Loperamide/simethicone is combination medication marketed under the trade name Imodium Multi-Symptom Relief (formerly Imodium A-D Advanced) used to treat diarrhea and gas simultaneously. It is manufactured by the McNeil Consumer Healthcare Division of McNeil PPC, Inc. It contains loperamide and simethicone. Loperamide is a μ-opioid receptor agonist that works in the intestines. Although it is an opioid, it has no effects on the central nervous system. It reduces diarrhea by slowing the transit time of contents through the intestinal tract thereby allowing more water to be reabsorbed from the intestinal lumen. Simethicone reduces gas by allowing smaller gas bubbles to coalesce into larger bubbles in the intestinal tract, making them easier to pass. Simethicone is not absorbed from the gastrointestinal tract so there are no systemic side effects. Precautions
Anti-diarrheal medications should be avoided if diarrhea is secondary to an infection. Avoid using such products in the presence of fever, black stools, bloody stools, or stools containing mucus. References
External links
"Loperamide hydrochloride mixture with simethicone". Drug Information Portal. U.S. National Library of Medicine.
Sometimes, breakthrough bleeding is classified as abnormal and thereby as a form of metrorrhagia, and sometimes it is classified as not abnormal.In the context of hemophilia, the term describes a bleeding that occurs while a patient is on prophylaxis. Presentation
The bleeding is usually light, often referred to as "spotting," though a few people may experience heavier bleeding.It is estimated that breakthrough bleeding affects around 25 % of combined oral contraceptive pill (COCP) users during the initial 3 to 4 months of use, it then usually resolves on its own. Mechanism
Breakthrough bleeding is commonly due to 4 factors: physiologic effects  of  OCs  on  the  endometrium,  OC-related  parameters,  (dose, formulation,  and  regimen),  patient behavior, (compliance,  using concomitant  medications,  and  smoking) and benign or malignant pathology. Treatment
Breakthrough bleeding that does not resolve on its own is a common reason for women to switch to different pill formulations, or to switch to a non-hormonal method of birth control. Terminology
Metrorrhagia is from metro = measure, -rrhagia = abnormal flow. The term is no longer recommended. See also
Menometrorrhagia
Istihadha
Menstruation
Menstruation in Islam
Postcoital bleeding
Vaginal bleeding
Withdrawal bleeding
Culture and menstruation

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