Catad_tema Chronic cerebral ischemia - articles

Phezam in the complex treatment of disorders cerebral circulation

M.A. Arabkhanova, L.I. Pyshkina, A.A. Kabanov, T.I. Kolesnikova, A.N. Yasamanova, M.Yu. Martynov, E.I. Gusev
Department of Neurology and Neurosurgery, Faculty of Medicine, Russian State medical university, Moscow

Studies conducted in recent decades have made it possible to formulate provisions on the dynamic nature and potential reversibility of cerebral ischemia, and, accordingly, on the need for measures to restore cerebral blood flow and protect the brain from ischemic damage. In the light of these ideas, one of the promising methods of influence aimed at improving the blood supply to the brain is the use of vasoactive drugs and therapeutic agents that regulate the hemostasis system, in combination with neuroprotection and influence on brain metabolism. A vasoactive drug that simultaneously regulates the hemostasis system is cinnarizine, and a drug that effectively affects brain metabolism is piracetam. Recently, special attention has been paid to combined drugs that improve both blood supply and metabolism in the brain tissue. One of these drugs is Phezam, one capsule of which contains 400 mg of piracetam and 25 mg of cinnarizine. IN clinical setting The effectiveness of Phezam has been established in a number of diseases, including in patients with chronic cerebrovascular insufficiency.
aim this study there was a study of the effect of Phezam on the neurological and neuropsychological status, rheological properties of blood and the state of cerebral blood flow in patients with acute cerebrovascular accident.

Material and methods
We examined 48 patients treated with Phezam in the neurological departments of the Moscow City Clinical Hospital No. N.I. Pirogov about acute violation cerebral circulation (CVA). The comparison group consisted of 25 people with ischemic stroke who were treated in the same departments of the City Clinical Hospital No. N.I. Pirogov, but who did not receive neuroprotective or metabolic therapy (these materials were analyzed retrospectively). The average age of patients in the main group with stroke was 63.9±8.8 years, in the comparison group - 61.5±10.7 years.
Diagnosis ischemic stroke was based on anamnestic data, neurological examination, CT or MRI of the brain. In the main group, 21 cases were diagnosed with a small stroke, the rest had moderately pronounced focal symptoms in the form of shallow paresis, slightly pronounced speech disorders and sensitivity disorders by the time of discharge. 28 patients had a left hemispheric stroke, 13 had a right hemispheric stroke, and 7 had a stroke in the vertebrobasilar system. In the comparison group, 9 cases were diagnosed with a small stroke, the rest, according to the records in the medical history, by the time of discharge had moderately pronounced focal symptoms in the form of shallow paresis, slightly pronounced speech disorders and sensitivity disorders. In 15 patients, the focus was localized in the left hemisphere, in 7 - in the right hemisphere, and in 3 - in the vertebrobasilar basin.
Before treatment and after 30 days of taking Phezam, an assessment of the neurological and neuropsychological status, the dynamics of higher cortical functions, ultrasonic dopplerography of the extra- and intracranial sections of the main arteries of the head, the study rheological properties blood (spontaneous and induced platelet aggregation). The Scandinavian Stroke Scale was used to quantify neurological symptoms. To assess the degree of disability at the time of discharge - the Barthel index. The severity of cognitive impairment was studied in dynamics according to a short psychiatric scale - MMSE (Mini Mental Scale Examination). The severity and prevalence of the occlusive process in the brachiocephalic arteries was determined using duplex scanning and Doppler ultrasound (USDG) based on generally accepted criteria. The drug was prescribed after the cessation of infusion therapy on the 7-10th day of the disease. The duration of the course of therapy was 1 month. (3 capsules 2 times a day, morning and afternoon, no later than 17:00). Other metabolic drugs and drugs that affect the hemostasis system were not prescribed during this period. The results obtained were processed using Statistica 6.0 (Statsoft) PC programs and Excell spreadsheets from the Microsoft Office for Window XP package. Data comparison was carried out using statistical non-parametric criteria - exact method Fisher and Yates-corrected χ 2 test, as well as Student's t-test for normally distributed variables.

Results and discussion
First of all, it should be noted that the use of Phezam was characterized by good tolerability of the drug and practically total absence side effects.
The main group and the comparison group did not differ significantly from each other in the structure of risk factors (Table 1).

Table 1. Structure and frequency of risk factors in the main group and in the comparison group

The severity of neurological disorders according to the "Scandinavian stroke scale" on days 3, 10 and 30 of the disease did not differ significantly between the main group and the control group (p>0.47). When assessing the dynamics of motor disorders on a 5-point scale by 3; 10; On the 20th and 30th days of the disease, no significant differences were found between the groups (p>0.63). There were also no significant differences by the 30th day of the disease in the severity of the Barthel index (75.8±6.2 and 77.1±7.9 points, respectively, p=0.44).
The main differences between the groups were observed in the assessment of higher cortical and cognitive impairments. In the main group, the use of Phezam was accompanied by a positive dynamics of subjective and objective symptoms. Subjectively, patients noted an improvement in general well-being, an increase in activity and general tone, a decrease in headaches, dizziness, a feeling of "enlightenment" in the head, and they more actively followed instructions. Positive effect treatment in the field of cognitive impairment was characterized by the fact that patients followed the instructions more clearly, got involved in the task faster, more easily switched from performing one task to another with improved attention during the execution of instructions. When assessing higher cortical functions in the group receiving Phezam, there was a faster dynamics of recovery of speech disorders, first of all, spontaneous speech improved, the activity of inclusion in the speech process, the semantic structure of speech was restored, patients were more active in speech therapy classes. This coincided with the best dynamics of these functions in the analysis of speech disorders according to the Scandinavian Stroke Scale. In patients with localization of the ischemic process in the vertebrobasilar system and the development of systemic vertigo, regression of vestibular disorders was observed ahead of the comparison group.
When performing ultrasound and duplex scanning of the main arteries of the head, it was found that the frequency and severity of multiple and hemodynamically significant lesions of the main arteries of the head did not differ between the main group and the comparison group. In both groups equally often (15.4 and 16.3%, respectively) there were changes in the spectrum in the form of a slight increase and spread of the systolic peak, partial closure of the spectral window (stenosing process less than 50%). Duplex scanning showed thickening of the intima-media complex in the common and internal carotid arteries in 62.7% of patients in the main group and in 67.1% of patients in the comparison group.
In the main group, after the course of treatment, there was a tendency to an increase in systolic and mean blood flow velocity, primarily in the basilar artery, as well as in the middle, anterior, and posterior cerebral arteries. A statistically significant positive dynamics of the pulsation index in the middle cerebral artery and the coefficient of reactivity of blood flow in the middle cerebral artery to hypercapnia was also noted after the end of the course of treatment. In addition, signs of discirculation in the venous plexuses in the vertebrobasilar system decreased.
In the study of the rheological properties of blood before the appointment of Phezam, spontaneous and induced aggregation for adrenaline, ADP and collagen, the size of aggregates and the rate of aggregation in both groups did not differ from each other, but were significantly increased compared to the normative indicators for the laboratory (p<0,016). В78,4% наблюдений в основной группе и в 73,9% в группе сравнения отмечалось изменение формы тромбоцитов (р=0,029 при сравнении с нормальными значениями). После курса Фезама показатели спонтанной агрегации и агрегации с адреналином, АДФ и коллагеном снижались. При этом наиболее выраженным было уменьшение спонтанной агрегации и агрегации на адреналин и АДФ (табл. 2).

Table 2. Spontaneous and induced platelet aggregation before and after the end of Phezam treatment

Thus, the positive effect of the use of the nootropic drug Phezam in the complex therapy was manifested primarily by the outstripping dynamics of the recovery of higher cortical and cognitive functions, as well as individual indicators of cerebral hemodynamics, spontaneous and induced platelet aggregation. We, as well as other researchers, observed the greatest clinical effect in the presence of speech disorders. In patients receiving Phezam, first of all, spontaneous speech improved, the activity of inclusion in the speech process, the semantic structure of speech was restored, that is, a positive functional reintegration of speech centers was noted. This seems to be due to a combined improvement in microcirculation (cinnarizine) and metabolism (piracetam) in Broca's and Wernicke's speech areas, as well as in the Heschl's gyrus in the left cerebral hemisphere.
The results obtained allow us to recommend Phezam for course use in the acute and early recovery periods of minor and non-disabling ischemic stroke occurring with speech and moderate cognitive disorders.

LITERATURE
1. Belostotskaya L.I., Chaika L.A., Gomon O.N. Influence of cinnarizine on mitochondrial oxidative systems, antioxidant activity of blood and behavior of rats under hypoxic conditions. Expert. and wedge. pharmacol. 2003;66:6:16-19.
2. Boyko A.N., Kabanov A.A., Yeskina T.A. et al. The effectiveness of Phezam in patients with chronic cerebral ischemia. Journal. nevrol. and psychiatrist. 2005; 105:9:36-41.
3. Buklin SB. Metabolic therapy with piracetam in patients in the acute period of ischemic stroke: Abstract of the thesis. dis.... cand. honey. Sciences 1987;26.
4. Gromova O.A., Grishina T.P., Sadin A.V. Influence of cinnarizine and alvitil on cerebral blood flow and higher nervous activity in chronic experimental cerebral ischemia. Journal. nevrol. and psychiatrist. 2004; 104:1:52-53.
5. E. I. Gusev, N. N. Bogolepov, G. S. Burd, and S. B. Buklina. Ultrastructural aspects of acute cerebral ischemia in conditions of nootropil use. Journal. nevrol. and psychiatrist. 1983;83:7:984-990.
6. Gusev E.I., Skvortsova V.I. cerebral ischemia. M 2001;328.
7. Turenkov KN., Bagmetov M.N., Epishina V.V. Comparative evaluation of the effectiveness of phenotropil and piracetam in laboratory animals with experimental cerebral ischemia. Journal. expert and wedge. pharmacol. 2007;40:2:24-29.
8. Adams H.P.Jr., Adams J.R., Brott T. et al. Guidelines for the early management of patients with ischemic stroke: a scientific statement from the stroke council of the American stroke association. Stroke 2003; 34:1056-1083.
9. De Deyn P.P., De Reuck J., Deberdt W. et al. for the members of the piracetam in acute stroke study (PASS) group. Treatment of acute ischemic stroke with piracetam. Stroke 1997;28: 2347-2352.
10. Poignet H., Beaughard M., Lecoin G., Massingham R. Functional, behavioral, and histological changes induced by transient global ischemia in rats: effects of cinnarizine and flunarizine. J Cereb Blood Flow Metab 1989;9:646-654.
11. Szalma I., Kiss A., Kardos L. et al. Piracetam prevents cognitive decline in coronary artery bypass: a randomized trial versus placebo. Ann Thorac Surg 2006;82:4:1430-1435.
12. KesslerJ., ThielA., Karbe H., Heiss W.D. Piracetam improves activated blood flow and facilitates rehabilitation of post-stroke aphasic patients. Stroke 2000;31:2112-2116.

V.P. Erichev, M.N. Efimova, L.V. Yakoubova
Preliminary data about the use of Phezam for the treatment of glaucomatous optic neuropathy is presented in the article. After the treatment course of Phezam a considerable part of the patients hasn’t been noted to have a depression of visual field for one year.
Treatment of glaucomatous optic neuropathy (GON) is one of the components of the complex treatment of glaucoma. Previously, cinnarizine (a calcium antagonist) and piracetam (a nootropic drug) were widely used for this purpose. The appearance in clinical practice of Phezam (Balkanpharma), which is a combination of cinnarizine 25 mg and piracetam 400 mg, makes it possible to achieve a simultaneous combination of the positive qualities of the two drugs in one medication. Therapy with the combined drug Phezam allows to reduce the number of tablets in comparison with the separate intake of cinnarizine and piracetam and thereby reduce the cost of treatment, increase the patients' compliance with the prescribed therapy.
It is known that Phezam has a multicomponent effect: antihypoxic, metabolic (nootropic) and vasodilating. In neurological practice, the drug is widely used to treat patients with chronic forms of cerebrovascular accident, as well as to prevent migraine and headaches of various origins. Doppler studies conducted with the use of Phezam showed a statistically significant improvement in hemodynamic parameters in the cerebral vessels.
The purpose of this study is to study the effect of Phezam on the stabilization of visual functions in patients with glaucoma.
Material and methods
The study included 46 patients with primary open-angle glaucoma (POAG) with normalized intraocular pressure (IOP). A total of 62 eyes were examined. The mean age of the patients was 68±2.4 years, of which 18 were men and 28 were women. 15 eyes were examined with the initial stage of POAG (group I), with advanced stage - 28 (group II) and with advanced stage - 19 eyes (group III).
The average level of IOP at the beginning of the study was 18.2±1.4 mm Hg. IOP was normalized in 28 cases with local antihypertensive therapy, in 6 cases after laser trabeculoplasty, and in 28 cases after antiglaucoma surgery.
All patients before and after treatment underwent a comprehensive examination according to the generally accepted method, including visometry, biomicroscopy, ophthalmoscopy, and tonometry.
The visual fields were examined by kinetic perimetry on a hemispherical perimeter (Carl Zeiss, Jena). According to the schemes obtained, the total value of the field of view in degrees along 8 meridians was calculated.
Static perimetry to determine the state of the central field of vision was performed on a Humphrey II 750 visual analyzer (USA).
The Central Threshold Test (Program Central 30-2) was performed twice for baseline setting and twice each time for control studies. Tests performed with a fixation loss of 20% or more and with 33% or more false positives and negatives were excluded as not being valid. The test results were evaluated in the numerical and gray scale formats standard for threshold test results of the visual field analyzer.
The overall visual field depression was assessed in 4 quadrants as the sum of the threshold values ​​of all tested points in dB from printouts in numerical format.
Control examinations were carried out immediately after the end of the course of treatment, then after 6 and 12 months. upon completion of the course of treatment.
In 22 patients (34 eyes), chronic cerebral ischemia was diagnosed as a concomitant pathology on the basis of anamnestic and clinical signs of cerebrovascular disease (headaches, noise in the head, dizziness, sleep and mood disturbances, increased fatigue, irritability, memory loss). arterial hypertension and atherosclerosis of the vessels of the brain and heart with coronary heart disease, as well as a history of transient disorders of cerebral circulation.
Phezam was prescribed 1 capsule 3 times a day for 3 months.
Statistical analysis used the Student's test.
Results and discussion
The study was successfully completed by 43 patients (58 eyes). Two patients dropped out of the study due to the lack of normalization of ophthalmotonus against the background of local antihypertensive therapy, which is associated with the natural course of the glaucoma process. One patient discontinued treatment due to side effects.
As a result of the treatment with Phezam, no significant increase in visual acuity (VA) was noted, regardless of the stage of the glaucoma process (Table 1). At the same time, a clinically significant decrease in visual acuity by 0.2 was observed in 2 patients with advanced POAG who had previously undergone surgical treatment for glaucoma. The deterioration of VA in this case may be associated with the progression of cataracts that were present before the start of the study, since no other objective data, including significant changes in visual fields during kinetic and static perimetry, were found in these patients.
When assessing the effect of Phezam on the total value of visual fields in patients with POAG, the following results were obtained (Table 2). As can be seen from the above data, Phezam's course intake did not have a statistically significant effect on the studied parameter in patients with initial and advanced stages of glaucoma (groups I and III) over the entire observation period. However, intragroup analysis showed some improvement in this indicator in individual patients.
Unlike patients of groups I and III, patients with advanced stage of glaucoma (group II) showed a statistically significant increase in the total value of visual fields after the end of Phezam treatment. The expansion of the peripheral boundaries of the visual field by 20-40 degrees (on average by 25.0 ± 2.8) by the end of the course of treatment was noted in 19 cases (73%).
The change in the general depression of the visual fields during treatment with Phezam was assessed in four quadrants. The sum of the threshold values ​​of all tested points, determined by four quadrants depending on the stage of POAG at different times of observation, is presented in Table 3.
The data presented in Table 3 show that the overall decrease in the sensitivity of the central visual field in the four quadrants in all groups did not change significantly over the entire observation period. However, the analysis of these changes in individual patients showed a decrease in the general depression of sensitivity in patients with advanced glaucoma (8 cases, 34%) due to a decrease in the number of relative defects of various intensity depths (from 25 to 40 dB), especially superficial ones.
In patients with the initial stage of glaucoma, the change in overall sensitivity was small. This seems logical, given that in the majority of patients with the initial stage of glaucoma, with clinical manifestations of GON, only a general depression of the visual field was observed without detection of localized deep defects or areas of reduced sensitivity in the Bjerrum area.
The appointment of Phezam made it possible to speak about the stabilization of visual functions within 12 months after the end of the course of treatment in 83% of patients with initial, 78% with advanced and 56% with advanced stages of the glaucoma process (Table 4).
conclusions
1. Influence of a single course of taking Phezam for 3 months. on the visual functions of patients with POAG, regardless of the stage of the disease, can be considered as a stable positive trend. Nevertheless, a positive dynamics of the studied parameters was noted both in the groups as a whole and in individual patients after 6 months. from the start of treatment.
Patients with advanced stage of glaucoma (group II) showed a statistically significant increase in the total value of visual fields after the end of a 3-month course of treatment with Phezam.
2. The conducted study showed Phezam's good tolerability and safety. Discontinuation of the drug was required only in 1 patient due to sleep disturbance.
3. The data obtained suggest that the repeated course use of Phezam after 5-6 months. after the end of the first course of treatment will achieve a more pronounced and stable clinical effect. In this regard, we consider it appropriate to further conduct studies of Phezam in the complex therapy of patients with POAG.

Literature
1. Kabanov A.A., Boyko A.N., Eskina T.A. and others. The use of Phezam in patients with chronic forms of circulatory disorders // Neurological journal - 2004. - No. 2. - P.30-36.
2. Shamshinova A.M., Volkov V.V. Functional research methods in ophthalmology.- M.: Medicine, 1998.- 415 p.
3. Flammer J. Glaucoma. - Huber, Bern, 2001. - R. 118
4. Mikelberg E., Drance S. The mode of progression of visual field defects in glaucoma // Am. J. Ophthalmol. - 1984. - Vol. 106. - P. 443-445.

The combination of piracetam and cinnarizine improves both blood circulation and metabolism of brain neurocytes, auditory and visual analyzers, contributing to the process of resuming their function. Both components mutually potentiate the action aimed at reducing vascular resistance, increasing the resistance of neurocytes in conditions of ischemia. The main mechanism of action is associated with the improvement of metabolic, bioenergetic processes in the nerve cell, an increase in the turnover rate of informational macromolecules and the activation of protein synthesis. Thanks to piracetam, ATP synthesis increases, oxygen utilization in the brain, glycolysis and protein synthesis processes improve; the exchange of phosphatylcholine, phosphadylethanolamine increases; improves GABA-ergic, cholinergic and glutamatergic neurotransmission; the plasticity of the cell membrane increases with aging, the processes of lipid peroxidation are inhibited, and the rheological properties of blood improve. Cinnarizine, blocking the transmembrane transport of Ca2+ into the cell, reduces vascular tone, sensitivity to the vasoconstrictive action of adrenaline, norepinephrine, bradykinin, improves the rheological properties of blood, increases the volume of regional blood flow without the occurrence of steal syndrome, increases the resistance of cells to hypoxia; does not affect blood pressure and heart rate, potentiates the anti-ischemic effect of piracetam. By preventing excessive overload of neurocytes, Ca2+ interrupts the rapid reactions of the glutamate-calcium cascade, which underlie neurocyte damage.
The combined drug is rapidly and completely absorbed from the gastrointestinal tract. Cinnarizine reaches maximum plasma concentrations 1 hour after oral administration. Completely metabolized, 91% bound to plasma proteins. 60% is excreted unchanged in the feces, the remaining amounts are excreted in the urine as metabolites. The maximum plasma concentration of piracetam is reached after 2-6 hours. It freely penetrates the blood-brain barrier.

Phezam indications for use

The use of Phezam is indicated for:

• disorders of cerebral circulation: atherosclerosis of cerebral vessels, which is accompanied by ischemic stroke; during the rehabilitation period after a traumatic brain injury;
• impaired memory, thinking function, concentration of attention;
• vascular dementia;
• mood disorders (with depression and irritability);
• encephalopathy of various origins;
• labyrinthopathy of various origins (dizziness, tinnitus, nystagmus, nausea, vomiting); Meniere's syndrome;
• in the complex treatment of sensorineural hearing loss;
• in the complex treatment of visual dysfunctions in open-angle glaucoma with stabilized intraocular pressure, macular degeneration, complicated high myopia;
• in the complex treatment of hypertension (arterial hypertension);
• in the complex treatment of neurocirculatory dystonia;
• for the prevention of kinetosis;
• to improve learning and memory in children with intellectual retardation.

The use of Phezam

Depending on the severity of the disease, adults are prescribed 1-2 capsules 3 times a day, children - 1-2 capsules 1-2 times a day for 1-3 months.

Contraindications to the use of Phezam

Hypersensitivity to the components of the drug, severe renal failure, I trimester of pregnancy and lactation, age up to 5 years.

Side effects of Phezam

Very rarely - hypersensitivity reactions (skin rash, photosensitivity).

Special instructions for the use of Phezam

Be wary appoint in diseases of the liver and kidneys. In severe renal failure, do not prescribe in high doses, even if the patient is on chronic hemodialysis.
The drug can give a false positive result during doping control of athletes, as well as in the determination of radioactive iodine (due to iodine-containing dyes in the capsule shell). During treatment with Phezam, alcohol should be avoided. Use with caution in patients with Parkinson's disease.
Despite the lack of data on the teratogenic effect of the drug, it is not recommended to use it in the first trimester of pregnancy and during lactation.

Phezam drug interactions

With simultaneous administration, it is possible to potentiate the sedative effect of drugs that depress the central nervous system, tricyclic antidepressants and alcohol, as well as nootropic and antihypertensive drugs. Vasodilators enhance the effect of the drug, and increase blood pressure - weaken.

Phezam overdose, symptoms and treatment

Irritability (in children).

Phezam storage conditions

In a dry, dark place at temperatures up to 25 ° C.

List of pharmacies where you can buy Phezam:

• Saint Petersburg

Eye pressure, intraocular pressure (IOP) or ophthalmotonus, is the pressure of the fluid contained inside the eyeball against the walls of the eye. Intraocular pressure is now determined by all persons who have crossed the 40-year mark, regardless of whether a person makes complaints or not. This is due to the fact that increased eye pressure is the main prerequisite for the development of a disease such as glaucoma, which, if left untreated, leads to complete blindness.

Measurement of intraocular pressure is carried out using a special tonometer, and the results are expressed in millimeters of mercury (mm Hg). True, ophthalmologists of the 19th century judged the hardness of the eyeball by pressing on the eye with their fingers. In other cases, in the absence of equipment, a similar method is used today as a preliminary assessment of the state of the organs of vision.

Why is it important to know the IOP?

The attention paid to such a health indicator as intraocular pressure is due to the role played by IOP:

• Keeps the spherical shape of the eyeball;
• Creates favorable conditions for the preservation of the anatomical structure of the eye and its structures;
• Maintains normal blood circulation in the microvasculature and metabolic processes in the tissues of the eyeball.

The statistical norm of eye pressure, measured by the tonometric method, is within 10 mm Hg. Art. (lower limit) - 21 mm Hg. Art. (upper limit) and has average values ​​in adults and children of the order of 15 - 16 mm Hg. Art., although after 60 years there is a slight increase in IOP due to aging of the body, and the norm of eye pressure for such persons is set differently - up to 26 mm Hg. Art. (tonometry according to Maklakov). At the same time, it should be noted that IOP does not differ in particular constancy and changes its values ​​(by 3-5 mm Hg) depending on the time of day.

It would seem that at night, when the eyes are resting, eye pressure should decrease, but this does not happen in all people, despite the fact that the secretion of aqueous humor slows down at night. Closer to the morning, eye pressure begins to rise and reaches its maximum, while in the evening, on the contrary, it decreases, therefore, in healthy adults, the highest IOP rates are noted early in the morning, and the lowest in the evening. Fluctuations in ophthalmotonus in glaucoma are more significant and amount to 6 or more mm Hg. Art.

Measurement of intraocular pressure

It should be noted that not all people sent for annual preventive examinations to an ophthalmologist are enthusiastic about the upcoming measurement of intraocular pressure. Women may be afraid to spoil carefully applied makeup, men will refer to the absence of any complaints about their own organs of vision. Meanwhile, the measurement of intraocular pressure is a mandatory procedure for persons who have "knocked" 40 or more, even if they assure the doctor of their full health.

Measurement of intraocular pressure is carried out using special equipment and instruments, but in general, modern ophthalmology uses 3 main types of measurement of intraocular pressure:

The aforementioned method according to Maklakov - many patients remember, know and dislike it most of all, because drops are dripped into the eyes that provide local anesthesia, and "weights" are installed (for a very short time), which are quickly removed and lowered onto a clean sheet of paper to leave prints indicating the magnitude of IOP. This method is more than 100 years old, but it still has not lost its relevance;

1. Pneumotonometry, very reminiscent of Maklakov's tonometry, but different in that an air jet is used for its implementation. Unfortunately, this study is not particularly accurate;
2. Electronography is the most modern method, successfully replacing the previous two. It is used mainly in specialized institutions (not all clinics can afford expensive ophthalmic equipment yet). The method is classified as non-contact, high-precision and safe research.

Most often in the Russian Federation and neighboring countries, Maklakov tonometry or non-contact tonometry using an electronograph is used.

Increased intraocular pressure

Increased eye pressure (ophthalmohypertension) is not necessarily the result of age-related changes, as many people think.

The reasons for an increase in IOP can be very diverse, for example:

• Constant tension of the organs of vision, leading to their overwork;
• Atherosclerosis;
• Persistent arterial hypertension (periodic jumps in blood pressure, as a rule, are not dangerous for the eyes);
• Vegetative-vascular dystonia;
• Psycho-emotional stress, chronic stress;
• Fluid retention in the body due to cardiovascular pathology;
• Intracranial hypertension often causes increased pressure in the fundus;
• Professional activity (wind musicians);
• Separate (strength) physical exercises;
• Medications used topically;
• Strong tea or coffee (due to caffeine);
• Heart rhythm disturbances, respiratory arrhythmia;
• Features of the anatomical structure of the eye;
• intoxication;
• Inflammatory process localized in the organ of vision;
• Diencephalic pathology;
• Traumatic brain injury;
• Diabetes;
• Menopause;
• hereditary pathology;
• Side effects of certain drugs, treatment with corticosteroid hormones.

Elevated intraocular pressure is often a sign of glaucoma, the risk of which increases markedly after age 40.

Warning signs of elevated IOP

Increased eye pressure may not show any special signs of trouble for a long time. A person continues to live in a normal rhythm, unaware of the impending danger, because the real symptoms of the pathological condition of the eyes appear only when the IOP changes significantly upwards. And here are some signs of the disease that may suggest that, postponing all matters, you should immediately visit an ophthalmologist to check your vision and measure intraocular pressure:

1. Pain in the eyes, in the area of ​​the eyebrows, in the frontal and temporal areas (or on one side of the head);
2. "Fog" before the eyes;
3. Multi-colored circles when looking at a burning lamp or lantern;
4. Feeling of heaviness, fullness and fatigue of the eyes by the end of the day;
5. Attacks of unmotivated lacrimation;
6. change in the color of the cornea (redness);
7. Decreased visual acuity, lack of image clarity (with glaucoma, patients often change glasses).

An increase in IOP and the development of glaucoma can be suspected if a person often changes glasses, because he begins not to see in the “old”, and also if this disease was diagnosed in close relatives.

For starters - drops from eye pressure

If the pathological process has not gone too far, but the degree of risk of developing glaucoma is quite high, then treatment usually begins with a direct impact on a high level of IOP, and for this purpose the doctor prescribes drops from eye pressure, which:

• Promote the outflow of fluid;
• Reduce the pressing effect on the capsule of the eye;
• Normalize tissue metabolism.

By the way, drops from eye pressure can cover different pharmacological groups, these are:

1. F2α prostaglandin analogues (Travoprost, Xalatan, Latanoprost);
2. Beta-blockers (selective - Betaxolol, and - non-selective - Timolol);
3. M-cholinomimetics (Pilocarpine);
4. Carbonic anhydrase inhibitors (local - Bronzopt, and plus drops from eye pressure: systemic - Diacarb in capsules and tablets).

In this regard, it is very important to correctly assess how drugs will affect the hydrodynamics of the organ of vision, whether it will be possible to quickly obtain a hypotensive effect, calculate how often a person will depend on drops, and also take into account contraindications and individual tolerance of individual drugs. If, with the prescribed treatment, everything did not go very smoothly, that is, no special effect was obtained from monotherapy with antihypertensive drugs, one has to turn to combined treatment using:

1. Travapress Plus, Azarga, Fotil-forte;
2. α and β-agonists (adrenaline, clonidine).

However, in such cases, it is not at all desirable to use more than two different drugs in parallel.

In addition to the listed medications for glaucoma (acute attack), osmotic agents are prescribed orally (Glycerol) and intravenously (Mannitol, Urea).

Of course, the examples of drops from eye pressure are by no means given for the patient to go and, on his own initiative, purchase them in a pharmacy. These drugs are prescribed and prescribed exclusively by an ophthalmologist.

In the treatment of increased eye pressure, in order to adequately assess the results achieved, the patient regularly measures IOP, checks visual acuity and the condition of the optic discs, that is, the patient during treatment closely cooperates with the attending physician and is under his control. To obtain the maximum effect from the treatment and prevent addiction to drugs, ophthalmologists recommend periodically changing drops from eye pressure.

The use of drops and other medications that reduce IOP involves treatment at home. In glaucoma, treatment depends on the form of the disease and the stage of the glaucoma process. If conservative therapy does not give the expected effect, laser exposure is used (iridoplasty, trabeculoplasty, etc.), which allows the operation to be performed without a hospital stay. Minimal trauma and a short rehabilitation period also make it possible to continue treatment at home after the intervention.

In advanced cases, when there is no other way out, surgical treatment is indicated for glaucoma (iridectomy, fistulizing interventions, operations using drains, etc.) with a stay in a specialized clinic under the supervision of doctors. In this case, the rehabilitation period is somewhat delayed.

Decrease in fundus pressure

Doctors involved in the treatment of eye diseases are also aware of another, opposite to increased IOP, phenomenon - ophthalmic hypotension, eye hypotension or a decrease in fundus pressure. This pathology develops quite rarely, but this does not make it less dangerous. Unfortunately, patients with hypotension of the eyes get to the ophthalmologist's office when a significant percentage of their vision has already been lost.

Such a late appeal is explained by the fact that there are no obvious signs of the disease, the initial stage proceeds almost without symptoms, except for a not very pronounced decrease in visual acuity, which people attribute to eye strain or age-related changes. The only symptom that appears later and can already alert the patient is dry eyes and loss of their natural luster.

Factors contributing to the reduction of intraocular pressure are not as diverse as the prerequisites that increase it. These include:

• Injury to the organs of vision in the past;
• Purulent infections;
• Diabetes;
• Dehydration
• arterial hypotension;
• Alcoholic drinks and drugs (marijuana);
• Glycerin (when ingested).

Meanwhile, a person who pays as much attention to the eyes as to other organs can prevent the undesirable consequences of a decrease in IOP by visiting an ophthalmologist and talking about the aforementioned “minor” symptoms. But if you do not notice signs of eye disease in a timely manner, you may face the fact of the development of an irreversible process - atrophy of the eyeball.

Treatment at home involves the use of eye drops: Trimecain, Leocain, Dikain, Collargol, etc. Useful are products with aloe extract, as well as B vitamins (B1).

A few tips for patients with high eye pressure

Patients suffering from increased IOP, which threatens the development of the glaucoma process, are recommended to follow some prevention rules:

As for low blood pressure, as mentioned earlier, it is one of the rare cases, so patients who experience suspicious signs (dull dry eyes) can be advised to contact a specialist as soon as possible who will tell you what to do next.

Video: about increased intraocular pressure and glaucoma

Video: about low intraocular pressure and its causes

If you are going on a trip or a business trip, do not forget to replenish your first-aid kit with a drug called Cofitsil Plus. This medicinal substance has a wide range of effects on the body due to a well-chosen combined composition. Caffeine, one of the main components of Coficil Plus, increases blood pressure. For indications for the use of the drug, read our article.

Indications for use

"Coficil Plus" is usually prescribed to adults and children over the age of fifteen to eliminate pain from migraines, menstruation, and dental problems. Since one of the active components of the drug is paracetamol, "Cofitil" is prescribed to relieve the low temperature that accompanies most colds of an infectious nature. "Coficil" is sometimes prescribed to patients with low pressure, and also if the patient complains of increased fatigue and a rapid decrease in performance. Due to the action of caffeine, the drug increases blood pressure.

"Coficil Plus" is usually prescribed to adults and children over the age of fifteen

The composition and medicinal properties of "Kofitsila Plus"

"Coficil" is presented in flat tablets of white, cream or marble color. The components of one capsule of the drug are:

• acetylsalicylic acid - 0.3 grams,
• paracetamol - 0.1 grams,
• caffeine - 0.05 grams.

One package of the drug contains 10 tablets. Each of the components of the drug has a certain effect on the patient's body:

• acetylsalicylic acid relieves pain, lowers temperature, relieves inflammation, prevents the formation of blood clots;
• caffeine stimulates the blood supply to the muscles, heart, kidneys, and brain, increases blood pressure, tones the body;
• paracetamol eliminates fever, relieves inflammation.

"Coficil Plus": instructions for use

"Coficil" should be taken internally during or immediately after a heavy meal. The maximum dose per day should not exceed 6 tablets. As a rule, the doctor prescribes the reception of "Coficil" one or two tablets up to three times a day. It is important that the interval between taking the medicine is at least four hours. In addition to ordinary water, Cofitsil Plus is allowed to be washed down with mineral water and milk. Patients who have abnormalities in the liver or kidneys are required to observe at least six hours of break between taking the tablets.

Take the tablets with plenty of water

The desired effect of the drug directly affects the duration of the course of treatment. If Cofitsil is used for an analgesic effect, it must be drunk within five days. For antipyretic effects on the body - no more than 3 days.

"Coficil plus" during pregnancy and lactation

The action of the substances that make up the drug interfere with the normal course of pregnancy and the development of the fetus. If "Cofitil" is prescribed to a nursing mother, breastfeeding should be stopped for the period of taking the drug. Acetylsalicylic acid leads to fetal malformations, inhibits labor and can provoke negative changes in the child's cardiovascular system.

Contraindications to taking "Coficil Plus"

The active ingredients of "Coficil" have a significant effect on the body, which is why it is contraindicated in children, pregnant and lactating women. For this reason, the drug is recommended to be taken only as prescribed by the doctor, and if after self-administration there are side effects from the effect of the drug on the body, you should immediately seek help from the hospital.

Apply "Kofitsil Plus" is strongly not recommended for:

• acute beriberi;
• chronic diseases of the stomach;
• heart attack;
• diseases of the liver and kidneys;

Do not take these pills if you have a heart attack.

• glaucoma;
• an allergic reaction to the active ingredients of the drug;
• surgical intervention;
• anxiety;
• increased excitability;
• hemophilia;
• telangiectasia;
• thrombocytopenia;
• hypothrombinemia.

Interaction of "Coficil Plus" with other drugs

If you are undergoing treatment concomitantly with taking Cofitil, you should discuss the possible effects of multiple drug interactions with your doctor, since each of the active components of Cofitil can interact with other medicines.

Side effects of "Coficil Plus"

Taking the medication contrary to the instructions for a long time can lead to dizziness, decreased visual function, decreased blood clotting, increased bleeding from the nose.

In children, long-term use of Coficil Plus can cause vomiting, mental disorders, disturbed sleep, and liver problems.

An overdose of the drug can cause vomiting, dizziness, convulsions, bleeding and spasms. The patient may suffer from shortness of breath or experience bronchospasm.

Analogues "Kofitsila Plus"

With reduced pressure, the patient may be assigned an analogue of "Cofitsil" - "Citropack". It has a similar composition of active ingredients, however, their dose in one tablet is somewhat underestimated compared to Cofitsil. "Citropack" is also prohibited for use by women during pregnancy and children under the age of sixteen.