Compound Glycyrrhizin Tablets

Drug name Common name: Compound Glycyrrhizin Tablets

Trade name: Meineng

Properties: This product is white sugar-coated tablets.

Components Glycyrrhizin 25mg (glycyrrhizic acid monoamine salt 35mg)

Glycine 25mg Methionine 25mg

Indications: Treat chronic liver disease and improve abnormal liver function

Can be used to treat eczema, dermatitis, and alopecia areata.

Usage and dosage: Adults usually take 2-3 tablets at a time, children take 1 tablet at a time, 3 times a day after meals.

It can increase or decrease according to age and symptoms.

Storage Store at room temperature.

Specification: 100 tablets/box

Imported drug registration certificate number )

Pharmacy address: 1-9, Lingxing International Center, No. 2 Guangqumennei Street, Chongwen District, Beijing Drug consultation: 010-67180242 ext. 85 Order hotline: 010-51296910 Drug name pinyin ffgcsgp Common name compound licorice The common name of sweetener is pinyin ffgcts. Manufactured by Japan Minengfayuan Pharmaceutical Co., Ltd. Main ingredients: monoammonium glycyrrhizinate 35mg (containing 25mg glycyrrhizic acid), glycine 25mg, DL-methionine (Methionine) 25mg. Specification: 25mg*100s. Unit box of compound glycyrrhizin (Meineng) Compound glycyrrhizin (trade name: Mineng; English name: StrongerNeo-MinophagenC, SNMC) is an intravenous and oral preparation first developed by Japan in 1948 with glycyrrhizic acid (glycyrrhizin) as the main ingredient. Because SNMC has anti-allergic and anti-inflammatory effects, it was mainly used in the field of dermatology to treat a variety of allergic skin diseases. In 1958, Japanese doctor Mr. Yamamoto tentatively used SNMC to treat patients with chronic hepatitis. As a result, the liver function index BSP (bromsulfonphthalein) value was significantly improved (there was no transaminase measurement at that time). Since then, SNMC has received attention as a drug for liver diseases in Japan, and a large number of basic and clinical studies have been conducted on it. In 1977, Japanese liver disease expert Professor Hiroshi Suzuki used a strict randomized double-blind control method to verify the efficacy of SNMC on chronic hepatitis, confirming that SNMC can effectively reduce ALT, AST and γ-GTP. Subsequently, in 1986, Hino Kunihiko verified the exact efficacy of SNMC in treating chronic hepatitis based on liver histopathology. In 2002, Kumada Hiromitsu also reported the long-term efficacy results of long-term application of SNMC in the treatment of more than 500 cases of chronic hepatitis C. He found that SNMC could reduce the incidence of liver cancer in chronic hepatitis C by more than 50% after 15 years of treatment [1]. Since the efficacy of SNMC is verified and supported by liver pathology, and there is a 22-year long-term efficacy study, it can be said that SNMC is the most certain and most in-depth researched among all hepatoprotective drugs. Currently, in the clinical practice of liver diseases in Japan It is widely used as the best liver protective agent. With the development of exchanges between China and Japan, from the late 1970s to the early 1980s, Japanese scholars came to my country to give lectures and introduced the value of glycyrrhizic acid in the treatment of liver diseases to the domestic medical community. Since then, imitations of domestically produced glycyrrhizic acid preparations have been produced. . As early as the 1980s, our hospital took the lead in clinical application of SNMC in China. After nearly 20 years of clinical application, it has accumulated certain experience and understanding of medication. Therefore, this article introduces the pharmacology, efficacy, administration methods, clinical efficacy and new research progress of SNMC.

Ingredients of SNMC SNMC injection: Each 20ml contains: MonoammoniumGlycyr_rhizinate 53mg (containing 40mg glycyrrhizic acid), glycine (Glycine) 400mg, L-Cysteine ??(L-Cysteine) 20mg; the additive contains sodium sulfite 16mg and appropriate amount of ammonia. SNMC tablets: Each tablet contains: 35 mg of monoammonium glycyrrhizinate (including 25 mg of glycyrrhizic acid), 25 mg of glycine, and 25 mg of DL-methionine. Glycyrrhizic acid is the main component of SNMC, commonly known as glycyrrhizin. It is a type of triterpenoid saponin from licorice extract. It consists of 1 molecule of glycyrrhetinic acid (Glycyrrhetinic Acid; GA) and 2 molecules of glucuronic acid. (Glucuron) composition. Chemical name: 20β-carboxy-11-oxo-30-norolean-12-en-3β-yl-2-O-β-D-glucopyranuronosyl-β-D-glucopyranosiduronic acid. Molecular formula: C42H62O16. Molecular weight: 822.94. Pharmacological effects and metabolic characteristics of SNMC. Anti-inflammatory effect: The anti-inflammatory effect of glycyrrhizic acid is mainly through selective inhibition of the metabolic enzymes that undergo a cascade reaction with arachidonic acid (Arachidonic Acid) - phospholipase A2 and lipase A2. This is accomplished by the activity of lipoxygenase, which prevents the production of inflammatory mediators such as prostaglandins and leukotrienes [2, 3]. Steroid-like effects: Glycyrrhizic acid has a strong affinity for the steroid hormone metabolizing enzyme (Δ5-β-reductase) in the liver, inhibiting the inactivation of cortisone and aldosterone in the liver, thus slowing down the metabolism of steroids and exerting their steroid effects. Same effect. However, the effects of glycyrrhizic acid are similar to corticosteroids, but also antagonistic. Immunomodulatory effect: Glycyrrhizic acid has T cell activation and regulation effects [4], gamma-interferon induction effect, NK cell activation effect, extrathymic T lymphocyte differentiation enhancement effect [5], etc. In addition, because glycyrrhizic acid also has steroid-like effects, it cannot be simply classified as an immunosuppressant or immune enhancer. In fact, it may be an immunomodulator with "two-way" effects. Inhibiting virus proliferation and inactivating viruses: Animal experiments show that glycyrrhizic acid can inhibit acne after animals are infected with vaccinia virus; in in vitro experiments, it can inhibit the proliferation of herpes virus (Herpesvirus) and has an inactivating effect; in recent years, it can be used Experiments on Alexander liver cancer cells that produce hepatitis B surface antigen (HBsAg) found that glycyrrhizic acid can inhibit the exocrine secretion of hepatitis B surface antigen, suggesting that glycyrrhizic acid has an anti-HBV effect [6,7]. In addition, the other two amino acids contained in SNMC - glycine and cysteine ??themselves also have detoxification and anti-allergic effects, and can offset the side effects of glycyrrhizic acid sodium and water retention. Metabolic characteristics of SNMC: The metabolism of glycyrrhetinic acid and glycyrrhizic acid in the body was measured by enzyme immunoassay, and it was found that the metabolism of glycyrrhizinic acid in the body was different depending on the route of administration. When 40ml of SNMC (containing 80mg of glycyrrhizic acid) is intravenously injected into normal people, the glycyrrhizic acid content in the blood decreases gradually, and can still be detected in the blood 48 hours later (10-15ng/ml); 6 hours after intravenous injection, the glycyrrhizic acid content Acid appears in the blood at a low concentration (ng/ml order), reaches a peak value (5-7ng/ml) after 24 hours, and then gradually decreases. Glycyrrhizic acid appeared in urine 27 hours after intravenous injection but was only 1.2% of the administered dose. Most of the glycyrrhizic acid injected intravenously into the body enters the enterohepatic circulation, and only a very small amount is metabolized into glycyrrhetinic acid. On the contrary, no glycyrrhizinic acid can be detected in the blood after oral administration of 100 mg of glycyrrhizic acid, and glycyrrhetinic acid has two high concentration peaks (200-500ng/ml) at 1 to 4 hours and 10 to 24 hours after taking the drug. This is due to Most of the glycyrrhizic acid is quickly converted into glycyrrhetinic acid in the upper gastrointestinal tract and enters the bloodstream. For patients with chronic hepatitis, the concentration of glycyrrhizic acid in the blood was significantly reduced 24 hours after intravenous injection of SNMC. Compared with healthy people, the conversion time of glycyrrhizic acid into glycyrrhetinic acid was delayed.

Usage and dosage of SNMC: Each 20ml (1 tube) of SNMC injection contains 53 mg of monoammonium glycyrrhizinate (containing 40 mg of glycyrrhizic acid), 400 mg of glycine, and 20 mg of L-cysteine ??hydrochloride. SNMC injection can be directly injected intravenously or intravenously dripped after appropriate dilution. 40ml/time is a standard dose and 100ml/time is a large dose. The dosage can be increased or decreased according to age. The maximum dose generally does not exceed 120ml/time. Usually, the specific usage for patients with chronic liver disease is as follows: start with continuous administration of 40ml to 60ml per day, and pay attention to whether the serum aminotransferase rebounds. After 4 to 8 weeks of treatment, the number of injections can be gradually reduced to 2 to 3 times per week. times, 40ml each time, to maintain treatment. If there is still no improvement in transaminase after 2 weeks of treatment with 40ml to 60ml per day, the dosage can be increased to 100ml, once a day. After patients have been treated with high doses for 2 to 8 weeks, they can gradually reduce the dose by 20ml each time for the next 4 to 8 weeks. When the dose is reduced to 40ml per day, the number of treatments can be gradually reduced to the maintenance dose. For severe hepatitis, in order to control liver inflammation as early as possible, high-dose therapy of 100ml per day can be started at the beginning. SNMC tablets are sugar-coated tablets, each containing 35 mg of monoammonium glycyrrhizinate (including 25 mg of glycyrrhizic acid), 25 mg of glycine, and 25 mg of DL-methionine. Usually, adults take 2 to 3 tablets each time, and children take 1 tablet each time, 3 times a day, orally after meals. It can be increased or decreased appropriately according to age and symptoms. Clinical application of SNMC Short-term continuous treatment (double-blind comparative trial) 133 cases of chronic hepatitis were studied in 36 hospitals in Japan. 40ml of SNMC was administered intravenously every day for 1 month, and a comparative study was conducted using a double-blind method. As a result, the effective rate was 68.7% (46 cases) in the treatment group and 27.3% (18 cases) in the control group. The comparison between the two groups was statistically significant (P<0.001). Liver function tests showed significant improvement in AST, ALT, and γ-GTP values, among which transaminase showed rapid and obvious improvement, confirming the efficacy of SNMC. Short-term continuous treatment is suitable for the treatment of acute hepatitis and mild to moderate chronic hepatitis. After drug withdrawal, oral SNMC tablets can prevent transaminase rebound. The effect of long-term intermittent therapy The long-term therapy of SNMC is aimed at patients with chronic hepatitis B whose transaminase continues to fluctuate in an abnormal range. Intermittent therapy is often used in order not to affect the patient's social activities as much as possible. In order to prevent transaminase rebound during long-term intermittent treatment, the dosage should be gradually reduced. The method is to start treatment with SNMC 40ml/time, intravenously once every other day or three times a week. When the transaminases decreased, maintenance treatment was changed to twice a week for 6 months. Later, it will be changed to once a week or once every other week, and the dosage will be gradually reduced and the medication will be discontinued. Fujisawa et al. used long-term intermittent SNMC therapy to treat 18 cases of chronic hepatitis B with persistent HBeAg positivity, including 16 cases of chronic active hepatitis and 2 cases of inactive hepatitis, with remarkable results. Eleven of 18 cases (61%) became HBeAg negative, and 7 cases (41%) underwent seroconversion. The treatment time was (1.2±0.8) years. The advantage of long-term intermittent therapy with SNMC is that it can reduce the number of injections for patients, inhibit transaminase rebound, make HBeAg negative, and make adverse reactions less likely to occur. Results of a comparative trial of different doses of chronic hepatitis and cirrhosis. 11 hospitals in Japan conducted a comparative trial of different drug doses on 178 patients with chronic hepatitis and cirrhosis [8]. 40 ml of SNMC was administered intravenously daily for 3 weeks, and after 2 weeks of treatment, 93 patients whose ALT was still higher than 1.5 times the upper limit of the normal value were treated with the 40 ml group and the 100 ml group. The results of the latter were higher than those of the former. The value shows a meaningful improvement. It can be concluded that for cases where the "40ml therapy" (i.e. standard dose therapy) is unsatisfactory, increasing the dose to 100ml (i.e. high dose therapy) can be effective. High-dose therapy is not suitable for all newly diagnosed patients. Its indications are chronic active hepatitis that is ineffective for "40ml therapy" and has severe liver cell inflammation. Iino et al. believe that for chronic active hepatitis B, if the ratio of helper T lymphocytes/cytotoxic T lymphocytes is below 1.0, intermittent treatment with 40ml of SNMC every day can also be effective.

For the treatment of chronic active hepatitis, high-dose therapy and "40ml therapy" also require a longer period of treatment. When the transaminase is in a stable state with a low value, intermittent therapy is used to gradually reduce the dose to prevent transaminase rebound. From August 1998 to March 2000, a prospective multi-center randomized controlled study was conducted on 194 cases of chronic hepatitis B in 7 cities in my country to observe the efficacy of different doses on hepatitis B. 194 patients were randomly divided into two groups. Group A, 99 patients, received SNMC at a therapeutic dose of 100ml, once a day, intravenously, for 4 weeks, and then changed to oral SNMC 3 tablets/time, 3 times a day, for 4 weeks; Group B, 95 patients, SNMC 40ml was injected intravenously, and SNMC tablets were taken orally after 4 weeks. The usage was the same as in group A. The results showed that the therapeutic effects of the two groups were similar. The simultaneous normalization rate of ALT and AST was 46.7% and 48.4% in the two groups respectively, and the rate of ALT and AST falling within 1.5 times the upper limit of normal value was 70.1%. There was no significant difference between the two groups. The improvement rate of total bilirubin was 62.9% in group A and 73.4% in group B. Serum albumin increased significantly in both groups. After 8 weeks of treatment, serum potassium decreased slightly and sodium increased, but there was no significant difference compared with before treatment. Regarding adverse reactions, 3 cases complained of chest discomfort but no change in electrocardiogram; 1 case developed hypertension, 7 cases had serum potassium lower than 3.5mmol/L, 2 cases developed mild anemia, and all recovered after symptomatic treatment. The results suggest that both the standard dose of 40ml per day and the high dose of 100ml per day can achieve the same therapeutic effect. Therefore, when patients first use this drug, daily administration of 40ml is sufficient. However, some Japanese scholars believe that to achieve improvement in liver pathology, 40ml is not enough, and a large dose of 100ml is needed. The effect of improving liver histology in chronic liver disease Hino et al. observed 40 hospitalized patients with chronic active hepatitis (average age (43.7 + 10.6) years, including 10 HBsAg positive cases and 8 HBeAg positive cases), adding 100 ml of SNMC to 250 ml of 5% glucose. Intravenous drip or direct intravenous injection of 100ml of SNMC, once a day, continuous treatment for 8 weeks, and the improvement of liver function and liver histology were studied. After 8 weeks of treatment, all liver parenchymal lesions showed significant improvement; improvement rate: 47.5% of focal necrosis, 55% of stellate cell phagocytosis, 47.5% of swelling, 50% of boundary plate destruction, and half of the bridging necrosis also disappeared. However, there was basically no effect on fibroplasia (5%) and lobular remodeling (7.1%). Most of the 40 cases had liver pathological examinations before and after treatment, and blind evaluation confirmed that high-dose SNMC therapy had a statistically significant improvement in hepatocellular inflammation. Inhibitory effect on liver carcinogenesis in chronic liver disease [1] Taking chronic hepatitis C as the subject, 100ml of SNMC was given daily. After 8 weeks of treatment, 84 patients in the treatment group continued to receive treatment 2 to 7 times a week for 2 years to 16 years (average 10.1 years), and 109 untreated cases as the control group were retrospectively observed for 1 to 16 years (average 9.2 years). After 15 years of follow-up observation, the canceration rate in the treatment group was reduced by about half (compared with the control group). Compared with P=0.002), especially those in the treatment group whose average ALT value was below the upper limit of normal (≤50IU) saw a significant reduction in the incidence of liver cancer (P=0.08). From this, it can be seen that in order to prevent the progression of liver disease, it is important to maintain the ALT value at a low value for a long time. Adverse reactions and treatments: Pseudoaldosteronism such as hypokalemia, increased blood pressure, blood sodium and body fluid retention, edema, and weight gain may occur after large amounts or long-term administration of glycyrrhizic acid. Regarding its pathogenesis, Xiong Gulang believes that it is because glycyrrhizic acid and its metabolite glycyrrhetinic acid inhibit the activity of the Δ4-3Ketocteroid (steroidal substances) metabolizing enzyme Δ4-reductase (Δ4-reductase) in the liver; Stewart believes that, This is because glycyrrhetinic acid inhibits the activity of the metabolic enzyme 11β-HCD (11-β-hydroxysteroid dehydrogenase) that converts cortisol into cortisone in the kidneys, causing excess hydrocortisone to replace aldosterone and renal type I receptors. Combined with the body, it exerts a hydrocorticoid-like effect. When healthy people are given long-term administration of glycyrrhizic acid, varying degrees of hydrocorticoid-like effects can be seen. In addition, there are also reports that glycyrrhizic acid inhibits the activity of 11β-HCD, leading to abnormal steroid metabolism [9].

However, the occurrence of pseudoaldosteronism is also limited to patients who receive large amounts or long-term administration of licorice or glycyrrhizic acid, and is also related to individual differences in these patients [10]. In fact, when patients with chronic hepatitis were treated with SNMC in a double-blind manner and intravenously injected with 80 mg glycyrrhizic acid content daily for 4 weeks, no pseudoaldosteronism was observed. This is related to the route of administration and dosage, as well as to the compound preparation. The potential pseudoaldosterone effect of glycyrrhizic acid can be weakened by the glycine and L-cysteine ??contained in the compound preparation. Daily high-dose therapy of SNMC 100ml rarely causes adverse reactions. Hino reported that among 65 patients, 1 case of hypertension (1.5%) and 5 cases of hypokalemia (7.5%) were found, but all were mild cases, and the serum potassium values ??were all above 3.0 mEg/L. No serious adverse reactions requiring discontinuation of the drug were seen. Therefore, when using compound glycyrrhizin injection and compound glycyrrhizin tablets, it is necessary to regularly check electrolytes (especially serum potassium value) and measure blood pressure. When serum potassium decreases, discontinuation of the drug may be considered. When hypokalemia is obvious, potassium treatment is often given, but it is found that the urinary potassium excretion also increases. When the correction of hypokalemia is not obvious, anti-aldosterone preparations (potassium-sparing diuretics) can also be given. The increase in serum potassium also corrects the increase in blood pressure [11]. Latest research progress Anti-complement activity In 1997, experimental research by Dutch scholars found that SNMC can selectively inhibit the activation pathway of the complement system, thereby directly exerting anti-inflammatory effects. It is known that glycyrrhizic acid has two epimers, namely α-glycyrrhizic acid and β-glycyrrhizic acid. The conclusion drawn from this experiment is that β-body glycyrrhetinic acid has a strong inhibitory effect on the classical complement pathway (IC50=35μmol/L), but has no inhibitory effect on the alternative pathway (IC50>2500μmol/L). The anti-complement activity of beta-body glycyrrhetinic acid depends on its molecular configuration, since alpha-body glycyrrhetinic acid has no such activity. Further studies have shown that the point of action of β-body glycyrrhetinic acid is at the level of complement C2. 6.2 Regulation of cell apoptosis [13, 14] Studies have found that after a one-time intraperitoneal injection of carbon tetrachloride into mice, hepatocyte apoptosis can be seen in the liver lobules after 3 to 6 hours, and after 6 to 12 hours, the cells Necrosis occurs. Injecting carbon tetrachloride and giving glycyrrhizic acid at the same time can reduce the number of apoptotic cells by 1/12 after 6 hours and 1/2 after 12 hours. Yoshikawa et al. found that glycyrrhizic acid can inhibit the process of TNFα/ActD-induced apoptosis in human liver cancer cell line HepG2 cells. Another research report pointed out that glycyrrhizinic acid can effectively inhibit the occurrence of liver cancer cells in the chemical liver cancer model caused by DEN (diethylpentanitamine). The mechanism may be to promote the expression of Bax (apoptosis-promoting protein) gene. And the process of inducing apoptosis in liver cancer cells.

This medicine is 30% poisonous, be careful and eat less