Remino600 mg

Remino is a nutritional supplement indicated as an adjunct therapy in adult patients with chronic kidney disease (CKD), particularly stages 3b-5 (not yet on dialysis), who are following a physician- and dietitian-supervised low-protein diet.

• Established/guideline-supported use: Used together with a low-protein diet (typically 0.3-0.6 g protein/kg/day) to help supply essential amino acids and nitrogen-free keto/hydroxy analogues, reducing nitrogenous waste (urea) production while helping to maintain adequate nutritional status and slow progression of uraemic symptoms in non-dialysis CKD.
• Adjunct use: May also be used in some dialysis patients (haemodialysis/peritoneal dialysis) with protein-energy wasting, as an adjunct to dietary protein management, under specialist supervision.

Remino is not a substitute for a low-protein diet; it is intended to be used only in conjunction with one, under nephrology and dietitian supervision, and is not indicated for patients with normal renal function or those not following a reduced-protein diet.

Each tablet/formulation of Amino Acid Ketoanalogues typically contains calcium salts of the keto/hydroxy analogues of the branched-chain and aromatic essential amino acids (such as ketoanalogue of leucine, isoleucine, valine, phenylalanine, and hydroxy-analogue of methionine), together with essential amino acids (such as lysine acetate, threonine, tryptophan, histidine, and tyrosine). Exact composition and strength can vary by manufacturer/brand; refer to the specific product label for the precise quantitative composition.

Remino is a combination nutritional/medicinal supplement containing nitrogen-free keto and hydroxy analogues of certain essential amino acids together with selected essential amino acids. In the body, the keto/hydroxy analogues are transaminated using the patient's own circulating nitrogen (from urea and other nitrogenous waste products) to form the corresponding essential amino acids, without adding additional nitrogen load. This allows Remino, when combined with a low-protein diet, to help meet essential amino acid requirements in chronic kidney disease while minimizing the production of urea and other nitrogenous metabolic waste that accumulates in renal failure.

Remino belongs to the therapeutic class of nutritional supplements/medical foods used in the dietary management of chronic kidney disease, specifically the class of essential amino acid keto-analogue preparations.

Mechanism of Action

Amino Acid Ketoanalogues supplies keto/hydroxy analogues of branched-chain and aromatic essential amino acids that lack the amino (nitrogen-containing) group found in standard amino acids. Through the enzymatic process of transamination in the liver and other tissues, these keto/hydroxy analogues accept an amino group from surplus circulating nitrogen (largely derived from the breakdown of urea and other nitrogenous waste products that accumulate in renal impairment), converting them into the corresponding essential amino acids (leucine, isoleucine, valine, phenylalanine, methionine). This process effectively recycles nitrogen that would otherwise need to be excreted by the failing kidneys, helping to lower blood urea nitrogen and reduce the metabolic burden on the kidneys, while the accompanying essential amino acids (lysine, threonine, tryptophan, histidine, tyrosine) supplement any dietary shortfall from a low-protein diet. The net effect is that Amino Acid Ketoanalogues, combined with dietary protein restriction, helps maintain adequate essential amino acid nutrition and protein synthesis while limiting nitrogen/urea generation, which may help control uraemic symptoms and support nutritional status in chronic kidney disease.

Pharmacokinetics

The keto/hydroxy analogues in Amino Acid Ketoanalogues are absorbed from the gastrointestinal tract and undergo transamination primarily in the liver, kidney, and muscle tissue to yield the corresponding essential amino acids, which then enter normal amino acid metabolic pathways. Calcium salts present in some formulations are also absorbed and contribute to the patient's overall calcium intake.

Remino tablets should be taken orally with meals, swallowed whole, and the daily dose divided across meals. It must always be used in conjunction with a low-protein diet supervised by a physician and dietitian; see Dosage and Administration for details.

Because Remino contains calcium salts, concurrent use with other calcium-containing products, calcium-based phosphate binders, or vitamin D analogues may increase the risk of hypercalcemia; serum calcium should be monitored during long-term concurrent use. Remino should be taken with meals but may need to be separated in timing from medicines whose absorption is significantly affected by co-administration with amino acids or calcium (e.g., certain phosphate binders, tetracyclines, or bisphosphonates) - consult a physician or pharmacist about spacing of doses. No other major, well-established clinically significant drug interactions have been established; inform the treating physician of all other medicines and supplements being used.

Remino is generally well tolerated. The most commonly reported side effect is mild gastrointestinal upset, particularly nausea. Other gastrointestinal complaints such as loss of appetite or a feeling of fullness may occasionally occur. Hypercalcemia can occur, especially with long-term use or in patients receiving additional calcium/vitamin D supplementation (see Precautions and Warnings). Hypersensitivity reactions are rare.

Data on the use of Remino during pregnancy and lactation are limited. As with any supplement used in the specific context of chronic kidney disease with a low-protein diet, Remino should be used during pregnancy and breastfeeding only if clearly needed and if the potential benefit justifies the potential risk to the fetus or infant, and only under close physician and nephrology/obstetric supervision, since dietary and nutritional management of CKD in pregnancy requires specialist individualization. Consult a physician before use in pregnancy or lactation.

Remino must be used only as an adjunct to, and never as a substitute for, a properly supervised low-protein diet; it should be prescribed and monitored by a nephrologist and dietitian experienced in the dietary management of chronic kidney disease. It is not intended for patients with normal renal function or those who are not following a reduced-protein diet, since the therapeutic rationale specifically depends on the low-protein-diet context.

Because some formulations of Remino contain calcium salts, serum calcium levels should be monitored periodically during long-term use, particularly in patients also receiving vitamin D analogues or calcium-based phosphate binders, to avoid hypercalcemia (see Contraindications). Renal function, nutritional status, and dietary protein intake should be reviewed regularly by the treating physician while on therapy.

There is limited specific data on overdose with Remino. Excessive intake may increase the risk of hypercalcemia due to the calcium content of some formulations, with symptoms such as nausea, vomiting, constipation, confusion, or muscle weakness. If overdose is suspected, seek immediate medical attention or contact a poison control center; do not attempt specific home treatment. Management is supportive and should be guided by a physician.

Store at room temperature (below 30°C), away from light and moisture. Keep out of reach of children.

Renal Impairment

Remino is specifically indicated for use in patients with chronic kidney disease as an adjunct to a supervised low-protein diet; dosing should be individualized by the treating nephrologist based on the degree of renal impairment.

Hepatic Impairment

There is limited specific data on use of Remino in hepatic impairment; use with caution and under medical supervision, since transamination of the keto-analogues occurs partly in the liver.

Elderly

No specific dose adjustment has been established for elderly patients beyond the usual individualization based on renal function, body weight, and nutritional status; use under physician supervision.

Duration of treatment with Remino is individualized and typically continues for as long as the patient remains on a supervised low-protein diet for chronic kidney disease management, with periodic reassessment of renal function, nutritional status, and serum calcium by the treating physician.

Essential amino acid keto-analogue nutritional supplement used in chronic kidney disease dietary management.

Amino Acid Ketoanalogues supplies nitrogen-free keto/hydroxy analogues of essential amino acids which, through hepatic and tissue transamination, are converted into the corresponding essential amino acids using nitrogen recycled from the body's own urea and nitrogenous waste, rather than from additional dietary protein. Combined with essential amino acids and a low-protein diet, this reduces nitrogen/urea generation while helping meet essential amino acid requirements, supporting nutritional status in chronic kidney disease. See Pharmacology for full details.

Safety and efficacy of Remino in children have not been well established. Use in pediatric chronic kidney disease patients on a low-protein diet should only be undertaken under specialist pediatric nephrology supervision, with dosing individualized to body weight and nutritional needs.