Norstrep

Norstrep Uses, Dosage, Side Effects, Food Interaction and all others data.

Loperamide inhibits the peristaltic activity of longitudinal and circular smooth muscle in the intestine by interacting with cholinergic and noncholinergic neuronal mechanisms responsible for producing the peristaltic reflex.

Loperamide binds to the opiate receptor in the gut wall, reducing propulsive peristalsis, and increase intestinal transit time.Loperamide is orally administered capsule. After administration absorption is more than 65% which occurs at a modest rate, with peak serum levels of 2-3 µgm/litre occurring at about 4 hours later after oral administration. The rest 35% is excreted unchanged in the faeces. Loperamide undergoes an extensive presystemic first pass metabolism in the gut wall and in the liver. Loperamide does not act centrally due to its high affinity for the gut wall and its presystemic metabolism. This is why it reaches the systemic circulation in very minute amount. The route of elimination is 0.63-1.4% in urine as unchanged drug, 58% is excreted in the bile and 15-23% appears in the faeces.

Loperamide is a synthetic anti-diarrheal indicated for the control and symptomatic relief of acute nonspecific diarrhea and of chronic diarrhea associated with inflammatory bowel disease. Loperamide is also indicated for reducing the volume of discharge from ileostomies. In man, Loperamide prolongs the transit time of the intestinal contents. It reduces the daily fecal volume, increases the viscosity and bulk density, and diminishes the loss of fluid and electrolytes. Tolerance to the antidiarrheal effect has not been observed. Loperamide is an opioid receptor agonist and acts on the mu opioid receptors in the myenteric plexus large intestines; it does not affect the central nervous system like other opioids. It works specifically by decreasing the activity of the myenteric plexus which decreases the motility of the circular and longitudinal smooth muscles of the intestinal wall. This increases the amount of time substances stay in the intestine, allowing for more water to be absorbed out of the fecal matter. Loperamide also decreases colonic mass movements and suppresses the gastrocolic reflex.

A synthetic fluoroquinolone (fluoroquinolones) with broad-spectrum antibacterial activity against most gram-negative and gram-positive bacteria. Norfloxacin inhibits bacterial DNA gyrase.

Norfloxacin is a quinolone/fluoroquinolone antibiotic. Norfloxacin is bactericidal and its mode of action depends on blocking of bacterial DNA replication by binding itself to an enzyme called DNA gyrase, which allows the untwisting required to replicate one DNA double helix into two. Notably the drug has 100 times higher affinity for bacterial DNA gyrase than for mammalian.

Norstrep
Uses
Dosage
Side Effect
Precautions
Interactions
Uses during Pregnancy
Uses during Breastfeeding
Accute Overdose
Food Interaction
Half Life
Volume of Distribution
Clearance
Interaction With other Medicine
Contradiction
Storage

Trade Name	Norstrep
Generic	Norfloxacin + Loperamide
Weight	200mg
Type	Capsule
Therapeutic Class
Manufacturer	Torque Pharmaceuticals Pvt Ltd
Available Country	India
Last Updated:	September 19, 2023 at 7:00 am

Uses

Loperamide is used for a symptomatic treatment of acute and chronic diarrhoea

Norfloxacin is a broad-spectrum fluoroquinolone antibiotic with variable activity against gram-positive and gram-negative bacteria. Typically reserved for the treatment of UTIs due to accumulation in the urine.

For the treatment of urinary tract infection

Norstrep is also used to associated treatment for these conditions: Chronic Functional Diarrhea, Diarrhoea, Intestinal stoma leak, Traveler's DiarrheaCystitis, Gonococcal cervicitis, Infectious diarrhea, Pyelitis, Pyelonephritis, Spontaneous Bacterial Peritonitis (SBP), Traveler's Diarrhea, Urethritis gonococcal

How Norstrep works

In vitro and animal studies show that Loperamide acts by slowing intestinal motility and by affecting water and electrolyte movement through the bowel. Loperamide inhibits peristaltic activity by a direct effect on the circular and longitudinal muscles of the intestinal wall. It is a non-selective calcium channel blocker and binds to opioid mu-receptors. Evidence also suggests that at higher concentrations it binds to calmodulin.

The bactericidal action of Norfloxacin results from inhibition of the enzymes topoisomerase II (DNA gyrase) and topoisomerase IV, which are required for bacterial DNA replication, transcription, repair, and recombination. Norfloxacin is a broad-spectrum antibiotic agent that is shown to be effective against various Gram-positive and Gram-negative bacterial species. The fluorine atom at the 6 position increases potency against gram-negative organisms, and the piperazine moiety at the 7 position is responsible for anti-pseudomonal activity

Dosage

Norstrep dosage

Acute diarrhoea-

The initial dose is 2 capsules for adults and 1 capsule for children older than eight; in addition 1 capsule should be taken at any subsequent loose stool. The daily dose, however should not exceed 8 capsules for adults, for children 4-6 capsules according to age.

Chronic diarrhoea-

Initial dose:

Adults: 2 capsules daily.
Children older than eight: 1 capsule daily.

Maintenance dose: One should aim at obtaining normal stools (e.g., one or two stools of good consistency a day). For this it may be necessary to adjust the initial dose (by increasing or decreasing it as required). Maintenance dose as a rule will vary from 1 to 6 capsules daily

Side Effects

On occasions paralytic ileus, abdominal cramps and bloating have been reported. Other side effects observed are skin reactions including urticaria, nausea, vomiting, constipation, tiredness, drowsiness, dizziness and dry mouth.

Toxicity

Oral, mouse: LD₅₀ = 105 mg/kg. Symptoms of overdose include constipation, drowsiness, lethargy, and nausea.

Precaution

It should be used with caution in patients with defective hepatic function as this might result in a relative overdose.

Interaction

No drugs are known to be incompatible with Loperamide

Elimination Route

Not significantly absorbed from the gut

Rapid

Half Life

9.1 to 14.4 hours (average 10.8 hours)

3-4 hours

Elimination Route

Excretion of the unchanged loperamide and its metabolites mainly occurs through the feces.

Norfloxacin is eliminated through metabolism, biliary excretion, and renal excretion. It is expected to undergo both glomerular filtration and tubular secretion during renal excretion, as shown by its high renal clearance rate of approximately 275 mL/min.

Pregnancy & Breastfeeding use

Safety of use of Loperamide during pregnancy has not been established, although studies in animal did not demonstrate any teratogenic effects. Therefore, it should not be administered to the patients during pregnancy. Although the fraction of loperamide secreted in the human milk is very low, caution is advised if it is to be administered to nursing mothers.

Contraindication

It should not be used in children less than 4 years of age. It must not be used when inhibition of peristalsis is to be avoided in particular when constipation are present or when abdominal distension develops particularly severely dehydrated children or in patients with acute ulcerative colitis or pseudomembranous colitis associated with broad spectrum antibiotics. It should not be used alone in acute dysentery associated with blood in stools and elevated temperature.