Gastrointestinal Agents ● Frequently there is a correlation between the
Inorganic Agents Used to Treat Gastrointestinal
Disorders
1. Products for altering gastric pH
2. Protectives for intestinal inflammation
3. Adsorbents for intestinal toxins 04 Cathartics or
laxatives for constipation
- Most of these products do not require a
prescription, which places the responsibility
directly on the pharmacist as to who should
purchase these items. Many of the indications are
symptoms of a more serious condition and
therefore, the professional pharmacist should
inform himself of the uses and limitations of these
products and all other products he sells and be
ready to advise his customers about their
utilization.
1. ANTACIDS
- The chief indication for administering an antacid is
to neutralize excess hydrochloric acid which may
be causing pain and possible ulceration.
- Another objective is to inactivate the proteolytic
enzyme, pepsin.
- The stomach pH can range from pH 1 when
empty to pH 7 when food is present.
- The low acid pH is due to the presence of
endogenous HCl which is always present under
physiological conditions.
- When hyperacidity develops, the results can
range from gastritis (a general inflammation of the
gastric mucosa) to peptic ulcer (a specified
circumscribed erosion)
- A peptic ulcer can be located in the lower end of
the esophagus (esophageal ulcer), the stomach
(gastric ulcer) and duodenum (duodenal ulcer).
- An esophageal ulcer occurs when the esophageal
sphincter is defective.
- Patients with this condition will frequently suffer
from “heartburn”, which is due to gastric acid
entering the esophagus either during a belch or
upon lying in bed.
- Frequently these people obtain relief by sleeping
on a bed elevated at the head to reduce the flow of
gastric fluid from the stomach into the esophagus.
emotional makeup of the individual and the
incidence of peptic ulcer. A tense individual who
contains his emotions tends to have a greater
incidence of peptic ulcer than does a person who
can “release” his tension.
● Whereas, malignancy and hemorrhage are more
common with gastric ulcers, perforation is more
common with duodenal ulcers. Depending on the
severity and location of an ulcer, treatment will
range from diet and antacid and/or anticholinergic
therapy to complete bed test and possible surgery.
Frequently, removal of an emotional stress situation
is indicated.
● Antacids are alkaline bases used to neutralize the
excess gastric HCl associated with gastritis and
peptic ulcers.
● While no antacid is “ideal”, there have been
certain criteria that have been developed.
Criteria of Antacids
1. should not be absorbable or cause systemic
alkalosis
2. should not be a laxative or cause constipation
3. should exert the effect rapidly and over a long
period of time
4. The reaction of the antacid with gastric HCl
should not cause a large evolution of gas.
5. should buffer in the pH 4-6 range
6. should probably inhibit pepsin
Sodium Bicarbonate as an Antacid
- Sodium bicarbonate is a highly water-soluble
antacid with a rapid onset of action but relatively
short duration.
- It can cause a sharp increase in gastric pH up to
or above pH 7.
- Because of the evolution of carbon dioxide in the
presence of acids, sodium bicarbonate can cause
belching and flatulence.
- Sodium bicarbonate will be found in many
effervescent antacid preparations.
- However, rather than being used as an antacid, its
main function is to react with an acid (citric, tartaric,
etc.) with the evolution of carbon dioxide.
- The result is a “sparkling” flavor in preparations
which would otherwise have a flat saline taste.
ALUMINUM HYDROXIDE USP 31
[Al (OH)3 ; Mol. wt. 77.96]
Properties: The USP 26 recognizes two physical
forms:
Aluminum Hydroxide Gel USP 26
- A white viscous suspension, from which small
amounts of clear liquid may separate on standing.
- The product is permitted to contain aromatics like
peppermint oil and sweetening substances such as
sucrose, glycerin, saccharin or other similar
substances.
- Not more than 0.5% of a preservative I also
allowed like sodium benzoate, benzoic acid, methyl
paraben, etc. It has a pH between 5.5 and 8.0.
Dried Aluminum Hydroxide Gel USP 26
- A white, colorless, tasteless, amorphous powder
insoluble in water and alcohol but soluble in dilute
mineral acids and solutions of fixed alkali
hydroxide.
- The dried gel is also official as Dried Aluminum
Hydroxide Gel and Tablets USP 26, a convenient
dosage form.
- Both forms are assayed in terms of their
aluminum oxide (Al2O3) content and their
acid-consuming capacity.
● The essential characteristic of the gel is the very
fine colloidal particle that would exhibit a large
surface area and thus great absorptive powers
upon which its therapeutic value depends. From a
chemical standpoint, the aluminum hydroxide gels
are ideal buffers in the pH 3-5 region due to their
amphoteric characters.
● A problem with the gels is that of a loss of antacid
properties on aging. Because of the water-soluble
astringent salt, aluminum chloride gel can cause
constipation and occasionally nausea and vomiting.
● The essential characteristic of the gel is the very
fine colloidal particle that would exhibit a large
surface area and thus great absorptive powers
upon which its therapeutic value depends. From a
chemical standpoint, the aluminum hydroxide gels
are ideal buffers in the pH 3-5 region due to their
amphoteric characters. ● A problem with the gels is
that of a loss of antacid properties on aging.
Because of the water-soluble astringent salt,
aluminum chloride gel can cause constipation and
occasionally nausea and vomiting
Uses
- Aluminum Hydroxide gel has been introduced in
therapeutics as gastric antacid and is now widely
employed in the treatment of hypochlorhydria and
peptic ulcer. It is also indicated for intestinal
toxemia.
- One of the theories is that its mechanism of action
is attributed to its capability of absorbing
hydrochloric acid, toxins, gases and bacteria.
- This is an advantage of the gel which apparently
absorbs pepsin. It can also interfere with the
adsorption of the other drugs and caution should be
exercised in the co-administration of the gels and
other drugs.
Calcium Containing Antacids
- This group of antacids differ from the aluminum
antacids in that their action is dependent upon their
basic properties and not on an amphoteric effect.
- Those used in medicine are poorly soluble salts
which will only go into solution if there is acid
present to consume the small amount of solubilized
salt already in solution.
- In vitro and in vivo studies show that the calcium
antacids raise the stomach pH to nearly 7. The
calcium antacids tend to be constipating and are
usually found in combination with magnesium
antacids.
CALCIUM CARBONATE USP 31
(CaCO3 ; Mol. wt. 100.09)
Synonyms: Precipitated Chalk
Properties:
- Calcium Carbonate USP 26 is a fine, white,
odorless, tasteless, microcrystalline powder which
is stable in air.
- It is practically insoluble in water but its solubility
is increased by the presence of any ammonium salt
or carbon dioxide.
- The presence of any alkali reduces its solubility. It
is insoluble in alcohol and dissolves with
effervescence in diluted acetic acid, diluted
hydrochloric acid and diluted nitric acid.
Uses:
- Because of its fast action, calcium carbonate is
one of the most popular antacids. Its action is
limited by the amount of salt that will go into the
solution.
- Thus, as gastric HCl consumes the solubilized
calcium carbonate, more goes into solution. This
process continues until the acid or the calcium
carbonate is consumed.
- Because of calcium’s constipated effect, most
calcium carbonate preparations will be found in
combination with the magnesium antacids.
- USP 26 recognizes Calcium carbonate
Lozenges and Oral suspension.
TRIBASIC CALCIUM PHOSPHATE NF 26
Synonyms: Precipitated Calcium Phosphate,
Tertiary Calcium Phosphate, Calcium Phosphate
Occurrence:
- Tribasic calcium Phosphate consists of a variable
mixture of calcium phosphates having the
approximate composition 10CaO.3P2O5.H2O.
- After ignition at 800°C for 30 minutes, it contains
an amount of phosphate equivalent to n.l.t. 90% of
tribasic calcium phosphate Ca3(PO4)2.
- Calcium phosphate is found abundantly in nature
as phosphorite or phosphate rock and apatite,
Ca3(PO4)2.CaF2
Properties:
- Tribasic Calcium Phosphate is a white, odorless
and tasteless powder, insoluble in water and
alcohol but dissolves readily in diluted HCl and
HNO3
Uses:
- As an antacid in the treatment of hyperacidity.
- The explanation is that the production of primary
and secondary phosphate diminishes the hydrogen
ion concentration of the gastric HCl. It has an
advantage over sodium bicarbonate or other
carbonate in that there is no gas produced that may
cause flatulence and does not alkalinize the
system.
- It is also used as a source of calcium for the
system but because of its insolubility, very little
calcium is absorbed and is therefore not valuable in
acute calcium deficiency.
Magnesium Containing Antacids
- There are a large number of official antacids
containing magnesium trisilicate, they all function in
the same manner.
- They are poorly soluble salts which can only go
into solution as acid consumes the small amount of
anion already in solution.
- As the pH of the stomach approaches neutrality,
the rate of dissolution of the magnesium salt slows
down and stops at neutrality, the rate of dissolution
of the magnesium salt slows down and stops and
stops at neutrality.
- Thus, it is the anion rather than the magnesium
cation that confers the antacid properties.
- The magnesium cation causes this group of
antacids to be laxatives. For this reason, they are
usually found in combination with aluminum and
calcium antacids in an attempt to equalize with
constipative and laxative reactions.
MAGNESIUM CARBONATE USP 31
[Mg(CO3)4.Mg(OH)2.5H2O]
Synonyms: Carbonate of Magnesia; Magnesium
Carbonate; Heavy Magnesium Carbonate
Properties:
- Magnesium carbonate is a white, bulky, odorless
powder having a slightly earthly taste and often
occurs in friable masses, nearly insoluble in water
to which imparts a slightly alkaline reaction which is
due to a slight dissociation of the Mg (OH)2.
- It is insoluble in alcohol but dissolves with
effervescence in dilute acids.
Uses:
- The antacid properties of Magnesium Carbonate
are due to the hydroxide and carbonate anion
reacting with the gastric HCl.
- Due to its very limited solubility, magnesium
carbonate dissolves only as carbonate and
hydroxide are being consumed.
MAGNESIUM HYDROXIDE USP 31
[Mg (OH)2 ; Mol. wt. 58.32]
Properties:
- Magnesium Hydroxide is a white, bulky powder,
practically insoluble in water and alcohol but
dissolves in acids.
Uses:
- Due to its basic character, it is an efficient antacid.
In high doses, it is used as a laxative. This is due to
the formation of magnesium chloride in the
stomach which exerts a “salt action” in the intestinal
tract, causing a mild laxative action.
MILK OF MAGNESIA is a suspension of
magnesium hydroxide containing n.l.t. 7% and
n.m.t. 8.5% Mg (OH)2. To minimize the interaction
of glass containers and Mg (OH)2, small amounts
of citric acid may be added. Suitable flavoring
agents may be added to Milk of Magnesia.
Milk of Magnesia is a very popular antacid and
laxative.
MAGNESIUM OXIDE USP 31
(MgO ; Mol. wt. 40.30)
Synonym: Magnesia
Properties:
- The USP recognizes two varieties of medical
Magnesium Oxide:
1) Light Magnesium
2) Heavy Magnesium Oxide
- These two forms of magnesium oxide are identical
in chemical composition and in purity. They are
white, odorless, powders that are nearly insoluble
in water and in alcohol. Both dissolve in dilute
acids. Upon exposure to air, they absorb carbon
dioxide and moisture.
- The two oxides differ from one another in density:
- 5 grams of Light magnesium Oxide occupy a
volume of approximately 40 to 50 mL.
- 5 grams of Heavy Magnesium Oxide occupy a
volume of approximately 10 to 20 mL.
- The Light Magnesium Oxide hydrolyzes to Mg
(OH)2 more easily than the heavy oxide.
Uses:
- Magnesia may be employed as a laxative, diuretic
and antacid.
- In order to prevent the formation of a gelatinous
mass, it should be administered in about 29 times
its weight of water. The magnesia should be added
to water and not reversed in order to avoid the
formation of hard lump.
- Internally, it is also given as an arsenic antidote.
MAGNESIUM TRISILICATE USP 31
(2MgO.3SiO2.xH2O;Mol. wt.260)
Composition:
- Magnesium Trisilicate USP is defined as a
compound of magnesium oxide and silicon dioxide
containing varying proportions of water.
- It contains n.l.t. 20% of magnesium oxide and
n.m.t. 45% of silicon dioxide.
Properties:
- Magnesium trisilicate occurs as a fine, white,
odorless tasteless powder, free from grittiness.
- It is insoluble in water and alcohol but readily
decomposed by mineral acids.
- It is assayed in terms of silicon dioxide and
magnesium oxide and must have a definite
magnesium oxide/silicon oxide ratio.
- As the amount of silicon dioxide increases with
respect to magnesium oxide, there is loss in
antacid capability.
Uses:
- Magnesium Trisilicate was introduced as a gastric
antacid especially valuable in peptic ulcer. It is
believed that is value depends on the following
reaction:
2 MgO.3SiO2.xH2O + 4H → 3 SiO2.xH2O + Mg2+
+ 2 H2O
- The colloidal silicic acid or hydrous silica which is
formed in the reaction has adsorptive powers and
could protect the ulcer from further acid and peptic
attack possible adsorbs the pepsin.
MAGNESIUM PHOSPHATE USP 31
[Mg3 (PO4)2.5H2O ; Mol. wt. 353]
Synonym: Tertiary Magnesium Phosphate
Properties:
- Magnesium Phosphate is a white, odorless and
tasteless powder which is readily soluble in diluted
mineral acids but almost insoluble in water.
Use: As an antacid
Combination Antacid Preparation
- Because no single antacid meets all the criteria
of an ideal antacid, several products are on the
market containing mixtures of antacids.
- Most of these combination products are an
attempt to balance the constipative effect of
calcium and aluminum with laxative effect of
magnesium.
- Some of these products are also a mixture of an
antacid with rapid onset of action and one with a
supposedly longer duration of action.
a) Aluminum Hydroxide Gel – Magnesium
Hydroxide Combination: Aludrox, WinGel, Maalox
and Cremalin
b) Aluminum Hydroxide Gel – magnesium
Trisilicate Combination: Gelusil, Tricreamalate,
Triosgel
c) Magaldrate – chemical combination of aluminum
hydroxide and magnesium hydroxide (Riopan)
d) Simethicone – containing antacids: Di-Gel,
Mylanta Because many people with gastric
hyperacidity complain of being “gassy” the
defoaming agent, simethicone, has been added to
some antacids.
e) Alginic acid – sodium bicarbonate containing
antacids: Gavison, Foamtab. This type of
preparation was formulated in an attempt to provide
a symptomatic relief or reflux esophagitis.
2. PROTECTIVES AND ADSORBENTS
- This group of gastrointestinal agents is commonly
used for the treatment of mild diarrhea.
- Diarrhea is a symptom and not a disease.
- It results when some factors impair digestion
and/or adsorption, thereby increasing the bulk of
the intestinal tract. The increased bulk stimulates
peristalsis, propelling the intestinal contents to the
anus.
Diarrhea - is a serious condition
Very Young/ Elderly Pt - particularly for the very
young or elderly patients.
Dehydration - The loss of fluids and electrolytes
can quickly lead to dehydration and electrolyte
imbalance.
- Acute diarrhea can be caused by bacterial toxins,
chemical poisons, drugs, allergy and disease. The
effect of these agents ranges from tissue damage
or irritation to that of causing electrolytes to flow
from body fluids into the intestinal tract.
- Chronic diarrhea can result from gastrointestinal
surgery, carcinomas, chronic inflammatory
conditions and various adsorptive defects.
- Most products for the treatment of diarrhea will
consist of an adsorptive protective, an antidiarrheal
agent and possibly an antibacterial agent.
- The ideal antidiarrheal should not act directly on
the smooth muscle of the gut to produce a
spasm-like effect which decreases peristalsis and
increases segmentation.
- The antibacterial is only effective if there is an
actual infection caused by microorganisms.
- The adsorbent-protective supposedly adsorb
toxins, bacteria and viruses along with providing a
protective coating of the intestinal mucosa.
Bismuth Containing Products
- The use of bismuth salts as an antidiarrheal agent
seems to be supported chiefly by tradition.
- They are considered as water insoluble but a
small amount goes into solution. The soluble
bismuth cation supposedly exerts a mild astringent
and antiseptic action.
- Intestinal hydrogen sulfide acts upon the bismuth
alts to form bismuth sulfide, hence, the black stool
resulting from the oral administration of
bismuth-containing preparations.
BISMUTH SUBNITRATE USP 31
[Bi(OH)2(NO3)4.BiO(OH)]
Synonyms: Basic Bismuth Nitrate; White Bismuth
Properties:
- Bismuth Subnitrate occurs as a white, slightly
hygroscopic powder which gives an acid reaction
using blue litmus paper. It is practically insoluble in
water and in alcohol but is readily dissolved by HCl.
It is assayed in terms of bismuth trioxide (Bi2O3).
- Bismuth Subnitrate is incompatible with
tragacanth, in which tragacanth precipitates as a
hard mass in the presence of the salt. This difficulty
may be overcome by the addition of sodium
biphosphate or trisodium phosphate.
Uses:
- It is used as an effective non-irritant intestinal
antiseptic.
- Bismuth salts lessens gastric secretion and
reduces acidity hence, it is employed in treating
gastric ulcers and inflammations.
- Bismuth Subnitrate is a common remedy against
diarrhea.
BISMUTH SUBCARBONATE USP 31
[BiO2(CO3)2.H2O]
Synonym: Basic Bismuth Carbonate
Properties:
- Bismuth Subcarbonate is a white or pale yellowish
white, odorless, tasteless powder which is stable in
air, but is slowly affected by light.
- It is practically insoluble in water but dissolves in
HCl with effervescence.
- Bismuth Subcarbonate is assayed in terms of its
bismuth trioxide content.
Uses:
- It is used for its protective and antacid effect in
inflammation of the stomach and bowels.
- It is also given in large doses (60 grams) for
rendering the alimentary canal opaque to x-ray.
- It is used as an astringent and adsorbent and in
the treatment of diarrhea and dysentery.
MILK OF BISMUTH USP 31
Synonyms: Bismuth Magma, Bismuth Cream
Composition:
- Milk of Bismuth contains bismuth hydroxide and
bismuth subcarbonate in suspension in water.
- It is made by converting bismuth subnitrate to
bismuth nitrate by the addition of nitric acid.
- Then, by the treatment with ammonium carbonate
and ammonia solution, bismuth nitrate is converted
to bismuth hydroxide and subcarbonate
Uses: Astringent Antacid
KAOLIN USP 31
(Al2O3.2SiO2.2H2O)
Synonym: Porcelain Clay; China Clay; Bolus Alba
Composition:
- Kaolin is a native hydrated aluminum silicate,
powdered and freed from gritty particles by
elutriation.
- It contains about 20.9% of aluminum with an
approximate formula Al2O3.2SiO2.2H2O formed by
weathering of feldspar, KalSi3O8.
Properties:
- A soft, yellowish white or whitish powder or in
lumps, insoluble in water and in cold dilute acids
and in solutions of alkali hydroxides.
- It has an earthly and clay-like taste. When
moistened with water, it assumes a darker color
and develops a marked clay-like color.
Uses:
- It is usually found together with the vegetable
carbohydrate, pectin (Kaopectate, Kao-Con) and
employed a protective and adsorbent in diarrheal
disorders.
- Kaolin-containing products have been reported to
interfere materially with the intestinal absorption of
lincomycin.
Activated Charcoal USP 31
- An adsorbent in the treatment of diarrhea
- An antidote in certain types of poisoning
3. SALINE CATHARTICS
- Saline cathartics (purgatives) are agents that
quicken and increase evacuation from the bowels.
- Laxatives are mild cathartics. Most products can
be purchased without prescription hence this group
has been widely used, abused and often
overpromoted by the manufactures.
The 1972 AMA Drug Evaluation states the criteria
when cathartics are properly used:
1) To ease defecation in patients with painful
hemorrhoids or other rectal disorders.
2) To avoid potentially hazardous rises in blood
pressure during defecation in patients with
hypertension, cerebral arterial diseases.
3) To relieve acute constipation.
4) To remove solid material from the intestinal tract
prior to certain roentgenographic studies.
- Laxatives should only be used for short term
therapy as prolonged use may lead to loss of
spontaneous bowel rhythm upon which normal
evacuation depends, causing the patient to become
dependent on laxatives, the so-called, “laxative
habit”.
4 Types of Laxative
1. Stimulant Laxatives act by local irritation on the
intestinal tract which increases peristaltic activity.
2. Bulk-forming Laxatives are made from
cellulose and other non-digestible polysaccharides
which swell when wet and with increased bulk
stimulate peristalsis.
3. Emollient Laxatives act neither as lubricants
facilitating the passage of compacted fecal material
or as stool softeners. Example is Mineral Oil.
4. Saline Cathartics act by increasing the osmotic
load of the gastrointestinal tract. They are salts of
poorly absorbable anions and sometimes cations.
The body relieves the hypertonicity of the gut by
secreting additional fluids into the intestinal tract.
The resolution increased bulk stimulate peristalsis.
MONOBASIC SODIUM PHOSPHATE USP 31
[NaH2.PO4.H2O ; Mol.wt.138]
Synonyms: Sodium Dihydrogen Phosphate;
Sodium Acid Phosphate, Primary Sodium
Phosphate, Sodium biphosphate
Properties:
- Sodium Biphosphate is a colorless crystal or as a
white crystalline powder. It is odorless and is
slightly deliquescent. Its solution is acid to litmus
and effervescent with sodium carbonate.
- These acidic properties are due to the acid
dihydrogen phosphate anion. The USP 26
recognizes salt in the anhydrous form and with one
or two moles of water of hydration.
Uses:
- Official category is as a urinary acidifier.
- It is also used as a cathartic.
- This salt is used to render the urine acidic in case
of cystitis with hexamethylenetetramine
(Methenamine), as this substance decomposes into
formaldehyde only in the presence of acids.
DIBASIC SODIUM PHOSPHATE USP 31
[Na2HPO4.7H2O; Mol. wt. 268.07]
Synonyms: Dibasic Sodium Phosphate; Disodium
Hydrogen Phosphate; Secondary Sodium
Phosphate
Properties:
- Sodium Phosphate occurs as a colorless or white
granular salt which effervesces in warm dry air. Its
solutions are alkaline to litmus and phenolphthalein
with a pH of 9.5. It is freely soluble in water and
very soluble in alcohol. It is also official with one,
two seven or twelve moles water of hydrogen.
Uses: Because of the poor intestinal permeability of
the monohydrogen phosphate ion, this product is
widely used as a saline cathartic.
Caution: This sodium Phosphate (Dibasic) should
never be confused with the commercial tribasic
sodium phosphate which is very alkaline and
caustic and should be used for intestinal purposes.
POTASSIUM TARTRATE USP 31
[KNaC4H4O6.4H2O Mol. wt. 282.23]
Synonyms: Rochelle Salt; Seignette Salt
Properties:
- Potassium sodium tartrate occurs as colorless
crystals or as a white crystalline powder having a
cooling saline taste.
- Because it effloresces slightly in warm, dry air, the
crystals are often coated with a white powder. It is
freely soluble in water and practically insoluble in
alcohol.
Uses:
- The main use of Rochelle Salt in therapeutics is
as cathartic, its activity ranging from mild laxative to
the more potent hydragogue depending upon the
dose administered.
- It is a pharmaceutical necessity and an ingredient
of Seidlitz Powder which is the form in which
potassium sodium tartrate is administered as
cathartic. It is an effervescent preparation and is a
palatable product.
- Rochelle Salt is one of the components of the
useful reagent, Fehling’s Solution, officially called
Alkaline Cupric Tartrate.
- This is an example of the chelate complexion
wherein the concentration of the cupric is very little
and is not precipitated by the sodium hydroxide
present in the present.
MAGNESIUM SULFATE USP 31
[MgSO4 .7H2O ; Mol. wt. 246.48]
Synonyms: Epsom Salt, Bitter salt
Preparation:
- Magnesium Sulfate can be prepared by:
1. Treating the mineral magnesite (MgCO3) with
hot dilute sulfuric acid,
2. Dissolving the mineral kieserite (MgSO4.H2O) in
water, heating and then concentrating the solution
to crystallization.
3. Heating by calcination dolomite
(MgCO3.CaCO3) then treating with HCl and
evaporating to dryness. The dried mass is
dissolved in sulfuric acid, boiled and filtered. The
filtrate containing magnesium sulfate is evaporated
to crystallization.
Properties:
- Magnesium Sulfate occurs as small, colorless
crystals, usually needle-like, with a cooling saline
bitter taste.
- It effloresces in air and its solutions are neutral to
litmus. It is freely soluble in boiling water and
sparingly in alcohol.
Uses:
- Magnesium Sulfate is an active cathartic
operation with but little pain or nausea and
producing watery stools. The chief objection to its
use is the disagreeable bitter taste which can be
lessened by administering the solution in an
ice-cold condition.
- Parenterally, it is used as an anticonvulsant. It
is also used locally in saturated solution for its
anesthetic effect in sprains and bruises and
appears to be possessed of some sort of
antiphlogistic action.

MAGNESIUM CITRATE USP 31

Synonyms: Citrate of Magnesia; Purgative
Lemonade
Preparation:
- Magnesium Citrate is made by reacting
magnesium carbonate with citric acid.
- Following the addition of flavoring agents, sodium
or potassium bicarbonate is added to react with the
remaining citric acid yielding a palatable,
carbonated, lemon flavored solution.
- It must be sterilized or pasteurized.

Non-Official Saline Cathartics

1. SODIUM SULFATE Glauber’s Salt
2. POTASSIUM PHOSPHATE Dibasic Potassium
Phosphate, Dipotassium Hydrogen Phosphate,
DKP
3. POTASSIUM BITARTRATE Cream of Tartar,
Potassium Acid Tartrate, Potassium Hydrogen
Tartrate
4. CALOMEL Mercurous Chloride, Mild Mercury
Chloride