Digestants

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Chapter: Essential pharmacology : Drugs For Emesis, Reflux And Digestive Disorders

These are substances intended to promote digestion of food. A number of proteolytic, amylolytic and lipolytic enzymes are marketed in combination formulations and are vigorously promoted for dyspeptic symptoms, and as appetite stimulants or health tonics.


DIGESTANTS

 

These are substances intended to promote digestion of food. A number of proteolytic, amylolytic and lipolytic enzymes are marketed in combination formulations and are vigorously promoted for dyspeptic symptoms, and as appetite stimulants or health tonics. They are occasionally beneficial, only when their elaboration in g.i.t. is deficient. Their routine use in tonics and appetite improving mixtures is irrational.

 

1. Hydrochloric Acid

 

It may be used in achlorhydria; 5–10 ml of dilute HCl (10%) should be further diluted to 100–200 ml with water and sipped with a straw (to prevent contact with teeth) during meals.

 

2. Pepsin

 

May be used along with HCl in gastric achylia due to atrophic gastritis, gastric carcinoma, pernicious anaemia, etc.

 

3. Papain

 

It is a proteolytic enzyme obtained from raw papaya. Its efficacy after oral ingestion is doubtful.

 

4. Pancreatin

 

It is a mixture of pancreatic enzymes obtained from hog and pig pancreas. It contains amylase, trypsin and lipase; indicated in chronic pancreatitis and other exocrine pancreatic deficiency states. Fat and nitrogen content of stools may be reduced and diarrhoea/ steatorrhoea may be prevented. It has to be used as enteric coated tablets or capsules to protect the enzymes from being themselves digested in stomach by pepsin. Nausea, diarrhoea and hyperuricaemia are the occasional side effects.

 

5. Diastase and Takadiastase

 

These are amylolytic enzymes obtained from the fungus Aspergillus oryzae. They have been used in pancreatic insufficiency, but efficacy is equivocal.

 

Preparations

 

ALVIZYME: Pancreatin 125 mg, simethicone 25 mg tab. BESTOZYME: Alfa amylase 320 mg, papain 60 mg, dimethicone 40 mg cap.

 

DIGENZYMES: Diastase 19 mg, pepsin 110 mg, papain 50 mg per 10 ml liq.

 

DIGIPLEX: Diastase 20 mg, pepsin 20 mg, vit B1 1 mg, vit B2 1 mg, vit B6 0.5 mg nicotinamide 10 mg, pantothenyl alcohol 2 mg, vit B12 0.5 μg per 10 ml liq. DIZEC: Pancreatin 250 mg, sod. tauroglycocholate 50 mg, methylpolysiloxane 25 mg tab.

 

LUPIZYME: Pepsin 12.5 mg, diastase 18.75 mg, vit B1 2 mg, B2 1 mg, B6 1.5 mg, B12 1 μg, pantothenol 1.5 mg, nicotinamide 15 mg per 5 ml syr.

 

PEPSINOZYME: Diastase 150 mg, pepsin 50 mg, papain 30 mg, vit B1 0.5 mg, vit B2 0.5 mg, niacinamide 5 mg, activated charcoal 75 mg tab.

 

RALCRIZYME: Pancreatin 150 mg, bile extract 25 mg, pepsin 5 mg, diastase 10 mg, methyl polysiloxane 25 mg tab.

 

TAKADIASTASE:   Takadiastase 162 mg tab.

 

Enzyme preparations containing an antispasmodic or a laxative and fixed dose combinations of pancreatine or pancrelipase containing amylase, protease and lipase with any other enzyme are banned in India.

 

Methyl Polysiloxane

 

(Dimethyl polysiloxane, Simethicone, Dimethicone) It is a silicone polymer, a viscous amphiphilic liquid—reduces surface tension and collapses froth, ‘antifoaming agent’. It is not absorbed from g.i.t. and is pharmacologically inert. Added to antacid, digestant and antireflux preparations (see above), it is claimed to relieve flatulence, to coat and protect ulcer surface, to aid dispersion of antacids in gastric contents, and to prevent gastroesophageal reflux. However, clinical efficacy is equivocal.

 

Dose: 40–120 mg 3 to 4 times a day.

 

DIMOL 40 mg tab. (single ingredient).

 

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