PEPSIN PLUS​ SYRUP (​Each 5ml contains​ sodium bicarbonate, peppermint oil, menthol, anise oil, ginger oil, lemon oil ​120mg/5mg/0.7mg/1mg/15mg/20mg​)

Indications

• Dyspepsia
• Flatulence
• Cough
• Insomnia
• Loss of appetite

Dosage

Children: As with adults, dosage for children should be determined by a healthcare provider based on age, weight, and clinical condition.

Adults: Dosage varies based on the form of anise used (e.g., whole seeds, powdered, or oil). Consult a qualified healthcare professional for specific dosing recommendations.

Mechanism of action

The active compounds in anise, particularly anethole, are thought to exert their effects through various mechanisms, including modulation of the gastrointestinal tract's motility, enhancement of mucosal secretion, and antimicrobial activity against a range of pathogens. Anethole may also interact with certain receptors, such as estrogen receptors, contributing to its potential hormonal effects.

Pharmacodynamics

Anise demonstrates several pharmacological effects, including carminative properties, which help alleviate gas and bloating, and antimicrobial effects against certain bacteria and fungi. It may also exhibit antioxidant activity, providing protection against oxidative stress. Anise has been used in traditional medicine for its potential to stimulate appetite and digestive functions, and it may have mild sedative properties.

Pharmacokinetics

The pharmacokinetics of anise have not been extensively studied in clinical settings. However, anise is generally considered to be rapidly absorbed when ingested, with its active constituents metabolized primarily in the liver. The elimination half-life of its key components has not been well-established, but its effects are typically experienced shortly after consumption and may last for a few hours. Anise is primarily excreted in urine as metabolites.

Adverse effects

• Allergic reactions
• Nausea
• Vomiting
• Diarrhea
• Skin irritation

Interactions

• May interact with anticoagulants
• May enhance the effects of sedatives
• Potential interaction with other herbal supplements

Precautions

• Use with caution in individuals with allergies to plants in the Apiaceae family
• Consult healthcare provider if pregnant or breastfeeding
• Monitor for allergic reactions in sensitive individuals

Pregnancy

Not enough reliable information is available regarding the safety of anise during pregnancy. It is advisable to consult a healthcare provider before use.

Breast-feeding

Limited data is available on the safety of anise while breastfeeding. Caution is recommended, and consulting a healthcare provider is advisable.

Storage

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

Formulations

• Whole seeds
• Ground powder
• Essential oil
• Tinctures

Indications

• Metabolic acidosis
• Acid-base imbalance
• Urinary alkalinization
• Treatment of certain poisonings
• Cardiac arrest in the context of metabolic acidosis

Dosage

Children: Refer to the BNF for Children for specific pediatric dosages, as they depend on the clinical condition

Adults: Refer to local guidelines and BNF for specific dosing recommendations as they may vary based on clinical condition and severity. General adult dosing for bicarbonate may range from 1 to 2 mEq/kg IV initially, followed by maintenance doses as needed.

Mechanism of action

Bicarbonate acts as a buffer that neutralizes excess acids in the body. It dissociates in solution to produce bicarbonate ions (HCO3-) which can react with hydrogen ions (H+) to form carbonic acid (H2CO3), subsequently leading to the production of carbon dioxide (CO2) and water (H2O). This process helps to raise the pH of the blood and other fluids, counteracting acidosis. Bicarbonate is involved in several metabolic pathways, including the urea cycle and various biosynthetic pathways.

Pharmacodynamics

Bicarbonate's primary pharmacodynamic effect is its ability to buffer hydrogen ions, thus increasing blood pH. This is essential in conditions such as metabolic acidosis, where the body accumulates excess acid. By raising blood pH, bicarbonate can help alleviate symptoms associated with acidemia, such as fatigue, confusion, and shortness of breath. Its effects can also influence the renal and respiratory systems to regulate acid-base homeostasis.

Pharmacokinetics

Bicarbonate is rapidly absorbed from the gastrointestinal tract. It is distributed throughout the body fluids, and its effects can be seen within minutes of administration. The kidneys play a significant role in bicarbonate homeostasis by reabsorbing bicarbonate from urine and excreting hydrogen ions. The elimination half-life can vary, depending on the patient's metabolic state and renal function.

Pregnancy

Use with caution. Consult with a healthcare provider before use.

Breast-feeding

Use with caution. Consult with a healthcare provider before use.

Storage

Store in a cool, dry place away from light.

Indications

• Nausea and vomiting (including motion sickness and morning sickness)
• Gastrointestinal discomfort
• Osteoarthritis
• Inflammation
• Cold and flu symptoms

Dosage

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

Adults: Refer to established guidelines for specific dosing; typically, doses range from 1 to 3 grams of dried ginger per day.

Mechanism of action

The active components of ginger, particularly gingerols, exert their effects primarily through the inhibition of pro-inflammatory cytokines and enzymes, such as cyclooxygenase and lipoxygenase. This action helps to reduce inflammation and pain. Additionally, ginger enhances gastrointestinal motility and has antiemetic properties, which are beneficial in treating nausea.

Pharmacodynamics

Ginger exhibits anti-inflammatory, antioxidant, and antinausea effects. Its ability to modulate the immune response and inhibit platelet aggregation contributes to its cardiovascular protective effects. The antiemetic properties of ginger are particularly effective in reducing nausea and vomiting associated with motion sickness and chemotherapy.

Pharmacokinetics

Ginger is rapidly absorbed in the gastrointestinal tract, with its active components being metabolized in the liver. The bioavailability of ginger compounds may vary, with gingerols being converted into shogaols during processing or heating. The elimination half-life and specific metabolic pathways have not been extensively studied, but the effects can be observed within 30 minutes to 2 hours after ingestion.

Contra-indications

• Gallstones
• Bleeding disorders
• Allergy to ginger or other plants in the Zingiberaceae family

Adverse effects

• Gastrointestinal disturbances (nausea, diarrhea, heartburn)
• Allergic reactions (skin rash, itching)
• Increased risk of bleeding

Interactions

• Anticoagulants (e.g., warfarin, aspirin)
• Antiplatelet agents
• Certain antihypertensives
• Diabetes medications (may enhance effects)

Precautions

• Use with caution in patients with diabetes, hypertension, or gallbladder disease
• Consult a healthcare provider before use in pregnancy or lactation

Pregnancy

Generally considered safe in food amounts, but high doses should be avoided due to potential effects on uterine contractions.

Breast-feeding

Considered safe in food amounts, but high doses should be avoided.

Storage

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

Formulations

• Dried ginger powder
• Ginger root (fresh)
• Ginger tea
• Ginger extract (liquid or capsule)
• Ginger oil

Indications

• Antiseptic cleaning
• Disinfection of surfaces
• Cleansing agents in personal care products

Dosage

Children: Refer to the BNF for Children for specific dosing recommendations based on age and weight.

Adults: Refer to the specific product recommendations and BNF guidelines for appropriate dosing based on the formulation and intended use.

Mechanism of action

The exact mechanism of action is not fully understood, but it is attributed to the denaturing of lipoprotein complexes and possibly other actions. The major site of action may be the cell membrane, where these agents may cause changes in permeability that allow the escape of enzymes, coenzymes, and metabolic intermediates. Additionally, cationic surfactants emulsify sebaceous material, facilitating its removal along with dirt and bacteria. The mild desquamating effect of quaternary ammonium compounds aids in cleaning.

Pharmacodynamics

Pharmacodynamics involves the study of the effects of drugs on biological systems. In this context, the interactions of quaternary ammonium compounds with cell membranes result in altered permeability and subsequent effects on cellular processes. This can lead to enhanced cleaning and antimicrobial activity, as well as potential alterations in metabolic pathways due to the release of intracellular components.

Pharmacokinetics

Pharmacokinetics refers to the absorption, distribution, metabolism, and excretion of substances. For quaternary ammonium compounds, specific pharmacokinetic data may not be fully characterized. Generally, these compounds may be absorbed through mucous membranes and skin, with variable distribution in body tissues. They are often metabolized in the liver and excreted primarily through urine.

Pregnancy

Use with caution. Limited data available on safety during pregnancy.

Breast-feeding

Use with caution. Limited data available on safety during breastfeeding.

Storage

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

Formulations

• Topical solutions
• Creams
• Lotions

Indications

• Scurvy prevention
• Digestive aid
• Immune system support
• Skin health
• Antimicrobial applications

Dosage

Children: There is no specific paediatric dosage for lemon; it can be given to children in moderate amounts as part of a balanced diet.

Adults: There is no specific adult dosage for lemon; it can be consumed in various forms such as fresh fruit, juice, or as part of food and beverages.

Mechanism of action

Lemon contains compounds such as citric acid, flavonoids, and essential oils. Citric acid may enhance the absorption of minerals and has a role in the Krebs cycle, promoting energy metabolism. Flavonoids possess antioxidant properties, which help combat oxidative stress and inflammation, while essential oils can exhibit antimicrobial and anti-inflammatory effects.

Pharmacodynamics

The pharmacodynamic effects of lemon are primarily attributed to its antioxidant properties, which help neutralize free radicals, reduce oxidative stress, and support overall health. The citric acid in lemon may also aid in alkalizing the body, improving metabolic processes, and supporting digestion.

Pharmacokinetics

The bioavailability of lemon compounds can vary based on the form of consumption (whole fruit, juice, or extract). Vitamin C is rapidly absorbed in the gastrointestinal tract and distributed throughout the body. The metabolism of flavonoids occurs primarily in the liver, and they may have a variable half-life depending on individual metabolism.

Adverse effects

• Allergic reactions in sensitive individuals
• Gastrointestinal discomfort
• Tooth enamel erosion with excessive use

Precautions

• Caution in individuals with citrus allergies
• May cause skin irritation if applied topically in concentrated forms

Pregnancy

Lemon is generally considered safe during pregnancy, but excessive intake should be avoided.

Breast-feeding

Lemon is safe during breastfeeding when consumed in normal dietary amounts.

Storage

Store in a cool, dry place. Fresh lemons should be kept in the refrigerator to maintain freshness.

Formulations

• Fresh lemon
• Lemon juice
• Lemon essential oil
• Lemon zest

Indications

• Topical analgesic for muscle and joint pain
• Cough suppressant in cough drops and lozenges
• Relief of minor throat irritation
• Cooling agent in various cosmetic and personal care products

Dosage

Children: Refer to BNF for Children for specific dosing guidelines, as doses may vary based on age and formulation.

Adults: For topical use, apply a thin layer to the affected area not more than 3 to 4 times daily. For cough drops, follow the product-specific instructions as per the formulation.

Mechanism of action

Menthol acts as an agonist for the transient receptor potential subtype M8 (TRPM8), a non-selective cation channel that is activated by cold temperatures. This activation leads to calcium influx in mast cells, inducing the release of histamine, which can trigger allergic responses such as urticaria, asthma, and rhinitis. Menthol's ability to induce histamine release via TRPM8 suggests potential therapeutic applications for TRPM8 antagonists in managing cold- and menthol-induced allergies.

Pharmacodynamics

Menthol produces a cooling effect by stimulating sensory neurons that convey cold sensations. It interacts with TRPM8 channels, leading to the activation of intracellular signaling pathways that can result in vasodilation and increased blood flow to the area of application. This cooling sensation can provide symptomatic relief in conditions characterized by pain or irritation.

Pharmacokinetics

Menthol is absorbed through the skin and mucous membranes, with systemic effects depending on the route of administration. Its bioavailability can vary, and it is metabolized primarily in the liver. The elimination half-life and excretion pathways have not been extensively characterized, but menthol is generally considered to have a rapid onset of action with effects lasting for a few hours.

Adverse effects

• Allergic reactions
• Urticaria
• Asthma
• Rhinitis
• Skin irritation

Precautions

• Use with caution in patients with known allergies to menthol or related compounds
• May exacerbate asthma in sensitive individuals

Pregnancy

There are no well-controlled studies of menthol in pregnant women. Menthol should be used during pregnancy only if clearly needed.

Breast-feeding

Menthol is excreted in breast milk. Caution should be exercised when administering to nursing mothers.

Storage

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

Formulations

• Topical ointment
• Cream
• Liquid

Indications

• Irritable bowel syndrome
• Dyspepsia
• Nausea
• Headaches
• Respiratory congestion

Dosage

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

Adults: Refer to the relevant product-specific information for dosing recommendations, as peppermint formulations can vary widely.

Mechanism of action

The primary active component, menthol, works by activating the TRPM8 (transient receptor potential cation channel subfamily M member 8) ion channel, which is involved in the sensation of cold and cooling. This action can lead to a localized anesthetic effect, reducing pain and discomfort. Additionally, menthol can cause relaxation of smooth muscle in the gastrointestinal tract, aiding in the relief of digestive symptoms.

Pharmacodynamics

Peppermint exhibits antispasmodic effects, particularly in the gastrointestinal tract, by relaxing the smooth muscles. It also has a mild analgesic effect due to its cooling sensation, which can provide symptomatic relief in various conditions. Furthermore, peppermint oil may have antimicrobial properties, contributing to its use in treating certain infections.

Pharmacokinetics

Menthol is rapidly absorbed after oral administration and is metabolized in the liver. The peak plasma concentration typically occurs within a few hours. The elimination half-life of menthol is approximately 1.5 to 2 hours, and it is primarily excreted in the urine as metabolites. The pharmacokinetics of peppermint oil can vary based on the formulation and route of administration.

Interactions

• peppermint oil + lomitapide: Unknown (increases exposure)

Pregnancy

Peppermint is generally considered safe for use in pregnancy when used in culinary amounts. However, high doses should be avoided due to potential uterine stimulation.

Breast-feeding

Peppermint is considered safe during breastfeeding when used in culinary amounts. Caution is advised with high doses as effects on the infant are not well studied.

Storage

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

Formulations

• Peppermint oil
• Peppermint extract
• Peppermint tea

Indications

• Pain relief
• Allergy symptoms
• Cold and flu symptoms
• Gastrointestinal discomfort
• Minor skin irritations

Dosage

Children: Dosage varies by specific drug; refer to pediatric dosing guidelines in established references for accurate dosing.

Adults: Dosage varies by specific drug; refer to product labeling or a trusted pharmacological reference for guidance.

Mechanism of action

The mechanism of action for public medications varies according to the specific drug. For example, analgesics like paracetamol act by inhibiting the synthesis of prostaglandins in the brain, while antihistamines block histamine receptors to reduce allergy symptoms.

Pharmacodynamics

Pharmacodynamics also varies by drug, with public medications generally exhibiting effects such as pain relief, reduction of inflammation, or alleviation of allergy symptoms. The efficacy and onset of action depend on the drug class, dosage form, and route of administration.

Pharmacokinetics

Pharmacokinetics of public medications typically includes absorption, distribution, metabolism, and elimination processes. Absorption rates can vary based on whether the drug is taken orally, topically, or via other routes. Most drugs undergo hepatic metabolism, and renal clearance is common for elimination, although specifics differ widely among individual medications.

Dosage

Children: Refer to the BNF for Children for appropriate dosing information in paediatric patients, as dosages should be determined based on age, weight, and specific clinical indications.

Adults: Refer to the specific prescribing information and clinical guidelines for dosing recommendations, as these can vary widely based on the condition being treated.

Mechanism of action

Pursuant acts through various pathways depending on its active ingredients and formulation. Generally, it may exert its effects by modulating neurotransmitter levels, influencing hormonal balance, or altering cellular signaling pathways to produce its therapeutic effects.

Pharmacodynamics

The pharmacodynamics of pursuant involve its interaction with specific receptors in the body, leading to a physiological response. This can include the inhibition or activation of certain biological pathways, ultimately resulting in the desired therapeutic outcomes. The effects can vary based on dosage and duration of treatment.

Pharmacokinetics

Pursuant is absorbed through the gastrointestinal tract and undergoes metabolism primarily in the liver. Its elimination half-life and excretion routes can vary based on individual patient factors and specific formulation. Factors such as age, liver function, and concurrent medications can influence its pharmacokinetic profile.

Pregnancy

Pursuant should be used in pregnancy only if the potential benefit justifies the potential risk to the fetus. Consult a healthcare provider before use.

Breast-feeding

Caution is advised when using pursuant during breastfeeding. It is important to consult a healthcare provider to assess potential risks and benefits.

Storage

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

Indications

• Pain relief
• Inflammation reduction
• Fever reduction
• Management of osteoarthritis
• Management of rheumatoid arthritis
• Relief of menstrual pain
• Management of acute gout

Dosage

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

Adults: Refer to the BNF for specific dosing recommendations based on the condition being treated.

Mechanism of action

Section acts primarily as a nonsteroidal anti-inflammatory drug (NSAID). It inhibits the cyclooxygenase enzymes (COX-1 and COX-2), leading to decreased formation of prostaglandins, which are mediators of inflammation, pain, and fever. This results in reduced inflammatory response and alleviation of pain.

Pharmacodynamics

The pharmacodynamic effects of Section include analgesic (pain-relieving), antipyretic (fever-reducing), and anti-inflammatory properties. By decreasing prostaglandin synthesis, it effectively reduces the sensation of pain and the signs of inflammation. The onset of action may vary depending on the route of administration, with oral forms typically taking longer to exhibit effects compared to injectable forms.

Pharmacokinetics

Section is well-absorbed from the gastrointestinal tract when administered orally, reaching peak plasma concentrations within a few hours. It is extensively metabolized in the liver, with metabolites excreted primarily in urine. The elimination half-life can vary based on the specific formulation and individual metabolic factors but generally ranges from several hours to a day.

Pregnancy

Consult healthcare provider for risks and benefits; effects may vary based on specific drug.

Breast-feeding

Consult healthcare provider; some drugs may pass into breast milk.

Storage

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

Mechanism of action

MODE OF ACTION ... NOT YET FULLY UNDERSTOOD BUT HAS BEEN ASCRIBED TO ... THE DENATURING OF LIPOPROTEIN COMPLEXES, & POSSIBLY OTHER ACTIONS. /QUATERNARY AMMONIUM COMPD/ EVIDENCE HAS BEEN PRESENTED THAT THE MAJOR SITE OF ACTION ... MAY BE THE CELL MEMBRANE, WHERE THE AGENTS MAY CAUSE CHANGES IN PERMEABILITY THAT PERMIT ESCAPE OF ENZYMES, COENZYMES, & METABOLIC INTERMEDIATES. /CATIONIC SURFACTANTS/ EMULSIFY SEBACEOUS MATERIAL, WHICH IS THEN REMOVED TOGETHER WITH DIRT & BACTERIA. THE MILD DESQUAMATING EFFECT OF THE QUATERNARY AMMONIUM COMPOUNDS AIDS IN CLEANING. /QUATERNARY AMMONIUM COMPD/

Mechanism of action

Exposure to low temperatures often causes allergic responses or urticaria. Similarly, menthol, a common food additive is also known to cause urticaria, asthma, and rhinitis. However, despite the obvious clinical implications, the molecular mechanisms responsible for inducing allergic responses to low temperatures and menthol have not been determined. Because a non-selective cation channel, transient receptor potential subtype M8 (TRPM8) is activated by cold and menthol, we hypothesized that this channel mediates cold- and menthol-induced histamine release in mast cells. Here, we report that TRPM8 is expressed in the basophilic leukemia mast cell line, RBL-2H3, and that exposure to menthol or low temperatures induced Ca(2+) influx in RBL-2H3 cells, which was reversed by a TRPM8 blocker. Furthermore, menthol, a TRPM8 agonist, induced the dose-dependent release of histamine from RBL-2H3 cells. When TRPM8 transcripts were reduced by siRNA (small interfering RNA), menthol- and cold-induced Ca(2+) influx and histamine release were significantly reduced. In addition, subcutaneous injection of menthol evoked scratching, a typical histamine-induced response which was reversed by a TRPM8 blocker. Thus, our findings indicate that TRPM8 mediates the menthol- and cold-induced allergic responses of mast cells, and suggest that TRPM8 antagonists be viewed as potential treatments for cold- and menthol-induced allergies. /DL-Menthol/ Menthol's characteristic cooling sensation is due, in part, to the activation of sensory neurons generally termed transient receptor potential (TRP) channels, in particular transient receptor potential melastatin family member 8 (TRPM8) and transient receptor potential subfamily A, member 1 (TRPA1). Menthol acts upon TRPM8 receptors by rapidly increasing intracellular calcium and mobilizing calcium flux through the channels to induce cold response signals at the application site. Aside from its cold-inducing sensation capabilities, menthol exhibits cytotoxic effects in cancer cells, induces reduction in malignant cell growth, and engages in synergistic excitation of GABA receptors and sodium ion channels resulting in analgesia. /DL-Menthol/ In recent years, the transient receptor potential melastatin member 8 (TRPM8) channel has emerged as a promising prognostic marker and putative therapeutic target in prostate cancer. We have found that forced overexpression of TRPM8 in PC-3 cells can inhibit the cell proliferation and motility probably through the TRPM8 activation. In this study, we aimed to investigate whether activating the TRPM8 channel by its selective agonist menthol can inhibit the proliferation and motility of androgen-independent prostate cancer (AIPC) with remarkable expression of TRPM8. Menthol is a naturally occurring compound, which has been widely used in cosmetics and pharmaceutical products, and also as flavoring in food. DU145 cells are androgen-independent but have a remarkable expression of TRPM8. The demonstration of the existence of TRPM8 and the absence of TRPA1 in DU145 cells provided the foundation for the following experiments, because both TRPM8 and TRPA1 are molecular targets of menthol. The outcome of MTT assay indicated that menthol inhibited the cell growth (p < 0.01). Cell cycle distribution and scratch assay analysis revealed that menthol induced cell cycle arrest at the G(0)/G(1) phase (p < 0.01). Furthermore, menthol inhibited the migration of DU145 cells by downregulating the focal-adhesion kinase. So it suggests that the activation of the existing TRPM8 channels may serve as a potential and pragmatic treatment for those AIPC with remarkable expression of TRPM8, and menthol is a useful compound for future development as an anticancer agent. /DL-Menthol/