DROCIN TRIPLE ACTION RELIEF

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

• Used in medical devices and containers for fluids
• Used in drug delivery systems

Dosage

Children: Polyvinyl is not a drug and therefore does not have a dosage.

Adults: Polyvinyl is not a drug and therefore does not have a dosage.

Mechanism of action

Polyvinyl does not have a pharmacological mechanism of action as it is a structural material rather than a drug. Its function is primarily physical, providing a safe and effective medium for storage and transport of medical fluids and medications.

Pharmacodynamics

As a polymer, polyvinyl does not exert pharmacodynamic effects typical of active pharmaceutical ingredients. Its role in medicine is to serve as an inert substance that provides a barrier to contamination and ensures the integrity of the contents it holds.

Pharmacokinetics

Polyvinyl is not absorbed or metabolized in the body in the way that drugs are. It remains in a stable form and is excreted unchanged if it enters the body, with no systemic effects or pharmacokinetic profile.

Pregnancy

Polyvinyl products are generally considered safe for use during pregnancy; however, specific formulations should be assessed for safety.

Breast-feeding

Polyvinyl compounds are unlikely to pose a risk during breastfeeding, but exposure should be minimized when possible.

Storage

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

Indications

• Preoperative skin antisepsis
• Wound irrigation and cleansing
• Management of minor cuts and abrasions
• Treatment of minor skin infections
• Disinfection of mucous membranes

Dosage

Children: Refer to specific product guidelines for concentration and application method, as doses may vary by formulation.

Adults: Refer to specific product guidelines for concentration and application method, as doses may vary by formulation.

Mechanism of action

Povidone-iodine exerts its antiseptic effects primarily through the release of free iodine, which penetrates microbial cell walls and disrupts protein and nucleic acid synthesis. This leads to cell lysis and death of a wide variety of pathogens. The mechanism involves the oxidation of essential cellular components, thus rendering microorganisms inactive.

Pharmacodynamics

Povidone-iodine demonstrates rapid bactericidal activity, effectively reducing the microbial load on the skin and in wounds. The antimicrobial efficacy is influenced by factors such as concentration, exposure time, and the presence of organic matter. Its broad-spectrum action makes it effective against gram-positive and gram-negative bacteria, fungi, and viruses, making it a versatile antiseptic.

Pharmacokinetics

Povidone-iodine is not significantly absorbed through intact skin; however, some absorption may occur with large or prolonged applications, especially on compromised skin. The elimination half-life of iodide is approximately 24 hours, with the majority excreted unchanged in the urine. Iodine levels can be temporarily elevated in the serum after application, particularly in patients with pre-existing thyroid conditions.

Contra-indications

• Hypersensitivity to povidone-iodine or any of the excipients
• Thyroid dysfunction
• Use in infants less than 2 months of age

Adverse effects

• Skin irritation
• Burning sensation
• Allergic reactions
• Staining of skin and clothing
• Thyroid dysfunction
• Electrolyte imbalance (with prolonged use)

Interactions

• May interfere with thyroid function tests
• Incompatibility with other antiseptics or disinfectants

Precautions

• Avoid contact with eyes
• Use with caution in patients with thyroid disease
• Not for deep puncture wounds or serious burns

Pregnancy

Generally considered safe for topical use, but should be used with caution. Consult a healthcare professional for guidance.

Breast-feeding

Suitable for topical use, but excessive use should be avoided. Consult a healthcare professional for guidance.

Storage

Store at room temperature, away from direct sunlight. Keep container tightly closed.

Formulations

• Topical solution
• Ointment
• Surgical scrub
• Swab sticks

Indications

• Allergic rhinitis
• Nasal congestion
• Ocular irritation

Dosage

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

Adults: Refer to BNF for specific dosing information.

Mechanism of action

Tetryzoline selectively activates alpha-1 adrenergic receptors, which are G-protein-coupled receptors that mediate vasoconstriction. This action reduces vascular permeability and alleviates the symptoms of ocular irritation and nasal congestion caused by vasodilation in the conjunctival and nasal capillaries.

Pharmacodynamics

Tetryzoline exhibits vasoconstricting and decongestant effects by constricting small arterioles in the nasal passages and conjunctival blood vessels. It is capable of crossing the blood-brain barrier, which may lead to additional effects such as hypotension, bradycardia, analgesia, hypothermia, sedation, and hypnosis due to its action on alpha-2 adrenoceptors and imidazole receptors.

Pharmacokinetics

The pharmacokinetics of tetryzoline involve absorption, distribution, metabolism, and excretion characteristics typical of sympathomimetic agents. Specific data on half-life, peak plasma concentrations, and elimination routes are not provided in the source material, hence further literature should be consulted for detailed pharmacokinetic parameters.

Adverse effects

• Local irritation
• Burning sensation in the eyes
• Dryness of the nasal mucosa
• Rebound congestion with prolonged use

Precautions

• Use with caution in patients with cardiovascular disease
• Use with caution in patients with hypertension
• Avoid prolonged use to prevent rebound congestion

Pregnancy

Safety in pregnancy has not been established; use only if clearly needed.

Breast-feeding

It is not known whether tetryzoline is excreted in human milk; caution is advised.

Storage

Store at room temperature, away from moisture and heat.

Formulations

• Ophthalmic solution
• Nasal spray

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.

Mechanism of action

Adrenergic receptors are G-protein-coupled receptors (GPCR) that regulate vascular tone: stimulation of alpha-1 adrenergic receptors leads to vasoconstriction. Ocular redness and nasal congestion often result from vasodilation of nasal, conjunctival, and corneal capillary blood vessels. Activation of alpha-1 adrenergic receptors have been therefore associated with a reduction of symptoms of ocular irritation and nasal congestion. Tetryzoline is a selective agonist of alpha-1 adrenergic receptors, causing vasoconstriction and alleviating ocular and nasal symptoms.

Pharmacodynamics

Tetryzoline is a sympathomimetic amine and an alpha-adrenergic agonist with vasoconstricting and decongestant properties. It works by constricting the smaller arterioles of the nasal passages and conjunctival blood vessels to ameliorate allergic rhinitis, nasal congestion, and ocular irritation. Tetryzoline is known to cross the blood-brain barrier to work on alpha-2 adrenoceptors and imidazole receptors, causing effects like hypotension, bradycardia, analgesia, hypothermia, sedation, and hypnosis.