Usage
- This medication, a combination of Mono Ammonium Glycyrrhizinate and Glycine, is primarily used to improve abnormal hepatic function in chronic liver diseases like chronic hepatitis and cirrhosis. It also has applications in treating various allergic skin conditions such as eczema, dermatitis, urticaria, pruritus, drug eruption or toxicoderma, stomatitis, infant strophulus, and phlycten.
- Pharmacological Classification: Hepatoprotective, anti-inflammatory, anti-allergic, and liver therapy agent.
- Mechanism of Action: Mono Ammonium Glycyrrhizinate exhibits anti-inflammatory and antiviral properties. Glycine and L-cysteine (or DL-methionine in some formulations) offer antioxidant and hepatoprotective effects. Glycine also acts as a lavage solution, helping remove blood and tissue fragments during surgical procedures.
Alternate Names
- Stronger Neo-Minophagen C
- Glycyron
- Neophagen
- Minophagen C
- Hishiphagen
- Lemigen
How It Works
- Pharmacodynamics and Pharmacokinetics: Mono ammonium glycyrrhizinate is metabolized to glycyrrhetinic acid, which inhibits 11β-hydroxysteroid dehydrogenase type 2, leading to increased cortisol activity. This can influence electrolyte balance, affecting sodium and potassium levels. The exact pharmacokinetic parameters, including absorption, distribution, metabolism, and excretion of the combined formulation, need further detailed clarification from available sources. A study indicated that the urinary recovery rate of Glycyrrhizic acid within 27 hours was 1.2% of the administered dose. Glycyrrhetinic acid appeared at 6 hours after administration and reached the maximum at 22 to 27 hours after administration. Additionally, following intravenous injection of 3H-glycyrrhizin to mice, its distribution was observed in all organs collected in 10 minutes post-dose with the highest levels measured in the liver.
- Mode of Action/Receptor Binding/Enzyme Inhibition/Neurotransmitter Modulation: The precise details of the combined formulation’s action at the cellular and molecular level, including receptor binding, enzyme inhibition or neurotransmitter modulation, require further elucidation from available research.
- Elimination Pathways: The sources do not explicitly detail the elimination pathways of the combined formulation (renal/hepatic excretion, metabolism by CYP enzymes, etc.). This information requires further sourcing from relevant literature or clinical studies.
Dosage
Standard Dosage
Adults:
5 to 20 mL intravenously once daily for general use. 40 to 60 mL intravenously once daily for chronic liver disease, either by bolus injection or infusion. The maximum daily dose should not exceed 100 mL.
Children:
Dosage should be determined by a physician based on the child’s weight and age. Pediatric safety data is limited.
Special Cases:
- Elderly Patients: Administer cautiously due to a higher risk of hypokalemia. Close monitoring of potassium levels is essential.
- Patients with Renal Impairment: Dosage adjustments may be necessary depending on creatinine clearance.
- Patients with Hepatic Dysfunction: Careful dosage adjustments are crucial due to potential impairment of drug metabolism.
- Patients with Comorbid Conditions: Individualized dosing considerations are necessary for patients with conditions like diabetes, cardiovascular disease, aldosteronism or myopathy.
Clinical Use Cases
The provided sources do not give specific dosage recommendations for clinical use cases such as intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations. This information needs further sourcing from relevant literature or clinical studies. Glycine component may have use as a lavage during surgical procedures.
Dosage Adjustments
Adjustments may be necessary for patients with renal or hepatic impairment, metabolic disorders, or genetic polymorphisms affecting drug metabolism. Close monitoring of serum potassium and blood pressure is recommended.
Side Effects
Common Side Effects:
Increased blood pressure, nausea, vomiting, general malaise, rash, upper abdominal discomfort, muscle pain, numbness, fever, coldness of limbs, cold sweat, thirst, palpitations, hives, itching.
Rare but Serious Side Effects:
Shock, anaphylactic shock, pseudoaldosteronism (edema, weight gain, hypertension, hypokalemia), hypokalemia.
Long-Term Effects:
Chronic continuous use can increase the risk of pseudoaldosteronism.
Adverse Drug Reactions (ADR):
Shock, anaphylaxis, and severe hypokalemia necessitate immediate medical intervention.
Contraindications
- Hypersensitivity to any component of the medication.
- Aldosteronism
- Myopathy
- Hypokalemia
Drug Interactions
Administer cautiously with drugs that might affect potassium levels or those metabolized by CYP450 enzymes. Avoid concomitant use with licorice-containing products due to potential for pseudoaldosteronism.
Pregnancy and Breastfeeding
The safety during pregnancy and lactation is not established. Use only if benefits outweigh potential risks. Animal studies show kidney malformation with high doses of monoammonium glycyrrhizinate.
Drug Profile Summary
(Refer to sections above for details)
Popular Combinations
The provided sources do not discuss specific popular drug combinations used with this medicine. This information needs to be researched in specialized literature. One study investigated the use of Glycine + Mono Ammonium Glycyrrhizinate in combination with 5% carpronium chloride for the treatment of alopecia areata.
Precautions
(Refer to sections above for details)
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Glycine + Mono Ammonium Glycyrrhizinate?
A: The standard adult dosage is 5 to 20 mL IV once daily. For chronic liver disease, 40 to 60 mL IV daily. Dosage adjustments are needed for children, the elderly, and those with renal or hepatic impairment.
Q2: What are the primary uses of this medication?
A: It is primarily used for chronic liver diseases and allergic skin conditions.
Q3: What are the serious side effects I should be aware of?
A: Shock, anaphylaxis, severe hypokalemia, and pseudoaldosteronism.
Q4: Are there any contraindications for this drug?
A: Yes. Contraindications include hypersensitivity, aldosteronism, myopathy, and hypokalemia.
Q5: Can this drug be used during pregnancy or breastfeeding?
A: Safety is not established. Use only if benefits clearly outweigh risks.
Q6: How does mono ammonium glycyrrhizinate work?
A: It has anti-inflammatory and antiviral effects and is metabolized to glycyrrhetinic acid. Glycyrrhetinic acid inhibits the enzyme 11β-hydroxysteroid dehydrogenase type 2 and impacts cortisol activity.
Q7: What is the role of glycine in this combination?
A: It acts as an antioxidant and hepatoprotective agent. It can also be used as a surgical lavage.
Q8: How should I monitor patients on this medication?
A: Monitor potassium levels, blood pressure, and watch for signs of pseudoaldosteronism and other side effects. Adjust dosage as needed.
Q9: What are the potential long-term effects of this medicine?
A: Pseudoaldosteronism is a potential risk with long-term use.
