ACTUAL INFORMATIONWhen it becomes necessary to quickly eliminate headache, muscle and other pain, a person is looking for effective remedies. Combined over-the-counter drugs have proven themselves well to solve current problems. The representative of this group is Andipal-V. Composition and form of release Andipal-B is a tablet preparation, the effect of which is realized through a combination of three active substances: metamizole sodium, bendazole hydrochloride and papaverine hydrochloride. For the convenience of dose selection, Andipal-B is available in four different dosages, respectively, the names of the drug are also different. Andipal-B is a standardized dosage for adults, which includes 250 mg of metamizole sodium and 20 mg each of bendazole hydrochloride and papaverine hydrochloride. If one Andipal-B tablet is not enough to effectively eliminate the pain syndrome, Andipal-extra is available, in which the dosage of metamizole sodium is increased to 500 mg, and papaverine hydrochloride to 40 mg. There is also Andipal-forte, in which the dosage of all three active ingredients is doubled compared to Andipal-B. For the convenience of treating individuals with low body weight and / or hypersensitivity to active substances, Andipal-neo was released, in which the dose of metamizole sodium was reduced to 175 mg, and bendazole hydrochloride and papaverine hydrochloride to 10 mg. These four forms of release of the drug are dispensed without a prescription, in addition to the packaging of the drug No. 100. There is also a prescription form of Andipal, which in addition to the mentioned active substances also includes phenobarbital (instruction of the Ministry of Health of Ukraine). Pharmacological properties Pharmacodynamics Metamizole sodium reduces the rate of lipid peroxidation, which helps to reduce the number of endoperoxides and free radicals. In addition, the rate of transmission of pain impulses through Gaulle beams from somatic and proprioceptive receptors is reduced, which, in turn, leads to an increase in the threshold of pain sensitivity in thalamic centers and an increase in heat transfer. Metamizole sodium is characterized by a mild anti-inflammatory effect, therefore, it slightly affects the retention of sodium and water in the body. Bendazole hydrochloride is a substance that is characterized by antispasmodic, vasodilating and hypotensive effects (mainly due to a decrease in cardiac output). Due to its ability to improve capillary blood flow, it improves blood circulation to internal organs. It also stimulates spinal cord function and promotes the regeneration of peripheral nerves by facilitating synaptic transmission. It causes a moderate immunostimulating effect, which is based on the regulation of the ratio of cAMP and cGMP, as a result of which the proliferation of mature sensitized T and B lymphocytes, the secretion of the factors of their interaction and the activation of their final effector function are stimulated. Papaverine hydrochloride, by analogy with bendazole hydrochloride, has myotropic hypotensive and antispasmodic properties. Its action is associated with blocking the activity of type IV phosphodiesterase. This leads to the cessation of cAMP hydrolysis, which, in turn, restricts the entry of calcium ions into the cell, as a result of which the kinase of myosin light chains is inactivated. As a result, contractile activity of predominantly smooth muscle cells decreases. Thus, papaverine hydrochloride reduces the tone of arterial vessels of various calibers. When used in therapeutic doses, there is practically no effect on the nervous system. Pharmacokinetics After the person has taken the pill, the active substances are rapidly hydrolyzed in the gastric juice and are completely absorbed into the blood as active metabolites. Metamizole sodium metabolites (4-methyl- and 4-formyl-amino-antipyrine) do not bind to plasma proteins. The action of the drug begins quite quickly (20–40 minutes after administration) and reaches its maximum within 2 hours. The drug metabolism occurs in the liver cells, and its products are excreted by the kidneys. Papaverine hydrochloride almost completely (up to 90%) binds to plasma proteins. It has the ability to freely pass through the histohematological barriers. It is deposited in adipose tissue and liver, the cells of which are metabolized. Subsequently, metabolic products are excreted by the kidneys. Indications All types of the drug are used to eliminate symptomatic pain syndrome, which is associated with spasm of blood vessels or smooth muscle structures of internal organs. The main indication for the use of the drug Andipal-B is the treatment of headache associated with an increase in blood pressure. But it must be borne in mind that the hypotensive effect of the drug is moderate and lasts 2-3 hours, therefore Andipal-B is suitable only for the treatment of neurocirculatory dystonia according to the hypertonic type, and for the treatment of hypertension it is necessary to select drugs with a different mechanism of action. Since migraine is a headache that is caused by capillary spasm, Andipal-B is well suited for stopping its attacks, especially in the absence of drugs with a more specific effect. Spasms of the smooth muscle wall of the internal organs can be manifested by pain in the stomach or intestines, cholecystitis, and hepatic colic. The most effective use of Andipal-B tablets for self-treatment of renal colic, especially if it is caused by the migration of not large stones, but sand. If renal / biliary colic is associated with the presence of biliary sludge in the gallbladder, then you can independently treat it with the help of tableted preparations and diet, and if bile ducts contain formed calculi, then self-medication should be abstained. Indications also include residual effects of poliomyelitis and trigeminal or facial neuritis, other neuralgia and radiculitis. A good effect from Andipal-B is observed with muscle pain, which was preceded by unusually intense physical activity (for example, a long walk or a new sport). Also, thanks to the antispasmodic and analgesic effects, Andipal-B can be used to symptomatically relieve bronchospasm, which follows acute viral lesions of the tracheobronchial tree. A type of Andipal containing phenobarbital can be used once before painful procedures (hair removal, minor operations, dental treatment) - painkillers and sedatives will greatly facilitate the tolerability of the procedure.
Doses and method of application Andipal-B is taken orally - the tablet is swallowed without chewing, washed down with a small amount of water. Typically, the drug is taken 1-2 tablets 1-3 r / day. In this case, the maximum daily dose is limited to sodium metamizole entering the body. Its maximum single dose is 1 g, and the daily dose should not exceed 3 g. Such dose and frequency of administration of the drug are suitable for adults and children over the age of 14 years. For children aged 12-14 years, only Andipal-neo is suitable, since it contains a reduced amount of metamizole sodium. For children under the age of 12, Andipal-B is not prescribed. The total duration of the course of treatment is determined based on the nature and course of the pathological process, the achievement of the effect and other components of the treatment complex. In this case, the duration of the course of independent use of the drug should not exceed 72 hours. Contraindications The main contraindication to the use of Andipal-B (due to the presence of metamizole sodium in its composition) is a fixed or suspected intolerance to pyrazolone derivatives such as phenazone, phenylbutazone. Like other combined NSAIDs, the drug is contraindicated in the presence of a patient with peptic ulcer of the stomach or duodenum in the acute stage, especially if it was complicated or complicated earlier by bleeding / perforation / penetration of the organ. Metamizole sodium affects the blood composition, therefore its use is limited for such congenital and acquired hematological disorders: congenital G-6-FDH deficiency, anemia of various origins (including hemolytic), neutropenia (cytostatic or infectious origin), granulocytopenia, porphyria, thrombocytopenia . If the patient is suspected of acute surgical pathology, it is recommended to refrain from self-medication with Andipal-B until being examined by a doctor.
Unlike symptomatic bronchospasm, disorders of the respiratory tract motility such as bronchial obstruction syndrome, bronchial asthma, various types of inhibition of the function of external respiration are a contraindication when prescribing a medicine.Given the effect of the drug on muscle tone, the drug is contraindicated in patients with its disorders - both myasthenic and convulsive disorders. It is also undesirable to prescribe it if the patient has disorders of motility of the colon by hypotonic type, chronic constipation. Andipal-B is not suitable for the treatment of intestinal obstruction, toxic megacolon, postoperative intestinal paresis. Since the components of the drug affect the function of the heart (the conductive system, cardiac output) and vascular tone, the drug cannot be used for heart failure, atrioventricular block, and a tendency to hypotension. Since metabolism and excretion of the active components of the drug are carried out by the liver and kidneys, acute violations of their function are also a contraindication to its purpose. In addition, contraindications to the use of Andipal include endocrinological disorders (hypothyroidism, diabetes mellitus, adrenal gland disorders), prostate adenoma, glaucoma (especially angle-closure); not prescribed for the treatment of the effects of traumatic brain injury. Also, in the treatment of patients of senile age (more than 75 years), the risk of developing hyperthermia increases. Application in certain categories of patients Metamizole sodium is known to be secreted into breast milk when used in therapeutic doses. To date, safe doses and the method of use in women during pregnancy and breastfeeding have not been established, therefore, it is recommended to refrain from using Andipal-B in them. The drug is not suitable for the treatment of children under the age of 12 years. Interaction with other drugs It is necessary to inform the attending physician about the self-administration of the drug, since it can interact with many drugs prescribed by the doctor. Metamizole sodium tends to enhance the effects of indirect anticoagulants, phenytoin, glucocorticosteroids, indomethacin and ibuprofen. In addition, it potentiates the analgesic, antipyretic and side effects of other NSAIDs. When combined with chlorpromazine or other phenothiazine derivatives, a sharp decrease in body temperature below normal values ​​is possible. Phentolamine and other ACE inhibitors are able to potentiate the effect of papaverine hydrochloride, which can lead to severe hypertension and uncontrolled erection up to priapism. The hematotoxicity of metamizole sodium can be enhanced by gold preparations, methotrexate, melphalan, thiamazole. The analgesic effect of metamizole sodium is enhanced with sedatives and tranquilizers (such as diazepam, codeine, barbiturates), and the toxic effect with tricyclic antidepressants due to a violation of the processes of its conversion in the liver.

Effect on reaction rate When taking Andipal-B, there is a slowdown in neuropsychiatric reactions and concentration of attention, therefore, during its administration should refrain from driving and other complex mechanisms. Overdose Overdose symptoms are mainly characterized by signs of intoxication with metamizole sodium. Signs of this condition include lethargy and drowsiness, headache, ischemic disorders, respiratory depression up to paralysis of the respiratory muscles; disorders of the gastrointestinal tract: from nausea and vomiting to emptying disorders, abdominal pain, etc. In addition, eye symptoms such as nystagmus, double vision (diplopia), and visual impairment can suggest an overdose. In rare cases, an overdose of metamizole sodium leads to hypothermia (a decrease in body temperature below normal numbers), coma, and a decrease in renal filtration up to anuria. An overdose of antispasmodics - bendazole hydrochloride and papaverine hydrochloride - is usually manifested by a sharp decrease in blood pressure, noticeable interruptions in the work of the heart (arrhythmia, tachycardia, atrioventricular block), general weakness, increased sweating, reddening of the skin due to a decrease in peripheral vascular tone. In addition, prolonged use of high doses of the drug may be accompanied by a skin rash or toxic hepatitis. Treatment of an overdose of the drug includes gastric lavage to eliminate possible residues, enterosorbents, forced diuresis, and support for vital functions. In extremely severe cases, hemodialysis is indicated. Application features Metamizole sodium in Andipal-B can cause Lyell syndrome (toxic epidermolysis). And although this pathological condition often accompanies the use of antibiotics, with its development it is also necessary to take into account the possible independent use of pain medications. While taking the medicine, you should exclude the use of alcohol due to the mutual potentiation of the effects. The effectiveness of the drug significantly decreases with tobacco smoking. Caution should be exercised when taking the drug in the presence of allergic diseases (such as hay fever) or inflammatory bowel disease (especially Crohn's disease or ulcerative colitis). When taking Andipal-B, it should be borne in mind that sore throat, difficulty swallowing, blanching of the skin, a rash on the skin or mucous membranes, as well as vaginitis or proctitis, are signs of increased individual sensitivity to the drug. Therefore, when these symptoms appear, an urgent examination by a doctor is required.

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