medicament Almiba is used for treatment of primary and secondary karnitinovy insufficiency at adults and children, including newborns and babies. A secondary karnitinova insufficiency at patients to whom the hemodialysis is carried out.

Suspicion on a secondary karnitinova 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 that results in considerable negative impact on quality of life;
• Muscle weakness and/or myopathy;
• Cardiopathy;
• Anemia, does not respond to treatment with erythropoietin or demands high doses of erythropoietin;
• Loss of muscle bulk.

Structure

Active ingredient: levocarnitine;

a left carnitine - 1 g

Excipients: hydrochloric acid, water for injections.

Route of administration

Drug is administered intravenously slowly within 2-3 min.

Use at congenital disturbance of metabolism. During therapy it is reasonable to control the level of a carnitine and acylcarnitine both in blood plasma, and in urine. The necessary dose depends on specifics of congenital disturbance of metabolism and weight of manifestations of a disease. In case of a sharp decompensation the recommended dose can make up to 100 mg/kg a day in 3-4 introductions. In case of need 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 it is necessary to control carnitine level in blood plasma. The secondary deficit of a carnitine is diagnosed at the acylcarnitine relation to free a carnitine in blood plasma more than 0.4 and/or when concentration of a free carnitine makes less than 20 µmol/l. The dose of 20 mg/kg should be entered intravenously struyno 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 approximately in 3 months after achievement of normal concentration of a carnitine in blood plasma. If to stop introduction of a carnitine its level by all means will begin to decrease again. Need repeated saturating a course of treatment is defined by quantitative definition of a carnitine in blood plasma through equal intervals and by monitoring of a condition of the patient.

Hemodialysis - maintenance therapy. After saturating a 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 inside in a dose of 1 g right after completion of another session.

Feature of use

Pregnant

In view of serious consequences of karnitinovy insufficiency for the pregnant woman, the risk of interruption of treatment for mother is considered big, than theoretical risk for a fruit, in case of treatment continuation.

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 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 overdose cases which threatened life.

Moderate gastrointestinal disorders were observed by

at long reception of an oral left carnitine, including fleeting 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 anticoagulants coumarinic increase in the international standard ratio of INR is possible. It is necessary to control carefully tolerance of medicament within the first week of reception and after any increase in a dose. Intravenous use of a left carnitine is usually well transferred.

Interaction

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 anticoagulants coumarinic increase in the international standard ratio of INR is possible

therefore their simultaneous use demands the reservation. INR or others 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.

Expiration date - 4 years.