Cocarnit

Pharmacological properties

the drug is a complex of metabolic substances and vitamins.

Nicotinamide - one of the forms of vitamin PP, takes part in redox processes in the cell, improves carbohydrate and nitrogen metabolism, normalizes lipid metabolism, reduces the level of atherogenic lipoproteins in the blood.

Cocarboxylase is a coenzyme that is formed in the body from thiamine (vitamin B₁) coming from outside. It plays an important role in carbohydrate metabolism; it is part of the carboxylase enzyme, which catalyzes the carboxylation and decarboxylation of α-keto acids. Indirectly promotes the synthesis of nucleic acids, proteins and lipids. Reduces the level of lactic and pyruvic acid in the body, promotes the absorption of glucose. Improves trophic nerve tissue.

Cyanocobalamin (vitamin b₁₂) in the body turns into an active form - adenosylcobalamin or cobamide, which has a high biological activity. Increases protein synthesis in the body and promotes its accumulation. Activates the metabolism of carbohydrates and lipids. Reduces cholesterol in the blood, prevents fatty liver. It is necessary for the normal functioning of the hematopoietic organs, it contributes to the accumulation of compounds in the red blood cells that contain sulfhydryl groups, increasing their resistance to hemolysis. Increases tissue regeneration ability. It has a positive effect on the function of the liver and nervous system.

Disodium adenosine triphosphate trihydrate is a derivative of adenosine, stimulates metabolic processes. It has a hypotensive and antiarrhythmic, vasodilating effect, including on coronary arteries.

The pharmacokinetics of the drug has not been investigated.

Indications

Neuritis, neuropathy (including diabetes mellitus, pernicious anemia); neuralgia of various origins; myalgia, sciatica; lumbago, sciatica; bursitis, tendonitis; Ibs myocarditis; myocardiopathies.

Application

In connection with the presence of lidocaine in the preparation before using the drug, it is necessary to make a skin test for increased sensitivity. swelling and redness at the injection site indicate the presence of hypersensitivity.

After dilution with Cocarnit solvent, administer in v / m 1-2 ampoules of the drug 1 time per day.

The duration of treatment and repeated courses depend on the course and severity of the disease.

Contraindications

For the drug Cocarnit: hypersensitivity to the components of the drug; cardiogenic shock and other types of shock; decompensated heart failure, q – t interval prolongation syndrome, severe forms of bradyarrhythmia, degree II – III av blockade, acute myocardial infarction, arterial hypotension, severe forms of ag; hemorrhagic stroke; obstructive diseases of the bronchopulmonary system; hyperkalemia, hypermagnesemia, severe forms of BA; erythremia, erythrocytosis, neoplasms, with the exception of cases accompanied by megaloblastic anemia and vitamin b12 deficiency; an ulcer of the stomach and duodenum in the acute stage; gout; hyperuricemia severe liver failure (including cirrhosis); decompensated diabetes, a sudden decrease in peripheral vascular resistance in history, hypercoagulation (including with acute thrombosis); inflammatory lung diseases.

Additionally, for the solvent - 0.5% solution of lidocaine hydrochloride: hypersensitivity to other local amide type anesthetics; weak sinus syndrome; Wolff-Parkinson-White syndrome; Adams-Stokes syndrome; angina pectoris of high functional class; history of epileptiform seizures associated with the introduction of lidocaine hydrochloride; myasthenia gravis; hypovolemia; porphyria; severe renal failure.

Side effects

When using the drug Cocarnit the following manifestations of adverse reactions are possible.

Neurological disorders: headache, dizziness, short-term loss of consciousness, sensation of constriction in the head, phobias, nervous agitation, paresthesia.

From the side of the organ of vision: blurred vision.

Cardiac disorders: tachycardia, pain in the region of the heart, arrhythmia, bradycardia, chest discomfort, palpitations, violation of AV conduction (block), asystole.

On the part of the vessels: decreased blood pressure, hypercoagulation.

From the respiratory system: shortness of breath, bronchospasm.

From the digestive system: nausea, metallic taste in the mouth, increased gastrointestinal motility.

Common disorders: a feeling of heat, malaise, fever, sweating, pain in the arms, back, neck, impaired purine metabolism.

From the skin and subcutaneous tissue: facial flushing, itching, rash, urticaria, acne, bullous rash, allergic dermatitis, exfoliative dermatitis.

From the immune system: hypersensitivity reactions, including anaphylactic shock, Quinckes edema.

From the kidneys and urinary system: increased diuresis.

Local reactions: changes at the injection site, including pain, hyperemia, itching, swelling.

Additionally, for the solvent (0.5% solution of lidocaine hydrochloride), the following manifestations of adverse reactions are possible.

Neurological disorders: motor anxiety, euphoria, drowsiness, sleep disturbance, tremor, trismus, convulsions (the risk of their development increases with hypercapnia and acidosis), motor block, impaired sensitivity.

From the side of the organ of vision: nystagmus, diplopia, photophobia, reverse blindness, conjunctivitis.

On the part of the hearing organ: hearing impairment, tinnitus, hyperacusis.

From the respiratory system: rhinitis, paralysis of the respiratory muscles, respiratory paralysis.

From the digestive system: vomiting, discomfort in the epigastrium.

General disorders: weakness, sensation of heat, cold or numbness of the extremities.

With prolonged and uncontrolled intake - hyperkalemia, hypermagnesemia.

special instructions

Solution must be applied immediately after its preparation. the color of the cooked solution must be red. do not apply solution if the color has changed.

As a solvent, a solution of lidocaine hydrochloride, which is included in the kit, is used. The introduction of the solution of lidocaine hydrochloride is carried out only by medical professionals. When treating the injection site with disinfectant solutions containing heavy metals, the risk of developing a local reaction in the form of pain and swelling increases.

Before using lidocaine hydrochloride for heart diseases (hypokalemia reduces the effectiveness of lidocaine), it is necessary to normalize the level of potassium in the blood plasma.

Use with caution in case of bradycardia, degree I AV block, incomplete AV block, intraventricular conduction disturbance, a tendency to arterial hypotension, moderate heart failure, moderate liver and kidney function impairment, respiratory failure, with a tendency to bronchospasm, after heart surgery, with a genetic predisposition to malignant hyperthermia, weakened patients and elderly patients, with hyperacid gastritis, gastric ulcer and duodenal ulcer (outside the stage of exacerbation), glaucoma, alcohol abuse, patients taking nitrates, calcium channel antagonists, β-adrenergic blockers.

Since prolonged use of the drug can lead to fatty degeneration of the liver, methionine-rich foods or methionine and other lipotropic drugs should be included in the diet of patients for its prevention.

The use of the drug can lead to an increase in the need for insulin for patients with diabetes mellitus, it is inappropriate to use for the correction of dyslipidemia in patients with diabetes mellitus.

During the treatment period, it is necessary to control the parameters of peripheral blood, liver function, the level of glucose and uric acid in the blood, with prolonged use it is necessary to control the level of potassium and magnesium in the blood.

During treatment, ECG monitoring is required.In case of sinus dysfunction, prolongation of the P – Q interval, expansion of QRS, or the appearance of arrhythmia, the dose of the drug should be reduced or treatment should be stopped.

During treatment with MAO inhibitors, lidocaine hydrochloride should not be used parenterally.

With the introduction of lidocaine hydrochloride, creatinine concentration may increase, which can lead to an error in the diagnosis of acute myocardial infarction.

Limit the use of products that include caffeine (coffee, tea and other drinks).

Do not use with drugs that increase blood coagulation. Caution must be exercised in the treatment of persons with a tendency to thrombosis and in patients with angina pectoris and to monitor blood coagulation. With a tendency to the development of leuko- and erythrocytosis, the dose of the drug must be reduced or temporarily suspended.

Use during pregnancy and lactation. Do not prescribe the drug during pregnancy. At the time of treatment with the drug, breast-feeding must be stopped.

Children. There is no experience with the use of the drug in children, so its use in this category of patients is not recommended.

Influence on the ability to drive vehicles or work with complex mechanisms. In cases where dizziness and a decrease in blood pressure are observed during treatment, one should refrain from driving vehicles or working with other mechanisms.

Interactions

Disodium adenosine triphosphate trihydrate. while taking with potassium-sparing diuretics, potassium preparations and APF inhibitors, the risk of developing hyperkalemia increases, with magnesium preparations - hypermagnesemia.

The drug can enhance the antianginal effect of β-adrenergic receptor blockers, nitrates.

With simultaneous use with dipyridamole, the effect of dipyridamole is enhanced, in particular the vasodilating effect.

Some antagonism is shown with simultaneous use with purine derivatives (caffeine and theophylline).

You can not enter simultaneously with cardiac glycosides in large doses, since the risk of side reactions from the cardiovascular system increases.

With simultaneous use with xanthinol nicotinate, the effect of sodium adenosine triphosphate is reduced.

Carbamazepine may enhance the effects of adenosine, leading to the development of blockade.

Cyanocobalamin. Aminoglycosides, salicylates, antiepileptic drugs, colchicine, potassium preparations reduce the absorption of cyanocobalamin, affect its kinetics. With simultaneous use with kanamycin, neomycin, polymyxin, tetracycline, the absorption of cyanocobalamin decreases.

Cyanocobalamin is pharmaceutically incompatible with ascorbic acid, heavy metal salts (inactivation of cyanocobalamin), thiamine bromide, pyridoxine, riboflavin (the cobalt ion contained in the cyanocobalamin molecule destroys other vitamins). The interaction of cyanocobalamin with thiamine increases the risk of allergic reactions caused by thiamine with chloramphenicol - the hematopoietic response to the drug decreases, the effect of cytamene decreases with cytamen, and the concentration of cyanocobalamin in the blood decreases with oral contraceptives. Antimetabolites and most antibiotics alter the results of microbiological studies of cyanocobalamin.

Lidocaine. With the combined use of lidocaine with drugs such as chlorpromazine, pethidine, bupivacaine, quinidine, disopyramide, amitriptyline, imipramine, nortriptyline, the concentration of lidocaine in the blood plasma decreases.

Antiarrhythmic drugs (including amiodarone, verapamil, quinidine, disopyramide, aymaline) - the cardiodepressive effect intensifies (Q-T interval lengthens and in very rare cases AV block or ventricular fibrillation may develop); simultaneous use with amiodarone can lead to the development of seizures.

Novocaine, procainamide, procainamide - possible excitation of the central nervous system, delirium, hallucinations.

Curare-like drugs - muscle relaxation increases (respiratory muscle paralysis is possible).

Ethanol enhances the inhibitory effect of lidocaine on respiration.

Cimetidine reduces hepatic clearance of lidocaine (decreased metabolism due to inhibition of microsomal oxidation), increases its concentration and the risk of toxic effects.

Blockers of β-adrenergic receptors slow down the metabolism of lidocaine in the liver, enhance the effects of lidocaine (including toxic ones) and increase the risk of developing bradycardia and arterial hypotension. With the simultaneous use of β-adrenergic receptor blockers and lidocaine, it is necessary to reduce the dose of the latter.

Cardiac glycosides - the cardiotonic effect of cardiac glycosides is weakened. Digitalis glycosides - against the background of intoxication, lidocaine may increase the severity of AV block.

Sleeping pills or sedatives - it is possible to increase the depressant effect on the central nervous system of sleeping pills and sedatives.

Narcotic analgesics (morphine) - the analgesic effect of narcotic analgesics, respiratory depression is enhanced.

MAO inhibitors (furazolidone, procarbazine, selegiline) - the risk of developing arterial hypotension increases.

Anticoagulants (including ardeparin, dalteparin, danaparoid, enoxaparin, heparin, warfarin) increase the risk of bleeding.

Drugs for anesthesia - the inhibitory effect on the respiratory center of drugs for anesthesia (hexobarbital, thiopental sodium iv) is enhanced.

Polymyxin B - requires monitoring of respiratory function.

Rifampicin - a decrease in the concentration of the latter in the blood is possible.

Propafenone - an increase in the duration and complication of side effects from the central nervous system is possible.

Prenylamine - the risk of developing ventricular arrhythmias such as pirouette is increased.

Anticonvulsants, barbiturates (phenobarbital) - it is possible to accelerate the metabolism of lidocaine in the liver, a decrease in blood concentration, an increase in the cardiodepressive effect.

Isadrine, glucagon - increased lidocaine clearance.

Norepinephrine, mexiletine - lidocaine clearance decreases (toxicity increases), hepatic blood flow decreases.

Acetazolamide, thiazide and loop diuretics reduce the effect of lidocaine as a result of hypokalemia.

Midazolam - increases the concentration of lidocaine in blood plasma.

Drugs that cause blockade of neuromuscular transmission, the effect of these drugs is enhanced, since they reduce the conductivity of nerve impulses.

Nicotinic acid / nicotinamide. Potentiates the action of fibrinolytic agents, antispasmodics and cardiac glycosides, enhances the toxic effect of alcohol on the liver.

Caution should be exercised when used concomitantly with antihypertensive drugs (an increase in hypotensive effect is possible), anticoagulants, acetylsalicylic acid (due to the risk of hemorrhages).

Reduces the effect of probenecine, the toxicity of neomycin and prevents the latter induced a decrease in the concentration of cholesterol and HDL. Reduces the toxic effect of barbiturates, anti-TB drugs, sulfonamides.

Oral contraceptives and isoniazid slow down the conversion of tryptophan to nicotinic acid and thus may increase the need for nicotinic acid. Antibiotics can enhance hyperemia caused by nicotinic acid. Cases of rhabdomyolysis when using nicotinic acid with lovastatin have been reported.

Overdose

Symptoms: dizziness, weakness, tremor, ventricular dysfunction; visual impairment; tonic-clonic convulsions; psychomotor agitation, syncope, associated with a sudden decrease in hell; collapse; congestive heart failure, pulmonary edema; hypercoagulation, peripheral vascular thrombosis; coma, asphyxiation; apnea or increased manifestations of adverse reactions.

Treatment: cessation of drug administration, oxygen therapy, anticonvulsants, vasoconstrictors (norepinephrine, mesatone), anticholinergics, symptomatic therapy, xanthines (aminophylline, theophylline) are antagonists of adenosine. The patient should be in a horizontal position; it is necessary to provide access to fresh air, oxygen supply and / or artificial respiration. Symptoms of the central nervous system are corrected by the use of short-acting benzodiazepines / barbiturates. Atropine (0.5–1 mg) is used to correct bradycardia and conduction disturbances, and in case of arterial hypotension sympathomimetics in combination with β-adrenergic agonists. With cardiac arrest, immediate resuscitation is indicated. Intubation, mechanical ventilation is possible. In the acute phase of an overdose, dialysis is ineffective. There is no specific antidote.

Storage conditions

At a temperature not exceeding 25 ° C.