Mechanism of action: block H-ChRs of the sympathetic and parasympathetic ganglia, the adrenal medulla and the carotid glomerulus.

According to their chemical structure, ganglion blockers are divided into:

Quaternary ammonium compounds: benzohexonium, pentamine, dimecoline, hygronium.

Tertiary amines: pachycarpine, pyrylene.

According to the duration of action, ganglion blockers are divided into:

Long-acting ganglion blockers (6-10 hours or more): benzohexonium (hexonium), dimecoline, pyrylene (pempidine tonsilate).

When the sympathetic and parasympathetic ganglia are blocked, the flow of impulses from the central nervous system to peripheral tissues decreases, which leads to a decrease in vascular tone, intestinal motility, production of exocrine glands, etc.

Medium-acting ganlioblockers (4-6 hours): pentamine (azamethonium).

Short-acting ganglion blockers (10-15 minutes): hygronium, arfonade.

Indications for the use of ganglion blockers:

Edema of the lungs, brain (pyrylene, pentamine).

Controlled hypotension in anesthesiology (hygrony).

Eclampsia, causalgia (pentamine, pachycarpine).

Relief of hypertensive crises (pentamine, benzohexonium).

Peptic ulcer of the stomach and duodenum (benzohexonium, pyrylene).

Obliterating endarteritis, spasm of peripheral vessels (pyrylene, pachycarpine, benzohexonium, pentamine).

Toxicosis of pregnancy (pyrylene).

Rodostimulation (pachycarpine).

Spasm of the intestines and biliary tract, renal colic (pentamine).

Baby Features: Children are prescribed only for hypertensive crises, edema of the brain, lungs, and left ventricular failure.

Side effects:

Constipation, bloating, intestinal atony (myasthenic syndrome) and bladder (urinary retention).

Tachycardia.

General weakness, dizziness.

Dry mouth.

Visual impairment.

Thrombosis.

Muscle relaxants (MR)

Antidepolarizing Mixed Depolarizing

Pipecuronium bromide Dioxonium Dithiline

(arduan), pancuronium

bromide, atrocurium

(traquarium), mevacu-

riy (mevacron).

Mechanism of action of anti-depolarizing MRs: block H-ChRs of skeletal muscles and compete with ACh for interaction with receptors.

Mechanism of action of depolarizing MRs: first, skeletal muscle H-AChRs are briefly activated (cholinomimetic phase). As a result, depolarization of the receptor membrane occurs, accompanied by fibrillation of skeletal muscles with loss of K. Depolarization is then replaced by loss of sensitivity of the receptor to ACh - desensitization. It is considered as a consequence of changes in the conformation of the receptor and the inhibitory effect of K on K-Na-ATPase, which delays the repolarization of the postsynaptic membrane and the restoration of its response to incoming impulses.

Mechanism of action of mixed MR: first induces a depolarizing phase and then acts as an anti-depolarizing MR. In the second phase, prozerin weakens the effect of dioxonium. During anesthesia with ether and fluorothane, the effect of dioxonium increases. See Figure 4.

Fig.5. Mechanism of action of muscle relaxants.

Indications for use:

Anesthesiology: tracheal intubation, endoscopic procedures (ditilin, dioxonium).

Reposition of bones in case of fracture, reduction of dislocations (vecuronium bromide, pancuronium bromide).

Treatment of tetanus, convulsive conditions (alcuronium chloride, dithiline).

Immobilization of the eyeball (ditilin).

Side effects:

Respiratory depression.

Muscle postoperative pain.

Cardiac arrhythmias.

Bronchospasm.

Hypokalemia.

Hyperhidrosis.

Increased intraocular pressure.

Neuromuscular block.

Children's features: children of the first years of life are highly sensitive to antidepolarizing muscle relaxants, this is due to a small supply of ACh in presynaptic endings. When excitation arrives, less ACh is released into the synaptic cleft. But the effect of using these drugs disappears faster than in adults. Most often used in anesthesiology.

These drugs block the action of acetylcholine and similar agonists on nicotinic receptors in both parasympathetic and sympathetic autonomic ganglia. Some members of the group also (or perhaps exclusively) block ion channels that are gated by nicotinic cholinergic receptors. Due to their ability to block all autonomic pathways, ganglion blockers are still of exceptional interest for pharmacological and physiological research. However, lack of selectivity leads to this wide range side effects that these drugs are rarely used in the clinic.
Ganglioblockers include:
- Short-acting drugs (trimethophan camsilate, hygronium, imekhin);
- Medicines of medium duration of action (benzohexonium, pentamin).

• Table . Drug interactions of anticholinergic drugs

  Primary drug	Concomitant drug	Type and level of interaction	Interaction mechanism	Result of interaction
  Ganglioblockers	Indomethacin and its analogues		Decreased synthesis of vasodilatory prostaglandins
  	Pyrazolone derivatives (phenylbutazone)	FD, functional blood pressure regulation system	Retention of Na+ ions and water	Reducing the hypotensive effect
  	Glucocorticosteroids	FD, functional blood pressure regulation system	Retention of Na+ ions and water	Reducing the hypotensive effect
  	Thiazide diuretics	FD, functional blood pressure regulation system	Excretion of Na+, K+ ions and water
  	Adrenergic agonists	PD, α and β adrenergic receptors	Antagonism due to stimulation of adrenergic receptors (vasoconstriction of organs abdominal cavity, skin, to a lesser extent skeletal muscles)	Weakening the effect of ganglion blockers: increasing the strength and frequency of heart contractions, increasing blood pressure
  	H1- histamine blockers, hypnotics, antipsychotics, narcotic analgesics, tricyclic antidepressants, local anesthetics	PD, functional blood pressure regulation system (CNS, peripheral vessels)	Synergy	Increased hypotensive effect
  	Anticholinesterase drugs (proserine, physostigmine, neostigmine methyl sulfate)	PD, cholinergic receptors	Antagonistic interaction: blockade of H-cholinergic receptors of the autonomic ganglia is weakened by an indirect cholinomimetic effect due to potentiation of the action of endogenous acetylcholine	They can be used in case of an overdose of ganglion blockers to reduce the effects caused by these drugs: impaired accommodation, dilation of the bronchi, decreased gastrointestinal motility, increased heart rate, decreased bladder tone, decreased blood pressure, etc. Can be used in cases of overdose of ganglion blockers to reduce the effects caused by these drugs: impaired accommodation, dilation of the bronchi, decreased gastrointestinal motility, increased heart rate, decreased bladder tone, decreased blood pressure
  	N-cholinomimetics	PD, cholinergic receptors	Antagonistic interaction: blockade of H-cholinergic receptors of the autonomic ganglia is weakened by a direct cholinomimetic effect	Can be used in case of overdose of ganglion blockers to reduce the pharmacodynamic effects caused by these drugs: disturbances of accommodation, bronchial dilatation, decreased gastrointestinal motility, increased heart rate, decreased bladder tone, decreased blood pressure
  	Other antihypertensive drugs	FD, functional blood pressure regulation system	Summation of effects	Increased hypotensive effect

  
  

They are derivatives of either quaternary nitrogen - hexamethonium bromide (benzohexonium) , Azamethonium bromide (pentamine), Trepirium iodide (hygronium), or tertiary - pachycarpine hydroiodide. pempidine(pyrylene). All quaternary amines are poorly absorbed in the gastrointestinal tract and do not pass into the central nervous system, while tertiary amines - are easily resorbed in the intestine and penetrate the blood-brain barrier.

The mechanism of their action is associated with the blockade of H-cholinergic receptors of the ganglia and the adrenal medulla (evolutionarily - the ganglion). The conduction of impulses to organs through the sympathetic and parasympathetic nerves decreases or stops (pharmacological denervation of organs), the sympathetic and parasympathetic influence on organs and tissues decreases. Vascular tone (arterioles and venules) is mainly determined by the sympathetic nervous system and endogenous adrenaline produced by chromaffin cells of the adrenal gland. Blockade of the sympathetic ganglia and adrenal medulla reduces the amount of norepinephrine (in synapses) and adrenaline (in the blood), blood vessels dilate (both arterioles and venules) - blood pressure drops. Ganglion blockers dilate peripheral vessels, improve blood supply and microcirculation in the extremities (indicated for spasm of peripheral vessels).

The function of the heart, smooth muscles, gastrointestinal tract, bladder, and glandular secretions are mainly supported by the parasympathetic system. Blockade of intramural parasympathetic ganglia inhibits the stimulating effect of the vagus nerve and reduces contractions of the smooth muscles of internal organs (gastrointestinal tract, bladder, bronchi, etc.), that is, it gives a pronounced antispasmodic effect. For the same reason, the secretion of glands (salivary, gastrointestinal tract) decreases, heart contractions become more frequent, and paralysis of accommodation develops. Indications for use:

1. Hypertensive crises. For this purpose, pentamine and benzohexonium are used.

2. Edema of the lungs and brain due to high blood pressure. Ganglion blockers dilate peripheral vessels (both arterioles and venules), blood is deposited in the periphery, its flow to the “right” heart is reduced and the pulmonary circulation is unloaded, decreasing hydrostatic pressure in the vessels of the lungs and brain. The expansion of venules helps to reduce the venous return of blood to the heart, which improves its working conditions.

3. Controlled hypotension. Artificial hypotension is used to bleed the surgical field during surgical interventions on the heart, cerebral vessels (the risk of edema is reduced), pelvic organs, and dental operations (on tissues with abundant blood supply). Ganglion blockers dilate peripheral vessels, and blood is deposited in the periphery, which leads to a decrease in bleeding in the surgical field. At the same time, ganglion blockers prevent the development of negative autonomic reactions to organs and blood vessels during surgical interventions. For controlled hypotension, short-acting drugs are mainly used (hydronium, imekhin - administered intravenously).

4. Treatment of peripheral vascular spasms (endarteritis, Raynaud's disease).

5. Peptic ulcer of the stomach and duodenum. Ganglion blockers reduce the secretion of gastric juice and relax the smooth muscles of the stomach and intestines, creating functional peace of the ulcerated mucosa.

In addition, ganglion blockers are sometimes used as bronchodilators (as one of the components of treatment), and pachycarpine, which stimulates uterine contractility, with weak labor.

Unfortunately, the use of ganglion blockers often leads to serious complications:

1) orthostatic collapsed state (a sharp drop in blood pressure when a person moves from a horizontal to a vertical position). Depositing blood in the vessels of the limbs and organs reduces systemic blood pressure in the vessels of the brain. When the position of the body changes due to gravity, the blood is redistributed - it goes to the underlying areas of the body, the brain bleeds, and the patient loses consciousness. For prevention, it is recommended to be in a horizontal position (lying down) for 1.5-2 hours after administration of the drug;

2) atony of the intestine (up to obstruction) and bladder. Due to the blockade of the parasympathetic ganglia, a pronounced antispasmodic effect, the motor and secretory functions of the gastrointestinal tract are disrupted, and constipation develops. Decreased bladder contractility can lead to urinary retention.

In addition, the use of ganglion blockers may be accompanied by photophobia (dilated pupils), visual impairment (accommodative paralysis), dry mouth, and tachycardia.

In addition to the central nervous system, the human body also has one that controls the functioning of many internal organs. Relatively recently, scientists have developed a new group of chemicals called “ganglioblockers.” Drugs from this group can control the functioning of the autonomic nervous system and improve the patient’s condition in many diseases.

Basic information

Thanks to numerous nerve endings, the autonomic system controls the activity of almost all internal organs (lungs, heart, intestines, etc.). The functioning of the autonomic nervous system itself is regulated by the brain. The transmission of nerve impulses is carried out thanks to special chemicals. In some clinical cases, it may be necessary to block the transmission of nerve impulses, that is, to suspend the production of these substances. Ganglioblockers can solve this problem.

Drugs can be short-, medium- and long-acting. Such drugs are used in anesthesiology, for the treatment of complex cases of toxicosis of pregnant women, hypertension. However, the action of ganglion blockers is not always effective and may be accompanied by side effects. Therefore, it is strictly forbidden to use such medications without consulting a doctor. Most drugs are not available in pharmacies without a prescription.

"Gigronium"

The drug is available in powder form for the preparation of a solution. The medication is administered by injection intravenously or intramuscularly. You can’t just buy Gigroniy at a pharmacy. The prescription must be written by the attending physician. Due to its ganglion-blocking effect, the drug is used in anesthesiology when it is necessary to control the patient’s blood pressure. In addition, the drug is used in obstetric practice. With its help it is possible to stop attacks of eclampsia.

"Gigronium" has a number of contraindications. This may include thrombosis, hypotension, acute stage of myocardial infarction, renal or liver failure. In old age (after 65 years), the medication is used with caution. Some patients may develop hypersensitivity.

The ganglion-blocking effect is observed within 5 minutes after intravenous administration of the drug and persists for 15-20 minutes. This is sufficient for short-term blood pressure control (for simple surgical interventions).

"Azamethonium bromide"

The drug is a potent ganglion blocker. The active component selectively blocks autonomic nerve receptors. Azamethonium bromide is widely used for hypertensive crises, bronchial asthma, pulmonary and cerebral edema. With the help of the drug, it is possible to control blood pressure in anesthesiology and normalize the condition of pregnant patients suffering from eclampsia.

The medication is used in the form of injections (intramuscular or intravenous). The exact dosage is determined by the doctor in accordance with the patient’s disease and the individual characteristics of the body. In this case, contraindications must be taken into account. These include the following conditions: angle-closure glaucoma, central nervous system, kidney and liver dysfunction, acute myocardial infarction. The medicine is used with caution in elderly people, as well as in patients suffering from bronchial asthma and thrombophlebitis.

"Gangleron"

By blocking vegetative impulses, the drug has an anesthetic and antispasmodic effect. For peptic ulcers of the stomach and duodenum, the drug "Gangleron" is widely used. The instructions indicate that the drug can also be prescribed for angina pectoris and impaired mobility of the gastrointestinal tract. The medicine is administered intramuscularly or subcutaneously. The dosage is determined by the doctor.

The medication has its contraindications, like other ganglion blockers. Drugs of this type are not used for arterial hypotension or in the presence of degenerative changes in the central nervous system. In rare cases, hypersensitivity to the active ingredient may develop. Under no circumstances should the medicine be administered intravenously. This can lead to a sharp decrease in blood pressure.

"Benzohexonium"

The drug is considered one of the most popular in the treatment of arterial hypertension. Allows you to quickly stop a hypertensive crisis "Benzohexonium". Instructions for use indicate that the drug can also be prescribed for chronic gastritis, some forms of bronchial asthma, gastric and duodenal ulcers. Benzohexonium tablets are used to treat mild pathologies. The instructions for use indicate that the drug is also available in the form of an injection solution.

The medicine is used to lower blood pressure in surgical practice (anesthetic effect). In this case, the drug is used in the form of a solution and is administered intravenously. For the treatment of stomach diseases, a solution for intramuscular administration can be used.

Taking the wrong medication can lead to side effects (weakness, dizziness, dry mouth). The deterioration in health is associated with a sharp decrease in blood pressure. It is recommended to use the drug in a hospital setting, where the patient can receive timely assistance in case of collapse.

"Pentamine"

The medicine has a pronounced hypotensive effect. The drug Pentamin is widely used for hypertensive crises. The instructions indicate that it is produced in the form of a solution for intramuscular or intravenous injection. The active ingredient is azomethonium bromide.

The medication is used in a hospital setting and can be prescribed for the following pathological processes: cerebral edema, pulmonary edema, a sharp increase in blood pressure, acute attacks of bronchial asthma, intestinal spasms, renal colic. To create controlled hypotension, Pentamin can also be used in anesthesiology. The instructions indicate that the medicine is available only by prescription.

The drug has the same contraindications as other ganglion blockers. These are myocardial infarction, hypotension, thrombophlebitis, and angle-closure glaucoma.

"Imekhin"

The medicine produces a pronounced hypotensive effect, like other ganglion blockers. Drugs from this group are widely used in surgical practice, as well as to relieve hypertensive crises. However, remove high blood pressure This medicine will not work at home. The medication is used exclusively under the supervision of a physician. The drug "Imekhin" is also used to treat cerebral and pulmonary edema and relieve acute attacks of bronchial asthma.

The drug has many side effects. One of them is which is characterized by a sharp decrease in blood pressure when changing body position (from vertical to horizontal). In addition, during therapy the patient may complain of dry mouth, general weakness, and frequent dizziness.

"Temekhin"

This ganglion blocking agent is available in tablet form. The medicine is prescribed for Raynaud's syndrome, gastric and duodenal ulcers, and arterial hypertension. The active ingredient produces a pronounced analgesic effect. It is recommended to take the tablets after meals. The dosage and duration of therapy are determined by the doctor.

Contraindications include the acute period of myocardial infarction, hypotension, liver and kidney damage, and angle-closure glaucoma. The medication is not suitable for self-medication. You can purchase tablets only with a doctor's prescription.

Bottom line

Ganglion blocking agents are indispensable in many areas of medicine. However, the use of drugs from this group should be strictly controlled by a specialist. An overdose can lead to serious side effects, including death. Therefore, ganglion blockers are used in hospitalization or in emergency medical care. You cannot use such drugs on your own, even after carefully studying the instructions.

The sensitivity of H-cholinergic receptors to the action of drugs is different, which also manifests itself with blockade of H-cholinergic receptors. Medicines of one group block H-cholinergic receptors of the autonomic ganglia, sinocarotid zone, and adrenal medulla - ganglion blockers; another group - block H-cholinergic receptors at neuromuscular synapses - peripherally acting muscle relaxants or curare-like drugs.

GANGLION BLOCKERS

By blocking H-cholinergic receptors of the sympathetic and parasympathetic autonomic ganglia, medicines this group causes a number of characteristic changes:

Ganglion blockers dilate blood vessels and reduce blood pressure, which is due to the blockade of sympathetic ganglia and the elimination of sympathetic vasoconstrictor impulses;

Ganglion blockers reduce the release of adrenaline by blocking H-cholinergic receptors in the adrenal medulla;

Ganglion blockers reduce impulses to the vasomotor center from the carotid glomerulus, blocking H-cholinergic receptors in the carotid sinocarotid zone; these properties of ganglion blockers are used to treat hypertension, however, it should be borne in mind that this may cause a sharp drop in blood pressure, especially when changing body position - orthostatic collapse (therefore, after taking ganglion blockers, you should be in a horizontal position for 2-3 hours); dilation of the vessels of the lower extremities and improvement of their blood supply make it possible to use ganglion blockers also for the treatment of diseases accompanied by peripheral circulatory disorders (obliterating endarteritis, etc.); They are also used for pulmonary and cerebral edema, as well as for controlled hypotension during operations to reduce blood loss (short-acting ganglion blockers);

Ganglion blockers reduce the tone of smooth muscles of internal organs and reduce the secretion of glands, including glands of the gastrointestinal tract; this allows them to be used for the treatment of gastric and duodenal ulcers, hyperacid gastritis, etc.;

Ganglioblockers have (some ganglioblockers) a stimulating effect on the muscles of the uterus (for example, pachycarpine increases the tone of the muscles of the uterus and also reduces blood pressure, which is used during childbirth, especially in the case of high blood pressure in women in labor);

Ganglion blockers reduce the effect of sympathetic innervation on organs; used in surgical practice as premedications prescribed before surgery in combination with other drugs.

Due to side effects (orthostatic collapse, intestinal and bladder atony, dry mouth, impaired accommodation, development of addiction), ganglion blockers are currently used as inpatient therapy.

SHORT-ACTING GANGLION BLOCKERS

IMEKHIN- used for controlled hypotension, for pulmonary and cerebral edema, to relieve a hypertensive crisis. Imekhin is administered intravenously as a 0.01% solution of the drug in a 5% glucose solution or isotonic sodium chloride solution. Side effects when using imekhin: allergic reactions. Imequin should not be administered in the same syringe with barbiturates. Imekhin release form: ampoules of 1 ml and 2 ml of 1% solution. List B.

An example of a recipe for imekhin in Latin:

Rp.: Sol. Imechini 1% 1 ml

D.t. d. N. 6 in ampull.

S. Dilute 1 ml of 1% solution in 100 ml of 5% glucose solution and administer intravenously 90-120 drops per day

HYGRONIUM(pharmacological analogues: trepirium iodide) - used for controlled hypotension in the form of a 0.1% solution for nephropathy in pregnant women, eclampsia. Hygronium is used to relieve a hypertensive crisis. Side effects of hygronium: a sharp decrease in blood pressure. Hygronium release form: 10 ml ampoules containing 0.1 g of drug powder. List B.

Example of a recipe for hygronia in Latin:

Rp.: Hygronii 0.1

D.t. d. N. 10 in ampull.

S. Dissolve the contents of the ampoule in an isotonic sodium chloride solution and administer intravenously.

LONG-ACTING GANGLION BLOCKERS

BENZOHEXONIUM(pharmacological analogues: hexamethonium benzosulfonate) - used for the treatment of hypertension, relief of hypertensive crises, spasm of peripheral vessels, gastric and duodenal ulcers, bronchial asthma. Benzohexonium is administered orally, subcutaneously, intramuscularly. Side effects when using benzohexonium: orthostatic collapse, mydriasis, bladder atony. Contraindications to the use of benzohexonium: arterial hypotension, liver and kidney dysfunction. Release form of benzohexonium: tablets of 0.1 g and ampoules of 1 ml of 2.5% solution. List B.

Example of a benzohexonium recipe in Latin:

Rp.: Tab. Benzohexonii 0.1 N. 20

D.S. 1 tablet 3 times a day.

Rp.: Sol. Benzohexonii 2.5% 1 ml

D.t. d. N. 6 in ampull.

S. 1 ml intramuscularly 1 time per day.

PENTAMINE(pharmacological analogues: Azamethonium bromide) - indications for use, side effects and contraindications for use are the same as for benzohexonium. Pentamine release form: ampoules of 1 ml of 5% solution. List B.

Example of a pentamin recipe in Latin:

Rp.: Sol. Pentamini 5% 1 ml

D.t. d. N. 6 in ampull.

S. 0.5 ml intramuscularly, gradually increasing the dose to 1 ml 2-3 times a day.

DIMECOLINE(pharmacological analogues: dimecoline iodide) - is close in action to benzohexonium. Dimecoline has the same indications for use, side effects and contraindications. Caution is required when combined with nitroglycerin, the effect of which is potentiated by dimecoline. Dimecoline release form: tablets of 0.025 g. List B.

Example of a recipe for dimecoline in Latin:

Rp.: Tab. Dimecolini 0.025 N. 50

D.S. 1 tablet 2 times a day, gradually increasing the dose to 2 tablets 2 times a day.

PACHYCARPINE HYDRIOIDIDE- used for spasms of peripheral vessels, to stimulate labor and reduce bleeding in the postnatal period. Pachycarpine hydroiodide is prescribed orally, subcutaneously, intramuscularly. Pachycarpine hydroiodide is contraindicated during pregnancy, severe hypotension, liver and kidney diseases. Release form pachycarpine hydroiodide: tablets 0.1 g; ampoules of 2 ml of 3% solution. Pachycarpine hydroiodide is available only with a doctor's prescription! List B.

Example of a recipe for pachycarpine hydroiodide in Latin:

Rp.: Tab. Pachycarpini hydroiodidi 0.1 N. 12

D.S. 1 tablet 2 times a day.

Rp.: Sol. Pachycarpini hydroiodidi 3% 2 ml

D.t. d. N. 10 in ampull. S. 2-4 ml intramuscularly 1 time per day.

CAMPHONIUM(pharmacological analogues: trimethidine methosulfate) - gives a pronounced ganglion-blocking effect. Camphonium is prescribed orally and parenterally (subcutaneously, intramuscularly). Indications for use, side effects and contraindications are typical for ganglion blockers. Kamphonium release form: powder; tablets 0.01 g; ampoules of 1 ml of 1% solution. List B.

Example of a camphonium recipe in Latin:

Rp.: Tab. Camphonii 0.01 N. 20

D.S. 1 tablet 1-2 times a day.

Rp.: Sol. Camphonii 1% 1 ml

D.t. d. N. 10 in ampull. S. 1 ml intramuscularly 1-2 times a day.

QUATERON- the action is close to benzohexonium. Quateron has the same indications for use, side effects and contraindications. Quateron is sometimes used to treat angina pectoris. Release form of quateron: powder and tablets of 0.02 g. List B.

Example of a quaterone recipe in Latin:

Rp.: Tab. Quateroni 0.02 N. 25

D.S. 1-2 tablets 3-5 times a day.

PYRYLENE(pharmacological analogues: pempidine tosylate) - used in the same cases as benzohexonium, has the same contraindications and side effects. Pyrylene release form: tablets of 0.005 g. List B.

Example of a pyrylene recipe in Latin:

Rp.: Tab. Pirileni 0.005 N. 20

D.S. 1-2 tablets 3-4 times a day.

TEMEKHIN- has indications for use, contraindications, side effects characteristic of ganglion blockers of this group. Tamekhin release form: tablets0.001 g each. List B.

Example of a tamehin recipe in Latin:

Rp.: Tab. Temechini 0.001 N. 50

D.S. 1 tablet 2-4 times a day.