Gastrointestinal System Drug Guide

2.
GASTRO-INTESTINAL SYSTEM
Chapter 2
GASTRO-INTESTINAL SYSTEM
2.1 Drugs for Dyspepsia and gastrooesophegal reflux p.100
2.1.1 Aluminium and magnesium containing antacids p.102
2.1.2 Compound antacid preparations p.103
2.2 Antispasmodics and other drugs altering gut motility p.104
2.3 Ulcer-healing drugs p.110
2.3.1 H2 receptor antagonists p.111
2.3.2 Selective antimuscarinics p.114
2.3.3 Proton pump inhibitors p. 114
2.3.4 Chelates and complexes p.120
2.3.5 Prostaglandin analogues p.120
2.3.6 Drugs for eradication of H. pylori p. 121
2.4 Drugs for acute diarrhoea p. 122
2.5 Drugs for chronic diarrhoeas p.124
2.6 Laxatives p. 126
2.6.1 Bulk forming laxatives p. 126
2.6.2 Stimulant laxatives p. 127
2.6.3 Faecal softeners p. 128
2.6.4 Osmotic laxatives p. 128
2.7 Preparations for haemorrhoids p. 130
2.7.1 Soothing haemorrhoidal preparations p. 130
2.7.2. Compound haemorrhoidal preparations with corticosteroids p. 131
2.7.3 Rectal sclerosants p. 131
2.8 Drugs affecting intestinal secretions p. 131
2.8.1 Drugs acting on gall bladder p. 131
2.8.2 Pancreatin p. 132
2.1 DRUGS FOR DISPEPSIA AND Antacid provides some symptomatic

GASTRO-OESOPHEGAL relief of dyspepsia. However, if
REFLUX symptoms persist in uninvestigated
dyspepsia, treatment involves a proton
Dyspepsia pump inhibitor for up to 4 weeks. If
Dyspepsia is associated upper patient do not respond to a proton pump
abdominal pain, fullness, early satiety, inhibitor, should be tested for
bloating, and nausea. It can also occur Helicobacter pylori (H. pylori) and given
with gastric and duodenal ulceration and eradication therapy (section 2.3.6) if H.
gastric cancer. However, most pylori test is positive.
commonly the cause and orgin are H. pylori positive patients with functional
uncertain. Dyspepsia associated with (investigated, non-ulcer) dyspepsia,
bleeding, dysphagia, recurrent vomiting, should be treated with eradication
or weight loss needs urgent endoscopic therapy. If symptoms persist, treatment
investigation. Sometimes some with either a proton pump inhibitor
medicines or patient’s life style may (section 2.3.3) or H2-receptor antagonist
cause dyspepsia. (section 2.3.1) can be given for 4 weeks.
These antisecretory drugs can be used
100
2. GASTRO-INTESTINAL SYSTEM
intermittently to control symptoms long treatment is titrated down to a level

term. However, most patients with which maintains remission (e.g. by
functional dyspepsia do not benefit reducing the dose of the proton pump
symptomatically from H. pylori inhibitor or by giving it intermittently, or
eradication therapy or antisecretory by substituting treatment with a
drugs. histamine H2-receptor antagonist).
Gastro-oesophageal reflux disease Patient with endoscopically confirmed
Gastro-oesophageal reflux disease (both erosive, ulcerative, or stricturing disease,
non-erosive and erosive) is associated or Barrett’s oesophagus, treatment with
with heartburn, acid regurgitation, and a proton pump inhibitor usually needs to
sometimes, difficulty in swallowing be maintained at the minimum effective
(dysphagia). Oesophagitis, ulceration, dose.
and stricture formation may occur with Pregnant woman with gastro-
associated asthma. oesophageal reflux is managed by
The management of gastro-oesophageal dietary and lifestyle changes; if no
reflux disease includes drug treatment, improvement of symptoms, an antacid
lifestyle changes and, in some cases, (section 2.1.1) or an alginate may be
surgery. Initial treatment is guided by the given. If this is ineffective, ranitidine
severity of symptoms and treatment is (section 2.3.1) may be advised.
then adjusted according to response. However, omeprazole (section 2.3.3) is
The extent of healing depends on the reserved for women with severe or
severity of the disease, the treatment complicated reflux disease.
chosen, and the duration of therapy. Children with gastro-oesophageal reflux
Patient with gastro-oesophageal reflux disease is common in infancy. However,
disease is treated with drugs. However, most symptoms resolve without
patient should be advised to change treatment between 12 and 18 months of
lifestyle such as cessation of smoking age. Infants with mild or moderate reflux
and alcohol, avoidance of fatty foods; without complications can be managed
other measures include weight reduction initially by changing the frequency and
and raising the head of the bed. In some volume of feed. A thickened formula feed
cases surgery may be required. can be used upon advice of a dietitian. If
Patient with gastro-oesophageal reflux necessary, a suitable alginate-containing
with mild symptoms may be managed by preparation can be used instead of
the use of antacids and alginates. thickened feeds. Older children with
Histamine H2-receptor antagonists reflux may be managed by life-style
(section 2.3.1) may also relieve changes; if necessary by treatment with
symptoms, but proton pump inhibitors an alginate containing preparation.
(section 2.3.3) provide more effective Non-resposive children to the above
relief of symptoms than H2-receptor measures or who have problems such
antagonists. When symptoms subside, as respiratory disorders or suspected
treatment is titrated down to a level oesophagitis need to be referred to
which maintains remission (e.g. by giving hospital; an H2-receptor antagonist
treatment intermittently). (section 2.3.1) may be tried to reduce
Patient with gastro-oesophageal reflux acid secretion. If the oesophagitis is
with severe symptoms or patient with a resistant to H2-receptor antagonists, the
proven or severe pathology (e.g. proton pump inhibitor omeprazole
oesophagitis, oesophageal ulceration, (section 2.3.3) can be advised.
oesophagopharyngeal reflux, Barrett’s Hepatic and renal impairment:
oesophagus) may be treated initially by Patients with fluid retention should avoid
giving a proton pump inhibitor (section antacids containing large amounts of
2.3.3); However, if symptoms persist sodium.
despite treatment for 4–6 weeks with a Interactions: Antacids should preferably
protonpump inhibitor, reassessment not be taken at the same time as other
should be done. When symptoms abate, drugs since they may impair absorption.
101
It may also damage enteric coatings PREPARATIONS CONTAINING

designed to prevent dissolution in the MIXUTURES OF ALUMINIUM
stomach. HYDROXIDE AND MAGNESIUM
HYDROXIDE[ED]
2.1.1 ALUMINIUM-AND MAGNESIUM-
CONTAINING ANTACIDS Proprietary Preparations
2.1.2 COMPOUND ANTACID Alimag (Asiatic), Tab. Tk. 0.52/Tab.
PREPARATIONS Alucil-S (Opsonin), Susp.Tk. 56.39/200 ml
Tab.Tk. 1.50/Tab.
Antacid (Popular), Tab. Tk. 0.53/Tab.
Antacids are basic compounds, which Antameal (Alco), Tab. Tk. 0.50/Tab.
neutralize hydrochloric acid in the gastric Antanil (Ibn Sina), Susp.Tk. 33.00/200 ml
secretions; they often relieve symptoms Tab. Tk. 0.52/Tab.
of gastrointestinal disorders associated Apcocid (Supreme), Tab. Tk. 0.50/Tab.
with gastric hyperacidity such as ulcer Apedrox (APC ), Susp. Tk. 30.00/200 ml
dyspepsia, non-erosive gastro- Biocid (Biopharma), Tab. Tk. 0.50/Tab.
oesophegal reflux disease and peptic Biocid MH (Biopharma),Susp.Tk.32.42/200 ml
Cytocid (Central), Susp. Tk. 32.00/200 ml
ulcer Antacids, sometimes also used in Entacyd (Square), Susp. Tk. 55.00/200 ml
functional (non-ulcer) dyspepsia but the Tab. Tk. 0.80/Tab.
evidence of benefit is uncertain. They G-Antacid MH (Gonoshasthaya), Tab.
are best given usually between meals Tk.0.53/Tab
and at bedtime when symptoms occur or Gascon (Popular), Tab. Tk. 1.20/Tab.
are expected. Liquid preparations are Jpdrox (Jayson), Susp. Tk. 57.00/200 ml;
more effective than solids and relatively Tab. Tk. 0.73/Tab.
Lactameal (Beximco), Tab. Tk. 0.53/Tab.;
insoluble antacids are longer acting. Susp. Tk. 33.00/200 ml
Presence of foods in the stomach can Magnogel (Amico ), Tab. Tk. 0.52/Tab.;
prolong the neutralizing activity. Antacids Tk.32.00/200 ml
may interact with many other drugs Oxecone (Acme), Susp.Tk. 57.33/200 ml;
affecting the rate and extent of their Tab. Tk. 0.73/Tab.
absorption (see Appendix-2). For this Sugel (Pacific), Susp. Tk. 24.06/200 ml; Tab.
reason, antacids should preferably not Tk. 0.38/Tab.
be taken at the same time with other
drugs. MAGNESIUM TRISILICATE
2.1.1 ALUMINIUM AND MAGNESIUM Indications: used as an antacid in dose

CONTAINING ANTACIDS upto 2 g by mouth; usually in combi-
nation with aluminium-containing
antacids
Salts of Aluminium (Aluminium
hydroxide gel) and Magnesium Cautions: see notes above; patients
(Magnesium hydroxide, Magnesium with impaired renal functions
trisilicate and Magnesium carbonate), Contraindications: see notes above
being relatively insoluble in water, are
Interactions: see Appendix-2
long-acting and are suitable for use as
antacid. Magnesium-containing antacids Side-effects: diarrhoea
tend to cause diarrhoea and aluminium
salts cause constipation; so mixtures of
these two preserve normal bowel Mixtures of 250mg of Dried
function. Some of these preparations Aluminium Hydroxide Gel and
contain high concentration of sodium 500mg of Magnesium Trisilicate
G-Antacid (Gonoshasthaya), Susp.
and should not be given to patients on Tk.32.00/200ml; Tab. Tk. 0.53/Tab.
sodium restricted diet.
102
2.1.2 COMPOUND ANTACID, ALUMINIUM -AND MAGNESIUM-

SIMETHICONE AND ALGINATE CONTAINING ANTACIDS WITH
PREPARATIONS ADDITIONAL INGREDIENTS
Compound preparations have no clear Simethicone which acts as a defoaming

advantages over simpler preparations; agent has been combined with an
their neutralising capacity may be the antacid formulation to relieve flatulence.
same. Complexes containing both
aluminium and magnesium such as ALGINATES
magaldrate hydrotalcite and
almasilate have been used. Alginate an anionic polysaccharide is
obtained from brown algae. Alginates
MAGALDRATE containing antacids form a viscous gel
(raft) that floats on the surface of
Magaldrate (Aluminium Magnesium stomach contents which impedes reflux
Hydroxide Sulfate) is a synthetic and protects oesophageal mucosa from
combination of aluminium and acid attack. Compound antacid
magnesium hydroxides and sulphates. It preparations contain alginic acid or
reacts initially rapidly with acid and sodium alginates with sodium
releases aluminium hydroxide, which bicarbonate/potassium bicarbonate,
then reacts more slowly to provide calcium carbonate. Some compounds
sustained neutralizing action. Magaldrate preparations also contain
may be given in doses of up to 2 g by alginate/alginic acid with dried
mouth. aluminium hydroxide, magnesium
trisilicate and sodium bicarbonate
Proprietary Preparations
Magacil (Opsonin), Tab., 400 mg, Tk. Proprietary Preparations
0.75/Tab.; Susp., 400 mg/5 ml , Tk. Sodium Alginate + Potassium Bicarbonate
37.74/200ml Algicid (Incepta), Susp., 500 mg + 100 mg
Magaplus (Kemiko), Susp., 400 mg/5 ml, Tk. /5ml, Tk. 125.00/200 ml ;Tab. , 500 mg + 100
54.20/200 ml mg, Tk. 3.50/Tab.
Marlox (Incepta), Tab., 400 mg, Tk. 1.00/Tab. Algicon (Leon), Tab. , 500 mg + 100 mg, Tk.
Oxecone-M (Acme), Tab. 400 mg,Tk. 1/Tab. ; 3.00/Tab. ;Susp., 500 mg + 100 mg /5ml,Tk.
Susp., 400 mg/5 ml, Tk. 54.20/200 ml 125.00/200 ml
Asynta (Square), Susp., 500 mg + 100 mg/5
Magaldrate 480mg + Simethicone20mg/Tab ml, Tk. 125.00/200 ml
Magaldrate 480mg + Simethicone20mg/5ml Gastrocon (Unimed), Tab., 500 mg + 100 mg,
suspension Tk. 4.50/Tab.;Susp., 500mg + 100 mg/5 ml,
Avlocid MS (ACI), Tab., , Tk. 3.00/Tab.; Tk. 155.00/200 ml
Susp., Tk. 100.00/200 ml Viscocid (Beximco), Susp. 500 mg+100 mg
Digecid Plus (Beximco), Tk. 2.00/Tab.; Susp., /5ml, Tk. 150.00/200 ml
Tk. 110.00/200 ml
Gastid (Eskayef), Tab., Tk. 3.00/Tab.; Susp., SIMETHICONE
Tk. 100.00/200 ml
Magacil Plus (Opsonin), Susp.Tk.75.19/200ml (Activated Dimethicone)
Magalrat Plus (Ibn Sina), Tab., Tk. 3.00/Tab.;
Susp., Tk. 100.00/200 ml Simethicone which is also known as
Maganta Plus (Square), Tab., Tk. 3.00/Tab.; Activated Dimethicone has been used
Susp., Tk. 100.00/200 ml for the relief of the painful symptomos of
Magaplus-X (Kemiko),Susp.Tk. 55.00/100 ml; excess gas in the digestive tract. Such
Tk. 100.00/200 ml
Marlox Plus (Incepta), Tab.Tk. 3.00/Tab.;
gas is frequently caused by excessive
Susp., Tk. 100.00/200 ml swallowing of air while eating foods that
Novelta (Orion), Tab. Tk. 3.00/Tab.; Tk. 65.00/ disagree, and this may also lead to
100 ml; Tk. 100.00/200 ml indigestion. It has also been used in
Oxecone-MS (Acme), Susp.Tk.100.00/200 ml infantile colic but evidence of benefit is
uncertain.
103
Simethicone acts in the stomach and Recocid Plus (Rephco), Susp., Tk. 75/200 ml;
intestine by changing the surface tension Tab. Tk. 2/Tab.
of gas bubbles, enabling them to
coalesce; thus gas is freed and 2.2 ANTISPASMODICS AND
eliminated more easily by belching or OTHER DRUGS ALTERING
passing flatus. GUT MOTILITY
Indications: flatulence, Abdominal
Gastrointestinal pain and discomfort may
distension, gas and windy colic.
be due to spasm of the smooth muscles
Simethicone drops are particularly indi-
which may be associated with dyspepsia
cated in infantile colic
irritable bowel syndrome or diverticular
Cautions; Contraindications; Side- disease. Antispasmodic drugs may be
effects: simethicone is an inert subst- useful as adjunctive treatment and are of
ance and no adverse effects have been two types: a) antimuscarinics; and b)
reported after oral administration direct smooth muscle relaxant.
Proprietary Preparations ANTIMUSCARINICS

Aeropac (Amico), Paed. drops, 67 mg/ml, Tk.
25.00/15 ml (see also section 8.1.3)
Bloatstop (Acme), Emulsion, 1 gm/100 ml, Tk. The antimuscarinics reduce intestinal
70.00/100 ml spasm, motility and gastric secretions,
Flacol (Square), Paed. drops, 67 mg/ml,, Tk.
and may be useful in some forms of
30.11/15 ml ;Tab. , 40mg, Tk. 1.50/Tab.
Flatulex (Opsonin), Paed. drops, 67 mg/ml,, dyspepsia, irritable bowel syndrome and
67 mg/ml, Tk. 22.64/15 ml diverticular disease. Antimuscarinics
Flatunil (Acme), Paed. drops, 67 mg/ml, 67 used in gastrointestinal muscle spasm
mg/ml, Tk. 30.00/15 ml include the tertiary amines Atropine
Gasnil (Eskayef), Paed. drops 67 mg/ml, Tk. sulphate, dicycloverine hydrochloride
30.00/15 ml and oxyphencyclimine hydrochloride
Lefoam (Incepta), Paed. drops, 67 mg/ml, Tk.
Trimebutine is a drug with
30.00/15 ml
Neodrop (Beximco), Paed. drops, 67 mg/ml, antimuscarinic and opioid agonist effects
Tk. 30.00/15 ml quaternary ammonium compounds
Pedicon (Orion), Paed. drops, 67 mg/ml, Tk. Hyoscine butylbromide Propantheline
25.09/10 ml ;Paed. drops, 67 mg/ml, Tk. bromide, oxyphenonium bromide, and
30.11/15 ml Tiemonium methylsulphate.
Semecon (Drug Int.), Paed. drops, 67 mg/ml,
Tk. 35.00/15 ml Dicycloverine hydrochloride has much
Simecol (Alco), Paed. drops, 67 mg/ml, Tk. less antimuscarinic action than atropine
28.00/15 ml and may also have some direct action on
Simet (ACI), Paed. drops, 67 mg/ml, Tk. smooth muscle. Hyoscine butylbromide
30.11/15 ml is advised as a gastro-intestinal
antispasmodic, but it is poorly absorbed.
Aluminium hydroxide and magnesium
hydroxide with simethicone Quaternary ammonium compounds are
Antacid MAX (Beximco), Tab. Tk. 2/Tab. ; less lipid soluble and so are less likely to
Antanil Plus (Ibn Sina), Susp. Tk. 65/200 ml; cross the blood-brain barrier; they are
Tab., Tk. 1.50/Tab. also less well absorbed. Although central
Avlocid Plus (ACI), Tab. Tk. 2/Tab. ;Susp.,
Tk. 75/200 ml
atropine like side-effects, such as
BIocid Plus (Biopharma), Susp. Tk. 75/200ml; confusion, are thereby reduced,
Tab. Tk. 2/Tab. peripheral atropine-like side-effects still
Entacyd Plus (Square), Susp.Tk. 75/200 ml; remain common. The elderly are
Tab. Tk. 2.00/Tab. particularly susceptible to glaucoma and
Flatameal DS (Beximco), Susp. Tk. 75/200 ml urinary retention.
Kdrox Plus (Kemiko), Tab. Tk. 2/Tab. Antimuscarinics are contraindicated in
Makcid Plus (Maks), Susp. Tk. 64/200 ml
Oxecone-S (Acme), Susp.Tk. 75/200 ml;
myasthenia gravis (but may be used to
Tab., Tk. 2.00/Tab. decrease muscarinic side-effects of
Peptacid (Amico),Tab.,Tk.1/Tab.;Tk.55/200 ml anticholinesterases), pyloric stenosis,
104
paralytic ileus, toxic megacolon, and Breast-feeding: should be avoided,

prostatic enlargement. It should be used present in milk; apnoea reported in infant
with caution in children and in the Dose: 10–20 mg 3 times daily; INFANT
elderly; in Down’s syndrome, reflux 6–24 months 5–10mg 3–4 times daily,
oesophagitis, diarrhoea, conditions 15 minutes before feeds; CHILD 2–12
associated with cardiac insufficiency and years 10mg 3 times daily
tachycardia, hypertension, ulcerative
colitis,autonomic neuropathy, acute Proprietary Preparations
myocardial infarction, pyrexia, individuals Abdorin (Opsonin), Tab., 10 mg, Tk.
susceptible to angle-closure glaucoma. 1.51/Tab.;Syrup, 10 mg/5 ml, Tk . 22.64/50 ml
Colicon (Square), Tab. , 10 mg, Tk. 2.01/Tab.
Side-effects of antimuscarinic drugs Inj., 20 mg/2 ml, Tk. 6.02/Amp.; Syrup, 10
(especially with high doses) include mg/5 ml, Tk. 30.11/50 ml
constipation, transient bradycardia Cyclopan (Incepta), Syrup, 10 mg/5 ml , Tk.
(followed by tachycardia, palpitations 30.00/50 ml ;Tab. , 10 mg, Tk. 2.00/Tab. Inj.,
and arrhythmias), reduced bronchial 20 mg/2 ml, Tk. 8.00/Amp.
Cyclovin (Somatec), Tab. , 10 mg, Tk.
secretions, urinary retention, dilatation of
2.01/Tab.; 10 mg/5 ml, Tk. 30.11/50 ml
the pupils with loss of accommodation, Dirin (Alco), Tab. , 10 mg, Tk. 2.00/Tab. ;
photophobia, dryness of the mouth and Syrup, 10 mg/5 ml, Tk. 40.00/50 ml
skin, occasional confusion (particularly in Diverin (ACI), Syrup, 10mg/5ml , Tk.
the elderly), nausea, vomiting and 30.11/50 ml ;Tab. , 10mg , Tk. 2.01/Tab. ;Tab.
giddiness. 20mg , Tk. 3.51/Tab.
Eraspa (MST), Tab. 10 mg, Tk. 2/Tab.
Ibspa (Pacific), Syrup, 10 mg/5 ml, Tk.
ATROPINE SULPHATE [ED] 18.80/50 ml ;Tab., 10 mg, Tk. 1.50/Tab.
Loverin(Beximco), Tab. , 10 mg, Tk.
Indications: aid in peptic ulcer 2.01/Tab.Syrup, 10 mg/5 ml, Tk. 30.00/50 ml
treatment, gastrointestinal spasm, renal Spalax (Navana), Syrup, 10 mg/5 ml, Tk.
and biliary coilc, pre-medication (see 30.11/50 ml
sec. 8.1.3)
HYOSCINE BUTYLBROMIDE [ED]
Cautions; Contraindications; Side-
effects: see notes above
Indications: symptomatic relief of
Interactions: see Appendix-2 gastro-intestinal, biliary or genitourinary
Dose: see section 8.1.3 colic (spasmodic pain) and irritable
bowel syndrome; dysmenorrhoea; as
Proprietary Preparations antispasmodic in endoscopy and
Atropine (Chemist), Inj.,1mg/ml, Tk. 2.52/1ml radiological procedures of gut; as an
Amp adjunct in the treatment of peptic ulcer
Atropine-Jayson (Jayson), Inj. 0.6 mg/1ml,
Tk. 5.00/1 ml Amp. Cautions; Contraindications; Side-
G-Atropine (Gonoshasthaya), Inj. 0.6 mg/1ml, effects: see notes above
Tk. 3.01/1ml Amp. Interactions: see Appendix-2
Dose: by mouth, 10-20 mg 4 times daily;
DICYCLOVERINE HYDROCHLORIDE CHILD 6-12 years, 10 mg 3 times daily.
(Dicyclomine hydrochloride)
By intramuscular or intravenous injection
Indications: symptomatic relief of (acute spasm), 20 mg, repeated after 30
gastro-intestinal disorders characterised minutes if necessary. CHILD not
by smooth muscle spasm recommended
Side effects: see notes above
Cautions: see notes above Proprietary Preparations
Altapan (Albion), Tab., 10 mg, Tk.1.80/Tab.
Contra-indications: see notes above;
Asipan (Asiatic), Tab., 20 mg, Tk. 3.00/Tab.
also infants under 6 months Buscon(Ibn Sina), Tab.,10 mg, Tk. 3.44/Tab.;
Pregnancy: not known to be harmful; Inj., 20 mg/ml , Tk. 7.10/Amp.
use only if essential
105
Butapan (Sanofi), Tab., 10 mg, Tk. 3.42/Tab.; TIEMONIUM METHYLSULPHATE

20 mg, Tk. 6.00/Tab.; Inj., 20 mg/ml ,
Tk.7.89/Amp.
Butason (Hudson), Tab., 10mg, Tk.1.75/Tab. Indications: symptomatic relief of
Colik (ACI), Inj., 20 mg/ml, Tk. 7.88/amp; Tab., gastrointestinal, biliary, renal and
10 mg, Tk. 3.44/Tab.; 20 mg, Tk. 6.70/Tab. genitourinary colic
Colipan(Medimet), Inj., 1 mg/ml, Tk.7.85/1 ml Cautions; Contraindications; Side-
Amp.; Tab., 10mg, Tk.3.00/Tab.; 20mg, effects: see notes above.
Tk.5.65/Tab.
G-Hyoscine (Gonoshasthaya), Tab. 10 mg,
Tk.3.35/Tab.; Inj., 20 mg/ml, Tk.7.75/Amp. Dose: by mouth 100-300 mg daily in
Hybucin (Supreme), Tab.,10mg, Tk. 3.40/Tab. divided doses; by intramuscular or slow
Hybut (Amico), Tab. 10 mg, Tk. 3.43/Tab. intravenous injection, 10 mg 2-3 times
Hysomide (Opsonin), Tab., 10 mg, Tk. 2.58/ daily
Tab.; 20 mg, Tk. 2.64/Tab.;Inj., 20 mg/ml, Tk.
5.93/Amp.
Spanil (Beximco), Tab.,10 mg, Tk. 3.44/Tab.
Algin (Renata), Inj., 2.5 mg/ml, Tk. 25/amp.;
Spasmoson (Jayson), Tab., 10 mg, Tk.
Syrup, 200 mg/100 ml, Tk. 90/100 ml; Tab.,
3.40/Tab.; Inj., 20 mg/ml, Tk. 7.88/Amp.
50mg, Tk. 6/Tab
Aspasom (Kemiko), Tab.,50 mg, Tk. 5/Tab.
OXYPHENONIUM BROMIDE Dysma (Rangs), Tab., 50 mg, Tk. 5/Tab.
Emogin (Somatec), Tab.,50 mg, Tk. 5.00/Tab.
Emonium (Beximco), Inj., 5 mg/2 ml, Tk.
Indications: symptomatic relief of 15.00/amp.; Tab., 50 mg, Tk. 5.00/Tab.
gastro-intestinal, biliary or genitourinary Norvis (Square), Inj., 5 mg/2 ml, Tk.
colic; as an adjunct in the treatment of 15.05/amp.; Syrup, 10 mg/5 ml, Tk. 87/100 ml;
peptic ulcer Tab. , 50 mg, Tk. 6.00/Tab.
Cautions; Contraindications; Side- Onium (Orion), Inj, 5 mg/2 ml, Tk. 15.06/amp;
effects: see notes above Tab., 50 mg, Tk. 5.02/Tab.;Syrup, 10 mg/5 ml,
Interactions: see Appendix-2 Tk. 85.00/100 ml ;Tk. 50.00/50 ml
Panium (Navana), Tab., 50 mg, Tk.
Dose: by mouth, 5-10 mg 3 times daily 5.00/Tab.;Inj., 5 mg/2 ml, Tk. 20.00/amp.
Previp (Genera), Tab. , 50 mg, Tk. 4.02/Tab.
Proprietary Preparations Relvos (Biopharma), Inj., 5 mg/2 ml, Tk.
Antrenex (Opsonin), Tab., 5 mg, Tk. 0.94/Tab. 15.00/amp ; Tab. , 50 mg, Tk. 5.00/Tab
Antrenyl (Novartis), Tab., 5 mg, Tk. 4.00/Tab. Spanium (Ziska), Inj., 5 mg/2 ml, Tk. 15/2ml
A-Spasm (Acme), Tab., 5 mg, Tk. 1.43/Tab. Amp.; 50 mg, Tk. 4/Tab.
Isonil (Amico), Tab., 5 mg, Tk. 1.41/Tab. Tiemo(Alco), Tab. , 50 mg, Tk. 4.00/Tab.
Tienum (Chemist), Inj. , 2 ml, Tk. 15/2 ml
PROPANTHELINE BROMIDE Amp; Tab. , 50 mg, Tk. 4/Tab.
Timoben (Benham), Tab., 50 mg, Tk. 5/Tab.
Timonac (RAK), Inj., 5 mg/2 ml , Tk.
Indications: symptomatic relief of 20.00/amp.;Tab., 50 mg, Tk. 6.00/Tab.
gastrointestinal colic, as an adjunct in Timonil (Popular), Tab. , 50 mg, Tk.
the treatment of peptic ulcer; adult 7.00/Tab. ;Inj., 5 mg/2 ml, Tk. 15.06/amp.
enuresis and urinary incontinence Timothy (Eskayef), Inj, 5 mg/2 ml, Tk.
15.00/amp ;Tab, 50 mg, Tk. 4.00/Tab.
Cautions; Contra indications; Side- Timozin (Incepta), Inj., 5 mg/2 ml, Tk.
effects: see notes above 15.00/amp.; Tab., 50 mg, Tk. 5.00/Tab.
Interactions: see Appendix-2 Tinilux (Sharif), Tab., 50 mg, Tk. 4.00/Tab.
Tinimet(Rephco), Inj.,5 mg/2 ml,Tk.20/amp.;
Dose: 15 mg 3 times daily 1 hour before 5mg/2ml, Tk. 25/amp.;Tab., 50 mg, Tk. 5/Tab.
meals and 30 mg at night, max. 120mg Tinium (Acme), Inj. , 5 mg/2 ml, Tk.
daily. CHILD not recommended 20.00/amp.;Tab., 50 mg, Tk. 5.00/Tab.
Tino (Delta), Tab. , 50 mg, Tk. 4.00/Tab.
Tispa (Concord), Tab. , 50 mg, Tk. 5.00/Tab.
Proprietary Preparation
Tium (Ad-din), Tab., 50 mg, Tk. 3.50/Tab.
Prokind (Beacon), Tab. 15 mg, Tk. 8.00/Tab.
Tivis (Beacon), Tab. , 50 mg, Tk. 5.00/Tab.;
Inj., 5 mg/2 ml, Tk. 16.00/amp.
Tynium (ACI), Inj, 5 mg/2 ml , Tk. 15.06/amp.;
Syrup, 10 mg/5 ml , Tk. 85.00/100 ml; Tab.,
50mg, Tk. 5.00/Tab.
106
Veralgin (Aristo), Inj., 5 mg/2 ml, Tk. ALVERINE CITRATE

25.00/amp. ;Tab. , 50 mg, Tk. 6.00/Tab.
Visalex (Leon), Tab. , 50 mg, Tk. 5.00/Tab.
Visarin (Pharmasia), Tab., 50 mg, Tk. 4/Tab. Indications: as an adjunct in gastro-
Viscer (Techno), Inj., 5 mg/2 ml, Tk. 12/amp. intestinal disorders characterised by
Visceral (Ibn Sina), Inj., 5 mg/2 ml, Tk. smooth muscle spasm; dysmenorrhoea
16.00/amp.; Tab. , 50 mg, Tk. 4.50/Tab. Contra-indications: paralytic ileus,
Visegin (Unimed), Tab. , , Tk. 5.00/Tab. breast-feeding
Viset (Healthcare), Inj., 5 mg/2 ml, Tk.
Caution: pregnancy,
25.00/amp. ; Syrup, 10 mg/5 ml, Tk. 90/100ml;
Tk. 55.00/50 ml ; Tab., 50 mg, Tk. 6.00/Tab. Side-effects: nausea; dyspnoea;
Visnil (Nipro JMI),Tab. , 50 mg , Tk. 4.00/Tab. headache, dizziness; pruritus, rash;
Visnor (Apex), Inj., 5 mg/2 ml, Tk. 15.00/amp; hepatitis also reported
Tab., 50 mg, Tk. 4.00/Tab. Dose: ADULT and CHILD over 12 years,
Visonium (Drug Int.), Tab., 50 mg,Tk. 4/Tab. 60–120mg 1–3 times daily.
Vispazin (Globe), Tab., 50 mg, Tk. 25/Tab.;
Inj., 5 mg/2 ml, Tk.15/2 ml Amp.
Visral (Opsonin), Syrup, 10 mg/5 ml, Tk.
Alve (Orion), Tab., 60 mg, Tk. 5.00/Tab.
63.91/100 ml;Supp., 20 mg, Tk. 6.02/Tab.; Inj.,
Alverin (Rangs), Tab., 60 mg, Tk. 5.00/Tab.
5 mg/2 ml, Tk. 11.32/amp.;Tab., 50 mg, Tk.
Dismonal (Opsonin), Tab., 60 mg, Tk.
3.02/Tab.
3.02/Tab.
Zeum (Novartis), Tab., 50 mg, Tk. 6.50/Tab.
Spasverin (Beacon), Tab., 60 mg, Tk. 5/Tab.
TRIMEBUTINE MALEATE
DROTAVERINE HYDROCHLORIDE
Indication: Irritable bowel Syndrome
Cautions: Pregnancy, breast feeding, Indications: as an antispasmodic in
children gastro-intestinal colic, biliary and
Contraindication: should not be taken genitourinary colic; tenesmus in
by anyone who is allergic to trimebutine dysentery; dysmenorrhoea
Side effects: abdominal pain, Cautions and Contraindications:
constipation, diarrhoea, dry mouth, pregnancy and lactation; impairment of
fatigue, foul taste, headaches, hot or liver or kidney (Appendix 3 & 4)
cold sensations, indigestion nausea, Interactions: see Appendix-2
rash
Side-effects: flushing, perspiration,
Dose: 200 mg 3 times daily before
palpitation and vertigo are reported
meals.
Dose: by mouth 40-80 mg 3 times daily.
Proprietary Preparations By subcutaneous or intramuscular
Timotor (Square), Tab.,100 mg, Tk. 5.01/Tab. injection, 40-80 mg up to three times
Trimotil (Incepta), Tab.,100 mg, Tk. 5.00/Tab. daily
By slow intravenous injection in acute
OTHER ANTISPASMODICS renal colic, 40-80 mg
Alverine, drotaverine, Mebeverine, Proprietary Preparations

and peppermint oil are believed to Dot (Acme), Tab., 40 mg, Tk. 1.76/Tab.;
directly relax intestinal smooth muscle 40mg/2 ml, Tk. 7.02/Amp
and may relieve spasm and pain in Dotarin(Popular), Tab., 40 mg, Tk. 1.76/Tab.;
irritable bowel syndrome and diverticular Inj., 40mg/2ml, Tk. 7.03/Amp.
Drotapan (Incepta), Tab., 40 mg,Tk. 1.75/Tab.
disease. They have no serious adverse Espa (Square), Inj., 40 mg/2 ml, Tk.
effects but like all antispasmodics should 7.02/Amp., 40 mg, Tk.1.75/Tab.
be avoided in paralytic ileus. N-Aspa (Albion), Tab., 40 mg, Tk. 1.81/Tab.
No-Spa (Ambee), Tab., 40 mg, Tk. 1.82/Tab.,
Inj. 40 mg/2 ml, Tk. 7.98/2 ml amp.
Rova (Kemiko), Tab., 40 mg, Tk. 2.00/Tab.
Span (Opsonin), Tab., 40 mg, Tk. 1.32/Tab.
Taverin (Beximco), Tab.,40 mg, Tk. 2.20/Tab.
107
MEBEVERINE HYDROCHLORIDE stimulates the motility of upper

gastrointestinal tract without affecting
Indications: as an adjunct in the secretion. It increases gastric peristalsis
treatment of symptomatic relief of leading to accelerated gastric emptying.
gastrointestinal colic, irritable bowel Metoclopramide is used for its prokinetic
syndrome and antiemetic properties. It has been
used in disorders of decreased
Cautions; Contraindications : paralytic gastrointestinal motility such as
ileus, pregnancy and breast-feeding, gastroparesis; in gastoesophageal reflux
porphyria; should be used with care in disease and dyspepsia; in nausea and
patients with cardiac disorder, hepatic or vomiting associated with cancer
renal insufficiency chemotherapy; and to stimulate gastric
Interactions: see Appendix-2 emptying during radiographic examina-
Side-effects: anorexia, dizziness, tions.
headache, insomnia, tachycardia have Domperidone is a dopamine antagonist
been reported with actions very similar to those of
Dose: ADULT and CHILD above 12 metoclopramide. It has been used as an
years 135 mg 3 times daily, prefeably 20 antiemetic in nausea and vomiting
mins before meals associated with cancer chemotherapy,
and also in disorders of gastrointestinal
Proprietary Preparations motility such as diabetic gastroparesis.
A-Meb (Acme), Tab., 135 mg, Tk. 6.00/Tab. Cisapride which is another prokinetic
Evarin (Delta), Tab., 135 mg, Tk. 6.00/Tab. drug has recently been withdrawn for its
Iriban (Incepta), SR Tab., 200 mg, Tk. reported serious and fatal arrhythmia.
10.00/Tab. ;Tab. 135 mg, Tk. 6.00/Tab.
Irisyn (Ibn Sina), Tab., 135 mg, Tk. 7.00/Tab.
Mave (Opsonin), SR Cap., 200 mg, Tk. Neurokinin-receptor antagonists
7.55/Cap.; Tab., 135 mg , Tk. 4.53/Tab.
Mebeverine (Albion), Tab.,135 mg,Tk. 6/Tab. APREPITANT
Mebiz (Sun), SR Cap., 200 mg, Tk.10/Cap.
Mespa (Ambee), Tab. 135 mg, Tk. 6.02/Tab.
Meverine (Drug Int.), SR Cap., 200 mg , Tk. It is an antiemetic drug mediates its
10.00/Cap.; Tab., 135 mg, Tk. 6.00/Tab. effect by blocking the neurokinin 1 (NK1)
Mevin (Square), SR Cap., 200 mg,Tk.10/Cap.; receptor.
135 mg, Tk. 6.00/Tab. See sectio section 7.8 Drugs used in
Rostil (Beximco), Tab., 135 mg, Tk. 7.00/Tab. nausea, vomiting and vertigo
Veripel (Beacon), SR Cap., 200 mg, Tk.9/Cap.
Indications: as an adjunct to
Veron (Eskayef), Tab., 135 mg, Tk. 6.08/Tab.
dexamethasone and a 5HT3-receptor
antagonist in preventing nausea and
OTHER DRUGS ALTERING GUT
vomiting associated with moderately and
MOTILITY
highly emetogenic chemotherapy
Cautions: should not be used
Gut smooth muscle exhibits intrinsic concurrently with pimozide, terfenadine,
motor activity which is modified by astemizole, or cisapride. Taking
autonomic innervation, local reflexes and aprepitant with these medications could
gut hormones to produce peristalsis. result in serious or life-threatening
Prokinetic drugs which include problems
domperidone and metoclopramide Contra-indications: acute porphyria ,
stimulate the motility of the gut by acting hepatic impairment;pregnancy; breast-
at various points within this complex feeding, child under 18 years of age.
system to enhance gut movement. Side-effects: hiccups, dyspepsia,
Metoclopramide posseses parasymp- diarrhoea, constipation, anorexia;
athetic activity and is a dopamine asthenia, headache, dizziness; less
receptor antagonist with direct effect on commonly weight changes, dry mouth,
the chemoreceptor trigger zone. It colitis, flatulence, stomatitis, abdominal
108
pain, duodenal ulcer, taste disturbance, Benidon (Benham), Susp , 5 mg/5 ml, Tk.
oedema, bradycardia, palpitations, 28./60 ml ; 10 mg, Tk. 2.00/Tab.
cough, euphoria, anxiety, confusion, Cosy (Orion), Susp., 5 mg/5 ml , Tk.
38.14/100 ml; Tk. 28.10/60 ml;Tab. , 10 mg,
drowsiness, thirst, abnormal dreams, Tk. 2.01/Tab.
chills, hyperglycaemia, polyuria, Deflux(Beximco), Paed drop, 5 mg/ml, Tk.
anaemia, dysuria, haematuria, 20.00/15 ml ;Susp.,5 mg/5 ml, Tk. 38/100 ml ;
hyponatraemia,neutropenia, myalgia, Tab. , 10 mg, Tk. 2.50/Tab.; DT Tab., 10 mg,
conjunctivitis, pharyngitis, sneezing, Tk. 2.00/Tab.
tinnitus, sweating, pruritus,rash, acne, Degut (Delta), Tab. , 10 mg, Tk. 2.00/Tab.
photosensitivity, and flushing; dyspnoea, Domar (Pacific), Susp, 5 mg/5 ml , Tk.
18.80/60 ml ;Tk. 30.08/100 ml ;Tab., 10 mg,
insomnia, visual disturbances, Tk. 2.26/Tab.
dysarthria, urticaria, and Stevens- Domidon (Ziska), Susp., 5mg/5ml, Tk.
Johnson syndrome also reported. 28.00/60ml; Tab., 10mg, Tk. 2.00/Tab.
Dose: ADULT over 18 years 125 mg 1 Domilin (General), Susp.,, 5 mg/5 ml , Tk.
hour before chemotherapy, then 80mg 40.15/100 ml;Tab. , 10 mg, Tk. 2.01/Tab.;
daily as a single dose for the next 2 Domilux (Popular), Susp, 5 mg/5 ml , Tk.
days; consult product literature for dose 35.00/60ml;Tab., 10 mg, Tk. 2.00/Tab.
Domin (Opsonin), Supp. 15 mg, Tk.
of concomitant corticosteroid and 5HT3- 3.77/Supp.; 30 mg, Tk. 6.04/Supp.;Paed
receptor antagonist. drops, 5 mg/ml , Tk. 15.10/15 ml; Susp., 5
mg/5 ml , Tk. 21.14/60 ml 10 mg, Tk. 1.51/Tab.
Generic Preparations Dominol (White Horse),Tab.,10mg, Tk. 2/Tab.
Capsule, 40 mg Domiren (Renata), Paed drops, 5 mg/ml, Tk.
25.00/15 ml ;Susp., 5 mg/5 ml , Tk. 35.00/60
ml; Tk. 38.00/100 ml ;Tab. , 10 mg, Tk. 2/Tab.
DOMPERIDONE
Domp (Albion), Susp., 5 mg/5 ml , Tk.
38.00/100ml ;Tab. , 10 mg, Tk. 2.00/Tab.
Indications: see notes above and under Dompi (Alco ), Susp., 5 mg/5 ml , Tk.
section 7.8 28.00/60ml ;Tab. , 10 mg, Tk. 2.00/Tab.;
Domstal (APC ), Susp., 5 mg/5 ml , Tk.
Cautions: pregnancy and breast- 28.00/60 ml ;Tab., 10 mg., Tk. 2.00/Tab.
feeding; not recommended for routine Don-A (Acme), Paed, drops, 5 mg/ml, Tk.
prophylaxis of post-operative vomiting or 20.07/15 ml; Tk. 25.10/30 ml;Supp., 30 mg,
for prolonged administration. Tk. 8.04/Supp.;15 mg, Tk. 5.01/Supp.;Susp.,
5mg/5 ml , Tk. 35.00/60ml; Tab., 10 mg, Tk.
Interactions: see Appendix-2 2.01/Tab.
Side-effects: rashes and other allergic Dopadon (Ibn Sina), Susp., 5 mg/5 ml , Tk.
reactions, raised prolactin concentration 30.00/60 ml ;Tab. , 10 mg, Tk. 2.25/Tab.
(galactorrhoea and gynocomastia), and Dopagut (Concord), Susp., 5 mg/5 ml , Tk.
28.00/60 ml ;Tab. , 10 mg, Tk. 2.00/Tab. ;
reduced libido.
DP Done (Central), Susp. , 5 mg/5 ml , Tk.
Dose: by mouth 10-20 mg 6 times daily; 28.00/60 ml ;Tab. , 10 mg, Tk. 2.00/Tab.
CHILD 200-400 micrograms/kg every Dysnov (Unimed), Paed, drops, 5 mg/ml, Tk.
4-8 hours 20.00/15 ml;Susp., 5 mg/5 ml , Tk. 38/100 ml;
Tab. , 10 mg, Tk. 2.00/Tab.
Proprietary Preparations Emidom (Somatec), Susp., 5 mg/5 ml , Tk.
Adegut (Supreme), Susp., 5 mg/5 ml , Tk. 28.11/60 ml ;Tab. , 10 mg, Tk. 2.50/Tab.
28.00/60 ml;Tab. , 10 mg, Tk. 2.50/Tab. Esogut (Biopharma), Paed. drops, 5 mg/ml,
Adorex (Ambee), Tab., 10 mg , Tk. 2/Tab; Tk. 20.08/15 ml ;Susp., 5 mg/5 ml, Tk.
Paed. Drop, 5 mg/ml , Tk. 20.07/15 ml; Suspn. 28.11/60 ml ;Tab. , 10 mg, Tk. 2.50/Tab.
5 mg/5 ml, Tk.38.18/100 ml Tk. 28.10/60 ml Gidora (Rephco), Susp., 5 mg/5 ml , Tk.
Anet (Kemiko), Susp., 5 mg/5 ml , Tk. 30.00/100 ml ;Tab. , 10 mg, Tk. 2.00/Tab.
35.00/60 ml; Tab. , 10 mg, Tk. 2.00/Tab. Paed. Gutset (Ad-din), Tab., 10mg, Tk. 2.00/Tab.;
drops, 5 mg/ml, Tk. 25.00/15 ml ;Supp., 15 Drop, 5mg/ml, Tk. 20.00/15 ml; Suspn., 60
mg, Tk. 6.00/Supp. ; 30 mg, Tk. 9.00/Supp. mg/60 ml , Tk. 28.00/60 ml
Atidon (Asiatic), Susp 5 mg/5 ml , Tk. I-Pop (Doctor TIMS), Tab., 10 mg, Tk. 2/Tab.
28.00/60 ml ;Tab. , 10 mg, Tk. 2.00/Tab. Loval (Jayson), Susp. , 5 mg/5 ml , Tk.
Avomit (Chemist), Tab. , 10 mg, Tk.2.00/Tab.; 28.10/60 ml ;Tab. , 10 mg, Tk. 2.01/Tab.
Suspn. , 5mg/5ml, Tk. 28.00/60 ml Makdom (Maks), Tab. , 10 mg, Tk. 2.00/Tab.
Motidom (Medimet), Tab., 10mg, Tk.1.50/Tab.
109
Motifast (Square), Tab. ,10mg, Tk. 2.50/Tab.; Interactions: see Appendix-2

Paed. drops, 5 mg/ml, Tk. 25/15 ml; 5mg/5ml,
Tk. 35/60 ml; Tab. , 10 mg, Tk. 2.50/Tab. Side-effects: drowsiness, restlessness,
Motilex (Techno), Susp., 5 mg/5 ml , Tk. depression, diarrhoea, extrapyramidal
35.00/60 ml ;Tab. , 10 mg, Tk. 2.00/Tab. effect (specially in children/ young adult),
Motinorm (Sharif), Tab. , 10 mg, Tk.2.00/Tab. hyperprolactinaemia.
Motistat(Globex), Tab. , 10 mg, Tk. 2.50/Tab.
Noburn (Beacon), Tab. , 10 mg, Tk. 2.00/Tab. Dose: by mouth 10 mg 3 times daily;
Normogut (Rangs), Syrup, 5mg/5ml, Tk. IM/IV 10 mg 3 times daily over 1-2
38.00/100 ml; Tab., 10mg, Tk. 2.00/Tab.; minutes. CHILD 1-5 mg 3 times daily.
Paed. Drops, 5 mg/ ml, Tk. 20.00/15 ml
Nudon (Organic), Tab. , 10 mg, Tk. 2.00/Tab. Proprietary Preparations
Omidon (Incepta), Paed. drops, 5 mg/ml, Tk. Maxocol (Medimet), Syrup, 5mg/5ml,
25.00/15 ml ;Susp., 5 mg/5 ml, Tk. 35/60 ml; Tk.15.77/100ml; Tab.,10mg, Tk.0.34/Tab.
Tk. 38.00/100 ml ; Tab. , 10 mg, Tk.2.00/Tab.; Meclid (Jayson), Inj., 10 mg/2 ml,Tk. 3.55/2 ml
Tab. , 10 mg, Tk. 2.00/Tab. Amp.
Paridon (Drug Int.,), Susp., 5 mg/5 ml , Tk. Metocol (Opsonin), Syrup, 5 mg/5 ml, Tk.
32.00/100 ml ;Tab. , 10 mg, Tk. 2.00/Tab. 13.92/100 ml; Paed. Drops, 1 mg/ml, Tk.
Peri (Hudson), Syrup, 5mg/5ml, Tk.35.00/100 9.37/15 ml
ml; Tab., 10mg, Tk.2.00/Tab. Migen (Albion), Syrup, 100 mg/100 ml, Tk.
Peridone (Astra), Tab., 10 mg, Tk. 2.00/Tab. 13.70/100 ml
Perigut (Leon), Susp., 5 mg/5 ml , Tk. 28/60ml Motilon (Sanofi), Inj., 10 mg/2 ml, Tk. 3.76/2
Perigut (Leon), Tab. , 10 mg, Tk. 2.00/Tab. ml Amp. ; Paed. drops, 1 mg/ml, Tk. 9.80/15
Perion (Globe), Suspn.,5mg /5 ml, Tk.30/60ml ml; Syrup, 100 mg/100 ml, Tk. 15.83/100 ml;
Tk. 38/100ml; Tab., 10 mg, Tk. 2/Tab. Tab., 10 mg, Tk. 0.34/Tab.
Prokinet (Nipro JMI), Susp., 5 mg/5 ml , Tk. Nutramid (Acme), Tab., 10 mg, Tk. 0.34/Tab.;
35.00/60 ml ;Tab. , 10 mg, Tk. 2.01/Tab. Syrup, 100 mg/100 ml, Tk. 10.65/60 ml
Ridon (Eskayef), Susp., 5 mg/5 ml , Tk.
28.00/60 ml; Tab, 10 mg, Tk. 2.00/Tab.,
2.3 ULCER HEALING DURGS
Powder, 10 mg/Sachet, Tk. 5.00/Sachet
Sandom (Sanofi, ), Paed. drops, 5 mg/ml,
Tk. 20.07/15 ml ;Susp., 5 mg/5 ml , Tk. 2.3.1 H2 RECEPTOR ANTAGONISTS
28.10/60 ml; , Tab., 10 mg, Tk. 2.01/Tab. 2.3.2 SELECTIVE ANTIMUSCARINICS
Sydon (MST), Tab., 10 mg, Tk. 2/Tab. 2.3.3 PROTON PUMP INHIBITORS
Tab. 10 mg, Tk. 2.50/Tab.
2.3.4 CHELATES AND COMPLEXES
Vave (ACI), Paed. drops, 5 mg/ml, Tk. 25/15
ml; Susp., 5 mg/5 ml , Tk. 35.00/60 ml; Tk. 2.3.5 PROSTAGLAND INALOGUES
40.00/100 ml;Tab. , 10 mg , Tk. 2.01/Tab. ODT 2.3.6 DRUGS FOR ERADICATION OF
Tab. , 10 mg , Tk. 5.00/Tab. HELICOBACTER PYLORI
Vegadon (Pharmasia), Susp., 5 mg/5 ml, Tk.
28.10/60 ml ;Tab. , 10 mg, Tk. 2.00/Tab. Peptic ulcer causes a distinct break in
Vomitop (Navana), Paed. drops, 5 mg/ml, Tk.
20.08/15 ml;Susp., 5 mg/5 ml, Tk. 28.00/60 ml;
the gastrointestinal mucosa of stomach
Tab., 10 mg, Tk. 1.50/Tab. or duodenum, although it may occur in
Xepadon (Amico), Paed. drops, 5 mg/ml, Tk. lower oesophagus and after surgery in
18/15 ml ;Susp., 5 mg/5 ml, Tk. 25/60 ml ; gastroenterostomy stoma. The genesis
Tab., 10 mg, Tk. 2/Tab. of peptic ulcer involves infection of
Xeridon (RAK), Susp.,5 mg/5 ml,Tk. 28/60 ml; gastric mucosa with Helicobacter pylori
Tab.,10 mg, Tk. 2/Tab. plus other factors such as imbalance
between the mucosal damaging
METOCLOPRAMIDE mechanisms (acid, pepsin) and mucosal
HYDROCHLORIDE protecting mechanisms (mucus,
see section 7.8 bicarbonate, PGE2 and PGI2). Gastric
ulceration and bleeding may also occur
Indications: see notes above with NSAIDs or corticosteroid use.
Cautions: hepatic and renal impairment, Nearly all duodenal ulcers and most
pregnancy and breast-feeding; avoid for gastric ulcer not associated with NSAIDs
3-4 days following gastrointestinal are caused by Helicobacter pylori.
surgery. With the discovery of the significance of
H. pylori infection as the major causative
110
factor of peptic ulceration, combined Side-effects: Adverse reactions are

antibacterial and antisecretory therapy is generally infrequent and are usually
increasingly recommended as the first reversible following a reduction of doses
line of treatment. Two-week triple or withdrawal of therapy. The comm-
therapy regimens are associated with onest side-effects reported are altered
high eradication rates, but adverse bowel habit, diarrhoea, dizziness,
effects are common and compliance is a reversible confusion, rashes, headache,
problem. Healing can be facilitated by myelgia and blood disorders including
general measures as bed rest, dietary agranulocytosis, leucopenia and
modification, stopping smoking and by thrombocytopenia; there have been
continuing antisecretory drug treatment. reports of impotence and
But relapse is common when treatment gynaecomastia.
ceases. Continued maintenance
treatment with H2 antagonists and CIMETIDINE
sucralfate has been shown to reduce
relapse. Maintenance therapy with Indications: benign gastric and
proton pump inhibitors (omeprazole, duodenal ulceration, stomal ulcer, reflux
lansoprozole) is also effective. For oesophagitis Zollinger-Ellison syndro-
recommended regimens of triple-drug me, other conditions where gastric acid
therapy against H. pylori infection, see reduction is beneficial. (see notes
section 2.3.6. above)
Cautions: see notes above: renal and
2.3.1 H2 -RECEPTOR ANTAGONISTS hapatic impairment (reduce dose);
pregnancy and breast-feeding. Avoid
H2-receptor antagonists reduce gastric intravenous injection in high dosage
acid (both basal and food stimulated) (may rarely cause arrhythmias) and in
and pepsin output as a result of H2- cardiovascular impairment.
receptor blockade. They have been used Interactions: see Appendix-2 (histamine
in peptic ulcer, gastrointestinal reflux H2-antagonists) and see notes above
diseases and in selected cases of
persistent dyspepsia. High doses of H2- Side-effects: altered bowel habit,
receptor antagonists have been used in dizziness, rash, tiredness; occasionally,
the Zollinger-Ellison syndrome, though a gynaecomastia (cimetidine only, and
proton pump inhibitor (see sec 2.3.3) is usually only in high dosage), reversible
now preferred. confusional states, reversible liver
damage, headache; rarely, decreased
Maintenance treatment with low doses of blood counts, alopecia, muscle or joint
H2-recepter antagonists have largely pain, bradycardia and AV block;
been replaced in H. pylori positive cases interstitial nephritis and acute
by eradication regimens. Treatment with pancreatitis (both cometidine); see also
H2-antagonists has not been effective in notes above
haematemesis and melaena, but once
haemorrhage has been controlled H2- Dose: by mouth, 400 mg twice daily
antagonists may be given to promote (with breakfast and it night) or 800 mg as
healing and reduce the risk of a single daily dose at night (benign
rebleeding. Treatment reduces the gastric and duodenal ulceration). Doses
frequency of acid aspiration in obstetric should be taken for at least 4 weeks (6
patients at delivery. weeks in gastric ulceration, 8 weeks in
NSAID associated ulceration); when
Cautions: H2-antagonists should be necessary the dose may be increased to
used with caution in patient with hepatic 400 mg 4 times daily or rarely (e.g. as in
or renal impairment, in pregnancy and in stress ulceration) to a max. of 2.4 g daily
breast feeding. H2-antagonists may mask in divided doses; CHILD 20-30 mg/kg
the symptoms of gastric cancer. daily in divided doses.
111
Maintenance: 400 mg at night or 400 mg Dose: benign gastric and duodenal

morning and night. ulceration; 20 mg twice daily or 40 mg at
Reflux oesophagitis, 400 mg 4 times night for 4-8 weeks; maintenance 20 mg
daily for 4-8 weeks. In Zollinger-Ellison at night. In Zollinger-Ellison syndrome,
syndrome, 400 mg 4 times daily or more 20 mg every 6 hours (higher dose in
those who have previously been
Gastric acid reduction (prophylaxis of receiving another H2-antagonist)
acid aspiration; do not use syrup),
obstetrics 400 mg at start of labour, then Proprietary Preparations
up to 400 mg every 4 hours if required Famodin (Acme), Tab., 20 mg, Tk. 2/Tab.;
(max. of 2.4 g daily); surgical procedures 40mg, Tk. 4/Tab.
400 mg 90-120 minutes before induction Famotack (Square), Tab., 40 mg, Tk. 4/Tab.;
of general anaesthesia. 20 mg, Tk. 2/Tab.
Famotid (Drug Int.), Tab., 20 mg, Tk. 2/Tab.;
Short bowel syndrome, 400 mg twice 40 mg, Tk. 4/Tab.
daily (with breakfast and at bedtime) Famotidine (Albion), Tab., 20 mg,
adjusted according to response. Tk.1.50/Tab.; 40 mg, Tk. 3/Tab.
Novatac(ACI), Tab. , 40 mg , Tk. 4.12/Tab.;
To reduce degradation of pancreatic 20mg, Tk. 2.26/Tab.
enzyme supplements, 0.8-1.6 g daily in 4 Servipep (Novartis), Tab., 20 mg, Tk. 4/Tab.;
divided doses according to response 1- 40 mg, Tk. 6/Tab.
11/2 hours before meals. Yamadin (Beximco), Tab., 20 mg, Tk.
1.90/Tab.; Tab., 40 mg, Tk. 3.82/Tab.
By intramuscular injection, 200 mg every
4-6 hours; max. 2.4g daily.
NIZATIDINE
By slow intravenous injection, 200 mg
given over at least 2 minutes; may be
Indications: see under Dose
repeated every 4-6 hours; if a large dose
Cautions: see notes above; also avoid
is needed or there is cardiovascular
rapid intravenous injection (risk of
impairment, the dose should be diluted
arrhythmias and postural hypotension);
and given over at least 10 minutes
hepatic impairment
(infusion is preferable); max. 2.4 g daily.
Interactions: see Appendix-2 (histamine
By intravenous infusion, 400 mg in 100 H2-antagonists) and notes above
ml of sodium chloride 0.9% intravenous Pregnancy: avoid unless essential
infusion given over ½ hour (may be Breast-feeding: amount too small to be
repeated every 4-6 hours) or by harmful
continuous infusion at an average rate of Side-effects: see notes above; also
50-100 mg/hour over 24 hours, max. 2.4 sweating; rarely nausea, fever,
g daily. CHILD, by intramuscular vasculitis, hyperuricaemia
injection or slow intravenous injection or Dose: benign gastric, duodenal or
infusion, 20-30 mg/kg body weight daily NSAID-associated ulceration, treatment,
in divided doses 300 mg in the evening or 150 mg twice
daily for 4–8 weeks; maintenance,
Generic Preparations 150mg at night
Injection, 200mg/2 ml, Tablet, 400mg; 200mg Gastro-oesophageal reflux disease,
150–300 mg twice daily for up to 12
FAMOTIDINE weeks. CHILD not recommended
Renal impairment: use half normal
Indications: see under Dose dose if eGFR 20–50 mL/minute/1.73m2;
Cautions: see under Cimetidine and use one-quarter normal dose if eGFR
notes above; does not inhibit hepatic less than 20 mL/minute/1.73m2
microsomal drug metabolism
Generic Preparation
Side-effects: see under Cimetidine; dry Capsule, 150 mg
mouth and anorexia also reported
112
RANITIDINE Acin (Biopharma), Tab., 150 mg, Tk.

2.01/Tab.; 300 mg, Tk.3.51/Tab.; Syrup, 75
mg/5 ml, Tk. 45.17/100 ml
Indications: benign gastric and Alin (Rephco), Tab.,150 mg, Tk.2.50/Tab.
duodenal ulceration stomal ulcer, reflux Amurun (Amulet), Tab., 150 mg, Tk. 2.00/Tab.
oesophagitis, Zollinger-Ellison synd- Antac (Ambee) , Syrup , 75mg / 5ml , Tk
rome, other conditions where reduction 40.15/100 ml; Tab., 150 mg , Tk. 1.81 /Tab.;
of gastric acidity is beneficial. (see notes Inj. , 50 mg / 2 ml , Tk. 5.32/2ml Amp
Asinar (Sanofi), Tab., 150 mg, Tk.2.50/Tab.
above)
Astac (Astra), Tab., 150 mg, Tk.2.00/Tab.
Cautions: see under Cimetidine; does Bentid (Benham), Tab.,150 mg,
not significantly inhibit hepatic micro- Tk.2.00/Tab.;150 mg, Tk.2.00/Tab.
somal drug metabolism. Ceptin-R (Leon), Tab.,150 mg, Tk.2.00/Tab.
Duran(Techno), Tab., 300 mg , Tk.4.00/Tab.;
Side-effects: see under Cimetidine, rare Syrup, 75 mg/5 ml, Tk. 40.00/100 ml.;
reports of breast swelling and IVInfusion, 50 mg/100 ml, Tk. 60.00/100 ml
tenderness in men; also rare reports of Eucon (Pacific), Tab.,150 mg, Tk. 1.43/Tab.
bradycardia, AV block and asystole. Gastab (Nipro JMI), Syrup, 75 mg/5 ml, Tk.
45.17/100 ml; Tab., 150 mg, Tk. 2.00/Tab.
Dose: by mouth, 150 mg twice daily Gastroloc (Beacon), Tab., 150 mg,
(morning and night), or for patients with Tk.2.00/Tab.;
gastric and duodenal ulceration; 300 mg Gepin (General), Inj., 50 mg/2 ml , Tk.
as a single daily dose at night for 4 to 8 10/Amp. Syrup, 75 mg/5 ml, Tk. 45.17/100 ml.;
weeks, up to 6 weeks in chronic episodic Tk. 80.30/100 ml;Tab.,150 mg, Tk.2.01/Tab.
G-Ranitidine (Gonoshasthaya), Tab.,150 mg,
dyspepsia, and up to 8 to 12 weeks in
Tk. 1.40/Tab.
reflux oesophagitis and NSAID Hi-Tac (Hudson), Tab., 150mg, Tk.2.00/Tab.
associated ulceration; Zollinger-Ellison Inseac (Ibn Sina), Syrup, 75 mg/5 ml, Tk.
synd-rome, 150 mg 3 times daily, 45.00/100 ml ;Tab., 150 mg, Tk.
increased if necessary to 6 g daily in 2.00/Tab.;Tab., 300 mg, Tk.4.00/Tab.
divided doses. Libret (Libra),Inj.,(IV Infusion), 50 mg/100 ml,
Tk. 55.21/100 ml
For maintenance, 150 mg at night. Lumeran (Aristo), Tab. 150 mg, Tk.2.00/Tab.
CHILD, 8-18 years, up to 150 mg twice Neoceptin R (Beximco), Inj., (IV Infusion), 50
daily. Gastric acid reduction (prophylaxis mg/100 ml, Tk. 101.00/100 ml.; Inj., 50 mg/2
of acid aspiration) in obstetrics, by ml, Tk. 6.00/Amp
mouth, 150 mg at onset of labour, then Neopep (Central), Tab., 150 mg, Tk.2.00/Tab.
every 6 hours. Neotack (Square), Inj., 50 mg/2ml , Tk.
10.00/amp.;Syrup, 75mg/5 ml, Tk.45.16/100ml
By intramuscular injection, 50 mg every Normacid (Kemiko), Inj., 50 mg/2 ml , Tk.
6-8 hours. 6.00/Amp.; Syrup, 75 mg/5 ml, Tk. 45.00/100
ml .;Tab. , 150 mg, Tk.2.50/Tab.
By slow intravenous injection, 50 mg Norma-H (Renata), Tab. , 150 mg,
diluted to 20 ml and given over at least 2 Tk.2.50/Tab.
minutes; may be repeated every 6-8 Off-H (Organic), Tab. , 150 mg, Tk.2.50/Tab.
hours. Ortac (Orion ), Inj, 50 mg/1 ml , Tk. 6.02/amp.;
IV Infusion, 50 mg/100 ml 50 mg/100 ml, Tk.
By intravenous injection, 25 mg/hour for 60.23/100 ml ;Tab, 150 mg, Tk.2.01/Tab.
2 hours; may be repeated every 6-8 Peptil H (Eskayef), Syurp, 75 mg/5 ml, Tk.
hours. 45.00/100 ml .;Tab, 150 mg, Tk. 1.80/Tab.;
Surgical procedures, by intramuscular or Inj, 50 mg/2 ml , Tk. 6.00/amp
Peptosol (Opso Saline), IV Infusion, 50
slow intravenous injection, 50 mg 45-60
mg/100 ml, Tk. 26.41/100 ml
minutes before induction (intravenous Protec-R (Globex), Tab., 150 mg, Tk. 2/Tab.
injection diluted to 20 ml and given over Randin (Maks ), Tab., 150 mg, Tk.2.50/Tab.
at least 2 minutes), or by mouth, 150 mg Rani (Alco ), Syrup, 75 mg/5 ml, Tk. 45.00/100
2 hours before induction, and also, when ml.; Tab. 150 mg, Tk.2.00/Tab.
possible on the preceding evening. Ranid (Ziska), Tab., 150mg, Tk. 1.10/Tab.
Ranidin (Acme), Inj., 50 mg/1 ml , Tk.
10/Amp.; Syrup, 75 mg/5 ml, Tk. 45.16/100
ml.; Tab., 150 mg, Tk.2.01/Tab.; 300 mg ,
Aceptin-R (Asiatic), Tab., 150 mg, Tk.2/Tab.;
Tk.4.01/Tab.
113
Ranison (Jayson), Inj., 50 mg/1 ml , Tk. 2.3.3 PROTON PUMP INHIBITORS
10.00/Amp.;Tab. ,150 mg, Tk.1.73/Tab.
Ranisyn (MST), Tab., 150 mg, Tk. 2.10/Tab.
Ranitab (Sonear), Tab. , 150 mg, Tk.2.05/Tab. These include Omeprazole, lansopra-
Ranitack (Ad-din), Tab., 150mg, Tk.1.50/Tab. zole, pantoprazole, rabeprazole and
Ranitid (Opsonin), Tab., 150 mg, esmoprazole. They produce profound
Tk.1.88/Tab.; 300 mg, Tk.3.02/Tab.;Inj., 50 and sustained inhibition of gastric acid
mg/1 ml , Tk. 7.52/Amp;Syrup, 75 mg/5 ml, Tk. secretion by blocking the hydrogen-
33.96/100ml
potassium-adenosine triphosphate
Ranitidine (Albion), Syrup, 75 mg/5 ml, Tk.
40.00/100ml; Tk. 70.00/200ml .;Tab. , 150 mg, enzyme system (the ‘proton pump’) of
Tk.2.00/Tab. the gastric parietal cell. They are
Ranitidine-R (Doctor TIMS), Tab. , 150 mg, effective short-term treatments for
Tk.2.50/Tab. gastric and duodenal ulcers. The
Ranitor (Popular), Tab., 150 mg, Tk.1.25/Tab. response is rapid and sustained (a single
Ranix (Chemist), Inj.,50mg/ 2 ml, Tk. 25.00/2 daily dose of omeprazole is sufficient to
ml Amp.
provide effective suppression of gastric
Rantec (Medimet), Tab., 150mg, Tk.2.00/Tab.;
300mg, Tk.3.50/Tab. acid for a 24 hour period), and thus
Ranul (Apex), Tab., 150 mg, Tk. 1.00/Tab. promotes better compliance than with
Ravia (Pharmasia), Tab.,150 mg, Tk.1.00/Tab. other anti ulcer drugs. Lansoprazole and
Recodin (Concord),Tab.,150 mg, Tk.1.50/Tab. pantoprazole appear to be comparable
Reetac-R (Navana),Tab.,150 mg, Tk.1.50/Tab. with omeprazole in efficacy.
Rhine (Healthcare),Tab.,150 mg, Tk.3.00/Tab.
Stomadin(Bios ), Tab. 150 mg, Tk. 2.00/Tab. Proton pump inhibitors are used as one
Syrup, 75 mg/5 ml, Tk. 45.00/100 ml.;Tab. , component of the eradication therapy for
150 mg, Tk. 2.50/Tab. H. pylori infection (See Section 2.3.6).
Tab.,150 mg, Tk.0.25/Tab.;Tab. , 300 mg, Tk. They are the drug of choice in the
4.50/Tab. treatment of gastro-oesophageal reflux
Tinadin (Delta), Tab. 150 mg, Tk.2.00 /Tab. diseases with severe symptoms (e.g.
Ulcar (Drug Int), Tab. 150 mg, Tk.2.50/Tab.;
Tab., 300 mg, Tk.4.00/Tab. structuring). Patients with endoscopically
Ultradin (Globe), Tab., 150 mg, Tk. 2.00/Tab. confirmed erosive, ulcerative or
Veridin (Veritas), Tab., 150 mg, Tk.2.50/Tab. stricturing oesophagitis need to be
Wintack (White Horse), Tab., 150 mg, maintained on a proton pump inhibitor.
Tk.2.00/Tab. Omeprazole and lansoprazole are
Xantid (ACI), Inj., 50 mg/2 ml, Tk. 7.53/amp; effective in the treatment of Zollinger-
Tab., 150 mg , Tk. 2.50/Tab.;Tab. , 300 mg , Ellison syndrome. They are also used in
Tk. 4.02/Tab.
Xardin (Sharif), Tab.,150 mg, Tk. 1.50/Tab. the prevention and treatment of NSAID
Zantac (GSK), Tab., 150 mg, Tk.3.57/Tab. induced ulcer in-patients who need to
Zenil (Rangs), Tab., 150mg, Tk. 2.00/Tab. continue NSAID treatment.
Zodin (Somatec), Syrup, 75 mg/5 ml, Tk. Cautions: Proton pump inhibitors should
40.15/100 ml ;Tab., 150 mg, Tk.2.01/Tab.
Zorep (Amico), Tab., 150 mg, Tk.1.50/Tab.
be used with caution in patients with liver
disease, in pregancy and in breast-
feeding; they may musk the symptoms of
2.3.2 SELECTIVE gastric cancer.
ANTIMUSCARINICS
Side-effects: These include
M1 selective antimuscarinic pirenzepine gastrointestinal disturbances (nausea,
blocks cholinergic stimulation of gastric vomiting, diarrhoea flatulence, abdomi-
acid secretion but has some anticholi- nal pain), hypersensitivity reactions
nergic adverse effects. It had been tried (rash, urticaria, pruritus, angiooedema);
in the treatment of peptic ulcer but has occasional headache, malaise, muscle
now been discontinued. and joint pain, blurred vision and dry
mouth.
114
DEXLANSOPRAZOLE Lansopril (Amico), Cap. , 15 mg, Tk.

3.50/Cap.; 30 mg, Tk. 5.00/Cap.
Lansoprol (Ziska), Cap., 30 mg, Tk. 4.00/Cap.
Indications: acid reflux, heartburn, Lantid (Opsonin), Cap., 15 mg, Tk.
difficulty swallowing, persistent cough, 2.26/Cap.; 30 mg, Tk. 3.77/Cap.
stomach ulcers(occasional use) Lap (Ambee), Cap. , 30 mg, Tk. 5.01/Cap
Cautions : liver disease, bone fracture, Protolan (Beximco), Cap. , 15 mg, Tk.
shoulder pain, elderly 4.00/Cap.;, 30 mg, Tk. 6.00/Cap.
Side effects: diarrhea, a low magnesium Zoton (General), Cap., 15 mg, Tk.
level, persistent muscle spasms, 3.51/Cap.;Cap., 30 mg, Tk. 6.02/Cap.
seizures, abdominal or stomach pain,
cramping, fever ESOMEPRAZOLE
Dose: 30 mg/60 mg once daily with or
without food Indications: listed in dosage
Caution: see notes above; exclude
Proprietary Preparation gastric malignancy before treatment;
Dexilant (Ziska), Cap. 30 mg, Tk. 9/Cap.; severe hepatic impairment
60mg, Tk. 16/Cap. Interactions: see Appendix-2
Dexlan (Ibn Sina), Cap., 30 mg, Tk. 15/Cap.;
Side-effects: headache, abdominal
Cap., 60 mg, Tk. 25/Cap.
pain, diarrhoea, nausea, vomiting,
pruritus, dizziness
LANSOPRAZOLE
Dose: erosive reflux esophagitis: 20-40
mg once daily for 4-8 weeks; mainte-
Indications: gastric ulcer, duodenal nance, 20 mg once daily
ulcer, reflux oesophagitis Zollinger- Symptomatic gastro-esophageal reflux:
Ellison syndrome; also used in 20 mg once daily for 4 weeks
conjunction with other drugs in triple Triple therapy for eradication of H. pylori
therapy for eradication of H. pylori 20 mg twice daily (with 1 g amoxycillin
Cautions: avoid in pregnancy and twice daily and 500mg calrithromycin
breast-feeding twice daily for 7 days
Side-effects: see notes above Alton (General), Inj., 40 mg/Vial, Tk. 100/Vial;
Tab., 20 mg, Tk. 5/Tab.; 40 mg, Tk. 8/Tab.
Dose: benign gastric ulcer 30 mg daily in
Asozit (White Horse), Cap., 20 mg, Tk. 7/Cap.
the morning before breakfast for a period Curacid (Rangs), Cap., 20mg, Tk. 6.00/Cap.;
of 4 to 8 weeks. For gastric or duodenal 40mg, Tk. 9.00/Cap.
ulcer associated with H. pyloroi in triple Ema (Globe), Cap., 20 mg, Tk. 7.00/Cap; 40
therapy for eradication of H. pylori, see mg, Tk. 9.00/Cap.; Tab., 20 mg, k. 4.75/Tab.;
section 2.3.6 40 mg, Tk. 8.00/Tab.; IV Inj., 40 mg/vial, Tk.
80.00/Vial
Emep (Aristo), Cap., 20 mg, Tk. 7/Cap.; 40mg,
Tk. 9/Cap.; Inj., 40 mg/Vial, Tk. 90/Vial; Tab.,
Enso (Kemiko), Cap., 15 mg, Tk. 3.00/Cap.;
20 mg, Tk. 5/Tab.
30 mg, Tk. 5.00/Cap.
Eprazol (Labaid), Cap., 20 mg, Tk. 7/Cap.
Lanozole (Medimet), Cap., 30 mg,
E-Proton (Doctor TIMS), Cap., 20 mg, Tk.
Tk.5.00/Cap.; 5 mg, Tk.3.00/Cap.
7/Cap.
Lansec (Drug Int), Cap. , 15 mg, Tk.
Erazole (Kemiko), Tab. 20 mg, Tk. 5/Tab.
3.50/Cap. 30 mg, Tk. 6.00/Cap.
Esmax (Concord), Cap., 20 mg, Tk. 6/Cap.;
Lansina (Ibn Sina), Cap. , 30 mg, Tk.
40mg, Tk. 8/Cap; Tab., 20 mg, Tk. 5/Tab.
6.00/Cap.
Esmosec (Techno), Tab., 20 mg, Tk. 5/Tab.;
Lanso (Square), Cap. , 15 mg, Tk. 3.51/Cap.;
40 mg, Tk. 8/Tab.
30 mg, Tk. 6.02/Cap.
Eso (Asiatic), Tab., 20 mg, Tk. 5.00/Tab.
Lansocon(Biopharma), Cap. , 30 mg, Tk.
Esocon (Biopharma), Cap., 20 mg, Tk.6/Cap.;
6.00/Cap.
40 mg, Tk. 9/Cap.; Inj., 40 mg/Vial, Tk. 65/Vial
Lansodin (Acme), Cap., 15 mg, Tk.
Esofour (Albion), Cap., 20 mg, Tk. 6/Cap.;
3.51/Cap.; 30 mg, Tk. 6.02/Cap.
20mg, Tk. 6/Cap. Tab., 20 mg, Tk. 5/Tab.;
Lansoprazole (Albion), Cap. , 15 mg, Tk.
40mg, Tk. 7/Tab.
3.50/Cap. ;30 mg, Tk. 6.00/Cap.
115
Esogel (Organic), Cap., 40 mg, Tk. 8.00/Cap. Neptor (Novartis), Cap. , 20 mg, Tk.
Esoking (Globex), Cap., 20 mg, Tk. 6.00/Cap. 8.00/Cap.; Cap., 40 mg, Tk. 12.00/Cap.
Esolin (Rephco), Tab. 40 mg, Tk. 8.00/Tab. ; Nexcap (Unimed), Cap. , 20 mg, Tk.
20 mg, Tk. 4.00/Tab. 7.00/Cap.; 40 mg, Tk. 9.00/Cap.
Esolok(Ibn Sina), Cap., 20 mg, Tk. 7.00/Cap.; Nexe (Apex ), Tab. , 20 mg, Tk. 5.00/Tab.; 40
40 mg, Tk. 8.00/Cap. ;Tab. , 20 mg, Tk. mg, Tk. 8.00/Tab.; Cap., 20 mg, Tk. 6.00/Cap.
4.00/Tab.; 40 mg, Tk. 7/Tab.; Inj., 40 mg/Vial, Nexum (Square), Cap., 20 mg, Tk. 6.02/Cap.;
Tk. 100/Vial 40 mg, Tk. 9.03/Cap. Tab. , 20 mg, Tk.
Esomenta (RAK), Cap., 20 mg, Tk. 5.01/Tab.; 40 mg, Tk. 8.04/Tab., Inj., 40
7.00/Cap.;Cap., 40 mg, Tk. 10.0/Cap. mg/Vial, Tk. 90.00/Vial
Esomep (ACI), Cap., 20 mg, Tk. 7.00/Cap. ; Opton (Beximco),Tab.20 mg,Tk.
40 mg, Tk. 9.00/Cap. ;Tab. , 20 mg , Tk. 5.00/Tab.; 40mg, Tk. 8.00/Tab.; Cap., 20 mg,
5.00/Tab. ; 40 mg , Tk. 8.00/Tab.Inj., 40 Tk. 7/Cap.; 40 mg, Tk.10/Cap.; Inj., 40 mg/Vial
mg/Vial, Tk. 90.00/Vial Tk. 110.00/Vial
Esomo (Amulet), Cap., 20 mg, Tk. 6.00/Cap.; Pepzol (Leon), Cap., 20 mg, Tk. 7.00/Cap. ;
40 mg, Tk. 8.00/Cap. 40 mg, Tk. 10.00/Cap.
Esonix (Incepta), Cap., 20 mg, Tk. 7.00/Cap. ; Prazia (Amico), Tab., 40 mg, Tk.
40 mg, Tk. 9.00/Cap.; Inj., 40 mg/Vial, Tk. 8.00/Tab.; 20mg, Tk. 5.00/Tab.
90.00/Vial ;Tab., 40 mg, Tk. 8.00/Tab. ;, 40 Progut(Popular), Tab. , 20 mg, Tk. 5.00/Tab.;
mg, Tk. 5.00/Tab. 40 mg, Tk. 8.00/Tab. ; Cap. , 40 mg, Tk.
Esopra (Alco), Cap., 20 mg, Tk. 6.00/Cap. ; 9.00/cap;20mg Tk.7.00/cap Inj., 40 mg/Vial,
40 mg, Tk. 9.00/Cap Tab. , 20 mg, Tk. Tk. 70.26/Vial;
4.00/Tab;. Tab. , 40 mg, Tk. 7.00/Tab. Pronex (Drug Int.), Inj., 40 mg/Vial, Tk.
Esoprex (Beacon), Cap. , 20 mg, Tk. 90.00/Vial ;Tab. , 20 mg, Tk. 5.00/Tab. ;Tab. ,
6.00/Cap.; 20 mg, Tk. 6.00/Cap.; 40 mg, Tk. 40 mg, Tk. 8.00/Tab.
8.00/Cap.;Inj., 40 mg/Vial, Tk. 100.00/Vial Sergel(Healthcare), Cap., 20 mg, Tk.
Esoprol (Ziska), Cap., 20mg, Tk. 5.00/Cap; 7.00/Cap. ;40 mg, Tk. 10.00/Cap.; Inj., 40
40mg, Tk. 8.00/Cap. mg/Vial, Tk. 100.00/Vial; Tab., 20 mg, Tk.
Esoral (Eskayef), Cap, 20 mg, Tk. 7.00/Cap.; 7.00/Tab.; 40 mg, Tk. 9.00/Tab.
Tab, 20 mg, Tk. 5.00/Tab. ; , Tab, 40 mg, Tk. Somazole (Ad-din), Cap., 20mg, Tk.
8.00/Tab.; Cap, 40 mg, Tk. 9.00/Cap.; Inj, 40 5.00/Cap.; 400mg, Tk. 8.00/Cap.
mg/Vial, Tk. 90.00/Vial S-Ome (Somatec), Tab. , 20 mg, Tk.
Esotac (Navana), Tab., 40 mg, Tk. 4.01/Tab. ; 40 mg, Tk. 7.03/Tab
7.03/Tab.;Cap., 20 mg, Tk. 6.00/Cap. 40 mg, Sompraz (Sun), Tab. , 20 mg, Tk.
Tk. 8.00/Cap. 6.00/Tab;40 mg, Tk. 9.00/Tab..;
Esotid (Opsonin), Cap., 20 mg, Tk. Somprazol (Sharif), Cap. , 20 mg, Tk.
4.53/Cap.; 40 mg, Tk. 6.79/Cap.;Powder, 20 6.00/Cap. ; 40 mg, Tk. 9.00/Cap.
mg/Sachet, Tk. 4.51/Sachet;Tab., 20 mg, Tk.
3.77/Tab. 40 mg, Tk. 6.02/Tab;Inj., 40 Esomeprazole + Naproxen
mg/Vial, Tk. 67.67/Vial Anaflex Max (ACI), Tab. , 20 mg + 375 mg,
Esotor (Nipro JMI), Tab. , 20 mg, Tk. Tk. 8.00/Tab.; 20 mg + 500 mg, Tk. 10.00/Tab.
5.00/Tab. ; 40 mg, Tk. 8.00/Tab. DemovoTM (Delta), Tab. , 20 mg + 375 mg,
Esover (Veritas), Cap. , 20 mg, Tk. Tk. 8.00/Tab. ; 20 mg + 500 mg, Tk. 10/Tab.
7.00/Cap.;40 mg, Tk. 9.00/Cap. Dinovo(Beximco)Tab. , 20 mg + 375 mg, Tk.
Esoz (Astra),Cap., 20 mg, Tk. 5.00/Cap. 8.00/Tab.; 20 mg + 500 mg, Tk. 10.00/Tab.
Esprazo (Pacific), Cap., 20 mg, Tk. 3.76/Cap. Emaprox (Globe), Tab.,20 mg + 375 mg, Tk.
Exium (Radiant), Cap. , 20 mg, Tk. 8.00/Tab.; 20 mg + 500 mg , Tk. 10.00/Tab.
7.50/Cap.; 40 mg, Tk. 9.50/Cap. Esona (Navana), Tab., 20 mg + 375 mg, Tk.
Exmart (MST), Tab., 20 mg, Tk. 5/Cap.; 40 8.00/Tab.; 20 mg + 500 mg, Tk. 10.00/Tab.
mg, TK. 8/Tab. Esoxen (Organic), Tab., Tk. 8.00/Tab.; 20 mg
Exome (Chemist), Tab., 20 mg, Tk. 5.00/Tab. + 500 mg, Tk. 10.00/Tab.
Exor (Orion), Cap. , 20 mg, Tk. 6.00/Cap.; 40 Inflect (Kemiko), Tab. , 20 mg + 375 mg, Tk.
mg, Tk. 9.00/Cap. ;Inj, 40 mg/Vial, Tk. 8.00/Tab.;Tab., 20 mg + 500 mg, Tk. 10/Tab.
100.00/Vial Locin(Globe ), Tab., 20 mg + 375 mg, Tk.
iMAX (Delta), Cap. , 20 mg, Tk. 5.00/Cap. 8.00/Tab.; 20 mg + 500 mg, Tk. 10.00/Tab.
Maxima (Acme), Cap., 20 mg, Tk. Nameso (Opsonin), Tab., 20 mg + 375 mg,
7.00//Cap.; 40 mg, Tk. 9.00/Cap.;Inj., 40 Tk. 6.02/Tab.; 20 mg + 500 mg, Tk. 7.52/Tab.
mg/Vial, Tk. 90.00/Vial Napren ES (Alco), Tab. , 20 mg + 375 mg, Tk.
Maxpro (Renata), Cap. , 20 mg, Tk. 8.00/Tab.; 20 mg + 500 mg, Tk. 10.00/Tab.
7.00/Cap.; Cap. , 40 mg, Tk. 8.00/Cap. Tab. , Napro-A Plus (Acme), Tab.,Tk. 8.00/Tab.;20
20 mg, Tk. 5.00/Tab. ;40 mg, Tk. 8.00/Tab.; mg + 500 mg, Tk. 10.00/Tab.
Inj., 40 mg/Vial, Tk. 90.00/Vial
116
Naproflex (Somatec), Tab. , 20 mg + 375 mg, Benign gastric or duodenal ulcer

Tk. 8.00/Tab. ; Tab. , 20 mg + 500 mg, Tk. associated with H. pylori, see section
10.00/Tab. 2.3.6 for eradication therapy.
Naprosyn Plus (Radiant), Tab., 20 mg + 500
mg, Tk. 20.00/Tab. Zollinger-Ellison syndrome, initially 60
Naprotec (Sharif), Tab. , 20 mg + 375 mg, Tk. mg once daily; usual range 20-120 mg
8.00/Tab.; 20 mg + 500 mg, Tk. 10.00/Tab. daily (above 80 mg in 2 divided doses).
Naprox Plus , (Eskayef), Tab, 20 mg + 375
mg, Tk. 8.00/Tab.; Tab, 20 mg + 500 mg, Tk. Erosive reflux oesophagitis, 20 mg daily
10.00/Tab. for 4 weeks, followed by a further 4
Naproxen Plus (Albion), Tab., 20 mg + 500 weeks if not fully healed; 40 mg daily has
mg, Tk. 6.89/Tab. been given for 8 weeks in reflux
Naprozol (General), Tab. , 20 mg + 375 mg, oesophagitis refractory to other
Tk. 8.00/Tab.;Tab. , 20 mg + 500 mg, Tk. treatment.
10.00/Tab.
Napsec (Drug Int), Tab. , 20 mg + 375 mg,
Tk. 8.00/Tab. ; Tab. , 20 mg + 500 mg, Tk. Proprietary Preparations
10.00/Tab. Aspra (Apex), Cap. , 20 mg, Tk. 4.00/Cap.;
Napxon (Ziska), Tab., 20 mg + 375 mg, Tk. Cosec (Drug Int.), Cap. , 20 mg, Tk.
8.00/Tab., 20 mg + 500 mg , Tk. 10.00/Tab. 5.00/Cap., 40 mg, Tk. 8.00/Cap.;Inj., 40
Nasopain (RAK ), Tab., 20 mg + 375 mg, Tk. mg/vial, Tk. 90.00/Vial
10.0/Tab.; 20 mg + 500 mg, Tk. 12.0/Tab. Curacid (Rangs), Cap., 20mg, Tk. 6.00/Cap.;
Neso (Aristo), Tab. , 20 mg + 375 mg, Tk. 40mg, Tk. 9.00/Cap.
8.00/Tab. ; 20 mg + 500 mg, Tk. 10.00/Tab. Ema (Globe), Cap., 20 mg, Tk. 7.00/Cap; 40
Novaxen Plus (Leon), Tab., 20 mg + 500 mg, mg, Tk. 9.00/Cap.; Tab., 20 mg, k. 4.75/Tab.;
Tk. 10.00/Tab. 40 mg, Tk. 8.00/Tab.; IV Inj., 40 mg/vial, Tk.
Novoxen (Orion), Tab. , 20 mg + 375 mg, Tk. 80.00/Vial
8.00/Tab. ; 20 mg + 500 mg, Tk. 10.00/Tab. Esoprol (Ziska), Cap., 20mg, Tk. 5.00/Cap;
Nupralgin Plus (Ibn Sina), Tab. , 20 mg + 40mg, Tk. 8.00/Cap.
500 mg, Tk. 10.00/Tab. ; 20 mg + 375 mg, Tk. Eupi (Pharmasia), Inj., 40 mg/vial, Tk.
8.00/Tab. 80.00/Vial; Cap., 20 mg, Tk. 5.00/Cap.
Progesic (Incepta), Tab. , 20 mg + 375 mg, Exmart (MST), Tab., 20 mg, Tk. 5/Cap.; 40
Tk. 8.00/Tab. ; 20 mg + 500 mg, Tk. 10/Tab. mg, Tk. 8/Tab.
Progut-N (Popular ), Tab. , 20 mg + 375 mg, Exome (Chemist), Tab., 20 mg, Tk. 5.00/Tab.
Tk. 8.00/Tab.; 20 mg + 500 mg, Tk. 10.00/Tab. G-Omeprazole (Gonoshasthaya), Cap.,20mg,
Ranoxen Plus (Rangs), Tab., 20 mg + 500 Tk 3.00/Cap. ;Inj., 40 mg/vial, Tk. 65.00/Vial
mg, Tk. 10.00/Tab. Healer (Amico), Cap. , 20 mg, Tk. 4.00/Cap.
Solivo (Healthcare), Tab., 20 mg + 375 mg, Inhibita (Delta), Cap., 20 mg, Tk. 4.00/Cap.;
Tk. 13.00/Tab. ;, 20 mg + 500 mg, Tk. 15/Tab. 40 mg, Tk. 7.00/Cap.
Twist (Chemist), Tab., 20 mg + 500 mg, Tk. Inpro (Biopharma), Cap., 20 mg, Tk.
10.00/Tab. 5.00/Cap.; 40 mg , Tk.7.03/Cap.; Inj., 40
Xenole (Square), Tab. , 20 mg + 375 mg, Tk. mg/vial, Tk. 70.00/Vial
8.00//Tab.; 20 mg + 500 mg, Tk. 10.00/Tab. I-Proton (Doctor TIMS), Cap., 20 mg, Tk.
5.00/Cap.
Losectil (Eskayef), Cap., 10 mg, Tk.2.00/Cap.
OMEPRAZOLE[ED] 20 mg , Tk. 4.00/Cap.; 40 mg, Tk.
7.00/Cap.Inj, 40 mg/vial, Tk. 70.00/Vial ;
Sachet, 20 mg, Tk. 5.00/Sachet; 40 mg, Tk.
Indications: see notes above 8.00/Sachet
Cautions: see notes above; exclude Lotil (Albion), Cap., 20 mg, Tk. 2.95/Cap.; 40
malignancy. mg, Tk. 4.00/ Tab.
Neopra (Supreme), Cap., 20 mg, Tk.
Interactions: see Appendix-2 5.00/Cap.
Side-effects: see notes above Norain (GSK), Cap., 20 mg, Tk. 4.40/Cap.
O-20 (Asiatic), Cap. , 20 mg , Tk. 5.00/Cap.;
Dose: benign gastric and duodenal 40 mg, Tk. 7.00 /Cap.
ulcers, 20 mg once daily for 4 weeks in OC-20 (Central), Cap. , 20 mg, Tk. 4.00/Cap.
duodenal ulceration or 8 weeks in gastric OLE (Bios), Cap., 20 mg, Tk. 4.00/Cap.; 20
ulceration; in severe cases increase to mg, Tk. 4.00/Cap.
40 mg daily; long term use not Ome (Somatec), Cap., 20 mg, Tk. 4.00/Cap.;
40 mg, Tk. 8.00/Cap.
recommended
Omeben (Benham), Cap. , 20 mg, Tk.5/Cap.
117
Omecron (Nipro JMI), Cap., 20 mg, Tk. Proceptin (Beximco), Cap. , 20 mg, Tk.
6.00/Cap.; 40 mg, Tk. 8.00/Cap. 5.00/Cap. ; 40 mg, Tk. 8.00/Cap.; Inj.,
Omegut (Popular), Tab. , 20 mg, Tk. 40mg/vial, Tk. 100.00/Vial
5.00/Tab.; 40 mg, Tk. 7.03/Tab.; Inj., Prolok(Ibn Sina), Cap. , 20 mg, Tk. 5.00/Cap.;
40mg/Vial, Tk.80.00/Vial Inj., 40 mg/vial, Tk. 90.00/Vial
Omelet (Amulet), Cap., 40 mg, Tk. 7.00/Cap.; Promezol (Sharif), Cap. , 20 mg,
Cap., 20 mg, Tk. 5.00/Cap. Tk.5.00/Cap.; 40 mg, Tk. 8.00/Cap.
Omenix (Incepta), Cap. , 20 mg, Tk. Prosectil (Pharmacil), Cap. , 20 mg, Tk.
5.00/Cap.; 40 mg, Tk. 8.00/Cap. Inj., 40 5.00/Cap.; Inj., 40 mg/vial, Tk. 90.00/Vial
mg/vial, Tk. 90.00/Vial; Sachet, 20 mg, Tk. Regerd (Organic), Cap. , 20 mg, Tk.
6.00/Sachet; 40 mg, Tk. 10.00/Sachet 5.00/Cap.;40 mg , Tk. 7.00/Cap.
Omenta (RAK), Cap., 20 mg, Tk.5.0/Cap.; Rome (Rephco), Cap. , 20 mg, Tk. 5.00/Cap.
Inj., 40 mg/vial, Tk. 90.00/Vial Seclo (Square), Cap. , 20 mg, Tk. 5.00/Cap.;
Omep (Aristo), Inj., 40mg/vial, Tk. 80.00/Vial.; 40 mg, Tk. 8.00/Cap. ;Inj., 40 mg/vial, Tk.
Cap. , 10 mg, Tk. 2.00/Cap. ; 20 mg, Tk. 80.00/Vial.; DR Tab. , 20 mg, Tk. 5.00/Tab.
5.00/Cap.; 40 mg, Tk.7.00/Cap. Somazole (Ad-din), Cap., 20mg, Tk.
Omepra (Alco), Cap. 20 mg, Tk. 4.00/Cap.; 5.00/Cap.; 400mg, Tk. 8.00/Cap.
Cap., 40 mg, Tk. 7.00/Cap. Stosec(Opso Saline), Inj., 40 mg/vial, Tk.
Omeprazole (APC), Cap., 20 mg, Tk. 52.83/Vial
2.50/Cap. Xeldrin (ACI), Inj., 40 mg/vial , Tk. 70.26/Vial.;
Ometac (Navana), Cap., 20 mg, Tk. Cap. , 10 mg, Tk. 2.01/Cap.; 20 mg, Tk.
4.02/Cap.; 40 mg, Tk. 6.02/Cap. 5.00/Cap.; 40 mg , Tk. 8.00/Cap.
Ometid (Opsonin), Cap., 20 mg, Tk. Xelopes (Beacon), Cap., 40 mg, Tk.
3.76/Cap.; 40 mg, Tk. 5.29/Cap.; Inj., 40 6.97/Cap.; 20 mg, Tk. 5.00/Cap.; Inj., 40
mg/vial, Tk. 67.67/Vial.;Sachet, 40 mg , Tk. mg/vial, Tk. 90.00/Vial
3.76/Sachet Xerosec (Sanofi), Cap., 10 mg, Tk. 2.51/Cap.;
Ometor (Astra),Cap., 20 mg, Tk. 4.00/Cap. 20 mg, Tk.5.00/Cap.; 40 mg, Tk.8.00/Cap.
Omex (Kemiko), Cap., 20 mg, Tk. 5.00/Cap.; Zilon (Radiant), Cap. ,20 mg, Tk.5.00/Cap.;40
40 mg, Tk. 7.00/Cap. mg, Tk. 7.50/Cap.
Omimak (Maks), Cap., 20 mg, Tk. 5.00/Cap.
Omirex (Jayson), Cap., 20 mg, Tk.
PANTOPRAZOLE
5.00/Cap.;Cap., 40 mg, Tk. 8.00/Cap.
Omizit (White Horse), Cap., 20 mg, Tk.
4.00/Cap. Indications: for suppression of acid
Omsec (Techno), Cap. , 20 mg, Tk. secretion in gastric or duodenal ulcer,
4.00/Cap.; Inj., 40 mg/vial, Tk. 70.00/Vial reflux oesophagitis Zollinger-Ellison
OP max (Concord), Cap. , 20 mg, Tk. syndrome; prophylaxis against acid
4.00/Cap.; Cap. , 40 mg, Tk. 7.00/Cap.
aspiration syndrome during indcution of
Opal (Healthcare), Cap., 20 mg, Tk.
10.00/Cap.; 40 mg, Tk. 8.00/Cap.; Inj., anaesthesia. In conjunction with other
40mg/vial, Tk. 95.00/Vial. drugs, for the eradication of H. pylori
Peptral (Labaid), Cap. , 20 mg, Tk. 5.00/Cap. Interactions: see Appendix-2
Perizol (Leon), Cap. , 20 mg, Tk. 5.00/Cap.;
Cap. , 40 mg, Tk. 8.00/Cap. Side-effects: see notes above
Piazol (Globex), Cap. , 20 mg, Tk. 5.00/Cap. Dose: by mouth in benign gastric ulcer
PPI (Acme), Cap., 40 mg, Tk. 8.00/Cap.; 20
or gastroesophageal reflux disease, 40
mg, Tk. 4.01/CapInj., 40 mg/vial, Tk. 80.00/Vial
Prazo (Pacific), Cap., 20 mg, Tk. 2.25/Cap.; mg daily in the morning for 4 weeks,
20 mg, Tk. 2.25/Cap.; Tab., 20 mg, Tk. followed by further 4 weeks if not fully
1.88/Tab. healed
Prazole (Renata), Cap., 20 mg, Tk. 4.02/Cap. Duodenal ulcer or gastritis associated
Prazover (Veritas), Cap., 20 mg, Tk. 5/Cap.
Presec (Unimed), Cap., 20 mg, Tk.4.00/Cap.;
with H. pylori, 40 mg twice daily (with
40 mg, Tk. 7.00/Cap. clarithromycin 250mg twice daily and
Prevas (General), Cap., 20 mg, Tk. metronidazole 400mg twice daily) for 7
5.00/Cap.; 40 mg, Tk. 7.03/Cap.Inj., 40 days.CHILD not recommended.
mg/vial, Tk. 80.00/Vial
Probitor (Novartis), Cap., 20 mg, Tk Proprietary Preparations
7.00/Cap.; 40 mg, Tk. 10.00/Cap. Europan (Globe), Inj., 40 mg, Tk. 70.00/Vial;
ProCap (Orion), Cap., 20 mg, Tk. 5.00/Cap.; Tab., 40 mg, Tk.6.00/Tab; 20 mg, Tk.
40 mg, Tk. 8.00/Cap. 4.00/Tab.
118
Exipro (Leon), Tab., 20 mg, Tk. 4.00/Tab.; 40 Panzer (Sun), Tab., 20 mg, Tk. 4.00/Tab.; 40
mg, Tk. 6.00/Tab. mg, Tk. 6.00/Tab.
Nixpan (Ad-din), Tab., 20 mg, Tk. 3.00/Tab.; Panzol (Amico), Tab., 20 mg, Tk. 3.50/Tab.;
40 mg, Tk. 5.00/Tab. 40 mg, Tk. 5.50/Tab.
P-20 (Asiatic), Tab., 20 mg, Tk. 4.00/Tab.; 40 PC (Central), Tab., 20 mg, Tk. 4.00/Tab.
mg, Tk. 6.00/Tab. Pentosa (Pharmasia), Tab., 20 mg, Tk.
Pagerd (Organic), Tab., 20 mg, Tk. 4.00/Tab.; 4.00/Tab.; 40 mg, Tk. 6.00/Tab.
40 mg, Tk. 6.00/Tab. Pramax (Concord), Tab., 20 mg, Tk.
Panoral (Eskayef), Tab., 20 mg, Tk. 4.00/Tab.; 4.00/Tab.; 40 mg, Tk. 6.00/Tab.
40 mg, Tk. 6.00/Tab. Prazolin (Rephco), Tab., 20 mg, Tk.
Panoz (Astra), Tab., 20 mg, Tk. 4.00/Tab. 4.00/Tab.; 40 mg, Tk. 6.00/Tab.
Panprazo (Pacific), Tab., 20 mg, Tk. 3.01/Tab. Pregel (Healthcare), Tab., 20 mg, Tk.
Panpro (Biopharma), Tab., 20 mg, Tk. 5.00/Tab.; 40 mg, Tk. 7.00/Tab.
5.00/Tab.; 40 mg, Tk. 6.00/Tab.; Inj., 40 Protium (Unimed), Tab., 20 mg, Tk.
mg/Vial, Tk. 70.00/Vial 5.00/Tab.; 40 mg, Tk. 9.00/Tab.
Pansec(Drug Intl), Tab., 20mg, Tk.5.00/Tab.; Protocid (Acme), Tab., 20 mg, Tk. 4.00/Tab.;
40 mg, Tk. 7.00/Tab.; Inj., 40 mg/Vial, Tk. 40 mg, Tk. 6.00/Tab.; Inj., 40 mg/Vial,
90.00/Vial Tk.70.26/Vial
Pansiv (MST), Tab., 20 mg, Tk. 4/Tab.; 40 Protoloc (Beacon), Tab., 20 mg, Tk.
mg, Tk. 6/Tab. 4.00/Tab.; 40 mg, Tk.6.00/Tab.
Pansos (Nipro JMI), Tab., 20mg, Tk. Protonil (Renata), Tab., 20 mg, Tk.4.00/Tab.;
3.00/Tab.; 40 mg , Tk. 5.00/Tab. DR Tab., 40 mg, Tk. 6.00/Tab.
Pantac (Navana), Tab., 20 mg, Tk. Proton-P (Aristo), Tab., 20 mg, Tk. 5.00/Tab.;
4.00/Tab.; 40 mg, Tk. 6.00/Tab. 40 mg, Tk.7.00/Tab.; Inj., 40 mg/Vial, Tk.
Pantex (ACI), Tab., 20 mg , Tk.4.00/Tab.; 40 80.00/Vial
mg , Tk. 6.00/Tab.; 40 mg/Vial, Tk. 70.26/Vial Topra (Jayson), Tab., 20 mg, Tk.3.00/Tab.;
Pantid (Opsonin), Tab., 20 mg, Tk. 2.26/Tab.; 40 mg, Tk.5.02/Tab.
40 mg, Tk. 3.77/Tab.; Inj., 40 mg/Vial, Tk. Trupan (Square), Tab., 20 mg, Tk. 5.00/Tab.;
63.91/Vial 40 mg, Tk. 7.00/Tab.; Inj., 40 mg/Vial, Tk.
Pantium (Radiant), Tab., 20 mg, Tk. 80.00/Vial
7.00/Tab.; 40 mg, Tk. 10.00/Tab. Zopan (Kemiko), Tab., 20 mg, Tk.4.00/Tab.;
Panto (Somatec), Tab., 20 mg, Tk. 4.00/Tab.; 40 mg, Tk. 6.00/Tab.
40 mg, Tk. 6.00/Tab.
Pantobex (Beximco), Tab., 20 mg, Tk. RABEPRAZOLE SODIUM
5.00/Tab.; 40 mg, Tk. 7.00/Tab.; Inj., 40
mg/Vial, Tk. 110.00/Vial
Pantochem (Chemist), Tab., 20 mg, Tk. Indications: listed in dose
3.00/Tab.; 40 mg, Tk. 5.00/Tab. Cautions: see notes above; exclude
Pantodac (Ziska), Tab., 20mg, Tk. 3.00/Tab.; gastric malignancy before starting
40mg, Tk. 9.00/Tab. treatment
Pantogen (General), Tab., 20 mg, Tk.
Contra-indications: pregnancy and
5.00/Tab.; 40 mg, Tk. 7.00/Tab.
Pantogut (Popular), Tab., 20 mg, Tk. breast-feedings
4.00/Tab.; 40 mg, Tk. 6.00/Tab. Interactions: see Appendix-2
Pantolok (Ibn Sina), Tab., 20 mg, Tk. Side-effects: chest pain, neck rigidity,
4.00/Tab.; 40 mg, Tk. 5.00/Tab.; Inj., 40 Hypertension, Abnormal ECG, GI
mg/Vial, Tk. 80.00/Vial diturbances, anxiety, insomnia
Pantomak (Maks), Tab., 20 mg, Tk. 4.00/Tab. Dose: erosive or ulcerative gastroesop-
Pantomax (Pharmacil), Inj., 40 mg/Vial,
hageal reflux disease, 20 mg daily for 4-
Tk.90.00/Vial
Pantonix (Incepta), Tab., 20 mg, Tk. 8 weeks; may be extended for further 8
5.00/Tab.; 40 mg, Tk. 7.00/Tab.; Inj., 40 weeks if necessary; maintenance, 20 mg
mg/Vial, Tk.90.00/Vial daily
Pantopra (Alco), Tab., 20 mg, Tk. 3.00/Tab.; Duodenal ulcer, 20mg daily for 4 weeks.
40 mg, Tk. 5.00/Tab. Pathological hypersecretory conditions
Pantoprazole (Albion), Tab., 20 mg, Tk. including Zollinger-Ellison syndrome,
3.00/Tab.; 40 mg, Tk. 5.00/Tab.
initially 60 mg once daily, may be
Pantosec (Techno), Inj., 40 mg/Vial, Tk.
70.00/Vial increased to 100-120 mg daily
Pantover (Veritas), Tab., 20 mg, Tk.
4.00/Tab.; Inj., 40 mg/Vial, Tk. 70.00/Vial
Pantrol (Apex), Tab., 20 mg, Tk. 3.00/Tab.
119
Proprietary Preparations Side-effects: may darken tongue and

Rabeprazole sodium 20mg blacken faeces; reduces absorption of
Acifix (Beximco), Tab.,Tk. 5.00/Tab. iron and calcium
Finix (Opsonin), Tab.,Tk. 3.77/Tab.
Paricel (ACI), Tab., Tk. 5.02/Tab. Dose: 240 mg two times daily half an
Rabe (Aristo), Tab., Tk. 5.00/Tab. hour before breakfast and evening
Rabeca (Square), Tab., Tk. 5.00/Tab. meals; may be used initially for 4 weeks,
Rabecon (Biopharma), Tab. Tk. 5.00/Tab. and if required max. for up to 8 weeks
Rabepes (Beacon), Tab., Tk. 5.00/Tab.
Rabeprazole (Albion), Tab. Tk.5.00/Tab.
Generic Preparation
Rabeprol (Somatec), Tab., Tk. 5.00/Tab.
Tablet, 120 mg
Rabesec (Drug Int), Tab., Tk. 5.00/Tab.
Rabetac (Navana)Tab., Tk. 5.00/Tab.
Rabifast (Eskayef), Tab., Tk. 5.00/Tab. SUCRALFATE
Rabigut (Popular), Tab., Tk. 7.00/Tab.
Rabizol (Acme), Tab., Tk. 5.00/Tab. Indications: palliative treatment of
Rabonac (Sharif), Tab., Tk. 5.00/Tab. benign gastric and duodenal ulceration;
Raboz (Leon), Tab. Tk. 5.00/Tab.
Rasonix (Incepta), Tab., Tk. 5.00/Tab. chronic gastritis
Razole (Kemiko), Tab., Tk. 5.00/Tab. Cautions: renal disease
Recepta (Medimet). Tab. Tk. 7.00/Tab.
Respite (Sanofi), Tab., Tk. 5.00/Tab. Interactions: see Appendix-2; antacids
should not be taken half an hour before
or after a dose
2.3.4 CHELATES AND COMPLEXES
Side-effects: constipation; gastric dis-
Tripotassium dicitratobismuthate is a comfort reported
bismuth chelate, which promotes healing Dose: 2g twice daily (on rising and at
of gastric and duodenal ulcers. It may bedtime) or 1g 4 times daily 1 hour
act by coating the ulcer or by stimulating before meals and at bedtime, taken for 4
bicarbonate secretion. As it is also likely weeks or in resistant casees up to 8
to adhere to food rather than to the weeks; max. 8g daily
surface of the ulcer, patients should be
advised to avoid large food, antacids, Proprietary Preparations
and large quantities of milk when taking Gastalfet (Beximco), Tab. 500 mg, Tk.
4.02/Tab.
bismuth chelate. Antepsin (Kemiko), Tab. 1 gm, Tk. 5.50/Tab.
Sucralfate is a complex of aluminium Ulsec (Asiatic), Tab. 1 gm, Tk. 4.00/Tab.
hydroxide and sulphated sucrose and
has minimal antacid properties. It has 2.3.5 PROSTAGALNDIN
been used for gastric and duodenal ANALOGUES
ulcers and may act by protecting the
mucosa from acid pepsin attack. Long Misoprostol, a synthetic analogue of
term use needs further assessment prostaglandin E1 (alprostadil) inhibits
because some aluminium may be gastric acid secretion promoting healing
absorbed. of gastric and duodenal ulcer. It can
protect against NSAID associated gastric
BISMUTH CHELATE ulcers but not dyspepsia.
(Tripotassium dicitratobismuthate)
MISOPROSTOL[ED]
Indications: palliative treatment of
benign gastric and duodenal ulceration Indications: see notes above and under
Cautions: avoid in severe renal dose
impairment, pregnancy and lactation; Cautions: conditions where hypoten-
see also notes above sion might precipitate severe complica-
tions (e.g. cerebrovascular disease,
cardiovascular disease)
120
Contraindications: pregnancy or plann- eradication the incidence of relapse

ing pregnancy (increases uterine tone). decreases. Studies have shown that with
Should not be used in women of child- H. pylori eradication only 5-10% patients
bearing age unless the patient requires experienced relapse within a year
NSAID therapy and is at high risk of compared to 85% of patients who do not
NSAID induced ulceration; patient must have H. pylori eradication, and the benifit
be advised of the risks of taking appeared to continue for about 7 years.
misoprostol if pregnant It is recommended that the presence of
Interactions: see Appendix-2 H. pylori be confirmed before starting
eradication treatment.
Side-effects: diarrhoea (may be severe,
reduced by giving single dose not One week’s triple therapy containing a
exceeding 200 micrograms and by proton pump inhibitor (omeprazole) and
avoiding magnesium containing clarithromycin with either metronidazole
antacids); also reported: abdominal pain, or amoxicillin produces eradication in
dyspepsia, flatulence, nausea and over 90% of patients. Clarithromycin
vomiting, abnormal vaginal bleeding may be substituted with both metroni-
(including intermenstrual bleeding, dazole and amoxicillin. Ranitidine or
menorrhagia, and post menopausal bismuth chelate may be used in place of
bleeding) omeprazole. Two weeks’ triple therapy
regimen may give higher eradication rate
Dose: benign gastric and duodenal but adverse effects are common and
ulceration, 800 micrograms daily (in 2-4 compliance is poor.
divided doses) with breakfast (or main
meals) and at bedtime; treatment should Recommended regimens for H. pylori
be continued for at least 4 weeks and eradication (7-day course)
may be continued for up to 8 weeks if
required. Prophylaxis of NSAID induced Omeprazole 20 mg twice daily +
peptic ulcer, 200 micrograms 2-4 times Clarithromycin 500 mg twice daily +
daily according to condition of patient Amoxicillin 1 g twice daily
Proprietary Preparations Lansoprazole 30 mg twice daily +

Clarithromycin 500 mg twice daily +
Cytomis (Incepta), Tab., 100 microgram, Tk.
Amoxicillin 1 g twice daily
8.00/Tab.; 200 microgram. Tk. 15.00/Tab.
G-Misoprostol (Gonoshasthaya), Tab., 200
Omeprazole 20 mg twice daily +
microgram, Tk.10.00 /Tab.
Indula (Renata), Tab., 200 microgram,Tk.
Metronidazole 400 mg twice daily
15.00/Tab.
Isovent (Square), Tab., 200 microgram, Tk.
Lansoprazole 30 mg twice daily +
15.05/Tab.; 600 microgram,, Tk. 40.00/Tab.
Misoclear (Acme), Tab., 200 microgram,, Tk.
Metronidazole 400 mg twice daily
15.00/Tab.
Misopa (Beximco), Tab.,200 microgram,, Tk.
Lansoprazole 30 mg twice daily+
15.00/Tab.
Metronidazole 400 mg twice daily+
Misotec (Sharif), Tab., 200 microgram, Tk.
Amoxicillin 1 g twice daily
15.00/Tab.
Misotol (Ziska), Tab., 200 microgram, Tk.
Omeprazole 20 mg twice daily +
15.00/Tab.
Metronidazole 400 mg thrice daily +
Amoxicillin 500 mg thrice daily
2.3.6 DRUGS FOR ERADICATION
OF HELICOBACTER PYLORI Pantoprazole 40mg twice daily+
Clarithromycin 500mg twice daily+
The causal role of H. pylori in gastric and Amoxycillin 1g twice daily
duodenal ulcer is now widely accepted. Ranitidine bismuth citrate 400 mg twice daily +
Long-term healing of gastric and Clarithromycin 500mg twice daily + Amoxicillin
duodenal ulcers can be achieved by 1 g twice daily
eradicating H. pylori, and after such
121
TRIPLE THERAPY COMBINED ORAL REHYDRATION THERAPY

PREPARATIONS
Oral rehydration therapy (ORT) by
Proprietary Preparations correcting fluid and electrolyte depletion
Lansoprazole 30 mg + Clarithromycin 500 mg
+ Amoxycillin 1 g
forms the basis of treatment for acute
Helicon Kit (General),Tab.Tk. 55.21/blister diarrhoea.
strip The solution of oral rehydration salts
Pylotrip (Square), Tab.Tk.55.00/blister strip (ORS) containing essential electrolytes
Pylopac (Beximco), Tab., Tk.45.00/blister strip
(sodium, potassium, chloride and
Omeprazole 20 mg + Clarithromycin 500mg + bicarbonate or citrate) and glucose is
Metronidazole 500mg indicated regardless of the age of the
Neo Kit (Beximco), Tab. Tk.55.00/ blister strip patient or the cause of the diarrhoea.
Amoxicillin + Clarithromycin + Rabeprazole The rationale for the use of glucose is
Sodium that it promotes active transport of
Pylocure kit (Opsonin) Tab.Tk.48.56/blister electrolytes. There is considerable
strip
evidence that cereal based solutions
tend to produce more rapid resolution of
2.4 DRUGS FOR ACUTE diarrhoea and a rice-based rehydration
DIARRHOEA solution (see below) are recommended
for patients with cholera. Home remedies
Diarrhoea is characterized by increased which have been used for oral
volume and frequency of liquid stools. It rehydration include green coconut water,
is commonly associated with infection, rice water, soups, weak tea and solution
but may result from accumulation of non- of various salts and sugars. The use of
absorbed osmotically active solute in gut soft drinks with low pH and high
such as in lactase deficiency, or when osmolality may exacerbate diarrhoea.
intestinal motility or morphology is Severe dehydration (greater than 10%
altered. Diarrhoea is a symptom of loss of body weight) requires intravenous
gastroenteritis and of most intestinal rehydration therapy (see below).
infections. Although viral diarrhoeas are
Withholding food during diarrhoea in
common, the severe forms of infectious
both children and adults is not
diarrhoeas are generally due to bacterial
recommended; feeding may decrease
pathogens such as Campylobacter jejuni
stool output and shorten duration of
Escherichia coli Salmonella Shigella
diarrhoea. Oral rehydration therapy
Spp, Vibrio cholera and Yarsinia
should therefore be combined with
enterocolitica. Intestinal protozoa such
normal dietary measures to avoid
as E.histolytica and Giardia also cause
malnutrition. Breast-feeding should be
diarrhoea. The first line of treatment in
continued throughout the rehydration
acute diarrhoea is oral rehydration
therapy. A rehydration phase that
therapy (ORT).
involves the replenishment of fluid and
Acute diarrhoea may lead to excessive elecrolytes lost through diarrhoea is
fluid and electrolyte loss and dehydration followed by a maintenance phase to
especially in infants and in elderly replace continuing loss.
patients. It is potentially life threatening
in infants and in frail and elderly persons. ORAL REHYDRATION SALTS[ED]
Severe dehydration associated with
acute diarrhoea (greater than 10% loss
Each sachet of the proprietary
of body-weight), requires intravenous
preparations contains: sodium chloride
rehydration therapy preferably with
1.75 g, potassium chloride 0.75 g,
ringers letate solution. Intravenous
trisodium citrate dihydrate 1.45 g and
therapy is also needed for patients who
anhydrous dextrose 10 g. This is the
are unable to drink.
WHO approved formulation for ORS.
122
Contents of one sachet are dissolved in Rice Saline (General), ORS, Tk. 15.00/500 ml
500 ml of drinking water for ready use. Sache,Tk. 9.00/250 ml Sachet
Neorice (Eskayef), ORS, Tk. 12.00/Sachet
ACI ORS (ACI), ORS, Tk. 4.58/Sachet ANTIDIARRHOEAL DRUGS WHICH
Asaline (Apex), ORS, Tk. 4.58/Sachet REDUCE MOTILITY
Easy ORS (Central), ORS, Tk. 4.58/Sachet
G-ORS (Gonoshasthaya), ORS, Tk 4/Sachet
K-SALINE N (Kemiko), ORS, Tk. 4.58/Sachet In acute diarrhoeas fluid and electrolyte
Neosaline (Eskayef), ORS, Tk. 4.58/Sachet replacement are the prime requirements,
Oralsaline (Albion), ORS, Tk. 5.00/Sachet especially in children. In chronic
Oralsaline Sweety (Albion) ORS,Tk. 5/Sachet diarrhoeas opioids (such as codeine,
Orasol (Sonear), ORS, Tk. 3.20/Sachet diphenoxylate, and mixtures containing
ORS (Popular), ORS, Tk. 4.58/Sachet
morphine or opium) are useful
R-Saline N (Rephco), ORS, Tk. 4.50/Sachet
R-Saline (Rephco), ORS, Tk. 3.20/Sachet symptomatic treatments, but loperamide
Saline R (Renata, Mirpur), ORS, Tk. may be preferable as it is unlikely to
4.58/Sachet cause dependence.
SOS (Supreme), ORS, Tk. 4.58/Sachet There are few side-effects associated
SOS Plus Mango(Supreme), ORS, Tk.
5.00/Sachet with these drugs but, except in the case
Super Saline (Amico), ORS, Tk. 4.57/Sachet of loperamide, excessive sedation may
Unisaline Fruity (Ibn Sina), ORS, Tk. occur in children and in patients with
5.00/Sachet chronic liver disease. They should be
Unisaline (Ibn Sina), ORS, Tk. 4.58/Sachet used with caution in colitic attacks as
Zeosaline (Sharif), ORS, Tk. 4.58/Sachet they may possibly increase the risk of
K-SALINE FRUITY (Kemiko), ORS, Tk. toxic megacolon. Prolonged use could
5.00/Sachet
possibly aggravate irritable bowel
syndrome.
IV REHYDRATION THERAPY
They should be used with caution in the
Proprietary Preparations elderly as they may induce faecal
Cholera Saline: impaction, producing incontinence,
Usual strength for IV infusion, potassium spurious diarrhoea, abdominal pain, and
chloride 0.1% sodium chloride 0.5% ;and rarely colonic obstruction.
sodium acetate 0.393%
Cholera Saline (Opsosaline), IV Infusion Tk.
LOPERAMIDE HYDROCHLORIDE
69.94/500ml; Tk. 91.72/1000ml
Dianak (Orion), IV Infusion Tk.49.78/500ml
Tk. 65.50/1000 ml Indications: acute diarrhoea in adults
Diasol (Libra), IV Infusion TK. 52.60 /500ml; and children over 4 years (see notes
Tk. 65.74/100ml above); chronic diarrhoea in adults only
Koloride (Beximco), IV Infusion Tk. 70.00
/500ml; Tk. 91.7/1000ml Side-effects: occasional rashes
Dose: acute diarrhoea, 4 mg initially
CEREAL BASED ORS followed by 2 mg after each loose stool
for up to 5 days; usual dose 6-8 mg
It contains sodium chloride 3.5 g, pota- daily, max. 16 mg daily; CHILD 4-8 years
ssium chloride 1.5 g, sodium bicarbonate 1 mg 4 times daily for up to 3 days only,
2.5 g and 50 g boiled rice powder to be 9-12 years 2 mg 4 times daily for up to 5
dissolved in 1 litre of boiled drinking days
water. Chronic diarrhoea in adults, initially, 4-8
mg daily in divided doses, subsequently
Proprietary Preparations adjusted according to response and
Easy ORS Plus Saline (Central), ORS, Tk. given in 2 divided doses for maintenance
12.00/Sachet
Rice ORS (Square), ORS, Tk. 10.00/500 ml
Sachet ;Tk. 6.00/250ml Sachet
Imotil (Square), Cap., 2 mg, Tk. 1.00/Cap.
Loperin (Opsonin), Cap., 2 mg, Tk. 0.75/Cap.
123
Lopamid (Acme), Cap., 2 mg, Tk. 1.00/Cap. ULCERATIVE COLITIS : for acute mild
Nomotil (Ziska), Cap. 2 mg, Tk. 0.60/Cap. to moderate diseases affecting rectum or
sigmoid colon, topical corticosteroid
2.5 DRUGS FOR CHRONIC treatment such as prednisolone enemas
DIARRHOEAS or suppositories will induce remission;
foam preparations are especially useful
Chronic diarrhoea may be associated where patients have difficulty retaining
with underlying diseases and therefore liquid enemas. More extensive diseases
symptomatic relief is less appropriate may be treated with an aminosalicylate
than treatment of disease itself. Where but may require oral corticosteroid
the disease process responsible for treatment. Severe extensive or fulminant
chronic diarrhoea can not be disease may need hospital admission,
satisfactorily suppressed, symptomatic intravenous corticosteroid administration,
relief with antimotility drugs such as intravenous fluid and electrolyte
loperamide or diphenoxylate with replacement and/or blood transfusion,
atropine may be appropriate. Bulk parenteral nutrition and antibiotics.
laxatives such as ispaghula (Isop gul), Corticosteroids are unsuitable for
methylcellulose bran etc. have also been maintenance treatment because of side-
used for symptomatic treatment because effects. Sulphasalazine mesalazine
of their absorptive capacity. Opioids with and olsalazine all have value in preven-
a central action (e.g. codeine) are better ting relapse and choice is related in part
avoided because of the risk of to their different side-effects. In resistant
dependence. cases azathioprine (see section 14.2.1)
IRRITABLE BOWEL SYNDROME: This 2 mg/kg daily, given under close
can present with pain, constipation, or supervision may be helpful.
diarrhoea, all of which may benefit from Laxatives are required to facilitate bowel
a high fibre diet with bran or other agents movement when proctitis is present but a
which increase stool bulk, if necessary. high fibre diet and bulk forming drugs
In some patients there may be important such as methylcellulose or ispaghula
psychological aggravating factors, which (Isop gul) are more useful in adjusting
respond to reassurance. Anti-diarrhoeal faecal consistency.
drugs such as loperamide may some-
times be necessary but prolonged use Symptoms of mild ulcerative colitis may
may aggravate the condition. Anti- be relieved with antidiarrhoeal drugs
spasmodics may relieve the pain. such as codeine or loperamide but they
should be used with caution in severe
INFLAMMATORY BOWEL DISEASES cases as paralytic ileus and toxic
Chronic inflammatory bowel diseases megacolon may be precipitated. For
include ulcerative colitis and Crohn’s similar reasons antispasmodics should
disease. Drug treatment consists of not be used in ulcerative colitis.
aminosalicylates (sulphasalazine, CROHN’S DISEASE: Treatment
mesalazine, balsalazine, olsalazine) and particularly of colonic diseases is similar
corticosteroids (hydrocortisone, budes- to that for ulcerative colitis. In small
onide and prednisolone). Maintenance of bowel disease sulphasalazine is of
nutrition is important. Severe chronic doubtful value. Oral corticosteroids (e.g.
active disease may require surgery. prednisolone) suppress inflammation,
MALABSORPTION SYNDROME : and metronidazole may be beneficial
individual conditions need specific possibly through antibacterial activity.
treatment and also general nutritional Other antibacterials should be given if
consideration. Thus coeliac disease specifically indicated and for managing
(gluten enteropathy) usually needs a bacterial overgrowth in the small bowel.
gluten free diet and pancreatic Infliximab, a monoclonal antibody
insufficiency needs pancreatin supple- inhibiting pro-inflammatory cytokines,
ments. and TNF-alpha has recently been
124
indicated for severe Crohn’s disease not have have sulphonamide related
refractory to corticosteroids, but may be side-effects, but have their own side-
associated with development of effects profiles which include watery
extrapulmonary tuberculosis. diarrhoea nausea, headache and
In both colitis and Crohn’s disease hypersensitivity reactions. Olsalazine
general nutritional care and appropriate may cause watery diarrhoea. Rare side-
supplements are essential. effects include blood disorders, rashes
Cholestyramine and aluminium and lupoid syndrome. 5-ASA should be
hydroxide mixture, bind unabsorbed bile used with caution during pregnancy and
salts and provide symptomatic relief of breast-feeding,
diarrhoea following ileal disease or
resection, in bacterial colonisation of the MESALAZINE
small bowel and in post-vagotomy
diarrhoea. Indications: maintenance of remission
PSEUDOMEMBRANOUS COLITIS: This in ulcerative colitis
is due to colonisation of the colon with Cautions: elderly, renal impairment,
Clostridium difficile that may develop pregnancy and breast-feeding; avoid
after antibiotic therapy. Ampicillin, administration with lactulose
clindamycin and lincomycin have been Contraindications: salicylate hypersen-
implicated most frequently but few sitivity; severe renal impairment
antibiotics are free of this side-effect. It is
usually of acute onset, but may run a Side-effects: nausea, diarrhoea, and
chronic course. Oral vancomycin or abdominal pain; headache; exacerbation
metronidazole has been advocated as of symptoms of colitis; rarely reversible
specific treatment. pancreatitis; reversible myocarditis also
reported
DIVERTICULAR DISEASE: This is
treated with a high fibre diet, bran Dose: by mouth, 1.2-2.4 g daily in
supplements and bulk forming laxatives. divided doses
Antispasmodics may provide
symptommatic relief when colic is a Generic Preparation
problem. Antibiotics should be used only ER Capsule, 250 mg; 500 mg
when the diverticula in the intestinal wall
become infected. Antidiarrhoeal drugs SULPHASALAZINE
which slow the intestinal motility (e.g.
codeine, diphen-oxylate and loperamide) Indications: induction and maintenance
could possibly exacerbate the symptoms of remission in ulcerative colitis;
of diverticular disease and are therefore treatment of active Crohn’s disease
contra-indicated.
Cautions: pregnancy; hepatic and renal
disease, glucose 6-phosphate
AMINOSALICYLATES dehydrogenase (G6PD) deficiency
including breast-feeding of affected
Sulphasalazine a chemical combi- infants; slow acetylator status; withdraw
nation 5-aminosalicylic acid (5-ASA) and treatment if blood disorders,
sulphapyridine, is useful in mild to hypersensitivity reactions, or other
moderate cases of ulcerative colitis and serious disorders occur; upper
Crohn's disease. Newer agents include gastrointestinal side-effects are common
olsalazine (2 molecules of 5- with doses over 4g daily; blood counts,
aminosalicylic acid bonded together liver function, and rheumatoid arthritis,
which separates in the lower bowel), see section 9.1.3
mesalazine (5-aminosalicylic acid in
Contraindications: salicylate and
slow release formulation) and
sulphonamide hypersensitivity; porphyria
balsalazide (a prodrug of 5-ASA). Unlike
sulphasalazine these newer agents do Interactions: see Appendix-2
125
Side-effects: nausea, vomiting, increase the risk of rectal bleeding as in

epigastric discomfort, headache, rashes; haemorrhoids. Laxatives are also of
occasionally, fever, minor haemato- value in drug induced constipation, for
logical abnormalities such as Heinz body the expulsion of parasites after
anaemia, reversible neutropenia, folate anthelmintic treatment, and to clear the
deficiency; reversible azospermia; rarely: alimentary tract before surgery and
pancreatitis, exacerbation of colitis, radiological procedures. The laxatives
thrombo-cytopenia, agranulo-cytosis, that are used have been divided into 4
Steven’s-Johnson syndrome, neuroto- main groups.
xicity, photo-sensitisation, lupus erythe-
matosus like syndrome, and pneu- 2.6.1 BULK FORMING LAXATIVES
monitis; proteinuria and crystalluria;
urine may be orange coloured; soft These relieve constipation by increasing
contact lenses may be stained faecal mass which stimulates peristalsis,
Dose: by mouth, acute attack 1-2 g 4 but patients should be told that the full
times daily (but see Cautions) until effect may take some days to develop.
remission occurs (if necessary, They are useful in the management of
corticosteroids may also be given), patients with colostomy, ileostomy,
reducing to a maintenance dose of 500 haemorrhoids, anal fissure, chronic
mg 4 times daily; CHILD over 2 years, diarrhoea associated with diverticular
acute attack 40-60 mg/kg daily, disease, irritable bowel syndrome, and
maintenance dose 20-30 mg/kg daily ulcerative colitis. Adequate fluid intake
By rectum, as suppositories, alone or in must be maintained to avoid intestinal
conjunction with oral treatment 0.5-1 g obstruction. Unprocessed rice or wheat
morning and night after a bowel bran, taken with food or fruit juice, is a
movement. As an enema, 3 g at night, most effective bulk forming preparation.
retained for at least 1 hour. Oat bran is also very good.
Methylcellulose ispaghula (Isop gul),
Proprietary Preparations and sterculia are useful in patients who
Reumazin (Aristo), Tab. 500 mg,Tk. 5.20/Tab. cannot tolerate bran. Methylcellulose
Sulfazin (Popular), Tab. 500 mg,Tk. 5.22/Tab. also acts as a faecal softener
Sulfacol (Drug Int.),Tab. 500 mg, Tk. 5/Tab.
Salazine (Opsonin),Tab.500 mg, Tk.3.92/Tab.;
ISPAGHULA HUSK
Supp. 500 mg, Tk.7.52/Supp.;
(Isop Gul husk or ‘bhushi’)
2.6 LAXATIVES Indications: see notes above

2.6.1 Bulk forming drugs Cautions: adequate fluid intake should
2.6.2 Stimulant laxatives be maintained to avoid intestinal
2.6.3 Faecal softeners obstruction; ulcerative colitis.
2.6.4 Osmotic laxatives Contraindications: intestinal obstruct-
tion, colonic atony, faecal impaction
Misconceptions about bowel habits have Side-effects: flatulence, rarely abdo-
led to excessive laxative use. Abuse minal distension
may lead to hypokalaemia and an atonic
non-functioning colon. The intake of Dose: ADULT 3.5g in water twice daily
dietary fibre usually relieves simple preferably after meals; CHILD over 6
constipation. The use of laxatives in years half the adult dose
children is undesirable and the COUNSELING: preparations that swell
introduction of fibre rich diet may be in contact with liquid should always be
sufficient to regulate bowel action. carefully swallowed with water and
Laxatives should generally be avoided should not be taken immediately before
except where straining will exacerbate a going to bed
condition (such as angina pectoris) or
126
Proprietary Preparation avoided, especially in pregnancy, as it

Albi-Tasty Ispaghul (Albion), Powder 3.5 gm, may inflame the colonic mucosa.
Tk. 4.00/Sachet
The parasympathomimetics such as
bethanechol distigmine, neostigmine and
LUBIPROSTONE pyridostigmine enhance parasym-
pathetic activity in the gut and increase
Indications: chronic constipation in intestinal motility. They are rarely used
adults, irritable bowel syndrome for their gastrointestinal effects but may
Side effects: nausea, diarrhea, be needed in cases of paralytic ileum, for
headache, flatulence example, postoperatively. Organic obs-
Contraindications: liver and kidney truction of the gut must first be excluded
disease; chronic diarrhea, bowel and they should be used with caution in
obstruction, diarrhea-predominant IBS bowel anastomosis.
Dose: 25 microgram twice daily to treat
constipation; 8 microgram twice daily to BISACODYL
treat IBS in women 18 years of age and
older
Indications: see under Dose; tablets act
Proprietary Preparation in 10-12 hours; suppositories act in 20-
Lubilax (Beacon), Cap., 8 microgram, 60 minutes
Tk.15/Cap; 24 microgram, Tk. 40/Cap. Cautions; Contraindications; Side-
effects: see notes on stimulant
METHYL CELLULOSE laxatives; tablets, griping; suppositories,
local irritation
Indications: see notes above Interactions: see Appendix-2
Cautions; Contraindications; Side-
Dose: by mouth for constipation, 10 mg
effects; Counseling: see under
at night; occasionally necessary to
Ispaghula Husk
increase to 15-20 mg; CHILD 5 mg
Dose: 800-1600g twice daily with at
least 300 ml water By rectal suppositories, for constipation
10 mg in the morning; CHILD 5 mg
Proprietary Preparation Before radiological procedures and
Celulose (Acme), Tk.0.82/Tab.
surgery, 10 mg by mouth at bedtime for
2 days before examination, and if
2.6.2 STIMULANT LAXATIVES necessary, a 10 mg suppository 1 hour
before examination
The recognised stimulant laxatives
include bisacodyl and members of the
anthraquinone group, e.g. senna Bisacodyl (Albion), Tab. , 5 mg, Tk.
Docusate sodium probably, acts both 0.70/Tab.
as a stimulant and as a softening agent. Duralax (Opsonin), Tab., 5 mg, Tk. 0.53/Tab.
Powerful stimulants such as cascara
and castor oil are obsolete now-a-days. SENNA[ED]
Stimulant laxative increases intestinal
motility and often causes abdominal Indications: constipation; bowel evacu-
cramp. They should not be used in ation before abdominal radiological pro-
intestinal obstruction. Prolonged use can cedures, endoscopy, and surgery; acts
precipitate the onset of an atonic in 8-12 hours
nonfunctioning colon and hypokalaemia.
Cautions; Contraindications and Side-
They should not be used in children.
effects: see notes on stimulant laxatives
Glycerol suppositories act as a rectal
stimulant by virtue of their mildly irritant Proprietary Preparation
action. Soft soap is a stronger irritant; Laxenna (GSK), Tab. 12mg, Tk. 1.25/Tab.
the use of soft soap enema should be
127
2.6.3 FAECAL SOFTENERS 2.6.4 OSMOTIC LAXATIVES
Liquid paraffin the classical lubricating Osmotic laxatives are drugs, which act
agent, has disadvantages (see below). by retaining fluid in the bowel by the
Bulk laxatives, non-ionic surfactant mechanism of osmosis. They may also
“wetting” agents e.g. docusate sodium, act by changing the pattern of water
and glycerol suppositories also have distribution in the faeces.
softening properties. Such drugs are Saline purgatives are commonly abused
useful in the management of but for occasional use these are quite
haemorrhoids and anal fissure. satisfactory. During their use, adequate
Enemas containing 130 ml of arachis oil fluid intake should be maintained. Where
(ground-nut oil) would lubricate and a rapid bowel evacuation is required,
soften impacted faeces and promote magnesium sulphate is still useful. This
bowel movement. For children above 6 should be used in a dose before
years, the dose has to be reduced in breakfast or on an empty stomach,
proportion to body-weight; not recomm- followed by plenty of warm fluid. This
ended for children under 6 years. treatment usually causes evacuation
within 2 hours. Magnesium hydroxide
is effective in mild constipation. But
LIQUID PARAFFIN
regular use of magnesium salts may be
habit-forming. Magnesium citrate has
Indication: constipation been used for bowel evacuation before
Cautions: avoid prolonged use; should colonic surgery, colonoscopy, or
not be taken immediately before going to radiological examinations to ensure that
bed the bowel is free of solid or dark
Side-effects: anal seepage of paraffin contents. Use of sodium salts should
and consequent anal irritation after be avoided as they may cause sodium
prolonged use, granulomatous reactions and water retention in susceptible
caused by absorption of small quantities individuals. In bowel clearance before
of liquid paraffin (especially from the endoscopy, radiological procedures and
emulsion), lipoid pneumonia, and surgery, phosphate enemas are useful.
interference with the absorption of A semi-synthetic disaccharide lactulose,
fatsoluble vitamins produces osmotic diarrhoea of low faecal
pH, and discourages the proliferation of
Dose: by mouth 10-30 ml of the oral ammonia producing organisms, but it is
emulsion (see below) as required not absorbed from the gastrointestinal
Generic Preparation tract. It is therefore useful in the
Liquid Paraffin Oral Emulsion BP, Oral treatment of hepatic encephalopathy.
Emulsion, contains liquid paraffin 5 ml, vanillin Lactitol is a bulk sweetener/osmotic
5 mg, chloroform 0.025 ml, benzoic acid laxative
solution 0.2 ml, methylcellulose-20 200 mg,
saccharin sodium 500 micrograms, water to LACTITOL
10 ml.
Liquid Paraffin and Magnesium Hydroxide Indications : to promote gut motility in
Oral Emulsion BP, Oral Emulsion, 25% liquid
paraffin in acquous suspension containing 6% chronic constipation
hydrated magnesium oxide. Dose: for
constipation, 5-20 ml as and when required. Proprietary Preparations
Laxitol (Eskayef), Powder, 10 gm, Tk.
Proprietary Preparations 12.00/Sachet; Oral Solu., 66.67 gm/100 ml,
Frelax (Beximco), Oral emulsion,Tk. 95/100ml Tk. 65.00/50 ml; Tk. 120.00/100 ml
Magfin (Incepta), Oral emulsion Tk. 95/100ml Maxilax (Opsonin), Powder, 10 gm, Tk.
Nesifin (Opsonin), Oral emulsion,Tk. 9.02/Sachet
83.57/100ml Sinalax (Ibn Sina), Powder, 10 gm, Tk.
13.00/Sachet
128
LACTULOSE Leaxe (Alco), Oral Solu., 3.40 gm/5 ml, Tk.

120.00/100 ml; Tk. 230.00/200 ml
Livax (Pacific), Oral Solu., 3.40 gm/5 ml, Tk.
Indications: constipation (may take up 105.26/100 ml; Tk. 187.97/200 ml
to 48 hours to act), hepatic (portal Livoton (Kemiko), Oral Solu., 3.40 gm/5 ml,
systemic) encephalopathy Tk. 70.00/50 ml; Tk. 120.00/100 ml; Tk.
230.00/200 ml
Contraindications: galactosaemia, Loctoz (Amico), Oral Solu., 3.40 gm/5 ml, Tk.
intestinal obstruction 100.00/100 ml
Interactions: see Appendix-2 Niprolac (Nipro JMI), Oral Solu., 3.40 gm/5
ml, Tk. 120.00/100 ml
Side-effects: flatulence, cramps, and Oralax (Somatec), Oral Solu., 3.40 gm/5 ml,
abdominal discomfort Tk. 120.00/100 ml
Dose: expressed in terms of an eoral Osmolax (Square), Oral Solu., 3.40 gm/5 ml,
Tk. 120.00/100 ml; Tk. 230.00/200 ml
solution containing lactulose 3.35 g/5ml Premesis (Globe), Oral Solu., 3.40 gm/5 ml,
Constipation, ADULT initially 15 ml twice Tk. 15.00/100 ml
daily, gradually reduced according to Regulose (General), Oral Solu., 3.40 gm/5 ml,
patient’s needs; CHILD under 1 year 2.5 Tk. 120.00/100 ml; Tk. 200.75/200 ml
Serelose (Beximco), Oral Solu., 3.40 gm/5 ml,
ml, 1-5 years 5 ml, 6-12 years 10 ml
Tk. 130.00/100 ml
twice daily, gradually reduced Sinalac (Ibn Sina), Oral Solu., 3.40 gm/5 ml,
Hepatic encephalopathy, 30-50 ml 3 Tk. 70.00/60 ml; Tk. 120.00/100 ml; Tk.
times daily, subsequently adjusted to 230.00/200 ml
Sivolac (Sharif), Oral Solu., 3.40 gm/5 ml, Tk.
produce 2-3 soft stools daily
100.00/100 ml
Softner (Rephco), Oral Solu., 3.40 gm/5 ml,
Proprietary Preparations Tk. 75.00/100 ml; Tk. 125.00/200 ml
Actilac (Healthcare), Oral Solu., 3.40 gm/5 ml, Tulac (Eskayef), Oral Solu., 3.40 gm/5 ml, Tk.
Tk. 125.00/100 ml; Tk. 230.00/200 ml 65.00/50 ml; Tk. 120/100 ml; Tk. 230/200 ml
Asilac (Asiatic), Oral Solu., 3.40 gm/5 ml, Tk. Tulos (Acme), Oral Solu., 3.40 gm/5 ml, Tk.
120.00/100 ml; Tk. 230.00/200 ml 120.00/100 ml
Avolac (Aristo), Oral Solu., 3.40 gm/5 ml, Tk. Veelac (Albion), Oral Solu., 3.40 gm/5 ml, Tk.
140.00/100 ml; Tk. 250.00/200 ml 100.00/100ml; Tk. 195.00/200ml
Biose (Bios), Oral Solu, 3.40 gm/5 ml, Tk. Xylose (Delta), Oral Solu., 3.40 gm/5 ml, Tk.
100.00/100 ml; Tk. 200.00/200 ml 120.00/100 ml
Conlax (Unimed), Oral Solu, 3.40 gm/5 ml, Tk.
100.00/100 ml; Tk. 200.00/200 ml
D-Lac (Drug Intl), Oral Solu, 3.40 gm/5 ml, Tk. MAGNESIUM HYDROXIDE[ED]
70.00/50 ml; Tk. 120.00/100 ml; Tk.
220.00/200 ml Indications: mild constipation (acts in 2-
Ezylax (Orion), Oral Solu., 3.40 gm/5 ml, Tk. 4 hours)
50.19/50 ml; Tk. 100.38/100 ml
Glovolac (Globex), Oral Solu., 3.40 gm/5 ml, Cautions: use only occasionally; the
Tk. 120.00/100 ml elderly; renal impairment; hepatic
Inolac (Incepta), Oral Solu., 3.40 gm/5 ml, Tk. impairment
120.00/100 ml
Laclose (Opsonin), Oral Solu., 3.40 gm/5 ml, Contraindication: intestinal obstruction
Tk. 90.23/100 ml Interactions: see Appendix-2 (Antacids
Lactolax (Pharmasia), Oral Solu.,, 3.40 gm/5 and absorbents)
ml, Tk. 100.00/100 ml
Lactu (Biopharma), Oral Solu., 3.40 gm/5 ml, Dose: aqueous suspension containing
Tk. 120.00/100 ml; Tk. 200.00/200 ml about 8% hydrated magnesium oxide,
Lactulose-H (Hudson), Oral Solu, 25-50 ml as and when required
3.35gm/5ml, Tk.110.00/100 ml
Laxativ (Rangs), Oral Solu, 3.35gm/5ml, Tk. Generic Preparations
100/100ml, Tk. 200/200ml Magnesiun Hydroxide Mixture BP (Cream of
Laxol (Navana), Oral Solu., 3.40 gm/5 ml, Tk. Magnesia), Oral Suspension containing about
50.19/50 ml; Tk. 120.00/100 ml; Tk. 8% hydrated magnesium oxide
200.75/200 ml Liquid Paraffin and Magnesium Hydroxide
Laxolac (Globe), Oral Solu, 3.40 gm/5 ml, Tk. Oral Emulsion BP see under Liquid Paraffin
115.00/100 ml (sec. 2.6.3)
129
Proprietary Preparations 2.7 PREPARATIONS FOR

ACME’s Milk of Magnesia (Acme), Susp., Tk. HAEMORRHOIDS
60.00/114 ml
Magmil (Pacific), Susp.,Tk. 45.11/100 ml; Tk. 2.7.1 SOOTHING HAEMORRHOIDAL
75.19/200 ml PREPARATIONS
Magnason (Jayson), Susp.,Tk. 50.00/100 ml 2.7.2 COMPOUND
Milk of Magnesia (Maks), Susp.,Tk. 25/114 ml HAEMORRHOIDAL
MOM (Opsonin), Susp., Tk. 45.11/100 ml PREPARATIONS WITH
CORTICOSTEROIDS
MAGNESIUM SULPHATE[ED] 2.7.3 RECTAL SCLEROSANTS
2.7.4 OTHER PREPARATIONS
Indications: rapid bowel evacuation
(acts in 2-4 hours when given by Anal and perianal pruritus, soreness,
mouth);injection preparation is used in and excoriation are best treated by
eclampsia and pre eclampsia.(see application of bland ointments,
section16.2.2.3) suppositories or dusting powders. These
Cautions; Contraindications: see conditions occur commonly in patients
under Magnesium Hydroxide; hepatic suffering from haemorrhoids, fistulas,
impairment and proctitis. Careful local toilet, as well
Side-effects: nausea, bloating, as, adjustment of the diet to avoid hard
abdominal cramps (usually transient stools, taking of bulk forming materials
reduced by taking more slowly); rarely such as bran (section 2.6.1) and a high
vomiting, anal irritation; urticaria, residue diet are also helpful. In proctitis
rhinorrhoea and dermatitis reported these measures may supplement
Dose: for rapid bowel evacuation (in 2-4 treatment with corticosteroids or
hours), 5-10 g in a glassful of water sulphasalazine.
preferably before breakfast. When necessary topical preparations
containing local anaesthetics or
Proprietary Preparation corticosteroids are used provided
Nalepsin (Beximco), Inj., (IV infusion) 4% perianal thrush has been excluded.
Tk.70.80/100ml Perianal thrush is best treated with
nystatin by mouth and by local
POLY ETHYLENE GLYCOL application.
(Macrogol)
2.7.1 SOOTHING HAEMORRHOIDAL
Indications:chronic constripation PREPARATIONS
Caution, Contraindications: see under
Magnisum hydroxide;breast feeding, Bland soothing preparations containing
pregnancy;cardiovascular impairment mild astringents such as bismuth
Side-effects: flatulence, cramps, and subgallate zinc oxide and hamamelis
abdominal discomfort may give symptomatic relief in
Dose:see preparation below haemorrhoids. Many proprietary
preparations also contain lubricants
Proprietary Preparation vasoconstrictors or mild antiseptics
Aqualax (Incepta), Susp., 17g/240ml,
Tk.120/240ml Prolonged application of preparations
containing resorcinol should be avoided
Dose: chronic constipation, ADULT and because it may interfere with thyroid
CHILD over 12years, 25mL 1–3 times daily function. Heparinoids are claimed to
usually for up to 2 weeks;maintenance, 25mL promote the resorption of local oedema
1–2 times daily and extravasated blood.
Local anaesthetics are used to relieve
pain associated with haemorrhoids anal
fissure, and pruritus but good evidence
is lacking. Lignocaine gel and ointment
130
are best applied on a plastic dilator PHENOL

which ensures contact with the base of
the fissure. Alternative local anaesthetics Indications: injection of hemorrhoids
include amethocaine, cinchocaine, and Side-effects: irritation, tissue necrosis
pramoxine, but they are more irritant. Dose: 2-3 ml of oily phenol injection into
Local anaesthetics should be used for the submucosal layer at the base of the
short periods only (no longer than 1-2 pile; several injections may be given at
weeks) since they may cause different sites, max. total injected 10 ml
sensitisation of the anal skin. at any one time
ADMINISTRATION. Unless otherwise
indicated a suppository is usually Generic Preparation
inserted into the rectum at night and Oily Phenol Injection BP, contains phenol
morning or after a bowel movement. 5% in a suitable fixed oil
Rectal ointments and creams are applied
at night and morning or after a bowel 2.7.4 OTHER PREPARATIONS
movement, externally by rectum using a
rectal nozzle. DIOSMIN WITH HESPERIDIN
Note. Local anaesthetic ointments can
be absorbed through the rectal mucosa
therefore excessive application should Indications: treatment of organic and
be avoided, particularly in infants and idiopathic chronic venous insufficiency of
children. the lower limbs with the following
symptoms: heavy legs; pain; nocturnal
cramps. Treatment of hemorrhoids and
2.7.2 COMPOUND PREPARATIONS
acute hemorrhoidal attacks
WITH CORTICOSTEROIDS
Side effects: some cases of monor
gastrointestinal and autonomic disorders
Corticosteroids are often combined with have been reported, but these never
antiseptics, antibiotics, local anaesth- required cessation of treatment
etics and soothing agents. They are Dose: in venous disease: 2 tablets daily.
suitable for occasional short term use In acute hemorrhoidal attacks: the
after exclusion of infections, such as dosage can be increased up to 6 tablets
herpes simplex; see section 12.3 for daily as prescribing information may vary
general comments on topical corticos- from country to country.
teroids.
Antibiotics may do little more than Proprietary Preparations
encourage the growth of resistant Diosmin 450mg with Hesperidin 50mg
bacteria and should be avoided. Daflon (I) (Servier),Tk.12/Tab
Diohes (Opsonin), Tk. 8/Tab
Proprietary Preparations Hemorif (Square), Tk. 8/Tab
Cinchocaine HCl 0.5% + Hydrocortisone 0.5% + Normanal (Renata), Tk. 8/Tab
Neomycin sulphate 1% + Esculin 1%;
Anustat (Beximco), Rectal Oint., Tk.70.00/15g. 2.8 DRUGS AFFECTING
Anorel (Popular), Rectal Oint.,Tk.80.30/15g INTESTINAL SECRETIONS
Erian (Square), Supp Tk.8/supp; Rectal
Ointment, Tk. 68.00/15g 2.8.1 DRUGS ACTING ON THE
Methovate (Gaco), Rectal Ointment, GALL BLADDER
Betametdhasone Valerate0.05 %++Lignocain 2.8.2 PANCREATIN
Hydrochloride 2.5%Tk.30.00/15gm 2.8.1 DRUGS ACTING ON THE
GALL BLADDER
2.7.3 RECTAL SCLEROSANTS
The bile acids chenodeoxycholic acid
Oily phenol injection is used to inject and ursodeoxycholic acid are used in
haemorrhoids particularly when those selected patients to dissolve cholesterol
are unprolapsed. gallstones as an alternative to surgery.
They are only suitable for patients who
131
have mild symptoms, unimpaired gall Livacor (Albion), Tab.,150 mg, Tk.
bladder function, and small or medium 10.00/Tab.; 300 mg, Tk. 20.00/Tab.
sized radiolucent stones; they are not Oxycol (Unimed), Tab., 150 mg, Tk. 20/Tab.;
300 mg, Tk. 36.00/Tab.
suitable for radio opaque stones, which Udca (Biopharma), Tab., 150 mg, Tk. 20/Tab.
are unlikely to be dissolved. Patients Udihep (Mundipharma), Tab. , 150 mg, Tk.
should preferably be supervised in 12.67/Tab.; S.R Tab. 300 mg, Tk. 23.50/Tab.
hospital because radiological monitoring Uliv (Acme), Tab., 150 mg, Tk. 12.05/Tab.,
is required. Long term prophylaxis may Tab. 250mg , Tk. 20.07/Tab.
be needed after complete dissolution of Ursocol (Sun), Tab., 150 mg, Tk. 11.05/Tab.;
the gallstones has been confirmed Tab., Tk. 20.10/Tab.
Ursodil (General),Tab.,300mg, Tk. 20.07/Tab.
(preferably with cholecystograms and Ursolic (Drug Int.), Tab.,150 mg, Tk.11/Tab.;
ultrasound on two separate occasions) 300 mg, Tk. 20/Tab.
as gallstones may recur in up to 25% of
patients within one year of stopping 2.8.2 PANCREATIN
treatment.
Dehydrocholic acid is used to improve
biliary drainage by stimulating the Supplements of pancreatin are given by
secretion of thin watery bile. It is given mouth to compensate for reduced or
after surgery of the biliary tract to flush absent exocrine secretion in cystic
the common duct and drainage tube and fibrosis, and following pancreatectomy,
wash away small calculi obstructing flow total gastrectomy, or chronic
through the common bile duct but its pancreatitis. They assist the digestion of
value has not been established. starch, fat, and protein.
Pancreatin is inactivated by gastric acid;
therefore pancreatin preparations are
URSODEOXYCHOLIC ACID best taken with food (or immediately
before or after food). Gastric acid
Indication: dissolution of cholesterol rich secretion may be reduced by giving
gallstone, primary biliary cirrhosis cimetidine or ranitidine an hour
Cautions: see notes above beforehand. Con-current use of antacids
Contra-indications: chronic liver also reduces gastric acidity. The newer
disease, peptic ulcer disease, non- enteric coated preparations enclosing
functioning gall bladder, inflammatory enteric coated granules (or minitablets)
bowl disease, pregnancy, radio-opaque can deliver a higher enzyme
stone and other conditions of the small concentration in the duodenum provided
intestine, colon and liver which interfere these are swallowed whole without
with entro-hepatic circulation of bile salts chewing.
Interactions: see Appendix-2 Pancreatin may irritate the skin around
Side-effects: nausea, vomiting, diarrhea mouth and anus, particularly if
and other gastrointestinal disturbance, preparations are retained in the mouth or
gallstone calcification; pruritus. dosage is excessive. Hypersensitivity
Dose: dissolution of gallstone,8-12mg/kg reactions occur occasionally and may
daily as a single dose at bedtime or in affect those handling the powder.
two divided doses; for up to 2 years; Dosage is adjusted according to size,
treatment is continued for 3-4 months needs and number/consistency of stools,
after stones dissolve. Primary biliary so that the patient thrives; extra
cirrhosis 10-15mg/kg daily in 2-4 divided allowance may be needed if heavy
doses. snacks are taken between meals.
Proprietary Preparations Proprietary Preparations

Leveric (Beximco), Tab., 150 mg, Tk.11/Tab.; A-Zyme (Acme), Tab., 325 mg, Tk. 3.50/Tab.
300 mg, Tk. 20/Tab.; Crezyme(Opsonin),Tab., 325 mg, Tk.1.88/Tab
Liconor (Opsonin), Tab., 150 mg, Tk. Suzyme(Square),Tab., 325 mg, Tk. 2.50/Tab.
8.30/Tab.; 300 mg, Tk. 15.10/Tab.;Syrup 250 Zymet (Beximco), Tab., 325 mg, Tk. 3/Tab.
mg/5 ml, Tk. 135.85/100 ml
132

Gastrointestinal System Drug Guide

Загружено:

Сведения о документе

Исходное описание:

Оригинальное название

Авторское право

Доступные форматы

Поделиться этим документом

Поделиться или встроить документ

Параметры публикации

Этот документ был вам полезен?

Это неприемлемый материал?

Авторское право:

Доступные форматы

Gastrointestinal System Drug Guide

Загружено:

Авторское право:

Доступные форматы

2.

2.1 DRUGS FOR DISPEPSIA AND Antacid provides some symptomatic

intermittently to control symptoms long treatment is titrated down to a level

It may also damage enteric coatings PREPARATIONS CONTAINING

2.1.1 ALUMINIUM AND MAGNESIUM Indications: used as an antacid in dose

2.1.2 COMPOUND ANTACID, ALUMINIUM -AND MAGNESIUM-

Compound preparations have no clear Simethicone which acts as a defoaming

Proprietary Preparations ANTIMUSCARINICS

paralytic ileus, toxic megacolon, and Breast-feeding: should be avoided,

Butapan (Sanofi), Tab., 10 mg, Tk. 3.42/Tab.; TIEMONIUM METHYLSULPHATE

Veralgin (Aristo), Inj., 5 mg/2 ml, Tk. ALVERINE CITRATE

Alverine, drotaverine, Mebeverine, Proprietary Preparations

MEBEVERINE HYDROCHLORIDE stimulates the motility of upper

Motifast (Square), Tab. ,10mg, Tk. 2.50/Tab.; Interactions: see Appendix-2

factor of peptic ulceration, combined Side-effects: Adverse reactions are

Maintenance: 400 mg at night or 400 mg Dose: benign gastric and duodenal

RANITIDINE Acin (Biopharma), Tab., 150 mg, Tk.

DEXLANSOPRAZOLE Lansopril (Amico), Cap. , 15 mg, Tk.

Naproflex (Somatec), Tab. , 20 mg + 375 mg, Benign gastric or duodenal ulcer

Proprietary Preparations Side-effects: may darken tongue and

Contraindications: pregnancy or plann- eradication the incidence of relapse

Proprietary Preparations Lansoprazole 30 mg twice daily +

TRIPLE THERAPY COMBINED ORAL REHYDRATION THERAPY

Side-effects: nausea, vomiting, increase the risk of rectal bleeding as in

2.6 LAXATIVES Indications: see notes above

Proprietary Preparation avoided, especially in pregnancy, as it

2.6.3 FAECAL SOFTENERS 2.6.4 OSMOTIC LAXATIVES

LACTULOSE Leaxe (Alco), Oral Solu., 3.40 gm/5 ml, Tk.

Proprietary Preparations 2.7 PREPARATIONS FOR

are best applied on a plastic dilator PHENOL

Proprietary Preparations Proprietary Preparations

Вам также может понравиться