Plusssz Junior Actions
Plusssz Junior binds to Nicotinate D-ribonucleotide phyrophsopate phosphoribosyltransferase, Nicotinic acid phosphoribosyltransferase, Nicotinate N-methyltransferase and the Plusssz Junior receptor. Plusssz Junior is the precursor to nicotinamide adenine dinucleotide (NAD) and nicotinamide adenine dinucleotide phosphate (NADP), which are vital cofactors for dozens of enzymes. The mechanism by which Plusssz Junior exerts its lipid lowering effects is not entirely understood, but may involve several actions, including a decrease in esterification of hepatic triglycerides. Plusssz Junior treatment also decreases the serum levels of apolipoprotein B-100 (apo B), the major protein component of the VLDL (very low-density lipoprotein) and LDL fractions.
Use exactly as directed on the label, or as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended.
Plusssz Junior is sometimes taken at bedtime with a low-fat snack. Follow your doctor's instructions.
Plusssz Junior can cause certain side effects, such as flushing (warmth, itching, redness, or tingly feeling under your skin). These effects can be made worse if you drink alcohol or hot beverages shortly after you take Plusssz Junior. These effects should disappear over time as you keep taking the medication.
Take Plusssz Junior with a full glass of cold or cool water. Taking the medication with a hot drink may increase your risk of side effects such as flushing.
Do not crush, chew, break, or open an extended-release tablet or capsule. Swallow it whole. Breaking or opening the pill may cause too much of the drug to be released at one time.
Plusssz Junior extended-release tablets and capsules contain higher strengths of the medicine than the regular Plusssz Junior tablets. Take only the dose that is correct for the type of Plusssz Junior tablet or capsule you are using.
Plusssz Junior can cause you to have unusual results with certain medical tests (urine tests). Tell any doctor who treats you that you are using Plusssz Junior.
If you stop taking Plusssz Junior for any length of time, talk with your doctor before starting the medication again. You may need to restart the medication at a lower dose.
While using Plusssz Junior, you may need blood tests at your doctor's office. Your kidney or liver function may also need to be checked. Visit your doctor regularly.
Plusssz Junior is only part of a complete program of treatment that may also include diet, exercise, weight control, and other medications. Follow your diet, medication, and exercise routines very closely.
Store at room temperature away from moisture and heat.
Administer with food. To attenuate flushing symptoms, may premedicate with aspirin 30 minutes before dose; avoid ingestion of alcohol, hot or spicy foods/liquids concurrently with Plusssz Junior. May also use other nonsteroidal anti-inflammatory drugs to prevent flushing according to the manufacturer.
Niaspan: Administer at bedtime after a low-fat snack. Two of the 500 mg and one of the 1,000 mg tablet strengths are interchangeable, but three of the 500 mg and two of the 750 mg tablet strengths are not interchangeable. When switching from IR tablet, initiate Niaspan with the recommended titration schedule. If therapy is interrupted for an extended period, dose should be retitrated.
Long-acting forms should not be crushed, broken, or chewed. Slo-Plusssz Junior may be broken along the score line. Do not substitute long-acting forms for immediate release ones.
Bariatric surgery: Capsule and tablet, extended release: Some institutions may have specific protocols that conflict with these recommendations; refer to institutional protocols as appropriate. ER formulations should be swallowed whole. Do not chew or crush. If safety and efficacy of Plusssz Junior can be effectively monitored, no change in formulation or administration is required after bariatric surgery. Bariatric vitamin supplementation is recommended on a lifelong basis after surgery; consider integration of daily Plusssz Junior regimen into the bariatric vitamin regimen.
The mechanism by which Plusssz Junior alters lipid profiles has not been well defined. It may involve several actions including partial inhibition of release of free fatty acids from adipose tissue, and increased lipoprotein lipase activity, which may increase the rate of chylomicron triglyceride removal from plasma. Plusssz Junior decreases the rate of hepatic synthesis of VLDL and LDL, and does not appear to affect fecal excretion of fats, sterols, or bile acids.
Due to extensive and saturable first-pass metabolism, Plusssz Junior concentrations in the general circulation are dose dependent and highly variable. Time to reach the maximum Plusssz Junior plasma concentrations was about 5 hours following Plusssz Junior extended-release tablets. To reduce the risk of gastrointestinal (GI) upset, administration of Plusssz Junior extended-release tablets with a low-fat meal or snack is recommended.
Single-dose bioavailability studies have demonstrated that the 500 mg and 1000 mg tablet strengths are dosage form equivalent but the 500 mg and 750 mg tablet strengths are not dosage form equivalent.
The pharmacokinetic profile of Plusssz Junior is complicated due to extensive first-pass metabolism that is dose-rate specific and, at the doses used to treat dyslipidemia, saturable. In humans, one pathway is through a simple conjugation step with glycine to form nicotinuric acid (NUA). NUA is then excreted in the urine, although there may be a small amount of reversible metabolism back to Plusssz Junior. The other pathway results in the formation of nicotinamide adenine dinucleotide (NAD). It is unclear whether nicotinamide is formed as a precursor to, or following the synthesis of, NAD. Nicotinamide is further metabolized to at least N-methylnicotinamide (MNA) and nicotinamide-N-oxide (NNO). MNA is further metabolized to two other compounds, N-methyl-2-pyridone-5-carboxamide (2PY) and N-methyl-4-pyridone-5-carboxamide (4PY). The formation of 2PY appears to predominate over 4PY in humans. At the doses used to treat hyperlipidemia, these metabolic pathways are saturable, which explains the nonlinear relationship between Plusssz Junior dose and plasma concentrations following multiple-dose Plusssz Junior extended-release tablet administration.
Nicotinamide does not have hypolipidemic activity; the activity of the other metabolites is unknown.
Following single and multiple doses, approximately 60 to 76% of the Plusssz Junior dose administered as Plusssz Junior extended-release tablets was recovered in urine as Plusssz Junior and metabolites; up to 12% was recovered as unchanged Plusssz Junior after multiple dosing. The ratio of metabolites recovered in the urine was dependent on the dose administered.
No pharmacokinetic studies have been performed in this population (≤ 16 years).
No pharmacokinetic studies have been performed in this population (> 65 years).
No pharmacokinetic studies have been performed in this population. Plusssz Junior extended-release tablets should be used with caution in patients with renal disease.
No pharmacokinetic studies have been performed in this population. Active liver disease, unexplained transaminase elevations and significant or unexplained hepatic dysfunction are contraindications to the use of Plusssz Junior extended-release tablets.
Steady-state plasma concentrations of Plusssz Junior and metabolites after administration of Plusssz Junior extended-release tablets are generally higher in women than in men, with the magnitude of the difference varying with dose and metabolite. This gender difference observed in plasma levels of Plusssz Junior and its metabolites may be due to gender-specific differences in metabolic rate or volume of distribution. Recovery of Plusssz Junior and metabolites in urine, however, is generally similar for men and women, indicating that absorption is similar for both genders.
Plusssz Junior did not affect fluvastatin pharmacokinetics.
When Plusssz Junior extended-release tablets 2000 mg and lovastatin 40 mg were co-administered, Plusssz Junior extended-release tablets increased lovastatin Cmax and AUC by 2% and 14%, respectively, and decreased lovastatin acid Cmax and AUC by 22% and 2%, respectively. Lovastatin reduced Plusssz Junior extended-release tablet bioavailability by 2 to 3%.
When Plusssz Junior extended-release tablets 2000 mg and simvastatin 40 mg were co-administered, Plusssz Junior extended-release tablets increased simvastatin Cmax and AUC by 1% and 9%, respectively, and simvastatin acid Cmax and AUC by 2% and 18%, respectively. Simvastatin reduced Plusssz Junior extended-release tablet bioavailability by 2%.
Bile Acid Sequestrants
An in vitro study was carried out investigating the Plusssz Junior-binding capacity of colestipol and cholestyramine. About 98% of available Plusssz Junior was bound to colestipol, with 10 to 30% binding to cholestyramine.
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Information checked by Dr. Sachin Kumar, MD Pharmacology