Reminyl
Reminyl
Reminyl (Galantamine)Pharmacological action
The selective competitive and reversible inhibitor of an acetylcholinesterase, is a tertiary alkaloid. Strengthens Acetylcholinum action, apparently, owing to linkage with an allosteric site of a receptor.
Indications
- Use Reminyl for treatment A dementia of Alzheimer type of easy or moderate degree, including with accompanying insufficiency of a cerebral circulation.
Dosage regimen
Reminyl is necessary to accept 2 times/sut, it is desirable during a breakfast and a supper.
The initial dose makes 8 mg/sut (on 4 mg), it it is necessary to accept 2 times/sut during 4 weeks.
The maintenance dose makes 16 mg/sut (on 8 mg), it also it is necessary to accept 2 times/sut not less than 4 weeks. The question on rising of a maintenance dose to as much as possible recommended 24 mg/sut (on 12 mg 2 times/sut) should be solved after an all-round estimation of the clinical situation, in particular the reached effect and shipping.
At moderate disturbances of function of a liver the initial dose should make 4 mg of 1 times/sut, it should be accepted in the morning within not less than 1 week. After that patients can accept on 4 mg 2 times/sut throughout not less 4 weeks. At the expressed disturbances of function of a liver (more than 9 points on a scale I Chajld-drink) the preparation is contraindicative.
At disturbance of function of kidneys Reminyl dose to correct it is not necessary. To patients with the expressed disturbances of function of kidneys Reminyl is contraindicative.
At simultaneous reception of strong inhibitors of isoenzymes CYP2D6 or CYP3A4 there can be a necessity for Reminyl dose decline.
Side effect
From the alimentary system: at carrying out of clinical tests often became perceptible a nausea, vomiting, abdominal pains, a dyspepsia, an anorexia. The nausea, vomiting and an anorexia became perceptible at women is more often.
From party TSNS: at carrying out of clinical tests often became perceptible delicacy, giddiness, a headache, drowsiness; also are described confusion of consciousness, sudden falling, a sleeplessness; seldom - a tremor, syncopes.
The other: often - depression of mass of a body, a trauma, a rhinitis, infections of urinary ways; seldom - a serious bradycardia.
Contraindications
- The expressed disturbances of function of kidneys;
- The expressed disturbances of function of a liver (more than 9 points on a scale I Chajld-drink);
- A hypersensibility to Galantaminum or other components of a preparation.
Pregnancy and lactemia
Reminyl is possible to prescribe at pregnancy only when the potential advantage of treatment for mother surpasses possible risk for a foetus.
In need of application of a preparation in a lactemia thoracal feeding should be stopped.
Special indicatings
At patients with an Alzheimer's disease reduction of mass of a body is often observed. Application of inhibitors of an acetylcholinesterase, including Reminyl , also can is accompanied by depression of mass of a body. Therefore during Reminyl treatmentt is necessary to watch changes of mass of a body of patients.
As well as other cholinomimetics,Reminyl is necessary to apply with care at diseases of cardiovascular system since owing to the pharmacological action cholinomimetics can cause vagotonic effects from heart (for example, a bradycardia).
At patients with the raised risk of development of erozivno-cankers GASTROINTESTINAL TRACT, for example having in the anamnesis, the condition of the patient for the purpose of early revealing of corresponding symptoms is necessary to supervise a peptic ulcer. Reminyl is not recommended to apply at patients with obstruction GASTROINTESTINAL TRACT, and also at patients by whom operation on digestion organs recently has been made.
It is considered, that cholinomimetics possess certain ability to cause generalised cramps.
With care prescribe Reminyl to patients with a serious bronchial asthma or chronic obstructive illness of lungs because of cholinomimetic activity of a preparation.
Reminyl is not recommended to apply at patients with obstruction of urinary ways, and also at the persons who have recently transferred operation on a bladder.
After sharp Reminyl cancellation (for example, at a preparation for surgery) exacerbations of symptoms do not arise.
Overdosage
Symptoms: some or all symptoms of a cholinergic crisis (a strong nausea, vomiting, the spastic abdominal pains, the strengthened salivation, a dacryagogue, an urine and feces incontience, a strong sweating, a bradycardia, a hypotension, a collapse, cramps) are possible muscular delicacy. The expressed muscular delicacy in a combination to a hypersecretion of a mucosa of a trachea and a bronchospasm can lead to a lethal outcome.
Treatment: if necessary spend symptomatic therapy. In serious cases as an antidote i.v. enter atropine (an initial dose of 0 mg; frequency of introduction and size of the subsequent doses depend on dynamics of a clinical condition of the patient).
Medicinal interaction
At simultaneous Reminyl application action of other cholinomimetics, therefore the given combination strengthens it is not recommended.
At simultaneous Reminyl application strengthens action of the preparations reducing the CARDIAC CONTRACTIONS RATE (for example, digoxin and beta adrenoblockers).
Pharmacokinetic interactions
Researches in vitro have shown, that the leading role in Galantaminum metabolism is played by isoenzymes CYP2D6 and CYP3A4.
The preparations which are strong inhibitors of isoenzymes CYP2D6 and CYP3A4, can enlarge AUC Galantaminum. Pharmacokinetic researches with a multiple dose of preparations have shown, that AUC Galantaminum is enlarged by 30 and 40 % .
Oppression of secretion of a gastric juice does not break Galantaminum absorption.
Conditions and periods of storage
The preparation should be stored in a place inaccessible to children at temperature from 15 to 30 C; the solution for intake cannot be frozen. A period of validity - 2 years.
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