LIQUID ( MAGNESIUM SULPHATE/ CONC SENNA INFUSION 250mg/0.90ml)

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

• Constipation
• Palliative care for bowel cleansing

Dosage

Children: Child 1 month–3 years: 3.75–15 mg once daily, adjusted according to response. Child 4–17 years: 3.75–30 mg once daily, adjusted according to response.

Adults: 7.5–15 mg once daily (max. per dose 30 mg daily), typically taken at bedtime. The initial dose should be low and increased gradually as needed, with higher doses prescribed under medical supervision.

Mechanism of action

Senna contains sennosides, which are metabolized in the colon to form active compounds that stimulate the peristaltic movement of the intestines. This promotes bowel evacuation by increasing the contraction of intestinal muscles and enhancing fluid secretion into the bowel, leading to softer stools.

Pharmacodynamics

The pharmacodynamic effect of senna includes increased intestinal motility and secretion of electrolytes and water into the intestines, resulting in softened stools and facilitation of bowel movements. Side effects may include abdominal cramps and gastrointestinal disturbances, as well as potential skin reactions.

Pharmacokinetics

Senna is not absorbed significantly in the gastrointestinal tract; its active metabolites exert their effects locally in the intestines. The onset of action is typically within 6 to 12 hours when taken orally. Metabolism occurs in the gut, and excretion is primarily via feces, with minimal systemic absorption.

Contra-indications

• Acute abdominal conditions
• Acute inflammatory bowel disease
• Intestinal obstruction
• Severe dehydration

Adverse effects

• Abdominal cramps
• Asthenia
• Gastrointestinal disorders
• Skin reactions
• Urine discolouration

Precautions

• Excessive use of stimulant laxatives can cause diarrhea and related effects such as hypokalaemia
• Local irritation - avoid prolonged contact with skin (incontinent patients or infants wearing nappies, risk of irritation and excoriation)
• Rodent studies indicate potential carcinogenic risk

Pregnancy

Manufacturers advise to avoid - limited information available.

Breast-feeding

Manufacturers advise to avoid - no information available.

Storage

Store at room temperature, away from moisture and heat.

Formulations

• Oral suspension
• Tablets
• Syrup
• Suppositories