Metifer

Metifer

mecobalamin

Manufacturer:

Ikapharmindo
Full Prescribing Info
Contents
Mecobalamin.
Description
Metifer 250 μg: Each capsule contains: Mecobalamin 250 μg.
Metifer 500 μg: Each capsule contains: Mecobalamin 500 μg.
Metifer Injection: Each ampoule (1 ml) contains: Mecobalamin 500 μg.
Action
Pharmacology: Capsule: Biochemically Mecobalamin is a coenzyme form of vitamin B12 with an active methyl group. It participates in transmethylation reactions and is the most active of all B12 homologues in the body with respect to nucleic acid, protein and lipid metabolism. It has also been demonstrated that Mecobalamin facilitates myelogenesis and nerve regeneration. Double-blind clinical trials showed that Mecobalamin is convincingly effective on peripheral neuropathies such as diabetic neurological disorders and multiple neuritis.
Drug Action: Mecobalamin is a homologue of vitamin B12 which participates in transmethylation reactions and plays an important role in the synthesis of nucleic acid and protein in nerve cells. Mecobalamin stimulates Schwan cells and thereby facilitating myelogenesis and enhancing protein synthesis.
Injection: Biochemically mecobalamin is a coenzyme form of vitamin B12 with an active methyl group. It participates in transmethylation reactions and is the most active of all B12 homologues in the body with respect to nucleic acid, protein and lipid metabolism. Metifer acts to repair damaged nerve tissue in nerve disorders, such as axonal degeneration and demyelination; and, it is involved in erythroblast maturation, promotion of erythroblast division, and heme synthesis, thus acting to improve the status of the blood in megaloblastic anemia. Double-blind clinical trials showed, that mecobalamin is effective not only on megaloblastic anemia but also on peripheral neuropathies such as diabetic neurological disorders and multiple neuritis.
Pharmacodynamics: Mecobalamin promotes the metabolism of nucleic acids, proteins and lipids. In an experiment using brain-derived cell strains obtained from albino rats, mecobalamin acted as a coenzyme in methionine synthesis. In particular, it was found to be involved in the synthesis of thymidine from deoxyuridine and to accelerate the synthesis of DNA and RNA. In other experiment using glia cells, mecobalamin was found to accelerate the synthesis of lecithin, a major component of the myelin sheath.
Mecobalamin is efficiently transferred to nerve tissues and improves metabolic disorders. Mecobalamin is a CH3-vitamin B12 which is found in high concentrations in blood and cerebrospinal fluid. In an experiment in rats, it was transferred to nerve cell organelles more efficiently than CN-vitamin B12. It also accelerated the synthesis of the major structural component of the axon (protein) in sciatic nerve cells of rats with experimental diabetes and returned the protein transport rate close to normal, resulting in the maintenance of axonal function.
Mecobalamin repairs nerve tissues in experimental nerve injury models. In experiments conducted in rats and rabbits, mecobalamin was neuropathologically and electrophysiologically shown to inhibit the onset of nerve degeneration due to the disturbances caused by adriamycin and vincristine, and streptozotocin-induced diabetes. Mecobalamin was also compared with steroids in term of their effects on the process of nerve regeneration in experimental facial paralysis models prepared by compressing the facial nerve of guinea pigs. Mecobalamin was found to be as effective as steroids for the recovery from paralysis when evaluated based on the winking reflex, induced electromyography and histological evaluation.
Mecobalamin inhibits abnormal excitation transmission by nerve tissues. The anterior and posterior roots of the spinal nerve were separated from the spinal cord of frogs and connected to the sciatic nerve. Electrical stimulation was given to the end of the sciatic nerve in Ringer's solution and the action potentials of the anterior and posterior roots were recorded. 500 μg/ml of DBCC, OH-vitamin B12, CH3-vitamin B12 were dissolved in the Ringer's solution and the inhibition of excitation transmision by these compounds was compared. The inhibition of nervous excitation transmission produced by CH3-vitamin B12 was the strongest.
Pharmacokinetics: Single dose: Blood concentration peaked (22310 pg/ml) 0.9 hr after the I.m. injection of a single dose of 500 μg of mecobalamin to healthy adults. The half-life was 6.3 hrs. The △Cmax for the increase in serum total vitamin B12 concentration was 21430 pg/ml and the △AUC12 was 185.21 hr·μg/ml.
Multiple doses: Patients with peripheral nerve disorders received an i.m. Injection of 500 μg of mecobalamin three times per week for 12 weeks. Blood vitamin B12 concentration had increased about 15-fold in 4 weeks after the start of treatment: it continued to increase thereafter to achieve a 30-fold increase in 12 weeks after the start of treatment.
Indications/Uses
Peripheral neuropathies.
Dosage/Direction for Use
Capsule: Metifer 250 μg: 3 times 2 capsules daily.
Metifer 500 μg: 3 times 1 capsule daily.
The dose should be adjusted according to age and severity of symptoms.
Injection: The usual adult dose is 1 ampoule equivalent to 500 μg of mecobalamin administered intramuscularly or intravenously three times a week. The dose should be adjusted according to the age of the patient and severeity of symptoms.
Contraindications
Patients known to be hypersensitive to this drug and to any component of this drug.
Special Precautions
Capsule: If there is lack of satisfactory clinical response after a certain period of time, it is not necessary to continue use of the drug. Administering high doses of the drug for extended periods of time to patients with occupational exposure to mercury or its compounds is not recommended.
Injection: Because Mecobalamin is susceptible to photolysis, Metifer ampoules are packaged in the LPE pack (Light Protect Easy open pack). Metifer Injection should be used promptly after the package is opened, and caution should be taken so as not to expose the ampoules to direct light.
In intramuscular administration, caution should be exercised as suggested as follows to avoid adverse effects on tissues or nerves.
Repeated injection at the same site should be avoided. Particular care should be exercised when administering this drug to prematures, neonates, nursing infants and children.
The course of nerves should be avoided for the site of injection.
If the patient complains of pain or if blood reflux occurs when the syringe needle is stuck, withdraw it immediately and try a different site.
Metifer injection is supplied in one-point-cut ampoules. The cut point of the ampoules should be wiped with an alcohol swab before opening.
This drug should not be used over a period of months if there is lack of satisfactory clinical response in patients with megaloblastic anemia or with peripheral neuropathies probably due to vitamin B12 deficiency.
Adverse Reactions
Capsule: Anorexia, nausea, diarrhea or other gastrointestinal disturbances may occur.
Injection: Hypersensitivity: Use of the drug should be discontinued if symptoms of hypersensitivity, such as eruptions occur.
Other: Pain and induration at the site of injection and headache, sweating or fever may rarely occur.
Drug Interactions
Injection: It is not known whether Metifer injection can cause significant clinical interactions with other drugs.
Storage
Store below 25°C, protect from light.
ATC Classification
B03BA05 - mecobalamin ; Belongs to the class of vitamin B12 (cyanocobalamin and analogues). Used in the treatment of anemia.
Presentation/Packing
Cap 250 mcg x 10 x 10's. 500 mcg x 10 x 10's. Inj (amp) 500 mcg/mL x 1 mL x 10's.
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