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Section 2

Profiles of 50 Drugs

What these symbols mean ?

­
- Effect of the drug under consideration increases.

¯
- Effect of the drug under consideration decreases.

s- Effect of other drugs (those mentioned under the column “Drugs/Drug Class”) increases.

t- Effect of the other drug decreases.

Any one of the above-mentioned four symbols may be present for each drug interaction under the column
“Effects”. When none is applicable, the column is left blank and explanation of the interaction is given under
the column “Notes”.

These symbols are used in the detailed drug profiles only.

Profiles of 50 Drugs 363


List of 50 Drugs with Detailed Profiles
Aluminium Hydroxide Frusemide
Amoxycillin Gentian Violet
Ampicillin Glibenclamide
Aspirin Glyceryl Trinitrate
Atropine Ibuprofen
Benzoic Acid and Salicyclic Acid Insulin
Benzyl Benzoate Isoniazid
Betamethasone Loperamide
Bisacodyl Mebendazole
Calamine Lotion Methyldopa
Chlorhexidene Metronidazole
Chloroquine Phosphate Miconazole
Chlorpheniramine Maleate Oral Contraceptives/Birth Control Pills
Co-trimoxazole ORS
Codeine Paracetamol
Dapsone Promethazine
Diazepam Propranolol
Digoxin Pyrimethamine & Sulfadoxine
Diphenhydramine Quinine
Ephedrine Ranitidine
Ergotamine Reserpine
Erythromycin Rifampicin
Ethambutol ` Salbutamol
Ferrous Sulphate Tetracycline
Folic Acid (Vitamin B) Vitamin A

364 A Lay Person's Guide


ALUMINIUM HYDROXIDE

Drug Group: Antacid


Principal Uses
It provides relief in the treatment of heartburn, indigestion and stomach pain, often associated with peptic
ulcers, hyperacidity and dyspepsia. Also used in treatment of hyperphosphataemia (high concentration of
phosphates in circulating blood).

It has a constipating effect and is therefore combined with magnesium-containing antacids (magnesium
hydroxide, magnesium trisilicate) which have a laxative effect and thus they cancel each other’s unwanted
effect.

Fixed-dose combinations of aluminium hydroxide with any other drug besides magnesium antacids is
considered unnecessary.

How this Drug Works


It counteracts the acid secreted in the stomach and thus reduces the degree of acidity, there by relieving
heartburn and indigestion. It reduces the action of an enzyme (chemical) ‘pepsin’ in the stomach, thereby
promoting the healing of peptic ulcer.

Dosage and Usage Information


Available Dosage Forms: Tablets and liquids with magnesium trisilicate, with others.

Dosage Adults 300-600 mg (1-2 tablets OR 1-2 teaspoonful) 3-6 times daily

How and When to Take

Stomach keeps on emptying itself and the action of the antacid lasts only for a short while, irrespective of
the dose taken. Hence it is important to take an antacid at frequent intervals as well as delay stomach
emptying. Food delays stomach emptying and prolongs the duration of antacid action.

It is best taken between meals and at bedtime. For continuous effect, take 1 hour after eating, followed by a
sip of water.

Tablets should be well chewed. Suspension should be shaken well before use. Do not swallow the tablet
whole.

What if you Exceed the Dose


The effects include nausea, vomiting and constipation. Consult your doctor if the symptoms are unusually
severe or the overdose is exceptionally large.

Profiles of 50 Drugs 365


Precautions

Be sure to tell your doctor if you have (i) long-term kidney problems (ii) constipation
(iii) bone disease

Do not swallow chewable tablets and shake all liquid preparations of antacids.

Do not take this drug for more than 2 weeks without physician’s guidance. During long-term use,
measurements of blood calcium and phosphorous levels should be done.

Pregnancy: Safety not established. Discuss with your doctor.

Breast feeding: This drug passes into breast milk. Avoid drug or refrain from nursing.

Infants and Children: Not recommended in children under 6 years except on the advice of a doctor.

Over 60: Increased likelihood of adverse effects. Reduced dose is necessary.

Food: Maintain regular intake of high-phosphate foods such as meat, fish, eggs, milk and milk products.

Alcohol: Should be avoided as it may increase stomach acidity.

Tobacco: Should be avoided as it may increase stomach acidity.

Possible Adverse Effects

Symptoms/Effects Frequency What to do

Constipation Common Discuss with doctor, only if severe


Nausea Rare "
Vomiting " Discuss with doctor as soon as possible
Bone pain " "
Muscle Weakness " "
Intestinal obstruction " Stop taking the drug and consult your doctor.

Interactions

Drugs/Drug Class Effects Notes


Blood-thinners t
Digitalis drugs t
Penicillamine t
Phenytoin t

366 A Lay Person's Guide


Drugs/Drug Class Effects Notes
Chloroquine t
Corticosteroids t
(e.g. beclomethasone)
Beta-blockers t
(e.g.propranolol)
Tetracyclines t
Iron preparations t
Phenothiazines t
Sodium polystyrene t
Sulfonate t
Enteric-coated tablets - Enteric coating is broken up leading to stomach irritation.

Effects of Long-term Use

Decreased levels of blood phosphates resulting in loss of calcium and phosphate from bone with weakening

AMOXYCILLIN

Drug Group: Antibiotic, Penicillin


Principal Uses

It is used to treat infections of ear, nose and throat, respiratory tract infections, cystitis (inflamation of the
bladder, usually urinary bladder), gonorrhoea (a sexually transmitted disease) and soft tissue infections.
Amoxycillin is preferred over ampicillin, when it is to be given by mouth, since it is absorbed better and can be
given thrice a day. Incidence of diarrhoea with amoxycillin is less.

How this Drug Works

It destroys the infecting bacteria by interfering with their ability to multiply and grow.

Dosage and Usage Information

Available Dosage Forms: Capsules, tablets, injections, dry syrup, kid tablets.

Dosage Adults: 250-500 mg every 8 hours.

Children: 8-15 mg/kg dose every 8 hours.

Profiles of 50 Drugs 367


How and When to Take

May be taken before or after food.

What if you Miss a Dose

Take as soon as possible. This will help to keep a constant amount of medicine in the blood/urine and enable
it to work well. Space the missed dose and the next dose 8 hours apart.

How to Stop Using this Drug

Do not stop using this drug without consulting your doctor, even if you feel better in a few days.

Precautions

Be sure to tell your doctor if you have:

- previous hypersensitivity (allergy) to drug


- general allergy (asthma, hay fever, hives)
- bleeding problems
- penicillin allergy

Pregnancy: No evidence of risk.

Breast feeding: Continue nursing.

Infants and Children: If it is given during an episode of infectious mononucleosis (a condition marked by fever,
sore throat, etc.), it may cause rash. The drug must be discontinued if it causes diarrhoea.

Diabetics: This drug may cause false positive test results with some urine sugar tests. Check with your doctor
before changing your diet/dose of medicine.

Others: If diarrhoea occurs (as a side-effect of this drug), do not take any diarrhoea medicine without
checking with your doctor.

Possible Adverse Effects

Symptoms/Effects Frequency What to do


Skin rash, hives, itching Rare Discuss with your doctor only if severe
Irritations of mouth & tongue " "
Black tongue " "
Nausea " "
Vomiting " "

368 A Lay Person's Guide


Symptoms/Effects Frequency What to do

Diarrhoea Rare Discuss with your doctor as soon as possible


Drug fever " "
Swollen painful joints " "
Note: Black tongue is temporary and will go away as soon as you stop taking this drug.

Interactions

Drugs/Drug Class Effects Notes


Birth control pills t Use an additional means of birth control while you are taking
this drug
Antacids ¯
Chloramphenicol ¯
Erythromycin ¯
Tetracyclines ¯

Effects of Long-term Use

Super-infections, often due to yeast organisms.

AMPICILLIN

Drug Group: Antibiotic, Penicillin


Principal Uses

It is used to treat variety of infections such as that of soft tissues, respiratory tract, intestine (eg., typhoid)
and urinary tract. It is also used to treat certain types of meningitis.

How this Drug Works

It destroys the infecting bacteria by interfering with their ability to multiply and grow.

Dosage and Usage Information

Available Dosage Forms: Tablets, capsules, dry syrup, injectables.

Note: The dose, often depends on the severity of infection and body weight of patients and not on body weight alone.

Profiles of 50 Drugs 369


Dosage Adults: 250-500 mg every 6 hours

Children: 12.5-25 mg/kg/dose every 6 hours

Dose in Meningitis: Adults: 6-12 gm/day in 4 divided doses. Children: 200-400 mg/kg a day.

Dose in Typhoid Carrier Stage: 1.5 gm 4 times a day for 1-3 months.

Dose in Gonorrhoea: Adults: 3.5 gm single dose preceded by 1 gm of probenecid half an hour before.

How and When to Take

Best taken on an empty stomach, 1 hour before or 2 hours after eating.

What if you Miss a Dose

Take as soon as possible. This will help to keep a constant amount of medicine in the blood/urine and enable
it to work well. Space the missed dose and the next dose 5-6 hours apart.

Precautions

Be sure to tell your doctor if you have:

- previous hypersensitivity (allergy) to drug

- general allergy (asthma, hay fever, hives)

- bleeding problems

- kidney disease

- penicillin allergy

Pregnancy: No evidence of risk.

Breast feeding: Continue.

Infants and Children: If it is given during an episode of infectious mononucleosis, it may cause rash.

Diabetics: This drug may cause false positive test results with some urine sugar tests. Check with your doctor
before changing your diet/dose of medicine.

Others: If diarrhoea occurs (as a side-effect of this drug), do not take any diarrhoea medicine without
checking with your doctor.

370 A Lay Person's Guide


Possible Adverse Effects

Symptoms/Effects Frequency What to do

Skin rash, hives, itching Common Discuss with your doctor only if severe.
Irritations of mouth & tongue " "
Black tongue " "
Nausea " "
Vomiting " "
Diarrhoea " Discuss with your doctor as soon as possible.
Drug fever " "
Swollen painful joints " "

Note: Black tongue is temporary and will go away as soon as you stop taking this drug.

Interactions

Drugs/Drug Class Effects Notes


Birth control Pills t Use an additional means of birth control while you are taking
this drug.
Antacids ¯
Chloramphenicol ¯
Erythromycin ¯
Tetracyclines ¯

Profiles of 50 Drugs 371


ASPIRIN

Drug Group: Pain killer, Anti-fever


Principal Uses

It relieves pain, lowers fever, reduces swelling and relieves rheumatic fever. Not to be given in children under
12 years.

In small doses, it helps the prevention of subsequent heart attacks.

How this Drug Works

It reduces the amount of chemicals which produce swelling and pain in the body. It alters those centres in the
brain that regulate body temperature and also causes sweating which leads to reduction of fever. It prevents
aggregation (coming together) of blood platelets/blood vessels, thus preventing clotting of blood.

Dosage and Usage Information

Available Dosage Forms: Tablets.

Adults: For pain/fever: 300-600 mg (1-2 tablets) as and when required or at an interval of 4 hours. Do not
exceed 6 gms in a day.

Children (over 12 years only): For pain/fever: 10-15 mg/kg as and when required or at an interval of 4-6 hours.
Do not exceed 3.6 gm in a day

For prevention of subsequent heart attacks: 75 to 150 mg every day.

For rheumatic fever : 100 mg/kg daily in 4-6 divided doses for 1-2 weeks and then 60-75 mg/kg daily as long as
needed (or for 3-6 weeks).

Note: Take it regularly. The full effects of this medicine will be seen after 2-3 weeks.

How and When to Take

Take with food, milk or plenty of water to avoid stomach irritation.

Enteric-coated tablets (aspirin tablets may have a enteric-coating so that they do not cause stomach
irritation) should not be crushed before use.

What if you Exceed the Dose

If restlessness, stomach pain, ringing noises in ears, blurred vision, breathing problems, fits or vomiting
occurs, seek medical help immediately.

372 A Lay Person's Guide


Precautions

Be sure to tell your doctor if you have:

- liver problems - kidney problems

- asthma - gout

- heart problems - overactive thyroid

- stomach ulcer - anemia

- nasal polyps (bulging tissue) - blood clotting problems

- planned to undergo any surgery

Pregnancy: Avoid. Use a safer alternative drug.

Breast feeding: The drug passes into the breast milk, but at normal doses adverse effects on the baby are
unlikely.

Infants and Children: Not to be used for children under 12 years except in juvenile rheumatoid (resembling
rheumatism) arthritis and rheumatic fever.

Over 60: Increased incidence of side-effects especially bleeding from stomach and anemia. Use cautiously.

Alcohol: Avoid. Increased likelihood of stomach irritation.

Possible Adverse Effects

Symptoms/Effects Frequency What to do


Nausea/vomiting Common Discuss with your doctor only if severe
Indigestion/Abdominal Rare Discuss with your doctor immediately
discomfort
Asthma-like attack " "
Anemia " "
Ulcer " "

Interactions

Drugs/Drug Class Effects Notes


Beta-blockers t
eg. Propranolol

Profiles of 50 Drugs 373


Drugs/Drug Class Effects Notes

Vitamin C ­ Aspirin toxicity


Medicines for diabetes s
(taken by mouth)
Antacids ¯
Corticosteroids ¯ Also increased stomach irritation
(cortisone-like medicines)
Urinary alkalizers ¯ Increased excretion.

Effects of Long-term Use

Except when prescribed for prevention of heart attack, aspirin should not be taken for longer than 10 days in
a row.

ATROPINE

Drug Group: Anticholinergic, Anti-Spasmodics


Principal Uses

Atropine (as Sulphate) is useful in relieving pain in the stomach arising due to spasms (frequent contractions)
of the intestine/muscles of the urinary tract or due to dysentery/diarrhoea. It reduces frequency/urgency
of urination. It is also used to relieve pain associated with stomach ulcer, along with antacids like aluminium
hydroxide or magnesium trisilicate. It is used in patients suffering from insecticide poisoning. It is used as eye
drops to dilate pupil before eye checkup and to treat certain eye conditions such as allergy/corneal burns.

It is also used in patients with non-ulcer dyspepsia, irritable bowel syndrome and diverticular disease
(diverticulum is a pouch or sac opening from any organ resembling a tube or a sac such as gut or bladder).

How this Drug Works

It blocks the action of the chemical ‘acetylcholine’, thus preventing the contraction of muscles and secretion
of the glands in the organs involved. This leads to prevention or relief of muscle spasms (hence called
anticholinergic).

374 A Lay Person's Guide


Dosage and Usage Information

Available Dosage Forms: Tablets 0.25 and 0.5 mg, injections 0.5 mg/ml
Usual Dosage Range for Pain: Adults: 0.6 mg as required
Children: 0.3 mg as required
For Insecticide Poisoning: According to severity of poisoning
For eye: 1-2 drops, 2-3 times daily

How and When to Take

For tablets : It should be taken 30-60 minutes before eating so that maximum drug is absorbed in the blood.
Take the tablet with a full glass of water.

What if you Miss a Dose

Take as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your
regular dosing schedule.

What if you Exceed the Dose

The symptoms include enlarged eye, vision problems, dry mouth and throat, increased heart rate, urinary
problems, high fever, confusion, fits, profound unconsciousness. Seek immediate medical advice.

How to Stop Using this Drug

Do not stop without consulting your doctor as the dose may have to be gradually reduced.

Precautions

Be sure to tell your doctor if you have:


- long-term liver/kidney problems - glaucoma
- urinary difficulties - myasthenia gravis
- heart problems or high BP - chronic bronchitis (breathing problems)
- enlargement of prostate gland - hernia or stomach ulcer
- planned to undergo surgery in the near future

Pregnancy: Avoid the drug as safety in pregnancy is not established. Avoid completely in the first 3 months of
pregnancy.

Breast feeding: The drug passes into the breast milk and may affect the baby. Avoid the drug as far as possible.

Profiles of 50 Drugs 375


Infants and Children: Increased chances of atropine toxicity, especially in children with Down’s syndrome or
brain damage.

Not prescribed for children under 2 years of age. Dose is increased gradually as needed and tolerated in older
children.

Over 60: This drug can increase urinary problems associated with prostate gland enlargement (a common
disorder in elderly men).

Driving and Hazardous Activities: It may cause blurred vision and impaired concentration. Avoid such
activities until you know how you react to this drug.

Diet: Avoid food that causes constipation. Avoid large amounts of tea.

Possible Adverse Effects

Symptoms/Effects Frequency What to do


Blurred vision Common Discuss with your doctor only if severe
Dry mouth " "
Reduced sweating Rare "
Constipation Common "
Dizziness Rare "
Increased heart rate " Discuss with your doctor as soon as possible
Confusion " "
Urinary problems " "
Headache/eye pain " "
Skin rash " "

Interactions

Drugs/Drug Class Effects Notes

Other atropine-like drugs s


(anticholinergics)
Ketoconazole tIncreased dose of ketoconazole may be necessary.
Haloperidol t
Phenothiazines t
Pilocarpine eye drops t

Effects of Long-term Use

Chronic constipation (constipation should be treated promptly with effective laxatives).

376 A Lay Person's Guide


BENZOIC ACID AND SALICYLIC ACID

Drug Group: Benzoic Acid : Antifungal


Salicylic Acid: Antiseptic, keratolytic (related to shedding of skin)

Principal Uses

It is used to treat mild superficial fungal infections, ringworm infections, particularly tinea corporis (tinea
circinata).

How this Drug Works

Benzoic acid and salicyclic acid when used together give beneficial effects as compared to their effects when
used alone. Salicyclic acid sheds off the dead skin. This suppresses the fungal growth and also aids in the
penetration of benzoic acid, which exerts antifungal action (destroys the fungus).

Dosage and Usage Information

Available Dosage Forms: Topical applicatio

How to Stop Using this Drug

Continue using this medicine till the infection is completely cured. Do not stop the treatment in-between or
else the infection may return.

Precautions

Others Avoid use on inflamed skin, moles, birthmarks, unusual warts with hair growing on them or warts on
the face.

Possible Adverse Effects

Symptoms/Effects Frequency What to do

Mild swelling Rare Discuss with your doctor only if severe


Skin irritation " Discuss with your doctor in all cases
starting after the therapy

Profiles of 50 Drugs 377


BENZYL BENZOATE

Drug Group: Scabicide (Anti-scabies)


Principal Uses

It should be used to treat scabies and sometimes in treatment against body lice. If skin infection is also
present along with scabies or develops, then it may be used with sulphadimidine.

How this Drug Works

When applied to the body, it kills the itch mite, a tiny insect that causes scabies. The itch mite usually resides
between the fingers, on the wrist flexures and in between the buttocks. It is also found in palms, soles, breasts
and the penis and causes sores with intense itching. Scabies is a disease caused by unhygienic conditions and
spreads through close body contact and infected clothes.

Dosage and Usage Information

Available Dosage Forms: Emulsion (25%).

Dosage Adults: Use as supplied.

Children: Dilute with an equal volume (1:1) of clean water.

Infants: One part is mixed with 3 parts of water

How and When to Take

Apply over the whole body below the neck preferably after a hot scrub/bath. Paint the application on the dry
skin and leave for 24 hours. Every time the hands are washed, apply the emulsion again. Repeat once, without
a further bath. At the end of two days, all the lotion is scrubbed off in a hot water bath.

Precautions

Do not apply to face or neck.

Others: All members in the patient’s family or at least those sharing the patient’s bed should be treated at the
same time. It is necessary to cover the body below the neck with benzyl benzoate to ensure complete cure.
The itch may sometimes persist for as long as 3 weeks but the application must not be repeated during the
period. (Your doctor may give you medicine like chloropheniramine to control itching). All infected clothing
and bedding should be disinfected by boiling, steaming or airing in the hot sun. Avoid getting benzyl
benzoate in the eyes. Any secondary infection or complications have to be treated after basic treatment is
over.

378 A Lay Person's Guide


Possible Adverse Effects

Symptoms/Effects Frequency What to do

Skin irritation Common Discuss with your doctor

BETAMETHASONE
Drug Group: Corticosteroid
Principal Uses

It is used to treat a variety of conditions caused by allergy/inflammation, such as skin problems, asthma or
arthritis.

Replaces corticosteroid deficiencies. It may be given by mouth to treat corticosteroid deficiency. Your body
naturally produces certain cortisone-like hormones which are necessary to maintain good health. If your
body does not produce enough, which may be due to pituitary or adrenal gland disorders, then your doctor
may prescribe this medicine to help make up the differences).

It should be taken only under medical supervision.

How this Drug Works

It stimulates the production of certain chemicals (enzymes) in the body, which are responsible for reducing
the body response to inflammation and thus prevent its symptoms (swelling, pain, redness).

Dosage and Usage Information

Available Dosage Forms: Tablets, injectables, cream, oral drops.

Note: Reduce dose for maintenance of minimum effective dose.

Profiles of 50 Drugs 379


How and When to Take

Tablets - Take with food to help prevent stomach upset

Cream - Be careful that this medicine does not enter your eyes.

Do not bandage or wrap the affected area. If your doctor has ordered an occlusive (closed) dressing, make
sure how you apply it. Since occlusive dressings increase the amount of medicine absorbed through your skin
and the possibility of side-effects, so use them only as directed.

What if you Miss a Dose

For tablets: If your dosing schedule is -

Every other day - take as soon as possible if you remember it the same morning, then go back to your regular
dosing schedule. If you do not remember, the missed dose until later, wait and take it the following morning.
Then skip a day and start your regular dosing schedule again.

Once a day - take as soon as possible, then go back to your regular dosing schedule. If you do not remember
until the next day, skip the missed dose and do not double the next one.

Several times a day - take as soon as possible, then go back to your regular dosing schedule. If you do not
remember until your next dose is due, double the next dose.

For cream: Apply as soon as possible. If almost time for next dose, skip the missed dose and apply the next
dose.

What if you Exceed the Dose

Headache, convulsions, heart failure are some of the symptoms. Seek immediate medical help.

How to Stop Using this Drug

Do not stop the tablets without consulting your doctor, who may supervise a gradual reduction in dosage.
Sudden stopping of long-term treatment may cause adrenal collapse. Drug affects your response to surgery,
illness, injury or stress for 2 years after discontinuing. Inform your doctor within 2 years.

Precautions

Be sure to tell your doctor if you have -

- an infection at the place of treatment - bone disease


- recently had surgery or a serious injury - colitis
- diabetes - fungus infection

380 A Lay Person's Guide


- glaucoma - heart disease
- herpes simplex infection of the eye - high BP
- high cholesterol levels - kidney disease
- liver disease - myasthenia gravis
- thyroid problems (overactive/underactive) - stomach ulcer
- T.B. (active/non-active/past) - swelling of hands/legs (for injection only)
- planned to undergo a skin test and/or any kind of surgery

Pregnancy: Avoid. It may cause the baby to have problems after birth such as slower growth. Risk to unborn
child outweighs drug benefits.

Breast feeding: It passes into the breast milk and may cause problems with growth or other unwanted effects in
infants or mothers taking this medicine. Avoid drug or refrain from nursing.

Infants and Children: Use only under medical supervision.

For drops: reduced dose may be necessary

For creams: The doctor must observe the child closely since this medicine may be absorbed through the skin
and affect the child’s growth.

If this medicine is used in the diaper area, avoid using tight fitting diapers/plastic pants on the child as it may
increase the absorption of this drug and cause side-effects.

Over 60: Reduced dose may be necessary. May aggravate edema, diabetes or ulcers and may cause cataracts
and osteoporosis.

Alcohol: Avoid. It may increase the risk of peptic ulcers.

Tobacco: Increased betamethasone effect. Possible toxicity.

Diet: Your doctor may want you to follow a low-salt and/or potassium rich diet.

Diabetics: It may cause your blood sugar levels to rise. Consult your doctor if you have any problems regarding
this.

Others: While taking this medicine, and after you stop taking it, do not have any immunizations without your
doctor’s approval. Also, other people living in your home should not receive oral polio vaccine, since there is
a chance they could pass the polio virus onto you. Also, avoid close contact with other people at school/work
who have recently taken oral polio vaccine.

If you have taken an injection in your joint, be careful not to put too much stress or strain on it for a while,
even if it begins to feel better.

Profiles of 50 Drugs 381


Possible Adverse Effects

Symptoms/Effects Frequency What to do

False sense of well being Common Discuss with your doctor only if severe
Increase in appetite " "
Indigestion " "
Nervousness " "
Trouble with sleeping " "
Darkening/Lightening of skin Rare "
colour
Dizziness/Lightheadedness " "
Headache " "
Increase in hair growth on body/ " "
face
Vision problems " Discuss with your doctor as soon as possible
Slow growth (in children) " "
Frequent urination " "
Increased thirst " "
Mood changes " “
Mental depression " "
Skin rash " "
Acne " "
Bloody/black stools " Stop drug now. Discuss with your doctor immediately.
Stomach/Back pain May occur Discuss with your doctor immediately.
Fainting even after
Continuous loss of appetite immediately
Continuous Headache you stop
Muscle weakness taking the
Weight loss drug
For Cream :
Irritation on skin Rare Discuss with your doctor as soon as possible
Pain redness, blisters " "

382 A Lay Person's Guide


Interactions

Drugs/Drug Class Effects Notes

Digoxin Increased risk of adverse effects with


digoxin
Insulin t
Blood thinner (taken by mouth) Altered effects of blood thinners
Vaccines Serious reaction can occur
Medicines for High BP t
Medicines for depression Increased mental disturbances
Folic Acid Requirement increase with long-term
therapy. Folic Acid supplements to be used
Aspirin/Similar medicines t Increased dose of aspirin required.
Water pills t Potassium depletion

Effects of Long-term Use

BISACODYL

Drug Group: Laxative/ Purgative


Principal Uses

It is used, on the advice and supervision of a doctor, to relieve constipation by causing complete evacuation of the
bowels. The evacuation is invariably associated with griping. The fully evacuated bowels become inactive (atonic)
and constipation usually follows for which a milder purgative is again needed. For this reason, it should not be
used in habitual treatment of constipation. It may be used to provide relief: (i) in case of worm infestations along
with the drugs that kill worm, (ii) during pregnancy, (iii) for a few days after child birth,
(iv) during preparation for examination or surgery, (v) for constipation of bed-fast patients, and (vi) following
surgery or other medical problems (heart disease, high blood pressure and hernia) when straining should be
avoided. All these are however indications for an emollient (soothing to skin) purgative like liquid paraffin.
Bisacodyl is preferably avoided in pregnancy.

Profiles of 50 Drugs 383


About Laxatives in General

Before prescribing laxatives it is important to be sure that the patient is constipated and that the
constipation is not secondary to an underlying undiagnosed complaint.
It is also important for those who complain of constipation to understand that bowel habit can vary
considerably in frequency without doing harm. Some people tend to consider themselves constipated
if they do not have a bowel movement each day. A useful definition of constipation is the passage of
hard stools less frequently than the patient’s own normal pattern and this can be explained to the
patient. Misconception about bowel habits have led to excessive laxative use. Abuse may lead to
hypokalaemia (low potassium) and an atonic (relaxed, free of normal tension), non-functioning
colour.
Thus laxatives should be generally avoided except where straining will exacerbate a condition (such as
angina) or increase the risk of anal bleeding as in piles. Laxatives are also of value in drug induced
constipation, for the expulsion of parasites after anthelminthic treatment and to clear alimentary tract
before surgery and radiological procedures. Prolonged treatment of constipation is seldom necessary
except occasionally in the elderly.
Children: The use of laxatives in children is undesirable and the introduction of fruit into diet may be
sufficient to regulate bowel action. In infants, constipation is often remedied by adjustment of the
diet.
Stimulant laxatives: Should seldom be needed. It is important to recognise that improved mobility
and provision of time and privacy for going to the toilet may be all that is required.
Source: BNF, Number 26 Sept. 1993. pp nos. 39-41
Note: Although there are products that contain more than one laxative in combination, such products are not as
advantageous. Moreover, combination products are more likely to cause side-effects.

How this Drug Works

It encourages bowel movements by acting on the intestinal wall. It increases the muscle contractions that
help to propel the stool mass.

Dosage and Usage Information

Available Dosage Forms: Tablets of 5 mg, suppositories of 5 and 10 mg, liquids. Tablets act in 10-12 hours and
suppositories in 20-60 minutes.

Dosage Adults: 5-10 mg (1-2 tablets) at bedtime.

384 A Lay Person's Guide


For Radiology: 10 mg (2 tablets) by mouth at bedtime 2 days before examination and if necessary, a 10 mg
suppository one hour before examination.

How and When to Take

It is taken at bedtime (to produce results, the next morning) with water. It is advisable to drink plenty of water
during constipation so as to make the stool softer.

Bisacodyl tablets are often coated to allow them to work properly without causing irritation and/or nausea
(enteric coated). To protect this coating, do not chew, crush or take the tablets within an hour of milk or
medicines used for acidity.

If taken on empty stomach it may cause intestinal cramping as it causes increased intestinal motility.

Precautions

Be sure to tell your doctor if you have

- diabetes - high blood pressure


- heart disease - anal bleeding like piles
- swallowing difficulty - laxative habit
- stomach pain - cramping in stomach area
- bloating - soreness in anal area
- nausea or vomiting.

Bisacodyl (enteric coated) tablets should not be given to children up to 6 years of age, as they may chew the
tablet leading to stomach irritation.

Do not Take this Drug

- in intestinal obstructions.
- for more than one or two days without medical advice (even if you have had no results from it).
- within 2 hours of taking other medicine since the desired effect of other medicine is reduced.
- just to clean out your system.
- if you miss a bowel movement for a day or two.
- if you have signs of appendicitis (lower stomach pain, mild fever vomiting, bloating).

Inform your doctor if you notice a sudden change in bowel habits or function that lasts longer than 2 weeks
or that keeps returning off and on.

Pregnancy: It may cause unwanted effects in a pregnant women if improperly used. Consult your doctor
before using.

Breast feeding: Consult your doctor before using it.

Profiles of 50 Drugs 385


Infants and Children: In general, any laxative should not be given to children up to 6 years of age, unless
prescribed by a physician.

Over 60: Weakness and lack of coordination may increase on repeated use of laxatives.

Possible Adverse Effects

Symptoms/Effects Frequency What to do

Breathing difficulty Rare Discuss with your doctor as soon as possible.


Burning or urination " "
Confusion " "
Headache " "
Irregular Heartbeat " "
Mood/Mental change " "
Muscle Cramps " "
Skin rash " "
Weakness " "
Belching " Discuss with your doctor only if severe.
Cramping " "
Diarrhoea " "
Nausea " "

Except griping, rebound constipation and occasional diarrhoea, bisacodyl is relatively non-toxic. Above
mentioned adverse drug effects are very very rare.

Interactions

Drugs/Drug Class Effects Notes

Waterpills t Their effect is nullified as laxatives cause


(Potassium sparing diuretics) excessive potassium loss.
Potassium Supplements t
Antacids (drugs used in ¯ If given within 1 hour, they dissolve enteric acidity
hyperacidity or ulcer) coating of bisacodyl causing stomach irritation.

Effects of Long-term use

It leads to dependence on the laxative action to produce bowel movement ("laxative habit"). In severe cases,
over use of some laxatives may damage the nerves, muscles, and tissues of the intestine and bowel.

386 A Lay Person's Guide


CALAMINE LOTION

Drug Group : Antiseptic


Antipruritic (Anti-itch)

Principal Uses

It is used to produce a soothing and protective effect on skin lesions caused by sun burn, eczema or allergic
rash, for itching and irritant conditions of skin. It my be applied to insect bites or stings for its smoothing
effect. It is not effective in fungal infections.

How this Drug Works

It protects and soothens the affected skin. The lotion is initially watery. When it is applied to the skin, the
evaporation of water produces a cooling effect, and oozing of pus is reduced.

Dosage and Usage Information

Available Dosage Forms: Pink-coloured lotion containing 15 gm calamine, 5 gm zinc oxide, 3 gm bentonite, 0.5
gm sodium citrate, 0.5 gm liquified phenol and 5 ml glycerol in 100 ml freshly boiled and cooled water.

Usual dosage: Apply as and when required.

How and When to Take

Apply to the affected area with clean cotton, without rubbing. If pus is oozing from the skin, the lotion
should be applied repeatedly, so that the skin does not become excessively dry.

Precautions

Do not apply to ulcers and infected skin lesions.

Profiles of 50 Drugs 387


CHLORHEXIDENE

Drug Group: Antiseptic


Principal Uses

Effective against a wide range of bacteria, some fungi and some viruses. It is used to treat superficial skin
infections such as superficial ulcers, and abrasions. It is used as an antiseptic solution to clean the skin, for
example, in the cleaning of the vulva and perineum (the area between vulva and anus in females) during
labour. It can also be used for gingivitis (swollen gums) and the prevention of plaque, mouth washes and for
the washing of hands before carrying out any surgical procedures.

How this Drug Works

It is an antiseptic and is effective against many bacteria. Thus it is useful for treating or preventing skin
infections. It is not effective against bacteria that cause TB as well as against fungus, eg., ringworm infections.

For general disinfectant purposes, chlorhexidine gluconate is commonly used in combination with
cetrimide.

Dosage and Usage Information

Available Dosage Forms: Mouthwash, dental gel, oral spray, powder form

Hospital concentrate: 20 %; acqueous solution 5 %; cream (water soluble) 1 %.

Dosage

For ulcers and skin-infections: 1% solution or powder/ointment as needed. For cleaning the skin and washing
hands before surgery: 0.5%.

For mouth wash: 0.1% thrice daily.

For bathing mothers and babies in maternity units and for cleaning wounds: 0.02%

How and When to Take

Hospital concentrate solution of 20% or powder form are available. The solutions of the required strength
(which varies as per use) are made and used. The dilutions from 20% concentrate are made as follows:

1.00% : dilute 5 ml of 20% concentrate to 100 ml with water.

0.50% : dilute one part of 20% solution with 39 parts of water

0.02% : dilute one part 0.5% solution with 24 volumes of clean water

388 A Lay Person's Guide


0.10% : dilute 1 ml of 20% concentrate to 200 ml with clean water or 2 ml of 0.5%: dilute solution to 10 ml
with clean water.

Note: Always use freshly boiled and cooled water for preparation of the solution. Old solutions lose potency.

Precautions

Others: At least 30 minutes should be allowed to elapse between the use of tooth paste and oral chlorhexidine.

Do not swallow.
Do not mix it with soap.
Do not store the diluted solution for more than 2 days.
Do not use cork/cork liners to close the containers containing chlorhexidine
Do not use it in the ears of patients with perforated ear drums.

Possible Adverse Effects

Symptoms/Effects Frequency What to do

Allergic rash Rare Discontinue use. Discuss with your doctor immediately.
Irritation of the mucous Rare "
membranes

CHLOROQUINE PHOSPHATE

Drug Group: Anti-malarial


Principal Uses

It is highly effective in most cases of malaria. In a few cases, it can fail. This occurs when the malaria parasites
are resistant to chloroquine. It is also used to treat lepra (related to leprosy) reactions, rheumatoid (like
rheumatism) arthritis and lupus erythematosus (see Glossary), not controlled by other drugs.

How this Drug Works

Anti-Malaria: It kills the microorganisms (germs) that cause malaria.


Rheumatoid Arthritis: It reduces the inflammation (swelling).

Dosage and Usage Information

Available Dosage Forms: Tablets, liquids, injectables

Profiles of 50 Drugs 389


Note: Choroquine base 150 mg is equivalent to chloroquine sulphate 200 mg which in turn is equivalent to chloroquine phosphate 250 mg.

Dosage

Adults: 600 mg base (4 tablets to be given immediately followed by 300 mg base (2 tablets) after six hours.
Then 300 mg base (2 tablets) to be given for two subsequent days in the morning.
Prevention: 300 mg base (2 tablets) to be taken once in a week (e.g., on every Sunday).

Children: First day 10 mg/kg followed by 5 mg/kg after six hours. Second and third day: 5 mg/kg/day as single
dose.
Prevention: 5 mg base/kg/week.
Lepra Reactions: 150 mg base (one tablet) three times a day for two weeks. (Clofazimine/aspirin is preferred
over chloroquine).
Rheumatoid Arthritis: 150 mg base (one tablet) daily for 6-12 months or longer. Chloroquine is to be used when
other drugs are ineffective or when they cannot be used. Preferred drug is hydroxychloroquine sulphate to be
given in a dose of 400-600 mg initially for 1-3 months and then in the dose of 200-400 mg.
How and When to Take
Take after meals or with milk to avoid nausea and vomiting due to stomach irritation.
What if you Exceed the Dose
The symptoms include vision problems, excitability, fits, loss consciousness (can even lead to death within 2
hours) Seek immediate medical help in all cases.
How to Stop Using this Drug
Keep taking this medicine for the full course of treatment even if you begin to feel better after a few doses.
Precautions
Be sure to tell your doctor if you have :
- alcohol habit - any blood disease
- vision problems - G-6PD deficiency
- liver disease - nerve/brain disease (e.g., fits)
- porphyria (a disorder of porphyrin metabolism)
- psoriasis (a condition characterised by reddish lesions on elbows, trunk, etc.)
Pregnancy: Can be used.
Breast feeding: Although it passes into the breast-milk, it can be safely used, in nursing mothers.
Infants and Children: Reduced dose necessary as per schedule.
Driving and Hazardous Activities: This drug causes dizziness and vision problems when taken in high doses.
Avoid such activities during therapy.
Alcohol: Avoid. Liver problems are likely to occur when you drink alcohol while taking this drug.

390 A Lay Person's Guide


Interactions
Drugs/Drug Class Effects Notes
Antacids ¯
Kaolin (antidiarrhoeal) ¯
Phenylbutazone Severe skin reactions
Gold salts ( like those used
in ayurvedic medicines) “
Effects of Long-term Use Eye damage

Drug Induced Problems in Malaria


Problem Drug/s Differentiation from Treatment
severe malaria
Chloroquine, Vomiting is even otherwise Anti emetics like Domperidone and
Quinine, common in malaria, usually at the Metaclopramide. In the young,
Mefloquine, height of fever. metaclopramide can cause extra-
Vomiting Halofantrine, pyramidal signs, so Promethazine
Tetracyclines, can be tried.
Primaquine
Chloroquine, Could be due to high fever, Usually mild; if bothersome, drugs
Quinine, dehydration and postural like Cinnarazine, Betahistine etc. can
Dizziness Mefloquine, hypotension. be used.
Halofantrine

Itching Chloroquine Anti histamines can be tried

Pain abdomen Chloroquine, In malaria, particularly Drug induced pain can be managed
Drug induced gastritis Quinine, falciparum, there may be acute with antacids or H2 receptor blockers
causes mild Mefloquine, pain over upper abdomen or right
discomfort and very Primaquine lower abdomen, mimicking acute
rarely abdominal abdominal syndromes.
cramps
Altered behaviour, Chloroquine, These symptoms can be due to Watchful expectancy; if needed,
hallucinations, etc. Quinine, severe falciparum infection or due tranquilizers like Haloperidol can be
Drug induced alterations Mefloquine to high grade fever in any type of used.
in behaviour and malaria. If these problems are
changes in the level of caused by severe infection, then
consciousness usually peripheral blood should show
appear after 24-48 hrs of falciparum infection, high degree
starting tt. By then the of parasitemia and the patient may
fever and presence of have other symptoms and signs of
malarial parasites may be severe malaria viz. anemia,
lower. And this can hyperpyrexia, jaundice etc.
occur on treatment for
any type of malaria.

Profiles of 50 Drugs 391


Drug Induced Problems in Malaria

Problem Drug/s Differentiation from Treatment


severe malaria
Convulsions Chloroquine, In severe malaria, convulsions Anticonvulsants like
Some antimalarials can Quinine, may be recurrent and may lead to phenobarbitone for recurrent
induce convulsions. It Mefloquine unarousable coma. convulsions. Mefloquine is better
may also be due to avoided in known epileptics.
hypoglycemia induced
by quinine.

Coma Quinine can In cerebral malaria, coma persists 25-50% dextrose, 50-100 ml
cause even after infusion of 50% intravenously.
hypoglycemia, dextrose.
which may
present as
coma.
Quinine In severe falciparum malaria, 25-50% dextrose, 50-100 ml
Hypoglycemia
especially in pregnancy and intravenously.
children, hypoglycemia can occur
even without quinine therapy.
Primaquine: It Anemia is a common feature in Usually self-limiting; withdraw the
Anemia can cause malaria, especially in children. drug; blood or packed cell
massive transfusion if needed.
hemolysis in
patients with
Glucose 6-
phosphate
dehydrogenase
deficiency
Jaundice Primaquine Severe malaria can cause Withdraw the drug.
may cause hemolytic jaundice, or rarely
hemolytic malarial hepatitis.
jaundice in
patients with
Glucose 6-
phosphate
dehydrogenase
deficiency
Hemoglobinuria Primaquine
(same group
as above)

Fever Artemisinin In cases of resistant malaria, with Self-limiting, disappears after the
Continuing even after derivatives the continuation of fever, the drug is stopped.
improvement in general general condition deteriorates
condition and significant and malarial parasite count
reduction in malarial increases.
parasites.
Source: <http://www.malariasite.com/malaria/DrugProblems.htm>

392 A Lay Person's Guide


CHLORPHENIRAMINE MALEATE

Drug Group : Antiallergic


Principal Uses

It is used to treat symptomatic relief of allergies (itching, swelling, redness) such as hay fever, urticaria,
hives, allergic swelling and allergic conjunctivitis (itching and redness of eyes).

It reduces sneezing and runny nose and depresses mucus secretion and thus provides relief in common cold
and cough. (It does not cure common cold.)

Other Uses

It may be used to treat allergic reactions to blood transfusions or x-ray contrast material and along with
adrenaline injection to treat acute allergic shock.

Its combination with pain killers, antidiarrhoeals, tranquilisers (sleeping drugs) steroids and other anti-
allergics are considered to be irrational.

How this Drug Works

It works by preventing the effects of a substance called histamine, which when produced in abnormal
amounts, in the body, may give rise to skin irritation, swelling and other symptoms of allergy.

Dosage and Usage Information

Available Dosage Forms: Tablets, liquids, injectables

Dosage

Adults: 4 mg ( 1 tablet or 1 teaspoonful) every 6 hours daily, but adjust the schedule to waking/sleeping
pattern.

Children: Above 6 years: 2 mg ( 2.5 ml or 1/2 teaspoonful) every 6 hours daily. Under 6 years: 1 mg ( 1.25 ml or
1/4 teaspoonful) every 6 hours daily.

How and When to Take

Take it with food or a glass of milk to lessen stomach irritation.

What if you Miss a Dose

Take as soon as you remember. If your next dose is due within 2 hours take a single dose now and skip the
next. Do not double the doses.

Profiles of 50 Drugs 393


What if you Exceed the Dose

Large overdose may lead to:

- drowsiness or agitation

- feeling faint

- flushing redness of face seeing, hearing or feeling things that are not there

- troubled breathing, seizures. Consult your doctor immediately.

Precautions

Be sure to tell your doctor if you have:

- long term liver problems, epileptic fits, glaucoma, urinary difficulties asthma, enlarged prostate, to
undergo any skin tests for allergies (the results of the tests may be affected).

Do not use this drug in premature/new born infants as serious side-effects may occur in to them.

Pregnancy: Safety is not established. Avoid this drug.

Breast feeding: Drug passes into the breast milk, and may cause unusual excitement or irritability in the infant.
It also tends to decrease the flow of breast milk sometimes. Use is not recommended.

Infants and Children: Reduced dose necessary.

Over 60: Reduced dose may be necessary. Increased likelihood of adverse effects.

Driving and Hazardous Activities: Machine operation should be avoided as this drug causes some people to
become drowsy and less alert.

Alcohol: Should be avoided as this drug adds up to the sedative (drowsy) effects of alcohol and other sedative
drugs.

Others: This drug may cause dryness of mouth, nose and throat. If dry mouth continues for more than 2
weeks, check with your dentist since it may increase the chance of dental disease.

Paradoxical stimulation in high doses in children.

When applied to skin, it causes allergic reactions. Avoid topical use.

394 A Lay Person's Guide


Possible Side-effects

Symptoms/Effects Frequency What to do

Sore throat and Fever Rare Discuss with your doctor immediately.
Unusual bleeding /bruising " "
Unusual weakness " "
Excitation (children) " Discuss with your doctor immediately and stop drug now.
Rash " "
Drowsiness Common Discuss with your doctor only if severe (reduce dose)
Change in vision Rare "
Urinary difficulties " "
Dry mouth, nose, throat " "
Loss of appetite " "
Stomach upset " "
Shaking / Tremor " "
Ringing or buzzing sound in ears " "
Thickening of bronchial Common "
secretions
Increased sensitivity to Sun Rare "
Increased sweating " "
Fast heartbeat " "

Interactions

Drugs/Drug Class Effects Notes

Sedatives (Sleeping Medicines) ­ Increased drowsiness


Medicine for Stomach Cramps ­
(Atropine and atropine-like drugs)
Betahistine t Increased drowsiness
Seizure medicine ­ "
Pain Medicine ­ "
Medicine that relax muscles. ­ "
Anaesthetics ­ “

Profiles of 50 Drugs 395


Drugs/Drug Class Effects Notes

All medicines that have toxic Toxic effects like ringing in ears, dizziness,
action on ear (e.g., aspirin in etc., are covered up by this drug.
large doses).
CNS depressants or s Increased drowsiness
­
(Medicines that slow down the
nervous system, possibly
causing drowsiness).
Furazolidone, isocarboxazid, ­ Concurrent use not recommended.
pargyline, phenelzine,
procarbazine, tranylcypromine)

Effects of Long-term Use

The effect of the drug may become weaker with prolonged use over a period of weeks or months as the body gets
used to it. A different anti-allergic (antihistamine) may be recommended by your doctor.

CO-TRIMOXAZOLE

Drug Group: Antibacterial combination

Principal Uses

Co-trimoxazole (trimethoprim plus sulphamethoxazole) is used in the treatment of urinary tract infections,
in acute respiratory infections, in the treatment of bacillary dysentery caused by bacteria, in abscess and skin
infections, in chancroid (a sexually transmitted disease), and in the treatment of typhoid.

How this Drug Works

It is a mixture of two drugs: 5 parts of sulphamethoxazole (a sulfa drug) and 1 part of trimethoprim. They
work synergistically by preventing the growth and multiplication of the bacteria that cause the infection and
thus cure the infection.

The combination is not effective in virus infections such as common cold and flu.

396 A Lay Person's Guide


Dosage and Usage Information

Available Dosage Forms: Tablets, liquids, injectables

Dosage

Adults: 800 mg sulphamethoxazole and 160 mg trimethoprim every 12 hours for 7 to 10 days.

Children: 25 mg/kg/dose sulphamethoxazole and 5 mg/kg/dose trimethoprim given at 12 hours interval


for 7-10 days.
Note: Use for 15 days in typhoid fever and continue for 3 months in typhoid carrier cases. Actual dosage schedule must be determined for each patient
individually.

How and When to Take

It is best taken with a full glass of water. Drinking lots of extra water every day will help to prevent its
unwanted effects.

What if you Miss a Dose

Take as soon as you remember. Then take next dose after 12 hours.

What if you Exceed the Dose

The signs include abdominal pain, vomiting, dizziness and confusion. Notify your doctor as soon as
possible.

How to Stop Using this Drug

Take the full course even if you feel better within a few days. Do not stop without consulting your doctor.

Precautions

Be sure to tell your doctor if you have:

- long-term kidney/liver problems


- blood disorders
- porphyria

Do not use: in patients hypersensitive (allergy) to sulfonamides (sulfa drugs).

Pregnancy: Avoid. It may cause birth defects in the baby.

Breast feeding: Drug passes into breast milk. At normal doses it is safe but discuss with your doctor.

Profiles of 50 Drugs 397


Infants and Children: Not to be used in infants below the age of 2 months.

Possible Adverse Effects

Symptoms/Effects Frequency What to do

Diarrhoea Common Discuss with your doctor only if severe.


Nausea/vomiting " Stop drug now. Discuss with your doctor
immediately.
Rash/itching " "
Severe skin reactions Rare "
Sore tongue " "
Headache/dizziness " "
Jaundice (liver damage) " "

Interactions

Drugs/Drug Class Effects Notes

Anticoagulants, e.g., Warfarin  Warfarin’s dose must be reduced.


Phenytoin  Phenytoin’s dose must be reduced.
Antidiabetic drugs  Excessive lowering of blood sugar levels.
(taken by mouth) Adjust the dose.
Methotrexate 
Diuretics  May lead to some blood disorder. Do not use
previously or simultaneously.
Methenamine Do not use (to treat urinary tract infections)
simultaneously.

Effects of Long-term Use

Not advisable without medical advice.

398 A Lay Person's Guide


CODEINE PHOSPHATE

Drug Group: Narcotic pain killer


Anti-diarrhoeal, Cough Suppressant
Dependence rating : Medium

Principal Uses

It is used to relieve mild to moderate pain. It is also used to suppress dry irritating cough.

How this Drug Works

It suppresses the perception to pain and calms the emotional response to pain. It also reduces the sensitivity
of the cough reflex.

Dosage and Usage Information

Available Dosage Forms: Tablets, liquids, nasal drops, injectables.

Dosage

Adults: Pain killer: 15-60 mg every 3-6 hours as needed. Cough Suppressant : 10-12 mg every 4-6 hours.

Children: Pain-killer: 0.5 mg/kg body weight/dose, 4 times daily. Cough-Suppressant (liquid preparations 15
mg /5 ml) : 3mg/kg per day in 3-4 divided doses. Not generally recommended in children. Should be avoided
in children under one year altogether.

Causes constipation in repeated dosing.

Overdosage

Symptoms include drowsiness, restlessness, agitation, nausea, vomiting, dry mouth, vertigo, weakness,
lethargy, coma, seizures. Consult your doctor immediately as overdose may lead to unconsciousness or
death.

Precautions

Be sure to tell your doctor if you have:


- history of drug abuse or alcoholism. - liver/kidney problems.
- gall bladder disease. - seizure disorder.
- brain disease. - heart disease.
- lung disease (asthma) - underactive thyroid.
- planned to have surgery (also dental surgery) - urination problems (enlarged prostate).

Profiles of 50 Drugs 399


Do not take this drug : If you are having an acute attack of asthma.

Pregnancy: Safety not established.

Breast feeding: It passes into the breast milk. Avoid.

Infants and Children: Do not use in children under 2 years of age.

Over 60: Reduced dose may be necessary as they are more susceptible to adverse effects.

Driving and Hazardous Activities: This drug may cause dizziness and drowsiness. Avoid hazardous activities
accordingly.

Alcohol: Avoid. Alcohol may increase the sedative (depressing) effects of this drug.

Others: It may cause dryness of mouth. If it continues for more than 2 weeks, check with your dentist as dry
mouth may increase the chance of dental disease.

Possible Side-effects

Symptoms/Effects Frequency What to do

Drowsiness Common Discuss with your doctor only if severe

Nausea/vomiting Common "

Constipation Common "

Urinary problems Rare "

Interactions

Drugs/Drug Class Effects Notes

Medicines with sedative effects ­ Increased Sedation.

(that slow down the nervous system)

e.g., Antidepressants, Antipsychotics,

Sleeping drugs and Antiallergics ­

Furazolidone ­ Use with caution in reduced dosage.

Effects of Long-term Use

Psychological and physical dependence as well as chronic constipation may occur. It should be preferably
used for short term only.

400 A Lay Person's Guide


Note : Its use in the treatment of productive cough is not considered to be rational. Although, it is often combined with antiallergics, the
combination is thought to be irrational.

Although, it is a constipating drug and is used in short term control of diarrhoea, this use is irrational. It
delays the elimination of the germs that cause diarrhoea by slowing down the movement of intestinal tract.
This may lead to serious reactions in children. It is used as a constipating drug in selected circumstances.

DAPSONE

Drug Group: Anti-infective,


Antileprotic
Principal Uses

It helps the body to overcome leprosy (Hansen’s disease) and to help control dermatitis herpetiformis, a skin
problem.

How this Drug Works

It inhibits the growth and multiplication of micro-organisms (germs) that cause leprosy.

Dosage and Usage Information

Available Dosage Forms: Tablets of 100 mg.

Dosage

Taken along with ethambutol, clofazimine and/or rifampicin depending on the nature of leprosy. A daily
dose of 100 mg may continue up to 6 months or 2 years depending on the treatment regimen.

Profiles of 50 Drugs 401


How and When to Take

To help clear up leprosy completely and permanently, it is important to take this medicine every day for the
full time of treatment (6 months or 2 years depending on the nature of infection).

It is best to take each dose at the same time every day, so you do not miss any doses.

What if you Miss a Dose

Take as soon as possible, and then follow regular schedule.

Precautions

Be sure to tell your doctor if you have:


- severe anemia
- liver/kidney problems
- G-6PD and/or methaemoglobin reductase (enzymes) deficiency.

Breast feeding: It passes into the breast milk.

Diet: For dermatitis herpetiformis : Your doctor may want you to follow a “gluten-free” diet. Discuss with
your doctor.

Possible Adverse Effects

Symptoms/Effects Frequency What to do

Fever Common Discuss with your doctor immediately


Loss of appetite " "
Pale skin " "
Skin rash " "
Unusual tiredness or weakness " "
Bluish fingernails, lips or skin Rare Discuss with your doctor only if severe
Troubled breathing " "
Itching/scaling of skin, " "
loss of hair
Mood changes " "
Sore throat " "
Yellow eyes or skin " "
Headache, Vomiting " "

402 A Lay Person's Guide


Interactions

Drugs/Drug Class Effects Notes


Para Aminobenzoic acid ¯ In treatment of leprosy (alone), the effect of
(PABA) dapsone is nullified
Any medicine that causes ¯ Increased chances of toxic side-effects of dapsone
blood disorders

DIAZEPAM

Drug Group: Benzodiazepines,


Muscle relaxant, Anti-anxiety,
Anticonvulsant
Dependence Rating : High
Principal Uses

It is used to relieve nervousness or tension, to treat anxiety and anxiety related sleeplessness, to relax muscles
or to relieve muscle spasms, to treat epilepsy (convulsions) to relieve the symptoms of acute alcohol
withdrawal and to sedate (induce sleep in) people undergoing certain medical procedures like anaesthesia.

How this Drug Works

It depresses activity in the part of the brain that controls emotion, by promoting the action of a chemical
nerve transmitter (GABA) which in turn prevents excessive brain activity that causes anxiety.

Profiles of 50 Drugs 403


Dosage and Usage Information

Available Dosage Forms: Tablets, liquids, injectables.

Dosage Range

Adults: 2-10 mg, 2-3 times daily (usually administered at night).

Note: Dose may be increased cautiously as needed and tolerated. Total daily dose should not exceed 60 mg. Actual dosage and
administration schedule must be determined by the physician for each patient individually.

How and When to Take

May be taken on empty stomach or with food or milk. The prolonged action capsule should not be opened
before administration.

What if you Miss a Dose

Take it immediately if you remember within one hour. However, if you remember later, skip the missed dose
and go back to your regular schedule. Do not double your dose.

What if you Exceed the Dose

The symptoms include severe drowsiness and weakness, staggering, slurred speech, unusually slow heart
rate and troubled breathing. Notify your doctor immediately. Commoner with injection.

How to Stop Using this Drug

Do not discontinue the drug abruptly if taken continuously for more than 4 weeks. Dosage should be
reduced gradually, so as to prevent withdrawal syndrome that include depression, confusion, tremor,
seizures, muscle cramping, sweating and vomiting.

Precautions

Be sure to tell your doctor if you have :


- had problems with alcohol or drug abuse - long-term liver or kidney problems.
- or had serious depression or mental illness. - epilepsy or history of seizures.
- or had serious breathing problems (emphysema, asthma etc.)
- myasthenia gravis.

Do not take this drug if :

- you have acute narrow angle glaucoma


- prescribed for a child under 6 months of age.

404 A Lay Person's Guide


Pregnancy: Avoid use during the entire term of pregnancy. It increases the chances of birth defects and may
cause the baby to become dependent on it.

Breast feeding: It passes into the breast-milk and causes drowsiness or breathing problems in babies of
mothers taking this drug. Avoid drug or refrain from nursing.

Infants and Children: Reduced dose necessary. Not to be used for

(i) children one months - 6 months of age


(ii) hyperactive or psychotic child of any age

Over 60: Increased chances of adverse effects. Reduced dose may be necessary.

Alcohol: Avoid. It increases sedative effects of this drug.

Tobacco: Avoid. It reduces the calming action of this drug.

Others: It produces psychological and/or physical dependence if used in large doses for long time.

Possible Side-effects

Symptoms/Effects Frequency What to do

Behaviour problems Rare Discuss with your doctor immediately


(anger, excitement)
Mental depression/confusion " "
Skin rash " "
Sore throat and fever " "
Yellowing of eyes/skin " "
Unusual bleeding/bruising " "
Drowsiness Common Discuss with your doctor only if severe
Dizziness/Unsteadiness " "
Headache Rare "
Vision problems " "
Slurred speech " "
Dry mouth " "
Stomach upset " "
Menstrual irregularity " "
Urinary problems " "
Unusual Weakness " "

Profiles of 50 Drugs 405


Interactions

Drugs/Drug Class Effects Notes

Digoxin Digoxin toxicity


Phenytoin Phenytoin toxicity
Levodopa ¯ Reduced effectiveness
Cimetidine ¯ "
Disulfuram ¯ "
Isoniazid ¯ "
Oral Contraceptives ¯ "
Valproic Acid ¯ "
Rifampicin ¯ "
Sedatives ­ Increased sedation
(e.g., antiallergics, muscle
relaxants, seizure medicine,
narcotics, sleeping medicine,
depression medicine, etc)
Water pills
Cardiac drugs (diltiazem, ¯ Blood pressure falls down severely.
verapamil, nifedipine)
Maprotiline Depressant effects
High blood pressure medicine Blood pressure falls down severely.
Furazolidone, pargyline, Increased sedation.
procarbazine (MAO inhibitors)

Effects of Long-term Use

Regular use of this drug over several weeks can lead to a reduction in its effect as the body gets used to it. It
may be habit forming when taken for very long periods.

406 A Lay Person's Guide


DIGOXIN

Drug Group: Digitalis group of medicine;


Antiarrhythmic heart Medicine

Principal Uses
It is given in the treatment of congestive heart failure and in the maintenance of normal heart rate and
rhythm. It should be used only under doctor’s supervision.

How this Drug Works


It restores the normal rate of the heart so that each beat is more effective in pumping blood. It thus improves
the strength and efficiency of the heart. This leads to better blood circulation, controls tiredness,
breathlessness and swelling of hands and ankles in patients with such problems.

Dosage and Usage Information

Available Dosage Forms: Tablets 0.25 mg. Injectables : 1 mg/ml

Dosage

Adults: 0.125-0.25 mg daily divided in 2-3 doses given 6-8 hours in one day.

Children: Reduce dose according to age and weight.

Dose: 10-20 mg/kg body weight every 6 hours. Maintenance : 10-20 mg/kg body weight in single/divided
doses.
Note: Actual dosage and administration schedule should be determined by the doctor for each patient individually.

How and When to Take

Take at the same time each day or preferably on an empty stomach. It may be taken with or after food (but not
milk and milk products).

For digoxin: To be taken by mouth. The amount to be taken is to be measured accurately with a specially
marked dropper.

What if you Miss a Dose

Take as soon as you remember. If your next dose is due within four hours, take both doses now and skip the
next. Return to your normal schedule the next day.

Profiles of 50 Drugs 407


What if you Exceed the Dose

The amount needed to help most people is very close to the amount that could cause serious problems from
overdose. The symptoms include loss of appetite, nausea, vomiting, diarrhoea, headache, confusion,
disturbances of heart rate and rhythm, severe weakness, chest pain, loss of consciousness.

Seek immediate medical advice in all cases.

How to Stop Using this Drug

Do not discontinue without consulting your doctor. Stopping suddenly may cause a serious change in heart
function.

Precautions

Be sure to tell your doctor if you have kidney/liver the following problems: thyroid, lung, heart attack,
rheumatic fever, plan to undergo any surgery; large amount of fiber, such as bran in your diet.

Pregnancy: This medicine passes from mother to fetus. Safety not established.

Breast feeding: Small amount of drug passes into the breast milk. Although at normal doses, effects on the baby
are unlikely, discuss with your doctor, Monitor nursing infant for adverse effects and discontinue dry or
refrain from nursing.

Infants and Children: Reduced dose necessary. Observe for irregular heart rate and rhythm in case of overdose,
as other signs are not clearly seen in children.

Over 60 years: Increased likelihood of adverse effects. Reduced dose may therefore be necessary.

Driving and Hazardous Activities: Do not drive until you know how this drug affects you. It can cause
drowsiness and mental confusion.

Diet: Avoid milk and milk products for 2 hours before and after taking this drug.

This drug may be more toxic if potassium levels fall. Hence include fruit and vegetables in your diet.

Avoid: caffeine containing beverages : Coffee, tea.

Tobacco: It can lead to serious disturbances of the heart rhythm. Avoid all forms of tobacco.

408 A Lay Person's Guide


Possible Adverse Effects

Symptoms/Effects Frequency What to do

Nausea, vomiting Common Discuss with your doctor in all cases


Constipation Rare "
Stomach pain " "
Bloating " "
Loss of appetite Common "
(May indicate a more serious
problem with your bowels).
Seeing, hearing things which Rare Discuss with your doctor immediately.
are not real
Heart rhythm disturbances Common "
Visual problems Common "
Tiredness Common Discuss with your doctor only if severe.
Skin rash Rare "
Confusion Rare "
Headache Rare "
Urinary problems Rare "
Dryness of skin and mouth Rare "

Interactions

Drugs/Drug Class Effects Notes

Water pills (other than Serious heart rhythm disturbances.

spironolactone and triamterene)


Quinidine
Cortisone like medicines ¯ Calcium toxicity
Amiodarone ­ Increased digoxin concentration.
Diltiazem ­
Erythromycin ­
Methimazole ­
Propylthiouracil ­
Quinine ­
Tetracyclines ­
Verapamil ­

Profiles of 50 Drugs 409


Drugs/Drug Class Effects Notes

Antacids ¯
Bleomycin ¯
Carmustine ¯
Cholestyramine ¯
Colestipol ¯
Cyclophosphamide ¯
Cytarabine ¯
Doxorubicin ¯
Methotrexate ¯
Penicillamine ¯
Procarbazine ¯
Thyroid hormones ¯
Vincristine ¯

Note: Since many drugs interact with digoxin, do not take any medication along with digoxin, without your doctor’s advice.

DIPHENHYDRAMINE

Drug Group: Anti allergy


Anti-vomit, Anti-Parkinsonism

Principal Uses

It is used to treat allergies like allergic rhinitis (cold due to allergy), skin allergies (hives), and adverse effects
due to food, drug or insect stings.

It is being used in the treatment of Parkinson’s disease and movement disorders. Reduces stiffness and
tremors in Parkinson’s disease.

It is used to treat vomiting and vertigo. It also relieves nausea and vomiting, motion sickness. It is thought to
relieve cough also. (It does not treat ‘cough’). Used as a sedative.

It is combination with painkillers, antidiarrhoeals, tranquilizers (sleeping drugs), steroids and other
antiallergics are considered to be irrational.

410 A Lay Person's Guide


How this Drug Works

It works by preventing the effects of a substance called histamine, which when produced in abnormal
amounts, in the body may give rise to skin irritation, swelling and symptoms of allergy.

Its natural side-effects are used to advantage: it’s atropine-like effects are used in management of motion
sickness and Parkinsonism, while it’s sedative effects are used to induce drowsiness/sleep.

Dosage and Usage Information

Available Dosage Forms: Tablets, liquids

Dosage

Adults: 25-50 mg/every 4-6 hours till symptoms are relieved, then 25-50 mg daily.

Note: Actual dosage and administration schedule must be determined by the physician for each patient individually.

Children: 12.5-25 mg ( 5-10 ml or 1-2 teaspoonful syrup) 3-4 times daily.

How and When to Take

Take with or following food to reduce stomach irritation.

For motion sickness: Take at least 30 minutes, (preferably 1 to 2 hours) before you begin to travel.

What if you Miss a Dose

Take as soon as you remember. If your next dose is due within 2 hours take a single dose and skip the next.

What if you Exceed the Dose

The symptoms include severe drowsiness, confusion in coordination, unsteadiness, muscle tremors,
agitation, fever, flushed face, dilated eyes, weak pulse, difficult breathing, profound unconsciousness.
Notify your doctor as soon as possible.

Precautions

Be sure to tell your doctor if you have :

- glaucoma - enlarged prostate


- asthma - peptic ulcer
- long-term liver problems. - kidney problems
- surgery within 2 months including dental surgery.

Profiles of 50 Drugs 411


Pregnancy: Avoid drug during the last three months. Use sparingly during the first six months only if clearly
needed.

Breast feeding: This drug passes into the breast-milk. Its use is not recommended, since there are chances it
may cause unusual excitement or irritability in the infant. Besides, it decreases the secretions of the body and
hence it is possible that the flow of breast milk may also be reduced. Avoid drug or refrain from nursing.

Infants and Children: Not given to premature and newborn infants. Reduced dose necessary. Not used in
children with chicken pox, flu-like infection or Reye’s syndrome (a condition in children marked by loss of
consciousness, and possible death).

Over 60: Reduced dose may be necessary. Increased likelihood of adverse effects. Such as urination difficulty,
diminished alertness and other brain and nervous system symptoms.

Alcohol: Avoid. Alcohol may increase the sedative (drowsy, sleepy) effects of this drug.

Driving and Hazardous Activities: Avoid such activities until you know how the drug affects you because the
drug can cause drowsiness.

Others: Discontinue this drug five days before diagnostic skin testing procedures in order to prevent false
negative test results. Do not use this drug if you have asthma or other lung problems, because it thickens the
secretions in the lung and makes it more difficult to remove (by absorption/ coughing). This drug may make
you more sensitive to sun. Use cautiously. This drug causes dry mouth. If this continues for more than 2
weeks, check with your dentist since dry mouth may lead to dental disease.

Possible Side-effects

Symptoms/Effects Frequency What to do

Sore throat and fever Rare Discuss with doctor immediately


Unusual bleeding or bruising " "
Unusual tiredness or weakness " "
Urinary problems " "
Disorientation/excitation " "
Drowsiness Common Discuss with doctor
Dry mouth "
Nausea/abdominal pain Rare
Vision problems "
Skin rash "
Increased sweating "

412 A Lay Person's Guide


Symptoms/Effects Frequency What to do

Ringing in ears "


Headache Rare
Nightmares "
Confusion "

Interactions
Drugs/Drug Class Effects Notes
All medicines with sedative s Oversedation
(drowsy, sleepy effect)
Atropine and Atropine-like s
medicines
MAO-inhibitors ­ Elimination of this drug is delayed and thus its
(eg., furazolidone, action is prolonged.
isocarboxazid, pargyline,
phenelzine, tranylcypromine)

Effects of Long-term Use

The effect of this drug may become weaker with prolonged use over a period of weeks or months as the body
adapts.

EPHEDRINE
Drug Group: Bronchodilators

Principal Uses

It is used in the treatment and prevention of asthma, in mild cases of allergic rash and itching and as nasal
spray to relieve the blocking of nostrils occurring during an attack of common cold. It may be used to treat
low blood pressure certain mental depression and narcolepsy (uncontrolled desire to sleep.)

Note: Continuous use of nasal sprays may worsen the condition leading to rebound congestion. Although it is effective in asthma, its
continual use may lead to development of tolerance. Hence it is better if other drugs for asthma (eg., salbutamol, aminophylline, etc. which
have lesser side-effects but are costlier) are taken in rotation during successive weeks. Fixed-dose combination with other bronchodilators
must be avoided.

How this Drug Works

It opens up the bronchial tubes (air ways) of the lungs by relaxing the muscles around them and thus

Profiles of 50 Drugs 413


facilitates easy breathing.

Similarly it also opens up the nostrils blocked during common cold.

Dosage and Usage Information

Available Dosage Forms: Tablets, syrups, inhalers, injectables

Dosage: Adults 15 mg to 60 mg, three times daily

For Asthma: 30 mg (1 tablet) repeated after six hours if necessary

For Prevention of Asthma: 30 mg (1 tablet) twice daily.


For Nasal blockade: 1-2 drops into each nostril as and when required. Avoid repeated and excessive dose.
For allergy: 30 mg (1 tablet) thrice daily for 5 days.

Children: 3 mg/kg/day every 6-8 hours.

How and When to Take

Take the last dose a few hours before bed time to avoid sleeplessness. For asthma - take the tablet at bed time
to avoid asthma attack at night. Diazepam is usually given along with it to avoid sleeplessness.

What if you Miss a Dose

Use it as soon as possible. Then use any remaining doses for that day at regularly-spaced intervals.

What if you Exceed the Dose

Signs (not all of them will occur). Blue coloured skin, chest pain, chills, fever, fits, dizziness high/low BP,
headache (severe), irregular heart beat, muscle cramps, troubled breathing, nausea, anxiety, large pupils,
vision problems, pale cold skin and weakness.

If you have exceeded a total dose of 240 mg/day and/or the above signs are observed, notify your doctor
immediately.

Precautions

Be sure to tell your doctor if you have:

- brain damage - diabetes


- enlarged prostate - heart or blood vessel disease
- high blood pressure - mental disease
- overactive thyroid - Parkinson’s disease
- fits

414 A Lay Person's Guide


Pregnancy: Safety for use has not been established. Must be used only if clearly needed. Discuss with your
doctor.

Breast feeding: Safety for use has not been established. Do not use the drug it refrain from nursing.

Over 60: Avoid. It causes retention of urine. Also do not use to treat asthma on elderly who develops
breathing difficulty for the first time, especially if he has chest pain and is sweating since he may be having a
heart attack and must be referred to the doctor immediately.

Cardiac Patients: Avoid in patients who have heart problem or high BP

Possible Adverse Effects

Symptoms/Effects Frequency What to do

Stomach upset Rare Discuss with your doctor only if severe


Difficulty in passing urine " Discuss with your doctor as soon as possible
Sleeplessness " "
Tremors " "
Increased heart rate " "
Mental disturbances and " "
hallucinations
Retention of urine (in patients " "
with enlarged prostate)

Interactions

Drugs/Drug Class Effects Notes

MAO Inhibitors Dangerous rise in BP


Digitalis drugs Increased risk fast heart rate
Medicines for high BP t

Effects of Long-term Use

For asthma: Tolerance may develop to this drug. For nasal blockade: Rebound congestion (i.e., symptoms
may return after sometime in an aggravated condition).

Profiles of 50 Drugs 415


ERGOTAMINE

Drug Group: Anti-Migraine,


Ergot drug

Principal Uses

It is used to treat migraine headaches and some kinds of throbbing headaches. It is not used to prevent
headaches but is used to treat an attack once it has started. It is most effective if taken at the first sign of that a
migraine is going to occur. Once headache and nausea are established, it is less likely to be effective and may
cause a stomach upset and increase the nausea of migraine.

It is used along with caffeine to increase its effectiveness but a fixed dose combination is not required. Its
fixed dose combination with other medicines (for vomiting, depression, etc.) are not rational.

How this Drug Works

When the blood vessels in the head dilate (expand) they release certain chemicals which produce pain.
Ergotamine relieves pain by narrowing the dilated blood vessels.

Dosage and Usage Information

Available Dosage Forms: Tablets

Dosage

Adults: 1-2 mg (2 tablets) daily, subsequently every 30 minutes, until complete relief is obtained. Not more
than 6 tablets daily.
Note: It should not be used prophylactically (for prevention of migraine). Use carefully under physician’s guidance. Overdose is dangerous.

How and When to Take

Take it at the first sign of headache or migraine attack.

Lie down in a quiet, dark room for at least 2 hours after taking it.

For sublingual (under-the-tongue) tablets: Dissolve the tablet under your tongue. The sublingual tablet should not
be chewed or swallowed since it works much faster when absorbed through the lining of the mouth.

Do not eat, drink or smoke while a tablet is dissolving.

416 A Lay Person's Guide


What if you Miss a Dose

Regular doses of this drug are not necessary and may be dangerous. Take only when you have symptoms of
migraine.

What if you Exceed the Dose

Symptoms such as nausea, vomiting, diarrhoea, cold skin, numb and painful hands or feet, gangrene (tissue
death) of fingers or toes, loss of limbs, confusion, seizures, profound unconsciousness (coma) may occur.
Notify your doctor as soon as possible.

How to Stop Using this Drug

If you have used it for a very long time (although it should not be used do not stop taking it without checking
with your doctor. If stopped suddenly, your headaches may return or worsen.

Precautions

Be sure to tell your doctor if you have:

- heart problem - poor blood circulation


- high blood pressure - infection
- had a recent heart attack - asthma
- kidney disease - liver disease
- used ergotamine within 48 hours prior to - overactive thyroid
any surgery

Pregnancy: Since it can stimulate labour, which could result in miscarriage.

Breast feeding: It passes into the milk and may have adverse effects on the baby. It may also reduce the milk
supply.

Infants and Children: Not to be used

Over 60: Use with caution. Hidden heart or circulatory problems may be aggravated.

Alcohol: Best avoided. Alcohol can make headaches worse. Besides some drinks provoke migraine in some
people and alcohol may be one of those drinks.

Tobacco: Best avoided as it may increase the harmful effects of this medicine.

Diet: Changes in diet do not affect the action of this drug but certain foods may provoke migraine attacks in
some people.

Others: Your doctor may want to evaluate the circulation (blood flow) to your hands and feet.

Profiles of 50 Drugs 417


Possible Side-effects

Symptoms/Effects Effects What to do

Localised swellings Common Discuss with your doctor only if severe


Itching Rare "
Chest pain " "
Numbness and tingling of " "
fingers and toes
Muscle pains in arms or legs " "
Nausea/vomiting " "
Diarrhoea " "
Headache " "
Depression " "
Dizziness " "
Numbness and tingling of " "
fingers and toes *

Red/violet blisters on skin


of hands/feet *
" "
Stomach pain/bloating
(Gangrene of intestine) " "
Due to Gangrene of hands/feet: Emergency surgery required
*

Interactions

Drugs/Drug Class Effects Notes

Erythromycin s Increased likelihood of adverse effects


Beta blockers (heart medicine) Circulatory (Blood flow) problems may
increase
Cold remedies Some ingredients in these products cause
dangerous rise in BP
Nitroglycerine t It is unable to prevent or relieve angina pain

Effects of Long-term Use

Headaches (after drug is discontinued following long term use) and poor circulation (blood flow) to hands
and feet.

418 A Lay Person's Guide


ERYTHROMYCIN

Drug Group: Antibiotic


Principal Uses

It is used to treat a broad variety of common infections. The important ones are (i) skin infections (ii) throat,
middle ear and chest infections, including some rare types of pneumonia such as mycoplasma pneumonia
and Legionnaires disease and (iii) in treatment of diphtheria, (iv) gonorrhoea, chlamydial infections, syphilis
and other sexually transmitted diseases (v) amoebic dysentery, (vi) for long-term prevention of recurrences
of rheumatic fever.

How this Drug Works

This drug prevents the growth and multiplication of susceptible organisms by interfering with their
formation of essential proteins.

Dosage and Usage Information

Available Dosage Forms: Tablets, capsules, syrups, injectables

Dosage : Adults: 250 mg to 1000 mg every 6 hours, according to severity and nature of infection.

Children: 3-8 years 100-200 mg 3-4 times daily.

Note: Actual dosage and administration schedule must be determined by the physician for each patient individually.

How and When to Take

It is best taken with a full glass of water on an empty stomach (eg., 1 hour before or 3/4 hours after meals).
However, certain brands of erythromycin such as erythromycin estolate and erythromycin ethyl succinate or
enteric-coated tablets should be taken on full or empty stomach (without regard to food).

What if you Miss a Dose

Take it as soon as possible. This will help to keep a constant amount of medicine in the blood. However, if it
is almost time for your next dose and your dosing schedule is:

- 2 doses a day, space the missed dose and the next dose 5-6 hours apart

- 3 or more doses a day - space the missed dose and the next dose 2-4 hours apart or double your next dose.

Then go back to your regular dosing schedule.

Profiles of 50 Drugs 419


What if you Exceed the Dose

Possible nausea, vomiting, diarrhoea and stomach upset are the symptoms of overdose. Notify your doctor.

How to Stop Using this Drug

Take the full course. Even if you feel better, the original infection may still be present and symptoms may
recur if treatment is stopped soon.

Precautions

Be sure to tell your doctor:


- if you have liver problem
- if you have loss of hearing

Pregnancy: Generally thought to be safe during pregnancy, except for erythromycin estolate which can cause
toxic liver reactions and hence should be avoided.

Breast feeding: This drug passes into the breast milk. Monitor nursing infant closely and discontinue drug or
nursing if adverse effect develop.

Infants and Children: More prone to stomach irritation. Reduced dose necessary.

Over 60: Itching reactions in the genital and anal regions as well as loss of hearing may occur.

Beverages: Avoid fruit juices and carbonated beverages for 1 hour after taking any nonenteric coated
preparation. May be taken with milk.

Alcohol: Avoid if you are taking erythromycin estolate.

Driving and Hazardous Activities: This drug may cause nausea and/or diarrhoea. Restrict activities as
necessary.

Others: Your doctor may want to check your liver function by performing a test if you are being given
erythromycin estolate.

Possible Adverse Effects

Symptoms/Effects Frequency What to do


Nausea/vomiting Common Discuss with your doctor immediately
Diarrhoea " "
Stomach cramps Rare "

420 A Lay Person's Guide


Rash/itching Common Stop drug and discuss with your doctor
Fever Rare "
Loss of hearing " "
Jaundice (yellowing of eyes More common "
and skin) with use of
erythromycin
estolate)

Interactions

Drugs/Drug Class Effects Note


Carbamazepine s Toxicity
Digoxin s "
Ergotamine Impaired blood circulation to extremities
Methyl Prednisolone s Excess steroid effects
Theophylline s Toxicity
Warfarin s Increased risk of bleeding
Clindamycin t
Lincomycin t
Penicillin t

Effects of Long-term Use

Courses of longer than 10 days may increase the risk of liver damage.

Profiles of 50 Drugs 421


ETHAMBUTOL

Drug Group: Anti-tubercular


Principal Uses

It is used in the treatment of tuberculosis. Given in conjunction with other antitubercular drugs, it helps to
boost their effect.

How this Drug Works

It prevents the growth and multiplication of the germs that cause tuberculosis (TB).

Dosage and Usage Information

Available Dosage Forms: Tablets, capsules (singly or in combination with other anti-tuberculosis drugs).

Dosage

Initial: 15 mg/kg body weight daily as single dose.

Re-treatment: 25 mg/kg body weight as a single dose for 60 days and then 15 mg/kg body weight.

What if you Miss a Dose

Continue regular dose as soon as you remember. If the next dose is within 4 hours, take the next dose now,
and skip the next dose.

How to Stop Using this Drug

Take this medicine for full time of treatment. Do not stop using it even if you begin to feel better after a few
weeks. You may have to take every day for as long as 1 to 2 years or more.

What if you Exceed the Dose

Large overdoses may cause headache and abdominal pain. Consult your doctor.

Precautions

Be sure to tell your doctor if you have -


- gout
- kidney disease
- cataracts or eye problems

422 A Lay Person's Guide


Pregnancy: Safety is not established. Discuss with your doctor.

Breast feeding: It passes into the breast milk, but at normal doses adverse effects on the baby are unlikely.
Discuss with your doctor.

Infants and Children: Do not give to children under 6 years.

Over 60: Increased likelihood of adverse effects. Reduced dose may be necessary. Have periodic eye-checks.

Driving and Hazardous Activities: This medicine may cause vision problems and dizziness. Be sure how you
react to this medicine before performing such activities.

Possible Adverse Effects

Symptoms/Effects Frequency What to do


Chills Common Stop drug. Discuss with your doctor immediately
Pain and swelling of " "
joints (toe, ankle, knee)
Tense, hot skin, over affected " "
joints
Blurred vision/loss of vision Rare "
eye pain (more common with
high dose)
Numb/tingling hands/feet " "
Dizziness " Discuss with your doctor only if severe
Skin rash " "
Stomach upset " "

Interactions

Drugs/Drug Class Effects Notes

Antacids (that contain ¯


aluminium)
All medicines that cause eye Increased toxic effects on eye
toxicity (check with your doctor)

Effects of Long-term Use

It may increase the risk of eye damage.

Profiles of 50 Drugs 423


FERROUS SULPHATE

Drug Group: Antianemic

Principal Uses

Iron salts should be given by mouth unless there are good reasons for using another route. Ferrous salts
show only marginal differences between one another in efficiency of absorption of iron. The oral dose of
elemental iron for deficiency should be 100 to 200 mg daily. It is customary to give this as dried ferrous
sulphate.
1. It is used in the treatment of iron deficiency anemia.

2. It is also used to prevent anemia in pregnant women, young children and in women who complain of
heavy blood loss during menstruation. It is often available in combination with folic acid, Vitamin B12 and
other vitamins/minerals. It’s combination with folic acid is used especially in anemia resulting from under
nutrition/pregnancy/lactation. Combinations of iron with other vitamins and minerals are irrational
and only add to cost and toxicity.

Note: The actual cause of anemia must be determined and treated accordingly.

How this Drug Works

It contains iron, which is necessary for the production of hemoglobin (Hb), which gives red colour to the
blood. Deficiency of iron causes deficiency of hemoglobin resulting in anemia. This medicine corrects this
deficiency and cures the anemia.

The iron-deficiency may occur due to undernutrition, bleeding piles, stomach ulcer, hookworm infection,
loss of blood during menstruation, repeated pregnancies.

Dosage and Usage Information

Available Dosage Forms: Tablets, capsules and liquids (in combination with other drugs).

In every 200 mg tablet of ferrous sulphate, 60 mg of elemental iron is made available.

Dosage: Adults: 200 mg thrice daily

Children: Age (years) Dose


Up to 1 1/4 tablet twice daily
1-5 1/2 tablet twice daily
6-12 1 tablet twice daily
(If impractical, use liquid preparation, if available.)

* Weight-wise : 6 mg/kg/day every 8 hours.

424 A Lay Person's Guide


Continue treatment for 6 months.

Prevention

Adults : 1 tablet (200 mg of ferrous sulphate) daily; begin with 1 tablet daily, then increase the dose depending
upon tolerance.

Children : 1 mg/kg/day every 12 hours.

How and When to Take

It is best taken with water 1 hour before or 2 hours after meals. However if stomach upset occurs, take with
food or immediately after meals.

While using liquid-form of iron, dilute the dose, if desired, in water. Avoid staining your teeth with the iron
medicine by placing the spoon/dropper well back on the tongue. Iron stains can be removed by brushing
with baking soda or medicinal peroxide.

What if you Miss a Dose

Skip the missed dose and go back to your regular dosing schedule. Do not double the doses.

What if you Exceed the Dose

The signs include diarrhoea (may contain blood), blue-lips and finger-nails, drowsiness, pale cleaning skin,
weakness, rapid heartbeat, shallow breathing, convulsions, coma.

Early signs of overdose may not appear for up to 60 minutes. Do not wait for the signs to appear. Get
emergency help immediately.

Precautions

Be sure to tell your doctor if you have:

-arthritis - (only for parenteral iron, absorption is poor in chronic arthritis)


-asthma/allergies -blood disease
-kidney infection -pancreatitis (swelling of pancreas)
-intestinal problems -liver disease
-stomach ulcer

Pregnancy: During the first 3 months, a proper diet provides enough iron. During the last 6 months, in order to
meet the increased needs of the developing baby an iron supplement may be recommended.

Breast feeding: Although it passes in to the breast milk it is not known to cause problems. Discuss with your
doctor before using it.

Profiles of 50 Drugs 425


Infants and Children: Keep out of reach of children. Overdose can prove dangerous. As few as 3 to 4 iron
tablets can cause serious poisoning.

Over 60: May need larger doses than usual. Ask doctor’s advice.

Diet: Avoid the following foods or take in very small amount at least 1 hour before or 2 hours after taking iron.
Do not take them simultaneously with iron

- eggs - cheese - yogurt/milk

- tea/coffee - cereals - whole grain items.

Alcohol: Avoid completely.

Others: Insist on taking tablets. The belief that iron injectables may cause rapid response is baseless
and besides being painful, they are costly and cause serious adverse effects. The so called slow-
release iron tablets are also not justified and must be avoided.

Iron medicine colour the stools black. This effect ceases once you stop using the medicine.

Possible Adverse Effects

Symptoms/Effects Frequency What to do

Nausea/Vomiting Rare Discuss with your doctor only if severe


Constipation Common "
Diarrhoea " "
Heartburn Rare "
Backache Common (with Discuss with doctor as soon as possible
injection only)
Chills " "
Dizziness " "
Headache " "
Troubled breathing " "
Skin rash " "
Numb, tingling
hands and feet " "
Stomach cramps Common with tablets "
(dark coloured stools)

426 A Lay Person's Guide


Interactions

Drugs/Drug Class Effects Notes


Antacids ¯
Tetracyclines t
Calcium supplements Do not take together. Space them at least 1-2 hours apart to get
full benefit.

FOLIC ACID

Drug Group: Vitamins


Principal Uses

Folic acid has few indications for long-term therapy since most causes of folate deficiency are self-limiting
or can yield to a short course of treatment. It should not be used in undiagnosed megaloblastic anemia (a type
of severe anemia) unless Vitamin B12 is administered concurrently.

It is used to treat folic acid deficiency which leads to a particular type of anemia. The main symptoms are
fatigue. Loss of appetite nausea, vomiting, hair loss and mouth sores. It may also lead to poor growth in
infants and children.

It is also given along with iron during pregnancy and lactation to prevent anemia (since pregnant women and
lactating mothers are prone to get anemia).

Additional folic acid supplements are to be given in the following conditions/ patients:

- Premature or low birth-weight infants

- Infants who feed on goat milk

Profiles of 50 Drugs 427


- Patient on haemodialysis

- Patient with blood disorders/psoriasis/other condition in which absorption of nutrients from intestine
is impaired

- Patients who are taking anticonvulsants (medicine for tremors/fits) deplete folic acid during pregnancy
to prevent a particular defect in the developing baby.

Note: Although folic acid and iron correct anemia, the actual cause of anemia must be found out and corrected by the doctor.

Dosage and Usage Information

Available Dosage Forms : Tablets, syrup (either singly or in combination with iron sulphate, etc.)

Dosage

Normal dietary requirements

(in mcg-micrograms, one millionth of a gram)

Children 0-6 months - 30 mcg/day


Children 6 months-1 year - 45 mcg/day
Children 1-3 years - 100 mcg/day
Children 4-6 years of age - 200 mcg/day
Adult males - 400 mcg/day
Adult females - 400 mcg/day
Pregnant females - 800 mcg/day
Breast feeding females - 500 mcg/day

Usual Adult Dose

- For folic acid deficiency and malnutrition: 5 mg (1 tablet) thrice daily for 3 weeks and then 5 mg (1 tablet)
daily for another 2 weeks.

- For preventing anemia in pregnancy and lactation: 0.5 mg daily from the 4th month onwards in
combination with 200 mg of ferrous sulphate (iron).

Usual Children’s Dose

For folic acid deficiency : Age (years) Dose


Up to 1 2.5 mg daily
1-5 5 mg daily
6-10 10 mg daily

428 A Lay Person's Guide


What if you Miss a Dose

Continue usual dosage.

What if you Exceed the Dose

Although some people believe that taking very large doses of vitamin is useful for treating certain medical
conditions, it is not true. Large doses should be taken only under doctor’s directions.

Precautions

Be sure to tell your doctor if you have:

- alcohol habit - diarrhoea (prolonged)


- liver disease - pernicious anemia (a special blood problem).
- haemolytic anemia (caused due to abnormal destruction of red blood cells)

Pregnancy: It is important that you receive the right amount of vitamins, especially folic acid throughout your
pregnancy.

Breast feeding: It is important that you receive the right amount of vitamins so that your baby will also get the
vitamins needed to grow properly.

Diet: The best sources are green leafy vegetables, mushrooms, liver, root vegetables, oranges, nuts, dried
pulses and egg yolks.

Heat may reduce the amount of folic acid in foods.

A balanced diet should provide all vitamins you need. Take supplements only if you cannot get enough
vitamins from your diet. You need proteins, minerals, carbohydrates and fat (found in food) for the vitamins
to work properly.

Possible Adverse Effects

Symptoms/Effects Frequency What to do

Fever Rare Discuss with your doctor as soon as possible.

Skin rash " "

Profiles of 50 Drugs 429


FUROSEMIDE (FRUSEMIDE)

Drug Group: Loop Diuretic


(Water Pill)
Principal Uses

It is used primarily to increase the volume of urine and thereby relieve the body of excessive water retention
(edema) that is commonly associated with heart failure and some form of liver disease and kidney disease. It
can be used to treat high blood pressure (BP) but along with other medicines for high BP that lower BP. A less
frequent use is to increase the amount of calcium excreted in the urine when the blood level of calcium is
abnormally high.

It is particularly useful for people with kidney problems because they do not respond to other diuretics
(water pills).

How this Drug Works

It acts on the kidneys, and increases the flow of urine. By doing so, it increases the elimination of salt
(sodium) and water from the body. Thus it reduces the volume of fluid in the blood and body tissues and
lowers the sodium content in the body. These changes also help to lower the blood pressure.

Dosage and Usage Information

Available Dosage Forms: Tablets usually 40 mg, injectables 20 mg per 2 ml.

Dosage

Adults: To relieve water retention: 20-80 mg as a single dose initially, if necessary, increase the dose by 20-40
mg/6-8 hours. Do not exceed 600 mg per day.

In hypertension (high BP): 40 mg once or twice daily.

Children: 1-2 mg/kg body weight daily.

For patients with kidney problems: High dose (up to 2 gm daily) may be required.

How and When to Take

May be taken with or following meals to reduce stomach irritation. To avoid night time urination, take it in the
morning, if you are taking a single dose daily. Or take the last dose no late than 6 pm, if you are taking more
than one dose daily.

What if you Miss a Dose

Take as soon as you remember. If it is time for the next dose, skip the missed dose and go back to regular
dosing schedule.

430 A Lay Person's Guide


Avoid taking any dose if you remember late in the day (after 6 pm).

What if you Exceed the Dose

The symptoms include dry mouth, thirst, lethargy, weakness, muscle cramping; nausea, vomiting, diarrhoea,
drowsiness, profound unconsciousness.

How to Stop Using this Drug

Do not stop the drug without consulting your doctor; symptoms may return.

Precautions

Be sure to tell your doctor if you have:

- diabetes - gout
- kidney disease - liver disease
- pancreatic disease - hearing problems
- prostate trouble - plan to have surgery in the near future

Pregnancy: It should not be used in pregnancy unless it has to be used for some serious complications. Avoid
completely during the first 3 months.

Breast feeding: It passes into the breast milk. Avoid drug or refrain from nursing.

Infants and Children: Avoid overdosage that could cause serious dehydration. Reduced dose necessary.

Over 60: Increased likelihood of adverse effects. Reduced dose may therefore be necessary.

Driving and Hazardous Activities: This drug causes vision problems and dizziness. Make sure how you react to
the drug before doing such activities.

Alcohol: It increases the likelihood of dehydration and hangovers after drinking alcohol. Avoid as far as
possible.

Sun: Some people become more sensitive to sun while using this drug. Avoid too much sun.

Diet: This drug may cause a loss of potassium from your body resulting in nausea, loss of appetite, weakness,
confusion. To help prevent this, eat or drink foods that have high potassium content (e.g., orange or other
citrus fruit juices).

Note: Discuss your diet with your doctor. This is important if you are already on a special diet (as for diabetes) or if you are taking a
potassium supplement or a medicine to reduce potassium loss. Extra potassium may not be necessary in some cases, too much potassium could
be harmful.

Profiles of 50 Drugs 431


Others: It increases blood sugar level, affecting control of diabetes. It increases blood uric level, affecting
control of gout. Your doctor may want to check your kidney function and levels of body salts (if used for
long term).

Possible Side-effects

Symptoms/Effects Frequency What to do


Skin rashes, hives Rare Discuss with your doctor only if severe
Headaches " "
Dizziness Common "
Blurred/Yellow vision Rare "
Ringing in ears " "
Numbness and Tingling " "
Reduced appetite " "
Indigestion " "
Nausea/vomiting " "
Diarrhoea " "
Jaundice " Discuss with your doctor immediately in all
cases
Fluid accumulation in lungs Rare "
Temporary hearing loss " "
Severe abdominal pain " "
Abnormal bleeding/bruising " "
Weakness " "
Sore throat and fever " "

Interactions

Drugs/Drug Class Effects Notes


Medicines for diabetes t Increased blood sugar level, dose should be adjusted.
Medicines for blood pressure s Lowers blood pressure. To avoid excessive lowering,
dose must be adjusted.
Lithium s Lithium toxicity
Anti-inflammatory drugs ¯
(medicines for swelling and
pain) e.g., indomethacin

432 A Lay Person's Guide


Drugs/Drug Class Effects Notes
Digoxin Potassium Increased disturbances of heart rhythm
levels of blood
fluctuate
Aminoglycoside antibiotics Increased risk of hearing problems.

Effects of Long-term Use

Serious problems are unlikely, but levels of salts, such as potassium, sodium and calcium, may occasionally
become depleted during prolonged use.

GENTIAN VIOLET
Drug Group: Antifungals
Antiseptic

Principal Uses

Gentian violet (or crystal violet) is used on the skin or inner lining of the mouth to treat some types of fungal
infections inside the mouth (thrush) and of the skin (e.g., boils, burns), as antiseptic in boils, impetigo (a
contagious skin infection), etc.

Dosage and Usage Information

Available Dosage Forms: Aqueous solution: 0.5-0.1 % for local application.

How and When to Take

Using a cotton swab, apply enough gentian violet to cover only the affected area. Not to be swallowed. While
applying to a child’s mouth, take care that it is not swallowed. Do not apply an occlusive dressing/airtight
covering since it may cause irritation of the skin.

What if you Miss a Dose

Apply it as soon as possible. If time for next dose, skip the missed dose and go back to regular dosing
schedule.

Profiles of 50 Drugs 433


How to Stop Using this Drug

To help clear up infection completely, keep using this medicine for the full time of treatment even though
your condition may have improved.

Precautions

It will stain the skin and clothing. Avoid getting the medicine on your clothes. In the UK it is now restricted to
application to unbroken skin because of concern about animal carcinogenicity and is no longer
recommended for application to mucous membranes or open wounds. Restrictions do not apply however
for skin marking prior to surgery.

Possible Adverse Effects

Symptoms/Effects Frequency What to do


Skin irritation Rare Discuss with your doctor as soon as possible
(not present before using
this medicine)

GLIBENCLAMIDE

Drug Group: Antidiabetic


Principal Uses

It is used to control certain types of diabetes mellitus (sugar diabetes). It is usually used only by adults who
develop diabetes after 30 years of age and whose diabetes cannot be controlled by diet alone and who do not
require insulin injections (or who do not require more than 20 units of insulin a day) to control their
condition. This type is called non-insulin dependent diabetes mellitus/maturity onset/adult diabetes.

How this Drug Works

It stimulates the production of a substance called insulin from pancreas (an organ in the body) which is
responsible for the uptake of sugar in the body cells. Thus it lowers the blood sugar levels and controls
diabetes (or disorder where blood sugar levels rise).

Dosage and Usage Information

Available Dosage Forms: Tablets of 5 mg

Dosage: Adults : Initially 2.5 mg daily with breakfast

434 A Lay Person's Guide


Maintenance : Dose may be increased at 7-day intervals by 2.5 mg daily as needed and tolerated till a maximum
of 15 mg daily.

Pediatric dose : Not recommended for children.

How and When to Take

Take the medicine daily with breakfast. If maintenance dose is 10 mg or more, divide into 2 equal doses: one
with morning meal and one with evening meals.

What if you Miss a Dose

Take before your next meal. If it is almost time for next dose, skip the missed dose and follow regular dosing
schedule.

What if you Exceed the Dose

Seek immediate medical advice in all cases. If early warning symptoms of excessively low blood sugar such as
faintness, sweating, trembling, confusion, weakness, nausea or headache occur, eat or drink something
sugary. Take emergency action if fits or loss of consciousness occur.

How to Stop Using this Drug

Do not stop using this drug without consulting your doctor; stopping the drug suddenly may lead to
worsening of diabetes.

Precautions

Be sure to tell your doctor if you have:

- adrenal (near or upon the kidney) disease - ulcer


- infection of severe type - kidney disease
- liver disease - pituitary disease
- planned to undergo any surgery/dental treatment - thyroid disease

Pregnancy: Should not be used because poor diabetic control. May lead to birth defects or death of foetus.
Insulin is substituted as it gives better diabetic control.

Breast feeding: It is thought that it passes into the breast milk. Avoid drug or refrain from nursing.

Infants and Children: Not prescribed.

Over 60: Reduced dose may be necessary. Your doctor should check your progress regularly. Blood sugar
levels should be taken so as to prevent any adverse effects (brain damage) due to fall in blood sugar level.

Profiles of 50 Drugs 435


Alcohol: Avoid. Alcohol may increase the drug's effect leading to fall in blood sugar. This drug may cause
intolerance of alcohol leading to stomach upset, headaches, sweating, redness of face and skin.

Driving and Hazardous Activities: Avoid these activities if you have warning signs of low blood sugar.

Sun: Use caution. Some people find their skin to be more sensitive to direct sunlight because of this
medicine.

Diet: A low carbohydrate, low fat diet must be maintained by diabetic patients. Many diabetic patients are
able to control their condition by following the advice of their doctors. In order for the drug to be fully
effective, diet and exercise advice should be properly followed.

Others: This drug may loose its effectiveness after certain period of time. Test for sugar in your blood/urine
as directed by the doctor to make sure your diabetes is being controlled.

Eat or drink something containing sugar if sign of low blood sugar occur.

Signs of low blood sugar include: Sweating, confusion, drowsiness, weakness, hunger, headache, nausea.

These signs occur if you - skip/delay meals, exercise much more than usual, cannot eat because of nausea,
drink significant amount of alcohol.

Possible Adverse Effects

Symptoms/Effects Frequency What to do


Dark urine Rare Stop the drug. Discuss with your doctor immediately.
Yellowing of eyes/skin " "
Unusual bleeding/bruising " "
Sore throat and fever " "
Weakness " "
Stomach upset Common Discuss with your doctor only if severe
Headache Rare "
Skin rash " "

Interactions

Drugs/Drug Class Effects Notes


Corticosteroids ¯
(Cortisone-like medicine)

436 A Lay Person's Guide


Drugs/Drug Class Effects Notes
Water Pills ¯
Rifampicin ¯
Estrogens ¯
Blood thinners (e.g., Warfarin) ­ Low blood sugar
Sulfa medicines ­ "
Aspirin ­ "
Beta blockers (Heart Medicines) ­ "“

Effects of Long-term Use

Reduced function of the thyroid gland. It is thought that it may cause heart and blood disorders (although
such reports are not conclusive).

GLYCERYL TRINITRATE

Drug Group: Anti-angina


Principal Uses

It is used to relieve the pain of angina attacks. It is not a cure for heart disease; it can only relieve symptoms,
and it may have to be taken for long periods of time.

The slow-release form of this medicine is used to prevent the development of angina.

How this Drug Works

It relaxes the blood vessels and increases the supply of blood and oxygen to the heart while reducing its work
load. It thus prevents angina attacks from occurring.

Dosage and Usage Information

Available Dosage Forms: Tablets, capsules, ointments.

Dosage

Adults: Sublingually (under the tongue), 0.3-1 mg, repeated as required.

Profiles of 50 Drugs 437


By mouth: 2.6-6.4 mg as modified-release tablets, 2-3 times daily; severe angina, 10 mg 3 times a day. IV: 10-
200 micrograms/minute.

Ointment: 1.5 - 3 cm thrice daily or more as required.

Transdermal patch (delivery 5 mg or 10 mg per 24 hours): Initially TTS-5 once daily. Increase if required
gradually up to TTS-10 twice daily.

Children: Not recommended.

How and When to Take

Capsules: Take this medicine with a full glass of water on an empty stomach. If taken either 1 hour before or
2 hours after meals, it will start working sooner. Tablets should not be crushed or chewed and capsules
should not be opened before swallowing if the tablets/capsules are sustained release.

Ointment: Before applying a new dose of ointment, remove any ointment remaining on the skin from a
previous dose to allow the fresh ointment to release the drug properly.

- Use a paper (cut as per the length mentioned in the dose) to measure the length of ointment.
- Do not rub or massage the ointment into the skin. Spread in a thin, even layer, covering an area of the
same size each time it applied.
- Apply to skin that has little or no hair.
- Apply each dose to a different area of skin to prevent skin problems.

Transdermal Patch: Do not try to trim or cut the adhesive patch to adjust the dosage.
- Apply the patch to a clean, dry skin area with little or no hair and free of scars, cuts or irritation. Remove
the previous patch before applying a new one.
- Apply a new patch if the first one becomes loose or falls off.
- Each dose is best applied to a different area to avoid skin problems.

What if you Miss a Dose

Capsules/tablets (regular, sustained release): Take it as soon as possible. However, if the next scheduled
dose is within 2 hours (or within 6 hours for extended release capsules/tablets) skip the missed dose and go
back to your regular dosing schedule. Do not double doses.

Ointment: Apply as soon as possible unless the next scheduled dose is within 2 hours. Then go back to your
regular dosing schedules.

Patch: Apply as soon as possible. Then go back to regular dosing schedule.

438 A Lay Person's Guide


What if you Exceed the Dose

Large overdoses may cause dizziness, vomiting, severe headache, fits or loss of consciousness. Notify your
doctor.

How to Stop Using this Drug

Do not stop using this drug after long-term use without asking your doctor. The dose is gradually reduced
over 4-6 weeks.

Precautions

Be sure to tell your doctor if you have anemia (blood disorders), glaucoma, intestinal problems, overactive
thyroid, low blood pressure, had an heart attack recently.

Pregnancy: Safety not established. Discuss with your doctor.

Breast feeding: The drug passes into the breast milk and may affect the baby. Discuss with your doctor.

Infants and Children: Not usually prescribed.

Over 60: They are more susceptible to the development of flushing, headache, dizziness, “black-out” spells,
fainting and falling.

Driving and Hazardous Activities: This drug may cause dizziness or faintness. Restrict activities as necessary.

Alcohol: Avoid. Alcohol may increase dizziness due to lowered blood pressure.

Tobacco: Avoid. It reduces the effectiveness of this drug.

Others: The dizziness or fainting caused by this drug is more likely to occur when you get up quickly from a
lying or sitting position, to stand for long time, exercise or if the weather is hot, so be cautious.

Your doctor may want to check your blood pressure and internal eye pressure as well as test your blood for
iron (hemoglobin) while you are using this drug for long time so as to check the effectiveness of this drug.

Possible Adverse Effects

Symptoms/Effects Frequency What to do


Blurred vision Rare Discuss with your doctor immediately
Dry mouth " "
Headache (severe or prolonged) " "
Dizziness Common "

Profiles of 50 Drugs 439


Symptoms/Effects Frequency What to do
Flushing of face and neck Common Discuss with your doctor immediately.
Vomiting " "
Rapid heartbeat " "
Skin rash Rare "

Interactions

Drugs/Drug Class Effects Notes


Medicines that reduce blood ­ Excessive lowering of blood pressure.
pressure Dosage adjustments should be made.
Aspirin ¯ Because they speed up the heart rate.
Sympathomimetics t Results in hypotension (lowered B.P.)
(mimicking action of
sympathetic system)

Effects of Long-term Use

The development of tolerance and temporary loss of effectiveness.

IBUPROFEN

Drug Group: Mild pain killer


Non-steroidal, Anti-inflammatory
Principal Uses

It relieves pain, stiffness and inflammation, that may accompany a number of disorders. It is used to provide
relief in rheumatoid arthritis, osteoarthritis, and gout (although it does not cure it). It relieves mild to
moderate headaches, menstrual pains, sprains, pain from injuries of muscles/bones and pain following
operations. It reduces fever also.

It is similar to aspirin in the way it can be used. Unlike aspirin, it rarely causes bleeding in the stomach.

How this Drug Works

It is thought that it reduces the amount of chemicals involved in the production of inflammation (swelling)
and pain.

440 A Lay Person's Guide


Dosage and Usage Information

Available Dosage Forms: Tablets, capsules and liquid syrups.

Dosage: Adults: 200-400 mg thrice daily.

Children: 20 mg/kg body weight in three divided doses.


Note: Actual dosage and administration schedule must be determined by the physician for each patient individually.

How and When to Take

May be taken with food or milk to prevent stomach irritation. Take with a full glass of water and remain
upright (do not lie down) for 30 minutes.
Note: If taken 30 minutes before meals or 2 hours after meals, it will get into the blood more quickly.

What if you Miss a Dose

Take as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and go
back to your regular dosing schedule.

What if you Exceed the Dose

Drowsiness, dizziness, ringing in ears, stomach upset, unsteadiness and finally profound unconsciousness
are the symptoms. Notify your doctor as soon as possible.

How to Stop Using this Drug

When taken for short term pain relief, it can be safely stopped as soon as you no longer need it. If prescribed
for long term use (for arthritis), do not stop taking this drug without consulting your doctor (in case of
arthritis, it may take one week or even more, for severe cases, before you begin to feel better).

Precautions

Be sure to tell your doctor if you have:

- kidney disease - liver disease

- heart disease - high blood pressure

- stomach ulcer - acidity

- asthma - allergy to aspirin

Pregnancy: It may cause defects in the unborn baby and may prolong labour. Discuss with your doctor.

Breast feeding: It does pass into the breast milk in minute amounts. It is better to avoid drug or refrain from
nursing.

Profiles of 50 Drugs 441


Infants and Children: Safety and effectiveness in children below 10 years is not established. Reduced doses
necessary.

Over 60: Increased likelihood of adverse effects. Reduced doses may be necessary.

Driving and Hazardous Activities: This drug may cause drowsiness or dizziness. Restrict activities as necessary.

Sun: It is thought that it may make some people sensitive to sunlight. Use caution.

Alcohol: Avoid. It may increase the risk of stomach problems.

Others: Check with your doctor. If your fever does not improve within 3 days or returns (when used to bring
down fever) if the painful area becomes red or swollen.

Possible Adverse Effects

Symptoms/Effects Frequency What to do


Skin rash Common Discuss with your doctor in all cases
Headaches " Discuss with your doctor only if severe
Dizziness " Discuss with your doctor as soon as possible
Vision problem Rare Discuss with your doctor in all cases as soon as possible
Ringing in the ears " "
Depression " "
Mouth sores " "
Indigestion Common Discuss with your doctor only if severe
Nausea/vomiting " "
Severe skin reactions Rare Stop the drug now. Discuss with your doctor immediately
Severe headache with
fever and stiff neck " "
Stomach ulcer " "
Jaundice/liver problems " "
Kidney damage with " "
painful urination, bloody
urine, reduced urine
formation.
Fatigue, weakness " "
Sore throat and fever " "

442 A Lay Person's Guide


Symptoms/Effects Frequency What to do

Bleeding/bruising Rare Discuss with your doctor in all cases as soon as possible

Wheezing/breathlessness " "

Interactions

Drugs/Drug Class Effects Notes


Lithium s Lithium toxicity
Digoxin s
Water pills t
Medicines for BP t
Acetaminophen s Kidney damage
Blood thinner Increased risk Dose adjustment necessary
of bleeding
Corticosteroids " "
Other Non-Steroidal
Anti-inflammatory drugs " "
(NSAIDs)
Aspirin " "
Valproic acid " "
Sulfinpyrozone " "“

Effects of Long-term Use

Ulcers in stomach and/or bowel, fluid retention.

Profiles of 50 Drugs 443


INSULIN

Drug Group: Hormones, antidiabetic


Principal Uses

Insulin is the only effective treatment in juvenile (insulin-dependent) type of diabetes. It may also be
prescribed in adult (maturity-onset) diabetes. It is to be used only under doctor’s observation.

When used along with a special meal plan and exercise, it can effectively control diabetes.

How this Drug Works

Not completely known. It facilitates the transport of sugar to the place where it is utilized. This occurs
primarily in the brain, the voluntary muscles, the heart muscle and the liver.

Dosage and Usage Information

Available Dosage Forms: Injectables

There are some drugs like sodium valproate that give false urine positive test. It is advisable to do blood
glucose estimation before adjusting insulin dose.

Dosage

Adults: The dose ( and type) of insulin is determined according to the needs of the individual patient.

How and When to Take

Inject insulin subcutaneously (under the skin) according to the schedule prescribed by your doctor. The
timing and frequency of injections will vary with the type of insulin prescribed. The table overleaf of insulin
action will help you understand the treatment schedule prescribed to you.

What if you Miss a Dose

Sugar will go up again.

What if you Exceed the Dose

Hypoglycaemia (lowering of blood sugar levels) may occur. Its symptoms include fatigue, weakness,
headache, nervousness, irritability, sweating, tremors, hunger, confusion, abnormal behaviour (resembling
alcoholic intoxication), loss of consciousness, fits, lack of concentration.

444 A Lay Person's Guide


Type Appearance Onset of Action Peak Action
Duration of Action
a) Fast-acting and short-term effect
1. Crystalline Clear Within 1 hour 3-4 hrs 5-8 hrs
(Mostly 1/2 hr)
2. Iso-insulin " Within 1 hour " 12-14 hrs
3. Semilente Milky " " "
4. Actrepid Clear 1/4 hour " 8-12 hrs
b) Medium-acting and medium-term effect
1. Globin Clear Within 1 hr 8-10 hrs 18-20 hrs
2. N.P.H. Milky Within 2 hrs " 24-30 hrs
3. Lente " " " 24-30 hrs
4. Repitard Clear Within 3 hrs " 18-20 hrs
c) Slow-acting and long-term effect
1. Protamine Zinc Milky 4-8 hrs 12-24 hrs Upto 36 hrs
Insulin
2. Ultralente Milky 6-8 hrs 16-24 hrs "

How to Stop Using this Drug

Do not discontinue using this drug without consulting your doctor. Diabetes that is insulin-dependent
requires continual treatment on a regular basis. Omission of insulin may result in life-threatening coma
(profound unconsciousness).

Precautions

Be sure to tell your doctor if you have :

- infection - kidney disease


- liver disease - thyroid disease
- plan to undergo a surgery - giddiness, sweating, etc.

Pregnancy: Insulin is the drug of choice for managing diabetes during pregnancy. To preserve the health of the
mother and the welfare of the fetus every effort must be made to establish the optimal dosage of insulin
necessary for “good control” and to prevent episodes of hypoglycaemia. Poor control of diabetes increase
the risk of birth defects.

Profiles of 50 Drugs 445


Breast feeding: It does not pass into the breast milk.

Insulin treatment of the mother has no adverse effects on the nursing infant.

Infants and Children: Reduced dose as necessary.

Over 60: Insulin requirement may change with aging. The aging brain adapts well to higher blood sugar levels.
Attempts to maintain strict normal blood sugar levels may cause a fall in blood sugar levels, which on
repeatedly occurring may cause brain damage.

Driving and Hazardous Activities: Usually no problem, but strenuous exercise alters your insulin and sugar
requirements. Avoid these activities if your blood sugar is not well controlled.

Alcohol: Avoid. It may cause low blood sugar and upset diabetic control.

Diet: The success of your treatment depends on your closely following the diet of your doctor.

Exercise: Your doctor may tell you what kind of exercise to do, the best time of day to do it, and how much you
should do daily.

Tobacco: Regular smoking increases insulin requirements. Try to avoid smoking, once you are on insulin
therapy. If you have not quit smoking initially and decide to quit smoking long after having started insulin
therapy, first consult your doctor who may want to change your insulin dose.

Others: Special care of your feet will help to prevent possible future trouble.

Urine tests: These tests are used to guide you in the control of your condition and must be done properly. Two
urine tests for sugar are widely used: the tablet urine test and the paper-strip urine test. Your doctor may want
you to test your urine for acetone.

Blood tests: Many patients have learned to measure their own blood sugar levels. If you are taking blood tests,
follow directions carefully.

The symptoms of hypoglycaemia (low blood sugar) may develop suddenly and may result from:

- using too much insulin.


- delaying or missing a scheduled snack/meal.
- sickness ( especially with vomiting/diarrhoea)
- exercising more than usual just before a meal
- drinking alcohol
- taking certain medicines.

The symptoms include anxiety chills, confusion, cold sweats difficulty in concentration, excessive hunger,
headache, vision problems, drowsiness. To treat these symptoms always keep a readily available form of

446 A Lay Person's Guide


sugar such as candy, sugar cubes, peppermint, etc. You should eat something or drink a glass of milk, if you
will not be having a snack/meal for an hour or more.

The symptoms of hyperglycaemia (high blood sugar) occur more slowly than those of hypoglycaemia. They
are dry mouth, drowsiness, dry skin, increased urination, loss of appetite, stomach ache, vomiting, troubled
breathing, rapid weight loss, unusual thirst, tiredness.

These symptoms occur if you do not take enough insulin, if you skip a dose, you overeat or do not follow a
proper diet or have fever/infection.

If you become sick, especially with vomiting, diarrhoea or fever, you still need insulin. So continue taking
your insulin and try to stay on a regular diet. If you can’t eat solid foods then drink fruit juices/soups, etc. ( to
avoid low blood sugar). Consult your doctor.

Regular monitoring of sugar levels in the urine and/or blood is required. Improvement in vision may occur
initially during the insulin treatment. Defer examination for spectacles for 6 weeks after starting insulin.

Possible Adverse Effects

Symptoms/Effects Frequency What to do

Injection-site irritation Common Discuss with your doctor as soon as possible.


Weakness/Sweating " "
Thinning of tissue at Rare "
injection-site
Rash/facial swelling " Stop drug now. Discuss with doctor immediately.
Shortness of breath " "
Severe, prolonged " "
hypoglycaemia.
Allergic reactions " "
(anaphylaxis)

Interactions

Drug/Drug Class Effects Notes

Aspirin and other similar ­


drugs
Beta blockers ­ Prolong the hypoglycaemia caused by insulin.
Fenfluramine ­
MAO inhibitor drugs. ­

Profiles of 50 Drugs 447


Drug/Drug Class Effects Notes

Medicines for diabetes ¯


(taken by mouth)
Cortisone-like drugs ¯
Chlortalidone ¯
Furosemide ¯
Birth Control Pills ¯
Phenytoin ¯
Thiazide diuretics ¯
Thyroid preparations ¯

Insulin Injection Technique


Taking insulin is easier than one thinks:

1. Organise everything in one place, i.e., insulin, alcohol, and cotton ball. Note syringe marking units: 40 or
100 units.

2. Wash hands well with soap and water.

3. Put syringe, plunger and needle in a strainer or wrap in a clean napkin and place in saucepan with water and
cover with a lid. Boil for five minutes.

4. Remove the articles from the saucepan. When they have cooled, insert the plunger in the barrel and fasten
needle to syringe with a slight twist.

5. Push the plunger in and out several times until all the water is completely removed from the syringe, Now
place these on the inverted cover of the saucepan.

Preferably use disposable syringe (which is discarded after each use) that are now available in India. (With the
use of disposable syringe steps 3,4,5 are not necessary.)

Preparing the Dose

1. Identify the type of insulin dose per ml.

2. Gently roll the insulin bottle several times by holding in both hands.

3. Wipe the top of the stopper of bottle with a cotton swab moistened with alcohol.

4. Take up the syringe once again. By pulling back the plunger, take air into to syringe, equal to the dose of
insulin required.

448 A Lay Person's Guide


5. Inject this air into the bottle of insulin. Keeping the syringe still inside the bottle, invert the bottle of
insulin and pull the plunger to withdraw insulin equal to the dose required.

6. In case air bubbles are present in the syringe, gently tap the syringe so that all the air bubbles collect
together and then with the syringe still pointing upward, plush the plunger to expel the air.

7. Take the needle out of the bottle.

8. If using combination, withdraw intermediate or long acting insulin first and follow the same
procedure for withdrawing plain or quick acting insulin.

Injecting the Dose

1. Cleanse the skin where the injection is to be made, i.e., the thigh or abdomen or arm (best site is
abdomen, then thigh, then arm.)

2. With one hand, stabilise the skin by spreading it or pinching up a large area of skin.

3. Pick up syringe with other hand and hold it as you would a pencil. Insert the needle straight into the
skin (900 angle). Be sure to insert needle all the way.

4. Now withdraw the plunger. If blood comes into the syringe, change the site of injection. If not,
inject the insulin by pushing the plunger all the way down.

5. Hold alcohol swab near the needle and pull the needle straight out of the skin. Press alcohol swab
over injection site for several seconds.

6. To avoid tissue changes, always change the site for each injection.

Source: Learning to Live with Diabetes, M.M.S. Ahuja, 11 65-67

Profiles of 50 Drugs 449


ISONIAZID

Drug Group: Anti-tuberculosis (TB)


Principal Uses

It is used to treat the development of active tuberculosis disease. It is used in combination with other
medicines such as rifampicin, pyrazinamide, ethambutol (which work in a way different from isoniazid), for
the treatment of TB. It is not to be used alone.

How this Drug Works

It is thought that this drug destroys susceptible TB germs by disrupting their cell wall.

Dosage and Usage Information

Available Dosage Forms: 100 mg, 300 mg tablets. Also in combination with rifampicin, pyrazinamide and
ethambutol. Also with thiacetazone.

Liquid: 100 mg per 5 ml

Dosage

Standard unsupervised treatment of isoniazid (for 6 months)-

Adults: 300 mg daily; child 10 mg/kg to 20 mg/kg daily (max. 300 mg) daily. Isoniazid to be taken along with
rifampicin and pyrazinamide (and if necessary with ethambutol) to avoid rapid development of resistance
and as advised by physician.

In longer regimes isoniazid is taken along with thiacetazone and streptomycin.

Treatment regimes separate for unsupervised and immunocompromised patients.

How and When to Take

Take the full course (you may have to take it every day for as long as 6 -12 months). Do not stop using it
without consulting your doctor, even if you feel better, since the infection may return if treatment is stopped
too soon.

What if you Miss a Dose

Take as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and go
back to your regular dosing schedule.

What if you Exceed the Dose

The symptoms include nausea, vomiting, dizziness, blurred vision, slurred speech, breathing difficulties, fits
and loss of consciousness. Notify your doctor immediately.

450 A Lay Person's Guide


Precautions

Be sure to tell your doctor if you have:

- liver problems - kidney problems


- diabetes - fits
- taken other medicines on long-term basis (e.g., phenytoin)
- plan to undergo surgery very soon. - drink alcoholic beverages every day.

Pregnancy: Safety is not established. Discuss with your doctor.

Breast feeding: Continue nursing.

Infants and Children: Use cautiously in children who get fits. Reduced dose necessary.

Over 60: Increased likelihood of adverse effects. Use caution.

Alcohol: Avoid. There is a greater risk of liver damage.

Driving and Hazardous Activities: Be sure how you react to this medicine before performing such activities.

Diabetes: This medicine may cause false test results with some urine sugar tests. Check with your doctor
before changing your diet or the dosage of your diabetes medicine.

Others: Your doctor may want to check your blood, eye and liver functions while you are on this drug.

Possible Adverse Effects

Symptoms/Effects Frequency What to do

Nausea/vomiting Common Discuss with your doctor only if severe.


Loss of appetite "
Fatigue/weakness "
Numbness/tingling "
Dizziness "
Yellowing of eyes and skin Rare Discuss with your doctor immediately
(hepatitis)
Mental and behavioural changes "
Twitching fits "

Profiles of 50 Drugs 451


Interactions

Drugs/Drug Class Effects Notes

Anticonvulsants s
(Medicine for fits/convulsions
e.g., carbamazepine, phenytoin)
Cortisone medicines

Effects of Long-term Use

Vitamin B-6 (pyridoxine) deficiency may occur and lead to nerve damage. Supplements of Vitamin B-6 in the
dose of 10 mg daily are given, particularly in patients who are -

- diabetic
- alcoholic
- malnourished
- suffering from renal failure

LOPERAMIDE

Drug Group: Anti-diarrhoeal


Principal Uses

It is used along with other measures to treat severe diarrhoea. However, it is not recommended for diarrhoea caused by
infection because it may delay the expulsion of harmful substances (which have caused diarrhoea) from the bowels.

It is often used for people with colostomies or ileotomies (cutting into the colon/ileum) to reduce the fluid
loss from the stomach (outlet).

How this Drug Works

It reduces the loss of water and salts from the bowel and slows bowel activity (movement and contraction)
resulting in the passage of firmer bowel movements at less frequent intervals and thus relieving diarrhoea
and stomach cramping.

Dosage and Usage Information

Available Dosage Forms: Tablets, capsules and liquids.

452 A Lay Person's Guide


Dosage

Adults: Acute diarrhoea: 4 mg initially, then 2 mg after each loose motion until diarrhoea is not controlled.

Chronic diarrhoea: 2-8 mg daily in 2-3 divided doses.

Total dose should not be more than 16 mg for 5 days.

Children: In divided doses at 0.48 mg/kg body weight and only after a loose motion.

Note: Use cautiously (only on physician’s guidance) for children. It should not be given to children below 2 years of age.

How and When to Take

May be taken on an empty stomach or with food if stomach irritation occurs.

What if you Miss a Dose

Do not take the missed dose. Go back to your regular dosing schedule.

What if you Exceed the Dose

The symptoms include drowsiness, lethargy, depression, dry mouth, vomiting. Notify your doctor as soon as
possible.

Precautions

Be sure to tell your doctor if you have:

- liver problem - kidney problem

- ulcer (colitis) - had recent stomach surgery

- are taking antibiotics (some antibiotics may cause diarrhoea. This medicine may make the diarrhoea caused by
antibiotics worse or make it last longer).

Pregnancy: Safety is not established. Discuss with your doctor.

Breast feeding: It is thought that it passes into the breast milk and could affect the baby. So avoid drug or refrain from
nursing.

Infants and Children: In babies and children, fluid loss caused by diarrhoea may result in severe condition. So avoid
giving this medicine. Do not use at all for children under 2 years of age.

Note: ORS (Oral Rehydration Salt) is the best measure to treat diarrhoea in children.

Over 60: Use with caution. There is an increased risk of blockage of the intestine. Besides in persons over 60 years

Profiles of 50 Drugs 453


of age, the fluid loss caused by diarrhoea may result in severe condition and hence they should not take any
anti-diarrhoeal medicine unless prescribed by their doctor.

Driving and Hazardous Activities: This drug may cause drowsiness or dizziness. Restrict activities as necessary.

Others: Check with your doctor if your diarrhoea does not stop after a few days or if you develop fever.

Possible Adverse Effects

Symptoms/Effects Frequency What to do

Bloating Rare Discuss with your doctor only if severe.

Constipation " "


Dizziness " "
Drowsiness " "
Dry mouth " "
Fever " "
Loss of appetite " "
Nausea/vomiting " "
Skin rash " Discuss with your doctor only if severe.
Stomach pain " "

Interactions

Drugs/Drug Class Effects Notes

Narcotic pain killers Severe constipation

Effects of Long-term Use

This drug is not usually taken for prolonged periods (except for persons with ileotomies) but special
problems are not expected during long-term use.

454 A Lay Person's Guide


MEBENDAZOLE

Drug Group: Anthelminthic


Principal Uses
It is used in the treatment of single or mixed worm infestation with pin worm, roundworm, hookworm, whip
worm.
It is used for hydatid cyst but as a prolonged treatment.
How this Drug Works
It works by keeping the worm from absorbing sugar (glucose).
Dosage and Usage Information
Available Dosage Forms: Tablets, liquids
Dosage
Adults: In roundworm, hookworm, and whip worm infestations: 1 tablet (100 mg) twice daily for 3 days. It
may be repeated after 3 weeks if necessary.
In hydatid cyst: 400-500 mg (4-5 tablets) thrice daily for 21-30 days.
Children: Same as Adult dose.
How and When to Take
No special preparation, e.g., special diets fasting, laxatives or enemas are required during or after taking
mebendazole. It can be taken with food.
For high doses: Take with fatty meals, e.g., milk, so that the medicine is absorbed better. If you are on low-fat
diet, check with your doctor.
What if you Miss a Dose
Take as soon as you remember. If it is almost time for your next dose skip the missed dose and go back to your
regular dosing schedule.
How to Stop Using this Drug
Stop only after a full course.
Precautions
Be sure to tell your doctor if you have Crohn’s disease (a kind of regional enteritis, or inflammation of the
intestine).

Profiles of 50 Drugs 455


Pregnancy: It should not be used in first 3-4 months of pregnancy. For use in the last 5-6 months, discuss with
your doctor.

Breast feeding: Quite safe.

Infants and Children: Avoid in children below 2 years of age.

Driving and Hazardous Activities: Be sure how you react to this drug before performing such activities since this
drug may produce dizziness.

Others: Pinworms may be easily passed from one person to another, especially in a household. Therefore all
household members may have to be treated at the same time. This helps to prevent infection or reinfection
of other household members.

For hookworms and whipworm infestation: Anemia may also develop for which your doctor may prescribe iron
supplements for you. You may have to take iron regularly for as long as 6 months after you stopped taking
mebendazole.

Possible Adverse Effects

Symptoms/Effects Frequency What to do

Stomach upset Rare Discuss with your doctor only if severe


Dizziness " "
Headache " "
Nausea " "
Skin rash " "

456 A Lay Person's Guide


METHYLDOPA

Drug Group: Antihypertensive


Medicine to lower blood pressure (BP)
Principal Uses

It is used to treat varying degrees (moderate to severe) of blood pressure. Medicines like water pills (to
reduce fluid retention) or other medicines that lower BP are used along with it to enhance its effect. Since it
does not reduce blood flow to the kidneys, it is given to people with kidney disorders. It should not be used in
case of mild and uncomplicated rise in BP.

How this Drug Works

High blood pressure adds to the workload of the heart and blood vessels (that carry blood). If this continues
for long time, the heart and blood vessels stop working properly. This can damage blood vessels of the brain,
heart and kidneys. It may also lead to heart attack or kidney failure. Hence it is necessary to control blood
pressure.

This medicine works by controlling nerve impulses. As a result, it relaxes blood vessels so that blood passes
through them more easily. This helps to lower blood pressure.

Dosage and Usage Information

Available Dosage Forms: Tablets

Dosage

Adults: Initially 250 mg, 2/3 times a day for 2 days; then adjust dose as required.

Maintenance dose: 0.5 mg - 2 gm in 2-4 divided doses.

How and When to Take

May be taken without regard to food.

What if you Miss a Dose

Take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back
to your regular dosing schedule.

What if you Exceed the Dose

The symptoms include marked drowsiness, weakness, confusion, nausea, vomiting, profound
unconsciousness. Notify your doctor immediately.

Profiles of 50 Drugs 457


How to Stop Using this Drug

Do not stop using this drug without consulting your doctor, who may reduce the dose gradually. Stopping
the drug suddenly may cause increase in BP.

Your doctor may want you to stop using the drug 5-7 days before surgery (under general anesthesia). Inform
your surgeon that you are on this drug and ask for guidance for stopping this drug.

Precautions

Be sure to tell your doctor if you have:

- liver problems - depression


- angina - anemia
- kidney problem - plan to undergo surgery under general anesthesia
- pheochranocytoma leading to hypertension, palpitation, headache, nausea, profuse sweating, etc.

Pregnancy: It is to be used only if clearly needed. Use the minimum effective dose.

Breast feeding: It passes into the breast milk. Avoid as far as possible. If drug is necessary, use cautiously.
Observe infants for drowsiness, inadequate feeding or any adverse effects. Then stop drug or refrain from
nursing.

Infants and Children: Reduced dose necessary.

Over 60: Use cautiously. Adverse effects like drowsiness, reduced mental activity, nasal congestion, dry
mouth are common. This drug can cause Parkinsonism (motion sickness) or intensify the existing
Parkinsonism.

Alcohol: Avoid. It can cause marked sedation (sleeping effect) and excessive fall in BP.

Driving and Hazardous Activities: It can cause drowsiness and fatigue.

Restrict activities as necessary.

Others: Your doctor may want to check your blood pressure as well as check your blood and urine regularly
while you are on this drug.

Possible Adverse Effects

Symptoms/Effects Frequency What to do

Headache Common Discuss with your doctor only if bothersome.


Dizziness " "
Rash Rare "“

458 A Lay Person's Guide


Symptoms/Effects Frequency What to do
Joint and muscle discomfort Rare Discuss with your doctor only if bothersome.
Fever Common "
Dry mouth " "
Nausea/vomiting Rare "“
Diarrhoea " "
Stomach pain with fever " Discuss with your doctor as soon as possible
and vomiting
Swelling of feet and hand Common "
Swelling of breasts " "
Decreased sexual ability Rare "
Jaundice " "
Weakness " "
Sore Throat " "
Abnormal bleeding or " "
bruising
Depression/confusion Common "
Nightmares Rare Stop drug immediately and notify your doctor
High fever (shortly after " "
starting to take this
medicine)

Interactions

Drugs/Drug Class Effects Notes


Medicine for diabetes s Excessive lowering of blood sugar levels
such as tolbutamide
Medicine that cause sedation s Excessive sedation
Tricylic Antidepressants t
Haloperidol Disorientation, abnormal behaviour
MAO Inhibitors High BP and behaviour change (seeing and hearing
things which are really not there)
Phenothiazines High BP

Effects of Long-term Use

Liver and blood problems may occur (rarely). Water retention may occur (if not taken with a water pill).

Profiles of 50 Drugs 459


METRONIDAZOLE

Drug Group: Antibacterial and


Antiprotozoal (anti-infective)
Principal Uses

It is used to treat certain infections of the vagina, abdomen, pelvis and gums. It is also used to treat
septicaemia (marked by fever and pus forming organisms in blood), infected leg ulcers and pressure sores. It
may prevent and treat infections following surgery.

In high doses, it can enter the brain and is used to treat abscesses occurring there.

It is used to treat amoebic dysentery and giardiasis (a kind of smelly dysentery).

How this Drug Works

It destroys essential components that are necessary for the cell life and growth of infecting organisms.

Dosage and Usage Information

Available Dosage Forms: Tablets, syrups, IV fluids, and injectables.

Dosage

Adults: For amoebic dysentery: 600 mg twice daily for 5-10 days.

For giardiasis: 600 mg twice daily for 5-10 days or 2 gm once daily for 3 days.

For vaginal infection/genito-urinary infection: one-day course - 2 gm as single dose or 1 gm twice every 12
hours. Seven-day course: 200 mg thrice daily for 7 days.

Children: 7.5 mg/kg for dysentery and giardiasis.

Note: 7-day course is preferred.

How and When to Take

May be taken with or following food, to avoid stomach irritation. If you are taking multiple doses, try to take
at evenly spaced time intervals to keep a constant amount of medicine in the blood.

What if you Miss a Dose

Take as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to
your regular dosing schedule. Do not double the doses.

460 A Lay Person's Guide


What if you Exceed the Dose

The symptoms include weakness, stomach irritation, nausea, vomiting, confusion, disorientation,
numbness/tingling. Notify your doctor as soon as possible.

How to Stop Using this Drug

Take the full course. Even if you feel better the infection may still be present and symptoms may return if
treatment is stopped too soon.

Precautions

Be sure to tell your doctor if you have:

- liver problem - kidney problem


- heart problem - blood disorders
- central nervous system disorders such as epilepsy (fits)

Pregnancy: Safety is not established. Discuss with your doctor. Avoid completely in the first three months of
pregnancy.

Breast feeding: It passes into the breast milk and causes adverse effects in the baby. Avoid drug or refrain from
nursing.

Note: If you refrain from nursing, the breast milk must be squeezed out or sucked out with a breast pump and thrown away.
Resume breast feeding after one or two days after you stop taking this drug.

Infants and children: Reduced dose necessary. Avoid in children with blood disorders.

Over 60: Infections in the genital and anal regions may occur. Report the development of rashes and itching
promptly to your doctor.

Driving and Hazardous Activities: This drug may cause dizziness or light-headedness. Restrict activities as
necessary.

Alcohol: Avoid. When taken along with metronidazole, it may cause flushing, nausea, vomiting, abdominal
pain and headache.

Others: It may cause dryness of mouth, an unpleasant or sharp metallic taste, and a change in taste sensation.
For temporary relief, use gum/candy/ice bits. If dry mouth continues for more than 2 weeks, check with
your dentist since it may increase the chances of dental disease. While using this medicine for vaginal
infection (trichomoniasis) your sexual partner must also be treated even if he has no symptoms. Also, it may
be desirable for your partner to wear a condom during intercourse.

This will help keep you from getting the infection back again.

Profiles of 50 Drugs 461


Your doctor may want to test your blood (cell count of blood) while you are on this medicine.

Possible Adverse Effects

Symptoms/Effects Frequency What to do

Nausea/loss of appetite Common Discuss with your doctor only if bothersome


Stomach pain/stomach upset " "
Headache " "
Dizziness " "
Dry mouth Rare "
Sharp metallic taste " "
Weakness " "
Numbness/tingling Common Stop drug now. Discuss with your doctor immediately.
Seizure (fits) Rare "
Mood changes " Discuss with your doctor as soon as possible.
Unsteadiness " "
Skin rash " Sore throat/fever
Any vaginal irritation/discharge/
dryness (not present before
using this drug) " "

Note: This drug may cause dark urine. This is only temporary and will go away when you stop this medicine.

Interactions

Drugs/Drug Class Effects Notes

Blood thinners (e.g., warfarin) s Abnormal bleeding. Adjust dose as required


and patient is observed closely for 1st 10 days of
simultaneous use.
Phenytoin s
Cimetidine (anti-ulcer antacid) ¯
Disulfuram (drug used to treat Severe emotional and behaviour changes.
alcohol habit)

Effects of Long-term Use

Not usually used for longer than 10 days. Prolonged use may cause temporary loss of sensation in the hands
and feet and may reduce the reduction of white blood cells.

462 A Lay Person's Guide


MICONAZOLE

Drug Group: Antifungal


Principal Uses

It is used to treat certain fungal infections, including fungal infections of the skin. It is a safe antifungal
agent.

How this Drug Works

It destroys/may prevent the growth and multiplication of the fungus which causes the infection.

Dosage and Usage Information

Available Dosage Forms: Topical creams

Dosage

Adults: 2% cream is applied twice daily.

I.V. infusion: 200 mg to 1.2 gm per infusion.

How and When to Take

Apply twice daily over affected area (covering it completely) and by rubbing it gently.

Do not cover it with any occlusive (closed) dressing or airtight covering. For nail infections: Clip nails as
short as possible. Apply cream and cover them with non-perforated occlusive dressing for 24 hours.

What if you Miss a Dose

Apply it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back
to your regular dosing schedule.

How to Stop Using this Drug

Do not stop using it without consulting your doctor. Keep using this medicine for the full time of treatment
(1 week to 1 month, depending on infection) even though your condition may have improved because
sudden stopping may cause return of symptoms.

Precautions

Keep this medicine away from the eyes. If your skin problem has not improved after you have used
miconazole for 4 weeks, check with your doctor.

Profiles of 50 Drugs 463


Possible Adverse Effects

Symptoms/Effects Frequency What to do

On local application

Skin rash, blistering, redness Rare Discuss with your doctor as soon as
or other signs of skin irritation possible.
(not present before using the
cream form of this medicine)
On systemic use
Fever and chills Common "
Skin rash/itching " "
Unusual bleeding/bruising Rare "
Unusual tiredness/weakness " "
Wheezing/troubled breathing " "
Nausea/vomiting Common Discuss with your doctor only if severe
Diarrhoea Rare "
Drowsiness " "
Flushing/redness of face/skin " "
Loss of appetite " "

Interactions

Drugs/Drug Class Effects Notes

Blood thinners ­ Dose adjustment necessary


Phenytoin s Phenytoin toxicity.

464 A Lay Person's Guide


ORAL CONTRACEPTIVES/BIRTH CONTROL PILLS

Drug Group: Female Sex Hormones


Other name: Estrogens/Progestogens
Principal Uses

This drug is considered a very effective method of preventing pregnancy. It is also used in the treatment of
conditions that benefit from added hormones, such as menstrual irregularity, heavy menstrual flow and
some problems of the uterus, menstrual and menopausal disorders.

However, it neither prevents nor cures venereal disease (V.D.).

How this Drug Works

When the combination of an estrogen and a progesterone (hormones which occur naturally in the female
body) are taken in correct dosage regularly, the levels of hormones increase to those levels that occur during
pregnancy. This, in turn, prevents the ovulation (formation and release of an egg from the ovary). Besides it
also leads to resistance to the passage of sperm as well as resistance to implantation (placement) of the egg
(if at all ovulation occurs). All these factors lead to prevention of pregnancy.

Dosage and Usage Information

Available Dosage Forms: Tablets

Dosage: 1 tablet daily

How and When to Take

Start treatment with the first tablet on the fifth day after the onset of menstruation (periods). Follow with 1
tablet daily (taken at the same time each day) for 21 consecutive days. Resume the treatment on eight day
following the last tablet taken during the preceding cycle. The schedule is to take the drug daily for three
weeks and to omit it for one week.

The tablet may be taken with or after food to avoid stomach irritation/vomiting.

What if you Miss a Dose

For 1 day: Take as soon as you remember. If you do not remember until the next day, take the missed tablet
plus the tablet that is regularly scheduled for that day (2 tablets on the same day). Then continue your regular
dosing schedule.

For 2 days in a row: Take 2 tablets a day for each of the next 2 days, then continue your regular dosing
schedule. In addition, use a second method of birth control to make sure that you are fully protected for the
rest of the cycle.

Profiles of 50 Drugs 465


For 3 days or more in a row: Stop taking the medicine completely and use another method of birth control until
your period begins or until your doctor determines that you are not pregnant. Then restart protection with a new
cycle of tablets.

What if you Exceed the Dose

The symptoms include headache, drowsiness, nausea, vomiting, fluid retention, abnormal vaginal bleeding, breast
enlargement and discomfort.

How to Stop Using this Drug

Do not discontinue this drug if spotting occurs. If it continues for more than one week, consult your physician. A
preparation with a higher estrogen content may be required.

Omitting this drug for only 1 day may not cause pregnancy. It is advisable to avoid pregnancy for 3 to 6 months,
after discontinuing this medicine.

Precautions

Be sure to tell your doctor if you have:

- heart problems, angina (heart pain), blood circulation problems, high BP, heart attack.
- mental depression or any other psychiatric problem
- family history of ischaemic heart disease, ischaemic cerebral vascular accident
- liver problems - kidney problems
- asthma - diabetes
- cancer - abnormal vaginal bleeding
- gallstones - migraine headaches
- menstrual problems - problems of uterus
- epilepsy (fits) - lumps in breasts
- planned to undergo surgery - varicose veins
- long-term immobilisation - Crohn’s disease

Pregnancy: Avoid this medicine completely during pregnancy. It may cause defects in the child.

Breast feeding: It passes into the breast milk and reduces the quality and quantity of milk. Avoid drug during
lactational amenorrhoea.

Your doctor may allow to use this medicine after you have been breast feeding for a while. Discuss this
thoroughly with your doctor. Prefer other methods of contraception.

Diet: Avoid excessive intake of salt if fluid retention, swelling of hands and feet occurs.

Tobacco: Avoid smoking cigarettes or use of tobacco in any other form completely during the use of this drug.

466 A Lay Person's Guide


Doing so may increase the risk of serious side-effects affecting the heart and/or blood circulation such as
dangerous blood clots, heart attack, or stroke. This risk increases with the age of the patient and is greater in
women of 35 years to the age of menopause.

Exposure to Sun: A few people may become more sensitive to sunlight while on the pill. Avoid too much
sun/sunlight until you know how you react to it.

If you develop brown blotchy spots on exposed areas, do not worry as they will disappear slowly when you
stop the medicine.

Others: Once you begin this medicine, your body will require at least 7 days to adjust before pregnancy will be
prevented; therefore you should use a second method of birth control for the first cycle (or 3 weeks) to
ensure full protection.

Diarrhoea lasting more than a few hours can impair the effectiveness of this medicine. So adopt another
method of birth control.

Missed periods may occur :

- if you have not taken the medicine exactly as scheduled (pregnancy may be a possibility).

- if medicine is not adjusted properly for your needs

- if you have taken this medicine for a long time (2 years or more) and then stopped the use.

Tablet should be taken at approximately same time each day. If delayed by longer than 12 hours
contraception protection may be lost.

Check with your doctor if you miss a period so that the cause can be determined.

When you stop using this medicine, it is very important that you wait at -least 3 months before becoming
pregnant. (Use another method of birth control that time). It takes some time for the effects of this drug to
wear off even after you stop using it. Hence it may cause birth defects in the child of a woman who gets
pregnant immediately after stopping the drug.

Possible Adverse Effects

Symptoms/Effects Frequency What to do

Coughing up blood Rare Stop drug now. Get emergency help now.
Headache (severe and sudden) “ "
Loss of co-ordination " "
Vision problems " "
Pains in chest/groin/leg " "“

Profiles of 50 Drugs 467


Symptoms/Effects Frequency What to do
Breathing problems " "
Slurring speech " "
Weakness, numbness or pain in " "
arm/leg
Key: All these symptoms could lead to heart attack or death.
Bulging eyes " Discuss with your doctor as soon as possible
Changes in vaginal bleeding " "
Double vision " "
Fainting " "
Urinary problems " "
Increased blood pressure " "
Lumps in or discharge Rare "
from breast
Mental depression " "
Stomach pain " "
Skin rash " "
Swelling, pain or tenderness in " "
upper stomach
Uncontrolled jerks " "
Unusual dark mole " "
Thick, white vaginal discharge " "
Yellowing of eyes/skin " "
Acne (less common after Common Discuss with your doctor only if severe or
first 3 months) bothersome.
Bloating of stomach " "
Cramps of lower stomach " "
Loss of appetite "
Nausea "
Swelling of ankles/feet "
Swelling & tenderness of breast "
Unusual weight gain "
Brown blotchy spots on Rare
exposed skin
Mild diarrhoea "

468 A Lay Person's Guide


Symptoms/Effects Frequency What to do
Dizziness Rare Discuss with your doctor only if severe or
bothersome.
Migraine headaches "
Increased body or facial hair "
Increased sensitivity to contact "
lenses.
Irritability "
Some loss of scalp hair "
Unusual decrease/increase "
in sexual desire.
Vomiting "

Interactions

Drugs/Drug Class Effects Notes


Cortisone-like medicines ¯ Use another method of birth control.
Barbiturates ¯ "
Carbamazepine ¯ "
Dihydroergotamine ¯ "
Griseofulvin ¯ "
Mineral Oil ¯ "
Neomycin ¯ "
Penicillins ¯ "
Phenytoin ¯ "
Primidone ¯ "
Phenylbutazone ¯ "
Oxyphenbutazone ¯ "
Sulfonamides ¯ "
Rifampicin ¯ "
Tetracyclines ¯ "
Tranquilizers ¯
(calming, sleep-inducing drugs) "
Valproic acid ¯ "
Benzodiazepines, e.g., Diazepam s Excessive sedation (sleep)

Profiles of 50 Drugs 469


Drugs/Drug Class Effects Notes
Metoprolol s
Prednisolone and Prednisone s
Theophyllines s Toxicity of theophyllines may occur.
Blood thinners Changes in the blood-clotting mechanism.
Antidepressants Adverse effect increases and effectiveness decreases.
Medicines for diabetes Changes in blood sugar levels.
Troleandomycin (TAO) Increased liver toxicity and jaundice.

Effects of Long-term Use

High blood pressure, gall bladder, disease with stones, growths/tumors in uterus, menstrual problems,
infertility.

Emergency Contraception

Hormonal method: The hormonal (yuzpe) method of emergency contraception is suitable for occasional
use. It involves taking two tablets each containing ethinyloestradiol 50 micrograms (mcg) and levonorgestrel
25 mcg, followed 12 hours later by a further two tablets. The method has only been established as effective if
the first dose is taken within 72 hours (3 days) of the unprotected intercourse. If vomiting occurs within 3
hours of taking the tablets, two replacement tablets can be given with an anti-emetic.

470 A Lay Person's Guide


ORAL REHYDRATION SALTS (ORS)

Drug Group: Antidiarrhoeal


Principal Uses

Oral rehydration salts (ORS) are specifically intended for the replacement of water and salts lost in acute
diarrhoea. It is vital that these losses are rectified as rapidly as possible, particularly in infants and young
children.

How this Drug Works

A person who passes frequent watery stools loses a large amount of water and salts from the body. Sudden
loss of water and salt (dehydration) causes marked weakness, thirst and sunken eye-balls. Severe diarrhoea
causes decreased urine output, increased pulse rate and unconsciousness resulting in death. It is estimated
that about one out of every 10 children born in developing countries dies of diarrhoea before reaching the
age of 5. Oral rehydration salts (ORS) contain sugar and mineral salts needed by the body. When taken
dissolved in water, they promptly replace the water and salts lost during diarrhoea and correct dehydration.

Dosage and Usage Information

Initial Treatment

The degree of dehydration is determined from the general appearance of the child and the following signs:

General Appearance Mild Moderate Severe


and Condition of Dehydration Dehydration Dehydration
Infant or Child
General condition Thirsty, Thirsty, restless Drowsy or comatose,
restless or lethargic limp, cold, sweaty,
irritable when bluish hands, feet
aroused.
Respiration Normal Deep Deep and rapid
Pulse Normal Rapid, weak Rapid and weak or
undetectable
Fontanelle, Eyes Normal Sunken Very sunken
Skin Pinch Pinch, retracts Pinch, retracts
retracts slowly very slowly (2 sec)
immediately
Mucous membranes Moist Dry Very dry
Urine flow Normal Reduced None
and dark

Profiles of 50 Drugs 471


Usage and Dosage Range

Degree of Amount of Approximate total fluid deficit (ml)


Dehydration Fluid needed
ml/kg 1-2 5-8 9-12 1-2 2-4
months months months months months
Moderate 100 200-400 400-600 600-800 1000 1200
Severe Intravenous fluid replacement needed

Note: 200 ml is 1 glass approximately. 1000 ml is one litre.

The maximum rate of fluid replacement for small children is about 300 ml per hour.

When intravenous infusion is not possible an attempt can be made to administer ORS by mouth using a
dropper at a rate of about 20 ml/kg body weight an hour.

Replacement of Continued Fluid Loss

After initial rehydration the child should be given:

- ORS in a quantity that matches the fluid loss in the stools,

- Plus the normal fluid intake, either as breast feeds or as a supplement of equal volumes of milk and clean
water.

Up to one third of the total fluid intake can be given as equal volumes of milk and clean water.

How and When to Take

The child should be offered its normal food as soon as possible. Infants over 4 months should be started on
semisolid foods. Fruit juices, bananas or coconut-water are particularly useful in repairing losses of
potassium.

1. If the preformulated ORS packets as above are not available, ORS solution can also be prepared from
home ingredients mentioned above - common salt, baking soda and sugar. Instead of glucose, use
sucrose (common table sugar) or even crude sugar called gur or jaggery. 40 gm of table sugar (about 8
teaspoons) is equivalent to 20 gm (4 teaspoons) of glucose. Mix 8 teaspoonful of sugar with 1
teaspoonful of baking soda together with 1 litre of boiled and cooled water or clean drinking water. Give
to child as indicated for packaged ORS.

As potassium chloride is not usually available, give the child any one of the following every 24 hours:

472 A Lay Person's Guide


2 large size bananas (mashed)

3 small size bananas (mashed)

3 cups of coconut water

2 cups of orange juice

2 cups of mashed papaya or

5 medium size ripe tomatoes

Gur, the crude sugar, also contains varying amounts of potassium.

2. If the above things are not available, prepare the solution with ordinary salt and sugar. For this take salt in
a teaspoon. Level it with a knife or a flat object. Add one level spoonful of salt to one litre of water and
mix. Taste the mixture. If it tastes more salty than tears, pour away and make it again with less salt. Finally
add 8 level teaspoons full of sugar and mix it well. Even rice water can be used in place of sugar.

3. For making the solution, boiled water is preferable, if available. If not, use clean drinking water.

4. Give instructions to the relatives regarding the preparation and administration of ORS solution.

Packets are recommended, each containing:

ORS - bicarbonate ORS - citrate

Sodium chloride 3.5 gm Sodium chloride 3.5 gm


Sodium bicarbonate 2.5 gm Trisodium citrate, dihydrate 2.9 gm
Potassium chloride 1.5 gm Potassium chloride 1.5 gm
Glucose 20.0 gm Glucose 20.0 gm

Dissolve, immediately before use, one packet in one litre of clean, boiled cooled water, or, because the
sizes of packets vary, in the quantity of water indicated on the packet. If a litre measure is not available,
use a glass. Average medium size glass has about 180-200 ml capacity. Sometimes soft drink bottles (for
example, Thums-Up or milk bottles) with known capacity may be available. The volume of fluid required
and the rate at which it should be given depend upon:

- the weight (age) of the child

- the initial degree of dehydration

- the rate of fluid loss as long as the diarrhoea persists

Profiles of 50 Drugs 473


Precautions

Others

1. The solution should be prepared fresh every day using a clean utensil and spoons and after washing hands
thoroughly. It should be kept covered in a cool place.

2. During ORS administration, measure the amount of urine passed. A patient who has received adequate
amounts of ORS will pass the normal (usual) amount (1500-2000 ml) of urine daily. Failure to increase
urine output suggests a need for administering more ORS. Continue ORS therapy till the diarrhoea stops
or the patient is referred to the doctor.

3. If ORS packets are stored at high temperature (more than 30 °C) and high humidity for a long time, the
product is likely to cake. If you have a limited supply of ORS, do not throw away ORS that has become
caked. It can still be used provided it dissolves completely in water. If the ORS has turned to a brown
colour it should not be used.

4. All cases of moderate or severe dehydration should be started on ORS fluid as mentioned above and
referred to the doctor.

5. Examples of fluids which are potentially dangerous and should be avoided: commercial soft drinks,
sweetened fruit drinks, sweetened tea, coffee, purgatives, medicinal teas or infusions.

Possible Adverse Effects

Used properly, it is quite safe.

474 A Lay Person's Guide


PARACETAMOL

Drug Group: Non-opioid analgesic, antipyretic


Principal Uses

Paracetamol (acetaminophen) is used to relieve mild to moderate pain and to reduce fever. Unlike aspirin, it
is not useful in treating the swelling of joints. It does not cause stomach upset or bleeding problems, like
aspirin, and is therefore an useful alternative.

How this Drug Works

It reduces the formation of chemicals (prostaglandins) that produce pain and fever.

Dosage and Usage Information

Available Dosage Forms: Tablets and syrups (125 mg/5ml)

Dose Adults: 500 mg-1gm, 3 to 4 times daily

Children: 16-20 mg/kg/dose, 3 to 4 times daily.

What if you Exceed the Dose

The effects include vomiting, stomach pain, drowsiness, lethargy, violent contractions of muscles, liver
damage, profound unconsciousness (in 2-5 days after large overdose). Seek immediate medical advice in all
cases.

Precautions

Be sure to tell your doctor if you have kidney/liver problems. Do not take this drug for more than 10 days in
a row, if you are an adult or for more than 5 days in a row, in case of children up to 12 years of age.

Over 60: Do not exceed a total dose of 2500 mg per day since excessive doses may cause liver and kidney
damage.

Alcohol: Prolonged heavy intake of alcohol with paracetamol may increase the risk of liver injury.

Possible Adverse Effects

Acute over dose produces liver damage. Chronic intake may produce drug-induced liver damage.

Note: Although it is often combined with other painkillers and medicines used to treat allergy, cold and muscular pain, such combinations
are not rational and should be avoided as far as possible. See also Annexures 4 and 5, Chapter 3, Section 1 of this book.

Profiles of 50 Drugs 475


PROMETHAZINE

Drug Group: Anti-allergic


Anti-vomit
Principal Uses

It is to relieve or prevent the symptoms of rhinitis and other types of allergy. It is used to reduce itching in a
variety of skin conditions including urticaria (hives), chickenpox and eczema. It prevents motion sickness,
nausea, vomiting, diarrhoea, and produces sleep in some people when used as nighttime sedation.

Also used as anti-tussive (anticough) in children, and as a preanaesthetic medication. Used in psychiatry as an
antipsychotic.

How this Drug Works

It blocks the actions of histamine (chemical producing allergy). It slows down the activity of the vomiting
center in the brain.

Dosage and Usage Information

Available Dosage Forms: Tablets, liquids and injectables.

Dosage

Adults: 12.5 mg to 25 mg every 4-6 hours daily as necessary

Note: Actual dose must be determined by the physician for each patient individually.

Children: 0.5-2.0 mg/kg/day every 6 to 8 hours by mouth or intra-muscular injection.

How and When to Take

Take with or following food to reduce stomach irritation. For motion sickness, take 1-2 hours before travel,
then every 4-6 hours as necessary.

What if you Miss a Dose

Take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back
to your regular dosing schedule.

What if you Exceed the Dose

The symptoms include marked drowsiness, weakness, unsteadiness, agitation, deep sleep, fits, coma
(profound unconsciousness). Seek medical help immediately.

476 A Lay Person's Guide


Precautions

Be sure to tell your doctor if you have:

- kidney problems - liver problems


- heart problems - urinary problems
- ulcer - asthma/lung problems
- enlarged prostate - blood disease

Pregnancy: Avoid use of this drug during the first and last 3 months; it can cause jaundice/muscle tremor, bleeding
in the newborn infant.

Breast feeding: It passes into the breast milk. Avoid drug or refrain from nursing.

Infants and Children: Reduced dose necessary. It should not be used in newborn infants. It should not be used to
control vomiting in children with flu/measles/chicken pox or other infections since it may cause muscle pain of
face, neck, back, legs and hands in such children.

Over 60: Increased likelihood of adverse effect such as drowsiness, dizziness, lethargy and impaired thinking
judgement and memory. This drug can increase the symptoms of prostatism.

Driving and Hazardous Activities: This drug can cause drowsiness, so avoid activities until you know how you react to
this drug.

Alcohol: Avoid. Alcohol may increase the sedative effects of this drug.

Sun: This drug may cause some people to become sensitive to sun. Avoid exposure to excessive sunlight until you
know how you react to this drug.

Others: It may cause dryness of the mouth, nose and throat. For temporary relief, use sugar/ice-bits in your
mouth. If dry mouth lasts for more than 2 weeks, check with your doctor since it can lead to dental disease. The
property is utilised for drying secretions in nasal cattarh (simple inflammation of mucous membrane). The drug is
preferred at bed time.

Possible Adverse Effects

Symptoms/Effects Frequency What to do

Drowsiness, lethargy Common Discuss with your doctor only if severe

Dry mouth " "

Blurred vision " "

Headache Rare "

Profiles of 50 Drugs 477


Symptoms/Effects Frequency What to do
Stomach upset Rare Discuss with your doctor only if severe
Rapid heart rate " "
Low BP " "
Chest tightness " "
Jaundice Discuss with your doctor as soon as possible
Hysteria " "
Muscle pain of face, neck, back " "
hands and legs
Blood diseases: Bruising, " "
Bleeding, sore throat, fever
Skin rash due to sun " Stop taking the drug and discuss with your
doctor

Interactions

Drugs/Drug Class Effects Notes


Sedative (sleep-inducing drugs) s
Atropine and Atropine-like drugs s
Antacids ¯ Take the two drugs at least 1 hour apart. May
retain antacid for longer duration in the
stomach.

Effects of Long-term Use

Long-term use of this drug is unnecessary. If taken for long time, it may cause abnormal movements of face
and limbs (Parkinsonism) which disappears when drug is stopped. Long-term use may lead to loss of
effectiveness of this drug.

478 A Lay Person's Guide


PROPRANOLOL

Drug Group: Antihypertensive,


Beta blocker
(medicine to treat blood pressure and heart problems)
Principal Uses

It is used to treat raised blood pressure, angina and abnormal heart rhythms. It is also useful in controlling fast
heart rate, symptoms of overactive thyroid gland, symptoms of anxiety and nervous tension (such as sweating
and tremors), preventing migraine headaches and in treatment of chronic alcoholism.

How this Drug Works

It works by affecting the response to some nerve impulses in certain parts of the body. As a result, they decrease
the need of blood and oxygen by the heart by reducing its workload. They also help the heart to beat more
regularly.

Dosage and Usage Information

Available Dosage Forms: Tablets

Dosage

- Anti-angina: 80-120 mg daily (starting dose) in 2-4 divided doses.

120-240 mg daily (maintenance dose)

- For treating irregular heart rhythm :30-160 mg daily.

- For high BP: 80-160 mg daily


Note: Actual dose may be determined by the doctor for each patient individually.

How to Use this Drug

Preferably taken soon after eating to maximize absorption of drug into the blood. Food enhances the absorption
of propranolol. To prevent harmless possible numbing effect, mix with soft food and swallow promptly. Do not
crush, break or chew before swallowing. Swallow the tablet or capsule whole.

What if you Miss a Dose

Take it as soon as possible. However if your next dose is within 4 hours (8 hours for slow-release/prolonged
action capsules), skip the missed dose and go back to your regular dosing schedule). Do not double the doses.

Profiles of 50 Drugs 479


Do not discontinue this drug abruptly.

What if you Exceed the Dose

The symptoms include irregular heart beat, dizziness, difficulty in breathing, bluish-coloured fingernails,
cold and sweaty skin, low BP, difficulty in breathing, seizures (fits), fainting, collapse or profound
unconsciousness.

Seek immediate medical advice in all cases.

How to Stop Using this Drug

Do not stop the drug without consulting your doctor. Abrupt stopping may lead to worsening of the
underlying condition. A gradual reduction of dose over a period of 2 weeks is recommended.

Precautions

Be sure to tell your doctor if you have:


- liver problems - kidney problems
- heart problems - diabetes
- poor circulation in the legs - myasthenia gravis
- breathing problems (lung disorders, e.g., asthma, bronchitis, emphysema)
- overactive thyroid - mental depression
- planned a surgery in the near future.

Pregnancy: Safety in pregnancy not established. Avoid completely in the first three months of pregnancy.
Discuss with your doctor for use in the other six months of pregnancy.

Breast feeding: The drug passes into the breast milk. The nursing infant must be closely observed by the doctor.
Discontinue drug or nursing if adverse effects develop.

Infants and Children : Safety and effectiveness is not established for children under 12 years of age.

Over 60: Increased risk of adverse effects. Use caution. Their progress must be regularly observed (
monitored) by the doctor.

Alcohol: Use cautiously. Alcohol may increase the drug’s ability to lower the blood pressure and may increase
its mild sedative effect.

Tobacco: It may reduce the drug’s efficiency in treating heart disorders and also reduce drug’s blood levels

480 A Lay Person's Guide


by increasing it’s elimination from the body. Besides this drug may increase the breathing problems caused by
smoking.

Driving and Hazardous Activities: This drug may cause dizziness and fall in blood pressure. So determine how
you react to this drug before performing such activities.

Others: Avoid hot environment; it enhances the fall in blood pressure due to this drug.

Avoid cold environments, it enhances the loss of circulation to hands and feet due to this drug.

Avoid exercise and exertion that produces light-headedness, excessive fatigue, or muscle cramping.

Diabetic patients should take this drug cautiously.

Possible Adverse Effects

Symptoms/Effects Frequency What to do


Skin rash Rare Discuss with your doctor only if severe/bother some.
Temporary loss of hair " "
Drug-induced fever " "
Dry, sore eyes " "
Stuffy nose " "
Numbness/tingling of
fingers and toes. " "
Lethargy Common "
Headache Rare "
Dizziness Common "
Indigestion Rare "
Nausea/vomiting " "
Diarrhoea " "
Sleeplessness Common "
Vivid dreams Rare "
Breathing problems " Discuss with your doctor as soon as possible.
Cold hands and feet Common "
Mental depression Rare "
Slow pulse rate " "

Profiles of 50 Drugs 481


Symptoms/Effects Frequency What to do

Anxiety Rare Discuss with your doctor as soon as possible.


Decreased sexual ability " "
Behaviour changes " "
Chest pain " "
Fever and sore throat " "
Abnormal bleeding, bruising " "

Interactions

Drugs/Drug Class Effects Notes


Other Medicines that lower BP s Excessive lowering of BP. Dose adjustments
necessary.
Lidocaine s
Reserpine s Causes sedation, depression, slowing of
heart rate and lowering of blood pressure.
Verapamil s Causes excessive depression of heart
function
Theophyllines t Reduced anti-allergic effect of theophyllines
Clonidine Rebound high BP if clonidine is stopped and propranolol is still being
taken.
Epinephrine High BP, slow heart rate.
Insulin May mask the ‘low-blood glucose level’ effect of
insulin.
Chlorpromazine ­
Cimetidine ­
Propylthiouracil ­
Barbiturates ¯
Indomethacin ¯
Rifampicin ¯

Effects of Long-term Use

Rarely in patients with advanced heart disease, eventual heart failure may occur. Reduced heart reserve and
eventual heart failure in susceptible individuals with advanced heart disease.

482 A Lay Person's Guide


PYRIMETHAMINE AND SULFADOXINE

Drug Group: Antimalarial.


Principal Uses

This combination is used only in the treatment of falciparum malaria that is resistant to (not cured by)
chloroquine. It should not be used for long-term or regular prophylaxis (prevention) of malaria or for vivax
malaria.

How this Drug Works

It interferes with and inhibits the growth of the germs that cause malaria.

Dosage and Usage Information

Available Dosage Forms: Tablets

Dosage

Adults: 3 tablets (each tablet contains 25 mg pyrimethamine and 500 mg sulfadoxine) as a single dose.

Children: 9-14 years: 2 tablets daily


4-8 years: 1 tablet daily
1-3 years: 1/2 tablet daily
2-11 months: 1/4 tablet daily

Weight-wise: 1.25 mg/kg pyrimethamine or 25 mg/kg sulfadoxine single dose.

How to Take this Drug

Take the prescribed dose once only.

Precautions

Be sure to tell your doctor if you have:


- liver or kidney problems - epileptic fits
- anemia - blood disorders.

Pregnancy: Avoid.

Breast feeding: It is secreted in breast milk. Avoid the drug.

Profiles of 50 Drugs 483


Possible Adverse Effects

Symptoms/Effects Frequency What to do


Loss of appetite Common Discuss with your doctor only if severe
Vomiting " "
Weakness/fatigue Rare Discuss with your doctor as soon as possible
Skin Rash " "
Bleeding/Bruising " "
Soreness, redness Common "
(with high doses)
Swelling of tongue " "
Sore throat/fever " "
Ulcers in mouth " "

Interactions

Drugs/Drug Class Effects Notes


Oral Antidiabetics s Fall in blood effect sugar levels. Reduced dose of
antidiabetics may be necessary.

Effects of Long-term Use

Long-term use not advisable (may lead to serious skin and blood disorders).

484 A Lay Person's Guide


QUININE

Drug Group: Antimalarial


Principal Uses

It is used in the treatment of falciparum malaria resistant to chloroquine.

It is also used in cerebral malaria.

How this Drug Works

It kills the malarial parasites.

Dosage and Usage Information

Available Dosage Forms: Tablets, injectables

Dosage

Adults: 600 mg, thrice daily for 7-10 days

or

I.V. Infusion: 20 mg/kg quinine diluted in other fluid (like dextrose) is infused for 4 hours, then 10 mg/kg is
infused every 8 hours, till the patient is able to take the tablet.

Children: 10 mg/kg body weight thrice daily for seven days followed if necessary by
pyrimethamine/sulfadoxine tablets.

How and When to Take

Take with or after meals to avoid stomach upset.

What if you Exceed the Dose

Take medical advice immediately if breathing problems, fits or loss of consciousness occurs.

How to Stop Using this Drug

For malaria - Do not stop without consulting your doctor. To help clear up the infection completely take the
full course even if you begin to feel better within a few days.

Precautions

Be sure to tell your doctor if you have:


- asthma - heart disease
- myasthenia gravis - kidney problems

Profiles of 50 Drugs 485


Quinine should be used cautiously in diabetics. It may cause hypoglycaemia (lowering of blood sugar).

Pregnancy: Can be safely used in therapeutic doses.

Breast feeding: Although it passes into the breast milk, the quantity is too little to affect the child.

Driving and Hazardous Activities: This drug causes blurring of vision, and may impair those activities.

Possible Adverse Effects

Symptoms/Effects Frequency What to do

Vision problems Common Discuss with your doctor as soon as possible


Headache " "
Ringing or buzzing in ears " "
Loss of hearing " "
Skin rash with intense itching Rare "
Diarrhoea " Discuss with your doctor only if severe
Nausea/vomiting Common "
Stomach upsets Rare "

Interactions

Drugs/Drug Class Effects Notes

Quinidine t Cinchonism (poisoning by quinine, cinchona) occurs


Digoxin s

486 A Lay Person's Guide


RANITIDINE

Common Brand Names: Zantac, Rantac, Ranitin


Drug Group: Anti-ulcer
Principal Uses

It is used in the prevention and treatment of peptic ulcer. It is also used in a disease called Zollinger-Ellison
syndrome, in which the stomach produces too much acid. Unlike cimetidine, a similar drug, ranitidine does
not affect the actions of certain enzymes in the liver, whereby many drugs are broken down. This means that
ranitidine can be taken with other drugs without causing an interaction that may reduce the effectiveness of
treatment.

How this Drug Works

It acts by reducing the amount of acid produced by the stomach, allowing the ulcers to heal.

Dosage and Usage Information

Available Dosage Forms: Tablets 150 mg and 300 mg orally in single dose and syrup ranitidine hydrochloride
50 mg/2 ml orally and IV slowly.

Dosage

For treatment of ulcer: 150 mg twice daily for 45 days

For prevention of ulcer: 150 mg daily at night.

For Zollinger-Ellison Syndrome: 600-900 mg daily in divided doses.

How to Use this Drug

The drug should be taken with or immediately following meals, preferably at bed time, so as to obtain the
longest period of stomach acid reduction.

What if you Miss a Dose

Take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back
to your regular dosing schedule.

What if you Exceed the Dose

The symptoms include confusion, delirium, slurred speech, flushing, sweating, drowsiness, muscle
twitching, fits and profound unconsciousness. Notify your doctor as soon as possible.

Profiles of 50 Drugs 487


How to Stop Using this Drug

Do not stop the drug without consulting your doctor; symptoms may recur.

Precautions

Be sure to tell your doctor if:

- you have liver problems- you have kidney problems

Pregnancy: Safety in pregnancy not established. Avoid if possible.

Breast feeding: The drug passes into the breast milk. It is advisable to avoid the drug or refrain from nursing.

Infants and children: Not usually prescribed since safety and effectiveness is not established.

Over 60: They must be observed for the development of nervous agitation or confusion. This drug may also
lead to the formation of masses of undigested vegetable fibers (patients with poor chewing ability/missing
teeth and those who have had stomach surgery are more prone to this and may show symptoms such as loss
of appetite, stomach fullness, nausea and vomiting).

Diet: Protein-rich foods produce maximal stomach acid secretion and hence should be avoided. Certain
food and drinks that irritate the stomach may make your problem worse.

Driving and Hazardous Activities: This drug may cause dizziness. Restrict activities as necessary.

Alcohol: Avoid. It may increase the stomach acidity and reduce the effectiveness of this drug.

Tobacco: Avoid completely or at least after taking the last dose of the day since it reduces the drug’s
effectiveness.

Others: If you have been using the drug for a long time, your doctor may want to check your blood and liver
function.

Possible Adverse Effects


Symptoms/Effects Frequency What to do
Skin rash Rare Discuss with your doctor only if severe/bothersome
Headache " "
Dizziness " "
Nausea " "

488 A Lay Person's Guide


Symptoms/Effects Frequency What to do

Constipation Rare D i s c u s s w i t h yo u r d o c t o r o n l y i f s e ve r e /
bothersome
Stomach pain " Discuss with your doctor as soon as possible
Confusion " "
Sore throat and fever " "
Unusual bleeding or bruising " "
Irregular heart beat " "
Unusual tiredness/weakness, " "
sexual impotence

Interactions

Drugs/Drug Class Effects Notes

Antacids ¯ Do not take any antacids within 1 hour of taking this


drug.

Medicines that are enteric-coated Enteric coating dissolves too rapidly.

Ketoconazole t Take ranitidine at least 2 hours after


ketoconazole.

Effects of Long-term Use

Courses of longer than 8 weeks are not usually necessary although repeat courses may be required in case the
symptoms return.

Continuous use of the drug for longer than 1 year is not recommended except in exceptional circumstances
because the safety of this drug for prolonged use has not yet been confirmed.

Profiles of 50 Drugs 489


RESERPINE

Drug Group: Antihypertensive


Medicine for high blood pressure (BP)
Principal Uses

Used primarily as a Step 2 medicine to control high BP (the treatment of hypertension is done in a step-by-
step method. It is started with a Step 1 medicine and then other medicines, that is, Step 2, 3 and 4 medicines,
are added one after the other depending upon the response and severity of symptoms.)

Because of high incidence of adverse effects with reserpine, it is used only in those cases in which
methyldopa, clonidine or propranolol are ineffective or produce adverse effects. Its use should be restricted.

How this Drug Works

It works by controlling nerve impulses along certain nerve pathways. As a result, it acts on the heart and
blood vessels to lower blood pressure.

Dosage and Usage Information

Available Dosage Forms: Tablets as part of combination drugs.

Dosage

Adults: 0.1 - 0.5 mg daily for 1-2 weeks

Note: Dose is adjusted by the doctor as needed and depending on tolerance.

How and When to Take

Take with or following food to reduce stomach irritation.

What if you Miss a Dose

Take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back
to your regular dosing schedule.

What if you Exceed the Dose

Marked drowsiness, flushed skin, incoordination, tremors, slow pulse, breathing problems, diarrhoea,
profound unconsciousness.

490 A Lay Person's Guide


How to Stop Using this Drug

Do not stop using this drug without consulting your doctor.

This medicine does not cure high BP but it does control it. So one must continue to take it as directed if you
expect to lower your BP and keep it down. You may have to take this medicine for the rest of your life.

Precautions

Be sure to tell your doctor if you have:


- recently had a stroke
- allergies/breathing problems such as asthma - epilepsy (seizure problems)
- gall stones - heart disease
- kidney disease - mental depression
- Parkinson’s disease - ulcerative colitis
- stomach ulcer - migraine headaches
- planned to undergo surgery under general anesthesia
- pheochromocytoma (a cell related disorder leading to high BP, nausea, anxiety, etc.).

Pregnancy: Use of this drug during the last month of pregnancy can cause lethargy, nasal congestion,
breathing problems and poor feeding in the new born infant.

Avoid this drug during the first 3 months and the last month. Use it only if clearly needed after discussing
with your doctor.

Breast feeding: This drug passes into the breast milk. Avoid drug or refrain from nursing.

Infants and Children: They must be observed carefully for excessive drowsiness, emotional instability on
gastrointestinal disturbances.

Over 60: Increased likelihood of adverse effects. Use caution. Avoid exposure to cold.

Driving and Hazardous Activities: This drug may impair mental alertness and judgement. Restrict activities as
necessary.

Alcohol: Avoid. This drug can increase the intoxicating effects of alcohol and eventually depress brain
function.

Diet: Avoid excessive sodium (salt) intake.

Profiles of 50 Drugs 491


Possible Side-effects

Symptoms/Effects Frequency What to do


Skin rash Rare Discuss with your doctor only if severe
Headache " "
Dizziness Common "
Nose bleeds " "
Nausea/Vomiting " "
Diarrhoea " "
Altered menstrual pattern Rare "
Bruising " Discuss with your doctor immediately
Agitation " "
Nervousness " "
Confusion " "
Breathing problems " "
Depression " "
Reduced Sexual ability " "
Ulcer " "
Breast enlargement " "

Interactions

Drugs/Drug Group Effects Notes


Levodopa
Medicine for seizures (fits) t Alteration in the seizure patterns of the patients
Digitalis drugs Heart rhythm disorders
Quinidine "
Blood thinners t With short-term use
s With long-term use

492 A Lay Person's Guide


RIFAMPICIN

Drug Class: Antibiotic,


Anti-Tuberculosis, Anti-Leprosy
Principal Uses

Rifampicin (rifampin) is used to treat tuberculosis (TB). It is given in combination with other drugs to
enhance its effectiveness.

It is used for leprosy in combination with other drugs such as dapsone and clofazimine.

It is also used in contacts of patients of meningococcal meningitis to prevent the disease.

It may be occasionally used in serious infections such as artificial heart valve infections (endocarditis) and
bone infections (osteomyelitis) along with other antibiotics so as to prevent the development of bacteria that
will resist the actions of the drug.

How this Drug Works

It kills the germs that cause tuberculosis (TB), leprosy, etc.

Dosage and Usage Information

Available Dosage Forms: Capsules, tablets, liquids


Adults: TB: 450-600 mg once daily (according to weight).
Meningitis: 600 mg once daily for 4 days.
Leprosy: 600 mg once a month for either 6 months or 24 months.

Children: 10-15 mg/kg body weight once daily.

How and When to Take

It is best taken with a full glass (8 ounces) of water on an empty stomach either 1 hour before or 2 hours after
eating. However if it upsets your stomach, you may take it with food.

Take the full course (which can be several months to years). Even if you feel better, the original infection may
still be present and the symptoms may return if treatment is stopped too soon.

Precautions

Be sure to tell your doctor if you :

- have long-term liver problems.

Profiles of 50 Drugs 493


- drink alcoholic beverage everyday.

- are taking oral contraceptive (an alternate method of contraception is advised.)

Pregnancy: It is claimed safe in pregnancy.

Breast feeding: Continue nursing.

Over 60: Increased likelihood of adverse effects. Reduced dose may be necessary.

Infants and Children: Must be observed closely for possible liver toxicity or blood problems. Reduced dose may
be necessary.

Alcohol: Avoid, so as to reduce the risk of liver problems.

Others: You may have to take this medicine everyday for as long as prescribed. It is important that you do not
miss any doses.

It causes urine, stool, saliva, sputum, sweat, semen and tears to turn reddish-orange or reddish-brown
colour. It also colours soft contact lenses permanently. So wear hard contact lenses instead of soft contact
lenses.

Possible Adverse Effects

Note: Some adverse effects are more common with intermittent therapy or after restarting interrupted
treatment.

Symptoms/Effects Frequency What to do


Diarrhoea Common Discuss with your doctor only if severe.
Stomach cramps " "
Skin rash Rare Discuss with your doctor only if severe.
Chills, fever (flu-like Rare Discuss with your doctor immediately.
symptoms)
Difficult breathing " "
Dizziness " "
Muscle and bone pain " "
Bloody/cloudy urine " "
Jaundice " "
Sore throat " "
Abnormal bruising/bleeding " "

494 A Lay Person's Guide


Interactions

Drugs/Drug Class Effects Notes


Anticoagulants t
Beta blockers such as t
propranolol, metoprolol
Cortisone-like drugs t
Cyclosporin t
Digitoxin t
Birth Control Pills t
Phenytoin t
Quinidine t
Oral antidiabetics t
(e.g., chlorpropamide)
Theophyllines t
Antacids ¯

Effects of Long-term Use

Prolonged use may cause liver damage. Fungal infection of mouth/tongue may also occur.

Profiles of 50 Drugs 495


SALBUTAMOL

Drug Group: Bronchodilator


Other name: Albuterol (Medicine for Asthma)
Principal Uses

It is used in the treatment of asthma and other breathing disorders such as bronchitis and emphysema.
Unlike similar drugs, it does not have any unwanted effects on the heart or blood pressure. It is also used in
delaying of premature labour.

How this Drug Works

It relaxes the muscles surrounding the bronchioles (air ways in the lung) and thus facilitate easy breathing. It
relaxes the muscles of the uterus, and is thus used in the delaying of labour.

Dosage and Usage Information

Available Dosage Forms: Tablets, liquids, inhalers, injectables

Dosage

Tablets Adults: 2 to 4 mg per dose every 6-8 hours.

Children: 0.01 - 0.1 mg/kg/dose every 8 hours.

Inhalers Adults: 400-800 micrograms daily (i.e. 1-2 inhalations, 3-4 times daily)

Children: 100 micrograms every 6-8 hours


Note: It is more effective and safe by inhalation than by mouth. One microgram = one millionth of a gram.

How and When to Take

For inhalation: Keep spray away from eyes because it may cause irritation. Do not take more than 2 inhalations
of the medicine at any one time, unless your doctor has asked you to do so. Allow 1-2 minutes after the first
inhalation to make certain that a second inhalation is necessary.

What if you Miss a Dose

Take it as soon as possible. Then use any regular doses for that day at regularly-spaced intervals.

How to Stop Using this Drug

Do not stop the drug without consulting your doctor.

496 A Lay Person's Guide


Precautions

Be sure to tell your doctor if you have:


- brain damage - diabetes
- enlarged prostate - heart or blood vessel disease
- mental disease - overactive thyroid
- Parkinson’s disease - fits

Pregnancy: Avoid this drug. Safety is not established. Although it can delay labour, it cannot prevent or stop
the labour completely.

Breast feeding: It passes into the breast milk, but does not cause any adverse effect on the nursing baby.
Discuss with your doctor.

Over 60: Increased likelihood of adverse effects. Reduced dose may therefore be necessary.

Driving and Hazardous Activities: Avoid such drugs until you know how the drug affects you before performing
such activities because this drug causes tremors.

Possible Adverse Effects

Symptoms/Effects Frequency What to do


Anxiety Common Discuss with your doctor only if severe
Palpitation " "
Muscle Cramp " "
Tremors " "
Restlessness " "
Headache Rare "
Fast heart beat " Discuss with your doctor in all cases.
Drowsiness " Discuss with your doctor only if severe
Nausea/vomiting " "
Sweating " "
Note: Salbutamol may cause a bad taste in the mouth which will go away once you stop taking it.

Interactions

Drugs/Drug Class Effects Notes

Sympathomimetics (medicines s Increased adverse effects


similar to salbutamol)
Beta blockers (medicines t
or ¯
for high BP.)

Profiles of 50 Drugs 497


TETRACYCLINE

Drug Group: Antibiotic


Principal Uses

It is used in the treatment of certain infections like rickettsial infections, cholera, brucellosis plague,
sexually transmitted diseases (STDs) such as gonorrhoea, and syphilis (when penicillin cannot be used),
pimples and respiratory tract infections (not responding to other antimicrobials). It is used along with other
drugs to treat malaria when chloroquine is not effective as well as problems of the eye such as trachoma,
conjunctivitis and sty.

How this Drug Works

Tetracycline kills bacterial organisms. Increasingly tetracycline resistant bacteria are seen. Doxycycline is the
preferred alternative.

Dosage and Usage Information

Available Dosage Forms: Capsules, tablets, IV injectables

Dosage

Adults: Capsules: 250 mg to 500 mg every six hours.


Note: For brucellosis, it must be used for 6 weeks; for chlamydial infections, it must be used for 2 weeks to 2 months; for STD it must be used
for 15-30 days.

Eye Ointment

Conjunctivitis: 4 times a day for 7-10 days.

Trachoma: 3-4 times a day for 6 weeks.


Note: Not recommended in children below 12 years of age.

How and When to Take

Take with lot of water at least 1 hour before or 2 hours after meals.

Eye ointment: The eye should be thoroughly cleaned with water before every fresh application of ointment.
Do not touch the tip of the applicator to the eye. The tube used for one patient should not be used for
another patient to avoid cross infections.

What if you Miss a Dose

Take as soon as you remember. Space the missed dose and the next dose 6 hours apart.

498 A Lay Person's Guide


How to Stop Using this Drug

Do not stop taking this drug without consulting your doctor. It is necessary to take the full course of
treatment even if you feel better within a few days.

Precautions

Be sure to tell your doctor if you have:

- kidney problems

- liver problems.

Pregnancy: Avoid. It discolours the teeth of the developing baby. Discuss with your doctor.

Breast feeding: It passes into the breast milk and may discolour the infant’s teeth.

Infants and Children: Not recommended for children below 12 years of age.

Diet: Do not take milk or milk products within 1-2 hours of the time you take this drug by mouth since it may
keep this medicine from working well.

Sun: Avoid too much sun or sunlamp unless you know how you react to the sun especially if you tend to burn
as easily. Sun-sensitivity may continue for several months after you stop taking this drug. Consult your doctor
if severe reaction occurs.

Others: Do not use improperly stored preparations or preparations after expiry date.

Possible Adverse Effects

Symptoms/Effects Frequency What to do


Nausea/vomiting Common Discuss with your doctor only if severe
Diarrhoea " "
Light sensitive rash Rare Stop the drug now. Discuss with your doctor
immediately
Rash/itching " "
Liver toxicity “ "
Kidney damage Rare but common "
with outdated/
improperly stored
preparations

Profiles of 50 Drugs 499


Interactions

Drugs/Drug Class Effects Notes


Birth control pills t Use alternative method
Iron ¯
Penicillins Tetracycline interferes with anti-bacterial action of
penicillin
Antacids ¯
Anticoagulants s

VITAMIN A

Drug Group: Vitamins


Principal Uses

It is useful in correcting Vitamin A deficiency.

Symptoms of deficiency : Night blindness (difficulty in seeing in dim light) is an early sign. Others are dry,
rough skin, loss of appetite, diarrhoea, low resistance to diseases, dry and swollen eyes. Severe deficiency
leads to blindness (due to ulcers in the eye) weak bones and teeth.

Night-blindness is the commonest cause of blindness in India and therefore judicious prophylactic
(preventive) use of Vitamin A can reduce the incidence of blindness in India. The government programme
advocates Vitamin A drops every six month till child reaches 5 years of age. It is used as a supplement in the
following conditions when the Vitamin A requirement increases above normal: cystic fibrosis, chronic
diarrhoea, obstruction of bile duct, overactive thyroid gland, long-term and use of lipid (fat) - lowering
drugs.

500 A Lay Person's Guide


Dosage and Usage Information

Available Dosage Forms: Tablets, capsules, syrups, injectables

Usual Dosage: Range 2500 to 200,000 IU (international units)

Normal Daily Requirements

Children 4-6 years of age : 2500 IU per day.


Adult males: 5000 IU per day.
Adult females: 4000 IU per day.
Pregnant females: 5000 IU per day.
Lactating females: 6000 IU per day.

Vitamin A Deficiency Prevention

(W H O Guidelines)

1. Undernourished 20,000 IU once a week


pregnant women
2. Children 1 - 6 years 200,000 IU of Vitamin A orally every 3-6months
3. Infants 6 -12 months 100,000 IU of Vitamin A orally every 3-6months
age and children
weighing less than 8 kg
4. Lactating Mothers 200,000 IU of Vitamin A orally once at delivery or during
(Breast feeding) next 2 months

Vitamin A Deficiency Treatment

1. Adults Immediately 200,000 IU Vitamin A orally


The next day 200,000 IU Vitamin A orally
2 weeks later 200,000 IU Vitamin A orally
2. Children less than Immediately 100,000 IU Vitamin A orally
1 year age and older The next day 100,000 IU Vitamin A orally
children with weight 4 weeks later 100,000 IU Vitamin A orally
less than 8 kg
3. Older children Immediately 200,000 IU Vitamin A orally
and adults The next day 200,000 IU Vitamin A orally
4 weeks later 200,000 IU Vitamin A orally

Profiles of 50 Drugs 501


Why we do not need to give Hepatitis B Vaccine for all newborns :
Letter to Health Minister

Dr. Anbumani Ramadoss cirrhosis and hepato-cellular carcinoma (HCC) is


Cabinet Minister much less than what is generally believed (5).
Ministry of Health & Family Welfare
Government of India, Nirman Bhavan 3) Newborns who get hep.B infection at birth from
New Delhi-110011 their hepB positive mothers have the highest risk of
getting HBeAg infection which the most infectious
Dear Dr. Ramadoss, variety of hep.B infection and which has the highest
chances of becoming carriers (6,7). Prevention of this
Through the news in the Times of India (Sep 6, 2005) perinatal (vertical) transmission from hepatitis-B
'Hepatitis-B threat bigger than AIDS' we came to know positive mothers requires that newborns at risk be
about the decision of the Health Ministry to launch the given the first dose of the vaccine within 12 hours of
programme throughout India to give hepatitis B birth (8). Hence the WHO, the American Academy of
vaccine to all newborns by including it in the National Pediatrics have recommended that for such newborns,
Immunization Programme. This decision seems to be the first dose of hep.B vaccine must be given not later
based on the impression that “hepatitis B is a bigger than 48 hours after birth. In India, since 77% births
problem than AIDS” and the news says, “Ministry take place at home, the first dose of hep.B vaccine
records also say that one in every 20 people in India is a would not be given immediately after birth but 6 weeks
carrier of this deadly virus”. As socially concerned after birth with the first dose of the triple vaccine in the
experts working in the field of Public Health, and National Programme. Hence in this programme 77%
Rational Drug Policy in India, we would like to point of the newborns will not be protected from the
out the following - mother- to-child mode of infection, which is the most
dangerous type of infection.
1) The claim that 4.7% of the Indian population is
chronically infected with hep.B virus is gross 4) If we want to take up Hepatitis B vaccination
overestimation based on a paper, which has programme at all then the Selective Vaccination
surprisingly made an elementary arithmetical mistake Strategy should be used like in other low prevalence
and also has unscientifically assumed that all those who countries like Japan, UK, Netherlands. The Selective
are found to be positive for hep.B infection are chronic Vaccination strategy which consists of identifying the
carriers of this infection. Using the same data correctly HBsAg positive mothers through antenatal screening
the actual 'hep.B carrier rate' works out to be only and vaccinating their newborns within 24 hours of
1.42% (1). The WHO has recommended hep-B birth. In India 2-3 % of mothers are hep.B positive,
vaccination of all newborns only for countries where and this selective strategy would protect about 40% of
this carrier rate is more than 2% (2). the newborns from the risk of HBeAg positivity by
vaccinating only the 3% of the newborns, and this
2) Hepatitis B is much more infectious than HIV. programme would cost one fourth of the Universal
However, whereas untreated HIV infection is 100% Strategy.(9) The cost-efficacy of HB Vaccination
fatal, in case of Hepatitis B infection only 10% of should be measured in terms of cost per highly
infected adults become chronic carriers and the infectious carriers (HBeAg positive) prevented and
average fatality rate due to Hepato Cellular Carcinoma not HBsAg positive carriers prevented. This is because
is much lower than what has been claimed (3). About as mentioned above, HBeAg positive carriers are far
90% of infected infants become carriers. But carriers more dangerous to public health, as they are far more
eliminate the hep B infection at an annual rate of up to infectious and are far more likely to develop serious
2% (4) and the overall incidence of the damage due to chronic liver disease later than mere HBsAg positives.
hep B infection -acute hepatitis, chronic persistent In India, only 65% of women get any health-care
hepatitis (CPH), chronic active hepatitis (CAH), during pregnancy. This highly cost-effective selective

502 A Lay Person's Guide


vaccination programme will not be very effective even References
for control of Hep. B. infection, (leave aside, it's
eradication from India) unless this coverage is 1) Phadke Anant, Kale Ashok. HBV Carrier Rate in India.
substantially improved. Secondly, it will not eradicate Indian Pediatr 2002; 39: 787.
hep B infection. But any way even if all newborns are
2) Ghendon Y. WHO Strategy for the global diminution of
vaccinated in the Universal Vaccination Programme, it
new
will take at least 65 years to eradicate hepatitis-B cases of hepatitis B. Vaccine 1990;8:S129-133
infection in India.
3) Jacob M. Puliyel, Riju Mittal, Vineet Tyagi and Sangeeta
5) With 25 million babies being born every year in Gupta. Routine Hepatitis B Immunization in India: Cost
India, even assuming that the cost of hepB vaccine per
child in this programme to be only Rs. 50/, (i. e. much Effectiveness Needs Reassessment. Indian Journal of
less than the current price), it would cost Rs. 125 crores Pediatrics,
annually for the vaccine alone. This is equal to our Volume 70, February, 2003.
budget for TB-control programme (the number one
4) Mendel (ed.) Infectious Diseases, 3rd edn., 1990, p. 1211-
killer of Indian adults) and is almost equal to the 1215.
combined cost of other 6 vaccines given to infants. The 5) Lodha Rakesh, Jain Yogesh et al. Hepatitis B in India, A
cost efficacy of this programme is also unfavourable - Review of Disease Epidemiology, Indian Pediatrics 2001;
about Rs. 700 per life year saved (10) compared to 38:349-371.
around Rs. 20 per life year saved for the measles
vaccination (11). 6) Harrison's Principles of Internal Medicine, 14th edition,
Eds. Fauci, Braunwald, Isslebacher, et al, .McGraw-Hill,
6) Those medical professionals who come in close 1998,
P 1679.
contact with blood, patients in need of dialysis/
repeated blood transfusion and persons exposed to 7) Diseases of the liver and biliary system. Sheila Sherlock and
unsafe sexual relations should be vaccinated against James Doolley, 9th edition, page 308
hep.B on a priority along with newborns of hepatitis
positive mothers. Giving this vaccine to all newborns, 8) Jordan R, Law M. An appraisal of the efficacy and cost
that too 6 weeks after birth, is neither effective in effectiveness of antenatal screening for hepatitis B. J Med
preventing the most dangerous, mother-to- child Screen 1997;4(3):117-27.
transmission nor is it good economics. It will primarily
benefit the manufacturers of this vaccine who have 9) Kale Ashok, Phadke Anant. Selective Versus Universal
Hepatitis B Vaccination In India. Paediatrics Today, Vol. 4,
succeeded in convincing a section of the medical
July 02, pp.199-207.
professionals through their usual techniques.
10) Aggarwal Rakesh A, Uday G, Subhash N. Assessment of
In view of the very serious, substantial issues cost-effectiveness of universal hepatitis B immunization in a
mentioned above, we request you to stall your decision low-income country with intermediate endemicity using a
to include the hepatitis B vaccination in the National Markov model. J Hepatol; 2003; 38:205-222.
immunization Programme, invite us for a detailed
discussion with the concerned officials/experts in 11) Universal Hepatitis-B Vaccination in India - A
your Ministry and initiate a public debate on this issue Questionable
Strategy; Anant Phadke, Ashok Kale, Peter R Mansfield
before taking a final decision.
(unpublished paper)
Sincerely yours, etc. Source: medico friend circle bulletin, Issue 313-314, October 2005
- January 2006.
cc. The Secretary, Ministry of Health & Family Welfare

Profiles of 50 Drugs 503


Are injections necessary?
Hardly ever !

Courtesy: Indian Academy of Pediatrics

most oral preparations are


as effective as injections

DRUGS ARE RARELY NECESSARY

504 A Lay Person's Guide