Almiba – amino acids and their derivatives.

Indications

Treatment of primary and secondary karnitinovy insufficiency at adults and children, including newborns and babies.

Secondary karnitinovy insufficiency at patients to whom the hemodialysis is carried out.

Suspicion on secondary karnitinovy insufficiency at patients to whom carry out a hemodialysis in the following cases:

• strong and persistent spasms in muscles and/or hypotensive episodes during dialysis;
• power deficit resulting in considerable negative impact on quality of life;
• muscle weakness and/or myopathy;
• cardiopathy;
• anemia which is not responding to treatment with erythropoietin or demanding high doses of erythropoietin;
• loss of muscle bulk.

Structure

• active ingredient: levocarnitine;
• 1 ampoule (5 ml) contains a left carnitine 1 g;
• other components: Acidum hydrochloricum, water for injections.

Contraindication

Hypersensitivity to medicament components.

Moderate gastrointestinal disturbances were observed by

at long reception of an oral left carnitine, including rapid nausea and vomiting, an abdominal pain and diarrhea. The dose decline often reduces or eliminates gastrointestinal symptoms. At long reception of an oral left carnitine it is necessary to control a specific smell of a body (reduction of a dose weakens or eliminates the smell caused by drug). At reception of a left carnitine with coumarinic anticoagulants the increase in the international ratio of INR is possible. It is necessary to control carefully shipping of Almiby within the first week of reception and after increase in a dose. Intravenous use of a left carnitine is usually transferred well.

Route of administration

is entered intravenously slowly within 2–3 min.

Use at congenital disturbance of metabolism.

in case of a sharp decompensation up to 100 mg/kg/days at 3–4 introductions. If necessary it is possible to apply also higher doses though at the same time side effects, in particular diarrhea can amplify.

Secondary deficit of a carnitine at patients to whom carry out a hemodialysis.

before therapy control of level of a carnitine in blood plasma.

at the acylcarnitine relation to a free carnitine in blood plasma more than 0.4 and/or when concentration of a free carnitine makes less than 20 µmol/l.

Dose of 20 mg/kg should be entered struyno intravenously at the end of each session of dialysis. The general reaction should be defined by monitoring of levels of an acylcarnitine and a free carnitine in plasma of blood and assessment of a condition of the patient. Normalization of maintenance of a carnitine in muscle tissue and cardiomyocytes occurs in 3 months after achievement of normal concentration of a carnitine in blood plasma. If to stop introduction of a carnitine, its levels surely will begin to decrease again. Need of the repeated saturating course of treatment is defined by quantitative definition of a carnitine in blood plasma by equal intervals and by monitoring of a condition of the patient.

Hemodialysis – maintenance therapy

After the saturating course of introduction of a left carnitine apply a maintenance dose – 1 g of medicament a day orally. In day of dialysis, medicament is used orally in a dose of 1 g right after completion of another session.

Use during pregnancy or feeding by a breast

Use of a left carnitine by the nursing women was not studied by

Feature of use

Ability to influence speed of response at control of motor transport or other mechanisms

.

Overdose

Messages about toxicity of a left carnitine at overdose was not. For treatment of overdose it is necessary to carry out maintenance therapy. High doses of medicament can cause diarrhea. Levokarnitin easily leaves from blood plasma by dialysis. Treatment: to take measures for removal of medicament from a digestive tract at intake, to carry out symptomatic and maintenance therapy. Did not report about the cases threatening overdose life.

Simultaneous use of glucocorticoids leads

to accumulation of a left carnitine in body tissues (except a liver). Other anabolic means enhance effect of Almiby.

In certain cases at reception of a left carnitine with coumarinic anticoagulants the increase in the international standard ratio of INR is possible

therefore their simultaneous use demands the reservation. INR or other tests of coagulation should be checked weekly while they are not stabilized, and monthly after that – at the patients accepting such anticoagulants together with a left carnitine.

Storage conditions

to Store

at a temperature not above 25 °C out of children's reach.