Off label use of drugs

off label use

.

FDA approval for specific indication

1
Clomipramine
Tricyclic antidepressant
**
___________________________
*** ( for
) premature ejaculation

Anafranil

2
Phenytoin
)epilepsy)
**
)wound healing(
stimulation of fibroblast proliferation,
facilitation of collagen deposition
**

3
Sildenafil
D:

 phosphodiestrase
cGMP
) (Erectile dysfunction
blood supply to penis

** pulmonary hypertension
right sided heart failure

4
Spironolactone
k-sparing diuretic

thiazide k ,

** Anti androgenic effect

5
Methotrexate


__________________________________

** (Ectopic
) pregnancy

,

Erythromycin

Macrolides

G+v
____________________________________
**
Prokinetic

7
Domperidone

Dopamine antagonist
(
)
____________________________
**

8
Clomiphene
:D

,

Selective estrogen receptor

)Modulator (SERM
Hypothalamus
ve feedback

________________________________

** off label
( )Hyopgonadism

:D

hypothalamus
LH
)) Sperm

,

( )



LH
Ve feedback

LH


:

9
Cabergoline
Dopamine agonist
,
, ( )

**
() Anorgasmia
delayed ejaculation
orgasm

( ) SSRI

**


premature
ejaculation ( )

:

01
Bupropion

sec line of ttt after SSRI

Weak serotonin and noradrenalin reuptake
inhibitor
epilepsy

___________________________________
**

**

Wellbutrine

00
Acetylcysteine
)N-acetyl l-cysteine (NAC

Disulfide linkage
Mucous
**
. liver

NAC

)(Paracetamol antidote
IV or Oral
Glutathione
toxic metabolite

NAPQI
**

*
Mucolytic


Acetyl cysteine

12
Cyproheptadine


1st generation antihistamincs

___________________________________
**

13
Tamsulosin
) ) Alpha 1 blocker drug
BPH

anatomy of UT



__________________________________
**
Alpha receptor

14
Metformin

DM type 2



__________________________________
**
,



Hyperandrogenism


Hormonal imbalance induced acne

15
Lactulose


__________________________________
** .



\:

Lactic acid
Acidic media

NH3 to NH4
colon blood
**
)Neomycin (Antibiotic

 Bacterial flora

16
Finasterid

Testosterone to dihydrotestosterone (active
)form
BPH

________________________________
**
Anti androgenic effect

17
Trypsin & chemotrypsin
,

Hoarseness of voice
:D

Larynx

Laryngitis
GERD
Epiglottitis
Laryngeal or thyroid cancer


**

:
Alphintern
Ambezim

18
Paroxetine
SSRI

19
Dexamethasone
:D

Arachidonic acid

___________________________________

3 4



Surfactant
.

Synergism Ondansetron

22
Gabapentin

Gama amino butyric acid

)GABA (inhibitory neurotransmitter


GABA

**
Neuropathic pain

**
Bipolar disorder

Mania and depression

!

Mood stabilizer
**
Post herpetic neuralgia

VZ virus

 ()

:D

21
Nitroglycerin
Ca channel blocker
2 Off label use
,
Anti angina
ca channel blocker
Verapamil

After and preload
_________________________________
**

Anal fissure
blood supply
.
:

Nitromak
Dinitra
Effox

Ca channel blocker

22
Acetyl salicylic acid
)(aspirin
Potent anti inflammatory , analgesic , anti pyretic
NSAIDS
COX 1 , 2 enzymes

______________________________
**
,

))Anti platelet

23
Phenobarbitone
)(long acting barbiturate

Anti convulsant , hypnotic

______________________________

** Drug interaction

Liver enzymes inducer

2 3
)Sominaletta syr (phenobarbitone

Bilirubin

24
Adrenaline

Anaphylactic shock

asthma cardiac arrest
______________________________
**


Potent vasoconstrictor effect

25
NSAIDS
:D



__________________________________
**
ACEI induced cough
.


)Angiotensin converting (AC

Bradykinin
vagal effect

Arachidonic acid


NSAIDS

**


Shift from ACEI to ARB (angiotensin receptor
) blocker
NSAIDS

..
Sulindac

Meloxicam

26
Topiramate
Approval 1996


_________________________________
** FDA approval
2212 weight loss

Side effect not effect
Not clear

Topamax

27
Propranolol


Non selective beta blocker

__________________________________
**
Hyperthyrodism

(L) and (D) isomer
L-propranolol

Beta blocking activity
D-propranolol

)T4 to T3 (most active form

Beta
blockers
**

Racemic mixture of propranolol
isomers

22
Acetazolamide
Mild diuretic lowering Nacl and bicarbonate level

Carbonic anhydrase

( 3 )

edema
_______________________________
**
Glaucoma

Aqueous humor

**
Sulphonamide derivative

29
Latanoprost
Travoprost
Bimatoprost





:D

32
Insulin
Treatment of DM type 1
________________________________
**

...

substrate

31
Misopristol

Mucous Hcl
________________________________
**

32
SSRI
Selective serotonin
reuptake inhibitors

TCA
...................
________________________________
**




Dapoxetine
ssri

 SSRI **
Escitalopram

Dapoxetine