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Nutritional and Dietary Supplementation during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Prokinetic agents stimulate upper gastrointestinal tract motility and are used primarily for the treatment of gastrointestinal reflux. Two agents are currently available in this class: cisapride (Propulsid) and metoclopramide (Reglan). Among 88 infants born to women who used cisapride during the first trimester, the frequency of congenital anomalies was not increased (Bailey et al., 1997). In Swedish Registry, 106 infants were exposed to cisapride during the first trimester, and the frequency of birth defects was not increased (Kallen, 2019).
Urological Anti-cancer Agents
Published in Karl H. Pang, Nadir I. Osman, James W.F. Catto, Christopher R. Chapple, Basic Urological Sciences, 2021
Bernadett Szabados, Thomas Powles
Side effects:Ileus − consider spasmolytic and prokineticsSensorimotor and autonomic neurotoxicityBone marrow suppression (neutropenia)HepatotoxicityDermatitis, stomatitisMyocardial ischaemia, myocardial infarction (coronary spasm).
General surgery
Published in Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan, Essential Notes for Medical and Surgical Finals, 2021
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan
Management: ‘Drip and suck,’ rehydrate and correct electrolyte imbalance. Decompress by colonoscopy if the diameter of the large bowel is >9 cm due to increased risk of perforation. Prokinetic agents may be helpful, e.g. neostigmine, erythromycin. Usually self-limiting. Surgery is indicated if conservative treatment fails.
The rare Ogilvie’s Syndrome in pregnancy. How to manage? A case report and literature review
Published in Journal of Obstetrics and Gynaecology, 2022
Vittorio Bresadola, Pier Paolo Brollo, Michele Graziano, Carlo Biddau, Tommaso Occhiali, Lorenza Driul
In cases of therapeutic failure of the intestinal decompressive non-invasive procedures only, the second therapeutic approach may involve the pharmacological treatment of the patient with neostigmine (2–2.5 mg, as an intravenous bolus, or 0.4–0.8 mg/h in continuous infusion for 24 h), an acetylcholinesterase inhibitor that rapidly enhances the effects of the parasympathetic system, promoting colonic decompression; the efficacy varies between 64% and 96%, while it is refractory in 20–40% of cases (Ponec et al. 1999). Treatment with neostigmine requires careful monitoring for possible side effects such as bronchospasm and bradycardia. Although occasional use of neostigmine during pregnancy has been reported in the literature, potential side effects in this patient population are not well known (Rausch et al. 2007). On the other hand, pregnancy, as per other authors, appears to be a contraindication to the use of neostigmine in the presence of ischaemic colitis or perforation, severe cardiac arrhythmias or in case of bronchospasm (Nicholson 1999; Vogel et al. 2016), due to the fear of the aforementioned adverse reactions. In general, neostigmine is rarely used, even in cases where it would be explicitly indicated (Loftus et al. 2002). In none of the cases of OS in pregnancy has this therapy been reported. Traditional prokinetics such as erythromycin, metoclopramide and cisapride are also often mentioned as treatment options, but they have never shown real efficacy (Bernardi et al. 2015).
Safety considerations when managing gastro-esophageal reflux disease in infants
Published in Expert Opinion on Drug Safety, 2021
Melina Simon, Elvira Ingrid Levy, Yvan Vandenplas
The scientific evidence-based approach for GER (D) management would be that no intervention is necessary as the natural evolution suggests a disappearance of troublesome regurgitation, the major presenting symptom, in the majority of the infants. As a consequence, reassurance and anticipatory guidance is recommended (Figure 1). Acid-related GERD in infants does exist, but only in a small subgroup of all infants presenting with troublesome regurgitation. Therefore, the consulted health-care provider should know the alarm or warning symptoms, in order to reassure appropriate referral of these patients (Table 1). Prokinetic medication seems a logic choice, but data on efficacy are disappointing and all drugs have a risk of inducing severe adverse effects. Worldwide, there is an erroneous belief among health-care providers that acid-blocking medication will decrease distress, resulting in an overuse. Moreover, acid-blocking medication is also associated with a high prevalence of adverse effects. According to the available evidence included in the most frequently applied guidelines, nutritional management is effective in reducing regurgitation and distress and is safe. The challenge is to spread this information to primary health-care providers in combination with knowledge of the alarm signs to reassure appropriate referral for the subgroup of infants needing investigations and drug treatment.
Mucoadhesive thermoreversible formulation of metoclopramide for rectal administration: a promising strategy for potential management of chemotherapy-induced nausea and vomiting
Published in Pharmaceutical Development and Technology, 2020
Mahmoud M. El-Sonbaty, Hatem R. Ismail, Alaa A. Kassem, Ahmed M. Samy, Mohamed A. Akl
Metoclopramide hydrochloride (MCP HCl) is a dopamine receptor antagonist. It is a potent prokinetic agent commonly used for the management of gastrointestinal (GI) disorders. Also, it is an effective antiemetic agent in the management of nausea and vomiting that related to migraine, cancer chemotherapy, pregnancy, or post-surgery (Zaki et al. 2007; Zuheir et al. 2013). Although MCP HCl is an inexpensive medication, there was no significant difference between it and Ondansetron in the prevention of postoperative vomiting (Isazadehfar et al. 2017). MCP HCl gains a renewed research interest regard it's in vitro and in vivo chemosensitizing properties. MCP HCl has a short half-life of 5 ± 1 h which required frequent administration (Henzi and Tramèr 2003; De Oliveira et al. 2012). However, oral forms of MCP HCl are rapidly absorbed in the GIT, it isn’t appropriate for children or elderly patients, as they are often vomited out before systemic absorption. In addition, MCP HCl oral bioavailability ranges from 32% to 98% due to extensive first-pass metabolism (Abdel-Rahman et al. 2009). The difficulty of repeated oral dosing and maintaining parenteral access for extensive periods besides poor patient compliance of injection route due to associated pain make it necessary and of the greatest need for an alternative to the oral or parenteral route is required. In this regard, the rectal delivery of MCP HCl-LS seems to be an attractive approach.