How Do Other Gastrointestinal Agents Work?

Other gastrointestinal agents are medications used to treat a wide range of disorders involving the digestive system. Gastrointestinal medications that do not fall into any specific class of gastrointestinal drugs are categorized as other gastrointestinal agents.

Other gastrointestinal agents include the following:

• Bismuth subgallate: Bismuth subgallate is a gastrointestinal deodorant that deodorizes flatulence and stool. Bismuth subgallate is a heavy metal salt that is relatively insoluble and poorly absorbed by the intestines. Bismuth subgallate is believed to deodorize by inhibiting colonic bacteria from acting on fermented food residues. 
• Chlordiazepoxide/clidinium: Chlordiazepoxide/clidinium is a combination medication that relieves anxiety, and is also antispasmodic, used to treat both emotional and physical factors of gastrointestinal conditions such as irritable bowel syndrome (IBS) and peptic ulcers.
  • Chlordiazepoxide relieves anxiety by depressing the central nervous system, including the limbic system that regulates emotional responses. Chlordiazepoxide enhances the activity of gamma-aminobutyric acid (GABA), a neurotransmitter that has inhibitory effects.
  • Clidinium reduces gastrointestinal spasms and acid secretions by inhibiting acetylcholine, a neurotransmitter that regulates muscle contraction and the function of secretory glands.
• Chlorophyll: Chlorophyll is a green pigment found in plants and algae. Chlorophyll is available over the counter, often used as a dietary supplement. Chlorophyll is used to reduce fecal and flatulence odor, however, it is not clear how it works and there is no conclusive evidence on its effectiveness as a gastrointestinal deodorant.
• Famotidine/calcium carbonate/magnesium hydroxide: Famotidine/calcium carbonate/magnesium hydroxide is a combination medication used to treat indigestion and heartburn. Famotidine reduces acid production in the stomach by blocking histamine H2-receptors. Calcium carbonate and magnesium hydroxide are antacids that neutralize gastric acid.
• Misoprostol: Misoprostol is a synthetic form of prostaglandin E1, a natural substance that protects the gastric mucous membrane (mucosa). Misoprostol inhibits stomach acid secretion and is used to prevent ulcers that can occur from the use of non-steroidal anti-inflammatory drugs (NSAIDs) which inhibit prostaglandin activity.
  • Misoprostol stimulates bicarbonate secretion in the duodenum which improves fat absorption in the intestines and is used to treat patients with fat malabsorption. Misoprostol strengthens uterine contraction and is used in pregnancy termination, and to soften and dilate the cervix and induce labor in full-term pregnancy.
• Nitroglycerin rectal: Nitroglycerin rectal is an ointment topically applied to treat pain from chronic rectal fissures. Nitroglycerin releases nitric oxide, which increases the concentration of a signaling molecule known as cyclic guanosine monophosphate (cGMP) in the inner anal sphincter muscle. This dilates blood vessels and relaxes the sphincter muscles, reducing pressure on the rectal fissures.
• Orlistat: Orlistat is a medication used in conjunction with diet and exercise, to manage obesity. Orlistat works by reducing the digestion and absorption of dietary fats. Orlistat inhibits gastric and pancreatic lipases, enzymes that break down triglycerides into absorbable free fatty acids and monoglycerides.
• Phenylephrine/cocoa butter rectal: Phenylephrine/cocoa butter rectal suppository is inserted into the rectum to treat hemorrhoids. Phenylephrine is a synthetic form of epinephrine, a hormone that makes the smooth muscles around blood vessels contract. Phenylephrine constricts blood vessels and reduces inflammation in the hemorrhoids, and cocoa butter moisturizes and lubricates the rectal/anal passage.
• Phenylephrine/mineral oil/petrolatum rectal: Phenylephrine/mineral oil/petrolatum rectal is a combination ointment applied in the anal canal to treat hemorrhoids. Phenylephrine constricts blood vessels and reduces inflammation, mineral oil softens the stool in the colon, and petrolatum acts as a moisturizer and lubricant.
• Phenylephrine/pramoxine/glycerin/petrolatum rectal: Phenylephrine/pramoxine/glycerin/petrolatum rectal is a combination rectal ointment to treat hemorrhoids. Phenylephrine constricts blood vessels and reduces inflammation, pramoxine numbs the area to relieve pain temporarily, glycerin acts as a stool softener and laxative, and petrolatum provides moisturizing and lubricating effects.
• Phenylephrine/witch hazel topical: Phenylephrine/witch hazel topical is a cooling gel applied to relieve pain from hemorrhoids. Phenylephrine constricts blood vessels and reduces inflammation in the hemorrhoids. The witch hazel component is a plant extract that contains tannins and oils that reduce inflammation and bleeding and help heal the tissue.
• Pramoxine: Pramoxine is a cream used to relieve pain and itching from hemorrhoids, vaginal itching, and skin irritations. Pramoxine is a local anesthetic that reduces pain and irritation by inhibiting the conduction of nerve impulses from the sensory nerves in the treatment area.
• Simethicone: Simethicone is a medication taken orally to relieve gas retention. Simethicone changes the surface tension of gas bubbles causing them to collapse, which enables easier passage of gas and prevents the formation of gas pockets in the gastrointestinal tract.
• Starch suppository: Starch suppositories are used to relieve hemorrhoid symptoms of pain, itching, and irritation. Topically applied starch forms a protective barrier in the anal passage and reduces pain and discomfort during bowel movements.
• Sucralfate: Sucralfate is a medication used in the treatment of gastrointestinal ulcers. Sucralfate adheres to the ulcer surface and protects it from gastric acid, digestive enzyme pepsin, and bile salts, allowing the ulcer to heal.
• Vasopressin: Vasopressin is used to prevent stomach distention that can occur after surgery, to dispel gas shadows that can interfere with stomach x-rays, and to treat diabetes insipidus, a condition that causes excessive and dilute urination that can lead to dehydration.
  • Vasopressin is a synthetic formulation of the natural hormone vasopressin, an antidiuretic hormone that maintains blood volume. Vasopressin increases the reabsorption of water in the kidneys, reducing fluid loss with urine. Vasopressin also stimulates peristalsis, a series of muscle contractions that move gas and other gastrointestinal contents.

Other gastrointestinal agents may be administered through different routes including:

• Oral: Tablets, capsules, chewable tablets, liquids, and suspensions
• Intra-anal/rectal: Ointments, gels, lotions, creams, and suppositories
• Injections: Intramuscular (IM), subcutaneous (SC), or intravenous (IV)

Uses of other gastrointestinal agents include:

• Bismuth subgallate:
  • Eliminate or reduce fecal odor with colostomy/ileostomy (surgical procedures to remove damaged parts of intestines and create an artificial opening in the stomach wall) or incontinence, and odor from flatulence
• Chlordiazepoxide/clidinium:
  • Control emotional and somatic factors in gastrointestinal disorders such as peptic ulcer, irritable bowel syndrome (IBS), and acute enterocolitis (intestinal inflammation)
• Chlorophyll:
  • Eliminate or reduce fecal odor with colostomy, ileostomy, or incontinence
  • Famotidine/calcium carbonate/magnesium hydroxide:
  • Relieve heartburn associated with indigestion
• Misoprostol:
  • Prevention of NSAID-induced ulcer
  • Pregnancy termination (in combination with mifepristone)
  • Prevention of stress ulcers (off-label)
  • Induction of labor (off-label)
  • Control of postpartum hemorrhage (off-label)
  • Treatment of incomplete abortion (off-label)
  • Fat malabsorption in pediatric cystic fibrosis patients (off-label)
  • Expulsion of conception products in intrauterine fetal death (orphan designation)
• Nitroglycerin rectal:
  • Treatment of chronic rectal fissure pain
• Orlistat:
  • Obesity management
  • Phenylephrine/cocoa butter:
  • Treatment of hemorrhoids
  • Phenylephrine/mineral oil/petrolatum rectal:
  • Treatment of hemorrhoids
  • Phenylephrine/pramoxine/glycerin/petrolatum rectal:
  • Treatment of hemorrhoids
• Phenylephrine/witch hazel topical:
  • Treatment of hemorrhoids
• Pramoxine:
  • Relieve minor skin irritation
  • Relieve vaginal itching
  • Relieve hemorrhoid pain and itching
• Simethicone:
  • Treatment of gas retention in the gastrointestinal tract
• Starch suppository:
  • Treatment of hemorrhoids
• Sucralfate:
  • Duodenal ulcer
  • Stress ulcer (off-label)
  • Gastric ulcer (off-label)
  • Stomatitis, oral inflammation (off-label)
  • Oral ulcerations and dysphagia (swallowing difficulty) in patients with epidermolysis bullosa, a condition that causes blisters on the skin and mucous membranes (orphan designation)
  • Oral complications after bone marrow transplantation (orphan designation)
• Vasopressin:
  • Abdominal distention
  • Diabetes insipidus
  • Abdominal roentgenography (x-ray)
  • Gastrointestinal hemorrhage (off-label)
  • Vasodilatory shock (off-label)

Side effects of other gastrointestinal agents vary with each drug. A few of the most common side effects may include:

• Bismuth subgallate:
  • Temporary darkening of the tongue
  • Temporary dark/black stool discoloration
• Chlordiazepoxide/clidinium:
  • Drowsiness and confusion
  • Ataxia (impaired balance, coordination, and speech)
  • Skin eruptions and edema
  • Menstrual irregularities
  • Constipation
  • Nausea
  • Xerostomia (dry mouth)
  • Increase or decrease in libido
• Chlorophyll:
  • Gastrointestinal cramping
  • Diarrhea
  • Dark green staining of stools
  • Famotidine/calcium carbonate/magnesium hydroxide:
  • Headache
  • Constipation
  • Diarrhea
• Misoprostol:
  • Diarrhea
  • Abdominal pain
  • Headache
  • Anaphylaxis (severe allergic reaction)
  • Anemia
  • Cardiac dysrhythmia (abnormal heart rhythm)
  • Rupture of uterus
  • Nitroglycerin rectal:
  • Headache
  • Dizziness and lightheadedness
  • Nausea and vomiting
  • Hypotension (low blood pressure), including orthostatic hypotension (blood pressure drop when standing up from sitting or lying down)
  • Allergic reactions
  • Methemoglobinemia (excessive methemoglobin in blood, a form of hemoglobin that doesn’t release oxygen to the tissue)
• Orlistat:
  • Oily spotting
  • Flatulence
  • Oily/fatty stool
  • Increased defecation and fecal incontinence
  • Nausea and vomiting
  • Reduced absorption of fat-soluble vitamins and beta-carotene
  • Phenylephrine/cocoa butter:
  • Allergic reaction
  • Phenylephrine/mineral oil/petrolatum rectal:
  • Allergic reaction
  • Phenylephrine/pramoxine/glycerin/petrolatum rectal:
  • Allergic reaction
  • Phenylephrine/witch hazel topical:
  • Allergic reaction
• Pramoxine:
  • Irritation
  • Pruritus (itching)
• Simethicone:
  • Loose stools
  • Starch suppository:
  • Irritation
  • Pruritus (itching)
• Sucralfate:
  • Constipation or diarrhea
  • Dry mouth
  • Flatulence and indigestion
  • Nausea and vomiting
  • Dizziness and vertigo
  • Headache
  • Insomnia
• Vasopressin:
  • Abdominal cramps
  • Allergic reaction
  • Angina (chest pain)
  • Bronchial constriction
  • Diarrhea
  • Nausea
  • Uterine contraction
  • Tremor
  • Vertigo

Information contained herein is not intended to cover all possible side effects, precautions, warnings, drug interactions, allergic reactions, or adverse effects. Check with your doctor or pharmacist to make sure these products do not cause any harm when you take them along with other medicines. Never stop taking your medication and never change your dose or frequency without consulting your doctor.

Generic and brand names of some of the other gastrointestinal agents include:

• ADH
• Alli
• bismuth subgallate
• Carafate
• Children's Gas X Tongue Twisters Thin Strips
• chlordiazepoxide/ clidinium
• Chloresium
• chlorophyll
• Cytotec
• Derifil
• Devrom
• Dual Action Complete
• famotidine/calcium carbonate/magnesium hydroxide
• Fleet Pain Relief
• Gas X
• Gas X Extra Strength
• Gas X Softgels
• Gas X Thin Strips
• Librax
• misoprostol
• Mylicon
• nitroglycerin rectal
• orlistat
• PALS
• PediaCare Infant's Gas Relief Drops
• Pepcid Complete
• Phazyme
• phenylephrine/cocoa butter rectal
• phenylephrine/mineral oil/petrolatum rectal
• phenylephrine/pramoxine/glycerin/petrolatum rectal
• phenylephrine/witch hazel topical
• pramoxine
• Preparation H Cooling Gel
• Preparation H Cream Maximum Strength Pain Relief
• Preparation H Ointment
• Preparation H Suppository
• ProctoFoam NS
• Rectiv
• simethicone
• St. Joseph Infant's Gas Relief
• Starch PR
• starch suppository
• sucralfate
• Tronolane
• Tucks Ointment
• Tucks Suppository
• Tums Dual Action
• vasopressin
• Vasostrict
• Xenical