Does Mexidol lower blood pressure or not? Drug review

Composition of the drug and release form

The main substance in the drug is ethylmethylhydroxypyridine succinate in a dose of 125 mg. Among the excipients: magnesium stearate, lactose monohydrate, carmellose sodium. The tablets are coated with a special coating, which consists of white opadry II, polyvinyl alcohol solution, titanium dioxide and talc.

Available in the form of injection solution and tablets. You can buy Mexidol in blister packs of 10 tablets or in jars with a capacity of 90 tablets. The solution is supplied in a dark or transparent ampoule with a special break point. The container contains 2 ml of liquid. Sold in packs of 5 and 10 ampoules.

"Mexidol" in the treatment of hypertension

Simply take 1 or 2 tablets orally, monitoring the result in the form of obtaining the desired pressure readings. The therapeutic effect occurs on average within 10 minutes. The maximum daily dose should not exceed 6 tablets, which is 800 mg. Frequency of use: 2 or 3 times a day. Taking the drug in tablet form should be combined with meals.

The substance is retained in the body for 5 hours; it is metabolized in liver cells and excreted by the kidneys.

Mexidol is administered intravenously by drip, at a rate of 40 to 60 drops per minute. The total duration of the procedure is 5-7 minutes. The content of the drug in plasma is measured after 4 hours, excretion occurs by the kidneys.

For injection, the drug is used in capsules with a 5% solution of the active substance in a volume of 2 ml. By injection, the drug is administered slowly, while the liquid from the ampoule is first diluted with saline solution. The course of therapy includes a course of the drug per day of no more than 1200 mg.

The advantage of Mexidol is the possibility of using it with other drugs that have a psychotropic effect.

Taking it together with sedatives and painkillers will enhance their effect. The dosage and duration of therapy is determined by the attending physician depending on the stage of the disease.

The principle of operation of the product

Whether Mexidol lowers blood pressure or not is best determined based on the principle of action of the medicine. The active substance provides protective properties for membranes and reduces the amount of free radicals. The product has an antihypoxic effect due to the enrichment of the blood flow with oxygen. Has anti-stress and anticonvulsant effects.

The pharmaceutical drug "Mexidol" contains ethylmethylhydroxypyridine succinate as an active ingredient.

The drug is a nootopic drug that improves the quality of mental activity. When consuming Mexidol, memory levels improve, human learning is stimulated and negative external influences are reduced. The drug helps normalize sleep and reduces the rate of onset of degenerative processes in the brain.

"Mexidol" is designed to protect cellular lipids in the membranes from oxidative reactions of the peroxide type. It also has other effects:

• normalizes blood viscosity;
• enhances the synthesis of enzymes to eliminate peroxide radicals;
• promotes restoration and stabilization of membrane structure;
• ensures normalization of cell function;
• accelerates the process of energy release in cell mitochondria;
• stimulates the speed of impulse transmission through synapses;
• restores the level and quality of blood circulation due to the normalization of rheological characteristics;
• reduces the amount of cholesterol in the bloodstream;
• the drug enhances the effects of tranquilizers, antidepressants and antipsychotic drugs. There is a layering of effects when used in parallel with anticonvulsants and hypnotics.

"Mexidol" is a universal drug that helps with neuroses and promotes the resorption of cholesterol plaques on the walls of blood vessels

Does Mexidol lower blood pressure or not? – The drug ensures restoration of blood pressure levels by normalizing the level of viscosity and fluidity of the blood. This provides less resistance to blood being pumped by the heart. It becomes obvious that Mexidol provides not only a decrease in blood pressure, but also its restoration at low levels. But in any case, it should be used only in consultation with a doctor.

pharmachologic effect

Antioxidant agent. Means for the correction of disorders in alcoholism, toxic and drug addiction.

Pharmacokinetics

With intramuscular administration, it is determined in the blood plasma for 4 hours after administration. The time to reach the maximum concentration Tmax is 0.45-0.5 hours. Cmax when administering a dose of 400-500 mg is 3.5-4.0 μg/ml. Mexidol quickly passes from the bloodstream into organs and tissues and is quickly eliminated from the body. The drug retention time (MRT) is 0.7-1.3 hours. The drug is excreted mainly in the urine, mainly in glucurone-conjugated form and in small quantities unchanged.

Pharmacodynamics

It has antihypoxic, membrane-protective, nootropic, anticonvulsant, anxiolytic effects, and increases the body's resistance to stress.
The drug increases the body's resistance to the effects of major damaging factors, to oxygen-dependent pathological conditions (shock, hypoxia and ischemia, cerebrovascular accident, intoxication with alcohol and antipsychotic drugs (neuroleptics)). Mexidol improves cerebral metabolism and blood supply to the brain, improves microcirculation and rheological properties of blood, and reduces platelet aggregation. Stabilizes the membrane structures of blood cells (erythrocytes and platelets) during hemolysis. It has a hypolipidemic effect, reduces the level of total cholesterol and LDL. Reduces enzymatic toxemia and endogenous intoxication in acute pancreatitis. The mechanism of action of Mexidol is due to its antihypoxic, antioxidant and membrane protective effects. It inhibits the processes of lipid peroxidation, increases the activity of superoxide dismutase, increases the lipid-protein ratio, reduces membrane viscosity, and increases its fluidity. Modulates the activity of membrane-bound enzymes (calcium-independent phosphodiesterase, adenylate cyclase, acetylcholinesterase), receptor complexes (benzodiazepine, GABA, acetylcholine), which enhances their ability to bind to ligands, helps preserve the structural and functional organization of biomembranes, transport of neurotransmitters and improve synaptic transmission.

Mexidol increases dopamine levels in the brain. Causes an increase in the compensatory activity of aerobic glycolysis and a decrease in the degree of inhibition of oxidative processes in the Krebs cycle under hypoxic conditions, with an increase in the content of ATP, creatine phosphate and activation of the energy-synthesizing functions of mitochondria, stabilization of cell membranes. Mexidol normalizes metabolic processes in the ischemic myocardium, reduces the necrosis zone, restores and improves the electrical activity and contractility of the myocardium, and also increases coronary blood flow in the ischemic zone, reduces the consequences of reperfusion syndrome in acute coronary insufficiency. Increases the antianginal activity of nitro drugs. Mexidol promotes the preservation of retinal ganglion cells and optic nerve fibers during progressive neuropathy, the causes of which are chronic ischemia and hypoxia. Improves the functional activity of the retina and optic nerve, increasing visual acuity.

Indications for use

The drug is prescribed after examination, a full visual examination and diagnostic measures. Due to the wide range of effects, the substance is prescribed in various cases. Mexidol and pressure are one of the priority areas of action.

Main indications:

• after the onset of ischemia;
• with abnormalities in the blood supply to the brain;
• as a stroke prevention;
• to eliminate unwanted effects after head injuries;
• with vegetative-vascular dystonia;
• at the onset of neurological and psychological disorders and when feeling anxious;
• to eliminate withdrawal symptoms characteristic of alcohol abuse;

The drug suppresses anxiety and fear, lowers lipid levels in body tissues and fluids

• for disorders and pathologies of the central nervous system due to strong psychological or stressful stress;
• to relieve symptoms of myocardial infarction;
• after the onset of purulent foci in the peritoneum;
• used to eliminate severe intoxication;
• for the treatment of glaucoma, regardless of the stage of the disorder.

Mode of application

Mexidol lowers blood pressure in hypertension if used in the form of 250 mg tablets up to three times a day. Using tablets means you need to drink a lot of water. In 1 day, a maximum of 800 mg of the product can be used, which in terms of tablets is 6 pieces. Exceeding the maximum dosage can only occur under the supervision of a specialist.

On average, the course of treatment with Mexidol for low or high blood pressure is about 1 month, but the duration depends on the condition and reason for use.

Considering the fact that Mexidol lowers blood pressure, you should stop the course in several stages so as not to provoke negative consequences. It is recommended to reduce the dosage over 3 days, this will prevent the onset of withdrawal syndrome.

The duration of treatment for coronary heart disease is 2 months. The specialist may prescribe re-use of the drug if the effect is insufficient. It is recommended to reuse in autumn and spring.

You should not take the medicine if the patient has a significantly reduced blood pressure and pulse, which is observed with hypotension and bradycardia

Mexidol reduces blood pressure when used intramuscularly or intravenously. The effectiveness of the injection is higher and the effect occurs faster. The appointment is made only by a doctor. In some cases, 200 ml can be used at a time.

The standard treatment method involves the use of 100 mg of Mexidol 2-3 times a day. If there are no negative effects, an increased dose is prescribed.

Depending on the disease, the dosage varies:

• for traumatic brain injuries, 300 mg 3-4 times a day is used for 14 days;
• to restore high-quality blood circulation in case of hypertension or hypotension, as well as disorders in the head area, use 300 mg 1 time / day for 10 days, using a dropper. The effect can be enhanced by intramuscular administration of half an ampoule 3 times a day;
• after a heart attack, the drug is used for 2 weeks, always as part of a complex;
• for the treatment of glaucoma, it is used for two weeks through intramuscular administration of 1 ampoule twice a day;
• to eliminate alcohol intoxication, drip administration is used 2 times a day for 1 week;
• in severe forms of drug intoxication, 100–200 mg can be prescribed, the course duration is 10 days;
• after pancreatitis, use 400 mg 2 times a day. To end treatment, you should gradually reduce the dosage.

It is recommended to use Mexidol during meals

Ethylmethylhydroxypyridine succinate (Mexidol) was synthesized at the Institute of Biochemical Physics. N.M. Emanuel RAS, studied and developed at the Research Institute of Pharmacology of the Russian Academy of Medical Sciences and the All-Union Scientific Center for the Safety of Biologically Active Substances [1]. The drug has a wide range of pharmacological effects, realized at least at two levels - neuronal and vascular. Thus, Mexidol has antioxidant [2], antihypoxic, anxiolytic [3], antistress, antialcohol [4], anticonvulsant, neuroprotective, nootropic, mnestic, neuropsychotropic, cardioprotective, antiatherosclerotic, antiplatelet, antiparkinsonian, vegetotropic effects [5].

As a result of chemoreactomic modeling of Mexidol, it was revealed [6] that this molecule can exhibit a complex neuroprotective effect due to both direct effects on neurons (activation of acetylcholine and GABA-A receptors, anti-inflammatory, antioxidant effects) and indirect effects (normalization of blood coagulation, antidiabetic and antiatherogenic effects). Indeed, Mexidol is able to modulate receptor complexes of brain membranes, in particular benzodiazepine, GABA, and acetylcholine, enhancing their ability to bind to specific ligands and increasing the concentration of dopamine in the brain [7].

Clinical studies [8–10] have shown a significant therapeutic effect of Mexidol in the treatment of neurological, mental and cardiovascular diseases. Thus, the drug has shown effectiveness in the treatment of neurotic and neurosis-like disorders, various conditions in alcoholism, including withdrawal syndrome, as well as acute and chronic disorders of cerebral circulation (stroke, discirculatory encephalopathy, vegetative-vascular dystonia), disorders of brain function during aging and atherosclerosis.

A significant advantage of Mexidol is its wide spectrum of pharmacological action, low toxicity, virtual absence of side effects (typical, for example, of some “standard” neuropsychotropic drugs), sedative, muscle relaxant, stimulating and euphoric effects [9].

This paper presents the results of a systematic analysis of the clinical use of Mexidol in neurological practice in adults. In the eLibrary and PubMed publication databases, 3624 articles on the study of ethylmethylhydroxypyridine succinate and Mexidol and 507 publications using the keyword “Mexidol” were found. Of these, 52 representative studies of the use of Mexidol in various areas of neurological practice in adults were identified. Data from a systematic analysis indicate the importance of using Mexidol to influence the pathogenetic factors of cerebral ischemia; in the therapy and rehabilitation of patients with cerebral ischemia; in vascular surgery; in the therapy and rehabilitation of patients with degenerative-dystrophic changes in the spine; in the treatment of neurodegenerative diseases, neuropathies caused by metabolic disorders (diabetes, hypothyroidism) and/or infectious diseases, as well as neuropsychological and autonomic disorders.

Effect of Mexidol on pathogenetic factors of cerebral ischemia

The drug affects such important factors in the pathogenesis of cerebral ischemia as hypoxia, high blood pressure (BP), atherosclerosis and chronic inflammation. Complex chemoreactomic modeling of the pharmacological effects of Mexidol in comparison with control molecules (choline alfoscerate, piracetam, glycine, Semax) showed that Mexidol can exhibit acetylcholinergic, GABAergic, anti-inflammatory, neuroprotective and neurotrophic, anticoagulant, hypoglycemic and hypolipidemic properties [6, 11], which counteract pathogenetic factors of cerebral ischemia. Mexidol is distinguished from comparison molecules by a more pronounced safety profile (lesser effects on serotonin, dopamine and adrenergic receptors, lesser degree of interaction with cardiac potassium channels, monoamine oxidase enzymes and cytochromes P450) (see figure).

Chemoreactomic analysis: the main molecular mechanisms of action of Mexidol [6]. COX-2 - cyclooxygenase-2; 5-LOG - 5-lipoxygenase.

The antihypoxic effect of Mexidol is associated with the preservation of red blood cells and stimulation of mitochondrial metabolism. A single dose of the drug (100 mg/kg) before acute stress prevented a decrease in the level of iron in the blood serum [12], which indicates that Mexidol increased the preservation of the structure of erythrocytes. The use of Mexidol in a model of acute hypoxia in rats [13] increased the antioxidant resource of the blood and the stability of mitochondria. The combined use of the arginase inhibitor L-norvaline and Mexidol had a pronounced endothelial-protective effect on the model of nitric oxide (NO) deficiency, which was expressed in an increase in the production of nitric oxide and endothelium-dependent vasodilation [14]. Due to its antiatherogenic effect, Mexidol is able to inhibit the development of hyperlipidemia, lipid peroxidation, and increase the antioxidant resource of plasma, thereby inhibiting atherogenesis [15]. The anti-inflammatory and anticoagulant effect of Mexidol is probably associated with modulation of prostaglandin metabolism [16].

Clinical studies have confirmed the prospects of using Mexidol for arterial hypertension (AH), which is a recognized risk factor for cerebrovascular pathology (WHO, 2011). It is well known that the selection of the most appropriate pharmacotherapy for hypertension, especially in elderly patients, remains an urgent problem, since “standard” therapy for hypertension is based on the use of diuretics, β-blockers, calcium channel antagonists and is associated with a whole range of undesirable side effects.

Mexidol demonstrated antihypertensive properties both during monotherapy and in combination with antihypertensive drugs. The results of a study [17], including men with moderate hypertension working in the Far North, who received Mexidol monotherapy for 2 weeks, showed the antihypertensive properties of the drug, as well as an improvement in the structural and functional state of erythrocytes. In another study [18], patients taking antihypertensive therapy in combination with Mexidol, during treatment, noted faster relief of headaches, dizziness, absence of weakness in the legs, increased exercise tolerance, improved memory and concentration compared to the control group. The hypotensive effect of Mexidol was established [19] in the treatment of young patients with stage I-II hypertension: when Mexidol was used in combination with bisoprolol, more effective correction of blood pressure was observed.

When Mexidol was included in combination therapy for patients with uncomplicated hypertensive crises [20], by the 7th day of treatment, blood pressure returned to normal, headaches and dizziness decreased significantly, and sleep improved.

Mexidol helped reduce depressive symptoms against the background of hypertension. In patients with hypertension and moderate anxiety disorders, the drug had a tranquilizing effect comparable in severity to Grandaxin. The anxiolytic effect of Mexidol was not accompanied by muscle relaxation, did not affect the speed and speed of reaction, and did not cause dependence [21].

The antiatherogenic effects of Mexidol have also been confirmed in clinical practice. In a study [22] of patients over 60 years of age with stage II-III hypertension, its hypolipidemic effect was noted (decreasing the levels of total cholesterol, low-density lipoproteins and increasing the concentration of high-density lipoproteins).

When performing surgical interventions under artificial circulation, Mexidol contributed to a decrease in the systemic inflammatory response, which was manifested by an increase in the concentrations of C-reactive protein (CRP), proinflammatory cytokines: tumor necrosis factor (TNF-α), interleukins (IL-6 and IL-8), as well as leukocytosis, increased erythrocyte sedimentation rate and other markers of inflammation. Lower concentrations of alanine aminotransferase, aspartate aminotransferase, γ-glutamyl transpeptidase, lactate dehydrogenase, creatine phosphogenase and myoglobin in the blood serum of patients receiving Mexidol indicated the organoprotective effect of the drug [23]. These observations suggest that Mexidol may reduce the incidence of neurological complications after operations performed under conditions of artificial circulation.

Ischemic diseases of the brain and Mexidol

The results of fundamental research [10] showed that Mexidol significantly increases local cerebral blood flow in conditions of global cerebral ischemia. The cerebrovascular mechanism of action of the drug is due, in particular, to its effect on the GABA-A receptors of cerebral vessels, since the improvement in blood flow is almost completely neutralized by the combined use of Mexidol and the GABA-A receptor inhibitor bicuculline [24].

Clinical studies have revealed the effectiveness of Mexidol in intensive therapy of acute severe ischemic stroke [8, 25], which is associated with its antihypoxic, neuroprotective and adaptogenic effects. The drug reduced the progression of ischemic penumbra and improved patient scores on the National Institutes of Health Stroke Scale (

National Institutes of Health Stroke Scale - NIHSS) and the Barthel index [26], contributed to the correction of the lipid spectrum and stabilization of hemostasis indicators [27], including in patients with ischemic stroke and type 2 diabetes mellitus [28], and showed its significance in the rehabilitation of patients after stroke [29].

The use of Mexidol in the complex treatment of ischemic stroke in the acute period [30] led to a significant improvement in cognitive, motor, and sensory functions, a decrease in fatigue, anxiety, and improved adaptation to physical activity, assessed using the NIHSS scale, the modified Rankin scale (mRS), and the Hamilton scale. The use of the drug in the complex treatment of patients with the consequences of ischemic cerebrovascular accidents [31] contributed to the regression of neurological symptoms, an increase in the speed of mental reactions, an improvement in speech activity, a decrease in the level of anxiety and an increase in the quality of life of patients.

A randomized, double-blind, placebo-controlled study [32] studying the effectiveness and safety of Mexidol in complex therapy in the acute period of ischemic stroke revealed significant advanced dynamics in the regression of neurological disorders according to the NIHSS scale by the 14th day of the disease compared with the placebo group ( p

<0.05), as well as significant functional recovery on the 21st day (
p
<0.05) in patients included in the study in the first 6 hours of the disease.

Carrying out thrombolytic therapy in combination with the use of Mexidol leads to a significantly faster reduction in the severity of neurological deficit and somatic complications. This combination creates conditions not only for the restoration of neurological functions, but also for the prevention of secondary brain damage reactions [33].

Mexidol therapy [34] improved well-being, memory and mnestic functions, and reduced the level of depression in the recovery period of ischemic stroke in the internal carotid artery system in elderly patients. Before treatment, patients complained of headaches, dizziness, and fatigue. During treatment, the intensity and number of complaints significantly decreased (headache, dizziness, staggering when walking, hearing loss, noise in the head, fatigue, irritability, emotional lability, weather sensitivity, memory loss, sleep disturbance), there was an expansion in the range of social and everyday activities, which indicated the activation of metabolic processes in the brain.

The effectiveness and safety of long-term sequential therapy with Mexidol in patients with hemispheric ischemic stroke in the acute and early recovery periods has been demonstrated. The randomized, double-blind, multicenter, placebo-controlled, parallel-group study EPIKA [35] included 150 patients aged 40 to 79 years, who were divided into two groups using simple randomization: patients in group 1 received therapy with Mexidol 500 mg/day. daily intravenous drip for 10 days, followed by taking 1 tablet (125 mg) 3 times a day for 8 weeks, patients of the 2nd group received placebo according to a similar regimen. At the end of therapy, the average mRS score was lower in group 1 than in group 2 ( p

=0.04).
The dynamics of the decrease in the average score on the mRS (visits 1–5) was more pronounced in group 1 ( p
= 0.023).
The proportion of patients who achieved recovery corresponding to 0-2 points according to mRS (5th visit) was significantly higher in group 1 ( p
= 0.039).
When tested on the NIHSS scale at the 5th visit, the mean value was lower in group 1 ( p
= 0.035).
The decrease in NIHSS score at the end of the course of therapy relative to the initial level in patients with diabetes mellitus was more pronounced in group 1 ( p
= 0.038).
In group 1, in the general population of patients and the subpopulation of patients with diabetes mellitus, the dynamics of improvement in quality of life were more significant and were observed from the 2nd visit. The proportion of patients who had no problems with movement in space was significantly higher in group 1 ( p
= 0.022).

Mexidol in the treatment of chronic cerebral ischemia

Mexidol helps to increase the survival of neurons both in acute ischemia and in conditions of chronic cerebral ischemia (CCI). The results [36] of experimental validation of the direct neuroprotective effect of Mexidol on a model of glutamate stress on cerebellar granule neurons in cell culture are presented. It has been shown that when combined with glutamate (model of acute ischemia), Mexidol significantly increases the survival of neurons (by 8-10% compared to the control). The effect of Mexidol was even more pronounced when it was added at the stage of growing a neuron culture (5-7 days, model of chronic ischemia) [36]: cell survival under conditions of glutamate stress increased by an average of 20%.

Clinical studies [37] have revealed the promise of using Mexidol to reduce the manifestations of asthenic syndrome, psychoemotional disorders and cochleovestibular disorders in patients with CCI. Mexidol helped reduce insulin resistance, hypertriglyceridemia, and hyperglycemia in patients with cerebrovascular diseases and metabolic syndrome [38]. The results of a study [39] involving 45 patients with moderate and severe CCI showed a higher effectiveness of treatment with Mexidol compared to the control group. In patients treated with the drug, the severity of motor activity disorders significantly decreased, the state indicators on the quality of life scale (SF-36) were normalized, and there was a significant improvement in the assessment of cognitive functions on the Mini-Mental State Examination (MMSE).

It is interesting to note that the available data from fundamental research indicate a geroprotective effect of Mexidol in conditions of cerebral ischemia. Thus, the results of a geronto-informational study of Mexidol [40] demonstrate the high potential of Mexidol as a geroprotector. The drug is characterized by a maximum set of positive properties (treatment of diseases of the central nervous system, cardiovascular pathology, metabolic disorders, anti-inflammatory and anti-infective effects, etc.). Mexidol and glycine are predicted to have the lowest frequency of side effects such as itching, constipation, paresthesia, vomiting, etc. A geronto-informational assessment of changes in the life expectancy of model organisms [41] showed that Mexidol helps to increase the average life expectancy of Caenorhabditis elegans

(by 22.7±10%), Drosophila (by 14.4±15%) and mice (by 14.6±3%, control preparations - no more than 6.1%). The use of Mexidol in the experiment prevented excessive accumulation of the aging marker lipofuscin in brain tissue after local permanent ischemia caused by ligation of the middle cerebral artery.

The best clinical effect was demonstrated with long-term continuous therapy with Mexidol: at the beginning of treatment, intravenous or intramuscular administration, followed by switching to tablet form. Compliance with such a regimen allows you to fully unlock the therapeutic potential of the drug and significantly increase the effectiveness of therapy [28, 35, 38, 39].

Considering the dose-dependent effect of Mexidol, in the treatment of comorbid vascular diseases, a sequential regimen of the drug is recommended: 500-1000 mg/day intravenous drip daily for 15 days with a transition to a tablet form of 750 mg/day.

For ease of administration by patients with comorbid vascular diseases, the drug Mexidol FORTE 250 has been released with a double dosage, which allows you to take 3 tablets per day instead of 6 and thereby increases patient adherence to treatment [28]​1​᠎.

The accumulated experience in the clinical use of Mexidol shows that it can be used in the complex treatment of patients with both acute and chronic cerebral circulatory failure against the background of standard therapy. A sequential scheme (at the beginning of treatment, an injection course, then a tablet course) of Mexidol in adequate dosages is also used in acute and long-term periods of traumatic brain injury, with post-hypoxic encephalopathies, epilepsy, polyneuropathies, asthenoneurotic syndromes, etc. Mexidol demonstrated a significant increase in the anti-ischemic effect compared with standard therapy.

Mexidol and vascular surgery

Carotid endarterectomy (CE) is recognized as the most successful method of preventing ischemic stroke in cases of significant stenosis of the carotid artery. The disadvantage of K.E. Elderly and senile patients have a high level of complications during and after surgery (24%), of which 60% develop during surgery. In a study [42], the use of Mexidol (1000 mg/day) as an antihypoxic accompaniment of CE in patients with stenosing atherosclerosis of the carotid artery with CCI significantly reduced the degree of brain hypoxia, shortened the operation time, improved the neurological status of patients and their performance of neuropsychological tests in the postoperative period .

The most pronounced effect of Mexidol therapy was a significant increase in the degree of brain oxygenation (regional oxygen saturation, rSO2). After a course of treatment with Mexidol, the average rSO2 value in the group was 60±5%, while in the control group it was significantly lower (48±6%). Moreover, in the control group, due to the need for constant correction of brain protection with anesthetic agents, the duration of the operation was 1.5-2 times longer. When using Mexidol, only in less than 5% of patients the readings of the rSO2 sensor on the operated side were less than the desired value (58%), which did not affect the results of CE. In the control group, rSO2 values ​​decreased to 38-41% in a significant (21%) proportion of patients. Thus, antihypoxic protection of the brain with Mexidol can prevent the formation of critically low blood oxygenation, which can reduce surgery time and improve the neurological status of patients in the postoperative period [42].

Mexidol in the therapy and rehabilitation of patients with degenerative-dystrophic changes in the spine

Spondylogenic diseases of the nervous system are an urgent problem due to their widespread prevalence, persistent disability and the need to limit physical activity at a young age (up to 45 years). In particular, lumbosacral radiculopathies occupy a leading (70%) place among all diseases of the peripheral nervous system. Particular attention should be paid to discogenic lumbosacral radiculopathies, the most common in the structure of neurological diseases in terms of the severity of the process and the difficulty of rehabilitation [43]. The results of clinical studies [44, 45] showed that the use of Mexidol is very significant for the correction of CCI in patients with vertebrogenic pathology.

The use of Mexidol in complex rehabilitation of patients after surgical treatment of lumbosacral radiculopathy was associated with a pronounced analgesic effect of the drug [46]. In the postoperative period, clinical improvement was noted, which was expressed in a greater reduction in pain on the visual analogue scale (Mexidol group - up to 1.2±0.5 points, control group - only up to 2.3±0.6 points). Sensitive disorders regressed in 83% of patients by the 14th day of treatment with Mexidol (74% in the control group); revival of reduced reflexes when using Mexidol was observed in 93% of patients (73% in the control group) [46].

The effectiveness and safety of the use of Mexidol in the complex treatment of patients with osteochondrosis of different parts of the spine in the presence of compression of the nerve ending or vascular reaction has been shown [47]. Positive dynamics of symptoms of neuropathic pain (intensity, severity, stinging, tolerability) were noted. During the treatment period, there was no pain due to provocative positions of the neck, forced posture of the head and neck, sleeping on an uncomfortable pillow, jerking movements of the head, and driving a car in an uncomfortable position. Before treatment with Mexidol as part of complex therapy, these factors led to compression of nerve endings and pain.

Mexidol as part of complex therapy for vertebrogenic radiculoischemic syndrome significantly increased the effectiveness of treatment and was well tolerated by patients [48]. A total significant improvement in the patients' condition on the scales of general clinical impression and pain intensity was achieved in 74% of patients receiving Mexidol (47% in the control group).

The use of the drug significantly reduced the severity of pain and accelerated the restoration of the function of spinal roots and peripheral nerves in patients with lumbosacral radiculopathy [49]. When using Mexidol, the greatest rate of pain reduction occurred on the 10-20th day of treatment. By 25-30 days, the pain syndrome was completely relieved in more than 50% of patients; in the remaining patients, the pain became moderate, and the need for painkillers decreased.

The inclusion of Mexidol in the complex therapy of spondylogenic radiculoischemia [50] significantly improved regenerative processes in nervous tissue and reduced the intensity of pain. Sensitive disorders regressed by the 14th day of treatment in 34 (82.9%) patients in the main group and 26 (74.3%) in the control group. Revival of reduced reflexes was noted in 93% of patients in the main group and 73% in the control group. The effectiveness of treatment was evidenced by the regression of pain in the radicular syndrome and the absence of an increase in segmental neurological disorders.

The analgesic effect of Mexidol was confirmed not only by the visual analogue scale and other scales for assessing pain reactions, but also by electroneuromyography (ENMG). Thus, in a study [51], which included patients with neurovascular syndrome against the background of degenerative-dystrophic changes in the lumbosacral spine, with the addition of standard therapy with Mexidol, an improvement in ENMG indicators was noted: an increase in spectral power and amplitudes, which indicates an acceleration of regenerative processes.

Complex therapy of lumbosacral radiculopathies [52] with the inclusion of Mexidol revealed its analgesic effect, and ENMG data indicated an increase in the rate of remyelination of nerve fibers. The greatest rate of pain reduction occurred on the 10-20th day of treatment, and by the 25th-30th day, in more than 50% of patients the pain syndrome was completely relieved, in the rest it became moderate.

The results of ENMG [52] showed that when using Mexidol, a significant ( p

<0.05) compared with standard therapy, an increase in the amplitude of the M-response, a decrease in the latency of the F-wave, and an increase in the speed of impulse conduction. Compared with the control group, changes in amplitude-velocity parameters and an increase in F-wave latency were noted, which indicates an axonal demyelinating process in both the proximal and distal sections of the branches of the lumbosacral region.

On the prospects of using Mexidol in the treatment of multiple sclerosis

Mexidol, exhibiting antioxidant and anti-inflammatory effects and modulating the activity of GABAergic and cholinergic neurotransmissions, helps prevent neurodegenerative processes. The effectiveness of Mexidol in multiple sclerosis has been most fully studied.

Multiple sclerosis is a chronic progressive neurological disease, which is one of the main causes of persistent disability among young people of working age. Already in the early stages of multiple sclerosis, there is damage to the myelin sheaths of the nerve trunks and the nerve fibers themselves, leading to atrophy of the brain substance and loss of oligodendrogliocytes that synthesize myelin. In basic research, experimental allergic encephalomyelitis is considered the standard model of multiple sclerosis [53–55]. In guinea pigs with experimental allergic encephalomyelitis, Mexidol preserved the structure of mitochondria. In particular, preserved mitochondria were found in cerebellar neurons, which was not observed in the natural course of encephalomyelitis.

During the clinical use of Mexidol [54] in complex therapy of patients with multiple sclerosis, the most significant differences were identified in the Stoop test (assessing voluntary attention, flexibility of thinking, speed of information processing, ability to correctly perform assigned tasks) and data from questionnaires assessing depression and chronic fatigue.

After treatment with Mexidol [54], a decrease in the expression of pro-inflammatory toll receptors of the TLR4 type on monocytes was observed, which corresponds to the deactivation of monocytes and a decrease in their sensitivity to the heat shock protein HSP72, which has an activating effect on monocytes due to the activation of TLR4 receptors. The use of Mexidol also led to an increase in the expression of dopamine receptors D3 and D5 on monocytes and B cells. Significant associations were found between immunological and neuropsychological indicators ( p

<0.05): increased expression of TLR2 and TLR4 receptors (markers of monocyte activation) corresponded to low results on cognitive tests. Increased CD80 TLR4 expression on monocytes and D3R and D5R expression on monocytes and B cells were directly associated with the severity of depression and chronic fatigue.

In a number of works [53, 55] on the study of the effectiveness of Mexidol in the treatment of multiple sclerosis, modern technology for hardware examination of patients was used to assess the condition of patients - superposition electromagnetic scanning (SPEMS), which makes it possible to indirectly assess the state of the myelin sheaths of nerves and the activity of neurotransmitter systems. Mexidol effectively reduced the progression of oxidative stress in patients with multiple sclerosis. According to the SPEM data of the brain, the level of demyelination significantly decreased compared to the baseline. The SPEMS results also indicated normalization of the activity of the tricarboxylic acid cycle and the respiratory chain when using Mexidol: increased levels of ubiquinone, decreased levels of hydroperoxides. There was an improvement in neurotransmitter transmission (increased levels of nicotinic and muscarinic acetylcholine receptors, increased levels of 5-hydroxytryptophan) while maintaining inhibitory brain mediation (GABA levels) [55].

In patients with relapsing-remitting and secondary progressive multiple sclerosis in the phase of unstable clinical remission, treatment with Mexidol demonstrated [53] a decrease in metabolic changes in brain tissue according to certain indicators (lactate, respiratory enzymes, lipid peroxidation), the state of neurotransmitter systems, and a decrease in the level of myelin degradation. A positive trend in changes in electrophysiological and clinical-psychological parameters was revealed. In characterizing the state of myelin according to SPEMS, attention was drawn to a significant decrease in swelling of the white matter after treatment with Mexidol, an increase in myelin synthesis and a decrease in the level of total demyelination in 84% of cases ( p

<0,01).

Thus, Mexidol can be used in complex therapy of multiple sclerosis as a drug that helps reduce pro-inflammatory reactions, normalize the condition of myelin sheaths and the most important neurotransmitter systems while improving cognitive functions, reducing the severity of depression and chronic fatigue.

Mexidol and neuropathies

Mexidol is effective for correcting the neurological complication of diabetes mellitus—diabetic polyneuropathy [56]. The administration of Mexidol to patients with diabetes mellitus potentiated the effect of antihypertensive drugs, positively affecting target organs and improving the effectiveness of prevention and treatment of chronic complications of the disease. During therapy, an improvement in the general condition of the patients and a significant reduction in the neuropathic manifestations of diabetic polyneuropathy were noted.

Mexidol has been shown [57] to be effective in patients with polyneuropathies caused by primary hypothyroidism. At the time of inclusion in the study, all patients were receiving replacement therapy (L-thyroxine). The results of ENMG revealed demyelinating, axonal or mixed lesions of peripheral nerves in all patients. 6 months after treatment, in patients in the control group, the rate of relapse of endocrine polyneuropathy was 67%, while during treatment with Mexidol it was only 15%. Mexidol therapy was associated with a significant improvement in lipid profile parameters (decrease in elevated total cholesterol levels from 7.7±1.9 to 5.4±0.9 µmol/l, p

=0,05).

Clinical data obtained by domestic researchers indicate the possibility of using Mexidol for infectious nerve lesions and to overcome complications of acute respiratory viral diseases (ARVI), herpes and tick-borne encephalitis.

Attention should be paid to recovery after ARVI in the elderly, when the risks of developing asthenic syndrome and worsening the manifestations of CCI increase significantly. In the treatment of elderly patients with ARVI [58], the use of Mexidol contributed to a more rapid relief of the manifestations of asthenia, autonomic lability and cognitive deficit. There was a significant improvement in cognitive functions in the group of patients taking Mexidol compared to the control: improvement in spatial and temporal orientation, concentration and memory.

Postherpetic neuralgia is a common complication of trigeminal ganglionitis, which occurs in 10% of patients. The use of Mexidol in complex therapy of patients with postherpetic facial neuralgia in the acute period contributed to a significant reduction in pain, improvement of emotional state, and reduction of hospital treatment time [59].

The relevance of studying and introducing new methods of treating tick-borne encephalitis into practical medicine is due to its widespread distribution and the annual increase in incidence. A study [60] on the inclusion of Mexidol in the pathogenetic therapy of a febrile form of tick-borne encephalitis showed that in the Mexidol group, compared with the control group, there were more pronounced positive dynamics of clinical manifestations, a greater proportion of favorable outcomes and a lower frequency of residual effects. Patients taking Mexidol experienced a significantly more rapid regression of headaches, dizziness, autonomic disorders (sleep disorders, skin hyperemia, red dermographism, blood pressure fluctuations) and residual effects (weakness, dizziness, etc.).

Thus, the use of Mexidol was characterized by more pronounced positive clinical dynamics and a higher proportion of cases with a favorable outcome of tick-borne encephalitis compared to piracetam.

Mexidol and Parkinson's disease

In a study [61], which included patients with Parkinson's disease who were on basic treatment with levodopa, the administration of Mexidol led to normalization of the methemoglobin content in erythrocytes.

Mexidol and myopathies

According to the results of the study [62], the restorative effect of Mexidol on the functions of the motor sphere in patients with myopathies was revealed in the absence of side effects. A positive clinical effect of Mexidol was noted in 58% of patients, improvement in motor function - in 36%; ENMG indicators improved in 45% of patients.

Mexidol in the treatment of neuropsychological and autonomic disorders

In the group of patients with CCI, when using Mexidol [63], a more pronounced and long-lasting positive effect was noted: a persistent decrease in the level of anxiety, a decrease in autonomic imbalance, and restoration of the sorption capacity of erythrocytes.

Complex treatment of patients with post-traumatic stress disorder was more effective when Mexidol was included in it. Against the background of standard medical and psychological rehabilitation (auto-training, progressive muscle relaxation, rational psychotherapy, drug therapy with antidepressants, tranquilizers, anticonvulsants), the intensity of headaches decreased by 36%, the level of alcoholism decreased by 37%; the level of anxiety decreased to normal in 70% of cases [64].

Mexidol was studied [65] in the treatment of patients with dysregulation of the autonomic nervous system. After a course of use of the drug, the severity of vegetative changes in those examined significantly decreased: the frequency of complaints about a tendency to reddening of the face, numbness or coldness of the fingers and toes decreased

Contraindications

Mexidol for low or high blood pressure may be contraindicated in various conditions complicated by other pathologies, otherwise there is a risk of harm to health.

Among the main contraindications:

• severe kidney pathologies up to the onset of acute failure;
• hypersensitivity to any substance in the medication, which may cause an allergic reaction;
• not prescribed for children under 16 years of age;
• should not be used by pregnant women;
• danger to the baby during lactation, as the drug can pass into breast milk.

Side effects

The doctor or instructions always notify the patient about possible side effects from using the drug; it is worth familiarizing yourself with the risks before starting treatment. Some undesirable influences can cause severe harm to a person; therefore, you must immediately report such a condition to your doctor.

Known side effects:

• nausea with vomiting;
• severe drying of the oral mucosa and desire to drink;
• allergic skin lesions;
• severe fatigue and drowsiness;
• neurological disorders: causeless anxiety or fear, up to the onset of depression;
• emotional disturbances;
• sweating;
• frequent onset of pain in the head;
• impaired coordination and dizziness;
• hypertension.

Mexidol helps with headaches and dizziness

Indications for the use of Mexidol

Instructions for use classify Mexidol as a universal drug. This drug is currently used in neurology, surgery and psychiatry. It can quickly eliminate headaches and dizziness, improve well-being and stabilize high blood pressure. The drug is capable of providing a rapid therapeutic effect in the event of seizures provoked by external factors in the form of medication.

The manufacturer offers a choice of solution or tablets for treatment.

This function allows you to use the following options for entering the active substance into the body:

• orally;
• intramuscularly;
• intravenously.

The drug allows you to treat the following diseases:

• disruption of the normal circulatory process;
• vegetative dystonia;
• myocardial infarction;
• purulent inflammatory processes occurring in the abdominal cavity;
• atherosclerosis;
• alcohol abuse withdrawal syndrome;
• peritonitis;
• pancreatitis in acute forms;
• overdose of neutroleptics.

The above list is not complete, since Mexidol is now actively used in the treatment of a fairly wide range of diseases. The drug is used as an addition to the complex treatment of diseases resulting from insufficient blood supply and nutrition to the tissues of internal organs.

The active substance has a beneficial effect on brain function, improving memory and the ability to concentrate. The drug is prescribed for ischemia and frequent surges in blood pressure. In the prevention and treatment of arterial hypertension, the drug is used only as a complex remedy in addition to conservative treatment.