Cemia

Cemia Uses, Dosage, Side Effects, Food Interaction and all others data.

Cemia is a xanthine oxidase inhibitor which is administered orally. It acts on purine catabolism without disrupting the biosynthesis of purine. It reduces the production of uric acid by inhibiting the biochemical reactions immediately preceding its formation. Cemia is a structural analogue of the natural purine base, hypoxanthine. It is an inhibitor of xanthine oxidase, the enzyme responsible for the conversion of hypoxanthine to xanthine and xanthine to uric acid, the end product of purine metabolism

Cemia decreases the production of uric acid by stopping the biochemical reactions that precede its formation . This process decreases urate and relieves the symptoms of gout, which may include painful tophi, joint pain, inflammation, redness, decreased range of motion, and swelling .

Trade Name Cemia
Availability Prescription only
Generic Allopurinol
Allopurinol Other Names 4-HPP, Allopurinol, Allopurinolum, Alopurinol
Related Drugs sodium bicarbonate, febuxostat, Zyloprim, probenecid, Uloric, Krystexxa, rasburicase, Elitek, Aloprim
Type Tablet
Formula C5H4N4O
Weight Average: 136.1115
Monoisotopic: 136.03851077
Protein binding

Allopurinol and oxypurinol are only negligibly bound to plasma proteins .

Groups Approved
Therapeutic Class Drugs used in Gout
Manufacturer Meridian Enterprises Pvt Ltd
Available Country India
Last Updated: September 19, 2023 at 7:00 am
Cemia
Cemia

Uses

Cemia is used for prevention and treatment of high blood uric acid level and gout, prevents deposition of urate crystal in kidney, serous membranes of liver, heart, air sac and joints of poultry.

Cemia is also used to associated treatment for these conditions: Hyperuricemia, Primary Gout, Recurrent calcium oxalate calculi, Secondary gout, Calcium oxalate calculi Renal Calculi

How Cemia works

Cemia is a structural analog of the natural purine base, hypoxanthine. After ingestion, allopurinol is metabolized to its active metabolite, oxypurinol (alloxanthine) in the liver , which acts as an inhibitor of xanthine oxidase enzyme .

Cemia and its active metabolite inhibit xanthine oxidase, the enzyme that converts hypoxanthine to xanthine and xanthine to uric acid. Inhibition of this enzyme is responsible for the effects of allopurinol. This drug increases the reutilization of hypoxanthine and xanthine for nucleotide and nucleic acid synthesis by a process that involves the enzyme hypoxanthine-guanine phosphoribosyltransferase (HGPRTase). This process results in an increased nucleotide concentration, which causes feedback inhibition of de novo purine synthesis. The end result is decreased urine and serum uric acid concentrations , which decreases the incidence of gout symptoms.

Accompanying the reduction of serum uric acid by allopurinol is an increase in the serum and urine concentrations of hypoxanthine and xanthine (due to inhibition of xanthine oxidase). In the absence of allopurinol, regular urinary excretion of oxypurines almost entirely occurs in the form of uric acid. After the ingestion of allopurinol, the contents of excreted urine are hypoxanthine, xanthine, and uric acid. Because each substance has its own individual solubility, the concentration of uric acid in plasma is decreased without exposing the renal tissues to a high load of uric acid, thereby decreasing the risk of crystalluria. By lowering the uric acid concentration in the plasma below its limits of solubility, allopurinol encourages the dissolution of gout tophi. Although the levels of hypoxanthine and xanthine are found to be increased after allopurinol ingestion, the risk of deposition in renal tissues is less than that of uric acid, as they become more soluble and are rapidly excreted by the kidney .

Dosage

Cemia dosage

Poultry- 25 mg/kg body or 2.5 gm/liter water for 3-5 days, or as directed by registered veterinarian.

Side Effects

The most frequent adverse reaction to Cemia is skin rash such as, pruritic maculopapular skin eruptions, sometimes scaly or exfoliative.

Toxicity

Oral TDLO (rat): 10 mg/kg; Oral LD50 (mouse): 78 mg/kg; Oral TDLO (mouse): 100 mg/kg

Use in pregnancy

Reproductive studies have been completed using rats and rabbit models at doses up to twenty times the normal human dose ( about 5 mg/kg per day), and it was concluded that fertility was not impaired and there was no fetal harm. There is a published report of a study in pregnant mice administered 50 or 100 mg/kg allopurinol intraperitoneally on gestation days 10 or 13. There were increased numbers of dead fetuses in dams administered 100 mg/kg allopurinol, however, death did not occur in those given 50 mg/kg. There were higher numbers of external malformations in fetuses at both doses of allopurinol on gestation day 10 and higher numbers of skeletal malformations in fetuses at both doses on gestation day 13. Despite the above findings, there are no adequate or well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if it is absolutely required .

Use in nursing

Both allopurinol and the metabolite oxipurinol have been found in the milk of a mother who was receiving allopurinol. Since the effect of allopurinol on the nursing infant is unknown, it is advisable to exercise caution when allopurinol is taken by a nursing woman .

Mutagenicity and carcinogenicity

Cytogenic studies demonstrate that allopurinol does not induce chromosomal abnormalities in human blood cells in vitro at concentrations up to 100 g/mL and in vivo at doses up to 60 mg/day for an average duration of 40 months. Cemia does not form nitroso compounds (which may be carcinogenic) or affect lymphocyte transformation in vitro. Evidence suggests that allopurinol does not have deleterious effects on DNA at any stage of the cell cycle and was not found to be mutagenic. No evidence of carcinogenicity has been observed in mice treated with allopurinol for up to a 2 year period .

Precaution

Before you use discuss with your doctor if you are allergic to it or its ingredients.

Interaction

Anticoagulant: Cemia prolongs the half life of the anticoagulant, dicumarol.

Diuretic: Concomitant use of Cemia and thiazide diuretics may contribute to the enhancement of Cemia toxicity.

Cytotoxic agent: Enhanced bone marrow suppression by cyclophosphamide and other cytotoxic agent has been reported among patients with neoplastic disease.

Food Interaction

  • Avoid alcohol.
  • Take with a full glass of water.
  • Take with food.

Volume of Distribution

Cemia and oxypurinol are both substrates for the enzyme xanthine oxidase, which is present in the cytoplasm of endothelial cells of capillaries, including sinusoids, with the highest activity demonstrated in the liver and intestinal lining. Tissue concentrations of allopurinol have not yet been reported in humans, however, it is probable that allopurinol and the metabolite oxypurinol would be measured in the highest concentrations in the abovementioned tissues. In animals, allopurinol concentrations are found to reach the highest levels in the blood, liver, intestine and heart, and lowest in the brain and lung tissues .

Elimination Route

This drug is about 90% absorbed from the gastrointestinal tract. Peak plasma levels normally occur at 1.5 hours and 4.5 hours post-dose for allopurinol and oxipurinol respectively. Following one oral dose of 300 mg of allopurinol, maximum plasma levels of about 3 mcg/mL of allopurinol and 6.5 mcg/mL of oxipurinol were measured .

Half Life

The plasma half-life of allopurinol is 1-2 hours, due to its rapid renal clearance .

Clearance

Since allopurinol and its metabolites are mainly eliminated by the kidney, accumulation of this drug can occur in patients with renal dysfunction or failure, and the dose of allopurinol should, therefore, be reduced. With a creatinine clearance of 10 to 20 mL/min, a daily dosage of 200 mg of allopurinol is suitable. When the creatinine clearance is less than 10 mL/min, the daily dosage should not be higher than 100 mg. With severe renal impairment (creatinine clearance measured at less than 3 mL/min) a longer interval between doses may be required .

Elimination Route

Approximately 80% of orally ingested allopurinol is found excreted in the urine as various metabolites . About 20% of ingested allopurinol is excreted in the feces .

Pregnancy & Breastfeeding use

Sufficient clinical data is not available. This drug should be used during pregnancy only if clearly indicated. Cemia has been found in breast milk, caution should be exercised when Cemia is administered to a lactating mother.

Contraindication

Patients who have developed a severe reaction to allopurinol should not be restarted the drug. Cemia should be withdrawn immediately when a skin rash or other evidence or sensitivity occurs. Dosage reduction should be considered in the presence of severe hepatic or renal disorder.

Acute Overdose

Over dosage may cause diarrhea, abdominal pain and neurotoxicity.

Interaction with other Medicine

Anticoagulant: Cemia prolongs the half life of the anticoagulant, dicumarol.

Diuretic: Concomitant use of Cemia and thiazide diuretics may contribute to the enhancement of Cemia toxicity.

Cytotoxic agent: Enhanced bone marrow suppression by cyclophosphamide and other cytotoxic agent has been reported among patients with neoplastic disease.

Storage Condition

Protect from light & keep in a cool and dry place. Keep out of reach of children.

Innovators Monograph

You find simplified version here Cemia

Cemia contains Allopurinol see full prescribing information from innovator Cemia Monograph, Cemia MSDS, Cemia FDA label

FAQ

What is Cemia used for?

Cemia is a medication used to decrease high blood uric acid levels. It is specifically used to prevent gout, prevent specific types of kidney stones and for the high uric acid levels that can occur with chemotherapy.

How safe is Cemia?

Cemia is considered very safe to take for a long period of time. There are unlikely to be any long-term effects.

How does Cemia work?

Cemia works by reducing the amount of uric acid made by body cells.

What are the common side effects of Cemia?

The more common side effects of Cemia can include:

  • skin rash.
  • diarrhea.
  • nausea.
  • changes in your liver function test results.
  • gout flare-up (if you have gout)

Is Cemia safe during pregnancy?

Limited data available on use of this Cemia in pregnant women to inform a drug-related risk.
This Cemia should only be used during pregnancy when there is no safe alternative and when the disease itself carries risks for the mother or child.

Is Cemia safe during breastfeeding?

If Cemia is required by the mother, it is not a reason to discontinue breastfeeding, but exclusively breastfed infants should be monitored if this Cemia is used, including observation for allergic reactions (such as rash) and periodic CBC and differential blood counts.

Can I drink alcohol with Cemia?

Yes, you can drink alcohol while taking Cemia. But drinking alcohol increases the level of uric acid in your blood and can trigger an attack of gout. If you feel safe, you can drink alcohol in moderation.

Can I drive after taking Cemia?

Cemia oral tablet may cause drowsiness. You shouldn't drive, use machinery, or do other tasks that require alertness until you know how Cemia affects you. It can also cause other side effects.

Should Cemia be taken daily?

Cemia should be taken every day to prevent a gout attack.

How many time can I take Cemia daily?

taken once a day or in divided doses.

When should be best taken of Cemia ?

It is usually taken once or twice a day, preferably after a meal. To help you remember to take Cemia, take it around the same time every day.

How long does Cemia take to work?

Cemia can take 2-3 months to become fully effective. It does not have any effect during a gout attack, although you should continue to take it regularly every day even if this happens.

What is the half life of Cemia?

Cemia has a plasma half-life of about 1 to 2 hours.

How long should I take Cemia?

For gout attacks – treatment is usually only for a few days. For FMF – treatment is usually long term. You may need to take it for the rest of your life. Talk to your doctor if you're not sure how long you need to take this medicine for.

Can I take Cemia for long-term?

Cemia is considered very safe to take for a long period of time.

Can Cemia affects my liver?

Cemia is a rare but well known cause of acute liver injury that has features of a hypersensitivity reaction and can be severe and even fatal.

Who should not take Cemia?

You should not use this Cemia if you have ever had a serious allergic reaction to Cemia. Stop taking the medicine and call your doctor at once if you have any signs of skin rash (no matter how mild), painful urination, blood in your urine, burning in your eyes, or swelling in your face or throat.

What happens if I miss a dose?

Take the Cemia oral dose as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time. Call your doctor for instructions if you miss an injection.

What happen If I stop taking Cemia?

If you stop Cemia treatment suddenly, there is a high risk that gout may get worse or you will get serious side effects. Only stop taking Cemia if a doctor tells you to. A doctor will help you to reduce your dose slowly so you do not get serious side effects.

Does Cemia affect my heart?

Cemia had no effect on heart rate variability, mean heart rate or dysrhythmias in our cohort of heart failure patients.

Can Cemia affect my kidneys?

Cemia does not cause worsening renal function and may have protective affects for the kidney.

Can Cemia affects my liver?

Cemia often used to prevent painful gout attacks, can cause liver injury within days to weeks of the start of treatment. Cemia may cause changes in liver function test results and liver failure.

Will Cemia affect my fertility?

There's no firm evidence to suggest that taking Cemia will reduce fertility in either men or women.

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*** Taking medicines without doctor's advice can cause long-term problems.
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