De-Nol

Helicobacter pylori is a common gram-negative bacterium that infects the gastric mucosa of about 50% of the world's population. The infection causes at least gastritis and is the main etiologic agent of gastric and duodenal ulcers and gastric cancer. [ 1 ] In recent years, success in treatment with standard regimens has become more difficult. Standard first-line triple therapy, including a proton pump inhibitor (PPI) and two antibiotics, usually clarithromycin and amoxicillin or metronidazole, has demonstrated a efficacy of almost 70%. [ 2 ]

In the 1970s, Gist-Brocades introduced a patented formulation of colloidal bismuth subcitrate (De-Nol) as an antiulcer agent.[ 3 ]

Indications De-Nol

The main indications for the use of De-Nol are the use of the drug during an exacerbation of a gastrointestinal tract disease. Take the drug for ulcers and duodenal ulcers. In the latter case, this is most relevant in cases where there is an exacerbation phase that could be associated with Helicobacter pylori.

Chronic gastritis is also the main indication for the use of the drug. This category also includes gastroduodenitis, which is in the acute phase of exacerbation. It can also be associated with Helicobacter pylori.

Irritable bowel syndrome is affected by this medicine. Especially if it occurs with symptoms of diarrhea. Functional dyspepsia, which is not associated with organic diseases of the gastrointestinal tract, can be eliminated by means of this medicine. De-Nol has a wide range of effects on the stomach, so it eliminates acute manifestations of any diseases in a short time. [ 4 ]

Release form

Tablets covered with a special shell are the form of release of the medicine. One blister can contain up to 14 tablets. Each of them has its own special coating. The amount of active substance in a tablet is 120 mg.

There is another form of release, these are also tablets, but there are only 7 of them in a blister. There can be up to 8 blisters in one box. The medicine is taken quite often, which is why it has such a large "packaging".

The medicine is not supplied as a suspension, because one dose of tablets is enough. One capsule contains a sufficient amount of active substance, which can provide relief in a matter of minutes. Naturally, if we are not talking about acute manifestations of diseases.

It is advisable to consult a doctor before buying. He will tell you how many tablets you need to buy. After all, much depends on the disease itself, its stage and development. De-Nol is a strong remedy that eliminates all the unpleasant symptoms associated with the gastrointestinal tract.

Pharmacodynamics

Pharmacodynamic properties of bismuth subcitrate. [ 5 ], [ 6 ]

• Bactericidal effect on H. pylori
• Binding to the base of the ulcer
• Pepsin inactivation
• Bile acid binding
• Stimulation of prostaglandin biosynthesis
• Inhibition of leukotriene biosynthesis
• Stimulation of complex formation with mucus
• Inhibition of various enzymes
• Epithelial growth factor binding
• Stimulation of lateral epithelial growth

Pharmacokinetics

Bismuth is a trivalent heavy metal element used in many medicinal applications.[ 7 ] This is based on the ability of bismuth to replace other metals such as iron, nickel, and zinc that play a catalytic or structural role.[ 8 ] Colloidal bismuth subcitrate (CBS) and bismuth subsalicylate (BSS) are commonly used in H. pylori treatment regimens. CBS is water-soluble while BSS is water-insoluble and both have low systemic absorption.[ 9 ] Bismuth absorption is not required for the effectiveness of H. pylori treatment regimens,[ 10 ] suggesting a local mechanism of action. Acid suppression further reduces bismuth absorption, enhancing the local effect in the gastric lumen as part of H. pylori treatment regimens. The effective concentration of bismuth is thought to be about 1 mg/mL at the standard therapeutic dose 15. Bismuth compounds also protect the gastric mucosa and promote ulcer healing.[ 11 ],[ 12 ] Bismuth alone can sometimes clear H. pylori infection, and eradication has been reported in rare cases with CBS.[ 13 ],[ 14 ]

Dosing and administration

The method of application and dosage of De-Nol directly depend on the disease that a person suffers from. Basically, the medicine is taken internally and washed down with plenty of water.

Adults and children over 12 years of age should take one tablet up to 4 times a day. The drug is taken 30 minutes before meals. It is also recommended to take 2 tablets at night. A slightly different regimen for taking the medication is possible. In this case, it is taken 2 tablets 2 times, also 30 minutes before meals.

Children aged 8 to 12 years should drink 1 tablet 2 times a day. This should be done 30 minutes before meals. Children aged 4 to 8 years should drink 8 mg of the medicine per kilogram of weight. The daily dosage must be divided into two doses.

The course of treatment does not exceed 2 months. In this case, much depends on the disease, its stage and progression.

Use De-Nol during pregnancy

The use of De-Nol during pregnancy is contraindicated. The drug contains active substances that can have a negative effect on the developing organism.

The fact is that many drugs are prohibited in the early stages of pregnancy. The mother's body is too weakened and does not perform its protective functions. The same can be said about the baby. The developing body should not be exposed to negative factors, especially in the early stages. This can worsen the child's development and lead to pathologies.

During breastfeeding, you should also refrain from using the product. After all, its active components can penetrate the baby's body along with milk. All this can lead to the development of negative factors. Therefore, if there is an urgent need to use the drug, you should consult a doctor. It is quite possible to avoid this.

Contraindications

Contraindications to the use of De-Nol mainly consist of persistent intolerance to the active components of the drug. Therefore, in case of individual intolerance, you should refrain from taking the medication.

Impaired kidney function and taking the drug are unacceptable. After all, most of the drug is excreted through these organs.

During pregnancy, taking De-Nol is strictly prohibited. The period of breastfeeding is also under a special ban, because the active substances can penetrate into the woman's milk, and then into the baby's body.

In any case, you should not start taking the medication on your own.

Side effects De-Nol

Side effects of De-Nol manifest themselves mainly from the digestive system and in the form of allergic reactions. Nausea, vomiting and frequent stools are possible, and constipation is also possible. All these side effects are not dangerous. They are mostly temporary.

Allergic reactions are also possible. They manifest themselves as a rash on the skin and severe itching. It is advisable to seek help from a doctor and, if necessary, replace the medication with another one or reduce the dosage.

If the medication is taken for a long time, encephalopathy may develop. This occurs due to significant accumulation of bismuth in the central nervous system.

If side effects do not go away over time, you should stop taking the medication.

Overdose

An overdose of De-nol is not excluded, but only if the drug was taken in too large a dose. This also occurs during long-term use of the drug. The main symptoms of the drug are impaired renal function.

What to do if an overdose occurs? In this case, gastric lavage is mandatory. It is necessary to prescribe activated charcoal and laxatives.

Symptomatic therapy should be used. If kidney failure is accompanied by high levels of bismuth in the blood plasma, then complex treatment should be used. In this case, dimercaptosuccinic and dimercaptopropanesulfonic acids will help.

If kidney damage is severe, hemodialysis is prescribed. In any case, if overdose symptoms appear, De-nol should be discontinued.

Interactions with other drugs

Interactions with other drugs are also possible. You cannot take other drugs for 30 minutes before and after taking the medication. The same applies to food and liquid consumption. Milk, fruits and fruit juices should be excluded from the diet. This can cause negative reactions from the gastrointestinal tract.

When ingesting irritating food and medication at the same time, the effectiveness of De-nol may be affected. In this case, the manifestation of negative factors is not excluded, as well as the complete absence of relief after taking the drug.

During the treatment of the stomach, it is necessary to completely exclude acidic food and other harmful products. Therefore, it is better to consult a doctor, so as not to aggravate the situation on your own and prevent the development of serious problems.

Storage conditions

The storage conditions of De-Nol must be observed in full. Thus, it is desirable that the storage temperature does not exceed 25 degrees. It is important to find the optimal storage location.

A dry place without sunlight is the ideal setting. Many people do not store medications in the medicine cabinet, which allows children to easily access them. In addition, this does not allow certain storage conditions to be met. As a result, the medication deteriorates and becomes unusable.

Medicines do not like dampness, it has a negative effect on them. In this case, the loss of the main positive properties of the drug is possible. You cannot store the medicine in the refrigerator. This increases the risk of deterioration of the main qualities of the drug, and also allows children to easily get to it. Therefore, it is best to give preference to an ordinary first aid kit. De-Nol does not require compliance with certain storage conditions, these are standard indicators, so in this case you need to start from the temperature regime.

Shelf life

The shelf life of the medicine is 48 months. Unlike suspensions, tablets can be stored after opening for a specified period of time. There is no need to even worry about this.

But despite this, it is necessary to pay attention to how the blister looks. If it is damaged, has punctures or the tablet shells are open, then you cannot take the product. Any mechanical damage puts everything at risk.

Incorrect storage conditions can also significantly reduce the shelf life. Therefore, it is worthwhile to immediately prepare a place for the tablets in the medicine cabinet, this is where all the optimal conditions are observed. There is no dampness, the required temperature regime is present, and there is no possibility of penetration of direct sunlight.

It is also necessary to monitor the appearance of the medication. The color and smell should remain unchanged. Otherwise, this indicates the influence of negative factors and the complete exclusion of taking the drug. De-Nol is undemanding to storage conditions, but it is on them that the shelf life of the drug depends.