A prophylactic natural muscle relaxant is used. Muscle relaxants for relieving muscle spasms: the basis of action and drug intake

In medicine, there are often situations when it is necessary to relax muscle fibers. For these purposes, those introduced into the body are used, they block neuromuscular impulses, and the striated muscles relax.

Medicines of this group are often used in surgery, to relieve seizures, before repositioning a joint dislocation, and even with exacerbations of osteochondrosis.

The mechanism of action of drugs

With severe pain in the muscles, a spasm may occur, as a result, movements in the joints are limited, which can lead to complete immobility. This issue is especially acute in osteochondrosis. The constant spasm interferes with the proper functioning of the muscle fibers, and, accordingly, the treatment is stretched indefinitely.

To bring the general well-being of the patient to a normal state, muscle relaxants are prescribed. Drugs for osteochondrosis are quite capable of relaxing muscles and reducing the inflammatory process.

Considering the properties of muscle relaxants, we can say that they find their application at any stage of treatment of osteochondrosis. The following procedures are more effective when applied:

• Massage. Relaxed muscles respond best to stimulation.
• Manual therapy. It is not a secret for anyone that the more effective and safe the influence of the doctor is, the more relaxed the muscles.
• Physiotherapy procedures.
• The effect of painkillers is enhanced.

If you often have it or you suffer from osteochondrosis, then you should not prescribe muscle relaxants on your own, drugs in this group should be prescribed only by a doctor. The fact is that they have a fairly extensive list of contraindications and side effects, so only a doctor can choose a medicine for you.

Classification of muscle relaxants

The division of drugs in this group into different categories can be viewed from different points of view. If we talk about what muscle relaxants are, the classification is different. Analyzing the mechanism of influence on the human body, only two types can be distinguished:

1. Peripheral drugs.
2. Central muscle relaxants.

Medicines can have effects that vary in duration, depending on this, they are distinguished:

• Ultra-short-acting.
• Short.
• Average.
• Long lasting.

Only a doctor can know exactly which drug is best for you in each case, so do not self-medicate.

Peripheral muscle relaxants

They are able to block nerve impulses that travel to muscle fibers. They are widely used: during anesthesia, with convulsions, with paralysis during tetanus.

Muscle relaxants, drugs of peripheral action, can be divided into the following groups:

All of these drugs affect cholinergic receptors in skeletal muscle, and therefore are effective for muscle cramps and pain. They act quite gently, which allows them to be used in various surgical procedures.

Centrally acting drugs

Muscle relaxants of this group can be further subdivided into the following types, taking into account their chemical composition:

1. Glycerin derivatives. These are Meprotan, Prenderall, Isoprotan.
2. Based on benzimidazole - "Flexin".
3. Mixed preparations, for example "Midocalm", "Baclofen".

Central muscle relaxants are able to block reflexes that have many synapses in muscle tissue. They do this by reducing the activity of interneurons in the spinal cord. These drugs not only relax, but have a broader effect, which is why they are used in the treatment of various diseases that are accompanied by increased muscle tone.

These muscle relaxants have practically no effect on monosynaptic reflexes, so they can be used for removal without turning off natural respiration.

If you are prescribed muscle relaxants (drugs), the names you can find are as follows:

• "Metacarbamol".
• "Baclofen".
• "Tolperisone".
• "Tizanidine" and others.

It is better to start taking medications under the supervision of a doctor.

The principle of using muscle relaxants

If we talk about the use of these drugs in anesthesiology, then the following principles can be noted:

1. It is necessary to use muscle relaxants only when the patient is unconscious.
2. The use of such drugs greatly facilitates artificial ventilation of the lungs.
3. Removing is not yet the most important thing, the main task is to carry out comprehensive measures to implement gas exchange and maintain blood circulation.
4. If muscle relaxants are used during anesthesia, this does not preclude the use of anesthetics.

When drugs of this group firmly entered medicine, it was possible to speak safely about the beginning of a new era in anesthesiology. Their use made it possible to simultaneously solve several problems:

After the introduction of such drugs into practice, anesthesiology got the opportunity to become an independent branch.

Scope of muscle relaxants

Considering that substances from this group of drugs have an extensive effect on the body, they are widely used in medical practice. You can list the following areas:

1. In the treatment of neurological diseases, which are accompanied by increased tone.
2. If you use muscle relaxants (drugs), lower back pain will also recede.
3. Before surgery in the abdominal cavity.
4. During complex diagnostic procedures for certain diseases.
5. During electroconvulsive therapy.
6. When carrying out anesthesiology without interrupting natural breathing.
7. For the prevention of complications after injuries.
8. Muscle relaxants (drugs) for osteochondrosis are often prescribed to patients.
9. To facilitate the recovery process after
10. The presence of an intervertebral hernia is also an indication for taking muscle relaxants.

Despite such an extensive list of the use of these drugs, you should not prescribe them yourself, without consulting a doctor.

Side effects after taking

If you are prescribed muscle relaxants (drugs), back pain should definitely leave you alone, only when taking these drugs can side effects be observed. On some it is possible, but there are more serious ones, among them it is worth noting the following:

• Decreased concentration, which is most dangerous for people driving a car.
• Lowering blood pressure.
• Increased nervous irritability.
• Bed-wetting.
• Allergic manifestations.
• Gastrointestinal problems.
• Convulsive states.

Especially often, all these manifestations can be diagnosed with the wrong dosage of drugs. This is especially true for anti-depolarizing drugs. It is urgently necessary to stop taking them and consult a doctor. Usually, an intravenous solution of neostigmine is given.

Depolarizing muscle relaxants are more harmless in this regard. When they are canceled, the patient's condition is normalized, and the use of medications to eliminate symptoms is not required.

You should be careful when taking those muscle relaxants (drugs) whose names are unfamiliar to you. In this case, it is better to consult a doctor.

Contraindications for use

Taking any medications should be started only after consulting a doctor, and these medications even more so. They have a whole list of contraindications, among them it can be noted:

1. They should not be taken by people who have kidney problems.
2. Reception is contraindicated in pregnant women and nursing mothers.
3. Psychological disorders.
4. Alcoholism.
5. Epilepsy.
6. Parkinson's disease.
7. Liver failure.
8. Children up to age 1 year.
9. Peptic ulcer disease.
10. Myasthenia gravis.
11. Allergic reactions to the drug and its components.

As you can see, muscle relaxants (drugs) have many contraindications, so you should not harm your health even more and start taking them at your own peril and risk.

Requirements for muscle relaxants

Modern drugs should not only be effective in relieving muscle spasm, but also meet certain requirements:

One of these drugs, which practically meets all the requirements, is "Midocalm". This is probably why it has been used in medical practice for more than 40 years, and not only in our country, but also in many others.

Among the central muscle relaxants, it differs significantly from others for the better. This drug acts on several levels at once: relieves increased impulse, suppresses the formation in pain receptors, slows down the conduct of hyperactive reflexes.

As a result of taking the drug, not only muscle tension decreases, but also its vasodilating effect is observed. This is perhaps the only medicine that relieves muscle spasm, but does not cause muscle weakness, and does not interact with alcohol.

Osteochondrosis and muscle relaxants

This disease is quite common in the modern world. Our lifestyle gradually leads to the appearance of back pain, to which we try not to react. But there comes a time when pain can no longer be ignored.

We go to the doctor for help, but precious time is often lost. The question arises: "Is it possible to use muscle relaxants in diseases of the musculoskeletal system?"

Since one of the symptoms of osteochondrosis is muscle spasm, there is reason to talk about the use of drugs to relax spasmodic muscles. During therapy, the following drugs from the group of muscle relaxants are most often used.

In therapy, it is usually not customary to take several drugs at the same time. This is provided so that you can immediately identify side effects, if any, and prescribe another medicine.

Almost all drugs are available not only in pill form, but there are also injections. Most often, with severe spasm and severe pain syndrome, the second form is prescribed for emergency assistance, that is, in the form of injections. The active substance quickly penetrates the bloodstream and begins its therapeutic effect.

The tablets are usually not taken on an empty stomach, so as not to harm the mucous membrane. Drink water. Both injections and pills are prescribed to be taken twice a day, unless there are special recommendations.

The use of muscle relaxants will only bring the desired effect if they are used in complex therapy, necessarily a combination with physiotherapeutic procedures, therapeutic exercises, massage.

Despite their high effectiveness, you should not take these drugs without first consulting your doctor. You cannot decide on your own which medicine is right in your case and will bring the greatest effect.

Do not forget that there are many contraindications and side effects that should not be discounted either. Only competent treatment will allow you to forget about pain and spasmodic muscles forever.

All muscle relaxants belong to the group of curariform drugs that act mainly in the area of ​​the motor nerve endings. They have the ability to relax the muscles of the striated muscles of the body, reduce muscle tone, while reducing the movement of the body as a whole. Sometimes this can lead to the fact that he becomes completely immobilized. For example, South American Indians used the sap of plants containing strychnine as arrow poison to immobilize animals.

Previously, muscle relaxants were often used only in anesthesiology to relieve muscle spasms during surgery. To date, the field of application of these drugs in modern medicine and cosmetology has increased significantly.

Muscle relaxants are divided into two groups:

Use of central muscle relaxants

According to their chemical characteristics, they are characterized by the following classification:

• final glycerol compounds (prendol);
• benzimidazole components (flexin);
• a set of mixed components (baclofen and others).

Muscle relaxants have the function of blocking polysynaptic impulses by decreasing the activity of pluggable spinal neurons. Moreover, their influence on monosynaptic reflexes is reduced to a minimum. At the same time, they have a central relaxing effect and are designed to relieve spasmodic reactions, and are also able to affect the body in various ways. Due to this, such drugs are widely used in modern medicine. They are used in the following industries:

1. Neurology (in cases of diseases characterized by an increase in muscle tone, as well as in diseases accompanied by impaired functionality of the body's motor activity).
2. Surgery (when it is necessary to relax the abdominal muscles, when carrying out complex instrumental analysis of certain diseases, as well as when conducting electroconvulsive treatment).
3. Anesthesiology (when natural breathing is turned off, as well as for preventive purposes after traumatic complications).

The use of peripheral muscle relaxants

Today there are such types:

• Non-depolarizing medicines (arduan, diplacin);
• depolarizing agents (ditilin);
• mixed action (dixony).

All these types have their own effect on the musculoskeletal cholinergic receptors, therefore, their use is carried out in order to provide local relaxation of muscle tissues. Their use in tracheal intubation greatly facilitates such manipulations.

Muscle relaxants are not drugs, they do not cure, they are used by anesthesiologists exclusively in the presence of anesthesia and respiratory equipment.

Before relaxants, sedatives and, preferably, analgesics are required, since the patient's consciousness must be turned off. If a person is conscious, then he will experience tremendous stress, since he will not be able to breathe on his own and will understand this, experience strong fear and horror. This condition can even bring the patient to the development of myocardial infarction!

Consequences and side effects

They have a fairly large effect on the nervous system. Because of this, they can be the cause of the appearance of such characteristic symptoms:

• weakness, apathy;
• drowsiness;
• dizziness and severe headaches ;;
• microdamage to muscles;
• convulsions;
• nausea and vomiting.

Contraindications to the use of a particular drug are determined by the anesthesiologist during surgery, anesthesia and in the postoperative period.

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Muscle relaxants or muscle relaxants are drugs that relax the striated muscles.

Classification of muscle relaxants.

The generally accepted classification is in which muscle relaxants are divided into central and peripheral. The mechanism of action of these two groups differs in the level of influence on the synapses. Central muscle relaxants affect the synapses of the spinal cord and medulla oblongata. And peripheral - directly to the synapses that transmit excitation to the muscle. In addition to the above groups, there is a classification that separates muscle relaxants depending on the nature of the effect.

Central muscle relaxants are not widely used in anesthetic practice. But drugs of peripheral action are actively used to relax skeletal muscles.

Allocate:

• depolarizing muscle relaxants;
• antidepolarizing muscle relaxants.

There is also a classification according to the duration of action:

• ultra-short - last 5-7 minutes;
• short - less than 20 minutes;
• medium - less than 40 minutes;
• long-acting - more than 40 minutes.

Depolarizing muscle relaxants are ultra-short: listenone, succinylcholine, ditilin. Short, medium and long acting drugs are mainly non-depolarizing muscle relaxants. Short-acting: mivacurium. Medium-acting: atracurium, rocuronium, cisatracurium. Long-acting: tubokurin, orphenadrine, pipcuronium, baclofen.

The mechanism of action of muscle relaxants.

Non-depolarizing muscle relaxants are also called non-depolarizing or competitive. This name fully characterizes their mechanism of action. Non-depolarizing muscle relaxants compete with acetylcholine in the synaptic space. They are tropic to the same receptors. But acetylcholine under the influence of cholinesterase is destroyed in a matter of milliseconds. Therefore, it is unable to compete with muscle relaxants. As a result of this action, acetylcholine is unable to act on the postsynaptic membrane and cause the process of depolarization. The chain of the neuromuscular impulse is interrupted. The muscle is not excited. To stop the blockade and restore conduction, you need to enter anticholinesterase drugs, for example, proserin or neostigmine. These substances will destroy cholinesterase, acetylcholine will not degrade and will be able to compete with muscle relaxants. Natural ligands will be preferred.

The mechanism of action of depolarizing muscle relaxants is to create a persistent depolarizing effect that lasts about 6 hours. The depolarized postsynaptic membrane is unable to receive and conduct nerve impulses, the signal transmission chain to the muscle is interrupted. In this situation, the use of anticholinesterase drugs as an antidote will be erroneous, since the accumulating acetylcholine will cause additional depolarization and increase neuromuscular blockade. Depolarizing relaxants generally have an ultra-short effect.

Sometimes muscle relaxants combine the actions of depolarizing and competitive groups. The mechanism of this phenomenon is unknown. It is assumed that antidepolarizing muscle relaxants have an aftereffect, in which the muscle membrane acquires persistent depolarization and becomes insensitive for a while. As a rule, these are drugs of a longer duration

The use of muscle relaxants.

The first muscle relaxants were the alkaloids of some plants, or curare. Then their synthetic counterparts appeared. It is not entirely correct to call all muscle relaxants curariform substances, since the mechanism of action of some synthetic drugs differs from that of alkaloids.

The main field of application of muscle relaxants has become anesthesiology. Currently, clinical practice cannot do without them. The invention of these substances allowed a huge leap forward in the field of anesthesiology. Muscle relaxants made it possible to reduce the depth of anesthesia, better control the work of body systems, and created conditions for the introduction of endotracheal anesthesia. For most operations, good relaxation of the striated muscles is essential.

The effect of muscle relaxants on the functioning of body systems depends on the selectivity of the effect on receptors. the more selective the drug, the fewer side effects from the organs it causes.

The following muscle relaxants are used in anesthesiology: succinylcholine, ditilin, listenone, mivacurium, cisatracurium, rocuronium, atracurium, tubocurarine, mivacurium, pipcuronium and others.

In addition to anesthesiology, muscle relaxants have found application in traumatology and orthopedics for muscle relaxation in reducing dislocation, fracture, as well as in the treatment of diseases of the back and ligamentous apparatus.

Side effects of relaxants.

On the part of the cardiovascular system, muscle relaxants can cause an increase in heart rate and an increase in pressure. Succinylcholine has a twofold effect. If the dose is small, it causes bradycardia and hypotension, if the dose is large, the opposite effects.

Depolarizing-type relaxants can lead to hyperkalemia if the patient's potassium level is initially elevated. This phenomenon occurs in patients with burns, major injuries, intestinal obstruction, tetanus.

In the postoperative period, undesirable effects are prolonged muscle weakness and pain. This is due to the continuing depolarization. Long-term recovery of respiratory function can be associated with both the action of muscle relaxants and hyperventilation, airway obstruction, or overdose of decurarizing drugs (neostigmine).

Succinylcholine is able to increase pressure in the ventricles of the brain, inside the eye, in the skull. Therefore, its use in the relevant operations is limited.

Depolarizing muscle relaxants in combination with drugs for general anesthesia can cause a malignant increase in body temperature. It is a life-threatening condition that is difficult to control.

The main names of drugs and their doses.

Tubocurarine. The dose of tubocurarine used for anesthesia is 0.5-0.6 mg / kg. The drug should be administered slowly, within 3 minutes. During the operation, maintenance doses of 0.05 mg / kg are administered fractionally. This substance is a natural curare alkaloid. It tends to decrease pressure, in high doses causes significant hypotension. The antidote of Tubocurarin is Neurin.

Ditilin. This drug belongs to the depolarizing type relaxants. It has a short but powerful effect. Creates well-controlled muscle relaxation. The main side effects: prolonged apnea, an increase in blood pressure. It has no specific antidote. Drugs have a similar effect listenone, succinylcholine, muscle relaxan.

Diplats in. Non-polarizing muscle relaxant. Lasts about 30 minutes. The dose sufficient for one operation is 450-700 mg. No significant side effects were observed with its use.

Pipecuronium. The dose for anesthesia is 0.02 mg / kg. It works for a long time, within 1.5 hours. Unlike other drugs, it is more selective and does not affect the cardiovascular system.

Esmeron(rocuronium). Intubation dose 0.45-0.6 mg / kg. Lasts up to 70 minutes. Bolus doses during surgery 0.15 mg / kg.

Pancuronium... Known as Pavulon. The dose is sufficient for the introduction of anesthesia 0.08-0.1 mg / kg. A maintenance dose of 0.01-0.02 mg / kg is administered every 40 minutes. It has multiple side effects of the cardiovascular system as it is a non-selective drug. May cause arrhythmia, hypertension, tachycardia. Significantly affects intraocular pressure. It can be used for Caesarean section operations, as it poorly penetrates the placenta.

All these drugs are used exclusively by anesthesiologists-resuscitators with specialized respiratory equipment!

N.V. ORGANON (Netherlands)

ATX: V03AB35 (Sugammadex)

Antidote to muscle relaxants

ICD: T48 Poisoning with drugs acting mainly on smooth and skeletal muscles and respiratory organs

Selective antidote to the muscle relaxants rocuronium bromide and vecuronium bromide. Sugammadex is a modified gamma cyclodextrin, which is a compound that selectively binds rocuronium bromide and vecuronium bromide. It forms a complex with them in the blood plasma, which leads to a decrease in the concentration of a muscle relaxant that binds to nicotinic receptors in the neuromuscular synapse. This leads to the elimination of the neuromuscular blockade caused by rocuronium bromide or vecuronium bromide.
There was a clear dependence of the effect on the dose of Sugammadex, which was administered at different periods of time and at different depths of the neuromuscular conduction block. Sugammadex was administered at doses from 0.5 to 16 mg / kg both after a single injection of rocuronium bromide at doses of 0.6, 0.9, 1 and 1.2 mg / kg, or after the introduction of vecuronium bromide at a dose of 0.1 mg / kg, and after the administration of maintenance doses of these muscle relaxants ...
Sugammadex can be used at various times after the administration of rocuronium bromide or vecuronium bromide.
Renal failure Two open-label clinical trials compared the efficacy and safety of sugammadex in patients with or without severe renal failure undergoing surgery. In one study, sugammadex was administered to eliminate the blockade caused by rocuronium bromide in the presence of 1-2 post-tetanic responses (4 mg / kg; n = 68); in another study, sugammadex was administered at the appearance of a second response in a four-shot stimulation mode (T2) (2 mg / kg; n = 30). Recovery of neuromuscular conduction after blockade was slightly longer in patients with severe renal failure compared with patients without renal failure. There were no cases of residual neuromuscular blockade or its recurrence in patients with severe renal insufficiency in these studies.
Influence on the QTc interval. In three clinical trials of Sugammadex used alone, or in combination with rocuronium bromide or vecuronium bromide, or in combination with propofol or sevoflurane, there was no clinically significant increase in the QT / QTc interval.

Indications

The pharmacokinetic parameters of sugammadex are calculated based on the summation of the concentrations of free sugammadex and sugammadex in the composition of the sugammadex-muscle relaxant complex. Pharmacokinetic parameters such as clearance and Vd are considered to be ...

Contraindications

- severe renal failure (CC - severe hepatic failure;
- pregnancy;
- the period of breastfeeding;
- children under 2 years old;
- hypersensitivity to the components of the drug.

Dosage

Sugammadex should only be administered by or under the direction of an anesthesiologist. An appropriate monitoring method is recommended to monitor the degree of neuromuscular blockade and the restoration of neuromuscular conduction. According to the generally accepted ...

Overdose

So far, one report has been received of an accidental overdose of the drug at a dose of 40 mg / kg. There were no significant side effects. Sugammadex is well tolerated at doses up to 96 mg / kg with no side effects ...

Drug interactions

Bond-type interactions (hormonal contraceptives)
Due to the introduction of sugammadex, the effectiveness of some drugs may decrease due to a decrease in their (free) plasma concentration. In such a situation, it is necessary ...

Side effect

Most often (≥1 / 100 to The following adverse reactions are associated with the use of sugammadex.
Body system
Frequency of occurrence
Adverse reactions
Immune system disorder
Rarely (from ≥1 / ...

During pregnancy and breastfeeding

It is not recommended to use Sugammadex during pregnancy due to insufficient data.
The study of the excretion of sugammadex in milk in women during lactation has not been carried out, but, based on data from preclinical studies, this probability is not ...

Application for impaired liver function

Contraindicated in severe hepatic impairment.

Application for impaired renal function

Contraindicated in severe renal failure (QC Use in children Contraindicated in children under 2 years of age.

Use in elderly patients

Elderly patients: after the administration of sugammadex, in the presence of 2 responses in TOF stimulation mode against the background of blockade caused by rocuronium bromide, the total recovery time of neuromuscular conduction (T4 / T1 ratio up to 0.9) in adult patients ...

special instructions

Respiratory function monitoring during restoration of neuromuscular conduction
It is necessary to carry out mechanical ventilation until adequate spontaneous breathing is fully restored after the neuromuscular blockade is eliminated. Even if there was a complete recovery ...

Special conditions for admission

contraindicated in pregnancy, used with caution when breastfeeding, contraindicated in liver dysfunction, contraindicated in renal dysfunction, contraindicated for children, use with caution in elderly patients

Pharmacokinetics

The pharmacokinetic parameters of sugammadex are calculated based on the summation of the concentrations of free sugammadex and sugammadex in the composition of the sugammadex-muscle relaxant complex. Pharmacokinetic parameters such as clearance and Vd are considered to be ...

Terms of dispensing from pharmacies

The drug is available with a prescription.

Storage conditions

The drug should be stored out of the reach of children, protected from light, at a temperature of 2 ° to 8 ° C. Do not freeze. Shelf life is 3 years.

Release form

The solution for intravenous administration is transparent, from colorless to light yellow.
1 ml
sugammadex sodium
108.8 mg,
which corresponds to the content of sugammadex
100 mg
Excipients: hydrochloric acid - q.s. to pH 7 ....

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It is accompanied by muscle tension in the place where there were violations in the disc and displacement of the vertebra. A protective state of the muscles with increased tone is created.

In this way, the body tries to fix the vertebra. Therefore, it turns out, despite the problem, to keep the spine in an upright position.

In the place of tension, a stable focus of pain is created. This signal is sent to the brain, which in turn gives the command to increase the tension. And the pain gets worse.

A vicious circle is created. Stiffness appears in the tension zone, there may be a spasm. This situation does not allow the vertebra to fall into place and adds a negative effect on the nerve endings.

Muscle relaxants are drugs that relax muscles. The attending physician determines the appropriateness of their use in each specific case.

Muscle relaxants for osteochondrosis: classification

The drugs are divided into two groups:

1. Peripheral action.
   Muscle relaxants act in the neuromuscular system, disrupting the natural transmission of impulses. They are used mainly for surgical interventions. This group of drugs is divided into two types according to the mechanism of interaction with receptors:
   • depolarizing,
   • non-depolarizing.
2. Central action.
   Muscle relaxants affect the central nervous system. In the treatment of osteochondrosis, centrally acting relaxing drugs are used.

What drugs belong to muscle relaxants

Medicines that relax the skeletal muscles are called muscle relaxants. In the complex treatment of osteochondrosis, they are used relatively recently. Prior to this, muscle relaxants were used only in operations to relieve muscle tone.

Indications for use and principle of action

Muscle relaxants are used for osteochondrosis as part of complex treatment. The drugs themselves do not have a therapeutic effect. By relaxing the muscles, they make it possible to effectively carry out other effective measures: manual therapy, physiotherapy exercises, massage.

Muscle relaxants are not suitable for self-medication. The drugs have many contraindications due to side effects, therefore, the appropriateness of their appointment and the choice of a specific remedy can only be determined by a doctor.

Most often, the doctor prescribes muscle relaxants if osteochondrosis causes severe pain and, as a result, there is a restriction in movement. The drugs complement the action of non-steroidal ones.

In cases where there are contraindications to the use of NSAIDs, muscle relaxants are prescribed to replace them to some extent: relieve pain and relax muscles for further assistance.

List of drugs

Most often, drugs are used for osteochondrosis:

1. :
   Experts classify the drug as one of the safest effective drugs in comparison with the bulk of muscle relaxants.
   • Well tolerated.
   • It makes it possible to reduce the use of non-steroidal anti-inflammatory drugs. Mydocalm relaxes muscle spasm, and Lidocaine in its composition gives an analgesic effect.
   • The patient does not experience a decrease in mental and physical activity.
2. :
   • The drug is effective in chronic muscle spasticity. It is also used for acute muscle spasm.
   • Relieves spasm and increases the strength of muscle contractions.
3. Tizanidine:
   • Applied in case of spasm in the muscles of the back with osteochondrosis.
   • Reduces muscle resistance during passive movements.
4. Baclofen :
   • Well tolerated.
   • Used for moderate to severe back pain.
   • In combination with other drugs, it makes it possible to shorten the treatment time.

Centrally acting drugs

Active substance
Tolperisone	Lidocaine + Tolperisone	Chlorzoxazone	Tizanidine	Baclofen
Name of drugs
Mydocalm	Midocalm-Richter	Chlorzoxazone	Sirdalud	Baklosan
Tolperisone - OBL			Tizalud	Lyorezal Intrathecal
			Tizanidine
			Tizanidine-Teva

Peripheral tablets

The drugs are used in the following procedures:

• surgical interventions,
• reduction of dislocations,
• tracheal intubation.

For the complex treatment of osteochondrosis, muscle relaxants of peripheral action are not used.

Non-depolarizing relaxants			Depolarizing relaxants
Long-acting	Medium action	Short acting	Ultra short action time
Pancuronium (pavulon)	Rocuronium (esmeron)	Mivacurium (mivacron)	Suxamethonium
Pipecuronium (arduan)	Atracurium (trakrium)
Tubocurarine (tubarin)	Cisatracurium (nimbex)
	Vecuronium (norkuron)

Side effects

To help patients suffering from osteochondrosis, muscle relaxants of central action are prescribed for complex therapy. The doctor evaluates the appropriateness of the appointment, taking into account in each case the possibility of negative consequences.

Muscle relaxants can cause side effects:

• muscle weakness
• headache,
• decreased attention
• dry mouth
• violation of the liver,
• depressing effect on the work of the central nervous system,
• sudden convulsions
• indigestion, nausea, abdominal pain,
• drowsiness,
• apathy,
• violation of pressure in the direction of decrease or increase,
• sleep disorder
• allergic reactions: rash, bronchospasm, anaphylactic shock,
• hallucinations are possible,
• decreased heart rate,
• emotional instability, depression,
• disorders of urination.

Due to the large set of possible adverse reactions, the drugs are used in hospital treatment or at home under the supervision of a specialist. At this time, activities that require increased attention, driving a car, are excluded.

Muscle relaxants are not prescribed for a long time. This is due to possible negative reactions of the body, the ability of drugs to become addictive and increase the patient's weight.

Contraindications

A feature of central muscle relaxants is their rapid absorption by the digestive system. Drug metabolites appear in the liver and are excreted by the kidneys in the urine. Among the list of drugs, only Baclofen is excreted unchanged.

The rapid absorption of muscle relaxants increases the list of contraindications to their use:

• renal failure
• liver disease
• Parkinson's disease,
• pregnancy,
• lactation,
• atherosclerosis,
• epilepsy,
• stomach ulcer
• drug addict,
• mental instability,
• myasthenia gravis,
• allergy to the drug.

Muscle relaxants may be appropriate in the complex therapy of osteochondrosis. Their use requires caution and qualified medical support.