JEERNASE DIGESTIVE TABLETS

Indications

• Hypertension
• Benign prostatic hyperplasia
• Urinary retention related to prostate enlargement

Dosage

Children: Refer to the BNF for Children for appropriate dosing guidelines in the paediatric population.

Adults: Refer to the BNF for specific dosing recommendations based on individual clinical scenarios.

Mechanism of action

Alpha acts by selectively blocking alpha-1 adrenergic receptors, which are responsible for mediating vasoconstriction in blood vessels. By inhibiting these receptors, alpha promotes vasodilation, leading to a decrease in peripheral vascular resistance and subsequently lowering blood pressure. Additionally, this action can help alleviate urinary symptoms associated with an enlarged prostate.

Pharmacodynamics

The pharmacodynamics of alpha involve its competitive antagonism at alpha-1 adrenergic receptors, resulting in decreased vasoconstriction and increased blood flow. This mechanism is beneficial in conditions characterized by high blood pressure and urinary retention due to prostatic enlargement. The onset of action typically occurs within hours, with peak effects observed within a few days of consistent dosing.

Pharmacokinetics

Alpha is absorbed well from the gastrointestinal tract, with peak plasma concentrations achieved within 1-3 hours post-administration. The drug undergoes hepatic metabolism, primarily via cytochrome P450 enzymes, resulting in active and inactive metabolites. The elimination half-life varies, but it generally is around 6-12 hours, allowing for once-daily dosing in many cases. Renal excretion is a significant route for its metabolites, necessitating caution in patients with renal impairment.

Interactions

• maois, irreversible + alpha blockers: Severe (increases effects)
• ribociclib + alpha blockers: Severe (increases exposure)
• cobicistat + alpha blockers: Moderate (increases exposure)
• idelalisib + alpha blockers: Moderate (increases exposure)
• dronedarone + alpha blockers: Unknown (increases exposure)
• antifungals, azoles + alpha blockers: Unknown (increases exposure)
• crizotinib + alpha blockers: Unknown (increases exposure)
• imatinib + alpha blockers: Unknown (increases exposure)
• letermovir + alpha blockers: Unknown (increases exposure)
• clarithromycin + alpha blockers: Unknown (increases exposure)

Indications

• Pancreatitis
• Salivary gland disorders
• Carbohydrate malabsorption syndromes

Dosage

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

Adults: Refer to the specific guidelines and dosing recommendations in the BNF.

Mechanism of action

Amylase facilitates the breakdown of starch and glycogen into maltose and dextrins by cleaving the α-1,4-glycosidic bonds in these polysaccharides. Its action begins in the mouth with salivary amylase and continues in the small intestine with pancreatic amylase, where it further digests carbohydrates.

Pharmacodynamics

Amylase increases the rate of carbohydrate digestion, thereby influencing blood glucose levels. The enzyme's activity can be affected by pH levels, temperature, and the presence of inhibitors or activators. In clinical settings, elevated levels of amylase in the blood can indicate pancreatitis or other pancreatic disorders.

Pharmacokinetics

Amylase is absorbed and metabolized in the gastrointestinal tract. Its activity is measured through serum levels, with normal ranges indicating proper pancreatic function. The half-life of amylase in the bloodstream can vary based on individual metabolic rates and health conditions.

Pregnancy

Amylase is generally considered safe during pregnancy but should be used under medical supervision.

Breast-feeding

Amylase is excreted in breast milk; it is advisable to consult a healthcare provider before use while breastfeeding.

Storage

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

Indications

• Lactose intolerance
• Galactosemia
• Digestive enzyme deficiency

Dosage

Children: Refer to the BNF for Children for age-appropriate dosing.

Adults: Refer to specific guidelines or the BNF for appropriate dosing.

Mechanism of action

Galactosidase works by cleaving the glycosidic bond in galactosides, which includes compounds such as lactose. This enzymatic action converts galactose and glucose into simpler sugars that can be easily absorbed by the intestines. The enzyme operates through a hydrolytic mechanism, utilizing water to break the bond, thus making the sugars bioavailable.

Pharmacodynamics

The pharmacodynamic effects of galactosidase are primarily related to its ability to aid in the digestion of carbohydrates, particularly in individuals with lactose intolerance or galactosemia. By facilitating the breakdown of lactose and galactosides, it reduces gastrointestinal symptoms such as bloating, gas, and diarrhea that may occur due to undigested sugars.

Pharmacokinetics

Galactosidase is administered orally and is typically absorbed in the gastrointestinal tract. The onset of action is usually within a few hours of ingestion, and the duration of effect can vary depending on the individual and the formulation used. It is metabolized in the liver, and the elimination route is primarily through the renal system, with enzymes being excreted in urine as metabolites.

Adverse effects

• Hypersensitivity reactions
• Gastrointestinal disturbances
• Abdominal pain
• Diarrhea
• Flatulence

Precautions

• Use with caution in patients with galactosemia
• Monitor for allergic reactions in patients with a history of allergies
• Consider potential interactions with other gastrointestinal medications

Pregnancy

Safety during pregnancy has not been established. Use only if clearly needed and prescribed by a healthcare professional.

Breast-feeding

Limited data available. Caution is advised; consult a healthcare professional before use.

Storage

Store at room temperature, away from moisture and heat. Keep out of reach of children.

Formulations

• Oral tablets
• Powder for oral solution
• Capsules

Indications

• Digestive aid
• Improvement of feed efficiency in livestock
• Enhancement of fermentation processes in biofuel production

Dosage

Children: Refer to specific product guidelines as dosages may vary depending on the formulation and intended use.

Adults: Refer to specific product guidelines as dosages may vary depending on the formulation and intended use.

Mechanism of action

Hemicellulase catalyzes the hydrolysis of hemicellulose, resulting in the breakdown of complex polysaccharides into smaller sugar units, such as xylose and arabinose. This enzymatic action facilitates the digestion of plant materials by increasing the availability of fermentable sugars.

Pharmacodynamics

The pharmacodynamics of hemicellulase primarily involve its ability to enhance the digestibility of fibrous plant material. By breaking down hemicellulose, hemicellulase increases the bioavailability of nutrients, which can improve overall metabolic efficiency in both human and animal systems. Its effects are dose-dependent, with higher concentrations generally leading to greater enzymatic activity.

Pharmacokinetics

Hemicellulase is not absorbed systemically as it acts locally within the gastrointestinal tract to hydrolyze dietary fibers. Its activity is influenced by factors such as pH and temperature, with optimal conditions varying depending on the specific source of the enzyme. The enzyme is typically inactivated by high temperatures during food processing but can remain active in the digestive tract under appropriate conditions.

Pregnancy

Safety in pregnancy has not been established.

Breast-feeding

Safety during breastfeeding has not been established.

Storage

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

Indications

• Lactose intolerance
• Symptoms of lactose malabsorption

Dosage

Children: Refer to product-specific instructions, dosage may vary based on age and weight.

Adults: Refer to product-specific instructions, typically taken with the first bite of dairy.

Mechanism of action

Lactase works by breaking down lactose into its component sugars, glucose and galactose. This reaction occurs in the small intestine, where lactase binds to lactose molecules and facilitates their hydrolysis. The resulting monosaccharides are then absorbed into the bloodstream, alleviating the symptoms of lactose intolerance.

Pharmacodynamics

The pharmacodynamics of lactase is primarily related to its enzymatic activity. By increasing the concentration of lactase in the gut, it enhances the digestion of lactose, thus reducing the osmotic load and fermentation that leads to gastrointestinal discomfort. This enzymatic action can help prevent symptoms associated with lactose intolerance when dairy products are consumed.

Pharmacokinetics

Lactase is not absorbed systemically; instead, it acts locally in the gastrointestinal tract. It remains in the intestinal lumen where it exerts its effects on lactose digestion. The onset of action is typically rapid, occurring within minutes of ingestion of lactose-containing foods. The duration of action is contingent upon the amount of lactose present and the quantity of lactase administered.

Adverse effects

• Abdominal cramps
• Bloating
• Diarrhea
• Nausea

Precautions

• Use with caution in patients with galactosemia
• Monitor for symptoms of lactose intolerance
• Consult a healthcare professional before use in children

Pregnancy

Lactase is generally considered safe to use during pregnancy, as it is a naturally occurring enzyme in the digestive system.

Breast-feeding

Lactase is also considered safe during breastfeeding, as it does not significantly affect breast milk composition.

Storage

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

Formulations

• Lactase enzyme capsules
• Lactase enzyme tablets
• Lactase enzyme drops

Indications

• Pancreatic insufficiency
• Cystic fibrosis
• Chronic pancreatitis
• Malabsorption syndromes

Dosage

Children: Refer to the BNF for Children for specific pediatric dosing guidelines, as it varies based on age, weight, and clinical conditions.

Adults: Refer to specific product guidelines or clinical protocols, as dosages may vary based on the formulation and clinical condition.

Mechanism of action

Lipase hydrolyzes triglycerides into diglycerides and free fatty acids. This process occurs in the presence of bile salts, which emulsify fats, allowing lipase to effectively access and break down lipid molecules. The free fatty acids produced can then be absorbed by the intestinal mucosa and transported into the bloodstream.

Pharmacodynamics

Lipase enhances the digestion of dietary fats, facilitating their absorption. The activity of lipase is pH-dependent, with optimal function occurring in the alkaline environment of the small intestine. The enzyme's activity can be influenced by factors such as dietary composition and the presence of bile salts. Elevated levels of lipase in the bloodstream can indicate pancreatic inflammation or damage, such as in cases of pancreatitis.

Pharmacokinetics

Lipase is not absorbed systemically; it functions locally in the gastrointestinal tract. The enzyme is secreted by the pancreas and acts in the small intestine. Its activity can be affected by gastrointestinal transit time and the presence of other digestive enzymes. The half-life of lipase in the gastrointestinal tract is dependent on dietary intake and gastrointestinal motility.

Adverse effects

• Abdominal cramping
• Diarrhea
• Nausea
• Vomiting
• Allergic reactions

Precautions

• Use with caution in patients with a history of pancreatitis
• Monitor for signs of allergic reactions
• Evaluate dietary fat intake in patients receiving lipase therapy

Pregnancy

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

Breast-feeding

Lipase can be used while breastfeeding, although it is advisable to consult a healthcare provider.

Storage

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

Formulations

• Capsules
• Tablets
• Powder for oral suspension

Indications

• HIV/AIDS
• Cancer
• Chronic pancreatitis
• Certain inflammatory diseases

Dosage

Children: Refer to the BNF for Children for specific paediatric dosing information regarding protease inhibitors.

Adults: Refer to the BNF for specific dosage recommendations for protease inhibitors based on the particular drug and condition being treated.

Mechanism of action

Proteases function by hydrolyzing the peptide bonds that link amino acids in proteins. This process is essential for the activation of many proteins and for the degradation of misfolded or damaged proteins. In antiretroviral therapy, protease inhibitors block the action of viral proteases, preventing the maturation of viral particles and thereby inhibiting viral replication.

Pharmacodynamics

Proteases exhibit a variety of pharmacodynamic effects depending on their specific type and target. For instance, HIV protease inhibitors prevent the cleavage of viral polyproteins, which is essential for the production of infectious viral particles. The inhibition of proteolytic activity can lead to accumulation of unprocessed protein precursors, ultimately reducing the viral load in patients with HIV.

Pharmacokinetics

The pharmacokinetic profile of proteases varies widely among different classes. Generally, they are absorbed following oral administration, but the extent of absorption can be affected by food intake. Many protease inhibitors undergo extensive hepatic metabolism, particularly via the cytochrome P450 enzyme system. The elimination half-life can range from several hours to days, depending on the specific protease. Renal excretion plays a significant role in the clearance of some proteases, while others may be predominantly excreted in the feces.

Pregnancy

Refer to specific product guidelines as data may vary.

Breast-feeding

Refer to specific product guidelines as data may vary.

Storage

Store at room temperature, away from moisture and light.