PUSHPAGIRI MEDICAL COLLEGE HOSPITAL

DRUG FORMULARY

PUSHPAGIRI COLLEGE OF PHARMACY PERUMTHURUTHY , TIRUVALL A KERALA

1.CHLORPHENIRAMINE [I]: Oral: Allergic conditions Parenteral: Adjunct in the emergency treatment of anaphylactic shock. It is taken with or without food. [C/I]: Hypersensitivity, neonates Dose: 4mg every 4-6 hour in adults orally, 10-20mg parenterally by IM,SC or slow IV over 1 minute. [P/C]: Elderly, pylori duodenal obstruction, angle-closure glaucoma, urinary retention, prostatic hyperplasia, epilepsy, renal and hepatic impairment, may affect performance of skilled tasks, BPH, bladder neck obstruction, hypertension. Pregnancy, lactation. It comes in the category B of pregnancy index. When combination with hydrocodone is given in pregnancy only if the potential benefit justifies the potential risk to the foetus. [A/E]: CNS depression, sedation, drowsiness, lassitude, dizziness, GI upsets, anorexia or increased appetite, epigastric pain, blurring of vision, dysuria, dryness of mouth, tightness in chest, hypotension, muscular weakness, tinnitus, euphoria, headache, paradoxical CNS stimulation. CV collapse and respiratory failure. [P/A]: Avil 25 mg tab, Avil inj, Corex 50ml syrup, Corex 100ml syrup, Piriton CS EXPT 120ml, Actifast suspension, Actifast tab, Coriminic syrup, Coriminic drops, Alex 100ml syrup, Alex sugar free syrup. [D/I]: Potentiates sedative effect of psychotropic drugs e.g. barbiturates, hypnotics, opioid analgesics, anxiolytics, and antipsychotics. Interaction with alcohol could be dangerous (sedation/ excitation) 2.LORATADINE [I]: pregnancy, lactation, child below 2 years [C/I]: Dose: in adult, 10mg once daily and in children, 5mg twice daily [P/C]: Severe hepatic damage, epilepsy, renal insufficiency [A/E]: Fatigue, giddiness, dizziness, dry mouth, headache, nausea, somnolence [P/A]: Alaspan 10mg tab, Alaspan syrup, Alaspan AM tab [D/I]: PLASMA CONCENTRATIONs increased by ketoconazole, cimetidine, nefazodone, erythromycin, and possibly other inhibitors of CYP3A4 3.SPIRONOLACTONE

[I]: edema, hepatic cirrhosis w/ aescites, and edema, diagnosis of primary hyperaldosteronism, preoperative management of hyperaldosteronism, hypertension, severe congestive heart failure, diuretic induced hypokalemia Dose: 100mg daily in edema, or dependant on urinary sodium/potassium ratio. In hyperaldosteronism, 100-400mg daily. In hypertension, 25-50mg daily. In severe CHF, 12.525mg daily initially and this may increase depending on response. [C/I]: anuria, hyperkalemia, acute or progressive renal insufficiency, Addisons disease [P/C]: patients at risk of developing hyperkalemia, and acidosis, monitor serum electrolytes; renal and hepatic impairment; dm; elderly; pregnancy [A/E]: fluid or electrolyte imbalance, gynaecomastia, GI upset, drowsiness, headache, hyponatraemia, tachycardia, hypotension, oliguria, hyperkalemia, confusion, weakness, parathesia, hirsutism, mental disturbances, menstrual irregularities, loss of libido and impotence. Fatal hyperkalemia in combination with ACE inhibitors and previous renal impairment, agranulocytosis [D/I]: sodium excretion effect may be inhibited by aspirin. May reduce ulcer-healing properties of carbenoxolone. Increased risk of nephrotoxicity when used w/NSAIDS or ciclosporin. Hyperkalemia may occur if given w\K supplements, ACE inhibitors, angiotensin II antagonists, NSAIDs, ciclosporin or trilostane. May increase the risk of orthostatic hypotension when used with barbiturates, narcotics or alcohol. May reduce vascular responsiveness to pressor amines. May increase T1/2 of digoxin. Increased risk of lithium toxicity when used concurrently. [P/A]: Aldactone 25mg tab, Aldobloc25mg tab, Fruselac 50mg tab, Lasilactone50mg tab, Fruselac ds tab, Amifru 40mg tab

4.FRUSEMIDE

[I]: Hypertension, edema associated with heart failure, pulmonary edema, oliguria in acute or chronic renal failure. Dose: in adults, 40-80mg daily in hypertension, in oedema, 20mg daily. [C/I]: Severe sodium and water depletion hypersensitivity to sulphonamides & furosemide, hypokalaemia, hyponatraemia, precomatose status associated with liver cirrhosis, anuria or renal failure. Addisons disease [P/C]: Prostatic hyperplasia. Hepatic or renal impairment, gout, DM, impaired micturition. Infusion rate should not exceed 4mg /minute to reduce the risk of ototoxicity. Monitor fluid and electrolyte balance and renal function. May lower serum levels of Ca & magnesium thus serum levels should be monitored. Pregnancy and lactation.

[A/E]: Fluid and electrolyte imbalance. Rashes, photosensitivity, nausea, diarrhea, blurred vision, dizziness, headache, hypotension. Bone marrow depression (rare), hepatic dysfunction. Hyperglycaemia, glycosuria, ototoxicity, rarely sudden death and cardiac arrest. Hypokalemia and magnesium depletion can cause cardiac arrhythmias. [D/I]: Analgesics reduce natriuretic action of furosimide. Antagonizes hypoglycemic agents & drugs used for gout. Hyperglycemia with antihypertensive agent diazoxide. Antagonizes muscle relaxants. Increased risk of ototoxicity when used with amino glycosides especially in renal impairment. May enhance nephrotoxicity of cephalosporins. Effects of antihypertensive enhanced .Action antagonized by corticosteroids. Phenytoin & indometacin may reduce effects of furosemide. May provoke severe hypotensive response w/ACE inhibitors. NSAIDS inhibit diuretic and anti hypertensive effects. Increased incidence of premature beats with cardiac glycosides. [P/A]: Lasix 20mg inj, Lasix 40 mg tab, Frusenat inj HYDROCORTISONE [I]: soft tissue inflammation, replacement therapy in adrenocortical therapy, joint inflammation, as supplement, acute adrenocortical insufficiency. Dose: 20-30mg daily in divided doses orally, in joint inflammations, 5-50mg depending on dose. [C/I]: viral/ fungal infections, tubercular/ syphilitic lesions, bacterial infections unless used in conjunction with appropriate chemotherapy

[P/C]: CHF, hypertension, DM, epilepsy, elderly patients on prolonged therapy, gradual withdrawal, pregnancy and lactation [A/E]: sodium and fluid retension. Potassium and calcium depletion. Muscle wasting, weakness, osteoporosis, GI disturbances and bleeding. Increased appetite and delayed wound healing. Bruising, striae, hirsutism, acne, flushing. Raised intracranial pressure, headache, depression, psychosis, menstrual irregularities. Hyperglycemia, glycosuria. Diabetes mellitus, obesity, moon-face, buffalo hump, suppression of pituitary-adrenocortical system. Growth retardation in children (prolonged therapy). Increased susceptibility for infection. Topical use: Dermal atrophy, local irritation, folliculate, hypertrichosis. Inhaled corticosteroids: may cause hoarseness, candidiasis of mouth and throat. Topical application to the eye: can produce corneal ulcers, raised IOP and reduced visual function. Intralesional injection: local hypo pigmentation of deeply pigmented skin. Intra- articular injection: joint damage, fibrosis, especially in load bearing joints. Abrupt withdrawal leading to acute adrenal insufficiency. Rapid IV injection may cause cardiovascular collapse. [D/I]: Thiazides may enhance hyperglycemia and hypokalaemia caused by corticosteroids. Increase incidence of peptic ulcer, or GI bleeding with concurrent NSAIDs administration. Response to anti coagulants altered. Dose of anti diabetics and antihypertensives need to be increased. Decreases serum concentration of salicylates and antimuscarinic agents. Ethanol may enhance gastric mucosal irritation. Reduced efficacy with concurrent use of carbamazepine,

phenytoin, primidone, barbiturates and rifampicin. Mutual inhibition of metabolism between ciclosporin and corticosteroids increases plasma concentration of both drugs. Enhanced effect in women taking estrogens or oral contraceptives. [P/A]: Efcorlin nasal drops TERBUTALINE [I]: oral and inhalation- acute bronchospasm Parenteral- severe bronchospasm. Dose: 5mcg/min for 20 min, increased every 20 min in steps of 2.5 mcg/min. in inhalation, 250mcg in metered dose inhaler, orally 2.5 or 3mg tid increased to 5mg tid if necessary. [C/I]: hypersensitivity to sympathomimetics any condition of mother or foetus in which prolongation of pregnancy is dangerous [P/C]: arrhythmias, hyperthyroidism, hypertension, diabetes, myocardial insufficiency, history of seizures, heart disease [A/E]: fine skeletal muscle tremor, especially hands, dizziness, anxiety, flushes, sweating, nausea, vomiting, lethargy, tinnitus, tachycardia, palpitations, muscle cramps, headache, paradoxical bronchospasm. IV: transient hyperglycemia, transient hyperkaelemia, (IV): MI, pulmonary edema, ketoacidosis [D/I]: antagonized effect of beta blockers. Increased risk of hyperkalemia with xanthine derivatives. Corticosteroids and diuretics; increased risk of arrhythmias with inhaled anesthetics, sympathomimetics [P/A]: Bricanyl 2.5mg tab, Bricanyl 5 mg tab, Bricanyl durules 5 mg tab, Bricanyl durules 7.5 mg tab, Bricanyl inj

MONTELUKAST [I]: oral- chronic asthma, prophylaxis of exercise- induced asthma, allergic rhinitis [C/I]: Dose: 10mg once daily in evenings in chronic asthma, in children, 4mg daily. [P/C]: not for the relief of acute bronchospasm. Not to be used as monotherapy for the prevention of exercise-induced bronchospasm. Patients in whom asthma is precipitated by aspirin or other NSAIDS should continue to avoid aspirin and NSAIDS. Do not abruptly substitute for oral or inhaled corticosteroids. Be alert for any signs of Churg- Strauss syndrome. Pregnancy and lactation. Children less than six months [A/E]: dizziness, fatigue, fever; rash; abdominal pain, dyspepsia, dental pain, gastroenterititis, increased AST; weakness; cough, nasal congestion. Aggression, agitation, angioedema,

arthralgia, bleeding tendency, bruising, cholestasis, diarrhea, dream abnormalities, drowsiness, edema, eosinoplilia, hallucinations, hepatic eosinophillic infiltration (rare), hepatitis, hypersensitivity, hypoaesthesia, insomnia, irritability, muscle cramps, myalgia, nausea, palpitation, pancreatitis, paraesthesia, purities, restlessness, seizure, urticaria, vasculitis, vomiting. Anaphylaxis, Churg-Strauss syndrome. [D/I]: metabolism may be increased with rifampicin, Phenobarbital, phenytoin, peripheral edema may occur with prednisone. [P/A] montair 4 mg tab, montair 5mg tab, montair 10 mg tab, montair granules, Montek 4 mg tab, romilast 10 mg tab, romilast 5 mg tab

SALBUTAMOL [I]: Oral or inhalation-acute bronchospasm, acute severe asthma, severe bronchospasm Parental- severe bronchospasm. DOSE: 2-4mg 3-4 times daily orally. In inhalation, 100 or 200mcg 3-4 times daily. [C/I]: Eclampsia and severe pre-eclampsia; intra-uterine infection, intra uterine foetal death, antepartum haemorrhage, placenta praevia and cord compression, threatened miscarriage, cardiac disease [P/C]: nil [A/E]: fine skeletal muscle tremor especially hands, tachycardia, palpitation, muscle cramps, headache, paradoxical bronchospasm, angioedema, urticaria, hypotension & collapse. Potentiallly serious hypokalaemia after large doses. [D/I]: Diuretics, corticosteroids and xanthenes may augment hypokalaemia.CV effects potentiated by MAOIs, TCAs, and sympathomimetics. Increases absorption of sulfamethoxazole when used together. May increase heart rate& BP when used with atomoxetine. Reduces serum levels of digoxine. Hypokalaemia induced by salbutamol increases the risk of digitalis toxicity. BP should be monitored if linezolide is used with salbutamol [P/A]:asthalin 100 ml syp,asthalin 200md inhaler , asthalin 2 mg tab , asthalin 4 mg tab , asthalin respules , asthalin respiratory soln , asthalin sa 4 mg tab PREDNISOLONE [I]: ORAL Allergic & inflammatory; poorly controlled, moderate to severe asthma, nephritic syndrome, rheumatoid arthritis, multiple sclerosis, infantile spasms, idiopathic thrombocytopenic purpura. INTRA ARTICULAR Joint inflammations. PARENTRAL Allergic & inflammatory disorders.

Dose: orally, 5-60mg daily, usually given in 2-4 divided doses. Parenterally, 5-60mg daily IV infusion for inflammatory disorders. [C/I]: Hypersensitivity; live vaccines; Herps simplex keratitis, systemic infections. [P/C]: Patients with hypothyroidism, cirrhosis, ulcerative colitis, CHF, convulsive disorders, thrombophloeditis, peptic ulcer, elderly. DM, hypertension, psychological disturbances, osteoporosis; pregnancy, lactation. Adrenal suppression & infection. May cause irreversible growth retardation, glaucoma, corneal perforation. [A/E]: Cushings syndrome & growth retardation in children; osteoporoses, fractures. Peptic ulceration; glaucoma, cataracts; hyper glycaemia, pancreatitis; increased appetite, obesity. TOPICAL: Thinning & atrophy, systemic absorption with prolonged use over large surface, broken skin or under occlusive dressing. INTRADERMAL/ INTRALESIONAL: Local hypo pigmentation of hyper pigmented lesions. OPHTHALMIC: Raised IOP and reduced visual function. Acute adrenal insufficiency precipitated by infection, trauma or surgery in patients on long-term therapy or following cessation of such therapy. CV collapse following rapid IV injection. [D/I]: Increased requirement of insulin & oral hypoglycemic. Actions blunted by barbiturates, phenytoin, rifampicin. Increased bioavailability with estrogens & oral contraceptives. Increases plasma salicylate levels. Increased risk of convulsions when used with ciclosporin, increased clearance by carbimazole or carbamazepine. Increased risk of GI bleeding & ulceration when used with NSAIDs . May decrease methotrexate clearance. [P/A]:kidpred syrup , omnacortil syrup , omnacortil 2.5mg tab , omnacortil 5 mg tab , omnacortil 10 mg tab , omnacortil 20 mg tab , omnacortil 30 mg tab , omnacortil 40 mg tab , omnacortil 2 ml inj , wysolone 5 mg tab, wysolone 10 mg tab , wysolone 20 mg tab TORASEMIDE [I]: ORAL- Hypertension, edema in patients with hepatic cirrhosis, edema INTRAVENOUS- edema Dose: 2.5-5mg once daily orally in hy [C/I]: hypersensitivity to sulphonylureas, renal failure with anuria, hepatic coma and pre-coma, hypotension, cardiac arrhythmias. Pregnancy and lactation. [P/C]: risk of hyper uricemia, gout and diabetes mellitus. Correct electrolyte disturbance and disorders of micturition before treatment. Monitor electrolyte balance, glucose uric acid, creatinine and lipids regularly. May impair ability to drive or operate machinery. [A/E]: electrolyte disturbances, e.g. hypokalaemia, dehydration, dry mouth, headache dizziness, hypotension, weakness, drowsiness, confusional states, loss of appetite, cramps, increased serum uric acid, glucose, lipids, urea and creatinine, increase in LFT, metabolic alkalosis, tinnitus and hearing loss.

[D/I]: increased risk of severe hypokalaemia with amphotercin B, corticosteroids,carbenooxolone, and hypokalaemia causing medications. Increased risk of lithium toxicity, increased risk of ototoxicity and nephrotoxicity with nephrotoxic or ototoxic medications, e.g. aminoglycosides. High dose of salicylates may increase risk of salicylate toxicity, with digoxin. Reduced diuretic effect with NSAIDs. Increased risk of hypotension with antihypertensives. [P/A]:dytor 10mg tab , dytor 20 mg tab , dytor 5 mg tab , dytor 40mg tab , tide 10mg tab , tide 20mg tab , tide inj. ACETAZOLAMIDE [I]: Oral: preoperative management of angle-closure glaucoma; adjunct in open-angle glaucoma, diuresis, prophylaxis of high altitude disorders, epilepsy Intravenous: chronic open angle glaucoma, acute closed angle glaucoma, epilepsy [C/I]: hypersensitivity to sulphonamides; na or k depletion, hepatic insufficiency, hepatic cirrhosis, hyperchloraemic acidosis; severe renal impairment, severe pulmonary obstruction, chronic non congestive angle closure glaucoma, adrenocortical insufficiency. Pregnancy, lactation. [P/C]: potassium supplements may be required, impaired hepatic or renal function, diabetes. Monitor plasma electrolytes and blood count regularly. IM route is not recommended. Caution whwn driving or operating machinery. Elderly [A/E]: drowsiness, paraesthesia, ataxia, headache, dizziness, thirst, anorexia, headache; confusion,malaise, depression; GI distress, metabolic acidosis, polyuria, hyperuricaemia, renal calculi, neprotoxitity, hepatic dysfunction. Rarely, skin reactions or blood dyscrasias. [D/I]: aids penetration of weakly acidic substances like sulphonamides across the blood and CSF barrier. May inhibit renal excretion of basic drugs, (e.g. quinidine, ephedrine & amphetamines) & promotes the excretion of acidic drugs. May increase salicylate toxicity (acidosis). Hypokalaemia with corticosteroids and potassium sparing diuretics. May increase excretion of lithium and primidone. May cause osteomalacia with anticonvulsants. May potentiate the effect of folic acid antagonists, oral hpoglycaemic agents, oral anticoagulants and severe reactions to sulphonamides. Dose: 250-375mg once daily or on alternate days. [P/A]: diamox 250mg tab OXYTOCIN [I]: Intravenous: adjunct in abortion, postpartum haemorrhage, labour induction, oxytocin challenge test for evaluating of foetal distress Dose: 10-20 milliunits/min in abortion

[C/I]: Cephalopelvis disproportion; abnormal presentation of the foetus; hydraminios; multiparae; previous caesarian section or other uterine surgery; hyperactive or hypertonic uterus, uterine rupture; contraindicated vaginal delivery(invasive cervical cancer, active genital herpes, prolapsed of the cord, cord presentation, total placenta previa or vasa previa): foetal distress where delivary is not imminent; severe pre-eclamptic toxaemia [P/C]: CV disorders; in more than 35 years; lactation. Moniter foetal and maternal heart rate, maternal BP and uterne motility. Monitor fluid intake and output during treatment, discontinue immediately if the uterus is hypertonic or hyperactive or if there is a foetal distress. Use of nasal spray may produce maternal dependence on its effects. IM administration not used regularly due to unpredictable effects of oxytocin. Not to be used for prolonged periods in resistant uterine inertia, severe pre-eclampsia, or severe CV disorders. Risk of water intoxication when used at high dosesfor prolonged periods. [A/E]: Foetus or neonate; jaundice; arrhythmias; bradycardia; brain, CNS damage; seizure; retinal haemorrhage; low Apgar score. Mother: transient hypotension, reflex tachycardia; nasal irritation, rhinorrhoea, lachrymation(following nasal administration); uterine bleeding, violent contraction, hypertonicity; spasm; nausea, vomiting. Maternal water intoxication(especially with slow infusion over 24 hours); prolonged uterine contractions causing foetal hypoxia and death; rupture of gravid uterus; afibrinogenaemia; subarachnoid haemorrhage. [D/I]: Possible severe HTN if given within 3-4 hours of vasoconstrictor in association with caudal block anaesthesia. Cyclopropane anaesthesia may increase risk of hypotension and maternal sinus bradycardia with abnormal AV rhythms. Dinoprostone and misoprostol may increase uterotonic effect of oxytonin, thus oxytonin should not be used within 6 hours after administration of vaginal prostaglandins. Concurrent use may increase the vasopressor effect of sypathomimetics. Concomitant use withprostaglandins increases risk of uterine rupture and cervical lacerations. [P/A]:Evatocin inj , pitocin inj NITROFURANTOIN [I]: Oral: acute uncomplicated urinary tract infections, prophylaxis of uncomplicated urinary tract infections. For 7 days Dose: 50-100mg 4 times daily for 7 days [C/I]: Severe renal impairment (anuria, oliguria, significantly elevated serum creatinine, CrCl less than60ml/min). hypersensitivity to nitrofurans, G6PD deficiency, infants less than 3 months. Pregnancy at term, during labour and delivery, or when the onset of labour is imminent. [P/C]: Elderly. Monitor hepatis and pulmonary function during prolonged therapy. Pre-existing pulmonary, hepatic, neurological, or allergic disorders, predisposition to peripheral neuropathy e.g. renal impairment, anaemia, diabetes mellitus, electrolyte imbalance, debility, vit B deficiency. Withdraw if signs of peripheral neuropathy occurs. Lactation. [A/E]: Nausea, vomiting, anorexia, abdominal pain, diarrhea,; headache; drowsiness; vertigo; dizziness, ntstagmus, benign intracranial hypertension; rash, utricaria,pruritus, fever, sialadenitis,

angioedema, erythema multiforme, exfoliative dermatitis, pancreatitis, lupus-like syndrome, myalgia, arthralgia; acute pulmonary sensitivity reactions, megaloblastic anaemia, leucopenia, granulocytopenia or agranulocytosis thrombocytopenia, aplastic anaemia, haemolytic anaemia(in G6PD-deficient patients); transient alopecia; brownish discoloration of urine. Peripheral polyneuropathy, hepatotoxicity, anaphylaxis, Stevens-Johnson syndrome, interstitial pneumonitis, pulmonary fibrosis. [D/I]: Reduced interaction with probenecid or sulfinpyrazone. Absorption reduced by Mg trisilicate. Antagonistic effects with quinoline antibacterials. Reduced effects with carbonic anhydrase inhibitors or urinary alkalinisers. [P/A]: Niftas 100mg tab DANAZOLE [I]: Oral: Endometriosis, benign breast disorders, hereditary angioedema, gynaecomastia, preoperative thinning of the endometrium, menorrhagia. [C/I]: Hypersensitivity, pregnancy, lactation, polyphyria, thromboembolic disorders; undiagnosed genital bleeding, markedly impaired renal, cardiac or hepatic dysfunction. [P/C]: Epilepsy, migraine; cardiac, hepatic, renal disorders. Severe hypertension, diabetes, polycythaemia, history of thrombosis; children. [A/E]: Edema, weght gain, sweating, acne, hirsutism, flushing, oily skin or hair, deepening of the voice, clitoral hypertrophy, amenorrhoea, hepatic dysfunction, CNS or GI disturbances, benign intracranial hypertension, reduction in breast size, elevated LFT values. Thromboembolis events and fatal strokes have been reported. Dose: 200-800mg daily in 2 divided doses adjusted according to the response for 3-6 months. [D/I]: increased serum levels of ciclosporin, warfarin, carbamazepine and tacrolimus. Increased incidence of insulin resistance in diabetic patients. [P/A]:danogen 100mg cap VITAMIN B [I]: Parenteral: megaloblastic anaemia caused by vitamin B12 deficiency [C/I]: [P/C]: [A/E]: Oral: anorexia, nausea, vomiting and diarrhea. Parenteral: rash, headache, hot sensation, diaphoresis and pain/ induration at IM injection site. Anaphylactoid reactions(parenteral) [D/I]: decreased GI tract absorption with neomycin, aminosalicylic acid, H2 blockers and colchicines. Reduced serum concentrations with oral contraceptives. Reduced effects in anaemia with parenteral chloramphenicol.

[P/A]:becosule 120ml syp, becosule cap , becosule z cap , cobadex 120 ml syp , nutrolin b plus cap , nutrolin b 60ml syp , nutrolin b ped tab , vit b p c tab , beplex forte tab , beplex forte inj 11ml , becozinc cap. Dose: 500mcg daily IV/IM parenterally VITAMIN C [I]: Oral: Scurvy, thalassaemia, metabolic disorders [C/I]: [P/C]: G6PD deficiency, haemochromatosis; hyperoxaluria. Diabetics; patients prone to recurrent renal calculi. Neonates; pregnancy( ingestion of large doses has resulted in scurvy in neonates); lactation. [A/E]: diarrhea, GI disturbances, may cause acidification of the urine; precipitation of urate, cystine or oxalate stones, or drugs in the urinary tract. Dose: 25-75mg daily in scurvy and 100-200mg daily in thalassemia [D/I]: Deferroxamine, hormonal contraceptives, flufenazine, warfarin, elemental iron, salicylates, disulfiram, fluphenazine, mexiletine, vitamin B12 [P/A]:celin 500mg tab , celin chewable tab VITAMIN E [I]: Oral: vitamin E deficiency, supplementation in cystic fibrosis, abetalipoproteinaemia [C/I]: [P/C]: [A/E]: hypertension, myopathy, thrombophloebitis, fatigue, weakness, nausea, headache, dizziness, blurred vision, diarrhea, abdominal pain, flatulence. Topical: contact dermatitis [D/I]: colestyramine, colestipol and orlistat may interfere with the vitamin E absorption. High doses of vitamin E potentiates the anticoagulant action of warfarin. Large doses of vitamin E may interfere response to iron supplementation. [P/A]: Evion 400mg cap , evion lc cap Dose: 40-50mg daily in deficiency and 100-200mg as supplementation LACTOBACILLUS [I]: Anti diarrheal, promote normal intestinal bacterial flora. Dosage regimen depends on product used. [C/I]:

[P/C]: [A/E]: [D/I]: [P/A]: Yogut tab Dose: dosage depends on products used. FOLIC ACID [I]: Oral: folate deficient megaloblastic anaemia, prophylaxis of megaloblastic anaemia in pregnancy, prophylaxis of neural tube defect in pregnancy, as supplement for women of childbearing potential. [C/I]: Undiagnosed megaloblastic anaemia; pernicious, aplastic or normocytic anaemias. [P/C]: Treatment resistance may occur in patients with depressed haematopoiesis, alcoholism, deficiencies of other vitamins. Neonates. [A/E]: GI disturbances, hypersensitivity reactions; bronchospasm [D/I]: Anti-epileptics, oral contraceptives, anti-TB agents, alcohol, aminopterin, methotrexate, pyrimethamine, trimethoprim and sulphonamides may result to decrease in serum folate concentrations. Decreases serum phenytoin concentrations. [P/A]:folvite tab, fa 5 mg tab, sysfol tab Dose: 5mg daily for 4 month in megaloblastic anaemia, in pregnancy, 0.2-0.5mg daily.

HYDROCHLOROTHIAZIDE [I]: Oral: Hypertension, edema associated with heart failure, nephrogenic diabetes insipidus. [C/I]: Severe hepatic and renal impairment, addisons disease, preexisting hypercalcaemia, anuria, sulphonamide allergy. Pregnancy, lactation. [P/C]: Existing electrolyte disturbances, hepatic cirrhosis, severe heart failure, edema, elderly, renal impairment. Monitor for signs if fluid and electrolyte disturbance. Diabetes mellitus, gout, hyperlipidaemia, hypercalcaemia,; ECG: LVH and/or ventricular eptopics (extrasystoles), may exacerbate or activate SLE in susceptible patients. [A/E]: Volume depletion and electrolyte imbalance, dry mouth, thirst, lethargy, drowsiness, muscle pain and cramps, hypotension, hypersensitivity reactions, e.g.: rashes and photosensitivity, thrombocytopenia, jaundice, pancreatitis, fatigue, weakness; may precipitate and attack of gout; impotence, hyperglycaemia; anorexia, nausea, gastric irritation, vomiting,

constipation, diarrhea, sialadenitis, dizziness, raised calcium concentration, hypersensitivity reactions. [D/I]: May cause hyponatremia when used with carbamazepine, may increase the risk of toxicity when used with allopurinol and tetracyclines. Potentiates hypotensive effect of alpha-blockers and ACE inhibitors. Diuretic induced hypokalaemia increase the toxicity of digitalis glycosides and risk of arrhythmias when used with drugs that prolong QT interval. When used with lithium, may increase the serum concentrations. Concurrent use with alcohol, barbiturates and opioids may enhance diuretic enhanced orthostatic hypotension. Anti-hypertensive effect may be reduced by corticosteroids NSAIDS or carbenoxolone. May enhance the nephrotoxicity of NSAIDS, neuromuscular blocking action of competitive muscle relaxants. Impaired control of diabetes by oral hypoglycaemic agents. [P/A]: Aquazide 12.5mg tab, Hydrazide 12.5 mg tab Dose: initially, 12.5mg daily in adults for hypertension.

1) TRIAMCINOLONE (I): Allergic and inflammatory disorder (C\I): Untreated systemic fungal, bacterial, viral or parasitic infection, hypersensitivity (P): Diabetes, hypertension, renal and liver impairment, glaucoma, psychosis, delayed tissue healing, cirrhosis, heart failure, recent MI, hypothyroidism, osteoporosis, peptic ulceration, thromboembolic disorders. Monitor height in child on prolonged therapy. Avoid rapid drug withdrawal. Elderly, children, pregnancy, lactation. (A\D); HPA axis suppression, intracranial hypertension, Cushings syndrome, growth retardation in children, osteoporosis, fractures. Peptic ulceration, glaucoma, hyperglycemia, GI upsets, increased appetite, increased fragility of skin, behavioral changes. Systemic absorption if applied to large area, broken skin or under occlusive dressing. Acute adrenal insufficiency may be precipitated by infection or trauma in patients on long-term corticosteroidal therapy or rapid withdrawal. DOSE; Orally in adult, 4-4mg daily, nasally 2sprays of 110 mcg into each nostril once nostril, intradermally, 1-3mg per site (INT): Lowering of plasma salicylates levels. Increased risk of GI bleeding and ulceration with NSAIDs. Antagonized blood glucose-lowering effects of ant diabetics. Increased risk of hyperkalaemia with amphotericin B, beta antagonist, beta blockers, potassium-depleting diuretics, and theophylline. Increased clearance of triamcinolone with ciclosporin, carbamazepine, phenytoin, barbiturate, rifampicin. Infections may develop if given with live vaccines. P/A: Kenacort 10mg inj, Kenacort 40mg inj

2) PIRACETAM (I): Nootropics and neurotonics (C\I); Hepatic and severe renal impairment. Cerebral hemorrhage. Pregnancy and lactation (P); Avoid abrupt withdrawal. Impaired renal function. Cardiac disorders. Haemostatic disorders. Patients who have recently undergone major surgery. Elderly (A\E); Hyperkinesia, nervousness, depression, diarrhea, rashes. CNS stimulation, sleep disturbances, dizziness, excitement, insomnia, somnolence, weight gain. DOSE; 7.2 gram daily in 2-3 divided doses orally in adults, 1-2gm tid via IV/IM in adults for cerebrocortical insufficiency (INT); May increase prothrombin time in patients who are on warfarin. P/A: Sumocetam syrup 3) PREGABALIN (I); Anticonvulsants (C\I); Hypersensitivity, pregnancy, lactation. Driving or working with machines or do other dangerous activities. (P); Discontinue treatment if patients develop severe angioedema. Withdraw treatment gradually over at least one week. May cause peripheral edema. Regular vision check is recommended. May decrease platelet count and prolong PR interval (A\E); dizziness, drowsiness, visual disturbance, ataxia, dysarthria, tremor, lethargy, memory impairment, euphoria, constipation, dry mouth, depression, confusion, agitation, hallucinations, excessive salivation, sweating, flushing, rash, muscle cramp, myalgia, thrombocytopenia, hypotension, hypertension. DOSE: Orally for partial seizures, 150-600 mg per day (INT); Concurrent use with oxycodone, Lorazepam and ethanol may increase the CNS effect. P/A: Esviga 75mg cap, Lyrica 75mg cap, Maxgalin 75mg cap, Maxgalin 50mg cap, maxgalin 150mg cap, PEG SR 150mg cap, PEG SR 75mg cap, Pregabid 75mg cap, Prebaxe 75mg cap, Pregalin 75mg cap, Pregalin SR 75mg cap 4) FLUNARIZINE (I): Migraine, vertigo, vestibular disorder, peripheral and cerebrovascular disorders (C/L): Pregnancy, lactation, GI or urinary tract obstruction, acute porphyrias. (P): Driving or operating machinery, epilepsy, elderly, CVS disease, glaucoma.

(A/E): Drowsiness, rarely weight gain, headache, depression, gastric pain, dry mouth, insomnia, extra pyramidal reactions, galactorrhoea. DOSE: In adults orally, 5-10mg daily at bedtime (INT): plasma levels reduced by phenytoin, carbemezapine, valproic acid. P/A: Mograin 10mg tab, Sibelium 5mg tab, Sibelium 10mg tab 5) VINPOCETIN (I): Dementia, cerebrovascular disorders, neurotonic (C\L): Pregnancy, lactation. (P): Hypertension or cardiac dysfunction. (A\E): Transient hypotension, tachycardia. DOSE: 15-30mg daily in 3 divided doses in adults P/A: Neurovin 5mg tab (INT): possible decrease in anticoagulation effect with warfarin. 6) CITICHOLINE (I): treatment of patients with cerebral injuries of vascular or traumatic origin, management of chronic cerebral vascular insufficiency and degenerative changes in senile dementia. (C\I): hypersensitivity to citicoline (P): hypotension and in case of hypotensive effect, can be treated with corticosteroids or sympathomimetics. (A\E): gastrointestinal disturbances, dizziness and fatigue. DOSE: Orally 200-6mg daily n divided doses, parenterally up to 1g IM/IV daily in adults. (INT): with medicines containing meclofenoxates or centrophenoxine, increases the effect of Ldopa. P/A: Somazina 500mg tab, Somazina OD 1gm tab, Somazina inj, Citistar 500mg tab, Citistar 1gm tab, Citinerve 500mg tab, Citinerve OD 1gm tab, Citinerve inj, Strocit inj, Strocit 500mg tab

7) ERGOTAMINE (I): Migraine

(C/I): Severe or uncontrolled hypertension, peripheral vascular disease, pregnancy, lactation, septic conditions, ischaemic heart disease, hyperthyroidism, impaired hepatic or renal function, hypersensitivity, cachexia, collagen disease and fibrotic conditions. (P): Anaemia. Monitor for signs of ergotism such as numbness or tingling of the extremities. (A/E); muscle cramps, stiffness, tiredness. Numbness and tingling of extremities. Nausea, vomiting, diarrhoea. Ergotism consisting of hypotension and gangrene of extremities, anginal pain and transient tachycardia or bradycardia. Severe peripheral vasoconstriction, CV disturbances. Due to vascular occlusions causing gangrene, MI, bowel necrosis, renal failure. Simultaneous use of OC or beta blockers increases the risk. DOSE: 1-2mg orally in adults and repeated after 30 minutes if required, 360mcg at the onset of attack parenterally and repeated at 5 minutes intervals. (INT): Vasoconstrictor effects enhanced by sympathomimetic agents e.g. adrenaline. Caffeine potentiates the action of ergotamine. Administration w/ in 6 hr of taking serotonin agonist may lead to increased and prolonged vasopastic reactions. May have increased risk of peripheral vasoconstriction w/ beta blockers. Erythromycin increases plasma concentration of ergotamine which may lead to ergotism. P/A: Vasograin tab 8) TRIHEXYPHENIDYL HYDROCHLORIDE (I): Prophylaxis of drug-induced extrapyramidal symptoms. Idiopathic parkinsonism. (C/I): Patients w/ closed angle glaucoma, chronic pulmonary disease, sick sinus syndrome, thyrotoxicosis, cardiac failure w/ tachycardia. (P): Glaucoma, obstructive disease of GI or genitourinary tracts. In elderly males w/ possible prostatic hypertrophy. In liver and renal disorders. Pregnancy and lactation. (A/E): Dry mouth, blurring of vision, constipation, urinary retention, glaucoma, confusion, drowsiness, restlessness, hallucinations. Arrhythmias, AV dissociation, multiple ventricular ectopics. DOSE: initially 1mg daily increased gradually to usual maintenance dose of 5-15mg daily in 3-4 divided doses orally. (INT): Delayed absorption of other oral drugs. Additive anticholinergic activity w/ tricyclic antidepressants, antiparkinsonian drugs, antihistaminics, phenothiazine and quinidine. P/A: TR 2mg tab, Pacitane 2mg tab, Hexin 2mg tab 9) METHYL PREDNISOLONE ACETATE

(I): Diseases and disorders of endocrine system, collagen, skin, eye, GI tract, respiratory system, or hematologic system; neoplastic diseases; allergies; edema; multiple sclerosis; tuberculous meningitis; trichinosis; rheumatic disorders; osteoarthritis; bursitis; localized inflammatory lesions, Lupus nephritis, Pneumocystis jiroveci pneumonia in AIDS patients

DOSE: In Adults Methylprednisolone - 4 to 160 mg P.O. daily in four divided doses, depending on disease or disorder. Acetate - 40 to 120 mg I.M., or 4 to 80 mg by intra-articular or soft-tissue injection, or 20 to 60 mg by intralesional injection (depending on type, size, and location of inflammation); may be repeated at 1 to 5 weeks. Sodium succinate high-dose therapy - 30 mg/kg I.V. over at least 30 minutes. May be repeated q 4 to 6 hours for 48 hours. (C/A): Hypersensitivity to drug or its component, Systemic fungal infections, Use in premature infants (with sodium succinate form, which contains benzyl alcohol) (P): Use cautiously in cardiovascular, hepatic, renal, or GI disease; active untreated infections; thromboembolitic tendency; idiopathic thrombocytopenic purpura; osteoporosis; myasthenia gravis; hypothyroidism; glaucoma; ocular herpes simplex; vaccinia or varicella; seizure disorders; metastatic cancer, pregnant or breastfeeding patients, children. Administration As needed and prescribed, give prophylactic antacids to prevent peptic ulcers in patients receiving high doses. When methylprednisolone acetate is substituted for oral form, know that I.M. dosage should equal oral dosage and should be given once daily. Know that methylprednisolone acetate is not for I.V. use. It may be given I.M. or by intra articular, intralesional, or soft-tissue injection. Be aware that methylprednisolone sodium succinate may be given I.M. or I.V. Reconstitute with bacteriostatic water for injection containing 0.9% benzyl alcohol, per manufacturer's instructions. In long-term methylprednisolone therapy, alternate-day therapy should be considered. For direct I.V. injection, inject each 500-mg dose over 2 to 3 minutes or more. For I.V. infusion, further dilute in compatible I.V. solution (such as 5% dextrose, 0.9% sodium chloride, or 5% dextrose in 0.9% sodium chloride injection) and give over 10 to 20 minutes. Maintain patient on lowest effective dosage, to minimize adverse effects. Route P.O. I.M. (acetate) Onset Rapid Peak 2-3 hr Duration 30-36 hr 1-4 wk

I.M., I.V. (succinate) Rapid

Unknown Unknown

6-48 hr 4-8 days

(A/E): CNS: headache, restlessness, nervousness, depression, euphoria, personality changes, psychoses, vertigo, paresthesias, insomnia, adhesive arachnoiditis, conus medullaris syndrome, increased intracranial pressure, seizures, meningitis.CV: hypotension, hypertension, arrhythmias, heart failure, shock, fat embolism, thrombophlebitis, thromboembolism. EENT: cataracts, glaucoma, increased intraocular pressure, nasal irritation, nasal septum perforation, sneezing, epistaxis, nasopharyngeal or oropharyngeal fungal infection, dysphonia, hoarseness, throat irritation, GI: nausea, vomiting, abdominal distention, rectal bleeding, dry mouth, anorexia, esophageal candidiasis, esophageal ulcer, peptic ulcer, pancreatitis, GU: amenorrhea, irregular menses, Respiratory: cough, wheezing, bronchospasm, Metabolic: decreased growth (in children), reduced carbohydrate tolerance, diabetes mellitus, hyperglycemia, sodium and fluid retention, hypokalemia, hypocalcemia, cushingoid state (with long-term use), hypothalamic-pituitary-adrenal suppression (with systemic use beyond 5 days), adrenal suppression (with long-term, high-dose use), acute adrenal insufficiency (with abrupt withdrawal), Musculoskeletal: muscle wasting, osteoporosis, osteonecrosis, tendon rupture, aseptic joint necrosis, muscle pain and weakness, steroid myopathy, spontaneous fractures (with long-term use), Skin: facial edema, rash, pruritus, urticaria, contact dermatitis, acne, decreased wound healing, bruising, hirsutism, thin and fragile skin, petechiae, purpura, striae, subcutaneous fat atrophy, skin atrophy, acneiform lesions, angioedema, Other: anosmia, bad taste, increased appetite, weight gain (with long-term use), Churg-Strauss syndrome, increased susceptibility to infection, aggravation or masking of infections, impaired wound healing, atrophy at injection site, local pain and burning, irritation, hypersensitivity reaction (INT): Drug-drug. Amphotericin B, mezlocillin, piperacillin, thiazide and loop diuretics, ticarcillin: additive hypokalemia, Fluoroquinolones: increased risk of tendon rupture, Isoniazid, phenobarbital, phenytoin, rifampin: decreased methylprednisolone efficacy, Ketoconazole: decreased methylprednisolone clearance, Live-virus vaccines: decreased antibody response to vaccine, increased risk of adverse reactions, Nonsteroidal anti-inflammatory drugs: increased risk of adverse GI effects, Oral anticoagulants: altered anticoagulant requirement, Drug-diagnostic tests. Calcium, potassium, thyroxine, triiodothyronine: decreased levels, Cholesterol, glucose: increased levels, Nitroblue tetrazolium test for bacterial infection: false-negative result, Drug-herbs. Echinacea: increased immune stimulation, Ginseng: immunomodulation, Drug-behaviors. Alcohol use: increased risk of gastric irritation and ulcers P/A: Depomedrol 40mg inj, Depomedrol 80mg inj 10) Naratriptan (I):Naratriptan is used for the treatment of the acute migraine attacks and the symptoms of migraine, including severe, throbbing headaches that sometimes are accompanied by nausea and sensitivity to sound or light. (A/E):Side effects include: dizziness, drowsiness, tingling of the hands or feet, nausea, dry mouth and unsteadiness. If these effects persist or worsen, notify your doctor promptly. Sideeffects which are unlikely and which should be promptly reported include: chest pain/pressure, throat pain/pressure, unusually fast/slow/irregular pulse, one-sided muscle weakness, vision problems, cold/bluish hands or feet, stomach pain, bloody diarrhea, mental/mood changes,

and fainting. In the unlikely event you have a serious allergic reaction to this drug, seek immediate medical attention. Symptoms of a serious allergic reaction include: rash, itching, swelling, severe dizziness, trouble breathing (swelling of the throat). (P): DOSE: (C/I): (INT): The use of naratriptan with MAOIs and serotonergic drugs may result in the life threatening serotonin syndrome. Make sure your doctor/pharmacist is aware of all your current medications (including as needed medications) before taking this drug. (P/A): Naratrex 2.5mg tab 11) GINKOBILOBA (I): cerebrovascular and peripheral activator, dementia (P): Patients receiving anticoagulants or drugs that may affect platelet aggregation (A/E): headache, dizziness, hypersensitivity reactions palpitations, GI disturbances, bleeding disorders, skin

DOSE: 40mg of extr tid in peripheral activation doses in adults, 120-240mg daily in divided doses in dementia in adults (P/A): Ginkoba 40mg tab, Bilovas 40mg tab

12) RIZATRIPTAN (I): Acute migraine attack (C\I): History of MI, peripheral vascular diseases, transient heart disease, uncontrolled hypertension, basilar or hemiplegic migraine, severe hepatic or renal impairment (P): Elderly, mild to moderate hepatic or renal impairment, coronary artery disease, pregnancy, lactation. May cause drowsiness. History of seizures. Ensure an interval of at least 24 hours after stopping an ergotamine compound and starting a serotonin (5HT1) agonist

(A/E): increased BP, chest pain, palpitation, skin flushing, nausea, abdominal pain, dry mouth, dizziness, fatigue, toxic epidermal necrolysis. DOSE: In adults. Initially given 10mg, if ineffective, second dose should not be taken for the same attack. Doses should be separated by at least 2 hours. Max: 20mg/24 hr. (INT): increased serum concentration with propranolol. Increased risk of vasospastic reactions when used with ergotamine and methysergide. Concurrent use with SSRIs may increase risk of serotonin syndrome. Concurrent use with or within 2 weeks of stopping MAOI treatment. P/A: Rizact 10mg tab 13) DEFLAZACORT (I): Allergic and inflammatory disorders (C\I): Systemic infection, live virus vaccines in those receiving immunosuppressive doses. (P): Adrenal suppression and infection, child, adolescent, elderly, history of TB, and steroid myopathy, hypertension, recent MI, CHF, liver failure, renal impairment , DM and glaucoma, osteoporosis, corneal perforation, severe affective disorders, epilepsy, peptic ulcer, hypothyroidism, pregnancy, lactation. (A\E): GI disturbances, musculoskeletal, endocrine, neuropsychiatric, ophthalmic, fluid and electrolyte disturbances, susceptible to infection, impaired healing, hypersensitivity, skin atrophy, striae, telangiectasia, acne, myocardial rupture following recent MI, thromboembolism. Dose: Up to 120mg daily orally in adults initially. Maintenance dose of 3-18mg/day (INT): antacids, ACE inhibitors , acetazolamide, adrenergic neuron blockers, ant diabetics, aspirin, barbiturate, beta blockers, calcium channel blockers, carbamezepine, carbanoxolone, cardiac glycosides, clonidine, coumarins, diazoxide, diuretics, erythromycin, hydralazine, ketoconazole, methotrexate, methyldopa, mifepristone, minoxidil, moxonidine, nitrates , nitroprusside, NSAIDs, estrogens, phenytoin, primidone, rifamycins, ritonavir, somatropin, beta2 sympathomimetics, theophylline, vaccines. P/A: Orthocort tab, Dezacor syp

LEVODOPA (i): Parkinsonism (C\I): Angle-closure glaucoma (P): Heart disease, liver or renal disease, pulmonary disease, endocrine disorders, seizure disorder, dementia or psychosis, open-angle glaucoma, osteomalacia, history of peptic ulcer. Monitor hepatic, psychiatric, haematological, renal and CV functions periodically. May impair ability to drive or operate machinery. Elderly. Avoid abrupt withdrawal. Pregnancy and lactation.

(A\E): GI disturbances e.g. nausea, vomiting, anorexia. GI bleeding in peptic ulcer patients. Orthostatic hypotension, cardiac arrhythmias. Psychiatric symptoms ( especially the elderly ) , depression w\ or w\o suicidal tendency. Abnormal involuntary movements or dyskinesias, delirium, hallucinations. Slight elevation of liver enzymes, BUN and uric acid. Transient leucopenia and thrombocytopenia. (P/A): Syndopa 110 TAB, Syndopa plus TAB, Syndopa 275mg TAB. DOSE: (INT): Increased postural hypotension and possible reduced absorption w/ TCAs. Reduced effects w\ phenothiazines, butyrophenones , thioxanthenes and other antipsychotic agents, reserpine,papaverine, phenytoin, isoniazid. Reversal of effects of levodopa monotherapy w/ pyridoxine. Exacerbation of abnormal involuntary movements and possibly delayed absorption w/ anticholinergics. Additive hypotensive effects w\ antihypertensive agents . Increased CNS toxicity w/ methyldopa. Exacerbation of parkinsonian symptoms w\ metoclopramide. Increased risk of hypotensive crises w/ nonselective MAOIs. Increased risk of cardiac arrhythmias w/ cyclopropane or halogenated anaesthetics.

CETRIZINE HYDROCHLORIDE (i); Allergic conditions (C\I): Hypersensitivity, lactation. (P): Hepatic or renal impairment, elderly, tasks, requiring mental alertness eg. Driving or operating heavy machinery, pregnancy (A/E): Somnolence, insomnia, malise, headache, dizziness, GI discomfort, dry mouth, abdominal pain, diarrhoea, nausea, vomiting, occasional hypersensitivity, epistaxis, pharyngitis, bronchospasm. (P/A): Alerid 10mg TAB, Alerid 30ml SYP, Cetrezol SYP, Cetrezol 10mg TAB, Cetiriz 10mg TAB, Cetzine 10mg TAB, Citizan 10mg TAB, Hicet 10mg TAB, Zyncet TAB, Zyrtec SYP, Sizon 5mg TAB. DOSE: (INT): Risk of increased INR and epistaxis when taken together with warfarin. CNS depressants and anticholinergics may potentiate CNS depression of cetrizine.

DEXCHLORPHENIRAMINE (i): Allergic conditions (C/I): Premature infants or full-term neonates

(P): Pregnancy, lactation, severe CV disorders, asthma. May impair the ability to drive or operate machinery. Angle-closure glaucoma, urinary retention, prostatic hypertrophy, pyloroduodenal obstruction, renal and hepatic impairment, elderly, epilepsy. (A/E): Exfoliated dermatitis. Sedation, antimuscarinic effects, CNS depression and disturbances, occasionally, paradoxical CNS stimulation, psychomotor impairment, headache, palpitations and arrhythmias, convulsions, sweating, myalgia, paraesthesias, extrapyramidal symptoms, tremor, sleep and GI disturbances. Rareley, hypersensitivity reactions and blood disorders, tinitis, hypotensions, hair loss. Injections may cause transient hypotension or CNS stimulation and irritiation. (P/A): Polaramine 2mg TAB. DOSE: (INT): CNS depressants e.g. alcohol, barbiturates,hypnotics, opioid analgesics,anxiolytic sedatives and neuroleptics, other antimuscarincs, MAOIs,betahistine,oxotoxic drugs.

BUDESONIDE (i): Treatment and prophylaxis of rhinitis, asthma. (C/I): Hypersensitivity. Acute infections uncontrolled by antimicrobial chemotherapy (P): Active or doubtfully quiescent tuberculosis, paradoxical bronchospasm, children, elderly, pregnancy, lactation. (A/E): Loss of skin collagen and SC atropy, local hypopigmentation of deeply pigmented skin, dryness, irritation, epistaxis, rarely ulceration or perforation of the nasal septum, smell and taste disturbances, hoarseness and candidiasis of the mouth or throat. (P/A): Budecort 0.5mg RESPULES, Budecort 100mcg INHALER, Budecort 100mcg ROTACAP, Budecort 200mcg INHALER, Budecort 200mcg ROTACAP, Budecort 400mcg ROTACAP, Rhinocort aqua NASAL SPRAY. DOSE: (INT): DESLORATADINE (I): allergic conditions (C/I): hypersensitivity (P): severe renal or hepatic failure, child less than 6 months, elderly, epilepsy, pregnancy, lactation.

(A/E): headache, fatigue, somnolence, dizziness, nausea, dyspepsia, xerostomia, dysmenorrhoea, pharyngitis. (P/A): Deslor 5mg TAB, Neoloridine rapiTAB. DOSE: (INT): FEXOFENADINE (i): seasonal allergic rhinitis, chronic ideopathy urticaria (C/I): hypersensitivity (P): renal impairment, pregnancy, lactation, child less than 6 years. (A/E): viral infections(cold or flu), headache, dizziness, drowsiness, fatigue, nausea, dyspepsia, dysmenorrhoea. (P/A): Allegra 120mg TAB, Allegra 30mg TAB, Allegra 180mg TAB. DOSE: (INT):co-administering with ketoconazole or erythromycin may increase plasma levels of fexofenadine. May increase adverse effects of other anticholinergics and CNS depressants. May increase arrhythmogenic effects of antipsychotic agents(phenothiazines) avoid concurrent usage.May reduce the efficacy of betahistine. Pramlintide may increase the anticholinergic effects of fexofenadine . Bioavailability may be increased by verapamil.Efficacy may be reduced by rifampin.

LEVOCETIRIZINE (i): Allergic condition (C/I): Lactation.End-stage renal (CrCl48 hr. A/E: Angina- like chest pain, headache, hypokalaemia,tremor,thrombocytopenia, bronchospasm. Super ventricular and ventricular arrhythmias, hypotension. P/A:Primacor inj. Dose: D/I:

METOLAZONE I: hypertension and oedema C/I: anuria, hepatic coma or precoma, pregnancy

P/C: pre-diabetes or DM, gout, SLE, hepatic and renal impairment, hypercholesterolaemia. Correct electrolyte disturbances prior to therapy. Risk of cross-sensitivity with sulphonamides, sulpohnylureas, carbonic anhydrase inhibitors, thiazides and loop diuretics. Lactation A/E: Chest pain, palpitation, necrotising angitis, orthostatic hypotension, syncope, venous thrombosis, vertigo, volume depletion, depression, dizziness, chills, drowsiness, fatigue, restlessness, headache, light headedness, petechiae, photosensitivity, hypersensitivity reactions, gout attacks, electrolyte disturbances, abdominal blotting, diarrhoea, abdominal pain, anorexia, constipation, epigastric distress, nausea, xerostomia, pancreatitis, vomiting, impotence, aplastic anaemia, thrombocytopenia, haemoconcentration, leukopenia, cholestatic jaundice, hepatitis, joint pain, muscle cramps, weakness, neuropathy, paraesthesia, blurred vision, increased BUN, glucosurea. Stevens-Johnson Syndrome, toxic epidermal necrolysis P/A: Zytanix-2.5mg and 5mg tab Dose: D/I: hypotensive and nephro toxic effects ofACE inhibitors may be enhanced. Absorption may be reduced with bile acid sequestrants. Hyperglycemic effect may be enhanced with diazoxide. May increase serum concentration and QTc-prolonging effect of dofetilide. May reduce lithium excretion. Hypotensive effect may be increased with alcohol. Increased risk of nephrotoxicity with cyclosporine. Severe electrolyte disturbance may occur with furoseamide

MEPHENTERMINE I: maintenance of BP in hypotensive states, hypotension secondary to spinal anaesthesia in obstetric patients C/I: hypotension caused by phenothiazines. Hypertension. Phaechromocytoma P/C: patient on MAO inhibitors. For shock due to loss of blood or fluid, give fluid replacement therapy primarily, CVS disease, hypertension, hyperthyroidism, chronic illness. Lactation and pregnancy. A/E: drowsiness, incoherence, hallucinations, convulsions, tachycardia. Fear,anxiety, restlessness, tremor, insomnia, confusion, irritability and psychosis. Nasuea, vomiting, reduced appetite, urinary retention, dyspnoea, weakness. AV block, CNS stimulation. Cerebral haemorrhage and pulmonary oedema, ventricular arrhythmias P/A: termin inj Dose: 30-45mg as a single dose or 15mg as a single dose D/I: antagonises effect of hypotensive agents. Severe HTN with MAOIs and possibly TCAs.Additive vasoconstrictive effects with ergot alkaloids, oxytocin. Risk of arrhythmia in patients undergoing anaesthesia with cyclopropane and halothane. CILOSTAZOL

I: peripheral vascular disease C/I: heart failure, known predisposition to bleeding, history of ventricular arrhythmias, QT interval prolongation, severe renal impairment, moderate to severe hepatic impairment P/C: congestive heart disease. concurrent therapy with clopidogrel has not been studied for safety or efficacy. Pregnancy and lactation. A/E: headache, dizziness, palpitations, diarrhoea, abnormal stools, pain, infection, peripheral oedema, nausea, vomiting, other cardiac arrhythmias, chest pain, rhinitis, pharyngitis, ecchymosis and skin rash P/I: cilodoc and pletoz 50mg and100mg tab Dose: 100mg bid D/I: co-admin with drugs that affect CYP3A4(erythromycin, other macrolides, diltiazen) or CYP2C19(omeprazole) may influence the pharmacokinetics of cilostazol.

ANTIANGINAL DRUGS NICORANDIL I:Angina pectoris C/I:Cardiogenic shock,hypotension,left ventricular failure with low filling pressure,lactation P/C:Hypovolumia,low systemic BP,acute pulmonary oedema,pregnancy.May impair ability to drive/operate machinery A/E:Headache(usuallytransitory),flushing,dizziness,nausea,vomiting&weakness.Hypotension&r erflux tachycardia at high doses P/A:Nikoran-48mg,2mg inj,5mg,10mg tab,K-cor&Korandil-5mg,10mg tab Dose:10-20mg bid D/I:Hypotensive interaction may occur with alcohol,TCAs,antihypertensives&other vasodilators.Enhanced hypotensive effect with sildenafil&other phospho diesterase type5 inhibitors ISOSORBIDE DINITRATE I:Management of angina,heart failure(oral&sublingual) Percutaneous transluminal coronary angioplasty(intracoronary) Unstable angina&heart failure(i.v) C/I:Severe hypotension/anaemia,hypovolaemia,heart failure due to obstruction/raised intra cranial pressure due to headtrauma/cerebral haemorrhage

P/C:Raised intra cranial pressure,hypotension,hypovolaemia.Mitral valve prolapse,arterial hypoxaemia ,glaucoma,elderly,hypothyroidism,malnutrition,pregnancy,lactation. A/E:Hypotension,tachycardia,flushing,headache,dizziness,palpitatioc,syncope,confusion.Nausea, vomiting,abdominal pain.Apprehension,restlessness,weakness&vertigo.Severe hypotension,circulatory collapse P/A:Sorbitrate&Isordil-5mg&10mg tab Dose: D/I:Increased hypotensive effects with alcohol/vasodilators.Marked orthostatic hypotension may occur when used with Ca channel blockers.Vasodilatory effect may be reduced with dihydro ergotamine.Ergotamine effects may be enhanced.Reduced effectiveness of SL form with disopyramide.Significant hypotension may occur with phosphodiesterase-5 inhibitors

HYPOLIPIDEMEIC DRUGS ATORVASTATIN I:Mixed dyslipidaemia,Nonfamilial hypercholestrolaemia hypercholestrolaemia,Heterozygous persistent elevations of familial serum

C/I:Hypersensitivity,active liver disease/unexplained transaminase,porphyria,pregnancy,lactation

P/C:Use with caution in patients who consume substantial quantities of alcohol,with history of liver disease,with risk factor for myopathy&rhabdomyolysis.Hypothyroidism should be properly managed before starting statin therapy.Use with caution in case of children