Tag Archives forDrugs

Drugs acting on the Ear

 

Otitis Externa

 

CHLORAMPHENICOL:

Indications: Bacterial infection in otitis externa.

Contraindications: This product is contra-indicated in persons sensitive to any of its components and where the tympanic membrane is perforated.

Dose and Administration: instilled two or three times daily or as directed. The patient must be lying on his/her side with the infected ear uppermost.

 

CLOTRIMAZOLE:

Indications: Fungal otitis externa, otomycoses.

Contraindications: Possible hypersensitivity to

Dose and Administration: Apply sparingly two or three times daily until two

weeks after clinical cure.

 

GENTAMICIN:

Indications: Otitis externa.

Contraindications: Viral, fungal, tuberculous or purulent conditions. Perforated

ear drum.

Dose and Administration: 3-4 drops three or four times daily.

 

CHLORAMPHENICOL-BENZOCAINE:

Indications: treatment of superficial infections of the external auditory canal caused by susceptible strains of various gram-positive and gram-negative organisms.

Contraindications: This product is contra-indicated in persons sensitive to any of its components and where the tympanic membrane is perforated.

Dose and Administration: instilled two or three times daily or as directed. The patient must be lying on his/her side with the infected ear uppermost.

 

POLYMEXIN-NEOMYCIN-HYDROCORTISONE:

Indications: indicated for the treatment of otitis externa due to, or complicated by, bacterial infection.

 

Contraindications: contra-indicated in patients in whom perforation of the tympanic membrane is known or suspected. Also contra-indicated in the presence of untreated viral, fungal and tubercular infections.

Dose and Administration: Following cleansing and drying of the external auditory meatus and canal as appropriate, three drops should be instilled into the affected ear three or four times daily. Alternatively, a gauze wick may be introduced into the external auditory canal and kept saturated with the solution; the wick may be left in place for 24 to 48 hours. Treatment should not be continued for more than 7 days without medical supervision. Children: use in children ( 3 years and over) at the same dose as adults. A possibility of increased absorption exists in very young children, thus Otosporin Ear Drops are not recommended in neonates and infants (<3 years).

 

GENTAMYCIN-BETAMETHASONE:

Indications: Acute & chronic otitis externa.

Contraindications: This medication should not be used by anyone allergic to

any of the ingredients of the medication. Also should not be used by anyone with

absent or perforated eardrum.

Dose and Administration: Put 3 or 4 drops into the affected ear three times

daily.

 

PHENAZONE-BENZOCAINE:

Indications: For the treatment of acute otitis media, simple catarrhal otitis, furunculosis and other inflammatory conditions and infections of the ear.

Contraindications: Sensitivity to any of the ingredients. The administration of Phenazone is contra-indicated where there is a family history of porphyria.

Dose and Administration: 5-10 drops, warmed to body temperature, to be instilled into the ear every two hours and the ear lightly plugged with cotton wool.

 

Removal of ear wax

Wax is a normal bodily secretion which provides a protective film on the meatal skin and need only be removed if it causes deafness or interferes with a proper view of the ear drum. Syringing is generally best avoided in young children, in patients with a history of recurrent otitis externa, a history of ear-drum perforation, or previous ear surgery.

 

DOCUSATE SODIUM:

Indications: helps soften the wax in your ears and makes ear wax removal, pain-free and effortless.

Contraindications: not use this product if your eardrum has been previously perforated, or if your ear is sore or inflamed.

Dose and Administration: should only be applied to the ear canal. With the head tilted, fill the ear with Waxsol using the dropper provided. On the next night apply Waxsol again as before.

Drugs for genito-urinary disorders

Drugs for urinary retention

Chronic retention is painless and often long-standing. Catheterisation is unnecessary unless there is deterioration of renal function. After the cause has initially been established and treated, drugs may be required to increase detrusor muscle tone. Benign prostatic hyperplasia is treated either surgically or medically with alpha-blockers. Dutasteride and finasteride are alternatives to alpha­blockers, particularly in men with a significantly enlarged prostate.

ALFUZOSIN HYDROCHLORIDE:

Indications: Benign prostatic hyperplasia

Contraindications: Alpha-blockers should be avoided in patients with a history of postural hypotension and micturition syncope.

Dose and Administration: Acute urinary retention associated with benign prostatic hyperplasia in men over 65 years, 10 mg once daily for 2–3 days during catheterisation and for one day after removal; max. 4 days.

Doxazosin:

Indications: treatment of both the urinary outflow obstruction and obstructive and irritative symptoms associated with BPH. also indicated for the treatment of hypertension alone or in combination with diuretics, beta-adrenergic blocking agents, calcium channel blockers or angiotensin-converting enzyme inhibitors.

Contraindications: Fainting, Priapism, Severe Hepatic Disease.

Dose and Administration: Benign Prostatic Hyperplasia 1–8 mg once daily. Hypertension 1–16 mg once daily.

TAMSULOSIN HYDROCHLORIDE:

Indications: Benign Prostatic Hypertrophy.

Contraindications: Micturition Syncope, Intraoperative Floppy Iris Syndrome,

Orthostatic Hypotension, and Priapism.

Dose and Administration: 400 micrograms daily as a single dose.

TERAZOSIN:

Indications: Benign Prostatic Hypertrophy, Hypertension.

Contraindications: Fainting, Orthostatic Hypotension, Priapism.

Dose and Administration: Initially 1 mg at bedtime; if necessary dose may be doubled at intervals of 1–2 weeks according to response, up to max. 10 mg once daily; usual maintenance 5–10 mg daily.

 

Drugs for urinary frequency, enuresis, and incontinence

 

SOLIFENACIN SUCCINATE:

Indications: urinary frequency, urgency and urge incontinence.

Contraindications: severe hepatic impairment, haemodialysis; breast-feeding.

Dose and Administration: 5 mg daily, increased if necessary to 10 mg once daily; child not recommended.

 

TOLTERODINE TARTRATE:

Indications: urinary frequency, urgency and incontinence

Contraindications: pregnancy and breast-feeding.

Dose and Administration: adult over 18 years, 2 mg twice daily; reduce to 1 mg twice daily if necessary to minimise side-effects. adult over 18 years, 4 mg once daily (dose form not appropriate for hepatic impairment or if creatinine clearance less than 30 mL/minute)

 

OXYBUTYNIN HYDROCHLORIDE:

Indications: urinary frequency, urgency and incontinence, neurogenic bladder instability, and nocturnal enuresis associated with overactive bladder.

Contraindications: pregnancy and breast-feeding.

Dose and Administration: adult and child over 12 years, initially 5 mg 2–3 times daily, increased if necessary to max. 5 mg 4 times daily; elderly initially 2.5–3 mg twice daily, increased to 5 mg twice daily according to response and tolerance; child 5–12 years, neurogenic bladder instability, 2.5–3 mg twice daily, increased to 5 mg 2–3 times daily; child under 5 years, see BNF for Children; child 7–18 years, nocturnal enuresis associated with overactive bladder, 2.5–3 mg twice daily increased to 5 mg 2–3 times daily (last dose before bedtime)

 

 

Preparations for Urolithiasis

ANETHOL, BORNEOL, FENCHONE, CAMPHENE & CINEOL: 

Indications: urolithiasis, nephrolithiasis and other renal and urinary disorders.

Contraindications: hypersensitivity to any of the ingredients.

Dose and Administration: one capsule 3-4 times daily, half an hour before meals.

POTASSIUM SODIUM HYDROGEN CITRATE:

Indications: for dissolving uric acid stones and preventing the formulation of

new stones.

Contraindications: in patients with acute or chronic renal failure or when

sodium chloride is totally forbiden.

Dose and Administration: the daily dose is 4 measuring spoonfuls taken in

three sparate portions after meals.

 

Drugs used in Urological Pain

HEXAMINE:

Indications: prophylaxis and long-term treatment of chronic or recurrent lower urinary-tract infections.

Contraindications: hepatic impairment, renal impairment, severe dehydration, gout, and metabolic acidosis.

Dose and Administration: 1 g every 12 hours (may be increased in patients with catheters to 1 g every 8 hours); child 6–12 years 500 mg every 12 hours.

TROSPIUM CHLORIDE:HERBAL( Extr. Sabal serrulatae sicc.25 mg Extr. Echinaceae sicc.30 mg)+Trospium chloride 2 mg

Indications: for all forms of spasmodic pain associated with micturition, for frequency or difficulty in emptying the bladder

resulting from disease of the bladder, prostate or urethra or caused by other states of urinary tract irritation.

Contraindications: should not be used in glaucoma, advanced benign prostatic enlargment

Dose and Administration:           2 tablets 3 times daily after meals.

 

Drugs for erectile dysfunction

 

ALPROSTADIL:

Indications: erectile dysfunction (including aid to diagnosis); neonatal congenital heart defects.

Contraindications: predisposition to prolonged erection (as in sickle cell anaemia, multiple myeloma or leukaemia); not for use with other agents for erectile dysfunction, in patients with penile implants or when sexual activity medically inadvisable; urethral application also contra-indicated in urethral stricture, severe hypospadia, severe curvature, balanitis, urethritis.

Dose and Administration: By direct intracavernosal injection, adult over 18 years, erectile dysfunction, first dose 2.5 micrograms, second dose 5 micrograms (if some response to first dose) or 7.5 micrograms (if no response to first dose), increasing in steps of 5–10 micrograms to obtain dose suitable for producing erection lasting not more than 1 hour (neurological dysfunction, first dose 1.25 micrograms, second dose 2.5 micrograms, third dose 5 micrograms, increasing in steps of 5–10 micrograms to obtain suitable dose); if no response to dose then next higher dose can be given within 1 hour, if there is a response the next dose should not be given for at least 24 hours; usual dose 5–20 micrograms; max. 60 micrograms; max. frequency of injection not more than 3 times per week with at least 24 hour interval between injections.

 

SILDENAFIL:

Indications: erectile dysfunction; pulmonary hypertension.

Contraindications: in patients receiving nitrates, in patients in whom vasodilation or sexual activity are inadvisable, or in patients with a previous history of non-arteritic anterior ischaemic optic neuropathy. In hypotension (avoid if systolic blood pressure below 90 mmHg), recent stroke, unstable angina, and myocardial infarction.

Dose and Administration: adult over 18 years initially 50 mg approx. 1 hour before sexual activity.

 

TADALAFIL:

Indications: erectile dysfunction.

Contraindications: in patients receiving nitrates, in patients in whom vasodilation or sexual activity are inadvisable, or in patients with a previous history of non-arteritic anterior ischaemic optic neuropathy. In hypotension (avoid if systolic blood pressure below 90 mmHg), recent stroke, unstable angina, and myocardial infarction. also moderate heart failure, uncontrolled arrhythmias, uncontrolled hypertension

Dose and Administration: adult over 18 years initially 20 mg approx. half an hour before sexual activity.

 

VARDENAFIL:

Indications: erectile dysfunction.

Contraindications: in patients receiving nitrates, in patients in whom vasodilation or sexual activity are inadvisable, or in patients with a previous history of non-arteritic anterior ischaemic optic neuropathy. In hypotension (avoid if systolic blood pressure below 90 mmHg), recent stroke, unstable angina, and myocardial infarction. also moderate heart failure, uncontrolled arrhythmias, uncontrolled hypertension also hereditary degenerative retinal disorders.

Dose and Administration: adult over 18 years initially 20 mg approx. half an hour before sexual activity.

 

 

 

Drugs used in Obstetrics

Prostaglandins and oxytocics

Prostaglandins and oxytocics are used to induce abortion or induce or augment labour and to minimise blood loss from the placental site. They include oxytocin, carbetocin, ergometrine, and the prostaglandins. All induce uterine contractions with varying degrees of pain according to the strength of contractions induced.

CARBOPROST:

Indications: postpartum haemorrhage due to uterine atony in patients unresponsive to ergometrine and oxytocin.

Contraindications: untreated pelvic infection; cardiac, renal, pulmonary, or hepatic disease

Dose and Administration: By deep intramuscular injection, 250 micrograms repeated if necessary at intervals of 11/2 hours (in severe cases the interval may be reduced but should not be less than 15 minutes); total dose should not exceed 2 mg (8 doses).

DINOPROSTONE:

Indications: Cervical Ripening Procedure, Induction of Labor.

Contraindications: active cardiac, pulmonary, renal or hepatic disease; placenta praevia or unexplained vaginal bleeding during pregnancy, ruptured membranes, major cephalopelvic disproportion or fetal malpresentation, history of caesarean section or major uterine surgery, untreated pelvic infection, fetal distress, grand multiparas and multiple pregnancy, history of difficult or traumatic delivery; avoid extra-amniotic route in cervicitis or vaginitis.

Dose and Administration: By vagina, cervical ripening and induction of labour at term, 1 pessary (in retrieval device) inserted high into posterior fornix and removed when cervical ripening adequate; if oxytocin necessary, remove 30 minutes before oxytocin infusion; remove if cervical ripening inadequate after 24 hours (dose not to be repeated).

By vagina, induction of labour, inserted high into posterior fornix, 3 mg, followed after 6–8 hours by 3 mg if labour is not established; max. 6 mg.

METHYLERGOMETRINE:

Indications: For routine management after delivery of the placenta; postpartum atony and hemorrhage; subinvolution. Under full obstetric supervision, it may be given in the second stage of labor following delivery of the anterior shoulder.

Contraindications: Hypertension; toxemia; pregnancy; and hypersensitivity.

Dose and Administration: Intramuscularly, 1 mL, 0.2 mg, after delivery of the anterior shoulder, after delivery of the placenta, or during the puerperium. May be repeated as required, at intervals of 2-4 hours. Orally, One tablet, 0.125 mg, 3 or 4 times daily in the puerperium for a maximum of 1 week.

OXYTOCIN:

Indications: Induction of labour for medical reasons or stimulation of labour in hypotonic uterine inertia.

Contraindications: hypertonic uterine contractions, fetal distress; any condition where spontaneous labour or vaginal delivery inadvisable; avoid prolonged administration in oxytocin-resistant uterine inertia, severe pre-eclamptic toxaemia, or severe cardiovascular disease.

Dose and Administration: max. 5 units in 1 day (may be repeated next day starting again at 0.001–0.002 units/minute).

Ductus arteriosus

ALPROSTADIL:

Indications: Aorta Dextratransposition with Intact Ventricular Septum, Coarctation of Aorta, Congenital Atresia of Pulmonary Valve, Congenital Heart Defect Requiring Open Patent Ductus Arteriosus, Ebstein’s Anomaly of the Tricuspid Valve, Pulmonary Artery Stenosis, Tetralogy Of Fallot, Tricuspid Valve Atresia.

Contraindications: Apnea, Pyloroduodenal Obstruction, and Respiratory Distress Syndrome in the Newborn.

Dose and Administration: By intravenous infusion, initially 10 nanograms/kg/minute, adjusted according to response in steps of 5– 10 nanograms/kg/minute; max. 100 nanograms/kg/minute.

INDOMETHACIN:

Indications: Patent Ductus Arteriosus, Nephrogenic Diabetes Insipidus, Twin Reversal Arterial Perfusion Syndrome.

Contraindications: Pregnancy, Blood Coagulation Disorder, Depression, Gastrointestinal Ulcer, Parkinsonism, Renal Disease, and Tobacco Smoker.

Dose and Administration: By intravenous injection, over 20–30 minutes, 3 doses at intervals of 12–24 hours, neonate under 48 hours, 200 micrograms/kg then 100 micrograms/kg then 100 micrograms/kg; neonate 2–7 days, 200 micrograms/kg then 200 micrograms/kg then 200 micrograms/kg; neonate over 7days, 200 micrograms/kg then 250 micrograms/kg then 250 micrograms/kg; solution prepared with 1–2 mL sodium chloride 0.9% or water for injections (not glucose and no preservatives).

Myometrial relaxants

Tocolytic drugs postpone premature labour and they are used with the aim of reducing harm to the child. However, there is no satisfactory evidence that the use of these drugs reduces mortality. The greatest benefit is gained by using the delay to administer corticosteroid therapy or to implement other measures which improve perinatal health (including transfer to a unit with neonatal intensive care facility).

ATOSIBAN:

Indications: uncomplicated premature labour.

Contraindications: eclampsia and severe pre-eclampsia, intra-uterine infection, intra-uterine fetal death, antepartum haemorrhage (requiring immediate delivery), placenta praevia, abruptio placenta, intra-uterine growth restriction with abnormal fetal heart rate, premature rupture of membranes after 30 weeks’ gestation.

Dose and Administration: By intravenous injection, initially 6.75 mg over 1 minute, then by intravenous infusion 18 mg/hour for 3 hours, then 6 mg/hour for up to 45 hours; max. duration of treatment 48 hours.

RITODRINE HYDROCHLORIDE:

Indications: uncomplicated premature labour.

Contraindications: in cardiac disease and in patients with significant risk factors for myocardial ischaemia; also be avoided in antepartum haemorrhage, intra-uterine infection, intra-uterine fetal death, placenta praevia, abruptio placenta, threatened miscarriage, cord compression, and eclampsia or severe pre-eclampsia.

Dose and Administration: By intravenous infusion, initially 50 micrograms/minute, increased gradually according to response by 50 micrograms/minute every 10 minutes until contractions stop or maternal heart rate reaches 140 beats per minute; continue for 12–48 hours after contractions cease(usual rate 150–350 micrograms/minute); max. rate
350 micrograms/minute; or by intramuscular injection, 10 mg every 3–8 hours continued for 12–48 hours after contractions have ceased; then by mouth (but see notes above), 10 mg 30 minutes before termination of intravenous infusion, repeated every 2 hours for 24 hours, followed by 10–20 mg every 4–6 hours, max. oral dose 120 mg daily. Orally, 10 to 20 mg every four to six hours.

Thyroid and antithyroid drugs

Thyroid hormones

Thyroid hormones are used in hypothyroidism (myxoedema), and also in diffuse non-toxic goitre, Hashimoto’s thyroiditis (lymphadenoid goitre), and thyroid carcinoma. Neonatal hypothyroidism requires prompt treatment for normal development. Levothyroxine sodium (thyroxine sodium) is the treatment of choice for maintenance therapy. In infants and children with congenital hypothyroidism and juvenile myxoedema, the dose of levothyroxine should be titrated according to clinical response, growth assessment, and measurements of plasma thyroxine and thyroid-stimulating hormone.

 

LEVOTHYROXINE SODIUM (Thyroxine sodium):

Indications: Congenital Hypothyroidism, Goiter, Hashimoto Thyroiditis, Hypothyroidism, Myxedema, and Thyroid Carcinoma.

Contraindications: Myocardial Infarction, Primary Adrenocortical Insufficiency, Thyrotoxicosis Crisis, Hyperthyroidism, And Pituitary Insufficiency.

Dose and Administration: adult, initially 50–100 micrograms once daily, preferably before breakfast, adjusted in steps of 25–50 micrograms every 3–4 weeks according to response (usual maintenance dose 100–200 micrograms once daily); in cardiac disease, severe hypothyroidism, and patients over 50 years, initially 25 micrograms once daily, adjusted in steps of 25 micrograms every 4 weeks according to response; usual maintenance dose 50–200 micrograms once daily.

 

Antithyroid drugs

Antithyroid drugs are used for hyperthyroidism either to prepare patients for thyroidectomy or for long-term management. Iodine has been used as an adjunct to antithyroid drugs for 10 to 14 days before partial thyroidectomy; however, there is little evidence of a beneficial effect. Iodine should not be used for long-term treatment because its antithyroid action tends. Propranolol is useful for rapid relief of thyrotoxic symptoms and may be used in conjunction with

antithyroid drugs or as an adjunct to radioactive iodine. Beta-blockers are also useful in neonatal thyrotoxicosis and in supraventricular arrhythmias due to hyperthyroidism. Propranolol has been used in conjunction with iodine to prepare mildly thyrotoxic patients for surgery but it is preferable to make the patient euthyroid with carbimazole.

 

CARBIMAZOLE:

Indications: hyperthyroidism either to prepare patients for thyroidectomy or for long-term management.

Contraindications: in patients with a previous history of adverse reactions.

Dose and Administration: the initial dose is in the range 20-60mg taken as two to three divided doses. Maintenance regimen the dose is gradually reduced.

 

PROPYLTHIOURACIL:

Indications: Hyperthyroidism, Thyrotoxicosis Crisis.

Contraindications: Agranulocytosis, Drug-Induced Hepatitis, Interstitial

Pneumonitis, Lactating Mother, Pancytopenia, and Pregnancy.

Dose and Administration: 50 mg by oral route 2 times per day.

Analgesics

Non-opioid analgesics

ASPIRIN:

Indications: mild to moderate pain, pyrexia; antiplatelet.

Contraindications: children under 16 years and in breast-feeding (Reye’s syndrome); previous or active peptic ulceration, haemophilia; not for treatment

of gout.

Dose and Administration: By mouth, 300–900 mg every 4–6 hours when necessary; max. 4 g daily; child under 16 years not recommended.

PARACETAMOL (Acetaminophen):

Indications: Arthritic Pain, Back Pain, Dysmenorrhea, Fever, Headache Disorder, Myalgia, Pain, and Toothache.

Contraindications: Acetaminophen Toxicity, Alcoholism, and Disease of Liver.

Dose and Administration: By mouth, 0.5–1 g every 4–6 hours to a max. of 4 g daily; child 2 months 60 mg for post-immunisation pyrexia, repeated once after 6 hours if necessary; 3 months–1 year 60–120 mg, 1–5 years 120–250 mg, 6–12 years 250–500 mg; these doses may be repeated every 4–6 hours when necessary (max. of 4 doses in 24 hours). By intravenous infusion over 15 minutes, adult and child over 50 kg, 1 g every 4–6 hours, max. 4 g daily; adult and child 10–50 kg, 15 mg/kg every 4–6 hours, max. 60 mg/kg daily; neonate and child less than 10 kg, 7.5 mg/kg every 4–6 hours, max. 30 mg/kg daily. By rectum adult and children over 12 years 0.5-1gm every 4-6 hours to a max. of 4gm daily. Children 3 months to 1 year 60-125mg. 1-5 years 125-250mg. 5-12 years 250-500mg. These doses may be repeated every 4-6 hours as necessary ( max. 4 doses in 24 hours).

PARACETAMOL-CAFFEINE:

Indications: Fever, Mild Arthritic Pain, Pain.

Contraindications: Acetaminophen Toxicity, Recovery Phase Following Myocardial Infarct, Alcoholism, Conduction Disorder of the Heart, Disease of Liver, Insomnia, Myocardial Ischemia, Necrotizing Enterocolitis, Peptic Ulcer.

Dose and Administration: Adults and children over 12 years of age 2 tablets (each tablet contain 500mg paracetamol & 65mg caffeine) up to 4 times daily not exceeding 8 tablets per 24 hours.

PARACETAMOL-CAFFEINE-CODEINE:

Indications: relief mild to moderate pain and fever.

Contraindications: Acetaminophen Toxicity, Recovery Phase Following Myocardial Infarct, Alcoholism, Conduction Disorder of the Heart, Disease of Liver, Insomnia, Myocardial Ischemia, Necrotizing Enterocolitis, Peptic Ulcer and in those patients with G6PD deficiency.

Dose and Administration: Adults and children over 12 years of age 2 tablets/capsules (each tablet contain 500mg paracetamol, 30mg caffeine & 8mg codeine phosphate) up to 4 times daily not exceeding 8 tablets per 24 hours.

Opioid analgesics

Opioid analgesics are usually used to relieve moderate to severe pain particularly of visceral origin. Repeated administration may cause dependence and tolerance, but this is no deterrent in the control of pain in terminal illness. Regular use of a potent opioid may be appropriate for certain cases of chronic non-malignant pain; treatment should be supervised by a specialist and the patient should be assessed at regular intervals. Opioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, shock, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders.

MORPHINE SULPHATE:

Indications: General Anesthesia Adjunct, Local Anesthesia Adjunct, Neonatal Abstinence Syndrome, Pain.

Contraindications: Acute Asthma Attack, Head Injury, Intracranial Hypertension, Paralytic Ileus, Status Epilepticus, Chronic Disease of Respiratory System, CNS Depression, Cor Pulmonale, Gastrointestinal Obstruction, Hypotension, Pancreatitis, Respiratory Depression.

Dose and Administration: Acute pain, by subcutaneous injection (not suitable for oedematous patients) or by intramuscular injection, initially 10 mg (elderly or frail 5 mg) every 4 hours (or more frequently during titration), adjusted according to response; neonate initially 100 micrograms/kg every 6 hours, adjusted according to response; child 1–6 months initially 100– 200 micrograms/kg every 6 hours, adjusted according to response; child 6 months–2 years initially 100–200 micrograms/kg every 4 hours, adjusted according to response; child 2–12 years initially 200 micrograms/kg every 4 hours, adjusted according to response; child 12–18 years initially 2.5–10 mg every 4 hours, adjusted according to response. By slow intravenous injection, initially 2.5 mg (reduce dose in elderly or frail) every 4 hours (or more frequently during titration), adjusted according to response; neonate initially 40– 100 micrograms/kg every 6 hours, adjusted according to response; child 1–6 months initially 100–200 micrograms/kg every 6 hours, adjusted according to response; child 6 months–12 years initially 100–200 micrograms/kg every 4 hours, adjusted according to response.

PETHIDINE HYDROCHLORIDE:

Indications: moderate to severe pain, obstetric analgesia; peri-operative analgesia.

Contraindications: Acute Asthma Attack, Head Injury, Intracranial Hypertension, Paralytic Ileus, Status Epilepticus, Chronic Disease of Respiratory System, CNS Depression, Cor Pulmonale, Gastrointestinal Obstruction, Hypotension, Pancreatitis, Respiratory Depression.

Dose and Administration: Acute pain, by subcutaneous or intramuscular injection, 25–100 mg, repeated after 4 hours; child, by intramuscular injection, 0.5–2 mg/kg. By slow intravenous injection, 25–50 mg, repeated after 4 hours. Premedication, by intramuscular injection, 25–100 mg 1 hour before operation; child 0.5–2 mg/kg. Postoperative pain, by subcutaneous or intramuscular injection, 25–100 mg, every 2–3 hours if necessary; child, by intramuscular injection, 0.5–2 mg/kg.

FENTANYL CITRATE:

Indications: Administration of General Anesthesia, General Anesthesia Adjunct, Postoperative Pain, Regional Anesthesia for Postoperative Pain, Regional Anesthesia for Surgery.

Contraindications: Acute Asthma Attack, Paralytic Ileus, Toxin-Mediated Diarrhea, Chronic Disease of Respiratory System, Cor Pulmonale, Inflammatory Bowel Disease, Respiratory Depression.

Dose and Administration: By slow intravenous injection, with spontaneous respiration, 50–100 micrograms (max. 200 micrograms on specialist advice), then 50 micrograms as required; child 1–5 micrograms/kg, then 1 microgram/kg as required. With assisted ventilation, 0.3–3.5 mg, then 100–200 micrograms as required; child 5–10 micrograms/kg, then 1–3 micrograms/kg as required. By intravenous infusion, with spontaneous respiration, adult and child, 50– 80 nanograms/kg/minute adjusted according to response. With assisted ventilation, adult and child, initially 10 micrograms/kg over 10 minutes then 100 nanograms/kg/minute adjusted according to response; adults may require up to 3 micrograms/kg/minute during cardiac surgery.

TRAMADOL HYDROCHLORIDE:

Indications: moderate to severe pain.

Contraindications: Alcohol Intoxication, Benzodiazepine Toxicity, Opioid Toxicity, Pregnancy, Respiratory Depression, Alcohol Withdrawal Syndrome, Central Nervous System Infection, CNS Depression, Epilepsy, Head Injury, Hypoglycemic Disorder, Hyponatremia, Intracranial Hypertension, Lower Seizure Threshold, Serotonin Syndrome, Severe Renal Disease, Substance Abuse, Suicidal.

Dose and Administration: adult and child over 12 years, by mouth, 50– 100 mg not more often than every 4 hours; total of more than 400 mg daily not usually required. adult and child over 12 years, by intramuscular injection or by intravenous injection (over 2–3 minutes) or by intravenous infusion, 50–100 mg every 4–6 hours. Postoperative pain, 100 mg initially then 50 mg every 10–20 minutes if necessary during first hour to total max. 250 mg (including initial dose) in first hour, then 50–100 mg every 4–6 hours; max. 600 mg daily.

SUFENTANYL CITRATE:

Indications: Administration of General Anesthesia, General Anesthesia Adjunct.

Contraindications: Bradycardia, Decreased Cardiac Function, Head Injury, Hypothyroidism, Intracranial Hypertension, Intracranial Lesion, Renal Disease.

Dose and Administration: Adult Dosage,In minor but painful general surgical procedures (anticipated duration of anesthesia of 1–2 hours) requiring endotracheal intubation and assisted or controlled respiration in adults, a total sufentanil dosage of 1–2 mcg/kg is administered IV in conjunction with nitrous oxide and oxygen; approximately 75% or more of the total dosage (titrated to patient response) may be administered by slow IV injection or infusion prior to intubation. Pediatric Dosage, The manufacturers state that when sufentanil is used to provide induction and maintenance of anesthesia without additional anesthetic agents in children younger than 12 years of age undergoing cardiovascular surgery, an initial anesthetic dose of 10–25 mcg/kg is administered IV in conjunction with 100% oxygen and a skeletal muscle relaxant; additional IV doses of up to 25–50 mcg each (or, alternatively, 1–2 mcg/kg each) are recommended as necessary based on response to the initial dose and as determined by changes in vital signs that indicate surgical stress or lightening of anesthesia.

TRAMADOL-PARACETAMOL:

Indications: moderate to severe pain.

Contraindications: Acetaminophen Toxicity, Alcohol Intoxication, Benzodiazepine Toxicity, Opioid Toxicity, Pregnancy, Respiratory Depression, Alcoholism, Alcohol Withdrawal Syndrome, Central Nervous System Infection, CNS Depression, Disease of Liver, Epilepsy, Head Injury, Hypoglycemic Disorder, Hyponatremia, Intracranial Hypertension, Lower Seizure Threshold, Serotonin Syndrome, Severe Renal Disease, Substance Abuse, Suicidal.

Dose and Administration: 2 tablets (tramadol hydrochloride 37.5 mg, paracetamol 325 mg) not more than every 6 hours; max. 8 tablets daily; child under 12 years not recommended.

 

Antimigraine Drugs

ERGOTAMINE TARTRATE:

Indications: treatment of acute migraine

Contraindications: Bacterial Septicemia, Buerger’s Disease, Coronary Angioplasty, Coronary Artery Disease, Disease of Liver, Induction of Labor, Intermittent Claudication, Lactating Mother, Nutritional Disorder, Occlusive Peripheral Vascular Disease, Phlebitis, Pregnancy, Premature Labor, Raynaud’s Phenomenon, Renal Disease, Severe Arteriosclerotic Vascular Disease, Severe Pruritus, Severe Uncontrolled Hypertension, Vascular Surgery.

Dose and Administration: adult and child over 12 years, 1–2 tablets (each contain ergotamine tartrate 1 mg, caffeine 100 mg) at onset; max. 4 tablets in 24 hours, not to be repeated at intervals of less than 4 days; max. 8 tablets in one week.

SUMATRIPTAN:

Indications: treatment of acute migraine.

Contraindications: Angina, Basilar Migraine, Cerebral Ischemia, Cerebrovascular Accident, Coronary Artery Disease, Hemiplegic Migraine, Ischemic Bowel Disease, Myocardial Infarction, Myocardial Ischemia, Ophthalmoplegic Migraine, Peripheral Vascular Disease, Prinzmetal Angina, Severe Hepatic Disease, Severe Uncontrolled Hypertension, Transient Cerebral Ischemia.

Dose and Administration: By mouth, 50 mg (some patients may require 100 mg); dose may be repeated after at least 2 hours if migraine recurs; max. 300 mg in 24 hours; Intranasally, 10–20 mg (adolescent 12–17 years 10 mg) into one nostril; dose may be repeated once after at least 2 hours if migraine recurs; max. 40 mg (adolescent 12–17 years 20 mg) in 24 hours.

RIZATRIPTAN:

Indications: treatment of acute migraine.

Contraindications: Angina, Basilar Migraine, Hemiplegic Migraine, Myocardial Infarction, Myocardial Ischemia, Prinzmetal Angina, Severe Uncontrolled Hypertension, Disease of Liver, Peripheral Vascular Disease, Renal Disease.

Dose and Administration: one tablet (5 mg) by oral route once, may repeat at 2-hour intervals; do not exceed 30 mg in 24 hours.

Other Antidepressant Drugs

Mirtazapine, a presynaptic alpha2-adrenoreceptor antagonist, increases central noradrenergic and serotonergic neurotransmission. It has few antimuscarinic effects, but causes sedation during initial treatment. Venlafaxine is a serotonin and noradrenaline re-uptake inhibitor (SNRI); it lacks the sedative and antimuscarinic effects of the tricyclic antidepressants. Tianeptine is an antidepressant agent with a novel neurochemical profile. It increases serotonin (5-hydroxytryptamine; 5-HT) uptake in the brain (in contrast with most antidepressant agents) and reduces stress-induced atrophy of neuronal dendrites. Like the selective serotonin reuptake inhibitors (SSRIs) and in contrast with most tricyclic antidepressant agents, tianeptine does not appear to be associated with adverse cognitive, psychomotor, sleep, cardiovascular or bodyweight effects and has a low propensity for abuse.

MIRTAZAPINE:

Indications: major depression.

Contraindications: Manic Bipolar Disorder, Severe Chronic Neutropenia, And Suicidal Ideation.

Dose and Administration: Initially 15 mg daily at bedtime increased within 2–4 weeks according to response; max. 45 mg daily as a single dose at bedtime or in 2 divided doses; child and adolescent under 18 years not recommended.

VENLAFAXINE:

Indications: Depression, Generalized Anxiety Disorder, Neuropathic Pain, And Post Traumatic Stress Disorder, Social Phobia, Vasomotor Symptoms associated with Menopause.

Contraindications: Hypertension, Narrow Angle Glaucoma, Ocular Hypertension, Prolonged QT Interval, Recovery Phase Following Myocardial Infarct, Severe Uncontrolled Hypertension, Suicidal Ideation, Upper GI Bleed.

Dose and Administration: Depression, adult over 18 years, 75 mg daily as a single dose, increased if necessary after at least 2 weeks to 150 mg once daily; max. 225 mg once daily; child under 18 years not recommended. Generalised anxiety disorder, adult over 18 years, 75 mg daily as a single dose; discontinue if no response after 8 weeks. Social anxiety disorder, adult over 18 years, 75 mg daily as a single dose; discontinue if no response after 12 weeks.

TIANEPTINE:

Indications: Indicated for depressive states of mild, moderate and sever intensity.

Contraindications: Children under 15 years age, pregnancy, breast-feeding or not to be used in combination with other drugs for depression such as non­selective MAOI.

Dose and Administration: The mean dosage is 3 tablets per day (37.5mg per day) to be taken just before the three meals.

Antimanic Drugs

Drugs are used in mania to control acute attacks and to prevent their recurrence.

Benzodiazepines: Use of benzodiazepines may be helpful in the initial stages of treatment until lithium achieves its full effect; they should not be used for long periods because of the risk of dependence.

Antipsychotic drugs:

In an acute attack of mania, treatment with an antipsychotic drug is usually required because it may take a few days for lithium to exert its antimanic effect.

Carbamazepine:

Carbamazepine may be used for the prophylaxis of bipolar disorder (manic-depressive disorder) in patients unresponsive to lithium; it seems to be particularly effective in patients with rapid-cycling manic-depressive illness (4 or more affective episodes per year).

Valproic acid:

Valproic acid is licensed for the treatment of manic episodes associated with bipolar disorder. It may be useful in patients unresponsive to lithium.

LITHIUM DERIVATIVES:

Indications: Bipolar Disorder, Bipolar Disorder in Remission, Manic Bipolar Disorder.

Contraindications: Lactating Mother, Lithium Toxicity, Pregnancy, Chronic Heart Failure, Conduction Disorder of the Heart, Diabetes Insipidus, Hyponatremia, Renal Disease, Severe Dehydration, Severe Infection.

Dose and Administration: For lithium carbonate adult and child over 12 years, treatment, initially 1–1.5 g daily; prophylaxis, initially 300–400 mg daily. For lithium sulphate, Treatment and prophylaxis, initially 1.04–3.12 g daily in 2 divided doses (elderly or patients less than 50 kg, 520 mg twice daily).​

Nitrates, Calcium Channel Blockers and Other Antianginal Drugs

Nitrates:

Glyceryl Trinitrate:

Indications: prophylaxis and treatment of angina; left ventricular failure; anal fissure; extravasation.

Contraindications: hypersensitivity to nitrates; hypotensive conditions and hypovolaemia; hypertrophic cardiomyopathy, aortic stenosis, cardiac tamponade, constrictive pericarditis, mitral stenosis; marked anaemia.

Dose and Administration:

Sublingually, 0.3–1 mg, repeated as required

By intravenous infusion, 10–200 micrograms/minute

By transdermal application, Prophylaxis of angina, apply one ‘5’ or one ‘10’ patch to lateral chest wall; replace every 24 hours, siting replacement patch on different area; max. two ‘10’ patches daily.

Isosorbide Dinitrate:

Indications: prophylaxis and treatment of angina; left ventricular failure. Contraindications: Allergic reactions to organic nitrates are extremely rare, but they do occur.

Dose and Administration: The usual starting dose is 5 mg to 20 mg, two or three times daily. For maintenance therapy, 10 mg to 40 mg, two or three times daily are recommended. Some patients may require higher doses.

Isosorbide Mononitrate:

Indications: prophylaxis of angina; adjunct in congestive heart failure. Contraindications: Allergic reactions to organic nitrates are extremely rare, but they do occur.

Dose and Administration: Initially 20 mg 2–3 times daily or 40 mg twice daily (10 mg twice daily in those who have not previously received nitrates); up to 120 mg daily in divided doses if required.

Calcium Channel Blockers:

Nifedipine:

Indications: prophylaxis of angina; hypertension; Raynaud’s phenomenon. Contraindications: cardiogenic shock; advanced aortic stenosis; within 1 month of myocardial infarction; unstable or acute attacks of angina; acute porphyria

Dose and Administration:

Hypertension, 20–30 mg once daily, increased if necessary to max. 90 mg once daily.

Angina prophylaxis, 30 mg once daily, increased if necessary to max. 90 mg once daily

Amlodipine:

Indications: treatment of hypertension. It may be used alone or in combination with other antihypertensive agents, symptomatic treatment of chronic stable angina alone or in combination with other antianginal agents.

Contraindications: cardiogenic shock, unstable angina, significant aortic stenosis; porphyria and breast-feeding.

Dose and Administration: Hypertension or angina, initially 5 mg once daily; max. 10 mg once daily.

Diltiazem:

Indications: treatment of hypertension. It may be used alone or in combination with other antihypertensive medications and management of chronic stable angina.

Contraindications: severe bradycardia, left ventricular failure with pulmonary congestion, second- or third-degree AV block (unless pacemaker fitted), sick sinus syndrome; acute porphyria; pregnancy and breast-feeding.

Dose and Administration: Angina and mild to moderate hypertension, 180– 300 mg once daily, increased if necessary to 360 mg once daily in hypertension and to 480 mg once daily in angina; elderly and in hepatic or renal impairment, initially 120 mg once daily

Nimodipine:

Indications: prevention and treatment of ischaemic neurological deficits following aneurysmal subarachnoid haemorrhage

Contraindications: within 1 month of myocardial infarction; unstable angina; porphyria.

Dose and Administration: Prevention, by mouth, 60 mg every 4 hours, starting within 4 days of aneurysmal subarachnoid haemorrhage and continued for 21 days. Treatment, by intravenous infusion via central catheter, initially 1 mg/hour (up to 500 micrograms/hour if body-weight less than 70 kg or if blood pressure unstable), increased after 2 hours to 2 mg/hour if no severe fall in blood pressure; continue for at least 5 days (max. 14 days); if surgical intervention during treatment, continue for at least 5 days after surgery; max. total duration of nimodipine use 21 days.

Verapamil:

See under treatment of Supraventricular arrhythmias.

Amlodipine and Valsartan:

Indications: treatment of hypertension also is used as initial therapy in patients who are likely to need multiple drugs to achieve their blood pressure goals

Contraindications: cardiogenic shock, unstable angina, significant aortic stenosis; porphyria, pregnency and breast-feeding.

Dose and Administration: In clinical trials with once daily (amlodipine and valsartan) using amlodipine doses of 5 mg to-10 mg and valsartan doses of 160 mg to -320 mg, the antihypertensive effects increased with increasing doses.

Other Antianginal Drugs:

Trimetazidine:

Indications: preventive treatment of episodes of angina pectoris and in ischaemia of neurosensorial tissues as in meniere`s disease.

Contraindications: pregnency and breast-feeding.

Dose and Administration: 70mg daily in two divided doses.

Ivabradine:

Indications: treatment of angina in patients in normal sinus rhythm.

Contraindications: severe bradycardia (not to be initiated if heart rate below 60 beats per minute); cardiogenic shock; acute myocardial infarction; immediately after cerebrovascular accident; sick-sinus syndrome; sino-atrial block; moderate to severe heart failure; patients with pacemaker; unstable angina; second- and third-degree heart block; congenital QT syndrome; pregnancy and breast-feeding.

Dose and Administration: Initially 5 mg twice daily, increased if necessary after 3–4 weeks to 7.5 mg twice daily (if not tolerated reduce dose to 2.5–5 mg twice daily); elderly initially 2.5 mg twice daily

Peripheral Vasodilators and Related Drugs:

Pentoxifylline:

Indications: treatment of patients with intermittent claudication on the basis of chronic occlusive arterial disease of the limbs. It may improve function and symptoms but is not intended to replace more definitive therapy, such as surgical bypass, or removal of arterial obstructions when treating peripheral vascular disease.

Contraindications: cerebral haemorrhage, extensive retinal haemorrhage, acute myocardial infarction; pregnancy and breast-feeding

Dose and Administration: 400 mg 2–3 times daily

Diosmin:

Indications: Treating hemorrhoids, Treating leg ulcers caused by poor circulation, when used in combination with hesperidin.

Contraindications: pregnancy and breast-feeding.

Dose and Administration: For the treatment of internal hemorrhoids: 1350 mg of diosmin plus 150 mg of hesperidin twice daily for 4 days followed by 900 mg of diosmin and 100 mg of hesperidin twice daily for 3 days. Some researchers also try 600 mg of diosmin three times daily for 4 days, followed by 300 mg twice daily for 10 days, in combination with 11 grams of psyllium daily. However, this lower diosmin dose does not seem to be as effective. For prevention of relapse internal hemorrhoids: 450 mg of diosmin plus 50 mg of hesperidin twice daily for 3 months of therapy. For the treatment of leg wounds due to bloodflow problems (venous stasis ulcers): the combination of 900 mg of diosmin and 100 mg of hesperidin daily has been used for up to 2 months

Beta Hydroxyethyl Rutosides:

Indications: indicated for oedema and symptoms (painful, tired, heavy, swollen legs with cramps and paraesthesia) associated with chronic venous insufficiency; postphlebitic syndrome, trophic disorders, varicose dermatitis and varicose ulcers. Also, it is indicated for symptoms of hemorrhoids (pain, exudation, pruritis and bleeding) and their complications.

Contraindications: pregnancy and breast-feeding.

Dose and Administration: 2 to 3 capsules of 300 a day with meals. After the disappearance of symptoms, usually in 2 to 4 weeks, it is advisable to continue treatment for some weeks to consolidate the results obtained.

Alpha-Adrenoceptor Blocking Drugs

Terazosin:

Indications: indicated for the treatment of symptomatic benign prostatic hyperplasia (BPH). also indicated for the treatment of hypertension alone or in combination with other antihypertensive agents such as diuretics or beta­adrenergic blocking agents.

Contraindications: contraindicated in patient’s known to be hypersensitive to terazosin hydrochloride.

Dose and Administration: Benign Prostatic Hyperplasia: 1 mg at bedtime is the starting dose The dose should be increased in a stepwise fashion to 2 mg, 5 mg, or 10 mg once daily to achieve the desired improvement of symptoms and/or flow rates. Hypertension: The usual recommended dose range is 1 mg to 5 mg administered once a day; however, some patients may benefit from doses as high as 20 mg per day.

Doxazosin:

Indications: treatment of both the urinary outflow obstruction and obstructive and irritative symptoms associated with BPH. also indicated for the treatment of hypertension alone or in combination with diuretics, beta-adrenergic blocking agents, calcium channel blockers or angiotensin-converting enzyme inhibitors.

Contraindications: contraindicated in patients with a known sensitivity to quinazolines.

Dose and Administration: Benign Prostatic Hyperplasia 1–8 mg once daily. Hypertension 1–16 mg once daily.

Alfuzosin:

Indications: indicated for the treatment of signs and symptoms of benign prostatic hyperplasia. It is not indicated for the treatment of hypertension. Contraindications: contraindicated for use in patients with moderate or severe hepatic impairment, contraindicated for use with potent CYP3A4 inhibitors such as ketoconazole, itraconazole, and ritonavir.

Dose and Administration: The recommended dosage is one 10 mg once daily.

Centrally Acting Antihypertensive Drugs

Methyldopa:

Indications: hypertension

Contraindications: contraindicated in patients with active hepatic disease, such as acute hepatitis and active cirrhosis, with liver disorders previously associated with methyldopa therapy. on therapy with monoamine oxidase (MAO) inhibitors. Dose and Administration: Initially 250 mg 2–3 times daily, increased gradually at intervals of at least 2 days, max. 3 g daily; elderly initially 125 mg twice daily, increased gradually, max. 2 g daily.

CLONIDINE:

Indications: in the treatment of hypertension.

Contraindications: not be used in patients with known hypersensitivity to

clonidine.

Dose and Administration: By slow intravenous injection, 150–00 micrograms;

max. 750 micrograms in 24 hours.

MOXONIDINE:

Indications: mild to moderate essential hypertension.

Contraindications: history of angioedema; conduction disorders (sick sinus syndrome, sino-atrial block, second- or third-degree AV block); bradycardia; life-threatening arrhythmia; severe heart failure; severe coronary artery disease, unstable angina; severe liver disease or severe renal impairment; also on theoretical grounds: Raynaud’s syndrome, intermittent claudication, epilepsy, depression, Parkinson’s disease; pregnancy and breast-feeding.

Dose and Administration: 200 micrograms once daily in the morning, increased if necessary after 3 weeks to 400 micrograms daily in 1–2 divided doses; max. 600 micrograms daily in 2 divided doses (max. single dose 400 micrograms)

Rilmenidine:

Indications: mild to moderate hypertension.

Contraindications: severe depression and severe renal failure.

Dose and Administration: 1mg daily as a single dose which can be increased if necessary after 1 month to 2mg daily in divided doses.

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