LECTURE 7 – Preparations used to treat some disorders of digestive system - I Dr. Ivana Daňková Dept. of Natural Drugs, Faculty of Pharmacy, VFU Brno PHYTOPHARMACEUTICALS academic year 2018/19 PHYTOPHARMACEUTICALS vs. Digestive system (GIT = Gastrointestinal tract) 2 Major disorders of GIT that can be treat by phytomedicines:  digestive disorders  damaged mucosa of GIT  ulceration  inflammation (pharyngitis, gastroenteritis)  vomiting  diarrhoea/constipation  some cases of infection, intoxication Therapy of DIGESTIVE COMPLAINTS 3 Dyspepsia – general term for digestive disorders = indigestion. Symptoms:  pain in the upper abdomen  heartburn (= pyrosis), hyperacidity  feeling of fullness, distension  belching, sickness, nausea  bloating, flatulence, meteorism  loss of appetite, poor appetite  Dyspepsia is frequently caused by gastroesophageal reflux disease (GERD) or gastritis, in a minority of other impairment of digestive system function. Therapy of DIGESTIVE COMPLAINTS 4  stomachic drugs – digestion-stimulating, appetite-stimulating drugs  cholagogic drugs, cholagogues – encourage the production and release of bile (fat digestion)  carminatives – act against flatulence, meteorism  spasmolytics – provide a mild relief for cramps (spasms) of smooth muscle tissue  antiphlogistics, anti-inflammatory agents – for healing of inflamed mucosa of digestive tract – pharyngitis, gastroenteritis, intestine catarrh  drugs for the treatment of peptic ulcers – for acceleration of healing to lessen the risk of dangerous complications  laxatives/antidiarrhoeal agents STOMACHIC DRUGS 5  herbs that act most directly on the stomach, stimulate secretion of gastric juice, increase gastric tonus and relieve the generalized stomach pain and cramping. They can stimulate also pancreatic secretion.  Contra-indications Do not use stomachic in case of:  an acute stomach or intestine catarrh (gastritis, enteritis, colitis)  hyperacidity of the stomach  an acute gastric or duodenal ulcers  Crohn´s disease  significant functional disorder of the liver, kidney, in case of heart failure,...  digestive disorders of unclear origin STOMACHIC DRUGS 6 active constituents of plant drugs:  essential oils – aromatic plant drugs (seeds, herbs), spices  e.g. of the families Apiaceae, Lamiaceae, Lauraceae, Myristiceae, Zingiberaceae, Pinaceae, Cupressaceae…  bitter principles  bitter-tasting compounds with no other pharmacological effects  different structures – mainly terpenes, of plant families:  Gentianaceae – monoterpenes (iridoids, secoiridoids,…)  Asteraceae – sesquiterpenic lactones  other bitter-tasting compounds: some flavonoids (e.g. in Citrus aurantium pericarp), alkaloids (e.g. quinine of Cinchona bark) STOMACHIC DRUGS 7 Plant drugs containing essential oils, e.g.:  Apiaceae family – mainly fruits, or other plant parts – root, herb  Anisi fructus – Pimpinella anisum, anise seed  Foeniculi amari fructus – Foeniculum vulgare, fennel  Carvi fructus – Carum carvi, caraway seed  Coriandri fructus – Coriandrum sativum  Levistici radix – Levisticum officinale  Angelicae radix – Angelica archangelica  herbs – e.g. parsley (Petroselinum), celery (Apium graveolens)  Lamiaceae family – herbs  Ocimum basilicum, Thymus vulgaris, Majorana hortensis, Salvia officinalis, Satureja hortensis, Mentha sp., Origanum vulgare, Rosmarinus officinalis,… STOMACHIC DRUGS 8 Other plant drugs containing essential oils, e.g.:  Calami aromatici rhizoma – Acorus calamus, Acoraceae, sweet-flag  Myristicae semen/flos – Myristica fragrans, Myristicaeae, nutmeg  Zingiberis rhizoma – Zingiber officinale, Zingiberaceae, ginger  Galangae rhizoma – Alpinia officinarum, Zingiberaceae, galanga  Cardamomi fructus – Elettaria cardamomum, Zingiberaceae, cardamom  Cinnamomi cortex – Cinnamomum zeylanicum, Lauraceae, cinnamon  Anisi stellati fructus – Illicium verum, Illiciaceae, star anise STOMACHIC DRUGS – essential oils 9 Acorus calamus rhizome Zingiber officinale rhizome Archangelica officinalis root Cinnamomum zeylanicum bark Illicium verum, fruit Elletaria cardamomum fruit Myristica fragrans seed/flower STOMACHIC DRUGS 10 Plant drugs containing bitter principles – terpenic structures (iridois, secoiridoids, sesquiterpenic lactones,...):  Gentianae radix – Gentiana lutea, Gentianaceae, gentian  Centaurii herba – Centaurium erythraea, Gentianaceae, centaury  Trifolii fibrini folium – Menyanthes trifoliata, Menyanthaceae, common bogbean  Absinthii herba – Artemisia absinthium, Asteraceae, wormwood  Millefolii herba – Achillea millefolium, Asteraceae, yarrow  Cnici benedicti herba – Cnicus benedictus, Asteraceae, holy thistle STOMACHIC DRUGS – bitter principles 11 Artemisia absinthium herb Centaurium erythraea herb Achillea millefolium herb Gentiana lutea root Menyanthes trifoliata leaf Cnicus benedictus herb STOMACHIC DRUGS 12 Plant drugs containing bitter principles – terpenic structures, e.g.:  Condurango cortex – Marsdenia condurango, Apocynaceae, marsdenia  Quassiae lignum – Quassia amara or Picrasma excelsa, Simaroubaceae, amargo (bitter ash, quassia wood)  Salviae folium – Salvia officinalis, Lamiaceae, red sage (picrosalvin) Other bitter-tasting drugs, e.g.:  Aurantii pericarpium – Citrus aurantium subsp. amara, Rutaceae – bitter-orange peel – bitter-tasting flavonoids  Lupuli flos – Humulus lupulus, Cannabaceae, hop – bitter substances in resin (humulone, lupulone)  Cinchonae cortex – Cinchona sp., Rubiaceae – alkaloid quinine  Lichen islandicus – Cetraria islandica, Parmeliaceae, iceland moss – bitter-tasting lichen acids STOMACHIC DRUGS 13 Marsdenia condurango bark Cinchona sp. bark Salvia officinalis leaf Quassia amara wood Citrus aurantium peel (pericarp) Humulus lupulus flowers Lichen islandicus STOMACHIC DRUGS 14 Other stomachic plant drugs, e.g.:  Capsici fructus – Capsicum annuum, C. frutescens, Solanaceae, pepper  Piperis nigri fructus – Piper nigrum, Piperaceae, black pepper CHOLAGOGUES 15  = herbal drugs that support production and the flow of bile into the small intestine  choleretics = direct cholagogues, stimulate bile production in liver  cholekinetics = indirect cholagogues, promote the flow of bile from the gall bladder into the duodenum  The role of bile is partially that of facilitating fat digestion but also of being a natural laxative CHOLAGOGUES 16  Indications of cholagogues:  to stimulate normal contractions to deliver bile to the small intestine  for disorders caused by insufficient or congested bile, such as intractable biliary constipation, jaundice and mild hepatitis  for symptoms of indigestion of fat-soluble substances  for helping the liver's detoxification work  for gallstones, unless they are lodged in the bile duct and causing a great deal of pain  Contra-indications of cholagogues:  painful gallstones, acute bilious colic, obstructive jaundice  acute cholecystitis unless gallstones, acute viral hepatitis, extremely toxic liver disorders CHOLAGOGUES 17  all bitter-tasting herbs are cholagogues to some degree  active constituents of plant drugs:  essential oils  bitter principles – bitter-tasting compounds – terpenic structures (iridoids, secoiridoids, diterpenes,..)  some flavonoids and other phenolic structures  some alkaloids – act as stimulators of liver function (production of bile) CHOLAGOGUES 18 Plant drugs containing essential oils and bitter terpenes, e.g.:  Menthae piperitae herba/folium – Mentha piperita, Lamiaceae, peppermint  Marrubii herba – Marrubium vulgare, Lamiaceae, white horehound  Taraxaci radix cum herba – Taraxacum officinale, Asteraceae, dandelion  sesquiterpenic lactones from Absinthii herba, Millefolii herba,…  iridoids, secoiridoids from Gentianae radix, Centaurii herba, Trifolii fibrini folium,… CHOLAGOGIC HERBS 19 Mentha piperita Marrubium vulgare Artemisia absinthium Taraxacum officinale Centaurium erythraea Achillea millefolium Gentiana luteaMenyanthes trifoliata CHOLAGOGUES 20 Other plant drugs used as cholagogues, e.g.:  Curcumae rhizoma – C. longa, C. xanthorrhiza, C. zedoaria, Zingiberaceae, turmeric – phenolic compounds, essential oils  Cynarae radix/folium – Cynara scolymus, Asteraceae, globe artichoke – phenolic acids derivatives  Boldo folium – Peumus boldus, Monimiaceae, boldo – alkaloids  Berberis radicis cortex – Berberis vulgaris, Berberidaceae, barberry – alkaloids  Chelidonii herba – Chelidonium majus, Papaveraceae, greater celandine – alkaloids  Fumariae herba – Fumaria officinalis, Papaveraceae, fumitory – alkaloids CHOLAGOGIC HERBS 21 Curcuma longa Cynara scolymus Chelidonium majus Berberis vulgaris Fumaria officinalisPeumus boldus CHOLAGOGUES 22 Other plant drugs used as cholagogues, e.g.:  Silybi mariani fructus (= Cardui mariae fructus) Silybum marianum (Carduus marianus), Asteraceae, milk-thistle herb  1.5-3% silymarin, a mixture of various flavonoid derivatives (flavonolignans) present only in the fruit – the principal components are silybin, silichrystin, silydianin  used mostly as a hepatoprotective agent but also as a component in preparations for bilious disorders Therapy of DIGESTIVE COMPLAINTS 23 Other plant drugs used in digestive preparations, e.g.:  Matricariae flos – Matricaria (Chamomilla) recutita, Asteraceae, chamomille  essential oils, terpenic lactones, mucilage, flavonoids, coumarines  as an antiphlogistic, spasmolytic, carminative and stomachic; disinfectant, calming properties  Hyperici herba – Hypericum perforatum, Hypericaceae, St.John´s wort  flavonoids, other phenolics, essential oils, tannins,…  anti-inflammatory and healing properties on mucose of gastrointestinal system Therapy of DIGESTIVE COMPLAINTS 24 Other plant drugs used in digestive preparations, e.g.:  Agrimoniae herba – Agrimonia eupatoria, Rosaceae, common agrimony  tannins, flavonoids,…  anti-inflammatory and healing properties in GIT, astringent effect  Aspalathi folium – Aspalathus linearis, Fabaceae, rooibos  mainly phenolic compounds (flavonoids, chalcones, phenolic acids),…  positive effect on digestion DIGESTIVE PREPARATIONS Drops, tinctures, medicinal solutions 25  TINCTURA AMARA  alcoholic extract (= tincture) of plant drugs containing bitter principles  maceration of four plant drugs in ethanol 60%:  Absinthii herba 10 g Trifolii fibrini folium 30 g Aurantii pericarpium 30 g Gentianae radix 30 g  Spiritus dilutus 1340 g  macerate 7 days at room temperature and add:  0.25 g Cinnamomi corticis etheroleum DIGESTIVE PREPARATIONS Drops, tinctures, medicinal solutions 26  ORIGINAL SCHWEDENBITTER Drops POR GTT SOL 1x500ML (Riviera Handels GmbH, Austria)  Extractum herbarum ethanolicum: extr. Absinthii herba, Gentianae radix, Angelicae radix, Calami rhizoma, Tormentillae rhizoma, Gummiresina myrha, Taraxaci radix, Marrubii herba, Zedoariae radix, Myristicae semen/flos, Juglandis pericarpium, Electuarium theriaca sine opio  contains 38 % of alcohol (V/V)  SUKL code: 0046796 OTC medicinal product  ATC: V11 (Phytopharmaceuticals and animal products) DIGESTIVE PREPARATIONS Drops, tinctures, medicinal solutions 27  Dr. Theiss SCHWEDEN BITTER  mixture of 13 herbal drugs  1 teaspoon before meal (3 times daily), or 1-2 teaspoons after „heavy meal“  CONDURANGO WINE (Herbadent)  malt wine enriched with water-alcoholic extract of Marsdenia condurango bark  suitable for the treatment of digestive disorders, in case of loss of appetite DIGESTIVE PREPARATIONS Drops, tinctures, medicinal solutions 28  KLOSTERFRAU MELISANA Concentrate POR+DRM SOL 1X95ML (Klosterfrau Berlin GmbH, Germany)  oral drops, solution for external use  Extractum herbarum ethanolicum 40,81 mg in 1 mL: extr. Melissae folium 4,2 mg, Inulae radix 5,6 mg, Angelicae radix 5,6 mg, Zingiberis radix 5,6 mg, Caryophylli flos 2,3 mg, Galangae radix 2,3 mg, Piperis nigri fructus 0,57 mg, Gentianae radix 5,6 mg, Myristicae semen 0,57 mg, Aurantii pericarpium 5,6 mg, Cinnamomi cortex 2,5 mg, Cassiae flos 0,29 mg, Cardamomi fructus 0,08 mg  contains 66.8 % of alcohol (V/V)  SUKL code: 0066927 OTC medicinal product  ATC: V11 (Phytopharmaceuticals and animal products) DIGESTIVE PREPARATIONS Drops, tinctures, medicinal solutions 29  AMOL POR GTT SOL 1X100ML (Takeda GmbH, Germany)  oral drops, solution for external use  Citronellae etheroleum 0.1 g Caryophylli floris etheroleum 0.1 g Cinnamomi zeylanici corticis etherol. 0.24 g Citri etheroleum 0.57 g Menthae piperitae etheroleum 0.24 g Lavandulae etheroleum 0.24 g Levomentholum 1.723 g in 100 mL  contains 68 % of alcohol (V/V)  SUKL code: 0049027 OTC medicinal product  ATC: V11 (Phytopharmaceuticals and animal products) DIGESTIVE PREPARATIONS Herbal teas 30  STOMARAN (Leros)  20x 1.5 g or 1x 100g  Angelicae radix Calami rhizoma Matricariae flos Agrimoniae herba Centaurii herba Hyperici herba Rubi fruticosi folium Menthae pip. herba Foeniculi amari fructus  SUKL code: 0043959  ATC: V11  Properties: stomachic, digestive, carminative, mild spasmolytic, antiphlogistic, choleretic effects  suitable for digestive disorders, loss of appetite, flatulence, feeling of fullness, abdominal distension  suitable also in case of gallbladder disorders as a support treatment  for adults and children over 12y.  CI: hypersensitivity to any component, acute inflammation of GIT, ulcerative disorders, biliary obstruction DIGESTIVE PREPARATIONS Herbal teas 31  STOMACHIC HERBAL TEA (Megafyt Pharma)  POR SPC 20X1.5GM  Absinthii herba 300 mg Menthae piperitae herba 300 mg Millefolii herba 300 mg Hyperici herba 150 mg Levistici radix 150 mg Liquiritiae radix 150 mg Foeniculi fructus 150 mg in 1 tea bag (1.5 g)  SUKL code: 0076433  ATC: V11  suitable for digestive disorders, loss of appetite, flatulence, feeling of fullness, abdominal distension  for adults and children over 12 years DIGESTIVE PREPARATIONS Herbal teas 32  DIGESTIVE HERBAL TEA (Megafyt Pharma)  20 x 2.0 g  Foeniculi fructus 30 % Anisi fructus 30 % Verbenae herba Rubi idaei folium Basilici herba Aspalathi folium (= rooibos) Matricariae flos Carvi fructus 4 % Zingiberis rhizoma 2 %  Leros Natur DIGESTIVE Herbal Tea  20 x 1.5 g  Menthae piperitae herba 30 % Cymbopogonis herba 20 % (= lemongrass) Serpylli herba 20 % Carvi fructus 10 % Matricariae flos 10 % Zingiberis rhizoma 10 % DIGESTIVE PREPARATIONS Herbal teas 33  STOMACH and INTESTINES Herbal Tea (Teekanne)  10 x 2.0 g  Menthae piperitae folium 40 % Matricariae flos 30 % Liquiritiae radix Cinnamomi cortex Melissae folium 5%  GASTRIC HERBAL TEA with agrimony (Apotheke)  20 x1.5 g  Millefolii herba Agrimoniae herba Hyperici herba Matricariae flos Calami rhizoma Angelicae radix CHOLAGOGIC PREPARATIONS Drops, tinctures, medicinal solutions 34  IBEROGAST POR GTT SOL 1x20ML (STEIGERWALD Arzneimittelwerk GmbH)  contains fluid hydro-alcoholic extract of: Iberidis amarae herba, Angelicae radix, Matricariae flos, Carvi fructus, Silybi mariani fructus, Melissae folium, Menthae piperitae folium, Chelidonii herba, Liquiritiae radix  contains 32.6 % of alcohol (V/V)  SUKL code: 0089031 OTC medicinal product  ATC: V11 (Phytopharmaceuticals and animal products)  dosage: adults 20 drops 3 times daily, children over 6y. 10 drops 3 times daily Iberis amara Brassicaceae CHOLAGOGIC PREPARATIONS Drops, tinctures, medicinal solutions 35  CHOLAGOL POR GTT SOL 1x20ML (IVAX/TEVA)  alcoholic/oil solution of: Curcumae longae rhizomatis pigmenta Magnesii salicylas tetrahydricus Menthae piperitae etheroleum Eucalypti etheroleum Frangula-emodinum  contains 11.4 % of alcohol  SUKL code: 0000699 OTC medicinal product  ATC: A05AX  Indications: cholelithiasis, chronic cholecystitis, dyspeptic disorders in chronic hepatopathy  dosage: 5-10 drops 3 times daily.  CI: hypersensitivity to any component, acute inflammation of gall bladder or liver, severe liver damage, renal insufficiency Not suitable for pregnant and lactating women, children up to 12y. and for children up to 17y. in feverish diseases CHOLAGOGIC PREPARATIONS Drops, tinctures, medicinal solutions 36  ROWACHOL POR GTT SOL 1x10ML (STEIGERWALD)  oral drops – solution of essential oils in olive oil: Pinenum  Pinenum  Camphenum Cineolum Menthonum Levomentholum Borneolum  SUKL code: 0092087 OTC medicinal product  ATC: V11  available also in capsules  ROWACHOL promotes bile release, relives cramps in the area of the gall bladder and biliary tract, by reducing bile congestion it promotes intermediary metabolism in the liver. It reduces cholesterol production in the liver and decreases its concentration in bile. CHOLAGOGIC PREPARATIONS Drops, tinctures, medicinal solutions 37  BILIOUS Herbal Drops (Grešík)  10% alcoholic extract of: Menthae piperitae herba Taraxaci herba Cichorii herba Rubi fruticosi folium Calendulae flos Curcumae rhizoma Agrimoniae herba Marrubii herba Inulae radix  BILIOUS Herbal Drops (Fytos)  contains extracts of: Taraxaci radix cum herba Verbenae herba Origani herba Agrimoniae herba Cichorii herba Inulae radix CHOLAGOGIC PREPARATIONS Herbal teas 38  THÉ SALVAT (Leros)  20x 1.0 g  Matricariae flos Frangulae cortex Boldo folium Agrimoniae herba Marrubii herba Menthae piperitae herba Taraxaci radix cum herba  SUKL code: 0056349  ATC: V11  do not boil (only infusion), drink warm. Always prepare fresh.  suitable as a part of liver and gall bladder diet  for digestive disorders, support bile production and flow, act against flatulence, abdominal distension; mild laxative effect  for adults and children over 10y.  CI: hypersensitivity to any component, acute inflammation of gall bladder, biliary obstruction, bilious and intestinal congestion, severe liver damage. Not suitable for pregnant and lactating women. CHOLAGOGIC PREPARATIONS Herbal teas 39  BILIOUS Herbal Tea (Megafyt Pharma)  POR SPC 20X1.5GM  Menthae piperitae herba 525 mg Agrimoniae herba 375 mg Marrubii herba 375 mg Rhei radix 225 mg in 1 tea bag (1.5 g)  SUKL code: 0053725  ATC: V11  tea support bile release - suitable for digestive disorders, loss of appetite, flatulence, feeling of fullness, abdominal distension  for adults and children over 12y. CHOLAGOGIC PREPARATIONS Herbal teas 40  LIVER–GALL BLADDER Herbal Tea (Megafyt Pharma)  20 x 1.5 g  Menthae piperitae herba 30 % Matricariae flos Taraxaci radix cum herba 20 % Foeniculi fructus 10 % Cymbopogonis herba (lemongrass) Schisandrae fructus Curcumae rhizoma 5 % Agrimoniae herba  LIVER–GALL BLADDER Herbal Tea (Leros)  20 x 1.5 g  Taraxaci radix cum herba 30 % Menthae piperitae herba 20 % Matricariae flos 20 % Foeniculi fructus 15 % Agrimoniae herba 5 % Curcumae rhizoma 5 % Schisandrae fructus 5 % CHOLAGOGIC PREPARATIONS Herbal teas 41  GALL BLADDER and PANCREAS Herbal Tea (Pavel Váňa)  40 x 1.6 g  Agrimoniae herba Silybi mariani fructus Helichrysi herba Menthae piperitae herba Inulae radix  LIVER-GALL BLADDER Herbal Tea (Teekanne)  10 x 2.0 g  Taraxaci radix cum herba Menthae piperitae folium Matricariae flos Foeniculi fructus Curcumae rhizoma Millefolii herba/flos Silybi mariani fructus DIGESTIVE PREPARATIONS Oral solid forms 42 GASTROVAL cps. (Valentis)  1 capsule contains:  EnzyBlend 75 mg – enzymes of Aspergillus fungus that participate on cleavage of proteins, lipids, sugars…  Gentianae radix Taraxaci radix Silybi mariani fructus – dry extract  usage: 2 capsules per day during meal CARMINATIVES 43  = drugs that prevents formation of gas in the gastrointestinal tract or facilitates the expulsion of gas from intestines  flatulence is usually accompanied by abdominal pain and distension  Carminative herbal preparations are often mixtures of essential oils and herbal spices  Carminative drugs are usually used also as spasmolytics CARMINATIVES 44 Plant drugs used as carminative and spasmolytic agents, e.g.:  Apiaceae family  Anisi fructus, Foeniculi fructus, Carvi fructus, Coriandri fructus Angelicae radix,...  Lamiaceae family  Menthae piperitae herba, Majoranae herba, Origani herba, Rosmarini herba, Thymi herba,…  others  Matricariae flos – Matricaria recutita, Asteraceae, German chamomille  Chamomillae romanae flos – Anthemis nobilis (Chamaemelum nobile), Asteraceae, Roman chamomille  Caryophylli flos – Syzygium aromaticum, Myrtaceae, clove  etc. CARMINATIVE DRUGS 45 Pimpinella anisum fruits Foeniculum vulgare fruits Coriandrum sativum fruits Majorana hortensis herb Origanum vulgare herb Carum carvi fruits Anthemis nobilis flower Syzygium aromaticum flower CARMINATIVE PREPARATIONS Drops, tinctures, medicinal solutions 46  Matricariae flos Matricaria recutita (syn. Matricaria chamomilla, Chamomilla recutita), Asteraceae (German) chamomile  Matricariae flos is mainly used as an antiphlogistic, spasmolytic, carminative, stomachic agent.  also ulcer-protecting, bactericidal, fungicidal activity has been demonstrated  the main uses internally are for gastrointestinal complaints (gastritis, enteritis, colitis, flatulence, cramp-like symptoms in the digestive tract) and menstrual problems CARMINATIVE PREPARATIONS Herbal teas 47  CHILDREN Herbal Tea with chamomile (Leros)  POR SPC 75GM  Matricariae flos 18 g Foeniculi fructus 16,50 g Menthae piperitae herba 9 g Althaeae radix 7,50 g Rubi fruticosi folium 7,50 g Plantaginis folium 5,25 g Lupuli flos 4,50 g Serpylli herba 3,75 g Sambuci nigrae flos 1,50 g Liquiritiae radix 1,50 g  SUKL code: 0094842  ATC: V11 CARMINATIVE PREPARATIONS Herbal teas 48  CHILDREN Herbal Tea (Megafyt Pharma)  20 x1.5 g  Matricariae flos 20 % Menthae piperitae herba 15 % Melissae herba Verbenae herba Tiliae flos Foeniculi fructus 10 %  suitable for children over 6 months of age  CHILDREN Herbal Tea (Megafyt Pharma)  20 x1.5 g  Matricariae flos 375 mg Menthae piperitae herba 375 mg Althaeae radix 300 mg Liquiritiae radix 300 mg Foeniculi fructus 150 mg in 1 tea bag (1.5 g)  suitable for children over 4 years CARMINATIVE PREPARATIONS Drops, tinctures, medicinal solutions 49  AQUA CARMINATIVA ČL 2009  Carvi etheroleum 0.1 g  Citri etheroleum 0.1 g  Citronellae etheroleum 0.1 g  Coriandri etheroleum 0.1 g  Foeniculi amari fructus etheroleum 0.1 g  Menthae piperitae etheroleum 0.1 g  Ethanolum 96% (V/V) 2.4 g  Aqua purificata 997.0 g  Talcum 5.0 g CARMINATIVE PREPARATIONS Drops, tinctures, medicinal solutions 50  AQUA CARMINATIVA RUBRA ČL 2009  Aurantii amari floris etheroleum 0.1 g Carvi etheroleum 0.1 g Caryophylli floris etheroleum 0.1 g Cinnamomi zeylanici corticis etheroleum 0.1 g Foeniculi amari fructus etheroleum 0.1 g Myristicae etheroleum 0.1 g Menthae piperitae etheroleum 0.1 g Citronellae etheroleum 0.5 g Coriandri etheroleum 0.5 g Citri etheroleum 1.0 g Ethanolum 96% (V/V) 6.2 g Sirupus simplex 266.0 g pigments 0.28 g Aqua purificata ad 1333.0 g Talcum 7.0 g CARMINATIVE PREPARATIONS Drops, tinctures, medicinal solutions 51  CHAMOMILLA Teva SOL 1X25ML (IVAX/TEVA)  solution for oral or external use  Matricariae extractum fluidum = liquid extract of Matricariae flos  contains up to 53 % alcohol  SUKL code: 0162391 OTC product  ATC: V11  extracts of Matricaria flowers are mainly used for their antiinflammatory, antiseptic and spasmolytic properties. They are stated to possess carminative, mild sedative properties and have been used for flatulent nervous dyspepsia, travel sickness, nasal catarrh, restlessness and specifically for gastrointestinal disturbance with associated nervous irritability in children CARMINATIVE PREPARATIONS Oral solid forms 52  COLPERMIN POR CPS ETD 20X187MG (Tillotts Pharma AG)  Menthae piperitae etheroleum 187 mg in 1 capsule  SUKL code: 0169682 OTC medicinal product  ATC: V11, A03AX  dosage: 1 capsule 3 times daily 30-60 min before meal  do not use in case of gastric hyperacidity CARMINATIVE PREPARATIONS For external use 53  DOMIFLAN Baby (Aromatica)  Anisi stellati etheroleum Foeniculi etheroleum Carvi fructus – extract Matricariae flos – extract Rosmarini folium – extract  suitable for children over 1 month of age  HBF Children Emulgel Against Flatulence (Herbacos)  Matricariae flos etheroleum Menthae piperitae etheroleum Anisi fructus etheroleum Foeniculi fructus etheroleum