DOCSLIB.ORG

Blood Glucose Response After Oral Lactulose Intake in Type 2 Diabetic Individuals

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Blood Glucose Response After Oral Lactulose Intake in Type 2 Diabetic Individuals World Journal of W J D Diabetes Submit a Manuscript: https://www.f6publishing.com World J Diabetes 2021 June 15; 12(6): 893-907 DOI: 10.4239/wjd.v12.i6.893 ISSN 1948-9358 (online) ORIGINAL ARTICLE Randomized Controlled Trial Blood glucose response after oral lactulose intake in type 2 diabetic individuals Thomas R Pieber, Eva Svehlikova, Ines Mursic, Tamara Esterl, Manfred Wargenau, Tina Sartorius, Lioba Pauly, Susann Schwejda-Guettes, Annalena Neumann, Valentin Faerber, John Friedrich Stover, Barbara Gaigg, Angelika Kuchinka-Koch ORCID number: Thomas R Pieber Thomas R Pieber, Eva Svehlikova, Ines Mursic, Tamara Esterl, Division of Endocrinology and 0000-0003-3554-0405; Eva Diabetology, Department of Internal Medicine, Medical University of Graz, Graz 8036, Austria Svehlikova 0000-0002-9743-2031; Ines Mursic 0000-0003-3836-6529; Manfred Wargenau, Department of Statistic, M.A.R.C.O. GmbH & Co. KG, Institute for Tamara Esterl 0000-0002-2615-680X; Clinical Research and Statistics, Düsseldorf 40211, Germany Manfred Wargenau 0000-0002-0886- 0158; Tina Sartorius 0000-0002-5264- Tina Sartorius, Department of Nutritional CRO, BioTeSys GmbH, Esslingen 73728, Germany 7207; Lioba Pauly 0000-0002-2673- 012X; Susann Schwejda-Guettes Lioba Pauly, Susann Schwejda-Guettes, Department of Medical & Clinical Affairs, Market 0000-0002-6635-6005; Annalena Access & Education Business Unit Enteral Nutrition, Bad Homburg 61352, Germany Neumann 0000-0002-9716-329X; Valentin Faerber 0000-0003-4250- Annalena Neumann, Valentin Faerber, Department of Medical, Clinical & Regulatory Affairs, 3389; John Friedrich Stover 0000- Business Unit Parenteral Nutrition, Keto-Analogues and Standard I.V. Fluids, Fresenius Kabi 0001-9457-0941; Barbara Gaigg 0000- Deutschland GmbH, Bad Homburg 61352, Germany 0002-8549-8877; Angelika Kuchinka- Koch 0000-0003-1874-1571. John Friedrich Stover, Department of Consultancy, Stover-Solutions, Zurich 8006, Switzerland Author contributions: Pieber TR, Barbara Gaigg, Angelika Kuchinka-Koch, Market Unit Lactulose, Fresenius Kabi Austria GmbH, Svehlikova E, Mursic I, and Esterl Linz 4020, Austria T performed the study, data Corresponding author: Valentin Faerber, PhD, Director, Department of Medical, Clinical & collection and interpretation; Stover JF, Pauly L, Schwejda- Regulatory Affairs, Business Unit Parenteral Nutrition, Keto-Analogues and Standard I. V. Guettes S, Kuchinka-Koch A, and Fluids, Fresenius Kabi Deutschland GmbH, Else-Kroener-Straße 1, Bad Homburg 61352, Gaigg B designed and supervised Germany. [email protected] the study; Wargenau M planned and performed the statistical analysis of the data and interpreted Abstract the results; Sartorius T, Neumann BACKGROUND A, and Faerber V wrote the Lactulose is approved for the symptomatic treatment of constipation, a gastrointe- manuscript; all authors reviewed, stinal (GI) complication common in individuals with diabetes. Lactulose products edited, and approved the contain carbohydrate impurities (e.g., lactose, fructose, galactose), which occur manuscript for submission. during the lactulose manufacturing process. These impurities may affect the blood glucose levels of individuals with type 2 diabetes mellitus (T2DM) using lactulose Supported by Fresenius Kabi for the treatment of mild constipation. A previous study in healthy subjects Deutschland GmbH, Germany. revealed no increase in blood glucose levels after oral lactulose intake. However, it is still unclear whether the intake of lactulose increases blood glucose levels in Institutional review board individuals with diabetes. WJD https://www.wjgnet.com 893 June 15, 2021 Volume 12 Issue 6 Pieber TR et al. Blood glucose after lactulose in diabetes statement: This study protocol was AIM reviewed and approved by the To evaluate the blood glucose profile after oral lactulose intake in mildly Independent Ethics Committee of constipated, non-insulin-dependent subjects with T2DM in an outpatient setting. the Medical University of Graz, METHODS Austria. This prospective, double-blind, randomized, controlled, single-center trial was Clinical trial registration statement: conducted at the Clinical Research Center at the Medical University of Graz, Austria, in 24 adult Caucasian mildly constipated, non-insulin-dependent subjects This study was registered in the with T2DM. Eligible subjects were randomized and assigned to one of six European Union Drug Regulating treatment sequences, each consisting of four treatments stratified by sex using an Authorities Clinical Trials incomplete block design. Subjects received a single dose of 20 g or 30 g lactulose Database, No. 2018-002359-14. (crystal and liquid formulation), water as negative control or 30 g glucose as Informed consent statement: All positive control. Capillary blood glucose concentrations were measured over a study participants provided period of 180 min post dose. The primary endpoint was the baseline-corrected written informed consent prior to area under the curve of blood glucose concentrations over the complete assess- enrollment. ment period [AUCbaseline_c (0-180 min)]. Quantitative comparisons were performed for both lactulose doses and formulations vs water for the equal lactulose dose vs Conflict-of-interest statement: The glucose, as well as for liquid lactulose vs crystal lactulose. Safety parameters study was sponsored by Fresenius included GI tolerability, which was assessed at 180 min and 24 h post dose, and Kabi Deutschland GmbH, adverse events occurring up to 24 h post dose. Germany. The sponsor’s representatives contributed to the RESULTS study design and the selection of In 24 randomized and analyzed subjects blood glucose concentration-time curves outcome measures before study after intake of 20 g and 30 g lactulose were almost identical to those after water start but had no role in study intake for both lactulose formulations despite the different amounts of carbohydrate impurities (≤ 3.0% for crystals and approx. 30% for liquid). The execution or data collection, or primary endpoint [AUC ] was not significantly different between data analyses. All other authors baseline_c (0-180 min) lactulose and water regardless of lactulose dose and formulation. Also with declare no potential conflicts of regard to all secondary endpoints lactulose formulations showed comparable interest related to this paper. results to water with one exception concerning maximum glucose level. A minor Data sharing statement: No increase in maximum blood glucose was observed after the 30 g dose, liquid additional data are available. lactulose, in comparison to water with a mean treatment difference of 0.63 mmol/L (95% confidence intervals: 0.19, 1.07). Intake of 30 g glucose significantly CONSORT 2010 statement: The increased all blood glucose endpoints vs 30 g liquid and crystal lactulose, authors read the CONSORT 2010 respectively (all P < 0.0001). No differences in blood glucose response were Statement, and the manuscript was observed between the different lactulose formulations. As expected, lactulose prepared and revised according to increased the number of bowel movements and was generally well tolerated. that statement. Subjects experienced only mild to moderate GI symptoms due to the laxative action of lactulose. Open-Access: This article is an open-access article that was CONCLUSION selected by an in-house editor and Blood glucose AUCbaseline_c (0-180 min) levels in mildly constipated, non-insulin fully peer-reviewed by external dependent subjects with T2DM are not affected by the carbohydrate impurities reviewers. It is distributed in contained in 20 g and 30 g crystal or liquid lactulose formulations. accordance with the Creative Commons Attribution Key Words: Lactulose; Constipation; Blood glucose; Type 2 diabetes mellitus; Laxative; NonCommercial (CC BY-NC 4.0) Sugar substitute license, which permits others to distribute, remix, adapt, build ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved. upon this work non-commercially, and license their derivative works on different terms, provided the Core Tip: Individuals with diabetes are at risk of developing constipation, which can be original work is properly cited and symptomatically treated with lactulose. The question arose whether carbohydrate the use is non-commercial. See: htt impurities in crystal and liquid lactulose formulations would increase blood glucose p://creativecommons.org/License levels in individuals with diabetes. This study demonstrates that, at the recommended s/by-nc/4.0/ maintenance dosage of 20 g and at a higher dosage of 30 g lactulose, the blood glucose baseline-corrected area under the curve from 0 to 180 min levels in mildly constipated, Manuscript source: Unsolicited non-insulin dependent subjects with type 2 diabetes mellitus are not affected. manuscript Specialty type: Endocrinology and metabolism Citation: Pieber TR, Svehlikova E, Mursic I, Esterl T, Wargenau M, Sartorius T, Pauly L, Schwejda-Guettes S, Neumann A, Faerber V, Stover JF, Gaigg B, Kuchinka-Koch A. Blood WJD https://www.wjgnet.com 894 June 15, 2021 Volume 12 Issue 6 Pieber TR et al. Blood glucose after lactulose in diabetes Country/Territory of origin: Austria glucose response after oral lactulose intake in type 2 diabetic individuals. World J Diabetes 2021; 12(6): 893-907 Peer-review report’s scientific URL: https://www.wjgnet.com/1948-9358/full/v12/i6/893.htm quality classification DOI: https://dx.doi.org/10.4239/wjd.v12.i6.893 Grade A (Excellent): 0 Grade B (Very good):
Load more

Recommended publications
  • Model Answer
    MAHARASHTRA STATE BOARD OF TECHNICAL EDUCATION (Autonomous) (ISO/IEC - 27001 - 2005 Certified) MODEL ANSWER WINTER– 18 EXAMINATION Subject Title: PHARMACEUTICAL CHEMISTRY-l Subject Code: 0806 ________________________________________________________________________________________ Important Instructions to examiners: 1) The answers should be examined by key words and not as word-to-word as given in the model answer scheme. 2) The model answer and the answer written by candidate may vary but the examiner may try to assess the understanding level of the candidate. 3) The language errors such as grammatical, spelling errors should not be given more Importance (Not applicable for subject English and Communication Skills. 4) While assessing figures, examiner may give credit for principal components indicated in the figure. The figures drawn by candidate and model answer may vary. The examiner may give credit for anyequivalent figure drawn. 5) Credits may be given step wise for numerical problems. In some cases, the assumed constant values may vary and there may be some difference in the candidate’s answers and model answer. 6) In case of some questions credit may be given by judgement on part of examiner of relevant answer based on candidate’s understanding. 7) For programming language papers, credit may be given to any other program based on equivalent concept. Page no.1/28 MAHARASHTRA STATE BOARD OF TECHNICAL EDUCATION (Autonomous) (ISO/IEC - 27001 - 2005 Certified) MODEL ANSWER WINTER– 18 EXAMINATION Subject Title: PHARMACEUTICAL CHEMISTRY-l Subject Code: 0806 ________________________________________________________________________________________ 1 ANSWER ANY EIGHT OF THE FOLLOWING. 16M (8x2) 1 a) State any four ideal properties of buffer solution. ANY The pH of buffer solution remains constant.
    [Show full text]
  • Influence of Bowel Preparation Before 18F-FDG PET/CT on Physiologic
    Influence of Bowel Preparation Before 18F-FDG PET/CT on Physiologic 18F-FDG Activity in the Intestine Jan D. Soyka1, Klaus Strobel1, Patrick Veit-Haibach1, Niklaus G. Schaefer1, Daniel T. Schmid1, Alois Tschopp2, and Thomas F. Hany1 1Department of Nuclear Medicine, University Hospital, Zurich, Switzerland; and 2Department for Biostatistics, University of Zurich, Zurich, Switzerland Our objective was to investigate the use of bowel preparation be- mendations have been made in order to reduce physiologic fore 18F-FDG PET/CT to reduce intestinal 18F-FDG uptake. uptake of 18F-FDG in the intestine or to improve the ability Methods: Sixty-five patients with abdominal neoplasias were to evaluate intestinal structures (5–8). However, no published assigned either to a bowel-preparation group (n 5 26) or to a na- tive group (n 5 39). 18F-FDG activity was measured in the small study has proven that bowel preparation before PET/CT intestine and the colon. Results: In the 26 patients with bowel is beneficial. We therefore conducted a naturally randomized preparation, average maximal standardized uptake value (SUV- and single-blinded study to evaluate the effects of bowel max) was 3.5 in the small intestine and 4.4 in the colon. In the cleansing on intestinal 18F-FDGactivityinPET/CT. 39 patients without bowel preparation, average SUVmax was 2.6 in the small intestine and 2.7 in the colon. 18F-FDG activity im- MATERIALS AND METHODS paired diagnosis in 6 patients (23%) in the bowel-preparation group and 11 patients (28%) in the native group (P 5 0.5). SUV- This prospective, naturally randomized, and single-blinded max in the colon was significantly higher in the bowel-prepara- study was approved by our local ethics committee.
    [Show full text]
  • Assessment Report on Cassia Senna L
    European Medicines Agency Evaluation of Medicines for Human Use London, 27 April 2007 Doc. Ref. EMEA/HMPC/51868/2006 Corr. COMMITTEE ON HERBAL MEDICINAL PRODUCTS (HMPC) ASSESSMENT REPORT ON CASSIA SENNA L. AND CASSIA ANGUSTIFOLIA VAHL, FOLIUM Herbal substance Cassia senna L. (C. acutifolia Delile) [Alexandrian or Khartoum senna] or Cassia angustifolia Vahl [Tinnevelly senna], folium (senna leaf) or a mixture of the two species Herbal preparation dried leaflets, standardised; standardised herbal preparations thereof Pharmaceutical forms Herbal substance for oral preparation Rapporteur Dr C. Werner Assessor Dr B. Merz Superseded 7 Westferry Circus, Canary Wharf, London, E14 4HB, UK Tel. (44-20) 74 18 84 00 Fax (44-20) 75 23 70 51 E-mail: [email protected] http://www.emea.europa.eu ©EMEA 2007 Reproduction and/or distribution of this document is authorised for non commercial purposes only provided the EMEA is acknowledged TABLE OF CONTENTS I. Introduction 3 II. Clinical Pharmacology 3 II.1 Pharmacokinetics 3 II.1.1 Phytochemical characterisation 3 II.1.2 Absorption, metabolism and excretion 4 II.1.3 Progress of action 5 II.2 Pharmacodynamics 5 II.2.1 Mode of action 5 • Laxative effect 5 II.2.2 Interactions 7 III. Clinical Efficacy 7 III.1 Dosage 7 III.2 Clinical studies 8 III.2.1 Constipation 8 III.2.2 Irritable bowel syndrome 10 III.2.3 Bowel cleansing 11 III.3 Clinical studies in special populations 15 III.3.1 Use in children 15 III.3.2 Use during pregnancy and lactation 16 III.4 Traditional use 17 IV.
    [Show full text]
  • Randomized Controlled Trial of a Natural Food-Based Fiber Solution to Prevent Constipation in Postoperative Spine Fusion Patients
    1.5 ANCC Contact Hours Randomized Controlled Trial of a Natural Food-Based Fiber Solution to Prevent Constipation in Postoperative Spine Fusion Patients Deborah Wittig-Wells ▼ Pam Sapp ▼ Melinda Higgins ▼ Erica Davis ▼ Jessica Carter ▼ Ani Jacob BACKGROUND: Constipation after orthopaedic surgery orthopaedic surgery occurs frequently, likely due to a occurs frequently, likely due to a combination of high levels combination of high levels of opioid medications for of opioid medications for severe pain management and severe pain management and mobility limitations after mobility limitations after surgery. It can result in serious surgery (Ross-Adjie, Monterosso, & Bulsara, 2015). complications, increased cost, and patient discomfort. Although constipation may be considered mild and PURPOSE: This study evaluated a natural food-based fiber self-limiting, it can increase the length of hospital stay and increase financial burdens for both the patient and the in- solution to prevent constipation in postoperative orthopae- stitution. Constipation may lead to significant morbidity dic patients. and, in rare cases, death (Davies et al., 2008). Reported METHODS: A posttest control group-randomized study rates of constipation in postoperative orthopaedic patients design was used. Dependent variables were presence of are between 40% and 60% (Park, Kim, Yun, & Yu, 2016; postoperative constipation, time to first bowel movement Ross-Adjie et al., 2015). Because constipation frequently (BM), and total number of postoperative BMs. Descriptive occurs in the postoperative orthopaedic population, pre- statistics, Student’s t tests, and Mann–Whitney nonparamet- vention and treatment of constipation are essential. ric 2-group tests with chi-square analysis were used. Level Dietary fiber is thought to improve gastrointestinal of significance for all tests was p < .05.
    [Show full text]
  • WO 2017/066488 Al
    (12) INTERNATIONAL APPLICATION PUBLISHED UNDER THE PATENT COOPERATION TREATY (PCT) (19) World Intellectual Property Organization International Bureau (10) International Publication Number (43) International Publication Date W O 2017/066488 A l 2 0 April 2017 (20.04.2017) P O P C T (51) International Patent Classification: (81) Designated States (unless otherwise indicated, for every A61K 31/485 (2006.01) A61P 25/04 (2006.01) kind of national protection available): AE, AG, AL, AM, A61K 31/5415 (2006.01) A61P 1/08 (2006.01) AO, AT, AU, AZ, BA, BB, BG, BH, BN, BR, BW, BY, BZ, CA, CH, CL, CN, CO, CR, CU, CZ, DE, DJ, DK, DM, (21) International Application Number: DO, DZ, EC, EE, EG, ES, FI, GB, GD, GE, GH, GM, GT, PCT/US20 16/0569 10 HN, HR, HU, ID, IL, EST, IR, IS, JP, KE, KG, KN, KP, KR, (22) International Filing Date: KW, KZ, LA, LC, LK, LR, LS, LU, LY, MA, MD, ME, 13 October 2016 (13.10.201 6) MG, MK, MN, MW, MX, MY, MZ, NA, NG, NI, NO, NZ, OM, PA, PE, PG, PH, PL, PT, QA, RO, RS, RU, RW, SA, (25) Filing Language: English SC, SD, SE, SG, SK, SL, SM, ST, SV, SY, TH, TJ, TM, (26) Publication Language: English TN, TR, TT, TZ, UA, UG, US, UZ, VC, VN, ZA, ZM, ZW. (30) Priority Data: 62/240,965 13 October 2015 (13. 10.2015) US (84) Designated States (unless otherwise indicated, for every 62/300,014 25 February 2016 (25.02.2016) US kind of regional protection available): ARIPO (BW, GH, GM, KE, LR, LS, MW, MZ, NA, RW, SD, SL, ST, SZ, (71) Applicant: CHARLESTON LABORATORIES, INC.
    [Show full text]
  • E42 Appendix 1 (Part 1 of 2): Categorization of Medications
    This single copy is for your personal, non-commercial use only. For permission to reprint multiple copies or to order presentation-ready copies for distribution, contact CJHP at [email protected] Appendix 1 (Part 1 of 2): Categorization of medications. Class and Type of Medication Specific Drugs Psychotropic Antiparkinsonian Benztropine, carbidopa/levodopa, levodopa/benserazide, pramipexole, procyclidine Hypnotic Zopiclone Antipsychotic (typical or atypical) Risperidone, olanzapine, quetiapine, haloperidol, perphenazine, loxapine, clozapine, methotrimeprazine Antidepressant Sertraline, trazodone, mirtazapine, citalopram, escitalopram, duloxetine Benzodiazepine Lorazepam, clonazepam, oxazepam Anticonvulsant Pregabalin, levetiracetam, phenytoin, valproic acid, gabapentin, divalproex, topiramate Cholinesterase inhibitor Donepezil Anticholinergic Atropine CNS stimulant Methylphenidate Cardiovascular Diuretic Furosemide, metolazone, spironolactone, indapamide, acetazolamide, hydrochlorothiazide Antilipemic Rosuvastatin, atorvastatin Antihypertensive Amlodipine, diltiazem, hydralazine ␤-Blocker Bisoprolol, metoprolol, carvedilol, propranolol ACE inhibitor Lisinopril, ramipril, enalapril, perindopril, fosinopril Angiotensin II receptor blocker Olmesartan, irbesartan, valsartan, candesartan Antianginal Nitroglycerin Hematologic Anticoagulant Enoxaparin, heparin, apixaban, rivaroxaban, warfarin Platelet inhibitor Acetylsalicylic acid, clopidogrel Anemia therapy Ferrous gluconate, ferrous fumarate Endocrine Hormone replacement Levothyroxine,
    [Show full text]
  • Medical Supplement
    MEDICAL SUPPLEMENT Name _______________________________________ Date ______________________________ Are you presently being treated for medical problems? ⃝ Yes ⃝ No If yes, for what problem and who is treating you?__________________________________________________ ___________________________________________________________________________________________ When was your last physical examination?______________________________________________________________ Where and by whom?_________________________________________________________________________ List all medications you are currently taking, including over the counter and herbal/natural preparations: Medication Dosage Why do you take it? Who prescribes? 1 1000 Darrington Drive, Suite 204, Cary, North Carolina 27513 | (P) 919.338.5620 | (F) 919.336.4519 | [email protected] MEDICAL SUPPLEMENT Do you have any drug, food, or environmental allergies? __________________________________________________________________________________________________ __________________________________________________________________________________________________ Have you had any bad drug reactions? Please describe. __________________________________________________________________________________________________ __________________________________________________________________________________________________ Please list any surgeries: Date ___________________Surgery For ___________________________________________ Date ___________________Surgery For ___________________________________________ Date ___________________Surgery
    [Show full text]
  • Melanosis Coli
    DOI: 10.31662/jmaj.2021-0031 https://www.jmaj.jp/ Images Melanosis Coli Akira Kuriyama Key Words: melanosis, constipation, laxatives, anthraquinone A 75-year-old man with a 23-year history of poorly controlled Informed Consent type 2 diabetes mellitus presented with chronic constipation. Written informed consent was obtained from the patient to Colonoscopy showed heavily pigmented mucosa, resembling publish this case report including the accompanying images. leopard skin, from the cecum through the ascending colon (Figure 1). The patient had been using senna glycoside for the References last 7 years, which supported a diagnosis of melanosis coli. A multicenter observational study with patients who had 1. Wang S, Wang Z, Peng L, et al. Gender, age, and concomitant undergone colonoscopy suggested that the prevalence of mela- diseases of melanosis coli in China: a multicenter study of 6,090 nosis coli is approximately 1.8% (1). Melanosis coli is associated cases. PeerJ. 2018;6:e4483. with the chronic use of laxatives, particularly those containing 2. Byers RJ, Marsh P, Parkinson D, et al. Melanosis coli is anthraquinones, such as senna, rhubarb, and cascara. It can associated with an increase in colonic epithelial apoptosis and develop within a few months of using anthraquinone-contain- not with laxative use. Histopathology. 1997;30(2):160-4. ing laxatives. Anthraquinones cause direct injury to and apop- 3. Biernacka-Wawrzonek D, Stepka M, Tomaszewska A, et al. tosis of the colonic epithelial cells, resulting in lipofuscin dep- Melanosis coli in patients with colon cancer. Przeglad osition in the macrophages of the lamina propria (2), which is gastroenterologiczny.
    [Show full text]
  • National Master List of Drugs and Lab Reagents
    ITEM NAME 1 CARDIOVASCULAR SYSTEM 1A Positive inotropic drugs 1AA Digtalis glycoside 02-01-00001 Digoxin 62.5mcg Tablet 2539500 02-01-00002 Digitoxin 100mcg Tablet 2397000 02-01-00003 Digoxin 125 mcg Tablet 2622000 02-01-00004 Digoxin 250 mcg Tablet 44165500 02-01-00005 Digoxin 50mcg /ml PG Elixir 800000 02-01-00006 Digoxin 250 mcg/ml inj (2ml) Ampoule 800000 1AB PHOSPHODIESTERASE INHIBITORS 02-01-00007 Enoximone 5mg/1ml inj (20ml) Ampoule 800000 1B DIURETICS 02-01-00008 Amiloride Hcl 5mg + Hydrochlorthiazide 50mg Tablet 50000000 02-01-00009 Bumetanide 1 mg Tablet 1369000 02-01-00010 Chlorthalidone 50mg Tablet 6360500 02-01-00011 Ethacrynic acid 50mg as sodium salt inj (powder for reconstitution) Vial 800000 02-01-00012 Frusemide 20mg/2ml inj Ampoule 9437000 02-01-00013 Frusemide 10mg/ml,I.V.infusion inj (25ml) Ampoule 800000 02-01-00014 Frusemide 40mg Tablet 78372000 02-01-00015 Frusemide 500mg Scored Tablet 800000 02-01-00016 Frusemide 1mg/1ml Oral solution peadiatric Liquid 800000 02-01-00017 Frusemide 4mg/ml Oral Solution 800000 02-01-00018 Frusemide 8mg/ml oral Solution 800000 02-01-00019 Hydrochlorothiazide 25mg Tablet 3173000 02-01-00020 Hydrochlorothiazide 50mg Tablet 3033500 02-01-00021 Indapamide 2.5mg Tablet 800000 02-01-00022 Indapamide 1.5mg S/R Coated Tablet 800000 02-01-00023 Spironolactone 25mg Tablet 8426000 02-01-00024 Spironolactone 100mg Tablet 5829500 02-01-00025 Xipamide 20mg Tablet 800000 1C BETA-ADRENOCEPTER BLOCKING DRUGS 02-01-00026 Acebutolol 100mg Tablet 800000 02-01-00027 Acebutolol 200mg Tablet 800000 02-01-00028 Atenolol 100mg Tablet 120000000 02-01-00029 Atenolol 50mg Tablet or (scored tab) 48893000 02-01-00030 Atenolol 25mg Tablet 8628500 02-01-00031 Bisoprolol fumarate 5mg Scored Tablet 800000 02-01-00032 Bisoprolol fumarate 10mg Scored Tablet 800000 02-01-00033 Carvedilol 6.25mg Tablet 3279500 02-01-00034 Carvedilol 12.5mg Tablet 2228500 02-01-00035 Carvedilol 25mg Tablet 2650000 02-01-00036 Esmolol Hcl 10mg/ml I.V.
    [Show full text]
  • A Case Report of Delirium Induced by Herbal Laxative Senna
    International Journal of Health Sciences and Research DOI: https://doi.org/10.52403/ijhsr.20210636 Vol.11; Issue: 6; June 2021 Website: www.ijhsr.org Case Report ISSN: 2249-9571 A Case Report of Delirium Induced by Herbal Laxative Senna Nimitha K J1, Porimita Chutia2, Pooja Misal3, Bhupendra Singh4 1,2,3 Senior Resident, 4Additional Professor, Department of Geriatric Mental Health, King George’s Medical University, Lucknow, India Corresponding Author: Nimitha K J ABSTRACT Constipation is one major complaint in elderly population. It may be due to physiological and anatomical reasons of aging, but it can be also due chronic medical and mental illnesses and due to use of multiple medications. Constipation itself is a precipitating factor for delirium. Drugs used for constipation can also be the culprit. A 64-year-old female who had a history of hypertension and chronic constipation presented with symptoms of confused and altered behavior, decreased oral intake, decreased sleep. On history taking it was known that she was using Herbal medication containing senna glycoside and other compounds since 8-9months. On examination she had signs of dehydration, disoriented and attention was impaired. On investigation her serum sodium was 122.6 mmol/ and other investigations were within normal limits. She was diagnosed as a case of Delirium according to ICD-10 criteria. Her dehydration was corrected by giving intravenous fluids and serum sodium level was corrected using salt capsules 2 tablets thrice daily. For disturbed sleep she was prescribed Tab Melatonin 10mg at bedtime and constipation was treated with per rectal enema and syrup lactulose 30ml at bedtime.
    [Show full text]
  • WO 2018/013871 Al 18 January 2018 (18.01.2018) W !P O PCT
    (12) INTERNATIONAL APPLICATION PUBLISHED UNDER THE PATENT COOPERATION TREATY (PCT) (19) World Intellectual Property Organization International Bureau (10) International Publication Number (43) International Publication Date WO 2018/013871 Al 18 January 2018 (18.01.2018) W !P O PCT (51) International Patent Classification: Published: A61K 31/715 (2006.01) A61P 43/00 (2006.01) — with international search report (Art. 21(3)) A61K 9/00 (2006.01) — before the expiration of the time limit for amending the (21) International Application Number: claims and to be republished in the event of receipt of PCT/US20 17/042022 amendments (Rule 48.2(h)) (22) International Filing Date: 13 July 2017 (13.07.2017) (25) Filing Language: English (26) Publication Language: English (30) Priority Data: 62/361,998 13 July 2016 (13.07.2016) US (71) Applicant: KALEIDO BIOSCIENCES, INC. [US/US]; 47 Moulton St, Cambridge, MA 02138 (US). (72) Inventors: VON MALTZAHN, Geoffrey, A.; 42 Myrtle St Apt Bl, Somerville, MA 02145 (US). RUBENS, Ja¬ cob, Rosenblum; 177 Hancock St., Cambridge, MA 02139 (US). (74) Agent: COLLAZO, Diana, M. et al; Lando & Anastasi, LLP, Riverfront Office Park, One Main Street, Suite 1100, Cambridge, MA 02142 (US). (81) Designated States (unless otherwise indicated, for every kind of national protection available): AE, AG, AL, AM, AO, AT, AU, AZ, BA, BB, BG, BH, BN, BR, BW, BY, BZ, CA, CH, CL, CN, CO, CR, CU, CZ, DE, DJ, DK, DM, DO, DZ, EC, EE, EG, ES, FI, GB, GD, GE, GH, GM, GT, HN, HR, HU, ID, IL, IN, IR, IS, JO, JP, KE, KG, KH, KN, KP, KR, KW, KZ, LA, LC, LK, LR, LS, LU, LY, MA, MD, ME, MG, MK, MN, MW, MX, MY, MZ, NA, NG, NI, NO, NZ, OM, PA, PE, PG, PH, PL, PT, QA, RO, RS, RU, RW, SA, SC, SD, SE, SG, SK, SL, SM, ST, SV, SY, TH, TJ, TM, TN, TR, TT, TZ, UA, UG, US, UZ, VC, VN, ZA, ZM, ZW.
    [Show full text]
  • Clozapine-Induced GI Hypomotility: from Constipation to Bowel Obstruction
    Pearls Clozapine-induced GI hypomotility: From constipation to bowel obstruction Andrew Cruz, MD, and Oliver Freudenreich, MD Dr. Cruz is a PGY-2 resident, MGH/ Table McLean Adult Psychiatry Residency atients who are treated with clozap- Program, and Dr. Freudenreich ine—a second-generation antipsy- Bowel regimen for chronic is Co-Director, Schizophrenia chotic approved for treatment-resistant constipation Clinical and Research Program, P Massachusetts General Hospital, schizophrenia—require monitoring for seri- Stool softener (daily) Boston, Massachusetts. ous adverse effects. Many of these adverse Docusate sodium 100 mg twice daily Disclosures effects, such as agranulocytosis or seizures, Stimulant laxative (weekly and as needed) The authors report no financial relationships with any company are familiar to clinicians; however, gastro- Bisacodyl, 5 to 15 mg/d, as needed whose products are mentioned in intestinal (GI) hypomotility is not always Senna glycoside, 15 mg/d, as needed this article, or with manufacturers of competing products. recognized as a potentially serious adverse effect, even though it is one of the most common causes for hospital admission.1 Its Staff who care for patients taking clozapine manifestations range from being relatively who live in a supervised setting should be benign (nausea, vomiting, constipation) to educated about the relevance of a patient’s potentially severe (fecal impaction) or even changing bowel habits or GI complaints. life-threatening (bowel obstruction, ileus, Also, teach patients about simple lifestyle toxic megacolon).2 modifications they can make to counteract GI hypomotility is caused by clozapine’s constipation, including increased physical strong anticholinergic properties, which activity, adequate hydration, and consum- lead to slowed smooth muscle contrac- ing a fiber-rich diet.
    [Show full text]