; very rarely – tremor, loss of consciousness, hypotension, preconsciousness.
Visual organ disorders: rare – bleeding in the anterior chamber of the eye, hyperopia, decreased visual acuity, myopia; very rare – conjunctival hyperemia, edema of the optic disk, diplopia.
Hearing and labyrinth disorders: rare – hearing impairment, hyperacusis, hypoacusis, true vertigo; very rare – tinnitus.
Cardiac disorders: rare – ischemia/myocardial infarction, angina pectoris, bradycardia, tachycardia, extrasystole, palpitations; very rare – heart failure, atrial fibrillation, arrhythmia.
Vascular disorders: rare – hypotension, hypertension, hot flashes; very rare – fluctuations in blood pressure, thrombophlebitis.
Gastrointestinal disorders: rare – abdominal discomfort, epigastric pain, dry mouth, nausea; very rare – hypersecretion of saliva, vomiting, dysphagia, stomatitis.
Skin and subcutaneous tissue pathology: rarely – erythema, hyperhidrosis, urticaria; very rarely – dermatitis, itching.
General disorders and reactions at the injection site: rarely – asthenia, malaise, burning sensation and inflammation at the injection site, thrombosis, discomfort in the chest.
Laboratory disorders: infrequent – decreased blood pressure; rare – increased blood pressure; hypertriglyceridemia, ST-segment depression, eosinopenia, impaired liver function tests, QT segment prolongation; very rare – increased LDH, abnormal EEG, PR prolongation.
Pregnancy use
The use during pregnancy and lactation is contraindicated.
Pregnancy
Vinpocetine penetrates through the placenta, but the plasma concentration, in the placenta and in the fetus is lower than in the mother. Teratogenic and embryotoxic effects were not detected. In animal studies, placental bleeding and abortions have occurred at high doses (presumably due to increased placental blood flow).
Breastfeeding
Vinpocetine penetrates into breast milk. According to preclinical studies with radioactively labeled vinpocetine, its concentration in breast milk was 10 times higher than in the blood of the mother. In 1 hour, 0.25% of the administered dose penetrates into the milk.
Similarities
Weight | 0.105 kg |
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Shelf life | 2 years. Do not use after the expiration date. |
Conditions of storage | In the dark place at a temperature not exceeding 25 °С. Store out of the reach of children. |
Manufacturer | Ozon, Russia |
Medication form | concentrate for preparation of infusion solution |
Brand | Ozon |
Other forms…
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