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SPAMOLYTIC AGENTS(anti-spasmine)
:-
They are agent used to reduce intestine al spasm & they include :-
A- anti-cholinergic drugs by blocking M. receptors on the effectors organ innervated by
parasympathetic nerves , so they inhibit action of Ach. , reduce GIT motility & secretion ,
but of little value in treatment of peptic ulcer & sometime use with the antacid at bedtime
to delay empty of stomach & increase remaining of antacid , but use to improve spasm of
smooth muscles of GIT , biliary system, GUT, IBS & in nocturnal enuresis , drug include
in this group are:- a- simple anti-cholinergic agents which include
1- atropine sulphate 0.6-1.2 mg by injection to repeated on needs .
2-camylofin dihydrochloride 1-2 tablets foe 2-3 times/day & 1 tablet for children .
3-homatropine methylbromide as anti-spasmine drop in dose of 10-20 drop three
times /day or as required .
4-hyoscine butylbromide 20mg four times /day & for childerrn 10 mg three times/day .
5- prifinium bromide 15-30 mg 3-4 times/day
b- compound preparation :
1-librax [chlordiazepoxide 5mg + clinidium bromide 2.5 mg ] tablets . use as 1-2
tablets before meal & at bedtime .
2-riabal Co.[prifium bromide 30mg +paracetamol 350 mg tablets ] 1-2 tablets up to
4 times/day
3-salabid or stelabid [isopropamide 5 mg + trifluoperazine 1 mg ] use as 1 tablet for
2-3 times/day .
4-[pipenzolate methylbromide 4 mg+ Phenobarbital 6 mg ] as solution per/ml use as
2-4 mg for body weight 10-20 kg , 4 mg for 20-40 kg body weight for 3-4 times/day .
B- direct acting spasmolytic like Mebewverine HCL :- use in dose of 100 mg three
times/day befor meal in 20 min. , it is a direct acting smooth muscles relaxant , use to
relief pain or spasm of colon as in IBS , it is not a cholinergic agent so it is of fewer side
effects , should be avoid in paralytic ileus .
c-metochlopramide HCL .
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APETIZER DRUG :-
It is an agent used to stimulate the appetite like :
1- cyproheptadine (periactine) :- it act by k\block serotonin & histamine H1-receptor ,
their effect to increase appetite due to its effect on serotonin receptor , some time used
in treatment of anorexia nervosa .
2- marijuana (grass) : recently legislation in several states where they legalized the
medical uses of marijuana(cannabinoid) as appetite stimulant especially among AIDS
patients with wasting syndrome .
3- insulin : it increase the appetite by decreasing blood dextrose concentration .
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APPETITE SUPRESSION AGENTS :
It is an agents used to suppress the appetite especially in over weight peoples like:
1-serotonin agonist (fenfluramine) : it is a selective serotonin agent of appetite suppress
effects + a toxic effect , its di-isomer difenfluramine (dexfenfluramine ) about twice as potent
2
as fenfluramine , it is could be of help in patients weight loss maintenance , their side effect
include 1-fatal pulmonary hypertension ,2-sedation, 3-diarrhea , 4-edema ,5-urinary
frequency ,6-impotence ,8-alopecia & 9-haemolytic anemia .
----their dose 20mg x2 - 40mg x3 /day in about 30 min before meal , it of peripheral effects
on CHO , & lipid metabolism .
2-mazindol : it potenciate sympathetic effect but structurally not related to amphetamine
agent, it act by direct effect on satiety center in hypothalamus & limbic region it use in dose
of 1-2 mg after meal for up to 3 months , not use in patients with thyrotoxicosis , peptic ulcer
& glaucoma , their side effect include insomnia , dry skin , agitation , urinary retention &
tachycardia .
3-amphetamine : it initiate response may be observe , it act at lateral hypothalamic feeding
center , but no evidence of long term- improvement in weight control .
4-biquanide as anti-diabetic agents , act as weight control via their effect to dercreas CHO
absorption from GIT & it is of anorexic effects .
5-thyrxine (T3-T4) one of their side effect include appetite anorexia or appetite stimulant .
6-bulk preparation like methyl-cellulose act by filling stomach with non-nutrient material .
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TREATMENT of Hiccup by using [ chlorpromazine , perphenazine , prochorperazine ,
metochopramide ]/ treatment of diffuse esophageal spasm & achalasia by using 1-isosorbid
dinitrite 5 mg sublingually or 10 mg swallow tablets , 2- nifedipine 10 mg sublingually or
swollen ./ carminative agent is an agent or substance use to assist in expelling gas from GIT
by relax the cardiac sphincter like charcoal & etc .