CHAPTER V: GASTROINTESTINAL AGENTS

1.
2.
3.
4.

Antacids alters gastric pH

Protectives - for intestinal inflammation
Adsorbents - for intestinal toxins
Cathartics or laxatives - for constipation

ANTACIDS
-

alkaline bases that neutralizes excess hydrochloric acid which causes pain and ulceration
to inactivate the proteolytic enzyme, pepsin

pH 1 empty stomach, excessive endogenous HCl

pH 7 food is present

Gastritis general inflammation of the gastric mucosa

Peptic Ulcer a general circumscribed erosion
o Esophageal ulcer lower end of the esophagus
- esophageal sphincter is defective, heartburn
o Gastric ulcer stomach
- malignancy and hemorrhage are common
- bleeding
o Duodenal Ulcer duodenum
- perforation

Criterias for Ideal Antacid:

1. not absorbable/cause systemic alkalosis
2. not a laxative nor cause constipation
3. exerts the effect rapidly and over a long period of time
4. not cause a large evolution of gas, flatulence
5. buffers in pH 4-6 range
6. inhibits pepsin

SODIUM BICARBONATE
-

drug of choice for metabolic acidosis

rapid action but short duration
causes belching and flatulence
function is to react with an acid
to mask the salinity of the drug, sparkling flavor

ALUMINUM HYDROXIDE [Al(OH)3]

-

Amphogel
treatment of hyperchlorhydria, peptic ulcer and intestinal toxemia
Physical Forms:
1. Suspension - Aluminum Hydroxide Gel white viscous suspension, pH 5.5-8.0
- includes sweetening agents, aromatics and preservatives
2. Powder - Dried Aluminum Hydroxide Gel amorphous powder, made into tablet
advantage of the gel is its large surface area and thus, great adsorption
but loses its antacid properties upon aging
causes constipation, nausea and vomiting

Pharmaceutical Chemistry 1: Gastrointestinal Agents | Suzette Pamela G. Santos | 1FPharmacy

Calcium-Containing Antacids
- causes constipation

CALCIUM CARBONATE [CaCO3]

-

Precipitated Chalk
microcrystalline powder, fast action
causes flatulence and constipation[Ca+2]
found in combination with Magnesium antacids
Lozenges and Oral Suspension
+ +
*hyperacidity
*flatulence

TRIBASIC CALCIUM PHOSPHATE Ca3(PO4)2

-

Precipitated Calcium Phosphate

after ignition at 800oC, 90% Tribasic calcium phosphate
found in nature as phosphorite/phosphate rock and apatite(Ca3(PO4)2CaF2
there is NO GAS PRODUCED and does not alkalinize the system

Magnesium-Containing Antacids
- antacid property depends on the anion/basic property
- Mg ion causes it to be laxative
o combination with Al and Ca antacids to equalize constipative and laxative action

MAGNESIUM CARBONATE [Mg(CO3)4Mg(OH)25H2O

-

antacid property are due to hydroxide and carbonate ions reacting with the gastric HCl

MAGNESIUM HYDROXIDE
-

laxative in high doses

exerts salt action (MgCl2) -> laxative action
MILK OF MAGNESIA suspension of Mg(OH)2

MAGNESIUM OXIDE
-

Magnesia
laxative and diuretic
o Light Variety occupies 40-50mL
o Heavy Variety occupies 10-20mL
arsenic antidote
prepared by adding Magnesia to water (1:20)

MAGNESIUM TRISILICATE 2MgO3SiO2xH2O

-

compound of MAGNESIUM OXIDE + SILICON DIOXIDE

silicic acid or hydrous silica has absorptive properties

MAGNESIUM PHOSPHATE Mg3(PO4)25H2O

Combination Antacid Preparations
- most of these combination are an attempt to balance the constipative effect of calcium and
aluminum with laxative effect of magnesium
a. Aluminum Hydroxide Gel Magnesium Hydroxide
Aludrox, WinGel, Maalox, Cramlin
b. Aluminum Hydroxide Gel Magnesium Trisilicate
Gelusil, Tricreamalate, Triosgel
c. Magaldrate combination of aluminum hydroxide and magnesium hydroxide
d. Simethicone defoaming agent
e. Alginic acid sodium Bicarbonate
- for reflux espophagitis
Pharmaceutical Chemistry 1: Gastrointestinal Agents | Suzette Pamela G. Santos | 1FPharmacy

PROTECTIVES AND ADSORBENTS

for the treatment of mild diarrhea

Acute diarrhea caused by bacterial toxins, chemical poisons, drugs, allergy (easily treated)
Chronic GI surgery carcinoma (over a long period of time)

Antidiarrheal decreases peristalsis

*slows down the movement of intestinal tract
1. Adsorptive-protective adsorbs toxins, bacteria and viruses, and provides protective coating of the
intestinal mucosa
2. Antidiarrheal should act directly on smooth muscle of the gut, producing spasm-like effect, which
decreases peristalsis and increases segmentation
3. Antibacterial agent only effective if there is an actual infection caused by microorganisms
Bismuth-containing Products
bismuth ion exerts a mild astringent and antiseptic action
o astringent causes constriction of the mucosa, destroying the bacteria

BISMUTH SUBNITRATE Bi(OH)2(NO3)4BiO(OH)

-

White Bismuth
hygroscopic powder, acidic with litmus paper
assayed in terms of bismuth trioxide (Bi2O3)
incompatible with tragacanth (precipitates as a hard mass)
o remedy is the addition of sodium biphosphate or trisodium phosphate
USES
- non-irritant intestinal antiseptic
- lessens gastric secretions, and reduces acidity
- remedy against diarrhea

BISMUTH SUBCARBONATE BiO2(CO3)2 H2O

-

yellowish white, affected by light

protective and antacid effect in the inflammations of the stomach and bowels
60 grams dose rendering the alimentary canal opaque to x-ray
astringent and adsorbent in the treatment of diarrhea and dysentery

MILK OF BISMUTH
-

Bismuth Magma/Bismuth Cream

Bismuth hydroxide + Bismuth subcarbonate (suspension)
o prepared through the conversion of bismuth subnitrate nitrate by adding HNO3
o then by treating it with ammonium carbonate and ammonia solution
used as ASTRINGENT and ANTACID

KAOLIN
-

Porcelain Cay/China Clay/Bolus Alba

native hydrated aluminum silicate
o elutriation powdered and freed from gritty particles
contains 20.9% aluminum
formed by the weathering of FELDSPAR (KAlSi3O8)
has an earthly and clay-like taste, turns darker when moistened with water
found together with pectin (Kaopectate)
ADSORBENT and PROTECTIVE in diarrheal conditions
interferes with intestinal absorption of lincomycin

ACTIVATED CHARCOAL
-

adsorbent in the treatment of diarrhea

antidote to some types of poisoning

Pharmaceutical Chemistry 1: Gastrointestinal Agents | Suzette Pamela G. Santos | 1FPharmacy

SALINE CATHARTICS
-

purgatives
agents that quicken and increase evacuation from the bowels
o Laxatives mild cathartics

laxative habit loss of bowel rhythm, and becoming dependent on laxatives

4 Types of Laxatives
1. Stimulant Laxatives act by local irritation on the intestinal tract, increasing the peristaltic
activity
2. Bulk-forming laxatives made from cellulose and polysaccharides, which swell when wet, and
this increased bulk stimulates peristalsis
3. Emollient Laxatives acts as lubricants or stool softeners
4. Saline Cathartics increases osmotic load of GI tract
Poorly absorbable ions used as saline cathartics:
biphosphate
phosphate
sulfate
tartrate
magnesium
They are water soluble and should be taken with large amounts of water to prevent excessive
loss of body fluids.

MONOBASIC SODIUM PHOSPHATE NaH2PO4H2O

-

slightly deliquescent
acidic to litmus, effervesces with sodium carbonate
URINARY ACIDIFIER
o in case of cystitis, with hexamethylenetramine* (Methenamine)
decomposes into formaldehyde in the presence of acids
CATHARTIC

DIBASIC SODIUM PHOSPHATE Na2HPO47H2O

-

white granular salt, effervesces in warm dry air

alkaline to litmus and phenolphthalein (pH 9.5)
1, 2, 7, 12 H2O (official)
SALINE CATHARTIC
should never be confused with tribasic sodium phosphate, which is very alkaline and caustic,
and should be used for intestinal purpose

POTASSIUM SODIUM TARTRATE KNaC4H4O64H2O

-

Rochelle Salt, Seignette Salt

colorless crystals with a cooling saline taste
often coated with white powder as it effloresces in warm dry air
CATHARTIC MILD LAXATIVE HYDRAGOGUE
o producing watery discharges from bowel
an ingredient of Seidlitz Powder
o form in which it is administered as cathartic
effervescent and palatable
component of Fehlings solution (Alkaline Cupric Tartrate)
o an example of chelate complexation

Pharmaceutical Chemistry 1: Gastrointestinal Agents | Suzette Pamela G. Santos | 1FPharmacy

MAGNESIUM SULFATE MgSO47H2O

-

Epsom salt, Bitter Salt

small colorless needle-like crystals with a cooling saline bitter taste
effloresces in air, neutral to litmus
active cathartic with little pain or nausea and produces watery stools
must be administered in ice-cold condition to avoid bitter taste

used parenterally as anticonvulsant

anesthetic effect in sprains and bruises
antiphlogistic action

Preparation
1. Magnesite (MgCO3) with hot dilute sulfuric acid
2. Kierserite (MgSO4H2O) in water, heating then, crystallization
3. Dolomite(MgCO3 CaCO3) heating by calcinations, treating with HCl
dissolved in sulfuric acid, boiled and filtered

MAGNESIUM CITRATE
-

Purgative Lemonade
MgCO3 + citric acid
sodium or potassium bicarbonate reacting with citric acid producing a lemon-flavored solution
must be sterilized or pasteurized

NON-OFFICIAL SALINE CATHARTICS

1. SODIUM SULFATE Glaubers Salt
2. POTASSIUM PHOSPHATE Dibasic Potassium Phosphate, DKP, Dipotassium Hydrogen
Phosphate
3. POTASSIUM BITRATE Cream of Tartar
4. CALOMEL Mercurous chloride, Mild Mercury Chloride

Pharmaceutical Chemistry 1: Gastrointestinal Agents | Suzette Pamela G. Santos | 1FPharmacy