Calimin

A pharmaceutical product that helps eliminate human health problems of a neuralgic nature is Kalimin. This drug was developed and is manufactured by the joint Israeli-German pharmaceutical corporation Merkle GmbH for Teva Pharmaceutical Industries Ltd.

How many diseases can affect the human body? But modern medicine has learned to fight most of them. In this, pharmaceutical products come to their aid. One of such drugs of the anticholinesterase pharmacological group, related to pyridostigmines, is Kalimin. It is actively and with high therapeutic results used by qualified specialists to relieve a number of diseases of a neuralgic nature.

Indications Calimin

Kalimin is a drug that works as a substance that inhibits the action of cholinesterase. Hence the indications for the use of the drug in question.

1. Muscle detraining.
2. Complete or partial paralysis.
3. Myasthenia is a pathological muscle fatigue and general weakness of the entire body.
4. Postoperative deterioration of intestinal peristalsis.
5. Problems with urination in the postoperative period (during gynecological surgery) or after childbirth.
6. Atonic constipation.
7. Myasthenic syndrome.
8. Post-traumatic failure in motor function coordination.
9. Encephalitis is an inflammatory process that occurs in the cells of the brain.
10. The period of rehabilitation recovery after poliomyelitis.

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Release form

Merkle GmbH produces the drug in question in the form of oblong white tablets for Teva Pharmaceutical Industries Ltd. – this is currently the only form of the drug Kalimin.

The tablet is convex on both sides. One side is divided into a deepening risk. In any pharmacy, this medicine can be found packaged in 100 units in a bottle with darkened glass. It is sealed with a plastic lid and foil coating, which controls the first opening.

The main active ingredient of the drug Kalimin is pyridostigmine bromide. Its concentration in one tablet is 0.06 g.

Additional chemical compounds present in the drug under consideration: microcrystalline cellulose (0.336 g), glutamic acid hydrochloride (0.002 g), corn starch (0.12 g), polyvidone K25 (0.06 g), colloidal silicon dioxide (0.063 g), magnesium stearate (0.003 g) and pure sanitized water (0.016 g).

The most common name of the drug in question is Kalimin 60, Kalimin 60 N.

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Pharmacodynamics

The main active ingredient of the drug under consideration, Kalimin, is pyridostigmine bromide. It is its pharmacological properties that determine the pharmacodynamics of this drug.

Cholinesterases are essential and very important enzymes of the human body, mostly found in skeletal muscle structures, in the cells of the nervous system. But the largest number of them is located in red blood cells - erythrocytes.

These cholinesterases are called acetylcholinesterase (AChE), and those that are found in blood serum are called pseudocholinesterases.

These substances have a direct effect on the hydrolysis of acetylcholine, which in turn ensures the normal transmission of nerve impulses. If the system, for some reason, violates its excitability, drugs capable of influencing the elements of the central nervous system in a certain way come to the aid of a person. In this case, these are drugs of the anticholinesterase pharmacological group (pyridostigmines), one of which is the drug Kalimin.

Pyridostigmine bromide is the active element of the drug in question, it affects the organs of the central nervous system as an anticholinesterase and cholinomimetic substance. When it enters the patient's body (in acceptable recommended doses), the drug improves neuromuscular signal transmission, increases skeletal muscle tone and improves the motility of the digestive tract, including the intestines, has a positive effect on the work of the bronchi and urinary organs in terms of improving long-term stress, not accompanied by fatigue, excitation of nerve centers.

But there are also alarming factors that should be taken into account when prescribing Kalimin in the treatment protocol. Pyridostigmine bromide becomes a catalyst in activating the secretion of the glands of the human exocrine system, and can provoke an attack of bradycardia (a type of arrhythmia with a heart rate of less than 60 beats per minute).

The drug can also cause miosis (narrowing of the pupils), as well as functional visual impairment, prolonged spasm of the ciliary muscle, referred to in medicine as accommodation spasm.

The drug Kalimin, when used in the treatment of a disease, does not have a central effect on the patient’s body.

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Pharmacokinetics

When it is necessary to connect a specific drug to the treatment, in addition to the pharmacological dynamics of the drug in question, the doctor treating the disease is also interested in its pharmacokinetics. An important factor in any therapy is the ability of the drug, in this case Kalimin, to penetrate the patient's body at high speed, as well as to be excreted from it by the excretory system without much delay. Effective excretion concerns both the volumes of the unchanged substance and its metabolites.

The drug in question is ingested orally, the time interval for adsorption and distribution takes on average from one and a half to three hours. After the stated period of time has passed, the largest amount of the active substance of the drug pyridostigmine bromide is found in the patient's blood.

The bioavailability of the components of the drug in question, depending on the individual characteristics of the body, is from 8 to 20%. If the patient's body develops myasthenia, this indicator usually decreases and can reach 4%.

The level of binding to blood proteins is very low.

Due to its negligible level of lipid solubility, Kalimin shows a reduced level of penetration into the elements of the central nervous system.

Pyridostigmine bromide is primarily metabolized in liver cells, transforming into metabolites of inactive action. The average plasma clearance in a person who does not suffer from pathological changes in the functioning of the body corresponds to a figure that falls within the range of 0.36 to 0.65 l / h per kilogram of the patient's weight.

The drug is partly excreted from the body unchanged, and partly in the form of metabolites. The half-life of Kalimin is determined to be 2 hours and 30 minutes.

As clinical studies have shown, the chemical compounds of the drug in question do not penetrate the blood-brain barrier.

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Dosing and administration

Any person must know that a medicinal product, including Kalimin, is used in the treatment of a disease only with the permission of a qualified experienced specialist. The developers of the drug have only suggested the recommended method of application and doses of the drug in question, and a more specific method and sequence of administration, the method of treatment and dosage adjustment remains with the attending physician conducting the therapy.

The manufacturer recommends that the patient take Kalimin during the period of his greatest physical activity. This intake will bring the maximum effect.

The tablet is swallowed with a sufficient amount of water.

The starting dosage recommended by the specialists of the manufacturing company is one to two tablets, one to two times a day.

If therapeutic efficacy cannot be achieved with this amount of the drug, the dose of Kalimin may be increased to one to three tablets, administered two to four times during the day.

The maximum daily dose of the drug administered should not exceed twelve pieces, which translates to 0.72 g.

But the amount of pyridostigmine bromide administered is prescribed to the patient strictly individually, depending on the severity of the disease and the patient's body's response to the drug and treatment in general.

Use Calimin during pregnancy

After the expectant mother has learned that she is already carrying a baby under her heart, she begins to ensure that as few substances as possible enter her body that can affect the natural course of fetal development. But one should not forget about the woman's health, because this factor can cause problems both in the development of the baby and during obstetrics.

Today, the use of Kalimin during pregnancy is permitted by doctors only if the therapeutic need for treatment outweighs the possibility of a negative impact of the drug's substances on the normal development of the fetus.

As clinical studies have shown, the drug is not able to penetrate the blood-brain barrier, but it is able to provoke premature birth, especially if it concerns the last weeks of pregnancy. This fact is explained by the fetotoxic properties of Kalimin.

Based on these pharmacological properties of the drug, doctors do not recommend therapy with the drug in question during lactation, when a woman is breastfeeding a newborn. Pyridostigmine bromide penetrates into breast milk. Therefore, feeding should be interrupted, transferring the infant to feeding with special adapted mixtures.

Contraindications

Any product manufactured by pharmaceutical companies is a medicine because it is capable of exerting a certain effect on the patient's body. And not always such an effect, when targeted at eliminating one problem, does not affect other areas and systems of the human body, affecting their functionality.

Contraindications to the use of the drug Kalimin are reflected in the list below:

1. Increased individual intolerance of the patient's body to one or more components of Kalimin.
2. Chronic form of obstructive bronchitis.

3. Intestinal obstruction, which is caused by a mechanical reason.

4. Bronchial asthma.

5. Thyrotoxicosis.

6. Obstruction of the biliary and urinary tract.

7. Myotonia is a special condition of muscle fibers, when a muscle that has entered a state of contraction does not relax for a long time.

8. Iritis is an inflammation of the iris of the eye.

9. If a depolarizing muscle relaxant was administered the day before.

10. Shock state of the body.

11. An attack of spasm of the muscles of the digestive tract.

12. Pregnancy.

13. Time for breastfeeding a newborn.

14. Age limitation is also a contraindication to the use of Kalimin. It is not recommended to include this drug in the treatment protocol for patients who are under 18 years of age.

15. Prohibition of consumption of alcoholic beverages.

Admission is permitted, but with special caution and under the supervision of a specialist, in the presence of the following diseases:

1. Myocardial infarction.

2. Persistent low blood pressure (hypotension).

3. Decompensation state of cardiac activity.

4. Dysfunction of the liver and kidneys.

5. Disruption of the rhythm of cardiac activity towards a decrease in the number of beats per minute (bradycardia).

6. Gallstone or urolithiasis, not complicated by complete obstruction of the ducts.

7. Ulcer of the stomach and duodenum.

8. Parkinson's disease.

9. Diabetes mellitus.

10. Postoperative period after intervention in the intestinal or stomach area.

11. Hyperthyroidism is an excess production of thyroid hormones in the body.

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Side effects Calimin

Due to the individual characteristics of the body and the special pharmacokinetics and pharmacokinetics of Kalimin, side effects of the drug in question may also appear during treatment.

1. An allergic reaction of the body to the administration of a drug: the appearance of a rash on the skin, redness and itching.
2. Increased activity of the glands of the secretory system: increased sweating, tearing and salivation, activation of the bronchial glands.
3. The appearance of nausea in the epigastric region, which, if intense, can provoke vomiting.
4. Diarrhea.
5. Cramping pain symptoms manifested in the epigastric region and lower abdomen.
6. Weakness of skeletal muscles.
7. Increase in the number of daily urges to urinate.
8. Drop in blood pressure.
9. Visual impairment.
10. The appearance of tremors.

11. Disruption of the rhythm of cardiac activity towards a decrease in the number of beats per minute (bradycardia).

During the treatment period, it is necessary to exercise increased caution when driving a car or operating other moving machinery that requires increased attention.

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Overdose

As clinical monitoring of Kalimin intake shows, an overdose of its leading active chemical component, which is pyridostigmine bromide, is quite possible both due to an excess of the administered amount of the substance and due to the individual susceptibility of the patient's body. In this case, the patient's body reacts to this with a response pathological symptomatology:

1. A sharp decline in strength.

2. The appearance of vision problems. Miosis.

3. Spasm of the bronchi.

4. Pulmonary edema.

1. Increased activity of the glands of the excretory system: increased sweating, lacrimation and salivation.

6. Dizziness.

7. Redness of the skin.

1. The appearance of nausea in the epigastric region, which, if intense, can provoke vomiting.
2. Intestinal colic.

10. Involuntary urination and defecation.

11. Increasing muscle weakness.

12. Severe hypotension.

13. Collapse is a sharp drop in blood pressure that can lead to cardiac arrest in the patient.

14. Paradoxical form of cardiac arrhythmia.

15. Bradycardia.

Measures to eliminate the symptoms of Kalimin overdose may include:

• Gastric lavage is the removal of any remaining drug that has not yet been absorbed into the mucous membrane.
• Intravenous administration of atropine (a natural alkaloid that belongs to the m-cholinergic receptor blockers).
• Oral administration of adsorbents. This may be activated carbon or any other enterosorbent.
• If cardiac arrest occurs or severe lung dysfunction is observed, doctors provide emergency resuscitation care.

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Interactions with other drugs

The drug in question can be used as the only medicine to relieve the problem, but much more often the situation arises when the attending physician needs to introduce not one drug into the therapy protocol, but two or more. In such a situation, the specialist must know in detail how this or that medicine will behave in complex treatment. Will it bring the expected effect or, on the contrary, harm the patient's health?

Therefore, the result of complex treatment directly depends on the interaction of the drug Kalimin with other drugs.

Pyridostigmine bromide loses its high pharmacological properties when taken in tandem with ganglionic blockers, as well as with chemical compounds belonging to the pharmacological group of m-anticholinergics.

A similar situation can occur when Kalimin is taken in combination with tricyclic antidepressants or medications taken for therapy associated with Parkinson's disease.

A similar result (reduction in the intensity of the pharmacological manifestation of pyridostigmine bromide) is observed with the parallel administration of quinidine, local anesthetics, as well as in the tandem effect of procainamide or drugs used to stop epileptic seizures.

When paired with morphine derivatives and barbiturate drugs, Kalimin enhances the effect of the former.

A similar clinical picture is observed with the combined use of pyridostigmine bromide with depolarizing muscle relaxants.

The use of the drug in question while taking ethanol is strictly prohibited.

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Storage conditions

Patients expect a quick and lasting effect from treatment. It can be achieved only by following all the requirements and recommendations of the attending physician conducting the therapy. But not the last place in the effectiveness of the therapy result is occupied by the correct content of the drug over the entire period of time recognized by the manufacturer as the expiration date.

If you follow absolutely all the recommendations, you can be sure that the drug will effectively “serve” for the entire period of permitted use.

Storage conditions for the medicinal product Kalimin are simple but mandatory:

1. The place where the drug is to be stored must be protected from direct sunlight.
2. The room temperature should be maintained, not allowing it to rise above +25 degrees above zero.
3. The humidity percentage is quite low.
4. The medicine must be kept in places that are inaccessible to teenagers and small children.

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Shelf life

Any product released by a corporation-manufacturer entering the pharmacy market is necessarily provided with date indicators on the packaging material indicating when the given medicinal product was produced. The second number indicates the end date, after which the medicinal product in question should not be used to treat a particular disease.

When Kalimin was released, the expiration date was set at three years from the date of production of the drug. But there is a clarification. After the first opening control shell has been torn off, the effective use time of the drug is reduced to six months.

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