LAXATIVE WITHOUT CONSEQUENCES

Press service of the "APTEKA Weekly" No. 11 (782) March 21, 2011

In ancient times, the ancient Greek philosopher and scientist Aristotle coined the term "catharsis" in relation to the theory of tragedy, which meant that a performance, evoking a range of feelings, forces the viewer to empathize, thereby purifying his soul. However, this ancient Greek concept has another, more mundane interpretation, which means physiological purification. Purification, due to the impossibility of carrying out which the life of any of us can turn into a real tragedy...

Most of our patients believe that they know what constipation is, but experts from the World Gastroenterology Organisation note that patients have different ideas about constipation. Thus, some of them (52%) consider it as the need to strain during defecation, others (44%) consider the formation of "sheep" feces as the main symptom, and still others - the inability to defecate when necessary (34%) or infrequent defecation (33%) (www.worldgastroenterology.org).

That is why it is important for the pharmacist and the doctor to know clear criteria that will allow them to judge whether the problem with which the patient has come to us is really constipation. In this, medical professionals will be helped by the Rome criteria developed by an international group of experts (Whitehead WE et al., 1991; Thompson WG et al., 1999). According to them, functional chronic constipation should be considered the presence of 2 or more symptoms that the patient experiences for at least 25% of the time: straining during defecation; fragmented or hard stool; feeling of incomplete emptying; feeling of anorectal blockage; manual assistance during defecation; less than 3 bowel movements per week; no diarrhea.

Syrup PRELAXAN There are many causes of constipation, but in any case it is not a disease, but a symptom. For example, diseases such as hemorrhoids and anal fissures, diabetes mellitus, hypercalcemia, thyroid insufficiency, depression, Parkinson's disease, multiple sclerosis. Constipation is caused by the use of certain medications; among other situations, groups and risk factors that cause constipation, - childhood and childhood age, people over 55 years old, previous abdominal or pelvic surgery, late pregnancy, limited mobility, inadequate diet (with a deficiency of fluid intake and dietary fiber), polypharmacy, especially in the elderly, and, finally, irrational use of laxatives (www.worldgastroenterology.org).

I would like to dwell on the latter in more detail, since laxatives are available without a prescription, and therefore have a great potential for irrational use - after all, neither the doctor nor the pharmacist have the opportunity to control the correct use of over-the-counter drugs by patients. This leads to the fact that patients often abuse some drugs, in particular laxatives. The affordability and safety of herbal laxatives give the patient a reason to consider this group of drugs the most convenient to use, which makes them the most in demand.

However, the herbal origin of any of the drugs, including those with a laxative effect, does not indicate its safety. Thus, the most popular laxatives among patients are based on senna leaves, barberry bark, barberry fruits (crude extract, infusions, teas) often have not only an irritating effect on the mucous membrane, which can cause spastic pain, nausea and vomiting, but also have a number of other adverse effects. First of all, such drugs cause a habituation syndrome, when with regular use of drugs of this group, their laxative effect disappears. Researchers associate this with degenerative changes in the nervous system of the large intestine.

In vitro and animal experiments, some researchers have also found mutagenic (presumably due to the presence of flavonoids), genotoxic (due to the content of emodin and aloe-emodin) and carcinogenic properties of senna extracts. In particular, they believe that the use of senna preparations is associated with the development of colorectal cancer (Sandnes D. et al., 1992; Siegers C.-P. et al., 1993; Satia JA et al., 2009). In one retrospective study involving 3049 patients and a prospective study including 1095 patients, in patients who underwent diagnostic colonoscopy, researchers found an increased risk of colorectal carcinoma in those who, most of whom used anthraquinone laxatives for a long time (Siegers .-P. et al., 1993).

Scientists attribute similar properties of anthraglycosides to the fact that under the influence of bacteria, anthraglycosides are broken down to anthrones, which, apparently, stimulate the synthesis of prostaglandins, and also have cytotoxic properties. In general, the results of the studies concluded that prolonged (short-term or irregular) use of such drugs causes a significant risk of developing complications.

All this forces us to look for laxatives that, even with their prolonged and uncontrolled use, would have a favorable risk/benefit ratio. Apparently, such a remedy is lactulose and a product based on it - PRELAXAN syrup, which is represented on the domestic pharmaceutical market since 2005 by the company "Yunatis".

Although the history of lactulose began in 1929 thanks to chemists Edna M. Montgomery and Claude S. Hudson, only in 1957 Friedrich Petuely discovered its bifidogenic activity -factor" (Der Bifidusfaktor), and then its laxative effect. This gave him reason to call lactulose "the ideal laxative for young children". Obtained from whey formed during the production of fermented milk products, lactulose, entering the colon unchanged, has a laxative effect, but, more importantly, is actively utilized by intestinal microorganisms, primarily bacteria of the genus Lactobacillus. Due to this, short-chain fatty acids (lactic, acetic, propionic and butyric) are formed from lactulose, which contributes to the normalization of microflora, an increase in the total volume of biomass, a decrease in pH in the lumen of the colon. The development of a number of pathogenic microorganisms (E. coli, clostridia and salmonella) is suppressed in the intestine and the number of bifidobacteria increases.

Unlike many other laxative products, PRELAXAN syrup combines such important properties as mildness of action, practically absence of irritating effect, habituation and withdrawal syndrome, in which constipation develops after stopping the drug. On the contrary, over time, the amount of PRELAXAN used can be reduced, and even its long-term use is not only safe, but also contributes to the preservation and restoration of normal intestinal function.

Over more than 40 years of experience in the use of lactulose, no toxic or serious side effects have been identified, which is especially important when using it in pediatrics. Due to this, PRELAXAN can be used not only by adults, but also by children from 1 year of age, as well as the elderly, pregnant and breastfeeding women.

All this allows us to recommend PRELAXAN syrup for:

dysbacteriosis: in adults - 2 teaspoons 2 times a day; in children over 3 years old - 1 teaspoon per day; in children aged 1 to 3 years - 0.5-1 teaspoon per day;