Cytoflavin in alcohol intoxication. Cytoflavin and alcohol - you can combine, but is it necessary? When can I take the substance
The compatibility of Cytoflavin and alcohol can cause serious disorders in the form of memory impairment, degradation, disorders of the gastrointestinal tract, problems with the nervous system and heart.
At the same time, the drug is effectively used in the treatment of chronic dependence on alcohol.
find the answer
Is there any problem? Need more information?Type in the form and press Enter!
Cytoflavin and alcohol compatibility
The active substances of the drug stimulate metabolic processes in the brain. This is due to the saturation of the cellular structures of energy glucose. Cytoflavin is prescribed for impaired blood circulation in the gray matter and oxygen starvation, which in itself is dangerous for humans.
If you still drink pills with an alcoholic drink, which negatively affects the state of nerve cells, then the situation will worsen many times over.
At best, the remedy will lose its effectiveness, since ethanol completely neutralizes the action of the components of the drug. In addition, the likelihood of adverse reactions increases significantly - from nausea with vomiting to epileptic seizures and stroke. Therefore, you should not drink alcohol during the course.
a brief description of
Cytoflavin is used for brain pathologies associated with impaired blood circulation. The drug consists of succinic acid, vitamins, which is why it has a metabolic, antioxidant and antihypoxic effect. Still tablets increase the adaptive properties of the body to stress during ischemia, oxygen starvation.
After taking the cellular structures are better saturated with nutrients, the work of the central nervous system, blood vessels of the heart and brain improves.
All this contributes to the normalization of general well-being after fainting, stroke, mechanical damage to the head.
Cytoflavin is produced in the form of tablets and solution for injection.
The first type of remedy is used to treat the following diseases:
- astheno-neurotic syndrome - lethargy, decreased intelligence, fatigue;
- complications after a stroke or acute deterioration of cerebral circulation;
- cerebrovascular pathologies associated with diseases of the cerebral vessels.
Liquid medicine for intravenous administration is used for ischemic stroke, various disorders of blood circulation in the gray matter, endotoxicosis, oxygen starvation after surgery, and also to improve the condition after anesthesia.
Application for addiction
Cytoflavin is often used to treat chronic alcoholism. The drug improves the general condition of the patient, metabolism in the brain, eliminates signs of intoxication. With the help of these pills, you can get rid of addiction to alcoholic beverages.
The therapy allows you to eliminate trembling in the hands, restore blood pressure, migraine. At the initial stage, the treatment is aimed at normalizing the water balance, since ethyl alcohol has a dehydrating effect. After that, medications are used to eliminate the symptoms, restore metabolism.
Cytoflavin has a beneficial effect on brain activity in patients with alcoholism. However, therapeutic procedures are required only under the supervision of the attending physician.
Use in withdrawal symptoms
A hangover is a state of acute intoxication of the body with the breakdown products of alcohol. The process occurs in people with chronic dependence, when ethanol is actively involved in metabolic processes. If this metabolism is prevented, then there is a craving for the drink.
Often, a hangover syndrome is removed with small doses of ethanol, which restore blood pressure, relieve tremors, headaches and other manifestations of intoxication. However, it is impossible to expose the body to chronic poisoning for a long time.
With free syndrome, a large amount of liquid (medicinal mineral water) or brine helps, while in severe cases, medical attention is required.
The hospital uses droppers with special medicinal substances that improve well-being and restore electrolyte balance. To normalize metabolic processes in cellular structures, Cytoflavin is prescribed.
Complications from combining
First of all, the entire therapeutic effect of the tablets is leveled if they are combined with alcohol.
The following consequences are still developing:
- mental degradation.
- Memory deterioration.
- Violation of the digestive system in the form of nausea with vomiting, pain in the upper part of the abdominal cavity.
- Negative changes in the central nervous system - headaches, irritability, irritability, panic attacks, depression.
- Problems with myocardial activity - tachycardia, pain in the chest, increased blood pressure.
- Redness or blanching of the skin.
- Hypoglycemia, gout.
- Acute renal failure, pathology of the urinary system.
- Rashes, hyperemia, itching, swelling, anaphylactic shock.
In severe cases, the patient is affected by a stroke, which often leads to death.
When can I take the substance
Co-administration of Cytoflavin with ethanol is extremely dangerous for humans, so it is necessary to wait a certain period after drinking drinks before taking the pills.
For men, this period is a day, while women will have to wait at least 32 hours. This will completely cleanse the roof of acetaldehyde and prevent the development of dangerous complications.
When can you drink
It is best to completely exclude alcohol during the course. The prohibition of ethanol will improve the effectiveness of therapy and protect against the negative effects of toxic substances.
For 14 (man) and 20 (women) hours before taking the medicine, it is allowed to consume no more than 50 g of quality alcohol. After the end of the course, a two-week pause is needed, otherwise the result of the treatment will be insignificant.
Cytoflavin and beer
The drug stimulates metabolic processes in the brain. With the correct implementation of clinical recommendations, the desired effect of treatment is achieved. Effective in the treatment of pathologies with impaired blood supply to the brain.
The intake of beer and other alcoholic beverages is prohibited during the entire course of therapy.
The following complications are observed:
- personal degradation;
- memory loss;
- headache;
- nausea;
- vomit;
- change in skin tone;
- depression;
- panic attacks;
- tachycardia;
- pain in the region of the heart;
- allergic reactions;
- acute renal failure.
Organs affected by the toxin
The combined use of pharmacological agents and alcohol has a toxic effect on the internal organs and body environment. Alcohol, entering into a chemical reaction with the drug, leads to poisoning, disrupts physiological processes, enhances or weakens the medicinal properties of drugs.
The liver suffers more than other organs. She gets hit twice. Many drugs have a side effect - hepatotoxicity, destroy cells, disrupt the physiology of the organ. In the liver, alcohol decomposes to ethanol, a substance 20-30 times more toxic than ethanol, which causes the death of hepatocytes.
Dangerous groups of drugs for the body in combination with alcohol:
- anti-inflammatory;
- hormonal;
- antibacterial;
- antifungal;
- means for controlling glucose in diabetes mellitus;
- anti-tuberculosis;
- cytostatics (chemotherapy drugs);
- tranquilizers (antiepileptic, psychotropic).
In second place among the internal organs exposed to the harmful effects of alcohol together with drugs are the heart and vascular system. Strong drinks against the background of drug therapy constrict blood vessels, increase blood pressure. The simultaneous intake of alcohol and chemicals leads to a malfunction of the myocardium, increases the risk of developing an attack of angina pectoris, a heart attack.
A mixture of ethanol and pharmaceuticals violates the qualitative composition of the blood, reduces clotting. This is dangerous for the occurrence of internal bleeding, strokes.
The state of the nervous system under the influence of alcohol and drugs
The autonomic nervous system, which is responsible for the coordinated functionality of all internal organs, is no less negatively affected. Under the influence of toxic substances, a chain reaction occurs, which is manifested by a disorder of the gastrointestinal tract (stomach, pancreas, small intestine), kidneys, endocrine glands.
Rules for taking drugs and alcohol
The intake of alcoholic beverages during the treatment period minimizes the clinical effect of therapy and creates the risk of developing complications of the disease.
If this cannot be avoided, follow the rules of conduct that will reduce the manifestation of negative consequences:
- Do not drink strong drinks (vodka, cognac, whiskey), choose dry wine (100-150 ml), beer (no more than 300 ml). Don't drink alcohol on an empty stomach.
- The interval between taking the medicine and alcohol should be at least 2 hours.
- To reduce the toxic effect, drink drugs that protect the liver (hepatoprotectors), pancreas (pancreatin), stomach (antacids ─ Rennie, Almagel).
If a person takes antiviral drugs for colds, anti-inflammatory drugs, alcohol in moderation does not pose a threat to the body.
Alcoholic drinks against the background of treatment are categorically contraindicated in case of cirrhosis of the liver, severe infectious diseases, during the course of chemotherapy.
Medications, alcohol and chronic diseases
If a person has chronic diseases, the simultaneous intake of alcohol and drugs is potentially dangerous for the functioning of vital organs. Since patients systematically take prescribed drugs, the influence of alcohol can lead to negative consequences.
People with chronic heart diseases (angina pectoris, heart defects) develop arrhythmias of varying severity. Heart attacks develop with severe pain, which is not stopped by Nitroglycerin, the risk of developing myocardial infarction increases significantly.
In chronic liver diseases (viral hepatitis, hepatosis), alcohol during treatment can become a trigger in the development of cirrhosis, hepatocellular carcinoma (cancer).
Drinking alcohol with cirrhosis leads to the following consequences:
- bleeding into the abdominal cavity;
- liver decomposition, infection, peritonitis;
- hepatic coma;
- fatal outcome.
If a person is on long-term treatment with sedatives, psychotropic drugs, tranquilizers, alcohol is contraindicated for him. This leads to severe depression, the appearance of obsessive states (hallucinations, phobias). Suicidal thoughts develop. Such a patient needs constant supervision and help of a psychiatrist.
The most dangerous combinations and consequences
The combination of alcohol and chemical-based drugs can lead to serious disorders in the body, and in some cases to fatal consequences.
List of drugs and their side effects in combination with alcohol:
| Name of the group, drug | Negative outcomes of interaction |
| Antipsychotics (tranquilizers, anticonvulsants, sleeping pills) | Severe intoxication, up to cerebral coma |
| CNS stimulants (Theofedrine, Ephedrine, Caffeine) | Rapid increase in blood pressure, hypertensive crisis |
| Hypotensive (Kaptofrin, Enalapril, Enap-N), diuretics (Indapamide, Furosemide) | Sudden drop in pressure, collapse |
| Analgesics, anti-inflammatory | Increased toxic substances in the blood, general poisoning of the body |
| Acetylsalicylic acid (Aspirin) | Acute gastritis, perforation of gastric ulcer and 12-PC |
| Paracetamol | Toxic destruction of the liver |
| Hypoglycemic (Glibenclamide, Glipizide, Metformin, Phenformin), insulin | Sudden decrease in blood sugar levels, hypoglycemic coma |
According to the World Health Organization, more than 90% of the world's inhabitants drink alcoholic beverages, and at least 40% drink alcohol every month, which is associated with a high risk of health problems. About 10% of men and 3-5% of women drink alcohol daily. In addition to characteristic changes in the brain, excessive alcohol consumption causes numerous disturbances in the functioning of almost all body systems, leading to the occurrence of multiple organ pathology. Therefore, it is not surprising that in most countries of the world, alcohol-related diseases are in 3rd-4th place among the causes of death. The problem of alcohol dependence is also relevant for Ukraine. As of January 1, 2007, 628,379 people, or 1,344.1 patients per 100,000 people, were registered with the dispensary narcological register in our country alone.
Alcohol dependence syndrome is a psychopathological hypostasis of a state of chronic intoxication. It is no coincidence that the treatment of such patients begins with the elimination of the metabolic consequences of prolonged exposure to ethanol on the patient's body. In this regard, attention is drawn to the drug cytoflavin, the spectrum of action of which, it seems, is quite consistent with the tasks of the initial stage of treatment of patients dependent on alcohol, the tasks of detoxification. Cytoflavin, produced by the scientific and technological pharmaceutical company Polisan (Russian Federation), is a clear yellowish solution, each milliliter of which contains 100 mg of succinic acid, 10 mg of nicotinamide, 20 mg of riboxin (inosine), 2 mg of riboflavin mononucleotide (riboflavin) , as well as excipients: N-methylglucamine (meglumine), sodium hydroxide and water for injection. Available as a solution for intravenous administration.
The pharmacological effects of the drug are due to the complex influence of the substances that make up its composition. The drug stimulates respiration and energy production in cells, improves the processes of oxygen utilization by tissues, restores the activity of antioxidant defense enzymes. The drug activates intracellular protein synthesis, promotes the utilization of glucose, fatty acids and the resynthesis of γ-aminobutyric acid (GABA) in neurons through the Roberts shunt. Cytoflavin improves coronary and cerebral blood flow, activates metabolic processes in the central nervous system, restores consciousness, reflex disorders, sensitivity disorders and intellectual-mnestic functions of the brain. It has an awakening effect when administered to patients with depressed consciousness due to anesthesia.
The intracellular interaction of nicotinamide, riboxin and riboflavin mononucleotide stimulates the formation of important endogenous redox enzymes - flavin adenine nucleotide (FAD) and nicotinamide adenine dinucleotide phosphate (NADP), which play an important role in cellular and tissue respiration. With intravenous infusion at a rate of about 2 ml / min (in terms of undiluted cytoflavin), succinic acid and riboxin (inosine) are utilized almost instantly and are not detected in blood plasma.
Riboxin (inosine) is metabolized in the liver with the formation of glucuronic acid, followed by its oxidation. In a small amount excreted by the kidneys. Nicotinamide is rapidly distributed to all tissues, penetrates through the placenta and into breast milk, is metabolized in the liver to form nicotinamide - methylnicotinamide, and excreted by the kidneys. The plasma half-life is about 1.3 hours, the stationary volume of distribution is about 60 liters, the total clearance is about 0.6 l / min. Riboflavin is unevenly distributed: the largest amount is in the myocardium, liver, and kidneys. The plasma half-life is about 2 hours, the stationary volume of distribution is about 40 liters, the total clearance is about 0.3 l / min. Penetrates through the placenta and into mother's milk. Contacts plasma proteins - 60%. Excreted by the kidneys, partly in the form of a metabolite; in high doses, mostly unchanged.
Cytoflavin is used to treat acute cerebrovascular accident, dyscirculatory (vascular) encephalopathy of the 1st-2nd stage and the consequences of cerebrovascular accidents (chronic cerebral ischemia); toxic and hypoxic encephalopathy in acute and chronic poisoning, endotoxicosis, as well as after depression of consciousness due to anesthesia. In adults, Cytoflavin is used exclusively intravenously in a dilution of 100-200 ml of 5-10% glucose solution or 0.9% sodium chloride solution 1-2 times a day with an interval between injections of 8-12 hours for 10 days. With rapid drip administration, adverse reactions may occur that do not require discontinuation of the drug: hyperemia of the skin of varying severity, sensations of heat, bitterness and dryness in the mouth, sore throat. With prolonged use of high doses, transient hypoglycemia, hyperuricemia, and exacerbation of gout may occur. Very rarely, there may be short-term pain and discomfort in the epigastric region and in the sternum, shortness of breath, nausea, headache, stupor, “tingling” in the nose, blanching of the skin of varying severity, skin itching.
Contraindications to the appointment of Cytoflavin are individual sensitivity to the components of the drug, the period of breastfeeding. Patients who are on mechanical ventilation are not recommended to administer the drug when the partial pressure of oxygen in the arterial blood decreases to less than 60 mm Hg. Art. With caution, the drug is prescribed for nephrolithiasis, gout, hyperuricemia. In case of overdose, symptomatic treatment is necessary, since there is no specific antidote. In critical conditions, the use of the drug should be carried out after the normalization of central hemodynamic parameters. It is possible to reduce the level of glucose in the blood (which must be taken into account when prescribing), during treatment with the drug, urine may acquire a light yellow color.
Cytoflavin ingredients such as succinic acid, inosine and nicotinamide are quite compatible with other drugs. But riboflavin, which is also part of the drug, reduces the activity of a number of antibiotics: doxycycline, tetracycline, oxytetracycline, erythromycin and lincomycin. In addition, it is incompatible with streptomycin. Chlorpromazine, imizin, amitriptyline, due to the blockade of flavinokinase, activate the inclusion of riboflavin in flavinadenine mononucleotide and flavinadenine dinucleotide and increase its excretion in the urine. Thyroid hormones speed up the metabolism of riboflavin. The drug reduces and prevents the side effects of chloramphenicol (impaired hematopoiesis, optic neuritis). Cytoflavin is compatible with drugs that stimulate hematopoiesis, antihypoxants, anabolic steroids. Thus, the pharmacological properties of cytoflavin suggest that it may be useful when administered to alcohol-dependent patients at the detoxification stage.
In connection with the above, the purpose of this work was to evaluate the efficacy and safety of Cytoflavin in the complex therapy of patients with alcoholism at the stage of relief of alcohol withdrawal syndrome.
Design, contingent and research methods
The work had the design of an open comparative clinical study in parallel groups without placebo control. The total duration of the study in both comparison groups was 10 days. During this period, there were 7 meetings of each patient with his researcher (visits), while visit No. 1 was devoted to screening (a preliminary study with the appointment of a date for hospitalization), and daily visits Nos. 2–6 (days 1–5 of treatment respectively) and the final visit No. 7 covered the period of relief of alcohol withdrawal syndrome and acute post-intoxication disorders. It is necessary to emphasize once again that the term “visit”, which is typical for the vocabulary of clinical trials, is conditional in this text, since all patients who participated in the study were in the hospital throughout the entire observation period.
The study included 60 patients who were diagnosed with alcohol withdrawal syndrome (F10.3) in accordance with ICD-10 criteria. All patients were scheduled (after a screening visit the day before) hospitalized in the departments of the Kharkiv City Clinical Narcological Hospital No. 9 (clinical base of the Institute of Neurology, Psychiatry and Narcology of the Academy of Medical Sciences of Ukraine (INPN AMNU, Kharkiv)). On admission, patients were randomly assigned to one of two study groups (30 patients - main group and 30 patients - control group). The average values of age, body weight and some indicators of alcohol history in patients of the main and control groups at the start of the study are presented in Table. one.
Table 1
Average values of age, body weight and some indicators of alcohol history in patients of the main and control groups at the start of the study
| Indicator, unit of measurement | Average values (M±m) | |
| Main group (n=30) |
Control group (n=30) |
|
| Age, years | 40.60±1.680 | 41.73±1.793 |
| Body weight, kg | 74.93± 1.246 | 75.80± 1.282 |
| Total experience of alcoholization (episodic + systematic), years | 13.63±0.653 | 13.87±0.645 |
| Experience of systematic alcoholization, years | 11.47±0.753 | 11.60±0.556 |
| Attempts to stop alcoholism, total | 4.10±0.337 | 4.37 ± 0.364 |
| Attempts to stop alcoholism, with remission | 1.67 ± 0.154 | 2.10±0.251 |
| Total duration of all remissions, years | 2.58±0.289 | 2.73±0.353 |
| The ratio of the total duration of all remissions to the experience of systematic alcoholization | 0.23±0.026 | 0.22 ± 0.023 |
| Duration of the period from the end of the last remission to the moment of hospitalization, months | 14.23± 1.576 | 11.46±0.976 |
| Daily dose of alcohol, grams abs. ethanol | 218.6± 17.726 | 215.0± 16.718 |
| Frequency rate of alcohol consumption (during the day) | 2.27 ± 0.214 | 2.39±0.240 |
Note:
< 0,05).
These data indicate that the selected comparison groups are quite comparable in terms of the main parameters indicated and, therefore, are suitable for a comparative analysis of the results of the standard and study types of treatment.
The scheme of detoxification therapy for patients addicted to alcohol was complex (Table 2).
table 2
Schemes of complex therapy in comparison groups at the stages of treatment
| Type of therapy (drugs, doses, mode of administration) | Main group | Control group |
|
+ | + |
Study Therapy: |
+ | – |
Notes:
"+" - this type of therapy is used in this group;
“–” - this type of therapy is not used in this group.
In the course of the study, a complex of clinical, psychometric and laboratory research methods was used to assess the current state of patients and, accordingly, the effectiveness and tolerability of the treatment used.
The clinical and psychopathological method was the main one in assessing the condition of patients throughout the study. The interpretation of data obtained using any other methods was carried out in the process of comparison with the results of a clinical and psychopathological study, which was carried out in accordance with the criteria for the International Classification of Diseases of the Tenth Revision (ICD-10) .
During treatment, patients of both groups were tested daily for the presence of alcohol vapor in the exhaled air (alco-test). To monitor the alcohol withdrawal syndrome during treatment, daily monitoring of vital indicators (blood pressure, heart rate, body temperature, etc.) and four times (at admission, as well as on the 3rd, 5th and 10th days) were carried out. treatment) assessment of the severity of withdrawal symptoms using the CIWA-Ar screening test. Twice, at admission and on the 10th day of observation, the intensity and structure of the pathological craving for alcohol were assessed using the glossary of N. V. Cherednichenko - V. B. Altshuller. Processing of the received data was carried out by methods of mathematical statistics (dispersion, correlation, regression analysis) on a PC using SPSS 15.0 and Excel programs (from the Microsoft Office 2003 package).
Results and discussion
Changes in hemodynamic parameters - systolic blood pressure (BP), diastolic blood pressure, heart rate (HR), as well as body temperature (t ° C) are the most important objective manifestations of that powerful homeostatic stress, which, in fact, is always the transition from systematic alcoholism to sobriety. That is why close attention was paid to these indicators (Fig. 1, 2).
Rice. one. Dynamics of the average values of systolic (A) and diastolic (B) blood pressure in patients of the main and control groups during the observation
Note:
* - differences between the main and control groups are significant (p< 0,05).
Rice. 2. Dynamics of the average values of heart rate (A) and body temperature (B) in patients of the main and control groups during the observation
Note:
* - differences between the main and control groups are significant (p< 0,05).
It is easy to see that the changes in all the mentioned physiological parameters are of the same type. First (from the 1st to the 3rd–5th visit) their increase is observed, then (from the 3rd to the 7th visit) they decrease. It is noteworthy that at the stage of relief of the withdrawal syndrome in patients who received standard therapy together with cytoflavin therapy (the main group), normalization of hemodynamic parameters occurred much earlier (Fig. 1A, 1B and 2A) than in patients who received only standard therapy (control group).
As a result, from the 3rd visit to the 7th (2–10th day from the start of the therapeutic program), hemodynamic parameters (systolic and diastolic blood pressure, heart rate) were found to be significant in the main group (p< 0,05) ниже, чем в контрольной группе (рис. 1А, 1Б и 2А). Что касается температуры тела, то по данному параметру достоверных различий между основной и контрольной группами на всём протяжении исследования не наблюдалось. Из приведённых данных следует, что цитофлавин на этапе купирования синдрома отмены алкоголя существенно уменьшает силу гомеостатического стресса, связанного с переходом от систематической алкоголизации к трезвости, что проявляется ускоренной нормализацией показателей гемодинамики.
The dynamics of the average results of the screening test to assess the severity of alcohol withdrawal syndrome CIWA-Ar (The Clinical Institute Withdrawal Assessment for Alcohol-Revised) during the relief of alcohol withdrawal syndrome in patients of the main and control groups is presented in Table. 3. It is clearly seen that the various manifestations of alcohol withdrawal syndrome taken into account by the CIWA-Ar screening test (nausea and/or vomiting, tactile disturbances, visual disturbances, auditory disturbances, tremor, paroxysmal sweating, anxiety, headache and/or heaviness in the head , agitation, disorientation and clouding of consciousness), reach their maximum degree of severity at the time of visit No. 4 (the 3rd day of the cessation of alcoholization), and then begin to decrease.
Table 3
Dynamics of the average results of the CIWA-Ar screening test during the relief of alcohol withdrawal syndrome
| Manifestations (symptom) of alcohol withdrawal syndrome | Average severity in points (M±m) | |||
| 1st visit (1st day) |
4th visit (3rd day) |
6th visit (5th day) |
7th visit (10th day) |
|
| Main group | ||||
| Nausea or vomiting | 0.33±0.09 | 0.83±0.22 | 0.45±0.14 | 0.00±0.00 |
| Tactile disorders | 0.43±0.09 | 1.45±0.23 | 0.90±0.15 | 0.00±0.00 |
| visual disturbances | 2.13±0.16 | 2.76±0.13 | 2.38±0.15 | 0.34±0.09 |
| Auditory disorders | 2.23±0.16 | 2.59±0.15 | 2.45±0.15 | 0.34±0.09 |
| Tremor | 3.13±0.10 | 3.62±0.22 | 2.62±0.22 | 0.38±0.09 |
| paroxysmal sweat | 2.73±0.23 | 2.76±0.17 | 1.76±0.17 | 0.62±0.09 |
| Anxiety | 2.80±0.20 | 3.97±0.21 | 2.48±0.13 | 1.38±0.09 |
| 0.07±0.05 | 0.34±0.09 | 0.10±0.06 | 0.00±0.00 | |
| 0.20±0.07 | 0.38±0.14 | 0.10±0.06 | 0.31±0.09 | |
| Excitation | 0.33±0.09 | 0.66±0.17 | 0.41±0.09 | 0.24±0.08 |
| Total | 14.40±0.58 | 19.34±0.87 | 13.66±0.78 | 3.62±0.17 |
| Control group | ||||
| Nausea or vomiting | 0.27±0.08 | 1.67±0.23 | 0.80±0.20 | 0.00±0.00 |
| Tactile disorders | 0.30±0.09 | 1.47±0.22 | 1.03±0.17 | 0.00±0.00 |
| visual disturbances | 2.10±0.13 | 2.70±0.14 | 2.37±0.12 | 0.37±0.09 |
| Auditory disorders | 2.00±0.19 | 2.73±0.14 | 2.37±0.10 | 0.15±0.07 |
| Tremor | 3.13±0.09 | 4.57±0.20** | 3.57±0.20** | 0.48±0.10 |
| paroxysmal sweat | 2.33±0.19 | 3.50±0.18** | 2.50±0.18** | 0.48±0.10 |
| Anxiety | 2.63±0.18 | 4.20±0.18** | 2.73±0.14** | 1.48±0.10 |
| Disorientation and confusion | 0.13±0.06 | 0.40±0.09 | 0.23±0.08 | 0.00±0.00 |
| Headache, heaviness in the head | 0.27±0.08 | 1.00±0.19 | 0.53±0.12 | 0.37±0.09 |
| Excitation | 0.43±0.09 | 0.63±0.16 | 0.77±0.14* | 0.37±0.09 |
| Total | 13.60±0.49 | 22.87±0.89** | 16.90±0.91** | 3.70±0.16 |
Notes:
* - differences with the main group are significant (p< 0,05);
** - differences with the main group are significant (p< 0,01).
At the same time, in the main group of patients, the reduction of some symptoms of the withdrawal syndrome occurred faster than in the control group, which was expressed (Table 3) in significantly (p< 0,05) меньших степенях выраженности тошноты или рвоты (визит № 4), тремора (визиты №№ 4–6), пароксизмального пота (визиты №№ 4–6), тяжести в голове или головной боли (визиты №№ 4–6) и, как следствие, тяжести синдрома отмены алкоголя в целом (визиты №№ 4–6). Поскольку, как уже было сказано, на этапе купирования синдрома отмены основная группа отличалась от контрольной только тем, что в ней помимо стандартной терапии применялся цитофлавин, ускоренную редукцию упомянутых выше симптомов и синдрома отмены алкоголя в целом следует считать обусловленной действием именно этого препарата.
Pathological attraction to alcohol (PVA) is a core symptom of the syndrome of addiction to this psychoactive substance. It is PVA that becomes the main cause of alcoholic excesses during treatment and relapses of alcoholization in the post-therapeutic period. The dynamics of the average severity of PVA, its components and their components in the examined main and control groups during treatment is presented in Table. four.
Table 4
Dynamics of the average severity of pathological craving for alcohol (PVA), its components and their components in the examined from the main (A) and control (B) groups during treatment
| PVA components and their components | Values of PVA components, points (M±m) | ||||
| Main group | Control group | ||||
| 1st visit (1st day) |
7th visit (10th day) |
1st visit (1st day) |
7th visit (10th day) |
||
| affective | subdepression | 1.43±0.10 | 1.34±0.10 | 1.37±0.11 | 1.19±0.11 |
| Anxiety | 1.80±0.15 | 1.31±0.13 | 1.87±0.16 | 1.37±0.12 | |
| Emotional lability | 0.80±0.10 | 0.79±0.10 | 0.90±0.12 | 0.85±0.13 | |
| Dysphoria | 0.87±0.13 | 0.62±0.09 | 0.93±0.14 | 0.74±0.10 | |
| Generally | 4.90±0.28 | 4.07±0.24 | 5.07±0.28 | 4.15±0.22 | |
| Vegetative | dreams | 1.10±0.19 | 0.48±0.09 | 1.13±0.18 | 0.81±0.08* |
| Mimic reactions | 0.90±0.06 | 0.48±0.09 | 0.93±0.05 | 0.81±0.08* | |
| Appetite changes | 1.00±0.14 | 0.34±0.09 | 1.17±0.14 | 0.78±0.12* | |
| Generally | 3.00±0.22 | 1.31±0.15 | 3.23±0.24 | 2.41±0.17** | |
| Ideatorny | attitude to alcohol | 1.73±0.11 | 1.34±0.09 | 1.70±0.10 | 1.41±0.10 |
| Attitude towards treatment | 1.00±0.14 | 0.90±0.11 | 0.93±0.14 | 0.67±0.09 | |
| Generally | 2.73±0.21 | 2.24±0.16 | 2.63±0.20 | 2.07±0.13 | |
| Behavioral Component | 0.90±0.13 | 0.86±0.10 | 0.83±0.12 | 0.78±0.10 | |
| PVA in general | 11.53±0.48 | 8.48±0.35 | 11.77±0.46 | 9.41±0.31 | |
Notes:
* - differences with the corresponding visit of the main group are significant (p< 0,05);
** - differences with the corresponding visit of the main group are significant (p< 0,01).
It is clearly seen that over the course of 10 days of observation, the intensity of PVA decreased markedly, which can be easily explained by the relief of the painful phenomena of the alcohol withdrawal syndrome.
Along with common features in the nature of PVA reduction, significant differences were found between the comparison groups.
A component-by-component comparative analysis found that in the main group, the severity of all components (appetite disorders, dreams, facial reactions) of the vegetative component of PVA on the 10th day of treatment was significantly lower than in the control group.
Since the main group differed from the control group only in that it used Cytoflavin in addition to standard therapy, all the above differences should be considered the result of the action of this drug.
Patients' sobriety regimen was assessed at each visit according to the results of the alcohol test, as well as by a retrospective anamnestic analysis of the period that had elapsed since each previous visit. The dynamics of the number of people who had alcoholic excesses during treatment, according to the positive results of the alcohol test during the visits, is shown in Fig. 3.
Note:
* - differences between the main and control groups are significant (p< 0,05).
It can be seen that the first alcoholic excesses began even at the stage of stopping the withdrawal syndrome, in hospital conditions (visit No. 6, or the 5th day from the start of treatment). At the same time, the frequency of alcoholic excesses in the control group was slightly higher than in the main group, which may be due to the ability of Cytoflavin to suppress the vegetative component of PVA (as mentioned above). However, the above differences between the comparison groups in the frequency of alcoholic excesses were not statistically significant, so this assumption needs further verification.
conclusions
- Cytoflavin accelerates the reverse development of such manifestations of alcohol withdrawal syndrome as arterial hypertension, tachycardia, nausea, vomiting, tremor, sweating, heaviness in the head and headache. At the same time, it is reliable (p< 0,05) снижается интегральный показатель тяжести алкогольной абстиненции по шкале CIWA-Ar (к 5-му дню лечения - на 31,35% по сравнению с той же комплексной фармакотерапией, но без цитофлавина).
- Cytoflavin contributes to the reduction of pathological craving for alcohol due to a significant (p< 0,01) снижения интенсивности его вегетативного компонента, оценённого при помощи глоссария Н. В. Чередниченко - В. Б. Альтшулера (к 5-му дню лечения - на 45,64% по сравнению с той же комплексной фармакотерапией, но без цитофлавина).
- The introduction of cytoflavin into complex pharmacotherapy was not accompanied by adverse events, which allows us to consider cytoflavin not only an effective, but also a safe agent in the complex detoxification of patients dependent on alcohol.
Literature
- Kalinin A.V. Clinical perspectives of gastroenterology and hepatology. - 2001. - No. 4. - S. 8–14.
- Schukin M. A. Alcohol and alcoholism // Internal diseases / Per. from English. - M.: Medicine, 1997. - S. 433–446.
- Indicators of the health of the population and the number of resources for the protection of health in Ukraine for 2006: Collection of the Ministry of Health. - Kiev, 2007.
- Churkin A. A., Martyushov A. N. Brief guide to the use of the ICD-10 in psychiatry and narcology. - M.: Triada-X, 2002. - 232 p.
- Friedman L. S., Fleming N. F., Roberts D. G., Hyman S. E. Narcology. - M.: Binom; St. Petersburg: Nevsky dialect, 1998. - 320 p.
- Minko A.I., Linsky I.V. Narcology: Scientific publication. - M.: Eksmo, 2004. - 736 p.
- Cherednichenko N. V., Altshuler V. B. Quantitative assessment of the structure and dynamics of pathological craving for alcohol in patients with alcoholism // Questions of Narcology. - 1992. - No. 3–4. - S. 14–17.
- Lapach S. N., Chubenko A. V., Babich P. N. Statistical methods in biomedical research using Excel. - Kyiv: Morion, 2000. - 320 p.
- Gubler E.V. Computational methods for the analysis and recognition of pathological processes. - M.: Medicine, 1978. - 294 p.
Cytoflavin is an intravenous drug that is prescribed for use to improve the course of metabolic processes in the brain.
Indications for use
- cerebral infarction
- Complications arising from cerebrovascular diseases
- Encephalopathy (both toxic and hypoxic)
- Endotoxicosis.
The drug is used to prevent the occurrence of hypoxic encephalopathy during cardiac surgery using a cardiopulmonary bypass system.
It can be prescribed to premature babies (gestation period - 28-36 weeks) during the complex treatment of cerebral ischemia.
Compound
One milliliter of solution contains:
- Succinic acid - 0.1 mg
- Nicotinamide - 0.01 mg
- Riboxin - 0.02 mg
- Riboflavin - 0.002 mg.
Additionally available:
- Meglumine
- Sodium hydroxide
- Water.
Medicinal properties
The therapeutic effect of the drug is due to the specific properties of each component of the solution.
Succinic acid takes part in the Krebs cycle, undergoes a transformation process and is converted into fumaric acid, which is involved in the tricarboxylic acid cycle. Succinic acid ensures the full flow of the process of ATP synthesis, as well as glycolysis. At the final stage of the cycle, the release of water with carbon dioxide is observed.
Inosine is an important participant in the formation of a number of nucleotide enzymes involved in the Krebs cycle (NAD, as well as FAD). Necessary for ATP synthesis.
Riboflavin is a synthetic analogue of vit.B2, it is involved in the Krebs cycle.
Nicotinamide goes through the process of transformation into NAD and NADP, it is they that have a stimulating effect on the production of ATP, activate cellular respiration.
Release form
Price from 105 to 1202 rubles.
The solution is a yellowish liquid, which is poured into 5 or 10 ml ampoules. Inside the blister pack contains 5 ampoules, the pack holds 1 or 2 packs.
Instructions for use
A solution with riboflavin is administered intravenously. The contents of the ampoules are diluted with 100-200 ml of saline or glucose solution. The daily dosage for adult patients usually does not exceed 10 ml (severe conditions - 20 ml). The duration of treatment is 10 days.
Use during pregnancy and breastfeeding
The drug can be prescribed during pregnancy (in exceptional cases) when fetal hypoxia is detected, the dosage and administration schedule are determined individually.
During lactation, Cytoflavin is not prescribed.
Contraindications
- Excessive susceptibility to components
- Pregnancy, GV
- Critically ill patient
- Reduced blood pressure (less than 60 mm Hg. Art.).
Precautionary measures
With extreme caution, drug treatment is prescribed for gout, nephrolithiasis, and hyperuricemia. In the presence of these diseases, it is necessary to consult a doctor about the optimal regimen for the administration of Cytoflavin.
Cross-drug interactions
The introduction of drugs with antibacterial drugs, namely Streptomycin, reduces the effectiveness of the latter.
Taking thyroid hormones can enhance the effects of Cytoflavin; antidepressants and alcohol have the opposite effect.
Side effects
Adverse symptoms develop quite rarely. In some cases, diagnosed:
- Violation of the CCC
- Headache
- Change in blood pressure
- Nausea and urge to vomit
- Urine color change
- lethargy
- Violation of thermoregulatory function.
Storage conditions and shelf life
It is necessary to store the ampoules in a dark and preferably cool place at a temperature not exceeding 25 C. If a precipitate forms at the bottom of the ampoules, the drug should not be used. The shelf life of Cytoflavin is 12 months.
Analogues
There are no complete analogues of Cytoflavin, but there are drugs with a similar medicinal effect.
Glycine
Biotiki, Russia
Price from 27 to 80 rubles.
Glycine contributes to the regulation of metabolic processes, normalizes the work of the central nervous system. The drug is prescribed for psycho-emotional stress, severe stress, insomnia, and also after an ischemic stroke. The main active ingredient of the drug is microencapsulated glycine, available in the form of lozenges.
Pros:
- Low price
- Designed for adults and children
- Released without a prescription.
Minuses:
- Cannot be combined with alcohol
- May cause allergic reactions
- To achieve a visible result, you will need to take the medicine for a long time.
Vegetative-vascular dystonia- This is a very difficult disease to treat due to the variety and manifestation of symptoms. These are psychosomatic disorders that lead to a malfunction of the heart, blood vessels, gastrointestinal tract, and brain. The mental state of the patient is disturbed, the quality of life and working capacity are reduced.
If treatment is not started on time, the VVD disease will progress and can cause organic damage to the heart, brain and other organs. The volume of therapy is prescribed by the doctor after a thorough examination of the patient. In the complex, Cytoflavin is often prescribed for VVD to eliminate negative symptoms.
Problems of the disease
Given the variety of symptoms, the treatment of VVD should be comprehensive and lengthy. Once they appear, the symptoms usually return again. For the treatment of vegetative-vascular dystonia (VVD), various types are used. These are drug therapy, physiotherapy, psychocorrection, spa treatment. Such an integrated approach helps to rehabilitate patients, restore lost health, and improve the quality of life. The right psychological attitude and faith in the possibility of healing are very important.
Metabolic processes and lack of energy resources play an important role in the development of symptoms. For replenishment, drugs that improve cell metabolism are used. These are various vitamin preparations.
One of the modern drugs for the treatment of vegetative-vascular dystonia (VVD) is Cytoflavin. This is a combination drug that contains succinic acid, inosine (riboxin), nicotinamide, riboflavin mononucleotide and excipients.
Pharmacological group - a means that improves tissue nutrition. Available in tablets and injections
The action of Cytoflavin in VVD
The effect of Cytoflavin in VVD is due to the following components:
- Succinic acid - is a metabolite of the Krebs cycle, the cycle of tricarboxylic acids - this is a key step in the respiration of all cells that use oxygen. It is not only energy, but also nutrition of body tissues. Amino acids, carbohydrates and other compounds are formed.
- Riboflavin is vitamin B2, a vitamin necessary for the body that affects metabolic processes. Flavonoids are necessary for the processes of oxidation and inactivation of harmful compounds. With its lack, hair, nails deteriorate, skin suffers. It is necessary for the production of red blood cells, antibodies. With a deficiency, it affects the functioning of the thyroid gland, reproductive function.
- Nicotinamide - vitamin PP - nicotinic acid amide. Participates in metabolic processes and nutrition of cells. Side effects: allergies in the form of a rash and itching, shortness of breath. If the dose is exceeded - heart rhythm disturbance, diarrhea, dizziness, increased blood sugar. Also thirst, nausea, vomiting, pain in the stomach, itchy skin. Long-term use can cause fatty degeneration of the liver.
- Inosine is an anabolic that improves metabolism and microcirculation in the heart. Improves heart rhythm and blood supply, activates metabolism, nourishes cells.
Cytoflavin is well absorbed and excreted.
Application of the drug
Cytoflavin is used for VVD, cerebrovascular diseases and neurasthenia. Can be used with increased physical or mental stress, with heart disease.
Contraindications to taking Cytoflavin
Individual intolerance to the components of the drug Cytoflavin in VVD:
- Not allowed for children under 18
- It is undesirable to use Cytoflavin in diseases of the gastrointestinal tract during an exacerbation, low blood pressure, urolithiasis, gout, purine metabolism disorders.
- You can not take Cytoflavin with VVD pregnant and breastfeeding.
Side effects
After taking Cytoflavin with VVD, there may be a headache, a decrease in blood pressure, epigastric pain, nausea, and diarrhea.
Allergy in the form of reddening of the skin, itching, up to anaphylactic shock. It is necessary to administer Cytoflavin with VVD slowly intravenously.
Cytoflavin Compatibility
Not compatible with streptomycin. Reduced activity of antibiotics (tetracycline, macrolides). Cases of overdose with Cytoflavin in VVD have not been noted. If you have diabetes, be sure to control your blood sugar. With hypertension - correction of drugs that reduce blood pressure.
Alcohol compatibility
Cytoflavin in VVD cannot be combined with alcohol, because it is possible to develop a pronounced allergic reaction, lower blood pressure, and develop tachycardia.
With vegetative-vascular dystonia, drinking with alcohol, especially during treatment, is strictly prohibited. A lot has been written about the dangers of alcohol in various sources. With vegetative-vascular dystonia, the use is very dangerous because alcohol-containing substances affect the brain, cardiovascular system, causing tachycardia, increased blood pressure. Alcohol affects the psyche, causing addiction and withdrawal symptoms. This greatly aggravates the course of the VSD.
When using Cytoflavin for VVD, the instructions do not indicate that alcohol should not be consumed. But with any treatment, doctors always warn about the dangers of alcohol. This is an additional burden on all organs, in particular on the liver. What will be the reaction of the body - it is difficult to predict. No sane person will drink alcohol during the course of treatment.
Analogues
Analogues are vitamin preparations that improve metabolism. Vinpocetine or Cavinton are not analogues of cytoflavin, because they belong to different pharmacological groups. Vinpocetine is a medicine that improves the blood supply to the brain, thereby improving nutrition.
Cytoflavin is used as a complex drug for the treatment of vegetative-vascular dystonia in combination with other drugs and has a positive effect.
In any case, self-administration of Cytoflavin with VVD is unacceptable, it is imperative that a doctor prescribe it according to indications. It is important to observe the dose and the interval between doses.
Accept - no more than 25 days.
According to the World Health Organization, more than 90% of the world's inhabitants drink alcoholic beverages, and at least 40% drink alcohol every month, which is associated with a high risk of health problems. About 10% of men and 3-5% of women drink alcohol daily. In addition to characteristic changes in the brain, excessive alcohol consumption causes numerous disturbances in the functioning of almost all body systems, leading to the occurrence of multiple organ pathology. Therefore, it is not surprising that in most countries of the world, alcohol-related diseases are in 3rd-4th place among the causes of death. The problem of alcohol dependence is also relevant for Ukraine. As of January 1, 2007, 628,379 people, or 1,344.1 patients per 100,000 people, were registered with the dispensary narcological register in our country alone.
Alcohol dependence syndrome is a psychopathological hypostasis of a state of chronic intoxication. It is no coincidence that the treatment of such patients begins with the elimination of the metabolic consequences of prolonged exposure to ethanol on the patient's body. In this regard, attention is drawn to the drug Cytoflavin, whose spectrum of action seems to be fully consistent with the tasks of the initial stage of treatment of patients dependent on alcohol - detoxification. Cytoflavin, produced by the scientific and technological pharmaceutical company Polisan (Russian Federation), is a clear yellowish solution, each milliliter of which contains 100 mg of succinic acid, 10 mg of nicotinamide, 20 mg of riboxin (inosine), 2 mg of riboflavin mononucleotide (riboflavin) , as well as excipients: N-methylglucamine (meglumine), sodium hydroxide and water for injection. Produced in the form of a solution for intravenous injection.
Cytoflavin improves coronary and cerebral blood flow, activates metabolic processes in the central nervous system, reduces reflex disturbances, sensitivity disorders and restores the intellectual-mnestic functions of the brain. It is used to treat acute cerebrovascular accident, dyscirculatory (vascular) encephalopathy of the 1st-2nd stage and the consequences of cerebrovascular accidents (chronic cerebral ischemia); toxic and hypoxic encephalopathy in acute and chronic poisoning, endotoxicosis due to anesthesia. In adults, Cytoflavin is used exclusively intravenously by slow drip in a dilution of 100-200 ml of 5-10% glucose solution or 0.9% sodium chloride solution 1-2 times a day with an interval between injections of 8-12 hours for 5 days.
The pharmacological properties of Cytoflavin suggest that it may be useful when administered to alcohol-dependent patients during the detoxification phase.
The aim of this work was to evaluate the efficacy and safety of Cytoflavin in the complex therapy of patients with alcoholism at the stage of relief of alcohol withdrawal syndrome.
An open comparative clinical study was conducted in parallel groups without placebo control. The study included 60 patients who were diagnosed with alcohol withdrawal syndrome (F10.3) in accordance with ICD-10 criteria. All patients were scheduled to be hospitalized in the departments of the Kharkiv City Clinical Narcological Hospital No. 9 (clinical base of the Institute of Neurology, Psychiatry and Narcology of the Academy of Medical Sciences of Ukraine (INPN AMNU), Kharkiv). On admission, patients were randomly assigned to one of two study groups (30 patients - main group and 30 patients - control group). Patients of the main group received standard therapy together with cytoflavin therapy, patients of the control group - only standard therapy. The total duration of the study in both comparison groups was 10 days. During this period, there were 7 meetings of each patient with his researcher (visits), while visit No. 1 was devoted to screening (a preliminary study with the appointment of a hospitalization date), and daily visits Nos. days of treatment, respectively) and the final visit No. 7 covered the period of relief of alcohol withdrawal syndrome and acute post-intoxication disorders. It should be clarified that the term “visit”, used in the vocabulary of clinical trials, is conditional in this text, since patients were in the hospital throughout the entire observation period.
The average values of age, body weight and some indicators of alcohol history in patients of the main and control groups at the start of the study are presented in Table. 1, the data of which indicate that the selected comparison groups are quite comparable in terms of the main parameters and, therefore, suitable for a comparative analysis of the results of standard and study types of treatment.
Table 1
Average values of age, body weight and some indicators of alcohol history in patients of the main and control groups at the start of the study
| Index | Average values (M±m) | |
| main group, n = 30 | Control group, n = 30 | |
| Age, years | 40.60±1.680 | 41.73±1.793 |
| Body weight, kg | 74.93± 1.246 | 75.80± 1.282 |
| Total experience of alcoholization (episodic + systematic), years | 13.63±0.653 | 13.87±0.645 |
| Experience of systematic alcoholization, years | 11.47±0.753 | 11.60±0.556 |
| Attempts to stop alcoholism, total | 4.10±0.337 | 4.37 ± 0.364 |
| Attempts to stop alcoholism, with remission | 1.67 ± 0.154 | 2.10±0.251 |
| Total duration of all remissions, years | 2.58±0.289 | 2.73±0.353 |
| The ratio of the total duration of all remissions to the experience of systematic alcoholization | 0.23±0.026 | 0.22 ± 0.023 |
| Duration of the period from the end of the last remission to the moment of hospitalization, months | 14.23± 1.576 | 11.46±0.976 |
| Daily dose of alcohol, grams abs. ethanol | 218.6± 17.726 | 215.0± 16.718 |
| Frequency rate of alcohol consumption (during the day) | 2.27 ± 0.214 | 2.39±0.240 |
Note:
* - differences between the main and control groups are significant ( p < 0,05).
The scheme of detoxification therapy for patients addicted to alcohol was complex (Table 2).
table 2
Schemes of complex therapy in comparison groups at the stages of treatment
| Type of therapy (drugs, doses, mode of administration) | Main group | Control group |
|
+ | + |
Study Therapy: |
+ | – |
Notes:
"+" - this type of therapy is applied;
"-" - this type of therapy is not used.
To assess the current state of patients and, accordingly, the effectiveness and tolerability of treatment, a complex of clinical, psychometric and laboratory research methods was used.
The clinical and psychopathological method was the main one in assessing the condition of patients throughout the study. The interpretation of data obtained using any other methods was carried out in the process of comparison with the results of a clinical and psychopathological study, which was carried out in accordance with the criteria for the International Classification of Diseases of the Tenth Revision (ICD-10) . During treatment, patients of both groups were tested daily for the presence of alcohol vapor in the exhaled air (alco-test). To monitor the alcohol withdrawal syndrome, daily monitoring of vital indicators (blood pressure, heart rate (HR), body temperature, etc.) and four times (at admission, as well as on the 3rd, 5th and 10th days) were carried out. treatment) assessment of the severity of withdrawal symptoms using the CIWA-Ar screening test. Twice, at admission and on the 10th day of observation, the intensity and structure of the pathological craving for alcohol (PVA) were assessed using the glossary of N. V. Cherednichenko and V. B. Altshuller. Processing of the received data was carried out by methods of mathematical statistics (dispersion, correlation, regression analysis) on a PC using SPSS 15.0 and Excel programs.
Changes in hemodynamic parameters - systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate, and body temperature ( t°C) are the most important objective manifestations of that powerful homeostatic stress, which, in fact, is always the transition from systematic alcoholism to sobriety (Fig. 1, 2).
Rice. one. Dynamics of the average values of systolic (a) and diastolic (b) blood pressure in patients of the main and control groups (* p < 0,05)
Rice. 2. Dynamics of the average values of heart rate (a) and body temperature (b) in patients of the main and control groups (* p < 0,05)
Main group; control group
It is not difficult to notice that the changes in all the mentioned physiological parameters are of the same type. First (from the 1st to the 3rd–5th visit) their increase is observed, then (from the 3rd to the 7th visit) they decrease. It is noteworthy that at the stage of relief of the withdrawal syndrome in patients who received standard therapy together with cytoflavin therapy (the main group), normalization of hemodynamic parameters occurred much earlier (Fig. 1a, 1b and 2a) than in patients who received only standard therapy (control group).
As a result, from the 3rd to the 7th visit, hemodynamic parameters (SBP, DBP, heart rate) were found to be significant in the main group ( p < 0,05) ниже, чем в контрольной (рис. 1а, 1б и 2а). Температура тела с той же достоверностью у пациентов обеих групп на всём протяжении исследования не отличалась. Из приведённых данных следует, что цитофлавин на этапе купирования синдрома отмены алкоголя существенно уменьшает силу гомеостатического стресса, связанного с переходом от систематической алкоголизации к трезвости, что проявляется ускоренной нормализацией показателей гемодинамики.
Various manifestations of alcohol withdrawal syndrome, taken into account by the CIWA-Ar screening test (nausea and / or vomiting, tactile disturbances, visual disturbances, auditory disturbances, tremor, paroxysmal sweating, anxiety, headache and / or heaviness in the head, agitation, disorientation and stupefaction), reach the maximum degree of severity at the time of visit No. 4 (the 3rd day of the cessation of alcoholization), and then begin to decrease (Table 3).
Table 3
Dynamics of the average results of the CIWA-Ar screening test during the relief of alcohol withdrawal syndrome
| Manifestations (symptom) of alcohol withdrawal syndrome | Average severity in points (M±m) | |||
| 1st visit (1st day) |
4th visit (3rd day) |
6th visit (5th day) |
7th visit (10th day) |
|
| Main group | ||||
| Nausea or vomiting | 0.33±0.09 | 0.83±0.22 | 0.45±0.14 | 0.00±0.00 |
| Tactile disorders | 0.43±0.09 | 1.45±0.23 | 0.90±0.15 | 0.00±0.00 |
| visual disturbances | 2.13±0.16 | 2.76±0.13 | 2.38±0.15 | 0.34±0.09 |
| Auditory disorders | 2.23±0.16 | 2.59±0.15 | 2.45±0.15 | 0.34±0.09 |
| Tremor | 3.13±0.10 | 3.62±0.22 | 2.62±0.22 | 0.38±0.09 |
| paroxysmal sweat | 2.73±0.23 | 2.76±0.17 | 1.76±0.17 | 0.62±0.09 |
| Anxiety | 2.80±0.20 | 3.97±0.21 | 2.48±0.13 | 1.38±0.09 |
| 0.07±0.05 | 0.34±0.09 | 0.10±0.06 | 0.00±0.00 | |
| 0.20±0.07 | 0.38±0.14 | 0.10±0.06 | 0.31±0.09 | |
| Excitation | 0.33±0.09 | 0.66±0.17 | 0.41±0.09 | 0.24±0.08 |
| Total | 14.40±0.58 | 19.34±0.87 | 13.66±0.78 | 3.62±0.17 |
| Control group | ||||
| Nausea or vomiting | 0.27±0.08 | 1.67±0.23 | 0.80±0.20 | 0.00±0.00 |
| Tactile disorders | 0.30±0.09 | 1.47±0.22 | 1.03±0.17 | 0.00±0.00 |
| visual disturbances | 2.10±0.13 | 2.70±0.14 | 2.37±0.12 | 0.37±0.09 |
| Auditory disorders | 2.00±0.19 | 2.73±0.14 | 2.37±0.10 | 0.15±0.07 |
| Tremor | 3.13±0.09 | 4.57±0.20** | 3.57±0.20** | 0.48±0.10 |
| paroxysmal sweat | 2.33±0.19 | 3.50±0.18** | 2.50±0.18** | 0.48±0.10 |
| Anxiety | 2.63±0.18 | 4.20±0.18** | 2.73±0.14** | 1.48±0.10 |
| Disorientation and confusion | 0.13±0.06 | 0.40±0.09 | 0.23±0.08 | 0.00±0.00 |
| Headache, heaviness in the head | 0.27±0.08 | 1.00±0.19 | 0.53±0.12 | 0.37±0.09 |
| Excitation | 0.43±0.09 | 0.63±0.16 | 0.77±0.14* | 0.37±0.09 |
| Total | 13.60±0.49 | 22.87±0.89** | 16.90±0.91** | 3.70±0.16 |
Notes:
p < 0,05;
** p < 0,01.
At the same time, in the main group of patients, the reduction of some symptoms of the withdrawal syndrome occurred faster than in the control group, which manifested itself in significantly ( p < 0,05) меньших степенях выраженности тошноты или рвоты (визит № 4), тремора (визиты №№ 4–6), пароксизмального пота (визиты №№ 4–6), тяжести в голове или головной боли (визиты №№ 4–6) и, как следствие, тяжести синдрома отмены алкоголя в целом (визиты №№ 4–6). Поскольку на этапе купирования синдрома отмены основная группа отличалась от контрольной только тем, что в ней, помимо стандартной терапии, применялся цитофлавин, то ускоренную редукцию упомянутых выше симптомов и синдрома отмены алкоголя в целом следует считать обусловленной действием именно этого препарата.
PVA is a core symptom of the syndrome of dependence on this psychoactive substance. It is PVA that becomes the main cause of alcoholic excesses during treatment and relapses of alcoholization in the post-therapeutic period.
During 10 days of observation, the intensity of PVA decreased markedly, which can be easily explained by the relief of the painful phenomena of the alcohol withdrawal syndrome. Along with common features in the nature of PVA reduction, significant differences were found between the comparison groups. A component-by-component comparative analysis found that in the main group, the severity of all components (appetite disorders, dreams, facial reactions) of the vegetative component of PVA on the 10th day of treatment was significantly lower than in the control group (Table 4). These differences can be considered the result of the action of this drug.
Table 4
Dynamics of the mean severity (PVA), its components and their components in the examined from the main and control groups during treatment
| PVA components and their components | Values of PVA components, points (M±m) | |||
| Main group | Control group | |||
| 1st visit (1st day) |
7th visit (10th day) |
1st visit (1st day) |
7th visit (10th day) |
|
| affective | ||||
| subdepression | 1.43±0.10 | 1.34±0.10 | 1.37±0.11 | 1.19±0.11 |
| Anxiety | 1.80±0.15 | 1.31±0.13 | 1.87±0.16 | 1.37±0.12 |
| Emotional lability | 0.80±0.10 | 0.79±0.10 | 0.90±0.12 | 0.85±0.13 |
| Dysphoria | 0.87±0.13 | 0.62±0.09 | 0.93±0.14 | 0.74±0.10 |
| Generally | 4.90±0.28 | 4.07±0.24 | 5.07±0.28 | 4.15±0.22 |
| Vegetative | ||||
| dreams | 1.10±0.19 | 0.48±0.09 | 1.13±0.18 | 0.81±0.08* |
| Mimic reactions | 0.90±0.06 | 0.48±0.09 | 0.93±0.05 | 0.81±0.08* |
| Appetite changes | 1.00±0.14 | 0.34±0.09 | 1.17±0.14 | 0.78±0.12* |
| Generally | 3.00±0.22 | 1.31±0.15 | 3.23±0.24 | 2.41±0.17** |
| Ideatorny | ||||
| attitude to alcohol | 1.73±0.11 | 1.34±0.09 | 1.70±0.10 | 1.41±0.10 |
| Attitude towards treatment | 1.00±0.14 | 0.90±0.11 | 0.93±0.14 | 0.67±0.09 |
| Generally | 2.73±0.21 | 2.24±0.16 | 2.63±0.20 | 2.07±0.13 |
| Behavioral Component | 0.90±0.13 | 0.86±0.10 | 0.83±0.12 | 0.78±0.10 |
| PVA in general | 11.53±0.48 | 8.48±0.35 | 11.77±0.46 | 9.41±0.31 |
Notes:
differences with the main group are significant: * p < 0,05;
** p < 0,01.
Patients' sobriety regimen was assessed at each visit according to the results of the alcohol test, as well as by a retrospective anamnestic analysis of the period that had elapsed since each previous visit. The dynamics of the number of people who had alcoholic excesses during treatment, according to the positive results of the alcohol test during the visits, is shown in Fig. 3. When calculating the relative values, the decrease in the number of groups during treatment was taken into account.
Rice. 3. Dynamics of the number of persons who had alcohol excesses during treatment, according to the positive results of the alcohol test, in absolute (a) and relative (b) values ( p < 0,05)
Main group; control group
It can be seen that the first alcoholic excesses began even at the stage of stopping the withdrawal syndrome, in hospital conditions (visit No. 6, or the 5th day from the start of treatment). At the same time, their frequency in the control group was somewhat higher than in the main group, which may be due to the ability of Cytoflavin to suppress the vegetative component of PVA. However, the above differences between the comparison groups in the frequency of alcoholic excesses were not statistically significant, so this assumption needs further verification.
Thus, as a result of the study, the effectiveness of the use of Cytoflavin in the detoxification therapy of patients dependent on alcohol was established.
Cytoflavin accelerates the reverse development of such manifestations of alcohol withdrawal syndrome as arterial hypertension, tachycardia, nausea, vomiting, tremor, sweating, heaviness in the head and headache. At the same time, it is reliable ( p < 0,05) снижается интегральный показатель тяжести алкогольной абстиненции по шкале CIWA-Ar (к 5-му дню лечения - на 31,35% по сравнению с той же комплексной фармакотерапией, но без цитофлавина).
This drug contributes to the reduction of pathological craving for alcohol due to a reliable ( p < 0,01) снижения интенсивности его вегетативного компонента (к 5-му дню лечения - на 45,64%).
The introduction of cytoflavin into complex pharmacotherapy was not accompanied by adverse events, which allows us to consider cytoflavin not only an effective, but also a safe agent in the complex detoxification of patients dependent on alcohol.
Literature
- Kalinin A.V. Clinical perspectives of gastroenterology and hepatology. - 2001. - No. 4. - S. 8–14.
- Schukin M. A. Alcohol and alcoholism // Internal diseases / Per. from English. - M.: Medicine, 1997. - S. 433–446.
- Indicators of the health of the population and the number of resources for the protection of health in Ukraine for 2006: Collection of the Ministry of Health. - Kiev, 2007.
- Churkin A. A., Martyushov A. N. Brief guide to the use of the ICD-10 in psychiatry and narcology. - M.: Triada-X, 2002. - 232 p.
- Friedman L. S., Fleming N. F., Roberts D. G., Hyman S. E. Narcology. - M.: Binom; St. Petersburg: Nevsky dialect, 1998. - 320 p.
- Minko A.I., Linsky I.V. Narcology: Scientific publication. - M.: Eksmo, 2004. - 736 p.
- Cherednichenko N. V., Altshuler V. B. Quantitative assessment of the structure and dynamics of pathological craving for alcohol in patients with alcoholism // Questions of Narcology. - 1992. - No. 3–4. - S. 14–17.
- Lapach S. N., Chubenko A. V., Babich P. N. Statistical methods in biomedical research using Excel. - Kyiv: Morion, 2000. - 320 p.
- Gubler E.V. Computational methods for the analysis and recognition of pathological processes. - M.: Medicine, 1978. - 294 p.