125mg 4 times a day or less; two chewable tablets are Extra Strength Gas-X
and Maximum Strength Mylanta Gas
. The generic name is simethicone.
Lactulose (pronounced /ˈlæktjʉloʊz/) is a synthetic, non-digestible sugar used in the treatment of chronic constipation and hepatic encephalopathy, a complication of liver disease. It is a disaccharide (double-sugar) formed from one molecule each of the simple sugars (monosaccharides) fructose and galactose. The commercial syrup used for treatment of constipation is dyed yellow-orange. It is produced commercially by isomerization of lactose.
In the treatment of chronic constipation, the metabolites of lactulose draw water into the bowel, causing a cathartic effect through osmotic action. It is safe for people of all ages, except for those in a very small percentage of the population that are galactose intolerant. Dosage may have to be adjusted over time to produce the desired effect because the laxative effect can decline with daily treatment.
In treating constipation lactulose works by increasing the water content and volume of the stools in the bowel, making them softer and easier to pass. Lactulose is made up of sugar molecules and is partly broken down by the bacteria that live in the lower part of the gut. This leads to the contents of the gut becoming more acidic because there are carboxylic acids among its metabolites, which are not absorbed from the lower bowel. That in turn causes water to be retained in the lower bowel. This increases the amount of water in the stools, softening them and making them easier to pass. The added volume of gas and flatulence caused by fermentation of the lactulose adds to the volume of the fecal material, and makes it easier to expel. The slightly acidic condition of the colon caused by the presence of acids causes active peristalsis. The combined effect of all of these processes relieves constipation in a very effective manner.
Common side effects are abdominal cramping, borborygmus, gas and pungent flatulence that some people find difficult to control in social situations. Excessively high dosage can cause explosive and uncontrollable diarrhea. In normal individuals, overdose is considered uncomfortable, but not life threatening. Uncommon normal side effects are nausea and vomiting. In sensitive individuals, such as the elderly or people with reduced kidney function, excess dosage can result in dehydration and electrolytic disturbances such as high sodium levels.
Prescribers should remember that, although it has less potential to cause dental caries than sucrose, lactulose is a sugar and therefore has that potential, especially when prescribed to children or older people. However, the risk is minimal under normal conditions of use.
Psyllium seed husks also known as ispaghula, isabgol, or psyllium, are portions of the seeds of the plant Plantago ovata, (genus Plantago), a native of India. They are hygroscopic, expanding and become mucilaginous.
Psyllium seed husk are indigestible and are a source of soluble dietary fiber. They are used to relieve constipation, irritable bowel syndrome, and diarrhea. They are also used as a regular dietary supplement to improve and maintain regular GI transit. The inert bulk of the husks helps provide a constant volume of solid material irrespective of other aspects of the diet or any disease condition of the gut. Some recent research is also showing them to be promising in lowering cholesterol and controlling diabetes.
Other uses include gluten-free baking, where ground psyllium seed husks bind moisture and help make breads less crumbly. The husks are used whole in their natural state, or dried and chopped or powdered for easier consumption. In either of these forms, one takes them by mixing them with water or another fluid. They are also available in capsules. Over-the-counter laxatives and fiber supplements such as Metamucil, Colon Cleanse, Serutan, Fybogel, Bonvit, Effersyllium, and Konsyl have psyllium husks as their main ingredient.
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(Redirected from Amitiza)
Lubiprostone (rINN, marketed under the trade name Amitiza) is a medication used in the management of chronic idiopathic constipation and irritable bowel syndrome. It was approved by the U.S. Food and Drug Administration (FDA) for this purpose on 31 January 2006.
Medical uses Lubiprostone is used for the treatment of chronic constipation of unknown cause in adults, as well as irritable bowel syndrome associated with constipation in women.
As of 20 July 2006, Lubiprostone has not been studied in children. There is current research underway to determine the efficacy in postoperative bowel dysfunction, and opioid-induced bowel dysfunction.
In clinical trials, the most common adverse event was nausea (31%). Other adverse events (≥5% of patients) included diarrhea (13%), headache (13%), abdominal distention (5%), abdominal pain (5%), flatulence (6%), sinusitis (5%) and vomiting (5%).
Contraindications There are no current data on use in people with liver or kidney complications. The effects on pregnancy have not been studied in humans but testing in Guinea pigs resulted in fetal loss. Amitiza is not approved for use in children. (FDA) consensus Amitiza is indicated for the treatment of irritable bowel syndrome with constipation (IBS-C) in WOMEN (emphasis added) ≥ 18 years old. (FDA) (not yet men, by, FDA ?, needs checking) Lubiprostone is contraindicated in patients exhibiting chronic diarrhea, bowel obstruction, or diarrhea-predominant irritable bowel syndrome.
Mechanism of action
Lubiprostone is a bicyclic fatty acid derived from prostaglandin E1 that acts by specifically activating ClC-2 chloride channels on the apical aspect of gastrointestinal epithelial cells, producing a chloride-rich fluid secretion. These secretions soften the stool, increase motility, and promote spontaneous bowel movements (SBM).
Symptoms of constipation such as pain and bloating are usually improved within one week, and SBM may occur within one day.
Unlike many laxative products, Lubiprostone does not show signs of tolerance, dependency, or altered serum electrolyte concentration. There was no rebound effect following withdrawal of treatment, but a gradual return to pre-treatment bowel movement frequency should be expected.
Minimal distribution of the drug occurs beyond the immediate gastrointestinal tissues. Lubiprostone is rapidly metabolized by reduction/oxidation, mediated by carbonyl reductase. There is no metabolic involvement of the hepatic cytochrome P450 system. The measurable metabolite, M3, exists in very low levels in plasma and makes up less than 10% of the total administered dose.
Data indicate that metabolism occurs locally in the stomach and jejunum.