Pronoran is a synthetic anti-parkinsonian drug. The action of the drug is characterized by the properties of the components included in its composition. Piribedil is the main active ingredient of Pronoran.
Due to the properties inherent in the active component of this tool, the drug, penetrating into the bloodstream of the patient's brain, has an effective anti-Parkinsonian effect.
Pronoran is used at all stages of the disease, and also has a direct effect on the underlying motor symptoms.
Clinical and pharmacological group
Anti-parkinsonic drug - dopaminergic receptor agonist.
Pharmacy sales terms
It is released on prescription.
How much does Prononoran cost in pharmacies? The average price is at the level of 600 rubles.
Release form and composition
The dosage form of Pronoran is a coated, red controlled release tablet.
The composition of the drug:
- The active substance is piribedil (50 mg per tablet);
- Inactive ingredients: povidone, magnesium stearate and talc;
- Shell composition: polysorbate 80, carmellose sodium, povidone, colloidal silicon dioxide, sodium bicarbonate, titanium dioxide, talc, sucrose, white beeswax, crimson dye.
Peronoran tablets are sold in 30 pcs. in blisters, 1 blister per pack.
The active ingredient of the tablets Pronoran is a dopamine receptor agonist. After penetrating the structures of the central nervous system, piribedil binds to dopamine receptors. It is also an antagonist of alpha receptors in brain structures that blocks.
Taken together, such an effect on various receptors of tissues and brain structures causes the anti-Parkinsonian therapeutic effect of the Pronoran tablets. The data were confirmed during clinical studies.
Indications for use
According to the instructions, Prononoran is used in such cases:
- Parkinson's disease (in forms that mainly include tremor) - as monotherapy, or in combination with levodopa drugs (at the onset of the disease and in the later stages of the disease, especially in forms accompanied by tremor).
- Chronic cognitive impairment and neurosensory deficiency in the process of aging (including disorders of memory and attention) - as an auxiliary symptomatic therapy.
- Symptoms of ophthalmologic diseases of the ischemic nature (decrease in color contrast, narrowing of the visual field, decrease in visual acuity, etc.).
- Intermittent claudication caused by obliterating diseases of the arteries of the lower extremities (stage II according to the classification of Leriche and Fontein) - as an auxiliary symptomatic therapy.
The use of Pronoran is contraindicated:
- With collapse;
- Children and teenagers under 18;
- In acute myocardial infarction;
- Simultaneously with neuroleptics (with the exception of clozapine);
- In case of hypersensitivity to piribedil or any auxiliary component.
The tablets contain sucrose, so the drug is also contraindicated in case of intolerance to fructose, galactose and / or glucose, with a deficiency of sucroisomaltase.
Use during pregnancy and lactation
Animal experiments did not reveal a direct or indirect negative impact on the development of the embryo and fetus, the process of childbirth and postnatal development. However, in mice, piribedil has been proven to penetrate the placental barrier and is distributed throughout the body of the fetus. Therefore, Pronoran is not recommended to appoint patients during pregnancy and 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 method of use
The instructions for use indicate that Pronoran is taken orally. The pill should be taken after a meal, drink half a glass of water, without chewing.
According to 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.
In Parkinson's Disease in the form of monotherapy prescribed 150-250 mg / day (3-5 tab. / day), divided into 3 doses per day. If necessary, taking the drug in a dose of 250 mg is recommended to take 2 tab. on 50 mg in the morning and in the afternoon and 1 tab. in the evening.
When used in combination with levodopa preparations, the daily dose is 150 mg (3 tab.): It is recommended to be divided into 3 doses.
When selecting the dose in case of its increase, it is recommended to titrate the dose, gradually increasing by 1 tab. (50 mg) every 2 weeks.
Termination of treatment
The abrupt cessation of dopaminergic receptor agonist therapy is associated with the risk of developing an antipsychotic malignant syndrome. To avoid this, the dose of piribedil should be reduced gradually, until complete withdrawal.
Disorder of habits and drives
In order to avoid the risk of developing habits and cravings, the lowest effective dose of the drug should be prescribed. If you experience these symptoms, you should consider reducing the dose or phasing out drug therapy (see “Special Instructions”).
The side effects of Pronoran are predominantly associated with its dopaminergic activity, are dose dependent, are moderate in nature, usually occur at the beginning of treatment and disappear after treatment.
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, agitation, hallucinations, confusion, drowsiness (sometimes in the daytime, up to a sudden sleep);
- Since the cardiovascular system: infrequently - arterial hypotension, orthostatic hypotension with instability of blood pressure, malaise or loss of consciousness;
- On the part of the digestive system: often - minor digestive disorders (flatulence, nausea, vomiting).
In patients with Parkinson’s disease, the following disorders may also occur: desire to shop, compulsive (psychogenic) overeating, gambling addiction, hypersexuality, and increased libido.
Overdose symptoms are disorders of the gastrointestinal tract function (nausea and vomiting caused by the action of piribedil on the chemoreceptor trigger zone) and blood pressure lability (its sharp increase or decrease).
In this case, the drug is immediately canceled and symptomatic therapy is prescribed.
- It is known that dopamine agonists violate the systemic regulation of blood pressure, as a result of which orthostatic hypotension may develop. It is recommended to control blood pressure, especially at the beginning of treatment, due to the general risk of orthostatic hypotension associated with taking dopaminergic drugs. Considering the age of the population receiving Piribedil therapy, the risk of falls, which can be caused by sudden falling asleep, hypotension, or confusion, should be considered.
- In some patients (especially in patients with Parkinson's disease), while receiving piribedil, a state of severe drowsiness, sometimes even sudden falling asleep, sometimes occurs suddenly. Sudden falling asleep during daily activities, in some cases unconscious or arising without prior symptoms, is extremely rare, but, nevertheless, patients driving a car and / or working on equipment requiring a high degree of attention should be warned about this. When such reactions occur, patients should abandon driving and / or working on equipment that requires a high degree of attention. In addition, consideration should be given to reducing the dose of piribedil or discontinuing therapy with this drug.
- It was reported cases of behavioral disorders that were associated with such manifestations as confusion, agitation, aggression. If you experience these symptoms, you need to consider reducing the dose or phasing out drug therapy.
Disorder of habits and desires:
- Patients should be supervised to detect the development of a conduct disorder. Patients and their caregivers should be warned about the possible symptoms of disorder of habits and drives (gambling addiction, increased libido and hypersexuality, an obsessive desire to shop and overeating / compulsive overeating) when taking dopamine agonists, including piribedila. If you experience these symptoms, you need to consider reducing the dose or phasing out drug therapy.
- Dopamine agonists can cause or intensify psychotic disorders such as delirium, delirium, and hallucinations (see the “Drug Interactions” section). If you experience these symptoms, you need to consider reducing the dose or phasing out drug therapy.
Malignant neuroleptic syndrome:
- Symptoms similar to the neuroleptic malignant syndrome have been reported with abrupt withdrawal of dopaminergic drugs (see section “Dosing regimen”).
Dyskinesia (motor disorders):
- In patients with progressive Parkinson’s disease while receiving levodopa preparations, dyskinesia may develop at the beginning of a piribedil dose titration. In this case, reduce the dose of piribedil.
- Peripheral edema has been reported during dopamine agonist therapy. This should be considered when appointing piribedil.-
- The dye crimson, which is part of the drug, in some patients increases the risk of allergic reactions.
When using the drug, you must consider the interaction with other drugs:
- The use of piribedil in conjunction with alcohol is not recommended.
- Antiemetic neuroleptics: antiemetic drugs that do not cause extrapyramidal symptoms should be used.
- Due to the mutual antagonism between dopaminergic anti-parkinsonian drugs and tetrabenazine, simultaneous administration of these drugs is not recommended.
- Caution must be exercised when prescribing piribedil with other drugs that have a sedative effect.
- In connection with the mutual antagonism between dopaminergic anti-parkinsonian drugs and antipsychotics, the simultaneous appointment with antipsychotics (with the exception of clozapine) is contraindicated (see the section “Contraindications”).
- Patients with extrapyramidal syndrome caused by the administration of antipsychotics should be prescribed anticholinergic therapy and dopaminergic antiparkinsonian drugs should not be prescribed (due to the blocking of dopaminergic receptors by neuroleptics).
- Dopaminergic receptor agonists can cause or exacerbate psychotic disorders. If neuroleptic drugs are prescribed to patients with Parkinson's disease receiving dopaminergic anti-parkinsonian drugs, the dose of the latter should be gradually reduced to permanent withdrawal (the sudden cancellation of dopaminergic drugs is associated with the risk of developing “malignant neuroleptic syndrome”) (see “Special instructions”).
In general, reviews about Pronoran are very few, since it is mainly prescribed to elderly patients. Opinions of patients about its effectiveness vary significantly, which does not allow to determine the exact degree of usefulness of this not very expensive drug.
When taking the drug, there are often pronounced side effects, so only an experienced specialist should select a treatment regimen for Parkinson's disease.
Structural analogues of the active substance:
Analogs on the therapeutic effect (means for the treatment of Parkinson's disease):
- On whom;
- Pantogam asset;
- PC Merz;
- Requipo Modutab;
- Role of CP;
Before using analogues consult your doctor.
Storage conditions and shelf life
There are no special conditions for storing tablets. It is recommended to store it in its original factory packaging out of the reach of children. The shelf life is 3 years from the date of manufacture.