Nicergoline, as an alpha 1 adrenergic receptor antagonist, mainly exerts therapeutic effects by improving cerebral circulation and metabolism. Its drug interactions should focus on cardiovascular and metabolic enzyme effects. The following is a detailed explanation of the mechanism of action and interaction:

1 Pharmacological effects

(1) Vasodilatory effect: selectively blocking alpha 1 receptors, reducing cerebral vascular resistance, and increasing cerebral blood flow by 20-30%.

(2) Metabolic improvement: enhances neuronal glucose utilization, promotes ATP production, and improves cognitive function.

(3) Platelet inhibition: reduces TXA2 production, inhibits platelet aggregation, and lowers the risk of thrombosis.

(4) Neuroprotection: Relieve ischemia-reperfusion injury and protect nerve cells through antioxidant effects.

2 drug interactions

2.1 Synergistic use of antihypertensive drugs

(1) Combined use with calcium channel blockers can cause superimposed hypotension, requiring monitoring of blood pressure and adjustment of dosage.

(2) ACEI drugs may enhance their vasodilatory effect, and should be administered in combination every 4 hours.

2.2 Effects of Anticoagulants

(1) Warfarin metabolism may be disrupted, increasing the risk of INR value fluctuations by 30% and requiring close monitoring.

(2) Combining with new oral anticoagulants may increase bleeding tendency, so avoid simultaneous use.

2.3 Central nervous system drugs

(1) Dopamine receptor agonists may enhance their vasodilatory effect, leading to orthostatic hypotension.

(2) Combined use with SSRI antidepressants may increase the risk of 5-HT syndrome.

2.4 Effects of Liver Enzymes

(1) CYP3A4 strong inhibitors (such as ketoconazole) can increase blood drug concentrations by 2-3 times, requiring a 50% reduction.

(2) CYP2D6 slow metabolizers need to extend the dosing interval to prevent drug accumulation.

2.5 Special Interactions

(1) Foods containing casein may cause a sudden increase in blood pressure, and a low casein diet is necessary during medication.

(2) Alcohol can enhance the vasodilation effect, and drinking alcohol is prohibited during medication.