Question-answer

How to take Mexidol® to maximize the therapeutic effect: Injections of 5–10 ml per day for 14 days, followed by switching to Mexidol® FORTE 250 tablets at 250 mg 3 times per day for 2 months.
The frequency of sequential therapy is 2–3 courses per year.

Mexidol® has a multimodal effect. Mexidol® consists of two related and functionally significant compounds: 2-ethyl-6-methyl-3-hydroxypyridine and succinate. This combination determines the multimodal properties and a wide range of pharmacological effects of the drug. Mexidol® is quickly absorbed from the gastrointestinal tract and with a blood flow enters organs and tissue, primarily to the brain. Once in the nerve cells of the brain, Mexidol® is concentrated in mitochondria (cellular “power plants”), where it realizes its pharmacological activity. The presence in the preparation of Mexidol® salt of amber acid (succinate) stimulates the formation of ATP molecules in the mitochondria (energy sources for processes in the body). Mexidol® stimulates the process of energy formation, prevents the development of acidification of the intracellular environment, which retains the functioning of neurons. Succinate stimulates tissue respiration, in conditions of a lack of oxygen, activating the Crebs cycle (a set of sequential reactions of the transformation of pyrovinoscular acid with the formation of energy sources for the cell) and, thus, increases the content of ATP and creative phosphate. The pyridine base and succinate in the molecule of the drug Mexidol® provide neutralization of free radicals and stimulate the cellular system of protection against them. They also provide stabilization of cell membranes. All this prevents the damage to cells and their death. Thus, Mexidol® increases the resistance of cells and tissues to hypoxia and oxidative stress. The main pharmacological effects of the drug include antioxidant, antihyplance and membrane -stabilizing, thanks to which such clinical effects as nootropic, anxiolytic, anti -amnestic and others are realized.

Mexidol® (ethyl methylhydroxypyridine succinate) is included in the main document of the regulatory framework - Clinical Guidelines "Ischemic Stroke and Transient Ischemic Attack in Adults" (2021) with the highest level of recommendation among neuroprotectors - A. The full text of the current recommendations is available on the website of the Ministry of Health of the Russian Federation. Mexidol® (ethyl methylhydroxypyridine succinate) is also included in the Standard of Emergency Medical Care for Acute Cerebrovascular Accident (Order of the Ministry of Health No. 466n dated July 5, 2016) and in the Standard of Specialized Medical Care for Cerebral Infarction (Order of the Ministry of Health No. 1740n dated December 29, 2012).

Mexidol® has been successfully used in clinical practice for more than 25 years and has many studies confirming its effectiveness and high security profile. Including studies were conducted in children over 6 years old and the elderly older than 75 years. Of the last large randomized controlled studies, the following can be distinguished: Epica (ischemic stroke), memo (chronic brain ischemia), mega (ADHD, children over 6 years old). Read more with them on this site or on a professional resource Pubmed. Also at the moment, the study of the world (ischemic stroke) is being carried out, the results of which will be published next year. We offer you to watch the video “Mexol®. Evidence medicine: just about the complex ”in the section of the site“ Expert Opinion ”.

Mexidol® 125 mg tablets is the only drug containing ethylmethydlhydroxypyrididine of succinate, allowed for use in children from 6 years of age with syndrome of attention deficiency and hyperactivity (ADHD). Mexidol® children are prescribed to increase concentration, perseverance, reduce signs of hyperactivity and impulsiveness.

Mexidol® combines with all drugs used to treat somatic diseases. The combination of Mexidol® with anxiolytics, antipsychotics, antidepressants, sleeping pills, antiepileptic, antiparkinsonic, and sedatives enhances their effect. This allows you to reduce the doses of these drugs and reduce side effects. Mexidol® enhances the effect of antihypertensive agents, increases the antianginal activity of nitrates and nitrate -like products. Mexidol® increases the resistance of the body with alcohol poisoning and antipsychotics, reduces the toxic effect of ethanol.

The duration of the course of treatment depends on the form and severity of the disease, the prevalence of the process, options for the clinical course and is determined by the attending physician. In order to fully disclose the therapeutic potential of the drug for patients over 18 years, long -term consistent therapy is recommended: V/V or V/M injections for 14 days at a dose of 200-500 mg 1 time per day with the subsequent transition to tablet forms of Mexidol® 125 mg. Or Mexidol® Fort 250 mg on 1 tablet/day for 2 months. It is constantly not necessary to use Mexidol®, the duration of the course should not exceed the recommended by the attending physician.

Mexidol® is administered intravenously. According to the instructions for use, Mexidol® is administered intravenously as a slow stream over 5–7 minutes. Intravenous drip administration is at a rate of 40–60 drops per minute. The doses administered depend on the type, severity, and progression of the disease.

How to breed Mexidol® for intravenous administration will tell you the instructions. According to it, a solution for intravenous administration of 50 mg/ml with an infusion method of administration should be diluted in a 0.9 % sodium chloride solution.

To maintain the qualities of the drug, proper storage is important. How to store Mexidol®: Keep the drug inaccessible to children, a place protected from light at a temperature of not higher than 25 ° C. Do not use the drug after expiration of the expiration date. The date of expiration date is the last day of the month indicated on the package. It is not recommended to store and subsequently use the open ampoule of the Mexidol® injection solution - this is unsafe.

Mexidol® is available in different forms. What's the difference between Mexidol® and Mexidol® FORTE? Mexidol® FORTE 250 offers a unique dosage of 250 mg per tablet. Standard Mexidol® contains 125 mg of the active ingredient ethylmethylhydroxypyridine succinate per tablet. The primary goal of Mexidol® FORTE 250 is to simplify patients' pharmacotherapy regimens and replace two 125 mg tablets with one 250 mg tablet. Given that Mexidol® has a pronounced dose-dependent effect (increasing the dosage increases the effectiveness of therapy while maintaining its safety profile), Mexidol® FORTE is a new standard dosage for physicians treating patients with acute and chronic conditions caused by ischemia and hypoxia of various origins.

Eating does not affect the effectiveness of Mexidol®. You can take Mexidol® before or after meals. The main thing is not to forget about the recommended rate of administration - 3 times a day, according to the instructions for the medical use of the drug Mexidol®.

Mexidol® is an original drug, also known as a reference drug¹⁵This term refers to the drug that was first registered and approved for use. Subsequently, the reference drug serves as a standard in bioequivalence and therapeutic equivalence studies during the registration of generic drugs.

Generic is a drug that contains an active substance identical to the original drug, but differing in production technologies, auxiliary components, dosages. To enter the market, a generic manufacturer does not conduct a full cycle of clinical trials and can sell generic after the patent protection of the original drug. Unlike generic, the original drug is the drug whose effectiveness and safety have been proven in preclinical and clinical studies. To go to the Russian market, the manufacturer of the drug is enough to conduct a study of bioequivalenia on healthy volunteers, and, deviations from the standard (original brand) are allowed very significant: from minus 20 % to plus 25 %, which cannot be compared with taking the drug in the conditions of pathology due to pathology decreased metabolism, severity and course of the disease. The advantage of original drugs is to pass the full phase of research confirming their effectiveness and safety.

Mexidol® is included in the ZhNVLP for 2024 (on the approval of the list of vital and most important drugs in 2024), the order of the Government of the Russian Federation of 10.10.2019 N 2406-r (as amended on 23.12.2023).

^* GUNLP is a list of vital and most important drugs.

Mexidol® after stroke: To fully utilize the drug's therapeutic potential, sequential long-term therapy with Mexidol is recommended (EPICA randomized clinical trial, 2017): initially, a course of 500 mg/day injections for 14 days (saturation phase), followed by a transition to 250 mg tablets 3 times daily for 2 months (maximization phase). To consolidate the effect and prevent recurrent stroke, 2-3 courses of therapy per year are recommended.

The drug Mexidol® is available in two forms: injection and tablet. This allows for consistent therapy - to begin treatment with a solution, which can be administered both intravenously and intramuscularly (phase of saturation of the therapeutic effect), and continue treatment with tablets (phase of maximization of the therapeutic effect). With this approach, the therapeutic potential of the drug is fully revealed and the effectiveness of therapy with Mexidol is significantly increased.

Mexidol's high safety profile has been repeatedly confirmed in clinical trials. For example, according to the results of a subanalysis of the MEMO RCT by age population, Mexidol's efficacy is comparable across all age groups, and its safety is comparable to placebo, including in patients over 75 years of age—the group in which adverse drug reactions occur most frequently. Thus, Mexidol therapy is effective and safe in patients of various age groups, including those over 75.

Mexidol® has proven effective in treating patients with cognitive impairment, including post-COVID-19. According to the results of a prospective, comparative, open-label study conducted in the "red zone" (2021), sequential therapy with Mexidol® (10 ml/day, 14 days) and Mexidol® FORTE 250 (250 mg 3 times/day, 2 months) significantly improved and normalized cognitive function by the end of therapy: +5.2 points on the MoCA scale with a total score of 26, corresponding to NORMAL. Meanwhile, in the control group, the average MoCA score increased by +1.1 points, and the total score was 23, which corresponds to cognitive impairment. Mexidol also normalized sleep and reduced the severity of asthenic symptoms, leading to improved quality of life. For more detailed information, we also suggest you read the article by Prof. Kovalchuk V.V.

According to the instructions for medical use, Mexidol® combines with all drugs used to treat somatic diseases. Moreover, Mexidol® has an additional stress-prototive effect, which will positively affect the condition of an alarming patient. Mexidol® enhances the effect of anxiolytics, which allows them to reduce their doses and reduce side effects. In order to completely disclose the therapeutic potential of the drug Mexidol®, consistent therapy is recommended: 14 days of injection (saturation phase), followed by switching to a tablet form from 6 weeks (phase of maximizing the therapeutic effect), repeated courses 2-3 times a year or during exacerbations.

In order to completely disclose the therapeutic potential of the drug Mexidol®, a consistent course of therapy is recommended: first the injection course is 14 days, followed by the transition to tablet forms - 8 weeks.

Recall that one of the frequent consequences of a viral infection is post -infectious asthenia. The causes of post -infectious asthenia are tissue hypoxia and metabolic acidosis arising from viral intoxication with a further violation of the processes of formation and consumption of cellular energy, which leads to the development of oxidative stress. Mexidol® effectively replenishes the energy deficiency necessary for the normal life of the body, while not causing drowsiness and does not have a muscle relaxant effect.

Cardiological indications are contained in the instructions for the medical use of the drug Mexidol®: coronary heart disease as part of complex therapy (tablets) and acute myocardial infarction as part of complex therapy (solution). The effectiveness and safety of the drug Mexidol® in therapy of chronic heart failure (CHF) has also been proven. According to the results of the latest randomized in parallel groups of cardiological research by V.V. Tolkacheva et al. Mexidol® in cardiology showed high efficiency in patients with XN II - III functional class (and coronary heart disease) as part of complex therapy. A significant improvement in the cognitive status of patients on the MOCA scale (+21 %), improvement of the health profile by the EQ-5D-5L questionnaire (a reliable improvement of mobility indicators, daily activities, reducing pain/discomfort by 34 %, as well as improving well-being by 25 %has been noted. Compared to the source indicators). In addition, this study showed the positive effect of Mexidol® on the quality of life-a reliable improvement in the Minnesotsky (MLHFQ) and KCCQ (KCCQ) questionnaires and the SF-36 questionnaire. In patients receiving Mexidol®, a reliable regression of the severity of asthenic manifestations (on the MFI-20 “-12 %” scale) and a significant decrease in the level of anxiety (on the Bek scale “-38 %”) were also noted. During the study of undesirable and serious undesirable phenomena, the Mexidol® was not registered with the use of the drug. Thus, prolonged sequential therapy with Mexidol® when adding to standard therapy in patients with XN II - III FC (according to NYHA) with moderate disorders of cognitive status, significantly improves cognitive functions, quality parameters, reduces the severity of asthenic syndrome and anxiety level. Mexidol® demonstrated high performance and safety indicators in the treatment of patients with a cardiological profile.

Of all cardiovascular diseases, hypertension is most closely associated with vascular brain damage: stroke, chronic cerebral ischemia, and cognitive impairment (CI). According to the Laboratory of Epidemiology and Disease Prevention at the Neurology Research Center of the Russian Academy of Sciences, which studied cognitive function in middle-aged patients with "uncomplicated" stage 1-2 hypertension (without a history of stroke or heart attack, without atherosclerotic stenosis of greater than 30% of the great vessels, without arrhythmia or diabetes), cognitive impairment was detected in 74% of those examined. The results of the MEMO study subanalysis (study of the effect of sequential therapy with Mexidol® and Mexidol® 250 FORTE on cognitive status, severity of asthenia, anxiety, autonomic, motor disorders and quality of life in patients with and without arterial hypertension (AH) against the background of CCI) provide grounds to consider long-term sequential use of Mexidol® and Mexidol® FORTE 250 in the complex treatment of patients with AH and CI against the background of CCI as an effective means of protecting the brain as a target organ of AH and a means of complex therapy of cognitive, emotional, asthenic, autonomic and motor disorders (Zakharov V.V., Ostroumova O.D., Kochetkov A.I., Klepikova M.V., Fedin A.I. International multicenter randomized double-blind placebo-controlled study to evaluate the efficacy and safety of sequential therapy in patients with chronic Cerebral ischemia with Mexidol® and Mexidol® FORTE 250 (MEMO study): results of a subanalysis in patients with arterial hypertension. Journal of Therapy. 2023; 9(1): 145–159) . We invite you to watch the video "Mexidol® for arterial hypertension (AH). AH and cognitive impairment, effective correction methods.

According to the package insert/SmPC, Mexidol®/Mexidol® FORTE 250 can be combined with all medications for the treatment of somatic diseases. Specifically, in patients with coronary artery disease and type 2 diabetes, the addition of Mexidol to basic therapy (statins, nitrates, and other medications) significantly increased the effectiveness of coronary artery disease therapy: the incidence of acute myocardial infarction decreased by 3.1 times, unstable angina by 1.5 times, and hospitalizations by 2.7 times, while also shortening the length of hospital stay. You can find more detailed information on the combination of Mexidol® with other medications in the article at the link below: https://mexidol.ru/blog/news/2019/statya-kombinirovannoe-primenenie-meksidola-s-izvestnymi-lekarstvennymi-sredstvami

Mexidol®^helps has been successfully used in ophthalmology for many years. The indication for primary open-angle glaucoma (as part of combination therapy) is listed in the instructions for use of Mexidol (solution). According to the SmPC, Mexidol®^preserve retinal ganglion cells and optic nerve fibers in progressive neuropathy caused by chronic ischemia and hypoxia. It improves the functional activity of the retina and optic nerve, increasing visual acuity.

In 2024, Mexidol®⁽ ethylmethylhydroxypyridine succinate) was included in the clinical guidelines for Primary Open-Angle Glaucoma (UUR A, UDD 1) and Primary Angle-Closure Glaucoma (UUR C, UDD 5).

According to the study by E. A. Egorov et al., the use of Mexidol^® as part of combination therapy for patients with primary open-angle glaucoma stages I–III leads to an increase in visual acuity (according to uncorrected visometry in patients with stages I–II and III glaucoma, and corrected visometry in patients with stages I–II glaucoma), a decrease in the elevated threshold of electrical sensitivity, and an increase in the reduced electrical lability of the optic nerve in patients with stages I–II and III glaucoma. Good tolerability and a high safety profile of the drug have also been confirmed¹³. Mexidol^® (ethylmethylhydroxypyridine succinate) is included in the National Guidelines on Glaucoma for Practicing Physicians (edited by E. A. Egorov, 4th edition).

Мексидол® в психиатрии с успехом применяется не одно десятилетие, в инструкции по медицинскому применению присутствуют следующие показания: тревожные расстройства при невротических и неврозоподобных состояниях, купирование абстинентного синдрома при алкоголизме с преобладанием неврозоподобных и вегетативно-сосудистых расстройств, постабстинентные расстройства, острая интоксикация антипсихотическими средствами.

The main clinical effects of Mexidol in alcohol withdrawal syndrome are as follows: nootropic, detoxifying, anti-anxiety, autonomic stabilizing, and anticonvulsant. More detailed information is provided in the video by Professor E.S. Kurasov:  https://mexidol.ru/ekspertnoe-mnenie-video/mnenie-spetsialistov/kurasov-es-primenenie-meksidola-pri-alkogolnom-abstinentnom-sindrome-pohmele

Mexidol® is allowed in children from 6 years of age and is successfully used in therapy of small patients with hyperactivity, impaired attention, impulsivity and ADHD (attention deficiency syndrome). The application scheme according to the instructions for medical use: 125 mg 2 r/day for 6 weeks. This scheme based on the results of RCT MEGA (2021) demonstrated high efficiency and safety.