Section 3

Short Profiles of 107 Drugs

Abbreviations Used in this Section Alcohol Breast feeding Driving Infants and Children Over 60
Over 60

Pregnancy Tobacco

Short Profiles of 107 Drugs

505

List of 107 Drugs with Short Profiles
Activated Charcoal Albendazole Allopurinol Alluminium Hydroxide & Magnesium Trisicate Aminophylline Amitriptyline Amphotericin Atenolol Beclomethasone Benzanthine Benzyle Penicillin Benzophenones Benzyl Penicillin Calcius Lactate Carbamazepine Cephalexin Chloramphenicol Chlorpramazine Cimetidine Clofazimine Clonidine Clotrimazole Cloxacillin Coaltar Cyclosporin Dexamethasone Diclofenac Sodium Diethyl Carbamazine Diloxanide Furoate Domperidone Doxycycline Epinephrine Ergocalciferol (Vit. D2) Ergometrine Ethinamide/Propionamide Ethosuximide Flucytosine Furazolidone Gentamicin Glucose Griseofulvin Haloperidol Hydralazine Hydrochlorthiazide Hydrocortisone Imipramine Indomethacin Iodine Ipecacuanha Iron Dextran Isoniazid+Thiacetazone (INH) isosorbide Dinitrate Ketoconazole Levamisole Levodopa + Carbidopa Levothyraxine Lindane (Gamma Benzene Hexachloride) Lithius Carbonate Mannitol Mefloquine Methylene Blue Metoclopramide Morphine Neomycin Niclosamide Nifedipine Nitrofurantoin (NFT) Nitrous Oxide Norethisterone Nystatin Pethidine Phenobarbitone Phenoxymethyl Penicillin Phenytoin Pilocarpine Piperazine Citrate Podophyllin Potassium Chloride Praziquantel Prednisolone Primaquine Procain Benzyl Penicillin Procainamide Pyrantel Pamoate Pyrazinamide Pyridoxine (Vit. B6) Quinidine Riboflavin (Vit. B2) Rifampicin + INH + Pyrazinamide Silver Sulfadiazine Silvernitrate Sodium Bicarbonate Sodium Chloride Sodium Thiosulphate Sodium Chloride + Dextrose (Glucose) Streptokinase (Enzyme) Sulface Sulfadimidine Tamoxifen Tetracaine Thiamine Trihexyl Phenidyl Valproicacid Verapamil Hydrochloride Vinblast Vincristine Warfarin (Mainly as Warfarin Sodium) Zinc Oxide

506

A Lay Person's Guide

Activated Charcoal
Use Antidote to treat overdose or poisoning by most drugs or chemicals Dosage Adults and Children above 6 years: 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
Can continue use of medicine Contraindicated
Over 60

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
Contraindicated Contraindicated Contraindicated

Can continue use of medicine Contraindicated

Contraindicated

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 With dig oxin, poisonous mushrooms, antide pressants (medicines used to treat depression), additional dose of 10-20 gm in 100 ml water is to be given every 2 hrs.

Safety not established

Adverse Effects Skin rashes, diarrhoea, disturbed colour vision, slow heart beat, loss of hair rarely reversible * Dizziness * Contraindicated in pregnancy * Blood disorders Additional Information During high dose therapy, careful monitoring of liver is advised. Interferes with oral contraceptives.

Short Profiles of 107 Drugs

507

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
Safety not established Contraindicated Reduced dose to be given Reduced dose to be given

Aluminium Hydroxide & Magnesium Trisilicate
Use 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
Safety not established Avoid
Over 60

Increased risk of adverse effects

Contraindicated

Contraindicated
Over 60

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.

Others * Kidney damage due to aluminium Adverse Effects Loss of phosphates from body, kidney stones, etc. Additional Information Drug Interactions * Magnesium trisilicate reduces absorption of iron/ tetracycline * Absorption of penicillamine reduced.

USE ANTACID TABLETS AND NOT THE LIQUID VERSION. YOU SAVE ON COST.

508

A Lay Person's Guide

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
Safety not established Contraindicated Increased risk of adverse effects

Additional Information 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.

Can continue use of medicine

Over 60

Increased risk of adverse effects

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.

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

Short Profiles of 107 Drugs

509

Amitriptyline
Use Antidepressant with sedative property sleep and avoids day-time drowsiness). Dosage Adults: 25-300 mg daily (1-4 times) Precaution
Safety not established Contraindicated Contraindicated

Amphotericin B
Brand Name (promotes 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
Contraindicated
Over 60

Contraindicated

Reduced dose to be given

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. Continue the drug and inform your doctor. Additional Information 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.

Fo r i n f e c t i o n s i n / a r o u n d m o u t h : 1 0 m g a s 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
Safety not established

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. Continue the drug and inform your doctor. 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.). Continue the drug and inform your doctor. GI tract problems like nausea, vomiting, diarrhoea, cramping.

510

A Lay Person's Guide

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

Contraindicated

Contraindicated
Over 60

Rational Therapy Tips Q. Can we use oral drugs a few months after the expiry date? Others

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

* 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.

Short Profiles of 107 Drugs

511

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 welltolerated. * Increased effect of drug seen on simul-taneous administration of chlorpromazine, cimetidine, oral c o n t r a c e p t ive s, f u r o s e m i d e a n d 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, lightheadedness, 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.

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
Can continue use of medicine Can continue use of medicine Can continue use of medicine Can continue use of medicine Contraindicated

Over 60

Can continue use of medicine

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. Additional Information 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.

512

A Lay Person's Guide

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. P h a r y n g i t i s : u p t o 2 7 . 3 k g b o d y we i g h t : 0.18 gm - 0.36 gm Body weight more than 27.3 kg: 0.54 gm (1 dose). Precaution
Contraindicated Contraindicated

Benzophenones
Use Sunscreen agents. Dosage 0.2% to 7% in oils, creams, aerosol sprays Additional Information Hypersensitivity reactions to benzyl salicylate has been reported. Skin reactions seen for sensitive skins.

Rational Therapy Tips Q. What is the role of antibiotic skin ointment?

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). Discontinue and call the doctor immediately.

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

Short Profiles of 107 Drugs

513

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
Contraindicated Contraindicated

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. Additional Information 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.

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.

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

Ans. None. You need systemic antibiotics.

514

A Lay Person's Guide

Carbamazepine
Brand Name Carbatol, Mazetol, Tegretol Use Anti-epileptic Dosage Adults: 100 mg twice daily. 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
Contraindicated Contraindicated Contraindicated

Additional Information Drug Interactions * * * Erythromycin increases the toxicity of the drug. Phenobarbitone, phenytoin decrease levels of the drug. Isoniazid, cimetidine, propoxyphene increase drug toxicity. Take with food. Notify physician if there is bleeding, jaundice, swelling of hands or feet, ulcers in mouth, fever and chills.

Patient Information * *

Contraindicated

Contraindicated
Over 60

Contraindicated

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, acuteurinar y 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. Rational Therapy Tips 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.

Short Profiles of 107 Drugs

515

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
Contraindicated Contraindicated Reduced dose to be given

Additional Information 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. 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.

* *

Patient Information * * *

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. Continue the drug and inform your doctor. * Bleeding due to hypothrobinemia (a blood disorder leading to bleeding tendency). * * *

Rational Therapy Tips Q. Is it rational to use a combination of antibiotics in the management of an infection? Ans. Seldom. Exceptions are meningitis, septicemia and tuberculosis.

516

A Lay Person's Guide

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
Safety not established Contraindicated Avoid

Additional Information 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.

Can continue use of medicine

Can continue use of medicine

Reduced dose to be given
Over 60

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.

Rational Therapy Tips Q. Should one use preparations which have a combination of antibiotics with other drugs, e.g., steroids, vitamins? Ans. Never.

Short Profiles of 107 Drugs

517

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
Avoid Contraindicated Reduced dose to be given

Notify doctor immediately if any of above persists or serious. Additional Information 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.

Contraindicated

Contraindicated
Over 60

Reduced dose to be given

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. * * * *

518

A Lay Person's Guide

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
Safety not established Contraindicated Reduced dose to be given

* Cigarette smoking reverses the inhibition of nocturnal gastric secretion produced by this drug. * Concomitant administration with carbamazepine increases the toxic effects of carbamazepine. * Decreases effective levels of digoxin in blood. Patient Information * Take with meals.

Contraindicated

Contraindicated
Over 60

Reduced dose to be given

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. Continue the drug and inform your doctor. Additional Information Drug Interactions * Prolongs action of warfarin type a n t i c o a g u l a n t s, p h e n y t o i n , p r o p a n o l o 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. Rational Therapy Tips 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.

Short Profiles of 107 Drugs

519

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
Can continue use of medicine Contraindicated Increased risk of adverse effects

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
Can continue use of medicine Contraindicated Contraindicated Contraindicated

Contraindicated
Over 60

Contraindicated

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. Additional Information 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.

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. Additional Information * 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.

520

A Lay Person's Guide

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. Continue the drug and inform your doctor. Additional Information 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 minutes before food. 6 hourly, at least 30

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
Contraindicated Contraindicated

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. Additional Information 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.

Short Profiles of 107 Drugs

521

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
Safety not established Contraindicated Contraindicated

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
Safety not established Safety not established

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.

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. Discontinue and call the doctor immediately. Additional Information 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.

522

A Lay Person's Guide

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
Safety not established Contraindicated Reduced dose to be given

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.

Contraindicated

Contraindicated
Over 60

Contraindicated

Others Peptic ulcer, glaucoma, TB, herpes infection, mental illness. Not to be stopped prolonged duration. Adverse Effects Abdominal stretching, nausea, vomiting, weight gain, peptic ulcer, impaired wound-healing, skin rashes, thin fragile skin, convulsions, insomnia, hiccups, menstr ual irregularities, increased sweating, cataracts, glaucoma, irregular heart beat, cardiac arrest, muscle weakness and loss of muscle mass. Additional Information Drug Interactions Phenytoin, phenobarbitone, rifampcin and ephedrine increase drug clearance. Aspirin, isoniazid should not be given as also aminophylline. suddenly if used for a

Rational Therapy Tips 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.

Short Profiles of 107 Drugs

523

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
Avoid Can continue use of medicine

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
Can continue use of medicine Can continue use of medicine Can continue use of medicine Contraindicated
Over 60

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. Additional Information Patient Information * Take satisfactory food and fluid. * Increase dose slowly.

Adverse Effects Pain may occur at the injection site, hemoglobin biosynthesis affected, redness of skin, itching, oedema, jaundice, nausea, vomiting. Continue the drug and inform your doctor. * Risks of GI side-effects. * Unsafe in acute porphyria (a rare inherited, blood disease). Additional Information Drug Interactions * Reduces excretion of lithium and also that of methotrexate (an anticancer drug). * Typical NSAID (non-steroidal anti-inflammtory drug) reactions.

524

A Lay Person's Guide

Diloxanide Furoate
Brand Name Furamide, Ambibactin BD, Dyrade pre ps, 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
Contraindicated Contraindicated Reduced dose to be given

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. Children: By mouth: 100-400 ug/kg ever y 8 hrs. By rectum : Varies with body weight 15 mg-0 mg (1-4 times). Precaution
Contraindicated Can continue use of medicine Can continue use of medicine Reduced dose to be given

Avoid

Can continue use of medicine

Over 60

Can continue use of medicine

Others Adverse Effects In most cases well tolerated. Mild side-effects include flatulence, vomiting and itching. Do not discontinue the drug. Contact your doctor. Additional Information Ineffective when administered alone in the treatment of extra-intestinal amoebiasis. Long term kidney problems, abnormal heart rhythms. Adverse Effects Rashes and other allergic reactions reported. Prolactin effects like enlargement of breasts and milk secretion. Continue the drug and inform your doctor. Additional Information Drug Interactions * Antipsychotic drugs and analgesics (opioids) should not be given.

Short Profiles of 107 Drugs

525

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
Contraindicated Contraindicated Contraindicated

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.

Contraindicated
Over 60

Reduced dose to be given

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

Rational Therapy Tips 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.

526

A Lay Person's Guide

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 Precaution
Contraindicated Contraindicated Contraindicated

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.

1 drop every 12 hrs.

Contraindicated

Contraindicated
Over 60

Contraindicated

Others * * * * * * Narrow angle glaucoma High BP Diabetes Overactive thyroid Heart problems Never give intravenously

Adverse Effects Cerebral haemor rhag e (serious 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. Additional Information Drug Interactions * P h e n o t h i a z i n e s ( e. g. , c h l o r p r o m a z i n e , prochlorperazine, etc. — a class of drugs used in

Rational Therapy Tips 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.

Short Profiles of 107 Drugs

527

Diarrhoea is a nutritional disease

Courtesy: Indian Academy of Pediatrics

treat with normal food, rice kanjee give water + salt + sugar solution DRUGS ARE RARELY NECESSARY
528

A Lay Person's Guide

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
Can continue use of medicine Can continue use of medicine Can continue use of medicine

* Phenytoin and barbiturates may increase degradation of Vit D resulting in decreased calcium levels and hence some disorders like osteomalacia (softening of bones) 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.

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. Additional Information 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 diuretics (like fr usemide, hydrochlothiazide), elevated calcium levels in blood may result. Rational Therapy Tips 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.

Short Profiles of 107 Drugs

529

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
Contraindicated

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
Contraindicated Contraindicated

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. Additional Information * Abdominal pain * Sensation of voice in ears * Slow heart beat * Difficulty in breathing * Chest pain * Vertigo * Hypertension * Gangrene Continue the drug and inform your doctor.

Adverse Effects Liver problems Additional Information 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

A Lay Person's Guide

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
Safety not established Contraindicated Reduced dose to be given

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
Safety not established Safety not established Contraindicated

Contraindicated

Contraindicated
Over 60

Reduced dose to be given

Others Liver and kidney problems. Blood disorders. Adverse Effects Nausea, vomiting, diarrhoea, rash, anemia, hallucinations, headache, vertigo, sedation. Liver dysfunction. Additional Information 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.

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, constipation, anemia, confusion, depression, rashes, urinary frequency, kidney damage, muscular weakness, edema, swelling of the tongue, vaginal bleeding, gum enlargement, agitation. Additional Information Patient Information * If gastro intestinal upset occurs, take with food or milk. * Do not discontinue medicine abruptly.

Short Profiles of 107 Drugs

531

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
Contraindicated Contraindicated

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
Contraindicated Contraindicated Contraindicated

Contraindicated

Avoid

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

Can continue use of medicine

Can continue use of medicine

Over 60

Increased risk of adverse effects

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

A Lay Person's Guide

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. Additional Information 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 problem with composition of solution/administration technique. * Very concentrated solutions may cause irritation. Increased blood sugar levels may result if too rapid administration. * Increase in serum insulin levels Additional Information Drug Interactions

Rational Therapy Tips 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.

* If patient receives cor tiosteroids 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.

Short Profiles of 107 Drugs

533

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 612 weeks. Note: Dose may be doubled if necessary. Precaution
Safety not established Safety not established

Additional Information 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.

Contraindicated

Contraindicated

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. Continue the drug and inform your doctor. Rational Therapy Tips Q. If temperature is high inspite of paracetamol, what should be done? Ans. Tepid water sponge.

534

A Lay Person's Guide

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 maximum 10 mg Adolescents: 30 mg Precaution
Safety not established Contraindicated Reduced dose to be given

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
Safety not established Contraindicated Contraindicated

Contraindicated

Contraindicated
Over 60

Reduced dose to be given

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. Continue the drug and inform your doctor. Additional Information 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.

Contraindicated

Contraindicated
Over 60

Reduced dose to be given

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

Short Profiles of 107 Drugs

535

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
Contraindicated Contraindicated Contraindicated

Thiazide drugs decrease response to 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.

Contraindicated
Over 60

Increased risk of adverse effects

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. Continue the drug and inform your doctor. Additional Information 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 other NSAIDS (non-steroidal antiinflammatory drugs, like ibuprofen, aspirin, diclofenac, phenylbutazone). Rational Therapy Tips 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.

536

A Lay Person's Guide

Hydrocortisone
Brand 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
Contraindicated Contraindicated Reduced dose to be given Reduced dose to be given
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
Safety not established Avoid Contraindicated

Avoid

Avoid

Contraindicated

Contraindicated

Over 60

Increased risk of adverse effects

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. Continue the drug and inform your doctor. Additional Information 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.

Contraindicated

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. Additional Information 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.

Short Profiles of 107 Drugs

537

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.

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.

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.

Children : Not recommended. Precaution
Contraindicated Contraindicated Contraindicated

Contraindicated

Contraindicated
Over 60

Reduced dose to be given

Others * * * * * * * * * *
Source : VHAI

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.
A Lay Person's Guide

Death in the bottle

538

Additional Information 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
Contraindicated Contraindicated Increased risk of adverse effects

Others * Patients with thyroid gland disorders. * If irritation occurs in superficial wounds without infection. Rational Therapy Tips 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) Adverse Effects Irritation, running nose, sore weeping eyes, fever, headache, coughing and pain and swelling over the angle of the jaw. Additional Information * 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.

Short Profiles of 107 Drugs

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
Avoid

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. Additional Information 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.

Rational Therapy Tips 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.

540

A Lay Person's Guide

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
Contraindicated Avoid Contraindicated

Additional Information 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.

* *

Contraindicated

Contraindicated
Over 60

Increased risk of adverse effects

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. Rational Therapy Tips Q. Which antitubercular drugs are not hepatotoxic? Ans. Streptomycin Ethambutol

Short Profiles of 107 Drugs

541

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
Safety not established Reduced dose to be given Contraindicated

3 tablets call the doctor immediately (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.

Avoid

Avoid

Reduced dose to be given
Over 60

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. Additional Information Patient information * In case chest pain persists after taking Rational Therapy Tips 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), nitrofurantoin, fuzazoladone, sulfonamide, nalidix acid, aspirin, analgin and naphtalene which is used in moth balls.

542

A Lay Person's Guide

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
Avoid Contraindicated Reduced dose to be given

Levamisole
Brand Name Vermisol, Vizole Use Antihelminthic Dosage Adults: 2.5 mg/kg Children: 2.5 mg/kg Precaution
Safety not established Safety not established Safety not established

Can continue use of medicine Can continue use of medicine

Can continue use of medicine

Over 60

Can continue use of medicine

Others Nausea, vomiting. Epigastric discomfort. Continue the drug and inform your doctor. Additional Information Not advisable to take drug in cases of kidney and liver insufficiency.

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 Continue the drug and inform your doctor. Additional Information 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,

Short Profiles of 107 Drugs

543

Fever is a friend ; it fights disease

Courtesy: Indian Academy of Pediatrics

when high, paracetamol alone is adequate

DRUGS ARE RARELY NECESSARY
544 A Lay Person's Guide

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
Safety not established Contraindicated Contraindicated

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. Additional Information Drug Interactions Reserpine, benzodiazepines (e.g., diazepam, used as anti-psychotic), phenothiazines ( 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 changes in posture. sudden

Contraindicated

Contraindicated

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. Continue the drug and inform your doctor. Others are irregular heart beat, mental changes,

Short Profiles of 107 Drugs

545

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
Can continue use of medicine Can continue use of medicine Can continue use of medicine

* 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.

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. Additional Information 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.

546

A Lay Person's Guide

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
Contraindicated Contraindicated Contraindicated

Lithium Carbonate
Brand Name Licab/XL Use Treatment of maniac depression, aggressive or selfmutilating 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
Avoid Contraindicated Increased risk of adverse effects Reduced dose to be given
Over 60

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. Additional Information Patient Information * Do not apply to face. * Notify physician if skin rashes occur. * Do not exceed prescribed dosage. Others

Contraindicated

Contraindicated

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. Continue the drug and inform your doctor.

Short Profiles of 107 Drugs

547

Additional Information Drug Interactions * * Theophylline, thiazide diuretics and furosemide should not be given. Indomethacin, phenytoin, tetracycline, methyldopa, carbamazepine, haloperidol, increase lithium toxicity and should not be given together. Maintain adequate fluid and salt intake. Drink 10 to 12 glasses of fluid daily. Take medication with food/milk. 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. Discontinue and call the doctor immediately.

Patient Information * * * * *

Discontinue therapy if signs of toxicity occur.

Essential Drugs Monitor

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

548

A Lay Person's Guide

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
Avoid Avoid Avoid

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.
Over 60

Avoid

Avoid

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. Additional Information Drug Interactions * Digoxin should not be taken. * Epileptic patients taking valproate should not take mefloquine.

* 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. Additional Information Patient Information * Take oral form after meals with a glass of water. * May stain skin blue, can be removed by a hypochlorite solution.

Short Profiles of 107 Drugs

549

Cleaning wounds immediately is essential

Courtesy: Indian Academy of Pediatrics

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

DRUGS ARE RARELY NECESSARY
550 A Lay Person's Guide

Metoclopramide
Brand 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
Safety not established Contraindicated Contraindicated

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
Contraindicated Contraindicated Contraindicated

Contraindicated
Over 60

Contraindicated

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. Continue the drug and inform your doctor. Additional Information 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.

Contraindicated

Contraindicated
Over 60

Reduced dose to be taken

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

Short Profiles of 107 Drugs

551

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

Neomycin
Use 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
Contraindicated

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) Additional Information 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.
A Lay Person's Guide

* * * *

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

552

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
Can continue use of medicine Can continue use of medicine Contraindicated

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: 520 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
Avoid Contraindicated Avoid

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. Additional Information 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.

Avoid

Avoid

Over 60

Increased risk of adverse effects

Contraindicated

Others * * * * * Low heart rate Severe low BP Liver problems Diabetes Allergy to nifedipine

Short Profiles of 107 Drugs

553

Adverse Effects Transient headache, flushing, lethargy. Less common: difficulty in breathing, chest pain, fainting, irregular heart beat, rashes/reddening. Discontinue and call the doctor immediately. * * Serious adverse effects may result in patients with compromised heart function Swelling over feet

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
Safety not established Avoid Avoid

Additional Information 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. Quinidine (antiarrhythmic) Rifampicin (antibacterial) Phenytoin (antiepileptic) Antihypertensive (against high BP) Muscle relaxants

Drug Interactions * * * * *

Avoid

Avoid

Avoid

Over 60

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. Continue the drug and inform your doctor. * Long-term therapy: Irreversible damage to lungs and liver.

554

A Lay Person's Guide

Additional Information 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.

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 consciousnessInhalation 25-50 % with oxygen. Precaution
Contraindicated Contraindicated

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.

Short Profiles of 107 Drugs

555

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
Contraindicated Contraindicated

* 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. Continue the drug and inform your doctor. Additional Information * 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.

Others. * * * * * * * Test for pregnancy Carcinoma of breast or reproductive organs. Liver problems Undiagnosed vaginal bleeding Missed abortion Asthma Heart problems

556

A Lay Person's Guide

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
Can continue use of medicine Contraindicated
Over 60

Continue the drug and inform your doctor. Additional Information 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.

Can continue use of medicine

Reduced dose to be taken

Others History of sensitivity to nystatin Adverse Effects Occasionally : nausea, vomiting and diarrhoea may result. * Following topical use allergic reaction may be seen.

Short Profiles of 107 Drugs

557

Pethidine
Use Narcotic analgesic (pain killer) Dosage Adults: 50-150 mg/dose Children: 1-2 mg/kg per dose IM or IV Precaution
Safety not established Contraindicated Reduced dose to be taken

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
Safety not established Contraindicated Contraindicated

Contraindicated

Contraindicated
Over 60

Reduced dose to be taken

Others Kidney, liver, heart problems, epileptic fits, asthma, bronchitis, thyroid disorder, prostate problems. Adverse Effects D i z z i n ess, n a usea , vo m i ti n g , d rowsi n ess, constipation, confusion, breath shortness, dry mouth. Overdose symptoms : * Muscle twitching, nervousness, shallow breathing, drowsiness loss of conscious-ness. Additional Information It produces drug dependence if periods of time. taken for long Others

Contraindicated

Contraindicated
Over 60

Contraindicated

* 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). Additional Information * Valproic acid and chloramphenicol decrease the metabolism of the drug.

558

A Lay Person's Guide

* Phenobarbitone shortens half life of doxycycline, quinidine, digitoxin, corticosteroids, 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.

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
Safety not established Contraindicated Contraindicated

Contraindicated
Over 60

Others Kidney, liver, heart problems, stomach problems Rational Therapy Tips 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 g ood compliance. It is better to change in case of failure rather than adding one more anti-convulsant. Adverse Effects Blood disorders, skin reactions, serum sickness, stomach upset, fever, kidney problems. Discontinue and call the doctor immediately. Additional Information Patient Information Have good potassium, sodium, calcium intake.

Short Profiles of 107 Drugs

559

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
Contraindicated Contraindicated

* 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. * Diabetic patient should report any abnormalities.

Others * Heart problems * IV administration not greater than 50 mg per min. Adverse Effects Slurred speech, mental confusion, dizziness, insomnia, ner vousness, 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. Additional Information Drug Interactions * Drugs affecting phenytoin, barbiturates, carbamazepine, folic acid, calcium gluconate, antacid, cloxacillin, dietary calciuam reduce phenytoin availability. Rational Therapy Tips 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.

560

A Lay Person's Guide

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
Safety not established Can continue use of medicine Avoid
Over 60

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
Increased risk of adverse effects Safety not established
Over 60

Reduced dose to be taken

Reduced dose to be taken

Can continue use of medicine

Can continue use of medicine

Avoid

Adverse Effects Transient: Salivation, sweating, blurred vision or eye pain. Continue the drug and inform your doctor. Additional Information Patient Information * Inform doctor in case of asthma, inflammed eye, if contact lens is being used or if other medication is being taken.

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 Continue the drug and inform your doctor.

Short Profiles of 107 Drugs

561

Additional Information 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
Contraindicated Contraindicated

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 Additional Information 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, clumsiness, unsteadiness, vomiting, confusion, diarrhoea, weakness, sore throat, unusual bleeding.

562

A Lay Person's Guide

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
Can continue use of medicine Can continue use of medicine Can continue use of medicine Avoid Can continue use of medicine Can continue use of medicine

* Nausea, diar rhoea, paralysis, hear t abnormalities, impaired brain functions, coma and in severe cases death. Discontinue the drug. Call the doctor immediately. Additional Information * 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).

Over 60

Others * High potassium levels especially in case of impaired kidney function. * Extensive tissue damage (e.g.burns) Adverse Effects * Decreased excretion.

Short Profiles of 107 Drugs

563

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
Avoid Can continue use of medicine Contraindicated

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
Contraindicated Contraindicated Contraindicated

Adverse Effects Burning, itching, hypopigmentation (sub-normal colouring of skin). Continue the drug and inform your doctor. Prolonged application around eyes leads to cataract and glaucoma. Do not withdraw suddenly. Additional Information Patient Information * Apply sparingly, i.e., rub in lightly - a light film rub. * Avoid getting in eyes. * Notify physician if the condition worsens.

Avoid

Adverse Effects Transient: Abdominal discomfort, headache dizziness. Occasional: Fever, rashes blood changes, nervous system disorders. Continue the drug and inform your doctor. Additional Information 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.

564

A Lay Person's Guide

Primaquine
Brand 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
Contraindicated Contraindicated Contraindicated

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
Contraindicated Contraindicated Contraindicated

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). Additional Information 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.

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).

Short Profiles of 107 Drugs

565

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
Can continue use of medicine Can continue use of medicine

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
Safety not established Can continue use of medicine Contraindicated

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. Additional Information 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.

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. Continue the drug and inform your doctor. Additional Information 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.

566

A Lay Person's Guide

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
Can continue use of medicine Safety not established

Pyridoxine (Vitamin B6)
Brand Name Pyricontin, Continus Part of several Vitamin B-complex preparations Use Deficiency of Vit.B 6 caused during isoniazid therapy. Dosage Adults: Dependency syndrome - 30-600 mg/day Maintenance - 50 mg/day Dr ug 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
Can continue use of medicine Can continue use of medicine Can continue use of medicine

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.

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 sideeffects. * Liver and kidney problems. * In use as substitute for balance diet.

Short Profiles of 107 Drugs

567

Adverse Effects High doses cause sensory neuropathy, unstable gait, numb feet and hands, weakness. Additional Information Dietary Source: Meat, bananas, potatoes, lime,beans and whole grain cereals. Recommended Daily Allowance (RDA): 0-6 months 6-12 months 4-6 yrs Adult males Females Pregnant women Lactating women : : : : : : : 0.3 mg 0.9 mg 1.3 mg 2.2 mg 2.0 mg 2.6 mg 2.5 mg

Quinidine
Brand Name Quinidine (B-W) Use 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
Safety not established Contraindicated Contraindicated

Safety not established

Avoid

Reduced dose to be taken
Over 60

Others * Heart block * Allergy to drug * Patient should be monitored closely
R. K. Laxman in The Times of India
Is there anybody in the house not affected by malaria ?

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 Continue the drug and inform your doctor.

568

A Lay Person's Guide

Additional Information Patient Information * * * Do not stop this drug suddenly. Do not take double doses. 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.

Riboflavin (Vitamin B2 )
Use To prevent/treat deficiency of riboflavin (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. Additional Information Patient Information

Drug Interactions

*

Rational Therapy Tips Q. Which is the most common irrational drug used for treatment of victims of polio? Ans. B1 , B6 , B12 combination tonics. They have 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

* 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.

Short Profiles of 107 Drugs

569

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
Contraindicated Avoid Reduced dose to be taken

* Report to your doctor if jaundice appears. Additional Information Drug Interactions * Rifampicin especially interacts with 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.

Contraindicated
Over 60

Reduced dose to be taken

Contraindicated

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. Rational Therapy Tips 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.

570

A Lay Person's Guide

Silver Nitrate
Use * To destroy warts and other small skin growths * In treatment of anal and vulval itching and other non- specific 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.

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
Contraindicated Contraindicated Contraindicated

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. Continue the drug and inform your doctor. Additional Information 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.

Short Profiles of 107 Drugs

571

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
Safety not established Safety not established Avoid

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 Additional Information 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.

Rational Therapy Tips 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.

Contraindicated

Avoid

Reduced dose to be taken
Over 60

572

A Lay Person's Guide

Sodium Chloride
Use To replace excessive losses of sodium and chloride ions. Loss as in case of excessive sweating, Addison’s disease (deficiency of cor tical 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 gastrointestinal lining and can cause nausea/diarrhoea. Additional Information More dilute solutions containing dextrose/ glucose are generally preferred.

Sodium Chloride + Dextrose (Glucose)
Use To replenish cholera. water lost in acute diarrhoea and

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.

Rational Therapy Tips 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. 4. Is hospitalised needing IV medication in severe disease. Immunisations.

Short Profiles of 107 Drugs

573

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.

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 deter mined individually by the condition and response Usually 1.5 million units over 1 hr by IV. Precaution
Contraindicated Safety not established Reduced dose to be taken

Contraindicated
Over 60

Others * Apart from osmotic disturbances, it is relatively non-toxic. * Large doses by mouth have a purgative action.

Others * * * * * Patients with high BP Coagulation defects Recent peptic ulcers Excessive bleeding Fever

Adverse Effects

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

574

A Lay Person's Guide

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
Safety not established Safety not established Safety not established

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
Contraindicated Contraindicated Contraindicated

Contraindicated

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. Additional Information * 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.

Over 60

Others * Liver damage * Kidney damage Adverse Effects * Nausea, vomiting * Blood disorders * Rashes/reddening * Kidney problems Additional Information 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.

Short Profiles of 107 Drugs

575

Tamoxifen
Brand 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
Contraindicated Contraindicated Contraindicated

Tetracaine
Use Local anaesthetic Dosage 1-2 drops of a 0.5% solution to conjuctiva Precaution
Safety not established Can continue use of medicine Can continue use of medicine

Others * * Plasma cholinesterase (an enzyme) deficiency Protect the eye from irritating chemicals.

Adverse Effects
Safety not established Avoid Safety not established
Over 60

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 endometrium (inner lining of the wall of uterus). Continue the drug and inform your doctor. Additional Information 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.

Burning, stinging, redness or other irritation of eye, blurred vision, convulsions, dizziness, nausea, vomiting, drowsiness, irregular heart beat, tiredness, muscle twitching. Additional Information Patient Information Prolonged used may cause delay in corneal epithelial healing (top surface skin of cornea).

576

A Lay Person's Guide

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 i n d u c e d d e f i c i e n c y : 4 0 m g / d ay. D i e t a r y supplement:1-2 mg/day. Genetic enzyme deficiency: 10-20 mg/day. Dietary supplements Infants: 0.3-0.5 mg/day, Children: 0.5-1.0 mg/day Precaution
Can continue use of medicine Can continue use of medicine Can continue use of medicine

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
Can continue use of medicine Contraindicated
Over 60

Contraindicated

Contraindicated

Contraindicated

Avoid

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. Continue the drug and inform your doctor. Decreased sweating, numbness of fingers.

Others If given together always, administer thiamine prior to glucose * Liver problems * Kidney problems * Do not substitute for balanced diet or exceed RDA Additional Information 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

Short Profiles of 107 Drugs

577

Additional Information 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 Discontinue and call the doctor immediately. Use caution in hot weather, may increase susceptibility to heat stroke.

Valproic acid
Brand 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
Contraindicated Contraindicated Contraindicated

Rational Therapy Tips 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.

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. Additional Information 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.

578

A Lay Person's Guide

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
Contraindicated Contraindicated Reduced dose to be taken

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
Avoid Contraindicated

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. Continue the drug and inform your doctor. Additional Information 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.

Contraindicated

Contraindicated
Over 60

Contraindicated

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. Additional Information 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.

Short Profiles of 107 Drugs

579

Vincristine
Brand 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. 2 mg/m of body surface area weekly. Precaution
2

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
Contraindicated Contraindicated Reduced dose to be taken

Avoid

Contraindicated

Contraindicated

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) Continue the drug and inform your doctor. Additional Information 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.

Contraindicated
Over 60

Reduced dose to be taken

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

580

A Lay Person's Guide

foetus or loss of blood from foetus. Continue the drug and inform your doctor. * In some patients receiving very high dose severe skin problems may result. Continue the drug and inform your doctor. Additional Information 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.

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 along- with other compounds to form some dental cements * Zinc oxide and clove oil/eugenol used as a temporar y dental filling. Thus used in preparations of medicated bandage, gauzes, ointments/creams, dusting powders, lotions and dental cements.

Rational Therapy Tips Q. Is it necessary to give Vitamin Bcomplex with antibiotics? Ans: No.

Short Profiles of 107 Drugs

581

How should be our relationships?
Take this medicine. Don’t ask too many questions.

Source: Abhay Shukla and Anant Phadke. Swathya Sathi. Part 1, CEHAT, Pune, 2000.

Hoarding knowledge
Look here - this is the way to make ORS.

Sharing knowledge

582

A Lay Person's Guide

Sign up to vote on this title
UsefulNot useful