Efficacy of mildronate in patients with alcohol withdrawal syndrome

This article presents the experience of effective use of the drug mildronate in drug treatment and psychiatric practice.

At the beginning – a few words about the drug itself, its use in general medicine and about its mechanisms of action.
Possibilities of clinical use of mildronate have been widely studied in cardiology, therapy, neurology and ophthalmology.

In particular, mildronate is used as:

• As an anti-ischemic agent in angina pectoris
• In acute and chronic cardiovascular failure, in myocardial dystrophic changes
• In disorders of blood circulation in the cerebral vessels (cerebral strokes, chronic insufficiency of cerebral circulation)
• In vascular eye pathology (hemorrhages of the retina and vitreous body, diabetic retinopathy)
• Pulmonary diseases (protracted bronchopneumonia, chronic bronchitis, bronchial asthma)
• To improve the performance of people with severe physical overexertion

Mildronate has the effect of

Distinct antioxidant and antihypoxant effect, being a reversible regulator of carnitine-dependent oxidation of fatty acids. As a result of taking mildronate improves oxygenation of body tissues, activation of redox processes in organs and tissues, including the brain. The drug promotes redistribution of blood flow to ischemic areas of the heart, brain, and retina.

Pharmacokinetic characteristics of mildronate

• rapidly absorbed from the gastrointestinal tract
• the bioavailability of mildronate is 78%.
• blood concentration of mildronate peaks 1-2 hours after ingestion
• the elimination half-life is 3-6 hours

Mildronate is used:

• for therapeutic purposes
• as a therapeutic and prophylactic course
• as monotherapy
• as part of complex therapy with other drugs

We studied the use of Midronate to relieve withdrawal syndrome in chronic alcoholism.

The aim of this work was to evaluate the effectiveness of Mildronate in the complex treatment of patients with alcoholism to relieve withdrawal.

Inclusion criteria for the study    

• Men 25-50 years old,
• Stage II chronic alcoholism with advanced withdrawal syndrome

Exclusion criteria

• Chronic alcoholism stage I and III
• Patients under 25 and over 50 years of age
• Severe concomitant somatic pathology
• Presence of psychotic disorders and epilepsy syndrome in the withdrawal state
• Concurrent use of narcotic and substance abuse agents other than alcohol with dependence on them
• Symptomatic alcoholism

Materials and methods of the study

The material of the study were:

1. Main group: 20 patients with chronic alcoholism stage II in the state of withdrawal.
2. Control group: 10 patients with chronic alcoholism stage II in withdrawal state.

Both groups of patients received comprehensive pharmacotherapy (detoxification treatment, vitamin therapy, tranquilizers in standardized doses).

The main group of patients in the treatment complex included the drug Mildronate under the following scheme: during the first 3 days – 500 mg (5 ml 10% solution) intramuscularly 2 times a day (morning, afternoon), later in capsules – 500 mg 2 times a day orally (morning, afternoon) for the next 7 days.

The clinical-psychopathological method of research was used.       

We developed a dynamic observation chart during treatment of patients with mildronate.

In the developed map of dynamic observation during the treatment of patients we used a 3-point scale for assessing disorders:

• 0 – absence of symptom,
• 1 – mild degree of severity of the disorder,
• 2 – average degree of disorder expression,
• 3 – severe severity of the disorder

The following symptoms were evaluated:

1. Asthenic disorders:
   • Signs of asthenia proper (emotional lability)
   • Autonomic manifestations (tachycardia, hyperhidrosis, pulse rate, arterial hypertension)
   • Sleep disturbance
   
2. Symptoms of intoxication neurological dysfunction (tremor, coordination disorders)
3. Degree of severity of secondary alcohol craving

The rate and degree of symptom reduction in patients during complex treatment with and without the use of mildronate was compared.

The following results were obtained. In the course of complex treatment with mildronate 3 – 5 days such manifestations of alcohol withdrawal syndrome as tachycardia, sweating, arterial hypertension, sleep improved faster, asthenia reduced, the degree of severity of secondary pathological craving for alcohol decreased markedly.

During treatment with mildronate we have not observed any side effects and complications of treatment with this drug. Nevertheless, the following side effects and contraindications for mildronate use have been described in literature: rare allergic reactions in the form of urticaria, unpleasant sensations in epigastrium area, feeling of heaviness in chest. The drug is not recommended for patients with thyroid hyperfunction, with cirrhosis of the liver, with severe chronic renal failure.

Conclusions

• Mildronate is an effective drug in the complex treatment of alcoholics with withdrawal syndrome
• Mildronate effectively accelerates relief of vegetative manifestations of withdrawal syndrome, including sleep disturbances
• Mildronate has a clear anti-asthenic effect in relieving alcohol withdrawal syndrome
• Mildronate reduces the severity of secondary pathological cravings for alcohol in the state of alcohol withdrawal
• Mildronate affects coordination disorders in alcohol withdrawal syndrome