Панимун Биорал
Панимун Биорал Uses, Dosage, Side Effects, Food Interaction and all others data.
Sporium Sterile Ophthalmic Emulsion is a preparation of Панимун Биорал 0.05% whichacts as immunomodulator in patients whose tear production is suppressed due toocular inflammation associated with keratoconjunctivitis sicca.
Панимун Биорал exerts potent immunosuppressive actions on T cells, thereby prolonging survival following organ and bone marrow transplants. This drug prevents and controls serious immune-mediated reactions including allograft rejection, graft versus host disease, and inflammatory autoimmune disease.
Some notable effects of cyclosporine are hypertrichosis, gingival hyperplasia, and hyperlipidemia. There is also some debate about this drug causing nephrotoxicity.
Trade Name | Панимун Биорал |
Availability | Prescription only |
Generic | Cyclosporine |
Cyclosporine Other Names | Ciclosporin, Ciclosporina, Ciclosporine, Ciclosporinum, Cyclosporin, Cyclosporin A, Cyclosporine |
Related Drugs | Humira, Cosentyx, methotrexate, hydroxychloroquine, tacrolimus, azathioprine, Enbrel, Remicade, Stelara, mycophenolate mofetil |
Type | |
Formula | C62H111N11O12 |
Weight | Average: 1202.635 Monoisotopic: 1201.841368058 |
Protein binding | About 50% of the administered dose is taken up by erythrocytes while about 34% is bound to lipoproteins. Prescribing information for Sandimmune states that 90% is mainly bound to lipoproteins. |
Groups | Approved, Investigational, Vet approved |
Therapeutic Class | Drugs for Dry eyes |
Manufacturer | |
Available Country | Russia |
Last Updated: | September 19, 2023 at 7:00 am |
Uses
This drug is used to increase tear production in patients whose tear production issuppressed due to ocular inflammation associated with dry eye syndrome(keratoconjunctivitis sicca).
Панимун Биорал is also used to associated treatment for these conditions: Atopic Dermatitis (AD), Bone Marrow Transplant Rejection, Chronic transplant rejection, Connective Tissue Disorders, Glomerulosclerosis, Focal Segmental, Graft Versus Host Disease (GVHD), Heart Transplant Rejection, Idiopathic Thrombocytopenic Purpura, Interstitial Cystitis, Juvenile Idiopathic Arthritis (JIA), Kidney Transplant Rejection, Liver Transplant Rejection, Nephritis, Lupus, Nephrotic Syndrome, Ocular Rosacea, Rejection, Transplant, Severe Ulcerative Colitis, Steroid Dependent Nephrotic Syndrome, Steroid Resistant Nephrotic Syndrome, Uveitis, Vernal Keratoconjunctivitis, Blistering disorder, Refractory Ulcerative colitis, Severe, active Rheumatoid arthritis, Severe, recalcitrant Plaque psoriasis, Suppressed tear production
How Панимун Биорал works
Панимун Биорал is a calcineurin inhibitor that inhibits T cell activation. Its binding to the receptor cyclophilin-1 inside cells produces a complex known as cyclosporine-cyclophilin. This complex subsequently inhibits calcineurin, which in turn stops the dephosphorylation as well as the activation of the nuclear factor of activated T cells (NF-AT) that normally cause inflammatory reactions. NF-AT is a transcription factor that promotes the production of cytokines such as IL-2, IL-4, interferon-gamma and TNF-alpha, all of which are involved in the inflammatory process. Specifically, the inhibition of IL-2, which is necessary for T cell activation or proliferation, is believed to be responsible for cyclosporine's immunosuppressive actions. In addition to the above, the inhibition of NF-AT leads to lower levels of other factors associated with T helper cell function and thymocyte development.
Dosage
Панимун Биорал dosage
Instill one drop of this drug twice a day in each eye approximately 12 hours apart. Itcan be used concomitantly with artificial tears, allowing a 15 minute interval betweenproducts
Side Effects
The most common adverse event is ocular burning. Other events reported includeconjunctival hyperemia, discharge, epiphora, eye pain, foreign body sensation,pruritus, stinging and visual disturbance (most often blurring).
Toxicity
The oral LD50 in rats is 1480 mg/kg and the TDLO in humans is 12 mg/kg.
Overdose information
In cases of overdose with oral cyclosporine, forced emesis and gastric lavage are recommended 2 hours after ingestion. There are little data available in the literature regarding overdoses with cyclosporine, but hepatotoxicity and nephrotoxicity may occur. One case report of an cyclosporine overdose due to medical error was made involving a 26 year old female and noted the occurrence of nausea, flushing, tremor, vertigo and vomiting, which resolved within about 1 day. Anorexia and a feeling of increased body girth were also experienced by this patient and resolved within about 2 weeks. When overdose with cyclosporine is observed, it is important to consider that dialysis and charcoal, hemoperfusion are not effective techniques to remove cyclosporine from the body.
Precaution
This drug should not be administered while wearing contact lenses. Patients withdecreased tear production typically should not wear contact lenses. If contact lensesare worn, they should be removed prior to the administration of the emulsion. Lensesmay be reinserted 15 minutes following administration of this medication.This drug may cause blurred vision. Do not drive, use machinery, or do any activitythat requires clear vision until you are sure you can perform such activities safely.
Food Interaction
- Avoid grapefruit products.
- Avoid potassium-containing products. Taking products that increase serum potassium may increase the risk of hyperkalemia.
- Avoid St. John's Wort.
- Take at the same time every day. Take consistently with regard to food.
[Moderate] GENERALLY AVOID: Administration with grapefruit juice (compared to water or orange juice) has been shown to increase blood concentrations of cyclosporine with a relatively high degree of interpatient variability.
The mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits.
GENERALLY AVOID: Administration with red wine or purple grape juice may decrease blood concentrations of cyclosporine.
In 12 healthy volunteers, 12 ounces total of a merlot consumed 15 minutes prior to and during cyclosporine administration (single 8 mg The time to reach peak concentration (Tmax) doubled, and oral clearance increased 50%. Similarly, one study were 12 healthy patients were administered purple grape juice and a single dose of cyclosporine showed a 30% and a 36% decrease in cyclosporine systemic exposure (AUC) and peak blood concentration (Cmax), respectively. The exact mechanism of interaction is unknown but may involve decreased cyclosporine absorption. There have been reports of impaired, unchanged, and enhanced absorption during administration with meals relative to the fasting state. The mechanisms are unclear. Some investigators found an association with the fat content of food. In one study, increased fat intake resulted in significantly increased cyclosporine bioavailability and clearance. However, the AUC and pharmacodynamics of cyclosporine were not significantly affected, thus clinical relevance of these findings may be minimal. Until more data are available, the consumption of red wine or purple grape juice should preferably be avoided or limited. All oral formulations of cyclosporine should be administered on a consistent schedule with regard to time of day and relation to meals so as to avoid large fluctuations in plasma drug levels.
MONITOR: Food has been found to have variable effects on the absorption of cyclosporine.
MANAGEMENT: Patients receiving cyclosporine therapy should be advised to either refrain from or avoid fluctuations in the consumption of grapefruits and grapefruit juice.
Панимун Биорал Hypertension interaction
[Major] The use of cyclosporine is contraindicated in patients with rheumatoid arthritis or psoriasis with uncontrolled hypertension.
Hypertension, possibly due to renal vasoconstriction, has occurred in 50% of patients receiving cyclosporine.
Antihypertensive therapy may be necessary for kidney, liver, and heart transplant recipients treated with cyclosporine.
Hypertension may decline with continued used, but has persisted in some patients.
Панимун Биорал Drug Interaction
Major: atorvastatin, atorvastatinModerate: aspirin, aspirin, mycophenolate mofetil, mycophenolate mofetil, furosemide, furosemideUnknown: omega-3 polyunsaturated fatty acids, omega-3 polyunsaturated fatty acids, pregabalin, pregabalin, cyanocobalamin, cyanocobalamin, ascorbic acid, ascorbic acid, cholecalciferol, cholecalciferol, cetirizine, cetirizine
Панимун Биорал Disease Interaction
Major: hypertension, renal dysfunctionModerate: hepatic dysfunction, malabsorption syndrome
Volume of Distribution
The distribution of cyclosporine in the blood consists of 33%-47% in plasma, 4%-9% in the lymphocytes, 5%-12% in the granulocytes, and 41%-58% in the erythrocytes. The reported volume of distribution of cyclosporine ranges from 4-8 L/kg. It concentrates mainly in leucocyte-rich tissues as well as tissues that contain high amounts of fat because it is highly lipophilic. Панимун Биорал, in the eye drop formulation, crosses the blood-retinal barrier.
Elimination Route
The absorption of cyclosporine occurs mainly in the intestine. Absorption of cyclosporine is highly variable with a peak bioavailability of 30% sometimes occurring 1-8 hours after administration with a second peak observed in certain patients. The absorption of cyclosporine from the GI tract has been found to be incomplete, likely due to first pass effects. Cmax in both the blood and plasma occurs at approximately 3.5 hours post-dose.
The Cmax of a 0.1% cyclosporine ophthalmic emulsion is 0.67 ng/mL after instilling one drop four times daily.
A note on erratic absorption
During chronic administration, the absorption of Sandimmune Soft Gelatin Capsules and Oral Solution have been observed to be erratic, according to Novartis prescribing information. Those being administered the soft gelatin capsules or oral solution over the long term should be regularly monitored by testing cyclosporine blood concentrations and adjusting the dose accordingly. When compared with the other oral forms of Sandimmune, Neoral capsules and solution have a higher rate of absorption that results in a higher Tmax and a 59% higher Cmax with a 29 % higher bioavailability.
Half Life
The half-life of cyclosporine is biphasic and very variable on different conditions but it is reported in general to last 19 hours. Prescribing information also states a terminal half-life of approximately 19 hours, but with a range between 10 to 27 hours.
Clearance
Cyclosporin shows a linear clearance profile that ranges from 0.38 to 3 Lxh/kg, however, there is substantial inter- patient variability. A 250 mg dose of cyclosporine in the oral soft gelatin capsule of a lipid micro-emulsion formulation shows an approximate clearance of 22.5 L/h.
Elimination Route
After sulfate conjugation, cyclosporine remains in the bile where it is broken down to the original compound and then re-absorbed into the circulation. Панимун Биорал excretion is primarily biliary with only 3-6% of the dose (including the parent drug and metabolites) excreted in the urine while 90% of the administered dose is eliminated in the bile. From the excreted proportion, under 1% of the dose is excreted as unchanged cyclosporine.
Pregnancy & Breastfeeding use
Pregnancy category C. There are no adequate and well-controlled studies of Панимун Биорал ophthalmic emulsion in pregnant women. It should be administered topregnant women if clearly needed. Панимун Биорал is known to be excreted in human milk following systemic administration but excretion in human milk after topical treatment has not been investigated.
Although blood concentrations are undetectable after topical administration of Панимун Биорал ophthalmic emulsion, caution should be exercised when it isadministered to a nursing woman.
Contraindication
Панимун Биорал is contraindicated in patients with active ocular infections and in patients with known or suspected hypersensitivity to any of the ingredients in the formulation.
Acute Overdose
No information provided
Interaction with other Medicine
No information provided
Storage Condition
Keep out of the reach of children. Keep in a cool and dry place, away from light. Do not use more than 4 weeks after opening
Innovators Monograph
You find simplified version here Панимун Биорал
Панимун Биорал contains Cyclosporine see full prescribing information from innovator Панимун Биорал Monograph, Панимун Биорал MSDS, Панимун Биорал FDA label
FAQ
What is Панимун Биорал used for?
Панимун Биорал is a calcineurin inhibitor, used as an immunosuppressant medication. Панимун Биорал is used together with other medicines to prevent the body from rejecting a transplanted organ (eg, kidney, liver, or heart).
How safe is Панимун Биорал?
Панимун Биорал is a very strong medicine. It can cause side effects that can be very serious, such as kidney problems. It may also decrease the body's ability to fight infections. You and your doctor should talk about the benefits of this medicine as well as the risks of using it.
How does Панимун Биорал work?
Панимун Биорал works by suppressing the immune system's responses. By reducing the immune response, Панимун Биорал prevents the immune system from attacking healthy tissues. In the same way, it prevents the body from treating a transplanted organ as foreign matter.
What are the common side effects of Панимун Биорал?
Common side effects of Панимун Биорал are include shaking, headache, dizziness, unusual growth of body hair, nausea/vomiting, diarrhea, stomach upset, or flushing. If any of these effects last or get worse, tell your doctor or pharmacist promptly. Unusual growth and swelling of the gums may occur.
Is Панимун Биорал safe during pregnancy?
Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
Is Панимун Биорал safe during breastfeeding?
Women taking Панимун Биорал are not advised to breast feed because Панимун Биорал is excreted in milk at concentrations similar to those in blood.
Can I drink alcohol with Панимун Биорал?
There is no particular reason for you to avoid alcohol while taking Панимун Биорал.
Can I drive after taking Панимун Биорал?
Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis). This medication may contain alcohol.
When is the best time to take Панимун Биорал?
Панимун Биорал should be taken with food to decrease stomach upset, but may be taken on an empty stomach. Панимун Биорал should be taken at the same time each day.
How often is Панимун Биорал taken?
The starting dose is usually 15 mg per kg of body weight per day. This is taken as a single dose 4 to 12 hours before organ transplantation and continued after transplantation as directed by your doctor.
How long does Панимун Биорал take to work?
Панимун Биорал may take from three to four months to reach optimal control.
What is the half life of Панимун Биорал?
Half-Life 8.4 to 27 hours. The time to peak blood Панимун Биорал concentrations ranges from 1.5 to 2 hours following oral administration of cyclosporine oral solution USP modified.
Can I stop Панимун Биорал suddenly?
You should consult your doctor before you stop taking this medicine or before you change the amount for any reason. You may become ill if you stop taking this medicine suddenly. You may want to take Панимун Биорал with some food if the medicine upsets your stomach.
What happens when I stop taking Панимун Биорал?
Your body may reject your transplanted organ or your symptoms of RA or psoriasis may return.
Does Панимун Биорал make my hair grow?
Панимун Биорал can potently induce hair growth in humans.
Is Панимун Биорал hard on kidneys?
Панимун Биорал is a very strong medicine. It can cause side effects that can be very serious, such as kidney problems. It may also decrease the body's ability to fight infections.
Does Панимун Биорал cause anxiety?
Панимун Биорал can increased anxiety-related behavior.
Who should not take Панимун Биорал?
You should not use Панимун Биорал if you are allergic to it. You may not be able to use Панимун Биорал if you have: kidney disease; untreated or uncontrolled high blood pressure; or any type of cancer.
What happens if I miss a dose?
Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
What happen if I overdose on Панимун Биорал?
Symptoms of a Панимун Биорал overdose include: vomiting. fatigue. rapid heart rate, or tachycardia. Overdosages of Панимун Биорал can cause liver and kidney toxicity. It can also increase people's risk of certain types of cancer, especially lymphoma and skin cancer.
Can Панимун Биорал affect my kidneys?
Панимун Биорал is a very strong medicine. It can cause side effects that can be very serious, such as kidney problems. It may also decrease the body's ability to fight infections.
Can Панимун Биорал affects my liver?
Liver injury was common in patients receiving Панимун Биорал. These abnormalities are usually self-limited and asymptomatic but may cause diagnostic difficulty if a preexisting liver disease is present.
Does Панимун Биорал affect heart rate?
Панимун Биорал did not affect heart rate but contractility (+dp/dtmax) tended to decrease, although not significantly.