View source for Simeticone

{{Short description|Anti-foaming agent used to reduce bloating, discomfort or pain caused by excessive gas}}
{{Missing information|the history of simeticone|date=September 2021}}
{{Infobox drug
| Verifiedfields = changed
| verifiedrevid = 417768970
| IUPAC_name = Poly(dimethylsiloxane), silicon dioxide
| image = Simethicone structure.svg
<!--Clinical data -->| image_class = skin-invert-image
| tradename = Infacol, Wind-eze, WindSetlers, others
| USAN = Simethicone<ref>{{cite web|title=Simethicone names|url=https://www.drugs.com/international/simethicone.html|publisher=Drugs.com|access-date=27 August 2017}}</ref>
| Drugs.com = {{drugs.com|monograph|simethicone}}
| pregnancy_category = C
| legal_US = OTC
| routes_of_administration = [[Oral administration|Oral]]
<!--Pharmacokinetic data -->| bioavailability = None
| protein_bound = 0%
| metabolism = Not metabolized
| elimination_half-life = N/A
| excretion = Feces
<!--Identifiers -->| CAS_number_Ref = {{cascite|correct|??}}
| CAS_number = 8050-81-5
| ATC_prefix = A03
| ATC_suffix = AX13
| PubChem = 6433516
| ChemSpiderID_Ref = {{chemspidercite|changed|chemspider}}
| ChemSpiderID = None
| DrugBank_Ref = {{drugbankcite|correct|drugbank}}
| DrugBank = DB09512
| ChEMBL_Ref = {{ebicite|changed|EBI}}
| ChEMBL = 1200838
<!--Chemical data -->| chemical_formula = (C<sub>2</sub>H<sub>6</sub>OSi)<sub>n</sub> · (SiO<sub>2</sub>)<sub>m</sub>
| molecular_weight = Variable
}}
'''Simeticone''' ([[International Nonproprietary Name|INN]]), also known as '''simethicone''' ([[United States Adopted Name|USAN]]), is an [[anti-foaming agent]] used to reduce [[bloating]], discomfort or pain caused by excessive gas.

==Medical uses==
[[File:Simethiconetablets.jpg|thumb|Simethicone tablets]]
Simethicone is used to relieve the symptoms of excessive gas in the [[gastrointestinal tract]], namely bloating, burping, and flatulence.<ref name=USOTClabel>{{cite web|title=Simethicone tablet|url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d93ff75d-9cdb-476c-bb65-eabeefb91a34|publisher=NIH DailyMed|access-date=27 August 2017|date=April 2016}}</ref><ref>{{cite web|title=Simeticone|url=https://www.nhs.uk/medicines/simeticone/|publisher=[[NHS]]|language=en|date=10 October 2019|access-date=30 January 2020}}</ref> While there is a lack of conclusive evidence that simethicone is effective for this use,⁣<ref>{{cite web| vauthors = Modi R, Clearfield HR, Levitt M | title=Belching, Bloating and Flatulence|url=http://patients.gi.org/topics/belching-bloating-and-flatulence/|publisher=American College of Gastroenterology|language=en|date=July 2013}}</ref><ref name="drugs.com">{{Cite web | url = https://www.drugs.com/monograph/simethicone.html | title = Simethicone | publisher = [[drugs.com]] | quote = Efficacy not established for the symptomatic relief of immediate postprandial upper abdominal distress}}</ref>{{Failed verification|date=January 2020|reason=Flatulence/bloating and IPPUAD are separate sections in source}} studies have shown that it can relieve symptoms of [[functional dyspepsia]]<ref>{{cite journal | vauthors = Holtmann G, Gschossmann J, Mayr P, Talley NJ | title = A randomized placebo-controlled trial of simethicone and cisapride for the treatment of patients with functional dyspepsia | journal = Alimentary Pharmacology & Therapeutics | volume = 16 | issue = 9 | pages = 1641–8 | date = September 2002 | pmid = 12197843 | doi = 10.1046/j.1365-2036.2002.01322.x | publisher = Wiley | s2cid = 23286985 | doi-access =  }}</ref> and [[bloating|functional bloating]].<ref>{{cite journal | vauthors = Burta O, Iacobescu C, Mateescu RB, Nicolaie T, Tiuca N, Pop CS | title = Efficacy and safety of APT036 versus simethicone in the treatment of functional bloating: a multicentre, randomised, double-blind, parallel group, clinical study | journal = Translational Gastroenterology and Hepatology | volume = 3 | issue = 72 | page = 72 | date = 25 September 2018 | pmid = 30511026 | pmc = 6256934 | doi = 10.21037/tgh.2018.09.11 | publisher = AME Publications | doi-access = free }}</ref>

It has not been fully established that simethicone is useful to treat [[Baby colic|colic]] in babies,<ref>{{cite journal | vauthors = Biagioli E, Tarasco V, Lingua C, Moja L, Savino F | title = Pain-relieving agents for infantile colic | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | article-number = CD009999 | date = September 2016 | issue = 9 | pmid = 27631535 | pmc = 6457752 | doi = 10.1002/14651858.CD009999.pub2 }}</ref> and it is not recommended for this purpose.<ref name="drugs.com"/> A study in the United Kingdom reported that according to parental perception simethicone helped infant colic in some cases.<ref>{{cite journal | vauthors = Goldman M, Beaumont T | title = A real world evaluation of a treatment for infant colic based on the experience and perceptions of 4004 parents | journal = British Journal of Nursing | volume = 26 | issue = 5 Suppl 1 | pages = S3–S10 | date = March 2017 | pmid = 28350192 | doi = 10.12968/bjon.2017.26.Sup5.S3 | s2cid = 32885530 }}</ref>

Simethicone can also be used for suspected [[postoperative]] [[abdominal discomfort]] in infants.<ref>{{cite journal | vauthors = Voepel-Lewis TD, Malviya S, Burke C, D'Agostino R, Hadden SM, Siewert M, Tait AR | title = Evaluation of simethicone for the treatment of postoperative abdominal discomfort in infants | journal = Journal of Clinical Anesthesia | volume = 10 | issue = 2 | pages = 91–94 | date = March 1998 | pmid = 9524891 | doi = 10.1016/S0952-8180(97)00249-3 }}</ref>

==Side effects==
Simethicone does not have any serious side effects.<ref name=":0" /> Two uncommon side effects (occurring in 1 in 100 to 1 in 1,000 patients) are constipation and nausea.<ref>{{cite web |title= Simethicone Side Effects in Detail |url=https://www.drugs.com/sfx/simethicone-side-effects.html| work = Drugs.com |access-date=27 August 2017}}</ref> 

Though poorly documented,<ref>{{Cite journal |last=Skelin |first=Marko |last2=Lucijanić |first2=Tomo |last3=Amidžić Klarić |first3=Daniela |last4=Rešić |first4=Arnes |last5=Bakula |first5=Miro |last6=Liberati-Čizmek |first6=Ana-Marija |last7=Gharib |first7=Hossein |last8=Rahelić |first8=Dario |date=February 2017 |title=Factors Affecting Gastrointestinal Absorption of Levothyroxine: A Review |url=https://linkinghub.elsevier.com/retrieve/pii/S0149291817300383 |journal=Clinical Therapeutics |language=en |volume=39 |issue=2 |pages=378–403 |doi=10.1016/j.clinthera.2017.01.005|url-access=subscription }}</ref> some studies show a possible negative interaction between simethicone and levothyroxine, meaning it can possibly bind levothyroxine in the GI tract and hence reduce its absorption leaving the patient prone to clinical manifestations of hypothyroidism. It is important to mention the long T<sub>1/2</sub> of levothyroxine which makes the phenomenon a matter of at least a week of using levothyroxine with simethicone. To prevent this interaction, simethicone is recommended to be taken at least 4 hours before or after levothyroxine.<ref>{{Cite journal |last=Balapatabendi |first=M. |last2=Harris |first2=D. |last3=Shenoy |first3=S. D. |date=2011-09-01 |title=Drug interaction of levothyroxine with infant colic drops |url=https://adc.bmj.com/lookup/doi/10.1136/archdischild-2011-300333 |journal=Archives of Disease in Childhood |language=en |volume=96 |issue=9 |pages=888–889 |doi=10.1136/archdischild-2011-300333 |issn=0003-9888|url-access=subscription }}</ref>

==Pharmacology==
Simethicone is a non-systemic [[surfactant]] which decreases the surface tension of gas bubbles in the GI tract.<ref name=":0">{{Cite journal| vauthors = Ingold CJ, Akhondi H |date=January 2021|title=Simethicone|url=https://www.ncbi.nlm.nih.gov/books/NBK555997/|journal=StatPearls [Internet].|pmid=32310457 }}</ref> This allows gas bubbles to leave the GI tract as [[flatulence]] or [[belching]].<ref name=":0" /> Simethicone does not reduce or prevent the formation of gas.<ref>{{cite web|title=Treatment of Gas|url=https://iffgd.org/symptoms-causes/intestinal-gas/treatment.html|publisher=International Foundation for Functional Gastrointestinal Disorders|language=en-gb|date=4 September 2015}}</ref> Its effectiveness has been shown in several [[in vitro|''in vitro'']] studies.<ref>{{cite journal | vauthors = Brecević L, Bosan-Kilibarda I, Strajnar F | title = Mechanism of antifoaming action of simethicone | journal = Journal of Applied Toxicology | volume = 14 | issue = 3 | pages = 207–11 | date = May 1994 | pmid = 8083482 | doi = 10.1002/jat.2550140311 | url = https://www.researchgate.net/publication/15114732 | access-date = 30 January 2020 | publisher = Wiley | s2cid = 7453218 }}</ref><ref>{{cite journal  | vauthors = Dittrich M, Miederer SE, Havertz B, Krastev R | title = Schaumzerstörung und Schaumverhinderung: Der Wirkmechanismus von Simeticon in vitro |journal= Journal für Gastroenterologische und Hepatologische Erkrankungen. |trans-title=Defoaming and antifoaming action of simethicone in vitro | language = German | date = 12 May 2010 | volume = 8 | issue = 3 | pages = 19–25 | url =  https://www.kup.at/kup/pdf/9192.pdf | publisher=Krause & Pachernegg }}</ref>

==Chemistry==
Simethicone is a mixture of [[dimethicone]] and [[silicon dioxide]].<ref name="merck-dimethicone"> {{cite encyclopedia |veditors = O'Neil MJ |encyclopedia=The Merck Index |title=Dimethicone |edition=14th |year=2006 |publisher=Merck |location=Whitehouse Station, NJ  |page=545 }} </ref>

==Names==
The INN name is "simethicone", which was added to the INN recommended list in 1999.<ref name=INN>{{cite journal|title=Recommended INN List 42|journal=WHO Drug Information|date=1999|volume=13|issue=3|url=https://www.who.int/medicines/publications/druginformation/innlists/RL42.pdf?ua=1|page=202}}</ref>

Simethicone is marketed under many brand names and in many [[combination drugs]]; it is also marketed as a veterinary drug.<ref name=brands>{{cite web|title=Simeticone international brands|url=https://www.drugs.com/international/simeticone.html|publisher=Drugs.com|access-date=27 August 2017}}</ref>

{{collapse top|Brands}}
Brand names include A.F., Acid Off, Aero Red, Aero-OM, Aero-Sim, Aerocol, Aerox, Aesim, Aflat, Air-X, Anaflat, Antiflat, Baby Rest, Bicarsim, Bicarsim Forte, Blow-X, Bobotic, Bobotik, Carbogasol, Colic E, Colin, Cuplaton, Degas, Dentinox, Dermatix, Digesta, Dimetikon Meda, Disflatyl, Disolgas, Elugan N, Elzym, Endo-Paractol, Enterosilicona, Espaven Antigas, Espumisan, Espumisan L, Flacol, Flapex, Flatidyl, Flatoril, Flatulex, Flucolic, Gas X, Gas-X, Gaselab, Gaseoflat, Gaseoflatex, Gaseophar, Gaseoplus, Gaseovet, Gaservol, Gasimetin, Gasnil, Gasofilm, Gastrex, Gastrosen, Gazim X, Gazix, Geludrox-HS, Genasyme, Ilio-Funkton, Imogas, Imogaze, Imonogas, Infacalm, Infacol, Infacolic, Lefax, Lefaxin, Lefoam, Logastin, Luftal, Maxi Flat, Meteosim, Metiorisan, Metsil, Mylanta, Mylicon, Mylicongas, Mylom, Mymus, Nanog, Neodrop, Neogasol, Neolanta, Orocure, Ovol, Pedicon, Phazin, Phazyme, Polysilane Junior, Restime, Rugby Gas Relief, Sab Simplex, Salinal, Semecon, Semeth, Sicongast, Siflat, Silbione, Siligas, Silipin, Sim, Simcone, Simecon, Simecrin, Simedill, Simegut, Simet, Simethicon, Simethicone, Simetic, Simeticon, Simeticona, Simeticone, Siméticone, Simeticonum, Simetigast, Simflat, Simicol, Simicon, Wilcon, Wind-eze and WindSetlers.<ref name=brands/>

It is also marketed as a [[combination drug]]:<ref name=brands/>
* with [[algeldrate]] as Kestomatine
* with [[aluminium]] or [[magnesium]] salts and in some cases both, as Alamag Plus, Almacone, Alposim, Aluphagel, Alutop, Amico-L Andursil, Axcel Eviline, Boots Wind Relief, Di-Gel, Diovol Plus, Diovol Plus AF, Gas Ban DS, Hydrosil, Iosopan Plus, Kremil, Kremil-S, Maalox Plus, Magasida, Mi-Acid, Mygel, Mylagen, Mylanta, Polysilane, Polysilane Delalande, Rumibex and Trial AG
* with [[alverine]] as Avarin, Meteospasmyl, Nady-Spasmyl
* with [[barium sulfate]] as Bario Dif
* with [[bismuth]] as Gastop
* with [[calcium carbonate]] as Flamints, Gaseoflatex Plus, Malugel, Titralac Plus
* with [[activated charcoal]] as Carbosylane, Clingest, Finigax. Flatuna
* with [[cinitapride]] as Rogastril Plus
* with [[clebopride]] as Flatoril 
* with [[dicycloverine]] as Cloact, Colicspam, Colimix, Colispas, Coliza-D, Cyclopam, Fri-Spas, Meftal Spas, Respas, Simcomine, Spasact, Spasmindon DPS
* with [[domperidone]] as Bigetric, Dom Simecon, Doprokin-S, Glomoti, Moperidona AF, Mutecium, Praxis
* with [[hydrotalcite]] as Altacide and Talsil Forte
* with [[homatropine]] as Aero-Sim Compuesto, Asestor, Factor AG, Sedotropina Flat
* with [[lactulose]] as Dinolak
* with [[levonorgestrel]] as Jaydess
* with [[loperamide]] as Eldoper Plus, Imodium Duo, Imolopesim, Loperamide HCl/Dimeticon, Loperuma, Lositala, Losiwuto, Regulane AF, Stoperan Plus, Toban F Plus
* with [[magaldrate]] as Aci Basic, Aci-Tip, Acicone-S, Acid-Farvet, Acifin, Amalset, Antiax, Asidrat, Assis, Avicid, Banacid-s, Buenox, Cremalon, Curecid, Digax, Digeril, Endcid, Gaseovet MS, Gastrine, Gastrogel, Gastroral, Gastrorapid, Magacid, Magal-D, Magalat, Magaldrato+Simeticona, Magaldrax, Maganta Plus, Magsilon, Marlox Plus, Megacil Plus, Megalrat Plus, Minicidez, Miopan Plus, Novelta, Oxecone-MS, Riopan Plus, Rolac Plus, Sedo Mag, Simagal, Simelgat Plus, Taimacon, Zymcon
* with [[metoclopramide]] as Anaflat Compuesto, Di-Aero OM, Digespar, Factorine, Pangastren
* with [[mosapride]] as M-Pride-MPS, Moxar, Moza MPS 
* with [[pancreatin]] as Anaflat Enzimático, Digenil, Digesflat, Enzym Lefax, Enzymet, Enzymin, fermento duodenal, Finigax Indigestion, Flaton, Flazymec, Gasflat, Gaszym, Gesdyp, Hazmolin, Komflat, MeteoZym, Pankreoflat, Tripanzym
* with [[papaverine]] as Espasmo Siligas
* with [[pinaverium]] as Alevian Duo, Pladuet, Planex
* with [[pipenzolate bromide]] as Cadinol, Gasorbol Gotas
* with [[phloroglucinol]] as Meteoxane 
* with [[trimebutine]] as Eumotil-S, Eumotrix Plus, Libertrim SDP, Libertrim SII, Muvett S
* with [[urea]] as Hidribet.

It is also marketed as a veterinary drug under the brands Birp and Methysilox.
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== References ==
{{Reflist|30em}}

{{Drugs for functional gastrointestinal disorders}}

[[Category:Antiflatulents]]
[[Category:Food additives]]
[[Category:Silicon]]
[[Category:Silicon dioxide]]
[[Category:Digestive system]]
[[Category:Silicones]]
[[Category:Over-the-counter drugs in the United States]]