Gepavil

General characteristics. Structure:

Active ingredients: 1200 mg or 2400 mg of L-valine, 1200 mg or 2400 mg of L-izoleytsina, 2400 mg or 4800 mg of a L-leucine.

Pharmacological properties:

Pharmacodynamics. Solution for infusions of GEPAVIL contains 3 amino acids, irreplaceable for the person, with a branched side chain: L-valine, L-izoleytsin, L-leucine necessary for synthesis of a number of proteins and other biologically important components. Branched amino acids provide stabilization of exchange of aromatic amino acids, have positive effect on exchange of proteins in muscles, a liver and neurotransmitters in the central nervous system.

Researches in the field of compensation of a malnutrition as risk factor of progressing of cirrhoses, showed that at successful compensation of a malnutrition with use of branched irreplaceable amino acids it is possible to achieve decrease in a lethality at liver cirrhoses. Usual states at which branched irreplaceable amino acids are used are states with negative nitrogenous balance, states with metabolic tension (hypermetabolism), states with an intolerantnost to proteins (liver cirrhoses). The protective effect of branched irreplaceable amino acids on development of a sakropeniya in persons of advanced and senile age is established. Researches at patients with liver cirrhoses at infusional administration of amino acids with a branched side chain showed that there is an increase in content in blood of the entered amino acids and reduction of aromatic amino acids and methionine, at the same time improvement of indicators of hepatic encephalopathy and the electroencephalogram is noted.

From three amino acids of drug Gepavil, according to the researches in vitro on skeletal muscles, it is shown that the leucine, first of all, is responsible for induction of synthesis of protein. The stimulating effect of a leucine on synthesis of protein is established through induction of broadcast of MRNK. At the same time there is a set of additional mechanisms, including phosphorylation of ribosomal protein, activation of a kinase of S6, factor of initiation (eIF) 4E. A key component in this process and the phosphorylation accompanying it, at mammals is alarm protein switch, the called mTOR (mammalian target of rapamycin). It is revealed that amino acids with a branched side chain, unlike other hydrophobic amino acids, are capable to provide the need for maintenance of structure of protein and promote reduction of speed of degradation of proteins, keeping their native structure. Moreover, amino acids with a branched side chain reduce proteolysis of proteins and their effect, apparently, is connected with insulinopodobny action on atrogin-1 (atrogin-1).

Indications to use:

Gepavil is appointed as a source of amino acids, irreplaceable for the person, with a branched side chain, biologically important components, necessary for synthesis, which deficit is noted at chronic diffusion diseases of a liver, chronic diseases of kidneys, at persons of senile age, at injuries, at a malnutrition syndrome. The main indications are therapy and parenteral food (partial or full, depending on introduction of additional components, such as solutions of carbohydrates and fatty emulsions) at an abnormal liver function (liver failure) in combination with a malnutrition, with or without symptoms of porto-system encephalopathy.

Route of administration and doses:

Intravenously, slowly, speed should not exceed 400 ml in 3 hours that corresponds to about 2,2 ml a minute. The dose of drug is established individually taking into account a condition of the patient and severity of a disease.

Adults: fluctuations of a daily dosage of active components of drug, amino acids with a branched side chain, make 0,15 to 0,25 g on body weight kg a day. An average daily dose - 0,2 g on body weight kg a day. The dosage corresponding 0,15 - 0,25 on body weight kg a day for drug solution Gepavil makes 6,2 – 10,4 ml of solution on body weight kg a day. The maximum dose makes 14,5 ml on body weight kg a day or 1015 ml of drug Gepavil in days, weighing 70 kg. For patients with a body weight index more than 29,9 dose needs to be calculated, proceeding from ideal weight.

At patients with the established increased need for amino acids with a branched side chain it is possible to use higher doses of drug.

Clinical trials showed that patients at states with negative nitrogenous balance, transfer a dose of branched amino acids to 0,7 g to body weight kg a day. However, the individual dose of amino acids with a branched chain for the specific patient decides by the doctor, on the basis of assessment of his state, the metabolic status and the available need of compensation of deficit of amino acids on a branched side chain.

Therapy duration drug Gepavil is established by the doctor, taking into account assessment of individual efficiency and safety.

Features of use:

At introduction of large volumes (1,0 l and more in days) and at long introduction (more than 10 days of daily use) of Gepavil it is necessary to control the content in blood of glucose, electrolytes, albumine, crude protein, KShchR, ASAT, ALAT, ShchF, creatinine, urea.

Side effects:

At drug use Gepavil, in compliance with indications and recommendations about a dosage, by-effects arise seldom.

Nausea, vomiting, inflows of heat and perspiration at Gepavil's introduction with a speed exceeding most recommended - 3,5 ml a minute is occasionally noted. At intravenous administration increase in values of liver enzymes can be noted, at such states it is necessary to control liver enzymes. Hypersensitivity reactions to active components of drug are possible. As well as at intravenous administration of all infusion solutions, can be noted: strengthening of a diuresis, thrombophlebitis if the long periods of introduction through peripheral veins are used. Development of phlebitis is possible, especially at a repeated venipuncture of the same vein.

Interaction with other medicines:

At the recommended amino acid dosage in infusion solution Gepavil do not interact among themselves, and also there are no data on interaction with other medicines.

Contraindications:

- hypersensitivity to drug components;

- inborn disturbance of metabolism of amino acids, such as syndrome "urine in the form of maple syrup", aminoaciduria and др;

- non-recoverable injuries of kidneys with uraemia;

- diabetes mellitus;

- states with an overhydratation, a hyponatremia, a hypopotassemia;

- acute or subacute fulminantny hepatitis;

- chronic heart failure in a condition of a decompensation;

- pregnancy;

- lactation period;

- children's and teenage age up to 18 years.

Overdose:

Intravenous administration of amino acids can be followed by the increased allocation with urine of copper and zinc that needs to be considered at purpose of microelements, in particular, at long intravenous food. Specific negative reactions of overdose are not described.

Issue conditions:

According to the recipe

Packaging:

Solution for infusions on 200 ml or 400 ml in bottles in packaging No. 1, No. 24 and No. 40.