Drug Action
Simeticone (activated dimeticone) is an antifoaming agent.
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Individual generic drug information
Extracted information for Simeticone only.
Simeticone (activated dimeticone) is an antifoaming agent.
Source page 98
DENTINOX ® Colic | Wind pains ▶BY MOUTH ▶Child 1 month–1 year: 2.5 mL, to be taken with or after each feed; may be added to bottle feed; maximum 6 doses per day INFACOL ® Colic | Wind pains ▶BY MOUTH ▶Child 1 month–1 year: 0.5–1 mL, to be taken before feeds
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DENTINOX ® The brand name Dentinox ® is also used for other preparations including teething gel.
Source page 98
Extracted information for Simeticone only.
There can be variation in the licensing of different medicines containing the same drug. Oral suspension ▶Infacol (Teva UK Ltd) Simeticone 40 mg per 1 ml Infacol 40mg/ml oral suspension sugar- free | 55 ml G £3.20 DT = £3.20 sugar-free | 85 ml G £4.66 DT = £4.66 Oral drops ▶Dentinox Infant (Dendron Ltd) Simeticone 8.4 mg per 1 ml Dentinox Infant colic drops | 100 ml G £2.01 DT = £2.01 Combinations available: Co-simalcite, p. 75. Simeticone with aluminium hydroxide and magnesium hydroxide, p. 75 4.2 Gastric and duodenal ulceration Peptic ulcer disease Description of condition Peptic ulcer disease includes gastric or duodenal ulceration, which is a breach in the epithelium of the gastric or duodenal mucosa. The main symptom of peptic ulcer disease is upper abdominal pain but other less common symptoms include nausea, indigestion, heartburn, loss of appetite, weight loss and a bloated feeling. Non-steroidal anti-inflammatory drugs p. 1193 (NSAIDs) use and Helicobacter pylori (H. pylori) infection are the most common causes of peptic ulcer disease. Smoking, alcohol consumption, and stress may also contribute to the development of peptic ulcer disease. NSAIDs may have an additive effect if there is co-existent H. pylori infection, further increasing the risk of peptic ulceration. The risk of upper gastro-intestinal side-effects varies between individual NSAIDs and is influenced by the dose and duration of use. For recommendations on individual NSAID choice, see under NSAIDs and gastro- intestinal events in Non-steroidal anti-inflammatory drugs p. 1193. Complications of peptic ulcer disease include gastric outlet obstruction and potentially life-threatening gastro- intestinal perforation and haemorrhage. Patients at high risk of developing gastro-intestinal complications with an NSAID include those with a history of complicated peptic ulcer, or those with more than 2 of the following risk factors: . age over 65 years; . high dose NSAIDs; . other drugs that increase the risk of gastro-intestinal adverse-effects (e.g. anticoagulants, corticosteroids, selective serotonin reuptake inhibitors); . serious co-morbidity (e.g. cardiovascular disease, hypertension, diabetes, renal or hepatic impairment); . heavy smoker; . excessive alcohol consumption; . previous adverse reaction to NSAIDs; . prolonged requirement for NSAIDs. Aims of treatment The aims of treatment are to promote ulcer healing, manage symptoms, treat H. pylori infection if detected and reduce the risk of ulcer complications and recurrence. Non-drug treatment g Lifestyle measures, such as healthy eating, weight loss (if obese), avoiding trigger foods, eating smaller meals, eating the evening meal 3–4 hours before going to bed, raising the head of the bed, smoking cessation, and reducing alcohol consumption may improve symptoms. Assess the patient for stress, anxiety, or depression, as these conditions may exacerbate symptoms. Urgent endoscopic investigation is required for patients with dysphagia, significant acute gastrointestinal bleeding, or in those aged 55 years and over with unexplained weight loss and symptoms of upper abdominal pain, reflux or dyspepsia. h Initial management g Drugs that induce peptic ulcers, such as NSAIDs, aspirin, bisphosphonates, immunosuppressive agents (e.g. corticosteroids), potassium chloride, selective serotonin reuptake inhibitors (SSRIs) and recreational drugs such as crack cocaine should be reviewed and stopped, if clinically appropriate. Antacids and/or alginates may be used for short-term symptom control, but long-term, continuous use is not recommended. h The treatment strategy in peptic ulcer disease can vary depending on whether a patient has H. pylori infection, or has recently taken NSAIDs. g The patient should be tested for H. pylori infection. h See Testing for Helicobacter pylori in Helicobacter pylori infection p. 89. g In patients who have tested positive for H. pylori and have no history of NSAID use, Helicobacter pylori infection p. 89 infection should be eradicated. If the ulcer is associated with NSAID use, a proton pump inhibitor or H2-receptor antagonist should be used for 8 weeks, followed by Helicobacter pylori infection p. 89 eradication treatment if the patient has tested positive for H. pylori. In patients who have tested negative for H. pylori and have no history of NSAID use, a proton pump inhibitor or histamine2-receptor antagonist (H2-receptor antagonist) should be used for 4–8 weeks. h Follow-up management g Patients with peptic ulcers (gastric or duodenal) who tested positive for H. pylori should be reviewed 6–8 weeks after starting eradication treatment and re-tested, depending on the size of the lesion. Patients with a gastric ulcer who tested positive for H. pylori should also have a repeat endoscopy 6–8 weeks after treatment to confirm ulcer healing, depending on the size of the lesion. If the ulcer is healed and the patient is to continue taking NSAIDs, the potential harm from NSAID treatment should be discussed. The need for NSAIDs should be reviewed at least every 6 months, and use on a limited, ’as-needed’ basis trialled. Consider reducing the dose, substituting the NSAID with paracetamol p. 465, or use of an alternative analgesic or low dose ibuprofen. In patients with previous ulceration, for whom NSAID continuation is necessary, or those at high risk of gastro- intestinal side effects, consider a cyclo-oxygenase (COX)-2 inhibitor instead of a standard NSAID (but see Cardiovascular Events under Non-steroidal anti-inflammatory drugs p. 1193). Gastro-protection with acid suppression therapy should always be co-prescribed. A proton pump inhibitor is the preferred choice for gastro-protection; other options include a H2-receptor antagonist or misoprostol, but the side effects of misoprostol limit its use. If symptoms recur after initial treatment, a proton pump inhibitor may be taken at the lowest dose possible to control symptoms. Treatment should be used on an ’as-needed’ Gastro-intestinal system basis with patients managing their own symptoms. In cases where there are persistent symptoms or an unhealed ulcer, the patient’s adherence to initial management should be checked and lifestyle advice reinforced. Other causes, such as malignancy, failure to detect H. pylori, inadvertent NSAID use, other ulcer-inducing medication, and rare causes such as Zollinger-Ellison syndrome or Crohn’s disease should be considered. Switching to an alternative acid suppression therapy, e.g. H2-receptor antagonists p. 78 may be beneficial if the response to proton pump inhibitor therapy is inadequate. Referral to a specialist for investigations and management should occur in refractory or recurrent peptic ulcer cases with gastro-oesophageal symptoms that are unexplained, or non-responsive to treatment. Patients with peptic ulcer disease who are on long-term treatment should receive an annual review of their symptoms and treatment. A step down approach, or stopping treatment, should be encouraged if possible and clinically appropriate. h Useful Resources Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management. National Institute for Health and Care Excellence. NICE guideline 184. September 2014, reviewed October 2019. www.nice.org.uk/guidance/cg184 ANTACIDS
Source pages 98, 99
Extracted information for Simeticone only.
INFACOL ® Patients or carers should be given advice on use of the Infacol ® dropper. l LESS SUITABLE FOR PRESCRIBING INFACOL ® Infacol ® is less suitable for prescribing (evidence of benefit in infantile colic uncertain). DENTINOX ® Dentinox ® colic drops are less suitable for prescribing (evidence of benefit in infantile colic uncertain).
Source page 98
Filter the extracted dose blocks for this individual drug.
First line only; read the complete Indications and dose section above.
2.5 mL, to be taken with or after
This is a first-line fragment. Read the full Indications and Dose section above.
Candidate age grouping · source page 98
First line only; read the complete Indications and dose section above.
0.5–1 mL, to be taken before feeds
This is a first-line fragment. Read the full Indications and Dose section above.
Candidate age grouping · source page 98