Tivortin solution for infusion 4.2% (42mg/ml) 200ml — Made in Ukraine — Free Delivery

Pharmacological properties

Pharmacodynamics. Arginine (α-amino-δ-guanidinovaleric acid) is an amino acid that belongs to the class of conditionally essential amino acids and is an active and versatile cellular regulator of numerous vital functions of the body, has important protective effects in the critical state of the body.

Arginine has an antihypoxic, membrane stabilizing, cytoprotective, antioxidant, detoxifying effect, manifests itself as an active regulator of interstitial metabolism and energy supply processes, plays a role in maintaining hormonal balance in the body. It is known that arginine increases the blood levels of insulin, glucagon, STH and prolactin, participates in the synthesis of proline, polyamines, agmatine, is involved in the processes of fibrinogenolysis, spermatogenesis, and has a membrane-depolarizing effect.

Arginine is a substrate for NO synthase, an enzyme that catalyzes the synthesis of nitric oxide in endothelial cells. The preparation activates guanylate cyclase and increases the level of cGMP in the vascular endothelium, reduces the activation and adhesion of leukocytes and platelets to the vascular endothelium, inhibits the synthesis of adhesion proteins VCAM-1 and MCP-1, thus preventing the formation and development of atherosclerotic plaques, inhibits the synthesis of endothelium is a powerful vasoconstrictor and stimulator of proliferation and migration of smooth muscle cells of the vascular wall. Arginine also inhibits the synthesis of asymmetric dimethylarginine, a potent endogenous stimulant of oxidative stress. The preparation stimulates the activity of the thymus gland, which produces T-cells, regulates blood glucose during exercise. It has an acid-forming effect and helps to correct acid-base balance.

Arginine is one of the main substrates in the urea cycle in the liver. The hypo-ammonia effect is realized by activating the conversion of ammonia into urea. It has a hepatoprotective effect due to antioxidant, antihypoxic and membrane-stabilizing activity, positively affects the processes of energy supply in hepatocytes.

Pharmacokinetics. With continuous intravenous infusion, Cmax of arginine in blood plasma is observed 20-30 minutes after the start of administration. Arginine crosses the placental barrier, is filtered in the renal glomeruli, but is almost completely reabsorbed in the renal tubules.

The pharmacokinetics of the oral solution have not been studied.

Indications

Atherosclerosis of the vessels of the heart and brain, atherosclerosis of peripheral vessels, including with manifestations of intermittent claudication, diabetic angiopathy, ischemic heart disease, ages, conditions after acute myocardial infarction and acute cerebrovascular accident, myocardiopathy, chronic heart failure, hypercholesterolemia, cholesterolemia interstitial pneumonia, idiopathic pulmonary hypertension, chronic postembolic pulmonary hypertension, acute and chronic hepatitis of various etiologies, hyperammonemia, hypoxic conditions, asthenic conditions during convalescence, including after infectious diseases and surgical interventions, metabolic alkalosis, decreased thymus development, delay fetus and preeclampsia.

Application

Solution for oral administration is used orally during meals, adults - 5 ml (1 scoop - 1 g of the preparation) 3–8 times a day; the maximum daily dose is 8 g.

The duration of the course of treatment is 8-15 days; if necessary, repeat the course of treatment.

The solution for infusion is injected intravenously at a rate of 10 drops per minute for the first 10-15 minutes, then the rate of administration can be increased to 30 drops per minute.

The daily dose of the preparation is 100 ml of solution.

In severe circulatory disorders in the central and peripheral vessels, with pronounced symptoms of intoxication, hypoxia, asthenic conditions, the dose of the preparation can be increased to 200 ml / day (100 ml 2 times a day).

The maximum rate of administration of the infusion solution should not exceed 20 mmol / h.

For children under 12 years of age, the dose of the preparation is 5-10 ml / kg / day.

For the treatment of metabolic alkalosis, the dose can be calculated as follows:

Arginine hydrochloride (mmol) ‧ 0.3 ‧ kg body weight / excess alkali (Be) (mmol / l).

The introduction should begin with half of the calculated dose. Additional correction should be carried out after obtaining the results of the restored acid-base balance.

Contraindications

Hypersensitivity, severe renal dysfunction, hyperchloremic acidosis, history of allergic reactions, the use of potassium-sparing diuretics, as well as spironolactone.

Side effects

After using an oral solution, there is rarely a feeling of mild discomfort in the stomach and intestines, nausea, which disappear on their own.

After intravenous administration, the following are possible: headache, feeling of heat, phlebitis at the injection site, rarely - allergic reactions.

Special instructions

It should be used with caution in case of electrolyte metabolism disorders, kidney diseases. when using the preparation, it is necessary to adhere to a balanced sleep and rest regimen, give up alcohol, nicotine and psychostimulants. if the severity of asthenia symptoms increases while taking the preparation, treatment should be canceled.

In patients with renal insufficiency, diuresis and plasma potassium levels should be checked before starting the infusion, since the preparation may contribute to the development of hyperkalemia.

Prescribe with caution in case of dysfunction of the endocrine glands, the preparation can stimulate the secretion of insulin and growth hormone.

Children. The preparationis used in children over the age of 3 years.

Application during pregnancy or lactation. The preparation crosses the placenta, therefore, during pregnancy, it can be used only when the expected benefit to the mother outweighs the potential risk to the fetus.

There are no data on the use of the preparation during lactation.

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

Interactions

The simultaneous use of aminophylline with arginine may be accompanied by an increase in blood insulin levels.

Arginine can cause severe and persistent hyperkalemia in the presence of hepatic failure in patients who take or have taken spironolactone. Previous use of potassium-sparing diuretics can also increase the concentration of potassium in the blood.

Arginine is incompatible with thiopental.

Overdose

Symptoms: hypersensitivity reactions, hypoglycemic conditions.

With intravenous administration of the solution, renal failure, hypoglycemia, metabolic acidosis are possible.

Treatment. In the presence of these phenomena, you must stop taking the preparation.

For oral administration, gastric lavage and sorbents are indicated. To eliminate the hypersensitivity reaction, desensitizing therapy is performed.

With the on / in the introduction, the physiological reactions should be monitored and the maintenance of vital body functions. If necessary - the introduction of alkalizing agents and diuretics (saluretics), crystalloid solutions (0.9% NaCl solution, 5% dextrose solution).

Storage conditions

In a dry, dark place at a temperature of 15-25 ° C.

The shelf life after opening the vial of Tivortin aspartate is 14 days. Do not freeze!