These are substances intended to promote digestion of food. A number of proteolytic, amylolytic and lipolytic enzymes are marketed in combination formulations and are vigorously promoted for dyspeptic symptoms, and as appetite stimulants or health tonics.
DIGESTANTS
These are substances
intended to promote digestion of food. A number of proteolytic, amylolytic and
lipolytic enzymes are marketed in combination formulations and are vigorously
promoted for dyspeptic symptoms, and as appetite stimulants or health tonics.
They are occasionally beneficial, only when their elaboration in g.i.t. is
deficient. Their routine use in tonics and appetite improving mixtures is
irrational.
1. Hydrochloric Acid
It may be used in achlorhydria; 5–10 ml of dilute HCl
(10%) should be further diluted to 100–200 ml with water and sipped with a
straw (to prevent contact with teeth) during meals.
2. Pepsin
May be used along with
HCl in gastric achylia due to atrophic gastritis, gastric carcinoma, pernicious
anaemia, etc.
3. Papain
It is a proteolytic
enzyme obtained from raw papaya. Its efficacy after oral ingestion is
doubtful.
4. Pancreatin
It is a mixture of pancreatic
enzymes obtained from hog and pig pancreas. It contains amylase, trypsin
and lipase; indicated in chronic pancreatitis and other exocrine pancreatic
deficiency states. Fat and nitrogen content of stools may be reduced and
diarrhoea/ steatorrhoea may be prevented. It has to be used as enteric coated
tablets or capsules to protect the enzymes from being themselves digested in
stomach by pepsin. Nausea, diarrhoea and hyperuricaemia are the occasional side
effects.
5. Diastase and Takadiastase
These are amylolytic enzymes obtained from
the fungus Aspergillus oryzae. They
have been used in pancreatic insufficiency, but efficacy is equivocal.
Preparations
ALVIZYME: Pancreatin
125 mg, simethicone 25 mg tab. BESTOZYME: Alfa amylase 320 mg, papain 60 mg,
dimethicone 40 mg cap.
DIGENZYMES: Diastase
19 mg, pepsin 110 mg, papain 50 mg per 10 ml liq.
DIGIPLEX: Diastase 20
mg, pepsin 20 mg, vit B1 1 mg, vit B2 1 mg, vit B6
0.5 mg nicotinamide 10 mg, pantothenyl alcohol 2 mg, vit B12 0.5 μg per 10 ml liq.
DIZEC: Pancreatin 250 mg, sod. tauroglycocholate 50 mg, methylpolysiloxane 25
mg tab.
LUPIZYME: Pepsin 12.5
mg, diastase 18.75 mg, vit B1 2 mg, B2 1 mg, B6
1.5 mg, B12 1 μg, pantothenol 1.5 mg, nicotinamide 15 mg per
5 ml syr.
PEPSINOZYME: Diastase
150 mg, pepsin 50 mg, papain 30 mg, vit B1 0.5 mg, vit B2
0.5 mg, niacinamide 5 mg, activated charcoal 75 mg tab.
RALCRIZYME: Pancreatin
150 mg, bile extract 25 mg, pepsin 5 mg, diastase 10 mg, methyl polysiloxane 25
mg tab.
TAKADIASTASE: Takadiastase 162 mg tab.
Enzyme preparations
containing an antispasmodic or a laxative and fixed dose combinations of
pancreatine or pancrelipase containing amylase, protease and lipase with any
other enzyme are banned in India.
(Dimethyl
polysiloxane, Simethicone, Dimethicone)
It is a silicone polymer, a viscous amphiphilic liquid—reduces surface tension
and collapses froth, ‘antifoaming agent’. It is not absorbed from g.i.t. and is
pharmacologically inert. Added to antacid, digestant and antireflux
preparations (see above), it is
claimed to relieve flatulence, to coat and protect ulcer surface, to aid
dispersion of antacids in gastric contents, and to prevent gastroesophageal
reflux. However, clinical efficacy is equivocal.
Dose: 40–120 mg 3 to 4 times
a day.
DIMOL 40 mg tab.
(single ingredient).
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