Phezam Research. Phezam application for stabilization of visual functions in patients with primary open-angle glaucoma with normalized intraocular pressure. Side effects of "Coficil Plus"

FEZAM - reliable protection of the brain

The brain receives 15 to 20% of the minute volume of blood. Regulation of adequate blood supply to the brain tissue in accordance with its metabolic needs and functional redistribution of local blood flow occurs due to changes in the resistance of small vessels. The discrepancy between the need of brain tissue for oxygen and its delivery leads to the development of various forms of cerebrovascular accidents. It can be:

• initial manifestations of a lack of cerebral circulation;
• transient disorders of cerebral circulation (transient ischemic attacks, cerebral crises);
• strokes;
• encephalopathy.

Slowly progressing cerebrovascular insufficiency entails changes in brain tissue, leads to oxygen starvation and gradual death of nerve cells. All this is accompanied by loss of working capacity, disability and even death.

Cerebral vascular disease ranks third among the causes of death in Ukraine.

For the correction of diseases, the pathogenesis of which is a violation of cerebral circulation, drugs of several pharmacological groups are used: vasodilators, nootropic drugs, agents that improve cerebral circulation and metabolic processes in the brain.

Vasoactive drugs, reducing the resistance of cerebral vessels, cause an increase in both total hemispheric and regional blood flow. This contributes to better oxygenation of the brain tissue, normalization of metabolic processes and improvement of the clinical condition of patients. Of great importance is the correct choice of the drug. Vasoactive drugs, especially in high doses, along with the expansion of cerebral vessels can significantly reduce the total peripheral resistance, reduce systemic blood pressure, which in conditions of chronic cerebrovascular insufficiency can lead to the progression of ischemic damage to the brain tissue. Such complications are described for papaverine, drotaverine, nicotinic acid and its derivatives. Therefore, for the correction of cerebral vascular disorders, it is desirable to use drugs that, in therapeutic doses, do not affect the indicators of central hemodynamics.

One of the effective drugs that improve cerebral circulation is Phezam.

This is a combined preparation containing 400 mg of piracetam and 25 mg of cinnarizine, which has proven itself in the complex therapy of cerebrovascular accidents.

The combination of both components enhances the antihypoxic effect, reduces the tone of the smooth muscles of the cerebral vessels. Phezam has a moderate antiplatelet activity, stimulates metabolic processes in the central nervous system, improves the integrative function of the brain, improves memory, and facilitates the learning process in children.

The toxicity of Phezam does not exceed the total toxicity of its components. In addition, Phezam was noted to be more effective and tolerable compared to the separate administration of its components.

Phezam is effective for:

• chronic insufficiency of cerebral circulation, caused, for example, by atherosclerosis of cerebral vessels or a stroke;
• brain injuries;
• inflammatory, intoxication and infectious diseases of the nervous system;
• migraine;
• psychoorganic syndrome;
• depressive states (including those resistant to antidepressants);
• Meniere's syndrome;
• memory and concentration disorders;
• increased irritability;
• schizophrenia;
• violations of the functions of the vestibular apparatus;
• to improve learning and memory in children with intellectual retardation.

Phezam is ideal in cases where the use of one piracetam causes tension and insomnia in the patient.

This drug is prescribed with caution to people suffering from diseases of the liver and kidneys. In severe renal failure, it is not prescribed in high doses, even if the patient is on chronic hemodialysis.

It should be remembered that since Phezam contains cinnarizine, it can cause a positive reaction in athletes during a “doping test”. Since the dyes in the tablet shell contain iodine, the results of studies using radioactive iodine may be distorted.

When dispensing the drug, it is imperative to focus the patient's attention on the fact that, with simultaneous administration, it is possible to increase the sedative effect of drugs that depress the central nervous system, tricyclic antidepressants and alcohol, as well as nootropic and antihypertensive drugs. Vasodilators increase the effect of the drug, and hypertensive agents weaken it.

The modern rhythm of life and frequent stresses have significantly increased the frequency of various diseases of the nervous system. Cerebral vascular diseases also contribute to these statistics. Therefore, nootropics and drugs that affect cerebral blood flow are among the most popular in the pharmacy chain.

Regardless of the etiological cause of the disease, the mechanism of damage to brain cells is cell hypoxia and impaired intracellular neuronal exchange. Traumatic brain injuries, tumors, hypertension, cerebral atherosclerosis, cervical osteochondrosis and many other reasons can adversely affect the tone of the cranial vessels and the volume of blood entering the brain. Violation of the blood supply inevitably leads to a decrease in the delivery of oxygen and glucose to the tissues. The result is brain hypoxia and impaired energy metabolism in cells. The situation is further aggravated by the fact that blood flow in the cerebral vessels most directly affects the pressure of the cerebrospinal fluid in the ventricles of the brain and meninges, and increased intracranial pressure leads to additional compression of the intracranial vessels and deterioration in the nutrition of brain cells. Cell resources are exhausted, and their death occurs. In this regard, it becomes clear that the main task of therapy for brain damage is to normalize its blood supply and activate metabolic processes in cells.

For many years, cinnarizine and piracetam have been the basis for the treatment of neurological pathology. Cinnarizine is a selective calcium channel blocker. A decrease in the supply of calcium ions to the smooth muscle cells of arterioles leads to a decrease in their response to biogenic active substances that have a vasoconstrictive effect (dopamine, vasopressin, norepinephrine, etc.), and to a decrease in the tone of the vascular wall. A unique property of cinnarizine is an effective, but not excessive, vasodilating effect in relation to the vessels of the brain in the absence of a pronounced effect on peripheral arterial pressure. In addition, cinnarizine reduces blood viscosity and increases the plasticity of erythrocyte membranes, which favorably affects microcirculation processes. The moderate antihistamine activity of cinnarizine helps to reduce tissue swelling, which, combined with a decrease in the tone of the sympathetic nervous system and a decrease in the excitability of the vestibular apparatus, has the most favorable effect on the patient's condition.

Piracetam is a classic nootropic. Its main effects: stimulation of energy and protein metabolism in brain cells, improved glucose utilization, increased cell resistance to hypoxia and interneuronal transmission of nerve impulses in the central nervous system.

Since patients have to take several drugs at once for a long time, the combined drug Phezam ® was developed for the convenience of treatment. each capsule contains 400 mg of piracetam and 25 mg of cinnarizine.

The combination of these two active ingredients in one capsule allowed not only to reduce the number of tablets taken simultaneously, but also had the most favorable effect on the clinical effect of Phezam®. cinnarizine reduces excitability caused by piracetam; substances have a mutually potentiating effect in relation to the blood supply to brain tissues and metabolic processes in cells. This, in turn, reduced the likelihood of side effects. An additional plus for buyers is the affordable price of the medicine.

The use of Phezam ® helps patients with chronic cerebrovascular accident maintain a high intellectual level and physical activity, prevent disability and improve the quality of life.

Phezam ® is prescribed for children with intellectual retardation, with asthenic syndrome, problems associated with previous perinatal encephalopathy or traumatic brain injury. The existing age limit (the drug is not prescribed to children under 5 years of age) is associated exclusively with the form of release in the form of capsules: in young children, preference is given to liquid forms of drugs.

For young and middle-aged people, Phezam® helps to quickly recover from traumatic brain injuries, it is easier to endure mental stress during a session at an institute or at work. The drug is effective as a prophylactic for frequent headaches, including migraine.

Since 2010, Phezam ® has appeared in pharmacies in a new package.

The high safety profile of Phezam ® makes it indispensable in geriatric practice. Phezam ® is widely used in the treatment of encephalopathies of various origins, in senile dementia, in the complex therapy of strokes in the recovery period, both hemorrhagic and ischemic. The course use of the drug 2-3 times a year allows you to increase mental and physical activity in the elderly, significantly improve their quality of life.

The pharmacist can inform the patient about Phezam®. being confident in the effectiveness and safety of the proven drug, and the affordable price and large package containing 60 capsules, make it profitable and convenient for customers.

Phezam for hypertension

Phezam - instructions for use, analogues, reviews, price

Phezam is a combined drug from the group of nootropics that improve cerebral circulation and, as a result, brain function. The drug is used in the treatment of cerebrovascular disorders (eg, vascular atherosclerosis, cerebrovascular insufficiency), strokes. encephalopathies of various origins (for example, against the background of hypertension, craniocerebral injuries, past infections, etc.), dementia (dementia) of vascular origin, disorders of memory, attention and mental work, as well as labyrinthopathy, Meniere's syndrome and neurological pathology of childhood .

Composition, names and formulations Phezam

Phezam is currently available in a single dosage form - capsules for oral administration. Often these capsules are called tablets, which is not scientifically correct, but it is quite suitable for denoting a dosage form intended for oral administration. However, it should be remembered that when people say "Phezam tablets", they mean exactly the form for oral administration, that is, capsules. In addition, there is a common misnomer for the drug "Phezama", which is often used in everyday speech. Therefore, when you hear the term "Phezam", you should know that we are talking about the drug "Phezam".

Phezam contains two active ingredients:

1. Cinnarizine - 25 mg;

This means that each capsule contains 400 mg of Piracetam and 25 mg of Cinnarizine. Due to this content of active substances, the drug is often called "Phezam 400 + 25" in the slang of medical workers. When a person sees a similar name, do not be afraid, since we are talking about the same Phezam.

Phezam contains the following substances as auxiliary components:

• Lactose;
• Silicon dioxide colloidal;
• magnesium stearate.

The capsule shell is 98% gelatin and 2% titanium dioxide dye.

Phezam capsules are dense, cylindrical in shape, painted white. Inside the capsules is a powdery mixture, painted in white or cream color. The powder inside the capsules may have small lumps, which, when lightly pressed with a dense object (for example, a spoon, glass rod, etc.), crumble and turn into powder. Phezam is available in packs of 60 capsules.

Phezam - mechanisms of action and scope of therapeutic application

The mechanism of action and therapeutic effects of Phezam are due to the active components that make up its composition. The general, resulting therapeutic and clinical property of Phezam is its ability to improve cerebral circulation and metabolism in the cells and nerve fibers of the brain. In fact, all other effects of Phezam are due precisely to the activation of blood flow and the intensification of metabolism in brain cells.

Since Phezam is a combination drug, which includes two active components, we will consider the properties of each of them and their resulting cumulative effect.

Piracetam is a nootropic agent that improves brain activity, having a positive effect on metabolic processes. Piracetam increases the rate of glucose consumption. which is the main nutrient for the brain, since the cells of the central nervous system are not able to receive the energy necessary to maintain vital activity and functioning from any other compounds. That is, under the influence of Piracetam, brain cells begin to actively feed, producing more energy, which is quite enough to ensure the intensive work of the organ. It is thanks to this that the speed of transmission of impulses between neurons increases, memory is activated, attention is concentrated and there is a general improvement in intellectual function.

In addition, Piracetam improves the blood supply to various parts of the brain in which there is vascular damage and moderate or mild oxygen starvation (ischemia). Due to the improvement of microcirculation in the brain, ischemia zones suffering from oxygen deficiency disappear, and the entire volume of neurons is included in intensive work. Improving blood flow is achieved not only through direct effects, but also indirectly, which consists in inhibiting platelet adhesion and, consequently, in preventing the formation of blood clots. Thus, Piracetam improves not only blood circulation, but also the properties of blood, making it as suitable as possible for circulation through microvessels. In areas of the brain prone to ischemia, Piracetam has a protective effect, increasing the resistance of neurons to hypoxia and death.

That is, Piracetam is able not only to improve cerebral circulation, but also to enhance the integrative function of the brain (the ability to synthesize and analyze, generalize, non-standard solutions, etc.), increase the productivity of intellectual work, consolidate memory, facilitate the learning process and the assimilation of new material and to restore and maintain brain function in the elderly.

Cinnarizine is a substance that has a pronounced effect directly on the vessels of the brain. Thus, cinnarizine dilates the vessels of the brain, reducing the tone of smooth muscles, as well as the severity of their reaction to biologically active substances that constrict blood vessels. Cinnarizine dilates blood vessels, due to which the blood flow is activated, and the supply of various parts of the brain with oxygen and nutrients is significantly improved. By improving blood circulation, the substance increases the resistance of brain tissues to a lack of oxygen. However, despite the vasodilating effect, Cinnarizine does not affect intracranial and arterial pressure.

Together, Cinnarizine and Piracetam enhance the effects of each other, so the severity of the resulting action of Phezam is higher compared to the use of drugs in isolation with a separation in time of administration. However, in Phezam, the sedative effect of Cinnarizine prevails, due to which a person does not feel psychomotor agitation, as when using Piracetam.

Phezam - indications for use (from which Phezam tablets)

Phezam is currently indicated for use in the treatment of various diseases and conditions associated with cerebrovascular accidents and injuries. as well as disorders of integrative function. However, not all of these conditions are included in the list of official indications for the use of the drug, since their effectiveness has not been scientifically proven. Therefore, we provide only a list of approved, official indications for the use of Phezam.

So, indications for the use of Phezam is the treatment of the following diseases or conditions:

Cerebral circulation disorders of any origin (atherosclerosis of cerebral vessels, subacute or chronic stroke, recovery period after hemorrhagic stroke, traumatic brain injury, osteochondrosis of the cervical spine, etc.); Recovery after a traumatic brain injury; memory impairment;
• Violation of the mental function (it is difficult to clearly formulate a thought, it is impossible to find a solution to a simple problem or think about the situation from different points of view, etc.);
• Violation of concentration;
• mood disorders;
• Intoxication of any origin;
• Asthenia of psychogenic origin (anxiety, depression, feeling of emotional discomfort, irritability, lability);
• Encephalopathy of various origins (against the background of chronic hypertension, traumatic brain injury, infection, surgery, anesthesia, etc.);
• Dementia (dementia) due to vascular pathology;
• Psychoorganic syndrome with a predominance of asthenia and adynamia, provoked by infectious and inflammatory diseases of the nervous system;
• Labyrinthopathy (pathology of the structures of the inner ear), manifested by tinnitus. nausea, vomiting, nystagmus. motion sickness;
• Meniere's syndrome;
• Aphasia (speech disorder) provoked by vascular pathology;
• Prevention of kinetosis (sickness, "seasickness", etc.);
• Prevention of migraine;
• Mild neurological pathology in children (poor learning, low concentration, insufficient long-term memory, etc.);
• In a comprehensive methodology for teaching children who have a lag in intellectual development.

Phezam (tablets) - instructions for use

Phezam capsules must be taken orally, swallowed whole, without chewing, without violating the integrity of the shell and without pouring the powder into a glass of water. The capsule should be washed down with a small amount of water (at least half a glass) or any other liquid, with the exception of carbonated sugary drinks, coffee and caffeinated energy drinks. For example, Phezam capsules can be washed down with mineral water. juice, tea, compote, fruit drink and other drinks. The only condition that Phezam's drinking liquid must satisfy is a low temperature, that is, the drink should not be hot, but warm or cool.

Phezam capsules can be taken at any convenient time, regardless of the meal. However, if a person suffers from any diseases of the gastrointestinal tract, then it is better for him to take Phezam capsules 20 to 30 minutes after eating. Moreover, a light snack, for example, an apple, is quite suitable as a meal. banana or other fruit, sandwich, piece of meat, etc.

You should try to always take Phezam capsules at the same time, for example, every day at 9-00 am, or daily at 8-00 and 18-00, depending on how many times a day it is recommended to drink the drug. Moreover, if a person missed a dose at the set time, then you should drink the capsule immediately, if the next term for taking Phezam has not come. If, after the missed capsule, the time for taking the next one has come up, then you should drink only one, not two, without trying to compensate for the forgotten dose of the drug.

For the treatment of various diseases, adults should take Phezam 1 - 2 capsules three times a day, for one to three months. Children over 5 years old, but under 18 years of age, also for the treatment of various diseases and conditions, Phezam should take 1 - 2 capsules, but only once or twice a day for 1.5 - 3 months. The duration of the course of therapy is determined by the severity of the disease and the rate of clinical improvement. You can not take Phezam for more than three months without a break. If necessary, treatment courses can be repeated 2-3 times during one calendar year.

Phezam overdose

An overdose of Phezam during the entire period of use of the drug has been recorded in a very limited number of times. The drug is safe, and even exceeding the therapeutic dosage by several times did not cause pronounced side effects that would force a person to stop taking Phezam. The only symptom of Phezam overdose in adults may be abdominal pain. which, as a rule, is normally tolerated and does not require discontinuation of the drug. An overdose of Phezam in children is manifested by insomnia, agitation, irritability, tremors, nightmares, hallucinations or convulsions.

If any symptoms of an overdose appear in adults and children, it is necessary to carry out symptomatic treatment aimed at stopping discomfort. In addition, it is recommended to carry out a gastric lavage. An overdose of Phezam can also be removed with hemodialysis.

Special instructions for the use of Phezam

Athletes should cancel the drug 2 to 3 days before doping tests, since cinnarizine contained in Phezam can give a positive test result.

In addition, the use of Phezam can give a false positive result of a study for the determination of radioactive iodine. since the composition of the capsule dye contains this trace element. Phezam also activates the thyroid gland. as a result, a person may experience tremor (trembling) of various parts of the body and anxiety.

If Piracetam causes insomnia and tension in a person, then Phezam should be replaced, which in such situations is the optimal drug. Phezam is also the drug of choice if doctors have prescribed Cinnarizine and Piracetam at the same time (this may be the appointment of different doctors).

Against the background of the use of Phezam, care should be taken when working with various mechanisms, including when driving, since cinnarizine at the initial stages of therapy can provoke drowsiness.

While taking Phezam, you should refrain from drinking alcohol, as this will provoke a massive death of brain cells.

When Phezam is used in people suffering from liver diseases. transaminase activity (AST, ALT) should be monitored once a week. With an increase in transaminase activity by more than 1.5 times from the upper limit of the norm, Phezam should be discontinued.

If a person has kidney disease, before prescribing Phezam, creatinine clearance should be determined using the Reberg test. If the creatinine clearance is more than 60 ml / min, then Phezam can be taken at the usual dosage, monitoring this laboratory indicator every 3 to 4 days. If the creatinine clearance was initially less than 60 ml / min or fell during the use of the drug, then the Phezam dosage should be halved and the intervals between doses should be increased.

Use during pregnancy and lactation

During experiments on animals, the absence of any negative effect of Phezam on the growth and development of the fetus was revealed. However, despite this, the drug is contraindicated for use during pregnancy. This is due to possible negative changes in the mental state of a woman, increased anxiety. lability of the emotional sphere and mood, which theoretically can have a bad effect on the course of pregnancy.

Because Phezam passes into milk. it is also contraindicated during breastfeeding. If a woman who is breastfeeding must take Phezam for any reason, then the baby should be transferred to artificial mixtures.

Interaction with other drugs

Phezam, when taken simultaneously, enhances the effect of sedatives, other nootropics, antihypertensives and alcoholic beverages. Moreover, Phezam enhances only the inhibitory effect on the central nervous system of all the listed groups of drugs.

Taking drugs that dilate blood vessels and lower blood pressure. causes all Phezam effects to be enhanced. Accordingly, drugs that narrow blood vessels and increase pressure, on the contrary, weaken the effects of Phezam.

Phezam improves the subjective tolerance of drugs from the group of neuroleptics and antidepressants.

Phezam: before or after meals - how to take

In many instructions for the use of Phezam, which are available on the leaflets, the inserts do not indicate how to take the drug with respect to food intake. Usually, if it is not specifically indicated how to take the drug - before, during or after a meal, this means that it can be used regardless of food, at any convenient time. This rule is also true for Phezam, which can really be taken regardless of food intake at any time convenient for a person.

However, experienced doctors or people who have used this drug repeatedly recommend taking it half an hour after eating. This option was chosen empirically as the optimal one, when they tried various ways of taking Phezam - during, before or after meals. The empirical conclusion that it is best to take Phezam half an hour after a meal is based on the fact that it is with this option that side effects are the least likely to develop, and the drug is well tolerated.

If Phezam needs to be taken several times a day, and full meals are not possible for some reason, then you can just have a snack with something, for example, an apple, a banana, nuts, a bun, a sandwich, etc. instead of lunch, afternoon tea or dinner. A small amount of food that has entered the stomach will completely replace a full meal in terms of minimizing the discomfort from the use of Phezam. Remember that the phrase "after a meal" does not mean that you must consume a complete lunch, dinner, breakfast or afternoon snack from your point of view. It only means that before taking the drug, you need to eat something, for example, a piece of bread, fruit, a sandwich, a piece of jelly or cold meat from soup, etc.

Phezam children

Phezam is used for therapy in children older than 5 years of age. If necessary, the use of Phezam in children from one year is allowed.

Phezam in children and adolescents normalizes sleep, eliminates nightmares, stops night awakenings, and reduces fatigue. increases efficiency, both mental and physical, and also relieves irritability. emotional instability, mood lability and excessive vulnerability. In addition, Phezam reduces the frequency of headaches in children, improves adaptation in a school or preschool team, stabilizes and maintains normal blood pressure, preventing its jumps. In general, Phezam normalizes the neuropsychic status of children, especially those suffering from various disorders of the emotional-volitional sphere.

Currently, as a rule, Phezam is used to eliminate poor sleep, irritability, tearfulness, mood instability, hysteria, poor concentration and other mild disorders of the emotional-volitional sphere in children of early and school age. The drug is usually prescribed by a neurologist. and not a psychiatrist, since it is not suitable for the treatment of severe mental illness, but it can be successfully used to eliminate minor disorders.

After the course of application, the child becomes balanced, less whiny, focused, attentive, he is not so quickly and easily upset, his mood does not change within one minute several times, he sleeps much more calmly at night, and mastering speech and other skills is more successful and faster. . Such positive changes, combined with good tolerability of the drug, allow doctors and parents to consider Phezam an effective drug and use it to improve mental performance and development of children.

In addition, Phezam is successfully used in children for the treatment of perinatal lesions of the central nervous system, recovery from traumatic brain injuries and past infectious diseases. In such situations, the drug normalizes brain function, reduces headaches, stabilizes night sleep, and also improves adaptation in a team and learning ability. Phezam can also improve the condition and promote the recovery of children with autism and mild neurological disorders.

Phezam side effects

Phezam is overwhelmingly well tolerated and rarely causes side effects. According to international standards, all side effects are classified into several groups depending on the frequency of their occurrence. Regarding Phezam, it was found that all side effects are recorded either sometimes or rarely. Moreover, “sometimes”, according to the international classification, means that the effect develops in less than one person out of a hundred, but more than 1 out of 1000. And “rarely” means that a side effect develops in more than 1 person out of 10,000 , but less than 1 in 1000. All Phezam side effects are transient, that is, they disappear on their own after the drug is discontinued and do not require any special treatment.

The side effects of Phezam include the following symptoms from various organs and systems:

1. From the side of the central nervous system:

• Hyperkinesis (twitching of limbs, excessive movements, etc.);
• Nervousness;
• Drowsiness;
• Depression;
• Dizziness;
• Headache;
• Ataxia (impaired coordination of movements);
• imbalance;
• Insomnia;
• Confusion;
• Excitation;
• Anxiety;
• hallucinations.

2. From the gastrointestinal tract:

• Disinhibition of sexual behavior;
• Increased sexual desire;
• Increase in body weight;
• Tremor of the limbs;
• Increased muscle tone.

Contraindications to the use of Phezam

There are relative and absolute contraindications to the use of Phezam. Absolute conditions are those in which the drug cannot be used under any circumstances. And contraindications are relative, in which the drug can be used with caution and under the supervision of a doctor.

Absolute contraindications to the use of Phezam are the following diseases and conditions:

• Severe renal failure. at which the creatinine clearance is less than 20 ml / min;
• severe liver failure;
• Psychomotor agitation present at the time of administration of the remedy;
• Chorea of ​​Huntington;
• Acute hemorrhagic stroke;
• Pregnancy;
• Breast-feeding;
• Age under 5 years;
• Sensitivity or individual intolerance to the components of the drug.

Relative contraindications to the use of Phezam are the following conditions or diseases:

Phezam - analogues

Currently, there are analogues and synonyms of Phezam on the pharmaceutical markets of Russia and the countries of the former USSR. Synonyms are called drugs containing exactly the same active substances as Phezam. Analogues are drugs containing various active substances (not the same as in Phezam), but having similar therapeutic and pharmacological effects.

Today, the following preparations-synonyms of Phezam are on sale:

• Combitropil capsules;
• NooKam capsules;
• Omaron tablets;
• Piracesin capsules.

Phezam's analogues are the following drugs:

1. Acefen tablets;

2. Bravinton concentrate;

3. Vero-Vinpocetine tablets;

6. Vinpocetine forte tablets;

26. Nooklerin solution;

27. noopept tablets;

28. Nootropil capsules, tablets and solution;

29. Omaron tablets;

30. Pantogam syrup and tablets;

31. pantocalcin tablets;

32. Picamilon tablets and solution;

33. Piracesin capsules;

39. Celestab capsules;

40. Cellex solution;

41. Ceraxon solution;

42. Cerebrolysate solution;

44. Encephabol tablets and suspension;

45. epithalamin powder;

46. Escotropil solution.

V.P. Erichev, M.N. Efimova, L.V. Yakoubova
Preliminary data about the use of Phezam for the treatment of glaucomatous optic neuropathy is presented in the article. After the treatment course of Phezam a considerable part of the patients hasn’t been noted to have a depression of visual field for one year.
Treatment of glaucomatous optic neuropathy (GON) is one of the components of the complex treatment of glaucoma. Previously, cinnarizine (a calcium antagonist) and piracetam (a nootropic drug) were widely used for this purpose. The appearance in clinical practice of Phezam (Balkanpharma), which is a combination of cinnarizine 25 mg and piracetam 400 mg, makes it possible to achieve a simultaneous combination of the positive qualities of the two drugs in one medication. Therapy with the combined drug Phezam allows to reduce the number of tablets in comparison with the separate intake of cinnarizine and piracetam and thereby reduce the cost of treatment, increase the patients' compliance with the prescribed therapy.
It is known that Phezam has a multicomponent effect: antihypoxic, metabolic (nootropic) and vasodilating. In neurological practice, the drug is widely used to treat patients with chronic forms of cerebrovascular accident, as well as to prevent migraine and headaches of various origins. Doppler studies conducted with the use of Phezam showed a statistically significant improvement in hemodynamic parameters in the cerebral vessels.
The purpose of this study is to study the effect of Phezam on the stabilization of visual functions in patients with glaucoma.
Material and methods
The study included 46 patients with primary open-angle glaucoma (POAG) with normalized intraocular pressure (IOP). A total of 62 eyes were examined. The mean age of the patients was 68±2.4 years, of which 18 were men and 28 were women. 15 eyes were examined with the initial stage of POAG (group I), with advanced stage - 28 (group II) and with advanced stage - 19 eyes (group III).
The average level of IOP at the beginning of the study was 18.2±1.4 mm Hg. IOP was normalized in 28 cases with local antihypertensive therapy, in 6 cases after laser trabeculoplasty, and in 28 cases after antiglaucoma surgery.
All patients before and after treatment underwent a comprehensive examination according to the generally accepted method, including visometry, biomicroscopy, ophthalmoscopy, and tonometry.
The visual fields were examined by kinetic perimetry on a hemispherical perimeter (Carl Zeiss, Jena). According to the schemes obtained, the total value of the field of view in degrees along 8 meridians was calculated.
Static perimetry to determine the state of the central field of vision was performed on a Humphrey II 750 visual analyzer (USA).
The Central Threshold Test (Program Central 30-2) was performed twice for baseline setting and twice each time for control studies. Tests performed with a fixation loss of 20% or more and with 33% or more false positives and negatives were excluded as not being valid. The test results were evaluated in the numerical and gray scale formats standard for threshold test results of the visual field analyzer.
The overall visual field depression was assessed in 4 quadrants as the sum of the threshold values ​​of all tested points in dB from printouts in numerical format.
Control examinations were carried out immediately after the end of the course of treatment, then after 6 and 12 months. upon completion of the course of treatment.
In 22 patients (34 eyes), chronic cerebral ischemia was diagnosed as a concomitant pathology on the basis of anamnestic and clinical signs of cerebrovascular disease (headaches, noise in the head, dizziness, sleep and mood disturbances, increased fatigue, irritability, memory loss). arterial hypertension and atherosclerosis of the vessels of the brain and heart with coronary heart disease, as well as a history of transient disorders of cerebral circulation.
Phezam was prescribed 1 capsule 3 times a day for 3 months.
Statistical analysis used the Student's test.
Results and discussion
The study was successfully completed by 43 patients (58 eyes). Two patients dropped out of the study due to the lack of normalization of ophthalmotonus against the background of local antihypertensive therapy, which is associated with the natural course of the glaucoma process. One patient discontinued treatment due to side effects.
As a result of the treatment with Phezam, no significant increase in visual acuity (VA) was noted, regardless of the stage of the glaucoma process (Table 1). At the same time, a clinically significant decrease in visual acuity by 0.2 was observed in 2 patients with advanced POAG who had previously undergone surgical treatment for glaucoma. The deterioration of VA in this case may be associated with the progression of cataracts that were present before the start of the study, since no other objective data, including significant changes in visual fields during kinetic and static perimetry, were found in these patients.
When assessing the effect of Phezam on the total value of visual fields in patients with POAG, the following results were obtained (Table 2). As can be seen from the above data, Phezam's course intake did not have a statistically significant effect on the studied parameter in patients with initial and advanced stages of glaucoma (groups I and III) over the entire observation period. However, intragroup analysis showed some improvement in this indicator in individual patients.
Unlike patients of groups I and III, patients with advanced stage of glaucoma (group II) showed a statistically significant increase in the total value of visual fields after the end of Phezam treatment. The expansion of the peripheral boundaries of the visual field by 20-40 degrees (on average by 25.0 ± 2.8) by the end of the course of treatment was noted in 19 cases (73%).
The change in the general depression of the visual fields during treatment with Phezam was assessed in four quadrants. The sum of the threshold values ​​of all tested points, determined by four quadrants depending on the stage of POAG at different times of observation, is presented in Table 3.
The data presented in Table 3 show that the overall decrease in the sensitivity of the central visual field in the four quadrants in all groups did not change significantly over the entire observation period. However, the analysis of these changes in individual patients showed a decrease in the general depression of sensitivity in patients with advanced glaucoma (8 cases, 34%) due to a decrease in the number of relative defects of various intensity depths (from 25 to 40 dB), especially superficial ones.
In patients with the initial stage of glaucoma, the change in overall sensitivity was small. This seems logical, given that in the majority of patients with the initial stage of glaucoma, with clinical manifestations of GON, only a general depression of the visual field was observed without detection of localized deep defects or areas of reduced sensitivity in the Bjerrum area.
The appointment of Phezam made it possible to speak about the stabilization of visual functions within 12 months after the end of the course of treatment in 83% of patients with initial, 78% with advanced and 56% with advanced stages of the glaucoma process (Table 4).
conclusions
1. Influence of a single course of taking Phezam for 3 months. on the visual functions of patients with POAG, regardless of the stage of the disease, can be considered as a stable positive trend. Nevertheless, a positive dynamics of the studied parameters was noted both in the groups as a whole and in individual patients after 6 months. from the start of treatment.
Patients with advanced stage of glaucoma (group II) showed a statistically significant increase in the total value of visual fields after the end of a 3-month course of treatment with Phezam.
2. The conducted study showed Phezam's good tolerability and safety. Discontinuation of the drug was required only in 1 patient due to sleep disturbance.
3. The data obtained suggest that the repeated course use of Phezam after 5-6 months. after the end of the first course of treatment will achieve a more pronounced and stable clinical effect. In this regard, we consider it appropriate to further conduct studies of Phezam in the complex therapy of patients with POAG.

Literature
1. Kabanov A.A., Boyko A.N., Eskina T.A. et al. The use of Phezam in patients with chronic forms of circulatory disorders // Neurological journal - 2004. - No. 2. - P.30-36.
2. Shamshinova A.M., Volkov V.V. Functional research methods in ophthalmology.- M.: Medicine, 1998.- 415 p.
3. Flammer J. Glaucoma. - Huber, Bern, 2001. - R. 118
4. Mikelberg E., Drance S. The mode of progression of visual field defects in glaucoma // Am. J. Ophthalmol. - 1984. - Vol. 106. - P. 443-445.

The combination of piracetam and cinnarizine improves both blood circulation and metabolism of brain neurocytes, auditory and visual analyzers, contributing to the process of resuming their function. Both components mutually potentiate the action aimed at reducing vascular resistance, increasing the resistance of neurocytes in conditions of ischemia. The main mechanism of action is associated with the improvement of metabolic, bioenergetic processes in the nerve cell, an increase in the turnover rate of informational macromolecules and the activation of protein synthesis. Thanks to piracetam, ATP synthesis increases, oxygen utilization in the brain, glycolysis and protein synthesis processes improve; the exchange of phosphatylcholine, phosphadylethanolamine increases; improves GABA-ergic, cholinergic and glutamatergic neurotransmission; the plasticity of the cell membrane increases with aging, the processes of lipid peroxidation are inhibited, and the rheological properties of blood improve. Cinnarizine, blocking the transmembrane transport of Ca2+ into the cell, reduces vascular tone, sensitivity to the vasoconstrictive action of adrenaline, norepinephrine, bradykinin, improves the rheological properties of blood, increases the volume of regional blood flow without the occurrence of steal syndrome, increases the resistance of cells to hypoxia; does not affect blood pressure and heart rate, potentiates the anti-ischemic effect of piracetam. By preventing excessive overload of neurocytes, Ca2+ interrupts the rapid reactions of the glutamate-calcium cascade, which underlie neurocyte damage.
The combined drug is rapidly and completely absorbed from the gastrointestinal tract. Cinnarizine reaches maximum plasma concentrations 1 hour after oral administration. Completely metabolized, 91% bound to plasma proteins. 60% is excreted unchanged in the feces, the remaining amounts are excreted in the urine as metabolites. The maximum plasma concentration of piracetam is reached after 2-6 hours. It freely penetrates the blood-brain barrier.

Phezam indications for use

The use of Phezam is indicated for:

• disorders of cerebral circulation: atherosclerosis of cerebral vessels, which is accompanied by ischemic stroke; during the rehabilitation period after a traumatic brain injury;
• impaired memory, thinking function, concentration of attention;
• vascular dementia;
• mood disorders (with depression and irritability);
• encephalopathy of various origins;
• labyrinthopathy of various origins (dizziness, tinnitus, nystagmus, nausea, vomiting); Meniere's syndrome;
• in the complex treatment of sensorineural hearing loss;
• in the complex treatment of visual dysfunctions in open-angle glaucoma with stabilized intraocular pressure, macular degeneration, complicated high myopia;
• in the complex treatment of hypertension (arterial hypertension);
• in the complex treatment of neurocirculatory dystonia;
• for the prevention of kinetosis;
• to improve learning and memory in children with intellectual retardation.

The use of Phezam

Depending on the severity of the disease, adults are prescribed 1-2 capsules 3 times a day, children - 1-2 capsules 1-2 times a day for 1-3 months.

Contraindications to the use of Phezam

Hypersensitivity to the components of the drug, severe renal failure, I trimester of pregnancy and lactation, age up to 5 years.

Side effects of Phezam

Very rarely - hypersensitivity reactions (skin rash, photosensitivity).

Special instructions for the use of Phezam

Be wary appoint in diseases of the liver and kidneys. In severe renal failure, do not prescribe in high doses, even if the patient is on chronic hemodialysis.
The drug can give a false positive result during doping control of athletes, as well as in the determination of radioactive iodine (due to iodine-containing dyes in the capsule shell). During treatment with Phezam, alcohol should be avoided. Use with caution in patients with Parkinson's disease.
Despite the lack of data on the teratogenic effect of the drug, it is not recommended to use it in the first trimester of pregnancy and during lactation.

Phezam drug interactions

With simultaneous administration, it is possible to potentiate the sedative effect of drugs that depress the central nervous system, tricyclic antidepressants and alcohol, as well as nootropic and antihypertensive drugs. Vasodilators enhance the effect of the drug, and increase blood pressure - weaken.

Phezam overdose, symptoms and treatment

Irritability (in children).

Phezam storage conditions

In a dry, dark place at temperatures up to 25 ° C.

List of pharmacies where you can buy Phezam:

• St. Petersburg