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COMMON TREATMENT MEASURES Doses given are for fit adults and may need to be modified for others.

Check pharmacopoiea for other contraindications, cautions and interactions 2010 Analgesics

Analgesic

Dosage

Contra-indications

Non-steroidal anti-inflammatory drugs (NSAIDS)

Mefenamic acid

250-500mg up to 3 times a day

Asthma, gastrointestinal, renal and liver disease, pregnancy

Diflunisal

250-500mg twice a day

Pregnancy, peptic ulcer, allergies, renal and liver disease

Non-NSAIDS

Paracetamol (acetaminophen)

500-1000mg up to 6 times a day (max 4mg daily)

Liver or renal disease, alcoholism or those on zidovudine

Nefopam

30-60mg up to 3 times a day

Convulsive disorders, pregnancy, elderly, renal, liver disease

Opioids

Codeine

10-60mg up to 6 times a day (or 30mg IM) 30mg up to 4 times a day (or 50mg IM)

Late pregnancy and liver disease

Dihydrocodeine

Children, hypothyroidism, asthma, renal disease

Anxiolytics

Anxiolytic

Dose

Comments Avoid in glaucoma Use with caution in the elderly Avoid in glaucoma Use with caution in the elderly

Diazepam

2-30mg daily in divided doses

Temazepam

5-10mg nocte

Corticosteroids

Corticosteroid

Topical dosage every 6 hours

Comments

Hydrocortisone hemisuccinate pellets

2.5mg dissolve in mouth close to ulcers

Use at an early stage of ulceration

Triamcinolone acetonide in carmellose gelatin paste DISCONTINUED 2009

Apply to lesions

Adheres best to dry mucosa; affords mechanical protection; of little benefit on tongue or palate

Betamethasone phosphate tablets

0.5mg ; use as mouthwash

More potent than preparations above; may produce adrenal suppression

Beclomethasone spray

1 puff 100 micrograms 1 puff 100 micrograms

May produce adrenal suppression

Budesonide spray

May produce adrenal suppression

Fluocinolone

Apply to lesion

May produce adrenal suppression

Fluocinonide cream, gel or ointment

Apply to lesion

May produce adrenal suppression

Clobetasol cream

Apply to lesion

May produce adrenal suppression

Prednisolone mouthwash

5mg

May produce adrenal suppression

Systemic immunosuppressants and immunomodulatory agents

Drug

Systemic dose

Comments

Prednisolone

Limit dosage in hypotension and Intially 40-80mg orally each day in diabetes mellitus divided doses, reducing as soon as possible to 10mg daily (give as enteric coated prednisolone with meals)

Azathioprine

2-2.5mg/kg daily

Contraindicated in pregnancy

Colchicine

500 micrograms, 3 times daily

Contraindicated in pregnancy, elderly, cardia renal or hepatic disease

Dapsone

1mg/kg/day

Contraindicated in G6PD deficiency, pregnancy, cardiorespiratory disease (monitor reticulocyte count closely)

Pentoxifylline

400mg twice daily

Contraindicated in cerebrovascular haemorrhage, myocardial infarction

Antifungals

Antifungal

Dosage and duration (continue for at least 48 h after lesions have cleared)* 10mg lozenge 100mg/ml suspension 10-400mg 6 hourly for at least 14-21 days

Possible drug interactions and contraindications

Amphotericin (topical)

Topical use; no problems

Nystatin (topical)

500 000 unit lozenge 100 000 unit pastille 100 000 unit per ml of suspension 100,000 units 6 hourly for at least 14-21 days

Topical use; often no problems but ma unpleasant taste, nausea or gastrointes disturbance

Miconazole (topical)

250mg tablet 25mg/ml gel 250mg 6 hourly for at least 14 -21days 50mg/g denture lacquer; apply weekly for at least 2 weeks

May interact with many drugs includin antidiabetics, anticoagulants, phenytoi midazolam, ciclosporin, cisapride and Avoid in pregnancy, porphyria. Even topical agent may be absorbed systemically. May impair oral contraceptive Not absorbed in achlorhydria. May int many drugs including anticoagulants, midazolam, cyclosporin, sertindole, te cisapride and astemizole. Avoid in pre porphyria. Hepatotoxic. Expensive May impair oral contraceptive May interact with many drugs includin antidiabetics, anticoagulants, phenytoi midazolam, cyclosporin, zidovudine, terfenadine, cisapride and astemizole. pregnancy, porphyria. May sometimes hepatotoxic and myelosuppressive. Ex May impair oral contraceptive Not absorbed in achlorhydria .May int

Ketoconazole (oral)

200-400mg daily for at least 14 days

Fluconazole (oral)

50-200mg daily for at least 14 days

100 mg capsules

Itraconazole (oral)

100-200mg daily for at least 14 days 10mg/ml liquid 10ml twice daily for at least 14 days

many drugs including digoxin, sertind anticoagulants, phenytoin, midazolam simvastatin, terfenadine, cisapride and Avoid in pregnancy, porphyria. Expen May impair oral contraceptive

* the higher doses are used in HIV infection

Antivirals

Disorder

Drug/dosage

Herpes simplex stomatitis

Aciclovir 100-200mg tablets five times daily, or oral suspension (200mg/5ml) five times daily Penciclovir 1% cream every 2 hours or 5% aciclovir cream every 2 hours

Recurrent herpes

Herpes varicella-zoster

Aciclovir 800mg oral five times daily or famciclovir 250mg three times daily, or famciclovir 750mg once daily

(Aciclovir (systemic preparations) - caution in renal disease and pregnancy. Occasional increase in liver enzymes and urea, rashes, CNS effects. Famciclovir - caution in renal disease and pregnancy. Occasionally causes nausea and headache).

Some antidepressants

Antidepressant Amitriptyline

Dose 25-75mg daily divided dose

Comments Contraindicated in recent myocardial infarction, arrhythmias, liver disease Contraindicated in recent myocardial infarction, arrhythmias, liver disease Contraindicated in recent myocardial infarction, arrhythmias, liver disease Caution with epilepsy, pregnancy, cardiac, liver, kidney disease, allergy or mania Contraindicated in pregnancy. cardiac arrhythmias and uncontrolled hypertension. Caution in glaucoma, bleeding disorders, breast feeding, hepatic or renal disease, and epilepsy. Avoid abrupt withdrawal.

Dothiepin

25mg three times a day or 75mg at night 10-100mg daily in divided doses

Clomipramine

Fluoxetine

20mg daily

Venlafaxine

37.5mg twice daily

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