Gastrointestinal Medicines
Pantoprazole
Pantoprazole

 Dosage Forms:

  • 20 mg and 40 mg enteric coated tablets or capsules.

Drug Group

Proton Pump inhibitor

Mechanism

Suppresses gastric acid secretion by specific inhibition of the hydrogen–potassium ATPase enzyme system at the secretory surface of the gastric parietal cells; blocks the final step of acid production.

Indications

Short-term treatment of erosive esophagitis associated with Gastroesophageal Reflux Disease (GERD). Healing and symptomatic relief of erosive esophagitis. Long-term treatment of pathological hypersecretory conditions, including Zollinger-Ellison syndrome.

Dosage and Administration:

  • The recommended adult oral dose is 40 mg given once daily for up to 8 weeks. For those patients who have not healed after 8 weeks of treatment, an additional 8-week course of Pantoprazole may be considered.

Precautions and Warnings

Generally, daily treatment with any acid-suppressing medications over a long period of time (eg, longer than 3 years) may lead to malabsorption of cyanocobalamin (vitamin B12) caused by hypo- or achlorhydria. Rare reports of cyanocobalamin deficiency occurring with acid-suppressing therapy.

Side Effects

The followings are the clinical adverse reactions considered possibly: Headache, Diarrhea, Flatulence, Abdominal pain, Rash, Eructation, Insomnia, Hyperglycemia, Nausea, Vomiting, anxiety, arthralgia, asthenia, back pain, bronchitis, chest pain, constipation, cough increased, dizziness, dyspepsia, dyspnea, flu syndrome, gastroenteritis, gastrointestinal disorder, hyperlipidemia, hypertonia, infection, liver function tests abnormal, migraine, neck pain, pain, pharyngitis, rectal disorder, rhinitis, SGPT increased, sinusitis, upper respiratory tract infection, urinary frequency and urinary tract infection.
Interactions: There have been post marketing reports of increased INR and prothrombin time in patients receiving proton pump inhibitors, including Pantoprazole and warfarin concomitantly. Increases in INR and prothrombin time may lead to abnormal bleeding and even death. Patients treated with proton pump inhibitors and warfarin concomitantly should be monitored for increases in INR and prothrombin time. Because of profound and long lasting inhibition of gastric acid secretion, pantoprazole may interfere with absorption of drugs where gastric pH is an important determinant of their bioavailability (eg, ketoconazole, ampicillin esters, and iron salts). 

Pregnancy and Lactation

Pregnancy category B. There are no adequate and well-controlled studies in pregnant women. This drug should be used during pregnancy only if clearly needed. Because Pantoprazole is excreted in human milk a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the benefit of the drug to the mother.

Packaging

  • PVC flacons of 14’s.
Lansoprazole
Lansoprazole

Dosage Forms:

  • 15 mg and 30 mg delayed release capsules.

Drug Group

Proton Pump inhibitor

Mechanism

Suppresses gastric acid secretion by specific inhibition of the hydrogen–potassium ATPase enzyme system at the secretory surface of the gastric parietal cells; blocks the final step of acid production.

Indications

Short-term treatment (up to 4 wk) of active duodenal ulcer, short-term treatment (up to 8 wk) of gastric ulcers, short-term treatment (up to 8 wk) of GERD: Severe erosive esophagitis; poorly responsive symptomatic GERD, long-term treatment of pathological hypersecretory conditions (eg, Zollinger-Ellison syndrome, multiple adenomas, systemic mastocytosis), maintenance therapy for healing of erosive esophagitis, duodenal ulcers, eradication of Helicobacter pylori infection in patients with active or recurrent duodenal ulcers in combination with clarithromycin and amoxicillin. Short-term treatment (up to 8 wk) of symptomatic GERD and erosive esophagitis in children 1–۱۱ yr short-term treatment (up to 7 days) of all grades of erosive esophagitis when patient is unable to take oral medication (IV).

Indications:

  • Short-term treatment (up to 4 wk) of active duodenal ulcer, short-term treatment (up to 8 wk) of gastric ulcers, short-term treatment (up to 8 wk) of GERD: Severe erosive esophagitis; poorly responsive symptomatic GERD, long-term treatment of pathological hypersecretory conditions (eg, Zollinger-Ellison syndrome, multiple adenomas, systemic mastocytosis), maintenance therapy for healing of erosive esophagitis, duodenal ulcers, eradication of Helicobacter pylori infection in patients with active or recurrent duodenal ulcers in combination with clarithromycin and amoxicillin. Short-term treatment (up to 8 wk) of symptomatic GERD and erosive esophagitis in children 1–۱۱ yr short-term treatment (up to 7 days) of all grades of erosive esophagitis when patient is unable to take oral medication (IV).

Precautions and Warnings

Symptomatic response to therapy with lansoprazole does not preclude the presence of gastric malignancy. Lansoprazole should be taken before eating. Lansoprazole products should not be crushed or chewed.

Side Effects

Symptomatic response to therapy with lansoprazole does not preclude the presence of gastric malignancy. Lansoprazole should be taken before eating. Lansoprazole products should not be crushed or chewed. Interactions: This supplement is similar in structure to the blood-thinning drug heparin, and the combination may cause bleeding in some people.
Interactions:  There have been post marketing reports of increased INR and prothrombin time in patients receiving proton pump inhibitors, including lansoprazole and warfarin concomitantly. Increases in INR and prothrombin time may lead to abnormal bleeding and even death. Patients treated with proton pump inhibitors and warfarin concomitantly should be monitored for increases in INR and prothrombin time.Because of profound and long lasting inhibition of gastric acid secretion, lansoprazole may interfere with absorption of drugs where gastric pH is an important determinant of their bioavailability (eg, ketoconazole, ampicillin esters, and iron salts).

Pregnancy and Lactation

Pregnancy category B. There are, however, no adequate or well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.

Packaging:

  • HDPE flacons of 14’s.
Mebeverine
Mebeverine

 Dosage Forms:

  • 200 mg extended release capsule.

Drug Group

Antispasmodic agent

Mechanism

Mebeverine hydrochloride is an antispasmodic with a direct action on the smooth muscle of the gastrointestinal tract.

Indications

It is used in irritable bowel syndrome.

Dosage and Administration:

  • Mebeverine is used in conditions such as irritable bowel syndrome in a usual dose of two capsules daily by mouth before meals.

Precautions and Warnings

It was suggested that Mebeverine HCl produced colonic stasis, which predisposed the patient to ulceration, but the manufacturers considered that the development of constipation and distal intestinal syndrome (meconium ileus equivalent) in this patient precipitated the development of stercoral ulceration. It was recommended that antispasmodics such as mebeverine should not be used for the symptomatic treatment of distal intestinal syndrome in cystic fibrosis. Mebeverine hydrochloride is considered to be unsafe in patients with porphyria. Don’t crash the capsules.

Side Effects

Although adverse effects appear rare, gastrointestinal disturbances, dizziness, headache, insomnia, anorexia, and decreased heart rate have been reported in patients receiving mebeverine. Cases of hypersensitivity, including erythematous rash, urticaria, and angioedema, have also been reported.
Interactions: Decreased serum levels if taken concurrently with sucralfate. Decreased serum levels of Ketoconazole, Theophylline when taken with lansoprazole. Lansoprazole appears to produce a dose dependent decrease in the absorption of cyanocobalamin.

Pregnancy and Lactation

Pregnancy category B. Mebeverine should be used during pregnancy only if clearly needed. Mebeverine is not excreted in human milk by therapeutic doses.

Packaging:

  • 10 capsules in one blister. 5 blisters in a box.
Domperidone

Domperidone

Dosage Forms:

  • 10 mg tablets

Drug Group

Dopamine antagonist

Mechanism

Domperidone is a dopamine antagonist with actions and uses similar to those of metoclopramide. It is used as an antiemetic for the short-term treatment of nausea and vomiting of various aetiologies and dyspepsia.

Indications

Domperidone is indicated for treatment of delayed gastric emptying of functional origin with gastro-oesophageal reflux and/or dyspepsia, Control of nausea and vomiting of central or local origin, as an anti-emetic in patients receiving cytostatic and radiation therapy, Facilitates radiological examination of the upper gastro-intestinal tract.

Dosage and Administration:

  • Acute conditions (nausea, vomiting, hiccup): Adults: 20 mg 3 to 4 times per day. Children 5 to 12 years old: 10 mg 3 to 4 times per day. Chronic conditions (dyspepsia): Adults: 10 mg taken 3 times per day. Children 5 to 12 years old: ½ tablet (5 mg) 3 to 4 times per day.

Precautions and Warnings

This drug should not be used whenever stimulation of gastric motility is to be avoided or could be harmful, e.g. in the presence of gastro-intestinal haemorrhage, obstruction or perforation. Since domperidone is highly metabolised in the liver, it should be used with caution in patients with hepatic impairment (and in the elderly).

Side Effects

Allergic reactions, such as rash or urticaria and also abdominal cramps have been reported. Dystonic reactions (extra pyramidal phenomena) may occur. Reversible raised serum prolactin levels have been observed which may lead to galactorrhoea and gynaecomastia. Hypertensive crises in patients with phaeochromocytoma may occur with administration of domperidone. Where the blood brain barrier is not fully developed (mainly in young babies) or is impaired, the possible occurrence of neurological side-effects cannot be totally excluded.
Interactions:  Concomitant administration of anti-cholinergic drugs may inhibit the anti-dyspeptic effects of domperidone. Anti-muscarinic agents and opioid analgesics may antagonise the effect of domperidone. Domperidone suppresses the peripheral effects (digestive disorders, nausea and vomiting) of dopaminergic agonists. Since domperidone has gastro-kinetic effects, it could influence the absorption of concomitant orally administered medicines, particularly those with sustained release or enteric coated formulations. As domperidone interferes with serum prolactin levels, it may interfere with other hypoprolactinaemic agents and with some diagnostic tests. Antacids and anti-secretory agents lower the oral bioavailability of domperidone. They should be taken after meals and not before meals, i.e. they should not be taken simultaneously with domperidone.

Pregnancy and Lactation

Pregnancy category B. Studies on pregnancy have not been done in humans. No adverse effects have been observed in breast-fed infants whose mothers were receiving domperidone, and it is usually compatible with breast feeding.

Packaging

  • 10 tablets in one blister. 3 blisters in a box.