Inosine adjuvant therapy, there are many considerations

The three major nutrients for human beings are sugar, fat and protein. However, the nutrients that we usually take in from our diet cannot be directly used by human cells. They must first be digested and absorbed, enter the blood circulation and then undergo biotransformation, in order to transform the energy that can be directly used by adult somatic cells. The biotransformation process that provides energy to cells is called the “tricarboxylic acid cycle”. Human cells need to obtain energy through the tricarboxylic acid cycle, and the key biological enzyme that catalyzes the tricarboxylic acid cycle is the pyruvate oxidase system.

Inosine can activate the pyruvate oxidase system in the human body, make the tricarboxylic acid cycle more efficient, allow the body cells to obtain more energy, and directly participate in the body’s nucleic acid, energy metabolism and protein synthesis. In other words, inosine can accelerate the operation of the “life factory” in human cells, provide more energy to make the cells “full of energy”, and can also promote the production of various “parts” of synthetic cells, and improve the cell’s self. Repair ability.

Clinical application often serves as a “supporting role”
As a drug, inosine can be used to treat leukopenia, thrombocytopenia, acute and chronic liver diseases, myocardial damage, central retinitis, optic atrophy, myocardial infarction, angina pectoris, cholecystitis, cholelithiasis and other diseases caused by various reasons Adjuvant treatment. Inosine has a weak effect on increasing white blood cells and has no obvious effect on severe neutropenia. However, because it has no obvious side effects, it can be used in conjunction with other white blood-increasing drugs to increase the therapeutic effect.

Inosine is an adjuvant medication. With the development of clinical evidence-based medicine, the clinical use of inosine is also constantly changing.

In terms of medication for children, inosine combined with vitamin B6 and vitamin B12 can treat children with anorexia, with few adverse reactions and obvious effects. Studies have used inosine as an intermediate product of purine metabolism, which can pass through the blood-brain barrier and quickly enter the central tissue, producing sedative and anticonvulsant effects, to treat Tourette syndrome in children, similar to haloperidol and tiapride The effect is equivalent. And inosine has no excessive sedation and extrapyramidal reactions, side effects are small, and children’s medication compliance is better. For the treatment of children’s multiple tics, there are clinical observations using Huaiqihuang granules, inosine, and lysine inositol vitamin B12 oral liquid combined treatment, combined with Chinese and Western medicine, the effect is better.

Inosine used to be mainly used to treat leukopenia and heart disease. Studies have shown that inosine may compete with protein kinases in the central nervous system to increase the expression of GAp-43 (a growth-related protein) and stimulate axon growth. Adenosine has this effect only through hydrolysis and deamination to produce inosine. To clarify the role and mechanism of inosine in central nerve regeneration and remodeling is of great significance to the clinical application of inosine to treat central nerve injury. Clinical efficacy observations Based on the treatment of inosine injection, combined application of Xingnaojing can effectively relieve brain and myocardial damage in patients with delayed encephalopathy after carbon monoxide poisoning, and can improve clinical efficacy.

Some people also use Niaoduqing and inosine to treat chronic renal failure. Niaoduqing is an oral Chinese patent medicine. Inosine injection can protect renal tubular epithelial cells, dilate blood vessels with insufficient oxygen supply, relieve vasospasm, and then improve the blood supply to the kidneys, which has a protective effect on renal function.

The compound inosine oral liquid can prevent the side effects of clozapine clinically, and is effective in preventing the side effects of clozapine on cardiovascular, granulocyte and autonomic nerves.

Various dosage forms and simple usage
The current dosage forms of inosine include tablets, capsules, granules, oral liquids and injections. Among them, granules and oral liquids are suitable for children to take, and injections are suitable for use in medical institutions under the supervision of medical staff. It is recommended that patients do not use injections by themselves at home.

Oral inosine, 0.2 to 0.6 grams per time for adults, 3 times a day; 0.1 to 0.2 grams for children, 3 times a day. Intravenous injection or intravenous drip of inosine, 0.2 to 0.6 grams each time, 1 to 2 times a day.

Inosine should be incompatible with other drugs in clinical use, except that it cannot be compatible with injections such as chloramphenicol, dipyridamole, and thiopental sodium. In clinical treatment, it has been found that inosine injection and pantuo for injection There are also contraindications for drugs such as prazol, vinpocetine for injection, ondansetron hydrochloride injection, musutan injection, promethazine hydrochloride injection, and scutellarin for injection, and attention should be paid during use. Therefore, when the two liquids are connected, the blank solution (normal saline without medicine or 5% glucose injection) should be fully rinsed to avoid compatibility reactions.

Creatinine
Inosine and creatinine are pronounced similarly, but the two are different substances. Inosine is a normal component of the human body and a drug, while creatinine is a biochemical indicator of renal function tests. This is not difficult to distinguish between professionals, but for the general public, the concepts of the two are easy to confuse, and the question “Is the inosine I eat and the creatinine I tested is the same thing?”

As a normal component of the human body, inosine is the precursor of adenine, which can directly enter human cells through the cell membrane and participate in energy metabolism and protein synthesis in the body. As a drug, inosine can activate the pyruvate oxidase system, increase the activity of coenzyme A, activate liver function, and enable tissues under low-energy hypoxia to continue to metabolize, helping to restore the function of damaged liver cells. In addition, inosine can also stimulate the body to produce antibodies and increase the absorption of iron in the intestine.

Creatinine (Cre) in the human body includes exogenous creatinine, which is ingested by food; endogenous creatinine is produced by metabolism of muscle tissue. For example, under strict control of diet and relatively stable muscle activity, the content of creatinine in the human body is basically stable, and its changes are mainly affected by endogenous creatinine.

Creatinine is divided into blood creatinine and urine creatinine: urine creatinine is the body’s creatinine released into the urine through the blood circulatory system; blood creatinine is a metabolite produced by human muscle creatine. Almost every day the creatine produced in the body is excreted from the body through the kidneys (urine). The change in the concentration of serum creatinine is mainly determined by the filtration capacity of the glomeruli (glomerular filtration rate). If the filtration capacity decreases, the creatinine concentration increases. When the kidney function is impaired, the normal excretion of creatinine is hindered, resulting in an increase in serum creatinine content. The increase in blood creatinine also means that renal function is impaired. Therefore, serum creatinine is an important indicator of kidney function. High creatinine generally refers to high blood creatinine.

It is known that creatinine is a metabolite of human creatine. Under normal renal function, the amount of creatine is proportional to the amount of muscle. Therefore, creatinine produced by muscular men is relatively higher. The amount of exercise and diet of men is larger than that of women, so the reference value of normal creatinine is higher for adult men than women. The normal level of serum creatinine in the elderly should be lower than that of the young. The serum creatinine of normal people is 53~106umol/L for males and 44~97umol/L for females. Urinary creatinine is normal at 8.4~13.25mmol/24 hours urine or 40mg/dl to 130mg/dl.

There are many factors that cause the increase of creatinine. Except for people with kidney disease, hypertension, diabetes, dyslipidemia, heart and brain diseases and trauma, and the influence of drugs can all cause the increase of serum creatinine. Among them, with the widespread use of contrast agents in clinical practice, the incidence of contrast agent nephropathy has also increased, which has become a serious problem in clinical treatment.

Of course, some non-disease conditions, such as fatigue in life, poor rest, and carelessness in life details, can also cause a certain range of blood creatinine to rise; water loss in the body, such as fever, excessive sweating, decreased water consumption, and more The urinary phase leads to blood concentration, reduced renal blood flow, and increased creatinine. The medical history should be carefully asked during clinical diagnosis to avoid errors.

Liver protection “icing on the cake”
As mentioned earlier, inosine helps to restore the function of damaged liver cells, so can inosine be compared with liver protection drugs?

The human liver is an organ with strong compensatory and self-repair capabilities. Even if damage occurs, as long as you have more rest and ensure adequate nutrition, the liver will repair itself. Therefore, the core concept of liver protection is “avoid injury and promote regeneration.” “Liver-protecting drugs” is a general concept, including nutrition, detoxification, anti-inflammatory, enzyme-lowering, choleretic and other drugs for liver maintenance.

Nutrition: contains various vitamins, trace elements, amino acids and polyene phospholipid choline and other drugs. Because when liver disease occurs, the body’s metabolic function decreases and the synthesis of nutrients decreases. Therefore, it is necessary to directly provide sufficient nutrients to the liver cells, so that it has enough “raw materials” to synthesize its own “accessories”, which is conducive to its repair.

Detoxification: The liver is the most important detoxification organ of the human body. When the function of the liver decreases, peroxides and free radicals in the body will accumulate in the liver, causing damage to liver cells. At this time, reduced glutathione, tiopronin, glucurolactone and other drugs can be used to provide the human body with a large amount of sulfhydryl and glucuronic acid, which can neutralize peroxides and free radicals in the human body and prevent these substances from affecting the body. Damage to liver cells.

Anti-inflammatory: No matter what kind of factor causes liver disease, the common mechanism of liver damage is inflammatory reaction. Glycyrrhizin preparations are usually used, which has a glucocorticoid effect, can produce anti-inflammatory effects and prevent inflammatory substances from damaging the liver.

Enzyme-lowering classes: For aminotransferases caused by liver injury [namely transaminase, there are two main types of transaminase used to detect liver function through blood tests in clinical practice, one is called alanine aminotransferase (ALT); the other is called aspartame Acid transaminase (AST)] is elevated, bifendate and bicyclol can be used to reduce aminotransferase, which can relieve symptoms such as liver pain, fatigue, and abdominal distension.

Cholestasis: For liver damage caused by cholestasis, adenosylmethionine, ursodeoxycholic acid and other drugs that promote bile secretion can be used to reduce the symptoms of cholestasis.

Inosine can increase the energy supply of liver cells, so it can nourish the liver and reduce transaminase to a certain extent. But the liver-protecting effect of inosine is achieved by promoting the metabolism of liver cells and enhancing the self-repair ability of liver cells. If liver damage is severe and normal cell metabolism is affected, inosine will have poor liver protection effects.

Therefore, the liver-protecting effect of inosine is only “icing on the cake”, and cannot “send charcoal in the snow.” When inosine is used alone, the liver protection effect is limited, and it can only be used as an auxiliary drug for liver maintenance. It needs to be combined with other liver protection drugs to achieve the best liver protection effect. Consult a doctor for specific applications.

Adjuvant medication also needs to be reasonable
Inosine is a normal component in the human body, and there are almost no side effects when used normally. Only when the dose is too large or the speed of intravenous infusion is too fast, slight adverse reactions will occur. During oral administration, occasionally stomach upset and mild diarrhea were observed. During intravenous administration, there may be adverse reactions such as facial flushing, nausea, and abdominal burning. In intravenous administration, if inosine is mixed and compatible with other drugs, it may interact and cause the drug to fail. Therefore, when intravenous infusion of inosine requires separate infusion, it cannot be mixed and compatible with other drugs. In addition, although inosine is normally contained in the human body, medicinal inosine is a synthetic product with certain impurities and may cause allergic reactions. Allergic reactions caused by inosine are mainly seen in the route of administration by injection, but less frequently by oral administration. People with allergies should use inosine cautiously and try to take oral administration instead of intravenous infusion.

A few decades ago, when our country was still short of medical treatment and medicine, inosine was widely used as a commonly used liver protection medicine. However, with the development of the times and the advancement of medical technology, more and more new liver-protecting drugs have been invented, and inosine has gradually changed from “commonly used drugs” to “adjuvant drugs”.

“Adjuvant medication”, as the name suggests, is a drug that can only play an adjuvant treatment, not a main therapeutic effect. Many people think that “adjuvant medications” are “nutritional drugs” and can be taken at will. This is a misconception. “Adjuvant medication” is also a medicine, and it also has its own indications and adverse reactions, and cannot be taken at will. Otherwise, it is not only a waste of money, but also unpredictable drug risks due to misuse of drugs. Inosine is an “adjuvant drug”, which means that if inosine is used alone, it will not be a good treatment for diseases. Only according to the specific disease, choose the appropriate treatment drug, and then use inosine together, it may play its role in helping the disease recovery.

For example, mild to moderate fatty liver does not require any medication at all. You only need to control your diet, increase exercise, and consume the fat in the liver cells, and the liver will regain its vitality. If it is a mild liver injury, the main treatment is to provide nutritional support to liver cells. At the same time, with inosine, it can mobilize the “enthusiasm” of muscle cells and accelerate the liver’s self-repair. If it is liver damage caused by drugs, alcohol or other toxic substances, the main treatment is to help the liver detoxify, and at the same time use inosine with nutritional support. If liver damage is caused by hepatitis virus, the main treatment that needs to be done is antiviral. While suppressing the virus, provide anti-inflammatory and nutritional support. If there are too many transaminase enzymes, they should also be treated with lowering enzymes. After accomplishing this, consider using inosine at the same time to promote liver repair.

Therefore, inosine needs to stand its own “auxiliary position” and use it in conjunction with other therapeutic drugs, but cannot “take the lead” alone. When you buy and use it, don’t forget that inosine is an “adjuvant drug” and you need to choose other therapeutic drugs to use together under the guidance of a doctor.