drug formulary

Transcription

drug formulary

HOSPITAL TENGKU AMPUAN RAHIMAH
DRUG FORMULARY
AUGUST 2011
1
DISCLAIMER
Editorial matter published herein is based on information supplied by Pharmaceutical
Services Division, Ministry of Health, Malaysia. Although every effort has been made in
compiling and checking the information contained in Drug Formulary for HTAR ensure that
they are accurate and valid up to the time of publishing, the publisher, editors or agents
shall not be responsible for the continued currency of the information or for any errors,
omissions or inaccuracies in this publication whether arising from negligence or otherwise,
how so ever or for any consequences arising therefrom. The publishers, authors and editors
also expressly disclaim any and all liability to any person whosoever in respect of any loss,
damage, death, personal injury or other consequences whatsoever, however caused or
arising, suffered by any such person by their use or reliance upon, in any way, the
information contained in this publication.
Original version of this drug formulary adapted from Pharmaceutical Division Ministry of
Health Malaysia and recompiled to suit the use in Hospital Tengku Ampuan Rahimah, Klang.
© August 2011, Pharmacy Department, HTAR. All Right Reserved.
No part of this publication may be reproduced, stored or transmitted in any form or by any
means without electronic, mechanical, photocopying, tape recording or other without
written permission of the copyright holder.
2
INTRODUCTION
This is a listing of MOH drug list incorporating the HTAR Formulary which is a subset of the
former. The drugs are listed according to the specialties and are in their non-proprietary
names (generic names). Brand names are included only as reference and are not indicative
of the actual stocks in the hospital. In fact, our policy is to use generics as far as possible in
view of the escalating costs of drugs
This updated August 2011 formulary is an updated version of the July 2007 formulary and
thus supercedes the latter. In line with the concept of “belanja berhemah”, we have
decided not to publish the hard copy HTAR Formulary but rather upload it into the hospital
website.
Please note that the MOH formulary as well as the HTAR formulary is only current at time of
printing and may have changed since. While every effort is made to ensure its currency,
errors and omissions may be expected.
The formulary is not a comprehensive data reference but serves only as a guide.
Use of certain drugs listed in this formulary and use of drugs not listed in this formulary is
not allowed unless specifically approved by the Director General of Health (DG). Drugs
which needs the approval by the DG are those which are :
a. Registered but not available in the MOH Formulary
b. Registered and available in the MOH Formulary but with different indication than
those listed in the MOH Formulary
c. Not registered and not available in the MOH Formulary
d. Not registered but available in the MOH Formulary
The secretariet of the Pharmaceutical Services Division will process the request of these
drugs based on the criteria set by the MOH Drug List Review Panel. For any help whatsoever
regarding this issue, please refer to our pharmacists.
Normawati Muhammad
Head of Pharmacy Department,
Hospital Tengku Ampuan Rahimah, Klang
3
CONTENTS
A
EMERGENCY
Toxicology/antidotes
8
9
B
GASTROINTESTINAL
Dyspepsia
Antispasmodics and drug altering gutmotility
Ulcer-healing drugs
Anti diarrheals
Laxatives
Local preparations for anal and rectal disorders
Drugs affecting intestinal secretions
Miscellaneous gastro intestinal
Antiemetic
17
18
19
21
27
27
29
30
31
33
C
CARDIOVASCULAR
Positive inotropic agents
Diuretics
Anti-arrhythmic drugs
Beta adrenoceptor blocking drugs
Drugs affecting the renin-angiotensin system and other antihypertensives
Nitrates, calcum channel blockers and potassium channel activators
Sympathomimetics
Anticoagulants and protamine
Antiplatelet drugs
Myocardial infarction and fibrinolysis
Lipid regulating drugs
Miscellaneous cardiovascular
39
40
42
45
47
50
60
66
67
71
73
77
81
D
RESPIRATORY
Bronchodilators
Corticosteroids
Cromoglycate, related therapy and leukotriene receptor antagonists
Respiratory stimulants and pulmonary surfactands
Miscellaneous respiratory
82
83
90
92
93
94
E
ANALGESICS
Non opioid analgesics
Opioid analgesics
Non steroidal anti inflammatory drugs (NSAIDS)
Neuropathic pain
95
96
98
106
110
F
PSYCHIATRY
Hypnotics and anxiolytics
Anti psychotics
Antidepressant drugs
Miscellaneous psychiatric
111
112
113
124
129
4
G
NEUROLOGY
Antimigraine drugs
Antiepileptics
Drugs used in parkinsonism and related disorders
Drugs used in substance dependence
Drugs for dementia
Central nervous system stimulants
Miscellaneous neurology
131
132
133
144
150
151
152
153
H
ANTIINFECTIVES
Antibacterial drugs
Antifungal drugs
Antiviral drugs
Antiprotozoal drugs
Anthelmintics
157
158
185
190
200
202
I
ENDOCRINE
Drugs used in diabetes
Thyroid and antithyroid drugs
Corticosteroids
Sex hormones
Hypothalamic and pituitary hormones and antiestrogens
Drugs affecting bone metabolism
204
205
212
215
218
219
222
J
OBSTETRICS, GYNAECOLOGY
Hormone replacement therapy
Infertility
Prostaglandin and oxytoxics
Treatment of vaginal and vulva conditions
Contraceptives
Miscellaneous obstetrics and gynecology
228
229
233
235
237
238
242
K
GENITOURINARY
Drugs for urinary retention
Drugs for urinary frequency, enuresis and continence
Miscellaneous genitourinary
243
244
246
246
L
DRUGS AFFECTING IMMUNE RESPONSE
Immunosuppresants
Immunomodulators
248
249
251
5
M
HEMATOLOGY/ONCOLOGY
Cytotoxic drugs
Sex hormones and hormone antagonists in malignant disease
Bleeding disorder
Miscellaneous harmotology/oncology
254
255
271
273
273
N
NUTRITION AND BLOOD DISORDER
Fluids and electrolytes
Intravenous nutrition
Minerals
Vitamins
Miscellaneous nutrition and blood disorder
276
277
283
284
286
294
P
RHEUMATOLOGY
Antirheumatic
Gout
Drugs used in neuromuscular disorders
Drugs for the relief of soft tissue inflammation
Miscellaneous rheumatology
299
300
303
303
303
303
Q
OPHTHALMOLOGY
Anti infective eye preparations
Anti infective with steroids
Corticosteroids and other anti inflammatory preparations
Anti virals
Mydriatics and cycloplegics
Treatment of glaucoma
Local anesthetics
Miscellaneous ophthalmology
305
306
309
310
311
311
313
317
317
R
EAR, NOSE AND OROPHARYNX
Ear preparations
Nose preparations
Oropharynx preparations
Antihistamines, hyposensitization and allergic emergencies
Mucolytics
Aromatic inhalations
Cough preparations
Systemic nasal decongestant
Miscellaneous ear, nose and oropharynx
320
321
322
325
327
332
332
333
334
334
6
S
DERMATOLOGY
Emollient and barrier preparations
Topical local anaesthetics and anti pruritics
Topical corticosteroids
Preparations for exzema and psoriasis
Acne and rasacea
Preparations for warts and calluses
Shampoos and other preparations for scalp conditions
Anti infective skin preparations
Disinfectants, skin cleansers and antiseptics
Miscellaneous dermatology
336
337
337
339
342
346
348
348
349
355
358
T
IMMUNOLOGICAL PRODUCTS AND VACCINES
Vaccines and antisera
Immunoglobulins
361
362
365
U
ANAESTHESIA
Induction/maintenance
Neuromuscular blocker
Topical anaesthesia
Local anaesthesia
Miscellaneous anaesthesia
367
368
372
374
376
380
V
DIAGNOSTIC
Radiocontrast media
Diagnostic aids and test preparation
382
383
383
W
MISCELLANEOUS
General disinfectant
Other disinfectants
385
386
386
7
1. EMERGENCY
Toxicology / Antidotes
8
Acetylcysteine 200mg/ml
A*
Trade Name : Parvolex
Indication :
Antidote for paracetamol poisoning
Dosage :
Diluted with dextrose 5% and infused IV. Initial, 150 mg/kg IV in 200 ml over 60 minutes, then 50
mg/kg IV in 500 ml over 4 hours, followed by 100 mg/kg IV in 1000 ml over 16 hours. Total dose:
300mg/kg in 20 hour
Precautions :
Asthma, history of bronchospasm and risk of anaphylactoid reactions and history of peptic
ulceration
Adverse Reactions :
Bronchoconstriction, nausea, vomiting, anaphylactic reactions, rash, hypotension, pruritus, rash,
urticaria
Contraindications :
Hypersensitivity to acetylcysteine products
Interactions :
Carbamazepine : increased risk of subtherapeutic carbamazepine levels. Nitroglycerin : enhanced
hypotension and nitroglycerin-induced headache. Penicillin G, tetracycline : loss of antibiotic efficacy
-------------------------------------------------------------------------------------------------------------------------------------Antivenene Malaysian Pit Viper Injection
B
Indication :
Bitten by pit viper
Dosage :
Reconstitute content for the vial with 5 ml sterile pyrogen-free distilled water. Administer by IV
infusion 200 ml of normal saline over a period of 1 - 2 hours
Precautions :
Sensitivity testing should be performed before the administration
Adverse Reactions :
Chest pain, hypotension, chills, nervousness, cellulitis, bruising, pruritus, rash, urticaria, anorexia,
nausea, coagulation disorder, back pain, circumoral paraesthesia, general paraesthesia, myalgia,
asthma, cough, dyspnoea, sputum increased, wheezing, allergic reaction, serum sickness,
subcutaneous nodule, wound infection, anaphylaxis, serum sickness
Contraindications :
Hypersensitivity to any component of the formulation, unless the benefits outweigh the risks and
appropriate management for anaphylaxis is available
Interactions :
Not known
-------------------------------------------------------------------------------------------------------------------------Antivenene Serum (Cobra) Injection
B
Indication :
Treatment for cobra bites
Dosage :
The reconstituted antivenin should be given by slow intravenous infusion, approximately
2ml/min.Subsequent dose can be given every 12 hours according to the clinical symptoms
Precautions :
Respiratory support maybe essential. Sensitivity testing should be performed before the
administration
9
Adverse Reactions :
Anaphylaxis with hypotension, dyspnea, urticaris, Immune hypersensitivity reaction , shock,
transfusion reaction due to serum protein reaction ,serum sickness
Contraindications :
Interactions :
Not known
-----------------------------------------------------------------------------------------------------------------------------Antivenene Serum (Sea snake) 1000 units/26.3 ml Injection
B
Indication :
Treatment for sea snake bites
Dosage :
1000 units by IV infusion over 1/2 to 1 hour. In severe cases 3000 -10000 units may be required
Precautions :
Adverse Reactions :
Contraindications :
Interactions :
Not known
---------------------------------------------------------------------------------------------------------------------------------Antivenene Serum Snake polyvalent Injection
B
Indication :
Antidote for snake bites
Dosage :
Recommended initial dose is 20ml by intravenous infusion. The injection should be given very slowly
as 5 minutes by direct slow intravenous route or 1hour by infusion. If symptoms continue, further
doses are administered as required until symptoms completely disappear
Precautions :
Adverse Reactions :
Contraindications :
Interactions :
Not known
----------------------------------------------------------------------------------------------------------------------------------
10
Calcium Disodium Edetate 200 mg Injection
A
Trade Name : Ca Disod. Versenate
Indication :
Lead Poisoning
Dosage :
60 - 70 mg/kg body weight daily given IV infusion in 2 daily doses for up to 5 days; repeated if
necessary after an interval of 2 days. Any further treatment with calcium edetate should not be
recommended for 7 days
Precautions :
Renal impairment, haematuria, proteinuria, cerebral oedema. Capable of producing toxic effects
which can be fatal, patients with lead encephalopathy, administer only after adequate urine flow is
established, children must be given adequate oral fluids during outpatient therapy
Adverse Reactions :
Nephrotoxicity, malaise, chills, thirst, nausea, vomiting, diarrhoea, abdominal pain, injection site
pain, myalgia, headache, hypotension (frequent), thrombophlebitis (frequent), immune
hypersensitivity reaction
Contraindications :
Hypersensitivity to edetate products, anuria or active renal disease, hepatitis
Interactions :
Not known
------------------------------------------------------------------------------------------------------------------------------Calcium Polystyrene Sulphonate Powder
A
Trade Name : Kalimate
Indication :
Hyperkalemia resulting from acute or chronic renal failure
Dosage :
15 - 30g daily in 2-3 divided doses. Each dose should be suspended in 30 - 50ml of water and
administered orally
Precautions :
Patients should be monitored for electrolytes disturbances, especially hypokalaemia and
hypercalcaemia. May cause perforation in intestine, necrosis in mucous membrane of intestine,
large intestine ulcer, colon necrosis
Adverse Reactions :
Bronchopneumonia associated with inhalation of calcium polystyrene sulphonate. Anorexia, nausea,
vomiting, constipation, diarrhea, colon perforation, hypopotassaemia, calcium overloading and
hypercalcaemia
Contraindications :
Should be avoided in patients with conditions such as hyperparathyroidism, multiple myeloma,
sarcoidosis, or metastatic carcinoma who may present with renal failure together with
hypercalcaemia
Interactions :
Digitalis preparation, antacid and laxatives containing aluminium, magnesium or calcium, dried
aluminium hydroxide gel, magnesium hydroxide, precipitate calcium carbonate. Calcium ions are
released from the resin in the gastrointestinal tract and this may reduce the absorption of
tetracycline given by mouth
-------------------------------------------------------------------------------------------------------------------------------
11
Charcoal, Activated 250 mg Tablet
C
Indication :
i) Diarrhoea and food poisoning ii) Reduce absorption of drugs, plant, inorganic
poison and chemicals in poisoning cases
Dosage :
i) ADULT 0.5-1 g given 3-4 times daily. CHILD half adult dose. ii) Need to be dissolved in liquid (slurry
consistency). ADULT and CHILD over 12 years: initial 30-100 g or 1-2 g/kg; repeat initial dose as soon
as possible or 20-50 g every 2-6 hours. CHILD over 1-12 years, 25-50 g or 1-2 g/kg; may repeat half
the initial dose every 2-6 hour as needed. CHILD to 1 year of age, 1 g/kg; may repeat half the initial
dose every 2-6 hours as needed. For maximum efficacy administer within 1 hour after ingestion of
toxic compound
Precautions :
Aspiration of charcoal, hydrocarbons, corrosive, imaging of gastroesophageal. Caution in patient at
risk of gastrointestinal obstruction
Adverse Reactions :
Black stools and gastrointestinal disturbances
Contraindications :
An unprotected airway, gastrointestinal tract not anatomically intact
Interactions :
Acarbose, carbamazepine, digoxin, frusemide, olanzapine, phenytoin; decreased effectiveness of
these drugs, reduce absorption of oral therapy and render their effectiveness, simultaneous oral
therapy should be avoided. Clear activated charcoal from stomach /avoid its usage if methionine
(specific oral antidote) is to be used
------------------------------------------------------------------------------------------------------------------------------D-Penicillamine 0.25 g Capsule
A
Trade Name : Cuprimine
Indication :
i) Treatment of severe lead poisoning, it is used as adjunctive treatment following initial treatment
with another chelating agent. May also be used as sole therapy in the treatment of asymptomatic
patients with moderately elevated blood concentrations ii) Wilson's Disease: to aid in elimination of
copper ions
Dosage :
i) 1.5 - 2 g daily in divided doses before food, maximum: 2 g daily for a year.
Maintenance : 0.75 - 1 g daily ii) Initially 500 mg daily in divided doses, increased
slowly over 3 months; usual maintenance : 1.25 g daily. Elderly not recommended
Precautions :
Allergy to penicillin, concomitant gold therapy, antimalarial, cytotoxic drug, renal dysfunction
Adverse Reactions :
Nausea, vomiting, myelosuppression, taste disorders, proteinuria, myasthenia gravis, optic neuritis,
tinnitus
Contraindications :
Penicillamine-related aplastic anaemia/agranulocytosis, hypersensitivity to penicillamine producs,
myasthenia gravis, pregnancy, lactation, rheumatoid arthritis patients with history of renal
insufficient
Interactions :
Alluminium hydroxide or phosphate, magnesium carbonate or hydroxide or oxide or trisilicate, iron,
digoxin, aurothioglucose
----------------------------------------------------------------------------------------------------------------------------------
12
Flumazenil 0.5 mg/5 ml Injection
B
Trade Name : Anexate
Indication :
i) Diagnosis and/or management of benzodiazepine overdose due to self-poisoning or accidental
overdose ii) Reversal of sedation following anaesthesia with benzodiazepine
Dosage :
i) Initial, 0.2 mg IV over 30 seconds; if desired level of consciousness not obtained after an additional
30 seconds, give dose of 0.3 mg IV over 30 seconds; further doses of 0.5 mg IV over 30 seconds may
be given at 1-minutes intervals if needed to maximum total dose of 3 mg; patients with only partial
response to 3 mg may require additional slow titration to a total dose of 5 mg; if no response 5
minutes after receiving total dose of 5 mg, overdose is unlikely to be benzodiazepine and further
treatment with flumazenil will not help ii) 0.2 mg IV over 15 seconds; if desired level of
consciousness is not obtained after waiting 45 seconds, a second dose of 0.2 mg IV may be given and
repeated at 60-seconds intervals as needed (up to a maximum of 4 additional times) to a maximum
total dose of 1 mg; most patients respond to doses of 0.6 to 1 mg; in the event of resedation,
repeated doses may be given at 20-minutes intervals if needed; for repeat treatment, no more than
1 mg (given as 0.5 mg/minute) should be given at any one time and no more than 3 mg should be
given in any one hour
Precautions :
Patients with a history of long-term benzodiazepine abuse, head injuries, history of panic disorder,
liver disease, drug and alcohol dependent patients, neuromuscular blocking agents
Adverse Reactions :
Cardiac arrhythmias, bradycardia, dizziness, nausea, vomiting, seizure, injection site pain, headache,
abnormal vision, blurred vision, agitation
Contraindications :
Hypersensitivity to flumazenil/benzodiazepines, cyclic antidepressant overdose, patients who have
been given a benzodiazepine for control of a potentially life-threatening condition (eg, control of
intracranial pressure or status epilepticus)
Interactions :
Thiopental : decreased duration of thiopental anaesthetic effects
---------------------------------------------------------------------------------------------------------------Fuller's Earth 30% Suspension
C
Trade Name : Fuller's Earth
Indication :
Adsorbent in pesticide poisoning
Dosage :
200 - 500 ml of Fuller's Earth together with magnesium sulphate or mannitol every 2
hours for several days
Precautions :
Not known
Adverse Reactions :
Irritation of the skin, inflammation, blistering, cracking, shedding of the nails, delayed healing of cuts
and wounds
Contraindications :
Not known
Interactions :
Not known
--------------------------------------------------------------------------------------------------------------------------------
13
Mesna 400 mg/4 ml Injection
A
Trade Name : Uromitexan
Indication :
For prevention of urotoxic effects of oxazaphosphorines e.g. ifosfamide and cyclophosphamide
Dosage :
IV injection at a dosage of 20% of the corresponding oxazaphosphorine dose at the times 0 hour
(concurrently with the oxazaphosphorine), 4 hours and 8 hours thereafter. CHILD: Dose given at
greater frequency (e.g. 6 times) and a shorter intervals (e.g. 3 hours)
Precautions :
Do not use multi-dose vial in infants and neonates due to benzyl alcohol content, patients treated
with mesna may have false positive test for urinary ketones, pregnancy
Adverse Reactions :
Hypotension, nausea, vomiting, headache, limb pain, headache, gastrointestinal effects, skin rash,
diarrhoea, abdominal pain, transient drop in blood pressure, increase in pulse rate
Contraindications :
Hypersensitivity to mesna/other thiol compounds
Interactions :
Warfarin: increased risk of bleeding. In vitro mesna is incompatible with cisplatin. The combination
of an oxazaphosphorine cytostatic agent with mesna and cisplatin in the same infusion solution is
not stable and is not to be used
-------------------------------------------------------------------------------------------------------------------------------Methylene Blue 1% Injection
B
Indication :
For treatment of idiopathic and drug-induced methaemoglobinemia
Dosage :
1 to 2 mg/kg (0.1 to 0.2 mL/kg of a 1% solution) IV very slowly over several minutes
Precautions :
Haemolytic anaemia (Heinz-body anaemia) and hyperbilirubinaemia in neonates who had been
exposed to methylene blue in the amniotic cavity. Do NOT administer by subcutaneous or
intrathecal injection. G6PD deficiency, renal impairment
Adverse Reactions :
Hypertension, hypotension, sweating symptom, abdominal pain, diarrhea, nausea, vomiting
,dizziness, headache, confusion, cardiac dysrhythmia, malignant hyperthermia, hemolytic anemia,
methemoglobinemia
Contraindications :
Hypersensitivity to methylene blue, severe renal impairment, methaemoglobinemia in cyanide
poisoning, intraspinal injection
Interactions :
Not known
---------------------------------------------------------------------------------------------------------------Naloxone HCl 0.4 mg/ml Injection
B
Trade Name : Narcan
Indication :
For the complete/partial reversal of narcotic depression including respiratory depression induced by
opioids such as natural and synthetic narcotics. Diagnosis of suspected acute opioids overdosage
Dosage :
Initially 0.4 - 2 mg IV repeated at intervals of 2 - 3 minutes according to patient's needs
14
Precautions :
Dependence may precipitate withdrawal symptoms, concurrent cardiotoxic drugs, pre-existing
cardiac disease, narcotic dependency, pregnancy, lactation, neonates
Adverse Reactions :
Opiate withdrawal symptoms, nausea, vomiting, tachycardia, tremor, sweating, pulmonary oedema,
hyperventilation, cardiac dysrhythmia, biliary colic, dysphagia, memory impairment, seizure,
agitation, dyspnea, laryngeal spasm, pulmonary edema, tachyarrhythmia
Contraindications :
Hypersensitivity to naloxone
Interactions :
Clonidine: hypertension
---------------------------------------------------------------------------------------------------------------Pralidoxime 0.5 g/20 ml Injection
B
Trade Name : Protopam
Indication :
Antidote in the treatment of organophosphorus insecticide poisoning and in the control of
overdosage by anticholinergic drugs used in the treatment of myasthenia gravis
Dosage :
1 - 2 g by IV infusion in 100 ml saline over 15 - 30 minutes or slow IV injection over 10 minutes as 5 %
solution. In water, followed after 1 hour by a second dose of 1 - 2 g. CHILD : 20 - 40 mg /kg body
weight, may be given depending on the severity and response to treatment
Precautions :
Myasthenia gravis, renal dysfunction, slow IV infusion may prevent tachycardia, laryngospasm and
muscle rigidity. Not effective in poisonings due to organophosphates without anticholinesterase
activity, not effective in poisonings due to phosphorus/inorganic phosphates, renal impairment
Adverse Reactions :
Nausea, vomiting, dizziness, headache, blurred vision, bitter after taste, hyperventilation, laryngeal
spasm
Contraindications :
Hypersensitivity to pralidoxime, phosphorus/inorganic phosphate poisoning, organophosphates
without anticholinesterase activity
Interactions :
Not known
---------------------------------------------------------------------------------------------------------------Protamine Sulphate 50 mg/5 ml Injection
B
Indication :
Heparin overdose and following cardiac or arterial surgery or dialysis procedures when
required to neutralize the effects of heparin administered during extracorporeal
circulation
Dosage :
5 ml slow IV injected over 10 minutes. If administered within 15 minutes of heparin
dose, 1 mg will neutralise approximately 100 units of heparin. If longer time has
elapsed, less protamine is required. Not more than 50 mg should be injected at any
one time
Precautions :
The rapid administration of protamine is associated with a higher incidence of adverse
haemodynamic effects and anaphylactoid-like reactions. A solution of 10 mg/mL should be injected
slowly over 1 to 3 minutes to prevent haemodynamic effects and anaphylactic-like reaction, patients
with a history of fish allergy may also develop sensitivity reaction
15
Adverse Reactions :
Hypotension, bradycardia, hypersensitivity reactions
Contraindications :
Hypersensitivity to protamine products
Interactions :
Not known
---------------------------------------------------------------------------------------------------------------Sodium Thiosulphate 500 mg/ml Injection
B
Indication :
For cyanide poisoning
Dosage :
ADULT : 300 mg sodium nitrite IV over 3 minutes followed after 5 minutes with 50 ml sodium
thiosulphate 50% injection administered over 10 minutes. CHILD : 4.5 - 10 mg/kg sodium nitrite IV
followed by 1.65 ml/kg of 25% sodium thiosulphate injection
Precautions :
Too rapid intravenous administration has caused hypotension
Adverse Reactions :
Diarrhoea, allergic contact dermatitis
Contraindications :
Not known
Interactions :
Not known
--------------------------------------------------------------------------------------------------------------------------
16
2. GASTRO-INTESTINAL
Dyspepsia
Antispasmodics and drugs altering gut motility
Ulcer-healing drugs
Antidiarrheals
Laxatives
Local preparations for anal and rectal disorders
Drugs affecting intestinal secretions
Antiemetics
Miscellaneous gastrointestinal
17
Magnesium Trisilicate Mixture
C
Indication :
Heartburn, dyspepsia
Dosage :
10-20 ml 3-4 times daily before meals
Precaution:
Renal impairment-nonabsorbable calcium, magnesium or aluminum preparations such as antacids or
laxatives should not be used in patients receiving oral cation-exchange resins. Alternatively, the
interaction may be avoided by administering the resin as an enema
Adverse Drug Reaction:
Diarrhoea, systemic alkalosis has been reported when administered orally with cation-exchange
resins
Contraindication:
Acute surgical abdomen, hypersensitivity to antacids, hypophosphataemia
Interaction:
Major: sodium polystyrene sulfonate (advoid). Moderate: tetracyclines, ketoconazole, itraconazole,
dipyridamole, quinolones, captopril, iron and aspirin (adjust frequency interval)
---------------------------------------------------------------------------------------------------------------Magnesium Trisilicate Tablet
C
Indication :
Heartburn, dyspepsia
Dosage :
ADULT 1-2 tablet to be chewed up to 6 times a day before meals. CHILD over 6 years
one tablet to be taken 3-4 times a day
Precaution:
Renal impairment
Diarrhoea
Contraindication:
Hypersensitivity to antacids, hypophosphataemia
Interaction:
Tetracyclines, ketoconazole, itraconazole, dipyridamole, quinolones, captopril, iron and aspirin
---------------------------------------------------------------------------------------------------------------Sodium Bicarbonate Mixture (Paediatric)
C
Trade Name : Mist Carminative Paed
Indication :
Heartburn for rapid relief of dyspepsia
Dosage :
CHILD up to 1 year 5 ml; up to 1-5 years 10 ml in 4 to 6 divided doses
Precaution:
Excessive bicarbonate may lead to hypovolaemia and metabolic alkalosis in impaired renal function.
History of congestive heart failure, history of renal impairment, cirrhosis, hypertension, concurrent
corticosteroids, maintain high urine output, monitor acid-base balance and electrolyte
Gastrointestinal cramps, flatulence, belching, alkalosis on prolong use
Contraindication:
Alkalosis, hypocalcaemia, hypochloraemia
18
Interaction:
Major: sodium polystyrene sulfonate (systemic alkalosis). Minor: amphetamine, aspirin,
chlorpropamide, itraconazole, ketoconazole, lithium, pseudoephedrine
-------------------------------------------------------------------------------------------------------------------------------------Sodium Bicarbonate, Magnesium Carbonate, Tincture Cardamom Compound Mixture
C
Trade Name : Carminative
Indication :
Heartburn, for rapid relief of dyspepsia
Dosage :
ADULT 10-20 ml 3 times daily
Precaution:
Renal impairment
Gastrointestinal cramps, flatulence, belching, alkalosis on prolong use
Contraindication:
Hypersensitivity to antacids, hypophosphataemia
Interaction:
Tetracyclines, ketoconazole, itraconazole, dipyridamole, quinolones, captopril, lithium and aspirin
----------------------------------------------------------------------------------------------------------------------------Domperidone 1 mg/ml Suspension
B
Trade Name : Motilium
Indication :
Nausea, vomiting, dyspepsia, gastro-esophageal reflux
Dosage :
Chronic dyspepsia : CHILD 2.5 mL/10 kg body weight 3 times daily and once more in
the evening if necessary. Dosage may be doubled in adults & childs over 1 year.
Acute and subacute conditions (particularly nausea and vomiting). CHILD: 5 mL/10
kg bodyweight. All to be taken 3-4 times daily
Precaution:
Baby under 1 year, hepatic impairment, renal insufficieny, pregnancy and lactation
Mild abdominal cramps, raised serum prolactin level
Contraindication:
Known hypersensitivity to domperidone or any of the excipients. Prolactin-releasing pituitary
tumour(prolactinoma). Should not be used when stimulation of gastric motility could be harmful:
gastro-intestinal haemorrhage, mechanicalobstruction or perforation
Interaction:
MAOIs, antacids, antisecretory drugs, azole antifungals, macrolide antibiotics, HIV protease
inhibitors, anticholinergic drugs, CYP3A4 inhibitors. Antacids or antisecretory agents should be taken
after meals when used concomitantly
----------------------------------------------------------------------------------------------------------------------------Domperidone 10 mg Tablet
Trade Name : Motilium
Indication :
Nausea, vomiting, dyspepsia, gastro-esophageal reflux
Dosage :
Chronic dyspepsia ADULT 10 mg 3 times daily. Acute and subacute conditions
(particularly nausea and vomiting):ADULT 20 mg 3-4 times daily
19
B
Precaution:
Dosage adjustment may be necessary in patients who are receiving domperidone concomitantly
with cimetidine,pregnancy, lactation
Mild abdominal cramps, raised serum prolactin level
Contraindication:
Known hypersensitivity to domperidone or any of the excipients. Prolactin-releasing pituitary
tumour(prolactinoma.) Should not be used when stimulation of gastric motility could be harmful:
gastro-intestinal haemorrhage, mechanical obstruction or perforation
Interaction:
MAOIs, antacids, antisecretory drugs, azole antifungals, macrolide antibiotics, HIV protease
inhibitors, anticholinergic drugs, CYP3A4 inhibitors. Antacids or antisecretory agents should be taken
after meals when used concomitantly
---------------------------------------------------------------------------------------------------------------------------Hyoscine N-Butylbromide 10 mg Tablet
B
Trade Name : Buscopan
Indication :
Gastrointestinal tract and genito-urinary tract spasm, dyskinesia of the biliary system
Dosage :
ADULT 10-20 mg 3-4 times daily. CHILD 6-12 years: 10 mg 3 times daily
Precaution:
Geriatric and pediatric patients, pregnancy, breastfeeding, intestinal atony, paralytic ileus and
ulcerative colitis, coronary artery diseases, arrhythmias , heart failure, hypertension, xerostomia,
hiatal hernia with reflux esophagitis, prostatic hypertrophy.
Xerostomia, dyshidrosis, tachycardia, urinary hesistancy and retention, allergic reactions, skin
reactions, confusions, excitement, constipation, paralytic ileus
Contraindication:
Obstructive disease of the gastrointestinal or urinary tract, narrow-angle glaucoma, cardiac
tachyarrhythmias, myasthenia gravis, prostatic hypertrophy with urinary retention
Interaction:
Intensifies anticholinergic effects of tricyclic antidepressants, antihistamines, quinidine, amantadine
and disopyramide. Enhances tachycardic effects of beta-adrenergic agents. Dopamine antagonist eg
metoclopramide reduces effects of both drugs on gastrointestinal tract
----------------------------------------------------------------------------------------------------------------------------Hyoscine N-Butylbromide 20 mg/ml Injection
B
Trade Name : Buscopan
Indication :
Gastrointestinal tract and genito-urinary tract spasm, dyskinesia of the biliary system
Dosage :
ADULT 20 - 40 mg. Max : 40 mg 6 - 8 hourly. CHILD 0.5 mg/kg/dose
Precaution:
Geriatric and pediatric patients, pregnancy, breastfeeding, intestinal atony, paralytic ileus and
ulcerative colitis, cardiac disease, coronary artery diseases, arrhythmias , heart failure, hypertension,
xerostomia, hiatal hernia with reflux esophagitis, prostatic hypertrophy
Xerostomia, dyshidrosis, tachycardia, urinary hesistancy and retention, allergic reactions, skin
reactions, confusions, excitement, constipation, paralytic ileus, rarely anaphylactoid reactions &
anaphylactic shock
20
Contraindication:
Obstructive disease of the gastrointestinal or urinary tract, narrow-angle glaucoma, cardiac
tachyarrhythmias, myasthenia gravis, prostatic hypertrophy with urinary retention, paraben allergy
(multi-dose vial for injection contains parabens)
Interaction:
Intensifies anticholinergic effects of tricyclic antidepressants, antihistamines, quinidine, amantadine
and disopyramide. Enhances tachycardic effects of beta-adrenergic agents. Dopamine antagonist eg
metoclopramide reduces effects of both drugs on gastrointestinal tract
----------------------------------------------------------------------------------------------------------------------------Mebeverine HCl 135 mg Tablet
B
Trade Name : Duspatalin
Indication :
Irritable bowel syndrome
Dosage :
135 mg 3 times daily
Precaution:
Hypersensitivity to mebeverine HCl, severe hepatic insufficency, porphyria
Dizziness, headache, nausea, peritonitis, skin reactions
Contraindication:
Cystic fibrosis, porphyria, paralytic ileus, hypersensitivity to any component of formulation
Interaction:
Not known
--------------------------------------------------------------------------------------------------------------------------Esomeprazole 20 mg Tablet
A*
Esomeprazole 40 mg Tablet
A*
Trade Name : Nexium
Indication :
i)Gastro-oesophageal reflux disease ii)H. pylori eradication
Dosage :
i)20mg daily for 4-8 weeks ii)40mg daily for 10 days in combination with amoxicillin 1g twice daily or
clarithromycin 500mg twice daily
Precaution:
Exclude gastric malignancy prior to treatment. Severe renal or hepatic insufficiency. Pregnancy;
lactation (discontinue). Long-term treatment should be kept under regular surveillance. Fructose
intolerance, glucose-galactose malabsorption or sucrase-isomaltase insufficiency. Monitoring when
initiating and ending concomitant treatment with warfarin.Severe liver impairment, Hypersensitivity
reactions e.g., angioedema and anaphylactic reaction/shock have been reported
Abdominal pain , constipation , diarrhoea , dyspepsia , flatulence , nausea , dizziness, headache
erythema multiforme , Stevens-Johnson syndrome, toxic epidermal necrolysis, dermatitis
Contraindication:
Hypersensitivity to esomeprazole, in patients with known hypersensitivity to any component of the
formulation
Interaction:
Citalopram, imipramine, clomipramine, phenytoin, diazepam, ketoconazole , itraconazole, warfarin,
effects on absorption, effects on hepatic metabolism/cytochrome P-450 pathways,clarithromycin
and amoxicillin (increase esomeprazole and 14-hydroxyclarithromycin plasma level)
-----------------------------------------------------------------------------------------------------------------------------
21
Esomeprazole 40 mg Injection
A*
Trade Name : Nexium
Indication :
i) Acute erosive/ ulcerative oesophagitis ii) Non -variceal upper gastrointestinal bleed
Dosage :
i) 20- 40 mg once daily for 2-5 days ii) 80 mg by IV bolus followed by 8mg/hour infusion for 72 hours
Precaution:
Exclude gastric malignancy prior to treatment. Severe renal or hepatic insufficiency. Pregnancy;
lactation (discontinue). Long-term treatment should be kept under regular surveillance. Fructose
intolerance, glucose-galactose malabsorption or sucrase-isomaltase insufficiency. Monitoring when
initiating and ending concomitant treatment with warfarin. Severe liver impairment
Abdominal pain , constipation , diarrhoea , dyspepsia , flatulence , nausea , dizziness, headache
erythema multiforme , Stevens-Johnson syndrome, toxic epidermal necrolysis, dermatitis
Contraindication:
Hypersensitivity to esomeprazole in patients with known hypersensitivity to any component of the
formulation
Interaction:
Citalopram, imipramine, clomipramine, phenytoin, diazepam, ketoconazole , itraconazole,
warfarin,effects on absorption, effects on hepatic metabolism/cytochrome P-450
pathways,clarithromycin and amoxicillin (increase esomeprazole and 14-hydroxyclarithromy)
-------------------------------------------------------------------------------------------------------------------------------Lansoprazole 30 mg Tablet
A*
Trade Name : Prevacid
Indication :
i) Peptic ulcer disease ii) Reflux oesophagitis iii) Zollinger-Ellison Syndrome iv) For eradication of
Helicobacter pylori in combination with antibiotic
Dosage :
i) 30 mg daily for 8 weeks ii) 30 mg once 1-2 times daily for 4-8 weeks iii) 60-120mg once daily
adjusted according to the patient's response iv) 30 mg twice daily in combination with any of the 2
antibiotics (clarithromycin 500 mg twice daily , amoxicillin 1 g twice daily or metronidazole 400 mg
twice daily) for 1-2 weeks
Precaution:
Hepatic impairment, elderly, pregnancy, lactation
Agitation, constipation, diarrhoea, dry mouth, abdominal distension, headache, sleepiness,
insomnia, dizziness, rash, pruritus, fever
Contraindication:
Hypersensitivity to lansoprazole, in patients with known hypersensitivity to any component of the
formulation
Interaction:
May retard metabolism and excretion of diazepam and phenytoin. May decrease plasma
concentration of theophylline, inhibition of gastric acid secretion may interfere with dissolution of
the drug
--------------------------------------------------------------------------------------------------------------------------------------
22
Omeprazole 20 mg Capsule
A
Trade Name : Losec
Indication :
Only for : i)Reflux oesophagitis ii)For eradication of Helicobacter pylori infection iii)Benign peptic
ulcer not responding to conventional therapy iv)Zollinger-Ellison Syndrome
Dosage :
i)20 - 80 mg 1 - 2 times daily up to 8 - 12 weeks ii)20 mg twice daily in combination with any of the 2
antibiotics (clarithromycin 500 mg twice daily, amoxicillin 1 g twice daily or metronidazole 400 mg
twice daily)for 1 - 2 weeks iii) 20 mg once daily for 4 - 6 weeks iv) ADULT: 20 - 120 mg once daily
adjusted according to the patient's response. CHILD 0.4 - 0.8 mg/kg/day
Precaution:
Proton pump inhibitors reduce gastric acidity and increase the risk of gastrointestinal infections. It
may mask symptoms of gastric cancer (exclude malignancy in suspected gastric ulcers)
Gastrointestinal effects such as diarrhoea, nausea and constipation, headache, cough, upper
respiratory tract infection, rash
Contraindication:
Hypersensitivity to omeprazole or to any of its components
Interaction:
May prolong elimination of diazepam, warfarin and phenytoin. Increases plasma concentration of
clarithromycin, ketoconazole
-----------------------------------------------------------------------------------------------------------------------------Omeprazole 40 mg Injection
A*
Trade Name : Losec
Indication :
i) Reflux oesophagitis, eradication of H. Pylori infection, benign peptic ulcer not responding to
conventional therapy, Zollinger-Ellison Syndrome ii) Endoscopically confirmed peptic ulcer
Dosage :
i) 40 mg IV once daily when oral therapy is inappropriate ii) 40- 160 mg by IV in single or divided
doses
Precaution:
Proton pump inhibitors reduce gastric acidity & increase the risk of GI infections. It may mask
symptoms of gastric cancer (exclude malignancy in suspected gastric ulcers)
GI effects such as diarrhoea, nausea & constipation, headache, cough, upper respiratory tract
infection, rash
Contraindication:
Hypersensitivity to omeprazole or to any of its components
Interaction:
May prolong elimination of diazepam, warfarin & phenytoin. Increases plasma concentration of
clarithromycin, ketoconazole
----------------------------------------------------------------------------------------------------------------------------------Pantoprazole 40 mg Injection
Trade Name : Controloc
Indication :
Bleeding peptic ulcer and acute stress ulceration
Dosage :
A*
40 mg twice daily until oral administration can be resumed. CHILD not recommended
23
Precaution:
Gastrointestinal disturbances (nausea and vomitting, diarrhoea, constipation, upper abdominal pain,
flatulence) skin rash, pruritus, dizziness, oedema, fever, depression, vision disturbances, headache,
liver enzyme changes, raised triglycerides
Contraindication:
Pregnancy, lactation, moderate to severe hepatic or renal impairment. Patients with known
hypersensitivity to any component of the formulation
Interaction:
May affect absorption of drugs which are pH-dependant in patients with known hypersensitivity to
any component of the formulation
-----------------------------------------------------------------------------------------------------------------------------Pantoprazole 40 mg Tablet
A*
Trade Name : Controloc
Indication :
i) Helicobacter pylori eradication ii) Peptic ulcer disease iii) Erosive and non-erosive reflux
oesophagitis (GERD and NERD) iv) Zollinger-Ellison Syndrome v) Prevention of NSAID induced
gastropathy
Dosage :
i) 40 mg twice daily in combination with any of the 2 antibiotics (Clarithromycin 500 mg twice daily,
Amoxicillin 1 g twice daily or Metronidazole 400 mg twice daily) for 1-2 weeks ii) 40 mg daily for 2 - 4
weeks iii) 20 - 40 mg daily on morning for 4 weeks iv) 40 mg twice daily. Maximum: 240 mg daily v)
20 mg daily. CHILD not recommended
Precaution:
Gastrointestinal disturbances (nausea and vomitting, diarrhoea, constipation, upper abdominal pain,
flatulence) skin rash, pruritus, dizziness, oedema, fever, depression, vision disturbances, headache,
liver enzyme changes, raised triglycerides
Contraindication:
Pregnancy, lactation, moderate to severe hepatic or renal impairment. Patients with known
hypersensitivity to any component of the formulation
Interaction:
May affect absorption of drugs which are pH-dependant in patients with known hypersensitivity to
any component of the formulation
---------------------------------------------------------------------------------------------------------------------------------Rabeprazole Sodium 20 mg Tablet
A*
Trade Name : Pariet
Indication :
i) Treatment and maintenance of erosive or ulcerative gastroesophageal reflux disease (GERD) ii)
Duodenal ulcers
Dosage :
i) 10-20 mg daily for 4-8 weeks, maintenance 10-20 mg daily ii) 20 mg daily at morning for up to 4-8
weeks
Precaution:
Liver disease, hepatic impairment, elderly, pregnancy, lactation
24
Agranulocytosis, thrombocytopenia, hepatic dysfunction, jaundice, interstitial pneumonia,
abdominal pain, diarrhoea, oedema, headache, dizziness, rash
Contraindication:
Hypersensitivity to rabeprazole or substituted benzimidazoles
Interaction:
Ampicillin, digoxin, iron, itraconazole, ketoconazole, warfarin
--------------------------------------------------------------------------------------------------------------------------------Ranitidine 150 mg Tablet
B
Ranitidine 300 mg Tablet
B
Trade Name : Zantac
Indication :
i) Benign gastric and duodenal ulcer ii) Reflux oesophagitis iii) Non-ulcer dyspepsia iv) ZollingerEllison Syndrome
Dosage :
i) 150 mg twice daily (at morning and night) or 300 mg on night for 4-8 weeks. Maintenance: 150300 mg on night ii) 150 mg twice daily or 300 mg on night for 8-12 weeks iii) 150 mg daily or twice
daily iv) 150 mg and may be increased as necessary to 6 g/day
Precaution:
H2-receptor antagonists should be used with caution in hepatic impairment, in renal impairment,
pregnancy and in breast-feeding. H2-receptor antagonists might mask symptoms of gastric cancer.
Avoid in porphyrias. Ranitidine and phenytoin is not recommended. If no alternatives exist, clinical
monitoring of patient response, tolerance and serum phenytoin concentrations is recommended,
especially during the first month of therapy
Gastrointestinal disturbances, diarrhoea, altered liver function tests (rarely liver damage), headache,
dizziness, rash and tiredness. Rare side-effects include acute pancreatitis, bradycardia, AV block,
confusion, depression and hallucinations particularly in the elderly or the very ill, hypersensitivity
reactions (including fever, arthralgia, myalgia, anaphylaxis), blood disorders (including
agranulocytosis, leucopenia, pancytopenia, thrombocytopenia) and skin reactions (including
erythema multiforme and toxic epidermal necrolysis). There have been occasional reports of
gynaecomastia and impotence
Contraindication:
Hypersensitivity to ranitidine
Interaction:
Absorption may be reduced by concomitant administration with high doses (2 g) of sucralfate
------------------------------------------------------------------------------------------------------------------------------Ranitidine 150 mg/10 ml Syrup
B
Trade Name : Zantac
Indication :
Peptic ulcer disease
Dosage :
CHILD 2-4 mg/kg 2 times daily. Maximum 300 mg daily
Precaution:
25
Gastrointestinal disturbances, diarrhoea, altered liver function tests (rarely liver damage), headache,
dizziness, rash and tiredness. Rare side-effects include acute pancreatitis, bradycardia, AV block,
confusion, depression and hallucinations particularly in the elderly or the very ill, hypersensitivity
reactions (including fever, arthralgia, myalgia, anaphylaxis), blood disorders (including
agranulocytosis, leucopenia, pancytopenia, thrombocytopenia) and skin reactions (including
erythema multiforme and toxic epidermal necrolysis). There have been occasional reports of
gynaecomastia and impotence
Contraindication:
Interaction:
-----------------------------------------------------------------------------------------------------------------------------Ranitidine 50 mg/2 ml Injection
B
Trade Name : Zantac
Indication :
i) Benign gastric/ duodenal ulceration, reflux oesophagitis, Zollinger Ellison Syndrome ii) Stress ulcer
prophylaxis in post-operative and high risk patients
Dosage :
i) ADULT: Slow IV injection of 50 mg diluted to 20 ml and given over at least 2 minutes. May be
repeated every 6-8 hours or IV infusion at rate of 25 mg/hour for 2 hours, may be repeated at 6-8
hours intervals or IM. CHILD: 1 mg/kg/dose 6-8 hourly. ii) Initial slow IV injection of 50 mg, then
continuous infusion of 125-250 mcg/kg/hour
Precaution:
Contraindication:
Interaction:
--------------------------------------------------------------------------------------------------------------------------------Sucralfate 1 g Tablet
A
Indication :
i) Benign gastric and duodenal ulceration ii) Stress ulcer prophylaxis
Dosage :
i) 2 g twice daily or 1 g 4 times daily for 4-6 weeks or in resistant cases up to 12 weeks (maximum 8 g
daily) ii) 1 g 6 times daily (maximum 8 g daily). CHILD not recommended
Precaution:
Chronic renal failure and on dialysis (avoid if severe), pregnancy, breast feeding. Administration of
sucralfate and enteral feeds should be separated by 1 hour dosing
Precaution:
Chronic renal failure and on dialysis (avoid if severe), pregnancy, breast feeding. Administration of
sucralfate and enteral feeds should be separated by 1 hour dosing
26
Constipation, diarrhoea, nausea, gastric discomfort, indigestion, dry mouth, drowsiness, dizziness,
skin rash, hypersensitive reaction including pruritus, back pain, vertigo
Contraindication:
Hypersensitivity to sucralfate products
Interaction:
Reduced the extent of absorption (bioavailability). Fluoroquinolones, tetracycline, warfarin,
phenytoin, ketoconazole, lansoprazole, digoxin, ranitidine, cimetidine, theophylline and
levothyroxine
-------------------------------------------------------------------------------------------------------------------------Diphenoxylate with Atropine Sulphate Tablet
B
Trade Name : Lomotil
Indication :
Acute diarrhoea
Dosage :
ADULT initially 4 tablet followed by 2 tablet 4 times daily until diarrhoea is controlled
Precaution:
Advanced hepatorenal disease, abnormal liver function, Down Syndrome
Euphoria, paraesthesia, central nervous system effects, anoneurotic oedema and other allergic
reactions, toxic megacolon, paralytic ileus, gastrointestinal disturbance. Atropine effects:
Hyperthermia, tachycardia, urinary retention, flushing, dry skin and mucous membranes. At
therapeutic dose- dryness of the mouth, difficulty in swallowing, thirst, reduce bronchial secretion,
mydriasis with cycloplegia
Contraindication:
Hypersensitivity to diphenoxylate hydrochloride or atropine, jaundice, acute diarrhoeal conditions
like antibiotic associated diarrhoea, pseudomembranous enterocolitis, acute ulcerative colitis and
infective diarrhoeas. Paralytic ileus and a ganglionosis. Not recommended for use in children
Interaction:
Barbiturates, tranquilizers, alcohol, MAOIs
-----------------------------------------------------------------------------------------------------------------------------Bisacodyl 10 mg Suppository
C
Trade Name : Dulcolax
Indication :
i) Constipation ii) Bowel preparation for radiological procedures and surgery
Dosage :
i) ADULT and CHILD over 10 years: 10 mg, CHILD less than 10 years 5 mg insert rectally ii) ADULT 1020 mg, CHILD over 4 years 5 mg the following morning before procedures insert rectally
Precaution:
Prolonged use, abdominal pain, inflammatory bowel disease, sudden, persistent change in bowel
habits and ulcerated haemorrhoids of rectal fissures
Rarely,electrolyte and fluid imblances, abdominal discomfort, diarrhoea, rectal burning, vomiting
Contraindication:
Ileus, intestinal obstruction, acute abdominal conditions, rectal bleeding, appendicitis
Interaction:
Milk, antacids, warfarin
-------------------------------------------------------------------------------------------------------------------------------------
27
Bisacodyl 5 mg Tablet
C
Trade Name : Dulcolax
Indication :
i) Constipation ii) Bowel preparation for radiological procedures and surgery
Dosage :
i) ADULT and CHILD over 10 years 5-10 mg, CHILD 4-10 years 5 mg. To be taken at night for effect on
the following morning ii) ADULT 10-20 mg the night before procedures, CHILD over 4 years 5 mg the
night before procedures
Precaution:
Prolonged use, abdominal pain, inflammatory bowel disease, sudden, persistent change in bowel
habits
Rarely,electrolyte and fluid imblances, abdominal discomfort, diarrhoea, rectal burning, vomiting
Contraindication:
Ileus, intestinal obstruction, acute abdominal conditions, rectal bleeding, appendicitis
Interaction:
Milk, antacids, warfarin
-----------------------------------------------------------------------------------------------------------------------------Glycerin 25% and Sodium Chloride 15% Enema
Trade Name : Ravin
Indication :
Constipation
Dosage :
1 enema as required
Precaution:
Frequent or prolonged use of laxatives may result in dependence
Rectal discomfort, burning sensation
Contraindication:
Hypersensitivity to any component in the preparation
Interaction:
Not known
-----------------------------------------------------------------------------------------------------------------------------
C
Lactulose 3.35 g/5 ml Liquid
B
Trade Name : Duphalac
Indication :
i) Constipation ii) Hepatic encephalopathy
Dosage :
i) ADULT 15 ml twice daily adjusted to patient's need. CHILD 0.5 ml/kg/dose once or twice daily ii)
30-50 ml 3-4 times daily, dose adjusted to produce 2-3 soft stools daily. CHILD 1 ml/kg/dose 3-4
times daily
Precaution:
Diabetics, patients with lactose intolerance, pregnancy, lactation
Flatulence, cramps and abdominal discomfort
Contraindication:
Galactosaemia, intestinal obstruction
Interaction:
Response may be altered by anti-infective agents
-------------------------------------------------------------------------------------------------------------------------------------
28
Liquid Paraffin
C
Indication :
Constipation
Dosage :
ADULT 10-30 ml daily at night but should not be taken immediately before going to bed. CHILD not
recommended
Precaution:
Avoid prolong use, patients with with recent change of bowel habits or suspected bowel malignancy
and rectal bleeding
Anal seepage of paraffin and consequent anal irritation after prolonged use, granulomatous
reactions caused by absorption of small quantities of liquid paraffin, lipoid pneumonia and
interference with the absorption of fat soluble vitamins
Contraindication:
Nausea, vomiting, undiagnosed abdominal pain, pregnancy, difficulty swallowing, bedridden
patients, children less than 3 years
Interaction:
May impair the absorption of fat soluble vitamin
--------------------------------------------------------------------------------------------------------------------------------Bismuth Subgallate and Benzyl Benzoate Suppository
C
Trade Name : Anusol
Indication :
For relief of pruritus, burning and soreness in patients with haemorrhoids and perianal conditions
Dosage :
Insert 1 suppository night and morning after bowel movements; do not use for longer than 7 days
Precaution:
Not for prolonged use. Use in children is not recommended
Local irritation
Contraindication:
Hypersensitivity to any component of preparation
Interaction:
Not known
--------------------------------------------------------------------------------------------------------------------------------Hydrocortisone Enema 0.1%
B
Indication :
Adjunctive treatment for ulcerative colitis and proctitis
Dosage :
ADULT 100 mg 1-2 times/day for 2-3 weeks. If used for longer than 3 weeks, taper treatment over 23 weeks
Precaution:
Prolonged use, untreated infection
Local irritation
Contraindication:
Hypersensitivity, bowel obstruction and perforation, extensive fistulas
Interaction:
Not known
-------------------------------------------------------------------------------------------------------------------------------
29
Lignocaine, Aluminium Acetate, Zinc Oxide and Hydrocortisone Ointment
A/KK
Trade Name : Xyloproct
Indication :
Anorectal pain, pruritis, inflammation and irritation
Dosage :
Apply once or twice daily. Not for prolonged use
Precaution:
Children less than 12 years, traumatised mucosa, sepsis in anorectal region or suspected herpes
simplex infection
Dry skin, pruritus, irritation, transient burning/stinging and atrophy of anal skin
Contraindication:
Hypersensitivity to local anaesthetics or to other components of the product
Interaction:
With large doses of lidocaine, risk of additional systemic toxicity in patients receiving other local
anaesthetics
----------------------------------------------------------------------------------------------------------------------------------Lignocaine, Aluminium Acetate, Zinc Oxide and Hydrocortisone Suppository
B
Trade Name : Xyloproct
Indication :
Anorectal pain, pruritis, inflammation and irritation
Dosage :
1 suppository to be used once or twice daily. Not for prolonged use
Precaution:
Children less than 12 years old, traumatised mucosa, sepsis in anorectal region or suspected herpes
simplex infection
Dry skin, pruritus, irritation, transient burning/stinging and atrophy of anal skin
Contraindication:
Hypersensitivity to local anaesthetics or to other components of the product
Interaction:
With large doses of lidocaine, risk of additional systemic toxicity in patients receiving other local
anaesthetics
----------------------------------------------------------------------------------------------------------------------------------Ursodeoxycholic Acid 250 mg Capsule
B
Trade Name : Ursofalk
Indication :
Cholestatic liver diseases (eg. primary biliary cirrhosis, primary cholangitis etc)
Dosage :
10-15 mg/kg daily in 2 to 4 divided doses usually for 3 months to 2 years. If there is no decrease in
stone size after 18 months, further treatment seems not to be useful
Precaution:
Hepatic enzymes (alanine and aspartate transaminase) should be monitored upon the initiation of
therapy and thereafter as indicated by the particular clinical circumstances
Nausea, vomiting, diarrhoea, gallstone calcification, pruritus, pulpy stools
Contraindication:
30
Radio-opaque stones, pregnancy, non-functioning gall bladder, chronic liver disease, peptic
ulceration, inflammatory diseases and other conditions of the small intestine, colon and liver which
interfere with enterohepatic circulation of bile salts
Interaction:
Absorption decreased by cholestyramine, colestipol or aluminium hydroxide containing antacids.
Should not be used with drugs such as oestrogenic hormones that increase bile cholesterol
---------------------------------------------------------------------------------------------------------------------------------Diosmin 450 mg and Hesperidin 50 mg Tablet
A/KK
Trade Name : Daflon
Indication :
i) Haemorrhoids ii) Chronic venous insufficiency
Dosage :
i) Acute attack: 6 tablets daily for the first 4 days, then 4 tablets daily in 2 divided doses for 3 days
and 2 tablets thereafter. Chronic: 2 tablets daily ii) 2 tab daily with meals
Precaution:
Lactation
Minor gastrointestinal disturbances, neurovegetative disorders
Contraindication:
Hypersensitivity to any component of preparation
Interaction:
Not known
---------------------------------------------------------------------------------------------------------------Essential Phospholipids Capsule
A/KK
Trade Name : Essentiale
Indication :
Nutritional supplement in liver disorders
Dosage :
ADULT 1-2 capsule
Precaution:
Not Known
Not known
Contraindication:
Not known
Interaction:
Cholestyramine, colestipol or antacids containing aluminium hydroxide
-----------------------------------------------------------------------------------------------------------------------------Magnesium, Aluminium Hydroxide and Simethicone Suspension
C
Trade Name : Maalox Plus
Indication :
As a buffering agent for reconstituting didanosine powder for oral administration so as to prevent
acid degradation of didanosine which is used for the treatment of paediatric patients (more than 6
months old) with symptomatic HIV infection
Dosage :
DDI should be mixed with water and diluted with the appropriate dose of antacids to a final
concentration of 10 mg per ml
31
Precaution:
Aluminium hydroxide may react with phosphate to form insoluble aluminium phosphate. This can be
overcome by regular intake of milk or phosphorus supplements. Elevated serum magnesium ion
concentration may cause central nervous system depression. Impaired bowel motility,
gastrointestinal obstruction, upper gastrointestinal bleeding
Gastrointestinal disturbances (constipation or diarrhoea), hypophosphatemia, seizures (serious)
Contraindication:
Severe debilitation, kidney failure
Interaction:
Inhibits absorption of tetracyclines, vitamin
-------------------------------------------------------------------------------------------------------------------------Mesalazine 500 mg Tablet
A
Trade Name : Salofalk
Indication :
Inflammatory bowel disease of ulcerative colitis and Crohn's disease. Only for patients who cannot
tolerate or do not respond to Sulfasalazine
Dosage :
ADULT: 250 - 500 mg 3 - 4 times daily for 3 - 6 weeks. CHILD up 2 years with Crohn's disease: 20 - 30
mg/daily in divided doses
Precaution:
Pregnancy, lactation, elderly
Allergic exanthema, drug fever, bronchospasm, lupus erythematosus-like syndrome, hepatitis,
pancreatitis, hair loss
Contraindication:
Severe hepatic and renal function disorders, active peptic ulcer, blood clotting abnormalities,
salicylate hypersensitivity, babies and infants
Interaction:
Sulfonylureas, coumarins, methotrexate, probenecid, sulfinpyrazone, frusemide, rifampicin
------------------------------------------------------------------------------------------------------------------------------Salicylazosulphapyridine (Sulfasalazine) 500 mg Tablet
A/KK
Trade Name : Salazopyrin
Indication :
i) Treatment of inflammatory bowel disease of ulcerative colitis and Crohn's disease
ii) Rheumatoid arthritis
Dosage :
i) ADULT, acute attack 1-2 g 4 times daily until remission occurs (if necessary corticosteroids may
also be given), reducing to a maintenance dose of 500 mg 4 times daily, CHILD over 2 years, acute
attack 40-60 mg/kg daily, maintenance dose 20-30 mg/kg daily ii) ADULT, initially; 0.5-1 g/day,
increase weekly to maintenance dose of 2 g/day in 2 divided doses, maximun 3 g/day. CHILD over 6
years, juvenile rheumatoid arthritis: 30-50 mg/kg/day in 2 divided doses up to a maximum of 2 g/day
Precaution:
Hepatic or renal impairment, G6PD deficiency, risk of haematological and hepatic toxicity
(differential white cell, red cell and platelet counts initially and at monthly intervals for first 3
months, liver function tests at monthly intervals for first 3 months), kidney function tests at regular
intervals, upper gastro-intestinal side-effects common over 4 g daily, porphyria
32
Nausea, anorexia, fever, blood disorders (megaloblastic anaemia), hypersensitivity reactions
(including exfoliative dermatitis, epidermal necrolysis, pruritus, photosensitisation, anaphylaxis,
serum sickness, ocular complications (including periorbital oedema), stomatitis, parotitis, ataxia,
aseptic meningitis, vertigo, tinnitus, insomnia, depression, hallucinations, kidney reactions (including
proteinuria, crystalluria, haematuria), oligospermia, urine may be coloured orange, bone marrow
depression, peripheral neuropathy
Contraindication:
Hypersensitivity to sulfonamides and salicylates, acute intermittent porphyria and children less than
2 years
Interaction:
Reduced absorption of folate, digoxin, antibacterial
---------------------------------------------------------------------------------------------------------------Sodium Biphosphate 16%, Sodium Phosphate 6% Solution
A
Trade Name : Fleet solution
Indication :
Bowel cleansing before colonic surgery, colonoscopy or radiological examination to ensure the
bowel is free of solid contents. It is not to be used for treatment of constipation
Dosage :
45 ml diluted with half a glass (120 mL) of water, followed by one full glass (240 mL) of water. Timing
of doses is dependent on the time of the procedure. For morning procedure, first dose should be
taken at 7 a.m. and second at 7 p.m. on day before the procedure. For afternoon procedure, first
dose should be taken at 7 p.m. on day before and second dose at 7 a.m. on day of the procedure.
Solid food should not be taken during the bowel preparation period. However clear fluids or water
can be taken liberally. CHILD under 12 years not recommended
Precaution:
Pregnancy, severe renal impairment, heart disease (chronic cardiac failure, hypertension and
oedema), ulcerative colitis (IBS) reflux oesophagitis, preexisting electrolyte disturbances (low serum
calcium concentration, hyperkalaemia)
Nausea, bloating, less frequently abdominal cramps and vomiting
Contraindication:
Gastrointestinal obstruction, gastric retention, gastrointestinal ulceration, perforated bowel,
congestive cardiac failure, toxic colitis, toxic megacolon or ileus
Interaction:
Salts of magnesium, aluminium and calcium will bind with phosphate and reduce the absorption.
Vitamin D will increase absorption of phosphate with diuretics and drugs affect serum electroytes
may induce hyperphosphataemia, hypocalcaemia and hypernatraemia
------------------------------------------------------------------------------------------------------------------------------Aprepitant 125 mg Capsule
A*
Trade Name : Emend
Indication :
In combination with other antiemetic agents for prevention of delayed nausea and vomiting
associated with initial and repeat course of highly emetogenic chemotherapy
Dosage :
125 mg 1 hour prior to chemotherapy on Day 1. To be given as part of a 3-day
regimen that includes a corticosteroid and a 5-HT3 antagonist
33
Precaution:
Moderate to severe liver impairment, pregnancy. Caution is advised both during and up to 2 weeks
after the end of treatment due to the inhibitory and inductive effects of aprepitant on CYP3A4
substrates
Hiccups, asthenia or fatigue, increased ALT/AST, constipation, diarrhea, dyspepsia, eructation,
headache, dizziness, anorexia, Stevens-Johnson syndrome and somnolence
Contraindication:
Hypersensitivity, breastfeeding, concurrent use of pimozide, terfenadine, astemizole, cisapride
Interaction:
Alfuzosin, alprazolam, astemizole, carbamazepine, cisapride, clarithromycin, dexamethasone,
diltiazem, eletriptan, ethinyl estradiol, etonogestrel, fentanyl ,ifosfamide, imatinib, irinotecan,
iraconazole, ketoconazole, levonorgestrel, medroxyprogesterone, methylprednisolone, midazolam,
norethindrone, norgestrel, paclitaxel, paroxetine, phenytoin, rifampin, ritonavir, etrfenadine,
tolbutamide, vinblastine ,vincristine, liposome vinorelbine, warfarin
-------------------------------------------------------------------------------------------------------------------------------------Granisetron HCl 1 mg Tablet
A
Trade Name : Kytril
Indication :
Prevention and treatment of nausea and vomiting associated with chemotherapy and radiotherapy
Dosage :
ADULT 1 mg twice daily or 2 mg once daily with the first dose to be administered
within 1 hour prior to cytostatic therapy. Maximum 9 mg/day
Precaution:
Subacute intestinal obstruction, pregnancy and lactation, liver disease
Headache, asthenia, fever, pain, bradycardia, constipation, nausea, leukopenia, thrombocytopenia,
hypersensitivity reaction, transiet increases in liver enzymes, rash
Contraindication:
Hypersensitivity to granisetron and other 5-HT3 receptor antagonists
Interaction:
Cytochrome P450 effect (minor). Apomorphine
-------------------------------------------------------------------------------------------------------------------------------------Granisetron HCl 3 mg/3 ml Injection
A
Trade Name : Kytril
Indication :
i) Prevention and treatment of nausea and vomiting associated with chemotherapy and
radiotherapy ii) Post-operative nausea and vomiting
Dosage :
i) ADULT 1-3 mg as an IV bolus not not less than 30 seconds; maximum 9 mg/day. CHILD over 2
years; single dose of 10-40 mcg/kg as an IV infusion; maximum 3 mg/day ii) ADULT 1 mg by slow IV
injection over 30 seconds prior to induction of anaesthesia
Precaution:
Subacute intestinal obstruction, pregnancy and lactation, liver disease
Headache, asthenia, fever, pain, bradycardia, constipation, nausea, leukopenia, thrombocytopenia,
hypersensitivity reaction, transiet increases in liver enzymes, rash
34
Contraindication:
Hypersensitivity to granisetron and other 5-HT3 receptor antagonists. Injection contains benzyl
alcohol and should not be used in neonates
Interaction:
Cytochrome P450 effect (minor). Apomorphine
---------------------------------------------------------------------------------------------------------------Meclozine HCl 25 mg and Pyridoxine 50 mg Tablet
B
Trade Name : Navidoxine
Indication :
Nausea and vomiting of pregnancy
Dosage :
1 - 2 tablet 2 - 3 times daily in severe cases
Precaution:
Use with caution in prostatic hyperthrophy, urinary retention, glaucoma and pyloroduodenal
obstruction, hepatic disease, severe heart failure, asthma. Avoid operating vehicles and machinery
Drowsiness, dry mouth, blurred vision, headache, gastrointestinal disturbance
Contraindication:
Hypersensitivity to meclozine
Interaction:
May enhanced sedative effect of central depressants including alcohol
---------------------------------------------------------------------------------------------------------------Metoclopramide HCl 10 mg Tablet
B
Trade Name : Maxolon
Indication :
i) Dyspepsia, flatulence, hiatus hernia, peptic ulceration, reflux oesophagitis, gastritis, duodenitis,
cholelithiasis, nausea, vomiting ii) Promote bowel transit during diagnostic procedures
Dosage :
i) ADULT over 20 years: 10 mg 3 times daily. ADULT between 12 - 20 years: 5 mg 3 times daily. CHILD
under 12 years: 0.12 mg/kg/dose 6 - 12 hourly ii) Single dose 5 - 10 minutes before examination;
ADULT and CHILD over 15 years: 10 - 20 mg; CHILD less than 15 years: 0.12 mg/kg/dose 6 - 12 hourly
Precaution:
Hepatic and renal impairment, elderly, young adults and children; may mask underlying disorders
such as cerebral irritation; avoid for 3 - 4 days following gastro-intestinal surgery, may cause acute
hypertensive response in phaeochromocytoma; pregnancy and breast feeding; porphyria. Use
cautiously in patients with depression, Parkinson's disease or hypertension
Extrapyramidal effects (especially in children and young adults), hyperprolactinaemia, tardive
dyskinesia, drowsiness, restlessness, anxiety, drowsiness, fatigue, akathisia, insomnia, depression,
neuroleptic malignant syndrome, diarrhoea, bronchospasm and cardiac conduction abnormalities
Contraindication:
Concomitant therapy with drugs which are likely to cause extrapyramidal reactions, epileptics,
gastrointestinal haemorrhage, obstruction (mechanical), or perforation, hypersensitivity to
metoclopramide, pheochromocytoma
Interaction:
Increased absorption of aspirin and paracetamol; opioid analgesics and antimuscarinics antagonise
effect on gastro-intestinal activity, antipsychotics (increased risk of extrapyramidal effects). Decrease
absorption of digoxin
---------------------------------------------------------------------------------------------------------------35
Metoclopramide HCl 10 mg/2 ml Injection
B
Indication :
Dosage :
i) ADULT over 20 years: 10 mg 3 times daily. ADULT between 12 - 20 years: 5 mg 3 times daily. CHILD
under 12 years: 0.12 mg/kg/dose 6 - 12 hourly ii) Single dose 5 - 10 minutes before examination;
ADULT and CHILD over 15 years: 10 - 20 mg; CHILD less than 15 years: 0.12 mg/kg/dose 6 - 12 hourly
Precaution:
such as cerebral irritation; avoid for 3 - 4 days following gastro-intestinal surgery, may cause acute
hypertensive response in phaeochromocytoma; pregnancy and breast feeding; porphyria. Use
cautiously in patients with depression, Parkinson's disease or hypertension
dyskinesia, drowsiness, restlessness, anxiety, drowsiness, fatigue, akathisia, insomnia, depression,
Contraindication:
Interaction:
Increased absorption of aspirin and paracetamol; opioid analgesics and antimuscarinics antagonise
effect on gastro-intestinal activity, antipsychotics (increased risk of extrapyramidal effects). Decrease
absorption of digoxin
-------------------------------------------------------------------------------------------------------------------------------------Metoclopramide HCl 5 mg/5 ml Syrup
B
Indication :
Dosage :
i) CHILD over 5 years: 2.5 - 5 ml 3 times daily. 3 - 5 years 2 ml 2 - 3 times daily. 1 - 3 years: 1 ml 2 - 3
times daily. Under 1 year: 1 ml 2 times daily ii) Single dose given 10 minutes before examination.
CHILD over 5 years: 2.5 - 5 ml. Between 3 - 5 years: 2 ml. Under 1 year: 1 ml
Precaution:
such as cerebral irritation; avoid for 3 - 4 days following gastrointestinal surgery, may cause acute
hypertensive response in phaeochromocytoma, pregnancy and breast feeding, porphyria. Use
cautiously in patients with depression, Parkinson's disease or hypertension, insulin dosage or timing
of dosage may require adjustment
dyskinesia, drowsiness, restlessness, anxiety, drowsiness, fatigue, akathesia, insomnia, depression,
Contraindication:
36
Interaction:
Increased absorption of aspirin, paracetamol, tetracycline, levodopa, ethanol, cyclosporine, opioid
analgesics and antimuscarinics antagonise effect on gastro-intestinal activity, antipsychotics
(increased risk of extrapyramidal effects). Decrease absorption of digoxin, antagonized by
anticholinergic drugs and narcotic analgesics. Additive sedative effects with alcohol, sedatives,
hypnotics, narcotics or tranquilizers
-------------------------------------------------------------------------------------------------------------------------------------Ondansetron 4 mg/2ml Injection
A
Trade Name : Zofran
Indication :
i)Prevention of nausea and vomiting induced by chemotherapy and radiotherapy
ii)Postoperative nausea and vomiting
Dosage :
i)8 mg given by IV infusion over 15 minutes or by IM immediately before treatment followed by 8 mg
orally every 12 hours for up to 5 days. CHILD 5 mg/m2 body surface IV over 15 minutes immediately
before chemotherapy followed by 4 mg orally every 12 hours for up to 5 days ii)Prevention : 4 mg
given by IV at induction of anaesthesia. CHILD over 2 years, 100 mcg/kg (max 4mg) by slow IV
before, during or after induction of anaesthesia. Treatment of postoperative: 4 mg by IM or slow.
CHILD over 2 years 100 mcg/kg (maximum 4mg) by slow IV
Precaution:
Pregnancy, lactation, hepatic impairment. May mask progressive ileus and/or gastric distension
Headache, malaise, fatique, sedation, diarrhea, constipation, anaphylaxis sensation of flushing or
warmth in the head and epigastrium, occasionally transient visual disturbances and dizziness,
involuntary movements, seizures and arrhythmias
Contraindication:
Hypersensitivity to any component of the preparation or other selective 5-HT3 antagonists
Interaction:
In patients treated with potent inducers of CYP3A4 (ie phenytoin, carbamazepine and rifampicin),
the oral clearance of ondansetron was increased and ondansetron blood concentrations were
decreased. Ondansetron may reduce the analgesic effect of tramadol
-------------------------------------------------------------------------------------------------------------------------------------Prochlorperazine Maleate 5mg Tablet
B
Trade Name : Stemetil
Indication :
i) Severe nausea and vomiting ii) Vertigo/labyrinthine disorders
Dosage :
i) Injection IM 12.5 mg stat and repeated if necessary after 6 hours or orally 20 mg stat followed by
10 mg after 2 hours. Prevention: 5 - 10 mg 2 - 3 times a day. CHILD (over 10 kg only) 250 mcg/kg 2 - 3
times a day ii) For labyrinthine disorders 5 mg 3 times daily, gradually increased to 30 mg daily in
divided doses, then reduced after several weeks to 5 - 10mg daily. Not recommended in children
Precaution:
Hypotension, pregnancy and lactation, glaucoma, prostatic hypertrophy, stenosing peptic ulcer,
children with acute illnesses, dehydration or electrolyte imbalance, signs and symptoms suggestive
of Reye's syndrome in children and adolescents, patients with tardive dyskinesia or a history of
neuroleptic malignant syndrome, epilepsy, acute narrow angle glaucoma, liver damage, insomnia
37
Extrapyramidal symptoms, drowsiness, postural hypotension, coma, neuroleptic malignant
syndrome, cholestatic jaundice, leucopenia and agranulocytosis, constipation, dry mouth, urinary
retention, liver damage and insomnia
Contraindication:
CNS depression or coma, bone marrow depression, phaeochromocytoma, hypersensitivity to
phenothiazines, comatose states, cardiovascular collapse
Interaction:
Tramadol, increased risk of seizures. Procyclidine, decreased phenothiazine serum concentrations,
decreased phenothiazine effectiveness, enhanced anticholinergic effects (ileus, hyperpyrexia,
sedation, dry mouth). Levodopa, loss of levodopa efficacy. Ethanol, increased central nervous system
depression and an increased risk of extrapyramidal reactions
---------------------------------------------------------------------------------------------------------------Prochlorperazine Mesylate 12.5 mg/ml Injection
B
Trade Name : Stemetil
Indication :
i) Severe nausea and vomiting ii) Vertigo/labyrinthine disorders
Dosage :
Deep IM injection, 12.5 mg repeated if necessary after 6 hours and then followed by an oral dose.
Not recommended in children
Precaution:
Hypotension, pregnancy and lactation, glaucoma, prostatic hypertrophy, stenosing peptic ulcer,
children with acute illnesses, dehydration or electrolyte imbalance, signs and symptoms suggestive
of Reye's syndrome in children and adolescents, patients with tardive dyskinesia or a history of
neuroleptic malignant syndrome, epilepsy, acute narrow angle glaucoma, liver damage, insomnia
Extrapyramidal symptoms, drowsiness, postural hypotension, coma, neuroleptic malignant
syndrome, cholestatic jaundice, leucopenia and agranulocytosis, constipation, dry mouth, urinary
retention, liver damage and insomnia
Contraindication:
CNS depression or coma, bone marrow depression, phaeochromocytoma, hypersensitivity to
phenothiazines, comatose states, cardiovascular collapse
Interaction:
Tramadol, increased risk of seizures. Procyclidine, decreased phenothiazine serum concentrations,
decreased phenothiazine effectiveness, enhanced anticholinergic effects (ileus, hyperpyrexia,
sedation, dry mouth). Levodopa, loss of levodopa efficacy. Ethanol, increased central nervous system
depression and an increased risk of extrapyramidal reactions
----------------------------------------------------------------------------------------------------------------
38
3. CARDIOVASCULAR
Positive inotropic drugs
Diuretics
Anti-arrhythmic drugs
Beta-adrenoceptor blocking drugs
Drugs affecting the renin-angiotensin system and some other
antihypertensive drugs
Nitrates, calcium-channel blockers, and potassium-channel activators
Sympathomimetics
Anticoagulants and protamine
Antiplatelet drugs
Mycocardial infarction and fibrinolysis
Antifibrinolytic drug and haemostatics
Lipid regulating drugs
Miscellaneous cardiovascular
39
Digoxin 0.25 mg Tablet
B
Trade Name : Lanoxin
Indication :
Heart failure , with atrial fibrillation, supraventricular arrhythmias (particularly, atrial fibrillation)
Dosage :
Rapid digitalisation: 1-1.5 mg in divided doses over 24 hours; less urgent digitalisation, 250 mcg-500
mcg daily (higher dose may be divided). Maintenance : 62.5mg -500 mcg daily (higher dose may be
divided) according to renal function and , in atrial fibrillation, on heart rate response; usual range,
125-250 mcg daily (lower dose may be appropriate in elderly)
Precaution:
Acute myocardial infarction, acute myocarditis, amyloid cardiomyopathy, AV block. Chronic
constrictive pericarditis, electrolyte imbalance (eg. hypokalaemia, hypocalcaemia or hypercalcaemia,
hypomagnesaemia), hypothyroidism, hypoxia, idiopathic hypertrophic subaortic stenosis. Renal
disease, severe bradycardia, severe heart failure and pulmonary disease, ventricular tachycardia and
Wolff-Parkinson-White syndrome
Adverse Reaction:
Nausea, vomiting, anorexia, diarrhoea, abdominal pains, salivation, sweating; headache, facial pain,
malaise, fatigue, drowsiness, depression, disorientation, mental confusion, delirium, hallucination,
visual disturbance.Hypokalaemia. Ventricular premature contractions, atrial or ventricular
arrhythmias and conduction defects
Contraindication:
Ventricular fibrillation, ventricular tachycardia except in certain cases, digitalis toxicity, beriberi heart
disease, hypersensitivity to digoxin, some cases of hypersensitive carotid sinus syndrome
Interaction:
Plasma concentration increased by quinidine, verapamil, nifedipine, amiodarone. Hypokalaemia may
be associated with diuretics, lithium, carbenoxolone, corticosteroids. Antacids, neomycin may
reduce serum level of digoxin
---------------------------------------------------------------------------------------------------------------Digoxin 50 mcg/ml Elixir
B
Indication :
Heart failure, supraventricular arrhythmias (particularly atrial fibrillation)
Dosage :
Rapid digitalization, give in divided doses; PREMATURE: 20-30 mcg/kg; FULLTERM: 25-35 mcg/kg;
CHILD 1-2 years : 35 to 60 mcg/kg; CHILD 2-5 years: 30-40 mcg/kg; CHILD 5-10 years: 20- 35 mcg/kg;
CHILD over 10 years: 10-15 mcg/kg. For daily maintenance doses or for gradual digitalization, give
20% to 30% of oral digitalizing dose for premature infants or 25% to 35% of oral digitalizing dose for
all other pediatric patients
Precautions:
Adverse Reaction:
visual disturbance.Hypokalaemia.Ventricular premature contractions, atrial or ventricular
40
Contraindication:
Interaction:
be associated with diuretics. Antacids and neomycin may reduce serum level of digoxin. Lithium,
carbenoxolone, corticosteroids
---------------------------------------------------------------------------------------------------------------Digoxin 500 mcg/2 ml Injection
A
Indication :
Heart failure with atrial fibrillation, supraventricular arrhythmias (particularly atrial fibrillation)
Dosage :
Rapid digitilisation: ADULT & CHILD over 10 years, initially 0.75 - 1.5 mg, followed by 250 mcg 6
hourly until digitilisation is complete
Precautions:
Adverse Reaction:
visual disturbance.Hypokalaemia.Ventricular premature contractions, atrial or ventricular
Contraindications:
Interactions:
be associated with diuretics, lithium, carbenoxolone, corticosteroids. Antacids, neomycin may
reduce serum level of digoxin
---------------------------------------------------------------------------------------------------------------Dobutamine HCl 250 mg/20 ml Injection
A
Trade Name : Dobutrex
Indication :
Hypotension and heart failure
Dosage :
Initial 0.5-1 mcg/kg/min by IV; maintenance 2.5-20 mcg/kg/min by IV; titrate according to response;
maximum dose 40 mcg/kg/min
Precautions:
Arrhythmias, hypovolaemia . May be ineffective in patients who have recently received a betablocker, in such cases peripheral vascular resistance may increase. Monitor EKG and blood pressure
constantly, serum potassium, pulmonary wedge pressure and cardiac output. Myocardial infarction
and severe coronary artery disease.
Adverse Reaction:
Increased heart rate, blood pressure and ventricular ectopic activity, , anginal pain, nonspecific chest
pain, palpitations shortness of breath, nausea, headache
41
Contraindications:
Hypersensitivity to dobutamine, idiopathic hypertrophic subaortic stenosis
Interactions:
Beta-blockers, nitroprusside
---------------------------------------------------------------------------------------------------------------Dopamine HCl 40 mg/ml Injection
B
Trade Name : Intropin
Indication :
Non-hypovolemic hypotension
Dosage :
Initial dose 2-5 mcg/kg/min with incremental changes of 5-10 mcg/kg/min at 10-15 minutes
intervals until adequate response is noted. Most patients are maintained at less than 20
mcg/kg/min. If dosage exceeds 50 mcg/kg/min, assess renal function frequently
Precautions:
Angina pectoris, conditions such as hypovolaemia, hypoxia, hypercapnia, and acidosis should be
corrected prior to administration of dopamine. Patients allergic to sulfite. Patients receiving MAOIs
will exhibit enhanced dopamine effects. Patients with pre-existing vascular damage secondary to
atherosclerosis, diabetes, Raynaud's disease or frostbite since dopamine can produce peripheral
necrosis or gangrene
Adverse Reaction:
Increased heart rate, blood pressure and ventricular ectopic activity, anginal pain, nonspecific chest
pain, palpitations and shortness of breath, nausea, headache
Contraindications:
Pheochromocytoma, tachyarrhythmias or ventricular fibrillation
Interactions:
Beta-blockers, methyldopa, phenytoin, tricyclic antidepressants
---------------------------------------------------------------------------------------------------------------Amiloride HCl 5 mg & Hydrochlorothiazide 50 mg Tablet
B
Trade Name : Moduretic
Indication :
i) Diuretic as an adjunct to the management of oedematous states ii) Hypertension
Dosage :
i) Initially 1 - 2 tab daily adjusted according to response. Max : 4 tabs daily. ii) 1 -2 tabs daily as a
single or divided dose
Precautions:
Diabetes mellitus. Electrolyte imbalance, concomitant use of other diuretics can result in
hyponatraemia and hypochloremia as well as increases in BUN levels. This is more frequent in
patients with hepatic cirrhosis and ascites, metabolic alkalosis or those with resistant oedema.
Metabolic or respiratory acidosis
Adverse Reaction:
Hyperkalaemia, rash, dizziness, headache, asthenia
Contraindications:
Hypersensitivity to hydrochlorothiazide/amiloride or sulfonamides, hyperkalaemia, anuria, renal
failure
Interactions:
Beta-blockers, nitroprusside
----------------------------------------------------------------------------------------------------------------
42
Bumetanide 0.5 mg/ml Injection
A*
Trade Name : Burinex
Indication :
Oedema used in furosemide allergic patient
Dosage :
IV injection: 1 - 2 mg repeated after 20 mins. IV infusion: 2 - 5 mg over 30 - 60 mins
Precautions:
Alterations in glucose metabolism, blood dyscrasias (thrombocytopenia), hepatic disease,
hyperuricaemia, hypokalaemia, hypovolaemia, ototoxicity particularly potentiation of
aminoglycoside ototoxicity, coadministration not recommended
Adverse Reaction:
Hypokalaemia, hyperuricaemia, muscle cramps, arthralgias
Contraindications:
Hypersensitivity to bumetanide products, anuria, severe electrolyte imbalance, hepatic coma
Interactions:
Amikacin, angiotensin converting enzyme inhibitors, digitoxin, digoxin, gentamicin, kanamycin,
lithium, neomycin, netilmicin, nonsteroidal antiinflammatory agents, streptomycin, tobramycin
---------------------------------------------------------------------------------------------------------------Furosemide 20 mg/2 ml Injection
B
Trade Name : Lasix
Indication :
Pulmonary oedema
Dosage :
Initially 20 -40 mg IM or slow IV (rate not exceeding 4 mg/min). CHILD: 0.5 - 1.5 mg/kg. Max: 20 mg
daily
Precautions:
Alterations in blood glucose and glucose tolerance tests. Diabetes mellitus, electrolyte imbalance
(eg: hypokalaemia, hyponatraemia), fluid imbalance, dehydration, blood volume reduction with
circulatory collapse and possible vascular thrombosis and emboli may occur with excessive diuresis,
especially in elderly patients. Gout or hyperuricaemia. Hepatic disease (cirrhosis and ascites).
Hypersensitivity to sulfonamides. Ototoxicity (hearing loss, tinnitus), avoid rapid injection, high
doses or concurrent administration of other ototoxic agents. If high-dose therapy is used, controlled
intravenous infusion is recommended at a rate not to exceed 4 mg/min. Severe progressive renal
disease (azotemia, oliguria). Systemic lupus erythematosus
Adverse Reaction:
Hypokalaemia, hyperuricaemia, hypotension, hyperglycaemia
Contraindications:
Anuria, hypersensitivity to furosemide, hepatic coma and pre-coma. Severe hypokalaemia, severe
hyponatraemia, hypovolaemia with or without concomitant hypotension
Interactions:
Activated charcoal, amikacin, gentamicin, kanamycin, angiotensin converting enzyme inhibitors,
aspirin, chloral hydrate, digoxin steroids, NSAIDs
---------------------------------------------------------------------------------------------------------------Furosemide 40 mg Tablet
Trade Name : Lasix
Indication :
Pulmonary oedema
B
43
Dosage :
ADULT: Initial 40 - 80 mg on morning if required, can be increased to a max of 1 g/day in certain
cases especially in chronic renal failure. CHILD : 1 - 3 mg/kg daily
Precautions:
Alterations in blood glucose and glucose tolerance tests. Diabetes mellitus, electrolyte imbalance
(eg, hypokalaemia, hyponatraemia), fluid imbalance, dehydration, blood volume reduction with
circulatory collapse and possible vascular thrombosis and emboli may occur with excessive diuresis
especially in elderly patients. Gout or hyperuricaemia. Hepatic disease (cirrhosis and ascites).
Hypersensitivity to sulfonamides. Ototoxicity (hearing loss, tinnitus), systemic lupus erythematosus
Adverse reaction:
Hypokalaemia, hyperuricaemia, hypotension, hyperglycaemia
Contraindications:
Anuria, hypersensitivity to furosemide, hepatic coma and pre-coma. Severe hypokalaemia, severe
hyponatraemia, hypovolaemia with or without concomitant hypotension
Interactions:
Activated charcoal, amikacin, gentamicin, kanamycin, angiotensin converting enzyme inhibitors,
aspirin, chloral hydrate, digoxin steroids, NSAIDs
---------------------------------------------------------------------------------------------------------------Hydrochlorothiazide 50 mg Tablet
B
Indication :
Diuretic, hypertension
Dosage :
ADULT: Diuretics; 25-200 mg daily. Hypertension 12.5-25 mg daily CHILD: Oedema and hypertension;
Adjunct; 1 to 2 mg/kg ORALLY daily in single or two divided doses; Children 2-12 years old MAX dose,
not to exceed 100 mg ORALLY daily; Infants less than 6 months old, may require doses up to 3 mg/kg
ORALLY daily in two divided doses, Infants up to 2 yrs old: MAX dose, not to exceed 37.5 mg ORALLY
daily
Precautions:
Renal or hepatic impairment, pregnancy and lactation, elderly, debilitated patients, syndrome lupus
erythematous. Monitor fluid and electrolytes, bronchial asthma
Adverse Reaction:
Metabolic disturbances, electrolyte imbalance, anorexia, gastrointestinal disturbances, headache,
dizziness, postural hypotension, paresthesia, impotence, yellow vision, hypersensitivity. Rarely
cholestatic jaundice, pancreatitis, blood dyscrasias
Contraindications:
Anuria, concurrent lithium therapy, renal decompensation
Interactions:
May enhance toxicity of digitalis glycosides, neuromuscular-blocking action of competitive muscle
relaxants, effect of antihypertensives. Increased risk of postural hypotension with alcohol,
barbiturates, opioids. Potassium-depleting effect enhanced by corticosteroids, ACTH, carbenoxolone
---------------------------------------------------------------------------------------------------------------Mannitol 10% Injection (10 g/100 ml)
A
Mannitol 20% Injection (20 g/100 ml)
A
Indication :
Cerebral oedema
Dosage :
0.25- 2 g/kg IV of a 15% to 25% solution over 30-60 minutes. Safety and efficacy not established in
children under 12 years of age
Precautions:
44
Cardiopulmonary dysfunction, renal dysfunction. An in-line filter should be used during intravenous
administration. Maintain proper fluid and electrolyte balance. Monitor urinary output. Renal
dysfunction and solutions should be examined for crystals before use. Solutions of 15% and 20%
should always be filtered
Adverse reaction:
Hyperkalaemia, diarrhoea, renal failure, acidosis, pulmonary oedema, seizure, thrombophlebitis,
urinary retention
Contraindications:
Anuria, pulmonary oedema/congestion, severe chronic heart failure, intracranial bleeding, renal
damage/dysfunction (after initiation of mannitol)
Interactions:
Lithium toxicity (with diuretic induce hyponatraemia)
---------------------------------------------------------------------------------------------------------------Spironolactone 25 mg Tablet
B
Trade Name : Aldactone
Indication :
Oedema and ascites in cirrhosis of the liver, congestive heart failure
Dosage :
ADULT: 100 - 200 mg daily in divided doses. Increase to 400 mg if required. CHILD: initially 3 mg/kg
daily in divided doses
Precautions:
Hyperkalaemia or progressive renal failure, impaired hepatic or renal function, diabetes mellitus,
patients likely to develop acidosis. Pregnancy and lactation
Adverse Reaction:
Headache, drowsiness, gastrointestinal disturbances including cramp and diarrhoea, ataxia, mental
confusion, hirsutism, deepening of the voice, menstrual irregularities, impotence, skin rashes,
hyponatraemia, hyperkalaemia
Contraindications:
Hypersensitivity, hyperkalaemia, renal failure, anuria, patients receiving other potassium-sparing
diuretics or potassium supplements
Interactions:
Angiotensin converting enzyme inhibitors, ciclosporin: hyperkalaemia. Aspirin: decreased
spironolactone effectiveness. Digoxin: digoxin toxicity (nausea, vomiting, cardiac arrhythmias).
NSAIDs: reduced diuretic effectiveness, hyperkalaemia
---------------------------------------------------------------------------------------------------------------Adenosine 3 mg/ml Injection
B
Trade Name : Adenocor
Indication :
Rapid conversion of paroxysmal supraventricular tachycardia to sinus rhythm
Dosage :
ADULT: Initially: 3 mg given as a rapid IV bolus (over 2 seconds). Second dose: If the first dose does
not result in elimination of the supraventricular tachycardia with in 1 or 2 minutes, 6 mg should be
given also as a rapid IV bolus. Third dose: If the second dose does not result in elimination of the
supraventicular tachycardia with in 1-2 minutes, 12 mg should be given also as a rapid IV bolus
Precautions:
Avoid concomitant use of dipyridamole and methylxanthines (eg: caffeine, theophylline). Cardiac
arrest, heart block, heart transplant patients, hypertension, hypotension, myocardial infarction.
Proarrhythmic events; new rhythms, particularly at time of conversion and unstable angina
45
Adverse Reaction:
Facial flush, dyspnoea, a feeling of thorasic constriction, nausea, lightheadedness, feeling of
discomfort, sweating, palpitations, hyperventilation, head pressure, apprehension, blurred vision,
burning sensation, bradycardia, chest pains, headache, dizziness, heaviness in arms, arm, back and
neck pains; metallic taste
Contraindications:
Bradycardia, bronchoconstrictive or bronchospastic lung disease (eg. asthma). Hypersensitivity to
adenosine, second-degree or third-degree AV block (unless pacemaker fitted), sinus node disease
(eg. sick sinus syndrome)
Interactions:
Actions may be potentiated by dipyridamole and carbamazepine. Theophylline & caffeine inhibit its
action
---------------------------------------------------------------------------------------------------------------Amiodarone 150mg/3 ml Injection
A*
Trade Name : Cordarone
Indication :
Arrhythmias when other drugs are contraindicated or ineffective
Dosage :
Initial infusion of 5mg/kg via large venous access over 20-120 minutes with ECG monitoring;
subsequent infusion given if necessary according to response up to a maximum of 1.2 g in 24 hours
Precautions:
Acute myocardial infarction, sino-atrio, block AV or other severe conduction disorder ( unless the
patient has a pacemaker),severe hypotension,severe respiratory failure, bradycardia,
cardiomegaly,corneal microdeposits (impaired vision)
Adverse Reaction:
Reversible corneal microdeposits; colored halos. Hyper or hypothyroidism. Rarely;
photosensitization and pigmentation. Reversible diffuse interstitial pneumopathy or peripheral
neuropathy
Contraindications:
Cardiogenic shock, hypersensitivity to amiodarone, second or third degree AV block (if no
pacemaker is present). Severe sinus bradycardia and severe sinus-node dysfunction
Interactions:
Antiarrhythmics, beta-blockers, stimulating laxatives, diuretics inducing hypokalaemia, systemic
corticosteroids, tetracosactide, amphotericin B, digitalis, anticoagulants, phenytoin, general
anaesthetic, ciclosporin
---------------------------------------------------------------------------------------------------------------Amiodarone 200 mg Tablet
A*
Trade Name : Cordarone
Indication :
Arrhythmias
Dosage :
200 mg 3 times daily for 1 week, then reduced to 200 mg twice daily for another week. Maintenance
dose, usually 200 mg daily or the minimum required to control the arrhythmia
Precautions:
Acute myocardial infarction, sino-atrio, block AV or other severe conduction disorder (unless the
patient has a pacemaker),severe hypotension,severe respiratory failure,bradycardia, cardiomegaly,
corneal microdeposits (impaired vision)
46
Adverse Reaction:
Reversible corneal microdeposits; colored halos. Hyper or hypothyroidism. Rarely;
photosensitization and pigmentation. Reversible diffuse interstitial pneumopathy or peripheral
neuropathy
Contraindications:
Cardiogenic shock, hypersensitivity to amiodarone, second or third degree AV block (if no
pacemaker is present). Severe sinus bradycardia and severe sinus-node dysfunction
Interactions:
Antiarrhythmics, beta-blockers, stimulating laxatives, diuretics inducing hypokalaemia, systemic
corticosteroids, tetracosactide, amphotericin B, digitalis, anticoagulants, phenytoin, general
anaesthetics, ciclosporin
---------------------------------------------------------------------------------------------------------------Atenolol 100 mg Tablet
B
Trade Name : Tenormin
Indication :
Hypertension, angina pectoris, myocardial infarction and arrhythmias
Dosage :
Hypertension and arrythmias; 50 - 100 mg daily, Angina; 100 mg daily, Myocardial infarction;
individualized
Precautions:
Avoid abrupt withdrawal; gradual withdrawal over a period of 1 to 2 weeks is recommended.
Bronchospastic disease, congestive heart failure, diabetes mellitus, hyperthyroidism/thyrotoxicosis.
Patients receiving clonidine - discontinue atenolol several days prior to withdrawal of clonidine.
Peripheral vascular and renal disease
Adverse Reaction:
Chronic heart failure, AV block, bradycardia, bronchospasm, dizziness, vertigo, nausea, fatigue,
diarrhea
Contraindications:
Hypersensitivity to atenolol products, bradycardia, 2nd and 3rd degree AV block overt cardiac
failure, cardiogenic shock, metabolic acidosis, severe peripheral circulatory disturbances, sick sinus
syndrome
Interactions:
Clonidine, catecholamine-depleting agents, beta-blockers
---------------------------------------------------------------------------------------------------------------Bisoprolol Fumarate 2.5 mg Tablet
A
Bisoprolol Fumarate 5 mg Tablet
A
Trade Name : Concor
Indication :
Treatment of stable moderate to severe congestive cardiac failure in addition to ACEI's and diuretics
Dosage :
1.25 mg once daily to 5 - 10 mg daily
Precautions:
Bronchospastic disease, congestive heart failure, diabetes mellitus, hyperthyroidism/thyrotoxicosis.
Peripheral vascular and renal disease
Adverse Reaction:
Arrythmia, bradycardia, chest pain, oedema, hypotension, dizziness, headache, fatique, diarrhoea,
nausea, impotency, cough, rhinitis
Contraindications:
47
Hypersensitivity, cardiac failure, pulmonary oedema, pregnancy, severe asthma or severe chronic
obstructive pulmonary disease, hypotension
Interactions:
Prazosin, digoxin, amiodarone, ACEI, antidiabetic agent, calcitriol, cholestyramine, Clonidine
---------------------------------------------------------------------------------------------------------------Carvedilol 25 mg Tablet
A*
Carvedilol 6.25 mg Tablet
A*
Trade Name : Dilatrend
Indication :
Treatment of stable moderate to severe congestive cardiac failure in addition to ACEI's and diuretics
Dosage :
3.125 mg twice daily for 2 weeks, then 6.25 mg twice daily for 2 weeks, then 12.5 mg twice daily for
2 weeks then 25 mg twice daily (titrated up to the highest tolerated level)
Precautions:
Avoid abrupt withdrawal, gradual withdrawal over a period of 1 to 2 weeks is recommended.
Bronchospastic disease, congestive heart failure, diabetes mellitus
Adverse Reaction:
Dizziness, headache, tiredness, gastrointestinal disorders, flu-like symptoms
Contraindications:
Hypersensitivity to carvedilol, asthma, bradycardia, 2nd and 3rd degree AV block, cardiogenic shock
overt cardiac failure, obstructive airway disease, severe chronic heart failure and hepatic impairment
Interactions:
Hypotensive effects potentiated by adrenergic neurone-blocking drugs, catecholamine depletors,
central nervous system depressants, diuretics and vasodilators. Action decreased by rifampicin.
Concurrent administration with cardiac glycosides may cause a sharp drop in heart rate
---------------------------------------------------------------------------------------------------------------Labetalol HCl 100 mg Tablet
B
Trade Name : Trandate
Indication :
Hypertension (including in pregnancy)
Dosage :
ADULT: 100 mg (50 mg in elderly) daily with food, increased at intervals of 14 days to usual dose of
200 mg twice daily, up to 800 mg twice daily (3 - 4 divided doses if higher dose). Max: 2.4 g daily
Precautions:
Anaesthesia/surgery, including when used in cases to control bleeding (myocardial depression).
Adverse Reaction:
Hypotension, bradycardia, nausea, vomiting
Contraindications:
Hypersensitivity to labetalol products, bradycardia, asthma/obstructive airway disease, cardiogenic
shock, heart block overt cardiac failure
Interactions:
Alpha-1 adrenergic blockers, amiodarone, cimetidine, clonidine, digoxin, dihydropyridine, calcium
channel blockers, diltiazem, enflurane, epinephrine, flunarizine, halothane, hypoglycemic agents,
imipramine, isoflurane, lidoflazine, methyldopa, verapamil
----------------------------------------------------------------------------------------------------------------
48
Labetalol HCl 100 mg/20 ml Injection
B
Trade Name : Trandate
Indication :
Hypertension crisis
Dosage :
ADULT: Bolus injection 50 mg IV for at least 1 min. Max: 200 mg. IV infusion, dilute 2 amps to 200ml
with sodium chloride and dextrose injection or 5% dextrose IV infusion, Hypertension of pregnancy;
20mg per hour doubled every 30 min to max 160 mg per hour
Precautions:
Anaesthesia/surgery, including when used in cases to control bleeding (myocardial depression).
Adverse Reaction:
Hypotension, bradycardia, nausea, vomiting
Contraindications:
Hypersensitivity to labetalol products, bradycardia, asthma/obstructive airway disease, cardiogenic
shock, heart block overt cardiac failure
Interactions:
Alpha-1 adrenergic blockers, amiodarone, bepridil, cimetidine, clonidine, digoxin, dihydropyridine,
calcium channel blockers, diltiazem, enflurane, epinephrine, flunarizine, halothane, hypoglycemic
agents, imipramine, isoflurane, lidoflazine, methyldopa, verapamil
---------------------------------------------------------------------------------------------------------------Metoprolol Tartrate 100 mg Tablet
B
Trade Name : Betaloc
Indication :
Hypertension, angina, myocardial infarction, arrhythmias
Dosage :
Hypertension: Initially 100 mg to maximum 400 mg daily, Angina: 50 mg - 100 mg in 2 - 3 times daily.
Myocardial infarction: 200 mg daily in divided doses. Arrythmias: 50 mg - 300 mg in 2 - 3 times daily
Precautions:
Pregnancy, lactation
Adverse Reaction:
Lassitude, gastrointestinal and sleep pattern disturbances; rarely, non-specific skin reactions and
coldness of extremities
Contraindications:
Hypersensitivity to metoprolol products, bradycardia, 2nd and 3rd degree AV block overt cardiac
failure, cardiogenic shock, obstructive pulmonary disease
Interactions:
Alpha-1 adrenergic blockers, amiodarone, chlorpromazine, chlorprothixene, cimetidine, clonidine,
digoxin, dihydropyridine, calcium channel blockers, flunarizine, fluoxetine, fluvoxamine, hydralazine,
hypoglycemic agents, lidocaine, methyldopa
-----------------------------------------------------------------------------------------------------------Propranolol HCl 40 mg Tablet
B
Trade Name : Inderal
Indication :
i) Hypertension ii) Angina iii) Myocardial infarct iv) Cardiac arrhythmia v) Portal hypertension vi)
Migraine vii) Thyrotoxicosis
49
Dosage :
i) Initially 80 mg twice daily increased as required to a usual range of 160 - 320 mg daily. CHILD:
Initial doses of 1 mg/kg in divided doses, can be increased to 2 - 4 mg/kg/day in divided doses ii)
Initial dose of 40 mg 2 - 3 times daily. Maintenance 120 - 240 mg daily iii) 40mg 4 times daily for 2 - 3
days then 80 mg twice daily, beginning 5 - 21 days after infarction iv) 10 - 40 mg 3 - 4 times daily v)
Initially 40 mg twice daily. The dose may be increased as required up to 160 mg twice daily vi) Initial
prophylaxis dose: 40 mg 2 - 3 times daily. The dose may be increased at weekly intervals up to 160
mg daily vii) Adjunct: 10 - 40 mg 3 - 4 times daily. CHILD: Arrythmias, thyrotoxicosis: 0.25 - 0.5 mg/kg
3 - 4 times daily as required
Precautions:
Avoid abrupt withdrawal, bronchospastic disease, congestive heart failure, diabetes, hepatic disease,
peripheral vascular disease, renal disease, myasthenia gravis, pregnancy, breast feeding
Adverse Reaction:
Bronchospasm, bradycardia, depression, nausea, vomiting, dizziness, central nervous system effects,
muscle cramps, fluid retention, skin rashes, dry mouth
Contraindications:
Hypersensitivity to propranolol, asthma, bradycardia, 2nd and 3rd degree AV block, cardiogenic
shock, overt cardiac failure, obstructive airway disease
Interactions:
Alpha-1 adrenergic blockers, amiodarone, chlorpromazine, cimetidine, clonidine, cocaine, digoxin,
dihydroergotamine, dihydropyridine, calcium channel blocker, disopyramide, epinephrine,
ergotamine, flecainide, flunarizine, fluvoxamine, furosemide, risk of lignocaine toxicity increased
---------------------------------------------------------------------------------------------------------------Captopril 25 mg Tablet
B
Trade Name : Capoten
Indication :
i) Hypertension ii) Congestive heart failure iii) Post-myocardial infarction iv) Diabetic nephropathy
Dosage :
i) Initially 12.5 mg twice daily. Maintenance: 50 mg 2 - 3 times daily, may be increased to maximum
450 mg/day ii) Initially 6.25 - 12.5 mg 3 times daily, increase after several days to 25 - 50 mg 3 times
daily iii) Initially 6.25 mg daily, gradually increased to 37.5 mg daily in divided doses iv) 75 - 100 mg
daily in divided doses
Precautions:
Anaphylaxis during lipid apheresis with dextran sulfate membranes and during hymenoptera
desensitization, angioedema; discontinue if laryngeal stridor or angioedema of the face, tongue, or
glottis is observed, aortic stenosis, breast feeding period, cough, impaired renal function
Adverse Reaction:
Rash, pruritus, flushing, angioedema, loss of taste perception, stomatitis, gastrointestinal irritation
and abdominal pain, leucopenia, cough
Contraindications:
Angioedema induced by other angiotensin converting enzyme (ACE) inhibitors during prior exposure.
Anuric renal failure during prior exposure to ACE inhibitors. Hypersensitivity to this or any other ACE
inhibitor. Pregnancy (second and third trimester pregnancy)
Interactions:
May increase serum K with Kalium K-sparing diuretics. Hypotensive effects enhanced by diuretics.
Antihypertensive effect diminished by indomethacin, salicylates, NSAIDs
----------------------------------------------------------------------------------------------------------------
50
Enalapril 10 mg Tablet
B
B
B
Trade Name : Renitec
Indication :
i) Hypertension ii) Congestive heart failure
Dosage :
i) Initially 5 mg daily, (ELDERLY 2.5 mg once daily), usual maintenance dose 10 - 20 mg daily.
Maximum: 40 mg/day in 1 - 2 divided doses ii) Initially 2.5 mg daily, usual maintenance dose 20 mg
daily in 1 - 2 divided doses; maximum: 40 mg/day
Precautions:
Symptomatic hypotension likely to occur in volume depleted patients eg. by diuretic therapy, dietary
salt restriction, dialysis, diarrhoea or vomiting, patients with heart failure with or without associated
renal insufficiency. Caution in severe heart failure, especially ischemic heart or cerebrovascular
disease. Patients with obstruction in the outflow tract of the left ventricle. Renal impairment
patients with bilateral renal artery stenosis or stenosis of the artery to a solitary kidney. Dosage
reduction and or discontinuation of the diuretic and or enalapril may be required. Serum potassium
should be monitored. Not recommended during pregnancy. Lactation. Children
Adverse Reaction:
Dizziness, headache, diarrhoea, fatigue, asthenia, cough, orthostatic hypotension, hyperkalaemia,
angioneurotic oedema (discontinue therapy)
Contraindications:
Angioedema induced by other angiotensin converting enzyme (ACE) inhibitors. hypersensitivity to
this or any other angiotensin converting enzyme inhibitor. Pregnancy (second and third trimesters
particularly)
Interactions:
May have additive effects with other antihypertensives, potassium supplement, potassium-sparing
diuretics or potassium-containing salt substitutes. Increased lithium level
---------------------------------------------------------------------------------------------------------------Hydralazine HCl 20 mg Injection
B
Indication :
Hypertensive crisis in pregnancy
Dosage :
i) Slow IV injection, ADULT: 5-10 mg diluted with 10ml sodium chloride 0.9%. May be repeated after
20-30 minutes if necessary. ii) IV infusion 200-300 mcg/minutes. Maintenance dose 50-150
mcg/minutes
Precautions:
Hepatic impairment, renal impairment, coronary artery disease, cerebrovascular disease
Adverse Reaction:
Tachycardia, palpitation, hypotension, fluid retention, gastrointestinal disturbances, headache,
dizziness, systemic lupus erythematosus-like syndrome, abnormal liver function, jaundice, blood
disorders including haemolytic anaemia, leukopenia, thrombocytopenia
Contraindications:
Idiopathic systemic lupus erythematous, severe tachycardia, high output heart failure, myocardial
insufficiency due to mechanical obstruction, dissecting aortic aneurysm, cor pulmonale, porphyria
Interactions:
Concomitant treatment with other vasodilators, calcium antagonists, ACE inhibitors, diuretics,
antihypertensives, tricyclic antidepressants and major tranquillisers, as well as the consumption of
alcohol, may potentiate the blood pressure-lowering effect
---------------------------------------------------------------------------------------------------------------51
Irbesartan 300 mg & Hydrochlorothiazide 12.5 mg Tablet
A*
Trade Name : CoAprovel
Indication :
Hypertension in patients who cannot tolerate ACE inhibitors because of cough
Dosage :
1 tablet daily
Precautions:
Caution in aortic or mitral valve stenosis, obstructive hyperthrophic cardiomyopathy, renal artery
stenosis. Monitoring of plasma potassium concentration is advised, particularly in elderly and
patients with renal impairment
Adverse Reaction:
Symptomatic hypotension including dizziness, hyperkalaemia, angioedema, nausea, vomiting,
fatigue, musculoskeletal pain,diarrhoea, dyspepsia, flushing, tachycardia, cough, sexual dysfunction,
rash, urticaria, headache, myalgia, athralgia, tinnitus, taste disturbances, hepatitis and renal
dysfunction
Contraindications:
Pregnancy (2nd and 3rd trimesters), lactation, severe hepatic and renal impairment, refractory
hypokalaemia, hypercalcaemia, biliary cirrhosis and cholestatis
Interactions:
Lithium, potassium-sparing diuretics, potassium supplements, central nervous system depressants,
antidiabetic drugs, cholestyramine, corticosteroids, ACTH, digitalis glycosides, NSAIDs, nondepolarising muscle relaxants, antigout medications and calcium salts
---------------------------------------------------------------------------------------------------------------Irbesartan 300 mg Tablet
A/KK
Irbesartan 150 mg Tablet
A/KK
Trade Name : Aprovel
Indication :
Hypertension, diabetic nephropathy (in patients who cannot tolerate ACE inhibitors because of
cough)
Dosage :
150 mg to 300 mg daily
Precautions:
Angioedema (present or past), lactation period, excessive hypotension, hepatic or renal impairment,
hyperkalaemia, hypertrophic cardiomyopathy, stenosis, aortic or mitral valve stenosis, surgery or
anaesthesia
Adverse Reaction:
Diarrhoea, dyspepsia or heart burn, fatigue, headache, upper respiratory tract infection,
angioedema of the face, lips or throat
Contraindications:
Hypersensitivity, pregnancy
Interactions:
Potassium supplements, potassium sparing diuretics, lithium, NSAIDs
---------------------------------------------------------------------------------------------------------------Losartan 50 mg Tablet
A/KK
Trade Name : Cozaar
Indication :
Patients intolerant of ACE inhibitors, only in the treatment of i) Hypertensive patient with left
ventricular hypertrophy ii) Hypertension in diabetics with proteinuria or nephropathy
52
Dosage :
Hypertension: Usual starting and maintenance dose: 50 mg once daily. Maximum increasing the
dose to 100 mg once daily. Patients with intravascular volume-depletion starting dose of 25 mg once
daily. Renal protection in Type 2 diabetic patients with proteinuria and hypertension, starting dose:
50 mg once daily, may be increased to 100 mg once daily based on blood pressure response
Precautions:
Angioedema: intravascular volume depletion (eg those treated with high-dose diuretics), electrolyte
imbalance: lower dose should be considered for patients with a history of hepatic impairment,
changes in renal function including renal failure may occur in susceptible individuals. Blood urea and
serum creatinine may be increased in patients with bilateral renal artery stenosis or stenosis of the
artery to a solitary kidney, lactation, children
Adverse Reaction:
Angioedema, headache, dizziness, cough
Contraindications:
Hypersensitivity to losartan, pregnancy
Interactions:
Fluconazole, lithium, rifampicin
---------------------------------------------------------------------------------------------------------------Losartan Potassium 100 mg and Hydrochlorothiazide 12.5 mg Tablet
A*
Trade Name : Hyzaar
Indication :
Hypertension in patients who cannot tolerate ACE inhibitors because of cough, hypertensive patient
with left ventricular hypertrophy
Dosage :
1 tablet once daily, may increase to maximum dose losartan 100 mg/ hydrochlorothiazide 25 mg
once daily
Precautions:
Angioedema. Not recommended for hepatic impairment or severe renal impairment (creatinine
clearance less or equal to 30 mL/min). Changes in renal function including renal failure may occur.
Bilateral renal artery stenosis or stenosis of the artery to a solitary kidney. Hypotension and
electrolyte or fluid imbalance may occur. Thiazide therapy may impair glucose tolerance, decrease
urinary calcium excretion, intermittent and slight increases in serum calcium may occur, increase
cholesterol and triglyceride levels, precipitate with or without a history of allergy or bronchial
asthma. Thiazides have also been reported to exacerbate or activate systemic lupus erythematosus.
Should not be initiated in patients with intravascular volume depletion (eg those treated with high
dose diuretics), black patients, lactation, children
Adverse Reaction:
Dizziness, asthenia and fatigue, vertigo. Anaphylactic reactions, angioedema, vasculitis including
Henoch-Schonlein purpura, hepatitis, diarrhoea, cough, urticaria, erythroderma, oedema,
palpitations, headache, electrolyte abnormalities, abdominal pain, nausea, bronchitis, pharyngitis,
sinusitis, upper respiratory infection, skin rash, back pain
Contraindications:
Hypersensitivity including to other sulfonamide-derived drugs, anuria. When used during second and
third trimesters, drugs that act directly on the renin-angiotensin system can cause foetal injury and
death. Discontinue as soon as possible if pregnancy is detected
53
Interactions:
Angiotensin converting enzyme inhibitors, calcitriol, chlorpropamide, cholestyramine, corticotropin,
cortisone, diazoxide, digitalis glycosides, diuretics, droperidol, hydrocortisone, indomethacin,
liquorice, lithium, methotrexate, methylprednisolone, prednisolone, propranolol, tolbutamide,
triamcinolone
---------------------------------------------------------------------------------------------------------------Losartan Potassium 50 mg and Hydrochlorothiazide 12.5 mg Tablet
A/KK
Trade Name : Hyzaar
Indication :
Hypertension in patients who cannot tolerate ACE inhibitors because of cough, hypertensive patient
with left ventricular hypertrophy
Dosage :
1 tablet once daily, may increase to maximum dose losartan 100 mg/ hydrochlorothiazide 25 mg
once daily
Precautions:
Angioedema. Not recommended for hepatic impairment or severe renal impairment (creatinine
clearance less than 30 mL/min). Changes in renal function including renal failure may occur. Bilateral
renal artery stenosis or stenosis of the artery to a solitary kidney. Hypotension and electrolyte or
fluid imbalance may occur. Thiazide therapy may impair glucose tolerance, decrease urinary calcium
excretion, intermittent and slight increases in serum calcium may occur increase cholesterol and
triglyceride levels, precipitate with or without a history of allergy or bronchial asthma. Thiazides
have also been reported to exacerbate or activate systemic lupus erythematosus. Should not be
initiated in patients with intravascular volume depletion (eg those treated with high dose diuretics),
black patients, lactation, children
Adverse Reaction:
Dizziness, asthenia and fatigue, vertigo. Anaphylactic reactions, angioedema, vasculitis including
Henoch-Schonlein purpura, hepatitis, diarrhoea, cough, urticaria, erythroderma, oedema,
palpitations, headache, electrolyte abnormalities, abdominal pain, nausea, bronchitis, pharyngitis,
sinusitis, upper respiratory infection, skin rash, back pain
Contraindications:
Hypersensitivity including to other sulfonamide-derived drugs, anuria. When used during second and
third trimesters, drugs that act directly on the renin-angiotensin system can cause foetal injury and
death. Discontinue as soon as possible if pregnancy is detected
Interactions:
Angiotensin converting enzyme inhibitors, calcitriol, chlorpropamide, cholestyramine, corticotropin,
cortisone, diazoxide, digitalis glycosides, diuretics, droperidol, hydrocortisone, indomethacin,
liquorice, lithium, methotrexate, methylprednisolone, prednisolone, propranolol, tolbutamide,
triamcinolone
---------------------------------------------------------------------------------------------------------------Methyldopa 250 mg Tablet
B
Trade Name : Aldomet
Indication :
Hypertension
Dosage :
250 mg 2 - 3 times daily, gradually increased at intervals of 2 or more days, maximum; 3 g/day.
ELDERLY initially 125 mg twice daily, increased gradually, maximum; 2 g daily
54
Precautions:
Avoid abrupt withdrawal, congestive heart failure, dialysis patients (risk of hypertension following
procedure), oedema, haemolytic anaemia, hypotension, liver disease, severe bilateral
cerebrovascular disease (risk of choreoathetotic movements)
Adverse Reaction:
Sedation, headache, weakness, dizziness, parkinsonism, bradycardia, orthostatic hypotension, GI
symptoms, hepatic impairment, impotence
Contraindications:
Hypersensitivity to methyldopa, history of hepatitis, autonomic dysfunction, bilateral cardiovascular
disease
Interactions:
Antihypertensive drugs, lithium, monoamine oxidase inhibitors (MAOIs)
---------------------------------------------------------------------------------------------------------------Minoxidil 5 mg Tablet
A*
Trade Name : Loniten
Indication :
Severe hypertension
Dosage :
ADULTS and CHILD above 12 years old: Initially 5 mg daily in single or divided doses (elderly 2.5 mg).
May increase by 5 - 10 mg daily at intervals of 3 or more days until optimum control is achieved.
Maximum 50 mg daily
Precautions:
Angina pectoris, breast feeding, cerebrovascular disease, cerebrovascular accident (recent),
congestive heart failure (without adequate diuretic therapy), dialysis, fluid retention, impaired renal
function, myocardial infarction
Adverse Reaction:
Salt and water retention, tachycardia, pericardial effusion and tamponad, hypertrichosis.
Occasionally; allergic rashes, gastrointestinal effects, breast tenderness, thrombocytopenia,
leucopenia
Contraindications:
Hypersensitivity to minoxidil products
Interactions:
Combination with guanethidine may produce orthostatic hypotension
-------------------------------------------------------------------------------------------------------------------------Perindopril 4 mg and Indapamide 1.25 mg Tablet
A/KK
Trade Name : Coversyl Plus
Indication :
Essential hypertension
Dosage :
One tablet daily
Precautions:
Renal insufficiency especially when associated with systemic autoimmune collagen vascular diseases.
Concomitant treatment with immunosuppressant or treatment causing leucopoenia. Marked
sodium and water depletion, hypotension, chronic heart failure, cirrhosis with oedema and ascites,
ischemic heart disease, cerebral circulatory insufficiency, severe cardiac insufficiency (grade IV) or
IDDM patients. Monitor serum potassium regularly. Surgery, elderly, hyperaldosteronism,
malnourishment, acute porphyria
Adverse Reaction:
55
Headache, asthenia, dizziness, sleep disturbances, cramps, hypotension, rash, gastrointestinal
disturbances, slight reversible increase in urea and plasma creatinine, hypokalaemia, hyponatraemia
with hypovolaemia, raised uric acid and blood glucose levels
Contraindications:
Bilateral renal artery stenosis or single functioning kidney, severe renal failure (creatinine clearance
less than 30 mL/min), dialysis patients, hepatic encephalopathy, severe hepatic impairment,
hyperkalaemia or hypokalaemia, untreated decompensated cardiac insufficiency. Previous history of
angioneurotic oedema linked to treatment with ACE inhibitor, hereditary or idiopathic angioneurotic
oedema. Pregnancy and lactation
Interactions:
Lithium, insulin, sulfonylureas, baclofen, NSAIDs, high dose salicylates, tricyclic antidepressants,
neuroleptics, corticosteroids, tetracosactide, potassium-sparing diuretics, potassium salts,
potassium-lowering drugs, anaesthesia, allopurinol, immunosuppressant, cardiac glycosides,
procainamide and other drugs which cause torsades de pointes, antihypertensive drugs, metformin,
calcium salts, ciclosporin, iodinated contrast media
---------------------------------------------------------------------------------------------------------------Perindopril 4 mg Tablet
B
Perindopril 8 mg Tablet
B
Trade Name : Coversyl
Indication :
i) Hypertension ii) Congestive heart failure iii) Stable coronary artery disease
Dosage :
i) 4 mg as single dose, may be increased to a single 8 mg dose. ELDERLY: Start treatment with 2 mg
dose. In renal insufficiency, dose should be adapted according to creatinine clearance ii) Single
starting oral dose of 2 mg should be increased to a single 4 mg once BP acceptability has been
demonstrated iii) 4 mg once daily for 2 weeks, may be increased to 8 mg once daily. ELDERLY: 2 mg
once daily for 1 week, then 4 mg once daily for the following week, may be increased up to 8 mg
once daily
Precautions:
Arterial hypotension, renal failure, water and sodium depletion, renovascular hypertension, surgery
or anaesthesia, elderly. Haemodialysis, avoid combination with highly permeable membranes
(polyacrylonitrile). Measure plasma creatinine at baseline and during the month following institution
of treatment. May precipitate excessive hypotension in severe chronic heart failure with or without
associated renal insufficiency. Patients with ischaemic heart disease or cerebrovascular disease in
whom excessive fall in blood pressure may result in myocardial infarction or cerebrovascular
accident, hepatic impairment
Adverse Reaction:
Gastrointestinal disorders, dizziness, headaches, mood and or sleep disorders, asthenia, taste
disorder, cramps, localized skin rashes, dry cough, angioneurotic oedema
Contraindications:
Angioedema induced by other angiotensin converting enzyme (ACE) inhibitors. Hypersensitivity to
this or any other angiotensin converting enzyme inhibitor. Pregnancy (second and third trimesters
particularly)
Interactions:
Potassium supplements or potassium-sparing diuretics may induce hyperkalaemia especially in renal
failure. Neuroleptics or imipramine-like antidepressants increase risk of postural hypotension. Serum
lithium concentrations may rise during lithium therapy
----------------------------------------------------------------------------------------------------------------
56
Prazosin HCl 1 mg Tablet
B
Prazosin HCl 2 mg Tablet
B
Trade Name : Minipress
Indication :
Hypertension
Dosage :
Initially 0.5 mg 2 - 3 times daily, the initial dose on retiring to bed at night; increased to 1 mg 2 - 3
times daily after 3 - 7 days: further increased if necessary to maximum 20 mg daily
Precautions:
Dizziness, lightheadedness, orthostatic hypotension, syncope, fainting and sudden loss of
consciousness due to first-dose effect
Adverse Reaction:
Dizziness, orthostatic hypotension, oedema, palpitations, urinary incontinence, dyspnoea, priapism,
headache, lack of energy, nausea
Contraindications:
Hypersensitivity to prazosin products or other quinazolines
Interactions:
Additive hypotensive effect with diuretics or other antihypertensives
---------------------------------------------------------------------------------------------------------------Ramipril 5 mg Tablet
A
Trade Name : Tritace
Indication :
i) Hypertension and congestive heart failure ii) Post-myocardial infarction iii) Reducing risk of
myocardial infarction, stroke or cardiovascular death in diabetics or patients with increased
cardiovascular risks
Dosage :
i) Initially 2.5 mg once daily, increased at intervals of 1 - 2 weeks to maximum 10 mg once daily ii)
Initially 2.5 mg twice daily for 2 days then increased to maximum 5 mg twice daily iii) Initially 1.25 2.5 mg once daily, increased to 5 mg once daily after 1 week, maximum dose: 10 mg once daily after
3 weeks
Precautions:
Renal or hepatic impairment, hyperstimulated renin-angiotensin system
Adverse Reaction:
Nausea, dizziness & headache, dry cough, hypotension, hypokalemia, fatigue, pruritus, rash & fever
,pancreatitis, angioedema
Contraindications:
Hypersensitivity, history of angioedema with ACE inhibitors, bilateral renal artery stenosis or a single
kidney with unilateral renal artery stenosis. Pregnancy and lactation
Interactions:
Enhanced hypotensive effects by alcohol, alprostadil and anaesthetics
---------------------------------------------------------------------------------------------------------------Sodium Nitroprusside 50 mg/5 ml Injection
A
Trade Name : Nipride
Indication :
i) Hypertensive crisis ii) Controlled hypotension during anaesthesia in order to reduce bleeding in
surgical procedures
Dosage :
i) By IV infusion, initially 0.5-1.5 mcg/kg/min, then adjusted before increasement of 0.5 mcg/kg/min
every 5 mins within range 0.5-8 mcg/kg/min (lower doses in patients already receiving other
57
antihypertensives); stop if marked response not obtained with max dose in 10 minutes. Use only in
infusion with 5 % Dextrose IV. ii) By IV infusion, max: 1.5 mcg/kg/min
Precautions:
Excessive hypotension, acute heart failure associated with reduced peripheral vascular resistance.
Cyanide toxicity, methaemoglobinemia, NADH-methaemoglobin reductase deficiency, drug-induced
(phenacetin, nitrites, nitrates, sulfonamides, dapsone, chlorates, chloroquine, primaquine and
phenazopyridine). Pre-existing anaemia and or hypovolaemia
Adverse reaction:
Tachycardia, postural hypotension, nausea, retching, diaphoresis, apprehension, headache,
restlessness, muscle twitching, retrosternal discomfort, palpitation, perspiration, dizziness,
drowsiness, paraesthesial warmth, abdominal pain. Irritation and reddening at injection site
Contraindications:
Hypersensitivity to nitroprusside, head trauma, symptomatic hypotension, encephalopathy
Interactions:
Hypotensive effect potentiated by ganglion blockers, other antihypertensive agents, volatile liquid
anaesthetics and other circulatory depressants
---------------------------------------------------------------------------------------------------------------Telmisartan 40 mg Tablet
A/KK
Telmisartan 80 mg Tablet
A/KK
Trade Name : Micardis
Indication :
Dosage :
40 - 80 mg a day
Precautions:
Angioedema (associated with aspirin and or penicillin allergy), discontinue with laryngeal stridor or
angioedema of the face, tongue or glottis. Aortic or mitral valve stenosis, biliary cirrhosis or biliary
obstruction, coronary artery disease and elderly
Adverse Reaction:
Headache, dizziness, upper respiratory infection and cough
Contraindications:
Hypersensitivity to telmisartan products, pregnancy and renal artery stenosis
Interactions:
Potassium-sparing diuretics, potassium supplements, salt substitutes containing potassium or other
medicinal products that may cause hyperkalaemia (esp digoxin, lithium) May increase hypotensive
effect of other antihypertensive
---------------------------------------------------------------------------------------------------------------Telmisartan 80 mg & Hydrochlorothiazide 12.5 mg Tablet
A/KK
Trade Name : Micardis Plus
Indication :
Dosage :
1 tablet daily
Precautions:
Hepatic impairment, progressive liver impairment, severe congestive heart failure, diabetes, gout,
obstructive hyperthropic cardiomyopathy, electrolyte imbalance, high cholesterol or triglycerides
Adverse Reaction:
Respiratory disorders, urinary tract infection, blood dyscrasias, precipitation of gout or latent
diabetes, electrolyte and fluid imbalances, metabolic and nutritional disorders, dizziness, vertigo,
visual disturbances, cardiovascular and gastrintestinal disturbances, systemic lupus erythematosus
58
Contraindications:
Cholestasis, biliary obstruction, severe hepatic impairment, severe renal impairment, lactation,
pregnancy, refractory hypokalaemia
Interactions:
Lithium, bepridil, calcitriol, calcium carbonate, carbamazepine, chlorpropamide, cholestyramine,
corticotropin, cortisone, cyclophosphamide, diazoxide, digoxin, droperidol, fludrocortisone,
fluorouracil, memantine, methotrexate, methylprednisolone, prednisolone, propranolol,
tolbutamide, triamcinolone
---------------------------------------------------------------------------------------------------------------Valsartan 80 mg and Hydrochlorothiazide 12.5 mg Tablet
A/KK
Trade Name : Co-Diovan
Indication :
Dosage :
1 tablet once daily
Precautions:
Risk of hypotension in sodium and or volume depleted patients, renal artery stenosis, renal and liver
disease, disturbance of serum electrolyte balance. Caution when driving or operating machinery
Adverse Reaction:
Headache, dizziness, fatigue, hypokalaemia, hyperuricaemia and other electrolyte imbalance,
orthostatic hypotension and increased lipids
Contraindications:
Pregnancy, lactation, severe hepatic impairment, biliary cirrhosis and cholestasis, anuria, severe
renal impairment. Refractory hypokalaemia, hyponatraemia, hypercalcaemia and symptomatic
hyperuricaemia
Interactions:
Concomitant treatment with potassium sparing diuretics or potassium supplements may increase
serum potassium levels. Caution if combined with other antihypertensives or lithium (serum lithium
monitoring)
---------------------------------------------------------------------------------------------------------------Valsartan 80 mg Tablet
A/KK
Trade Name : Diovan
Indication :
Patients who cannot tolerate ACE inhibitors because of cough, in i) Hypertension ii) Heart failure iii)
Post myocardial infarction
Dosage :
i) 80 or 160 mg once daily. May be increased to 320 mg once daily. ii) 40 mg twice daily. Uptitration
to 80 mg and 160mg twice daily. Max: 320 mg in divided doses. iii) 20 mg twice daily increased over
several weeks to 160mg twice daily if tolerated.
Precautions:
Volume depletion, unilateral renal artery stenosis, monitor serum potassium concentrations, severe
heart failure, aortic or mitral valve stenosis, coronary artery disease, hypertrophic cardiomyopathy,
elderly, severe renal impairment, biliary cirrhosis or obstruction. Combination of ACE inhibitor, âblocker may impair ability to drive or operate machinery, pregnancy, lactation
Adverse reaction:
Headache, dizziness, viral infection, neutropenia, upper respiratory tract infection, hyperkalaemia,
cough, diarrhoea, abdominal pain, back pain, fatigue, asthenia, oedema, syncope, rhinitis, sinusitis,
nausea, pharyngitis and arthralgia
Contraindications:
Hypersensitivity to valsartan products
59
Interactions:
Potassium-sparing diuretics, potassium supplements, cimetidine, co-trimoxazole, ACE inhibitors,
phenobarbital, ketoconazole
---------------------------------------------------------------------------------------------------------------Amlodipine 10 mg Tablet
B
Amlodipine 5 mg Tablet
B
Trade Name : Norvasc
Indication :
Hypertension
Dosage :
5 mg once daily. Max: 10 mg
Precautions:
Angina (exacerbation) during initiation of treatment; with dosage increases; during beta-blocker
withdrawal; taper slowly prior to calcium channel blocker therapy. Aortic stenosis (reduced
myocardial oxygenation with drug-induced hypotension), congestive heart failure, pregnancy,
hepatic impairment
Adverse Reaction:
Headache, dizziness, gingival hyperplasia, tachycardia, peripheral oedema
Contraindications:
Hypersensitivity to amlodipine, symptomatic hypotension, persistent dermatologic reactions,
congestive heart failure
Interactions:
Cyclosporin, fluconazole, itraconazole, ketoconazole, vardenafil
---------------------------------------------------------------------------------------------------------------Amlodipine 5 mg and Valsartan 160 mg Tablet
A*
Trade Name : Exforge
Indication :
Essential hypertension in patients whose blood pressure is not adequately controlled by
monotherapy
Dosage :
Doses range from amlodipine besylate 5 mg/valsartan 160 mg to amlodipine besylate 10
mg/valsartan 320 mg ORALLY once daily, with dose titration occurring every 1 to 2 weeks if
necessary. MAX amlodipine besylate 10 mg/valsartan 320 mg
Precautions:
Risk of hypotension in sodium or volume depleted patient, beta blocker withdrawal should be
gradual. Severe renal impairment, dialysis. Unilateral/ bilateral renal stenosis, stenosis to a solitary
kidney, after recent kidney transplantation, hepatic impairment, biliary obstructive disorders. Aortic
or mitral stenosis, obstructive hyperthrophic cardiomyopathy
Adverse reaction:
Nasopharyngitis, flu, headache, oedema, peripheral oedema, fatigue, flushing, asthenia, vertigo,
tachycardia, palpitations, orthostatic hypotension, cough, pharyngolaryngeal pain, gastointestinal
disturbances, rash, erythema, joint swelling, back pain, arthralgia. Rare: Hypersensitivity.
Amlodipine: Gastritis, gingival hyperplasia, gynaecomastia, leucopaenia, myalgia, pancreatitis,
hepatitis, thrombocytopaenia, vasculitis. Valsartan: Neutropaenia, increases in creatinine, serum
potassium and BUN
Contraindications:
Pregnancy and lactation, hypersensitivity to amlodipine, valsartan or any component of the product
60
Interactions:
Potassium Supplement. Potassium-sparing diuretic, potassium containing salt substitutes or other
drugs that may increase potassium level
---------------------------------------------------------------------------------------------------------------Diltiazem HCl 30 mg Tablet
B
Trade Name : Herbesser
Indication :
Treatment of angina pectoris in the following cases: i) inadequate response or intolerance to betablockers and Isosorbide Dinitrate ii) contraindication to beta-blockers iii) coronary artery spasm
Dosage :
60 mg 3 times daily (elderly initially twice daily); increased if necessary to 360 mg
daily
Precautions:
AV block (first degree), combination therapy with beta-blockers (with left ventricular dysfunction),
congestive heart failure, gastrointestinal hypermotility (extended release dose forms),
gastrointestinal obstruction (extended release dose forms), hypotension, impaired liver function
(reduced metabolism, enhanced response). Impaired renal function. Paroxysmal supraventricular
tachycardia conversion, persistent dermatologic reactions induced by calcium antagonists have
progressed to erythema multiforme or exfoliative dermatitis
Adverse reaction:
Headache, dizziness, peripheral oedema, gingival hyperplasia, AV block, bradycardia
Contraindications:
Acute myocardial infarction with pulmonary congestion, atrial fibrillation or flutter (IV dose forms): i)
Accessory bypass tract (Wolff-Parkinson-White, Lown-Ganong-Levine) ii) Short PR syndromes.
Hypersensitivity to this or other calcium channel blocker
Interactions:
Aspirin, beta-adrenergic blockers, carbamazepine, cimetidine, cisapride, cyclosporin, digitoxin,
digoxin, enflurane, lithium, lovastatin, methylprednisolone, midazolam, nifedipine, oral
anticoagulants, phenytoin, quinidine, rifampin, saquinavir, simvastatin
---------------------------------------------------------------------------------------------------------------Felodipine 10 mg Tablet
A/KK
Felodipine 5 mg Tablet
A/KK
Trade Name : Plendil
Indication :
Hypertension
Dosage :
Initiate at 5 mg once daily. Usual dose, 5 - 10 mg once daily in the morning
Precautions:
Rarely precipitate significant hypotension which can lead to myocardial ischaemia
Adverse Reaction:
Flushing, headache, palpitations, dizziness, fatigue. Ankle swelling (appears to be dose-related). Mild
gingival hyperplasia
Contraindications:
Hypersensitivity to felodipine or other calcium channel blockers, symptomatic hypotension,
peripheral vascular disease, persistent dermatologic reactions, cardiovascular arterial disease and
congestive haeart failure
61
Interactions:
Beta-adrenergic blockers, cyclosporin, fluconazole, itraconazole, ketoconazole, magnesium, oral
anticoagulants, phenobarbital and saquinavir
---------------------------------------------------------------------------------------------------------------Glyceryl Trinitrate 0.5 mg Tablet
C
Trade Name : Angised
Indication :
Prophylaxis and treatment of angina and left ventricular failure
Dosage :
0.5-1 mg sublingually
Precautions:
Severe hepatic , renal impairment, hypothyroidism, malnutrition, hypothermia. Cerebrovascular
disease, lung disease or cor pulmonale, pregnancy, lactation, glaucoma, mitral valve prolapse,
cardiac tamponade, syncope. Avoid prolonged excessive hypotension. Nitrate-free interval is
recommended in patients on continuous treatment with nitrates to reduce the risk of tolerance
Adverse Reaction:
Flushing,
dizziness,
throbbing
headache,
vomiting,
restlessness,
blurred
vision,tachycardia,bradycardia , hypotension (which can be severe), syncope, and cyanosis
rarely),methaemoglobinaemia, respiratory impairment
Contraindications:
For sublingual:Severe anaemia, early myocardial infarction, increased intracranial pressure,
symptomatic hypotension, hypersensitivity to organic nitrates
Interactions:
Imipramine, atropine, nitrates and sildenafil
---------------------------------------------------------------------------------------------------------------Glyceryl Trinitrate 25 mg/5 ml Injection
A
Trade Name : Nitro-bid
Indication :
Prophylaxis and treatment of angina, left ventricular failure. Not for direct IV injection.
Dosage :
Initial 5 mcg/min delivered via infusion pump. Subsequent titration must be adjusted to clinical
situation with dose increment becoming more cautious as partial response is seen.
Precautions:
Severe renal or hepatic impairment. Need to be diluted for infusion via approved administration sets
only. Absorption by plastics & filters. Nitrate-free interval is recommended in patients on continuous
treatment with nitrates to reduce the risk of tolerance
Adverse Reaction:
Flushing, dizziness, tachycardia and throbbing headache. Large doses cause vomiting, restlessness,
blurred vision, hypotension (which can be severe), syncope and rarely cyanosis and
methaemoglobinaemia, impairment of respiration and bradycardia
Contraindications:
For IV :Constrictive pericarditis, pericardial tamponade, restrictive cardiomyopathy, symptomatic
hypotension, hypersensitivity to organic nitrates
Interactions:
Hypotensive effect enhanced by alcohol, beta blockers, antihypertensives, tricyclic antidepressants,
narcotics, sildenafil. May potentiate effects of antihistamines, anticholinergics. Antagonises pressor
action of sympathomimetics
---------------------------------------------------------------------------------------------------------------62
Isosorbide Dinitrate 10 mg Tablet
B
Trade Name : Isordil
Indication :
Prophylaxis and treatment for: i) Angina ii) Left ventricular failure
Dosage :
i) 30 - 120 mg daily in divided doses ii) 40 - 160 mg, up to 240 mg if required; in acute episodes: 5 10 mg by sublingually
Precautions:
Acute myocardial infarction,cerebral hemorrhage,congestive heart failure, glaucoma,
hyperthyroidism,hypertrophic, cardiomyopathy, hypotension,methemoglobinemia, recent head
trauma, severe anemia, volume depletion
Adverse Reaction:
GI disturbances, headache, hypotension, tachycardia
Contraindications:
Hypersensitivity to organic nitrates, anaemia, symptomatic hypotension
Interactions:
Hypotensive effects may be enhanced by alcohol, beta-blocker, calcium channel blocker,
antihypertensive, sildenafil, tricyclic antidepressant
---------------------------------------------------------------------------------------------------------------Isosorbide-5-Mononitrate 30 mg SR Tablet
A
Trade Name : Imdur
Indication :
Prophylaxis and treatment of angina pectoris
Dosage :
30-120 mg daily
Precautions:
Acute myocardial infarction,cerebral hemorrhage, congestive heart failure, glaucoma,
hyperthyroidism, hypertrophic, cardiomyopathy, hypotension,methemoglobinemia, recent head
trauma, severe anemia, volume depletion
Adverse Reaction:
GI disturbances, headache, hypotension, tachycardia
Contraindications:
Hypersensitivity to organic nitrates, anaemia, symptomatic hypotension
Interactions:
Hypotensive effects may be enhanced by alcohol, beta-blocker, calcium channel blocker,
antihypertensive, sildenafil and tricyclic antidepressant
---------------------------------------------------------------------------------------------------------------Nifedipine 10 mg Tablet
B
Trade Name : Adalat
Indication :
Hypertension
Dosage :
Initial dose of 10 mg twice daily. Usual range 10 - 30 mg 3 times daily. Maximum: 120 - 180 mg per
day
Precautions:
Angina (exacerbation) during initiation of treatment, with dosage increases during beta-blocker
withdrawal, taper slowly prior to calcium channel blocker therapy. Chronic renal insufficiency,
combination therapy with beta-blockers (with left ventricular dsfunction)
63
Adverse Reaction:
Peripheral oedema, headache, dizziness, tachycardia
Contraindications:
Hypersensitivity to nifedipine, symptomatic hypotension, persistent dermatologic reactions, chronic
heart failure
Interactions:
Beta-adrenergic blockers, cimetidine, digoxin, diltiazem, fluconazole, itraconazole, ketoconazole,
magnesium, oral anticoagulants, phenytoin, quinidine, rifampin, saquinavir, vincristine
---------------------------------------------------------------------------------------------------------------Nimodipine 10 mg/50 ml Infusion Solution
A*
Trade Name : Nimotop
Indication :
Prophylaxis & treatment of ischaemic neurological deficits caused by cerebral vasospasm following
subarachnoid haemorrhage of aneurysmal origin
Dosage :
IV infusion of 1 mg/hour for a period of 2 hours (about 15 mcg/kg/hour). IV therapy should be
started no later than 4 days after haemorrhage & continue for up to 10 - 14 days
Precautions:
Generalised cerebral oedema or raised intracranial pressure, hypotension. Pregnancy. Monitor renal
function when used with nephrotoxic drugs
Adverse Reaction:
Severe blood pressure lowering. Gastrointestinal disturbances. In addition for infusion: deterioration
of renal function, disturbances of heart rhythm, phlebitis, increase of liver enzymes
Contraindications:
Hypersensitivity to nimodipine, within 1 month of myocardial infarction, unstable angina
Interactions:
Potentiates effects of antihypertensives. IV beta-blockers (avoid). Possible increase of nimodipine
blood concentration with cimetidine. Possible decrease of nimodipine efficacy with rifampicin.
Nephrotoxic drugs, monitor renal function, zidovudine, cimetidine, antiepileptics, rifampicin,
grapefruit juice
---------------------------------------------------------------------------------------------------------------Pentoxifylline 400 mg Tablet
A/KK
Trade Name : Trental
Indication :
Peripheral vascular disease
Dosage :
400 mg 2 - 3 times daily
Precautions:
Hypotension, coronary artery disease, renal impairment, severe hepatic impairment
Adverse reaction:
Gastrointestinal effects, hypersensitivity reactions, dizziness, agitation, sleep disturbances, headache
Contraindications:
Cerebral haemorrhage, extensive retinal haemorrhage, acute myocardial infarction, pregnancy and
lactation
Interactions:
Increased risk of bleeding with ketorolac, possibly increased risk of bleeding with other NSAIDs
----------------------------------------------------------------------------------------------------------------
64
Verapamil HCl 40 mg Tablet
B
Trade Name : Isoptin
Indication :
i) Supraventricular tachyarrhythmias (SVT) prophylaxis ii) angina
Dosage :
ADULT: 40 - 80 mg 3-4 times daily. In oral long term therapy, max: 480 mg daily
Precautions:
First degree AV block, bradycardia, hypotension. May impair ability to drive or operate machinery.
Pregnancy, lactation. Severe hepatic impairment. Slows down markedly the elimination of alcohol
and prolongs the duration of alcohol
Adverse Reaction:
Constipation, dizziness, nausea or vertigo, headache, hypotension, ankle oedema, flushing, fatigue,
nervousness, paraesthesia, bradycardiac arrhythmias, dyspnoea, raised prolactin levels, single cases
of galactorrhoea, myalgia, arthralgia, allergic skin reactions, purpura, photosensitisation dermatitis,
gynaecomastia, reversible increase in transaminases and or alkaline phosphatase, gingival
hyperplasia, tachycardia, palpitations, impotence, tinnitus, tremor, heart failure
Contraindications:
Cardiovascular shock, complicated acute myocardial shock, severe conduction disorders (2nd and
3rd degree AV block, SA block), sick sinus syndrome, heart failure, atrial fibrillation/flutter and
simultaneous preexcitation syndrome, myasthenia gravis
Interactions:
Increased risk of myocardial depression with beta-blockers or inhalation anaesthetic. May increase
plasma digoxin concentration and plasma cyclosporin concentration
---------------------------------------------------------------------------------------------------------------Verapamil HCl 5 mg/2 ml Injection
A/KK
Trade Name : Isoptin
Indication :
Supraventricular tachycardia
Dosage :
5 mg by slow IV. The dose can be repeated after 5 - 10 mins. Recommended max. total dose : 15 mg
Precautions:
Cardiac failure, complicated acute myocardial infarction, atrial fibrillation with Wolff-ParkinsonWhite syndrome, hepatic impairment
Adverse Reaction:
Constipation, dizziness, nausea or vertigo, headache, hypotension, ankle oedema, flushing, fatigue,
nervousness, paraesthesia, bradycardiac arrhythmias, dyspnoea, raised prolactin levels, single cases
of galactorrhoea, myalgia, arthralgia, allergic skin reactions, purpura, photosensitisation dermatitis,
gynaecomastia, reversible increase in transaminases and or alkaline phosphatase, gingival
hyperplasia, tachycardia, palpitations, impotence, tinnitus, tremor, heart failure
Contraindications:
Marked bradycardia, sick-sinus syndrome. 2nd or 3rd degree AV block. Chronic heart failure,
cardiogenic shock. Pregnancy
Interactions:
Effects enhanced by beta-blockers, antiarrhythmics or inhalation anaesthetic. May intensify effects
of other antihypertensives. Lithium (attenuated by verapamil, enhanced neurotoxicity). Increases
plasma level of cyclosporin, theophylline, digoxin, carbamazepine
----------------------------------------------------------------------------------------------------------------
65
Adrenaline Acid (Epinephrine) Tartrate 1 mg/ml Injection
B
Indication :
Cardiopulmonary resuscitation
Dosage :
0.5-1 mg given by SC or IM
Precautions:
Elderly patients, patients with; CV disease, pulmonary oedema, hypertension, hyperthyroidism,
diabetes, psychoneurotic illness, asthma, prefibrillatory rhythm, or anesthetic cardiac acidents.
Bronchial asthma/emphysema,cerebrovascular hemorrhage, pregnancy, lactation, children
Adverse Reaction:
Hypertension, arrhythmias, nausea, vomiting, headache, shortness of breath, sneezing
Contraindications:
Cardiac dilatation, coronary insufficiency. Within 2 weeks of MAOI use.Organic brain damage,
narrow-angle glaucoma. Shock. Concurrent use with local anesthetics for injection of certain areas
(eg; fingers, toes, ears); increased risk of vasoconstriction and sloughing of tissue. oncurrent use with
cyclopropane or halogenated hydrocarbon anaesthetics; may produce fatal ventricular arrhythmias.
Labor; may delay the second stage
Interactions:
Beta-blocking,alpha-adrenergic blockers agents,antihistamines,tricyclic antidepressants carvedilol,
chlorpromazine, halothane, moclobemide, rocuronium, selegiline, timolol,methyldopa, diuretics,
oxytoxic drugs
---------------------------------------------------------------------------------------------------------------Ephedrine HCl 30 mg/ml Injection
B
Indication :
Treatment of bronchial spasm in asthma, adjunct to correct haemodynamic imbalances and treat
hypotension in epidural and spinal anaesthesia
Dosage :
By IM, SC or IV. Severe, acute bronchospasm : 12.5-25 mg. Further dosage should be determine by
patient response. When used as a pressor agent : ADULT 25 - 50 mg SC/IM. If necessary, a second IM
dose of 50 mg or an IV dose of 25 mg may be given. Direct IV injection, 10 - 25 mg may be given
slowly. Maximum parenteral ADULT dose : 150 mg in 24 hours. CHILD : 3 mg/kg or 100 mg/m2 SC or
IV daily, in 4 - 6 divided doses
Precautions:
Angina pectoris, chronic heart disease. Chronic use may cause an anxiety state. Prostatic
hypertrophy, pregnancy
Adverse reaction:
Nervousness, anxiety, apprehension, fear, tension, agitation, excitation, restlessness, weakness,
irritability, insomnia, dizziness, lightheadness, vertigo, confusion, delirium, hallucinations or
euphoria. Throbbing headache, respiratory difficulty, fever or a feeling of warmth, pallor, dryness of
the nose and throat, precordial pain, sweating, mild epigastric distress, anorexia, nausea or
vomiting. Acute urinary retention or difficulty in urination. May initially decrease urine formation.
Palpitation and tachycardia. Extrasystoles and potentially fatal arrhythmias including ventricular
fibrillation especially in patients with organic heart disease
Contraindications:
Anaesthesia with cyclopropane or halothane, diabetes (for ephedrine injection). Hypersensitivity to
ephedrine or other sympathomimetic amines. Hypertension or other cardiovascular disorders,
obstetrical procedures with maternal blood pressure, lactation
66
Interactions:
Should not be administered concomitantly with other sympathomimetic agents. Alpha and betaadrenergic blocking agents. Cyclopropane or halogenated hydrocarbons general anaesthetics. MAOIs
---------------------------------------------------------------------------------------------------------------Noradrenaline Acid Tartrate (Norepinephrine Bitartrate) 4 mg/4 ml Injection
A
Trade Name : Levophed
Indication :
Septic shock and shock where peripheral vascular resistance is low
Dosage :
Infuse and titrate to desired pressure response. Range: 0.05 - 0.5 mcg/kg/minute
Precautions:
Peripheral vascular thrombosis, concomitant cyclopropane and halothane anaesthesia, profound
hypoxia. Coadministration with MOAIs or tricyclic antidepressants. Sulfite allergy (seen more
frequently in asthmatic than nonasthmatic patients)
Adverse Reaction:
Gangrene, cyanosis peripheral. Occasionally, bradycardia, anxiety, transient headache, plasma
volume depletion (prolonged administration), respiratory difficulty, ischaemic injury
Contraindications:
Blood volume deficit
Interactions:
MAOIs, tricyclic antidepressants
---------------------------------------------------------------------------------------------------------------Enoxaparin Sodium 40 mg Injection
A*
Enoxaparin Sodium 60 mg Injection
A*
Trade Name : Clexane
Indication :
i) Prevention of Deep Vein Thrombosis(DVT) especially in perioperative and high risk surgical cases ii)
Treatment of DVT iii) Unstable angina and non Q wave Myocardial Infarction
Dosage :
i) Prophylaxis fo DVT especially in surgical patients: moderate risk, 20 mg SC approximately 2 hours
before surgery then 20 mg every 24 hours for minimum 7 - 10 days, high risk (eg orthopaedic
surgery, medical patients, 40mg every 24 hours for at least 6 days until patient ambulant, max 14
days. ii) Treatment of DVT or pulmonary embolism, 1.5 mg/kg every 24 hours, usually for 5 days and
until adequate oral anticoagulation established. iii) Unstable angina and non-ST-segment-elevation
myocardial infarction 1 mg/kg every 12 hours, usually for 2 - 8 days
Precautions:
Carefully monitor patients for possible spinal or epidural bleeding and if neurological impairment is
detected, treat immediately. Active or history of recent gastrointestinal ulceration and
haemorrhage, bacterial endocarditis, bleeding diathesis. Concomitant therapy with agents that
inhibit platelets. Congenital or acquired bleeding disorders. Do not give via intramuscular injection.
Elderly patients and patients with renal insufficiency may experience delayed elimination of
enoxaparin. Haemorrhagic stroke, post-op period following brain & spinal cord or ophthalmological
surgery. Uncontrolled arterial hypertension. Use with extreme caution in patients with history of
heparin-induced thrombocytopenia. Diabetic retinopathy, low molecular weight heparins or
unfractionated heparin cannot be used interchangeably, unit for unit
Adverse Reaction:
Haemorrhagic symptoms, thrombocytopenia (rare), haematomas & skin necrosis at injection site;
skin allergies or systemic allergic reactions
67
Contraindications:
Active major bleeding, hypersensitivity to enoxaparin, heparin, thrombocytopenia due to
enoxaparin, acute GI ulcer
Interactions:
Increased risk of haemorrhage when used with NSAIDs, ticlopidine, corticosteroids, dextran 40. May
potentiate effects of oral anticoagulants. Vit K antagonists, anti-platelet drugs
---------------------------------------------------------------------------------------------------------------Fondaparinux Sodium 2.5 mg/0.5 ml Injection
A*
Trade Name : Arixtra
Indication :
i) Prevention of venous thromboembolic events (VTE) in orthopedic surgery (e.g. hip fracture, major
knee or hip replacement surgery), abdominal surgery in patients at risk of thromboembolic
complication. ii) Treatment of unstable angina or non-ST segment elevation myocardial infarction
[UA/NSTEMI] in patients for whom urgent invasive management (PCI) is not indicated. iii) Treatment
of ST segment elevation myocardial infarction (STEMI) in patients managed with thrombolytics or
are not receiving other forms of reperfusion therapy
Dosage :
i) 2.5 mg once daily given by SC, administered 6 hr following surgical closure provided homeostasis
has been established. Usual duration of therapy is 5 to 9 days; for hip fracture patients, an extended
course of up to 24 days is recommended. ii) ADULT more than 18 years: 2.5 mg once daily given by
SC, initiated as soon as possible after diagnosis and continued for up to 8 days or until hospital
discharge. If patient needs to undergo PCI, unfractionated heparin to be admin as per local practice
protocol, taking into account the patient's bleeding risk and time of last dose of fondaparinux.
Fondaparinux may be restarted no earlier than 2 hr after sheath removal. iii) ADULT more than 18
years: 2.5 mg once daily; first dose to be given IV (directly through an existing IV line or as infusion in
25 or 50 ml of 0.9% saline over 1-2 min), subsequent doses to be given SC. Treatment to be initiated
as soon as diagnosis is made and continued up to a max of 8 days or until hospital discharge,
whichever comes earlier. If patient needs to undergo non-primary PCI, unfractionated heparin to be
admin as per local practice protocol, taking into account the patient's bleeding risk and time of last
dose of fondaparinux. Fondaparinux may be restarted no earlier than 3 hr after sheath removal
Precautions:
Increased haemorrhagic risk eg congenital or acquired coagulopathy, active ulcerative GI disease,
recent intracranial haemorrhage or shortly after brain, spinal or ophth surgery, diabetic retinopathy,
uncontrolled arterial hypertension, moderate renal impairment (CrCl < 30-50 mL/min), severe
hepatic impairment. Measure platelet counts at baseline & end of treatment. Elderly. Pregnancy &
lactation. Avoid concurrent administration with drugs that may increase haemorrhagic risk
Adverse Reaction:
Pruritus, rash, injection site hemorrhage, fever, anemia, bleeding, thrombocytopenia, fever, nausea,
vomiting, constipation
Contraindications:
Active major bleeding; increased risk for major bleeding episodes;risk of uncontrollable hemorrhage,
bacterial endocarditis, body weight less than 50 kg for prophylactic therapy of hip fracture, hip
replacement or knee replacement surgery, or abdominal surgery; increased risk for major bleeding
episode. Fondaparinux-related thrombocytoenia. Hypersensitivity to fondaparinux. Severe renal
impairment (CrCl less than 30 ml/min)
Interactions:
Agents that increase the risk of hemorrhage (eg, other anticoagulants, NSAIDs, platelet inhibitors).
Discontinue prior to administration of fondaparinux
---------------------------------------------------------------------------------------------------------------68
Heparin 1000 units/ml Injection
B
Heparin 5000 units/ml Injection
B
Indication :
i) Prophylaxis and treatment of venous thrombosis and pulmonary embolism. ii) Treatment of
myocardial infarction and arterial embolism. iii) Prevention of clotting in arterial and heart surgery
and for prevention of cerebral thrombosis
Dosage :
i) By IV injection, loading dose of 5000 units (10,000 units in severe pulmonary embolism) followed
by continuous infusion of 15-25 units/kg/hr. By SC injection (for DVT) of 15,000 units every 12 hours
(laboratory monitoring on daily basis essential to adjust dose). Small adult or child, lower loading
dose then, 15-25 units/kg/hr by IV infusion, or 250 units/kg every 12 hours by SC injection. ii) As i),
for unstable angina and acute peripheral arterial occlusion. iii) Prophylaxis in general surgery, by SC
injection, 5000 units 2 hour before surgery, then every 8-12 hours for 7 days or until patient is
ambulant, during pregnancy (with monitoring), 5000-10000 units every 12 hours. An adjusted dose
regimen may be used for major orthopaedic surgery or low molecular weight heparin may be
selected
Precautions:
Heparin should be used cautiously in patients with allergies since it is of animal origin, renal and
hepatic disease. Hypertension during menstruation. Patients with indwelling catheters. Precaution
must be taken if using long-term subcutaneous heparin in pregnant women and bacterial
endocarditis
Adverse Reaction:
Haemorrhage, cutaneous necrosis, thrombocytopenia, anaphylaxis, hyperkalaemia
Contraindications:
Hypersensitivity, in patients who are actively bleeding, or have blood dyscrasias, in patients with
haemophilia or other blood disorders, and in cases where sufficient blood coagulation tests are not
available
Interactions:
Alprostadil, alteplase, aspirin, cefoperazone, clopidogrel, dextran, moxalactam, reteplase, urokinase,
warfarin, digitalis, tetracyclines, nicotine, antihistamines, ACE inhibitors, analgesics,
dipyridamole,drotrecogin Alfa, iloprost, nitrates, sibutramine
---------------------------------------------------------------------------------------------------------------Heparin Sodium 50 units in Sodium Chloride Injection
B
Trade Name : Hepsal
Indication :
To maintain patency of peripheral venous catheters
Dosage :
Flush with 5 ml (50 units) every 4 hours or as required
Precautions:
Heparin should be used cautiously in patients with allergies since it is of animal origin, renal and
hepatic disease. Hypertension during menstruation. Patients with indwelling catheters. Precaution
must be taken if using long-term subcutaneous heparin in pregnant women. Bacterial endocarditis
Adverse Reaction:
Haemorrhage, cutaneous necrosis, thrombocytopenia, anaphylaxis, hyperkalaemia
Contraindications:
Hypersensitivity in patients who are actively bleeding or have blood dyscrasias, in patients with
haemophilia or other blood disorders and in cases where sufficient blood coagulation tests are not
available
69
Interactions:
Alprostadil, alteplase, aspirin, cefoperazone, clopidogrel, dextran, moxalactam, reteplase, urokinase,
warfarin, digitalis, tetracyclines, nicotine, antihistamines, ACE inhibitors, analgesics,
dipyridamole,drotrecogin Alfa, iloprost, nitrates, sibutramine
---------------------------------------------------------------------------------------------------------------Warfarin Sodium 1 mg Tablet
B
Warfarin Sodium 2 mg Tablet
B
B
B
Trade Name : Coumadin
Indication :
Treatment and prophylaxis of thromboembolic disorders
Dosage :
Initially 10 mg daily for 2 days. Maintenance dose, 3-9 mg daily according to the INR (taken at the
same time each day)
Precautions:
Severe to moderate hepatic or renal insufficiency, concomitant use of antiplatelet drugs or drugs
with ulcerogenic activity. Surgery and dental extraction, congestive heart failure. Concurrent use
with thrombolytic drugs, known or suspected protein C deficiency. Moderate to severe
hypertension, severe diabetes, severe allergic or anaphylactic disorders. Patients with
hyperthyroidism or hypothyroidism may have a substantially altered response to warfarin. Avoid
concurrent use with herbal medicines and limit Vitamin K rich vegetables
Adverse Reaction:
Haemorrhage, alopecia, fever, gastrointestinal disorders, hypersensitivity reactions, `purple toes'.
Occasionally skin necrosis (obese elderly patients), jaundice, hepatic dysfunction, nausea, vomiting,
pancreatitis
Contraindications:
Haemorrhagic tendencies, pregnancy, blood dyscrasias, hypersensitivity to warfarin
products
Interactions:
Activity potentiated by cimetidine, clofibrate, co-trimoxazole, erythromycin, quinidine,
phenylbutazone, sulfonamides, amiodarone, rifampicin, carbamazepine, phenytoin, azole
antifungals, metronidazole. Drugs which may increase risk of bleeding including aspirin, NSAIDs,
dipyridamole, clopidrogel, ticlopidine
---------------------------------------------------------------------------------------------------------------Dabigatran Etexilate 110 mg Capsule
A*
Trade Name : Pradaxa
Indication :
Prevention of venous thromboembolic events in patients who have undergone total knee
replacement or total hip replacement surgery
Dosage :
Following total knee replacement: Initially ADULT 110 mg (ELDERLY, 75 mg) within 1- 4 hours after
surgery, then 220 mg (ELDERLY, 150 mg) once daily thereafter for 6-10 days
Following total hip replacement: Initially ADULT 110 mg (ELDERLY, 75 mg) within 1- 4 hours after
surgery, then 220 mg (ELDERLY, 150 mg) once daily thereafter for 28-35 days
Precautions:
Patients at risk for bleeding, recent biopsy or major trauma, spinal & epidural anaesthesia, lumbar
puncture, pregnancy & lactation, children
70
Adverse Reaction:
Bleeding, anaemia, haematoma, haemorrhage, haematuria, decreased haemoglobin, wound
secretion, post-procedural discharge
Contraindications:
Severe renal and hepatic impairment, active bleeding, organic lesion at risk of bleeding, concomitant
treatment with quinidine, pregnancy and lactation
Interactions:
Heparins, fondaparinux, desirudin, thrombolytic agents, GPIIb/IIIa receptor antagonists, clopidogrel,
ticlopidine, dextran, sulfinpyrazone, vitamin K antagonists, amiodarone, quinidine, NSAIDs,
sibutramine
---------------------------------------------------------------------------------------------------------------Acetylsalicylic Acid 100 mg, Glycine 45 mg Tablet
B
IndIication :
Prevention of myocardial infarct, stroke, vascular occlusion and deep vein thrombosis. Transient
ischaemic attacks
Dosage :
1 tablet daily
Precautions:
Dyspepsia, gastric mucosal lesions, haemorrhagic disorders, gout, intolerant to aspirin, renal or
hepatic impairment, asthma and G6PD deficiency
Adverse Reaction:
Nausea, vomiting, dyspepsia, GI ulceration, haematemesis, malaena. Occasionally
hepatotoxicity
Contraindications:
Bleeding disorders. Hypersensitivity to salicylate
Interactions:
Alcohol, dipyridamole, metoclopramide, metoprolol, carbonic anhydrase inhibitors, corticosteroids,
coumarin anticoagulants, sulphonylureas, methotrexate, phenytoin, valproic acid, probenecid,
sulphinpyrazone
---------------------------------------------------------------------------------------------------------------Clopidogrel 75 mg Tablet
A*
Trade Name : Plavix
Indication :
Prevention of myocardial infarct, stroke or established peripheral arterial disease. As second/third
line treatment in patients who are sensitive to acetylsalicylic acid & intolerant to ticlopidine
Dosage :
75 mg once daily
Precautions:
Avoid for first few days after MI and for 7 days after ischaemic stroke; not recommended in unstable
angina, coronary artery bypass grafting and percutaneous transluminal coronary angioplasty;
patients at risk of increased bleeding from trauma, surgery or other pathological conditions;
discontinue 7 days before elective surgery if antiplatelet effect not desirable, liver impairment, renal
impairment, pregnancy. Based on literature data, patients with genetically reduced CYP2C19
function (intermediate or poor metabolisers) have lower systemic exposure to the active metabolite
of clopidogrel and diminished antiplatelet responses, and generally exhibit higher cardiovascular
events rates following myocardial infarction than do patients with normal CYP2C19 function
Adverse reaction:
GI bleeding, purpura, bruising haematoma, epistaxis, haematuria, ocular haemorrhage, intra cranial
bleeding, abdominal pain, dyspepsia, gastritis & constipation, rash, pruritus
71
Contraindications:
Active pathological bleeding such as peptic ulcer & intracranial haemorrhage, breast feeding
Interactions:
Cytochrome P450 effect. Amiodarone, cisapride, ciclosporin, diltiazem, irbesartan, losartan, oral
hypoglycemics, paclitaxel, phenytoin, quinidine, sildenafil, tamoxifen, verapamil, warfarin, aspirin,
heparin, thrombolytics, NSAIDs, atorvastatin, erythromycin, clarithromycin. Concomitant use of the
drugs that inhibit CYP2C19 should be discouraged
----------------------------------------------------------------------------------------------------------Dipyridamole 75 mg Tablet
B
Trade Name : Persantin
Indication :
As an adjunct to oral anticoagulation/ antiplatelet therapy in the prophylaxis of cerebrovascular
events
Dosage :
75-150 mg 3 times daily to be taken 1 hour before meals
Precautions:
Rapidly worsening angina, aortic stenosis, recent myocardial infarction, heart failure, may
exacerbate migraine, hypotension, myasthenia gravis
Adverse Reactions:
Gastrointestinal effects, dizziness, myalgia, headache, hypotension, hot flushes and tachycardia,
rash, urticaria, exacerbation of angina pectoris, bronchospasm and angioedema, increased bleeding
during and after surgery
Contraindications:
Hypersensitivity to dipyridamole or tartrazine dye (25 mg tablets)
Interactions:
Adenosine, indomethacin, low molecular weight heparins, streptokinase, theophylline
---------------------------------------------------------------------------------------------------------------Ticlopidine HCl 250 mg Tablet
A/KK
Trade Name : Ticlid
Indication :
i) Prevention of thrombotic stroke for patients who are sensitive /intolerant to Acetysalicylic Acid ii)
Maintenance of coronary bypass surgery or angioplasty iii) Maintenance of patency of access in
patients on chronic haemodialysis
Dosage :
250 mg twice daily taken with food
Precautions:
Predisposition to bleeding, including gastric or duodenal ulcers. Underlying haematologic disorders.
Concomitant oral anticoagulant therapy or nonsteroidal antiinflammatory agents (including aspirin).
Liver disease, patients undergoing lumbar puncture or surgical procedure. Ticlopidine should be
discontinued if the absolute neutrophil count falls below 1200/mm3 or if the platelet count falls
below 80,000/mm3. If possible, ticlopidine should be discontinued 10 to 14 days prior to surgery
Adverse reaction:
Minor gastrointestinal disorders. Rarely cutaneous allergic manifestations, thrombocytopenia,
cholestatic icterus and or rise in transaminases. Neutropenia and thrombocytopenia (monitor full
blood count weekly initially)
Contraindications:
Hypersensitivity to ticlopidine or its components, patients with active bleeding disorders.
Neutropenia or thrombocytopenia, severe liver impairment
72
Interactions:
Any drugs likely to produce coagulation
---------------------------------------------------------------------------------------------------------------Streptokinase 1,500,000 IU Injection
A*
Trade Name : Streptase
Indication :
Acute myocardial infarction, acute pulmonary embolism
Dosage :
Myocardial infarction: 1,500,000 units over 30 - 60 minutes. Pulmonary embolism: 250,000 units by
IV infusion over 30 minutes, then 100,000 units every hour for up to 12-72 hours with monitoring of
clotting factors
Precautions:
Arterial invasive procedures should be avoided before and during treatment and invasive venous
procedures should be performed carefully. Spontaneous bleeding from internal sites may occur.
Concurrent use of anticoagulants with streptokinase is not recommended. Concurrent use of
heparin may be required during intracoronary administration of streptokinase. Precaution must be
taken during concurrent use of drugs that may alter platelet function (dextran, aspirin,
indomethacin, phenylbutazone) and anticoagulants
Adverse reaction:
Nausea, vomiting, bleeding, reperfusion arrhythmias, hypotension, bronchospasm
Contraindications:
Hypersensitivity to streptokinase products, streptococcal infections within 6 months haemorrhage,
cardiovascular arrest, surgery or trauma within 1 month, subacute bacterial endocarditis
Interactions:
Aspirin, dipyridamole, eptifibatide, warfarin
---------------------------------------------------------------------------------------------------------------Tenecteplase 10,000 unit (50 mg) Injection
A*
Trade Name : Metalyse
Indication :
Acute myocardial reinfarction where streptokinase is contraindicated due to previous streptokinase
induced antibodies. [Indicated when antibodies was given more than 5 days and less than 12
months]
Dosage :
Less than 60 kg: 30 mg, 60 - 69 kg: 35 mg, 70 - 79 kg: 40 mg; 80 -90 kg: 45 mg, 90 kg or above: 50 mg.
Administer single IV bolus over 5-10 seconds
Precautions:
SBP > 180 mmHg, cerebrovascular disease, known/suspected stroke or TIA, recent GI or GUT
bleeding, recent IM injection, elderly > 75 years, low body weight < 60 kg
Adverse Reaction:
Nausea, vomiting, hemorrhage, bleeding, epistaxis, GI & GU bleeding, superficial bleeding,
reperfusion arrhythmia, hypotension, allergic reaction, fever
Contraindications:
Active internal bleeding, hypersensitivity to tenecteplase, history of cerebrovascular accident,
intracranial or intraspinal surgery or trauma within 2 months, intracranial neoplasm, arteriovenous
malformation, or aneurysm, known bleeding diathesis, severe uncontrolled hypertension,
intracranial aneurysm
Interactions:
Drug that affected coagulation and alter platelet function
------------------------------------------------------------------------------------------------------73
Urokinase 6000 IU Injection
A
Trade Name : Urokinase
Indication :
Treatment of thromboembolic disease such as mycocardial infarction, peripheral artery occlusion,
pulmonary embolism, retinal artery thrombosis and other ophthalmologic use
Dosage :
ADULT: Acute pulmonary embolism: IV loading dose 4400 iu/kg over 10 mins, maintenance 4400
iu/kg/hour for 12 hours. Peripheral vascular occlusion: infuse 2500 iu/ml into clot at a rate of 4000
iu/min for 2 hours. This may be repeated up to 4 times. Hyphaema: 5000 IU in 2 ml saline solution is
injected and withdrawn repeatedly over the iris. If residual clot remains, leave 0.3ml in the anterior
chambers for 24-48 hours to facilitate futher dissolution
Precautions:
Surgery within 10 days. Intra arterial diagnostic procedure within 10 days. Ulcerative wounds.
Recent trauma with possibility of internal injuries. Pregnancy and the first 10 days of the postpartum
period. Ulcerative colitis, diverticulitis or an active bleeding lesion of the gastrointestinal or
genitourinary tract
Adverse Reaction:
Bleeding, hypotension, epistaxis, bronchospasm
Contraindications:
Hypersensitivity to urokinase products, cerebrovascular accident, internal bleeding, surgery or
trauma within 10 days
Interactions:
Heparin, oral anticoagulants
---------------------------------------------------------------------------------------------------------------Factor VIII Inhibitor Bypassing Activity Injection
A
*[Drug taken from National Blood Bank – Not kept in hospital]
Trade Name : Feiba
Indication :
Treatment and prophylaxis of hemorrhage in hemophilia A, B and non-hemophiliacs with acquired
inhibitors to factor VIII, IX, XI
Dosage :
Individualized dosage
Precautions:
Hepatic disease ,newborn ,non-hemophilic patients ,thrombosis risk factors .Risk of disseminated
intravascular coagulation, liver damage, CHD, acute thrombosis and or embolism. Pregnancy and
lactation
Adverse Reaction:
Complication of infusion, headache, flushing, fever, chills, change in blood pressure or pulse rate
,myocardial infarction , hives ,disseminated intravascular coagulation, DIC, thromboembolic disorder
, anaphylactoid reaction
Contraindications:
Bleeding episodes resulting from coagulation factor deficiencies , disseminated intravasular
coagulation , fibrinolysis ,normal coagulation mechanism
Interactions:
Antifibrinolytics, tranexamic acid
----------------------------------------------------------------------------------------------------------------
74
Factor IX Injection
A
Trade Name : Alphanine,profilnine
Indication :
Prevention and control of bleeding in patients with factor IX deficiency due to haemophilia B
Dosage :
Dose varies according to the patient and the circumstances of the bleeding. i) Mild haemorrhage:
initial dose of 30 units/kg body weight. ii) Moderate haemorrhage: initial dose of 50 units/kg iii)
Major haemorrhage/surgery: Initial dose of 75 - 100 units/kg. Half of these doses may be repeated
after 18-24 hrs if necessary.
Precautions:
Risk of thrombosis. Use with caution in patients with liver dysfunction
Adverse Reaction:
Allergic reactions, mild chills, nausea, fever,nausea, vomiting, headache, flushing, intravascular
coagulation,thrombosis
Contraindications:
Hypersensitivity to Factor IX or any component of the formulation. Disseminated intravascular
coagulation
Interactions:
Coadministeration with aminocaproic acid may increase risk for thrombosis
---------------------------------------------------------------------------------------------------------------Factor VIIa (Recombinant) eptacog alfa (activated) 60 KIU (1.2 mg) Injection
A*
Trade Name : Novoseven
Indication :
Treatment of bleeding episodes and prevention of excessive bleeding in connection with surgery in
patients with inherited or acquired haemophilia with inhibitors to coagulation factors VIII or IX
Dosage :
Initially 4.5 KIU (90 mcg)/kg body weight IV bolus over 2-5 minutes, followed by 3-6 KIU (60-120
mcg)/kg body weight depending on type & severity of haemorrhage or surgery performed. Dosing
interval: initially 2-3 hour to obtain haemostasis and until clinically improved. If continued therapy is
needed, dose interval can be increased successively to every 4, 6, 8 or 12 hours
Precautions:
Advanced atherosclerotic disease: increased risk of thrombotic events. Concomitant use of activated
or nonactivated prothrombin complex concentrates: increased risk of thrombotic events .Crush
injury; disseminated intravascular coagulation (DIC),Septicemia: increased risk of thrombotic events
.Elderly, non-hemophilia, intracerebral hemorrhage patients: increased risk of arterial
thromboembolic adverse events, including myocardial ischemia, myocardial infarction, cerebral
ischemia and or infarction.
Adverse Reaction:
Rash, itching, nausea, fever, headache, malaise, diaphoresis, changes in blood pressure,renal failure,
cerebrovascular disorder, angina pectoris, atrial arrhythmia, circulatory shock, hemorrhage,
hemarthrosis
Contraindications:
Hypersensitivity to Factor VII or any component of the formulation
Interactions:
Simultaneous use of prothrombin complex concentrates, activated or not should be avoided
----------------------------------------------------------------------------------------------------------------
75
Factor VIII Injection
A
Trade Name : Alphanate,Hemofil M
Indication :
Prevention and control of bleeding in patients with factor VIII deficiency due to classical haemophilia
A
Dosage :
Dose varies according to the patient and the circumstances of the bleeding. i) Mild to moderate:
Usually a single dose of 10-15units/kg. ii) More serious haemorrhage/minor surgery:Initially 15-25
units/kg followed by 10-15 units/kg every 8 - 12 hours if required iii) Severe haemorrhage/major
surgery: Initial : 40 - 50 units/kg followed by 20 - 25 units/kg every 8-12 hrs.
Precautions:
Risk of thrombosis and transmission of infection, pregnancy. Intravascular haemolysis after
large/frequently repeated doses in patients with blood groups A,B, or AB
Adverse reaction:
Allergic reactions (chills, urticaria, fever), headache, intravascular haemolysis, increased body temp,
development of factor VIII antibodies
Contraindications:
Disseminated intravascular coagulation, underlying thrombosis
Interactions:
Not known
---------------------------------------------------------------------------------------------------------------Tranexamic Acid 100 mg/ml Injection
B
Trade Name : Transamin, Cyklokapron
Indication :
Haemorrhage associated with excessive fibrinolysis
Dosage :
ADULT: Slow IV 0.5-1 g (10 - 15 mg/kg) 3 times daily. Continuous infusion at a rate of 25 - 50 mg/kg
daily. CHILD: slow IV 10 mg/kg/day 2-3 times daily
Precautions:
Cardiovascular disease, cerebrovascular disease, concomitant antifibrinolytic therapy. Concomitant
therapy with oestrogens or thrombolytics. Renal impairment and transurethral prostatectomy
(potential for intravesicular clotting)
Adverse reaction:
Nausea, vomiting, diarrhoea, hypotension, thrombosis, disturbances in colour vision
Contraindications:
Severe renal impairment, thromboembolic disease, intravascular clotting process, disturbance of
colour vision, subarachnoid haemorrhage
Interactions:
Anti-inhibitor coagulant complex oral contraceptive, oestrogen, tretinoin
---------------------------------------------------------------------------------------------------------------Tranexamic Acid 250 mg Capsule
B
Trade Name : Transamin
Indication :
Haemorrhage associated with excessive fibrinolysis
Dosage :
ADULT: 1-1.5 g (15-25 mg/kg) 2-4 times daily. CHILD: 25 mg/kg/day 2-3 times daily. Menorrhagia
(initiated when menstruation has started), 1 g 3 times daily for up to 4 days; maximum 4 g daily
76
Precautions:
Cardiovascular disease, cerebrovascular disease, concomitant antifibrinolytic therapy. Concomitant
therapy with oestrogens or thrombolytics. Renal impairment and transurethral prostatectomy
(potential for intravesicular clotting)
Adverse Reaction:
Nausea, vomiting, diarrhoea, hypotension, thrombosis, disturbances in colour vision
Contraindications:
Severe renal impairment, thromboembolic disease, intravascular clotting process, disturbance of
colour vision and subarachnoid haemorrhage
Interaction:
Anti-inhibitor coagulant complex, oral contraceptive, oestrogen, tretinoin
-------------------------------------------------------------------------------------------------------------------------Atorvastatin 20 mg Tablet
A*
Trade Name : Lipitor
Indication :
Hypercholesterolaemia and coronary heart disease intolerant or not responsive to other forms of
therapy
Dosage :
10 mg once daily. Maximum: 80 mg daily
Precautions:
Heavy alcohol use, history of liver disease. Discontinue therapy if serum transaminase levels rise to 3
times upper limit of normal and are persistent. This class of drug has been known to cause myopathy
and renal failure due to rhabdomyolysis. Concomitant administration of fibrates, niacin, cyclosporin
or erythromycin may increase the risk of myopathy
Adverse Reaction:
Gastrointestinal disturbances, headache, myalgia, asthenia, insomnia, angioneurotic oedema,
muscle cramps, myostitis, myopathy, cholestatic jaundice, peripheral neuropathy, pruritus
Contraindications:
Liver disease, hypersensitivity to atorvastatin, pregnancy or lactation
Interactions:
Risk of myopathy increased with concurrent administration of cyclosporin, fibric acid derivatives,
erythromycin, niacin or azole antifungals. Decreased atorvastatin plasma concentration with oral
antacid suspensions containing magnesium and aluminium hydroxides and colestipol
---------------------------------------------------------------------------------------------------------------Ezetimibe 10 mg & Simvastatin 20 mg Tablet
A*
Trade Name : Vytorin
Indication :
Primary hypercholesterolemia
Dosage :
Usual starting dose: 10/20 mg/day
Precautions:
Unexplained muscle pain, tenderness or weakness, heavy alcohol use, past history of liver disease or
current moderate to severe hepatic insufficiency, major surgery, renal insufficiency
Adverse Reactions:
Myalgia, headache, upper respiratory infection, hepatotoxicity, anaphylaxis, angioedema druginduced myopathy, rhabdomyolysis, abdominal pain, diarrhoea, fatigue, thrombocytopenia,
hepatitis, hypersensitivity reactions including rash and angioedema, pancreatitis, nausea, anaemia,
constipation, asthenia, jaundice, muscle cramps, dizziness, paresthesia, peripheral neuropathy,
alopecia, pruritus
77
Contraindications:
Hypersensitivity to ezetimibe or simvastatin or any of its components. Active liver disease or
unexplained persistent elevations in serum transaminases, pregnancy, lactation
Interactions:
Itraconazole, ketoconazole, erythromycin, clarithromycin, HIV protease inhibitors, gemfibrozil,
niacin, cyclosporine, danazol, amiodarone, verapamil, cholestyramine, diltiazem, fibrates, grapefruit
juice, coumarin derivatives, antacids
---------------------------------------------------------------------------------------------------------------Ezetimibe 10 mg Tablet
A*
Trade Name : Ezetrol
Indication :
i) Co-administration with statins for patients who have chronic heart disease or are chronic heart
disease equivalent or familial hypercholesterolaemia with target LDL-C not achieved by maximum
dose of statins ii) Monotherapy in patients with documented biochemical intolerance to statins
Dosage :
10 mg once daily. Not recommended for children less than 10 years old
Precautions:
Children under 10 years old, moderate to severe hepatic insufficency, myopathy, pregnancy and
lactation
Adverse Reaction:
Abdominal pain, arthralgia, back pain, cough, diarrhoea, fatigue, headache, sinusitis
Contraindications:
Avoid co-administration with fibrates. Hypersensitivity to ezetimibe, active liver disease or
persistently elevated liver enzymes
Interactions:
Cholestyramine, fibrates, cyclosporin
---------------------------------------------------------------------------------------------------------------Gemfibrozil 300 mg Capsule
A/KK
Trade Name : Lopid
Indication :
Treatment of hyperlipoprotinaemias (TYPES IIA, IIB, III, IV, V)
Dosage :
ADULT: 1200 mg/day in 2 divided doses, 30 minutes before breakfast and dinner. Dose range from
0.9-1.5 g daily
Precautions:
Cholelithiasis, concomitant use of anticoagulants and hydroxymethylglutaryl coenzyme A (HMG-CoA)
reductase inhibitor (statin) risk of rhabdomyolysis. Diabetes, hypothyroidism, not recommended for
patients with type IIa hyperlipidemia (low-density lipoproteins cholesterol elevations only)
Adverse Reaction:
Dizziness, chest pain, fatigue, rash, pruritis, dermatitis, urticaria, pain in extremities, abdominal and
epigastric pain, diarrhoea, vomiting, flatulence, gout, headache, paraesthesia, blurred vision.
Myalgia, rhabdomyolysis especially when coadministered with a statin
Contraindications:
Hypersensitivity to gemfibrozil, severe hepatic or renal dysfunction, gall stones, neonates, children,
pregnancy, lactation
78
Interactions:
Co-admin with repaglinide may lead to an increase in the serum levels of repaglinide. May enhance
the effects of oral anticoagulants. May also increase the plasma concentrations of ciclosporin and
associated nephrotoxicity when used concurrently
---------------------------------------------------------------------------------------------------------------Lovastatin 20 mg Tablet
B
Trade Name : Mevacor
Indication :
Hypercholesterolaemia and coronary heart disease
Dosage :
20 mg once daily. Maximum: 80 mg daily
Precautions:
times upper limit of normal and are persistent. This class of drug has been known to cause myopathy
and renal failure due to rhabdomyolysis. Concomitant administration of fibrates, niacin, ciclosporin
or erythromycin may increase the risk of myopathy
Adverse reactions:
Gastrointestinal upsets, headache, skin rashes, fatigue, pruritis, dry mouth, sleep disorders. Rarely,
hepatitis, hypersensitivity syndrome, erythema multiforme, toxic epidermal necrolysis
Contraindications:
Pregnancy, liver disease, hypersensitivity to lovastatin, lactation
Interactions:
Use with caution with coumarin anticoagulants and with immunosuppressive drugs, gemfibrozil or
niacin (as a lipid lowering agent) or erythromycin. Itraconazole
---------------------------------------------------------------------------------------------------------------Pravastatin Sodium 20 mg Tablet
A
Trade Name : Pravachol
Indication :
therapy
Dosage :
10 - 20 mg once daily. Maximum: 40 mg daily
Precautions:
times upper limit of normal and are persistent. May cause myopathy and renal failure due to
rhabdomyolysis. Concomitant administration of fibrates, nicotinic acid, immunosuppressives
including cyclosporin, macrolide antibiotics (erythromycin, clarithromycin), itraconazole and
ketoconazole, may increase the risk of myopathy
Adverse Reaction:
Rash, myalgia, headache, non-cardiac chest pain, nausea, vomiting, diarrhoea, fatigue
Contraindications:
Hypersensitivity to pravastatin, liver disease, pregnancy or lactation
Interactions:
Cholestyramine, ciprofibrate, colestipol, cyclosporin, erythromycin, fenofibrate, gemfibrozil, niacin
----------------------------------------------------------------------------------------------------------------
79
Rosuvastatin 10 mg Tablet
A*
Rosuvastatin 20 mg Tablet
A*
Trade Name : Crestor
Indication :
Dyslipidaemia not responsive to atorvastatin 40 mg or equivalent doses of other statins
Dosage :
Initially 5-10 mg once daily increased if necessary at intervals of at least 4 weeks to 20 mg once daily,
increased after further 4 weeks to 40 mg daily ONLY in severe hypercholesterolemia with high
cardiovascular risk. Patient of Asian origin, patients on concomitant ciclosporin/fibrate and patients
with risk factors for myopathy/rhabdomyolysis (including personal/family history of muscular
disorders/toxicity), the maximum dose should be 20 mg daily
Precautions:
Monitor renal and liver function. Predisposing factors for myopathy such as renal impairment,
advanced age, hypothyroidism. Acute serious conditions suggestive of myopathy or predisposing to
the development of renal failure secondary to rhabdomyolysis. Concurrent use of fibrates may cause
severe myositis and myoglobinuria, concurrent use of other lipid-lowering therapies/ciclosporin may
increase the risk of myopathy
Adverse Reactions:
Pharyngitis, headache, diarrhoea, dyspepsia, nausea, myalgia, asthenia, back pain, flu syndrome,
urinary tract infection, rhinitis, sinusitis, altered liver function tests, paraesthesia, abdominal pain,
flatulence, constipation and vomiting
Contraindications:
Active liver disease including elevated serum transaminases more than 3 times upper limit of
normal. Severe renal impairment (creatinine clearance less than 30 mL/min). Patients with
myopathy. Patients receiving concomitant ciclosporin. Pregnancy and lactation
Interactions:
Warfarin, vitamin K antagonists, ciclosporin, gemfibrozil, lopinavir/ritonavir, antacids (aluminium
and magnesium hydroxide), erythromycin, ketoconazole, spirinolactone, cimetidine, oral
contraceptives, digoxin, fenofibrate
---------------------------------------------------------------------------------------------------------------Simvastatin 20 mg Tablet
A/KK
Simvastatin 40 mg Tablet
A/KK
Trade Name : Zocor
Indication :
therapy
Dosage :
10 - 20 mg once daily. Maximum: 80 mg daily
Precautions:
times upper limit of normal and are persistent. May cause myopathy and renal failure due to
rhabdomyolysis. Concomitant administration of fibrates, nicotinic acid, immunosuppressives
including ciclosporin, macrolide antibiotics (erythromycin, clarithromycin), itraconazole and
ketoconazole or nefazodone may increase the risk of myopathy
Adverse Reaction:
Abdominal pain, flatulence, constipation, asthenia and headache, rarely hepatitis, hypersensitivity
syndrome, upper respiratory infection
Contraindications:
Hypersensitivity to simvastatin products, active liver disease, pregnancy and lactation
80
Interactions:
May cause slight elevation of serum digoxin. Cholestyramine and colestipol increase bioavailability
of simvastatin. Increased concentrations with mibefradil
---------------------------------------------------------------------------------------------------------------Alprostadil 500 mcg/ml Injection
Trade Name : Prostin VR
Indication :
For treatment of congenital heart diseases which are ductus arteriosus dependent
Dosage :
0.05 - 0.1 mcg/kg/min by continuous IV infusion, then decreased to lowest effective dose
Precautions:
Concurrent anticoagulants, neonates with bleeding tendencies, spinal cord injury
Adverse Reactions:
Bradycardia, fever, hypotension, tachycardia, neonatal apnoea, seizures
Contraindications:
Neonates with respiratory distress syndrome
Interactions:
Heparin
A*
---------------------------------------------------------------------------------------------------------------Trimetazidine 20 mg Tablet
B
Trade Name : Vastarel
Indication :
Prophylactic treatment of episodes of angina pectoris
Dosage :
20mg 3 times daily
Precautions:
Pregnancy especially first trimester, unstable angina, hypertension, renal or hepatic insufficiency
Adverse reaction:
Gastrointestinal disorders such as nausea and vomiting
Contraindications:
Concomitant administration with MAOIs
Interactions:
Not known
---------------------------------------------------------------------------------------------------------------Trimetazidine 35 mg MR Tablet
B
Trade Name : Vastarel MR
Indication :
Prophylactic treatment of episodes of angina pectoris
Dosage :
35 mg twice daily in the morning and evening with meals
Precautions:
Pregnancy especially first trimester, unstable angina, hypertension, renal or hepatic insufficiency
Adverse reaction:
Gastrointestinal disorders such as nausea and vomiting
Contraindications:
Concomitant administration with MAOIs
Interactions:
Not known
---------------------------------------------------------------------------------------------------------------81
4. RESPIRATORY
Bronchodilators
Corticosteroids
Cromoglycate, related therapy and leukotriene receptor antagonists
Respiratory stimulants and pulmonary surfactants
Miscellaneous respiratory
82
Aminophylline 25 mg/ml Injection
B
Indication :
Reversible airways obstruction, acute severe asthma
Dosage :
Deteriorating acute asthma not previously treated with theophylline, by slow IV injection over 20
minutes 250 - 500 mg (5 mg/kg), then as for acute severe asthma. Acute severe asthma by IV
infusion : 500 mcg/kg/hour, adjusted according to plasma-theophylline concentration. CHILD : 6
month - 9 years : 1 mg/kg/hour, 10 - 16 years : 800 mcg/kg/hour
Precautions :
Hyperthyroidism, glaucoma, diabetes mellitus, angina pectoris, pulmonary, cardiovascular, renal or
hepatic diseases. Pregnancy, children and elderly. Active peptic ulcer disease, seizure disorders,
cardiac arrhythmias (not including bradyarrhythmias). Patients with migraine headaches may
experience an increased frequency of headaches. Patients with congestive heart failure, cor
pulmonale, prolonged fever, hypothyroidism, liver disease, sepsis with multi-organ failure, and shock
may require reduced theophylline dosage. Concommitant medication use which results in reduced
theophylline clearance
Adverse Reactions :
Tachycardia, palpitations, nausea and other gastrointestinal disturbances, headache, CNS
stimulation, insomnia, arrythmias, also allergy to ethylenediamine which can cause urticaria,
erythema, and exfoliative dermatitis
Contraindication :
Hypersensitivity to theophylline or derivatives, hypersensitivity to ethylenediamine
Interactions :
Azole antifungals, ciprofloxacin, clarithromycin, erythromycin : increased risk of theophylline
toxicity. Caffeine : increased caffeine level. Halothane : increased risk of arrthmia
-------------------------------------------------------------------------------------------------------------------------Ipratropium Bromide 0.0125% Inhalation Solution (125 mcg/ml)
B
Ipratropium Bromide 0.025% Inhalation Solution (250 mcg/ml)
B
Trade Name : Atrovent
Indication :
Only for treatment of : i) Patients with ischaemic heart disease who develop extrasystole with
salbutamol or terbutaline ii) Patients with chronic bronchitis who have airway obstruction and who
do not respond to salbutamol or terbutaline. Reversible airways obstruction, particularly in chronic
obstructive pulmonary disease
Dosage :
ADULT : 500 mcg up to 4 times daily. CHILD 5 - 12 years : 125 - 250 mcg up to 4 times daily, 12 years :
250 - 500 mcg up to 4 times daily
Precautions :
Narrow-angle glaucoma, prostatic hypertrophy, cystic fibrosis, bladder-neck obstruction
Adverse Reactions :
Headache, nausea, dry mouth, rare and reversible anticholinergic side effects, ocular side effects if
substances enters eyes, cough
Contraindication :
Hypersensitivity to ipratropium products, atropine, soya lecithin or related food products
Interactions :
Bronchodilatory effect intensified by beta-adrenergic and xanthine preparation. Anticholinergic
effects of other drugs may be enhanced. Cisapride - loss of cisapride efficacy
---------------------------------------------------------------------------------------------------------------83
Ipratropium Bromide 0.5 mg and Salbutamol 2.5 mg per UDV
B
Trade Name : Combivent
Indication :
Management of reversible bronchospasm associated with obstructive airway
diseases
Dosage :
Acute attacks : 1 unit dose vial. In severe cases not relieved by 1 unit dose vial, 2 unit dose vials may
require, patient should consult a doctor immediately. Maintenance : 1 unit dose vial 3 - 4 times daily
Precautions :
Patients predisposed to glaucoma, insufficiently controlled diabetes mellitus, recent myocardial
infarction, severe organic heart or vascular disorders, hyperthyroidism, phaechromocytoma, risk of
narrow-angle glaucoma, prostatic hypertrophy or bladder-neck obstruction, hypoxia, cystic fibrosis,
pregnancy and lactation, uriticaria, angioedema, rash, broncospasm, oropharyngeal oedema
Adverse Reactions :
Headache, dizziness, nervousness, tachycardia, fine tremor, palpitations. Potentially serious
hypokalaemia may result from beta2-agonist therapy, dryness of mouth, dysphonia, ocular
complications, allergic type reactions
Contraindication :
Hypersensitivity to atropine or its derivatives or to any other component. Hypertrophic obstructive
cardiomyopathy or tachyarrythmia
Interactions :
Xanthine derivatives, other anticholinergics, beta2-agonists, beta-blockers, tricyclic anti depressants,
MAOIs, glucocorticoids - increased risk of tachycardia, agitation, hypomania, hypokalaemia
---------------------------------------------------------------------------------------------------------------Ipratropium Bromide 20 mcg and Salbutamol base 100 mcg/dose Inhalation
B
Trade Name : Combivent
Indication :
Management of reversible bronchospasm associated with obstructive airway diseases
Dosage :
ADULT and ELDERLY : 2 inhalations 4 times daily. Maximum : 12 inhalations daily. CHILD under 12
years not recommended
Precautions :
Patients predisposed to glaucoma, insufficiently controlled diabetes mellitus, recent myocardial
infarction, severe organic heart or vascular disorders, hyperthyroidism, phaechromocytoma, risk of
narrow-angle glaucoma, prostatic hypertrophy or bladder-neck obstruction, hypoxia, cystic fibrosis,
pregnancy and lactation, urticaria, angioedema, rash, broncospasm, oropharyngeal oedema
Adverse Reactions :
Headache, dizziness, nervousness, tachycardia, fine tremor, palpitations. Potentially serious
hypokalaemia may result from beta2-agonist therapy, dryness of mouth, dysphonia, ocular
complications, allergic type reactions
Contraindication :
Hypersensitivity to atropine or its derivatives or to any other component. Hypertrophic obstructive
cardiomyopathy or tachyarrythmia
Interactions :
Xanthine derivatives, other anticholinergics, beta2-agonists, beta-blockers, tricyclic anti depressants,
MAOIs, glucocorticoids : increased risk of tachycardia, agitation, hypomania, hypokalaemia
--------------------------------------------------------------------------------------------------------------------------
84
Ipratropium Bromide 20 mcg/dose Inhalation
Trade Name : Atrovent
Indication :
Only for treatment of : i) Patients with chronic bronchitis who have airway
obstruction and who do not respond to Salbutamol or Terbutaline ii) Patients with
ischaemic heart disease who develop extrasystole with Salbutamol or Terbutaline
Dosage :
20 - 40 mcg 3 - 4 times daily. In the early treatment, up to 80 mcg 3 - 4 times daily.
CHILD up to 6 years : 20 mcg 3 times daily, 6 - 12 years : 20 - 40 mcg 3 times daily
B
Precautions :
Narrow - angle glaucoma, prostatic hypertrophy, cystic fibrosis
Adverse Reactions :
Headache, nausea, dry mouth, rare and reversible anticholinergic side effects, ocular side effects if
substances enters eyes, cough
Contraindication :
Hypersensitivity to atropine and its derivatives
Interactions :
Bronchodilatory effect intensified by beta-adrenergic and xanthine preparation. Anticholinergic
effects of other drugs may be enhanced. Cisapride - loss of cisapride efficacy
---------------------------------------------------------------------------------------------------------------Salbutamol 0.5 % Inhalation Solution
Trade Name : Ventolin
Indication :
Asthma and other conditions associated with reversible airways obstruction
Dosage :
2 ml may be inhaled up to 4 times daily over a period of 3 minutes per inhalation
(0.5 ml diluted in 2.5 ml of normal saline by inhalation over 5 to 15 minutes)
B
Precautions :
Thyrotoxicosis, hyperthyroidism, cardiovascular disease, arrhythmias, susceptiility to QT-interval
prolongation, hypokalaemia, diabetes mellitus, not appropriate for managing premature labour,
pregnancy and lactation
Adverse Reactions :
Slight tremor (particularly in the hands), nervous tension, headache, peripheral dilatation and
palpitations, tachycardia, arrhythmias, disturbances of sleep and behaviour in children, muscle
cramps, hypersensitivity reactions including paradoxical bronchospasm, urticaria, angioedema,
hypotension, pulmonary oedema, erythema multiforme
Contraindication :
Hypersensitivity to any of their components
Interactions :
Antagonism with beta-blockers. Use with caution with additional adrenergic drugs, MAOI inhibitors
or tricyclic antidepressants - increased risk of tachycardia, agitation or hypomania
---------------------------------------------------------------------------------------------------------------Salbutamol 0.5 mg/ml Injection
Indication :
85
A
Dosage :
500 mcg by SC/IM injection 4 hourly or 250 mcg by slow IV. If required, by IV
infusion, initially 5 mcg/min adjusted according to response and heart rate, usually
in the range 3 - 20 mcg/min
Precautions :
Thyrotoxicosis, pregnancy and lactation. Potential for paradoxical bronchospasm, patients with
cardiovascular disorders, hyperthyroidism, diabetes mellitus, phaeochromocytoma, patients with
history of aneursym and patients who are usually responsive to sympathomimetics amines. Labour
and delivery may be complicated
Adverse Reactions :
Haemorrhage, thrombocytopenia, tachycardia and palpitations, erythema, ventricular ectopic beats,
myocardial ischaemia and infarction have been reported following IV administration. Fine tremor
(particularly in the hands), nervous tension, headache, peripheral dilatation and palpitations,
tachycardia, arrhythmias, disturbances of sleep and behaviour in children. Muscle cramps and
hypersensitivity reactions including paradoxical bronchospasm, urticaria, and angioedema
Contraindication :
Hypersensitivity, hyperthyroidism or thyrotoxicosis, tachycardia or tachycardiac arrthymias,
subvalvular aortic stenosis
Interactions :
Monoamine oxidase inhibitors - increased risk of tachycardia, agitation or hypomania
---------------------------------------------------------------------------------------------------------------Salbutamol 100 mcg/dose Inhalation
Indication :
Dosage :
ADULT : 100 - 200 mcg up to 3 - 4 times daily. CHILD : 100 mcg increased to 200 mcg
if necessary
B
Precautions :
Thyrotoxicosis, pregnancy and lactation, hyperthyroidism, cardiovascular disease, arrhythmias,
susceptiility to QT-interval prolongation, hypokalaemia, diabetes mellitus, not appropriate for
managing premature labour, pregnancy and lactation
Adverse Reactions :
Contraindication :
Interactions :
---------------------------------------------------------------------------------------------------------------Salbutamol 2 mg Tablet
Indication :
86
B
Dosage :
CHILD 2 - 6 years : 1 - 2 mg 3 - 4 times daily, 6 - 12 years : 2 mg 3 - 4 times daily.
CHILD over 12 years and ADULT : 2 - 4 mg 3 - 4 times daily
Precautions :
Thyrotoxicosis
Adverse Reactions :
Fine tremor (particularly in the hands), nervous tension, headache, peripheral dilatation and
palpitations, tachycardia, arrhythmias, disturbances of sleep and behaviour in children
Contraindication :
Hypersensitivity to any of their components. Premature labour e.g. placenta praevia, associated with
toxaemia of pregnancy or antepartum haemorrhage from whatever cause
Interactions :
Monoamine oxidase inhibitors - increased risk of tachycardia, agitation or hypomania
---------------------------------------------------------------------------------------------------------------Salbutamol 200 mcg Inhalation Powder
B
Trade Name : Buventhol
Indication :
Dosage :
CHILD : 100 - 200 mcg. Maintenance : 100 - 200 mcg 2 - 4 times daily. ADULT : 100 - 400 mcg.
Maitenance : 100 - 400 mcg 2 - 4 times daily
Precautions :
Thyrotoxicosis, pregnancy and lactation, hyperthyroidism, cardiovascular disease, arrhythmias,
susceptiility to QT-interval prolongation, hypokalaemia, diabetes mellitus, not appropriate for
managing premature labour, pregnancy and lactation
Adverse Reactions :
Contraindication :
Interactions :
---------------------------------------------------------------------------------------------------------------Terbutaline Sulphate 0.3 mg/ml Syrup
Trade Name : Bricanyl
Indication :
Dosage :
CHILD less than 7 years : 75 mcg/kg 3 times daily, 7 - 15 years : 2.5 mg 2 - 3 times
daily
B
Precautions :
Hypertension, cardiovascular disease, unstable diabetes, hypersensitivity to sympathomimetic
amines, hypertrophic cardiomyopathy, hypokalaemia, convulsive disorders and hyperthyroidism
87
Adverse Reactions :
Palpitations, tachycardia, increases in ejection fraction, increases in cardiac output have been
reported following subcutaneous terbutaline, tremor and tonic cramp
Contraindication :
Hypersensitivity to terbutaline and other sympathomimetic amines
Interactions :
Beta-blockers - inhibit bronchodilating effect. Monoamine oxidase inhibitors - increased risk of
tachycardia, agitation, or hypomania. Theophylline - decreased theophylline concentrations
-------------------------------------------------------------------------------------------------------------------------------------Terbutaline Sulphate 0.5 mg/ml Injection
Indication :
B
Bronchial asthma, chronic bronchitis, emphysema and other lung diseases where
broncoconstriction is a complicating factor
Dosage :
SC, IM or slow IV : 250-500 mcg up to 4 times daily. CHILD 2 - 15 years 10mcg/kg to a
maximum of 300 mcg. Continuous IV infusion, as a solution containing 3 - 5 mcg/ml,
1.5 - 5 mcg/minute for 8 - 10 hours; reduce dose for children
Precautions :
Adverse Reactions :
Tremor, tonic cramp and palpitations (reversible within first 1 - 2 week of treatment)
Contraindication :
Thyrotoxicosis
Interactions :
tachycardia, agitation or hypomania. Theophylline - decreased theophylline concentrations
---------------------------------------------------------------------------------------------------------------Terbutaline Sulphate 10 mg/ml Inhalation Solution
B
Indication :
Dosage :
ADULT : 5 - 10 mg 2 -4 times daily, additional doses may be necessary in severe acute asthma. CHILD
up to 3 years : 2 mg, 3 - 6 years : 3 mg, 6 - 8 years : 4 mg, over 8 years : 5 mg 2 - 4 times daily
Precautions :
amines, hypertrophic cardiomyopathy, hypokalaemia
Adverse Reactions :
Tremor, tonic cramp, and palpitations (reversible within first 1 - 2 week of treatment)
Contraindication :
Interactions :
Beta-blockers : inhibit bronchodilating effect. Monoamine oxidase inhibitors : increased risk of
tachycardia, agitation, or hypomania. Theophylline : decreased theophylline concentrations.
---------------------------------------------------------------------------------------------------------------88
Terbutaline Sulphate 2.5 mg Tablet
B
Indication :
Dosage :
ADULT: Initially 2.5 mg 3 times daily for 1 - 2 week, then up to 5 mg 3 times daily. CHILD less than 7
years: 75 mcg/kg 3 times daily, 7 - 15 years: 2.5 mg 2 - 3 times daily
Precautions :
Adverse Reactions :
Palpitations, tachycardia, increases in ejection fraction, increases in cardiac output have been
reported following subcutaneous terbutaline, tremor and tonic cramp
Contraindication :
Interactions :
tachycardia, agitation or hypomania. Theophylline - decreased theophylline concentrations
---------------------------------------------------------------------------------------------------------------Theophylline 125 mg Tablet
B
Trade Name : Nuelin
Indication :
Reversible airways obstruction, acute severe asthma
Dosage :
ADULT: 125 mg 3 - 4 times daily after food, increased to 250 mg if required. CHILD: 1 - 15 years : 5
mg/kg/dose (up to 600 mg/ day) every 3 - 4 times daily
Precautions :
Active peptic ulcer disease, seizure disorders, cardiac arrhythmias (not including bradyarrhythmias).
Patients with migraine headaches may experience an increased frequency of headaches. Patients
with congestive heart failure, cor pulmonale, prolonged fever, hypothyroidism, liver disease, sepsis
with multi-organ failure and shock may require reduced theophylline dosage. Concomittant
medication use which results in reduced theophylline clearance
Adverse Reactions :
Tachycardia, palpitations, nausea and other gastrointestinal disturbances, headache, central nervous
system stimulation, insomnia, arrythmias
Contraindication :
Hypersensitivity to theophylline
Interactions :
Azole antifungals, ciprofloxacin, clarithromycin, erythromycin: increased risk of theophylline toxicity.
Caffeine: increased caffeine level. Halothane: increased risk of arrythmia
---------------------------------------------------------------------------------------------------------------Theophylline 250 mg Long Acting Tablet
Trade Name : Nuelin SR
Indication :
Reversible airways obstruction and acute severe asthma
Dosage :
ADULT: 250 mg 2 times daily. CHILD under 12 years : Up to 10 mg/kg body weight 2 times daily
89
B
Precautions :
Active peptic ulcer disease, seizure disorders, cardiac arrhythmias (not including bradyarrhythmias).
Patients with migraine headaches may experience an increased frequency of headaches. Patients
with congestive heart failure, cor pulmonale, prolonged fever, hypothyroidism, liver disease, sepsis
with multi-organ failure and shock may require reduced theophylline dosage. Concomitant
medication use which results in reduced theophylline clearance
Adverse Reactions :
Tachycardia, palpitations, nausea and other gastrointestinal disturbances, headache, central nervous
system stimulation, insomnia, arrythmias
Contraindication :
Hypersensitivity to theophylline
Interactions :
Azole antifungals, ciprofloxacin, clarithromycin, erythromycin: increased risk of theophylline toxicity.
Caffeine: increased caffeine level. Halothane: increased risk of arrythmia
---------------------------------------------------------------------------------------------------------------Tiotropium Bromide Inhalation 18 mcg Capsules
A*
Trade Name : Spiriva
Indication :
Long term maintenance treatment of bronchospasm and dypsnoea associated with COPD.
Tiotropium has usually been added to standard therapy (e.g. inhaled steroids, theophylline,
albuterol rescue)
Dosage :
Inhale the contents of one capsule once daily with the handihaler device at the same time of day.
Child and adolescent under 18 years, not recommended
Precautions :
Myasthenia gravis, narrow angle glaucoma, prostatic hyperplasia, renal impairment, pregnancy,
bladder neck obstruction, moderate to severe renal failure
Adverse Reactions :
Xerostomia, upper respiratory tract infection, sinusitis, rash, cataract, angioedema, tachycardia,
urinary retention, angina pectoris, hypercholesterolemia, hyperglycemia
Contraindication :
Hypersensitivity to tiotropium and its derivatives or any component of the formulation (contains
lactose). Not for use as an acute ("Rescue") bronchodilator
Interactions :
Beta-agonists and other anticholinergics
---------------------------------------------------------------------------------------------------------------Beclomethasone Dipropionate 100 mcg/dose Inhalation
B
Trade Name : Becotide
Indication :
Prophylaxis of asthma especially if not fully controlled by bronchodilators
Dosage :
ADULT : 100 mcg 3 - 4 times daily or 200 mcg twice daily. CHILD more than 6 years : 50 - 100 mcg 2 4 times daily
Precautions :
Pulmonary tuberculosis, pregnancy. Adrenal insufficiency (when replacing systemic corticosteroid
therapy), exposure to viral infection (chickenpox, measles), ocular herpes simplex, tuberculosis
(active or quiescent), untreated fungal, bacterial, or systemic viral infections
90
Adverse Reactions :
Candidiasis of the mouth and throat, hoarseness or throat irritation, headache, secondary
hypocortisolism, osteoporosis, cataract, glaucoma, paradoxical bronchospasm (discontinue
immediately). Patients are advised to gargle after using the medication
Contraindication :
Hypersensitivity to beclomethasone dipropionate, acute asthma exacerbations, status asthmaticus.
Special care is necessary in patients with active or quiescent pulmonary tuberculosis
Interactions :
Not known
---------------------------------------------------------------------------------------------------------------Budesonide 1 mg/2 ml Nebulising Solution
Budesonide 500 mcg/2 ml Nebulising Solution
Trade Name : Pulmicort
Indication :
Maintenance treatment of asthma as prophylactic therapy especially if not fully
controlled by bronchodilators
Dosage :
ADULT : Initially 1 - 2 mg twice daily. CHILD 3 months - 12 years of age : 500 mcg - 1
mg. Maintenance dose : half of the above doses
B
B
Precautions :
Acute exacerbations, accompanied by increased mucous viscosity and mucous plugging. Caution in
viral infections such as varicella, in untreated fungal and bacterial infections of the respiratory
system. Pregnancy and lactation
Adverse Reactions :
Mild irritation of the throat, coughing, and generally reversible hoarseness of the voice. Bad taste,
dryness of the throat. Candidiasis of the mouth and throat, paradoxical bronchoconstriction,
headache, nausea, tiredness, thirst, diarrhoea, skin reaction
Contraindication :
Hypersensitivity to budesonide. Moderate to severe bronchiectasis
Interactions :
Oral or parenteral corticosteroids - effects enhanced by the concomitant use. Amiodarone increased risk of developing Cushing's syndrome. Ketoconazole, erytromycin, ritonavir - increased
budesonide plasma concentrations
---------------------------------------------------------------------------------------------------------------Budesonide 200 mcg/dose Inhalation
B
Trade Name : Pulmicort
Indication :
Maintenance treatment of asthma as prophylactic therapy especially if not fully controlled by
bronchodilators
Dosage :
ADULT : 200 - 1600 mcg daily in 2 - 4 divided doses. Maintenance with twice daily dosing. CHILD
more than 7 years 200 - 800 mcg, 2 - 7 years 200 - 400 mcg. To be taken orally in 2 - 4 divided doses
Precautions :
Acute exacerbations, accompanied by increased mucous viscosity and mucous plugging. Caution in
viral infections such as varicella, in untreated fungal and bacterial infections of the respiratory
system. Pregnancy and lactation
91
Adverse Reactions :
Mild irritation of the throat, coughing, and generally reversible hoarseness of the voice. Bad taste,
dryness of the throat. Candidiasis of the mouth and throat, paradoxical bronchoconstriction,
headache, nausea, tiredness, thirst, diarrhoea, skin reaction
Contraindication :
Hypersensitivity to budesonide. Moderate to severe bronchiectasis
Interactions :
Oral or parenteral corticosteroids - effects enhanced by the concomitant use. Amiodarone increased risk of developing Cushing's syndrome. Ketoconazole, erytromycin, ritonavir - increased
budesonide plasma concentrations
---------------------------------------------------------------------------------------------------------------Montelukast Sodium 10 mg Tablet
A*
Trade Name : Singulair
Indication :
Chronic treatment of asthma and relief of symptoms of seasonal allergic rhinitis for children more
than 15 years and adults
Dosage :
CHILD more than 15 years and ADULT: 10 mg daily at bedtime
Precautions :
Should not be used for treatment of acute asthma attacks. Should not be abruptly substituted for
inhaled or oral corticosteroids. Pregnancy and lactation. Patients with known aspirin sensitivity
should continue avoidance of aspirin or NSAIDs while taking montelukast. Paediatric less than 6
month
Adverse Reactions :
Abdominal pain, headache ,thirst, diarrhea, hyperkinesia, flu-like symptoms, eczematous dermatitis
and rash
Contraindication :
Hypersensitivity to any component of montelukast
Interactions :
Phenobarbitone
---------------------------------------------------------------------------------------------------------------Montelukast Sodium 4 mg Oral Granules
A*
Indication :
Asthmatics, not controlled on high dose inhaled corticosteroids more than 1600 mcg/day and with
co-morbid allergic disorders. Chronic treatment of asthma
Dosage :
12 months - 5 years: 1 packet of 4mg oral granules daily at bedtime
Precautions :
month
Adverse Reactions :
and rash
92
Contraindication :
Interactions :
Phenobarbitone
---------------------------------------------------------------------------------------------------------------Montelukast Sodium 5 mg Chewable Tablet
A*
Indication :
Asthmatics, not controlled on high dose inhaled corticosteroids more than 1600 mcg/day and with
co-morbid allergic disorders. Chronic treatment of asthma
Dosage :
CHILD 6 - 14 years: One 5 mg chewable tablet daily at bedtime
Precautions :
month
Adverse Reactions :
and rash
Contraindication :
Interactions :
Phenobarbitone
---------------------------------------------------------------------------------------------------------------Beractant Intratracheal Suspension (200 mg phospholipids in 8 ml vial)
A*
Trade Name : Survanta
Indication :
Treatment of newborn baby with birth weight of 700 g or greater undergoing mechanical ventilation
for respiratory distress syndrome, whose heart rate and arterial oxygenation are continuously
monitored
Dosage :
100 mg/kg (4 ml/kg) body weight via endotracheal tube every 6 hours (1 - 4 doses)
Precautions :
Continuous monitoring with arterial or transcutaneous measurement of systemic oxygen and carbon
dioxide
Adverse Reactions :
Transient bradycardia, hypoxia, endotracheal tube reflux
Contraindication :
Not known
Interactions :
Not known
----------------------------------------------------------------------------------------------------------------
93
Budesonide 160 mcg and Formoterol 4.5 mcg Inhalation
A
Trade Name : Symbicort
Indication :
Mild, moderate and severe persistent asthma
Dosage :
ADULT : 1 - 2 puff twice daily, maximum : 4 puff twice daily. ADOLESCENT (12 - 17 years) : 1 - 2 puff
twice daily. CHILD less than 6 years are not recommended
Precautions :
Not for acute attack. Taper dose when discontinuing treatment. Thyrotoxicosis, diabetes mellitus,
heart disease, hypokalaemia, severe cardiovascular disorders, hypertropic obstructive
cardiomyopathy, tuberculosis, phaeocromocytoma
Adverse Reactions :
Headache, insomnia, tremor, restlessness, oral candidiasis, cough, hoarseness
Contraindication :
Hypersensitivity to budesonide or formoterol or inhaled lactose
Interactions :
Itraconazole, ketoconazole, MAOI, tricyclic antidepressan, ritonavir, phenothiazines
---------------------------------------------------------------------------------------------------------------Salmeterol 25 mcg and Fluticasone Propionate 125 mcg Inhalation
A*
Salmeterol 50 mcg and Fluticasone Propionate 250 mcg Inhalation
A/KK
Trade Name : Seretide
Indication :
Regular treatment of reversible obstructive airways diseases including asthma
Dosage :
ADULT and CHILD more than 12 years : 1 - 2 puff twice daily. CHILD over 4 years : 1 puff twice daily
Precautions :
Not for acute unstable or acutely deteriorating asthma. Active or quiescent pulmonary tuberculosis,
thyrotoxicosis. When transferring from systemic to inhaled steroid therapy, monitor adrenocortical
function regularly and withdraw systemic corticosteroid therapy gradually. Pregnancy and lactation
Adverse Reactions :
Hoarseness and dystonia, throat irritation, headache, oropharyngeal candidiasis and palpitations,
tremor, cardiac arrhythmias (atrial fibrillation and supraventricular tachycardia)
Contraindication :
Hypersensitivity to any of the ingredients of salmeterol, fluticasone or any component of the
product
Interactions :
Beta-blockers, strong CYP3A4 inhibitors e.g. ketoconazole, ritonavir
----------------------------------------------------------------------------------------------------------------
94
5. ANALGESICS
Non-opioid analgesics
Opioid analgesics
Non-steroidal anti-inflammatory drugs (NSAIDs)
Neuropathic pain
95
Acetylsalicylic Acid 300 mg Soluble Tablet
C
Trade Name : Aspirin Soluble
Indication :
Mild to moderate pain
Dosage :
300 - 900 mg every 4 - 6 hours as required. Max 4 g daily. Use in children not recommended
Precautions :
Renal disorders, G6PD deficiency, pregnancy, patients with flu, chicken pox or haemorrhagic fever.
History of peptic ulcer or those prone to dyspepsia and those with gastric mucosal lesion; asthma or
allergic disorders; dehydrated patients; uncontrolled hypertension; impaired renal or hepatic
function; elderly
Adverse Reactions :
Gastric haemorrhage, hypersensitivity, thrombocytopenia,GI disturbances; prolonged bleeding time,
rhinitis, urticaria and epigastric discomfort; angioedema, salicylism, tinnitus; bronchospasm
Contraindications :
Gastric and duodenal ulcers, haemorrhagic diathesis, hypersensitivity to aspirin or other NSAIDs,
children under 12 years old.Hypersensitivity (attacks of asthma, angioedema, urticaria or rhinitis);
pregnancy (third trimester); patients with haemophilia or haemorrhagic disorders; gout; severe renal
or hepatic impairment; lactation
Interactions :
Acetazolamide, Dipyridamol : salicylate toxicity (vomiting, tachycardia, hyperpnea, mental
confusion) or acetazolamide toxicity (fatigue, lethargy, somnolence, confusion, hyperchloremic
metabolic acidosis). Alendronate : GI distress. Antacids, calcium. Alcohol, corticosteroids,
phenylbutazone and oxyphenbutazone may increase risk of GI ulceration. Aspirin increases
phenytoin levels. May antagonize actions of uricosurics and spironolactone
-------------------------------------------------------------------------------------------------------------------------Ketorolac Tromethamine 30 mg/ml Injection
A*
Trade Name : Toradol
Indication :
Short term management of moderate to severe postoperative pain
Dosage :
ADULT : By IM/IV injection.(over not less than 15 seconds.) Initially 15 mg 4 - 6 hourly. MAXIMUM:
90 mg daily
Precautions :
Active hepatitis and cholestasis, conditions predisposing to GI toxicity, conditions predisposing to or
exacerbated by fluid retention, cardiac or hepatic impairment, elderly. History of GIT disease,
Coagulation disorders
Adverse Reactions :
Bronchospasm, dyspnoea, gastrointestinal disturbances and ulceration, dizziness, drowsiness, dry
mouth, hallucinations, headache, insomnia, myalgia, sweating, tinnitus, vertigo, urinary tract and
kidney disorders, bradycardia, flushing, hypertension, pallor, purpura, thrombocytopenia, asthma,
dyspnoea, pulmonary oedema, skin reactions, hypersensitivity reactions, bleeding, asthenia,
injection site pain, weight gain
Contraindications :
Hystory of peptic ulcer or coagulation disorders, hypersensitivity to ketorolac, NSAIDs, aspirin,
oxpentifylline, probenecid, lithium or other prostaglandin synthesis inhibitors. Gastrointestinal
bleeding, suspected or confirmed cerebrovascular (intracranial) bleeding, history of haemorrhagic
diatheses, including coagulation disorders. Individuals with complete or partial syndrome of nasal
polyps, angioedema or bronchospasm. Dehydration or hypovolaemia from any cause. Moderate or
96
severe renal impairment (serum creatinine more than 180 mmol/L). History of asthma. Patients who
have had operations with a high risk of haemorrhage or incomplete haemostasis. Patients on
anticoagulants including low dose heparin. Pregnancy, labour, delivery or lactation. Children less
than 16 year
Interactions :
ACEIs : decreased antihypertensive and natriuretic effects. Aspirin, NSAIDs : enhanced
gastrointestinal adverse effects (peptic ulcers, gastrointestinal bleeding and or perforation) and
possible increase in serum ketorolac levels. Beta-adrenergic block
---------------------------------------------------------------------------------------------------------------Paracetamol 120 mg/5 ml Syrup
C
Trade Name : Panadol
Indication :
Mild to moderate pain and pyrexia
Dosage :
CHILD: up to 1 year: 60 - 120 mg. 1 - 5 years: 120 - 240 mg. 6 - 12 years: 240 - 480 mg per dose.
Repeat every 4 - 6 hours when necessary. Maximum of 4 doses in 24 hours
Precautions :
Renal and hepatic failure. Avoid chronic use
Adverse Reactions :
Allergic reactions, skin rash
Contraindications :
Nephropathy
Interactions :
Anticoagulants, alcohol, liver enzyme inducers, aspirin, chloramphenicol and phenobarbitone
---------------------------------------------------------------------------------------------------------------Paracetamol 125 mg Suppository
B
Paracetamol 250 mg Suppository
B
Indication :
Symptomatic relief of fever and post operative pain for paediatric cases
Dosage :
CHILD 1 - 5 years: 125 - 250 mg; 6 - 12 years: 250 - 500 mg; 3 - 11 months: 80 mg inserted every 4 - 6
hours if necessary, maximum 4 doses in 24 hours. INFANTS under 3 months should not be given
Paracetamol unless advised by doctor; a dose of 10 mg/kg (5 mg/kg if jaundiced) is suitable
Precautions :
Adverse Reactions :
Contraindications :
Nephropathy
Interactions :
---------------------------------------------------------------------------------------------------------------Paracetamol 500 mg Tablet
Trade Name : Panadol
Indication :
Mild to moderate pain and pyrexia
Dosage :
ADULT: 500 - 1000 mg every 4 - 6 hours, maximum of 4 g daily
97
C
Precautions :
Adverse Reactions :
Contraindications :
Nephropathy
Interactions :
---------------------------------------------------------------------------------------------------------------Parecoxib Sodium 40mg Injection
A*
Trade Name : Dynastat
Indication :
Management of post operative pain in the immediate post operative setting only
Dosage :
40 mg followed by 20 or 40 mg every 6 to 12 hours, as required. Use limited to two days only with a
maximum dose of 80 mg/day. Reduce the initial dose by 50% in elderly less than 50 kg
Precautions :
Moderate hepatic impairment, severe renal impairment, pre-disposition to fluid retention, coronary
artery bypass graft surgery, dehydration, history of G1 perforations, ulcers or bleeds. Patients with
hypertension or with bleeding disorders
Adverse Reactions :
Hypotension, back pain, dizziness, alveolar osteitis, ecchymosis, peripheral oedema, bradycardia ,
increased creatinine, hypokalaemia, agitation, insomnia, cerebrovascular disorders, Stevens-Johnson
Syndrome, pharyngitis oliguria erythema multiforme, acute renal failure
Contraindications :
Patients undergoing Coronary Bypass Grafting (CABG) procedures and patients with elevated
cardiovascular risk such as those with congestive heart failure (NYHA II-IV), established ischaemic
heart disease and or cerebrovascular disease, patients who have experienced asthma, urticaria, or
allergic-type reactions after taking acetylsalicylic acid, NSAIDs, COX-2 specific inhibitors,
hypersensitivity to sulphonamides
Interactions :
Warfarin, diuretics, antihypertensives, ACEI, ciclosporin, tacrolimus, fluconazole, ketoconazole,
propafenone, metoprolol, phenytoin, diazepam, lithium, CYP2C19 substances
---------------------------------------------------------------------------------------------------------------Dihydrocodeine Tartrate 30 mg Tablet
B
Trade Name : DF 118
Indication :
For the control of moderate to severe chronic pain
Dosage :
ADULT: 30 - 60 mg every 4 - 6 hours. PAED, over 4 yrs: 0.5 - 1 mg/kg body weight every 4-6 hours
Precautions :
Hypothyroidism, chronic hepatic or adrenocortical disease, renal insufficiency, elderly
Adverse Reactions :
GI disturbance, headache, vertigo, respiratory depression
Contraindications :
Respiratory depression, obstuctive airway disease, acute alcoholism, acute asthmatic attack
98
Interactions :
Naltrexone : precipitation of opioid withdrawal symptoms.MAOIs, phenothiazines, CNS depressants,
cimetidine
---------------------------------------------------------------------------------------------------------------Fentanyl 25 mcg/h Transdermal Patch
A*
Fentanyl 50 mcg/h Transdermal Patch
A*
Trade Name : Durogesic
Indication :
As a second line drug in the management of chronic cancer pain. The use is to be
restricted to pain specialists, palliative medicine specialists and oncologists.
Dosage :
Patients who have not previously received a strong opioid analgesic, initial dose , one 25 mcg/hour
patch to be replaced after 72 hours. Patients who have received a strong opioid analgesic, initial
dose based on previous 24 hours opioid requirement (oral morphine sulphate 90 mg over 24 hours =
one 25 mcg/hour patch). Not recommended in children.
Precautions :
Elderly, neonates, children, obstetric patients,hepatic/renal dysfunction, pulmonary disease,
increased intracranial pressure, pregnancy, lactation. Avoid exposing patch to direct heat.Not for
acute or post-op pain. COPD or other pulmonary disease, bradyarrhythmias, brain tumour, impaired
consciousness or coma. Withdraw gradually. May impair ability to drive or operate machinery. Fever
Adverse Reactions :
Local skin reaction, constipation, nausea, vomiting, drowsiness, dry mouth, psychomimetic effect
(dysphoria, hallucination, nightmare), urinary retention, respiratory depression (clinically significant
respiratory depression is a rare occurance in patients whose opioid doses have been titrated against
pain), physical dependence (physical dependence can be prevented by gradual withdrawal of
opioids).Hypoventilation, somnolence, confusion, hypotension, bradycardia, headache, pruritus,
sweating, rash, erythema.
Contraindications :
Hypersensitivity, acute pain, raised intra-cranial pressure, respiratory depression and biliary colic
(these conditions are not contra-indicated in patients who are terminally ill)
Interactions :
CNS depressant, including opiods, sedatives, hypnotics, general anaesthetics, phenothiazines,
tranquilizers, skeletal muscle relaxants, sedating antihistamines and alcohol beverages : additive
depressant effects, ritonavir.
---------------------------------------------------------------------------------------------------------------Fentanyl Citrate 50 mcg/ml Injection
A
Indication :
Analgesia during operation, relief of pain in the immediate postoperative period.
Adjunct in maintenance of general / regional anaesthesia.
Dosage :
Dose should be individualized according to age, body weight, physical status, underlying pathological
conditions and type of surgery and anaesthesia. With spontaneous respiration, 50 - 200 mcg, then
50 mcg every 20 - 30 minutes. as required. With assisted respiration: 0.3 - 3.5 mg, then 100 - 200
mcg as required up to 600 mcg. CHILD:Child with spontaneous respiration: 3 - 5 mcg/kg, then 1
mcg/kg as required. Child with assisted ventilation : 10 - 15 mcg/kg, then 1 - 3 mcg/kg as required
Precautions :
Pulmonary function impairment, liver/kidney dysfunction, cardiac arrhythmias, myasthenia gravis
99
Adverse Reactions :
Respiratory depression, apnoea, muscle rigidity, bradycardia, cardiac dysrhythmia, tachyarrhythmia,
chest pain, hypertension, hypotension, hypoventilation, neutropenia
Contraindications :
Children more than 2 years, asthma, respiratory depression, head injury, patients receiving MAOIs
within previous 14 days, hypersensitivity, increased intracranial pressure, pregnancy and lactation
Interactions :
Amiodarone : cardiac toxicity (low cardiac output). Azole antifungals, macrolide antibiotics :
increased or prolonged opioid effects (CNS depression, respiratory depression). Beta-adrenergic
blockers, calcium channel blockers : severe hypotension. Carbamazepine : decreased plasma
concentrations of fentanyl. Diazepam : significant decreases of mean arterial pressure and systemic
vascular resistance. Naltrexone : precipitation of opioid withdrawal symptoms. Phenytoin :
decreased plasma concentrations of fentanyl. Protease inhibitors : increased risk of fentanyl toxicity
(CNS depression, respiratory depression).
-------------------------------------------------------------------------------------------------------------------------Morphine HCl 10 mg/5 ml Solution
Indication :
For use in management of moderate to severe pain especially that associated with
neoplastic disease
Dosage :
5 - 20 mg or more regularly every 4 hours in terminal pain
B
Precautions :
Neonates, children, infants less than 3 months, elderly, obstetric patients, chronic obstructive airway
disease, asthma; pregnancy, lactation, renal and hepatic impairment, hypothyroidism, head injury,
intracranial lesions; hypotension, circulatory shock; seizure-prone patients; adrenocortical
insufficiency; prostatic hyperplasia; inflammatory or obstructive bowel disease; myasthaenia gravis
Adverse Reactions :
Constipation, nausea, vomiting, drowsiness, dry mouth, psychomimetic effect (dysphoria,
hallucination, nightmare), urinary retention, respiratory depression (rare). Convulsions; dry mouth,
headache, vertigo; palpitations; hypothermia; pruritus, urticaria; tachycardia, bradycardia; blurred
vision; miosis; dependency
Contraindications :
Raised intra-cranial pressure, respiratory depression and biliary colic (these conditions are not
contra-indicated in patients who are terminally ill). Hypersensitivity to morphine, acute or severe
asthma; paralytic ileus; obstructive airway disease; acute liver disease; comatose patients;
pregnancy, acute alcoholism
Interactions :
MAOIs: hypotension and exaggeration of CNS and respiratory depressant effects. Naltrexone:
precipitation of opioid withdrawal symptoms. Cimetidine : morphine toxicity (CNS depression,
respiratory depression)
-------------------------------------------------------------------------------------------------------------------------Morphine Sulphate 10 mg Controlled Release Tablet
Morphine Sulphate 30 mg Controlled Release Tablet
Trade Name : MST Continus
Indication :
Prolonged relief of severe pain associated with neoplastic disease; assists in
procuring sleep where sleeplessness is due to pain or shock
100
A
A
Dosage :
10 - 60 mg 12 hourly intervals, depend upon the severity of the pain
Precautions :
Neonates, children, elderly, obstetric patients, chronic obstructive airway disease, pregnancy,
lactation, renal and hepatic impairment, hypothyroidism
Adverse Reactions :
Contraindications :
Raised intra-cranial pressure, respiratory depression and biliary colic (these conditions are not
contra-indicated in patients who are terminally ill). Hypersensitivity to morphine, acute or severe
asthma; paralytic ileus; obstructive airway disease; acute liver disease; comatose patients;
pregnancy. acute alcoholism, head injury, paralytic ileus, delayed gastric emptying, obstructive
airways disease, cardiac arrhythmias, acute hepatic disease; concurrent MAOIs (or within 2 week).
Not recommended for pre-operation use or for the 1st 24 hour post-operation. Pregnancy &
lactation. Children
Interactions :
MAOIs: hypotension and exaggeration of CNS and respiratory depressant effects including sedatives
or hypnotics, general anaesthetic, phenothiazines, other tranquillizers, muscle relaxants,
antihypertensives, alcohol; respiratory depression, cimetidine. Naltrexone: precipitation of opioid
withdrawal symptoms. Cimetidine: morphine toxicity
-------------------------------------------------------------------------------------------------------------------------Morphine Sulphate 10 mg/ml Injection
Indication :
For moderate to severe pain especially that associated with neoplastic disease
Dosage :
ADULT: 10 - 20 mg/kg or more SC or IM every 4 hours in terminal pain. CHILD: Up to
1 month: 0.15 mg/kg body weight; 1 - 12 months: 0.2 mg/kg body weight; 1 - 5
years: 2.5 - 5 mg ; 6 - 12 years: 5 - 10 mg
B
Precautions :
Children less then 1 year, neonates, premature infants, elderly, chronic obstructive airway disease,
pregnancy, lactation, renal and hepatic impairment, hypothyroidism
Adverse Reactions :
Contraindications :
Acute bronchial asthma, respiratory insufficiency, severe CNS depression, GI obstruction, biliary colic
(these conditions are not contra-indications in patients who are terminally ill), hypersensitivity to
morphine, MAOIs
Interactions :
MAOIs: hypotension and exaggeration of CNS and respiratory depressant effects. Naltrexone:
precipitation of opioid withdrawal symptoms. Cimetidine : morphine toxicity (CNS depression,
respiratory depression)
---------------------------------------------------------------------------------------------------------------101
Nalbuphine HCl 10 mg/ml Injection
Trade Name : Nubain
Indication :
Perioperative analgesia, for relief of moderate to severe pain
Dosage :
10 - 20 mg SC, IM or IV every 3 - 6 hours
B
Precautions :
Impaired renal/hepatic function, MI, impaired respiration, biliary tract surgery
Adverse Reactions :
Sedation, sweating, GI upsets, vertigo, dry mouth, allergic reactions
Contraindications :
Hypersensitivity to nalbuphine
Interactions :
Phenothiazines, alcohol, CNS depressants
-------------------------------------------------------------------------------------------------------------------------Oxycodone HCl 10 mg Prolonged Release Tablet
A*
Oxycodone HCl 20 mg Prolonged Release Tablet
A*
Trade Name : Oxycontin
Indication :
Management of moderate to severe chronic cancer pain non-responsive to morphine (in accordance
with WHO step-wise ladder of chronic pain management) [Initiated by Chronic Pain Specialist only]
Dosage :
ADULT, ELDERLY and CHILDREN more than 18 years, opioid-naive patients: 10 mg 12 hourly. Renal or
hepatic impairment: 5 mg 12 hourly. Titrate dose carefully, as frequently as once a day if necessary,
to achieve pain relief
Precautions :
History or tendency for drug abuse. Risk of criminal diversion similar to morphine; obstructive
pulmonary disease or cor pulmonale, substantial decrease in respiratory reserve, hypoxia,
hypercapnia, pre-existing respiratory depression or kyphoscoliosis associated with respiratory
depression (increased risk for respiratory depression); circulatory shock, hypovolemia, concurrent
use with other drugs which may decrease blood pressure; concomitant administration with central
nervous system depressants; elderly or debilitated patients (greater risk of respiratory depression);
head injury, increased intracranial pressure, central nervous system depression or coma; acute
abdominal conditions; acute alcoholism, delirium tremens; Addison?s disease; iliary tract disease,
including acute pancreatitis. Hypothyroidism, biliary tract disease, pancreatitis, inflammatory bowel
disorders, prostatic hypertrophy, adrenocortical insufficiency; renal/hepatic disease; 24 hours prior
to cordotomy or other pain relieving surgery; abdominal surgery, chronic non-malignant pain. Avoid
abrupt cessation of prolonged use & therapy. May impair ability to drive or operate machinery.
Pregnancy
Adverse Reactions :
GI and CNS disturbances, bronchospasm, dyspnoea, pharyngitis, voice alteration, orthostatic
hypotension, rash, sweating, pruritus, fever and chills, constipation, xerostomia, asthenia, dizziness,
sedated, apnoea, respiratory arrest, respiratory depression
Contraindications :
Acute or severe bronchial asthma or hypercarbia, hypersensitivity to oxycodone, paralytic ileus,
respiratory depression. Acute respiratory depression, cor pulmonale, cardiac arrhythmias, acute
asthma or other obstructive airways disease, paralytic ileus, suspected surgical abdomen, severe
renal impairment, delayed gastric emptying, acute alcoholism, brain tumour, increased
cerebrospinal or intracranial pressure, head injury, severe CNS depression, convulsive disorders,
102
delirium tremens, hypercarbia. Concurrent MAOIs (or within 2 weeks). Pre-operative or within 24
hours post-operative. Lactation
Interactions :
Anticholinergics, antihypertensives, CNS depressants including sedatives or hypnotics, general
anaesthetics, phenothiazines, other tranquillizers, alcohol, other opioids & neuroleptics; muscle
relaxants, coumarin derivatives, metoclopramide, MAOIs, neuromuscular blockers, opioid analgesics,
drugs that involve cytochrome P450 enzyme system eg CYP3A4, CYP2D6
---------------------------------------------------------------------------------------------------------------Oxycodone HCl 5 mg Immediate Release Capsules
A*
Oxycodone HCl 10 mg Immediate Release Capsules
A*
Trade Name : Oxynorm
Indication :
i)As a second line drug in the management of opioid responsive, moderate to severe chronic cancer
pain ii)As a step-down analgesic drug in post-operative procedures (Initiated by palliative medicine
physicians, oncologists, anaesthesiologists, haematologists and pain specialists only)
Dosage :
Initially 5 mg every 4 to 6 hours, increased if necessary according to severity of pain, usual max. 400
mg daily, but some patients may require higher doses
Precautions :
History or tendency for drug abuse. Risk of criminal diversion similar to morphine; obstructive
pulmonary disease or cor pulmonale, substantial decrease in respiratory reserve, hypoxia,
hypercapnia, pre-existing respiratory depression or kyphoscoliosis associated with respiratory
depression (increased risk for respiratory depression); circulatory shock, hypovolemia, concurrent
use with other drugs which may decrease blood pressure; concomitant administration with central
nervous system depressants; elderly or debilitated patients (greater risk of respiratory depression);
head injury, increased intracranial pressure, central nervous system depression or coma; acute
abdominal conditions; acute alcoholism, delirium tremens; Addison?s disease; iliary tract disease,
including acute pancreatitis. Hypothyroidism, biliary tract disease, pancreatitis, inflammatory bowel
disorders, prostatic hypertrophy, adrenocortical insufficiency; renal/hepatic disease; 24 hours prior
to cordotomy or other pain relieving surgery; abdominal surgery, chronic non-malignant pain. Avoid
abrupt cessation of prolonged use & therapy. May impair ability to drive or operate machinery.
Pregnancy
Adverse Reactions :
GI and CNS disturbances, bronchospasm, dyspnoea, pharyngitis, voice alteration, orthostatic
hypotension, rash, sweating, pruritus, fever and chills, constipation, xerostomia, asthenia, dizziness,
sedated, apnoea, respiratory arrest, respiratory depression
Contraindications :
Acute or severe bronchial asthma or hypercarbia, hypersensitivity to oxycodone, paralytic ileus,
respiratory depression. Acute respiratory depression, cor pulmonale, cardiac arrhythmias, acute
asthma or other obstructive airways disease, paralytic ileus, suspected surgical abdomen, severe
renal impairment, delayed gastric emptying, acute alcoholism, brain tumour, increased
cerebrospinal or intracranial pressure, head injury, severe CNS depression, convulsive disorders,
delirium tremens, hypercarbia. Concurrent MAOIs (or within 2 weeks). Pre-operative or within 24
hours post-operative. Lactation
Interactions :
Anticholinergics, antihypertensives, CNS depressants including sedatives or hypnotics, general
anaesthetics, phenothiazines, other tranquillizers, alcohol, other opioids & neuroleptics; muscle
relaxants, coumarin derivatives, metoclopramide, MAOIs, neuromuscular blockers, opioid analgesics,
drugs that involve cytochrome P450 enzyme system eg CYP3A4, CYP2D6
---------------------------------------------------------------------------------------------------------------103
Pethidine HCl 100 mg/2 ml Injection
Pethidine HCl 50 mg/ml Injection
Indication :
For relief of moderate to severe pain (medical and surgical), pre-anaesthetic
medication and obstetrical analgesia
Dosage :
ADULT: 0.5 - 2 mg/kg SC or IM every 3 - 4 hours if necessary. CHILD: by IM 0.5 - 2 mg/kg.
Up to 1 year : 1- 2 mg/kg weight IM, 1 - 5 years : 12.5 - 25 mg IM, 6 - 12 years: 25 - 50 mg IM
B
B
Precautions :
Cirrhosis, elderly, neonates, children, liver/renal dysfunction, convulsive disorders, reduced cardiac
output, cardiac infarction, cardiac disease, supraventricular tachycardia, pregnancy, lactation.May
impair ability to drive or operate machinery. Elderly. Reduced plasma protein binding.
Phaeochromocytoma. Hypothyroidism, Addison's disease. Prostatic hypertrophy, urethral stricture.
Diabetes. Glaucoma
Adverse Reactions :
Respiratory depression, dizziness, sweating, disorientation, hallucination,agitation, tremor,
multifocal myoclonus, convulsion, Gastrointestinal disturbances, hypotension, hypertension,
bradycardia, urine retention, Lightheadedness, dizziness, sedation, sweating, bizzare feeling,
disorientation, hallucinations, psychosis. Dry mouth, nausea, vomiting, constipation. Hypotension,
vasodilation, tachycardia, bradycardia, gangrene. Rash, pruritus, urticaria, erythema, injection site
complications, anuria. Increased biliary tract pressure, choledochoduodenal sphincter spasm.
Neurotoxicity, neuropsychiatric toxicity. Hyperactivity or agitation, depression, mental clouding,
dysphoria
Contraindications :
Hypersensitivity, concurrent use of MAOIs, intracranial lesions causing increased pressure,
atrioventricular flutter, respiratory depression, renal failure and a predisposition to convulsions or
seizures. Head injury, brain tumour. Cardiac arrhythmias. Concurrent use of MAOIs. Pre-eclampsia,
eclampsia. Convulsive states. Diabetic acidosis. Acute alcoholism or delerium tremens. Severe liver
disease, incipient encephalopathy, low platelet count, coagulation disorders or receiving
anticoagulant treatment. Continuous IV infusion in renal impairment. Patient-controlled analgesia in
young children & adult wiith poor cognitive function
Interactions :
Cimetidine: pethidine toxicity (respiratory depression, central nervous system depression,
hypotension). Isoniazid: hypotension and central nervous system depression. Moclobemide:
cardiovascular instability, hyperpyrexia, coma or possible serotonin syndrome (hypertension,
hyperthermia, myoclonus, mental status changes). Naltrexone: precipitation of opioid withdrawal
symptoms. Phenothiazines: increase in central nervous system and respiratory depression.
Phenytoin: decreased pethidine effectiveness. Procarbazine, selegiline: cardiac instability,
hyperpyrexia, coma. Ritonavir: increased risk of central nervous system stimulation and excitation.
Barbiturates, chloral hydrate, benzodiazepines. Butyrophenones, CNS depressants: pethidine
enhances the CNS depressant effects of these drugs. MAOIs, amphetamine reactions.
Anticoagulants. Reduces paracetamol absorption
---------------------------------------------------------------------------------------------------------------Tramadol HCl 50 mg Capsule
Trade Name : Tramal
Indication :
Post-operative pain, chronic cancer pain, analgesia/pain relief for patients with
impaired renal function
Dosage :
50 - 100 mg every 4 hours. Max 400 mg daily. Not recommended in children
104
A/KK
Precautions :
Reduced level of consciousness, respiratory disorders, increased intracranial pressure, pregnancy,
lactation, history of epilepsy. Opiate dependence, hypersensitivity to morphine-like analgesics,
children less than 1 year. Myxedema, hypothyroidism or hypoadrenalism. Hepatic or renal function
disorders
Adverse Reactions :
Sweating, dizziness, vomiting, dry mouth, gastrointestinal disturbances, cerebral convulsions
especially on co-medication with neuroleptics, physical dependence. Rarely, palpitations,
tachycardia, faintness, circulatory collapse, headaches, constipation, skin reactions. Very rarely,
muscular weakness, altered appetite, micturition disturbances
Contraindications :
Narcotic withdrawal treatment, hypersensitivity, acute alcoholism. Acute intoxication with alcohol,
analgesics, sedatives or psychotropic drugs. MAOI therapy
Interactions :
Amitryptiline, chlorpromazine, clozapine, dothiepin, fluoxetine, fluvoxamine, haloperidol,
risperidone, sertraline, sulpiride, thioridazine, trifluoperazine: increased risk of seizures.
Moclobemide, selegiline: nausea, vomiting, cardiovascular collapse, respiratory depression, seizures.
Carbamazepine: decreased tramadol efficacy. Digoxin: increased risk of digoxin toxicity (nausea,
vomiting, cardiac arrhythmias). Increased incidence of seizures when used with tricyclic
antidepressants eg cyclobenzaprine, MAOI, SSRIs, neuroleptic agents and other drugs that lower the
seizure threshold
---------------------------------------------------------------------------------------------------------------Tramadol HCl 50 mg/ml Injection
Trade Name : Tramal
Indication :
Post-operative pain, chronic cancer pair and analgesia/pain relief for patients with
impaired renal function
Dosage :
ADULT: By IM / IV inj. (over 2-3 mins) or by IV infusion. Initially 100 mg then 50 - 100
mg every 4 - 6 hours. Max: 600 mg daily. Child not recommended
A
Precautions :
Reduced level of consciousness, respiratory disorders, increased intracranial pressure, pregnancy,
lactation, history of epilepsy. Opiate dependence, hypersensitivity to morphine-like analgesics,
children less than 1 year. Myxedema, hypothyroidism or hypoadrenalism. Hepatic or renal function
disorders
Adverse Reactions :
Sweating, dizziness, vomiting, dry mouth, gastrointestinal disturbances, cerebral convulsions
especially on co-medication with neuroleptics, physical dependence. Rarely, palpitations,
tachycardia, faintness, circulatory collapse, headaches, constipation, skin reactions. Very rarely,
muscular weakness, altered appetite, micturition disturbances
Contraindications :
Narcotic withdrawal treatment, hypersensitivity, acute alcoholism. Acute intoxication with alcohol,
analgesics, sedatives or psychotropic drugs. MAOI therapy
Interactions :
Amitryptiline, chlorpromazine, clozapine, dothiepin, fluoxetine, fluvoxamine, haloperidol,
risperidone, sertraline, sulpiride, thioridazine, trifluoperazine: increased risk of seizures.
Moclobemide, selegiline: nausea, vomiting, cardiovascular collapse, respiratory depression, seizures.
Carbamazepine: decreased tramadol efficacy. Digoxin: increased risk of digoxin toxicity (nausea,
vomiting, cardiac arrhythmias). Increased incidence of seizures when used with tricyclic
105
antidepressants eg cyclobenzaprine, MAOI, SSRIs, neuroleptic agents and other drugs that lower the
seizure threshold
---------------------------------------------------------------------------------------------------------------Celecoxib 200 mg Capsule
Trade Name : Celebrex
Indication :
i) Osteoarthritis ii) Rheumatoid Arthritis iii) Acute pain iv) Ankylosing Spondylitis
Dosage :
i) ADULTS: 200 mg once daily. CHILD not recommended ii) 100mg twice daily,
increased if necessary to 200 mg 2 times daily; CHILD not recommended iii) 400mg
as a single dose on first day followed by 200mg once daily on subsequent days iv)
Initial, 200 mg once daily or 100 mg twice daily; if no effect after 6 weeks, may
increase to max. 400 mg daily in 1-2 divided doses. If no response following 2 weeks
of treatment with 400 mg/day, consider discontinuation and alternative treatment
A*
Precautions :
Hypertension, cardiac conditions, liver/renal dysfunction, elderly, fluid retention, children,
asthmatic, coagulation defects, pregnancy (third trimester)
Adverse Reactions :
Gastrointestinal disorders, flatulence, insomnia, pharyngitis, sinusitis, dizziness, vertigo, hearing
disturbance, photosensitivity, blood disorder, fluid retention, renal failure, hepatic impairment,
Steven-Johnson syndrome, allergic reactions, chest pain, oedema, hot flushes, flu-like symptoms.
Gastric side effects are lesser with this drug as compared to other NSAIDs
Contraindications :
Hypersensitivity to celecoxib, allergic-type reaction to sulphonamides, aspirin or other nonsteroidal
anti-inflammatory agents, ischaemic heart disease and stroke patient
Interactions :
Diuretics, anti-coagulants, sulphonylureas, captopril, phenytoin, digoxin, fluconazole, lithium,
antacids, aspirin, glucocorticoids, warfarin
---------------------------------------------------------------------------------------------------------------Diclofenac 1% Emulgel
A
Trade Name : Voltaren
Indication :
Post-traumatic inflammation of the tendons,ligaments & joints. Localised forms of soft tissue
rheumatism and degenerative rheumatism
Dosage :
Apply 3 - 4 times daily and gently rubbed in
Precautions :
Do not apply to diseased skin or open wounds or injuries. Avoid contact with eyes or mucous
membranes. Systemic side effects when applied to large areas of skin & over a prolonged period of
time
Adverse Reactions :
Allergic or non allergic contact dermatitis. Generalized skin rash, hypersensitivity and
photosensitivity reactions
Contraindications :
Hypersensitivity to diclofenac or other NSAIDs, proctitis and isopropanol or propylene glycol
Interactions :
Increase plasma concentration of lithium, methotrexate & warfarin. Reduces effects of diuretics &
beta blockers
---------------------------------------------------------------------------------------------------------------106
Diclofenac Sodium 12.5 mg Suppository
Diclofenac Sodium 50 mg Suppository
Diclofenac Sodium 25 mg Suppository
Indication :
Pain and inflammation in rheumatic disease and juvenile arthritis
Dosage :
75 - 150 mg daily in divided doses. CHILD 1-12 years, Juvenile arthritis; 12.5- 25 mg
daily
A
A
A
Precautions :
Previous history of gastrointestinal ulceration, bleeding or perforation. Renal dysfunction.
Hypertension or cardiac conditions aggravated by fluid retention and oedema. History of liver
dysfunction, coagulation defects
Adverse Reactions :
Occasionally gastrointestinal disorders, headache, dizziness, vertigo, rash, proctitis
Contraindications :
Patients with history of hypersensitivity to diclofenac or aspirin/other NSAIDs. Peptic or intestinal
ulcer. Lactation. Use of suppository is contraindicated in patients with recent rectal bleeding
Interactions :
Increases plasma concentration of warfarin, lithium, & methotrexate. May reduce effects of diuretics
& beta blockers. May alter plasma concentration of sulfonylureas. Caution with concomitant use of
diuretics and antihypertensives (eg beta-blockers, ACEI ), methotrexate, other NSAIDs and
corticosteroids, SSRIs. Monitoring recommended for patients receiving anticoagulants, antiplatelets
agents as well as blood glucose level if used concomitantly with antidiabetics. Digoxin, ciclosporin,
quinolones
---------------------------------------------------------------------------------------------------------------Diclofenac Sodium 50 mg Tablet
Indication :
Pain and inflammation in rheumatic disease
Dosage :
ADULTS: Initial dose of 150 mg daily. Mild or long term: 75 - 150 mg daily in 2 to 3
divided doses after food. PAEDS 1 year and above : 1 - 3 mg/kg body weight daily
B
Precautions :
Previous history of gastrointestinal ulceration, bleeding, or perforation. Renal dysfunction.
Hypertension or cardiac conditions aggravated by fluid retention and oedema. History of liver
dysfunction, coagulation defects
Adverse Reactions :
Epigastric pain, GI disturbances, slight dizziness
Contraindications :
Hypersensitivity, rhinitis, urticaria, asthma or allergic reactions to aspirin or other anti-inflammatory
agents
Interactions :
Increases plasma concentration of warfarin, lithium and methotrexate. May reduce effects of
diuretics & beta blockers. May alter plasma concentration of sulfonylureas. Aspirin, warfarin,
digoxin, methotrexate, ciclosporin
----------------------------------------------------------------------------------------------------------------
107
Diclofenac Sodium 75 mg/3 ml Injection
Indication :
Dosage :
75 mg once daily (2 times daily in severe cases) for not more than 2 days
A
Precautions :
Patient with CHF, dehydration, hypertension, decreased renal or hepatic function, active GIT
ulceration or bleeding, pre-existing asthma
Adverse Reactions :
Pruritus, rash, contact dermatitis, pain, dry skin, exfoliation, paraesthesia, constipation, diarrhoea,
headache, dizziness, vertigo, nausea, vomiting, gastrointestinal disorders, anorexia, increase
transaminases
Contraindications :
Hypersensitivity to diclofenac or any component of the formulation, aspirin or other NSAIDs,
asthma, rhinitis, porphyria, pregnancy (third trimester)
Interactions :
ACEI, angiotensin II antagonists, anticoagulants, cholestyramine and colestipol, ticlopidine, aspirin.
Monitoring recommended for patients receiving anticoagulants, antiplatelets agents as well as blood
glucose level if used concomitantly with antidiabetics. Lithium, digoxin, ciclosporin, quinolones
---------------------------------------------------------------------------------------------------------------Ibuprofen 200 mg Tablet
B
Trade Name : Brufen
Indication :
Dosage :
ADULT : 200 - 400 mg 3 times daily after food, maximum. 2.4 g daily CHILD : 20-30 mg/kg body
weight daily in divided doses
Precautions :
Patients with active or severe peptic ulceration, history of bronchial asthma, renal or hepatic
disorders, bleeding disorders, CV disease, pregnancy and lactation
Adverse Reactions :
Peptic ulceration, GI bleeding, headache, dizziness, nervousness, skin rash, pruritus, tinnitus,
oedema depression, drowsiness, insomnia, blurred vision, hypersensitivity, impairment of renal
function, dyspepsia, thrombocytopaenia, visual disturbances, nausea, vomiting, epigastric pain,
heartburn, jaundice, hepatitis, depression
Contraindications :
Patients with history of hypersensitivity to aspirin/other NSAIDs, active peptic ulcer, hypersensitivity,
lactation, neonates
Interactions :
Coumarin-type anticoagulants, aspirin or NSAIDs, digitalis glycosides, lithium, methotrexate,
diuretics, cefoperazone, valproic acid, ciclosporin, gold compound, other nephrotic medications,
probenecid. Moclobemide enhances effects of ibuprofen. Increased risk of gastrointestinal bleeding
with warfarin. Lost of BP response with ACEI
----------------------------------------------------------------------------------------------------------------
108
Indomethacin 25 mg Capsule
Trade Name : Indocid
Indication :
Dosage :
50 - 200 mg daily in divided doses, with food. Child not recommended
B
Precautions :
Active or previous history of gastrointestinal ulceration, bleeding, or perforation. History of
renal/liver dysfunction. Hypertension or cardiac conditions aggravated by fluid retention and
oedema. May aggravate depression/psychiatric disorders such as epilepsy, mental depression,
Parkinsonism. Patients with coagulation defects. Renal impairment. Retinal disturbances. Elderly.
Pregnancy and lactation
Adverse Reactions :
Gastrointestinal disturbances and bleeding, headache, vertigo, depression, epigastric disease,
dizziness, somnolence, depression & fatigue, anxiety, psychic disturbances including psychotic
episodes, mental confusion, tinnitus, corneal deposits, retinal disturbances, oedema, weight gain,
flushing, sweating, thrombocytopenia, rash, pruritus & urticaria
Contraindications :
Hypersensitivity, rhinitis, urticaria, asthma or allergic reactions to aspirin or other anti-inflammatory
agents, proctitis, pregnancy & lactation
Interactions :
Salicylates, anticoagulant drugs, probenecid, methotrexate, ciclosporin, lithium, digoxin, betablockers, captopril, heparin or thrombolytic agents, aminoglycosides, digitalis glycosides.
antihypertensives, diuretics especially triamterene, diflunisal, other salicylates, cefamandole,
cefoperazone, cefotetan, plicamycin, valproic acid, gold compound, other nephrotoxics & zidovudine
---------------------------------------------------------------------------------------------------------------Ketoprofen 2.5% Gel
Trade Name : Orudis
Indication :
As a short term treatment for traumatic lesions, sprains, tendinitis, oedema, bruises
Dosage :
Apply twice daily. Maximum 20 g daily
A
Precautions :
Avoid in children less than 5 years. If skin rash occurs after gel application, treatment should be
stopped
Adverse Reactions :
Pruritus and localised erythema
Contraindications :
Avoid in patient with exudative dermatoses, eczema, sores, infected skin. Do not apply to the
mucous membranes or eyes
Interactions :
Not known
-------------------------------------------------------------------------------------------------------------------------Ketoprofen 30 mg Transdermal Plaster
A
Trade Name : Ketotop
Indication :
Treatment of signs & symptoms of arthritis deformans, periarthritis humero-scapularis, tendinitis,
peritendinitis, sore muscle, swelling, pain resulting from trauma (eg. contusion, distorsion, sprain).
109
Dosage :
Apply 1 plaster to the affected area twice daily
Precautions :
Avoid in children less than 5 years. If skin rash occurs after application, treatment should be
stopped. Pregnancy
Adverse Reactions :
Pruritus and localised erythema.
Contraindications :
Avoid in patient with exudative dermatoses, eczema sores & infected skin. Do not apply to the
mucous membranes or eyes.
Interactions :
Not known
-------------------------------------------------------------------------------------------------------------------------Mefenamic Acid 250 mg Tablet
B
Trade Name : Ponstan
Indication :
Mild to moderate pain
Dosage :
ADULT: 250 - 500 mg 3 times daily after meals. CHILD over 6 months: 6.5 - 25 mg/kg daily 3 - 4 times
daily for not longer than 7 days except in juvenile arthritis
Precautions :
Elderly, renal impairment, asthmatic sensitive to NSAIDs or salicylates, pregnancy, increased risk of
serious cardivascular thrombotic events, myocardial infarction
Adverse Reactions :
Diarrhoea, skin rash, allergic, glomerulonephritis, non-oliguric renal failure, thrombocytopenia,
reversible haemolytic anaemia, hypertension, oedema, myocardial infarction
Contraindications :
Gastrointestinal ulceration or inflammatory bowel disease, renal/hepatic impairment
Interactions :
Alendronate, ACEIs, antacids, beta-adrenergic blockers, calcium channel blocker, ciclosporin,
diuretics, methotrexate, sulphonylureas, warfarin
---------------------------------------------------------------------------------------------------------------Methyl Salicylate 25% Ointment
Indication :
Relief of pain associated with musculoskeletal discomfort
Dosage :
To be applied to affected area
C
Precautions :
Avoid contact with eyes, open wounds
Adverse Reactions :
Extreme overdosage results in excessive irritation, tinnitus, nausea, vomiting
Contraindications :
Patient with aspirin or salicylate idiosyncrasy
Interactions :
Not known
--------------------------------------------------------------------------------------------------------------------------
110
6. PSYCHIATRY
Hypnotics and anxiolytics
Anti-psychotics
Antidepressants
Miscellaneous psychiatry
111
Alprazolam 0.25 mg Tablet
A/KK
Trade Name : Xanax
Indication :
Anxiety disorders
Dosage :
0.25 - 0.5 mg 3 times daily (elderly or delibitated 0.25 mg 2-3 times daily), increased if necessary to a
total dose of 3 mg/day. Not recommended for children
Precautions :
Avoid operating vehicles or machinery, abuse prone patient, pregnancy and breastfeeding, renal or
hepatic dysfunction, elderly patients, obesity, untreated open angle glaucoma, impaired pulmonary
function. Prolonged use can lead to dependence
Adverse Reactions :
Drowsiness, blurred vision, coordination disorder, gastrointestinal disturbance, agitation,
lightheadedness, dry mouth, depression, headache, confusion, hypotension, syncope, tachycardia,
seizures, respiratory depression, coma, constipation, diarrhoea, nausea, vomiting, insomnia, nasal
congestion, rigidity, increased salivation, dermatitis, sedation
Contraindications :
Hypersensitivity to benzodiazepines, acute narrow angle glaucoma, concomitant use of
ketoconazole/ itraconazole, CNS depression
Interactions :
Ketoconazole, fluconazole, itraconazole, contraceptives; increased alprazolam serum concentrations
and potential alprazolam toxicity (sedation, slurred speech, CNS depression). Omeprazole,
erythromycin, clarithromycin, cimetidine; benzodiazepine toxicity (CNS depression, ataxia, lethargy).
Sertraline, increased risk of psychomotor impairment and sedation. Fluoxetine, increased risk of
alprazolam toxicity (somnolence, dizziness, ataxia, slurred speech, hypotension, psychomotor
impairment). Fluvoxamine, increased risk of CNS side effects. Ritonavir, increased plasma
concentrations of alprazolam and enhanced alprazolam effects. Antihistamine/decongestant
combinations, antipsychotic, ethanol, mirtazapine, phenothiazines, venlafaxine (increased risk of
CNS depression, psychomotor impairment), sedative/hypnotics, tricyclic antidepressants (CNS
depression)
-------------------------------------------------------------------------------------------------------------------------Chloral Hydrate 200 mg/5 ml Mixture
Indication :
Preoperative sedation
Dosage :
ADULT : 0.5 - 1 g (max 2 g) with plenty of water at bedtime.CHILD : 30 - 50 mg/kg up
to a max dose of 1 g
B
Precautions :
History of gastritis or duodenal ulcers, mentally depressed patients, severe cardiac disease,
respiratory disease, lactation, acute intermitent porphyria, skin/mucous membrane irritation, avoid
prolonged use and abrupt withdrawal
Adverse Reactions :
Arrhythmias, hallucination, disorientation, nausea, vomiting, diarrhoea, gastric irritation, vertigo,
nightmares, delirium, flatulence, abdominal distention, leucopenia, eosinophilia, ketonuria,
respiratory depression, rashes
Contraindications :
Hypersensitivity to chloral hydrate products, cardiac disease, hepatic or renal impairment,
pregnancy, breast feeding, porphyria, gastritis
112
Interactions :
Warfarin, increased risk of bleeding. Frusemide, cardiovascular toxicity (diaphoresis, hypertension,
tachycardia). Alcohol, increased sedation. May reduce effect of phenytoin
-------------------------------------------------------------------------------------------------------------------------Lorazepam 1 mg Tablet
A/KK
Trade Name : Ativan
Indication :
i) Severe anxiety ii) Insomnia
Dosage :
i) 1 - 4 mg increase to 10 mg daily in divided doses. ELDERLY (or delibitated) half adult dose ii) 1 - 2
mg at bedtime. Not recommended in children
Precautions :
Concomitant use of central nervous system drugs such as phenothiazines, narcotic analgesics,
barbiturates, antidepressants, scopolamine and MAOIs; elderly and debilitated patients, patients
with a limited pulmonary reserve, doses exceeding 2 mg/day in geriatric patients or debilitated
patients, not recommended in patients with primary depressive disorder or psychosis. Potential for
drug abuse, impaired liver/renal function
Adverse Reactions :
Fatigue, hypotension, ataxia, respiratory depression, sedation, confusion, depression, headache,
nausea, tremor, urinary retention, vertigo, withdrawal syndrome, bradycardia, dependence or abuse
Contraindications :
Respiratory depression, acute pulmonary insufficiency, sleep apnoea syndrome, severe hepatic
impairment, myasthenia gravis, phobic or obsessional states, depression or anxiety with depression,
acute narrow-angle glaucoma, hypersensitivity to benzodiazepines
Interactions :
Theophylline, decreased benzodiazepine effectiveness. Valproic acid, increased lorazepam
concentrations. Clozapine, alcohol or central nervous system depressants, will give additive central
nervous system depression effect. Contraceptive, decreased lorazepam effect. Rifampicin, decreased
effect of lorazepam. Digoxin, increased serum digoxin concentrations
---------------------------------------------------------------------------------------------------------------Aripiprazole 10mg Tablet
A*
Aripiprazole 15mg Tablet
A*
Trade Name : Abilify, AripMT
Indication :
i) Treatment of acute episodes of schizophrenia and for maintenance of clinical improvement during
continuation therapy. ii) Treatment of acute manic episodes associated with bipolar I disorder
Dosage :
Schizophrenia: 10 or 15 mg/day. Maintenance dose: 15 mg/day. Bipolar mania: Starting dose: 15 or
30 mg/day. Dose adjustment should occur at intervals of not less than 24 hour
Precautions :
Suicide, tardive dyskinesia, neuroleptic malignant syndrome, seizure disorder, diabetes mellitus, CV
disease, cerebrovascular disease, dementia-related psychosis and CV adverse events in elderly. May
disrupt body's ability to increase/reduce core body temperature. Dysphagia, pregnancy & lactation.
May impair ability to drive or operate machinery. Safety and efficacy have not been established in
children less than 13 years of age
Adverse Reactions :
Insomnia, restlessness, headache, dizziness, akathisia, somnolence, sedation, tremor, extrapyramidal
disorder, blurred vision, tachycardia, orthostatic hypotension, nausea, vomiting, constipation,
113
dyspepsia, asthenia/fatigue, weight gain, anxiety diabetic ketoacidosis , neuroleptic malignant
syndrome, seizure, peripheral oedema
Contraindications :
Patients who are hypersensitive to aripiprazole or to any of the excipients.
Interactions :
Enhance effect of antihypertensive agents, alcohol, quinidine, ketoconazole, carbamazepine
-------------------------------------------------------------------------------------------------------------------------Chlorpromazine HCl 100 mg Tablet
B
Chlorpromazine HCl 25 mg Tablet
B
Trade Name : Largactil
Indication :
Psychosis mania and agitation
Dosage :
ADULT : Initial dose - 25 mg 3 times daily according to response up to 1 g daily. PAEDIATRIC: Up to 5
years: 0.5 mg/kg body weight every 4 - 6 hours (Maximum 40 mg daily). CHILD 6 - 12 years: A third to
half adult dose (Maximum 75 mg daily)
Precautions :
Pregnancy and lactation, elderly, epilepsy or history of seizure, impaired kidney and liver function,
Parkinson's disease, severe hypotension, hypothyroidism, cardiac failure, phaeochromocytoma,
myasthenia gravis & prostate hypertrophy. Avoid in patient hypersensitive to phenothiazines,
history of narrow-angle glaucoma or agranulocytosis. Monitor BP & complete blood count. Avoid
exposure to sunlight
Adverse Reactions :
Postural hypotension, akathisia, tardive dyskinesia, arrhythmias, constipation, haematologic effects,
agranulocytosis, aplastic anaemia, thrombocytopenia, neuroleptic malignant syndrome, jaundice,
agitation, insomnia, parkinsonism symptoms, drowsiness, convulsion and tachycardia, acute
dystonia, leukopenia, angioedema, bronchospasm, urticaria, hyperprolactinemia, eye, cardiac, skin &
subcutanoues tissue disorders, dry mouth, respiratory depression, neuroleptic malignant syndrome.
Rarely agranulocytosis, priapism
Contraindications :
Hypersensitivity to chlorpromazine products, phenothiazines, myelosuppression, coma, severe CNS
depression, bone marrow depression
Interactions :
Alcohol, CNS depressant, anticholinergic, tramadol, phenobarbitone, beta-blockers (metoprolol,
atenolol, propranolol), captopril,norepinephrine, procyclidine, warfarin, epinephrine, cimetidine,
ethanol, adrenaline, antacids, amphetamine, amiodarone, bumetamide, chlorothiazides,
clarithromycin, erythromycin, frusemide, phenytoin, antiarrhythmics, antidepressants & other
antipsychotics, carbamazepine
-------------------------------------------------------------------------------------------------------------------------Clozapine 100 mg Tablet
A
Trade Name : Clozaril
Indication :
Treatment of resistant schizophrenia
Dosage :
Initial dose : 12.5 mg ( once or twice ) daily, increase slowly in steps of 25 - 50 mg up to 300 mg daily
within 2 - 3 weeks. Maximum 900 mg/day
Precautions :
Patients who are elderly, cachectic, or have serious underlying medical illnesses; cardiovascular and
or pulmonary disease; discontinue treatment if myocarditis is suspected; history of seizures; history
114
of neuroleptic malignant syndrome; rapid escalation of dose, prostatic hypertrophy, hypotension,
impaired renal or liver function, seizure disorder, hyperglycemia and diabetes mellitus. WBC &
absolute neutrophil counts (weekly during the 1st 18 week, at least monthly thereafter) can be
performed, eosinophilia, thrombocytopenia. Concurrent use of drugs with a substantial potential to
depress bone marrow function & of long-acting depot antipsychotics should be avoided. Caution
when patients drive vehicles or operate machinery. Narrow-angle glaucoma, chronic constipation, ,
lactation, pregnancy. Monitoring of standing & supine BP is necessary during the 1st few week of
treatment in patients with Parkinson's disease
Adverse Reactions :
Hyperglycemia, agranulocytosis, sedation, salivation, cardiovascular effects, dizziness / vertigo,
seizures, drowsiness, confusion, blurred vision, dry mouth, jaundice, leucopenia, neuroleptic
malignant syndrome, anticholinergic toxicity, hepatitis, hypotension, syncope, constipation, tremor,
weight gain, tachycardia, hypersalivation. Eosinophilia, ketoacidosis, hyperosmolar coma,
convulsions, ECG changes, circulatory collapse, arrhythmias, myocarditis, cardiomyopathy,
thromboembolism, aspiration of ingested food, intestinal obstruction, ileus, faecal impaction,
hepatitis, pancreatitis, fulminant hepatic necrosis, interstitial nephritis, neuroleptic malignant
syndrome, unexplained sudden death
Contraindications :
Severe hepatic and renal impairment, myeloproliferative disorders, uncontrolled epilepsy,
pregnancy, lactation, coma, hypersensitivity to clozapine products, myocarditis with clozapine
history, agranulocytosis with clozapine history (except due to previous chemotherapy), WBC less
than 3500, GI/GU obstruction, narrow angle glaucoma, CNS depression
Interactions :
Tramadol, carbamazepine, fluoxetine, sertraline, fluvoxamine, erythromycin, phenobarbitone,
phenytoin, rifampicin, cimetidine, benzodiazepines, other antipsychotics, tricyclic antidepressants,
valproic acid derivatives. Alcohol, MAOIs, CNS depressants, narcotics, antihistamines, anticholinergic
drugs, antihypertensive agents, adrenaline, drugs with resp depressant effects, omeprazole,
cimetidine, carbamazepine, SSRIs, lithium, azole antimycotics, protease inhibitors, caffeine, nicotine
-------------------------------------------------------------------------------------------------------------------------Flupenthixol Decanoate Depot 20 mg/ml lnjection
B
Trade Name : Fluanxol
Indication :
Chronic psychoses
Dosage :
By deep IM, initial test dose of 5-20 mg, then after at least 7 days. 20 - 40 mg repeated at intervals of
2 - 4 weeks. Maximum 400 mg weekly. Usual maintenance dose 50 mg every 4 weeks to 300 mg
every 2 weeks. ELDERLY, initially quarter to half adult dose. CHILD not recommended. Deep IM
recommended. Not for IV use
Precautions :
Patients known to have a predisposition to movement disorders (may cause extrapyramidal
symptoms). Hepatic or renal impairment. CV or respiratory disease, phaeochromocytoma.
Convulsive disorders. Withdraw gradually if patient was previously treated with neuroleptics with
sedative effect. Patients on high doses and long-term therapy should be monitored carefully. Should
not be given during pregnancy and lactation
Adverse Reactions :
Sedation, restlesness, extrapyramidal symptoms, anticholinergic effects, weight gain. Insomnia,
drowsiness. Rarely extrapyramidal symptoms, if recommended dose is exceeded. Occasionally
tardive dyskinesia in long-term therapy
Contraindications :
Hypersensitivity to flupenthixol. Extremely excitable or overactive patients. Acute alcohol,
barbiturate or opiate poisoning. Bone marrow depression, coma
115
Interactions :
Barbiturates, guanethidine or similar compounds, metoclopramide and piperazine, tramadol. May
enhance the response to alcohol, and other CNS depressants
-------------------------------------------------------------------------------------------------------------------------Haloperidol 1.5 mg Tablet
B
Haloperidol 5 mg Tablet
B
Trade Name : Serenace
Indication :
Schizophrenia and other psychoses
Dosage :
ADULT : 1.5 - 5 mg 2 - 3 times daily up to 30 mg daily. Paed : Initial: 0.05 mg/kg/day or 0.25-0.5
mg/day given in 2-3 divided doses; increase by 0.25-0.5 mg every 5-7 days; maximum: 0.15
mg/kg/day. Maximum 10 mg
Precautions :
Concomitant anticoagulant use, concomitant CNS depressant use (anaesthetics, opiates, and
alcohol), history of convulsive disorders, known allergies or allergic reactions to drugs, manic
patients, neuroleptic malignant syndrome, elderly patients, impaired liver function, CV disease,
thyrotoxicosis. Parkinsonism, angle-closure glaucoma, benign prostatic hyperplasia; severe cardiac
or hepatic disease, presence of acute infections or leucopaenia; hyperthyroidism; pregnancy, elderly,
children. Patients receiving anticoagulants. Discontinue treatment upon signs of neurological toxicity
in patients taking lithium. Temperature regulation: Impaired core body temperature regulation may
occur
Adverse Reactions :
Extrapyramidal symptoms (EPS), tardive dyskinesia, sedation, hypotension, tachycardia, insomnia,
anxiety, weight changes, anticholinergic effects, gynaecomastia, galactorrhoea, menstrual
irregularities, neuroleptic malignant syndrome, arrhythmias, seizure, jaundice, hyperpyrexia.
Anxiety, depression, anorexia, leukopaenia
Contraindications :
Parkinson's disease, severe CNS depression, bone marrow suppression, severe cardiac or hepatic
disease, comatose states, hypersensitivity to haloperidol. Lactation
Interactions :
Tramadol, fluoxetine, fluvoxamine, carbamazepine, cisapride,dicoumarol, procyclidine, methyldopa,
olanzapine, rifampicin, lithium, tricyclic antidepressants. May increase the plasma levels of
haloperidol when used with clozapine or chlorpromazine
-------------------------------------------------------------------------------------------------------------------------Haloperidol 5 mg/ml Injection
B
Trade Name : Serenace
Indication :
Acute psychoses and mania
Dosage :
ADULT: IM or IV , 2 mg - 10 mg then every 4 - 8 hours according to response to total maximum 18
mg daily. Use in child is not recommended
Precautions :
Concomitant anticoagulant use, concomitant CNS depressant use (anaesthetics, opiates, and
alcohol), history of convulsive disorders, known allergies or allergic reactions to drugs, manic
patients, neuroleptic malignant syndrome, elderly patients, impaired liver function, CV disease,
thyrotoxicosis. Parkinsonism, angle-closure glaucoma, benign prostatic hyperplasia; severe cardiac
or hepatic disease, presence of acute infections or leucopaenia; hyperthyroidism; pregnancy, elderly,
children. Patients receiving anticoagulants. Discontinue treatment upon signs of neurological toxicity
116
in patients taking lithium. Temperature regulation: Impaired core body temperature regulation may
occur
Adverse Reactions :
Extrapyramidal symptoms (EPS), tardive dyskinesia, sedation, hypotension, tachycardia, insomnia,
anxiety, weight changes, anticholinergic effects, gynaecomastia, galactorrhoea, menstrual
irregularities, neuroleptic malignant syndrome, arrhythmias, seizure, jaundice, hyperpyrexia.
Anxiety, depression, anorexia, leukopaenia
Contraindications :
Parkinson's disease, severe CNS depression, bone marrow suppression, severe cardiac or hepatic
disease, comatose states, hypersensitivity to haloperidol. Lactation
Interactions :
Tramadol, fluoxetine, fluvoxamine, carbamazepine, cisapride,dicoumarol, procyclidine, methyldopa,
olanzapine, rifampicin, lithium, tricyclic antidepressants. May increase the plasma levels of
haloperidol when used with clozapine or chlorpromazine
-------------------------------------------------------------------------------------------------------------------------Lithium Carbonate 300 mg Tablet
A
Indication :
i) Prophylaxis and treatment of acute mania and hypomania episodes ii)Prophylaxis
of manic depression in bipolar illness or bipolar depression and recurrent depression
Dosage :
1800 mg/day in 2-3 divided doses, desired serum lithium level ranging between 0.4-1 mmol/litre.
Maintenance 900-1200 mg/day in 2-3 divided doses
Precautions :
Cardiovascular insufficiency, elderly, electrolyte imbalance, current infection, impaired renal
function, volume depletion, thyroid disorder, CAD, myasthaenia gravis, pregnancy and lactation.
Monitor serum levels cardiac, renal and thyroid function regularly. Maintain adequate fluid intake.
Avoid alcohol. May impair ability to perform skilled tasks. Discontinue temporarily 24 hours prior to
major surgery
Adverse Reactions :
Gastrointestinal effect, vertigo, dazed feeling, fine hand tremor, polyuria, drowsiness, muscle
weakness, anorexia, dry mouth, fatigue, seizures, leucocytosis, goitre, coma. Exacerbation of
psoriasis, acne, rash, nausea, diarrhoea, vertigo,loss of concentration, tremors, hypothyroidism,
weight gain, cardiac arrhythmias; exophthalmos, restlessness
Contraindications :
Renal insufficiency, Addison's disease, untreated hypothyrodism, lactation, delibated or dehydrated
patient, pregnancy, disturbed electrolyte balance, major surgery
Interactions :
Diuretics, steroids, haloperidol, fluphentixol, diazepam, methyldopa, tetracyclines, phenytoin,
carbamazepine, Lithium toxicity with ACE inhibitors, caffeine, COX2 inhibitors, metronidazole, nondepolarising neuromuscular blockers, NSAIDs, potassium iodide, SSRIs, tricyclic antidepressants
-------------------------------------------------------------------------------------------------------------------------Olanzapine 5mg Disintegrating Tablet
A*
Olanzapine 10mg Disintegrating Tablet
A*
Trade Name : Zyprexa Zydis
Indication :
i) Acute and maintenance treatment of schizophrenia and other psychoses where positive and or
negative symptoms are prominent ii) Short-term use for acute mania episodes associated with
Bipolar 1 disorder
117
Dosage :
i) 5 - 10 mg once daily, increase to 10 mg once daily within 5 - 7 days, adjust by 5 - 10 mg/day at 1
week intervals, maximum 20 mg/day ii) 10 - 15 mg once daily, increase by 5 mg/day at intervals of
not less than 24 hours. Maintenance 5 - 20 mg/day; maximum 20 mg/day
Precautions :
History of neuroleptic malignant syndrome, patients with liver disease, seizure disorder, pneumonia,
narrow angle glaucoma, pregnancy, cardiovascular disease, history of breast cancer, tardive
dyskinesia, gastrointestinal obstruction, paralytic ileus, cerebrovascular disease, elderly,
hypotension, hypovolaemia, dehydration, risk of aspiration pneumonia, hyperglycemia and diabetes
mellitus. Elevated ALT and or AST, hepatic impairment, limited hepatic functional reserve, seizures,
low leukocyte/neutrophil counts, history or existing bone marrow depression, hypereosinophilic
conditions, myeloproliferative disease, prostatic hypertrophy, paralytic ileus. Pregnancy and
lactation. May impair ability to drive or operate machinery
Adverse Reactions :
Somnolence, agitation, dizziness, constipation, drowsiness, weight gain, peripheral oedema, dry
mouth, postural hypotension, elevated liver transaminases, hyperglycaemia, diabetic ketoacidosis,
weight gain, dizziness, increased appetite, orthostatic hypotension, dry mouth, constipation, tardive
dyskinesia
Contraindications :
Hypersensitivity to olanzapine products, narrow angle glaucoma, lactation
Interactions :
Carbamazepine, ciprofloxacin, fluvoxamine, levodopa, haloperidol, activated charcoal, ethanol,
central alpha-2 agonists, cimetidine, epinephrine, muscle relaxants, tricyclic antidepressants. May
antagonise the effects of dopamine agonist. Other centrally-acting drugs including alcohol. Activated
charcoal
-------------------------------------------------------------------------------------------------------------------------Perphenazine 4 mg Tablet
B
Indication :
Schizophrenia and other psychoses
Dosage :
ADULT: Initially 4 mg 3 times daily adjusted according to response, maximum 24 mg daily. ELDERLY:
1/4 to 1/2 adult dose. CHILD not recommended
Precautions :
Concomitant epinephrine use, seizure disorder, patients undergoing alcohol withdrawal, pregnancy
and lactation, respiratory impairment secondary to pulmonary infection or chronic pulmonary
disorders, increased risk of tardive dyskinesia development in older patients, sulfite hypersensitivity,
history of neuroleptic malignant syndrome, patients with hepatic or renal impairment;
cardiovascular disease, Parkinson's disease, epilepsy, depression, myasthenia gravis, paralytic ileus,
prostatic hypertrophy, history of jaundice, blood dyscrasias. May affect driving especially when first
started, elderly
Adverse Reactions :
CNS effects (extrapyramidal effects), drowsiness, insomnia, convulsion, allergic reaction, tachycardia,
postural hypotension, dizziness, impaired glucose tolerance, tardive dyskinesia, liver damage,
nausea, vomiting, cardiac arrest, agranulocytosis, haemolytic anaemia, hepatotoxicity, alter
temperature regulation, neuroleptic malignant syndrome, GI disturbances, nasal congestion,
antimuscarinic symptoms, cardiovascular symptoms, ECG changes, endocrine effects, blood
dyscrasias, photosensitisation, contact sensitisation, rashes, jaundice, corneal and lens opacities,
purplish pigmentation of the skin and eye
118
Contraindications :
Blood dyscrasias, bone marrow suppression, subcortical brain damage, comatose/obtunded
patients, hypersensitivity to perphenazine products, severe liver disease, high doses of CNS
depressants, hypersensitivity to perphenazine, lactation
Interactions :
Tramadol, increased risk of seizures. Cisapride, levofloxacin, cardiotoxicity. Procyclidine, decreased
phenothiazine serum concentrations, decreased phenothiazine effectiveness, enhanced
anticholinergic effects (ileus, hyperpyrexia, sedation, dry mouth). Pethidine, increase in central
nervous system and respiratory depression. Levodopa, loss of levodopa efficacy. Ethanol, increased
central nervous system depression and an increased risk of extrapyramidal reactions. Class Ia and III
antiarrhythmics, beta 2 agonists, carbamazepine, central alpha 2 agonists, systemic corticosteroids,
diuretics, lithium, tricyclic antidepressants. MAOIs, antiepileptics. Avoid alcohol, kava kava, gotu
kola, valerian & St John's wort
-------------------------------------------------------------------------------------------------------------------------Quetiapine Fumarate 300 mg Extended Release Tablet
Quetiapine Fumarate 400 mg Extended Release Tablet
Trade Name : Seroquel XR®
Indication :
i) Schizophrenia ii) Moderate to severe manic episodes in bipolar disorder iii) Major
depressive episodes in bipolar disorder
Dosage :
i) & ii) 300 mg once daily on Day 1 and 600 mg on Day 2. Maintenance dose: 400 800 mg once daily. Maximum dose: 800 mg daily iii) 50 mg on Day 1, 100 mg on Day
2, 200 mg on Day 3 and 300 mg on Day 4. Recommended daily dose is 300 mg. May
be titrated up to 600 mg daily
A*
A*
Precautions :
Pregnancy, hepatic impairment, renal impairment, cerebrovascular disease, hyperglycaemia and
diabetes mellitus. Cardiovascular disease, use with drugs known to prolong QTc interval. Renal &
hepatic impairment. History of seizures & diabetes mellitus. Pregnancy & lactation. Elderly. May
affect ability to drive or operate machinery
Adverse Reactions :
Headache, somnolence, weight gain, postural hypotension, tachycardia, palpitations, dizziness, rash,
abdominal pain, constipation, dyspepsia, anorexia, dry mouth, constipation, leucopenia, dyspepsia,
elevated serum transaminases (ALT, AST), mild asthenia, peripheral oedema, weight gain, syncope,
rhinitis
Contraindications :
Hypersensitivity, severe CNS depression, bone marrow suppression, blood dyscrasias, severe hepatic
disease, coma
Interactions :
Antihypertensives, cimetidine, CNS depressants, alcohol, carbamazepine, barbiturates, valproate,
phenytoin, rifampicin, thioridazine, ketoconazole, erythromycin. Other centrally-acting drugs,
alcohol, macrolide antibiotics
-------------------------------------------------------------------------------------------------------------------------Risperidone 1 mg Tablet
Risperidone 2 mg Tablet
Trade Name : Risperdal
Indication :
Psychoses and schizophrenia
A
A
119
Dosage :
ADULT : 2 mg in 1 - 2 divided doses on first day then 4 mg in 1 - 2 divided doses on 2nd day then 6
mg in 1 - 2 divided doses on 3rd day (slower titration appropriate in some patients); usual range 4 - 8
mg daily; dose above 10 mg daily only if benefit outweigh risk (maximum 16 mg daily). Elderly (or in
hepatic or renal impairment): initially 0.5 mg twice daily increased in steps of 0.5 mg twice daily to 1
- 2 mg twice daily. Not recommended in children under 15 years
Precautions :
Neuroleptic malignant syndrome, tardive dyskinesia, QT prolongation, cardiovascular or
cerebrovascular disease or conditions that predispose patients to orthostatic hypotension,
hypothermia or hyperthermia, previous diagnosis of breast cancer or prolactin-dependent tumours,
renal insufficiency, hepatic insufficiency, Lewy body dementia or Parkinson's disease, seizure history,
pathologic changes in blood count, dysphagia, elderly patients, hypotension, hypovolaemia,
dehydration, agents prolonging QT, risk of aspiration pneumonia. Known cardiovascular disease,
dosage should be gradually titrated as recommended, a dose reduction should be considered when
hypotension occurs. Epilepsy, pregnancy ad lactation. May affect ability to drive or operate
machinery
Adverse Reactions :
Somnolence, dizziness, hyperkinesia, nausea, extrapyramidal effects, constipation, anxiety,
headache, rhinitis, rash, dyspepsia, tachycardia, dry mouth, weight gain, sexual dysfunction,
hyperprolactinaemia, menstrual irregularities, severe hypotension, tardive dyskinesia, neuroleptic
malignant syndrome and hyperglycaemia
Contraindications :
Hyperprolactinaemia, hypersensitivity to risperidone products, prolonged QT interval
Interactions :
Tramadol, increased risk of seizures. Carbamazepine, increased risperidone clearance. Levodopa,
loss of levodopa efficacy. Clozapine, decreased risperidone clearance. Amphotericin, Class Ia and III
antiarrhythmics, acetalozamide, central alpha2 agonists, systemic corticosteroids, diuretics, tricyclic
antidepressants
-------------------------------------------------------------------------------------------------------------------------Sulpiride 200 mg Tablet
Trade Name : Dogmatil
Indication :
Acute and chronic schizophrenia, chronic delusional psychoses
Dosage :
200-400 mg twice daily; 800 mg daily in predominantly negative symptoms and 2.4 g
daily in mainly positive symptoms. Elderly, lower initial dose; increased gradually
according to response. Child under 14 years not recommended
B
Precautions :
Cardiovascular disease, manic or hypomanic patients, renal insufficiency, neuroleptic malignant
syndrome, hyperthyroidism, pulmonary disease, urinary retention, previous hypersensitivity to other
benzamide derivatives eg. metoclopramide, elderly patients. Pregnancy, lactation, Parkinson's
disease. May be exacerbated by the presence of bradycardia, hypokalaemia, a long QT which is
either congential or acquired (due to combination with a medicinal product increasing the QT
interval). Do not use in the event of congential galactosaemia, glucose/galactose malabsorption
syndrome or lactase deficiency and children less than 6 year. Parkinson's disease, renal impairment,
epileptic patients. Avoid alcohol
Adverse Reactions :
Extrapyramidal syndrome, drowsiness, dry mouth, urinary retention, tachycardia, postural
hypotension, dizziness, galactorrhoea, gynaecomastia, amenorrhoea, sedation, somnolence. Early
120
dyskinesia, tardive dyskinesia, sedation or drowsiness, transient hyperprolactinemia, weight gain, QT
interval prolongation, orthostatic hypotension, neuroleptic malignant syndrome
Contraindications :
Hypersensitivity to sulpiride, phaeochromocytoma, prolactin dependent tumour, in combination
with sultopride and dopamine agonists apart from in patients with Parkinson's disease, lactation,
levodopa, class Ia and III antiarrhythmics, certain neuroleptics (thioridazine, chlorpromazine,
levomepromazine, trifluoperazine, cyamemazine, amisulpride, tiapride, pimozide, haloperidol,
droperidol), bepridil, cisapride, diphemanil, erythromycin, mizolastine, vincamine, halofantrine,
pentamidine, sparfloxacin, moxifloxacin
Interactions :
Tramadol, increased risk of seizures. Other central nervous system depressants, alcohol, levodopa.
Dopamine agonists, sultopride, halofantrine, pentamidine, sparfloxacin, moxifloxacin, bradycardiac
agents, hypokalaemic agents, antihypertensives, if treatment with neuroleptics is necessary in
patients with Parkinson's disease receiving treatment with dopamine agonists, the latter must be
gradually reduced and then discontinued
-------------------------------------------------------------------------------------------------------------------------Trifluoperazine HCI 5 mg Tablet
B
Trade Name : Stelazine
Indication :
Psychotic disorder
Dosage :
ADULT: Initially 5 mg twice daily, increase by 5 mg after 1 week, then at 3-day intervals. Maximum
40 mg/day. CHILD up to 12 years: Initially up to 5 mg daily in divided doses adjusted to response, age
and body weight
Precautions :
Tardive dyskinesias may develop, concomitant lithium therapy (encephalopathic syndrome), may
increase anginal pain, neuroleptic malignant syndrome, glaucoma or retinopathy. If affected by
drowsiness do not drive or operate machinery. cardiovascular or respiratory disease,
phaeochromocytoma, parkinsonism, epilepsy, renal or hepatic impairment, pregnancy and lactation
Adverse Reactions :
Seizures, extrapyramidal effects, blood dyscrasias, agranulocytosis, neuroleptic malignant syndrome,
dry mouth, constipation, orthostatic hypotension, blurred vision, tardive dyskinesia, urinary
retention, photosensitivity, rash, nausea, tachycardia, dizziness, fatigue, headache, weight gain,
jaundice, dystonic reaction in children, sensitivity reactions eg agranulocytosis, leucopenia,
leucocytosis and haemolytic anaemia
Contraindications :
Coma, bone marrow depression, hypersensitivity to trifluoperazine products and other
phenothiazines, pre-existing liver damage, central nervous system depression
Interactions :
Tramadol, increased risk of seizures. Lithium, weakness, dyskinesias, increased extrapyramidal
symptoms, encephalopathy and brain damage. Procyclidine, decreased phenothiazine serum
concentrations and effectiveness, enhanced anticholinergic effects (ileus, hyperpyrexia, sedation,
dry mouth). Phenytoin, increased or decresed phenytoin levels and possibly reduced phenothiazine
levels. Ethanol, increased central nervous system depression and an increased risk of extrapyramidal
reactions. Amphotericins, class Ia and III antiarrhythmics, beta2 agonists, acetazolamide, central
alpha2 agonists, systemic corticosteroids, diuretics, MAOIs, tricyclic antidepressants
--------------------------------------------------------------------------------------------------------------------------
121
Zuclopenthixol Acetate 50 mg/ml Injection
A*
Trade Name : Clopixol - Acuphase
Indication :
Only for treatment of agitated and violent patients suffering from schizophrenia
who are not responding to the available standard drugs
Dosage :
50 - 150 mg repeated after 2 - 3 days if necessary. Additional dose may be needed 1 - 2 days after
the first injection. Maximum cumulative dose 400 mg per course and maximum 4 injections;
maximum duration of treatment 2 weeks. Change to oral dose 2 - 3 days after the last injection.
Child not recommended
Precautions :
Previous hypersensitivity to other neuroleptic agents, particularly thioxanthenes, fluphenazine and
perphenazine. Hepatic or renal disease or cardiovascular disease, pregnancy, breastfeeding,
epileptic or parkinsonian patients or organic brain syndrome. Patients on long-term therapy should
be monitored carefully. May affect ability to drive or operate machinery
Adverse Reactions :
Extrapyramidal syndrome, drowsines, anticholinergic effect, tachycardia, postural hypotension,
dizziness, tardive dyskinesia, urinary retention, disturbed accommodation, tachycardia
Contraindications :
Severe central nervous system depression, coma, blood dyscrasias, phaeocromocytoma. Previous
hypersensitivity to zuclopenthixol or clopenthixol. Comatose states, acute alcohol, barbiturate and
opiate intoxication. Pregnancy
Interactions :
Alcohol, barbiturates and central nervous system depressant, tricyclic antidepressant,
metoclopramide - increased effect
-------------------------------------------------------------------------------------------------------------------------Zuclopenthixol Decanoate 200 mg/ml Injection
A*
Trade Name : Clopixol Depot
Indication :
Only for treatment of agitated and violent patients suffering from schizophrenia who are not
responding to the available standard drugs
Dosage :
By deep IM injection test dose 100 mg followed after 7 - 28 days by 100 - 200 mg or more followed
by 200 - 400 mg at intervals of 2 - 4 weeks adjusted according to response. Maximum 600 mg
weekly. Child not recommended
Precautions :
Previous hypersensitivity to other neuroleptic agents, particularly thioxanthenes, fluphenazine and
perphenazine, Hepatic or renal disease or cardiovascular disease, pregnancy, breastfeeding, epileptic
or parkinsonian patients or organic brain syndrome. Patients on long-term therapy should be
monitored carefully. May affect ability to drive or operate machinery
Adverse Reactions :
Extrapyramidal syndrome, drowsines, anticholinergic effect, tachycardia, postural hypotension,
dizziness, tardive dyskinesia, urinary retention, disturbed accommodation
Contraindications :
Severe central nervous system depression, blood dyscrasias, phaeocromocytoma. Previous
hypersensitivity to zuclopenthixol or clopenthixol. Comatose states, acute alcohol, barbiturate and
opiate intoxication. Pregnancy
122
Interactions :
Alcohol, barbiturates and central nervous system depressant, tricyclic antidepressant,
metoclopramide - increased effect
-------------------------------------------------------------------------------------------------------------------------Paliperidone 3mg Extended Release Tablet
A*
Paliperidone 6mg Extended Release Tablet
A*
Trade Name : Invega
Indication :
Second or third line treatment of schizophrenia
Dosage :
ADULT 6 mg once daily in the morning, adjusted if necessary; usual range 3 -12 mg daily. Renal
impairment (creatinine clearance between 10-50 mL/min) 3 mg once daily. Avoid if creatinine
clearance less than 10mL/min
Precautions :
Neuroleptic malignant syndrome, tardive dyskinesia (discontinue use), diabetes mellitus,
cerebrovascular disease or conditions predisposing to hypotension, seizure, Parkinson's disease,
conditions that contribute to core body temperature elevation or dehydration, pregnancy,
adolescent and children. May impair ability to drive or operate machinery
Adverse Reactions :
Headache, tachycardia, akathisia, sinus tachycardia, extrapyramidal disorder, somnolence, dizziness,
sedation, tremor, hypertonia, dystonia, orthostatic hypotension & dry mouth. Menstrual
disturbances, erectile dysfunction, galactorrhoea and gynaecomastia
Contraindications :
Lactation, hypersensitivity to Paliperidone, Risperidone or to any product component
Interactions :
Centrally acting drugs, alcohol, levodopa, dopamine agonists, itraconazole
---------------------------------------------------------------------------------------------------------------Ziprasidone 20mg/ml Injection
A*
Trade Name : Zeldox
Indication :
Acute agitation in schizophrenia
Dosage :
ADULT: Initially 10 mg (every 2 hour) or 20 mg (every 4 hour). Maximum: 40 mg/day. IM
administration more than 3 days has not been studied
Adverse Reactions :
Injection site pain, asthenia, headache, hypertension, postural hypertension, diarrhoea, nausea,
somnolence, dizziness, akathisia
Contraindications :
QT-interval prolongation, recent myocardial infarction, uncompensated heart failure, cardiac
arrhythmias requiring treatment with Class IA and III antiarrhythmic drugs, drugs that prolong QT
interval
Interactions :
Class IA and III antiarrhythmics, drugs that prolong QT interval, central nervous system drugs/alcohol
----------------------------------------------------------------------------------------------------------------
123
Amitriptyline HCl 25 mg Tablet
B
Trade Name : Laroxyl
Indication :
Depression
Dosage :
Initially 75 mg. ADULT and ELDERLY : 30 - 75 mg daily in divided doses or as a single dose at bedtime,
increase gradually as necessary to 150 - 200 mg. CHILD under 16 years are not recommended
Precautions :
Cardiac disease, hyperthyroidism, impaired hepatic and renal function, urinary retention, history of
seizures, glaucoma, suicide risk, pregnancy, lactation, elderly, phaeochromocytoma, history of
mania, phychoses, angle-closure glaucoma, concurrent anticonvulsive therapy, anaesthesia
Adverse Reactions :
Dry mouth, constipation, nausea, vomiting, urinary retention, blurred vision, drowsiness, dizziness,
tachycardia, increased appetite, confusion, seizures, myocardial infarction, stroke, agranulocytosis,
thrombocytopenia, rash and hypersensitivity reactions, blood sugar changes, endocrine side effects,
impotence, menstrual irregularities, bone marrow depression
Contraindications :
Hypersensitivity to drug/class. Immediate recovery phase after myocardial infarction, heart block,
mania. MAOI use within the last 14 days
Interactions :
Barbiturate, phenytoin, carbamazepine, cimetidine, amphetamines, antiarrhythmics, class Ia and III,
anticholinergics, antihistamines, beta 2 agonists, benzodiazepines, systemic carbonic anhydrase
inhibitors, central alpha 2 agonists, cholinergic agents, clozapine, intranasal decongestants,
flumazenil, halothane, lithium, MAOIs, methylphenidate, metoclopramide, muscle relaxants,
nitrates, opiates, antipsychotics, phenytoin, protease inhibitors, sedatives/hypnotics, SSRIs,
indirect/mixed sympathomimetics, cimetidine, fluoxetine, clonidine
-------------------------------------------------------------------------------------------------------------------------Dothiepin HCl 75 mg Tablet
A
Trade Name : Prothiaden
Indication :
Depression of any aetiology
Dosage :
Initially 75 mg (ELDERLY 50-75 mg) daily in divided doses or single dose at bedtime, increased
gradually as necessary to 150 mg daily (ELDERLY 75 mg may be sufficient), up to 225 mg daily in
some circumstances. CHILD is not recommended
Precautions :
May activate latent schizophrenia, exaggerate paranoid delusions, renal or hepatic impairment,
Pregnancy, lactation and children less than 16 years
Adverse Reactions :
Drowsiness, extrapyramidal symptoms, tremor, confusional state, disorientation, dizziness,
anticholinergic effects, paraesthesia, hypotension, tachycardia, palpitations, arrhythmias,
conduction defects, libido changes, nausea, vomiting, constipation, rash, pharyngitis, impotence,
anemia
Contraindications :
Concomitant use of MAOIs, recovery phase of myocardial infarction, hepatic failure, epilepsy
124
Interactions :
Alcohol, barbiturate, tranquilliser, MAOIs, anticholinergic, antihistamine, sympathomimetics, 5 HT
agonist, benzodiazepines, carbamazepine, clozapine, cyclosporine, digoxin, haloperidol, phenytoin,
linezolid, metoclopramide, ritonavir, tramadol, lithium, NSAIs, thioridazine, warfarin
-------------------------------------------------------------------------------------------------------------------------Duloxetine 30 mg Capsule
A*
Duloxetine 60 mg Capsule
A*
Trade Name : Cymbalta
Indication :
Major depressive disorder, diabetic peripheral neuropathic pain
Dosage :
ADULT: 60 mg once daily up to a maximum dose of 120mg/day (in divided doses) CHILD and
ADOLESCENT under 18 years not recommended
Precautions :
History of mania/hypomania, seizures, renal impairment, elderly, liver transaminase elevations,
pregnancy and lactation, suicidal ideation and behavior or worsening depression, controlled narrowangle glaucoma, diabetes; may worsen glycemic control, hepatic impairment; increased risk of liver
injury and aggravation of pre-existing liver disease, hepatic insufficiency; risk of drug toxicity
Adverse Reactions :
Gastrointestinal disorders, excessive sweating, CNS disorders (eg dizziness, fatigue, insomnia,
somnolence, blurred vision, dysuria), hepatotoxicity, suicidal thought, increased urinary frequency,
increased libido, palpitation
Contraindications :
Concomitant use with MAOIs, potent CYP1A2 inhibitors, hepatic or severe renal impairment,
uncontrolled narrow-angle glaucoma, hypersensitivity to duloxetine or any other component of the
product
Interactions :
Drugs metabolised by CYP2D6 (eg flecainide, vinblastine, carbamazepine, tricyclic antidepressants),
potent CYP1A2 inhibitors/inducers, CNS-active drugs (eg diazepam, imipramine, phenytoin,
haloperidol, alcohol)
-------------------------------------------------------------------------------------------------------------------------Escitalopram 10 mg Tablet
A*
Trade Name : Lexapro
Indication :
i) Treatment of major depressive episodes ii) Treatment of panic disorder with or
without agoraphobia
Dosage :
i) 10 mg once daily; may be increased to max 20 mg daily. ii) Panic disorder with or without
agoraphobia :Initially 5 mg for the first week, thereafter increased to 10 mg daily. May be further
increased up to max 20 mg daily, dependent on individual patient response. ELDERLY initially half
adult dose, lower maintenance dose may be sufficient. CHILD and ADOLESCENT under 18 years not
recommended
Precautions :
Paradoxical anxiety, seizures, mania, diabetes, suicidal tendencies, hyponatraemia, haemorrhage,
electroconvulsive therapy, reversible selective MAO-A inhibitors, serotonin syndrome, St John's
Wort, lactation, renal and hepatic function impairment, abnormal bleeding, avoid abrupt
discontinuation, may activate hypomania or mania, concomitant use of NSAIDs
125
Adverse Reactions :
Dizziness, headache, nausea, sweating, somnolence, insomnia, constipation, diarrhoea, decreased
appetite, sexual dysfunction, fatigue, pyrexia, sinusitis, yawning, rash, Steven Johnson Syndrome,
rhinitis, blurred vision, nasal congestion, prolactinemia, dry mouth, decrease prothrombin, hepatic
failure, hypoglycemia, hypokalemia, suicidal ideation, diaphoresis, Syndrome of inappropriate
antidiuretic hormone secretion(SIADH)
Contraindications :
Concurrent use of MAOIs or within 14 days of discontinuing MAOS treatment
Interactions :
MAOI, selegiline, lithium, tryptophan, agents that may lower seizure threshold, St John's Wort,
omeprazole, high doses of cimetidine, drugs metabolised by CYP2D6 and CYP2C19 enzymes, alcohol,
aspirin, NSAIDs, warfarin, carbamazepine, ketoconazole, linezolid, tramadol, metoprolol, 5 HT
agonist, gingko, lamotrigine
-------------------------------------------------------------------------------------------------------------------------Fluoxetine HCl 20 mg Capsule
A
Trade Name : Prozac
Indication :
i) Depressive illness ii) Obsessive-compulsive disorder
Dosage :
i) 20 mg once daily increased after 3 weeks if necessary, usual dose 20 - 60 mg (ELDERLY 20 - 40 mg)
once daily max 80 mg once daily (ELDERLY max 60 mg once daily). ii) Initially 20 mg once daily
increased after 2 weeks if necessary, usual dose 20 - 60 mg (ELDERLY 20 - 40 mg) once daily, max 80
mg (ELDERLY max 60 mg) once daily, discontinue if no improvement within 10 weeks. CHILD and
ADOLESCENT under 18 years are not recommended
Precautions :
History of seizure, elderly, volume depletion, diabetes, pregnancy and breastfeeding, impaired
renal/liver function, abnormal bleeding, anxiety and insomnia, hyponatremia, rash, avoid abrupt
withdrawal
Adverse Reactions :
Tremor, asthenia, gastrointestinal disorder, inappropriate secretion of adrenocortical hormone,
nervousness, insomnia, headache, anorexia, anxiety, dry mouth, decreased libido, delayed
ejaculation, anorgasmia, sweating and serotonin syndrome
Contraindications :
Present or recent treatment with MAOIs, hypersensitivity to fluoxetine
Interactions :
Drugs metabolised by cytochrome P450, CNS active drugs, drugs highly bound to protein plasma.
Benzodiazepines, caffeine, ergotamine, clozapine, lithium, MAOIs, phenytoin, antipsychotics,
propranolol, warfarin.
-------------------------------------------------------------------------------------------------------------------------Fluvoxamine 100 mg Tablet
B
Fluvoxamine 50 mg Tablet
B
Trade Name : Luvox
Indication :
Depressive disorder
Dosage :
For depression, initially 50 - 100 mg daily in the evening, increased if necessary to 300 mg daily (over
150 mg in divided doses); usual maintenance dose 100 mg daily. CHILD and ADOLESCENT under 18
years not recommended
126
Precautions :
Concomitant use with MAOIs, hepatic insufficiency, children, epilepticus, pregnancy, lactation,
cardiovascular disease, avoid abrupt withdrawal, elderly, abnormal bleeding, hyponatremia, may
activate mania or hypomania, history of seizure, suicidal ideation, worsening depression
Adverse Reactions :
Blurred vision, dry mouth, tremor, gastrointestinal disturbances, somnolence, constipation,
headache, insomnia, vomiting, dizziness, agitation, extrapyramidal effects, bradycardia, seizures,
hepatotoxicity, withdrawal syndrome, Steven Johnson Syndrome, anphylactic reaction, abnormal
ejaculation, hepatitis, asthenia, abnormal bleeding, hyponatremia, seizure, serotonin syndrome,
worsening depression, hypomania, mania (rare), suicidal thoughts
Contraindications :
Use of MAOI within 14 days, coadministration of terfenadine, astemizole or cisapride, may cause
increased plasma concentrations of these drugs and an increased incidence of side effects,
hypersensitivity to fluvoxamine
Interactions :
Warfarin, phenytoin, theophyline, propanolol, lithium, benzodiazepines, caffeine, ergotamine,
MAOIs, sildenafil, statins, heparin, NSAIDs, aspirin, carbamazepin, clozapin, haloperidol, proton
pump inhibitor, tricyclic antidepressants, grapefruit, St. John wort, dilatiazem, metoclopramide,
serotonergic drugs, linezolid, tramadol, celecoxib
-------------------------------------------------------------------------------------------------------------------------Mirtazapine 15 mg Orodispersible Tablet
A*
Mirtazapine 30 mg Orodispersible Tablet
A*
Indication :
Episodes of major depression
Dosage :
Initially 15 mg daily at bedtime increased according to response up to 45 mg daily as a single dose at
bedtime or in 2 divided doses. CHILD and ADOLESCENT under 18 years not recommended
Precautions :
Heart disease, hypotension, epilepsy, hepatic and renal impairment, pregnancy, mania and
hypomania, hypersensitivity to other anti-depressant, suicidal ideation and behavior or worsening
depression; increased risk in children and adolescents
Adverse Reactions :
Agranulocytopenia, neutropenia, mania, dizziness, increase appetite, constipation, somnolence.
Patients should be advised to report any fever, sore throat, stomatitis or other signs of infection
during treatment. Blood count should be performed and the drug stopped immediately if blood
dyscrasia suspected, increased appetite, raised serum cholesterol and serum triglycerides, raised ALT
(SGPT) level, asthenia, dizziness, dream disorder, agranulocytosis, neutropenia, seizure, worsening
depression, suicidal ideation
Contraindications :
Hypersensitivity to mirtazapine or component of formulation, MAOIs, procarbazine, selegiline
Interactions :
Clonidine, monoamine oxidase inhibitors, ethanol, warfarin, carbamazepine, phenytoin,
ketoconazole, cimetidine, methadone, rifampicin, antivirals, St. John's wort, diazepam, fluoxetine,
fluvoxamine, linezolid, olanzapine, tramadol, venlafaxine
--------------------------------------------------------------------------------------------------------------------------
127
Moclobemide 150 mg Tablet
A*
Trade Name : Aurorix
Indication :
Treatment of depressive syndrome
Dosage :
Initially 300 mg daily in divided doses. Gradually to increase up to 600 mg daily in divided doses
depending on response. Usual range 150 - 600 mg daily. Not recommended in children
Precautions :
Avoid in excited and agitated patient, thyorotoxicosis, hepatic impairment, pregnancy, lactation,
hypertensive, avoid ingestion of excessive amounts of tyramine-rich foods, occipital headache,
palpitations, neck stiffness, tachycardia or bradycardia, coadministration with dextromethorphan
resulted in vertigo, tremor, nausea and vomiting
Adverse Reactions :
Sleep disturbance, dizziness, gastrointestinal disturbance, restlessness, agitation, blurred vision, dry
mouth, headache, constipation, possible hyponatraemia, diaphoresis, rash, increase libido,
abdominal pain, hepatotoxicity, oedema, orthostatic hypotension, tremor
Contraindications :
Acute confusional state, hypersensitivity to moclobemide, concomitant use with selective serotonin
reuptake inhibitors, conventional MAOIs or tricyclic antidepressants, concomitant use of narcotics
Interactions :
Tricyclic antidepressants, beta-2 agonist, carbamazepine
-------------------------------------------------------------------------------------------------------------------------Sertraline HCI 50 mg Tablet
B
Trade Name : Zoloft
Indication :
Major depression, obsessive-compulsive disorder (OCD), panic disorder
Dosage :
Depression, obsessive-compulsive disorder: 50 mg/day. Panic disorder: Initially 25 mg/day. After 1
week, increase dose to 50 mg/day. All dose changes should be made at intervals of more than 1
week, max: 200 mg/day
Precautions :
Concomitant use with tryptophan and fenfluramine, impaired hepatic function, electroconvulsive
therapy, abnormal bleeding, avoid abrupt discontinuation, hyponatraemia, history of seizures, MAO
inhibitors, uricosuric effect
Adverse Reactions :
Male sexual dysfunction, gastrointestinal complain, tremor, dizziness, insomnia, headache, dry
mouth, somnolence, ejaculatory dysfunction, dyspepsia, decreased libido, sweating, anorexia,
agitation, visual disturbances, serotonin syndrome, withdrawal syndrome, rash, pharyngitis,
purpura, agranulocytosis, elevated liver enzyme, antidepressants increase the risk of suicidal
Contraindications :
Concurrent use or recent use of MAOIs, hypersensitivity to sertraline products
Interactions :
MAO inhibitors, serotonergic drugs, caffeine/ergotamine, cimetidine, lithium, metoprolol,
phenytoin, propranolol, warfarin, alcohol, central nervous system depressants, carbamezepine,
clozapine, cyclosporine, NSAIDs, aspirin, erythromycin, metoclopramide, tramadol, St. John's wort,
tolbutamide, tricyclic antidepressants, zolpidem
--------------------------------------------------------------------------------------------------------------------------
128
Venlafaxine HCl 75 mg Extended Release Capsule
A*
Trade Name : Efexor XR
Indication :
i) Depression ii) Generalized anxiety disorder iii) Social anxiety disorder (social
phobia) iv) Panic disorder
Dosage :
i), ii) & iii) ADULT: 75 mg once daily. May increase dose by 75 mg/day every 4 days to a maximum
dose of 225 mg/day iv) 37.5 mg/day for the first 4-7 days after which the dose should be increased
to 75 mg once daily. CHILD and ADOLESCENT under 18 years not recommended
Precautions :
Activation of mania/hypomania, changes in appetite or weight, glaucoma, history of seizure,
hyponatraemia, syndrome of inappropriate antidiuretic hormone syndrome (SIADH), patients with
recent myocardial infarction or unstable heart disease, sustained hypertension, suicidal ideation,
lactation, elderly, renal and liver function impairment, avoid abrupt discontinuation
Adverse Reactions :
Abnormal ejaculation, anorgasmia, impotence, anorexia, constipation, weight loss, diarrhoea,
dyspepsia, anxiety, dizziness, insomnia, nervousness, somnolence, tremor, asthenia, abnormal
bleeding, activation of mania, suicide ideation, hepatitis, hypertension, hyponatraemia, seizures,
sweating symptom, nausea, dream disorder, headache, blurred vision
Contraindications :
Recent or concomitant use of MAOIs, risk of potentially life-threatening serotonin syndrome
hypersensitivity to venlafaxine hydrochloride or any other component of the product
Interactions :
Clozapine, dexfenfluramine, droperidol, fenfluramine, haloperidol, linezolid, lithium,
metoclopramide, moclobemide, NSAIDs, procarbazine, selegiline, thioridazine, tramadol,
trifluoperazine, amoxicillin, aspirin, celecoxib ,diclofenac, etoricoxib, ginkgo, NSAIDs, jujube
,ketoprofen, ketorolac, mefenamic acid, meloxicam, mirtazapine, phenylbutazone, procarbazine,
sulindac, zolpidem
-------------------------------------------------------------------------------------------------------------------------Methylphenidate HCl 10 mg Tablet
Trade Name : Ritalin
Indication :
Hyperkinetic disorder (attention deficit hyperactivity disorder)
Dosage :
CHILD over 6 years, initially 5 mg 1 - 2 times daily, increased if necessary at weekly
intervals by 5 - 10 mg daily to maximum of 60 mg daily in divided doses; discontinue
if no response after 1 month, also suspend periodically to assess child's condition
(usually finally discontinued during or after puberty)
A
Precautions :
May exacerbate behavioral disturbance and thought disorder in psychotic patients. Not for severe
depression. Chronic abuse can lead to marked tolerance and psychic dependence. Epilepsy and
hypertension. Monitor blood count during long-term treatment. Careful supervision during drug
withdrawal. Children less than 6 years. Pregnancy and lactation. Caution in road/machinery users.
Cardiovascular disease, alcohol/drug abuse, hyperthyroidism
Adverse Reactions :
Nervousness, insomnia, decreased appetite. Ocassionally headache, drowsiness, dizziness, dry
mouth, tachycardia, palpitations, arrhythmias, changes in blood pressure and heart rate.
Gastrointestinal disturbances, skin reactions, fever, arthralgia. Rare: blurred vision, moderately
reduced weight gain and minor growth retardation in children. Seizures, dependency, leucopenia
129
Contraindications :
Anxiety and tension states, agitation, tics, tics in siblings, familial history or diagnosis of Tourette's
syndrome, glaucoma, hyperthyrodism, cardiac arrythmias, severe angina pectoris, hypersensitivity to
drug/class, children less than 6 years of age, MAOIs use within 14 days
Interactions :
Pressor agents, MAOIs, anticoagulants, anticonvulsants, tricyclic antidepressants, phenylbutazone,
guanethidine
--------------------------------------------------------------------------------------------------------------------------
130
7. NEUROLOGY
Antimigraine drugs
Antiepileptics
Drugs used in Parkinsonism and related disorders
Drugs used in substance dependence
Drugs used for dementia
Central nervous system stimulants
Miscellaneous neurology
131
Flunarizine HCl 5 mg Capsule
B
Trade Name : Sibelium
Indication :
i) Migraine prophylaxis ii) Maintenance treatment of vestibular disturbances and of cerebral and
peripheral disorders
Dosage :
i) ADULT: 5 - 10 mg daily preferably at night. ELDERLY more than 65 years: 5 mg at night.
Maintenance 5-day treatment at the same daily dose ii) 5 - 10 mg at night. If no improvement after 1
month, discontinue treatment
Precautions :
Narrow-angle glaucoma, obesity, urinary retention. May affect ability to drive and operate
machinery. Pregnancy, breast feeding. Dosage reduction may be necessary in renal impairment,
prostatic hyperplasia, pyloroduodenal obstruction, epilepsy, hepatic impairment, elderly, young
children. Pregnancy, lactation
Adverse Reactions :
Sedation, dizziness, dry mouth and constipation. Increased appetite, sedation, nausea, fatigue.
Rarely, hypersensitivity reactions, face oedema, rash, central nervous system stimulation,
hallucinations, seizures, depression, drowsiness, headache, palpitation, arrhythmias, gastrointestinal
disturbance, palpitations, blood disorders, convulsions, sweating, myalgia, paraesthesias,
extrapyramidal effects, sleep disturbances, confusion, tinnitus, tremor, hypotension, hair loss
Contraindications :
Hypersensitivity to the drug. Children less than 2 years. Postural giddiness
Interactions :
Central effects of sedatives, hypnotics, antihistamines, including certain common cold preparations
and alcohol may be enhanced. Antagonised hypotensive effect of adrenergic neuron blockers. May
mask warning signs of damage caused by ototoxic drugs eg. aminoglycosides
---------------------------------------------------------------------------------------------------------------Pizotifen 0.5 mg Tablet
B
Trade Name : Sandomigran
Indication :
Prophylactic treatment of vascular headache
Dosage :
ADULT: 0.5 mg in the evening for first 2 days, then 0.5 mg mid-day and evening for next 2 days, then
0.5 mg 3 times daily. CHILD: Up to 1.5 mg daily in divided doses
Precautions :
Narrow-angle glaucoma, obesity, urinary retention. May affect ability to drive and operate
machinery. Pregnancy, breast feeding. Dosage reduction may be necessary in renal impairment,
prostatic hyperplasia, pyloroduodenal obstruction, epilepsy, hepatic impairment, elderly, young
children. Pregnancy, lactation
Adverse Reactions :
Sedation, dizziness, dry mouth and constipation. Increased appetite, sedation, nausea, fatigue.
Rarely, hypersensitivity reactions, face oedema, rash, central nervous system stimulation,
hallucinations, seizures, depression, drowsiness, headache, palpitation, arrhythmias, gastrointestinal
disturbance, palpitations, blood disorders, convulsions, sweating, myalgia, paraesthesias,
extrapyramidal effects, sleep disturbances, confusion, tinnitus, tremor, hypotension, hair loss
Contraindications :
Hypersensitivity to the drug. Children less than 2 years. Postural giddiness
132
Interactions :
Central effects of sedatives, hypnotics, antihistamines, including certain common cold preparations
and alcohol may be enhanced. Antagonised hypotensive effect of adrenergic neuron blockers. May
mask warning signs of damage caused by ototoxic drugs eg. aminoglycosides
---------------------------------------------------------------------------------------------------------------Carbamazepine 100 mg/5 ml (2% w/v) Syrup
A
Trade Name : Tegretol
Indication :
Epilepsy
Dosage :
ADULT: Initially, 100-200 mg once or twice daily gradually increased by increments of 100-200 mg
every 2 week. Maintenance: 0.8-1.2 g daily in divided doses. CHILD: 10-15 years: 0.6-1 g daily; 5-10
years: 400-600 mg daily; 1-5 years: 200-400 mg daily; less than or equal to 1 year: 100-200 mg daily.
Alternatively, 10-20 mg/kg body weight daily in divided doses. Max: Adult: 1.6 g daily
Precautions :
Breast feeding, pregnancy, liver or kidney dysfunction, increased intraocular pressure, history of
cardiac damage, elderly patients, glaucoma, may exacerbate certain types of idiopathic epilepsy.
Avoid abrupt discontinuation. Neonatal withdrawal syndrome. Potential for an increase in risk of
suicidal thoughts or behaviours
Adverse Reactions :
Rash, Stevens-Johnson Syndrome, nausea, drowsiness, dizziness, ataxia, blood dyscrasias, confusion,
agitation, visual disturbance, constipation or diarrhoea, anorexia, leukopenia, blood disorders,
Syndrome of inappropriate ADH (SIADH), cardiac conduction abnormalities, gynaecomastia. Allergic
skin reactions, leukopenia, vomiting, accommodation disorders, diplopia, raised liver enzymes,
thrombocytopenia and hyponatraemia, exfoliative dermatitis
Contraindications :
Hypersensitivity to carbamazepine products or tricyclic compounds, bone marrow suppression,
porphyria. Concomitant MAOIs, pregnancy
Interactions :
Plasma level is increased by erythromycin, diltiazem, isoniazid, verapamil, fluoxetine, cimetidine and
decreased by other antiepileptics and theophylline. May reduce alcohol tolerance and antagonise
the effects of non-depolarising muscle relaxants. Cytochrome P450 3A4 inducers or inhibitors, oral
contraceptive
---------------------------------------------------------------------------------------------------------------Carbamazepine 200 mg CR Tablet
A
Trade Name : Tegretol CR
Indication :
Epilepsy
Dosage :
ADULT: Initial, 200 mg twice daily for the first week, may increase dosage by 200 mg/day at weekly
intervals until optimal response is obtained. Maximum 1.6 g/day. CHILD: usual maximum dosage
1000 mg/day in children 12-15 years of age, 1200 mg/day in patients above 15 years of age
Precautions :
Initial and periodic complete blood counts, liver function tests and urinalysis. Monitor plasma levels.
History haematological reactions. Road/machinery users. Increased intraocular pressure, latent
133
psychosis, confusion, agitation. Mixed seizure disorders. Elderly. Avoid abrupt discontinuation.
Neonatal withdrawal syndrome. Potential for an increase in risk of suicidal thoughts or behaviours
Adverse Reactions :
Syndrome of Inappropriate ADH (SIADH), cardiac conduction abnormalities, gynaecomastia. Allergic
Contraindications :
Interactions :
contraceptive
---------------------------------------------------------------------------------------------------------------Carbamazepine 200 mg Tablet
B
Trade Name : Tegretol
Indication :
i) Epilepsy ii) Trigeminal neuralgia
Dosage :
i) ADULT: 100 - 200 mg 1 - 3 times daily increased gradually to usual dose of 0.8 - 1.2 g daily in
divided doses. CHILD: Up to 1 year: 100 - 200 mg daily; 1 - 5 yrs: 200 - 400 mg daily; 5 - 10 years: 400
- 600 mg daily; 10 - 15 years: 0.6 - 1 g daily ii) ADULT: Initially, 100 mg once or twice daily gradually
increased as necessary. Maintenance: 400-800 mg daily in 2-4 divided doses. Max: 1.2 g daily
Precautions :
Avoid abrupt discontinuation. Neonatal withdrawal syndrome. Potential for an increase in risk of
Adverse Reactions :
Syndrome of Inappropriate ADH (SIADH), cardiac conduction abnormalities, gynaecomastia. Allergic
Contraindications :
Interactions :
contraceptive
----------------------------------------------------------------------------------------------------------------
134
Clonazepam 2 mg Tablet
B
Trade Name : Rivotril
Indication :
i) Epilepsy ii) Non-epileptic myoclonus
Dosage :
i) ADULT: Initially, 1 mg given at night for 4 nights, gradually increased over 2-4 week. Elderly: 500
mcg. Maintenance: 4-8 mg daily. Maximum dosage: 20 mg/day. CHILD: 5-12 years: Initially, 0.5 mg
daily; 1-5 years: 0.25 mg daily. Maintenance (given in 2-4 divided doses): 5-12 years: 3-6 mg daily; 15 years: 1-3 mg daily; infants: 0.5-1 mg daily. Maximum 200 mcg/kg/day. ii) ADULT: Initially, 250 mcg
twice daily, increased after 3 days up to 1 mg daily. Max: 4 mg daily
Precautions :
Avoid abrupt withdrawal, renal insufficiency, respiratory disease, acute intermittent porphyria,
uncontrolled open angle glaucoma, elderly, pregnancy, lactation, may exacerbate tonic seizures.
Patients with spinal or cerebellar ataxia, acute alcohol or drug intoxification, severe liver damage,
sleep apnoea, renal and hepatic diseases. History of depression and or suicide attempts.
Simultaneous use of other anti-epileptics. Avoid driving and operating machinery
Adverse Reactions :
Drowsiness, ataxia, aggravation of seizure, fatigue, dizziness. Tiredness, sleepiness, lassitude,
muscular hypotonia, muscle weakness, light-headedness, ataxia, slowed reaction, poor
concentration, restlessness, confusion, agitation, excitability, irritability, disorientation, anterograde
amnesia, depression. Increased production of saliva or bronchial secretions in infants and young
children, coordination disturbances, vertigo, anorexia, visual disturbances, libido changes
Contraindications :
Hypersensitivity to clonazepam products and benzodiazepines, severe liver disease, narrow angle
glaucoma, respiratory depression, acute pulmonary insufficiency
Interactions :
Alcohol may reduce the efficacy of treatment or produce unexpected side effects. Increases
phenytoin or primidone concentrations. Combination with valproate may cause petit mal status
epilepticus. Amiodarone, carbamazepine, theophylline. Barbiturates, hydantoins, carbamazepine,
other centrally-acting drugs, alcohol
---------------------------------------------------------------------------------------------------------------Diazepam 10 mg/2 ml Injection
B
Trade Name : Valium
Indication :
i) Status epilepticus ii) Skeletal muscle spasm iii) Anxiety disorders
Dosage :
i) Status epilepticus, by slow IV: 5-10 every 10-15 minute (rate not more than 5 mg/min), to a total
dose of 30 mg, may repeat in 2 hour if needed. Infants 30 days to 5 years, 0.05-0.3 mg/kg/dose given
over 2-3 minutes, every 15-30 minutes to a total dose of 5 mg, repeat in 2-4 hours if necessary.
CHILD more than 5 years, 1 mg by slow IV, every 2-5 minutes, maximum 10 mg, repeat in 2-4 hours if
necessary ii) Skeletal muscle spasm, by slow IV or IM, 5-10 mg repeated if necessary in 3-4 hours.
CHILD (tetanus): 30 days - 5 years, 1-2 mg IM or IV slowly every 3-4 hours as needed. 5 years and
above, 5-10 mg IM or IV slowly every 3-4 hours if needed iii) Anxiety disorders, 2-10 mg by slow IV
(not more than 5 mg/min). Repeat if necessary every 3-4 hours
Precautions :
Respiratory disease, history of drug or alcohol abuse, drug dependence, pregnancy, breast feeding,
renal and hepatic impairment and avoid operating vehicles or machinery
Adverse Reactions :
Drowsiness, dizziness, vertigo, hallucinations, blurred vision, confusion, muscle weakness, fatigue,
incontinence or urinary retention, constipation, rashes, changes in libido, leukopenia and
135
gastrointestinal, hypotension, ataxia, respiratory depression, sedation, depression, headache,
nausea, tremor, withdrawal syndrome, neutropenia, hepatotoxicity, pancytopenia,
thrombocytopenia, blood dyscrasias, bradycardia, dependence/abuse. Paradoxical reactions in
children and elderly
Contraindications :
Respiratory depression, acute pulmonary insufficiency, severe hepatic impairment, acute narrow
angle glaucoma, myasthenia gravis, hypersensitivity to diazepam products, patients less than 6
months old, alcohol intoxication, central nervous system depression
Interactions :
Central nervous system depressants, barbiturates, alcohol, isoniazid, rifampicin, phenytoin, ritonavir,
omeprazole, cimetidine, theophylline, digoxin, erythromycin, itraconazole
---------------------------------------------------------------------------------------------------------------Diazepam 5 mg Rectal Solution
Trade Name : Stesolid
Indication :
Status epilepticus, skeletal muscle spasm
Dosage :
Status epilepticus - ADULT: 0.5 mg/kg repeated after 12 hours if necessary. CHILD
(febrile convulsions, prolonged or recurrent): 0.5 mg/kg (maximum 10 mg), repeated
if necessary. Not recommended for children below 2 years
C
Precautions :
renal and hepatic impairment and avoid operating vehicles or machinery
Adverse Reactions :
gastrointestinal disturbances. Paradoxical reactions in children and elderly
Contraindications :
angle glaucoma, myasthenia gravis
Interactions :
Central nervosu system depressants, alcohol, barbiturates, antibacterials, antivirals, omeprazole
---------------------------------------------------------------------------------------------------------------Gabapentin 300 mg Capsule
A*
Gabapentin 600 mg Tablet
A*
Trade Name : Neurontin
Indication :
i) Add-on therapy for intractable partial epilepsy, refractory to standard anti-epileptic drugs ii)
Treatment of various types of neuropathic pain, both peripheral (which includes diabetic
neuropathy, post-herpetic neuralgia, trigeminal neuralgia) in adult more than 18 years
Dosage :
i) ADULT: 900 - 1800 mg/day in 3 divided doses. CHILD: 10-40 mg/kg/day in 3 divided doses ii)
ADULT: 900 mg/day in 3 equally divided doses, maximum: 3600 mg/day. Initiate therapy with 300
mg once on Day 1, 300 mg twice daily on Day 2, 300 mg three times daily on Day 3. Thereafter, the
dose may be increased in 3 equally divided doses up to maximum 3600 mg/day
Precautions :
Renal insufficiency, patients less than 12 years old, diabetes, pregnancy, lactation, elderly, renal
impairment, haemodialysis, absence seizures. Avoid abrupt withdrawal. Discontinuation of
gabapentin and or addition or substitution of alternative therapy should be gradual, over a minimum
136
of 1 week. May affect ability to drive or operate machinery. Potential for an increase in risk of
Adverse Reactions :
Somnolence, dizziness, ataxia, weight gain, fatigue, nystagmus, tremor, diplopia, amnesia, dyspepsia,
asthenia, leukopenia, headache, myalgia
Contraindications :
Hypersensitivity to gabapentin
Interactions :
Antacid like Maalox reduced the bioavailability of gabapentin
---------------------------------------------------------------------------------------------------------------Lamotrigine 100 mg Tablet
A
Lamotrigine 50 mg Tablet
A
Trade Name : Lamictal
Indication :
i) Adjunctive or monotherapy for partial seizures and generalised tonic-clonic seizures not
satisfactorily controlled with other antiepileptic drugs ii) Prevention of mood episodes in adult 18
years and above with bipolar disorder, predominately by preventing depressive episodes
Dosage :
i) Up to 200 mg daily in single or divided dosage ii) 25- 200 mg daily
Precautions :
Concomitant use of other antiepileptics, discontinue therapy at the first sign of rash, renal, hepatic
or cardiac impairment, pregnancy, lactation. Closely monitor and consider withdrawal if
hypersensitivity syndrome develops. Avoid abrupt withdrawal (reduce dosage stepwise over a
period of 2 week) unless serious skin reaction occurs. Significant hepatic or renal impairment.
Monitor and adjust dose if necessary in women who are starting or stopping hormonal
contraceptives during Lamictal therapy. Close supervision of patients at high risk of suicide in bipolar
disorder. Potential of an increase in risk of suicidal thoughts or behaviours
Adverse Reactions :
Dizziness, fatigue, headache, hypersensitivity reactions, rashes, malaise, leukopenia,
thrombocytopenia, photosensitivity, blurred vision, conjunctivitis, drowsiness, insomnia, ataxia,
nausea. Irritability, drowsiness, insomnia, tremor, nystagmus, ataxia, diplopia, blurred vision,
gastrointestinal disturbances, arthralgia, pain including back pain. Rarely, severe skin reactions
including Stevens-Johnson syndrome and toxic epidermal necrolysis
Contraindications :
Hypersensitivity to lamotrigine products, hepatic impairment
Interactions :
Metabolism is increased by carbamazepine, phenobarbital, phenytoin and primidone, decreased by
valproate. Central nervous system events occur with carbamazepine. Rifampicin,
ethinyloestradiol/levonorgestrel combination enhances the metabolism of lamotrigine. Sodium
valproate reduces the metabolism of lamotrigine. Possible interference with folate metabolism
during long-term therapy
---------------------------------------------------------------------------------------------------------------Levetiracetam 500 mg Tablet
A*
Trade Name : Keppra
Indication :
i) Monotherapy therapy in the treatment of partial onset seizures with or without secondary
generalization in patients from age 16 years of age with newly diagnosed epilepsy ii) Adjunctive
treatment in partial onset seizures with or without secondary generalization in adults and children
137
from 4 years of age with epilepsy; juvenile myoclonic epilepsy and idiopathic generalized tonic clonic
epilepsy from 12 years of age
Dosage :
i) Monotherapy ADULTS and ADOLESCENT (from 16 years) : Starting dose: 250 mg twice daily,
Increase dose to 500 mg twice daily after 2 week. Dose can be further increased by 250 mg twice
daily every 2 week depending upon the clinical response. Max: 1500 mg twice daily. ii) ADULT more
than 18 years and ADOLESCENT (12-17 years) more than or equal to 50 kg: Initially 500 mg twice
daily may be increased up to 1500 mg twice daily. Dose changes can be made in 500 mg twice daily
increments or decrements 2-4 weekly. CHILD (4-11 years) and ADOLESCENT (12-17 years) less than
50 kg : Initially 10 mg/kg twice daily, may be increased up to 30 mg/kg twice daily. Dose changes
should not exceed increments or decrements of 10 mg/kg twice daily every 2 weeks. CHILD more
than or equal to 50 kg: Adult dose
Precautions :
Avoid abrupt discontinuation, renal impairment, severe hepatic impairment, pregnancy, lactation,
elderly. May affect ability to drive or operate machinery. Potential for an increase in risk of suicidal
thoughts or behaviours
Adverse Reactions :
Asthenia, somnolence, dizziness, anorexia, diarrhoea, nausea, dyspepsia, rash, diplopia
Contraindications :
Hypersensitivity to levetiracetam products
Interactions :
Evening primrose, ginkgo
---------------------------------------------------------------------------------------------------------------Phenobarbitone 30 mg Tablet
Trade Name : Luminal
Indication :
Epilepsy
Dosage :
ADULT: 60 - 180 mg daily on. CHILD: Up to 8 mg/kg daily
B
Precautions :
Depression, renal impairment, pulmonary insufficiency, elderly, avoid abrupt discontinuation,
pregnancy, breast feeding, porphyria, hyperactivity in children
Adverse Reactions :
Hypersensitivity, rash, hypotension, drowsiness, ataxia, respiratory depression, dyskinesias
Contraindications :
Hypersensitivity to phenobarbital products, porphyria
Interactions :
Alcohol, antibacterial, warfarin, antidepressants, other antiepileptics, antipsychotics, antiviral,
ciclosporin
---------------------------------------------------------------------------------------------------------------Phenobarbitone Sodium 200 mg/ml Injection
B
Trade Name : Gardenal
Indication :
Status Epilepticus
Dosage :
ADULT: 10 mg/kg IV at a rate of not faster than 100 mg/minute. Initial maximum dose does not
exceeding 1 gm. Daily maintenance of 1 - 4 mg/kg/day. CHILD: 10 - 20 mg/kg/dose loading dose,
followed by repeated doses at 10 mg/kg/dose (strictly in ICU setting). Maintenance 5 - 8 mg/kg/day
138
Precautions :
Depression, renal impairment, pulmonary insufficiency, elderly, avoid abrupt discontinuation,
pregnancy, breast feeding, porphyria, hyperactivity in children
Adverse Reactions :
Hypersensitivity, rash, hypotension, drowsiness, ataxia, respiratory depression, dyskinesias
Contraindications :
Hypersensitivity to phenobarbital products, porphyria
Interactions :
Alcohol, antibacterial, warfarin, antidepressants, other antiepileptics, antipsychotics, antiviral,
ciclosporin
---------------------------------------------------------------------------------------------------------------Phenytoin Sodium 30mg Capsule
B
Phenytoin Sodium 100 mg Capsule
B
Trade Name : Dilantin
Indication :
Epilepsy
Dosage :
ADULT and CHILD more than 6 years: 300-400 mg/day in 3 - 4 divided doses before meals.
Maximum: 600 mg/day. CHILD: Initially 5 mg/kg/day in 2 - 3 divided doses. Maintenance: 4 - 8
mg/kg/day. Maximum: 300 mg/day
Precautions :
Avoid abrupt withdrawal, liver insufficiency, porphyria, discontinue if skin rash occurs, diabetes,
elderly, pregnancy, breast feeding. Severe myocardial insufficiency. Pregnancy. Potential for an
increase in risk of suicidal thoughts or behaviours
Adverse Reactions :
Nystagmus, ataxia, lethargy, blood dyscrasias, cardiovascular toxicity, nausea, vomiting, headache,
tremor, insomnia, gingival hypertrophy, acne, lupus erythematosus, Stevens-Johnson syndrome,
leukopenia, megaloblastic anaemia, hirsutism, hepatitis. Slurred speech, decreased coordination,
mental confusion, constipation, toxic hepatitis, liver damage, hematopoietic complications,
dermatological manifestations, agranulocytosis, bullous dermatosis, granulocytopenic disorder, liver
damage, nephrotoxicity, pancytopenia, purpuric rash, scaling eczema, thrombocytopenia, toxic
epidermal necrolysis
Contraindications :
Hypersensitivity to phenytoin or hydantoin products, sinus bradycardia, SA block, second and third
degree AV block and Adams-Stokes syndrome (intravenous phenytoin only)
Interactions :
Chloramphenicol, anticoagulants, diazepam, oestrogen, cimetidine, fluconazole etc may increase
serum levels. Methotrexate, folic acid, carbamazepine, theophylline, etc may decrease serum levels.
Increased phenytoin serum levels with alcohol (acute intake), disulfiram, omeprazole, ticlopidine,
salicylates, SSRIs, benzodiazepines, antifungal agents, calcium channel blockers. Decreased
phenytoin serum levels with alcohol (acute intake), rifampicin, ciprofloxacin, vigabatrin, sucralfate,
theophylline, reserpine, diazoxide, anticonvulsants, antineoplastics
---------------------------------------------------------------------------------------------------------------Phenytoin Sodium 125 mg/5ml Suspension
Indication :
Epilepsy
B
139
Dosage :
ADULT and CHILD more than 6 years: 300-400 mg/day in 3 - 4 divided doses before meals.
Maximum: 600 mg/day. CHILD: Initially 5 mg/kg/day in 2 - 3 divided doses. Maintenance: 4 - 8
mg/kg/day. Maximum: 300 mg/day
Precautions :
Adverse Reactions :
Contraindications :
Interactions :
---------------------------------------------------------------------------------------------------------------Phenytoin Sodium 250 mg/5ml Injection
B
Indication :
Status epilepticus
Dosage :
i) Status epilepticus: ADULT 10 - 15 mg/kg by slow IV. Maximum 50 mg/minute. Maintenance: 100
mg orally/IV every 6 - 8 hours. CHILD 15 - 20 mg/kg by slow IV. Maximum: 1 - 3 mg/kg/minute ii)
Neurosurgery 100 - 200 mg IM approximately at 4 hourly interval
Precautions :
Adverse Reactions :
140
Contraindications :
Interactions :
---------------------------------------------------------------------------------------------------------------Sodium Valproate 200 mg Tablet
B
Trade Name : Epilim
Indication :
Epilepsy
Dosage :
ADULT: Initially 600 mg/day in 2 - 3 divided doses, dose may be increased by 200 mg at 3-day
intervals to max 2.5 g/day. Usual maintenance dose: 1-2 g/day (20-30 mg/kg/day).
CHILD: More than 20 kg. Initially 400 mg/day with spaced increases until control is achieved (usually
20-30 mg/kg/day), dose may be increased to 35 mg/kg/day. Less than 20 kg 20 mg/kg/day, in severe
cases the dose may be increased provided plasma concentration can be monitored
Precautions :
Monitor liver function, avoid sudden withdrawal, certain metabolic disorders, fatigue, loss of
appetite, vomiting. Pregnancy and lactation. Avoid concomitant use of salicylates in children less
than 3 years due to risk of liver toxicity, use of salicylates in children less than 16 years is also not
recommended. Monitor liver function before therapy and during first 6 months. Potential for an
Adverse Reactions :
Nausea, vomiting, headache, dizziness, ataxia, tremor, weight gain, transient hair loss, oedema,
thrombocytopenia, leukopenia. Liver dysfunction, gastrointestinal disorders
Contraindications :
Hepatic disease or significant hepatic dysfunction, hypersensitivity to valproate sodium, valproic acid
or divalproex sodium, porphyria
Interactions :
Increases phenobarbital, primidone and phenytoin plasma concentrations. Potentiates toxic effect of
carbamazepine. Risk of rash may be increased by coadministration with lamotrigine. May potentiate
the effect of neuroleptics, MAOIs, antidepressants and benzodiazepines. Potentiate effects of
MAOIs. Monitor prothrombin time when used with anticoagulants. Caution when used with newer
anti-epileptics whose pharmacodynamics are not well-established
---------------------------------------------------------------------------------------------------------------Sodium Valproate 200 mg/5 ml Syrup
B
Trade Name : Epilim
Indication :
Epilepsy
Dosage :
CHILD: More than 20 kg. Initially 400 mg/day with spaced increases until control is achieved (usually
20-30 mg/kg/day), dose may be increased to 35 mg/kg/day. Less than 20 kg, 20 mg/kg/day. Severe
cases: 50 mg/kg daily
141
Precautions :
appetite, vomiting. Pregnancy, lactation, Avoid concomitant use of salicylates in children less than 3
years due to risk of liver toxicity, use of salicylates in children less than 16 years is also not
Adverse Reactions :
thrombocytopenia (dose related), leukopenia. Gastrointestinal disorders, liver failure, children under
the age of two years are at increased risk, pancreatitis
Contraindications :
Interactions :
the effect of neuroleptics, MAOIs, antidepressants and benzodiazepines. Monitor prothrombin time
when used with anticoagulants. Caution when used with newer anti-epileptics whose
pharmacodynamics are not well-established
---------------------------------------------------------------------------------------------------------------Sodium Valproate 400 mg Injection
B
Trade Name : Epilim
Indication :
Status epilepticus
Dosage :
ADULT and CHILD above 10 years: 10 to 15 mg/kg/day IV, may increase 5 to 10 mg/kg/week to
achieve optimal clinical response (Maximum 60 mg/kg/day or less with a therapeutic range of 50 to
100 mcg/mL)
Precautions :
appetite, vomiting. Pregnancy, lactation, Avoid concomitant use of salicylates in children less than 3
years due to risk of liver toxicity, use of salicylates in children less than 16 years is also not
Adverse Reactions :
thrombocytopenia (dose related), leukopenia. Gastrointestinal disorders, liver failure, children under
the age of two years are at increased risk, pancreatitis
Contraindications :
Interactions :
the effect of neuroleptics, MAOIs, antidepressants and benzodiazepines. Monitor prothrombin time
when used with anticoagulants. Caution when used with newer anti-epileptics whose
pharmacodynamics are not well-established
---------------------------------------------------------------------------------------------------------------142
Topiramate 15 mg Capsule Sprinkle
A*
Trade Name : Topamax
Indication :
Add-on therapy for intractable partial epilepsy
Dosage :
ADULT: 200 - 400 mg/day in 2 divided doses. Maximum 1600 mg/day. CHILD: initial 25 mg (1-3
mg/kg/day), then titrated by 1-3 mg/kg/1-2 weeks in 2 divided doses. Maintenance 5-9 mg/kg/day in
2 divided doses
Precautions :
Avoid abrupt withdrawal, hepatic or renal impairment, behavioral disorders or cognitive deficit,
paraesthesia, predisposition to or history of nephrolithiasis, pregnancy, lactation. Ensure adequate
hydration. May impair ability to drive or operate machinery. Potential for an increase in risk of
Adverse Reactions :
Cognitive dysfunction, sedation, diarrhoea, weight loss, dizziness, abdominal pain, nausea, anorexia,
confusion, impaired speech, ataxia, drowsiness, fatigue, asthenia, visual disturbances, nystagmus,
taste disorder, leucopenia, renal calculi, somnolence and paraesthesia
Contraindications :
Hypersensitivity to topiramate, breast feeding
Interactions :
Plasma concentration decreased by phenytoin and carbamazepine. Metabolism of oral
contraceptive (oestrogens and progestogens) accelerated (reduced contraceptive effect)
---------------------------------------------------------------------------------------------------------------Topiramate 25 mg Tablet
A*
Topiramate 50 mg Tablet
A*
Trade Name : Topamax
Indication :
Add-on therapy for intractable partial epilepsy
Dosage :
ADULT: 200 - 400 mg/day in 2 divided doses. Maximum 1600 mg/day. CHILD: initial 25 mg (1-3
mg/kg/day), then titrated by 1-3 mg/kg/1-2 weeks in 2 divided doses. Maintenance 5-9 mg/kg/day in
2 divided doses
Precautions :
Avoid abrupt withdrawal, hepatic or renal impairment, behavioral disorders or cognitive deficit,
paraesthesia, predisposition to or history of nephrolithiasis, pregnancy, lactation. Ensure adequate
hydration. May impair ability to drive or operate machinery. Potential for an increase in risk of
Adverse Reactions :
Cognitive dysfunction, sedation, diarrhoea, weight loss, dizziness, abdominal pain, nausea, anorexia,
confusion, impaired speech, ataxia, drowsiness, fatigue, asthenia, visual disturbances, nystagmus,
taste disorder, leucopenia, renal calculi, somnolence and paraesthesia
Contraindications :
Hypersensitivity to topiramate, breast feeding
Interactions :
Plasma concentration decreased by phenytoin and carbamazepine. Metabolism of oral
contraceptive (oestrogens and progestogens) accelerated (reduced contraceptive effect)
----------------------------------------------------------------------------------------------------------------
143
Amantadine HCl 100 mg Capsule
B
Trade Name : Symmetrel
Indication :
Parkinson's disease
Dosage :
Initial dose: 100 mg daily and is increased to 100 mg twice daily (not later than 4 p.m.) after a week.
Elderly over 65 years: less than 100 mg or 100 mg at intervals of more than 1 day
Precautions :
Seizure disorder, psychiatry disorder, recurrent eczema, gastric ulceration. Patients with
cardiovascular or liver disease, impaired renal function. Elderly. Withdrawal of the drug should be
gradual
Adverse Reactions :
Oedema of ankles, livedo reticularis, depression, hallucination, nausea, vomiting, dizziness,
insomnia, blurred vision, dry mouth. Seizures, psychosis, confusion, ataxia, heart failure, depression,
orthostatic hypotension, blood dyscrasias, urinary retention, irritability, gastrointestinal disturbances
Contraindications :
Hypersensitivity to amantadine products, pregnancy, lactation, epilepsy, history of gastric ulceration,
severe renal impairment
Interactions :
Alcohol, methyldopa, metoclopramide, domperidone, antipsychotic, antimuscarinics. Enhances the
adverse effects of antimuscarinics and levodopa. Central nervous system stimulants, drugs that raise
urinary pH
---------------------------------------------------------------------------------------------------------------Benzhexol 2 mg Tablet
B
Trade Name : Artane
Indication :
i) Parkinson's disease ii) Drug induced parkinsonism iii) Dystonias
Dosage :
ADULT: Initially 1 mg daily. Maintenance: 5 - 15 mg daily in 3 - 4 divided doses. CHILD: 0.02
mg/kg/dose 8 hourly, gradually increasing to 0.1 - 0.3 mg/kg/dose
Precautions :
Autonomic neuropathy, heart disease, hepatic or renal disease, hyperthyroidism, paediatric, elderly,
potential for abuse, prostatic hypertrophy, glaucoma, obstructive disease of gastrointestinal or
genitourinary, pregnancy and lactation. Use with caution in patients with ileostomy or colostomy.
Avoid driving or hazardous activities. Monitor intraocular pressure
Adverse Reactions :
Severe mental disturbances, confusion, drowsiness, restlessness, hallucinations, excitement, nausea
and vomiting, dry mouth, blurring of vision, constipation, urinary retention, glaucoma
Contraindications :
Children under 3 years, narrow-angle glaucoma, closed-angle glaucoma, tardive dyskinesias,
prostatic enlargement, paralytic ileus, chronic pulmonary disease, sick sinus syndrome,
thyrotoxicosis, cardiac failure with tachycardia, lactation
Interactions :
Alcohol and central nervous system depressants may increase the sedative effect of benzhexol.
Delayed absorption of other oral drugs
----------------------------------------------------------------------------------------------------------------
144
Entacapone 200 mg Tablet
A
Trade Name : Comtan
Indication :
Parkinson's Disease. An adjunct to standard levodopa/benserazide or levodopa/carbidopa for use in
patients with parkinson's disease and end of dose motor fluctuations, who cannot be stabilised on
those combinations
Dosage :
200 mg to be taken with each daily dose of levodopa/dopa-decarboxylase inhibitor.
May be taken with or without food
Precautions :
Levodopa-induced orthostatic hypotension may be aggravated. Abrupt withdrawal
Adverse Reactions :
Nausea, vomiting, abdominal pain, constipation, diarrhoea, urine may be coloured reddish-brown,
dry mouth, dyskinesia, dizziness, anaemia, rarely elevated liver enzymes, gastrointestinal symptoms,
insomnia, hallucinations, confusion, paroniria, aggravated parkinsonism, dizziness, dystonia,
hyperkinesia, fatigue, increased sweating, fall. Extremely rare (potentially serious adverse reactions):
Hepatitis, sudden sleep onset episodes, neuroleptic malignant syndrome, rhabdomyolysis
Contraindications :
Pregnancy and breast-feeding, hepatic impairment, phaeochromocytoma, history of neuroleptic
malignant syndrome or non-traumatic rhabdomyolysis. Concomitant use with selective and
nonselective MAO-A and MAO-B inhibitors
Interactions :
Entacapone and ferrous product should be taken at least 2 - 3 hours apart. Dosage of levodopa and
other antiparkinson drugs may need to be adjusted when initiating entacapone. Effects of medicinal
products metabolised by catechol-O-methyl transferase (COMT) may be potentiated. MAO-A
inhibitors, tricyclic antidepressants, noradrenaline reuptake inhibitors, medicinal products
metabolized by COMT, selegiline, warfarin
---------------------------------------------------------------------------------------------------------------Levodopa 100 mg, Benserazide 25 mg HBS capsule
B
Trade Name : Madopar HBS
Indication :
Parkinson's Disease
Dosage :
Initial: 100/25 mg 1-2 times/day, increase every 3-4 days until therapeutic effect, optimal dosage:
400/100 mg to 800/200 mg/day divided into 4-6 doses. Dose: 200/50 mg used only when
maintenance therapy is reached and not to exceed levodopa 1000-1200 mg/benserazide 250-300
mg per day
Precautions :
Open-angle glaucoma, depression, diabetes, severe cardiovascular disease, bronchial asthma, renal,
hepatic or endocrine disease, history of psychoses or convulsion. Lactation. Perform liver function
and blood count tests during treatment. Discontinue 12-48 hours before surgery requiring general
anaesthesia. If patient must undergo surgery without Madopar having been withdrawn, avoid
anaesthesia with cyclopropane or halothane
Adverse Reactions :
Anorexia, nausea and vomiting, diarrhoea, insomnia, agitation, cardiac arrhythmias, postural
hypotension (rarely labile hypertension), dizziness, tachycardia, arrhythmias, reddish discoloration of
urine and other body fluid, rarely hypersensitivity, abnormal involuntary movement. Lost or change
of taste. Abnormal involuntary movements. Rarely, skin reactions, haemolytic anaemia, mild,
transient leukopenia and thrombocytopenia. Agitation, anxiety, insomnia, hallucination, delusion
and temporal disorientation in the elderly
145
Contraindications :
Hypersensitivity to this drug. Patient on MAOIs therapy with decompensated endocrine, renal or
hepatic function, cardiac disorders, psychiatric diseases or closed-angle glaucoma. Pregnancy.
Patients less than 25 years. Lactation. Combination with MAOIs (except selegiline)
Interactions :
Hypertensive crisis with MAOIs, increased hypotensive effect with antihypertensives, antagonism
effect of antipsychotic, reduced absorption by iron, plasma concentration increased by
metoclopramide. Tricylic antidepressant, phenothiazines, phenytoin, pyridoxine. Potentiates effects
of sympathomimetics. Neuroleptics, opioids, antihypertensives containing reserpine, antacid,
protein-rich meal
---------------------------------------------------------------------------------------------------------------Levodopa 200 mg, Benserazide 50 mg Tablet
B
Trade Name : Madopar
Indication :
Parkinson's Disease
Dosage :
Initial: 100/25 mg 1-2 times/day, increase every 3-4 days until therapeutic effect, optimal dosage:
400/100 mg to 800/200 mg/day divided into 4-6 doses. Dose: 200/50 mg used only when
maintenance therapy is reached and not to exceed levodopa 1000-1200 mg/benserazide 250-300
mg per day
Precautions :
Open-angle glaucoma, depression, diabetes, severe cardiovascular disease, bronchial asthma, renal,
hepatic or endocrine disease, history of psychoses or convulsion. Lactation. Perform liver function
and blood count tests during treatment. Discontinue 12-48 hours before surgery requiring general
anaesthesia. If patient must undergo surgery without Madopar having been withdrawn, avoid
anaesthesia with cyclopropane or halothane
Adverse Reactions :
Anorexia, nausea and vomiting, diarrhoea, insomnia, agitation, cardiac arrhythmias, postural
hypotension (rarely labile hypertension), dizziness, tachycardia, arrhythmias, reddish discoloration of
urine and other body fluid, rarely hypersensitivity, abnormal involuntary movement. Lost or change
of taste. Abnormal involuntary movements. Rarely, skin reactions, haemolytic anaemia, mild,
transient leukopenia and thrombocytopenia. Agitation, anxiety, insomnia, hallucination, delusion
and temporal disorientation in the elderly
Contraindications :
Hypersensitivity to this drug. Patient on MAOIs therapy with decompensated endocrine, renal or
hepatic function, cardiac disorders, psychiatric diseases or closed-angle glaucoma. Pregnancy.
Patients less than 25 years. Lactation. Combination with MAOIs (except selegiline)
Interactions :
metoclopramide. Tricylic antidepressant, phenothiazines, phenytoin, pyridoxine. Potentiates effects
of sympathomimetics. Neuroleptics, opioids, antihypertensives containing reserpine, antacid,
protein-rich meal
----------------------------------------------------------------------------------------------------------------
146
Levodopa 250 mg and Carbidopa 25 mg Tablet
Levodopa 100 mg and Carbidopa 25 mg Tablet
Trade Name : Sinemet
Indication :
Parkinson's disease
Dosage :
Patients not receiving Levodopa before, initially 100 - 125 mg 3 - 4 times daily
adjusted according to response. Maintenance: 0.75 - 2 g in divided doses. In patients
previously treated with Levodopa the dose should be about 20 - 25% of the dose
previous being taken
B
B
Precautions :
Not recommended for treatment of drug-induced extrapyramidal reactions. The occurrence of
dyskinesias in patients previously treated with levodopa alone may require dosage reduction. All
patients should be observed carefully for the development of depression with concomitant suicidal
tendencies. Cardiovascular disease or pulmonary disease, bronchial asthma. Hepatic impairment,
renal impairment, endocrine disease, chronic wide-angle glaucoma. Observe carefully when the
dosage is reduced abruptly or discontinued, especially if the patient is receiving neuroleptics.
Pregnancy, women of childbearing potential. Not recommended in patients less than 18 years
Adverse Reactions :
Central nervous system: Anxiety, confusion, nervousness, mental depression, psychotic symptoms.
Anorexia, nausea and vomiting, diarrhoea, insomnia, agitation, postural hypotension, dizziness,
chest pain, tachycardia, arrhythmias, reddish discoloration of urine and other body fluid. Dyskinesia,
muscle twitching and blepharospasm may be taken as early signs to consider dosage reduction.
Gastrointestinal bleeding, development of duodenal ulcer, dark saliva, leukopenia, hemolytic and
non-hemolytic anemia, thrombocytopenia, agranulocytosis, angioedema, urticaria, pruritus,
paresthesia, increased libido, dyspnea, alopecia, rash, dark sweat, dark urine
Contraindications :
Hypersensitivity to this drug. Patient on MAOIs therapy or 2 weeks prior to initiating therapy. May
be administered concomitantly with or an MAOI with or selectivity for MAO type B (eg selegiline
HCl). Narrow-angle glaucoma with compensated endocrine, renal or hepatic function, cardiac
disorders, psychiatric diseases or closed-angle glaucoma, undiagnosed skin lesion, melanoma,
pregnancy
Interactions :
metoclopramide. Linezolid, clonidine, anticholinergics, tricylic antidepressant, phenothiazines,
phenytoin, papaverine, selegiline and high protein diet
---------------------------------------------------------------------------------------------------------------Piracetam 1.2 g Tablet
Trade Name : Nootropil
Indication :
Mild cognitive impairment, post concussional head syndrome, head injury disorder,
chronic vertigo and myoclonus
Dosage :
Initially 7.2 g daily in 2 - 3 divided doses, increased according to response by 4.8 g
daily every 3 - 4 days to maximum of 20 g daily. CHILD under 16 years not
recommended
Precautions :
Renal insufficiency (possible need for dose adjustments), elderly patients with multiple diseases
Adverse Reactions :
147
A*
Nervousness, agitation, irritability, anxiety and sleep disturbances, fatigue or drowsiness,
gastrointestinal disturbances
Contraindications :
Previous hypersensitivity to piracetam. Huntington's chorea
Interactions :
Warfarin: an increased risk of bleeding
---------------------------------------------------------------------------------------------------------------Piribedil 50 mg Tablet
A*
Trade Name : Trivastal Retard
Indication :
Parkinson disease
Dosage :
As monotherapy: 150 - 250 mg as 3 - 5 divided doses daily. As combination with L-dopa therapy: 50 150 mg daily (50 mg per 250 mg of L-dopa)
Precautions :
Hepatic dysfunction, elderly, psychosis, parkinsonism, mania, thyroid disorder
Adverse Reactions :
Drowsiness, confusion, anxiety, dizziness, delusions, hallucinations, hypotension, tachycardia,
extrapyramidal effects, dyskinesias, mania, gastric discomfort, nystagmus, changes in liver function,
gastrointestinal disorders (nausea, vomiting, flatulence), orthostatic hypotension, drowsiness
Contraindications :
Hypersensitivity to piribedil, cardiogenic shock, acute phase of myocardial infaction
Interactions :
Dopaminergic antagonists
---------------------------------------------------------------------------------------------------------------Pramipexole Dihydrochloride 0.125 mg Tablet
A*
Trade Name : Sifrol
Indication :
Treatment for signs and symptoms of advanced idiopathic Parkinson's disease. It
may be used as monotherapy or in combination with levodopa
Dosage :
Dose escalation: 0.125 mg 3 times daily on week 1 then 0.25 mg 3 times daily week 2 then 0.5 mg 3
times daily on week 3. Increase by 0.75 mg at weekly intervals if needed up to maximum of 4.5
mg/day. Patient on levodopa: Reduced dose. Renal impairment: creatinine clearance: 20 - 50
ml/minute: initially 0.125 mg twice daily, creatinine clearance less than 20 ml/minute initially 0.25
mg daily as a single dose, maximum dose: 1.5 mg twice daily
Precautions :
Renal impairment, severe cardiovascular disease. Avoid abrupt withdrawal. Pregnancy and lactation.
May impair ability to drive or operate machinery
Adverse Reactions :
Nausea, constipation, somnolence, hallucination, confusion, dizziness, dyskinesia, amnesia, asthenia,
dream disorder, extrapyramidal movements, insomnia, orthostatic hypotension
Contraindications :
Hypersensitivity to pramipexole or to any of the excipients
Interactions :
Cimetidine, amantadine, antipsychotics (typical), central nervous system depressants. Avoid alcohol
----------------------------------------------------------------------------------------------------------------
148
Procyclidine HCl 10 mg/2 ml Injection
B
Trade Name : Kemadrin
Indication :
i) All forms of Parkinson's disease (idiopathic paralysis agitants), post-encephalitis and
arteriosclerosis
ii) To control troublesome extrapyramidal symptoms induced by neuroleptic drugs including pseudoparkinsonism, acute dystonic reactions and akathisia
Dosage :
By IM injection 5 - 10 mg repeated if necessary after 20 minutes. Maximum 20 mg
daily. By IV injection 5 - 10 mg
Precautions :
Hypotension, severe psychoses, prostatic hypertrophy, tachycardia, urinary retention, hepatic or
rena impairment, lactation, pregnancy, children, elderly
Adverse Reactions :
Excitability, dizziness, hallucinations (seen on abuse), dry mouth, constipation, urinary retention,
agitation, restlessness, convulsions
Contraindications :
Closed-angle glaucoma, narrow-angle glaucoma, hypersensitivity to procyclidine products,
gastrointestinal tract or urinary outflow obstruction, prostatic hypertrophy, tardive dyskinesia in
patients on neuroleptic drugs
Interactions :
Anticholinergic-like drugs, chlorpromazine, haloperidol, promethazine, thioridazine, trifluoperazine
and prochlorperazine. Reduced peristaltic movement affects absorption of erythromycin, penicillin
---------------------------------------------------------------------------------------------------------------Ropinirole HCl 0.25 mg Tablet
A*
Trade Name : Requip
Indication :
Parkinson disease in younger patients and patients with dyskinesias, especially peak
dose dyskinesias
Dosage :
0.25 mg 3 times daily gradually increasing till adequate response obtained up to a maximum of 24
mg/day. Most patients need 3-9 mg/day
Precautions :
Several renal or hepatic failure, concomitant use of alcohol, others central nervous system
depressants and neuroleptics. Pregnancy. May impair ability to drive or operate machinery.
Withdrawal should be gradual
Adverse Reactions :
Dizziness, headache, somnolence, nausea, vomiting, dyskinesia, hallucinations (dose related), sleep
attacks, postural hypotension, syncope, abdominal pain
Contraindications :
Hypersensitivity to ropinirole, pregnancy and lactation, hepatic or severe renal impairment
Interactions :
Neuroleptics and other centrally active dopamine antagonist, other dopamine agonists,
ciprofloxacin, high dose oestrogen, hormone replacement therapy, antiarrhythmias, inhibitors of
CYP1A2 eg, cimetidine, erythromycin, fluvoxamine, isoniazid, ritonavir and zileuton may increase
serum concentrations of ropinirole. Ethanol, kava kava, gotu kola, valerian and St John's wort may
increase central nervous system depression
---------------------------------------------------------------------------------------------------------------149
Selegiline HCl 5 mg Tablet
Trade Name : Jumex
Indication :
Only for treatment of late stage Parkinsonism with on and off phenomenon
Dosage :
5 mg twice daily at breakfast and lunch. Maximum 10 mg/day
A*
Precautions :
History of peptic ulcer, pregnancy and lactation, elderly, concurrent use of tricyclic antidepressants,
uncontrolled hypertension. Suicidal ideation and behavior or worsening depression, increased risk
during the first few months of therapy or following changes in dosage (particularly in children,
adolescents and young adults with major depressive disorder)
Adverse Reactions :
Hypotension, nausea, confusion, agitation, hallucination, dyskinesia, sleep disturbances, psychosis,
constipation, dry mouth, headache, tremor, dizziness
Contraindications :
Extrapyramidal symptoms not related to dopamine deficiency, thyrotoxicosis, narrow angle
glaucoma agitated psychosis, hypersensitivity to selegiline products. Pregnancy
Interactions :
Hyperpyrexia and central nervous system toxicity with pethidine. Hypertension and central nervous
system excitation with fluoxetine and sertraline. Hypotension with MAOIs. Carbamazepine,
amitriptyline, amphetamine
---------------------------------------------------------------------------------------------------------------Methadone 5mg/ml Syrup
A
Indication :
Detoxification treatment of narcotic addiction
Dosage :
10 - 40 mg orally once daily. Increased by up to 10 mg daily (maximum increase 30 mg weekly) until
no signs of withdrawal or intoxication, usual dose range 60 - 120 mg daily. CHILD not recommended
Precautions :
May cause dependence on prolonged use. Avoid alcoholic beverages, effects on ability to drive or
operate machine. Methadone, even in low doses is a special hazard for children, non-dependent
adults are also at risk of toxicity and dependent adults are at risk if tolerance is incorrectly asessed
during induction
Adverse Reactions :
Constipation, nausea, vomiting, asthenia, dizziness, somnolence, cardiac arrest, disease of
cardiovascular system, shock, respiratory arrest, respiratory depression, diaphoresis, constipation,
sedation
Contraindications :
Hypersensitivity to methadone, severe hepatic impairment, respiratory depression, obstructive
airways disease, ulcerative colitis, concomitant administration with monoamine oxidase inhibitors
(MAOIs) or within 2 weeks of discontinuation
Interactions :
Buprenorphine, didanosine, efavirenz, fluconazole, fluvoxamine, naltrexone, nevirapine, rifampin,
risperidone, ritonavir, voriconazole, zidovudine
----------------------------------------------------------------------------------------------------------------
150
Donepezil HCl 5 mg Tablet
A
Donepezil HCl 10 mg Tablet
A
Trade Name : Aricept
Indication :
Treatment of mild to moderate dementia in Alzheimer's disease, as well as in patients with severe
Alzheimer's disease. [psychiatrists and neurologists only]
Dosage :
5 - 10 mg once daily at bedtime. Maximum 10 mg daily
Precautions :
Gastrointestinal disease or history of ulcer disease, asthma or obstructive pulmonary disease or
seizures or those receiving concurrent NSAIDs, pregnancy, cardiac conduction abnormalities,
anaesthesia with succinylcholine
Adverse Reactions :
Diarrhoea, muscle cramps, nausea, vomiting, insomnia, fatigue, dizziness, hallucination, agitation,
loss of appetite
Contraindications :
Hypersensitivity to donepezil hydrochloride and piperidine derivatives. Pregnancy and lactation
Interactions :
Has the potential for synergistic activity with concurrent succinylcholine, other neuromuscular
blocking agents or cholinergic agonist. Has the potential to interfere with drugs having
anticholinergic activity. Muscle relaxants drugs, suxamethonium
---------------------------------------------------------------------------------------------------------------Rivastigmine 1.5 mg Capsule
A*
Trade Name : Exelon
Indication :
For psychiatrists and neurologists only. Mild to moderately severe dementia associated with
Alzheimer's or Parkinson's disease
Dosage :
Initial dose 1.5 mg 2 times daily, may increase by 1.5 mg 2 times daily every 2 weeks to maximum of
6 mg 2 times daily. If treatment is interrupted for several days, should be reinitiated at the lowest
daily dose
Precautions :
History of toxicity (especially excessive cholinergic responses) related to other cholinesterase
inhibitors (e.g: tacrine), diabetes, cardiovascular/pulmonary disease, gastrointestinal disorders,
concurrent use of agents with anticholinergic activity, urogenital tract obstruction, parkinsonism,
pregnancy, renal or hepatic insufficiency, high incidence of nausea and vomiting, concurrent NSAIDs,
asthma or obstructive pulmonary disease, anorexia, weight loss, neurological conditions resulting in
seizures, extrapyramidal symptoms, tremor
Adverse Reactions :
Nausea, vomiting, anorexia, dizziness, diarrhoea, abdominal pain, loss of appetite, dyspepsia and
headache
Contraindications :
Known hypersensitivity to the drug, other carbamate derivatives, severe liver impairment
Interactions :
Cholinomimetic drugs, anticholinergic medications, succinylcholine-type muscle relaxants during
anaesthesia, diazepam, digoxin, fluoxetine and warfarin
----------------------------------------------------------------------------------------------------------------
151
Rivastigmine 4.6mg/24hr Transdermal Patch
A*
Rivastigmine 9.5 mg/24hr Transdermal Patch
A*
Trade Name : Exelon® patch 5, Exelon®patch 10
Indication :
Mild to moderately severe dementia associated with Alzheimer's or Parkinson's
disease
Dosage :
Initial, 4.6 mg/24 hr patch TOPICALLY once daily; after a minimum of 4 weeks and good tolerability,
increase the dose to 9.5 mg/24 hr patch once daily
Precautions :
Sick-sinus syndrome, conduction defects, urinary obstruction, seizures in predisposed patients,
asthma or obstructive pulmonary disease. Pregnancy and lactation. Hepatic impairment, renal
impairment, anesthesia, low body weight, nicotine use. May impair ability to drive or operate
machinery
Adverse Reactions :
Vomiting, nausea, anorexia, decreased appetite, anxiety, depression, insomnia, dizziness, headache,
diarrhoea, dyspepsia, abdominal pain, application site reaction
Contraindications :
Hypersensitivity to rivastigmine, other carbamate derivatives and other components of the product
Interactions :
Cholinomimetic drugs, anticholinergic medications, succinylcholine-type muscle relaxants during
anaesthesia
---------------------------------------------------------------------------------------------------------------Atomoxetine HCl 10 mg Capsule
A*
Atomoxetine HCl 18 mg Capsule
A*
Trade Name : Strattera
Indication :
Attention deficit hyperactivity disorder (ADHD) in children 6 years and older who do not respond to
methylphenidate or who have intolerable effects or have tics. Diagnosis should be made according
to DSM IV criteria or the guidelines in ICD-10
Dosage :
CHILD and ADOLESCENTS up to 70 kg: Initially 0.5 mg/kg/day for at least 7 days, then increased
according to response. Maintenance: 1.2 mg/kg/day. ADULTS and ADOLESCENTS more than 70 kg:
Initially 40 mg/day for at least 7 days then increased according to response. Maintenance: 80
mg/day. Max 100 mg/ day
Precautions :
Hypotension, cardiovascular or cerebrovascular disease. Hypertension tachycardia. Urinary retention
or bladder dysfunction. Monitor growth in children, QT interval prolongation, history of seizures,
susceptibility to angle-closure glaucoma, hepatic impairment, suicidal ideation. Pregnancy and
lactation
Adverse Reactions :
Gastrointestinal disorder or cardiovascular disorders, weight loss, decreased appetite, weight loss.
Nervous system disorders such as dizziness, headache, insomnia, somnolence, mood swings, urinary
retention, dysmenorrhea, ejaculation disorder. Orthostatic hypotension and syncope, psychiatric
disorders such as irritability, suicidal thought
Contraindications :
Concomitant use with MAOIs. Narrow-angle glaucoma, liver injury, jaundice
152
Interactions :
MAOIs, CYP2D6 inhibitors (fluoxetine, paroxetine), salbutamol, pressor agents, drugs that affect
noradrenaline
---------------------------------------------------------------------------------------------------------------Piracetam 1 g Injection
A*
Trade Name : Nootropil
Indication :
Treatment of cerebral functional impairment and ischaemic stroke
Dosage :
30 - 160 mg/kg/day orally or parenterally 2 times daily or 3 to 4 times daily. Maximum: 24 g/day
Precautions :
Renal insufficiency (possible need for dose adjustments), elderly patients with multiple diseases
Adverse Reactions :
Nervousness, agitation, irritability, anxiety and sleep disturbances, fatigue or drowsiness,
gastrointestinal disturbances
Contraindications :
Previous hypersensitivity to piracetam. Huntington's chorea
Interactions :
Warfarin: an increased risk of bleeding
---------------------------------------------------------------------------------------------------------------Betahistine Dihydrochloride 24 mg Tablet
Trade Name : Betaserc®
Indication :
Vertigo, tinnitus and hearing loss associated with Meniere's disease
Dosage :
24 mg twice daily
A*
Precautions :
Betahistine should not be given to patients with phaeochromocytoma. It should be given with care
to patients with asthma, peptic ulcer disease or a history of peptic ulcer disease. Antihistamines may
block some or all of intended effects of betahistine. Liver disease, pregnancy, lactation
Adverse Reactions :
Nausea, vomiting, skin rash, pruritus
Contraindications :
Hypersensitivity, phaeochromocytoma
Interactions :
Selegiline
---------------------------------------------------------------------------------------------------------------Baclofen 10 mg Tablet
Trade Name : Lioresal
Indication :
Spasticity of the skeletal muscle
Dosage :
ADULT: 5 mg 3 times daily. Max: 80 mg daily. CHILD: 0.75 - 2 mg/kg daily (more than 10 years,
maximum: 2.5 mg/kg daily)
B
Precautions :
Pregnancy, patients suffering not only from spasticity but also from psychotic disorders,
schizophrenia or confusional states, epilepsy, cerebrovascular or respiratory insufficiency. Central
153
nervous system depressants, antihypertensives, levodopa. Caution in road users. Avoid abrupt
discontinuation
Adverse Reactions :
Daytime sedation, drowsiness, nausea and other central nervous system disorders, gastrointestinal
disturbances, dysuria, frequency of micturition, enuresis or retention of urine, respiratory
depression
Contraindications :
Epilepsy and other convulsive conditions, corticol or subcorticol brain damage, peptic ulceration,
known hypersensitivity to baclofen
Interactions :
Tricyclics and lithium enhance muscle relaxant effect, ACE inhibitor, diuretics and antihypertensives
enhance hypotensive effect. Sedative effect enhanced with alcohol, anxiolytics and hypnotics.
Excretion reduced by ibuprofen and possibly other NSAIDs
---------------------------------------------------------------------------------------------------------------Clostridium Botulinum Toxin Type A 100 units
Clostridium Botulinum Toxin Type A 500 units
Trade Name : Botox
Indication :
i) Focal dystonias ii) Hemifacial spasm iii) Spasticity including cerebral palsy
Dosage :
20 - 200 units 3 months once
A*
A*
Precautions :
Anaphylaxis and corneal exposure.Subclinical or clinical evidence of marked defective
neuromuscular transmission
Adverse Reactions :
Misplaced injections may paralyse nearby muscle groups and excessive doses may paralyse distant
muscle, influenza-like syndrome. Exacerbation of existing eyelid abnormalities, ptosis, diplopia,
spread of the paralytic effect to mid-facial muscles, keratitis, dry eyes, minor bruising, lid swelling,
burning sensation, dysphagia
Contraindications :
Generalised disorders of muscle activity eg. myasthenia gravis, bleeding disorders, pregnancy and
breast feeding
Interactions :
Effects enhanced by aminoglycosides and non-depolarizing muscle relaxant
---------------------------------------------------------------------------------------------------------------Diazepam 5 mg Tablet
B
Trade Name : Valium
Indication :
i) Muscle spasm of varied aetiology, including tetanus ii) Anxiety disorders
Dosage :
i) ADULT: 2-10 mg 3-4 times daily. CHILD 6 months and older: 0.12 - 0.8 mg/kg daily in divided doses,
every 6-8 hours ii) ADULT : 2 mg 3 times daily, increased in severe anxiety to 15 - 30 mg daily in
divided doses. ELDERLY (or delibitated) half adult dose. CHILD (night terrors), 1 - 5 mg at bedtime
Precautions :
renal and hepatic impairment and avoid operating vehicles or machinery. Safety and effectiveness
not established in children less than 6 months of age
154
Adverse Reactions :
gastrointestinal, hypotension, ataxia, respiratory depression, sedation, depression, headache,
nausea, tremor, withdrawal syndrome, neutropenia, hepatotoxicity, pancytopenia,
thrombocytopenia, blood dyscrasias, bradycardia, dependence/abuse. Paradoxical reactions in
children and elderly
Contraindications :
angle glaucoma and untreated open angle glaucoma, myasthenia gravis, hypersensitivity to
diazepam products, patients less than 6 months old, alcohol intoxication and central nervous system
depression. Pregnancy and lactation
Interactions :
Erythromycin, clarithromycin, isoniazid, fentanyl, alfentanil, itraconazole, ketoconazole, digoxin,
phenytoin, rifampicin, ethanol, carbamazepine, phenobarbital, levodopa, lithium, amitriptyline,
codeine, fluvoxamine, ginkgo, morphine, primidone, St John's Wort, theophylline, thiopental
---------------------------------------------------------------------------------------------------------------Mecobalamin 500 mcg Tablet
B
Trade Name : Methylcobal
Indication :
Peripheral neuropathies
Dosage :
1 tablet 3 times daily. The dosage should be adjusted according to age of patient and severity of
symptoms
Precautions :
Discontinue medication if there is no response after taking orally for several months
Adverse Reactions :
Anorexia, nausea, diarrhoea, pain and induration at IM injection site. Headache, sweating or hot
sensation
Contraindications :
Not known
Interactions :
Not known
---------------------------------------------------------------------------------------------------------------Neostigmine Methylsulphate 2.5 mg/ml Injection
B
Trade Name : Prostigmine
Indication :
i) Myasthenia gravis ii) Reversal of non-depolarising neuromuscular blockade
Dosage :
i) ADULT: 1 - 2.5 mg at suitable intervals by SC, IM or IV. Usual total daily dose 5 - 20 mg. CHILD: 200 500 mcg at suitable intervals throughout the day. NEONATE: 50 - 250 mcg every 4 hours ii) By IV
injection over 1 minute, 50 - 70 mcg/kg (maximum 5 mg) after or with atropine sulphate 0.6 - 1.2 mg
Precautions :
Bronchial asthma (extreme caution), bronchitis, bradycardia, peptic ulcer, epilepsy, parkinsonism,
155
Adverse Reactions :
Allergic reactions, salivation, gastrointestinal upsets, diaphoresis, diarrhea, flatulence, increased
peristalsis, nausea and vomiting, cardiac dysrhythmia, anaphylaxis, seizure, bronchospasm,
respiratory arrest, respiratory depression
Contraindications :
Mechanical intestinal or urinary obstruction, peritonitis
Interactions :
Antagonism effect by lithium, antimuscarinics, aminoglycoside, clindamycin, procainamide,
quinidine, propranolol. Enhanced effect of suxamethonium. Chloroquine have potential to increase
symptoms of myasthenia gravis. Cyclopropane or halothane
---------------------------------------------------------------------------------------------------------------Pyridostigmine Bromide 60 mg Tablet
B
Trade Name : Mestinon
Indication :
Myasthenia gravis
Dosage :
ADULT: 30 - 120 mg at suitable intervals throughout the day, total daily dose 0.3 - 1.2 g. CHILD up to
6 years initially 30 mg, 6 - 12 years initially 60 mg, usual total daily dose 30 - 360 mg
Precautions :
Bronchial asthma (extreme caution) or bronchitis, renal disease, cardiac dysrhythmias, cholinergic
crisis
Adverse Reactions :
Abdominal cramps, excessive sweating, bronchoconstriction, lacrimation, bradycardia, asystole,
diaphoresis, diarrhoea, nausea, vomiting, cramp, muscle fasciculation, asthenia, miosis
Contraindications :
Intestinal or urinary obstruction
Interactions :
Potentiates actions of morphine derivatives and barbiturates, succinylcholine
--------------------------------------------------------------------------------------------------------------------------
156
8. ANTIINFECTIVES
Antibacterials
Antifungals
Antivirals
Antiprotozoals
Anthelmintics
157
Amikacin 250 mg/2 ml Injection
A
Amikacin 500 mg/2 ml Injection
A
Trade Name : Amikin
Indication :
Infections due to susceptible organisms
Dosage :
ADULT: (IM or IV): 15 mg/kg/day 8 - 12 hourly for 7 - 10 days. Maximum: 1.5 g/day. CHILD: 15
mg/kg/day 8 - 12 hourly. Maximum: 1.5 g/day. Neonates: Initial loading dose of 10 mg/kg followed
by 7.5 mg/kg/day 12 hourly. Maximum 15mg/kg/day
Precautions :
Myasthenia gravis, renal impairment, pregnancy and lactation. Tinnitus or vertigo may be indications
of vestibular injury and impending bilateral irreversible damage
Adverse Reactions :
Ototoxicity and nephrotoxicity, rarely skin rash, fever, paraesthesia, athralgia, anaemia, hypotension
Contraindications :
Hypersensitivity to aminoglycosides
Interactions :
Potentiation of toxicity in combination with loop diuretics, cephalothin, vancomycin, cyclosporin.
Prolongs action of neuromuscular blockers. Increased risk of respiratory depression with either
halothane, methoxyflurane & neuromuscular blockers
---------------------------------------------------------------------------------------------------------------Amoxicillin & Clavulanate 228 mg/5 ml Syrup
A/KK
Trade Name : Augmentin
Indication :
Infections caused by susceptible organisms
Dosage :
Moderate infections: CHILD 7 - 12 year: 10 ml, 2 - 6 year: 5 ml. Severe infections: 2 6 year: 10 ml
Precautions :
Renal impairment, severe hepatic dysfunction
Adverse Reactions :
Diarrhoea, pseudomembraneous colitis, indigestion, GI upsets, increased liver enzyme
Contraindications :
Hypersensitivity to penicillins, possible cross sensitivity with other β-lactams. History of penicillinassociated cholestatic jaundice or hepatic dysfunction
Interactions :
Aminoglycosides, anti-coagulants, oral contraceptives, methotrexate
---------------------------------------------------------------------------------------------------------------Amoxicillin 1 g & Clavulanate 200 mg Injection
A
Indication :
Infections caused by susceptible organisms. Respiratory tract, skin, soft tissue, GUT infection,
septicaemia, peritonitis, post-operative infection & osteomyelitis
Dosage :
CHILD less than 3 months: 30mg/kg 12 hourly. 3 months - 12 years: 30mg/kg 6 - 8 hourly. ADULT: 1.2
g by IV or intermittent infusion 6 - 8 hourly
Precautions :
Pregnancy, breast-feeding, renal or liver failure, pseudomembranous colitis
158
Adverse Reactions :
Diarrhoea, pseudomembraneous colitis, GI upsets, increased liver enzyme, urticaria and
erythematous multiforme, Steven-Johnson syndrome, toxic epidermal necrolysis, exfoliative
dermatitis, transient leucopenia, thrombocytopenia, haemolytic anaemia
Contraindications :
Hypersensitivity to penicillins, possible cross sensitivity with other â-lactams. History of penicillinassociated cholestatic jaundice or hepatic dysfunction
Interactions :
Aminoglycosides, anti-coagulants, oral contraceptives, methotrexate
-------------------------------------------------------------------------------------------------------------------------Amoxicillin 500 mg & Clavulanate 125 mg Tablet
A/KK
Indication :
Infections due to beta-lactamase producing strain where amoxicillin alone is not appropriate.
Respiratory tract, skin, soft tissue, GUT infection, septicaemia, peritonitis, post-operative infection &
osteomyelitis
Dosage :
ADULT & CHILD more than 12 years: Mild to moderate infections: 625 mg twice daily. Severe
infections: 1 g twice daily
Precautions :
Renal or hepatic impairment, pregnancy
Adverse Reactions :
Diarrhoea, indigestion, nausea, vomiting, candidiasis, rash, pseudomembranous colitis, hepatitis,
cholestatic jaundice, crystalluria, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal
necrolysis, reversible leucopaenia, thrombocytopaenia, haemolytic anaemia, CNS disturbances
Contraindications :
Hypersensitivity to penicillins, possible cross sensitivity with other β-lactams. History of penicillinassociated cholestatic jaundice/hepatic dysfunction
Interactions :
Aminoglycosides, anticoagulants, oral contraceptives, methotrexate
-------------------------------------------------------------------------------------------------------------------------Amoxicillin 250 mg Capsule
Indication :
Infections caused by susceptible strains of gram positive and gram negative organisms
Dosage :
ADULT: 250 - 500 mg 3 times daily. CHILD: 20 - 40 mg/kg/day in divided doses 8 hourly
Precautions :
Hypersensitivity to cephalosporins, renal or hepatic impairment, superinfection
Adverse Reactions :
Diarrhoea, indigestion, urticarial or erythematous rash, hepatitis, cholestatic jaundice
Contraindications :
Hypersensitivity to penicillins
Interactions :
Aminoglycosides, oral contraceptives
B
----------------------------------------------------------------------------------------------------------------
159
Amoxicillin Trihydrate 125 mg/5 ml Syrup
B
Indication :
Infections caused by susceptible strains of gram positive and gram negative organisms
Dosage :
CHILD less than 10 years: 125 - 250 mg 8 hourly. CHILD less than 20 kg: 20 - 40 mg/kg/day in 3 - 4
divided doses
Precautions :
Adverse Reactions :
Contraindications :
Interactions :
-------------------------------------------------------------------------------------------------------------------------Ampicillin Sodium 1g & Sulbactam Sodium 500mg Injection
A
Trade Name : Unasyn 1.5g
Indication :
Treatment of susceptible bacterial infections
Dosage :
ADULT: 1.5 - 12 g/day in divided doses 6 - 8 hourly. Maximum: 4 g Sulbactam per day. CHILD: 150300mg/kg/day 6 - 8 hourly. Prophylaxis: 1.5 -3 g at induction of anaesthesia. May be repeated 6 - 8
hourly
Precautions :
Overgrowth of non-susceptible organism. Check periodically for organ system dysfunction during
prolong therapy
Adverse Reactions :
GI disturbances, phlebitis, skin rashes, itching, blood disorders, anaphylaxis and superinfection
Contraindications :
History of allergic reaction to any penicillins
Interactions :
Concurrent use with oral contraceptives may result in decreased contraceptive effectiveness
-------------------------------------------------------------------------------------------------------------------------Ampicillin Sodium 500 mg Injection
B
Trade Name : Penbritin
Indication :
Treatment of susceptible bacterial infections (non beta-lactamase-producing organisms); meningitis
Dosage :
250 - 500 mg IM/IV every 4 - 6 hours. Maximum: 400 mg/kg/day. Meningitis: 2 g 6 hourly. CHILD:
150 mg/kg/daily IV in divided doses. Usual children dose less than 10 years, half adult dose
Precautions :
Hypersensitivity to cephalosporins. Chronic treatment requires assessment of renal, hepatic&
haematopoietic functions. Renal impairment, lymphatic leukaemia
Adverse Reactions :
GI disturbances, skin rashes, pruritis, urticartia, fever, anaphylaxis, blood disorders, superinfection
Contraindications :
160
Interactions :
Excretion impaired by probenecid. Increased risk of skin rashes with allopurinol. May decrease
effectiveness of oral contraceptives and atenolol
---------------------------------------------------------------------------------------------------------------Ampicillin Trihydrate 125 mg/5 ml Suspension
B
Trade Name : Penbritin
Indication :
Treatment of susceptible bacterial infections (non beta-lactamase-producing organisms)
Dosage :
CHILD: 50 - 100 mg/kg/day 4 times daily. Under 1 year: 62.5 - 125 mg 4 times daily, 1 - 10 years: 125
- 250 mg 4 times daily
Precautions :
Hypersensitivity to cephalosporins. Severe renal dysfunction
Adverse Reactions :
Diarrhoea, indigestion, nausea, vomiting, occasionally rashes
Contraindications :
Interactions :
Bacteriostatic drugs, anticoagulants
-------------------------------------------------------------------------------------------------------------------------Azithromycin 250 mg Tablet
A*
Trade Name : Zithromax
Indication :
i) Treatment of complicated respiratory tract infection not responding to standard macrolides ii)
Adult treatment of uncomplicated genital infections due to Chlamydia trichomatis or susceptible
Neisseria gonorrhoea iii) Prophylaxis against Mycobacterium avium complex in patients with
advanced HIV
Dosage :
i) 500 mg daily for 3 days ii) 1 g as a single dose iii) 1 g weekly
Precautions :
Moderate or severe renal impairment, liver impairment, pregnancy & lactation
Adverse Reactions :
Nausea, abdominal discomfort, vomiting, flatulence, diarrhoea & loose stools. Hearing impairment,
interstitial nephritis, acute renal failure, abnormal liver function, dizziness & vertigo, convulsions,
headache, somnolence
Contraindications :
Known hypersensitivity to azithromycin or any of the macrolides
Interactions :
Antacids, ergot derivatives. Monitor patients on concurrent warfarin, digoxin or cIclosporin
---------------------------------------------------------------------------------------------------------------Azithromycin 500 mg Injection
A*
Trade Name : Zithromax
Indication :
Only for treatment of severe atypical pneumonia
Dosage :
500 mg IV as a single daily dose for a minimum of two days followed by 500 mg oral dose as a single
daily dose to complete a 7 - 10 days course
161
Precautions :
Moderate or severe renal impairment, sever liver impairment, pregnancy & lactation
Adverse Reactions :
Nausea, abdominal discomfort, vomiting, flatulence, diarrhoea& loose stools. Hearing impairment,
interstitial nephritis, acute renal failure, abnormal liver function, dizziness& vertigo, convulsions,
headache, somnolence
Contraindications :
Known hypersensitivity to azithromycin or any of the macrolides
Interactions :
Antacids, ergot derivatives. Monitor patients on concurrent warfarin, digoxin or ciclosporin. Increase
levels of tacrolimus, phenytoin, bromocriptine, disopyramide
---------------------------------------------------------------------------------------------------------------Bacampicillin 400 mg Tablet
B
Trade Name : Penglobe
Indication :
Infections caused by ampicillin-sensitive gram positive& gram negative microorganisms
Dosage :
ADULT: 400 mg twice daily. Severe infection: 800 mg twice daily. CHILD more than 25 kg: 12.5 - 25
mg/kg 12 hourly
Precautions :
Adverse Reactions :
Contraindications :
Interactions :
-------------------------------------------------------------------------------------------------------------------------Benzathine Penicillin 2.4 mega units Injection (1.8 g)
B
Trade Name : Penadur L.A.
Indication :
i) Treatment of mild to moderately severe infections due to Penicillin G-sensitive organisms ii)
Treatment of syphillis
Dosage :
i) ADULT: 1.2 mega units IM ii) For syphillis: 2.4 mega units weekly for 1 - 3 weeks
Precautions :
Diabetes. Not for SC, IV or intralumbarly or into body cavities. Impaired renal function, infants,
elderly, hypersensitivity to cephalosporins
Adverse Reactions :
Allergic reactions, glossitis, stomatitis, haemolytic anaemia, leucopenia, thrombocytopenia,
agranulocytosis, neuropathy, nephropathy, Jarisch-Herxheimer reactions secondary to bacteriolysis
Contraindications :
Hypersensitivity to penicillins& cephalosporins. Severe pneumonia, empyema, sepsis, pericarditis,
meningitis, peritonitis or arthritis requiring high dose of penicillin levels, bronchial asthma
Interactions :
Bacteriostatic antibiotics, anti-inflammatory, antirheumatics, antipyretics, probenecids, oral
contraceptives
---------------------------------------------------------------------------------------------------------------162
Benzylpenicillin 1 mega unit (600 mg) Injection
B
Benzylpenicillin 5 mega units (3 g) Injection
B
Indication :
i) Infections caused by susceptible organisms ii) Infective endocarditis
Dosage :
i) ADULT: 600 - 1200 mg IM 4 times daily, increased if necessary in more serious infections. CHILD:
50 - 100 mg/kg body weight daily IV in 2 - 4 divided doses ii) ADULT: 7.2 g daily by slow IV infusion in
6 divided doses
Precautions :
History of anaphylaxis, accelerated (e.g. hives) or serum sickness reaction to previous penicillin
administration
Adverse Reactions :
Hypersensitivity reactions, GI disturbances, eosinophilia, haemolytic anaemia, leucopenia,
agranulocytosis. Convulsions in the presence of severely reduced renal function, epilepsy, meningitis
or cerebral oedema or during cardiopulmonary bypass procedure
Contraindications :
History of anaphylaxis, accelerated (e.g. hives) or serum sickness reaction to previous penicillin
administration
Interactions :
Bacteriostatic antibiotics, anti-inflammatory, antirheumatics, antipyretics, probenecids, oral
contraceptives
---------------------------------------------------------------------------------------------------------------Cefazolin Sodium 1 g Injection
A
Trade Name : Cefazolin Sandoz
Indication :
Infection caused by cefazolin-sensitive microorganism, infection of the respiratory tract, urogenital
tract, skin and soft tissue, bile duct, bones and joint, endocarditis, systemic septic infection, perioperative/ surgical prophylaxis
Dosage :
ADULT: Uncomplicated infections: 500 - 1000 mg 2 - 3 times daily. Moderately severe and severe
infections: 500 - 1000 mg 3 - 4 times daily. Severe life-threatening infections: 1 - 1.5 g 4 times daily.
Rarely, dose up to 12 g daily
Precautions :
Allergic, diathesis with bronchial asthma or hay fever, history of GI disease, renal impairment,
Adverse Reactions :
Drug induced fever, reddening of skin with heat sensation, angioneurotic edema, itch, Steven
Johnson Syndrome, urticaria, eosinophilia, allergic nephritis, GI disturbances, anaphylactic reactions.
Pseudomembranous enterocolitis, leukopenia, thrombocytopenia, neutropenia and hepatotoxicity
Contraindications :
Hypersensitivity to cephalosporins
Interactions :
Warfarin, probenecid
---------------------------------------------------------------------------------------------------------------Cefepime 1 g Injection
A*
Trade Name : Maxipime
Indication :
Febrile neutropenia, septicaemia, lower respiratory tract infection, urinary tract infection, skin and
skin structure infections, gynaecologic and intra-abdominal infections
163
Dosage :
ADULT: 1 - 2 g twice daily for most infections. For severe infections including febrile neutropenia: 2 g
3 times daily. CHILD: 25 - 50 mg/kg 3 times daily
Precautions :
Hypensensitivity, pseudomembranous colitis& superinfection may occur. Discontinue therapy if
allergic reaction occurs. Pregnancy, lactation
Adverse Reactions :
GI disturbances (diarrhoea, nausea, vomiting), history of colitis, hypersensitivity, respiratory and CNS
disorders including headache, vaginitis
Contraindications :
Hypersensitivity to cephalosporins, penicillins or other beta-lactam antibiotics
Interactions :
Typhoid vaccine
---------------------------------------------------------------------------------------------------------------Cefoperazone Sodium 1 g Injection
A
Trade Name : Cefobid
Indication :
Infections due to gram-negative bacteria
Dosage :
ADULT: 1 - 2 g twice daily IM or IV. By IV, adult dose may be doubled. Maximum: 16 g daily in divided
doses. CHILD & INFANT: 50 - 200 mg/kg/day in 2 - 4 divided doses. NEONATE less than 8 days: 50 200 mg/kg/day 12 hourly
Precautions :
Penicillin-sensitive patients, severe biliary obstruction, severe hepatic disease or coexisting renal
dysfunction
Adverse Reactions :
Hypersensitivity reactions eg. rash, urticaria, fever, neutropenia (reversible), hypothrombinaemia, GI
effects & local reactions, vitamin K deficiency
Contraindications :
Hypersensitvity to cephalosporins
Interactions :
Heparin, typhoid vaccine, warfarin
---------------------------------------------------------------------------------------------------------------Cefoperazone Sodium 500 mg & Sulbactam Sodium 500 mg Injection
A
Trade Name : Sulperazon
Indication :
i) Treatment of infections due to multi-drug resistance pathogens producing B-lactamase ii)
Treatment of infections caused by Acinetobacter species
Dosage :
ADULT: 1 - 2 g twice daily. CHILD: 40 - 80 mg/kg/day
Precautions :
Hepatic dysfunction& concomitant renal impairment, ingestion of alcoholic beverages; overgrowth
of nonsusceptible organisms
Adverse Reactions :
Diarrhoea, nausea, vomiting, maculopapular rash, urticaria; eosinophilia; drug fever
Contraindications :
Known allergy to penicillins, sulbactam or cephalosporins
164
Interactions :
Heparin, typhoid vaccine, warfarin
---------------------------------------------------------------------------------------------------------------Cefotaxime 1 g Injection
A
Trade Name : Claforan
Indication :
Infections due to gram-negative bacteria
Dosage :
ADULT: 1 g 12 hourly (up to 12 g/day in severe cases). CHILD: 50 - 180 mg/kg/day in 4 - 6 divided
doses
Precautions :
Hypersensitivity to penicillins, history of gastrointestinal disease especially colitis, pregnancy &
lactation
dverse Reactions :
Rash, pruritus, diarrhoea, nausea, vomiting, colitis, thrombocytopenia, eosinophilia, leucopenia,
hypersensitivity reactions, GI effects, anaphylactic shock(rare)
Contraindications :
Interactions :
Aminoglycosides, probenecid, typhoid vaccine
---------------------------------------------------------------------------------------------------------------Ceftazidime 1 g Injection
A
Ceftazidime 2 g Injection
A
Trade Name : Fortum
Indication :
Severe gram negative bacterial infections
Dosage :
ADULT: 1 g 8 hourly or 2 g 12 hourly. In severe infections: 2 g 8 hourly. CHILD: 25 - 150 mg/kg/day in
2 - 3 divided doses
Precautions :
Hypersensitivity to penicillins, renal impairment
Adverse Reactions :
GI upsets, CNS effects, phlebitis or thrombophlebitis at the IV injection site, pain and/or
inflammation after IM injection, very rarely hypersensitivity reactions. Transient haematologicals
changes
Contraindications :
Interactions :
Aminoglycosides, probenecid, chloramphenicol, live typhoid vaccine
---------------------------------------------------------------------------------------------------------------Ceftriaxone 0.25g Injection
Trade Name : Rocephin
Indication :
i.Gonorrhea ii. Chancroid
Dosage :
i.250mg by deep IM injection
100mg/kg/day
A
ii. Single IM injection 250mg only. For severe infection up to
165
Precautions :
Previous hypersensitivity to penicillins, anaphylactic shock, severe renal& hepatic failure, pregnancy.
Ceftriaxone and calcium -containing solutions may be administered sequentially to one another if
the infusion lines are thoroughly flushed between infusions with compatible fluid. Diluents
containing calcium (Ringer's / Hartmann's solution) are not to be used to reconstitute
ceftriaxonevials or to further dilute a reconstituted vial for IV administration because a precipitate
can form. Ceftriaxone must not be administered simultaneously with calcium- containing
intravenous solutions, including continous calcium -containing infusions such as parenteral nutrition
via a Y-site, because precipaitation of ceftriaxone-calcium can occur
Adverse Reactions :
GI upsets, haematological changes, skin reactions, coagulation disorders, phlebitis, agranulocytosis,
renal precipitations
Contraindications :
Hypersensitivity to cephalosporins. Neonates aged less than or 28 days if they require treatment
with calcium-containing intravenous solutions, including calcium-containing infusions such as
parenteral nutrition, because of the risk of precipitation of ceftriaxone-calcium
Interactions :
Ciclosporin, typhoid vaccine
---------------------------------------------------------------------------------------------------------------Ceftriaxone 1g Injection
A
Trade Name : Rocephin
Indication :
Dosage :
ADULT: 1 - 2 g once daily. Severe infection: 4 g daily at 12 hour intervals. INFANT & CHILD, 3 weeks 12 years: 20 - 80 mg/kg body weight daily. CHILD with body weight 50 kg or more: adult dose.
NEONATE up to 2 weeks: 20 - 50 mg/kg body weight daily, not to exceed 50 mg/kg
Precautions :
Previous hypersensitivity to penicillins, anaphylactic shock, severe renal& hepatic failure, pregnancy.
Ceftriaxone and calcium -containing solutions may be administered sequentially to one another if
the infusion lines are thoroughly flushed between infusions with compatible fluid. Diluents
containing calcium (Ringer's / Hartmann's solution) are not to be used to reconstitute
ceftriaxonevials or to further dilute a reconstituted vial for IV administration because a precipitate
can form. Ceftriaxone must not be administered simultaneously with calcium- containing
intravenous solutions, including continous calcium -containing infusions such as parenteral nutrition
via a Y-site, because precipaitation of ceftriaxone-calcium can occur
Adverse Reactions :
GI upsets, haematological changes, skin reactions, coagulation disorders, phlebitis, agranulocytosis,
renal precipitations
Contraindications :
Hypersensitivity to cephalosporins. Neonates aged less than or 28 days if they require treatment
with calcium-containing intravenous solutions, including calcium-containing infusions such as
parenteral nutrition, because of the risk of precipitation of ceftriaxone-calcium
Interactions :
Ciclosporin, typhoid vaccine
----------------------------------------------------------------------------------------------------------------
166
Cefuroxime Axetil 125 mg Tablet
A/KK
Trade Name : Zinnat
Indication :
Upper respiratory tract, GUT, skin & soft tissue infections, urinary tract infection (UTI),
pyelonephritis
Dosage :
ADULT: 250 mg twice daily ;UTI: 125 mg twice daily. CHILD:125 mg twice daily. Maximum 250
mg/day
Precautions :
Anaphylactic reaction to penicillins
Adverse Reactions :
GI disturbances occasionally pseudomembraneous colitis, hypersensitivity reactions, eosinophilia,
headache, superinfection
Contraindications :
Interactions :
Aminoglycosides, typhoid vaccine
---------------------------------------------------------------------------------------------------------------Cefuroxime Axetil 125 mg/5 ml Suspension
A
Trade Name : Zinnat
Indication :
Dosage :
30 mg/kg/day in 2 divided doses
Precautions :
Adverse Reactions :
Contraindications :
Interactions :
---------------------------------------------------------------------------------------------------------------Cefuroxime Sodium 1.5 g Injection
A
Cefuroxime Sodium 750 mg Injection
A
Trade Name : Zinacef
Indication :
Infections caused by susceptible organisms, surgical prophylaxis
Dosage :
ADULT: 750 mg 6 - 8 hours IM or IV. Severe infections: 1.5 g three times to four times daily IV. CHILD:
30 - 100 mg/kg/day in 3 - 4 divided doses. Surgical prophylaxis: 1.5 g IV
Precautions :
Adverse Reactions :
167
Contraindications :
Interactions :
---------------------------------------------------------------------------------------------------------------Cephalexin Monohydrate 125 mg/5 ml Syrup
B
Trade Name : Ceporex
Indication :
Respiratory tract infections, ear, nose and throat infections, urinary tract infections, obstetric and
gynaecologic infections
Dosage :
CHILD: 25 - 100 mg/kg/day every 6 hourly. Maximum: 4 g daily
Precautions :
Hypersensitivity to penicillins, renal impairment, superinfection
Adverse Reactions :
GI disturbances, overgrowth of non-susceptible organisms, hypersensitivity reactions, reversible
neutropenia
Contraindications :
Interactions :
Concurrent treatment with high doses of cephalosporins& aminoglycosides or potent diuretics may
adversely affect renal function. Probenecid may increase or prolong plasma level& toxicity of
cephalosporins
---------------------------------------------------------------------------------------------------------------Cephalexin Monohydrate 250 mg Capsule
B
Trade Name : Ceporex
Indication :
i) Respiratory tract infection, urinary tract infection ii) Complicated, recurrent or chronic infections,
bronchitis iii) Pneumonia
Dosage :
i) 250 mg 6 hourly ii) 250 - 500 mg 6 hourly iii) 1 - 1.5 g 3 times daily or 4 times daily. Maximum: 6
g/day
Precautions :
cephalosporins
Adverse Reactions :
GI disturbances, overgrowth of non-susceptible organisms, hypersensitivity reactions, reversible
neutropenia
Contraindications :
Interactions :
cephalosporins
----------------------------------------------------------------------------------------------------------------
168
Chloramphenicol Sodium Succinate 1 g Injection
B
Trade Name : Chloromycetin
Indication :
Treatment of typhoid, paratyphoid fevers, bronchopneumonia and enteric infection
Dosage :
ADULT: 1.5 - 3 g daily in divided doses every 6 hourly. CHILD: 25 -100 mg/kg/day in divided doses
every 6 hourly
Precautions :
Repeated courses& chronic treatment, infants, impaired liver or kidney function. Frequent
haematological examination is recommended
Adverse Reactions :
Depression of bone marrow leading to agranulocytosis, thrombocytopenia purpura, leucopenia and
aplastic anaemia. Peripheral& optic neuritis, erythema multiforme, GI disorders, urticaria, dry mouth
and blurred vision
Contraindications :
Hypersensitivity, pregnancy and lactation, anaemia, porphyria
Interactions :
Phenobarbitone& rifampicin may reduce the plasma concentration. Drugs which potentially depress
bone marrow function. May potentiate actions of phenytoin, sulfonylureas& anticoagulants
---------------------------------------------------------------------------------------------------------------Ciprofloxacin 100 mg/50 ml Injection
A
Trade Name : Ciprobay
Indication :
Treatment of infections due to susceptible bacterial strains
Dosage :
ADULT uncomplicated infections:200 mg/day; acute gonorrhoea and acute uncomplicated cystitis in
women can be treated with a single infusion of 100 mg.Other infections: 400-800 mg/day
Precautions :
Epilepsy, CNS disorder, liver damage, renal impairment. Avoid prolonged exposure to sunlight
Adverse Reactions :
Nausea, diarrhoea, vomiting, dyspepsia, abdominal pain, flatulence, anorexia, dizziness, headache,
tiredness, agitation, trembling, insomnia, peripheral paralgesia, sweating, unsteady gait, convulsions,
increase in intracranial pressure, anxiety states, nightmares, confusion, depression, hallucinations,
impaired taste and smell, visual disturbances, tinnitus, transitory impairment of hearing, especially
at high frequencies, skin reactions
Contraindications :
Hypersensitivity to ciprofloxacin or other quinolones. Children, adolescents, pregnancy and lactation
Interactions :
Theophylline, iron, magnesium, aluminium, calcium, sulcralfate, antacids, probenecid, NSAIDs,
antineoplastics, immunosuppressants, cyclosporin, warfarin, glibenclamide, metoclopramide and
other prokinetic drugs
---------------------------------------------------------------------------------------------------------------Ciprofloxacin 250 mg Tablet
Trade Name : Ciprobay
Indication :
Treatment of infections due to susceptible bacterial strains
Dosage :
ADULT: 125-750 mg twice daily. Acute gonorrhoea: a single dose of 250 mg
169
A
Precautions :
Epilepsy, CNS disorder, liver damage, renal impairment. Avoid prolonged exposure to sunlight
Adverse Reactions :
Nausea, diarrhoea, vomiting, dyspepsia, abdominal pain, flatulence, anorexia, dizziness, headache,
tiredness, agitation, trembling, insomnia, peripheral paralgesia, sweating, unsteady gait, convulsions,
increase in intracranial pressure, anxiety states, nightmares, confusion, depression, hallucinations,
impaired taste and smell, visual disturbances, tinnitus, transitory impairment of hearing, especially
at high frequencies, skin reactions
Contraindications :
Hypersensitivity to ciprofloxacin or other quinolones. Children, adolescents, pregnancy and lactation
Interactions :
Theophylline, iron, magnesium, aluminium, calcium, sulcralfate, antacids, probenecid, NSAIDs,
antineoplastics, immunosuppressants, cyclosporin, warfarin, glibenclamide, metoclopramide and
other prokinetic drugs
---------------------------------------------------------------------------------------------------------------Clarithromycin 250 mg Tablet
A*
Trade Name : Klacid
Indication :
Only for i) treatment of complicated respiratory tract infection not responding to standard
macrolides ii) eradication of Helicobacter pylori infection
Dosage :
i) 250 - 500 mg twice daily. Up to 6 - 14 days ii) 500 mg twice daily with omeprazole & amoxicillin. Up
to 2 weeks
Precautions :
Impaired hepatic function & moderate to severe renal impairment
Adverse Reactions :
Nausea, dyspepsia, abdominal pain & diarrhoea. Headache & skin rash. Reversible hearing loss.
Alteration of sense of smell with taste perversion. Glossitis, stomatitis, oral monilia, tongue
discoloration, tooth discoloration (reversible)
Contraindications :
Known hypersensitivity to macrolides. Patients receiving terfenadine therapy with pre-existing
cardiac abnormalities or electrolyte disturbances
Interactions :
Modest increase of circulating theophylline or carbamazepine levels. May potentiate effects of
warfarin or digoxin. May alter metabolism of terfenadine resulting in increased levels of terfenadine.
Inhibition of metabolism with ritonavir
---------------------------------------------------------------------------------------------------------------Clindamycin HCl 300 mg Capsule
A*
Trade Name : Lincocin
Indication :
i) Skin and soft tissue infections, bone& joint infections ii) Cerebral toxoplasmosis iii) Children less
than 8 years old:Treatment and prophylaxis of malaria in combination with quinine, as an alternative
to doxycline
Dosage :
i) ADULT: 150 - 300 mg every 6 hours; up to 450 mg every 6 hours in severe infections; CHILD: 3 - 6
mg/kg every 6 hours ii) 600 mg 6 hourly for 6 weeks iii) 10mg/kg twice a day, in combination with
quinine. The combination to be given for 7 days
170
Precautions :
History of GI disease, especially colitis. Renal or hepatic impairment. Perform periodic liver and
kidney function tests with prolonged therapy and in neonates and infants. Discontinue immediately
if diarrhoea or colitis develops. Pregnancy and lactation
Adverse Reactions :
Diarrhoea occasionally with acute colitis (discontinue), abdominal pain, GI upsets, skin reactions,
jaundice, hematopoietic changes, pseudomembranous enterocolitis, pruritus, vaginitis
Contraindications :
Hypersensitivity to clindamycin or lincomycin
Interactions :
Neuromuscular blockers, erythromycin
---------------------------------------------------------------------------------------------------------------Cloxacillin Sodium 125 mg/5 ml Suspension
B
Trade Name : Orbenin
Indication :
Treatment of susceptible bacterial infections, notably penicillinase-producing
staphylococci
Dosage :
CHILD 2 - 10 years: 250 mg 6 hourly, less than 2 years: 125 mg 6 hourly
Precautions :
Renal impairment. Neonates born to mothers hypersensitive to penicillin. Hypersensitivity to
cephalosporins
Adverse Reactions :
Occasional rashes, GI upsets, anaphylaxis
Contraindications :
Hypersensitivity to cloxacillin products/penicillins
Interactions :
Probenecid impairs renal excretion. Decreases anticoagulant effect
---------------------------------------------------------------------------------------------------------------Cloxacillin Sodium 250 mg Capsule
B
Indication :
Treatment of susceptible bacterial infections, notably penicillinase-producing staphylococci
Dosage :
ADULT: 250 - 500 mg every 6 hours. CHILD: 2 - 10 years: 250 mg 4 times daily; less than 2 years: 125
mg 4 times daily
Precautions :
Renal impairment. Neonates born to mothers hypersensitive to penicillin. Hypersensitivity to
cephalosporins
Adverse Reactions :
Occasional rashes, GI upsets, anaphylaxis
Contraindications :
Interactions :
Probenecid impairs renal excretion. Decreases anticoagulant effect
----------------------------------------------------------------------------------------------------------------
171
Cloxacillin Sodium 250 mg Injection
B
Cloxacillin Sodium 500 mg Injection
B
Indication :
Treatment of susceptible bacterial infections, notably penicillinase-producing staphylococci
infections
Dosage :
ADULT: 250 to 500 mg every 6 hours depending on type and severity of infection. CHILD less than 20
kg: 25 to 50 mg/kg/day in equally divided doses every 6 hours
Precautions :
History of asthma or allergic-type reactions to other medications, overgrowth of nonsusceptible
organisms
Adverse Reactions :
Fever, rash, nausea, vomiting, diarrhoea, hepatotoxicity, anaphylaxis
Contraindications :
Interactions :
Allopurinol, chloramphenicol. Probenecid impairs renal excretion. Anticoagulant effect is decreased.
Tetracycline, oestrogen-containing oral contraceptives
---------------------------------------------------------------------------------------------------------------Dapsone 100 mg Tablet
B
Indication :
i)Leprosy ii) Dermatitis herpetiformis
Dosage :
i) ADULT: 6 - 10 mg/kg weekly (around 50 - 100 mg daily). CHILD: 1 - 2 mg/kg/day. Maximum: 100
mg/day ii) ADULT: 50 - 300 mg daily
Precautions :
Cardiac, pulmonary, hepatic or renal disease, pregnancy, lactation
Adverse Reactions :
Nausea, vomiting, anorexia; fever, malaise, headache; dizziness, tachycardia, nervousness, insomnia,
skin disorders, agranulocytosis, peripheral neuritis, psychosis, haemolysis, methaemoglobinemia;
hypersensitivity reactions
Contraindications :
Hypersensitivity to dapsone products, severe anaemia, G6PD deficiency
Interactions :
Rifampicin increases plasma clearance of dapsone. Excretion decreased by probenecid.
Pyrimethamine may increase the likelihood of haematologic reactions
---------------------------------------------------------------------------------------------------------------Doxycycline 100 mg Capsule
Trade Name : Vibramycin
Indication :
Dosage :
ADULT: 200 mg on the first day followed by 100 mg daily. Severe infections: 200 mg daily
Precautions :
Lactation, myasthenia gravis, hepatic or renal impairment
Adverse Reactions :
GI distress, anorexia, maculopapular and erythematous rash, tooth discolouration in children
172
B
Contraindications :
Hypersensitivity to tetracyclines/doxycycline, porphyria, pregnancy, lactation, children less than 12
years
Interactions :
Anticoagulants, penicillin, antacids, ferum, acitretin, isotretinoin, methotrexate
-------------------------------------------------------------------------------------------------------------------------Erythromycin Stearate 250mg Tablet
B
Indication:
Infections due to susceptible organism
Dosage :
ADULT: 250 - 500 mg 6 hourly. CHILD: 30 - 50 mg/kg/day in 4 divided doses
Precautions :
Hypersensitivity, porphyria
Adverse Reactions :
Abdominal discomfort, mild allergic reaction; liver dysfunction with or without jaundice; reversible
hearing loss, prolonged Q-T interval, ventricular arrhythmias, GI disturbances
Contraindications :
Hepatic& renal impairment, myasthenia gravis
Interactions :
Can increase plasma concentration of warfarin, theophylline, carbamazepine, cyclosporin, possibly
phenytoin. Combination with ergotamine increases risk of peripheral ischaemia. Caution when taken
with terfenadine or astemizole
---------------------------------------------------------------------------------------------------------------Erythromycin Ethylsuccinate 200 mg/5 ml Suspension
B
Trade Name : Erythrocin
Indication :
Dosage :
CHILD: mild to moderate infection: 30 - 50 mg/kg/day in equally divided doses every 6 hours. For
more severe infection this dose may be doubled. Doses may be given 2 - 3 times a day
Precautions :
Adverse Reactions :
Contraindications :
Interactions :
---------------------------------------------------------------------------------------------------------------Erythromycin Ethylsuccinate 400 mg Tablet
Trade Name : EES
Indication :
B
173
Dosage :
ADULT: 400 mg 6 hourly or 800 mg 12 hourly. Maximum 4 g/day. CHILD: 30 - 50 mg/kg/day in 2 - 4
divided doses
Precautions :
Adverse Reactions :
Contraindications :
Interactions :
---------------------------------------------------------------------------------------------------------------Erythromycin Lactobionate 500 mg Injection
A*
Trade Name : Erythrocin
Indication :
Only for treatment of i) certain forms of meningitis ii) septicaemia not responding to usual
antibiotics iii) mycoplasma pneumonia iv) infection with gram-positive organisms (e.g. tetanus,
streptococcal infection) associated with Penicillin allergy, only when oral erythromycin cannot be
given
Dosage :
ADULT& CHILD: 15 - 20 mg/kg/day in divided doses by IV infusion or intermittently by slow IV over 1
hour at intervals not more than 6 hourly. Maximum: 4 g/day
Precautions :
Adverse Reactions :
Phlebitis; mild allergic reaction; liver dysfunction with or without jaundice, reversible hearing loss,
prolonged Q-T interval, ventricular arrhythmias, GI disturbances
Contraindications :
Hypersensitivity, porphyria. Systemic: concomitant use with ergot derivatives or cisapride
Interactions :
-------------------------------------------------------------------------------------------------------------------------Ethambutol HCl 400 mg Tablet
B
Trade Name : Myambutol
Indication :
Tuberculosis
Dosage :
ADULT & CHILD more than 13 years: Initial treatment: 15 mg/kg as a single daily dose 24 hourly.
Retreatment: 25 mg/kg/day as a single dose 24 hourly. Concurrent anti-TB drug required. After 60
days, decrease to 15 mg/kg body weight as single dose 24 hourly
Precautions :
Reduced visual acuity. Reduced dosage in impaired renal function. May precipitate attack of gout.
Ocular examination is recommended
174
Adverse Reactions :
Generally well tolerated but may provoke reversible retrobulbar neuritis with a reduction of visual
acuity, central scotoma& green-red colour blindness, allergic rashes, GI disturbances, jaundice,
peripheral neuritis, confusion, hallucinations, joint pain, fever, malaise, headache, dizziness,
anorexia& abdominal pain
Contraindications :
Optic neuritis; history of previous adverse effects with ethambutol
Interactions :
Aluminium hydroxide, ethionamide
-------------------------------------------------------------------------------------------------------------------------Fusidic Acid 500 mg Injection
A*
Trade Name : Fucidin
Indication :
Treatment of severe staphylococcal infections especially Methicillin Resistant Staphylococcus aureus
(MRSA). To be used in combination therapy only
Dosage :
ADULT : 500 mg 3 times daily diluted to 250 - 500 ml infused slowly over 2 hours. Maximum : 2 g
daily. CHILD and INFANT : 20 mg/kg/day divided into 3 equal doses infused slowly over 2 - 4 hours
Precautions :
Hepatic insufficiency, pregnancy and lactation
Adverse Reactions :
Reversible jaundice, thrombophlebitis
Contraindications :
Hypersensitivity to fusidic acid and or its salts
Interactions :
Hepatotoxicity and increased plasma concentrations of fusidic acid and ritonavir. An increased risk of
myopathy or rhabdomyolysis with simvastatin
---------------------------------------------------------------------------------------------------------------Gentamicin Sulphate 80 mg/2 ml Injection
B
Trade Name : Garamycin
Indication :
Dosage :
ADULT: 3 - 5 mg/kg/day 8 hourly IM or IV. CHILD up to 2 weeks: 3mg/kg every 12 hours; 2 weeks - 12
years: 2 mg/kg 8 hourly
Precautions :
Pregnancy. Patients with reduced renal function, myasthenia gravis or Parkinson
Adverse Reactions :
Vestibular& auditory toxicity, renal toxicity, neuromuscular blockade, superinfection, nausea,
vomitting, rash, blood disorders
Contraindications :
Known hypersensitivity. Patients with pre-existent vestibular& or cochlear disease. Administration of
other ototoxic and/or nephrotoxic antibiotics. Pregnancy and lactation
Interactions :
Concurrent or sequestial administration with potent antidiuretics, anaesthetics, neuromuscular
blockers, other aminoglycosides, polymyxin, amphotericin B, mannitol, cephalosporins
----------------------------------------------------------------------------------------------------------------
175
Imipenem 500 mg and Cilastatin 500 mg Injection
A*
Trade Name : Tienam
Indication :
Severe infections caused by susceptible pathogens especially useful in infections involving ESBL
organisms. Not to be used for prophylaxis
Dosage :
Based on type or severity of infection, susceptibility of pathogen(s) and patient condition including
body weight and renal function. ADULT: 1 - 2 g/day in 3 - 4 divided doses. Maximum: 4 g/day or 50
mg/kg/day. Infusion rate: less than 500 mg dose: over 20 - 30 minutes, more than 500 mg: dose over
40 - 60 minutes. CHILD: 15 - 30 mg/kg/dose, infusion at 6 - 12 hourly intervals depending on age.
Maximum: 2 g/day
Precautions :
Hypersensitivity to penicillins, cephalosporins and other beta lactams. History of GI disease. Caution
in patients with CNS disorders and or compromised renal function in whom accumulation of drug
could occur. If CNS symptoms occur, dosage should be decreased or discontinued. Usage during
pregnancy, lactation and children less than 3 months or paediatrics patients with impaired renal
function
Adverse Reactions :
Thrombophlebitis, pain, erythema & tenderness following injection. Rash, urticaria, pruritus, GI
disturbances, pseudomembranous colitis, haematological disturbances, increase in liver enzymes,
taste perversion. Myoclonic activity, seizures, psychic disturbances, confusional states
Contraindications :
Hypersensitivity to local anaesthetics of the amide-type and in patients with severe shock or heart
block
Interactions :
Ganciclovir
-------------------------------------------------------------------------------------------------------------------------Isoniazid 100 mg Tablet
B
Isoniazid 400 mg Tablet
B
Indication :
i) Tuberculosis ii)Tuberculous meningitis
Dosage :
i) ADULT and CHILD 5 mg/kg (4-6 mg/kg) daily,maximum 300 mg daily) or 10 mg/kg 3 times weekly ii)
15 - 20 mg/kg daily
Precautions :
Increased risk of hepatitis in severe renal dysfunction, chronic liver disease, daily users of alcohol,
increased risk of fatal hepatitis in females
Adverse Reactions :
Peripheral neuropathy and hepatotoxicity, psychiatric sign or symptom, agranulocytosis, anaemia,
megaloblastic anaemia, thrombocytopenia, systemic lupus erythematosus, seizure
Contraindications :
Acute liver disease, hypersensitivity to isoniazid
Interactions :
Inhibits metabolism of antiepileptics (carbamazepine, ethosuximide and phenytoin) and diazepam,
reduced plasma concentration of ketoconazole and increased theophylline plasma concentration
--------------------------------------------------------------------------------------------------------------------------
176
Levofloxacin 500 mg Tablet
A*
Trade Name : Loxof, Cravit
Indication :
Community acquired pneumonia
Dosage :
500 mg daily for 7 - 14 days
Precautions :
Renal impairment (CrCl less than 50 mL/minute), CNS disorders, predisposition to seizures, lowered
convulsion threshold, diabetes mellitus, conditions predisposing to torsade de pointes, significant
bradycardia, cardiomyopathy, G6PD deficiency. Ensure adequate hydration. Avoid excessive sun
exposure. May affect ability to drive or operate machinery
Adverse Reactions :
Diarrhoea, nausea, headache, blurred vision, hypoglycemia, tendinitis, anaphylactic reactions,
Stevens-Johnson syndrome
Contraindications :
Hypersensitivity to quinolones, pregnancy & lactation. Children and growing adolescents less than
18 years old
Interactions :
Antacids, sucralfate, divalent cations, multivitamin, theophylline, warfarin, NSAIDS, antidiabetic
agents, amiodarone, chlorpromazine, cortisone, dexamethasone, diclofenac, disopyramide,
ibuprofen, indomethacin, iron, ketoprofen, ketorolac, mefenamic acid, meloxicam, naproxen,
phenylbutazone, piroxicam, prednisolone, prochlorperazine, quinidine
---------------------------------------------------------------------------------------------------------------Linezolid 2mg/ml Injection
A*
Trade Name : Zyvox
Indication :
MRSA patient with severe sepsis requiring intensive care and not clinically responding
to vancomycin
Dosage :
ADULT: 600 mg twice daily for 10 - 14 days. CHILD: 10 mg/kg 3 times daily. PREMATURE NEONATES
less than 7 days: 10 mg/kg twice daily
Precautions :
Monitor Full Blood Count (FBC) in patients with pre-existing myelosuppression, increased bleeding
risk or who receive medications that may decrease haemoglobin levels, platelet count or function, or
who received linezolid for more than 2 weeks. Pregnancy
Adverse Reactions :
Headache, insomnia, thrombocytopenia, myelosuppression, optic nerve disorder, peripheral
neuropathy, diarrhoea, nausea, myelosuppression, vomiting, constipation, rash, dizziness, fever
Contraindications :
Hypersensitivity to linezolid
Interactions :
Citalopram, dopamine, epinephrine, escitalopram, fluoxetine, fluvoxamine, sertraline, venlafaxine,
pseudoephedrine, tramadol
----------------------------------------------------------------------------------------------------------------
177
Meropenem 1 g Injection
A*
Meropenem 500 mg Injection
A*
Trade Name : Meronem
Indication :
i. Emperical treatment for presume infections in patients (adult and children) with febrile
neutropenia, used as monotherapy or in combination with anti-virals or antifungal agent ii.
Septicaemia iii. Serious infections in renal impaired patients
Dosage :
ADULT: 0.5 - 1g 3 times daily, CHILD: 10 - 20 mg/kg 3 times daily (except meningitis 40 mg/kg)
Precautions :
History of hypersensitivity to carbapenems or other beta-lactam antibiotics, penicillins and
cephalosporins. Monitor transaminase and bilirubin levels when used in hepatic disease. Not
recommended for MRSA infections. Consider diagnosis of pseudomembranous colitis in patients
who develop diarrhoea. Critically ill patients with Pseudomonas aeruginosa infection. Pregnancy and
lactation
Adverse Reactions :
Local injection site reactions, rash, pruritus, urticaria, abdominal pain, nausea, vomiting, diarrhoea,
headache, paraesthesia, oral and vaginal candidiasis, reversible thrombocytopenia, leucopenia,
eosinophilia, thrombocytopenia, neutropenia
Contraindications :
Hypersensitivity to meronem, carbapenems, penicillins or other beta-lactam antibiotics
Interactions :
Probenecid, valproic acid, typhoid vaccine
---------------------------------------------------------------------------------------------------------------Metronidazole 200 mg Tablet
B
Trade Name : Flagyl
Indication :
Anaerobic infection
Dosage :
800 mg initially followed by 400 mg 8 hourly. CHILD: 7.5 mg/kg every 8 hours
Precautions :
Caution in patient with active disease of CNS except for brain abscess or hepatic encephalopathy.
Adverse Reactions :
Unpleasant taste in mouth, furry tongue, gastrointestinal disturbances, urticaria, angioedema,
drowsiness, dizziness, headache, ataxia, skin rashes, pruritus, darkening of urine, peripheral
neuropathy or transient epileptiform seizures, leucopenia, nausea, vomiting, erythema multiforme,
hepatitis, jaundice, thrombocytopenia, aplastic anaemia, myalgia, arthralgia
Contraindications :
Hypersensitivity to metronidazole. Chronic alcohol dependence
Interactions :
Alcohol, warfarin, phenobarbitone, lithium, phenytoin, cimetidine, amiodarone, busulfan,
carbamazepine, cholestyramine, cyclosporine, dihydroergotamine, disulfiram, ergotamine,
fluorouracil, tacrolimus
---------------------------------------------------------------------------------------------------------------Metronidazole 500 mg/100 ml Injection
Trade Name : Metrogyl
Indication :
Anaerobic infections
A
178
Dosage :
ADULT: 500 mg IV infusion 8 hourly. CHILD: 7.5 mg/kg body weight every 8 hours
Precautions :
If administered for more than 10 days, haematological tests are recommended. Re-administer
immediately after haemodialysis. Caution in patient with active disease of CNS except for brain
abscess or hepatic encephalopathy. Pregnancy & lactation
Adverse Reactions :
GI disturbances, urticaria, angioedema, drowsiness, dizziness, headache, ataxia, skin rashes, pruritus,
darkening of urine, peripheral neuropathy or transient epileptiform seizures, leucopenia,
anaphylaxis
Contraindications :
Hypersensitivity to metronidazole
Interactions :
Alcohol, warfarin, phenobarbitone, lithium, phenytoin, cimetidine, amiodarone, busulfan,
carbamazepine, cholestyramine, cyclosporine, dihydroergotamine, disulfiram, ergotamine,
fluorouracil, tacrolimus
---------------------------------------------------------------------------------------------------------------Netilmicin Sulphate 150mg/2ml Injection
A
Trade Name : Netromycin
Indications :
Systemic infections
Dosage :
ADULT: 4 - 6.5 mg/kg/day IM or IV in 2 - 3 equally divided doses for 7 - 14 days. Maximum: 7.5
mg/kg/day. CHILD: 5 - 7.5 mg/kg/day 8 - 12 hourly depending on gestation and age. Maximum: 7.5
mg/kg/day
Precautions :
Renal impairment; neuromuscular disorder eg myasthenia gravis or Parkinson, hypocalcaemia.
Pregnancy & lactation. Good hydration during treatment required
Adverse Reactions :
Nephrotoxicity, neurotoxicity (auditory & vestibular toxicity); local reactions; GI effects, fever; blood
coagulation abnormalities
Contraindications :
Known allergy to netilmicin products/aminoglycosides
Interactions :
Lysine, tacrolimus, neuromuscular blockers such as alcuronium, pancuronium, rocuronium,
vecuronium
---------------------------------------------------------------------------------------------------------------Nitrofurantoin 100 mg Tablet
B
Trade Name : Furadantin
Indication :
Uncomplicated lower urinary tract infections
Dosage :
i) Acute uncomplicated infections: ADULT: 50 mg every 6 hours or 100 mg every 12 hours with food
for 7 days. CHILD more than 3 months: 3mg/kg/day in 4 divided doses ii) Severe chronic recurrent
infection: ADULT: 100 mg every 6 hours with food for 7 days (dose reduced or discontinued if severe
nausea) iii) Prophylaxis: 50 - 100 mg at night. CHILD over 3 months: 1 mg/kg at night
Precautions :
Pulmonary disorders or hepatic impairment, neurological or allergic disorders, anaemia, diabetes
mellitus, elderly and debilitated, monitor lung and liver function on long-term therapy
179
Adverse Reactions :
Anorexia, nausea, vomiting, diarhoea, acute and chronic pulmonary reactions, peripheral
neuropathy, hypersensitivity reactions, hepatic reaction (hepatic necrosis, hepatic failure, hepatitis,
jaundice)
Contraindications :
Impaired renal function, infants less than 3 months old, glucose-6-phosphate deficiency (G6PD)
including breast-feeding of affected infants, pregnancy at term and porphyria
Interactions :
Concurrent use with norfloxacin may result in antagonism of antibacterial effect of norfloxacin.
Fluconazole may increased risk of hepatic or pulmonary toxicity. Probenecid, antacids
---------------------------------------------------------------------------------------------------------------Ofloxacin 100 mg Tablet
A
Trade Name : Tarivid
Indication :
i) As second-line treatment of leprosy ii) As second-line treatment for tuberculosis and multidrug
resistant tuberculosis (MDR-TB) iii) Sequential therapy for UTI and pyelonephritis
Dosage :
i) 400 mg/day ii) 400 mg twice daily iii) 200 mg twice daily
Precautions :
CNS disorders or other risk factors that may predispose to seizures or lower the seizure threshold.
Renal or hepatic impairment, diabetes. Avoid exposure to direct sunlight. Children less than 18 years
Adverse Reactions :
Rash, GI discomfort, insomnia, dizziness, rash, pruritus, headache, photosensitivity, diarrhoea,
nausea, vomiting, cardiac dysrhythmia, QT prolongation, immune hypersensitivity reaction,
traumatic or non-traumatic rupture of tendon, peripheral neuropathy, seizure
Contraindications :
Hypersensitivity to quinolones. Pregnancy, lactation
Interactions :
Antacids, sucralfate, oral antidiabetics, warfarin, theophylline, probenecid, aminoglycosides, betalactam antibiotics
-------------------------------------------------------------------------------------------------------------------------------------Phenoxymethyl Penicillin 125 mg Tablet
C
Trade Name : Penicillin V
Indication :
i) Treatment or prophylaxis of infections caused by susceptible organisms ii)
Prophylactic, rheumatic fever
Dosage :
i) ADULT: 500 - 750 mg 6 hourly.CHILD; up to 1 year: 62.5 mg, 1 - 5 years: 125 mg, 6 - 12 years: 250
mg 6 hourly ii) ADULT: 125 - 250 mg twice daily. CHILD: 25 - 50 mg/kg in divided doses every 6 - 8
hours. Maximum: 3 g/day
Precautions :
Use cautiously in patients with penicillin or cephalosporin. Hypersensitivity reactions or asthma.
Haematological& renal function test required on long-term treatment. Not for trivial infection. Renal
or hepatic impairment
Adverse Reactions :
Skin rashes, anaphylaxis, urticaria, fever, joint pain. Haemolytic anaemia, blood disorders,
gastrointestinal distress& superinfection
180
Contraindications :
Hypersensitivity to penicillin
Interactions :
Antirheumatics& antipyretics inhibit excretion. Neomycin may cause malabsorption
-------------------------------------------------------------------------------------------------------------------------------------Piperacillin 4 g & Tazobactam 500 mg Injection
A*
Trade Name : Tazocin 4.5 g
Indication :
Febrile neutropenia, lower respiratory tract infection and severe sepsis
Dosage :
- Adult and children more than 12 years: 4.5 g 8 hourly - Renal insufficiency: CrCL 20 - 80 ml/minute:
4.5 g 8 hourly. CrCL less than 20ml/minute: 4.5 g 12 hourly - Neutropenia adult and children more
than 12 years, more than 50 kg: 4.5 g 6 hourly in combination with aminoglycosides - Children with
normal renal function & less than 50kg: 90 mg/kg 6 hourly in combination with aminoglycosides
Precautions :
Bleeding manifestations, neuromuscular excitability in renal impairment, increased risk of fever and
rash in cystic fibrosis, patients requiring sodium restriction. Not to use in children who do not have
neutropenia
Adverse Reactions :
Allergic reaction, diarrhoea, nausea and vomiting, headache, injection site reactions, rash, pruritus,
anaphylaxis
Contraindications :
Hypersensitivity to penicillins, cephalosporins or beta-lactamase inhibitors
Interactions :
Methotrexate, probenecid, typhoid vaccine, vecuronium
---------------------------------------------------------------------------------------------------------------Procaine Benzylpenicillin Aqueous 4 mega units (4 g) Injection
B
Indication :
Treatment of infections due to Penicillin G-sensitive organisms
Dosage :
ADULT: 300,000 - 900,000 units (300 - 900 mg) IM daily. CHILD: Up to 1 year: 150 mg IM daily. 1 - 5
years: 300 mg IM daily. 6 - 12 years: 600 mg IM daily
Precautions :
History of penicillin or cephalosporin. Hypersensitivity reactions. Histories of significant allergies and
or asthma. Inadvertent intra-arterial administration or injection into or near major peripheral nerves
or blood vessels
Adverse Reactions :
Hypersensitivity reactions, especially skin rashes, diarrhoea, nausea, anaphylaxis, haemolytic
anaemia and neutropenia, prolongation of bleeding time and defective platelet function,
convulsions and other signs of CNS toxicity (encephalopathy has followed intrathecal administration
and can be fatal) and electrolyte disturbances
Contraindications :
History of anaphylactic, accelerated allergic (eg, hives) or serum sickness reactions to previous
penicillin administration. Hypersensitivity to procaine
Interactions :
Probenecid, bacteriostatic antibacterials such as chloramphenicol and tetracyclines, anticoagulants,
methotrexate and oral contraceptives
---------------------------------------------------------------------------------------------------------------181
Pyrazinamide 500 mg Tablet
B
Indication :
Tuberculosis
Dosage :
ADULT & CHILD : 25 mg/kg daily or 35 mg/kg 3 times weekly
Precautions :
Slightly impaired liver function, hyperuricaemia, arthralgia, renal insufficiency, diabetes mellitus
Adverse Reactions :
Liver toxicity depending on treatment duration & concomitant therapy. Transient increase in serum
transminase levels, acute atrophy of the liver. Nausea, vomiting, anorexia, diarrhoea, abdominal
pain. Hyperuricaemia may occur with dosages more than 2 g/day
Contraindications :
Porphyria, severe liver damage, acute liver disease, pregnancy, lactation
Interactions :
Concurrent use of pyrazinamide and zidovudine may result in decreased efficacy of pyrazinamide.
Cyclosporin, ethionamide
---------------------------------------------------------------------------------------------------------------Rifampicin 150 mg Capsule
B
Rifampicin 300 mg Capsule
B
Trade Name : Rifadin
Indication :
i) Tuberculosis ii) Leprosy iii) Prophylaxis for meningococcal meningitis
Dosage :
i) ADULT: 450 - 600 mg as a single morning dose. CHILD: 10 - 20 mg/kg body weight daily in 1 - 2
doses. Directly observed therapy (DOT): 10 mg/kg twice weekly or 3 times/week. Maximum: 600 mg
ii) 600 mg/day iii) 600 mg twice daily for 2 days
Precautions :
Alcoholism, patients with impaired liver function, pregnancy, lactation
Adverse Reactions :
Flushing,
itching,
gastrointestinal
reactions,
pseudomembranous
colitis,
hepatitis,
thrombocytopenia, muscle weakness. Flu syndrome may occur with intermittent dosage regimens.
May produce a reddish brown discoloration of body fluids
Contraindications :
Hypersensitivity and jaundice patient
Interactions :
May reduce the activity of anticoagulant, corticosteroids, cyclosporin, digitalis, oral contraceptives,
oral hypoglycaemics
---------------------------------------------------------------------------------------------------------------Streptomycin Sulphate 1 g Injection
B
Indication :
Tuberculosis
Dosage :
0.5 - 1 g IM of Streptomycin base daily or at longer intervals, cumulative dose should not exceed 100
g
Precautions :
Renal and hepatic impairment. Elderly, poor oral and parenteral nutrition. Pregnancy and lactation
Adverse Reactions :
Ototoxicity, nephrotoxicity, shock, vitamin K and vitamin B deficiency, Steven-Johnson syndrome
182
Contraindications :
Hypersensitivity to other aminoglycosides
Interactions :
Used with blood substitutes and diuretics intensify nephrotoxicity and ototoxicity. Possible inhibition
of respiration with anaesthetics or muscle relaxants
---------------------------------------------------------------------------------------------------------------Sulphamethoxazole 200 mg & Trimethoprim 40 mg/5ml Suspension
B
Trade Name : Bactrim
Indication :
Infections caused by susceptible pathogens
Dosage :
CHILD less than 12 years: Trimethoprim 6 mg & Sulphamethoxazole 30 mg/kg/day, divided into 2
equal doses. CHILD more than 12 years: Standard dose: 10 ml diluted and infused twice daily. Severe
infections: 15 ml diluted and infused twice daily
Precautions :
Haematological disorders, elderly, pregnancy, lactation, G6PD deficiency, folate deficiency, impaired
renal function
Adverse Reactions :
Gastrointestinal upsets, stomatitis, glossitis and skin rashes, tinnitus, erythema multiforme, StevensJohnson syndrome, Lyell's syndrome, leucopenia, neutropenia, thrombocytopenia, agranulocytosis,
megaloblastic anaemia, pancytopenia or purpura, hyperkalaemia
Contraindications :
Marked liver parenchymal damage, blood dyscrasias, severe renal impairment, pregnancy,
hypersensitivity. Use with caution in premature babies or full-term infants in the neonatal period
Interactions :
Increased risk of thrombocytopenia with thiazide diuretics in elderly. May require dosage reduction
of warfarin and phenytoin. May displace methotrexate from plasma protein binding sites. Increased
risk of venticular arrhythmias with amiodarone
---------------------------------------------------------------------------------------------------------------Sulphamethoxazole 400 mg & Trimethoprim 80 mg Injection
A
Indication :
i) Severe or complicated infections when oral therapy is not feasible ii) Treatment and prophylaxis of
pneumocystis carinii pneumonia (PCP) in immunocompromised patients
Dosage :
i) ADULT: 960 mg twice daily increased to 1.44 g twice daily in severe infections. CHILD: 36 mg/kg
daily in 2 divided doses increased to 54 mg/kg/day in severe infections ii) Treatment: ADULT & CHILD
over 4 weeks: 120 mg/kg/day PO/IV infusion in 2 - 4 divided doses for 14 days. Prophylaxis: ADULT:
960 mg once daily or 960 mg on alternate days (3 times a week) or 960 mg twice daily on alternate
days (3 times a week). CHILD 6 weeks - 5 months: 120 mg twice daily on 3 consecutive days or 7 days
per week; 6 months - 5 years: 240 mg; 6 - 12 years: 480 mg
Precautions :
renal function
Adverse Reactions :
183
Contraindications :
Interactions :
---------------------------------------------------------------------------------------------------------------Sulphamethoxazole 400 mg & Trimethoprim 80 mg Tablet
B
Indication :
i) Severe or complicated infections due to susceptible infection ii) Treatment and prophylaxis of
pneumocystis carinii pneumonia (PCP) in immunocompromised patients
Dosage :
i) ADULT: 1 - 3 tablets twice daily ii) Treatment: ADULT & CHILD over 4 weeks: 120 mg/kg/day in 2 - 4
divided doses for 14 days. Prophylaxis: ADULT: 960 mg once daily or 960 mg on alternate days (3
times a week) or 960 mg twice daily on alternate days (3 times a week). CHILD; 6 weeks - 5 months:
120 mg twice daily on 3 consecutive days or 7 days per week; 6 months - 5 years: 240 mg; 6 - 12
years: 480 mg
Precautions :
renal function
Adverse Reactions :
Contraindications :
Interactions :
---------------------------------------------------------------------------------------------------------------Trimethoprim 300 mg Tablet
B
Trade Name : Alprim
Indication :
Treatment of urinary tract infections due to susceptible pathogens
Dosage :
ADULT: 200 mg daily in 1 or 2 divided doses or 300 mg daily as a single dose. Acute infection: 200 mg
twice daily. CHILD: 6 - 12 years: 100 mg twice daily; 6 months - 5 years: 50 mg twice daily. 6 weeks 5 months: 25mg twice daily
Precautions :
Renal/hepatic impairment, folate deficiency, elderly and malnourished patients or with possible
folate deficiency
Adverse Reactions :
Rash, pruritus, exfoliative dermatitis, nausea, vomiting, anorexia, and infrequent hematologic
reactions (thrombocytopenia, leucopenia and megaloblastic anaemia) with chronic high dose
184
Contraindications :
Hypersensitivity to trimethoprim or any component, megaloblastic anaemia due to folate deficiency
Interactions :
Increased effect, toxicity or levels of phenytoin, increased myelosuppression with methotrexate,
may increase levels of digoxin
---------------------------------------------------------------------------------------------------------------Vancomycin HCL 500mg Injection
A*
Trade Name : Vancocin
Indication :
Only for the treatment of MRSA and CAPD peritonitis
Dosage:
Slow IV infusion, ADULT: 500 mg over at least 60 minutes every 6 hours or 1 g over at least 100
minutes every 12 hours. NEONATE up to 1 week, 15 mg/kg initially, then 10 mg/kg every 12 hours.
INFANT
1 - 4 weeks, 15 mg/kg initially then 10 mg/kg every 8 hours. CHILD over 1 month, 10 mg/kg every 6
hours
Precautions :
Rapid infusion-related reactions. Hearing loss, renal impairment, pregnancy and lactation
Adverse Reactions :
Thrombophlebitis, febrile reactions with rigor during administration, nephrotoxicity, ototoxicity,
nausea and vomiting
Contraindications :
Known hypersensitivity to this antibiotic
Interactions :
Increased risk of ototoxicity with loop diuretics, aminoglycosides. Increased risk of nephrotoxicity
with aminoglycosides and cephalosporins
---------------------------------------------------------------------------------------------------------------Amphotericin B 50 mg Injection
A
Trade Name : Fungizone
Indication :
Systemic fungal infections
Dosage :
ADULT: 0.25 mg/kg/day by IV infusion, gradually increase if tolerated to 1 mg/kg/day. Maximum in
severe cases: 1.5 mg/kg daily or on alternate days. For neonates, lower doses are recommended
Precautions :
Avoid rapid infusion, renal impairment. Hepatic & renal function tests, blood count & plasma
electrolyte monitoring are required. Pregnancy, lactation
Adverse Reactions :
Fever, headache, anorexia, weight loss, GI disturbances, malaise, epigastric pain, dyspepsia,
generalized pain, anaemia, abnormal renal function. Rarely cardiovascular toxicity, haematologic
reactions, neurologic reactions, liver failure
Contraindications :
Hypersensitivity
Interactions :
Corticosteroids, nephrotoxic antibiotics and antineoplastics
----------------------------------------------------------------------------------------------------------------
185
Caspofungin Acetate 50 mg Injection
A*
Caspofungin Acetate 70 mg Injection
A*
Trade Name : Cancidas
Indication :
Confirmed systemic fungal infection in patients who are refractory or intolerant to other fungal
therapies
Dosage :
Invasive aspergillosis & invasive candidiasis: ADULT: Initially, 70 mg infused over 1 hour followed by
subsequent doses of 50 mg/day. Oesophageal candidiasis: ADULT: 50 mg by slow IV infusion over
approximately 1 hour
Precautions :
Concomitant ciclosporine; use only if benefits outweigh risk of possible hepatic toxicity, liver
impairment, myelosuppression, pregnancy, lactation, renal insufficiency
Adverse Reactions :
Fever, nausea, vomiting, flushing, rash, dyspnoea, dystonia, facial swelling, pruritus, increased liver
enzymes, complication of infusion, thrombophlebitis, headache
Contraindications :
Hypersensitivity to caspofungin acetate
Interactions :
Tacrolimus, cyclosporine, inducer of drug clearance (e.g. efavirenz, nevirapine, rifampicin,
dexamethasone, phenytoin, carbamazepine)
---------------------------------------------------------------------------------------------------------------Clotrimazole 1% Ear Drop
Trade Name : Candid Ear Drops
Indication :
Otomycosis; concomitant therapy with antibiotics and corticosteroid ear drops
Dosage :
4 to 5 drops 3 to 4 times daily
Precautions :
Perforated eardrums, otitis media, pegnancy and lactation
Adverse Reactions :
local irritation
Contraindications :
Hypersensitive to clotrimazole
Interactions :
Not known
B
---------------------------------------------------------------------------------------------------------------Fluconazole 100 mg Capsule
A
Trade Name : Diflucan
Indication :
i) Oropharyngeal candidiasis, atrophic oral candidiasis associated with dentures, other candidal
infections of mucosa ii) Tinea pedis, corporis, cruris, versicolor and dermal candidiasis iii) Invasive
candidal & cryptococcal infections (including meningitis) iv) Prevention of relapse of cryptococcal
meningitis in AIDS patients after completion of primary therapy v) Prevention of fungal infections in
immunocompromised patients considered at risk as a consequence of HIV infections or neutropenia
following cytotoxic chemotherapy, radiotherapy or bone marrow transplant
186
Dosage :
i) Oropharyngeal candidiasis: 50 - 100 mg daily for 7 - 14 days (Maximum 14 days) except in severely
immunocompromised patients, treatment can be continued for longer periods. Atrophic oral
candidiasis associated with dentures: 50 mg daily for 14 days. Other candidal infections of mucosa:
50 - 100 mg daily for 14 - 30 days. CHILD: 3 - 6 mg/kg on first day then 3 mg/kg daily (every 72 hours
in NEONATE up to 2 weeks old, every 48 hours in NEONATE 2 - 4 weeks old) ii) 50 mg daily for 2 - 4
weeks, maximum 6 weeks iii) 400 mg initially then 200 - 400 mg daily for 6 - 8 weeks. CHILD: 6 - 12
mg/kg daily (every 72 hours in NEONATE up to 2 weeks old, every 48 hours in NEONATE 2 -4 weeks
old) iv) 100 - 200 mg daily v) 50 - 400 mg daily. CHILD: 3 - 12 mg/kg daily (every 72 hours in NEONATE
up to 2 weeks old, every 48 hours in NEONATE 2 - 4 weeks old)
Precautions :
Pregnancy, lactation, renal impairment
Adverse Reactions :
Nausea, abdominal pain, diarrhoea, flatulence; rash, headache
Contraindications :
Known hypersensitivity to fluconazole or to related azole compounds, co-administration of
terfenadine
Interactions :
Warfarin, oral sulfonylureas, phenytoin, rifampicin, cyclosporin, theophylline, cisapride
---------------------------------------------------------------------------------------------------------------Fluconazole 2 mg/ml Injection
A
Trade Name : Diflucan
Indication :
i) Oropharyngeal candidiasis, atrophic oral candidiasis associated with dentures, other candidal
infections of mucosa ii) Tinea pedis, corporis, cruris, versicolor and dermal candidiasis iii) Invasive
candidal& cryptococcal infections (including meningitis) iv) Prevention of relapse of cryptococcal
meningitis in AIDS patients after completion of primary therapy v) Prevention of fungal infections in
immunocompromised patients considered at risk as a consequence of HIV infections or neutropenia
following cytotoxic chemotherapy, radiotherapy or bone marrow transplant
Dosage :
i) 50 - 100 mg daily for 7 - 14 days (Maximum 14 days) except in severely immunocompromised
patients, treatment can be continued for longer periods. Atrophic oral candidiasis associated with
dentures: 50 mg daily for 14 days. Other candidal infections of mucosa: 50 - 100 mg daily for 14 - 30
days. CHILD: 3 - 6 mg/kg on first day then 3 mg/kg daily (every 72 hours in NEONATE up to 2 weeks
old, every 48 hours in NEONATE 2 - 4 weeks old) ii) 50 mg daily for 2 - 4 weeks, maximum 6 weeks iii)
400 mg initially then 200 - 400 mg daily for 6 - 8 weeks. CHILD: 6-12 mg/kg daily (every 72 hours in
NEONATE up to 2 weeks old, every 48 hours in NEONATE 2 - 4 weeks old) iv) 100 - 200 mg daily v) 50
- 400 mg daily. CHILD: 3 - 12 mg/kg daily (every 72 hours in NEONATE up to 2 weeks old, every 48
hours in NEONATE 2 - 4 weeks old)
Precautions :
Pregnancy, lactation, renal impairment
Adverse Reactions :
Nausea, abdominal pain, diarrhoea, flatulence; rash, headache
Contraindications :
Known hypersensitivity to fluconazole or to related azole compounds, co-administration of
terfenadine
Interactions :
Warfarin, oral sulfonylureas, phenytoin, rifampicin, cyclosporin, theophylline, cisapride
---------------------------------------------------------------------------------------------------------------187
Griseofulvin (Ultramicrosize 125 mg = 250 mg Microsize) Tablet
B
Trade Name : Fulcin
Indication :
Dermatophyte infections of the skin, scalp, hair and nails, where topical therapy has failed or
inappropriate
Dosage :
ADULT: 500 mg daily up to 1 g daily in divided doses, CHILD: 10 mg/kg daily in divided doses or as a
single dose
Precautions :
Ability to drive and operate machinery may be impaired. Lactation. May damage sperm cells - male
should not father children within 6 month of treatment
Adverse Reactions :
Oral thrush, gastrointestinal distress, taste perversion, dizziness, confusion, headache, depression,
insomnia, fatigue, peripheral neuritis, photosensitivity, skin rashes, urticaria, erythema multiforme,
leucopaenia, proteinuria
Contraindications :
Established porphyria, hepatocellular failure, SLE and related conditions, pregnancy
Interactions :
Absorption reduced by barbiturates. Effectiveness reduced by liver enzyme inducing drugs.
Decreases anticoagulant effect of warfarin. Reduces effectiveness of oral contraceptive.
Enhancement of effects of alcohol
---------------------------------------------------------------------------------------------------------------Itraconazole 10 mg/ml Oral Solution
A*
Trade Name : Sporanox
Indication :
Treatment of: i) oral and/or oesophageal candidiasis ii) fluconazole resistant and/or oesophageal
candidiasis
Dosage :
i) 200 mg daily in 2 intakes, or in 1 intake, for 1 week. If no response after 1 week, continue
treatment for another week ii) 100 - 200 mg twice daily for 2 weeks. If no response after 2 weeks,
continue treatment for another 2 weeks. The 400 mg daily dose should not be used for more than 14
days
Precautions :
Lactation, history of liver or renal disease, children, decreased gastric acidity. Patients with risk
factors for congestive heart failure such as ischaemic and valvular cardiac disease
Adverse Reactions :
Rash, hypokalemia, diarrhoea, nausea and vomiting, Stevens-Johnson syndrome, neutropenic
disorder, hepatotoxicity, anaphylaxis
Contraindications :
Pregnancy, hypersensitivity to itraconazole
Interactions :
Rifampicin& phenytoin reduce oral bioavailability of itraconazole. Inhibits metabolism of warfarin,
digoxin, terfenadine, cyclosporin A, astemizole, cisapride, oral midazolam
----------------------------------------------------------------------------------------------------------------
188
Itraconazole 100 mg Capsule
A*
Trade Name : Sporanox
Indication :
i) Dermatomycosis including pityriasis versicolor ii) Oral candidiasis iii) Palmar tinea manus and
plantar tinea pedis iv) Fingernail onychomycosis v) Toenail onychomycosis vi) Vulvovaginal
candidiasis
Dosage :
i) 200 mg once daily for 7 days ii) 100 mg daily for 15 days iii) 200 mg twice daily for 7 days iv) 200
mg twice daly for 1 week/month v) 200 mg twice daily for 1 week/month for 3 months vi) 200 mg
morning and evening for 1 day or 200 mg once daily for 3 days
Precautions :
Lactation, history of liver or renal disease, children, decreased gastric acidity. Patients with risk
factors for congestive heart failure such as ischaemic and valvular cardiac disease
Adverse Reactions :
Rash, hypokalemia, diarrhoea, nausea and vomiting, Stevens-Johnson syndrome, neutropenic
disorder, hepatotoxicity, anaphylaxis
Contraindications :
Pregnancy, hypersensitivity to itraconazole
Interactions :
Rifampicin& phenytoin reduce oral bioavailability of itraconazole. Inhibits metabolism of warfarin,
digoxin, terfenadine, cyclosporin A, astemizole, cisapride, oral midazolam
---------------------------------------------------------------------------------------------------------------Ketoconazole 200 mg Tablet
A/KK
Trade Name : Nizoral
Indication :
i) Pityriasis versicolor ii) Systemic mycosis (other skin mycoses) iii) Nail infections
Dosage :
i) 200 mg with meal once daily for 10 days ii) 200 - 400 mg daily for 4 weeks - 6 months iii) 200 - 400
mg daily for 6 - 12 months. Maximum 400 mg daily
Precautions :
Adrenal insufficiency or borderline adrenal function, prolonged periods of stress, pregnancy &
lactation
Adverse Reactions :
GI disturbances; pruritus; elevated liver function tests. Rarely, acute allergic reactions, hepatitis,
gynaecomastia, photophobia, alopecia
Contraindications :
Liver disease, recovery phase of hepatitis, known hypersensitivity
Interactions :
Antacids, H2 receptor antagonist, antimuscarinic agents, alcohol, warfarin, prednisolone, quinidine,
cyclosporin, phenytoin, rifampicin, oral contraceptives
---------------------------------------------------------------------------------------------------------------Nystatin 100,000 units/ml Suspension
B
Trade Name : Mycostatin
Indication :
Prevention and treatment of candidiasis of the skin and mucous membranes, protection against
candidas overgrowth during antimicrobial /corticosteroid therapy and as selective decontamination
regimens
189
Dosage :
NEWBORN: 50,000-100,000 units daily. CHILD up to 5 years: 100,000 -500,000 units 6 hourly. CHILD
up to 6-12 years and ADULT: 500,000-1,000,000 units 3 to 4 times daily
Precautions :
Not intended to treat systemic mycoses. If hypersensitivity develops, discontinue use
Adverse Reactions :
GI disturbances, rash, urticaria , Steven Johnson Syndrome, oral irritation
Contraindications :
Hypersensitivity to nystatin
Interactions :
Not known
-------------------------------------------------------------------------------------------------------------------------------------Terbinafine HCl 250 mg Tablet
A*
Trade Name : Lamisil
Indication :
Fungal infections especially onchomycosis caused by dermatophytes
Dosage :
250 mg once daily for 6 weeks for fingernails: 12 weeks for toenails
Precautions :
Severe liver or renal dysfunction (creatinine clearance less than 50 ml/min or serum creatinine of
more than 300 µmol/L) should receive a lower dose. Pregnancy and lactation
Adverse Reactions :
Gastrointestinal symptoms, skin reactions, headache, dizziness, vertigo, lymphocytopenia, and visual
disturbance
Contraindications :
Hypersensitivity to terbinafine
Interactions :
Induce metabolism (eg, rifampicin) and may be inhibited by drugs which inhibit cytochrome P-450
(eg, cimetidine)
---------------------------------------------------------------------------------------------------------------Acyclovir 200 mg Tablet
A/KK
Acyclovir 800 mg Tablet
A/KK
Trade Name : Zovirax
Indication :
i) Mucocutaneous Herpes Simplex infection in immunocompromised and AIDS patients ii) Primary
and recurrent Varicella Zoster infection in immunocompromised and AIDS patients iii) Severe Kaposi
Varicella Eruption (Eczema herpeticum) iv) Severe primary HSV infections (eg. Neonatal herpes,
encephalitis, eczema herpeticum, genital herpes, gingival stomatitis, vaginal delivery with maternal
vulva herpes) v) Severe and complicated varicella infection (eg. Encephalitis, purpura fulminans) vi)
Severe zoster infection in paediatrics (eg. Encephalitis, purpura fulminans, immunocompromised
patients and facial, sacral and motor zoster)
Dosage :
i) ADULT: initially 400 mg 5 times daily for 7 - 14 days. CHILD less than 2 years: 200 mg 4 times daily,
CHILD more than 2 years: 400 mg 4 times daily ii), iii) and iv) ADULT: 200 - 400 mg 4 times daily.
CHILD: less than 2
years, half adult dose; more than 2 years, adult dose v) ADULT: 800 mg 5 times daily for 7 days vi)
ADULT: 20 mg/kg (maximum: 800 mg) four times daily for 5 days, CHILD 6 years: 800 mg four times
daily. CHILD less than 2 years; 400mg 4 times daily, more than 2 years; 800mg 4 times daily
190
Precautions :
Patients with pre-existing neurologic, renal, or hepatic impairment, dehydrated patient, elderly and
lactation
Adverse Reactions :
Skin rashes; GI effects; fatigue
Contraindications :
Patients known to be hypersensitivity to acyclovir
Interactions :
Increased mean half-life & plasma concentration with probenecid
---------------------------------------------------------------------------------------------------------------Acyclovir 250 mg Injection
A*
Indication :
Treatment and prophylaxis of herpes simplex in immunocompromised, severe initial genital herpes
and Varicella -Zoster
Dosage :
ADULT: 5 mg/kg by IV infusion 8 hourly for 5 days, doubled to 10mg/kg every 8 hourly in varicellazoster in the immunocompromised and in simplex encephalitis (usually given for at least 10 days in
encephalitis; possibly for 14 - 21 days). NEONATE & INFANT up to 3 months with disseminated
herpes simplex: 20mg/kg every 8 hourly for 14 days (21 days in CNS involvement), varicellazoster 1020mg/kg every 8 hourly usually for 7 days. CHILD, 3 months - 12 years: Herpes simplex or Varicella
Zoster: 250 mg/m2 8 hourly for 5 days, doubled to 500 mg/m2 8 hourly for varicella-zoster in the
immunocompromised and in simplex encephalitis (usually given for 10 days in encephalitis)
Precautions :
In patients receiving Zovirax IV at higher doses, specific care regarding renal function should be
taken, particularly when patients are dehydrated or have any renal impairment
Adverse Reactions :
Skin rashes; GI effects, neurological reactions (IV infusion)
Contraindications :
Patients known to be hypersensitivity to acyclovir
Interactions :
Increased mean half-life & plasma concentration with probenecid
-------------------------------------------------------------------------------------------------------------------------------------Didanosine 100 mg Tablet (ddI)
A*
Trade Name : Videx
Indication :
HIV infection, in combination with other antiretrovirals
Dosage :
ADULT less than 60 kg: 125 mg twice daily or 250 mg once daily; more than 60 kg: 400 mg once daily
or 200 mg twice daily. CHILD more than 8 months: 120 mg/m2 twice daily, 2 weeks - 8 months: 100
mg/m2 twice daily
Precautions :
Peripheral neuropathy, history of pancreatitis, lactic acidosis, renal impairment, phenylketonuria,
pregnancy & lactation
Adverse Reactions :
Pancreatitis, peripheral neuropathy, hepatomegaly, lactic acidosis, optic neuritis, retinal disorder,
steatosis of liver, rash, pruritis, asthenia, headache, nausea, vomiting, abdominal pain, diarrhoea,
chills, fever, pain, retinal depigmentation, optic neuritis, anorexia, dyspepsia, flatulence, parotid
gland enlargement, arthralgia, myopathy
191
Contraindications :
Hypersensitivity to didanosine
Interactions :
Allopurinol, ketoconazole, itraconazole, dapsone, ganciclovir/ valganciclovir, hydroxyurea,
methadone, quinolone antibiotics, ribavirin, stavudine, tenofovir, ethanol
---------------------------------------------------------------------------------------------------------------Didanosine 2 g Oral Solution (ddI)
A*
Trade Name : Videx
Indication :
Dosage :
ADULT less than 60 kg: 125 mg twice daily or 250 mg once daily; more than 60 kg: 400 mg once daily
or 200 mg twice daily. CHILD more than 8 months: 120 mg/m2 twice daily, 2 weeks - 8 months: 100
mg/m2 twice daily
Precautions :
Peripheral neuropathy, history of pancreatitis, lactic acidosis, renal impairment, phenylketonuria,
pregnancy & lactation
Adverse Reactions :
Pancreatitis, peripheral neuropathy, rash, pruritis, asthenia, headache, nausea/vomiting, abdominal
pain, diarrhoea, chills, fever, pain, retinal depigmentation, optic neuritis, anorexia, dyspepsia,
flatulence, parotid gland enlargement, anthralgia, myopathy, hypoglycaemia & hyperglycaemia,
rhabdomyolysis
Contraindications :
Hypersensitivity to didanosine
Interactions :
Allopurinol, ketoconazole, itraconazole, dapsone, ganciclovir / valganciclovir, hydroxyurea,
methadone, quinolone antibiotics, ribavirin, stavudine, tenofovir, ethanol
---------------------------------------------------------------------------------------------------------------Efavirenz 600 mg Tablet
A*
Trade Name : Stocrin
Indication :
Combination therapy for HIV infections with a protease inhibitor and or Nucleoside Reverse
Transcriptase Inhibitors (NRTIs)
Dosage :
ADULT: 600 mg once daily. ADOLESCENT & CHILD less than 17 years, more than 40 kg: 600 mg once
daily, 32.5 - less than 40 kg: 400 mg once daily, 25 - less than 32.5 kg: 350 mg once daily, 20 - less
than 25 kg: 300 mg once daily, 15 - less than 20 kg: 250 mg once daily, 13 - less than 15 kg: 200 mg
once daily. No studies in children less than 3 years or less than 13 kg. Tablet formulation unsuitable
for children less than 40 kg
Precautions :
Pregnancy, lactation and renal impairment
Adverse Reactions :
Dizziness, nausea, headache, fatigue, rash including erythema multiforme & Stevens-Johnson
Syndrome, allergic reaction, abnormal coordination, ataxia, confusion, stupor, vertigo, vomiting,
diarrhoea, hepatitis, impaired concentration, insomnia, anxiety, abnormal dreams, somnolence,
depression, abnormal thinking, agitation, amnesia, delirium, emotional liability, euphoria,
hallucination and psychosis
Contraindications :
Hypersensitivity, concomitant terfenadine, cisapride, midazolam, triazolam and ergot derivatives
192
Interactions :
Amprenavir, indinavir, ritonavir, saquinavir, rifamycins, clarithromycin, oral contraceptives,
anticonvulsants, methadone, St. John's wort, sertraline, cetirizine, lorazepam. Other compounds that
are substrates of CYP3A4 may have decreased plasma concentration when coadministered with
efavirenz
-------------------------------------------------------------------------------------------------------------------------------------Entecavir 0.5 mg Tablet
A*
Trade Name : Baraclude
Indication :
First line treatment of Chronic Hepatitis B in patients who satisfy the criteria for treatment and
require long-term therapy or have a very high baseline viral load
Dosage :
0.5 mg once daily
Precautions :
Monitor hepatic function after treatment discontinuation. Patient with renal impairment. Liver
transplant recipients. Pregnancy and lactation
Adverse Reactions :
Swelling, erythema, pruritus, rash, stinging of skin, burning sensation
Contraindications :
Hypersensitivity to entecavir or to any component of the product
Interactions :
Drugs that reduce renal function or compete for active tubular secretion may increase serum
concentration of either entecavir or co-administered drug
---------------------------------------------------------------------------------------------------------------Indinavir Sulfate 400 mg Capsule
A*
Trade Name : Crixivan
Indication :
i) Post-exposure prophylaxis (PEP) among healthcare workers in high-risk HIV occupational exposure
ii) For therapy as part of combination antiretroviral treatment on adult HIV patients ie Highly Active
Anti-Retroviral Therapy (HAART)
Dosage :
ADULT: 800 mg every 8 hours. CHILD (investigational): 500 mg/m2 every 8 hours (patients with
smaller body surface area (BSA) may require lower doses of 300 - 400 mg/m2 every 8 hours)
Precautions :
Nephrolithiasis, acute haemolytic anaemia, hyperglycaemia, pregnancy, lactation, hyperlipidaemia
Adverse Reactions :
Asthenia/fatigue, abdominal pain, dry mouth, flatulence, lymphadenopathy
Contraindications :
Breast feeding, known hypersensitivity to this compound
Interactions :
Ketoconazole, rifampicin, cisapride, astemizole, phenobarbitone, phenytoin, carbamazepine,
dexamethasone, sildenafil, St. John's Wort
---------------------------------------------------------------------------------------------------------------Lamivudine 10 mg/ml Oral Solution
Trade Name : 3TC
Indication :
HIV infection in combination with other antiretroviral agents
193
A*
Dosage :
ADULT: 150 mg twice daily or 300 mg once daily. INFANT under 1 month: 2 mg/kg twice daily. CHILD
1 month or over: 4 mg/kg twice daily. Maximum 300 mg daily
Precautions :
Moderate to severe renal impairment, advanced cirrhotic liver disease, pregnancy, lactation, chronic
hepatitis B or C, hepatic disease
Adverse Reactions :
Nausea, vomiting, diarrhoea, abdominal pain, cough, headache, fatigue, insomnia, malaise, fever,
rash, alopecia, muscle disorders, peripheral neuropathy, pancreatitis, neutropenia, anaemia,
thrombocytopenia and red-cell aplasia, lactic acidosis, raised liver enzymes and serum amylase,
hepatomegaly
Contraindications :
Hypersensitivity to lamivudine, abnormally low neutrophil counts or abnormally low haemoglobin
levels
Interactions :
Trimethoprim, interferon alfa, ribavirin, sulfamethoxazole, zalcitabine
---------------------------------------------------------------------------------------------------------------Lamivudine 100 mg Tablet
A*
Lamivudine 150 mg Tablet
A*
Trade Name : Zeffix
Indication :
Management of chronic hepatitis B infection associated with evidence of hepatitis B viral replication
and active liver inflammation
Dosage :
ADOLESCENTS more than 16 years and ADULTS: 100 mg/dose once daily
Precautions :
Moderate to severe renal impairment, advanced cirrhotic liver disease, pregnancy, lactation, chronic
hepatitis B or C, hepatic disease
Adverse Reactions :
Nausea, vomiting, diarrhoea, abdominal pain, cough; headache, fatigue, insomnia, malaise, fever,
rash, alopecia, muscle disorders, peripheral neuropathy, pancreatitis, neutropenia, anaemia,
thrombocytopenia and red-cell aplasia, lactic acidosis, raised liver enzymes and serum amylase,
hepatomegaly
Contraindications :
Hypersensitivity to lamivudine, abnormally low neutrophil counts or abnormally low haemoglobin
levels
Interactions :
Trimethoprim, interferon alfa, ribavirin, sulfamethoxazole, zalcitabine
---------------------------------------------------------------------------------------------------------------Lopinavir 200 mg and Ritonavir 50 mg Tablet
A*
Trade Name : Kaletra
Indication :
As second line protease inhibitor if intolerant to indinavir/ ritonavir as part of HAART regimen
Dosage :
ADULT and CHILD with BSA greater than 1.4 m2 or body weight 40kg and over: 2 tablets twice daily
Precautions :
Hepatic impairment, renal impairment, haemophilia, pregnancy, diabetes, pancreatitis
194
Adverse Reactions :
Dyslipidemia, hyperglycaemia, hypercholesterolemia, increased triglycerides, diarrhoea, nausea,
headache, pain, insomnia
Contraindications :
Hypersensitivity to lopinavir or ritonavir, concomitant use with drugs that are highly dependent on
CYP3A or CYP2D6 for clearance
Interactions :
Antiarrhythmias, anticonvulsant, antihistamines, benzodiazepines, calcium channel blockers,
cisapride, clarithromycin, dexamethasone, disulfiram, didanosine
---------------------------------------------------------------------------------------------------------------Lopinavir/Ritonavir Oral Solution
A
Trade Name : Kaletra
Indication :
Management of patients with asymptomatic and symptomatic (early or advanced) HIV Infection with
CD4 cell counts
Dosage :
12 mg/kg twice daily for those 7 - 15 kg and 10mg/kg twice daily for those 15 - 40 kg taken with
food, up to a maximum dose of 533 mg Lopinavir/13.3mg Ritonavir in children greater than 45 kg (5
ml) twice daily
Precautions :
Hepatic impaiment, renal impairment, haemophilia, pregnancy, diabetes, pancreatitis
Adverse Reactions :
Dyslipidaemia, hyperglycaemia, hypercholesterolemia, increased triglycerides, diarrhoea, nausea,
headache, pain, insomnia
Contraindications :
Hypersensitivity to lopinavir or ritonavir, concomitant use with drugs that are highly dependent on
CYP3A or CYP2D6 for clearance
Interactions :
Antiarrhythmias, anticonvulsant, antihistamines, benzodiazepines, calcium channel blockers,
cisapride, clarithromycin, dexamethasone, disulfiram, didanosine
---------------------------------------------------------------------------------------------------------------Nevirapine 200 mg Tablet
A*
Indication :
Treatment of HIV-1 infection in combination with other antiretroviral agents
Dosage :
200 mg once daily for first 14 days then 200 mg twice daily
Precautions :
Hepatic impairment, history of chronic hepatitis, hepatic disease, pregnancy. Avoid use in patients
with CD4 cell counts more than 250 cells/mm3 in adult women and 400 cells/mm3 in adult men
Adverse Reactions :
Hepatitis, hepatic failure (life threatening), hepatotoxicity, severe skin reaction, headache, fatique,
diarrhoea, nausea, rash
Contraindications :
Hypersensitivity to nevirapine or any component of the formulation, breast feeding, severe hepatic
impairment
Interactions :
Methadone, rifampicin, ketoconazole, other antivirals such as saquinaxir, indinavir, St. John's wort,
warfarin
---------------------------------------------------------------------------------------------------------------195
Palivizumab 100mg Injection
A*
Trade Name : Synagis
Indication :
For the prevention of serious lower respiratory tract disease caused by respiratory syncytial virus
(RSV) in paediatric patients at high risk of RSV disease
Dosage :
15 mg/kg IM once a month during season of RSV risk
Precautions :
Should be given with caution to patients with thrombocytopenia or any coagulation disorder.
Injection should be given within 6 hours after reconstitution
Adverse Reactions :
Fever, nervousness, diarrhoea, vomiting, rhinitis, cough, wheeze, pain, rash, leucopenia, abnormal
liver function tests
Contraindications :
Hypersensitivity to humanised monoclonal antibodies
Interactions :
Carcinogenesis, mutagenesis and reproductive toxicity studies have not been performed
---------------------------------------------------------------------------------------------------------------Ritonavir 100 mg Capsule
A*
Trade Name : Norvir
Indication :
Progressive or advanced HIV infection in combination with other antiretroviral agents. Criteria for
use: a) Clinical AIDS b) CD4 less than 350 cells or c) Viral load more than 10,000 copies/ml
Dosage :
ADULT: initially 300 mg twice daily, increase by 100 mg twice daily increments to 600 mg twice daily.
For older child who can swallow soft gelatin capsule; 250 mg/m2 twice daily for 2 days, if tolerate
400 mg/m2 twice daily onwards
Precautions :
Hepatic impairment
Adverse Reactions :
Asthenia, gastrointestinal and neurological disturbances, anorexia, taste perversion, dyslipidemia,
pancreatitis, hepatitis, Stevens-Johnson syndrome
Contraindications :
Hypersensitivity, lactation, severe hepatic impairment
Interactions :
Decreased plasma concentration with phenobarbital, carbamazepine, dexamethasone, phenytoin,
rifampicin. Risk of myopathy with concurrent use of lovastatin, simvastatin
---------------------------------------------------------------------------------------------------------------Stavudine 30 mg Capsule
A*
Trade Name : Zerit
Indication :
Dosage :
ADULT more than 60 kg: 40 mg twice daily; less than 60 kg: 30 mg twice daily. CHILD more than 30
kg: 30 mg twice daily; less than 30 kg: 15 mg twice daily
Precautions :
Renal and hepatic impairment, peripheral neuropathy, elderly, pregnancy and lactation
196
Adverse Reactions :
Headache, rash, gastrointestinal effects, peripheral neuropathy, abdominal pain, allergic reaction,
anaemia, anorexia, chills, diabetes mellitus, fever, hepatic failure, hepatitis, hepatomegaly,
hyperglycaemia, hyperlactatemia, insomnia, lactic acidosis, leukopenia, macrocytosis, motor
weakness, myalgia, pancreatitis, redistribution /accumulation of body fat, thrombocytopenia
Contraindications :
Hypersensitivity to stavudine
Interactions :
Zidovudine, doxorubicin, ribavirin, didanosine
---------------------------------------------------------------------------------------------------------------Stavudine 30 mg, Lamivudine 150 mg & Nevirapine 200 mg Tablet
A*
Trade Name : SLN 30
Indication :
Fixed dose triple therapy for treatment of HIV infection in adults once patients have been stabilized
on the maintenance regimen of nevirapine 200 mg twice daily and have demonstrated adequate
tolerability to nevirapine
Dosage :
One tablet twice daily for patients weighing less than 60 kg
Precautions :
Hepatitis B or C. Discontinue immediately if severe life-threatening skin reactions occur and do not
rechallenge. Avoid concomitant prednisone. Perform baseline and periodic liver function tests.
Adverse Reactions :
Peripheral neuropathy, pancreatitis, chills, fever, malaise, diarrhoea, constipation, dyspepsia,
asthenia, anorexia, nausea/vomiting, chest, abdominal and back pain, depression, anxiety, flu
syndrome, sweating, dizziness, dyspnoea, rash, pruritus. Stevens-Johnson syndrome, toxic epidermal
necrolysis, serious hepatitis, hepatic failure, hypersensitivity reactions characterised by rash with
constitutional symptoms and visceral involvement, gastrointestinal disturbances, fatigue,
somnolence, myalgia
Contraindications :
Patients who are just initiating therapy with nevirapine. These patients require a lead-in dose of
nevirapine 200 mg daily, whereas this formulation contains the maintenance dose of nevirapine 200
mg twice daily
Interactions :
Trimethoprim and sulphamethoxazole, rifampicin, ketoconazole, oral contraceptives, methadone
---------------------------------------------------------------------------------------------------------------Telbivudine 600 mg Tablet
A*
Trade Name : Sebivo
Indication :
Treatment of chronic hepatitis B in patients with evidence of viral replication and
active liver inflammation
Dosage :
ADULT and CHILD over 16 years: 600 mg once daily. Moderate to severe renal impairment: CrCL 3049ml/minute, 600 mg every 48 hours. CrCL
Precautions :
Renal impairment: Use caution in patients with moderate-to-severe renal dysfunction and end stage
renal disease (ESRD); dosing adjustment required (ClCr
197
Adverse Reactions :
Dizziness, headache, increased blood amylase and lipase, diarrhoea, nausea, elevated ALT, rash,
increased blood creatinine phosphokinase, fatigue, abdominal pain, dyspepsia. Increased AST,
myopathy, arthralgia, myalgia, malaise
Contraindications :
Hypersensitivity to telbivudine or any component of the product
Interactions :
Increased risk of peripheral neuropathy when telbivudine given with interferon alfa
---------------------------------------------------------------------------------------------------------------Zidovudine 1% Injection
A
Trade Name : Retrovir
Indication :
To reduce the rate of maternal-foetal transmission of HIV in: i) HIV-positive pregnant women over 14
weeks of gestation ii) Their newborn infants
Dosage :
i) 200 mg 3 times/day or 300 mg twice daily until start of labor. During labour, by IV infusion initially
2 mg/kg over 1 hour followed by continuous IV infusion at 1 mg/kg/hr until delivery ii) 2 mg/kg orally
every 6 hours within 12 hours after birth. If unable to receive oral dose: FULL TERM: 1.5 mg/kg/dose
every 6 hours, INFANTS 30 weeks and less than 35 weeks gestation at birth: 1.5 mg/kg/dose every 12
hours; at 2 weeks of age, advance to 1.5 mg/kg/dose every 8 hours, INFANTS less than 30 weeks
gestation at birth: 1.5 mg/kg/dose every 12 hours; at 4 weeks of age, advance to 1.5 mg/kg/dose
every 8 hours
Precautions :
Monitor carefully haematological parameters. If anaemia or myelosuppression occurs dose
adjustments are suggested. Patients with pre-existing bone marrow compromise. Pregnancy and
lactation
Adverse Reactions :
Anaemia, neutropenia, leucopenia, nausea, headache, rash, abdominal pain, fever, myalgia,
paraesthesia, vomiting, insomnia and anorexia. Asthenia, malaise, somnolence, diarrhoea, dizziness,
sweating, dyspnoea, dyspepsia, flatulence, bad taste, chest pain, loss of mental acuity, anxiety,
urinary frequency, depression, generalised pain, chills, cough, urticaria, pruritus and flu-like
syndrome
Contraindications :
Abnormally low neutrophil cell count (less than 0.75 x 109L) or abnormally low Hb levels (less than
7.5 g/dL)
Interactions :
Chronic paracetamol use, potentially nephrotoxic or myelosuppressive drugs, probenecid
---------------------------------------------------------------------------------------------------------------Zidovudine 10 mg/ml Syrup
A*
Indication :
i) Management of patients with asymptomatic and symptomatic (early or advanced) HIV infections
with CD4 cell counts less than 500 cu. mm. ii) Neonatal prophylaxis
Dosage :
i) ADULT: 500 - 600 mg/day in 2 - 3 divided doses. CHILD more than 3 months: 360 - 480 mg/m2 daily
in 3 - 4 divided doses; maximum 200 mg every 6 hours ii) 2 mg/kg 6 hourly within 12 hours after
birth up to 6 weeks
198
Precautions :
lactation
Adverse Reactions :
paraesthesia, vomiting, insomnia and anorexia. Asthenia, malaise, somnolence, diarrhoea, dizziness,
syndrome
Contraindications :
Abnormally low neutrophil cell count (less than 0.75 x 109/L) or abnormally low Hb levels (less than
7.5 g/dL)
Interactions :
---------------------------------------------------------------------------------------------------------------Zidovudine 100 mg Capsule
A*
Indication :
i) Management of patients with asymptomatic and symptomatic (early or advanced) HIV infections
with CD4 cell counts less than 500 cu. mm ii) Neonatal prophylaxis
Dosage :
i) Adult: 500 - 600 mg/day in 2 - 3 divided doses. Child more than 3 months: 360 - 480 mg/m2 daily in
3 - 4 divided doses; maximum 200 mg every 6 hours ii) 2 mg/kg 6 hourly within 12 hours after birth
up to 6 weeks
Precautions :
lactation
Adverse Reactions :
paraesthesia, vomiting, insomnia and anorexia, asthenia, malaise, somnolence, diarrhoea, dizziness,
syndrome
Contraindications :
Abnormally low neutrophil cell count (less than 0.75 x 109/L) or abnormally low Hb levels (less than
7.5 g/dL)
Interactions :
---------------------------------------------------------------------------------------------------------------Zidovudine 300 mg & Lamivudine 150 mg Tablet
Trade Name : Combivir
Indication :
HIV infection in combination with at least one other antiretroviral drug
Dosage :
ADULT and CHILD over 12 years: 1 tablet twice daily
199
A*
Precautions :
Advanced cirrhotic liver disease due to chronic hepatitis B infection. Severe hepatic or renal
impairment. Monitor haematological parameters
Adverse Reactions :
Headache, malaise, fatigue, gastrointestinal effects, upper abdominal pain, fever, rash, pancreatitis,
peripheral neuropathy, leucopenia, neutropenia, anaemia, thrombocytopenia
Contraindications :
Hypersensitivity, patients with abnormally low neutrophil counts or abnormally low haemoglobin
levels
Interactions :
Trimethoprim, phenytoin, paracetamol, aspirin, codeine, morphine, indomethacin, ketoprofen,
naproxen, oxazepam, lorazepam, cimetidine, clofibrate, dapsone and isoprinosine, potentially
nephrotoxic or myelosuppressive drugs, ribavirin
---------------------------------------------------------------------------------------------------------------Chloroquine Phosphate 250 mg Tablet (150 mg Chloroquine base)
C
Indication :
Treatment of malaria - acute attack
Dosage :
ADULT 600 mg base stat, 300 mg 6 - 8 hours later and a further 300 mg on each of 2 following days.
CHILD 3 - 4 years : 150 mg base stat, 75 mg 6 hours later, then 75 mg daily for 2 days. CHILD 5 - 8
years : 300 mg stat, 150 mg 6 hours later, then 150 mg daily for 2 days
Precautions :
May exacerbate psoriasis or trigger an acute attack of hepatic porphyria (metabolic abnormality).
Pre-existing kidney damage, first trimester of pregnancy
Adverse Reactions :
Loss of appetite, nausea, pressure over the stomach, visual disturbances
Contraindications :
G6PD deficiency, diseases of haematopoietic organs or CNS, retinopathy
Interactions :
Simultaneous use of corticosteroids can accentuate possible myopathies and cardiomyopathies
---------------------------------------------------------------------------------------------------------------Primaquine 7.5 mg base Tablet
B
Indication :
i) Treatment of malaria ii) Prophylaxis together with a schizonticide such as
chloroquine
Dosage :
i) ADULT: 15 mg daily for 14 days. CHILD: 0.3 mg/kg body weight daily for 14 days ii) ADULT: 30 mg
once weekly. CHILD: 0.5 mg once weekly
Precautions :
Use with caution in patients with a deficiency in G6PD (may cause acute haemolytic anaemia) and
patients with a nicotinamide-adenine dinucleotide hydroxide (NADH) methaemoglobin-reductase
deficiency (at risk of developing methaemoglobinaemia and cyanosis)
Adverse Reactions :
Anaemia, leucocytosis, abdominal pain, methaemoglobinaemia
Contraindications :
Concomitant medications which cause bone marrow suppression, rheumatoid arthritis, lupus
erythematosus, glucose-6-phosphate dehydrogenase (G6PD) deficiency, pregnancy
200
Interactions :
Artemether/ lumefantrine
---------------------------------------------------------------------------------------------------------------Quinine Sulphate 300 mg Tablet
B
Indication :
Suppression or treatment of chloroquine-resistant Plasmodium Falciparum malaria in conjunction
with other antimalarial agents
Dosage :
300 - 600 mg daily. Treatment : 1.2 - 2 g daily in divided doses. CHILDS less than 1 year : 100 - 200 mg
daily, 1 - 3 years : 200 - 300 mg daily, 4 - 6 years: up to 500 mg daily, more than 7 years : up to 1 g
daily. All above doses are given for 7 days in 2 - 3 divided doses
Precautions :
Atrial fibrillation or other serious heart disease, myasthenia gravis, history of asthma, optic neuritis,
tinnitus, hypoglycaemia
Adverse Reactions :
Headache, fever, vomiting, muscle weakness, excitement, confusion, blindness, deafness, loss of
consciousness, fall in blood pressure, rash, hypoglycaemia, dysphagia, epigastric pain, nausea,
vomiting, disseminated intravascular coagulation, thrombocytopenia, hepatotoxicity, ototoxicity
(rare), hemolytic uremic syndrome, interstitial nephritis
Contraindications :
Presence of haemoglobinuria during malaria or of optic neuritis, glucose-6-phosphate
dehydrogenase deficiency, hypersensitivity to quinine, myasthenia gravis
Interactions :
Amiodarone, terfenadine, thioridazine, digoxin, cimetidine, astemizole, cyclosporine, droperidol,
mefloquine, methadone, pancuronium, rifapentine
---------------------------------------------------------------------------------------------------------------Quinine Dihydrochloride 600 mg/2 ml Injection
B
Indication :
Suppression or treatment of chloroquine-resistant Plasmodium Falciparum malaria in conjunction
with other antimalarial agents
Dosage :
By slow intravenous infusion (over 4 hours). ADULT : 20 mg/kg followed by 10 mg/kg every 8 hours.
CHILD : 20 mg/kg followed by 10 mg/kg every 12 hours, initial dose should be half in patients who
have received quinine, quinidine or mefloquine during the previous 12 or 24 hours
Precautions :
Atrial fibrillation or other serious heart disease, myasthenia gravis, history of asthma, optic neuritis,
tinnitus, hypoglycaemia
Adverse Reactions :
Headache, fever, vomiting, muscle weakness, excitement, confusion, blindness, deafness, loss of
consciousness, fall in blood pressure, rash, hypoglycaemia, dysphagia, epigastric pain, nausea,
vomiting, disseminated intravascular coagulation, thrombocytopenia, hepatotoxicity, ototoxicity
(rare), haemolytic uremic syndrome, interstitial nephritis
Contraindications :
Presence of haemoglobinuria during malaria or of optic neuritis, glucose-6-phosphate
dehydrogenase deficiency, hypersensitivity to quinine, myasthenia gravis
Interactions :
Amiodarone, terfenadine, thioridazine, digoxin, cimetidine, astemizole, cyclosporine, droperidol,
mefloquine, methadone, pancuronium, rifapentine
-------------------------------------------------------------------------------------------201
Sulfadoxine 500 mg and Pyrimethamine 25 mg Tablet
B
Trade Name : Fansidar
Indication :
Treatment of Plasmodium falciparum malaria in patients in whom chloroquine resistance is
suspected and malaria prophylaxis for travellers to areas where chloroquine-resistant malaria is
endemic
Dosage :
Treatment as single dose. ADULT : 2 - 3 tablet. CHILD more than 45 kg : 3 tablets, 45 to 31 kg : 2
tablets, 30 to 21 kg : 1 and half tablets, 20 to 11 kg : 1 tablet, 5 to 10 kg : one-half tablet
Precautions :
Discontinue if skin reactions occur. Avoid excessive exposure to sunlight. Analysis for crystalluria
during prolonged prophylaxis therapy is recommended, impaired renal or hepatic function, periodic
blood counts are recommended, possible folate deficiency, severe allergic or bronchial asthma
Adverse Reactions :
Rash, pruritus, contact dermatitis, urticaria, nausea and feeling of fullness, headache. Rarely, StevenJohnson and Lyell's syndromes, blood dyscrasias, liver cell damage, agranulocytosis, aplastic
anaemia, thrombocytopenia, hepatitis, nephrotoxicity
Contraindications :
Hypersensitivity to sulfonamides. Premature or newborn infants, pregnancy, prophylactic
(prolonged) use in patients with renal/hepatic failure and with blood dyscrasias
Interactions :
Methotrexate, sulfamethoxsazole, trimethoprim, zidovudine, lorazepam
-------------------------------------------------------------------------------------------------------------------------------------Albendazole 200 mg Tablet
C
Trade Name : Zentel
Indication :
i) Single or mixed infestations of intestinal parasites ii) Strongyloides infection
Dosage :
i) ADULT and CHILD over 2 years : 400 mg as a single dose ii) 400 mg as a single dose for 3
consecutive days. CHILD 12 - 24 months : half adult dose
Precautions :
Discontinue therapy if liver function test elevations are significant, retinal lesions, cerebral
hypertensive episodes, pregnancy, hepatic disease, retinal lesions
Adverse Reactions :
Gastrointestinal discomfort, dizziness, headache, erythema multiforme, Stevens-Johnson syndrome,
agranulocytosis, aplastic anemia, leukopenia, pancytopenia, thrombocytopenia, hepatotoxicity
Contraindications :
Patients with hypersensitivity to albendazole or to the benzimidazole drug class, pregnancy (avoid
pregnancy for at least one month following therapy)
Interactions :
Concurrent use with dexamethasone may result in an increased risk of albendazole adverse effects.
---------------------------------------------------------------------------------------------------------------Albendazole 200 mg/5 ml Suspension
C
Trade Name : Zentel
Indication :
i) Single or mixed infestations of intestinal parasites ii) Strongyloides infection
Dosage :
i) ADULT and CHILD over 2 years : 400 mg as a single dose ii) 400 mg as a single dose for 3
consecutive days. CHILD 12 - 24 months : half adult dose
202
Precautions :
Discontinue therapy if liver function test elevations are significant, retinal lesions, cerebral
hypertensive episodes, pregnancy, hepatic disease, retinal lesions
Adverse Reactions :
Gastrointestinal discomfort, dizziness, headache, erythema multiforme, Stevens-Johnson syndrome,
agranulocytosis, aplastic anemia, leukopenia, pancytopenia, thrombocytopenia, hepatotoxicity
Contraindications :
Patients with hypersensitivity to albendazole or to the benzimidazole drug class, pregnancy (avoid
pregnancy for at least one month following therapy)
Interactions :
Concurrent use with dexamethasone may result in an increased risk of albendazole adverse effects.
----------------------------------------------------------------------------------------------------------------
203
9. ENDOCRINE
Drugs used in diabetes
Thyroid and antithyroid drugs
Corticosteroids
Sex hormones
Hypothalamic and pituitary hormones and anti-estrogens
Drugs affecting bone metabolism
Miscellaneous endocrine
204
Acarbose 50 mg Tablet
A/KK
Trade Name : Glucobay
Indication :
Only for treatment of: i) Non insulin dependent diabetes mellitus (NIDDM) when diet therapy is
insufficient ii) Non insulin dependent diabetes mellitus (NIDDM) in combination with existing
conventional oral therapy where glycaemic control is inadequate
Dosage :
Initially 50 mg daily, increase to 3 times daily up to 100 mg 3 times daily. Max 200 mg 3 times daily
Precautions :
Asymptomatic liver enzyme elevations especially at higher dosages. Monitor liver enzyme during 6 12 months of treatment
Adverse Reactions :
Flatulence and bowel sounds, diarrhoea and abdominal pain
Contraindications :
Patients less than 18 years, chronic intestinal disorders associated with distinct disturbances of
digestion and absorption, conditions which may deteriorate as a result of increased intestinal gas
formation, pregnancy, lactation, severe renal impairment
Interactions :
Thiazide and other diuretic, corticosteriod, thyroid product, estrogens, oral contraceptives,
phenytoin, nicotinic acid, sympatomimetic, calcium channel blocker, isoniazid, cholestyramine,
intestinal absorbents, digestive enzymes
-------------------------------------------------------------------------------------------------------------------------------------Dextrose Powder
B
Indication :
Use as a diagnostic agent for diabetes
Dosage :
75 g stat
Precautions :
Diabetes mellitus or carbohydrate intolerance and hyperglycaemia may accentuate neurologic
damage for an ischemic insult, patients at risk for cerebral ischemia, acute stroke, impending cardiac
arrest, or severe hypotension unless hypoglycaemia is suggested or until glucose is determined.
Adverse Reactions :
Thrombophlebitis, rebound hypoglycaemia, hypokalaemia.
Contraindications :
Do not use concentrated solutions of dextrose in patients with anuria, diabetic coma and
hyperglycaemia, intracranial or intraspinal haemorrhage, delirium tremens in dehydrated patients
and glucose-galactose malabsorption syndrome.
Interactions :
Not known.
---------------------------------------------------------------------------------------------------------------------------------Glibenclamide 5 mg Tablet
B
Trade Name : Daonil
Indication :
Diabetes mellitus type 2
Dosage :
Range: 2.5 - 15 mg daily (with or immediately after breakfast). Initially 2.5 mg daily increasing by 2.5
mg required for metabolic control. Max: 15 mg daily
205
Precautions :
Elderly, mild and moderate hepatic and renal impairment. Cross-sensitivity to sulphonamides and its
derivatives
Adverse Reactions :
Gastrointestinal disturbance, blood dyscrasia, increase appetite, weight gain, skin rashes, pruritus,
hypersensitivity reaction.
Contraindications :
Diabetes mellitus type 1, diabetic coma, severe renal or renal impairment, pregnancy
Interactions :
Alcohol, beta blockers, biguanides, MAOIs, sulphonamides, thyroid hormone, ACE inhibitor,
analgesic
--------------------------------------------------------------------------------------------------------------------------------Gliclazide 30 mg Modified Release Tablet
B
Trade Name : Diamicron MR
Indication :
Dosage :
30 mg daily, adjust according to response every 4 weeks, max 120 mg daily
Precautions :
Hepatic and or renal impairment. Hypoglycaemia may occur with reduced dietary intake or too high
doses
Adverse Reactions :
Nausea, headache, rashes and gastrointestinal disturbances. Rarely, haematological disorders
Contraindications :
Diabetes type 1. Severe renal or hepatic insufficiency, diabetic ketoacidosis, diabetic precoma.
Pregnancy and lactation. Avoid concomitant treatment with miconazole preparation
Interactions :
Potentiates hyperglycaemia with danazol, chlorpromazine, glucocorticoids, progestogens, beta 2
agonist. Potentiated hypoglycaemic effect with sulfonamides, salicylates, phenylbutazone, betablockers, alcohol, H2 antagonists, NSAIDs, ACE inhibitors, MAOIs, fluconazole, ketoconazole and
miconazole. Diminished hypoglycaemic effect with thiazide diuretics, corticosteroids and oestrogens.
---------------------------------------------------------------------------------------------------------------------------------Gliclazide 80 mg Tablet
B
Trade Name : Diamicron
Indication :
Dosage :
Initially 40-80 mg daily. Total daily dose may vary from 80- 320 mg orally. Adjust dose according to
patient's individual response
Precautions :
Hepatic and or renal impairment. Hypoglycaemia may occur with reduced dietary intake or too high
doses
Adverse Reactions :
Nausea, headache, rashes and gastrointestinal disturbances. Rarely, haematological disorders
Contraindications :
Children with epiphyseal fusion. Active neoplasia, progression or recurrence of underlying
intracranial lesion, critically ill patient, proliferative or pre-proliferative diabetic retinopathy
206
Interactions :
Potentiates hyperglycaemia with danazol, chlorpromazine, glucocorticoids, progestogens, beta2
agonist. Potentiated hypoglycaemic effect with sulfonamides, salicylates, phenylbutazone, betablockers, alcohol, H2 antagonists, NSAIDs, ACE inhibitors, MAOIs, fluconazole, ketoconazole and
miconazole. Diminished hypoglycaemic effect with thiazide diuretics, corticosteroids and oestrogens.
-------------------------------------------------------------------------------------------------------------------------------Glucagon (Lyophilised) 1 mg/ml Injection
B
Trade Name : Glucagen
Indication :
Management of hypoglycaemia
Dosage :
ADULT: 1 mg by SC, IM or IV. Repeat in 20 minutes if necessary. CHILD less than 20 kg: 0.02 to 0.03
mg/kg/dose or 0.5mg dose SC, IM or IV. Maximum: 1mg/dose. CHILD greater than 20 kg: 1mg SC, IM
or IV
Precautions :
Patients with marked depletion of liver glycogen stores
Adverse Reactions :
Gastrointestinal upset, hypersensitivity
Contraindications :
Glucagonoma, insulinoma, phaeochromocytoma
Interactions :
Not known
--------------------------------------------------------------------------------------------------------------------------------Insulin Aspart 100 IU/ml Injection
A*
Trade Name : Novorapid
Indication :
Diabetic Type 1 and 2 in patients that still experienced hypoglycaemia with use of human insulin
Dosage :
Dose to be individualised. The average daily insulin requirement is between 0.5 to 1.0 units/kg body
weight
Precautions :
Decreased insulin requirements due to hepatic or renal impairment, malabsorption, diarrhoea,
nausea/vomiting, hypothyroidism hypokalaemia, stress due to fever, infection, surgery, trauma,
systemic allergic reactions
Adverse Reactions :
Transient oedema, local reactions and fat hypertrophy at injection site, hypoglycaemia,
hypokalaemia, generalized hypersensitivity
Contraindications :
Hypersensitivity to insulin aspart and its components, hypoglycaemia
Interactions :
Oral hypoglycaemic agents, ocreotide, MAOIs, alcohol, lithium, non selective beta blocker, ACE
inhibitor, salicylates, anabolic steroids, glucocorticoids, oral contraceptives, sulphonamides,
disopyramides, diuretics fibrates, fluoxetine, propoxyphene, thyroid hormone, symphatomimetics,
danazol, niacin, isonazide, guanethidine, reserpine, clonidine, phenothiazine
-------------------------------------------------------------------------------------------------------------------------------
207
Insulin Glargine 300 IU/3ml Injection
A*
Trade Name : Lantus
Indication :
i) Diabetes mellitus type I in adults and child over 6 years ii) Diabetes mellitus type II in adult
Dosage :
ADULT and CHILD over 6 years: individualised dose given by SC, once daily at the same time every
day
Precautions :
Insulin dose adjustment may be needed with renal or hepatic impairment, illness, stress, emotional
disturbances or in elderly patients, may impair ability to drive and operate machinery
Adverse Reactions :
Severe hypoglycemic episodes, lipodystrophy, rash, diabetic ketoacidosis, allergic skin reactions
Contraindications :
Hypersensitivity, intravenous administration
Interactions :
ACE inhibitors, aspirin, beta- blockers, fibrates, fluoxetine, fenfluramine, fluoroquinolones, ginseng,
MAOIs, oestrogen and progestogens, somatropin, lithium, clonidine, sulphonamide antibiotic,
pentoxifylline.
-------------------------------------------------------------------------------------------------------------------------------Insulin Recombinant Neutral Human short-acting 100 IU/ml Injection in 10ml vial
B
Trade Name : Actrapid/Humulin
Indication :
Insulin dependent diabetes mellitus, non insulin dependent diabetes unresponsive to treatment to
diet or oral hypoglycaemics. hyperkalaemia to assure proper utilisation of glucose and reduce
glucosuria in non diabetic patients receiving parenteral nutrition
Dosage :
Dose to be individualised. The average daily insulin requirement is between 0.5-1.0 units/kg body
weight
Precautions :
Psychic stress, infection, pregnancy
Adverse Reactions :
Rare incidence of allergy and lipoatrophy
Contraindications :
Hypoglyacemia, insulinoma
Interactions :
MAOIs, alcohol, corticosteroid, oral contraceptives, beta-blocker, thyroid hormone, diuretic
--------------------------------------------------------------------------------------------------------------------------------Insulin Recombinant Synthetic Human, intermediate-acting 100 IU/ml Penfill and Refill
B
Trade Name : Insulatard
Indication :
diet or oral hypoglycaemics, hyperkalaemia to assure proper utilisation of glucose and reduce
Dosage :
weight
Precautions :
208
Adverse Reactions :
Contraindications :
Interactions :
-------------------------------------------------------------------------------------------------------------------------------------Insulin Recombinant Synthetic Human, pre-mixed 100 IU/ml Penfill and Refill
B
Trade Name : Mixtard
Indication :
Dosage :
weight
Precautions :
Adverse Reactions :
Contraindications :
Interactions :
MAOIs, alcohol, corticosteroid, oral contraceptives, beta- blocker, thyroid hormone, diuretic.
-------------------------------------------------------------------------------------------------------------------------------------Insulin Recombinant Synthetic Human, short-acting 100 IU/ml Penfill and Refill
B
Trade Name : Actrapid
Indication :
Dosage :
weight
Precautions :
Adverse Reactions :
Contraindications :
Interactions :
-------------------------------------------------------------------------------------------------------------------------------
209
Metformin 500 mg and Glibenclamide 2.5 mg Tablet
A/KK
Metformin 500 mg and Glibenclamide 5 mg Tablet
A/KK
Trade Name : Glucovance
Indication :
As second-line therapy when diet, exercise and initial treatment with sulphonylurea or metformin do
not result in adequate glycemic control in patients with type 2 diabetes mellitus
Dosage :
One tablet twice daily, titrate up to a maximum daily dose of 2000 mg metformin/20 mg
glibenclamide
Precautions :
Adrenal or pituitary insufficiency elderly, debilitated or malnourished patients, excessive alcohol
intake, hypoxic states due to shock, acute chronic heart failure or acute myocardial infarction, lactic
acidosis, severe metabolic complication due to accumulation of metformin, liver or renal disease,
peripheral vascular disease, pulmonary disease, pregnancy or lactation, stress caused by infection,
fever, trauma or surgery
Adverse Reactions :
Hypoglycemia, lactic acidosis, cobalamin deficiency, abdominal pain, diarrhoea, nausea and
vomiting, dizziness
Contraindications :
Renal disease or renal dysfunction, chronic heart failure requiring pharmacologic treatment, acute or
chronic metabolic acidosis, including diabetic ketoacidosis with or without coma, hypersensitivity to
metformin or glibenclamide
Interactions :
Cationic drugs that are eliminated by renal tubular secretion. Thiazide and other diuretics,
corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin,
nicotinic acid, sympathomimetics, calcium channel blockers and isoniazid may produce
hyperglycaemia and lead to loss of glycaemic control. The hypoglycaemic action of sulphonylureas
may be potentiated by NSAIDs and other highly protein-bound drugs, salicylates, sulfonamides,
chloramphenicol, probenecid, coumarins, MAOIs, β-blockers, ciprofloxacin, oral miconazole.
-------------------------------------------------------------------------------------------------------------------------------Metformin HCl 500 mg Extended Release Tablet
A/KK
Trade Name : Glucophage XR
Indication :
Diabetes mellitus who experienced gastrointestinal side effects with normal metformin
Dosage :
500 mg once daily. Maximum dose 2000 mg once daily with evening meal
Precautions :
Dehydration, serious infection or trauma, patients undergoing surgery, pregnancy, lactation,
children. Monitor serum B12 levels annually.
Adverse Reactions :
Metallic taste, epigastric discomfort, nausea, vomiting, decreased vitamin B12 absorption. Rarely,
diarrhoea, anorexia.
Contraindications :
Diabetic pre-coma, ketoacidosis, renal impairment, chronic liver disease, cardiac failure,
hypoxaemia, history of lactic acidosis, acute alcohol intoxication, hypoxia.
Interactions :
Alcohol, sulfonylureas, cimetidine, anticoagulants.
------------------------------------------------------------------------------------------------------------------------------
210
Metformin HCl 500 mg Tablet
B
Trade Name : Glucophage
Indication :
Diabetes mellitus
Dosage :
500 mg 3 times daily or 850 mg twice daily with food, maximum: 3 g daily in 3 divided doses
Precautions :
Dehydration, serious infection or trauma, patients undergoing surgery, pregnancy, lactation,
children. Monitor serum B12 levels annually
Adverse Reactions :
Anorexia, nausea, vomiting, diarrhoea (usually transient), abdominal pain, metalic taste, rarely lactic
acidosis (withdraw treatment), decreased vitamin-B12 absoption, erythema
Contraindications :
Diabetic pre-coma, ketoacidosis, renal impairment, chronic liver disease, cardiac failure,
hypoxaemia, history of lactic acidosis, acute alcohol intoxication, hypoxia
Interactions :
Alcohol, sulfonylureas, cimetidine, anticoagulants.
-------------------------------------------------------------------------------------------------------------------------------Repaglinide 2 mg Tablet
A*
Trade Name : Novonorm
Indication :
Type 2 diabetes mellitus (as monotherapy or in combination with metformin when metformin alone
is inadequate)
Dosage :
0.5 mg within 30 minutes before main meal. If patients are transferred from another oral
hypoglycaemic agent. Start dose with 1 mg before each main meal. Max single dose: 4 mg before
each main meal. Max 16 mg/day
Precautions :
Patients more than 75 years, debilitated or malnourished patients, renal impairment.
Adverse Reactions :
Hypoglycaemia, transient visual disturbances, gastrointestinal disturbances, hypersensitivity
reactions of skin, arthralgia.
Contraindications :
Type 1 diabetes, diabetic ketoacidosis with or without coma. Pregnancy, lactation. Children less than
12 years. Severe hepatic impairment, concomitant therapy with medicinal products which are
CYP3A4 inhibitors or inducers.
Interactions :
Type 1 diabetes, diabetic ketoacidosis with or without coma. Pregnancy, lactation. Children less than
12 years. Severe hepatic impairment, concomitant therapy with medicinal products which are
CYP3A4 inhibitors or inducers.
------------------------------------------------------------------------------------------------------------------------------Rosiglitazone 8 mg Tablet
A*
Trade Name : Avandia
Indication :
Diabetes mellitus with insulin resistant features, combined with sulphonylureas, metformin,
acarbose and or insulin, delays introduction of insulin in type 2 diabetes mellitus already on maximal
doses of two or more oral hypoglycaemic agents
211
Dosage :
4 mg once daily or in 2 divided doses, may be increased to 8 mg/day in 1-2 divided doses after 12
week
Precautions :
Increased risk of myocardial ischeamia, exacerbate heart failure. Increased risk of fracture, especially
in women. Active liver disease, alanine transaminase level more than 2.5 times upper limit of
normal, type 1 diabetes, oedema (especially when used in combination with insulin), lack of
adequate contraception in premenopausal anovulatory women
Adverse Reactions :
Headache, anaemia, hepatotoxicity, weight gain, oedema.
Contraindications :
Patients with cardiac failure (NYHA Class I-IV) or history of cardiac failure, known ischeamic heart
disease, hepatic impairment, pregnancy and breastfeeding, diabetic ketoacidosis, hypersensitivity to
rosiglitazone product.
Interactions :
Gemfibrozil, rifampicin.
----------------------------------------------------------------------------------------------------------------------------Sitagliptin 100 mg Tablet
A*
Trade Name : Januvia
Indication :
Management of diabetes in patients with renal failure where metformin is contraindicated and
elderly with multiple co morbidities that always experience hypoglycemia with other antidiabetic..
Not to be used in diabetic patient whose sugar control, HBA1c is more than 9%
Dosage :
ADULT over 18 years, 100 mg once daily. Dosage in renal failure: 50 mg once daily if creatinine
clearance equal or more than 30 to equal or less than 50 mL/min. 25 mg orally once if creatinine
clearance less than 30 mL/min or with end stage renal disease requiring hemodialysis, may be
administered without regard to the timing of hemodialysis
Precautions :
Should not be used in patient with type 1 diabetes or for the treatment of diabetic ketoacidosis,
pregnancy, lactation. Dosage adjustments are needed in patients with moderate or severe renal
function impairment
Adverse Reactions :
Gastrointestinal disturbances, peripheral oedema, upper respiratory tract infection, nasopharyngitis,
pain, osteoarthritis, less commonly anorexia, headache, drowsiness, dizziness, hypoglycaemia,
osteoarthritis
Contraindications :
Ketoacidosis; pregnancy; breast-feeding; History of a serious hypersensitivity reaction to Sitagliptin,
such as anaphylaxis or angioedema
Interactions :
Ciclosporine: Sitagliptin mean peak plasma concentrations may be increased modestly
(approximately 68%), which is not expected to be clinically important. Digoxin: Digoxin mean peak
plasma levels may be increased slightly (approximately 18%); no dosage adjustment is
recommended. Ketoconazole
------------------------------------------------------------------------------------------------------------------------------Carbimazole 5 mg Tablet
Trade Name : Neo-mercazole
Indication :
Hyperthyroidism
B
212
Dosage :
ADULT: Initially 10 - 60 mg daily in divided doses. Maintenance: 5 - 20 mg daily
Precautions :
Liver disorders, pregnancy, breast feeding.
Adverse Reactions :
Nausea, mild gastrointestinal disturbance, rashes, bone marrow supression
Contraindications :
May be given to pregnant women. Treatment should be discontinued 3 - 4 weeks before delivery.
Infants should not breast fed by mothers taking carbimazole.
Interactions :
Concurrent use of digoxin and carbimazole may result in decreased peak serum levels of digoxin.
Antithyroid drugs, by reducing the extent of hyperthyroidism, decrease the metabolism of clotting
factors and thus reduce the effects of oral anticoagulants.
-------------------------------------------------------------------------------------------------------------------------------------Iodine and Potassium Iodide Solution
B
Trade Name : Lugol's Solution
Indication :
i) Pre-operative treatment of thyrotoxicosis ii) Thyrotoxicosis crisis
Dosage :
i) 1 ml daily in divided doses ii) 2 - 3 ml daily
Precautions :
Should not be used for long term treatment. Pregnancy, lactation, children
Adverse Reactions :
Hypersensitivity reactions, headache, lacrimation.
Contraindications :
Breast feeding
Interactions :
Concomitant use with lithium may result in hypothyroidism and decrease the effects of oral
anticoagulants.
-----------------------------------------------------------------------------------------------------------------------------------Levothyroxine Sodium 100 mcg Tablet
B
Trade Name : Oroxine
Indication :
Hypothyroidism
Dosage :
ADULT: 1.7 mcg/kg/day orally in a single daily dose (usual maintenance dose is 100 - 125 mcg/day 70
kg adult). CHILD; 0 - 3 months: 10 - 15 mcg/kg/day; 3 - 6 months: 8 - 10 mcg/kg/day; 6 - 12 months: 6
- 8 mcg/kg/day; 1 - 5 years: 5 - 6 mcg/kg/day; 6 - 12 years: 4 - 5 mcg/kg/day; more than 12 years: 2 3 mcg/kg/day
Precautions :
Angina, heart failure, diabetes mellitus, diabetes insipidus, elderly, long-standing hypothyroidism,
adrenal insufficiency, myxoedema. Do not use for treatment of obesity or for weight loss. Pregnancy,
lactation
Adverse Reactions :
Nervousness, excitability, tremor, muscle weakness, cramps, sweating, flushing, heat intolerance,
headache, insomnia, tachycardia, palpitations, angina pectoris, excessive weight loss, menstrual
irregularities, diarrhoea, vomiting, convulsions, cardiac arrhythmia, heart failure, coma, myocardial
infarction, osteopenia, pseudotumor cerebri, seizure
213
Contraindications :
Untreated hyperthyroidism; uncorrected adrenal failure; recent myocardial infarction
Interactions :
Reduced absorption with iron, cholestyramine, colestipol, aluminium- and magnesium-containing
antacids, calcium carbonate, simethicone, sucralfate. May alter requirements of antidiabetic drugs.
Reduced efficacy of thyroid replacement therapy with imatinib. Reduced tri-iodothyronine serum
levels with amiodarone. Reduced serum levels of thyroxine with carbamazepine, phenytoin,
phenobarbital, rifampicin, oestrogens. May change hypoprothrombinaemic response to warfarin
and other oral anticoagulants. Increased risk of significant hypertension and tachycardia with
ketamine
------------------------------------------------------------------------------------------------------------------------------Levothyroxine Sodium 25 mcg Tablet
B
Trade Name : Euthyrox
Indication :
Hypothyroidism
Dosage :
ADULT:1.7 mcg/kg/day ORALLY in a single daily dose (usual maintenance dose is 100-125 mcg/day
70 kg adult) CHILD; 0-3 months: 10-15 mcg/kg/day; 3-6 months: 8-10 mcg/kg/day; 6-12 months: 6-8
mcg/kg/day; 1-5 years: 5-6 mcg/kg/day; 6-12 years: 4-5 mcg/kg/day; more than 12 years: 2-3
mcg/kg/day
Precautions :
Angina, heart failure; diabetes mellitus; diabetes insipidus; elderly; long-standing hypothyroidism;
adrenal insufficiency; myxoedema. Do not use for treatment of obesity or for weight loss. Pregnancy,
lactation
Adverse Reactions :
Nervousness, excitability, tremor, muscle weakness, cramps; sweating, flushing, heat intolerance,
headache, insomnia, tachycardia, palpitations, angina pectoris, excessive weight loss; menstrual
irregularities; diarrhoea, vomiting, convulsions, cardiac arrhythmia, heart failure, coma,myocardial
infarction, osteopenia, pseudotumor cerebri, seizure.
Contraindications :
Untreated hyperthyroidism; uncorrected adrenal failure; recent myocardial infarction.
Interactions :
Reduced absorption with iron, colestyramine, colestipol, aluminium- and magnesium-containing
antacids, calcium carbonate, simethicone, sucralfate. May alter requirements of antidiabetic drugs.
Reduced efficacy of thyroid replacement therapy with imatinib. Reduced tri-iodothyronine serum
levels with amiodarone. Reduced serum levels of thyroxine with carbamazepine, phenytoin,
phenobarbital, rifampicin, oestrogens. May change hypoprothrombinaemic response to warfarin
and other oral anticoagulants. Increased risk of significant hypertension and tachycardia with
ketamine.
------------------------------------------------------------------------------------------------------------------------------Propylthiouracil 50 mg Tablet
B
Indication :
Palliative treatment of hypothyroidism as an adjunct to ameliorate hyperthyrodism in preparation
for surgical treatment or radioactive iodine therapy and in the management of thyrotoxicosis crisis
Dosage :
CHILD: Initial 5 - 7 mg/kg/day in divided doses every 8 hours. Maintenance: 1/3 to 2/3 of the initial
dose in divided doses every 6 - 8 hours. ADULT: Initial dose: 300 - 450 mg daily in divided doses every
8 hours. Maintenance: 100 - 150 mg daily in divided doses every 8 - 12 hours
214
Precautions :
Renal impairment
Adverse Reactions :
Gastric distress, headache, nausea, skin rash
Contraindications :
Pregnancy, lactation, bleeding disorders or easy bruising
Interactions :
Dicumarol, warfarin, carbimazole
---------------------------------------------------------------------------------------------------------------------------------Dexamethasone 0.5 mg Tablet
A
Trade Name : Decadron
Indication :
Croup, septic shock, cerebral oedema and respiratory distress syndrome including status
asthmaticus
Dosage :
0.5 - 9 mg daily, depending upon the disease being treated. Up to 15 mg daily in severe disease
Precautions :
Discontinue treatment by reducing the dosage gradually.
Adverse Reactions :
Fluid and electrolyte disturbances, muscle weakness, peptic ulcer.
Contraindications :
Hypersensitivity, systemic fungal infection.
Interactions :
Barbiturates, phenytoin, rifampin may decreases dexamethasone effects; dexamethasone decreases
effect of salicylates, vaccines, toxoids. Increased effect: Salmeterol: The addition of salmeterol has
been demonstrated to improve response.
------------------------------------------------------------------------------------------------------------------------------Dexamethasone Sodium Phosphate 8 mg/2 ml Injection
B
Trade Name : Decadron
Indication :
Croup, septic shock, cerebral oedema and respiratory distress syndrome including status
asthmaticus
Dosage :
Initially 0.5 - 9 mg IM, IV or infusion daily, depending upon the disease being treated
Precautions :
During periods of stress. Mask the signs of infection and decrease resistance to infection.
Adverse Reactions :
Contraindications :
Hypersensitivity. systemic fungal infections.
Interactions :
Barbiturates, phenytoin, rifampicin may decrease dexamethasone effects; dexamethasone
decreases effect of salicylates, vaccines, toxoids. Increased effect: Salmeterol: The addition of
salmeterol has been demonstrated to improve response.
-------------------------------------------------------------------------------------------------------------------------------
215
Hydrocortisone 10 mg Tablet
B
Indication :
Glucocorticoid replacement therapy in primary or secondary adrenal insufficiencies and long term
management of congenital adrenal hyperplasia in children
Dosage :
ADULT: 20 - 30 mg daily in divided doses. CHILD: 10 - 30 mg daily in divided doses
Precautions :
Adverse Reactions :
Contraindications :
Interactions :
Concurrent use of barbiturates, carbamazepine, phenytoin, primidone or rifampicin may enhance
the metabolism and reduce the effects of systemic corticosteroids. Oral contraceptives or ritonavir
may increase plasma concentrations of corticosteroids.
-------------------------------------------------------------------------------------------------------------------------------------Hydrocortisone Sodium Succinate 100 mg Injection
C
Trade Name : Solu-Cortef
Indication :
Conditions responsive to systemic or local glucocorticoid injection therapy especially in emergencies
Dosage :
Initially 100 - 500 mg IV over 30 seconds to more than 10 minutes. Dose may be repeated at
intervals of 2, 4 or 6 hours
Precautions :
Adverse Reactions :
Contraindications :
Interactions :
Concurrent use of barbiturates, carbamazepine, phenytoin, primidone or rifampicin may enhance
the metabolism and reduce the effects of systemic corticosteroids. Oral contraceptives or ritonavir
may increase plasma concentrations of corticosteroids.
-----------------------------------------------------------------------------------------------------------------------------Methylprednisolone Sodium Succinate 0.5 g Injection
A
Trade Name : Solu-Medrol
Indication :
Suppression of inflammatory and allergic disorders, cerebral oedema, immunosuppression
treatment of haematological and oncological disorders, treatment of shock states and endocrine
disorders
Dosage :
15 - 30 mg/kg daily. Large doses may be repeated 4 - 6 hourly for up to 48 hours
Precautions :
Adverse Reactions :
Fluid and electrolyte disturbances, muscle weakness, peptic ulcer, osteoporosis, abdominal
distention, nausea and vomiting.
216
Contraindications :
Interactions :
Decreased effect: Phenytoin, phenobarbital, rifampicin increases clearance of methylprednisolone.
Potassium depleting diuretics enhance potassium depletion. Increased toxicity: Skin test antigens,
immunizations decrease response of methylprednisolone.
-------------------------------------------------------------------------------------------------------------------------------------Prednisolone 3 mg/5 ml Syrup
B
Trade Name : Prednisone
Indication :
i) Replacement therapy for primary and secondary adrenocortical insufficiency ii) Adrenogenital
syndrome iii) Other therapy
Dosage :
i) 5 - 25 mg daily in divided doses ii) 10 - 20 mg/m2 body surface daily in divided doses iii) ADULT: 5 60 mg daily. CHILD: 0.5 - 2 mg/kg/day in divided doses every 6 - 8 hours or as a single daily
Precautions :
Adverse Reactions :
Fluid and electrolyte disturbances, muscle weakness and peptic ulcer, osteoporosis, abdominal
Contraindications :
Hypersensitivity and systemic fungal infection.
Interactions :
Phenytoin, phenobarbital, rifampin increase clearance of methylprednisolone. Potassium depleting
diuretics enhance potassium depletion. Skin test antigens and immunizations decrease response.
Increase circulating glucose level and may need adjustment of insulin or oral hypoglycaemics.
------------------------------------------------------------------------------------------------------------------------------Prednisolone 5 mg Tablet
B
Trade Name : Prednisone
Indication :
i) Replacement therapy for primary and secondary adrenocortical insufficiency ii) Adrenogenital
syndrome iii) Other therapy
Dosage :
i) 5 - 25 mg daily in divided doses ii) 10 - 20 mg/m2 body surface daily in divided doses iii) ADULT: 5 60 mg daily. CHILD: 0.5 - 2 mg/kg/day in divided doses every 6 - 8 hours or as a single daily
Precautions :
Adverse Reactions :
Fluid and electrolyte disturbances, muscle weakness and peptic ulcer, osteoporosis, abdominal
Contraindications :
Hypersensitivity and systemic fungal infection.
Interactions :
Phenytoin, phenobarbital, rifampin increase clearance of methylprednisolone. Potassium depleting
diuretics enhance potassium depletion. Skin test antigens and immunizations decrease response.
Increase circulating glucose level and may need adjustment of insulin or oral hypoglycaemics.
-------------------------------------------------------------------------------------------------------------------------------
217
Triamcinolone Acetonide 40 mg/ml Injection
A/KK
Trade Name : Kenacort-A
Indication :
Allergies, dermatoses, rheumatoid arthritis and opthalmic diseases
Dosage :
40-80 mg deep into the gluteal muscle
Precautions :
Intercurrent infection, hypothyroidism, cirrhosis, active or latent tuberculosis, renal insufficiency,
cardiac failure, diabetes, glaucoma, myasthenia gravis, pregnancy.
Adverse Reactions :
Local atrophy, post injection flare, pigmentation changes, sodium and fluid retention, peptic ulcer,
impaired wound healing, purpura, striae, increased ocular/intracranial pressure with cushingnoid
state, growth retardation.
Contraindications :
Systemic fungal infection, unstable or infected joints, lactation.
Interactions :
Phenytoin, phenobarbitone, rifampicin, carbamazepine, hypoglycaemics, diuretics,
anticholinesterases, salicylates.
------------------------------------------------------------------------------------------------------------------------------Progesterone 8% Vaginal Gel
A*
Trade Name : Crinone
Indication :
Treatment of infertility due to inadequate luteal phase
Dosage :
90 mg intravaginally daily from day of egg retrieval till pregnancy established
Precautions :
Severe hepatic impairment. Discontinue use if thrombophlebitis, cerebrovascular disorders,
pulmonary embolism and retinal thrombosis occur. History of psychic depression, diabetic patients.
May affect ability to drive or operate machinery.
Adverse Reactions :
Constipation, dizziness, headache, mood swings, cerebrovascular accident, cerebrovascular disease,
myocardial infarction, thrombosis of retinal artery, venous thromboembolism, dementia, ectopic
pregnancy, pulmonary embolism, gastrointestinal disturbances, joint pain, decreased libido,
nervousness, breast tenderness and pain, dyspareunia, nocturia, allergy, cramps, fatigue, pain,
genital moniliasis and pruritus, aggressive reaction, vaginal dryness, cystitis, urinary tract infection,
vaginal discharge.
Contraindications :
Undiagnosed vaginal bleeding, breast or genital organ malignancy, acute porphyria,
thrombophlebitis, thromboembolic disorder, cerebral apoplexy, missed abortion, lactation.
Interactions :
Should not be used concurrently with other local intravaginal therapy.
-----------------------------------------------------------------------------------------------------------------------------Testosterone 250 mg/ml Injection
A*
Trade Name : Testoviron-Depot
Indication :
Only for treatment of male infertility, protein deficiency during convalescence after surgery and
wasting disorder. In women, supplementary therapy of progressive mammary carcinoma
218
Dosage :
By IM only. Hypogonadism 250 mg every 2-3 weeks. To maintain an adequate androgenic effect 250
mg every 3-6 weeks. Potency disorders 250 mg every 4 weeks. Male climateric disorders: 250 mg
every 3-4 weeks. Repeated 6-8 weeks courses at 2-3 months interval
Precautions :
Geriatric patient, healthy males with delayed puberty, benign prostatic hyperthrophy, priapism and
or excessive sexual stimulation may develop, oligospermia may occur with prolonged administration
or excessive dosage. If severe upper abdominal complaints, liver enlargement or signs of intra
abdominal haemorrhage, a liver tumour should be taken into consideration. Development of
hypercalcaemia in female patients (stop treatment).
Adverse Reactions :
Oedema, signs of virilisation in women, inhibition of spermatogenesis.
Contraindications :
Hypersensitivity to testosterone, males with breast carcinoma, androderm therapy has not been
evaluated in women and must not be used in women. Testosterone may cause foetal harm.
Extensive cardiac, hepatic or renal disease. History of or existing hepatic tumour.
Interactions :
An increased risk of cyclosporin toxicity (renal dysfunction, cholestasis, paraesthesias), concurrent
use with dicumarol may result in bleeding.
----------------------------------------------------------------------------------------------------------------------------Desmopressin 0.1 mg Tablet
A
Desmopressin 0.2 mg Tablet
A
Trade Name : Minirin
Indication :
i)Central diabetes insipidus ii)Primary nocturnal enuresis iii)Treatment of nocturia associated with
nocturnal polyuria in adult
Dosage :
i)ADULT and CHILD: 0.1 mg 3 times daily. Maintenance: 0.3-0.6 mg daily ii)ADULT and CHILD over 5
years, 0.2 mg at bed time; withdraw for 1 week for assessment after 3 months iii)Initially 0.1 mg at
night. May be increased to 0.2 mg and then to 0.4 mg by means of weekly increase
Precautions :
Avoid fluid overload in the very young & the elderly, conditions characterised by fluid & or
electrolyte imbalance & those at risk for increased intracranial pressure. Caution in renal
concentration capacity testing for children less than 1 year.
Adverse Reactions :
Nausea, hypertension, hypotension, palpitation, anaphylaxis, transient headache, stomach pain,
epistaxis , fatigue, transient fall in BP with reflex tachycardia and facial flushing.
Contraindications :
Hypersensitivity to desmopressin; hyponatremia or a history of hyponatremia; moderate-to-severe
renal impairment.
Interactions :
Chlorpropamide, fludrocortisone, lithium, carbamazepine , chloropromazine, indomethacin.
---------------------------------------------------------------------------------------------------------------------------------Desmopressin 100 mcg/ml Nasal Spray
Indication :
i) Diabetes Insipidus ii) Primary nocturnal enuresis
Dosage :
i) ADULT : 10 - 20 mcg 1-2 times daily. CHILD: 5 - 10mcg 1-2 times daily ii) 10-40 mcg
219
A
Precautions :
Avoid fluid overload in the very young and the elderly, conditions characterized by fluid and or
electrolyte imbalance and those at risk for increased intracranial pressure. Caution in renal
concentration capacity testing for infant less than 1 year.
Adverse Reactions :
epistaxis and fatigue, transient fall in blood pressure with reflex tachycardia and facial flushing.
Contraindications :
Hypersensitivity to desmopressin, hyponatremia or a history of hyponatremia, moderate-to-severe
renal impairment , unstable angina pectoris, decompensated cardiac insufficiency and von
Willebrand's disease type IIB.
Interactions :
Chlorpropamide, fludrocortisone, lithium, carbamazepine, chloropromazine, indomethacin.
-------------------------------------------------------------------------------------------------------------------------------------Desmopressin Acetate 4 mcg/ml Injection
A
Indication :
i) Diabetes insipidus ii) Haemostasis in peri-operative situations
Dosage :
i) ADULT : 1 - 4 mcg IV daily. CHILD :0.4 mcg daily ii) 0.3 mcg/kg IV
Precautions :
Avoid fluid overload in the very young and the elderly, conditions characterized by fluid and or
electrolyte imbalance and those at risk for increased intracranial pressure. Caution in renal
concentration capacity testing for infant less than 1 year.
Adverse Reactions :
epistaxis and fatigue, transient fall in blood pressure with reflex tachycardia and facial flushing.
Contraindications :
Hypersensitivity to desmopressin, hyponatremia or a history of hyponatremia, moderate-to-severe
renal impairment , unstable angina pectoris, decompensated cardiac insufficiency and von
Willebrand's disease type IIB.
Interactions :
Chlorpropamide, fludrocortisone, lithium, carbamazepine, chloropromazine, indomethacin.
------------------------------------------------------------------------------------------------------------------------------Octreotide 0.1 mg/ml Injection
A
Trade Name : Sandostatin
Indication :
i) Acromegaly ii) Treatment of patients with symptoms associated with gastro-entero-pancreatic
endocrine tumours iii) Carcinoid tumours with features of the carcinoid syndrome, VIPomas,
glucagonomas, gastrinomas/Zollinger-Ellison syndrome, GRFomas, insulinomas iv) Prevention of
complications following pancreatic surgery v) Emergency management of bleeding gastroeosophageal varices in patients with cirrhosis
Dosage :
i, ii and iii) Initially 0.005 - 0.1 mg SC 1 - 2 times daily, increase gradually up to 0.1 - 0.2 mg 3 times
daily iv) 0.1 mg 3 times daily for 7 consecutive days, starting on the day of operation, at least 1 hour
before laparotomy v) 25 mcg/hour for 5 days by continous IV infusion
Precautions :
Growth hormone secreting pituitary tumours (can expand and cause space occupying effects),
insulinomas (exaggerate hypoglycaemia), diabetes, pregnancy and lactation.
220
Adverse Reactions :
Local reaction and discomfort at injection site. Anorexia, nausea, vomiting, crampy abdominal pain,
abdominal bloating, flatulence, loose stools, diarrhoea, steatorrhea, rarely progressive abdominal
distension, severe epigastric pain, abdominal tenderness, guarding, acute pancreatitis. Impairment
of post-prandial glucose tolerance, hyperglycaemia, hypoglycemia, isolated case of hepatic
dysfunction, bradycardia, anaphylactic reactions. Long-term treatment: gallstones.
Contraindications :
Hypersensitivity to octreotide.
Interactions :
Reduces absorption of cyclosporin, cimetidine. Increases bioavailability of bromocriptine.
---------------------------------------------------------------------------------------------------------------------------------Synthetic ACTH (Tetracosactrin Acetate) 250 mcg/ml Injection
A
Trade Name : Synacthen
Indication :
Diagnostic test to differentiate primary adrenal from secondary (pituitary) adrenocortical
insufficiency
Dosage :
Adrenocortical insufficiency: IM, IV (over 2 minutes): Peak plasma cortisol concentrations usually
occur 45-60 minutes after administration CHILD less than 2 years: 0.125 mg, CHILD more than 2
years and ADULTS: 0.25-0.75 mg, when greater cortisol stimulation is needed, an IV infusion may be
used: CHILD more than 2 years and ADULTS: 0.25 mg administered at 0.04 mg/hour over 6 hours
Precautions :
Due to side effects or potentially fatal allergic reactions, therefore, patients should be monitored for
at least one hour after administration in a controlled setting. Discontinue treatment by reducing the
dosage gradually.
Adverse Reactions :
Bradycardia, hypertension, peripheral oedema, tachycardia, rash, whealing with redness at the
injection site, anaphylaxis, hypersensitivity reaction.
Contraindications :
Hypersensitivity to natural ACTH. avoid injections containing benzyl alcohol in neonates.
Interactions :
Decreased effect: Spironolactone, hydrocortisone, cortisone.
-----------------------------------------------------------------------------------------------------------------------------------Terlipressin 1 mg Injection
A*
Trade Name : Glypressin
Indication :
Acute oesophageal variceal bleeding
Dosage :
2 mg IV bolus over 1 minute. Maintenance: 1 - 2 mg IV bolus 4 - 6 hourly until bleeding is controlled,
up to 24 - 36 hours
Precautions :
Asthma, hypertension, advanced arteriosclerosis, coronary insufficiency, cardiac arrhythmias, renal
insufficiency.
Adverse Reactions :
Fibrinolysis, bradycardia, facial pallor, increased blood pressure and ECG changes, peripheral
vasoconstriction, increased intestinal peristalsis, stool urgency and possible stool incontinence,
uterine contractions, bronchial constriction.
Contraindications :
Pregnancy.
221
Interactions :
Not known.
---------------------------------------------------------------------------------------------------------------------------------Vasopressin 20 units/ml Injection
A
Trade Name : Pitressin
Indication :
i) Pituitary diabetes insipidus ii) Oesophageal variceal bleeding
Dosage :
i) 5 - 20 units SC or IM every 4 hours ii) 20 units in 100 - 200 ml 5% dextrose saline over 15 minutes
as infusion which may be repeated after at intervals of 1 - 2 hours. Maximum: 4 doses
Precautions :
Heart failure, migraine, epilepsy, asthma or other conditions which might be exacerbated by fluid
retention, renal impairment. Avoid fluid overload.
Adverse Reactions :
Pallor, nausea, belching, abdominal cramps, hypersensitivity reaction, sweating, urticaria, gangrene,
arrhythmias, angina and bronchoconstriction, anaphylaxis, cardiac arrest or shock.
Contraindications :
Hypersensitivity to vasopressin, vascular disease especially coronary artery disease, chronic nephritis
and pregnancy (3rd trimester).
Interactions :
Carbamazepine, chlorpropamide, clofibrate, urea, fludrocortisone, tricyclic antidepressants,
noradrenaline, lithium, heparin and alcohol.
------------------------------------------------------------------------------------------------------------------------------Alendronate Sodium 70mg and Cholecalciferol 2800 IU Tablet
A*
Trade Name : Fosamax Plus
Indication :
Osteoporosis in post menopausal women with a history of vertebral fracture and whom oestrogen
replacement therapy is contraindicated
Dosage :
1 tablet once weekly [contains cholecalciferol 2800 units in a weekly dose, equivalent to 400 units
daily]. Swallow the tablet whole with a full glass of plain water only on an empty stomach at least 30
minutes before breakfast (and any other oral medication); stand or sit upright for at least 30 min and
do not lie down until after eating breakfast
Precautions :
Discontinue in case of dysphagia, odynophagia, retrosternal pain or new or worsening heartburn.
Active upper gastrointestinal problems (dysphagia, esophageal diseases, gastritis, duodenitis or
ulcers). CrCl less 35 ml/min. Correct hypocalcemia and other disorders affecting mineral metabolism
(eg vit D deficiency) before starting therapy. Monitor serum Calcium and urine. Children, pregnancy
and lactation.
Adverse Reactions :
Urticaria, myalgia, malaise; nausea, vomiting, esophageal stricture/perforation, oropharyngeal
ulceration; esophagitis, esophageal erosions, esophageal ulcers; localized osteonecrosis of the jaw;
bone, joint and or muscle pain; rash, pruritus, angioedema, fever, hypocalcemia, gastric or duodenal
ulcers, Stevens-Johnson syndrome, toxic epidermal necrolysis, ocular inflammations (uveitis, iritis,
scleritis).
Contraindications :
Esophageal abnormalities which inhibit esophageal emptying (ie, achalasia, stricture), increased risk
for adverse esophageal effects, hypocalcemia; decreases in serum calcium and phosphate have
222
occurred during therapy, resolve hypocalcemia prior to beginning therapy, inability to sit or stand in
an upright position for at least 30 minutes.
Interactions :
Calcium supplements, antacids. Hormone replacement therapy. Olestra, mineral oils, orlistat,
cholestyramine, colestipol. Anticonvulsants, cimetidine, thiazides
------------------------------------------------------------------------------------------------------------------------------Calcitonin (synthetic Salmon) 100 IU Injection
A*
Trade Name : Miacalcic
Indication :
Acute hypercalcaemia
Dosage :
5 - 10 IU/kg/day SC/IM (in 1 - 2 divided doses) to 400 units every 6 - 8 hours adjusted according to
clinical and biochemical response (no additional benefit with over 8 units/kg every 6 hours. 5 - 10
units/kg slow IV over at least 6 hours
Precautions :
Pregnancy, lactation, caution when driving vehicles or operating machinery.
Adverse Reactions :
Nausea, vomiting, flushing, chills, dizziness, polyuria. Rarely, local hypersensitivity reactions,
anaphylactoid-like reactions.
Contraindications :
Hypersensitivity to calcitonin.
Interactions :
Ketoprofen inhibit the calciuric and uricosuric effects of calcitonin. Calcitonin cause a significant
decrease in the mean values of lithium plasma levels.
-----------------------------------------------------------------------------------------------------------------------------Calcitonin (Synthetic Salmon) 200 IU Nasal Spray
A*
Trade Name : Miacalcic
Indication :
Osteoporosis
Dosage :
200 units daily
Precautions :
Pregnancy, lactation, caution when driving vehicles or operating machine. Should not be given to
children more than a few weeks. Possibility of systemic allergic reaction exists.
Adverse Reactions :
Rhinitis, ulcerative rhinitis, sinusitis, epitaxis, flushing, dizziness, headache, gastrointestinal
disturbances, musculoskeletal pain, pharyngitis, fatigue, dysgeusia. Rarely, hypertension, vomiting,
arthralgia, cough, oedema, flu-like symptoms, abnormal vision.
Contraindications :
Hypersensitivity to calcitonin.
Interactions :
Ketoprofen inhibit the calciuric and uricosuric effects of calcitonin. Calcitonin cause a significant
decrease in the mean values of lithium plasma levels.
------------------------------------------------------------------------------------------------------------------------------------Ibandronic Acid 150 mg Tablet
Trade Name : Bonviva
Indication :
Treatment of postmenopausal osteoporosis to reduce the risk of fracture
223
A*
Dosage :
150 mg once monthly
Precautions :
Concurrent therapies with corticosteroids, chemotherapy, radiotherapy; increased risk for
osteonecrosis especially in the jaw. Creatinine clearance less than 35 ml/minute, vitamin D and
mineral deficiencies to be corrected before initiating therapy.
Adverse Reactions :
Rash, abdominal pain, diarrhoea, indigestion, nausea, arthralgia, back pain, myalgia, headache,
bronchitis, dyspepsia, nausea, flu-like symptoms.
Contraindications :
Hypersensitivity to ibandronate or to any of its excipients. Inability to stand or sit upright for 60
minutes. Uncorrected hypocalcaemia, hypocalcaemia, esophageal reactions.
Interactions :
Concurrent use with calcium and antacids may result in reduced alendronate absorption.
---------------------------------------------------------------------------------------------------------------------------------Pamidronate Disodium 30 mg Injection
A*
Trade Name : Aredia
Indication :
Hypercalcaemia of malignancy (tumour -induced hypercalcaemia)
Dosage :
Dose depends on the initial serum calcium levels. Doses range from a single infusion of 30 - 90 mg
Precautions :
Risk of hypocalcaemia especially in patients with Paget's disease, monitor if pre-existing anaemia,
leucopenia, or thrombocytopenia are present, follow complete blood count during the first 2 weeks
of treatment, history of hypoparathyroidism. Do not administer as a bolus injection or with other
bisphosphonates or Calcium-containing IV infusions. Monitor serum electrolytes, Calcium,
phosphates, renal function (at the start of treatment and prior to each further dose). Renal
impairment, cardiac disease. Caution in road/machinery users. Pregnancy, lactation. Children.
Severe hepatic impairment. Patients should be advised to inform their dentist while under treatment
or if dental surgery is planned.
Adverse Reactions :
Myelosuppression, hypertension, hypotension, thrombophlebitis, malaise, nausea, vomiting, fever,
anorexia, hypomagnesaemia, hypokalaemia, hyperkalaemia, hypernatraemia, hypocalcaemia,
hypophosphataemia, anaemia, thrombocytopenia, lymphocytopenia, headache, insomnia,
somnolence, conjunctivitis, hypertension, gastrointestinal disturbances, rash, transient
musculoskeletal pain, reactions at infusion site, deterioration of preexisting renal disease, acute
renal failure, increased serum creatinine increased serum urea. Uncommon: allergic reactions,
seizures, agitation, dizziness, lethargy, uveitis, dyspepsia, pruritus, muscle cramps, abnormal liver
function tests. Rare: focal segmental glomerulosclerosis, nephrotic syndrome, anaphylactic shock,
reactivation of herpes simplex and zoster, leukopenia, confusion, visual hallucinations, scleritis,
episcleritis, xanthopsia, left ventricular failure, chronic heart failure, haematuria.
Contraindications :
Hypersensitivity to biphosphonates.
Interactions :
Caution when coadministration with potentially nephrotoxic drugs. Combination with thalidomide
may increase risk of renal dysfunction.
------------------------------------------------------------------------------------------------------------------------------
224
Zoledronic Acid 4 mg Injection
A*
Trade Name : Zometa
Indication :
i) Treatment of hypercalcaemia of malignancy ii) Prevention of skeletal related events in patients
with multiple myeloma involving multiple bone lesions
Dosage :
4 mg reconstituted and should be given as a 15 minutes IV infusion every 3-4 weeks
Precautions :
Assess hydration status prior to administration. Monitor serum electrolytes and creatinine. Evaluate
serum creatinine prior to each administration. If renal function has deteriorated, the dose should be
withheld. Not recomended in patients with bone metastases with severe renal impairment (serum
creatinine greater than 3.0 mg/dl) Severe renal or hepatic impairment. Patients should be advised to
inform the dentist during treatment and if dental surgery is foreseen. Caution is advised when
bisphosphonates are administered with aminoglycosides or other potentially nephrotoxic drugs,
since these agents may have an additive effect, resulting in a lower serum calcium level for longer
periods than required.
Adverse Reactions :
Alopecia,
dermatitis,
hypokalaemia,
hyperkalaemia,
hypernatremia,
hypocalcemia,
hypomagnesemia, hypophosphatemia, shivering, abdominal pain, diarrhoea, nausea, vomiting,
arthralgia, bone pain, myalgia, headache, paraesthesia, upper tract infection, cough, dyspnoea,
upper respiratory infection, anemia, neutropenia, thrombocytopenia, nephrotoxicity, aseptic
necrosis of bone and jaw , pleural effusion. Rise in body temp, flu-like syndrome, elevation of serum
creatinine, renal impairment, conjunctivitis. Hypersensitivity reactions, hypertension, shortness of
breath, dizziness, sleeping disturbances, gastrointestinal reactions, loss of appetite, local reactions at
infusion site, rash, pruritus.
Contraindications :
Hypersensitivity to zoledronic acid or other bisphosphonates, pregnancy, lactation.
Interactions :
Aminoglycosides, other potentially nephrotoxic drugs, thalidomide.
----------------------------------------------------------------------------------------------------------------------------------Bromocriptine Mesilate 2.5 mg Tablet
A/KK
Trade Name : Parlodel
Indication :
i) Hypogonadism or Galactorrhoea ii) Acromegaly
Dosage :
i) Initially 1 - 1.25 mg at bedtime increased gradually, usual dose: 7.5 mg daily in divided doses. Max
30 mg daily ii) 1.25 - 2.5 mg at bedtime for 3 days and may be increased by 1.25 - 2.5 mg every 3 - 7
days up to 30 mg a day in divided doses
Precautions :
Nursing mothers, children under 15 years old, peptic ulcer disease, postpartum, puerperal women
with high blood pressure, coronary artery disease, psychic disorders, concomitant use of other ergot
alkaloid. Fertility may be restored (contraception needed), malignancy excluded before use for
benign breast disease, acromegalic patients with history of peptic ulceration.
Adverse Reactions :
Hypotension, peripheral vasoconstriction, dyskinesias, fatigue, nausea, vomiting, constipation,
drowsiness, confusion, psychomotor excitation, hallucinations, dyskinesias, dryness of the mouth,
leg cramps, allergic skin reactions. On prolonged treatment, reversible pallor of fingers and toes.
Contraindications :
Hypersensitivity to bromocriptine products, toxaemia of pregnancy, hypertension in postpartum and
during puerperium.
225
Interactions :
Clarithromycin - elevations in serum levels of bromocriptine. Inhibit ciclosporin metabolism.
Erythromycin - significantly increase the bioavailability of bromocriptine. Bromocriptine, may
decrease the metabolism of sirolimus, tacrolimus . Alcohol reduces tolerance to bromocriptine and
vice-versa. Effects of antihypertensives may be potentiated. Avoid concurrent psychotropics.
------------------------------------------------------------------------------------------------------------------------------Cabergoline 0.5 mg Tablet
A*
Trade Name : Dostinex
Indication :
i) Treatment of hyperprolactinaemic disorders ii) Prevention of puerperal lactation and suppression
of lactation in HIV infected mothers only
Dosage :
i) Hyperprolactinaemia: 0.25 mg 1-2 times per week ii) HIV mothers only: Prevent lactation 2 tab first
day after delivery. Interruption of lactation: 0.25 mg 12 hourly for 2 days
Precautions :
Eclampsia, pre-eclampsia or pregnancy induced hypertension. Do not administer dopamine D2
receptor antagonists concurrently. High initial doses (1mg), especially with concurrent
antihypertensive regimens, liver disease.
Adverse Reactions :
Orthostatic hypotension, valvular regurgitation, abdominal pain, vertigo, pleural effusion, pulmonary
fibrosis, constipation, nausea, dizziness, headache, somnolence, depression, fatigue, sleeplessness,
dyspepsia, gastritis, weakness, fatigue, constipation, vomiting, breast pain, hot flushes, depression,
tingling.
Contraindications :
Hypersensitivity to cabergoline or potent inhibitors of CYP3A4 (includes protease inhibitors, azole
antifungals and some macrolide antibiotics), uncontrolled hypertension.
Interactions :
Activity and tolerability may be affected by antiemetics, antihypertensives, psychotropics and
macrolide antibiotics.
-------------------------------------------------------------------------------------------------------------------------------Danazol 200 mg Capsule
A/KK
Trade Name : Ladogal
Indication :
i)Endometriosis and gynaecomastia ii)Menorrhagia iii)Prophylaxis of hereditary angioedema
Dosage :
i)200 - 800 mg daily for max of 9 months ii)200 mg daily for 12 weeks ii)400 mg daily. Reduce to 200
mg daily after 2 months attack free period
Precautions :
Haemophilia, epilepsy, migraine or cardiac or renal dysfunction, require careful observation. Periodic
liver function tests should be performed, exacerbation of acute intermittent porphyria.
Adverse Reactions :
Hepatic dysfunction, weight gain, acne, menstrual disturbances.
Contraindications :
Undiagnosed abnormal vaginal bleeding, hepatic or renal or cardiac dysfunction.
Interactions :
Co-administration of oral anticoagulants has resulted in a prolonged prothrombin time and
haemorrhages. Carbamazepine : significant increases in carbamazepine levels which resulted in
toxicity. Clomifene : result in inhibition of response to clomifene. Cyclosporin : increased cyclosporin
226
blood levels and toxicity. Sirolimus, Tacrolimus : decrease the metabolism, causing increased plasma
concentrations of sirolimus and tacrolimus.
----------------------------------------------------------------------------------------------------------------------------------Goserelin 3.6 mg Depot Injection
A
Trade Name : Zoladex
Indication :
Prostate cancer,endometriosis,leiomyoma uteri and assissted reproduction,breast cancer in
premenopausal and perimenopausal women suitable for hormonal manipulation
Dosage :
mg depot injection every 28 days
Precautions :
Initially may increase bone pain, increase serum testosterone levels, and worsen symptoms of
prostatic cancer.Isolated cases of spinal cord compression and renal impairment from ureteral
obstruction have occurred.History of prior treatment that may have resulted in bone mineral density
loss or patients with increased risk factors for decreased bone mineral density.
Adverse Reactions :
Bone pain, hot flashes, gynecomastia, impotence, breakthrough bleeding, deep venous thrombosis,
depression, imsomnia.
Contraindications :
Pregnancy, lactation, hypersensitivity to goserelin products, leutenizing hormone-releasing hormon
(LHRH) or LHRH analogues. Depot injection of 10.8 mg is contraindicated in women.
Interactions :
Not Known.
--------------------------------------------------------------------------------------------------------------------------------
227
10. OBSTETRICS & GYNAECOLOGY
Hormone replacement therapy
Infertility
Prostaglandin and oxytocics
Treatment of vaginal and vulval conditions
Contraceptices
Miscellaneous Obstetrics and Gynaecology
228
Conjugated Oestrogens 0.625 mg & Medroxyprogesterone Acetate 2.5 mg Tablet
A
Trade Name : Premelle 2.5
Indication :
Management of moderate to severe vasomotor symptoms associated with menopause, prevention
and management of postmenopausal osteoporosis, atropic vaginitis and atropic urethritis in post
menopausal woman with intact uterus
Dosage :
1 tablet daily
Precautions :
Myocardia infarction, stroke, breast, endometrial and ovarian cancer, pregnancy, gallbladder
disease, retinal vascular thrombosis, proptosis, diplopia, migraine, hypercalcaemia, fluid retention,
hypertriglyceridemia, hepatic impairment, past history of cholestatic jaundice, elevated blood
pressure, asthma, epilepsy, hypocalcaemia, hypothyroidism, abnormal uterine bleeding, depression
Adverse effects :
Breast pain, breakthrough bleeding, dysmenorrhea, spotting, breast tenderness or enlargement,
discharge, arthralgias, leg cramp, depression, vaginitis, weight changes.
Contraindications :
Pregnancy, known or suspected cancer of the breast and estrogen dependent neoplasia,
undiagnosed abnormal genital bleeding, active thrombophlebitis or thromboembolic disorders, liver
dysfunction or disease. Active or recent arterial thromboembolic disease.
Interactions :
Rifampin may reduce effectiveness.
-------------------------------------------------------------------------------------------------------------------------------------Conjugated Oestrogens 0.625 mg Tablet
A
Trade Name : Premarin
Indication :
i) Osteoporosis ii) Female hypoestrogenism iii) Vasomotor symptoms or atrophic vaginitis and
urethritis
Dosage :
i) 0.625 mg daily ii) 0.3 - 1.25 mg daily iii) 0.3 - 1.25 mg daily
Precautions :
Familial hyperlipoproteinaemia, uterine bleeding and mastodynia, uterine fibroids, impaired liver
function, fluid retention, hypocalcaemia and renal insufficiency, addition of a progesterone for seven
or more days of a cycle of oestrogen administration have reported a lowered incidence of
endometrial hyperplasia, gall bladder disease, patient who have been treated for endometrial
carcinoma, endometriosis, patient with pre-existing hypertension, fibrocystic disease of the breast,
migraine headache, uterine leiomyoma.
Adverse effects :
Nausea, endometrial cancer (postmenopausal), oedema, weight changes, breast changes, headache
migraine, steepening of corneal curvature, changes in libido, change in menstrual flow, vomiting,
aggravation of porphyria, cholestatic jaundice, alopecia, breakthrough bleeding, spotting,
amenorrhoea, bloating, dizziness.
Contraindications :
Oestrogen-dependent neoplasia, known or suspected pregnancy, undiagnosed abnormal vaginal
bleeding.
Interactions :
Rifampicin may reduce effectiveness.
--------------------------------------------------------------------------------------------------------------------------------------
229
Dydrogesterone 10 mg Tablet
A/KK
Trade Name : Duphaston
Indication :
i) Dysmenorrhoea ii) Endometriosis iii) Dysfunctional uterine bleeding (to arrest and to prevent
bleeding) iv) Threatened abortion v) Habitual abortion vi) Post menopausal complaints (hormone
replacement therapy in combination with oestrogen)
Dosage :
i) 10 mg bd from day 5 - 25 of cycle ii) 10 mg bd - tds from day 5 - 25 of the cycle or continuously iii)
To arrest bleeding :10 mg bd with an oestrogen once daily for 5 - 7 days, To prevent bleeding : 10 mg
bd with an oestrogen once daily from day 11 - 25 of the cycle iv) 40 mg at once, then 10mg 8hrly
until symptoms remit v) 10 mg bd until 20th week of pregnancy vi) 10-20 mg daily during last 12-14
days of each cycle.
Precautions :
Pregnancy.
Adverse effects :
Breakthrough bleeding, altered liver function, angioedema, haemolytic anaemia.
Contraindications :
Breast and genital cancers, abnormal vaginal bleeding.
Interactions :
Enzyme inducing drugs such as carbamazepine, griseofulvin, phenobarbitone, phenytoin and
rifampicin may enhance the clearance of progesterone. Progesterone may inhibit ciclosporin
metabolism leading to increased plasma-ciclosporin.
------------------------------------------------------------------------------------------------------------------------------Estradiol 1 mg (14 tablet) & Estradiol 1 mg with Dydrogesterone 10 mg (14 tablet)
A*
Trade Name : Femoston 1/10
Indication :
Hormone Replacement Therapy for women with disorders due to natural or surgically induced
menopause with intact uteri
Dosage :
One tablet daily without pill-free interval, starting with 1 mg of Estradiol for first 14 days, followed
by 1mg Estradiol with 10 mg Dydrogestrone daily for the next 14 days
Precautions :
Periodic general and gynaecological exam and mammogram should be instituted. Patients in the
perimenopausal phase are advised to take non-hormonal contraceptive precautions. Interruption of
HRT 1 month before surgery should be considered. Epilepsy, migraine, cardiac failure, hypertension,
porphyria, haemoglobinopathies, otosclerosis, uterine leiomyomata, endometriosis, lactation.
Adverse effects :
Breast tenderness, nausea, headache, oedema, breakthrough bleedings, skin reactions.
Contraindications :
Known or suspected carcinoma of the breast, endometrial carcinoma or other hormone dependent
neoplasia. Acute or chronic liver disease. History of liver disease where the liver function tests have
not returned to normal. History of venous thromboembolic diseases (e.g. deep venous thrombosis
or pulmonary embolism). Abnormal genital bleeding. Known or suspected pregnancy.
Interactions :
Barbiturates, phenytoin, rifampicin, carbamazepine.
--------------------------------------------------------------------------------------------------------------------------------------
230
Estradiol 1 mg with Dydrogesterone 5 mg Tablet
A*
Trade Name : Femoston Conti
Indication :
i) Hormone replacement therapy for the relief of symptoms due to oestrogen deficiency ii)
Prevention of postmenopausal osteoporosis in women with a uterus
Dosage :
One tablet daily, taken continuously without interruption. Should be used only in postmenopausal
women more than 12 month after menopause
Precautions :
Periodic general and gynaecological exam and mammogram should be instituted. Patients in the
perimenopausal phase are advised to take non-hormonal contraceptive precautions. Interruption of
HRT 1 month before surgery should be considered. Epilepsy, migraine, cardiac failure, hypertension,
porphyria, haemoglobinopathies, otosclerosis, uterine leiomyomata, endometriosis, lactation.
Adverse effects :
Breast tenderness, nausea, headache, oedema, breakthrough bleedings, skin reactions.
Contraindications :
Known or suspected carcinoma of the breast, endometrial carcinoma or other hormone dependent
neoplasia. Acute or chronic liver disease. History of liver disease where the liver function tests have
not returned to normal. History of venous thromboembolic diseases (e.g. deep venous thrombosis
or pulmonary embolism). Abnormal genital bleeding. Known or suspected pregnancy.
Interactions :
Barbiturates, phenytoin, rifampicin, carbamazepine.
------------------------------------------------------------------------------------------------------------------------------Estradiol Valerate 1 mg Tablet
A*
Trade Name : Progynova
Indication :
Oestrogen replacement therapy - only those who cannot tolerate Premarin
Dosage :
1 mg daily continuously or 21 day regimen with 1 week of tablet free interval
Precautions :
Associated with adverse lipoprotein metabolism, impairment of glucose tolerance, possible
enhancement of mitotic activity in breast epithelial tissue. Hypercoagulability, familial
hyperlipoproteinaemia, fluid retention, uterine bleeding and mastodynia, impaired liver function
and aspirin hypersensitivity (tartazine dye).
Adverse effects :
Headache, nausea, hypertension, myocardia infarction, thromboembolism, vaginal bleeding, breast
tension, increase in body weight.
Contraindications :
Severe liver disease, breast cancer (except metatastic disease), oestrogen dependent neoplasia,
known or suspected pregnancy, undiagnosed abnormal vaginal bleeding, thromboembolic disorders.
Interactions :
Barbiturates, phenylbutazone, hydantoins, rifamcipin and ampicillin may impair action of the drug.
Requirements for oral antidiabetics and insulin can change.
--------------------------------------------------------------------------------------------------------------------------------Estradiol Valerate 2 mg and Norgestrel 500 mcg with Estradiol Valerate 2 mg Tablet
B
Trade Name : Progyluton
Indication :
Pre and post menopausal syndrome, primary and secondary amenorrhea, menstrual irregularities.
Deficiency symptoms after oophorectomy or radiological castration for noncarcinomatous disease
231
Dosage :
Start on the 5th day of menstrual cycle - 1 tab daily for 21 days then stop for 7 days. If patient
forgets dose at usual time, it should be taken within following 12 hours
Precautions :
Asthma, epilepsy, migraine, hypertension, cardiac or renal dysfunction, endometrial hyperplasia,
metabolic bone diseases, endometrial cancer, breast cancer, gall bladder disease, pancreatitis,
lactation, surgery, liver disorders, enlargement of uterine fibromyomata.
Adverse effects :
Changes in vaginal bleeding pattern, change in amount of cervical secretion, premenstrual-likesyndrome, cystitis-like-syndrome, increase in size of uterine leiomyomata, vaginal candidiasis,
amenorrhoea, changes in cervical erosion, nausea, cholestatic jaundice, changes in appetite,
vomiting, abdominal cramps, bloating, increased incidence of gall bladder disease, pancreatitis.
Headache, dizziness, mental depression, nervousness, migraine. Increase or decrease in weight,
oedema, changes in libido, fatigue, backache, reduced carbohydrate tolerance, aggravation of
porphyria, pyrexia, anaphylactoid reactions.
Contraindications :
Known or suspected pregnancy, including use for missed abortion or as a diagnostic test for
pregnancy. Oestrogen or progestin may cause foetal harm when administered to a pregnant woman.
Known or suspected cancer of the breast. Known or suspected oestrogen -dependent neoplasm,
severe liver dysfunction, jaundice or severe pruritus during a previous pregnancy, previous or
existing liver tumours, existing or suspected hormone-dependent tumours of uterus or mammae.
Severe diabetes with vascular changes, previous or existing thromboembolic processes,
endometriosis, disturbances of lipometabolism, a history of herpes gestationis, otosclerosis with
deterioration during previous pregnancies, Dubin-Johnson syndrome, Rotor syndrome, sickle-cell
anemia.
Interactions :
Rifampicin, barbiturates, phenytoin, rifampicin, phenylbutazone, ampicillin. Requirements for oral
antidiabetics and insulin can change.
-----------------------------------------------------------------------------------------------------------------------------Medroxyprogesterone Acetate 5 mg Tablet
B
Trade Name : Provera/Farlutal
Indication :
i) Secondary amenorrhoea ii) Abnormal uterine bleeding due to hormonal imbalance
Dosage :
i) 5-10 mg daily for 5-10 days. To produce optimum secretory transformation 10 mg daily for 10 days
ii) 5-10 mg daily for 5-10 days on day 15-21 of menstrual cycle. Optimum secretory transformation
10 mg daily for 10 days from day 15 of the cycle
Precautions :
Depressions, diabetes, epilepsy, migraine, asthma.
Adverse effects :
Gastrointestinal distress, oedema, menstrual disorders, dermatologic effects, nausea, fatique,
depression, acne, hirsutism, breast tenderness, thromboembolic phenomena, galactorrhoea,
decreased glucose tolerance, anaphylaxis, corticoid like reaction (high doses).
Contraindications :
Thromboembolic disorders, liver disease, known or suspected malignancy of breast or genital
organs, undiagnosed abnormal vaginal bleeding, known or suspected pregnancy, hypersensitivity to
medroxyprogesterone products.
Interactions :
Aminoglutethimide, rifampicin.
-------------------------------------------------------------------------------------------------------------------------------
232
Tibolone 2.5 mg Tablet
A*
Trade Name : Livial
Indication :
Complaints resulting from natural or surgical menopause and in cases at high risk for breast
carcinomas where general hormone replacement therapy is contraindicated
Dosage :
2.5 - 5mg daily
Precautions :
Women with hormone dependent tumours, cardiovascular or cerebrovascular disorders including
thrombophlebitis, thromboembolic processes or a history of these conditions, undiagnosed vaginal
bleeding and severe liver disorders. Liver disease. Patients with hypercholesterolaemia and impaired
glucose tolerance. Stop tibolone 4 weeks before elective surgery when prolonged immobilisation
after surgery is likely.
Adverse effects :
Endometrial hyperplasia and endometrial carcinoma (rare), change in body weight, vaginal bleeding,
gastrointestinal upsets, changes in liver parameters, increased facial hair growth and pretibial
oedema.
Contraindications :
Hypersensitivity to tibolone, breast cancer (known or suspected), oestrogen-dependent neoplasms,
cerebrovascular disease, history of stroke, arterial disease, thromboembolic disorders, history of
cholestatic jaundice, hepatic tumours (benign or malignant), abnormal vaginal bleeding.
Interactions :
Phenytoin, carbamazepine and rifampicin may enchance the metabolism of tibolone and thus
reduce its activity.
-------------------------------------------------------------------------------------------------------------------------------Chorionic Gonadotrophin Human (HCG) 5000 IU Injection
*
Trade Name : Pregnyl
Indication :
Treatment of infertile women to induce ovulation and as a luteal support in controlled ovarian
hyperstimulation cycles
Dosage :
Induction of ovulation: 5000 - 10,000 units one day following last dose of menotropin. Up to 3
repeat injections of 5000 units each may be given within the following 9 days to prevent
insufficiency corpus luteum
Precautions :
Use of human gonadotrophin either to induce ovulation or as a luteal support, may increase the risk
of ovarian hyperstimulation syndrome (OHSS).
Adverse effects :
Thromboembolism, oedema, headache, irritability, restlessness, depression and tiredness, salt and
fluid retention, pain at injection site, skin rashes.
Contraindications :
Androgen dependent neoplasia prior allergic reaction to chorionic gonadotrophin, active
thrombophlebitis.
Interactions :
When used with gonadotrophins (Follicle Stimulating Hormone), ovarian hyperstimulation
syndrome, enlargement of ovarian cysts or rupture of ovarian cysts and multiple births may occur.
---------------------------------------------------------------------------------------------------------------------------------
233
Clomifene Citrate 50 mg Tablet
Trade Name : Clomid
Indication :
Anovulatory infertility
Dosage :
50 mg daily from 2nd - 6th or 5th - 9th day of menstrual cycle. Increase dose gradually by increments
of 50 mg if there is no response until a dosage of 200 mg daily is achieved
Precautions :
Pelvic examination prior to initial treatment, ophthalmological evaluation in patients developing
visual symptoms, multiple pregnancies can occur, ovarian hyperstimulation syndrome and abnormal
ovarian enlargement may occur.
Adverse effects :
Blurred vision, vasomotor flushing, abdominal pain and ovarian enlargement (which may be part of
the ovarian hyperstimulation syndrome).
Contraindications :
Pregnancy, uncontrolled thyroid or adrenal dysfunction, liver disease, abnormal uterine bleeding,
ovarian cysts, organic intracranial lesion.
Interactions :
Danazol can results in inhibition of response to clomifene. Ethinyl estradiol can results in suppression
of response to ethinyl estradiol. When used concomitantly with gonadorelin acetate gonadotrophins
(FSH), it may increase the risk of ovarian hyperstimulation syndrome (OHSS).
--------------------------------------------------------------------------------------------------------------------------------Follitropin Alpha (Recombinant Human FSH) 75 IU Injection
A*
Trade Name : Gonal F
Indication :
i) Infertility treatment in anovulatory women who have been unresponsive to treatment with
clomiphene citrate ii) Stimulation of follicular development for intra-uterine cycles iii) Stimulation of
follicular development in assisted reproductive technology in the management of infertility
Dosage :
i) 75 - 150 IU daily, should commence within the first 7 days of the menstrual cycle and increased by
37.5 IU or 75 IU at 7 or 14 days interval. Max daily dose 225 IU ii) 150 - 225 IU daily commencing on
days 2 or 3 of the cycle. Max daily dose 450 IU
Precautions :
Evaluate patient for hypothyroidism, adrenocortical deficiency, hyperprolactinaemia and pituitary or
hypothalamic tumours before starting therapy.
Adverse effects :
Fever, arthralgia, pain in lower abdominal region, nausea, vomiting and weight gain, ovarian
hyperstimulation syndrome (OHSS), multiple pregnancy.
Contraindications :
Pregnancy, lactation, ovarian enlargement or cyst not due to polycystic ovarian disease,
gynaecological haemorrhages of unknown aetiology, ovarian, uterine or mammary carcinoma
tumours of the hypothalamus and pituitary gland.
Interactions :
Other ovulation stimulation agents may potentiate the follicular response whereas concurrent use in
GnRH agonist- induced pituitary desensitization may increase the dosage of Gonal-F needed to elicit
an adequate ovarian response.
-------------------------------------------------------------------------------------------------------------------------------
234
Carboprost Tromethamine 250 mcg Injection
A*
Trade Name : Hemabate
Indication :
Postpartum haemorrhage refractory to oxytocin
Dosage :
ADULT: by deep IM injection; 250 mcg, may repeat at 15-90 minute, intervals to a total dose of 2 mg
(8 doses), followed by subsequent doses of 250 mcg at intervals of 1.5 to 3.5 hours. Dosage may be
increased to 500 mcg/dose if contractility is inadequate
Precautions :
Glaucoma, elevated intraocular pressure, asthma or history of asthma. Cephalopevic relationships
carefully evaluated prior to use. During use, uterine activity, foetal status and the progression of
cervical dilation evaluated at frequent intervals. In patients with history of hypertonic uterine
contractility or tetanic uterine contractions, recommended that uterine activity and state of foetus
be monitored throughout labour. Possible uterine rupture where high tone myometrical
contractions are sustained.
Adverse effects :
Nausea, vomiting and diarrhoea, paraesthesia, fever or chills, dystonia, breast tenderness,
hyperthermia and flushing, bronchospasm, cardiovascular collapse.
Contraindications :
Hypersensitivity to prostagladin, acute pelvic inflammatory disease, cardiac, renal, pulmonary or
hepatic disease.
Interactions :
Not known.
------------------------------------------------------------------------------------------------------------------------------Dinoprostone (Prostagladine E2) 3 mg Vaginal Tablet
A
Trade Name : Prostin E2
Indication :
Induction of labour by vagina
Dosage :
3 mg vaginal tablet to be inserted high into the posterior formix. A second 3 mg tablet may be
inserted after 6-8 hours if labour is not established. Max 6 mg
Precautions :
Glaucoma elevated intraocular pressure, asthma or history of asthma. Cephalopelvic relationships
carefully evaluated prior to use. During use, uterine activity, fetal status and progression of cervical
dilatation evaluated at frequent intervals. In patients with history of hypertonic uterine.
Adverse effects :
Gastrointestinal upsets, uterine hypercontractility with or without fetal bradycardia, rapid cervical
dilatation with low Apgar score, headache.
Contraindications :
Hypersensitivity to dinosprostone, pelvic inflammatory disease, extrauterine pregnancy,
cephalopelvic disproportion, fetal distress, placenta previa, hypertonic or hyperactive uterine
patterns, unexplained vaginal bleeding during current pregnancy.
Interactions :
Oxytocin: an increased risk of oxytocic toxicity (uterine hyperstimulation). Wait at least 30 minutes
after removal of vaginal insert before initiating oxytocin.
------------------------------------------------------------------------------------------------------------------------------
235
Ergometrine Maleate 0.5 mg/ml Injection
C+
Indication :
Prevention and treatment of postpartum and postabortal haemorrhage due to uterine atony
Dosage :
IM 200 - 1000 mcg and IV 250 - 500 mcg
Precautions :
Exacerbations of porphyria. Not recommended for routine use prior to delivery of the placenta.
Patients with heart disease, hepatic dysfunction, hypertension, mitral valve stenosis, obliterative
vascular disease, renal impairment, sepsis or venoarterial shunts. Hyperstimulation of the uterus
during labor. Patients with calcium deficiency.
Adverse effects :
Nausea and vomiting, abdominal pain, diarrhoea, headache, dizziness, tinnitus, chest pain ,
palpitations, bradycardia, dyspnoea, hypertension, hypersensitivity reactions and ergotism has been
reported. Cardiovascular effects, including arrhythmias and myocardial infarction and
bronchospasm.
Contraindications :
Induction of labour, in cases of threatened spontaneous abortion, and in patients with a history of
hypersensitivity or idiosyncratic reactions.
Interactions :
Combined use of delavirdine and ergometrine may cause elevated ergometrine serum
concentration. Avoid concomitant use with antivirals like indinavir,saquinavir etc.
-------------------------------------------------------------------------------------------------------------------------------------Gemeprost (Prostagladin E1 Synthetic Analogue) 1 mg Pessary
A
Trade Name : Cervagem
Indication :
Inducing abortion in the first trimester
Dosage :
Cervical dilatation: 1 pessary 3 hourly before surgery to a max of 5 pessaries over 24 hours
Precautions :
Obstructive airway disease, elevated intraocular pressure, cervicitis or vaginitis, ulcerative colitis,
cardiovascular disease, renal or hepatic disease. Patients with hypertension or hypotension.
Adverse effects :
Vaginal bleeding, mild uterine pain, gastrointestinal disturbances, headache, muscle weakness,
dizziness, flushing, chills, backache, dyspnoea, chest pain, palpitations and mild pyrexia. Anapylactic
reactions (rare).
Contraindications :
Hypersensitivity to gemeprost or other prostagladin derivatives. Acute pelvic inflammatory disease
and uterine scars Induction of labour or cervical softening at term.
Interactions :
Not known.
------------------------------------------------------------------------------------------------------------------------------Oxytocin 10 units/ml Injection
B
Trade Name : Pitocin
Indication :
Induction of labour
Dosage :
IV: 0.5 - 1 milliunits/minute; gradually increase dose in increments of 1 - 2 milliunits/minute until
desired contraction pattern is established; dose may be decreased after desired frequency of
contractions is reached and labor has progressed to 5 - 6 cm dilation
236
Precautions :
For induction or enhancement only as IV infusion, careful monitoring of fetal heart rate and uterine
contractions are required.
Adverse effects :
Gastrointestinal upsets, water intoxication resulting from large amounts of solution or too rapid
infusion, cardiac arrhythmias.
Contraindications :
Hypersensitivity to oxytocin, significant cephalopelvic disproportion, unfavorable fetal positions,
fetal distress, hypertonic or hyperactive uterus, contraindicated vaginal delivery.
Interactions :
Prostaglandins, inhalation anaesthetics, vasoconstrictor agents.
------------------------------------------------------------------------------------------------------------------------------Oxytocin 5 units & Ergometrine Maleate 0.5 mg/ml Injection
C+
Trade Name : Syntometrine
Indication :
i) Prevention and treatment of post partum haemorrhage ii) Management of third stage of labour
Dosage :
i) 1 ml IM, may be repeated after 2 hours. Should not exceed 3 ml within 24 hours ii) For routine
management of third stage of labour, 1 ml IM following delivery of the anterior shoulder or
immediately after delivery of the child
Precautions :
Hypertension, cardiac, hepatic or renal disease. Should not be given until after delivery of child & in
multiple births not until the last child has been delivered.
Adverse effects :
Gastrointestinal upsets, abdominal pain, headache, dizziness, skin rashes. Rarely hypertension,
bradycardia, cardiac arrthymias, chest pain, anaphylactoid reactions.
Contraindications :
Pregnancy, labour (except second stage following delivery of the anterior shoulder), severe
hypertension, pre-eclampsia, eclampsia, severe disorders of cardiac, hepatic or renal function,
occlusive vascular disease, sepsis and in patients with a history of hypersensitivity.
Interactions :
Vasoconstrictors, prostaglandins, halothane anaesthesia.
-------------------------------------------------------------------------------------------------------------------------------Clotrimazole 500 mg Vaginal Tablet
B
Indication :
Vaginal candidiasis
Dosage :
500 mg as a single one-time dose
Precautions :
Monitor hepatic function in patients with pre-existing hepatic impairment, not for ophthalmic use
and vaginal use in pregnant patients should be supervised by a physician.
Adverse effects :
Local irritation or skin reaction and mild burning, nausea, vomiting, troches, increased liver enzymes.
Contraindications :
Hypersensitivity to clotrimazole.
237
Interactions :
Concurrent use with betamethasone may result in increased susceptibility to skin infection or
enhanced organism growth. Concurrent use with tacrolimus may increase plasma concentration of
tacrolimus and cause toxicity (nephrotoxicity, hyperglycaemia, hyperkalaemia), fentanyl.
------------------------------------------------------------------------------------------------------------------------------Conjugated Oestrogens 0.625 mg/g Cream
A
Trade Name : Premarin
Indication :
Atrophic vaginitis and post menopausal atrophic urethritis
Dosage :
Intravaginally or topically 2 - 4 g daily depending on severity of condition. Total dose not exceeding 4
g. Administration should be cyclic, with 3 weeks on conjugated oestrogens and one week off.
Oestrogens should be used for the shortest duration possible when treating atrophic vaginitis. Every
3 to 6 months attempts should be made to taper or discontinue therapy and conjugated oestrogens
should be titrated to give the lowest possible dosage to control symptoms
Precautions :
Systemic absorption may occur. Precautions as for oral premarin should be considered.
Adverse effects :
Nausea, abdominal cramp, oedema, rash.
Contraindications :
Oestrogen dependent neoplasia, known or suspected pregnancy, undiagnosed abnormal vaginal
bleeding, thromboembolic disorders, neuro-ophthalmologic vascular disease, breast cancer (except
metastatic disease therapy).
Interactions :
Not known.
------------------------------------------------------------------------------------------------------------------------------Cyproterone Acetate 2 mg & Ethinyloestradiol 0.035 mg Tablet
A*
Trade Name: Diane 35
Indication:
Androgen dependent diseases in women
Dosage :
1 tablet daily for 21 days from the first day of the cycle, followed by 7 tab free days
Precautions :
Diabetes, hypertension, varicose veins, otosclerosis, multiple sclerosis, epilepsy, porphyria, tetany,
chorea minor, history of phlebitis. Benign and rarely, malignant liver tumours which may lead to life
threatening intra abdominal haemorrhage have been observed. If severe upper abdominal
complaints, liver enlargement or signs of intra abdominal haemorrhage occur, a liver tumour should
be taken into consideration
Adverse Effects :
Hepatotoxicity, anaemia, myocardial ischaemia, oedema, thromboembolic disease, headache,
gastric upsets, nausea, breast tension, changes in body weight and libido, intermenstrual bleeding,
depressive mood, chloasma, fluid retention
Contraindications :
Pregnancy, lactation, severe disturbances of liver function, history of idiopathic jaundice or severe
pruritus during pregnancy, previous or existing liver tumours, malignant diseases (not prostatic
carcinoma), thromboembolic disorders, acute liver disease, hypersensitivity
238
Interactions:
Barbiturates, phenylbutazone, hydantoins, rifampicin and ampicillin may impair the action of the
drug. Requirements for oral antidiabetics and insulin can change
-------------------------------------------------------------------------------------------------------------------------------------Desogestrol 150 mcg & Ethinyloestradiol 30 mcg Tablet
C
Trade Name: Marvelon
Indication:
Contraception
Dosage :
1 tablet daily for 21 days, subsequent courses repeated after 7 day interval (during which withdrawal
bleeding occurs)
Precautions :
Gastrointestinal disease (impaired absorption of oral contraceptive steroids in the small bowel due
to inflammatory disease, diarrhoea, ileostomy or jejunoileal bypass may result in contraceptive
failure). Severe varicose veins, hepatic cell adenoma, latent or overt cardiac failure, renal
dysfunction, epilepsy, migraine, hypertension, diabetes, smoking, surgery or prolonged
immobilization
Adverse Effects :
Thromboembolic disease, hypertension, gall bladder disease, nausea, vomiting, migraine
Contraindications :
Thromboembolic disorders, coronary artery disease, breast or endometrial cancer, oestrogen
dependent neoplasia, undiagnosed abnormal vaginal bleeding, cholestatic jaundice of pregnancy,
hepatic adenomas or carcinomas, known or suspected pregnancy
Interactions:
Irregular bleeding and reduced efficacy with anticonvulsant, barbiturates, tetracyclines, rifampicin,
activated charcoal, certain laxatives, antidiabetic drugs. Monitor patients receiving alprazolam
therapy for an increased response to the benzodiazepine
-------------------------------------------------------------------------------------------------------------------------------------Levonorgestrel 1.5mg Tablet
A*
Trade Name : Escapelle
Indication :
Emergency contraception within 72 hours of unprotected sexual intercourse for the female victim of
sexual violence to prevent unwanted pregnancy
Dosage :
1.5 mg as a single dose as soon as possible after coitus [preferably within 12 hours but no later than
after 72 hours]
Precautions :
Not effective in terminating an existing pregnancy, not recommended for routine use as a
contraceptive and in patients with severe hepatic dysfunction
Adverse Effects :
Acne, weight gain, abdominal pain, nausea, dizziness, headache, depression, breast tenderness, cyst
of ovary, fatigue pelvic inflammatory disease, sepsis, menstrual irregularities
Contraindications :
Genital bleeding of unknown etiology, pregnancy
Interactions :
Effectiveness is reduced by enzyme inducing drugs such as barbiturates, phenytoin, carbamazepine,
St. John's Wort, rifampicin, ritonavir and griseofulvin
--------------------------------------------------------------------------------------------------------------------------------------
239
Levonorgestrel Releasing Intrauterine System
A*
Trade Name : Mirena
Indication :
Contraception (Initial release rate of 20 mcg/24 hours)
Dosage :
One unit intrauterine device to be inserted into the uterine cavity within 7 days of the onset of
menstruation or immediately after first trimester abortion. Postpartum insertion should be
postponed until 6 weeks after delivery. One unit IUD is effective for 5 years
Precautions :
Discontinue treatment if crescendo migraine or other symptoms indicating transient cerebral
ischaemia, exceptionally severe headache, jaundice, marked increase of blood pressure, unexplained
loss of vision or other symptoms of retinal thrombosis occurs. Hormone dependent neoplasia
including breast cancer, malignancies affecting the blood or leukaemias, severe arterial disease eg
stroke or myocardia infarction. Diabetics. In recurrent endometriosis, pelvic infections or if an acute
infection does not respond to treatment within a few days, perforation, accidental pregnancy. Not a
contraceptive of choice during lactation
Adverse Effects :
Menstrual changes, lower abdominal pain, acne or other skin problems, backpain, mastalgia,
headache, vaginal discharge, mood changes, nausea, oedema, weight gain, decreased libido,
sweating, hair loss, greasy hair, ectopic pregnancy, pelvic inflammatory disease (PID), perforation of
uterine wall, enlarged follicles may develop
Contraindications :
Active hepatic disease, active thrombophlebitis or thromboembolic disorders, haemorrhagic
diathesis, carcinoma of the breast, pregnancy, undiagnosed abnormal uterine bleeding, undiagnosed
abnormal genital bleeding, history of idiopathic intracranial hypertension, hypersensitivity
Interactions :
Not known
--------------------------------------------------------------------------------------------------------
Medroxyprogesterone Acetate 150 mg/3 ml Injection
B
Trade Name : Provera/Farlutal
Indication :
Prevention of pregnancy and to provide long term contraception
Dosage :
To be administered every 3 month
Precautions :
Depression, epilepsy, migraine, asthma, diabetes, cardiac or renal dysfunction, fluid retention,
thromboembolic disorders, cerebral apoplexy.
Adverse effects :
Gastrointestinal distress, oedema, menstrual disorders, dermatologic effects.
Contraindications :
Thromboembolic disorders, liver disease, breast or genital cancer, undiagnosed abnormal vaginal
bleeding, known or suspected pregnancy, hypersensitivity to medroxyprogesterone products.
Interactions :
Concurrent use with aminoglutethimide may result in decreased medroxyprogesterone efficacy.
Concurrent use with nevirapine may result in loss of contraceptive efficacy. Concurrent use with
succinylcholine may result in prolongation of neuromuscular blockade.
-------------------------------------------------------------------------------------------------------------------------------
240
Norethisterone 0.35mg Tablet
C
Trade name : Noriday
Indication :
Contraception
Dosage :
1 tablet daily starting on the first day of the menstrual bleeding
Precautions :
Gastrointestinal disease (impaired absorption of oral contraceptive steroids in the small bowel due
to inflammatory disease, diarrhoea, ileostomy or jejunoileal bypass may result in contraceptive
failure)
Adverse Effects :
Gastrointestinal distress, oedema, menstrual disorders, dermatologic effects, nausea, fatique,
depression, acne, hirsutism, breast tenderness, thromboembolic phenomena, galactorrhoea,
decreased glucose tolerance, anaphylaxis, corticoid like reaction (high doses)
Contraindications :
Hypersensitivity, breast carcinoma, liver disease or dysfunction, pregnancy, incomplete abortion,
abnormal and undiagnosed vaginal bleeding, active or history of thromboembolic disease,
thrombophlebitis, hypercoagulable state. Cerebral vascular or coronary artery diseases
Interactions :
Effectiveness may be reduced by antibiotics, phenytoin, carbamazepine, barbiturates, rifampicin
-------------------------------------------------------------------------------------------------------------------------------------Norethisterone Enanthate 200 mg/ml Injection
B
Trade name : Noristerat
Indication :
Contraception
Dosage :
By deep IM injection only. First injection is within first 5 days of the cycle. The next 3 injections are
given at 8 weeks interval after which the injection interval should be extended to 12 weeks
Precautions :
Benign and rarely malignant liver tumours which may lead to life threatening intra abdominal
haemorrhage have been observed. If severe upper abdominal complaints, liver enlargement or signs
of intra abdominal haemorrhage occur, a liver tumour should be considered. Porphyria, diabetes,
smoking, age, sickle cell anaemia, history of phlebitis or thromboembolic diseases, impaired liver
function, history of extrauterine pregnancy if one tube is missing
Adverse Effects :
Nausea, headache, dizziness, depressive moods, spotting, breakthrough bleeding, amenorrhoea,
rarely weight gain
Contraindications :
Pregnancy, thromboembolic diseases, hypertension, acute and severe chronic liver disease, existing
or treated breast or uterine cancers, severe diabetes with vascular changes, history of or existing
liver tumours, disturbances of lipid metabolism, history of extrauterine pregnancy if one tube is
missing
Interactions :
Action may be impaired by barbiturates, phenylbutazone, hydantoins, rifampicin and ampicillin
--------------------------------------------------------------------------------------------------------------------------------------
241
Raloxifene HCl 60 mg Tablet
A*
Trade Name : Evista
Indication :
Prevention and treatment of post menopausal osteoporosis
Dosage :
1 tablet daily
Precautions :
Elderly, excessive exercise, hypoglycaemia, breast cancer.
Adverse effects :
Has been associated with increased risk of thromboembolism (deep vein thrombosis, pulmonary
embolism) and superficial thrombophlebitis. Hot flushes and leg cramps.
Contraindications :
Women with child bearing potential, active thromboembolic disorder, pregnancy.
Interactions :
Ampicillin and cholestyramine decrease raloxifene absorption.
------------------------------------------------------------------------------------------------------------------------------Salbutamol 5 mg/5 ml Injection
A*
Indication :
Prevention of uncomplicated premature labour only
Dosage :
Infusions containing 5 mg in 500ml (10 mcg/ml) at the rate of 10 - 45 mcg/min increased at intervals
of 10 minutes until evidence of patient response as shown by reduction of strength, frequency or
duration of contractions; maintain rate for 1 hour after contractions have stopped, then gradually
reduce by 50% every 6 hours
Precautions :
Potential for paradoxical bronchospasm, patients with cardiovascular disorders, hyperthyroidism,
diabetes mellitus, phaeochromocytoma, patients with history of aneurysm and patients who are
usually responsive to sympathomimetic amines. Labour and delivery may be complicated.
Thyrotoxicosis, pregnancy and lactation.
Adverse effects :
Haemorrhage, thrombocytopenia, tachycardia and palpitations, erythema, ventricular ectopic beats,
myocardial ischaemia and infarction have been reported following IV administration. Fine tremors
(particularly in the hands), nervous tension, headache, peripheral dilatation and palpitations,
tachycardia, arrhythmias. Muscle cramps and hypersensitivity reactions including paradoxical
bronchospasm, urticaria and angioedema.
Contraindications :
Hypersensitivity, hyperthyroidism or thyrotoxicosis, tachycardia or tachycardic arrthymias,
subvalvular aortic stenosis.
Interactions :
Hypertensive crisis and other adverse effects occur frenquently with the concurrent use of indirectacting sympathomimetics. Concomitant administration of salbutamol and other beta-2 agonists with
corticosteroids, diuretics or xanthines increases the risk of toxicity.
-------------------------------------------------------------------------------------------------------------------------------
242
11. GENITOURINARY
Drugs for urinary retention
Drugs for urinary frequency, enuresis and continence
Miscellaneous genitourinary
243
Doxazosin Mesilate 4 mg CR Tablet
A*
Trade Name : Cardura XL
Indication :
Benign Prostatic Hyperplasia
Dosage :
4 mg once daily
Precautions:
Gastrointestinal disorders, pregnancy, lactation, history of gastrointestinal obstruction, oesophageal
obstruction
Adverse Reactions:
Postural hypotension, vertigo, headache, fatigue, dizziness, oedema and asthenia
Contraindications:
Hypersensitivity to doxazosin and other quinazolines
Interactions:
In patients currently on beta blockers, the first dose response (marked initial drop in blood pressure,
particularly on standing) to an alpha-1 adrenergic blocking drug may be exaggerated, tadalafil,
sildenafil, vardenafil
-------------------------------------------------------------------------------------------------------------------------------------Dutasteride 0.5 mg Capsule
A*
Trade Name : Avodart
Indication :
Benign prostatic hyperplasia in men with an enlarged prostate gland
Dosage :
0.5 mg daily
Precautions:
Concurrent use of CYP3A4 enzyme inhibitors (e.g. ritonavir), capsules should not be handled by
women who are pregnant or who may become pregnant due to the possibility of absorption of
dutasteride through the skin and the potential risk of a fetal anomaly
Adverse Reactions:
Impotence, decrease libido, ejaculation disorders, gynaecomastia, breast tenderness, allergic
reactions including rash, prutitus, urticaria and localized edema.
Contraindications:
Severe hepatic impairment, women, child and adolescent
Interactions:
Verapamil, diltiazem, cimetidine, ciprofloxacin, ketoconazole, ritonavir
-------------------------------------------------------------------------------------------------------------------------------------Finasteride 5 mg Tablet
A*
Trade Name : Proscar
Indication :
Treatment and control of benign prostatic hyperplasia
Dosage :
5 mg a day as a single dose. Clinical responses occur within 12 weeks - 6 months of initiation of
therapy. Long-term administration is recommended for maximal response
Precautions:
Patients should be screened for prostatic carcinoma, hepatic dysfunction, patients with a large
residual urinary volume or a severely diminished urinary flow rate should be monitored for
obstructive uropathy and may not be candidates for finasteride therapy, crushed tablets should not
be handled by a woman when she is pregnant or may potentially be pregnant because of the
possibility of absorption and the subsequent potential risk to the male foetus
244
Adverse Reactions:
Sexual dysfunction, breast tenderness or enlargement
Contraindications:
Hypersensitivity to finasteride products, known or suspected pregnancy
Interactions:
Not known
-------------------------------------------------------------------------------------------------------------------------------------Terazosin HCl 1 mg Tablet
A
Terazosin HCl 2 mg Tablet
A
Trade Name : Hytrin
Indication :
Only for treatment of Benign Prostatic Hyperplasia. Not to be used for treatment of
hypertension
Dosage :
Initially 1 mg at night, increased in a stepwise fashion to 2 mg, 5 mg or 10 mg once
daily
Precautions:
Carcinoma of the prostate and benign prostatic hyperplasia may cause the same symptoms. Prostate
cancer should be ruled out prior to treatment. Dizziness, lightheadedness, orthostatic hypotension,
syncope (first-dose effect)
Adverse Reactions:
Tachycardia, dizziness, syncope, headache and asthenia
Contraindications:
Hypersensitivity to terazosin products or other quinazolines
Interactions:
In patients currently on beta blockers, the first dose response (marked initial drop in blood pressure,
particularly on standing) to an alpha-1 adrenergic blocking drug may be exaggerated. Concomitant
therapy with ibuprofen and antihypertensive agents has been reported to result in increases in
blood pressure and interference with blood pressure control
-------------------------------------------------------------------------------------------------------------------------------------Tamsulosin HCl 400 mcg Extended Release Tablet
A*
Trade Name : Harnal® OCAS
Indication :
Second line treatment of functional symptoms of benign prostatic hyperplasia (BPH) in patients who
do not tolerate first line drugs or when first line drugs are inappropriate or contraindicated
Dosage :
400 mcg once daily
Precautions:
Patients receiving antihypertensive treatment, elderly patients, hepatic and renal impairment,
during cataract surgery (risk of intra-operative floppy iris syndrome)
Adverse Reactions:
Abnormal ejaculation, reduced libido, priapism, intra-operative floppy iris syndrome (IFIS), dizziness,
syncope, palpitations, postural hypotension, rhinitis, vomiting, constipation, diarrhoea, rash,
angioedema, asthenia, drowsiness, blurred vision
Contraindications:
History of orthostatic hypotension, severe hepatic insufficiency, hypersensitivity to Tamsulosin HCl
or any other component of the product
245
Interactions:
Drugs which may reduce blood pressure, cimetidine, fluoxetine, ketoconazole, sildenafil
-------------------------------------------------------------------------------------------------------------------------------------Tolterodine Tartrate ER 2 mg Capsule
A*
Trade Name : Detrusitol SR
Indication :
Treatment of overactive bladder with symptoms of urinary, frequency or urge
incontinence
Dosage :
4 mg once daily. May decrease to 2 mg once daily depending on response and
tolerability
Precautions:
Significant bladder outlet obstruction, gastrointestinal obstruction disorders, renal disease, hepatic
disease, autonomic neuropathy, hiatus hernia, concomitant treatment with CYP3A4 inhibitors
Adverse Reactions:
Mild to moderate antimuscarinic effects, dryness of mouth, dyspepsia, reduced lacrimation
Contraindications:
Urinary retention, uncontrolled narrow angle glaucoma, toxic megacolon, myasthenia gravis.
Interactions:
Erythromycin, clarithromycin, metoclopramide, cisapride
-------------------------------------------------------------------------------------------------------------------------------------Flavoxate HCl 100 mg Tablet
A
Trade Name : Urispas
Indication :
Urinary frequency and incontinence, dysuria, urgency, bladder spasm due to catheterisation
Dosage :
ADULT: 200 mg 3 times daily. CHILD under 12 years not recommended
Precautions:
Pregnancy and lactation, suspected glaucoma. May affect ability to drive or operate machinery
Adverse Reactions:
Gastrointestinal disturbances, vertigo, headache, mental confusion especially in elderly, drowsiness,
fatigue and nervousness, tachycardia and palpitations, urticaria, eosinophilia and hyperpyrexia
Contraindications:
Pyloric or duodenal obstruction, obstructive intestinal lesions or ileus, achalasia, gastrointestinal
haemorrhage, obstructive uropathies of the lower urinary tract, children less than 12 years
Interactions:
Other antimuscarinic drugs
-------------------------------------------------------------------------------------------------------------------------------------Potassium Citrate 3 g/10 ml and Citric Acid Mixture
Indication :
For systemic or urine alkalinization
Dosage :
ADULT: 10 ml 3 times daily well diluted with water. CHILD up to 1 year: 2.5 ml 3
times daily; 1 - 5 years: 5 ml 3 times daily; 6 - 12 years: 10 ml 3 times daily. To be
taken well diluted with water
246
C
Precautions:
Congestive heart failure, hypertension, pulmonary or peripheral oedema, toxaemia of pregnancy,
monitor serum electrolytes especially bicarbonate in patients with renal disease, decreased urinary
output, especially in the presence of hypocalcaemia
Adverse Reactions:
Hyperkalaemia, metabolic alkalosis, nausea, vomiting, diarrhoea, mild diuresis
Contraindications:
Severe renal impairment with oliguria, azotemia or anuria, Addison's disease, adynamic episodica
hereditaria, acute dehydration, heat cramps, severe myocardial damage, potassium citrate in
patients with hyperkalemia, sodium citrate for patients on sodium restriction
Interactions:
Concurrent administration of potassium citrate with potassium- containing medications,
angiotensin-converting enzyme inhibitors or cardiac glycosides, concurrent administration with
aluminum-based gels
-------------------------------------------------------------------------------------------------------------------------------------Sodium Bicarbonate, Citric Acid, Sodium Citrate and Tartaric Acid - 4 g per sachet
B
Trade Name : Ural
Indication :
For relieving of discomfort in mild urinary tract infection, symptomatic relief of
dysuria to enchance the action to certain antibiotics especially some sulphonamides.
In gout as urinary alkalinizers to prevent cystallisation of urates
Dosage :
4- 8 g (1- 2 sachets) dissolved in a glass of cold water 4 times daily as prescribed
Precautions:
Patients on sodium restricted diet
Adverse Reactions:
Mild laxative effect, systemic alkalosis or hyperthermia with prolonged or excessive usage
Contraindications:
Renal failure or hyperthermia
Interactions:
Not known
--------------------------------------------------------------------------------------------------------------------------------------
247
12. DRUGS AFFECTING IMMUNE RESPONSE
Immunosuppressants
Immunomodulators
248
Antilymphocyte/Antithymocyte Immunoglobulin (from Horse) Injection
A*
Trade Name : Atgam
Indication :
i) To be used when conventional anti-rejection therapy is not successful ii) Treatment of aplastic
anaemia not responding to oxymethalone after 3 months, in which there is persistent pancytopenia
with repeated attacks of septicaemia and bleeding. iii) Severe aplastic anaemia with the following
parameters: a) Granulocyte less than 0.5x109/L b) Platelet less than 20x109/L c) Reticulocyte less
than 20x109/L iv) As a conditioning regime prior to transplant. v) Graft-versus-host disease
treatment
Dosage :
10 - 30 mg/kg body weight daily. Slow IV infusion (over at least 4 hours) diluted in 250 - 500 ml
Normal Saline. For Graft versus host disease treatment:40 mg/kg/day
Precautions:
Perform test dose, prophylactic platelet transfusion before and after infusion. Sodium and fluid
overload. Monitor for allergic reactions and serum sickness Monitor for signs of leukopenia,
thrombocytopenia or concurrent infection. Perform skin testing
Adverse Reaction:
Severe and unremitting thrombocytopenia or leucopenia, generalized rash, tachycardia, dyspnoea,
hypotension, anaphylaxis.
Contraindications:
Hypersensitivity, acute viral illness.
Interactions:
Live vaccines, increased risk of infection.
-------------------------------------------------------------------------------------------------------------------------------------Azathioprine 50 mg Tablet
A
Trade Name : Imuran
Indication :
i)Acute leukaemia ii)Immunosuppressive agent
Dosage :
i) 1-4 mg/kg/day ii) 1.5-2 mg/kg/day
Precautions:
Chronic immunosuppression , increases risk of neoplasm, hematologic toxicity, mutagenicity.
Bleeding or bruising or signs of infection, bone marrow suppression. Monitor FBC weekly during first
8 week of therapy especially with high dose or severe renal/hepatic impairment. Inherited deficiency
of thiopurine methyltransferase enzyme. Avoid excessive sun/UV exposure. Pregnancy, lactation and
elderly
Adverse Reaction:
Gastrointestinal disturbances, myelosuppression, pancreatitis, fever. Opportunistic infections
especially in transplant patients receiving concomitant other immunosuppressants. Bone marrow
depression, leucopenia, thrombocytopenia, nausea. Uncommonly, anaemia, hypersensitivity
reactions, cholestasis, pancreatitis
Contraindications:
Hypersensitivity, pregnancy, previous alkylating agents such as cyclophosphamide, chlorambucil,
melphalan (risk of neoplasms)
Interactions:
ACEI, Angiotensin II Antagonist, warfarin, allopurinol, live vaccines, antibacterial. Reduces the
neuromuscular blockade of curare, tubocurarine but potentiates that of succinylcholine
--------------------------------------------------------------------------------------------------------------------------------------
249
Mycophenolate Sodium 360mg Tablet
A*
Trade Name : Myfortic
Indication :
Prophylaxis of acute transplant rejection in adult patients receiving allogenic renal transplant in
combination with ciclosporin and corticosteroids
Dosage :
720 mg twice daily
Precautions:
Avoid in patients with rare hereditary deficiency of hypoxanthine-guanine hosphoribosyl-transferase
(HGPRT) (eg, Lesch-Nyhan and Kelley-Seegmiller syndrome). Associated with an increased risk of
congenital malformations and spontaneous abortions when used during pregnancy. CellCept and
myfortic dosage forms should not be used interchangeably due to differences in absorption.
Increased risk of developing lymphomas & other malignancies particularly of the skin.
Oversuppression of the immune system with increased susceptibility to infection. Active serious
digestive system disease. Bone marrow depression. Perform regular complete blood counts for
monitoring neutropenia. Effective contraception must be used. Lactation. Severe chronic renal
impairment. Avoid live attenuated vaccines. Increased risk for opportunistic infections such as
activation of latent viral infections including BK virus -associated nephropathy
Adverse Reaction:
Leucopenia, neutropenia, lymphomas and skin malignancies. Increased risk of infections,
constipation, insomnia, increased risk of first trimester pregnancy loss and increased risk of
structural abnormalities in the infants born to mothers receiving mycophenolate during pregnancy.
Diarrhoea, viral, bacterial & fungal infections, anaemia, thrombocytopenia, headache, cough,
abdominal distension, abdominal pain, abdominal tenderness, dyspepsia, flatulence, gastritis, loose
stools, nausea, vomiting, fatigue, pyrexia, abnormal hepatic function tests, increased blood
creatinine
Contraindications:
Hypersensitivity, pregnancy, hypersensitivity to mycophenolate sodium, mycophenolic acid,
mycophenolate mofetil or any other component of the product
Interactions:
Azathioprine, live vaccines, aciclovir, antacids with aluminium and magnesium hydroxides,
cholestyramine and drugs that interfere with enterohepatic circulation, ganciclovir, tacrolimus, oral
contraceptives and cyclosporin
-------------------------------------------------------------------------------------------------------------------------------------Tacrolimus 0.5 mg Capsule
A*
Tacrolimus 1 mg Capsule
A*
Trade Name : Prograf
Indication :
i) Primary immunosuppressant agent for all solid organ transplantation ii) Rescue therapy for
rejection
Dosage :
i) 0.2 mg/kg/day in 2 divided doses ii) 0.3 mg/kg/day in 2 divided doses
Precautions:
Renal or hepatic insufficiency, monitor blood glucose levels, increased risk of infections and possibly
lymphoma, hyperkalaemia, hypertension, myocardial hypertrophy and neurotoxicity. Monitor blood
pressure, ECG, visual status, electrolytes (especially K), haematology parameters. Children less than
2 year who are Epstein-Barr virus sero-negative. Patients with allergenic disposition. May impair
ability to drive or operate machinery. Continuous IV therapy should not be continued for more than
7 days. Avoid excessive exposure to sun or UV light. Increased risk for opportunistic infections such
as activation of latent viral infections including BK virus -associated nephropathy
250
Adverse Reaction:
Hypertension, angina, tachycardia, pleural and pericardial effusion, hypotension, arrhythmias,
ventricular or septal hypertrophy, cardiomyopathy, gastrointestinal disturbances, headache, tremor,
dizziness, anxiety, confusion and infection
Contraindications:
Hypersensitivity to tacrolimus products, macrolides, polyoxyethylated castor oil (parenteral
formulation) or structurally related compounds, pregnancy and lactation
Interactions:
Aminoglycosides, cisplatin, amphotericin B, additive or synergistic renal function impairment.
Spironolactone, hyperkalaemia. NSAIDs, acute renal failure. Live vaccines, risk of infection in
immunocompromised hosts, reduced effectiveness of vaccine. Fluconazole, nifedipine, diltiazem,
clarithromycin, erythromycin, chloramphenicol, increased risk of tacrolimus toxicity (nephrotoxicity,
hyperglycaemia, hyperkalaemia)
-------------------------------------------------------------------------------------------------------------------------------------Ciclosporin 25 mg Capsule Microemulsion
A*
Trade Name : Sandimmun Neoral
Indication :
Only for: i) Patients in whom donor specific transplantation cannot be carried out and in young
children to minimise side-effects of steroids ii) Follow-up cases of bone marrow transplant iii)
Patients with severe rheumatoid arthritis not responding to other second line drugs iv) Patients with
idiopathic nephrotic syndrome who are steroid toxic or poor response to cyclophosphamide v)
Severe aplastic anemia, pure red cell aplasia vi) Cases of recalcitrant psoriasis and atopic eczema vii)
Treatment of chronic ocular inflammatory disorders/uveitis
Dosage :
i & ii) Initially 12.5 - 15 mg/kg/day, beginning on the day before transplant. Maintenance approx 12.5
mg/kg/day for 3 - 6 months before being tapered off to zero by 1 year of transplantation iii) 3
mg/kg/day in 2 divided doses for first 6 weeks. May increased gradually to maximum 5 mg/kg.
Treatment withdrawn if no response after 3 months iv) ADULT: 5 mg/kg/day in 2 divided doses.
CHILD: 6 mg/kg/day in 2 divided doses. Patients with permitted levels of kidney failure, the starting
dose must not more than 2.5 mg/kg/day v) 12 mg/kg/day vi) 2.5 mg/kg/day in 2 divided doses
increasing if there is no improvement after 4 weeks by 0.5 -1 mg/kg/month up to maximum 5
mg/kg/day vii) 5 mg/kg/day in 2 divided doses, may increase to 7 mg/kg/day in resistant cases.
Maintenance: Less than 5 mg/kg/day especially during remission
Precautions:
History of allergic reactions, pregnancy, monitor BP, serum electrolytes, renal and hepatic function,
hypertension & malignancies. Neoral and Sandimmun are not bioequivalent - dosage adjustments
and increased monitoring needed. Increased risk for opportunistic infections such as activation of
latent viral infections including BK virus -associated nephropathy
Adverse Reaction:
Nephrotoxicity, hepatotoxicity, gum hyperplasia, hypertension, neurotoxicity, convulsions, increased
malignancy risk, tremor, paraesthesia, hypertrichosis, facial oedema, acne, gingival hypertrophy,
hyperkalaemia, fluid retention, increased susceptibility to infections, gastrointestinal symptoms
Contraindications:
Hypersensitivity to ciclosporin or any other component, rheumatoid arthritis or psoriasis patients
with abnormal renal function, uncontrolled hypertension, malignancies, uncontrolled infections in
rheumatoid arthritis patients, primary or secondary immunodeficiency in rheumatoid arthritis
patients, psoriasis patients receiving PUVA (psoralen plus ultraviolet A) or UVB (ultraviolet B)
therapy, methotrexate or other immunosuppressants, coal tar, radiation therapy & lactation
251
Interactions:
Etoposide, statins, vaccines, immunosuppressive drugs except corticosteroids, live vaccines,
nephrotoxic drugs, NSAIDs, hepatic enzyme inducers. Increased ciclosporin level by diltiazem,
doxycycline, erythromycin, ketoconazole, nicardipine, verapamil, oral contraceptives. Drugs which
reduce ciclosporin level are carbamazepine, isoniazid, phenobarbitone, phenytoin and rifampicin.
Increased risk of convulsion when used concurrently with high-dose methylprednisolone
-----------------------------------------------------------------------------------------------------------------------------------Ciclosporin 100 mg/ml Drink Solution
A*
Trade Name : Sandimmum Neoral
Indications:
Only for :
i) Patients in whom donor specific transplantation cannot be carried out and in young children to
minimise side-effects of steroids
ii) Follow-up cases of bone marrow transplant
iii) Patients with severe Rheumatoid arthritis not responding to other second line drugs
iv) Patients with idiopathic nephrotic syndrome who are steroid toxic or poor response to
cyclophosphamide
v) Severe aplastic anaemia, pure red cell aplasia
vi) Cases of recalcitrant psoriasis and atopic eczema
Dosage :
i & ii) Initially 12.5 - 15 mg/kg/day, beginning on the day before transplant. Maintenance approx 12.5
mg/kg/day for 3 - 6 months before being tapered off to zero by 1 year of transplantation
iii) 3 mg/kg/day in 2 divided doses for first 6 weeks. May increased gradually to maximum 5 mg/kg.
Treatment withdrawn if no response after 3 months
iv) ADULT: 5 mg/kg/day in 2 divided doses. CHILD: 6 mg/kg/day in 2 divided doses. Patients with
permitted levels of kidney failure, the starting dose must not more than 2.5 mg/kg/day
v) 12 mg/kg/day
vi) 2.5 mg/kg/day in 2 divided doses increasing if there is no improvement after 4 weeks by 0.5 -1
mg/kg/month up to maximum 5 mg/kg/day
Precautions :
History of allergic reactions, pregnancy; monitor BP, serum electrolytes, renal and hepatic function,
hypertension & malignancies. Neoral and Sandimmun are not bioequivalent - dosage adjustments
and increased monitoring needed. Increased risk for opportunistic infections such as activation of
latent viral infections including BK virus -associated nephropathy
Adverse Reactions :
Nephrotoxicity, hepatotoxicity, gum hyperplasia, hypertension, neurotoxicity, convulsions, increased
malignancy risk, tremor, paraesthesia, hypertrichosis, facial oedema, acne, gingival hypertrophy;
hyperkalaemia, fluid retention, increased susceptibility to infections, gastrointestinal symptoms
Contraindications :
Hypersensitivity to ciclosporin, or any other component. Rheumatoid arthritis or psoriasis patients
with abnormal renal function, uncontrolled hypertension, malignancies, uncontrolled infections in
rheumatoid arthritis patients, primary or secondary immunodeficiency in rheumatoid arthritis
patients, psoriasis patients receiving PUVA (psoralen plus ultraviolet A) or UVB (ultraviolet B)
therapy, methotrexate or other immunosuppressants, coal tar, radiation therapy, lactation
252
Interactions :
Etoposide, statins,vaccines, immunosuppressive drugs except corticosteroids, live vaccines,
nephrotoxic drugs, NSAIDs, hepatic enzyme inducers. Increased ciclosporin level by diltiazem,
doxycycline, erythromycin, ketoconazole, nicardipine, verapamil, oral contraceptives. Drugs which
reduce ciclosporin level are carbamazepine, isoniazid, phenobarbitone, phenytoin and rifampicin.
Increased risk of convulsion when used concurrently with high-dose methylprednisolone
---------------------------------------------------------------------------------------------------------------Mycophenolate Mofetil 250 mg tablet
A*
Mycophenolate Mofetil 500 mg tablet
A*
Trade Name : Cellcept
Indication :
i) Prophylaxis of acute organ rejection in patients receiving allogenic renal, cardiac and hepatic
transplant ii) Used with steroids for induction and maintenance of severe lupus nephritis resistant or
intolerant to cyclophosphamide therapy
Dosage :
i) Renal transplant rejection: ADULT: 1 g twice daily. CHILD (3 months and older): 600 mg/m(2)/dose,
twice daily; maximum daily dose, 2 g/10 mL. Cardiac transplant rejection: 1.5 g twice daily. Hepatic
transplant rejection: 1.5 g twice daily ii) Induction phase: 2 - 3 g/day for up to 6 months.
Maintenance phase: dose gradually tapers to 1 g/day
Precautions:
Full blood count weekly for 4 weeks, then twice a month for 2 months, then monthly in the first
year. Elderly, active serious gastro-intestinal disease, delayed graft function. Avoid exposure to
sunlight. Bone marrow suppression, monitor neutrophil count. If neutropenia develops, stop
treatment or reduce dose. Perform relevant diagnostic tests as necessary & complete blood counts
weekly. Severe active digestive diseases, severe chronic renal failure. Pregnancy & lactation.
Increased risk for opportunistic infections such as activation of latent viral infections including BK
virus -associated nephropathy
Adverse Reaction:
Myelosuppression, hypertension, infection, diarrhoea, nausea and vomiting, constipation,
abdominal pain, dyspepsia, dizziness, insomnia, headache, tremor, leucopenia, anaemia,
thrombocytopenia, leucocytosis, polycythaemia, electrolyte imbalances
Contraindications:
Hypersensitivity to mycophenolate mofetil and mycophenolic acid, pregnancy
Interactions:
Antacids, cholestyramine, decreased mycophenolate mofetil efficacy. Iron decreased
mycophenolate mofetil efficacy. Azathioprine, drugs which interfere with enterohepatic
recirculation, acyclovir, ganciclovir
--------------------------------------------------------------------------------------------------------------------------------------
253
14. HAEMATOLOGY / ONCOLOGY
Cytotoxic drugs
Sex hormones and hormone antagonists in malignant disease
Bleeding disorder
Miscellaneous Haematology / Oncology
254
Actinomycin D (Dactinomycin) 500 mcg/ml Injection
A
Trade Name : Cosmegen
Indication :
i) For solid tumours ii) Gestational trophoblastic disease
Dosage :
ADULT: 500 mcg IV daily for max of 5 days. CHILD: 1.5 mg/m2 once every 3 weeks (if weight less than
10 kg, 50 mcg/kg) ii) 500 mcg IV on Days 2, 4, 6, 8, 10, repeat every 7 - 10 days or 500 mcg IV bolus
on Days 1 and 2, repeat every 15 days
Precautions:
Avoid extravasation, severe soft tissue damage. Concomitant radiation therapy may exaggerate
dactinomycin toxicity
Adverse Reaction:
Myelosuppression, nausea, vomiting, mucositis, alopecia, rash, radiation recall reactions, hepatitis.
Malaise, fatigue, fever, myalgia, gastrointestinal, haematologic and dermatologic effects
Contraindications:
Pregnancy, lactation, chickenpox or herpes zoster infection
Interactions:
Live vaccines may result in an increase risk of infection, radiation therapy, possibly reduced
absorption of phenytoin
-------------------------------------------------------------------------------------------------------------------------------------All-Trans Retinoic Acid 10 mg Capsule
A*
Trade Name : Vesanoid
Indication :
Acute promyelocytic leukaemia
Dosage :
Induction: 45 mg/m2 daily for 30 - 90 days. Maintenance: 45 mg/m2 daily for 2 weeks every 3
months. Refer to protocols
Precautions:
Avoid pregnancy during and for at least 1 month after stopping treatment. Monitor haematological,
coagulation profile, liver function test, serum lipid levels. To be used with caution in pre-existing
hypertriglyceridaemia, diabetes mellitus, obesity. Anticipate and treat retinoic acid syndrome
Adverse Reaction:
Headache, fever, weakness, fatigue, nausea, vomiting, dry skin, rash, peripheral oedema, mycosis,
conjunctivitis, hypotension, hypertension, arrhythmias, heart failure, flushing, dizziness, anxiety,
depression, paresthesias, confusion, pseudotumour cerebri, gastrointestinal bleeding, abdominal
pain, diarrhoea, constipation, retinoic acid syndrome, bone pain, muscle pain, joint pain, increase in
serum triglycerides and cholesterol
Contraindications:
Hypersensitivity to retinoids, pregnancy and lactation
Interactions:
Concurrent use with drugs which inhibit hepatic cytochrome P450 enzyme system, eg ketoconazole,
cimetidine, ciclosporin, diltiazem, erythromycin, rifampicin, verapamil may increase risk of toxicity.
Use together with vitamin A supplements may result in increase in toxicity. Avoid ethanol. Exposure
to paclitaxel result in increased risk of paclitaxel toxicity. Tranexamic Acid may result in increased
risk of thrombosis
------------------------------------------------------------------------------------------------------------------------------------
255
Bleomycin HCl 15 mg Injection
A
Trade Name : Bleocin
Indication :
Squamous cell carcinoma, germ cell tumours, lymphomas. Routes: SC, IM, IV (either as bolus or as
infusion over 24 hours), intra-arterial, intra-pleural
Dosage :
15 - 60 mg weekly in divided doses or 10 - 20 mg/m2 once or twice weekly or 10 mg/m2 slow bolus
in 15 minutes D1 and D15. Max: 400 mg. CHILD: 10 - 15 mg/m2 over 6 hours every 3 - 4 weeks
Precautions:
Beware of increased risk of pulmonary fibrosis in elderly patients (more than 70 years), if
radiotherapy has been given to the chest, if cumulative lifetime doses of bleomycin are exceeded or
if high concentrations of oxygen is given after bleomycin therapy. Monitor lung function. Risk of
anaphylatic reaction is higher in patients with lymphoma receiving bleomycin. Reconstitute in 0.9%
sodium chloride or sterile water. Should not reconstitute in dextrose-containing solutions
Adverse Reaction:
Erythema, hyperpigmentation of skin, nail changes, mucositis, chills, fever, pneumonitis, pulmonary
fibrosis, Raynaud's phenomenon, hyperpyrexia, hyperkeratosis, striae, stomatitis
Contraindications:
Hypersensitivity to bleomycin, severe pulmonary disease, pregnancy, lactation
Interactions:
Phenothiazines, cisplatinum, radiotherapy, zidovudine
-------------------------------------------------------------------------------------------------------------------------------------Capecitabine 500 mg Tablet
A*
Trade Name : Xeloda
Indication :
i)Metastatic breast cancer in elderly and poor performance status patients and refractory to taxanes
ii) Metastatic colon cancer, first line in elderly and poor performance status patients
iii) Colon cancer, adjuvant therapy for stage III (Duke's Stage C) following surgery
Dosage :
i) & ii) 1250 mg/m2 twice daily (morning and evening) for 2 weeks, every 21 days iii) Recommended
for a total of 24 weeks (8 cycles of 2 weeks of drug administration and 1 week rest period
Precautions:
Patient with bone marrow suppression, poor nutritional status, elderly patients (more than 80
years), hepatic or renal dysfunction
Adverse Reaction:
Myelosuppression, oedema, fatigue, fever, abdominal pain, palmar-plantar erythrodysesthesia,
dermatitis, nausea and vomiting, stomatitis, anorexia, diarrhoea, constipation, paraesthesia
Contraindications:
Hypersensitivity to capecitabine, fluorouracil or any component of formulation, severe renal
impairment, pregnancy, lactation
Interactions:
Warfarin
-------------------------------------------------------------------------------------------------------------------------------------Carboplatin 450 mg Injection
Trade Name : Paraplatin
Indication :
Adult solid tumours, paediatric tumours. Salvage therapy for lymphoma
256
A*
Dosage :
360 - 400 mg/m2 BSA, by IV infusion over 15 mins to 1 hour on Day 1 every 4 weeks. Alternatively,
prescription may be based on Area Under Curve (AUC) calculations. CHILD: 500-600 mg/m2 over 1
hour once every 3 weeks. Salvage regimes in lymphomas - refer to specific protocols
Precautions:
Myelosuppression, renal impairment. Monitor blood counts and renal function. Do not use infusion
sets or needles containing aluminium, avoid extravasation
Adverse Reaction:
Myelosuppression, alopecia, mucositis, electrolyte disturbances, nausea and vomiting,
nephrotoxicity, ototoxicity, peripheral neuropathy
Contraindications:
Hypersensitivity to cisplatin/ platinum products or mannitol, pregnancy, lactation, severe
myelosuppression
Interactions:
Nephrotoxic and ototoxic drugs, phenytoin. If platinum compound is used with taxane, to be given
after taxane. Increased risk of infection by live vaccines, zidovudine
-------------------------------------------------------------------------------------------------------------------------------------Chlorambucil 2 mg Tablet
A
Trade Name : Leukeran
Indication :
Low grade lymphoma, chronic lymphocytic leukaemia. Ovarian cancer
Dosage :
200 mcg/kg body weight daily for 4 - 8 weeks
Precautions:
Myelosuppression. Monitor blood counts. History of seizures. If generalised skin rash develops
during treatment, to stop therapy to avoid progressing to erythema multiforme, toxic epidermal
necrolysis or Stevens-Johnson syndrome
Adverse Reaction:
Myelosuppression, azoospermia/amenorrhoea, rash, allergic reactions, seizures, nausea and
vomiting, diarrhoea, stomatitis, interstitial pneumonitis, pulmonary fibrosis, transient elevation of
liver enzymes, secondary malignancies
Contraindications:
Hypersensitivity to chlorambucil, pregnancy
Interactions:
Ciclosporin, phenobarbital, phenytoin, allopurinol, live vaccines
-------------------------------------------------------------------------------------------------------------------------------------Cisplatin (Cis-Platinum) 50 mg Injection
A
Trade Name : Platinul
Indication :
Germ cell tumours, ovarian tumours, adult solid tumours, lymphomas
Dosage :
Germ cell tumours: 20 mg/m2 daily for 5 days every 3 weeks for 3 - 4 courses. Ovarian tumours: 75
mg/m2 once every 3 weeks as part of combination therapy or 100 mg/m2 IV once every 3 weeks as
a single agent. Baseline creatinine clearance, pretreatment hydration and forced diuresis are
mandatory. CHILD: 100mg/m2 over 6 hours once every 3 weeks. Lymphomas: Refer to protocols
Precautions:
Monitor blood counts, renal and neurologic function. Protect from light. Materials used to
prepare/administer cisplatin should not contain aluminium. Mandatory pre-hydration and posthydration with mannitol diuresis
257
Adverse Reaction:
Acute renal failure, chronic renal insufficiency, myelosuppression, severe nausea and vomiting,
ototoxicity, peripheral neuropathy, autonomic neuropathy, electrolyte disturbances (eg
hypokalemia, hypomagnesemia), bone marrows and ears, seizures, loss of hearing, deafness or
vestibular toxicity
Contraindications:
Hypersensitivity to cisplatin/platinum-containing products, pre-exisiting renal insufficiency,
myelosuppression, hearing impairment. Pregnancy, lactation, peripheral neuropathy, severe bone
marrow suppression
Interactions:
Sodium thiosulphate, bleomycin. If platinum compound is used with taxane, to be given after
taxane, live vaccine, azidamfenicol, aminoglycosides
-------------------------------------------------------------------------------------------------------------------------------------Cyclophosphamide 1 g Injection
A
Trade Name : Endoxan
Indication :
i) Solid tumours (adult and paediatric), leukaemia, non-Hodgkin's lymphoma, multiple myeloma ii)
Severe lupus nephritis (Class III and IV) iii) Other systemic vasculitis iv) Systemic lupus
erythematosus, rheumatoid arthritis, polyarteritis nodosa, wegener granulomatosis v) Pemphigus
vulgaris
Dosage :
i) ADULT: 600 - 750 mg/m2 IV once every 3 weeks as part of combination regime. CHILD: Dose
variable depending on disease and protocol. Range 600 mg/m2 to 2 g/m2 infusion over 1 hour to 6
hours (lower doses can be given as bolus). Care with pre and post-hydration. Mesna to be given with
doses more than 1 g/m2. Higher doses are used in haematopoetic stem cell transplant-refer to
specific protocols ii) 750 mg/m2 BSA monthly for 18 months iii) 750 mg/m2 BSA monthly for 6
months. Dose can be adjusted up to 1,000 mg/m2 BSA to achieve adequate leucocyte suppression
iv) 500 - 1000 mg intravenously (Regime varies according to indication). Starting dose may be given
fortnightly then at monthly intervals followed by 3 monthly intervals v) 500 mg infusion on the 2nd
day of the dexamethasone-cyclophosphamide pulsed regime, the cycle is repeated every 4 weeks up
to 6 cycles or till remission followed by oral cyclophosphamide
Precautions:
Myelosuppression, renal/hepatic impairment, elderly patients
Adverse Reaction:
Myelosuppression, syndrome of inappropriate ADH secretion, haemorrhagic cystitis, fibrosis of
bladder, alopecia, nausea and vomiting, anorexia, diarrhoea, headache, rash, flushing of face.
Adverse reactions with high doses of cyclophophamide include heart failure and interstitial
pneumonitis
Contraindications:
Hypersensitivity to cyclophosphamide. Pregnancy, lactation
Interactions:
Doxorubicin, cimetidine, thiazide diuretics. Succinyl choline, halothane, nitrous oxide. Increased
bone marrow depression with allopurinol, barbiturates, phenytoin, corticosteroids, chloramphenicol,
interferon alfa. Radiotherapy, live vaccines
--------------------------------------------------------------------------------------------------------------------------------------
258
Cyclophosphamide 50 mg Tablet
A
Trade Name : Endoxan
Indication :
i) Solid tumours, leukaemia, lymphoma, autoimmune disorders, autoimmune bullous diseases,
connective tissue disease, pyoderma gangrenosum ii) For severe lupus nephritis (Class III & IV),
systemic vasculitis and steroid resistant/dependent nephrotic syndrome iii) Systemic lupus
erythematosus (SLE), rheumatoid arthritis, polyarteritis nodosa, wegener granulomatosis
Dosage :
i) Solid tumours, leukaemia, lymphoma, autoimmune disorders, autoimmune bullous diseases,
connective tissue disease, pyoderma gangrenosum ii) For severe lupus nephritis (Class III & IV),
systemic vasculitis and steroid resistant/dependent nephrotic syndrome iii) Systemic lupus
erythematosus (SLE), rheumatoid arthritis, polyarteritis nodosa, wegener granulomatosis
Precautions:
Myelosuppression, renal/hepatic impairment, elderly patients
Adverse Reaction:
Myelosuppression, syndrome of inappropriate ADH secretion, haemorrhagic cystitis, fibrosis of
bladder, alopecia, nausea and vomiting, anorexia, diarrhoea, headache, rash, flushing of face
Contraindications:
Hypersensitivity to cyclophosphamide. Pregnancy, lactation
Interactions:
Doxorubicin, cimetidine, thiazide diuretics. Radiotherapy, live vaccines. Succinyl choline, halothane,
nitrous oxide. Increased bone marrow depression with allopurinol, barbiturates, phenytoin,
corticosteroids, chloramphenicol, interferon alfa
-------------------------------------------------------------------------------------------------------------------------------------Cytarabine 100 mg Injection
A
Trade Name : Cytosar
Indication :
i) Central nervous system lymphoma ii) Meningeal leukemia iii) Non Hodgkin's Lymphoma iv) High
dose cytarabine as conditioning to cytoreduce the disease before stem cell transplant for relapsed or
refractory leukemia v) As salvage for acute lymphocytic leukemia vi) As salvage for acute myeloid
leukemia vii) As palliative chemotherapy in elderly acute myeloid leukemia/ myelodysplastic
syndrome
Dosage :
Standard doses 100 - 200 mg/m2 daily over 5 - 10 days. Higher doses for
intensification/consolidation: 1000 - 3000 mg/m2 daily over 3 - 5 days depending on specific
protocols. CHILD: Dose variable depending on disease and protocol. Range from 100 mg/m2 to 3
g/m2 twice daily. May be given as SC, IV bolus or infusion. Intrathecal dose: Less than 1 year: 15 mg,
1 - 2 years: 20 mg, 2 - 3 years: 25 mg, more than 3 years: 30 mg. (ENSURE THAT PREPARATION IS
SUITABLE FOR INTRATHECAL USE)
Precautions:
Renal and hepatic impairment. Patients over 50 years old (for high dose therapy), pregnancy and
lactation. Pre-existing drug-induced bone marrow suppression, leukocyte and platelet counts should
be monitored daily, bone marrow examinations should be performed periodically, hepatic
impairment, women of childbearing age, infants, severe gastrointestinal, central nervous system and
pulmonary toxicity when using high dose schedules
Adverse Reaction:
Myelosuppression, alopecia, fever, mucositis, nausea and vomiting, rash, neurotoxicity, headache,
dizziness, somnolence, photophobia, cerebellar toxicity, pneumonitis, pulmonary oedema,
conjunctivitis, hepatic dysfunction
259
Contraindications:
Hypersensitivity to cytarabine products. Pregnancy, lactation
Interactions:
Increased cytotoxicity when radiotherapy, alkylating agents, methotrexate and purine analogues are
given together with cytarabine. Increased ototoxicity if used concurrently with cisplatin
-------------------------------------------------------------------------------------------------------------------------------------Dacarbazine 100 mg Injection
A*
Indication :
i) Malignant melanoma, sarcomas, neuroblastomas and other childhood solid tumours ii) Hodgkin's
Disease
Dosage :
i) 250 mg/m2 for 5 days, may be repeated every 3 weeks ii) 375 mg/m2 IV every 2 weeks
Precautions:
Renal or hepatic impairment, bone marrow depression. Pregnancy. Avoid extravasation
Adverse Reaction:
Nausea, vomiting, myelosuppression, flu-like symptoms, alopecia, rash, photosensitivity, vesicant,
paresthesias, ataxia, lethargy, headache, confusion, seizures, anaphylactic reactions, elevation of
liver enzymes
Contraindications:
Hypersensitivity to dacarbazine products, pregnancy, lactation
Interactions:
Drugs that induce hepatic P450 enzymes (eg phenobarbital, phenytoin) may lead to decreased
efficacy. Increased risk of infection by the live vaccine
------------------------------------------------------------------------------------------------------------------------------------Daunorubicin HCl 20 mg Injection
A*
Trade Name : Cerubidin
Indication :
i) Acute myeloblastic leukaemia (AML) ii) Acute lymphoblastic leukemia (ALL)
Dosage :
i) 45 - 60 mg/m2 IV daily for 3 - 5 days ii) 25 - 45 mg/m2 once a week for first 4 weeks during
induction phase. Caution: Total cumulative dose of daunorubicin and doxorubicin must not exceed
500 mg/m2 due to risk of cardiotoxicity. CHILD: 30-45 mg/m2/dose infusion over 6 hours. Schedule
depends on protocol. Need to check cardiac function closely by echocardiography every cumulative
dose of 100mg/m2 to max. 360 mg/m2
Precautions:
Hepatic impairment. Previous radiotherapy to chest. Avoid extravasation
Adverse Reaction:
Alopecia, radiation recall reactions. Hyperpigmentation of nails. Myelosuppression. Nausea,
vomiting, mucositis, diarrhoea, hepatic/renal impairment, discolouration of urine. ECG
abnormalities, congestive cardiac failure
Contraindications:
Hypersensitivity to daunorubicin. Pregnancy, lactation, pre-existing myelosupression, congestive
cardiac failure, arrhythmias or previous treatment with high cumulative doses of anthracyclines
Interactions:
Increased risk of infection by live vaccines, azidamfenicol, chloramphenicol, ciclosporin
-------------------------------------------------------------------------------------------------------------------------------------
260
Docetaxel 20 mg/0.5 ml Injection
A*
Trade Name : Taxotere
Indication :
i)Adjuvant treatment of patients with high risk node-positive breast cancer in combination with
doxorubicin and cyclophosphamide ii) Breast cancer, locally advanced or metastatic, not previously
on cytotoxic therapy, in combination with doxorubicin iii) First line therapy in non small cell lung
cancer in stage 3- 4 and performance status 0 ? 1, in combination with cisplatin iv) Inoperable locally
advanced squamous cell carcinoma of head and neck, in combination with cisplatin and 5-FU for
induction treatment v) Prostate cancer, in combination with prednisolone
Dosage :
i) 75 mg/m2 IV over 1 hour after doxorubicin 50 mg/m2 and cyclophosphamide 500 mg/m2 every 3
weeks for 6 cycles ii) 75 mg/m2 IV over 1 hour every 3 week in combination with doxorubicin 50
mg/m2 iii) Administer IV over 1 hour every 3 weeks. Chemotherapy-naive patients 75 mg/m2
immediately followed by 75 mg/m2 cisplatin over 30-60 mins or carboplatin (AUC 6 mg/mL/min)
over 30-60 minutes. Monotherapy of non small cell lung cancer (NSCLC) after failure of prior
platinum-based chemotherapy 75 mg/m2 iv) 100 mg/m2 IV over 1 hour every 3 weeks v) 60-75
mg/m2 IV over 1 hour every 3 weeks, administer with oral prednisolone 5 mg twice daily given
continuously
Precautions:
All patients should receive premedication with corticosteroids against hypersensitivity reactions.
Monitor blood counts, liver function tests. Avoid extravasation
Adverse Reaction:
Fluid retention syndrome, hypersensitivity reactions. rash, alopecia, oedema, peripheral neuropathy,
myelosuppression, elevation of liver enzymes, nausea, vomiting, stomatitis, diarrhoea, fatigue,
weakness, paroxysmal atrial tachycardia, atrial flutter, dysrrhythmia, hypertension and heart failure
Contraindications:
Hypersensitivity to docetaxel or Polysorbate 80, neutrophil count less than 1500 cells/mm³. Severe
liver impairment. Pregnancy and lactation
Interactions:
Increased risk of infection by the live vaccine. Drugs which affect liver cytochrome P450 enzyme
system may affect the antitumour and toxic effects of docetaxel. Less toxicity if taxanes given before
platinum compounds if combination of taxane and platinum is used
-------------------------------------------------------------------------------------------------------------------------------------Doxorubicin HCl 50 mg Injection
A
Trade Name : Adriamycin
Indication :
i) Solid tumours, leukaemia, non-Hodgkin's lymphoma ii) Leukaemia (ALL induction) iii) Multiple
myeloma
Dosage :
i) 30 - 75 mg/m2 IV as a single dose at 21 day intervals ii) 25 - 45 mg/m2 once a week for the first 4
weeks during induction or re-induction phase (refer to specific protocol. Caution: Total cumulative
dose of doxorubicin must not exceed 550 mg/m2 due to risk of cardiotoxicity. CHILD: 30
mg/m2/dose over 6 - 24 hours for 1 - 2 days. Need to check cardiac function closely by
echocardiography every cumulative dose of 100 mg/m2 to maximum 360 mg/m2 iii) 9 mg/m2 over
24 hours infusion for 4 days at monthly intervals
Precautions:
Cardiac failure, heart disease, hypertension. Previous radiotherapy to chest, elderly. Avoid in
pregnancy and lactation. Avoid extravasation
261
Adverse Reaction:
Alopecia, myelosuppression, mucositis, diarrhoea, hyperpigmentation of skin and nails, arrhythmias,
congestive heart failure, nausea, vomiting, discolouration of urine, palmar-plantar
erythrodysethesia, pericardial effusion, cardiomyopathy, radiation recall reactions, second
malignancy
Contraindications:
Hypersensitivity to doxorubicin, marked myelosuppression induced by previous chemotherapy or
radiotherapy. Previous treatment with tolerance doses of anthracyclines, significantly impaired
cardiac function, angina pectoris, cardiac arrhythmias or recent myocardial infarction.
Interactions:
Live vaccines, phenytoin, radiation therapy, mitomycin C, 6-mercaptopurine, cyclophosphamide, 5fluorouracil, ciclosporin, digoxin, paclitaxel, phenobarbital, trastuzumab, stavudine, zidovudine
-------------------------------------------------------------------------------------------------------------------------------------Epirubicin 50 mg Injection
A*
Trade Name : Adriamycin
Indication :
Breast cancer, Non-Hodgkin's lymphoma, Leukaemia (ALL induction), gastric cancer, ovarian cancer
Dosage :
60 - 100 mg/m2 body area injected IV in 3 - 5 min, repeated at 21 day intervals. CHILD: 50 mg/m2
over 6 hours. Schedule depends on protocol
Precautions:
Pre-existing cardiac disease, renal or liver impairment, previous radiotherapy, elderly patients. Avoid
extravasation. Avoid cumulative doses beyond 900 mg/m2
Adverse Reaction:
Myelosuppression, leukopenia, thrombocytopenia, nausea, vomiting, cardiotoxicity (arrhythmias,
conduction disturbances, myopericarditis syndrome, dilated cardiomyopathy, congestive cardiac
failure), alopecia, mucositis, vesicant, rash, hyperpigmentation of skin and nails, radiation recall
reaction, discolouration of urine
Contraindications:
Hypersensitivity to anthracyclines, severe cardiac impairment, recent myocardial infarct, severe liver
dysfunction, pregnancy, lactation
Interactions:
Paclitaxel and other anthracyclines, Cimetidine, cyclophophamide, 5-fluorouracil, heparin, live
vaccines, trastuzumab, zidovudine
------------------------------------------------------------------------------------------------------------------------------------Etoposide 100 mg/5 ml Injection
A*
Trade Name : Vepesid
Indication :
i) For treatment of children with solid tumours, juvenile myelomonocytic leukemia (JMML) and
Langerhan cell histiocytosis ii) Leukaemia, lymphoma iii) Testicular cancer, lung cancer, gestational
trophoblastic disease, gastric cancer, sarcoma
Dosage :
i) CHILD: 60-120 mg/m2/day by IV for 3 - 5 days every 3 - 6 weeks depending on protocols ii)
Maintenance or palliative chemotherapy for elderly acute myeloid leukemia, consolidation therapy
for acute lymphoblastic leukemia, stem cell mobilization (Refer to protocol) iii) 100 mg/m2 by IV
every other day for 3 doses repeated every 3-4 weeks
262
Precautions:
Use with caution in hepatic or renal impairment, myelosuppression. Administer intravenously over
30 to 60 minutes to reduce risk of hypotension. Anaphylaxis following IV administration to be
anticipated and treated appropriately
Adverse Reaction:
Myelosuppression, nausea and vomiting, alopecia, hypersensitivity reaction, local inflammatory
reaction at site of injection, radiation recall reaction, secondary malignancy
Contraindications:
Hypersensitivity to podophyllins, severe hepatic dysfunction, pregnancy, lactation
Interactions:
Ciclosporin, calcium antagonists, methotrexate, warfarin. Increased risk of infection by the live
vaccine
----------------------------------------------------------------------------------------------------------------------------------Fluorouracil 250 mg/5 ml Injection
A*
Trade Name : 5-FU
Indication :
Cancers of gastro-intestinal tract, breast and pancreas, head and neck. Ophtalmological indication:
trabeculectomy
Dosage :
500 - 600 mg/m2 IV in combination with other cytotoxic agents, repeated every 3 weeks or 300 - 450
mg/m2 IV slow bolus daily for 5 days in combination with biological response modifiers, repeated
every 4 weeks or 3000 - 3750 mg/m2 as a continuous infusion over 5 days in combination with a
platinum compound every 3 to 4 weeks
Precautions:
Caution in ischaemic heart disease, renal or hepatic dysfunction, elderly. Previous pelvic irradiation,
previous treatment with alkylating agents. Discontinue upon development of unexpected grade 3 or
4 stomatitis, oesophagopharyngitis, diarrhoea, myelosuppression or neurologic toxicities
Adverse Reaction:
Myelosuppression, mucositis, pigmentation of infused vein, somnolence, confusion, ataxia, fits,
encephalopathy, changes in ECG, chest pain, nausea and vomiting, diarrhoea, photosensitivity, hand
foot syndrome
Contraindications:
Hypersensitivity to fluorouracil, pregnancy, lactation
Interactions:
Leucovorin, warfarin, methotrexate, thymidine
----------------------------------------------------------------------------------------------------------------------------------Gemcitabine HCl 1 g Injection
A*
Trade Name : Gemzar
Indication :
i) Locally advanced or metastatic non-small cell lung cancer ii) Locally advanced or metastatic
pancreatic cancer iii) In combination with carboplatin in the treatment of patients with recurrent
epithelial ovarian carcinoma, who have relapsed more than six months, following platinum-based
therapy iv) In combination with paclitaxel for treatment of patients with metastatic breast cancer
who have relapsed following adjuvant/ neoadjuvant chemotherapy. Prior chemotherapy should
have included an anthracycline unless clinically contraindicated
Dosage :
i) Alone or with cisplatin: 1000 mg/m2 day 1 & 8 every 3 weeks or 1000 mg/m2 day 1, day 8, day 15
every 4 weeks ii) Initially 1000 mg/m2 weekly for 7 weeks followed by 1 week rest. Subsequent
cycles 1000 mg/ m2 weekly for 3 weeks followed by 1 week rest iii) Gemcitabine 1000 mg/m2 as 30
263
minutes IV infusion day 1 & 8 of each 21-day cycle followed by carboplatin on day 1 to attain a target
AUC of 4 mg/ml/minute iv) 1250 mg/m2 on days 1 and 8 of each 21-day cycle with paclitaxel 175
mg/m2 given as a 3-hour infusion before gemcitabine on day 1 of each 21-day cycle
Precautions:
Caution in hepatic dysfunction, myelosuppression, renal impairment. Avoid prolonging infusion
times more than 60 minutes
Adverse Reaction:
Flu-like symptoms, proteinuria, nausea, vomiting, myelosuppression, oral soreness, rash, pruritus,
elevation of liver enzymes, haematuria, dyspnoea, allergic reactions, myalgia, alopecia, diarrhoea,
haemolytic uraemic syndrome, adult respiratory distress syndrome
Contraindications:
Hypersensitivity to gemcitabine. Pregnancy, lactation
Interactions:
Increased risk of infection by live vaccines. Cisplatin, etoposide, radiotherapy
--------------------------------------------------------------------------------------------------------------------------------Idarubicin 10 mg Injection
A*
Trade Name : Zavedos
Indication :
i) Acute promyelocytic leukaemia ii) Relapse Acute myeloid leukemia (with sibling match) iii) Acute
myeloid leukemia, acute lymphoblastic leukemia (salvage therapy)
Dosage :
i) Induction phase: 12 mg/m2 IV slow bolus on Days 3, 5 and 7. Consolidation phase, month 1: 12
mg/m2 IV on Days 1 and 2. Repeat monthly for 3 courses ii) 12 mg/m2 D1-3 iii) 12 mg/m2 D1-3 as
part of FLAG-IDA regimen
Precautions:
Risk for cardiotoxicity increased in elderly, hypertension, heart disease, previous treatment with
anthracyclines, previous chest radiotherapy. Cumulative doses more than 150 mg/m2 are associated
with decreased left ventricular ejection fraction. Monitor cardiac function. Caution against sun
exposure. Avoid extravasation. Anticipate and prevent tumour lysis syndrome. Caution with
abnormal liver function tests
Adverse Reaction:
Cardiotoxicity, myelosuppression, nausea, vomiting, diarrhoea, mucositis, alopecia, rash,
photosensitivity, hyperpigmentation, vesicant, discolouration of urine, leukopenia,
thrombocytopenia
Contraindications:
Hypersensitivity to idarubicin and other anthracyclines. Pregnancy, lactation, cardiac impairment,
renal and hepatic impairment
Interactions:
Probenecid, sulfinpyrazone, heparin. Live vaccine, other myelosuppressants, azidamfenicol,
chloramphenicol, ciclosporin, trastuzumab
-------------------------------------------------------------------------------------------------------------------------------Ifosfamide 1 g Injection
A*
Trade Name : Holoxan
Indication :
i) Solid tumours ii) Leukaemia iii) Lymphoma
Dosage :
i) 1.2 - 2.4 g/m2/day for 3 - 7 days as a 30 - 120 minutes infusion. Alternatively, can also be given as a
single high dose, eg. 5 g/m2 in a 24 hour infusion. Cycles may be repeated every 3 - 4 weeks ii)
CHILD: 400 - 3000 mg/m2/day for 3 - 5 days according to protocol iii) Refer to protocols
264
Precautions:
Brain metastases, electrolyte imbalance, hepatic and renal impairment. Hydration required. Renal
function should be checked prior to administration. Co-administration with mesna, which is a
urothelial protective agent is mandatory
Adverse Reaction:
Alopecia, myelosuppression, nausea and vomiting, diarrhoea, mucositis, transient abnormalities of
liver enzymes, acute hepatocellular injury (not common at standard doses), erythematous rash,
pruritis, pigmentary changes, photosensitivity, acute renal failure (high dose), headache, drowsiness,
dizziness, encephalopathy/ acute confusion (high dose)
Contraindications:
Hypersensitivity to ifosfamide, pregnancy, lactation. Severe myelosupression
Interactions:
Phenobarbital, carbamazepine, phenytoin
-------------------------------------------------------------------------------------------------------------------------------------Irinotecan HCl Trihydrate 100 mg/5ml Injection
A*
Trade Name : Campto
Indication :
Only for patients with colorectal cancer who: i) have relapsed within 6 months after the end of
adjuvant chemotherapy with 5-fluorouracil-based regime ii) have progressive disease despite 5fluorouracil chemotherapy for advanced disease iii) good performance status (WHO of 2 or less) The
treatment must be given in a tertiary oncology centre or have clearance in writing by an oncologist
Dosage :
In combination therapy (for previously untreated patients): 180 mg/m2 once every 2 weeks as an IV
infusion over 90 mins followed by infusion with folinic acid and 5-fluorouracil. In monotherapy (for
previously treated patients): 350 mg/m2 administered as an intravenous infusion over 90 minutes
period once every 3 weeks
Precautions:
Diarrhoea (early or late) must be treated adequately with delay of subsequent cycle until recovery.
Antiemetic premedication is recommended. Avoid extravasation. Caution with myelosuppression.
Patients over 65 years old, patients who have previously received pelvic / abdominal radiation and
with poor performance status have increased risk of bone marrow suppression and diarrhoea,
neutopenia: may lead to sepsis and death
Adverse Reaction:
Myelosuppression, diarrhoea (early or late), nausea, vomiting, alopecia, dyspnoea, weakness,
hypotension, acute renal failure, colitis
Contraindications:
Hypersensitivity to irinotecan, pregnancy and lactation, inflammatory bowel disease, bowel
obstruction, plasma bilirubin concentration 1.5 times the upper limit of reference range
Interactions:
Increased risk of infection by the live vaccine, diuretics increase risks of dehydration secondary to
vomiting/diarrhea, prophylactic dexamethasone as an antiemetic may enhance lymphocytopenia,
prochlorperazine may increase incidence of akathisia, antineoplastic agents (myelosuppression and
diarrhoea)
-------------------------------------------------------------------------------------------------------------------------------------L-Asparaginase 10,000 IU Injection
Trade Name : Leunase
Indication :
i) Acute lymphoblastic leukemia ii) Non-hodgkin's lymphoma
265
A*
Dosage :
i) 5,000 iu/m2 for 10 days during induction, 10,000 iu/m2 also used with high dose methotrexate
rescue in consolidation phase of acute lymphoblastic leukemia ii) CHILD: 5,000 - 25,000 iu/m2 per
dose depending on protocol
Precautions:
Haematologic, renal and hepatic dysfunction, pregnancy. Monitor for severe allergic reactions,
caution in underlying coagulopathy and lactation
Adverse Reaction:
Hypersensitivity reactions (urticaria, chills, fever, anaphylaxis), hyperglycaemia, lethargy, depression,
confusion, coagulopathy, anorexia, mild nausea and vomiting, acute pancreatitis, coma,
myelosuppression (usually mild), hepatic dysfunction, renal dysfunction, somnolence, hallucination,
central nervous system disturbances including depression, coma, transient bone-marrow depression
Contraindications:
Hypersensitivity to L-Asparaginase, history of pancreatitis
Interactions:
Vincristine, cyclophosphamide, methotrexate, steroids, live vaccine
-------------------------------------------------------------------------------------------------------------------------------------Melphalan 2 mg Tablet
A
Trade Name : Alkeran
Indication :
i) Multiple myeloma ii) Neuroblastoma, rhabdomyosarcoma iii) Recurrent neuroblastoma (palliative)
Dosage :
i) 8 - 10 mg/m2 for 4 days every 4 weeks ii) 10 - 35 mg/m2 once every month For dose regimes, refer
to protocols
Precautions:
Use with caution in renal impairment and elderly. Dose adjustment with blood count. To be taken on
empty stomach 1 hour before or 2 hours after meals
Adverse Reaction:
Bone marrow depression, mild gastrointestinal effects, diarrhoea, pulmonary fibrosis, interstitial
pneumonitis, alopecia, syndrome of inappropriate ADH secretion, secondary malignancy
Contraindications:
Lactation, pregnancy, hypersensitivity to melphalan, severe myelosuppression
Interactions:
Ciclosporine, steroid, cimetidine
-------------------------------------------------------------------------------------------------------------------------------------Mercaptopurine 50 mg Tablet
A
Trade Name : Puri-Nethol
Indication :
i) Langerhan's cell histocytosis ii) Acute lymphoblastic leukaemia iii) Acute promyelocytic leukaemia
APML (maintenance)
Dosage :
ADULT: Maintenance therapy: 60 - 75 mg/m2 body surface area once daily. Adjust doses depending
on peripheral blood counts. CHILD: 2.5 mg/kg body weight or 25 - 100 mg/m2 body surface area
once daily according to protocol. Refer to protocols
Precautions:
Dose reduction with an abnormal liver or renal function. Myelosuppression (temporarily discontinue
treatment with an abnormally large fall in any formed blood element), inherited deficiency of the
enzyme thioguanine methyltransferase (TPMT), hepatotoxicity, reduce dosage when administered
with allopurinol, pregnancy. Take on an empty stomach
266
Adverse Reaction:
Bone marrow depression, nausea and vomiting, hepatotoxicity, rash, hyperpigmentation,
hyperuricaemia
Contraindications:
Lactation, pregnancy, severe bone marrow suppression, severe liver disease, hypersensitivity to
mercaptopurine
Interactions:
Allopurinol, methotrexate, warfarin, decreased anticoagulant effectiveness, sulfasalazine
----------------------------------------------------------------------------------------------------------------------------------Methotrexate 2.5 mg Tablet
A
Indication :
i) Acute lymphoblastic leukaemia and acute promyelocytic leukemia (maintenance) ii) Extensive
plaque psoriasis, erythrodermic psoriasis, pustular psoriasis, Reiter's syndrome, connective tissue
disease
Dosage :
i) ADULT: 20 mg/m2 weekly. CHILD: 20 - 30 mg/m2 weekly according to protocol ii) Relapsed acute
lymphoblastic leukaemia (ALL): 100 mg/m2/day for 5 days 6 weekly according to protocol iii) Dose
used by dermatologist: 5 - 25 mg weekly. Liver biopsy after cumulative dose of 1.5 gram and repeat
liver biopsy with additional gram received. Maximum cumulative dose is 4 gram. Monitor full blood
count (FBC), renal and liver function iv) Rheumatoid arthritis, psoriatic arthropathy: dose used by
rheumatologist: 2.5 mg/week orally starting dose, increasing to 7.5 - 20 mg/weekly
Precautions:
Impaired renal function, pleural effusion, ascitis, poor nutritional status, myelosuppression, acute or
chronic hepatotoxicity (elevated transaminases, fibrosis, cirrhosis), pulmonary toxicity (dry cough,
pneumonitis), nephrotoxicity with high-dose therapy, patients with a creatinine clearance of less
than 60 ml/minute should not receive high-dose methotrexate, high-dose or intrathecal
methotrexate therapy must not be formulated with diluents containing preservatives, women of
child-bearing potential, gastrointestinal toxicity (vomiting, diarrhoea, stomatitis), tumour lysis
syndrome in patients with rapidly growing tumors, severe and sometimes fatal skin reactions,
potentially fatal infections (especially Pneumocystis carinii pneumonia), neurotoxicity
(leukoencephalopathy, seizures), high-dose methotrexate therapy will generally require the use of
leucovorin rescue, care should be taken in handling the body fluids of persons receiving
antineoplastic agents
Adverse Reaction:
Myelosuppression, nausea, vomiting, diarrhoea, mucositis, transient abnormalities in serum levels of
liver enzymes, acute hepatocellular injury (not common at standard dose), erythematous rash,
dizziness, acute confusion (high dose), interstitial pneumonitis, myelosuppression, interstitial
pneumonitis
Contraindications:
Pregnancy, lactation, severe myelosuppression, serious renal and liver impairment, increase risk of
toxicity in the presence of third space fluid (pleural effusion, ascites)
Interactions:
Alcohol, aminophenazone, amiodarone, amitriptyline, antibiotics, cisplatinum, ciclosporin, cytosine
arabinoside, diclofenac, etoposide, etretinate, 5-fluorouracil, NSAIDs, salicylates, nephrotoxic drugs,
sulfonamides, tetracyclines, teniposide, warfarin, folic acid
-----------------------------------------------------------------------------------------------------------------------------------
267
Methotrexate 50 mg Injection
A
Indication :
i) Solid tumours ii) Gestational trophoblastic disease iii) Acute leukaemia/lymphomas iv) Rheumatoid
arthritis, psoriatic arthropathy, severe/erythrodermic psoriasis
Dosage :
i) 50 mg/m2 once every 2 - 3 weeks in combination with other drugs ii) 50 mg IV Day 1, 3, 5, 9 every
3 weeks. For high risk gestational trophoblastic disease, use 100 mg/m2 as part of EMA-CO regime
iii) High dose regimes: 500 - 3000 mg/m2 per dose may be used, employing the 500 mg
preparations. CHILD: Central nervous system prophylaxis for acute leukaemia 2 gm/m2 over 24
hours with folinic acid rescue, 3 doses for B-cell lineage. 4 doses for T-lineage all every 3 weeks.
Relapse acute lymphoblastic leukaemia (ALL): 1 gm/m2 over 36 hours with folinic acid rescue every 3
weeks for 9 doses, maintenance: 50 mg/m2 every 2 weeks. B-cell lymphoma: 3 gm/m2 over 3 hours
with folinic acid rescue for three doses. Methotrexate level monitoring recommended when using
high dose regimens. The 500 mg strength is not for intrathecal (IT) use. Dosage for intrathecal
treatment and prophylaxis in leukaemia: less than 1 year: 5 mg, 1 - 2 years: 7.5 mg, 2 - 3 years: 10
mg, more than 3 years: 12.5 mg. IT preparation must be clearly stated/verified. ENSURE THAT
PREPARATION IS SUITABLE FOR INTRATHECAL USE iv) Dose used by rheumatologist: 10 - 15 mg IM
injection or oral weekly. Dose used by dermatologist: 10 - 25 mg IM injection weekly
Precautions:
Patients with a creatinine clearance of less than 60 ml/minute, impaired renal function, pleural
effusion, ascitis and poor nutritional status should not receive high-dose methotrexate. High-dose or
intrathecal methotrexate therapy must NOT be formulated with diluents containing preservatives.
High-dose methotrexate therapy requires the use of leucovorin rescue. Myelosuppression, acute or
chronic hepatotoxicity (elevated transaminases, fibrosis, cirrhosis), pulmonary toxicity (dry cough,
pneumonitis). Women of child-bearing potential, gastrointestinal toxicity (vomiting, diarrhoea,
stomatitis), tumour lysis syndrome in patients with rapidly growing tumors, severe and sometimes
fatal skin reactions, potentially fatal infections (especially pneumocystis carinii pneumonia),
neurotoxicity (leukoencephalophathy, seizures), care should be taken in handling the body fluids of
persons receiving antineoplastic agents
Adverse Reaction:
Myelosuppression, nausea, vomiting, diarrhoea, mucositis, transient abnormalities in serum levels of
liver enzymes, acute hepatocellular injury (not common at standard dose), erythematous rash,
dizziness, acute confusion (high dose), interstitial pneumonitis, myelosuppression, interstitial
pneumonitis
Contraindications:
Pregnancy, lactation, severe myelosuppression, serious renal and liver impairment, increase risk of
toxicity in the presence of third space fluid (pleural effusion, ascites)
Interactions:
Alcohol, aminophenazone, amiodarone, amitriptyline, antibiotics, cisplatinum, ciclosporin, cytosine
arabinoside, diclofenac, etoposide, etretinate, 5-fluorouracil, NSAIDs, salicylates, nephrotoxic drugs,
sulfonamides, tetracyclines, teniposide, warfarin, folic acid
-------------------------------------------------------------------------------------------------------------------------------------Mitomycin-C 10 mg Injection
A*
Trade Name : Mitomycin-C
Indication :
i) Gastrointestinal, lung, breast, cervical cancers ii) Bladder tumours iii) Opthalmological conditions:
conjunctival squamous neoplasia, squamous cell carcinoma of conjunctiva, trabeculectomy chronic
lymphocytic leukaemia, chronic myelogenous leukaemia. Gastric, colorectal, lung cancer
268
Dosage :
i) 10 - 20 mg/m2 body surface area (BSA) given as a single dose through a running IV infusion
repeated every 6 - 8 weeks. The whole schedule may be repeated depending on the bone marrow ii)
10 - 40 mg daily or every other day (intravesical) iii) 0.4 mg topically as a single application for
opthalmological conditions, duration: 1 to 3 minutes
Precautions:
Bleeding tendency, radiotherapy, extravasation, hepatic dysfunction, myelosuppression, renal
impairment
Adverse Reaction:
Nephrotoxicity, delayed myelosuppression, nausea and vomiting, alopecia, congestive heart failure,
fever, haemolytic uraemic syndrome-risk increase when cumulative dose more than 50 mg/m2,
interstitial pneumonitis
Contraindications:
Thrombocytopenia, coagulation disorders, pregnancy, lactation, hypersensitivity to mitomycin,
hepatotoxicty
Interactions:
Vinblastine, vince alkaloids may increase risk of cardiotoxicity when given together with mitomycin C
---------------------------------------------------------------------------------------------------------------------------------Mitoxantrone 20 mg/10ml Injection
A*
Trade Name : Novantrone
Indication :
Acute leukaemia, elderly patients with acute myeloid leukaemia (AML), relapsed/resistant acute
leukaemia, non-Hodgkin's lymphoma (NHL)
Dosage :
10 - 12 mg/m2 IV daily for 3 days, in combination with other cytotoxic agents. Refer to protocol.
CHILD: 5 - 10 mg/m2 daily for 3 - 5 days according to protocol. Treatment of acute leukaemia,
ADULT: 8 - 12 mg/m2/day once daily for 4 - 5 days. CHILD more than 2 years: same as adult dose.
CHILD 2 years: 0.4 mg/kg/day once daily for 3 - 5 days
Precautions:
Myelosuppression or poor general condition in cases with functional cardiac changes including
congestive heart failure and decrease in left ventricular ejection fraction, hepatic insufficiency,
children, pregnancy, lactation
Adverse Reaction:
Myelosuppression, nausea, vomiting, stomatitis, alopecia, hepatotoxicity, congestive cardiac failure,
constipation, diarrhoea, arrhythmias, discolouration of urine and other secretions, alopecia,
secondary malignancy, fatigue, fever, headache, amenorrhoea, abdominal pain, acute myeloid
leukaemia, myelodysplasia of the spinal cord
Contraindications:
Hypersensitivity to mitoxantrone products, pregnancy, lactation, severe myelosuppression, cardiac
dysfunction
Interactions:
Increased risk of infection by the live vaccine, trastuzumab
-------------------------------------------------------------------------------------------------------------------------------------Oxaliplatin 50 mg Injection
A*
Trade Name : Eloxatin
Indication :
Only for patients with colorectal cancer who: i) have relapsed within 6 months after the end of
adjuvant chemotherapy with 5-fluorouracil-based regime ii) have progressive disease despite 5-
269
fluorouracil chemotherapy for advanced disease iii) good performance status (WHO of 2 or less). The
treatment must be given in a tertiary oncology centre or have clearance in writing by an oncologist
Dosage :
85 mg/m2 IV repeated every 2 weeks
Precautions:
Presence or history of peripheral neuropathy, pre-existing renal or hepatic impairment, significant
bone marrow suppression may cause pulmonary fibrosis, avoid extravasation
Adverse Reaction:
Anaphylactic, anaemia, dyspnoea, febrile neutropenia, thrombocytopenia, fatigue, fever, nausea,
diarrhoea, colitis, increased liver enzymes, dyspnoea
Contraindications:
Hypersensitivity to oxaliplatin, pregnancy, lactation, bone marrow suppression, hepatic impairment
Interactions:
Drugs with potential neurological toxicity, docetaxel, paclitaxel, aminoglycosides
-----------------------------------------------------------------------------------------------------------------------------------Paclitaxel 30 mg/5 ml Injection
A*
Trade Name : Taxol / Anzatax
Indication :
i) Treatment of recurrent breast cancer, after failure of anthracycline-based chemotherapy ii)
Primary adjuvant therapy in advanced ovarian cancer in combination with cisplatin iii) Treatment of
locally advanced or metastatic non-small cell lung cancer (NSCLC) in chemonaive patients in
combination with platinum compounds
Dosage :
i) 175 mg/m2 IV over 3 hours every 3 weeks ii) 175 mg/m2 IV over 3 hour followed by cisplatin 75
mg/m2 in every 3 weeks or 135 mg/m2 IV over 24 hours followed by cisplatin 75 mg/m2 every 3
weeks iii) 135 mg/m2 IV over 24 hours followed by cisplatin 75 mg/m2 every 3 weeks
Precautions:
Severe neutropenia, severe hepatic impairment. Caution in patients with ischaemic heart disease,
myocardial infarction and conduction defects. Taxane to be given first when used in combination
with platinum analogue to avoid myelosuppression. Increased risk of infection by live vaccines
Adverse Reaction:
Alopecia, myelosuppression, severe neutropenia, peripheral neuropathy, arrhythmias, hypotension,
hypersensitivity reactions, arthralgia, myalgia
Contraindications:
History of hypersensitivity reaction to paclitaxel or polyoxyethylated castor oil (Cremophor EL) or
any component of preparation. Pregnancy, lactation
Interactions:
Doxorubicin, live vaccines, phenytoin, ketoconazole, St John's Wort
-------------------------------------------------------------------------------------------------------------------------------------Vinblastine Sulphate 10 mg Injection
A
Trade Name : Velbe
Indication :
Hodgkin's disease, choriocarcinoma resistant to other chemotherapeutic agents, non-small cell lung
cancer, Langerhans cell histiocytosis
Dosage :
ADULT: Lung cancer - 6 mg/m2 (maximum 10 mg) on Day 1. Hodgkin's disease- refer to protocol.
CHILD: Usual weekly dose: 6 mg/m2 weekly or 3 weekly depending on protocol
270
Precautions:
Intrathecal administration can be fatal. Should not be injected into an extremity with impaired
circulation. Patients carefully monitored for infection until white cell count has return to normal
levels if leukopenia with less than 2000 white blood cells per mm3 occurs following dose
Adverse Reaction:
Myelosuppression, nausea, vomiting, anorexia, generalized fatigue, constipation, alopecia,
dermatitis, vesicant, neurotoxicity, syndrome of inappropriate secretion of anti-diuretic hormone
Contraindications:
Hypersensitivity to vinblastine. Pregnancy, lactation. Leukopenia, presence of bacterial infection
Interactions:
Mitomycin C, phenytoin. Drugs which inhibit cytochrome P450 enzymes, voriconazole, itraconazole
-------------------------------------------------------------------------------------------------------------------------------------Vincristine Sulphate 1 mg Injection
A
Trade Name : Oncovin
Indication :
i) Solid tumours ii) Gestational trophoblastic disease iii) Non-Hodgkin's lymphoma iv) Multiple
myeloma v) Acute lymphoblastic leukemia
Dosage :
i) ADULT: 1.4 mg/m2 weekly (maximum 2 mg weekly) ii) Refer to protocol iii) 1.4 mg/m2 weekly
(maximum 2 mg weekly) iv) 0.4 mg/m2 IV continuous infusion on days 1 - 4 v) Refer to protocol.
CHILD: 1 mg/m2 to 2 mg/m2 weekly according to protocol (0.05 mg/kg for infants less than 10kg)
Precautions:
Pre-existing neuropathy or neuromuscular disease. Dose adjustment needed if impaired liver
function, elderly patients. Avoid extravasation
Adverse Reaction:
Sensorimotor neuropathy, autonomic neuropathy (severe constipation, ileus, urinary retention and
incontinence), cranial nerve dysfunction (hoarseness, diplopia, facial weakness), myelosuppression,
alopecia. Vesicant, rash, abdominal pain, SIADH, hypersensitivity, pain in jaws, bone, limb or parotid
gland, depression, confusion, nausea, vomiting, diarrhoea, myelosupression usually mild
Contraindications:
Hypersensitivity to vincristine. Pregnancy, lactation, Charcot-Marie-Tooth syndrome. Fatal if given
intrathecally. NOT FOR INTRATHECAL USE
Interactions:
If used together with L-asparaginase, L-asparaginase should be given 12-24 hours after vincristine
injection. Digoxin, paclitaxel, cisplatin, methotrexate, nifedipine, etoposide, isoniazid, melphalan,
metronidazole, verapamil, phenytoin
------------------------------------------------------------------------------------------------------------------------------------Anastrozole 1 mg Tablet
A*
Trade Name : Arimidex
Indication :
Treatment of hormone responsive metastatic or locally advanced breast cancer after failure of
tamoxifen
Dosage :
1 mg daily
Precautions:
Hyperlipidemia, moderate to severe hepatic impairment, severe impairment of renal function
(creatinine clearance less than 20 mL/min). Lowers circulating oestrogen levels which may cause a
reduction in bone mineral density
271
Adverse Reaction:
Hot flashes, asthenia, peripheral oedema, vaginal bleeding, deep vein thrombosis, arthralgia,
backpain, cough, dypsnea, headache, nausea, rash, hypercholesterolaemia
Contraindications:
Hypersensitivity to anastrazole, pregnancy. Not indicated for premenopausal women
Interactions:
Oestrogens, tamoxifen
----------------------------------------------------------------------------------------------------------------------------------Letrozole 2.5 mg Tablet
A*
Trade Name : Femara
Indication :
i) Treatment of hormone responsive metastatic or locally advance breast cancer after failure of
tamoxifen ii) Adjunct for node positive postmenopausal women with early breast cancer (positive or
unknown oestrogen or positive progesterone receptor status / receptor status) who have received 5
years of adjuvant tamoxifen therapy
Dosage :
2.5 mg once daily
Precautions:
Impaired liver function. Only to be used in postmenopausal women. Cirrhosis and severe hepatic
dysfunction, risk of drug toxicity pregnancy, potential for maternal and fetal malformations
Adverse Reaction:
Headache, nausea, fatigue, arthralgia, musculoskeletal pain, hot flushes, facture of bone, heart
failure, myocardial infarction
Contraindications:
Hypersensitivity to letrozole, pregnancy, lactation
Interactions:
Inhibitors of the cytochrome P450 enzymes, tamoxifen
-------------------------------------------------------------------------------------------------------------------------------------Tamoxifen Citrate 20 mg Tablet
A
Trade Name : Nolvadex
Indication :
Breast cancer
Dosage :
20-40 mg daily
Precautions:
Caution in patients with leukopenia, thrombocytopenia, retinopathy or with family/past history of
hypercoagulable states or thromboembolic disease. Pelvic examination should be carried out for
patients on long term use of tamoxifen
Adverse Reaction:
Menopausal symptoms, fluid retention, peripheral oedema, nausea, vomiting, myelosuppression,
tumour flare, endometrial hyperplasia, polyps and small risk of endometrial cancer, visual
disturbance including corneal changes, cataracts and retinopathy
Contraindications:
Hypersensitivity to Tamoxifen. Pregnancy and lactation, pulmonary embolus history, history of deep
vein thrombosis
272
Interactions:
Warfarin, allopurinol, ciclosporin, bromocriptine, rifampicin, clopidogrel, cyclophosphamide,
fluorouracil, methotrexate, mitomycin, concurrent use with letrozole may result in reduced letrozole
serum concentrations, aminoglutethimide may decrease tamoxifen plasma concentrations
-------------------------------------------------------------------------------------------------------------------------------------Filgrastim (G-CSF) 30 MU/ml Injection
A*
Trade Name : Neupogen
Indication :
i) Reduction in the duration of neutropenia and incidence of febrile neutropenia in cytotoxic
chemotherapy for malignancy except chronic myeloid leukemia and myelodysplastic syndrome ii)
Haemopoeitic stem cell transplantation (HSCT)/stem cell harvesting
Dosage :
i) Adult: SC or IV 5 mcg/kg/day. Initiation: 24 - 72 hours after chemotherapy. Duration: Until a
clinically adequate neutrophil recovery is achieved (absolute neutrophil count of at least 1 x 109/L
on 2 consecutive days) ii) Refer to protocol
Precautions:
Secondary acute myeloid leukemia. Perform regular white blood cell, platelet and hematocrit count
throughout therapy. Monitor ANC and spleen size. Bone marrow infiltrating infections or
malignancy. Sickle cell disease. Pregnancy and lactation
Adverse Reaction:
Chest pain, fever, hypersensitivity reaction, alopecia. Bone pain, flu-like symptoms, nausea and
vomiting, adult respiratory distress syndrome, sickle cell crisis, hepatomegaly, splenic enlargement,
transient hypotension, epistaxis urinary abnormalities (dysuria, proteinuria, hematuria),
exacerbation of rheumatoid arthritis, thrombocytopenia, anemia raised uric acid
Contraindications:
Hypersensitivity to filgrastim, severe congenital neutropenia (Kostmann's syndrome) with abnormal
cytogenetics
Interactions:
Vincristine, topotecan, lithium
-------------------------------------------------------------------------------------------------------------------------------------Imatinib Mesylate 100 mg Tablet
A*
Imatinib Mesylate 400 mg Tablet
A*
Trade Name : Glivec
Indication :
i) ADULT and CHILD: Philadelphia positive (Ph+) chronic myeloid leukaemia in chronic phase and in
early acceleration after failure of interferon therapy ii) Treatment of patients with unresectable and
or metastatic, malignant gastrointestinal stromal tumours (GIST) who are positive for CD117/c-kit
Dosage :
i) ADULT: Chronic phase chronic myeloid leukemia: 400 mg once daily. Accelerated phase or blast
crisis chronic myeloid leukemia: 600 mg once daily. CHILD more than 2 years, chronic myeloid
leukemia: 340 mg/m2 daily. Max: 60 mg/day ii) Unresectable and or metastatic, malignant
gastrointestinal stromal tumours GIST: 400 mg/day
Precautions:
Hepatic or severe renal impairment. History of cardiac disease. Severe fluid retention may occur. It is
recommended that patients be weighed regularly. Regular monitoring of complete blood counts and
liver function tests. Children less than 3 year. Pregnancy, lactation (avoid)
Adverse Reaction:
Myelosuppression, gastrointestinal disturbances, eczema, rash, myalgia, arthralgia, fluid retention,
pneumonia, cardiac failure and hepatic failure, gynaecomastia (due to reduced testosterone),
vomiting, nausea
273
Contraindications:
Hypersensitivity to imatinib or any component of the product. Avoid pregnancy and lactation
Interactions:
Alfuzosin, aprepitant, carbamazepine, dexamethasone, ketoconazole, levothyroxine, phenobarbital,
phenytoin, rifampin, simvastatin, St John's Wort, warfarin, ciclosporin and paracetamol
----------------------------------------------------------------------------------------------------------------------------------Leucovorin Calcium (Calcium Folinate) 50 mg Injection
A
Trade Name : Leucovorin Calcium
Indication :
i) Biochemical modulator for 5-Fluorouracil in the treatment of colorectal cancer ii) As rescue for
high dose methotrexate iii) Gestational trophoblastic disease
Dosage :
i) 20 mg/m2 daily for 5 days before 5-Fluorouracil or 200 mg/m2 IV infusion over 2 hours prior to 5Fluorouracil on Day 1 and Day 2 or 500 mg/m2 IV Day 1 weekly (refer to specific protocol) ii) Starting
24 - 42 hours of methotrexate administration, doses usually 15 - 30 mg/m2 every 6 hours for 8 to 12
doses depending on protocol and serum methotrexate levels iii) 6 - 12 mg exactly 30 hours after
each dose of methotrexate. In EMA-CO regime for high risk gestational trophoblastic disease, use 30
mg IM
Precautions:
Pregnancy, lactation, seizure disorder
Adverse Reaction:
Anaphylatoid reactions, urticaria, nausea, vomiting
Contraindications:
Hypersensitivity to leucovorin, pernicious anaemia or megaloblastic anaemia where vitamin B12 is
deficient
Interactions:
Phenobarbitone, phenytoin
-------------------------------------------------------------------------------------------------------------------------------------Peginterferon Alpha-2a 180 mcg Prefilled Syringe
A*
Trade Name : Pegasys
Indication :
i) Chronic hepatitis C usually in combination with ribavirin (Important to establish hepatitis C virus
(HCV) genotype and viral load where combination treatment is advocated) ii) For the treatment of
both HbeAg-positive and HbeAg-negative chronic hepatitis B with compensated liver disease and
evidence of viral replication who are not responding or tolerating oral antiviral therapy (Initiated by
Hepatologist and Gasteroenterologist only)
Dosage :
i) 180 mcg weekly with ribavirin 800 mg daily for 24 weeks in patients in genotype 2 and 3 and 180
mcg weekly with ribavirin (1000 - 1200 mg) for 48 weeks for those with genotype 1 and 4. 135 mg
dose may be used for patients who cannot tolerate the 180 mcg dose ii) 180 mcg subcutaneously
once a week for 48 weeks
Precautions:
Chronic liver disease, cardiovascular disease, history of autoimmune disease, diabetes mellitus,
hypothyroidism or hyperthyroidism, renal impairment, pregnancy, breast feeding, geriatric patient,
monitor CBC regularly. Baseline neutrophil counts less than 1500 cells/mm3, baseline platelet counts
less than 90,000 cells/mm3, baseline Hb less than 12 g/dL. Combination with myelosuppressive
agents. Autoimmune disorders, psoriasis, hypoglycemia, hyperglycemia, history of depression,
ophthalmic, cardiac or pulmonary disorders. Discontinue use in patients who develop evidence of
274
hepatic decompensation. Perform standard haematological and biochemical tests before and
periodically during therapy. May impair ability to drive or operate machinery
Adverse Reaction:
Headache, alopecia, dermatitis, nausea, vomiting, abdominal pain, neutropenia, anaemia, dyspnoea,
myalgia, fatigue, rigors, fever, depression, arthralgia, gastrointestinal disturbances, irritability, flulike symptoms, insomnia, asthenia, pharyngitis, weight loss, anorexia, dizziness, granulocytopenia,
thrombocytopenia, injection site and acute hypersensitivity reactions
Contraindications:
Hypersensitivity, autoimmune hepatitis, decompensated cirrhosis, severe psychiatric disorder,
pregnancy and lactation. Neonate and infant three years and below
Interactions:
ACEI, fluorouracil, melphalan, prednisolone, theophylline, warfarin, zidovudine, didanosine
-----------------------------------------------------------------------------------------------------------------------------------Rituximab 500 mg/50 ml Injection
A*
Trade Name : Mabthera
Indication :
i) Treatment of patients with relapsed or chemo-resistant low grade or follicular B-cell NonHodgkin's lymphoma ii) Adjunctive therapy with combination chemoagents for aggressive NonHodgkin Lymphoma iii) Severe active rheumatoid arthritis with inadequate response or intolerance
to other disease-modifying anti-rheumatic drugs (DMARDs) including one or more tumour necrosis
factor (TNF) inhibitor therapies
Dosage :
i) 375 mg/m2 body surface area administered as an IV infusion through a dedicated line once weekly
for 4 weeks ii) Combination with CHOP as 375 mg/m2 BSA once every 3 to 4 weeks
Precautions:
Hypersensitivity reaction may be severe, caution in patient receiving cardiotoxic chemotherapy,
history of cardiovascular disease and pregnancy. Monitor for tumour lysis syndrome. Use with
caution in heart disease and monitor for infusion-related events. Medication for treatment of
hypersensitivity must be available for immediate use during administration
Adverse Reaction:
Angina, cardiac arrythmias, lymphopenia, fever, chills, rigor, angioedema, nausea, rash, headache,
dizziness, renal toxicity, hypotension, bronchospasm, mucocutaneous reactions, arrhythmias, chest
pain, cough, rhinitis, dyspnoea
Contraindications:
Hypersensitivity or anaphylactic reactions to murine proteins or any component of the formulation,
breast feeding
Interactions:
Cisplatin, live vaccines, rotavirus vaccines
--------------------------------------------------------------------------------------------------------------------------------------
275
16. NUTRITION AND BLOOD DISORDER
Fluids and electrolytes
Intravenous nutrition
Minerals
Vitamins
Miscellaneous Nutrition and blood disorder
276
Continuous Ambulatory Peritoneal Dialysis Solution containing 1.5% Dextrose
B
B
B
Indication :
For chronic renal diseases requiring dialysis and acute therapy-resistance renal
failure eg. prior to transfer to a dialysis centre
Dosage :
Dose depending on clinical cases
Precautions:
Abdominal sepsis, previous abdominal surgery or severe inflammatory bowel disease. Dialysis
solutions should be warmed to body temperature with dry heat because wet heat carries a risk of
microbial contamination
Adverse Reactions:
Peritonitis, hernias, hyperglycaemia, protein malnutrition and catheter complications. Long-term
peritoneal dialysis results in progressive structural changes to the peritoneal membrane ultimately
resulting in dialysis failure
Contraindications:
Not known
Interactions:
Drug with low molecular weight, high water solubility, low volume of distribution, low protein
binding and high renal clearance are most extensively removed by dialysis e.g. aminoglycosides.
Dialysis-induced changes in fluids and electrolytes
-------------------------------------------------------------------------------------------------------------------------------------Dextrose 50% Injection
B
Indication :
For parenteral replenishment of fluid and minimal carbohydrate calories as required
by the clinical condition of the patient
Dosage :
According to the needs of the patient
Precautions:
Diabetes mellitus or carbohydrate intolerance and hyperglycaemia may accentuate neurologic
damage for an ischaemic insult. Patients at risk for cerebral ischaemia, acute stroke, impending
cardiac arrest or severe hypotension unless hypoglycaemia is suggested or until glucose is
determined
Adverse Reactions:
Thrombophlebitis, rebound hypoglycaemia, hypokalaemia, pulmonary embolism, right atrial
thrombosis, extravasation
Contraindications:
Do not use concentrated solutions of dextrose in patients with anuria, diabetic coma,
hyperglycaemia, intracranial or intraspinal haemorrhage, delirium tremens in dehydrated patients
and glucose-galactose malabsorption syndrome. Do not administered simultaneously with blood
through the same infusion set because of the possibility that pseudoagglutination of red cells may
occur
Interactions:
Not known
--------------------------------------------------------------------------------------------------------------------------------------
277
Human Albumin Injection
B
Indication :
i) Acute hypovolemic shock ii) Hypoproteinaemia iii) Neonatal hyperbilirubinaemia
Dosage :
i) ADULT 25 g. CHILD 0.6 g/kg body weight ii) Maximum daily dose is 2g iii) 1 g/kg
before exchange transfusion. Dose is given at rate of 1 ml of 25% solution per
minute
Precautions:
Hepatic or renal failure due to protein load; rapid infusion of albumin solutions may cause vascular
overload
Adverse Reactions:
CHF precipitation, oedema, hypertension, hypervolemia, hypotension, tachycardia,chills, fever,
headache, pruritus, rash, urticaria, nausea, vomiting, bronchospasm, pulmonary oedema,
anaphylaxis
Contraindications:
Hypersensitivity to albumin; patients at risk for acute circulatory overload (cardiac failure,
pulmonary edema, severe anemia)
Interactions:
ACE inhibitors: May have increased risk of atypical reactions; withhold ACEIs for at least 24 hours
prior to plasma exchanges using large volumes of albumin
-------------------------------------------------------------------------------------------------------------------------------------Oral Rehydration Salt
C
Indication :
Replacement of fluid and electrolytes loss in diarrhoea
Dosage :
ADULT: 200 - 400 ml ( 1 - 2 sachets ) for every loose motion. CHILD: 200 ml (1 sachet)
for every loose motion. In severe dehydration 100 ml/kg for 3 - 4 hours. INFANT: 1 1.5 times their usual feed volume (50 ml per stool for small infant)
Precautions:
Cardiac failure, hypertension, impaired renal function, peripheral and pulmonary oedema, toxaemia
in pregnancy
Adverse Reactions:
Hypernatremia, nausea and vomiting
Contraindications:
Patients with renal failure or hyperkalaemia
Interactions:
Potassium sparing diuretics
-------------------------------------------------------------------------------------------------------------------------------------Potassium Chloride 1 g/10 ml Injection
B
Indication :
For the correction of severe hypokalaemia and when sufficient potassium cannot be
taken by mouth
Dosage :
By slow IV infusion depending on the deficit or the daily maintenance requirements.
1 g diluted in 500 ml normal saline or glucose and given slowly over 2 - 3 hours
Precautions:
Severe renal impairment, cardiac disease, hyperkalaemia. Initial potassium replacement therapy,
should not involve glucose infusions, because glucose may cause a further decrease in the plasma
potassium concentration
278
Adverse Reactions:
Nausea, vomiting, gastrointestinal ulceration, electrocardiogram changes
Contraindications:
Acute dehydration, heat cramps, hyperkalaemia, renal failure and in conditions in which potassium
retention is present or where additives of potassium and chloride could be clinically detrimental
Interactions:
Potassium sparing diuretics, salt substitutes, ACE inhibitors, angiotensin-II receptor antagonists,
methenamine, ciclosporin, tacrolimus
-------------------------------------------------------------------------------------------------------------------------------------Potassium Chloride 1 g/15 ml Mixture
C
Indication :
Potassium depletion
Dosage :
1 g once or twice daily until serum potassium is restored
Precautions:
Adverse Reactions:
Nausea, vomiting, gastrointestinal ulceration, ECG changes
Contraindications:
Interactions:
-------------------------------------------------------------------------------------------------------------------------------------Potassium Chloride 600 mg SR Tablet
B
Trade Name : Slow-K
Indication :
For the treatment and specific prevention of hypokalaemia
Dosage :
ADULT: 2 - 3 tablets daily. Severe deficiency: 9 - 12 tablets daily or according to the
needs of the patient
Precautions:
Adverse Reactions:
Nausea, vomiting, gastrointestinal ulceration, ECG changes
Contraindications:
Interactions:
--------------------------------------------------------------------------------------------------------------------------------------
279
Ringer's Solution Injection
B
(contained sodium chloride, potassium chloride and calcium chloride)
Indication :
As a source of electrolytes and water for hydration/replenishing of chloride
Dosage :
Precautions:
Congestive heart failure, circulatory insufficiency, kidney dysfunction, hypoproteinaemia, cirrhotic
disease, hypervolaemia, urinary tract obstruction and patients receiving drugs that cause sodium
retention, eg corticosteroids or corticotropin
Adverse Reactions:
Nausea, vomiting, diarrhoea, abdominal cramps, congestive heart failure, hypertension, tachycardia,
fluid accumulation, irritability, restlessness, weakness, headache, dizziness, obtundation, convulsions
Contraindications:
Hypernatraemia or fluid retention, hypersensitivity, sodium chloride solutions with preservatives in
newborns for injection or flushing of intravenous lines or mixing medications, hypertonic saline
abortifacient in pregnancies less than 15 weeks
Interactions:
Not known
-------------------------------------------------------------------------------------------------------------------------------------Sodium Bicarbonate 8.4% (1 mmol/ml) Injection
B
Indication :
For acceleration of excretion in drug intoxication (where excretion of the drug into
the urine is accelerated by elevated urine pH) and for acidosis
Dosage :
According to the needs of the patient. In severe shock due to cardiac arrest: 50 ml
by IV
Precautions:
Renal impairment, peptic ulcer, congestive heart failure, oedema, cirrhosis
Adverse Reactions:
Gastrointestinal cramps, flatulence, alkalosis
Contraindications:
Alkalosis, hypernatraemia, hypocalcaemia, hypochloraemia, severe pulmonary oedema, unknown
abdominal pain
Interactions:
Amphetamine, aspirin, chlorpropamide, dextroamphetamine, ephedrine, itraconazole,
ketoconazole, lithium, pseudoephedrine, flecainide
-------------------------------------------------------------------------------------------------------------------------------------Sodium Chloride 0.18% with Dextrose 10% Injection
Sodium Chloride 0.18% with Dextrose 4.23% Injection
Sodium Chloride 0.45% with Dextrose 10% Injection
Indication :
For replenishing fluid and energy and for restoring or maintaining the concentration
of sodium and chloride ions
Dosage :
280
B
B
B
B
C
Precautions:
Restrict intake in impaired renal function, cardiac failure, hypertension, peripheral and pulmonary
oedema, toxaemia of pregnancy. Diabetes mellitus or carbohydrate intolerance and hyperglycaemia
may accentuate neurologic damage for an ischaemic insult. Patients at risk for cerebral ischaemia,
acute stroke, impending cardiac arrest or severe hypotension unless hypoglycaemia is suggested or
until glucose is determined
Adverse Reactions:
Thrombophlebitis, rebound hypoglycaemia, hypokalaemia, sodium accumulation and oedema
Contraindications:
Hypernatraemia or fluid retention, hypersensitivity (ophthalmic products), sodium chloride solutions
with preservatives in newborns, for injection or flushing of intravenous lines or mixing medications,
hypertonic saline abortifacient in pregnancies less than 15 weeks
Interactions:
Not known
-------------------------------------------------------------------------------------------------------------------------------------Sodium Chloride 0.45% Injection
B
Indication :
For replenishing fluid and for restoring / maintaining the concentration of sodium
and chloride ions
Dosage :
100 - 1000 ml by IV or according to the needs of the patient
Precautions:
oedema, toxaemia of pregnancy
Adverse Reactions:
fluid accumulation, irritability, restlessness, weakness, headache, dizziness, obtundation and
convulsions
Contraindications:
Interactions:
Not known
-------------------------------------------------------------------------------------------------------------------------------------Sodium Chloride 20% Injection
B
Indication :
Addition of sodium electrolyte in parenteral nutrition bags especially in paediatrics
or neonates with restricted fluid allowance
Dosage :
Precautions:
Adverse Reactions:
fluid accumulation, irritability, restlessness, weakness, headache, dizziness, obtundation, convulsions
281
Contraindications:
Interactions:
During therapy with corticosteroids or ACTH there may be an increased retention of sodium and
chloride. Decreased levels of lithium
-------------------------------------------------------------------------------------------------------------------------------------Sodium Chloride 3% Injection
B
Indication :
Acute dilutional hyponatraemia
Dosage :
Precautions:
Adverse Reactions:
fluid accumulation, irritability, restlessness, weakness, headache, dizziness, obtundation, convulsion
Contraindications:
Interactions:
During therapy with corticosteroids or ACTH there may be an increased retention of sodium and
chloride. Decreased levels of lithium
-------------------------------------------------------------------------------------------------------------------------------------Sodium Lactate Compound (Hartmanns Solution/Ringer-lactate]
C
Indication :
Replacement of extracellular losses of fluid and electrolytes, as an alkaliniser agent
Dosage :
100-1000 ml by IV or according to the needs of the patient
Precautions:
Metabolic or respiratory alkalosis, congestive heart failure, other sodium-retaining conditions,
concurrent corticosteroids, conditions impairing lactate utilisation (severe hepatic insufficiency,
shock, beriberi, hypoxia) and during prolonged therapy
Adverse Reactions:
Anxiety, panic attacks, apprehension or fear, paraesthesias, tremors, dizziness, metabolic alkalosis,
hypokalaemia
Contraindications:
Lactic acidosis, severe acidosis, hypernatraemia and conditions where sodium administration would
be detrimental
Interactions:
Not known
--------------------------------------------------------------------------------------------------------------------------------------
282
Water for Injection
C
Indication :
As a diluent and vehicle for the administration of medications
Dosage :
Precautions:
The stability of any medicament prepared should be checked
Adverse Reactions:
Not known
Contraindications:
Not known
Interactions:
Not known
-------------------------------------------------------------------------------------------------------------------------------------Amino Acids Injection
A
Trade Name : Vamin
Indication :
Source of amino acids in patients needing IV nutrition
Dosage :
Dose to be individualised. ADULT usually 500-2000 ml by IV. ADULT usual requirement for amino
acid: 1-2 g/kg/day
Precautions:
Liver disease, renal impairment
Adverse Reactions:
Gastrointestinal upset, flushing, sweating, thrombophlebitis
Contraindications:
Patients with inborn errors of amino acid metabolism, irreversible liver damage, severe uraemia
without dialysis
Interactions:
Not known
-------------------------------------------------------------------------------------------------------------------------------------Fat Emulsion 20% for IV Infusion
A
Trade Name : Intralipid
Indication :
Source of lipid in patients needing IV nutrition
Dosage :
Dose to be individualised. ADULT usual lipid requirement 2-3 g/kg/day. INFANT 0.5-1 g/kg/day
Precautions:
Renal insufficiency, uncompensated diabetes, certain forms of liver insufficiency (monitor liver
function), metabolic disorders and sepsis
Adverse Reactions:
Fever, hypertriglyceridaemia, shivering, chills, nausea and vomiting
Contraindications:
Pathological hyperlipidaemia, severe liver damage and acute shock
Interactions:
Not known
--------------------------------------------------------------------------------------------------------------------------------------
283
Trace Elements and Electrolytes (Adult) Solution
A*
Trade Name : Addamel Solution
Indication :
Only to be used to cover daily loss of electrolyte and trace elements for patient on parenteral
nutrition
Dosage :
10 ml added to 500-1000 ml solution, given by IV infusion
Precautions:
Impaired biliary or renal function, liver dysfunction (especially cholestasis. Manganese blood levels
and liver function should be monitored regularly (monthly). Should be stopped if manganese levels
rise into the potentially toxic range
Adverse Reactions:
Not known
Contraindications:
Total biliary obstruction. Should not be given undiluted
Interactions:
Not known
-------------------------------------------------------------------------------------------------------------------------------------Calcium Carbonate 500 mg Tablet
A/KK
Indication :
To be used only for elemental calcium supplementation and phosphate binding activity in patients
with chronic renal failure
Dosage :
Initial 2.5 g daily and increased up to 17 g daily
Precautions:
Renal impairment, hypercalcaemia-associated disease eg, other malignancies, sarcoidosis, elderly
Adverse Reactions:
Gastrointestinal irritation, constipation, flatulence, gastric hypersecretion and acid rebound,
hypercalcaemia, alkalosis and renal dysfunction
Contraindications:
Patients with calcium renal calculi or history of renal calculi, hypercalcaemia, hypophosphataemia
Interactions:
Co-administration with thiazide diuretics or vitamin D may lead to milk-alkali syndrome and
hypercalcaemia. Decreased absorption with corticosteroids. Decreases absorption of tetracyclines,
atenolol, iron, quinolones, alendronate, natrium fluoride, zinc and calcium-channel blockers.
Enhances cardiac effects of digitalis glycosides and may precipitate digitalis intoxication
-------------------------------------------------------------------------------------------------------------------------------------Calcium Gluconate 10% Injection
B
Indication :
i) Acute hypocalcaemia ii) Hypocalcaemic tetany iii) Cardiac resuscitation
Dosage :
i) 1-2 g (2.25-4.5 mmol). CHILD 50 mg/kg ii) ADULT 1g (2.2 mmol) by slow IV injection followed by
continuous infusion of 4 g (8.8 mmol) daily iii) IV or intracardiac injection, 10 ml
Precautions:
Extravasation during IV injection. Renal impairment, cardiac disease or sarcoidosis
Adverse Reactions:
Sloughing or necrosis of the skin, soft tissue calcification. Hypercalcaemia (excessive use)
284
Contraindications:
Hypercalcaemia, hypercalciurea, severe renal failure, patients treated with digitalis
Interactions:
Increased inotropic and toxic effects when used with cardiac glycosides. Complex formation with
tetracyclines
-------------------------------------------------------------------------------------------------------------------------------------Calcium Lactate 300 mg Tablet
C
Indication :
For prophylaxis of calcium deficiency and treatment of chronic hypocalcaemia
Dosage :
ADULT 1-5 g daily in divided doses
Precautions:
Calcium enhances the effect of cardiac glycosides on the heart and may precipitate arrhythmias. In
large doses, monitor serum calcium concentration and kidney function weekly, renal impairment,
history of renal stones
Adverse Reactions:
Mild gastrointestinal disturbances, bradycardia, arrhythmias
Contraindications:
Ventricular fibrillation during cardiac resuscitation, hypercalcaemia, hypercalciuria, severe renal
failure
Interactions:
Allopurinol, aspirin, chlorothiazide, ciprofloxacin, digoxin, doxycycline, hydrochlorothiazide,
itraconazole, ketoconazole, levothyroxine, metolazone, minocycline, norfloxacin, ofloxacin,
oxytetracycline, pefloxacin, tetracycline, ticlopidine, verapamil, zalcitabine
-------------------------------------------------------------------------------------------------------------------------------------Lanthanum Carbonate 1000mg Chewable Tablet
A*
Trade Name : Fosrenol
Indication :
Phosphate binding agent for the treatment of hyperphosphataemia in dialysis patients with
sustained hypercalcaemia of more than three months and secondary hyperparathyroidism
Dosage :
Initial: 750 to 1500 mg/day in divided doses with meals, then titrate in increments of 750 mg/day at
intervals of 2 to 3 weeks. Maintenance: 1500-3000 mg/day in divided doses. Max: 3750 g/day
Precautions:
Caution when used in patients with acute peptic ulcer, ulcerative colitis, Crohn's disease or bowel
obstruction. Tablets should be thoroughly chewed before swallowing. Pregnancy and lactation
Adverse Reactions:
Gastrointestinal disturbances, including nausea, vomiting, constipation, diarrhoea, dyspepsia and
abdominal pain
Contraindications:
Specific contraindications have not been determined
Interactions:
Possibly reduces absorption of ketoconazole, chloroquine, hydroxychloroquine or other compounds
that are known to interact with antacids (give at least 2 hours apart)
--------------------------------------------------------------------------------------------------------------------------------------
285
Magnesium Sulphate 50% Injection
C
Indication :
Treatment and prophylaxis of hypomagnesaemia. Prevention and treatment of life-threatening
seizures in the treatment of toxemias of pregnancy (pre-eclampsia and eclampsia)
Dosage :
ADULT 5-10 ml by IM. CHILD 20-40 mg/kg body weight as a 20% solution by IM. Hypomagnesaemia:
0.5-1 mmol/kg body weight up to 160 mmol magnesium over to 5 days. Eclampsia: IV 4 g over up to
20 minutes followed by IV infusion at rate of 1 g every hour. Recurrent seizures may require an
additional IV bolus of 2-4 g (4 g if body weight over 70 kg)
Precautions:
Impaired renal function and those receiving digitalis glycosides. Pregnancy and lactation. Product
contains aluminum therefore increasing the risk of aluminum toxicity
Adverse Reactions:
Hypotension, flushing, sweating, depression of reflexes, flaccid paralysis, hypothermia, circulatory
collapse, depression of cardiac function, central nervous system depression, abnormal ECG, heart
block, hypotension, vasodilatation, blood coagulation disorder with prolonged bleeding time
Contraindications:
Heart block, myocardial damage
Interactions:
Additive central depressant effects with central nervous system depressants. Neuromuscular
blocking agents, cardiac glycosides, nifedipine
-------------------------------------------------------------------------------------------------------------------------------------Potassium Dihydrogen Phosphate Injection
A
Indication :
For treatment of hypophosphataemia or phosphate replacement in parenteral nutrition
Dosage :
Parenteral nutrition: 10 - 20 mmoles of phosphate daily
Precautions:
Renal insufficiency, cardiac disease, metabolic alkalosis
Adverse Reactions:
Diarrhoea, nausea, stomach pain, flatulence, vomiting, bradycardia, hyperkalaemia, weakness,
dyspnoea
Contraindications:
Renal insufficiency, renal failure, hyperphosphataemia, hypocalcaemia, hyperkalaemia,
hypernatraemia, Addison's disease
Interactions:
Aluminium and magnesium-containing antacids, sucralfate, potassium-sparing diuretics, salt
substitutes, ACE inhibitors, digitalis
-------------------------------------------------------------------------------------------------------------------------------------Alfacalcidol 0.25 mcg Capsule
A/KK
Alfacalcidol 1 mcg Capsule
A/KK
Trade Name : One-alpha
Indication :
Treatment of: i) Renal osteodystrophy in patients on haemodialysis ii) Hypoparathyroidism and
pseudohypoparathyroidism iii) Adjunct to the management of tertiary hyperparathyroidism iv)
Rickets and osteomalacia v) Osteoporosis
Dosage :
Initial dose ADULT and CHILD above 20kg body weight : 1 mcg daily; CHILD under 20kg body weight :
0.05 mcg/kg/day. Maintenance dose : 0.25 mcg to 2 mcg daily
286
Precautions:
Take care to ensure correct dose to infants, monitor plasma calcium and creatinine during dosage
titration
Adverse Reactions:
Hypercalcaemia, nausea, vomiting, polydipsia, polyuria
Contraindications:
Hypercalcaemia, metastatic calcification, vitamin D toxicity and hypersensitivity to calcitriol products
Interactions:
Antiepileptics, diuretics, barbiturates
-------------------------------------------------------------------------------------------------------------------------------------Alfacalcidol 2 mcg/ml Drops
A*
Trade Name : One-Alpha
Indication :
Dosage :
NEONATES : 0.1 mcg/kg/day
Precautions:
titration
Adverse Reactions:
Contraindications:
Interactions:
-------------------------------------------------------------------------------------------------------------------------------------Alfacalcidol 2 mcg/ml Injection
A*
Trade Name : One-Alpha
Indication :
Dosage :
Initial dose : 1 mcg per haemodialysis. Maximum dose 6 mcg per haemodialysis and not more than
12 mcg per week
Precautions:
titration
Adverse Reactions:
Contraindications:
Interactions:
--------------------------------------------------------------------------------------------------------------------------------------
287
Ascorbic Acid 100 mg Tablet
C
Indication :
Vitamin C deficiency
Dosage :
ADULT: 100-250 mg once or twice daily CHILD: 100 mg three times daily for one week followed by
100mg daily until symptoms abate.
Precautions:
Use cautiously in patients with preexisting kidney stone disease, erythrocyte G6PD deficiency,
haemochromatosis, thalassaemia or sideroblastic anaemia and avoid rapid intravenous injections
Adverse Reactions:
In large doses, gastrointestinal disturbances, renal calcium oxalate calculi formation
Contraindications:
History of hyperoxaluria
Interactions:
Antacids, aspirin, contraceptives combination, cyanocobalamin, deferoxamine, gentamicin,
haloperidol, iron, levodopa, methotrexate, warfarin
-------------------------------------------------------------------------------------------------------------------------------------Calcitriol 0.25 mcg Capsule
A/KK
Trade Name : Rocaltrol
Indication :
Treatment of: i) Postmenopausal osteoporosis ii) Renal osteodystrophy in patients on haemodialysis
iii) Hypoparathyroidism and rickets iv) Secondary hyperparathyroidism in renal failure
Dosage :
i) 0.25 mcg 2 times daily ii) Initial dose 0.25 mcg. In patients with normal or only slightly reduced
serum calcium levels, doses of 0.25 mcg every other day is sufficient iii) 0.25 mcg/day given in the
morning iv) ADULT and CHILD 3 years and older : Initially 0.25 mcg/ml. CHILD less than 3 years : 10 to
15 ng/kg/day
Precautions:
Monitor serum calcium, phosphorus, magnesium and alkaline phosphatase, urinary calcium and
phosphorus. Patients on digitalis. Pregnancy and lactation. Take care to ensure correct dose to
infants, monitor plasma calcium and creatinine during dosage titration
Adverse Reactions:
Hypercalcaemia, nausea, vomiting, polydipsia, polyuria, weakness, headache, somnolence, dry
mouth, constipation, muscle pain, bone pain, metallic taste
Contraindications:
Hypercalcaemia, vitamin D toxicity, abnormal sensitivity to the effects of vitamin D, malabsorption
syndrome
Interactions:
Cytochrome P450 effect. Cholestyramine, thiazides diuretics, corticosteroids, magnesium-containing
antacids, digitalis
-------------------------------------------------------------------------------------------------------------------------------------Calcitriol 1 mcg/ml Injection
A*
Trade Name : Calcijex
Indication :
Management of hypocalcaemia and/or secondary hyperparathyroidism in patients undergoing
chronic renal dialysis
Dosage :
Initially dose, depending on severity, 1 mcg (0.02 mg/kg) to 2 mcg 3 times weekly, approximately
every other day
288
Precautions:
Monitor serum calcium, phosphorus, magnesium and alkaline phosphatase, urinary calcium and
phosphorus. Patients on digitalis. Pregnancy and lactation.Take care to ensure correct dose to
infants, monitor plasma calcium and creatinine during dosage titration
Adverse Reactions:
Hypercalcaemia, nausea, vomiting, polydipsia, polyuria, weakness, headache, somnolence, dry
mouth, constipation, muscle pain, bone pain, metallic taste
Contraindications:
Interactions:
Cytochrome P450 effect. Cholestyramine, thiazides diuretics, corticosteroids, magnesium-containing
antacids, digitalis
-------------------------------------------------------------------------------------------------------------------------------------Cyanocobalamin 1 mg Injection
B
Indication :
i) Prophylaxis of anaemia associated with Vitamin B12 deficiency ii) Uncomplicated pernicious
anaemia or Vitamin B12 malabsorption
Dosage :
i) Prophylaxis of anaemia: 250-1000 mcg IM every month ii) Uncomplicated pernicious anaemia or
Vitamin B12 malabsorption: Initial 100 mcg daily for 5-10 days followed by 100-200 mcg monthly
until complete remission is achieved. Maintenance: 100 mcg monthly. CHILD 30-50 mcg daily for 2 or
more weeks (to a total dose of 1-5mg). Maintenance: 100 mcg monthly to sustain remission
Precautions:
Hereditary optic atrophy, vitamin B12 therapy can mask folic acid deficiency, hypokalaemia and risk
of gastric cancer is higher in patients with pernicious anaemia
Adverse Reactions:
Diarrhoea, urticaria, pruritus, skin rash, hypokalaemia, polycythemia vera, volume overload
Contraindications:
Hypersensitivity to any component of cyanocobalamin or hydroxycobalamin formulations
Interactions:
Neomycin, aminosalicylic acid, histamine H2 receptor antagonists, colchicine, oral contraceptives,
chloramphenicol
-------------------------------------------------------------------------------------------------------------------------------------Multivitamin Injection
B
Trade Name : Parentrovite
Indication :
For prevention and treatment of vitamin deficiencies
Dosage :
Initially 2 - 4 pairs IV 4 - 8 hourly, reducing to 1 pair IV daily. For less serious cases, 1 pair IV 1 - 2
times daily or based on individual requirements
Precautions:
Severe renal or liver failure
Adverse Reactions:
Hypervitaminosis, high doses may induce paraesthesia and hypotension
Contraindications:
Hypersensitivity to product components
289
Interactions:
Pyridoxine will antagonise the therapeutic effect of levodopa (should not be administered
concurrently), vitamin B6 reduces the plasma levels of phenobarbitone and phenytoin, ascorbic acid
increases plasma level of ethinyloestradiol
-------------------------------------------------------------------------------------------------------------------------------------Multivitamin Syrup
C
Indication :
Dosage :
CHILD 5 ml daily or based on manufacturer
Precautions:
Adverse Reactions:
Hypervitaminosis
Contraindications:
Interactions:
Pyridoxine will antagonise the therapeutic effect of levodopa (should not be administered
concurrently), vitamin B6 reduces the plasma levels of phenobarbitone and phenytoin, ascorbic acid
increases plasma level of ethinyloestradiol
-------------------------------------------------------------------------------------------------------------------------------------Multivitamin Tablet
B
Indication :
Dosage :
1 - 2 tablets daily or based on individual requirements
Precautions:
Adverse Reactions:
Hypervitaminosis
Contraindications:
Interactions:
Not known
-------------------------------------------------------------------------------------------------------------------------------------Pyridoxine HCl 10 mg Tablet
B
Indication :
i) Pyridoxine-dependent convulsions in infancy ii) Sideroblastic anaemia iii) B6-deficient anaemia in
adult iv) Prophylaxis to peripheral neuritis in isoniazid therapy v) Nausea and vomiting of pregnancy
and irradiation sickness
Dosage :
i) INFANT 4 mg/kg daily for short periods ii) 100 - 400 mg daily in divided doses iii) ADULT 20 - 50 mg
up to 3 times daily iv) Prophylaxis 10 mg daily, therapeutic 50 mg 3 times daily v) 20 - 100 mg daily
Precautions:
Pregnancy, lactation, neonatal seizures, concurrent treatment with levodopa. Long term use in a
dose of 200 mg or more daily has been associated with neuropathy
290
Adverse Reactions:
Peripheral sensory neuropathy, hypotonia, respiratory difficulties, nausea and other gastrointestinal
complaints, photosensitivity, vesicular lesions and bullous lesions
Contraindications:
Hypersensitivity to pyridoxine or any component of preparation
Interactions:
Levodopa, penicillamine, selegiline, phenytoin
-------------------------------------------------------------------------------------------------------------------------------------Riboflavine 3 mg Tablet
C
Indication :
For prevention and treatment of riboflavine deficiency
Dosage :
CHILD: 2.5-10 mg/day in divided doses. ADULT: 5-30 mg/day in divided doses
Precautions:
Riboflavin deficiency often occurs in the presence of other vitamin B deficiencies. High content of
riboflavin and pyridoxine in some commercial infant formula
Adverse Reactions:
Urine discoloration
Contraindications:
Hypersensitivity to riboflavin products
Interactions:
Decreased absorption with probenecid
-------------------------------------------------------------------------------------------------------------------------------------Thiamine Mononitrate 10 mg Tablet
C
Indication :
i) For the prevention or treatment of Vitamin B1 deficiency syndromes including beri-beri and
peripheral neuritis associated with pellagra ii) Wernicke-Korsakoff Syndrome
Dosage :
i) Mild to chronic deficiency: 10-25 mg daily. Severe deficiency: 200- 300 mg daily ii) 500 mg every 8
hours for 2 days, followed by 100 mg 2 times daily until patient can take oral dose
Precautions:
Not known
Adverse Reactions:
Contact dermatitis, chronic pigmented purpura, skin rash, itching
Contraindications:
Hypersensitivity to thiamine or any component
Interactions:
Alkaline solutions, bicarbonates, carbonates, citrates, erythromycin lactobionate, iron salts,
methohexital, neutral solutions, alkaline barbiturate solutions (eg phenobarbital, thiopental)
-------------------------------------------------------------------------------------------------------------------------------------Thiamine HCl 100 mg/ml Injection
B
Indication :
i) For the prevention or treatment of Vitamin B1 deficiency syndromes including beri-beri and
peripheral neuritis associated with pellagra ii) Wernicke-Korsakoff Syndrome
Dosage :
i) Mild to chronic deficiency: 10-25 mg daily. Severe deficiency: 200- 300 mg daily ii) 500 mg every 8
hours for 2 days, followed by 100 mg 2 times daily until patient can take oral dose
291
Precautions:
Use with caution with parenteral route (especially IV) of administration
Adverse Reactions:
Pain on injection, contact dermatitis, chronic pigmented purpura
Contraindications:
Hypersensitivity to thiamine or any component
Interactions:
Alkaline solutions, bicarbonates, carbonates, citrates, erythromycin lactobionate, iron salts,
methohexital, neutral solutions, alkaline barbiturate solutions (eg phenobarbital, thiopental)
-------------------------------------------------------------------------------------------------------------------------------------Vitamin B Complex 10 ml Injection
B
Indication :
Prophylaxis and treatment of vitamin B deficiency
Dosage :
1-2 ml daily by IM
Precautions:
Not for treatment of pernicious anaemia or other megaloblastic anaemias where vitamin B12 is
deficient
Adverse Reactions:
Risk of anaphylactic shock. Allergy to cobalamins, megaloblastic anaemia of pregnancy
Contraindications:
Allergy to cobalamins, megaloblastic anaemia of pregnancy
Interactions:
Pyridoxine reduces the effect of levodopa
-------------------------------------------------------------------------------------------------------------------------------------Vitamin B Complex Tablet
C
Indication :
Prophylaxis and treatment of vitamin B deficiency
Dosage :
1-2 tablets daily
Precautions:
Not for treatment of pernicious anaemia or other megaloblastic anaemias where vitamin B12 is
deficient
Adverse Reactions:
Peripheral neuropathies (long term administration of large doses of pyridoxine)
Contraindications:
Allergy to cobalamins, megaloblastic anaemia of pregnancy
Interactions:
Pyridoxine reduces the effect of levodopa
-------------------------------------------------------------------------------------------------------------------------------------Vitamin B1, B6, B12 Injection
Trade Name : Neurobion
Indication :
For deficiency or raised requirement of Vitamin B1, B6, B12
Dosage :
Mild cases: 1 ampoule given by IM 2-3 times weekly. Severe cases: 1 ampoule daily
292
B
Precautions:
Photolysis. Repeated injection at the same site should be avoided. Care should be exercised when
administering to neonates, premature infants, infants and children. The course of nerves should be
avoided for the site of injection. If the patient complaints of pain or if blood reflux occurs when the
needle is stuck, withdraw it immediately and try at a different site
Adverse Reactions:
Pain and induration at site of injection, headache, sweating or hot sensation
Contraindications:
Not known
Interactions:
High vitamin B6 dose decreases action of Levodopa
-------------------------------------------------------------------------------------------------------------------------------------Vitamin B1, B6, B12 Tablet
B
Trade Name : Neurobion
Indication :
For deficiency or raised requirement of Vitamin B1, B6, B12
Dosage :
1 - 3 tablets 3 times daily swallowed unchewed
Precautions:
Discontinue medication if there is no response after taking orally for several months
Adverse Reactions:
Anorexia, nausea or diarrhoea, skin rash and hypersensitivity
Contraindications:
Patients treated with levodopa
Interactions:
High vitamin B6 dose decreases action of Levodopa
-------------------------------------------------------------------------------------------------------------------------------------Vitamin K1 1 mg/ml Injection
C
Trade Name : Konakion
Indication :
Vitamin K deficiency in neonates
Dosage :
1 mg given by IM or IV
Precautions:
IV or IM administration only when necessary (risk of anaphylaxis). Hypersensitivity reactions possible
even at first administration. The anticoagulant action of heparin not counteracted by
phytomenadione Vitamin K
Adverse Reactions:
Anaphylactic reactions during intravenous administration, dermatitis at injection site, haemolytic
anaemia
Contraindications:
Hypersensitivity to Vitamin K, menadione (K3) administration in glucose-6-phosphate
dehydrogenase deficiency
Interactions:
Decreases the effects of oral anticoagulants, fatty foods
--------------------------------------------------------------------------------------------------------------------------------------
293
Vitamin K1 10 mg/ml Injection
B
Trade Name : Konakion
Indication :
Haemorrhage associated with hypoprothrombinaemia caused by overdose of anticoagulants
Dosage :
0.5 - 20 mg by very slow IV at a rate not exceeding 1 mg per minute
Precautions:
IV or IM administration only when necessary (risk of anaphylaxis). Hypersensitivity reactions possible
even at first administration. The anticoagulant action of heparin not counteracted by
phytomenadione Vitamin K. Reduce dose in elderly, liver impairment
Adverse Reactions:
Anaphylactic reactions during intravenous administration, dermatitis at injection site, haemolytic
anaemia
Contraindications:
Hypersensitivity to Vitamin K, menadione (K3) administration in glucose-6-phosphate
dehydrogenase deficiency
Interactions:
Decreases the effects of oral anticoagulants, fatty foods
-------------------------------------------------------------------------------------------------------------------------------------Deferasirox 125 mg Dispersible Tablet
A*
Deferasirox 500 mg Dispersible Tablet
A*
Trade Name : Exjade
Indication :
Treatment of chronic iron overload due to blood transfusions (transfusional haemosiderosis) in adult
and pediatric patients aged 2 years and above
Dosage :
Initial 20 mg/kg/day. Starting dose can also be based on transfusion rate and existing iron burden.
Max is 30 mg/kg/day
Precautions:
Increased risk of potentially fatal acute renal failure, concomitant use of medicines that depress
renal function, elderly, haematologic disorders (including neutropenia, thrombocytopenia and
agranulocytosis), acute renal failure with advanced-stage disorders renal conditions
Adverse Reactions:
Rash, urticaria, abdominal pain, diarrhoea, nausea, vomiting, backache, headache, cough, bronchitis,
fever, influenza, cytopenia, drug-induced hepatitis, increased liver enzyme, anaphylaxis,
hypersensitivity disorder, arthralgia, cataract, retinal disorder, raised intraocular pressure, hearing
loss, infection of ear, fatigue, acute renal failure
Contraindications:
Hypersensitivity to deferasirox or to any component of the product
Interactions:
Aluminium containing antacids
-------------------------------------------------------------------------------------------------------------------------------------Deferiprone 500 mg Tablet
A*
Trade Name : Ferriprox
Indication :
Treatment of iron overload in patients with thalassemia major for whom desferrioxamine therapy is
contraindicated or inadequate. Add on therapy to desferrioxamine for thalassemia patients with
cardiac complication
294
Dosage :
25 mg/kg 3 times a day for total daily dose of 75 mg/kg. Doses greater 100 mg/kg are not
recommended
Precautions:
In case of persistent arthropathy, deferiprone therapy should be discontinued. Monitor neutrophil
counts weekly. Interrupt therapy if patient develops an infection
Adverse Reactions:
Genotoxicity, neutropenia, agranulocytosis, tachycardia, vasculitis, weight gain, zinc deficiency,
abdominal pain, urine discoloration, hepatotoxicity, visual impairment, joint problems, ototoxicity
and skin rash
Contraindications:
Severe liver dysfunction, existing neutropenia, agranulocytosis, pregnancy and lactation
Interactions:
Aluminium containing antacids. Due to the risk of additive toxicity, use with drugs that may cause
neutropenia or agranulocytosis is not recommended
-------------------------------------------------------------------------------------------------------------------------------------Desferrioxamine B Methanesulphonate 0.5 g Injection
A
Trade Name : Desferal
Indication :
i) Acute iron poisoning in children ii) Investigation and treatment of haemochromatosis iii) Diagnosis
and treatment of aluminium toxicity in patients with renal failure and dialysis iv) Chronic iron toxicity
or overload
Dosage :
i) 2 g by IM immediately and 5 g by mouth after gastric lavage ii) 0.5 - 1.5 g by IM injection daily iii)
Diagnosis: 5 mg per kg by slow intravenous infusion during the last hour of haemodialysis.
Treatment: 5 mg per kg once a week by slow intravenous infusion during the last hour of dialysis iv)
30 - 50 mg/kg
Precautions:
Safety and effectiveness have not been established in children under the age of 3 years, vision or
auditory problem. Concomitant vitamin C with desferrioxamine in patients with severe chronic iron
overload or cardiac failure, high doses and concomitant low ferritin levels have been associated with
growth retardation, increased susceptibility to Yersinia enterocolitica, Yersinia pseudotuberculosis,
mucormycosis, patients with aluminum overload or aluminum-related encephalopathy
Adverse Reactions:
Thrombocytopenia, hypotension, tachycardia, flushing, rash, anaphylactic reaction, disturbance of
vision and hearing, vomiting, diarrhoea, shock, tachyarrhythmia, ototoxicity (frequent), mycosis
(rare)
Contraindications:
Anuria or severe renal disease
Interactions:
Ascorbic acid, phenothiazines
-------------------------------------------------------------------------------------------------------------------------------------Erythropoietin Human Recombinant 2000 IU/0.5ml Injection
A
Trade Name : Eprex
Indication :
i) Treatment of anaemia associated with chronic renal failure. Dialysis patients who are haemoglobin
less than 8 g or exhibiting symptoms of anaemia although haemoglobin more than 8 g and pretransplant cases ii) Anaemia in cancer (non-myeloid malignancies) with concomitant chemotherapy
295
Dosage :
i) ADULT by IV injection over 1-5 minutes, initially 50 units/kg 3 times weekly adjusted according to
response in step of 25 units/kg 3 times weekly at interval of at least 4 weeks. CHILD initially as for
adult. Maintenance, bodyweight under 10 kg usually 75-150 units/kg 3 times weekly, bodyweight
10-30 kg usually 60-150 units/kg 3 times weekly, bodyweight over 30 kg usually 30-100 units/kg 3
times weekly ii) ADULT by SC injection (max. 1 ml per injection site), initially 150 units/kg 3 times
weekly, increased if appropriate rise in haemoglobin not achieved after 4 weeks to 300 units/kg 3
times weekly. Discontinue if inadequate response after 4 weeks at higher dose
Precautions:
To minimize the risk of hypertension, the rate of increase in haemoglobin should not exceed 2
g/dL/month. Measure haemoglobin levels once weekly until levels stabilise and periodically
thereafter, more frequent monitoring should be done in patients with a baseline haemoglobin of
more than 14 g/dL. History of seizures, gout, porphyria. Conditions associated with thrombotic or
vascular events, hepatic dysfunction. Monitor platelet count during first 8 week of therapy. Evaluate
ferrous stores during therapy. Ferrous substitution is recommended for patients whose serum
ferritin levels are 15 g/dL. Ischaemic heart disease, chronic heart failure. Pregnancy and lactation
Adverse Reactions:
Dizziness, drowsiness, headache, arthralgia, myalgia, increased blood pressure, hypertensive crisis,
thrombocytosis, skin reactions at injection site (SC). Hyperkalaemia, hyperphosphataemia, increased
BUN and uric acid, increased creatinine (especially in chronic renal failure patients)
Contraindications:
Uncontrolled hypertension. In elective surgery patients not participating in an autologous blood predonation programme who have severe coronary, peripheral, arterial, carotid or cerebrovascular
diseases including patients with recent myocardial infarction or cerebrovascular accident
Interactions:
Potentiated by hematinic agents. Dose adjustment required if given together with ciclosporin
-------------------------------------------------------------------------------------------------------------------------------------Ferric Ammonium Citrate 800 mg/10 ml Paediatric Mixture
C
Indication :
Prevention and treatment of iron-deficiency anaemias
Dosage :
CHILD up to 1 year 5 ml, 1 - 5 years 10 ml, taken well diluted with water
Precautions:
Haemochromatosis, haemoglobinopthies, existing gastrointestinal diseases. Should be well diluted
with water and drink through a straw to prevent teeth discoloration
Adverse Reactions:
Abdominal cramps, nausea, vomiting, diarrhoea or constipation, dark stools, heartburn, temporary
teeth staining and discolouration of urine
Contraindications:
Not to be given in patient receiving repeated blood transfusion. Haemochromatosis, haemolytic
anaemia, known hypersensitivity to iron salts
Interactions:
Concurrent administration with Vitamin C increases absorption of oral iron. Given with tetracycline,
decreased tetracycline and iron effectiveness. Fluoroquinolones, levodopa, methyldopa,
penicillamine, antacids, H2 blockers, proton pump inhibitors, chloramphenicol. Dairy foods,
decreased iron bioavailability. Aluminium, calcium or magnesium containing products, decreased
iron effectiveness
--------------------------------------------------------------------------------------------------------------------------------------
296
Ferrous Fumarate 200 mg Tablet
C
Indication :
Prevention and treatment of iron-deficiency anaemias
Dosage :
Prophylactic 200 mg daily. Therapeutic 200 mg 2 times daily. CHILD up to 6 years 80-140 mg 2 times
daily
Precautions:
Avoid in patients with peptic ulcer, enteritis, receiving frequent blood transfusions or ulcerative
colitis. Administration of iron for more than 6 months should be avoided except in patients with
continuous bleeding or menorrhagia
Adverse Reactions:
Abdominal cramps, nausea, vomiting, diarrhoea or constipation, dark stools, heartburn, temporary
teeth staining and discolouration of urine
Contraindications:
Haemochromatosis, haemolytic anaemia, known hypersensitivity to iron salts
Interactions:
Concurrent administration with Vitamin C increases absorption of oral iron. Given with tetracycline,
decreased tetracycline and iron effectiveness. Fluoroquinolones, levodopa, methyldopa,
penicillamine, antacids, H2 blockers, proton pump inhibitors, chloramphenicol. Dairy foods,
decreased iron bioavailability. Aluminium, calcium or magnesium containing products, decreased
iron effectiveness
-------------------------------------------------------------------------------------------------------------------------------------Folic Acid 5 mg Tablet
C
Indication :
i) For the prevention and treatment of folate deficiency states ii) For the prevention of neural tube
defect in the foetus
Dosage :
i) ADULT initially 5 mg daily for 4 months or until haematopoietic response obtained. Maintenance: 5
mg every 1 - 7 days depending on underlying disease CHILD up to 1 year, 500 mcg/kg daily; over 1
year, as adult dose ii) 5 mg daily starting before pregnancy and continued through the first trimester
Precautions:
Folic acid should never be given alone or in conjunction with inadequate amounts of vitamin B 12 for
the treatment of undiagnosed megaloblastic anaemia (masking of true deficiency state)
Adverse Reactions:
Gastrointestinal disturbances, urticaria, pruritus
Contraindications:
Pernicious, aplastic or normocytic anaemias
Interactions:
Antiepileptics, oral contraceptives, aminosalicylates, barbiturates, antituberculous drugs, alcohol
and folic acid antagonists such as aminopterin, methotrexate, trimethoprim and sulphonamides
-------------------------------------------------------------------------------------------------------------------------------------Iron Dextran 50 mg Fe/ml Injection
B
Indication :
Severe iron deficiency anaemia
Dosage :
An initial test dose of 0.5 ml should be given over the desired route. For severe iron deficiency
anaemia, 1-2 ml daily given by deep IM. Dosage is individualized according to total iron deficit
297
Precautions:
Anaphylaxis has occurred with parenteral iron dextran. Patients with history of allergic disorders,
asthma, rheumatoid arthritis, inflammatory disorders such as lupus erythematosus
Adverse Reactions:
Anaphylactic reactions, chest pain, hypertension, urticaria, pruritus, rash, abdominal pain, nausea,
vomiting, diarrhoea, leucocytosis, arthralgias, arthritis, convulsions, seizures, headache, respiratory
arrest, dyspnoea, haematuria
Contraindications:
Haemachromatosis, haemosiderosis, haemolytic anaemia and all anaemias other than iron
deficiency anaemia, hypersensitivity to product or any of its components and parenteral preparation
is not for subcutaneous administration
Interactions:
Mycophenolate mofetil, decreased mycophenolate mofetil efficacy. Chloramphenicol, decreased
iron effectiveness
-------------------------------------------------------------------------------------------------------------------------------------Iron Sucrose 100 mg/5 ml Injection
A*
Trade Name : Venofer
Indication :
Dialysis patients on erythropoietin therapy, second and third trimester pregnancy and post partum
anaemia patients with iron deficiency: i) who are not responsive to oral iron therapy ii) who may be
at risk of allergic reactions to iron dextran injection
Dosage :
Individualised dosage. ADULT and ELDERLY: Cumulative dose is to be administered in single doses of
100 - 200 mg of iron 2 - 3 times weekly depending on Hb level. By IV drip infusion, slow IV injection
or directly into the venous limb of the dialyser
Precautions:
Avoid fast infusion as can cause hypotension, cardiovascular collapse. Do not administer
concomitant with oral iron preparations
Adverse Reactions:
Anaphylactoid reactions, metallic taste, headache, nausea, vomiting, hypotension, diarrhoea, leg
cramp, loss of consciousness, seizure, dyspnoea
Contraindications:
Anaemia not due to iron deficiency, iron overload or disturbances in utilisation of iron, history of
asthma, eczema or atopy, history of cirrhosis or hepatitis, serum transaminases 3 times the upper
limit, acute or chronic infection, chronic alcoholism
Interactions:
Doxycycline, levodopa, methyldopa, mycophenolate mofetil, ofloxacin, omeprazole, penicillamine,
tetracycline, zinc
-----------------------------------------------------------------------------------------------------------------------------------
298
17. RHEUMATOLOGY
Antirheumatic
Gout
Drugs used in neuromuscular disorders
Drugs for the relief of soft-tissue inflammation
Miscellaneous rheumatology
299
Celecoxib 200 mg Capsule
A*
Trade Name : Celebrex
Indication :
i) Osteoarthritis ii) Rheumatoid Arthritis iii) Acute pain iv) Ankylosing Spondylitis
Dosage :
i) ADULTS: 200 mg once daily. CHILD not recommended ii) 100mg twice daily, increased if necessary
to 200 mg 2 times daily; CHILD not recommended iii) 400mg as a single dose on first day followed by
200mg once daily on subsequent days iv) Initial, 200 mg once daily or 100 mg twice daily; if no effect
after 6 weeks, may increase to max. 400 mg daily in 1-2 divided doses. If no response following 2
weeks of treatment with 400 mg/day, consider discontinuation and alternative treatment.
Precautions:
Hypertension, cardiac conditions, liver/renal dysfunction, elderly, fluid retention, children,
asthmatic, coagulation defects, pregnancy (third trimester).
Adverse Effects:
GI disorders, flatulence, insomnia, pharyngitis, sinusitis, dizziness, vertigo, hearing disturbance,
photosensitivity, blood disorder, fluid retention, renal failure, hepatic impairment, Steven-Johnson
syndrome, allergic reactions, chest pain, oedema, hot flushes, flu-like symptoms. Gastric side effects
are lesser with this drug as compared to other NSAIDs.
Contraindications:
Hypersensitivity to celecoxib, allergic-type reaction to sulphonamides, aspirin or other nonsteroidal
anti-inflammatory agents, ischaemic heart disease and stroke patient.
Interactions:
Diuretics, anti-coagulants, sulphonylureas, captopril, phenytoin, digoxin, fluconazole, lithium,
antacids, aspirin, glucocorticoids, warfarin.
--------------------------------------------------------------------------------------------------------------------------------Etoricoxib 60 mg Tablet
A*
Etoricoxib 90 mg Tablet
A*
Etoricoxib 120 mg Tablet
A*
Trade Name : Arcoxia
Indication :
i)Acute and chronic treatment of signs and symptoms of osteoarthritis (OA) and rheumatoid arthritis
(RA) ii)Acute gouty arthritis iii)Acute pain
Dosage :
i) OA: 60 mg once daily. RA: 90 mg once daily ii & iii) Acute gouty arthritis and acute pain: 120 mg
once daily (Given the exposure to COX-2 inhibitors, doctors are advised to use the lowest effective
dose for the shortest possible duration of treatment)
Precautions:
Bleeding disorders, liver disease, renal impairment , hypertension, recent myocardial infarct,
cardiovascular disease, hyperlipidaemia, diabetes, smoking, peripheral arterial disease.
Adverse Effects:
Small increase in blood pressure, increased risk of thrombotic complication, headache, dizziness,
fatigue, insomnia, nausea, vomiting, diarrhoea, heartburn, taste disturbance, decreased appetite
and flatulence.
Contraindications:
Patients who experienced asthma, urticaria or allergic type of reaction after taking aspirin or NSAIDs,
acute peptic ulcer, severe renal or hepatic disease,ischaemic heart disease and stroke, hypertensive
patient whose blood pressure is not under control.
Interactions:
Warfarin, ACEIs, lithium, methotrexate, oral contraceptives, rifampicin, aspirin, SSRIs.
-------------------------------------------------------------------------------------------------------------------------------
300
Hydroxychloroquine Sulphate 200 mg Tablet
A
Trade Name : Plaquenil
Indication :
i) SLE and mixed connective tissue disease for skin, joint and serosa ii) Second line therapy for acute
rheumatoid arthritis
Dosage :
i) Initially 400 mg daily in divided dose. Maintenance : 200 - 400 mg daily ii) ADULT : 400 - 600 mg
daily. Maintenance: 200 - 400 mg daily. CHILD : up to 6.5 mg/kg daily (maximum 400mg daily)
Precautions:
Liver disease, alcoholism or concurrent administration with known hepatotoxic drugs. G6PD
deficiency, renal impairment or metabolic acidosis, patients with psoriasis or porphyria,
haematologic disorders. If patient develops pigmentary abnormality or visual field defect,
discontinue drug.
Adverse Effects:
Gastrointestinal disturbances, nausea, vomiting and diarrhea, headache, skin reactions, bleaching of
hair, alopecia, blurred vision, difficulty in focusing, blood dyscrasias, drug-induced myopathy,
disorder of cornea, cardiovascular: Torsades de pointes, agranulocytosis, retinopathy, ototoxicity
(rare).
Contraindications:
Pre-existing maculopathy, pregnancy, hypersensitivity to 4-aminoquinoline compound, long-term
use in children, retinal or visual field changes from prior 4-aminoquinoline compound.
Interactions:
Digoxin - increase level, metoprolol.
-------------------------------------------------------------------------------------------------------------------------------------Leflunomide 10 mg Tablet
A*
Trade Name : Arava
Indication :
i) Persistent active rheumatoid arthritis ii) Active psoriatic arthritis
Dosage :
Loading dose: 100 mg once daily for 3 days. Maintenance: 10-20 mg once daily
Precautions:
Patients who are taking other drugs that can cause liver injury. Liver enzymes should be monitored
at least monthly for three months after starting leflunomide and at least quarterly thereafter. If the
alanine aminotransferase (ALT) rises to greater than two times the upper limit of normal while the
patient is on leflunomide, leflunomide should be stopped, cholestyramine washout begun to speed
the removal of leflunomide from the body and follow-up liver function tests conducted at least
weekly until the ALT value is within normal range. Renal impairment, anaemia, leucopenia,
thrombocytopenia, history of tuberculosis.
Adverse Effects:
Gastrointestinal disturbances, anorexia, oral mucosa ulceration, elevation of liver parameters,
headache, dizziness, paraesthesias, increase blood pressure, weight loss, increase hair loss, eczema,
dry skin, mild allergic reactions, leucopenia, mild hyperlipidaemia. Rarely, Stevens-Johnson
syndrome, toxic epidermal necrolysis, erythema multiforme.
Contraindications:
Patients with pre-existing liver disease. Patients with elevated liver enzymes (alanine
aminotransferase greater than two times the upper limit of normal). Severe immunodeficiency state,
serious infection, severe hypoproteinaemia, pregnant women or women of childbearing potential
who are not using reliable contraception, lactation, significantly impaired bone marrow function or
significant anaemia, leucopenia, neutropenia or thrombocytopenia.
301
Interactions:
Other antirheumatic or immuno-suppressive agents, alcohol, phenytoin, warfarin, tolbutamide.
-------------------------------------------------------------------------------------------------------------------------------------Meloxicam 7.5 mg Tablet
A/KK
Trade Name : Mobic
Indication :
Only for patients not responding to other NSAIDs in the treatment of i) painful osteoarthritis ii)
rheumatoid arthritis
Dosage :
i) initially 7.5 mg daily. May be increased to 15 mg daily ii) initially 15 mg daily. May be reduced to
7.5 mg daily. Maximum 15 mg daily. Child under 12 years not recommended
Precautions:
History of gastrointestinal disease, liver cirrhosis, dehydration. Chronic heart failure, nephrotic
syndrome, overt renal disease, recent major surgical procedures. Withdraw if peptic ulceration or
gastrointestinal bleeding occurs. Concomitant anticoagulant or diuretic treatment. Elderly.
Adverse Effects:
Dyspepsia, nausea, abdominal pain, pruritis, skin rash, constipation. Vomiting, flatulence, diarrhoea,
anaemia, pruritus, lightheadedness, headache, oedema.
Contraindications:
Active peptic ulceration, pregnancy, lactation, hypersensitivity to NSAIDs or aspirin, severe hepatic
insufficiency, non-dialysed severe renal insufficiency. Children less than 15 year.
Interactions:
NSAIDs, salicylates, oral anticoagulants, ticlopidine, heparin, thrombolytics, lithium, methotrexate,
IUD, diuretics, antihypertensives, cholestyramine, ciclosporin.
-------------------------------------------------------------------------------------------------------------------------------Naproxen Sodium 275 mg Tablet
A
Trade Name : Symflex
Indication :
i) Rheumatic arthritis, osteoarthritis and alkylosing spondylitis ii) Acute gout iii) Muscular skeletal
disorder and dysmenorrhoea
Dosage :
i) 0.5 - 1 g daily in 2 divided doses ii) 750 mg initially then 250 mg 8 hourly iii) 500 mg initially then
250 mg every 6 - 8 hours as required
Precautions:
Active or previous history of gastrointestinal ulceration, bleeding or perforation. History of renal or
liver dysfunction or coagulation defects. Hypertension or cardiac conditions aggravated by fluid
retention and oedema, dehydration, diuretics, pregnancy and lactation.
Adverse Effects:
Abdominal discomfort, epigastric distress, gastrointestinal reactions, peptic ulceration, skin rash,
pruritus, insomnia, visual disturbance, headache, nausea, peripheral oedema, tinnitus, vertigo.
Prolongs bleeding time.
Contraindications:
Hypersensitivity, active or history of peptic ulceration. Patients whom aspirin & other NSAIDs
induced symptoms of asthma, rhinitis, urticaria or other allergic reactions.
Interactions:
Probenecid, oral anticoagulants, thiazide diuretics, ACEIs, beta-blockers, methotrexate, lithium,
aspirin, other NSAIDs.
--------------------------------------------------------------------------------------------------------------------------------
302
Allopurinol 300 mg Tablet
B
Trade Name : Zyloric
Indication :
Gout or uric acid and calcium oxalate renal stones
Dosage :
Initial dose : 100-300 mg daily. Maintenance : 300-600 mg daily. Maximum: 900 mg daily
Precautions:
Renal/hepatic dysfunction, asymptomatic hyperuricaemia, Hypersensitivity and pregnancy.
Adverse Effects:
Skin rash, maculopapular, pruritic, Stevens-Johnson Syndrome, peripheral neuritis, alopecia, GI
upset, toxic epidermal necrolysis. Acute attack of gouty arthritis in early stages of therapy. Skin
reactions (discontinue immediately at first sign of rash). Very rarely, granulomatous hepatitis.
Occasionally; thrombocytopenia, agranulocytosis, & aplastic anaemia in patients with impaired renal
function.
Contraindications:
Hypersensitivity to allopurinol, pregnancy, lactation, acute gout, asymptomatic hyperuricaemia.
Interactions:
Oral anticoagulants, azathioprine, antidiabetics, mercaptopurine.Use only quarter of the usual dose
of 6-mercaptopurine or azathioprine when given concurrently. Increases plasma half-life of adenine
arabinoside. Effects decreased by uricosurics & large doses of salicylates.
-------------------------------------------------------------------------------------------------------------------------------------Eperisone HCl 50 mg Tablet
A
Trade Name : Myonal
Indication :
Myotonic symptoms associated with cervical syndrome, periarthritis of shoulder and lumbago
spastic paralysis
Dosage :
50 mg 3 times daily
Precautions:
Hepatic disorders, drug hypersensitivity.
Adverse Effects:
Weakness, dizziness, insomnia, drowsiness, numbness or trembling in the extremities, hepatic and
renal dysfunction/ haematological changes, rashes, GI disturbances, urinary disorders.
Contraindications:
Not known.
Interactions:
Methocarbamol, tolperisone HCl.
-------------------------------------------------------------------------------------------------------------------------------------Prolase Tablet
Trade Name : Papase
Indication :
Oedema and inflammation in conjunction with other physical or chemotherapeutic measures
Dosage :
2 tablet 4 times daily
Precautions:
Renal or hepatic dysfunction and pregnancy.
Adverse Effects:
Skin rash, vertigo and gastrointesinal upsets.
Contraindications:
303
B
Blood clotting disease.
Interactions:
No known.
--------------------------------------------------------------------------------------------------------------------------------------
304
18. OPHTHALMOLOGY
Anti-infective eye preparations
Anti-infective with steroids
Corticosteroids
Corticosteroids and other anti-inflammatory preparations
Antiviral
Mydristics and cycloplegics
Treatment of glaucoma
Local anaesthetics
Miscellaneous ophthalmology
305
Amphotericin B 0.15% Eye Drops
Indication :
Fungal infection of the cornea
Dosage :
1 drop hourly or 2 hourly
Precautions :
Renal impairment.
Adverse Effects :
Nausea and vomiting, anaemia, thrombocytopenia.
Contraindications :
Hypersensitivity to Amphotericin B.
Interactions :
Cyclosporin, digitalis glycosides, non-depolarizing neuromuscular blockers.
-------------------------------------------------------------------------------------------------------------------------------Chloramphenicol 0.5% Eye Drops
C
Trade Name : CMC
Indication :
Broad spectrum antibiotic in superficial eye infections
Dosage :
1 - 2 drops every 3 - 4 hours
Precautions :
Overgrowth of non-susceptible organisms in prolonged use.
Adverse Effects :
Allergic reactions, superinfection, bone marrow hypoplasia including aplastic anaemia.
Contraindications :
Hypersensitivity to chloramphenicol products.
Interactions :
Not known.
--------------------------------------------------------------------------------------------------------------------------------Chloramphenicol 1% Eye Ointment
C
Trade Name : CMC
Indication :
Conjunctivitis and other superficial eye infection
Dosage :
Apply 1/2 inch of ointment every 3 - 4 times into the conjunctival sac
Precautions :
Overgrowth of non-susceptible organisms in prolonged use.
Adverse Effects :
Allergic reactions, superinfection, bone marrow hypoplasia including aplastic anaemia.
Contraindications :
Hypersensitivity to chloramphenicol products.
Interactions :
Not known.
--------------------------------------------------------------------------------------------------------------------------------
306
A
Ciprofloxacin HCl 0.3% Ophthalmic Solution
A*
Trade Name : Ciloxan
Indication :
i)For corneal ulcer
ii) For bacterial conjunctivitis
Dosage :
i) 2 drops every 15 minutes for first 6 hours, then 2 drops every 30 minutes for the rest of the day.
Second day : 2 drops every hour. Subsequent days (3rd - 14th day) : 2 drops every 4 hours.
ii) 1 - 2 drops 2 hourly into the conjunctival sac while awake for 2 days and 1-2 drops 4 hourly while
awake for the next 5 days
Precautions :
Prolonged use may result in overgrowth of nonsusceptible organisms. Discontinue use at first
appearance of skin rash or other sign of hypersensitivity reactions. Children less than 1 year
Adverse Reactions :
Local burning or discomfort, itching, lid oedema, tearing, white crystalline precipitates which resolve
Contraindications :
History of hypersensitivity to ciprofloxacin or other quinolones
Interactions :
Not known
-------------------------------------------------------------------------------------------------------------------------------------Fusidic Acid 1% Eye Drops
A
Trade Name : Fucithalmic
Indication :
For staphylococcal infections
Dosage :
1 drop in conjunctival sac 12 hourly. To be continued for 2 days after the eye appears normal. On the
first day of treatment, may be applied more frequently : 1 drop 4 hourly. Surgical prophylaxis : 1
drop every 12 hours, 24 - 48 hours before operation
Precautions :
Do not apply to eyes with contact lenses.
Adverse Effects :
Transient stinging.
Contraindications :
Allergy to any of the constituents.
Interactions :
Cross allergy between fusidic acid and other antibiotics has not been reported.
-------------------------------------------------------------------------------------------------------------------------------------Gentamicin 0.3% Eye Drops
A/KK
Indication :
Broad spectrum antibiotic in superficial eye infections and also for Pseudomonas aeruginosa
Dosage :
1 - 2 drops every 4 hours, in severe infection dosage may be increased up to 2 drops every hour
Precautions :
Contact lens users, overgrowth of non-susceptible organisms on prolonged use, discontinue if
irritation or sensitization occurs, pre-existing renal, vestibular, or auditory impairment, concomitant
anesthesia, risk for neuromuscular blockade, respiratory paralysis, concomitant neurotoxic, ototoxic,
nephrotoxic drugs.
307
Adverse Effects :
Non-specific conjunctivitis, conjunctival epithelial defect and hyperemia, temporary burning
sensation (rare), irritation, stinging, itching and dermatitis,hypokalemia, hypomagnesemia,
hypocalcemia.
Contraindications :
Hypersensitivity to Gentamicin or aminoglycosides products.
Interactions :
Not known.
--------------------------------------------------------------------------------------------------------------------------------Gentamicin 0.3% Eye Ointment
A/KK
Indication :
Conjunctivitis, blepharitis, blepharo-conjunctivitis, keratitis, keratoconjunctivitis, episcleritis,
dacrocystitis, corneal ulcers, styes and infected eye socket
Dosage :
Apply into the conjunctival sac 3 - 4 times daily
Precautions :
nephrotoxic drugs.
Adverse Effects :
hypocalcemia.
Contraindications :
Hypersensitivity to Gentamicin or aminoglycosides products.
Interactions :
Not known.
----------------------------------------------------------------------------------------------------------------------------------Gentamicin 3% Fortified Eye Drops
A
Indication :
Broad spectrum antibiotic in superficial eye infections and also for Pseudomonas aeruginosa
Dosage :
Dose according to the needs of the patient
Precautions :
nephrotoxic drugs
Adverse Reactions :
hypocalcemia
Contraindications :
Hypersensitivity to Gentamicin or aminoglycosides products
Interactions :
Not known
--------------------------------------------------------------------------------------------------------------------------------------
308
Moxifloxacin 0.5% Ophthalmic Solution
A*
Trade Name : Vigamox
Indication :
Treatment of conjunctivitis caused by susceptible organism
Dosage :
CHILD more than 1 year and ADULT: 1 drop to affected eye(s) 3 times daily for 7 days
Precautions :
Not to be injected subconjuctivally or introduced directly to the anterior chamber of the eye,
prolong use, pregnancy and lactation.
Adverse Effects :
Conjunctivitis, decreased visual acuity, dry eye, keratitis, ocular discomfort, hyperemia, pain and
pruritus, subconjunctival hemorrhage, tearing.
Contraindications :
Hypersensitivity to moxifloxacin and quinolone.
Interactions :
Warfarin, concomitant use with QT prolonging agents (eg. Class 1a and class III antiarrythmic,
erythromycin, cisapride, antipsychotic, cyclic antidepressant), antacid, sucralfate.
-------------------------------------------------------------------------------------------------------------------------------Betamethasone Disodium Phosphate 0.1% Eye/Ear Drops
A
Trade Name : Betnesol
Indication :
Non-infected inflammatory conditions of the eyes/ears
Dosage :
1 - 2 drops every 1 - 2 hours until controlled then reduce frequency
Precautions :
Prolonged use in infants. May impair ability to drive or operate machinery. Pregnancy. Withdrawal if
there is spread of infection.
Adverse Effects :
Rise in intraocular pressure, corneal ulcers. Rarely, acute sensitization to neomycin, optic nerve
damage, visual acuity and field defects.
Contraindications :
Bacterial, fungal, viral, tuberculous or purulent conditions of the eye. Glaucoma, herpetic keratitis
(e.g. dendritic ulcer). Hypersensitivity to any component of the preparation.
Interactions :
Not known.
-------------------------------------------------------------------------------------------------------------------------------------Dexamethasone and Neomycin Sulphate and Polymyxin B Sulphate Ophthalmic Suspension A
Trade Name : Maxitrol
Indication :
Treatment of ocular inflammation when concurrent use of an antimicrobial is judged necessary
Dosage :
1 - 2 drops hourly for severe cases and 4 - 6 hourly for mild infection
Precautions :
Glaucoma, corneal or scleral thinning, history of HSV infection.
Adverse Effects :
Burning and stinging or local irritation may occur. Hypersensitivity (due to neomycin content). Ocular
itching, reddening, conjunctival oedema, rash or persistent irritation, periorbital oedema.
309
Contraindications :
Hypersensitivity to its component, viral, fungal, tuberculosis and other infections of the eye.
Interactions :
Not known.
------------------------------------------------------------------------------------------------------------------------------------Dexamethasone and Neomycin Sulphate and Polymyxin B Eye Ointment
A
Trade Name : Maxitrol
Indication :
Treatment of ocular inflammation when concurrent use of an antimicrobial is judged necessary
Dosage :
Apply 1 - 1.5 cm 3 - 4 times daily, may be used adjunctively with drops at bedtime
Precautions :
Glaucoma, corneal or scleral thinning, history of HSV infection.
Adverse Effects :
Burning and stinging or local irritation may occur. Hypersensitivity (due to neomycin content). Ocular
itching, reddening, conjunctival oedema, rash or persistent irritation, periorbital oedema.
Contraindications :
Hypersensitivity to its component, viral, fungal, tuberculosis and other infections of the eye.
Interactions :
Not known.
-------------------------------------------------------------------------------------------------------------------------------------Antazoline HCl, Tetrahydrozoline HCl and Benzalkonium Cloride Eye Drops
A/KK
Trade Name : Spersallerg
Indication :
Hay fever, conjunctivitis, allergic conjunctivitis, vernal keratoconjunctivitis and eczematosa
Dosage :
ADULT : Instill 1 drop, 3 - 4 times daily, into the lower eyelid. CHILD 2 - 12 years : Instill 1 drop daily
or twice daily
Precautions :
Transient irritation may occur immediately after instillation.
Adverse Effects :
Mild burning sensation, headache, and sleepiness, tachycardia, blurred vision.
Contraindications :
Hypersensitivity to any of the components of product, dry eyes; especially keratoconjunctivitis sicca,
risk of narrow angle glaucoma, receiving monoamine oxidase inhibitors or within 14 days of its
treatment, children under two years of age; due to the greater incidence of systemic absorption and
effects.
Interactions :
Not known.
------------------------------------------------------------------------------------------------------------------------------Fluorometholone 0.1% Ophthalmic Suspension
Trade Name : FML liquifilm, Flarex ophth Susp
Indication :
Treatment of steroid responsive ocular inflammation
Dosage :
1-2 drops 2 - 4 times dailyy
Precautions :
Glaucoma, corneal or scleral thinning.
310
A*
Adverse Effects :
Burning or stinging, ocular irritation, unpleasant taste, blurred vision, increased intra-ocular
pressure, glaucoma, cataract, corneal thinning.
Contraindications :
Hypersensitivity to its component, ocular viral or fungal or tuberculosis infection, contact lense use.
Interactions :
Not known.
----------------------------------------------------------------------------------------------------------------------------------Acyclovir 3% Eye Ointment
A*
Indication :
Only for the treatment of herpes simplex keratitis
Dosage :
Apply 1 cm 5 times daily. Continue for at least 3 days after healing
Precautions :
Not known.
Adverse Effects :
Local irritation and inflammation reported , vision abnormalities.
Contraindications :
Hypersensitivity to acyclovir.
Interactions :
Not known.
-------------------------------------------------------------------------------------------------------------------------------------Atropine Sulphate 1% Eye Drops
B
Indication :
Determination of refraction, strabismus, iritis and iridocyclitis, after extra or intracapsular extraction
of lens
Dosage :
PREOPERATIVE MYDRIASIS : one drop of a 1% solution supplemented with one drop of 2.5 or 10%
phenylephrine prior to surgery. ANTERIOR UVEITIS or POSTOPERATIVE MYDRIASIS : one drop of a 1%
or 2% solution up to 3 times a day
Precautions :
Risk of systemic effects with the eye drops in infants under 3 months-eye ointment preferred
Adverse Effects :
Transient stinging and raised intra-ocular pressure, local irritation, hyperaemia, oedema and
conjunctivitis
Contraindications :
Glaucoma or suspected glaucoma. Hypersensitivity
Interactions :
Not known
-------------------------------------------------------------------------------------------------------------------------------------Cyclopentolate 1% Eye Drops
A
Trade Name : Cyclogyl
Indication :
Mydriasis and cycloplegia
Dosage :
1 - 2 drops several times a day. Refractory procedures, ADULT : 1 drop of 0.5% solution. CHILD 6 - 12
years : 1 drop of 1% solution. CHILD less than 6 years : 1 - 2 drops of 1% solution
311
Precautions :
May impair ability to drive or operate machinery
Adverse Effects :
Mild tachycardia, secretion decrease and action on the CNS, blurred vision, increased intraocular
pressure, allergic reactions
Contraindications :
Narrow-angle glaucoma
Interactions :
Cyclopentolate may interfere with antiglaucoma action of carbachol or pilocarpine
-------------------------------------------------------------------------------------------------------------------------------------Homatropine 2% Eye Drops
B
Indication :
Treatment of anterior segment inflammation. Producing cycloplegia and mydriasis for refraction
Dosage :
1 drop 1 - 4 times daily
Precautions :
Systemic toxicity especially in infants and small children.Children with brain damage, Down's
syndrome. Elderly, keratoconus, avoid bright light, driving, or hazardous activity while pupils are
dilated,avoid contact with oral mucosa; wash hands thoroughly after use.
Adverse Effects :
Transient stinging, local irritation, keratitis, pain in eye, raised intraocular pressure.
Contraindications :
Hypersensitivity to homatropine products, primary glaucoma or tendency toward glaucoma (e.g.
narrow anterior chamber).
Interactions :
Cisapride, procainamide.
--------------------------------------------------------------------------------------------------------------------------------Phenylephrine HCI 2.5% Eye Drops
B
Trade Name : Mydfrin
Indication :
For pupillary dilation in uveitis, for refraction without cyclopegic. For fundoscopy and other
diagnostic procedures
Dosage :
Mydriasis and vasoconstriction: 1 drop of 2.5% or 10% solution, repeated in one hour if necessary.
Chronic mydriasis: 1 drop of a 2.5% or 10% solution 2 - 3 times a day. Uveitis with posterior
synechiae (treatment) or synechiae, posterior (prophylaxis): 1 drop of a 2.5% or 10% solution,
repeated in one hour if necessary, not to exceed three times a day. Treatment may be continued the
following day, if necessary
Precautions :
Caution if administered with or up to 3 weeks after MAOI therapy. Infant with cardiac anomalies. To
prevent pain and subsequent lacrimation on administration, a suitable topical anesthetic may be
applied a few minutes before use of phenylephrine solution. Repeated use of phenylephrine,
especially in older patients, may result in rebound miosis and a reduced mydriatic effect. Medication
may cause increased sensitivity of eyes to light.
Adverse Effects :
Marked increase in blood pressure in low-weight neonates, infant and adult with idiopathic
hypotension. Cardiovascular reactions in the elderly.
312
Contraindications :
Narrow-angle glaucoma, infant, elderly with severe arteriosclerotic, cardiovascular or
cerebrovascular disease. During intraocular operative procedures when corneal epithelial barrier is
disturbed. Not recommended for use in low birth weight infants.
Interactions :
Tricyclic antidepressants, propranolol.
------------------------------------------------------------------------------------------------------------------------------Tropicamide 1% Eye Drops
A/KK
Trade Name : Mydriacyl
Indication :
Topical use to produce cycloplegic refraction for diagnostic purposes
Dosage :
1 - 2 drops several times a day
Precautions :
Individuals susceptible to belladona alkaloids, inflammed eyes, pregnancy, children, elderly. Infants
and children, may cause central nervous system disturbances.
Adverse Effects :
Increased intraocular pressure, dryness of mouth, transient stinging, allergic reactions, tachycardia,
headache, parasympathetics stimulation, blurred vision, photosensitivity.
Contraindications :
Primary glaucoma or a tendency toward glaucoma. Sensitivity to tropicamide.
Interactions :
Antimuscarinic effects potentiated by concomitant use of amantadine, tricyclic antidepressants,
phenothiazine and butyrophenones and antihistamines.
-------------------------------------------------------------------------------------------------------------------------------Acetazolamide 250 mg Tablet
B
Trade Name : Diamox
Indication :
Reduction of intraocular pressure in open-angle glaucoma, secondary glaucoma and peri-operatively
in angle-closure glaucoma
Dosage :
250 - 500 mg daily
Precautions :
Not generally recommended for prolonged use but if given monitor blood count and plasma
electrolyte concentration, pulmonary obstruction (risk of acidosis), elderly, pregnancy and lactation,
Stevens-Johnson syndrome, toxic epidermal necrosis, high-dose aspirin, high dose may decrease
diuresis and may increase drowsiness, pulmonary obstruction or emphysema.
Adverse Effects :
Nausea, vomiting, diarrhoea, taste disturbances, loss of appetite, paraesthesia, flushing, headache,
dizziness, fatigue, irritability, depression, thirst, polyuria, reduced libido, metabolic acidosis and
electrolyte disturbances on long-term therapy.
Contraindications :
Hypokalaemia, hyponatraemia, hyperchloraemic acidosis, severe hepatic impairment, renal
impairment, sulphonamide hypersensitivity.
Interactions :
Aspirin, cyclosporin, digitalis , digoxin, lithium, phenytoin, quinidine, topiramate.
---------------------------------------------------------------------------------------------------------------------------------
313
Acetazolamide 500 mg Injection
B
Trade Name : Diamox
Indication :
Reduction of intra-ocular pressure in open-angle glaucoma, secondary glaucoma and perioperatively in angle-closure glaucoma
Dosage :
250 - 500 mg given by IM or IV
Precautions :
Not generally recommended for prolonged use but if given monitor blood count and plasma
electrolyte concentration, pulmonary obstruction (risk of acidosis), elderly, pregnancy and lactation,
Stevens-Johnson syndrome, toxic epidermal necrosis, high-dose aspirin, high dose may decrease
diuresis and may increase drowsiness, pulmonary obstruction or emphysema.
Adverse Effects :
Nausea, vomiting, diarrhoea, taste disturbances, loss of appetite, paraesthesia, flushing, headache,
dizziness, fatigue, irritability, depression, thirst, polyuria, reduced libido, metabolic acidosis and
electrolyte disturbances on long-term therapy.
Contraindications :
Hypokalaemia, hyponatraemia, hyperchloraemic acidosis, severe hepatic impairment, renal
impairment, sulphonamide hypersensitivity.
Interactions :
Aspirin, cyclosporin, digitalis , digoxin, lithium, phenytoin, quinidine, topiramate.
-------------------------------------------------------------------------------------------------------------------------------Bimatoprost 0.03% Ophthalmic Solution
A*
Trade Name : Lumigan
Indication :
Lowering of intraocular pressure in patients with open-angle glaucoma and ocular hyperten
Dosage :
1 drop in affected eye(s) once daily at evening
Precautions :
Aphakia, pseudoaphakia, active intraocular inflammation, macular oedema, renal impairment, liver
impairment, pregnancy, lactation.
Adverse Effects :
Eyelash formation, conjunctival hyperemia, iris pigmentation, ocular pruritus, conjunctival oedema,
headache, hypertension, common cold, acute upper respiratory infection, superficial punctuate
keratitis.
Contraindications :
Hypersensitivity to bimatoprost or any component of the product.
Interactions :
Latanoprost.
-------------------------------------------------------------------------------------------------------------------------------Brimonidine Tartrate 0.15% Ophthalmic
Trade Name : Alphagan P
Indication :
Lowering of intraocular pressure in patients with open-angle glaucoma or ocular hypertension
Dosage :
1 drop in the affected eye(s) 3 times daily
Precautions :
Severe cardiovascular disease, liver impairment, renal impairment, depression, Raynauld?s
phenomenon, orthostatic hypotension, thromboangiitis obliterans, pregnancy, lactation.
314
A*
Adverse Effects :
Oral dryness, ocular hyperemia, burning and stinging, headache, blurring, foreign body sensation,
fatigue, drowsiness, conjunctival follicles, ocular pruritus.
Contraindications :
Hypersensitivity to brimonidine, concomitant MAOI therapy.
Interactions :
Alcohol, sedative, barbiturates, opiates, anaesthesia, tricyclic antidepressant, beta blocker,
antihypertensive.
-------------------------------------------------------------------------------------------------------------------------------Dorzolamide HCl 2% Ophthalmic Solution
A*
Trade Name : Trusopt
Indication :
All glaucoma patients where beta-blockers are contraindicated and when intraocular pressure is not
well controlled by other drugs
Dosage :
Monotherapy : 1 drop 3 times daily. Adjunctive therapy with an ophthalmic beta-blocker : 1 drop 2
times daily. When substituting for another ophthalmic antiglaucoma agent with this product,
discontinue the other agent after proper dosing on one day and start Trusopt on the next day. If
more than 1 topical ophthalmic drug is used, the drugs should be administered at least 10 mins
apart
Precautions :
Patients with severe renal or hepatic impairment. Pregnancy and lactation. Children. Remove
contact lens prior to administration and do not reinsert 15 minutes after use. Acute angle glaucoma,
sensitivity to sulfonamide, concomitant use of oral carbonic-anhydrase inhibitors, conjunctivitis and
lid reactions reported with chronic administration, ocular infection or inflammation, recent ocular
surgery, reports of bacterial keratitis associated with the use of multiple dose containers of
ophthalmic products
Adverse Reactions :
Burning, stinging, conjunctivitis, eyelid inflammation, eye itching, eyelid irritations, headache, bitter
taste, nausea, itching, fatigue/asthenia, blurred vision, tearing. Rarely, iridocyclitis and rash.
Angioedema, bronchospasm, urticaria, pruritis, dizziness, paraesthesia, transient myopia (resolve
upon discontinuation) and superficial punctate keratitis
Contraindications :
Patients who are hypersensitive to any component of this product
Interactions :
High dose of salicylate therapy. Potential additive effect with oral carbonic anhydrase inhibitors
-------------------------------------------------------------------------------------------------------------------------------------Latanoprost 0.005% Eye Drops
A*
Trade Name : Xalatan
Indication :
Reduction of elevated intraocular pressure in patients with open-angle glaucoma
Dosage :
The recommended dosage is one drop (1.5 µg) in the affected eye(s) once daily in the evening. If
more than one topical ophthalmic drug is being used, the drugs should be administered at least five
(5) minutes apart
Precautions :
Inflammatory, neovascular, angle closure or congenital glaucoma, open angle glaucoma of
pseudophakic patients, pigmentary glaucoma, acute attacks of closed angle glaucoma, pregnancy
and lactation. Contact lens users.
315
Adverse Effects :
Slight discomfort, mild to moderate conjunctival hyperaemia, transient punctate ephitelial erosions,
increased pigmentation of iris, rash.
Contraindications :
Known hypersensitivity to any component of the products.
Interactions :
Effects additive to beta-adrenergic antagonist, adrenergic agonists, carbonic anhydrase inhibitors
and cholinergic agonists. Other eye preparation containing thiomersal.
--------------------------------------------------------------------------------------------------------------------------------Pilocarpine 2% Eye Drops
B
Indication :
Miotics in chronic open-angle glaucoma
Dosage :
1 drop 1 - 4 times a day
Precautions :
Retinal disease; conjunctival or corneal damage. Intraocular pressure and visual fields should be
monitored in those with simple chronic glaucoma and those receiving long-term treatment with a
miotic. Caution in cardiac disease, hypertension, asthma, peptic ulceration, urinary-tract obstruction
and parkinson's disease.
Adverse Effects :
Ciliary spasm leads to headache and browache which may be more severe in the initial 2 - 4 weeks of
treatment. Ocular side effects include burning, itching, smarting, blurred vision, conjunctival vascular
congestion, myopia, lens changes with chronic use, vitreous haemorrhage and pupillary block.
Contraindications :
Contraindicated in conditions where pupillary constriction is undesirable such as acute iritis, anterior
uveitis and some forms of secondary glaucoma. Acute inflammatory disease of the anterior
segment.
Interactions :
Not known.
------------------------------------------------------------------------------------------------------------------------------Timolol Maleate 0.5% Eye Drops
A
Trade Name : Timoptol,timoptol-XE,Timo-comod
Indication :
Elevated intraocular pressure, chronic open angle galucoma
Dosage :
Initially, 1 drop of 0.25% 2 times daily, if clinical response is not adequate, 1 drop of 0.5% 2 times
daily
Precautions :
History of atopy or a history of severe anaphylactic reaction to a variety of allergens, pregnancy and
lactation. May impair ability to drive or operate machinery.
Adverse Effects :
Bradycardia, hypotension, confusion, depression, dizziness, fatigue, abdominal pain, diarrhoea,
nausea, vomiting, dyspepsia, dry eye, ocular burning, corneal anaesthesia.
Contraindications :
Bronchial asthma or a history of bronchial asthma, severe COPD, sinus bradycardia, second or third
degree atrioventricular block, overt cardiac failure and cardiogenic shock.
316
Interactions :
Cathecolamine-depleting drugs. Concurrent administration of oral or systemic beta-adrenergic
blockers. Concurrent use of beta-blockers and digitalis with diltiazem or verapamil may have additive
effects in prolonging atrioventricular conduction time. Quinidine.
-------------------------------------------------------------------------------------------------------------------------------Proparacaine HCI 0.5% Ophthalmic Drops
B
Trade Name : Alcaine
Indication :
Topical anaesthesia in ophthalmic procedures
Dosage :
Deep anaesthesia, 1 drop in each eye every 5 to 10 minutes for 5 to 7 doses. Superficial anaesthesia,
1 to 2 drops in each eye before surgery or diagnostic procedure. Tonometry and/or tonography
procedure, 1 to 2 drops in each eye before procedure
Precautions :
Use cautiously in patients with cardiac disease and hyperthyroidism, prolonged use not
recommended. Protect the eye from irritants, rubbing and foreign bodies during period of
anaesthesia
Adverse Effects :
Transient stinging and burning, conjunctival redness, keratitis, systemic toxicity. Long term use may
result in corneal damage, loss of vision and retard healing
Contraindications :
Hypersensitivity
Interactions :
Hyaluronidase, St John's wort, increase effects of phenylephedrine, tropicamide
-------------------------------------------------------------------------------------------------------------------------------Balanced Salt Solution
Trade Name : BSS
Indication :
For irrigation during ocular surgery
Dosage :
Irrigate as directed
Precautions :
For local use only. The use of additives with this solution may cause corneal decompensation
Adverse Effects:
Ocular irritation
Contraindications :
Hypersensitivity to any of the components of product
Interactions :
Not known
A
--------------------------------------------------------------------------------------------------------
Hypromellose 0.3% Eye Drops
Trade Name : Dacrolux
Indication :
Tear deficiency, ophthalmic lubricant; for relief of dry eyes and eye irritation
Dosage :
1 - 2 drops several times a day
317
B
Precautions :
Self-prescribed use as an ocular lubricant should not exceed 3 days, avoid contamination of
the applicator tip through contact, remove viscoelastic solutions form the anterior chamber at
the end of the surgical procedure, treat emergent elevations of intraocular pressure
Adverse Effects :
Increases in intraocular pressure, blurred vision
Contraindications :
Hypersensitivity to hydroxypropyl methylcellulose
Interactions :
Not known
-------------------------------------------------------------------------------------------------------------------------------------Hypromellose 0.3%, Carbomer 980 Ophthalmic Gel
B
Trade Name : Genteal Gel
Indication :
Symptomatic relief of severe dry eye conditions and as lens lubricant during ophthalmic diagnostic
procedures
Dosage :
Instill 1-2 drops in affected eye(s) as needed
Precautions :
Avoid contamination of the applicator tip through contact, self-prescribed use as an ocular lubricant
should not exceed 3 days ,treat emergent elevations of intraocular pressure.
Adverse Effects :
Blurred vision, raised intraocular pressure, transient, postoperatively, Sticking of eyelids (discharge).
Contraindications :
Hypersensitivity to hypromellose.
Interactions :
Not known
-------------------------------------------------------------------------------------------------------------------------------Ketorolac Tromethamine 0.5% Eye drops
A
Trade Name : Acular
Indication :
i) Ocular itching due to allergic conjunctivitis ii) Prophylaxis and reduction of inflammation and
associated symptoms following ocular surgery
Dosage :
i) 1 drop 4 times daily ii) 1 drop 4 times daily starting 24 hours post-operation, continue for 2 weeks
Precautions :
Bleeding tendencies, ocular surgery, dry eye syndrome, diabetes mellitus, rheumatoid arthritis.
Avoid contact lens use.
Adverse Effects :
Transient burning sensation in the eye, corneal edema, eye irritation.
Contraindications :
Hpersensitivity to its component, aspirin, NSAIDs or phenylacetic acid derivatives. Pregnancy third
trimester.
Interactions :
Antiplatelet, anticoagulant, aspirin, NSAIDs : may increase ocular bleeding risk post-operation.
Intraocular cholinergic agent : may decrease cholinergic agent efficacy.
--------------------------------------------------------------------------------------------------------------------------------
318
Sodium Chloride 0.9% Eye Drops
C
Indication :
Irrigation of conjunctival sac
Dosage :
1 - 2 drops every 3 - 4 hours
Precautions :
Not known
Adverse Effects :
Can cause temporary burning and irritation
Contraindications :
Hypersensitivity
Interactions :
Not known
-------------------------------------------------------------------------------------------------------------------------------------Sodium Cromoglycate 2% Eye Drops
A/KK
Trade Name : Opticrom
Indication :
Prevention and treatment of allergic conjunctivitis including seasonal and perennial allergic
conjunctivitis and vernal keratoconjunctivitis
Dosage :
1 or 2 drops 4 times daily
Precautions :
Pregnancy, lactation, children up to 4 years of age, elderly.
Adverse Effects :
Transient stinging and burning may occur after instillation and other symptoms of local irritation,
itching, redness and severe swelling of the eyes.
Contraindications :
Patients with known hypersensitivity to sodium cromoglycate or any other ingredient of the
products.
Interactions :
Not known.
-----------------------------------------------------------------------------------------------------------------------------------
319
19. EAR, NOSE AND OROPHARYNX
Ear preparations
Nose preparations
Oropharynx preparations
Antihistamies, hyposensitisation and allergic emergencies
Mucolytics
Aromatic inhalations
Cough preparations
Systemic nasal decongestants
Miscellaneous ear, nose and oropharynx
320
Betamethasone Disodium Phoshate 0.1% Ear Drops
B
Betamethasone Disodium Phoshate 0.5% Ear Drops
B
Trade Name : Betnesol
Indication :
Non-infected inflammatory conditions
Dosage :
Apply 2 - 3 drops every 2 - 3 hours, reduce frequency when relief obtained
Precautions :
Prolonged use in infants, pregnancy, may result in secondary fungal infections.
Adverse Reactions :
Local sensitivity reactions.
Contraindications :
Viral, fungal, tuberculosis, purulent eye infection, glaucoma, herpetic keratitis, otitis media, history
of perforation of the ear drum.
Interactions :
As general with other corticosteroids.
-------------------------------------------------------------------------------------------------------------------------------------Chloramphenicol 5% w/v Ear Drops
C
Trade Name : Chloromycetin
Indication :
Acute otitis media, otitis externa with perforation
Dosage :
Apply 2 - 3 drops into the ear 2 - 3 times daily. Not to be used for long term
Precautions :
Use with caution in the presence of perforated tymphanic membrane. Overgrowth of nonsusceptible infection over prolonged use.
Adverse Reactions :
Sensitivity to the vehicle propylene glycol, local irritation with symptoms of burning, itching,
urticaria, transient stinging.
Contraindications :
Hypersensitivity to chloramphenicol products, perforated tympanic membrane, chronic otitis media
with perforation.
Interactions :
With other antibacterials, antiepileptics, anticoagulants, cyclosporine.
-------------------------------------------------------------------------------------------------------------------------------------Framycetin Sulphate 0.5%, Dexamethasone 0.05% and Gramicidin 0.005% Ear Drops A/KK
Trade Name : Sofradex
Indication :
Otitis externa
Dosage :
Apply 2 - 3 drops 3 to 4 times daily
Precautions :
Glaucoma, pregnancy, prolonged use in infants.
Adverse Reactions :
Sensitivity reactions.
Contraindications :
Herpes simplex infection, viral diseases of cornea and conjuctiva, tuberculosis and fungal diseases of
eyes, herpetic keratitis.
321
Interactions :
Can increase nephrotocixity with amphotericin, cyclosporine.
-------------------------------------------------------------------------------------------------------------------------------------Ofloxacin 0.3% Otic Solution
A
Trade Name : Tarivid
Indication :
Acute otitis media with tympanostomy tubes, chronic suppurative otitis media with perforated
tympanic membranes and otitis externa
Dosage :
CHILD: 1 - 12 years: 5 drops twice daily for 10 days. ADULT and CHILD over 12 years: 6 - 10 drops
twice daily and remain in the ear about 10 minutes
Precautions :
If otic therapy does not resolve otorrhea after a full course of therapy, further evaluation is
suggested for other underlying causes. Prolonged use may result in overgrowth of fungal.
Adverse Reactions :
Ear ache, secondary fungal infection, otalgia, hearing reduction.
Contraindications :
Hypersensitiviti to ofloxacin, pregnancy, lactation.
Interactions :
Antacids, sucralfate, oral antidiabetics, warfarin, theophylline, probenecid, aminoglycosides, betalactam antibiotics.
----------------------------------------------------------------------------------------------------------------------------------Sodium Bicarbonate 5% w/v Ear Drops
C
Indication :
To soften the impacted ear wax
Dosage :
2-3 drops 3-4 times daily
Precautions :
Not known.
Adverse Reactions :
Contact dermatitis to sodium bicarbonate.
Contraindications :
Not known
Interactions :
Not known
-------------------------------------------------------------------------------------------------------------------------------------Alkaline Nasal Douche
Indication :
To remove nasal plug due to radiation
Dosage :
To be diluted with an equal volume of warm water before use
Precautions :
Epistaxis, not to be used in cranial surgery or trans nasal neuro surgical procedure.
Adverse Reactions :
Excessive use can be toxic due to its absorption.
Contraindications :
Not known.
322
B
Interactions :
Not known.
-------------------------------------------------------------------------------------------------------------------------------------Bismuth Subnitrate, Iodoform and Liquid Paraffin Paste
B
Trade Name : BIPP
Indication :
As a mild antiseptic for wounds and abscesses. Sterile gauze impregnated with paste for packing
cavities after otorhinological surgery
Dosage :
As directed for local application
Precautions :
Hyperthyroidism, nasal packing use not more than 3 days. Ear packing use not more than 2 weeks.
Adverse Reactions :
Erythematous rash, encephalopathy reported only with large packs or when placed directly on
neural tissue, nasal mucosal fibrosis.
Contraindications :
Allergy to iodine or other components in the preparations.
Interactions :
Not known
-------------------------------------------------------------------------------------------------------------------------------------Fusafungine 1% Nasal Spray
A
Trade Name : Locabiotal
Indication :
Local antibiotic, anti-inflammatory treatment of infectious and inflammatory syndromes of the
respiratory mucosa
Dosage :
ADULT : 1 oral or 1 nasal inhalation 4 hourly, withdraw if no improvement after 7 days. CHILD : 1 oral
or 1 nasal inhalation 6 hourly, withdraw if no improvement after 7 days
Precautions :
Treatment should be less than 10 days, reevaluate after this.
Adverse Reactions :
Rare cases of buccopharyngeal irritation and sneezing.
Contraindications :
Hypersensitivity to fusafungine. Children less than 30 months of age (risk of laryngospasm).
Interactions :
Systematically report any other ongoing treatment to the doctor or pharmacist so as to avoid any
interaction between several drugs.
-------------------------------------------------------------------------------------------------------------------------------------Mometasone Furoate 50 mcg Aqueous Nasal Spray
A*
Trade Name : Nasonex
Indication :
Allergic rhinitis
Dosage :
ADULT and CHILD over 12 years: 100 mcg/day (2 sprays) to each nostril once daily. Maximum 200
mcg (4 sprays) once daily. Reduce to 50 mcg (1 spray) once daily when control achieved. CHILD 6 - 12
years old: 50 mcg (1 spray) to each nostril once daily
323
Precautions :
Presence of untreated localized infection involving the nasal mucosa, recent nasal surgery or trauma,
pregnancy, infection e.g. tuberculosis, infection of the respiratory tract, untreated systemic fungal,
bacterial, viral or parasitic infections or ocular herpes simplex, systemic effects e.g. hypercorticism,
reduced bone mineral density and adrenal suppression, untreated systemic infections.
Adverse Reactions :
Headache, pharyngitis, cough epistaxis, viral infection, chest pain, dysmenorrhoea, vomiting, nausea,
diarrhoea, dyspepsia.
Contraindications :
Severe nasal infections especially candidiasis, patients with haemorrhagic diathesis or a history of
recurrent nasal bleeding, fungal, viral or tubercular skin lesions, herpes simplex or zoster,
hypersensitivity to mometasone or other corticosteroids, status asthmaticus or other acute episodes
of asthma (oral inhalation).
Interactions :
CYP3A4, amphotericin, antidiabetic agents, antifungal agents (imidazole), diuretics, potassiumwasting (loop or thiazide), fluoroquinolones.
-------------------------------------------------------------------------------------------------------------------------------------Oxymetazoline HCl 0.025% (Paediatric) Nasal Spray
A
Trade Name : Afrin, Iliadin
Indication :
Acute colds, paranasal sinusitis and otitis media
Dosage :
2 - 3 sprays into each nostril twice daily for child more than 1 year
Precautions :
Cardiovascular disease, diabetes mellitus, hypertension, prostatic enlargement, prolonged use over
3 to 5 days, thyroid disease.
Adverse Reactions :
After local use of oxymetazoline transient irritation may occur. Rebound congestion may occur after
frequent or prolonged nasal use. Systemic effects have occurred after local administration, burning,
sneezing, nasal dryness, hypertension.
Contraindications :
Skin and mucosal inflammation of the nasal vestibules with incrustation, narrow angle glaucoma,
hypersensitivity to oxymetazoline or other adrenergic agents.
Interactions :
Anticholinergic, beta blockers, linezolid, methylphenidate, tricyclic antidepressants, hypertensive
crisis if used during treatment with MAOI.
-------------------------------------------------------------------------------------------------------------------------------------Oxymetazoline HCl 0.05% (Adult) Nasal Spray
A
Trade Name : Afrin, Iliadin
Indication :
Acute colds, paranasal sinusitis and otitis media
Dosage :
2 - 3 sprays into each nostril twice daily, maximum 6 sprays per nostril/day
Precautions :
Cardiovascular disease, diabetes mellitus, hypertension, prostatic enlargement, prolonged use over
3 to 5 days, thyroid disease.
Adverse Reactions :
324
After local use of oxymetazoline transient irritation may occur. Rebound congestion may occur after
frequent or prolonged nasal use. Systemic effects have occurred after local administration, burning,
sneezing, nasal dryness, hypertension.
Contraindications :
Skin and mucosal inflammation of the nasal vestibules with incrustation, narrow angle glaucoma,
hypersensitivity to oxymetazoline or other adrenergic agents.
Interactions :
Anticholinergic, beta blockers, linezolid, methylphenidate, tricyclic antidepressants, hypertensive
crisis if used during treatment with MAOI.
-------------------------------------------------------------------------------------------------------------------------------------Benzydamine HCl 0.15% Solution
B
Trade Name : Difflam
Indication :
For relief of painful condition of the oral cavity
Dosage :
Used as a 30 seconds gargle or rinse, undiluted. ADULT 15 ml. CHILD less 12 years 5-15 ml.
Uninterrupted treatment should not be more than 7 days
Precautions :
Hepatic or renal impairment, pregnancy, children less than 6 years, in bacterial infection,
appropriate antibacterial therapy should be used in addition to product.
Adverse Reactions :
Oral numbness, dryness or thirst, tingling, warm feeling in mouth, altered sense of taste.
Contraindications :
Known hypersensitivity to the drug or to any of the components of the vehicle.
Interactions :
Not known.
-------------------------------------------------------------------------------------------------------------------------------------Chlorhexidine Gluconate 0.2 % Mouthwash
C
Trade Name : Hibitane
Indication :
As a gargle
Dosage :
Rinse mouth with 10 ml for about 1 minute twice daily
Precautions :
Avoid prolonged skin contact with alcoholic solution. Avoid contact with eyes, brain, meninges,
middle ear and body cavities. For external use only.
Adverse Reactions :
Occasionally, irritative skin reactions, extremely rare, generalised allergic reactions.
Contraindications :
Patients who have previously shown a hypersensitivity reaction to chlorhexidine. However, such
reaction are extremely rare.
Interactions :
Not known.
-------------------------------------------------------------------------------------------------------------------------------------Choline Salicylate 8.7%, Cetylkonium Chloride 0.01% Dental Gel
B
Trade Name : Bonjela
Indication :
For relief of the pain and discomfort in mouth ulcers and sores, infant teething and denture irritation
325
Dosage :
Apply to area 4 times daily
Precautions :
Excessive use can lead to salicylate poisoning. During therapy, do not give aspirin to children 16 year.
Co-administration with drugs for blood clots and gout. Stomach ulcer. Pregnancy.
Adverse Reactions :
Not known.
Contraindications :
Infants less than 4 months or in patients with a history of salicylate sensitivity. Preparations
containing aspirin should not be given to young children during treatment to avoid any risk of
excessive salicylate levels.
Interactions :
Not known.
-------------------------------------------------------------------------------------------------------------------------------------Glycerin
B
Indication :
As a lubricant and osmotic dehydrating agent
Dosage :
Apply to area when required
Precautions :
Cause irritation when given locally, local anesthetic may be used before application
Adverse Reactions :
Mainly due to dehydration action, irritation
Contraindications :
Not known
Interactions :
Not known
-------------------------------------------------------------------------------------------------------------------------------------Thymol Compound Gargle
C
Indication :
For sore throat and minor mouth inflammation
Dosage :
To be gargled 3-4 times daily
Precautions :
Not to be swallowed.
Adverse Reactions :
Irritant to the gastric mucosa.
Contraindications :
Not known.
Interactions :
Not known
-------------------------------------------------------------------------------------------------------------------------------------Triamcinolone Acetonide 0.1% Oral Paste
Trade Name : Kenalog in Orabase
Indication :
Oral and perioral lesions
Dosage :
Apply a thin layer to affected area 2-4 times daily
326
B
Precautions :
Tuberculosis, peptic ulcer, diabetes mellitus, pregnancy.
Adverse Reactions :
Prolonged use may lead to possible absorption.
Contraindications :
Hypersensitivity to any of its components, fungal or bacterial infections of the mouth or throat,
herpetic lesions of known viral origin or intraoral lesions.
Interactions :
Minor interaction with hypoglycaemic agents.
-------------------------------------------------------------------------------------------------------------------------------------Cetirizine HCl 10 mg Tablet
A/KK
Trade Name : Zyrtec
Indication :
Urticaria, allergic dermatoses (insect bites, atopic eczema), perennial rhinitis, allergic rhinitis
Dosage :
ADULT and CHILD over 6 years:10 mg daily or 5 mg twice daily. Child 2-6 years: 5 mg once daily or
2.5 mg twice daily
Precautions :
Activities requiring mental alertness. Concurrent use of central nervous system depressants. Renal
insufficiency or hepatic dysfunction, elderly. Patient less than 2 years.
Adverse Reactions :
Somnolence, fatigue, headache and dry mouth.
Contraindications :
Hypersensitivity to cetirizine or hydroxyzine.
Interactions :
Decreased cetirizine clearance resulting in elevated cetirizine serum concentrations and possibly
cetirizine toxicity with theophylline.
-------------------------------------------------------------------------------------------------------------------------------------Chlorpheniramine Maleate 10 mg/ml Injection
B
Trade Name : Piriton
Indication :
Allergic conditions
Dosage :
10 - 20 mg IM or SC, repeated if required. Not to exceed 40 mg in 24 hours. 10 - 20 mg over 1 minute
by slow IV
Precautions :
Porphyria, pregnancy, asthma, glaucoma, avoid operating vehicles or machinery. Parenteral injection
have to be protected from light to prevent discolouration.
Adverse Reactions :
Drowsiness, dizziness, stinging or burning sensation at injection site, hypotension, CNS stimulation,
tinnitus, blurred vision, irritability, lassitude.
Contraindications :
Hypersensitivity to chlorpheniramine.
Interactions :
Alcohol pontentiate CNS depressants, actions prolonged by MOAIs, anticholigernic drugs.
--------------------------------------------------------------------------------------------------------------------------------------
327
Chlorpheniramine Maleate 2 mg/5 ml Syrup
C
Indication :
Symptomatic treatment of allergic conditions responsive to antihistamine
Dosage :
CHILD 1 - 2 years : 1 mg twice daily, 2 - 5 years : 1 mg every 4 - 6 hours (maximum 6 mg daily), 6 - 12
years : 2 mg every 4 - 6 hours (maximum 12 mg daily)
Precautions :
Porphyria, pregnancy, asthma, glaucoma, avoid operating vehicles or machinery.
Adverse Reactions :
Drowiness, dizziness, hypotension, CNS stimulation, tinnitus, blurred vision, irritability, lassitude.
Contraindications :
Interactions :
Alcohol pontentiate CNS depressants, actions prolonged by MAOIs, anticholigernic drugs.
-------------------------------------------------------------------------------------------------------------------------------------Chlorpheniramine Maleate 4 mg Tablet
C
Indication :
Symptomatic treatment of allergic conditions responsive to antihistamines
Dosage :
ADULT : 4 mg every 4 - 6 hours. Maximum 24 mg daily. CHILD 1 - 2 years : 1 mg twice daily, 2 - 5
years : 1 mg every 4 - 6 hours (maximum 6 mg daily), 6 - 12 years : 2 mg every 4 - 6 hours (maximum
12 mg daily)
Precautions :
Prophyria, pregnancy, asthma, glaucoma avoid operating vehicles or machinery.
Adverse Reactions :
Drowsiness, dizziness, hypotension, CNS stimulation, tinnitus, blurred vision, irritability, lassitude.
Contraindications :
Interactions :
Alcohol, CNS depressants, MAOIs, anticholinergics drugs.
-------------------------------------------------------------------------------------------------------------------------------Desloratadine 5 mg Tablet
A*
Trade Name : Aerius
Indication :
Allergic rhinitis and chronic idiopathic urticaria
Dosage :
ADULT & CHILD more than 12 years : 5 mg once daily. CHILD: 6-11 yr: 2.5 mg; 1-5 yr: 1.25 mg; 6-11
mth: 1 mg. Doses to be taken once daily
Precautions :
Phenylketonuric patient, severe renal or hepatic failure; children less than 6 month, elderly,
epilepsy, preg-nancy and lactation.
Adverse Reactions :
Fatigue, headache and dry mouth.
Contraindications :
Hypersensitivity to desloratadine or loratadine.
328
Interactions :
Amphetamines, alcohol, betahistine, CNS depressants, acetylcholinesterase Inhibitors.
-------------------------------------------------------------------------------------------------------------------------------------Hydroxyzine HCl 25 mg Tablet
A
Trade Name : Atarax
Indication :
Allergic pruritus
Dosage :
Initially 25 mg at night, increased if necessary up to 25 mg 3-4 times daily. ADULT and CHILD more
than 10 years : 50 - 75 mg; 6 - 10 years: 25 - 50 mg; 1 - 5 years: 12.5 - 25 mg; to be taken daily in
divided doses
Precautions :
Concomitant administration with central nervous system depressants, asthma, dose adjustment in
liver disease. Avoid driving and operating machinery. Lactation, ECG abnormalities, porphyria.
Adverse Reactions :
Sleepiness, drowsiness, headache, dizziness, weakness, depression and irritability, dry mouth, chest
tightness, tremor, convulsions, hypersensitivity reactions (wheezing, shortness of breath).
Contraindications :
Pregnancy, breastfeeding and hypersensitivity reaction.
Interactions :
Sedating antihistamines may enhance the sedative effects of CNS depressants including alcohol,
barbiturates, hypnotics, opioid analgesics, anxiolytic sedatives and antipsychotics. Have an additive
antimuscarinic action with other antimuscarinic drugs.
-------------------------------------------------------------------------------------------------------------------------------------Levocetirizine Dihydrochloride 5 mg Tablet
A*
Trade Name : Xyzal
Indication :
Symptomatic treatment of allergic rhinitis (including persistent allergic rhinitis) and chronic idopathic
urticaria
Dosage :
Children above 6 years and adults: 5 mg orally once daily (Swallow whole, do not chew/crush).
Precautions :
Concurrent alcohol use; should be avoided due to potential increase in CNS depression and sedation,
concurrent use of other central nervous system depressants; should be avoided due to potential
increase in CNS depression and sedation, renal function, impaired; increased risk of adverse
reactions, dosage adjustment required
Adverse Reactions :
Asthenia, somnolence, nasopharyngitis, pharyngitis, xerostomia, fatigue, fever
Contraindications :
Hemodialysis patients, hypersensitivity to levocetirizine, cetirizine, or any component of the product,
end-stage renal disease, (CrCl less than 10 mL/min), renally impaired pediatric patients between 6
months and 11 years old
Interactions :
Concurrent alcohol use; should be avoided due to potential increase in CNS depression and sedation,
concurrent use of other central nervous system depressants; should be avoided due to potential
increase in CNS depression and sedation, renal function, impaired; increased risk of adverse
reactions, dosage adjustment required
--------------------------------------------------------------------------------------------------------
329
Loratadine 1 mg/ml Syrup
A
Trade Name : Clarityne
Indication :
Allergic rhinitis, chronic urticaria and other allergic dermatological disorders
Dosage :
ADULT and CHILD over 6 years : 10 mg once daily. CHILD 2 - 6 years: 5 mg once daily
Precautions :
Impaired liver and renal function (use lower dose). Should not take with alcohol and avoid operating
vehicle and machinery.
Adverse Reactions :
Headache, nervousness, sedation.
Contraindications :
Hypersensitivity to loratadine.
Interactions :
Cimetidine, erythromycin, ketoconazole and other hepatic enzyme inhibitors.
-------------------------------------------------------------------------------------------------------------------------------------Loratadine 10 mg Tablet
B
Trade Name : Clarityne
Indication :
Allergic rhinitis and allergic dermatoses
Dosage :
ADULT and CHILD over 6 years 10 mg once daily. CHILD 2 - 6 years: 5 mg once daily
Precautions :
Impaired liver and renal function (use lower dose). Should not take with alcohol and avoid operating
vehicle and machinery.
Adverse Reactions :
Headache, sedation, nervousness.
Contraindications :
Hypersensitivity to loratadine.
Interactions :
Cimetidine, erythromycin, ketoconazole and other hepatic enzyme inhibitors.
-------------------------------------------------------------------------------------------------------------------------------------Loratadine 5 mg and Pseudoephedrine Sulphate 120 mg Tablet
A/KK
Trade Name : Clarinase
Indication :
For treatment of allergic rhinitis and allergic dermatoses
Dosage :
ADULT and CHILD over 12 years 1 tablet twice daily
Precautions :
Avoid in hepatic insufficiency, renal insufficiency (use lower initial dose), pregnancy, hypertension,
diabetes mellitus, ischaemic heart disease, increased intraocular pressure, hyperthyroidism,
prostatic hypertrophy, stenosing peptic ulcer, elderly, lactating, prostatic hypertrophy.
Adverse Reactions :
Headache, nervousness, dizziness, tachycardia, rhinitis, pruritis, acne, insomnia, fatigue, pharyngitis,
somnolence, nausea, palpitations, tachycardia.
Contraindications :
Narrow-angle glaucoma, urinary retention, severe coronary artery disease, severe hypertension,
concomitant therapy with MAOIs or within 10 days of continuing such treatment, hyperthyroidism,
hepatic and renal impairment, hypersensitivity to loratadine or pseudoephedrine.
330
Interactions :
Loratadine is metabolised by cytochrome P450 isoenzymes CYP3A4 and CYP2D6. Therefore
concomitant administration of other drugs that inhibit or are metabolised by these hepatic enzymes
may result in changes in plasma concentrations of either drug, bromocriptine, hydrocodone,
selegiline.
-----------------------------------------------------------------------------------------------------------------------------------Promethazine HCl 25 mg/ml Injection
B
Trade Name : Phenergan
Indication :
Allergic conditions
Dosage :
By deep IM: ADULT: 25 - 50 mg, maximum 100 mg. CHILD: 5 - 10 years : 6.25 - 12.5 mg. By slow IV:
25 - 50 mg in a solution of 2.5 mg/ml in water for injection. Maximum 100 mg
Precautions :
Pregnancy, lactation, cardiovascular or hepatic diseases, narrow angle glaucoma, asthma, COPD,
pediatric patient, peptic ulcer, pyloduodenal obstruction, prostatic hypertrophy.
Adverse Reactions :
Sedation, gastrointestinal disturbances, antimuscarinic effects, muscular weakness, tinnitus, allergic
reactions, blood disorders, respiratory depression.
Contraindications :
Hypersensitivity to promethazine. Comatose patients, acute attack of asthma, children under 2
years, SC and intra- or peri-arterial injection.
Interactions :
Antihypertensives, phenothiazines, alcohol, anticholinergics, tricyclic antidepressants, MAOIs,
evening primrose oil.
-------------------------------------------------------------------------------------------------------------------------------------Promethazine HCl 5 mg/5 ml Syrup
B
Trade Name : Phenergan
Indication :
Allergic conditions
Dosage :
CHILD 2 - 5 years: 5 - 15 mg daily, 5 - 10 years : 10 - 25 mg daily
Precautions :
Pregnancy, lactation, cardiovascular or hepatic diseases, narrow angle glaucoma, asthma, COPD,
paediatric patient, peptic ulcer, pyloduodenal obstruction, prostatic hypertrophy.
Adverse Reactions :
Sedation, gastrointestinal disturbances, antimuscarinic effects, muscular weakness, tinnitus, allergic
reactions, blood disorders, respiratory depression.
Contraindications :
Hypersensitivity to promethazine. Comatose patients, acute attack of asthma, children under 2
years.
Interactions :
Antihypertensives, phenothiazines, alcohol, anticholinergics, tricyclic antidepressants, MAOIs,
evening primrose oil.
--------------------------------------------------------------------------------------------------------------------------------------
331
Bromhexine HCl 4 mg/2 ml Injection
A
Trade Name : Bisolvon
Indication :
Secretolytic therapy in acute and chronic bronchopulmonary diseases associated with abnormal
mucous secretion and impaired mucous transport
Dosage :
4 mg SC, IM or IV 2 - 3 times daily
Precautions :
Gastrointestinal ulceration, pregnancy and lactation.
Adverse Reactions :
Occasionally gastrointestinal effects, skin rashes very rarely. Gastrointestinal disturbances,
headache, dizziness, sweating, skin rash, transient rise in serum transaminase.
Contraindications :
Hypersensitivity to bromhexine.
Interactions :
May lead to higher antibiotic concentration in lung tissue. Oral anticoagulants.
-------------------------------------------------------------------------------------------------------------------------------------Bromhexine HCl 8 mg Tablet
B
Trade Name : Bisolvon
Indication :
Secretolytic therapy in acute and chronic bronchopulmonary diseases associated with abnormal
mucous secretion and impaired mucous transport
Dosage :
ADULT and CHILD more than 12 years : 8 mg 3 times daily, 6 - 12 years : 4 mg 3 times daily, 2 - 6
years : 4 mg 2 times daily
Precautions :
Gastrointestinal ulceration, pregnancy and lactation.
Adverse Reactions :
Occasionally gastrointestinal effects, skin rashes very rarely. Gastrointestinal disturbances,
headache, dizziness, sweating, skin rash, transient rise in serum transaminase.
Contraindications :
Hypersensitivity to bromhexine.
Interactions :
May lead to higher antibiotic concentration in lung tissue. Oral anticoagulants.
-------------------------------------------------------------------------------------------------------------------------------------Menthol 1.6% in Industrial Methylated Spirit Inhalation
C
Indication :
Decongestion of the upper respiratory tract
Dosage :
As directed for local use
Precautions :
Not known.
Adverse Reactions :
Hypersentivity reactions including contact dermatitis.
Contraindications :
Not known.
Interactions :
Not known
--------------------------------------------------------------------------------------------------------------------------------------
332
Ammonium Bicarbonate, Tincture Ipecac, etc Mixture
C
Trade Name : Expect Stimulant
Indication :
Cough
Dosage :
10 - 20 ml 3 times daily
Precautions :
Can be irritant to mucous membrane.
Adverse Reactions :
If consumed in very large dose can cause nausea and vomiting.
Contraindications :
Hepatic or renal impairment.
Interactions :
Not known.
-------------------------------------------------------------------------------------------------------------------------------------Diphenhydramine HCl 10 mg/5 ml Elixir
C
Trade Name : Benadryl
Indication :
Cough and allergic rhinitis
Dosage :
CHILD 2 - 6 years : 6.25 mg 3 - 4 times daily, 6- 12 years : 12.5 - 25 mg 3 - 4 times daily
Precautions :
Renal or hepatic disease, glaucoma or in patients on MAOIs. May cause drowsiness, may impair
ability to drive and operate machine.
Adverse Reactions :
Sedation, dizziness, coordination problems, dry mucous membranes, blurred vision, paradoxical CNS
stimulation, nasal stuffiness, palpitation, epigastric discomfort.
Contraindications :
Hypersensitivity to diphenhydramine or other antihistamines of similar chemical structure, in
breastfeeding, newborns or infants.
Interactions :
Additive effects if use with hypnotics, sedatives, tranquilizers. Actions prolonged by MAOIs.
-------------------------------------------------------------------------------------------------------------------------------------Diphenhydramine HCl 14 mg/5 ml and Ammonium Chloride 135 mg/5 ml Expectorant
C
Trade Name : Benadryl
Indication :
Cough
Dosage :
ADULT : 5 - 10 ml 2 - 3 times daily. CHILD : 2.5 - 5 ml 2 - 3 times daily
Precautions :
Renal or hepatic disease, glaucoma or in patients on MAOIs. May cause drowsiness, may impair
ability to drive and operate machine.
Adverse Reactions :
Sedation, dizziness, coordination problems, dry mucous membranes, blurred vision, paradoxical CNS
stimulation, nasal stuffiness, palpitation, epigastric discomfort.
Contraindications :
Hypersensitivity to diphenhydramine or other antihistamines of similar chemical structure, lactation,
newborns or infants.
333
Interactions :
Additive effects if use with hypnotics, sedatives, tranquilizers. Actions prolonged by MAOIs.
-------------------------------------------------------------------------------------------------------------------------------------Triprolidine HCl 2.5 mg and Pseudoephedrine HCl 60 mg Tablet
B
Trade Name : Actifed
Indication :
Decongestion of the upper respiratory tract in common cold, hay fever, allergic and vasomotor
rhinitis and aerotitis
Dosage :
ADULT 2.5 mg every 4 - 6 hours; maximum dose 10 mg/day. CHILD 6 - 12 years : 1.25 mg every 4 - 6
hours; maximum dose 5 mg/day, 2 - 4 years : 0.625 mg every 4 - 6 hours; maximum dose 2.5
mg/day, 4 - 6 years : 0.938 mg every 4 - 6 hours; maximum dose 3.744 mg/day, 4 months - 2 years :
0.313 mg every 4-6 hours; maximum dose 1.25 mg/day. Not FDA approved in children less than 6
years old
Precautions :
Diabetes, hypertension, heart disease, hyperthyroidism, elevated intraocular pressure, prostatic
enlargement, asthma, chronic obstructive pulmonary disease, prostatic hypertrophy, pyloric
obstruction, stenosing peptic ulcer and avoid operating vehicles and machinery.
Adverse Reactions :
Drowsiness, sleep disturbances, skin rashes, dryness of nose, mouth and throat, hypotension or
hypertension, tachycardia, anorexia, nausea, vomiting, constipation, diarrhea, abdominal pain,
wheezing, tightness of chest, impotence, blurred vision, urinary retention.
Contraindications :
Angle-closure glaucoma, hypersensitivity to triprolidine products, neonates.
Interactions :
Antihypertensives, tricyclic antidepressants, decongestants, appetite suppressants, amphetaminelike psychostimulant, other sympathomimetics.
-------------------------------------------------------------------------------------------------------------------------------------Betahistine Dihydrochloride 24 mg Tablet
A*
Trade Name : Betaserc®
Indication :
Vertigo, tinnitus and hearing loss associated with Meniere's disease
Dosage :
24 mg twice daily
Precautions :
Betahistine should not be given to patients with phaeochromocytoma. It should be given with care
to patients with asthma, peptic ulcer disease or a history of peptic ulcer disease. Antihistamines may
block some or all of intended effects of betahistine. Liver disease, pregnancy, lactation.
Adverse Reactions :
Nausea, vomiting, skin rash, pruritus.
Contraindications :
Hypersensitivity, phaeochromocytoma.
Interactions :
Selegiline.
--------------------------------------------------------------------------------------------------------------------------------------
334
Cinnarizine 25 mg Tablet
B
Trade Name : Stugeron
Indication :
Vestibular disorders
Dosage :
One tablet 3 times daily
Precautions :
Pregnancy, Parkinson's disease. May affect ability to drive or operate machinery.
Adverse Reactions :
Gastrointestinal disturbances, epigastric pain, nausea and vomiting, tinnitus, lupus erythematosus.
Contraindications :
Avoid in porphyria.
Interactions :
Alcohol, CNS depressants.
-------------------------------------------------------------------------------------------------------------------------------------Cocaine 10% Solution
B
Indication :
To produce local anaesthesia or vasoconstriction during endoscopic nasal surgery, turbinectomy
septoplasty, polypectomy etc
Dosage :
Maximum total dose recommended for application to the nasal mucosa in healthy adult is 1.5 to 2
mg/kg of a 10% cocaine solution
Precautions :
Avoid in porphyria and direct sunlight.
Adverse Reactions :
Can cause addiction, arrythmia, palpitation, central nervous system stimulation, syncope, seizure,
coronary arteriosclerosis.
Contraindications :
Never given by injection due to its marked sympathomimetic effects.
Interactions :
Interacts with some drugs and can cause arrhythmia.
--------------------------------------------------------------------------------------------------------------------------------------
335
21. DERMATOLOGY
Emollient and barrier preparation
Topical local anaesthetics and antipruritics
Topical corticosteroids
Preparations for eczema and psoriasis
Acne and rosacea
Preparations for warts and calluses
Shampoos and other preparations for scalp conditions
Anti-infective skin preparations
Disinfectants, skin cleaners & antiseptics
Miscellaneous dermatology
336
Aqueous Cream
C
Indication :
Dry skin
Dosage :
As a soap or apply to the skin as an emollient cream
Precautions:
It should not be used before phototherapy or in phototesting procedures
Adverse Reaction:
Not known
Contraindications:
Not known
Interactions:
Not known
-----------------------------------------------------------------------------------------------------------------------------------Calamine Cream
C
Indication :
Prickly heat or insect bites
Dosage :
Apply to the affected area as required
Precautions:
Avoid contact with eyes and other mucous membranes
Adverse Reaction:
Rash or irritation
Contraindications:
Not known
Interactions:
Not known
-------------------------------------------------------------------------------------------------------------------------------------Calamine Lotion
C
Indication :
Prickly heat or insect bites
Dosage :
Apply to the skin as required and allow to dry, 1-3 times daily
Precautions:
Adverse Reaction:
Rash or irritation
Contraindications:
Not known.
Interactions:
Not known.
-------------------------------------------------------------------------------------------------------------------------------------Calamine with 2 - 6% Precipitated Sulphur Lotion
Indication :
Acne vulgaris
Dosage :
Apply to the skin as required and allow to dry, 1 - 3 times daily
337
C
Precautions:
Avoid contact with eyes and other mucous membranes. Do not use on children under 2 years
without consulting a physician
Adverse Reaction:
Rash or irritation
Contraindications:
Not known
Interactions:
Not known
-------------------------------------------------------------------------------------------------------------------------------------Emulsificants Ointment
C
Indication :
Xerosis and ichthyosis
Dosage :
Use as a soap and emollient
Precautions:
Should not be used before phototherapy or in phototesting procedures
Adverse Reaction:
Not known
Contraindications:
Hypersensitivity to any component
Interactions:
Not known
-------------------------------------------------------------------------------------------------------------------------------------Paraffin, White Soft
C
Paraffin, Yellow Soft
C
Trade Name : Vaseline
Indication :
Xerosis and ichthyosis
Dosage :
Apply to the affected area
Precautions:
Avoid exposure to fire
Adverse Reaction:
Contraindications:
Interactions:
Not known
----------------------------------------------------------------------------------------------------------------------------------Crotamiton 10 % Cream
A/KK
Trade Name : Eurax
Indication :
i) Pruritus ii) Scabies iii) Insect bite reactions
Dosage :
i) and iii) Massage into affected area until the medication is completely absorbed. Repeat as needed.
Apply 2 or 3 times daily ii) Apply topically (do not rinse off), apply a second time and leave on skin for
338
24 - 48 hours. For resistant scabies, treatment (2 applications at 24 hour interval) may be repeated
after 1 week
Precautions:
Avoid contact with eyes, face, mouth and mucous membranes. Pregnancy. Avoid applying to
inflamed skin or raw, oozing skin surfaces. Discontinue use of crotamiton if severe skin irritation
develops
Adverse Reaction:
Local skin irritation or contact allergy
Contraindications:
Do not apply on nipples when breastfeeding, hypersensitivity to crotamiton
Interactions:
Not known
--------------------------------------------------------------------------------------------------------------------------------Miconazole 2% Cream
B
Trade Name : Daktarin
Indication :
i) Fungal infections: Tinea pedis, Tinea corporis, Tinea capitis and other dermatophyte infections
caused by Trichophyton and Epidermophyton species ii) Antifungal agent that has been in various
candida infections including vaginal candidiasis
Dosage :
i) Skin Infection: Apply sparingly and rub gently onto affected area 1-2 times daily continuing for 10
days after lesions have healed ii) Apply twice daily continuing for 10 days after lesions have healed
Precautions:
First trimester of pregnancy, lactation. Local sensitization or irritation, to discontinue use
Adverse Reaction:
Ocassional skin irritation or sensitivity, contact dermatitis, vaginal burning due to cream base
Contraindications:
Children less than 2 year. Hypersensitivity to manizole products
Interactions:
Not known
-------------------------------------------------------------------------------------------------------------------------------------Clobetasol Propionate 0.05% Cream
A
Trade Name : Dermovate
Indication :
Short term treatment only of more resistant dermatoses eg. psoriasis, recalcitrant eczemas, lichen
planus, discoid lupus erythematosus and other conditions which do not respond satisfactorily to less
potent steroids
Dosage :
Apply sparingly once or twice daily, changing to lower potency therapy as soon as condition is
controlled. For mild to moderate use maximum for 2 weeks. For moderate to severe maximum
duration 4 consecutive weeks. Max: 50 g/week
Precautions:
INFANTS and CHILD: prolonged and continuous use, pregnancy, avoid contact with eyes. Do not use
for greater than 2 consecutive weeks or with occlusive dressing
Adverse Reaction:
Local atrophic skin changes, hypercorticism, burning, stinging, irritation and adrenal suppression
Contraindications:
Rosacea, acne vulgaris, skin lesions caused by viral, fungal and bacterial infections. Hypersensitivity
to clobetasol or other corticosteroid
339
Interactions:
Not known
------------------------------------------------------------------------------------------------------------------------------------Clobetasol Propionate 0.05% Ointment
A
Trade Name : Dermovate
Indication :
Short term treatment only of more resistant dermatoses eg. psoriasis, recalcitrant eczemas, lichen
planus, discoid lupus erythematosus and other conditions which do not respond satisfactorily to less
potent steroids
Dosage :
Apply sparingly once or twice daily, changing to lower potency therapy as soon as condition is
controlled. For mild to moderate use maximum for 2 weeks. For moderate to severe maximum
duration 4 consecutive weeks. Max:50 g/week
Precautions:
INFANT and CHILD: prolonged and continuous use, pregnancy, avoid contact with eyes. Do not use
for greater than 2 consecutive weeks or with occlusive dressing
Adverse Reaction:
Local atrophic skin changes, hypercorticism, burning, stinging, irritation and adrenal suppression
Contraindications:
Rosacea, acne vulgaris, skin lesions caused by viral, fungal and bacterial infections. Hypersensitivity
to clobetasol or other corticosteroid
Interactions:
Not known
-------------------------------------------------------------------------------------------------------------------------------------Clobetasone Butyrate 0.05% Cream
A/KK
Trade Name : Eumovate
Indication :
Eczema and dermatitis of all types
Dosage :
Apply up to four times daily until condition improves, then reduce frequency
Precautions:
Infants and children, prolonged and continuous use, pregnancy. Discontinue if secondary infection
develops, avoid prolonged application to face
Adverse Reaction:
Hypersensitivity to clobetasone or other corticosteriods. Transient adrenal suppression.
Pigmentation changes and hypertrichosis
Contraindications:
Skin lesions caused by viral, fungal and bacterial infections. Hypersensitivity to clobetasone or other
corticosteroids
Interactions:
Not known
------------------------------------------------------------------------------------------------------------------------------------Clobetasone Butyrate 0.05% Ointment
Trade Name : Eumovate
Indication :
Eczema and dermatitis of all types
Dosage :
Apply up to four times daily until condition improves, then reduce frequency
340
A
Precautions:
Infants and children, prolonged and continuous use, pregnancy. Discontinue if secondary infection
develops, avoid prolonged application to face
Adverse Reaction:
Hypersensitivity to clobetasone or other corticosteriods. Transient adrenal suppression. Pigmentary
changes and hypertrichosis
Contraindications:
Skin lesions caused by viral, fungal and bacterial infections. Hypersensitivity to clobetasone or other
corticosteroids
Interactions:
Not known
-------------------------------------------------------------------------------------------------------------------------------------Hydrocortisone 1% Cream
B
Indication :
Inflammatory and pruritic manifestations of corticosteroid responsive dermatoses
Dosage :
Apply sparingly to affected area 2 - 3 times daily until condition improve, then reduce frequency
Precautions:
Prolonged use in infants and children, ulceration at infection site, diabetes mellitus
Adverse Reaction:
Local atrophic skin changes, impaired skin healing
Contraindications:
Fungal and bacterial infections, tuberculosis of the skin, viral disease of the skin, acne vulgaris,
rosacea, perioral dermatitis. Hypersensitivity to hydrocortisone
Interactions:
Not known
----------------------------------------------------------------------------------------------------------------------------------Mometasone Furoate 0.1% Cream
A*
Trade Name : Elomet
Indication :
Steroid responsive dermatosis and vitiligo. Used where a potent steroid is required for short
duration not more than 6 weeks
Dosage :
Apply once daily to affected areas. Do not use in paediatric patients for longer than 3 weeks
Precautions:
Systemic absorption may be increased if extensive body surface are treated. Do not use occlusive
dressing. Long term use in infant and children. Avoid contact with eyes, pregnancy, lactation
Adverse Reaction:
Burning, pruritus, skin atrophy, paraesthesia, tingling or stinging
Contraindications:
Hypersensitivity to mometasone or any component of the formulation
Interactions:
CYP3A4
--------------------------------------------------------------------------------------------------------------------------------------
341
Acitretin 25 mg Capsule
A*
Trade Name : Neotigason
Indication :
Generalised pustular and or erythrodermic psoriasis, pityriasis rubra pilaris, Darier's Disease,
Icthyosiform Erythrodermas - Bullous and non-bullous forms, extensive naevus verrucosus, extensive
psoriasis
Dosage :
ADULT: initially 25-30 mg daily for 2-4 weeks, then adjusted according to response, usually within
range 25-50 mg daily for further 6-8 weeks (max: 75 mg daily). CHILD: 500 mcg/kg daily occasionally
up to 1 mg/kg daily to a max. 35 mg daily for limited periods
Precautions:
Long-term treatment, diabetes, obesity, alcoholism, disturbances of lipid metabolism
Adverse Reaction:
Symptoms of hypervitaminosis A, localized but reversible hair loss, thinning and scaling of the skin,
paronychia, muscle and joint pain
Contraindications:
Pregnancy and lactation, liver and kidney insufficiency, hypervitaminosis A, excessively elevated
blood lipid values
Interactions:
Oral contraceptives, progestogen may result in loss of contraceptive effectiveness. Ethanol may
result in a prolonged risk of teratogenicity. Possible hypervitaminosis with vitamin A. Reduces
protein binding of Phenytoin
-------------------------------------------------------------------------------------------------------------------------------------Calcipotriol 50 mcg/g Cream
A*
Trade Name : Daivonex
Indication :
Only for the treatment of Psoriasis Vulgaris
Dosage :
Apply to the affected skin lesions twice daily. Maintenance therapy may be achieved with less
frequent application. The weekly dose should not exceed 100 g.
Precautions:
Should not be used on the face since the formulation may give rise to irritation of the facial skin.
Careful handwashing after use is recommended
Adverse Reaction:
Transient local irritation and very rarely, facial dermatitis may occur, hypercalcaemia
Contraindications:
Hypersensitivity to any constituents of the calcipotriol. Disorders of calcium metabolism
Interactions:
Not known
-------------------------------------------------------------------------------------------------------------------------------------Calcipotriol 50 mcg/g Ointment
A*
Trade Name : Daivonex
Indication :
Dosage :
Apply to the affected skin lesions twice daily. Maintenance therapy may be achieved with less
frequent application. The weekly dose should not exceed 100 g
342
Precautions:
Should not be used on the face since the ointment formulation may give rise to irritation of the facial
skin. Careful handwashing after use is recommended
Adverse Reaction:
Transient local irritation and very rarely, facial dermatitis may occur, hypercalcaemia
Contraindications:
Interactions:
Not known
-------------------------------------------------------------------------------------------------------------------------------------Calcipotriol 50 mcg/ml Scalp Solution
A*
Trade Name : Diavonex
Indication :
Dosage :
Apply to the affected skin lesions twice daily. Weekly maintenance therapy may be achieved with
less frequent application. The weekly dose should not exceed 100 g
Precautions:
Should not be used on the face since the formulation may give rise to irritation of the facial skin.
Careful handwashing after use is recommended
Adverse Reaction:
Transient local irritation and very rarely, facial dermatitis may occur and hypercalcaemia
Contraindications:
Interactions:
Not known
-------------------------------------------------------------------------------------------------------------------------------------Calcipotriol Hydrate 50 mcg/g & Betamethasone Dipropionate 0.5 mg/g Ointment
A*
Trade Name : Daivobet
Indication :
Resistant plaque psoriasis
Dosage :
Apply once daily up to 4 weeks with maximum weekly dose of 100g and maximum treatment area
30% of body surface
Precautions:
Avoid contact with face and eyes. Avoid application on large areas of damaged skin, under occlusive
dressings or in skin folds. Pregnancy and lactation
Adverse Reaction:
Pruritus, rash, local transient irritation, dermatitis, erythema, aggravation of psoriasis,
photosensitivity and hypersensitivity reactions
Contraindications:
Disorders of calcium metabolism, viral, fungal or bacterial skin infections, parasitic infections, skin
manifestations in relation to tuberculosis or syphilis, rosacea, acne rosacea, perioral dermatitis, acne
vulgaris, skin atrophy, striae atrophicae, fragility of skin
Interactions:
Alatrofloxacin, alcuronium, Amphotericin B Liposome, Anthrax Vaccine Adsorbed, Anthrax Vaccine
Adsorbed, Bacillus of Calmette and Guerin Vaccine Live, Carbamazepine, Ciprofloxacin, Diphtheria
Toxoid, Adsorbed, Ethinyl Estradiol, Etonogestrel
----------------------------------------------------------------------------------------------------------------------------------
343
Carbamide (Urea) 10 % Cream
B
Trade Name : Calmurid
Indication :
Contact irritant dermatitis, infantile eczemas, acute and chronic allergic eczemas, icthyosis,
hyperkeratotic
Dosage :
Apply sparingly and rub into affected area 2 - 3 times daily and when required after cleansing skin
Precautions:
Avoid contact with eyes, discontinue use if oral inflammation persists or worsens. Use with caution
on inflammed skin or exudative lesions: irritation may results
Adverse Reaction:
Skin irritation, rash and ischaemic skin necrosis
Contraindications:
Hypersensitivity to urea or any component
Interactions:
Not known
----------------------------------------------------------------------------------------------------------------------------------Coal Tar 20% Solution
B
Indication :
Dandruff, seborrhoeic dermatitis, atopic dermatitis, eczema and psoriasis
Dosage :
Use 100 ml in a bath
Precautions:
Do not apply to acutely inflammed skin. Avoid contact with eyes and do not apply coal tar
preparations (other than bath emulsions) to genital or rectal areas
Adverse Reaction:
Skin ulcerations, hypersensitivity reactions including allergic contact dermatitis, aggravations of
status varicosus. The use of ultraviolet light and coal tar may produce or aggravate herpes lesions
keratocystomatosis, folliculitis, erythema and a smarting
Contraindications:
Presence of folliculitis and acne vulgaris. Active or inflammed psoriasis, weeping eczema,
erythrodermic and generalized pustular psoriasis, photosensitivity
Interactions:
Not known
-------------------------------------------------------------------------------------------------------------------------------------Cocois Co. Ointment
Indication :
Scalp psoriasis and severe seborrhoeic dermatitis
Dosage :
Rub a small amount into the scalp gently
Precautions:
Avoid eyes, mucosa, genital, rectal areas, broken or inflammed skin
Adverse Reaction:
Dermatitis, folliculitis
Contraindications:
Hypersensitivity to any of its ingredients
344
B
Interactions:
Not known
-------------------------------------------------------------------------------------------------------------------------------------Hydroxyurea 500 mg Capsule
A
Trade Name : Hydrea
Indication :
i)Solid tumours ii) Chronic myelocytic leukaemia and myeloproliferative disease iii)Severe psoriasis
eg. Extensive plaque psoriasis, erythrodermic psoriasis, pustular psoriasis -as third line therapy.
Dosage :
i)Intermittent therapy : 80 mg/kg orally as a single dose every 3rd day. Continuous therapy : 20 - 30
mg/kg orally as a single dose dly. Concomitant therapy with irradiation : 80 mg/kg orally as a single
dose every 3rd day.(administration of hydroxyurea should be started at least 7 days before initiation
of irradiation and continued during radiotherapy as well). ii)Continuous therapy (20 - 30 mg/kg orally
as a single dose daily, therapy should be interrupted if the white blood cell count drops below
2500/mm3, or the platelet count below 100,000/mm3. iii) 500 mg tds.
Precautions:
Hydroxyurea is mutagenic and clastogenic. Correct anaemia prior to initiating hydroxyurea therapy.
Exacerbation of postirradiation erythema. Elderly patients, marked renal dysfunction, impairment of
fertility.
Adverse Reaction:
Myelosupression, GI disturbances, Hyperpigmentation, facial erythema, diffuse maculopapular rash,
headache, drowsiness, confusion ,transient renal function abnormalities.
Contraindications:
Severe bone marrow depression , pregnancy, lactation, hypersensitivity to hydroxyurea products.
Interactions:
Didanosine, stavudine and zidovidine (in HIV-infected patients), fatal and non fatal pancreatitis,
hepatotoxicity, and peripheral neuropathy. Live vaccines, fluorouracil, methotrexate, cytarabine
-------------------------------------------------------------------------------------------------------------------------------------Salicylic Acid 2 - 10% Ointment
C
Indication :
Seborrhoeic dermatitis, scalp, psoriasis and hyperkeratotic skin disorders
Dosage :
Apply sparingly to the affected area 2-3 times daily
Precautions:
Avoid contact with eyes and mucous membranes
Adverse Reaction:
Local irritation
Contraindications:
Hypersensitivity to salicylic acid. Age less than 2 years, diabetes with impaired circulation
Interactions:
Not known
-------------------------------------------------------------------------------------------------------------------------------------Tar, Coal Tar and Oleyl Alcohol Liquid
Trade Name : Polytar
Indication :
Dandruff, seborrhoeic dermatitis and atopic dermatitis
Dosage :
Massage into wet hair, rinse and repeat. Use once or twice weekly
345
A/KK
Precautions:
Do not apply to acutely inflammed skin. Avoid contact with eyes, do not apply coal tar preparations
(other than bath emulsions) to genital or rectal areas
Adverse Reaction:
Skin ulcerations and hypersensitivity reactions including allergic contact dermatitis, the use of
ultraviolet light and coal tar may produce or aggravate folliculitis erythema and a smarting reaction
Contraindications:
Folliculitis and acne vulgaris, weeping eczema, erythrodermic, generalized pustular psoriasis and
photosensitivity
Interactions:
Not known
-------------------------------------------------------------------------------------------------------------------------------------Zinc Oxide Cream
C
Indication :
Skin protective in various skin conditions such as nappy rash, eczema and problem skin
Dosage :
Apply 3 times daily or as required
Precautions:
Hypersensitivity to any component. Avoid contact with eyes. Not to be applied over deep or
puncture wounds, infections or lacerations
Adverse Reaction:
Contraindications:
Weeping dermatoses
Interactions:
Not known
-----------------------------------------------------------------------------------------------------------------------------Adapalene 0.1% Gel
A*
Trade Name : Differin
Indication :
Acne vulgaris where comedones, papules and pustules predominate in those sensitive to benzoyl
peroxide or topical tretinoin [third line treatment]
Dosage :
Apply once daily to the affected areas after washing at bedtime
Precautions:
Avoid contact with eyes, lips angles of the nose and mucosa membranes. Do not apply to cuts,
abrasion, eczematous skin or sunburned skin. Minimize exposure to slight including sunlamps
Adverse Reaction:
Erythema, scaling, dryness, pruritus, burning sensation
Contraindications:
Hypersensitivity to adapalene or any of its components
Interactions:
Methotrexate
-------------------------------------------------------------------------------------------------------------------------------------Azelaic Acid 20% Cream
Trade Name : Skinoren
Indication :
Acne vulgaris
A*
346
Dosage :
Apply twice daily. Treatment should not exceed 6 months
Precautions:
Avoid contact with eyes. May cause hypopigmentation. Should not use with occlusive dressings or
wrappings
Adverse Reaction:
Occasionally, local skin irritation, pruritus, tingling feeling, burning or stinging
Contraindications:
Hypersensitivity to propylene glycol and azelaic acid products
Interactions:
Not known
-------------------------------------------------------------------------------------------------------------------------------------Benzoyl Peroxide 5% Gel
B
Trade Name : Panoxyl
Indication :
Mild to moderate acne vulgaris
Dosage :
Apply sparingly once or twice daily
Precautions:
Avoid contact with eyes, mouth and other mucous membranes. May bleach dyed clothing and
fabrics. Avoid unnecessary sun exposure
Adverse Reaction:
Burning or stinging contact dermatitis, redness
Contraindications:
Hypersensitivity to benzoyl peroxide products
Interactions:
Not known
-------------------------------------------------------------------------------------------------------------------------------------Isotretinoin 10 mg Capsule
A*
Isotretinoin 20 mg Capsule
A*
Trade Name : Roaccutane
Indication :
Only for treatment of i) Severe nodulo-cystic acne ii) Acne conglobata iii) Acne fulminans iv) Severe
acne vulgaris failing conventional treatment WARNING: THIS DRUG IS TERATOGENIC
Dosage :
Initially: 0.5 mg/kg body weight daily (in one to or two divided doses) with food once. Maintenance:
0.1 - 1 mg/kg daily body weight
Precautions:
Diabetes, obesity, alcoholism, disturbances of lipid metabolism and childbearing potential,
hepatotoxicity, inflammatory bowel disease, nursing mothers, visual problems, corneal opacities
Adverse Reaction:
Dry mucosa, dermatitis facialis, pruritus, sweating. Occasionally, reversible alopecia, muscle and
joint pain. Rarely, inflammatory bowel disease, hyperuricaemia, benign intracranial hypertension,
visual disturbances and photosensitivity reactions. Haematuria or proteinuria, hirsutism,
pancreatitis, lymphadenopathy
Contraindications:
Pregnancy and lactation. Hepatic or renal insufficiency. Hypervitaminosis A. Patients with excessively
elevated blood lipid values. Concomitant tetramycin therapy. Hypersensitivity to isotretinoin
products or paraben
347
Interactions:
Concurrent use with vitamin A intensifies symptoms of hypervitaminosis A. Doxycycline,
minocycline, tetracycline may result in pseudotumour cerebri. Ethanol - a disulfiram-like reaction.
Food - Increases its bioavailability
----------------------------------------------------------------------------------------------------------------------------------Tretinoin 0.05% Cream
A
Trade Name : Retin-A
Indication :
Acne vulgaris and recalcitrant cases of acne (comedonal type)
Dosage :
Apply thinly to the affected area once daily or twice daily. Avoid exposure to sunlight. Duration of
treatment: 8 - 12 weeks is required before any noticeable response
Precautions:
Exposure to sunlight including sunlamp should be minimized. Avoid contact with eyes, mouth, angle
of the nose and mucous membrane. Eczema, sunburn, pregnancy and lactation. Special caution is
indicated in cases of simultaneous treatment with other preparations
Adverse Reaction:
Erythema, oedema, blistering, hypopigmentation or hyperpigmentation, sensitivity to sunlight
Contraindications:
Acute dermatitis, rosacea. Hypersensitivity to tretinoin or parabens
Interactions:
Betamethasone, betamethasone dipropionate, clotrimazole, dexamethasone, fluconazole,
hydrocortisone, ketoconazole, methotrexate, methylprednisolone, paclitaxel, prednisolone,
tetracycline, tranexamic acid, triamcinolone
-------------------------------------------------------------------------------------------------------------------------------------Podophyllum 10 - 20% Paint
B
Indication :
External anogenital warts
Dosage :
Apply 2 - 3 drops carefully to lesion after protecting surrounding area with vaseline. Wash off after 6
hours or if feel burning sensation and repeat 2 - 3 times weekly or once weekly
Precautions:
Sensitive parts of the body. Caustic to healthy skin. Keep away from eyes
Adverse Reaction:
Inflammation of the surrounding skin may occur, in which case treatment should be suspended
Contraindications:
Pregnancy, use on bleeding warts, moles, birthmarks and concomitant steroid therapy
Interactions:
Not known
-------------------------------------------------------------------------------------------------------------------------------------Ketoconazole 2% Shampoo
Trade Name : Nizoral
Indication :
Resistant dandruff only
Dosage :
Apply twice weekly for 2 - 4 weeks. Prophylaxis: Once every 1 - 2 weeks
Precautions:
After prolonged treatment with topical corticosteroids
348
A
Adverse Reaction:
Local irritation, pruritus, alopecia and photosensitivity
Contraindications:
Known hypersensitivity to ketoconazole products
Interactions:
Concurrent use with ethanol may result in a disulfiram-like reaction (flushing, vomiting, increased
respiratory rate, tachycardia)
-------------------------------------------------------------------------------------------------------------------------------------Acyclovir 5% Cream
A*
Indication :
Herpes simplex infections of the skin, including initial and recurrent labial and genital herpes simplex
infections
Dosage :
Apply every 4 hours for 5 - 10 days
Precautions:
Application to mucous membranes, pregnancy, lactation. Should not be used in the eyes
Adverse Reaction:
Transient burning or stinging or erythema, mild drying or flaking of the skin
Contraindications:
Hypersensitivity to acyclovir or valacyclovir
Interactions:
Not known
------------------------------------------------------------------------------------------------------------------------------------Selenium Sulphide 2.5% Shampoo
A/KK
Trade Name : Selsun
Indication :
Dandruff, seborrheic dermatitis of scalp
Dosage :
Dandruff: apply 5-10 mL topically twice weekly for 2 weeks, then 1-4 times per month, as needed,
leave on for 2-3 min, then rinse thoroughly. Seborrheic dermatitis of scalp: apply 5-10 mL topically
twice weekly for 2 weeks, then 1-4 times per month, as needed, leave on for 2-3 min, then rinse
thoroughly
Precautions:
Avoid contact with eyes, mucous membranes, inflamed or broken skin or to extensive areas of the
skin
Adverse Reaction:
Oiliness or dryness of hair and scalp, hair discoloration, cutaneous sensitization and alopecia
Contraindications:
Acute inflammation or exudation, broken skin, hypersensitivity to drug
Interactions:
Not known
-------------------------------------------------------------------------------------------------------------------------------------Amorolfine 5 % Nail Lacquer
Trade Name : Loceryl
Indication :
Fungal nail infections
A*
349
Dosage :
Apply to affected nail once or sometimes twice a week after filling and cleansing, allow to dry, treat
finger nail for 6 months, toe nail for 9 - 12 months (review at intervals of 3 months)
Precautions:
Avoid contact with eyes, previous hypersensitivity or intolerance to other topical antifungal agents
Adverse Reaction:
Slight transient burning sensation
Contraindications:
Hypersensitivity to amorolfine
Interactions:
Not known
----------------------------------------------------------------------------------------------------------------------------------Benzoic Acid Compound Ointment
C
Trade Name : Whitfields
Indication :
Tinea infections of thickened skin of palms and soles
Dosage :
Apply sparingly to affected area once or twice daily
Precautions:
Contact with the eyes, mouth and other mucous membranes should be avoided
Adverse Reaction:
Local irritation
Contraindications:
Hypersensitivity, use in children less than 2 years, diabetes impaired circulation
Interactions:
Not known
-----------------------------------------------------------------------------------------------------------------------------------Benzyl Benzoate 25 % Emulsion (Adult)
C
Indication :
Scabies and pediculosis
Dosage :
After bath, apply over the whole body, neck down and leave on for 24 hours then wash off. Reapply
for another 24 hours, the first repeat application should be within 5 days of the initial application, a
third application may be required in some cases
Precautions:
Contact with mucous membranes, head, face, broken or inflammed skin, avoid contact with eyes.
Not recommended for children, lactation (withhold during treatment)
Adverse Reaction:
May be irritant to the skin of some patients, burning sensation especially on genitalia and
excoriations occasionally rashes, stinging and contact dermatitis, local irritation, particularly in
children, splash contact with benzyl benzoate may produce irritation to the eyes and mucous
membranes
Contraindications:
Hypersensitivity to benzyl benzoate
Interactions:
Not known
--------------------------------------------------------------------------------------------------------------------------------------
350
Clotrimazole 1% Cream
B
Trade Name : Canesten
Indication :
Cutaneous candidiasis, Tinea corporis, Tinea cruris, Tinea pedis and Tinea versicolor
Dosage :
Rub in gently onto affected and surrounding skin 2 or 3 times daily continuing for about 2 weeks
beyond the dissapearance of all symptoms
Precautions:
Contact with eyes and mucous menbranes should be avoided
Adverse Reaction:
Skin reactions, contact dermatitis, pruritis
Contraindications:
Hypersensitivity to clotrimazole
Interactions:
Not known
-------------------------------------------------------------------------------------------------------------------------------------Fusidic Acid 2% Cream
A
Indication :
Skin infections caused by staphylococci, streptococci, corynebacterium minutissumun and other
sodium fusidate-sensitive organisms
Dosage :
Apply to affected area 2 - 3 times daily
Precautions:
Adverse Reaction:
Rashes, irritation, pruritus and contact dermatitis
Contraindications:
Infections caused by non-susceptible organisms in particular Pseudomonas aeruginosa
Interactions:
Not known
-------------------------------------------------------------------------------------------------------------------------------------Fusidic Acid 2% in Betamethasone Valerate 0.1% Cream
A/KK
Trade Name : Fucicort
Indication :
Inflammatory dermatosis where bacterial infection is likely to occur eg atopic eczema, discoid
eczema, stasis eczema, seborrhoic dermatitis, contact dermatitis, lichen simplex chronicus, psoriasis,
discoid lupus erythematosus
Dosage :
Uncovered lesion- Apply 2 to 3 times daily. Covered lesions- Less frequent applications may be
adequate
Precautions:
Avoid prolong use on flexures and intertriginous areas should be avoided
Adverse Reaction:
Mild stinging, irritation, rash
Contraindications:
Viral disease of skin, perioral dermatitis, acne rosacea and ulcerative condition
351
Interactions:
Not known
-------------------------------------------------------------------------------------------------------------------------------------Gamma Benzene Hexachloride 0.1 % Lotion
C
Trade Name : Lindane
Indication :
Scabies
Dosage :
Apply lotion to entire body from neck down for 8 to 12 hours, then rinse
Precautions:
Seizures, dermatitis, dizziness, eczema, papular lesions, itching, Henoch- Schonlein purpura,
percutaneous absorption, atypical leukaemia, aplastic anemia and abnormal vision on the use of
lindane cream
Adverse Reaction:
Seizures, dermatitis, dizziness, eczema, papular lesions, itching, Henoch- Schonlein purpura,
percutaneous absorption, atypical leukaemia, aplastic anemia and abnormal vision on the use of
lindane cream
Contraindications:
Pregnancy and premature babies, lactation. Avoid in patients with a history of epilepsy (e.g. HIV,
history of head trauma or prior seizure, CNS tumor, excessive alcohol consumption) or who have a
low body-weight, hypersensitivity to lindane products, Norwegian (crusted) scabies ,other skin
conditions (e.g. atopic dermatitis, psoriasis) that may increase systemic absorption
Interactions:
Not known
-------------------------------------------------------------------------------------------------------------------------------------Gentamicin 0.1% Cream
A*
Indication :
For localised infections
Dosage :
Apply 2 - 3 times daily
Precautions:
Discontinue if irritation or sensitization occurs
Adverse Reaction:
Avoid prolonged use
Contraindications:
Hypersensitivity to gentamicin or other aminoglycosides
Interactions:
Not known
-------------------------------------------------------------------------------------------------------------------------------------Mupirocin 2% Ointment
Trade Name : Bactroban
Indication :
For MRSA infections only
Dosage :
ADULT and CHILD: Apply up to three times daily for 3 - 5 days
352
A
Precautions:
Not for ophthalmic or intranasal use. Use with caution if there is evidence of moderate or severe
renal impairment
Adverse Reaction:
Stinging or burning, pruritus
Contraindications:
Hypersensitivity to mupirocin products
Interactions:
Avoid products with polyethylene glycol
--------------------------------------------------------------------------------------------------------------------------------Neomycin 0.5% Cream
B
Indication :
Infections of the skin due to susceptible organisms
Dosage :
Apply sparingly to affected area up to 3 times daily (For short term use, 1 - 2 weeks)
Precautions:
Superinfection may occur on prolonged use. Renal impairment
Adverse Reaction:
Skin sensitization or contact dermatitis. The sensitivity disappears when treatment is discontinued
Contraindications:
Hypersensitivity to neomycin or other aminoglycosides
Interactions:
Not known
--------------------------------------------------------------------------------------------------------------------------------Nystatin 100,000 units/g Cream
C
Trade Name : Mycostatin
Indication :
Prevention and treatment of cutaneous infections caused by Candida albicans
Dosage :
Apply liberally to affected area twice daily or as required. After lesion has disappeared continue
treatment for 10 days to prevent relapses. Nail infection: Cut nails as short as possible. Apply cream
once daily until growth of new nail has set in
Precautions:
Pregnancy
Adverse Reaction:
Skin irritation
Contraindications:
Hypersensitivity to nystatin
Interactions:
Not known
-------------------------------------------------------------------------------------------------------------------------------------Permethrin 5% w/v Lotion
A*
Trade Name : A-Scabs
Indication :
Treatment of scabies
Dosage :
Apply thoroughly to all body parts. Leave on for 8 - 14 hours. Not recommended for children less
than 2 years old
353
Precautions:
May exacerbate pruritus, oedema and erythema
Adverse Reaction:
Swelling, erythema, pruritus, rash, stinging of skin, burning sensation
Contraindications:
Hypersensitivity to permethrin and other synthetic pyrethrin
Interactions:
Not known
--------------------------------------------------------------------------------------------------------------------------------Silver Sulfadiazine 1% Cream
B
Trade Name : Flamazine
Indication :
Prevention and treatment of infections in severe burns, leg ulcers where infections may prevent
healing and for the prophylaxis of infections in skin grafting
Dosage :
Burns: Apply 3 mm thick layer twice daily with sterile applicator. Leg ulcer: apply at least 3 times a
week
Precautions:
Those allergic to sulfonamides may show cross-sensitivity to silver sulfadiazine. Haemolysis may
occur with glucose-6-phosphate deficiency. Accumulation may occur in renal or hepatic insufficiency
Adverse Reaction:
Transient leucopenia has occurred with topical silver, haemolytic anaemia, probable febrile reaction,
irritation, itching and burning at the application site, argyria, hyperpigmentation
Contraindications:
Hypersensitivity to silver or to silver sulphadiazine. Pregnant women at or near term (increased
kernicterus). Preterm infants or newborns during first two months
Interactions:
Concomitant cimetidine therapy may increase the likelihood of causing leucopenia in silver
sulfadiazine-treated burn patients
------------------------------------------------------------------------------------------------------------------------------------Sodium Fusidate 2% Ointment
A
Indication :
Skin infections caused by staphylococci, streptococci, corynebacterium minutissumun and other
sodium fusidate-sensitive organisms
Dosage :
Apply to affected area 2 - 3 times daily
Precautions:
Adverse Reaction:
Rash, irritation, pruritus, contact dermatitis
Contraindications:
Infection caused by non-susceptable organism in particular pseudomonas aeruginosa
Interactions:
Not known
-----------------------------------------------------------------------------------------------------------------------------------
354
Sodium Thiosulphate 10-20% Solution
C
Indication :
Fungicides. For the treatment of pityriasis versicolor
Dosage :
Apply to all affected parts of the body and face with a brush after a bath once daily or twice daily or
3 times daily
Precautions:
Discontinue topical use if irritation or sensitivity occurs, rapid IV infusion has caused transient
hypotension
Adverse Reaction:
Hypotension, coma, psychosis, confusion, contact dermatitis, local irritation, neuromuscular and
skeletal weakness, tinnitus, diarrhoea (following large accidental ingestion)
Contraindications:
Hypersensitivity to sodium thiosulphate or any component of the formulation
Interactions:
Not known
-------------------------------------------------------------------------------------------------------------------------------------Acriflavine 0.1% Lotion
C
Indication :
Infected skin, lesions, cuts, abrasions, wounds and burns
Dosage :
Apply undiluted three times daily to the affected part
Precautions:
Prolonged application, may stain skin, hair & fabric.
Adverse Reaction:
Hypersensitivity to acriflavine compound
Contraindications:
Hypersensitivity to acriflavine compound.
Interactions:
Not known
------------------------------------------------------------------------------------------------------------------------------------Alcohol 70% Solution
C
Indication :
Use as antiseptic and disinfectant
Dosage :
Apply to the skin undiluted or when needed
Precautions:
Pregnancy, nursing mothers, elderly
Adverse Reaction:
Mental impairment, gastrointestinal disturbances, severe effects include respiratory depression,
coma and death
Contraindications:
Not known
Interactions:
Chlorpropamide, metronidazole, cefoperazone, cefoperazone/sulbactam and cefotaxime
--------------------------------------------------------------------------------------------------------------------------------------
355
Cetrimide 1-2% Lotion.
C
Trade Name : Cetavlon
Indication :
As shampoo and cleansing agent
Dosage :
Apply to affected area
Precautions:
Contact with the eyes, brain, meninges, and middle ear should be avoided. Cetrimide should not be
used in body cavities or as an enema
Adverse Reaction:
Cutaneous irritation and local effects
Contraindications:
Hypersensitivity to cetrimide
Interactions:
Not known
-------------------------------------------------------------------------------------------------------------------------------------Chlorhexidine Gluconate 4% Scrub
C
Trade Name : Hibiscrub
Indication :
Surgical hand scrub/disinfection, pre-op skin preparation
Dosage :
Surgical hand disinfection: Apply 5ml to clean hands and forearms for 1 min. Rinse and repeat with
another 5ml for a further 2 mins and then rinse and dry. General skin disinfection: Apply appropriate
quantity to wet area and scrub for 1 min. Rinse thoroughly & dry
Precautions:
For external use only. Avoid contact with eyes and middle ear
Adverse Reaction:
Occasionally irritative skin reactions, generalised allergic reactions, may cause gastrointestinal
disturbances. Inhalation of solvent vapours may give rise to nausea, headaches and dizziness
Contraindications:
Hypersensitivity to chlorhexidine gluconate or any component of the formulation
Interactions:
Not known
-------------------------------------------------------------------------------------------------------------------------------------Chlorhexidine Gluconate 5% Solution
C
Trade Name : Hibitane
Indication :
i) Preoperative skin disinfection ii) Wounds or burns iii) Emergency disinfection of instruments
Dosage :
i) & iii) 1 : 10 in 70 % Alcohol ii) 1 : 100
Precautions:
Avoid contact with meninges, application into hairy areas and not use as a preoperative skin
preparation for the face or head. Keep disinfectant solution out of the eyes, ears and mouth
Adverse Reaction:
Mucosal irritation (discontinue if desquamation), parotid gland swelling, irritation and
gastrointestinal disturbances. Inhalation of solvent vapours may give rise to nausea, headaches and
dizziness
Contraindications:
Hypersensitivity to any of its components
356
Interactions:
Avoid cemented glass components
-------------------------------------------------------------------------------------------------------------------------------------Chlorinated Lime Solution & Buffered Acetate Solution
C
Trade Name : Eusol-T
Indication :
Wound or ulcer
Dosage :
Apply to affected areas undiluted as a cleansing agent
Precautions:
Topically applied hypochlorites may dissolve blood clots and cause bleeding
Adverse Reaction:
Skin irritation
Contraindications:
Patients who have previously shown a hypersensitivity reaction
Interactions:
Not known
---------------------------------------------------------------------------------------------------------------------------------Hydrogen Peroxide 20 volume Solution
C
Indication :
Skin disinfection, particularly cleansing and deodorising wounds and ulcers
Dosage :
Hydrogen Peroxide 6% (=approx. 20 vol) shall be dispensed. For cleansing wounds: 1.5% to 6%
solution apply 2-3 times daily or when nescessary. As a mouthwash: rinse the mouth for 2-3 minutes
with 15ml of hydrogen peroxide 6% diluted in half a tumblerful of warm water 2-3 times daily.
Disinfecting cleaned equipment: immersion for 30 minutes in 6% solution. As ear drop for removal of
wax: hydrogen peroxide 6% diluted with 3 parts of water preferably just before use
Precautions:
Large or deep wound, avoid normal skin, bleaches fabric. Strong solution which contain 27% and
30% (100 vol) are only for the preparation of weaker solution and should not be applied to tissue
undiluted
Adverse Reaction:
Bleaching effect on hair, irritating burn on the skin, mucous membrane and eye. Continued use as a
mouthwash may cause reversible hypertrophy of the papillae of the tongue
Contraindications:
Should not be used in abscesses
Interactions:
Incompatible with reducing agents, including organic matter and oxidisable substances, some
metals, metallic salts, iodides and permanganates
------------------------------------------------------------------------------------------------------------------------------------Potassium Permanganate 1:10,000 Solution
Indication :
Cleansing and deodorising suppurative eczematous reactions and wounds
Dosage :
As soaks or wet dressing 1 - 3 times daily or as required
Precautions:
357
C
Adverse Reaction:
Irritant to tissues and stain skin brown
Contraindications:
Interactions:
Not known
-------------------------------------------------------------------------------------------------------------------------------Povidone Iodine 10% (equivalent to 1% iodine) Solution
B
Indication :
Skin operation prior to surgery, in cleansing open wounds, as an antiseptic for operative wounds
infections
Dosage :
Paint the area once or twice daily and allow to dry
Precautions:
Highly toxic if ingested, sodium thiosulfate is the most effective chemical antidote, avoid contact
with eyes, use with caution in infants and nursing women
Adverse Reaction:
Rash, pruritus, local oedema
Contraindications:
Hypersensitivity to iodine or any component of the formulation
Interactions:
Not known
-----------------------------------------------------------------------------------------------------------------------------------Colchicine 0.5 mg Tablet
B
Indication :
i) Acute gout and prophylaxis of recurrent gout. ii) Leucocytoclastic Vasculitis either cutaneous or
systemic involvement, Behcet's syndrome, Urticarial vasculitis, Systemic sclerosis, Sweet's syndrome
and severe recalcitrant aphthous stomatitis
Dosage :
i) Initial dose, 0.5-1.2 mg, then 0.5-0.6 mg every hour until relief of pain is obtained or vomiting or
diarrhoea occurs (Maximum : 8 mg). The course should not be repeated within 3 days. Prevention of
attacks during initial treatment with allopurinol or uricosuric drugs: 0.5 mg 1-3 times daily. ii) 0.5 mg
1-3 times daily depends on disease and severity, up to a maximum of 3 mg/day
Precautions:
Pregnancy, lactation, children and elderly, GI disease, cardiac, renal and hepatic impairment.
Prolonged therapy not recommended
Adverse Reaction:
Bone marrow depression with aplastic anaemia, peripheral neuritis, myopathy, hair loss,
gastrointestinal disturbances, epigastric pain, diarrhoea, nausea, vomiting, myelosuppression,
abdominal pain, diarrhoea, gastrointestinal haemorrhage, rashes, renal and hepatic damage in
excessive doses. Rarely peripheral neuritis, myopathy, alopecia and with chronic therapy blood
disorders like agranulocytosis, aplastic anaemia
Contraindications:
Serious GI, renal, hepatic & cardiac disorders and those with blood dyscrasias, hypersensitivity to
colchicine, children under 2 years old, pregnancy, debilitated patients, SC/IM administration
Interactions:
Reversible malabsorption of Vit B12, action inhibited by acidifying agents & enhanced by alkalinizing
agents, cyclosporin, erythromycin. Response to CNS depressants and sympathomimetics may
increase when used concurrently with colchicine. Increased risk of myopathy when used
358
concurrently with simvastatin. Potential risk of severe drug interactions, including death in certain
patients treated with colchicine and concomitant P-glycoprotein or strong CYP3A4 inhibitors such as
clarithromycin, ciclosporin, erythromycin, calcium channel antagonists (verapamil, diltiazem),
telithromycin, ketoconazole, itraconazole, HIV protease inhibitors and nefazodone. P-glycoprotein or
strong CYP3A4 inhibitors are not to be used in patients with renal or hepatic impairment who are
taking cochicine. A dose reduction or interruption of colchicine treatment should be considered in
patients with normal renal and hepatic function if treatment with a P-glycoprotein or a strong
CYP3A4 inhibitors required. Avoid consuming grapefruit and grapefruit juice while using colchicines
-------------------------------------------------------------------------------------------------------------------------------------Magnesium Sulphate 45% Paste
C
Indication :
Inflammatory skin conditions such as boils and carbuncles
Dosage :
Apply under dressing
Precautions:
Adverse Reaction:
Prolonged or repeated use may damage the surrounding skin
Contraindications:
Hypersensitivity to magnesium sulfate
Interactions:
Not known
-------------------------------------------------------------------------------------------------------------------------------------Protein Free Haemodialysate 10% Jelly
A
Trade name: Soloseryl
Indication :
Trophic lesions in patients with arterial occlusive disease and with chronic venous insufficiency, burn
injuries, impaired wound healing, decubitus ulcers and skin ulcer caused by irradiation
Dosage :
Precautions:
Burning sensation after application
Adverse Reaction:
Allergic skin reactions
Contraindications:
Interactions:
Not known
-------------------------------------------------------------------------------------------------------------------------------------Protein Free Haemodialysate 5% Ointment
A
Trade name: Soloseryl
Indication :
Trophic lesions in patients with arterial occlusive disease and with chronic venous insufficiency, burn
injuries, impaired wound healing, decubitus ulcers and skin ulcer caused by irradiation
Dosage :
Precautions:
Burning sensation after application
359
Adverse Reaction:
Allergic skin reactions
Contraindications:
Interactions:
Not known
--------------------------------------------------------------------------------------------------------------------------------------
360
22. IMMUNOLOGICAL PRODUCTS AND VACCINES
Vaccines and antisera
Immunoglobulins
361
BCG Vaccine Freeze-Dried Injection
C
Indication :
For the prevention of tuberculosis
Dosage :
0.1 ml by intradermal injection. INFANT under 12 months: 0.05 ml
Precautions :
Children born to HIV positive mothers, pregnancy.
Adverse Effects :
Superficial, self healing ulceration, injection site reaction, lymphadenopathy.
Contraindications :
Congenital or acquired cell-mediated immune deficiencies (including HIV), patients with systemic
corticosteroid/ immunosuppressive treatment, malignant condition, pyrexia, generalised infected
dermatoses, organ abnormalities.
Interactions :
Not known.
-------------------------------------------------------------------------------------------------------------------------------------Haemophilus Influenzae Type B Conjugate 10 mcg Vaccine
C
Trade Name : Act-Hib
Indication :
Immunisation of infants against Haemophilus Influenzae Type B
Dosage :
0.5 ml IM
Precautions :
Presence of fever or acute infection.
Adverse Effects :
Injection site reaction, fever.
Contraindications :
Hypersensitivity to any components of the vaccine.
Interactions :
Not known.
-----------------------------------------------------------------------------------------------------------------------------------Hepatitis B Vaccine Injection
C
Trade Name : B-Hepavac
Indication :
Immunisation against infections caused by Hepatitis B virus
Dosage :
ADULTS over 20 years: 10 mcg/dose. ADOLESCENT 11 - 19 years: 5 mcg/dose. NEWBORN and CHILD
up to 10 years: 2.5 mcg/dose. INFANTS born to HBsAg positive mothers: 3 doses of 0.5 ml each.
Second dose to be given after 1 month and booster dose after 6 months
Precautions :
Pregnancy, immunodeficiency and or receiving immunosuppresant therapy, severely compromised
cardiopulmonary status.
Adverse Effects :
Fatigue, malaise, nausea, diarrhoea, reactions at injection site.
Contraindications :
Hypersensitivity to any of the components.
Interactions :
Not known.
--------------------------------------------------------------------------------------------------------------------------------------
362
Meningococcal A, C, Y, W 135 Vaccine Injection
B
Indication :
Immunisation against meningococcal diseases caused by Neisseria meningitis Group A, Group C,
Group Y or Group W-135
Dosage :
Prophylaxis: 0.5 ml subcutaneously
Precautions :
Infants less than 18 months have a lower rate of seroconversion to C, Y and W135.
Adverse Effects :
Temporary hyperthermia and mild erythema at injection site.
Contraindications :
Hypersensitivity to thiomersal or any component of the form.
Interactions :
Decreased effect with administration of immunoglobulin within 1 month.
--------------------------------------------------------------------------------------------------------------------------------Pneumococcal Vaccine (Polyvalent)
A
Trade Name : Pneumo 23
Indication :
Prevention of pneumococcal infections in high risk subjects from the age of 2 years including patient
with a history of splenectomy or scheduled splenectomy
Dosage :
Primary injection: 1 single injection (0.5 ml) only. Booster: Must not be given within 5 years except in
very high risk patient who received the vaccine while under immunosuppressive treatment
Precautions :
Pregnancy.
Adverse Effects :
Injection site reaction, fever, haemolytic anaemia, thrombocytopenia, anaphylactoid reaction.
Contraindications :
Hypersensitivity to pneumococcal vaccine components.
Interactions :
Not known.
-------------------------------------------------------------------------------------------------------------------------------------Rabies Human Diploid Cell Vaccine (Lyophilised) Injection
B
Trade Name : Imorab
Indication :
Pre-exposure and post-exposure vaccination against rabies
Dosage :
Prophylaxis: 3 dose (1 ml each) schedule on days 0, 7 and 28. Booster dose after every 2 - 3 years.
Post exposure prophylaxis: use after attack of a potential rabid animal: 1 dose on days 0, 3, 7, 14 and
30. In previously vaccinated individuals 2 doses on day 0 and 3
Precautions :
Allergy to neomycin.
Adverse Effects :
Erythema of injection site, fever with mild asthenia.
Contraindications :
Pregnancy, acute febrile illness.
Interactions :
Corticosteroids, immunosuppressives.
----------------------------------------------------------------------------------------------
363
Tetanus Toxoid Injection
C
Trade Name : ATT
Indication :
Immunization against tetanus infection
Dosage :
0.5 ml at 2 months followed by second dose after 4 weeks and third dose after another 4 weeks.
Booster every 10 years
Precautions :
Not recommended for children less than 7 years.
Adverse Effects :
Local reaction, fever, headache and malaise, brachial (cervical) neuritis, Guillain-Barre syndrome,
nausea, arthralgia, anaphylaxis, Arthus type urticaria.
Contraindications :
Hypersensitivity to any component of the vaccine, febrile illness or acute infection.
Interactions :
Chloramphenicol.
-------------------------------------------------------------------------------------------------------------------------------------Tuberculine PPD Injection
B
Trade Name : Tuberculine
Indication :
For routine Mantoux (tuberculin sensitivity) test
Dosage :
10 units is injected intradermally
Precautions :
Sensitivity to tuberculin may be diminished in the following conditions: viral or severe bacterial
infection including HIV infection and severe tuberculosis, neoplastic disease particularly lymphoma,
sarcoidosis, corticosteroid or immunosuppressive therapy, recent administration of live virus
vaccines, ultraviolet light treatment, chronic renal failure and malnutrition. Tuberculins may be
adsorbed onto the surface of syringes and should therefore be administered immediately.
Tuberculin skin tests should not generally be administered to known tuberculin reactors because of
the risk of a severe reaction at the test site.
Adverse Effects :
Pain and pruritus may occur at the injection site, occasionally with vesiculation, ulceration or
necrosis in highly sensitive persons. If given to patients with tuberculosis a severe reaction may
occur. Granuloma has been reported. Hypersensitivity reactions, including anaphylaxis, to
tuberculins have been reported rarely.
Contraindications :
Subcutaneous injection, hypersensitivity to tuberculin purified protein derivative, previous severe
reaction (e.g. Vesiculation, ulceration, necrosis).
Interactions :
Corticosteroid, immunosuppressive therapy, live virus vaccines.
-------------------------------------------------------------------------------------------------------------------------------------Varicella Virus Vaccine Live Attenuated Injection
A*
Trade Name : Okavax, varivax, varilrix
Indication :
Dosage :
ADULT and CHILD 13 years or more: 2 doses of 0.5 ml SC injection separated by 4 - 8 weeks apart.
CHILD 12 months - 12 years: 0.5ml SC as a single dose
364
Precautions :
Discontinue maintenance chemotherapy equal or less than 1 week prior to injection and
recommence therapy after equal or more than 1 week after injection. Malignant solid tumours,
women of child-bearing potential should practise adequate contraceptive measures 1 month prior to
vaccination and 2 month after vaccination. Cardiovascular, kidney, liver, haematological or
developmental abnormalities. History of seizures, diagnosed immunodeficiency states, abnormal
immune system function. Concomitant immunosupressive therapy. Vaccine may not effective in
patients receiving blood or gamma-globulin preparation within 3 month prior to vaccination. Other
live viral vaccines should only be given equal or more than 4 weeks after Okavax.
Adverse Effects :
Fever, rash, urticaria, erythema, pruritus. Rarely, local reaction, anaphylactoid symptoms.
Contraindications :
Reinforcement therapy for leukaemia or extensive therapy using strong immunosuppressives. Acute
myelogenous leukaemia or malignant lymphoma.
Interactions :
Transfusion and administration of gamma-globulin preparations: The vaccine may not be effective in
those receiving blood or gamma-globulin preparation within 3 month before vaccination.
Vaccination of such individuals should be delayed until equal or more than 3 months has elapsed.
For those receiving high dose gamma-globulin therapy, ie equal or more than 200 mg/kg, eg patients
with Kawasaki disease or acute immune thrombocytopenic purpura (ITP), vaccination should be
delayed until equal or more than 6 months has elapsed. If gamma-globulin is administered within 14
days after administration of the vaccine, the vaccine may not be effective. Such individuals should be
re-vaccinated equal or more than 3 months after the initial vaccination. Other live vaccine
preparations: Those receiving other live vaccines, eg oral polio, measles, mumps, rubella, BCG or
yellow fever vaccine, are advised to wait until equal or more than 4 weeks has elapsed before being
vaccinated. Incompatibilities: The vaccine should not be mixed with other vaccines or medications in
the same syringe.
-------------------------------------------------------------------------------------------------------------------------------Anti RhD Gamma Globulin 250 mcg/2 ml Injection (500 units=100 mcg)
B
Trade Name : Rhogam
Indication :
Prevention of Rh(D) sensitisation by IM injection to rhesus-negative woman after delivery of rhesuspositive infant
Dosage :
50 - 100 mcg within 72 hours after incompatible blood transfusion: 25 mcg (125 units) per ml
transfused blood, up to 1000 mcg
Precautions :
Never administer by IV or to infant. IgA deficiency. Hypersensitivity to thiomersal or human Ig.
Adverse Effects :
Pain at injection site. Slight temperature elevation.
Contraindications :
RhD positive mother.
Interactions :
Live virus vaccines.
-----------------------------------------------------------------------------------------------------------------------------------
365
Hepatitis B Immunoglobulin (Human) Injection
A
Trade Name : Hyperhep/Hepabig
Indication :
i) For post-exposure prophylaxis of hepatitis B ii) Prophylaxis against recurrence of hepatitis B
infection in chronic hepatitis B post liver transplantation
Dosage :
i) Recommended dose in ADULT and CHILD more than 10 years: A single dose of 500 units IM within
48 hours and not more than 1 week after exposure ii) Different regimens depending on hepatitis B
virus (HBV) DNA positivity
Precautions :
Extreme hypogammaglobulinaemia, severe thrombocytopenia, bleeding disorders.
Adverse Effects :
Local reaction at injection site, headache, malaise, fever, nephrotic syndrome.
Contraindications :
Selective IgA deficiencies.
Interactions :
Live vaccines.
-------------------------------------------------------------------------------------------------------------------------------------Tetanus Immunoglobulin Human 250 Units/Vial Injection
B
Trade Name : Hyper-Tet
Indication :
Passive immunization against tetanus
Dosage :
Prophylaxis of tetanus: IM 250 units. Treatment of tetanus: IM 30 - 300 units/kg
Precautions :
Known intolerence to blood or blood derivatives.
Adverse Effects :
Pain, tenderness, erythema at injection site, fever (mild), urticaria, angioedema, muscle stiffness,
anaphylaxis reaction, sensitization to repeated injections.
Contraindications :
HIV patients.
Interactions :
Never administer tetanus toxoid and tetanus immunoglobulin (TIG) in same syringe (toxoid will be
neutralized), toxoid may be given at a separate site, concomitant administration with T-dependant
antigen (Td) may decrease its immune response, especially in individuals with low prevaccination
antibody titers.
------------------------------------------------------------------------------------------------------------------------------------
366
20. ANAESTHESIA
Induction / Maintenance
Neuromuscular blocker
Topical anaesthesia
Local anaesthesia
Miscellaneous anaesthesia
367
Dexmedetomidine HCl 100 mcg/ml Injection
A*
Trade Name : Precedex
Indication :
Sedation of intubated and mechanically ventilated ICU patients. For use only by specialist
anaesthetist
Dosage :
Not to be infused for more than 24 hours, 1 mcg/kg over 10 minutes as loading dose. Maintenance
dose: 0.2 - 0.7 mcg/kg/hr
Precautions :
Significant cardiovascular dysfunction, advanced heart block, renal and hepatic impairment, elderly
more than 65 years, pregnancy, lactation, diabetes mellitus, chronic hypertension.
Adverse Reactions:
Hypotension (more frequent), hypertension, cardiovascular disease, nausea, dry mouth, hypoxia,
somnolence.
Contraindications:
Hypersensitivity to dexmedetomidine.
Interactions:
Enhances effects of anaesthesia, sedative, hypnotics and other CNS depressants, opiods.
-----------------------------------------------------------------------------------------------------------------------------------Etomidate 20 mg/10 mg Injection
A*
Trade Name : Etomidate Lipuro
Indication :
Induction of general anaesthesia for haemodynamically unstable patients
Dosage :
CHILD greater 10 years and ADULT: 0.15 - 0.3 mg/kg ELDERLY: 0.15 mg/kg - 0.2 mg/kg
Precautions :
Not for administration by prolonged infusion due to hazarads of prolonged suppression of
endogenous cortisol and aldosterone production, severe asthma, severe cardiovascular disease. Not
to use for maintenance of anaesthesia. Opioid analgesics or benzodiazepines may be given as
premedications to reduce risk of convulsions. Pre-existing epilepsy. Elderly and child less than 10
years. Pregnancy and lactation.
Adverse Reactions:
Hypotension, adrenal suppression, myoclonus, transient skeletal movements, uncontrolled eye
movements, hiccups. Excitatory phenomena eg, involuntary myoclonic muscle movements,
convulsions; hypersensitivity reactions, pain on injection; postoperative nausea and vomiting.
Contraindications:
Hypersensitivity to etomidate. Reduced or at risk of reduced adrenocortical function. Porphyria.
Interactions:
Fentanyl, verapamil, St. John'swort. Antipsychotics, sedatives or opioids; calcium-channel blockers.
---------------------------------------------------------------------------------------------------------------------------------Isoflurane Liquid
B
Trade Name : Forane
Indication :
i) Induction and ii) Maintenance of anaesthesia
Dosage :
i) Induction- Initiate at a concentration of 0.5 % ii) Maintenance- 1 - 2.5 % in oxygen or nitrous oxide
mixture. 0.5 - 0.75 % with oxygen and nitrous oxide for Caesarian section
368
Precautions :
Uterine curettage, raised intracranial pressure, cardiac, respiratory, renal or hepatic impairment.
Elderly or obese patients. May impair ability to drive or operate machinery. Avoid alcohol.
Concomitant use with adrenaline or other sympathomimetics. Pregnancy and lactation.
Adverse Reactions:
Cardio-respiratory depression, hepatic injury, hepatotoxicity, jaundice, malignant hyperthermia,
gastrointestinal upset, ileus, post-operation shivering. Hypotension, arrhythmias, transient rise in
cerebrospinal fluid pressure.
Contraindications:
Hypersensitivity to isoflurane, halogenated agents. Genetic susceptibility to malignant hyperthermia.
Porphyria.
Interactions:
Potentiates action of nondepolarising muscle relaxants. Enhance effects of neuromuscular blockers,
central nervous system depressants. Enhanced hypotensive effects of ACE inhibitors, tricyclic
antidepressants (TCAs), MAOIs, antihypertensives, antipsychotics, beta-blockers
-----------------------------------------------------------------------------------------------------------------------------------Ketamine 10 mg/ml Injection
B
Trade Name : Ketalar
Indication :
Sole anaesthetic for short procedures or induction of anaesthesia in certain types of patients (e.g in
shock states)
Dosage :
IV - onset 30 sec : 2 mg/kg body weight or IM - onset 3 - 4 min : 10 mg/kg body weight
Precautions :
Those prone to hallucinations, severe coronary heart disease, eclampsia/pre-eclampsia, history of
convulsive or psychiatric disorders, raised intracranial or intraocular pressure. Glaucoma, elderly,
alcoholics, epilepsy.
Adverse Reactions:
Cardiovascular stimulation, increased arterial pressure, tachycardia, emergence phenomena
(hallucination and other transient psychotic squelae, vivid dreams), muscle hyperactivity. Irrational
behaviour. Increased muscle tone sometimes resembling seizures. Temporary hypertension,
hypotension, bradycardia, arrhythmias. respiratory depression, apnoea, laryngospasm, diplopia,
nystagmus; nausea, vomiting, lachrymation; hypersalivation; raised intraocular and cerebrospinal
fluid pressure; skin irritation and pain at injection site.
Contraindications:
Hypersensitivity to ketamine products, conditions where hypertension is hazardous. History of
cardiovascular accident; severe angina, myocardial infarction, raised ocular and intracranial
pressure, psychiatric disorders.
Interactions:
Atracurium, metrizamide, theophylline, tramadol, tubocurarine, barbiturates, opioid. Inhalational
anaesthetics and cerebral depressants may prolong effect of ketamine and delay recovery.
Prolonged recovery with concomitant use of barbiturates and/or opioids. Sustained hypertension
with thyroid hormones.
----------------------------------------------------------------------------------------------------------------------------------Midazolam 5 mg/ml Injection
Midazolam 15mg/3ml Injection
Trade Name : Dormicum
Indication :
A
A
369
Pre-operative sedation, induction of general anaesthesia, premedication and sedation in ICU and
sedation for minor procedures
Dosage :
Usual sedative range 2.5 - 7.5 mg (about 70 mcg/kg by IV injection over 30 seconds). Premedication
by IM injection 70 - 100 mcg/kg 30 -60 minutes before surgery; ELDERLY: 1 - 1.5 mg/kg. Induction:
Induction by slow IV infusion 200 - 300 mcg/kg (ELDERLY 100 - 200 mcg/kg. CHILD over 7 years 150 200 mcg/kg); Maximum: 0.35mg/kg. Sedation in ICU 0.03 - 0.2 mg/kg/hour
Precautions :
Elderly, COPD, congestive heart failure, respiratory failure, severe electrolyte and fluid disturbances,
pregnancy and lactation, hepatic and renal impairment, labor and delivery, prolonged use and
abrupt withdrawal, moderate lowering of intraocular pressure in ophthalmic. Children under 15 kg
not to exceed 1 mg/ml.
Adverse Reactions:
Muscle stiffness, induration of veins, pain, redness, headache, apnoea, nausea, coughing, vomitting,
drowsiness, respiratory depression, phlebitis, gastrointestinal disturbances, increased appetite,
jaundice, hypotension, bronchospasm, pain at the site of injection.
Contraindications:
Acute narrow angle glaucoma, hypersensitivity to midazolam products, acute alcohol intoxication,
shock, lactation.
Interactions:
Neuroleptics, tranquilizer, antidepressant, hypnotics, analgesics, anaesthetics, antipsychotics,
anxiolytics, antiepiletics, antihistamines, erythromycin, clarithromycin, cimetidine, omeprazole,
diltiazem, efavirenz, indinavir, nelfinavir, ritonavir, saquinavir, fluvoxamine, halothane, sevoflurane,
thiopental, itraconazole, theophylline, atorvastatin.
---------------------------------------------------------------------------------------------------------------------------------Midazolam 7.5 mg Tablet
A/KK
Trade Name : Dormicum
Indication :
Pre and post-operative sedation
Dosage :
ADULT: Usually 7.5 - 15 mg at bedtime; or for premedication, 30 - 60 minutes before the procedure.
For ELDERLY, debilitated or impaired liver/kidney function: 7.5 mg
Precautions :
Elderly, COPD, congestive heart failure, respiratory failure, severe electrolyte and fluid disturbances,
pregnancy and lactation, hepatic and renal impairment, labor and delivery, prolonged use and
abrupt withdrawal, moderate lowering of intraocular pressure in ophthalmic. Children under 15 kg
not to exceed 1 mg/ml.
Adverse Reactions:
Muscle stiffness, induration of veins, pain, redness, headache, apnoea, nausea, coughing, vomitting,
drowsiness, respiratory depression, phlebitis, gastrointestinal disturbances, increased appetite,
jaundice, hypotension, bronchospasm, pain at the site of injection.
Contraindications:
Acute narrow angle glaucoma, hypersensitivity to midazolam products, acute alcohol intoxication,
shock, lactation.
Interactions:
Neuroleptics, tranquilizer, antidepressant, hypnotics, analgesics, anaesthetics, antipsychotics,
anxiolytics, antiepiletics, antihistamines, erythromycin, clarithromycin, cimetidine, omeprazole,
diltiazem, efavirenz, indinavir, nelfinavir, ritonavir, saquinavir, fluvoxamine, halothane, sevoflurane,
thiopental, itraconazole, theophylline, atorvastatin.
----------------------------------------------------------------------------------------------------------------------------------
370
Propofol 1 % Injection
A*
Trade Name : Diprivan
Indication :
Induction & maintenance of general anaesthesia. Sedation of ventilated ICU patients
Dosage :
Induction: 1.5-2.5mg/ kg at the rate of 20-40 mg every 10 seconds. CHILD more than 8 years: usually
2.5mg/ kg. Maintenance: IV 25-50 mg repeated according response. IV infusion: 4-12mg/kg/hour;
CHILD more than 3 years: 9-15 mg/kg/ hour. Sedation: 0.3 - 4 mg/kg/hour up to 3 days
Precautions :
Monitor blood lipid concentration in patients at risk for fat overload, risk of convulsion in epileptic
patients, monitor signs of hypotension, airway obstruction and oxygen desaturation. Cardiac,
respiratory, renal or hepatic impairment; hypovolaemic or debilitated patients; disorders of fat
metabolism or conditions where lipid emulsions should be used cautiously. Do not use in pregnancy,
do not use for obstetric anaesthesia. Avoid in lactation, has been used for termination in 1 st
trimester. Ability to drive or operate machinery may be affected. Bradycardia. Contains EDTA which
chelates metal ions, including zinc. Hence, consider need for supplemental zinc during prolonged
administration especially in patients predisposed to zinc deficiency eg. patients with burns,
diarrhoea, major sepsis. Contains no antimicrobial preservatives. When aspirated, must be drawn
aseptically into sterile syringe or giving set immediately after opening ampoule or breaking vial seal.
Administration must commence with or without delay. Asepsis must be maintained for Diprivan &
infusion instrument throughout infusion period. Any fluids added to Diprivan line must be
administered close to cannula site. Diprivan must not be administered via microbiological filter.
Single infusion must not exceed 12 hour. At the end of the procedure or at 12 hours, whichever is
sooner, both reservoir & infusion line must be discarded & replaced as appropriate.
Adverse Reactions:
Very common: Local pain on induction. Common: Hypotension, bradycardia, transient apnoea during
induction, nausea & vomiting & headache during recovery phase, withdrawal symptoms in children,
flushing in children. Uncommon: Thrombosis & phlebitis. Rare: Epileptiform movements, including
convulsions & opisthotonus during induction, maintenance & recovery. Very rare: Rhabdomyolysis,
pancreatitis, post-operative fever, discoloration of urine following prolonged administration,
anaphylaxis - may include angioedema, bronchospasm, erythema & hypotension - sexual
disinhibition, pulmonary oedema, post-operative unconsciousness.
Contraindications:
Children less than 3 years and obstetric anaesthesia.
Interactions:
Bupivacaine, lidocaine, succinylcholine. Diprivan has been used in association with spinal and
epidural anaesthesia and with commonly used premedicants, neuromuscular-blocking drugs,
inhalational agents and analgesic agents; no pharmacological incompatibility has been encountered.
Lower doses of Diprivan may be required where general anaesthesia is used as an adjunct to
regional anaesthetic techniques. Incompatibilities: Diprivan should not be mixed prior to
administration with injections or infusion fluids other than with 5% Dextrose in PVC bags or glass
infusion bottles or lignocaine injection or alfentanil injection in plastic syringes. The neuromuscularblocking agents, atracurium and mivacurium should not be given the same IV line as Diprivan
without prior flushing.
--------------------------------------------------------------------------------------------------------------------------------Sevoflurane Liquid
Trade Name : Sevorane
Indication :
To be used only for i) induction and ii) maintenance of anaesthesia
371
A*
Dosage :
i) Up to 8% in oxygen or nitrous oxide-oxygen mixture ii) maintenance: 1 - 3%
Precautions :
Avoid the use of flow rates of less than 2 litres/minute with soda lime in patients with renal disease.
Raised intracranial pressure, cardiac, respiratory, renal or hepatic impairment, elderly or obese
patients. Maintenance of haemodynamic stability is important in patients with coronary artery
disease. Concomitant use with adrenaline or other sympathomimetics. Pregnancy and lactation.
Adverse Reactions:
Cardiorespiratory depression, hypotension, malignant hyperthermia, agitation, laryngospasm,
increased cough, salivation, acute renal failure, shivering, nausea, vomiting, rarely dystonic
movements in children, postoperative hepatitis and seizure-like activity.
Contraindications:
Hypersensitivity to sevoflurane/halogenated anaesthetics, malignant hyperthermia.
Interactions:
Isoniazid, nitrous oxide, thiopental, midazolam, phenobarbital, primidone, rocuronium, vecuronium,
atracurium, succinylcholine, tubocurarine, verapamil. Potentiates action of non-depolarising muscle
relaxants.
-------------------------------------------------------------------------------------------------------------------------------------Thiopental Sodium 500 mg Injection
B
Trade Name : Pentothal
Indication :
i) General anaesthesia, induction ii) Anticonvulsant for cases resistant to conventional
anticonvulsants in the ICU
Dosage :
i) ADULT : For induction 200 - 400 mg. For repeat injection 3 - 5 mg/kg over 10 - 15 seconds until
desired depth of anaesthesia is obtained. Not FDA approved for use in pediatric patients ii) 75 - 125
mg IV single dose; for local-anaesthetic induced convulsion: 125 - 250 mg IV over 10 minutes
Precautions :
Reduce dose in severe liver disease, cardiovascular disease, elderly, bronchiol asthma,
adrenocorticol insufficiency, lactation, renal function impairment, hypotension or shock, neoplastic
lesion of lower bowel.
Adverse Reactions:
Cardio-respiratory depression, arrhythmias, coughing, laryngospasm, bronchoconstriction,
haemolytic anaemia with renal failure, vasodilation, intracranial pressure changes, hepatotoxicity
and erythema, delirium, headache, amnesia, seizures, rash, abdominal pain, rectal bleeding,
thrombophlebitis, pain at injection site, salivation, shivering.
Contraindications:
Porphyria, status asthmaticus, respiratory failure, shock and fixed cardiac output states,
hypersensitivity to barbiturates, undergoing rectal surgery.
Interactions:
Alfentanil, hydromorphone, metoclopramide, midazolam, sevoflurane, nalbuphine, pentazocine,
propoxyphene, alcohol, succinylcholine, probenecid.
------------------------------------------------------------------------------------------------------------------------------------Atracurium Besylate 25 mg/2.5 ml Injection
Trade Name : Tracrium
Indication :
Muscle relaxation
Dosage :
A*
372
ADULT and CHILD more than 1 month: Initially 300 - 600 mcg/kg IV injection. Subsequent doses of 80
- 200 mcg/kg may be given as necessary. IV infusion: 5 - 10 mcg/kg/minute (300 - 600 mcg/kg/hour)
Precautions :
Other neuromuscular disease, severe cardiovascular disease, myasthenia gravis & severe electrolyte
disorders.
Adverse Reactions:
Tachycardia, flushing, skin and allergic reactions.Transient hypotension attributed to histamine
release. Rarely, bronchospasm, anaphylactoid reactions.
Contraindications:
Not known.
Interactions :
Effect enhanced by inhalation anaesthesia, aminoglycoside, polymyxins, lithium, magnesium salts,
procainamide and quinidine.
------------------------------------------------------------------------------------------------------------------------------------Pancuronium Bromide 4 mg/2 ml lnj
B
Trade Name : Pavulon
Indication :
Muscle relaxant as an adjunct to general anaesthesia
Dosage :
ADULT: Initially 50 - 100 mcg/kg IV, then 10 - 20 mcg/kg as required. CHILD: Initially 60 - 100 mcg/kg
then 10 - 20 mcg/kg. NEONATE: 30 - 40 mcg/kg then 10 - 20 mcg/kg. Intensive care, by IV, 60 mcg/kg
every 60 - 90 minutes
Precautions :
Pre-existing pulmonary and renal disease, pregnancy and neonate acidosis, severe electrolyte
disturbances.
Adverse Reactions:
Local reaction at injection site.
Contraindications:
Myasthenia gravis or myasthenic syndrome.
Interactions:
Increased activity with ether, halothane, isoflurane and cyclopropane.
-------------------------------------------------------------------------------------------------------------------------------------Rocuronium Bromide 10 mg/ml Injection
A*
Trade Name : Esmeron
Indication :
As an adjunct to general anaesthesia to facilitate endotracheal intubation, to provide skeletal muscle
relaxation during surgery and to facilitate mechanical ventilation in adults, children and infants from
3 months of age
Dosage :
ADULT (usual) : Intubation: (rapid sequence intubation) initial, 0.6-1.2 mg/kg IV Intubation: (tracheal
intubation) initial, 0.6 mg/kg IV Intubation: maintenance, 0.1-0.2 mg/kg IV repeated as needed.
Intubation: maintenance, 0.01-0.012 mg/kg/minute continuous IV infusion. Skeletal muscle
relaxation: initial, 0.6 mg/kg IV, maintenance, 0.1-0.2 mg/kg IV repeated as needed or 0.01-0.012
mg/kg/minute continuous IV infusion. CHILD: (usual) Intubation: (age 3 months-12 yr) initial, 0.6
mg/kg/dose IV, maintenance, 0.075-0.125 mg/kg IV as needed or 0.012 mg/kg/min continuous IV
infusion. Skeletal muscle relaxation: (age 3 months-12 yr) initial, 0.6 mg/kg/dose IV, maintenance,
0.075-0.125 mg/kg IV as needed or 0.012 mg/kg/min continuous IV infusion
Precautions :
Hepatic, biliary tract and renal diseases, condition associated with prolonged circulation time,
neuromuscular disease, hypothermic condition, obesity, hypokalaemia, hypermagnesaemia,
373
hypocalcaemia, hypoproteinaemia, dehydration, acidosis, hypercapnia, cachexia increases effects.
Not recommended to drive or operate machinery within 24 hour after full recovery.
Adverse Reactions:
Minimal histamine-releasing and cardiovascular effects, high doses produce mild vagolytic activity.
Rare anaphylactic reactions. Itching and erythematous reactions at the site of injection and or
generalized histaminoid reactions example bronchospasm and cardiovascular changes.
Contraindications:
Hypersensitivity to rocuronium products.
Interactions:
Anaesthetics, other non-depolarising neuromuscular blocking agents, neostigmine, edrophonium,
pyridostigmine, aminopyridine derivatives, phenytoin or carbamazepine, noradrenaline,
azathioprine, theophylline and calcium chloride.
----------------------------------------------------------------------------------------------------------------------------------Suxamethonium Chloride 50 mg/ml lnj
B
Trade Name : Scoline
Indication :
Muscle relaxant as an adjunct to anaesthesia
Dosage :
Initial test dose 5 - 10 mg may be given. Usual single dose 0.3 - 1.1 mg/kg IV. Maximum 100 mg
according to the depth and duration of relaxation required. 2.5 - 4 mg/kg IM, maximum 150 mg
Precautions :
Cardiac disease, severe trauma or electrolyte imbalance, pre-existing hyperkalaemia. Ocular surgery,
glaucoma. Elderly.
Adverse Reactions :
Transient muscle fasciculation before relaxation, increased intraocular and intragastric pressure,
post-operative pain, bradycardia, tachycardia, hypertension, hypotension, muscarinic effects.
Contraindications :
Patients who are burnt, severely hyperkalaemic with penetrating eye wounds, malignant
hyperpyrexia, massively traumatised patients or those with extensive muscle degeneration eg.
recent paraplegia.
Interactions :
Enhanced effect by aminoglycoside, clindamycin, cyclophosphamide, neostigmine, pyridostigmine,
rivastigmine and possibly donepezil. Arrhythmias if given with digoxin.
-------------------------------------------------------------------------------------------------------------------------------------Ethyl Chloride Spray
C
Indication :
For minor surgical procedures including lancing boils, incision and drainage of small abscesses, pain
due to athletic injuries and pain due to injection administration
Dosage :
Spray to affected area at a distance of about 30cm until a fine white film is produced
Precautions :
Ethyl chloride is highly flammable and mixtures of the gas with 5% to 15% of air are explosive; never
use it in the presence of an open flame or near electric cautery equipment. Caution should be taken
to avoid frostbite; when used for cryotherapy, protect adjacent skin with petrolatum. Inhalation of
ETHYL CHLORIDE can produce narcosis or even fatal coma with respiratory or cardiac arrest. Cover
eyes, nose and mouth if spraying near the face.To protect against tissue sloughing, cover the skin
adjacent to the area being treated with petrolatum. Avoid spilling the liqd on the skin. Freezing may
also distort the histological structure of biopsy specimens. Highly flammable. Avoid inhalation when
used as local anaesthesia
374
Adverse Reactions :
Transient hypertension, narcosis, vomiting and coma. Thawing of frozen tissue after surgery may be
painful. Chemical frostbite may occur following prolonged spraying onto the skin. Nephrotoxicity or
hepatotoxicity (long-term exposure)
Contraindications:
Hypersensitivity to ethyl chloride products and vascular impairment of the extremities. Porphyria.
Application on broken skin or mucous membranes
Interactions :
Cisatracurium, St John's Wort
-------------------------------------------------------------------------------------------------------------------------------------Lidocaine 25mg and Prilocaine 25mg Cream
A
Trade Name : Emla
Indication :
Used for painless venepunctures, radial artery cannulations before extradural/spinal and other
regional blocks in children above 1 year old and adults. Also used in chronic renal failure patients for
insertion of A-V fistulas and shunts for haemodialysis.
Dosage :
Apply a thick layer under occlusive dressing at least 1 hour before the procedure
Precautions :
Not for use on wounds or mucous membrane, atopic dermatitis. Application in vicinity of the eyes
Adverse Reactions :
Oedema, itching and exanthema allergic reactions, increase methaemoglobin level. Paleness,
erythema (redness). Mild burning sensation, itch or warmth in leg ulcer
Contraindications :
Congenital or idiopathic methaemoglobinaemia, avoid in infant less than 6 months old. Open
wounds other than leg ulcers. Genital mucosa of children. Impaired tympanic membrane. Prior to
intracutaneous injection of a live vaccine eg BCG, infants less or 12 month, preterm infants with
gestational age less than 37 week
Interactions :
Potentiation of cardiac effects, antiarrhythmias; other local anaesthetics. Increased risk of systemic
toxicity in patients receiving other local anaesth. Sulfonamides
-------------------------------------------------------------------------------------------------------------------------------------Lignocaine 10 % w/w Spray
B
Indication :
For surface anaesthesia in dental practice, in otorhinolaryngology and paracentesis
Dosage :
Spray to affected part
Precautions :
Cardiovascular disease, wounds or traumatised mucosa in the application region. Partial or complete
heart block, elderly and patients in poor general health. Advanced liver disease or severe renal
dysfunction. Avoid contact with eyes, wound or traumatised mucosa
Adverse Reactions :
Circumoral paraesthesia, numbness of the tongue, light headedness, tinnitus, severe hypotension,
bradycardia, arrhythmia, cardiovascular collapse. Sore throat, hoarseness, loss of voice, allergic
reactions (rare)
Contraindications :
Hypersensitivity to lidocaine or amide type of local anaesthetics
375
Interactions :
Potentiation of cardiac effects antiarrhythmias. Lidocaine should be used with caution with dental
injection anaesthesia, other local anaesthetics or class intrabursal (IB) antiarrhythmic drugs, as the
toxic effects are additive. Tocainide and drugs that reduce the clearance of lidocaine (eg, cimetidine
or β-blockers) may cause potentially toxic plasma concentrations when lidocaine is given in repeated
high doses over a long time period
-------------------------------------------------------------------------------------------------------------------------------------Lignocaine 2% Jelly
B
Trade Name : Xylocaine
Indication :
Use for endotracheal tubes and instruments, painful procedures in the ear, nose and throat, burns,
wounds, abrasions, lacerations; catheterisation of the male and female urethra and for symptomatic
treatment of cystitis and urethritis
Dosage :
Apply to affected area 10 mins before catheterization, etc
Precautions :
Traumatised mucosa and sepsis in the region of application, chronic heart failure, bradycardia or
respiratory depression, hepatic insufficiency. Should not be used as ophthalmic drug. Presence of
sepsis or severely traumatized mucosa in area of application. When used for endotracheal tube
lubrication, avoid introducing into the lumen of the tube. Closely supervise patients being treated
with class III antiarrhythmic drugs eg amiodarone and monitor ECG due to the additive effects.
Adverse Reactions:
Allergic reactions. Intoxication, cutaneous and hypersensitivity symptoms. Sore throat. Central
nervous system excitation followed by depression with drowsiness, respiratory failure and coma,
numbness of tongue and perioral region, myocardial depression, peripheral vasodilation,
hypotension, bradycardia, arrhythmia, cardiac arrest. Prolonged use in the eye may lead to severe
contact keratitis and corneal damage.
Contraindications:
Hypersensitivity to lidocaine or amide type of local anaesthetics. Hypovolaemia, heart block or other
conduction disturbances.
Interactions:
Potentiation of cardiac effects antiarrhythmias. Drugs structurally related to local anaesthesia.
-------------------------------------------------------------------------------------------------------------------------------Bupivacaine 0.5 % Heavy Injection
A
Trade Name : Marcaine Spinal Heavy
Indication :
Used for spinal anaesthesia
Dosage :
ADULT: 2 - 4 ml. Not to exceed 2 mg/kg in a single dose
Precautions :
Neurological disorder, severe bradycardia, cardiac conduction abnormalities, hypoxaemia, acidosis,
hyperkalaemia, predisposition to malignant hypothermia, pregnancy. Resuscitative equipment &
drugs should be immediately available. Hypovolaemia due to haemorrhage or dehydration,
aortocaval occlusion, coronary or cerebrovascular disease. Chronic neurological disorders. May
impair ability to drive or operate machinery.
Adverse Reactions:
Confusion, nervousness, dizziness, tinnitus, respiratory depression and convulsion, hypotension and
bradycardia, hypersensitivity.
376
Contraindications:
Hypovolaemia, complete heart block, intravenous regional anaesthesia (Bier's block). Acute active
disease of the CNS eg meningitis, tumours, poliomyelitis & cranial haemorrhage, active TB or
metastatic lesions in the vertebral column. Septicaemia. Pernicious anaemia with subacute
combined degeneration of the spinal cord. Pyrogenic infection of the skin at or adjacent to the site
of puncture. Cardiogenic or hypovolaemic shock. Coagulation disorders or ongoing anticoagulant
treatment.
Interactions:
Hyaluronidase, propofol, rapacuronium, verapamil, antiarrhythmias.
-------------------------------------------------------------------------------------------------------------------------------------Bupivacaine 0.5 % Injection
B
Trade Name : Marcaine
Indication :
For peripheral sympathetic nerve and epidural (excluding caudal) anaesthesia and obstetrics
anaesthesia
Dosage :
Regional nerve block or epidural block: 15 - 30 ml. Nerve block of finger or toe: 2 - 6 ml. Maximum: 2
mg/kg body weight in any 4 hours period, equivalent to 25 - 30 ml in adults of average weight
Precautions :
Neurological disorder, severe bradycardia, cardiac conduction abnormalities, hypoxaemia, acidosis,
hyperkalaemia, predisposition to malignant hypothermia, pregnancy
Adverse Reactions:
Confusion, nervousness, dizziness, tinnitus, respiratory depression and convulsion, hypotension and
bradycardia, hypersensitivity, arrhythmias and cardiac arrest; methemoglobinaemia; seizures,
restlessness. Prolonged block.
Contraindications:
Hypovolaemia, complete heart block, intravenous regional anaesthesia (Bier's block). Acute active
disease of the CNS eg meningitis, tumours, poliomyelitis & cranial haemorrhage, active TB or
metastatic lesions in the vertebral column. Septicaemia. Pernicious anaemia with subacute
combined degeneration of the spinal cord. Pyrogenic infection of the skin at or adjacent to the site
of puncture. Cardiogenic or hypovolaemic shock. Coagulation disorders or ongoing anticoagulant
treatment.
Interactions:
Hyaluronidase, propofol, rapacuronium, verapamil, antiarrhythmias.
--------------------------------------------------------------------------------------------------------------------------------Bupivacaine 0.5 % with Adrenaline 1:200,000 Injection
B
Trade Name : Marcaine-Adrenaline
Indication :
Regional nerve block or epidural block.
Dosage :
10 - 40 ml (0.25 %) or maximum : 2 mg/kg body weight in any 4 hours period, equivalent to 25 - 30
ml of 0.5% solution
Precautions :
Preexisting neurological or neuromuscular disease eg myasthenia gravis; CNS or spinal cord disease
eg meningitis, spinal fluid block, cranial or spinal haemorrhage, tumours, poliomyelitis, syphilis, TB or
metastatic lesions of the spinal cord, severe hepatic disease, severe renal dysfunction,
hyperthyroidism, epilepsy, severe bradycardia, severe cardiac conduction abnormalities, severe
shock or digitalis intoxication, Stokes-Adams or Wolff-Parkinson-White syndrome, hypoxaemia,
acidosis, hyperkalaemia, predisposition to malignant hypothermia, fetal bradycardia/tachycardia
377
frequently follows paracervical block with some amide type local anesth & may be associated with
fetal acidosis & hypoxia. Added risk in prematurity, toxaemia of pregnancy & fetal distress. Monitor
fetal heart rate. Pregnancy. Allergic type reactions including anaphylactic type symptoms & lifethreatening or less severe asthmatic episodes in certain susceptible people. Extreme caution in
patients with severe or untreated hypertension, poorly controlled thyrotoxicosis, ischaemic heart
disease, heart block, cerebrovascular insufficiency, advanced diabetes & any other pathological
condition that might be aggravated by effects of adrenaline. Adrenaline may induce anginal pain in
patients suffering from ischaemic heart disease. Ventricular fibrillation, prefibrillatory rhythm,
tachycardia, myocardial infarction, phenothiazine-induced circulatory collapse & prostatic
hypertrophy.
Adverse Reactions:
Light headedness, nervousness, apprehension, euphoria, confusion, drowsiness, tinnitus, blurred
vision, diplopia, nausea, vomiting, sensations of heat, cold or numbness, urinary retention,
paraesthesia circumoral, hyperacusis, twitching, tremors, convulsions, unconsciousness, resp
depression &/or arrest, agitation, numbness of the tongue, difficulty in swallowing & slurred speech.
CV: bradycardia, hypotension: Haemodynamic: maternal hypotension. Neurologic: spinal block of
varying magnitude (including total spinal block), hypotension secondary to spinal motor, sensory
&/or autonomic (sphincter control) deficit of some lower spinal segment w/ slow recovery (several
mth) or incomplete recovery in rare instances when caudal or lumbar epidural block has been
attempted. Backache & headache. Neuropathy, peripheral nerve injury & arachnoiditis. Inadvertent
subarachnoid inj may lead to CNS depression, resp arrest & CV collapse. Allergic: cutaneous lesions,
urticaria, oedema or anaphylactoid reactions.
Contraindications:
Allergy or hypersensitivity to amide type local anesth. Epidural or spinal anesth in patients with
uncorrected hypotension. Infection and/or septicaemia. Obstetric paracervical block, IV regional
anesth (Bier's block). Thyrotoxicosis; regions with compromised blood supply, extremities. severe
hemorrhage, severe hypotension or shock and arrhythmias, such as complete heart block, which
severely restrict cardiac output (spinal anesthesia).
Interactions:
May potentiate the cardiac effects of antiarrhythmics (eg mexiletine & lignocaine). CNS acting drugs:
tricyclic antidepressants or MAOIs, phenothiazines & butyrophenones. Oxytocic drugs of the ergot
type. Adrenergic neuron blocking agents eg guanethidine, debrisoquine, bethanidine. β-blocker eg
propranolol. Inhalation anesth eg chloroform, halothane, cyclopropane, trichloroethylene or other
halogenated cmpds. Cardiac glycosides, quinidine, hypoglycaemics.
----------------------------------------------------------------------------------------------------------------------------------Levobupivacaine 5mg/ml Injection
A
Trade Name : Chirocaine
Indication :
Production of local or regional anesthesia for surgery and obstetrics, and for postoperative pain
management
Dosage :
Surgical anesthesia : Lumber epidural : 10 - 20 ml (50 - 150 mg) , caesarean section : 15 - 30 ml (75 150 mg), intrathecal: 3 ml (15 mg), peripheral nerve block : 1 - 40 ml, ilioinguinal/iliohypogastric
block. CHILD : 0.25 - 0.5 ml/kg (1.25-2.5 mg/kg)
Precautions :
Use with caution in patients with hypotension, hypovolemia, heart block, hepatic or cardiac
impairment.
Adverse Reactions:
Hypotension, anemia, nausea, vomiting, fever, pruritus, cardiac arrest, cardiac dysrhythmia, apnea.
Contraindications:
Hypotension, anemia, nausea, vomiting, fever, pruritus, cardiac arrest, cardiac dysrhythmia, apnea.
378
Interactions:
St John's Wort.
-------------------------------------------------------------------------------------------------------------------------------------Lignocaine HCl (Lidocaine) 2% Injection
B
Indication :
Local anesth by infiltration IV regional anesthesia and nerve block. Emergency management of
ventricular arrhythmias particularly after myocardial infarction and cardiac surgery
Dosage :
Local anesthesia : ADULT Maximum: 200 mg; CHILD Maximum: 30 mg/kg Cardiac arrhythmias :
ADULT 50-100 mg IV. Maximum: 200-300 mg/hour; CHILD Loading dose: 0.8-1 mg/kg IV repeated if
necessary up to 3-5 mg/kg followed by a continuous infusion of 10-50 mcg/kg/min
Precautions :
Neurological disorder, severe bradycardia, cardiac conduction abnormalities, pregnancy, congestive
heart failure, respiratory depression, hepatic or renal insufficiency, epilepsy, shock, myasthenia
gravis. Elderly. Pregnancy and lactation.
Adverse Reactions:
Nervousness, dizziness, sedation, blurred vision, tinnitus, gastrointestinal effects, dose-related
methaemoglobinaemia and cyanosis. Restlessness, excitement, nervousness, paraesthesia, vomiting,
muscle twitching and tremors, convulsions. Numbness of tongue and perioral region, light
headedness, sedation, CNS depression, respiratory failure and coma. Arrhythmias, bradycardia,
cardiac arrest, anaphylaxis. Lassitude, amnesia, foetal intoxication.
Contraindications:
Local inflammation and/or sepsis, septicaemia. Hypovolaemia, heart block and other conduction
disturbances, bradycardia, cardiac decompensation or hypotension.
Interactions:
Potentiation of cardiac effects antiarrhythmias, phenytoin, beta-blockers, cimetidine.
-------------------------------------------------------------------------------------------------------------------------------------Lignocaine 2% Viscous Solution
A
Indication :
For post-tonsilectomy, sore throat, dumping syndrome, hiccough, reflux vomiting, painful lesions of
the mouth, cardiospasm, instrumentation of the respiratory and digestive tract
Dosage :
To be taken orally as directed
Precautions :
Traumatised mucosa and sepsis, minimum interval between doses: 3 hours. Monitoring should be
considered with amiodarone. Partial or complete heart block, elderly and patients in poor general
health. Advanced liver disease or severe renal dysfunction.
Adverse Reactions:
Intoxication, hypersensitivity, drowsiness, excitement, dizziness, nausea, vomiting, blurred vision.
Allergic reactions (rare).
Contraindications:
Hypersensitivity to lidocaine or amide type of local anaesthetics.
Interactions:
Potentiation of cardiac effects, antiarrhythmias. Dental injection anaesthesia, other local
anaesthesia or class intrabursal (IB) antiarrhythmic drugs.
--------------------------------------------------------------------------------------------------------------------------------------
379
Ropivacaine HCl 2 mg/ml Injection
A*
Ropivacaine HCl 7.5 mg/ml Injection
A*
Trade Name : Naropin
Indication :
i) Surgical anaesthaesia including obstetrics ii) Acute pain management
Dosage :
Dose adjusted according to patient physical status and nature of procedure. i) Lumbar epidural: 1525 ml of 7.5 mg/ml solution; Caesarean section, 15-20 ml of 7.5 mg/ml solution in incremental doses
( max . total dose 150 mg). ii) lumbar epidural: 10-20 ml of 2mg/ml solution followed by 10-15 ml of
2 mg/ml solution at interval at of least 30 minutes. Labour pain 6-10 ml/hour of 2mg/ml solution
Precautions :
Severe liver disease, acidosis, chronic renal disease. Resuscitative equipment and drugs for treating
toxic reactions should be immediately available.
Adverse Reactions:
Confusion, respiratory depression and convulsion, hypersensitivity, tachycardia, nausea, backache,
Horner's syndrome. Bradycardia, vomiting, paraesthesia, temperature elevation, headache, urinary
retention, dizziness, hypertension, hypotension, rigors, tachycardia, anxiety, hypoesthesia.
Contraindications:
Hypovolaemia, hypersensitivity to ropivacaine/amide-type anaesthetics, severe hypotension,
complete heart block. General contraindications related to epidural anaesthesia, regardless of the
local anaesthetic used, should be taken into account.
Interactions:
Hyaluronidase, propofol, rapacuronium, verapamil, antiarrhythmias, fluvoxamine, imipramine,
theophylline and enoxacin. Concomitant use with other related amide-type local anaesthetic.
-------------------------------------------------------------------------------------------------------------------------------------Atropine Sulphate 1mg/ml Injection
B
Indication :
i) Reduce vagal inhibition,salivary and bronchiol secretion in anaesthesia ii) Reversal of excessive
bradycardia iii) Reversal of effect of competitive muscle relaxants iv) Overdosage with other
compounds having muscarinic action v) Organophosphate poisoning
Dosage :
i) ADULT 300-600 mcg IM/SC 30-60 minutes before anaesthesia or 300-600 mcg IV immediately
before induction of anaesthesia ii) ADULT 0.5-1 mg repeated, every 3-5 minutes. Max Dosage: 0.04
mg/kg body weight iii) ADULT 0.6-1.2 mg before or with anticholinesterase iv) ADULT 0.5-1 mg IV/SC,
repeated every 2 hour v) ADULT 2 mg IV/IM, every 30 minutes according to clinical response.
Cholinesterase reactivator should be given at the earliest possible time
Precautions :
paediatric and geriatric patients, debilitated patients with lung disease, autonomic neuropathy,
hepatic or renal disease, may cause heat prostration, patients with ileostomy or colostomy,
diarrhoea may indicate incomplete intestinal obstruction, avoid driving or hazardous activities, may
cause neuromuscular blockade resulting in weakness or paralysis, hyperthyroidism, coronary heart
disease, acute myocardial ischemia, CHF, tachyarrhythmia, tachycardia, HTN, or prostatic
hypertrophy, pregnancy, neonates.
Adverse Reactions:
Constipation, transient bradycardia (followed by tachycardia, palpitations & arrhythmias), reduced
bronchial secretions, urinary urgency & retention, dilatation of the pupils with loss of
accommodation, photophobia, dry mouth, flushing & dryness of the skin.
380
Contraindications:
Hypersensitivity to atropine or anticholinergics, narrow-angle glaucoma, reflux oesophagitis,
obstructive gastrointestinal disease/uropathy, ulcerative colitis or toxic megacolon, unstable
cardiovascular status in acute haemorrhage or thyrotoxicosis.
Interactions:
Loss of cisapride efficacy, procainamide coadministered with atropine may result in additive
antivagal effects on atrioventricular nodal conduction Major interaction with potassium, topiramate,
effect of atropine and other antimuscuranic may be enahnced by concomitant administration of
drug with antimuscuranic properties. MAOIs may enhance atropine effect. Reduce GIT motality may
affect other oral drug absorption.
----------------------------------------------------------------------------------------------------------------------------------Glycopyrrolate 200 mcg/ml Injection
A*
Indication :
i) To reduce secretions (respiratory tract) for certain types of surgery ii) Reversal of neuromuscular
block in patients where atropine is contraindicated
Dosage :
i) ADULT: 0.2 - 0.4 mg by IV before anaesthesic induction or intraoperatively. CHILD: 4-8 mcg/kg up
to a max of 200 mcg (0.2 mg) by IV ii) 0.2 mg by IV for each 1 mg of neostigmine or 5 mg
pyridostigmine
Precautions :
Autonomic neuropathy, children and elderly patients, congestive heart failure, coronary heart
disease, hypertension, hyperthyroidism, ileostomy or colostomy, mild hepatic or renal disease,
prostatic hypertrophy, tachyarrythmia, tachycardia. May cause heat prostration, neuromuscular
blockade.
Adverse Reactions :
Dry mouth, blurred vision, tachycardia, urinary retention, constipation, severe allergic reactions
including anaphylactic/anaphylactoid reactions; hypersensitivity; urticaria, pruritus, dry skin, and
other dermal manifestations; some degree of mental confusion and/or excitement, especially in
elderly.
Contraindications :
Glaucoma, obstructive uropathy, GI obstruction, myasthenia gravis, hypersensitivity to
glycopyrrolates newborns less than 1 month of age.
Interactions :
Cisapride, with other anticholinergics or medications with anticholinergic activity, such as
phenothiazines, antiparkinson drugs, or tricyclic antidepressants, may intensify the antimuscarinic
effects and may result in an increase in anticholinergic side effects.Post-marketing reports have
included cases of heart block and QTc interval prolongation associated with the combined use of
glycopyrrolate and an anticholinesterase.
--------------------------------------------------------------------------------------------------------------------------------------
381
22. DIAGNOSTIC
Radiocontrast media
Diagnostic aids and test preparation
382
Barium Sulphate Suspension
B
Trade Name : Baritop, Barytgen
Indication :
For x-ray examination of the alimentary tract:
i) Oesophagus
ii) Stomach and duodenum
iii) Colon
Dosage :
i) Up to 150 ml of a 50% - 200% suspension orally
ii) Up to 300 ml of a 30% - 200% suspension orally
iii) Up to 2 litre of a 30% - 200% suspension orally
Precautions :
Intestinal obstruction, pyloric stenosis or lesions which may predispose to obstruction, conditions
which may predispose to perforation such as acute ulcerative colitis and acute diverticulitis.
Adequate hydration should be ensured after the procedure to prevent severe constipation, history
of bronchial asthma or allergy, previous reaction to a contrast agent, hypertension, advanced cardiac
disease, intussusception with symptoms of more than 24 hours duration, tracheoesophageal fistula
Adverse Reactions :
Hypersensitivity reactions, constipation, aspiration pneumonia if aspirated, ventricular fibrillation,
bradycardia, asystole, electrocardiographic changes, and hypotension, urticaria, pruritus, erythema
and generalized rashes, dysphagia, constipation, diarrhea, acute pritonitis, anaphylactic reactions,
headache, dyspnea
Contraindications :
Gastrointestinal perforation, acute bleeding from gastrointestinal tract, peritonitis, pneumatosis
intestinalis, gross intestinal obstruction, known or suspected perforation, hypersensitivity to
anything in the barium sulfate suspension
Interactions :
Not known
--------------------------------------------------------------------------------------------------------
Fluorescein 1 mg Ophthalmic Strip
B
Trade Name : Fluorets
Indication :
Diagnostic fluorescein angiography or angioscopy of the fundus and of the iris vasculature
Dosage :
Moisten tip with tear fluid from lower fornix, sterile water or ophthalmic solution and gently stroke
across the conjunctiva
Precautions :
History of allergy or bronchial asthma. Pregnancy especially in the first trimester, lactation
Adverse Effects :
Nausea and headache, other symptoms and signs of hypersensitivity, allergic conjunctivitis, periorbital oedema, anaphylactic reaction, urticaria, rash
Contraindications :
Hypersensitivity to any of the components of product. Not to be used with soft contact lenses
Interactions :
Not known
--------------------------------------------------------------------------------------------------------
383
Hydroxyethyl Cellulose Jelly
B
Trade Name : KY Jelly
Indication :
For lubricating purpose
Dosage :
Apply sufficiently for lubricating purpose
Precautions:
Not known
Adverse effects:
Not known
Contraindications:
Not known
Interactions:
Not known
--------------------------------------------------------------------------------------------------------------------------------------
384
23. MISCELLANEOUS
General disinfectant
Other disinfectant
Diagnostic radiopharmaceuticals
Therapeutic radiopharmaceutials
385
Ether Solvent
C
Indication :
To remove adhesive plaster from the skin
Dosage :
Dose depending on the route and procedure
Precautions:
Not known
Adverse Reactions:
Not known
Contraindications:
Hypersensitivity to iohexol/iopromide products, intrathecal corticosteroids, immediate repeat
myelography, local or systemic infection
Interactions:
Not known
-------------------------------------------------------------------------------------------------------------------------------------Chlorinated Lime Powder
C
Indication :
Antiseptic and disinfectants
Dosage :
Not applicable
Precautions:
Bleaches fabric, irritant, do not use on open wounds
Adverse Reactions:
Irritating to skin, dissolves blood clots, delay clotting
Contraindications:
Not known
Interactions:
No interaction found
-------------------------------------------------------------------------------------------------------------------------------------Sodium Hypochlorite Solution
C
Trade Name : Milton, Clorox
Indication :
Low-level disinfectant and antiseptic
Dosage :
Antiseptic: less than 0.5%. Disinfectant: 5%
Precautions:
For external use only, avoid eye or mucous membrane contact, do not use on open wounds
Adverse Reactions:
Dissolves blood clots, delays clotting. Higher concentration-corrosive to the eye, the skin and
respiratory tract
Contraindications:
Hypersensitivity to any component of the formulation
Interactions:
Not known
--------------------------------------------------------------------------------------------------------------------------------------
386
INDEX
387
3TC, 193
5-FU, 263
Abilify, 113
Acarbose 50 mg Tablet, 205
Acetazolamide 250 mg Tablet, 313
Acetazolamide 500 mg Injection, 314
Acetylcysteine 200mg/ml, 9
Acetylsalicylic Acid 100 mg, Glycine 45 mg
Tablet, 71
Acetylsalicylic Acid 300 mg Soluble Tablet, 96
Acitretin 25 mg Capsule, 342
Acriflavine 0.1% Lotion, 355
Act-Hib, 362
Actifed, 334
Actinomycin D (Dactinomycin) 500 mcg/ml
Injection, 255
Actrapid, 208, 209
Acular, 318
Acyclovir 200 mg Tablet, 190
Acyclovir 250 mg Injection, 191
Acyclovir 3% Eye Ointment, 311
Acyclovir 5% Cream, 349
Acyclovir 800 mg Tablet, 190
Adalat, 63
Adapalene 0.1% Gel, 346
Addamel Solution, 284
Adenocor, 45
Adenosine 3 mg/ml Injection, 45
Adrenaline Acid (Epinephrine) Tartrate 1
mg/ml Injection, 66
Adriamycin, 261, 262
Aerius, 328
Afrin, 324
Albendazole 200 mg Tablet, 202
Albendazole 200 mg/5 ml Suspension, 202
Alcaine, 317
Alcohol 70% Solution, 355
Aldactone, 45
Aldomet, 54
Alendronate Sodium 70mg and Cholecalciferol
2800 IU Tablet, 222
Alfacalcidol 0.25 mcg Capsule, 286
Alfacalcidol 1 mcg Capsule, 286
Alfacalcidol 2 mcg/ml Drops, 287
Alfacalcidol 2 mcg/ml Injection, 287
Alkaline Nasal Douche, 322
Alkeran, 266
Allopurinol 300 mg Tablet, 303
All-Trans Retinoic Acid 10 mg Capsule, 255
Alphagan P, 314
Alphanate, 76
Alphanine, 75
Alprazolam 0.25 mg Tablet, 112
Alprim, 184
Alprostadil 500 mcg/ml Injection, 81
Amantadine HCl 100 mg Capsule, 144
Amikacin 250 mg/2 ml Injection, 158
Amikacin 500 mg/2 ml Injection, 158
Amikin, 158
Amiloride HCl 5 mg & Hydrochlorothiazide 50
mg Tablet, 42
Amino Acids Injection, 283
Aminophylline 25 mg/ml Injection, 83
Amiodarone 150mg/3 ml Injection, 46
Amiodarone 200 mg Tablet, 46
Amitriptyline HCl 25 mg Tablet, 124
Amlodipine 10 mg Tablet, 60
Amlodipine 5 mg and Valsartan 160 mg
Tablet, 60
Amlodipine 5 mg Tablet, 60
Ammonium Bicarbonate, Tincture Ipecac, etc
Mixture, 333
Amorolfine 5 % Nail Lacquer, 349
Amoxicillin & Clavulanate 228 mg/5 ml Syrup,
158
Amoxicillin 1 g & Clavulanate 200 mg
Injection, 158
Amoxicillin 250 mg Capsule, 159
Amoxicillin 500 mg & Clavulanate 125 mg
Tablet, 159
Amoxicillin Trihydrate 125 mg/5 ml Syrup, 160
Amphotericin B 0.15% Eye Drops, 306
Amphotericin B 50 mg Injection, 185
Ampicillin Sodium 1g & Sulbactam Sodium
500mg Injection, 160
Ampicillin Sodium 500 mg Injection, 160
Ampicillin Trihydrate 125 mg/5 ml
Suspension, 161
Anastrozole 1 mg Tablet, 271
Anexate, 13
Angised, 62
Antazoline HCl, Tetrahydrozoline HCl and
Benzalkonium Cloride Eye Drops, 310
Anti RhD Gamma Globulin 250 mcg/2 ml
Injection (500 units=100 mcg), 365
Antilymphocyte/Antithymocyte
Immunoglobulin (from Horse) Injection,
249
Antivenene Malaysian Pit Viper Injection, 9
Antivenene Serum (Cobra) Injection, 9
Antivenene Serum (Sea snake) 1000
units/26.3 ml Injection, 10
388
Antivenene Serum Snake polyvalent Injection,
10
Anusol, 29
Anzatax, 270
Aprepitant 125 mg Capsule, 33
Aprovel, 52
Aqueous Cream, 337
Arava, 301
Aredia, 224
Aricept, 151
Arimidex, 271
Aripiprazole 10mg Tablet, 113
Aripiprazole 15mg Tablet, 113
AripMT, 113
Arixtra, 68
Artane, 144
A-Scabs, 353
Ascorbic Acid 100 mg Tablet, 288
Aspirin Soluble, 96
Atarax, 329
Atenolol 100 mg Tablet, 47
Atgam, 249
Ativan, 113
Atomoxetine HCl 10 mg Capsule, 152
Atomoxetine HCl 18 mg Capsule, 152
Atorvastatin 20 mg Tablet, 77
Atracurium Besylate 25 mg/2.5 ml Injection,
372
Atropine Sulphate 1% Eye Drops, 311
Atropine Sulphate 1mg/ml Injection, 380
Atrovent, 83, 85
ATT, 364
Augmentin, 158
Aurorix, 128
Avandia, 211
Avodart, 244
Azathioprine 50 mg Tablet, 249
Azelaic Acid 20% Cream, 346
Azithromycin 250 mg Tablet, 161
Azithromycin 500 mg Injection, 161
Bacampicillin 400 mg Tablet, 162
Baclofen 10 mg Tablet, 153
Bactrim, 183, 184
Bactroban, 352
Balanced Salt Solution, 317
Baraclude, 193
Baritop, 383
Barium Sulphate Suspension, 383
Barytgen, 383
BCG Vaccine Freeze-Dried Injection, 362
Beclomethasone Dipropionate 100 mcg/dose
Inhalation, 90
Becotide, 90
Benadryl, 333
Benzathine Penicillin 2.4 mega units Injection
(1.8 g), 162
Benzhexol 2 mg Tablet, 144
Benzoic Acid Compound Ointment, 350
Benzoyl Peroxide 5% Gel, 347
Benzydamine HCl 0.15% Solution, 325
Benzyl Benzoate 25 % Emulsion (Adult), 350
Benzylpenicillin 1 mega unit (600 mg)
Injection, 163
Benzylpenicillin 5 mega units (3 g) Injection,
163
Beractant Intratracheal Suspension (200 mg
phospholipids in 8 ml vial), 93
Betahistine Dihydrochloride 24 mg Tablet,
153, 334
Betaloc, 49
Betamethasone Disodium Phoshate 0.1% Ear
Drops, 321
Betamethasone Disodium Phoshate 0.5% Ear
Drops, 321
Betamethasone Disodium Phosphate 0.1%
Eye/Ear Drops, 309
Betaserc, 153, 334
Betnesol, 309, 321
B-Hepa, 362
Bimatoprost 0.03% Ophthalmic Solution, 314
BIPP, 323
Bisacodyl 10 mg Suppository, 27
Bisacodyl 5 mg Tablet, 28
Bismuth Subgallate and Benzyl Benzoate
Suppository, 29
Bismuth Subnitrate, Iodoform and Liquid
Paraffin Paste, 323
Bisolvon, 332
Bisoprolol Fumarate 2.5 mg Tablet, 47
Bisoprolol Fumarate 5 mg Tablet, 47
Bleocin, 256
Bleomycin HCl 15 mg Injection, 256
Bonjela, 325
Bonviva, 223
Botox, 154
Bricanyl, 87, 88, 89
Brimonidine Tartrate 0.15% Ophthalmic, 314
Bromhexine HCl 4 mg/2 ml Injection, 332
Bromhexine HCl 8 mg Tablet, 332
Bromocriptine Mesilate 2.5 mg Tablet, 225
Brufen, 108
BSS, 317
Budesonide 1 mg/2 ml Nebulising Solution, 91
389
Budesonide 160 mcg and Formoterol 4.5 mcg
Inhalation, 94
Budesonide 200 mcg/dose Inhalation, 91
Budesonide 500 mcg/2 ml Nebulising
Solution, 91
Bumetanide 0.5 mg/ml Injection, 43
Bupivacaine 0.5 % Heavy Injection, 376
Bupivacaine 0.5 % Injection, 377
Bupivacaine 0.5 % with Adrenaline 1:200,000
Injection, 377
Burinex, 43
Buscopan, 20
Ca Disod. Versenate, 11
Cabergoline 0.5 mg Tablet, 226
Calamine Cream, 337
Calamine Lotion, 337
Calamine with 2 - 6% Precipitated Sulphur
Lotion, 337
Calcijex, 288
Calcipotriol 50 mcg/g Cream, 342
Calcipotriol 50 mcg/g Ointment, 342
Calcipotriol 50 mcg/ml Scalp Solution, 343
Calcipotriol Hydrate 50 mcg/g &
Betamethasone Dipropionate, 343
Calcitonin (synthetic Salmon) 100 IU Injection,
223
Calcitonin (Synthetic Salmon) 200 IU Nasal
Spray, 223
Calcitriol 0.25 mcg Capsule, 288
Calcitriol 1 mcg/ml Injection, 288
Calcium Carbonate 500 mg Tablet, 284
Calcium Disodium Edetate 200 mg Injection,
11
Calcium Gluconate 10% Injection, 284
Calcium Polystyrene Sulphonate Powder, 11
Calmurid, 344
Campto, 265
Cancidas, 186
Candid Ear Drops, 186
Canesten, 351
Capecitabine 500 mg Tablet, 256
Capoten, 50
Captopril 25 mg Tablet, 50
Carbamazepine 100 mg/5 ml (2% w/v) Syrup,
133
Carbamazepine 200 mg CR Tablet, 133
Carbamazepine 200 mg Tablet, 134
Carbamide (Urea) 10 % Cream, 344
Carbimazole 5 mg Tablet, 212
Carboplatin 450 mg Injection, 256
Carboprost Tromethamine 250 mcg Injection,
235
Cardura XL, 244
Carminative, 19
Carvedilol 25 mg Tablet, 48
Carvedilol 6.25 mg Tablet, 48
Caspofungin Acetate 50 mg Injection, 186
Caspofungin Acetate 70 mg Injection, 186
Cefazolin Sandoz, 163
Cefazolin Sodium 1 g Injection, 163
Cefepime 1 g Injection, 163
Cefobid, 164
Cefoperazone Sodium 1 g Injection, 164
Cefoperazone Sodium 500 mg & Sulbactam
Sodium 500 mg Injection, 164
Cefotaxime 1 g Injection, 165
Ceftazidime 1 g Injection, 165
Ceftazidime 2 g Injection, 165
Ceftriaxone 0.25mg Injection, 165
Ceftriaxone 1g Injection, 166
Cefuroxime Axetil 125 mg Tablet, 167
Cefuroxime Axetil 125 mg/5 ml Suspension,
167
Cefuroxime Sodium 1.5 g Injection, 167
Cefuroxime Sodium 750 mg Injection, 167
Celebrex, 106, 300
Celecoxib 200 mg Capsule, 106, 300
Cellcept, 253
Cephalexin Monohydrate 125 mg/5 ml Syrup,
168
Cephalexin Monohydrate 250 mg Capsule,
168
Ceporex, 168
Cerubidin, 260
Cervagem, 236
Cetirizine HCl 10 mg Tablet, 327
Cetrimide 1-2% Lotion., 356
Charcoal, Activated 250 mg Tablet, 12
Chirocaine, 378
Chloral Hydrate 200 mg/5 ml Mixture, 112
Chlorambucil 2 mg Tablet, 257
Chloramphenicol 0.5% Eye Drops, 306
Chloramphenicol 1% Eye Ointment, 306
Chloramphenicol 5% w/v Ear Drops, 321
Chloramphenicol Sodium Succinate 1 g
Injection, 169
Chlorhexidine Gluconate 0.2 % Mouthwash,
325
Chlorhexidine Gluconate 4% Scrub, 356
Chlorhexidine Gluconate 5% Solution, 356
Chlorinated Lime Powder, 386
Chlorinated Lime Solution & Buffered Acetate
Solution, 357
Chloromycetin, 169, 306, 321
390
Chloroquine Phosphate 250 mg Tablet (150
mg Chloroquine base), 200
Chlorpheniramine Maleate 10 mg/ml
Injection, 327
Chlorpheniramine Maleate 2 mg/5 ml Syrup,
328
Chlorpheniramine Maleate 4 mg Tablet, 328
Chlorpromazine HCl 100 mg Tablet, 114
Chlorpromazine HCl 25 mg Tablet, 114
Choline Salicylate 8.7%, Cetylkonium Chloride
0.01% Dental Gel, 325
Chorionic Gonadotrophin Human (HCG) 5000
IU Injection, 233
Ciclosporin 100 mg/ml Drink Solution, 252
Ciclosporin 25 mg Capsule Microemulsion,
251
Cinnarizine 25 mg Tablet, 335
Ciprobay, 169
Ciprofloxacin 100 mg/50 ml Injection, 169
Ciprofloxacin 250 mg Tablet, 169
Cisplatin (Cis-Platinum) 50 mg Injection, 257
Claforan, 165
Clarinase, 330
Clarithromycin 250 mg Tablet, 170
Clarityne, 330
Clexane, 67
Clindamycin HCl 300 mg Capsule, 170
Clobetasol Propionate 0.05% Cream, 339
Clobetasol Propionate 0.05% Ointment, 340
Clobetasone Butyrate 0.05% Cream, 340
Clobetasone Butyrate 0.05% Ointment, 340
Clomid, 234
Clomifene Citrate 50 mg Tablet, 234
Clonazepam 2 mg Tablet, 135
Clopidogrel 75 mg Tablet, 71
Clopixol - Acuphase, 122
Clopixol Depot, 122
Clorox, 386
Clostridium Botulinum Toxin Type A 100 units,
154
Clostridium Botulinum Toxin Type A 500 units,
154
Clotrimazole 1% Cream, 351
Clotrimazole 1% Ear Drop, 186
Clotrimazole 500 mg Vaginal Tablet, 237
Cloxacillin Sodium 125 mg/5 ml Suspension,
171
Cloxacillin Sodium 250 mg Capsule, 171
Cloxacillin Sodium 250 mg Injection, 172
Cloxacillin Sodium 500 mg Injection, 172
Clozapine 100 mg Tablet, 114
Clozaril, 114
Coal Tar 20% Solution, 344
CoAprovel, 52
Cocaine 10% Solution, 335
Cocois Co. Ointment, 344
Co-Diovan, 59
Colchicine 0.5 mg Tablet, 358
Combivent, 84
Combivir, 199
Comtan, 145
Concor, 47
Conjugated Oestrogens 0.625 mg &
Medroxyprogesterone Acetate 2.5 mg, 229
Conjugated Oestrogens 0.625 mg Tablet, 229
Conjugated Oestrogens 0.625 mg/g Cream,
238
Continuous Ambulatory Peritoneal Dialysis
Solution containing 1.5% Dextrose, 277
Controloc, 23, 24
Cordarone, 46
Cosmegen, 255
Coumadin, 70
Coversyl, 56
Coversyl Plus, 55
Cozaar, 52
Cravit, 177
Crestor, 80
Crinone, 218
Crixivan, 193
Crotamiton 10 % Cream, 338
Cuprimine, 12
Cyanocobalamin 1 mg Injection, 289
Cyclogyl, 311
Cyclopentolate 1% Eye Drops, 311
Cyclophosphamide 1 g Injection, 258
Cyclophosphamide 50 mg Tablet, 259
Cyklokapron, 76
Cymbalta, 125
Cyproterone Acetate 2 mg & Ethinyloestradiol
0.035 mg Tablet, 238
Cytarabine 100 mg Injection, 259
Cytosar, 259
Dabigatran Etexilate 110 mg Capsule, 70
Dacarbazine 100 mg Injection, 260
Dacrolux, 317
Daflon, 31
Daivobet, 343
Daivonex, 342
Daktarin, 339
391
Danazol 200 mg Capsule, 226
Daonil, 205
Dapsone 100 mg Tablet, 172
Daunorubicin HCl 20 mg Injection, 260
Decadron, 215
Deferasirox 125 mg Dispersible Tablet, 294
Deferasirox 500 mg Dispersible Tablet, 294
Deferiprone 500 mg Tablet, 294
Dermovate, 339, 340
Desferal, 295
Desferrioxamine B Methanesulphonate 0.5 g
Injection, 295
Desloratadine 5 mg Tablet, 328
Desmopressin 0.1 mg Tablet, 219
Desmopressin 0.2 mg Tablet, 219
Desmopressin 100 mcg/ml Nasal Spray, 219
Desmopressin Acetate 4 mcg/ml Injection,
220
Desogestrol 150 mcg & Ethinyloestradiol 30
mcg Tablet, 239
Detrusitol SR, 246
Dexamethasone 0.5 mg Tablet, 215
Dexamethasone and Neomycin Sulphate and
Polymyxin B Eye Ointment, 310
Dexamethasone and Neomycin Sulphate and
Polymyxin B Sulphate, 309
Dexamethasone Sodium Phosphate 8 mg/2 ml
Injection, 215
Dexmedetomidine HCl 100 mcg/ml Injection,
368
Dextrose 50% Injection, 277
Dextrose Powder, 205
DF 118, 98
Diamicron, 206
Diamicron MR, 206
Diamox, 313, 314
Diane 35, 238
Diavonex, 343
Diazepam 10 mg/2 ml Injection, 135
Diazepam 5 mg Rectal Solution, 136
Diazepam 5 mg Tablet, 154
Diclofenac 1% Emulgel, 106
Diclofenac Sodium 12.5 mg Suppository, 107
Diclofenac Sodium 25 mg Suppository, 107
Diclofenac Sodium 50 mg Suppository, 107
Diclofenac Sodium 50 mg Tablet, 107
Diclofenac Sodium 75 mg/3 ml Injection, 108
Didanosine 2 g Oral Solution (ddI), 192
Differin, 346
Difflam, 325
Diflucan, 186, 187
Digoxin 0.25 mg Tablet, 40
Digoxin 50 mcg/ml Elixir, 40
Digoxin 500 mcg/2 ml Injection, 41
Dihydrocodeine Tartrate 30 mg Tablet, 98
Dilantin, 139, 140
Dilatrend, 48
Diltiazem HCl 30 mg Tablet, 61
Dinoprostone (Prostagladine E2) 3 mg Vaginal
Tablet, 235
Diosmin 450 mg and Hesperidin 50 mg Tablet,
31
Diovan, 59
Diphenhydramine HCl 10 mg/5 ml Elixir, 333
Diphenhydramine HCl 14 mg/5 ml and
Ammonium Chloride 135 mg/5 ml
Expectorant, 333
Diphenoxylate with Atropine Sulphate Tablet,
27
Diprivan, 371
Dipyridamole 75 mg Tablet, 72
Dobutamine HCl 250 mg/20 ml Injection
A,
41
Dobutrex, 41
Docetaxel 20 mg/0.5 ml Injection, 261
Dogmatil, 120
Domperidone 1 mg/ml Suspension, 19
Domperidone 10 mg Tablet, 19
Donepezil HCl 5 mg Tablet, 151
Dopamine HCl 40 mg/ml Injection, 42
Dormicum, 369, 370
Dorzolamide HCl 2% Ophthalmic Solution, 315
Dostinex, 226
Dothiepin HCl 75 mg Tablet, 124
Doxazosin Mesilate 4 mg CR Tablet, 244
Doxorubicin HCl 50 mg Injection, 261
Doxycycline 100 mg Capsule, 172
D-Penicillamine 0.25 g Capsule, 12
Dulcolax, 27, 28
Duloxetine 30 mg Capsule, 125
Duloxetine 60 mg Capsule, 125
Duphalac, 28
Duphaston, 230
Durogesic, 99
Duspatalin, 21
Dutasteride 0.5 mg Capsule, 244
Dydrogesterone 10 mg Tablet, 230
Dynastat, 98
EES, 173
Efavirenz 600 mg Tablet, 192
Efexor XR, 129
Elomet, 341
Eloxatin, 269
Emend, 33
392
Emla, 375
Emulsificants Ointment, 338
Enalapril 10 mg Tablet, 51
Endoxan, 258, 259
Enoxaparin Sodium 40 mg Injection, 67
Enoxaparin Sodium 60 mg Injection, 67
Entacapone 200 mg Tablet, 145
Entecavir 0.5 mg Tablet, 193
Eperisone HCl 50 mg Tablet, 303
Ephedrine HCl 30 mg/ml Injection, 66
Epilim, 141, 142
Epirubicin 50 mg Injection, 262
Eprex, 295
Ergometrine Maleate 0.5 mg/ml Injection, 236
Erythrocin, 173, 174
Erythromycin Ethylsuccinate 200 mg/5 ml
Suspension, 173
Erythromycin Ethylsuccinate 400 mg Tablet,
173
Erythromycin Lactobionate 500 mg Injection,
174
Erythropoietin Human Recombinant 2000
IU/0.5ml Injection, 295
Escapelle, 239
Escitalopram 10 mg Tablet, 125
Esmeron, 373
Esomeprazole 20 mg Tablet, 21
Esomeprazole 40 mg Injection, 22
Esomeprazole 40 mg Tablet, 21
Essential Phospholipids Capsule, 31
Essentiale, 31
Estradiol 1 mg (14 tablet) & Estradiol 1 mg
with Dydrogesterone 10 mg, 230
Estradiol 1 mg with Dydrogesterone 5 mg
Tablet, 231
Estradiol Valerate 1 mg Tablet, 231
Estradiol Valerate 2 mg and Norgestrel 500
mcg with Estradiol Valerate, 231
Ethambutol HCl 400 mg Tablet, 174
Ether Solvent, 386
Ethyl Chloride Spray, 374
Etomidate 20 mg/10 mg Injection, 368
Etomidate Lipuro, 368
Etoposide 100 mg/5 ml Injection, 262
Etoricoxib 120 mg Tablet, 300
Eumovate, 340
Eurax, 338
Eusol-T, 357
Evista, 242
Exelon, 151
Exelon® patch 5, 152
Exelon®patch 10, 152
Exforge, 60
Exjade, 294
Expect Stimulant, 333
Ezetimibe 10 mg & Simvastatin 20 mg Tablet,
77
Ezetimibe 10 mg Tablet, 78
Ezetrol, 78
Factor IX Injection, 75
Factor VIIa (Recombinant) eptacog alfa
(activated) 60 KIU (1.2 mg) Injection, 75
Factor VIII Inhibitor Bypassing Activity
Injection, 74
Factor VIII Injection, 76
Fansidar, 202
Farlutal, 232, 240
Fat Emulsion 20% for IV Infusion, 283
Feiba, 74
Felodipine 10 mg Tablet, 61
Felodipine 5 mg Tablet, 61
Femara, 272
Femoston 1/10, 230
Femoston Conti, 231
Fentanyl 25 mcg/h Transdermal Patch, 99
Fentanyl 50 mcg/h Transdermal Patch, 99
Fentanyl Citrate 50 mcg/ml Injection, 99
Ferric Ammonium Citrate 800 mg/10 ml
Paediatric Mixture, 296
Ferriprox, 294
Ferrous Fumarate 200 mg Tablet, 297
Filgrastim (G-CSF) 30 MU/ml Injection, 273
Finasteride 5 mg Tablet, 244
Flagyl, 178
Flamazine, 354
Flarex ophth Susp, 310
Flavoxate HCl 100 mg Tablet, 246
Fleet solution, 33
Fluanxol, 115
Fluconazole 100 mg Capsule, 186
Fluconazole 2 mg/ml Injection, 187
Flumazenil 0.5 mg/5 ml Injection, 13
Flunarizine HCl 5 mg Capsule, 132
Fluorescein 1 mg Ophthalmic Strip, 383
Fluorets, 383
Fluorometholone 0.1% Ophthalmic
Suspension, 310
Fluorouracil 250 mg/5 ml Injection, 263
Fluoxetine HCl 20 mg Capsule, 126
393
Flupenthixol Decanoate Depot 20 mg/ml
lnjection, 115
Fluvoxamine 100 mg Tablet, 126
Fluvoxamine 50 mg Tablet, 126
FML liquifilm, 310
Folic Acid 5 mg Tablet, 297
Follitropin Alpha (Recombinant Human FSH)
75 IU Injection, 234
Fondaparinux Sodium 2.5 mg/0.5 ml Injection,
68
Forane, 368
Fortum, 165
Fosamax Plus, 222
Fosrenol, 285
Framycetin Sulphate 0.5%, Dexamethasone
0.05% and Gramicidin 0.005% Ear Drops,
321
Fucicort, 351
Fucidin, 175, 351, 354
Fucithalmic, 307
Fulcin, 188
Fuller's Earth, 13
Fuller's Earth 30% Suspension, 13
Fungizone, 185
Furadantin, 179
Furosemide 20 mg/2 ml Injection, 43
Furosemide 40 mg Tablet, 43
Fusafungine 1% Nasal Spray, 323
Fusidic Acid 1% Eye Drops, 307
Fusidic Acid 2% Cream, 351
Fusidic Acid 2% in Betamethasone Valerate
0.1% Cream, 351
Fusidic Acid 500 mg Injection, 175
Gabapentin 300 mg Capsule, 136
Gabapentin 600 mg Tablet, 136
Gamma Benzene Hexachloride 0.1 % Lotion,
352
Garamycin, 175, 307, 308, 352
Gardenal, 138
Gemcitabine HCl 1 g Injection, 263
Gemeprost (Prostagladin E1 Synthetic
Analogue) 1 mg Pessary, 236
Gemfibrozil 300 mg Capsule, 78
Gemzar, 263
Gentamicin 0.1% Cream, 352
Gentamicin 0.3% Eye Drops, 307
Gentamicin 0.3% Eye Ointment, 308
Gentamicin 3% Fortified Eye Drops, 308
Gentamicin Sulphate 80 mg/2 ml Injection,
175
Genteal Gel, 318
Glibenclamide 5 mg Tablet, 205
Gliclazide 30 mg Modified Release Tablet, 206
Gliclazide 80 mg Tablet, 206
Glivec, 273
Glucagen, 207
Glucagon (Lyophilised) 1 mg/ml Injection, 207
Glucobay, 205
Glucophage, 211
Glucophage XR, 210
Glucovance, 210
Glycerin, 326
Glycerin 25% and Sodium Chloride 15%
Enema, 28
Glyceryl Trinitrate 0.5 mg Tablet, 62
Glyceryl Trinitrate 25 mg/5 ml Injection, 62
Glycopyrrolate 200 mcg/ml Injection, 381
Glypressin, 221
Gonal F, 234
Goserelin 3.6 mg Depot Injection, 227
Granisetron HCl 1 mg Tablet, 34
Granisetron HCl 3 mg/3 ml Injection, 34
Griseofulvin (Ultramicrosize 125 mg = 250 mg
Microsize) Tablet, 188
Haemophilus Influenzae Type B Conjugate 10
mcg Vaccine, 362
Haloperidol 1.5 mg Tablet, 116
Haloperidol 5 mg Tablet, 116
Haloperidol 5 mg/ml Injection, 116
Harnal® OCAS, 245
Hemabate, 235
Hemofil M, 76
Hepabig, 366
Heparin 1000 units/ml Injection, 69
Heparin 5000 units/ml Injection, 69
Heparin Sodium 50 units in Sodium Chloride
Injection, 69
Hepatitis B Immunoglobulin (Human)
Injection, 366
Hepatitis B Vaccine Injection, 362
Hepsal, 69
Herbesser, 61
Hibiscrub, 356
Hibitane, 325, 356
Holoxan, 264
Homatropine 2% Eye Drops, 312
Human Albumin Injection, 278
Humulin, 208
Hydralazine HCl 20 mg Injection, 51
Hydrea, 345
Hydrochlorothiazide 50 mg Tablet, 44
Hydrocortisone 1% Cream, 341
Hydrocortisone 10 mg Tablet, 216
Hydrocortisone Enema 0.1%, 29
394
Hydrocortisone Sodium Succinate 100 mg
Injection, 216
Hydrogen Peroxide 20 volume Solution, 357
Hydroxychloroquine Sulphate 200 mg Tablet,
301
Hydroxyethyl Cellulose Jelly, 384
Hydroxyurea 500 mg Capsule, 345
Hydroxyzine HCl 25 mg Tablet, 329
Hyoscine N-Butylbromide 10 mg Tablet, 20
Hyoscine N-Butylbromide 20 mg/ml Injection,
20
Hyperhep, 366
Hyper-Tet, 366
Hypromellose 0.3% Eye Drops, 317
Hypromellose 0.3%, Carbomer 980
Ophthalmic Gel, 318
Hytrin, 245
Hyzaar, 53, 54
Ibandronic Acid 150 mg Tablet, 223
Ibuprofen 200 mg Tablet, 108
Idarubicin 10 mg Injection, 264
Ifosfamide 1 g Injection, 264
Iliadin, 324
Imatinib Mesylate 100 mg Tablet, 273
Imatinib Mesylate 400 mg Tablet, 273
Imdur, 63
Imipenem 500 mg and Cilastatin 500 mg
Injection, 176
Imorab, 363
Imuran, 249
Inderal, 49
Indinavir Sulfate 400 mg Capsule, 193
Indocid, 109
Indomethacin 25 mg Capsule, 109
Insulatard, 208
Insulin Aspart 100 IU/ml Injection, 207
Insulin Glargine 300 IU/3ml Injection, 208
Insulin Recombinant Neutral Human shortacting 100 IU/ml Injection in 10ml vial, 208
Insulin Recombinant Synthetic Human,
intermediate-acting 100 IU/ml Penfill and
Refill, 208
Insulin Recombinant Synthetic Human, premixed 100 IU/ml Penfill and Refill, 209
Insulin Recombinant Synthetic Human, shortacting 100 IU/ml Penfill and Refill, 209
Intralipid, 283
Intropin, 42
Invega, 123
Iodine and Potassium Iodide Solution, 213
Ipratropium Bromide 0.0125% Inhalation
Solution (125 mcg/ml), 83
Ipratropium Bromide 0.025% Inhalation
Solution (250 mcg/ml), 83
Ipratropium Bromide 0.5 mg and Salbutamol
2.5 mg per UDV, 84
Ipratropium Bromide 20 mcg and Salbutamol
base 100 mcg/dose Inhalation, 84
Ipratropium Bromide 20 mcg/dose Inhalation,
85
Irbesartan 150 mg Tablet, 52
Irbesartan 300 mg & Hydrochlorothiazide 12.5
mg Tablet, 52
Irbesartan 300 mg Tablet, 52
Irinotecan HCl Trihydrate 100 mg/5ml
Injection, 265
Iron Dextran 50 mg Fe/ml Injection, 297
Iron Sucrose 100 mg/5 ml Injection, 298
Isoflurane Liquid, 368
Isoniazid 100 mg Tablet, 176
Isoniazid 400 mg Tablet, 176
Isoptin, 65
Isordil, 63
Isosorbide Dinitrate 10 mg Tablet, 63
Isosorbide-5-Mononitrate 30 mg SR Tablet, 63
Isotretinoin 10 mg Capsule, 347
Isotretinoin 20 mg Capsule, 347
Itraconazole 10 mg/ml Oral Solution, 188
Itraconazole 100 mg Capsule, 189
Januvia, 212
Jumex, 150
Kaletra, 194, 195
Kalimate, 11
Kemadrin, 149
Kenacort-A, 218
Kenalog in Orabase, 326
Keppra, 137
Ketalar, 369
Ketamine 10 mg/ml Injection, 369
Ketoconazole 2% Shampoo, 348
Ketoconazole 200 mg Tablet, 189
Ketoprofen 2.5% Gel, 109
Ketoprofen 30 mg Transdermal Plaster, 109
Ketorolac Tromethamine 0.5% Eye drops, 318
Ketorolac Tromethamine 30 mg/ml Injection,
96
Ketotop, 109
Klacid, 170
Konakion, 293, 294
KY Jelly, 384
Kytril, 34
Labetalol HCl 100 mg Tablet, 48
Labetalol HCl 100 mg/20 ml Injection, 49
Lactulose 3.35 g/5 ml Liquid, 28
395
Ladogal, 226
Lamictal, 137
Lamisil, 190
Lamivudine 10 mg/ml Oral Solution, 193
Lamivudine 100 mg Tablet, 194
Lamivudine 150 mg Tablet, 194
Lamotrigine 100 mg Tablet, 137
Lamotrigine 50 mg Tablet, 137
Lanoxin, 40, 41
Lansoprazole 30 mg Tablet, 22
Lanthanum Carbonate 1000mg Chewable
Tablet, 285
Lantus, 208
Largactil, 114
Laroxyl, 124
Lasix, 43
L-Asparaginase 10,000 IU Injection, 265
Latanoprost 0.005% Eye Drops, 315
Leflunomide 10 mg Tablet, 301
Letrozole 2.5 mg Tablet, 272
Leucovorin Calcium, 274
Leucovorin Calcium (Calcium Folinate) 50 mg
Injection, 274
Leukeran, 257
Leunase, 265
Levetiracetam 500 mg Tablet, 137
Levobupivacaine 5mg/ml Injection, 378
Levocetirizine Dihydrochloride 5 mg Tablet,
329
Levodopa 100 mg and Carbidopa 25 mg
Tablet, 147
Levodopa 100 mg, Benserazide 25 mg HBS
capsule, 145
Levodopa 200 mg, Benserazide 50 mg Tablet,
146
Levodopa 250 mg and Carbidopa 25 mg
Tablet, 147
Levofloxacin 500 mg Tablet, 177
Levonorgestrel 1.5mg Tablet, 239
Levonorgestrel Releasing Intrauterine System,
240
Levophed, 67
Levothyroxine Sodium 100 mcg Tablet, 213
Levothyroxine Sodium 25 mcg Tablet, 214
Lexapro, 125
Lidocaine 25mg and Prilocaine 25mg Cream,
375
Lignocaine 10 % w/w Spray, 375
Lignocaine 2% Jelly, 376
Lignocaine 2% Viscous Solution, 379
Lignocaine HCl (Lidocaine) 2% Injection, 379
Lignocaine, Aluminium Acetate, Zinc Oxide
and Hydrocortisone Ointment, 30
Lignocaine, Aluminium Acetate, Zinc Oxide
and Hydrocortisone Suppository, 30
Lincocin, 170
Lindane, 352
Linezolid 2 mg/ml Injection, 177
Lioresal, 153
Lipitor, 77
Liquid Paraffin, 29
Lithium Carbonate 300 mg Tablet, 117
Livial, 233
Locabiotal, 323
Loceryl, 349
Lomotil, 27
Loniten, 55
Lopid, 78
Lopinavir 200 mg and Ritonavir 50 mg Tablet,
194
Lopinavir/Ritonavir Oral Solution, 195
Loratadine 1 mg/ml Syrup, 330
Loratadine 10 mg Tablet, 330
Loratadine 5 mg and Pseudoephedrine
Sulphate 120 mg Tablet, 330
Lorazepam 1 mg Tablet, 113
Losartan 50 mg Tablet, 52
Losartan Potassium 100 mg and
Hydrochlorothiazide 12.5 mg Tablet, 53
Losartan Potassium 50 mg and
Hydrochlorothiazide 12.5 mg Tablet, 54
Losec, 23
Lovastatin 20 mg Tablet, 79
Loxof, 177
Lugol's Solution, 213
Lumigan, 314
Luminal, 138
Luvox, 126
Maalox Plus, 31
Mabthera, 275
Madopar, 145, 146
Magnesium Sulphate 45% Paste, 359
Magnesium Sulphate 50% Injection, 286
Magnesium Trisilicate Mixture, 18
Magnesium Trisilicate Tablet, 18
Magnesium, Aluminium Hydroxide and
Simethicone Suspension, 31
Mannitol 10% Injection (10 g/100 ml), 44
Mannitol 20% Injection (20 g/100 ml), 44
Marcaine, 377
Marcaine Spinal Heavy, 376
Marcaine-Adrenaline, 377
Marvelon, 239
396
Maxipime, 163
Maxitrol, 309, 310
Maxolon, 35, 36
Mebeverine HCl 135 mg Tablet, 21
Meclozine HCl 25 mg and Pyridoxine 50 mg
Tablet, 35
Mecobalamin 500 mcg Tablet, 155
Medroxyprogesterone Acetate 150 mg/3 ml
Injection, 240
Medroxyprogesterone Acetate 5 mg Tablet,
232
Mefenamic Acid 250 mg Tablet, 110
Meloxicam 7.5 mg Tablet, 302
Melphalan 2 mg Tablet, 266
Meningococcal A, C, Y, W 135 Vaccine
Injection, 363
Menthol 1.6% in Industrial Methylated Spirit
Inhalation, 332
Mercaptopurine 50 mg Tablet, 266
Meronem, 178
Meropenem 1 g Injection, 178
Meropenem 500 mg Injection, 178
Mesalazine 500 mg Tablet, 32
Mesna 400 mg/4 ml Injection, 14
Mestinon, 156
Metalyse, 73
Metformin 500 mg and Glibenclamide 2.5 mg
Tablet, 210
Metformin 500 mg and Glibenclamide 5 mg
Tablet, 210
Metformin HCl 500 mg Extended Release
Tablet, 210
Metformin HCl 500 mg Tablet, 211
Methadone 5mg/ml Syrup, 150
Methotrexate 2.5 mg Tablet, 267
Methotrexate 50 mg Injection, 268
Methyl Salicylate 25% Ointment, 110
Methylcobal, 155
Methyldopa 250 mg Tablet, 54
Methylene Blue 1% Injection, 14
Methylphenidate HCl 10 mg Tablet, 129
Methylprednisolone Sodium Succinate 0.5 g
Injection, 216
Metoclopramide HCl 10 mg Tablet, 35
Metoclopramide HCl 10 mg/2 ml Injection, 36
Metoclopramide HCl 5 mg/5 ml Syrup, 36
Metoprolol Tartrate 100 mg Tablet, 49
Metrogyl, 178
Metronidazole 200 mg Tablet, 178
Metronidazole 500 mg/100 ml Injection, 178
Mevacor, 79
Miacalcic, 223
Micardis, 58
Micardis Plus. See
Miconazole 2% Cream, 339
Midazolam 5 mg/ml Injection, 369
Midazolam 7.5 mg Tablet, 370
Milton, 386
Minipress, 57
Minirin, 219, 220
Minoxidil 5 mg Tablet, 55
Mirena, 240
Mirtazapine 15 mg Orodispersible Tablet, 127
Mirtazapine 30 mg Orodispersible Tablet, 127
Mist Carminative Paed, 18
Mitomycin-C, 268
Mitomycin-C 10 mg Injection, 268
Mitoxantrone 20 mg/10ml Injection, 269
Mixtard, 209
Mobic, 302
Moclobemide 150 mg Tablet, 128
Moduretic, 42
Mometasone Furoate 0.1% Cream, 341
Mometasone Furoate 50 mcg Aqueous Nasal
Spray, 323
Montelukast Sodium 10 mg Tablet, 92
Montelukast Sodium 4 mg Oral Granules, 92
Montelukast Sodium 5 mg Chewable Tablet,
93
Morphine HCl 10 mg/5 ml Solution, 100
Morphine Sulphate 10 mg Controlled Release
Tablet, 100
Morphine Sulphate 10 mg/ml Injection, 101
Morphine Sulphate 30 mg Controlled Release
Tablet, 100
Motilium, 19
Moxifloxacin 0.5% Ophthalmic Solution, 309
MST Continus, 100
Multivitamin Injection, 289
Multivitamin Syrup, 290
Multivitamin Tablet, 290
Mupirocin 2% Ointment, 352
Myambutol, 174
Mycophenolate Mofetil 250 mg tablet, 253
Mycophenolate Mofetil 500 mg tablet, 253
Mycophenolate Sodium 360mg Tablet, 250
Mycostatin, 189, 353
Mydfrin, 312
Mydriacyl, 313
Myfortic, 250
Myonal, 303
Nalbuphine HCl 10 mg/ml Injection, 102
Naloxone HCl 0.4 mg/ml Injection, 14
Naproxen Sodium 275 mg Tablet, 302
397
Narcan, 14
Naropin, 380
Nasonex, 323
Navidoxine, 35
Neo-mercazole, 212
Neomycin 0.5% Cream, 353
Neostigmine Methylsulphate 2.5 mg/ml
Injection, 155
Neotigason, 342
Netilmicin Sulphate 150mg/2ml Injection, 179
Netromycin, 179
Neupogen, 273
Neurobion, 292, 293
Neurontin, 136
Nevirapine 200 mg Tablet, 195
Nexium, 21, 22
Nifedipine 10 mg Tablet, 63
Nimodipine 10 mg/50 ml Infusion Solution, 64
Nimotop, 64
Nipride, 57
Nitro-bid, 62
Nitrofurantoin 100 mg Tab, 179
Nizoral, 189, 348
Nolvadex, 272
Nootropil, 147, 153
Noradrenaline Acid Tartrate (Norepinephrine
Bitartrate) 4 mg/4 ml Injectio, 67
Norethisterone 0.35mg Tablet, 241
Norethisterone Enanthate 200 mg/ml
Injection, 241
Noriday, 241
Noristerat, 241
Norvasc, 60
Norvir, 196
Novantrone, 269
Novonorm, 211
Novorapid, 207
Novoseven, 75
Nubain, 102
Nuelin, 89
Nuelin SR, 89
Nystatin 100,000 units/g Cream, 353
Nystatin 100,000 units/ml Suspension, 189
Octreotide 0.1 mg/ml Injection, 220
Ofloxacin 0.3% Otic Solution, 322
Ofloxacin 100 mg Tablet, 180
Okavax, 364
Olanzapine 10mg Disintegrating Tablet, 117
Olanzapine 5mg Disintegrating Tablet, 117
Omeprazole 20 mg Capsule, 23
Omeprazole 40 mg Injection, 23
Oncovin, 271
Ondansetron, 37
One-alpha, 286
One-Alpha, 287
Opticrom, 319
Oral Rehydration Salt, 278
Orbenin, 171, 172
Oroxine, 213
Orudis, 109
Oxaliplatin 50 mg Injection, 269
Oxycodone HCl 10 mg Immediate Release
Capsules, 103
Oxycodone HCl 10 mg Prolonged Release
Tablet, 102
Oxycodone HCl 20 mg Prolonged Release
Tablet, 102
Oxycodone HCl 5 mg Immediate Release
Capsules, 103
Oxycontin, 102
Oxymetazoline HCl 0.025% (Paediatric) Nasal
Spray, 324
Oxymetazoline HCl 0.05% (Adult) Nasal Spray,
324
Oxynorm, 103
Oxytocin 10 units/ml Injection, 236
Oxytocin 5 units & Ergometrine Maleate 0.5
mg/ml Injection, 237
Paclitaxel 30 mg/5 ml Injection, 270
Paliperidone 3mg Extended Release Tablet,
123
Paliperidone 6mg Extended Release Tablet,
123
Palivizumab 100mg Injection, 196
Pamidronate Disodium 30 mg Injection, 224
Panadol, 97
Pancuronium Bromide 4 mg/2 ml lnj, 373
Panoxyl, 347
Pantoprazole 40 mg Injection, 23
Pantoprazole 40 mg Tablet, 24
Papase, 303
Paracetamol 120 mg/5 ml Syrup, 97
Paracetamol 125 mg Suppository, 97
Paracetamol 250 mg Suppository, 97
Paracetamol 500 mg Tablet, 97
Paraffin, White Soft, 338
Paraffin, Yellow Soft, 338
Paraplatin, 256
Parecoxib Sodium 40mg Injection, 98
Parentrovite, 289
Pariet, 24
Parlodel, 225
Parvolex, 9
Pavulon, 373
398
Pegasys, 274
Peginterferon Alpha-2a 180 mcg Prefilled
Syringe, 274
Penadur L.A, 162
Penbritin, 160, 161
Penglobe, 162
Penicillin V, 180
Pentothal, 372
Pentoxifylline 400 mg Tablet, 64
Perindopril 4 mg and Indapamide 1.25 mg
Tablet, 55
Perindopril 4 mg Tablet, 56
Perindopril 8 mg Tablet, 56
Permethrin 5% w/v Lotion, 353
Perphenazine 4 mg Tablet, 118
Persantin, 72
Pethidine HCl 100 mg/2 ml Injection, 104
Pethidine HCl 50 mg/ml Injection, 104
Phenergan, 331
Phenobarbitone 30 mg Tablet, 138
Phenobarbitone Sodium 200 mg/ml Injection,
138
Phenoxymethyl Penicillin 125 mg Tablet, 180
Phenylephrine HCI 2.5% Eye Drops, 312
Phenytoin Sodium 100 mg Capsule, 139
Phenytoin Sodium 125 mg/5ml Suspension,
139
Phenytoin Sodium 250 mg/5ml Injection, 140
Pilocarpine 2% Eye Drops, 316
Piperacillin 4 g & Tazobactam 500 mg Injectio,
181
Piracetam 1 g Injection, 153
Piracetam 1.2 g Tablet, 147
Piribedil 50 mg Tablet, 148
Piriton, 327, 328
Pitocin, 236
Pitressin, 222
Pizotifen 0.5 mg Tablet, 132
Plaquenil, 301
Platinul, 257
Plavix, 71
Plendil, 61
Pneumo 23, 363
Pneumococcal Vaccine (Polyvalent), 363
Podophyllum 10 - 20% Paint, 348
Polytar, 345
Ponstan, 110
Potassium Chloride 1 g/10 ml Injection, 278
Potassium Chloride 1 g/15 ml Mixture, 279
Potassium Chloride 600 mg SR Tablet, 279
Potassium Citrate 3 g/10 ml and Citric Acid
Mixture, 246
Potassium Dihydrogen Phosphate Injection,
286
Potassium Permanganate 1:10,000 Solution,
357
Povidone Iodine 10% (equivalent to 1%
iodine) Solution, 358
Pradaxa, 70
Pralidoxime 0.5 g/20 ml Injection, 15
Pramipexole Dihydrochloride 0.125 mg Tablet,
148
Pravachol, 79
Pravastatin Sodium 20 mg Tablet, 79
Prazosin HCl 1 mg Tablet, 57
Prazosin HCl 2 mg Tablet, 57
Precedex, 368
Prednisolone 3 mg/5 ml Syrup, 217
Prednisolone 5 mg Tablet, 217
Prednisone, 217
Pregnyl, 233
Premarin, 229, 231, 238
Premelle 2.5, 229
Prevacid, 22
Primaquine 7.5 mg base Tablet, 200
Procaine Benzylpenicillin Aqueous 4 mega
units (4 g) Injection, 181
Prochlorperazine Maleate 5mg Tablet, 37
Prochlorperazine Mesylate 12.5 mg/ml
Injection, 38
Procyclidine HCl 10 mg/2 ml Injection, 149
profilnine, 75
Progesterone 8% Vaginal Gel, 218
Prograf, 250
Progyluton, 231
Progynova, 231
Prolase Tablet, 303
Promethazine HCl 25 mg/ml Injection, 331
Promethazine HCl 5 mg/5 ml Syrup, 331
Proparacaine HCI 0.5% Ophthalmic Drops, 317
Propofol 1 % Injection, 371
Propranolol HCl 40 mg Tablet, 49
Propylthiouracil 50 mg Tablet, 214
Proscar, 244
Prostigmine, 155
Prostin E2, 235
Prostin VR, 81
Protamine Sulphate 50 mg/5 ml Injection, 15
Prothiaden, 124
Protopam, 15
Provera, 232, 240
Prozac, 126
Pulmicort, 91
Puri-Nethol, 266
399
Pyrazinamide 500 mg Tablet, 182
Pyridostigmine Bromide 60 mg Tablet, 156
Pyridoxine HCl 10 mg Tablet, 290
Quetiapine Fumarate 300 mg Extended
Release Tablet, 119
Quetiapine Fumarate 400 mg Extended
Release Tablet, 119
Quinine Dihydrochloride 600 mg/2 ml
Injection, 201
Quinine Sulphate 300 mg Tablet, 201
Rabeprazole Sodium 20 mg Tablet, 24
Rabies Human Diploid Cell Vaccine
(Lyophilised) Injection, 363
Raloxifene HCl 60 mg Tablet, 242
Ramipril 5 mg Tablet, 57
Ranitidine 150 mg Tablet, 25
Ranitidine 150 mg/10 ml Syrup, 25
Ranitidine 300 mg Table, 25
Ranitidine 50 mg/2 ml Injection, 26
Ravin, 28
Renitec, 51
Repaglinide 2 mg Tablet, 211
Requip, 149
Retin-A, 348
Retrovir, 198, 199
Rhogam, 365
Riboflavine 3 mg Tablet, 291
Rifadin, 182
Rifampicin 150 mg Capsule, 182
Rifampicin 300 mg Capsule, 182
Ringer's Solution Injection (contained sodium
chloride, potassium chloride and calcium
chloride), 280
Risperdal, 119
Risperidone 1 mg Tablet, 119
Risperidone 2 mg Tablet, 119
Ritalin, 129
Ritonavir 100 mg Capsule, 196
Rituximab 500 mg/50 ml Injection, 275
Rivastigmine 1.5 mg Capsule, 151
Rivastigmine 4.6mg/24hr Transdermal Patch,
152
Rivastigmine 9.5 mg/24hr Transdermal Patch,
152
Rivotril, 135
Roaccutane, 347
Rocaltrol, 288
Rocephin, 165, 166
Rocuronium Bromide 10 mg/ml Injection, 373
Ropinirole HCl 0.25 mg Tablet, 149
Ropivacaine HCl 2 mg/ml Injection, 380
Ropivacaine HCl 7.5 mg/ml Injection, 380
Rosiglitazone 8 mg Tablet, 211
Rosuvastatin 10 mg Tablet, 80
Rosuvastatin 20 mg Tablet, 80
Salazopyrin, 32
Salbutamol 0.5 % Inhalation Solution, 85
Salbutamol 0.5 mg/ml Injection, 85
Salbutamol 100 mcg/dose Inhalation, 86
Salbutamol 2 mg Tablet, 86
Salbutamol 200 mcg Inhalation Powder, 87
Salbutamol 5 mg/5 ml Injection, 242
Salicylazosulphapyridine (Sulfasalazine) 500
mg Tablet, 32
Salicylic Acid 2 - 10% Ointment, 345
Salmeterol 25 mcg and Fluticasone
Propionate 125 mcg Inhalation, 94
Salmeterol 50 mcg and Fluticasone
Propionate 250 mcg Inhalation, 94
Salofalk, 32
Sandimmum Neoral, 252
Sandimmun Neoral, 251
Sandomigran, 132
Sandostatin, 220
Scoline, 374
Sebivo, 197
Selegiline HCl 5 mg Tablet, 150
Selenium Sulphide 2.5% Shampoo, 349
Selsun, 349
Serenace, 116
Seretide, 94
Seroquel XR, 119
Sertraline HCI 50 mg Tablet, 128
Sevoflurane Liquid, 371
Sevorane, 371
Sibelium, 132
Sifrol, 148
Silver Sulfadiazine 1% Cream, 354
Simvastatin 20 mg Tablet, 80
Simvastatin 40 mg Tablet, 80
Didasine 100 mg Tablet (ddI), 191
Sinemet, 147
Singulair, 92, 93
Sitagliptin 100 mg Tablet, 212
Skinoren, 346
SLN 40, 197
Slow-K, 279
Sodium Bicarbonate 5% w/v Ear Drops, 322
Sodium Bicarbonate 8.4% (1 mmol/ml)
Injection, 280
Sodium Bicarbonate Mixture (Paediatric), 18
Sodium Bicarbonate, Citric Acid, Sodium
Citrate and Tartaric Acid - 4 g per sachet,
247
400
Sodium Bicarbonate, Magnesium Carbonate,
Tincture Cardamom Compound Mixture, 19
Sodium Biphosphate 16%, Sodium Phosphate
6% Solution, 33
Sodium Chloride 0.18% with Dextrose 10%
Injection, 280
Sodium Chloride 0.18% with Dextrose 4.23%
Injection, 280
Sodium Chloride 0.45% Injection, 281
Injection, 280
Injection, 280
Sodium Chloride 0.9% Eye Drops, 319
Injection, 280
Sodium Chloride 20% Injection, 281
Sodium Chloride 3% Injection, 282
Sodium Cromoglycate 2% Eye Drops, 319
Sodium Fusidate 2% Ointment, 354
Sodium Hypochlorite Solution, 386
Sodium Lactate Compound (Hartmanns
Solution/Ringer-lactate], 282
Sodium Nitroprusside 50 mg/5 ml Injection,
57
Sodium Thiosulphate 10-20% Solution, 355
Sodium Thiosulphate 500 mg/ml Injection, 16
Sodium Valproate 200 mg Tablet, 141
Sodium Valproate 200 mg/5 ml Syrup. See
Sodium Valproate 400 mg Injection, 142
Sofradex, 321
Solu-Cortef, 216
Solu-Medrol, 216
Spersallerg, 310
Spiriva, 90
Spironolactone 25 mg Tablet, 45
Sporanox, 188, 189
Stavudine 30 mg Capsule, 196
Stavudine 40 mg, Lamivudine 150 mg &
Nevirapine 200 mg Tablet, 197
Stelazine, 121
Stemetil, 37, 38
Stesolid, 136
Stocrin, 192
Strattera, 152
Streptase, 73
Streptokinase 1,500,000 IU Injection, 73
Streptomycin Sulphate 1 g Injection, 182
Stugeron, 335
Sucralfate 1 g Tablet, 26
Sulfadoxine 500 mg and Pyrimethamine 25
mg Table, 202
Sulperazon, 164
Sulphamethoxazole 200 mg & Trimethoprim
40 mg/5ml Suspension, 183
80 mg Injection, 183
80 mg Tablet, 184
Sulpiride 200 mg Tablet, 120
Survanta, 93
Suxamethonium Chloride 50 mg/ml lnj, 374
Symbicort, 94
Symmetrel, 144
Synacthen, 221
Synagis, 196
Synthetic ACTH (Tetracosactrin Acetate) 250
mcg/ml Injection, 221
Syntometrine, 237
Tacrolimus 0.5 mg Capsule, 250
Tacrolimus 1 mg Capsule, 250
Tamoxifen Citrate 20 mg Tablet, 272
Tamsulosin HCl 400 mcg Extended Release
Tablet, 245
Tar, Coal Tar and Oleyl Alcohol Liquid, 345
Tarivid, 180, 322
Taxol, 270
Taxotere, 261
Tazocin 4.5g, 181
Tegretol, 133, 134
Tegretol CR, 133
Telbivudine 600 mg Tablet, 197
Telmisartan 40 mg Tablet, 58
Telmisartan 80 mg & Hydrochlorothiazide
12.5 mg Tablet, 58
Telmisartan 80 mg Tablet, 58
Tenecteplase 10,000 unit (50 mg) Injection, 73
Tenormin, 47
Terazosin HCl 1 mg Tablet, 245
Terazosin HCl 2 mg Tablet, 245
Terbinafine HCl 250 mg Tablet, 190
Terbutaline Sulphate 0.3 mg/ml Syru, 87
Terbutaline Sulphate 0.5 mg/ml Injection, 88
Terbutaline Sulphate 10 mg/ml Inhalation
Solution, 88
Terbutaline Sulphate 2.5 mg Tablet, 89
Terlipressin 1 mg Injection, 221
Testosterone 250 mg/ml Injection, 218
Testoviron-Depot, 218
Tetanus Immunoglobulin Human 250
Units/Vial Injection, 366
Tetanus Toxoid Injection, 364
Theophylline 125 mg Tablet, 89
Theophylline 250 mg Long Acting Tablet, 89
401
Thiamine HCl 100 mg/ml Injection, 291
Thiamine Mononitrate 10 mg Tablet, 291
Thiopental Sodium 500 mg Injection, 372
Thymol Compound Gargle, 326
Tibolone 2.5 mg Tablet, 233
Ticlid, 72
Ticlopidine HCl 250 mg Tablet, 72
Tienam, 176
Timo-comod, 316
Timolol Maleate 0.5% Eye Drops, 316
Timoptol, 316
timoptol-XE, 316
Tiotropium Bromide Inhalation 18 mcg
Capsules, 90
Tolterodine Tartrate ER 2 mg Capsule, 246
Topamax, 143
Topiramate 15 mg Capsule Sprinkle, 143
Topiramate 25 mg Tablet, 143
Topiramate 50 mg Tablet, 143
Toradol, 96
Trace Elements and Electrolytes (Adult)
Solution, 284
Tracrium, 372
Tramadol HCl 50 mg Capsule, 104
Tramadol HCl 50 mg/ml Injection, 105
Tramal, 104, 105
Trandate, 48, 49
Tranexamic Acid 100 mg/ml Injection, 76
Tranexamic Acid 250 mg Capsule, 76
Transamin, 76
Trental, 64
Tretinoin 0.05% Cream, 348
Triamcinolone Acetonide 0.1% Oral Paste, 326
Triamcinolone Acetonide 40 mg/ml Injection,
218
Trifluoperazine HCI 5 mg Tablet, 121
Trimetazidine 20 mg Tablet, 81
Trimetazidine 35 mg MR Tablet, 81
Trimethoprim 300 mg Tablet, 184
Triprolidine HCl 2.5 mg and Pseudoephedrine
HCl 60 mg Tablet, 334
Tritace, 57
Trivastal Retard, 148
Tropicamide 1% Eye Drops, 313
Trusopt, 315
Tuberculine, 364
Tuberculine PPD Injection, 364
Unasyn 1.5, 160
Ural, 247
Urispas, 246
Urokinase, 74
Urokinase 6000 IU Injection, 74
Uromitexan, 14
Ursodeoxycholic Acid 250 mg Capsule, 30
Ursofalk, 30
Valium, 135, 154
Valsartan 80 mg and Hydrochlorothiazide 12.5
mg Tablet, 59
Valsartan 80 mg Tablet, 59
Vancocin, 185
Vancomycin HCL 500mg Injection, 185
Varicella Virus Vaccine Live Attenuated
Injection, 364
varilrix, 364
varivax, 364
Vaseline, 338
Vasopressin 20 units/ml Injection, 222
Vastarel, 81
Vastarel MR, 81
Velbe, 270
Venlafaxine HCl 75 mg Extended Release
Capsule, 129
Venofer, 298
Ventolin, 85, 86, 242
Vepesid, 262
Verapamil HCl 40 mg Tablet, 65
Verapamil HCl 5 mg/2 ml Injection, 65
Vesanoid, 255
Vibramycin, 172
Videx, 191, 192
Vigamox, 309
Vinblastine Sulphate 10 mg Injection, 270
Vincristine Sulphate 1 mg Injection, 271
Vitamin B Complex 10 ml Injection, 292
Vitamin B Complex Tablet, 292
Vitamin B1, B6, B12 Injection, 292
Vitamin B1, B6, B12 Tablet, 293
Vitamin K1 1 mg/ml Injection, 293
Vitamin K1 10 mg/ml Injection, 294
Voltaren, 106, 107, 108
Vytorin, 77
Warfarin Sodium 1 mg Tablet, 70
Water for Injection, 283
Whitfields, 350
Xalatan, 315
Xanax, 112
Xeloda, 256
Xylocaine, 376, 379
Xyloproct, 30
Xyzal, 329
Zantac, 25, 26
402
Zavedos, 264
Zeffix, 194
Zeldox, 123
Zentel, 202
Zerit, 196
Zidovudine 1% Injection, 198
Zidovudine 10 mg/ml Syrup, 198
Zidovudine 100 mg Capsule, 199
Zidovudine 300 mg & Lamivudine 150 mg
Tablet, 199
Zinacef, 167
Zinc Oxide Cream, 346
Zinnat, 167
Ziprasidone 20mg/ml Injection, 123
Zithromax, 161
Zocor, 80
Zofran, 37
Zoladex, 227
Zoledronic Acid 4 mg Injection, 225
Zoloft, 128
Zometa, 225
Zovirax, 190, 191, 311, 349
Zuclopenthixol Acetate 50 mg/ml Injection,
122
Zuclopenthixol Decanoate 200 mg/ml
Injection, 122
Zydis, 117
Zyloric, 303
Zyprexa, 117
Zyrtec, 327
Zyvox, 177
403

drug formulary

Transcription

Similar documents

super chibi cheat sheet

Calpine Northwest Geysers Enhanced Geothermal

principles of injection coding

average screen time spent per person per day in zero tv homes the

Presentation - Muzzicycles

Allergy Bazaar – Station 2 Poster Layout Intracutaneous

Modern. Robust. DMS Integrated. Cost-Effective. Web

Bubbling Tablets - Stanford University

Quality and Performance Built Right In

´ Chemical Iberica