Blemaren

Pharmacological properties

upon dissolution of effervescent tablets blemarin in water, potassium-sodium hydrocitrate is formed and carbon dioxide is released. in this case, residual alkaline ions are formed, which are secreted by the kidneys. Thus, an increase in the urine ph index occurs (depending on the dose, it is neutralized or alkalized). this increases the degree of dissociation and, at the same time, the degree of dissolution of uric acid and cystine. confirmation of litholysis of uric acid calculi is performed by x-ray.

When taking the drug, the excretion of citrates increases and the excretion of calcium in the urine decreases. Alkalization of urine, increased excretion of citrates and decreased excretion of calcium lead to a decrease in the amount of calcium oxalate in the urine, since in a weak alkaline environment, citrate forms stable complexes with calcium. In addition, citrate ion should be considered as an effective physiological inhibitor of crystal formation and accumulation of calcium oxalate and calcium phosphate.

Pharmacokinetics After taking Blemaren for a day, the tablets are effervescent, the injected amount of sodium and potassium is excreted from the body by the kidneys for 24–48 hours. With prolonged use of the drug, daily excretion of potassium and sodium corresponds to daily intake. In the blood or in the blood plasma, there are no significant changes in the indicators of gases in the blood or electrolytes. This means that due to renal regulation of alkalization, the acid-base balance in the body is maintained, and the accumulation of sodium and potassium during normal renal function does not occur.

Indications

Blemaren is used to treat urolithiasis with the goal of:

- alkalization of urine in patients with urate calculi in the presence of concomitant calcium calculi or without them;

- metaphylaxis of calcium calculi (prevention of re-formation of new calculi and / or increase in residual fragments).

Application

The average daily dose is determined individually, it is established by determining the pH of urine.

Effervescent tablets are taken after dissolving in a liquid (water or fruit juice). The liquid may be slightly cloudy and have some undissolved particles on the surface.

The daily dose is divided into 3 equal parts, which are taken during the day (for example, at 8:00, 14:00, 21:00). If you need a daily dose of more than 3 tablets, it is recommended to take one tablet in the morning, one in the middle of the day, and the rest at night.

Monitoring the effectiveness of the drug is carried out by determining the pH of fresh urine 3 times a day before the next dose. To do this, use standard indicator strips enclosed in each package. The indicator zone of the test strip should be briefly immersed in urine, then taken out and after 2 minutes compare the obtained color of the test strip with the color scale applied to the set of indicator strips, and record certain pH values ​​in the control calendar. The dose of the drug is considered correctly selected if the pH values ​​determined 3 times a day are within the recommended limits for each pathology. Changing the color of unused indicator strips does not affect pH results.

To dissolve uric acid (urate) calculi, urine pH should be in the range of 7.0–7.2.

If the daily pH profile is below 7.0, the dose should be increased, and if it is above 7.2, lower.

For maintenance treatment of patients with urolithiasis, which is accompanied by calcium calculi, the pH level must be kept in the range of 6.2–6.8.

If the daily profile of pH values ​​is below the level of 6.2, the dose should be increased, and if it is above the level of 6.8, reduce.

In order to dissolve urea-oxalate mixed stones and metaphylaxis of the formation of calcium-oxalate stones, urine pH must be maintained for a certain time at a level of 6.8–7.4.

The drug Blemaren before remote nephrolithotripsy with mixed (X-ray inhomogeneous) stones is used to enhance its effectiveness, reduce the structural density of the stone and reduce the number of repeated sessions. The duration of citrate therapy in order to prepare for remote lithotripsy should be at least 3 weeks.

To alkalize urine in patients with cystine stones, the pH of the urine should be in the range of 7.5–8.5. This requires a higher dose of the drug.

During cytostatic therapy, urine pH should not be lower than 7.0, and in the treatment of late skin porphyria, 7.2–7.5.

Uricosuric therapy, as well as the treatment of urate stones, should be carried out at a urine pH of 7.0–7.2.

The pH value that can be determined using standard indicator strips is in the range of 5.4–7.4. If it is necessary to control the pH of urine in patients with cystine calculi or with late porphyria of the skin, special indicator strips should be used to determine the pH in the range of 7.2–9.7.

For the dissolution of calculi (depending on their size and composition), the duration of the course of treatment is from 4 weeks to 6 months. To prevent relapse of nephrolithiasis, the drug should be prescribed in courses, the duration and frequency of which are set individually for each patient.

Contraindications

Hypersensitivity to the components of the drug; renal failure; urinary tract infections caused by bacteria that decompose urea (risk of struvite stones); metabolic alkalosis; episodic hereditary adynamia.

Side effects

With individual intolerance to any components of the drug, hypersensitivity reactions are possible. in some cases, taking pills can cause gastrointestinal upsets in predisposed patients. reported belching, heartburn, abdominal pain, flatulence, diarrhea, nausea, vomiting.

special instructions

In conditions that contribute to the formation of urinary calculi (for example, parathyroid adenoma, uric acid calculi, which are associated with malignoma), etiotropic therapy should be taken.

When dissolving uric acid stones, one should not allow for many days to excessive alkalization of urine (pH above 7.8), given the possible appearance of a precipitate of phosphate salts on the surface of the uric acid calculus, which may prevent its further dissolution. In addition, a prolonged and pronounced alkaline metabolic state is undesirable.

Before using the drug, it is necessary to determine the level of electrolytes in blood plasma and check kidney function. If there is a suspicion of renal tubular acidosis, it is necessary to additionally monitor the indicators of acid-base balance.

During treatment, the parameters of urine and blood tests should be regularly checked. Particular attention should be paid to the acid-base balance.

Patients with heart failure should take into account the effect of potassium on myocardial excitability: 1 tablet of Blemaren contains 380 mg of potassium ions or 9.7 mmol of potassium, which can affect the effect of cardiac glycosides (an increase in extracellular potassium concentration reduces the effectiveness of glycosides, and its decrease enhances the arrhythmogenic effect )

In patients with impaired uric acid metabolism, the drug is recommended to be combined with allopurinol.

Persons who adhere to a diet that restricts sodium intake should take into account the increased sodium content in this drug (1 tablet contains 220 mg of sodium ions or 9.7 mmol of sodium).

During therapy with the drug, it is recommended to adhere to a low-protein diet, that is, limit the intake of foods rich in purines (e.g. meat, sausages, animal entrails, sardines), as well as limit the intake of salt. Every day you need to drink 2-3 liters of liquid in the form of tea, fruit juice or alkaline mineral water.

The drug does not contain carbohydrates and it can be used to treat patients with diabetes.

Patients with severe hepatic impairment should take Blemaren only under close monitoring.

The drug should not be used in patients with hereditary galactose intolerance, with Lapp lactase deficiency or impaired glucose-galactose absorption.

Use during pregnancy or lactation. When using the drug according to the instructions, there was no negative effect during pregnancy and lactation.

The ability to influence the reaction rate when driving vehicles or other mechanisms. Does not affect.

Children. The effectiveness and safety of the drug in children has not been studied enough, therefore, it is not recommended to assign it to patients of this age category.

Interactions

Interaction studies were conducted only for adults. the simultaneous administration of preparations containing citrate and aluminum can cause an increase in aluminum resorption, therefore, it is recommended to adhere to a 2-hour pause between taking such drugs.

The drug enhances the therapeutic effect of allopurinol.

Some drugs designed to lower blood pressure (aldosterone antagonists and other low potassium diuretics such as triamterenes, spironolactones and amilorides), ACE inhibitors, sartans, and painkillers and anti-inflammatory drugs (NSAIDs and peripheral analgesics) can reduce potassium excretion that should be taken into account while prescribing them with Blemaren (increased risk of hyperkalemia). An increase in the extracellular concentration of potassium reduces the severity of the action of cardiac glycosides, while its decrease increases the effect of arrhythmogenic cardiac glycosides.

With prolonged use of Blemaren, accumulation of quinidine in the body in case of its simultaneous administration is possible, as well as a decrease in the effectiveness of nitrofurantoin (alkaline reaction of the medium), salicylates and lithium preparations (accelerated excretion).

Overdose

With normal renal function, an undesirable effect of the drug on changes in physiological parameters of metabolism was not observed either at the usual recommended dose or at a higher one, since the release of excess alkalis by the kidneys is a natural mechanism for regulating the acid-base balance in the body.

The upper limit of the urine pH range indicated above should not be exceeded for several days, since there is an increased risk of phosphate crystallization due to an increase in pH (pH 7.8); in addition, the apparent alkaline metabolic status is not considered a long-term problem.

Possible overdose can be corrected by reducing the dose of the drug. If necessary, measures can be taken to treat metabolic alkalosis.

Storage conditions

At a temperature not exceeding 30 ° c.