Ketobest tablet contains the following compounds: 67 mg of DL-α-keto isoleucine calcium, 101 mg of α-keto leucine calcium, 68 mg of α-keto phenylalanine calcium, 86 mg of α-keto valine calcium, 59 mg of DL-α-hydroxy methionine calcium, 105 mg of L-lysine acetate, 53 mg of L-threonine, 23 mg of L-tryptophan, 38 mg of L-histidine, 30 mg of L-tyrosine, a total of 36 mg of nitrogen, and a total of 50 mg of calcium (equivalent to 125 mmol).
Mechanism
Pharmacological Effects: Ketobest facilitates the absorption of essential amino acids while minimizing the intake of amino-nitrogen. Upon consumption, the keto analogues undergo transamination by extracting nitrogen from non-essential amino acids, leading to reduced formation of urea by reusing the amino group.
This process lowers the accumulation of uremic toxins. Keto and/or hydroxy-acids do not cause excessive filtration by residual nephrons.
Supplements containing ketoacids have a positive impact on renal hyperphosphatemia and secondary hyperparathyroidism, potentially improving renal osteodystrophy. When used alongside a very low protein diet, Ketobest enables a decrease in nitrogen intake while preventing negative outcomes associated with insufficient dietary protein and malnutrition.
Absorption and Distribution: In individuals with normal conditions, the plasma level of keto analogues increases 10 minutes post oral intake. These levels peak at approximately 5 times the initial concentration within 20-60 minutes and return to normal after 90 minutes. The absorption in the gastrointestinal tract is swift.
The simultaneous rise in keto analogue and corresponding amino acid levels in the plasma indicates rapid transamination of keto analogues. Given their integration into metabolic cycles through the body’s natural pathways for disposing of α-ketonic acids, exogenous intakes are swiftly incorporated. Ketoacids follow the same breakdown pathways as conventional amino acids.
Safety Considerations:
Toxicology investigations demonstrate the low toxicity of Ketobest. Chronic toxicity studies identified the minimum toxic dose (MIT) as 1200 mg/day for dogs and 2700 mg/day for rats, respectively.
Upon conversion to human equivalent doses (70 kg), the MIT stands at 84 g/day (based on dog data) and 189 g/day (based on rat data). Ketobest was observed to have no adverse effects on fetal development.
Indications/Usage:
Ketobest is used for preventing and treating damage caused by faulty or deficient protein metabolism in cases of chronic renal insufficiency, particularly in patients with a glomerular filtration rate (GFR) below 25 mL/min, along with restricted protein intake of 40 g/day or less for adults.
Dosage/Usage Instructions:
For adults weighing 70 kg: Take 4-8 tablets three times a day during meals, unless directed otherwise. Swallow the tablets whole. Ketobest is administered as long as the GFR remains below 25 mL/min and the prescribed diet limits protein intake to a maximum of 40 g/day for adults.
Overdosage:
No symptoms of overdose have been reported to date.
Contraindications:
Ketobest should not be used in cases of hypercalcemia or disturbed amino acid metabolism. Individuals with hereditary phenylketonuria should be cautious as Ketobest contains phenylalanine.
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Warnings:
Patients with phenylketonuria should use Ketobest with caution due to its phenylalanine content.
Special Precautions:
To ensure proper absorption and metabolism of amino acids, Ketobest should be taken during meals. Regular monitoring of serum calcium levels is advised. Adequate calorie intake should be maintained.
Use in Pregnancy & Lactation:
There is no available experience regarding the use of Ketobest during pregnancy and lactation.
Side Effects:
Hypercalcemia (elevated calcium levels) may occur. If this happens, it’s recommended to reduce vitamin D intake. If hypercalcemia persists, both the dosage of Ketobest and other sources of calcium should be reduced.
Drug Interactions:
Simultaneous use of medications containing calcium (e.g., acetolyte) may lead to abnormal increases in serum calcium levels.
As uremic symptoms improve with Ketobest, consider reducing the administration of aluminium hydroxide. Serum phosphate levels should also be monitored and managed. T
o avoid interference with absorption, do not take medications that form sparingly soluble compounds with calcium (e.g., tetracyclines, quinolones like ciprofloxacin and norfloxacin, drugs containing iron, fluoride, and estramustine) together with Ketobest.
Storage:
Keep Ketobest stored at temperatures not exceeding 25°C.
Ketobest interactions
Certainly, here is a summary of the drug interactions associated with Ketobest based on the information you provided:
- Calcium-Containing Medications: Simultaneous use of medications containing calcium (e.g., acetolyte) can potentially cause abnormal increases in serum calcium levels or intensify hypercalcemia.
- Aluminum Hydroxide: As uremic symptoms improve with Ketobest, it’s advised to reduce the administration of aluminium hydroxide.
- Serum Phosphate: Monitor and be cautious about reducing serum phosphate levels.
- Interference with Absorption: Avoid taking medications together with Ketobest that form sparingly soluble compounds with calcium. This includes medications like tetracyclines, quinolones (e.g., ciprofloxacin and norfloxacin), iron-containing drugs, fluoride-containing drugs, and estramustine-containing drugs. To prevent interference with absorption, allow a minimum of 2 hours between the intake of Ketobest and drugs from these categories.
- Heart/Cardiac-Active Glycosides: Increased blood calcium concentration can lead to heightened susceptibility to heart/cardiac-active glycosides, thereby increasing the risk of arrhythmia.
Conclusion
Ketobest is a medication primarily used for the prevention and treatment of damage caused by faulty or deficient protein metabolism in individuals with chronic renal insufficiency, particularly those with a glomerular filtration rate (GFR) below 25 mL/min.
The medication is intended to be used in conjunction with a restricted protein intake of 40 g/day or less for adults. It contains a combination of amino acids and compounds like keto analogues that aid in minimizing the intake of amino-nitrogen and facilitating essential amino acid absorption.
