Medicines and You

= Chemical Compound
= Indications
= Dosage
= Contraindication
= Special Precautions
= Adverse Reactions
= Drug-Drug Interaction

Alimentary System

Antacids

  • AI (OH)3 gel 250mg, Mg trisilicate 500mg
  • Hyperacidity & peptic ulcer
  • Severe renal insufficiency; prolonged therapy
  • Rarely, constipation, diarrhoea. Hypophosphatemia (prolonged use, large dose)
  • Interferes w/ absorption of cimetidine, mexiletine, chlorpromazine, diflunisal, ketoconazole, penicillamine, pivampicillin, tetracyclines.

Antiulcerants

  • Nizatidine
  • Active duodenal & benign gastric ulcer, gastroesophageal reflux disease
  • Symptomatic response to nizatidine does not preclude gastric malignancy; moderate to severe renal insufficiency; pregnancy & lactation.
  • Somnolence, Sweating; urticaria, anaemia.
  • AL (OH)3 dried gel
  • Uncomplicated peptic ulcer, gastric hyperacidity & phosphate binding in renal dysfunction.
  • Hypophosphataemia.
  • Chronic renal failure; may cause phosphate depletion.
  • Constipation.
  • Affects absorption of tetracyclines, penicillins, sulfonamides, quinidine, Fe, digoxin, indomethacin, naproxen, phenylbutazone, vit.
  • Pantoprazole
  • Short term treatment of duodenal ulcers, gastric ulcers, moderate & severe forms of reflux oesophagitis. Eradication of Helicobacter pylori in gastric & duodenal ulcers.
  • Pregnancy, lactation. Combination therapy for eradication of H pylori in patients w/ moderate to severe hepatic or renal impairment.
  • Not for mild GI complaints eg nervous dyspepsia. Exclude gastric & esophageal malignancy. Childn. Severe liver impairment.
  • Nausea, upper abdominal pain, flatulence, skin rash, pruritus, dizziness, oedema, fever, depression, vision disturbances; headache, diarrhoea (w/ Controcol IV).
  • May affect absorption of drugs which are pH-dependent.

Omeprazole
Treatment of duodenal & benign gastric ulcers including those complicating NSAID therapy. Treatment of reflux oesophagitis. Zollinger-Ellison Syndrome. Eradication of H pylori. Long-term treatment for recurrent duodenal ulcer.
Exclude malignancy if gastric ulcer is suspected.
Headache. Rarely, rash, pruritus, dizziness, paraesthesia, somnolence, insomnia, vertigo, diarrhoea, constipation, abdominal pain, nausea, vomiting, flatulence, increased liver enzymes, malaise, hypersensitivity reactions.
May prolong elimination of diazepam, warfarin & phenytoin. Increases Plasma conc of clarithromycin.

Famotidine
Duodenal or benign gastric ulcer, hypersecretory conditions
Exclude gastric neoplasm. Renal Dysfunction (creatinine clearance > 10mL/min). Pregnancy, lactation, childn.
Headache, dizziness, constipation, diarrhoea, nausea & vomiting, rash, abdominal discomfort, anorexia & fatigue. Pruritus, urticaria, cholestatic jaundice, anaphylaxis, angioedema, arthralgia, dry mouth.

Lansoprazole
Duodenal ulcer, Gastric & stomal ulcer, Reflux oesophagitis, Zollinger-Ellison syndrome.
Hepatic disorders, elderly, pregnancy, lactation
Rarely, hepatic enzyme & hematological changes. Constipation, diarrhea, dry mouth, abdominal distension, headache, sleepiness, insomnia, dizziness, rash, pruritus, fever
May retard metabolism & excretion of diazepam & phenytoin. May decrease plasma concentration of theophylline.

Roxatidine acetate HCI
Treatment of disorders of the upper GIT caused by excexx gastric acid eg duodenal ulcer & Begign lesions in the region of the pyloric sphincter (intrapyloric & pre-pyloric ulcers, benign gastric ulcer), prophylaxis of recurrent gastric & duodenal ulcers, reflux oesophagitis.
Anuria. Child <14 yr.
Pregnancy, lactation.
Occasionally headache; rarely diarrhoea, constipation, nausea, vomiting, other GI complaints. Isolated reports of dizziness, troubled sleep, restlessness, drowsiness, hypersensitivity reactions, skin rashes, itching.

Cimetidine
Tab Active peptic ulcer, NSAID-induced lesions, Oesophageal reflux disease, zollinger-Ellison syndrome, Amp, stress ulceration, Mendelson’s syndrome, In conjunction w/ anesth
Impaired renal function; gastric malignancy; hemodialysis; pregnancy, lactation; elderly.
Mild & transient diarrhea; tiredness; dizziness; rash. Occasionally, mild gynaecomastia; reversible confusional state; leucopenia, thrombocytopenia. Rarely, hepatitis; interstitial nephritis; pancreatitis.
May affect metabolism of warfarin-type anti-coagulants, phenytoin, theophylline.

Ranitidine HCI.
Symptomatic relief of heartburn, dyspepsia & hyperacidity, duodenal ulcer & benign gastric ulcer, duodenal & benign gastric ulcer associated w/ NSAIDs, prophyaxis of NSAID-induced duodenal damage, reflux esophagitis, chronic episodic dyspepsia, zollinger-Ellison syndrome, Amp.
GI malignancy; dyspeptic symptoms; severe renal &/or hepatic impairment; pregnancy, lactation. Patients w/ history of porphyria or peptic ulcer. Patients on NSAIDs.
Occasionally reversible hepatitis. Rarely agranulocytosis, acute pancreatitis, arthralgia, myalgia; hypersensitivity; reversible mental confusion (severely ill/elderly patients); skin rash, reversible leucopenia & thrombo- cytopenia; headache, dizziness.

GIT Regulators, Antiflatulents & Anti-inflammatories

Alexitol Na
 Peptic ulcer, Gastric hyperacidity, pyrosis & heartburn of pregnancy
Renal insufficiency; low phosphate diet; prolonged use.
Constipation, diarrhoea; intestinal obstruction.
Impairs absorption of tetracyclines.

Domperidone
Nausea & Vomiting, Digestive disorder associated w/ slow gastric evacuation or esophageal reflux, epigastric or retrosternal burning sensation.
GI hemorrhage, mechanical obstruction, perforation.
babies < 1 yr; pregnancy.
Rarely, mild abdominal cramps. Raised serum prolactin levels.
Antagonized by anticholinergic drugs. Antacids or antisecretory agents should be taken after meals when used concomitantly.

Cisapride
Upper GI discomfort characterized by early satietly, postprandial fullness, inability to finish a normal sized meal, bloating, excessive belching, anorexia, nausea, vomiting & epigastric burning or pain. Gastro-oesophageal reflux disorders. Chronic & excessive regurgitation or vomiting in babies. Intestinal & colonic motility dysfunction.
CYP3A4 inhibitors including azole antifungals, macrolide antibiotics, HIV protease inhibitors & nefazodone. Acquired long QT interval, premature neonates w/ gestational age of ,36 wk, from 0-3 mth after delivery.
Hepatic or renal insufficiency. Pregnancy & lactation. Elderly. Patients w/ or suspected of having the risk factors for cardiac arrhythmia.
Transient abdominal cramping, borborygmi & diarrhea. Occasionally mild & transient headache, slight dizziness.
Accelerates absorption of CNS depressants, anticoagulants, paracetamol, H2-blockers & alcohol. Effects on GI motility reduced by anticholinergics.

Antispasmodics

Hyoscine-N-butylbromide.
Oral GIT & GUT spasm, spasm & dykinesia of the biliary system. Parenteral acute GI, biliary & GUT spasm, including biliary & renal colic. Aid in diagnostic & therapeutic procedures, where spasm may be a problem, eg gastroduodenal endoscopy, radiology.
Myasthenias gravis, megacolon. Parenteral: glaucoma, hypertrophy of the prostate w/ urinary retention, mechanical stenosis of GIT, tachycardia.
narrow-angle glaucoma, patients susceptible to intestinal urinary outlet obstructions & in those inclined to tacharrhythmia.
Xerostomia, dyshidrosis, tachycardia, urinary retention, allergic reactions, skin reactions, rarely dyspnea (in patients w/ history of bronchial asthma or allergy). Parenteral: Visual accommodation disturbance, infrequently injection site pain (after IM inj), rarely anaphylactoid reactions & anaphylactic shock.
Intensifies anticholinergic effects of tricyclic antidepressants, antihistamines, quinidine, amantadine & disopyramide. Enhances tachycardic effects of ß-adrenergic agents. Dopamine antagonists reduce effects of both drugs on GIT.

Butropium Br.
Spasmodic pain in gastritis, enteritis, peptic ulcer, cholelithiasis & cholecystopathy.
Glaucoma; impaired urination due to prostatomegaly; severe heart disease; paralytic ilues.
prostatomegaly; CHF; arrhythmia; ulcerative colitis; hyperthyroidism; high environmental temp; may impair ability to drive or operate machinery.
Infrequently, impaired ocular accommodation; dry mouth, GI disturbances; impaired urination; headache, drowsiness; dizziness; tachycardia; flushing; unusual tiredness. Rarely, hypotension; skin rash.
Effects potentiated by tricyclic antidepressants, phenothiazines, MAOIs, antihistamines.

Mebeverine HCI.
Symptomatic treatment of abdominal pain & cramps, bowel disturbances & intestinal discomfort related to irritable bowel syndrome. Treatment of GI spasm secondary to organic diseases.

Antidiarrheals

Loperamide HCI.
Diarrhoea.
When inhibition of peristalsis is to be avoided. Impaired hepatic function.
Childn <6 yr.
Dry mouth, nausea, vomiting, abdominal pain, constipation.

Diphenoxylate HCI 2.5mg, atropine sulfate 25ug.
Adjunctive therapy to proper rehydration in diarrhea; after colostomy or ileostomy for control of stool formation, & for relief of symptoms in ulcerative colitis.
Diarrhea associated w/ pseudomembranous colitis. Diarrhea caused by enterotoxin producing bacteria.
Advanced hepatorenal disease, abnormal liver function. Childn <6 yr. Down’s syndrome.
Euphoria, paresthesia, CNS effects, angioneurotic edema & other allergic reactions, toxis megacolon, paralytic ileus, GI disturbance. Atropine effects: hyperthermia, tachycardia, urinary retention, flushing, dry skin & mucous membranes.
Barbiturates, tranquilizers, alcohol, MAOIs.

Dioctahedral smectite.
Treatment of acute & chronis diarrhoea in patient > 6 yr.
May interfere w/ absorption levels & /or rates of other drugs.
Rarely, aggravation of constipation.

Activated charcoal.
Diarrhoea & poisoning due to food, heavy metals & drugs.
Diarrhea accompanied by fever.
Take 2 hr before or >1 hr after oral medication. Childn <6 yr. Not recommended for pesticides poisoning.
GI upsets. Dark to black stool.
medicinal charcoal may interfere w/ drug absorption in the GIT when taken simultaneously.

Laxatives, Purgatives

Bisacodyl.
Constipation. Prep of colon for diagnostic procedures, in pre-& post-op treatment & in conditions which require defaecation to be facilitated.
Ileus intestinal obstruction, acute surgical abdominal conditions; severe dehydration.
Childn; pregnancy
Rarely, abdominal discomfort & diarrhoea.
At high doses, risk of electrolyte imbalance increased w/ concurrent use of diuretics & adrenocorticoids. Cardiac glycosides.

Lactulose.
Chronic constipation, pre-coma & coma hepaticum
low galactose diet, galactosemia.
Flatulence.
Response may be altered by anti-infective agents.

Macrogol 4000.
Symptomatic treatment of constipation in adults.
Inflammatory organic colopathies (ulcerous rectocolitis, Crohn’s disease), occlusive & subocclusive syndrome, abdominal painful syndrome of undetermined reasons.
Prolonged use
May interfere w/ the absorption of other drugs if administered simultaneously. It is recommended to take other drugs at least 2 hr apart.

Per satchet 4000 macrogol 64g, KCI 0.75 g, saccharin Na 0.036g, Na bicarbonate 1.68g, NaCI 1.46g, anhydrous na sulphate 5.7g.
Clearing of bowels in preparation for endoscopic & radiological examinations & colonic surgery.
Dehydration, severe heart failure, colonic disease, actual or suspected ileus or intestinal occlusion, childn.
In elderly patients, administration only under medical supervision.
Nausea & vomiting at the beginning of administration.

Ispaghula husk.
diverticular disease, spastic & irritable colon, ulcerative colitis. Constipations due to insufficient fibre.
Intestinal obstruction.
Should be taken w/sufficient fluid to prevent fecal impaction or esophageal obstruction.
Abdominal discomfort, flatulence in large doses.

Standardised senna (equiv to 7.5 mg total sennosides).
Constipation.
Intestinal obstruction, undiagnosed abdominal symptoms.
Prolonged use; inflammatory bowel disease; may interfere w/ diagnostic tests.
Mild abdominal discomfort; diarrhea w/ excessive loss of water & electrolytes (high doses), atonic non-functioning colon (prolonged use).

Digestives

Amylase 10,000 u, protease 9,000 u, lipase 240 u, desoxycholic acid 30mg, dimethylpolysiloxane 25mg, vit B1 10mg, vit B2 5mg, vit B6 5mg, vit B12 5µg, niacinamide 10mg, Ca pantothenate 5 mg
Digestive disorders manifested by bloating, belching flatulence & abdominal discomfort.

Cholagogues, Cholelitholytics & Hepatic Protectors

Per cap Essential phospholipids 175mg, vit B1 3mg, vit B2 3mg, vit B6 3mg, vit B12 3µg, vit E 3.3mg, nicotinamide 15mg. Per forte cap Essential phospholipids 300mg, vit B1 6mg, vit B2 6mg, vit B12 6µg, vit E 6 mg, nicotinamide 30mg, vit B6 6mg.
Hepatitis, cirrhosis, intoxification, fatty degeneration of the liver of any origin, cholestasis, prophylaxis of gallstone formation, radiation syndrome, pre-& post-op care esp in liver/ gall-bladder surgery

Silymarin 70 mg, curcuma 13.5 mg, celandine 2 mg.
Therapeutic relief of chronic inflammatory liver disease & liver cirrhosis.
closure of bile ducts. People suffering from gallstones.
Isolated cases of mild laxative effect & stomach discomfort.

Per cap Glucometamine 150 mg, glucodiamine 30mg, nicotinamide ascorbate 20mg. Per 100ml syr Glucometamine 3.75g,, glucoodiamine 1g, nicotinamide ascorbate 0.5g, sorbitol 65.78g. per 10ml amp Glucometamine 750mg, glucodiamine 200mg, nicotinamide 100mg.
Endogenous & exogenous intoxications, acute & chronic liver disease, hepatic cirrhosis, physical & mental overwork, fatty liver degeneration, alcoholism.