GIT DRUGS

FOR COMMUNITY PHARMACY

PRACTICE COURSE.

Prepared by: MSc Lillian Alnsour

Drugs used in the treatment
of GERD and PUD
Non-Pharmacological treatment

Elevate the
head of the Lose weight Stop smoking
bed 6-8 inches

Limit meal size

Decrease Decrease
and avoid
alcohol intake caffeine intake
heavy meals
Pharmacological treatment

HISTAMINE RECEPTOR
PROTON PUMP BLOCKERS (H2): PROTECTANTS:
INHIBITORS cimetidine, famotidine, sucralfate for PUD
ranitidine

ANTIBIOTICS: triple
therapy to kill H.pylori BISMUTH
(clarithromycin SUBSALICYLATES: to ANTACIDS
+metronidazole/ coat peptic ulcers
amoxicillin+PPI)
 • PPIs reduce stomach acid and protect the
lining of the stomach and duodenum. While
PPIs do not kill H. Pylori, they do help fight
the H.pylori infection.
• PPIs are generally well tolerated. Adverse effects:
PROTON • Common: headache, nausea, diarrhoea, abdominal
pain, fatigue, dizziness. Infrequent: dry mouth,
PUMP increased sweating , rash, itch, flatulence,
constipation, decreased absorption of
INHIBITORS cyanocobalamin (vitamin B12) may occur with long
term use.
• Except for omeprazole, all proton pump inhibitors
(PPIs) are classified as category B drugs by the US
Food and Drug Administration (FDA), which means
that they are safe to use during pregnancy.
 Take dose with a full glass of water.

Can be taken safely with antacids.

Do not confuse heartburn with symptoms of a heart attack.

Patient These drugs are usually taken for 4-8 weeks only, unless
recommended otherwise by the doctor.
education Take the medication for the full prescribed length of time.

May increase the risk of bone fracture in those using it long

term and above the age of 50. Tell the doctor if you have
osteoporosis or osteopenia.
 • Esomeprazole:
• TABS 20 MG (NEXIUM®), TABS 40 MG (NEXIUM®, PUMPINOX®)
• VIAL 40 MG (NEXIUM®)
• Lansoprazole
• CAPS/TABS 15,30 MG (LANSAZOL®, LANSOMID®, LANZOTEC®,
LANZOPRAL®,LANZOR®, LAZAL®, PEPTAZOLE®, TAKEPRON®, ULTRAZOLE®)
• Omeprazole
• OMEPRAZOLE TABS OR CAPS 20 MG (LOSEC®, OMEDAR®, OPRAZOLE®), TABS
PPIs OR CAPS 10 MG (HYPOSEC®, GASEC®, LOPRAZ®, LOSEC®, ODASOL®,OMEDAR®,
OMEPREX®,OMISEC®, OPRAZOLE®, RISEK®, RYTHMOGASTRY®OMEPREX®)
• VIAL 40 MG (IPROTON®, LORDIN®, LOSEC®, ODASOL®, OPRAZOLE®, RISEC®)
• Pantoprazole:
• TABS 40 MG (CONTROLOC®, PANTODAR®, PANTOLOC®, PANTOVER®,
PROTON®, RAZON®)
• Rabeprazole
• TABS 10,20 MG (PARIET®)
Omeprazole Lansoprazole

Rebeprazole

Esomeprazole
Pantoprazole
 • Work by blocking histamine, a chemical in the
HISTAMINE body that signals the stomach to produce acid.
• Pregnancy: Safe to use; ADEC category B1.
RECEPTOR • Breastfeeding: No adverse effects reported.

BLOCKERS • Adverse effects

• Infrequent: hypotension.
• Rare: headache, tiredness, dizziness, confusion
(especially in elderly people), diarrhoea,
constipation, rash;thrombocytopenia,
agranulocytosis, hepatitis, vasculitis, interstitial
nephritis.
 Avoid alcohol consumption and smoking as it interferes
with the action of histamine antagonists.

The medication can cause drowsiness.

Do not confuse heartburn with symptoms of a heart attack.

Patient Do not take this drug if you are allergic to the drug, or have
pain swallowing food, blood in vomit, or stool. Refer to the
education doctor if any of these symptoms develop.
Take the medication for the full prescribed length of time,
even if the symptoms improve.

Tell your doctor if you have kidney or liver disease, history

of long QT syndrome, stomach cancer, asthma, COPD, or
other breathing problems.
 • FAMOTIDINE:
HISTAMINE • TABS 10 MG (ACIFAM®, FAMODINE®, GASTRIFAM®), TABS
20,40 MG (ACIFAM®, AMODINE®, FAMODAR®,
RECEPTOR FAMODINE®, GASTRIFAM®,PEPCIDIN®).
• RANITIDINE:

BLOCKERS • AMPS 50 MG/AMPS (EPADOREN®, RANIDINE®, ROLAN®,

TUPAST®, ZANTAC®,ZYDAC®)
• SYRUP 75 MG/5ML (EPADOREN®, RANIDINE®)
• TABS 75 MG (NADINE®, PEPTACID®, RANACID®,
RANIDINE®, ZANTAC®), TABS 150 MG (ANTAGONIN®,
HISTAC®, NADINE®, PEPTAC®, PEPTACID®, RANID®,
RANIDINE®, ROLAN®, ZANTAC®), TABS 300 MG
(ANTAGONIN®, HISTAC®, NADINE®, PEPTAC®, RANID®,
RANIDINE®,ROLAN®, ZANTAC®)
Cimetidine

Famotidine Ranitidine Nizatidine

 • Antacids neutralize acid in the stomach. It
contains ingredients, such as aluminum, calcium
or magnesium which act as bases to counteract
stomach acid and raise pH. Used to relieve
symptoms of acid reflux, heartburn or
indigestion.
ANTACIDS • Adverse effects include: diarrhoea or
constipation, flatulence (wind), stomach cramps,
feeling sick or vomiting
• Pregnancy: Safe to use as antacids; ADEC
category A.
 Take between meals or at bedtime when symptoms occur or you expect they
might occur. Optimum effect achieved if taken 1-3 hours after meals.

Tablets should be chewed or sucked before swallowing for the best effect. Drink a
glass of water afterwards.

Patient Antacids should not be administered with food containing large amounts of oxalic
acid, such as spinach, bran/ cereals, as they may reduce absorption of calcium.

education Constipation is exacerbated by antacids containing aluminum and calcium.

Increase bulk fibre and fluid intake.
Diarrhoea exacerbated by laxative effect of antacids containing magnesium

Tell your doctor if you have Heart failure, chronic renal failure, cirrhosis, and
oedema. You should avoid antacids containing sodium; as it may increase fluid
retention.
ANTACIDS
• ALUMINIUM + MAGNESIUM COMPLEXES SUSP.
(ALKACID®, ALOXAL®, ALUMAG®,HYDROGEL®,
MAALOX PLUS®, MAALOX®, MOXAL PLUS®,
MOXAL®, NEUTRACID®, NOVAGEL PLUS®,
NOVAGEL®)
• ALUMINIUM + MAGNESIUM COMPLEXES TABS
(ACENIL®, ALUMAG®, MALUGEL®, MAALOXPLUS®,
MAALOX®, MOXAL PLUS®, MOXAL®, NOVAGEL
PLUS®, NOVAGEL®, RAMCID®)
• SIMETICONE TABS 120-125 MG (CHEWABLE)
(DEFLAT®, GAZIX®)
• Calcium Carbonate (TUMS®)
• Sodium alginate & sodium hydrogen carbonate &
calcium carbonate (GAVISCON®)
Drugs used in the treatment
of Irritable Bowel Syndrome
(IBS)
Non-Pharmacological treatment

Consume more
Avoid sorbitol and
oat-based food Do not skip meals Decrease alcohol
carbonated
and drink enough and eat slowly intake
beverages
fluids

Decrease coffee
Limit fruits and
and tea intake to 3 Exercise regularly
vegetables intake
cups daily
Pharmacological treatment

Antispasmodics:
Bulk-forming laxatives Antimotility medication
antimuscarinic and
to relieve constipation for diarrhea
anticholinergic drugs

Tricyclic
antidepressants and
BZDs to relieve
abdominal pain and
cramping
 • Anticholinergics work by inhibiting GIT
secretions, reducing motility and tone in GIT.
Antimuscarinics work as smooth muscle
relaxants.
Anticholinergic • Adverse effects:
and • Dry mouth, difficulty in urination, constipation,
sensitivity to light, drowsiness.
antimuscarinic • Most anticholinergics are pregnancy category B2.
agents This means that safety in pregnancy has not been
well established. They should not be used in
pregnant women or those likely to become
pregnant unless the expected benefits outweigh any
potential risk.
 May cause drowsiness and
coordination problems.

Drug may cause dry mouth,

Patient difficulty in urination, constipation,
education sensitivity to light, drowsiness.
Contraindicated in patients with
prostatic hypertrophy or glaucoma.
Anticholinergic • Hyoscine-N-butylbromide: Buscopan®
• Otilonium bromide: Spasmomen ®
and • Prifinium bromide: Fridial®
antimuscarinic
agents
 • Work by depressing all levels of CNS by increasing
BENZODIAZEPINES GABA activity, an inhibitory neurotransmitter.
• Pregnancy: most are category D.
• Adverse effects:
• Drowsiness, dizziness, tiredness, dry mouth,
diarrhea, upset stomach, changes in appetite.
 Do not take with opioid medicines, alcohol or other CNS
depressants.

The medication can cause drowsiness.

Do not drive or use heavy machinery until you know how the
drug affects your balance.

Patient Do not stop suddenly taking the medicine as it may lead to

seizures, shaking, muscle cramps, and vomiting.

education The medicine can cause abuse and dependance.

The medicine can cause drowsiness and coordination problems.

 • Chlordiazepoxide and clidinium bromide: Librax®
BENZODIAZEPINES
Drugs used in the treatment
of Diarrhea
Non-Pharmacological treatment

Drink liquids such Eat foods rich in

After each loose
as fruit juice Drink between potassium like
stool, drink one
without added meals not during. bananas and
cup of liquid.
sugar. potatoes.

Eat foods rich in Eat foods rich in Avoid creamy,

sodium like broths, soluble fibers like fried and sugary
and crackers. oatmeal and rice. foods.
Pharmacological treatment

Bismuth Antimotility
Probiotics
subsalicylate medication

Antimicrobials if
diarrhea is caused Oral rehydration
by a microbial solution or salts
infection.
 • Loperamide works by slowing intestinal
motility through opioid receptors, has direct
effects on circular and longitudinal muscles,
Antimotility reduces fecal volume, increases viscosity.
agents: • Adverse effects:
• Dizziness, fatigue, abdominal pain, constipation,
Loperamide nausea, dry mouth, angioedema, bullous eruptions,
flatulence, rash.
• Loperamide is pregnancy category B
 You should consult a physician if symptoms does not
improve in 48 hours if blood develops in stool, or if fever
occurs.
Tiredness, dizziness, or drowsiness may occur. Avoid
driving or using heavy machinery.

Patient Do not consume alcohol or OTC drugs.

education Dry mouth can be decreased by frequent sips of water,

hard candy or sugarless gum.

Do not overdose or take this drug longer than prescribed

as it may be habit-forming.
 • Loperamide: Imodium ®

Antimotility
agents:
Loperamide
Drugs used in the treatment
of Constipation
Non-Pharmacological treatment

Drink enough water Make a routine for going

Regular exercise. Avoid holding in stools.
each day. to the toilet.

Eat foods rich in fibers

Elevate the feet (for ex.
like fruits,vegetables and Add bulking agents like
on a step/platform)
cereals. Recommended wheat bran to your diet.
while passing stools.
(18-30g) per day.
Pharmacological treatment

Bulking Osmotic Stool

agents laxatives softeners

Stimulant
laxatives
 • Increase in bowel content volume triggers
stretch receptors in the intestinal wall, which
causes reflex contraction (peristalsis) that
propels the bowel content forward
• Insoluble and non-absorbable
• Nondigestible
Bulking agents • Must be taken with lots of water!
(or it will make constipation worse)
• Psyllium
• Bran
• Methylcellulose
 Avoid taking the medication if a
bowel obstruction, severe
constipation, colitis, or toxic
megacolon is present.
Patient
education Inform the doctor if any of these
conditions are present: heart
disease, ulcerative colitis, Crohn’s
disease or toxic megacolon
 • Effective in 1-3 hours
• Used to purge intestine (e.g. surgery, poisoning)
• Fluid is drawn into the bowel by osmotic force, increasing

Osmotic laxatives volume and triggering peristalsis

• Nondigestible sugars and alcohols
• Lactulose (broken down by bacteria to acetic and lactic acid,
which causes the osmotic effect)
• Salts
• Milk of Magnesia (Mg(OH)2)
• Epsom Salt (MgSO4)
• Glauber’s Salt (Na2SO4)
• Sodium Phosphates (used as enema)
• Sodium Citrate (used as enema)
• Polyethylene glycol
 Adverse effects:
• Abdominal cramping, abdominal distention, belching,
flatulence, excessive bowel activity, dehydration.
 Avoid taking the medication if a bowel obstruction, severe
constipation, colitis, or toxic megacolon is present.

Inform the doctor if any of these conditions are present: heart

disease, ulcerative colitis, Crohn’s disease or toxic megacolon

Patient The liquid form of lactulose may become slightly darker in color,
this is harmless. However, if the liquid becomes too dark or too

education thick/thin in texture, then stop using the medicine.

The contents of Movicol sachet should be dissolved in 125mL of

water before consumption. Can be stored in the fridge for up to 6
hours.

Drink a lot of water when taking osmotic laxatives to reduce

possibility of gas and cramps.
 • Effective in 1-3 hours
• Used to purge intestine (e.g. surgery, poisoning)
• Fluid is drawn into the bowel by osmotic force, increasing

Osmotic laxatives volume and triggering peristalsis

• Nondigestible sugars and alcohols
• Lactulose (broken down by bacteria to acetic and lactic acid,
which causes the osmotic effect)
• Salts
• Milk of Magnesia (Mg(OH)2)
• Epsom Salt (MgSO4)
• Glauber’s Salt (Na2SO4)
• Sodium Phosphates (used as enema)
• Sodium Citrate (used as enema)
• Polyethylene glycol
 Adverse effects:
• Abdominal cramping, abdominal distention, belching,
flatulence, excessive bowel activity, dehydration.
 • Increases intestinal motility
Stimulant • Irritate the GI mucosa and pull water into the lumen
Laxatives • Indicated for severe constipation where more rapid effect
is required (6-8 hours)
• Castor Oil - From the Castor Bean
• Senna - Plant derivative
• Bisacodyl
• Lubiprostone -PGE1 derivative that stimulates chloride
channels, producing chloride rich secretions

Bisacodyl • Laxative abuse is the most common cause of constipation.

Senna • It is best to avoid stimulant laxatives in pregnancy because
they can induce uterine contractions.

• Adverse effects: Abdominal cramping, excessive diarrhea,

rectal burning, vertigo, nausea, vomiting.

Ispaghula husk
 Avoid taking the medication if a bowel
obstruction, severe constipation, colitis, or toxic
megacolon is present.
Inform the doctor if any of these conditions are
present: heart disease, ulcerative colitis,
Patient Crohn’s disease or toxic megacolon

education Pink, red, violet or black discoloration of urine

may occur with cascara or senna.

Avoid taking antacids within 1 hour of taking

bisacodyl tablets.
Stool • Docusate sodium (surfactant and stimulant): to help

Softeners- “wet” and soften stool.

• Liquid Paraffin (oral solution)

Emollients • Glycerin suppositories.

• May take a week or longer to be effective.

• Adverse effects:
• Rectal discomfort, burning sensation, abdominal
cramping, excessive bowel activity, allergic reaction.
Docusate • Stool softeners are generally considered safe during
pregnancy.
 Avoid taking the medication if a
bowel obstruction, severe
constipation, colitis, or toxic
megacolon is present.
Patient
education Inform the doctor if any of these
conditions are present: heart
disease, ulcerative colitis, Crohn’s
disease or toxic megacolon
Drugs used in the treatment
of Nausea and Vomitting
 • Tightens the muscles at the entry of the
stomach and relaxes the muscles at the exit
of the stomach, which helps speed up the
passage of food through the stomach into
the intestine, which helps prevent vomiting
and reduces nausea. Also blocks stimulation
in the “vomiting center” in the brain which
reduces the sensation of nausea and
Dromperidone prevents vomiting.
• Pregnancy category C
• Adverse effects: headache,
dizziness, dry mouth, nervousness,
flushing, stomach cramps, hot
flashes.
 Avoid drinking alcohol when
taking the medication as it may
make you feel sleepy.
Patient
education Do not drive, work with
machines, or engage in
dangerous tasks until you know
how this medication affects you.
 • Blocks dopamine receptors and serotonin
receptors in CNS. Desensitizes tissues to
acetylcholine, increases upper Gi motility but not
secretions, and increases lower esophageal
Metoclopromide sphincter tone.
• Adverse effects: extrapyramidal symptoms,
fatigue, sedation, headache, dizziness,
somnolence, diarrhea, nausea, menstrual
disorders, dyskinesia.
• Pregnancy category B.
 Avoid drinking alcohol when taking the
medication as it may make you feel sleepy.

Do not drive, work with machines, or engage in

dangerous tasks until you know how this
Patient medication affects you.

education Stop taking metoclopramide if serious side

effects occur, such as dyskinesia (abnormal
muscle movements).
Do not take metoclopramide for more than 12
weeks because it can cause tardive dyskinesia.
 • Produces antiemetic action by its central action
Meclizine on chemoreceptor trigger zone. Lowers
sensitivity of labyrinth apparatus, which
transmits stimuli to the CTZ and stimulates the
vomiting center. A potent H1 receptor
antihistaminic agent with anticholinergic activity.

• Adverse effects: Abdominal pain, tachycardia

diarrhea, blurred vision, constipation, anxiety,
insomnia nausea, headache, urinary retention,
skin rash.
• Pregnancy category A.
 Avoid drinking alcohol when
taking the medication as it may
make you feel sleepy.
Patient
education Do not drive, work with
machines, or engage in
dangerous tasks until you know
how this medication affects you.
Thank you