Blemaren effervescent tablets in containers 80 pcs — Made in Germany — Free Delivery

Pharmacological properties

Pharmacodynamics. when effervescent tablets of blemaren are dissolved in water, potassium-sodium hydrocitrate is formed and carbon dioxide is released. In this case, residual alkaline ions are formed, which are excreted by the kidneys. thus, an increase in the ph of urine 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 the litholysis of uric acid calculi is performed by X-ray.

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

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

Indications

Blemaren is used to treat urolithiasis in order to:

- alkalinization of urine in patients with urate calculi with or without concomitant calcium calculi;

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

Application

The average daily dose is determined individually, it is established by determining the pH of the 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 a daily dose of more than 3 tablets is required, it is recommended to take one tablet in the morning, one in the middle of the day, and the rest at night.

Control over the effectiveness of the preparation is carried out by determining the pH of fresh urine 3 times a day before the next intake of the preparation. To do this, use the standard test strips included in each package. The indicator zone of the test strip should be briefly immersed in urine, then removed and after 2 minutes compare the obtained color of the test strip with the color scale printed on the set of indicator strips, and record the determined pH values ​​in the control calendar. The dose of the preparation is considered correctly selected if the pH values ​​determined 3 times a day are within the recommended limits for each pathology. Discoloration of unused test 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 profile of pH values ​​is below 7.0, the dose should be increased, and if it is above 7.2, reduced.

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

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

For dissolution of urate-oxalate mixed stones and metaphylaxis of the formation of calcium-oxalate stones, urine pH must be maintained at a certain time at the level of 6.8–7.4.

Before performing remote nephrolithotripsy with mixed (X-ray inhomogeneous) stones, the Blemaren preparation 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 extracorporeal lithotripsy should be at least 3 weeks.

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

When carrying out cytostatic therapy, urine pH should be at least 7.0, and in the treatment of tardive porphyria of the skin, 7.2-7.5.

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

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

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

Contraindications

Hypersensitivity to the components of the preparation; renal failure; urinary tract infections caused by bacteria that break down urea (risk of struvite stones); metabolic alkalosis; episodic hereditary weakness.

Side effects

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

Special instructions

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

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

Before using the preparation, it is necessary to determine the level of electrolytes in the blood plasma and check the kidney function. If you suspect 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 the extracellular concentration of potassium reduces the effectiveness of glycosides, and its decrease enhances the arrhythmogenic effect ).

For patients with impaired uric acid metabolism, it is recommended to combine the preparation with allopurinol.

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

During preparation therapy, it is recommended to adhere to a low-protein diet, that is, limit the use of foods rich in purines (for example, meat, sausages, animal entrails, sardines), and also limit salt intake. Drink 2-3 liters of liquid daily in the form of tea, fruit juice or alkaline mineral water.

The preparation does not contain carbohydrates and can be used to treat patients with diabetes mellitus.

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

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

Application during pregnancy or lactation. When using the preparation according to the instructions, no negative effects were observed during pregnancy and lactation.

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

Children. The efficacy and safety of using the preparation in children has not been studied enough, therefore it is not recommended to prescribe it to patients of this age category.

Interactions

Interaction studies have been conducted in adults only. the simultaneous use 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 preparations.

The preparation enhances the therapeutic effect of allopurinol.

Certain preparations used to lower blood pressure (aldosterone antagonists and other low potassium diuretics such as triamterenes, spironolactones, and amilorides), ACE inhibitors, sartans, and pain relievers and anti-inflammatory preparations (NSAIDs and peripheral analgesics) can reduce potassium excretion , what should be taken into account when simultaneously prescribing them with Blemaren (the risk of hyperkalemia increases). 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, quinidine may accumulate in the body if taken simultaneously, as well as a decrease in the effectiveness of nitrofurantoin (alkaline reaction of the medium), salicylates and lithium preparations (accelerated elimination).

Overdose

With normal renal function, the undesirable effect of the preparation on the change in the physiological parameters of metabolism was not noted either at the usual recommended dose, or at a higher one, since the excretion 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 as there is an increased risk of phosphate crystallization due to an increase in pH (pH 7.8); furthermore, an overt alkaline metabolic status is not considered a long-term problem.

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

Storage conditions

At a temperature not exceeding 30 ° c.