Rowatinex: Drug Composition, Uses, Mechanism of Action, Administration, Side Effects and Studies

Urinary stones are a common disease and account for approximately 12% of patient visits in outpatient urology departments.

The terpene combination (Rowatinex) is known to help with the expulsion of urinary stones .

Treatment modalities for urinary stones include shock wave lithotripsy (SWL), laparoscopic removal, and percutaneous surgery, all of which are less invasive than open surgery.

Shock wave lithotripsy is noninvasive and does not require general anesthesia or hospital admission.

Shock wave lithotripsy is widely used as the primary treatment for urinary stones because its clinical outcome is good and it can be performed in an outpatient setting.

Rowatinex history

The terpene combination (Rowatinex) was developed in the 1950s and is known to reduce pain induced by ureteral stones and increase the spontaneous passage of urinary stones when used in a supporting role.

Bak et al. reported that Rowatinex can reduce the frequency of urinary stone pain and significantly increase early spontaneous passage of urinary stones.

Rowatinex ingredients

Rowatinex contains glycerin (glycerol) which is harmful in high doses. It can cause headache, stomach upset, and diarrhea. This medicine may cause allergic reactions (possibly delayed) as it contains ethyl hydroxyethylzoate (E215) and sodium propyl hydroxybenzoate (E217).

Rowatinex contains essential oils that help dissolve or break down and remove (break down and eliminate) kidney and urinary stones.

Rowatinex relieves muscle spasm, thus reducing pain from kidney and urinary colic. Rowatinex is also used to alleviate the effects associated with mild urinary tract infections.

Rowatinex is a terpenic-type essential oil consisting of pinene (3%), camphene (15%), borneol (10%), anethole (4%) and cineole (3%).

Pinene – Pinene (C10H16) is a bicyclic monoterpene chemical compound. There are two structural isomers of pinene found in nature: α-pinene and β-pinene.

As the name suggests, both forms are important components of pine resin; They are also found in the resins of many other conifers, as well as non-coniferous plants such as camphor (Heterotheca) and large mugwort (Artemisia tridentata).

Both isomers are used by many insects in their chemical communication system. The two isomers of pinene constitute the main component of turpentine.

Camphene : It is a bicyclic monoterpene. It is almost insoluble in water, but very soluble in common organic solvents. It volatilizes easily at room temperature and has a pungent odor.

It is a minor component of many essential oils such as turpentine, cypress oil, camphor oil, citronella oil, neroli, ginger oil, and valerian. It is produced industrially by catalytic isomerization of the most common alpha-pinene.

Camphene is used in the preparation of fragrances and as a food additive for flavoring. Its use in the mid-19th century as fuel for lamps was limited by its explosiveness.

Borneol : it is a bicyclic organic compound and a derivative of terpene. The hydroxyl group in this compound is placed in an endo position. There are two different enantiomers of borneol. Both d – (+) borneol and l – (-) – borneol are found in nature.

Anethole : Anethole (also known as camphor anise [citation needed]) is an organic compound that is widely used as a flavoring substance. It is a derivative of phenylpropene, a type of aromatic compound that is widely found in nature, in essential oils.

It provides a large component of the smell and taste of anise and fennel (both in the botanical family Apiaceae), anise myrtle (Myrtaceae), licorice (Fabaceae), camphor, magnolia flowers and star anise (Illiciaceae).

Closely related to anethole is its estragole isomer, abundant in tarragon (Asteraceae) and basil (Lamiaceae), which has a flavor reminiscent of anise. It is a colorless, fragrant, slightly volatile liquid.

Anethole is only slightly soluble in water but exhibits high solubility in ethanol. This trait causes certain anise-flavored liqueurs to become opaque when diluted with water, the ouzo effect.

Cineol : It is also known by a variety of synonyms: 1,8-cineole, 1,8-cineole, cajeputol, 1,8-epoxy-p-menthane, 1,8-oxide-p-menthane, eucalyptol, eucalyptol, 1 , 3,3-trimethyl-2-oxabicyclo [2.2.2] octane, cineole, cineole

Eucalyptol is a natural organic compound that is a colorless liquid. It is a cyclic ether and a monoterpenoid.

In 1870, FS Cloez identified and attributed the name eucalyptol to the dominant oil portion of Eucalyptus globulus.

Each capsule contains : pinene [α + β] 31.0 mg. Caffeine 15.0 mg. Cineol 3.0 mg. Fenchone 4.0 mg. Borneol 10.0 mg. Anethol 4.0 mg. The other ingredients are olive oil (33 mg per capsule).

The capsule shell contains : gelatin, glycerin, sodium ethylhydroxybenzoate E215, sodium, propylhydroxybenzoate E127, FD + C sunset yellow, Yellow No. 6 EEC No. 110 85%, Quinoline Yellow, EEC No. 104 70%.

Rowatinex uses

Effective kidney stone treatment is like the holy grail for stone formers or people suffering from kidney stones. Kidney stone is one of the most common reasons for visiting the hospital emergency room.

Passing a kidney stone can give you an extreme feeling of pain, said to be ten times more painful than natural childbirth.

There are medical procedures that can help remove a kidney stone from a patient, procedures such as extracorporeal shock wave lithotripsy (ESWL) are not evasive and can surely help the patient to get rid of the stone.

However, these procedures are expensive and will not guarantee that you will not have another stone attack.

People who have experienced the pain of passing a stone will absolutely fear another painful experience, but unfortunately, there will be a greater chance of forming another stone after you have had the first one.

There is an absolute cure for kidney stone, there is no procedure that will make a stone former break free from another stone attack.

But the least a person can do is make a lifestyle change and decrease the frequency of stone attacks and deal with these painful crystals while they are very small and can dissolve.

Rowatinex is a diuresis that relaxes the urinary tract and helps to pass and dissolve stones.

If you have been diagnosed with stones and the stone is less than 5mm, your urologist may recommend that you simply go home to drink fluids, take pain relievers, and wait for the stone to pass, which will be lucky if it passes in the next few hours. The stones will not pass for a few weeks.

This drug does not have any side effects and all its components are safe, it is even safe for pregnant and lactating mothers. So if you suffer from kidney stones, suggest that you consult your urologist about Rowatinex

Treatment modalities for ureteral stones are determined by the size, number, and location of urinary stones in the urinary tract.

Due to recent technological advances in surgical instruments, the treatment of ureteral stones has diversified.

Shock wave lithotripsy, open surgery, and ureteroscopic stone removal are being widely performed. Medical expulsion therapy can be applied when the size of the stones is small.

After Chaussy et al. Shock wave lithotripsy was introduced in 1980 for the treatment of urinary stones. Shock wave lithotripsy has become the main treatment modality for urinary stones.

Shock wave lithotripsy is a non-invasive treatment for urinary stones. However, stone expulsion does not occur immediately after shock wave lithotripsy; rather, the waste is released slowly over about 1 month.

Remaining stones can cause obstruction, recurrent infection, or stone regrowth.

Medical treatment has been shown to be effective in inhibiting stone growth and urinary stone recurrence. Previous studies have reported that Rowatinex can help with the removal of remaining stones after shock wave lithotripsy.

Rowatinex does not have a significant effect on the rate of kidney stone clearance after extracorporeal shock wave lithotripsy.

However, Rowatinex achieves stone clearance in a greater number of patients and exhibits a significantly faster clearance rate, meaning that Rowatinex can accelerate stone passage after extracorporeal shock wave lithotripsy.

Rowatinex Mechanism of Action

Rowatinex is used to treat ureteral stones, kidney stones, kidney colic, and other urological conditions.

The exact mechanism of action of Rowatinex is not yet fully understood. In preclinical experiments, Rowatinex was confirmed to have antilitogenic, antibacterial, anti-inflammatory, spasmolytic, and analgesic properties.

The antilitogenic property, which influences the lithogenesis of renal oxalate, is important because most urinary stones are composed of calcium oxalate aggregates.

Inhibition of remnant stone formation after shock wave lithotripsy could increase the long-term success rate of shock wave lithotripsy.

Additionally, Rowatinex has shown antibacterial effects against a variety of pathogens. Rowatinex has anti-inflammatory and analgesic properties derived from cineole and anethole, which are important for patients who have urolithiasis with spasms, inflammation, pain, and infection.

According to Horvath, Rowatinex and its individual terpenes, such as camphene, cineole, and borneol, have antispasmodic effects in smooth muscle preparations in animal models.

Studies with the Rowatinex

Patients with extracorporeal shock wave lithotripsy

In a four-week study after extracorporeal shock wave lithotripsy (13.3%) of patients in the Rowatinex group had full stone clearance.

After eight weeks, the percentage increased to (53.3%) for the Rowatinex group. After twelve weeks (93.3%) of the patients in the Rowatinex group showed a complete elimination of stones.

The high stone-free rate reported from the fourth and twelfth weeks was significant (p <0.05).

Kidney stone expulsion

Djaladat et al, reported that Rowatinex increases urine excretion by increasing renal blood flow and has antispasmodic effects that can help with the expulsion of kidney stones.

Engelstein et al, in their prospective, randomized, double-blind study, showed that the expulsion rate of ureteral stones in the Rowatinex group was higher than in the placebo group in 87 patients in the emergency room (81% compared with 59%).

However, the number of subjects in that study was small and the authors did not consider stone size and duration of treatment.

In a randomized trial by Romics et al, the urinary stone expulsion rate was higher and the duration of treatment was shorter in the Rowatiex group than in the placebo group; no significant differences were found in age, sex, or stone size between the two groups.

The urinary stone expulsion rate 2 weeks after initial shock wave lithotripsy was not significantly different between the two groups (37.4% compared to 35.5%, p = 0.684).

However, 4 weeks after the initial shock wave lithotripsy, the cumulative expulsion rate of ureteral stones in group 1 was higher than in group 2 (72.2% compared to 61.1%, p = 0.022).

This result indicates that Rowatiex was not effective in passing stones in the short term, but was effective over a 4 week treatment period.

This finding can be explained by the properties of Rowatinex, which increases urine excretion and has an antispasmodic effect.

The number of shock wave lithotripsy sessions and the duration of treatment were not significantly different between the groups. The complication rate after shock wave lithotripsy was not significantly different between the two groups.

Fifteen patients (10.2%) in group 1 and 40 patients (11.4%) in group 2 underwent ureteroscopic stone removal due to constant cramping pain or a small effect of shock wave lithotripsy (p = 0.756).

Acute pyelonephritis, which may have been induced by shock wave lithotripsy, occurred in one patient (0.7%) in group 1 and in one patient (0.3%) in group 2 (P = 0.503). No other adverse effects, such as diarrhea, nausea and vomiting, were observed.

That study is significant because it was a pilot study of the effects of Rowatinex on the expulsion of a remnant of urinary stones after shock wave lithotripsy in Korea. This study had several limitations.

First, shock wave lithotripsy was not performed by a single operator and the observation period was only 4 weeks.

Second, stone components expelled by patients with ureteral stones could not be routinely analyzed because they were difficult to retrieve from patients.

Therefore, the relationship between the stone component and the Rowatinex effect could not be determined. Third, pain was not assessed; therefore, it could not be determined whether Rowatinex reduced colic pain.

Fourth, the pain reliever and Tamsulosin prescribed with Rowatinex may have influenced the effects of Rowatinex. Finally, the results of this study are based on a retrospective review.

Therefore, confounding and measurement bias could not be reduced as much as they could have been in a prospective or randomized study. Additional studies from multiple centers are guaranteed.

A prospective, randomized, double-blind study was conducted in 87 patients with ureterolithiasis, evaluating the effect of the essential oil preparation of Rowatinex for the treatment of ureterolithiasis.

Patients with ureteral stones

Forty-three patients were treated with Rowatinex and 44 patients with placebo.

Despite the larger mean stone diameter in the Rowatinex group of patients, the overall stone expulsion rate was significantly higher in the Rowatinex group compared to placebo: 81% and 59%, respectively (0.025> p> 0.01).

This higher stone expulsion rate is observed in patients with disappearance of pretreatment ureteral dilation (when patients with expelled stones are excluded) (0.05> p> 0.001).

Seven patients in the Rowatinex group had mild to moderate gastrointestinal disturbances; but no other significant side effects were observed during treatment in either group.

It was concluded in that study that early treatment with Rowatinex for patients with ureteral stones is indicated before considering other more aggressive measures.

What you need to know before taking Rowatinex

Keep this leaflet. This medicine has been prescribed for you. Don’t pass it on to others. It can harm them, even if their symptoms are the same as yours.

Do not store above 25 ° C. Keep the bottle tightly closed. The expiration date refers to the last day of that month. Do not dispose of medicines through sewage or household waste.

Do not take Rowatinex if:

If you are allergic to α-pinene, β-pinene, camphene, borneol, anethole, fenchone, cineole. or any of the other ingredients in this medicine.

Talk to your doctor first before taking Rowatinex. Do not take Rowatinex for the treatment of urinary stones unless your doctor has confirmed a diagnosis of urinary stones, especially in the case of children.

Rowatinex is not suitable for patients with severe pain (colic), decreased urine output, or severe urinary tract infection. Children and adolescents under 18 years of age should not take Rowatinex.

Talk to your doctor or pharmacist before taking Rowatinex if you are taking medications to thin the blood or medications that are broken down by the liver.

Other medications include:

Medicines to thin the blood (oral anticoagulants, for example warfarin). Medicines that are broken down in the liver (consult your doctor for more information).

Driving and using machines

Rowatinex is unlikely to have an effect on driving or the ability to use machines.

How to take the Rowatinex?

Rowatinex should be taken on an empty stomach half an hour before meals. Rowatinex should only be taken by swallowing the capsule whole. Do not bite or chew the capsules.

The recommended dose for adults is : take one capsule 3-4 times a day, half an hour before meals. 3 to 5 oral drops 4 to 5 times a day before meals or in the presence of colic 20 to 30 oral drops 4 to 5 times a day.

The recommended dose for children and adolescents : there are no data available for children 0 to 6 years. Children 6 to 14 years, are 1 to 2 oral drops twice a day before meals.

Adolescents from 14 to 18 years old, it is 3 to 5 oral drops 4 to 5 times a day before meals or in the presence of colic 20 to 30 oral drops 4 to 5 times a day.

If you take more Rowatinex than you should

If you have taken more drops than you should, talk to your doctor or pharmacist. Taking too much Rowatinex can cause:

Upset stomach (gastric irritation). If you have taken more capsules than you should, consult your doctor or pharmacist immediately.

Just take it as soon as you remember. Then continue taking your next dose at the usual time.

Rowatinex side effects

A small number of patients have noticed side effects such as mild and temporary stomach upset (gastric disturbances).

Rowatinex was effective in increasing the expulsion rate of ureteral stones 4 weeks after the initial shock wave lithotripsy.

Rowatinex can increase the long-term success rate of shock wave lithotripsy, especially when used for more than 4 weeks without significant adverse effects.