1 TRENKA Chem. pharm. Fabrik Ges.m.b.H EUCARBON – a product of Trenka Ges.m.b.H. Vienna ® P.P. Presentation Eucarbon – Med. rep. Vers. English Date: (MHK) – 37 p. Grafic: (MHK)

2 Contents TRENKA Chem. pharm. Fabrik Ges.m.b.H 1.Basics - EUCARBON ® and the Intestine 2.Ingredients of EUCARBON ® 3.Application & Effects of EUCARBON ® 4.Major Indications 5.FAQ 6.Interesting Facts 7.Contra-indications 8.Guidelines for Professionals

3 1. Basics TRENKA Chem. pharm. Fabrik Ges.m.b.H ● developed in 1909 ● by Mag. F. Trenka & Prof. Pauli ● proven, unchanged formulation EUCARBON ® – proven for more than 100 years

4 1. Basics TRENKA Chem. pharm. Fabrik Ges.m.b.H ● Total surface: approx. 400m 2 ● Total length: Small intestine: 4 to 6 meters Large intestine: 1 to 2 meters Our intestine – a universe

5 2. Components The best in compressed form TRENKA Chem. pharm. Fabrik Ges.m.b.H ●Finely-pulverized vegetable charcoal ●Senna leaves ●Rhubarb roots ●Purified Sulfur ●Essential mint oils ●Essential fennel oils

6 2. Components – Function Classification according to the functions of the ingredients Adsorbent:Finely-pulverized vegetable charcoal Laxative:Senna leaves Rhubarb roots Purified Sulfur Carminative & Spasmolytic: Essential mint oil Essential fennel oil TRENKA Chem. pharm. Fabrik Ges.m.b.H

7 2. Components – Types of Charcoal TRENKA Chem. pharm. Fabrik Ges.m.b.H ●Vegetable charcoal: carbonisation ●Finely-pulverised vegetable charcoal (EUCARBON ® ): carbonisation + pulverisation ●Activated charcoal: carbonisation + activation The difference lies in the adsorption power.

8 TRENKA Chem. pharm. Fabrik Ges.m.b.H Activated charcoal has an adsorption power which is times higher than vegetable charcoal (acc. to Non-clinical overview, Module 2.4., dated 4/2011) 2. Components – Activated charcoal / vegetable charcoal

9 2. Components – Types of Charcoal Activated charcoal: TRENKA Chem. pharm. Fabrik Ges.m.b.H ●Inhibits the effect of other drugs and ●causes constipation  Resolves one problem, but creates another

10 TRENKA Chem. pharm. Fabrik Ges.m.b.H 2. Components – Senna & Rhubarb Active substances in senna & rhubarb: anthraquinone glycosides (AG) ● stimulate intestinal peristalsis ● reduce water adsorption in the intestine

11 TRENKA Chem. pharm. Fabrik Ges.m.b.H 2. Components – Anthraquinone Glycosides ● Each EUCARBON ® tablet contains 5 mg AG ● The average treshold for a laxative effect by AG is 30 mg / day ● To achieve a laxative effect with EUCARBON ®, an average of 5 tablets / day is required

12 TRENKA Chem. pharm. Fabrik Ges.m.b.H 2. Bestandteile – Gereinigter Schwefel Therapeutische Nutzung und Wirksamkeit: ●Gelber Feststoff, der in der Natur in reiner Form vorkommt ●Orale Anwendungen von elementarem Schwefel spielen in der Pharmakotherapie praktisch keine Rolle ●Im Europäischen Arzneibuch ist Schwefel nur in Verbindung mit externen Anwendungen erwähnt ●Kommt seit langer Zeit in der Balneotherapie zum Einsatz ●Wird seit Jahrzehnten aufgrund seiner abführenden, fungiziden, bakteriostatischen und antiparasitären Wirkung nach oraler Gabe angewandt

13 TRENKA Chem. pharm. Fabrik Ges.m.b.H 2. Bestandteile – Gereinigter Schwefel ●Setzt Schwefelwasserstoffbläschen im Dünndarm frei ●Diese Schwefelwasserstoffbläschen stimulieren die Darmperistaltik

14 2. Components – Mint & Fennel TRENKA Chem. pharm. Fabrik Ges.m.b.H ●Mint & fennel ●stimulate evacuation of intestinal gases ●reduce painful contractions ●relieve cramps of the unstriated intestinal muscles ●relieve the feeling of painful tension ●stop the development of bacteria which cause fermentations ●essential mint oils stimulate bile secretion. Bile is necessary for lipolysis

15 TRENKA Chem. pharm. Fabrik Ges.m.b.H 3. Application & Effects of EUCARBON How to use EUCARBON ® to achieve one effect/ a combination of effects Simply change dosage and/or duration of treatment

16 TRENKA Chem. pharm. Fabrik Ges.m.b.H 3. Application & Effects of EUCARBON Effects: ● At low doses, from 1 to 3 tablets daily, EUCARBON ® has an adsorbent effect ● At higher doses, from 4 to 6 tablets daily, EUCARBON ® has both, an adsorbent and a laxative effect

17 TRENKA Chem. pharm. Fabrik Ges.m.b.H 3. Application & Effects of EUCARBON Duration of treatment: ● Mid to long-term treatment (8 to 12 weeks): EUCARBON ® becomes an intestinal regulator WEEKS

18 TRENKA Chem. pharm. Fabrik Ges.m.b.H 4. Major Indications ●Dyspepsia ● Bloating ● Flatulence ●Meteorism ●Indigestion ●All types of constipation ●Slow bowel ●Hemorrhoids ●Anal fissures 1 – 3 tablets/day (adsorbing effect) 4 – 6 tablets/day (laxative and absorbing effect)

19 TRENKA Chem. pharm. Fabrik Ges.m.b.H 5. FAQ ● Pain at the moment of defecation ● Reflex constipation due to fear of pain Why should EUCARBON ® be used for treatment of hemorrhoids and anal fissures? Serious problem of these two pathologies:  That’s why soft stool is essential in these two pathologies

20 TRENKA Chem. pharm. Fabrik Ges.m.b.H 5. FAQ Why does EUCARBON ® provide soft stool? Anthraquinone glycosides are hydrophilic.  Once in the colon, they soak up water and thus provide soft stool. Conclusio: The more fluid we want a faecal bolus to be, the higher the dosage of EUCARBON ® should be.

21 TRENKA Chem. pharm. Fabrik Ges.m.b.H 6. Interesting Facts EUCARBON ® is an intestinal transit regulator. Treatment of the irritable bowel syndrome (IBS) = EUCARBON ®  Idea that should guide our activity !

22 TRENKA Chem. pharm. Fabrik Ges.m.b.H 6. Interesting Facts – Irritable Bowel Syndrome A brief overview of the irritable bowel syndrome: Patients complain about a certain number of symptoms in the gastro-intestinal tract.  Diagnosis takes place through elimination. ● The physician carries out the required investigations ● if there is no organic cause / explanation, and if the symptoms persist  the diagnosis is irritable bowel syndrome

23 TRENKA Chem. pharm. Fabrik Ges.m.b.H 6. Interesting Facts – Irritable Bowel Syndrome Various causes of the IBS: ● Stress ● Mainly sedentary activities ● Unbalanced diet ● Bad food hygiene ● Lack of exercise ● Long-term medical treatment ● etc.

24 TRENKA Chem. pharm. Fabrik Ges.m.b.H 6. Interesting Facts – IBS, Symptoms & Treatment Symptoms of the IBS: ● Gases ● Constipation ● Diarrhoea ● Constipation occurring alternately with diarrhoea ● Diffuse abdominal pain in the lower abdomen Treatment of the IBS:  There is only one treatment of the IBS: symptomatic treatment

25 TRENKA Chem. pharm. Fabrik Ges.m.b.H 6. Interesting Facts – IBS, Symptomatic Treatment ● against flatulence ● against diarrhoea ● against constipation ● against pain Additional prescription of an anxiolytic adsorbent antidiarrhoeal laxative antispasmodic

26 TRENKA Chem. pharm. Fabrik Ges.m.b.H 6. Interesting Facts – IBS, Treatment with EUCARBON ® ● Adsorbent ● Laxative ● Antispasmodic at low doses EUCARBON ® is an adsorbent at high doses EUCARBON ® is also a laxative essential mint & fennel oil in EUCARBON ® have a spasmolytic & carminative effect Moreover, EUCARBON ® yields a reduction of abdominal distension by adsorption and elimination of gases, considerably reducing pain

27 TRENKA Chem. pharm. Fabrik Ges.m.b.H 6. Interesting Facts – IBS, Treatment with EUCARBON ® Treating the IBS with EUCARBON ® to achieve regulation of the intestinal transit, 2 conditions should be observed: 1. Duration of treatment 2. Dose reduction in function of intestinal transit improvement

28 TRENKA Chem. pharm. Fabrik Ges.m.b.H 6. Interesting Facts – IBS, Duration of Treatment The average duration of treatment with EUCARBON ® until achieving intestinal transit regulation is weeks WEEKS If the patient stops treatment before intestinal transit regulation is achieved, treatment should be started anew!

29 TRENKA Chem. pharm. Fabrik Ges.m.b.H 6. Interesting Facts – IBS, Dose Reduction Criterion for reduction of the dose: faecal bolus As soon as the faecal bolus becomes softer or as soon as there are signs of diarrhoea, it can be concluded that ● intestinal transit has improved and ● dose should be reduced, until achieving regulation of digestion

30 TRENKA Chem. pharm. Fabrik Ges.m.b.H 6. Interesting Facts – Ultrasonography & Radiology EUCARBON ® before ultrasonography and radiology: To prepare patients for: ● x-ray examinations of the kidneys, the gallbladder, the liver and the spleen ● Abdominal ultrasonography Objectives: To obtain clear radiographs, we need an adsorbing and laxative effect ●total elimination of gases ●intensive cleaning of the digestive tract

31 TRENKA Chem. pharm. Fabrik Ges.m.b.H 6. Interesting Facts – Ultrasonography & Radiology Three possible preparation patterns: 3 days before examination: 2 tablets – 3x per day 1 day before examination: 4 tablets in the morning and 4 tablets in the evening In urgent cases: 6 – 8 tablets in the evening in one single intake before going to sleep  The shorter the preparation time, the higher the dosage must be

32 TRENKA Chem. pharm. Fabrik Ges.m.b.H 7. Contra-indications Like all other laxatives, EUCARBON ® may not be taken in case of: ● appendicitis ● intestinal obstruction ● surgery emergencies Other contra-indications: progressing gastro-intestinal ulcers – an ulcer is an open wound which triggers pain when getting in contact with sulphur. In case of healed ulcers EUCARBON ® may be taken safely.

33 TRENKA Chem. pharm. Fabrik Ges.m.b.H 8. Guidelines for Professionals Gastroenterologists ● all indications of EUCARBON ® ● obviously, the focus should be the Irritable Bowel Syndrome ● let us not forget proctology with the problems of pain at the moment of defecation Classification of physicians to visit according to their ability and frequency of prescribing EUCARBON ® :

34 TRENKA Chem. pharm. Fabrik Ges.m.b.H 8. Guidelines for Professionals Internal Medicine: ● all indications of EUCARBON ® General Practitioners: ● all indications ● the General Practitioner also encounters many cases of the irritable bowel syndrome Radiologists: ● preparation of patients for x-ray examinations and abdominal ultrasonography

35 TRENKA Chem. pharm. Fabrik Ges.m.b.H 8. Guidelines for Professionals Gynecologists ● constipation is a pathology of pregnant women ● hormonal problem (prolactin) ● one of the side-effects of this pregnancy hormone is constipation ● as pregnancy progresses, abdominal pressure increases – even small amounts of gas often cause severe complaints and extreme discomfort ● pregnant women should use EUCARBON ® only on medical advice

36 TRENKA Chem. pharm. Fabrik Ges.m.b.H 8. Guidelines for Professionals Each physician should advise the patient of the laxative effect of EUCARBON ® and – as for any other laxative – it should be used with precaution, in order to avoid diarrhoea!

37 TRENKA Chem. pharm. Fabrik Ges.m.b.H Thank you for your attention!