Pronoran. Indications for use, instructions, analogs, what is it for, price, reviews

Pronoran is a drug that is indicated for use for partial recovery intellectual abilities lost due to age reasons.

Forms of release and composition of the drug

The drug from the pharmaceutical company "Les Laboratoires Servier" (France) is available in controlled-release tablets, coated with a water-soluble red coating.

This type of tablets is made using a special technology, thanks to which the action of the active components included in their composition can be programmed, providing the desired effect at the right time. This allows you to prolong the effect of the drug and minimize the number of doses.

The package may contain 2 blisters of 15 tablets each or 1 blister for 30 tablets, as well as instructions with a detailed description of the product and how it is used.

The active ingredient in Pronoran is piribedil. This substance belongs to the group of antiparkinsonian and dopaminergic drugs.

Each tablet contains:

• piribedil - 50 g;
• excipients that form the basis of the tablet: povidone (20 mg), talc (130 mg);
• the connections used to create the shell.

Pharmacological properties

In the process of natural aging of the body, gradually:

• the rate of neurogenesis (formation of neurons) slows down;
• the production of dopamine decreases - a substance synthesized in their cytoplasm and is responsible for the work of dopamine receptors, through which signals are transmitted that provide the cognitive process.

Over time, a lack of dopamine leads to a decrease in the activity of dopamine receptors and leads to:

• weakening of memory;
• attention disorders;
• decrease in the ability to perceive new information.

Α-adenoreceptors are overly activated, transmitting to the brain "inhibition signals", the work of which was previously regulated by norepinephrine, a derivative of dopamine.

As a result:

• a person's movements become awkward, slowed down, constrained;
• articulation is disturbed;
• facial features become immobile;
• the ability to perform small accurate movements is lost;
• symptoms of Parkinson's disease appear.

Pronoran (indications for the use of this drug are associated with a lack of dopamine) as a means of dealing with the described problems, it has the following properties:

Properties	Description
Dopaminergic	Stimulating dopamine receptors and helping to improve brain activity aimed at: study; memorization; processing of information.
Antiparkinsonian	Ability to weaken / eliminate manifestations of neurological syndrome (parkinsonism): stiffness (sustained increase in muscle tone); tremor of the limbs; Difficulty maintaining balance while moving vision problems associated with the rigidity of the muscles of the eye.

Previously, in the treatment of such pathologies, only DOPA-containing agents (levodopa) were used. Their action was aimed at replenishing the lack of dopamine, which, with prolonged use, gave a number of undesirable reactions.

In comparison with them, Pronoran, being an agonist of dopamine receptors (ADR), has a number of advantages, in particular, a lower risk of development:

• peptic ulcer;
• vasospasm;
• erythromellalgia;
• pleurisy;
• pulmonary fibrosis.

The use of Pronoran in Parkinson's disease allows in the early stages to delay the need for levodopa. In the later stages, it is necessary to do with a smaller dose and reduce the negative effect of DOPA-containing agents on the body.

Also, when treating with this drug, it is possible to achieve:

• less severity of motor disorders;
• weakening the symptoms of Parkinson's disease;
• partial elimination of neuropsychological disorders;
• normalization of the emotional state;
• improving the patient's quality of life;

Pharmacodynamics and pharmacokinetics

Absorbed into the blood, the active substance of the drug piribedil penetrates the blood-brain barrier and enters the bloodstream of the brain. There it, by binding to dopamine receptors and being their agonist, stimulates the parts of the brain that are responsible for the intellectual abilities of a person.

At the same time, possessing the properties of an antagonist (suppressing the activity) of receptors (α-adenoreceptors), stimulation of which causes vasoconstriction and increased muscle tone, piribedil eliminates symptoms parkinsonism.

The properties of piribedil as a dopamine receptor agonist and a blocker of α-adenoreceptors mutually reinforce each other, due to which, with regular intake of Pronoran, the symptoms of Parkinson's disease and partially cognitive functions are restored:

• memory is strengthened;
• the level of concentration of attention increases;
• the ability to assimilate new knowledge improves.

Pronoran is metabolized by the liver and excreted in the urine as metabolites. The half-life is 12 hours, while the concentration of the drug required to obtain a therapeutic effect is maintained for 24 hours.

Indications for use

Pronoran is indicated for use in case of dopamine deficiency caused by:

• age-related changes;
• hereditary factor;
• poisoning with toxic substances and the associated insufficient activity of dopamine receptors;
• in cases where partial blocking of α-adenoreceptors is required.

Partial blocking is required when:

Indications	Description
Persistent cognitive decline and sensorineural deficits	The problem manifests itself in old age: weakening of memory; inability to concentrate; difficulties in assimilating information. The drug is prescribed as an adjuvant for symptomatic treatment.
Parkinson's disease	The disease is manifested by the following external symptoms: tremor; a characteristic posture when walking (the body is tilted forward, the knees and elbows are slightly bent, the gait is shuffling, steps are small); Difficulty maintaining balance immobility of facial features; slow speech; decrease in intellectual abilities. The drug is prescribed for monotherapy of the disease at all stages or as part of complex therapy, together with levodopa. The most striking therapeutic effect from the use of Pronoran is observed in forms of the disease accompanied by tremor.
Intermittent claudication	These are recurrent and intensifying sharp pains in the leg caused by diseases of the peripheral arteries of the legs. Pronoran is prescribed as a remedy for the patient's condition.
Ophthalmic problems	They are caused by a spasm of blood vessels and muscles that control the work of the organs of vision, provided that they are a consequence of parkinsonism. The remedy is prescribed to eliminate symptoms.

Contraindications

Self-administration of Pronoran can be dangerous for the patient, since there are a number of contraindications that exclude the possibility of its use.

In particular:

• excessive sensitivity to piribedil or to the excipients contained in the tablets;
• life-threatening conditions, characterized by a sharp drop in blood pressure and a slowdown in the pulse;
• acute heart disease;
• undergoing treatment with antipsychotics (the exception is clozapine);
• age category up to 18 years old.

With caution, under the supervision of a doctor, a drug containing sucrose, prescribed for patients with intolerance to glucose, lactose, fructose, as well as people with diseases liver and kidney.

At what age can the drug be used?

Pronoran, the indications for the use of which are determined by a specialist, is focused on the older age category. No studies have been conducted to clarify its effect on a young organism, children, pregnancy and the condition of the fetus.

For this reason, the drug is not prescribed:

• patients under 18 years of age;
• pregnant women;
• nursing mothers;

For women of childbearing age, Pronoran can be used provided that they use reliable means contraception: the nature of the problems that may arise if conception occurred during the treatment period, unpredictable.

Instructions for use, dosage

The tablet is taken orally, after meals and washed down with ½ glass of clean water.

The recommended dosage regimen depends on the diagnosis made:

• with weakening of memory, decreased intellectual abilities, difficulty concentrating, problems that are not a consequence of Parkinson's disease: 1 tablet daily. In severe cases of the disease, the number of doses can be increased to 2 per day;
• for Parkinson's disease and treatment exclusively with Pronoran: from 3 to 5 tablets, divided into 3 doses daily. If the maximum dose is prescribed, it is recommended to adhere to the following algorithm: 2 tablets after breakfast and lunch, 1 tablet after dinner;
• in the complex therapy of Parkinson's disease (using Pronoran and levodopa) - 1 tablet 3 times a day.

If it is necessary to change the dose towards its increase, this should be done in stages, adding 1 tablet every 10-14 days. An abrupt cessation of piribedil intake, which can provoke the development of neuroleptic malignant syndrome, is also unacceptable. This is a serious and dangerous mental disorder. With a gradual dose reduction, the probability of ZNS is minimal.

If 1 dose of the drug was missed, you cannot double the dose: the next dose is performed at the usual time and in the usual amount. The course of treatment is extended by a day if 1 tablet per day is prescribed or the required number of hours is 2 or more tablets per day.

The duration of the course, the specific dose and treatment regimen are determined by the doctor and can be adjusted if necessary. For example, if a patient's tastes and habits have changed dramatically as a result of taking Pronoran, there are changes in behavior.

Side effects

Side effects from taking the drug are associated with the dopaminergic abilities of Pronoran. At the right dose, their intensity is usually moderate. Undesirable effects are most pronounced at the beginning of the course of treatment, then gradually weaken, and after stopping treatment, they disappear.

The following adverse reactions to the drug may occur:

• mental disorders: lack of clarity of consciousness, excessive agitation, hallucinations. Attacks of aggression are possible;
• nervous system problems: dizziness, drowsiness, movement disorders;
• decrease in blood pressure, pressure surges;
• from the gastrointestinal tract: diarrhea, flatulence, slight nausea;
• Behavioral changes: Some patients experienced uncharacteristic gambling, hypersexuality, overeating, and shopping.

To avoid such violations, the minimum dose that has a therapeutic effect is selected. If undesirable reactions appear later, in the course of treatment, the doctor will adjust the dose: as a rule, after reducing it, the side effects weaken or disappear.

Overdose

Pronoran, the indications for the use of which are associated with the action of dopamine, in case of an overdose, leads to excessive stimulation of the part of the brain responsible for the gag reflex.

For this reason, the patient may experience:

• nausea;
• urge to vomit;
• sudden pressure surges (BP lability).

If there are signs of an overdose, Pronoran should be canceled. Until it is completely eliminated from the body, drugs are used to eliminate symptoms and alleviate the patient's condition.

special instructions

Pronopan, being a psychotropic drug, has a certain effect on the brain. In some situations, taking it, increasing the likelihood of injury, can be dangerous for the patient himself and for those around him.

In this regard, it must be borne in mind that:

• in Parkinson's disease, piribedil, which is part of the drug, can cause a sudden feeling of drowsiness, sometimes so strong that a person is unable to fight sleep. For this reason, when undergoing a course of treatment, it is necessary to refuse to drive vehicles and perform any work requiring increased attention and associated with a high level of danger;
• since dopamine agonists have the ability to disrupt the blood pressure regulation system, attacks of orthostatic hypotension are possible. This is an abrupt temporary decrease in blood pressure with a sharp change in body position. These jumps are not dangerous, but, provoking dizziness and fainting, can cause injury from a fall, especially when it comes to elderly people;
• the effect of piribedil on the central nervous system causes hypersexuality, a tendency to risky adventures, and aggression. In combination with confusion of consciousness and excessive agitation, this can provoke a number of actions that entail damage to property or damage to the health of the patient himself and those around him. For this reason, the patient must be constantly monitored.

Also, during treatment with Pronoran, the following are possible:

• movement disorders: tremor, tic, myoclonus, chaotic, devoid of a specific purpose, movements of arms, legs, inadequate facial expressions;
• swelling of the limbs;
• neuroleptic malignant syndrome (rarely, with abrupt withdrawal of the drug).

In the presence of these symptoms, a doctor's consultation is necessary: ​​dose adjustment leads to their weakening and complete disappearance.

Drug interactions

Pronoran practically does not bind to blood proteins, therefore it does not affect the properties of other drugs. However, its simultaneous use with antipsychotics is contraindicated: these drugs provide directly opposite effects. If it is necessary to prescribe a course of antipsychotics to the patient, the dose of Pronoran is first gradually reduced (in order to avoid the development of ZNS) until complete cancellation.

An exception is clozapine (azaleptin), a new generation antipsychotic that does not affect the functioning of these receptors.

The joint appointment of Pronoran and tetrobenazine-based drugs is not recommended, since piribedil and tetobenzain are antagonist substances.

It is not recommended to use antiemetics during treatment with Pronoran, as well as to take drugs that provide a sedative effect. The use of alcoholic beverages is also undesirable. If you need to take any other medications, you should definitely notify your doctor about this.

Analogs

Pronoran, the indications for the use of which should be determined only by a doctor, has no complete analogues. In modern therapeutic practice, 9 drugs with ADR properties, but with other active components, are allowed to be used. These are its group counterparts.

They are divided into 2 types - ergoline and non-ergoline products.

Non-ergoline remedies

Their active component is synthetic compounds with the ability to stimulate dopamine receptors. This type of drug, while causing fewer side effects, is considered preferable.

Mirapex

A drug with the active ingredient promipexole, which has a similar effect to piribedil on dopamine receptors. According to research data, Mirapex has proven itself better as a means of reducing the manifestations of tremors and eliminating neurotransmitter disorders in the early stages of Parkinson's disease.

At the same time, it is inferior in effectiveness to Pronoran in the fight against muscle rigidity and hypokinesia (limited tempo and range of motion).

In general, according to a number of indicators, Pronoran is considered more effective in the early stages of Parkinson's disease, and Mirapex is considered more effective in the later stages.

It should be taken into account the fact that treatment with Mirapex costs 2-3 times more than with Pronoran.

Ropinol

Non-ergoline ADR, in which the active ingredient is ropinol hydrochloride, is intended for the treatment of Parkinson's disease and the weakening of the manifestations of parksonism.

A drug:

• compensates for dopamine deficiency;
• partially restores lost motor functions;
• eliminates muscle stiffness;
• relieves tremors.

In Parkinson's disease, it can be used in the early stages for monotherapy, in the later stages - in combination with levodopa in order to reduce its dose and increase the effect.

Rotigotine

An agonist of dopamine receptors of the non-ergoline type with the active substance rotigotine is used in the form of a patch applied to the area of ​​the shoulder blades, abdomen or thigh. The indications for use are Parkinson's disease and restless legs syndrome.

In comparison with Pronoran, the drug has a wider list of contraindications, side effects, can cause hypertension, muscle pain, insomnia.

Apomorphine

Semisynthetic alkaloid derivative of morphine with ADR properties. Available in the form of a solution for injection. The main area of ​​application is the treatment of alcoholism and situations when an urgent need to cleanse the stomach. It is used less often for the treatment of Parkinson's disease and parksonism, since, by stimulating the heromeceptor trigger zone, it can induce vomiting.

Ergoline remedies

They are based on derivatives of the ergot alkoloid. Appointed only if it is impossible to use non-ergoline analogues.

Bromocriptine

The active ingredient is bromocriptine-KB, a dopamine channel stimulant. The action of the drug is aimed mainly at the treatment of female diseases associated with excessive secretion of the hormone prolactin and with menstrual irregularities.

As an ADR, it can be used in the treatment of Parkinson's disease and diseases similar to it in etiology.

A drug:

• makes the main manifestations of parkinsonism less intense: tremor, muscle stiffness, hypokinesia;
• possessing the properties of an antidepressant, partially eliminates the manifestations of depression characteristic of the disease;
• improves the emotional state of the patient.

Permax

The active ingredient of the drug is pergolide. As a stimulant of dopamine receptors, the drug is used as an antiparkinsonian agent for illness Parkinson's and similar etiology disorders of motor functions, decreased intellectual abilities, weakening memory.

Cabergoline

ADR, with the active substance cabergoline, which is a derivative of the ergot alkoloid. Cabergoline is most effective in treating early-stage Parkinson's disease. In a later period, it can be used in complex treatment, in parallel with levodopa, when the use of other drugs is impossible.

This group of drugs also includes Lizurid and Vasobral, which have similar properties.

The nosological analogues of Pronoran include drugs that do not have the ability to stimulate dopamine receptors.

These are, in particular, medications:

• replenishing dopamine deficiency by introducing into the body its biological precursor - levodopa. The most popular of them are: Madopar, Nakom, Sinemet, Sinedopa;
• blocking enzymes responsible for the breakdown of dopamine: Entacapone and Tolcapon;
• eliminating the symptoms of the disease but, at the same time, not affecting the work of dofing mechanisms: Amantadine and Budipin.

Terms, conditions of sale and storage

Pronoran is dispensed only with a doctor's prescription, the shelf life is 3 years from the date of manufacture, the drug must be stored at a temperature not exceeding 30 ° C. After the expiration date or if the storage conditions are violated, the use of this product may be hazardous to health.
Price

The cost of one package for 30 pcs. is 300 rubles.

Pronoran is indicated for use with a lack of dopamine. It helps to eliminate movement disorders inherent in old age and slow down the development of Parkinson's disease.

Video about the drug

Pronoran: