Ganamotil (Itopride hydrochloride) is an orally active Gastroprokinetic agent. Ganamotil film coated tablets contain 50 mg of itopride hydrochloride. The tablet has been formulated to provide immediate release.
Ganamotil (Itopride hydrochloride) is used in the treatment of gastrointestinal symptoms of:
- Functional Dyspepsia.
- Non -Ulcer Dyspepsia (chronic gastritis) i.e., Sensation of bloating, Early satiety, Upper abdominal pain or discomfort, Anorexia, Heartburn, Nausea and Vomiting.
DOSAGE AND ADMINISTRATION
Adults: the recommended dose of Ganamotil (Itopride hydrochloride) for adult patients is 150 mg daily [one tablet (50 mg) taken orally three times a day before meals]. The dose may be reduced according to the patients age and symptoms.
Mechanism of Action: Ganamotil (Itopride hydrochloride) activates gastrointestinal propulsive motility due to its dopamine D2 antagonizing activity and acetylcholinesterase inhibitory activity. Itopride activates acetylcholine release and inhibits its degradation.
Pharmacodynamics: Ganamotil (Itopride hydrochloride) also has antiemetic action through interaction with D2 receptors located in the chemoreceptor trigger zone.
Ganamotil (Itopride hydrochloride) has been shown to accelerate gastric emptying in humans. The action of Ganamotil is highly specific for the upper gastrointestinal tract. Ganamotil does not affect serum gastrin levels.
Absorption: Ganamotil (Itopride hydrochloride) is rapidly and almost completely absorbed from the gastrointestinal tract. Relative bioavailability is calculated to be 60% due to liver first pass metabolism, there is no effect of food on bioavailability. Peak plasma levels (Cmax 0.28 microgram/mL) are reached after 0.5 to 0.75 hours after 50 mg of itopride hydrochloride.
Following multiple oral doses ranging from 50 mg to 200 mg tid, itopride hydrochloride and its metabolites showed linear pharmacokinetics over a treatment period of seven days. with minimal accumulation.
Distribution: Approximately 96% of Ganamotil (Itopride hydrochloride) is bound to plasma proteins. Albumin accounts for most of the binding. Alpha-1-acid-glycoprotein accounts for less than 15% of binding.
Distribution Approximately 96% of Ganamotil (Itopride hydrochloride) is bound to plasma proteins. Albumin accounts for most of the binding. Alpha-1 -acid – glycoprotein accounts for less than 15% of binding.
Metabolism: Ganamotil (Itopride hydrochloride) undergoes extensive hepatic metabolism in humans. Three (3) metabolites have been identified, of which only one exerts minor activity without pharmacological relevance (approximately 2-3% of that of itopride).
The primary metabolite in humans is the N-oxide, generated by oxidation of the tertiary amine N-dimethyl group. Ganamotil is metabolized by a flavin-dependent mono-oxygenase (FMO3). The abundance and efficiency of the human FMO- isozymes can be subject to genetic polymorphisms, which can lead to a rare autosomal recessive condition known as trimethylaminuria (fish odor syndrome).
The half-life of Ganamotil may therefore be longer in trimethylaminuria patients. In vivo pharmacokinetic studies on CYP- mediated reactions revealed that Ganamotil showed neither inhibitory nor inductory effect on CYP2C19 and CYP2E1. CYP content and uridine diphosphate glucuronosyl transferase activity were not altered with the administration of itopride.
Excretion: Ganamotil (Itopride hydrochloride) and its metabolites are primarily excreted in the urine. The urinary excretions of Ganamotil and its N-oxide were 3.7% and 75.4%, respectively, in healthy subjects after oral administration of a single therapeutic dose. The terminal phase half-life of Ganamotil was approximately six (6) hours.
Ganamotil (Itopride hydrochloride) is contraindicated in patients with known hypersensitivity to itopride hydrochloride or any of the excipients. Ganamotil should not be used in patients in whom an increase in gastrointestinal motility could be harmful, e.g., gastrointestinal hemorrhage, mechanical obstruction or perforation.
General: Ganamotil (Itopride hydrochloride) enhances the action of acetylcholine and may produce cholinergic side effects.
Metabolic interactions are not expected since Ganamotil (Itopride hydrochloride) is primarily metabolized by flavine monooxygenase and not by CYP450. No changes in protein binding have been seen with coadministration of warfarin, diazepam, diclofenac sodium, ticlopidine hydrochloride, nifedipine, and nicardipine hydrochloride.
Since Ganamotil has gastrokinetic effects it could influence the absorption of concomitantly orally administered drugs. Particular caution should be taken with drugs with a narrow therapeutic index, sustained release or enteric-coated formulations.
Anti-ulcer drugs like cimetidine, ranitidine, teprenone and cetraxate do not alter the prokinetic action of itopride, Anticholinergic drugs may reduce the action of Ganamotil.
PREGNANCY & LACTATION
There are no adequate and well-controlled studies in pregnant women. Therefore, Ganamotil (Itopride hydrochloride) should not be used during pregnancy unless the benefits outweigh the potential risks. There are no known effects of Ganamotil on labor or delivery.
Because Ganamotil is excreted in milk, and because of the potential for adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
Safety of this product in children under the age of 16 has not been established.
In general, appropriate caution should be exercised in the administration and monitoring of Ganamotil (Itopride hydrochloride) in elderly patients reflecting the greater frequency of decreased hepatic, renal function, and of concomitant disease or other drug therapy.
The following adverse events have been reported in patients receiving Ganamotil (Itopride hydrochloride).
- Blood and lymphatic system disorders: Leukopenia and thrombocytopenia.
- Immune system disorders: Anaphylactoid reaction.
- Endocrine disorders: Increased prolactin level and gynecomastia.
- Nervous system disorders: Dizziness, headache and tremor.
- Gastrointestinal disorders: Diarrhea, constipation, abdominal pain, increased saliva and nausea.
- Hepato-biliary disorders:
- Skin and subcutaneous tissue disorders: Rash, redness, and itching.
- Investigations: Increased AST (SGOT), increased ALT (SGPT), increased gamma -GTP, increased alkaline phosphatase, and increased bilirubin.
There have been no reported cases of overdose in humans. In of overdose the usual measures of gastric lavage and symptomatic therapy should be applied.
- Store between 15 °C – 30 °C
- Do not use beyond the expiration date.
Ganamotil- Product information
|Product||Ganamotil Oral Tablets|
|Available concentrations||50 mg|
|Company||Novell Pharma – Egypt.|
|Active Ingredients||Itopride hydrochloride – Brand NAME: Ganaton .|
|Anatomical main group||ALIMENTARY TRACT AND METABOLISM|
|Therapeutic subgroup||DRUGS FOR FUNCTIONAL GASTROINTESTINAL DISORDERS|
|Legal status||Prescription only|
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