Pronoran

Pronoran is a synthetic antiparkinsonian agent. The effect of the drug is characterized by the properties of the components that make up its composition. Piribedil is the main active ingredient of Pronoran.

Thanks to the properties inherent in the active component of this drug, the drug, penetrating the bloodstream of the patient's brain, has an effective antiparkinsonian effect.

Pronoran is used at all stages of the disease, and also has a direct effect on the main motor symptoms.

Clinical and pharmacological group

An antiparkinsonian drug is an agonist of dopaminergic receptors.

Conditions of leave from pharmacies

It is released on prescription.

Price list

How much does Pronoran cost in pharmacies? The average price is at the level of600 rubles.

Form of issue and composition

The drug form of Pronoran is coated with red controlled release tablets.

Composition of the preparation:

The active substance is pyribedil (50 mg in one tablet);
Inactive ingredients: povidone, magnesium stearate and talc;

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The composition of the shell: polysorbate 80, carmellose sodium, povidone, silicon dioxide colloid, sodium hydrogen carbonate, titanium dioxide, talc, sucrose, white beeswax, dye crimson.

Propranol tablets are sold in 30 pcs. in blisters, 1 blister per package.

Pharmacological effect

The active substance of tablets Pronoran is an agonist of dopamine receptors. After penetrating the structures of the central nervous system, pyribedil binds to dopamine receptors. It is also an antagonist of alpha receptors in the brain structures that block.

Together, this effect on various receptors in the tissues and structures of the brain determines the antiparkinsonian therapeutic effect of Pronoran tablets. The data were confirmed during clinical trials.

Indications for use

According to the instructions, Pronoran is used in such cases:

Parkinson's disease (in forms predominantly involving tremor) - in the form of monotherapy, or in combination with drugs levodopa (at the onset of the disease and at later stages of the disease, especially in forms accompanied by tremor).
Chronic violation of cognitive function and neurosensory deficit in the process of aging (incl. disorders of memory and attention) - as an auxiliary symptomatic therapy.
Symptoms of ophthalmic diseases of ischemic nature (reduction of contrast of colors, narrowing of the field of vision, reduction of visual acuity, etc.).
Intermittent claudication caused by obliterating diseases of arteries of the lower limbs (stage II according to the classification of Lerish and Fontaine) - as an auxiliary symptomatic therapy.

Contraindications

The use of Pronoran is contraindicated:

At a collapse;
Children and teenagers under 18;
With acute myocardial infarction;
Simultaneously with neuroleptics (except for clozapine);
With increased sensitivity to pyribedilum or any auxiliary component.

The composition of the tablets includes sucrose, so the drug is also contraindicated for intolerance to fructose, galactose and / or glucose, with a deficiency of sucrose isomaltase.

Use in pregnancy and lactation

Experiments on animals did not reveal any direct or indirect negative impact on the development of the embryo and fetus, the process of childbirth and postnatal development. However, it has been proven that in mice, piribedil penetrates the placental barrier and is distributed throughout the fetus. Therefore, it is not recommended to appoint Pronoran to patients during pregnancy and to women of reproductive age who do not use reliable methods of contraception.

Due to the lack of reliable information, the drug should not be used during lactation.

Dosage and route of administration

The instructions for use indicate that Pronoran is taken internally. The tablet should be taken after a meal, washed down with half a glass of water, without chewing.

For all indications (except Parkinson's disease)the drug is prescribed in a dose of 50 mg (1 tab.) 1 time / day. In more severe cases - 50 mg 2 times / day.

With Parkinson's Diseasein the form of monotherapy, 150-250 mg / day (3-5 tablets / day), divided into 3 divided doses per day. If you need to take the drug in a dose of 250 mg, it is recommended to take 2 tablets. on 50 mg in the morning and in the afternoon and 1 tab. in the evening.

When used in combination with drugs levodopa daily dose is 150 mg (3 tablets): it is recommended to divide into 3 divided doses.

When choosing a dose in case of its increase, it is recommended to titrate the dose, gradually increasing by 1 tab. (50 mg) every 2 weeks.

Discontinuation of treatment

A sharp cessation of therapy with a dopaminergic receptor agonist is associated with a risk of malignant neuroleptic syndrome. To avoid this, you should reduce the dose of piribedil gradually, until complete withdrawal.

Disorder of habits and drives

To avoid the risk of occurrence of disorders of habits and drives, the lowest effective dose of the drug should be given. If such symptoms occur, consideration should be given to reducing the dose or gradually stopping therapy with the drug. section "Special instructions").

Side effects

Side effects of Pronoran are mainly associated with its dopaminergic activity, depend on the dose, are of moderate nature, usually appear at the beginning of treatment and after it end.

Classification of undesirable reactions: often (≥1 / 100, <1/10), infrequently (≥1 / 1000, <1/100).

Possible side effects:

Allergic reactions;
From the side of the central nervous system: often - dizziness, excitement, hallucinations, confusion, drowsiness (sometimes in the daytime, until sudden falling asleep);
From the side of the cardiovascular system: infrequently - arterial hypotension, orthostatic hypotension with unstable blood pressure, malaise or loss of consciousness;
From the digestive system: often - minor digestive disorders (flatulence, nausea, vomiting).

In patients with Parkinson's disease, the drug can also cause the following disorders: the desire to shop, compulsive (psychogenic) overeating, a penchant for gambling, hypersexuality and increased libido.

Overdose

Symptoms of overdose are disorders of the function of the gastrointestinal tract (nausea and vomiting due to the action of pyribedil on chemoreceptor trigger zone) and lability of arterial pressure (its sharp increase or decrease).

In this case, the drug is immediately withdrawn and symptomatic therapy is prescribed.

special instructions

Orthostatic hypotension:

It is known that dopamine agonists disrupt the systemic regulation of blood pressure, which can lead to the development of orthostatic hypotension. It is recommended to monitor blood pressure, especially at the beginning of treatment, due to the general risk of developing orthostatic hypotension associated with dopaminergic drugs. Given the age of the population receiving pyribedyl therapy, the risk of falls that can be caused by sudden falling asleep, hypotension, or confusion is accounted for.

Sudden falling asleep:

In some patients (especially in patients with Parkinson's disease) on the background of taking piribedil, a state of severe drowsiness sometimes suddenly occurs until sudden falling asleep. Sudden falling asleep during daily activity, in some cases unconscious or arising without previous symptoms, is extremely rare, but, nevertheless, patients driving a car and / or working on equipment requiring a high degree of attention must be warned about this. If such reactions occur, patients should refuse to drive and / or work on equipment requiring a high degree of attention. In addition, consideration should be given to reducing the dose of piribedil or discontinuing therapy with this drug.

Behavioral disorders:

There were reported cases of behavioral disorders that were associated with such manifestations as confusion, agitation, aggression. If such symptoms occur, consider lowering the dose or gradually stopping therapy with the drug.

Disorder of habits and drives:

Patients should be monitored to detect the development of a behavioral disorder. Patients and their caregivers should be warned about possible symptoms of a disorder of habits and drives (addiction to gambling, increased libido and hypersexuality, obsessive desire to shop and overeating / compulsive overeating) when taking dopamine agonists, incl. piribedil. If such symptoms occur, consider lowering the dose or gradually stopping therapy with the drug.

Psychotic disorders:

Dopamine agonists can induce or exacerbate psychotic disorders such as delirium, delirium and hallucinations (cf. section "Drug Interactions"). If such symptoms occur, consider lowering the dose or gradually stopping therapy with the drug.

Malignant neuroleptic syndrome:

Symptoms similar to those with malignant neuroleptic syndrome have been reported, with the abrupt withdrawal of dopaminergic drugs (see Fig. section "Dosage regimen").

Dyskinesia (movement disorders):

In patients with advanced Parkinson's disease, levodopa preparations may cause dyskinesia at the beginning of titration of the dose of piribedil. In this case, reduce the dose of piribedil.

Peripheral edema:

There was reported the occurrence of peripheral edema on the background of therapy with dopamine agonists. This should be taken into account when prescribing piribedil.

Excipients:

Dye crimson, which is part of the drug, in some patients increases the risk of allergic reactions.

Drug Interactions

When using the drug, it is necessary to take into account the interaction with other drugs:

It is not recommended to use pyribedil together with alcohol.
Antiemetic antipsychotics: antiemetic drugs should be used that do not cause extrapyramidal symptoms.
In connection with the mutual antagonism between dopaminergic antiparkinsonian drugs and tetrabenazine, simultaneous administration of these drugs is not recommended.
Care should be taken when prescribing piribedil with other drugs that have a sedative effect.
In connection with the mutual antagonism between dopaminergic antiparkinsonian drugs and antipsychotics, simultaneous appointment with neuroleptics (except for clozapine) is contraindicated (see. section "Contraindications").
Patients with extrapyramidal syndrome caused by taking antipsychotics should be treated with anticholinergic drugs and should not prescribe dopaminergic antiparkinsonian drugs (due to neuroleptic blocking of dopaminergic receptors).
Dopaminergic receptor agonists can cause or exacerbate psychotic disorders. If neuroleptics are required for patients with Parkinson's disease receiving dopaminergic antiparkinsonian drugs, the dose of the latter should gradually decline until the final withdrawal (sudden abolition of dopaminergic drugs is associated with a risk of developing "malignant neuroleptic syndrome") (see. section "Special instructions").

Reviews

In general, reviews about Pronoran are very few, since it is mainly prescribed for elderly patients. The opinions of patients on its effectiveness differ significantly, which does not allow to determine the exact degree of usefulness of this not very expensive drug.

When taking the drug is often observed pronounced side effects, so select a scheme of treatment for Parkinson's disease should only an experienced specialist.

Analogues

Structural analogs for the active substance:

Piribedil.

Analogues on the curative effect (agents for the treatment of Parkinson's disease):

Azilect;
Benserazide;
Bromocriptine;
Duellin;
Zimox;
Izik;
Cognitive;
Creeded;
Levodopa;
Madopar;
Mendileks;
Midantan;
Mirapex;
On whom;
Niar;
Newpro;
Pantogam;
Pantogam is an asset;
Pantokaltsin;
Parcón;
Permax;
Mertz PC;
Pramipexole;
Rekvip Modabit;
Rolprin SR;
Segan;
Selegiline;
Sinemet;
Stalevo;
Tasmar;
Tremonorm;
Tropacin;
Phenotropil;
Cyclodol;
Eldepril;
Yumeks.

Before using analogues, consult your doctor.

Storage conditions and shelf life

There are no special conditions for the storage of tablets. It is recommended to store it in its original packaging in a place inaccessible to children. Shelf life is 3 years from the date of manufacture.