Our IBS Mexican research working group has been working on a couple of CTs w/a b.i.d. 100mg pinaverium bromide + 300mg dimethicone dose combination at both 4 & 12 week treatment w/positive results for lower abdominal pain & abdominal distention relief (50% at 2wks, 80% at 4wks and almost 90% at 12wks) and improvement in the Bristol stool scale for all 4 Rome III subtypes.
We were wondering if anyone in the clinical research community has any similar experience using otilonium bromide or cimetropium w/or without dimethicone association that could share similarities and/or differences among these three cuaternarian ammonium derivatives.
Pinaverium is largely used in France and frequently efficient, as is simethicone.
Associations of the latter with alverine citrate or phloroglucinol iare also commercialized and of demonstrated efficiency , especially the former.
Otilonium and cimeropium fail to the commercialized in France.
In my opinion, the main problem lies in the reason why one may be efficient and an other not in a same patient in an unpredictible way.
Hi Ronnie,
Good to hear from you. I've been struggling w/ResearchGate's platform trying to find out why my original answer addressed to you does not show up. Nevertheless, here again are my comments.
Unfortunately none of the afore discussed drugs are available in the U.S. as you clearly mentioned. Since you are a very well known and experienced Neurogastroenterologist specialized in upper gastroenterology tract diseases, I was wondering if you had been previously exposed to the afore mentioned drug data since the considerable overlap between GERD/dyspepsia and IBS is well known and very few treatment options for IBS are FDA approved.
Nevertheless, since you are a world traveller exposed to many gastroenterology colleagues, I will be grateful if you could comment on this and let me know.
Have a great day. Let's keep in touch.
JAVR
Thanks, Dr. Maroy for your insight. Being pinaverium bromide, otilonium and cimetropium cuaternarian ammonium derivatives w/very low oral bioavailability (6-10%) and mainly acting in the "L-VOC" intestinal calcium channels, we ask ourselves if there could be more or less channel affinity or selectivity among the three of them.
IBS is a complex biological model, not easily understood due to many factors related to alodinia and visceral hypesensitivity expressed differently by each patient depending on their social, cultural and psychological background. Attempting or pretending to solve such a complex functional disease based on a mono drug therapy seems unrealistic. A multi drug combination address to control the nuclear symptoms seems more logical.
I was wondering if you could provide us w/additional information as to why the other products failed commercially in France.
Best rgds
Available in the pharmaceutical market in Mexico are alverine citrate 60mg combined with 300 mg of dimethicone per dose, otilonium bromide 40 mg per dose exclusively without dimethicone, as well as pinaverium bromide 100 mg with 100 or 300 mg of dimethicone per dose. All antispasmodic drugs have level II evidence and "B" recommendation for the pinaverium + dimethicone combination, and level II evidence and "C" recommendation for alverine + dimethicone according to the Clinical Guidelines for Tx of IBS 2009 (https://www.gastro.org.mx/wp-content/uploads/2014/06/intestino-irritable3.pdf) of the Mexican Association of Gastroenterology. Not available in the Mexican market are cimetropium bromide nor phloroglucinol.
Dear Jose Arturo
The reasons why various drugs are available in certain countries or not are a mix of local regulations and of commercial choices of companies.
I agree completely on the complex, multiple and poorly understood mechanisms of functional troubles. It warrants an try-and-test method.
However, in my opinion after 30 y. working on the subject is that the solution does'nt lie in a deductive but on an inductive methodology.
Depression is, in fact and contrary to the prevalent opinion, is a neurobiochemical illness and not a merely psychic disease.
Association with classical depressive symptoms and efficiency of a good treatment favor my conception and leaves symptomatic treatments far behind.
If you are interrested, you could have a look on the english abstract of my book in french on the present subject.
Sincerely yours
bmaroy.free.fr
Thank you, Dr. Maroy, for your comments and recommendations. I will most definitely read your book. A priori, I fully agree that mood alterations such as depressive states are neurochemical imbalances, bottomline. The relatively new neurogastroenterology as a neuroscience, has shown us that neuroplasticity is an important part of most of the functional gastrointestinal diseases and many psicoactive drugs such as low dose TCA or SSIRs are being used as neuromodulators concomitantly w/antispasmodic drugs or any other drugs. Concerning antIspasmodic treatments, we are actively and continuously looking for the best therapeutic index/ratio among them. Our next step will be starting to combine different antispasmodics w/psicoactive drugs.
Best rgds
JAVR