Riboxin Renewal 200 mg, 50 film-coated tablets (Update)

As Viktor Maleev, adviser to the Research Institute of Epidemiology of Rospotrebnadzor, told RBC, effective means have not yet been created in the world and doctors use combinations of existing ones to treat coronavirus. The Ministry of Health specified which ones in the list of recommended drugs. These included hydroxychloroquine, interferon, lopinavir and ritonavir.

At the beginning of September, the Ministry of Health released the updated, eighth version of recommendations for the prevention, diagnosis and treatment of the new coronavirus infection COVID-19. Available infographics are published on the ministry’s website.

As experts note, the drugs umifenovir and recombinant interferon alpha (IFN-α) can be used to prevent coronavirus. After contact with someone infected with SARS-CoV-2, you should take hydroxychloroquine.

The material was commented on and checked by Natalya Valerievna Polenova, candidate of medical sciences, family doctor, cardiologist, pediatric cardiologist, nutritionist at GMS Clinic.

What we know about COVID-19

COVID-19 is an infectious disease caused by the coronavirus SARS-CoV-2. Discovered in China at the end of 2021, by May 15 it had infected 4.4 million people worldwide. Most of those with symptoms complain of fever, cough and difficulty breathing. Special medications and vaccines against COVID-19 have not yet been developed. However, virologist and head of the MIPT genome engineering laboratory Pavel Volchkov said that the first effective cure for coronavirus infection may appear in the fall.

In general, the Ministry of Health recommends the use of six drugs to treat coronavirus. these are favipiravir, remdesivir, umifenovir, hydroxychloroquine, azithromycin and interferon alfa.

Riboxin or Mildronate – which is better for the heart?

Manufacturer: GRINDEX (Latvia)
Release form: capsules

Active ingredient: meldonium

Both drugs have different active ingredients, but the same therapeutic effect. Riboxin is involved in the processes of glucose processing by the body, due to which the energy balance in the cellular structures of the myocardium is improved.

The action of its analogue Mildronate is to stimulate enzymatic activity, which leads to an increase in the energy potential of the body. For the heart, the best drug is Meldonium. Its effect on the heart muscle gives good results, and in practice it has proven its effectiveness in the treatment of cardiac diseases.

Hydroxychloroquine and mefloquine

Doctors have been using drugs based on chloroquine for more than 70 years to treat malaria and autoimmune diseases (for example, systemic lupus erythematosus). Scientists have found that the active substance is also effective against the SARS-CoV-2 virus. In March, the Chinese holding Shanghai Pharmaceuticals provided Russia with the drug hydroxychloroquine (a derivative of chloroquine) for the treatment of COVID-19. The Ministry of Health did not identify any contraindications and allowed its use, donating more than 68 thousand packages to hospitals, despite the fact that hydroxychloroquine is not registered in Russia.

Scientists are still arguing about the validity of using hydroxychloroquine. Research by French infectious disease specialist Didier Raoult showed positive results. But the Associated Press published data from American studies. An analysis of medical records of patients treated with the drug showed that hydroxychloroquine was less effective than standard treatments.

In April, the Federal Medical and Biological Agency of the Russian Federation conducted clinical trials of mefloquine (an analogue of hydroxychloroquine approved in Russia). Scientists found out how effective and safe this antimalarial drug is. According to preliminary data from a study involving 347 patients, after using mefloquine, positive dynamics were noted in 78% of cases. The FMBA will provide its final conclusions at the end of May.

pharmachologic effect

Manufacturer: TATHIMPHARMPREPARATIONS (Russia)
Release form: tablets, solution for intravenous administration

Active ingredient: inosine

Analogs: Preductal, ATF, Lindaxa

Riboxin improves metabolic processes in the myocardium, increases the supply of oxygen to the cellular structures of the heart muscle, and restores the rhythm of heart contractions.

Lopinavir and ritonavir

A combination of antiviral drugs called kaletra is used to treat HIV. According to WHO, the use of the drug in combination with other medications is effective in the fight against coronavirus. At the end of January, the Ministry of Health included lopinavir with ritovinar in the list of drugs recommended for COVID-19 as antiviral therapy. As a result, the demand and sales of kaletra increased tenfold. Experts warn that uncontrolled use of the drug without a doctor's prescription can cause harm to health, including diarrhea and liver damage.

Chinese scientists have found that lopinavir and ritonavir are not effective in treating mild to moderate COVID-19. Taking medications does not improve the clinical picture; moreover, it may cause side effects. The experiment involved 86 patients, of which 34 people took a combination of lopinavir and ritonavir, and 17 patients did not receive any drugs. After two weeks, both groups showed similar results, but those taking the medications experienced side effects.

Detoxification products

The main purpose of detoxification pharmaceuticals is to bind and remove alcohol residues, its breakdown products and other toxic particles. Detoxification does not cure alcoholism, it only helps the body quickly cope with poisoning,

The following groups of detoxification drugs are most often used to overcome binge drinking:

• Absorbents designed to collect and retain toxins on their surface or in their pores. The most striking representative is activated carbon. This is a cheap, natural, safe and quite effective first aid remedy for alcohol poisoning. It is taken at the rate of 1 capsule or tablet per 10-12 kg of weight. The maximum single dose is 15 tablets. Enterosgel, Smecta, Polysorb can be used as absorbents. They are available in tablet or powder form and are taken orally.
• Infusion detoxification solutions. Prescribed to increase blood volume and accelerate the removal of toxins from excess fluid through the kidneys. In this case, crystalloid (based on sodium chloride), colloid solutions - polyglucin, reopliglucin, hemodez, gekodez, and other plasma substitutes can be used. Administered intravenously.
• Laxatives and emetics. The greatest effect is provided by fast-acting medications - castor oil or 25% magnesium sulfate solution.

You need to understand that taking laxatives and absorbents is justified only in cases of minor poisoning or short-term binge drinking, in which there is no significant deterioration in well-being. In all other situations, infusion therapy is required.

Remdesivir

Remdesivir is used to treat Ebola fever. Canadian scientists from the University of Alberta have found that the drug blocks the reproduction of coronavirus. Studies have proven the effectiveness of the antiviral agent in the treatment of MERS respiratory syndrome and SARS-CoV, the RNA structure of which is similar to coronavirus. Virologists obtained identical results in the case of SARS-CoV-2, which causes COVID-19, and concluded that remdesivir could be used for treatment. The New England Journal of Medicine also published the results of a study in which the use of the drug improved the condition of 68% of patients. Japanese Prime Minister Shinzo Abe said in parliament on April 28 that he plans to authorize the use of remdesevir to treat COVID-19. In the United States, the drug was successfully tested, and on May 2, the Department of Sanitary Inspection issued an emergency permit for its use.

Riboxin or Asparkam – which is better?

Manufacturer: MEDISORB (Russia)
Release form: tablets

Active ingredient: potassium aspartate, magnesium aspartate

Both drugs are used for various cardiac diseases. Riboxin is better suited for stabilizing metabolic processes. Its use is preferable for ASD (heart disease in the form of a ventricular septal defect). With this pathology, Riboxin strengthens the walls of the myocardium and improves oxygen supply to the heart muscle.

If there is an electrolyte imbalance, that is, a lack of potassium and magnesium in the blood serum, Asparkam will be the best analogue for the heart. It stimulates the contractility of the heart muscle, which leads to positive results in myocardial function.

Recommendations for the treatment of heart disease always remain with the cardiologist. In this case, self-medication is unacceptable. The prescription of Riboxin or its analogues is based on mandatory examination of patients through laboratory and instrumental examination.

Only a doctor can prescribe quality therapy and answer the question: how to replace Riboxin in various pathological processes in the heart muscle.

APN01

The Austrian biotechnology company APEIRON Biologics AG has begun clinical trials of the drug APN01, which was developed in the early 2000s. Scientists have discovered that the ACE2 protein, which is part of it, suppresses infections caused by viruses of the SARS group. It also helps protect the lungs during respiratory failure.

The authorities of Austria, Germany and Denmark agreed to conduct clinical trials of the drug. During the study, 200 patients with COVID-19 will receive APN01. Then virologists will evaluate the effect of the drug, and also analyze its effectiveness and safety for patients who require artificial ventilation.

Adjuvant therapy

When recovering from a drunken state, great attention is paid to stabilizing the functioning of internal organs.

In this case, the following may be prescribed:

• Pharmaceuticals containing sodium, potassium, calcium, magnesium - these minerals are necessary for the functioning of internal organs, and with prolonged alcoholism, their deficiency occurs. A prominent representative of this group’s means of breaking up binge drinking is Methusol. Administered intravenously, it has a rehydrating, diuretic, detoxifying, and antioxidant effect. With its help, rapid replenishment of circulating blood volume during hypovolemia is achieved, blood viscosity is reduced, its rheological properties are improved, and tissue dehydration is prevented. Exhibits a hemodynamic effect, promotes cell adaptation to lack of oxygen.
• Hepatoprotectors necessary for the protection and restoration of liver cells. This can be Heptral, Essentially, administered intravenously. An excellent effect is provided by Remaxol®, containing succinic acid, meglumine, riboxin, methionine, nicotinamide, sodium, potassium, magnesium chlorides, sodium hydroxide. It reduces bilirubin, improves the release of direct bilirubin into bile and the oxidation of cholesterol.
• Nootropics – improve brain function. The most commonly administered drug is Piracetam.

Ribavirin

It is quite difficult to assess the effectiveness and safety of ribavirin. On the one hand, this drug inhibits the reproduction of the vast majority of viruses, on the other, the mechanism of action of ribavirin is not fully understood. At the end of January, the Ministry of Health recommended the use of this antiviral drug to treat coronavirus. It is prescribed to children for respiratory syncytial infection (a rare type of acute respiratory viral infection), which causes severe lung damage. The drug is used for severe influenza, for measles in children with immunodeficiency, and in combination with interferon ribavirin to treat viral hepatitis C.

However, Academician of the Russian Academy of Sciences Alexander Chuchalin criticized the recommendations of the Ministry of Health. When prescribing the drug to adults, it is necessary to take into account its teratogenicity (threat of disruption of embryonic development), therefore ribavirin is strictly contraindicated during pregnancy. Despite the fact that the drug inhibits the reproduction of many viruses, it is very toxic and causes many side effects.

At the end of March, the Ministry of Health excluded ribavirin from the list of recommended drugs for the treatment of COVID-19.

Ivermectin

Australian scientists from Monash University and the Royal Melbourne Hospital have discovered an antiparasitic agent that virtually destroys the SARS-CoV-2 virus within 48 hours, reducing its presence by 99%. According to researchers, the use of ivermectin will help avoid severe complications of COVID-19, as well as prevent the spread of the virus. During the experiments, ivermectin was added to cells infected with SARS-CoV-2. After 24 hours, the proportion of viral RNAs decreased by 93%, and after 48 hours, the presence of the virus decreased by 99%.

A single treatment with ivermectin can reduce the virus by 5 thousand times in 48 hours, scientists say. The drug is approved by WHO.

Reviews

Mikhail, 28 years old (Omsk) I have been involved in strength sports for a long time. Initially, to increase the body’s resistance to physical activity, the trainer recommended using Riboxin. Maybe, of course, he helped, but it was unnoticeable to me. I felt the difference only after I was offered to replace Riboxin with Mildronate. After using it for 2 weeks, I can train much longer, fatigue has disappeared, and the effectiveness of training has increased.

Irina Vitalievna, general practitioner (Norilsk) It is very difficult to say what is better than Riboxin or drugs that have a similar effect to it. If we talk about structural analogues of Riboxin, then there is practically no difference in effectiveness. In this case, you need to pay attention to additional substances and price. Some patients prefer to be treated with expensive medications, others choose cheap domestic ones. As for drugs that have a composition different from Riboxin, an individual approach is required. Each medicine is aimed at getting rid of certain diseases, but only has its own contraindications and side effects.

Svetlana Maksimovna, 64 years old (Belgorod) I have been suffering from chronic coronary heart disease (angina) for a long time. To maintain my health, I took Inosie-F as prescribed by my doctor. The medicine is produced in Taiwan and is quite expensive. I am a pensioner, my pension is small, there is no one to help me. Recently, a friend told me that there is a domestic substitute for Inozie-F - Riboxin, which costs a penny. I decided to try it. The result pleased me. The effect of the drugs is the same, but the price of Riboxin is much lower.

Nelfinavir

Nelfinavir is used in combination with other antiviral drugs to treat HIV. The study was carried out by Japanese scientists. According to the data obtained, the drug is able to block the reproduction of SARS-CoV-2. Virologists studied nine similar drugs and found that nelfinavir is effective even in small doses. Therefore, it is recommended to include it in the list of potentially effective drugs for the treatment of COVID-19.

What to do while there is no vaccine

• wear medical masks when visiting public places;
• on the street and in crowded places, maintain a distance of at least 1.5 m from others;
• avoid contact with people who have been exposed to the virus;
• stay at home if possible;
• wash your hands thoroughly with soap;
• use a disinfectant with an alcohol content of at least 60%;
• do not touch your face;
• monitor hygiene in the house.

Expert commentary

What medications, besides antiviral drugs and antibiotics, are recommended for the treatment of COVID-19 by the Russian Ministry of Health?

According to the eighth version of the resolution “Prevention, diagnosis and treatment of new coronavirus infection (COVID-19)” of the Ministry of Health of the Russian Federation, patients infected with the SARS-CoV-2 virus should receive pathogenetic and supportive symptomatic therapy if necessary. The first group of drugs includes, first of all: glucocorticosteroids (GCS), interleukin inhibitors (tocilizumab, canakinumab), anticoagulants (enoxaparin, fraxiparin).

Glucocorticosteroids are able to prevent the release of cytokines, substances responsible for the development of a violent inflammatory reaction, which can lead to a very dangerous complication “cytokine storm”. GCS may be useful in the treatment of severe forms of COVID-19 to prevent irreversible tissue damage and uncontrolled multiple organ failure.

It should be noted that for mild to moderate severity of the disease, that is, for patients not receiving oxygen, GCS are not indicated. So there is not the slightest need to buy hormones from pharmacies for use at home.

Drugs from the group of cytokine inhibitors are used when the lung parenchyma is damaged by more than 50%, that is, stage CT-3, CT-4 in combination with signs of increasing intoxication: long-term fever, very high levels of inflammatory markers in the blood.

In groups of patients at high risk of thrombus formation, for the prevention of so-called coagulopathies, it is advisable to prescribe anticoagulants used subcutaneously. Evidence of the effectiveness of oral anticoagulants for COVID-19 is not yet sufficient, however, if the patient was taking them before the disease, the drug should be continued until then. High-risk groups include patients with cardiovascular pathology, diabetes, and obesity.

How is symptomatic treatment of coronavirus carried out?

Drugs for symptomatic treatment of COVID-19 include antipyretic drugs, antitussive drugs that improve sputum discharge. Paracetamol is recognized as the safest antipyretic drug.

There is no need to wait until a certain level of fever is reached before using an antipyretic drug. In the presence of headache and muscle pain, poor tolerance to symptoms of intoxication and fever, it is possible to use drugs even at a relatively low body temperature.

What can you take to prevent coronavirus?

The most important characteristics of a diet that helps strengthen the immune system are: adequate daily calorie intake, sufficient intake of protein and a number of micronutrients, especially vitamin C, D, A, iron and zinc, increased intake of dietary fiber and, if necessary, probiotics, maintaining water balance. According to the clinical recommendations of the Russian Association of Endocrinologists, to prevent vitamin D deficiency in adults aged 18-50 years, it is recommended to receive at least 600-800 IU of the vitamin per day. People over 50 years old - at least 800-1000 IU of vitamin D per day.

There are some indirect indications of zinc's potential antiviral effect against COVID-19, although their biomedical relevance remains to be explored. Based on recent data on the clinical course of the disease, it appears that zinc may have protective effects against COVID-19 by reducing the incidence of pneumonia, preventing ventilator-induced lung injury, and improving antibacterial and antiviral immunity, especially in older adults.

Ascorbic acid (vitamin C, AA) takes part in such vital physiological processes as hormone production, collagen synthesis, stimulation of the immune system, etc. The latter effect can be due to both the direct antiviral effect of AA and its anti-inflammatory and antioxidant properties.

Riboxin's analogues

It is not always possible to prescribe Riboxin to patients with concomitant diseases in case of cardiac dysfunction. It is possible to carry out high-quality treatment of cardiac pathology with the help of various drugs analogues of Riboxin, which give an equivalent therapeutic effect. In pharmacies, such medications are sold under the guise of:

• generics;
• synonyms;
• combination medications with a similar mechanism of action.

New generation analogues of Riboxin successfully relieve pathological symptoms, improving cardiac function.

Table of Riboxin analogues with price and country of origin

A large selection of Riboxin analogues in tablets helps the doctor to efficiently treat cardiac patients and achieve stabilization of the pathological process.

What else can replace Riboxin, what analogues are available in the pharmacy chain? The list can be supplemented with the following medications:

• Lindax;
• Rimecore;
• Indrinol;
• Triducard MV;
• Cardionate;
• Deprenorm MV.

Such a wide selection of Riboxin substitutes allows the doctor to adjust drug therapy for various heart pathologies and improve its functionality.

Trimetazidine

Manufacturer: ALSI Pharma (Russia)
Release form: tablets

Active ingredient: trimetazidine

The drug stimulates metabolic processes in the heart muscle, prevents oxygen starvation and regulates the ion transport of potassium and magnesium in the cellular structures of the myocardium. Thanks to the action of Trimetazidine, capillary blood flow improves, which promotes regression of the ischemic area of ​​the heart muscle.

This analogue of Riboxin is used, 1 tablet 2-3 times a day. The course of therapy is determined by the doctor depending on the type of disease and the degree of its activity.

Preductal

Manufacturer: SERVIER (Russia)
Release form: tablets, capsules

Active ingredient: trimetazidine

Preductal has a positive effect on local metabolism, stimulating it. By improving the nutrition of the heart muscle, intracellular acidosis and the area of ​​myocardial damage are reduced. The action of the analogue does not lead to changes in hemodynamic parameters.

The drug is prescribed 1 tablet 2 times a day, and capsules 1 time a day, as they have a prolonged effect. The duration of treatment is determined individually.

ATP

Manufacturer: MICROGEN (Russia)
Release form: solution for intramuscular and intravenous administration

Active ingredient: triphosadenine

ATP is a natural component of body tissues, which ensures the normalization of metabolic processes. The analogue improves coronary circulation and impulse conduction of the heart, helping to restore heart rhythm.

Depending on the degree of activity of cardiac pathology, the drug is prescribed intramuscularly at 1.0 ml 1 time per day, followed by increasing the dosage as recommended by a doctor. The IV analogue of Riboxin is administered only in a hospital setting in a dosage of 1.0 to 5.0 ml.

Riboxin LekT

Manufacturer: TYUMEN HFZ (Russia)
Release form: tablets, solution for intravenous administration

Active ingredient: inosine

The drug improves metabolism in the heart muscle, increases the supply of oxygen to the myocardium, and restores heart rhythm. Riboxin LekT helps restore capillary blood flow in the area of ​​cardiac ischemia.

The analogue is used orally and intravenously according to a schedule determined by the doctor.

Meldonium

Manufacturer: PHARMSTANDARD-LEKSREDSTVA (Russia)
Release form: capsules

Active ingredient: meldonium

Meldonium is included in the pharmacological group of metabolic drugs. The analogue restores oxygen delivery to the cellular structures of the myocardium. The drug slows down the formation of an ischemic focus, enhances regenerative processes in it and shortens the recovery period after acute myocardial infarction.

An analogue of Riboxin is prescribed orally, 1–2 capsules. The frequency of its administration and the course of treatment are determined by the doctor depending on the type and activity of the pathological process.

Cytoflavin

Manufacturer: POLYSAN NTFF (Russia)
Release form: tablets, solution for intravenous administration

Active ingredient: succinic acid, inosine, nicotinamide, riboflavin

Cytoflavin is a combination drug whose active ingredients are natural metabolites that improve tissue respiration. The analogue has an antioxidant effect and improves the delivery of oxygen to the cellular structures of the body.

The drug gives good results for vascular pathologies of various origins. The medication is prescribed 2 tablets 2 times a day for 25 days.

Ribonosine

Manufacturer: BORISOV MEDICAL DRUGS PLANT (Republic of Belarus)

Release form: tablets and solution for intravenous administration

Active ingredient: inosine

The drug helps to increase the contractility of the heart muscle, resulting in an increase in myocardial stroke volume. Ribonosine has a positive effect on metabolic processes occurring in the myocardium. Under its action, heart rhythm is restored, blood clotting is reduced, and tissue regeneration of the ischemic area is stimulated.

The analogue is taken 1 tablet 3 times a day or 200 mg intravenously 1 time a day. The duration of treatment is recommended by the doctor.