Andipal

Andipal is a combination drug that contains several active ingredients:

1. Bendazole: An anti-inflammatory and analgesic agent commonly used to relieve pain and inflammation.
2. Metamizole sodium: Also known as analgin, it is an anti-inflammatory, antipyretic and analgesic drug used to relieve pain and fever.
3. Papaverine hydrochloride: A muscle relaxant that relieves spasms of the smooth muscles of organs such as the intestines and urinary tract. It is also used to relieve spasms of the intragastric muscles.
4. Phenobarbital: An anticonvulsant and hypnotic used to treat seizures and as a sleep aid.

This drug is often used to relieve various types of pain, including headaches, muscle spasms, toothaches, etc. It may be prescribed by a doctor for short-term symptom relief, but is not recommended for long-term use without consulting a doctor due to the presence of phenobarbital, which is a barbiturate and may have side effects with long-term use.

Indications Andipala

1. Headache: Including tension headache, migraine and other forms of headache.
2. Muscle Spasms: Andipal can help relieve muscle spasms caused by a variety of reasons such as injury, overwork, or other conditions.
3. Intestinal spasms: For various gastrointestinal disorders accompanied by pain and spasms.
4. Menstrual Pain: To relieve pain and discomfort associated with the menstrual cycle.
5. Toothache: For toothache, including dental caries or after tooth extraction.
6. Pain in urological diseases: To relieve pain in cystitis, pyelonephritis and other urological diseases.

Release form

Tablets: This is the most common form the drug is available in. Tablets are usually packaged in blisters or jars and are taken orally with water.

Pharmacodynamics

1. Bendazole: Bendazole has anti-inflammatory and analgesic effects. It blocks cyclooxygenase, which leads to a decrease in the formation of prostaglandins responsible for inflammation and pain. This helps reduce inflammation and relieve pain.
2. Metamizole sodium (analgin): Metamizole sodium has anti-inflammatory, antipyretic and analgesic effects. It reduces the formation of prostaglandins, which leads to a decrease in pain and inflammation.
3. Papaverine hydrochloride: Papaverine is a myotropic antispasmodic. It relaxes the smooth muscles of blood vessels, the gastrointestinal tract and other organs, which helps relieve spasms and improve blood supply.
4. Phenobarbital: Phenobarbital is a barbiturate that has sedative and anticonvulsant effects. It reduces the excitability of the central nervous system, which can help relieve nervous tension and improve sleep quality.

The combination of these components allows the drug to have a wide spectrum of action and be used to relieve various types of pain and spasms.

Pharmacokinetics

1. Bendazole:

• Suction:
  • Well absorbed from the gastrointestinal tract.
• Distribution:
  • It is evenly distributed throughout the body tissues.
• Metabolism:
  • Metabolized in the liver to active metabolites.
• Withdrawal:
  • It is excreted by the kidneys, mainly in the form of metabolites.
• Half-life:
  • Approximately 2-4 hours.

2. Metamizole sodium (Analgin):

• Suction:
  • Rapidly and completely absorbed from the gastrointestinal tract.
• Distribution:
  • It is well distributed throughout tissues, penetrates the placental barrier and into breast milk.
• Metabolism:
  • Metabolized in the liver to active metabolites.
• Withdrawal:
  • It is excreted by the kidneys, mainly in the form of metabolites.
• Half-life:
  • Approximately 7-12 hours.

3. Papaverine hydrochloride:

• Suction:
  • Well absorbed from the gastrointestinal tract.
• Distribution:
  • It is evenly distributed throughout the tissues, penetrates the placental barrier and into breast milk.
• Metabolism:
  • Metabolized in the liver.
• Withdrawal:
  • It is excreted by the kidneys in the form of metabolites.
• Half-life:
  • Approximately 0.5-2 hours.

4. Phenobarbital:

• Suction:
  • Slowly but completely absorbed from the gastrointestinal tract.
• Distribution:
  • It is widely distributed throughout the body's tissues, including the brain, and passes through the placental barrier and into breast milk.
• Metabolism:
  • Metabolized in the liver.
• Withdrawal:
  • Excreted by the kidneys, 25-50% unchanged.
• Half-life:
  • Approximately 2-4 days.

Dosing and administration

1. For adults: The usual adult dose is 1-2 tablets (or capsules) of Andipal up to 3 times daily. For greater pain or spasm relief, your doctor may recommend increasing the dosage to 2 tablets (or capsules) per dose. The maximum daily dose is usually no more than 6 tablets (or capsules).
2. For children: The dosage for children is determined based on the child's age and weight, so it is important to follow the doctor's instructions or the instructions on the medication.
3. For elderly patients: For elderly patients, it is usually recommended to start with a lower dosage due to possible increased sensitivity to the drug and increased risk of side effects.
4. Directions for use: Tablets (or capsules) should be taken orally with a glass of water. The injection solution should be administered intramuscularly or intravenously only by a doctor or medical professional.
5. Duration of treatment: The duration of the course of treatment is determined by the doctor depending on the nature and severity of the disease. Andipal is usually used for a short period of time to relieve symptoms.

Use Andipala during pregnancy

1. Metamizole sodium:

   • Metamizole sodium is not recommended for use during pregnancy due to limited safety data and a possible risk of agranulocytosis (a decrease in the number of granulocytes in the blood), which is a serious side effect. Research suggests that use of metamizole in the first trimester may increase the risk of congenital anomalies (Dathe et al., 2017).

2. Phenobarbital:

   • Phenobarbital, used as an anticonvulsant, may cause developmental delays and alterations in neuroendocrine function in offspring. Animal studies have shown that phenobarbital may impair reproductive function and delay the onset of puberty in offspring exposed to phenobarbital prenatally (Gupta & Yaffe, 1981).
   • Phenobarbital may also reduce the production of gonadotropic hormones, which are important for maintaining pregnancy, and may lead to miscarriage (Patil & Rao, 1982).

3. Papaverine hydrochloride:

   • There is insufficient data on the effects of papaverine hydrochloride on pregnancy. However, it is known to relax smooth muscles and may affect the uterus. The use of papaverine should be carefully justified by a doctor.

4. Bendazole:

   • Bendazole has immunomodulatory and vasodilating properties. There is insufficient data on its safety during pregnancy, which requires caution when using it.

Contraindications

1. Individual intolerance to the components of the drug: People with a known allergy to bendazole, metamizole sodium, papaverine hydrochloride, phenobarbital or other ingredients of the drug should not take Andipal.
2. Severe impairment of liver or kidney function: Since metabolism and elimination of the drug occurs primarily via the liver and kidneys, patients with severe impairment of these organs may be at risk of accumulation of active metabolites or other metabolic by-products.
3. Hypertension: The drug should be used with caution in patients with hypertension due to the possible effect on blood pressure.
4. Pregnancy and breastfeeding: The use of Andipal during pregnancy or breastfeeding should be discussed with a doctor, as its safety in these cases may not be sufficiently studied.
5. Childhood: Andipal should be used in children under strict medical supervision and only if the benefits outweigh the potential risks.
6. Porphyria: Andipal is contraindicated in patients with porphyria due to the possibility of exacerbating this disease.

Side effects Andipala

1. Drowsiness and dizziness: This is one of the most common side effects that can be caused by the drug. Patients may experience drowsiness, fatigue, or dizziness after taking Andipal.
2. Lowering blood pressure: Papaverine contained in Andipal may cause lowering of blood pressure in some patients, especially when the drug is administered rapidly.
3. Dry mouth: This is one of the common side effects associated with antispasmodic and analgesic drugs.
4. Gastrointestinal disorders: Various gastrointestinal disorders such as nausea, vomiting, diarrhea or constipation may occur.
5. Allergic reactions: Some patients may experience allergic reactions such as skin rash, itching, or angioedema.
6. Central Nervous System Depression: Phenobarbital, contained in Andipal, can cause central nervous system depression, manifested by drowsiness, fatigue, and even respiratory depression in overdose.
7. Seizures: Some patients may experience seizures as a result of using this drug.
8. Other side effects: Other adverse effects may also occur, such as heart rhythm disturbances, changes in blood pressure, increased liver activity, etc.

Overdose

1. Extreme drowsiness or fainting.
2. Severe heart rhythm problems, including fast or slow heartbeats.
3. Dizziness and severe headache.
4. Cramps or muscle spasms.
5. Severe breathing difficulties, including respiratory arrest.
6. Changes in blood pressure, including hypertension or hypotension.

Interactions with other drugs

1. Alcohol: Concomitant use of alcohol with Andipal may enhance its sedative effect and cause drowsiness and dizziness.
2. Centrally acting drugs: The use of Andipal together with other drugs that have a depressant effect on the central nervous system, such as hypnotics, sedatives, antidepressants or neuroleptics, may increase the sedative effect and cause increased drowsiness.
3. Anticonvulsants: Using Andipal with anticonvulsants may reduce their effectiveness or increase side effects.
4. Antidepressants: Concomitant use of Andipal with serotonin reuptake inhibitors (eg, sertraline, fluoxetine) may increase the risk of developing serotonin syndrome.
5. Antihypertensive agents: Papaverine contained in Andipal may enhance the hypotensive effect of antihypertensive drugs, which may lead to a significant decrease in blood pressure.