formulary

ISBN: 978-969-8295-18-9ISBN: 978-969-8295-18-9ISBN: 978-969-8295-18-9ISBN: 978-969-8295-18-9

Muhammad Shuja Tahir FRCS(Ed), FCPS(Hon)

Professor of Surgery and ChairmanIndependent Foundation Trust

March, 2010

PREFACE

The hospital formulary is being published for the first time by Independent University Hospital in the public interest. It will be provided free of cost to all of the hospital doctors regularly for immediate referral and prescribing medicine which will be available at the hospital pharmacy. It is to facilitate the patients to get hospital medicine. It includes the medicines according to PVMS list. It includes generic names of the medicines. The brand names have been given for simplicity & better compliance by the hospital pharmacy and doctors.

It is hoped that it will improve pharmaceutical service of this hospital. The selection of drugs has been done by a team after consultation with all the specialists/Professors of this hospital.

It will be updated on yearly basis. We would keep adding to the formulary during the year.

The hospital pharmacists will be available to all doctors to discuss the drug uses, abuses & interactions. Please use their help in public interest.

We would love to have your views for improvement in this effort, please don’t hesitate to suggest changes for the next edition.

CONTENTS

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Description

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Analgesics

Anti Bacterials

Anti Fungal Drugs

Anti Helminthics

Anti Tuberculous Drugs

Anti Protozoal Drugs

Gastro Intestinal Drugs

Cardiovascular Drugs

Anti Coagulants

Diuretics

Respiratory Drugs

Opthalmological Drugs

Gynaecological Drugs

Anti Allergic Drugs

Intravenous Fluids

Vitamins and minerals

Anti Diabetic Drugs

Vaccines

ENT Preparations

Metabolic Agents

Anti Epileptics

Anaesthetics

1

ANALGESICS

1- ANALGESICS

ANALGESICS (NON OPIOID)1.1 PARACETAMOL

Antipyretic inhibits PGE 2 synthesis, no anti-inflammatory proper-ties.

INDICATIONS

Mild to moderate pain, pyrexia.

CONTRA-INDICATIONS

Hepatic and renal impairment, alcohol dependence.

ADVERSE EFFECTS

Adverse effects rare, but rashes, blood disorders, and acute pancreatitis reported.Important: liver damage (and less frequently renal damage).

DOSAGE, FORM & STRENGTHAdults;

By mouth 500-1000mg every 4-6 hours to a maximum of 4 g daily:

Children:

3 months - 1 years: 60-120mg QDS 1-5 years: 120-250mg6-12years: 250-500mg

These doses may be repeated every 4-6 hours when necessary (maximum of 4 doses in 24 hours)

Available as:

Calpol, Disprol, Duragesic, Kanamol, Panadol, Paracetamol, Provas

Independent University Hospital FORMULARY 2010

1.2. ACETYLSALICYLIC ACIDinhibits COX-1 and COX-2. Also anti-platelet action by inhibiting TXA 2

INDICATIONS

Pain , Fever, Anti-inflammatory, IHD and Thromboembolic CVA, Prophylaxis and acute treatment

CONTRA- INDICATION

Acetylsalicylic acid should not be taken by patients suffering from,Active peptic ulceration,Haemophilia allergic to aspirinasthma or in the last three months of pregnancy.< 16 years old (risk of reye`s syndrome, liver and brain damage).

ADVERSE EFFECT

Nausea, dyspepsia, heartburn, epigastric discomfort.

DOSAGE, FORM & STRENGTHAdults

300-900mg 4 to 6 hourly 75mg once a day for prophylaxis 300mg stat for acute MI or CVA

Children:

Not recommended.

Available as:

aspirin, Disprin, Ascard, Loprin, Aspro

1.3. MEFENAMIC ACIDMild strength NSAID, unselective COX inhibitor

INDICATIONS

Mild to moderate pain in rheumatoid arthritis including juvenile arthritis, oseoarthrosis, and related conditions; dysmenorrhoea, menorrhagia.

2

ANALGESICS


CONTRA-INDICATIONS

Ulcerative lesions of gastro-intestinal tract. Inflammatory bowel disease.Renal or hepatic impairment. Aspirin, anti-inflammatory induced allergy.

ADVERSE EFFECTS

Drowsiness; diarrhoea or rashes.Thromobocytopenia, hemolytic anaemia.Convulsions in over dosage.


Tabs: 500 mg three times daily.

Children 6 months-1 year:

Susp: 5ml.2-4 Years: 1ml.5-8 Years: 15ml.9-12 Years: 20ml.All eight hourly for not more than seven days.

Available as:

Anapen, Forte, Fengesic, Fenstan, Fonstal, Mefgesic, Meflin, Mefnac, Mefnagen, Mefnax, Mefo-250, Meftan, Mepon,

Minacid, Neomef, Neurontin, Novomic, Ponstan

1.4 DICLOFENAC SODIUMMedium strength NSAID

INDICATIONS

Acute back pain, post-operative pain, pain in acute trauma and fractures, renal colic.

CONTRA- INDICATIONS

Active peptic ulcer.aspirin/anti-inflammatory induced allergy. Proctitis.


3

ANALGESICS

ADVERSE EFFECTS

Transient epigastric pain, G.I. disturbances, headach, oedema. Rarely blood dysheamopoiesis, peptic ulcer, abnormalities of liver and renal function, skin reaction, pain at injection site.

DOSAGEAdults;

oral: 50mg TDS, 75mg BD, 100mg ODintramuscular: 75mg in Ampule of 3 ml.Intravenous: 75mg in Ampule of 3 ml in 500ml normal

saline

Children over 1 Year;

1-3 mg/kg body wt daily in divided doses.

Available as:

Athrotec, Artifen, Artinil-K, Beflam Cytopan, Dicloran, Fastaid, Fenac, Mobikare, Motaar, Voren, Sofac. Voltral

1.5 IBUPROFENNSAID, Inseletive COX inhibitor, As well as (mild) anti-inflammatory, it also has anti-pyrexial and analgesic properties.

INDICATIONS

Musculoskeletal Pain, Fever Rheumatiod arthritis, juvenile rheu-matoid arthritis, (JRA), ankylosing spondylitis, osteoarthritis, spondylitis, osteoarthritis, seronegative arthropathies, periarticular disorders, soft tissue injuries. Mild to moderate Gynecological pain.

CONTRA INDICATIONS

Active peptic ulcer, aspirin/anti-inflammatory induce allergy.

ADVERSE EFFECTS

G.I. upset or bleeding, rash.Rarely thrombocytopenia.Rarely aseptic meningitis.


4

ANALGESICS

DOSAGEAdults;

1200-1800 mg daily in divided dose. Maximum 2400mg daily.

Children;

Usually, 20mg/kg body-wt. Upto 40mg/kg daily. Dose should not exceed 500mg daily for children weighing less than 30kg.

Available as:

Brufen, Dolofen,Dolofam, Ibuprofen, Profen, Zefen

1.6 INDOMETHACINMedium strength NSAID, unselective COX inhibitor

INDICATIONS

Especially ankylosing spondylitis, RA, Pain and moderate to severe inflammation in rheumatic disease and other acute musculoskeletal disorders; acute gout; dysmenorrhoea; closure of ductus arteriosus.

CONTRA INDICATIONS

Acute peptic ulcer, history of G.I.T. lesions, aspirine or anti- inflammatory induced or allergy. Pregnancy and lactation.

ADVERSE EFFECT

Frequently gastro-intestinal disturbances including diarrhoea, headache, dizziness and light-headedeness, gastro-intestinal ulceration and bleeding.Blurred vision, corneal deposits, peripheral neuropathy. On rectal administration, prritus, discomfort & bleeding.

DOSAGE, FORM & STRENGTH

oral: 25-50mg QDS100gm BD (maximum dose 200mg daily).

Rectal suppositories: 100 mg at night and in the morning if required.

Combined oral and rectal treatment: maximum total daily dose

5


ANALGESICS

150-200mg.

Available as:

Anglocid, Indacin, Indocin, Liometacen, Methacid

1.7 NAPROXENNSAID, unselective COX inhibitor

INDICATION:

RA musculoskeletal pain, Post Operative pain, acute gout, dysmenorrhoea,

ADVERSE EFFECT

G.I upset, G.I bleeding, rash, Thrombocytopenia


250-500mg B.D

Available as:

Apranax, Dolosyn, Flexin, Naprosyn, Naprox, Proxen, Synflex

1.8 PIROXICAMINDICATIONS

Rheumatoid arthritis, osteoarthrosis, ankylosing spondylitis, acute musculo-skeletal disorders, acute gout, juvenile chronic arthritis (JCA).

CONTRA-INDICATIONS

Aspirin. Anti-inflammatory induced allergy. Active peptic ulcer, history of recurrent ulceration.

ADVERSE EFFECT

G.I. disturbancees, skin reactions, oedema,CNA effects, malaise, tinnitus.


40-200mg daily as a single dose.

6


ANALGESICS

Children over 6 years;

JCA only; under 15kg, 5mg; 16-25kg, 10mg; 26-45 kg, 15 mg; over 46kg, 20mg.

Available as:

Brexin, Feldene, Mobicam, Roxicam, Weldene

ANALGESICS (OPIOID)

1.9 CODIENE PHOSPHATE INDICATIONS

Mild to Moderate Pain, Diarrhoea, Cough

ADVERSE EFFECTS

Nausea, Vomiting, Constipation, Drowsiness, Respiratory Depression, Hypotension

DOSAGE

30-60mg QDS

Available as:

Codogesic,Napadoc, Paineze, Paracod, Paracodeine, Tocor, Forte

1.10 MORPHINE HYDROCHLORIDE OR SULPHATEINDICATIONS

Acute pulmonary oedema: peri-operative analgesia, acute MI.

CONTRA-INDICATIONS

Avoid in raised intra cranial pressure or head injury (in addition to interfering with respiration, it affects pupillary responses vital for neurological assessment).

ADVERSE EFFECTS

Nausea and vomiting (particularly in initial stages). Constipation, and drowsiness; larger doses produce respiratory depression and hypo tension; other side-effects include difficulty in micturition.Ureteric or biliary spasm, dry mouth bardycardia, hypo tension,

7


ANALGESICS

hypothermia, hallucinations, mood changes, utcaria and pruritus.


5-50mg sub cutaneous / intramuscular 4 hourly.2.5-10mg intravenously 4 hourly.

Adults;

5-50mg sub cutaneous / intramuscular 4 hourly.2.5-10mg intravenously 4 hourly.Children upto 1 month;

150 micrograms/kg 1-12 months 200 micrograms/kg.1-5 Years: 2.5-5mg.6-12 Years: 5-10mg.Slow intravenous injection; quarter to half corresponding. intra-

muscular dose.

Myocardial infarction, by slow intravenous injection (2mg/minute). 10 mg followed by a further 5-10 mg if necessary ;elderly or frail patients, reduce dose by half.Acute pulmonary oedema, by slow intravenous injection (2mg/minute). 5 mg.Chronic pain, by mouth or by subcutaneous or intramuscular injection, 5-20 mg regularly every 4 hours; dose may be increased according to needs.Oral dose: should be approximately double corresponding intramuscular dose and triple to quadruple corresponding intra-muscular diamorphine dose.By rectum, as suppositories, 14-30 mg regularly every 4 hours.

Available as:

Magnus, Mr Morphine, Mst Continus

8


ANALGESICS

2- ANTI BACTERIALS

2.1 BENZYLPENICILLININDICATIONS

Throat infections, otitis media, streptococcal endocarditis, meningococcal and pneumonia; prophylaxis in limb amputation, in rheumatic fever, in splenectomy and sickle cell disease.

CONTRA-INDICATIONS

Penicillin hypersensitivity

ADVERSE EFFECTS

Hypersensitivity reactions including urticaria, fever, joint pains; angioedema; transient leucopenia and thrombocytopenia; anaphylactic shock in hypersensitive patients; diarrhoea after administration by mouth.


Inj: 600mg=(1 million iu)in vial base.

Adults;

By intramuscular or by slow intravenous injection or by infusion.

1.2 g daily in 4 divided doses, increased if necessary to 2.4g daily or more.

Premature infant and neonate;

50mg/kg daily in 2 divided doses; infant 1-4 weeks, 75 mg/kg daily in 3 divided doses.Children 1 month-12 years;

100mg/kg daily in 4 divided doses.

Available as:

Benzyl, Pencillin, Benzyl Pencillin Polybiotic


9

ANTI

BACTERIALS

2.2 AMPICILLIN (Anhydrous, Thrihydrate, Sodium)

INDICATIONS

Urinary-tract infections, otitis media, sinusitis, chronic bronchitis, invasive salmonellosis, gonorrhoea.

CONTRA- INDICATIONS

Penicillin hypersensitivity

ADVERSE EFFECTS

Nausea, diarrhoea; rashes (discontinue treatment); rarely, pseudo membranous colitis.


Cap or Tab: 250mg; 500mgSusp: 125mg/ml, 250mg/ml (base) Inj: 500mg in vial (base)

Adults;

By mouth, 0.25-1 g every 6 hours, at least 30 minutes

Children under 10 Years;

Any route, half adult dose.

Available as:

Omnipen, Pencit, Ampi-plus, Wilclox

2.3 AMOXYCILLININDICATIONS

Respiratory, ENT, UTI and Soft tissue infections. Gonorrhoea. Dental abscess adjunct to surgical management. Prophylaxis of bacterial endocarditis.

CONTRA-INDICATIONS

History of previous hypersensitivity reaction to penicillin and /or cephalosporins.Do not inject parenteral solutions into or near an artery or nerve.

ANTI

BACTERIALS


10

ADVERSE EFFECTS

Anaphylaxis. Glossitis, Stomatitis, gastritis, sore throat, dry mouth, furry tongue. Anemia. Hemorrhagic manifestation. Interstitial nephritis (e.g oligurea, hematuria), Nephrotoxicity.


Cap: 250mg, 500mgInj: 250mg, 500mgSusp: 125mg/5ml, 250 mg/5mlCaps/Drops/Syp:

Adults;

250-500mg three times daily. Children:

125mg 3 times dailyProphylaxis of endocarditis: single 3gm dose one hour before dental peocedure from which bacteraemia may arise. Repeat 6 hours later if necessary.

Available as:

Amoxicillin, Wymox, Amoxil, Ospamox, Supramox

2.4 FLUCLOXACILLININDICATIONS

Staphy lococcal infections, otitis externa, pheumonia, cellulitis, impetigo, osteomyelitis

CONTRA-INDICATIONS

history of previous hypersensitivity

ADVERSE EFFECT

Cholestatic jaundice, Anaphylaxis, Glossitis, Stomatitis, gastritis, sore throat, dry mouth

DOSAGE

250mg-500mg QDS maximum dose 8mg daily


11

ANTI

BACTERIALS

Available as:

Bactoxyl, Biflocin, Delflox, F-Clox, Flomoxin, Flucomox

2.5 CO-AMOXICLAVMixture of amoxicillin and clavulanic acid.

INDICATIONS

Respiratory tract infections, genito-urinary infections, abdominal infections cellulitis

CONTRA-INDICATIONS

H/O Penicillin hypersensitivity

ADVERSE EFFECT

hepatitis, cholestatic jaundice

DOSAGE

less than 40kg; 250mg / 125 TDSmore than 40kg; 500mg / 125 TDS

Available as:

Augmentin, calamox

2.6 CEPHALEXINFirst generation cephalosporin INDICATIONS

Septicaemia; endocarditis; UTI, respiratory tract, skin and soft tissue infections.

CONTRA INDICATIONS

Impaired renal function.

ADVERSE EFFECTS

Hypersenseitivity reactions. G.I. disturbances, convulsions, eosinophilia, neutropenia, leucopenia, rise in liver enzymes and blood urea. Positive Coombs test.


12

ANTI

BACTERIALS

DOSAGE FORM & STRENGTHAdults;

250mg 6 hourly or 500mg 8 hourly.By intramuscular injection or intravenous injection or infusion, 0.5 g every 6-12 hours.

Children;

25-50 mg/kg daily (in divided doses), increased to 100 mg/kg daily in severe infections.

Available as:

Ceporex, Keflex, Zafalexin

2.7 CEPHRADINEFirst generation cephalosporin

INDICATIONS

Infections of respiratory and gastrointestinal tracts and of skin and sofl tissues, bones and joints. Septicaemia, endocarditis, prophy-laxis in surgery. UTI.

CONTRA-INDICATIONS

Hypersensitivity to cephalosporins or related antibiotics.

ADVERSE EFFECTS

G.I. disturbances (nausea, vomiting, diarrhoea) and hypersensitiv-ity pneumonia. Eosinophilia, transient neutropenia. leucopenia, thrombocytopenia. Elevated SGOT and SGPT. Mild elevation in BUN. Headache, dizziness and paraesthesia. Fever and dyspnea.


Cap: 250mgSusp: 125mg/5ml

Adults;

1 -2gm daily in 2 or 4 divided doses;(max, 4 gm daily).


13

ANTI

BACTERIALS

Children;

25-50 mg/kg daily in 2 or 4 divided doses; (maximum 4 gm daily).

Available as:

Velosef, Infexin, Cephride

2.8 CEFACLORSecond generation cephalosporin

INDICATIONS

infections due to sensitive gram positive and gram-negative bacteria.

CONTRA-INDICATIONS

cephalosporin hypersensitivity.

ADVERSE EFFECT

diarrhoea, nausea, vomiting, abdominal discomfort, headache, Allergic reactions.

DOSAGE

250-500mg 8H Maximum 4gm daily.

Available as:

Ceclor, Acef, Cefalor

2.9 CEFUROXIMESecond generation cephalosporin

INDICATIONS

infections due to sensitive gram positive and gram-negative especially haemophiles influenzas and neisseria gonorrhoea.

CONTRA-INDICATIONS

cephalosporin hypersensitivity.

ADVERSE EFFECT

diarrhoea, nausea, vomiting, abdominal discomfort, headache,


14

ANTI

BACTERIALS

Allergic reactions.

DOSAGE

oral: 250mg BDintravenous: 750mg TDSProphylaxis: 1.5gm single dose

Available as:

Zinacef, Zinnat, Roxat, Roxime, Cefroxil

2.10 CEFTAZIDIME SODIUMThird generation cephalosporin

INDICATIONS

Infections of the lower respiratory tract, skin and soft tissue. Septicaemia. Severe infections in immunocompromised patrients. UTI and gonorrhoea.

CONTRA-INDICATIONS

Cephalosporin hypersensitivity, prophyria.

ADVERSE EFFECTS

Hypersensitivity reactions. G.I. disturbances, eosinophilia, neutropenia, leucopenia, thrombocytopenia, rise in liver enzymes and blood urea. Positive Coombs test.


Inj: 500mg/lg

Adults;

By deep intramuscular or slow intravenous injection or by intrave-nous infusion, 1-2 g every 8-10 hour increased in severe infections up to 8gm daily, in 3 divided doses.

Children over 3 months;

30-60 mg/kg daily in 2-4 divided doses, increased to 100-150 mg/kg daily for sever infections.


15

ANTI

BACTERIALS

Available as:

Fortum, Cefcom, Epocef

2.11 CEFTRIAXONEThird generation cephalosporin

INDICATIONS

Severe respiratory and genitourinary tract, bone and joint, abdom-inal infections, sepsis, meningitis, Surgical prophylaxis.

CONTRA- INDICATIONS

Cephalosporin hypersensitivity; porphyria.

ADVERSE EFFECTS

Diarrhoea and rarely pseudo membranous colitis, nausea and vomiting.Allergic reactions including rashes, pruritus, urticaria, serum sickness-like reaction with rashes, fever and arthralgia, and anaphylaxis; erythema multiform , toxic epidermal necolysis reported; eosinophilic and rarely thrombocytopenia or neutropenia; disturbances in liver enzymes, transient hepatitis and cholestatic jaundice; other side-effects reported include reversible interstitial nephritis, hyperactivity,nervousness, sleep disturbances, confusion, hypcrtonia, and dizziness.


Inj: 250mg 500mg, IGf

Adults; By intramuscular injection, or by intravenous injection over 2-4 minutes, or by intravenous infusion, 1g daily as a single dose; 2-4 g daily as a single dose in severe infections;Neonates: 20-50mg / kg daily.Children: 20-80mg / kg daily.

Surgical prophylaxis, 1 g as a single dose.

Available as:

Rocephin, Norbac, Oxidil, Unitrixone, Fortexone, Trophin


16

ANTI

BACTERIALS

2.12 CEFOTAXIME SODIUMThird generation cephalosporin

INDICATIONS

Infections of the respiratory tract, kidney, urinary tract and repro-ductive organs, including gonorrhoea, septicaemia, endocarditis, meningitis.Infections of bone joint, soft tissues and skin. Abdominal infections of ear and tliroat. Infected burns and wounds.

CONTRA- INDICATIONS

Hypersensitivity to cephalosporins.

ADVERSE EFFECTS

Pain at injection site, hypersensitivity reactions.G.I. disturbances, candidiasis, thrombocytopcnia, rise in liver enzymes and blood urea. Positive coomb's test.


Inj: 250mg, 500mg, Ig.

Adults;

1 gm intravascular or intramuscular every 12 hours; serious infections, 3-6 gm daily in three or four divided doses; (max 12 gm daily). Use 2 gm by IV route. Neonates: 50mg/kg daily; Children: 100-150mg/kg daily. Both in two to four divided doses; max 200mg/kg daily.

Available as:

Cefotax, Claforan, Zafixime

2.13 CIPROFLOXACIN INDICATIONS

Gram-negative and Gram-positive infections, enteric fever, respiratory infection(except pneumococcal), UTI.


17

ANTI

BACTERIALS

CONTRA-INDICATIONS

Children and growing adolescents except where benefits exceed risk. Pregnancy and lactation.

ADVERSE EFFECTS

G.I. disturbances. Dizziness, headache tremors, confusion, convulsions, sleep disorders, rashes, photosensitivity, joint pain. Judgement may be impaired. Transient increase in serum creatinine level.Haematological. hepatic and renal disturbances, vasculitis. pseudo membranous colitis, haemorrhagic bullae. Stevens-Johnson and Lyells syndrome, visual disturbances, transient hearing loss, tenosynovitis. Impaired taste, smell and tachycardia.


Tab: 250mg. 500mg. Inj: 250mg/100ml.

Adults;By mouth,

250-750 mg twice daily. 500mg may be required in resistant cases. Most other infections, 500-750mg twice daily.

By intravenous infusion,

Prophylaxis of meningitis, (over 30-60 minutes), 200 mg twice daily. Urinary-tract infections, 100mg twice daily. Gonorrhoea, 100mg as a single dose.

Children;

It is not recommended but where benefit outweighs risk, by mouth,

7.5-15 mg/kg daily in 2 divided doses or by intravenous infusion,

5-10 mg/kg daily in 2 divided doses.


18

ANTI

BACTERIALS

Available as:

Ciprocide, Ciproxin, Novidat, Mercip, Hipro

2.14 OFLOXACININDICATIONS

UTI, lower respiratory tract infections, gonorrhoea and non-gonococcal unethritis cerricitis.

CONTRA-INDICATIONS


ADVERSE EFFECT

transient hypotension anxiety, unsteady gait, neuropathy

DOSAGE

200-400mg BD

Available as:

Tarivid, Oflox, Oflomed, Tariflox

2.15 LEVOFLOXACININDICATIONS

active against gram-positive and gram-negative organism, community acquired pneumonia.

CONTRA-INDICATIONS


ADVERSE EFFECT

G.I. disturbances. Dizziness, headache tremors, confusion, convulsions, sleep disorders, rashes, photosensitivity, joint pain. Judgement may be impaired. Transient increase in serum creatinine level.Haematological. hepatic and renal disturbances, vasculitis. pseudo membranous colitis, haemorrhagic bullae.


19

ANTI

BACTERIALS

Stevens-Johnson and Lyells syndrome, visual disturbances, transient hearing loss, tenosynovitis. Impaired taste, smell and tachycardia.

DOSAGE

250-500mg BD

Available as:

Dynaquin, Effiflox, Levofloxa, Qumic, Zevo

2.16 NALIDIXIC ACIDINDICATIONS

Urinary tract infections. Gastro-intestinal infections due to Gram-Negative orgaisms.

CONTRA-INDICATIONS

History of convulsive disorders. Porphyria.

ADVERSE EFFECTS

G.I., CNS and visual disturbances. Skin rashes, blood dyscrasias, convulsions, photosensitivity, intracranial hypertension.


Tab: 500mg - 1000mg 4 times daily.

Available as:

Negram, Uridix, Urixin

2.17 NORFLOXACININDICATIONS

Cystitis, Pyelitis, Cytopyelitis, polynephritis, specially infections caused by mul t ip le res is tant problem organisms. Typhoid/paratyphoid fever and acute gastroenteritis.

CONTRA-INDICATIONS

Pregnancy, lactation. Prepubertal children and growing adoles-cents.


20

ANTI

BACTERIALS

ADVERSE EFFECTS

Nausea, headache, dizziness, rash, heartburn, abdominal cramps, diarrhoea, anorexia, sleep disturbances, anxiety, irritabil-ity, convulsions, hypersensitivity reactions, confusions, paraesthesia, hemolytic anaemia, pancreatitis, hepatitis, photosensitivity; avoid excessive sunlight.


Tab: 400mg

Adults;

Urinary tract infections, 1 tab twice daily. Typhoid/paratyhoid fever and acute gastroenteritis,

1 tab thrice daily for 14 days.Children;

Not recommended.

Available as:

Noroxin, Utinor

2.18 DOXYCYCLINEINDICATIONS

PID, Pneumonia; respiratory, gastro- intestinal tract, soft tissue, ophthalmic and urinary tract infections.

CONTRA-INDICATIONS

Latter half of pregnancy. Lactation.

ADVERSE EFFECTS

Tooth discolouration, enamel hypoplasia, reduced fibula growth rate. Avoid use in children under 8 years, in pregnancy and lactation

unless no alternative.G.I. disturbances. Allergic reactions and Superinfections.DOSAGE, FORM & STRENGTH

Cap or tab: 100mgInj: 100mg in vial.


21

ANTI

BACTERIALS

Adults;

200mg with food or fluid on the first day, then l00mg daily.IV 200mg first day in one or two infusion.

Available as:

Vibramycin, Wellcodox, Supramycin-100

2.19 ERYTHROMYCININDICATIONS

Alternative to penicillin in hypersensitive patients; campylobacler enteritis, pneumonia, legionnaires' disease, syphilis, non-gonococcal uretluitis, chronic prostatitis, acne vulgaris; diphtheria and whooping cough prophylaxis.

CONTRA-INDICATIONS

Porphyria; contra-indicated in liver disease

ADVERSE EFFECTS

Nausea, vomiting, abdominal discomfort, diarrhoea after large doses.Urticaria, rashes and other allergic reactions.Reversible hearing loss also reported after large doses; if given for more than 14 days may occasionally cause cholestatic jaundice.


Cap or tab: 250mg; 500mgSusp: 200mg/5ml.

Adult and Children over 8 years;

By mouth: 250-500mg every 6 hours or 0.5 -1g every 12 hours; Maximum 4 g daily.

Children upto 2 years; 125 mg every 6 hours, 2-8 years: 250 mg every 6 hours,By intravenous infusion.Adult and Children;

Severe infections, 50 mg/kg daily by continuous infusion or in divided doses every 6 hours;


22

ANTI

BACTERIALS

Available as:

Erythrocin, Erybron, Trycin

2.20 GENTAMICININDICATIONS

Septicaemia and neonatal sepsis; meningitis and other CNS infections, biliary tract infection, acute pyelonephritis or prostatitis, endocarditis caused by Strep, Viridans or strep. Faecalis (with a penicillin).

CONTRA-INDICATIONS

Pregnancy, myasthenia gravis

ADVERSE EFFECTS

Vestibular and auditory damage, nephrotoxicity; rarely, hypomag-nesaemia on prolonged therapy, pseudo membranous colitis.


Inj: 80mg/2mlAdults;

By intramuscular or by slow intravenous injection over at least 3 minutes or by intravenous infusion, 2-5mg/kg daily (in divided doses every 8 hours).In renal impairment the interval between successive doses should be increased to 12 hours when the creatinine clearance is 30-70 ml/minute, 24 hours for 10-30 ml/minute, 48 hours for 5-10 ml/minute, and after twice-weekly dialysis for less than 5 ml/minute.

Children up to 2 weeks; 3mg/kg every 12 hours.2 weeks -12 years; 2mg/kg every 8 hours.

Available as:

Genticyn, Refobacin


23

ANTI

BACTERIALS

2.21 LINCOMYCININDICATIONS

Serious Sensitive Infection, Gram positive Cocci, Joint and bone infections.

CONTRA-INDICATIONS

Clindamycin sensitivity

ADVERSE EFFECTS

Persistent diarrhoea, colitis; discontinue immediately


Cap: 600mgInj: 600mg Syrup:

Adults;

600mg three or four times daily.0.6-4.8gm in divided daily dose.Children under 1 month;

Not recommended.

Available as:

Lincocin, Mincomycin, Omicin

2.22 METRONIDAZOLEINDICATIONS

Anaerobic infections, protozoal infections

CONTRA-INDICATIONS

Hepatic encephalopathy, CNS disorders. Pregnancy, lactation.

ADVERSE EFFECTS

Nausea, vomiting, unpleasant taste, and gastro- intestinal distur-bances; rashes, urticaria and angioedema; rarely drowsiness, headache, dizziness, ataxia, and darkening, of urine; on pro-longed or intensive therapy peripheral neuropathy, transient epileptiform seizures, and leucopenia.


24

ANTI

BACTERIALS


Tab: 200mg, 400mg.Inj: 500mg in 100ml vial

Adult;

Anaerobic infections (usually treated for 7 days), by mouth, 800mg initially then 400mg every 8 hours; by rectum, 1g every 8 hours.by intravenous infusion, 500mg every 8 hours.

Children;

1-3 Years: 50mg every 8 hours for 3 days. 3-7 Years: 100mg every 12 hours.7-10 years: 100mg every 8 hours.

Acute dental infections, by mouth, 200mg every 8 hours for 3-7 days.Surgical prophylaxis, by mouth, 4mg every 8 hours started 24 hours before surgery, then continued postoperatively by intrave-nous infusion, 500mg shortly before surgery then every 8 hours untill oral administration can be started.7.5mg/kg every 8 hours.

Available as:

Flagyl, Klint, Diazol, Metrozil

2.23 OXYTETRACYCLINE HYDROCHLORIDEINDICATIONS

Oxytetracycline sensitive infections, by chlamydia.

CONTRA-INDICATIONS

Latter half of pregnancy. Avoid use in children under 8 years, in pregnancy and lactation unless no alternative.

ADVERSE EFFECTS

Tooth discolouration, en hypoplasia, reduced fibula growth rate.GI disturbances.Allergic reactions, Superinfections.


25

ANTI

BACTERIALS


Cap: 250mgSusp: 125mg / 5ml

Adults: 250-500mg four times daily.Children: 25-50mg/kg daily in four divided doses.

Available as:

Terramycin,Oxytetracycline

2.24 CO-TRIMOXAZOLEINDICATIONS

Invasive salmonellosis, Typhoid fever, bone and joint infections due to Haemophilus Influenzae, urinary-tract infections, sinusitis, exacerbations of chronic bronchitis, gonorrhoea in pencillin-allergic patients.

CONTRA-INDICATIONS

Pregnancy, infants under 6 weeks (risk of kernicterus), renal or hepatic failure, jaundice, blood disorders; porphyria.

ADVERSE EFFECTS

Nausea, vomiting, diarrhoea.Glossitis, rashes, erythema multiforme, epidermal necrolysis, eosinophilia, agranulocytosis, granulocytopenia, purpura, leucopenia, thrombocytopenia; megaloblastic anaemia due to trimethoprim; pseudomebranous colitis, jaundiced and hepatic necrosis reported.


By mouth, 480-960mg every 12 hours, Maximum 1.44g.

Children: Every 12 hours.6 weeks to 5 months: 120mg.6 months to 5 years: 240mg.6-12 years: 480mg.Prophylaxis of recurrent urinary-tract infection;


26

ANTI

BACTERIALS

Adults: 480mg at night.Children: 6-12 mg/kg at night.

Available as:

Septran, Bactrim, Nicotrim, Trimoxin

2.25 CHLORAMPHENICOL

Broad spectrum anti-biotic

INDICATIONS

Typhoid fever, H. Influcnzae meningitis, severe infections when careful clinical assessment indicates no other antibiotics are effective.

CONTRA-INDICATIONS

Pregnancy,breast-feeding,porphyria.

ADVERSE EFFECTS

Blood disorders including irreversible aplastic anaemia (aplastic anaemia attributed to chloramphenicol has terminated in leukae-mia).Peripheral neuritis, optic neuritis. erythema multiforme. Nausea, vomiting, diarrhoea and nocturnal haemoglobinuria.


Inj: 1g in vialSusp: 75mg/5mlAdults;

By mouth or by intravenous injection or infusion, 50mg/Kg daily in 4 divided doses.

Children;Infants under 2 weeks;

25 mg/kg daily in 4 divided doses.


27

ANTI

BACTERIALS

2 weeks-01 year;

50mg/kg daily in 4 divided doses.

Available as:

Chloramphenicol, Methachlor, Dexachlor


28

ANTI

BACTERIALS

3- ANTI FUNGAL DRUGS

3.1 CLOTRIMAZOLEINDICATIONS

Candidial and mixed candidial / trichomonal vaginal infections.

CONTRA-INDICATIONS

Hypersensitivity to Clotrimazole.

ADVERSE EFFECTS

Local mild burning or irritation Hypersensitivity reactions.


Vaginal cream: 1% Insert contents of the applicator intravaginally at night as a single dose.

Vaginal tabs: 100mg.Adult; 100mg inserted nightly for six nights.

Vaginal tabs: 500mg;Adults; 1 inserted as single dose at night.

Children; Not applicable.

Available as:

Canesten, Clonil Vag, Clomazol, Gynosporin

3.2 GRISEOFULVINDermatophyte infections of skin, nails, scalp where topical therapy inappropriate.

CONTRA-INDICATIONS

Prophyria, severe liver disease.

ADVERSE EFFECTS

Drowsiness, headache, gastric distress. Urticarial reactions, photosensitivirty and rarely precipitation of SLE.


29

ANTI

FUNGAL

DRUGS


Cap or tab: 125mg, 250mg, 500mg

Adults;

500mg- 1gm daily, preferably in divided doses after meals.

Children;

10mg/kg body-wt. daily in divided doses.

Available as:

Grifulvin, Griseofulvin

3.3 NYSTATININDICATIONS

Oral, esophageal and intestinal candidiasis.

CONTRA-INDICATIONS

Tuberculous or viral lesion. Hypersensitivity.

ADVERSE EFFECTS

Nausea, vomiting and diarrhoea in high doses.


Tab: 500,000, iu, Syp: 200mg/5ml.Adults; Drops:

Oral infections, 1ml four times daily. Intestinal infections, 5ml four times daily,Children; 1ml four times daily. Tabs:

Adults: 1-2 tabs, four times daily.

Available as:

Nilstat, Mycitracin, Neomycin Oint, Polymyx


30

ANTI

FUNGAL

DRUGS

4- ANTI HELMINTHICS

4.1 ALBENDAZOLEINDICATIONS

Adjunct to surgery in hydatid cyts caused by Echinococcous granulosus or E. Multi-locularies, or primary treatment if surgery is not possible.

CONTRA-INDICATIONS

Pregnancy. Adequate non-hormonal contraceptive measures must be taken during, and for one month after treatment .

ADVERSE EFFECT

Gastro-intestinal disturbances, headache, dizziness, changes in liver enzymes; rarely reversible alopecia; rash, fever blood disor-ders including leucopenia and pancytopenia allergic shock if cyts leakage; convulsions and meningism in cerebral disease.


Tab: 400mgSyp: 40mg/5ml

400mg twice daily for 3 days can be repeated after 3days

E. granulosus.Adult;Adjunct in surgical treatment;

Over 60 kg, medical treatment, 800mg daily in divided doses for 28 days; 3 cycles of treatment may be given.

Available as:

Zentel, Almed , Wormocid

4.1 LEVAMISOLE HCLINDICATIONS

Intestinal worm infection by A. lumbricoidesn, Americanus, A. duodenals, E. vermicularis, T. trichiura, S. Stercorarius and T.


31

ANTI

HELMINTHICS

Colubriformis.

CONTRA-INDICATIONS

Pregnancy and in cases of microfilaraemia.

ADVERSE EFFECTS

Usually mild and transient. Nausea, vomiting, abdominal pain, giddiness, headache.


Tab: 40mgSingle dose after meal. In severe hookworm infection, second dose after 1 to 7 days is suggested .

Adults: 120mg.Children 1-4 years: 40mg.5-15 years: 80mg.

Available as:

Antiworm, Geomisole, Ketrax, Nilpar

4.3 MEBENDAZOLEINDICATIONS

Threadworm, roundworm, whipworm and hookworm infections.

CONTRA-INDICATIONS

Pregnancy

ADVERSE EFFECTS

Rarely abdominal pain. Diarrhoea; hypersensetivity reactions including exantheme, rash uticaria, and angioedma.


Chewable tab: 100mgSusp: 100mg/5mlThreadworms.Adult and Children over 2 years;

100 mg as a single dose;


32

ANTI

HELMINTHICS

if reinfection occurs second dose may be needed after 2-3 weeks;

Children under 2 years;

Not yet recommended.

Available as:

Vermox, Vermin, Deworm, Wormdox

4.4 PYRANTEL PAMOATEINDICATIONS

Roundworm, Threadworm, and Hookworm infections.

CONTRA-INDICATIONS

Hepatic dysfunction.

ADVERSE EFFECTS

Anorexia, abdominal cramps, nausea, vomiting, diarrhoea; headache, dizziness, sleep disturbance; rash.


Tab: 250mgP9 250/5ml

Adult and Children over 6 months;

Ascaris lumbricoides alone, a single dose of 5 mg/kg:Mixed infections involving Ascaris lumbricoidess; single dose of 10 mg.kg.

Available as:

Combantrin, Pamotrine, Pirental, Pypam, Pyrentrin, Womaq

4.5 THIABENDAZOLEINDICATIONS

Strongylodiasis, cutaneous and visceral larva migrans, dracontiasis, symptoms of trichinosis; secondary treatment for threadworm infestations; adjunct in hookworm, whipworm, or roundworm.


33

ANTI

HELMINTHICS

CONTRA-INDICATIONS

Pregnancy (teratogenesis in animal studies)

ADVERSE EFFECTS

Anorexia, nausea, vomiting, dizziness, diarrhoea, headache, pruritus, drowsiness; hypersensitivity reactions including fever, chills, angioedema, rashes, arythema multitus, collapse parenchymal liver damage.


Tab: 40mgSyp: 40/5ml

25 mg/kg (maximum 1.5g) every 12 hours for 3 days.


34

ANTI

HELMINTHICS

5- ANTI TUBERCULOUS DRUGS

5.1 ETHAMBUTOLINDICATIONS

Prophylaxis and treatment of tuberculosis only in conjunction with other anti-tuberculosis drugs.

CONTRA-INDICATIONS

Optic neuritis, impaired renal function.

ADVERSE EFFECTS

Optic neuritis (related to dose and duration of treatment). Anaphylactic reactions. Anorexia, nausea, vomiting, abdominal distress. Fever, malaise headache dizziness. Elevated serum uric acid level.


Tab: 400mg

Adults;

15mg/kg daily as a single dose.

Children;

Treatment, 25mg/kg daily as a single dose for 60 days, then 15mg/kg daily as a single dose.

Available as:

Myambutol, Pulmobutol

5.2 ISONIAZIDINDICATIONS

Tuberculosis, in combination with other drugs; prophylaxis.

CONTRA-INDICATIONS

Drug-induced liver disease.


35

ANTI

TUBERCULOUS

DRUGS

ADVERSE EFFECTS

Nausea, vomiting, peripheral neuritis (prophylaxes is done with high dose pyridoxine). Optic neuritis, convulsions, psychotic episodes; hyper sensitivity reactions, fever, erythema multiforme, purpura; agranulocytosis; hepatitis especially over age of 35 years; systemic lupus erythematosus, pellagra hyperglycaemia & gynaecomastia.


Tab: 100mg.By mouth or by injections.

Adult: 300mg daily.Children: 5-10mg / kg daily, 300mg maximum

Available as:

Aceta INH, Isonex Forte

5.3 PYRAZINAMIDEINDICATIONS

Treatment of tuberculosis only in conjunction with other anti-tuberculous drugs.

CONTRA INDICATIONS

Liver disease, pregnancy

ADVERSE EFFECTS

Hepatitis which can be minimized by dosage adjustment, photosensitivity.


Tab: 500mg

Adults;

20-30mg/kg daily in divided doses,maximum 3gm daily.

Children;

Not recommended.


36

ANTI

TUBERCULOUS

DRUGS

Available as:

Pyrazin, Pyrazid, Pyrazinamide

5.4 RIFAMPICININDICATIONS

Tuberculosis

CONTRA-INDICATIONS

Jaundice, porphyria

ADVERSE EFFECTS

Gastro-intestinal symptoms including anorexia, nausea, vomiting, diarrhoea (pseudomebranouscohti sreported).Those occurring mainly on intermittent therapy include Influenzae like syndrome (with chills, fever, dizziness, bone pain), respiratory symptoms (including shortness of breath), collapse and shock.Hemolytic anaemia, acute renal failure, thrombocytopenic purpura; alterations of liver function, jaundice; flushing, urticaria, and rashes.Other side-effects reported include oedema, muscular weakness and myopathy, leucopenia, eosinophilia, menstrual disturbances.Urine, saliva, and other body secretions coloured orange-red.


Cap or Tab: 150mg, 3(M)mg, 450mg, 600mg.Syp: 200mg/10ml.Less than 50kg 450mg more than 50kg 600mgunder 2 years: 10mg per kg

Available as:

Rifapin, Rifacin

5.5 STREPTOMYCININDICATIONS

Broad spectrum antibiotic therapy particularly for mixed infec-tions.


37

ANTI

TUBERCULOUS

DRUGS

CONTRA-INDICATIONS

In patients who have shown previous hypersensitivity reactions.

ADVERSE EFFECTS

Proteinuria. Increased SGOT, SGPT. Increased or decreased reticulocyte count. Tinnitus. Confusion, disorientation. Purpura. rash, urticaria. Numbness, skin tingling. Nausea, vomiting. Pulmonary fibrosis.


Adults: 1gm daily.

Available as:

Polybiotic Streptomycin


38

ANTI

TUBERCULOUS

DRUGS

DRUGS

Rifampicin (R)

INH (H)

Ethambutol (E)

DOSAGEmg/kg/day

10 (8-12)

5 (4-6)

15 (15-20)

PZA (P)

Streptomxcin (S)

Thiaocetazone (T)

25 (20-30)

15 (12-18)

2.5

Dosage Guidelines Recommended by WHOFor Treating TB Patients.

Weight Category

Initial PhaseMyrin-P Forte

Continuation Phase Myrin

30-39kg

40-54kg

55-70kg

2 Tablets

3 Tablets

4 Tablets

2 Tablets

3 Tablets

4 Tablets

Myrin-P Forte

Myrin

Rifampicin 150mgEthambutol 275mgIsoniazid 75mgPyrazinamide 400mg

Rifampicin 150mgEthambutol 275mgIsoniazid 75mg

DRUGS DOSAGEmg/kg/day


39

ANTI

TUBERCULOUS

DRUGS

6- ANTI PROTOZOAL DRUGS

6.1 CHLOROQUINE PHOSPHATEINDICATIONS

Malaria, hepatic, amoebiasis, giardiasis, rheumatoid arthritis.

CONTRA-INDICATIONS

Headache, GI distress. Skin eruptions, depigmentation, hair loss, blurred vision, corneal opacities, retinal damage. Blood disorders.


Tab: 150mg.Syp: 50mg / 5ml.Inj:

Adults;

Initial dose 600mg followed by 300mg after 6 hours, 300mg daily for 2days.

Children;

Malaria suppressive, 5mg/kg as chloroquine base at weekly intervals.

Available as:

Resochin, Nivaquine, Geniquin

6.2 PYRIMETHAMINE WITH SULFADOXINEINDICATIONS.

Prevention and treatment of plasmodium falciparum malaria.

CONTRA-INDICATIONS

Suplphonamide sensitivity, severe liver or kidney dysfunction, blood dyscrasias, neonales. pregnancy and lactation.

ADVERSE EFFECTS

Skin rash, (discontinue immediately), pharyngitis, pruritus, G.I. disturbance, skin rashes, blood dyscrasisas, erythema multiforme, Stevens-Johnson syndrome and Lyell's syndrome.


40

ANTI

PROTOZAL

DRUGS


Tab: 500mg +25mgSusp:

SUSPENSION

Adults (Curative dose): 15ml in single dose.Children (Curative single dose).

Under 4 years; 2.5ml.4-6 years; 5ml.7-9 years; 7.5ml.10-14 years; 10ml.

Prophylactic dose;Adults;

Non-Immune subjects, 5ml as a single dose once in a week.Semi-immune subjects, 10-15ml once every four weeks.Children;

Under 4 years: 2.5ml as a single dose.4-8 years: 5ml as a single dose.9-14 years: 7.5ml as a single doses.The mentioned prophylactic dose is once every 2 wks for nonimmune subjects while once every 4 weeks for semi-immune subjects.

TABS.ProphylaxisAdults;

Over 14 years; 1 weekly treatment 2-3 as a single dose.

Children;

Under 9-14 years; 3/4 adults dose-Treatment.

Available as:

Fansidar, Amalar, Melofin

6.3 ARTHEMETHER WITH LUMEFANTRINEINDICATIONS

Treatment of uncomplicated falciparum malaria, treatment of benign matane.


41

ANTI

PROTOZAL

DRUGS

CONTRA-INDICATIONS

Arrhythmia

ADVERSE EFFECT

Abdominal pain, anorexia, diarrhoea, vomiting, nausea, palpita-tions, cough, headache, dizziness, sleep disturbances, arthralgia pruritus rash.

DOSAGE

20mg Tab4 tablets initially followed by 5dose of tables each at 8,24,36,48,60 hours.

Available as:

Amblum, Co-methe, Exafal, Falcinil, Gen-m


42

ANTI

PROTOZAL

DRUGS

7- GASTRO INTESTINAL DRUGS

ANTIULCER DRUGS

7.1 MAGNESIUM TRISILICATEINDICATIONS

Dyspepsia

CONTRA-INDICATIONS

Hypophospataemia

ADVERSE EFFECTS

Diarrhoea, Belching due to liberated CO2


Tablet: 2-3 tabs 4-6 times in a day.

Available as:

Gelusil, Gaviscon, Simethicone, Mucaine

7.2 SUCRALFATEINDICATIONS

Benign gastric and duodenal ulceration; chronic gastritis.

CONTRA- INDICATIONS

Renal impairment.

ADVERSE EFFECTS

Constipation; diarrhoea, nausea, indigestion, gastric discomfort, dry mouth, rash, puritus, back pain, dizziness, insomnia, vertigo and drowsiness.


Tab: 1g2g twice daily or 1g 4 times daily. 1 hour before meals and at bedtime, taken for up to 6 weeks or in resistant cases 12 weeks; maximum 8g daily.


43

GASTRO INTESTINAL

DRUGS

Prophylaxis of stress ulceration; suspension 1g 6 times daily maximum 8g daily.

Available as:

Crafilm, Ulcocid, Ulsanic

7.3 CIMETIDINEINDICATIONS

Benign gastric and duodenal ulceration, reflux oesophagitis, Zolinger-Ellison's syndrome.Other conditions where gastric acid reduction is beneficial.

CONTRA-INDICATIONS

Impaired renal function, malignancy, pregnancy lactation.

ADVERSE EFFECTS

Altered bowel habits, dizziness, rash, tiredness; reversible confusional states, reversible liver damage, headache, decreased blood counts, muscle or joint pain, hypersensitivity.Bradycardia and AV block; interstitial nephritis and acute pancre-atitis. Gynaecomastia is also an occasional problem with cimetidine but usually only in high dosage.


Tab: 400mgInj: 200mg IM, IV.

Adults;

By mouth, 400mg twice daily and at night or 500mg at night.Benign gastric and duodenal ulceration for at least 4 weeks.6 weeks in gastric ulceration.

8 weeks in NSAID -associated ulceration.

Children; 20-30mg/kg daily in divided doses. By slow intravenous injections, 200mg given one at least 2 minutes; may be repeated every 4-6 hours.By intravenous infusion, 400mg in 100 ml of 0.9% sodium


44

GASTRO INTESTINAL

DRUGS

choloride infused over 30-60 minutes (may be repeated every4-6 hour) or by continuous infusion at one average rate of 50- 100mg/hour over 24 hours, maximum 2.4g daily.

Available as:

Cimet, Ulcerax, Tagamet, Ulcedine

7.4 RANITIDINEINDICATIONS

Benign gastric and duodenal ulceration, stomah ulcer, reflux oesophagitis. Zollinger-Ellison syndrome, other conditions where reduction of gastric acid is beneficial.

CONTRA-INDICATIONS

Malignancy, pregnancy & lactation,

ADVERSE EFFECTS

Headache, dizziness. Rarely hepatitis, thrombocytopenia, leucopenia, hypersensitivity, confusion, breast symptoms.


Tab: 150mg, 300mgInj: 150 mg/ml

Adults;

By mouth, 150mg twice daily morning and night or 300mg at night,Benign gastric and duodenal ulceration for 4 to 8 weeks, 6 weeks in NSAID-associated ulceration; in duodenal ulcer 300mg can be given twice daily for 4 weeks to achieve a higher healing rate.

Children;

Peptic ulcer 2-4 mg/kg twice daily. Maximum 300 mg daily.

Maintenance; 150mg at night.

Prophylaxis of NSAID- induced duodenal ulcer, 150mg twice daily.


45

GASTRO INTESTINAL

DRUGS

Reflux oesophagitis; 150mg twice daily or 300mg at night for up to 8 weeks.Zollinger-Ellison syndrome; 150mg 3 times daily increased if necessary to up to 6g daily to divided doses. Before introduction of anaesthesia; intravenous injection diluted to 20ml and given over at least 2 minutes or by mouth, 150mg 2 hours before induction of anaesthesia, and also when possible on the proceeding evening.By slow intravenous injection, 50mg diluted to 20ml and given over at least 2 minutes; may be repeated every 6-8 hours.Prophylaxis of stress ulceration, initial slow intravenous injection

of 50mg then continuous infusion, 125-250 micrograms/kg per hour (may be followed by 150mg twice daily by mouth when oral feeding commences).

Available as:

Zantac, Nulcer, Ranulcid, Pepticure

7.5 OMEPRAZOLEProton pump inhibitors inhibit the secretion of gastric acid by blocking the proton pump.

CONTRA-INDICATIONS

pregnancy, liver disease.

ADVERSE EFFECT

nausea, vomiting, flatulence, diarrhoea, headache, dizziness, gynaecomastia.

DOSAGE

20mg 00 for 4 weeks (D4)20mg 00 for 8 weeks (G4)IV infusion 40mg 1 hours

Available as:

Losec, Omega, Risek, Omezol, Teph 20


46

GASTRO INTESTINAL

DRUGS

7.6 KAOLIN PECTININDICATIONS

Diarrhoea, dysentery

CONTRA-INDICATIONS

In acute diarrhea kaolin pectin is not recommended.

ADVERSE EFFECTS

No significant adverse effects are known.

DOSAGE, FORM & STRENGTH Susp

Adults; 10-30ml every four hours.Children under 1 year; 5ml.1-5 years; 10ml.Over 5 years; 10-30ml. All every four hours.

Available as:

Streptomagma, Diarhol, Kaltin

7.7 LOPERAMIDE HCLINDICATIONS

Symptomatic treatment of acute diarrhea.

CONTRA-INDICATIONS

Ulcerative colitis, anti-biotic associated diarrhea.

ADVERSE EFFECTS

Abdominal cramps, dizziness, drowsiness and skin reaction.


4mg initially followed by 2mg after each stool.

Available as:

Imodium, Lomide


47

GASTRO INTESTINAL

DRUGS

ANTI-EMETICS

7.8 CYCLIZINEINDICATIONSInj: for prevention and treatment of nausea and vomiting and drug-induce vomiting, especially that associated with the adminis-tration of narcotic drugs.CONTRA-INDICATIONSContra-indicated during drive

ADVERSE EFFECTSDrowsiness, occasional dry mouth and blurred vision; cyclizine may aggravate severe heart failure and counteract the haemodynamic benefits of opioids.

DOSAGE, FORM & STRENGTHTab: 50mgSyp: 12.5mg/mlInj: 50mg/ml

Adults; 1 amp IV/IM upto three times a day.

Children over 12 years; 4 tsp.6-12 years; 2 tsp.2-5 years; 1 tsp. All three times daily.

Adults; 1 tab Children over 12 years; 1 tab.6-12 years; ½ tab.2-5 years; 1/4 tab. All three times daily.

Available as:Marzine, Migril, Tagril


48

GASTRO INTESTINAL

DRUGS

7.9 DIMENHYDRINATEINDICATIONS

Vertigo, Nausea and vomiting . Motion sickness.

CONTRA-INDICATIONS

Comatose or greatly depressed state, hypersensitivity, pressure of large amounts of CNS depressants, bone marrow depression, blood dyscrasias, sub cortical brain damage, Parkinson’s disease, liver damage, jaundice, renal insufficiency, cerebral arteriosclero-sis, coronary disease, severe hypotension or hypertension, mitral insufficiency, pheochromocytoma.

ADVERSE EFFECTS

Sedation, extra pyramidal syndrome, anticholinergic effects and orthostatic hypertension.


Tab: 50mg Inj: 50mg/ml Syp: 12.5mg/4ml Drops/ Tabs

Adults; 50-100 two or three times daily.

1-6 years; 12.5-25 mg.7-12 years; 25-50 mg; both two or three times daily. Children under 1 year; Not recommended.

Inj: By IM/IV inj (same quantitiy as mentioned above).

Available as:

Gravinate, Devinate

7.10 METOCLOPRAMIDE HYDROCHLORIDEINDICATIONS

Nausea and vomiting, particularly in gastro-intestinal disorders and treatment with cytotoxics or radiotherapy.


49

GASTRO INTESTINAL

DRUGS

CONTRA- INDICATIONS

Recent gastro-intestinal surgery, prolactin-dependent breast carcinoma, phaeochromocytoma.

ADVERSE EFFECTS

Extra pyramidal effects especially in children/young adults, hyperprolactinaemia, occasionally dysikinesia on prolonged administration, drowsiness, restlessness, diarrhoea and depres-sion.


Tab: 10mg.Syp: 5mg/5ml.Inj: 5mg/ml.

Adults;

By mouth, or by intramuscular injection or by intravenous injection

over 1-2 minutes, 10mg 5mg.

Young adults 15-19 years under 60 kg; 3 times daily.Children upto 1 year or upto 10 kg; 1 mg twice daily.1-3 years or 10-14 kg; 1 mg 2-3 times daily.5-9 years or 20-29 kg; 2.5mg 3 times daily.9-14 years or 30 kg and over; 5mg 3 times daily.

Available as:

Metomid, Maxolon, Clopan

7.11 ONDANSETRON5HTs antagonist which block 5HT3 receptors in the GIT and CNS

INDICATIONS

Vomiting

CONTRA-INDICATIONS

Pregnancy, hepatic, impairment


50

GASTRO INTESTINAL

DRUGS

ADVERSE EFFECT

constipation headache, flushing, hiccups

DOSAGE8mg TDS oral IV

Available as:Zofran, Ondanles, Ondison, Onset, Setron

7.12 PROCHLORPERAZINEINDICATIONSVomiting, Vertigo, Labyrinthine disorders

CONTRA-INDICATIONSPregnancy, hepatic, impairment

ADVERSE EFFECTSedation, Extra pyramidal effects.

DOSAGE5-20mg 3 times, Maximum 75-100mg

Available as:Stemetil, Dometil

ANTI-SPASMODICS

7.13 ATROPINE SULPHATE INDICATIONS

Used prior to the administration of general anaesthesia. Concomitantly with Neostigmine to counteract Muscarinic effects.As antidote for oregano-phosphorous insecticide poisoning, mushroom poisoning.

CONTRA-INDICATIONS

Closed angle glaucoma, Patients with narrow angle between the iris and cornea, gastric or duodenal ulcer causing stenosis and


51

GASTRO INTESTINAL

DRUGS

significant gastric retention; urinary retention in prostate hypertro-phy, paralytic ileus, debilitated patients with esophageal reflux or oesophagitis. Since heat loss through sweating is suppressed, caution in high ambient temperature as hyperpyrexia may result, Particularly in infants.

ADVERSE EFFECTS

Xerostomia, altered taste perception, nausea, vomiting, dysphagia, heartburn, constipation, bloated feeling, paralytic ileus, gastrointestinal reflux.Urinary hesitancy and retention, impotence.Blurred vision, mydriasis, photo phobia, cyclophegia, increased intra ocular pressure. Palpitation, bardycardia following low dose.Headache, flushing, nervousness, drowsiness, weakness, dizzi-ness, insomnia, fever.Suppression of lactation, nasal congestion, severe allergic reac-tions or drug idiosyncrasies including anaphylaxis and urticaria.


Inj: 0.5 mg/mlAdults; 0.4-0.6mg IVChildren; 0.02mg/kg body weight IV at the time of induction or IM 30 minutes before induction with a maximum dose of 0.6mg.Infants below 5kg; 0.5 to 0.1 mg.

Available as:

Atrolate, Isopto Atropine, Motilex

7.14 HYOSCINEINDICATIONS

Smooth muscle spasm

CONTRA-INDICATIONS

Closed angle glaucoma.


52

GASTRO INTESTINAL

DRUGS

ADVERSE EFFECTS

Dry mouth with difficulty in swallowing and thirst, dilatation of the pupils with loss of accommodation and sensitivity to light, increased intra-ocular pressure, flushing, dry skin, bradycardia followed by tachycardia, palpitation and constipation; rarely fever, confusional states and rashes.

DOSAGE, FORM & STRENGTHTab/Injection

Adults;

1 amp IM or IV

1 tab tds.

Available as:

Buscopan, Spasler, Spasmogin

7.15 DOMPERIDONEINDICATIONS

Nausea, vomiting, dyspepsia, gastroesophegeal reflex.

CONTRA-INDICATIONS

renal impairment pregnancy, breast feeding, prolactinoma, hepatic impairment.

ADVERSE EFFECT

GI disturbance, increased prolactin concentration, extapyramidal effects and rashes.

DOSAGEAdult

35kg 10-20mg 3-4 time 80mg max85kg 250-500mg/kg 3-4 time2.4mg/kg max daily Peridone

Available as:

Motilium, Pelton, Domcin, Peridone


53

GASTRO INTESTINAL

DRUGS

7.16 MEBEVERINEINDICATIONS

Adjunct in GI disorders characterized by smooth muscle spasm.

CONTRA-INDICATIONS

paralytic ileus

ADVERSE EFFECT

Allergic reaction

DOSAGEAdult

130-150mg 3 times daily.

Available as:

Colofac, Zeespa, Mevrin

7.17 ORAL REHYDRATION SALTS (ORS)INDICATIONS

Fluid and electrolyte loss in diarrhoea.

CONTRA-INDICATIONS

Hypertension

ADVERSE EFFECTS

No significant adverse effects


NaCl 3.5%, Trisodium citrate dehydrate 2.0% sachet. According to fluid loss, usually 200-400 ml solution after every loose motion.

Infant; 1-1 ½ times usual feed volumeChildren; 200ml after every loose, motion


GASTRO INTESTINAL

DRUGS

54

8- CARDIOVASCULAR DRUGS

8.1 ATENOLOLINDICATIONS

Cardiac dysrhythmias, treatment of myocardial infraction. Early and late intervention after myocardial infraction.Management of hypertension, angina pectoris. Cardiac dysrhythmias.Treatment of myocardial infraction. Early and late intervention after myocardial infraction.

CONTRA- INDICATIONS

Asthma or history of obstructive airways disease, uncontrolled heart failure, sick sinus syndrome, second or third degree heart block, cardiogenic shock.

ADVERSE EFFECTS

Brady cardia, heart failure, broncho spasm, peripheral vasoconstriction, gastro-intestinal disturbances, fatigue, sleep disturbances; Rare reports of rashes and dry eyes.


Tab: 50mg,100mg,

Hypertension: 50 or 100mg once daily.Angina; Usually 100mg once daily or 50mg twice

daily.Dysrhythmias

Initial dose. 2.5mg IV inj over 2.5 min. can be repearetd at 5 min intervals until response observed max 10mg infusion: 0.15 mg/kg over 20 min. Oral maintenance dose 50-100 mg once daily.

Myocardial infraction.

Early intervention within 12 hours; 5-10mg slow IV inj. (1mg/min); 50mg orally 12 hour later; then 100mg once daily commencing 12 hours later.


55

CARDIOVASCULAR

DRUGS

Late Intervention: 100mg daily for long term prophylaxis of myocardial infraction.

Children;

Not recommended.

Available as:

Tenormin, Cartac, Pule

8.2 CAPTOPRILINDICATIONS

Mild to moderate hypertension as adjunct to thiazide diuretics. Severe hypertension where other measures have failed.Adjunct to diuretics and , where appropriate, digitalis in congestive cardiac failure.

CONTRA- INDICATIONS

Neutropenia, agranulocytosis, proteinuria, hypotension, rash, loss of taste, cough (rare).

ADVERSE EFFECTS

Neutropenia, agranulocytosis, proteinuria, hypotension, rash, loss of taste, cough (rare).


Tab: 25mg

Hypertension.

Mild to moderate hypertension. Initially 12.5mg twice daily with a thiazide.Maintenance;

25-50mg twice daily increasing gradually at 2-4 week intervals.

Congestive cardiac failure, initially 6.25mg or 12.5mg.Maintenance;

25mg three times daily. Maximum 150mg daily.

Available as:

Capoten, Catoper


56

CARDIOVASCULAR

DRUGS

8.3 DIGOXININDICATIONS

Digitalis therapy, particularly congestive heart failure.

CONTRA-INDICATIONS

Ventricular tachycardia. Hypertrophic obstructive cardiomyopathy.Elective electro-conversion. Hypercalcaemia.

ADVERSE EFFECTS

Gastrointestinal, visual and conduction disturbances.


Tab: 0.25mgInj: 0.25mg/ml

Adults Maintenance; 250-500mg daily.Elderly Maintenance; 125-250 mg daily.Children Maintenance; Usually 10-20mcg/kg daily in

single or divided doses.

Available as:

Digox, Digoxin, Doxin, Lanoxin

8.4 DILTIAZEMINDICATIONS

Angina pectoris

CONTRA- INDICATIONSnd rdPregnancy. Sickness syndrome; 2 or 3 degree AV block, ankle

oedema, nausea, headache, rash.


Tab: 30mg

Adults;

Usually 60mg three times daily, increasing if necessary to maxi-mum 480mg daily in divided doses. Initially 60mg twice daily.


57

CARDIOVASCULAR

DRUGS

Children; Not recommended.

Available as:

Herbesser, Tiazem

8.5 DOBUTAMINE HYDROCHLORIDEINDICATIONS

Inotropic support in infraction, cardiac surgery, cardiomyopathies, septic shock, and carcinogenic shock.

CONTRA-INDICATIONS

Severe hypotension complicating to cardiogenic shock.

ADVERSE EFFECTS

Tachycardia and marked increase in systolic blood pressure indicate over dosage.


Inj 250mg, By intravenous infusion, 2.5-10 micro-grams/kg/minute, adjusted according to response.

Available as:

Dobex, Dobuject, Dobutamed

8.6 DOPAMINE HYDROCHLORIDEINDICATIONS

Cardiogenic shock ininfraction or cardiac surgery.

CONTRA-INDICATIONS

Tachyarrhythmia and phaeochromocytoma.

ADVERSE EFFECTS

Nausea and vomiting, peripheral vasocontriction, hypotension, hypertension, tachycardia.


Inj: 200 mg/mlBy intravenous infusion, 2-5 micrograms/kg/ minute initially.


58

CARDIOVASCULAR

DRUGS

Available as:

Dopamine, Intropin, Tropin

8.7 ENALAPRIL MALEATEINDICATIONS

All grades of essential hypertension; congestive heart fail-ure(adjunct).

CONTRA0INDICATIONS

Hypersenitivity to ACE inhibitors: known or suspected renovasular disease, aortic stenosis or outflow tract obstruction; pregnancy; porphyria.

ADVERSE EFFECTS

Persistent dry cough, throat discomfort, voice changes, dizziness. Headache, fatigue, weakness, hypertension, change of taste, sore mouth, nausea, diarrhoea, muscle cramps, rash and angioedema.Rarely pancreatitis, renal impairment; pancreatitis.


Tab: 5mg, 10mgAdults;

Hypertension, initially 5mg daily; if used in addition to diuretic, in elderly patients, or in renal impairment, initially 2.5 mg daily.Maintenance dose;

10-20mg daily; maximum 40mg daily. Heart failure (adjunct), initially 2.5mg daily Maximum 10-20mg daily.

Available as:

Renitec, Ramitace, Cardace

8.8 ISOSORBIDE DINTRATEINDICATIONS

Prophylaxis and treatment of angina; left ventricular failure.

CARDIOVASCULAR

DRUGS


59

CONTRA-INDICATIONS

Marked amaemia, head trauma, cerebralhaemorrhage, closed-angle glaucoma.

ADVERSE EFFECTS

Throbbing headache, flushing dizziness, postural hypotension, tacycardia.


Tab: 5mg, 10mgSublinually, 5-10mgBy mouth, daily in divided doses, angina 30-120mg, left ventricu-lar failure 40-160mg, up to 240mg if required, By intravenous infusion, 2-10mg/hour.

Available as:

Isoket, Isdin, Isobid, Isocord

8.9 GLYCERYL TRINITRATEINDICATIONS

Prophylaxis and treatment of angina; left ventricular failure.

CONTRA-INDICATIONS

Marked anaemia, head trauma, cerebral hemorrhage, closed-angle glaucoma.

ADVERSE EFFECTS

Throbbing headache, flushing, dizziness, postural hypotension, tachycardia.

DOSAGE, FORM & STRENGTHTablets.Injection.

Sublingually, 0.3-1mg. Repeated as required.By mouth, 2.6-6.4mg as modified-release tablet, 2-3 times daily; Severe angina, 10mg 3 times daily. By intravenous infusion, 10-200 micro-grams/minute.


60

CARDIOVASCULAR

DRUGS

Available as:

Angiocard, Angised, Nitronal

8.10 METHYLDOPAINDICATIONS

Hypertension, in conjuction with diuretic; hypertensive crisis when immediate effect not necessary.

CONTRA-INDICATIONS

History of depression, active liver disease, pheochromocytoma; porphyria.

ADVERSE EFFECTS

Dry mouth, sedation, depression, drowsiness, diarrhoea, fluid retention, failure of ejaculation, liver damage, hemolytic anaemia, lupus erythematosus-like syndrome, parkinsonism, rashes, nasal stiffness.


Tab: 250mgInj: 250mg

Adults;

By mouth, 250mg 2-3 times daily, gradually increased at intervals of 2 or more days; maximum daily dose 3g.

Elderly;

125 mg twice daily initially, gradually increased; maximum daily dose 2g.By intravenous infusion, methyl dopamine hydrochloride 250-500mg, repeated after 6 hours if required.

Available as:

Aldomet, Hypergen, Llskomet, Normet

8.11 NIFEDIPINEINDICATIONS

Prophylaxis and treatment of angina; hypertension; Reynaud’s phenomenon.


61

CARDIOVASCULAR

DRUGS

CONTRA-INDICATIONS

Cardiogenic shock; advanced aortic stenosis; pregnancy; porphyria.

ADVERSE EFFECTS

Headache, flushing, dizziness lethargy, also gravitational oedema, rash, nausea, increased frequency of micturition, eye pain, gum hyperplasis; depression reported; telangiecasia reported.


Cap: 10mg

Adults & Elderly;

Angina and Reynaud’s phenomenon, initially 10mg (elderly) 3 times with or after food.

Maintenance;

5-20 mg 3 times daily, for immediate effects in angina bite into capsule and retain liquid in mouth or swallow.

Available as:

Adalat, Nifed, Nifelat

8.12 PROPRANOLOL HYDROCHLORIDEINDICATIONS

Management of hypertension, angina pectoris. Prophylaxis after myocardial infraction, cardiac dysrhymais, migraine. Tremor, anxiety, prophylaxis of upper gastrointestinal bleeding in patients with portal hypertension and oesphageal varices.

CONTRA-INDICATIONS

Asthma or history of obstructive airways disease, uncontrolled heart failure, sick sinus syndrome, second or third degree heart block, cardiogenic shock.

ADVERSE EFFECTS

Bradycardia, heart failure, broncho spasm, peripheral


62

CARDIOVASCULAR

DRUGS

vasoconstricition, gastrointestinal disturbances, fatigue,sleep disturbances.Rare reports of rashes and dry eyes (reversible on withdrawal).


Tab: 10mg, 40mgInj: 1mg/mlAdjust dosage according to response.Hypertension:Adults;

Usually 160-320mg daily. Angina pectoris usually 120-240mg daily. Anxiety, migraine, essential tremor: Usually 120-240mg daily.

Children;

Migraine: 20mg orally two or three times daily.

Adults;

80-320 mg daily. Post myocardial infraction. Begin 5-21 days post infact, 40mg four times daily for 2-3 days, then 80mg twice daily or 160mg once daily.Emergency treatment of dysrhythmias: 1mg given over 1 min. May be repeated at 2 min intervals to a maximum of 10mg (concious patients) or 5 mg (under anaesthesia).

Children;

Dysrhythmias (as a guide):0.025-0.05mg/kg body-wt IV injection slowly under ECG control, three or four times daily.

Available as:

Inderal, Opinol, Oprinol

8.13 VERAPAMIL HYDROCHLORIDEINDICATIONS

Treatment and prophylaxis of angina pectoris, supra ventricular tachycardia of reciprocating type assosiated with wolff Parkinson white syndrome.


63

CARDIOVASCULAR

DRUGS

Mild to moderate hypertension.

CONTRA-INDICATIONS

Hypotension, bradycardia, second and third-degree AV block, sick sinus syndrome, cardiogenic shock, sino-atrial block.History of heart failure or significantly impaired left ventricular function, even if controlled by therapy.Atrialflutter or fibrillation complicating Wolff-Parkinson-White syndro; porphyria.

ADVERSE EFFECTS

Constipation; less commonly nausea, vomiting, flushing, head-ache , d i z z i nes s , fa t i gue , ank le oedema; ra re l y reversibleimpairment of liver function, allergic reactions (ery-thema, pruritus).Rarely gynaecomastia and gingival hyperplasia after intravenous administration, hypotension, bradycardia, heart block, and asystole.


Tab: 80mg

Adults;By mouth:

Supra ventricular arrhythmias, 40-120mg 3 times daily. Angina, 80-120mg 3 times daily.Hypertension, 240-480 daily in 2-3 divided doses. By slow

intravenous injection over 2 minutes (3 minutes in elderly), 5-10mg (preferably with ECG monitoring); In paroxysmal

Tachyarrthmia;

A further 5mg after 5-10 minutes if required.

Available as:

Calan, Isocardin


64

CARDIOVASCULAR

DRUGS

8.14 AMLODIPINECalcium channel blocker.

INDICATIONS

Hypertension, Prophylaxis of angina.

CONTRA-INDICATIONS

Cardiogenic shock, unstable angina, aortic stenosis.

ADVERSE EFFECTS

Abdominal pain Nausea palpitation, Flushing, Edema, Headache, Dizziness, Fatigue, Sleep Disturbance.


Adults; By mouth: 5mg once a day 10mg Maximum

Available as:

Amodip, Amlodip, Norvasc


65

CARDIOVASCULAR

DRUGS

9- ANTI COAGULANTS

9.1 HEPARININDICATIONS

Deep-vein thrombosis and pulmonary embolism. Unstable angina, acute peripheral arterial occlusion, myocardial infarction.

CONTRA-INDICATIONS

Haemophilia & other haemorrhagic disorders, thrombocytopenia, peptic ulcer, cerebral aneurysm, severe hypertension, severe of eye or nervous system, hypersensitivity to heparin.


Inj: 5000iu/ml

Adults;

Deep-vein thrombosis and pulmonary embolism, by intravenous

injection, loading dose of 5000 units followed by continuous infusion of 18 units/kg per hours or by subcutaneous injection of 15000 units every 24 hours (both adjusted daily by laboratory monitoring).

Small Adult or Child;

Lower loading dose then, 15-25 units/kg/hour by intravenous

infusion, 250 units/kg every 12 hours by subcutaneous injection.

Unstable angina, acute peripheral arterial occlusion, as intrave-

nous regimen for deep-vein thrombosis and pulmonary embolism,

by subcutaneous injection, 5000 units 2 hours before surgery, then every 8-12 hours for 7 days or until patient is ambulant (monitoring not needed); during pregnancy (with monitoring), 5000-10000 units every 12 hours.

Available as:

Ecfast, Epsoclar, Mediparine, Multiparin


66

ANTI

COAGULANTS

9.2 TRANEXAMIC ACID INDICATIONS

As an anti-plasm in drug in hemorrhagic disease (purpurea, aplastic anaemia, cancer, leukemia etc.) and abnormal bleeding.

CONTRA-INDICATIONS

Thromoboembolic disease.

ADVERSE EFFECTS

Nausea, vomiting, diarrhoea; giddiness on rapid intravenous injection.


Cap: 250mgInj: 250mg/5ml, By mouth, 1-1.5g 2-4 times daily. I/V injection, 1g 3 times daily.

Available as:

Transamin, Transcam, Tranxic, Traumax

9.3 CLOPIDROGRELAntiplatelet agent

INDICATIONS

Prevention of atherosclerotic event, MI, ischemic stroke.

CONTRA-INDICATIONS

Active bleeding, Renal impairment, Pregnancy.

ADVERSE EFFECTS

Dyspepsia, Abdominal pain, Diarrhea, Bleeding disorders.


75mg once a day Acute MI 300mg once than 75mg OD

Available as:

Platex, Ogrel, Clavix


67

ANTI

COAGULANTS

10- DIURETICS

10.1 FUROSEMIDEINDICATIONS

Oedema, oliguria due to renal failure.

CONTRA-INDICATIONS

Precomatose states associated with liver cirrhosis.

ADVERSE EFFECTS

Hyponatraemia, hypokalaemia, hypocholaemicalkalosis, increased calcium exceryion, hypotension; less commonly nausea, gastro-intestinal disturbances, hyperuricaemia and gout; hyper-glycaemia (less common than with thiazides).Temporary increased in plasma cholesterol and triglyceride concentrations; rarely rashes and bone marrow depression (withdraw treatment), pancreatitis (with large parenteral doses), tinnitus and deafness (usually with large parenteral doses and rapid administration and in renal impiration).


Tab: 40mgInj: 20mg/2ml

Adults;

By mouth, oedema, initially 40mg in the morning. Maintenance 20mg daily or 40 mg on alternate days, increased in resistant oedema to 80mg daily.

Children;

1-3mg/kg daily. intravenous injection or slow intravenous injection (rate not exceeding 4mg/minute), initially 20-5mg.

Children;

0.5-1.5mg/kg to maximum daily dose of 20mg.


68

DIURETICS

Available as:

Fusemid, Lasix

10.2 MANNITOLINDICATIONS

Cerebral oedema.

CONTRA-INDICATIONS

Congestive cardiac failure, pulmonary oedema.

ADVERSE EFFECTS

Chills, fever.


Inj: 20%, 40% I/V,

By intravenous infusion, diuresis, 50-200g over 24 hour, preceded by a test dose of 200mg/kg slow intravenous injection.

10.3 SPIRONOLACTONEINDICATIONS

Oedema and ascites in cirrhosis of the liver, malignant ascites, nephrotic syndrome, congestive heart failure; primary aldosteronism.

CONTRA-INDICATIONS

Hyperkalaemia, hyponatraemia, severe renal impairment; pregnancy and bread-feeding; Addison’s disease.

ADVERSE EFFECTS

Gastro-intestinal disturbances, gynaecomastia; hyperkalaemia; hypotension.


Tab: 25mg, 100mg

Adults; 100-200mg daily, increased to 400mg if required.


69

DIURETICS

Children; Initially 3mg/kg daily in divided doses.

Available as:

Aldactazide, Aldactone, Spidar, Spiromide

10.4 BENDROFLUAZIDEINDICATIONS

Edema, Hypertension

CONTRA-INDICATIONS

Hypokalaemia, hyponatraemia, severe renal impairment; Hypercalcemia Addison’s disease.

ADVERSE EFFECTS

Gastro-intestinal disturbances, impotence, hypokalaemia; hypotension, hyponatraemia.


Edema 5-10mg once daily.hypertension 2.5mg once daily.

Avialable as:

Fortzaar, Hyzaar, Co-osar, Aldactazide, Moduretic


70

DIURETICS

11- RESPIRATORY DRUGS

11.1 AMINOPHYLINEINDICATIONS

Asthma, bronchopenumonia, bronchitis, Cheyne-Stokes respira-tion, paroxysmal dyspnoea associated with left heart failure.

CONTRA-INDICATIONS

Allergy to theophylline, caffeine, theobromine, ethylendiamine.

ADVERSE EFFECTS

Tachycardia, palpitions, nausea, gastro-intestinal disturbances, headache, insomnia, arrhythmias, and convulsions especially if given rapidly by intravenous injection.


Tab: 100mgInj: 250mg/ml

Adults; Loading dose 6mg/kg.Maintenance; 0.5mg/kg/hr IV infusion. Cardiac failure: 0.3mg/kg/hr. Liver disease.0.2 mg/kg/hr. Both cardiac failure and liver disease: 0.1mg/kg/hr.Children; 5mg/kg six hourly SLOW I.V inj.

Available as:

Aminolin, Amphyll

11.2 EPHEDRINE HYDROCHLORIDEINDICATIONS

Reversible airways obstruction.

CONTRA-INDICATIONS

Hyperthyroidism, hypertension, coronary disease, prostatic hypertrophy, hyperexcitibility, closed angle glaucoma.


71

RESPIRATORY

DRUGS

ADVERSE EFFECTS

Tachycardia, anxiety, restlessness, insomnia common; also mouth, cold extremities.


Tab / Inj: 50/ml

Adults;

3 times daily; 15-60mg 3 times daily.

Children upto 1 year; 7.5 mg.1-5 years; 15mg.6-12years; 30mg.

Available as:

Abenol Plus, Deltarhinol, Efed, Ephedrine

11.3 SALBUTAMOLShort acting beta agonist

INDICATIONS

Asthma and other conditions associated with reversible airways obstruction; premature labour.

CONTRA0INDICATIONS

Though Salbutamol inj. are recommended for the prevention of uncomplicated premature labor associated with toxaemia of pregnancy or ante partum haemorrhage from whatever cause is contra-indicated.Threatened abortion during first or second trimester of pregnancy. History of hypersensitivity.

ADVERSE EFFECTS

Fine tremor (usually hands), nervous tension, headache, periph-eral vasodilation tachycardiac hypokalaemia after high doses (acsm recommends monitor plasma-potassium in severe asthma; hypersensitivity reactions including paradoxical broncho spasm, urticaria, andangioedema reported; slight pain on intramuscular injection.


72

RESPIRATORY

DRUGS


oral 2mg TDS 8mg Maximum

Children: less then 2 years 100microgram 4 times daily.

2-6 years: 1-2mg 4 times daily.6-12 years: 2mg 4 times daily.subcutaneously: 500microgram 4 hourly.Intravenous: 5microgram Initially.Inhalation: 100-200microgram 3-4 times daily.

Available as:

Ventolin, Ventomed, Bretheez-e

11.4 SALMETROLLong acting beta agonist

INDICATIONS

Asthma and other conditions associated with reversible airways obstruction; premature labour.

CONTRA INDICATIONS

Pregnancy and Breast Feeding

ADVERSE EFFECTS

Oropharyegeal Irritation taste disturbance, Rash, insomnia, Nausea, Pruritus


50micrograms twice daily.

Available as:

Servent

11.5 BECLOMETHSONEinhaled corticosteroids


73

RESPIRATORY

DRUGS

INDICATIONS

Prophylaxis of asthma.

CONTRA INDICATIONS

Tuberculosis

ADVERSE EFFECTS

Hoarsness, candidiasis


50micrograms twice daily.

Available as:

Becotide, Clenil

11.6 IPRATROPIUM BROMIDE Anti-muscarinic bronchodilator

INDICATIONS

Reversible COPD.

CONTRA INDICATIONS

BPH, Glaucoma.

ADVERSE EFFECTS

Dry month, nausea, constipation, headache.


20-40 microgram QDS

Available as:

Atrovent

11.7 DEXAMETHASONEINDICATIONS

Emergency parenteral therapy; intra-articular and soft tissue conditions.Rheumatic allergic and inflammatory conditions.


74

RESPIRATORY

DRUGS

CONTRA-INDICATIONS

Hypertension, renal insufficiency etc.

ADVERSE EFFECTS

Hypertension, sodium and water retention and potassium loss. Cushing;s syndrome with moon face, striae, and acne. Suppression of growth in children, adrenal atrophy.


Tab: 0.5mgInj: 4mg/ml vial of 5ml

Adults;

By mouth, usual range 0.5-9mg daily. By intramuscular or slow

intravenous injection or infusion (as dexamethasone phosphate). Initial 0.5-20 mg.

Children;

200-500micrograms/kg daily. Cerebal oedema (as dexamethasone phosphate), by intravenous

injection, 10mg initially, then 4mg by intramuscular injection every 6 hours as required for 2-10 days.

11.8 HYDROCORTISONE SODIUM SUCCINATEINDICATIONS

Adrenal failure; overwhelming infections (with chemotherapy).

CONTRA-INDICATIONS

Systemic fungal infections. Known hypersensitivity to components.

ADVERSE EFFECTS

Fluid and electrolyte disturbances, peptic ulceration and hemor-rhage, impaired wound healing.


Inj: 250mg/2ml

Adults; 100-500mg by slow IV inj.


75

RESPIRATORY

DRUGS

Children; Dose may be reduced according to severity of condition and response butshould not fail below 25mg daily.

11.9 PREDNISOLONEINDICATIONS

Suppression of inflammatory and allergic disorders.

CONTRA-INDICATIONS

Peptic ulceration, hypertension, diabetes.

ADVERSE EFFECTS

Hyperglycemia, osteoporosis, depression, euphoria, peptic ulceration, cushingoid changes.


Tab: 5mg

Adults;

By mouth, initially, up to 10-20mg daily (severe disease, up to 60mg daily), preferably taken in the morning after breakfast; can often be reduced within a few days but may need to be continued for several weeks or months.

Maintenance;

Usual range, 2.5-15mg daily, but higher doses may be needed; cushingoidside- effects increasingly likely with doses above 7.5 mg daily. By intramuscular injection prednisolone accetate, 25-100mg once or twice weekly.

EXPECTORANTS AND COUGH SYRUPS

11.10 SYP. AMINOPHYLINE 32mg

Diphenhydramine 8mg;


76

RESPIRATORY

DRUGS

Chloride 30mgMenthol 0.98mgAlcohol 5% Bottle of 450ml

11.11 SYP. AMMONIUM CHLORIDE 100mgSod Chlorpheniramine Maleate 2mg Ephidrine HCL 7 mg. Menthol 1mg/5ml bottle of 450ml.


77

RESPIRATORY

DRUGS


78

RESPIRATORY

DRUGS

Step-1

Step-2

Step-3

Step-4

Step-5

Short acting beta 2 agonist

Step-1+ inhaled corticosteroids

Step-1+step-2+ Long acting beta 2 agonist

Step-1+step-2+step-3+ 6weeks of leukotrine receptor antagonist oral theophyllineoral beta 2 agonist

Step1 + step 2 + step 3 + oral prednisolone

Moderate Acute asthma

Severe Acute asthma

Life threatening Acute asthma

1. Oxygen.2. Salbutamol/Terbutaline (Nebulise).3. Oral Prednisolone 40-50mg.

1. Oxygen.2. Salbutamol/Terbutaline (Nebulise).3. Oral Prednisolone 40-50mg or IV hydrocortisone400mg in 4 divided doses.

1. Oxygen.2. Salbutamol/Terbutaline (Nebulise).3. Oral Prednisolone 40-50mg.4. IV hydrocortisone 400mg in 4 divided doses5. Ipratropium (Nebulise).

Managment of Asthma

12- OPTHALMOLOGICAL DRUGS

12.1 CHLORAMPHENICOL INDICATIONS

Bacterial conjunctivitis.

ADVERSE EFFECTS

Aplastic anaemia (rare).


Eye drops: 0.5%Eye ointment: 1%Adults & Children;

Ointment 1 application three to four hourly.Drops 2 drops three hourly.

12.2 GENTAMICININDICATIONS

Ocular bacterial infections.

ADVERSE EFFECTS

Transient irritation, Superinfections.

DOSAGE FORM & STRENGTH

Eye drops: 0.3%

Adults; Children;

2-4 drops three times or four times daily and at night.

12.3 SULFACETAMIDE SODIUMINDICATIONS

Acute conjunctivitis, superficial cornel ulcer, and other inflamma-tory conditions of the eyes.

ADVERSE EFFECTS

Transient irritation.Superinfections.


79

OPTHALMOLOGICAL

DRUGS


Eye ointment : 10%, Eye drops: 10%, 20%

1 drops two hourly

MIOTICS AND ANTIGLAUCOMA DRUGS

12.4 ACETAZOLAMIDEINDICATIONS

Congestive heart failure, oedema and toxaemia of pregnancy, pre-menstrual tension. Epilepsy, Glaucoma.

CONTRA-INDICATIONS

Chronic closed angle glaucoma. Renal hyperchloraemic acidosis. Adrenal insufficiently. Sodium or potassium depletion.

ADVERSE EFFECTS

Flush ing, th i r s t , headache, drows iness , polyur ia, paraesthesia,blood dyscrasias, excitment, rash.


Tab: 250mg

Adults;

Initially 250-375mg once daily. Pre-menstrual tension: 125-375mg OD 5-10 days before menstruation. Epilepsy: 250mg-1mg daily in divided doses.Children under 2 years;

125mg daily; 2-12 years, 125-750mg daily in divided doses Glaucoma.

Adults; 1-4 daily in divided doses.Children & Infants; ½ tab daily; 1/2-3 tabs daily in divided

doses.

12.5 PILOCARPINE NITRATEINDICATIONS

Glaucoma


80

OPTHALMOLOGICAL

DRUGS

CONTRA-INDICATIONS

Acute iritis. Soft contact lenses.


Eye drops: 2%, 4%Adults & Children: 2 drops thrice daily.

MYDRIATIC / CYCLOPLEGIC DRUGS

12.6 ATROPINEINDICATIONS

Long acting mydriatic and cycloplegic for use in uveitis and refraction.

CONTRA-INDICATIONS

Narrow angle glaucoma. Soft lenses.

ADVERSE EFFECTS

Transient stinging, dry mouth, blurred vision, photo phobia, tachycardia, headache. Psychotic reaction, behavioral changes.


Eye drops: 1 %

Adults and children

Uveitis, 1 drops three times daily. Refraction, 1-2 drops one hour before examination.

12.7 HOMATROPINE HYDRO BROMIDEINDICATIONS

Mydriatic and cycloplegic with more rapid onset and shorter duration than atropine.

CONTRA-INDICATIONS

Narrow angle glaucoma.


Eye drops: 2%


81

OPTHALMOLOGICAL

DRUGS

Adults & Children; 1 or more drops as required.

12.8 TROPICAMIDEINDICATIONS

Mydriatic and cyclopegic (with a rapid recovery of accommoda-tion) for refraction.

CONTRA- INDICATIONS

Unknown intra ocular pressure. In infants put pressure over Lacrimal sac for 1 minute.

ADVERSE EFFECTS

Transient sitngind, dry mouth, blurred vision, photophobia, tachycardia, headache, psychotic reactions, behavioral changes.


Eye drops: 1%

Adults & Children;

1 or 2 drops of either strength at 1-5 min intervals.

12.9 CHLORAMPHENICOL+HYDROCORTISONE ACETATE

INDICATIONS

Ocular infections.

CONTRA-INDICATIONS

Viral, fungal, tuberculous or purulent infections. Glaucoma.

ADVERSE EFFECTS

Rise in intra-ocular pressure, corneal thinning, cataract. Aplastic anaemia(rare).


Apply once daily to once hourly depending on severity.


82

OPTHALMOLOGICAL

DRUGS

12.10 PREDNISOLONEINDICATIONS

Steroid responsive inflammation of the palpebral and bulbat conjunctiva, cornea and anterior segment of the globe.

CONTRA-INDICATIONS

Viral, fungle tuberculous and other infections of the eye.

ADVERSE EFFECTS

Rise in intra-ocular pressure, corneal thinning cataract, fungal infection.


Eye drops: 1%

Adults & Children;

1-2 drops 2-4 times daily. During initial 24-48 hours the dosage may safely be increased to 2 drops every hour.

ANTIGLAUCOMA DRUGS

12.11 BETAXOLOL HYDROCHLORIDE INDICATIONS

Ocular hypertension, chronic open-angle glaucoma.

CONTRA-INDICATIONSSinus bardycardia, cardiogenic shock, uncompensated cardiac failure, soft lenses.

ADVERSE EFFECTS

Transient discomfort. Rarely decreased corneal sensitivity. Erythema, corneal punctate staining, keratitis.


Eye drops: 0.5%

Adults; 1 drops twice daily.


83

OPTHALMOLOGICAL

DRUGS

Children; Not recommended.

12.12 BETAMETHASONEINDICATIONS

Non-inflected inflammatory conditions of the eye. In opthalmology indications include uveitis, marginal keratitis, allergic conjuntivitis, blepharitis and episcleritis.

CONTRA-INDICATIONS

Viral, fungal, tuberculous or purulent infections. Dendritic ulcer, Glaucoma.

ADVERSE EFFECTS

Corneal thinning cataract, rise in intra-ocular pressure; avoid unnecessary use.


Eye drops: 0.1%Adults & Strength: 1 or 2 drops one or two hourly.

DIAGNOSTIC AGENTS

12.13 FLUORESCEIN SODIUMINDICATIONS

Detection of lesions foreign bodies.


84

OPTHALMOLOGICAL

DRUGS

13- GYNAECOLOGICAL DRUGS

13.1 OXYTOCININDICATIONS

Induction of labour in case of post maturity, premature rupture of membranes or preeclampsia. Primary and secondary uterineintertia. Caesarean section. Post partum uterine atomy.

CONTRA-INDICATIONS

Cephalopelvic disproportion, abnormal presentation. Excessive distension of the uterus (e.g. in multiple pregnancy, hydramnios), parity greater than 4, elderly multiport, previous. Caesarean section or other surgery involving the uterus. Severe toxaemia, predisposition to amniotic fluid embolism (foetal death in utero, abruption placentae), hypertonic construction, placenta praevia.

ADVERSE EFFECTS

Very occasionally prolonged or too rapid infusion of syntocinon has antidiuretic effects, which may cause transient water intoxica-tion, with headaches and nausea.


Inj: 5 iu / mlInduction or enhancement of labour: IV drip infusion of a 5% dextrose solution containing 1iu syntocinon per 100 ml. The initial infusions rate of 1-4mU/ min=0.1-0.4ml/min )2-8 drops/min) may be gradually increased until the desired response is achieved (maximum 20mU/min = 2ml/min = 40 drops/min) provided the foetal heart rate and the frequency and duration of contraction are carefully monitored.

Third stage of labour and purpureum (hemorrhage, subinvolution of the uterus):5-10iu IM or 5iu slowly IV.

Caesarean Section: 5iu intramurally after delivery of the foetus.


85

GYNAECOLOGICAL

DRUGS

14- ANTI ALLERGIC DRUGS

14.1 ADRENALINEINDICATIONS

Emergency treatment of acute anaphylaxis; cardiopulmonary resuscitation.

CONTRA-INDICATIONS

Hyperthyroidism, diabetes mellitus, ischemic heart disease, hypertension, elderly patients.

ADVERSE EFFECTS

Anxiety, tremor, tachycardia, arrhythmias, dry mouth, cold extremi-ties.


Inj: 1 in 1000/mlAcute anaphylaxis, by intramuscular injection, see table belowImportant: intravenous route is for cardiac resuscitation.

These dose may be repeated every 10 minutes, according to blood pressure and pulse, until improvement occurs (may be repeated several times). Volume of adrenaline injection 1 in 1000 (1mg/ml) for intramuscular injection in anaphylactic shock.

Age Volume of Adrenaline 1 in 1000Under 1 Year 0.05 mL1 Year 0.1 mL

12 Years 0.2 mL13-4 Years 0.3 mL15 Years 0.4 mL16-12 Years 0.5 mL

1Adults 0.5-1 mL

14.2 CHLOROPHENIRAMINE MALEATEINDICATIONS

Symptomatic relief of allergy such as hay fever, urticaria; emer-


86

ANTI

ALLERGIC

DRUGS

gency treatment of anaphylactic reactions.

CONTRA-INDICATIONS

CNS depression, hypersensitivity to Chlopheniramine Maleate driving.

ADVERSE EFFECTS

Drowsiness, impaired reactions Dizziness.


Tab: 4 mg

Adults;

By mouth, 4mg every 4-6 hours, maximum 24 mg daily.

Children 1-2 Years; 1 mg twice daily.6-12 years; 2mg every 4-6 hours, maximum 12 mg

daily.By slow intravenous injection over 1 minutes, 10-20mg, diluted in syring with 5-10 ml blood.

Available as:

Avil, Flueze, Coldene

14.3 PROMETHAZINE HCLINDICATIONS

Allergic conditions

CONTRA-INDICATIONS

Hypersensitivity to promethazine HCL, driving.

ADVERSE EFFECTS

Drowsiness, impaired reactions. Dizziness, disorientation, photosensitivity, Extra pyramidal reactions, convulsions (high doses)


Syp: 5mg/5ml


87

ANTI

ALLERGIC

DRUGS

Elixir/ Tabs.

Adults; 10-20mg two or three times daily.

Children under 1 years; Not recommended.1-5 years; 5-15mg.Over 5 years; 10-25mg. If two doses in 24

hours are required, use lower amount stated.

Adults; 25-50mg by deep IM inj or slow

IV inj after dilution.Children under 5 years; Not recommended.Over 5 years; 6.25-12.5mg by deep IM inj.

Available as:

Phenergan, Tixylix

14.4 CETRIZINEINDICATIONS

Allergic conditions

CONTRA-INDICATIONS

BPH, Glaucoma, Pyloroduodenal obstruction.

ADVERSE EFFECTS

Drowsiness, impaired reactions. Dizziness, disorientation, photosensitivity, Extra pyramidal reactions, convulsions (high doses), Urinary retention, Blurred vision.


5-10mg twice daily.

Available as:

Zyrtec, Rigix, Serzine


88

ANTI

ALLERGIC

DRUGS

14.5 LORATIDINEINDICATIONS

Allergic conditions, hay fever, urticaria.

CONTRA-INDICATIONS


ADVERSE EFFECTS



5-10mg twice daily.

Available as:

Antial, Allergat, Xalar, Lorate

14.6 CLEMASTINEINDICATIONS

Allergic conditions, hay fever, urticaria.

CONTRA-INDICATIONS


ADVERSE EFFECTS



1mg twice daily (Maximum 6mg daily)

Available as:

Alereas, Tandegyl


89

ANTI

ALLERGIC

DRUGS

15- INTRAVENOUS FLUIDS


90

BRAND NAME GENERIC NAMEElectrolytes (mEq/Liter)

+Na +K ++Mg Cr Lactate++Ca

Dextrose(as monohydrate)

(gms/L)

Ringolact

Ringolact-D

Ringolact-M

Pladex-5

Plasaline

Pladex-10

25% Dextrose injection

Pladexsal

Pladexsal 1/2

Pladexsal 1/3

Pladexsal 1/5

Nisf Normal Saline

Ringer`s Solution

Osmotol

Darrow`s Solution

Peri Solution

Located Ringer`s Injection

5% Dextrose and electrolytes injection

5% Dextrose and Electrolytes Injection

5% Dextrose Intravenous Infusion

0.9% Sodium ChlorideIntravenous Infusion

(Normal Saline)

10% Dextrose Injection Infusion

25% Dextrose Injection

5% Dextrose and 0.45% Sodium

Chloride Injection

5% Dextrose and 0.45% Sodium

Chloride Injection

3.3% Dextrose and 0.3 Sodium

Chloride Injection

0.18% Sodium Choride and 4.3% Dextrose

Intravenous Infustion

0.45% Sodium Choride Injection

Composed SodiumChloride Injection

20% Mannitol Intravenous Infusion

Lactated Potassic Saline Injection

Peritoneal DialysisSolution

130

130

60

–

150

–

–

154

77

51

30

77

147

–

121

140

4

4

20

–

–

–

–

–

–

–

–

–

4

–

35

--

2.7

2.7

3

–

–

–

–

–

–

–

–

–

4.4

–

-

4

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

1.5

108.7

108.7

60

–

150

–

–

154

77

51

30

77

156

–

103

102

28

28

23

–

–

–

–

–

–

–

–

—

–

–

53

43.5

–

50

55

55

–

110

275

50

50

33

47

–

–

–

–

16

INTRAVENOUS

FLUIDS

15.1 POLYGELLINEINDICATIONS

Blood loss, plasma loss, dehydration, hypovlaemic shock, volume losses during and after surgery, extra corporeal circulation, hematolysis, dehydration circulation states, for use in heart-lung-machines, for perfusion of isolated organs, plasma exchange, intra operative hemodilution. Carrier for low dose insulin infusion.

CONTRA-INDICATIONS

No absolute contra-indications is known.In presence of relative contra-indications (e.g cardiac insufficiency, fixed hypertension, cardiogenic shock) infusion should be per-formed under proper supervision.

ADVERSE EFFECTS

Wheal, transitory urticaria, skin reactions, temporary hypotension, raised temperature and or shivering may occur.


Inj 35mg with electrolytes bag of 500ml with set. As per doctor’s advise. 50ml to be infused in one hour. In emer-gency cases where immediate volume replacement is needed polygeline can be infused rapidly.


91

INTRAVENOUS

FLUIDS

16- VITAMINS AND MINERALS

16.1 ASCORBIC ACIDINDICATIONS

Vitamin C deficiency, prevention and treatment of scurvy.


Tab: 50mg

Prophylactic;

25-75 mg daily.

Therapeutic;

Not less than 250mg daily individed doses.

16.2 CALCIUM GLUCONATE.INDICATIONS

Calcium deficiency, pregnancy and lactation.

CONTRA-INDICATIONS

Conditions associated with Hypercalcaemiaandypercalciuria.

ADVERSE EFFECTS

Mild gastro- intestinal disturbances; bradycardia, arrhythmias, and irritation after intravenous injection.


Tab: 100mg

Adults;

By mouth, daily in divided doses, as calcium gluconate or latate. By deep intramuscular injection or by slow intravenous injection.

Acute.Hpocalcaemia.Calcium gluconate 1-2g.Children;

Obtain paediatric advice; intramuscular route not recommended.


92

VITAMINS

AND

MINERALS

16.3 CALCIUM LACTATEINDICATIONS

Calcium deficiency, pregnancy and lactation.

CONTRA-INDICATIONS

Conditions associated with hypercalcaemiaandhypercalciuria.

ADVERSE EFFECTS

Mild Gastro-intestinal disturbances; bradycardia, arrhythmias, and irritation after intravenous injection.


Tab: 300mg

Adults;

By mouth, daily in divided doses, as calcium gluconate or lactate. By deep intramuscular injection or by slow intravenous injection,

acute hypocalcaemia, calcium gluconate 1-2g.

Children;

Obtain paediatric advice; intramuscular route not recommended.

16.4 VITAMIN COMPLEXINDICATIONS

Neuralgia and neuritis of toxic and non-toxic origin.

DOSAGE, FORM & STRENGTHTab/Inj

Adults;1 inj daily or no alternate days. 3 tabs daily.

VITAMINS AND HEMATINICS

16.5 FERROUS GLUCONATEINDICATIONS

Iron deficiency anaemia.


93

VITAMINS

AND

MINERALS

VITAMINS

AND

MINERALS


Syp: 300mg/5ml

Prophylactic;

2 tabs daily before food.

Therapeutic;

4-6 tabs daily in divided doses before food.

Children6-12 years;

Prophylactic and therapeutic, 1-3 tabs daily.

16.6 FERROUS SULPHATEINDICATIONS

Iron deficiency anaemia.


Tab: 150mgFerrus iron.

Therapeutic;

120-180 daily in divided doses.

Prophylactic;

69mg daily.

Children;

Therapeutic, daily in divided doses.

Upto 1 year; 36mg.1-5 years; 72mg.Under 1 year; 6-12mg.

16.7 FOLIC ACIDINDICATIONS

Megaloblastic anaemia due to folic acid deficiency.

CONTRA-INDICATIONS

Megaloblastic anaemia due to vitamin B12 deficiency.


94

VITAMINS

AND

MINERALS

ADVERSE EFFECTS

Nausea, constipation.

DOSAGE, FROM & STRENGTH

Tab: 5mg

Adults;

Initially 10-20mg daily for 14 days then 5-10mg daily.

16.8 B COMPLEXINDICATIONS

Multi-vitamin supplement for infants.


Syp: vit B1 3mg, Vit B2 3mg, pyridoxine 2mg nicotinamide 23mg/5ml.

Adults; 1-2 tsp daily.Children; 1tsp daily.


95

VITAMINS

AND

MINERALS

17- ANTI DIABETIC DRUGS

17.1 GLIBENCLAMIDEINDICATIONS

Diabetes mellitus

CONTRA-INDICATIONS

Juvenile diabetes with ketosis; impairment of renal function; stress; pregnancy’ diabetic coma.

ADVERSE EFFECTS

Nausea and sensation of fullness are exceptional. Changes in haemopoietic systemic are rare.

DOSAGE, FORM & STRENGTHTablet,

Initially 5mg daily (elderly patients 2.5mg), adjusted according to response; maximum 15mg daily; taken with breakfast.

17.2 GLICLAZIDEINDICATIONS

Diabetes mellitus.

CONTRA-INDICATIONS

Juvenile diabetes with ketosis; impairment of renal function; stress; pregnancy; diabetic coma.

ADVERSE EFFECTS

Nausea and sensation of fullness are exceptional. Change in haemopoietic system are rare.


Initially, 40-80mg daily, adjusted according to response; up to 160mg as a single dose, with breakfast; higher doses divided; maximum 320mg daily.


96

ANTI

DIABETIC

DRIGS

17.3 METFORMIN HYDROCHLORIDE

INDICATIONS

Diabetes mellitus.

CONTRA-INDICATIONS

Hepatic or renal impairment (withdraw if renal impairment sus-pected), predisposition to lactic acidosis, heart failure, severe infection or trauma, dehydration, alcohol dependence; preg-nancy, breast-feeding.

ADVERSE EFFECTS

Anorexia, nausea, vomiting, diarrhoea (usually transient), lactic acidosis (withdraw treatment), decreased vitamin B12 absorption.


500 mg every 8 hours or 850 mg every 12 hours with or after food; maximum 3g daily in divided doses though most physicians limit this to 2 g daily.


97

ANTI

DIABETIC

DRIGS

18- VACCINES

18.1 TETANUS TOXOIDINDICATIONS

Tetanus vaccines stimulate the production of the protective anti-toxin.


Inj: 0.5 ml0.5 mL or as stated on the label, by intramuscular or deep subcuta-neous injection followed after 4 weeks by a second dose and after a further 4 weeks by a third dose.

18.2 HEPATITIS B VACCINEINDICATIONS

Active immunization against hepatitis B virus.

CONTRA-INDICATIONS

Severe febrile infections.

ADVERSE EFFECTS

Mild transient local soreness, erythema and induration at inj site, low grade fever, malaise, nausea, dizziness.


Inj: 0.5mg/1 ml

Adults & Children;

1 dose by IM inj, into the deltoid muscle, repeated 1 month and 6 month later.

18.3 RABIES VACCINESINDICATIONS

Prophylaxis and therapy to rabies.


Inj: 50mg in vial, By SC or IM route.


98

VACCINES

Prophylaxis;

Day-1 1 dose.st

Day 7 2 dose.nd

Day 28 3 dose.rd

Booster after one year then every three years.

Therapeutic;

In non-vaccinated subjects.Day-1 1 dose.st

Day 3 2 dose.nd

Day 14 3 dose.rd

Day 28 4 dose.th

Day 30 5 dose.th

Day 90 6 dose.th

(Optional)

18.4 ANTI SNAKE VENOMINDICATIONS

The snake bite may cause local systemic effects. Local effects include pain, swelling, bruising and tender enlargement of regional lymph nodes. Systemic effects include early transient hypotension with syncope, angioedema, abdominal colic, diarrhoea, and vomiting with later persistent or recurrent hypotension. ECG abnormalities, spontaneous systemic bleeding, coagulopathy, adult respiratory distress syndrome, and acute renal failure.

DOSAGE, FORM &B STRENGTH

Inj: 10ml in vial.The anti snake venum diluted with 2-3 volumes of sodium chloride intravenous infusions 0.9% and given by slow intravenous injection (not more than 2ml of diluted anti venom per minute) or by intrave-nous infusion. The same dose should be used for adults and children. The dose can be repeated in 1-2 hours if there is no clinical improvement. Adrenaline injection must be kept for treatment of anaphylactic anti venum injection.


99

VACCINES

19- ENT PREPARATIONS

19.1 POLYMYXIN B SULPHATEINDICATIONS

For the treatment of inflammatory otitis externa due to, or compli-cated by, bacterial infection.


10,000 u/ml

Adults;

3 drops 3 or 4 times daily into affected ear.

Children;

1 or 2 drops 3 or 4 times daily into affected ear.

19.2 POLYMYXIN B SULPHATE + LIGNOCAINE HCLINDICATIONS

For the symptomatic relief and treatment of otitis extrena.


10,00 u + 50mg/ml

Adults;

3 drops 3 or 4 times daily into affected ear.

Children;

1 or 2 drops 3 or 4 times daily into affected ear.

19.3 SODA GLYCERINDOSAGE, FORM & STRENGTH

Drops 2-5%

19.4 POLYMYXIN B SULPHATE + HYDROCORTISONE ACETATE + NEOMYCIN SULPHATE

INDICATIONS

For the treatment of inflammatory otitis externa due to, or compli-cated by, bacterial infection.


100

ENT

PREPRATIONS


5mg/ml + 10mg/ml + 5mg/ml

Adults; 3 drops 3 or 4 times daily into affected ear.Children; 1 or 2 drops 3 or 4 times daily into

affected ear.


101

ENT

PREPRATIONS

20- METABOLIC AGENTS

20.1 ALLOPURINOLZYLORIC 100mg, 300mg

INDICATIONSAllopurinol is indicated for reducing urate. Uric acid formation in conditions where urate/uric acid deposition has already occurred (e.g. gouty arthritis, skin tophi, nephrolithiasis) or in a predictable clinical risk (e.g. treatment of malignancy potentially leading to zinc acid nephropathy).

CONTRA- INDICATIONNot a treatment for acute gout but continue if attack develops when already receiving allopurinol, and treat attack separately.

ADVERSE- EFFECTRashes (withdraw therapy; if rash mild, re-introduce cautiously but discontinue immediately if recurrence occurs).Skin reactions associated with exfoliation, fever, lymphadenopthy, arthralgia, and or eosinophilia, resembling Stevens-Johnson or Lyell’s Syndrome, occur rarely.Gastro-intestinal disorders.Rarely malaise, headache, vertigo, drowsiness, taste disturbances, hypertension, symptomless xanthine deposits in muscle, alopecia, hepatotoxicity, paraesthesia and neuropathy.

DOSAGE, FROM & STRENGTHTab: 100mg, 300mg

Children;In neoplastic conditions, enzyme disorders 10-20 mg/kg daily.


102

METABOLIC

AGENTS

21- ANTI-EPILEPTICS

21.1 CARBAMAZEPINEINDICATIONS

Anti-Epileptics, Mood Stabilizer, Analgesic, Prophylaxis of maniac depressive psychosis unresponsive to lithium. Generalized tonic clonic and partial seizures, diabetic neuropathy. Trigeminal neuralgia.

CONTRA-INDICATIONS

A-V conduction abnormalities unless paced. Lactation.

ADVERSE EFFECTS

Vertigo, Ataxia, Gastric upset, diplopia, dry mouth, drowsiness & dizziness. Oedema & rarely hyponatraemia. Blood dyscrasias, rashes, toxic epidermal necrolysis, hair loss. Acute renal failure. Lymph-node enlargement, cardiac conduction disturbances, hepatitis, and cholestatic jaundice.

DOSAGE, FORM & STRENGTHAdults & Children;

100-200mg O.D / B.DMaximum Dose 2000mg DailyChildren

upto 1 Year: 100-200mg.1-5 Year: 200-400mg.5-10 Year: 400-600mg.10-15 Year: 600mg-1gm.All daily in divided doses.

Available as:

Epilex, Seizunil, Tegral, Epitab Xr, Carbanil

21.2 DIAZEPAMBenzodiazepene long acting


103

ANTI

EPILEPTICS

INDICATIONS

Short-term use in anxiety or insomnia, adjunct in acute alcohol with drawl; status epileptics, muscle spasm, peri-operative.

CONTRA-INDICATIONS

Respiratory depression; acute pulmonary insufficiency: not for phobic or obsessional states, chronic psychosis; porphyria.

ADVERSE EFFECT

Drowsiness and lightheadedness the next day; confusion and atexia (especially in the elderly); amnesia may occur; dependence.Occasionally; headache, vertigo, hypotension, salivation changes, gastro-intestinal disturbances, rashes , visual distur-bances, changes in libido urinary retention.Blood disorders and jaundice reported.On intravenous injection: pain, thromobophlebitis, and rarely apnoea or hypotension.


By mouth: Anxiety 2mg - 3 times daily, increased if necessary, to 15-30 mg daily in divided dose.

Elderly or debilitated;

Half adult dose, Insomnia associated with anxiety, 5-15mg at bedtime.

Children;

Night terrors and somnambulism, 1-2 mg at bedtime.By intramus-

cular injection or slow intravenous injection (into a large vein, at a rate of not more than 5 mg/minute), for severe anxiety, control of

acute panic attacks, and acute alcohol withdrawal, 10mg, repeated if necessary after 4 hours. By rectum: as rectal solution, for acute anxiety and agitation.

Adult and children over 3 Years;

10 mg(elderly 5 mg), repeated; after 5 minutes if necessary.


104

ANTI

EPILEPTICS

Children 1-3 Year; 5mg.

Available as:

Valium, Cerelium, Diazepam, Relax, Relaxipam

21.3 PHENYTOIN SODIUMINDICATIONS

Status epilepticus; seizures in neuro-surgery; arrhythmias.

CONTRA-INDICATION

Sinus bardycardia, sino-atrial block, and second third degree heart block; stokes-adams sydrome; prophyria.

ADVERSE EFFECTS

Gum atrophy, Blood disorders, Intravenous injection may cause cardiovascular and CNS depression (particularly if injection too rapid) with arrhythmias, hypo tension, and cardiovascular col-lapse; alterations, in respiratory function (including respiratory arrest.)


150-500mg / Day in 1-2 doses orally.15mg / kg intravenous at 50mcg / min.

Adults;

By slow intravenous injection (with blood pressure and ECG monitoring), status epileptic us, 15mg/kg at a rate not exceeding 50mg per minute, as a loading dose.Maintenance doses of about 100mg should be given thereafter at intervals of every 6 hours, monitored by measurement of plasma concentration; rate and dose reduced according to weight. Instramuscular injection not recommended.

Available as:

Dihydan, Dilantin, Epitoin, Fentin, Phenton-s


105

ANTI

EPILEPTICS

21.4 SODIUM VALPROATEINDICATIONS

Anti-epileptics, Mood stabilizer

CONTRA-INDICATIONS

Hepatic dysfunction, Porphyrias

ADVERSE EFFECT

Sedation, Weight gain, hair loss, oedema, pancreatitis, hepatic failure, hyperammonaemia, thrombocytopenia, neurological effects.


300mg B.D orally.Usual maintenance, 1-2 gm daily. Maximum 2.5 gm daily.

Available as:

Dapakan, Epilim, Epival, Malprate, Orifral, Valep, Valpro, Valprox


106

ANTI

EPILEPTICS

22- ANAESTHETICS

INHALATIONAL ANAESTHETICS

22.1 ENFLURANE Enflurane is a volatile anaesthetic similar to halothane, but is less potent, about twice the concentration being necessary for induc-tion and maintenance

INDICATIONS

Enflurane is usually given to supplement nitrous oxide-oxygen mixtures and may be given in preference to halothane when repeated anaesthesia is required.

CONTRA-INDICATIONS

Avoid in porphyria ADVERSE EFFECTS

Enflurance is a powerful cardio respiratory depressant. Shallow respiration is likely to result in a rise of arterial carbon dioxide tension, but ventricular arrhythmias are uncommon. It is probably safe to use adrenaline infiltrations. Myocardial depression may result in fall in cardiac output and in arterial hypotension.


Inhalation fluid: Using a specifically calibrated vaporizer, induc-tion, increased gradually from 0.4% to maximum of 4.5% in air, oxygen, or nitrous oxide-oxygen, according to response.

22.2 ISOFLURANEIsoflurane is an isomer of enflurane. It has a potency intermediate between that of halothane and enflurene.Heart rhythm is gradually stable during rate may rise, particularly in younger patients. Systemic arterial pressure may fall, due to decreases in systemic vascular and with less decrease in cardiac output than occurs with halothane.


107

ANAESTHETICS

Respiration is depressed. Muscle relaxation is produced and muscle relaxant drugs potentiated.

INDICATIONS

Isoflurane is used for induction and maintenance of anaesthesia.

CONTRA-INDICATIONS

Contra-indicated in patients, hypersensitivity to Isoflurane.

ADVERSE EFFECTS

Cardio-respiratory depression, bradycardia, ventricular arrhyth-mia.


Inhalation: Using a specficially calibrated vaporizer, induction, increased gradually from 0.5% to 3% in oxygen or nitrous oxide-oxygen ; an additional 0.5-1% may be required when given with oxygen alone; caesarean section, 0.5-0.7% in nitrous oxide-oxygen.

Children; 1.5-2%Maintenance; 0.5-2%.

INTRAVENOUS ANAESTHETICS

22.3 KETAMINEINDICATIONS

Induction & maintenance of anaesthesia. It is mainly used for paediatric anaesthesia. Particularly when repeated administrations are required.

CONTRA-INDICATIONS

Ketamine is contraindicated in patients with hypertentsion and is best avoided in those prone to hallucinations.

ADVERSE EFFECTS

There is cardiovascular stimulation and arterial pressure may rise with tachycardia.


108

ANAESTHETICS

High incidence of hallucinations. Recovery is relatively slow.


Inj: 50mg/ml in 10 ml vial (base)Intramuscular injection: short procedures, initially 6.5-13 mg/kg (10mg/kg usually produces12-25minutes of surgical anaesthe-sia). Diagnostic maneuvers and procedure not involving intense pain, initially 4 mg/kg. Intravenous injection: over at least 60 seconds. Short procedures, initially 1-4.5 mg/kg usually produces 5-10 minutes of surgical anaesthesia.Intravenous infusion: of a solution containing 1 mg/ml. Longer procedures & induction. Total drip infusion 10-45 micro-grams/kg/minute, rate adjusted according to response.

22.4 THIOPENTAL SODIUMThiopental sodium is an ultrashort-acting depressant of the central nervous system which induces hypnosis and anaesthesia, but notanalgesia. It produces hypnosis within 30-40 seconds of intravenous injection. Recovery after a small dose is rapid, with after a small dose is rapid. With some somnolence and retrograde amnesia.

INDICATIONS

Thiopental sodium is indicatedAs the sole anesthetic for brief(15 minutes) procedure, For induction of anesthesia prior to administration of other anes-thetic agents.To supplement regional anesthesia.

To provide hypnosis during balanced anesthesia with other agents for analgesia or muscle relaxation.For the control of convulsive states during or following inhalation anesthesia, local anesthesia, or other cause. In neurosurgical patients with increased intra cranial pressure, if


109

ANAESTHETICS

adequate ventilation is provided, and For narcoanalysis and narcosynthesis in psychiatric disorders.

CONTRA-INDICATIONS

Absolute contra-indications are;Absence of suitable veins for intravenous administration.Hypersensitivity (allergy) to barbiturates.Status asthmaticus.Latent or manifest porphyria.

Relative contra-indications are;Severe cardiovascular diseases. Hypotension or shockConditions in which the hypnotic effect may be prolonged or potentiated, excessive premeditation, Addison’s diseases, hepatic or renal dysfunction , myxedema, increased blood urea, severe anemia, asthma and myasthenia gravis.

ADVERSE EFFECTS

Care should be taken in administering the drug to patients with advanced cardiac disease, increased intra cranial pressure.Asthma. Mythenia gravis. Endocrine insufficiently (pituitary, thyroid. Adrenal, pancreas). Respiratory depression which may result from either unusual responsiveness to thiopental.Laryngospasm may occur with light thiopental sodium.Narcosis at intubation, or in the absence of intubation, if foreign matter of secretions in the respiratory tract create irritation. Myocardial depression may occur with thiopental sodium.


Inj: 500mg.Intravenous injection: in fit and pre-medicated adults, initially 100- 150 mg (4-6 ml of 2.5% solution)over 10-15 seconds, repeated if necessary according to response after 20-30 seconds; or up to 4 mg/kg


110

ANAESTHETICS

Children; Induction 2-7 mg/kg.

Available as:

Pentathal

22.5 PROPOFOLShort acting anaesthetic

INDICATIONS

Intravenous anaesthesia

ADVERSE EFFECT

Flushing, Transient apnoea, Thrombosis, Phlebitis

CONTRA INDICATION

Pregnancy, Breast Feeding

Dose;

1.5-2.5mg/kg @ of 20-40mg every 10 seconds

Available as:

Diprivan, Fresofol, Pofol, Propofol, Recofol

LOCAL ANAESTHETICS

22.6 LIDOCAINE HYDROCHLORIDEShort acting and quick onset

INDICATIONS

Topical anaesthesia, infilteration anaesthesia, intravenous regional anaesthesia

CONTRA INDICATIONS

Hypovolaemia.Complete heart block.Avoid in porphyria.Do not use solutions containing adrenaline for anaesthesia in


111

ANAESTHETICS

appendages.

ADVERSE EFFECTS

Hypotension. Bradycardia.Cardiac arrest.CNS effects include agitation, euphoria, respiratory depression, convulsions.


Inj: 1%, 2% in vial, Inj. 1%, 2% + Epinephrine, 1:100,000,1:200,000 in vial. 2-4% Dental cartridge 2% +Epinephrine 1:80,000 Gel 5%.

Infiltration Anaesthesia:

0.25 -0.5% with adrenaline 1 in 200000, using 2-50 ml of a 0.5% solution in minor surgery and up to 60ml for extensive surgery.

Nerve Blocks:

With adrenaline 1 in 200000, 1% to a maximum of 50 ml,2% to a maximum of 25 ml. Epidural and Caudal block,

With adrenaline 1 in 200000, 1% to a maximum of 50 ml, 2% to a maximum of 25 ml.

Surface Anaesthesia,

Usual strengths 2-4%. Mouth throat , and upper gastro-intestinal tract, maximum 200 mg.

22.7 BUPIVICAINELong acting and slow onset

INDICATIONS

Topical anaesthesia, infilteration anaesthesia, intravenous regional anaesthesia, Spinal anaesthesia, epidural anaesthesia


112

ANAESTHETICS

CONTRA INDICATIONS

Hypovolaemia.Complete heart block.Avoid in porphyria.Do not use solutions containing adrenaline for anaesthesia in appendages.

ADVERSE EFFECTS

Hypotension. Bradycardia.Cardiac arrest.CNS effects include agitation, euphoria, respiratory depression, convulsions.


0.5% 20ml, 5mg/ml for spinal anaesthesia.

How to calculate safe dose of local anaesthestics


113

ANAESTHETICS

Drug concentration is expressed as percentage

Percentage is measured as per 100ml

Lignocaine 1% 10mg/ml

20mg/ml Lignocaine 2%

2.5mg/ml Bupivicaine 0.25%

Drug Maximum Dosewithout adrenaline

Maximum Dosewith adrenaline

Lignocaine 300mg 500mg

Bupivicaine 150mg 300mg

ANTICHOLINERGICS

22.8 NEOSTIGMINE METHYLSULPHATEINDICATIONS

Neostigmine is useful in the therapy of pathological muscle weakness caused by myasthenia gravis, hemiplegia and monoplegia. Atonic constipation especially postoperative intesti-nal atony and urinary retention, paroxysmal tachycardia. Neostigmine antagonizes effects of synthetic curare like drugs.

CONTRA-INDICATIONS

Mechanical, intestinal or urinary obstructions. History of sensitivity to the drug.

ADVERSE EFFECTS

Side effects are most commonly related to over dosage.Muscarinic effects: nausea, vomiting, diarrhea, increased saliva-tion, abdominal cramps, fasciculation, weakness.


Inj: 05mg or 2.5mg/ml in amp. of 1 ml. Myasthenia gravis: 1.0-3.0 mg S/C or I/M daily.Postoperative intestinal atony or urinary retention: 0.25 mg S/C or I/M prophylactically immediately after operation, repeatedly after 4 t0 6 hours.Paroxysmal tachycardia: 0.5-1.0 mg S/C or I/M.

Hemiplegia , Monoplegia: 0.5-1.0 mg S/C or I/M followed by a glycerine suppository or saline enema. Flatulence of pregnancy: 0.5 mg S/C or I/M every 5 to 10 days.

NEUROMUSCULAR BLOCKING AGENTS

22.9 ATRACURIUM BESYLATEINDICATIONS

A muscle relaxation for a wide range of procedures and to facilitate controlled ventilation. For endo-tracheal intubation where subse-


114

ANAESTHETICS

quent muscle relaxation is required.

CONTRA-INDICATIONS

Hypersensitivity to atracurium besylate.

ADVERSE EFFECTS

Tracrium should be administrated only with adequate general anaesthesia and under the close supervision of an experienced anaesthetist and with adequate facilities for endotracheat intubation and artificial ventilation.


Inj: 10mg/ml.Over one minute, 0.3-0.6 mg/kg depending on the duration of full block required. This dosage provides relaxation for15-35 minutes.Full block can be prolonged with supplementary doses of 0.1-0.2 mg/kg as required.

Endotracheal intubation can usually be accomplished within 90 sec, from the IV inj. Of 0.5-0.6 mg/kg. As an infusion: After initial bolus dose of 0.3-0.6 mg/kg. Neuromuscular block can be maintained by administration as a continuos infusion at rates so 0.3-0.6 mg/kg hour.

22.10 PANCURONIUM BROMIDE INDICATIONS

As an adjuvant in adult/child surgical anaesthesia to obtain surgical relaxation so that operative manipulations are facilitated.

CONTRAINDICATIONS

Moderate rise of mean arterial pressure may occur. Pancuronium decreases intra ocular pressure and induces meiosis. A few cases of reactions at the site of injection have been reported.


Inj: 2mg/kg, Intravenous injection: Initially for intubation 50-100 micro-grams/kg then 10-20 micrograms/kg as required.


115

ANAESTHETICS

Children;

Initially 60-100 micrograms/kg, then 10-20 micrograms/kg. Neonate;

30-40 micrograms/kg initially then 10-20 micrograms/kg. Intensive care, by intravenous injection, 60 micrograms/kg every 60-90 minutes.

22.11 SUXAMETHONIUM CHLORIDEINDICATIONS

Endotracheal intubation.Short surgical interventions, especially in the abdomen, setting of fractures and dislocations, bronchoscopy, cytoscopy, etc .), gynaecological examination and interventions in obstetrics & electroconvulsive therapy. Intravenous drip for prolonged muscle relaxation in abdominal surgery.

CONTRA INDICATIONS

Severe hepatic functional disorders.Pulmonary oedema.

ADVERSE EFFECTS

Prolonged muscle paralysis may occur in patients with low or a typical plasma pseudocholinesterase enzymes. Prolonged paralysis also occur in dural block, which occur after repeated doses of suxamethonium and is caused by developing of a non-depolarizing block following the primary depolarizing block. DOSAGE, FORM & STRENGTH

Inj: 50mg/kg.Administration preferably by I/V inj; in special circumstances also I/M inj.

Drip infusion for continuous muscle relaxation.Combination with all the usual anaesthesia agents is possible. Dosage according to desired degree of muscle relaxation. Dose of 0.1-0.2 mg/kg body wt usually produce muscle relaxation for 1-3 minutes without interfering with respiration.


116

ANAESTHETICS

BENDROFLUAZIDE 73A BENZYLPENICILIN 10ACETAZOLAMIDE 83 BETAXOLOL HCL 86ADRENALINE 89 BUPIVICAINE 118ALBENDAZOLE 33ALLOPURINOL 107AMINOPHYLINE 74 CAMLODIPINE 68

CALCIUM GLUCONATE 96AMOXICILLIN 11

CALCIUM LACTATE 97AMPICILLIN 11

CAPTOPRIL 59AMINOPHYLINE SYP 80

CARBAMAZEPINE 108AMMONIUM CHLORIDE SYP 80

CARDIOVASCULAR DRUGS 58ANAESTHETICS 112

CEFACLOR 15ANALGESIC (OPIOID) 7

CEFOTAXIME SODIUM 18ANALGESICS (NON OPIOID) 1

CEFTAZIDIME SODIUM 16ANTI ALLERGIC DRUGS 89

CEFTRIAXONE 17ANTI BACTERIALS 10

CEFUROXIME 16ANTI COAGULANTS 69

CEPHALEXIN 13ANTI DIABETIC DRUGS 100

CEPHRADINE 14ANTI EMETICS 50

CETRIZINE 91ANTI EPILEPTICS 108

CHLORAMPHENICOL+HYD-ANTI FUNGAL DRUGS 31

ROCORTISONE ACETATE 85ANTI HELMINTHICS 33

CHLORAMPHENICOL 29ANTI PROTOZAL DRUGS 42

CHLORAMPHENICOL 82ANTI SNAKE VENOM 103

CHLOROPHENIRAMINE ANTI SPASMODICS 54

MALEATE 90ANTI TUBERCULOUS DRUGS 37

CHLOROQUINE PHOSPHATE 42ANTICHOLINERGICS 119

CIMETIDINE 46ANTIGLAUCOMA DRUGS

CIPROFLOXACIN 19ANTIULCER DRUGS 45

CLEMASTINE 92ARTHEMETHER WITH

CLOPIDROGREL 70LUMEFANTRINE 44

CLOTRIMAZOLEX 31ASCORBIC ACID 96

CO-AMOXICLAV 13ATENOLOL 58

CODIENE PHOSPHATE 7ATRACURIUM BESYLATE 120

CO-TRIMOXAZOLE 28ATROPINE SULPHATE 54, 84

CYCLIZINE 50

DBDEXAMETHASONE 78

B COMPLEX 99DIAGNOSTIC AGENTS

BECLOMETHSONE 77


116

INDEX

23- INDEX

116

INDEX

DIAZEPAM 109 HDICLOFENAC SODIUM 3HEMATINICS 98DIGOXIN 60HEPARIN 69DILTIAZEM 60HOMATROPINE HYDRO DIMENHYDRINATEX 51BROMIDE 84DIURETICS 71HYDROCORTISONE SODIUM DOBUTAMINE HCL 61SUCCINATE 78DOMPERIDONE 55HYOSCINE 55DOPAMINE HCL 61

DOXYCYCLINE

IE IBUPROFFEN 4

INDOMETHACIN 5ENALAPRIL MALEATE 62INTRAVENOUS ENFLURANE 112ANAESTHETICS 113ENT DRUGS 105INTRAVENOUS FLUIDS 94EPHEDRINE HCL 74IPRATROPIUM 77ERYTHOMYCIN 23ISOFLURANE 112ETHAMBUTOL 37ISONIAZID 37EXPECTORANTS AND ISOSORBIDE DINTRATE 63COUGH SYRUPS 80

KFKAOLIN PECTIN 49FERROUS GLUCONATE 98KETAMINE 113FERROUS SULPHATE 98

FLUCLOXACILLIN 12FLUORESCEIN SODIUM 87 LFOLIC ACID 99

LEVAMISOLE HCL 33FUROSEMIDE 71LEVOFLOXACIN 21LIDOCAINE HCL 116LINCOMYCIN 25

G LOCAL ANAESTHETICS 116LOPERAMIDE HCL 49GASTRO INTESTINAL DURGS 45LORATIDINE 92GENTAMICIN 24

GENTAMICIN 82GLIBENCLAMIDE 100 MGLICLAZIDE 100

MAGNESIUM TRISILICATE 45GLYCERYL TRINITRATEX 63MANNITOL 72GRISEOFULVIN 31MEBENDAZOLE 34GYNAECOLOGICAL DRUGS 88MEBEVERINE 56


MEFENAMIC ACID 2 PILOCARPINE NITRATE 84METABOLIC AGENTS 107 PIROXICAM 6METFORMIN 101 POLYGELLINE 95METHYDOPA 64 POLYMYXIN B SULPHATE + METROCLOPRAMIDE HCL 52 HYDROCORTISONE ACETATE + METRONIDAZOLE 26 NEOMYCIN SULPHATE 106MIOTICS 83 POLYMYXIN B SULPHATE + MORPHINE SULPHATE 8 LIGNOCAINE HCL 105MYDRIATIC DRUGS 84 POLYMYXIN B SULPHATE 105MYRIN P 41 PREDNISOLONE 79MYRIN 41 PROCHLORPERAZINE 53

PROMETHAZINE HCL 90PROPOFOL 116PROPRANOLOL HCL 66N PYRANTEL PAMOATE 35

NALIDIXIC ACID 21 PYRAZINAMIDE 38NAPROXEN 6 PYRIMETHAMINE WITH NEOSTIGMINE SULFADOXINE 42METHYLSULPHATE 119NEUROMUSCULAR BLOCKING AGENTS 120

RNIFEDIPINE 65NORFLOXACIN 22 RABIES VACCINES 102NYSTATIN 32 RANITIDINE 47

RESPIRATORY DRUGS 74RIFAMPICIN 39

OO R S 56

SOFLOXACIN 20OMEPRAZOLE 48 SALBUTAMOL 75ONDANSETRON 53 SALMETROL 76OPHTHALMOLOGICAL SODA GLYCERIN 105DRUGS XX 82 SODIUM VALPROATE 111OXYTETRACYCLINE SPIRONOLACTONE 72HYDROCHLORIDE 27 STREPTOMYCIN 40OXYTOCIN 88 SUCRALFATE 45

SULFACETAMIDE SODIUM 82SUXAMETHONIUM CHLORIDE 121

PPANCURONIUM BROMIDE 121PARACETAMOL 1PHENYTOIN SODIUM 110


116

INDEX

T VTETANUS TOXOID 102 VACCINE 102THIABENDAZOLE 35 VERAPAMIL H C L 67THIOPENTALSODIUM 114 VITAMIN COMPLEX 97TRANEXAMIC ACID 70 VITAMINE AND MINERALS 96


116

INDEX

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