Ranitidine +Cisapride Pharmacology

Ranitidine +Cisapride

About Ranitidine +Cisapride
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Mechanism of Action of Ranitidine +Cisapride
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Pharmacokinets of Ranitidine +Cisapride
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Onset of Action for Ranitidine +Cisapride
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Duration of Action for Ranitidine +Cisapride
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Half Life of Ranitidine +Cisapride
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Side Effects of Ranitidine +Cisapride
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Contra-indications of Ranitidine +Cisapride
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Special Precautions while taking Ranitidine +Cisapride
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Pregnancy Related Information
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Old Age Related Information
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Breast Feeding Related Information
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Children Related Information
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Indications for Ranitidine +Cisapride
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Interactions for Ranitidine +Cisapride
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Typical Dosage for Ranitidine +Cisapride
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Schedule of Ranitidine +Cisapride
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Storage Requirements for Ranitidine +Cisapride
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Effects of Missed Dosage of Ranitidine +Cisapride
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Effects of Overdose of Ranitidine +Cisapride
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Ranitidine

About Ranitidine
A histamine H2-receptor antagonist, Furan derivative, Anti-secretory G.I agent,Anti ulcer.
Mechanism of Action of Ranitidine
Ranitidine is a H2 (Histamine) receptor antagonist. Histamine is the most potent stimulus of acid secretion and acts as the common mediator. H2 receptor is a G-protein coupled receptor. It induces adenylate cyclase which converts ATP to cyclic AMP. This cyclic AMP acts on proton pump and exchange extracellular potassium ion for intracellular hydrogen ion across the parietal cell membrane. Ranitidine reversibly competes with Histamine for binding to H2 receptors on the parietal cells and predominantly inhibits basal acid secretion.
Anaesthetic adjuncts: It is used in patients undergoing prolonged operations, caesarian section,obese patients those are at increased risk of gastric regurgitation and aspiration pneumonia. It raises pH of gastric juice and also reduces its volume and thus chances of regurgitation. It is now routinely used before prolonged surgery.
Pharmacokinets of Ranitidine
Absorption: Ranitidine is 50 % absorbed after oral administration. Distribution: Distributed mainly to body tissues in unbound form. Metabolism: Ranitidine undergoes metabolism in the liver. Excretion: It is excreted mainly in urine and in the faeces.
Onset of Action for Ranitidine
60 minutes
Duration of Action for Ranitidine
13hours
Half Life of Ranitidine
1.6- 2.4 hours
Side Effects of Ranitidine
1. Headache
2. Dizziness
3. Constipation
4. Vertigo
5. Confusion
6. Rash
7. Blurred vision
8. Thrombocytopenia
9. Leukopenia
Contra-indications of Ranitidine
1. Hypersensitivity to Ranitidine
Special Precautions while taking Ranitidine
1. Hepatic impairment
2. Renal impairment
3. Acute Porphyria
Pregnancy Related Information
Use with caution
Old Age Related Information
Use with caution
Breast Feeding Related Information
Use with caution
Children Related Information
Use with caution
NEONATES: Contraindicated
Indications for Ranitidine
1. Duodenal ulcer
2. Benign gastric ulcer
3. Zollinger- Ellison syndrome
4. Gastroesophageal reflux
5. Acid indigestion
6. Heart burn
7. Sour stomach
8. Stress ulcers
9. Oesophagitis
10.Preanaesthetic medication
Interactions for Ranitidine
Antacids: Ranitidine absorption may be decreased.
Diazepam: Efficacy of diazepam decreased.
Procainamide: Renal clearance of procainamide decreased.
Sulfonylureas: Hypoglycemic effects of glipizide enhanced.
Theophyllines: Increased efficacy of theophyllines with possible toxicity.
Warfarin: Increased hypoprothrombinemic effects.
Lab tests: False positive tests for urine proteins with multistix may occur.
Typical Dosage for Ranitidine
Adult: 300mg / day
Duodenal ulcer, benign gastric ulcer: 300 mg /day as single dose at bed time or in 2 divided dose (morning and bed time) for minimum of 4 weeks.
Maintenance dose: 150 mg / day at bed time.
Zollinger- Ellison syndrome: 300 - 450 mg / day in 2 - 3 divided doses; dose can be increased if necessary to a maximum up to 6g / day .
Gastroesophageal reflux: 300 mg / day as single dose at bed time or in 2 divided doses (morning and bed time) for maximum 2 months. In severe conditions dose can be increased to 600 mg / day in 4 divided doses for 3 months
Acid indigestion, Heart burn, Sour stomach: Dose: 75 mg once daily to a maximum up to 150 mg / day.
Oesophagitis: 150 mg/ day.
Dyspepsia: 75 - 300 mg / day depending on the severity of disease.
PAM: 150mg given night and in the morning before surgical procedures.
Children:
Duodenal ulcer, benign gastric ulcer: 4 - 8 mg / kg body weight / day in 2 divided doses.
Maximum dose: 300 mg / day
Schedule of Ranitidine
H
Storage Requirements for Ranitidine
Store at 15 - 30 degree C in a tightly closed container. Protect from light.
Effects of Missed Dosage of Ranitidine
Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose. Continue the regular schedule. Do not double the dose.
Effects of Overdose of Ranitidine
Give supportive measures and symptomatic treatment. Drug can be removed from the body by inducing emesis and or by gastric lavage. Activated charcoal is given to reduce the absorption of the drug. Haemodialysis can be done if necessary.

Cisapride

About Cisapride
A serotonin 5-HT4 receptor agonist, parasympathomimetic, Gastrointestinal prokinetic agent.
Mechanism of Action of Cisapride
Cisapride is a Prokinetic drug. It is a 5 HT4 receptor agonist as well as 5HT3 receptor antagonist in the myenteric plexus. Enterochromaffin cells in the gastrointestinal mucosa produces and releases serotonin in response to stimuli (chemical or mechanical stimulation).Serotonin will enhances peristaltic movement by stimulating sensory neurons in the myenteric plexus. Stimulation of 5HT4 receptors will increase the release of Acetylcholine. The metabolite of Cisapride produces 5HT3 antagonism and suppresses the inhibitory transmission in myenteric plexus. These all results in increased oesophageal peristaltic activity, lower oesophageal sphincter tone and enhances intestinal propulsive activity.
Pharmacokinets of Cisapride
Absorption: Cisapride is well absorbed after oral administration.
Distribution: It is very rapidly distributed in the body mainly to tissues in protein bound forms.
Metabolism: Cisapride is extensively metabolised in the liver.
Excretion: It is excreted mainly in urine and faeces.
Onset of Action for Cisapride
30 - 60 minutes
Duration of Action for Cisapride
7 - 10 hours
Half Life of Cisapride
6 - 12 hours
Side Effects of Cisapride
1.Diarrhoea
2.Abdominal cramps
3.Headache
4.Constipation
5.Nausea
6.Urinary frequency
7.Rhinitis
8.Cough
Contra-indications of Cisapride
1.Hypersensitivity to Cisapride
2.Ventricular tachycardia
3.Ventricular fibrillation
4.Ventricular arrhythmia
5.Torsades de pointes
6.Ischaemic heart diseases
7.Congestive heart failure
8.Hypokalaemia
9.Respiratory failure
10.Hypokalaemia
11.Hypomagnesaemia
12.Respiratory failure
13.Renal failure
14.Gastrointestinal haemorrhag

Special Precautions while taking Cisapride
1.Hepatic impairment
2.Renal impairment
Pregnancy Related Information
Contraindicated
Old Age Related Information
Use with caution
Breast Feeding Related Information
Use with caution
Children Related Information
Use with caution
NEONATES: use with caution
Indications for Cisapride
1.Gastroesophageal reflux diseases
2.Gastroparesis
3.Non ulcer dyspepsia
4.Disorders associated with decreased gastric motility
5.Chronic constipation
6.Nausea
Interactions for Cisapride
Diazepam: Enhanced efficacy by cisapride due to increased gastric emptying.
Alcohol: Sedative effect augmented.
Anti-convulsants: Plasma levels of anticonvulsants must be carefully montiored.
Anti-coagulants: Prothrombin time increased.
Anti-cholinergics: Antagonize the effects of cisapride.
Typical Dosage for Cisapride
Adult:
Oral: 40 mg / day in 4 divided doses 15 minutes before each meal and at bed time. Dose can be increased if needed to 80 mg / day.
Non ulcer dyspepsia: 30 mg / day in 3 divided doses for 1 month.
Gastroesophageal reflux diseases: 30 mg / day in 3 divided doses for 3 months and if needed additional 10 mg can be given at bed time.
Disorders associated with decreased gastric motility: 30 - 40 mg / day in 3 - 4 divided doses for 1 ? months.
Chronic constipation: 15 mg / day in 3 divided doses; dose can be increased to 30 mg / day if necessary.
Children (suspension only): 0.2 mg 3 times daily, maximum daily dose is 0.8 mg / kg / day.
Schedule of Cisapride
N/A
Storage Requirements for Cisapride
Store at 15 - 30 degree C in a tightly closed container. Protect from heat and light. Keep out of the reach of children
Effects of Missed Dosage of Cisapride
Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose. Continue the regular schedule. Do not double the dose.
Effects of Overdose of Cisapride
Give supportive measures and symptomatic treatment.
Drug can be removed from the body by gastric lavage. Absorption of the drug can be reduced by administration of activated charcoal.

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