Serratiopeptidase is a pro-teolytic enzyme, which binds to alpha-2-mac-roglobulin in the blood, there by, helps to mask us agnogenicity but retains its enzymatic activity and is slowly transferred to site of inflammation.

It reduces swelling and edema improves microiroculation and accelerates the elimination of sputum by breaking down the liquifying mucus secretions and fibrin clots, hence it acts as anti-inflammatory antiedematous and anti-fibrin-olytic. One of the useful actions of it is that it increases the concentration of antibiotic at the site of infection.

Diclofenac potassium is a non-steroictal anti-inflammatory, analgesic and anti-pyretic drug, which inhibit prostaglandin synthesis by interfering with the action of prostaglandin synthetase. It is ideally suited for patients on sodium free diet, hypertensive patients and those on diuretic therapy.

Bioavailability – 100%; Protein – binding more than 99%; Metabolism – hepatic, no active metabolites exist; Half life – 1.2-2 hr (35% of the drug enters enterohepatic recirculation); Excretion – biliary, only 1% in urine

Pregnancy-with caution

Breast feeding-with caution

Old age-with caution

Adult: One tablet of CEP-DP should be taken three times in a day orally. It is advised not to take empty stomach.

Tramadol hydrochloride is a centrally acting synthetic opioid analgesic in an orally disintegrating tablet farm. The mode of action of tramadol has yet to be fully understood
but it is believed to work through modulation of the noradrenergic and serotonergic systems in addition to its mild agonism of the µ opioid receptor. The contribution of non-opioid activity is demonstrated by the analgesic effects of tramadol not being fully antagonized by the µ-opioid receptor agonist naloxone.
Opioid activity is due to both low affinity binding of the parent compound and higher affinity binding of the o-demethylated metabolite M1 to µ opioid receptors.

Tandam is well absorbed orally with and absolute bioavailability of 75%.Tandam has a volume of distribution of approximately 2.7 L/KG and is 20% bound to plasma proteins. Tramadol is extensively metabolized by a no. Of pathways including CYP2D6 and CYP3AA as well as by conjugation parent metabolites. The formulation of M1 is dependent upon CYP2D6 and as such is subject to inhibition, which may affect the non-therapeutic response. Tandam metabolites are excreted primarily in the urine with observed plasma.

This newer NSAID is a relatively weak inhibitor of PG synthesis and there is some evidence to indicate relative COX-2 selectivity. Anti-inflammatory action may be exerted by other mechanisms as well, eg. Reduced generation of superoxide by neutrophils, inhibition of PAF synthesis and TNFα release, free radical scavanging, inhibition of metalloproteinase activity in cartilage.

The analgesic, antipyretic and anti-inflammatory activity of nimesulide has been rated comparable to other NSAIDs.

It has been used primarily for short lasting painful inflammatory conditions like sports injuries, sinusitis and other ear-nose-throat disorders, dental surgery, bursitis, low backache, dysmenorrhoea, postoperative pain, osteoarthritis and for fever.

PARACETAMOL – Paracetomal has negligible anti-inflammatory action. It is a poor inhibitor of PG synthesis in peripheral tissues, but more active on COX in brain.

One explanation offered for the discripancy between its analgesic-antipyretic and anti-inflammatory actions is its poor ability to inhibit COX in the presence of peroxides which are generated at sites of inflammation but are not present in brain.

NOM-P is almost completely absorbed orally, 99% plasma protein bound, extensively metabolized and excreted mainly in urine with a t ½ of 2-5 hours. Paracetamol is well absorbed orally, only about 1/3 is protein bound in plasma and it is uniformly distributed in the body. It is conjugated with glucuronic acid and sulfate and is excreted rapidly in urine. Plasma t ½ is 2-3 hours. Effects after an oral dose last 3-5 hours

In contrast to aspirin, paracetamol does not stimulate respiration or affect acid-base balance, does not increase cellular metabolism. It has no effects on CVS. Gastric irritation is insignificant-mucosal erosion and bleeding occur rarely only in overdose.

NOM-P does not affect platelet function or clotting factors and is not uricosuric.

In isolated antipyretic doses NOM-P is safe and well tolerated. Nausea and rashes occur occasionally, leucopenia is rare.

Adverse effects of NOM-P are gastrointestinal (epigastralgia, heart burn, nausea, loose motions), dermatological (rash, pruritus) and central (somnolence, dizziness).

IN NOM-P For a variety of conditions requiring anti-inflammatory, analgesic, antipyretic activities, e.g. osteoarthritis, extra-articular rheumatic diseases, pain and inflammation after operative intervention and following acute trauma, relief of fever and pain associated with acute respiratory tract inflammation and dysmenorrhea.

Routes of Administration and Dosage

Oral dosage form in adults :100 mg b.i.d In children : 5 mg/kg/day in 2 or 3 divided doses.

NOM-P is contraindicated in hypersensitivity, active peptic ulcer, moderate to severe hepatic disease and in pregnancy.

can be given- no risks are known in connection with therapeutic doses.

Allowed in therapeutic doses for women who are breast-feeding, only small concentrations in breast milk.

well suited

10-12 mg / kg every 4 to 6 hrs.

Those with Alcohol abuse, Colitis, Crohn’s disease, diverticulitis, gastric ulcer, Diabetes mellitus, Hemorrhoids, Hepatitis, renal disease, rectal irritation or bleeding, Systemic lupus erythematosus and Tobacco abuse may have increased chance of adverse effects.

When NOM-P is taken along with Cyclosporine, Digitalis glycosides, Lithium, Methotrexate, Phenytoin there will be elevated serum levels of these drugs and an increased chance of adverse effects.

PHARMACOLOGY OF THE DRUG MENOL/MENOL-PLUS

Vitamins are essential for normal metabolic functions including hematopoiesis. The B-complex vitamins are necessary for the conversion of carbohydrate, protein and fat into tissue and energy.

METHYL COBALAMIN

Methyl cobalamin is one of the two-coenzyme forms of vit. B12. Evidence indicates this form of vit. B12 in addition to having a theoretical advantage over cyanocobalamin actually has some metabolic and therapeutic applications not shared by the other forms of vit. B12. Methyl cobalamin, and will highlight the potential therapeutic relevance for Bell’s palsy. cancer, diabetic, neuropathy, eye function, heart rate, variability, HIV, homocysterinemia, male-impotence and sleep disorders.

FOLIC ACID

Folic acid water-soluble vitamin in its fully reduced form (Tetrahydrofolate, folate serve as a 1-carbon for synthesis of purines and pyrimidines as well as in the remethylation cycle of homo-cyst to methionine. Folic acid is a complex vitamin after absorption from the gastrointestinal tract. Folic acid is hepatically converted to tetrahydrofolic acid, which is a cofactor in the biosynthesis of purines and thymidylates of nucleic acids. An exogenous source of folic acid is necessary for the maintenance of normal erythropoiesis.

(Its deficiency can lead to meagloblastic and macrocytic anemias as a result of impairment of thymidylate synthesis).

PYRIDOXINE HYDROCHLORIDE

Pyridoxine- dependent seizures an autosomal recessives trait, result from a defective binding of pyridoxine to its apoenzyme, glutamate decarboxylase, the apoenzyme catalyses the conversion of glutamic acid to gamma aminobutyric acid (GABA) which acts as an inhibitory neurotransmitter in the central nervous system. Seizure threshold is lowered in infants with reduced concentrations of GABA.

CONTRAINDICATIONS

Known hypersensitivity to vit. B6. Menol is contraindicated in patients known to be hypersensitive to any of its components.

General certain conditions listed above may require additional nutritional supplementation. During pregnancy, for instance, supplementation with fat-soluble vitamins and minerals may be required according to the dietary habits of the individual. MENOL-PLUS is not intended for treatment of severe specific deficiencies. Information for the Patient: Because toxic reactions have been reported with injudicious use of certain vitamins, urge patients to follow your specific instructions regarding dosage regimen.

As little as 5 mg pyridoxine daily can decrease the efficacy of levodopa in the treatment of Parkinson’s. Therefore, MENOL-PLUS is not recommended for patients undergoing such therapy.

Usual adult dosage: one tablet daily.

Safety and effectiveness in pediatric patients have not been established.

(2)-Prevention and/or treatment of vit. B6 deficiency.

Menol-plus is indicated for supportive nutritional supplementation in conditions in which water-soluble vitamins are required prophylactically or therapeutically. These include: Conditions causing depletion, or reduced absorption or bioavailability of water-soluble vitamins – Gastrointestinal disorders, chronic alcoholism, febrile illnesses, prolonged or wasting diseases, hyperthyroidism or poorly-controlled diabetes. Conditions resulting in increased needs for water-soluble vitamins – Pregnancy, severe burns, recovery from surgery.

Pharmacology of the Drug-Diclofenac Potassium+Serratiopeptidase