Enzyme-based drugs are widely used in ophthalmological practice. The drug "Gemaza" belongs to such medications. It is based on recombinant prourokinase, a thrombolytic substance that specifically affects blood clotting. The use of this remedy helps improve blood supply to the eye by reducing the formation of blood clots. It is important to know how this medication is administered, side effects and complications.
Composition, description of the drug and its form
The drug "Gemaza" (instructions for use of this drug are required to be studied) contains recombinant prourokinase, as well as additional substances such as dextran 40 and sodium chloride.
The medicine in question goes on sale in the form of a lyophilisate, which is a white amorphous or porous mass that has no odor and is intended for the preparation of an intravenous solution.
The drug "Gemaza" in glass ampoules is placed in contour cells or plastic trays, which are sealed in cardboard packs.
It should also be said that this medication requires the presence of a special substance - a liquid that is poured into bottles.
Restrictions
A contraindication to the use of the drug is acute renal failure.
"Gemaza" in ophthalmology is not recommended for the following conditions:
- individual intolerance to constituent substances;
- risk of bleeding;
- tuberculosis;
- retinopathy due to uncompensated diabetes;
- hypertonic disease;
- chronic renal failure;
- decompensated liver diseases;
- hemophilia;
- thrombocytopenia;
- history of stroke;
- During pregnancy and breastfeeding;
- endocarditis of bacterial origin.
Pharmacology of an ophthalmic drug
How does the drug "Gemaza" work? The instructions for use state that the action of this enzyme agent is due to its active component - prourokinase. It is an enzyme - serine protease. According to the chemical structure, this substance is a single-chain molecule (with a molecular weight of 54 thousand Daltons), which includes two polypeptide chains that are connected by a disulfide bridge with molecular weights of 20 and 34 thousand Daltons.
The principle of action of this drug is based on the specific stimulation of the conversion of profibrinolysin into the fibrinolytic component of plasma - fibrinolysin, as well as the ability to destroy fibrin clots.
Signs of overdose
Exceeding the dosage leads to such an undesirable phenomenon as hemorrhage in the eye.
Using the drug without dilution or violating the instructions for use may lead to undesirable reactions. High concentrations of recombinant prourokinase lead to a high risk of developing preretinal, subretinal or intraretinal bleeding. This condition is relieved by intramuscular injection of 200 mg of Etimzilat.
The drug "Gemaza": purpose (indications)
The use of the drug in question in ophthalmic practice is due to its high effectiveness in the following cases:
- with subretinal, preretinal and intraretinal hemorrhages;
- with hemophthalmos and hyphema;
- with thrombosis of the central veins in the branches of the retina or occlusion of the central arteries;
- with identified fibrinoid syndrome of various origins;
- for the purpose of preventing adhesions after antiglaucomatous interventions.
Indications for use
According to the instructions for Gemaza, the drug is used for:
- Hemophthalmia (hemorrhage into the eye cavity or, in other words, into the vitreous body of the eye);
- Hyphema (hemorrhage in the anterior chamber of the eye);
- Preretinal (in the space between the layer of nerve fibers and the posterior hyaloid membrane of the vitreous body), subretinal (in the space between the layers of the retinal neuroepithelium and pigment epithelium) or intraretinal (into the thickness of the retina) hemorrhage;
- Fibrioid syndrome of various origins;
- Occlusion (acute circulatory disorder) of the central artery of the retina, as well as its branches;
- Thrombosis of the central retinal vein (formation of a blood clot inside it), as well as thrombosis of its branches.
As a prophylactic agent, Gemaza can be prescribed to prevent the development of adhesions in the postoperative period after removal of glaucoma.
Prohibitions on the use of the solution
In what cases should the drug "Gemaza" not be prescribed? Instructions for use (injections should only be performed by an experienced specialist) indicate the following prohibitions:
- liver diseases, which are accompanied by severe hemostasis disorders;
- tendency to bleeding, including the presence of hemorrhagic diathesis, hemophilia, thrombocytopenia, and so on;
- cardiopulmonary resuscitation, as well as other resuscitation procedures performed for longer than 10 minutes;
- bleeding from the gastrointestinal tract, including with a duration of up to 28 days, spinal or intracranial interventions with a duration of up to 56 days, extensive surgical interventions or injuries with a duration of up to 28 days;
- cardiogenic shock of the fourth class (according to the Killip classification);
- active form of tuberculosis;
- renal failure occurring in a chronic form;
- puncture of large vessels, including the subclavian vein;
- hemorrhagic (diabetic) lesions of the retina;
- recent or history of hemorrhagic stroke;
- hypertensive crisis;
- high systolic or diastolic blood pressure;
- bacterial or septic endocarditis;
- hypersensitivity to sodium chloride, prourokinase or dextran 40;
- dissecting aortic aneurysm or suspicion of it;
- pregnancy period.
Contraindications
The use of Gemaza is contraindicated in patients under 18 years of age, during pregnancy, conditions with a high risk of bleeding, bacterial endocarditis, gastrointestinal bleeding, hypertensive crisis, arterial hypertension, as well as in cases of hypersensitivity to the components included in the drug and during the period of breastfeeding .
The drug is not prescribed to patients with active tuberculosis, severe hepatocellular failure, chronic renal failure and proliferative diabetic retinopathy with third and fourth degree gliosis.
The drug "Gemaza": instructions for use
How should the drug in question be used? To do this, the contents of 1 ampoule must be diluted in 0.5 ml of 0.9% sodium chloride solution. The resulting solution will be equal to a dose of 5 thousand ME.
The administration of such a drug should be carried out subconjunctivally (that is, under the conjunctiva) or parabulbarly (that is, in the lower eyelid area).
The duration of therapy with this drug is 10 injections per course (no more).
How should Gemaza be used for rinsing with hyphema or massive fibrin effusion in the anterior part of the visual organ? To do this, you need to take 0.2 ml of the drug with a diluted lyophilisate and bring it to 0.5 ml with a 0.9% sodium chloride solution.
For intravitreal administration of this medication, use 0.1 ml of solution and dilute it with 0.1-0.2 ml of 0.9% sodium chloride solution. This drug can be used once for hemophthalmia of various origins and fibrinoid syndrome.
It should also be said that the drug “Gamaza” (the description of the drug was presented above) is very often used as a prophylactic agent for adhesions after antiglaucomatous interventions. To do this, it is diluted in the same ratio as for subconjunctival use. After this, the medication is injected into the filtration cushion at the very beginning of the postoperative period.
Indications
The drug Gemaza is used to improve blood supply in such pathologies as hemophthalmos.
The drug "Gemaza" for the eyes is prescribed in the following cases:
- hemophthalmos;
- venous thrombotic formations in the retina;
- hemorrhages;
- hyphema;
- prevention of postoperative adhesions;
- fibrinoid syndromes;
- retinal artery occlusion.
Overdose and interaction
With a single administration of the drug in question in a dosage of more than 5 thousand IU, the risk of developing allergic reactions, which were described in side effects, significantly increases.
During surgical interventions and in case of overdose during treatment with this drug, in order to reduce the risk of hemorrhage, it is recommended to additionally use the drug “Etamzilat” in the form of intramuscular injections (at a dosage of 250-500 mg).
It is strictly forbidden to use Gemaza with Collalysin injections. This drug should be used with other thrombolytics with extreme caution.
You cannot mix two drugs at once in one syringe (with the exception of Dexamethasone).
special instructions
If a patient develops arterial hypotension and bradycardia, treatment with Gemaza should be suspended until blood pressure is stabilized and the heart rate is normalized.
To reduce the likelihood of hemorrhages during surgical operations, it is recommended to use etamsylate simultaneously with Gemaza - 250-500 mg intramuscularly.
The drug should be used with caution in combination with other thrombolytics.
During treatment with this drug, care should be taken when driving a car and working with complex mechanisms.
Ophthalmic drug "Gemaza": reviews and similar products
What can replace the medication in question? Its analogues are drugs such as Actilis, Fibrinolysin, Metaliz and Thrombovazim.
What do people who suffer from visual problems say about this remedy? Most often, reviews of this drug are left by those who use it for hemorrhages in ophthalmic practice. At the same time, patients claim that such injections are very effective and efficient. They help well and fully cope with the task.
Despite the unpleasantness of the treatment procedure (such injections are quite painful), patients are advised to be patient a little and not to bring their condition to the point of removal of the vitreous.
As for negative reviews about this product, they are most often associated with the development of side effects, as well as the presence of a huge number of contraindications. In addition, many patients believe that the cost of the drug "Gemaza" is overpriced (costs about 750-850 rubles).
Side effects
Ophthalmic enzyme products are not characterized by a wide variety of adverse reactions, since the active substance is close to physiological. Deterioration of the patient's condition after using the drug is observed only with the development of a hypersensitivity reaction. In this case, the patient notes swelling around the eye, chemosis, conjunctival hyperemia, burning, and discomfort.
Drops based on "Gemaza" are not used, since this form of the drug does not make it possible to carry out the exact dosage of the medication.
Properties of Gemaza
The active component of the drug, the recombinant fibrinolytic proenzyme prourokinase, is formed during the genetic transformation of the bacterium Escherichia coli. It works as follows. When combined with small doses of plasmin, prourokinase takes the form of plasminogen activator - urokinase, which can catalyze the transition of plasminogen to plasmin. It is worth pointing out that urokinase is the main plasminogen activator even without fibrin.
Gemaza is practically non-allergenic and has a high specificity of action. The direction of modification of the N-terminal receptor-binding domain of RPU suppresses its interaction with the urokinase receptor, so its systemic administration eliminates any potential side effects due to stimulation of regulatory processes that control cell migration and tissue remodeling. The drug is characterized by increased affinity for fibrin, and is completely resistant to plasminogen activator inhibitors.
A drug
For what purpose is the drug "Gemaza" used in ophthalmology? Instructions for use and purpose of this medication will be indicated below. You will also learn about the release form of the product mentioned, contraindications for its use and side effects.
Composition, description of the drug and its form
The drug "Gemaza" (instructions for use of this drug are required to be studied) contains recombinant prourokinase, as well as additional substances such as dextran 40 and sodium chloride.
The medicine in question goes on sale in the form of a lyophilisate, which is a white amorphous or porous mass that has no odor and is intended for the preparation of an intravenous solution.
The drug "Gemaza" in glass ampoules is placed in contour cells or plastic trays, which are sealed in cardboard packs.
It should also be said that this medication requires the presence of a special substance - a liquid that is poured into bottles.
Pharmacology of an ophthalmic drug
How does the drug "Gemaza" work? The instructions for use state that the action of this enzyme agent is due to its active component - prourokinase. It is an enzyme - serine protease.
According to the chemical structure, this substance is a single-chain molecule (with a molecular weight of 54 thousand Daltons), which includes two polypeptide chains that are connected by a disulfide bridge with molecular weights of 20 and 34 thousand Daltons.
The principle of action of this drug is based on the specific stimulation of the conversion of profibrinolysin into the fibrinolytic component of plasma - fibrinolysin, as well as the ability to destroy fibrin clots.
Kinetic characteristics of the drug
How does local absorption of the drug "Gemaza" occur? The instructions for use state that the peak concentration of this drug in the tissues of the visual organs is reached after two hours, and after another half a day its traces can be detected in the patient’s blood.
The half-life of recombinant prourokinase is approximately 6 hours. It should be noted that due to the use of small dosages of the drug, it is impossible to achieve its systemic effect.
The drug "Gemaza": purpose (indications)
The use of the drug in question in ophthalmic practice is due to its high effectiveness in the following cases:
- with subretinal, preretinal and intraretinal hemorrhages;
- with hemophthalmos and hyphema;
- with thrombosis of the central veins in the branches of the retina or occlusion of the central arteries;
- with identified fibrinoid syndrome of various origins;
- for the purpose of preventing adhesions after antiglaucomatous interventions.
Prohibitions on the use of the solution
In what cases should the drug "Gemaza" not be prescribed? Instructions for use (injections should only be performed by an experienced specialist) indicate the following prohibitions:
- liver diseases, which are accompanied by severe hemostasis disorders;
- tendency to bleeding, including the presence of hemorrhagic diathesis, hemophilia, thrombocytopenia, and so on;
- cardiopulmonary resuscitation, as well as other resuscitation procedures performed for longer than 10 minutes;
- bleeding from the gastrointestinal tract, including with a duration of up to 28 days, spinal or intracranial interventions with a duration of up to 56 days, extensive surgical interventions or injuries with a duration of up to 28 days;
- cardiogenic shock of the fourth class (according to the Killip classification);
- active form of tuberculosis;
- renal failure occurring in a chronic form;
- puncture of large vessels, including the subclavian vein;
- hemorrhagic (diabetic) lesions of the retina;
- recent or history of hemorrhagic stroke;
- hypertensive crisis;
- high systolic or diastolic blood pressure;
- bacterial or septic endocarditis;
- hypersensitivity to sodium chloride, prourokinase or dextran 40;
- dissecting aortic aneurysm or suspicion of it;
- pregnancy period.
The drug "Gemaza": instructions for use
How should the drug in question be used? To do this, the contents of 1 ampoule must be diluted in 0.5 ml of 0.9% sodium chloride solution. The resulting solution will be equal to a dose of 5 thousand ME.
The administration of such a drug should be carried out subconjunctivally (that is, under the conjunctiva) or parabulbarly (that is, in the lower eyelid area).
The duration of therapy with this drug is 10 injections per course (no more).
For intravitreal administration of this medication, use 0.1 ml of solution and dilute it with 0.1-0.2 ml of 0.9% sodium chloride solution. This drug can be used once for hemophthalmia of various origins and fibrinoid syndrome.
It should also be said that the drug “Gamaza” (the description of the drug was presented above) is very often used as a prophylactic agent for adhesions after antiglaucomatous interventions. To do this, it is diluted in the same ratio as for subconjunctival use. After this, the medication is injected into the filtration cushion at the very beginning of the postoperative period.
Side effects of the drug
During treatment with Gemaza, the patient may develop allergic reactions in the form of:
- hyperemia of the skin in the face or injection site;
- swelling;
- allergic tenonitis in the form of chemosis, decreased mobility of the eyeball and conjunctival hyperemia.
Overdose and interaction
With a single administration of the drug in question in a dosage of more than 5 thousand IU, the risk of developing allergic reactions, which were described in side effects, significantly increases.
During surgical interventions and in case of overdose during treatment with this drug, in order to reduce the risk of hemorrhage, it is recommended to additionally use the drug “Etamzilat” in the form of intramuscular injections (at a dosage of 250-500 mg).
It is strictly forbidden to use Gemaza with Collalysin injections. This drug should be used with other thrombolytics with extreme caution.
You cannot mix two drugs at once in one syringe (with the exception of Dexamethasone).
Special Information
If bradycardia or arterial hypotension develops, the administration of the medication should be suspended until heart rate and blood pressure normalize.
Ophthalmic drug "Gemaza": reviews and similar products
What can replace the medication in question? Its analogues are drugs such as Actilis, Fibrinolysin, Metaliz and Thrombovazim.
What do people who suffer from visual problems say about this remedy? Most often, reviews of this drug are left by those who use it for hemorrhages in ophthalmic practice. At the same time, patients claim that such injections are very effective and efficient. They help well and fully cope with the task.
Despite the unpleasantness of the treatment procedure (such injections are quite painful), patients are advised to be patient a little and not to bring their condition to the point of removal of the vitreous.
As for negative reviews about this product, they are most often associated with the development of side effects, as well as the presence of a huge number of contraindications. In addition, many patients believe that the cost of the drug "Gemaza" is overpriced (costs about 750-850 rubles).
Source: https://fb.ru/article/259200/preparat-gemaza-instruktsiya-po-primeneniyu-v-oftalmologii-i-otzyivyi
What to replace it with?
If it is impossible to use the main drug, a replacement is selected from the list of analogues, one of which is Thrombovazim.
Analogues of "Gemaza" include:
- "Aktiliz";
- "Thrombovasim";
- "Metaliz";
- "Fibrinolysin";
- "Batroxobin";
- "Zigris".
These agents also include active enzyme substances that destroy fibrin accumulation and blood clots. They are used in the absence of Hemase or in the presence of hypersensitivity to prourokinase. Substitutes are also administered subconjunctivally, intravitreally or parabulbarly for local effects on the affected vessels. Despite the painfulness of the procedure, this is the fastest and most effective way to influence circulatory disorders.
