Brainmax 100 mg/ml + 100 mg/ml solution for intravenous and intramuscular injection 5 ml ampoules 10 pcs.

As part of the complex therapy for acute and chronic cerebrovascular disorders:
- ischemic stroke (brain infarction), transient ischemic attack;
- dyscirculatory encephalopathy, cerebrovascular insufficiency;
- mild cognitive impairments of atherosclerotic origin;
- reduced work capacity;
- mental and physical overloads (including in athletes, see "Special Instructions").

• For acute cerebrovascular disorders, including ischemic stroke and transient ischemic attack, the drug is administered in the first 10 days as part of combination therapy - 5 ml (500 mg + 500 mg) once daily intravenously by infusion; for the following 14 days - 5 ml (500 mg + 500 mg) twice daily intramuscularly.

• For dyscirculatory encephalopathy in the decompensation phase, the drug is administered 2.5 ml (250 mg + 250 mg) intravenously by infusion twice daily for 14 days. Then intramuscularly 2.5 ml once daily for 14 days.

• For chronic cerebral blood supply disorders and in the treatment of the consequences of acute cerebrovascular disorders, the drug is administered intramuscularly or intravenously 2.5 ml (250 mg + 250 mg) twice daily for 10 days. Then orally 2 capsules (500 mg + 500 mg) once daily or 1 capsule of the drug (250 mg + 250 mg) twice daily. The total treatment course lasts 4-6 weeks.

• For cognitive disorders and encephalopathy, the drug is prescribed intramuscularly 2.5 ml (250 mg + 250 mg) once daily for 14-30 days.

• For reduced performance, asthenic conditions, and mental and physical overloads, the drug is prescribed intramuscularly 5 ml (500 mg + 500 mg) once daily for 10-14 days. If necessary, treatment may be repeated after consultation with a physician in 2-3 weeks.
Due to the possible development of an excitatory effect, the drug BRAINMAX® is recommended to be used in the first half of the day. The method of administration and duration of the treatment course are determined individually, depending on the indication, severity of the condition, and other factors.

Per 1 ml:
Active ingredients: ethylmethylhydroxypyridine succinate - 100.0 mg, meldonium dihydrate - 100.0 mg.
Excipients: hydrochloric acid solution 7 M - to pH 4.0-5.0, water for injections - to 1.0 ml.

A clear liquid ranging from light yellow to brownish-yellow in color.

- Hypersensitivity to the components of the drug
- Acute liver failure
- Acute kidney failure
- Increased intracranial pressure (in cases of impaired venous outflow and intracranial tumors)
- Pregnancy
- Breastfeeding period
- Age under 18 years

With caution
Chronic liver and kidney diseases, bronchial asthma.

Use during pregnancy and breastfeeding
The BRAINMAX® drug is contraindicated during pregnancy and breastfeeding due to insufficient data on the efficacy and safety of the drug during these periods. Breastfeeding should be discontinued prior to starting the medication.

Meldonium may yield a positive result in doping control. Since January 1, 2016, meldonium has been included in the list of prohibited substances by the World Anti-Doping Agency.
Patients with chronic liver and kidney diseases should exercise caution when using the medication for an extended period.
There is insufficient data on the use of the medication in children under 18 years of age.

Effect on the ability to drive vehicles and operate machinery
During the course of treatment, caution should be exercised when performing work that requires increased attention and quick psychomotor reactions (driving vehicles, operating machinery, etc.).

The frequency of side effects was determined according to the classification of the World Health Organization (WHO): very common (> 10%); common (> 1%, but 0.1%, but 0.01%, but < 0.1%); very rare (< 0.01%); frequency unknown (frequency cannot be determined based on available data).Meldonium Blood and lymphatic system disorders Frequency unknown: eosinophilia. Immune system disorders Rare: allergic reactions (skin redness, skin rash, urticaria, itching, swelling, angioedema). Cardiac disorders Very rare: tachycardia. Vascular disorders Rare: decreased or increased blood pressure. Gastrointestinal disorders Common: dyspeptic phenomena. Nervous system disorders Common: headaches. Frequency unknown: agitation. General disorders Frequency unknown: general weakness.Ethylmethylhydroxypyridine succinate Immune system disorders Very rare: angioedema, urticaria. Gastrointestinal disorders Very rare: dry mouth, nausea, pain, burning and discomfort in the epigastric region, heartburn, flatulence, diarrhea. Nervous system disorders Very rare: headache. Skin and subcutaneous tissue disorders Very rare: rash, itching, hyperemia. Psychiatric disorders Very rare: drowsiness.If you notice any other side effects not listed in the instructions, please inform your doctor.The drug is low in toxicity and does not cause severe adverse reactions. Symptoms: decreased blood pressure, accompanied by headache, tachycardia, dizziness, and general weakness. Drowsiness, insomnia. Treatment: treatment is usually not required; symptoms resolve on their own within 24 hours. In cases of pronounced manifestations, supportive and symptomatic treatment is administered.Meldonium Enhances the effects of coronary dilators, certain antihypertensive agents, and cardiac glycosides. Can be combined with prolonged-release forms of nitrates, other antianginal agents, anticoagulants, antiplatelet agents, antiarrhythmic agents, diuretics, and bronchodilators. Due to the possible development of tachycardia and arterial hypotension, caution should be exercised when combining with nitroglycerin (for sublingual use) and antihypertensive agents (especially alpha-adrenergic blockers and short-acting forms of nifedipine). Simultaneous use of the drug with other preparations containing meldonium is not permitted as it may increase the risk of adverse reactions.Ethylmethylhydroxypyridine succinate Ethylmethylhydroxypyridine succinate can be combined with all medications used for the treatment of somatic diseases. Enhances the effects of benzodiazepines, antidepressants, anxiolytics, antiepileptic agents (carbamazepine), and antiparkinsonian agents (levodopa), as well as nitrates. Reduces the toxic effects of ethanol.

BRAINMAX® is a combined medicinal product, the action of which is determined by its components. Pharmacodynamics

Meldonium
A structural analogue of gamma-butyrobetaine. It inhibits gamma-butyrobetaine hydroxylase, suppresses the synthesis of carnitine, and the transport of long-chain fatty acids across cell membranes, preventing the accumulation of activated forms of unoxidized fatty acids - derivatives of acylcarnitine and acyl-CoA in cells.
In conditions of ischemia, it restores the balance of oxygen delivery and consumption processes in cells, prevents disturbances in adenosine triphosphate (ATP) transport; at the same time, it activates glycolysis, which occurs without additional oxygen consumption. As a result of reduced carnitine concentration, gamma-butyrobetaine, which has vasodilating properties, is synthesized more intensively. Meldonium, in conditions of ischemia, restores the balance of oxygen delivery and consumption processes in cells, prevents disturbances in ATP transport; at the same time, it activates glycolysis, which occurs without additional oxygen consumption. The mechanism of action determines the diversity of its pharmacological effects: increased performance, reduced symptoms of mental and physical strain, activation of tissue and humoral immunity, cardioprotective action.
In the case of acute ischemic damage to the myocardium, it slows the formation of the necrotic zone and shortens the rehabilitation period. In heart failure, it increases myocardial contractility, enhances tolerance to physical exertion, and reduces the frequency of angina attacks. In acute and chronic ischemic disorders of cerebral circulation, it improves blood circulation in the ischemic area and promotes blood redistribution in favor of the ischemic site. It has a tonic effect on the central nervous system, alleviating functional disorders of the somatic and autonomic nervous systems in patients with chronic alcoholism during withdrawal syndrome.

Ethylmethylhydroxypyridine succinate
Ethylmethylhydroxypyridine succinate is an inhibitor of free radical processes and a membrane protector. It has anti-hypoxic, stress-protective, nootropic, anticonvulsant, and anxiolytic effects.
The mechanism of action of ethylmethylhydroxypyridine succinate is due to its antioxidant and membrane-protective effects. The drug inhibits lipid peroxidation, increases the activity of superoxide dismutase, enhances the lipid-protein ratio, and improves the structure and function of cell membranes. Ethylmethylhydroxypyridine succinate modulates the activity of membrane-bound enzymes (calcium-independent phosphodiesterase, adenylate cyclase, acetylcholinesterase), receptor complexes (benzodiazepine, gamma-aminobutyric acid, acetylcholine), which enhances their ability to bind with ligands, contributes to the preservation of the structural-functional organization of biomembranes, neurotransmitter transport, and improves synaptic transmission. Ethylmethylhydroxypyridine succinate increases dopamine levels in the brain. It causes enhanced compensatory activation of aerobic glycolysis and reduces the degree of inhibition of oxidative processes in the Krebs cycle under hypoxia, increasing ATP and creatine phosphate levels, and activating energy-synthesizing functions of mitochondria.
It increases the body's resistance to various damaging factors (shock, hypoxia and ischemia, cerebrovascular disorders, ethanol intoxication, and antipsychotic medications).
In conditions of critically reduced coronary blood flow, it helps maintain the structural-functional organization of cardiomyocyte membranes, stimulates the activity of membrane enzymes - phosphodiesterase, adenylate cyclase, acetylcholinesterase. It supports the activation of aerobic glycolysis that develops during acute ischemia and contributes to the restoration of mitochondrial redox processes under hypoxia, increasing ATP and creatine phosphate synthesis. It ensures the integrity of the morphological structures and physiological functions of the ischemic myocardium.
It improves the clinical course of myocardial infarction, enhances the effectiveness of ongoing therapy, and reduces the frequency of arrhythmias and disturbances in intracardiac conduction.
It normalizes metabolic processes in the ischemic myocardium, increases the antianginal activity of nitrates, improves the rheological properties of blood, and reduces the consequences of reperfusion syndrome in acute coronary insufficiency.
It reduces enzymatic toxemia and endogenous intoxication in acute pancreatitis.
It improves metabolism and blood supply to the brain, microcirculation, and rheological properties of blood, reducing platelet aggregation.
It stabilizes the membranes of blood cells (erythrocytes and platelets), reducing the likelihood of hemolysis. It has a hypolipidemic effect, decreasing total cholesterol and low-density lipoprotein levels.

Meldonium + Ethylmethylhydroxypyridine succinate
The combined use of meldonium and ethylmethylhydroxypyridine succinate leads to a synergistic pharmacodynamic interaction of the two components, enhancing the neuroprotective activity of the product. When using the combined medicinal product BRAINMAX®, the anti-hypoxic, antioxidant, nootropic, and anti-ischemic effects of the two active substances exceed the pharmacological effect of each component used separately, leading to a reduction in clinical manifestations of cerebrovascular insufficiency, improvement in cognitive functions, enhancement of memory and attention, normalization of emotional state, reduction of symptoms of mental and physical strain, increased performance, and increased tolerance to mental and physical loads.
Clinical studies have shown that the BRAINMAX® product, compared to its single components (meldonium and ethylmethylhydroxypyridine succinate), has a more pronounced positive effect on the condition of patients with ischemic stroke in the acute and early recovery periods, increasing the level of functionality and mobility of patients, significantly reducing the severity of cognitive impairments, and improving neurological status.

After intramuscular administration of the drug, the maximum concentration of active substances in the blood plasma is reached within 0.25 - 1 hour.
The drug is well distributed in organs and tissues, with an apparent volume of distribution averaging 250-350 L for ethylmethylhydroxypyridine and 35-80 L for meldonium. The half-life of the drug is from 0.26 to 0.73 hours for ethylmethylhydroxypyridine; T1/2 of meldonium with parenteral administration of 2-4 ml of BRAINMAX® is from 1 to 3.5 hours, and with administration of higher doses (8 ml), T1/2 increases to 7 hours.