Cough-Ex Cough Mixture

Indications

• Skin disinfection
• Preparation of skin before injections
• Cleansing minor wounds

Dosage

Children: Apply to the skin as required; consult product literature for specific guidance.

Adults: Apply to the skin as required for disinfection.

Mechanism of action

Alcohol exerts its antiseptic effect by denaturing proteins, disrupting cell membranes, and dehydrating microbial cells, leading to cell lysis and death.

Pharmacodynamics

Alcohol has broad-spectrum antimicrobial activity, effective against bacteria, fungi, and viruses. Its efficacy is influenced by concentration, with higher concentrations generally being more effective.

Pharmacokinetics

Alcohol is rapidly absorbed through the skin and mucous membranes. It is metabolized primarily in the liver, with a half-life that varies based on the individual's metabolic rate and the amount consumed.

Contra-indications

• Concomitant use with lithium
• Regular use in neonates
• Patients with severe burns when diathermy has been preceded by application of alcoholic skin disinfectants

Adverse effects

• Eye erythema
• Punctate keratitis
• Cytotoxicity
• Eye discolouration

Interactions

• Increases risk of visual disturbances with antiepileptics
• Increases concentration with methylphenidate
• Increases risk of facial flushing and skin irritation with topical pimecrolimus
• Increases concentration with retinoids
• Increases concentration with acitretin
• Increases risk of facial flushing and skin irritation with topical tacrolimus
• Decreases antidiuretic effect with vasopressin

Precautions

• Avoid regular application to inflamed or broken skin or mucosa
• Avoid broken skin
• Flammable

Pregnancy

Sufficient iodine may be absorbed to affect the fetal thyroid in the second and third trimester.

Breast-feeding

Avoid regular or excessive use.

Storage

Store in a cool, dry place away from heat and direct sunlight.

Formulations

• Betadine 2.5% dry powder spray
• Industrial methylated spirit
• Povidone-Iodine 25 mg per 1 gram

Indications

• Dyspepsia
• Flatulence
• Bloating
• Cough relief
• Antimicrobial support

Dosage

Children: Consult appropriate pediatric herbal guidelines, as specific dosing is not universally established.

Adults: Refer to herbal supplement guidelines for dosing, as specific doses can vary widely based on preparation and concentration.

Mechanism of action

Aniseed contains several active compounds, including anethole, which is believed to exert its effects primarily through modulation of the gastrointestinal system. Anethole can stimulate the secretion of digestive enzymes and has been shown to possess antispasmodic properties, potentially alleviating symptoms related to gastrointestinal discomfort. Additionally, its antimicrobial properties may contribute to inhibiting the growth of certain pathogens.

Pharmacodynamics

The pharmacodynamic profile of aniseed is characterized by its ability to enhance digestive function and alleviate symptoms of dyspepsia. Its antispasmodic effects are mediated through inhibition of smooth muscle contractions in the gut. Aniseed may also exhibit mild sedative properties, contributing to its use as a calming herbal remedy. The overall effect is a combination of digestive support and potential relief from gastrointestinal discomfort.

Pharmacokinetics

The pharmacokinetics of aniseed components, particularly anethole, involve oral absorption followed by distribution throughout the body. Anethole is metabolized in the liver and excreted primarily in the urine. The onset of action can vary based on the form of administration, with herbal teas generally producing effects within a few hours, while concentrated extracts may have a more rapid onset. The duration of action is also influenced by the dose and form used.

Adverse effects

• Allergic reactions
• Dermatitis
• Gastrointestinal upset

Interactions

• May interact with anticoagulants, increasing the risk of bleeding
• Can enhance the effects of sedative medications

Precautions

• Use with caution in individuals with a history of allergies, particularly to plants in the Apiaceae family
• May cause skin irritation in sensitive individuals

Pregnancy

Generally considered safe when used in culinary amounts, but high doses should be avoided due to potential hormonal effects.

Breast-feeding

Considered safe when used in culinary amounts, but high doses should be avoided.

Storage

Store in a cool, dry place away from direct sunlight and moisture.

Formulations

• Whole seeds
• Essential oil
• Ground powder

Indications

• Food preservative
• Treatment of urea cycle disorders
• Metabolic disorders involving benzoyl-CoA

Dosage

Children: Refer to the BNF for Children for specific dosing guidelines based on condition.

Adults: Refer to the BNF for specific dosing guidelines based on condition.

Mechanism of action

Benzoate acts mainly by inhibiting the growth of bacteria and fungi through its ability to lower the pH, creating an environment that is less favorable for microbial growth. It is also involved in metabolic pathways where it helps in the conjugation of toxic substances, facilitating their excretion from the body.

Pharmacodynamics

Benzoate is known for its antimicrobial properties, which are particularly effective against a wide range of fungi and bacteria. Its efficacy as a preservative is due to its ability to penetrate microbial cell membranes and disrupt their metabolic processes. Additionally, it has been observed to modulate various metabolic pathways, particularly those associated with aromatic compound degradation.

Pharmacokinetics

After ingestion, benzoate is rapidly absorbed in the gastrointestinal tract. It is metabolized primarily in the liver, where it undergoes conjugation with glycine to form hippurate, which is then excreted in the urine. The half-life of benzoate varies depending on individual metabolic rates but is generally short due to its efficient conversion and excretion.

Pregnancy

There is limited data on the use of benzoate in pregnancy. Consultation with healthcare professionals is advised before use.

Breast-feeding

Limited data is available on the excretion of benzoate in breast milk. Caution is recommended when administering to nursing mothers.

Storage

Store in a cool, dry place away from direct sunlight. Keep out of reach of children.

Indications

• Anti-inflammatory support
• Muscle soreness relief
• Management of gout
• Sleep aid
• Antioxidant supplementation

Dosage

Children: Refer to specific product guidelines, as doses can vary based on formulation and intended use.

Adults: Refer to specific product guidelines, as doses can vary based on formulation and intended use.

Mechanism of action

The beneficial effects of cherries are attributed to their high content of anthocyanins and phenolic compounds, which exert antioxidant effects by scavenging free radicals. These compounds may also modulate inflammatory pathways by inhibiting pro-inflammatory cytokines and enzymes, thus contributing to their anti-inflammatory properties.

Pharmacodynamics

Cherries may help reduce muscle soreness after exercise, lower uric acid levels, and improve joint health in conditions like gout and arthritis. The anti-inflammatory effects are beneficial in managing symptoms associated with chronic inflammatory diseases. Additionally, the presence of melatonin may support sleep quality by regulating circadian rhythms.

Pharmacokinetics

The bioavailability of cherry compounds varies; anthocyanins are absorbed in the gastrointestinal tract and may be metabolized into various forms. Peak plasma concentrations typically occur within a few hours after consumption. The elimination half-life of cherry metabolites can vary, and factors like individual metabolism, the form of cherry consumed, and the presence of other dietary components can influence pharmacokinetics.

Pregnancy

Cherries are generally considered safe to consume during pregnancy. They provide beneficial nutrients but should be eaten in moderation.

Breast-feeding

Cherries are also safe during breastfeeding and can provide essential vitamins and antioxidants.

Storage

Store cherries in a cool, dry place. Refrigeration can extend their freshness, ideally in a perforated plastic bag.

Formulations

• Fresh cherries
• Dried cherries
• Cherry juice
• Cherry extract

Indications

• Acidulant in food and beverages
• Preservative in pharmaceutical formulations
• pH adjuster in various chemical preparations

Dosage

Children: Refer to product-specific guidelines for appropriate dosing based on formulation and indication.

Adults: Refer to product-specific guidelines for appropriate dosing based on formulation and indication.

Mechanism of action

Citric acid acts by chelating metal ions, which can enhance the solubility of certain compounds and improve their bioavailability. It also contributes to the acidity of the environment, which can influence enzymatic activity and metabolic pathways, particularly in the degradation of citronellol.

Pharmacodynamics

Citric acid exhibits mild pharmacological effects primarily attributed to its role in metabolic processes. It aids in the regulation of pH levels, which can impact enzymatic reactions and biochemical pathways. The acid's chelating properties may help to reduce the toxicity of certain metal ions in biological systems.

Pharmacokinetics

Citric acid is rapidly absorbed after oral administration and is metabolized in the liver. It undergoes conversion to various metabolites in the citric acid cycle, contributing to energy production. The elimination primarily occurs through urine, with minimal accumulation in the body.

Pregnancy

Citric acid is generally regarded as safe during pregnancy when used in food amounts. However, consult a healthcare provider for advice on medicinal use.

Breast-feeding

Citric acid is considered safe during breastfeeding when consumed in food amounts. For medicinal use, consult a healthcare provider.

Storage

Store in a cool, dry place away from direct sunlight.

Indications

• Management of drug interactions
• Optimization of combination therapy in chronic diseases
• Prevention of adverse drug reactions

Dosage

Children: Refer to specific drug monographs for paediatric dosing, considering age, weight, and specific clinical circumstances.

Adults: Refer to specific drug monographs for adult dosing based on individual drug characteristics and interaction potential.

Mechanism of action

Drug interactions can alter the absorption, distribution, metabolism, or excretion of drugs. For instance, one drug may inhibit or induce metabolic enzymes, leading to increased or decreased plasma concentrations of another drug. Additionally, drugs may compete for binding sites on proteins, affecting the free concentration of active drug in the bloodstream.

Pharmacodynamics

The pharmacodynamics of drug interactions involve changes in the efficacy and safety profiles of drugs when administered together. This can result in additive, synergistic, or antagonistic effects, where the combined effect of two drugs is greater than or less than the sum of their individual effects.

Pharmacokinetics

Pharmacokinetic interactions can occur at various stages: absorption (altered gastrointestinal pH or motility), distribution (competition for protein binding), metabolism (induction or inhibition of cytochrome P450 enzymes), and excretion (altered renal clearance). These interactions can significantly impact the therapeutic window of drugs, necessitating careful monitoring.

Pregnancy

Consult a healthcare provider. Safety during pregnancy has not been established.

Breast-feeding

Consult a healthcare provider. Excretion in breast milk is unknown.

Storage

Store in a cool, dry place, away from direct sunlight.

Indications

• Use as a preservative in pharmaceutical formulations
• Antimicrobial agent in cosmetic and food products
• Potential use in the management of inflammatory conditions due to salicylate biosynthesis

Dosage

Children: Refer to the BNF for Children for appropriate dosing information.

Adults: Refer to the specific product guidelines and BNF for appropriate dosing information.

Mechanism of action

Hydroxybenzoate functions primarily as a preservative by inhibiting the growth of microorganisms. It exerts its effects through the disruption of microbial cell metabolism, thereby preventing spoilage and degradation. The compound is involved in various biosynthetic pathways, including the production of salicylates, which possess anti-inflammatory properties.

Pharmacodynamics

Hydroxybenzoate displays antimicrobial activity against a range of bacteria and fungi. Its efficacy is influenced by factors such as pH and concentration, with higher concentrations generally leading to greater antimicrobial effects. The compound may also exhibit antioxidant properties, contributing to its protective effects in various formulations.

Pharmacokinetics

The pharmacokinetics of hydroxybenzoate involves its absorption, distribution, metabolism, and excretion. It is readily absorbed when applied topically or ingested. Once in the system, it is metabolized primarily in the liver, with metabolites excreted through the urine. The elimination half-life may vary based on the formulation and route of administration.

Pregnancy

There is limited information available regarding the safety of hydroxybenzoate during pregnancy. Consult a healthcare provider for advice.

Breast-feeding

It is unclear if hydroxybenzoate is excreted in human milk. Consult a healthcare provider before use.

Storage

Store in a cool, dry place, away from direct sunlight. Keep out of reach of children.

Indications

• Allergic conditions
• Autoimmune diseases
• Asthma and chronic obstructive pulmonary disease (COPD)
• Certain cancers (e.g., leukemia, lymphoma)
• Skin conditions (e.g., dermatitis)
• Inflammatory bowel disease
• Multiple sclerosis exacerbations
• Severe infections requiring immunosuppression

Dosage

Children: Refer to BNF for Children for specific dosing; doses vary significantly based on the child's age, weight, and condition being treated.

Adults: Refer to BNF for specific dosing; typically, initial doses range from 4 to 48 mg depending on the severity of the condition.

Mechanism of action

Methylprednisolone exerts its effects by binding to glucocorticoid receptors, leading to the modulation of gene expression. This interaction influences the transcription of anti-inflammatory proteins while suppressing the expression of pro-inflammatory genes, ultimately resulting in reduced inflammation and immune response.

Pharmacodynamics

The pharmacodynamic effects of methylprednisolone are characterized by its ability to decrease inflammation, suppress the immune response, and affect carbohydrate metabolism. Therapeutic doses lead to various systemic effects, including modification of leukocyte distribution and inhibition of cytokine production.

Pharmacokinetics

Methylprednisolone is well absorbed after oral administration, with a bioavailability of approximately 50%. It has a volume of distribution that reflects extensive tissue binding. The drug is metabolized primarily in the liver through conjugation and reduction, and its metabolites are excreted in urine. The half-life varies based on the route of administration but is generally around 18 to 36 hours.

Adverse effects

• Increased blood pressure
• Hyperglycemia
• Weight gain
• Mood changes
• Insomnia
• Gastrointestinal disturbances
• Increased susceptibility to infections

Interactions

• methylphenidate+apraclonidine: Severe (decreases effects)
• methylthioninium chloride+bupropion: Severe (increases risk of severe hypertension)
• methylphenidate+linezolid: Severe (increases risk of elevated blood pressure)
• rasagiline+methylphenidate: Severe (increases risk of a hypertensive crisis)
• mao-inhibitors+methylphenidate: Severe (increases risk of a hypertensive crisis)
• dronedarone+methylprednisolone: Moderate (increases exposure)
• miconazole+methylprednisolone: Moderate (increases concentration)
• antifungals, azoles+methylprednisolone: Moderate (increases exposure)
• crizotinib+methylprednisolone: Moderate (increases exposure)

Precautions

• Use with caution in patients with hypertension
• Monitor blood glucose levels in diabetic patients
• Consider potential for infection risk due to immunosuppression
• Evaluate for psychiatric effects in susceptible individuals

Pregnancy

Corticosteroids may be used during pregnancy if the potential benefit justifies the risk to the fetus. Careful monitoring is advised.

Breast-feeding

Corticosteroids are excreted in breast milk; caution is advised. Monitor the infant for potential effects.

Storage

Store in a cool, dry place, away from light. Keep out of reach of children.

Formulations

• Tablets
• Injectable solutions
• Topical preparations

Mechanism of action

Methylsulphate functions as a methylating agent, transferring a methyl group to nucleophiles. This process involves the formation of a sulfonium ion, which is highly reactive and can readily react with nucleophilic sites on various substrates, leading to methylation reactions.

Pharmacodynamics

The pharmacodynamics of methylsulphate is primarily related to its role as a methylating agent in biochemical reactions. It can alter the structure and function of biological molecules, potentially affecting cellular processes and signaling pathways. However, detailed pharmacodynamic studies specific to therapeutic use are limited.

Pharmacokinetics

There is limited information on the pharmacokinetics of methylsulphate, given its typical use as a reagent in laboratory settings rather than a clinical drug. When used in chemical reactions, its reactivity and transformation into other compounds would dictate its pharmacokinetic profile, which could vary significantly based on the specific context of use.

Pregnancy

There is limited data on the use of methylsulphate in pregnancy. Consult relevant guidelines.

Breast-feeding

Data on the excretion of methylsulphate in human milk is not available. Caution is advised.

Storage

Store in a cool, dry place, away from direct sunlight.

Indications

• High cholesterol
• Hypertension
• Digestive issues
• Antimicrobial infections
• Respiratory conditions

Dosage

Children: Refer to established guidelines and clinical evidence for specific dosing, as no exact dosages are provided for wild garlic.

Adults: Refer to established guidelines and clinical evidence for specific dosing, as no exact dosages are provided for wild garlic.

Mechanism of action

The active compounds in wild garlic, particularly allicin, exhibit antimicrobial properties by disrupting the integrity of microbial cell membranes, leading to cell death. Additionally, these compounds may enhance nitric oxide production, promoting vasodilation and cardiovascular health.

Pharmacodynamics

Wild garlic possesses various pharmacological effects, including antimicrobial, antifungal, and anti-inflammatory activities. The presence of sulfur compounds, such as ajoene and diallyl sulfide, contributes to its potential health benefits, including cholesterol-lowering effects and support for immune function.

Pharmacokinetics

The bioavailability of the active compounds in wild garlic can vary based on the method of preparation and consumption. Allicin, for instance, is rapidly metabolized in the body, leading to its short-lived effects. The absorption of these compounds occurs primarily in the gastrointestinal tract, and their metabolites are excreted through urine.

Pregnancy

Consult a healthcare professional before use. Safety during pregnancy is not well established.

Breast-feeding

Consult a healthcare professional before use. Safety during breastfeeding is not well established.

Storage

Store in a cool, dry place, away from direct sunlight.

Mechanism of action

Ethanol affects the brain’s neurons in several ways. It alters their membranes as well as their ion channels, enzymes, and receptors. Alcohol also binds directly to the receptors for acetylcholine, serotonin, GABA, and the NMDA receptors for glutamate. The sedative effects of ethanol are mediated through binding to GABA receptors and glycine receptors (alpha 1 and alpha 2 subunits). It also inhibits NMDA receptor functioning. In its role as an anti-infective, ethanol acts as an osmolyte or dehydrating agent that disrupts the osmotic balance across cell membranes. ... Ethanol is known to affect a large number of membrane proteins that participate in signaling pathways such as neurotransmitter receptors, enzymes, and ion channels, and there is extensive evidence that ethanol interacts with a variety of neurotransmitters. The major actions of ethanol involve enhancing the inhibitory effects of gamma-aminobutyric acid (GABA) at GABAa receptors and blockade of the N-methyl-D-aspartate (NMDA) subtype of glutamate, an excitatory amine acid (EAA) receptor. Animal studies indicate that the acute effects of ethanol result from competitive inhibition of glycine binding to NMDA receptor and disruption of glutamatergic neurotransmission by inhibiting the response of the NMDA receptor. Persistent glycine antagonism and attenuation of glutamatergic neurotransmission by chronic ethanol exposure results in tolerance to ethanol by enhancing EAA neurotransmission and NMDA receptor upregulation. The latter appears to involve selective increases in NMDA R2B subunit concentrations and other molecular changes in specific brain loci. The abrupt withdrawal of ethanol thus produces a hyperexcitable state that leads to the ethanol withdrawal syndrome and excitotoxic neuronal death. GABA-mediated inhibition, which normally acts to limit excitation, is eliminated during ethanol withdrawal syndrome and further intensifies this excitation. In addition, NMDA receptors function to inhibit the release of dopamine in the nucleus accumbens and mesolimbic structures, which modulate the reinforcing action of addictive xenobiotics such as ethanol. By inhibiting NMDA receptor activity, ethanol could increase dopamine release from the nucleus accumbens and ventral tegmental area and could thus create dependence. Chronic ethanol administration also results in tolerance, dependence, and an ethanol withdrawal syndrome, mediated, in part, by desensitization and or downregulation of GABAa receptors. The development of alcoholic ketoacidosis (AKA) requires that a combination of physical and physiologic events occur. The normal response to starvation and depletion of hepatic glycogen stores is for amino acids to be converted to pyruvate. Pyruvate can serve as a substrate for gluconeogenesis, be converted to acetyl-CoA, which can enter the Krebs cycle or can be utilized in various biosynthetic pathways (eg, fatty acid, ketone bodies, cholesterol, and acetylcholine) ... Ethanol metabolism generates NADH, resulting in an excess of reducing potential. This high redox state favors the conversion of pyruvate to lactate, diverting pyruvate from being a substrate for gluconeogenesis. To compensate for the lack of normal metabolic substrates, the body mobilizes fat from adipose tissue and increased fatty acid metabolism as an alternative source of energy. This response is mediated by a decrease in insulin and an increased secretion of glucagon, catecholamines, growth hormone, and cortisol. Fatty acid metabolism results in the formation of acetyl-CoA and it combines with the excess acetate that is generated from ethanol metabolism to form acetoacetate. Most of the acetoacetate is reduced to beta-hydroxybutyrate due to the excess reducing potential or high redox state of the cell. Volume depletion interferes with the renal elimination of acetoacetate and beta-hydroxybutyrate, and contributes to the acidosis. An elevated lactate concentration may result from shunting from pyruvate or

Pharmacodynamics

Alcohol produces injury to cells by dehydration and precipitation of the cytoplasm or protoplasm. This accounts for its bacteriocidal and antifungal action. When alcohol is injected in close proximity to nerve tissues, it produces neuritis and nerve degeneration (neurolysis). Ninety to 98% of ethanol that enters the body is completely oxidized. Ethanol is also used as a cosolvent to dissolve many insoluble drugs and to serve as a mild sedative in some medicinal formulations. Ethanol also binds to GABA, glycine, NMDA receptors and modulates their effects. Ethanol is also metabolised by the hepatic enzyme alcohol dehydrogenase.