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The pharmacy clinics often admit such medications related to digestive diseases, such as the time taken for various digestive diseases. Is it pre-meal or post-meal or is it served with food? Is it good to eat in the morning or at bedtime? For this problem, each drug has its mechanism of action and its pharmacokinetic properties. In pharmacy clinics, when pharmacists are confessing drug use, they should guide patients according to their classification and characteristics.

Outpatient digestive system diseases are classified into the following categories: antacids, H2 receptor antagonists, proton pump inhibitors, gastric mucosal protectors, gastro-intestinal anticonvulsants, digestive aids, prokinetic agents, laxatives, antidiarrheals , Microecological drugs, antibacterial and antibacterial drugs, etc. (Hepatobiliary disease adjuvant drugs and other gastrointestinal drugs will not be described in this article).

Here we pharmacists will explain in detail the best time to take medicine for various types of digestive diseases.

Antacids

Representative drugs include sodium bicarbonate tablets, aluminum magnesium carbonate tablets, compound aluminum hydroxide tablets, and aluminum phosphate gels.

Sodium bicarbonate tablets and aluminum magnesium carbonate tablets can directly neutralize stomach acid and quickly relieve symptoms such as acid reflux, stomach burn, and stomach pain. Usually 1 to 2 hours after the meal, gastric acid secretion is more, so it should be taken 1 to 2 hours after the appropriate meal, 3 times a day. Due to the active digestive system at night, the secretion of gastric acid has increased. Some patients may feel stomach burning sensation at night, and they may take it before going to bed. As the effect of acid-suppressing drugs on neutralizing stomach acid is good and fast, it can be taken according to your doctor’s advice when it is uncomfortable.

In addition to neutralizing gastric acid, compound aluminum hydroxide tablets can still form a protective film on the ulcer surface. In order to avoid the influence of food, it is recommended to take one hour before meals or before going to bed.

Similarly, the aluminum phosphate gel has the dual role of antacid and gastric mucosal protection, according to different indications should choose a different time of taking: esophageal disease in postprandial administration, esophageal hiatal, gastro-esophageal reflux, esophagitis in the postprandial Taken before going to bed at night, it is mainly used to inhibit stomach acid. Gastritis and gastric ulcers are taken half an hour before meals, making it easier to form protective layers of gastric mucosa. Duodenal ulcers are taken 3 hours after a meal and when they are in pain. At this point, the stomach has been empty and the drug is more likely to enter the duodenum.

H2 receptor antagonist

Representative drugs include cimetidine tablets, ranitidine tablets, famotidine tablets, and nizatidine dispersible tablets.

These drugs have the effect of reducing gastric acid secretion by inhibiting the H2 receptor on the parietal cells. Cimetidine has more adverse reactions, and it has been rare to actually use gastrointestinal ulcers. Others determine the time of administration according to their pharmacokinetic characteristics, ranitidine 2 times daily, morning and evening service, or daily dose before bedtime. Famotidine is taken 2 times a day and taken half an hour after a meal. Nizatdin served daily doses before going to bed.

Proton pump inhibitor

Representative drugs include omeprazole enteric-coated tablets, lansoprazole enteric-coated tablets, rabeprazole sodium enteric-coated capsules, pantoprazole enteric-coated capsules, and ellaprezole enteric-coated tablets.

The proton pump inhibitor inhibits the final step of gastric acid production by binding to the H+-K+ ATPase of the parietal cells. The clinically used proton pump inhibitors are mostly weakly alkaline drugs, and their original drug activity is extremely small, and they are transported to the gastric mucosal wall cells after absorption into the bloodstream of the intestine, and finally reach the secretory canal and acidic cavity to play a role. Therefore, postprandial use can delay the time it takes to reach the intestine, delay the peak time, and cannot control postprandial gastric acid in a timely manner. Therefore, such drugs need to be taken about half an hour before meals, most of which are taken once a day and taken in the morning. If the doctor stated twice daily, take it before breakfast and before dinner.

Gastric mucosal protective agent

Representative drugs include colloidal barium tartrate capsules, sucralfate suspensions, glutamine pellets, esolatin maleate tablets, rebamipide tablets, teprenone capsules, and the like.

There are many types of gastric mucosal protective agents and the mechanism of action is not the same. There are also differences in the timing of taking different drugs. Drugs such as tinctures, sucralfate suspensions, and glutamine granules can be used to form a protective film on the wounds of gastrointestinal mucosal ulcers or to directly repair gastrointestinal mucosa. Suggestions 3 to 4 times a day, half an hour before meals Take 1 hour and sleep.

Isoprazole maleate tablets strengthen the combination of gastric epithelial cells, enhance the stability of gastric mucosa, increase the role of gastric mucosal blood flow and play an anti-ulcer effect, it is recommended three times a day, take half an hour before meals.

Rebapac Tablets have a variety of pharmacological mechanisms on the gastrointestinal mucosa. Can be used for acute gastritis, chronic gastritis, acute exacerbation of gastric mucosal lesions (erosion, hemorrhage, congestion, edema) improvement, the drug instructions indicate three times a day, morning and evening and before going to bed, pharmacokinetic information is still Unclear, clinicians generally take half an hour before meals.

Tepretone capsules can improve gastric mucosal lesions, inhibit the action of certain active factors associated with gastric mucosal injury, increase gastric mucin effects and gastric mucosal blood flow, and its pharmacokinetics show that blood taken after half an hour to 1 hour after meals The area under the drug concentration-time curve (AUC) is the largest, so it is recommended to take it from half an hour to one hour after meals.

Gastrointestinal spasm

Representative drugs include trimebutine tablets, pinaverium bromide tablets, and trouvirine hydrochloride tablets.

Trimebutine tablets have a two-way regulating effect on gastrointestinal smooth muscle, 3 times a day, and the doctor usually takes it before meals.

Pinaverium bromide is an antispasmodic agent acting on the gastrointestinal tract. It is a calcium antagonist that acts to relax gastrointestinal smooth muscle by inhibiting the influx of calcium ions into the intestinal smooth muscle cells. It should be swallowed with water when eating, but do not take it when lying or before going to bed, because the relaxation of gastrointestinal smooth muscle, the lying position may lead to food and other reflux and there is the risk of food entering the trachea.

Hydrochloride druvinchrine tablet is a pro-muscular antispasmodic drug that acts directly on smooth muscle cells. It works by inhibiting myosin light chain muscle enzymes to relax the smooth muscles, thereby eliminating the use of sputum and sputum, regardless of the effects of food.

Digestive aids

Representative drugs are compound digestive enzyme capsules, compound azintide enteric-coated tablets and so on.

These drugs contain a variety of ingredients that are secreted by stomach enzymes, pancreatic enzymes, and digestive enzymes to aid in digestion. Postprandial use can help patients with indigestion symptoms caused by lack of digestive enzymes. If taken before meals, stomach may be present in the state of fasting. Because of the risk of ulcers in the intestines, it is recommended that they be taken after meals.

Gastrointestinal motility drug

Representative drugs include itopride hydrochloride dispersible tablets, metoclopramide tablets, mosapride disodium citrate dispersible tablets, and domperidone.

The pharmacological mechanism of these drugs is to accelerate the gastric emptying by enhancing the contraction of the stomach and intestines, and to inhibit vomiting. It is recommended to take 15-30 minutes before meals.

Laxative

Representative drugs are magnesium sulfate solution, bisacodyl enteric-coated tablets, lactulose oral solution, polyethylene glycol 4000 powder and so on.

Magnesium sulphate solution used for catharsis, fasting each morning fasting; for gallbladder, 3 times a day, before meals or between meals.

Bisacodyl enteric-coated tablets are rarely absorbed after oral administration and act directly on the large intestine, stimulating their sensory nerve endings, causing increased reflex motility of the rectum leading to defecation, no effect on the taking effect before or after the meal, and in order for the patient to form The habit of squeezing the stool in the morning is recommended before bedtime at night, and milk and antacids should not be taken within 2 hours before and after taking the medicine.

Lactulose is converted by the digestive tract flora into low-molecular-weight organic acids in the colon, causing a drop in pH in the intestine, and by retaining water, increasing the volume of the feces to stimulate the colonic motility and restoring the circadian rhythm of the colon. Due to the most active digestive tract flora at mealtime, it is recommended to take it once for breakfast.

Polyethylene glycol 4000 dispersion is a linear long-chain polymer, which fixes water molecules through hydrogen bonds, keeps water in the colon, increases fecal moisture content, and softens feces, thereby improving constipation symptoms. After oral administration, it is neither absorbed by the digestive tract nor involved in biotransformation, and is only effective after 24 to 48 hours after administration, so the administration time is not affected by food. However, other drugs before oral administration may be washed away from the digestive tract. If other drugs are needed, it is recommended that they be separated by more than 2 hours.

Antidiarrheal

The representative drug is loperamide hydrochloride tablets.

Loperamide hydrochloride tablets act on opioid receptors in the intestinal wall, preventing the release of acetylcholine and prostaglandins, thereby inhibiting bowel movements and prolonging the retention time of intestinal contents. When taking diarrhea, fasting or half an hour before meals is more effective.

The representative drug has montmorillonite powder

Montmorillonite powder has stratified structure and non-uniform charge distribution, and has fixed and inhibitory effects on viruses, germs, and toxins produced in the digestive tract. It has the ability to cover the digestive tract mucosa and binds to mucin glycoproteins. , to repair and improve the defense function of mucosal barrier against attacking factors from both qualitative and quantitative aspects. If you need to take other drugs, it is recommended to be separated from this product for a period of time to avoid being adsorbed by montmorillonite. To avoid the effects of food, it is recommended to take an empty stomach between meals.

Microecological agents

Representative drugs include compound Lactobacillus acidophilus tablets, live Bacillus coagulans tablets, and complex lactic acid bacteria capsules.

These drugs are used for the treatment of intestinal disorders caused by disorders of the intestinal flora. It should be noted that the use of antacids and antibacterials combined with this product may reduce its efficacy, so it is administered separately (with intervals of 3 hours). , Citric acid, medicinal charcoal, tinctures, etc. can inhibit, absorb live bacteria, can not be used together. Choose the time to avoid the above-mentioned mutual influence drugs when taking. If there is no other drug, it can be taken after meals.

Antibacterial and antibacterial drugs

Representative drugs include berberine hydrochloride tablets, montmorillonite powder, anti-helicobacter pylori drugs such as clarithromycin tablets, amoxicillin capsules, and metronidazole dispersible tablets.

Berberine hydrochloride tablets are effective against intestinal infections caused by Shigella and E. coli. Combined with tannins can reduce the efficacy, it is recommended oral after meals.

Foods have little effect on the pharmacokinetics of clarithromycin tablets and amoxicillin capsules. Patients with ulcers are advised to take them after meals. Metronidazole Dispersible Tablets Instructions for use should be taken 1 hour before meals.

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