Disorders of cerebral circulation

Briefly about the disease

Causes: chronic disorders of cerebral circulation (CNMK) are caused by persistent narrowing of the lumen of the main arteries of the head, for example due to atherosclerotic disorders. Also, the deterioration of the blood supply to the brain tissue can develop due to the lesion of small vessels (microangiopathy) in arterial hypertension (AH), diabetes mellitus (DM). All this is accompanied by chronic ischemia and hypoxia of various parts of the brain, i.e. a discrepancy between their needs for oxygen and glucose and the real intake of these substances.

Symptoms: they release several degrees of severity of HNMK. The characteristic initial signs of disorders of "cerebral nutrition" (stage I of discirculatory encephalopathy), which usually cause the primary treatment for medicinal products, include:

- "Dull" headaches, dizziness, noise in the head (autonomic disorders);

• decreased memory and performance, absent-mindedness (cognitive impairment);
• irritability, tearfulness, depressed mood (psycho-emotional problems).

Rx zone
Most drugs used in the complex pharmacotherapy of HNMK belong to the prescription list: they are prescribed only by a doctor (neurologist, therapist), taking into account the cause, the course of the disease, the prevailing symptomatology, etc. The competence of the first person is informing the pharmacy client about the properties of these medicines, if there are several identical drugs in the pharmacy, the selection of trade names according to the INNs issued.

Antiaggregants
Purpose of application: primary and secondary prevention of strokes.

Principle of action: suppression of platelet aggregation, improvement of rheological properties and microcirculation of blood in areas of cerebral ischemia.

Representatives of the group: dipyridamole (Curantil, etc.), dipyridamole + acetylsalicylic acid (Agrenoks), clopidogrel (Plavix, Zilt, Clopidogrel-Teva, Lopirel, Plagril, etc.), clopidogrel + acetylsalicylic acid (Coplavix, Plagril A).

Features of the group
The most famous antiaggregant - acetylsalicylic acid in the range of doses of 50-300 mg - is allowed to leave without a prescription. More about it - in the section "OTC-zone".
According to the Orange Book FDA, from the imported clopidogrel, registered in Russia, the therapeutically equivalent to the reference preparation (Plavix) are the genera Delplat-75, Cardutol, Clopidogrel-Teva, Clopilelet, Lopirel, Plagril (therapeutic equivalence code AB) ². EMA refers to the same category of generic Zilt, Clopidogrel-TAD3.

Statins
Purpose of the application: reduction of "bad" cholesterol in the blood, prevention of atherothrombotic complications of CNMK (including stroke).

Principle of action: inhibition of the enzyme that regulates the synthesis of cholesterol in the liver.

Representatives of the group: atorvastatin (Liprimar, Atoris, Tulip, etc.), rosuvastatin (Krestor, Akorta, Mertenil, etc.), simvastatin (Zokor, Vazilip, Simgal, Sincard, etc.)

Features of the group
Statins-generics, therapeutically equivalent (AB) to referent drugs (according to the FDA version):

atorvastatin (referent - Lipimar) - Torvas, Tulip;
simvastatin (referent - Zokor) - Simgal, Sincard.

Means that improve cerebral circulation
The purpose of the application: restoration of the damaged blood supply to the brain, reduction of cognitive, emotional, vegetative symptoms of HNMK.

Principle of action: selective expansion of cerebral vessels, improvement of microcirculation in ischemic zones, optimization of oxygen and glucose delivery.

Representatives of the group: vinpocetine (Cavinton, Cavinton comfort, Cavinton forte, Telekton, etc.), nimodipine (Nimotop, Nimopin), pentoxifylline (Trental, Agapurin, Vazonit, etc.), cinnarizine (Stugeron, Cinnarizin)

Features of the group
To improve cerebral circulation, ginkgo biloba preparations are also widely used, permitted for leave without a prescription (see section "OTC zone").

Nootropics
The purpose of the application: improvement of brain functions, reduction of cognitive-emotional, vegetative disorders.

The principle of action: increasing the intake of glucose and oxygen by brain tissues, optimizing blood circulation, increasing the resistance of neurons to hypoxia, improving the conduct of nerve impulses.

Representatives of the group: pyracetam (Nootropilum, Lucetam, etc.), phenotropil (Fentropil), choline alfoscerate (Gliatilin, Cerepro, etc.), Cerebrolysin, and others.

Metabolic means
The purpose of the application: increasing the resistance of brain tissue to hypoxia, reducing cognitive, autonomic symptoms.

Principle of action: optimize the processes of energy formation in the ischemic zones, promote the improvement of cerebral blood supply.
Representatives of the group: acetylcarnitine (carnitine), ethylmethylhydroxypyridine succinate (Mexidol, Mexident, Mexicor, etc.), Actovegin, Solcoseryl, and others.

Features of the group
Individual metabolics shown with symptoms of HNMK are allowed to be dispensed without a prescription (see section "OTC zone").

OTC zone
Over-the-counter products used in the complex therapy of HNMK are often included in the list of appointments of a doctor. At the same time, most of them can be independently recommended by the pinnacle with a direct complaint of the client to the initial symptoms of HNMK. In this case, of course, it is necessary to advise the visitor at the first opportunity to go to the doctor.

Angioprotectors - preparations of ginkgo biloba
Rationale recommendations: normalize the blood supply to the brain, reduce the "viscosity" of blood, increase the absorption of oxygen, glucose, brain resistance to hypoxia. Reduce cognitive impairment, dizziness, tinnitus.

Variants of the offer: Tanakan, Bilobil, Vitrum Memori, Ginkoum, Ginos, Memoplant, etc.

Features of the group
Tanakan, Vitrum Memori, Ginkoum, Ginos and Memoplant contain standardized extracts of leaves of ginkgo biloba. In other words, the percentage range of the content of bioactive substances (flavonol glycosides, ginkgolides-bilobalides) that determine the pharmacological effects of this medicinal plant is specified in them precisely. However, only Tanakan and Memoplant include the extract of ginkgo biloba brand EGb 761®, in relation to which the largest international evidence base of effectiveness for HNMK5 has been accumulated.
Preparations of ginkgo are contraindicated in pregnant and lactating women. They are used with caution in AH - a frequent companion of KhMNC.To treat the symptoms of HNMK, ginkgo biloba preparations take 40 mg 3 times a day for at least 3 months. The possibility of increasing the dose and conducting repeated courses should be agreed with the doctor.
When using the patient antiagregantov not recommended parallel reception of ginkgo biloba because of increased risk of bleeding.
In 2015, the extract of ginkgo biloba entered TOP10 appointments (by INN) by neurologists with discirculatory encephalopathy4.

Antiaggregants - cardioaspirines (50-300 mg)
Rationale for the recommendation: by suppressing platelet aggregation, reduce the "viscosity" of the blood. They are used for long-term prophylaxis of thrombosis and strokes.

Variants of the offer: Aspirin Cardio, Cardi ASK, Cardiomagnolo, Trombo ACC and others.

Features of the group
Initially, low-dose preparations of acetylsalicylic acid (ASA) are prescribed to the patient by a doctor who determines an adequate daily dose (can range from 50 to 300 mg). If the patient already uses this remedy, the pharmacist can recommend ASA to him on an "on-call" dose to replenish his home supplies, because with NHMK, aspirin is used on an ongoing basis.
ASA should not be taken in parallel with ginkgo biloba.

OTC Nootropics
Rationale for the recommendation: increases brain resistance to hypoxia, improves interneuronal nerve conduction, normalizes blood viscosity. It improves memory processes, helps to reduce headaches, psychoemotional disorders.

Variants of the offer: Noopept.

Features of the group
Noopept is contraindicated in pregnancy and lactation.
In the absence of contraindications, we allow an independent intake of the drug at a dose of 20 mg per day by a course of 1.5-3 months. An increase in the daily dose, the possibility of combining Noopept with other neurotropic drugs should be agreed with the doctor.

Metabolic drugs - glycine preparations
Rationale for the recommendation: glycine normalizes nerve conduction, reduces excitation processes in the central nervous system, helps to increase mental performance and reduce psychoemotional disorders.

Variants of the offer: Glycine, Glycine-Bio, etc.

Features of the group

Glycine has no restrictions on reception during pregnancy and lactation, it is compatible with any medications.
Mode of glycine intake with a decrease in mental capacity - 100 mg 2-3 times a day under the tongue 14-30 days.