Gastroenterology Case No 8. Probiotics in IBS.

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Gastroenterology Case No 8. Probiotics in IBS.

Probiotics In IBS!

IBS –3 types!

IBS-C (Constipation)

IBS-D( Diarrhoea )& IBS-M(mixed type)

প্রোবায়োটিক (live microrganism) হলো নন ডাইজেস্টেবল ফুড ইনগ্রেডিয়েন্ট,যেটা মূলত Bacteria এর বৃদ্ধি & Activity কে Stimulate করে। ৪টি গবেষণার মধ্যে তিনটি রিপোর্ট করেছে যে,, Probiotics গুলো IBS এর symptoms গুলো আরও খারাপ করে বা উন্নতি করে না

আরও এক গবেষণায় দেখা গেছে ১০টি probiotic যেমন Bifidobacte-rium breve, Bifidobacterium longum, and Lactobacillus acidophilus species গুলো significantly Pain & bolating থেকে উপশম দিলেও Stool frequency or Consistency কোনো Change দেখা যায় নি

অনেকই Diarrhoea এর ফ্রিকোয়েন্সি কমানোর জন্য লং টাইম Probiotics দিয়ে থাকে।যা Costly ও বটে

IBS- Diarrhoea তে Diarrhoea এর ফ্রিকোয়েন্সি কমানোর জন্য আমরা Rifaximin Antibiotics দিতে পারি,

Tab Rifaxim 550 mg
Tablet 1.Rifamax 550mg (AS A Rifaximin 4-Quinolone preparations).

BD—-১৪ দিন

Indications of Tablet:-Rifamax 550mg (AS A Rifaximin 4-Quinolone preparations).

Rifamax is indicaed in-

Treatment of traveler’s diarrhea by noninvasive strains of E. coli
reduction in risk of overt hepatic encephalopathy
bacterial overgrowth of irritable bowel syndrome.

Pharmacology of Tablet:-Rifamax 550mg (AS A Rifaximin 4-Quinolone preparations).

Rifaximin is a semisynthetic, rifamycin-based non-systemic antibiotic. Very little of the drug will pass the gastrointestinal wall into the circulation as is common for other types of orally administered antibiotics. Rifaximin inhibits bacterial RNA synthesis by its action on the beta-subunit of the DNA-dependent RNA polymerase. It shows the same broad spectrum activity as rifamycin which exerts bactericidal action against many species of Gram-positive and Gram-negative, aerobic and anaerobic bacteria.

Dosage & Administration of Tablet:-Rifamax 550mg (AS A Rifaximin 4-Quinolone preparations).

Traveler’s Diarrhea: For patients ≥12 years of age: 200 mg 3 times daily for 3 days.
Hepatic Encephalopathy: For patients ≥18 years of age: 550 mg 2 times daily.
Bacterial overgrowth of irritable bowel syndrome: 400 mg 3 times daily for 10 days or 550 mg 3 times daily for 14 days. Can be taken with or without food

Interaction of Tablet:-Rifamax 550mg (AS A Rifaximin 4-Quinolone preparations).

In an in vitro study has suggested that Rifamax induces CYP3A4. However, in patients with normal liver function, Rifamax at the recommended dosing regimen is not expected to induce CYP3A4.

Contraindications of Tablet:-Rifamax 550mg (AS A Rifaximin 4-Quinolone preparations).

Contraindicated in patients with a hypersensitivity to Rifaximin or to any of the rifamycin antimicrobial agents, or any components of this product

Side Effects of Tablet:-Rifamax 550mg (AS A Rifaximin 4-Quinolone preparations).

Side effects include flatulence, headache, abdominal pain, rectal tenesmus, defecation urgency, nausea, constipation, pyrexia, vomiting. Reactions have been reported, including anaphylaxis, angioneurotic edema, and exfoliative dermatitis.

Pregnancy & Lactation of Tablet:-Rifamax 550mg (AS A Rifaximin 4-Quinolone preparations).

Pregnancy category C. It is not known whether Rifaximin is excreted in human milk or not.

Precautions & Warnings

Rifamax is not found to be effective in patients with diarrhea complicated by fever and/or blood in the stools. Rifamax therapy should be discontinued if diarrhea symptoms get worse or persist for more than 24-48 hours and alternative antibiotic therapy should be considered. Pseudomembranous colitis has been reported with nearly all antibacterial agents and may range in severity from mild to life-threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhea subsequent to the administration of antibacterial agents.

Use in Special Populations

Renal Impairment: The pharmacokinetics of Rifamax in patients with impaired renal function has not been studied.
Hepatic Impairment: The systemic exposure of Rifamax was markedly elevated in patients with hepatic impairment compared to healthy subjects.

Overdose Effects

No specific information is available on the treatment of over dosage with Rifamax. In case of over dosage, discontinue Rifamax, treat symptomatically and institute supportive measures as required.

Therapeutic Class of Tablet:-Rifamax 550mg (AS A Rifaximin 4-Quinolone preparations).

4-Quinolone preparations

• IBS–C তে Antidepressant হিসেবে SSRI IBS-C তে হিসেবে Antidepressant হিসেবে আমরা SSRI Clomipramine hydrochloride // Duloxetine**দিতে পারি! কারন এর Anticholinergic Effect কম যার ফলে আলাদা Constipation বাড়ানোর chance থাকে না!!

Duloxetine (1+0+0)–2 Month or Timex *

Tablet 1.Duloxen 60mg AS A Duloxetine Hydrochloride AS A Serotonin-norepinephrine reuptake inhibitor (SNRI).

Indications of Tablet:-Duloxen 60mg AS A Duloxetine Hydrochloride AS A Serotonin-norepinephrine reuptake inhibitor (SNRI).

Duloxen is a serotonin and norepinephrine reuptake inhibitor (SNRI) indicated for-

Major Depressive Disorder (MDD)
Generalized Anxiety Disorder (GAD)
Diabetic Peripheral Neuropathic Pain (DPNP)
Fibromyalgia and
Chronic Musculoskeletal Pain.

Pharmacology of Tablet:-Duloxen 60mg AS A Duloxetine Hydrochloride AS A Serotonin-norepinephrine reuptake inhibitor (SNRI).

Duloxetine Hydrochloride is a selective serotonin and norepinephrine reuptake inhibitor (SSNRI) for oral administration. Duloxetine is a less potent inhibitor of dopamine reuptake. Duloxetine has no significant affinity for dopaminergic, adrenergic, cholinergic, histaminergic, opioid, glutamate, and GABA receptors in vitro. Duloxetine does not inhibit monoamine oxidase (MAO). Orally administered Duloxetine hydrochloride is well absorbed. Elimination of Duloxetine is mainly through hepatic metabolism.

Dosage & Administration of Tablet:-Duloxen 60mg AS A Duloxetine Hydrochloride AS A Serotonin-norepinephrine reuptake inhibitor (SNRI).

Major Depressive Disorder (MDD)-

Starting Dose: 40 mg/day to 60 mg/day
Target Dose: Acute: 40 mg/day (20 mg twice daily) to 60 mg/day (once daily or as 30 mg twice daily); Maintenance: 60 mg/day
Maximum Dose: 120 mg/day

Generalized Anxiety Disorder (GAD)-

Starting Dose: 60 mg/day
Target Dose: 60 mg/day (once daily)
Maximum Dose: 120 mg/day

Diabetic Peripheral Neuropathic Pain (DPNP)-

Starting Dose: 60 mg/day
Target Dose: 60 mg/day (once daily)
Maximum Dose: 60 mg/day

Fibromyalgia-

Starting Dose: 30 mg/day
Target Dose: 60 mg/day (once daily)
Maximum Dose: 60 mg/day

Chronic Musculoskeletal Pain-

Starting Dose: 30 mg/day
Target Dose: 60 mg/day (once daily)
Maximum Dose: 60 mg/day

Some patients may benefit from starting at 30 mg once daily. There is no evidence that doses greater than 60 mg/day confers an additional benefit, while some adverse reactions were observed to be dose-dependent. A gradual dose reduction is recommended to avoid discontinuation symptoms.

Interaction of Tablet:-Duloxen 60mg AS A Duloxetine Hydrochloride AS A Serotonin-norepinephrine reuptake inhibitor (SNRI).

Both CYP1A2 and CYP2D6 isozymes are responsible for Duloxen metabolism. When Duloxen was co-administered with fluvoxamine, a potent CYP1A2 inhibitor, the AUC, Cmax and t of Duloxen was increased. Other drugs that inhibit CYP1A2 metabolism include cimetidine and quinolone antimicrobials such as ciprofloxacin and enoxacin would be expected to have similar effects and these combinations should be avoided. Because CYP2D6 is involved in Duloxen metabolism, concomitant use of Duloxen with potent inhibitors of CYP2D6 may result in higher concentrations of Duloxen.

Side Effects of Tablet:-Duloxen 60mg AS A Duloxetine Hydrochloride AS A Serotonin-norepinephrine reuptake inhibitor (SNRI).

The most commonly observed adverse events in Duloxen treated patients were nausea, dizziness, dry mouth, constipation, decreased appetite, fatigue, somnolence, increased sweating, hyperhidrosis and asthenia. It may slightly increase blood pressure. No clinically significant differences were observed for QT, PR, and QRS intervals between Duloxen-treated and placebo-treated patients.

Pregnancy & Lactation of Tablet:-Duloxen 60mg AS A Duloxetine Hydrochloride AS A Serotonin-norepinephrine reuptake inhibitor (SNRI).

Pregnancy: Pregnancy Category C. There are no adequate and well-controlled studies in pregnant women; therefore, Duloxetine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Labor and Delivery: The effect of Duloxetine on labor and delivery in humans is unknown. Duloxetine should be used during labor and delivery only if the potential benefit justifies the potential risk to the fetus.

Lactation: It is unknown whether or not Duloxetine and/or it’s metabolites are excreted into human milk, but nursing while on Duloxetine is not recommended

Therapeutic Class of Tablet:-Duloxen 60mg AS A Duloxetine Hydrochloride AS A Serotonin-norepinephrine reuptake inhibitor (SNRI).

• IBS-D তে TCA, IBS type D te antidepressants হিসেবে TCA (Amitriptylin) দিতে পারি.. কারন এর AntiCholinergic Effect আছে ;;যার জন্য Constipation করতে পারে;;এতে Diarrhoea এর frequency কমবে!!!

Amitriptyline (0+0+1)—3 month(evening)

Tablet 2:-Tryptin 25mg (AS A Amitriptyline Hydrochloride AS A Tricyclic Anti-depressant).

Indications of Tablet :-Tryptin 25mg (AS A Amitriptyline Hydrochloride AS A Tricyclic Anti-depressant).

Tryptin is indicated in-

Depressive Illness: particularly where sedation is required.
Nocturnal Enuresis in children.
Prophylaxis of Migraine.
Tension Headache.
Chronic Pain.

Pharmacology of Tablet :-Tryptin 25mg (AS A Amitriptyline Hydrochloride AS A Tricyclic Anti-depressant).

The mechanism of action of this drug is not fully elucidated. It is suggested that amitriptyline inhibits the membrane pump mechanism responsible for the re-uptake of transmitter amines, such as norepinephrine and serotonin, thereby increasing their concentration at the synaptic clefts of the brain. These amines are important in regulating mood. The monoamine hypothesis in depression, one of the oldest hypotheses, postulates that deficiencies of serotonin (5-HT) and/or norepinephrine (NE) neurotransmission in the brain lead to depressive effects. This drug counteracts these mechanisms, and this may be the mechanism of amitriptyline in improving depressive symptoms. Whether its analgesic effects are related to its mood-altering activities or attributable to a different, less obvious pharmacological action (or a combination of both) is unknown.

Dosage & Administration of Tablet :-Tryptin 25mg (AS A Amitriptyline Hydrochloride AS A Tricyclic Anti-depressant).

Depression: Initially 75 mg (Elderly and Adolescents 30-75 mg) daily in divided doses or as a single dose at bedtime increased gradually as necessary to 150-200 mg; Child under 16 years not recommended for depression.

Nocturnal Enuresis: Child 7-10 years: 10-20 mg, 11-16 years: 25-50 mg at night; max. period of treatment (including gradual withdrawal) 3 months-full physical examination before the further course.

Prophylaxis of Migraine: 100 mg daily.

Tension Headache: 10-25 mg three times daily.

Interaction of Tablet :-Tryptin 25mg (AS A Amitriptyline Hydrochloride AS A Tricyclic Anti-depressant).

TCA enhances the sedative effect of alcohol and opioid analgesics. When TCA is used with Moxifloxacin or Terfenadine, it increases the risk of ventricular arrhythmias. Disulfirum and Cimetidine inhibit the metabolism of Tryptin. When TCA is used with diuretics, it enhances the risk of postural hypotension.

Contraindications of Tablet :-Tryptin 25mg (AS A Amitriptyline Hydrochloride AS A Tricyclic Anti-depressant).

Amitriptyline is contraindicated in myocardial infarction, arrythmias, particularly heart block of any degree, mania and severe liver disease. Initially, sedation may affect the ability to drive or operate machinery.

Side Effects of Tablet :-Tryptin 25mg (AS A Amitriptyline Hydrochloride AS A Tricyclic Anti-depressant).

Anticholinergic: Excessive perspiration, dry mouth, blurred vision, hyperpyrexia, urinary retention and urinary tract dilatation.
Cardiovascular reactions: Hypotension, syncope, postural hypotension, hypertension, tachycardia, palpitations, myocardial infarction, etc.
CNS and Neuromuscular: Confusional states, disturbed concentration, disorientation, delusions, etc.
Allergic: Skin rash, urticaria, photosensitization, etc.
Haematological: Bone-marrow depression.
Gastrointestinal: Nausea, epigastric distress, vomiting, anorexia, stomatitis, unpleasant taste, weight loss, diarrhoea, constipation, etc.
Endocrine: Testicular swelling, gynaecomastia, breast enlargement, galactorrhoea, etc.

Pregnancy & Lactation of Tablet :-Tryptin 25mg (AS A Amitriptyline Hydrochloride AS A Tricyclic Anti-depressant).

Pregnancy Category C. Amitriptyline has been shown to cross the placenta. Amitriptyline should be used during pregnancy only if the potential benefit to the mother justifies the potential risk to the fetus. Amitriptyline is excreted into breast milk. Because of the potential for serious adverse reactions in nursing infants from Amitriptyline, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

Therapeutic Class of Tablet :-Tryptin 25mg (AS A Amitriptyline Hydrochloride AS A Tricyclic Anti-depressant).

Tricyclic Anti-depressant

R jodi Pain থাকলে Meverine hydrochloride (Rostil) & Alverine (Alve) দিতে পারি!!!(Both IBs-c&D)For prevent Constipation আমরা laxative দিতে পারি

Tablet 3.Rostil 135mg (AS A Mebeverine hydrochloride AS A Anticholinergics).

Indications of Tablet:-Rostil 135mg (AS A Mebeverine hydrochloride AS A Anticholinergics).

Rostil is indicated for the:

Symptomatic treatment of irritable bowel syndrome (IBS)
Chronic irritable colon
Spastic constipation
Mucous colitis
Colicky abdominal pain
Persistent non-specific diarrhoea

Description of Tablet:-Rostil 135mg (AS A Mebeverine hydrochloride AS A Anticholinergics).

Rostil is a musculotropic antispasmodic agent used to relieve cramps or spasms of the stomach and intestine (gut). It is particularly useful in treating irritable bowel syndrome (IBS) and similar conditions. It works by relaxing the muscles and helping restore the normal movement of the gut.

Dosage & Administration

For adults, elderly and children over 10 years:

Mebeverine Hydrochloride 135 mg tablet: 1 tablet 03 times daily.
Mebeverine Hydrochloride 200 mg capsule: 1 capsule 02 times daily.

This is most effective when taken 20 minutes before meals. After several weeks when the desired effect has been obtained, the dosage may be gradually reduced.

Missed dose: If a dose of this medicine is missed, that should be taken as soon as possible. However, if it is almost time for the next dose, then skip the missed dose and the regular dosing schedule should be maintained. Dose should not be doubled at the same time to compensate the missed dose.

Use in children: Mebeverine is not recommended for children under 10 years.

Contraindications of Tablet:-Rostil 135mg (AS A Mebeverine hydrochloride AS A Anticholinergics).

Hypersensitivity to the drug or any other ingredients.

Side Effects of Tablet:-Rostil 135mg (AS A Mebeverine hydrochloride AS A Anticholinergics).

Generally Rostil is well tolerated. However, few side-effects like skin rash, urticaria and angioedema may appear

Pregnancy & Lactation of Tablet:-Rostil 135mg (AS A Mebeverine hydrochloride AS A Anticholinergics).

No teratogenicity has been shown in animal experiments. However, the usual precautions concerning the administration of any drug during pregnancy should be exercised. Mebeverine does not excrete in the breast milk after administering at therapeutic dose.

Precautions & Warnings

Caution should be exercised in porphyria or allergic reaction to this or any other medicine of this group.

Overdose Effects

On theoretical grounds it may be predicted that CNS excitability will occur in case of overdosage. No specific antidote is known: gastric lavage and symptomatic treatment is recommended

Therapeutic Class of Tablet:-Rostil 135mg (AS A Mebeverine hydrochloride AS A Anticholinergics).

Anticholinergics

Tablet 4.Somolax 60mg (AS A Alverine Citrate AS A Anticholinergics).

Indications of Tablet:-Somolax 60mg (AS A Alverine Citrate AS A Anticholinergics).

Somolax is indicated in-

Irritable Bowel Syndrome
Bowel movement disturbances caused by small sacs or pouches in the wall of the gut (diverticular disease)
Abdominal pain associated with menstrual periods (Primary dysmenorrhea)
Relief of other conditions associated with spasm of involuntary muscle
Pharmacology of Tablet:-Somolax 60mg (AS A Alverine Citrate AS A Anticholinergics).
Alverine Citrate is a smooth muscle relaxant. Smooth muscle is a type of muscle that is not under voluntary control; it is the muscle present in places such as the gut and uterus. Alverine Citrate acts directly on the muscle in the gut, causing it to relax. This prevents the muscle spasm which occur in the gut in conditions such as irritable bowel syndrome and diverticular disease. Alverine Citrate also relaxes the smooth muscle in the uterus. It is therefore also used to treat painful menstruation, which is caused by muscle spasm in the uterus (dysmenorrhea).
Dosage & Administration of Tablet:-Somolax 60mg (AS A Alverine Citrate AS A Anticholinergics).
Adult: Orally: 60-120 mg 1-3 times daily.
Interaction of Tablet:-Somolax 60mg (AS A Alverine Citrate AS A Anticholinergics).
There are no drug interactions reported with this medicine.
Contraindications of Tablet:-Somolax 60mg (AS A Alverine Citrate AS A Anticholinergics).
Paralytic ileus or known hypersensitivity to any of the ingredients.
Side Effects of Tablet:-Somolax 60mg (AS A Alverine Citrate AS A Anticholinergics).
Possible side effects may include nausea, headache, dizziness, itching, rash and allergic reactions.
Pregnancy & Lactation of Tablet:-Somolax 60mg (AS A Alverine Citrate AS A Anticholinergics).
Although no teratogenic effects have been reported, use during pregnancy or lactation is not recommended as evidence of safety in preclinical studies are limited.
Precautions & Warnings of Tablet:-Somolax 60mg (AS A Alverine Citrate AS A Anticholinergics).
Avoid Somolax in patients with intestinal obstruction or paralytic ileus.
Use in Special Populations
Children under 12 years: Not recommended
Overdose Effects
Can produce hypotension and atropine like-toxic effects. Management for overdose is as like as atropine poisoning with continuation of supportive therapy for hypotension.
Therapeutic Class of Tablet:-Somolax 60mg (AS A Alverine Citrate AS A Anticholinergics).
Anticholinergics

Laxative:-

Laxative hisebe amra dite pari

Tablet 4:-Ezylife 10 mg (As a Sodium Picosulfate Stimulant Laxative).

Indications of Tablet :-Ezylife 10 mg (As a Sodium Picosulfate Stimulant Laxative).

Ezylife is indicated in the following conditions-

Constipation of any etiology
Relief from prolonged & recurrent constipation
Bowel clearance before surgery, childbirth or radiological investigations.

Pharmacology of Tablet :-Ezylife 10 mg (As a Sodium Picosulfate Stimulant Laxative).

Sodium Picosulfate is a triarylmethane group derivative stimulant laxative. After oral administration it is activated by the colonic bacteria and acts locally in the colon. The active form then stimulates the nerve endings of the intestinal wall and results in colonic peristalsis with promotion of accumulation of water and electrolytes in the colonic lumen. This results in stimulation of defecation, reduction of transit time and softening of the stool. Stimulation of the rectum causes increased motility and a feeling of rectal fullness. The rectal effect may help to restore the “call to stool”.

Dosage & Administration of Tablet :-Ezylife 10 mg (As a Sodium Picosulfate Stimulant Laxative).

For oral administration. The following dosages are recommended to be taken at night to produce evacuation the following morning. It is recommended to start with the lowest dose. The dose may be adjusted up to the maximum recommended dose to produce regular stools. The maximum recommended daily dose should not be exceeded:

10 mg tablet dose:

Adults and children over 10 years of age: 5-10 mg per day.
Children aged 4-10 years: 2.5-5 mg per day.

Oral Solution (5 mg/5 ml) dose:

Adults and children over 10 years of age: 5-10 ml or one to two teaspoonful per day.
Children aged 4-10 years: 2.5-5 ml or half to one teaspoonful per day.
Children from One month to 4 years of age: 0.25 ml/kg body weight per day.

Concentrated Oral Solution (7.5 mg/ml) dose:

Adults and children over 10 years of age: 0.67-1.33 ml per day.
Children aged 4-10 years: 0.33-0.67 ml per day.

Side Effects of Tablet :-Ezylife 10 mg (As a Sodium Picosulfate Stimulant Laxative).

Hypersensitivity, dizziness, syncope, vasovagal response, gastrointestinal disorders, diarrhea, abdominal pain and abdominal cramps, nausea, vomiting.

Dosage & Administration of Tablet :-Ezylife 10 mg (As a Sodium Picosulfate Stimulant Laxative).

Adults and children over 10 years of age: 5-10 mg per day.
Children aged 4-10 years: 2.5-5 mg per day.

Oral Solution (5 mg/5 ml) dose:

Adults and children over 10 years of age: 5-10 ml or one to two teaspoonful per day.
Children aged 4-10 years: 2.5-5 ml or half to one teaspoonful per day.
Children from One month to 4 years of age: 0.25 ml/kg body weight per day.

Concentrated Oral Solution (7.5 mg/ml) dose:

Adults and children over 10 years of age: 0.67-1.33 ml per day.
Children aged 4-10 years: 0.33-0.67 ml per day.

Interaction of Tablet :-Ezylife 10 mg (As a Sodium Picosulfate Stimulant Laxative).

The concomitant use of diuretics or adreno-corticosteroids may increase the risk of electrolyte imbalance if excessive doses are taken. Concurrent administration of antibiotics may reduce the laxative action of Ezylife.

Contraindications of Tablet :-Ezylife 10 mg (As a Sodium Picosulfate Stimulant Laxative).

Ileus or intestinal obstruction, severe painful and/or feverish acute abdominal conditions (e.g. appendicitis) potentially associated with nausea and vomiting, acute inflammatory bowel diseases, severe dehydration, known hypersensitivity to Sodium Picosulfate or any other component of the product.

Precautions & Warnings of Tablet :-Ezylife 10 mg (As a Sodium Picosulfate Stimulant Laxative).

Prolonged excessive use may lead to fluid and electrolyte imbalance and hypokalemia. Harmful for those suffering from alcoholism. To be taken into account in pregnant or breast-feeding women, children and high-risk groups such as patients with liver disease or epilepsy.

Overdose Effects of Tablet :-Ezylife 10 mg (As a Sodium Picosulfate Stimulant Laxative).

Laxatives when taken in chronic overdosage may cause chronic diarrhea, abdominal pain, hypokalemia, secondary hyperaldosteronism, and renal calculi. Renal tubular damage, metabolic alkalosis, and muscle weakness secondary to hypokalemia have also been described in association with chronic laxative abuse.

Therapeutic Class of Tablet :-Ezylife 10 mg (As a Sodium Picosulfate Stimulant Laxative).

Stimulant Laxative

• 5HT Antagonist Ondansetron( Tab emistat) ibs-D তে বেশ Effective

Tablet 6. Emistat 8mg (As a Ondansetron AS A Anti-emetic drugs).

Indications of Tablet:-Emistat 8mg (As a Ondansetron AS A Anti-emetic drugs).

Emistat is a serotonin subtype 3 (5-HT3) receptor antagonist indicated:

Prevention of nausea and vomiting associated with initial and repeat courses of emetogenic cancer chemotherapy.
Prevention and treatment of post-operative nausea and vomiting.
Prevention of radiotherapy-induced nausea and vomiting.

Description of Tablet:-Emistat 8mg (As a Ondansetron AS A Anti-emetic drugs).

Emistat oral soluble film is a orally dissolving film designed to be applied on top of the tongue where it will dissolve within 20 seconds and then is swallowed with saliva. Oral soluble film does not require water to aid dissolution or swallowing. The active ingredient in Emistat is Emistat base, the racemic form of Emistat, and a selective blocking agent of the serotonin 5-HT3 receptor type. The empirical formula is C₁₈H₁₉N₃O representing a molecular weight of 293.3.

Pharmacology of Tablet:-Emistat 8mg (As a Ondansetron AS A Anti-emetic drugs).

Ondansetron is a potent, highly selective 5HT₃ receptor-antagonist. Its precise mode of action in the control of nausea and vomiting is not known. Chemotherapeutic agents and radiotherapy may cause release of 5HT in the small intestine initiating a vomiting reflex by activating vagal afferents via 5HT₃ receptors. Ondansetron blocks the initiation of this reflex. Activation of vagal afferents may also cause a release of 5HT in the area postrema, located on the floor of the fourth ventricle, and this may also promote emesis through a central mechanism. Thus, the effect of ondansetron in the management of the nausea and vomiting induced by cytotoxic chemotherapy and radiotherapy is probably due to antagonism of 5HT₃ receptors on neurons located both in the peripheral and central nervous system. The mechanisms of action in post-operative nausea and vomiting are not known but there may be common pathways with cytotoxic induced nausea and vomiting.

Dosage of Tablet:-Emistat 8mg (As a Ondansetron AS A Anti-emetic drugs).

Chemotherapy-Induced Nausea and Vomiting-
Adults, Pediatric patients (6 months to 18 years):

8 mg tablet/orodispersible tablet: Three 0.15 mg/kg doses, up to a maximum of 16 mg per dose.
4 mg orodispersible tablet: Three 0.15 mg/kg doses, up to a maximum of 16 mg per dose.
Injection: Three 0.15 mg/kg doses, up to a maximum of 16 mg per dose, infused intravenously over 15 minutes.

Radiotherapy-Induced Nausea and Vomiting-
Adults:

8 mg tablet/orodispersible tablet: Initial Dose: 8 mg orally 1 to 2 hours before radiotherapy. Post Radiotherapy: 8 mg orally every 8 hours for up to 5 days after a course of treatment.
4 mg orodispersible tablet: Three 0.15 mg/kg doses, up to a maximum of 16 mg per dose.
Injection: Three 0.15 mg/kg doses, up to a maximum of 16 mg per dose, infused intravenously over 15 minutes.

Postoperative Nausea and Vomiting-
Adults:

8 mg tablet/orodispersible tablet: 16 mg given as two 8 mg tablets
4 mg orodispersible tablet: 16 mg
Injection: 4 mg

Pediatrics (>40 kg): Injection: 4 mg
Pediatrics (40 kg): Injection: 0.1 mg/kg

Chemotherapy-induced Nausea and Vomiting-
Adults/Geriatric/Child of 12 years or over:

Highly emetogenic cancer chemotherapy: 30 ml (24 mg) Ondansetron Oral Solution administered 30 minutes before start of emetogenic chemotherapy.
Moderate emetogenic cancer chemotherapy: 10 ml (8 mg) Ondansetron Oral Solution administered 30 minutes before start of emetogenic chemotherapy. A further 10 ml dose should be administered after 8 hours of the first dose. One 10 ml dose should be administered twice a day (every 12 hours) for 1-2 days after completion of chemotherapy.

Pediatric (4-11 years): 5 ml (4 mg) Ondansetron Oral Solution should be taken 30 minutes before the start of chemotherapy. The other 2 doses should be taken 4 and 8 hours after the first dose. Then 5 ml oral solution should be administered 3 times a day (every 8 hours) for 1-2 days after completion of chemotherapy.

Oral solution:

Radiotherapy induced Nausea and Vomiting (Adults/Geriatric/Child of 12 years or over):

The recommended oral dosage: 10 ml (8 mg) Ondansetron Oral Solution 3 times daily.
For total body irradiation: 10 ml (8-mg) Ondansetron Oral Solution should be administered 1 to 2 hours before each fraction of radiotherapy administered each day.
For single high-dose fraction radiotherapy to the abdomen: one 10 ml Ondansetron Oral Solution should be administered 1 to 2 hours before radiotherapy, with subsequent doses every 8 hours after the first dose for 1 to 2 days after completion of radiotherapy.
For daily fractionated radiotherapy to the abdomen: 10 ml (8-mg) Ondansetron Oral Solution should be administered 1 to 2 hours before radiotherapy, with subsequent doses every 8 hours after the first dose for each day radiotherapy is given.

Postoperative Nausea and Vomiting (Adults/Geriatric/Child of 12 years or over):

20 ml (16 mg) Ondansetron Oral Solution 1 hour before induction of anesthesia

Oral Soluble Film:

Prevention of nausea and vomiting associated with highly emetogenic cancer chemotherapy:

Adult oral dose: 24 mg given successively as three 8 mg films 30 minutes before the start of chemotherapy.

Prevention of nausea and vomiting associated with moderately emetogenic cancer chemotherapy:

Adults and pediatric patients 12 years of age and older: One 8 mg film 30 minutes before chemotherapy followed by an 8 mg dose 8 hours later. Administer one 8 mg film twice a day (every 12 hours) for 1 to 2 days after completion of chemotherapy.
Pediatric patients 4 through 11 years of age: One 4 mg film three times a day. Administer the first dose 30 minutes before chemotherapy, with subsequent doses 4 and 8 hours later. Administer one 4 mg film three times a day (every 8 hours) for 1 to 2 days after completion of chemotherapy.
Prevention of nausea and vomiting associated with radiotherapy: The adult dosage is one 8 mg film three times a day.
Postoperative nausea and vomiting: The adult dose is 16 mg given successively as two 8 mg films 1 hour before anesthesia.

Side Effects of Tablet:-Emistat 8mg (As a Ondansetron AS A Anti-emetic drugs).

Frequently reported adverse events were headache, constipation and diarrhea, but the majority have been mild or moderate in nature. In chemotherapy-induced nausea and vomiting, rash has occurred in approximately 1% of patients receiving Emistat. There also have been reports to a sensation of flushing or warmth, hiccups and liver enzyme abnormalities. Rare cases of anaphylaxis, brochospasm, tachycardia, angina (chest pain), hypokalemia, shortness of breath have also been reported, except for bronchospasm and anaphylaxis, the relationship to Emistat is unclear. There have been no evidence to extrapyramidal reactions, in rare case oculogyric crisis appearing alone, as well as with other dystonic reactions without definitive clinical evidence. In case of PONV, with the exception of headache, rates of these events were not significantly different in the Emistat and placebo groups.

General Queries 1:

How emistat reduce diarrhoea in ibs D?

Answer is: iBS -D তে Serotonin receptr Stimulate হয় যার জন্য,,Diarrhoea এর ফ্রিকোয়েন্সী বেড়ে যায়

আর Emistat হলো 5HT receptor antagonist__Receptor কে ব্লক করে দিয়ে,Stimulte হতে দেয় না,ultimately Diarrhoea এর Frequency কমে

Git এর Ovar motility ও কমিয়ে দেয়

এভাবে IBS-D তে কাজ করে.

2.Ondansetron এর ডোজ কেমন হবে?

Answer is:TDS (three times a day).

Hopefully bojate peresi.

Criteria of IBS

Recurrent Abdominal pain (avg) 1day/ week লাস্ট ৩মাস & সাথে

• Related to defecation

• মলের ফ্রিকোয়েন্সি পরিবর্তন

•stool এর Appearance chnge

Ref- Harrison

Raiyyan Tahsan Date:23-01-2025 Thursday Time:1-39-55 PM

Raiyyan Tahsan

Raiyyan Tahsan