Friday, September 19, 2008


The human gastrointestinal tract is the stomach and intestine, sometimes including all the structures from the mouth to the anus. (The "digestive system" is a broader term that includes other structures, including the accessory organs of digestion).
In an adult male human, the gastrointestinal (GI) tract is 5 metres (20 ft) long in a live subject, or up to 9 metres (30 ft) without the effect of muscle tone, and consists of the upper and lower GI tracts. The tract may also be divided into foregut, midgut, and hindgut, reflecting the embryological origin of each segment of the tract.
The GI tract always releases hormones to help regulate the digestive process. These hormones, including gastrin, secretin, cholecystokinin, and grehlin, are mediated through either intracrine or autocrine mechanisms, indicating that the cells releasing these hormones are conserved structures throughout evolution.

                                       (a) CIMETIDINE : 
                               H2 Receptor Antagonist;  Antiulcer
It inhibits the gastric acid secretion stimulated by histamine, food, pentagastrin, insulin etc..                                              
 Potent inhibitor of metabolism of numerous other drugs eliminated by hepatic mixed-                       function oxidase system
Duration of action : 4-6 hrs

           Treatment for duodenal ulcer, Gastric ulcer,Benign: 
For adults-400mg twice daily or 800mg  daily  at bedtime for 4 - 8 weeks. May be 400mg daily at bed time.
For children: Infant under 1 yr : 20mg/kg in divided doses.
Over 1 year : 25-30mg /kg i divided doses.
Maximum dose : 2-4 g/day in div.doses.
Treatment of STRESS ULCER:
Adult : 200- 400mg orally or by a nosogastric tube every 4 to 6 hrs.

Treatment of Shot bowel syndrom:
Adult : 400mg twice.... with brakfast and at bed time.

Cimetidine in OBSTETRICS :
Adult : 400mg at start of labour, if require  400mg every 4 hrs

Intra venous rout :  For intractable ulcer in hospitalised patients

Intra muscular rout : For intractable ulcer in hospitalised patients

Special precautions : pregnancy  , lactation

            1  CIMETIDINE 200mg tab ,  company - Zydus Cadila
            2  LOCK-2 tab 200mg ,    company -   Zydus Cadila       
            3  TYMIDIN 200mg tab  ,  company - SPPL
                                      (b) CISAPRIDE  : 
                                                  Orally given for Chronic constipation, Non-ulcer dyspepsia,
Reflux oesophagitis, Impaired gastric emptying.

     Adult   :  10mg thrice daily may be increased up to 20mg, given 15mts before food
    Child     :  0.2mg/kg  3-4 times daily

* The Regulatory Authorities in India have not officially announced 
   the discontinuation of CISAPRIDE from the Indian market.
   Cisapride has been voluntarily withdrawn in the U.S. by
   Janssen Pharmaceutca.
   However it was available in the U.S. till july 14th 2000.

            1. Esorid tab 10mg, 20mg        company - Sun
            2. Ciza 10mg, 20mg, syp 30ml..   company- Intas
            3. cisapro 10mg, 20mg, syp          company- Zydus Alidac         

                                      (c) DOMPERIDONE : 
                               Dopamine Receptor Blocker; Antiemetic
Abolishes nausea and vomiting due to awide awide variety of causes.

DOSAGE : Adult - 10 to 20mg thrice daily 
USES: This medication increases movement through the digestive system. It is used to treat symptoms of stomach disorders. It may also be used to prevent nausea and vomiting caused by certain medications. Due to safety concerns, this medication is not to be used by breast-feeding women to increase production of breast milk.
HOW TO USE: Take this medication by mouth as prescribed usually 30 minutes before meals and at bedtime. Do not increase your dose or take this more often than directed. Your condition will not improve any faster but the risk of side effects will be increased.
SIDE EFFECTS : Headache, dizziness, dry mouth, nervousness, flushing, or irritability may occur the first several days as your body adjusts to the medication. Trouble sleeping, stomach cramps, hot flashes and leg cramps have also been reported. If any of these effects continue or become bothersome, inform your doctor. Notify your doctor immediately if you develop: chest pain, slow/fast/irregular heartbeat, swelling of the feet or ankles, difficulty urinating, swelling of the breasts or discharge from the nipple in men or women, menstrual changes, sexual difficulties. If you notice other effects not listed above, contact your doctor or pharmacist.
PRECAUTIONS: Tell your doctor your medical history, especially of: history of breast cancer, allergies. Limit your intake of alcoholic beverages. This medication should be used only if clearly needed during pregnancy. Discuss the risks and benefits with your doctor. Domperidone passes into breast milk. Due to the potential risks to a nursing infant, breast-feeding while using this drug is not recommended. Consult your doctor before breast-feeding (see also Uses section).
      * 1. Domstal - 10mg tab, MT 10mg, 5mg DT,  Suspension
             company - Torrent
         2. Cosdome -   comp - Cosome HC
         3. Domperon -   comp - zydus alidac
         4. Gastractive -  comp - Ethnor    
         1. Domperidon 10 + Omeprazole 20./ eg: Omez-D,  Domstal RD etc..        
         2. Domperidon 10 + Pantoprazole
             eg: Pantop D, DSR  etc..
         3. Domperidon 10 + Ranitidine 150
             eg: Rantac D, Aciloc RD  etc..
         4. Domperidon 10 + Paracetamol          eg: Domstal P, etc..          
         5. Domperidon 10 + Cinnerizine 20mg. eg: Dompon CZ

                                    (D) ESOMEPRAZOLE
                                Proton pump inhibitor
DRUG CLASS AND MECHANISM: Esomeprazole is in a class of drugs called proton pump inhibitors (PPIs) which block the production of acid by the stomach. Other drugs in the same class include omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex) and pantoprazole (Protonix). Chemically, esomeprazole is very similar to omeprazole. Proton pump inhibitors are used for the treatment of conditions such as stomach and duodenal ulcers, gastroesophageal reflux disease (GERD) and the Zollinger-Ellison syndrome which all are caused by stomach acid. Esomeprazole, like other proton-pump inhibitors, blocks the enzyme in the wall of the stomach that produces acid. By blocking the enzyme, the production of acid is decreased, and this allows the stomach and esophagus to heal. Esomeprazole was approved by the FDA in February, 2001
STORAGE: Store at room temperature, 15-30°C (59-86°F) in a tightly closed container.
PRESCRIBED FOR: Esomeprazole is approved for the treatment of gastroesophageal reflux disease (GERD) and in combination with amoxicillin and clarithromycin (Biaxin) for the treatment of patients with ulcers and H. pylori infection. Since it is very similar to omeprazole, it also is likely that it will be used for the treatment of Zollinger-Ellison syndrome. Esomeprazole also is approved for short term use in children ages 1-11 for GERD.
DOSING: For GERD, 20 or 40 mg of esomeprazole is given once daily for 4-8 weeks.  In children ages 1-11, the dose is 10 or 20 mg daily.
For the treatment of H. pylori, 40 mg is administered once daily in combination with amoxicillin and clarithromycin for 10 days.
Esomeprazole capsules should be administered one hour before meals, swallowed whole and should not be crushed or chewed. Patients with difficulty swallowing can open the capsule and mix the pellets with applesauce. The applesauce should not be hot and the pellets should not be chewed or crushed.
DRUG INTERACTIONS: Esomeprazole potentially can increase the concentration in blood of diazepam (Valium) by decreasing the elimination of diazepam in the liver. Esomeprazole may have fewer drug interactions than omeprazole.
The absorption of certain drugs may be affected by stomach acidity. Therefore, esomeprazole and other PPIs that reduce stomach acid also reduce the absorption and concentration in blood of ketoconazole (Nizoral) and increase the absorption and concentration in blood of digoxin (Lanoxin). This may lead to reduced effectiveness of ketoconazole or increased digoxin toxicity, respectively.
PREGNANCY: Use of esomeprazole in pregnant women has not been adequately evaluated.
NURSING MOTHERS: Esomeprazole has not been adequately studied in nursing women.
SIDE EFFECTS: Esomeprazole, like other PPIs, is well-tolerated. The most common side effects are diarrhea, nausea, vomiting, headaches, rash and dizziness. Nervousness, abnormal heartbeat, muscle pain, weakness, leg cramps and water retention occur infrequently.

                       (E) FAMOTIDINE  : 
                     H2 Receptor antagonist
Reduces basal nocturnal and stimulated gastric acid secretion.
Efectively heals duodnal and gastric ulcers and prevents recurrence.
Reduces oesophageal reflux and is effective in Zollinger-Ellison syndrome.
DOSAGE :  Adult - 40mg once at bed time
                                  20mg twicw daily
                                 It is not recomented in childrens

Before taking Famotidine:

Tell your doctor if you have kidney disease, liver disease, trouble or pain swallowing food, vomiting with blood, or bloody or black stools.

You may not be able to take famotidine, or you may require a dosage adjustment or special monitoring during treatment, if you have any of the conditions listed above.
Famotidine is in the FDA pregnancy category B. This means that it is not expected to be harmful to an unborn baby. Do not take famotidine without first talking to your doctor if you are pregnant or could become pregnant during treatment.
Moreover, famotidine passes into breast milk. It is not known whether famotidine will harm a nursing infant, therefore do not take this medication without first talking to your doctor if you are breast-feeding a baby.

Available brands
1.Famocid 20mg,40mg   (sun) 
  2.Famonite -                        company -  zydus alidac
     3. Famotin                             company   -  usv 
     4. Topcid                                company    -   Torrent

                  (F) H.PILORI KIT

 1. HELIBACT   -      Each combi pack contains Omiprazole 20mg + Amoxicillin 750mg +          Tinidazole 500 mg (RPG)

2.  HELIGO       -       Clarithromycin 250mg + Lanzoprazole 30mg + Tinidazole 500mg (INTAS)

3 .  HP KIT        -       2 capsules of Omiprazole 20mg + 2 tablet of Amoxicillin each contain 750mg + 2 tablet of Tinidazole each contain 500mg (SUN)

4. PYLOKIT     -      2 cap of Lanzoprezole 30mg + 2 tab of Tinidazole 500mg + 2 tab of Clarithromycin 250mg     (CIPLA)

                        (G)  LANZOPRAZOLE
                                Proton pump inhibitor

Lanzoprezole  is a proton-pump inhibitor (PPI) which inhibits the stomach's production of gastric acids. It is manufactured by a number of companies worldwide under several brand names. In the United States it was first approved by the Food and Drug Administration (FDA) in 1995.
Lansoprazole has been available as a generic drug since Prevacid patent protection expired on November 10, 2009 Since 2009 Lansoprazole has been available over the counter (OTC) in the U.S. in a 15 mg dose marketed by Novartis as Prevacid 24HR.

Lansoprazole's plasma elimination half-life is not proportional to the duration of the drug's effects to the person (i.e. gastric acid suppression). The mean plasma elimination half-life is 1.5 hours, and the effects of the drug last for over 24 hours after it has been used for 1 day or more. Lansoprazole, 30 mg administered nasogastrically, effectively controls intragastric pH and is an alternative to i.v. pantoprazole in patients who are unable to swallow solid dosage formulations.
Lansoprazole is indicated for:
  • Treatment of ulcers of the stomach and duodenum, and NSAID-induced ulcers. DOSE-30mg one daily 4-8 weeks.
  • Adjunctive treatment of Helicobacter pylori infection, alongside antibiotics. Treatment to kill Helicobacter pylori (H. pylori) causing ulcers or other problems involves using two other drugs besides lansoprazole. This treatment is known as "triple therapy", and involves taking twice daily for 10 or 14 days lansoprazole 30 mg, amoxicillin 1,000 mg, and clarithromycin 500 mg.
  • Treatment of gastroesophageal reflux disease (GERD) (also known as acid reflux disease).
  • Treatment of Zollinger-Ellison Syndrome. DOSE-60mg/day daily dose upto 120mg in div doses.

Lansoprazole interacts with several other drugs, either due to its own nature or as a proton pump inhibitor.
  • PPIs reduce absorption of antifungals (itraconazole and ketoconazole)  and possibly increase Digoxin in plasma
  • Increases plasma concentrations of Cilostazol (risk of toxicity)
  • Lansoprazole possibly interacts with, amongst other drugs:
  • Sucralfate, ampicillin, bisacodyl, clopidogrel, delavirdine, fluvoxamine, iron salts, voriconazole, aminophylline and theophylline.
SIDE EFFECTS OF Lanzoprazole

Infrequent: dry mouth, insomnia, drowsiness, blurred vision, rash, pruritus

Side effects of proton pump inhibitors in general and lansoprazole in particular may include:
  • Infrequent: dry mouth, insomnia, drowsiness, blurred vision, rash, pruritus
  • Rarely and very rarelytaste disturbance, liver dysfunction, peripheral oedema, hypersensitivity reactions (including bronchospasm, urinary, angioedema, anaphylaxis), photosensitivity,feversweatingdepressioninterstitial nephritis, blood disorders (including leukopenialeukocytosis, pancytopenia, thrombocytopenia), arthralgiamyalgia, skin reactions including (erythroderma  Stevens–Johnson syndrometoxic epidermal necrolysisbullous eruption)
  • Severe: Gastro-intestinal disturbances (such as nausea 1.3%, abdominal pain 2.1%, diarrhea 3.8%).
Proton-pump inhibitors may be associated with a greater risk of hip fractures and Clostridium difficile-associated diarrhea. Antacid preparations such as lansoprazole by suppressing acid mediated break down of proteins, leads to an elevated risk of developing food and drug allergies. This happens due to undigested proteins then passing into the gastrointestinal tract where sensitisation occurs. It is unclear whether this risk occurs with only long-term use or with short-term use as well. Patients are frequently administered the drugs in intensive care as a protective measure against ulcers, but this use is also associated with a 30% increase in occurrence of pneumonia.


Lansoprazole is available as a generic drug in the US, Russian Federation, UK, Canada, Belgium, Finland,France, Colombia, Italy, Sweden, and Mexico.
The drug is also sold under several brand names, including:
  • Agopton (Germany),Digest (Indonesia), Duogast (Syria) , GERD (Pakistan) , Gastrolan (Indonesia), Lanciprol (Greece) , Lansazol (Jordan), Lansobene (Austria), Lansoloc (South Africa), Lansoprazol(Denmark), Lansoptol (Hungary), Lansor (Turkey),Lansox (Italy),  Lanston LFDT (South Korea) , Lenzo (India),   Lanzol (India, Ireland) ,   Lanzotec (Jordan) ,  Lanzul (Romania/Slovenia) ,  Lanton (Israel) , Lanzo (Sweden) , Lanzopral (Argentina, Chile, Peru, Venezuela) , Lanzor (France, South Africa) ,   Lanzostad (Lithuania, Latvia, Estonia) ,  Laprazol (Greece) , Limpidex (Italy),   Monolitum (Spain) , Ogast and OgastORO (France) , Ogastro (Mexico), Prevacid (U.S. and Canada), Prosogan and Prosogan FD (Indonesia), pro-ulco (Spain),   Refluxon (Hungary) ,   Sabax (Serbia) ,   SOLOX (New Zealand) ,   Takepron (Japan),   Zolt (Finland),    Zoton (Italy, Ireland, Australia, UK),   ZOMEL (Ireland), Lanzap (Romania),  Levant (Romania),   Lantrea (Poland)


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