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Eluxadoline: a Treatment for IBS with Diarrhoea in Adults
■ NEW PRODUCT Eluxadoline: a treatment for IBS with diarrhoea in adults STEVE CHAPLIN Eluxadoline (Truberzi) KEY POINTS is an oral mixed opioid- receptor agonist/ ■ Eluxadoline is an opioid-receptor agonist/antagonist with low systemic absorption antagonist licensed for ■ It is licensed for the treatment of irritable bowel syndrome with diarrhoea in the treatment of irritable adults and is recommended by NICE as a second-line agent bowel syndrome with ■ The recommended dosage is 75–100mg orally twice daily diarrhoea in adults. ■ In clinical trials, response rates were 27%–31% with eluxadoline and 19.5% with placebo after 26 weeks’ treatment This article examines its ■ Common adverse effects include constipation, nausea and abdominal pain properties, efficacy in ■ Pancreatitis and sphincter of Oddi spasm were uncommon adverse events clinical trials and side- ■ Treatment with eluxadoline costs £88.20 per month. effects. he initial management of irritable locally within the gastrointestinal tract, Tbowel syndrome (IBS) entails dietary slowing gastrointestinal transit, reducing and lifestyle change and treatment with urgency and improving stool consistency; antispasmodic agents.1 For people with its abuse potential is low. IBS and diarrhoea, loperamide is the anti- Eluxadoline is licensed for the treat- motility agent of first choice, adjusting the ment of IBS with diarrhoea in adults. The dose to achieve optimum stool consist- recommended dosage is 100mg twice ency. If this is unsatisfactory, treatment daily (reduced to 75mg twice daily if with a low-dose tricyclic antidepressant poorly tolerated). Treatment should be should be considered, with an SSRI a initiated at the lower dose in older people further option if this is unsuccessful. -
Palliative Care Case of the Month
PALLIATIVE CARE CASE OF THE MONTH “Treating Non-Infectious Diarrhea” by Robert Arnold, MD Volume 19, No. 98 August, 2019 Case 1: Mr. Jones is a 58-year-old man with short gut Three drugs are used because of their ability to slow down the syndrome. Palliative Care was consulted for goals of care, gut, allowing for more time for absorption of intestinal fluids a however quickly it became clear uncontrolled diarrhea was a decrease of diarrhea. The most well-know is loperamide, a larger priority. He said having to change the bag every few hours synthetic opiate which has minimal absorption. The dosing is 4 completely interfered with his living a normal life. He said, “I’d mg after one’s first bowel movement and then 2 mg after every rather die than have all of this diarrhea.” unformed stool, up to 16 mg (in palliative care patients there is some data for use up to 54 mg).9, 10 Loperamide should be Case 2: A 62-year-old woman with non-small cell lung cancer continued for 12 hours after diarrhea is stopped. Adverse effects is receiving immunotherapy. She has done quite well but is include mostly constipation, abdominal cramps, nausea and distressed by her diarrhea. She tried Lomotil and Imodium but rarely CNS effects like fatigue or dizziness. Cases of torsades de neither worked. When seeing her palliative care doctor, she said, pointes and death have been reported with higher than “It isn’t worth treating my cancer if I can’t live a normal life.” 9 recommended doses. -
Anti-Diarrheal Activity and Brine Shrimp Lethality Bioassay of Methanolic Extract of Cordyline Fruticosa (L.) A
Naher et al. Clinical Phytoscience (2019) 5:15 https://doi.org/10.1186/s40816-019-0109-z ORIGINAL CONTRIBUTION Open Access Anti-diarrheal activity and brine shrimp lethality bioassay of methanolic extract of Cordyline fruticosa (L.) A. Chev. leaves Sharmin Naher1*, Md. Abdullah Aziz1, Mst. Irin Akter2, S. M. Mushiur Rahman1, Sadiur Rahman Sajon1 and Kishor Mazumder1,3 Abstract Background: Cordyline fruticosa (L.) A. Chev. (Asparagaceae) is a plant which is traditionally used for the treatment of cough, bloody cough, diarrhea, dysentery, high fever, difficulties in urine, bloody urine, small pox, madness, skin eruptions, joint pains, rheumatic bone pains, sore throat, neck pain, bleeding hemorrhoids and inflammation in the digestive tract. Therefore, the present work aims to investigate the antidiarrheal and cytotoxic activities of methanolic extract of Cordyline fruticosa leaves in mice and brine shrimp, respectively. Methods: The effects of the methanol extract of Cordyline fruticosa leaves (MCFL) on castor oil-induced diarrhea, magnesium sulphate induced diarrhea and charcoal meal test in mice were investigated. In addition, brine shrimp lethality bioassay method was used to evaluate cytotoxic activity of MCFL. Results: In castor oil induced diarrheal test, MCFL at the dose of 200, 400 and 800 mg/kg body weight significantly (∗P< 0.05, versus control) and dose-dependently reduced the frequency of diarrhea. The frequency of magnesium sulphate-induced diarrhea was significantly reduced by MCFL at the dose of with 800 mg/kg. In the charcoal meal test, the extract at the dose of 400 and 800 mg/kg body weight significantly (∗P< 0.05) reduced the distance travelled by charcoal along the intestinal tract when compare with control. -
FDA Warns About an Increased Risk of Serious Pancreatitis with Irritable Bowel Drug Viberzi (Eluxadoline) in Patients Without a Gallbladder
FDA warns about an increased risk of serious pancreatitis with irritable bowel drug Viberzi (eluxadoline) in patients without a gallbladder Safety Announcement [03-15-2017] The U.S. Food and Drug Administration (FDA) is warning that Viberzi (eluxadoline), a medicine used to treat irritable bowel syndrome with diarrhea (IBS-D), should not be used in patients who do not have a gallbladder. An FDA review found these patients have an increased risk of developing serious pancreatitis that could result in hospitalization or death. Pancreatitis may be caused by spasm of a certain digestive system muscle in the small intestine. As a result, we are working with the Viberzi manufacturer, Allergan, to address these safety concerns. Patients should talk to your health care professional about how to control your symptoms of irritable bowel syndrome with diarrhea (IBS-D), particularly if you do not have a gallbladder. The gallbladder is an organ that stores bile, one of the body’s digestive juices that helps in the digestion of fat. Stop taking Viberzi right away and get emergency medical care if you develop new or worsening stomach-area or abdomen pain, or pain in the upper right side of your stomach-area or abdomen that may move to your back or shoulder. This pain may occur with nausea and vomiting. These may be symptoms of pancreatitis, an inflammation of the pancreas, an organ important in digestion; or spasm of the sphincter of Oddi, a muscular valve in the small intestine that controls the flow of digestive juices to the gut. Health care professionals should not prescribe Viberzi in patients who do not have a gallbladder and should consider alternative treatment options in these patients. -
Instruction Sheet: Constipation
University of North Carolina Wilmington Abrons Student Health Center INSTRUCTION SHEET: CONSTIPATION The Student Health Provider has treated you for constipation. Constipation consists of a change from your usual pattern, with stools becoming less frequent and more difficult to pass. There is no set number of bowel movements a person should have each day or week. People vary widely in frequency of bowel movements, from three times a day to three times a week. Most everyone experiences constipation sometime in his/her life. Certain medicines, such as prescription pain pills, calcium antacids, calcium supplements, antihistamines, diet pills, calcium channel blockers, and diuretics (fluid pills) can cause constipation. Other factors which increase constipation include age, pregnancy, chronic laxative abuse, and a diet low in fiber. Americans, in general, consume a low fiber diet. Fiber acts as a natural laxative: Fiber draws water into the stool and increases the bulk of stools, resulting in softer stools and more rapid movement of stools through the intestine. Fiber in the diet not only minimizes constipation; fiber may prevent diverticulitis, hemorrhoids, intestinal polyps, and even cancer of the bowel. A high fiber diet is also helpful in weight control/reduction. MEASURES WHICH YOU SHOULD TAKE TO HELP TREAT AND PREVENT CONSTIPATION: 1. Drink plenty of fluids every day. Four to six glasses of water or other non-alcoholic beverage help keep stools soft. 2. Exercise daily. Even mild exercise like walking improves bowel function. 3. Consume a diet high in fiber. Fruits, vegetables, whole wheat bread, oatmeal, and bran cereal are all high in fiber. -
Medicines That Affect Fluid Balance in the Body
the bulk of stools by getting them to retain liquid, which encourages the Medicines that affect fluid bowels to push them out. balance in the body Osmotic laxatives e.g. Lactulose, Macrogol - these soften stools by increasing the amount of water released into the bowels, making them easier to pass. Older people are at higher risk of dehydration due to body changes in the ageing process. The risk of dehydration can be increased further when Stimulant laxatives e.g. Senna, Bisacodyl - these stimulate the bowels elderly patients are prescribed medicines for chronic conditions due to old speeding up bowel movements and so less water is absorbed from the age. stool as it passes through the bowels. Some medicines can affect fluid balance in the body and this may result in more water being lost through the kidneys as urine. Stool softener laxatives e.g. Docusate - These can cause more water to The medicines that can increase risk of dehydration are be reabsorbed from the bowel, making the stools softer. listed below. ANTACIDS Antacids are also known to cause dehydration because of the moisture DIURETICS they require when being absorbed by your body. Drinking plenty of water Diuretics are sometimes called 'water tablets' because they can cause you can reduce the dry mouth, stomach cramps and dry skin that is sometimes to pass more urine than usual. They work on the kidneys by increasing the associated with antacids. amount of salt and water that comes out through the urine. Diuretics are often prescribed for heart failure patients and sometimes for patients with The major side effect of antacids containing magnesium is diarrhoea and high blood pressure. -
Réglementation De La Pharmacie
R E C U E I L D E T E X T E S S U R L A P H A R M A C I E Mis à jour le 13 février 2017 par l’Inspection de la pharmacie P R É A M B U L E La réglementation relative à la pharmacie en vigueur en Nouvelle-Calédonie résulte de la coexistence des dispositions adoptées par la Nouvelle-Calédonie au titre de ses compétences en matières d’hygiène publique, de santé et de professions de la pharmacie1, et de celles adoptées par l’Etat au titre de ses compétences en matières de garanties des libertés publiques, de droit civil et de droit commercial2. Sur le contenu du recueil En 1954, la Nouvelle-Calédonie s’est vue étendre les articles L. 511 à L. 520 et L. 549 à L. 665 de l’ancien Livre V relatif à la Pharmacie du code de la santé publique métropolitain par la loi n° 54-418 du 15 avril 1954 étendant aux territoires d'outre-mer, au Togo et au Cameroun certaines dispositions du Code de la santé publique relatives à l'exercice de la pharmacie3, dont les modalités d’application ont été fixées par le décret modifié n° 55-1122 du 16 août 1955 fixant les modalités d'application de la loi n° 54-418 du 15 avril 1954 étendant aux territoires d'outre-mer, au Togo et au Cameroun certaines dispositions du code de la santé publique relatives à l'exercice de la pharmacie4. Depuis sont intervenues la loi- cadre Defferre5, la loi référendaire de 19886 et la loi organique n° 99-209 du 19 mars 1999 dont les apports ont eu pour résultat le transfert de ces articles de la compétence de l’Etat à la compétence de la Nouvelle-Calédonie, permettant à celle-ci de s’en approprier et de les modifier à sa guise par des délibérations du congrès de la Nouvelle-Calédonie7. -
Pharmacy and Poisons (Third and Fourth Schedule Amendment) Order 2017
Q UO N T FA R U T A F E BERMUDA PHARMACY AND POISONS (THIRD AND FOURTH SCHEDULE AMENDMENT) ORDER 2017 BR 111 / 2017 The Minister responsible for health, in exercise of the power conferred by section 48A(1) of the Pharmacy and Poisons Act 1979, makes the following Order: Citation 1 This Order may be cited as the Pharmacy and Poisons (Third and Fourth Schedule Amendment) Order 2017. Repeals and replaces the Third and Fourth Schedule of the Pharmacy and Poisons Act 1979 2 The Third and Fourth Schedules to the Pharmacy and Poisons Act 1979 are repealed and replaced with— “THIRD SCHEDULE (Sections 25(6); 27(1))) DRUGS OBTAINABLE ONLY ON PRESCRIPTION EXCEPT WHERE SPECIFIED IN THE FOURTH SCHEDULE (PART I AND PART II) Note: The following annotations used in this Schedule have the following meanings: md (maximum dose) i.e. the maximum quantity of the substance contained in the amount of a medicinal product which is recommended to be taken or administered at any one time. 1 PHARMACY AND POISONS (THIRD AND FOURTH SCHEDULE AMENDMENT) ORDER 2017 mdd (maximum daily dose) i.e. the maximum quantity of the substance that is contained in the amount of a medicinal product which is recommended to be taken or administered in any period of 24 hours. mg milligram ms (maximum strength) i.e. either or, if so specified, both of the following: (a) the maximum quantity of the substance by weight or volume that is contained in the dosage unit of a medicinal product; or (b) the maximum percentage of the substance contained in a medicinal product calculated in terms of w/w, w/v, v/w, or v/v, as appropriate. -
Pharmacology on Your Palms CLASSIFICATION of the DRUGS
Pharmacology on your palms CLASSIFICATION OF THE DRUGS DRUGS FROM DRUGS AFFECTING THE ORGANS CHEMOTHERAPEUTIC DIFFERENT DRUGS AFFECTING THE NERVOUS SYSTEM AND TISSUES DRUGS PHARMACOLOGICAL GROUPS Drugs affecting peripheral Antitumor drugs Drugs affecting the cardiovascular Antimicrobial, antiviral, Drugs affecting the nervous system Antiallergic drugs system antiparasitic drugs central nervous system Drugs affecting the sensory Antidotes nerve endings Cardiac glycosides Antibiotics CNS DEPRESSANTS (AFFECTING THE Antihypertensive drugs Sulfonamides Analgesics (opioid, AFFERENT INNERVATION) Antianginal drugs Antituberculous drugs analgesics-antipyretics, Antiarrhythmic drugs Antihelminthic drugs NSAIDs) Local anaesthetics Antihyperlipidemic drugs Antifungal drugs Sedative and hypnotic Coating drugs Spasmolytics Antiviral drugs drugs Adsorbents Drugs affecting the excretory system Antimalarial drugs Tranquilizers Astringents Diuretics Antisyphilitic drugs Neuroleptics Expectorants Drugs affecting the hemopoietic system Antiseptics Anticonvulsants Irritant drugs Drugs affecting blood coagulation Disinfectants Antiparkinsonian drugs Drugs affecting peripheral Drugs affecting erythro- and leukopoiesis General anaesthetics neurotransmitter processes Drugs affecting the digestive system CNS STIMULANTS (AFFECTING THE Anorectic drugs Psychomotor stimulants EFFERENT PART OF THE Bitter stuffs. Drugs for replacement therapy Analeptics NERVOUS SYSTEM) Antiacid drugs Antidepressants Direct-acting-cholinomimetics Antiulcer drugs Nootropics (Cognitive -
Drug Name Plate Number Well Location % Inhibition, Screen Axitinib 1 1 20 Gefitinib (ZD1839) 1 2 70 Sorafenib Tosylate 1 3 21 Cr
Drug Name Plate Number Well Location % Inhibition, Screen Axitinib 1 1 20 Gefitinib (ZD1839) 1 2 70 Sorafenib Tosylate 1 3 21 Crizotinib (PF-02341066) 1 4 55 Docetaxel 1 5 98 Anastrozole 1 6 25 Cladribine 1 7 23 Methotrexate 1 8 -187 Letrozole 1 9 65 Entecavir Hydrate 1 10 48 Roxadustat (FG-4592) 1 11 19 Imatinib Mesylate (STI571) 1 12 0 Sunitinib Malate 1 13 34 Vismodegib (GDC-0449) 1 14 64 Paclitaxel 1 15 89 Aprepitant 1 16 94 Decitabine 1 17 -79 Bendamustine HCl 1 18 19 Temozolomide 1 19 -111 Nepafenac 1 20 24 Nintedanib (BIBF 1120) 1 21 -43 Lapatinib (GW-572016) Ditosylate 1 22 88 Temsirolimus (CCI-779, NSC 683864) 1 23 96 Belinostat (PXD101) 1 24 46 Capecitabine 1 25 19 Bicalutamide 1 26 83 Dutasteride 1 27 68 Epirubicin HCl 1 28 -59 Tamoxifen 1 29 30 Rufinamide 1 30 96 Afatinib (BIBW2992) 1 31 -54 Lenalidomide (CC-5013) 1 32 19 Vorinostat (SAHA, MK0683) 1 33 38 Rucaparib (AG-014699,PF-01367338) phosphate1 34 14 Lenvatinib (E7080) 1 35 80 Fulvestrant 1 36 76 Melatonin 1 37 15 Etoposide 1 38 -69 Vincristine sulfate 1 39 61 Posaconazole 1 40 97 Bortezomib (PS-341) 1 41 71 Panobinostat (LBH589) 1 42 41 Entinostat (MS-275) 1 43 26 Cabozantinib (XL184, BMS-907351) 1 44 79 Valproic acid sodium salt (Sodium valproate) 1 45 7 Raltitrexed 1 46 39 Bisoprolol fumarate 1 47 -23 Raloxifene HCl 1 48 97 Agomelatine 1 49 35 Prasugrel 1 50 -24 Bosutinib (SKI-606) 1 51 85 Nilotinib (AMN-107) 1 52 99 Enzastaurin (LY317615) 1 53 -12 Everolimus (RAD001) 1 54 94 Regorafenib (BAY 73-4506) 1 55 24 Thalidomide 1 56 40 Tivozanib (AV-951) 1 57 86 Fludarabine -
Western Judicial Circuit Felony Drug Court
Western Judicial Circuit Felony Drug Court (Athens-Clarke and Oconee Counties) PARTICIPANT HANDBOOK This handbook belongs to: 325 E. Washington Street, Suite 210 Athens, Georgia 30601 (706) 208-7078 (706) 613-3179 (fax) Table of Contents Welcome 3 Overview 4-5 Confidentiality 5 Treatment 5 Program Phases 6-10 Commencement 11 Program Rules 12-14 Program Fees 15 The Drug Court Team 15 Staffings 15 Court Appearances 16 Incentives 17 Sanctions and Treatment Responses 17 Termination 18 Drug/Chemical Testing 19 Prohibited Drugs/Permitted Medications 20-27 Travel/Leave Requests 27 Compliance & Home Visits/Job Checks, Searches 28 Search Requirements 28 Commencement Ceremony 29 Conclusion 29 Important Phone Numbers 30 Community Resources 31 Attachment I: Random Drug Screen Policy Attachment II: Urine Abstinence Testing/Incidental Alcohol Exposure Contract (original signed copy on file with Felony Drug Court) Attachment III: Emergency On-call Telephone Policy Attachment IV: Felony Drug Court Contract 2 Welcome to the Western Judicial Circuit Felony Drug Court! This Handbook was designed to answer your questions and provide specific information about what you must do in order to successfully complete the requirements of the Western Judicial Circuit Felony Drug Court Program. As a participant, you are expected to follow the instructions found in this Handbook, as well as the instructions of the Felony Drug Court Judge, Staff, and Treatment Provider. You will also be expected to comply with the treatment plan developed for you by your Treatment Provider. This handbook is not exhaustive and there is no possible way to make it complete and detailed to answer every question or situation that arises. -
Racecadotril in the Treatment of Acute Diarrhea in Children
Eberlin et al. BMC Pediatrics (2018) 18:124 https://doi.org/10.1186/s12887-018-1095-x RESEARCH ARTICLE Open Access Racecadotril in the treatment of acute diarrhea in children: a systematic, comprehensive review and meta-analysis of randomized controlled trials Marion Eberlin1, Min Chen2, Tobias Mueck1 and Jan Däbritz3,4* Abstract Background: Racecadotril is a guideline-recommended option for the treatment of acute diarrhea in children but existing guidelines and previous reviews of the field are based on a small fraction of published evidence. Therefore, we have performed a systematic search for randomized controlled trials evaluating racecadotril as add-on or in comparison to other treatments. Methods: A search was performed in PubMed, Scopus and Google Scholar without limits about country of origin or reporting language. A meta-analysis was conducted for the five most frequently used efficacy parameters. Results: We have retrieved 58 trials, from nine countries including six in comparison to placebo, 15 in comparison to various active treatments and 41 as add-on to various standard treatments (some multi-armed studies allowing more than one comparison). Trials used 45 distinct efficacy parameters, most often time to cure, % of cured children after 3 days of treatment, global efficacy and number of stools on second day of treatment. Racecadotril was superior to comparator treatments in outpatients and hospitalized patients with a high degree of consistency as confirmed by meta-analysis for the five most frequently used outcome parameters. For instance, it reduced time to cure from 106.2 h to 78.2 h (mean reduction 28.0 h; P < 0.0001 in 24 studies reporting on this parameter).