EPERISONE Eperisone (full name: eperisone hydrochloride) is an antispasmodic drug, sold in Japan, India and Bangladesh under the

brand name Myonal. Eperisone acts by relaxing both skeletal muscles and vascular smooth muscles, and demonstrates a variety of effects such as reduction of myotonia, improvement of circulation, and suppression of the pain reflex. The drug inhibits the vicious cycle of myotonia by decreasing pain, ischaemia, and hypertonia in skeletal muscles, thus alleviating stiffness and spasticity, and facilitating muscle movement. Eperisone also improves dizziness and tinnitus associated with cerebrovascular disorders or cervical spondylosis. Eperisone has a relatively low incidence of sedation when compared with other anti-spasmodic drugs; this simplifies the clinical application of the drug and makes it an attractive choice for patients who require anti-spasmodic therapy without a reduction in alertness. Eperisone also facilitates voluntary movement of the upper and lower extremities without reducing muscle power; it is therefore useful during the initial stage of rehabilitation and as a supporting drug during subsequent rehabilitative therapy. Indications Spastic paralysis in conditions such as cerebrovascular disease, spastic spinal paralysis, cervical spondylosis, post-operative sequelae (including cerebrospinal tumour), sequelae to trauma (eg. spinal trauma, head injury), amyotrophic lateral sclerosis, cerebral palsy, spinocerebellar degeneration, spinal vascular diseases and other encephalomyelopathies; improvement of muscular hypertonic ymptoms in conditions such as cervical syndrome, periarthritis of the shoulder, lumbago. Presentation Eperisone hydrochloride is available as the brand name preparation Myonal as 50 mg enteric coated tablets. An experimental form of the drug, as a transdermal patch system, has shown promising results in laboratory tests on rodents; however, this product is not currently available for human use. Dosage and administration In adults, the usual dose of eperisone is 50-150 mg per day, in divided doses after meals. However, the dosage is adjusted by the prescribing clinician depending on factors such as severity of symptoms, patient age and response. Eperisone has not been established as definitely safe for paediatric use, therefore its use in paediatrics cannot be recommended without further study. If elderly patients are treated with eperisone, it is recommended that a reduced dose is used, and the patient closely monitored for signs of psychological hypofunction during treatment. Safety during pregnancy and breast-feeding Eperisone has not been established to be safe for use by pregnant women; therefore the drug should only be used in pregnant women, or women who may be pregnant, if the expected therapeutic benefits will outweigh the possible risks associated with treatment. The manufacturers of Myonal recommend that the drug is not used during lactation (breast-feeding). If eperisone must be used, it is recommended that the patient stops breast-feeding for the duration of treatment. (It has been reported that Eperisone is excreted in breast milk in an animal study (in rats). Pharmacology IUPAC name: (2RS)-1-(4-Ethylphenyl)-2-methyl-3-piperidin-1ylpropan-1-one monohydrochloride C17H25NO·HCl- mass number= 295.85 Skeletal muscle relaxation Relaxation of hypertonic skeletal muscles Improves intramuscular blood flow Suppression of spinal reflex potentials Reduction of muscle spindle sensitivity via motor neurons Vasodilatation and augmentation of blood flow Analgesic action and inhibition of the pain reflex in the spinal cord Contraindications Eperisone is contraindicated in patients with known hypersensitivity to the drug. Cautions Eperisone should be administered with care in patients with a history of

hypersensitivity to any medication, or with disorders of liver function (Eperisone may aggravate hepatic dysfunction). Weakness, light-headedness, sleepiness or other symptoms may occur. In the event of such symptoms, the dosage should be reduced or treatment discontinued. Patients should be cautioned against engaging in potentially hazardous activities requiring alertness, such as operating machinery or driving a car. Side effects Shock and Anaphylactoid reactions: In the event of symptoms such as redness, itching, urticaria, oedema of the face and other parts of the body, dyspnoea etc, treatment should be discontinued and appropriate measues taken. Oculo-muco-cutaneous syndrome (Stevens Johnson Syndrome) and Toxic Epidermal Necrolysis: Serious dermatopathy such as oculo-mucocutaneous syndrome (Stevens-Johnson syndrome) or toxic epidermal necrolysis may occur. Patients should be carefully observed, treatment discontinued and appropriate measures taken, in the event of symptoms such as fever, erythema, blistering, itching, ocular congestion or stomatitis, etc Other side effects: anaemia, rash, pruritus, sleepiness, insomnia, headache, nausea ang vomiting, anorexia, abdominal pain, diarrhoea, constipation, urinary retention or incontinence. Drug interactions There have been reports of disturbances in ocular accommodation occuring after the concomitant use of tolperisone hydrochloride and methocarbamol. HEMARATE Contents Fe fumarate 320 mg (elemental Fe 105 mg), vit B1 10 mg, vit B2 10 mg, vit B6 5 mg, vit B12 50 mcg, vit C 500 mg, vit E 30 iu, nicotinamide 30 mg Indications Nutritional & Fe-deficiency anemia due to pregnancy, lactation & menstrual blood loss. Prevention & treatment of conditions associated w/ B-complex deficiency. Dosage Adult 1 tab daily. Administration Should be taken on an empty stomach (Best taken between meals. May be taken w/ meals to reduce GI discomfort.). MIMS Class Vitamins & Minerals (Pre & Post Natal) / Antianemics ATC Classification B03AE10 - Various combinations ; Belongs to the class of iron in other combinations. Used in the treatment of anemia. Poison Schedule Non-Rx

GALVUS (vildaglipti Main use Type 2 diabetes How does it work? Galvus tablets contain the active ingredient vildagliptin, which is a type of medicine called a dipeptidyl peptidase-4 (DPP-4) inhibitor. It is used to treat type 2 or non-insulin dependent diabetes (NIDDM). Vildagliptin works by increasing the amount of two incretin hormones found in the body, called glucagon-like peptide-1 (GLP-1) and glucosedependent insulinotropic peptide (GIP). These hormones are normally produced naturally by the body in response to food intake. Their function is to help control blood sugar (glucose) levels. GLP-1 and GIP have two main actions that help to control blood glucose. Firstly, they stimulate the pancreas to produce insulin in response to increasing levels of glucose in the blood. (Insulin is the main hormone Active ingredient Vildagliptin Manufacturer Novartis

responsible for controlling sugar levels in the blood. It causes cells in the body to remove sugar from the blood.) GLP-1 also reduces the production of glucagon. (Glucagon is a hormone that normally increases glucose production by the liver.) GLP-1 and GIP are normally broken down by an enzyme in the body called dipeptidyl peptidase-4 (DPP-4). Vildagliptin works by binding to this enzyme and preventing it from breaking down the GLP-1 and GIP. This increases the levels of these hormones in the body and so increases their effect on controlling blood sugar. What is it used for?

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This medicine is not recommended for people receiving dialysis or who have moderate to severe kidney disease. This medicine is not recommended for people with severe heart failure. This medicine is not recommended for children and adolescents under 18 years of age because it has not been studied in this age group. This medicine contains lactose and should not be taken by people with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption.

Type 2 diabetes (non-insulin dependent diabetes).

Galvus is used for people with type 2 diabetes whose blood sugar is not sufficiently controlled by other antidiabetic medicines. It can be added to treatment with metformin; a sulphonylurea, for example gliclazide; or another type of antidiabetic medicine known as a thiazolidinedione, for example pioglitazone or rosiglitazone. Warning!

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately. Pregnancy and breastfeeding

Hypoglycaemia (low blood glucose) has been commonly reported when this medicine is used in combination with metformin or sulphonylurea medicines, eg glimepiride. Symptoms of hypoglycaemia usually occur suddenly and may include cold sweats, cool pale skin, tremor, anxious feeling, unusual tiredness or weakness, confusion, difficulty in concentration, excessive hunger, temporary vision changes, headache, nausea and palpitations. You should talk to your doctor or diabetes specialist about this and make sure you know what to do if you experience these symptoms. Your ability to concentrate or react may be reduced if you have low blood sugar, and this can cause problems driving or operating machinery. You should take precautions to avoid low blood sugar when driving - discuss this with your doctor. This medicine may also cause dizziness or fatigue. If affected you should take care driving or operating machinery. People with diabetes have a higher risk of developing foot ulcers and blistering of the skin. It is therefore important to have a good foot care routine. Consult your doctor if you get any new blisters or ulcers while taking this medicine. Rare cases of inflammation of the liver (hepatitis) have been reported in people taking this medicine. For this reason, your liver function should be checked before starting treatment, every three months during the first year of treatment, and regularly thereafter. You should consult your doctor if you develop any of the following symptoms while taking this medicine, so that your liver can be checked: unexplained nausea, vomiting, abdominal pain, fatigue, loss of appetite, darkened urine or yellowing of the eyes or skin (jaundice).

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine. • The safety of this medicine for use during pregnancy has not been established. It should not be used during pregnancy. Diabetes mellitus is usually controlled using insulin during pregnancy, because this provides a more stable control of blood sugar. If you get pregnant while taking this medicine, or are planning a pregnancy, you should seek medical advice from your doctor. It is not known if this medicine passes into breast milk. The manufacturer states that it should not be used by breastfeeding mothers. Seek medical advice from your doctor.

Side effects Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect. Common (affect between 1 in 10 and 1 in 100 people) • • • • • • • • Tremor (when used with metformin or a sulphonylurea). Headache (when used with metformin or a sulphonylurea). Dizziness (when used with metformin or a sulphonylurea). Low blood sugar levels (when used with metformin or a sulphonylurea). Nausea (when used with metformin). Feeling weak (when used with a sulphonylurea). Weight gain (when used with a glitazone). Swelling of the legs and ankles due to excess fluid retention (when used with a glitazone).

Use with caution in • People over 75 years of age. People with mild heart failure. People taking ACE inhibitor medicines, eg captopril.

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Not to be used in Type 1 diabetes. Diabetic ketoacidosis. Decreased liver function. Pregnancy. Breastfeeding.

Uncommon (affect between 1 in 100 and 1 in 1000 people) • • • • Fatigue (when used with metformin). Constipation (when used with a sulphonylurea). Headache (when used with a glitazone). Feeling weak (when used with a glitazone).

Rare (affect between 1 in 1000 and 1 in 10,000 people) • • • Changes in liver function. Inflammation of the liver (hepatitis). Allergic reaction called angioedema, which may involve swelling of the face, tongue or throat, difficulty swallowing or breathing, rash or hives (stop taking this medicine and consult your doctor immediately if you experience these symptoms).

Before taking Januvia Do not use this medication if you are allergic to Januvia, or if you are in a state of diabetic ketoacidosis (call your doctor for treatment with insulin). Before taking Januvia, tell your doctor if you have kidney disease or if you are on dialysis. If you have any of these conditions, you may not be able to use Januvia, or you may need a dosage adjustment or special tests during treatment. FDA pregnancy category B. Januvia is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether sitagliptin passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Januvia should not be given to a child younger than 18 years old without a doctor's advice. How should I take Januvia? Take Januvia exactly as it was prescribed for you. Do not take the medication in larger or smaller amounts, or take it for longer than recommended by your doctor. Your doctor may occasionally change your dose to make sure you get the best results from this medication. You may take this medicine with or without food. Follow your doctor's instructions. Januvia is only part of a complete program of treatment that also includes diet, exercise, weight control, and possibly other medications. It is important to use this medicine regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely. To be sure this medication is helping your condition, your blood will need to be tested on a regular basis. Your kidney function may also need to be tested. It is important that you not miss any scheduled visits to your doctor. Your medication needs may change if you become sick or injured, if you have a serious infection, or if you have any type of surgery. Your doctor may want you to stop taking Januvia for a short time if any of these situations affect you. Store Januvia at room temperature away from moisture, heat, and light. What happens if I miss a dose? Take the missed dose as soon as you remember (be sure to take the medicine with food if your doctor has instructed you to). If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose. What happens if I overdose? Seek emergency medical attention if you think you have used too much of this medicine. You may have signs of low blood sugar, such as hunger, headache, confusion, irritability, drowsiness, weakness, dizziness, tremors, sweating, fast heartbeat, seizure (convulsions), fainting, or coma. What should I avoid while taking Januvia? Follow your doctor's instructions about any restrictions on food, beverages, or activity while you are taking Januvia. Januvia side effects Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have fever, sore throat, and headache with a severe blistering, peeling, and red skin rash. These could be signs of a serious side effect. Less serious Januvia side effects may include: • • runny or stuffy nose, sore throat; headache; or

Very rare (affects less than 1 in 10,000 people) • Inflammation of the nose and throat, causing a blocked or runny nose and sore throat (nasopharyngitis).

The side effects listed above may not include all of the side effects reported by the medicine's manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist. How can this medicine affect other medicines? It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to ensure that the combination is safe. Medicines that increase blood sugar levels as a side effect may make this medicine, and other antidiabetic medicines, less effective at controlling blood sugar. Medicines that can increase blood sugar levels include the following: • • • bronchodilators (beta agonists), eg salbutamol, terbutaline, salmeterol corticosteroids, eg prednisolone levothyroxine thiazide diuretics, eg bendroflumethiazide.


JANUVIA

Generic Name: sitagliptin (SI ta glip tin) Brand Names: Januvia What is Januvia? Januvia is an oral diabetes medicine that helps control blood sugar levels. It works by regulating the levels of insulin your body produces after eating. Januvia is for people with type 2 diabetes (non-insulin-dependent) diabetes. It is sometimes used in combination with other diabetes medications, but is not for treating type 1 diabetes. Januvia may also be used for purposes other than those listed here. Important information about Januvia Do not use Januvia if you are allergic to sitagliptin or if you are in a state of diabetic ketoacidosis (call your doctor for treatment with insulin). Before taking Januvia, tell your doctor if you have kidney disease or are on dialysis. If you have any of these conditions, you may not be able to use sitagliptin, or you may need a dosage adjustment or special tests during treatment. You may take this medicine with or without food. Follow your doctor's instructions. Follow your doctor's instructions about any restrictions on food, beverages, or activity while you are taking Januvia. Januvia is only part of a complete program of treatment that also includes diet, exercise, weight control, and possibly other medications. It is important to use this medicine regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely.

nausea, stomach pain, diarrhea.

effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist. Brand Name: Neobloc Generic Name: Metropolol tartrate Indications: Hypertension and chronic angina pectoris Drug Classification: Anti-hypertensive drug, Beta-blocker Mechanism of Action: A selective beta blocker that selectively blocks beta 1 receptors, decreases cardiac output, peripheral resistance and cardiac oxygen consumption and depresses rennin secretion. Dosage: Adult-initially 100mg daily, may increase at weekly interval to max. 400mg/day/ Maintenance 100-400mg/day. Special Precaution: Avoid abrupt withdrawal. Diabetes, anesth, 1st trimester of pregnancy Pregnancy Risk: C, D in 2nd and 3rd trimesters Adverse Reaction: GI and sleep pattern disturbances headache, dizziness, and weakness. Contraindications: Heart block> 1st degree, AV block II and III, cardiogenic shock, overt cardiac failure, sinus, bradycardia, bronchospastic disease. Form: Tablets- 100mg, 200mg. Injection-1mg/ 1 ml in 5-ml ampules, Nursing Responsibilities: ➢ Check for the patient’s apical pulse before giving the medication; if pulse is slower do not give the drug. ➢ In diabetic patients, monitor the glucose level closely because the drug masks common sign and symptoms of hypoglycemia. ➢ Monitor the BP frequently, the drug masks common signs and symptoms of shock. ➢ Beta blockers may mask tachycardia caused by hyperthyroidism. ➢ When teraphy is stopped, reduce dose gradually for 1-2 weeks. ➢ Instruct patient to take drug exactly as prescribed. ➢ Caution patient to avoid tasks requiring mental alertness until response to therapy has bee established. ➢ Instruct patient not to stop drug suddenly. ➢ Drug is not advised for breastfeeding women. Brand name: Plavix Generic name: Clopidogrel Drug Classification: Anticoagulant, antithrombotics & fibrinolytics Indication: for the reduction of atherosclerotic events (MI, stroke & vascular death) in patients w/ atherosclerosis documented by recent stroke, MI or established peripheral arterial disease. For the treatment of patients suffering from non- ST segment elevation acute coronary syndrome (unstable angina or nonQ wave MI) in combination w/ ASA. Mechanism of Action: low dosage aspirin appear to inhibit clot formation by blocking the synthesis of prostaglandin, which in turn prevents formation of the platelet- aggregating substance thromboxane A2. Clopidogrel Dosage: 75 mg daily Contraindication: Severe liver impairment. Peptic ulcer and intracranial hemorrhage. Lactation. Special Precaution: Patients who may be at risk of increased bleeding from trauma, surgery or other pathological conditions. Patients w/ moderate hepatic disease who may have bleeding diatheses. Pregnancy. Adverse Reaction: CNS: depression, dizziness, fatigue, headache EENT: epistaxis RESP: cough, dyspnea CV: Chest pain, edema, hypertension GI: GI bleeding, abdominal pain, diarrhea, dyspepsia, gastritis DERM: pruritus, purpura, rash HEMAT: bleeding, neutropenia, thrombotic thrombocytopenic purpura METAB: hypercholesterolemia MS: arthralgia, back pain MISC: fever, hypersensitivity reactions Form: Film- coated tablet- 75mg

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at1-800-FDA-1088. What other drugs will affect Januvia? Before you take Januvia, tell your doctor if you are also taking digoxin (Lanoxicaps, Lanoxin). You may not be able to take this medicine, or you may require a dosage adjustment or special monitoring. Although Januvia is not as likely to cause hypoglycemia (low blood sugar) as some other oral diabetes medications, tell your doctor if you are taking any other drugs that can potentially lower blood sugar, such as: • • • • • probenecid (Benemid); nonsteroidal anti-inflammatory drugs (NSAIDs); aspirin or other salicylates (including Pepto-Bismol); sulfa drugs (Bactrim and others); a monoamine oxidase inhibitor (MAOI);or beta-blockers (Tenormin and others).

This list is not complete and there may be other drugs that can interact with Januvia. Tell your doctor about all the prescription and over-thecounter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor Where can I get more information? • Your pharmacist can provide more information about Januvia.

What does my medication look like? Sitagliptin is available with a prescription under the brand name Januvia. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you. • • • • Januvia 25 mg - pink, round, film-coated tablets Januvia 50 mg - light beige, round, film-coated tablets Januvia 100 mg - beige, round, film-coated tablets Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed. Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, upto-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse

Pregnancy Risk Category: B Nursing Responsibilities: ➢ Assess patient for symptoms of stroke, peripheral vascular disease, or MI periodically during therapy. ➢ Monitor patient for signs of thrombotic thrombocytic purpura (thrombocytopenia, microangiopathic hemolytic anemia, neurologic findings, renal dysfunction, fever). ➢ Monitor bleeding time during therapy. ➢ Monitor CBC with differential and platelet count periodically during therapy.