Gemase

Gemase has a thrombolytic and fibrinolytic effect.

Indications of the gemase

It is used to eliminate a variety of ophthalmic diseases:

• hemophthalmus or hyphema;
• hemorrhages having subretinal, preretinal or intra-retinal character;
• diagnosed fibrinoid syndrome of different nature;
• occlusion in the central artery or thrombosis affecting the central vein in the retina, as well as its branches;
• prevention of adhesions after surgical procedures of antiglaucomatous nature.

[1], [2]

Release form

The release is made in the form of a powder (5000 IU), from which an intravenous solution is made, in ampoules of glass with a capacity of 1-2 ml. Inside one plate contains 3, 5 or 10 such ampoules.

Produced in the form of a medicinal liquid (volume 10 million IU), which is contained in flakonchikah capacity of 0.5 liters (inside the pack - 6 of these bottles).

Pharmacodynamics

The drug is enzymatic, and its action is due to the activity of the main element - prourokinase (it is an enzyme - serine endopeptidase). In its chemical structure, it is a single-stranded molecule with a molecular weight of 54,000 Daltons, which also contains 2 chains of a polypeptide character bound by a disulfide bridge, and have a molar mass of 20,000 and 34,000 Daltons.

The mechanism of the therapeutic effect consists of a specific stimulation of the processes of conversion of the fibrinolysin into a separate fibrinolytic element of the blood - the substance plasmin. This component can destroy clots of fibrin.

[3], [4], [5], [6], [7]

Pharmacokinetics

Peak values within the eye tissues are noted after 2 hours, and traces of medication are observed inside the blood after 12 hours after application.

The half-life of the drug is about 6 hours. Systemic exposure does not develop, because the drug is used in small portions.

[8], [9], [10]

Dosing and administration

Standard method of dissolving the powder and using a medicament solution.

It is necessary to dissolve the contents of the 1st ampoule LS in a 0.9% solution of sodium chloride (0.5 ml). The size of the portion after dissolving the powder is 5000 IU. Entering the drug is required parabulbar (injection inside the lower eyelid) or subconjunctival method (in the area under the conjunctiva). During this course, a maximum of 10 medical injections are allowed.

Performing lavage during the treatment of a hyphema or massive fibrinous effusion into the anterior eye chamber.

It is required to take the solution in a dose of 0.2 ml, in which the powder (dose 1000 ME) or 0.1 ml of the therapeutic solution with powder in a volume of 500 ME will be diluted, after which it should be brought to 0.5 ml with 0.9 % solution of sodium chloride.

Use of intravitreal methods of administration.

It is required to take 0.1 ml of the prepared solution, which is obtained by standard dissolution (500 ME), and then diluted with 0.9% sodium chloride solution (0.1-0.2 ml). It is necessary to use in hemophthalms of various genesis, and in addition, with fibrinoid syndrome - a one-time intra-viral injection.

To prevent the development of adhesions after performing surgical operations of antiglaucomatous nature.

It is required to dissolve the drug in the proportions that are used for subconjunctival administration. Further it is required to inject the preparation into the filtration pad at the initial stage of the postoperative period in the amount of 1-3 injections - the surgeon determines the more accurate scheme.

It must be taken into account that it is forbidden to mix Gemase with other medicines inside the same syringe (except for dexamethasone).

[15], [16], [17]

Use of the gemase during pregnancy

Apply gemazu during pregnancy is prohibited.

Contraindications

The main contraindications:

• the tendency to bleeding, among which such violations as hemophilia, diathesis of hemorrhagic nature, thrombocytopenia, etc .;
• bleeding in the gastrointestinal tract that occurred less than 28 days before the use of drugs, operations in the cerebrospinal and intracranial areas that occurred at least 56 days before the use of the drug, extensive surgery or trauma that appeared at least 28 days before the use of the drug, which increases the likelihood of bleeding ;
• carrying out CPR or other resuscitation procedures performed for more than 10 minutes;
• hepatic pathology, against which there are marked forms of hemostasis disorders;
• kidney failure of a chronic nature, in which the serum creatinine is greater than 0.02 g / l, and urea is more than 0.5 g / l;
• puncture in the area of any large vessel (among them the subclavian vein);
• problems with retinal function, having a hemorrhagic diabetic character (such as retinopathy);
• a recent stroke, having a hemorrhagic origin (or having a history of the patient);
• hypertensive crisis;
• increased systolic blood pressure (more than 180 mmHg) or diastolic blood pressure (more than 110 mmHg);
• Cardiogenic shock, having the 4th stage in accordance with the classification of Killip;
• tuberculosis in the active stage;
• endocarditis of septic character;
• suspected aortic dissection;
• the presence of intolerance with respect to sodium chloride, prourokinase, and also dextran 40.

[11]

Side effects of the gemase

The use of medication can cause the appearance of allergic side effects:

• swelling;
• cutaneous hyperemia at the injection site or on the face;
• tenonitis, which is of an allergic nature, the symptoms of which are conjunctival hyperemia, chemosis, and in addition deterioration of motor mobility of the eyeball.

[12], [13], [14]

Overdose

With a single injection of drugs in a dose of more than 5000 IU, the risk of developing allergic symptoms that are indicated among the side effects increases.

When intoxication or during surgical operations against the background of the drug, in order to reduce the likelihood of hemorrhages, it is necessary to perform the general application of the substance etamzilate in the form of intravenous injections in portions 0.25-0.5 g.

Interactions with other drugs

You can not combine the drug with injections of collagen.

Caution is required when combining drugs with other thrombolytics.

Simultaneous use of the drug with dexamethasone and emoxipin is allowed.

[18], [19]

Storage conditions

Gemase in ampoules or flacon (they should be placed vertically) is kept out of the reach of small children, a dark place with a temperature within the range of 2-8 ° C.

Shelf life

Gemase can be used for 2 years from the date of manufacture of the medicament.

Application for children

Since there is too little data on the use of medicines in pediatrics, it is not recommended to prescribe it to children.

Analogues

Analogues of the drug are such drugs as fibrinolysin, actilize, thrombovazim, and also metalase.

Reviews

Gemase is often used to eliminate ophthalmic hemorrhages. Most patients in their reviews indicate that injections are effective and effective, help cope with violations.