Myonal (Eperisone) is NOT Effective for Treating Lactic Acidosis
Myonal (eperisone) has no role in the treatment of lactic acidosis. The medication you're referring to appears to be a muscle relaxant, and there is no evidence supporting its use for lactic acid management. The evidence provided includes metamizole (an analgesic/antipyretic) 1, but neither eperisone nor metamizole have any established role in treating lactic acidosis.
What Actually Works for Lactic Acidosis
The treatment of lactic acidosis focuses on addressing the underlying cause, not on medications like Myonal:
Primary Treatment Strategy
The cornerstone of lactic acidosis management is identifying and aggressively treating the underlying cause 2. This includes:
- Restore tissue perfusion with fluid resuscitation (15-20 mL/kg/h isotonic saline initially) if shock is present 2
- Treat sepsis aggressively with source control, antibiotics within 3 hours, and hemodynamic support 2
- Discontinue offending medications immediately, such as metformin in patients with renal impairment or NRTIs in HIV patients 2, 3
What NOT to Use
Sodium bicarbonate is explicitly NOT recommended for improving hemodynamics or reducing vasopressor requirements in hypoperfusion-induced lactic acidemia with pH ≥7.15 4, 2. Two blinded, crossover RCTs comparing equimolar saline and bicarbonate in patients with lactic acidosis failed to reveal any difference in hemodynamic variables or vasopressor requirements 4. Bicarbonate administration may cause sodium and fluid overload, increase lactate and PCO₂, and decrease serum ionized calcium 4, 5.
Definitive Treatment for Specific Causes
- For metformin-associated lactic acidosis: Hemodialysis is the definitive treatment and often reverses symptoms 2, 6
- For D-lactic acidosis (short bowel syndrome): Restrict mono/oligosaccharides, encourage polysaccharides, provide thiamine supplements, and administer broad-spectrum antibiotics 2
- For NRTI-induced lactic acidosis: Discontinue NRTIs immediately due to high mortality without intervention 2
Common Pitfalls to Avoid
- Do NOT use muscle relaxants or analgesics like Myonal/eperisone or metamizole for lactic acidosis treatment—they have no therapeutic role
- Do NOT ignore persistent hyperlactatemia (≥2 mmol/L) even in the absence of hypotension, as it may indicate occult tissue hypoperfusion 2
- Do NOT delay imaging when mesenteric ischemia is suspected (lactic acidosis + abdominal pain + elevated urea)—diagnostic delay is the dominant factor in mortality (30-70%) 2