Medicinal Products

AMMONAPS 500 mg

Generic drug of the therapeutic class: Metabolism and nutrition
active ingredients: Sodium phenylbutyrate
laboratory: Swedish Orphan Inter AB

Compressed
Box of 1 bottle of 250
All forms

Indication

AMMONAPS is indicated as adjunctive therapy in the long-term management of urea cycle disorders involving deficiency of carbamylphosphate synthetase, ornithine transcarbamylase or argininosuccinate synthetase.
It is indicated in all neonatal forms (complete enzyme deficiency occurring in the first 28 days of life) and also in the forms of late revelation (partial enzymatic deficit occurring after the first month of life) with a history of encephalopathy hyperammonaemic.

Dosage AMMONAPS 500 mg Tablet Box of 1 Bottle of 250

Treatment with AMMONAPS should be supervised by a physician experienced in the treatment of urea cycle disorders.
AMMONAPS tablets are indicated for adults and children who can swallow tablets. AMMONAPS is also available in the form of granules recommended for use in infants, children unable to swallow tablets and in patients with dysphagia.
The daily dose must be adapted individually according to the protein tolerance of the patient and the food protein intake necessary for its growth and development.
The total daily dose of sodium phenylbutyrate usually used in clinical practice is:
. 450-600 mg / kg / day in children under 20 kg,
. 9.9-13.0 g / m² / day in children over 20 kg, adolescents and adults.
The safety and efficacy of doses greater than 20 g / day (40 tablets) have not been established.
Therapeutic monitoring : Plasma levels of ammonia, arginine, essential amino acids (especially branched amino acids), carnitine and proteins should be kept within normal limits and that of glutamine levels below 1000 μmol / L.

Nutritional Surveillance : AMMONAPS should be combined with a low protein diet and in some cases supplemented with essential amino acids and carnitine.
In neonatal forms deficient in carbamylphosphate synthetase or ornithine transcarbamylase, supplementation with citrulline or arginine is required at a dose of 0.17 g / kg / day or 3.8 g / m² / day.
In arginine succinate synthetase deficiency, supplementation with arginine is necessary at a dose of 0.4 to 0.7 g / kg / day or 8.8 to 15.4 g / m² / day.
If caloric supplementation is indicated, it is recommended to use a protein free preparation.
The total daily dose of AMMONAPS should be divided into equal doses administered at each meal (for example, 3 times daily). The tablets should be taken with a large volume of water.

Against indications

• Pregnancy
• Breastfeeding
• Hypersensitivity to the active substance or to any of the excipients listed under Composition.

Adverse effects Ammonaps

In clinical trials with AMMONAPS, 56% of patients experienced at least one adverse event and 78% of these adverse events were considered unrelated to AMMONAPS.
These undesirable effects mainly concern the reproductive and gastrointestinal tract.
Adverse reactions are listed below by organ system class and frequency. Frequency is defined as: very common (≥ 1/10), frequent (≥ 1/100, <1/10), uncommon (≥ 1/1000, <1/100), rare (≥ 1/10) 000, <1/1000), very rare (<1 / 10, 000) and undetermined (can not be estimated from the available data). Within each frequency group, adverse effects should be presented in order of decreasing severity.
Hematological and lymphatic system disorders:
Common: Anemia, thrombocytopenia, leukopenia, leukocytosis, thrombocytosis.
Uncommon: Aplastic anemia, bruising.
Metabolism and nutrition disorders:
Common: Metabolic acidosis, alkalosis, decreased appetite.
Psychiatric disorders:
Frequent: Depression, irritability.
Nervous system disorders:
Frequent: Syncope, headache.
Heart conditions:
Common: Edema.
Uncommon: Arrhythmia.
Gastrointestinal disorders:
Common : Abdominal pain, vomiting, nausea, constipation, dysgeusia
Uncommon : Pancreatitis, peptic ulcer, rectal hemorrhage, gastritis.
Skin and subcutaneous tissue disorders:
Common : Rash, abnormal smell of the skin.
Renal and urinary disorders:
Common: Renal tubular acidosis.
Disorders of the reproductive organs and the breast:
Very common : Amenorrhea, irregular menstruation.
Investigations:
Frequent: Decreased blood levels of potassium, albumin, total protein and phosphate. Increased blood levels of alkaline phosphatase, transaminases, bilirubin, uric acid, chloride, phosphate and sodium. Weight gain.
A probable case of AMMONAPS toxicity (450 mg / kg / day) has been reported in an 18-year-old anorexic patient with metabolic encephalopathy associated with lactic acidosis, severe hypokalemia, pancytopenia, peripheral neuropathy and pancreatitis .
She was cured after dose reduction with the exception of recurrent episodes of pancreatitis which ultimately led to discontinuation of treatment.
Reporting of suspected adverse reactions
The reporting of suspected adverse reactions after authorization of the drug is important. It allows continuous monitoring of the benefit / risk ratio of the drug. Health professionals report any suspected adverse reactions via the reporting system - see Annex V.

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