Neurology
- Active ingredient (INN)
- piracetam
- Composition (active ingredients)
- piracetam - 200,0 mg
- Фармакотерапевтическая группа
- nootropic agent
- Pharmacotherapeutic group
- solution for intravenous and intramuscular administration of 200 mg / ml 5 ml № 10
- Сonditions of supply
- on prescription
Indications
- symptomatic treatment of intellectual-mnestic disorders in the absence of an established diagnosis of dementia;
- reduction of manifestations of cortical myoclonus in patients sensitive to piracetam, both as monotherapy and as part of complex therapy (in order to determine the sensitivity to piracetam in a specific case, a trial course of treatment can be performed).
Dosage regimen
Intravenously or intramuscularly.
Parenteral administration of piracetam is prescribed if it is impossible to use the oral form of the drug (unconsciousness, difficulty swallowing).
Intravenous administration is preferred.
Intravenous infusion of a daily dose is performed through a catheter at a constant rate for 24 hours a day (for example, in the initial stage of treatment of severe myoclonia).
The drug is pre-diluted in one of the compatible infusion solutions.:
- dextrose 5%, 10% or 20%;
- fructose 5%, 10%, 20%;
- sodium chloride 0.9%;
- dextran 40 10% (in a solution of sodium chloride 0.9%);
- Ringer's solution;
- a solution of mannitol 20%.
The total volume of solution intended for administration is determined taking into account the clinical indications and the condition of the patient.
Intramuscularly, the drug is administered if the introduction through the vein is difficult or the patient is overexcited. The volume of solution administered intramuscularly cannot exceed 5 ml. The frequency of administration of the drug is similar to that of its intravenous or oral use.
When the opportunity arises, they switch to the oral administration of the drug (see instructions for medical use of the appropriate form of release of the drug). The duration of treatment is determined by the doctor depending on the disease and taking into account the dynamics of the symptoms.
- With memory disorders, intellectual impairment
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2,4-4,8 g / day in divided doses during the first few weeks, then they switch to maintenance therapy 2.4 g / day in 2-3 doses, 1.2 g / day is possible
- Cortical myoclonia treatment
-
treatment begins with 7,2 g / day, every 3-4 days the dose is increased by 4.8 g / day until the maximum dose of 24 g / day is reached. divided into 2-3 introductions. The dose of the remaining drugs for the treatment of myoclonia is not changed. In the future, according to the results of treatment, it is necessary, if possible, to reduce the dose of drugs for the treatment of myoclonia. After starting treatment with piracetam, treatment is continued until the symptoms of the disease persist. In patients with an acute episode, the course of the disease may change over time, therefore, every 6 months, attempts should be made to reduce the dose or discontinue the drug. To avoid sudden relapse, the dose is reduced by 1.2 g every 2 days (in order to prevent the possibility of sudden relapse of seizures in Lans-Adams syndrome - every 3-4 days)
- Elderly patients
-
Elderly patients with renal insufficiency should undergo dose adjustment (see "Renal failure"). With long-term treatment, creatinine clearance should be regularly evaluated to determine the need for dose adjustment.
Renal failure:
Piracetam is excreted almost exclusively by the kidneys, in the treatment of patients with renal failure or requiring monitoring of renal function, caution should be exercised.
The half-life increases in direct proportion to the deterioration of renal function and creatinine clearance, this is also true for elderly patients whose creatinine excretion depends on age.
The dose should be adjusted depending on the size of creatinine clearance (CC):
Creatinine clearance for men can be calculated based on the concentration of serum creatinine, but the following formula:
KK (ml / min) = [140 - age (years)] x body weight (kg) / [72 x KK serum & nbsp; (mg / dl)]
Creatinine clearance for women can be calculated by multiplying the resulting value by a factor of 0.85.
Kidney Function: Normal, KK: & nbsp; & gt; 80 ml / min, dosing regimen: usual dose in 2-4 doses
Kidney Function: Mild Renal Failure, KK: & nbsp; 50-79 ml / min, dosing regimen: 2/3 of the usual dose in 2-3 doses
Renal function: Average renal failure, KK: & nbsp; 30-49 ml / min, dosing regimen: 1/3 of the usual dose in 2 divided doses
Renal function: Severe renal failure, KK: & lt; 30 ml / min, dosing schedule: 1/6 of the usual dose once
Renal function: Terminal renal failure, dosage regimen: contraindicated
Liver failure:
Patients with isolated impaired liver function do not need dose adjustment. For patients with impaired function of the kidneys and liver, dosing is carried out according to the scheme (see section "Renal failure").
