Cyra D Uses

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What is Cyra D?

Cyra D is a medicine that increases the movements or contractions of the stomach and bowel. Cyra D is also used to treat nausea and vomiting caused by other drugs used to treat Parkinson's Disease.

Cyra D is to be given only by or under the immediate supervision of your doctor.

Cyra D indications

An indication is a term used for the list of condition or symptom or illness for which the medicine is prescribed or used by the patient. For example, acetaminophen or paracetamol is used for fever by the patient, or the doctor prescribes it for a headache or body pains. Now fever, headache and body pains are the indications of paracetamol. A patient should be aware of the indications of medications used for common conditions because they can be taken over the counter in the pharmacy meaning without prescription by the Physician.
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Dyspeptic symptom complex often associated with delayed gastric emptying, gastroesophageal reflux disease (GERD) or esophagitis: Epigastric sense of fullness, feeling of abdominal distention, upper abdominal pain, flatulence (gassiness), eructation (belching), and heartburn.

Short-term treatment of nausea and vomiting of various origins including functional, organic, infectious, diabetic origin, or induced by radiotherapy or medicine therapy. (It is not considered suitable for chronic nausea and vomiting, nor for the routine prophylaxis of postoperative vomiting.)

Treatment of nausea and vomiting induced by dopamine agonists ie, L-dopa and bromocriptine used in Parkinson's disease.

Cyra D may also be given as needed, together with paracetamol for the symptomatic treatment of nausea and vomiting associated with migraine.

Uses of Cyra D in details

There are specific as well as general uses of a drug or medicine. A medicine can be used to prevent a disease, treat a disease over a period or cure a disease. It can also be used to treat the particular symptom of the disease. The drug use depends on the form the patient takes it. It may be more useful in injection form or sometimes in tablet form. The drug can be used for a single troubling symptom or a life-threatening condition. While some medications can be stopped after few days, some drugs need to be continued for prolonged period to get the benefit from it.

Cyra D is used to treat vomiting or nausea caused due to indigestion, diseases or drugs. It is also used to relieve fullness of stomach, belching and heavy bloating, gas and heartburn for a longer period up to 2 weeks.

Cyra D description

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Cyra D is a synthetic anticoagulant and an indanedione derivative. It prevents the formation of active procoagulation factors II, VII, IX, and X, as well as the anticoagulant proteins C and S, in the liver by inhibiting the vitamin K mediated gamma-carboxylation of precursor proteins.

Cyra D dosage

Cyra D is injected submucosally in the urinary bladder in close proximity to the ureteral orifice. The injection of Cyra D creates increased tissue bulk thereby providing coaptation of the distal ureter during filling and contraction of the bladder. The dextranomer microspheres are gradually surrounded by host connective tissue.

Directions For Use

Cyra D is to be administered only by qualified surgeons experienced in the use of a cystoscope and trained in the technique of subureteric and/or intraureteric injections injections (with Cyra D or other materials).

It is recommended to use the Cyra D metal needle (3.7F x 23G tip x 350 mm) for safe and accurate administration of Cyra D. To assist the physician in positioning the needle, the Cyra D metal needle has a circular mark 6 mm from the needle tip. To show the position of the needle bevel, there is a square mark 8 mm from the needle tip. The marks are for reference only.

Cyra D can be injected with any common pediatric cystoscope with a minimum 4 French working channel. A type of cystoscope witha straight working channel is also well adapted for this type of procedure. The child is placed in a lithotomy position under general anesthesia and cystoscopy is performed to localize the ureteral orifices.

Before injecting Cyra D the following is recommended:

  • Flush physiological saline solution through the needle.
  • Fasten the needle tightly to the syringe.
  • Remove the air from the needle by injecting the gel into the needle up to a point where a droplet is visible at the tip.

Please note that the luer lock adapter is snapped onto the syringe and held in place with friction only. It can rotate freely or be pulled off should enough force be applied. Because of this, it is recommended that the thumb and forefinger are held firmly around both the glass syringe barrel and the luer lock adapter when assembling the needle and syringe. To facilitate proper threading/fastening of needle hub and luer lock adapter, please both push and rotate them firmly together.

To avoid any interruption in patient treatment or the need to repeat a procedure because of leakage or breakage of a syringe, it is recommended that extra syringes be kept in inventory.

Cyra D is easily injected by finger pressure on a normal syringe with any commonly used pediatric cystoscope. Due to its viscoelastic properties, Cyra D can be injected through a fine needle – no special injection device is necessary.

Injection Techniques

Several techniques have been described for the endoscopic treatment of VUR including a subureteric injection (STING procedure), a single intra-ureteric injection (HIT procedure) and a double (proximal and distal) intra-ureteric injection (Double-HIT procedure). The Double-HIT procedure is a refinement of the original STING and HIT procedures and has been reported to result in greater clinical success rates.

In general, the bladder is semi-filled to allow for good visualization of the ureteral orifice(s) and to avoid tension within the submucosal layer of the ureter secondary to overdistension. For the HIT procedure, hydrodistention of the ureteral orifice is initiated to define the site of injection within the submucosa of the intramural ureter. The needle is inserted approximately 4 mm in the submucosa of the mid- to distal ureteral tunnel at the 6 o

Cyra D interactions

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Concomitant administration of anticholinergic drugs may antagonise the antidyspeptic effect of Cyra D.

Antacids and antisecretory drugs should not be given simultaneously with oral formulations of Cyra D as they lower its oral bioavailability.

The main metabolic pathway of Cyra D is through CYP3A4. In vitro and human data show that the concomitant use of drugs that significantly inhibit this enzyme may result in increased plasma levels of Cyra D. Examples of potent CYP3A4 inhibitors include: Azole antifungals eg, fluconazole*, itraconazole, ketoconazole* and voriconazole*; macrolide antibiotics eg, clarithromycin* and erythromycin*; HIV protease inhibitors eg, amprenavir, atazanavir, fosamprenavir, indinavir, nelfinavir, ritonavir and saquinavir; calcium antagonists eg, diltiazem and verapamil; amiodarone*; aprepitant; nefazodone; telithromycin*.

(*Also prolong the QTc interval; see Contraindications.)

Separate pharmacokinetic/pharmacodynamic interaction studies with oral ketoconazole or oral erythromycin in healthy subjects confirmed a marked inhibition of Cyra D's CYP3A4 mediated first-pass metabolism by these drugs.

With the combination of Cyra D 10 mg 4 times daily and ketoconazole 200 mg twice daily, a mean QTc prolongation of 9.8 msec was seen over the observation period, with changes at individual time points ranging from 1.2-17.5 msec. With the combination of Cyra D 10 mg 4 times daily and erythromycin 500 mg 3 times daily, mean QTc over the observation period was prolonged by 9.9 msec, with changes at individual time points ranging from 1.6-14.3 msec. Both the Cmax and AUC of Cyra D at steady-state were increased approximately 3-fold in each of these interaction studies.

The contribution of increased plasma concentrations of Cyra D to the observed effect on QTc is not known.

In these studies, Cyra D monotherapy at 10 mg 4 times daily resulted in increases in mean QTc of 1.6 msec (ketoconazole study) and 2.5 msec (erythromycin study), while ketoconazole monotherapy (200 mg twice daily) and erythromycin monotherapy (500 mg 3 times daily) led to increases in mean QTc of 3.8 and 4.9 msec, respectively, over the observation period.

In another multiple-dose study in healthy subjects, no significant increases in QTc were noted during steady-state treatment with Cyra D monotherapy at 40 mg 4 times daily (total daily dose of 160 mg, which is double the maximum daily dose) at plasma concentrations of Cyra D that were at least similar to those found in the combination arms of the interaction studies.

Theoretically, since Cyra D has gastrokinetic effects, it could influence the absorption of concomitantly orally administered drugs, particularly those with sustained release or enteric-coated formulations. However, in patients already stabilised on digoxin or paracetamol, concomitant administration of Cyra D did not influence the blood levels of these drugs.

Cyra D may also be given with neuroleptics, the action of which it does not potentiate; dopaminergic agonists (bromocriptine, L-dopa), whose unwanted peripheral effects eg, digestive disorders, nausea and vomiting, it suppresses without counteracting their central properties.

Cyra D side effects

See also:
What are the possible side effects of Cyra D?

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Adverse Events

The safety of Cyra D in the treatment of VUR is based on a pivotal randomized study in which 39 children were treated with Cyra D, two nonrandomized supportive studies in which 170 children were treated with Cyra D, and a nonrandomized post-approval study in which 165 children were treated with Cyra D. Follow-up for the pivotal and supportive studies was 12 months; follow-up for the post-approval study was 5 years (5-year data available for 31 of the 165 enrolled subjects (18.8%) ). No patients died during the course of these studies.

A list of the treatment -related adverse events occurring in > 1% of patients in all four studies is presented in Table 1.

Table 1: List of Treatment-Related Adverse Events Occurring in > 1% of Patients in the Pivitol, Supportive and Post-Approval Studies

Adverse Event Category pivotal Study

(n=39 Cyra D patients)

Supportive Studies

(n=170 Cyra D patients)

post-Approval Study

(n=165 Cyra D patients)

Urinary tract infection (UTI)(i) 6 (I5.4%)(ii, iii) 13 (7.6%)(ii, iii) 3 (1.8%)
Ureteral dilatation(iv) 1 (2.6%) 6 (3.5%) 0 (0%)
Nausea/Vomiting/Abdominal pain(v) 0 (0%) 2 (1.2%) 0 (0%)
Abdominal discomfort 0 (0%) 0 (0%) 2 (1.2%)
Dysuria 0 (0%) 0 (0%) 2 (1.2%)
Micturition urgency 0 (0%) 0 (0%) 2 (1.2%)
Pollakiuria 0 (0%) 0 (0%) 2 (1.2%)
Urinary incontinence 0 (0%) 0 (0%) 2 (1.2%)
Vesicoureteric reflux 0 (0%) 0 (0%) 2 (1.2%)
(i) Cases of UTI typically occurred in patients with persistent reflux.

(ii) Patients in the nonrandomized studies received antibiotic prophylaxis until the 3-month voiding cystourethrogram (VCUG). After that only those patients whose treatment had failed received further antibiotic prophylaxis. The patients in the randomized study received antibiotic prophylaxis 1 month post-treatment.

(iii) All UTI cases were successfully treated with antibiotics.

(iv) No case of ureteral dilatation required intervention and most cases resolved spontaneously.

(v) Both cases of nausea/vomiting/abdominal pain were resolved.

The following adverse events were associated with the use of Cyra D from spontaneous post-marketing surveillance reporting or from clinical studies (occurring ≤ 1%) and include but are not limited to: ureteral obstruction with or without hydronephrosis (some cases requiring temporary placement of a ureteric stent, and rare cases of ureteral re-implant procedures), hematuria, urgency, frequency, pyelonephritis, foreign body reaction, calcification, pyrexia, hypertonic bladder, bladder irritation, and Henoch-Schonlein purpura.

Adverse events should be reported to:

Salix Product Information Call Center, Phone: 1-800-508-0024, Fax: 1-510-595-8183, E-mail: Salix@medcomsol.com

Cyra D contraindications

Hypersensitivity to Cyra D or any ingredient of Cyra D.

If patients are taking oral ketoconazole, fluconazole, voriconazole, erythromycin, clarithromycin, telithromycin, amiodarone, selective serotonin reuptake inhibitors, HIV protease inhibitors, calcium antagonists which can increase plasma concentrations of Cyra D, leading to a prolonged QTc interval. These medicines can increase plasma concentrations of Cyra D leading to a prolonged QTc interval. Patients with long QT syndrome develop a very fast heart rhythm disturbance leading to a sudden loss of consciousness.

Gastrointestinal hemorrhage (bleeding), obstruction, perforation or conditions where gastrointestinal stimulation or movements may be dangerous.

Prolactin-releasing pituitary tumor (prolactinoma).

Active ingredient matches for Cyra D:

Domperidone

Rabeprazole


Unit description / dosage (Manufacturer)Price, USD
Cyra D 20+30 Capsule$ 0.06
CYRA D 30 MG/20 MG CAPSULE SR 1 strip / 10 capsule srs each (Systopic Laboratories Pvt Ltd)$ 0.63

List of Cyra D substitutes (brand and generic names):

CYRA IT 20 MG/150 MG TABLET SR 1 strip / 10 tablet srs each (Systopic Laboratories (P) Ltd.)$ 1.86
D Febrol 20+500 Tablet (Vostok & Wilcure Remedies)$ 0.03
D Rab 20 mg Tablet (D.M. Care Biotech (P) Ltd.)$ 0.06
D RAB CAPSULE 1 strip / 15 capsules each (D.M. Care Biotech (P) Ltd.)$ 1.45
D.M.P. 10 mg x 1000's
D.M.P. 10 mg x Blister pk
DALIA 25MG CAPSULE 1 strip / 10 capsules each (Zydus Cadila)$ 1.75
Dany 10 mg x 1, 000's (Athens)
Dany 5 mg/5 mL x 30 mL (Athens)
DANY cream 2 % x 15g (Athens)
Dany NA Cream (Athens)$ 1.90
DARRI syr 1 mg x 30ml (Aden Healthcare)$ 0.56
Datzol D 20+10 Capsule (Datla Laboratories)$ 0.07
Daweison 10 mg
Daweison 10 mg x Blister pk
Dazole D 40+10 Tablet (Daksh Pharma)$ 0.09
Deczole D 40+10 Tablet (Events Pharmaceuticals Pvt Ltd)$ 0.11
Defire 20+10 Tablet (Robin Pharmaceuticals)$ 0.10
Deflux NA Injection (Lafit)$ 626.98
Degurge DSR 20+30 Capsule (Tablets (India) Limited)$ 0.07
Degurge DSR 30mg/20mg Capsule (Tablets (India) Limited)$ 0.07
Demoreb 20 mg Tablet (Events Pharmaceuticals Pvt Ltd)$ 0.08
Demoreb D 20+10 Tablet (Events Pharmaceuticals Pvt Ltd)$ 0.09
DENOSIA SUSPENSION 1 bottle / 30 ML suspension each (Kontest Chemicals Ltd)$ 0.43
20 mg x 10's (Tablets (India) Limited)$ 0.46
Depump 20mg TAB / 10 (Tablets (India) Limited)$ 0.46
Depump 20 mg Tablet (Tablets (India) Limited)$ 0.05
DEPUMP 20MG TABLET 1 strip / 10 tablets each (Tablets (India) Limited)$ 0.47
DEPUMP tab 20 mg x 10's (Tablets (India) Limited)$ 0.46
Depump 20mg TAB / 10 (Tablets (India) Limited)$ 0.46
Depump 20mg Tablet (Tablets (India) Limited)$ 0.05
Dercon 10 mg
DEREK 10 MG TABLET 1 strip / 10 tablets each (Albert David Ltd)$ 0.45
DEREK 20 MG TABLET 1 strip / 10 tablets each (Albert David Ltd)$ 0.87
Derek 10mg Tablet (Albert David Ltd)$ 0.05

References

  1. PubChem. "rabeprazole". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
  2. PubChem. "domperidone". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
  3. DrugBank. "domperidone". http://www.drugbank.ca/drugs/DB01184 (accessed September 17, 2018).

Reviews

The results of a survey conducted on ndrugs.com for Cyra D are given in detail below. The results of the survey conducted are based on the impressions and views of the website users and consumers taking Cyra D. We implore you to kindly base your medical condition or therapeutic choices on the result or test conducted by a physician or licensed medical practitioners.

User reports

Consumer reported useful

No survey data has been collected yet


Consumer reported price estimates

No survey data has been collected yet


1 consumer reported time for results

To what extent do I have to use Cyra D before I begin to see changes in my health conditions?
As part of the reports released by ndrugs.com website users, it takes 1 month and a few days before you notice an improvement in your health conditions.
Please note, it doesn't mean you will start to notice such health improvement in the same time frame as other users. There are many factors to consider, and we implore you to visit your doctor to know how long before you can see improvements in your health while taking Cyra D. To get the time effectiveness of using Cyra D drug by other patients, please click here.
Users%
1 month1
100.0%


2 consumers reported age

Users%
< 11
50.0%
6-151
50.0%


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Information checked by Dr. Sachin Kumar, MD Pharmacology

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