Drug reference
Haemorrhoids (particularly when unprolapsed) ▶BY SUBMUCOSAL INJECTION ▶Adult: 2–3 mL, dose (using phenol 5%) to be injected into the submucosal layer at the base of the pile; several injections may be given at different sites, max. total injected 10 mL at any one time
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When prepared extemporaneously, the BP states Oily Phenol Injection, BP consists of phenol 5% in a suitable fixed oil.
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Abdominal sepsis. abscess. dizziness. erectile dysfunction. fever. hepatitis. increased risk of infection. injection site necrosis. ulcer. urinary disorders
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There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: solution for injection Solution for injection ▶Phenol (Non-proprietary) Phenol 50 mg per 1 ml Oily phenol 5% solution for injection 5ml ampoules | 10 ampoule P £81.21 DT = £81.21 10 Reduced exocrine secretions Exocrine pancreatic insufficiency Description of condition Exocrine pancreatic insufficiency is characterised by reduced secretion of pancreatic enzymes into the duodenum. The main clinical manifestations are maldigestion and malnutrition, associated with low circulating levels of micronutrients, fat-soluble vitamins and lipoproteins. Patients also present with gastro-intestinal symptoms such as diarrhoea, abdominal cramps and steatorrhoea. Exocrine pancreatic insufficiency can result from chronic pancreatitis, cystic fibrosis, obstructive pancreatic tumours, coeliac disease, Zollinger-Ellison syndrome, and gastro- intestinal or pancreatic surgical resection. Aims of treatment The aim of treatment is to relieve gastro-intestinal symptoms and to achieve a normal nutritional status. Drug treatment Pancreatic enzyme replacement therapy with pancreatin below is the mainstay of treatment for exocrine pancreatic insufficiency. Pancreatin contains the three main groups of digestive enzymes: lipase, amylase and protease. These enzymes respectively digest fats, carbohydrates and proteins into their basic components so that they can be absorbed and utilised by the body. g Pancreatin should be administered with meals and snacks. The dose should be adjusted, as necessary, to the lowest effective dose according to the symptoms of maldigestion and malabsorption. h Fibrosing colonopathy has been reported in patients with cystic fibrosis taking high dose pancreatic enzyme replacement therapy (in excess of 10 000 units/kg/day of lipase). Possible risk factors are gender (in children, boys are at greater risk than girls), more severe cystic fibrosis, and concomitant use of laxatives. The peak age for developing fibrosing colonopathy is between 2 and 8 years. Manufacturers of Pancrease HL ® and Nutrizym 22 ® recommend that the total dose of pancreatin used in patients with cystic fibrosis should not usually exceed 10 000 units/kg/day of lipase. Manufacturers of pancreatin recommend that if a patient taking pancreatin develops new abdominal symptoms (or any change in existing abdominal symptoms) the patient should be reviewed to exclude the possibility of colonic damage. There is limited evidence that acid suppression may improve the effectiveness of pancreatin. g Acid- suppressing drugs (proton pump inhibitors or H2-receptor antagonists) may be trialled in patients who continue to experience symptoms despite high doses of pancreatin. Levels of fat-soluble vitamins and micronutrients (such as zinc and selenium) should be routinely assessed and supplementation advised whenever necessary. h Pancreatin preparations Preparation Protease Amylase Lipase units units units Gastro-intestinal system Creon® 10000 capsule, e/c 10 000 granules Creon® Micro e/c granules (per 100 mg) Pancrex® granules (per gram) Pancrex V® capsule, powder Pancrex V ‘125’® capsule, powder Pancrex V® e/c tablet Pancrex V® Forte e/c tablet Pancrex V® powder (per gram) 30000 25 000 Higher-strength pancreatin preparations Preparation Protease Amylase Lipase units units units Creon® 25000 capsule, e/c pellets 18000 25 000 Creon® 40000 capsule, e/c granules 1600 25000 40 000 Nutrizym 22® capsule, e/c 19800 22 000 minitablets Pancrease HL® capsule, e/c 22500 25 000 minitablets Non-drug treatment g Dietary advice should be provided. Food intake should be distributed between three main meals per day, and two or three snacks. Food that is difficult to digest should be avoided, such as legumes (peas, beans, lentils) and high-fibre foods. Alcohol should be avoided completely. Reduced fat diets are not recommended. h Medium-chain triglycerides (see MCT oil, in Borderline substances), which are directly absorbed by the intestinal mucosa, were thought to be useful in some patients. However evidence has shown that MCT-enriched preparations offer no advantage over a normal balanced diet. PANCREATIC ENZYMES
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2–3 mL, dose (using phenol 5%) to be injected
First-line fragment. Read the complete Indications and Dose section above.
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