Gastroenteritis and diarrhea: Smecta, Bedelix, Gastropax… should these drugs be banned and what should they be replaced with?

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According to the annual review of Prescrire magazine, medicinal clays such as Smecta or Gastropax should be avoided because they contain lead. While the epidemic of gastroenteritis is in full swing, what can we replace these drugs with?

“Medicated clays used in various intestinal disorders, including diarrhea (…) should be avoided due to their natural contamination with lead”, we can read in the annual review of the journal Prescribe. This updates a list of drugs to be avoided because they have “an unfavorable balance of benefits and risks in all the clinical situations in which they are approved”.

Also read:
Diarrhoea: ANSM advises against Smecta for infants

Why should these medicines be discarded?

Among the 107 molecules identified in 2022 are therefore diosmectite (Smecta), hydrotalcite (Rennieliquo), monmectite (Bedelix or Gelox) and kaolin (Gastropax and Neutroses). The lead contained in these medicinal clays has “neurological, hematological, renal, cardiovascular and reproductive toxic effects, most of which increase with exposure dose,” warn the authors of the review. Prescribe. The editor-in-chief, Séverine Carré-Pétraud, who is also a doctor of pharmacy, adds that the drugs in question only work “on the symptoms, they do not cure the disease”: “Clay only has the effect of modifying the appearance of feces, without acting on fluid loss and risk of dehydration.”

Why are they still on the market?

The National Medicines Safety Agency (ANSM) approves the sale of these medicinal clays despite the warnings launched since 2020 by the journal Prescribe, asking that they be withdrawn from the market. “We consider that the risks they run are disproportionate to the expected effects”, summarizes Séverine Carré-Pétraud.

What should these substances be replaced with?

To replace the clay, it is possible to take treatments such as Loperamide (Immodium) or Racecadotril. “But again, these drugs only work on the symptoms, they don’t cure diarrhea,” insists the editor.

What recommendations should be followed?

Séverine Carré-Pétraud rather gives food recommendations to follow. “The most important thing is to stay well hydrated and then adjust your diet.” Small children will thus be given rehydration solutions and rice porridge. When they are a little bigger, starch, lean meat, fruit and vegetables. And for adults, starchy foods, well-prepared and salty grains. Dairy products should be avoided, with the exception of yogurt. “As part of a mild infection, such as gastroenteritis, diarrhea is not serious. It develops naturally in a favorable way. It is a matter of a few days,” she concludes.

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