NEUTRAFLUX SUSPENSION

Indications

• Dyspepsia
• Colic
• Wind pains

Dosage

Children: For children aged 1 month to 1 year: 0.5–1 mL, to be taken before feeds. For children aged 5–11 years: 5–10 mL three times a day, alternatively as required. For children aged 12–17 years: 10–20 mL three times a day, alternatively as required.

Adults: 10–20 mL three times a day, alternatively as required, to be made up with water.

Mechanism of action

Simeticone acts as a surfactant, decreasing the surface tension of gas bubbles in the gastrointestinal tract. This action facilitates the coalescence of mucus-covered gas bubbles, leading to their expulsion. The clinical efficacy of simeticone is attributed to these antifoam properties, which help alleviate discomfort caused by trapped gas.

Pharmacodynamics

Simeticone effectively decreases the surface tension of gas bubbles within the gastrointestinal tract, thereby facilitating their expulsion. It has a short duration of action, as it is typically administered on an as-needed basis, and possesses a wide therapeutic index because it is not absorbed systemically, making it generally safe for use.

Pharmacokinetics

Simeticone is not absorbed into the systemic circulation and is excreted unchanged. It has a localized effect within the gastrointestinal tract, where it acts to alleviate symptoms related to gas. Due to its lack of systemic absorption, the pharmacokinetics of simeticone are characterized by rapid action following administration, with effects lasting only as long as the drug is present in the gastrointestinal tract.

Contra-indications

• Hypophosphataemia
• Severe renal impairment
• Hepatic coma

Adverse effects

• Diarrhoea
• Nephrolithiasis (long term use)

Interactions

• Magnesium salts may interact with other medications and should be avoided in patients with renal impairment.

Precautions

• Use with caution in patients with heart failure, hypermagnesaemia, metabolic alkalosis, or respiratory alkalosis.
• Avoid antacids containing large amounts of sodium in patients with fluid retention.

Pregnancy

Simeticone is generally considered safe during pregnancy as it is not systemically absorbed.

Breast-feeding

Simeticone is considered safe during breastfeeding as it is not systemically absorbed.

Storage

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

Formulations

• Oral suspension (Infacol 40mg/ml, Dentinox Infant colic drops)
• Chewable tablets (Dentinox)
• Liquid form (sugar-free options available)

Indications

• Gastroesophageal reflux disease (GERD)
• Heartburn
• Esophagitis
• Dyspepsia

Dosage

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

Adults: Refer to BNF for specific dosing guidelines.

Mechanism of action

Alginic acid works by reacting with sodium bicarbonate in the presence of gastric acid to form sodium alginate, which creates a gel-like substance that floats on top of the gastric contents. This gel acts as a physical barrier to prevent acid reflux into the esophagus, thereby alleviating symptoms associated with GERD. It may also help protect the esophageal mucosa from damage caused by acid exposure.

Pharmacodynamics

The pharmacodynamics of alginic acid are primarily associated with its ability to form a viscous gel in acidic conditions. This gel not only helps to neutralize gastric acid but also provides a protective layer against reflux. The onset of action is relatively rapid, with effects typically occurring within minutes of ingestion, making it effective for immediate relief from symptoms of heartburn and acid reflux.

Pharmacokinetics

Alginic acid is not absorbed systemically; instead, it remains in the gastrointestinal tract where it exerts its local effects. The gel formed by alginic acid is primarily eliminated through the feces. Its pharmacokinetic profile indicates a low potential for drug interactions, as it does not significantly affect the absorption of other medications when taken as directed.

Adverse effects

• Gastrointestinal disturbances (e.g., bloating, flatulence)
• Allergic reactions (rare)

Precautions

• Use with caution in patients with a history of gastrointestinal obstruction
• Monitor for allergic reactions in sensitive individuals

Pregnancy

Alginic acid is generally considered safe during pregnancy, but it is advisable to consult a healthcare professional before use.

Breast-feeding

Alginic acid is likely safe during breastfeeding, but it is recommended to consult a healthcare professional.

Storage

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

Formulations

• Oral suspension
• Chewable tablets
• Gastroesophageal reflux disease (GERD) formulations

Indications

• Dyspepsia
• Peptic ulcer disease
• Gastroesophageal reflux disease (GERD)
• Heartburn
• Diarrhea
• Mucosal irritations

Dosage

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

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

Mechanism of action

Aluminum acts as an astringent, causing local shrinkage or constriction of body tissues through osmotic flow of fluids away from the area of application. This mechanism assists in reducing mucous secretions and managing conditions such as peptic ulcers and diarrhea. Additionally, it can help in drying and hardening of tissues when applied topically.

Pharmacodynamics

Aluminum-based antacids work by neutralizing gastric acid, leading to an increase in gastric pH. This action helps to alleviate symptoms associated with excess gastric acid, such as heartburn and discomfort. The astringent properties of aluminum also contribute to its therapeutic effects in managing mucosal irritations and secretions.

Pharmacokinetics

Aluminum is absorbed minimally when taken orally, with a bioavailability of about 0.1 to 0.5%. The majority of aluminum is excreted renally, and its half-life can be prolonged in individuals with renal impairment. Long-term use may lead to accumulation and potential toxicity, particularly impacting bone and neurological health.

Interactions

• aluminiumhydroxide+deferasirox: Severe (decreases exposure)
• aluminiumhydroxide+enteralfeeds: Unknown (increases risk of blocked enteral or nasogastric tubes)
• aluminiumhydroxide+roxadustat: Unknown (decreases exposure)

Pregnancy

Aluminum compounds are generally considered safe in pregnancy when used as directed. However, excessive exposure should be avoided.

Breast-feeding

Aluminum is excreted in breast milk; caution is advised when administered to nursing mothers.

Storage

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

Formulations

• aluminium hydroxide suspension
• aluminium hydroxide tablets

Indications

• Nutritional supplementation
• Herbal therapy for various conditions
• Preservation of medicinal properties of plants

Dosage

Children: Dosage for dried herbal preparations in children should be approached cautiously and is best determined by a healthcare professional. Refer to paediatric guidelines for specific dosing recommendations.

Adults: Dosage for dried herbal preparations varies widely depending on the specific herb and its intended use. Refer to specific guidelines or reputable sources for dosing information.

Mechanism of action

The mechanism of action for dried herbal preparations varies depending on the specific plant material involved. Generally, the active constituents in dried herbs can exert their effects through various pathways, such as modulating neurotransmitter systems, influencing metabolic pathways, and acting on specific receptors in the body. For instance, flavonoids, terpenes, and alkaloids found in certain dried herbs can exhibit anti-inflammatory, antioxidant, or antimicrobial properties.

Pharmacodynamics

The pharmacodynamics of dried drugs depend on their specific chemical constituents. These compounds can affect physiological functions, such as modulating inflammatory responses, enhancing immune function, or affecting neurotransmission. The effects can vary widely based on the type of herb, the method of drying, and the concentration of active ingredients.

Pharmacokinetics

The pharmacokinetics of dried herbal preparations can vary significantly based on the specific herb used. Generally, after ingestion, the active compounds are absorbed in the gastrointestinal tract, metabolized primarily by the liver, and then excreted through urine or feces. The bioavailability of these compounds can be influenced by factors such as the form of the preparation (e.g., powder, extract), the presence of other food substances, and individual patient characteristics.

Pregnancy

Safety during pregnancy has not been established. Consult a healthcare provider before use.

Breast-feeding

Consult a healthcare provider before use during breastfeeding.

Storage

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

Dosage

Children: Refer to specific guidelines for pediatric dosing; consult the BNF for Children for accurate dosage information.

Adults: Refer to specific guidelines for use; dosage may vary based on the context of use.

Mechanism of action

Hydroxide ions act primarily as bases, neutralizing acids to form water and salts. They participate in various biochemical pathways, including selenium metabolism and the degradation of reactive oxygen species. Hydroxide can influence enzyme activity and stability by altering the pH of the environment, thereby affecting metabolic reactions.

Pharmacodynamics

Hydroxide ions can impact biological processes by changing the local pH, which influences enzyme activity, ion transport, and the solubility of other compounds. Their ability to neutralize acids can help regulate physiological pH, contributing to homeostasis in living organisms.

Pharmacokinetics

As an inorganic ion, hydroxide does not undergo traditional pharmacokinetic processes like absorption, distribution, metabolism, or excretion. Instead, it is rapidly equilibrated in biological fluids and participates in acid-base reactions, having immediate effects on the local environment.

Pregnancy

There is limited information regarding the use of hydroxide during pregnancy. Consult a healthcare professional for advice.

Breast-feeding

Limited data is available on the excretion of hydroxide in breast milk. Consult a healthcare professional before use.

Storage

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

Indications

• Gastric hyperacidity
• Heartburn
• Indigestion
• Gastritis
• Peptic ulcers

Dosage

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

Adults: Refer to specific product guidelines for dosing, as it may vary based on formulation.

Mechanism of action

Trisilicate works by reacting with hydrochloric acid in the stomach to form neutral compounds, which reduces acidity. This action helps to alleviate symptoms of acid-related disorders by increasing the pH level in the stomach.

Pharmacodynamics

Trisilicate exhibits its therapeutic effects primarily through acid neutralization. By decreasing the acidity of gastric contents, it provides symptomatic relief from conditions such as gastritis, gastroesophageal reflux disease (GERD), and peptic ulcers. The onset of action is typically rapid, with effects lasting for a few hours.

Pharmacokinetics

The pharmacokinetics of trisilicate involve minimal systemic absorption since the drug primarily acts locally within the gastrointestinal tract. The compound is excreted unchanged in the feces. Its onset of action is usually within minutes after administration, with a duration of effect that can last several hours, depending on gastric emptying and the formulation used.

Pregnancy

Trisilicate is not recommended for use during pregnancy unless the potential benefit justifies the potential risk to the fetus.

Breast-feeding

Trisilicate may be used during breastfeeding, but it is advisable to consult a healthcare professional before use.

Storage

Store in a cool, dry place, protected from light.

Mechanism of action

Simethicone is a surfactant that decreases the surface tension of gas bubbles in the gastrointestinal tract, more easily allowing gas to exit the body. The clinical use of simethicone is based on its antifoam properties. Silicone antifoams spread on the surface of aqueous liquids, forming a film of low surface tension and thus causing collapse of foam bubbles. Simethicone reportedly allows mucus-surrounded gas bubbles in the GI tract to coalesce and be expelled.

Pharmacodynamics

Simethicone decreases the surface tension of gas bubbles in the gastrointestinal tract, facilitating their expulsion. It has a short duration of action as it is generally given as needed, and a wide therapeutic index as it is not systemically absorbed.

Mechanism of action

Aluminum Acetate is an astringent. An astrignent is a chemical that tends to shrink or constrict body tissues, usually locally after topical medicinal application. The shrinkage or constriction is through osmotic flow of water (or other fluids) away from the area where the astringent was applied. Astringent medicines cause shrinkage of mucous membranes or exposed tissues and are often used internally to check discharge of blood serum or mucous secretions. This can happen with a sore throat, hemorrhages, diarrhea, or with peptic ulcers. Externally applied astringents, which cause mild coagulation of skin proteins, dry, harden, and protect the skin. Acne sufferers are often advised to use astringents if they have oily skin. Astringents also help heal stretch marks and other scars. Mild astringent solutions are used in the relief of such minor skin irritations as those resulting from superficial cuts, allergies, insect bites, or fungal infections such as athlete's foot. Excessive dietary aluminum has been proposed to be a factor contributing to several neurological disorders in humans. Six 8-week-old female Swiss Webster mice were fed for 10 wk purified diets containing 100 (control), 500 or 1000 ug aluminum/g diet. Brain and liver lipid peroxidation was determined by evaluating the production of 2-thiobarbituric acid reactive substances in brain and liver homogenates in the presence or absence of 50 uM ferrous iron. 2-Thiobarbituric acid reactive substances production in the absence of iron in brain homogenates from mice fed the 1000 ug/g diet was higher (30%) than that in the 100 ug/g control group (3.1 vs 2.4 nmol 2-thiobarbituric acid reactive substances/mg protein). The addition of ferrous iron increased 2-thiobarbituric acid reactive substances production in brain homogenates from all 3 dietary groups. The iron induced 2-thiobarbituric acid reactive substances production was 26% higher in the 1000 ug/g brain homogenates than in the 100 ug/g group (4.9 vs 3.9 nmol 2-thiobarbituric acid reactive substances/mg protein). Brain 2-thiobarbituric acid reactive substances production in the presence and absence of iron was similar between the 100 and 500 ug/g aluminum groups. 2-Thiobarbituric acid reactive substances production in liver homogenates measured either with or without iron was similar for the 3 groups. These results show that, in mice, dietary aluminum intoxication leads to increased brain 2-thiobarbituric acid reactive substance production, suggesting that enhanced lipid peroxidation may be one possible mechanism underlying the neurological damage associated with increased tissue aluminum. Evidence is presented indicating that dementias are associated with a relative insufficiency of magnesium in the brain. Such insufficiency may be attributable to low intake or retention of magnesium; high intake of a neurotoxic metal, such as aluminum, which inhibits activity of magnesium requiring enzymes; or impaired transport of magnesium and/or enhanced transport of the neurotoxic metal into brain tissue. It is proposed that Alzheimer's disease involves a defective transport process, characterized by both an abnormally high incorporation of aluminum and an abnormally low incorporation that an altered serum protein contributes to the progression of Alzheimer's disease by having a greater affinity for aluminum than for magnesium, in contrast to the normal protein, which binds magnesium better than aluminum. The altered protein crosses the blood-brain barrier more efficiently than the normal protein and competes with the normal protein in binding to brain neurons. Binding of the altered protein to the target neurons would both facilitate aluminum uptake and impede magnesium uptake. Evidence suggests that albumin is the serum protein that is altered. Aluminum is established as a neurotoxin, although the basis for its toxicity is unknown. It recently has been shown to alter the function of the blood-brain barrier, which regulates ex