Normoric Er
Normoric Er Uses, Dosage, Side Effects, Food Interaction and all others data.
Normoric Er is a non-purine, selective xanthine oxidase (XO) inhibitor. It decreases serum uric acid level by inhibiting xanthine oxidase, which is responsible for uric acid production. Xanthine oxidase breaks down hypoxanthine to xanthine and thus to uric acid. Normoric Er is not expected to inhibit other enzymes involved in purine and pyrimidine synthesis and metabolism at therapeutic concentrations.
Normoric Er is a novel, selective xanthine oxidase/dehydrogenase inhibitor that works by decreasing serum uric acid in a dose-dependent manner. In healthy subjects, febuxostat decreased the mean serum uric acid and serum xanthine concentrations, as well as the total urinary uric acid excretion. Normoric Er at daily doses of 40-80 mg reduced the 24-hour mean serum uric acid concentrations by 40 to 55%. Closely related to the drug-induced reduction of serum uric acid levels and mobilization of urate crystals in tissue deposits, febuxostat is associated with gout flares.
Unlike allopurinol and oxypurinol, febuxostat has no inhibitory actions against other enzymes involved in purine and pyrimidine synthesis and metabolism, because it does not structurally resemble purines or pyrimidines.
| Trade Name | Normoric Er |
| Availability | Prescription only |
| Generic | Febuxostat |
| Febuxostat Other Names | Fébuxostat, Febuxostat, Febuxostatum |
| Related Drugs | allopurinol, Zyloprim, probenecid, Uloric, Krystexxa |
| Type | Tablet |
| Formula | C16H16N2O3S |
| Weight | Average: 316.375 Monoisotopic: 316.088163078 |
| Protein binding | Febuxostat is approximately 99.2% bound to plasma proteins, primarily to albumin. Plasma protein binding is constant over the concentration range achieved with 40 mg and 80 mg doses. |
| Groups | Approved |
| Therapeutic Class | Drugs used in Gout |
| Manufacturer | Vasu Organics Pvt Ltd |
| Available Country | India |
| Last Updated: | September 19, 2023 at 7:00 am |
Uses
Normoric Er is used for the long-term management of Hyperuricemia in patients with gout. It is not recommended for use in the treatment of asymptomatic Hyperuricemia.
Normoric Er is also used to associated treatment for these conditions: Chronic, symptomatic Hyperuricemia
How Normoric Er works
Gout is a form of acute arthritis that is characterized by the accumulation of crystals of monosodium urate and urate crystals in or around a joint, leading to inflammation and persistent urate crystal deposition in bones, joints, tissues, and other organs that may exacerbate over time. Hyperuricemia is closely related to gout, whereby it may exist for many years before the first clinical attack of gout; thus, aberrated serum uric acid levels and hyperuricemia are believed to be the biochemical aberration involved in the pathogenesis of gout. Xanthine oxidoreductase (XOR) can act as a xanthine oxidase or xanthine dehydrogenase. In humans, it is a critical enzyme for uric acid production as it catalyzes the oxidation reaction steps from hypoxanthine to xanthine and from xanthine to uric acid in the pathway of purine metabolism. Normoric Er potently inhibits XOR, blocking both its oxidase and dehydrogenase activities. With high affinity, febuxostat binds to XOR in a molecular channel leading to the molybdenum-pterin active site, where allopurinol demonstrates relatively weak competitive inhibition.
XOR is mainly found in the dehydrogenase form under normal physiological conditions; however, in inflammatory conditions, XOR can be converted into the xanthine oxidase form, which catalyzes reactions that produce reactive oxygen species (ROS), such as peroxynitrite. ROS contribute to vascular inflammation and alterations in vascular function. As febuxostat can inhibit both forms of XOR, it can inhibit ROS formation, oxidative stress, and inflammation. In a rat model, febuxostat suppressed renal ischemia-reperfusion injury by attenuating oxidative stress.
Dosage
Normoric Er dosage
The recommended starting dosage of Normoric Er is 40 mg once daily. For patients who do not achieve a serum uric acid concentration of less than 6 mg/dL after 2 weeks at the 40 mg dose, Normoric Er 80 mg once daily is recommended. Normoric Er can be administered without regard to food or antacid use.
Side Effects
The most common adverse events associated with the use of Normoric Er may include liver function abnormalities, nausea, arthralgia, and rash.
Toxicity
Oral lowest published toxic dose (TDLO) in humans is 1.82 mg/kg/14D (intermittent). Oral LD50 is 300 mg/kg in mice, 3200 mg/kg in rabbits, and 980 mg/kg in rats.
No dose-limiting toxicities were observed with febuxostat administered at doses up to 300 mg daily for seven days in healthy subjects. There are no reports of overdose of febuxostat in clinical studies and there is no known antidote. Overdose should be managed by symptomatic and supportive care.
Precaution
Gout Flare: An increase in gout flares is frequently observed during initiation of anti-hyperuricemic agents, including Normoric Er. If a gout flare occurs during treatment, Normoric Er need not be discontinued. Prophylactic therapy (i.e., non-steroidal anti-inflammatory drug (NSAID) or colchicine upon initiation of treatment) may be beneficial for up to six months.
Cardiovascular Events: A higher rate of cardiovascular thromboembolic events was observed in patients treated with febuxostat than allopurinol in clinical trials. Monitor for signs and symptoms of MI and stroke.
Liver Enzyme Elevation: Transaminase elevations have been observed in febuxostat -treated patients. Monitor liver function tests periodically.
Interaction
Concomitant administration of Normoric Er with azathioprine, mercaptopurine or theophylline could increase plasma concentrations of these drugs resulting in severe toxicity.
Food Interaction
- Take with or without food. A high fat meal decreases Cmax and AUC in a clinically insignificant way.
Normoric Er Drug Interaction
Unknown: aspirin, aspirin, rosuvastatin, apixaban, omega-3 polyunsaturated fatty acids, furosemide, atorvastatin, metoprolol, metoprolol, esomeprazole, amlodipine, omega-3 polyunsaturated fatty acids, acetaminophen, clopidogrel, acetaminophen, multivitamin, cyanocobalamin, ascorbic acid, cholecalciferol, rivaroxaban
Normoric Er Disease Interaction
Major: secondary hyperuricemiaModerate: CV disease, renal dysfunction, hepatic impairment
Volume of Distribution
The apparent steady-state volume of distribution (Vss/F) of febuxostat ranges from 29 to 75 L, indicating a low to medium volume of distribution.
Elimination Route
After oral administration, about 85% of febuxostat is absorbed rapidly. Tmax ranges from 1 to 1.5 hours. Following once-daily oral administration, Cmax was approximately 1.6 ± 0.6 mcg/mL at a dose of 40 mg febuxostat and 2.6 ± 1.7 mcg/mL at a dose of 80 mg febuxostat.
A high-fat meal decreased Cmax by 49% and AUC by 18%, but there were no clinically significant changes in the ability of febuxostat to decrease serum uric acid concentrations.
Half Life
The apparent mean terminal elimination half-life of approximately 5 to 8 hours.
Clearance
Following oral administration of single doses of 10 to 240 mg, the mean apparent total clearance ranged from 10 to 12 L/h.
Elimination Route
Normoric Er is eliminated via both hepatic and renal pathways. Following oral administration of 80 mg radiolabeled febuxostat, approximately 49% of the dose was recovered in the urine. In urine, about 3% of the recovered dose accounted for unchanged febuxostat, 30% accounted for the acyl glucuronide metabolite, 13% accounted for oxidative metabolites and their conjugates, and 3% accounted for unidentified metabolites.
Approximately 45% of the total dose was recovered in the feces, where 12% of the dose accounted for the unchanged parent drug. About 1% accounted for the acyl glucuronide metabolite, 25% accounted for oxidative metabolites and their conjugates, and 7% accounted for unidentified metabolites.
Pregnancy & Breastfeeding use
Pregnancy Category C. There are no adequate and well-controlled studies in pregnant women. Normoric Er should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
Lactation: It is not known whether this drug is excreted in human milk. Caution should be exercised when Normoric Er is administered to a nursing woman.
Contraindication
Normoric Er is contraindicated in patients being treated with azathioprine, mercaptopurine, or theophylline.
Special Warning
Pediatric Use: Safety and effectiveness in pediatric patients under 18 years of age have not been established
Acute Overdose
Febustat was studied in healthy subjects in doses up to 300 mg daily for seven days without evidence of dose-limiting toxicities.
Storage Condition
Keep out of the reach of children. Keep in a cool & dry place, protected from light.
Innovators Monograph
You find simplified version here Normoric Er
Normoric Er contains Febuxostat see full prescribing information from innovator Normoric Er Monograph, Normoric Er MSDS, Normoric Er FDA label
FAQ
How safe is Normoric Er?
Normoric Er is a medication used long-term to treat gout due to high uric acid levels. It is generally recommended only for people who cannot take allopurinol.
How safe is Normoric Er?
Take one tablet each day. There have been a few reports of Normoric Er causing a serious allergic reaction. Although this is rare, if you experience any of these symptoms, you should stop taking Normoric Er and contact your doctor straightaway.
How does Normoric Er work?
Normoric Er works by decreasing the amount of uric acid that is made in the body.
What are the common side effects of Normoric Er?
Common side effects of Normoric Er are include:
- Arm, back, or jaw pain
- black, tarry stools
- bloody nose
- blurred vision
- chest pain or discomfort
- chills
- cloudy urine
- confusion
- cough
- dark urine
- decreased frequency or amount of urine
- diarrhea
- difficult or labored breathing
- difficulty with moving
- dizziness
- dry mouth
- fainting
- fast, irregular, pounding, or racing heartbeat or pulse
- feeling of fullness
- fever
Is Normoric Er safe during pregnancy?
Some experts advise against use during pregnancy as the potential risk for humans is unknown.
Is Normoric Er safe during breastfeeding?
There are no data on the effects of this drug on the breastfed infant or its effects on milk production. Some experts advise against breastfeeding as a risk to the breastfeeding infant cannot be excluded.
Can I drink alcohol with Normoric Er?
Alcohol doesn't interact significantly with Normoric Er, but it does increase the level of urate in the blood.
Can I drive after taking Normoric Er ?
Be aware that you may experience dizziness, sleepiness, blurred vision and numbness or tingling sensation during treatment and should not drive or operate machines, if affected.
When is the best time to take Normoric Er?
It is best taken in the morning. If you do shift work or want to take your medicine at night, talk to your doctor, nurse or pharmacist.
Can I take Normoric Er on an empty stomach?
You can take Normoric Er with or without food.
How long does Normoric Er take to work?
Normoric Er should be taken every day to prevent a gout attack. It can take six 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.
Does Normoric Er affect the liver?
No instances of acute liver failure or chronic liver injury have been reported due to Normoric Er, but the clinical experience with this agent is limited.
Can I take Normoric Er for a long time?
Treatment with Normoric Er is usually long-term unless you experience an adverse effect. Continue to take the tablets unless you are advised otherwise by a doctor.
Is Normoric Er bad for my heart?
Normoric Er does not increase or decrease the risk of cardiovascular disease but may increase the risk of CVD death.
Is Normoric Er bad for kidney?
Normoric Er has shown to be safe and effective in patients with moderate to severe renal impairment, and dose adjustment is not required in these patients.
Can Normoric Er be stopped?
You should not stop using Normoric Er suddenly.
What happen If I stop taking Normoric Er?
If Normoric Er treatment is stopped there is a high risk that your gout may worsen. You should continue to take it even if you do not have symptoms.
Who should not take Normoric Er?
Taking Normoric Er may increase your risk of serious or fatal heart problems. Seek medical attention if you have chest pain, trouble breathing, fast heartbeats, sudden severe headache, numbness or weakness on one side of your body, or problems with vision or speech. You should not use Normoric Er if you also use azathioprine or mercaptopurine.
What happens if I miss a dose?
Take the medicine 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.
What happen if I take too much Normoric Er?
If you take too much Normoric Er, call your healthcare provider or local Poison Control Center or seek emergency medical attention right away. If Normoric Er is administered by a healthcare provider in a medical setting, it is unlikely that an overdose will occur. However, if an overdose is suspected, seek emergency medical attention.
Will Normoric Er affect my fertility?
The effects of Normoric Er on fertility are not currently known, but it's unlikely to be harmful.
