Among the many vitamins there are neurotropic, or B vitamins. They are necessary for the normal functioning of the central and peripheral nervous system. Their prescription as part of complex therapy in our country is the standard for the treatment of neuralgia, radiculitis, sciatica, and acute back pain.
One of the characteristic representatives of combined drugs of group B is Milgamma, which is actively used for protrusions and hernias, for example, of the lumbar spine. How justified is the use of this drug and other vitamins in general? Is there a therapeutic effect from prescribing vitamins? If so, how long should you take this drug to improve your well-being if you have a hernia in the lumbar spine?
Hernia on MRI.
Mechanism of action of Milgamma
Milgamma is not one drug, but a set of three vitamins that are classified as neurotropic. Without them, normal functioning of the nervous system is impossible. These are B1, or thiamine, B6, or pyridoxine, and B12, or cyanocobalamin. Additionally, the complex drug contains 20 mg of local anesthetic - lidocaine, which makes intramuscular injection of vitamins painless. All these vitamins, from the manufacturer’s point of view, have a beneficial effect on inflammation, increase blood flow, and improve the metabolism of nervous tissue. Vitamins B1 and B6 potentiate each other, and cyanocobalamin takes part in the synthesis of the nerve sheath, consisting of myelin. After intramuscular injection, vitamins quickly enter the bloodstream and are distributed throughout the body.
Description and composition of Alflutop
It is impossible to name just one active substance of Alflutop - this is a whole list of biologically active components obtained from small sea fish, including sprat, bellyfish, anchovy and whiting. The main value of the composition lies in the content of mucopolysaccharides, amino acids and peptides, as well as a large number of minerals: calcium, potassium, copper, magnesium, zinc, sodium and iron.
Therapy with Alflutop helps prevent the destruction of the structure of healthy tissues, and also triggers the processes of cell division from which cartilage is formed. In addition, the therapeutic effect is enhanced by the natural synthesis of hyaluronic acid. Both processes complement each other and restore cartilage that has lost its functions. This explains the drug's ability to relieve pain.
Indications for use of Milgamma
The drug is indicated not for separate, independent treatment (monotherapy), but as part of the so-called complex therapy. This means that separate use of Milgamma may be useless. Does this mean that this drug “does not work”? You will find the answer to this question at the end of the article. Naturally, the official indications are neurological pathology.
In addition to neuralgia, neuritis, plexitis and polyneuropathies of various origins, Milgamma is indicated for nocturnal muscle cramps, and especially in old age. Since compression radiculopathy with protrusions and hernias occurs with symptoms of inflammation, the clinic of “lumbago” or lumbago with an aggravated hernia can, to a first approximation, be considered a clinic of neuritis. Therefore, the drug is indicated from this point of view for the relief of pain symptoms, as well as sensory and motor disorders in the presence of a clinically significant hernia, for example, the cervical spine.
Alflutop
The medicine is produced in ampoules for intramuscular or intra-articular injections of 1 ml of 1% solution in an amount of 10 pieces.
It contains:
- 100 mg extract from sea fish.
It contains a number of bioactive components that have a protective effect and help restore joint tissue and fluid:
- Dermatan sulfate;
- a number of mucopolysaccharides;
- hyaluronic acid;
- polypeptides;
- creatane sulfate;
- amino acids;
- chondroitin sulfate;
- proteoglycans;
- macro- and microelements: zinc, iron, magnesium, sodium, potassium;
- rosemary oil 7.5%.
- additional components: phenol, distilled water.
Action
The presence of hyaluronic acid and other components determines the stabilization of the processes of destruction of the main substance of cartilage tissue - type 2 beta collagen fibers. This mainly occurs due to the regulation of the enzyme system that destroys cartilage fibers. The product also improves microcirculation of joint tissues (reduces capillary permeability) and promotes the restoration of collagen fibers.
The drug exhibits a trophic effect on tissues, which promotes their regeneration, according to the principle of replacing lost biologically active agents with drug components.
There is also a pronounced anti-inflammatory effect: the use of Alflutop reduces the amount of C-reactive peptide, seromucoids, globulins, fibrinogen and the level of leukocyte infiltration in the joint fluid.
Mode of application
Alflutop is prescribed to be injected intramuscularly for the treatment of polyarthrosis or osteochondrosis, 1 ml every day for a course of no less than 20 days.
If single large joints are affected and there is severe pain in them, which prevents the patient from walking, the drug is prescribed to be injected into the joint cavity, 2 ml per injection, every three days. After 6 intra-articular injections, they switch to intramuscular injections until the course duration is at least 20 days.
After six months, it is recommended to repeat the treatment course with Alflutop.
Instructions for use for hernia
There are no special features in the use of Milgamma for intervertebral hernia. The drug is administered as usual, deep intramuscularly. The official instructions recommend that in case of severe pain syndrome, administer 2 milliliters of the drug daily for 5 or 10 days. Then it is advisable to switch to the drug Milgamma compositum for oral administration. It is distinguished by the absence of vitamin B12. The second option is to continue giving injections (shots), but not daily, but every other day. The general course can last 2-3 weeks.
Milgamma and Alflutop regimen
The frequency of treatment and drug use regimens are selected by the doctor. Milgamma is administered intramuscularly for 3 weeks. Injections are given daily or every other day. After 10 days, the drug begins to be used 3 times a week. Alflutop is used as intra-articular injections. Injections are given every 3 days. The recommended single dose is 1-2 ml. The course includes 5-6 injections. The effectiveness of treatment increases if, after completion of intra-articular injections, Alflutop continues to be administered intramuscularly. The chondroprotector is used for at least 6 months.
Milgamma is administered intramuscularly for 3 weeks.
Contraindications and side effects, overdose
Contraindications for taking Milgamma, in addition to increased individual sensitivity, are pregnancy, lactation and childhood, severe forms of cardiovascular failure. The most common side defect was allergic reactions, in the form of skin rash. “Rarely” means no more often than one patient in a thousand. Also in some cases, dizziness, tachycardia, vomiting, as well as increased sweating and convulsions were noted. Sometimes local irritation may occur at the injection site of the drug.
You should also take into account some features of the administration of vitamins. The drug is incompatible with phenobarbital, riboflavin, as well as some citrates and carbonates. Milgamma weakens the effects of levodopa. If a patient is diagnosed with Parkinson's disease and is being treated with levodopa, then this must be taken into account. There may be an interaction with penicillamine or the anti-tuberculosis antibiotic isoniazid. Since the drug contains the local anesthetic lidocaine, if the patient uses norepinephrine together with Milgamma, this may adversely affect cardiac activity.
Material and methods
The case histories of 87 patients with spondyloarthrosis in the structure of occupational pathology of the musculoskeletal system from physical overload and functional overstrain were retrospectively assessed. All patients underwent clinical and physiological examination. Duration of observation: 5 years (2013–2017).
Inclusion criteria: age 18 years and older, presence of facet syndrome at the lumbosacral and/or cervical level, confirmed by neuroimaging, and signed informed consent.
Exclusion criteria: contraindications in accordance with the instructions for use of the drug Alflutop, taking chondroprotectors for 1 month before inclusion in the study. During hospital observation, patients did not take NSAIDs or analgesics. Additionally, B vitamins, muscle relaxants (tizanidine or tolperisone), metabolites were prescribed, physiotherapy was carried out according to indications (sinusoidal modulated current therapy, diadynamic therapy, electrophoresis of drugs, for example halidor), massage.
All observation cases were divided into two groups: group 1 consisted of 31 patients (20 women, 11 men), group 2 - 56 patients (25 women, 31 men). In group 1, Alflutop was injected 10 times paravertebrally into four points at the lumbosacral level (2 ml) or into two points at the lumbosacral level (1 ml) and two points at the cervical level (1 ml). In group 2, Alflutop was administered 10 times intramuscularly, 1-2 ml deep.
Demographic information is shown in the table.
Group Demographics
Of the peculiarities in the groups, it is worth noting that among the patients of group 1, 3 women and 5 men suffered from vibration disease, the remaining 23 patients suffered from muscular-tonic and radicular compression syndromes of the cervical and/or lumbosacral level. In all patients, neuroimaging reveals spinal spondyloarthrosis.
In group 2, 8 patients were diagnosed with vibration disease with radiculopathy of the lumbosacral level, the remaining 48 patients had diagnosed muscular-tonic and radicular compression syndromes of the cervical and/or lumbosacral level. Neuroimaging revealed spinal spondyloarthrosis in all patients.
All patients underwent a standard neurological examination. The main tool for pain assessment was the visual analogue scale (VAS). The number of exacerbations of back pain over 1 year was also assessed.
For statistical analysis, the R software package was used (The R Project for Statistical Computing, https://www.r-project.org). All statistical tests were two-sided, with a significance level of 5%; all confidence intervals (CIs) were two-sided 95%; Continuous data are represented by the number of observations, mean with standard deviation (SD), median (Me) and range; discrete quantities are described by absolute and relative frequencies.
Drug analogues
Milgamma is produced by the German company Ferwag-Pharma, it is produced in ampoules of 2 milliliters, used only intramuscularly, there are three packaging options - 5 ampoules, 10 and 25. Accordingly, the medicine can be designed for a long course of treatment. The cost of the most popular package - 10 ampoules - ranges from 405 to 730 rubles.
Milgamma is a popular drug in the CIS countries, and it has quite a lot of imitators. These include:
- Binavit;
- Vitaxon;
- the more famous and widely used Kombilipen;
- Compligam B;
- Larigama.
Binavit is a domestic drug produced by the Armavir biofactory with a price for a similar package of 239 rubles. Combilipen is a drug from Pharmstandard, with an average cost of 270 rubles. Compligam B is produced by the domestic company Sotex, with an average cost of 250 rubles, and Larigama is produced by the Russian company Grotex LLC, and its cost is approximately 260 rubles per package.
Attention. There is also the drug Milgamma compositum, which has a slightly different effect. Firstly, it contains only one vitamin B6, and benfotiamine, a derivative of vitamin B1, and secondly, it is available in tablets and is more expensive, that is, it does not have a form for parenteral administration.
There is also the drug Milgamma compositum, which has a slightly different effect. Firstly, it contains only vitamin B6 and benfotiamine, a derivative of vitamin B1, and secondly, it is available in tablets and dragees, it does not have a form for parenteral administration. Accordingly, the drug Milgamma can be considered more effective because it contains vitamin B12, or cyanocobalamin.
A deficiency of this vitamin can lead to a neurological disorder such as sensory or posterior columnar ataxia. In this case, the pathways of the joint-muscular sense lying in the posterior columns of the spinal cord are affected. They carry proprioceptive sensitivity, or muscle-joint sense, to the brain for analysis. Thanks to the work of this analyzer, we can be aware in complete darkness where our limbs are, and when walking on a flat surface in the dark, we do not fall, because we know how our legs are rearranged and where our torso is. With posterior columnar ataxia, this sensation is blurred or lost altogether. Therefore, one of the characteristic clinical symptoms will be a fall, or an unsteady gait of patients at night, for example, when getting up to go to the toilet. The patient should walk in good light to see the position of his legs.
If such symptoms are present, it is very likely that there is a deficiency of vitamin B 12, since sensitive ataxia is a characteristic sign of deep pernicious anemia.
Patient reviews about the drug Alflutop
Patients say the main disadvantage of this treatment is the high cost of the drug, which, in combination with a long course of treatment, is not affordable for every patient.
The effectiveness of the drug directly depends on timely treatment. The more advanced the case, the more difficult it is to restore the damaged cartilage. To fully restore it will require longer time, more courses, as well as more patience.
The vast majority of patients want to get an immediate effect, but in terms of restoring the cartilage body, it takes a lot of time, since its tissue grows naturally, thanks to cell division and the action of natural hyaluronic acid. In this regard, you can find negative reviews indicating the ineffectiveness of the drug. However, most doctors who use this medicine claim that with enough patience and strict adherence to courses, you can achieve good results with Alflutop.
