Yu.B. Belousov, M.A. Mukhina
Department clinical pharmacology with the course of pharmacokinetics GOUVPO RSMU

Currently attached great importance use in various diseases nervous system nootropic drugs that affect the metabolism of neurons and have a vasoactive and antihypoxic effect. Nootropic drugs of different groups are also united by the ability (in varying degrees for different drugs) to cause an improvement in the integrative activity of the brain in EEG indicators:

• facilitating the passage of information between the hemispheres,
• an increase in the level of wakefulness,
• strengthening the absolute and relative power of the EEG spectrum (electroencephalogram) of the cortex and hippocampus,
• an increase in the dominant peak.

Nootropics increase the resistance of the central nervous system to various disorders, facilitate learning and memory processes, increase cortico-subcortical control and improve information exchange in the brain. An improvement in microcirculation in the brain can be both the result of an increase in metabolic activity and the result of an effect on blood properties (an increase in erythrocyte mobility or an inhibition of an increase in platelet aggregation). A number of authors, among the most significant mechanisms of action of effective nootropics, highlight their neuroprotective properties and the ability to facilitate the restoration of brain tissue in the case of damage of various origins. Despite the differences in the spectrum of nootropic drugs, all drugs have a positive effect on memory, i.e. self-notropic action.

Therefore, among the large number of drugs with nootropic action, two groups of substances are usually distinguished: nootropic drugs with a dominant mystic effect and "neuroprotective agents".

The first group of drugs includes racetams - drugs of predominantly metabolic action (piracetam, oxiracetam, aniracetam, phenotropil, etc.), drugs that enhance the synthesis of acetylcholine and its release (lecithin, aminopyridine derivatives, etc.), cholinergic receptor agonists (oxotremorine ), acetylcholinesterase inhibitors (physostigmine, tacrine, amiridine, galantamine, rivastigmine, etc.), drugs with a mixed mechanism of action (instenon), neuropeptides and their analogs and substances that affect the excitatory amino acid system.

The group of "neuroprotectors" unites metabolism activators (actovegin, instenon, xanthine derivatives of pentoxifylline), vasodilators (instenon, vinpocetine, nicergoline, etc.), calcium antagonists (cinnarizine, flunarizin, etc.), antioxidants, exifone, paxidol, .) and substances that affect the GABA system (pantogam, picamilon, nicotinamide, phenibut, etc.).

The last few years have been characterized by the search and study of the mechanism of action of new and existing nootropic drugs. Obtaining the latest information about the nature of memory impairments involving neurobiochemical changes at various levels - neuronal, synaptic, membrane, cellular, molecular - made it possible to purposefully approach the search for means of correcting these impairments, as a result of which a number of new substances were obtained that possess significant nootropic activity and original mechanisms of action.

Obviously, all currently available drugs are most effective for treating patients with mild or moderate mental impairment. Therefore, it is necessary to develop new and more actively implement existing methods for diagnosing disorders of the cognitive and mnestic functions of the brain in dementia, cerebrovascular accidents, minimal cerebral dysfunction in children, alcoholic intoxication and with neuropsychiatric overloads of a very different plan at the most early stages diseases.

Among the cyclic derivatives of GABA in terms of the severity of nootropic activity, the phenyl derivative of the racetam series phenotropil® (M-carbamoyl-methyl-4-phenyl-2-pyrolidone) is of undoubted interest (Fig. 1).

Phenotropil is a new original domestic highly effective nootropic drug and possesses a wide range accompanying components of pharmacological activity. In terms of the spectrum of action and the breadth of therapeutic doses, it has no analogues in domestic and foreign pharmacology, while the effects of the drug depend on the dose and the initial state of the subject.

The experiment was carried out to study psycho- and neurotropic effects and determine the safety of the drug. It was found that phenotropil has a pronounced antiamnestic activity in doses of 6-750 mg / kg, has a direct activating effect on the integrative functions of the brain, improves metabolic processes and regional blood flow in the ischemic areas of the brain, restores speech and motor activity in case of their violation, and in doses of 100-750 mg / kg has a pronounced antihypoxic, anti-convulsive and anxiolytic activity. The psychostimulating effect is manifested by a moderately pronounced effect in relation to physical activity, an increase in physical performance, a pronounced antagonism of the cataleptic effect of neuroleptics, a weakening of the severity sleeping pills ethanol and hexenal. Phenotropil counteracts phenamine toxicity, increases the threshold of pain sensitivity and the threshold of aggression. The drug has a mild diuretic effect. A significant decrease in body weight was noted against the background of course use. Revealed pronounced antidepressant activity without adverse reactions, inherent in antidepressants, an improvement in vision and smell, an aggravation of taste, an improvement in peripheral circulation, an increase in sexual potency were noted. The drug is low-toxic, easily penetrates the blood-brain barrier, its effects develop from a single dose. Phenotropil does not possess embryotoxicity, mutagenic and carcinogenic properties. In animal experiments, it reduces the growth of spontaneous malignant tumors... Phenotropil is not addictive, addictive and withdrawal.

There have been a number of studies in mice and rats that have studied different kinds pharmacological activity of phenotropil.

Double blind comparative study adaptogenic and anti-stress effects of several notropic drugs on rats under various extreme conditions. We used three models of experimental stress, conventionally named “painful”, “emotiogenic” and “antiorthostatic” stress. Piracetam, phenotropil, pantogam (hopantenic acid), phenibut and its isomers, pyriditol (pyritinol) were taken as reference drugs. Intact animals that were under the same experimental conditions and received saline were used as controls. The indicator of the effectiveness of the drugs was the "protective index", which was calculated as the difference between the lesion of the gastric mucosa in the control group and a similar indicator in the group of animals that received the above drugs. The maximum protective index could be equal to one, and a zero value of the index indicated no effect. According to the results of the study, piracetam, phenotropil, phenibut, pantogam and pyriditol had the greatest protective effect against “emotional stress” (the “protective index” was 1.0, 0.99, 0.89, 0.87 and 0.70, respectively) ; with painful "stress - phenibut, phenotropil, piracetam, pyriditol, pan-togam ((" protective index "was, respectively, 0.76, 0.72, 0.65, 0.62, 0.58); with" antiorthostatic »Stress - phenotropil, phenibut, pyriditol, piracetam, pantogam (the“ protective index ”was 1.0, 0.99, 0.56, 0.52, 0.50, respectively). The effect of these nootropic drugs on the level of cortisol in the blood was also studied.It was found that against the background of the use of phenotropil, the content of cortisol in the blood was significantly lower than in the group with saline, while in the group of piracetam at a dose of 200 mg / kg the level of cortisol exceeded the indicators in all the studied groups by 1.5-2 times.

Another study examined the effect of piracetam and phenotropil on metabolic processes. During the trial, the effects of drugs on the development of a conditioned passive avoidance reflex in rats with amnesia caused by maximum electroconvulsive shock, scopolamine and corazole (antiamnesic activity) were compared, antihypoxic activity was assessed (on various models of hypoxia), the effects on motor activity (psychostimulating effect ), anti-drug effect (for ethanol), anticonvulsant activity (convulsive agents: bikuculin, corazole, caffeine, thiosemi-carbazide, picrotoxin and electroshock). It was found that the nootropic effect of phenotropil is detected already at a dose of 3.0 mg / kg, while the antiamnestic effect of phenotropil at doses of 25-100 mg / kg exceeds the effect of piracetam at doses of 300-1200 mg / kg by 12.5-40 times. Phenotropil (50-300 mg / kg) is highly effective in all types of hypoxia (piracetam exhibits some anti-hypoxic effect only under conditions of hypobaric hypoxia, starting from a dose of 200 mg / kg). Phenotropil prevents the development of seizures and prevents the death of animals from them. At doses of 25-250 mg / kg, phenotropil increases physical activity in the first 5-10 minutes. research by 8-18%, in the next 15-20 minutes. physical activity decreases and even becomes somewhat lower than that in the control group. Phenotropil stimulates redox processes, increases glucose utilization, increases energy potential by accelerating ATP turnover, increases the activity of adenylate cyclase and glutamate decarboxylase, and enhances the synthesis of nuclear RNA. In doses of 100-300 mg / kg, it increases the content of DA, HA and serotonin (5-OT), practically does not affect the content of GABA. Thus, phenotropil is a highly effective nootropic drug that is significantly superior in activity to piracetam. At the same time, phenotropil, in contrast to piracetam, has a pronounced antihypoxic and anticonvulsant activity.

Pharmacokinetics of Phenotropil.

At present, a method has been developed for the determination of trace amounts of phenotropil in biological objects (gas chromatographic analysis on capillary and packed columns using the method of internal standardization). At the same time, the absorption, distribution and excretion of the drug from the body of animals was studied with various methods of administration. The developed method of pharmacokinetic studies allows for the therapeutic monitoring of the concentration of the drug during the course of therapy and the development of an optimal dosage regimen for its practical use.

Phenotropil is rapidly absorbed with extravascular routes of administration, and with the oral route of administration, the drug is absorbed faster than with intramuscular administration, and the maximum concentration of phenotropil in the blood at oral administration is achieved faster. An experimental study of phenotropil pharmacokinetics was carried out on outbred male rats weighing 200 ± 20 g. ... Phenotropil was administered intravenously, intramuscularly and orally at a dose of 100 mg / kg. The high rate of absorption of phenotropil when administered orally is probably associated with high degree its lipophilicity. This is also evidenced by the time to reach the maximum concentration of the drug in the blood (T max p / o = 0.84 h; Tmax i / m = 1.46 h). The values ​​of the half-elimination periods T1 / 2 and the elimination constants Kel are close to each other for different methods of administration of phenotropil, which indicates a relatively slow excretion of the drug from the body of rats. High values the apparent volume of distribution of phenotropil in rats suggest the mechanism of intracellular distribution of the drug. The total clearance of phenotropil is lower than the clearance of creatinine, which indicates its possible reabsorption in the renal tubules. The degree of absolute bioavailability of phenotropil with extravascular methods of its administration is approximately 100%.

In other experimental studies, the bioavailability of phenotropil tablets and aqueous solution when administered orally on rabbits weighing 3.0 ± 0.1 kg. The rate of absorption of phenotropil after taking the tablets was lower than when taking an aqueous solution, and the time to reach the maximum concentration of phenotropil in plasma was almost 4 times the time after taking an aqueous solution. At the same time, after taking the tablets, the rate of excretion of phenotropil from the body was significantly lower, i.e., the circulation time of phenotropil in the blood of rabbits after the introduction of the tablets was significantly longer than after the introduction of an aqueous solution.

A study of the excretion of the drug from the body of rats was carried out. It was found that about 40% of the administered dose of phenotropil is excreted in the urine, and the main amount of the drug (94%) is excreted in the first 24 hours, and on the third day only trace amounts of urine are determined.

Phenotropil in clinical practice.

Possibilities of using Phenotropil in healthy individuals.

Krasnov V.N. et al. studied the effectiveness of short-term (up to 10 days) use of Phenotropil in 32 people. In this case, the "asthenic", "cognitive", "affective" and "psychovegetative" sections of the clinical and psychopathological map, the scale of the general clinical impression were used. The observations were divided into 2 groups: 1) practically healthy, experiencing asthenic and subclinical affective (anxious-depressive) and psychovegetative disorders; 2) former participants in the liquidation of the consequences of the Chernobyl accident with a moderately pronounced psychoorganic syndrome. In patients of the 2nd group, an additional neuropsychological study was carried out. When using phenotropil at doses of 200-400 mg / day for 10 days in both groups, an activating effect was revealed with the normalization of autonomic regulation, an increase in resistance to intense physical exertion and emotional stress, an increase in the success of performing intellectual tasks with a recorded increase in the level of attention, working memory , tempo and speed characteristics of intellectual activity. There was a moderate decrease in the need for food and sleep, isolated episodes of anxiety (compensated for in activity), as well as single disturbances in falling asleep associated with the use of the drug later than 15-16 hours. With a ten-day course of use, phenotropil had a more stable positive effect, in particular on cognitive functions, in the 1st observation group. The effects of phenotropil were manifested with a single dose.

The use of phenotropil as a functional state corrector is recommended at a dose of 100 mg once to persons whose professional activity associated with large mental and physical activity... The drug has passed clinical testing in people working in stressful, extreme conditions with the development of drug use regimens. We used complex psychological and psychophysiological methods to assess the dynamics of the mental state in 57 men in extreme conditions of activity while taking phenotropil (50-500 mg / day) for a two-week course of treatment. Asthenoneurotic, asthenic and astheno-depressive syndromes were most susceptible to reductions. The first clear signs were observed already on the 2nd day of therapy, and in extreme conditions of activity 5-6 hours after a single oral administration. If, in the presence of severe pathology, the doses of phenotropil, regardless of the nature of the disorders, were practically the same and varied only taking into account the individual characteristics of the dynamics of the state, then with less pronounced disorders of mental activity, a more differentiated selection of doses was required. So, in the case of the astheno-neurotic nature of the disorders, the doses of phenotropil with moderately pronounced asthenic disorders were less high and amounted to 50-200 mg / day, and in the case of astheno-depressive manifestations, a more prolonged treatment with the use of 100-500 mg was necessary for the successful correction of the condition. / day Phenotropil did not increase the reaction time and improved coordination of movements. In addition, the drug had a favorable tolerability profile. According to the results of clinical testing, a pronounced positive effect of phenotropil on the psychophysical status of patients was observed when using it both immediately after extreme exposure in the acute period of mental disorders, and during the period of manifestation of residual reactions.

Picture 1.
Spatial chemical formula of piracetam and phenotropil

Malyugin V.N. et al. studied the effect of phenotropil in various dosages on the indicators of physical and mental performance of people in the usual conditions of educational and training activities. A group of apparently healthy men received a single dose of phenotropil at a dose of 100 mg, 200 mg, or placebo before the start of training sessions. To study mental performance, 4 computerized tests were used: 1 - "confused lines" (concentration and stability of attention); 2 - "finding numbers" (the ability to distribute attention and stability); 3 - "sorting words" (the speed of processing of visual verbal information, as well as the tempo characteristic mental processes); 4 - "memorization" (study of short-term memory for verbal information). To study the physical working capacity of the subjects, veloergometry was carried out (test PWC-170), the indices of absolute and relative physical working capacity were assessed. The study showed an increase in the average group values ​​of indicators of mental and physical performance after an intense training load compared to the background, in particular, the values ​​of the following indicators increased: concentration and stability of attention, ability to distribute attention and its stability, functional mobility nervous processes, short-term memory, absolute and relative physical performance. Thus, phenotropil helps to increase the intellectual and mnestic function of the brain. The severity of the effect on the dynamics of psychological and physiological indicators in practically healthy individuals was higher when taking phenotropil 100 mg / day than 200 mg / day.

The effect of phenotropil on the resistance of aviation specialists to hypoxia to shorten the duration of the course of hypoxic therapy was studied Razsolov N.A. et al. in another clinical, placebo-controlled study in which pilots and members of the ground profession were observed. The criterion for the end of the formation of adaptation to hypoxia was considered to be an increase in the duration of breathing with a hypoxic mixture until the partial pressure of oxygen in arterialized blood decreased by 2 times during the period from the first breathing cycle to the third. The studies were carried out before and 60 minutes after taking phenotropil at a dose of 100 mg. At the beginning of the course of treatment in aircrew and ground occupations, the duration of breathing with a hypoxic gas mixture until the partial pressure of oxygen decreased by 50% was 2.8 + 0.3 min, and 60 minutes after taking the drug it increased to 3.3 + 0.19 minutes (p<0,05). Применение плацебо не выявило такой динамики. Для формирования адаптации к гипоксии у пилотов потребовалось 10-11, а улиц наземных профессий - 14-15 сеансов. При использовании плацебо средняя продолжительность курса лечения составляла у пилотов 18-20, а у лиц наземных профессий 25-28 сеансов. В исследовании было продемонстрировано, что фенотропил оказывает защитный эффект при однократном приеме и ускоряет развитие адаптации к гипоксии при курсовом лечении. Это может быть использовано в клинической практике для сокращения сроков гипоксической терапии, а также для защиты лиц от повреждающего действия гипоксического фактора.

Portugalov S.N. et al. conducted a comparative placebo-controlled study of phenotropil, sydnocarb and placebo in athletes with high physical and psycho-emotional stress. The drugs were used once for 3 days. Efficiency was assessed by the rowing ergonomic test, by the swimming step test, by liquid gas chromatography and chromium-mass spectrometry, by biochemical analyzes (lactate, urea, glucose, 17 OCS), by subjective self-assessment. A single use of phenotropil increased physical performance by 4-6% compared with placebo and 2-4% compared with sydno-carb. The use of phenotropil for 3 days maintained a high level of efficiency and consolidated the achieved results. Phenotropil did not affect the hormonal profile of athletes. The use of phenotropil significantly increased the reserves of the adrenal cortex, which indicates its stress-protective effect. Adverse reactions to single and course use were not found. The quality of sleep significantly improved with a decrease in its duration; upon awakening, the athletes noted a feeling of vigor and good mood. Phenotropil did not cause negative side effects inherent in psychostimulants (irritability, feelings of inner tension, anxiety, headache, "emptiness"). Subjectively, while taking phenotropil, athletes noted a surge of warmth, comfort, self-confidence, absence of anxiety, absence of fatigue, and some improvement in vision.

Use of Phenotropil for medicinal purposes.

To date, positive experience has been accumulated in the use of phenotropil in persons with various diseases of the central nervous system: ischemic stroke in the acute period, early recovery period, late recovery period, with circulatory encephalopathy and in the presence of initial manifestations of cerebral circulation insufficiency, in the acute period of traumatic brain injury (TBI) and with the consequences of the transferred TBI, with asthenia of various origins.

Velskaya G.N. et al. studied the effectiveness of phenotropil in 42 patients in the acute period of mild and moderate cerebral infarction. The patients were divided into two groups: the main group (30 people), in addition to the basic therapy, received phenotropil YuOmg / day, the control group (12 people), in addition to the basic therapy, received piracetam 1600mg / day. Already on the 10th day of treatment in both groups, significant (p<0,05) улучшения по двум разделам шкалы Mini Mental State Examination (MMSE): «восприятие» и «память», а в группе фенотропила - дополнительно по разделу «концентрация внимания и счет». К окончанию курса когнитивные функции по шкале MMSE достоверно (р<0,05) улучшились в двух подгруппах больных, однако, динамика в процентном соотношении в группе фенотропила была более выраженной, чем в группе пирацетама (+20,2% и + 15,3%, соответственно). Анализ изменений ЭЭГ показал, что после применения фенотропила у больных усиливалась регулярность и выраженность альфа-ритма, у некоторых пациентов отмечалась нормализация реактивных показателей ЭЭГ, вследствие чего гипервентиляция не вызывала существенных изменений биоэлектрической активности головного мозга.

Gerasimova M.M. et al. studied the effectiveness of phenotropil in 20 patients in the early recovery period of cerebral stroke. According to the severity of neurological deficit, the patients were divided into two subgroups: with severe disorders (internal capsule syndrome, aphasia, emotional and volitional disorders - 7 patients) and with moderate disorders (pyramidal syndrome, sleep disorders - 13 patients). A good result of treatment in the form of a complete restoration of functions and a significant regression of neurological symptoms by the end of a month's course of treatment was obtained in 40% of patients in the first and in 85% of patients in the second subgroups, a satisfactory result (a decrease in the severity of neurological symptoms) - in 50% and 5% of patients. respectively. In addition, under the influence of treatment, significant (p<0,05) снижение уровня антител к общему белку миелину (на 33,9 %) и к фосфолипидам (на 6,7 %).

Savchenko A. Yu. Et al. in the treatment of 30 patients in the late recovery period of ischemic stroke (1-3 years after the stroke), phenotropil was prescribed at a dose of 200 mg per day. Against the background of taking phenotropil, significant (p<0,05) положительная динамика неврологических проявлений: уменьшение парезов и параличей, нарушения чувствительности, координации, высших мозговых функций. Когнитивные функции по шкале MMSE улучшились (р<0,05) с 12,12±1,06 до 16,36±1,11 баллов. Было выявлено улучшение (р<0,05) показателей качества жизни по шкале EuruQol-5D: мобильность (с 2,02±0,18 до 1,44±0,15 баллов), самообслуживание (с 1,96±0,14до 1,31±0,12 баллов), бытовая активность (с 2,30±0,18 до 1,61 ±0,17 баллов), тревога (с 2,75±0,28 до 1,74±0,15 баллов).

The use of phenotropil in the treatment of discirculatory encephalopathy opens up new prospects for the social and labor rehabilitation of this contingent of patients. Spasenkov B.A. et al. conducted a comparative study of the effect of phenotropil on the optimization of therapy for discirculatory encephalopathy. The research was carried out for 2 years. Patients received combination therapy with piracetam or phenotropil for 21 days twice a year. We used general clinical and laboratory methods, as well as monitoring control. From the first days, the effectiveness of treatment was assessed more highly by patients receiving phenotropil than by patients receiving piracetam. Patients in the phenotropil group noted the appearance of a "clear head" feeling, a decrease in complaints of headaches (especially frontal-temporal localization). The beneficial effects increased towards the end of the 3rd week. The Luria test score significantly increased in all patients. The coordination of movements improved, the manifestations of vestibular disorders decreased. The positive dynamics of the general condition of patients in the phenotropil group was 85% higher than that in patients in the piracetam group. On the background of phenotropil, sleep improved in most patients, and the attacks of depressive affect disappeared. In patients who were followed up for 2 years, while taking phenotropil (2 courses per year), the condition remained stable.

Gustoe A.V. et al. conducted a comparative study of 50 patients with stage I and II discirculatory encephalopathy with moderate cognitive impairment. The patients were divided into 2 homogeneous groups - the main group and the comparison group. In the main group, taking phenotropil orally at a dose of 200 mg / day began in a hospital and then continued on an outpatient basis. Patients in the comparison group received traditional therapy in inpatient conditions, and then continued taking piracetam on an outpatient basis at 1.2 g / day. Neuropsychological testing, neurological and physical examination were performed before taking the drug, after 15 and 30 days of therapy. To assess cognitive functions, the most informative tests were selected: verbal associations, repetition of numbers, test "10 words", pattern recognition test, test for reciprocal coordination. In the main group, there was a significant improvement in indicators for all tests at the end of treatment, and for some - after 15 days of phenotropil therapy. There was also a significant increase in the speech activity of patients in the main group: before treatment - 10.48 ± 0.67 points; after 15 days - 12.37 ± 0.70 points; at the end of treatment - 14.83 ± 0.99 points (p<0,05), чего не наблюдалось в группе сравнения. У пациентов, принимавших фено-тропил, увеличилось также количество запоминаемых слов в тесте «10 слов» по сравнению с исходными показателями; цифр в тесте на повторение цифр, повысилось количество узнанных рисунков. В группе сравнения достоверное отличие от показателей до лечения было лишь в тесте повторения цифр. Также в основной группе было зафиксировано достоверное увеличение скорости движений в руках (проба на реципрокную координацию) в отличие от пациентов из группы сравнения. Фенотропил повышал концентрацию внимания у пациентов, увеличивал активность больных в двигательной и речевой сферах, положительно влиял на память. По результатам исследования авторы рекомендуют применять фенотропил в комплексном лечении дисциркуля-торных энцефалопатии.

However, the earliest manifestation of cerebral vascular pathology (even before the onset of a stroke and clinically pronounced discirculatory encephalopathy) is the initial manifestation of cerebral circulation insufficiency (CPCF), the criteria for the presence of which are headache, dizziness, noise, recurring at least once a week for at least three months. in the head, memory loss, decreased performance (at least two of the above signs are necessary). It is known that the increasing manifestations of NPNMC lead to the development of the next stage - discirculatory encephalopathy, therefore it is very important to timely identify such patients and correct the manifestations of cerebrovascular insufficiency. Selyanina N.V. et al. conducted a study of the effectiveness of phenotropil in 20 patients with NSAID at the age of 40 to 50 years. The drug was administered at YuOmg / day for 30 days. After the course of treatment, the patients' complaints of the asthenic plan decreased: fatigue, physical fatigue decreased significantly, to a lesser extent - anxiety, irritability, headaches disappeared. Asthenia indicators on the MFI-20 asthenia scale are reliable (p<0,01) снизились до уровня нормы, составив в среднем по группе 10,5±1,2 балла. Результаты тестирования по таблицам Шульте показали достоверное (р<0,01) уменьшение времени отыскивания чисел (с 32,1±3,3сек. до 24,3±2,8сек.). Показатели вегетативной дистонии по субъективной оценке пациентов (по вопроснику) и объективного статуса (по схеме) достоверно (р<0,01) уменьшились. Качество жизни по визуально-аналоговой шкале улучшилось с 62% до 74,4%.

Kalinsky P.P. et al conducted a comparative study of the effectiveness of phenotropil at a dose of 100 mg (23 patients) and standard nootropic therapy (20 patients) in the acute period of TBI. It was found that by the 7th day in the phenotropil group, all patients noted a decrease in asthenia, fatigue, at the same time a feeling of vigor, activity appeared, daytime sleepiness disappeared and the mood background improved. A minor headache persisted in only 8 people (35%). By the same period, 11 people (55%) of the control group had complaints of an asthenic nature and moderate vegetative manifestations. By the 14th day of therapy, only 4 people (17%) who took phenotropil had mild asthenic complaints. By the same period, asthenic manifestations in the control group persisted in 7 people (35%).

Odinak M.M. et al. studied the effectiveness of phenotropil and piracetam in the treatment of the consequences of TBI. The study included two groups of 24 patients with different duration of TBI. One group of patients received piracetam 400 mg twice a day, and the other received phenotropil 50 and 100 mg twice a day. The course of treatment was 30 days. Subjective assessment of the condition, assessment of the dynamics of micro-focal symptoms, neuro-mapping and transcranial ultrasound Doppler sonography were carried out. Phenotropil in comparison with piracetam had a more pronounced positive effect, especially at a dose of 100 mg. Improvement occurred already on the 3-4th day, and the most expression was manifested in patients with asthenic syndrome. Most patients on the background of phenotropil noted a surge of strength, improved mood, vision. A good effect was observed in 58.3% of patients in the phenotropil group and 33.3% in the piracetam group, a satisfactory effect in 33.3% and 50% of cases, respectively, and an unsatisfactory effect in 8.4% and 16.7 % of cases, respectively.

Similar results were obtained Aleshina N.V. et al. when conducting a randomized study in 26 patients with long-term sequelae of TBI (7-10 years of injury) in the form of asthenic-depressive, neurotic, hypochondriacal, behavioral disorders, who were treated in the city psycho-neurological dispensary. Patients who received phenotropil at a dose of 100mg for 30 days, compared with patients who received piracetam at a dose of 800mg per day, tranquilizers and fortifying agents, after the course of treatment had a more pronounced positive effect: complete regression of the anxious component, increased mood background with the disappearance of daily fluctuations and suicidal tendencies, positive changes in the intellectual-mnestic sphere, improvement of the associative processes of thinking and social adaptation.

Savchenko A. Yu. Et al. when prescribing phenotropil to 33 patients with the consequences of a previous TBI (1-3 years old), significant (p<0,05) позитивные изменения в неврологическом статусе (снижение выраженности парезов и регресс координаторных нарушений), улучшение ряда когнитивных показателей (по шкале MMSE), уменьшение выраженности депрессии по Госпитальной шкале тревоги и депрессии, улучшение качества жизни по всем подшкалам EuroQol-5D.

Fedin A.I. et al conducted a comparative placebo-controlled study of the efficacy of phenotropil and piracetam in patients with asthenic syndrome and chronic fatigue syndrome. All patients were divided into three groups: those who received phenotropil at a dose of 200-250 mg per day (68 people), received piracetam at a dose of 1200 mg per day (65 people), and received placebo (47 people). The duration of treatment was 4 weeks. The indicators of working memory, assessed using a number of neuropsychological methods (Luria's test "memorizing 10 words", Schulte tables), in patients in the phenotropil group significantly exceeded those in the treatment with piracetam and placebo (p<0,05). Эффективность фенотропила после курса лечения астенического синдрома и синдрома хронической усталости составила 83,3 % (30 больных) и 87,5% (28 больных), соответственно. В то же время после курса лечения пирацетамом хороший и удовлетворительный эффект был отмечен в 48,8 % (22 пациента) при астеническом синдроме и в 55 % (11 пациентов) при синдроме хронической усталости. На фоне применения плацебо у больных с обоими синдромами полного регресса жалоб и нормализации объективных показателей достигнуто не было.

In another placebo-controlled study, patients with asthenic syndrome of psychogenic genesis received monotherapy with phenotropil 100 mg twice a day or placebo for 30 days. A standard clinical and physiological study was carried out taking into account the intensity of the main complaints on a graded scale and a quantitative assessment of autonomic disorders (a point questionnaire; a quantitative assessment of asthenic disorders). The average indicators in the group receiving phenotropil significantly improved already on the 7th day of therapy. After the course of treatment, all indicators remained at a high level, the level of autonomic disorders significantly decreased, significantly differing from the corresponding indicators in the placebo group. In the placebo group, on the 7th day, the indicator of "well-being" slightly increased, but after a course of treatment, its decrease was observed. The average subjective assessment of the effectiveness of treatment in the phenotropil group was almost 2 times higher than that in the placebo group. No side effects were observed in patients. In the phenotropil group, patients from the first day of treatment noted an increase in efficiency, an improvement in mood, and a surge of energy.

The effect of small doses of phenotropil in general somatic practice has been confirmed. In 96 patients with diseases such as vegetative-vascular dystonia, long-term consequences of TBI, decreased mental and intellectual functions, cerebroasthenic and asthenodepressive symptoms, hypertension with a distinct asthenic symptom-complex, phenotropil monotherapy was carried out for 4 weeks with titration of daily doses from 12 to 10 mg. The effects of phenotropil in doses of 12.5-25 mg were manifested from the 3rd day of administration, and in doses of 50-100 mg - from the 1st day. Against the background of therapy, mood improved, vigor, confidence appeared, memory improved, adequacy of response, dizziness, headache, fatigue, weakness, fatigue decreased or completely disappeared, sleep improved and its duration was reduced by an average of 2 hours, blood pressure was corrected to normal or decreased by 10-20 mm Hg. Art., the indicators of mental and physical performance significantly increased. By the 7th day of therapy, the manifestations of the depressive symptom complex completely disappeared.

Phenotropil as a nootropic drug also has a positive effect in persons suffering from chronic alcoholism. Ivanets N. N. et al. studied the effectiveness of phenotropil in post-withdrawal syndrome and during remission. Patients with II-III stages of alcoholism (respectively, with a pronounced "deprivation syndrome", less pronounced "deprivation syndrome" or "in remission") received phenotropil 100 mg 1 or 2 times a day for 3-14 days. In most cases (87.5% of the total), already from the 1st day of administration, the activating and nootropic effects of the drug were manifested, mood increased, the pace of thinking accelerated, lethargy, weakness, and fatigue decreased. While taking Phenotropil, the patients felt more alert and active, their irritability decreased. Asthenic and intellectual-mnestic disorders decreased depending on the day of therapy. A more effective dose in patients of group 3 was a dose of 50 and 100 mg with a single application in the morning. The euphorizing effect was not observed in any case against the background of the use of phenotropil. The stimulating effect of phenotropil was more pronounced at a dose of 50 mg in a slight increase in motor activity. At all doses, the drug reduced the duration of night sleep. The use of phenotropil increased the need for the implementation of activities, which must be taken into account when conducting therapy.

Phenotropil is an effective and safe drug of the nootropic group and can be used for a wide range of asthenic conditions from lungs (physiogenic asthenia) to deep, vital asthenic states of endogenous genesis. The best results were observed in the treatment of patients with organic brain diseases of various origins. Evaluation of the effectiveness of phenotropil in patients with organic diseases of the central nervous system of various origins, with neuroses and neurosis-like states, schizophrenia and cyclothymia was carried out in 50 patients with a disease duration of 1-10 years. Monotherapy with phenotropil against the background of the cancellation of the previous treatment was carried out at a dose of 150-500 mg twice a day for a month. The patient's condition was assessed by a clinical-descriptive method using a quantified assessment system: background, on the 3rd, 7th, 14th, 21st and 30th days of therapy. Phenotropil had a positive effect on asthenic symptoms, mainly in patients with organic brain disease, influenced the intellectual-mnestic sphere, increased the power of the mid-frequency a-rhythm in the 8.8-10.6 Hz band. A distinct psychoactivating effect was revealed in the first 14 days of therapy. The combination of nootropic, psychoactivating, vegetotropic and adaptogenic effects determines the originality of the drug's action. The stimulating effect of phenotropil is comparable to that of psychostimulants, however, phenotropil is devoid of undesirable phenomena inherent in psychostimulants (development of dependence, tolerance, withdrawal syndrome, etc.), and exhibits a normoenergetic effect.

As a result of the use of phenotropil in people both with signs of the disease and in healthy people, the following effects were observed:

• improving the integrative activity of the brain, increasing efficiency;
• improvement of short-term and long-term memory, learning ability, attention and intellectual activity;
• increasing resistance to the effects of various aggressive, extreme factors; stress, hypoxia, trauma, intoxication (alcohol, etc.), shock, etc.;
• improving social adaptation and quality of life.

In the presence of CNS pathology, in addition to the above effects, phenotropil is characterized by the following:

• correction of autonomic disorders;
• psychoactivating and normoenergetic effect in asthenia without euphorization, without the development of addiction and withdrawal syndrome;
• fast and significant regression of the existing focal neurological symptoms.

The main effects and possibilities of using phenotropil are shown in the table.

Table 1.
The main effects and possibilities of using phenotropil

The life of a modern person is filled with all kinds of things that negatively affect the state of the whole organism. In order to give the body additional strength to deal with stressful situations, viral diseases and other ailments, it is necessary to take.

There are many nootropics, but the most common of them is a drug designed to stimulate the work of the brain, central nervous system and the whole body as a whole, as well as increase resistance in the fight against infectious and viral diseases.

Before you start taking any nootropic and Phenotropil in particular, you need to take into account many nuances, study the practical experience of doctors and reviews of people who have taken the drug.

Due to the fact that recently stimulating nootropics have gained great popularity, the specialists of our site decided to study this issue in more detail, and they began by collecting available information about the practical experience of using the drug Phenotropil.

Indications and contraindications in the theses

Indications for admission:

• decrease in efficiency;
• weakness and general malaise;
• a condition that manifests itself as general lethargy and apathy;
• psychological and neurological diseases (, unreasonable fear, depression, and so on).
• obesity.

Contraindications:

• an allergic reaction to one of the components of the drug;
• with impaired liver and kidney function;
• in acute psychotropic conditions and after a recent panic attack.

Also, the drug should not be taken unless there is a compelling need for it.

Real life stories

Several real-life feedback stories collected on numerous forums about nootropic drugs that are dedicated to Phenotropil.

The first story is not the best experience

By Nikolay Vlasov, 32 years old.

I always had a negative attitude to taking all kinds of stimulating drugs, as I was firmly convinced that they could cause not only benefit, but also harm. That is why, if I felt that the body was weakening, then I resorted to traditional medicine. Although, I remember, in my student years during the sessions I accepted, but I did not feel the proper effect.

From the very beginning of the working week, there was a lot of monotonous work and, accordingly, I did not get enough sleep. Seeing my deplorable state, a colleague advised me to take it, because, according to him, it cheers up and stimulates the body very well.

Feeling that hot tea and fruits would not help me after work, I went and bought this drug. To my surprise, it was relatively inexpensive, about 1,000 rubles, and they let me go without a prescription.

Also, while standing in line at the pharmacy, I noticed that you can buy from nootropics, and a lot of foreign analogues, the price, which hits the wallet well.

1. First, I would like to point out that some for several days there was absolutely no effect... There was no surge of strength or similar sensations, on the contrary, for the first 5 days, fatigue appeared. As it turned out later, the effect of the drug is cumulative and it manifests itself in a week.
2. Secondly, the effect of the drug is comparable to coffee, only lasts all day.
3. Thirdly, if everything is in order with your performance and you do not feel constant fatigue, then you should not take this drug in order to further increase your performance.

As a result, there is undoubtedly the effect of taking this drug, but it should be borne in mind that it is not worth getting too addicted to such medications (I read on the Internet that some have been taking them for several years). In the pharmacy itself, I was advised to take a course of pills and take a break for 1-2 months.

The second story - adequate, but subjective assessments

According to Anna Vangelieva, 21 years old.

I am a student of a medical university and it seems that lack of sleep has become an integral part of me, since there is a huge amount of material to learn, and fatigue constantly makes itself felt.

Before the session, I did not sleep for 2 days and, accordingly, during the couples I felt very bad, darkened in my eyes and dizzy, the teacher took me to the nurse.

After a little questioning what could have caused such a state, I told her that because of my studies I do not get enough sleep all the time and I do not feel well. After giving a lecture on what to do in order to prevent this situation from happening again, the nurse advised me to take it for a month to increase brain activity and stimulate the body.

After couples, I went to the pharmacy and bought Phenotropil for 800 rubles (they were released without a prescription). I read it, and I was pleased that the drug has a minimum number of side effects and contraindications (according to the instructions, the drug is not recommended for those who may have an allergic reaction to the components of the drug).

After a month of admission, I want to tell you about my observations:

1. The effect did not come immediately, but only after a while. This is due to the fact that the effect of the drug on the human body is revealed gradually.
2. If you have an allergic reaction to the active ingredient of the drug, then there is no point in looking for it, since they contain the same basic substance. Better to find another way out of this situation.
3. If there is a need for active stimulation of the body, it is better to give preference to vegetables and fruits that stimulate brain activity. Such as ginger, mint, pomegranate, broccoli and citrus fruits.

From the practice of patients

I will share my observations on taking Phenotropil over the past few days. I took 200 mg in the morning. The main effect can be described as follows: "I do everything efficiently and quickly!"

It became interesting and exciting to work, almost complete concentration on the process, too many thoughts and ideas are spinning in my head at once, I had to take a piece of paper and a pen and put everything in order. The desire for an extra hour to sleep has disappeared. But, nevertheless, I recommend taking the drug exclusively in the morning (100 milligrams to begin with).

Nikolay Andreichenko, 25 years old

I bought it yesterday and took 2 tablets in the evening. Sensations strange, as if the temperature. It worked well and productively, went to bed at 2 am, turned around for half an hour and fell asleep. I was able to wake up after 6 hours and also took the drug in the morning. It works fine, but the impression is that these are not pills, but I spur myself on.

Nikita Mirov, 30 years old

Strongly against these pills, because I think that Phenotropil is a terrible thing. Several years ago, as an exemplary student, I decided to work hard at the first session in my life, but I bought IT, they advised me.

As a result, I didn’t get enough sleep for almost all exams. Because I could not sleep, even when I wanted to. Such is the unpleasant experience I had in my first year.

Alina Ulakhly, 28 years old

People who are severely obese and are actively struggling with extra pounds, while following a diet, take phenotropil for weight loss. For weight loss, the drug began to be used in the 80s of the XX century, earlier the drug was used as a doping for athletes, as well as for therapeutic purposes in the treatment of a number of diseases. In some countries, phenotropil is considered a prohibited drug. In Russia, the drug can be purchased with a doctor's prescription. It is not recommended to prescribe pills for weight loss on your own.

The drug phenotropil is available in tablets of 10 and 30 pieces in one package. The main active ingredient in this drug is phenyloxopyrrolidinylacetamide (each tablet contains 100 milligrams of the substance). The preparation contains auxiliary components: lactose, starch, calcium stearate. Phenotropil, the instructions for use of which are in each package, is a nootropic drug that affects the neurons of the brain.

Properties of the drug

Initially, phenotropil was used to treat diseases of the central nervous system, depression, neurotic conditions, etc. Later it turned out that the drug helps to cope with obesity and speed up the process of losing weight. The medicine increases activity, fights stress manifestations, eliminates memory impairments and improves a person's physical capabilities, can activate the brain, improve blood circulation, enhance attention and facilitate learning.

The drug helps to activate metabolism, speed up thought processes, and prevent seizures. Phenotropil tablets improve mood, increase sensitivity to pain, cope with lethargy, chronic fatigue. The use of the drug stabilizes the functioning of the nervous system, reduces the risk of developing brain hypoxia, improves vision, and helps protect the body from the effects of toxins.

Phenotropil for weight loss reduces appetite and reduces hunger, so during the day a person begins to eat less.

Calorie deficiency triggers the process of fat burning, while losing weight remains vigorous, active, able to exercise. The drug increases stamina and performance even in those people who adhere to strict.

Despite all the useful properties, this drug has only an auxiliary effect in the fight against excess weight, reducing food cravings. It is impossible to cope with obesity and reduce body weight with one medication. Only by following a diet, adhering to the principles of proper nutrition and exercising, you can achieve the desired results and get rid of extra pounds.

Indications for taking phenotropil are the following symptoms and diseases:

• Seizures;
• Diseases of the central nervous system;
• Dysfunctions of the brain;
• Nervous exhaustion;
• Memory impairment, decreased attention;
• Increased fatigue;
• Violations of learning processes;
• Depression, frequent stress;
• Obesity;
• Hypoxia;
• Chronic alcohol dependence, etc.

How to use?

The number of doses and a single dose of the drug must be prescribed by a doctor. On average, for the treatment of diseases affecting the central nervous system, phenotropil should be taken at 200-300 mg per day (a single dose of the drug is 100-200 mg, the maximum permitted daily dose is 750 mg). It is necessary to take pills in the morning after meals, if the daily dose does not exceed 100 mg. With a higher dosage, it is recommended to divide the medicine into two doses (the second dose should be no later than 15.00).

Usually, the course of taking phenotropil is 30 days. On the recommendation of a doctor, treatment with a nootropic drug can last from 2 weeks to 2-3 months. After a break of 30 days, pills can be taken again.

When dealing with extra pounds, it is recommended to use phenotropil once a day in the morning (taking pills after 15.00 provokes insomnia at night). You need to drink the medicine immediately after eating. The dose of the drug is selected individually for each person and is 100-200 mg (1-2 tablets).

The course of taking pills should last at least one month; in some cases, doctors recommend that their patients use phenotropil for weight loss up to 8 weeks. The next course of obesity treatment can be carried out within a month. Long-term use or overdose of the drug causes side effects.

Contraindications

Despite the beneficial properties, phenotropil is not recommended for use in the following cases:

• During pregnancy;
• During lactation;
• With individual intolerance to the components of the drug.

It is forbidden to drink a slimming agent for small children, persons suffering from atherosclerosis, hypertension, chronic liver and kidney diseases, and nervous disorders. Before taking phenotropil, it is recommended to conduct a complete examination of the body.

Side effects

• Temperature increase;
• Insomnia;
• Increased heart rate;
• Redness of the skin;
• Increased nervous irritability;
• Pressure rise;
• Anxiety;
• Limb tremor;
• Hallucinations;
• Violation of orientation in space.

If these symptoms appear, it is recommended to stop taking the drug and consult a doctor.

Price

The drug used for weight loss belongs to the middle price category. In Russia, a package of phenotropil of 10 tablets of 100 mg each costs from 400 to 450 rubles on average. The price of 30 100 mg tablets in different pharmacies varies from 950 to 1050 rubles.

Should I take?

It is not recommended to use phenotropil for weight loss for a long time, the tablets are addictive and psychological dependence. Side effects from taking phenotropil can negatively affect the health and condition of the body. Before taking pills, it is necessary to assess the potential harm that the drug causes. If you feel unwell and exacerbated chronic diseases, it is better to refuse to take the drug. Before using this medication to combat obesity, you should consult with your doctor.

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Trade name: PHENOTROPIL ® (PHENOTROPIL ®)

International non-proprietary name:

Chemical name:

N-carbamoyl-methyl-4-phenyl-2-pyrrolidone

Pharmacological properties

Pharmacotherapeutic group:

Nootropic agent

Pharmacodynamics.

Phenotropil is a nootropic drug that has a pronounced antiamnestic effect, has a direct activating effect on the integrative activity of the brain, promotes the consolidation of memory, improves concentration and mental activity, facilitates the learning process, increases the speed of information transfer between the cerebral hemispheres, increases the resistance of brain tissue to hypoxia and toxic effects, has an anticonvulsant effect and anxiolytic activity, regulates the processes of activation and inhibition of the central nervous system, improves mood.

Phenotropil has a positive effect on metabolic processes and blood circulation in the brain, stimulates redox processes, increases the energy potential of the body due to the utilization of glucose, improves regional blood flow in ischemic areas of the brain. It increases the content of norepinephrine, dopamine and serotonin in the brain, does not affect the level of GABA, does not bind to either GABA A or GABA B receptors, and does not significantly affect the spontaneous bioelectric activity of the brain.

Phenotropil does not affect respiration and the cardiovascular system, exhibits an unexpressed diuretic effect , has anorexigenic activity when used as a course.

The stimulating effect of Phenotropil is manifested in its ability to have a moderately pronounced effect in relation to motor reactions, in increasing physical performance, in a pronounced antagonism to the cataleptic effect of neuroleptics, as well as in weakening the severity of the hypnotic effect of ethanol and hexenal.

The psychostimulating effect of Phenotropil prevails in the ideational sphere . The moderate psychostimulating effect of the drug is combined with anxiolytic activity, improves mood, has some analgesic effect, increasing the threshold of pain sensitivity.

The adaptogenic effect of Phenotropil is manifested in an increase in the body's resistance to stress under conditions of excessive mental and physical stress, with fatigue, hypokinesia and immobilization, at low temperatures.

Against the background of taking Phenotropil, an improvement in vision was noted, which manifests itself in an increase in acuity, brightness and visual fields.

Phenotropil improves blood circulation in the lower extremities.

Phenotropil stimulates the production of antibodies in response to the introduction of an antigen, which indicates its immunostimulating properties, but at the same time it does not contribute to the development of immediate hypersensitivity and does not change the allergic inflammatory reaction of the skin caused by the introduction of a foreign protein.

With the course use of Phenotropil, drug dependence, tolerance, "withdrawal syndrome" do not develop.

The action of Phenotropil is manifested with a single dose, which is important when using the drug in extreme conditions.

Phenotropil does not possess teratogenic, mutagenic, carcinogenic and embryotoxic properties. Toxicity is low, the lethal dose in an acute experiment is 800 mg / kg.

Pharmacokinetics.

Phenotropil is rapidly absorbed, penetrates into various organs and tissues, easily passes through the blood-brain barrier. Absolute oral bioavailability of the drug is 100%. The maximum concentration in the blood is reached after 1 hour, the half-life is 3-5 hours. Phenotropil is not metabolized in the body and is excreted unchanged from the body. Approximately 40% of the drug is excreted in the urine and 60% of the drug is excreted in the bile and sweat.

Indications for use

Diseases of the central nervous system of various origins, especially those associated with vascular diseases and metabolic disorders in the brain, intoxication, (in particular, with post-traumatic conditions and the phenomena of chronic cerebrovascular insufficiency), accompanied by a deterioration in intellectual-mnestic functions, a decrease in motor activity;

Neurotic conditions, manifested by lethargy, increased exhaustion, decreased psychomotor activity, impaired attention, memory impairment;

Learning Disorders; Mild to moderate depression; Psychoorganic syndromes, manifested by intellectual-mnestic disorders and apathetic-abulic phenomena, as well as sluggish states in schizophrenia;

Convulsive states;

Obesity(alimentary-constitutional genesis);

Prevention of hypoxia, increasing resistance to stress, correction of the functional state of the body in extreme conditions of professional activity in order to prevent the development of fatigue and increase mental and physical performance, correction of the daily biorhythm, inversion of the "sleep-wakefulness" cycle;

Chronic alcoholism(in order to reduce the phenomena of asthenia, depression, intellectual-mnestic disorders).

CONTRAINDICATIONS

Individual intolerance.

PRECAUTIONARY MEASURES

Phenotropil is used with caution in patients with severe organic lesions of the liver and kidneys, severe forms of arterial hypertension, in patients with atherosclerosis, as well as in patients who have had previous panic attacks, anxious raptoid states or acute psychotic conditions, especially with psychomotor agitation, due to the possibility of exacerbating anxiety, panic, hallucinations and delusions, as well as in patients prone to allergic reactions to nootropic drugs of the pyrrolidone group.

APPLICATION DURING PREGNANCY AND LACTATION

Phenotropil should not be prescribed during pregnancy and lactation due to the lack of clinical trial data.

DOSAGE AND APPLICATION

Phenotropil is used orally, immediately after a meal. The dose of the drug and the duration of treatment should be determined by the doctor. Doses vary depending on the characteristics of the patient's condition. The average single dose is 150 mg (100 mg to 250 mg); the average daily dose is 250 mg (200 mg to 300 mg). The maximum allowable dose is 750 mg per day. It is recommended to divide the daily dose into 2 doses. A daily dose of up to 100 mg should be taken once in the morning, and over 100 mg should be divided into two doses. The duration of treatment can vary from 2 weeks to 3 months. The average duration of treatment is 30 days. If necessary, the course can be repeated in a month.

To increase efficiency - 100-200 mg once a day in the morning, for 2 weeks (for athletes - 3 days).

SIDE EFFECT

Insomnia (if the drug is taken later than 15 hours). In some patients, in the first 1-3 days of taking the drug, psychomotor agitation, hyperemia of the skin, a feeling of warmth, an increase in blood pressure may occur.

OVERDOSE

Overdose cases were not observed. Treatment: symptomatic therapy.

INTERACTION WITH OTHER DRUGS

Phenotropil can enhance the effect of drugs that stimulate the central nervous system, antidepressants and nootropic drugs.

SPECIAL INSTRUCTIONS

With excessive psychoemotional exhaustion against the background of chronic stress and fatigue, chronic insomnia, a single dose of Phenotropil on the first day can cause a sharp need for sleep. Such patients on an outpatient basis should be advised to start the course of taking the drug on non-working days.

RELEASE FORM

Each can, 1, 2 or 3 blister packs together with instructions for use in a cardboard box.

Storage conditions

List B. In a dry, dark place and out of reach of children, at a temperature not exceeding 30 0 С

TERMS OF RELEASE FROM PHARMACIES