Relanium: instructions for use (tablets and ampoules)

Indications for use

The most effective use of the medicine is in the following cases:

• convulsive syndrome;
• borderline states accompanied by anxiety and fear;
• moderate withdrawal symptoms;
• eclampsia;
• tetanus;
• spastic muscle conditions.

In addition to its neurological focus, the drug is also used in complex treatment for such therapeutic diseases as stomach ulcers, angina pectoris, arterial hypertension; in gynecology – for menopausal and menstrual disorders.

Side effects

Treatment with Relanium can cause side effects from various organs and systems. The most common ones include:

• drowsiness, decreased performance;

• muscle hypotonicity;
• decrease in blood pressure;
• weakening of sexual desire;
• allergic manifestations;
• disturbances of speech and visual function;
• confusion, disorientation;
• bradycardia, tachycardia;
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• cold extremities;
• thrombosis;
• dry mouth;
• digestive dysfunction;
• paradoxical reactions (increased excitability, insomnia, tremor);
• changes in laboratory blood parameters.

If dosages are observed, adverse reactions are rare, but during therapy the patient requires medical supervision. If adverse reactions develop, you must immediately stop treatment and consult a specialist.

Contraindications

Relanium belongs to list No. 1 of potent drugs. In addition to renal and liver failure, contraindications associated with the metabolism of the drug, there are the following diseases for which use is prohibited:

• closed-angle glaucoma, severe chronic failure (since the drug has an anticholinergic effect);
• myasthenia gravis (since Relanium is partly a muscle relaxant);
• severe withdrawal syndrome, acute intoxication with substances that depress the central nervous system;
• coma, shock;
• ataxia of spinal and cerebral origin.

Like any medicine, Relanium is contraindicated in case of increased individual sensitivity. The drug is also prohibited for use during pregnancy, lactation, children under six months of age (when taken orally), and for newborns when administered into a vein or muscle.

Analogs

Analogue drugs include drugs based on the active ingredient diazepam, which have similar indications for use.

Before replacing one drug with another, you should consult your doctor, as drugs may have different side effects and specific uses.

Dosage

The drug is available in the form of a solution for intravenous and intramuscular administration, in tablet form and in the form of dragees. There are also film-coated Relanium tablets for children.

Intravenous and intramuscular administration of relanium is used in emergency conditions and in case of premedication. Administer simultaneously intravenously slowly up to 10 mg of the drug; if necessary, repeat after a quarter of an hour until a dose of 30 mg is reached. For children from two to five years old, the maximum dose is 1 mg; over five – 2 mg.

When administered intravenously, 100 mg of the drug is pre-diluted in 500 ml of isotonic solution or 5% glucose solution. Injected at a rate of 1 ml per minute into a large vein. When taken orally, from 2.5 to 10 mg.

B vitamins in the treatment of pain

Interest in the widespread use of a combination of B vitamins for pain came from practice. Since 1950, in many countries around the world they began to be considered as analgesics [1, 7, 8, 13]. It is well known that B vitamins are neurotropic and significantly affect processes in the nervous system. In our country, B vitamins are used very widely. Injections of both individual vitamins (B1, B6, B12) and their combinations are especially popular. Clinical experience shows that parenteral use of thiamine (B1), pyridoxine (B6) and cyanocobalamin (B12) relieves pain well, normalizes reflex reactions, and eliminates sensitivity disorders. Therefore, for pain syndromes, doctors often resort to using vitamins of this group in combination with other drugs. The popularity of B vitamins is associated with other aspects. When working with patients suffering from pain, one often encounters certain difficulties. Firstly, these are various complications of pharmacotherapy. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) is often rejected by patients themselves due to side effects, mainly from the gastrointestinal tract (GIT). Secondly, if any drug is ineffective, it is necessary to prescribe drugs from several groups simultaneously, which increases the risk of side effects and also, as a rule, increases the cost of treatment. Thirdly, many patients have contraindications to various pain-relieving physiotherapeutic procedures (electrotherapy, magnetic therapy, thermal procedures, etc.). Often, due to pain, they cannot leave the house, and, accordingly, carrying out any procedures outside the home is excluded. In addition, it is not always possible to carry out the necessary muscle or epidural blockades due to the lack of appropriate conditions or specialists.

Currently, more than 100 studies have been published showing clinical improvement with the use of B vitamins in patients with pain syndromes [1, 5, 7, 8, 15, 18, 24, 28]. At the same time, a number of issues remain incompletely studied. Do B vitamins have analgesic properties? What is the mechanism of action? How safe is the combination of these vitamins? Can they be combined with NSAIDs for pain? Is this combination treatment more effective than monotherapy? How effective are B vitamins in treating back pain? So far, there is little convincing scientific data proving that pain reduction is associated with the specific analgesic properties of vitamin preparations. However, several special clinical and experimental studies have already been conducted to study B vitamins as potential analgesics for various pain syndromes [5, 12–14, 17, 18, 19, 25].

Clinical researches

Vitamin B12 (cyanocobalamin)

Since 1950, vitamin B12 has been considered in many countries as an analgesic. Of 94 studies of vitamin B12 for pain, only one showed no benefit. But all these works did not meet modern requirements for conducting research [7]. In 2000, the first randomized control trial of intramuscular vitamin B12 injections for chronic back pain was conducted. Data from 60 patients aged 18 to 65 years showed a significant reduction in pain and improvement in motor functions [18]. Another study compared the effectiveness of vitamin B12 with the antidepressant nortriptyline in treating neuropathic pain in 100 patients with diabetic polyneuropathy. There was a significant decrease in VAS pain by 3.66 points in the group receiving vitamin B12 injections compared to the group receiving nortriptyline (0.84 point decrease in VAS pain). There was a significant decrease in paresthesia, burning sensation and chilliness [27].

Vitamin B1 (thiamine)

According to a large meta-analysis of 13 randomized trials of thiamine in diabetic and/or alcoholic polyneuropathy (741 patients), conducted over the period 1966–2005, it is concluded that large doses of this vitamin can provide short-term reduction in pain intensity, paresthesia, improvement temperature and vibration sensitivity. Good tolerance of vitamin B1 is emphasized. The authors point out the weak evidence base and the need for new research in this direction [3].

Vitamin B6 (pyridoxine)

Vitamin B6 is most often used in the treatment of pain associated with carpal tunnel syndromes. Of the 14 studies of pyridoxine for carpal tunnel syndrome, eight showed a positive result, while others found either no effect or an unproven effect [4]. However, it should be noted that pyridoxine in large doses can cause a toxic effect. Currently, a dose of 200 mg/day is considered safe for the treatment of carpal tunnel syndrome. At a higher daily dose, it is recommended to monitor its concentration in the blood. The risk of toxic effects (sensory neuropathy) occurs at daily doses above 500 mg. In the treatment of carpal tunnel syndrome, it is recommended to combine vitamin B6 with NSAIDs for 3 months [21].

Vitamin B complex

Many studies emphasize that in the treatment of pain, a combination of vitamins B1, B6 and B12 is more effective than monotherapy with any of these vitamins [1, 8, 20, 24, 30].

A special randomized, double-blind study was devoted to studying the effectiveness of the combined vitamin preparation Neurobion (B1 - 100 mg, B6 - 200 mg, B12 - 200 mcg) in the prevention of relapses in back pain. The drug was used 1 tablet 3 times a day. According to the study protocol, after the end of acute phase therapy (not exceeding 3 weeks), patients received preventive treatment for 6 months. During the study, 59 patients were observed, 30 of whom received Neurobion, and 29 received placebo. The results showed that, despite the fact that the number of patients with severe pain increased in both groups, during treatment with Neurobion the number of patients without pain also increased. As for the frequency of pain, in the group receiving Neurobion, there was a significantly greater number of cases of absence of pain during the observation course [24].

The effectiveness of the combined drug Neurobion for parenteral administration (B1 - 200 mg, B6 - 200 mg, B12 - 1 mg) was studied using a retrospective analysis of 1082 patients with various pain syndromes [20]. An assessment of the available data made it possible to state that, regardless of the diagnosis, 481 patients received treatment with Neurobion in ampoules without the use of any other medications. In 78% of all cases of treatment with Neurobion in ampoules, regardless of accompanying therapy, a positive result was described. In patients with polyneuropathies, a positive result was obtained in 86% of cases. In 45% of patients with back pain, the therapeutic effect was rated as good or very good. 47% of patients in this group showed significant improvement or moderate gradual improvement. The tolerability of the drug was rated by doctors as “good” and “very good.” It has been shown that the recommended range of doses of vitamins B1, B6 and B12 either does not lead to the development of adverse events, or their severity is insignificant. The authors conclude that in acute cases, intramuscular injections of Neurobion should be given once a day; in less severe conditions or during the rehabilitation period, only one injection two or three times a week is recommended. There is no doubt that regular injections of the drug contribute to the patient’s positive attitude towards therapy, which allows for a full-fledged treatment process. This point is important from the point of view of a better understanding by the doctor of the peculiarities of the course of the disease during this treatment. The work emphasizes that, despite the existence of different points of view, currently the use of B vitamins can be considered a successful method of treating a number of neuropathies and back pain [20].

B vitamins and NSAIDs

According to a number of clinical studies, the duration of therapy for vertebral pain syndromes can be reduced by using a combination of vitamins B1, B6, B12 and diclofenac, instead of monotherapy with diclofenac. In addition, when carrying out this combination therapy, a more pronounced analgesic effect can be achieved. To test this hypothesis, in 1990, a comparison was made of the clinical effectiveness of diclofenac (25 mg) and a combination drug that included diclofenac (25 mg), vitamin B1 (50 mg), B6 ​​(50 mg) and B12 (0.25 mg) in a multicenter, randomized, double-blind study that included 418 patients [5]. All patients received 2 capsules 3 times a day for no more than two weeks. In case of complete cessation of pain, therapy ended after 1 week. The data obtained from the analysis of 376 patients were considered suitable for statistical analysis. 53 of 184 patients treated with combination therapy and 48 of 192 patients treated with diclofenac alone were able to discontinue the drug due to significant pain relief after one week of treatment. The differences favoring the combination of diclofenac and B vitamins were statistically significant in patients with severe pain at the start of treatment. Differences in adverse events in the compared therapeutic groups were not significant. As a result of a clinical study, evidence was obtained that combination therapy with diclofenac + B vitamins is more effective than using diclofenac alone for the treatment of vertebral pain syndrome [5]. Identical results were obtained in several other clinical studies in patients with degenerative diseases at the lumbar spine level [15, 17, 28]. It is interesting to note that in a study of B vitamins and diclofenac for experimental pain in healthy individuals, an analgesic effect was noted, but it did not depend on the vitamins [2].

As a result of numerous discussions involving specialists from various fields, it was decided that it was necessary to create an evidence base in the form of extensive double-blind studies examining the effectiveness of combinations of B vitamins. A multicenter, double-blind study of the effectiveness of diclofenac compared with a combination of diclofenac with B vitamins (Neurobion). According to the results of this large multicenter study involving 400 patients, the combination of B vitamins + diclofenac tended to be more effective. The therapeutic effect was observed in a shorter period of time when using a combination of drugs than when treating with diclofenac alone, and the results of combination therapy were better. The study also suggests that the differences may be more pronounced when treating only patients with severe or extremely severe pain, as well as when treating with lower daily doses of diclofenac [30].

In general, summarizing the data on the use of B complex vitamins with NSAIDs for back pain, several conclusions can be drawn. B vitamins enhance analgesia when used simultaneously with diclofenac (NSAID). With combination therapy (NSAIDs + B vitamins), the severity of pain, according to the subjective report of patients, significantly decreases earlier than with NSAID monotherapy. When NSAIDs are combined with B vitamins, the dose of NSAIDs can be reduced [1, 5, 15, 28, 30].

Experimental studies

Several studies emphasize that both combination and separate use of vitamins B1, B6 and B12 have an analgesic effect [6, 9–14, 19, 22, 23, 25, 29].

Experimental work studying the effects of a combination of vitamins B1, B6 and B12 on pain showed inhibition of nociceptive responses caused by formaldehyde, which did not change after administration of naloxone. It has been suggested that the antinociceptive effect of the combined vitamin complex may be due to inhibition of synthesis and/or blocking the action of inflammatory mediators [9]. Other work has shown that B complex vitamins enhance the effects of norepinephrine and serotonin, the main “antinociceptive” neurotransmitters. In addition, the experiment revealed suppression of nociceptive responses not only in the dorsal horn, but also in the thalamus optica [13]. Injections of both individual vitamins B1, B6, B12, and their combination led to a decrease in thermal hyperalgesia in an experiment with sciatic nerve ligature and spinal ganglion compression [29].

B vitamins in combination with dexamethasone, as well as monotherapy with vitamin B12, enhance the analgesic effect in experimental neuropathic pain [6, 10]. A decrease in neuropathic pain has been shown in rats with experimental diabetes [11]. There is evidence of a synergistic effect in reducing tactile allodynia with the simultaneous use of vitamin B12, benfotiamine and the anticonvulsant carbamazepine or gabapentin [19, 22]. These data are important for understanding the mechanisms of action of drugs when used concomitantly in patients with neuropathic pain.

The results of experimental work generally indicate that B vitamins have certain analgesic properties.

Conclusion

With a normal and varied diet, the intake of vitamins into the body is quite sufficient to prevent any vitamin deficiency. There are two groups of disorders for which vitamin therapy is unconditionally indicated. First: vitamin deficiency conditions (beriberi, pellagra, alcoholism, malabsorption, cystic fibrosis, etc.). Second: genetic defects in vitamin metabolism. Moreover, both of these groups of vitamin deficiency conditions constitute a very small part of all prescriptions for vitamin preparations [16]. In practice, B vitamins are most often prescribed as adjuvants for conditions not accompanied by vitamin deficiency: pain syndromes, psychoses, alopecia, asthenia, tunnel syndromes. Very often, good treatment results are achieved. With the advent of synthetic vitamins, it became possible to obtain in one dose of the drug the amount of vitamins that a person would receive from food throughout the year. At these pharmacological doses, vitamins B1, B6 and B12 can probably be considered as “new” drugs. And it is possible that in such doses these drugs acquire new properties, including the ability to reduce pain.

Currently, interesting experimental studies are ongoing on the use of vitamins as active drugs for the treatment of pain. However, today we can state that B vitamins have certain analgesic properties. In this regard, vitamin B12 comes first, followed by B6 and B1. The complex (B1+B6+B12) has a more pronounced analgesic effect than monotherapy with B1, B6, B12. In the treatment of acute back pain, a combination of B vitamins with NSAIDs is more effective and safe than NSAID monotherapy.

For questions regarding literature, please contact the editor.

An. B. Danilov , Doctor of Medical Sciences, Professor of MMA named after. I. M. Sechenova , Moscow

Reviews from people

Oksana Stupchenko

:

When the doctor prescribed this medicine for me, she didn’t even write it down on my card, but wrote it down for my aunt so that no one would know that I was taking it; most likely, it would not be advisable for people to know what the medicine is; a young girl was drinking at that time. This was about 9 years ago. You need to drink it a little at a time, a quarter, but it didn’t help me with my problem. I even took a whole tablet and it didn’t affect my consciousness in any way. With alcohol it’s the same garbage, after half an hour I’m sober. The doctor herself, this one said that she drank it for a whole year, only then it helped her. Her son died, and she took it hard. But to be honest, the medicine is not very good, I know, if you take a small dose it can make you feel uneasy, it causes hallucinations. I myself have neurosis and phobia, because of this I drank it. So I’ve had a phobia for 11 years, but then I took Relanium for less than a month and quit. It has a bad effect on internal organs. By the way, neuroses occur due to problems with the thyroid gland and gastrointestinal tract, so check the thyroid gland and stomach, if there is duodenitis, then it can cause neurosis. I also have duodenitis and problems with the thyroid gland, the bouquet is shorter :). But medicines and herbs (for duodenitis) have not helped yet, and it has not become any easier.

Valery Dyachenko

:

With alcohol withdrawal syndrome, the best thing is that I drink for several days, I don’t crave alcohol at all (I used to drink like a horse), my sleep has returned to normal. I can’t stand phenazepam at all; I start vomiting after one tablet. And I can take 4 tablets of Relium at a time, well, I’m a little slow, but I feel great, really, to each his own! Katya tell me why do you need it? Is it something you’re used to or is it vital?

pharmachologic effect

Relanium is a tranquilizer with a benzodiazepine active ingredient. The anxiolytic effect manifests itself in the relief of anxiety, anxiety, fear and emotional stress.

There are three groups of anxiolytics. The drug in question belongs to the second generation anxiolytics. To date, their effect has not been fully studied. But the main manifestations of the drug’s work are expressed in the effect on the subcortical areas of the human brain. The hypothalamus and thalamus, in particular, are responsible for emotional reactions in the human body.

The drug is prescribed against seizures, as a sedative, as a hypnotic and a muscle relaxant.

The sedative effect is based on the effect on the brain stem and thalamus. This reduces feelings of fear, worry and anxiety. To achieve a hypnotic effect, brain cells are inhibited.

When used as an anticonvulsant drug, it is important to know that Relanium only relieves spreading epileptogenic activity. But the excited focus does not go away.

When used as a muscle relaxant, there is the possibility of direct inhibition of nerves and muscles. A pronounced effect is observed after at least two days of use, in some cases – after a week.

Possible decrease in blood pressure and decreased sensitivity. Does not affect symptoms of a psychotic nature.

Practical experience is the most important

Before taking such a potent drug as Relanium, we recommend studying the reviews of people who have already tried this product on their own skin.

Relanium was prescribed to me for depression. Yes, it relieves discomfort and insomnia goes away. But the terrible mood and feeling of uselessness have not gone away. In general, you can drink if necessary. Only it is now equated to a narcotic and you cannot buy it without a psychiatrist’s prescription.

NN, taken from the forum

My mother is a group 3 disabled person and also suffers from constant high blood pressure. The ambulance always gave her Relanium, it quickly relieves anxiety and lowers blood pressure. It makes you fall asleep well, but as soon as the effect of the drug wears off, you immediately wake up.

Olya

My son began to notice shaking hands and lips. The child just started school. We consulted a psychiatrist and Haloperidol was prescribed. The neurologist canceled it and prescribed Relanium for the night. And indeed, on the third day of treatment, the child became calmer and more relaxed. The tremor went away. But drowsiness appeared.

Svetlana, mother of two children

Conclusions from reviews

Advice from patients:

• Do not prescribe Relanium for yourself, only after visiting a doctor;
• drink at night, as you really want to sleep after taking it;
• Do not take for a long time, it is addictive.

Pros and cons based on reviews and practical experience:

• perfectly relieves epilepsy attacks;
• when taken for hypertension, it easily reduces blood pressure without visible side effects;
• causes severe drowsiness;
• causes strong psychological dependence;
• after taking it, the head becomes heavy, the consciousness is cloudy;
• saves from panic attacks during psychosis;
• A single dose is enough.

Overdose

Manifested by confusion, drowsiness, decreased reflexes, paradoxical arousal, deep sleep, reduced response to painful stimulation, stupor, areflexia , impaired visual perception, apnea, severe weakness, shortness of breath, bradycardia, tremor, nystagmus, collapse, drop in blood pressure, respiratory depression , cardiac activity, coma.

Therapy involves forced diuresis , gastric lavage, taking enterosorbents, maintaining body functions, and mechanical ventilation.

The specific antagonist is flumazenil, used exclusively in hospital settings. Flumazenil is not prescribed to patients with epilepsy who are taking benzodiazepines (the drug may provoke an epileptic seizure). Hemodialysis is not effective in case of overdose.