Trevia 100mg film coated Tablets (Sitagliptin phosphate monohydrate)

Combipack Oral Rehydration Salts BP 21.8g + Zinc Sulfate Tablets 20mg

Combipack Oral Rehydration Salts BP 21.8g + Zinc Sulfate Tablets 20mg

The key constituents of ORS are sodium and glucose. The central principle of oral rehydration therapy (ORT) is the utilization of sodium-glucose co-transport in the small intestine, a phenomenon which remains largely unaffected during acute infectious diarrhea. Thus, the success of ORT is largely dependent on glucose-driven sodium absorption (transcellular route) leading to passive absorption of water by the paracellular route. The clinical result is usually rapid rehydration and correction of acidosis.

The therapeutic benefits in acute diarrhea may be attributed to the effects of zinc on various components of the immune system and the direct gastrointestinal effects. Zinc deficiency is associated with lymphoid atrophy, decreased cutaneous delayed hypersensitivity responses, lower thymic homone activity, a decreased number of antibodies forming cells and impaired T killer cell activity. Zinc deficiency has also been recently shown to affect the differentiation of CD4 response towards Th1 rather than Th2 pathways. The direct intestinal effects of zinc deficiency include decreased brush border activity, enhanced security response to cholera toxin, and altered intestinal permeability, which is reversed by supplementation.

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Indications

For the treatment of dehydration due to diarrhea in children and adults.

Contraindications

The preparation is contraindicated in patients with dehydration of 10% or more and continued vomiting.

Dosage and administration

Dosage of ORS sachets

Dissolve entire content of packet in one liter of drinking water.

  • Infants: one liter over a 24 hour period.
  • Children: one liter over an 8 to 24 hour period, according to age.
  • Adults: drink freely as required.

Continue treatment until diarrhea stops.

Warning: discard remaining solution after 24 hours

Dosage of Zinc tablets

Dispense uniformly one tablet in one teaspoonful of water and then take it. It can also be dispensed in breast milk before use.

For infants less than six months of age: 10mg per day

For children 6 months & above: 20mg per day

Duration of therapy: 14 days

Warnings and precautions

Oral rehydration salts should be reconstituted only with water and at the volume stated. Fresh drinking water is generally appropriate, but freshly boiled and cooled water is preferred when the solution is for infants. The solution should not be boiled after it is prepared. Other ingredients such as sugar should not be added. Unused solution should be stored in a refrigerator and discarded 24 hours after preparation.

Oral rehydration solutions are not appropriate for patients with gastro-intestinal obstruction, oliguric or anuric renal failure, or when parenteral rehydration therapy is indicated as in severe dehydration or intractable vomiting.

Prolonged use of high doses of zinc supplements by mouth or parenterally, leads to copper deficiency with associated sideroblastic anaemia and neutropenia; full blood counts and serum cholesterol should be monitored to detect early signs of copper deficiency.

Drug interactions

None has been described for ORS.

The absorption of zinc may be reduced by iron supplements, penicillamine, phosphorus containing preparations and tetracyclines.

Zinc supplements reduce the absorption of copper, fluoroquinolones.

Special populations

Pregnancy and lactation: there are no special problems with pregnant and lactating women

Neonates: although any moderately dehydrated individual is at risk of adverse effects, particularly if ORS are used inappropriately, there should be special concerns about this group.

Children: As for neonates, there should be special concerns for young infants but there are no special problems with other children.

The elderly: there are no special problems with this group.

Concurrent disease: there should be special concerns about patients who are hypernatremic before treatment

Overdosage

No information is available on the acute overdosage of ORS

In acute overdosage of zinc salts are corrosive, due to the formation of zinc chloride by stomach acid; treatment consists of giving milk or alkali carbonates and activated charcoal. The use of emetics or gastric lavage should be avoided.

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