1. 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: 28.6.2013 (MHK) – 37 p. Grafic: 28.6.2013 (MHK)

2. 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. 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. 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. 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. 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. 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. 8 TRENKA Chem. pharm. Fabrik Ges.m.b.H Activated charcoal has an adsorption power which is 8 - 15 times higher than vegetable charcoal (acc. to Non-clinical overview, Module 2.4., dated 4/2011) 2. Components – Activated charcoal / vegetable charcoal

9. 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. 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. 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. 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. 13 TRENKA Chem. pharm. Fabrik Ges.m.b.H 2. Bestandteile – Gereinigter Schwefel ●Setzt Schwefelwasserstoffbläschen im Dünndarm frei ●Diese Schwefelwasserstoffbläschen stimulieren die Darmperistaltik

14. 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. 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. 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. 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 1 234 11 56789101112 WEEKS

18. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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 8 - 12 weeks. 1 2 3 4 5 6 7 8 9 10 11 12 WEEKS If the patient stops treatment before intestinal transit regulation is achieved, treatment should be started anew!

29. 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. 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. 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. 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. 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. 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. 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. 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. 37 TRENKA Chem. pharm. Fabrik Ges.m.b.H Thank you for your attention!