Section 3, Lay Person's Guide to Medicines

505

Abbreviations Used in this Section

Alcohol

Breast feeding

Driving

Infants and Children

Over 60

Pregnancy

Tobacco

Section 3

Short Profiles of 107 Drugs


Over 60

506

Activated CharcoalAlbendazoleAllopurinolAlluminium Hydroxide & Magnesium TrisicateAminophyllineAmitriptylineAmphotericinAtenololBeclomethasoneBenzanthine Benzyle PenicillinBenzophenonesBenzyl PenicillinCalcius LactateCarbamazepineCephalexinChloramphenicolChlorpramazineCimetidineClofazimineClonidineClotrimazoleCloxacillinCoaltarCyclosporinDexamethasoneDiclofenac SodiumDiethyl CarbamazineDiloxanide FuroateDomperidoneDoxycyclineEpinephrineErgocalciferol (Vit. D2)ErgometrineEthinamide/PropionamideEthosuximideFlucytosineFurazolidoneGentamicinGlucoseGriseofulvinHaloperidolHydralazineHydrochlorthiazideHydrocortisoneImipramineIndomethacinIodineIpecacuanhaIron DextranIsoniazid+Thiacetazone (INH)isosorbide DinitrateKetoconazoleLevamisoleLevodopa + Carbidopa

List of 107 Drugs with Short Profiles

LevothyraxineLindane (Gamma Benzene Hexachloride)Lithius CarbonateMannitolMefloquineMethylene BlueMetoclopramideMorphineNeomycinNiclosamideNifedipineNitrofurantoin (NFT)Nitrous OxideNorethisteroneNystatinPethidinePhenobarbitonePhenoxymethyl PenicillinPhenytoinPilocarpinePiperazine CitratePodophyllinPotassium ChloridePraziquantelPrednisolonePrimaquineProcain Benzyl PenicillinProcainamidePyrantel PamoatePyrazinamidePyridoxine (Vit. B6)QuinidineRiboflavin (Vit. B2)Rifampicin + INH + PyrazinamideSilver SulfadiazineSilvernitrateSodium BicarbonateSodium ChlorideSodium ThiosulphateSodium Chloride + Dextrose (Glucose)Streptokinase (Enzyme)SulfaceSulfadimidineTamoxifenTetracaineThiamineTrihexyl PhenidylValproicacidVerapamil HydrochlorideVinblastVincristineWarfarin (Mainly as Warfarin Sodium)Zinc Oxide

A Lay Person's Guide

Activated Charcoal

Use

Antidote to treat overdose or poisoning by most drugs or chemicals

Dosage

A d u l t s a n d C h i l d r e n a b o v e 6 y e a r s :20 gm in 100 ml of water. Repeat every 20 min. till dose of 100 gm.

Children below 6 years: 10 gm in 50-100 ml of water.

Precaution

Others

* Do not give before induction of vomitting by ipecacuanha.

* Do not take chocolate.

* If unconscious do not force fluid intake.

Adverse Effects

Mild constipation

Additional Information

Patient Information

W i t h d i g o x i n , p o i s o n o u s m u s h r o o m s , ant idepressants (medic ines used to treat depression), additional dose of 10-20 gm in 100 ml water is to be given every 2 hrs.

Albendazole

Brand Name

ABZ , Albezole

Use

Antihelminthic

Dosage

Adults: For hydatid cysts : 800 mg daily in divided doses for 28 days followed by 14 tablet-free days (3 cycles). Along with surgery: 2 cycles before and 2 cycles after surgery).

For enterobius, tapeworm and trichuris: 400 mg daily for 3 days for adults and children above two years.

Precaution

Adverse Effects

Skin rashes, diarrhoea, disturbed colour vision, slow heart beat, loss of hair rarely reversible

* Dizziness

* Contraindicated in pregnancy

* Blood disorders


During high dose therapy, careful monitoring of liver is advised.

Interferes with oral contraceptives.

507

Can continue use of medicine


Contra-indicated

Contra-indicated

Contra-indicated

Contra-indicated

Contra-indicated

Contra-indicated

Safetynotestablished


Over 60

Over 60

Over 60

Allopurinol

Brand Name

Zyloric

Use

Antigout

Dosage

Adults: Mild gout - 200-300 mg daily. Severe gout: 400-600 mg daily. With anti-cancer agent, 600-800 mg daily (doses of more than 300 mg should be divided in 2/3 doses)

Children: Not recommended

Precaution

Others

* Acute attack of gout* Impaired kidney function

Adverse Effects

Skin rashes, fever chills, kidney inflammation, anemia, liver damage, drowsiness, red irritated eyes

Continue the drug and inform the doctor.

Drug Interactions

Allopurinol should not be given with thiazides (used as diuretics, to get rid of water and salt in kidneys)

* It enhances the serum levels of aminophylline.

Patient Information

Take with food.

Take each dose with full glass of water. Drink atleast 10-12 glasses of fluid each day.

* Do not take much Vitamin C.

* Notify physician if skin rash occurs.

Aluminium Hydroxide & Magnesium TrisilicateUse

Antacid, for relief of pain in patients suffering from gastric or duodenal ulcer.

Dosage

Adults: 1-6 tablets (4-6 times) daily in accordance with the patient’s needs (Magnesium trisilicate 250 mg + Aluminium hydroxide 120 mg)

Tablets to be chewed and not swallowed

Precaution

Others

* Kidney damage due to aluminium

Adverse Effects

Loss of phosphates from body, kidney stones, etc.


Drug Interactions

* Magnesium trisilicate reduces absorption of iron/ tetracycline

* Absorption of penicillamine reduced.

Contra-indicated

Contra-indicated

Contra-indicated


Reduced

dose to

be given

Reduced

dose to

be given

Increased risk of adverse effects

AvoidSafetynotestablished

USE ANTACID TABLETS

AND NOT THE LIQUID

VERSION.

YOU SAVE ON COST.

508 A Lay Person's Guide

Over 60

Aminophylline

Brand Name

Sedonal

Use

Asthma and severe respiratory problems combined with bronchopneumonia

Dosage

Adults: By slow injection - (13 to 15 mg/kg/day divided in 3 doses)

By Mouth - (100-300 mg) 3 - 4 times daily after food

Precaution

Others

Use with caution in cases of severecardiac disease, severe renal or hepatic (liver related) disease, acute heart injury, heart failure, peptic ulcer.

Adverse Effects

Gastrointestinal irritation, nausea, vomiting, gastrointestinal bleeding.

Continue the drug and inform your doctor

* Stimulation of CNS: anxiety, headache, confusion, restlessness, vertigo and palpitations (increased activity of heart).

Continue the drug and inform your doctor.

* Overdosage is especially dangerous in children.


Drug Interactions

* Effect of drug is decreased by cigarette and marijuana smoking, phenobarbitol and charcoal boiled foods.

* Effect of drug enhanced by cimetidine, erythromycin, influenza virus vaccine among others.

* Drug enhances effect of ephedrine.

* It decreases effect of phenytoin.

Patient Information

* If GI upset occurs, take with food.

* Do not chew or crush enteric coated/ sustained release tablets.

* Take every 6 hrs (round the clock) or as directed by the physician.

* Notify physician if adverse effects occur.

* Avoid drinking large amounts of caffeine containing beverages such as tea, coffee, cocoa, cola drinks and chocolates, which enhance the adverse effects of the drug.

509

Contra-indicated





Rational Therapy Tips

Q. Which type of cough syrup should be prescribed to the children below the age of one year, expectorant or suppressant?

Ans. Usually no cough syrup should be given to children below the age of one year. Water


Over 60

Amitriptyline

Use

Antidepressant with sedative property (promotes sleep and avoids day-time drowsiness).

Dosage

Adults: 25-300 mg daily (1-4 times)

Precaution

Others

Heart problems, epilepsy, liver and kidney problems glaucoma, trouble of prostate.

Adverse Effects

Fast heart beat, heart block, hallucinations, decrease in memory, delusions, anxiety, nervousness, dizziness, fatigue, headache, tremors, seizures, skin rashes, urinary retention, bone marrow depression, diarrhoea, increased perspiration, flushing, chills.



Drug Interactions

* Phenothiazines, cimetidine, procainamide, quinidine may increase the toxic effects of the drug.

* Amitriptyline reverses the antihypertensive effect of clonidine, guanethidine.

Patient Information

* Avoid prolonged exposure to sunlight or sunlamps.

* Do not discontinue therapy without consent of

physician.

Amphotericin B

Brand Name

Fungizone Intravenous

Use

Antifungal against fungal infections in or around mouth.

Fungal infection of intestine. To treat fungal infection affecting blood (systemic fungal infections).

Dosage

For in f e c t i on s in/ar ound mou th : 10 mg as lozenge/suspension 4 times daily for 10-15 days. Increase dose in severe infections

Systemic infections: Daily dosage ranges 0.25 mg/kg upto 1 mg/kg by IV infusion.

For intestinal infections: 100-200 mg every 6 hrs.

Precaution

Others

Hypersensitivity to the drug.

Should not be given with terfenadine.

Adverse Effects

Fever, headache, anorexia (reduced appetite with aversion to food), malaise, muscle and joint pain.


Abnormal kidney function like nephrocalci-nosis (difused collection of calcium and related salts in kidney), and renal tubular acidosis (inability to pass high acid content urine, etc.).


GI tract problems like nausea, vomiting, diarrhoea,

cramping.

Contra-indicated

Contra-indicated

Contra-indicated

Contra-indicated


Reduced

dose to

be given



Over 60

Anemia and weight loss, irregular heart beat, blood clot defects, convulsions and other neurologic symptoms, hearing loss, blurred vision, acute liver failure, rashes.


Drug Interactions

Corticosteroids and antineoplastics (medicines used to treat cancer) should not be given with the drug. It endows more power to digitalis.

Atenolol

Brand Name

Altol

Use

* Antihypertensive to treat variation in rhythm of heart beat

* to treat obstructive cardiomyopathy

* to treat angina

* to prevent complication after myocardial infarction.

Dosage

Adults: By mouth

For hypertension: 50-100 mg daily

For angina: 100 mg daily

For arrhythmia: 50-100 mg daily

Precaution

Others

* Long term kidney problems

* Poor circulation

* Lung disorders

Adverse Effects

Nausea, vomiting, diarrhoea, fatigue and dizziness.

Decreased rate of heart beat, increased risk of

congestive heart failure/heart block, decreased

blood pressure, cold hands and feet and

disturbances of CNS (depression hallucination,

sleep disturbances and visual disturbances), swelling

over feet.

511


Q. Can we use oral drugs a few months after the expiry date?

Ans. Legally no. There might be slight reduction in the potency of the drug.

Contraindicated

Contraindicated

Avoid

Contraindicated


Beclomethasone

Brand Name

Aerocort inhaler, Beclate nasal, Cloben, Ecodax-G, NC-Derm, Stecort-NM

Use

Given to asthmatic patients who do not respond to bronchodilators alone.

Dosage

Adults: 2 puffs (3-4 times daily) for asthma. 1 spray in each nostril (2-4 times).

Children : reduce dose according to age and weight .

Precaution

Others

* If TB or other respiratory infection has occurred.

* Any nasal ulcers or surgery.

Adverse Effects

Irritation of nasal passages and fungal infection of mouth and throat.

Discontinue and call the doctor immediately.


Patient Information

* Rinse mouth with water or mouth wash after each use to help reduce dry mouth and hoarseness.

* Allow at least one minute between inhalations.

Over 60

Never stop the drug therapy.

Additional information

Drug Interactions

* Some drugs like reserpine may have an additive effect when taken with this drug.

* Use caution in case combination is used.

* Nifedipine used together is usually well- tolerated.

* Increased effect of drug seen on simul-taneous administration of chlorpromazine, cimetidine, ora l contracept ives, furosemide and hydralazine.

* Effect of drug decreased by antacids and thyroid hormones.

* Effect reversed by norepinephrine or dopamine.

* Antagonises action of theophyllines.

* Prolongs insulin action.

Patient Information

* Do not discontinue medication abruptly.

* Notify physician if you experience difficulty in breathing especially on exertion/lying down, night cough, swelling of extremities, or any of the other adverse effects.

* May produce drowsiness, dizziness, light-headedness, blurred vision. Hence caution while driving or similar job requiring alertness.

* Diabetics - may mask signs of low blood sugar or other blood glucose levels.

* May be taken without regard to meals.

Contra-indicated







Benzanthine Benzyl Penicillin

Use

Antibiotic to treat infections like rheumatic fever, syphilis (a sexually transmitted disease) and pharyngitis (inflammation of the joint opening of wind pipe and gullet).

Dosage

Adults: Rheumatic fever: 0.72 gm every 4 weeks or 12-24 lakh units every 3 weeks IM.

Syphilis: initial stage 1.44 gm as single dose,later 4.2 gm twice at 7 day intervals.

Pharyngitis: 0.72 gm as single dose, 1.44 gm daily.

Children: Syphilis: upto 2 yrs: 0.03 gm/kg (1 dose). 2-12 yrs: Adult dose.

Phar yng i t i s : upto 27 .3 kg body we ight : 0.18 gm - 0.36 gm

Body weight more than 27.3 kg: 0.54 gm (1 dose).

Precaution

Others

* Allergy to penicillin and cephalosporins

* Kidney and heart problems

* It should be administered by IM route only and no other route.

* Administer slowly after sensitivity testing.

Adverse Effects

On high doses - lethargy, confusion, convulsions, liver problems, allergic reactions like skin rashes, sudden severe allergic reactions (anaphylaxis).


Benzophenones

Use

Sunscreen agents.

Dosage

0.2% to 7% in oils, creams, aerosol sprays


Hypersensitivity reactions to benzyl salicylate has been reported. Skin reactions seen for sensitive skins.

513

Contraindicated Contraindicated


Q. What is the role of antibiotic skin ointment?

Ans. Very little. Most skin infections in childen would need oral antibiotics. Further there is a risk of sensitisation with ointments.


Benzyl Pencillin

Use

Antibiotic to treat a variety of infections, wound infections, boils, diphtheria, inflammation of tonsils, pneumonia, scarlet fever, rheumatoid (resembling rheumatism) fever, and in case of other inflammations.

Dosage

Adults: IV injections (600 mg), 4-6 times daily.

Children: Upto 12 years 25-30 mg/kg daily.

Neonates: 30 mg/kg daily

Precaution

Adverse Effects

* Allergy to penicillin and cephalosporins

* Kidney and heart problems. To be given after sensitivity testing.

Additional information

On high doses - lethargy, confusion, convulsions, liver problems, allergic reactions like skin rashes, anaphylaxis (sudden severe allergic reactions).

Discontinue the drug and call the doctor immediately.

Calcium Lactate

Brand Name

Calcinol, Leclyte, Regolyte

Use

Calcium supplement for growing children, pregnant women and lactating women, in patients with post menopausal osteoporosis, in patients with vitamin deficiency, rickets and osteomalcia.

Dosage

I. Acute hypocalcemia (low calcium levels)

Adults: max 2 gm daily by IM or IV injection.Children: by slow IV (100-125 mg/kg) body w e i g h t max 4 times daily.

II. Nutritional Supplement: (300 mg-1.5 gm) daily by mouth.

Others

Renal calculi (solid collections in kidney)

Adverse Effects

Rarely - Gastrointestinal disturbances

Increased calcium levels in blood resulting in loss of appetite, nausea, vomiting, constipation, abdominal pain, dryness of mouth, thirst and increased urination.


Drug Interactions

* Some components of diet, e.g., oxalic acid (spinach), phytic acid (bran and whole cereals) and phosphorous (milk and other dairy products) interfere with calcium absorption.

* Corticosteroids interfere with calcium absorption.* Oral calcium compounds reduce effective levels of

oral tetracyclines. * Calcium antagonises the effect of verampil.

Patient Information

* Notify physician if any of the adverse effects persist or become serious.


Q. What is the role of antibiotic ear drops in otitis media?

Ans. None. You need systemic antibiotics.

Contraindicated Contraindicated


Over 60

Carbamazepine

Brand Name

Carbatol, Mazetol, Tegretol

Use

Anti-epileptic

Dosage

Adul t s : 100 mg twice da i ly. Increase to 2 gm daily in divided doses slowly and as required.

Elderly: 50 mg twice daily as above.

Children: 10-20 mg/kg

Precaution

Others

* Liver problems

* Blood disorders

* Glaucoma

* Heart problems

* Kidney problems

* Bone marrow depression

* Psychotic problems

Adverse Effects

Dizziness, drowsiness, confusion, headache, fatigue, blurred vision, anemia, abnormal liver function, acuteurinary retention paralysis, pneumonia rashes, abdominal pain dryness of mouth, hypertension, congestive heart failure, muscle and joint pain, fever and chills.

Continue the drug and inform doctor.


Drug Interactions

* Erythromycin increases the toxicity of the drug.

* Phenobarbitone, phenytoin decrease levels of the drug.

* Isoniazid, cimetidine, propoxyphene increase drug toxicity.

Patient Information

* Take with food.

* Notify physician if there is bleeding, jaundice, swelling of hands or feet, ulcers in mouth, fever and chills.

515

Contra-indicated

Contra-indicated

Contra-indicated

Contra-indicated

Contra-indicated

Contra-indicated


Q. What is the best treatment for anemia in children?

Ans. Most of the time it is iron deficiency anemia. Iron syrup or drops should be used in the dose given below:

Elemental Iron: 6 mg/kg/day. Most Iron syrups in the market, with notable exceptions, contain around 30 mg of elemental iron per 5 ml.


Cephalexin

Brand Name

Alcephin, Alexin, Carbicol, Cefamax, Nufex, Phexis

Use

Respiratory and urinary tract infections, bone and joint infections

Dosage

Adults: 250-500 mg every 6 hrs.

Children: 25 mg/kg daily in divided doses,

Less than 1 year : 125 mg every 12 hours

1-5 years: 125 mg every 8 hours

Precaution

Others.

Kidney problems.

Allergic reaction to pencillin or cephalosporin, blood disorders.

Adverse Effects

Most Common :

GI disturbances and allergic reaction to the drug (especially in people with history of allergy to the drug, asthma and hay fever).

* Allergic reactions may range from mild to life threatening.

* Decrease in number of blood cells (platelets and leucocytes).

* May affect liver and kidneys.

* CNS also may be affected.


* Bleeding due to hypothrobinemia (a blood

disorder leading to bleeding tendency).


Drug Interactions

* Bacteriostatic (those stopping growth or multiplication of bacteria) agents interfere with the bactericidal (those that kill bacteria) action of the drug.

* Probencid prolongs action of the drug.

* Concomitant use of nephrotoxic (toxic to kidneys) agents (like vancomycin, polymyxin B and aminoglycoside group of antibiotics) with this drug increases the probability of kidney poisoning.

Patient Information

* Complete full course of therapy.

* May cause GI upset - take with food/milk.

* Notify physician if you have experienced allergic reaction to cephalosporin penicillins, or their related group of drugs.

* Notify physician if diarrhoea - especially if severe with mucus, blood/pus.

* May give a false positive test for glucose in some tests.

* Drug excreted through breast milk.


Q. Is it rational to use a combination of antibiotics in the management of an infection?

Ans. Seldom. Exceptions are meningitis, septicemia and tuberculosis.

Contra-indicated

Contra-indicated

Reduced dose to be given


Over 60

Chloramphenicol

Brand Name

Chlorocort, Chloromycetin, Dexosyt C

Use

Antibiotic for typhoid ferver.

Dosage

Adults: 500 mg by mouth 4 times daily.

Childrem: more than 2 weeks old : 25 - 50 mg per kg body weight by mouth in 4 divided doses (max. 100 mg/kg body weight).

Precaution

Others

* Blood disorder.

* Liver or kidney problems.

Adverse Effects

Most serious:

Bone marrow depression. Hence decrease in all populations of blood cells resulting in anemia and compromised immune response.

This can be prevented by examination of blood smear.

GI Disturbances - rare. Sometimes inflammation of mouth, tongue or intestine.

CNS Related problems - headache, mild depression, confusion/delirium and damage to optic and other nerves may occur on long time use.

In some cases, allergic reaction to the drug may be triggered.

Can give rise to toxic reactions in premature infants -

may prove to be fatal.


Drug Interactions

* Prolongs effects of drugs like dicumarrol, phenytoin, phenobarbitol, tolbutamide, chlorpropamide.

* Paracetamol prolongs effect of the drug.

* Concurrent penicillin and chloramphenicol may decrease the penicillin effect and prolong the effect of chloramphenicol.

* Response to iron salts and Vit.B2 may be decreased when given with this drug.

Patient Information

* Preferably taken on an empty stomach one hour before or two hours after meals.

* Take with food if GI upset occurs

* Take every six hours round the clock.

* Notify physician if fever, sore throat, tiredness or unusual bleeding or bruising occurs.

517


Q. Should one use preparations which have a combination of antibiotics with other drugs, e.g., steroids, vitamins?

Ans. Never.

Contra-indicated





Avoid


Over 60

Chlorpromazine

Brand Name

Neoclam forte, Trinicalm forte

Use

Tranquilizer and sedative to treat acute psychosis, hallucinations, schizophrenia.

It reduces the phase of manic drepression, to control anxiety and tension and also extreme nausea.

Dosage

Adults: 50-100 mg/day divided into 3 doses.

Children: 1.5 mg/kg/day divided into 3 doses

Precaution

Others

Contraindications: Kidney or liver problems, epilepsy, heart problems, glaucoma, Parkinson’s disease.

Adverse Effects

* Sudden death.

* Liver damage resulting in jaundice.

* Blood disorders.

* Alteration in blood pressure, increased heart beat, cardiac arrest, irregularities in rhythm of heart beats

* Exposure to sunlight may lead to skin reactions

* Allergic reactions as skin rashes.

* Hormonal disorders.

Overdosage : Fatal or leading to coma. In general, CNS

depression.

Notify doctor immediately if any of above persists or serious.


Drug Interactions

* Caution in patients using barbiturates, narcotics, anaesthetics, or alcohol and anticholinergic drugs.

* Absorption is reduced if antidiarrhoeal mixtures and antacids are simultaneously administered.

* Epinephrine should not be used.

* Simultaneous administration of phenytoin will lead to phenytoin toxicity character-ised in part by liver damage.

* May aggravate neuromuscular respiratory depression in conjunction with poly-lypeptide antibiotics like capreomycin, polymixin B, bacitracin.

* It should not be used with metoclopramide and domperidone.

Patient Information

* May cause drowsimess. Avoid during day tasks requiring alertness.

* Avoid alcohol and other depressants.

* Avoid prolonged exposure to sunlight.

* Avoid changing posture frequently.

* Caution while climbing stairs.

* Caution in case of hot weather.

* Avoid phenobarbitone.

Contra-indicated

Contra-indicated

Contra-indicated



Avoid


Over 60

Cimetidine

Use

To treat gastric ulcers and duodenal ulcers or inflammation of oesophagus.

Dosage

Adults: 400 mg (2-4 times daily) by mouth.

Children: 20-30 mg/kg daily in divided doses.

Precaution

Contraindications

Liver or kidney problems.

Adverse Effects

* Gynaecomastia (excessive development of male mammary glands, sometimes secreting milk).

* Irregular heart beats.

* Fever. Headache.

* Decrease in white blood cells.

* Liver toxicity.



Drug Interactions

* P r o l o n g s a c t i o n o f w a r f a r i n t y p eant icoagulants, phenyto in , propanolo l , lidocaine, theophylline and benzodiazepine derivatives (e.g. diazepam).

* Antacids if needed should preferably be taken at spaced intervals from time of taking this drug.

* Interferes with action of ketoconazole.

* Cigarette smoking reverses the inhibition of nocturnal gastric secretion produced by this drug.

* Concomitant administration with carba-mazepine increases the toxic effects of carbamazepine.

* Decreases effective levels of digoxin in blood.

Patient Information

* Take with meals.

519

Contra-indicated

Contra-indicated

Contra-indicated





Q. Is there any need for routine use of antiinflammatory drugs while treating acute infections, e.g., tonsilitis and pharyngitis?

Ans. No, they are of no added advantage.


Over 60

Clofazimine

Brand Name

Clofazine, Hansepran

Use

Antileprosy (with dapsone and rifampicin). Also used in healing chronic skin ulcers due to M.ulcerans.

Dosage

Adults: 0.8-1.6 mg/kg daily usually 100 mg daily + 300 mg once a month

Children: 1 mg/kg daily

If body weight less than 25 kg: give 2 daily doses together on alternate days.

For erythemarodosum Leprosy: 200 to 300 mg daily for no longer than 3 months

Precaution

Others

Patients with problems of stomach and intestine, liver problems.

Early pregnancy.

Adverse Effects

Bowel obstruction, water retention, stomach upset and pain.

Reversible brown to pink discoloration of skin and discoloration of hair, sweat, tears, faeces and urine.


* Rush to the doctor in case of loss of vision, bloody black stools, yellow eyes and vomiting.

* If discoloration of skin occurs, one should not get frightened.

Drug Interactions

Not known.

Clonidine

Brand Name

Arkamin, Catapres, Clothalton

Use

Antihypertensive to treat migraine and menstrual cramps (dysmenorrhoea).

Dosage

Adults: 0.2-0.8 mg daily taken in 2 divided doses not greater than 2.4 mg daily.

Precaution

Others

* Stop drug slowly.

* Low blood pressure

Adverse Effects

Dry mouth, drowsiness, sedation, consti-pation, headache and fatigue abnormalities in liver function, weight gain, congestive heart failure, rashes, burning of eyes and dryness of nasal mucosa.

Should not be withdrawn.


Drug Interactions

Clonidine may enhance the CNS depressant effects of alcohol, barbiturates (like phenobarbitone) and sedatives.

Patient Information

* Abrupt withdrawal may cause rapid rise in BP.

* Avoid cough cold or allergy medications.

* If dizziness occurs, avoid sudden changes in posture.

Contra-indicated


Contra-indicated

Contra-indicated

Contra-indicated

Contra-indicated

Contra-indicated




Clotrimazole

Brand Name

Calcrem

Use

Antifungal

Dosage

Adults: Vaginal Cream: 1-2 times daily.

Vaginal Pessaries: Once daily at bedtime(100-500 mg/dose).

Skin Cream: 2-3 times solution spray as directed.

Precaution

No known problems

Adverse Effects

Burning and irritation on the skin surface at the site of application of cream, rash.



Patient Information

* To achieve maximum effect of the medication allow pessary to dissolve slowly in the mouth of the vagina.

Drug Interactions

Not known

Cloxacillin

Brand Name

Bioclox, Klox

Use

Antibiotic to treat infections caused by organisms which are resistant to treatment by benzyl pencillin (eg.bronchitis, infections of bone, skin, wounds).

Dosage

Adults: By mouth 500 mg 6 hourly, at least 30 minutes before food.

IM injection - 500 mg every 4-6 hours.

IV injection - 0.5-1.0gm every 4-6 hours.

Children: 1/4 - 1/2 adult dose.

Precaution

Others

* Allergy to penicillin and cephalosporins.

* Kidney and heart problems.

Adverse Effects

On high doses - lethargy, confusion, convulsions, liver problems, allergic reactions like skin rashes.


Drug Interactions

* Aminoglycosides (gentamycin, neomycin, streptomycin, etc.) should not be given.

Patient Information

* Complete full course of therapy.

* Take on empty stomach 1 hr before or 2 hrs after meals.

* Take each dose with full glass of water (no carbonated drinks).

* Take at even intervals.

521

Contra-indicated

Contra-indicated


Coal tar

Brand Name

Dexobin Skin+

Use

Antiseptic, antiparasitic, antifungal, antibacterial, keratolytic (looseners of dead cells on skin surface).

Dosage

Adults: Use 20% solution (or dilute with three parts of water) on the affected areas of the skin, one to three times a day.

For use on scalp: Dilute 20% 10 times with water.

For bath: Add 100 ml of 20% solution to the bath and soak in it for 5 minutes.

Children: Dose not established.

Precaution

Others

* Open wounds, inflammed skin, infected skin.

* Patients intolerant to tars may be intolerant to coal tars also.

Adverse Effects

Induction of acne type skin eruptions and sensitivity to sun.

Cyclosporin

Use

Powerful immunosuppresant in the prevention of transplant rejection.

Atopic dermatitis (unusual inflammation of skin), psoriasis, rheumatoid arthritis.

Dosage

Organ Transplantation: Used alone (10-15 mg/kg) as 1 dose 4-12 hrs. before trans-plantation followed by 10-15 mg/kg daily for 1-2 weeks and then reduced to 2-6 mg/kg.

Bone Marrow Transplantation: 3-5 mg/kg by IV infusion over 2-hrs from day before transplantation to 2 weeks post operatively, then 12.5 mg/kg by mouth for 3-6 months.

Precaution

Adverse Effects

Liver dysfunction, fatigue, gastro-intestinal disturbances, burning sensation in hands and feet, headache, rash, anemia , weight increase, convulsions, muscle cramps, inflammation of pancreas, kidney damage, mild tremor, abnormal growth of gum.



Drug Interactions

* Amphotericin B, erythromycin or ketoconazole should not be coadmin-istered since it increases cyclosporin toxicity.

* Phenobarbitol, phenytoin, rifampicin and trimethoprim sulphamethaxole should not be given.

Contra-indicated

Contra-indicated





Over 60

Dexamethasone

Brand Name

Decdan, Idizoine, Millicortenol, Wymesone

Use

Used to treat skin disorders, asthma, joint pain and stiffness.

Dosage

Adults: 0.5-20 mg/daily in divided doses orally.

Children: 0.5-2 mg daily in divided doses upto maximum of 15 mg/day.

Precaution

Others

Peptic ulcer, glaucoma, TB, herpes infection, mental illness.

Not to be stopped suddenly if used for a prolonged duration.

Adverse Effects

Abdominal stretching, nausea, vomiting, weight gain, peptic ulcer, impaired wound-healing, skin rashes, thin fragile skin, convulsions, insomnia, hiccups, menstrual ir regularities, increased sweating, cataracts, glaucoma, irregular heart beat, cardiac arrest, muscle weakness and loss of muscle mass.


Drug Interactions

Phenytoin, phenobarbitone, rifampcin and ephedrine increase drug clearance.

Aspirin, isoniazid should not be given as also

aminophylline.

Reduces action of antidiabetic and anti-hyptensive drugs.

Patient Information

* Take with meals or snacks in morning prior to 9 am. Take single daily or alternate day doses.Take at evenly spaced intervals.

* Notify physician if signs of unusual weight gain, blood vomiting, puffing of the face, menstrual irregularities, fever cold or infection.

* Avoid abrupt withdrawal of therapy.

523

Contra-indicated

Contra-indicated

Contra-indicated




Q. For calculating dose per kg for a malnourished child should the actual weight be considered or is the expected weight required?

Ans. Actual weight.


Contra-indicated

Over 60

Diclofenac Sodium

Brand Name

Catagesic, Dic-SR, Diclofam, Diclomax, Diclomol, Diclonac, Dicloran, Dolfex, Fenacon, Fenaplus, Fensaide, Frenacplus, Frenac-MR

Use

Pain and inflammation in joints (rheumatoid), acute gout, analgesic, for fever.

Dosage

Adults: By mouth: 75-150 mg daily in 2-3 divided doses (preferably after food).

By deep IV injection into gluteal muscle: 75 mg once daily for 2 days.

By rectum: 75-150 mg daily in divided doses.

Childr en (1-12 yrs) : By mouth or rectum: 1-3 mg/kg daily in divided doses.

Precaution

Adverse Effects

Pain may occur at the injection site, hemoglobin biosynthesis affected, redness of skin, itching, oedema, jaundice, nausea, vomiting.


* Risks of GI side-effects.

* Unsafe in acute porphyria (a rare inherited, blood disease).


Drug Interactions

* Reduces excretion of lithium and also that of methotrexate (an anticancer drug).

* Typical NSAID (non-steroidal anti-inflammtory

drug) reactions.

Diethyl Carbamazine

Brand Name

Banocide, Hetrazan

Use

For prevention and treatment against filarial infestation and cough and asthma associated with filarial infection.

Dosage

1 mg/kg daily in 3 divided doses on 1st day then increase gradually to 6 mg/kg over 2-3 days after meals. Treat for 21 days (total dose of 72-126 mg/kg).

Precaution

Others

* Antimalarial therapy.

* Impaired kidney functions.

Adverse Effects

Typical Mazotti reactions: skin rash, fever joint pain, aches, headache, eye and vision problems and decrease in BP.

Continue to use the drug and inform the doctor.


Patient Information

* Take satisfactory food and fluid.

* Increase dose slowly.

Avoid Can continue use of medicine

Contra-indicated





Domperidone

Brand Name

Domstal

Use

Antiemetic, given to get relief from nausea and vomiting when on treatment with anticancer drugs

Dosage

Adults: By mouth: 10-20 mg every 4-8 hrs. daily.

By rectum: 30-60 mg daily every 4-8 hrs.

Childr en: By mouth: 100-400 ug/kg every 8 hrs.

By rectum : Varies with body weight 15 mg-0 mg (1-4 times).

Precaution

Others

Long term kidney problems, abnormal heart rhythms.

Adverse Effects

Rashes and other allergic reactions reported.

Prolactin effects like enlargement of breasts and milk secretion.



Drug Interactions

* Antipsychotic drugs and analgesics (opioids) should not be given.

Over 60

Diloxanide Furoate

Brand Name

Furamide, Ambibact in BD, Dyradepreps, Entamizole, Flagyl-DF

Use

Treatment of asymptomatic intestinal amoebiasis (condition where infection of intestine by amoebias is indicated by passage of cysts in faeces, but no clinical symptoms are seen).

* Also used alongwith other drugs to treat amoebic dysentery or amoebic infection of liver.

Dosage

For Asymptomatic Amoebic Infections:

Adults: 500 mg every 8 hours for 10 days.

Children: 20 mg/kg daily in 3 divided doses.

Precaution

Adverse Effects

In most cases well tolerated. Mild side-effects include flatulence, vomiting and itching.

Do not discontinue the drug. Contact your doctor.


Ineffective when administered alone in the treatment of extra-intestinal amoebiasis.

525

Contra-indicated

Contra-indicated

Avoid







Contra-indicated


Over 60

Doxycycline

Brand Name

Biodoxi, Duracyclin, Vivocycline, Lydox

Use

Antibiotic tetracycline.

Treatment of variety of infections including inflammation of prostate, pelvic inflam-matory disease and acne.

Dosage

Adults: 50-200 mg daily.

Children: Not recommended.

For acne: 50 mg daily for 6-12 weeks or longer. Capsules should be swallowed during meals with plenty of fluid.

Precaution

Others

* Allergy to tetracycline.

* Liver, kidney problems.

* Surgery under general anaesthesia.

Pregnancy: take only in first four months.

Adverse Effects

Nausea, vomiting, diarrhoea, black tongue, ulcers, rashes, fatty liver, anemia, discoloration of thyroid gland, abnormal pigmentation of conjuctiva of eye. Continue the drug and inform the doctor.


Drug Interactions

* Antacids, iron and alkali should not be given since they impair the absorption of the drug.

Food and dairy products also impair the absorption.

* Barbiturates (class of medicines that slow down the nervous system), carbamazepine and phenytoin decrease the half-life of doxycycline.

* Aminophylline and doxycycline may increase the incidence of gasto-intestinal effects.

Patient Information

* Take with food not milk.

* Take each dose with full glass of water.

* Avoid prolonged exposure to sunlight.

Contra-indicated

Contra-indicated

Contra-indicated

Contra-indicated



Q. What is the role of liver tonics in hepatitis?

Ans. Most liver tonics available in the market have no proven value in case of jaundice in newborn or viral hepatitis in children. Only drug manufacturers tell that they are useful but no authentic literature or authority agrees with them.


Over 60

Epinephrine

Use

Antiasthmatic, antiglaucoma, decongestant

Useful in sudden severe shocks.

Dosage

For aerosols (strength 0.2 to 0.3 mg/spray) - 1 inhalation, repeated in 1-2 min. if needed then wait for 4 hrs. till the next.

Eye Drops - 1 drop every 12 hrs.

Precaution

Others

* Narrow angle glaucoma

* High BP

* Diabetes

* Overactive thyroid

* Heart problems

* Never give intravenously

Adverse Effects

Cerebral haemorrhage (ser ious bleeding) , hallucination, impairment of memory, panic, suicidal tendencies.

Palpitations, changes in blood pressure, irregular heart beat, decreased urine formation and and painful urination. Heart burn, haemorrhage at site of injection.

Respiratory difficulties.


Drug Interactions

* Phenoth i az ines ( e . g. , ch lo r promaz ine , prochlorperazine, etc. — a class of drugs used in

treatment of nausea, vomiting, and nervous, mental and emotional conditions) reverse the effect and should not be given.

* Insulin should be increased for diabetic patients when this drug is given.

Patient Information

Do not exceed the dosage.

* Notify physician if dizziness or chest pain occurs.

527


Q. Is it rational to use steroids as a ‘WONDER' drug during any type of ailment?

Ans. It is not. Steroids have very specific indications. They are dangerous in ordinary fevers or nonspecific ailments. Two good examples of their rational use are asthma and nephrotic syndrome. Two common examples of misuse are hepatitis and high fever.

Contra-indicated

Contra-indicated

Contra-indicated

Contra-indicated

Contra-indicated

Contra-indicated


528

Diarrhoea is anutritional disease

treat with normal food, rice kanjeegive water + salt + sugar solution

DRUGS ARE RARELY NECESSARY

Co

urtesy

: Ind

ian

Aca

dem

y o

f Ped

iatrics


Ergocalciferol (Vit D 2)

Use

Preventing rickets or during rickets necessary for the absorption of calcium and phosphate.

Dosage

Adults: 10 micrograms (400 units) is given by intramuscular injection or gelatin capules containing 25,000 to 50,000 units orally.

Precaution

Others

Monitoring of plasma calcium in high dosages, and in kidney disorders, is necessary.

Adverse Effects

Weakness, headache, sleep disturbances, nausea, vomiting, dry mouth, constipation, muscle pain, bone pain and metallic taste.

Later, excessive urination, excessive thirst, loss of appetite, weight loss, conjunctivitis, inflammation of pancreas, inability to face light, excessive nasal discharge, itching, fever, decreased vigor, increased blood pressure, irregular heart beats.


Drug Interactions

* Use of magnesium containing antacid may cause increased magnesium levels in blood.

* Cholestyramine interferes with absorption of Vit D

* If patient is treated simultaneously with Vit D and thiazide diuret ics ( l ike frusemide, hydrochlothiazide), elevated calcium levels in blood may result.

* Phenytoin and barbiturates may increase degradation of Vit D resulting in decreased calcium levels and hence some disorders like o s t e o m a l a c i a ( s o f t e n i n g o f b o n e s ) and rickets.

Patient Information

* Very important to comply with dosage instructions, diet and calcium supplemen-tation.

* Notify physician if any of adverse effects persist for long or become serious.

* Avoid use of magnesium containing antacids/ laxatives while taking this drug.


Q. How safe is aspirin in childhood fevers?

Ans. It is best avoided. It has possible etiologic links with Rye's Syndrome (coma + liver damage), a serious disease. Its use for treatment of fever in children below 12 years is not recommended, specially in cases of chickenpox and influenza.




529Short Profiles of 107 Drugs

Ergometrine

Use

For the active management of the third stage of labour and in treatment of bleeding during labour.

Dosage

Adults: 0.5 mg IV

Precaution

Adverse Effects

* Contraindicated in pregnancy and before 3rd stage of labour.

* To be avoided in breech presentation (delivery of child with feet or buttocks first).

* Rule out multiple pregnancies before its use.


* Abdominal pain

* Sensation of voice in ears

* Slow heart beat

* Difficulty in breathing

* Chest pain

* Vertigo

* Hypertension

* Gangrene


Ethionamide/Propionamide

Brand Name

Myobid-250

Use

Antileprosy used only when therapy with primary agents are ineffective.

Dosage

Adults: 250 mg twice daily. Increase by 125 mg/day every 5 days until a dose of 15-20 mg/kg is reached

Children : 5-7.5 mg/kg daily.

Precaution

Adverse Effects

Liver problems


Liver dysfunction, stomach upset, metallic taste, acne, allergic reaction, hair fall, convulsions, vision problems, dizziness, headache, fall in BP, arthritis

Continue to use the drug and inform the doctor.

530

Contra-indicated

Contra-indicated

Contra-indicated


Over 60

Ethosuximide

Use

Anticonvulsant (to treat convulsions during epileptic fits).

Dosage

Adults : 500 mg initially and gradually increase as required upto 2 gm daily.

Children : 10 mg/kg initially and increase as required upto 30 mg/kg

Precaution

Others

Liver and kidney problems

Adverse Effects

GI symptoms including n a u s e a , v o m i t i n g , diarrhoea, weight loss, abdominal pain, con-stipation, anemia, confusion, depression, rashes, urinary frequency, kidney damage, muscular weakness, edema, swelling of the tongue, vaginal bleeding, gum enlargement, agitation.


Patient Information

* If gastro intestinal upset occurs, take with food or milk.

* Do not discontinue medicine abruptly.

Flucytosine

Use

Antifungal against severe fungal infection of blood and urinary tract.

Dosage

Adults:100-150 mg/kg/day in 4 divided doses by mouth or as IV infusion.

Children: 12-16 mg/kg daily by mouth or IV infusion.

Precaution

Others

Liver and kidney problems.

Blood disorders.

Adverse Effects

Nausea, vomiting, diarrhoea, rash, anemia, hallucinations, headache, vertigo, sedation.

Liver dysfunction.


Patient Information

* May cause gastro intestinal upset.

* Nausea and vomiting may be reduced or avoided by taking capsules a few at a time over a 15 minute period.

Contra-indicated

Contra-indicated

Contra-indicated




Contra-indicated

Safety notestablished



Over 60

Furazolidone

Brand Name

Alfumet+, Dependal-M, Furoxone, Kaltin-MF, Lomofen, Metrogyl-F

Use

Antibacterial and antiprotozoal.

Treatment of diarrhoea and gastroenteritis of bacterial origin.

Used at site of injection (with nifroxime) to treat vaginal infections.

Dosage

Adults:100 mg (4 times daily) for 2-5 days.

Infant Children: 2 - 1 2 M o n t h s : 1 2 . 5 m g . 1-4 Years: 25 mg. 5 Years & above: 50 mg 4 times daily.

Precaution

Others

G6PD Deficiency

Adverse Effects

* Mild toxic symptoms (headache, nausea)

* Measle-like rashes

* Changes in blood

* When used for vaginal infections may occasionaly cause swelling of vulva or itching.


Patient Information

* Foods with high tyramine content (cheese, beer, red wine) and alcohol should be avoided during and for short time after treatment.

Gentamicin

Brand Name

Biogaracin, Garamycin, Genticyn, Lyramycin

Use

* To treat infections of blood by organisms or their toxins

* To treat meningitis and other infections of CNS

* Against inflammations of kidney and prostate gland.

* Topical application may be used against eye/ear infections.

Dosage

By intramuscular-slow injection/IV infusion.

Adults: 2-5 mg/kg/day (in divided doses) every 8 hours.

Children: 0-2 weeks old: 3 mg/kg every 12 hours, 2 weeks -12 yrs: 2 mg/kg every 8 hours.

Eye ointment: 0.1 - 0.3% every 6-12 hours.

Eye/ear drops: 0.1 - 0.3% every 4-8 hours.

Precaution

Others

* Must be stopped before you have general anaesthesia

* Should not be given for longer than ten days usually.

* Reduce dose if kidney problems.

532

Contra-indicated

Contra-indicated

AvoidContra-indicated

Contra-indicated

Contra-indicated

Contra-indicated





Adverse Effects

Abnormal liver and kidney functions, anemia, roaring in the ears, paralysis, dizziness, vertigo, confusion, lethargy, respiratory distress, headache rashes, tremor, muscle twitching and weakness, decreased appetite, weight loss, joint pain, palpitations, burning at the injection site.


Amphotericin B, bacitracin, cisplastin increase the adverse effects of the drug.

Glucose

Brand Name

Beplex, Emlytepreps, Gesicaine heavy 5%

Use

To replace water deficit which may occur under different conditions like coma, aging.

Dosage

Adults:1-3 ltrs. of 20-50 % solution daily by slow IV infusion

Adverse Effects

* Fever, infection at site of injection, damage to tissues/blood vessels, dehyd-ration, mental confusion or unconsciousness may result if p r o b l e m w i t h c o m p o s i t i o n o f solution/administration technique.

* Very concentrated solutions may cause irritation. Increased blood sugar levels may result if too rapid administration.

* Increase in serum insulin levels


Drug Interactions

* If pat ient receives cor t iosteroids or corticotropin, parenteral fluids should be administered with caution.

* Dextrose administration may cause Vit B complex deficiency.

* Blood and dextrose should not be admin-istered

simlutaneously through the same infusion to

prevent clumping.


Q. How do you justify the use of antibiotics?

Ans. Antibiotics are necessary only in bacterial infections. Infection mostly presents as fever though every fever may not be due to infection. Only if you suspect bacterial infection then use an antibiotic.


Griseofulvin

Brand Name

Grisactin FP, Grisofil FP, Idifulvin, Walavin 250

Use

Antifungal for treatment of variety of fungal infections of skin, nails and hair

Dosage

Adults: By mouth 10-15 mg/kg daily in 3 divided doses for 1-18 months depending on infection.

Children: By mouth - 10 mg/kg/day 6-12 hrs. for 6-12 weeks.

Note: Dose may be doubled if necessary.

Precaution

Others

* Porphyria (rare, inherited blood disease)

* Pregnancy

* Sensitivity to sunlight

* Pencillin sensitivity

* Systemic Lupus Erythematosus (a chronic, inflammatory disease affecting the skin and various internal organs)

Adverse Effects

Skin rashes, edema, oral thrush, nausea, vomiting, diarrhoea, headache, fatigue, mental confusion, photo allergy.



Drug Interactions

* It decreases the efficacy of warfarin, phenytoin and barbiturates (e.g., pheno-barbitone).

* Take entire course of therapy - effects are seen after sometime.

* Sensitivity to sunlight may occur. Avoid exposure to sunlight.

* Notify physician if fever/sore throat rashes occur.

534


Q. If temperature is high inspite of paracetamol, what should be done?

Ans. Tepid water sponge.

Contra-indicated

Contra-indicated




Haloperidol

Brand Name

Depidol, Halidol, Hexidol, Serenace, SereBanthine

Use

Antipsychotic, to treat schizophrenia, mania, agitation, excitation, dangerously impulsive behaviour

Dosage

Adults: Mental illness: 1.5-20 mg/day initially and increased gradually if needed upto 200 mg

Children: (not recommended), 25-50 micrograms/kg daily to maximum10 mg

Adolescents: 30 mg

Precaution

Others

For liver and kidney problems, epilepsy, lung disorder, Parkinson's disease

Adverse Effects

Abnormal movements of face and limbs, lethargy, weight gain, dizziness, rash.


Patient Information

* Notify physician if impaired vision, jaundice, tremors or muscle twitching occur.

Over 60

Over 60

Hydralazine

Brand Name

Corbetazine +

Use

Antihypertensive preferred in pregnancy, although safety is not established

Dosage

Adults: 40-100 mg daily in 4 divided doses, maximum 200 mg daily.

Children: 0.75-7.5 mg/kg/daily every 6-8 hrs.

Precaution

Others

* Kidney or liver problems.

* Heart problems

* Old age.

Adverse Effects

Headache, nausea, vomiting, fast heart beat, numbness and tingling, rashes, fever, difficulty in urination, fluid accumulation, loss of appetite. Redness of eyes, nasal stiffness.



Patient Information

* Take with meals

* Do not discontinue this medication suddenly.

* Avoid cold, cough or allergy medication.

* If dizziness occurs, avoid sudden changes in posture.

Contra-indicated

Contra-indicated

Contra-indicated




Contra-indicated

Contra-indicated

Contra-indicated

Contra-indicated




Over 60

Hydrochlorthiazide

Brand Name

Adelphane, Esidrex, Arkamin H, Beta Biduret, Betanol D+, Ciplar H+, Dibeta+, Esidrex, Invozide+

Use

Diuretic, used to reduce fluid retention, treat kidney disorders, heart problems and high BP.

Dosage

Adults : 25-200 mg daily

Children : 2 mg/kg/day every 12 hours.

Precaution

Others

Kidney diseases, liver diseases, gout, diabetes.

Adverse Effects

Cramps, abdominal bloating, constipation, jaundice, frequent urination, impotence, headache, weakness, lethargy, fatigue, muscle cramps, nervousness, agitation, anemia, chest pain, skin rashes, blurred vision, chills, flushing.



Drug Interactions

Barbiturates (like phenobarbitone) and narcotics (eg. opium, morphine, pethidine) aggravate adverse effects and decreases the efficacy of thiazides (a class of drugs used as diuretics, eg., frusemide, hydro-chlorthiazide) and so does indomethacin and o ther NSAIDS (non-s te ro ida l an t i -inflammatory drugs, like ibuprofen, aspirin, diclofenac, phenylbutazone).

T h i a z i d e d r u g s d e c r e a s e r e s p o n s e t o norepinephrine.

Cholestyramine and colestipol decrease the absorption of drug.

Patient Information

* Take with food or milk.

* Will increase urination early during the day, may increase blood sugar levels in diabetes so notify the physician.

* Eat food rich in potassium.

536

Contra-indicated

Contra-indicated

Contra-indicated

Contra-indicated


Q. Which are the commonly used drugs in which dose should be calculated on the basis of active base and not on the actual strength of the salt?

Ans.

1. Chloroquine for treatment of malaria. Most chloroquine tablets containing 250 mg of phosphate salt (150 mg of base). Most liquid preparations have 50 mg of chloroquine base per 5 ml.

2. Theophyline preparations in use for bronchial asthma. Different preparations have different strengths of the base. Find it out from the manufacturer.



HydrocortisoneBrand Name

Wycort , Allocort, Furain-S

Use

Corticosteroid - used to make up for deficiencies of the gluco-corticoid group of hormones.

Topical application helps treatment of various skin disorders.

Dosage

Adults: 100-200 mg varies according to condition.

Children: 20-40 mg every 4-6 hr. IM or IV.

Replacement therapy 20-25 mg/day oral.

Precaution

Others

Peptic ulcer, glaucoma, TB, herpes infection, mental illness

Adverse Effects

Indigestion, weight gain, acne are common adverse effects. Prolonged high dosage may cause diabetics, glaucoma, fragile bones and thin skin.

May retard growth in children.

Otherwise same adverse effects and actions to be taken as dexamethasone.


Barbiturates, anticonvulsants, rifampicin reduce effect of drug. Effect of antidiabetic and antihypertensive drugs reduced by drug.

Severe reactions possible with vaccines.

Same precautions otherwise as dexamethasone.

Over 60

Over 60

Imipramine

Brand Name

Depsonil

Use

Antidepressant (for long-term use)

Dosage

Adults: 75-200 mg daily (increased in exceptional circumstances)

Children: Reduced dose according to age and weight.

Precaution

Others

Heart problems, epileptic effects, glaucoma, prostate trouble

Adverse Effects

Fast heart beat, palpitation, heart block, confusion, disturbed concentration, halluci-nation, decrease in memory, delusions, anxiety, nervousness panic, insomnia, skin rashes, bone marrow depression, abdominal cramps, diarrhoea, flushing chills, urinary retention, jaundice.



Drug Information

* Phenothiazines, cimetidine, quinidine, procainamide increase the toxicity of the drug.

* The drug antagonises the actions of clonidine, guanethidine, methyldopa, metrizamide, disulfuran, et al.

Contra-indicated

Contra-indicated

Contra-indicated

Contra-indicated

Contra-indicated


Avoid

AvoidAvoid

Contra-indicated


537




Indomethacin

Brand Name

Indicin, Indo Cap/SR

Use

Non steroidal anti-inflammatory, antiarthritis, antigout

Dosage

Adults: For arthritis: 25-50 mg, 2-4 times daily, increase by 25-50 mg daily at one week interval.

For gout: 100 mg daily and then 50 mg thrice daily till required.

Children : Not recommended.

Precaution

Others

* History of GI lesions.

* If headache persists

* Impaired kidney function.

* Presence of infection

* Eye complaints

* Hypertension

* Impaired liver function

* Low blood counts

* Parkinson's.

* Epileptic fits.

Adverse Effects

Pain in upper regions of abdomen, heart burn,

indigestion, bleeding from peptic ulcers, blood in

stools, jaundice, headache, nervousness, tension,

fall in blood pressure, chest pain, irregular heart

beat, congestive heart failure, kidney damage,

anemia, asthma, rashes, blurred vision.

Over 60

Patient Information

* Avoid prolonged exposure to sunlight or sunlamps.

* Avoid alcohol and other depressant drugs.

* Notify physician if dry mouth, difficulty in urination or excessive sedation occurs.

538

Contra-indicated

Contra-indicated

Contra-indicated

Contra-indicated

Contra-indicated


What are hazardous drugs?Hazardous drugs are those with high unfavourable side-effects. Since safer and effective alternatives are usually available, they should not be marketed at all. See Chapters 2, 3, 4 and 8 of Section 1 for more information.

Death in the bottle

So

urce : V

HA

I



Drug Interactions

Indomethacin reduces the effects of furosemide and thiazide diuretics.

With lithium can lead to lithium toxicity.

Aspirin should not be given with the drug.

Patient Information

* Take with food/ milk/antacid.

* Notify physician if skin rashes edema, weight gain black stools.

Iodine

Brand Name

Iodophil, Viscous, Urografin

Use

Antiseptic for wounds, burns, ulcers.

* To disinfect the skin preoperatively

Dosage

Use a solution containing 2.5 gm/100 ml water as required.

For sterilising water : add 4 drops to 1000 ml water, at least 15 min before use.

Note: Wash skin and all other surfaces before applying iodine solution.

Precaution

Others

* Patients with thyroid gland disorders.

* If irritation occurs in superficial wounds without infection.

Adverse Effects

Irritation, running nose, sore weeping eyes, fever, headache, coughing and pain and swelling over the angle of the jaw.


* Store in glass or earthen ware container with a well waxed stopper.

* Do not use metal bowls.

* Accidental ingestion causes vomiting, diarrhoea, stomach pain.

Give milk/starch mucilage (sticky, viscous preparation) before inducing vomiting and then give activated charcoal.

Contra-indicated

Contra-indicated


Q. Which is the safest and most effective antipyretic and analgesic to be used in children?

Ans. Common ones which can be used are:

1. Paracetamol - (Dose 10-15 mg/kg/dose every 4-6 hrs)

2. Mefenamic acid - (Dose 6 mg/kgm/dose every 6 hrs)

3. Ibuprofen - (Dose 20 mg/kg/day divided into 3 doses)

539



Ipecauanha

Use

Antiemetic (Antivomit)

Dosage

Adults: 30 ml

Children: 6-18 months: 10 ml

Older Children: 15 ml dose followed by tumblerful of water and repeated after 20 minutes if necessary

Adverse Effects

* Excessive vomiting and mucosal damage.

* Cardiac effects if absorbed.

Discontinue and call doctor immediately.

Iron Dextran

Use

Supplementation of iron to correct iron deficiency anemia

Dosage

Adults: 30-100 mg deep IM injection

Children: Reduced dose 30-60 mg

Precaution

Others

* Liver damage

* History of allergy or asthma

Adverse Effects

* Allergic reactions could occur - rashes, itching, difficulty with breathing, sometimes fatal allergic reactions.

* IM injections - variable degrees of soreness at or near the site of injection.

* IV administration - inflammation of blood vessel at the site of injection, if too rapid IV infusion, reddening all over the body may result. Pigmentation of the skin at the site of injection.


Drug Interactions

* Response to iron dextran injections is delayed in patients with iron deficiency anemia also receiving chloramphemiol.

* Resistance to treatment may occur in cases of decreased generation of blood cells, alcholism, presence of antimetabolic drugs and deficiencies of Vit. B 6, B 12 C or E.

* Vit.C enhances absorption of iron.

540


Q. Is there any role of haemoglobin or protein preparations in anemia or malnutrition?

Ans. Haemoglobin tonics and protein preparations are very expensive and have minimal utility if any. A patient who cannot afford to have food is likely to suffer from these problems, so how can he/she afford to buy these tonics. It is advised not to use these tonics in affluent community also as they are usually unnecessary and irrational. Don't ever give free samples of these drugs to poor patients as they are likely to buy them later from the chemists. They should be in your hospital pharmacy or on your desk.

Avoid


Isoniazid (INH) & Thiacetazone

Use

Treatment of TB

Dosage

Adults:1 tablet daily (300 + 150 mg) by mouth.

Children under 6 years: 1 tab (100 + 50 mg), 6-12 yrs.: 2 tablets (100+50 mg), Over 12 years: 1 tablet (300 + 150 mg) daily by mouth. When the combination is given to small children, an extra dose of INH upto 10-20 mg/kg (max.300 mg) can be given because INH elimination from their bodies seems more rapid. Take on empty stomach.

Precaution

Others

Liver damage, high risk of adverse effects on nervous disorders in malnourished, anemics and those with seizure disorders

Adverse Effects

INH allergic reaction can cause serious liver damage especially in people over 35 years and regular alcohol consumers.

INH causes deficiency of Vitamin B 6 leading to nerve pain and tenderness in hands, feet.

Blurred vision/changes in vision.

Damage to the nervous system.

Allergic reaction to thiacetazone can be fatal. If there is allergy/itching, discontinue and call the doctor immediately.

Over 60


Drug Interactions

* INH can interact with anti-convulsants, antiepilepics (carbamezipine, phenytoin) to reduce activity of latter.

* INH interacts with antacids.

Antacids if needed should be taken at one hour interval before or after taking INH.

Patient Information

* If a dose is missed, take as soon as you remember, skip if time for the next dose. Do not take double doses.

* Pyridoxine (B6) supplementation may be necessary to decrease adverse effects.

* Take on empty stomach, 1-2 hrs before meals. In case of stomach upset, take with food after crushing and mixing with water.


Contra-indicated

Contra-indicated



Q. Which antitubercular drugs are not hepatotoxic?

Ans. Streptomycin

Ethambutol


Contra-indicated

Over 60

Isosorbide Dinitrate

Brand Name

Isordil, Sorbitrate, Isomac - Retard

Use

* To treat sudden severe attacks of chest pain (acute angina).

* To prevent frequency of heart stroke or failure (angina pectoris) or congestive heart failure.

Dosage

Acute attacks: 5-10 mg every 2-3 hours sublingually or as chewable tabs.

Prevention: 20-40 mg 3-4 times daily or as per patients' need. Upto 120 mg daily in divided doses may be necessary. Increase in dose should be gradual.

Precaution

Others

Allergy to nitrates

Adverse Effects

* Most serious could be excessively lowered BP

Overdose: Bluish lips, finger nails, fainting, dizziness, unusually seizures, blurred vision and skin rash.

* Headache is a common untoward effect, it does not require discontinuation.


Patient information

* In case chest pain persists after taking

3 tablets ca l l the doctor immediate ly (1 tab = 5-10 mg of the drug).

* Do not stop taking the the drug suddenly.

Consult doctor about this. Sudden stoppage may cause heart attack.

* Do not take other drugs without consulting doctor, especially those against high BP, irregularity of heart beat, (e.g., anti-blood clotting agents, and anti-depressants.)

* Store in tightly closed containers. Exposing the drug to air causes it to lose its effectiveness.

* Take on an empty stomach with full glass of water to allow fast action.

* Extended release capsules and tablets are not to be broken or crushed or chewed before they are swallowed

Inform doctor in case of blood disorders or anaemia, glaucoma, food absorption problem, hemorrhage of blood vessel supplying to head, liver problem, recent heart attack.

542




Q. Which drug should be avoided in a patient having G-6PD deficiency?

Ans. A number of drugs lead to severe intravascular hemolysis in a known patient of G-6PD deficiency. The drugs known to cause significant hemolysis in G-6PD deficient children include antimalarials (primaquine, quinine chloroquine), n i t r o f u r a n t o i n , f u z a z o l a d o n e , sulfonamide, nalidix acid, aspirin, analgin and naphtalene which is used in moth balls.


Contra-indicated

Avoid Avoid


Ketoconazole

Brand Name

Funazole

Use

Antifungal agent

Dosage

Adults: 200 mg once daily with food (14 days) maximum 400 mg daily.

Children: 3 mg/kg daily.

Precaution

Others

Liver or kidney problems, stomach ulcers, if there have been allergic reactions to antifungal drugs.

Never to be taken with terfenadine.

Adverse Effects

Nausea, abdominal pain, itching, skin rashes, fatal liver damage



Drug Interactions

* Antacids and ulcer healing drugs should not be given.

* Take the dose at the same time every day.

* Do not store in damp places.

* Do not take with antacids.

* Take with food.

* Notify physician if abdominal pain, diarrhoea,

Over 60

Levamisole

Brand Name

Vermisol, Vizole

Use

Antihelminthic

Dosage

Adults: 2.5 mg/kg

Children: 2.5 mg/kg

Precaution

Others

Nausea, vomiting.

Epigastric discomfort.



Not advisable to take drug in cases of kidney and liver insufficiency.

Avoid Contra-indicated










544

Fever is a friend ;it fights disease

when high, paracetamol alone is adequate


Co

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: Ind

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Levodopa + Carbidopa

Brand Name

Bidopal, Levopa, Syndopa, Tidomet

Use

To treat Parkinson's disease

Dosage

Adults: 125 mg twice daily after food for 1 week, then 125 mg 4 times daily for 1 week and finally 375 mg daily upto 8 gm daily maximum.

Children: Above 12 yrs: Same as adult dose.

Upto 12 yrs.: Dosage not established.

Precaution

Others

* Hypersensitivity to the drug.

* Patients with suspicious history of skin lesions, skin cancer or melanoma.

* With heart problems, lung, kidney or liver disease

* Severe psychosis

* Peptic ulcer

* Glaucoma

Adverse Effects

Uncontrolled movements, nausea and vomiting, abdominal pain, headache, psychotic problems like hallucinations, anxiety, agitation and delusions, nightmares, fatigue.


Others are irregular heart beat, mental changes,

urinary retention, muscle twitching, burning sensation of tongue, bitter taste, diarrhoea, constipation, skin rash increased sweating, blurred vision, loss of hair, fluid accumulation, edema, weight gain, dark sweat or urine.

Altered taste.


Drug Interactions

Reserpine, benzodiazepines (e.g., diazepam, used as a n t i - p s y ch o t i c ) , p h e n o t h i a z i n e s ( e . g . , chlorpromazine), butyrophenones, thioxanthenes (used as anti-psychotics) reduce the efficacy of levodopa and should not be given with it. Phenytoin reverses the effect. Levodopa increases heartbeats with anaesthetics like halothane, has enhanced low BP effect with antihypertensives, while iron reduces absorption of levadopa. Levadopa levels increased by domperidone and metoclopramide.

Amphetamines should not be be given as they affect the heart adversely.

Dietary effects

Avoid taking Vitamin B 6.

Patient Information

* May cause GI upset so take with food.

* May cause darkening of urine or sweat.

* If fainting, dizziness occurs, avoid sudden changes in posture.

Contra-indicated

Contra-indicated

Contra-indicated

Contra-indicated



Levothyroxime

Use

Thyroid replacement therapy (for thyroid hormone deficiency)

Dosage

Adults : Initially for 2-4 weeks (0.1 mg daily) to be increased (0.05 mg) every 2-3 weeks

Children : Initially 0.025mg increased to 0.1 mg and maintained

Precaution

Others

Diabetes

Heart Problems

Adverse Effects

* Rare except in case of over dosages.

* Symptoms of over dosage/too rapid dosage include palpitation, elevated pulse pressure increased heart beats, irregular heart beats, cardiac arrest.

* Tremors, headache, nervousness, insomnia.

* GI disorders

* Allergic skin reaction (symptoms differ in case of chronic and acute over dosage.


Drug Interactions

Thyroid replacement increases anticoagulant (antiblood clot) effects with agents such as warfarin or bishydroxycoumarin. Hence, during thyroid therapy reduce dose of anti-coagulants to one third.

* Thyroid therapy may require increase in dosage of insulin or oral hypoglycemic (low blood sugar inducing) agents.

* Cholestyramine interferes with the uptake of thyroid from the intestine. About 4-5 hours should elapse between intake of both drugs.

* If oestrogens are taken, levels of hormone required in blood are lowered, hence increased dose of thyroid needed.

Patient Information

* Replacement therapy is generally needed for a life time.

* Do not discontinue except on the advice of a physician.

* Notify physician case of adverse effects.

* Partial hair loss seen in children during first few months of thyroid therapy. Usually a transient phenomenon. Hair is recovered back.

546





Over 60

Lindane (Gamma Benzene Hexachloride)

Use

To treat scabies and infestation (of scalp, body and pubic hair) by lice.

Dosage

Adults: 1% lotion/oint. applied to the affected parts for 12-24 hours.

Scabies: Repeat after 4 days.

Precaution

Others

* Do not apply to broken skin.

* Do not apply to mucous membranes.

* If it enters the eye, rinse with water immediately.

* Boil all clothes, towel of patient.

Adverse Effects

Nervousness, sleeplessness, irrtability, vertigo, profound unconsciousness.

Irregular heart beats.

Never to be taken orally.


Patient Information

* Do not apply to face.

* Notify physician if skin rashes occur.

* Do not exceed prescribed dosage.

Lithium Carbonate

Brand Name

Licab/XL

Use

Treatment of maniac depression, aggressive or self-mutilating behaviour

Dosage

Adults: 0.25-2 gm daily dose adjusted to achieve a +

plasma concentration of 0.4-1.0 mmol Li /litre 12 hours after preceding dose on 4th or 7th day of treatment and then every week for 4 weeks and then every 3 months.

Precaution

Others

Heart or circulatory problems,kidney or liver problems, overactive thyroid gland, myasthema gravis.

Serum Lithium levels to be monitored regularly and +

kept between 0.4 to 1.0 mmol Li /litre.

Adverse Effects

Muscular pain, blurred vision, gastro-intestinal disturbances, vomiting, diarrhoea, increased CNS disturbances like drowsiness, loss of power of muscular coordination (ataxia), tremor, lack of coordination, weight gain, convulsions.


Contra-indicated

Contra-indicated

Contra-indicated

Contra-indicated

Contra-indicated

Contra-indicated


Avoid Increased risk of adverse effects



Drug Interactions

* Theophylline, thiazide diuretics and furosemide should not be given.

* Indomethacin, phenytoin, tetracycl ine, methyldopa, carbamazepine, haloperidol, increase lithium toxicity and should not be given together.

Patient Information

* Maintain adequate fluid and salt intake.

* Drink 10 to 12 glasses of fluid daily.

* Take medication with food/milk.

Discontinue therapy if signs of toxicity occur.

* Avoid sauna bath (causes dehydration)

* Contact physician if fever or diarrhoea occur.

Mannitol

Brand Name

Stilamin

Use

Osmotic diuretics

Dosage

Adults: By IV infusions : Diuresis 50-200 gm over 24 hours, preceded by a test dose of 200 mg/kg by slow IV injection.

Cerebral oedema : 1 gm/kg as a 20% solution given by IV infusion.

Others

Heart failure and pulmonary oedema (excessive fluid in lungs)

Adverse Effects

Chills, fever, urinary retention, edema, dryness of mouth, thirst, dehydration.


548

"Oh but every medicine has these things called side-effects you know...."

Essen

tial D

rugs M

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itor


Over 60

Mefloquine

Use

Antimalarial

Dosage

Adults: 250 mg per week for 4 weeks

Children: 2-5 years: 1/4 adult dose, 6-8 years: 1/2 adult dose, 9-11 years: 3/4 adult dose.

Precaution

Others

Nausea, vomiting

Adverse Effects

Digestive problems dizziness, headache, sleep disturbances, hallucinations, itching, skin rashes and lesions.

Slow heart beat abnormal spontaneous sensations of burning, pricking.

Confusion, depressive feeling.

Continue the drug and consult your doctor.


Drug Interactions

* Digoxin should not be taken.

* Epileptic patients taking valproate should not take mefloquine.

Methylene Blue

Use

Treatment of drug induced methaemo-globinemia, the presence of methemoglobin (a transformation of haemoglobin) in circulating blood.

Also in treatment of urinary tract infection.

Dosage

1% solution of methylene blue as injection, using a dose of 1 mg/kg.

Adverse Effects

* Discolours urine and stool (blue green).

* May cause bladder irritation.

* Nausea, vomiting, diarrhoea.

* Large doses-abdominal pain, dizziness, headache profuse sweating, fever, mental confusion and decreased oxygen carrying capacity of blood.

* Subcutaneous Injection: Inflammation at site of injection.

* Intrathecal injection: Neural damage.

* Injection in aminiotic sac - irregularities in heart beat of foetus, anemia in newborn, blood disorders and blue skin.


Patient Information

* Take oral form after meals with a glass of water.

* May stain skin blue, can be removed by a hypochlorite solution.

Avoid

Avoid

Avoid

Avoid

Avoid


550

Cleaning woundsimmediately is essential

clean with soap & water only----- ointments not necessary


Co

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Over 60

Morphine

Brand Name

Morcontin Continus

Use

* To relieve pain - moderate to severe, caused by injury, surgery or any form of chronic pain.

* Induces sleep and lessens anxiety. Therefore may be used as a premedi-cation before surgery.

* Reduces intestinal motility (power of spontaneous movement) and is used in the symptomatic treatment of diarrhoea.

Dosage

5-25 mg per dose. However, dosage may vary from individual to individual.

Administered as tablets or injections.

Precaution

Others

Should be taken with caution in patients suffering from impaired liver function, prostate enlargement, shock or decreased blood volume.

* Contraindicated in head injury and in patients with lung diseases.

Adverse Effects

In normal doses: Nausea, vomiting, consti-pation, drowsiness, confusion may cause transient side-effects.

In larger doses: Respiratory problems, decrease in blood circulation and blood pressure, convulsions.

Over 60

MetoclopramideBrand Name

Emenil, Maxeron, Perinom, Tomid

Use

Anti-vomit agent

Dosage

Adults: 10-15 mg, 4 times daily. Not greater than 0.5 mg/kg body weight.Take 30 mins. before meals and at bedtime.

Children: 0.5-2.0 mg/kg/day every 6-8 hrs.

Precaution

Others

Kidney and liver problems, patients with epilepsy

Adverse Effects

Muscle dystonias (abnormal muscle contractions).

* CNS: drowsiness restlessness, fatigue, loss of sleep, depression.

* GI nausea, diarrhoea, rapid heart beat, asthmatic attacks.

Drug induced movement disorder.



Drug Interactions

Sedatives and tranquilisers should not be taken with the drug. Drug reduces the absorption of digoxin, cimetidine and accelerates that of tetracycline, levodopa, aspirin and diazepam.

Patient Information

* Take medication 30 mins before meal.

* Notify physician if involuntary movement of eyes and limbs occur.

551

Contra-indicated

Contra-indicated

Contra-indicated

Contra-indicated


Contra-indicated

Contra-indicated

Contra-indicated

Contra-indicated

Contra-indicated

Reduced dose to be taken


In long-term use: Habit forming and causes addiction.


Drug Interactions

* If taken with other sedatives and alcohol, increases the sedative effects.

Nitrous oxide, diazepam, chlorpromazine, cimetidine should not be given.

Patient Information

Notify physician if shortness of breath occurs.

Physical dependence occurs on prolonged use.

NeomycinUse

Bacterial infection in ears, bowel sterilisation, acute eye infection.

Dosage

As eyedrops: 0.5% (3500 units/ml); bowel sterilisation: by mouth - 1 gm every 4 hours

Precaution

Adverse Effects

* Nausea, vomiting and diarrhoea.* Decreased absorption of nutrients.* Colitis (inflammation of colon)* Prolonged use/high dosage therapy - damage to

kidneys and auditory system.* Topical preparations may also cause kidney damage

(nephrotoxicity) and damage to auditory system (ototoxicity)


Drug Interactions

Oral Neomycin therapy* Should not be administered with penicillin V

potassium.* Decreases effect of digitalis. Space the intervals

between intake of the two drugs.* Enhances effects of oral anticoagulants by causing

malabsorption of Vitamin K.* Avoid concurrent use of diuretics to reduce risks

of adverse effects.* Avoid concurrent use of other nephrotoxic and

ototoxic agents (kidney and ear toxic).Patient Information

Oral therapy

* Complete full course of therapy.* Notify physician if ringing in ears, hearing

impairment or dizziness occur.Topical application

* Cleanse affected area prior to application unless otherwise directed.

Contra-indicated

Source : Medical Ethics Vol.3, No.4October - December 1995


Over 60

Niclosamide

Brand Name

Niclosan

Use

Antihelminthic

Dosage

Adults: 2 gm as a single dose for 7-14 days.

Children: (11 - 34 kgs) 0.5 - 1 gm as a single dose.

(Above 34 kgs): 1 - 1.5 gm as a single dose.

Precaution

Others

Chew tablets properly

Adverse Effects

Nausea, constipation, rectal bleeding, drowsiness, headache, skin rashes, fever, weakness, bad taste in mouth, rapid heart beats, backache and irritability.


Patient Information

* Chew tablets, then swallow with a small amount of water.

* Take with food (after breakfast).

* Use laxative to relieve constipation if necessary.

* Notify physician if condition worsens, or if rash or irritation develops.

553

Nifedipine

Brand Name

Calcigard, Depicor, Depin, Myogard, Nicardia, Nifelat

Use

* Treatment and prevention of angina and myocardialinfarction

* Used to control high blood pressure

Dosage

Adults: 10 mg thrice daily during meals or after. Increase to 20 mg if required. Liver problems in elderly: 5 mg thrice daily. Usual maintenance dose: 5-20 mg, 3 times daily.

For immediate relief

From heart stroke: Bite into capsule and swallow liquid.

For mild to moderately high blood pressure: 30 mg once daily. Increase if necessary. Decrease if liver problems.

Maxmimum 90 mg/day once.

Precaution

Others

* Low heart rate

* Severe low BP

* Liver problems

* Diabetes

* Allergy to nifedipine

Contra-indicated



Avoid Avoid

Avoid Avoid

Contra-indicated

Contra-indicated



Over 60

Adverse Effects

Transient headache, flushing, lethargy.

Less common: difficulty in breathing, chest pain, fainting, irregular heart beat, rashes/reddening.


* Serious adverse effects may result in patients with compromised heart function

* Swelling over feet


Patient Information

* Do not stop taking this drug suddenly. Consult the doctor before doing so.

* More effective when low sodium diet and exercise are included in the daily regime.

Drug Interactions

* Quinidine (antiarrhythmic)

* Rifampicin (antibacterial)

* Phenytoin (antiepileptic)

* Antihypertensive (against high BP)

* Muscle relaxants

Nitrofurantoin (NFT)

Brand Name

Furadantin, Nephrogesic, Trifuran

Use

Prevention and treatment of infections of urinary tract.

Dosage

Daily 5-7 mg/kg

Adults: 50-100mg 4 times daily, during or immediately after meals for about 14 days.

Infants: 1 month or more: 5-7 mg/kg/day. Reduce dosage if it is to be used beyond 10-14 days.

Preventive dose : 50-100 mg as a single dose at bed time.

Precaution

Others

* Not to be used in case of kidney damage, diabetes, liver damage.

Adverse Effects

* Dangerous drug especially in the old. Affects peripheral nervous system (PNS).

* Anemia and other blood disorders.

* Rare : skin rashes, fever or other allergic reactions.


* Long-term therapy: Irreversible damage to lungs and liver.

Avoid

Avoid Avoid Avoid

AvoidSafetynotestablished



Patient Information

* Take medication even after symptoms subside till you have completed the entire course.

* Avoid the drug as far as possible especially if you are over 60 yrs.

* Gives a false positive result for urinary glucose (in tests for diabetes).

* Interacts with a wide range of drugs. Inform doctor of all drugs being taken before taking NFT.

555

Nitrous Oxide

Use

Inhalation anaesthetic

Dosage

General anaesthesia induction: 70 % with 30 % oxygen.

Maintenance - Inhalation 30% to 70% with oxygen.

For obstetrics or procedures not requiring loss of consciousness-

Inhalation 25-50 % with oxygen.

Precaution

Others

* Intestinal obstruction

* Pneumothorax (air in pleural cavity of lungs)

* Head injury

* High doses in prolonged delivery.

Adverse Effects

Diffusion, lack of oxygen, drug induced high fever, delirium, irregular heart beats, inability to walk, loss of bladder and bowel control, mental changes, n u m b n e s s i n h a n d s , l e g s or feet or unsteadiness, breathing problems, nausea, vomiting, sore throat, blood disorders.

Contra-indicated

Contra-indicated


Norethisterone

(Combined oral contraceptive pills)

Brand name

Noristerat

Use

Female sex hormones

* for treatment of menstrual disorders (absence of periods)

* bleeding of uterus

* to treat endometriosis (see below)

* as a contraceptive

Dosage

Adults: To prevent pregnancy - 1-5 mg/day starting on day 5 of the cycle and continuing uninterrupted thereafter.

Female hormonal imbalance: 5-20 mg a day on day 5 through day 25 of menstrual cycle.

Endometriosis (a condition in which fragments of uterine lining occur outside the uterus in the pelvic cavity): Initially 10 mg a day for 2 weeks, then led by 5 mg at 2 week intervals upto 30 mg/day for 6-9 months.

Precaution

Others.

* Test for pregnancy

* Carcinoma of breast or reproductive organs.

* Liver problems

* Undiagnosed vaginal bleeding

* Missed abortion

* Asthma

* Heart problems

* Depression

* Epilepsy

* Kidney problems

* Migraine, pregnancy

* Thrombophlebitis (a kind of inflammation of veins)

Adverse Effects

Heart disorders, pulmonary embolism (a kind of obstruction in the lungs), altered menstrual patterns, vision problems, bulging eyes, severe headaches, pain in chest, groin or leg, breathing problems, slurred speech, numbness or pain in arm or leg, mental depression, skin rashes changes in appetite and weight.



* Take at same time each day.

* When used for contraception. Discontinue use when a dose is missed and use alternative birth control method until menstrual cycle begins or pregnancy is ruled out.

Contra-indicated

Contra-indicated


Over 60

Nystatin

Brand Name

Mycostatin

Use

Oral form: to treat infection in mouth and intestinal infections caused mainly by fungi.

Topical: to treat skin infections caused by fungi.

Vaginal: to fungal infection of vagina/vulva.

In most cases above, the causative fungus is of Candida albicans.

Dosage

Adults: Oral form : 500,000 to 100,0000 units 3 to 4 times/day.

Infants: 100,000 units or more 4 times daily.

For lesions of mouth : Suspension containing 100,000 units used.

For tropical use: 100,000 units per gm. of ointment/cream/gel may be applied. For vaginal infection : 1 or 2 pessaries contanining 100,000 units inserted daily. (1 mg = 3000 units)

Precaution

Others

History of sensitivity to nystatin

Adverse Effects

Occasionally : nausea, vomiting and diarrhoea may result.

* Following topical use allergic reaction may be seen.

557



Patient Information

* All the nystatin a doctor prescribes should be taken even if you feel better before the entire course finishes. If stopped too soon, symptoms can come back.

Contra-indicated





Over 60

Over 60

Pethidine

Use

Narcotic analgesic (pain killer)

Dosage

Adults: 50-150 mg/dose

Children: 1-2 mg/kg per dose IM or IV

Precaution

Others

Kidney, liver, heart problems, epileptic fits, asthma, bronchitis, thyroid disorder, prostate problems.

Adverse Effects

Dizziness, nausea , vomit ing , drowsiness, constipation, confusion, breath shortness, dry mouth.

Overdose symptoms :

* Muscle twitching, nervousness, shallow breathing, drowsiness loss of conscious-ness.


It produces drug dependence if taken for long periods of time.

Phenobarbitone

Use

CNS (Central Nervous System) depressant to treat seizure

Dosage

Adults: 2 mg/kg daily (max 100 mg) at night. Increase if required to 6 mg/kg in 2 or more divided doses.

Children: 3-6 mg/kg daily.

Infants: Upto 8 mg/kg may be required for beneficial effect.

Precaution

Others

* Acute intermittent porphyria (a rare, inherited blood disorder)

* Liver and kidney problems

* Breathing problems

Adverse Effects

Sleep inducing, thinking abnormality, agitation, confusion, nightmares, circulatory collapse, vomiting, constipation, skin rashes, thrombosis (blood clotting) and gangrene due to intra-arterial injection, headache, liver damage, anemia, sore throat, arthritic pain, rickets, (a calcium deficiency disease in young children and infants), osteomalacia (softening of bones with severe pain).


* Valproic acid and chloramphenicol decrease the metabolism of the drug.

Contra-indicated

Contra-indicated

Contra-indicated




Contra-indicated

Contra-indicated

Contra-indicated

Contra-indicated

Contra-indicated



Over 60

* Phenobarbi tone shor tens ha l f l i fe of doxycycline, quinidine, digitoxin, corti-costeroids, griseofulvin, rifampicin, and phenytoin. Alongwith frusemide it results in hypotension (below normal BP).

Patient Information

Do not increase the dose without consulting a physician.

Be cautious while driving when on treatment.

559

Phenoxymethyl Penicillin

Use

Antibiotic to treat inflammation of tonsils, middle ear and skin;

* Rheumatic fever

Dosage

Adults :250-500 mg every 6 hrs, 30 min before food.

Children : 25-30 mg/kg per day in 4 divided doses.

Precaution

Others

Kidney, liver, heart problems, stomach problems

Adverse Effects

Blood disorders, skin reactions, serum sickness, stomach upset, fever, kidney problems.



Patient Information

Have good potassium, sodium, calcium intake.

Contra-indicated

Contra-indicated

Contra-indicated



Q. What is rational about anti-convulsant therapy?

Ans. Use one drug at a time and try to use the second one only if a fair trial of about 4 to 8 weeks has been tried with the first drug with adequate dosage and good compliance. It is better to change in case of failure rather than adding one more anti-convulsant.


Phenytoin

Brand Name

Dilantin, Eptoin

Use

Anticonvulsant used against some forms of epilepsy (grandmal and temporal lobe epilepsy)

Dosage

Adults: 4-5 mg/kg daily increased by 25 mg daily upto max. 10 mg/kg daily.

Children: 5 mg/kg in 2 divided doses increased slowly upto max. 8 mg/kg daily.

Precaution

Others

* Heart problems

* IV administration not greater than 50 mg per min.

Adverse Effects

Slurred speech, mental confusion, dizziness, insomnia, nervousness, motor twitchings, headache, tremors, drowsiness, seizures, nausea, vomiting, diarrhoea / constipation, skin rashes, anemia, liver damage, problems with gums, hirsutism (excessive body hair), acute inflammation of lungs (pneumonitis).

Continue to take the drug and inform the doctor.


Drug Interactions

* Drugs affecting phenytoin, barbiturates, carbamazepine, folic acid, calcium gluconate, antacid, cloxacillin, dietary calciuam reduce phenytoin availability.

* Phenytoin reduces the effects of different drugs: dexamethasone, prednisolone, furosemide, digitoxin.

Patient Information

* Take medication with food.

* Maintain good dental hygiene

* Urine discoloration may occur.

* D i a b e t i c p a t i e n t s h o u l d r e p o r t a n y abnormalities.

Contra-indicated

Contra-indicated


Q. D o e s p h e n o b a r b i t o n e a f f e c t performance of a child?

Ans. Yes. In quite a few children it causes hyperactivity and reduces their attention span.


Piperazine Citrate

Brand Name

Helmazan

Use

Anti-helminthic drug.

Treatment of infestation with round worms and thread worms

Dosage

For infestation by round worms: 75 mg/kg (maximum 3.5 gm) as a single dose for 2 consecutive days for adults and children.

Thread worm infestation: 65 mg/kg as a single dose (max. 2.5 gm) given for 7 days.

To prevent reinfection : a second course may be required 1-2 weeks after the first.

Precaution

Others

Not to be taken by patients with epilepsy, kidney problems and liver problems.

Adverse Effects

Serious adverse effects are rare.

Overdosage or impaired excretion may result in nausea, vomiting, diarrhoea or severe damage to nervous system


Over 60

Pilocarpine

Brand Name

Carpo-Miotic, Pilocar

Use

* First drug of choice to treat glaucoma (condition in which pressure of fluid inside the eye increases).

* To treat dryness of mouth- e.g., following head/neck radiation treatment.

* To counteract dilation of pupils caused by drugs during eye surgery.

Dosage

As eye drops: 0.5 - 4.0% solution instilled as eye drops, every 4-8 hours.

To treat dryness of mouth: 2.5 - 5 mg orally

Precautuion

Adverse Effects

Transient: Salivation, sweating, blurred vision or eye pain.



Patient Information

* Inform doctor in case of asthma, inflammed eye, if contact lens is being used or if other medication is being taken.

Over 60

561

Avoid





Avoid







Drug Interactions

* Interacts with phenothiazine, anti-psychotics (against mental disorders)

* It also interacts with other antihelminthics. For instance, it antagonises the action of pyrantel pamoate.

Podophyllin

Use

Used for warts around the anal/genital regions or on soles of feet. Can be treated by topical application.

Dosage

Adults: Apply a solution (10-15%) for 1-6 hrs. Repeat after 1 week for 4 weeks.

For large lesions - Use 5-10% to minimise toxicity.

Children: same as above

Precaution

Adverse Effects

* Friable bleeding or recently biopsied warts.

Avoid application on

* Mole or birthmarks

* To small areas of intact skin

* Avoid contact with mouth or eyes

* Do not use near heat, open flame or smoking


System toxicity: Death can occur if amount as small as 300 mg is ingested. Kidney and liver failure, cerebral toxicity. System toxicity includes stomach pain, c lumsiness, unsteadiness, vomit ing, confusion, diarrhoea, weakness, sore throat, unusual bleeding.

Contra-indicated

Contra-indicated


Over 60

Potassium Chloride

Brand Name

K-Grad, Kay-Ciel, Keylyte, Potklor, Electral preps

Use

To compensate for loss of potassium (e.g., prolonged diarrhoea/vomiting, prolonged treatment with diuretics, kidney disease, long term treatment with corticosteroids).

* Digoxin toxicity.

* Hypokalemia (abnormally low potassium in circulating blood).

Dosage

(1 Tab.= 312 mg of potassium)

* Potassium Chloride tabs/powder dissolved in water/juice (not tomato juice).

* Oral consumption should be in form of well diluted solutions to avoid severe nausea.

* To be consumed immediately after or with meals to lessen possibility of upset stomach.

Precaution

Others

* High potassium levels especially in case of impaired kidney function.

* Extensive tissue damage (e.g.burns)

Adverse Effects

* Decreased excretion.

563

* N a u s e a , d i a r r h o e a , p a r a l y s i s , h e a r t abnormalities, impaired brain functions, coma and in severe cases death.

Discontinue the drug. Call the doctor immediately.


* IV injections should be given slowly as high blood concentration can effect heart function.

* Black tarry tools or bloody vomit indicate stomach/intestinal bleeding. Consult doctor immediately.

* Should not be taken with potassium sparing diuretics those that (increase urine, reduce salt and water in kidneys), cylosporins (drugs used to reduce body’s natural immunity in patients receiving organ transplants) and ACE inhibitors (used to lower high BP).

Avoid







Praziquantel

Use

Antihelminthic.

Effective against tape worms or schistomes (a group of parasites including flukes of the genus schistoma).

Dosage

* Given as a single dose of 40 mg/kg after a light breakfast.

* Alternatively, as 3 doses of 20 mg/kg.

* Differs with type of infestation

* Should be preferably swallowed without grinding/breaking because of very bitter taste.

Precaution

Adverse Effects

Transient: Abdominal discomfort, headache dizziness.

Occasional: Fever, rashes blood changes, nervous system disorders.



Patient Information

* Do not miss any doses.

* If there is cyst (abnormal sac or closed cavity with liquid or solid matter) formation by the worm in brain, the drug can cause irreversible eye damage.

Prednisolone

Use

Corticosteroid - (used against inflammation, allergic disorders of skin, blood disorders, some liver disorders, gastrointestinal, kidney disorders and disorders of nervous system).

Dosage

Adults: 5-60 mg/day, varies according to condition. Not greater than 250 mg daily.

Children: 2 mg/kg/day every 6-8 hrs orally after meals.

Preparations for topical application: 0.5% strength.

Precaution

Adverse Effects

Burning, itching, hypopigmentation (sub-normal colouring of skin).


Prolonged application around eyes leads to cataract and glaucoma.

Do not withdraw suddenly.


Patient Information

* Apply sparingly, i.e., rub in lightly - a light film rub.

* Avoid getting in eyes.

* Notify physician if the condition worsens.

Avoid

Avoid Can continue use of medicine

Contra-indicated

Contra-indicated

Contra-indicated

Contra-indicated


PrimaquineBrand Name

PMQ-INGA

Use

Antimalarial used after standard malaria therapy to destroy certain forms of malaria germs in the liver (radical cure of Plasmodium Vivax).

Dosage

Adults: 0.25 mg/kg or 15 mg daily for 14 days.

For G-6PD Deficiency: 0.75 mg/kg weekly for 8 weeks.

Children: Over 1 year 0.25 mg/kg for 14 days.

Precaution

Others

Acutely ill suffering from systemic infections like rheumatoid arthritis and Lupus erytho-matosis (SLE), blood disorders like anemia.

Pregnancy.

G-6PD deficiency (an inherited deficiency leading to a glycogen storage disease).

Adverse Effects

GI tract problems like nausea, vomiting, distress and cramps, anemia, headache, rashes, vision problems.

Haemolysis (destruction of red blood cells), cyanosis (dark blue or purple coloration of skin and mucous membrane) , methemo-globinemia (deficency of a hemoglobin, methoglobin, in circulating blood).


Drug Interactions

Quinidine hydrochloride increases the toxicity of this drug and should not be given.

Patient Information

* Complete therapy course

* If stomach upsets seen may be taken with food and antacids.

565

Procain Benzyl Penicillin

Use

Antibiotic against some sexually transmitted diseases.

Dosage

Adults: 300-600 mg 1-2 times daily for 2 days after constitutional symptoms have resolved and for minimum of 7 days. Or 5-10 lakh units, 12 hourly IM.

Gonorrhoea: 5 gm at 2 injection sites.

Syphilis: 6 gm daily at 2 sites for 10 days. Later 9 gm daily in 9 divided doses for 15 days.

Neuro and Cardiovascular syphilis: 12 gm daily in divided doses for 20 days.

Children: Congenital syphilis : upto 32 kg of body weight - 0.05 gm/kg daily for 10 days.

Initial and late syphilis: Over 12 yrs.: as for adults.

Note: Some children may require upto 0.1 gm/kg of body weight daily in divided doses.

Precaution

Others

Administer by IM route only (to be given only after sensitivity testing).

Adverse Effects

As for Cloxacillin

* Very high doses in veneral diseases may give rise to anxiety confusion, agitation, or depression, seizures, hallucinations, fear of impending death. Also anaphylaxis (sudden severe allergic shock).

Contra-indicated

Contra-indicated

Contra-indicated

Contra-indicated

Contra-indicated

Contra-indicated


Procainamide

Brand Name

Pronestyl

Use

Used to treat irregularities of heart beat.

Dosage

Adults: By mouth: 250 mg every 4-6 hrs.

Slow IV injection: 25-50 mg/min as required. (maximum 1 gm).

Maintenance IM injection: (100-250 mg) every 4-6 hours.

Precaution

Others

Kidney problems, asthma, myasthenia gravis (a type of chronic, progressive, muscular weakness), heart block, heart failure, low BP.

Adverse Effects

Hypotension (subnormal BP) serious disturbances of cardiac rhythm, anorexia (low appetite and food aversion), nausea, rashes, systemic lupus erythematosus (a chronic inflammatory disease affecting the skin and various organs).

Discontinue the drug and inform doctor.


Drug Interactions

Cimetidine and lidocaine should not be given with the drug.

Patient Information

* Do not discontinue the therapy unless instructed by physician.

* Take at evenly spaced intervals.

Pyrantel Pamoate

Brand Name

Pymoate Combination

Use

Antihelminthic

Dosage

Adults: 10-15 mg/kg as a single dose.

Children: Below 2 years not to be used. Above 2 yrs use adult dose (course may be repeated in 2/3 weeks).

Roundworms: adults and children 10 mg/kg in a single dose.

Hookworms: children and adults, 20mg/kg/day for 3 days.

Precaution

Others

In liver problems: Iron supplementation to patients is advised. Use with caution in liver patients.

Adverse Effects

Headache, dizziness, sleeplessness, rash, stomach (GI) upset. These are mild and transient.



For pinworm infestation treat all members of the household simultaneously. Should not be used with piperazine.

May be required to take iron tablets every day to clear up anemia resulting from hookworm infection.

Contra-indicated






Pyrazinamide

Brand Name

Lynamide, P-Zide, PZA-Ciba, Piraldina, Pyzina

Use

To treat tuberculosis

Dosage

For first 2 months, 20 to 30 mg/kg/day in 3-4 divided doses.

Precaution

Others

* Liver damage

* History of gout or diabetes mellitus.

* If skin rashes seen then withdraw.

Adverse Effects

Abnormal liver function, enlargement of liver, jaundice, vomiting, diarrhoea, gout, anemia and rashes, sensitivity to light and sunlight.

Patient Information

If fever, loss of appetite, nausea, vomiting, darkened urine, notify physician.

567

Pyridoxine (Vitamin B )6

Brand Name

Pyricontin, Continus

Part of several Vitamin B-complex preparations

Use

Deficiency of Vit.B caused during isoniazid 6

therapy.

Dosage

Adults: Dependency syndrome - 30-600 mg/day

Maintenance - 50 mg/day

Drug induced deficiency: 10-300 mg/day depending on the causative drug.

Hereditary anemia: 200-600 mg/day then 30-50 mg/day for life.

Dependency syndrome:

Infants: 2-10 mg/day.

Children: adult dose.

Dietary supplement: 2.5-10 mg/day for 3 weeks, then 2-5 mg/day for several weeks.

Precaution

Others

* Parkinson’s disease treated with Levodopa.

* Doses greater than 200 mg/day for 30 days cause dependency.

* Doses greater than 2 - 6 gm cause serious side-effects.

* Liver and kidney problems.

* In use as substitute for balance diet.







Over 60

Adverse Effects

High doses cause sensory neuropathy, unstable gait, numb feet and hands, weakness.


Dietary Source: Meat, bananas, potatoes, lime,beans and whole grain cereals.

Recommended Daily Allowance (RDA):

0-6 months : 0.3 mg

6-12 months : 0.9 mg

4-6 yrs : 1.3 mg

Adult males : 2.2 mg

Females : 2.0 mg

Pregnant women : 2.6 mg

Lactating women : 2.5 mg

Quinidine

Brand Name

Quinidine (B-W)

U s e

Slows heart rate and treats irregularities of heart rhythm.

Dosage

(As quinidine sulphate) 200-400 mg 3 times a day. Take with food or milk to reduce possibility of stomach upset.

Do not crush or chew before swallowing.

200 mg test dose can be administered to check for allergic reaction to the drug.

Precaution

Others

* Heart block

* Allergy to drug

* Patient should be monitored closely

Adverse Effects

* Some individuals are very sensitive and can experience blurred vision, dizziness, severe headache, ringing in the ears, rashes or other forms of allergic reactions.

* Diarrhoea is common.

* Anemia and other blood disorders.

* In some cases, the drug itself can cause irregularities in rhythm of heart beats


Contra-indicated

Contra-indicated

Avoid Reduced dose to be taken



Is there anybody in the house not affected by malaria ?

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Patient Information

* Do not stop this drug suddenly.

* Do not take double doses.

Drug Interactions

* Adverse effect may result on interaction with drugs like digoxin digitalis, drugs against high BP, anti-coagulants and muscle relaxants.

* Phenytoin/phenobarbitone reduce the efficacy of quinidine.

569

Riboflavin (Vitamin B )2

Use

To prevent/treat deficiency of ribof lavin (deficiency symptoms include sore throat, inflammation of mouth, red denuded lips, glossy tongue, skin changes over face and trunk extremities, blood changes and anaemia, nervous system disorders).

Also used as permitted colouring agent for food.

Dosage

Recommended daily intake: 0.6 mg per 1000 Kcal dietary requirement. (Dietary sources include - cereals, whole grains, leafy vegetables, milk, cheese, eggs, meats).

Treatment of deficiency: 5-10 mg riboflavin per day.

Adverse Effects

* Excess riboflavin is excreted in urine.

* Prolonged use of large doses of riboflavin alone may deplete other B vitamins and it is therefore best taken with other B vitamins.


Patient Information

* Requirements are increased during pregnancy and lactation.

* Usually administered by mouth, but may be injected if for any reason it cannot be absorbed or utilised by the oral route.


Q. Which is the most common irrational drug used for treatment of victims of polio?

Ans. B , B , B combination tonics. They have 1 6 12

no role to play in the treatment of polio.

Q. What is the role of neurotonics in mental retardation?

Ans. No documented role of these drugs is available in the authentic literature


Over 60

Rifampicin + INH + Pyrazinamide

Brand Name

Tricox, Rifater, Montorip, Rinzid

Use

* For initial intensive phase treatment of tuberculosis

* Can be used in the continuous phase also

Dosage

Upto 5 tabs a day providing Rifampicin 600 mg, INH 400 mg and Pyrazinamide 1250 mg. Given as a single dose one hour before food in the morning.

Precaution

Othersiven

* Individuals allergic to any of the compo-nents of the combination.

* Liver disease

* Jaundice

* Gout

* To be administered with caution in patients with liver damage, alcoholics, potential pyridoxine (B 6) deficients.

Adverse Effects

* Generally well tolerated.

* May cause liver damage, gout, uric acid accumulation, disturbances of nervous system.

* Photosensitivity

Do not stop the drug therapy on your own.

* Report to your doctor if jaundice appears.


Drug Interactions

* R i f a m p i c i n e s p e c i a l l y i n t e r a c t s w i t h anticoagulants (anti blood clotting agents), oral antidiabetics and oral contraceptives.

* INH interacts with several drug. Pyrazinamide interferes with action of probenecid (used in gout therapy).

* Antacids reduce absorption of INH and rifampicin.

* Pyridoxine supplementation should be taken by patients taking this drug especially those prone to pyridoxine (B 6) deficiency.

* Foods like cheese should be avoided.

* Food decreases absorption of INH and rifampicin.


Q. Which antitubercular drug should not be used under 3 years of age?

Ans. Ethambutol has ocular (eye related) toxicity, which is difficult to assess under 3 years of age.


Contra-indicated

Contra-indicated




Silver Nitrate

Use

* To destroy warts and other small skin growths

* In treatment of anal and vulval itching and other nonspecific infection

* In eyedrops

* In burns to reduce infection.

Dosage

Non specific infections: Anal or vulval itching - 1% solution used.

As eye drops: 0.2 - 0.6% solution

Burns: 0.5% solution

Others

* Discontinue use if redness or irritation occurs.

* Do not apply to wounds, cuts or broken skin.

Adverse Effects

* Corrosive and can cause damage to various tissues.

* Chronic application causes silver poisoning (permanent discoloration of skin, conjunctiva and other internal organs).

* Blood changes

Continue the drug and inform the doctor.

Additional Inforamtion

Patient Information

* Fatal dose as low as 2 gms.

* Oral intake is harmful and can be treated with 10 gm/ltr solution of sodium chloride. Consult doctor.

* If splashed in the eyes, wash copiously with water.

571

Silver Sulfadiazine

Brand Name

Argenex, SSZ, Applicaps, Silvirin

Use

* For treatment and prevention of infections in severe burns.

* Infected leg ulcers.

Dosage

1 % cream applied daily to a thickness of 3-5 mm

Precaution

Others

Liver and kidney problems/impairment

Sensitivity to sulfonamide

Adverse Effects

Adverse effects due to sulfadiazine (similar to those for sulfonamides) may occur.

Rare: Local reactions/fungal infections of the wound may occur.



Patient Information

* Apply with a sterile gloved hand once or twice daily. Or use a sterile applicator.

* When feasible bathe the patient daily.

* Continue treatment till satisfactory healing has occured and no more risk of infection.

Contra-indicated

Contra-indicated

Contra-indicated


Over 60

Sodium Bicarbonate

Brand Name

Acidin, Acigone, Electral forte, Gaviscon

Use

* Relief from indigestion

* Excess acidity in stomach

* Heartburn

* Relieves discomforts due to peptic ulcers

* To reduce acidity of urine and to relieve painful urination

* To reduce the risk of kidney stones in gout sufferers

* To decrease the acidity of body fluids due to diarrhoea or kidney problems

* Wash solutions and spray solutions for the throat and nose to render mucus less viscous.

* Taken to relieve cough

* As an eye lotion

* As ear drop to soften and remove wax.

* Rinsing solution for contact lenses.

Dosage

Indigestion: 1-16 gms as required orally

Gout: 1-16 gms 4 times daily

To decrease acidity of body fluids : Intra-venous infusion

As eye solution : 3.5 % solution in warm water

Precaution

Others

* Long-term liver, kidney, heart problems

* High BP

* Severe abdominal pain or nausea.

* Low sodium diet

* Not for acidity caused due to respiratory problems

Note: Not to be used daily for longer than 2 weeks.

Adverse Effects

Prolonged use: Weakness fatigue, irritability and muscle cramps.

* Increased sodium in blood may lead to above and/or fluid accumulation in various organs of the body


Drug Interactions

Interacts with oral blood clotting agents, t e t r a c y c l i n e s , p h e n a t h i a z i n e s , o r a l i r o n preparations, lithium, diuretics and corticosteroids.



AvoidSafety notestablished



Q. What is the best solution for blocked nose?

Ans: Saline nasal drops. It can be prepared by adding 1/4 teaspoon of common salt to a glass of water. Boil it and cool it.


Sodium Chloride

Use

To replace excessive losses of sodium and chloride ions.

Loss as in case of excessive sweating,

Addison’s disease (def ic iency of cor t ica l hormones), kidney problems, diarrhoea.

* Used alongwith other electrolyte solutions and dextrose as a dialysis solution in treatment of renal failure or to assist removal of poisonous substances from the body.

Dosage

0.9% solution given orally or injected depending on patient requirements.

Others

Should be used cautiously in patients with heart failure, kidney problems, during pregnancy.

Injection by IV should be administered cautiously to young children and elderly.

Adverse Effects

No long term adverse effect. Solutions with high content of sodium chloride are irritant to g a s t r o i n t e s t i n a l l i n i n g a n d c a n c a u s e nausea/diarrhoea.


More dilute solutions containing dextrose/ glucose are generally preferred.

573

Sodium Chlor ide + Dext r ose (Glucose)

Use

To replenish water lost in acute diarrhoea and cholera.

Addition of dextrose facilitates absorption of sodium from the intestinal tract.

Dosage

As sodium chloride and dextrose IV infusion, compound sodium chloride and glucose oral powder or sodium chloride and dextrose tabs.

Adverse Effects

Large excess may lead to diarrhoea.


Q. When should one give injection as a treatment to a child?

Ans:

1 When the child is unable to swallow.

2. Is vomiting persistently.

3. Is hospitalised needing IV medication in severe disease.

4. Immunisations.


Over 60

Sodium Thiosulphate

Use

Treatment of cyanide poisoning.

Given IV along with sodium nitrite.

* In treatment of certain types of skin disorders caused by specific fungi.

* Used as a footbathm at swimming pools to prevent ringworm infections.

Dosage

In cyanide poisoning: 10 ml of 3 % sodium nitrite in water for injection by IV over 3 minutes followed by 50 ml of sodium thiosulphate injecting 25 % solution by IV over 10 minutes.

Skin disorders: 20 % solution applied once or twice daily.

Foothbath: 10 % solution used.

Others

* Apart from osmotic disturbances, it is relatively non-toxic.

* Large doses by mouth have a purgative action.

Streptokinase (enzyme)

Brand Name

Embokinaze, Streptase

Use

To dissolve clots formed in the heart and lungs and clots formed in other parts of the body; and during kidney dialysis.

Dosage

By intravenous infusion: Dosage determined individually by the condition and response Usually 1.5 million units over 1 hr by IV.

Precaution

Others

* Patients with high BP

* Coagulation defects

* Recent peptic ulcers

Adverse Effects

* Excessive bleeding

* Fever

* Rashes and allergic reactions to the enzyme may be triggered.


Drug Interactions

* Interacts with antiblood coagulants and antiplatelet drugs to increase the risk of bleeding (platelets are disc-shaped structures in blood that perform several functions related to blood clotting).

Contra-indicated

Contra-indicated




Sulfacetamide

Brand Name

Nebasulf preps, Triple sulfa, Albucid

Use

As a sodium salt used mainly by local application infections or injuries of the eye.

Dosage

For acute conjuctivitis / to prevent infections after burns etc: 10% solution applied every 2 hours or 30% solution applied twice daily.

Ointment containing 2.5, 6.0 or 10.0% are also used.

Precaution

Others

* Sulfacetamide sodium ointment should not be applied to penetrating wounds of the cornea.

* Should not be used in individuals sensitive to sulfonamides.

Adverse Effects

* Local application to eye may cause stinging but not severe burning and does not necessitate discontinuance of treatment.

* Allergic reactions may occur in patients sensitive to sulfonamides.


* Local anaesthetics that are esters of P-Amino Benzoic Acid (PABA) may interfere with antibacterial action of sulfacetamide if used simultaneously.

* Sulphacetamide prescribed should be used even if symptoms disappear earlier to prevent relapse of infection.

* Stop medication if there is skin reaction or itching or burning sensation.

575

Sulfadimidine

Use

Treatment of urinary tract infections.

Meningitis

Dosage

Adults: 1-2 tablets four times daily.

Children upto 6 yrs. : half tablet 2 times daily.

6-12 yrs.: 1 tablet 2 times per day.

Note: One Tablet = 500 mg

Precaution

Others

* Liver damage

* Kidney damage

Adverse Effects

* Nausea, vomiting

* Blood disorders

* Rashes/reddening

* Kidney problems


Patient Information

* Not to be taken if patient is allergic to sulphonamides.

* Not to be taken with chemically related drugs like acetazolamide, oral antidia-betics or thiazide diuretics.

* Large intake of water (1-2 litre/day) mandatory to avoid crystallisation of drugs and damage to kidneys.

Contra-indicated

Contra-indicated

Contra-indicated

Contra-indicated





Over 60

Over 60

TamoxifenBrand Name

Mamofen, Nolvadex, Tamofen, Tamoxifen -biochem, Tamoxifen-lyka

Use

Anticancer drug for treatment of breast cancer before and after menopause

Also used to treat certain types of infertility.

Dosage

10-20 mg twice daily (20-40 mg/day). Do not crush or break tablets before taking.

Precaution

Others

* Do not stop drug suddenly without consulting doctor

* Decreased dose may be needed in liver damage.

Adverse Effects

* Hot flushes* Nausea* Vaginal bleeding* Irregular menstruation* Visual disturbances* Weight gain* Increased risk of developing cancer of endo-

metrium (inner lining of the wall of uterus).



Patient Information

* Useful for oestrogen hormone dependent tumour of breast.

* Antacids could be taken at one to two hour intervals before or after taking the drug to decrease risk of adverse effects.

Tetracaine

Use

Local anaesthetic

Dosage

1-2 drops of a 0.5% solution to conjuctiva

Precaution

Others

* Plasma cholinesterase (an enzyme) deficiency

* Protect the eye from irritating chemicals.

Adverse Effects

Burning, stinging, redness or other irritation of eye, blurred vision, convulsions, dizziness, nausea, vomiting, drowsiness, irregular heart beat, tiredness, muscle twitching.


Patient Information

Prolonged used may cause delay in corneal epithelial healing (top surface skin of cornea).

Contra-indicated

Contra-indicated

Avoid

Contra-indicated







Thiamine

Brand name

Benalgis, Beneuron

Use

Vitamin B1, mainly associated with metabolism of carbohydrates in the body to treat deficiency of B1 (characterised by beriberi, fatigue, loss of appetite, irregular heart beat and problems with nervous system)

Dosage

Adults: Beriberi: 5-10mg thrice daily. Alcohol induced def i c i ency : 40 mg/day. Die ta r y supplement :1-2 mg/day. Genet ic enzyme deficiency: 10-20 mg/day.

Dietary supplements

Infants: 0.3-0.5 mg/day,

Children: 0.5-1.0 mg/day

Precaution

Others

If given together always, administer thiamine prior to glucose

* Liver problems

* Kidney problems

* Do not substitute for balanced diet or exceed RDA


Dietary sources : Cereals, meats.

Recommended daily allowance (RDA)-

4-6 years: 0.9 mg

Adult males: 1.4 mg

Adult females: 1 mg

Pregnant women: 1.4 mg

Lactating women: 1.5 mg

577

Trihexyl Phenidyl(Benzhexol Hydrochloride)

Brand Name

Hexidal, Hexinal, Neocalm + Forte, Pacitone, Trinicalm, Forte Plus

Use

Anti-parkinsonism as well as drug-induced Parkinsonism.

Dosage

Adults: 1-2 mg on 1st day, increased by 2 mg at 3-4 day interval till required and upto 6-10 mg per day.

Children: Dose not established.

Precaution

Others

* Narrow angle glaucoma

* Peptic ulcer

* Myasthenia gravis

* Intestinal problems

* Urinary problems

Adverse Effects

Skin rashes, psychoses, hallucinations, heavyness of limbs, dry mouth, nausea, vomiting, constipation abdominal pain, blurred vision, urinary retention, muscular weakness, muscular cramping.


Decreased sweating, numbness of fingers.




Contra-indicated

Contra-indicated

Contra-indicated

Contra-indicated

Avoid



Over 60


Phenothiazines (e.g., chlorpromazine), haloperidol, should not be given with the drug.

Patient Information

If GI upset occurs may be taken with food. Causes drowsiness, dizziness or blurred vision


Use caution in hot weather, may increase susceptibility to heat stroke.

Valproic acidBrand Name

Epilex, Valparin, Alkalets

Use

Antiepileptic

Used for all forms of epilepsy.

Dosage

Adults: 15-30 mg/kg/day in one or two divided doses. Increase as required by 200 mg daily at twice weekly intervals, to a max. of 2-5 gm daily.

Children: 15 mg/kg daily in divided doses and increase as required.

Daily doses of 730 mg are required.

Infants: may require upto 40 mg/kg

Precaution

Others

* Liver and pancreas problems

* Blood disorders

* Severe epilepsy

* Mental retardation

Adverse Effects

Loss of control, seizure, general uneasiness, weakness, lethargy, loss of appetite, vomiting, jaundice, water retention, liver function, weight gain, hair loss, tremor, drowsiness, lack of muscular coordination.


Drug Interactions

* Phenobarbitone and phenytoin should not be given with the drug.

Patient Information

* Take with food.

* Do not chew tabs or capsules. Swallow whole to avoid local irritation of mouth.

Contra-indicated

Contra-indicated

Contra-indicated


Q. What is the best way to administer oral iron?

Ans: Ascorbic acid (Vitamin C) increases the iron absorption from intestines. Phytates in food (cereals), phosphates in milk and avidin in raw egg decreases iron absorption. Hence oral iron should be taken between the meals on an empty stomach - preferably with Vitamin C.


Over 60

Verapamil Hydrochloride

Brand Name

Calaptin, Harteze, Isoptin, Vasoptin, Veramil

Use

Anti-anginal (Calcium channel blocker)

Antihypertensive

Dosage

Adults: 120-480 mg daily in divided doses orally. IV inj - 5-10 mg slow IV

Children: 2-4 mg/kg daily every 8 hrs. oral, 0.5 mg/kg daily loading dose followed by 5 mcg/kg/min.

Precaution

Others

* Heart problems

* Kidney problems

Adverse Effects

Congestive heart failure, hypotension, slow heart beat, dizziness, weakness, headache, nausea, constipation, sleep disturbances, blurred vision, diarrhoea, cramps, rashes, sweating, shortness of breath, muscle cramps, joint pain, cardiac arrest.


Propranolol (a beta blocker) and methyldopa should not be given.

Dietary Effects

Calcium and Vitamin D reduce the absorption of the drug. Should not be withdrawn abruptly.

579

Vinblastine

Use

To treat abnormal cell growth in some kinds of cancer and some non-cancerous conditions.

Dosage

Injected intravenously : 0.3 mg/kg per week.

Dosage varied depending on type of cancer and condition of patient.

Precaution

Others

* If liver problems reduce dose by about 75%.

Adverse Effects

* Can affect normal cells too.

* Decrease in WBCs hence decreased resistance to infections.

* Damage to nervous systems.

* Inflammation at site of injection.

* Reversible hair loss.



Patient Information

* In case of redness, pain or swelling at site of injection, inform doctor immediately.

* Even if nausea experienced, dose should be continued (alongwith other drugs to deal with nausea).

* Inform doctor if suffering from chicken pox, gout, kidney stone or liver problems.

* Inform if medication for thyroid problem, gout are being taken.

* Inform doctor if chloramphenicol, flucytosine, interferons are being taken.

Contra-indicated

Avoid

Contra-indicated

Contra-indicated

Contra-indicated

Contra-indicated

Contra-indicated



VincristineBrand Name

Cytocristin, Neocristin, Vincristin, Biochem

Use

To treat abnormal cell growth in some kinds of cancer and some non-cancerous conditions.

Dosage

Administered intravenously together with cortico steroids or other drugs.

22 mg/m of body surface area weekly.

Precaution

Others

* In case of redness, pain or swelling at side of injection, seek immediate medical attention.

* Dosage reduced by 75% in case of liver problems.

Adverse Effects

Severe damage to nervous system and loss of muscular functions.

Abdominal pain and severe constipation decrease in white blood corpuscles (though less severe than vinblastine)



Patient Information

* Adequate amount of fluid intake is very essential.

* In case of severe constipation, laxatives may be used after proper medical advice.

* Doctor should be informed if suffering from chickenpox, gout, kidney stones, liver disease, nerve or muscle disease.

* Doctor should be informed if probencid and sulfinpyrazine are also being taken at the time of treatment.

Warfarin

(Mainly as warfarin sodium)

Brand Name

Uniwarfin

Use

Anticoagulant.

Prevention and treatment of clot formation in blood vessels.

Effective when given orally, IV or IM.

Dosage

Independent of age. Decided on basis of prothrombin (a clotting factor) activity of the blood.

Initial dose: 30-50 mg per day Lower for the old/frail.

Maintenance dose: 3-12 mg daily.

Precaution

Others

Even minor bumps/bruises may bleed excessively.

Contraindicated in :

* Severe increase in BP

* Severe to moderate problems of liver or kidney

* Bleeding tendencies

Adverse Effects

Major risk: Loss of blood from almost any organ of the body.

* When consumed orally during pregnancy, can cause birth defects in the growing

Contra-indicated

Contra-indicated

Avoid

Contra-indicated

Contra-indicated

Contra-indicated




Over 60

foetus or loss of blood from foetus.


* In some patients receiving very high dose severe skin problems may result.



Patient Information

* Therapeutic effect begins in 12 hours. Maximum at 36-48 hrs and persists for 5-6 days.

* For immediate effect, heparin may be given as IV injection to cover the initial 36 - 48 hours.

* A wide variety of drugs interact.

* Consult doctor before consuming any drugs simultaneously.

* Inform doctor or dentist before any kind of surgery.

Drug Interactions

* Aspirin prolongs or intensifies its effects.

581

Zinc Oxide

Use

* Applied externally as a mild astringent (as an agent which causes contraction of tissues, arrests secretion and controls bleeding) for the skin

* As a soothing and protective application in eczema (inflammation of skin)

* Use alongwith other compounds to form some dental cements

* Zinc oxide and clove oil/eugenol used as a temporary dental fi l l ing. Thus used in preparations of medicated bandage, gauzes, ointments/creams, dusting powders, lotions and dental cements.


Q. Is it necessary to give Vitamin B-complex with antibiotics?

Ans: No.


582

Take this medicine.

Don’t ask too many

questions.

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the way to make ORS.

How should be our relationships?

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d A

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t Ph

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Sa

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art 1, CE

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e, 2000.


Documents

Section 3, Lay Person's Guide to Medicines