Domestic colloidal bismuth subcitrate gastro-norm in the complex treatment of diseases of the digestive system. Analogues of bismuth tripotassium dicitrate: a review of substitutes for action and active substance Colloidal bismuth subcitrate instructions
special instructions
Colors feces black.
Indications for use
Peptic ulcer of the stomach and duodenum in the acute phase, incl. associated with Helicobacter pylori. chronic gastritis and gastroduodenitis in the acute phase, incl. associated with Helicobacter pylori. irritable bowel syndrome, which occurs mainly with symptoms of diarrhea. functional dyspepsia, not associated with organic diseases of the gastrointestinal tract.
pharmachologic effect
Antiulcer, gastroprotective
At pH 4 and below (gastric juice), insoluble oxychloride and bismuth citrate precipitate, and chelate compounds with a protein substrate are formed. they cover the ulcer surface, protect it (this polymer glycoprotein complex is more effective than normally secreted mucus) from the effects of acid, pepsin and bile. Coagulates proteins and causes the death of Helicobacter pylori. When administered orally, it is practically not absorbed and is excreted in the faeces. Only a small amount of bismuth is cleaved from the colloidal complex, enters the bloodstream, and then is excreted in the urine. It promotes the healing of peptic ulcers, restores the protective function and preserves the integrity of the barrier of the gastric mucosa, reduces the frequency of recurrence of duodenal ulcers. Stimulates the synthesis of PGE2, which increases the formation of mucus and bicarbonate secretion, improves the quantitative and qualitative characteristics of gastric mucus and mucin production. Leads to the accumulation of epidermal growth factor in the area of the defect. Reduces the activity of pepsin and pepsinogen. It covers the ulcer surface with a white foamy coating that persists for several hours. in patients who took the drug 3 hours before surgery, a thin white layer is present only on the ulcer craters. With monotherapy, Helicobacter pylori disappears in 30% of cases, when combined with metronidazole or amoxicillin - in 90%. With prolonged use of high doses, especially in patients with impaired renal function, reversible encephalopathy may develop.
Overdose
Symptoms: with frequent use of large doses, the development of renal failure is possible. Treatment: gastric lavage, administration of activated charcoal and saline laxatives, symptomatic therapy. Patients with impaired renal function, accompanied by a high level of bismuth in plasma, are administered complexing agents containing SH groups - dimercaptosuccinic and dimercaptopropanesulfonic acids. In case of severe renal failure, hemodialysis is performed.
Indigestion and other digestive problems can hardly be considered a rarity, since no one is immune from such disorders, regardless of age and gender. Fortunately, modern medicine offers a lot of medicines, including adsorbents. Bismuth tripotassium dicitrate is considered quite good (the pharmacological name of the drug is De-Nol). So what properties does this tool have? Is it safe to treat children? What is its cost? These questions are of interest to many readers.
Release form of the drug
The drug is produced in the form of oval white tablets. The main active substance is bismuth tripotassium dicitrate. Tablets are placed in blisters of 8 pieces. In the pharmacy you can buy a package of 7 or 14 blisters.
Of course, the drug also contains some auxiliary components, including povidone, corn starch, magnesium stearate, macrogol 6000.
Pharmacological properties of the drug
The active substance of the drug has pronounced anti-inflammatory and astringent properties. Once in the acidic environment of the stomach, bismuth tripotassium dicitrate is converted to bismuth citrate and bismuth oxychloride. In the future, these substances form the so-called chelate complexes, which are deposited on the surface of the damaged mucous membrane, acting as a protective film.
In addition, the drug activates the protective mechanisms of the gastric mucosa, stimulates the secretion of mucus and bicarbonate. Thus, the medicine protects the mucous membrane of the digestive tract from the effects of aggressive acids, enzymes and salts. Moreover, against the background of therapy, there is a decrease in the activity of pepsinogen and pepsin, as well as the accumulation of epidermal growth factor in the area of mucosal damage, which, in turn, contributes to tissue repair processes.
Bismuth dicitrate has a detrimental effect on Helicobacter pylori. This compound accumulates inside the microorganism, which further leads to the destruction of the cytoplasmic membrane of the cell and its death. By the way, the medicine penetrates under the layer of duodenal mucus - it is here that the concentration of bacteria is greatest. That is why the drug is more effective than similar drugs.
The drug is practically not absorbed by the walls of the digestive system and does not penetrate into the bloodstream. It is excreted from the body along with the feces unchanged. However, with prolonged use, bismuth can accumulate in the central nervous system.
Indications for use
A drug containing bismuth tripotassium dicitrate is quite often used in medicine. In particular, it is prescribed for irritable bowel syndrome, especially if it is accompanied by bouts of diarrhea. Also, the drug helps with indigestion, if the cause is not organic lesions of the gastrointestinal tract.
Indications for admission are also exacerbations of gastroduodenitis and chronic gastritis. This remedy is effective in the treatment of ulcerative lesions of the digestive tract caused by Helicobacter pylori.
The drug "De-Nol" (bismuth tripotassium dicitrate): instructions for use
Of course, first of all, patients are interested in how to take this or that medication correctly. Only a doctor can prescribe a medicine containing bismuth tripotassium dicitrate. Instructions for use contains all the necessary recommendations.
For example, adult patients are usually prescribed to take one tablet four times a day or two tablets twice a day. It is advisable to drink them 30 minutes before meals or at bedtime. It is better to take the tablets with a sufficient amount of water.
For children aged 8 to 12 years, the daily dose is 240 mg of the active substance. Bismuth tripotassium dicitrate should be taken one tablet twice a day. If we are talking about patients 4-8 years old, then the daily rate depends on body weight - 8 mg per kilogram. The full dose should be divided into two doses.
The duration of the course of treatment depends on many factors, but, as a rule, therapy lasts 1-2 months. After stopping the intake for another 2 months, you should not take drugs containing bismuth, as this substance accumulates in the body.
Contraindications for admission
Many people are wondering if all categories of patients can take a medicine containing bismuth tripotassium dicitrate? The instruction states that there are some contraindications, although there are not so many of them. In particular, it is not recommended to be taken by pregnant women, as well as new mothers while breastfeeding. A contraindication is also individual hypersensitivity to this substance. It should also not be used to treat patients suffering from renal insufficiency.
Are there possible complications during therapy?
So, the doctor prescribed you De-Nol. What complications can this drug cause? Bismuth tripotassium dicitrate, or rather drugs, the main active substance of which it is, rarely lead to the development of side effects. Nevertheless, some complications are still possible, so you should familiarize yourself with their list. During therapy, disorders of the digestive system may occur, including nausea, constipation, diarrhea and vomiting. In some patients, the drug causes allergic reactions, which are manifested by skin itching, redness, rashes, swelling.
You should be very careful when taking this remedy for a long time, since bismuth tends to accumulate in nerve tissues, which, in turn, is fraught with the development of encephalopathy.
Analogues and other drugs with the same properties
Of course, on the modern pharmaceutical market there are many drugs containing bismuth tripotassium dicitrate. Analogues that have the same properties, but have a different composition, also exist. But only a doctor can select the appropriate remedy, taking into account the characteristics of your body, the form of the disease, etc. If we are talking about drugs containing the same bismuth compound, then Bisnol, Tribimol, Ventrison and Trimo.
Pretty good sorbents are drugs such as Almagel, Enterol and Enterosgel. If we are talking about digestive disorders associated with diseases of the stomach, liver or pancreas, Gastal, Pepsan and Heptaral will be effective, which will help relieve symptoms such as indigestion and nausea. Motilium will help eliminate unpleasant dyspeptic phenomena. Some of these medicines are more expensive, some have a milder effect, in any case, there is a choice, and quite a lot.
How much does the medicine cost?
For many people, the question of cost is far from the last on the list. So how much will the De-Nol drug, which contains bismuth tripotassium dicitrate, cost? The price, of course, will depend on the pharmacy you use, where you live, the manufacturer, etc.
The cost of a package of 56 tablets ranges from 390 to 470 rubles. If we are talking about a box of 112 pieces, then its price is about 650-700 rubles. Given the fact that one package is enough for a full course of treatment, the cost of the drug can be considered quite affordable.
Formula: C12H10BiK3O14, chemical name: bismuth (III) potassium 2-hydroxy-1,2,3-propane tricarboxylate (salt 1:3:2).
Pharmacological group: organotropic agents / gastrointestinal agents / gastroprotectors.
Pharmachologic effect: antiulcer, gastroprotective.
Pharmacological properties
In gastric juice (at a pH of 4 or less), insoluble bismuth citrate and oxychloride are precipitated, chelate compounds are formed with a protein substrate; they cover the surface of the ulcer, protect it from the influence of acid, bile and pepsin (this polymer glycoprotein complex is more effective than normally secreted mucus). Bismuth tripotassium dicitrate coagulates protein compounds and destroys Helicobacter pylori. When ingested, bismuth tripotassium dicitrate is almost not absorbed in the gastrointestinal tract and is excreted in the intestines with feces. Only a very small part of bismuth is separated from the colloidal complex and absorbed into the blood, and then excreted by the kidneys in the urine.
Bismuth tripotassium dicitrate helps to preserve the integrity and restore the protective function of the barrier of the gastric mucosa, the healing of peptic ulcers, and reduces the frequency of recurrences of duodenal ulcers. Bismuth tripotassium dicitrate has a stimulating effect on the production of prostaglandin E2, which increases bicarbonate secretion and mucus formation, improves mucin production, as well as the qualitative and quantitative characteristics of gastric mucus. Bismuth tripotassium dicitrate leads to the accumulation of epidermal growth factor in the area of the mucosal defect. Bismuth tripotassium dicitrate reduces the activity of pepsinogen and pepsin. The drug covers the surface of the ulcer with a foamy white coating that persists for several hours; in patients who took the drug 3 hours before surgery, a thin white layer is only on the craters of ulcers. With monotherapy of bismuth tripotassium dicitrate, Helicobacter pylori disappears only in 30% of cases, with combined treatment with amoxicillin or metronidazole - in 90% of cases.
With prolonged use of high doses, especially in patients with impaired renal function, reversible encephalopathy may occur.
Indications
Exacerbation of peptic ulcer of the duodenum and stomach, including those associated with Helicobacter pylori; exacerbation of chronic gastroduodenitis and gastritis, including those associated with Helicobacter pylori; functional dyspepsia, which is not associated with organic diseases of the gastrointestinal tract; irritable bowel syndrome, which occurs mainly with symptoms of diarrhea.
Method of application of bismuth tripotassium dicitrate and doses
Bismuth tripotassium dicitrate is taken orally. Patients older than 12 years: 4 times a day, 120 mg half an hour before meals and the last time at bedtime or 2 times a day, 240 mg; patients 8 - 12 years old: 2 times a day, 120 mg; patients 4 - 8 years: 8 mg / kg per day in 2 divided doses. The duration of therapy is 4 - 8 weeks, during the next 8 weeks you can not take drugs that contain bismuth; a second course of treatment is possible after 8 weeks.
To remove Helicobacter pylori, it is necessary to combine bismuth tripotassium dicitrate with oral metronidazole - 250 mg 4 times a day and amoxicillin 250 mg 4 times a day (in the presence of hypersensitivity to amoxicillin, tetracycline is used - 500 mg 3 times a day) for 10 days.
Do not use long-term high doses of the drug. Do not use bismuth tripotassium dicitrate for more than 8 weeks. Also, do not exceed the established daily doses during therapy. When treating bismuth tripotassium dicitrate, do not use other drugs that contain bismuth. At the end of the course therapy with the drug in recommended doses, the content of the active active substance in the blood plasma does not exceed 3-58 µg/l, and intoxications are observed only when the plasma level of the active active substance is more than 100 µg/l. When using bismuth tripotassium dicitrate, it is possible to stain the feces in a dark color due to the formation of bismuth sulfide, and also, sometimes, a slight darkening of the tongue. During treatment with the drug should not drink alcohol. Within half an hour before and after taking the drug, you must refrain from taking solid food, drinks (including milk, juices), antacids.
Contraindications for use
Hypersensitivity, the period of breastfeeding, pregnancy, a pronounced violation of the functional state of the kidneys.
Application restrictions
There is no data.
Use during pregnancy and lactation
The use of bismuth tripotassium dicitrate is contraindicated in pregnancy. During therapy with bismuth tripotassium dicitrate, breastfeeding should be discontinued.
Side effects of bismuth tripotassium dicitrate
Digestive system: nausea, increased stool, vomiting, constipation;
allergic reactions: itching, skin rash;
others: with prolonged use of high doses of bismuth tripotassium dicitrate, the development of encephalopathy, which is associated with the accumulation of bismuth in the central nervous system.
Interaction of bismuth tripotassium dicitrate with other substances
Bismuth tripotassium dicitrate reduces the absorption of tetracycline. Drugs that contain bismuth (including vikair, vikalin) increase the likelihood of developing systemic side effects (increased blood levels of bismuth) when used together with bismuth tripotassium dicitrate. Within 30 minutes before and after taking bismuth tripotassium dicitrate, it is not recommended to use other drugs orally, as well as to take liquids and food, in particular, antacids, fruits, milk, juices, because when taken together, they can have an effect on the effectiveness of bismuth tripotassium dicitrate.
Overdose
With an overdose (frequent intake of large doses) of bismuth tripotassium dicitrate, renal failure may develop. Necessary: gastric lavage, taking saline laxatives and activated charcoal, symptomatic treatment; patients with impaired renal function, which is accompanied by a high plasma level of bismuth, are administered complexing agents that contain SH groups - dimercaptopropanesulfonic and dimercaptosuccinic acids; in severe renal failure, hemodialysis is necessary.
The drug is characterized by astringent, anti-inflammatory and antibacterial properties.
note
Vitridinol is a structural analogue of the more well-known drug De-Nol.
Active ingredient and release form
The drug is available in the form of coated tablets intended for oral administration. Each of them contains 304.6 mg of bismuth tripotassium dicitrate, which corresponds to 120 mg of the active ingredient - bismuth oxide. Light yellow tablets are packed in 56 pieces in polyethylene jars with a tight lid.
Pharmacological properties
By stimulating the biosynthesis of prostaglandin E and increasing mucus secretion, protective mechanisms are launched at the cellular level and the resistance of the gastric and duodenal mucosa to the ulcerogenic effects of HCl and the proteolytic enzyme, pepsin, increases. In the area of erosive or ulcerative lesions, epidermal growth factor accumulates, which accelerates the repair process.
The level of absorption of the active substance is minimal. A very small amount of bismuth compounds penetrates into the systemic circulation. Metabolites are excreted through the intestines. Bismuth that enters the bloodstream is excreted by the kidneys.
Indications for taking Vitridinol tablets
The medicine is prescribed for the following diseases and pathological conditions:
- , not associated with organic lesions of the structures of the digestive tract;
- followed by ;
- exacerbation of chronic hyperacid;
- in the acute phase;
- and 12 duodenal ulcer.
note
The drug is effective for inflammation, erosion and ulcers of the mucous membrane of the upper gastrointestinal tract, caused by the pathogenic effect of Helicobacter pylori bacteria.
Contraindications
Vitridinol is not prescribed if a patient is hypersensitive to bismuth dicitrate. Serious renal dysfunction is also a contraindication, since excretory disorders can cause bismuth accumulation in the body and intoxication.
The drug is not prescribed for children under 4 years of age.
Dosing regimen
Tablets are taken orally, without chewing, with a small amount of water, 1 pc. 2-4 r / day half an hour before meals. The daily dose is determined by the gastroenterologist depending on the age of the patient. The tool is intended for course therapy, the duration of which can be from 4 to 8 weeks. At the end of it, it is not recommended to take medicines containing bismuth compounds for 2 months.
Side effects
Overdose of Vitridinol
No cases of acute overdose have been reported.
With prolonged treatment with high doses, as well as against the background of renal failure, bismuth accumulation in brain structures is possible with the development of encephalopathy as a result of toxic effects.
The concentration leading to toxic damage to the central nervous system is 100 µg/l, and if the prescribed dosages are observed and the normal functional activity of the kidneys, the level of Bi in the blood does not rise above 58 µg/l.
Interaction with other pharmacological agents
No drug antagonism was found.
When taken in parallel with other drugs (in particular, antacids), the absorption of the drug may be impaired.
Vitridinol during pregnancy and lactation
Data on the safety of drugs for the fetus and infant is not enough, therefore women during pregnancy (regardless of the term) and nursing mothers, this medicine is contraindicated.
Additional instructions
Do not exceed the allowable daily doses and take the drug continuously for more than 2 months.
During treatment, it is possible to stain the stool black, which is not a sign of pathology.. In rare cases, there is a darkening of the tongue.
Conditions of storage and sale through pharmacy chains
No prescription is required to purchase this anti-ulcer drug.
The tablets should be stored in the original container at a temperature not exceeding +25°C.
Keep away from children!
The shelf life is 36 months from the date of issue.
Vitridinol analogs
The analogues of Vitridinol in terms of the active ingredient and therapeutic effect are:
- Ulcavis;
- Vikanol;
- De-Nol;
- Escape;
- Novobismol;
- Ventrisol.
Plisov Vladimir, doctor, medical commentator