Coxiwin 2.5%

Dosage

Children: Refer to the BNF for Children for appropriate dosing information in paediatric cases, especially in instances of overdose.

Adults: Refer to the BNF for specific dosing information based on clinical circumstances, particularly in cases of overdose.

Mechanism of action

Ethylene glycol is metabolized by alcohol dehydrogenase to glycoaldehyde, which is subsequently converted to glycolic, glyoxylic, and oxalic acids. These metabolites contribute to anion gap metabolic acidosis and are responsible for tissue injury through the formation of insoluble calcium oxalate crystals.

Pharmacodynamics

The toxicity of ethylene glycol arises from its metabolites, particularly glycolic and oxalic acids. These compounds induce metabolic acidosis, lead to renal failure through calcium oxalate crystal deposition in the kidneys, and can cause neurological impairment. The anion gap increases due to the accumulation of these acids, leading to complications such as cardiovascular instability and potential multi-organ failure.

Pharmacokinetics

Ethylene glycol is rapidly absorbed after oral ingestion. It undergoes first-pass metabolism primarily in the liver, where it is converted into its toxic metabolites. The elimination half-life of ethylene glycol varies but is generally prolonged in cases of renal impairment. Renal excretion of metabolites contributes to the duration of toxicity, necessitating prompt medical intervention in cases of overdose.

Adverse effects

• Metabolic acidosis
• Renal failure
• CNS depression
• Hypocalcemia
• Cardiovascular collapse
• Pulmonary edema

Precautions

• Use with caution in patients with renal impairment
• Monitor for signs of metabolic acidosis
• Evaluate electrolyte levels, particularly calcium

Pregnancy

There is limited data on the safety of ethylene glycol in pregnancy. It should only be used if clearly needed.

Breast-feeding

It is unknown if ethylene glycol is excreted in human milk. Caution is advised.

Storage

Store in a tightly closed container at room temperature, away from heat and moisture.

Formulations

• Liquid

Indications

• Constipation
• Bowel preparation prior to surgical procedures or diagnostic tests

Dosage

Children: Refer to specific guidelines or BNF for Children for dosing information.

Adults: Refer to specific guidelines or BNF for detailed dosing information.

Mechanism of action

Polyethylene glycol works by osmotically retaining water in the intestinal lumen, which increases the water content of the stool. This enhances the passage of stool through the intestines and promotes bowel movements. The high molecular weight of polyethylene glycol prevents its absorption in the gastrointestinal tract, ensuring that it remains in the lumen to exert its effects.

Pharmacodynamics

The pharmacodynamic profile of polyethylene glycol involves its ability to increase stool water content, thereby reducing stool consistency and facilitating easier passage. It does not stimulate intestinal motility directly but rather relies on the osmotic effect to promote bowel evacuation. The onset of action typically occurs within 24 to 96 hours after ingestion.

Pharmacokinetics

Polyethylene glycol is not absorbed systemically, and its pharmacokinetics are characterized by its presence solely in the gastrointestinal tract. It is excreted unchanged in the stool. The volume of polyethylene glycol administered can influence the effectiveness and timing of its action, but its absorption is negligible, making systemic side effects rare.

Adverse effects

• Abdominal cramping
• Diarrhea
• Nausea
• Vomiting
• Bloating
• Flatulence

Precautions

• Use with caution in patients with gastrointestinal disorders or bowel obstruction.
• Ensure adequate hydration during use to prevent dehydration.

Pregnancy

Polyethylene glycol is generally considered safe during pregnancy, but should be used under medical supervision.

Breast-feeding

Polyethylene glycol is excreted in breast milk in very small amounts and is generally regarded as safe during breastfeeding.

Storage

Store at room temperature, away from moisture and heat.

Formulations

• Powder for oral solution
• Liquid formulation

Indications

• Coccidiosis
• Protozoan infections

Dosage

Children: Refer to the BNF for Children for specific paediatric dosing recommendations.

Adults: Refer to the BNF for specific dosing guidelines.

Mechanism of action

Toltrazuril acts by inhibiting the mitochondrial respiratory chain of protozoa, leading to a disruption of ATP synthesis. This mechanism results in the inhibition of the growth and reproduction of coccidia, particularly Eimeria species, by impairing their energy metabolism.

Pharmacodynamics

Toltrazuril exhibits its effects through selective targeting of the protozoan parasites' mitochondrial functions. The disruption of ATP synthesis results in reduced energy availability for cellular processes, ultimately leading to the death of the parasite. It has a high efficacy against various stages of the coccidian life cycle.

Pharmacokinetics

Toltrazuril is well absorbed after oral administration, with peak plasma concentrations occurring within a few hours. It is extensively metabolized in the liver, with metabolites contributing to its pharmacological activity. The elimination half-life allows for sustained effects against parasitic infections. The drug is primarily excreted via feces.

Pregnancy

There is limited data on the use of toltrazuril in pregnancy. It should only be used if the potential benefit justifies the potential risk to the fetus.

Breast-feeding

It is not known whether toltrazuril is excreted in human milk. Caution should be exercised when administering toltrazuril to nursing women.

Storage

Store below 30°C. Protect from light and moisture.

Indications

• Topical formulations
• Emulsifying agent
• pH adjustment in solutions
• Cosmetic preparations

Dosage

Children: Refer to specific product guidelines for appropriate dosing, as the dosage may vary based on formulation and indication.

Adults: Refer to specific product guidelines for appropriate dosing, as the dosage may vary based on formulation and indication.

Mechanism of action

As an amine, triethanolamine is capable of accepting a hydrogen ion to form hydroxide and a conjugate acid, which effectively raises the pH of the solution. As a surfactant, it lowers the interfacial tension in mixtures or solutions, preventing the separation of emulsions or the precipitation of compounds out of solution.

Pharmacodynamics

Triethanolamine acts primarily as a surfactant or alkalizing agent, aiding in the emulsification and solubilization of compounds, as well as in raising the pH of solutions. Its surfactant properties make it useful in improving the stability and consistency of topical formulations.

Pharmacokinetics

The pharmacokinetics of triethanolamine have not been extensively studied, but it is generally considered to be minimally absorbed through the skin when used topically. Its effects are primarily local, occurring at the site of application rather than systemically.

Pregnancy

There is insufficient data on the use of triethanolamine during pregnancy. Caution is advised.

Breast-feeding

Limited information is available regarding the excretion of triethanolamine in human milk. Caution is recommended.

Storage

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

Formulations

• Topical cream
• Ointment
• Gel

Mechanism of action

Ethylene glycol is metabolized by alcohol dehydrogenase to glycoaldehyde, which is then metabolized to glycolic, glyoxylic, and oxalic acids. These acids, along with excess lactic acid are responsible for the anion gap metabolic acidosis. Oxalic acid readily precipitates with calcium to form insoluble calcium oxalate crystals. Tissue injury is caused by widespread deposition of oxalate crystals and the toxic effects of glycolic and glyoxylic acids.

Mechanism of action

As an amine, trolamine is capable of accepting a hydrogen to form hydroxide and a conjugate acid. This raises the pH of the solution. As a surfactant, it can lower the interfacial tension in a mixture or solution to prevent separation of emulsions or precipitation of a compound out of solution.

Pharmacodynamics

Acts as a surfactant or alkalizing agent to aid in emulsification and solubilizing of compounds or in raising the pH of a solution