TASK №12

Diagnosis.

Irritable bowel syndrome with diarrhea.

Per os Parenterally
T. Amoxicillini 1000mg x 2 times \ S. Papaverini 2 ml in 2% \ m in one
day syringe
T. Mebeverini 200mg x 2 times \ S. Cerucali 1,0
day.

Questions:

Are the indicated dose, route of administration correct?

T. Amoxicillini 1000mg x 2 times \ day

T. Mebeverini 200mg x 2 times \ day.

Antibiotic was recently approved by the FDA for diarrhea-predominant irritable

bowel syndrome (IBSd).
If the growth of too much bacteria is responsible for the IBS-D symptoms - small
intestinal bacterial overgrowth, the patient can be administered antibiotics.
Amoxicillin-clavulanic acid could be effective in the treatment of bacterial
overgrowth-related diarrhea ( IBS-D).

Mebeverine is a musculotropic antispasmodic agent without atropic, prescribed for

IBS-D. It works by relaxing the intestinal muscles causing the problem.

Dosage

Mebeverine –

As HCL – 100 or 135 mg 3 times/day.

Extended release 200 mg 2 times/day.
As Embonate – 150 mg 3 times/day

Amoxicillin (2 × 1000 mg)

Medication must be administered enterally.

Conclusion – Indicated dose, and route of administration is correct

 Are drugs chemically compatible?

The drugs are chemically compatible

Are drugs pharmacologically compatible?

Antibiotics help

Make harmful gut bacteria less dangerous

Help protect the intestinal lining from bacterial infection

Lower inflammation, the body’s attack against bacteria and viruses

Preserve healthy bacteria in the colon

Mebeverine is an antispasmodic drug that is claimed to act directly on the

colonic muscle and is virtually free of systemic adverse reactions.

They are pharmacologically compatible

Are there any violations of bioavailability, absorption processes,

transport, metabolism, excretion of drugs present?

Absorption: Mebeverine is rapidly and completely absorbed after oral

administration of tablets. The modified release formulation permits a twice daily
dosing scheme. ... The relative bioavailability of the modified release capsule
appears to be optimal with a mean ratio of 97%

Absorption:

Mebeverine is rapidly and completely absorbed after oral administration of tablets.

The modified release formulation permits a twice daily dosing scheme.

Distribution:

No significant accumulation occurs after multiple doses.

Biotransformation:

Mebeverine hydrochloride is mainly metabolized by esterases, initially splitting the

ester bonds into veratric acid and mebeverine alcohol. The main metabolite in
plasma is DMAC (Demethylated carboxylic acid). The steady state elimination
half-life of DMAC is 5.77h. During multiple dosing (200 mg b.i.d.) the Cmax of
DMAC is 804 ng/ml and tmax is about 3 hrs. The relative bioavailability of the
modified release capsule appears to be optimal with a mean ratio of 97%.

Elimination:

Mebeverine is not excreted as such, but metabolised completely; the metabolites

are excreted nearly completely. Veratric acid is excreted into the urine; mebeverine
alcohol is also excreted into the urine, partly as the corresponding carboxylic acid
(MAC) and partly as the demethylated carboxylic acid (DMAC).

Amoxicillin

Bioavailability 95% by mouth

Metabolism less than 30% biotransformed in liver
Elimination half-life 61.3 minutes
Excretion Kidneys

Conclusion - No violations of bioavailability, absorption processes,

transport, metabolism, excretion of drugs present

Suggestions for treatment optimization.

Generally recommended that you take mebeverine only when necessary. So, start
taking it when your symptoms flare up, and continue to take it until you feel better.
Stop taking it when your symptoms settle down again (this is usually within a
week or two).

Changing antibiotic to - Rifaximin (Xifaxan, Salix) has been shown to be effective,

has a low incidence of resistance, and has few serious side effects.

Follow diet low in FODMAPs (Fermentable Oligosaccharides, Disaccharides,

Monosaccharides And Polyols) or foods low in a type of sugar called fructose
(which is found in many types of fruit).

Fiber supplements

Probiotics

Antispasmodics + Anti-diarrheal ( Loperamide )