Eglonil - instructions for use, analogs, reviews and release forms (capsules 50 mg, tablets 200 mg, 0.5% solution, injections in injections) of the drug for the treatment of migraine and depression in adults, children and pregnancy. Composition and alcohol

In this article, you can read the instructions for using the drug Egonil. Presented are reviews of visitors to the site - consumers of this medication, as well as opinions of doctors specialists on the use of Eglonil in their practice. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Analogues of Eglonil in the presence of existing structural analogues. Use for the treatment of migraine and depression in adults, children, as well as during pregnancy and lactation. Composition and interaction of the drug with alcohol.

Egonil - atypical antipsychotic from the group of substituted benzamides.

Sulpiride (the active substance of the drug Eglonil) has a moderate neuroleptic activity in combination with stimulating and thymoanaleptic (antidepressant) action.

Neuroleptic effect is associated with antidophaminergic action. In the central nervous system, Sulpiride blocks predominantly dopaminergic receptors of the limbic system, and affects the neostriatic system insignificantly, it has an antipsychotic effect. The peripheral action of sulpiride is based on oppression of presynaptic receptors. With an increase in the amount of dopamine in the central nervous system, the improvement in mood is associated with a decrease in the development of symptoms of depression.

The antipsychotic effect of Eglonil is manifested in doses of more than 600 mg per day, in doses up to 600 mg per day, a stimulating and antidepressant effect predominates.

Sulpiride has no significant effect on adrenergic, cholinergic, serotonin, histamine, and GABA receptors.

In small doses, sulpiride can be used as an additional agent in the treatment of psychosomatic diseases, in particular,it is effective in stopping the negative mental symptoms of peptic ulcer of the stomach and duodenum. In irritable bowel syndrome, sulpiride reduces the intensity of abdominal pain and leads to an improvement in the clinical state of the patient.

Low doses of sulpiride (50-300 mg per day) are effective in dizziness, regardless of etiology. Eglonil stimulates the secretion of prolactin and has a central antiemetic effect (suppression of the vomiting center) by blocking the dopamine D2 receptors in the trigger zone of the vomiting center.

Composition

Sulpiride + auxiliary substances.

Pharmacokinetics

The biological availability of dosage forms intended for oral administration is 25-35% and is characterized by significant individual variability. Sulpiride has a linear kinetics after taking doses in the range of 50 to 300 mg. Binding to plasma proteins is approximately 40%. Small amounts of sulpiride appear in breast milk and penetrate the placental barrier. In the human body, sulpiride is only slightly exposed to metabolism: 92% of the intramuscular dose administered is excreted unchanged in the urine.Sulpiride is excreted mainly through the kidneys, by glomerular filtration.

Indications

As a monotherapy or in combination with other psychotropic drugs:

• acute and chronic schizophrenia;
• acute delirious states;
• depression of various etiologies;
• neurosis and anxiety in adult patients, with ineffectiveness of conventional methods of treatment (only for capsules 50 mg);
• neurotic states, accompanied by retardation;
• psychosomatic symptoms (especially with peptic ulcer of the stomach and duodenum and hemorrhagic rectocolitis);
• severe behavioral disorders (agitation, self-mutilation, stereotypy) in children over the age of 6, especially in combination with autism syndromes (50 mg capsules only).

Forms of release

Capsules 50 mg.

Tablets 200 mg.

Solution for intramuscular injection (injections in ampoules for injection).

Solution for oral administration (preferably for children) 0.5%.

Instructions for use and dosage

Pills

Acute and chronic schizophrenia, acute delirious psychosis, depression: daily dose is from 200 to 1000 mg, divided into several receptions.

Capsules

Neurosis and anxiety in adult patients: the daily dose is 50 to 150 mg for 4 weeks maximum.

Severe behavioral disorders in children: a daily dose of 5 to 10 mg / kg body weight.

Solution for intramuscular injection (ampoules)

In acute and chronic psychoses, treatment is started with intramuscular injections at a dose of 400-800 mg per day and continues in most cases for 2 weeks. The goal of therapy is to achieve a minimally effective dose.

When intramuscular introduction of sulpiride, the usual rules for IM injections are observed: deep into the outer upper quadrant of the gluteus muscle, the skin is pre-treated with an antiseptic.

Depending on the clinical picture of the disease in / m injection of sulpiride is prescribed 1-3 times a day, which allows you to quickly soften or stop the symptoms. As soon as the patient's condition allows, you should move on to taking the drug inside. The course of treatment is determined by the doctor.

Tablets and capsules are taken 1-3 times a day, washed down with a small amount of liquid, regardless of food intake.

The goal of therapy is to achieve a minimally effective dose.

It is not recommended to take the drug in the afternoon (after 16 hours) due to increased levels of activity.

Doses for the elderly: the initial dose of sulpiride should be 1 / 4-1 / 2 doses for adults.

Side effect

• the development of reversible hyperprolactinemia, the most frequent manifestations of which are galactorrhea, amenorrhea, menstrual cycle disorder;
• gynecomastia;
• impotence;
• frigidity;
• increased sweating;
• increase in body weight;
• sedative effect;
• drowsiness;
• dizziness;
• tremor;
• early dyskinesia (spasmodic torticollis, oculogic crises, trismus), which occurs when an anticholinergic antiparkinsonian agent is prescribed;
• extrapyramidal syndrome and associated disorders (akinesia, sometimes combined with muscle hypertonia and partially eliminated with anticholinergic antiparkinson agents, hyperkinesia-hypertonus, motor agitation, acacia);
• hyperthermia (fever);
• tachycardia;
• increase or decrease in blood pressure;
• in rare cases, the development of orthostatic hypotension is possible;
• prolongation of the QT interval;
• very rare cases of the syndrome "torsade depointes";
• skin rash.

Contraindications

• prolactin-dependent tumors (eg, pituitary prolactinoma and breast cancer);
• hyperprolactinemia;
• acute intoxication with ethanol (alcohol), hypnotics, opioid analgesics;
• affective disorders, aggressive behavior, manic psychosis;
• pheochromocytoma;
• the period of breastfeeding;
• children under 18 years of age (for tablets and solution for intramuscular injection);
• children under 6 years (for capsules);
• in combination with sultopride, dopaminergic receptor agonists (amantadine, apomorphine, bromocriptine, cabergoline, entacapone, lizard, pergolide, pyribedil, pramipexole, kinagolide, ropinirole);
• hypersensitivity to sulpiride or other ingredient of the drug;
• in connection with the presence of lactose in the formulation, it is contraindicated in congenital galactosemia, glucose malabsorption / galactose syndrome, or lactase deficiency.

Application in pregnancy and lactation

Experiments on animals have not revealed a teratogenic effect. A small number of women taking low doses of Eglonil during pregnancy (about 200 mg per day) did not have a teratogenic effect.There is no data on the use of higher doses of sulpiride. There is also no evidence of the potential effect of neuroleptic drugs taken during pregnancy on the development of the fetal brain. Therefore, as a precaution, it is preferable not to use sulpiride during pregnancy.

However, in the case of using this drug during pregnancy, it is recommended, as far as possible, to limit the dose and duration of treatment. In newborns whose mothers received long-term treatment with high doses of antipsychotics, gastrointestinal symptoms (bloating, etc.), associated with atropine-like effects of certain drugs (especially in combination with anti-Parkinson drugs), and extrapyramidal syndrome were rarely observed.

With prolonged treatment of the mother, or with the use of high doses, as well as in the case of the appointment of the drug shortly before the birth, the monitoring of the activity of the nervous system of the newborn is justified.

The drug penetrates into breast milk, so you should stop taking the drug during breastfeeding.

Use in children

Contraindicated in children under the age of 18 (for tablets and solution for intramuscular injection); children under the age of 6 years (for capsules).

special instructions

Malignant neuroleptic syndrome: with the development of hyperthermia of undiagnosed origin, Eglonil should be discontinued, as this may be one of the signs of a malignant syndrome described with the use of neuroleptics (pallor, hyperthermia, autonomic dysfunction, impaired consciousness, rigidity of muscles).

Signs of autonomic dysfunction, such as increased sweating and labile blood pressure, may precede the onset of hyperthermia and, therefore, represent early warning signs.

Although such an effect of neuroleptics may have an idiosyncratic origin, it appears that some of the risk factors may predispose to it, for example, dehydration or organic brain damage.

Increase in the QT interval: Sulpiride prolongs the QT interval depending on the dose. This action, which is known to increase the risk of developing a serious ventricular arrhythmia, such as "torsade de pointes", is more pronounced in the presence of a bradycardia,hypokalemia, or congenital or acquired extended QT interval (combination with drug eliciting QT interval prolongation).

If the clinical situation allows, it is recommended, prior to the appointment of the drug, to be convinced of the absence of factors that may contribute to the development of this type of arrhythmia:

• Bradycardia with a number of strokes less than 55 bpm;
• hypokalemia;
• congenital lengthening of the QT interval;
• simultaneous treatment with a drug capable of causing a pronounced bradycardia (less than 55 bpm), hypokalemia, slowing of intracardiac conduction or prolongation of the QT interval.

Except in cases of urgent intervention, patients requiring treatment with neuroleptics are advised to conduct an electrocardiogram during the status assessment.

In exceptional cases, this drug should not be used in patients with Parkinson's disease.

In patients with impaired renal function, reduced doses should be used and control enhanced; In severe forms of renal failure, intermittent courses of treatment are recommended.

Control during treatment with sulpiride should be strengthened:

• in patients with epilepsy, since the convulsive threshold can be lowered;
• in the treatment of elderly patients exhibiting greater sensitivity to postural hypotension, sedation and extrapyramidal effects.

Consumption of alcohol or the use of drugs containing ethyl alcohol during treatment with the drug is strictly prohibited.

Impact on the ability to drive vehicles and manage mechanisms

During treatment with Egonilom it is prohibited to drive vehicles and work with mechanisms that require increased attention, as well as alcohol intake.

Drug Interactions

Contraindicated combinations

Dopaminergic receptor agonists (amantadine, apomorphine, bromocriptine, cabergoline, entacapone, lizard, pergolide, pyribedil, pramipexole, kinagolide, ropinirole), in addition to patients suffering from Parkinson's disease: there is a mutual antagonism between dopaminergic receptor agonists and neuroleptics. In extrapyramidal syndrome, induced by neuroleptics, dopaminergic receptor agonists are not used, in such cases, anticholinergics are used.

Sultopride: the risk of ventricular arrhythmias increases, in particular of atrial fibrillation.

Unrecommended combinations

Drugs capable of causing ventricular arrhythmias of the "torsade de pointes" type: antiarrhythmic drugs of class 1a (quinidine, hydroquinidine, disopyramide) and class 3 (amiodarone, sotalol, dofetilide, ibutilide), some antipsychotics (thioridazine, chlorpromazine, levomepromazine, trifluoperazine, cyamemazine, amisulpride, tiapride, haloperidol, droperidol, pimozide) and other drugs such as: bepridil, cisapride, difemanil, intravenous erythromycin, mizolastine, intravenous vincamine, etc.

Ethanol (alcohol): enhances the sedative effect of neuroleptics. Violation of attention creates a danger for driving and transporting machinery. Avoid the consumption of alcoholic beverages and the use of drugs containing ethyl alcohol.

Levodopa: there is mutual antagonism between levodopa and neuroleptics. Patients suffering from Parkinson's disease should be prescribed the lowest effective dose of both drugs.

Agonists of dopaminergic receptors (amantadine, apomorphine, bromocriptine, cabergoline, entacapone, lisuride, pergolide, piribedil, pramipexole, kinagolid, ropinirole), patients suffering from Parkinson's disease: between agonists of dopaminergic receptors exist and neurolepticsmutual antagonism. The above drugs can cause or exacerbate psychosis. If neuroleptic treatment is required for a patient suffering from Parkinson's disease and receiving a dopaminergic antagonist, the dose of the latter should be gradually reduced to cancellation (the abrupt withdrawal of dopaminergic agonists can lead to the development of a malignant neuroleptic syndrome).

Halofantrine, pentamidine, sparfloxacin, moxifloxacin: increased risk of ventricular arrhythmias, in particular "torsade de pointes". If possible, an antimicrobial drug that causes ventricular arrhythmia should be discarded. If combinations can not be avoided, first check the QT interval and ensure ECG monitoring.

Combinations that require caution

Drugs that cause bradycardia (calcium channel blockers with bradycardic effect: diltiazem, verapamil, beta-blockers, clonidine, guanfacine, alkaloids, digitalis, cholinesterase inhibitors: donepezil, rivastigmine, tacrine, ambenonium chloride, galantamine, pyridostigmine, neostigmine): enhanced risk of ventricular arrhythmias , in particular "torsade de pointes". Clinical and ECG monitoring is recommended.

Drugs that lower the level of potassium in the blood (potassium-withdrawing diuretics, laxative stimulant, amphoteric B (intravenously), glucocorticoids, tetracosactide): the risk of ventricular arrhythmias, in particular "torsade de pointes", is increasing. Before prescribing the drug, hypokalemia should be eliminated and clinical, cardiographic control, and electrolyte level control should be established.

Combinations that should be taken into account

Antihypertensive drugs: increased antihypertensive effect and increased postural hypotension (additive effect).

Other CNS depressants: morphine derivatives (analgesics, antitussives and substitution therapy), barbiturates, benzodiazepines and other anxiolytics, hypnotics, sedative antidepressants, sedative antagonists of histamine H1 receptors, central antihypertensives, baclofen, thalidomide - CNS depression, attention deficit creates The danger for driving transport and working on machine tools.

Sucralfate, antacid agents containing Mg and / or Al, reduce the bioavailability of oral dosage forms by 20-40%. Eglonil should be prescribed 2 hours prior to admission.

Analogues of the drug Egonil

Structural analogs for the active substance:

• Betamax;
• Vero Sulpirid;
• Prosulfin;
• Sulpiride;
• Eglek.

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