Медикаменты Цитофлавин и Актовегин применяются в медицинской практике для терапии патологических нарушений в центральной нервной системе. Они эффективны для восстановления кровообращения и улучшения трофики структур и тканей головного мозга, повышают функциональные возможности нервной системы и способствуют ее укреплению, ускоряют транспортировку к нейронам кислорода и глюкозы.
Сходства составов Цитофлавина и Актовегина
В таблетированной форме лекарства используются при следующих заболеваниях и симптомах:
- острые нарушения кровообращения в структурах головного мозга;
- последствия цереброваскулярных заболеваний (церебральный атеросклероз сосудов мозга, ишемический инсульт);
- разные формы хронической недостаточности циркуляции крови, черепно-мозговые травмы, деменция;
- периферические нарушения кровообращения, их осложнения (трофические язвы, ангиопатия, варикоз);
- гипоксическая и токсическая энцефалопатии как следствие острых и хронических отравлений, эндотоксикозов, постнаркозного угнетения сознания;
- реабилитационный период после кардиохирургических операций в условиях искусственного кровообращения.
Препараты допускаются к применению при беременности в безопасных терапевтических дозировках. Возможно их использование в терапии патологических нарушений мозгового кровообращения у детей любого возраста, включая новорожденных.
Актовегин и Цитофлавин запрещается применять в лечебных целях при наличии у пациента одного или нескольких абсолютных противопоказаний:
- гиперчувствительность к компонентам состава;
- декомпенсированная стадия сердечной, дыхательной или полиорганной недостаточности;
- олигурия;
- отек легких или периферических органов;
- анурия;
- острая гипотония.
Актовегин и Цитофлавин запрещается применять при гиперчувствительности к компонентам состава.
Отличия Цитофлавина от Актовегина
Несмотря на то что данные фармацевтические средства используются в одинаковых клинических ситуациях и выполняют похожие функции, они имеют ряд отличий:
- Фармакотерапевтическая группа. Актовегин относится к биогенным стимуляторам, а Цитофлавин — к препаратам, действующим на ЦНС.
- Состав. Основным действующим веществом Актовегина является депротеинизированный гемодериват (200 мг), выделенный из крови телят. Цитофлавин считается поликомпонентным препаратом и включает основные вещества — янтарную кислоту (300 мг), никотинамид (0,025 г), рибоксин (0,05 г) и рибофлавин (0,005 г).
- Форма выпуска. Актовегин, кроме таблеток, производится в виде мази, геля, крема, растворов для инфузий и инъекций, офтальмологического геля. Это позволяет использовать его в комплексной терапии в качестве системного и местного средства. Изолированное применение форм для наружного использования позволяет исключить системное воздействие и активизировать только местные восстановительные процессы. В виде растворов характеризуется высокой биодоступностью и быстрым началом действия. Цитофлавин выпускается в виде таблеток и ампул с раствором для в/в инфузий.
- Побочные действия. У Актовегина отсутствуют зарегистрированные побочные действия, кроме индивидуальной непереносимости компонентов, проявляющейся аллергическими реакциями. При использовании Цитофлавина могут наблюдаться такие отрицательные реакции: развитие головной боли, дискомфорта в органах пищеварительного тракта, транзиторная гипогликемия, обострение хронической подагры, аллергические проявления (зуд и гиперемия кожных и слизистых покровов).
- Взаимодействие с медикаментозными средствами. Никаких особых указаний по сочетанию с другими медикаментами для Актовегина не предусмотрено. Цитофлавин несовместим со Стрептомицином и снижает эффективность некоторых антибактериальных средств (Доксициклина, Эритромицина и др.), уменьшает побочные реакции Хлорамфеникола, совместим с любыми анаболиками, средствами для активизации гемопоэза, антигипоксантами.
- Количество таблеток в упаковке. Актовегин — 10, 30, 50 шт., Цитофлавин — 50, 100.
- Стоимость. Лечебный курс Цитофлавина практически в 3 раза дешевле, чем аналогичный по продолжительности курс Актовегина.
- Особенности применения. Актовегин противопоказан женщинам во время грудного вскармливания, в то время как Цитофлавин назначается со строгим соблюдением терапевтической дозировки медикамента.
Кроме того, отличается у лекарств способ применения и продолжительность курса. Цитофлавин применяют перорально по 2 таблетки 2 раза в день, рекомендованный интервал между приемами составляет 8-10 часов. Таблетки необходимо пить не позже чем за 30 минут до еды, запивая водой (100 мл), запрещается разжевывание препарата. Рекомендуется принимать рано утром и не позднее 18.00. Продолжительность терапевтического курса — 25 дней. Рекомендованный перерыв между курсами — не менее 4 недель.
Цитофлавин применяют перорально по 2 таблетки 2 раза в день.
Внутривенное капельное ведение Цитофлавина: на 100-200 мл раствора 5-10% декстрозы или 0,9% натрия хлорида.
Дозировки Актовегина зависят от особенностей патологического процесса:
- В таблетированной форме назначают перорально перед едой по 1-2 шт. 3 раза в сутки. Таблетки нельзя разжевывать, необходимо запивать небольшим количеством воды.
- Для парентерального введения начальная доза — 10-20 мл, затем применяют по 5 мл 1 раз в сутки, ежедневно или через день.
- Для ежедневной внутривенной инфузии вводят капельно 250 мл специального раствора со скоростью 2-3 мл/мин. Курс лечения составляет 10-20 инфузий.
- Местное применение. Актовегин гель используют для локального лечения и очищения ран. Толщина слоя зависит от особенностей поражения. Крем и мазь используют для продолжительного лечения нарушений целостности кожи (язв, пролежней, ран, с целью профилактики повреждений при лучевой терапии). Количество обработок поверхности, продолжительность курса лечения определяются индивидуально в зависимости от клинических проявлений заболевания, способности кожных покровов к регенерации.
- Глазной гель используют только для пораженного глаза в количестве 1 капля препарата 2-3 раза в день.
Упаковка Актовегина (50 шт.) в таблетированной форме стоит около 1500 руб., на месячный курс взрослому надо минимум 2 упаковки. Таблетки Цитофлавина (50 шт.) можно купить за 410 руб., ориентировочная стоимость одного курса лечения — 900 руб.
1 капельница с Актовегином будет стоить около 200 руб., с Цитофлавином — 100 руб.
Что лучше?
Оба лекарства хорошо зарекомендовали себя в медицинской практике, поэтому сказать, какое из них лучше, сложно. Данные медикаменты можно использовать комплексно для усиления клинического эффекта. При таком использовании отмечается повышение количественного содержания глюкозы в структурах нейронов, что обусловлено одновременным действием медикаментов.
У Актовегина есть лекарственные формы для местного применения в офтальмологии, гинекологии и дерматологии. Его можно вводить и в виде инъекций, и в качестве внутривенных инфузий.
У Цитофлавина больше отрицательных реакций, нет возможности использовать его для локальной терапии или в инъекционном виде. Но при этом он отличается доступной ценой. Медикамент разрешено использовать с осторожностью в лактационном периоде.
Оба препарата хорошо сочетаются с нейропротекторами и ноотропами, при этом запрещается одновременный прием Цитофлавина и некоторых антибактериальных средств.
Отзывы врачей о Цитофлавине и Актовегине
Валентина, гинеколог, 54 года, Москва
Использую Актовегин и Цитофлавин для нормализации фетоплацентарного кровообращения на разных сроках гестации у беременных. Препараты хорошо влияют на нормализацию этого процесса, что подтверждается проведением доплера. Никаких побочных явлений со стороны этих препаратов на организм беременной или плода я не встречала. Они достаточно безопасные и эффективные. Доступно объясняю пациентками механизм действия и предоставляю возможность выбрать. Большинство отдают предпочтение Актовегину, несмотря на высокую стоимость.
Игорь, невропатолог, 46 лет, Белгород
Применяю данные препараты для коррекции нарушений мозгового кровообращения в раннем восстановительном периоде после ишемических инсультов у пациентов всех возрастных групп. Чаще отдаю предпочтение Актовегину. При его использовании отсутствуют побочные явления со стороны ЦНС, за всю свою практику не встретил ни одной аллергической реакции на его компоненты. Цитофлавин тоже достаточно эффективен, но часто провоцирует побочные реакции, требующие экстренной замены препарата.
Отзывы пациентов
Марина, 48 лет, Кемерово
4 года назад в результате ДТП получила закрытую черепно-мозговую травму. Во время стационарного лечения в отделении политравмы кололи Актовегин, потом перевели на таблетированную форму препарата. После 3 курса реабилитационного лечения по рекомендации врача перешла на более доступный Цитофлавин. Ощущения во время приема не поменялись, никакого отрицательного действия я не вижу, при этом врач-невропатолог отмечает прогресс восстановительного процесса.
Ольга, 33 года, Сочи
По результатам второго планового УЗИ на 21 неделе беременности врач диагностировал внутриутробную задержку развития плода в результате нарушения маточного кровотока. Меня положили в стационар, где неделю капали Актовегин. По результатам контрольного УЗИ специалисты отметили положительную динамику, перевели на таблетки и выписали домой. Начиная с 31 недели попросила врача подобрать более доступный аналог, и она назначила Цитофлавин в таблетках для поддержки плода. Благодаря такому лечению родила здорового ребенка.
Владимир, 62 года, Астрахань
После перенесенного в прошлом году инсульта назначили капельницы с Актовегином в стационаре. После выписки на амбулаторное наблюдение предложили перейти на отечественный бюджетный аналог Цитофлавин в таблетках. Но через 15 дней стал отмечать сильные головные боли по ночам. Невропатолог сказал, что это побочное действие компонентов препарата и снова назначил Актовегин. Уже следующей ночью после возобновления приема этого препарата я спал спокойно. Так что сэкономить у меня не получилось, но зато никаких побочных реакций я теперь не ощущаю.
Цитофлавин и Актовегин применяют для комплексной терапии патологий центральной нервной системы. Эти средства имеют много общих свойств.
Сходства составов Цитофлавина и Актовегина
Цитофлавин воздействует на обменные процессы ЦНС. Действующие компоненты:
- рибоксин;
- рибофлавин;
- янтарная кислота;
- никотинамид.
Форма выпуска — таблетки и раствор для уколов.
Янтарная кислота имеет антиоксидантные, тонизирующие свойства, улучшает снабжение клеток кислородом и глюкозой. Никотинамид представляет собой витамин PP, участвует в метаболизме клеток, предотвращает дегенерацию нервных тканей.
Рибоксин поддерживает белковый обмен, воздействует на обмен глюкозы при нехватке кислорода. Вещество проникает в клетки, нормализует процессы обмена в миокарде, улучшает кровообращение. Рибофлавин представляет собой витамин B2, регулирует обмен жиров и белков, улучшает функции органов зрения.
При нарушенном кровообращении ставят капельницы. Длительность терапии продолжается 25 дней. Вечером нужно пить лекарство не позже 18:00, потому что оно может вызвать нарушения сна. При необходимости назначают повторный курс лечения, при этом нужно сделать перерыв в 1 месяц.
- першение в горле;
- повышение температуры;
- головная боль.
Детям средство не назначают.
- подагра;
- нарушения функции почек.
Актовегин воздействует на процессы клеточного обмена. Активное вещество — депротеинизированный гемодериват, который представляет собой экстракт из крови телят. Форма выпуска: таблетки, ампулы, гель, мазь, крем.
- имеет нейропротекторные, метаболические свойства;
- нормализует энергетический обмен веществ;
- способствует усвоению глюкозы;
- снижает последствия кислородного голодания тканей;
- нормализует микроциркуляцию.
Средство применяется при лечении нарушений мозгового кровообращения, периферического кровообращения, варикоза, в терапии последствий ЧМТ и инсульта. Используется для комплексного лечения ожогов, трофических язв, поражений роговицы глаз.
- кожная сыпь;
- покраснение кожи;
- появление головной боли;
- жжение в месте применения.
- непереносимость компонента препарата;
- беременность;
- лактация.
Отличия Цитофлавина от Актовегина
Эти лекарства различаются по составу и свойствам. В состав Цитофлавина входят природные метаболиты. Действующие вещества медикаментов неодинаковые. Цитофлавин имеет 4 активных ингредиента, Актовегин — 1 компонент — гемодериват крови телят.
Некоторые страны не применяют Актовегин, но в СНГ его применяют. Цитофлавин изготовлен в России, но за границей также используется, клинические испытания подтвердили его эффективность.
Актовегин имеет много форм выпуска:
Цитофлавин имеет форму таблеток и раствора для внутривенных инъекций.
Эти медикаменты можно применять совместно для повышения эффективности. При этом повышается уровень глюкозы в крови. Актовегин также используют в гинекологии и дерматологии, в отличие от второго препарата. Цитофлавин стоит меньше, чем Актовегин. Оба лекарства можно применять совместно с ноотропными средствами и нейропротекторами.
Стоимость Цитофлавина (Россия):
- 100 таблеток — 699 руб.;
- 50 шт. — 381 руб.;
- 10 мл р-р для в/в введения — 930 руб.
Цена Актовегина (Австрия):
- 5 мл раствор для инъекций 5 шт. — 697 руб.;
- 10 мл раствор для инъекций 5 шт. — 1245 руб.;
- 2 мл раствор для инъекций 25 шт. — 1750 руб.;
- таблетки 200 мг 50 шт. — 1757 руб.
Что лучше?
Актовегин назначают при поражении головного мозга, для увеличения работоспособности. Средство мягко воздействует на ткани. Актовегин применяют при ВСД, трофических язвах, он уменьшает содержание глюкозы в крови, назначают для профилактики поражений роговицы глаза при использовании контактных линз. Противопоказанием считают повышенную чувствительность к препарату.
Цитофлавин улучшает тканевое дыхание, нормализует кровообращение головного мозга, имеет антиоксидантное действие.
Медикамент устраняет тревожность и депрессию, нормализует память, улучшает качество жизни. Препарат применяют при ишемии и после инфаркта мозга.
Что лучше назначить для терапии пациентов, решает лечащий врач в зависимости от индивидуальных особенностей организма и формы протекания болезни.
Отзывы врачей о Цитофлавине и Актовегине
Кондратьев Евгений Васильевич, психиатр, Москва
Больным с астенией часто назначают Цитофлавин. Он обладает высокой эффективностью и имеет малое количество побочных проявлений.
Федорова Наталья Сергеевна, невролог, Сургут
Цитофлавин применяется для повышения работоспособности, при нарушении мозгового кровообращения, вегетативных расстройствах нервной системы. Высокую эффективность в клинической практике препарат показал при лечении болезни Паркинсона.
Листьева Татьяна Ивановна, невролог, Новосибирск
Актовегин назначают при нарушениях кровообращения головного мозга. Лекарство переносится хорошо, иногда больные отмечают легкое головокружение или скачки давления. Это состояние быстро проходит и не мешает лечебному воздействию препарата.
Отзывы пациентов
Светлана Ивановна, 58 лет, Санкт-Петербург
В прошлом году у мужа был инсульт, после этого нарушилась координация движений, ухудшилась память и речь, для лечения последствий врач назначил Цитофлавин. Супруг принимал препарат по инструкции, назначенной доктором. Сейчас прошли тяжелые симптомы, общее состояние улучшилось.
Александр, 46 лет, Вологда
Применял Цитофлавин по назначению врача, чтобы избавиться от депрессии. Принимал лекарство, строго соблюдая дозировки, назначенные доктором. После окончания курса лечения стало лучше, появилась бодрость, депрессия прошла.
Наталья, 32 года, Киров
Актовегин принимала после черепно-мозговой травмы для нормализации кровоснабжения мозга. Препарат эффективный, быстро помог, сейчас состояние отличное, никаких последствий ЧМТ не наблюдается.
Все об уникальном препарате — актовегин
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Актовегин и Глиатилин (Церепро,Церетон). Актовегин и Цитофлавин. Инсульты. Менингиты. Энцефалиты. Нейроинфекции. Эпилепсия
ЧМТ, деменция, энцефалопатии, алкогольная интоксикация. Пантогам. Элькар. Ипидакрин. Взрослые и дети
Глиатилин – это фрагмент нейромедиатора центральной нервной системы ацетилхолина в комбинации с веществом, который нужен для поступления холина (витаминноподобное вещество) в головной мозг, чтобы обеспечить процессы, способствующие восстановлению повреждений в ДНК (так называемый «процесс репарации»).
Кстати, холин – строительный материал для всех клеток, но особенно для клеток мозга (кроме того, что это важный гепатопротектор: он препятствует и камнеобразованию в ЖП, и жировому гепатозу печени).
Опыты, проведенные в клинике под руководством проф. М.М.Одинака, доказали следующее:
если начать лечение Глиатилином как можно раньше, это поможет обойтись без осложнений в остром периоде заболевания.
Кроме того, данный факт позволяет специалистам проводить лечебную гимнастику с больными в самые первые дни после болезни. Это очень важно, т.к. способствует предупреждению такого частого и опасного осложнения у подобных пациентов, как воспаление легких.
Применение Глиатилина улучшает когнитивные функции больных людей: улучшаются память, внимание, речь и мышление.
Глиатилин вводят (вначале) внутривенно больному (две — три недели), а далее (когда уже начинается непосредственно восстановительный период) можно продолжать применение этого медикамента в его капсульной форме.
Профессор М.М. Одинак подчеркивает тот факт, что, несмотря на незначительные побочные эффекты, которые отмечаются в инструкции к Глитиалину (редко – тошнота и аллергия), на практике применение этого лекарственного средства показало полное отсутствие побочных эффектов.
По этой причине применять Глиатилин можно и длительно при хронических формах цереброваскулярной болезни.
Показано применение Глиатилина в постинсультный период длительно с небольшими перерывами. Такая терапия может длиться годами именно в силу того, что переносимость Глиатилина очень хорошая.
Помимо инсультов, Глиатилин может использоваться в случае ЧМТ, деменции, болезни Альцгеймера, энцефалопатий различного генеза, состояний после отравления организма, включая алкогольную интоксикацию, в случае астении у больных и т.д.
Кроме того, Глиатилин применяется при поражениях ЦНС инфекционного характера, по окончании сложных нейрохирургических операций, при длительно протекающих оперативных вмешательствах с использованием искусственного кровообращения (при применении Глиатилина в кардиохирургии восстановление больных происходит быстрее).
Взаимодействие лекарственное и с алкоголем: нет данных.
Зная области использования Актовегина и Глиатилина, вы можете сделать для себя определенные выводы. Мы не раскрываем полную инструкцию к Глиатилину, но даем краткое описание клинических исследований этого препарата и возможностей его применения.
А что думают специалисты по поводу этих двух препаратов?
2.У больных, перенесших геморрагический инсульт, эффективным оказался лишь Актовегин.
Если говорить о совместимости Актовегина и Глиатилина, то надо сказать, что допускается прием обоих препаратов в одном курсе лечения (одновременно или последовательно: сначала курс одного медикамента, а потом -другого).
Прием препаратов допускается только по назначению врача.
В инструкции к Глиатилину ничего не сказано об использовании этого медикамента в терапии детей, однако практика показывает, что в исключительных случаях Глиатилин применяют, но только под строгим контролем врачей: после тяжелых ЧМТ (кома, явные признаки повреждения мозга), в случае диагнозов "аутизм" и "гиперактивность (СДВГ)".
Детям от 0 до 2 лет этот медикамент не назначают!
Наиболее применяемыми аналогами итальянского Глиатилина являются российские препараты Церепро (C erepro) и Церетон ( Cereton). Количество активного (действующего) вещества в капсулах и растворах (в ампулах) у них одинаковое.
Считается, что аналоги менее эффективны и чаще возможны побочные реакции, однако дженерики дешевле оригиналов.
Цитофлавин – это комплексный препарат (витамины В2 и РР, янтарная кислота и инозин) с широким спектром фармакологического действия; метаболическое средство ( улучшает метаболизм головного мозга). Более подробно о Цитофлавине (Cytoflavin) читайте в инструкции к нему.
Дополнительно специалисты включили в комплексное лечение нейроинфекции у детей следующие медикаменты:
внутрь раствор Элькар (принимать препарат – от трех недель до месяца; семьдесят – сто мг на кг массы ребенка).
Кроме того, с момента исчезновения основных признаков болезни начинают прием внутрь еще одного медикамента, а именно популярного сегодня Пантогама: в течение 30 дней (пятьдесят — семьдесят миллиграммов на килограмм массы).
Пантогам производит ноотропный и противосудорожный эффекты, применим при эпилепсии, разрешен к использованию даже у грудничков.
С помощью такой комплексной терапии удается добиться максимальных результатов: предотвращается развитие тяжелых неврологических осложнений после нейроинфекции.
Для любого родителя здоровье ребенка — самое главное, поэтому к лечению детей нужно подходить со всей серьезностью и полагаться только на мнение лучших специалистов.
Доктор мед.наук Е.В.Силина и канд.мед. наук Комаров из ОАО " Реабилитационного центра для инвалидов" Преодоление" пишут в своей статье, что болезни мозга (имеются в виду как головной,так и спинной мозг) многообразны, но основные причины, из-за которых происходит повреждение вещества мозга — это ишемия и гипоксия. Препаратов для терапии патологий в этой области много, но, к сожалению, нет "универсального механизма действия" у этих медикаментов, поэтому приходится применять комплекс средств.
Основная проблема на сегодняшний день заключается в следующем:
при использовании этих медикаментов плохо учитываются показания и противопоказания к их применению, взаимодействие лекарственных средств, из-за чего нередки побочные эффекты. Помимо этого, не учитываются те дозировки препаратов, которые использовались в клинических исследованиях, а ведь именно клинические опыты могут служить доказательством необходимости применения медикаментов.
Так, к примеру, в различных областях медицины широко применяются препараты, в основе которых — янтарная кислота (Цитофлавин и др.), в комплексе с антигипоксантом Актовегин.
Сегодня использование минимальных доз этих медикаментов (особенно Актовегина) по сравнению с дозами, которые применялись в клинических опытах,- обычное явление в стационарах.
В практике стационаров использование, скажем, 5 миллилитров Актовегина в сутки для терапии одного больного — очень частое явление.
Далее авторы статьи задают вопрос: "А кому может помочь такое, чисто формальное назначение лекарства?"
Дополнительно о Цитофлавине можно прочесть здесь, а о Глиатилине — тут.
Возможно, кому-то пригодится информация о применении Мексидола и Танакана(=Билобила) в терапии патологий ЦНС.
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