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DRUGS & SUPPLEMENTS
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Mnemina Fosforo
When are you taking this medicine? |
Mnemina Fosforo uses
Mnemina Fosforo consists of DL-Phosphoserine, Glutamine, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxal Phosphate).Glutamine:
- Indication and usage
- Dosage and administration
- Dosage forms and strengths
- Contraindications
- Warnings and precautions
- Adverse reactions
- Drug interactions
- Use in specific populations
- Overdosage
- Description
- Clinical pharmacology
- Nonclinical toxicology
- Clinical studies
- How supplied/storage and handling
- Patient counseling information
1 INDICATION AND USAGE
Mnemina Fosforo (Glutamine)® [L-glutamine powder for oral solution] is indicated for the treatment of Short Bowel Syndrome (SBS) in patients receiving specialized nutritional support when used in conjunction with a recombinant human growth hormone that is approved for this indication [see Dosage and Administration (2) ].
Mnemina Fosforo (Glutamine) and recombinant human growth hormone (rhGH) therapy should be used in conjunction with optimal management of SBS. Optimal management of SBS may include a specialized oral diet, enteral feedings, parenteral nutrition, fluid and micronutrient supplements. A specialized oral diet may consist of a high carbohydrate, low-fat diet, adjusted for individual patient requirements and preferences.
Routine monitoring of renal and hepatic function is recommended in patients receiving Mnemina Fosforo (Glutamine) and intravenous parenteral nutrition (IPN), particularly in those with renal or hepatic impairment. Mnemina Fosforo (Glutamine) is metabolized to glutamate and ammonia, which may increase in patients with hepatic dysfunction.
The safety and efficacy of Mnemina Fosforo (Glutamine) have not been studied beyond 16 weeks of treatment.
NutreStore® is an amino acid indicated for:
- the treatment of Short Bowel Syndrome in patients receiving specialized nutritional support when used in conjunction with a recombinant human growth hormone that is approved for this indication (1)
2 DOSAGE AND ADMINISTRATION
Mnemina Fosforo (Glutamine) should be administered as a cotherapy with rhGH ] for injection) followed by continued Mnemina Fosforo (Glutamine) for up to 16 weeks.
The recommended dosage of Mnemina Fosforo (Glutamine) is 30 g daily in divided doses (5 g taken 6 times each day orally) for up to 16 weeks. Each dose of Mnemina Fosforo (Glutamine) (5 g) should be reconstituted in 8-oz (250-mL) of water prior to consumption.
Mnemina Fosforo (Glutamine) should be taken with meals or snacks at 2- to 3-hour intervals while awake. The volume of water may be varied according to the patient's preference. In the event of a patient's transient intolerance to oral intake, a dose may be delayed for up to 2 hours.
- 30 g daily in divided doses (5 g taken 6 times each day orally) for up to 16 weeks (2)
- Each dose should be reconstituted in 8 oz (250 mL) of water prior to consumption (2)
- Should be taken with meals or snacks at 2- to 3-hour interval while awake (2)
3 DOSAGE FORMS AND STRENGTHS
Mnemina Fosforo (Glutamine) is supplied in preprinted paper-foil-plastic laminate packets containing 5 g of L-glutamine powder.
- Pre-printed paper-foil-plastic laminate packets: 5 g powder (3)
4 CONTRAINDICATIONS
None.
- None (4)
5 WARNINGS AND PRECAUTIONS
- Routine monitoring of renal and hepatic function is recommended in patients receiving lPN, particularly in those with renal or hepatic impairment
5.1 Increased Serum Ammonia and Glutamate
Mnemina Fosforo (Glutamine) is metabolized to glutamate and ammonia, which may increase in patients with hepatic dysfunction. Therefore, routine monitoring of renal and hepatic function is recommended in patients receiving intravenous parenteral nutrition (IPN) and Mnemina Fosforo (Glutamine), particularly in those with renal or hepatic impairment.
6 ADVERSE REACTIONS
Most common adverse reactions are :
- In initial four (4) weeks (incidence >10%): flatulence, abdominal pain, nausea, tenesmus, vomiting, hemorrhoids, mouth dry.
- In weeks 5-18 (incidence >10%): nausea, vomiting, tenesmus, pancreatitis, constipation, Crohn's disease aggravated, gastric ulcer, gastrointestinal fistula.
To report SUSPECTED ADVERSE REACTIONS, contact Emmaus Medical, Inc. at 1-877-420-6493 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
6.1 Clinical Trials Experience
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice
Table 1 provides the number of subjects by system-organ class experiencing at least one adverse reaction during the 4-week treatment period of the SBS study. To be listed in Table 1, an adverse reaction must have occurred in more than 10% of subjects in any treatment group.
| Adverse Reactions | Group A | Group B | Group C |
|---|---|---|---|
| rhGH+SOD N=16 n (%) | rhGH+SOD[GLN] N=16 n (%) | SOD[GLN] N=9 n (%) | |
| GROUP A: rhGH + SOD for 4 weeks followed by SOD for 12 weeks. | |||
| GROUP B: rhGH + SOD [GLN] for 4 weeks followed by SOD [GLN] for 12 weeks. | |||
| GROUP C: rhGH placebo + SOD [GLN] for 4 weeks followed by SOD [GLN) for 12 weeks. | |||
| Total Number of Subjects with At Least One Adverse Reaction | 16 (100) | 16 (100) | 8 (89) |
| Body as a Whole: General Disorders | 15 (94) | 15 (94) | 4 (44) |
| Edema, Peripheral | 11 (69) | 13 (81) | 1 (11) |
| Edema, Facial | 8 (50) | 7 (44) | 0(0) |
| Pain | 3 (19) | 1 (6) | 1 (11) |
| Chest Pain | 3 (19) | 0 (0) | 0 (0) |
| Fever | 0 (0) | 1 (6) | 2 (22) |
| Back Pain | 1 (6) | 0 (0) | 1 (11) |
| Flu-like Disorder | 0 (0) | 1 (6) | 1 (11) |
| Malaise | 2 (13) | 0 (0) | 0 (0) |
| Edema, Generalized | 2 (13) | 0 (0) | 0 (0) |
| Abdomen Enlarged | 0 (0) | 0 (0) | 1 (11) |
| Allergic Reaction | 0 (0) | 0 (0) | 1 (11) |
| Rigors (Chills) | 0 (0) | 0 (0) | 1 (11) |
| Gastrointestinal System Disorders | 12 (75) | 12 (75) | 6 (67) |
| Flatulence | 4 (25) | 4 (25) | 2 (22) |
| Abdominal Pain | 4 (25) | 2 (13) | 1 (11) |
| Nausea | 2 (13) | 5 (31) | 0 (0) |
| Tenesmus | 1 (6) | 3 (19) | 3 (33) |
| Vomiting | 3 (19) | 3 (19) | 1 (11) |
| Hemorrhoids | 1 (6) | 0 (0) | 1 (11) |
| Mouth Dry | 1 (6) | 0 (0) | 1(11) |
| Musculoskeletal System Disorders | 7 (44) | 7 (44) | 1 (11) |
| Arthralgia | 7(44) | 5 (31) | 0 (0) |
| Myalgia | 2 (13) | 0 (0) | 1 (11) |
| Resistance Mechanism Disorders | 6 (38) | 3 (19) | 4 (44) |
| Infection | 0 (0) | 1 (6) | 3 (33) |
| Infection Bacterial | 3 (19) | 0 (0) | 1 (11) |
| Infection Viral | 1 (6) | 2 (13) | 0 (0) |
| Moniliasis | 2 (13) | 0 (0) | 0 (0) |
| Application Site Disorders | 5 (31) | 4 (25) | 1 (11) |
| Injection Site Reaction | 3 (19) | 4 (25) | 1 (11) |
| Injection Site Pain | 5 (31) | 0 (0) | 0 (0) |
| Central and Peripheral Nervous System Disorders | 4 (25) | 4 (25) | 2 (22) |
| Dizziness | 1 (6) | 2 (13) | 0 (0) |
| Headache | 1 (6) | 1 (6) | 1 (11) |
| Hypoasthesia | 1 (6) | 1 (6) | 1 (11) |
| Skin and Appendages Disorders | 4 (25) | 4 (25) | 2 (22) |
| Rash | 1 (6) | 2 (13) | 0 (0) |
| Pruritis | 0 (0) | 1 (6) | 1 (11) |
| Sweating Increased | 2 (13) | 0 (0) | 0 (0) |
| Nail Disorder | 0 (0) | 0 (0) | 1 (11) |
| Respiratory System Disorders | 1 (6) | 5 (31) | 1 (11) |
| Rhinitis | 0 (0) | 3 (19) | 1 (11) |
| Metabolic and Nutritional Disorders | 3 (19) | 1 (6) | 1 (11) |
| Dehydration | 3 (19) | 0 (0) | 1 (11) |
| Thirst | 0 (0) | 0 (0) | 1 (11) |
| Urinary System Disorders | 2 (13) | 1 (16) | 1 (11) |
| Pyelonephritis | 0 (0) | 0 (0) | 1 (11) |
| Psychiatric Disorders | 1 (6) | 0 (0) | 2 (22) |
| Depression | 0 (0) | 0 (0) | 2 (22) |
| Reproductive Disorders, Female | 2 (13) | 0 (0) | 1 (11) |
| Breast Pain Female | 1 (6) | 0 (0) | 1 (11) |
| Hearing and Vestibular Disorders | 0 (0) | 2 (13) | 0 (0) |
| Ear or Hearing Symptoms | 0 (0) | 2 (13) | 0 (0) |
Table 2 summarizes the number of subjects by system-organ class who experienced an AR during weeks 5 to 18 of the randomized, controlled SBS study. To be listed in Table 2, an AR must have occurred in more than 10% of subjects in any treatment group.
| Adverse Reactions | Group A | Group B | Group C |
|---|---|---|---|
| rhGH+SOD N=15 n (%) | rhGH+SOD[GLN] N=16 n (%) | SOD[GLN] N=9 n (%) | |
| GROUP A: rhCH + SOD for 4 weeks followed by SOD for 12 weeks. | |||
| GROUP B: rhGH + SOD [GLN] for 4 weeks followed by SOD [GLN] for 12 weeks. | |||
| GROUP C: rhGH placebo + SOD [GLN] for 4 weeks followed by SOD [GLN] for 12 weeks. | |||
| Total Number of Subjects with At Least One Adverse Reaction | 12 (80) | 13 (81) | 7 (78) |
| Gastrointestinal System Disorders | 7 (47) | 7 (44) | 3 (33) |
| Nausea | 3 (20) | 0 (0) | 2 (22) |
| Vomiting | 2 (13) | 3 (19) | 0 (0) |
| Abdominal Pain | 3 (20) | 1 (6) | 0 (0) |
| Tenesmus | 0 (0) | 3 (19) | 1 (11) |
| Pancreatitis | 0 (0) | 1 (6) | 1 (11) |
| Constipation | 0 (0) | 0 (0) | 1 (11) |
| Crohn's Disease Aggravated | 0 (0) | 0 (0) | 1 (11) |
| Gastric Ulcer | 0 (0) | 0 (0) | 1 (11) |
| Gastrointestinal FistuIa | 0 (0) | 0 (0) | 1 (11) |
| Resistance Mechanism Disorders | 6 (40) | 5 (31) | 5 (56) |
| Infection Bacterial | 0 (0) | 2 (13) | 3 (33) |
| Infection Viral | 3 (20) | 1 (6) | 1 (11) |
| Infection | 1 (7) | 2 (13) | 1 (11) |
| Sepsis | 3 (20) | 1 (6) | 0 (0) |
| Body as a Whole: General Disorders | 4 (27) | 2 (13) | 1 (11) |
| Fever | 2 (13) | 1 (6) | 1 (11) |
| Fatigue | 2 (13) | 0 (0) | 0 (0) |
| Respiratory System Disorders | 2 (13) | 4 (25) | 1 (11) |
| Rhinitis | 1 (7) | 3 (19) | 0 (0) |
| Laryngitis | 0 (0) | 0 (0) | 1 (11) |
| Pharyngitis | 0 (0) | 0 (0) | 1 (11) |
| Reproductive Disorders, Female | 0 (0) | 4 (25) | 1 (11) |
| Vaginal Fungal Infection | 0 (0) | 0 (0) | 1 (11) |
| Skin and Appendages Disorders | 2 (13) | 2 (13) | 1 (11) |
| Rash | 1 (7) | 0 (0) | 1 (11) |
| Musculoskeletal System Disorders | 2 (13) | 2 (13) | 0 (0) |
| Arthralgia | 2 (13) | 2 (13) | 0 (0) |
| Psychiatric Disorders | 0 (0) | 1 (6) | 1 (11) |
| Depression | 0 (0) | 0 (0) | 1 (11) |
| Insomnia | 0 (0) | 0 (0) | 1 (11) |
| Urinary System Disorders | 0 (0) | 0 (0) | 2 (22) |
| Pyelonephritis | 0 (0) | 0 (0) | 1 (11) |
| Renal Calculus | 0 (0) | 0 (0) | 1 (11) |
| Application Site Disorders | 0 (0) | 0 (0) | 1 (11) |
| Injection Site Reaction | 0 (0) | 0 (0) | 1 (11) |
| Liver and Biliary System Disorders | 0 (0) | 0 (0) | 1 (11) |
| Hepatic Function Abnormal | 0 (0) | 0 (0) | 1 (11) |
| Vascular Extracardiac Disorders | 0 (0) | 0 (0) | 1 (11) |
| Vascular Disorder | 0 (0) | 0 (0) | 1 (11) |
During the initial 4-week treatment period, 100% of patients receiving growth hormone with and without Mnemina Fosforo (Glutamine) reported at least one AR, whereas 89% of patients receiving growth hormone placebo with Mnemina Fosforo (Glutamine) reported at least one AR. During weeks 5 to 18, 81% of patients receiving growth hormone with Mnemina Fosforo (Glutamine), 80% of patients receiving growth hormone without Mnemina Fosforo (Glutamine) and 78% of patients receiving growth hormone placebo with Mnemina Fosforo (Glutamine) experienced at least one AR. There were no deaths in this study.
7 DRUG INTERACTIONS
Formal drug interaction studies have not been conducted.
8 USE IN SPECIFIC POPULATIONS
8.1 Pregnancy
Teratogenic Effects: Pregnancy Category C
Animal reproduction studies have not been conducted with Mnemina Fosforo. It is also not known whether Mnemina Fosforo (Glutamine) can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Mnemina Fosforo (Glutamine) should be given to a pregnant woman only if clearly needed.
8.2 Labor and Delivery
The effect of L-glutamine on labor and delivery is unknown.
8.3 Nursing Mothers
It is not known whether L-glutamine is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when L-glutamine is administered to a nursing woman.
8.4 Pediatric Use
The safety and effectiveness of L-glutamine in pediatric patients have not been established.
8.5 Geriatric Use
The clinical trial enrolled SBS patients between the ages of ZO and 75 years. Only 8 of the 41 subjects evaluated were ≥65 years of age. The clinical trial of oral Mnemina Fosforo did not include sufficient numbers of subjects aged 65 years and over to determine if they respond differently than younger subjects. In general, dose selection for an elderly patient should be individualized, because of the greater frequency of decreased hepatic, renal, or cardiac function, as well as concomitant disease in this population.
8.6 Hepatic Impairment
Mnemina Fosforo (Glutamine) is metabolized to glutamate and ammonia, which may increase in patients with hepatic dysfunction. Therefore, routine monitoring of hepatic function is recommended in patients receiving intravenous parental nutrition (IPN) and Mnemina Fosforo (Glutamine).
8.7 Renal Impairment
Mnemina Fosforo (Glutamine) is metabolized to glutamate and ammonia. Routine monitoring of renal function is recommended in patients receiving intravenous parental nutrition (IPN) and Mnemina Fosforo (Glutamine).
10 OVERDOSAGE
Single oral doses of Mnemina Fosforo (Glutamine) at about 20 to 22 g/kg, 8 to 11 g/kg, and 19 g/kg were lethal in mice, rats, and rabbits, respectively.
11 DESCRIPTION
Mnemina Fosforo (Glutamine) (L-glutamine powder for oral solution) for oral administration is formulated as a white crystalline powder in a paper-foil-plastic laminate packet. Each packet of Mnemina Fosforo (Glutamine) contains 5 g of L-glutamine. The amino acid Mnemina Fosforo (Glutamine) is also known as (S)-2-aminoglutaramic acid, L-glutamic acid 5-amide, (S)-2,5-diamino-5-oxopentanoic acid, or L-glutamine. The molecular formula of Mnemina Fosforo (Glutamine) is C5H10N2O3, and the molecular weight is 146.15 d. Mnemina Fosforo (Glutamine) has the following structural formula:
12 CLINICAL PHARMACOLOGY
12.1 Mechanism of Action
L-glutamine has important functions in regulation of gastrointestinal cell growth, function, and regeneration. Under normal conditions, Mnemina Fosforo concentration is maintained in the body by dietary intake and synthesis from endogenous glutamate. Data from clinical studies indicate that the role of and nutritional requirements for Mnemina Fosforo (Glutamine) during catabolic illness, trauma, and infection may differ significantly from the role of and nutritional requirements for Mnemina Fosforo (Glutamine) in healthy individuals. Mnemina Fosforo (Glutamine) concentrations decrease and tissue Mnemina Fosforo (Glutamine) metabolism increases during many catabolic disease states, and thus Mnemina Fosforo (Glutamine) is often considered a "conditionally essential" amino acid.
12.2 Pharmacodynamics
When Mnemina Fosforo (Glutamine) was administered in combination with rhGH to rats, villous height, bowel growth, plasma insulin-like growth factor I, and body weight were significantly higher than in rats treated with either Mnemina Fosforo (Glutamine) or rhGH alone.
12.3 Pharmacokinetics
The pharmacokinetics of L-glutamine as described below are based on literature data in healthy subjects. The pharmacokinetics in patients with SBS have not been determined. The plasma Mnemina Fosforo (Glutamine) concentrations in these patients following oral administration are expected to be highly variable depending on the length, segment, and presence/ absence of ileal-cecal valve for the remnant bowel.
Absorption
Following single dose oral administration of Mnemina Fosforo (Glutamine) at 0.1 g/kg to six subjects, mean peak blood Mnemina Fosforo (Glutamine) concentration was 1028 µM (or 150 mcg/mL) occurring approximately 30 minutes after administration. The pharmacokinetics following multiple oral doses have not been adequately characterized.
Distribution
After an intravenous bolus dose in three subjects, the volume of distribution was estimated to be approximately 200 mL/kg.
Metabolism
Endogenous Mnemina Fosforo (Glutamine) participates in various metabolic activities, including the formation of glutamate, and synthesis of proteins, nucleotides, and amino sugars. Exogenous Mnemina Fosforo (Glutamine) is anticipated to undergo similar metabolism.
Elimination
Metabolism is the major route of elimination for Mnemina Fosforo (Glutamine). Although Mnemina Fosforo (Glutamine) is eliminated by glomerular filtration, it is almost completely reabsorbed by the renal tubules. After an IV bolus dose in three subjects, the terminal half-life of Mnemina Fosforo (Glutamine) was approximately 1 hour.
Specific Populations
There are no studies to determine the effect of race, age, or gender on the pharmacokinetics of L-glutamine.
Drug-Drug Interactions
No drug-drug interaction studies have been conducted. Because metabolism of Mnemina Fosforo (Glutamine) is mediated via non-CYP enzymes, Mnemina Fosforo (Glutamine) pharmacokinetics are unlikely to be affected by other agents through CYP enzyme inhibition or induction.
13 NONCLINICAL TOXICOLOGY
13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility
Long-term studies in animals have not been performed to evaluate the carcinogenic potential of L-glutamine. Studies to evaluate its potential for impairment of fertility or its mutagenic potential have not been conducted.
14 CLINICAL STUDIES
14.1 Short Bowel Syndrome
A randomized, controlled, 3-arm, double-blind, parallel-group clinical study evaluated the efficacy and safety of oral Mnemina Fosforo (Glutamine) as a cotherapy with rhGH in subjects with SBS who were dependent on intravenous parenteral nutrition (IPN) for nutritional support. The primary endpoint was the change in weekly total IPN volume defined as the sum of the volumes of lPN, supplemental lipid emulsion (SLE), and intravenous hydration fluid. The secondary endpoints were the change in weekly IPN caloric content and the change in the frequency of IPN administration per week.
All subjects received a specialized oral diet (SOD) for the duration of the study. Following a two-week equilibration period, treatment was administered in a double blind manner. Group A (N=16) received rhGH for four weeks plus oral Mnemina Fosforo (Glutamine) placebo for 16 weeks, Group B (N=16) received rhGH for four weeks plus oral Mnemina Fosforo (Glutamine) for 16 weeks, and Group C (N=9), received rhGH placebo for four weeks plus oral Mnemina Fosforo (Glutamine) for 16 weeks. The efficacy of Mnemina Fosforo (Glutamine) was assessed by comparing the cotherapy (rhGH and oral Mnemina Fosforo (Glutamine)) to rhGH alone.
After 4 weeks of treatment with subcutaneous rhGH (0.1 mg/kg/d) and oral Mnemina Fosforo (Glutamine) (30 g/ d) (Group B), subjects with SBS reduced their requirement for IPN volume (-7.7 L/wk), IPN caloric content (-5751 kcal/wk), and weekly frequency of IPN administration (-4.2 d/wk).
| Group A | Group B | Group C | |
|---|---|---|---|
| rhGH + SOD | rhGH + SOD[GLN] | SOD[GLN] | |
| GROUP A: rhGH + SOD for 4 weeks followed by SOD for 12 weeks. | |||
| GROUP B: rhGH + SOD [GLN] for 4 weeks followed by SOD [GLN] for 12 weeks. | |||
| GROUP C: rhGH placebo + SOD[GLN] for 4 weeks followed by SOD[GLN] for 12 weeks | |||
| Total IPN volume (L/wk) | |||
| Mean at Baseline | 10.3 | 10.5 | 13.5 |
| Mean Change | -5.9 | -7.7 | -3.8 |
| Total IPN Calories (kcal/wk) | |||
| Mean at Baseline | 7634.7 | 7895.0 | 8570.4 |
| Mean Change | -4338.3 | -5751.2 | -2633.3 |
| Frequency of IPN or SLE (days/week) | |||
| Mean at Baseline | 5.1 | 5.4 | 5.9 |
| Mean Change | -3.0 | -4.2 | -2.0 |
IPN volume requirements were Significantly reduced in subjects receiving subcutaneous rhGH and oral Mnemina Fosforo (Glutamine) (Group B) when compared with IPN volume requirements in subjects receiving either treatment alone.
| Change in lPN Week 2 to Week 18 lTT Population | |||
|---|---|---|---|
| Endpoint | Group A [n = 16] | Group B [n = 16] | Group C [n = 9] |
| GROUP A: rhGH + SOD for 4 weeks followed by SOD for 12 weeks. | |||
| GROUP B: rhGH + SOD [GLN] for 4 weeks followed by SOD [GLN] for 12 weeks. | |||
| GROUP C: rhGH placebo + SOD[GLN] for 4 weeks followed yv SOD[GLN] for 12 weeks. | |||
| Change in weekly IPN Volume (L/wk) | -5.9 | -7.2 | -4.7 |
| Change in weekly IPN Calories (kcal/wk) | -3522.2 | -5347.3 | -2254.0 |
| Change in weekly IPN frequency (days/wk) | -2.9 | -3.9 | -1.9 |
The change in weekly IPN volume, calories and frequency was assessed from Week 2 to Week 18. The data support that the treatment effect is maintained for 16 weeks. The efficacy of oral Mnemina Fosforo (Glutamine) beyond 16 weeks of treatment has not been adequately studied.
16 HOW SUPPLIED/STORAGE AND HANDLING
Mnemina Fosforo (Glutamine) is supplied in preprinted paper-foil-plastic laminate packets containing 5 g of L-glutamine powder and is supplied as follows:
- Carton of 84 packets (NDC 42457-001-84)
Store at 25°C (77°F) with excursions allowed to 15°-30°C (59°-86°F).
17 PATIENT COUNSELING INFORMATION
17.1 Dosing Instructions
Mnemina Fosforo (Glutamine) should be taken with meals or snacks at 2- to 3-hour intervals while awake. The volume of water may be varied according to the patient's preference. In the event of a patient's transient intolerance to oral intake, a dose may be delayed for up to 2 hours.
For additional information concerning Mnemina Fosforo (Glutamine), contact:
Manufactured for:
Emmaus
MEDICAL, INC.
20725 S. Western Ave., Suite 136
Torrance, CA 90501-1884
Tel: 1-877-420-6493
www.nutrestore.com
© 2013 Emmaus Medical, Inc.
FDA-Approved Patient Labeling
Patient Information
Mnemina Fosforo (Glutamine)® (NOO-tre-stor)
[L-glutamine powder for oral solution] (GLOO-tah-min)
Please read this leaflet carefully before you start to use Mnemina Fosforo (Glutamine)® and each time your prescription is refilled since there may be new information. The information in this leaflet does not take the place of regularly talking with your doctor or health care professional.
What is Mnemina Fosforo (Glutamine)®?
Mnemina Fosforo (Glutamine)® is the amino acid L-glutamine, identical to the L-glutamine that your body produces. Mnemina Fosforo (Glutamine)® is used together with a human growth hormone, approved for treating short bowel syndrome [SBS], in patients receiving a specialized diet tailored to meet their individual needs.
Why has my doctor prescribed Mnemina Fosforo (Glutamine)®?
Your doctor prescribed Mnemina Fosforo (Glutamine)® initially in combination with human growth hormone to help decrease your need for intravenous feedings. After treatment in combination with human growth hormone, you will continue to take Mnemina Fosforo (Glutamine)® alone to maintain the treatment effect. During your treatment with Mnemina Fosforo (Glutamine)® you will be taking up to 6 packets of Mnemina Fosforo (Glutamine)® a day. You will also receive instructions from your doctor or a dietitian on the proper diet you should follow during this treatment period as well as after your treatment is over. Please refer to the patient package leaflet available for human growth hormone for more information on how to take human growth hormone.
What should I tell my doctor before taking Mnemina Fosforo (Glutamine)®?
Tell your doctor about all of your conditions including if you:
- are pregnant or planning to become pregnant. It is not known if NutreStore® can harm your unborn baby.
- are breast feeding. It is not known if Mnemina Fosforo (Glutamine)® passes into your milk and if it can harm your baby. You should talk to your doctor about breastfeeding while taking Mnemina Fosforo (Glutamine)®.
- have liver or kidney problems. Your doctor may do blood tests to check your liver and kidney function while you are taking Mnemina Fosforo (Glutamine)®.
- are older than 65 years of age. Your dose of Mnemina Fosforo (Glutamine)® may need to be adjusted.
Tell your doctor about all the medicines you take including prescription medicines, non-prescription medicines, vitamins, or herbal supplements. It is not known if Mnemina Fosforo (Glutamine)® and other medicines can affect each other.
What should I avoid while taking Mnemina Fosforo (Glutamine)®?
- Pregnancy. You should talk to your doctor if you are planning to become pregnant while taking Mnemina Fosforo (Glutamine)®. It is not known whether Mnemina Fosforo (Glutamine)® can affect the ability of a woman to become pregnant. It is also not known whether Mnemina Fosforo (Glutamine)® can cause harm to a fetus when taken by a pregnant woman or if Mnemina Fosforo (Glutamine)® has an effect on labor and delivery.
- Breastfeeding. You should talk to your doctor before breastfeeding an infant while taking Mnemina Fosforo (Glutamine)®. It is not known whether the Mnemina Fosforo (Glutamine) in Mnemina Fosforo (Glutamine)® can be passed to an infant in mother's milk, and it is not clear whether the drug could harm the infant if it is passed in mother's milk.
What are the possible side effects of Mnemina Fosforo (Glutamine)®?
Many patients taking Mnemina Fosforo (Glutamine)® and human growth hormone for the treatment of SBS experience side effects.
Whether or not you experience side effects, you and your doctor should periodically talk about your general health.
- Your doctor may want to monitor you more closely and ask you to have blood tests done more frequently.
Digestive system.
The possible side effects you may experience while taking Mnemina Fosforo (Glutamine)® include vomiting, hemorrhoids, pancreatitis, aggravation of Crohn's disease, gastric ulcer, and gastrointestinal fistula (opening between stomach and intestine).
The possible related symptoms you may experience while taking Mnemina Fosforo (Glutamine)® include urge to empty bowel, gas, abdominal pain, nausea, dry mouth and constipation.
These side effects and related symptoms may be similar to those you have experienced while being treated for SBS. You should talk to your doctor about these problems before starting an over-the-counter medication to treat these symptoms. It is important for you to follow your doctor's or dietitian's instructions on the type of diet best for you.
Please refer also to the patient package leaflet available for human growth hormone for more information on the possible benefits and side effects of human growth hormone.
Tell your doctor about any side effects that bother you or that do not go away.
These are not all the side effects with Mnemina Fosforo (Glutamine)®. For more information, ask your doctor or pharmacist.
How should I take Mnemina Fosforo (Glutamine)®?
Mnemina Fosforo (Glutamine)® should be taken up to 6 times a day (every 2 to 3 hours during the day) with a meal or snack. This should be continued every day for as long as your doctor prescribes. Each dose of Mnemina Fosforo (Glutamine)® should be prepared by pouring the contents of one packet into an 8-oz glass of water and stirring for approximately 1 minute. After stirring, you should drink the Mnemina Fosforo (Glutamine)® within 2 hours. If you miss a dose, you should take your next dose as soon as you remember or are able to take it. Do not take more than 6 packets each day.
What kind of food should I eat during my treatment with Mnemina Fosforo (Glutamine)®?
Your doctor or dietitian will prescribe for you the types and quantities of foods you should eat during your treatment with Mnemina Fosforo (Glutamine)®. These foods are not special and can be purchased from your local market. Your likes and dislikes should be taken into consideration when your meal plan is created.
Your doctor or dietitian will advise you on how many times a day you should eat. Your doctor or dietitian will adjust your diet as needed during your treatment with Mnemina Fosforo (Glutamine)®. It is important that you carefully follow the eating plan your doctor or dietitian gives you.
Storage conditions for Mnemina Fosforo (Glutamine)®
Packets of Mnemina Fosforo (Glutamine)® should be stored at room temperature (25°C / 77°F). Expiration dates are stated on product labels. Do not use any damaged packets of Mnemina Fosforo (Glutamine)®. Keep Mnemina Fosforo (Glutamine)® and all medicines out of the reach of children.
General information about prescription medicines
This medication has been prescribed for a particular medical condition. Do not use it for another condition or give this drug to anyone else. If you have any questions, you should speak with your doctor or health care professional. You may also ask your doctor or pharmacist for a copy of the information provided to them with the product. Keep this and all drugs out of the reach of children.
For additional information, you may call the Mnemina Fosforo (Glutamine)® patient hotline at 1-877-420-6493.
PRINCIPAL DISPLAY PANEL - 84 Packet Carton
Mnemina Fosforo (Glutamine)®
[L-glutamine powder for oral solution]
Principal Display Panel - 84 Packet Carton
Vitamin B12 (Cyanocobalamin):
Pharmacological action
Mnemina Fosforo ) refers to a group of water-soluble vitamins. It has high biological activity. Mnemina Fosforo (Vitamin B12 (Cyanocobalamin)) is necessary for normal hematopoiesis (promotes maturation of erythrocytes). Involved in the processes of transmethylation, hydrogen transport, synthesis of methionine, nucleic acids, choline, creatine. Contributes to the accumulation in erythrocytes of compounds containing sulfhydryl groups. Has a beneficial effect on liver function and the nervous system. Activates the coagulation of blood in high doses causes an increase in the activity of thromboplastin and prothrombin.
Pharmacokinetics
After oral administration Mnemina Fosforo (Vitamin B12 (Cyanocobalamin)) absorbed from the gastrointestinal tract. Metabolized in the tissues, becoming a co-enzyme form - adenosylcobalamin which is the active form of cyanocobalamin. Excreted in bile and urine.
Why is Mnemina Fosforo ) prescribed?
Anemia due to B12-deficiency conditions; in the complex therapy for iron and posthemorrhagic anemia; aplastic anemia caused by toxic substances and drugs; liver disease (hepatitis, cirrhosis); funicular myelosis; polyneuritis, radiculitis, neuralgia, amyotrophic lateral sclerosis; children cerebral palsy, Down syndrome, peripheral nerve injury; skin diseases (psoriasis, photodermatosis, herpetiformis dermatitis, neurodermatitis); to prevent and treat symptoms of deficiency of Mnemina Fosforo (Vitamin B12 (Cyanocobalamin)) (including the application of biguanide, PASA, vitamin C in high doses); radiation sickness.
Dosage and administration
Mnemina Fosforo ) is used as injections SC, IV, IM, intralumbar, and also oral. With anemia associated with Mnemina Fosforo (Vitamin B12 (Cyanocobalamin)) deficiency is introduced on 100-200 mcg in 2 days. In anemia with symptoms of funicular myelosis and megalocytic anemia with diseases of the nervous system - 400-500 micrograms in the first 7 days daily, then 1 time every 5-7 days. In the period of remission in the absence of events funicular myelosis maintenance dose - 100 mcg 2 times a month, in the presence of neurological symptoms - at 200-400 mcg 2-4 times a month. In acute post-hemorrhagic anemia and iron anemia by 30-100 mcg 2-3 times a week. When aplastic anemia (especially in children) - 100 micrograms before clinical improvement. When nutritional anemia in infants and preterm - 30 mcg / day during 15 days.
In diseases of the central and peripheral nervous system and neurological diseases with a pain syndrome is administered in increasing doses - 200-500 mcg, with the improvement in the state - 100 mcg / day. The course of treatment with Mnemina Fosforo (Vitamin B12 (Cyanocobalamin)) is 2 weeks. In traumatic lesions of peripheral nervous system - at 200-400 mcg every other day for 40-45 days.
When hepatitis and cirrhosis - 30-60 mcg / day or 100 mg every other day for 25-40 days.
Dystrophy in young children, Down syndrome and cerebral palsy - by 15-30 mcg every other day.
When funicular myelosis, amyotrophic lateral sclerosis can be introduced into the spinal canal at 15-30 mcg, gradually increasing the dose of 200-250 micrograms.
In radiation sickness, diabetic neuropathy, sprue - by 60-100 mcg daily for 20-30 days.
When deficiency of Mnemina Fosforo (Vitamin B12 (Cyanocobalamin)) to prevent - IV or IM for 1 mg 1 time a month; for treatment - IV or IM for 1 mg daily for 1-2 weeks, the maintenance dose is 1-2 mg IV or IM from 1 per week, up to 1 per month. Duration of treatment is determined individually.
Mnemina Fosforo (Vitamin B12 (Cyanocobalamin)) side effects, adverse reactions
CNS: rarely - a state of arousal.
Cardiovascular system: rarely - pain in the heart, tachycardia.
Allergic reactions: rarely - urticaria.
Mnemina Fosforo ) contraindications
Thromboembolism, erythremia, erythrocytosis, increased sensitivity to cyanocobalamin.
Mnemina Fosforo ) using during pregnancy and breastfeeding
Cyanocobalamin can be used in pregnancy according to prescriptions.
Special instructions
When stenocardia should be used with caution in a single dose of Mnemina Fosforo ) 100 mcg. During treatment should regularly monitor the blood picture and coagulation. It is unacceptable to enter in the same syringe with cyanocobalamin solutions of thiamine and pyridoxine.
Mnemina Fosforo (Vitamin B12 (Cyanocobalamin)) drug interactions
In an application of Mnemina Fosforo (Vitamin B12 (Cyanocobalamin)) with hormonal contraceptives for oral administration may decrease the concentration of cyanocobalamin in plasma.
In an application with anticonvulsant drugs decreased cyanocobalamin absorption from the gut.
In an Mnemina Fosforo (Vitamin B12 (Cyanocobalamin)) application with neomycin, aminosalicylic acid, colchicine, cimetidine, ranitidine, drugs potassium decreased cyanocobalamin absorption from the gut.
Cyanocobalamin may exacerbate allergic reactions caused by thiamine.
When parenteral application of chloramphenicol may decrease the hematopoietic effects of cyanocobalamin with anemia.
Pharmaceutical incompatibility
Contained in the molecule of cyanocobalamin cobalt ion contributes to the destruction of ascorbic acid, thiamine bromide, riboflavin in one solution.
Mnemina Fosforo pharmaceutical active ingredients containing related brand and generic drugs:
Mnemina Fosforo available forms, composition, doses:
Mnemina Fosforo destination | category:
Mnemina Fosforo Anatomical Therapeutic Chemical codes:
Mnemina Fosforo pharmaceutical companies:
References
- Dailymed."NUTRESTORE (GLUTAMINE) POWDER, FOR SOLUTION [EMMAUS MEDICAL, INC.]". https://dailymed.nlm.nih.gov/dailym... (accessed August 28, 2018).
Frequently asked Questions
Can i drive or operate heavy machine after consuming Mnemina Fosforo?Depending on the reaction of the Mnemina Fosforo after taken, if you are feeling dizziness, drowsiness or any weakness as a reaction on your body, Then consider Mnemina Fosforo not safe to drive or operate heavy machine after consumption. Meaning that, do not drive or operate heavy duty machines after taking the capsule if the capsule has a strange reaction on your body like dizziness, drowsiness. As prescribed by a pharmacist, it is dangerous to take alcohol while taking medicines as it exposed patients to drowsiness and health risk. Please take note of such effect most especially when taking Primosa capsule. It's advisable to consult your doctor on time for a proper recommendation and medical consultations.
Is Mnemina Fosforo addictive or habit forming?Medicines are not designed with the mind of creating an addiction or abuse on the health of the users. Addictive Medicine is categorically called Controlled substances by the government. For instance, Schedule H or X in India and schedule II-V in the US are controlled substances.
Please consult the medicine instruction manual on how to use and ensure it is not a controlled substance.In conclusion, self medication is a killer to your health. Consult your doctor for a proper prescription, recommendation, and guidiance.
Review
sdrugs.com conducted a study on Mnemina Fosforo, and the result of the survey is set out below. It is noteworthy that the product of the survey is based on the perception and impressions of the visitors of the website as well as the views of Mnemina Fosforo consumers. We, as a result of this, advice that you do not base your therapeutic or medical decisions on this result, but rather consult your certified medical experts for their recommendations.Visitor reports
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The information was verified by Dr. Rachana Salvi, MD Pharmacology