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Bluebookcomplete PDF
DRUG FORMULARY
AUGUST 2011
1
DISCLAIMER
Original version of this drug formulary adapted from Pharmaceutical Division Ministry of
Health Malaysia and recompiled to suit the use in Hospital Tengku Ampuan Rahimah, Klang.
No part of this publication may be reproduced, stored or transmitted in any form or by any
means without electronic, mechanical, photocopying, tape recording or other without
written permission of the copyright holder.
2
INTRODUCTION
This is a listing of MOH drug list incorporating the HTAR Formulary which is a subset of the
former. The drugs are listed according to the specialties and are in their non-proprietary
names (generic names). Brand names are included only as reference and are not indicative
of the actual stocks in the hospital. In fact, our policy is to use generics as far as possible in
view of the escalating costs of drugs
This updated August 2011 formulary is an updated version of the July 2007 formulary and
thus supercedes the latter. In line with the concept of “belanja berhemah”, we have
decided not to publish the hard copy HTAR Formulary but rather upload it into the hospital
website.
Please note that the MOH formulary as well as the HTAR formulary is only current at time of
printing and may have changed since. While every effort is made to ensure its currency,
errors and omissions may be expected.
The formulary is not a comprehensive data reference but serves only as a guide.
Use of certain drugs listed in this formulary and use of drugs not listed in this formulary is
not allowed unless specifically approved by the Director General of Health (DG). Drugs
which needs the approval by the DG are those which are :
The secretariet of the Pharmaceutical Services Division will process the request of these
drugs based on the criteria set by the MOH Drug List Review Panel. For any help whatsoever
regarding this issue, please refer to our pharmacists.
Normawati Muhammad
Head of Pharmacy Department,
Hospital Tengku Ampuan Rahimah, Klang
3
CONTENTS
A EMERGENCY 8
Toxicology/antidotes 9
B GASTROINTESTINAL 17
Dyspepsia 18
Antispasmodics and drug altering gutmotility 19
Ulcer-healing drugs 21
Anti diarrheals 27
Laxatives 27
Local preparations for anal and rectal disorders 29
Drugs affecting intestinal secretions 30
Miscellaneous gastro intestinal 31
Antiemetic 33
C CARDIOVASCULAR 39
Positive inotropic agents 40
Diuretics 42
Anti-arrhythmic drugs 45
Beta adrenoceptor blocking drugs 47
Drugs affecting the renin-angiotensin system and other antihypertensives 50
Nitrates, calcum channel blockers and potassium channel activators 60
Sympathomimetics 66
Anticoagulants and protamine 67
Antiplatelet drugs 71
Myocardial infarction and fibrinolysis 73
Lipid regulating drugs 77
Miscellaneous cardiovascular 81
D RESPIRATORY 82
Bronchodilators 83
Corticosteroids 90
Cromoglycate, related therapy and leukotriene receptor antagonists 92
Respiratory stimulants and pulmonary surfactands 93
Miscellaneous respiratory 94
E ANALGESICS 95
Non opioid analgesics 96
Opioid analgesics 98
Non steroidal anti inflammatory drugs (NSAIDS) 106
Neuropathic pain 110
F PSYCHIATRY 111
Hypnotics and anxiolytics 112
Anti psychotics 113
Antidepressant drugs 124
Miscellaneous psychiatric 129
4
G NEUROLOGY 131
Antimigraine drugs 132
Antiepileptics 133
Drugs used in parkinsonism and related disorders 144
Drugs used in substance dependence 150
Drugs for dementia 151
Central nervous system stimulants 152
Miscellaneous neurology 153
H ANTIINFECTIVES 157
Antibacterial drugs 158
Antifungal drugs 185
Antiviral drugs 190
Antiprotozoal drugs 200
Anthelmintics 202
I ENDOCRINE 204
Drugs used in diabetes 205
Thyroid and antithyroid drugs 212
Corticosteroids 215
Sex hormones 218
Hypothalamic and pituitary hormones and antiestrogens 219
Drugs affecting bone metabolism 222
K GENITOURINARY 243
Drugs for urinary retention 244
Drugs for urinary frequency, enuresis and continence 246
Miscellaneous genitourinary 246
5
M HEMATOLOGY/ONCOLOGY 254
Cytotoxic drugs 255
Sex hormones and hormone antagonists in malignant disease 271
Bleeding disorder 273
Miscellaneous harmotology/oncology 273
P RHEUMATOLOGY 299
Antirheumatic 300
Gout 303
Drugs used in neuromuscular disorders 303
Drugs for the relief of soft tissue inflammation 303
Miscellaneous rheumatology 303
Q OPHTHALMOLOGY 305
Anti infective eye preparations 306
Anti infective with steroids 309
Corticosteroids and other anti inflammatory preparations 310
Anti virals 311
Mydriatics and cycloplegics 311
Treatment of glaucoma 313
Local anesthetics 317
Miscellaneous ophthalmology 317
6
S DERMATOLOGY 336
Emollient and barrier preparations 337
Topical local anaesthetics and anti pruritics 337
Topical corticosteroids 339
Preparations for exzema and psoriasis 342
Acne and rasacea 346
Preparations for warts and calluses 348
Shampoos and other preparations for scalp conditions 348
Anti infective skin preparations 349
Disinfectants, skin cleansers and antiseptics 355
Miscellaneous dermatology 358
U ANAESTHESIA 367
Induction/maintenance 368
Neuromuscular blocker 372
Topical anaesthesia 374
Local anaesthesia 376
Miscellaneous anaesthesia 380
V DIAGNOSTIC 382
Radiocontrast media 383
Diagnostic aids and test preparation 383
W MISCELLANEOUS 385
General disinfectant 386
Other disinfectants 386
7
1. EMERGENCY
Toxicology / Antidotes
8
Acetylcysteine 200mg/ml A*
Trade Name : Parvolex
Indication :
Antidote for paracetamol poisoning
Dosage :
Diluted with dextrose 5% and infused IV. Initial, 150 mg/kg IV in 200 ml over 60 minutes, then 50
mg/kg IV in 500 ml over 4 hours, followed by 100 mg/kg IV in 1000 ml over 16 hours. Total dose:
300mg/kg in 20 hour
Precautions :
Asthma, history of bronchospasm and risk of anaphylactoid reactions and history of peptic
ulceration
Adverse Reactions :
Bronchoconstriction, nausea, vomiting, anaphylactic reactions, rash, hypotension, pruritus, rash,
urticaria
Contraindications :
Hypersensitivity to acetylcysteine products
Interactions :
Carbamazepine : increased risk of subtherapeutic carbamazepine levels. Nitroglycerin : enhanced
hypotension and nitroglycerin-induced headache. Penicillin G, tetracycline : loss of antibiotic efficacy
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9
Adverse Reactions :
Anaphylaxis with hypotension, dyspnea, urticaris, Immune hypersensitivity reaction , shock,
transfusion reaction due to serum protein reaction ,serum sickness
Contraindications :
Hypersensitivity to any component of the formulation, unless the benefits outweigh the risks and
appropriate management for anaphylaxis is available
Interactions :
Not known
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10
Calcium Disodium Edetate 200 mg Injection A
Trade Name : Ca Disod. Versenate
Indication :
Lead Poisoning
Dosage :
60 - 70 mg/kg body weight daily given IV infusion in 2 daily doses for up to 5 days; repeated if
necessary after an interval of 2 days. Any further treatment with calcium edetate should not be
recommended for 7 days
Precautions :
Renal impairment, haematuria, proteinuria, cerebral oedema. Capable of producing toxic effects
which can be fatal, patients with lead encephalopathy, administer only after adequate urine flow is
established, children must be given adequate oral fluids during outpatient therapy
Adverse Reactions :
Nephrotoxicity, malaise, chills, thirst, nausea, vomiting, diarrhoea, abdominal pain, injection site
pain, myalgia, headache, hypotension (frequent), thrombophlebitis (frequent), immune
hypersensitivity reaction
Contraindications :
Hypersensitivity to edetate products, anuria or active renal disease, hepatitis
Interactions :
Not known
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11
Charcoal, Activated 250 mg Tablet C
Indication :
i) Diarrhoea and food poisoning ii) Reduce absorption of drugs, plant, inorganic
poison and chemicals in poisoning cases
Dosage :
i) ADULT 0.5-1 g given 3-4 times daily. CHILD half adult dose. ii) Need to be dissolved in liquid (slurry
consistency). ADULT and CHILD over 12 years: initial 30-100 g or 1-2 g/kg; repeat initial dose as soon
as possible or 20-50 g every 2-6 hours. CHILD over 1-12 years, 25-50 g or 1-2 g/kg; may repeat half
the initial dose every 2-6 hour as needed. CHILD to 1 year of age, 1 g/kg; may repeat half the initial
dose every 2-6 hours as needed. For maximum efficacy administer within 1 hour after ingestion of
toxic compound
Precautions :
Aspiration of charcoal, hydrocarbons, corrosive, imaging of gastroesophageal. Caution in patient at
risk of gastrointestinal obstruction
Adverse Reactions :
Black stools and gastrointestinal disturbances
Contraindications :
An unprotected airway, gastrointestinal tract not anatomically intact
Interactions :
Acarbose, carbamazepine, digoxin, frusemide, olanzapine, phenytoin; decreased effectiveness of
these drugs, reduce absorption of oral therapy and render their effectiveness, simultaneous oral
therapy should be avoided. Clear activated charcoal from stomach /avoid its usage if methionine
(specific oral antidote) is to be used
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12
Flumazenil 0.5 mg/5 ml Injection B
Trade Name : Anexate
Indication :
i) Diagnosis and/or management of benzodiazepine overdose due to self-poisoning or accidental
overdose ii) Reversal of sedation following anaesthesia with benzodiazepine
Dosage :
i) Initial, 0.2 mg IV over 30 seconds; if desired level of consciousness not obtained after an additional
30 seconds, give dose of 0.3 mg IV over 30 seconds; further doses of 0.5 mg IV over 30 seconds may
be given at 1-minutes intervals if needed to maximum total dose of 3 mg; patients with only partial
response to 3 mg may require additional slow titration to a total dose of 5 mg; if no response 5
minutes after receiving total dose of 5 mg, overdose is unlikely to be benzodiazepine and further
treatment with flumazenil will not help ii) 0.2 mg IV over 15 seconds; if desired level of
consciousness is not obtained after waiting 45 seconds, a second dose of 0.2 mg IV may be given and
repeated at 60-seconds intervals as needed (up to a maximum of 4 additional times) to a maximum
total dose of 1 mg; most patients respond to doses of 0.6 to 1 mg; in the event of resedation,
repeated doses may be given at 20-minutes intervals if needed; for repeat treatment, no more than
1 mg (given as 0.5 mg/minute) should be given at any one time and no more than 3 mg should be
given in any one hour
Precautions :
Patients with a history of long-term benzodiazepine abuse, head injuries, history of panic disorder,
liver disease, drug and alcohol dependent patients, neuromuscular blocking agents
Adverse Reactions :
Cardiac arrhythmias, bradycardia, dizziness, nausea, vomiting, seizure, injection site pain, headache,
abnormal vision, blurred vision, agitation
Contraindications :
Hypersensitivity to flumazenil/benzodiazepines, cyclic antidepressant overdose, patients who have
been given a benzodiazepine for control of a potentially life-threatening condition (eg, control of
intracranial pressure or status epilepticus)
Interactions :
Thiopental : decreased duration of thiopental anaesthetic effects
----------------------------------------------------------------------------------------------------------------
13
Mesna 400 mg/4 ml Injection A
Trade Name : Uromitexan
Indication :
For prevention of urotoxic effects of oxazaphosphorines e.g. ifosfamide and cyclophosphamide
Dosage :
IV injection at a dosage of 20% of the corresponding oxazaphosphorine dose at the times 0 hour
(concurrently with the oxazaphosphorine), 4 hours and 8 hours thereafter. CHILD: Dose given at
greater frequency (e.g. 6 times) and a shorter intervals (e.g. 3 hours)
Precautions :
Do not use multi-dose vial in infants and neonates due to benzyl alcohol content, patients treated
with mesna may have false positive test for urinary ketones, pregnancy
Adverse Reactions :
Hypotension, nausea, vomiting, headache, limb pain, headache, gastrointestinal effects, skin rash,
diarrhoea, abdominal pain, transient drop in blood pressure, increase in pulse rate
Contraindications :
Hypersensitivity to mesna/other thiol compounds
Interactions :
Warfarin: increased risk of bleeding. In vitro mesna is incompatible with cisplatin. The combination
of an oxazaphosphorine cytostatic agent with mesna and cisplatin in the same infusion solution is
not stable and is not to be used
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14
Precautions :
Dependence may precipitate withdrawal symptoms, concurrent cardiotoxic drugs, pre-existing
cardiac disease, narcotic dependency, pregnancy, lactation, neonates
Adverse Reactions :
Opiate withdrawal symptoms, nausea, vomiting, tachycardia, tremor, sweating, pulmonary oedema,
hyperventilation, cardiac dysrhythmia, biliary colic, dysphagia, memory impairment, seizure,
agitation, dyspnea, laryngeal spasm, pulmonary edema, tachyarrhythmia
Contraindications :
Hypersensitivity to naloxone
Interactions :
Clonidine: hypertension
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16
2. GASTRO-INTESTINAL
Dyspepsia
Antispasmodics and drugs altering gut motility
Ulcer-healing drugs
Antidiarrheals
Laxatives
Local preparations for anal and rectal disorders
Drugs affecting intestinal secretions
Antiemetics
Miscellaneous gastrointestinal
17
Magnesium Trisilicate Mixture C
Indication :
Heartburn, dyspepsia
Dosage :
10-20 ml 3-4 times daily before meals
Precaution:
Renal impairment-nonabsorbable calcium, magnesium or aluminum preparations such as antacids or
laxatives should not be used in patients receiving oral cation-exchange resins. Alternatively, the
interaction may be avoided by administering the resin as an enema
Adverse Drug Reaction:
Diarrhoea, systemic alkalosis has been reported when administered orally with cation-exchange
resins
Contraindication:
Acute surgical abdomen, hypersensitivity to antacids, hypophosphataemia
Interaction:
Major: sodium polystyrene sulfonate (advoid). Moderate: tetracyclines, ketoconazole, itraconazole,
dipyridamole, quinolones, captopril, iron and aspirin (adjust frequency interval)
----------------------------------------------------------------------------------------------------------------
18
Interaction:
Major: sodium polystyrene sulfonate (systemic alkalosis). Minor: amphetamine, aspirin,
chlorpropamide, itraconazole, ketoconazole, lithium, pseudoephedrine
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Domperidone 10 mg Tablet B
Trade Name : Motilium
Indication :
Nausea, vomiting, dyspepsia, gastro-esophageal reflux
Dosage :
Chronic dyspepsia ADULT 10 mg 3 times daily. Acute and subacute conditions
(particularly nausea and vomiting):ADULT 20 mg 3-4 times daily
19
Precaution:
Dosage adjustment may be necessary in patients who are receiving domperidone concomitantly
with cimetidine,pregnancy, lactation
Adverse Drug Reaction:
Mild abdominal cramps, raised serum prolactin level
Contraindication:
Known hypersensitivity to domperidone or any of the excipients. Prolactin-releasing pituitary
tumour(prolactinoma.) Should not be used when stimulation of gastric motility could be harmful:
gastro-intestinal haemorrhage, mechanical obstruction or perforation
Interaction:
MAOIs, antacids, antisecretory drugs, azole antifungals, macrolide antibiotics, HIV protease
inhibitors, anticholinergic drugs, CYP3A4 inhibitors. Antacids or antisecretory agents should be taken
after meals when used concomitantly
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20
Contraindication:
Obstructive disease of the gastrointestinal or urinary tract, narrow-angle glaucoma, cardiac
tachyarrhythmias, myasthenia gravis, prostatic hypertrophy with urinary retention, paraben allergy
(multi-dose vial for injection contains parabens)
Interaction:
Intensifies anticholinergic effects of tricyclic antidepressants, antihistamines, quinidine, amantadine
and disopyramide. Enhances tachycardic effects of beta-adrenergic agents. Dopamine antagonist eg
metoclopramide reduces effects of both drugs on gastrointestinal tract
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Esomeprazole 20 mg Tablet A*
Esomeprazole 40 mg Tablet A*
Trade Name : Nexium
Indication :
i)Gastro-oesophageal reflux disease ii)H. pylori eradication
Dosage :
i)20mg daily for 4-8 weeks ii)40mg daily for 10 days in combination with amoxicillin 1g twice daily or
clarithromycin 500mg twice daily
Precaution:
Exclude gastric malignancy prior to treatment. Severe renal or hepatic insufficiency. Pregnancy;
lactation (discontinue). Long-term treatment should be kept under regular surveillance. Fructose
intolerance, glucose-galactose malabsorption or sucrase-isomaltase insufficiency. Monitoring when
initiating and ending concomitant treatment with warfarin.Severe liver impairment, Hypersensitivity
reactions e.g., angioedema and anaphylactic reaction/shock have been reported
Adverse Drug Reaction:
Abdominal pain , constipation , diarrhoea , dyspepsia , flatulence , nausea , dizziness, headache
erythema multiforme , Stevens-Johnson syndrome, toxic epidermal necrolysis, dermatitis
Contraindication:
Hypersensitivity to esomeprazole, in patients with known hypersensitivity to any component of the
formulation
Interaction:
Citalopram, imipramine, clomipramine, phenytoin, diazepam, ketoconazole , itraconazole, warfarin,
effects on absorption, effects on hepatic metabolism/cytochrome P-450 pathways,clarithromycin
and amoxicillin (increase esomeprazole and 14-hydroxyclarithromycin plasma level)
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21
Esomeprazole 40 mg Injection A*
Trade Name : Nexium
Indication :
i) Acute erosive/ ulcerative oesophagitis ii) Non -variceal upper gastrointestinal bleed
Dosage :
i) 20- 40 mg once daily for 2-5 days ii) 80 mg by IV bolus followed by 8mg/hour infusion for 72 hours
Precaution:
Exclude gastric malignancy prior to treatment. Severe renal or hepatic insufficiency. Pregnancy;
lactation (discontinue). Long-term treatment should be kept under regular surveillance. Fructose
intolerance, glucose-galactose malabsorption or sucrase-isomaltase insufficiency. Monitoring when
initiating and ending concomitant treatment with warfarin. Severe liver impairment
Adverse Drug Reaction:
Abdominal pain , constipation , diarrhoea , dyspepsia , flatulence , nausea , dizziness, headache
erythema multiforme , Stevens-Johnson syndrome, toxic epidermal necrolysis, dermatitis
Contraindication:
Hypersensitivity to esomeprazole in patients with known hypersensitivity to any component of the
formulation
Interaction:
Citalopram, imipramine, clomipramine, phenytoin, diazepam, ketoconazole , itraconazole,
warfarin,effects on absorption, effects on hepatic metabolism/cytochrome P-450
pathways,clarithromycin and amoxicillin (increase esomeprazole and 14-hydroxyclarithromy)
--------------------------------------------------------------------------------------------------------------------------------
Lansoprazole 30 mg Tablet A*
Trade Name : Prevacid
Indication :
i) Peptic ulcer disease ii) Reflux oesophagitis iii) Zollinger-Ellison Syndrome iv) For eradication of
Helicobacter pylori in combination with antibiotic
Dosage :
i) 30 mg daily for 8 weeks ii) 30 mg once 1-2 times daily for 4-8 weeks iii) 60-120mg once daily
adjusted according to the patient's response iv) 30 mg twice daily in combination with any of the 2
antibiotics (clarithromycin 500 mg twice daily , amoxicillin 1 g twice daily or metronidazole 400 mg
twice daily) for 1-2 weeks
Precaution:
Hepatic impairment, elderly, pregnancy, lactation
Adverse Drug Reaction:
Agitation, constipation, diarrhoea, dry mouth, abdominal distension, headache, sleepiness,
insomnia, dizziness, rash, pruritus, fever
Contraindication:
Hypersensitivity to lansoprazole, in patients with known hypersensitivity to any component of the
formulation
Interaction:
May retard metabolism and excretion of diazepam and phenytoin. May decrease plasma
concentration of theophylline, inhibition of gastric acid secretion may interfere with dissolution of
the drug
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22
Omeprazole 20 mg Capsule A
Trade Name : Losec
Indication :
Only for : i)Reflux oesophagitis ii)For eradication of Helicobacter pylori infection iii)Benign peptic
ulcer not responding to conventional therapy iv)Zollinger-Ellison Syndrome
Dosage :
i)20 - 80 mg 1 - 2 times daily up to 8 - 12 weeks ii)20 mg twice daily in combination with any of the 2
antibiotics (clarithromycin 500 mg twice daily, amoxicillin 1 g twice daily or metronidazole 400 mg
twice daily)for 1 - 2 weeks iii) 20 mg once daily for 4 - 6 weeks iv) ADULT: 20 - 120 mg once daily
adjusted according to the patient's response. CHILD 0.4 - 0.8 mg/kg/day
Precaution:
Proton pump inhibitors reduce gastric acidity and increase the risk of gastrointestinal infections. It
may mask symptoms of gastric cancer (exclude malignancy in suspected gastric ulcers)
Adverse Drug Reaction:
Gastrointestinal effects such as diarrhoea, nausea and constipation, headache, cough, upper
respiratory tract infection, rash
Contraindication:
Hypersensitivity to omeprazole or to any of its components
Interaction:
May prolong elimination of diazepam, warfarin and phenytoin. Increases plasma concentration of
clarithromycin, ketoconazole
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Omeprazole 40 mg Injection A*
Trade Name : Losec
Indication :
i) Reflux oesophagitis, eradication of H. Pylori infection, benign peptic ulcer not responding to
conventional therapy, Zollinger-Ellison Syndrome ii) Endoscopically confirmed peptic ulcer
Dosage :
i) 40 mg IV once daily when oral therapy is inappropriate ii) 40- 160 mg by IV in single or divided
doses
Precaution:
Proton pump inhibitors reduce gastric acidity & increase the risk of GI infections. It may mask
symptoms of gastric cancer (exclude malignancy in suspected gastric ulcers)
Adverse Drug Reaction:
GI effects such as diarrhoea, nausea & constipation, headache, cough, upper respiratory tract
infection, rash
Contraindication:
Hypersensitivity to omeprazole or to any of its components
Interaction:
May prolong elimination of diazepam, warfarin & phenytoin. Increases plasma concentration of
clarithromycin, ketoconazole
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Pantoprazole 40 mg Injection A*
Trade Name : Controloc
Indication :
Bleeding peptic ulcer and acute stress ulceration
Dosage :
40 mg twice daily until oral administration can be resumed. CHILD not recommended
23
Precaution:
Proton pump inhibitors reduce gastric acidity and increase the risk of gastrointestinal infections. It
may mask symptoms of gastric cancer (exclude malignancy in suspected gastric ulcers)
Adverse Drug Reaction:
Gastrointestinal disturbances (nausea and vomitting, diarrhoea, constipation, upper abdominal pain,
flatulence) skin rash, pruritus, dizziness, oedema, fever, depression, vision disturbances, headache,
liver enzyme changes, raised triglycerides
Contraindication:
Pregnancy, lactation, moderate to severe hepatic or renal impairment. Patients with known
hypersensitivity to any component of the formulation
Interaction:
May affect absorption of drugs which are pH-dependant in patients with known hypersensitivity to
any component of the formulation
------------------------------------------------------------------------------------------------------------------------------
Pantoprazole 40 mg Tablet A*
Trade Name : Controloc
Indication :
i) Helicobacter pylori eradication ii) Peptic ulcer disease iii) Erosive and non-erosive reflux
oesophagitis (GERD and NERD) iv) Zollinger-Ellison Syndrome v) Prevention of NSAID induced
gastropathy
Dosage :
i) 40 mg twice daily in combination with any of the 2 antibiotics (Clarithromycin 500 mg twice daily,
Amoxicillin 1 g twice daily or Metronidazole 400 mg twice daily) for 1-2 weeks ii) 40 mg daily for 2 - 4
weeks iii) 20 - 40 mg daily on morning for 4 weeks iv) 40 mg twice daily. Maximum: 240 mg daily v)
20 mg daily. CHILD not recommended
Precaution:
Proton pump inhibitors reduce gastric acidity and increase the risk of gastrointestinal infections. It
may mask symptoms of gastric cancer (exclude malignancy in suspected gastric ulcers)
Adverse Drug Reaction:
Gastrointestinal disturbances (nausea and vomitting, diarrhoea, constipation, upper abdominal pain,
flatulence) skin rash, pruritus, dizziness, oedema, fever, depression, vision disturbances, headache,
liver enzyme changes, raised triglycerides
Contraindication:
Pregnancy, lactation, moderate to severe hepatic or renal impairment. Patients with known
hypersensitivity to any component of the formulation
Interaction:
May affect absorption of drugs which are pH-dependant in patients with known hypersensitivity to
any component of the formulation
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24
Adverse Drug Reaction:
Agranulocytosis, thrombocytopenia, hepatic dysfunction, jaundice, interstitial pneumonia,
abdominal pain, diarrhoea, oedema, headache, dizziness, rash
Contraindication:
Hypersensitivity to rabeprazole or substituted benzimidazoles
Interaction:
Ampicillin, digoxin, iron, itraconazole, ketoconazole, warfarin
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25
Adverse Drug Reaction:
Gastrointestinal disturbances, diarrhoea, altered liver function tests (rarely liver damage), headache,
dizziness, rash and tiredness. Rare side-effects include acute pancreatitis, bradycardia, AV block,
confusion, depression and hallucinations particularly in the elderly or the very ill, hypersensitivity
reactions (including fever, arthralgia, myalgia, anaphylaxis), blood disorders (including
agranulocytosis, leucopenia, pancytopenia, thrombocytopenia) and skin reactions (including
erythema multiforme and toxic epidermal necrolysis). There have been occasional reports of
gynaecomastia and impotence
Contraindication:
Hypersensitivity to ranitidine
Interaction:
Absorption may be reduced by concomitant administration with high doses (2 g) of sucralfate
------------------------------------------------------------------------------------------------------------------------------
Sucralfate 1 g Tablet A
Indication :
i) Benign gastric and duodenal ulceration ii) Stress ulcer prophylaxis
Dosage :
i) 2 g twice daily or 1 g 4 times daily for 4-6 weeks or in resistant cases up to 12 weeks (maximum 8 g
daily) ii) 1 g 6 times daily (maximum 8 g daily). CHILD not recommended
Precaution:
Chronic renal failure and on dialysis (avoid if severe), pregnancy, breast feeding. Administration of
sucralfate and enteral feeds should be separated by 1 hour dosing
Precaution:
Chronic renal failure and on dialysis (avoid if severe), pregnancy, breast feeding. Administration of
sucralfate and enteral feeds should be separated by 1 hour dosing
26
Adverse Drug Reaction:
Constipation, diarrhoea, nausea, gastric discomfort, indigestion, dry mouth, drowsiness, dizziness,
skin rash, hypersensitive reaction including pruritus, back pain, vertigo
Contraindication:
Hypersensitivity to sucralfate products
Interaction:
Reduced the extent of absorption (bioavailability). Fluoroquinolones, tetracycline, warfarin,
phenytoin, ketoconazole, lansoprazole, digoxin, ranitidine, cimetidine, theophylline and
levothyroxine
--------------------------------------------------------------------------------------------------------------------------
Bisacodyl 10 mg Suppository C
Trade Name : Dulcolax
Indication :
i) Constipation ii) Bowel preparation for radiological procedures and surgery
Dosage :
i) ADULT and CHILD over 10 years: 10 mg, CHILD less than 10 years 5 mg insert rectally ii) ADULT 10-
20 mg, CHILD over 4 years 5 mg the following morning before procedures insert rectally
Precaution:
Prolonged use, abdominal pain, inflammatory bowel disease, sudden, persistent change in bowel
habits and ulcerated haemorrhoids of rectal fissures
Adverse Drug Reaction:
Rarely,electrolyte and fluid imblances, abdominal discomfort, diarrhoea, rectal burning, vomiting
Contraindication:
Ileus, intestinal obstruction, acute abdominal conditions, rectal bleeding, appendicitis
Interaction:
Milk, antacids, warfarin
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27
Bisacodyl 5 mg Tablet C
Trade Name : Dulcolax
Indication :
i) Constipation ii) Bowel preparation for radiological procedures and surgery
Dosage :
i) ADULT and CHILD over 10 years 5-10 mg, CHILD 4-10 years 5 mg. To be taken at night for effect on
the following morning ii) ADULT 10-20 mg the night before procedures, CHILD over 4 years 5 mg the
night before procedures
Precaution:
Prolonged use, abdominal pain, inflammatory bowel disease, sudden, persistent change in bowel
habits
Adverse Drug Reaction:
Rarely,electrolyte and fluid imblances, abdominal discomfort, diarrhoea, rectal burning, vomiting
Contraindication:
Ileus, intestinal obstruction, acute abdominal conditions, rectal bleeding, appendicitis
Interaction:
Milk, antacids, warfarin
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28
Liquid Paraffin C
Indication :
Constipation
Dosage :
ADULT 10-30 ml daily at night but should not be taken immediately before going to bed. CHILD not
recommended
Precaution:
Avoid prolong use, patients with with recent change of bowel habits or suspected bowel malignancy
and rectal bleeding
Adverse Drug Reaction:
Anal seepage of paraffin and consequent anal irritation after prolonged use, granulomatous
reactions caused by absorption of small quantities of liquid paraffin, lipoid pneumonia and
interference with the absorption of fat soluble vitamins
Contraindication:
Nausea, vomiting, undiagnosed abdominal pain, pregnancy, difficulty swallowing, bedridden
patients, children less than 3 years
Interaction:
May impair the absorption of fat soluble vitamin
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29
Lignocaine, Aluminium Acetate, Zinc Oxide and Hydrocortisone Ointment A/KK
Trade Name : Xyloproct
Indication :
Anorectal pain, pruritis, inflammation and irritation
Dosage :
Apply once or twice daily. Not for prolonged use
Precaution:
Children less than 12 years, traumatised mucosa, sepsis in anorectal region or suspected herpes
simplex infection
Adverse Drug Reaction:
Dry skin, pruritus, irritation, transient burning/stinging and atrophy of anal skin
Contraindication:
Hypersensitivity to local anaesthetics or to other components of the product
Interaction:
With large doses of lidocaine, risk of additional systemic toxicity in patients receiving other local
anaesthetics
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30
Radio-opaque stones, pregnancy, non-functioning gall bladder, chronic liver disease, peptic
ulceration, inflammatory diseases and other conditions of the small intestine, colon and liver which
interfere with enterohepatic circulation of bile salts
Interaction:
Absorption decreased by cholestyramine, colestipol or aluminium hydroxide containing antacids.
Should not be used with drugs such as oestrogenic hormones that increase bile cholesterol
----------------------------------------------------------------------------------------------------------------------------------
31
Precaution:
Aluminium hydroxide may react with phosphate to form insoluble aluminium phosphate. This can be
overcome by regular intake of milk or phosphorus supplements. Elevated serum magnesium ion
concentration may cause central nervous system depression. Impaired bowel motility,
gastrointestinal obstruction, upper gastrointestinal bleeding
Adverse Drug Reaction:
Gastrointestinal disturbances (constipation or diarrhoea), hypophosphatemia, seizures (serious)
Contraindication:
Severe debilitation, kidney failure
Interaction:
Inhibits absorption of tetracyclines, vitamin
--------------------------------------------------------------------------------------------------------------------------
32
Adverse Drug Reaction:
Nausea, anorexia, fever, blood disorders (megaloblastic anaemia), hypersensitivity reactions
(including exfoliative dermatitis, epidermal necrolysis, pruritus, photosensitisation, anaphylaxis,
serum sickness, ocular complications (including periorbital oedema), stomatitis, parotitis, ataxia,
aseptic meningitis, vertigo, tinnitus, insomnia, depression, hallucinations, kidney reactions (including
proteinuria, crystalluria, haematuria), oligospermia, urine may be coloured orange, bone marrow
depression, peripheral neuropathy
Contraindication:
Hypersensitivity to sulfonamides and salicylates, acute intermittent porphyria and children less than
2 years
Interaction:
Reduced absorption of folate, digoxin, antibacterial
----------------------------------------------------------------------------------------------------------------
33
Precaution:
Moderate to severe liver impairment, pregnancy. Caution is advised both during and up to 2 weeks
after the end of treatment due to the inhibitory and inductive effects of aprepitant on CYP3A4
substrates
Adverse Drug Reaction:
Hiccups, asthenia or fatigue, increased ALT/AST, constipation, diarrhea, dyspepsia, eructation,
headache, dizziness, anorexia, Stevens-Johnson syndrome and somnolence
Contraindication:
Hypersensitivity, breastfeeding, concurrent use of pimozide, terfenadine, astemizole, cisapride
Interaction:
Alfuzosin, alprazolam, astemizole, carbamazepine, cisapride, clarithromycin, dexamethasone,
diltiazem, eletriptan, ethinyl estradiol, etonogestrel, fentanyl ,ifosfamide, imatinib, irinotecan,
iraconazole, ketoconazole, levonorgestrel, medroxyprogesterone, methylprednisolone, midazolam,
norethindrone, norgestrel, paclitaxel, paroxetine, phenytoin, rifampin, ritonavir, etrfenadine,
tolbutamide, vinblastine ,vincristine, liposome vinorelbine, warfarin
--------------------------------------------------------------------------------------------------------------------------------------
34
Contraindication:
Hypersensitivity to granisetron and other 5-HT3 receptor antagonists. Injection contains benzyl
alcohol and should not be used in neonates
Interaction:
Cytochrome P450 effect (minor). Apomorphine
----------------------------------------------------------------------------------------------------------------
36
Interaction:
Increased absorption of aspirin, paracetamol, tetracycline, levodopa, ethanol, cyclosporine, opioid
analgesics and antimuscarinics antagonise effect on gastro-intestinal activity, antipsychotics
(increased risk of extrapyramidal effects). Decrease absorption of digoxin, antagonized by
anticholinergic drugs and narcotic analgesics. Additive sedative effects with alcohol, sedatives,
hypnotics, narcotics or tranquilizers
--------------------------------------------------------------------------------------------------------------------------------------
37
Adverse Drug Reaction:
Extrapyramidal symptoms, drowsiness, postural hypotension, coma, neuroleptic malignant
syndrome, cholestatic jaundice, leucopenia and agranulocytosis, constipation, dry mouth, urinary
retention, liver damage and insomnia
Contraindication:
CNS depression or coma, bone marrow depression, phaeochromocytoma, hypersensitivity to
phenothiazines, comatose states, cardiovascular collapse
Interaction:
Tramadol, increased risk of seizures. Procyclidine, decreased phenothiazine serum concentrations,
decreased phenothiazine effectiveness, enhanced anticholinergic effects (ileus, hyperpyrexia,
sedation, dry mouth). Levodopa, loss of levodopa efficacy. Ethanol, increased central nervous system
depression and an increased risk of extrapyramidal reactions
----------------------------------------------------------------------------------------------------------------
38
3. CARDIOVASCULAR
Positive inotropic drugs
Diuretics
Anti-arrhythmic drugs
Beta-adrenoceptor blocking drugs
Drugs affecting the renin-angiotensin system and some other
antihypertensive drugs
Nitrates, calcium-channel blockers, and potassium-channel activators
Sympathomimetics
Anticoagulants and protamine
Antiplatelet drugs
Mycocardial infarction and fibrinolysis
Antifibrinolytic drug and haemostatics
Lipid regulating drugs
Miscellaneous cardiovascular
39
Digoxin 0.25 mg Tablet B
Trade Name : Lanoxin
Indication :
Heart failure , with atrial fibrillation, supraventricular arrhythmias (particularly, atrial fibrillation)
Dosage :
Rapid digitalisation: 1-1.5 mg in divided doses over 24 hours; less urgent digitalisation, 250 mcg-500
mcg daily (higher dose may be divided). Maintenance : 62.5mg -500 mcg daily (higher dose may be
divided) according to renal function and , in atrial fibrillation, on heart rate response; usual range,
125-250 mcg daily (lower dose may be appropriate in elderly)
Precaution:
Acute myocardial infarction, acute myocarditis, amyloid cardiomyopathy, AV block. Chronic
constrictive pericarditis, electrolyte imbalance (eg. hypokalaemia, hypocalcaemia or hypercalcaemia,
hypomagnesaemia), hypothyroidism, hypoxia, idiopathic hypertrophic subaortic stenosis. Renal
disease, severe bradycardia, severe heart failure and pulmonary disease, ventricular tachycardia and
Wolff-Parkinson-White syndrome
Adverse Reaction:
Nausea, vomiting, anorexia, diarrhoea, abdominal pains, salivation, sweating; headache, facial pain,
malaise, fatigue, drowsiness, depression, disorientation, mental confusion, delirium, hallucination,
visual disturbance.Hypokalaemia. Ventricular premature contractions, atrial or ventricular
arrhythmias and conduction defects
Contraindication:
Ventricular fibrillation, ventricular tachycardia except in certain cases, digitalis toxicity, beriberi heart
disease, hypersensitivity to digoxin, some cases of hypersensitive carotid sinus syndrome
Interaction:
Plasma concentration increased by quinidine, verapamil, nifedipine, amiodarone. Hypokalaemia may
be associated with diuretics, lithium, carbenoxolone, corticosteroids. Antacids, neomycin may
reduce serum level of digoxin
----------------------------------------------------------------------------------------------------------------
40
Contraindication:
Ventricular fibrillation, ventricular tachycardia except in certain cases, digitalis toxicity, beriberi heart
disease, hypersensitivity to digoxin, some cases of hypersensitive carotid sinus syndrome
Interaction:
Plasma concentration increased by quinidine, verapamil, nifedipine, amiodarone. Hypokalaemia may
be associated with diuretics. Antacids and neomycin may reduce serum level of digoxin. Lithium,
carbenoxolone, corticosteroids
----------------------------------------------------------------------------------------------------------------
42
Bumetanide 0.5 mg/ml Injection A*
Trade Name : Burinex
Indication :
Oedema used in furosemide allergic patient
Dosage :
IV injection: 1 - 2 mg repeated after 20 mins. IV infusion: 2 - 5 mg over 30 - 60 mins
Precautions:
Alterations in glucose metabolism, blood dyscrasias (thrombocytopenia), hepatic disease,
hyperuricaemia, hypokalaemia, hypovolaemia, ototoxicity particularly potentiation of
aminoglycoside ototoxicity, coadministration not recommended
Adverse Reaction:
Hypokalaemia, hyperuricaemia, muscle cramps, arthralgias
Contraindications:
Hypersensitivity to bumetanide products, anuria, severe electrolyte imbalance, hepatic coma
Interactions:
Amikacin, angiotensin converting enzyme inhibitors, digitoxin, digoxin, gentamicin, kanamycin,
lithium, neomycin, netilmicin, nonsteroidal antiinflammatory agents, streptomycin, tobramycin
----------------------------------------------------------------------------------------------------------------
Furosemide 40 mg Tablet B
Trade Name : Lasix
Indication :
Pulmonary oedema
43
Dosage :
ADULT: Initial 40 - 80 mg on morning if required, can be increased to a max of 1 g/day in certain
cases especially in chronic renal failure. CHILD : 1 - 3 mg/kg daily
Precautions:
Alterations in blood glucose and glucose tolerance tests. Diabetes mellitus, electrolyte imbalance
(eg, hypokalaemia, hyponatraemia), fluid imbalance, dehydration, blood volume reduction with
circulatory collapse and possible vascular thrombosis and emboli may occur with excessive diuresis
especially in elderly patients. Gout or hyperuricaemia. Hepatic disease (cirrhosis and ascites).
Hypersensitivity to sulfonamides. Ototoxicity (hearing loss, tinnitus), systemic lupus erythematosus
Adverse reaction:
Hypokalaemia, hyperuricaemia, hypotension, hyperglycaemia
Contraindications:
Anuria, hypersensitivity to furosemide, hepatic coma and pre-coma. Severe hypokalaemia, severe
hyponatraemia, hypovolaemia with or without concomitant hypotension
Interactions:
Activated charcoal, amikacin, gentamicin, kanamycin, angiotensin converting enzyme inhibitors,
aspirin, chloral hydrate, digoxin steroids, NSAIDs
----------------------------------------------------------------------------------------------------------------
Hydrochlorothiazide 50 mg Tablet B
Indication :
Diuretic, hypertension
Dosage :
ADULT: Diuretics; 25-200 mg daily. Hypertension 12.5-25 mg daily CHILD: Oedema and hypertension;
Adjunct; 1 to 2 mg/kg ORALLY daily in single or two divided doses; Children 2-12 years old MAX dose,
not to exceed 100 mg ORALLY daily; Infants less than 6 months old, may require doses up to 3 mg/kg
ORALLY daily in two divided doses, Infants up to 2 yrs old: MAX dose, not to exceed 37.5 mg ORALLY
daily
Precautions:
Renal or hepatic impairment, pregnancy and lactation, elderly, debilitated patients, syndrome lupus
erythematous. Monitor fluid and electrolytes, bronchial asthma
Adverse Reaction:
Metabolic disturbances, electrolyte imbalance, anorexia, gastrointestinal disturbances, headache,
dizziness, postural hypotension, paresthesia, impotence, yellow vision, hypersensitivity. Rarely
cholestatic jaundice, pancreatitis, blood dyscrasias
Contraindications:
Anuria, concurrent lithium therapy, renal decompensation
Interactions:
May enhance toxicity of digitalis glycosides, neuromuscular-blocking action of competitive muscle
relaxants, effect of antihypertensives. Increased risk of postural hypotension with alcohol,
barbiturates, opioids. Potassium-depleting effect enhanced by corticosteroids, ACTH, carbenoxolone
----------------------------------------------------------------------------------------------------------------
Spironolactone 25 mg Tablet B
Trade Name : Aldactone
Indication :
Oedema and ascites in cirrhosis of the liver, congestive heart failure
Dosage :
ADULT: 100 - 200 mg daily in divided doses. Increase to 400 mg if required. CHILD: initially 3 mg/kg
daily in divided doses
Precautions:
Hyperkalaemia or progressive renal failure, impaired hepatic or renal function, diabetes mellitus,
patients likely to develop acidosis. Pregnancy and lactation
Adverse Reaction:
Headache, drowsiness, gastrointestinal disturbances including cramp and diarrhoea, ataxia, mental
confusion, hirsutism, deepening of the voice, menstrual irregularities, impotence, skin rashes,
hyponatraemia, hyperkalaemia
Contraindications:
Hypersensitivity, hyperkalaemia, renal failure, anuria, patients receiving other potassium-sparing
diuretics or potassium supplements
Interactions:
Angiotensin converting enzyme inhibitors, ciclosporin: hyperkalaemia. Aspirin: decreased
spironolactone effectiveness. Digoxin: digoxin toxicity (nausea, vomiting, cardiac arrhythmias).
NSAIDs: reduced diuretic effectiveness, hyperkalaemia
----------------------------------------------------------------------------------------------------------------
45
Adverse Reaction:
Facial flush, dyspnoea, a feeling of thorasic constriction, nausea, lightheadedness, feeling of
discomfort, sweating, palpitations, hyperventilation, head pressure, apprehension, blurred vision,
burning sensation, bradycardia, chest pains, headache, dizziness, heaviness in arms, arm, back and
neck pains; metallic taste
Contraindications:
Bradycardia, bronchoconstrictive or bronchospastic lung disease (eg. asthma). Hypersensitivity to
adenosine, second-degree or third-degree AV block (unless pacemaker fitted), sinus node disease
(eg. sick sinus syndrome)
Interactions:
Actions may be potentiated by dipyridamole and carbamazepine. Theophylline & caffeine inhibit its
action
----------------------------------------------------------------------------------------------------------------
46
Adverse Reaction:
Reversible corneal microdeposits; colored halos. Hyper or hypothyroidism. Rarely;
photosensitization and pigmentation. Reversible diffuse interstitial pneumopathy or peripheral
neuropathy
Contraindications:
Cardiogenic shock, hypersensitivity to amiodarone, second or third degree AV block (if no
pacemaker is present). Severe sinus bradycardia and severe sinus-node dysfunction
Interactions:
Antiarrhythmics, beta-blockers, stimulating laxatives, diuretics inducing hypokalaemia, systemic
corticosteroids, tetracosactide, amphotericin B, digitalis, anticoagulants, phenytoin, general
anaesthetics, ciclosporin
----------------------------------------------------------------------------------------------------------------
Carvedilol 25 mg Tablet A*
Carvedilol 6.25 mg Tablet A*
Trade Name : Dilatrend
Indication :
Treatment of stable moderate to severe congestive cardiac failure in addition to ACEI's and diuretics
Dosage :
3.125 mg twice daily for 2 weeks, then 6.25 mg twice daily for 2 weeks, then 12.5 mg twice daily for
2 weeks then 25 mg twice daily (titrated up to the highest tolerated level)
Precautions:
Avoid abrupt withdrawal, gradual withdrawal over a period of 1 to 2 weeks is recommended.
Bronchospastic disease, congestive heart failure, diabetes mellitus
Adverse Reaction:
Dizziness, headache, tiredness, gastrointestinal disorders, flu-like symptoms
Contraindications:
Hypersensitivity to carvedilol, asthma, bradycardia, 2nd and 3rd degree AV block, cardiogenic shock
overt cardiac failure, obstructive airway disease, severe chronic heart failure and hepatic impairment
Interactions:
Hypotensive effects potentiated by adrenergic neurone-blocking drugs, catecholamine depletors,
central nervous system depressants, diuretics and vasodilators. Action decreased by rifampicin.
Concurrent administration with cardiac glycosides may cause a sharp drop in heart rate
----------------------------------------------------------------------------------------------------------------
48
Labetalol HCl 100 mg/20 ml Injection B
Trade Name : Trandate
Indication :
Hypertension crisis
Dosage :
ADULT: Bolus injection 50 mg IV for at least 1 min. Max: 200 mg. IV infusion, dilute 2 amps to 200ml
with sodium chloride and dextrose injection or 5% dextrose IV infusion, Hypertension of pregnancy;
20mg per hour doubled every 30 min to max 160 mg per hour
Precautions:
Anaesthesia/surgery, including when used in cases to control bleeding (myocardial depression).
Avoid abrupt withdrawal; gradual withdrawal over a period of 1 to 2 weeks is recommended.
Bronchospastic disease, congestive heart failure, diabetes mellitus
Adverse Reaction:
Hypotension, bradycardia, nausea, vomiting
Contraindications:
Hypersensitivity to labetalol products, bradycardia, asthma/obstructive airway disease, cardiogenic
shock, heart block overt cardiac failure
Interactions:
Alpha-1 adrenergic blockers, amiodarone, bepridil, cimetidine, clonidine, digoxin, dihydropyridine,
calcium channel blockers, diltiazem, enflurane, epinephrine, flunarizine, halothane, hypoglycemic
agents, imipramine, isoflurane, lidoflazine, methyldopa, verapamil
----------------------------------------------------------------------------------------------------------------
49
Dosage :
i) Initially 80 mg twice daily increased as required to a usual range of 160 - 320 mg daily. CHILD:
Initial doses of 1 mg/kg in divided doses, can be increased to 2 - 4 mg/kg/day in divided doses ii)
Initial dose of 40 mg 2 - 3 times daily. Maintenance 120 - 240 mg daily iii) 40mg 4 times daily for 2 - 3
days then 80 mg twice daily, beginning 5 - 21 days after infarction iv) 10 - 40 mg 3 - 4 times daily v)
Initially 40 mg twice daily. The dose may be increased as required up to 160 mg twice daily vi) Initial
prophylaxis dose: 40 mg 2 - 3 times daily. The dose may be increased at weekly intervals up to 160
mg daily vii) Adjunct: 10 - 40 mg 3 - 4 times daily. CHILD: Arrythmias, thyrotoxicosis: 0.25 - 0.5 mg/kg
3 - 4 times daily as required
Precautions:
Avoid abrupt withdrawal, bronchospastic disease, congestive heart failure, diabetes, hepatic disease,
peripheral vascular disease, renal disease, myasthenia gravis, pregnancy, breast feeding
Adverse Reaction:
Bronchospasm, bradycardia, depression, nausea, vomiting, dizziness, central nervous system effects,
muscle cramps, fluid retention, skin rashes, dry mouth
Contraindications:
Hypersensitivity to propranolol, asthma, bradycardia, 2nd and 3rd degree AV block, cardiogenic
shock, overt cardiac failure, obstructive airway disease
Interactions:
Alpha-1 adrenergic blockers, amiodarone, chlorpromazine, cimetidine, clonidine, cocaine, digoxin,
dihydroergotamine, dihydropyridine, calcium channel blocker, disopyramide, epinephrine,
ergotamine, flecainide, flunarizine, fluvoxamine, furosemide, risk of lignocaine toxicity increased
----------------------------------------------------------------------------------------------------------------
Captopril 25 mg Tablet B
Trade Name : Capoten
Indication :
i) Hypertension ii) Congestive heart failure iii) Post-myocardial infarction iv) Diabetic nephropathy
Dosage :
i) Initially 12.5 mg twice daily. Maintenance: 50 mg 2 - 3 times daily, may be increased to maximum
450 mg/day ii) Initially 6.25 - 12.5 mg 3 times daily, increase after several days to 25 - 50 mg 3 times
daily iii) Initially 6.25 mg daily, gradually increased to 37.5 mg daily in divided doses iv) 75 - 100 mg
daily in divided doses
Precautions:
Anaphylaxis during lipid apheresis with dextran sulfate membranes and during hymenoptera
desensitization, angioedema; discontinue if laryngeal stridor or angioedema of the face, tongue, or
glottis is observed, aortic stenosis, breast feeding period, cough, impaired renal function
Adverse Reaction:
Rash, pruritus, flushing, angioedema, loss of taste perception, stomatitis, gastrointestinal irritation
and abdominal pain, leucopenia, cough
Contraindications:
Angioedema induced by other angiotensin converting enzyme (ACE) inhibitors during prior exposure.
Anuric renal failure during prior exposure to ACE inhibitors. Hypersensitivity to this or any other ACE
inhibitor. Pregnancy (second and third trimester pregnancy)
Interactions:
May increase serum K with Kalium K-sparing diuretics. Hypotensive effects enhanced by diuretics.
Antihypertensive effect diminished by indomethacin, salicylates, NSAIDs
----------------------------------------------------------------------------------------------------------------
50
Enalapril 10 mg Tablet B
Enalapril 20 mg Tablet B
Enalapril 5 mg Tablet B
Trade Name : Renitec
Indication :
i) Hypertension ii) Congestive heart failure
Dosage :
i) Initially 5 mg daily, (ELDERLY 2.5 mg once daily), usual maintenance dose 10 - 20 mg daily.
Maximum: 40 mg/day in 1 - 2 divided doses ii) Initially 2.5 mg daily, usual maintenance dose 20 mg
daily in 1 - 2 divided doses; maximum: 40 mg/day
Precautions:
Symptomatic hypotension likely to occur in volume depleted patients eg. by diuretic therapy, dietary
salt restriction, dialysis, diarrhoea or vomiting, patients with heart failure with or without associated
renal insufficiency. Caution in severe heart failure, especially ischemic heart or cerebrovascular
disease. Patients with obstruction in the outflow tract of the left ventricle. Renal impairment
patients with bilateral renal artery stenosis or stenosis of the artery to a solitary kidney. Dosage
reduction and or discontinuation of the diuretic and or enalapril may be required. Serum potassium
should be monitored. Not recommended during pregnancy. Lactation. Children
Adverse Reaction:
Dizziness, headache, diarrhoea, fatigue, asthenia, cough, orthostatic hypotension, hyperkalaemia,
angioneurotic oedema (discontinue therapy)
Contraindications:
Angioedema induced by other angiotensin converting enzyme (ACE) inhibitors. hypersensitivity to
this or any other angiotensin converting enzyme inhibitor. Pregnancy (second and third trimesters
particularly)
Interactions:
May have additive effects with other antihypertensives, potassium supplement, potassium-sparing
diuretics or potassium-containing salt substitutes. Increased lithium level
----------------------------------------------------------------------------------------------------------------
52
Dosage :
Hypertension: Usual starting and maintenance dose: 50 mg once daily. Maximum increasing the
dose to 100 mg once daily. Patients with intravascular volume-depletion starting dose of 25 mg once
daily. Renal protection in Type 2 diabetic patients with proteinuria and hypertension, starting dose:
50 mg once daily, may be increased to 100 mg once daily based on blood pressure response
Precautions:
Angioedema: intravascular volume depletion (eg those treated with high-dose diuretics), electrolyte
imbalance: lower dose should be considered for patients with a history of hepatic impairment,
changes in renal function including renal failure may occur in susceptible individuals. Blood urea and
serum creatinine may be increased in patients with bilateral renal artery stenosis or stenosis of the
artery to a solitary kidney, lactation, children
Adverse Reaction:
Angioedema, headache, dizziness, cough
Contraindications:
Hypersensitivity to losartan, pregnancy
Interactions:
Fluconazole, lithium, rifampicin
----------------------------------------------------------------------------------------------------------------
53
Interactions:
Angiotensin converting enzyme inhibitors, calcitriol, chlorpropamide, cholestyramine, corticotropin,
cortisone, diazoxide, digitalis glycosides, diuretics, droperidol, hydrocortisone, indomethacin,
liquorice, lithium, methotrexate, methylprednisolone, prednisolone, propranolol, tolbutamide,
triamcinolone
----------------------------------------------------------------------------------------------------------------
54
Precautions:
Avoid abrupt withdrawal, congestive heart failure, dialysis patients (risk of hypertension following
procedure), oedema, haemolytic anaemia, hypotension, liver disease, severe bilateral
cerebrovascular disease (risk of choreoathetotic movements)
Adverse Reaction:
Sedation, headache, weakness, dizziness, parkinsonism, bradycardia, orthostatic hypotension, GI
symptoms, hepatic impairment, impotence
Contraindications:
Hypersensitivity to methyldopa, history of hepatitis, autonomic dysfunction, bilateral cardiovascular
disease
Interactions:
Antihypertensive drugs, lithium, monoamine oxidase inhibitors (MAOIs)
----------------------------------------------------------------------------------------------------------------
Minoxidil 5 mg Tablet A*
Trade Name : Loniten
Indication :
Severe hypertension
Dosage :
ADULTS and CHILD above 12 years old: Initially 5 mg daily in single or divided doses (elderly 2.5 mg).
May increase by 5 - 10 mg daily at intervals of 3 or more days until optimum control is achieved.
Maximum 50 mg daily
Precautions:
Angina pectoris, breast feeding, cerebrovascular disease, cerebrovascular accident (recent),
congestive heart failure (without adequate diuretic therapy), dialysis, fluid retention, impaired renal
function, myocardial infarction
Adverse Reaction:
Salt and water retention, tachycardia, pericardial effusion and tamponad, hypertrichosis.
Occasionally; allergic rashes, gastrointestinal effects, breast tenderness, thrombocytopenia,
leucopenia
Contraindications:
Hypersensitivity to minoxidil products
Interactions:
Combination with guanethidine may produce orthostatic hypotension
--------------------------------------------------------------------------------------------------------------------------
55
Headache, asthenia, dizziness, sleep disturbances, cramps, hypotension, rash, gastrointestinal
disturbances, slight reversible increase in urea and plasma creatinine, hypokalaemia, hyponatraemia
with hypovolaemia, raised uric acid and blood glucose levels
Contraindications:
Bilateral renal artery stenosis or single functioning kidney, severe renal failure (creatinine clearance
less than 30 mL/min), dialysis patients, hepatic encephalopathy, severe hepatic impairment,
hyperkalaemia or hypokalaemia, untreated decompensated cardiac insufficiency. Previous history of
angioneurotic oedema linked to treatment with ACE inhibitor, hereditary or idiopathic angioneurotic
oedema. Pregnancy and lactation
Interactions:
Lithium, insulin, sulfonylureas, baclofen, NSAIDs, high dose salicylates, tricyclic antidepressants,
neuroleptics, corticosteroids, tetracosactide, potassium-sparing diuretics, potassium salts,
potassium-lowering drugs, anaesthesia, allopurinol, immunosuppressant, cardiac glycosides,
procainamide and other drugs which cause torsades de pointes, antihypertensive drugs, metformin,
calcium salts, ciclosporin, iodinated contrast media
----------------------------------------------------------------------------------------------------------------
Perindopril 4 mg Tablet B
Perindopril 8 mg Tablet B
Trade Name : Coversyl
Indication :
i) Hypertension ii) Congestive heart failure iii) Stable coronary artery disease
Dosage :
i) 4 mg as single dose, may be increased to a single 8 mg dose. ELDERLY: Start treatment with 2 mg
dose. In renal insufficiency, dose should be adapted according to creatinine clearance ii) Single
starting oral dose of 2 mg should be increased to a single 4 mg once BP acceptability has been
demonstrated iii) 4 mg once daily for 2 weeks, may be increased to 8 mg once daily. ELDERLY: 2 mg
once daily for 1 week, then 4 mg once daily for the following week, may be increased up to 8 mg
once daily
Precautions:
Arterial hypotension, renal failure, water and sodium depletion, renovascular hypertension, surgery
or anaesthesia, elderly. Haemodialysis, avoid combination with highly permeable membranes
(polyacrylonitrile). Measure plasma creatinine at baseline and during the month following institution
of treatment. May precipitate excessive hypotension in severe chronic heart failure with or without
associated renal insufficiency. Patients with ischaemic heart disease or cerebrovascular disease in
whom excessive fall in blood pressure may result in myocardial infarction or cerebrovascular
accident, hepatic impairment
Adverse Reaction:
Gastrointestinal disorders, dizziness, headaches, mood and or sleep disorders, asthenia, taste
disorder, cramps, localized skin rashes, dry cough, angioneurotic oedema
Contraindications:
Angioedema induced by other angiotensin converting enzyme (ACE) inhibitors. Hypersensitivity to
this or any other angiotensin converting enzyme inhibitor. Pregnancy (second and third trimesters
particularly)
Interactions:
Potassium supplements or potassium-sparing diuretics may induce hyperkalaemia especially in renal
failure. Neuroleptics or imipramine-like antidepressants increase risk of postural hypotension. Serum
lithium concentrations may rise during lithium therapy
----------------------------------------------------------------------------------------------------------------
56
Prazosin HCl 1 mg Tablet B
Prazosin HCl 2 mg Tablet B
Trade Name : Minipress
Indication :
Hypertension
Dosage :
Initially 0.5 mg 2 - 3 times daily, the initial dose on retiring to bed at night; increased to 1 mg 2 - 3
times daily after 3 - 7 days: further increased if necessary to maximum 20 mg daily
Precautions:
Dizziness, lightheadedness, orthostatic hypotension, syncope, fainting and sudden loss of
consciousness due to first-dose effect
Adverse Reaction:
Dizziness, orthostatic hypotension, oedema, palpitations, urinary incontinence, dyspnoea, priapism,
headache, lack of energy, nausea
Contraindications:
Hypersensitivity to prazosin products or other quinazolines
Interactions:
Additive hypotensive effect with diuretics or other antihypertensives
----------------------------------------------------------------------------------------------------------------
Ramipril 5 mg Tablet A
Trade Name : Tritace
Indication :
i) Hypertension and congestive heart failure ii) Post-myocardial infarction iii) Reducing risk of
myocardial infarction, stroke or cardiovascular death in diabetics or patients with increased
cardiovascular risks
Dosage :
i) Initially 2.5 mg once daily, increased at intervals of 1 - 2 weeks to maximum 10 mg once daily ii)
Initially 2.5 mg twice daily for 2 days then increased to maximum 5 mg twice daily iii) Initially 1.25 -
2.5 mg once daily, increased to 5 mg once daily after 1 week, maximum dose: 10 mg once daily after
3 weeks
Precautions:
Renal or hepatic impairment, hyperstimulated renin-angiotensin system
Adverse Reaction:
Nausea, dizziness & headache, dry cough, hypotension, hypokalemia, fatigue, pruritus, rash & fever
,pancreatitis, angioedema
Contraindications:
Hypersensitivity, history of angioedema with ACE inhibitors, bilateral renal artery stenosis or a single
kidney with unilateral renal artery stenosis. Pregnancy and lactation
Interactions:
Enhanced hypotensive effects by alcohol, alprostadil and anaesthetics
----------------------------------------------------------------------------------------------------------------
Amlodipine 10 mg Tablet B
Amlodipine 5 mg Tablet B
Trade Name : Norvasc
Indication :
Hypertension
Dosage :
5 mg once daily. Max: 10 mg
Precautions:
Angina (exacerbation) during initiation of treatment; with dosage increases; during beta-blocker
withdrawal; taper slowly prior to calcium channel blocker therapy. Aortic stenosis (reduced
myocardial oxygenation with drug-induced hypotension), congestive heart failure, pregnancy,
hepatic impairment
Adverse Reaction:
Headache, dizziness, gingival hyperplasia, tachycardia, peripheral oedema
Contraindications:
Hypersensitivity to amlodipine, symptomatic hypotension, persistent dermatologic reactions,
congestive heart failure
Interactions:
Cyclosporin, fluconazole, itraconazole, ketoconazole, vardenafil
----------------------------------------------------------------------------------------------------------------
60
Interactions:
Potassium Supplement. Potassium-sparing diuretic, potassium containing salt substitutes or other
drugs that may increase potassium level
----------------------------------------------------------------------------------------------------------------
61
Interactions:
Beta-adrenergic blockers, cyclosporin, fluconazole, itraconazole, ketoconazole, magnesium, oral
anticoagulants, phenobarbital and saquinavir
----------------------------------------------------------------------------------------------------------------
62
Isosorbide Dinitrate 10 mg Tablet B
Trade Name : Isordil
Indication :
Prophylaxis and treatment for: i) Angina ii) Left ventricular failure
Dosage :
i) 30 - 120 mg daily in divided doses ii) 40 - 160 mg, up to 240 mg if required; in acute episodes: 5 -
10 mg by sublingually
Precautions:
Acute myocardial infarction,cerebral hemorrhage,congestive heart failure, glaucoma,
hyperthyroidism,hypertrophic, cardiomyopathy, hypotension,methemoglobinemia, recent head
trauma, severe anemia, volume depletion
Adverse Reaction:
GI disturbances, headache, hypotension, tachycardia
Contraindications:
Hypersensitivity to organic nitrates, anaemia, symptomatic hypotension
Interactions:
Hypotensive effects may be enhanced by alcohol, beta-blocker, calcium channel blocker,
antihypertensive, sildenafil, tricyclic antidepressant
----------------------------------------------------------------------------------------------------------------
Isosorbide-5-Mononitrate 30 mg SR Tablet A
Trade Name : Imdur
Indication :
Prophylaxis and treatment of angina pectoris
Dosage :
30-120 mg daily
Precautions:
Acute myocardial infarction,cerebral hemorrhage, congestive heart failure, glaucoma,
hyperthyroidism, hypertrophic, cardiomyopathy, hypotension,methemoglobinemia, recent head
trauma, severe anemia, volume depletion
Adverse Reaction:
GI disturbances, headache, hypotension, tachycardia
Contraindications:
Hypersensitivity to organic nitrates, anaemia, symptomatic hypotension
Interactions:
Hypotensive effects may be enhanced by alcohol, beta-blocker, calcium channel blocker,
antihypertensive, sildenafil and tricyclic antidepressant
----------------------------------------------------------------------------------------------------------------
Nifedipine 10 mg Tablet B
Trade Name : Adalat
Indication :
Hypertension
Dosage :
Initial dose of 10 mg twice daily. Usual range 10 - 30 mg 3 times daily. Maximum: 120 - 180 mg per
day
Precautions:
Angina (exacerbation) during initiation of treatment, with dosage increases during beta-blocker
withdrawal, taper slowly prior to calcium channel blocker therapy. Chronic renal insufficiency,
combination therapy with beta-blockers (with left ventricular dsfunction)
63
Adverse Reaction:
Peripheral oedema, headache, dizziness, tachycardia
Contraindications:
Hypersensitivity to nifedipine, symptomatic hypotension, persistent dermatologic reactions, chronic
heart failure
Interactions:
Beta-adrenergic blockers, cimetidine, digoxin, diltiazem, fluconazole, itraconazole, ketoconazole,
magnesium, oral anticoagulants, phenytoin, quinidine, rifampin, saquinavir, vincristine
----------------------------------------------------------------------------------------------------------------
64
Verapamil HCl 40 mg Tablet B
Trade Name : Isoptin
Indication :
i) Supraventricular tachyarrhythmias (SVT) prophylaxis ii) angina
Dosage :
ADULT: 40 - 80 mg 3-4 times daily. In oral long term therapy, max: 480 mg daily
Precautions:
First degree AV block, bradycardia, hypotension. May impair ability to drive or operate machinery.
Pregnancy, lactation. Severe hepatic impairment. Slows down markedly the elimination of alcohol
and prolongs the duration of alcohol
Adverse Reaction:
Constipation, dizziness, nausea or vertigo, headache, hypotension, ankle oedema, flushing, fatigue,
nervousness, paraesthesia, bradycardiac arrhythmias, dyspnoea, raised prolactin levels, single cases
of galactorrhoea, myalgia, arthralgia, allergic skin reactions, purpura, photosensitisation dermatitis,
gynaecomastia, reversible increase in transaminases and or alkaline phosphatase, gingival
hyperplasia, tachycardia, palpitations, impotence, tinnitus, tremor, heart failure
Contraindications:
Cardiovascular shock, complicated acute myocardial shock, severe conduction disorders (2nd and
3rd degree AV block, SA block), sick sinus syndrome, heart failure, atrial fibrillation/flutter and
simultaneous preexcitation syndrome, myasthenia gravis
Interactions:
Increased risk of myocardial depression with beta-blockers or inhalation anaesthetic. May increase
plasma digoxin concentration and plasma cyclosporin concentration
----------------------------------------------------------------------------------------------------------------
65
Adrenaline Acid (Epinephrine) Tartrate 1 mg/ml Injection B
Indication :
Cardiopulmonary resuscitation
Dosage :
0.5-1 mg given by SC or IM
Precautions:
Elderly patients, patients with; CV disease, pulmonary oedema, hypertension, hyperthyroidism,
diabetes, psychoneurotic illness, asthma, prefibrillatory rhythm, or anesthetic cardiac acidents.
Bronchial asthma/emphysema,cerebrovascular hemorrhage, pregnancy, lactation, children
Adverse Reaction:
Hypertension, arrhythmias, nausea, vomiting, headache, shortness of breath, sneezing
Contraindications:
Cardiac dilatation, coronary insufficiency. Within 2 weeks of MAOI use.Organic brain damage,
narrow-angle glaucoma. Shock. Concurrent use with local anesthetics for injection of certain areas
(eg; fingers, toes, ears); increased risk of vasoconstriction and sloughing of tissue. oncurrent use with
cyclopropane or halogenated hydrocarbon anaesthetics; may produce fatal ventricular arrhythmias.
Labor; may delay the second stage
Interactions:
Beta-blocking,alpha-adrenergic blockers agents,antihistamines,tricyclic antidepressants carvedilol,
chlorpromazine, halothane, moclobemide, rocuronium, selegiline, timolol,methyldopa, diuretics,
oxytoxic drugs
----------------------------------------------------------------------------------------------------------------
66
Interactions:
Should not be administered concomitantly with other sympathomimetic agents. Alpha and beta-
adrenergic blocking agents. Cyclopropane or halogenated hydrocarbons general anaesthetics. MAOIs
----------------------------------------------------------------------------------------------------------------
68
Heparin 1000 units/ml Injection B
Heparin 5000 units/ml Injection B
Indication :
i) Prophylaxis and treatment of venous thrombosis and pulmonary embolism. ii) Treatment of
myocardial infarction and arterial embolism. iii) Prevention of clotting in arterial and heart surgery
and for prevention of cerebral thrombosis
Dosage :
i) By IV injection, loading dose of 5000 units (10,000 units in severe pulmonary embolism) followed
by continuous infusion of 15-25 units/kg/hr. By SC injection (for DVT) of 15,000 units every 12 hours
(laboratory monitoring on daily basis essential to adjust dose). Small adult or child, lower loading
dose then, 15-25 units/kg/hr by IV infusion, or 250 units/kg every 12 hours by SC injection. ii) As i),
for unstable angina and acute peripheral arterial occlusion. iii) Prophylaxis in general surgery, by SC
injection, 5000 units 2 hour before surgery, then every 8-12 hours for 7 days or until patient is
ambulant, during pregnancy (with monitoring), 5000-10000 units every 12 hours. An adjusted dose
regimen may be used for major orthopaedic surgery or low molecular weight heparin may be
selected
Precautions:
Heparin should be used cautiously in patients with allergies since it is of animal origin, renal and
hepatic disease. Hypertension during menstruation. Patients with indwelling catheters. Precaution
must be taken if using long-term subcutaneous heparin in pregnant women and bacterial
endocarditis
Adverse Reaction:
Haemorrhage, cutaneous necrosis, thrombocytopenia, anaphylaxis, hyperkalaemia
Contraindications:
Hypersensitivity, in patients who are actively bleeding, or have blood dyscrasias, in patients with
haemophilia or other blood disorders, and in cases where sufficient blood coagulation tests are not
available
Interactions:
Alprostadil, alteplase, aspirin, cefoperazone, clopidogrel, dextran, moxalactam, reteplase, urokinase,
warfarin, digitalis, tetracyclines, nicotine, antihistamines, ACE inhibitors, analgesics,
dipyridamole,drotrecogin Alfa, iloprost, nitrates, sibutramine
----------------------------------------------------------------------------------------------------------------
69
Interactions:
Alprostadil, alteplase, aspirin, cefoperazone, clopidogrel, dextran, moxalactam, reteplase, urokinase,
warfarin, digitalis, tetracyclines, nicotine, antihistamines, ACE inhibitors, analgesics,
dipyridamole,drotrecogin Alfa, iloprost, nitrates, sibutramine
----------------------------------------------------------------------------------------------------------------
70
Adverse Reaction:
Bleeding, anaemia, haematoma, haemorrhage, haematuria, decreased haemoglobin, wound
secretion, post-procedural discharge
Contraindications:
Severe renal and hepatic impairment, active bleeding, organic lesion at risk of bleeding, concomitant
treatment with quinidine, pregnancy and lactation
Interactions:
Heparins, fondaparinux, desirudin, thrombolytic agents, GPIIb/IIIa receptor antagonists, clopidogrel,
ticlopidine, dextran, sulfinpyrazone, vitamin K antagonists, amiodarone, quinidine, NSAIDs,
sibutramine
----------------------------------------------------------------------------------------------------------------
Clopidogrel 75 mg Tablet A*
Trade Name : Plavix
Indication :
Prevention of myocardial infarct, stroke or established peripheral arterial disease. As second/third
line treatment in patients who are sensitive to acetylsalicylic acid & intolerant to ticlopidine
Dosage :
75 mg once daily
Precautions:
Avoid for first few days after MI and for 7 days after ischaemic stroke; not recommended in unstable
angina, coronary artery bypass grafting and percutaneous transluminal coronary angioplasty;
patients at risk of increased bleeding from trauma, surgery or other pathological conditions;
discontinue 7 days before elective surgery if antiplatelet effect not desirable, liver impairment, renal
impairment, pregnancy. Based on literature data, patients with genetically reduced CYP2C19
function (intermediate or poor metabolisers) have lower systemic exposure to the active metabolite
of clopidogrel and diminished antiplatelet responses, and generally exhibit higher cardiovascular
events rates following myocardial infarction than do patients with normal CYP2C19 function
Adverse reaction:
GI bleeding, purpura, bruising haematoma, epistaxis, haematuria, ocular haemorrhage, intra cranial
bleeding, abdominal pain, dyspepsia, gastritis & constipation, rash, pruritus
71
Contraindications:
Active pathological bleeding such as peptic ulcer & intracranial haemorrhage, breast feeding
Interactions:
Cytochrome P450 effect. Amiodarone, cisapride, ciclosporin, diltiazem, irbesartan, losartan, oral
hypoglycemics, paclitaxel, phenytoin, quinidine, sildenafil, tamoxifen, verapamil, warfarin, aspirin,
heparin, thrombolytics, NSAIDs, atorvastatin, erythromycin, clarithromycin. Concomitant use of the
drugs that inhibit CYP2C19 should be discouraged
-----------------------------------------------------------------------------------------------------------
Dipyridamole 75 mg Tablet B
Trade Name : Persantin
Indication :
As an adjunct to oral anticoagulation/ antiplatelet therapy in the prophylaxis of cerebrovascular
events
Dosage :
75-150 mg 3 times daily to be taken 1 hour before meals
Precautions:
Rapidly worsening angina, aortic stenosis, recent myocardial infarction, heart failure, may
exacerbate migraine, hypotension, myasthenia gravis
Adverse Reactions:
Gastrointestinal effects, dizziness, myalgia, headache, hypotension, hot flushes and tachycardia,
rash, urticaria, exacerbation of angina pectoris, bronchospasm and angioedema, increased bleeding
during and after surgery
Contraindications:
Hypersensitivity to dipyridamole or tartrazine dye (25 mg tablets)
Interactions:
Adenosine, indomethacin, low molecular weight heparins, streptokinase, theophylline
----------------------------------------------------------------------------------------------------------------
72
Interactions:
Any drugs likely to produce coagulation
----------------------------------------------------------------------------------------------------------------
74
Factor IX Injection A
*[Drug taken from National Blood Bank – Not kept in hospital]
Trade Name : Alphanine,profilnine
Indication :
Prevention and control of bleeding in patients with factor IX deficiency due to haemophilia B
Dosage :
Dose varies according to the patient and the circumstances of the bleeding. i) Mild haemorrhage:
initial dose of 30 units/kg body weight. ii) Moderate haemorrhage: initial dose of 50 units/kg iii)
Major haemorrhage/surgery: Initial dose of 75 - 100 units/kg. Half of these doses may be repeated
after 18-24 hrs if necessary.
Precautions:
Risk of thrombosis. Use with caution in patients with liver dysfunction
Adverse Reaction:
Allergic reactions, mild chills, nausea, fever,nausea, vomiting, headache, flushing, intravascular
coagulation,thrombosis
Contraindications:
Hypersensitivity to Factor IX or any component of the formulation. Disseminated intravascular
coagulation
Interactions:
Coadministeration with aminocaproic acid may increase risk for thrombosis
----------------------------------------------------------------------------------------------------------------
Factor VIIa (Recombinant) eptacog alfa (activated) 60 KIU (1.2 mg) Injection A*
Trade Name : Novoseven
Indication :
Treatment of bleeding episodes and prevention of excessive bleeding in connection with surgery in
patients with inherited or acquired haemophilia with inhibitors to coagulation factors VIII or IX
Dosage :
Initially 4.5 KIU (90 mcg)/kg body weight IV bolus over 2-5 minutes, followed by 3-6 KIU (60-120
mcg)/kg body weight depending on type & severity of haemorrhage or surgery performed. Dosing
interval: initially 2-3 hour to obtain haemostasis and until clinically improved. If continued therapy is
needed, dose interval can be increased successively to every 4, 6, 8 or 12 hours
Precautions:
Advanced atherosclerotic disease: increased risk of thrombotic events. Concomitant use of activated
or nonactivated prothrombin complex concentrates: increased risk of thrombotic events .Crush
injury; disseminated intravascular coagulation (DIC),Septicemia: increased risk of thrombotic events
.Elderly, non-hemophilia, intracerebral hemorrhage patients: increased risk of arterial
thromboembolic adverse events, including myocardial ischemia, myocardial infarction, cerebral
ischemia and or infarction.
Adverse Reaction:
Rash, itching, nausea, fever, headache, malaise, diaphoresis, changes in blood pressure,renal failure,
cerebrovascular disorder, angina pectoris, atrial arrhythmia, circulatory shock, hemorrhage,
hemarthrosis
Contraindications:
Hypersensitivity to Factor VII or any component of the formulation
Interactions:
Simultaneous use of prothrombin complex concentrates, activated or not should be avoided
----------------------------------------------------------------------------------------------------------------
75
Factor VIII Injection A
*[Drug taken from National Blood Bank – Not kept in hospital]
Trade Name : Alphanate,Hemofil M
Indication :
Prevention and control of bleeding in patients with factor VIII deficiency due to classical haemophilia
A
Dosage :
Dose varies according to the patient and the circumstances of the bleeding. i) Mild to moderate:
Usually a single dose of 10-15units/kg. ii) More serious haemorrhage/minor surgery:Initially 15-25
units/kg followed by 10-15 units/kg every 8 - 12 hours if required iii) Severe haemorrhage/major
surgery: Initial : 40 - 50 units/kg followed by 20 - 25 units/kg every 8-12 hrs.
Precautions:
Risk of thrombosis and transmission of infection, pregnancy. Intravascular haemolysis after
large/frequently repeated doses in patients with blood groups A,B, or AB
Adverse reaction:
Allergic reactions (chills, urticaria, fever), headache, intravascular haemolysis, increased body temp,
development of factor VIII antibodies
Contraindications:
Disseminated intravascular coagulation, underlying thrombosis
Interactions:
Not known
----------------------------------------------------------------------------------------------------------------
76
Precautions:
Cardiovascular disease, cerebrovascular disease, concomitant antifibrinolytic therapy. Concomitant
therapy with oestrogens or thrombolytics. Renal impairment and transurethral prostatectomy
(potential for intravesicular clotting)
Adverse Reaction:
Nausea, vomiting, diarrhoea, hypotension, thrombosis, disturbances in colour vision
Contraindications:
Severe renal impairment, thromboembolic disease, intravascular clotting process, disturbance of
colour vision and subarachnoid haemorrhage
Interaction:
Anti-inhibitor coagulant complex, oral contraceptive, oestrogen, tretinoin
--------------------------------------------------------------------------------------------------------------------------
Atorvastatin 20 mg Tablet A*
Trade Name : Lipitor
Indication :
Hypercholesterolaemia and coronary heart disease intolerant or not responsive to other forms of
therapy
Dosage :
10 mg once daily. Maximum: 80 mg daily
Precautions:
Heavy alcohol use, history of liver disease. Discontinue therapy if serum transaminase levels rise to 3
times upper limit of normal and are persistent. This class of drug has been known to cause myopathy
and renal failure due to rhabdomyolysis. Concomitant administration of fibrates, niacin, cyclosporin
or erythromycin may increase the risk of myopathy
Adverse Reaction:
Gastrointestinal disturbances, headache, myalgia, asthenia, insomnia, angioneurotic oedema,
muscle cramps, myostitis, myopathy, cholestatic jaundice, peripheral neuropathy, pruritus
Contraindications:
Liver disease, hypersensitivity to atorvastatin, pregnancy or lactation
Interactions:
Risk of myopathy increased with concurrent administration of cyclosporin, fibric acid derivatives,
erythromycin, niacin or azole antifungals. Decreased atorvastatin plasma concentration with oral
antacid suspensions containing magnesium and aluminium hydroxides and colestipol
----------------------------------------------------------------------------------------------------------------
Ezetimibe 10 mg Tablet A*
Trade Name : Ezetrol
Indication :
i) Co-administration with statins for patients who have chronic heart disease or are chronic heart
disease equivalent or familial hypercholesterolaemia with target LDL-C not achieved by maximum
dose of statins ii) Monotherapy in patients with documented biochemical intolerance to statins
Dosage :
10 mg once daily. Not recommended for children less than 10 years old
Precautions:
Children under 10 years old, moderate to severe hepatic insufficency, myopathy, pregnancy and
lactation
Adverse Reaction:
Abdominal pain, arthralgia, back pain, cough, diarrhoea, fatigue, headache, sinusitis
Contraindications:
Avoid co-administration with fibrates. Hypersensitivity to ezetimibe, active liver disease or
persistently elevated liver enzymes
Interactions:
Cholestyramine, fibrates, cyclosporin
----------------------------------------------------------------------------------------------------------------
78
Interactions:
Co-admin with repaglinide may lead to an increase in the serum levels of repaglinide. May enhance
the effects of oral anticoagulants. May also increase the plasma concentrations of ciclosporin and
associated nephrotoxicity when used concurrently
----------------------------------------------------------------------------------------------------------------
Lovastatin 20 mg Tablet B
Trade Name : Mevacor
Indication :
Hypercholesterolaemia and coronary heart disease
Dosage :
20 mg once daily. Maximum: 80 mg daily
Precautions:
Heavy alcohol use, history of liver disease. Discontinue therapy if serum transaminase levels rise to 3
times upper limit of normal and are persistent. This class of drug has been known to cause myopathy
and renal failure due to rhabdomyolysis. Concomitant administration of fibrates, niacin, ciclosporin
or erythromycin may increase the risk of myopathy
Adverse reactions:
Gastrointestinal upsets, headache, skin rashes, fatigue, pruritis, dry mouth, sleep disorders. Rarely,
hepatitis, hypersensitivity syndrome, erythema multiforme, toxic epidermal necrolysis
Contraindications:
Pregnancy, liver disease, hypersensitivity to lovastatin, lactation
Interactions:
Use with caution with coumarin anticoagulants and with immunosuppressive drugs, gemfibrozil or
niacin (as a lipid lowering agent) or erythromycin. Itraconazole
----------------------------------------------------------------------------------------------------------------
79
Rosuvastatin 10 mg Tablet A*
Rosuvastatin 20 mg Tablet A*
Trade Name : Crestor
Indication :
Dyslipidaemia not responsive to atorvastatin 40 mg or equivalent doses of other statins
Dosage :
Initially 5-10 mg once daily increased if necessary at intervals of at least 4 weeks to 20 mg once daily,
increased after further 4 weeks to 40 mg daily ONLY in severe hypercholesterolemia with high
cardiovascular risk. Patient of Asian origin, patients on concomitant ciclosporin/fibrate and patients
with risk factors for myopathy/rhabdomyolysis (including personal/family history of muscular
disorders/toxicity), the maximum dose should be 20 mg daily
Precautions:
Monitor renal and liver function. Predisposing factors for myopathy such as renal impairment,
advanced age, hypothyroidism. Acute serious conditions suggestive of myopathy or predisposing to
the development of renal failure secondary to rhabdomyolysis. Concurrent use of fibrates may cause
severe myositis and myoglobinuria, concurrent use of other lipid-lowering therapies/ciclosporin may
increase the risk of myopathy
Adverse Reactions:
Pharyngitis, headache, diarrhoea, dyspepsia, nausea, myalgia, asthenia, back pain, flu syndrome,
urinary tract infection, rhinitis, sinusitis, altered liver function tests, paraesthesia, abdominal pain,
flatulence, constipation and vomiting
Contraindications:
Active liver disease including elevated serum transaminases more than 3 times upper limit of
normal. Severe renal impairment (creatinine clearance less than 30 mL/min). Patients with
myopathy. Patients receiving concomitant ciclosporin. Pregnancy and lactation
Interactions:
Warfarin, vitamin K antagonists, ciclosporin, gemfibrozil, lopinavir/ritonavir, antacids (aluminium
and magnesium hydroxide), erythromycin, ketoconazole, spirinolactone, cimetidine, oral
contraceptives, digoxin, fenofibrate
----------------------------------------------------------------------------------------------------------------
80
Interactions:
May cause slight elevation of serum digoxin. Cholestyramine and colestipol increase bioavailability
of simvastatin. Increased concentrations with mibefradil
----------------------------------------------------------------------------------------------------------------
Trimetazidine 20 mg Tablet B
Trade Name : Vastarel
Indication :
Prophylactic treatment of episodes of angina pectoris
Dosage :
20mg 3 times daily
Precautions:
Pregnancy especially first trimester, unstable angina, hypertension, renal or hepatic insufficiency
Adverse reaction:
Gastrointestinal disorders such as nausea and vomiting
Contraindications:
Concomitant administration with MAOIs
Interactions:
Not known
----------------------------------------------------------------------------------------------------------------
Trimetazidine 35 mg MR Tablet B
Trade Name : Vastarel MR
Indication :
Prophylactic treatment of episodes of angina pectoris
Dosage :
35 mg twice daily in the morning and evening with meals
Precautions:
Pregnancy especially first trimester, unstable angina, hypertension, renal or hepatic insufficiency
Adverse reaction:
Gastrointestinal disorders such as nausea and vomiting
Contraindications:
Concomitant administration with MAOIs
Interactions:
Not known
----------------------------------------------------------------------------------------------------------------
81
4. RESPIRATORY
Bronchodilators
Corticosteroids
Cromoglycate, related therapy and leukotriene receptor antagonists
Respiratory stimulants and pulmonary surfactants
Miscellaneous respiratory
82
Aminophylline 25 mg/ml Injection B
Indication :
Reversible airways obstruction, acute severe asthma
Dosage :
Deteriorating acute asthma not previously treated with theophylline, by slow IV injection over 20
minutes 250 - 500 mg (5 mg/kg), then as for acute severe asthma. Acute severe asthma by IV
infusion : 500 mcg/kg/hour, adjusted according to plasma-theophylline concentration. CHILD : 6
month - 9 years : 1 mg/kg/hour, 10 - 16 years : 800 mcg/kg/hour
Precautions :
Hyperthyroidism, glaucoma, diabetes mellitus, angina pectoris, pulmonary, cardiovascular, renal or
hepatic diseases. Pregnancy, children and elderly. Active peptic ulcer disease, seizure disorders,
cardiac arrhythmias (not including bradyarrhythmias). Patients with migraine headaches may
experience an increased frequency of headaches. Patients with congestive heart failure, cor
pulmonale, prolonged fever, hypothyroidism, liver disease, sepsis with multi-organ failure, and shock
may require reduced theophylline dosage. Concommitant medication use which results in reduced
theophylline clearance
Adverse Reactions :
Tachycardia, palpitations, nausea and other gastrointestinal disturbances, headache, CNS
stimulation, insomnia, arrythmias, also allergy to ethylenediamine which can cause urticaria,
erythema, and exfoliative dermatitis
Contraindication :
Hypersensitivity to theophylline or derivatives, hypersensitivity to ethylenediamine
Interactions :
Azole antifungals, ciprofloxacin, clarithromycin, erythromycin : increased risk of theophylline
toxicity. Caffeine : increased caffeine level. Halothane : increased risk of arrthmia
--------------------------------------------------------------------------------------------------------------------------
83
Ipratropium Bromide 0.5 mg and Salbutamol 2.5 mg per UDV B
Trade Name : Combivent
Indication :
Management of reversible bronchospasm associated with obstructive airway
diseases
Dosage :
Acute attacks : 1 unit dose vial. In severe cases not relieved by 1 unit dose vial, 2 unit dose vials may
require, patient should consult a doctor immediately. Maintenance : 1 unit dose vial 3 - 4 times daily
Precautions :
Patients predisposed to glaucoma, insufficiently controlled diabetes mellitus, recent myocardial
infarction, severe organic heart or vascular disorders, hyperthyroidism, phaechromocytoma, risk of
narrow-angle glaucoma, prostatic hypertrophy or bladder-neck obstruction, hypoxia, cystic fibrosis,
pregnancy and lactation, uriticaria, angioedema, rash, broncospasm, oropharyngeal oedema
Adverse Reactions :
Headache, dizziness, nervousness, tachycardia, fine tremor, palpitations. Potentially serious
hypokalaemia may result from beta2-agonist therapy, dryness of mouth, dysphonia, ocular
complications, allergic type reactions
Contraindication :
Hypersensitivity to atropine or its derivatives or to any other component. Hypertrophic obstructive
cardiomyopathy or tachyarrythmia
Interactions :
Xanthine derivatives, other anticholinergics, beta2-agonists, beta-blockers, tricyclic anti depressants,
MAOIs, glucocorticoids - increased risk of tachycardia, agitation, hypomania, hypokalaemia
----------------------------------------------------------------------------------------------------------------
84
Ipratropium Bromide 20 mcg/dose Inhalation B
Trade Name : Atrovent
Indication :
Only for treatment of : i) Patients with chronic bronchitis who have airway
obstruction and who do not respond to Salbutamol or Terbutaline ii) Patients with
ischaemic heart disease who develop extrasystole with Salbutamol or Terbutaline
Dosage :
20 - 40 mcg 3 - 4 times daily. In the early treatment, up to 80 mcg 3 - 4 times daily.
CHILD up to 6 years : 20 mcg 3 times daily, 6 - 12 years : 20 - 40 mcg 3 times daily
Precautions :
Narrow - angle glaucoma, prostatic hypertrophy, cystic fibrosis
Adverse Reactions :
Headache, nausea, dry mouth, rare and reversible anticholinergic side effects, ocular side effects if
substances enters eyes, cough
Contraindication :
Hypersensitivity to atropine and its derivatives
Interactions :
Bronchodilatory effect intensified by beta-adrenergic and xanthine preparation. Anticholinergic
effects of other drugs may be enhanced. Cisapride - loss of cisapride efficacy
----------------------------------------------------------------------------------------------------------------
85
Dosage :
500 mcg by SC/IM injection 4 hourly or 250 mcg by slow IV. If required, by IV
infusion, initially 5 mcg/min adjusted according to response and heart rate, usually
in the range 3 - 20 mcg/min
Precautions :
Thyrotoxicosis, pregnancy and lactation. Potential for paradoxical bronchospasm, patients with
cardiovascular disorders, hyperthyroidism, diabetes mellitus, phaeochromocytoma, patients with
history of aneursym and patients who are usually responsive to sympathomimetics amines. Labour
and delivery may be complicated
Adverse Reactions :
Haemorrhage, thrombocytopenia, tachycardia and palpitations, erythema, ventricular ectopic beats,
myocardial ischaemia and infarction have been reported following IV administration. Fine tremor
(particularly in the hands), nervous tension, headache, peripheral dilatation and palpitations,
tachycardia, arrhythmias, disturbances of sleep and behaviour in children. Muscle cramps and
hypersensitivity reactions including paradoxical bronchospasm, urticaria, and angioedema
Contraindication :
Hypersensitivity, hyperthyroidism or thyrotoxicosis, tachycardia or tachycardiac arrthymias,
subvalvular aortic stenosis
Interactions :
Monoamine oxidase inhibitors - increased risk of tachycardia, agitation or hypomania
----------------------------------------------------------------------------------------------------------------
Salbutamol 2 mg Tablet B
Trade Name : Ventolin
Indication :
Asthma and other conditions associated with reversible airways obstruction
86
Dosage :
CHILD 2 - 6 years : 1 - 2 mg 3 - 4 times daily, 6 - 12 years : 2 mg 3 - 4 times daily.
CHILD over 12 years and ADULT : 2 - 4 mg 3 - 4 times daily
Precautions :
Thyrotoxicosis
Adverse Reactions :
Fine tremor (particularly in the hands), nervous tension, headache, peripheral dilatation and
palpitations, tachycardia, arrhythmias, disturbances of sleep and behaviour in children
Contraindication :
Hypersensitivity to any of their components. Premature labour e.g. placenta praevia, associated with
toxaemia of pregnancy or antepartum haemorrhage from whatever cause
Interactions :
Monoamine oxidase inhibitors - increased risk of tachycardia, agitation or hypomania
----------------------------------------------------------------------------------------------------------------
87
Adverse Reactions :
Palpitations, tachycardia, increases in ejection fraction, increases in cardiac output have been
reported following subcutaneous terbutaline, tremor and tonic cramp
Contraindication :
Hypersensitivity to terbutaline and other sympathomimetic amines
Interactions :
Beta-blockers - inhibit bronchodilating effect. Monoamine oxidase inhibitors - increased risk of
tachycardia, agitation, or hypomania. Theophylline - decreased theophylline concentrations
--------------------------------------------------------------------------------------------------------------------------------------
88
Terbutaline Sulphate 2.5 mg Tablet B
Trade Name : Bricanyl
Indication :
Asthma and other conditions associated with reversible airways obstruction
Dosage :
ADULT: Initially 2.5 mg 3 times daily for 1 - 2 week, then up to 5 mg 3 times daily. CHILD less than 7
years: 75 mcg/kg 3 times daily, 7 - 15 years: 2.5 mg 2 - 3 times daily
Precautions :
Hypertension, cardiovascular disease, unstable diabetes, hypersensitivity to sympathomimetic
amines, hypertrophic cardiomyopathy, hypokalaemia, convulsive disorders and hyperthyroidism
Adverse Reactions :
Palpitations, tachycardia, increases in ejection fraction, increases in cardiac output have been
reported following subcutaneous terbutaline, tremor and tonic cramp
Contraindication :
Hypersensitivity to terbutaline and other sympathomimetic amines
Interactions :
Beta-blockers - inhibit bronchodilating effect. Monoamine oxidase inhibitors - increased risk of
tachycardia, agitation or hypomania. Theophylline - decreased theophylline concentrations
----------------------------------------------------------------------------------------------------------------
89
Precautions :
Active peptic ulcer disease, seizure disorders, cardiac arrhythmias (not including bradyarrhythmias).
Patients with migraine headaches may experience an increased frequency of headaches. Patients
with congestive heart failure, cor pulmonale, prolonged fever, hypothyroidism, liver disease, sepsis
with multi-organ failure and shock may require reduced theophylline dosage. Concomitant
medication use which results in reduced theophylline clearance
Adverse Reactions :
Tachycardia, palpitations, nausea and other gastrointestinal disturbances, headache, central nervous
system stimulation, insomnia, arrythmias
Contraindication :
Hypersensitivity to theophylline
Interactions :
Azole antifungals, ciprofloxacin, clarithromycin, erythromycin: increased risk of theophylline toxicity.
Caffeine: increased caffeine level. Halothane: increased risk of arrythmia
----------------------------------------------------------------------------------------------------------------
90
Adverse Reactions :
Candidiasis of the mouth and throat, hoarseness or throat irritation, headache, secondary
hypocortisolism, osteoporosis, cataract, glaucoma, paradoxical bronchospasm (discontinue
immediately). Patients are advised to gargle after using the medication
Contraindication :
Hypersensitivity to beclomethasone dipropionate, acute asthma exacerbations, status asthmaticus.
Special care is necessary in patients with active or quiescent pulmonary tuberculosis
Interactions :
Not known
----------------------------------------------------------------------------------------------------------------
91
Adverse Reactions :
Mild irritation of the throat, coughing, and generally reversible hoarseness of the voice. Bad taste,
dryness of the throat. Candidiasis of the mouth and throat, paradoxical bronchoconstriction,
headache, nausea, tiredness, thirst, diarrhoea, skin reaction
Contraindication :
Hypersensitivity to budesonide. Moderate to severe bronchiectasis
Interactions :
Oral or parenteral corticosteroids - effects enhanced by the concomitant use. Amiodarone -
increased risk of developing Cushing's syndrome. Ketoconazole, erytromycin, ritonavir - increased
budesonide plasma concentrations
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92
Contraindication :
Hypersensitivity to any component of montelukast
Interactions :
Phenobarbitone
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93
Budesonide 160 mcg and Formoterol 4.5 mcg Inhalation A
Trade Name : Symbicort
Indication :
Mild, moderate and severe persistent asthma
Dosage :
ADULT : 1 - 2 puff twice daily, maximum : 4 puff twice daily. ADOLESCENT (12 - 17 years) : 1 - 2 puff
twice daily. CHILD less than 6 years are not recommended
Precautions :
Not for acute attack. Taper dose when discontinuing treatment. Thyrotoxicosis, diabetes mellitus,
heart disease, hypokalaemia, severe cardiovascular disorders, hypertropic obstructive
cardiomyopathy, tuberculosis, phaeocromocytoma
Adverse Reactions :
Headache, insomnia, tremor, restlessness, oral candidiasis, cough, hoarseness
Contraindication :
Hypersensitivity to budesonide or formoterol or inhaled lactose
Interactions :
Itraconazole, ketoconazole, MAOI, tricyclic antidepressan, ritonavir, phenothiazines
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94
5. ANALGESICS
Non-opioid analgesics
Opioid analgesics
Non-steroidal anti-inflammatory drugs (NSAIDs)
Neuropathic pain
95
Acetylsalicylic Acid 300 mg Soluble Tablet C
Trade Name : Aspirin Soluble
Indication :
Mild to moderate pain
Dosage :
300 - 900 mg every 4 - 6 hours as required. Max 4 g daily. Use in children not recommended
Precautions :
Renal disorders, G6PD deficiency, pregnancy, patients with flu, chicken pox or haemorrhagic fever.
History of peptic ulcer or those prone to dyspepsia and those with gastric mucosal lesion; asthma or
allergic disorders; dehydrated patients; uncontrolled hypertension; impaired renal or hepatic
function; elderly
Adverse Reactions :
Gastric haemorrhage, hypersensitivity, thrombocytopenia,GI disturbances; prolonged bleeding time,
rhinitis, urticaria and epigastric discomfort; angioedema, salicylism, tinnitus; bronchospasm
Contraindications :
Gastric and duodenal ulcers, haemorrhagic diathesis, hypersensitivity to aspirin or other NSAIDs,
children under 12 years old.Hypersensitivity (attacks of asthma, angioedema, urticaria or rhinitis);
pregnancy (third trimester); patients with haemophilia or haemorrhagic disorders; gout; severe renal
or hepatic impairment; lactation
Interactions :
Acetazolamide, Dipyridamol : salicylate toxicity (vomiting, tachycardia, hyperpnea, mental
confusion) or acetazolamide toxicity (fatigue, lethargy, somnolence, confusion, hyperchloremic
metabolic acidosis). Alendronate : GI distress. Antacids, calcium. Alcohol, corticosteroids,
phenylbutazone and oxyphenbutazone may increase risk of GI ulceration. Aspirin increases
phenytoin levels. May antagonize actions of uricosurics and spironolactone
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96
severe renal impairment (serum creatinine more than 180 mmol/L). History of asthma. Patients who
have had operations with a high risk of haemorrhage or incomplete haemostasis. Patients on
anticoagulants including low dose heparin. Pregnancy, labour, delivery or lactation. Children less
than 16 year
Interactions :
ACEIs : decreased antihypertensive and natriuretic effects. Aspirin, NSAIDs : enhanced
gastrointestinal adverse effects (peptic ulcers, gastrointestinal bleeding and or perforation) and
possible increase in serum ketorolac levels. Beta-adrenergic block
----------------------------------------------------------------------------------------------------------------
97
Precautions :
Renal and hepatic failure. Avoid chronic use
Adverse Reactions :
Allergic reactions, skin rash
Contraindications :
Nephropathy
Interactions :
Anticoagulants, alcohol, liver enzyme inducers, aspirin, chloramphenicol and phenobarbitone
----------------------------------------------------------------------------------------------------------------
98
Interactions :
Naltrexone : precipitation of opioid withdrawal symptoms.MAOIs, phenothiazines, CNS depressants,
cimetidine
----------------------------------------------------------------------------------------------------------------
99
Adverse Reactions :
Respiratory depression, apnoea, muscle rigidity, bradycardia, cardiac dysrhythmia, tachyarrhythmia,
chest pain, hypertension, hypotension, hypoventilation, neutropenia
Contraindications :
Children more than 2 years, asthma, respiratory depression, head injury, patients receiving MAOIs
within previous 14 days, hypersensitivity, increased intracranial pressure, pregnancy and lactation
Interactions :
Amiodarone : cardiac toxicity (low cardiac output). Azole antifungals, macrolide antibiotics :
increased or prolonged opioid effects (CNS depression, respiratory depression). Beta-adrenergic
blockers, calcium channel blockers : severe hypotension. Carbamazepine : decreased plasma
concentrations of fentanyl. Diazepam : significant decreases of mean arterial pressure and systemic
vascular resistance. Naltrexone : precipitation of opioid withdrawal symptoms. Phenytoin :
decreased plasma concentrations of fentanyl. Protease inhibitors : increased risk of fentanyl toxicity
(CNS depression, respiratory depression).
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100
Dosage :
10 - 60 mg 12 hourly intervals, depend upon the severity of the pain
Precautions :
Neonates, children, elderly, obstetric patients, chronic obstructive airway disease, pregnancy,
lactation, renal and hepatic impairment, hypothyroidism
Adverse Reactions :
Constipation, nausea, vomiting, drowsiness, dry mouth, psychomimetic effect (dysphoria,
hallucination, nightmare), urinary retention, respiratory depression (rare). Convulsions; dry mouth,
headache, vertigo; palpitations; hypothermia; pruritus, urticaria; tachycardia, bradycardia; blurred
vision; miosis; dependency
Contraindications :
Raised intra-cranial pressure, respiratory depression and biliary colic (these conditions are not
contra-indicated in patients who are terminally ill). Hypersensitivity to morphine, acute or severe
asthma; paralytic ileus; obstructive airway disease; acute liver disease; comatose patients;
pregnancy. acute alcoholism, head injury, paralytic ileus, delayed gastric emptying, obstructive
airways disease, cardiac arrhythmias, acute hepatic disease; concurrent MAOIs (or within 2 week).
Not recommended for pre-operation use or for the 1st 24 hour post-operation. Pregnancy &
lactation. Children
Interactions :
MAOIs: hypotension and exaggeration of CNS and respiratory depressant effects including sedatives
or hypnotics, general anaesthetic, phenothiazines, other tranquillizers, muscle relaxants,
antihypertensives, alcohol; respiratory depression, cimetidine. Naltrexone: precipitation of opioid
withdrawal symptoms. Cimetidine: morphine toxicity
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101
Nalbuphine HCl 10 mg/ml Injection B
Trade Name : Nubain
Indication :
Perioperative analgesia, for relief of moderate to severe pain
Dosage :
10 - 20 mg SC, IM or IV every 3 - 6 hours
Precautions :
Impaired renal/hepatic function, MI, impaired respiration, biliary tract surgery
Adverse Reactions :
Sedation, sweating, GI upsets, vertigo, dry mouth, allergic reactions
Contraindications :
Hypersensitivity to nalbuphine
Interactions :
Phenothiazines, alcohol, CNS depressants
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102
delirium tremens, hypercarbia. Concurrent MAOIs (or within 2 weeks). Pre-operative or within 24
hours post-operative. Lactation
Interactions :
Anticholinergics, antihypertensives, CNS depressants including sedatives or hypnotics, general
anaesthetics, phenothiazines, other tranquillizers, alcohol, other opioids & neuroleptics; muscle
relaxants, coumarin derivatives, metoclopramide, MAOIs, neuromuscular blockers, opioid analgesics,
drugs that involve cytochrome P450 enzyme system eg CYP3A4, CYP2D6
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103
Pethidine HCl 100 mg/2 ml Injection B
Pethidine HCl 50 mg/ml Injection B
Indication :
For relief of moderate to severe pain (medical and surgical), pre-anaesthetic
medication and obstetrical analgesia
Dosage :
ADULT: 0.5 - 2 mg/kg SC or IM every 3 - 4 hours if necessary. CHILD: by IM 0.5 - 2 mg/kg.
Up to 1 year : 1- 2 mg/kg weight IM, 1 - 5 years : 12.5 - 25 mg IM, 6 - 12 years: 25 - 50 mg IM
Precautions :
Cirrhosis, elderly, neonates, children, liver/renal dysfunction, convulsive disorders, reduced cardiac
output, cardiac infarction, cardiac disease, supraventricular tachycardia, pregnancy, lactation.May
impair ability to drive or operate machinery. Elderly. Reduced plasma protein binding.
Phaeochromocytoma. Hypothyroidism, Addison's disease. Prostatic hypertrophy, urethral stricture.
Diabetes. Glaucoma
Adverse Reactions :
Respiratory depression, dizziness, sweating, disorientation, hallucination,agitation, tremor,
multifocal myoclonus, convulsion, Gastrointestinal disturbances, hypotension, hypertension,
bradycardia, urine retention, Lightheadedness, dizziness, sedation, sweating, bizzare feeling,
disorientation, hallucinations, psychosis. Dry mouth, nausea, vomiting, constipation. Hypotension,
vasodilation, tachycardia, bradycardia, gangrene. Rash, pruritus, urticaria, erythema, injection site
complications, anuria. Increased biliary tract pressure, choledochoduodenal sphincter spasm.
Neurotoxicity, neuropsychiatric toxicity. Hyperactivity or agitation, depression, mental clouding,
dysphoria
Contraindications :
Hypersensitivity, concurrent use of MAOIs, intracranial lesions causing increased pressure,
atrioventricular flutter, respiratory depression, renal failure and a predisposition to convulsions or
seizures. Head injury, brain tumour. Cardiac arrhythmias. Concurrent use of MAOIs. Pre-eclampsia,
eclampsia. Convulsive states. Diabetic acidosis. Acute alcoholism or delerium tremens. Severe liver
disease, incipient encephalopathy, low platelet count, coagulation disorders or receiving
anticoagulant treatment. Continuous IV infusion in renal impairment. Patient-controlled analgesia in
young children & adult wiith poor cognitive function
Interactions :
Cimetidine: pethidine toxicity (respiratory depression, central nervous system depression,
hypotension). Isoniazid: hypotension and central nervous system depression. Moclobemide:
cardiovascular instability, hyperpyrexia, coma or possible serotonin syndrome (hypertension,
hyperthermia, myoclonus, mental status changes). Naltrexone: precipitation of opioid withdrawal
symptoms. Phenothiazines: increase in central nervous system and respiratory depression.
Phenytoin: decreased pethidine effectiveness. Procarbazine, selegiline: cardiac instability,
hyperpyrexia, coma. Ritonavir: increased risk of central nervous system stimulation and excitation.
Barbiturates, chloral hydrate, benzodiazepines. Butyrophenones, CNS depressants: pethidine
enhances the CNS depressant effects of these drugs. MAOIs, amphetamine reactions.
Anticoagulants. Reduces paracetamol absorption
----------------------------------------------------------------------------------------------------------------
105
antidepressants eg cyclobenzaprine, MAOI, SSRIs, neuroleptic agents and other drugs that lower the
seizure threshold
----------------------------------------------------------------------------------------------------------------
Diclofenac 1% Emulgel A
Trade Name : Voltaren
Indication :
Post-traumatic inflammation of the tendons,ligaments & joints. Localised forms of soft tissue
rheumatism and degenerative rheumatism
Dosage :
Apply 3 - 4 times daily and gently rubbed in
Precautions :
Do not apply to diseased skin or open wounds or injuries. Avoid contact with eyes or mucous
membranes. Systemic side effects when applied to large areas of skin & over a prolonged period of
time
Adverse Reactions :
Allergic or non allergic contact dermatitis. Generalized skin rash, hypersensitivity and
photosensitivity reactions
Contraindications :
Hypersensitivity to diclofenac or other NSAIDs, proctitis and isopropanol or propylene glycol
Interactions :
Increase plasma concentration of lithium, methotrexate & warfarin. Reduces effects of diuretics &
beta blockers
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106
Diclofenac Sodium 12.5 mg Suppository A
Diclofenac Sodium 50 mg Suppository A
Diclofenac Sodium 25 mg Suppository A
Trade Name : Voltaren
Indication :
Pain and inflammation in rheumatic disease and juvenile arthritis
Dosage :
75 - 150 mg daily in divided doses. CHILD 1-12 years, Juvenile arthritis; 12.5- 25 mg
daily
Precautions :
Previous history of gastrointestinal ulceration, bleeding or perforation. Renal dysfunction.
Hypertension or cardiac conditions aggravated by fluid retention and oedema. History of liver
dysfunction, coagulation defects
Adverse Reactions :
Occasionally gastrointestinal disorders, headache, dizziness, vertigo, rash, proctitis
Contraindications :
Patients with history of hypersensitivity to diclofenac or aspirin/other NSAIDs. Peptic or intestinal
ulcer. Lactation. Use of suppository is contraindicated in patients with recent rectal bleeding
Interactions :
Increases plasma concentration of warfarin, lithium, & methotrexate. May reduce effects of diuretics
& beta blockers. May alter plasma concentration of sulfonylureas. Caution with concomitant use of
diuretics and antihypertensives (eg beta-blockers, ACEI ), methotrexate, other NSAIDs and
corticosteroids, SSRIs. Monitoring recommended for patients receiving anticoagulants, antiplatelets
agents as well as blood glucose level if used concomitantly with antidiabetics. Digoxin, ciclosporin,
quinolones
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107
Diclofenac Sodium 75 mg/3 ml Injection A
Trade Name : Voltaren
Indication :
Pain and inflammation in rheumatic disease
Dosage :
75 mg once daily (2 times daily in severe cases) for not more than 2 days
Precautions :
Patient with CHF, dehydration, hypertension, decreased renal or hepatic function, active GIT
ulceration or bleeding, pre-existing asthma
Adverse Reactions :
Pruritus, rash, contact dermatitis, pain, dry skin, exfoliation, paraesthesia, constipation, diarrhoea,
headache, dizziness, vertigo, nausea, vomiting, gastrointestinal disorders, anorexia, increase
transaminases
Contraindications :
Hypersensitivity to diclofenac or any component of the formulation, aspirin or other NSAIDs,
asthma, rhinitis, porphyria, pregnancy (third trimester)
Interactions :
ACEI, angiotensin II antagonists, anticoagulants, cholestyramine and colestipol, ticlopidine, aspirin.
Monitoring recommended for patients receiving anticoagulants, antiplatelets agents as well as blood
glucose level if used concomitantly with antidiabetics. Lithium, digoxin, ciclosporin, quinolones
----------------------------------------------------------------------------------------------------------------
108
Indomethacin 25 mg Capsule B
Trade Name : Indocid
Indication :
Pain and inflammation in rheumatic disease
Dosage :
50 - 200 mg daily in divided doses, with food. Child not recommended
Precautions :
Active or previous history of gastrointestinal ulceration, bleeding, or perforation. History of
renal/liver dysfunction. Hypertension or cardiac conditions aggravated by fluid retention and
oedema. May aggravate depression/psychiatric disorders such as epilepsy, mental depression,
Parkinsonism. Patients with coagulation defects. Renal impairment. Retinal disturbances. Elderly.
Pregnancy and lactation
Adverse Reactions :
Gastrointestinal disturbances and bleeding, headache, vertigo, depression, epigastric disease,
dizziness, somnolence, depression & fatigue, anxiety, psychic disturbances including psychotic
episodes, mental confusion, tinnitus, corneal deposits, retinal disturbances, oedema, weight gain,
flushing, sweating, thrombocytopenia, rash, pruritus & urticaria
Contraindications :
Hypersensitivity, rhinitis, urticaria, asthma or allergic reactions to aspirin or other anti-inflammatory
agents, proctitis, pregnancy & lactation
Interactions :
Salicylates, anticoagulant drugs, probenecid, methotrexate, ciclosporin, lithium, digoxin, beta-
blockers, captopril, heparin or thrombolytic agents, aminoglycosides, digitalis glycosides.
antihypertensives, diuretics especially triamterene, diflunisal, other salicylates, cefamandole,
cefoperazone, cefotetan, plicamycin, valproic acid, gold compound, other nephrotoxics & zidovudine
----------------------------------------------------------------------------------------------------------------
109
Dosage :
Apply 1 plaster to the affected area twice daily
Precautions :
Avoid in children less than 5 years. If skin rash occurs after application, treatment should be
stopped. Pregnancy
Adverse Reactions :
Pruritus and localised erythema.
Contraindications :
Avoid in patient with exudative dermatoses, eczema sores & infected skin. Do not apply to the
mucous membranes or eyes.
Interactions :
Not known
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110
6. PSYCHIATRY
Hypnotics and anxiolytics
Anti-psychotics
Antidepressants
Miscellaneous psychiatry
111
Alprazolam 0.25 mg Tablet A/KK
Trade Name : Xanax
Indication :
Anxiety disorders
Dosage :
0.25 - 0.5 mg 3 times daily (elderly or delibitated 0.25 mg 2-3 times daily), increased if necessary to a
total dose of 3 mg/day. Not recommended for children
Precautions :
Avoid operating vehicles or machinery, abuse prone patient, pregnancy and breastfeeding, renal or
hepatic dysfunction, elderly patients, obesity, untreated open angle glaucoma, impaired pulmonary
function. Prolonged use can lead to dependence
Adverse Reactions :
Drowsiness, blurred vision, coordination disorder, gastrointestinal disturbance, agitation,
lightheadedness, dry mouth, depression, headache, confusion, hypotension, syncope, tachycardia,
seizures, respiratory depression, coma, constipation, diarrhoea, nausea, vomiting, insomnia, nasal
congestion, rigidity, increased salivation, dermatitis, sedation
Contraindications :
Hypersensitivity to benzodiazepines, acute narrow angle glaucoma, concomitant use of
ketoconazole/ itraconazole, CNS depression
Interactions :
Ketoconazole, fluconazole, itraconazole, contraceptives; increased alprazolam serum concentrations
and potential alprazolam toxicity (sedation, slurred speech, CNS depression). Omeprazole,
erythromycin, clarithromycin, cimetidine; benzodiazepine toxicity (CNS depression, ataxia, lethargy).
Sertraline, increased risk of psychomotor impairment and sedation. Fluoxetine, increased risk of
alprazolam toxicity (somnolence, dizziness, ataxia, slurred speech, hypotension, psychomotor
impairment). Fluvoxamine, increased risk of CNS side effects. Ritonavir, increased plasma
concentrations of alprazolam and enhanced alprazolam effects. Antihistamine/decongestant
combinations, antipsychotic, ethanol, mirtazapine, phenothiazines, venlafaxine (increased risk of
CNS depression, psychomotor impairment), sedative/hypnotics, tricyclic antidepressants (CNS
depression)
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112
Interactions :
Warfarin, increased risk of bleeding. Frusemide, cardiovascular toxicity (diaphoresis, hypertension,
tachycardia). Alcohol, increased sedation. May reduce effect of phenytoin
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113
dyspepsia, asthenia/fatigue, weight gain, anxiety diabetic ketoacidosis , neuroleptic malignant
syndrome, seizure, peripheral oedema
Contraindications :
Patients who are hypersensitive to aripiprazole or to any of the excipients.
Interactions :
Enhance effect of antihypertensive agents, alcohol, quinidine, ketoconazole, carbamazepine
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114
of neuroleptic malignant syndrome; rapid escalation of dose, prostatic hypertrophy, hypotension,
impaired renal or liver function, seizure disorder, hyperglycemia and diabetes mellitus. WBC &
absolute neutrophil counts (weekly during the 1st 18 week, at least monthly thereafter) can be
performed, eosinophilia, thrombocytopenia. Concurrent use of drugs with a substantial potential to
depress bone marrow function & of long-acting depot antipsychotics should be avoided. Caution
when patients drive vehicles or operate machinery. Narrow-angle glaucoma, chronic constipation, ,
lactation, pregnancy. Monitoring of standing & supine BP is necessary during the 1st few week of
treatment in patients with Parkinson's disease
Adverse Reactions :
Hyperglycemia, agranulocytosis, sedation, salivation, cardiovascular effects, dizziness / vertigo,
seizures, drowsiness, confusion, blurred vision, dry mouth, jaundice, leucopenia, neuroleptic
malignant syndrome, anticholinergic toxicity, hepatitis, hypotension, syncope, constipation, tremor,
weight gain, tachycardia, hypersalivation. Eosinophilia, ketoacidosis, hyperosmolar coma,
convulsions, ECG changes, circulatory collapse, arrhythmias, myocarditis, cardiomyopathy,
thromboembolism, aspiration of ingested food, intestinal obstruction, ileus, faecal impaction,
hepatitis, pancreatitis, fulminant hepatic necrosis, interstitial nephritis, neuroleptic malignant
syndrome, unexplained sudden death
Contraindications :
Severe hepatic and renal impairment, myeloproliferative disorders, uncontrolled epilepsy,
pregnancy, lactation, coma, hypersensitivity to clozapine products, myocarditis with clozapine
history, agranulocytosis with clozapine history (except due to previous chemotherapy), WBC less
than 3500, GI/GU obstruction, narrow angle glaucoma, CNS depression
Interactions :
Tramadol, carbamazepine, fluoxetine, sertraline, fluvoxamine, erythromycin, phenobarbitone,
phenytoin, rifampicin, cimetidine, benzodiazepines, other antipsychotics, tricyclic antidepressants,
valproic acid derivatives. Alcohol, MAOIs, CNS depressants, narcotics, antihistamines, anticholinergic
drugs, antihypertensive agents, adrenaline, drugs with resp depressant effects, omeprazole,
cimetidine, carbamazepine, SSRIs, lithium, azole antimycotics, protease inhibitors, caffeine, nicotine
--------------------------------------------------------------------------------------------------------------------------
116
in patients taking lithium. Temperature regulation: Impaired core body temperature regulation may
occur
Adverse Reactions :
Extrapyramidal symptoms (EPS), tardive dyskinesia, sedation, hypotension, tachycardia, insomnia,
anxiety, weight changes, anticholinergic effects, gynaecomastia, galactorrhoea, menstrual
irregularities, neuroleptic malignant syndrome, arrhythmias, seizure, jaundice, hyperpyrexia.
Anxiety, depression, anorexia, leukopaenia
Contraindications :
Parkinson's disease, severe CNS depression, bone marrow suppression, severe cardiac or hepatic
disease, comatose states, hypersensitivity to haloperidol. Lactation
Interactions :
Tramadol, fluoxetine, fluvoxamine, carbamazepine, cisapride,dicoumarol, procyclidine, methyldopa,
olanzapine, rifampicin, lithium, tricyclic antidepressants. May increase the plasma levels of
haloperidol when used with clozapine or chlorpromazine
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117
Dosage :
i) 5 - 10 mg once daily, increase to 10 mg once daily within 5 - 7 days, adjust by 5 - 10 mg/day at 1
week intervals, maximum 20 mg/day ii) 10 - 15 mg once daily, increase by 5 mg/day at intervals of
not less than 24 hours. Maintenance 5 - 20 mg/day; maximum 20 mg/day
Precautions :
History of neuroleptic malignant syndrome, patients with liver disease, seizure disorder, pneumonia,
narrow angle glaucoma, pregnancy, cardiovascular disease, history of breast cancer, tardive
dyskinesia, gastrointestinal obstruction, paralytic ileus, cerebrovascular disease, elderly,
hypotension, hypovolaemia, dehydration, risk of aspiration pneumonia, hyperglycemia and diabetes
mellitus. Elevated ALT and or AST, hepatic impairment, limited hepatic functional reserve, seizures,
low leukocyte/neutrophil counts, history or existing bone marrow depression, hypereosinophilic
conditions, myeloproliferative disease, prostatic hypertrophy, paralytic ileus. Pregnancy and
lactation. May impair ability to drive or operate machinery
Adverse Reactions :
Somnolence, agitation, dizziness, constipation, drowsiness, weight gain, peripheral oedema, dry
mouth, postural hypotension, elevated liver transaminases, hyperglycaemia, diabetic ketoacidosis,
weight gain, dizziness, increased appetite, orthostatic hypotension, dry mouth, constipation, tardive
dyskinesia
Contraindications :
Hypersensitivity to olanzapine products, narrow angle glaucoma, lactation
Interactions :
Carbamazepine, ciprofloxacin, fluvoxamine, levodopa, haloperidol, activated charcoal, ethanol,
central alpha-2 agonists, cimetidine, epinephrine, muscle relaxants, tricyclic antidepressants. May
antagonise the effects of dopamine agonist. Other centrally-acting drugs including alcohol. Activated
charcoal
--------------------------------------------------------------------------------------------------------------------------
Perphenazine 4 mg Tablet B
Indication :
Schizophrenia and other psychoses
Dosage :
ADULT: Initially 4 mg 3 times daily adjusted according to response, maximum 24 mg daily. ELDERLY:
1/4 to 1/2 adult dose. CHILD not recommended
Precautions :
Concomitant epinephrine use, seizure disorder, patients undergoing alcohol withdrawal, pregnancy
and lactation, respiratory impairment secondary to pulmonary infection or chronic pulmonary
disorders, increased risk of tardive dyskinesia development in older patients, sulfite hypersensitivity,
history of neuroleptic malignant syndrome, patients with hepatic or renal impairment;
cardiovascular disease, Parkinson's disease, epilepsy, depression, myasthenia gravis, paralytic ileus,
prostatic hypertrophy, history of jaundice, blood dyscrasias. May affect driving especially when first
started, elderly
Adverse Reactions :
CNS effects (extrapyramidal effects), drowsiness, insomnia, convulsion, allergic reaction, tachycardia,
postural hypotension, dizziness, impaired glucose tolerance, tardive dyskinesia, liver damage,
nausea, vomiting, cardiac arrest, agranulocytosis, haemolytic anaemia, hepatotoxicity, alter
temperature regulation, neuroleptic malignant syndrome, GI disturbances, nasal congestion,
antimuscarinic symptoms, cardiovascular symptoms, ECG changes, endocrine effects, blood
dyscrasias, photosensitisation, contact sensitisation, rashes, jaundice, corneal and lens opacities,
purplish pigmentation of the skin and eye
118
Contraindications :
Blood dyscrasias, bone marrow suppression, subcortical brain damage, comatose/obtunded
patients, hypersensitivity to perphenazine products, severe liver disease, high doses of CNS
depressants, hypersensitivity to perphenazine, lactation
Interactions :
Tramadol, increased risk of seizures. Cisapride, levofloxacin, cardiotoxicity. Procyclidine, decreased
phenothiazine serum concentrations, decreased phenothiazine effectiveness, enhanced
anticholinergic effects (ileus, hyperpyrexia, sedation, dry mouth). Pethidine, increase in central
nervous system and respiratory depression. Levodopa, loss of levodopa efficacy. Ethanol, increased
central nervous system depression and an increased risk of extrapyramidal reactions. Class Ia and III
antiarrhythmics, beta 2 agonists, carbamazepine, central alpha 2 agonists, systemic corticosteroids,
diuretics, lithium, tricyclic antidepressants. MAOIs, antiepileptics. Avoid alcohol, kava kava, gotu
kola, valerian & St John's wort
--------------------------------------------------------------------------------------------------------------------------
Risperidone 1 mg Tablet A
Risperidone 2 mg Tablet A
Trade Name : Risperdal
Indication :
Psychoses and schizophrenia
119
Dosage :
ADULT : 2 mg in 1 - 2 divided doses on first day then 4 mg in 1 - 2 divided doses on 2nd day then 6
mg in 1 - 2 divided doses on 3rd day (slower titration appropriate in some patients); usual range 4 - 8
mg daily; dose above 10 mg daily only if benefit outweigh risk (maximum 16 mg daily). Elderly (or in
hepatic or renal impairment): initially 0.5 mg twice daily increased in steps of 0.5 mg twice daily to 1
- 2 mg twice daily. Not recommended in children under 15 years
Precautions :
Neuroleptic malignant syndrome, tardive dyskinesia, QT prolongation, cardiovascular or
cerebrovascular disease or conditions that predispose patients to orthostatic hypotension,
hypothermia or hyperthermia, previous diagnosis of breast cancer or prolactin-dependent tumours,
renal insufficiency, hepatic insufficiency, Lewy body dementia or Parkinson's disease, seizure history,
pathologic changes in blood count, dysphagia, elderly patients, hypotension, hypovolaemia,
dehydration, agents prolonging QT, risk of aspiration pneumonia. Known cardiovascular disease,
dosage should be gradually titrated as recommended, a dose reduction should be considered when
hypotension occurs. Epilepsy, pregnancy ad lactation. May affect ability to drive or operate
machinery
Adverse Reactions :
Somnolence, dizziness, hyperkinesia, nausea, extrapyramidal effects, constipation, anxiety,
headache, rhinitis, rash, dyspepsia, tachycardia, dry mouth, weight gain, sexual dysfunction,
hyperprolactinaemia, menstrual irregularities, severe hypotension, tardive dyskinesia, neuroleptic
malignant syndrome and hyperglycaemia
Contraindications :
Hyperprolactinaemia, hypersensitivity to risperidone products, prolonged QT interval
Interactions :
Tramadol, increased risk of seizures. Carbamazepine, increased risperidone clearance. Levodopa,
loss of levodopa efficacy. Clozapine, decreased risperidone clearance. Amphotericin, Class Ia and III
antiarrhythmics, acetalozamide, central alpha2 agonists, systemic corticosteroids, diuretics, tricyclic
antidepressants
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120
dyskinesia, tardive dyskinesia, sedation or drowsiness, transient hyperprolactinemia, weight gain, QT
interval prolongation, orthostatic hypotension, neuroleptic malignant syndrome
Contraindications :
Hypersensitivity to sulpiride, phaeochromocytoma, prolactin dependent tumour, in combination
with sultopride and dopamine agonists apart from in patients with Parkinson's disease, lactation,
levodopa, class Ia and III antiarrhythmics, certain neuroleptics (thioridazine, chlorpromazine,
levomepromazine, trifluoperazine, cyamemazine, amisulpride, tiapride, pimozide, haloperidol,
droperidol), bepridil, cisapride, diphemanil, erythromycin, mizolastine, vincamine, halofantrine,
pentamidine, sparfloxacin, moxifloxacin
Interactions :
Tramadol, increased risk of seizures. Other central nervous system depressants, alcohol, levodopa.
Dopamine agonists, sultopride, halofantrine, pentamidine, sparfloxacin, moxifloxacin, bradycardiac
agents, hypokalaemic agents, antihypertensives, if treatment with neuroleptics is necessary in
patients with Parkinson's disease receiving treatment with dopamine agonists, the latter must be
gradually reduced and then discontinued
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121
Zuclopenthixol Acetate 50 mg/ml Injection A*
Trade Name : Clopixol - Acuphase
Indication :
Only for treatment of agitated and violent patients suffering from schizophrenia
who are not responding to the available standard drugs
Dosage :
50 - 150 mg repeated after 2 - 3 days if necessary. Additional dose may be needed 1 - 2 days after
the first injection. Maximum cumulative dose 400 mg per course and maximum 4 injections;
maximum duration of treatment 2 weeks. Change to oral dose 2 - 3 days after the last injection.
Child not recommended
Precautions :
Previous hypersensitivity to other neuroleptic agents, particularly thioxanthenes, fluphenazine and
perphenazine. Hepatic or renal disease or cardiovascular disease, pregnancy, breastfeeding,
epileptic or parkinsonian patients or organic brain syndrome. Patients on long-term therapy should
be monitored carefully. May affect ability to drive or operate machinery
Adverse Reactions :
Extrapyramidal syndrome, drowsines, anticholinergic effect, tachycardia, postural hypotension,
dizziness, tardive dyskinesia, urinary retention, disturbed accommodation, tachycardia
Contraindications :
Severe central nervous system depression, coma, blood dyscrasias, phaeocromocytoma. Previous
hypersensitivity to zuclopenthixol or clopenthixol. Comatose states, acute alcohol, barbiturate and
opiate intoxication. Pregnancy
Interactions :
Alcohol, barbiturates and central nervous system depressant, tricyclic antidepressant,
metoclopramide - increased effect
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122
Interactions :
Alcohol, barbiturates and central nervous system depressant, tricyclic antidepressant,
metoclopramide - increased effect
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123
Amitriptyline HCl 25 mg Tablet B
Trade Name : Laroxyl
Indication :
Depression
Dosage :
Initially 75 mg. ADULT and ELDERLY : 30 - 75 mg daily in divided doses or as a single dose at bedtime,
increase gradually as necessary to 150 - 200 mg. CHILD under 16 years are not recommended
Precautions :
Cardiac disease, hyperthyroidism, impaired hepatic and renal function, urinary retention, history of
seizures, glaucoma, suicide risk, pregnancy, lactation, elderly, phaeochromocytoma, history of
mania, phychoses, angle-closure glaucoma, concurrent anticonvulsive therapy, anaesthesia
Adverse Reactions :
Dry mouth, constipation, nausea, vomiting, urinary retention, blurred vision, drowsiness, dizziness,
tachycardia, increased appetite, confusion, seizures, myocardial infarction, stroke, agranulocytosis,
thrombocytopenia, rash and hypersensitivity reactions, blood sugar changes, endocrine side effects,
impotence, menstrual irregularities, bone marrow depression
Contraindications :
Hypersensitivity to drug/class. Immediate recovery phase after myocardial infarction, heart block,
mania. MAOI use within the last 14 days
Interactions :
Barbiturate, phenytoin, carbamazepine, cimetidine, amphetamines, antiarrhythmics, class Ia and III,
anticholinergics, antihistamines, beta 2 agonists, benzodiazepines, systemic carbonic anhydrase
inhibitors, central alpha 2 agonists, cholinergic agents, clozapine, intranasal decongestants,
flumazenil, halothane, lithium, MAOIs, methylphenidate, metoclopramide, muscle relaxants,
nitrates, opiates, antipsychotics, phenytoin, protease inhibitors, sedatives/hypnotics, SSRIs,
indirect/mixed sympathomimetics, cimetidine, fluoxetine, clonidine
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124
Interactions :
Alcohol, barbiturate, tranquilliser, MAOIs, anticholinergic, antihistamine, sympathomimetics, 5 HT
agonist, benzodiazepines, carbamazepine, clozapine, cyclosporine, digoxin, haloperidol, phenytoin,
linezolid, metoclopramide, ritonavir, tramadol, lithium, NSAIs, thioridazine, warfarin
--------------------------------------------------------------------------------------------------------------------------
Duloxetine 30 mg Capsule A*
Duloxetine 60 mg Capsule A*
Trade Name : Cymbalta
Indication :
Major depressive disorder, diabetic peripheral neuropathic pain
Dosage :
ADULT: 60 mg once daily up to a maximum dose of 120mg/day (in divided doses) CHILD and
ADOLESCENT under 18 years not recommended
Precautions :
History of mania/hypomania, seizures, renal impairment, elderly, liver transaminase elevations,
pregnancy and lactation, suicidal ideation and behavior or worsening depression, controlled narrow-
angle glaucoma, diabetes; may worsen glycemic control, hepatic impairment; increased risk of liver
injury and aggravation of pre-existing liver disease, hepatic insufficiency; risk of drug toxicity
Adverse Reactions :
Gastrointestinal disorders, excessive sweating, CNS disorders (eg dizziness, fatigue, insomnia,
somnolence, blurred vision, dysuria), hepatotoxicity, suicidal thought, increased urinary frequency,
increased libido, palpitation
Contraindications :
Concomitant use with MAOIs, potent CYP1A2 inhibitors, hepatic or severe renal impairment,
uncontrolled narrow-angle glaucoma, hypersensitivity to duloxetine or any other component of the
product
Interactions :
Drugs metabolised by CYP2D6 (eg flecainide, vinblastine, carbamazepine, tricyclic antidepressants),
potent CYP1A2 inhibitors/inducers, CNS-active drugs (eg diazepam, imipramine, phenytoin,
haloperidol, alcohol)
--------------------------------------------------------------------------------------------------------------------------
Escitalopram 10 mg Tablet A*
Trade Name : Lexapro
Indication :
i) Treatment of major depressive episodes ii) Treatment of panic disorder with or
without agoraphobia
Dosage :
i) 10 mg once daily; may be increased to max 20 mg daily. ii) Panic disorder with or without
agoraphobia :Initially 5 mg for the first week, thereafter increased to 10 mg daily. May be further
increased up to max 20 mg daily, dependent on individual patient response. ELDERLY initially half
adult dose, lower maintenance dose may be sufficient. CHILD and ADOLESCENT under 18 years not
recommended
Precautions :
Paradoxical anxiety, seizures, mania, diabetes, suicidal tendencies, hyponatraemia, haemorrhage,
electroconvulsive therapy, reversible selective MAO-A inhibitors, serotonin syndrome, St John's
Wort, lactation, renal and hepatic function impairment, abnormal bleeding, avoid abrupt
discontinuation, may activate hypomania or mania, concomitant use of NSAIDs
125
Adverse Reactions :
Dizziness, headache, nausea, sweating, somnolence, insomnia, constipation, diarrhoea, decreased
appetite, sexual dysfunction, fatigue, pyrexia, sinusitis, yawning, rash, Steven Johnson Syndrome,
rhinitis, blurred vision, nasal congestion, prolactinemia, dry mouth, decrease prothrombin, hepatic
failure, hypoglycemia, hypokalemia, suicidal ideation, diaphoresis, Syndrome of inappropriate
antidiuretic hormone secretion(SIADH)
Contraindications :
Concurrent use of MAOIs or within 14 days of discontinuing MAOS treatment
Interactions :
MAOI, selegiline, lithium, tryptophan, agents that may lower seizure threshold, St John's Wort,
omeprazole, high doses of cimetidine, drugs metabolised by CYP2D6 and CYP2C19 enzymes, alcohol,
aspirin, NSAIDs, warfarin, carbamazepine, ketoconazole, linezolid, tramadol, metoprolol, 5 HT
agonist, gingko, lamotrigine
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126
Precautions :
Concomitant use with MAOIs, hepatic insufficiency, children, epilepticus, pregnancy, lactation,
cardiovascular disease, avoid abrupt withdrawal, elderly, abnormal bleeding, hyponatremia, may
activate mania or hypomania, history of seizure, suicidal ideation, worsening depression
Adverse Reactions :
Blurred vision, dry mouth, tremor, gastrointestinal disturbances, somnolence, constipation,
headache, insomnia, vomiting, dizziness, agitation, extrapyramidal effects, bradycardia, seizures,
hepatotoxicity, withdrawal syndrome, Steven Johnson Syndrome, anphylactic reaction, abnormal
ejaculation, hepatitis, asthenia, abnormal bleeding, hyponatremia, seizure, serotonin syndrome,
worsening depression, hypomania, mania (rare), suicidal thoughts
Contraindications :
Use of MAOI within 14 days, coadministration of terfenadine, astemizole or cisapride, may cause
increased plasma concentrations of these drugs and an increased incidence of side effects,
hypersensitivity to fluvoxamine
Interactions :
Warfarin, phenytoin, theophyline, propanolol, lithium, benzodiazepines, caffeine, ergotamine,
MAOIs, sildenafil, statins, heparin, NSAIDs, aspirin, carbamazepin, clozapin, haloperidol, proton
pump inhibitor, tricyclic antidepressants, grapefruit, St. John wort, dilatiazem, metoclopramide,
serotonergic drugs, linezolid, tramadol, celecoxib
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127
Moclobemide 150 mg Tablet A*
Trade Name : Aurorix
Indication :
Treatment of depressive syndrome
Dosage :
Initially 300 mg daily in divided doses. Gradually to increase up to 600 mg daily in divided doses
depending on response. Usual range 150 - 600 mg daily. Not recommended in children
Precautions :
Avoid in excited and agitated patient, thyorotoxicosis, hepatic impairment, pregnancy, lactation,
hypertensive, avoid ingestion of excessive amounts of tyramine-rich foods, occipital headache,
palpitations, neck stiffness, tachycardia or bradycardia, coadministration with dextromethorphan
resulted in vertigo, tremor, nausea and vomiting
Adverse Reactions :
Sleep disturbance, dizziness, gastrointestinal disturbance, restlessness, agitation, blurred vision, dry
mouth, headache, constipation, possible hyponatraemia, diaphoresis, rash, increase libido,
abdominal pain, hepatotoxicity, oedema, orthostatic hypotension, tremor
Contraindications :
Acute confusional state, hypersensitivity to moclobemide, concomitant use with selective serotonin
reuptake inhibitors, conventional MAOIs or tricyclic antidepressants, concomitant use of narcotics
Interactions :
Tricyclic antidepressants, beta-2 agonist, carbamazepine
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128
Venlafaxine HCl 75 mg Extended Release Capsule A*
Trade Name : Efexor XR
Indication :
i) Depression ii) Generalized anxiety disorder iii) Social anxiety disorder (social
phobia) iv) Panic disorder
Dosage :
i), ii) & iii) ADULT: 75 mg once daily. May increase dose by 75 mg/day every 4 days to a maximum
dose of 225 mg/day iv) 37.5 mg/day for the first 4-7 days after which the dose should be increased
to 75 mg once daily. CHILD and ADOLESCENT under 18 years not recommended
Precautions :
Activation of mania/hypomania, changes in appetite or weight, glaucoma, history of seizure,
hyponatraemia, syndrome of inappropriate antidiuretic hormone syndrome (SIADH), patients with
recent myocardial infarction or unstable heart disease, sustained hypertension, suicidal ideation,
lactation, elderly, renal and liver function impairment, avoid abrupt discontinuation
Adverse Reactions :
Abnormal ejaculation, anorgasmia, impotence, anorexia, constipation, weight loss, diarrhoea,
dyspepsia, anxiety, dizziness, insomnia, nervousness, somnolence, tremor, asthenia, abnormal
bleeding, activation of mania, suicide ideation, hepatitis, hypertension, hyponatraemia, seizures,
sweating symptom, nausea, dream disorder, headache, blurred vision
Contraindications :
Recent or concomitant use of MAOIs, risk of potentially life-threatening serotonin syndrome
hypersensitivity to venlafaxine hydrochloride or any other component of the product
Interactions :
Clozapine, dexfenfluramine, droperidol, fenfluramine, haloperidol, linezolid, lithium,
metoclopramide, moclobemide, NSAIDs, procarbazine, selegiline, thioridazine, tramadol,
trifluoperazine, amoxicillin, aspirin, celecoxib ,diclofenac, etoricoxib, ginkgo, NSAIDs, jujube
,ketoprofen, ketorolac, mefenamic acid, meloxicam, mirtazapine, phenylbutazone, procarbazine,
sulindac, zolpidem
--------------------------------------------------------------------------------------------------------------------------
129
Contraindications :
Anxiety and tension states, agitation, tics, tics in siblings, familial history or diagnosis of Tourette's
syndrome, glaucoma, hyperthyrodism, cardiac arrythmias, severe angina pectoris, hypersensitivity to
drug/class, children less than 6 years of age, MAOIs use within 14 days
Interactions :
Pressor agents, MAOIs, anticoagulants, anticonvulsants, tricyclic antidepressants, phenylbutazone,
guanethidine
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130
7. NEUROLOGY
Antimigraine drugs
Antiepileptics
Drugs used in Parkinsonism and related disorders
Drugs used in substance dependence
Drugs used for dementia
Central nervous system stimulants
Miscellaneous neurology
131
Flunarizine HCl 5 mg Capsule B
Trade Name : Sibelium
Indication :
i) Migraine prophylaxis ii) Maintenance treatment of vestibular disturbances and of cerebral and
peripheral disorders
Dosage :
i) ADULT: 5 - 10 mg daily preferably at night. ELDERLY more than 65 years: 5 mg at night.
Maintenance 5-day treatment at the same daily dose ii) 5 - 10 mg at night. If no improvement after 1
month, discontinue treatment
Precautions :
Narrow-angle glaucoma, obesity, urinary retention. May affect ability to drive and operate
machinery. Pregnancy, breast feeding. Dosage reduction may be necessary in renal impairment,
prostatic hyperplasia, pyloroduodenal obstruction, epilepsy, hepatic impairment, elderly, young
children. Pregnancy, lactation
Adverse Reactions :
Sedation, dizziness, dry mouth and constipation. Increased appetite, sedation, nausea, fatigue.
Rarely, hypersensitivity reactions, face oedema, rash, central nervous system stimulation,
hallucinations, seizures, depression, drowsiness, headache, palpitation, arrhythmias, gastrointestinal
disturbance, palpitations, blood disorders, convulsions, sweating, myalgia, paraesthesias,
extrapyramidal effects, sleep disturbances, confusion, tinnitus, tremor, hypotension, hair loss
Contraindications :
Hypersensitivity to the drug. Children less than 2 years. Postural giddiness
Interactions :
Central effects of sedatives, hypnotics, antihistamines, including certain common cold preparations
and alcohol may be enhanced. Antagonised hypotensive effect of adrenergic neuron blockers. May
mask warning signs of damage caused by ototoxic drugs eg. aminoglycosides
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132
Interactions :
Central effects of sedatives, hypnotics, antihistamines, including certain common cold preparations
and alcohol may be enhanced. Antagonised hypotensive effect of adrenergic neuron blockers. May
mask warning signs of damage caused by ototoxic drugs eg. aminoglycosides
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133
psychosis, confusion, agitation. Mixed seizure disorders. Elderly. Avoid abrupt discontinuation.
Neonatal withdrawal syndrome. Potential for an increase in risk of suicidal thoughts or behaviours
Adverse Reactions :
Rash, Stevens-Johnson Syndrome, nausea, drowsiness, dizziness, ataxia, blood dyscrasias, confusion,
agitation, visual disturbance, constipation or diarrhoea, anorexia, leukopenia, blood disorders,
Syndrome of Inappropriate ADH (SIADH), cardiac conduction abnormalities, gynaecomastia. Allergic
skin reactions, leukopenia, vomiting, accommodation disorders, diplopia, raised liver enzymes,
thrombocytopenia and hyponatraemia, exfoliative dermatitis
Contraindications :
Hypersensitivity to carbamazepine products or tricyclic compounds, bone marrow suppression,
porphyria. Concomitant MAOIs, pregnancy
Interactions :
Plasma level is increased by erythromycin, diltiazem, isoniazid, verapamil, fluoxetine, cimetidine and
decreased by other antiepileptics and theophylline. May reduce alcohol tolerance and antagonise
the effects of non-depolarising muscle relaxants. Cytochrome P450 3A4 inducers or inhibitors, oral
contraceptive
----------------------------------------------------------------------------------------------------------------
134
Clonazepam 2 mg Tablet B
Trade Name : Rivotril
Indication :
i) Epilepsy ii) Non-epileptic myoclonus
Dosage :
i) ADULT: Initially, 1 mg given at night for 4 nights, gradually increased over 2-4 week. Elderly: 500
mcg. Maintenance: 4-8 mg daily. Maximum dosage: 20 mg/day. CHILD: 5-12 years: Initially, 0.5 mg
daily; 1-5 years: 0.25 mg daily. Maintenance (given in 2-4 divided doses): 5-12 years: 3-6 mg daily; 1-
5 years: 1-3 mg daily; infants: 0.5-1 mg daily. Maximum 200 mcg/kg/day. ii) ADULT: Initially, 250 mcg
twice daily, increased after 3 days up to 1 mg daily. Max: 4 mg daily
Precautions :
Avoid abrupt withdrawal, renal insufficiency, respiratory disease, acute intermittent porphyria,
uncontrolled open angle glaucoma, elderly, pregnancy, lactation, may exacerbate tonic seizures.
Patients with spinal or cerebellar ataxia, acute alcohol or drug intoxification, severe liver damage,
sleep apnoea, renal and hepatic diseases. History of depression and or suicide attempts.
Simultaneous use of other anti-epileptics. Avoid driving and operating machinery
Adverse Reactions :
Drowsiness, ataxia, aggravation of seizure, fatigue, dizziness. Tiredness, sleepiness, lassitude,
muscular hypotonia, muscle weakness, light-headedness, ataxia, slowed reaction, poor
concentration, restlessness, confusion, agitation, excitability, irritability, disorientation, anterograde
amnesia, depression. Increased production of saliva or bronchial secretions in infants and young
children, coordination disturbances, vertigo, anorexia, visual disturbances, libido changes
Contraindications :
Hypersensitivity to clonazepam products and benzodiazepines, severe liver disease, narrow angle
glaucoma, respiratory depression, acute pulmonary insufficiency
Interactions :
Alcohol may reduce the efficacy of treatment or produce unexpected side effects. Increases
phenytoin or primidone concentrations. Combination with valproate may cause petit mal status
epilepticus. Amiodarone, carbamazepine, theophylline. Barbiturates, hydantoins, carbamazepine,
other centrally-acting drugs, alcohol
----------------------------------------------------------------------------------------------------------------
136
of 1 week. May affect ability to drive or operate machinery. Potential for an increase in risk of
suicidal thoughts or behaviours
Adverse Reactions :
Somnolence, dizziness, ataxia, weight gain, fatigue, nystagmus, tremor, diplopia, amnesia, dyspepsia,
asthenia, leukopenia, headache, myalgia
Contraindications :
Hypersensitivity to gabapentin
Interactions :
Antacid like Maalox reduced the bioavailability of gabapentin
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137
from 4 years of age with epilepsy; juvenile myoclonic epilepsy and idiopathic generalized tonic clonic
epilepsy from 12 years of age
Dosage :
i) Monotherapy ADULTS and ADOLESCENT (from 16 years) : Starting dose: 250 mg twice daily,
Increase dose to 500 mg twice daily after 2 week. Dose can be further increased by 250 mg twice
daily every 2 week depending upon the clinical response. Max: 1500 mg twice daily. ii) ADULT more
than 18 years and ADOLESCENT (12-17 years) more than or equal to 50 kg: Initially 500 mg twice
daily may be increased up to 1500 mg twice daily. Dose changes can be made in 500 mg twice daily
increments or decrements 2-4 weekly. CHILD (4-11 years) and ADOLESCENT (12-17 years) less than
50 kg : Initially 10 mg/kg twice daily, may be increased up to 30 mg/kg twice daily. Dose changes
should not exceed increments or decrements of 10 mg/kg twice daily every 2 weeks. CHILD more
than or equal to 50 kg: Adult dose
Precautions :
Avoid abrupt discontinuation, renal impairment, severe hepatic impairment, pregnancy, lactation,
elderly. May affect ability to drive or operate machinery. Potential for an increase in risk of suicidal
thoughts or behaviours
Adverse Reactions :
Asthenia, somnolence, dizziness, anorexia, diarrhoea, nausea, dyspepsia, rash, diplopia
Contraindications :
Hypersensitivity to levetiracetam products
Interactions :
Evening primrose, ginkgo
----------------------------------------------------------------------------------------------------------------
Phenobarbitone 30 mg Tablet B
Trade Name : Luminal
Indication :
Epilepsy
Dosage :
ADULT: 60 - 180 mg daily on. CHILD: Up to 8 mg/kg daily
Precautions :
Depression, renal impairment, pulmonary insufficiency, elderly, avoid abrupt discontinuation,
pregnancy, breast feeding, porphyria, hyperactivity in children
Adverse Reactions :
Hypersensitivity, rash, hypotension, drowsiness, ataxia, respiratory depression, dyskinesias
Contraindications :
Hypersensitivity to phenobarbital products, porphyria
Interactions :
Alcohol, antibacterial, warfarin, antidepressants, other antiepileptics, antipsychotics, antiviral,
ciclosporin
----------------------------------------------------------------------------------------------------------------
138
Precautions :
Depression, renal impairment, pulmonary insufficiency, elderly, avoid abrupt discontinuation,
pregnancy, breast feeding, porphyria, hyperactivity in children
Adverse Reactions :
Hypersensitivity, rash, hypotension, drowsiness, ataxia, respiratory depression, dyskinesias
Contraindications :
Hypersensitivity to phenobarbital products, porphyria
Interactions :
Alcohol, antibacterial, warfarin, antidepressants, other antiepileptics, antipsychotics, antiviral,
ciclosporin
----------------------------------------------------------------------------------------------------------------
139
Dosage :
ADULT and CHILD more than 6 years: 300-400 mg/day in 3 - 4 divided doses before meals.
Maximum: 600 mg/day. CHILD: Initially 5 mg/kg/day in 2 - 3 divided doses. Maintenance: 4 - 8
mg/kg/day. Maximum: 300 mg/day
Precautions :
Avoid abrupt withdrawal, liver insufficiency, porphyria, discontinue if skin rash occurs, diabetes,
elderly, pregnancy, breast feeding. Severe myocardial insufficiency. Pregnancy. Potential for an
increase in risk of suicidal thoughts or behaviours
Adverse Reactions :
Nystagmus, ataxia, lethargy, blood dyscrasias, cardiovascular toxicity, nausea, vomiting, headache,
tremor, insomnia, gingival hypertrophy, acne, lupus erythematosus, Stevens-Johnson syndrome,
leukopenia, megaloblastic anaemia, hirsutism, hepatitis. Slurred speech, decreased coordination,
mental confusion, constipation, toxic hepatitis, liver damage, hematopoietic complications,
dermatological manifestations, agranulocytosis, bullous dermatosis, granulocytopenic disorder, liver
damage, nephrotoxicity, pancytopenia, purpuric rash, scaling eczema, thrombocytopenia, toxic
epidermal necrolysis
Contraindications :
Hypersensitivity to phenytoin or hydantoin products, sinus bradycardia, SA block, second and third
degree AV block and Adams-Stokes syndrome (intravenous phenytoin only)
Interactions :
Chloramphenicol, anticoagulants, diazepam, oestrogen, cimetidine, fluconazole etc may increase
serum levels. Methotrexate, folic acid, carbamazepine, theophylline, etc may decrease serum levels.
Increased phenytoin serum levels with alcohol (acute intake), disulfiram, omeprazole, ticlopidine,
salicylates, SSRIs, benzodiazepines, antifungal agents, calcium channel blockers. Decreased
phenytoin serum levels with alcohol (acute intake), rifampicin, ciprofloxacin, vigabatrin, sucralfate,
theophylline, reserpine, diazoxide, anticonvulsants, antineoplastics
----------------------------------------------------------------------------------------------------------------
140
Contraindications :
Hypersensitivity to phenytoin or hydantoin products, sinus bradycardia, SA block, second and third
degree AV block and Adams-Stokes syndrome (intravenous phenytoin only)
Interactions :
Chloramphenicol, anticoagulants, diazepam, oestrogen, cimetidine, fluconazole etc may increase
serum levels. Methotrexate, folic acid, carbamazepine, theophylline, etc may decrease serum levels.
Increased phenytoin serum levels with alcohol (acute intake), disulfiram, omeprazole, ticlopidine,
salicylates, SSRIs, benzodiazepines, antifungal agents, calcium channel blockers. Decreased
phenytoin serum levels with alcohol (acute intake), rifampicin, ciprofloxacin, vigabatrin, sucralfate,
theophylline, reserpine, diazoxide, anticonvulsants, antineoplastics
----------------------------------------------------------------------------------------------------------------
141
Precautions :
Monitor liver function, avoid sudden withdrawal, certain metabolic disorders, fatigue, loss of
appetite, vomiting. Pregnancy, lactation, Avoid concomitant use of salicylates in children less than 3
years due to risk of liver toxicity, use of salicylates in children less than 16 years is also not
recommended. Monitor liver function before therapy and during first 6 months. Potential for an
increase in risk of suicidal thoughts or behaviours
Adverse Reactions :
Nausea, vomiting, headache, dizziness, ataxia, tremor, weight gain, transient hair loss, oedema,
thrombocytopenia (dose related), leukopenia. Gastrointestinal disorders, liver failure, children under
the age of two years are at increased risk, pancreatitis
Contraindications :
Hepatic disease or significant hepatic dysfunction, hypersensitivity to valproate sodium, valproic acid
or divalproex sodium, porphyria
Interactions :
Increases phenobarbital, primidone and phenytoin plasma concentrations. Potentiates toxic effect of
carbamazepine. Risk of rash may be increased by coadministration with lamotrigine. May potentiate
the effect of neuroleptics, MAOIs, antidepressants and benzodiazepines. Monitor prothrombin time
when used with anticoagulants. Caution when used with newer anti-epileptics whose
pharmacodynamics are not well-established
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142
Topiramate 15 mg Capsule Sprinkle A*
Trade Name : Topamax
Indication :
Add-on therapy for intractable partial epilepsy
Dosage :
ADULT: 200 - 400 mg/day in 2 divided doses. Maximum 1600 mg/day. CHILD: initial 25 mg (1-3
mg/kg/day), then titrated by 1-3 mg/kg/1-2 weeks in 2 divided doses. Maintenance 5-9 mg/kg/day in
2 divided doses
Precautions :
Avoid abrupt withdrawal, hepatic or renal impairment, behavioral disorders or cognitive deficit,
paraesthesia, predisposition to or history of nephrolithiasis, pregnancy, lactation. Ensure adequate
hydration. May impair ability to drive or operate machinery. Potential for an increase in risk of
suicidal thoughts or behaviours
Adverse Reactions :
Cognitive dysfunction, sedation, diarrhoea, weight loss, dizziness, abdominal pain, nausea, anorexia,
confusion, impaired speech, ataxia, drowsiness, fatigue, asthenia, visual disturbances, nystagmus,
taste disorder, leucopenia, renal calculi, somnolence and paraesthesia
Contraindications :
Hypersensitivity to topiramate, breast feeding
Interactions :
Plasma concentration decreased by phenytoin and carbamazepine. Metabolism of oral
contraceptive (oestrogens and progestogens) accelerated (reduced contraceptive effect)
----------------------------------------------------------------------------------------------------------------
Topiramate 25 mg Tablet A*
Topiramate 50 mg Tablet A*
Trade Name : Topamax
Indication :
Add-on therapy for intractable partial epilepsy
Dosage :
ADULT: 200 - 400 mg/day in 2 divided doses. Maximum 1600 mg/day. CHILD: initial 25 mg (1-3
mg/kg/day), then titrated by 1-3 mg/kg/1-2 weeks in 2 divided doses. Maintenance 5-9 mg/kg/day in
2 divided doses
Precautions :
Avoid abrupt withdrawal, hepatic or renal impairment, behavioral disorders or cognitive deficit,
paraesthesia, predisposition to or history of nephrolithiasis, pregnancy, lactation. Ensure adequate
hydration. May impair ability to drive or operate machinery. Potential for an increase in risk of
suicidal thoughts or behaviours
Adverse Reactions :
Cognitive dysfunction, sedation, diarrhoea, weight loss, dizziness, abdominal pain, nausea, anorexia,
confusion, impaired speech, ataxia, drowsiness, fatigue, asthenia, visual disturbances, nystagmus,
taste disorder, leucopenia, renal calculi, somnolence and paraesthesia
Contraindications :
Hypersensitivity to topiramate, breast feeding
Interactions :
Plasma concentration decreased by phenytoin and carbamazepine. Metabolism of oral
contraceptive (oestrogens and progestogens) accelerated (reduced contraceptive effect)
----------------------------------------------------------------------------------------------------------------
143
Amantadine HCl 100 mg Capsule B
Trade Name : Symmetrel
Indication :
Parkinson's disease
Dosage :
Initial dose: 100 mg daily and is increased to 100 mg twice daily (not later than 4 p.m.) after a week.
Elderly over 65 years: less than 100 mg or 100 mg at intervals of more than 1 day
Precautions :
Seizure disorder, psychiatry disorder, recurrent eczema, gastric ulceration. Patients with
cardiovascular or liver disease, impaired renal function. Elderly. Withdrawal of the drug should be
gradual
Adverse Reactions :
Oedema of ankles, livedo reticularis, depression, hallucination, nausea, vomiting, dizziness,
insomnia, blurred vision, dry mouth. Seizures, psychosis, confusion, ataxia, heart failure, depression,
orthostatic hypotension, blood dyscrasias, urinary retention, irritability, gastrointestinal disturbances
Contraindications :
Hypersensitivity to amantadine products, pregnancy, lactation, epilepsy, history of gastric ulceration,
severe renal impairment
Interactions :
Alcohol, methyldopa, metoclopramide, domperidone, antipsychotic, antimuscarinics. Enhances the
adverse effects of antimuscarinics and levodopa. Central nervous system stimulants, drugs that raise
urinary pH
----------------------------------------------------------------------------------------------------------------
Benzhexol 2 mg Tablet B
Trade Name : Artane
Indication :
i) Parkinson's disease ii) Drug induced parkinsonism iii) Dystonias
Dosage :
ADULT: Initially 1 mg daily. Maintenance: 5 - 15 mg daily in 3 - 4 divided doses. CHILD: 0.02
mg/kg/dose 8 hourly, gradually increasing to 0.1 - 0.3 mg/kg/dose
Precautions :
Autonomic neuropathy, heart disease, hepatic or renal disease, hyperthyroidism, paediatric, elderly,
potential for abuse, prostatic hypertrophy, glaucoma, obstructive disease of gastrointestinal or
genitourinary, pregnancy and lactation. Use with caution in patients with ileostomy or colostomy.
Avoid driving or hazardous activities. Monitor intraocular pressure
Adverse Reactions :
Severe mental disturbances, confusion, drowsiness, restlessness, hallucinations, excitement, nausea
and vomiting, dry mouth, blurring of vision, constipation, urinary retention, glaucoma
Contraindications :
Children under 3 years, narrow-angle glaucoma, closed-angle glaucoma, tardive dyskinesias,
prostatic enlargement, paralytic ileus, chronic pulmonary disease, sick sinus syndrome,
thyrotoxicosis, cardiac failure with tachycardia, lactation
Interactions :
Alcohol and central nervous system depressants may increase the sedative effect of benzhexol.
Delayed absorption of other oral drugs
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144
Entacapone 200 mg Tablet A
Trade Name : Comtan
Indication :
Parkinson's Disease. An adjunct to standard levodopa/benserazide or levodopa/carbidopa for use in
patients with parkinson's disease and end of dose motor fluctuations, who cannot be stabilised on
those combinations
Dosage :
200 mg to be taken with each daily dose of levodopa/dopa-decarboxylase inhibitor.
May be taken with or without food
Precautions :
Levodopa-induced orthostatic hypotension may be aggravated. Abrupt withdrawal
Adverse Reactions :
Nausea, vomiting, abdominal pain, constipation, diarrhoea, urine may be coloured reddish-brown,
dry mouth, dyskinesia, dizziness, anaemia, rarely elevated liver enzymes, gastrointestinal symptoms,
insomnia, hallucinations, confusion, paroniria, aggravated parkinsonism, dizziness, dystonia,
hyperkinesia, fatigue, increased sweating, fall. Extremely rare (potentially serious adverse reactions):
Hepatitis, sudden sleep onset episodes, neuroleptic malignant syndrome, rhabdomyolysis
Contraindications :
Pregnancy and breast-feeding, hepatic impairment, phaeochromocytoma, history of neuroleptic
malignant syndrome or non-traumatic rhabdomyolysis. Concomitant use with selective and
nonselective MAO-A and MAO-B inhibitors
Interactions :
Entacapone and ferrous product should be taken at least 2 - 3 hours apart. Dosage of levodopa and
other antiparkinson drugs may need to be adjusted when initiating entacapone. Effects of medicinal
products metabolised by catechol-O-methyl transferase (COMT) may be potentiated. MAO-A
inhibitors, tricyclic antidepressants, noradrenaline reuptake inhibitors, medicinal products
metabolized by COMT, selegiline, warfarin
----------------------------------------------------------------------------------------------------------------
146
Levodopa 250 mg and Carbidopa 25 mg Tablet B
Levodopa 100 mg and Carbidopa 25 mg Tablet B
Trade Name : Sinemet
Indication :
Parkinson's disease
Dosage :
Patients not receiving Levodopa before, initially 100 - 125 mg 3 - 4 times daily
adjusted according to response. Maintenance: 0.75 - 2 g in divided doses. In patients
previously treated with Levodopa the dose should be about 20 - 25% of the dose
previous being taken
Precautions :
Not recommended for treatment of drug-induced extrapyramidal reactions. The occurrence of
dyskinesias in patients previously treated with levodopa alone may require dosage reduction. All
patients should be observed carefully for the development of depression with concomitant suicidal
tendencies. Cardiovascular disease or pulmonary disease, bronchial asthma. Hepatic impairment,
renal impairment, endocrine disease, chronic wide-angle glaucoma. Observe carefully when the
dosage is reduced abruptly or discontinued, especially if the patient is receiving neuroleptics.
Pregnancy, women of childbearing potential. Not recommended in patients less than 18 years
Adverse Reactions :
Central nervous system: Anxiety, confusion, nervousness, mental depression, psychotic symptoms.
Anorexia, nausea and vomiting, diarrhoea, insomnia, agitation, postural hypotension, dizziness,
chest pain, tachycardia, arrhythmias, reddish discoloration of urine and other body fluid. Dyskinesia,
muscle twitching and blepharospasm may be taken as early signs to consider dosage reduction.
Gastrointestinal bleeding, development of duodenal ulcer, dark saliva, leukopenia, hemolytic and
non-hemolytic anemia, thrombocytopenia, agranulocytosis, angioedema, urticaria, pruritus,
paresthesia, increased libido, dyspnea, alopecia, rash, dark sweat, dark urine
Contraindications :
Hypersensitivity to this drug. Patient on MAOIs therapy or 2 weeks prior to initiating therapy. May
be administered concomitantly with or an MAOI with or selectivity for MAO type B (eg selegiline
HCl). Narrow-angle glaucoma with compensated endocrine, renal or hepatic function, cardiac
disorders, psychiatric diseases or closed-angle glaucoma, undiagnosed skin lesion, melanoma,
pregnancy
Interactions :
Hypertensive crisis with MAOIs, increased hypotensive effect with antihypertensives, antagonism
effect of antipsychotic, reduced absorption by iron, plasma concentration increased by
metoclopramide. Linezolid, clonidine, anticholinergics, tricylic antidepressant, phenothiazines,
phenytoin, papaverine, selegiline and high protein diet
----------------------------------------------------------------------------------------------------------------
Piribedil 50 mg Tablet A*
Trade Name : Trivastal Retard
Indication :
Parkinson disease
Dosage :
As monotherapy: 150 - 250 mg as 3 - 5 divided doses daily. As combination with L-dopa therapy: 50 -
150 mg daily (50 mg per 250 mg of L-dopa)
Precautions :
Hepatic dysfunction, elderly, psychosis, parkinsonism, mania, thyroid disorder
Adverse Reactions :
Drowsiness, confusion, anxiety, dizziness, delusions, hallucinations, hypotension, tachycardia,
extrapyramidal effects, dyskinesias, mania, gastric discomfort, nystagmus, changes in liver function,
gastrointestinal disorders (nausea, vomiting, flatulence), orthostatic hypotension, drowsiness
Contraindications :
Hypersensitivity to piribedil, cardiogenic shock, acute phase of myocardial infaction
Interactions :
Dopaminergic antagonists
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148
Procyclidine HCl 10 mg/2 ml Injection B
Trade Name : Kemadrin
Indication :
i) All forms of Parkinson's disease (idiopathic paralysis agitants), post-encephalitis and
arteriosclerosis
ii) To control troublesome extrapyramidal symptoms induced by neuroleptic drugs including pseudo-
parkinsonism, acute dystonic reactions and akathisia
Dosage :
By IM injection 5 - 10 mg repeated if necessary after 20 minutes. Maximum 20 mg
daily. By IV injection 5 - 10 mg
Precautions :
Hypotension, severe psychoses, prostatic hypertrophy, tachycardia, urinary retention, hepatic or
rena impairment, lactation, pregnancy, children, elderly
Adverse Reactions :
Excitability, dizziness, hallucinations (seen on abuse), dry mouth, constipation, urinary retention,
agitation, restlessness, convulsions
Contraindications :
Closed-angle glaucoma, narrow-angle glaucoma, hypersensitivity to procyclidine products,
gastrointestinal tract or urinary outflow obstruction, prostatic hypertrophy, tardive dyskinesia in
patients on neuroleptic drugs
Interactions :
Anticholinergic-like drugs, chlorpromazine, haloperidol, promethazine, thioridazine, trifluoperazine
and prochlorperazine. Reduced peristaltic movement affects absorption of erythromycin, penicillin
----------------------------------------------------------------------------------------------------------------
149
Selegiline HCl 5 mg Tablet A*
Trade Name : Jumex
Indication :
Only for treatment of late stage Parkinsonism with on and off phenomenon
Dosage :
5 mg twice daily at breakfast and lunch. Maximum 10 mg/day
Precautions :
History of peptic ulcer, pregnancy and lactation, elderly, concurrent use of tricyclic antidepressants,
uncontrolled hypertension. Suicidal ideation and behavior or worsening depression, increased risk
during the first few months of therapy or following changes in dosage (particularly in children,
adolescents and young adults with major depressive disorder)
Adverse Reactions :
Hypotension, nausea, confusion, agitation, hallucination, dyskinesia, sleep disturbances, psychosis,
constipation, dry mouth, headache, tremor, dizziness
Contraindications :
Extrapyramidal symptoms not related to dopamine deficiency, thyrotoxicosis, narrow angle
glaucoma agitated psychosis, hypersensitivity to selegiline products. Pregnancy
Interactions :
Hyperpyrexia and central nervous system toxicity with pethidine. Hypertension and central nervous
system excitation with fluoxetine and sertraline. Hypotension with MAOIs. Carbamazepine,
amitriptyline, amphetamine
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150
Donepezil HCl 5 mg Tablet A
Donepezil HCl 10 mg Tablet A
Trade Name : Aricept
Indication :
Treatment of mild to moderate dementia in Alzheimer's disease, as well as in patients with severe
Alzheimer's disease. [psychiatrists and neurologists only]
Dosage :
5 - 10 mg once daily at bedtime. Maximum 10 mg daily
Precautions :
Gastrointestinal disease or history of ulcer disease, asthma or obstructive pulmonary disease or
seizures or those receiving concurrent NSAIDs, pregnancy, cardiac conduction abnormalities,
anaesthesia with succinylcholine
Adverse Reactions :
Diarrhoea, muscle cramps, nausea, vomiting, insomnia, fatigue, dizziness, hallucination, agitation,
loss of appetite
Contraindications :
Hypersensitivity to donepezil hydrochloride and piperidine derivatives. Pregnancy and lactation
Interactions :
Has the potential for synergistic activity with concurrent succinylcholine, other neuromuscular
blocking agents or cholinergic agonist. Has the potential to interfere with drugs having
anticholinergic activity. Muscle relaxants drugs, suxamethonium
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151
Rivastigmine 4.6mg/24hr Transdermal Patch A*
Rivastigmine 9.5 mg/24hr Transdermal Patch A*
Trade Name : Exelon® patch 5, Exelon®patch 10
Indication :
Mild to moderately severe dementia associated with Alzheimer's or Parkinson's
disease
Dosage :
Initial, 4.6 mg/24 hr patch TOPICALLY once daily; after a minimum of 4 weeks and good tolerability,
increase the dose to 9.5 mg/24 hr patch once daily
Precautions :
Sick-sinus syndrome, conduction defects, urinary obstruction, seizures in predisposed patients,
asthma or obstructive pulmonary disease. Pregnancy and lactation. Hepatic impairment, renal
impairment, anesthesia, low body weight, nicotine use. May impair ability to drive or operate
machinery
Adverse Reactions :
Vomiting, nausea, anorexia, decreased appetite, anxiety, depression, insomnia, dizziness, headache,
diarrhoea, dyspepsia, abdominal pain, application site reaction
Contraindications :
Hypersensitivity to rivastigmine, other carbamate derivatives and other components of the product
Interactions :
Cholinomimetic drugs, anticholinergic medications, succinylcholine-type muscle relaxants during
anaesthesia
----------------------------------------------------------------------------------------------------------------
152
Interactions :
MAOIs, CYP2D6 inhibitors (fluoxetine, paroxetine), salbutamol, pressor agents, drugs that affect
noradrenaline
----------------------------------------------------------------------------------------------------------------
Piracetam 1 g Injection A*
Trade Name : Nootropil
Indication :
Treatment of cerebral functional impairment and ischaemic stroke
Dosage :
30 - 160 mg/kg/day orally or parenterally 2 times daily or 3 to 4 times daily. Maximum: 24 g/day
Precautions :
Renal insufficiency (possible need for dose adjustments), elderly patients with multiple diseases
Adverse Reactions :
Nervousness, agitation, irritability, anxiety and sleep disturbances, fatigue or drowsiness,
gastrointestinal disturbances
Contraindications :
Previous hypersensitivity to piracetam. Huntington's chorea
Interactions :
Warfarin: an increased risk of bleeding
----------------------------------------------------------------------------------------------------------------
Baclofen 10 mg Tablet B
Trade Name : Lioresal
Indication :
Spasticity of the skeletal muscle
Dosage :
ADULT: 5 mg 3 times daily. Max: 80 mg daily. CHILD: 0.75 - 2 mg/kg daily (more than 10 years,
maximum: 2.5 mg/kg daily)
Precautions :
Pregnancy, patients suffering not only from spasticity but also from psychotic disorders,
schizophrenia or confusional states, epilepsy, cerebrovascular or respiratory insufficiency. Central
153
nervous system depressants, antihypertensives, levodopa. Caution in road users. Avoid abrupt
discontinuation
Adverse Reactions :
Daytime sedation, drowsiness, nausea and other central nervous system disorders, gastrointestinal
disturbances, dysuria, frequency of micturition, enuresis or retention of urine, respiratory
depression
Contraindications :
Epilepsy and other convulsive conditions, corticol or subcorticol brain damage, peptic ulceration,
known hypersensitivity to baclofen
Interactions :
Tricyclics and lithium enhance muscle relaxant effect, ACE inhibitor, diuretics and antihypertensives
enhance hypotensive effect. Sedative effect enhanced with alcohol, anxiolytics and hypnotics.
Excretion reduced by ibuprofen and possibly other NSAIDs
----------------------------------------------------------------------------------------------------------------
Diazepam 5 mg Tablet B
Trade Name : Valium
Indication :
i) Muscle spasm of varied aetiology, including tetanus ii) Anxiety disorders
Dosage :
i) ADULT: 2-10 mg 3-4 times daily. CHILD 6 months and older: 0.12 - 0.8 mg/kg daily in divided doses,
every 6-8 hours ii) ADULT : 2 mg 3 times daily, increased in severe anxiety to 15 - 30 mg daily in
divided doses. ELDERLY (or delibitated) half adult dose. CHILD (night terrors), 1 - 5 mg at bedtime
Precautions :
Respiratory disease, history of drug or alcohol abuse, drug dependence, pregnancy, breast feeding,
renal and hepatic impairment and avoid operating vehicles or machinery. Safety and effectiveness
not established in children less than 6 months of age
154
Adverse Reactions :
Drowsiness, dizziness, vertigo, hallucinations, blurred vision, confusion, muscle weakness, fatigue,
incontinence or urinary retention, constipation, rashes, changes in libido, leukopenia and
gastrointestinal, hypotension, ataxia, respiratory depression, sedation, depression, headache,
nausea, tremor, withdrawal syndrome, neutropenia, hepatotoxicity, pancytopenia,
thrombocytopenia, blood dyscrasias, bradycardia, dependence/abuse. Paradoxical reactions in
children and elderly
Contraindications :
Respiratory depression, acute pulmonary insufficiency, severe hepatic impairment, acute narrow
angle glaucoma and untreated open angle glaucoma, myasthenia gravis, hypersensitivity to
diazepam products, patients less than 6 months old, alcohol intoxication and central nervous system
depression. Pregnancy and lactation
Interactions :
Erythromycin, clarithromycin, isoniazid, fentanyl, alfentanil, itraconazole, ketoconazole, digoxin,
phenytoin, rifampicin, ethanol, carbamazepine, phenobarbital, levodopa, lithium, amitriptyline,
codeine, fluvoxamine, ginkgo, morphine, primidone, St John's Wort, theophylline, thiopental
----------------------------------------------------------------------------------------------------------------
155
Adverse Reactions :
Allergic reactions, salivation, gastrointestinal upsets, diaphoresis, diarrhea, flatulence, increased
peristalsis, nausea and vomiting, cardiac dysrhythmia, anaphylaxis, seizure, bronchospasm,
respiratory arrest, respiratory depression
Contraindications :
Mechanical intestinal or urinary obstruction, peritonitis
Interactions :
Antagonism effect by lithium, antimuscarinics, aminoglycoside, clindamycin, procainamide,
quinidine, propranolol. Enhanced effect of suxamethonium. Chloroquine have potential to increase
symptoms of myasthenia gravis. Cyclopropane or halothane
----------------------------------------------------------------------------------------------------------------
156
8. ANTIINFECTIVES
Antibacterials
Antifungals
Antivirals
Antiprotozoals
Anthelmintics
157
Amikacin 250 mg/2 ml Injection A
Amikacin 500 mg/2 ml Injection A
Trade Name : Amikin
Indication :
Infections due to susceptible organisms
Dosage :
ADULT: (IM or IV): 15 mg/kg/day 8 - 12 hourly for 7 - 10 days. Maximum: 1.5 g/day. CHILD: 15
mg/kg/day 8 - 12 hourly. Maximum: 1.5 g/day. Neonates: Initial loading dose of 10 mg/kg followed
by 7.5 mg/kg/day 12 hourly. Maximum 15mg/kg/day
Precautions :
Myasthenia gravis, renal impairment, pregnancy and lactation. Tinnitus or vertigo may be indications
of vestibular injury and impending bilateral irreversible damage
Adverse Reactions :
Ototoxicity and nephrotoxicity, rarely skin rash, fever, paraesthesia, athralgia, anaemia, hypotension
Contraindications :
Hypersensitivity to aminoglycosides
Interactions :
Potentiation of toxicity in combination with loop diuretics, cephalothin, vancomycin, cyclosporin.
Prolongs action of neuromuscular blockers. Increased risk of respiratory depression with either
halothane, methoxyflurane & neuromuscular blockers
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158
Adverse Reactions :
Diarrhoea, pseudomembraneous colitis, GI upsets, increased liver enzyme, urticaria and
erythematous multiforme, Steven-Johnson syndrome, toxic epidermal necrolysis, exfoliative
dermatitis, transient leucopenia, thrombocytopenia, haemolytic anaemia
Contraindications :
Hypersensitivity to penicillins, possible cross sensitivity with other â-lactams. History of penicillin-
associated cholestatic jaundice or hepatic dysfunction
Interactions :
Aminoglycosides, anti-coagulants, oral contraceptives, methotrexate
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159
Amoxicillin Trihydrate 125 mg/5 ml Syrup B
Indication :
Infections caused by susceptible strains of gram positive and gram negative organisms
Dosage :
CHILD less than 10 years: 125 - 250 mg 8 hourly. CHILD less than 20 kg: 20 - 40 mg/kg/day in 3 - 4
divided doses
Precautions :
Hypersensitivity to cephalosporins, renal or hepatic impairment, superinfection
Adverse Reactions :
Diarrhoea, indigestion, urticarial or erythematous rash, hepatitis, cholestatic jaundice
Contraindications :
Hypersensitivity to penicillins
Interactions :
Aminoglycosides, oral contraceptives
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160
Interactions :
Excretion impaired by probenecid. Increased risk of skin rashes with allopurinol. May decrease
effectiveness of oral contraceptives and atenolol
----------------------------------------------------------------------------------------------------------------
161
Precautions :
Moderate or severe renal impairment, sever liver impairment, pregnancy & lactation
Adverse Reactions :
Nausea, abdominal discomfort, vomiting, flatulence, diarrhoea& loose stools. Hearing impairment,
interstitial nephritis, acute renal failure, abnormal liver function, dizziness& vertigo, convulsions,
headache, somnolence
Contraindications :
Known hypersensitivity to azithromycin or any of the macrolides
Interactions :
Antacids, ergot derivatives. Monitor patients on concurrent warfarin, digoxin or ciclosporin. Increase
levels of tacrolimus, phenytoin, bromocriptine, disopyramide
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162
Benzylpenicillin 1 mega unit (600 mg) Injection B
Benzylpenicillin 5 mega units (3 g) Injection B
Indication :
i) Infections caused by susceptible organisms ii) Infective endocarditis
Dosage :
i) ADULT: 600 - 1200 mg IM 4 times daily, increased if necessary in more serious infections. CHILD:
50 - 100 mg/kg body weight daily IV in 2 - 4 divided doses ii) ADULT: 7.2 g daily by slow IV infusion in
6 divided doses
Precautions :
History of anaphylaxis, accelerated (e.g. hives) or serum sickness reaction to previous penicillin
administration
Adverse Reactions :
Hypersensitivity reactions, GI disturbances, eosinophilia, haemolytic anaemia, leucopenia,
agranulocytosis. Convulsions in the presence of severely reduced renal function, epilepsy, meningitis
or cerebral oedema or during cardiopulmonary bypass procedure
Contraindications :
History of anaphylaxis, accelerated (e.g. hives) or serum sickness reaction to previous penicillin
administration
Interactions :
Bacteriostatic antibiotics, anti-inflammatory, antirheumatics, antipyretics, probenecids, oral
contraceptives
----------------------------------------------------------------------------------------------------------------
Cefepime 1 g Injection A*
Trade Name : Maxipime
Indication :
Febrile neutropenia, septicaemia, lower respiratory tract infection, urinary tract infection, skin and
skin structure infections, gynaecologic and intra-abdominal infections
163
Dosage :
ADULT: 1 - 2 g twice daily for most infections. For severe infections including febrile neutropenia: 2 g
3 times daily. CHILD: 25 - 50 mg/kg 3 times daily
Precautions :
Hypensensitivity, pseudomembranous colitis& superinfection may occur. Discontinue therapy if
allergic reaction occurs. Pregnancy, lactation
Adverse Reactions :
GI disturbances (diarrhoea, nausea, vomiting), history of colitis, hypersensitivity, respiratory and CNS
disorders including headache, vaginitis
Contraindications :
Hypersensitivity to cephalosporins, penicillins or other beta-lactam antibiotics
Interactions :
Typhoid vaccine
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164
Interactions :
Heparin, typhoid vaccine, warfarin
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Cefotaxime 1 g Injection A
Trade Name : Claforan
Indication :
Infections due to gram-negative bacteria
Dosage :
ADULT: 1 g 12 hourly (up to 12 g/day in severe cases). CHILD: 50 - 180 mg/kg/day in 4 - 6 divided
doses
Precautions :
Hypersensitivity to penicillins, history of gastrointestinal disease especially colitis, pregnancy &
lactation
dverse Reactions :
Rash, pruritus, diarrhoea, nausea, vomiting, colitis, thrombocytopenia, eosinophilia, leucopenia,
hypersensitivity reactions, GI effects, anaphylactic shock(rare)
Contraindications :
Hypersensitivity to cephalosporins
Interactions :
Aminoglycosides, probenecid, typhoid vaccine
----------------------------------------------------------------------------------------------------------------
Ceftazidime 1 g Injection A
Ceftazidime 2 g Injection A
Trade Name : Fortum
Indication :
Severe gram negative bacterial infections
Dosage :
ADULT: 1 g 8 hourly or 2 g 12 hourly. In severe infections: 2 g 8 hourly. CHILD: 25 - 150 mg/kg/day in
2 - 3 divided doses
Precautions :
Hypersensitivity to penicillins, renal impairment
Adverse Reactions :
GI upsets, CNS effects, phlebitis or thrombophlebitis at the IV injection site, pain and/or
inflammation after IM injection, very rarely hypersensitivity reactions. Transient haematologicals
changes
Contraindications :
Hypersensitivity to cephalosporins
Interactions :
Aminoglycosides, probenecid, chloramphenicol, live typhoid vaccine
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165
Precautions :
Previous hypersensitivity to penicillins, anaphylactic shock, severe renal& hepatic failure, pregnancy.
Ceftriaxone and calcium -containing solutions may be administered sequentially to one another if
the infusion lines are thoroughly flushed between infusions with compatible fluid. Diluents
containing calcium (Ringer's / Hartmann's solution) are not to be used to reconstitute
ceftriaxonevials or to further dilute a reconstituted vial for IV administration because a precipitate
can form. Ceftriaxone must not be administered simultaneously with calcium- containing
intravenous solutions, including continous calcium -containing infusions such as parenteral nutrition
via a Y-site, because precipaitation of ceftriaxone-calcium can occur
Adverse Reactions :
GI upsets, haematological changes, skin reactions, coagulation disorders, phlebitis, agranulocytosis,
renal precipitations
Contraindications :
Hypersensitivity to cephalosporins. Neonates aged less than or 28 days if they require treatment
with calcium-containing intravenous solutions, including calcium-containing infusions such as
parenteral nutrition, because of the risk of precipitation of ceftriaxone-calcium
Interactions :
Ciclosporin, typhoid vaccine
----------------------------------------------------------------------------------------------------------------
Ceftriaxone 1g Injection A
Trade Name : Rocephin
Indication :
Infections caused by susceptible organisms
Dosage :
ADULT: 1 - 2 g once daily. Severe infection: 4 g daily at 12 hour intervals. INFANT & CHILD, 3 weeks -
12 years: 20 - 80 mg/kg body weight daily. CHILD with body weight 50 kg or more: adult dose.
NEONATE up to 2 weeks: 20 - 50 mg/kg body weight daily, not to exceed 50 mg/kg
Precautions :
Previous hypersensitivity to penicillins, anaphylactic shock, severe renal& hepatic failure, pregnancy.
Ceftriaxone and calcium -containing solutions may be administered sequentially to one another if
the infusion lines are thoroughly flushed between infusions with compatible fluid. Diluents
containing calcium (Ringer's / Hartmann's solution) are not to be used to reconstitute
ceftriaxonevials or to further dilute a reconstituted vial for IV administration because a precipitate
can form. Ceftriaxone must not be administered simultaneously with calcium- containing
intravenous solutions, including continous calcium -containing infusions such as parenteral nutrition
via a Y-site, because precipaitation of ceftriaxone-calcium can occur
Adverse Reactions :
GI upsets, haematological changes, skin reactions, coagulation disorders, phlebitis, agranulocytosis,
renal precipitations
Contraindications :
Hypersensitivity to cephalosporins. Neonates aged less than or 28 days if they require treatment
with calcium-containing intravenous solutions, including calcium-containing infusions such as
parenteral nutrition, because of the risk of precipitation of ceftriaxone-calcium
Interactions :
Ciclosporin, typhoid vaccine
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166
Cefuroxime Axetil 125 mg Tablet A/KK
Trade Name : Zinnat
Indication :
Upper respiratory tract, GUT, skin & soft tissue infections, urinary tract infection (UTI),
pyelonephritis
Dosage :
ADULT: 250 mg twice daily ;UTI: 125 mg twice daily. CHILD:125 mg twice daily. Maximum 250
mg/day
Precautions :
Anaphylactic reaction to penicillins
Adverse Reactions :
GI disturbances occasionally pseudomembraneous colitis, hypersensitivity reactions, eosinophilia,
headache, superinfection
Contraindications :
Hypersensitivity to cephalosporins
Interactions :
Aminoglycosides, typhoid vaccine
----------------------------------------------------------------------------------------------------------------
167
Contraindications :
Hypersensitivity to cephalosporins
Interactions :
Aminoglycosides, typhoid vaccine
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168
Chloramphenicol Sodium Succinate 1 g Injection B
Trade Name : Chloromycetin
Indication :
Treatment of typhoid, paratyphoid fevers, bronchopneumonia and enteric infection
Dosage :
ADULT: 1.5 - 3 g daily in divided doses every 6 hourly. CHILD: 25 -100 mg/kg/day in divided doses
every 6 hourly
Precautions :
Repeated courses& chronic treatment, infants, impaired liver or kidney function. Frequent
haematological examination is recommended
Adverse Reactions :
Depression of bone marrow leading to agranulocytosis, thrombocytopenia purpura, leucopenia and
aplastic anaemia. Peripheral& optic neuritis, erythema multiforme, GI disorders, urticaria, dry mouth
and blurred vision
Contraindications :
Hypersensitivity, pregnancy and lactation, anaemia, porphyria
Interactions :
Phenobarbitone& rifampicin may reduce the plasma concentration. Drugs which potentially depress
bone marrow function. May potentiate actions of phenytoin, sulfonylureas& anticoagulants
----------------------------------------------------------------------------------------------------------------
169
Precautions :
Epilepsy, CNS disorder, liver damage, renal impairment. Avoid prolonged exposure to sunlight
Adverse Reactions :
Nausea, diarrhoea, vomiting, dyspepsia, abdominal pain, flatulence, anorexia, dizziness, headache,
tiredness, agitation, trembling, insomnia, peripheral paralgesia, sweating, unsteady gait, convulsions,
increase in intracranial pressure, anxiety states, nightmares, confusion, depression, hallucinations,
impaired taste and smell, visual disturbances, tinnitus, transitory impairment of hearing, especially
at high frequencies, skin reactions
Contraindications :
Hypersensitivity to ciprofloxacin or other quinolones. Children, adolescents, pregnancy and lactation
Interactions :
Theophylline, iron, magnesium, aluminium, calcium, sulcralfate, antacids, probenecid, NSAIDs,
antineoplastics, immunosuppressants, cyclosporin, warfarin, glibenclamide, metoclopramide and
other prokinetic drugs
----------------------------------------------------------------------------------------------------------------
170
Precautions :
History of GI disease, especially colitis. Renal or hepatic impairment. Perform periodic liver and
kidney function tests with prolonged therapy and in neonates and infants. Discontinue immediately
if diarrhoea or colitis develops. Pregnancy and lactation
Adverse Reactions :
Diarrhoea occasionally with acute colitis (discontinue), abdominal pain, GI upsets, skin reactions,
jaundice, hematopoietic changes, pseudomembranous enterocolitis, pruritus, vaginitis
Contraindications :
Hypersensitivity to clindamycin or lincomycin
Interactions :
Neuromuscular blockers, erythromycin
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171
Cloxacillin Sodium 250 mg Injection B
Cloxacillin Sodium 500 mg Injection B
Trade Name : Orbenin
Indication :
Treatment of susceptible bacterial infections, notably penicillinase-producing staphylococci
infections
Dosage :
ADULT: 250 to 500 mg every 6 hours depending on type and severity of infection. CHILD less than 20
kg: 25 to 50 mg/kg/day in equally divided doses every 6 hours
Precautions :
History of asthma or allergic-type reactions to other medications, overgrowth of nonsusceptible
organisms
Adverse Reactions :
Fever, rash, nausea, vomiting, diarrhoea, hepatotoxicity, anaphylaxis
Contraindications :
Hypersensitivity to cloxacillin products/penicillins
Interactions :
Allopurinol, chloramphenicol. Probenecid impairs renal excretion. Anticoagulant effect is decreased.
Tetracycline, oestrogen-containing oral contraceptives
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172
Contraindications :
Hypersensitivity to tetracyclines/doxycycline, porphyria, pregnancy, lactation, children less than 12
years
Interactions :
Anticoagulants, penicillin, antacids, ferum, acitretin, isotretinoin, methotrexate
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173
Dosage :
ADULT: 400 mg 6 hourly or 800 mg 12 hourly. Maximum 4 g/day. CHILD: 30 - 50 mg/kg/day in 2 - 4
divided doses
Precautions :
Hepatic& renal impairment, myasthenia gravis
Adverse Reactions :
Abdominal discomfort, mild allergic reaction; liver dysfunction with or without jaundice; reversible
hearing loss, prolonged Q-T interval, ventricular arrhythmias, GI disturbances
Contraindications :
Hypersensitivity, porphyria
Interactions :
Can increase plasma concentration of warfarin, theophylline, carbamazepine, cyclosporin, possibly
phenytoin. Combination with ergotamine increases risk of peripheral ischaemia. Caution when taken
with terfenadine or astemizole
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174
Adverse Reactions :
Generally well tolerated but may provoke reversible retrobulbar neuritis with a reduction of visual
acuity, central scotoma& green-red colour blindness, allergic rashes, GI disturbances, jaundice,
peripheral neuritis, confusion, hallucinations, joint pain, fever, malaise, headache, dizziness,
anorexia& abdominal pain
Contraindications :
Optic neuritis; history of previous adverse effects with ethambutol
Interactions :
Aluminium hydroxide, ethionamide
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175
Imipenem 500 mg and Cilastatin 500 mg Injection A*
Trade Name : Tienam
Indication :
Severe infections caused by susceptible pathogens especially useful in infections involving ESBL
organisms. Not to be used for prophylaxis
Dosage :
Based on type or severity of infection, susceptibility of pathogen(s) and patient condition including
body weight and renal function. ADULT: 1 - 2 g/day in 3 - 4 divided doses. Maximum: 4 g/day or 50
mg/kg/day. Infusion rate: less than 500 mg dose: over 20 - 30 minutes, more than 500 mg: dose over
40 - 60 minutes. CHILD: 15 - 30 mg/kg/dose, infusion at 6 - 12 hourly intervals depending on age.
Maximum: 2 g/day
Precautions :
Hypersensitivity to penicillins, cephalosporins and other beta lactams. History of GI disease. Caution
in patients with CNS disorders and or compromised renal function in whom accumulation of drug
could occur. If CNS symptoms occur, dosage should be decreased or discontinued. Usage during
pregnancy, lactation and children less than 3 months or paediatrics patients with impaired renal
function
Adverse Reactions :
Thrombophlebitis, pain, erythema & tenderness following injection. Rash, urticaria, pruritus, GI
disturbances, pseudomembranous colitis, haematological disturbances, increase in liver enzymes,
taste perversion. Myoclonic activity, seizures, psychic disturbances, confusional states
Contraindications :
Hypersensitivity to local anaesthetics of the amide-type and in patients with severe shock or heart
block
Interactions :
Ganciclovir
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176
Levofloxacin 500 mg Tablet A*
Trade Name : Loxof, Cravit
Indication :
Community acquired pneumonia
Dosage :
500 mg daily for 7 - 14 days
Precautions :
Renal impairment (CrCl less than 50 mL/minute), CNS disorders, predisposition to seizures, lowered
convulsion threshold, diabetes mellitus, conditions predisposing to torsade de pointes, significant
bradycardia, cardiomyopathy, G6PD deficiency. Ensure adequate hydration. Avoid excessive sun
exposure. May affect ability to drive or operate machinery
Adverse Reactions :
Diarrhoea, nausea, headache, blurred vision, hypoglycemia, tendinitis, anaphylactic reactions,
Stevens-Johnson syndrome
Contraindications :
Hypersensitivity to quinolones, pregnancy & lactation. Children and growing adolescents less than
18 years old
Interactions :
Antacids, sucralfate, divalent cations, multivitamin, theophylline, warfarin, NSAIDS, antidiabetic
agents, amiodarone, chlorpromazine, cortisone, dexamethasone, diclofenac, disopyramide,
ibuprofen, indomethacin, iron, ketoprofen, ketorolac, mefenamic acid, meloxicam, naproxen,
phenylbutazone, piroxicam, prednisolone, prochlorperazine, quinidine
----------------------------------------------------------------------------------------------------------------
177
Meropenem 1 g Injection A*
Meropenem 500 mg Injection A*
Trade Name : Meronem
Indication :
i. Emperical treatment for presume infections in patients (adult and children) with febrile
neutropenia, used as monotherapy or in combination with anti-virals or antifungal agent ii.
Septicaemia iii. Serious infections in renal impaired patients
Dosage :
ADULT: 0.5 - 1g 3 times daily, CHILD: 10 - 20 mg/kg 3 times daily (except meningitis 40 mg/kg)
Precautions :
History of hypersensitivity to carbapenems or other beta-lactam antibiotics, penicillins and
cephalosporins. Monitor transaminase and bilirubin levels when used in hepatic disease. Not
recommended for MRSA infections. Consider diagnosis of pseudomembranous colitis in patients
who develop diarrhoea. Critically ill patients with Pseudomonas aeruginosa infection. Pregnancy and
lactation
Adverse Reactions :
Local injection site reactions, rash, pruritus, urticaria, abdominal pain, nausea, vomiting, diarrhoea,
headache, paraesthesia, oral and vaginal candidiasis, reversible thrombocytopenia, leucopenia,
eosinophilia, thrombocytopenia, neutropenia
Contraindications :
Hypersensitivity to meronem, carbapenems, penicillins or other beta-lactam antibiotics
Interactions :
Probenecid, valproic acid, typhoid vaccine
----------------------------------------------------------------------------------------------------------------
Precautions :
Use cautiously in patients with penicillin or cephalosporin. Hypersensitivity reactions or asthma.
Haematological& renal function test required on long-term treatment. Not for trivial infection. Renal
or hepatic impairment
Adverse Reactions :
Skin rashes, anaphylaxis, urticaria, fever, joint pain. Haemolytic anaemia, blood disorders,
gastrointestinal distress& superinfection
180
Contraindications :
Hypersensitivity to penicillin
Interactions :
Antirheumatics& antipyretics inhibit excretion. Neomycin may cause malabsorption
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181
Pyrazinamide 500 mg Tablet B
Indication :
Tuberculosis
Dosage :
ADULT & CHILD : 25 mg/kg daily or 35 mg/kg 3 times weekly
Precautions :
Slightly impaired liver function, hyperuricaemia, arthralgia, renal insufficiency, diabetes mellitus
Adverse Reactions :
Liver toxicity depending on treatment duration & concomitant therapy. Transient increase in serum
transminase levels, acute atrophy of the liver. Nausea, vomiting, anorexia, diarrhoea, abdominal
pain. Hyperuricaemia may occur with dosages more than 2 g/day
Contraindications :
Porphyria, severe liver damage, acute liver disease, pregnancy, lactation
Interactions :
Concurrent use of pyrazinamide and zidovudine may result in decreased efficacy of pyrazinamide.
Cyclosporin, ethionamide
----------------------------------------------------------------------------------------------------------------
182
Contraindications :
Hypersensitivity to other aminoglycosides
Interactions :
Used with blood substitutes and diuretics intensify nephrotoxicity and ototoxicity. Possible inhibition
of respiration with anaesthetics or muscle relaxants
----------------------------------------------------------------------------------------------------------------
183
Contraindications :
Marked liver parenchymal damage, blood dyscrasias, severe renal impairment, pregnancy,
hypersensitivity. Use with caution in premature babies or full-term infants in the neonatal period
Interactions :
Increased risk of thrombocytopenia with thiazide diuretics in elderly. May require dosage reduction
of warfarin and phenytoin. May displace methotrexate from plasma protein binding sites. Increased
risk of venticular arrhythmias with amiodarone
----------------------------------------------------------------------------------------------------------------
184
Contraindications :
Hypersensitivity to trimethoprim or any component, megaloblastic anaemia due to folate deficiency
Interactions :
Increased effect, toxicity or levels of phenytoin, increased myelosuppression with methotrexate,
may increase levels of digoxin
----------------------------------------------------------------------------------------------------------------
Amphotericin B 50 mg Injection A
Trade Name : Fungizone
Indication :
Systemic fungal infections
Dosage :
ADULT: 0.25 mg/kg/day by IV infusion, gradually increase if tolerated to 1 mg/kg/day. Maximum in
severe cases: 1.5 mg/kg daily or on alternate days. For neonates, lower doses are recommended
Precautions :
Avoid rapid infusion, renal impairment. Hepatic & renal function tests, blood count & plasma
electrolyte monitoring are required. Pregnancy, lactation
Adverse Reactions :
Fever, headache, anorexia, weight loss, GI disturbances, malaise, epigastric pain, dyspepsia,
generalized pain, anaemia, abnormal renal function. Rarely cardiovascular toxicity, haematologic
reactions, neurologic reactions, liver failure
Contraindications :
Hypersensitivity
Interactions :
Corticosteroids, nephrotoxic antibiotics and antineoplastics
----------------------------------------------------------------------------------------------------------------
185
Caspofungin Acetate 50 mg Injection A*
Caspofungin Acetate 70 mg Injection A*
Trade Name : Cancidas
Indication :
Confirmed systemic fungal infection in patients who are refractory or intolerant to other fungal
therapies
Dosage :
Invasive aspergillosis & invasive candidiasis: ADULT: Initially, 70 mg infused over 1 hour followed by
subsequent doses of 50 mg/day. Oesophageal candidiasis: ADULT: 50 mg by slow IV infusion over
approximately 1 hour
Precautions :
Concomitant ciclosporine; use only if benefits outweigh risk of possible hepatic toxicity, liver
impairment, myelosuppression, pregnancy, lactation, renal insufficiency
Adverse Reactions :
Fever, nausea, vomiting, flushing, rash, dyspnoea, dystonia, facial swelling, pruritus, increased liver
enzymes, complication of infusion, thrombophlebitis, headache
Contraindications :
Hypersensitivity to caspofungin acetate
Interactions :
Tacrolimus, cyclosporine, inducer of drug clearance (e.g. efavirenz, nevirapine, rifampicin,
dexamethasone, phenytoin, carbamazepine)
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186
Dosage :
i) Oropharyngeal candidiasis: 50 - 100 mg daily for 7 - 14 days (Maximum 14 days) except in severely
immunocompromised patients, treatment can be continued for longer periods. Atrophic oral
candidiasis associated with dentures: 50 mg daily for 14 days. Other candidal infections of mucosa:
50 - 100 mg daily for 14 - 30 days. CHILD: 3 - 6 mg/kg on first day then 3 mg/kg daily (every 72 hours
in NEONATE up to 2 weeks old, every 48 hours in NEONATE 2 - 4 weeks old) ii) 50 mg daily for 2 - 4
weeks, maximum 6 weeks iii) 400 mg initially then 200 - 400 mg daily for 6 - 8 weeks. CHILD: 6 - 12
mg/kg daily (every 72 hours in NEONATE up to 2 weeks old, every 48 hours in NEONATE 2 -4 weeks
old) iv) 100 - 200 mg daily v) 50 - 400 mg daily. CHILD: 3 - 12 mg/kg daily (every 72 hours in NEONATE
up to 2 weeks old, every 48 hours in NEONATE 2 - 4 weeks old)
Precautions :
Pregnancy, lactation, renal impairment
Adverse Reactions :
Nausea, abdominal pain, diarrhoea, flatulence; rash, headache
Contraindications :
Known hypersensitivity to fluconazole or to related azole compounds, co-administration of
terfenadine
Interactions :
Warfarin, oral sulfonylureas, phenytoin, rifampicin, cyclosporin, theophylline, cisapride
----------------------------------------------------------------------------------------------------------------
187
Griseofulvin (Ultramicrosize 125 mg = 250 mg Microsize) Tablet B
Trade Name : Fulcin
Indication :
Dermatophyte infections of the skin, scalp, hair and nails, where topical therapy has failed or
inappropriate
Dosage :
ADULT: 500 mg daily up to 1 g daily in divided doses, CHILD: 10 mg/kg daily in divided doses or as a
single dose
Precautions :
Ability to drive and operate machinery may be impaired. Lactation. May damage sperm cells - male
should not father children within 6 month of treatment
Adverse Reactions :
Oral thrush, gastrointestinal distress, taste perversion, dizziness, confusion, headache, depression,
insomnia, fatigue, peripheral neuritis, photosensitivity, skin rashes, urticaria, erythema multiforme,
leucopaenia, proteinuria
Contraindications :
Established porphyria, hepatocellular failure, SLE and related conditions, pregnancy
Interactions :
Absorption reduced by barbiturates. Effectiveness reduced by liver enzyme inducing drugs.
Decreases anticoagulant effect of warfarin. Reduces effectiveness of oral contraceptive.
Enhancement of effects of alcohol
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188
Itraconazole 100 mg Capsule A*
Trade Name : Sporanox
Indication :
i) Dermatomycosis including pityriasis versicolor ii) Oral candidiasis iii) Palmar tinea manus and
plantar tinea pedis iv) Fingernail onychomycosis v) Toenail onychomycosis vi) Vulvovaginal
candidiasis
Dosage :
i) 200 mg once daily for 7 days ii) 100 mg daily for 15 days iii) 200 mg twice daily for 7 days iv) 200
mg twice daly for 1 week/month v) 200 mg twice daily for 1 week/month for 3 months vi) 200 mg
morning and evening for 1 day or 200 mg once daily for 3 days
Precautions :
Lactation, history of liver or renal disease, children, decreased gastric acidity. Patients with risk
factors for congestive heart failure such as ischaemic and valvular cardiac disease
Adverse Reactions :
Rash, hypokalemia, diarrhoea, nausea and vomiting, Stevens-Johnson syndrome, neutropenic
disorder, hepatotoxicity, anaphylaxis
Contraindications :
Pregnancy, hypersensitivity to itraconazole
Interactions :
Rifampicin& phenytoin reduce oral bioavailability of itraconazole. Inhibits metabolism of warfarin,
digoxin, terfenadine, cyclosporin A, astemizole, cisapride, oral midazolam
----------------------------------------------------------------------------------------------------------------
189
Dosage :
NEWBORN: 50,000-100,000 units daily. CHILD up to 5 years: 100,000 -500,000 units 6 hourly. CHILD
up to 6-12 years and ADULT: 500,000-1,000,000 units 3 to 4 times daily
Precautions :
Not intended to treat systemic mycoses. If hypersensitivity develops, discontinue use
Adverse Reactions :
GI disturbances, rash, urticaria , Steven Johnson Syndrome, oral irritation
Contraindications :
Hypersensitivity to nystatin
Interactions :
Not known
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190
Precautions :
Patients with pre-existing neurologic, renal, or hepatic impairment, dehydrated patient, elderly and
lactation
Adverse Reactions :
Skin rashes; GI effects; fatigue
Contraindications :
Patients known to be hypersensitivity to acyclovir
Interactions :
Increased mean half-life & plasma concentration with probenecid
----------------------------------------------------------------------------------------------------------------
191
Contraindications :
Hypersensitivity to didanosine
Interactions :
Allopurinol, ketoconazole, itraconazole, dapsone, ganciclovir/ valganciclovir, hydroxyurea,
methadone, quinolone antibiotics, ribavirin, stavudine, tenofovir, ethanol
----------------------------------------------------------------------------------------------------------------
193
Dosage :
ADULT: 150 mg twice daily or 300 mg once daily. INFANT under 1 month: 2 mg/kg twice daily. CHILD
1 month or over: 4 mg/kg twice daily. Maximum 300 mg daily
Precautions :
Moderate to severe renal impairment, advanced cirrhotic liver disease, pregnancy, lactation, chronic
hepatitis B or C, hepatic disease
Adverse Reactions :
Nausea, vomiting, diarrhoea, abdominal pain, cough, headache, fatigue, insomnia, malaise, fever,
rash, alopecia, muscle disorders, peripheral neuropathy, pancreatitis, neutropenia, anaemia,
thrombocytopenia and red-cell aplasia, lactic acidosis, raised liver enzymes and serum amylase,
hepatomegaly
Contraindications :
Hypersensitivity to lamivudine, abnormally low neutrophil counts or abnormally low haemoglobin
levels
Interactions :
Trimethoprim, interferon alfa, ribavirin, sulfamethoxazole, zalcitabine
----------------------------------------------------------------------------------------------------------------
194
Adverse Reactions :
Dyslipidemia, hyperglycaemia, hypercholesterolemia, increased triglycerides, diarrhoea, nausea,
headache, pain, insomnia
Contraindications :
Hypersensitivity to lopinavir or ritonavir, concomitant use with drugs that are highly dependent on
CYP3A or CYP2D6 for clearance
Interactions :
Antiarrhythmias, anticonvulsant, antihistamines, benzodiazepines, calcium channel blockers,
cisapride, clarithromycin, dexamethasone, disulfiram, didanosine
----------------------------------------------------------------------------------------------------------------
Stavudine 30 mg Capsule A*
Trade Name : Zerit
Indication :
HIV infection, in combination with other antiretrovirals
Dosage :
ADULT more than 60 kg: 40 mg twice daily; less than 60 kg: 30 mg twice daily. CHILD more than 30
kg: 30 mg twice daily; less than 30 kg: 15 mg twice daily
Precautions :
Renal and hepatic impairment, peripheral neuropathy, elderly, pregnancy and lactation
196
Adverse Reactions :
Headache, rash, gastrointestinal effects, peripheral neuropathy, abdominal pain, allergic reaction,
anaemia, anorexia, chills, diabetes mellitus, fever, hepatic failure, hepatitis, hepatomegaly,
hyperglycaemia, hyperlactatemia, insomnia, lactic acidosis, leukopenia, macrocytosis, motor
weakness, myalgia, pancreatitis, redistribution /accumulation of body fat, thrombocytopenia
Contraindications :
Hypersensitivity to stavudine
Interactions :
Zidovudine, doxorubicin, ribavirin, didanosine
----------------------------------------------------------------------------------------------------------------
197
Adverse Reactions :
Dizziness, headache, increased blood amylase and lipase, diarrhoea, nausea, elevated ALT, rash,
increased blood creatinine phosphokinase, fatigue, abdominal pain, dyspepsia. Increased AST,
myopathy, arthralgia, myalgia, malaise
Contraindications :
Hypersensitivity to telbivudine or any component of the product
Interactions :
Increased risk of peripheral neuropathy when telbivudine given with interferon alfa
----------------------------------------------------------------------------------------------------------------
Zidovudine 1% Injection A
Trade Name : Retrovir
Indication :
To reduce the rate of maternal-foetal transmission of HIV in: i) HIV-positive pregnant women over 14
weeks of gestation ii) Their newborn infants
Dosage :
i) 200 mg 3 times/day or 300 mg twice daily until start of labor. During labour, by IV infusion initially
2 mg/kg over 1 hour followed by continuous IV infusion at 1 mg/kg/hr until delivery ii) 2 mg/kg orally
every 6 hours within 12 hours after birth. If unable to receive oral dose: FULL TERM: 1.5 mg/kg/dose
every 6 hours, INFANTS 30 weeks and less than 35 weeks gestation at birth: 1.5 mg/kg/dose every 12
hours; at 2 weeks of age, advance to 1.5 mg/kg/dose every 8 hours, INFANTS less than 30 weeks
gestation at birth: 1.5 mg/kg/dose every 12 hours; at 4 weeks of age, advance to 1.5 mg/kg/dose
every 8 hours
Precautions :
Monitor carefully haematological parameters. If anaemia or myelosuppression occurs dose
adjustments are suggested. Patients with pre-existing bone marrow compromise. Pregnancy and
lactation
Adverse Reactions :
Anaemia, neutropenia, leucopenia, nausea, headache, rash, abdominal pain, fever, myalgia,
paraesthesia, vomiting, insomnia and anorexia. Asthenia, malaise, somnolence, diarrhoea, dizziness,
sweating, dyspnoea, dyspepsia, flatulence, bad taste, chest pain, loss of mental acuity, anxiety,
urinary frequency, depression, generalised pain, chills, cough, urticaria, pruritus and flu-like
syndrome
Contraindications :
Abnormally low neutrophil cell count (less than 0.75 x 109L) or abnormally low Hb levels (less than
7.5 g/dL)
Interactions :
Chronic paracetamol use, potentially nephrotoxic or myelosuppressive drugs, probenecid
----------------------------------------------------------------------------------------------------------------
198
Precautions :
Monitor carefully haematological parameters. If anaemia or myelosuppression occurs dose
adjustments are suggested. Patients with pre-existing bone marrow compromise. Pregnancy and
lactation
Adverse Reactions :
Anaemia, neutropenia, leucopenia, nausea, headache, rash, abdominal pain, fever, myalgia,
paraesthesia, vomiting, insomnia and anorexia. Asthenia, malaise, somnolence, diarrhoea, dizziness,
sweating, dyspnoea, dyspepsia, flatulence, bad taste, chest pain, loss of mental acuity, anxiety,
urinary frequency, depression, generalised pain, chills, cough, urticaria, pruritus and flu-like
syndrome
Contraindications :
Abnormally low neutrophil cell count (less than 0.75 x 109/L) or abnormally low Hb levels (less than
7.5 g/dL)
Interactions :
Chronic paracetamol use, potentially nephrotoxic or myelosuppressive drugs, probenecid
----------------------------------------------------------------------------------------------------------------
199
Precautions :
Advanced cirrhotic liver disease due to chronic hepatitis B infection. Severe hepatic or renal
impairment. Monitor haematological parameters
Adverse Reactions :
Headache, malaise, fatigue, gastrointestinal effects, upper abdominal pain, fever, rash, pancreatitis,
peripheral neuropathy, leucopenia, neutropenia, anaemia, thrombocytopenia
Contraindications :
Hypersensitivity, patients with abnormally low neutrophil counts or abnormally low haemoglobin
levels
Interactions :
Trimethoprim, phenytoin, paracetamol, aspirin, codeine, morphine, indomethacin, ketoprofen,
naproxen, oxazepam, lorazepam, cimetidine, clofibrate, dapsone and isoprinosine, potentially
nephrotoxic or myelosuppressive drugs, ribavirin
----------------------------------------------------------------------------------------------------------------
200
Interactions :
Artemether/ lumefantrine
----------------------------------------------------------------------------------------------------------------
202
Precautions :
Discontinue therapy if liver function test elevations are significant, retinal lesions, cerebral
hypertensive episodes, pregnancy, hepatic disease, retinal lesions
Adverse Reactions :
Gastrointestinal discomfort, dizziness, headache, erythema multiforme, Stevens-Johnson syndrome,
agranulocytosis, aplastic anemia, leukopenia, pancytopenia, thrombocytopenia, hepatotoxicity
Contraindications :
Patients with hypersensitivity to albendazole or to the benzimidazole drug class, pregnancy (avoid
pregnancy for at least one month following therapy)
Interactions :
Concurrent use with dexamethasone may result in an increased risk of albendazole adverse effects.
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203
9. ENDOCRINE
Drugs used in diabetes
Thyroid and antithyroid drugs
Corticosteroids
Sex hormones
Hypothalamic and pituitary hormones and anti-estrogens
Drugs affecting bone metabolism
Miscellaneous endocrine
204
Acarbose 50 mg Tablet A/KK
Trade Name : Glucobay
Indication :
Only for treatment of: i) Non insulin dependent diabetes mellitus (NIDDM) when diet therapy is
insufficient ii) Non insulin dependent diabetes mellitus (NIDDM) in combination with existing
conventional oral therapy where glycaemic control is inadequate
Dosage :
Initially 50 mg daily, increase to 3 times daily up to 100 mg 3 times daily. Max 200 mg 3 times daily
Precautions :
Asymptomatic liver enzyme elevations especially at higher dosages. Monitor liver enzyme during 6 -
12 months of treatment
Adverse Reactions :
Flatulence and bowel sounds, diarrhoea and abdominal pain
Contraindications :
Patients less than 18 years, chronic intestinal disorders associated with distinct disturbances of
digestion and absorption, conditions which may deteriorate as a result of increased intestinal gas
formation, pregnancy, lactation, severe renal impairment
Interactions :
Thiazide and other diuretic, corticosteriod, thyroid product, estrogens, oral contraceptives,
phenytoin, nicotinic acid, sympatomimetic, calcium channel blocker, isoniazid, cholestyramine,
intestinal absorbents, digestive enzymes
--------------------------------------------------------------------------------------------------------------------------------------
Dextrose Powder B
Indication :
Use as a diagnostic agent for diabetes
Dosage :
75 g stat
Precautions :
Diabetes mellitus or carbohydrate intolerance and hyperglycaemia may accentuate neurologic
damage for an ischemic insult, patients at risk for cerebral ischemia, acute stroke, impending cardiac
arrest, or severe hypotension unless hypoglycaemia is suggested or until glucose is determined.
Adverse Reactions :
Thrombophlebitis, rebound hypoglycaemia, hypokalaemia.
Contraindications :
Do not use concentrated solutions of dextrose in patients with anuria, diabetic coma and
hyperglycaemia, intracranial or intraspinal haemorrhage, delirium tremens in dehydrated patients
and glucose-galactose malabsorption syndrome.
Interactions :
Not known.
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Glibenclamide 5 mg Tablet B
Trade Name : Daonil
Indication :
Diabetes mellitus type 2
Dosage :
Range: 2.5 - 15 mg daily (with or immediately after breakfast). Initially 2.5 mg daily increasing by 2.5
mg required for metabolic control. Max: 15 mg daily
205
Precautions :
Elderly, mild and moderate hepatic and renal impairment. Cross-sensitivity to sulphonamides and its
derivatives
Adverse Reactions :
Gastrointestinal disturbance, blood dyscrasia, increase appetite, weight gain, skin rashes, pruritus,
hypersensitivity reaction.
Contraindications :
Diabetes mellitus type 1, diabetic coma, severe renal or renal impairment, pregnancy
Interactions :
Alcohol, beta blockers, biguanides, MAOIs, sulphonamides, thyroid hormone, ACE inhibitor,
analgesic
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Gliclazide 80 mg Tablet B
Trade Name : Diamicron
Indication :
Diabetes mellitus type 2
Dosage :
Initially 40-80 mg daily. Total daily dose may vary from 80- 320 mg orally. Adjust dose according to
patient's individual response
Precautions :
Hepatic and or renal impairment. Hypoglycaemia may occur with reduced dietary intake or too high
doses
Adverse Reactions :
Nausea, headache, rashes and gastrointestinal disturbances. Rarely, haematological disorders
Contraindications :
Children with epiphyseal fusion. Active neoplasia, progression or recurrence of underlying
intracranial lesion, critically ill patient, proliferative or pre-proliferative diabetic retinopathy
206
Interactions :
Potentiates hyperglycaemia with danazol, chlorpromazine, glucocorticoids, progestogens, beta2
agonist. Potentiated hypoglycaemic effect with sulfonamides, salicylates, phenylbutazone, beta-
blockers, alcohol, H2 antagonists, NSAIDs, ACE inhibitors, MAOIs, fluconazole, ketoconazole and
miconazole. Diminished hypoglycaemic effect with thiazide diuretics, corticosteroids and oestrogens.
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207
Insulin Glargine 300 IU/3ml Injection A*
Trade Name : Lantus
Indication :
i) Diabetes mellitus type I in adults and child over 6 years ii) Diabetes mellitus type II in adult
Dosage :
ADULT and CHILD over 6 years: individualised dose given by SC, once daily at the same time every
day
Precautions :
Insulin dose adjustment may be needed with renal or hepatic impairment, illness, stress, emotional
disturbances or in elderly patients, may impair ability to drive and operate machinery
Adverse Reactions :
Severe hypoglycemic episodes, lipodystrophy, rash, diabetic ketoacidosis, allergic skin reactions
Contraindications :
Hypersensitivity, intravenous administration
Interactions :
ACE inhibitors, aspirin, beta- blockers, fibrates, fluoxetine, fenfluramine, fluoroquinolones, ginseng,
MAOIs, oestrogen and progestogens, somatropin, lithium, clonidine, sulphonamide antibiotic,
pentoxifylline.
--------------------------------------------------------------------------------------------------------------------------------
Insulin Recombinant Neutral Human short-acting 100 IU/ml Injection in 10ml vial B
Trade Name : Actrapid/Humulin
Indication :
Insulin dependent diabetes mellitus, non insulin dependent diabetes unresponsive to treatment to
diet or oral hypoglycaemics. hyperkalaemia to assure proper utilisation of glucose and reduce
glucosuria in non diabetic patients receiving parenteral nutrition
Dosage :
Dose to be individualised. The average daily insulin requirement is between 0.5-1.0 units/kg body
weight
Precautions :
Psychic stress, infection, pregnancy
Adverse Reactions :
Rare incidence of allergy and lipoatrophy
Contraindications :
Hypoglyacemia, insulinoma
Interactions :
MAOIs, alcohol, corticosteroid, oral contraceptives, beta-blocker, thyroid hormone, diuretic
---------------------------------------------------------------------------------------------------------------------------------
Insulin Recombinant Synthetic Human, intermediate-acting 100 IU/ml Penfill and Refill B
Trade Name : Insulatard
Indication :
Insulin dependent diabetes mellitus, non insulin dependent diabetes unresponsive to treatment to
diet or oral hypoglycaemics, hyperkalaemia to assure proper utilisation of glucose and reduce
glucosuria in non diabetic patients receiving parenteral nutrition
Dosage :
Dose to be individualised. The average daily insulin requirement is between 0.5-1.0 units/kg body
weight
Precautions :
Psychic stress, infection, pregnancy
208
Adverse Reactions :
Rare incidence of allergy and lipoatrophy
Contraindications :
Hypoglyacemia, insulinoma
Interactions :
MAOIs, alcohol, corticosteroid, oral contraceptives, beta-blocker, thyroid hormone, diuretic
--------------------------------------------------------------------------------------------------------------------------------------
Insulin Recombinant Synthetic Human, pre-mixed 100 IU/ml Penfill and Refill B
Trade Name : Mixtard
Indication :
Insulin dependent diabetes mellitus, non insulin dependent diabetes unresponsive to treatment to
diet or oral hypoglycaemics, hyperkalaemia to assure proper utilisation of glucose and reduce
glucosuria in non diabetic patients receiving parenteral nutrition
Dosage :
Dose to be individualised. The average daily insulin requirement is between 0.5-1.0 units/kg body
weight
Precautions :
Psychic stress, infection, pregnancy
Adverse Reactions :
Rare incidence of allergy and lipoatrophy
Contraindications :
Hypoglyacemia, insulinoma
Interactions :
MAOIs, alcohol, corticosteroid, oral contraceptives, beta- blocker, thyroid hormone, diuretic.
--------------------------------------------------------------------------------------------------------------------------------------
Insulin Recombinant Synthetic Human, short-acting 100 IU/ml Penfill and Refill B
Trade Name : Actrapid
Indication :
Insulin dependent diabetes mellitus, non insulin dependent diabetes unresponsive to treatment to
diet or oral hypoglycaemics, hyperkalaemia to assure proper utilisation of glucose and reduce
glucosuria in non diabetic patients receiving parenteral nutrition
Dosage :
Dose to be individualised. The average daily insulin requirement is between 0.5-1.0 units/kg body
weight
Precautions :
Psychic stress, infection, pregnancy
Adverse Reactions :
Rare incidence of allergy and lipoatrophy
Contraindications :
Hypoglyacemia, insulinoma
Interactions :
MAOIs, alcohol, corticosteroid, oral contraceptives, beta-blocker, thyroid hormone, diuretic
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209
Metformin 500 mg and Glibenclamide 2.5 mg Tablet A/KK
Metformin 500 mg and Glibenclamide 5 mg Tablet A/KK
Trade Name : Glucovance
Indication :
As second-line therapy when diet, exercise and initial treatment with sulphonylurea or metformin do
not result in adequate glycemic control in patients with type 2 diabetes mellitus
Dosage :
One tablet twice daily, titrate up to a maximum daily dose of 2000 mg metformin/20 mg
glibenclamide
Precautions :
Adrenal or pituitary insufficiency elderly, debilitated or malnourished patients, excessive alcohol
intake, hypoxic states due to shock, acute chronic heart failure or acute myocardial infarction, lactic
acidosis, severe metabolic complication due to accumulation of metformin, liver or renal disease,
peripheral vascular disease, pulmonary disease, pregnancy or lactation, stress caused by infection,
fever, trauma or surgery
Adverse Reactions :
Hypoglycemia, lactic acidosis, cobalamin deficiency, abdominal pain, diarrhoea, nausea and
vomiting, dizziness
Contraindications :
Renal disease or renal dysfunction, chronic heart failure requiring pharmacologic treatment, acute or
chronic metabolic acidosis, including diabetic ketoacidosis with or without coma, hypersensitivity to
metformin or glibenclamide
Interactions :
Cationic drugs that are eliminated by renal tubular secretion. Thiazide and other diuretics,
corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin,
nicotinic acid, sympathomimetics, calcium channel blockers and isoniazid may produce
hyperglycaemia and lead to loss of glycaemic control. The hypoglycaemic action of sulphonylureas
may be potentiated by NSAIDs and other highly protein-bound drugs, salicylates, sulfonamides,
chloramphenicol, probenecid, coumarins, MAOIs, β-blockers, ciprofloxacin, oral miconazole.
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210
Metformin HCl 500 mg Tablet B
Trade Name : Glucophage
Indication :
Diabetes mellitus
Dosage :
500 mg 3 times daily or 850 mg twice daily with food, maximum: 3 g daily in 3 divided doses
Precautions :
Dehydration, serious infection or trauma, patients undergoing surgery, pregnancy, lactation,
children. Monitor serum B12 levels annually
Adverse Reactions :
Anorexia, nausea, vomiting, diarrhoea (usually transient), abdominal pain, metalic taste, rarely lactic
acidosis (withdraw treatment), decreased vitamin-B12 absoption, erythema
Contraindications :
Diabetic pre-coma, ketoacidosis, renal impairment, chronic liver disease, cardiac failure,
hypoxaemia, history of lactic acidosis, acute alcohol intoxication, hypoxia
Interactions :
Alcohol, sulfonylureas, cimetidine, anticoagulants.
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Repaglinide 2 mg Tablet A*
Trade Name : Novonorm
Indication :
Type 2 diabetes mellitus (as monotherapy or in combination with metformin when metformin alone
is inadequate)
Dosage :
0.5 mg within 30 minutes before main meal. If patients are transferred from another oral
hypoglycaemic agent. Start dose with 1 mg before each main meal. Max single dose: 4 mg before
each main meal. Max 16 mg/day
Precautions :
Patients more than 75 years, debilitated or malnourished patients, renal impairment.
Adverse Reactions :
Hypoglycaemia, transient visual disturbances, gastrointestinal disturbances, hypersensitivity
reactions of skin, arthralgia.
Contraindications :
Type 1 diabetes, diabetic ketoacidosis with or without coma. Pregnancy, lactation. Children less than
12 years. Severe hepatic impairment, concomitant therapy with medicinal products which are
CYP3A4 inhibitors or inducers.
Interactions :
Type 1 diabetes, diabetic ketoacidosis with or without coma. Pregnancy, lactation. Children less than
12 years. Severe hepatic impairment, concomitant therapy with medicinal products which are
CYP3A4 inhibitors or inducers.
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Rosiglitazone 8 mg Tablet A*
Trade Name : Avandia
Indication :
Diabetes mellitus with insulin resistant features, combined with sulphonylureas, metformin,
acarbose and or insulin, delays introduction of insulin in type 2 diabetes mellitus already on maximal
doses of two or more oral hypoglycaemic agents
211
Dosage :
4 mg once daily or in 2 divided doses, may be increased to 8 mg/day in 1-2 divided doses after 12
week
Precautions :
Increased risk of myocardial ischeamia, exacerbate heart failure. Increased risk of fracture, especially
in women. Active liver disease, alanine transaminase level more than 2.5 times upper limit of
normal, type 1 diabetes, oedema (especially when used in combination with insulin), lack of
adequate contraception in premenopausal anovulatory women
Adverse Reactions :
Headache, anaemia, hepatotoxicity, weight gain, oedema.
Contraindications :
Patients with cardiac failure (NYHA Class I-IV) or history of cardiac failure, known ischeamic heart
disease, hepatic impairment, pregnancy and breastfeeding, diabetic ketoacidosis, hypersensitivity to
rosiglitazone product.
Interactions :
Gemfibrozil, rifampicin.
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Carbimazole 5 mg Tablet B
Trade Name : Neo-mercazole
Indication :
Hyperthyroidism
212
Dosage :
ADULT: Initially 10 - 60 mg daily in divided doses. Maintenance: 5 - 20 mg daily
Precautions :
Liver disorders, pregnancy, breast feeding.
Adverse Reactions :
Nausea, mild gastrointestinal disturbance, rashes, bone marrow supression
Contraindications :
May be given to pregnant women. Treatment should be discontinued 3 - 4 weeks before delivery.
Infants should not breast fed by mothers taking carbimazole.
Interactions :
Concurrent use of digoxin and carbimazole may result in decreased peak serum levels of digoxin.
Antithyroid drugs, by reducing the extent of hyperthyroidism, decrease the metabolism of clotting
factors and thus reduce the effects of oral anticoagulants.
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213
Contraindications :
Untreated hyperthyroidism; uncorrected adrenal failure; recent myocardial infarction
Interactions :
Reduced absorption with iron, cholestyramine, colestipol, aluminium- and magnesium-containing
antacids, calcium carbonate, simethicone, sucralfate. May alter requirements of antidiabetic drugs.
Reduced efficacy of thyroid replacement therapy with imatinib. Reduced tri-iodothyronine serum
levels with amiodarone. Reduced serum levels of thyroxine with carbamazepine, phenytoin,
phenobarbital, rifampicin, oestrogens. May change hypoprothrombinaemic response to warfarin
and other oral anticoagulants. Increased risk of significant hypertension and tachycardia with
ketamine
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Propylthiouracil 50 mg Tablet B
Indication :
Palliative treatment of hypothyroidism as an adjunct to ameliorate hyperthyrodism in preparation
for surgical treatment or radioactive iodine therapy and in the management of thyrotoxicosis crisis
Dosage :
CHILD: Initial 5 - 7 mg/kg/day in divided doses every 8 hours. Maintenance: 1/3 to 2/3 of the initial
dose in divided doses every 6 - 8 hours. ADULT: Initial dose: 300 - 450 mg daily in divided doses every
8 hours. Maintenance: 100 - 150 mg daily in divided doses every 8 - 12 hours
214
Precautions :
Renal impairment
Adverse Reactions :
Gastric distress, headache, nausea, skin rash
Contraindications :
Pregnancy, lactation, bleeding disorders or easy bruising
Interactions :
Dicumarol, warfarin, carbimazole
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Hydrocortisone 10 mg Tablet B
Indication :
Glucocorticoid replacement therapy in primary or secondary adrenal insufficiencies and long term
management of congenital adrenal hyperplasia in children
Dosage :
ADULT: 20 - 30 mg daily in divided doses. CHILD: 10 - 30 mg daily in divided doses
Precautions :
Discontinue treatment by reducing the dosage gradually.
Adverse Reactions :
Fluid and electrolyte disturbances, muscle weakness, peptic ulcer.
Contraindications :
Hypersensitivity, systemic fungal infection.
Interactions :
Concurrent use of barbiturates, carbamazepine, phenytoin, primidone or rifampicin may enhance
the metabolism and reduce the effects of systemic corticosteroids. Oral contraceptives or ritonavir
may increase plasma concentrations of corticosteroids.
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216
Contraindications :
Hypersensitivity, systemic fungal infection.
Interactions :
Decreased effect: Phenytoin, phenobarbital, rifampicin increases clearance of methylprednisolone.
Potassium depleting diuretics enhance potassium depletion. Increased toxicity: Skin test antigens,
immunizations decrease response of methylprednisolone.
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Prednisolone 5 mg Tablet B
Trade Name : Prednisone
Indication :
i) Replacement therapy for primary and secondary adrenocortical insufficiency ii) Adrenogenital
syndrome iii) Other therapy
Dosage :
i) 5 - 25 mg daily in divided doses ii) 10 - 20 mg/m2 body surface daily in divided doses iii) ADULT: 5 -
60 mg daily. CHILD: 0.5 - 2 mg/kg/day in divided doses every 6 - 8 hours or as a single daily
Precautions :
Discontinue treatment by reducing the dosage gradually.
Adverse Reactions :
Fluid and electrolyte disturbances, muscle weakness and peptic ulcer, osteoporosis, abdominal
distention, nausea and vomiting.
Contraindications :
Hypersensitivity and systemic fungal infection.
Interactions :
Phenytoin, phenobarbital, rifampin increase clearance of methylprednisolone. Potassium depleting
diuretics enhance potassium depletion. Skin test antigens and immunizations decrease response.
Increase circulating glucose level and may need adjustment of insulin or oral hypoglycaemics.
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217
Triamcinolone Acetonide 40 mg/ml Injection A/KK
Trade Name : Kenacort-A
Indication :
Allergies, dermatoses, rheumatoid arthritis and opthalmic diseases
Dosage :
40-80 mg deep into the gluteal muscle
Precautions :
Intercurrent infection, hypothyroidism, cirrhosis, active or latent tuberculosis, renal insufficiency,
cardiac failure, diabetes, glaucoma, myasthenia gravis, pregnancy.
Adverse Reactions :
Local atrophy, post injection flare, pigmentation changes, sodium and fluid retention, peptic ulcer,
impaired wound healing, purpura, striae, increased ocular/intracranial pressure with cushingnoid
state, growth retardation.
Contraindications :
Systemic fungal infection, unstable or infected joints, lactation.
Interactions :
Phenytoin, phenobarbitone, rifampicin, carbamazepine, hypoglycaemics, diuretics,
anticholinesterases, salicylates.
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218
Dosage :
By IM only. Hypogonadism 250 mg every 2-3 weeks. To maintain an adequate androgenic effect 250
mg every 3-6 weeks. Potency disorders 250 mg every 4 weeks. Male climateric disorders: 250 mg
every 3-4 weeks. Repeated 6-8 weeks courses at 2-3 months interval
Precautions :
Geriatric patient, healthy males with delayed puberty, benign prostatic hyperthrophy, priapism and
or excessive sexual stimulation may develop, oligospermia may occur with prolonged administration
or excessive dosage. If severe upper abdominal complaints, liver enlargement or signs of intra
abdominal haemorrhage, a liver tumour should be taken into consideration. Development of
hypercalcaemia in female patients (stop treatment).
Adverse Reactions :
Oedema, signs of virilisation in women, inhibition of spermatogenesis.
Contraindications :
Hypersensitivity to testosterone, males with breast carcinoma, androderm therapy has not been
evaluated in women and must not be used in women. Testosterone may cause foetal harm.
Extensive cardiac, hepatic or renal disease. History of or existing hepatic tumour.
Interactions :
An increased risk of cyclosporin toxicity (renal dysfunction, cholestasis, paraesthesias), concurrent
use with dicumarol may result in bleeding.
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219
Precautions :
Avoid fluid overload in the very young and the elderly, conditions characterized by fluid and or
electrolyte imbalance and those at risk for increased intracranial pressure. Caution in renal
concentration capacity testing for infant less than 1 year.
Adverse Reactions :
Nausea, hypertension, hypotension, palpitation, anaphylaxis, transient headache, stomach pain,
epistaxis and fatigue, transient fall in blood pressure with reflex tachycardia and facial flushing.
Contraindications :
Hypersensitivity to desmopressin, hyponatremia or a history of hyponatremia, moderate-to-severe
renal impairment , unstable angina pectoris, decompensated cardiac insufficiency and von
Willebrand's disease type IIB.
Interactions :
Chlorpropamide, fludrocortisone, lithium, carbamazepine, chloropromazine, indomethacin.
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220
Adverse Reactions :
Local reaction and discomfort at injection site. Anorexia, nausea, vomiting, crampy abdominal pain,
abdominal bloating, flatulence, loose stools, diarrhoea, steatorrhea, rarely progressive abdominal
distension, severe epigastric pain, abdominal tenderness, guarding, acute pancreatitis. Impairment
of post-prandial glucose tolerance, hyperglycaemia, hypoglycemia, isolated case of hepatic
dysfunction, bradycardia, anaphylactic reactions. Long-term treatment: gallstones.
Contraindications :
Hypersensitivity to octreotide.
Interactions :
Reduces absorption of cyclosporin, cimetidine. Increases bioavailability of bromocriptine.
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Terlipressin 1 mg Injection A*
Trade Name : Glypressin
Indication :
Acute oesophageal variceal bleeding
Dosage :
2 mg IV bolus over 1 minute. Maintenance: 1 - 2 mg IV bolus 4 - 6 hourly until bleeding is controlled,
up to 24 - 36 hours
Precautions :
Asthma, hypertension, advanced arteriosclerosis, coronary insufficiency, cardiac arrhythmias, renal
insufficiency.
Adverse Reactions :
Fibrinolysis, bradycardia, facial pallor, increased blood pressure and ECG changes, peripheral
vasoconstriction, increased intestinal peristalsis, stool urgency and possible stool incontinence,
uterine contractions, bronchial constriction.
Contraindications :
Pregnancy.
221
Interactions :
Not known.
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222
occurred during therapy, resolve hypocalcemia prior to beginning therapy, inability to sit or stand in
an upright position for at least 30 minutes.
Interactions :
Calcium supplements, antacids. Hormone replacement therapy. Olestra, mineral oils, orlistat,
cholestyramine, colestipol. Anticonvulsants, cimetidine, thiazides
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223
Dosage :
150 mg once monthly
Precautions :
Concurrent therapies with corticosteroids, chemotherapy, radiotherapy; increased risk for
osteonecrosis especially in the jaw. Creatinine clearance less than 35 ml/minute, vitamin D and
mineral deficiencies to be corrected before initiating therapy.
Adverse Reactions :
Rash, abdominal pain, diarrhoea, indigestion, nausea, arthralgia, back pain, myalgia, headache,
bronchitis, dyspepsia, nausea, flu-like symptoms.
Contraindications :
Hypersensitivity to ibandronate or to any of its excipients. Inability to stand or sit upright for 60
minutes. Uncorrected hypocalcaemia, hypocalcaemia, esophageal reactions.
Interactions :
Concurrent use with calcium and antacids may result in reduced alendronate absorption.
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224
Zoledronic Acid 4 mg Injection A*
Trade Name : Zometa
Indication :
i) Treatment of hypercalcaemia of malignancy ii) Prevention of skeletal related events in patients
with multiple myeloma involving multiple bone lesions
Dosage :
4 mg reconstituted and should be given as a 15 minutes IV infusion every 3-4 weeks
Precautions :
Assess hydration status prior to administration. Monitor serum electrolytes and creatinine. Evaluate
serum creatinine prior to each administration. If renal function has deteriorated, the dose should be
withheld. Not recomended in patients with bone metastases with severe renal impairment (serum
creatinine greater than 3.0 mg/dl) Severe renal or hepatic impairment. Patients should be advised to
inform the dentist during treatment and if dental surgery is foreseen. Caution is advised when
bisphosphonates are administered with aminoglycosides or other potentially nephrotoxic drugs,
since these agents may have an additive effect, resulting in a lower serum calcium level for longer
periods than required.
Adverse Reactions :
Alopecia, dermatitis, hypokalaemia, hyperkalaemia, hypernatremia, hypocalcemia,
hypomagnesemia, hypophosphatemia, shivering, abdominal pain, diarrhoea, nausea, vomiting,
arthralgia, bone pain, myalgia, headache, paraesthesia, upper tract infection, cough, dyspnoea,
upper respiratory infection, anemia, neutropenia, thrombocytopenia, nephrotoxicity, aseptic
necrosis of bone and jaw , pleural effusion. Rise in body temp, flu-like syndrome, elevation of serum
creatinine, renal impairment, conjunctivitis. Hypersensitivity reactions, hypertension, shortness of
breath, dizziness, sleeping disturbances, gastrointestinal reactions, loss of appetite, local reactions at
infusion site, rash, pruritus.
Contraindications :
Hypersensitivity to zoledronic acid or other bisphosphonates, pregnancy, lactation.
Interactions :
Aminoglycosides, other potentially nephrotoxic drugs, thalidomide.
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225
Interactions :
Clarithromycin - elevations in serum levels of bromocriptine. Inhibit ciclosporin metabolism.
Erythromycin - significantly increase the bioavailability of bromocriptine. Bromocriptine, may
decrease the metabolism of sirolimus, tacrolimus . Alcohol reduces tolerance to bromocriptine and
vice-versa. Effects of antihypertensives may be potentiated. Avoid concurrent psychotropics.
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226
blood levels and toxicity. Sirolimus, Tacrolimus : decrease the metabolism, causing increased plasma
concentrations of sirolimus and tacrolimus.
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227
10. OBSTETRICS & GYNAECOLOGY
Hormone replacement therapy
Infertility
Prostaglandin and oxytocics
Treatment of vaginal and vulval conditions
Contraceptices
Miscellaneous Obstetrics and Gynaecology
228
Conjugated Oestrogens 0.625 mg & Medroxyprogesterone Acetate 2.5 mg Tablet A
Trade Name : Premelle 2.5
Indication :
Management of moderate to severe vasomotor symptoms associated with menopause, prevention
and management of postmenopausal osteoporosis, atropic vaginitis and atropic urethritis in post
menopausal woman with intact uterus
Dosage :
1 tablet daily
Precautions :
Myocardia infarction, stroke, breast, endometrial and ovarian cancer, pregnancy, gallbladder
disease, retinal vascular thrombosis, proptosis, diplopia, migraine, hypercalcaemia, fluid retention,
hypertriglyceridemia, hepatic impairment, past history of cholestatic jaundice, elevated blood
pressure, asthma, epilepsy, hypocalcaemia, hypothyroidism, abnormal uterine bleeding, depression
Adverse effects :
Breast pain, breakthrough bleeding, dysmenorrhea, spotting, breast tenderness or enlargement,
discharge, arthralgias, leg cramp, depression, vaginitis, weight changes.
Contraindications :
Pregnancy, known or suspected cancer of the breast and estrogen dependent neoplasia,
undiagnosed abnormal genital bleeding, active thrombophlebitis or thromboembolic disorders, liver
dysfunction or disease. Active or recent arterial thromboembolic disease.
Interactions :
Rifampin may reduce effectiveness.
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229
Dydrogesterone 10 mg Tablet A/KK
Trade Name : Duphaston
Indication :
i) Dysmenorrhoea ii) Endometriosis iii) Dysfunctional uterine bleeding (to arrest and to prevent
bleeding) iv) Threatened abortion v) Habitual abortion vi) Post menopausal complaints (hormone
replacement therapy in combination with oestrogen)
Dosage :
i) 10 mg bd from day 5 - 25 of cycle ii) 10 mg bd - tds from day 5 - 25 of the cycle or continuously iii)
To arrest bleeding :10 mg bd with an oestrogen once daily for 5 - 7 days, To prevent bleeding : 10 mg
bd with an oestrogen once daily from day 11 - 25 of the cycle iv) 40 mg at once, then 10mg 8hrly
until symptoms remit v) 10 mg bd until 20th week of pregnancy vi) 10-20 mg daily during last 12-14
days of each cycle.
Precautions :
Pregnancy.
Adverse effects :
Breakthrough bleeding, altered liver function, angioedema, haemolytic anaemia.
Contraindications :
Breast and genital cancers, abnormal vaginal bleeding.
Interactions :
Enzyme inducing drugs such as carbamazepine, griseofulvin, phenobarbitone, phenytoin and
rifampicin may enhance the clearance of progesterone. Progesterone may inhibit ciclosporin
metabolism leading to increased plasma-ciclosporin.
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230
Estradiol 1 mg with Dydrogesterone 5 mg Tablet A*
Trade Name : Femoston Conti
Indication :
i) Hormone replacement therapy for the relief of symptoms due to oestrogen deficiency ii)
Prevention of postmenopausal osteoporosis in women with a uterus
Dosage :
One tablet daily, taken continuously without interruption. Should be used only in postmenopausal
women more than 12 month after menopause
Precautions :
Periodic general and gynaecological exam and mammogram should be instituted. Patients in the
perimenopausal phase are advised to take non-hormonal contraceptive precautions. Interruption of
HRT 1 month before surgery should be considered. Epilepsy, migraine, cardiac failure, hypertension,
porphyria, haemoglobinopathies, otosclerosis, uterine leiomyomata, endometriosis, lactation.
Adverse effects :
Breast tenderness, nausea, headache, oedema, breakthrough bleedings, skin reactions.
Contraindications :
Known or suspected carcinoma of the breast, endometrial carcinoma or other hormone dependent
neoplasia. Acute or chronic liver disease. History of liver disease where the liver function tests have
not returned to normal. History of venous thromboembolic diseases (e.g. deep venous thrombosis
or pulmonary embolism). Abnormal genital bleeding. Known or suspected pregnancy.
Interactions :
Barbiturates, phenytoin, rifampicin, carbamazepine.
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Estradiol Valerate 2 mg and Norgestrel 500 mcg with Estradiol Valerate 2 mg Tablet B
Trade Name : Progyluton
Indication :
Pre and post menopausal syndrome, primary and secondary amenorrhea, menstrual irregularities.
Deficiency symptoms after oophorectomy or radiological castration for noncarcinomatous disease
231
Dosage :
Start on the 5th day of menstrual cycle - 1 tab daily for 21 days then stop for 7 days. If patient
forgets dose at usual time, it should be taken within following 12 hours
Precautions :
Asthma, epilepsy, migraine, hypertension, cardiac or renal dysfunction, endometrial hyperplasia,
metabolic bone diseases, endometrial cancer, breast cancer, gall bladder disease, pancreatitis,
lactation, surgery, liver disorders, enlargement of uterine fibromyomata.
Adverse effects :
Changes in vaginal bleeding pattern, change in amount of cervical secretion, premenstrual-like-
syndrome, cystitis-like-syndrome, increase in size of uterine leiomyomata, vaginal candidiasis,
amenorrhoea, changes in cervical erosion, nausea, cholestatic jaundice, changes in appetite,
vomiting, abdominal cramps, bloating, increased incidence of gall bladder disease, pancreatitis.
Headache, dizziness, mental depression, nervousness, migraine. Increase or decrease in weight,
oedema, changes in libido, fatigue, backache, reduced carbohydrate tolerance, aggravation of
porphyria, pyrexia, anaphylactoid reactions.
Contraindications :
Known or suspected pregnancy, including use for missed abortion or as a diagnostic test for
pregnancy. Oestrogen or progestin may cause foetal harm when administered to a pregnant woman.
Known or suspected cancer of the breast. Known or suspected oestrogen -dependent neoplasm,
severe liver dysfunction, jaundice or severe pruritus during a previous pregnancy, previous or
existing liver tumours, existing or suspected hormone-dependent tumours of uterus or mammae.
Severe diabetes with vascular changes, previous or existing thromboembolic processes,
endometriosis, disturbances of lipometabolism, a history of herpes gestationis, otosclerosis with
deterioration during previous pregnancies, Dubin-Johnson syndrome, Rotor syndrome, sickle-cell
anemia.
Interactions :
Rifampicin, barbiturates, phenytoin, rifampicin, phenylbutazone, ampicillin. Requirements for oral
antidiabetics and insulin can change.
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232
Tibolone 2.5 mg Tablet A*
Trade Name : Livial
Indication :
Complaints resulting from natural or surgical menopause and in cases at high risk for breast
carcinomas where general hormone replacement therapy is contraindicated
Dosage :
2.5 - 5mg daily
Precautions :
Women with hormone dependent tumours, cardiovascular or cerebrovascular disorders including
thrombophlebitis, thromboembolic processes or a history of these conditions, undiagnosed vaginal
bleeding and severe liver disorders. Liver disease. Patients with hypercholesterolaemia and impaired
glucose tolerance. Stop tibolone 4 weeks before elective surgery when prolonged immobilisation
after surgery is likely.
Adverse effects :
Endometrial hyperplasia and endometrial carcinoma (rare), change in body weight, vaginal bleeding,
gastrointestinal upsets, changes in liver parameters, increased facial hair growth and pretibial
oedema.
Contraindications :
Hypersensitivity to tibolone, breast cancer (known or suspected), oestrogen-dependent neoplasms,
cerebrovascular disease, history of stroke, arterial disease, thromboembolic disorders, history of
cholestatic jaundice, hepatic tumours (benign or malignant), abnormal vaginal bleeding.
Interactions :
Phenytoin, carbamazepine and rifampicin may enchance the metabolism of tibolone and thus
reduce its activity.
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233
Clomifene Citrate 50 mg Tablet
Trade Name : Clomid
Indication :
Anovulatory infertility
Dosage :
50 mg daily from 2nd - 6th or 5th - 9th day of menstrual cycle. Increase dose gradually by increments
of 50 mg if there is no response until a dosage of 200 mg daily is achieved
Precautions :
Pelvic examination prior to initial treatment, ophthalmological evaluation in patients developing
visual symptoms, multiple pregnancies can occur, ovarian hyperstimulation syndrome and abnormal
ovarian enlargement may occur.
Adverse effects :
Blurred vision, vasomotor flushing, abdominal pain and ovarian enlargement (which may be part of
the ovarian hyperstimulation syndrome).
Contraindications :
Pregnancy, uncontrolled thyroid or adrenal dysfunction, liver disease, abnormal uterine bleeding,
ovarian cysts, organic intracranial lesion.
Interactions :
Danazol can results in inhibition of response to clomifene. Ethinyl estradiol can results in suppression
of response to ethinyl estradiol. When used concomitantly with gonadorelin acetate gonadotrophins
(FSH), it may increase the risk of ovarian hyperstimulation syndrome (OHSS).
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234
Carboprost Tromethamine 250 mcg Injection A*
Trade Name : Hemabate
Indication :
Postpartum haemorrhage refractory to oxytocin
Dosage :
ADULT: by deep IM injection; 250 mcg, may repeat at 15-90 minute, intervals to a total dose of 2 mg
(8 doses), followed by subsequent doses of 250 mcg at intervals of 1.5 to 3.5 hours. Dosage may be
increased to 500 mcg/dose if contractility is inadequate
Precautions :
Glaucoma, elevated intraocular pressure, asthma or history of asthma. Cephalopevic relationships
carefully evaluated prior to use. During use, uterine activity, foetal status and the progression of
cervical dilation evaluated at frequent intervals. In patients with history of hypertonic uterine
contractility or tetanic uterine contractions, recommended that uterine activity and state of foetus
be monitored throughout labour. Possible uterine rupture where high tone myometrical
contractions are sustained.
Adverse effects :
Nausea, vomiting and diarrhoea, paraesthesia, fever or chills, dystonia, breast tenderness,
hyperthermia and flushing, bronchospasm, cardiovascular collapse.
Contraindications :
Hypersensitivity to prostagladin, acute pelvic inflammatory disease, cardiac, renal, pulmonary or
hepatic disease.
Interactions :
Not known.
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235
Ergometrine Maleate 0.5 mg/ml Injection C+
Indication :
Prevention and treatment of postpartum and postabortal haemorrhage due to uterine atony
Dosage :
IM 200 - 1000 mcg and IV 250 - 500 mcg
Precautions :
Exacerbations of porphyria. Not recommended for routine use prior to delivery of the placenta.
Patients with heart disease, hepatic dysfunction, hypertension, mitral valve stenosis, obliterative
vascular disease, renal impairment, sepsis or venoarterial shunts. Hyperstimulation of the uterus
during labor. Patients with calcium deficiency.
Adverse effects :
Nausea and vomiting, abdominal pain, diarrhoea, headache, dizziness, tinnitus, chest pain ,
palpitations, bradycardia, dyspnoea, hypertension, hypersensitivity reactions and ergotism has been
reported. Cardiovascular effects, including arrhythmias and myocardial infarction and
bronchospasm.
Contraindications :
Induction of labour, in cases of threatened spontaneous abortion, and in patients with a history of
hypersensitivity or idiosyncratic reactions.
Interactions :
Combined use of delavirdine and ergometrine may cause elevated ergometrine serum
concentration. Avoid concomitant use with antivirals like indinavir,saquinavir etc.
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236
Precautions :
For induction or enhancement only as IV infusion, careful monitoring of fetal heart rate and uterine
contractions are required.
Adverse effects :
Gastrointestinal upsets, water intoxication resulting from large amounts of solution or too rapid
infusion, cardiac arrhythmias.
Contraindications :
Hypersensitivity to oxytocin, significant cephalopelvic disproportion, unfavorable fetal positions,
fetal distress, hypertonic or hyperactive uterus, contraindicated vaginal delivery.
Interactions :
Prostaglandins, inhalation anaesthetics, vasoconstrictor agents.
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237
Interactions :
Concurrent use with betamethasone may result in increased susceptibility to skin infection or
enhanced organism growth. Concurrent use with tacrolimus may increase plasma concentration of
tacrolimus and cause toxicity (nephrotoxicity, hyperglycaemia, hyperkalaemia), fentanyl.
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238
Interactions:
Barbiturates, phenylbutazone, hydantoins, rifampicin and ampicillin may impair the action of the
drug. Requirements for oral antidiabetics and insulin can change
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239
Levonorgestrel Releasing Intrauterine System A*
Trade Name : Mirena
Indication :
Contraception (Initial release rate of 20 mcg/24 hours)
Dosage :
One unit intrauterine device to be inserted into the uterine cavity within 7 days of the onset of
menstruation or immediately after first trimester abortion. Postpartum insertion should be
postponed until 6 weeks after delivery. One unit IUD is effective for 5 years
Precautions :
Discontinue treatment if crescendo migraine or other symptoms indicating transient cerebral
ischaemia, exceptionally severe headache, jaundice, marked increase of blood pressure, unexplained
loss of vision or other symptoms of retinal thrombosis occurs. Hormone dependent neoplasia
including breast cancer, malignancies affecting the blood or leukaemias, severe arterial disease eg
stroke or myocardia infarction. Diabetics. In recurrent endometriosis, pelvic infections or if an acute
infection does not respond to treatment within a few days, perforation, accidental pregnancy. Not a
contraceptive of choice during lactation
Adverse Effects :
Menstrual changes, lower abdominal pain, acne or other skin problems, backpain, mastalgia,
headache, vaginal discharge, mood changes, nausea, oedema, weight gain, decreased libido,
sweating, hair loss, greasy hair, ectopic pregnancy, pelvic inflammatory disease (PID), perforation of
uterine wall, enlarged follicles may develop
Contraindications :
Active hepatic disease, active thrombophlebitis or thromboembolic disorders, haemorrhagic
diathesis, carcinoma of the breast, pregnancy, undiagnosed abnormal uterine bleeding, undiagnosed
abnormal genital bleeding, history of idiopathic intracranial hypertension, hypersensitivity
Interactions :
Not known
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240
Norethisterone 0.35mg Tablet C
Trade name : Noriday
Indication :
Contraception
Dosage :
1 tablet daily starting on the first day of the menstrual bleeding
Precautions :
Gastrointestinal disease (impaired absorption of oral contraceptive steroids in the small bowel due
to inflammatory disease, diarrhoea, ileostomy or jejunoileal bypass may result in contraceptive
failure)
Adverse Effects :
Gastrointestinal distress, oedema, menstrual disorders, dermatologic effects, nausea, fatique,
depression, acne, hirsutism, breast tenderness, thromboembolic phenomena, galactorrhoea,
decreased glucose tolerance, anaphylaxis, corticoid like reaction (high doses)
Contraindications :
Hypersensitivity, breast carcinoma, liver disease or dysfunction, pregnancy, incomplete abortion,
abnormal and undiagnosed vaginal bleeding, active or history of thromboembolic disease,
thrombophlebitis, hypercoagulable state. Cerebral vascular or coronary artery diseases
Interactions :
Effectiveness may be reduced by antibiotics, phenytoin, carbamazepine, barbiturates, rifampicin
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241
Raloxifene HCl 60 mg Tablet A*
Trade Name : Evista
Indication :
Prevention and treatment of post menopausal osteoporosis
Dosage :
1 tablet daily
Precautions :
Elderly, excessive exercise, hypoglycaemia, breast cancer.
Adverse effects :
Has been associated with increased risk of thromboembolism (deep vein thrombosis, pulmonary
embolism) and superficial thrombophlebitis. Hot flushes and leg cramps.
Contraindications :
Women with child bearing potential, active thromboembolic disorder, pregnancy.
Interactions :
Ampicillin and cholestyramine decrease raloxifene absorption.
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242
11. GENITOURINARY
Drugs for urinary retention
Drugs for urinary frequency, enuresis and continence
Miscellaneous genitourinary
243
Doxazosin Mesilate 4 mg CR Tablet A*
Trade Name : Cardura XL
Indication :
Benign Prostatic Hyperplasia
Dosage :
4 mg once daily
Precautions:
Gastrointestinal disorders, pregnancy, lactation, history of gastrointestinal obstruction, oesophageal
obstruction
Adverse Reactions:
Postural hypotension, vertigo, headache, fatigue, dizziness, oedema and asthenia
Contraindications:
Hypersensitivity to doxazosin and other quinazolines
Interactions:
In patients currently on beta blockers, the first dose response (marked initial drop in blood pressure,
particularly on standing) to an alpha-1 adrenergic blocking drug may be exaggerated, tadalafil,
sildenafil, vardenafil
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Finasteride 5 mg Tablet A*
Trade Name : Proscar
Indication :
Treatment and control of benign prostatic hyperplasia
Dosage :
5 mg a day as a single dose. Clinical responses occur within 12 weeks - 6 months of initiation of
therapy. Long-term administration is recommended for maximal response
Precautions:
Patients should be screened for prostatic carcinoma, hepatic dysfunction, patients with a large
residual urinary volume or a severely diminished urinary flow rate should be monitored for
obstructive uropathy and may not be candidates for finasteride therapy, crushed tablets should not
be handled by a woman when she is pregnant or may potentially be pregnant because of the
possibility of absorption and the subsequent potential risk to the male foetus
244
Adverse Reactions:
Sexual dysfunction, breast tenderness or enlargement
Contraindications:
Hypersensitivity to finasteride products, known or suspected pregnancy
Interactions:
Not known
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245
Interactions:
Drugs which may reduce blood pressure, cimetidine, fluoxetine, ketoconazole, sildenafil
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246
Precautions:
Congestive heart failure, hypertension, pulmonary or peripheral oedema, toxaemia of pregnancy,
monitor serum electrolytes especially bicarbonate in patients with renal disease, decreased urinary
output, especially in the presence of hypocalcaemia
Adverse Reactions:
Hyperkalaemia, metabolic alkalosis, nausea, vomiting, diarrhoea, mild diuresis
Contraindications:
Severe renal impairment with oliguria, azotemia or anuria, Addison's disease, adynamic episodica
hereditaria, acute dehydration, heat cramps, severe myocardial damage, potassium citrate in
patients with hyperkalemia, sodium citrate for patients on sodium restriction
Interactions:
Concurrent administration of potassium citrate with potassium- containing medications,
angiotensin-converting enzyme inhibitors or cardiac glycosides, concurrent administration with
aluminum-based gels
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Sodium Bicarbonate, Citric Acid, Sodium Citrate and Tartaric Acid - 4 g per sachet B
Trade Name : Ural
Indication :
For relieving of discomfort in mild urinary tract infection, symptomatic relief of
dysuria to enchance the action to certain antibiotics especially some sulphonamides.
In gout as urinary alkalinizers to prevent cystallisation of urates
Dosage :
4- 8 g (1- 2 sachets) dissolved in a glass of cold water 4 times daily as prescribed
Precautions:
Patients on sodium restricted diet
Adverse Reactions:
Mild laxative effect, systemic alkalosis or hyperthermia with prolonged or excessive usage
Contraindications:
Renal failure or hyperthermia
Interactions:
Not known
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247
12. DRUGS AFFECTING IMMUNE RESPONSE
Immunosuppressants
Immunomodulators
248
Antilymphocyte/Antithymocyte Immunoglobulin (from Horse) Injection A*
Trade Name : Atgam
Indication :
i) To be used when conventional anti-rejection therapy is not successful ii) Treatment of aplastic
anaemia not responding to oxymethalone after 3 months, in which there is persistent pancytopenia
with repeated attacks of septicaemia and bleeding. iii) Severe aplastic anaemia with the following
parameters: a) Granulocyte less than 0.5x109/L b) Platelet less than 20x109/L c) Reticulocyte less
than 20x109/L iv) As a conditioning regime prior to transplant. v) Graft-versus-host disease
treatment
Dosage :
10 - 30 mg/kg body weight daily. Slow IV infusion (over at least 4 hours) diluted in 250 - 500 ml
Normal Saline. For Graft versus host disease treatment:40 mg/kg/day
Precautions:
Perform test dose, prophylactic platelet transfusion before and after infusion. Sodium and fluid
overload. Monitor for allergic reactions and serum sickness Monitor for signs of leukopenia,
thrombocytopenia or concurrent infection. Perform skin testing
Adverse Reaction:
Severe and unremitting thrombocytopenia or leucopenia, generalized rash, tachycardia, dyspnoea,
hypotension, anaphylaxis.
Contraindications:
Hypersensitivity, acute viral illness.
Interactions:
Live vaccines, increased risk of infection.
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Azathioprine 50 mg Tablet A
Trade Name : Imuran
Indication :
i)Acute leukaemia ii)Immunosuppressive agent
Dosage :
i) 1-4 mg/kg/day ii) 1.5-2 mg/kg/day
Precautions:
Chronic immunosuppression , increases risk of neoplasm, hematologic toxicity, mutagenicity.
Bleeding or bruising or signs of infection, bone marrow suppression. Monitor FBC weekly during first
8 week of therapy especially with high dose or severe renal/hepatic impairment. Inherited deficiency
of thiopurine methyltransferase enzyme. Avoid excessive sun/UV exposure. Pregnancy, lactation and
elderly
Adverse Reaction:
Gastrointestinal disturbances, myelosuppression, pancreatitis, fever. Opportunistic infections
especially in transplant patients receiving concomitant other immunosuppressants. Bone marrow
depression, leucopenia, thrombocytopenia, nausea. Uncommonly, anaemia, hypersensitivity
reactions, cholestasis, pancreatitis
Contraindications:
Hypersensitivity, pregnancy, previous alkylating agents such as cyclophosphamide, chlorambucil,
melphalan (risk of neoplasms)
Interactions:
ACEI, Angiotensin II Antagonist, warfarin, allopurinol, live vaccines, antibacterial. Reduces the
neuromuscular blockade of curare, tubocurarine but potentiates that of succinylcholine
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249
Mycophenolate Sodium 360mg Tablet A*
Trade Name : Myfortic
Indication :
Prophylaxis of acute transplant rejection in adult patients receiving allogenic renal transplant in
combination with ciclosporin and corticosteroids
Dosage :
720 mg twice daily
Precautions:
Avoid in patients with rare hereditary deficiency of hypoxanthine-guanine hosphoribosyl-transferase
(HGPRT) (eg, Lesch-Nyhan and Kelley-Seegmiller syndrome). Associated with an increased risk of
congenital malformations and spontaneous abortions when used during pregnancy. CellCept and
myfortic dosage forms should not be used interchangeably due to differences in absorption.
Increased risk of developing lymphomas & other malignancies particularly of the skin.
Oversuppression of the immune system with increased susceptibility to infection. Active serious
digestive system disease. Bone marrow depression. Perform regular complete blood counts for
monitoring neutropenia. Effective contraception must be used. Lactation. Severe chronic renal
impairment. Avoid live attenuated vaccines. Increased risk for opportunistic infections such as
activation of latent viral infections including BK virus -associated nephropathy
Adverse Reaction:
Leucopenia, neutropenia, lymphomas and skin malignancies. Increased risk of infections,
constipation, insomnia, increased risk of first trimester pregnancy loss and increased risk of
structural abnormalities in the infants born to mothers receiving mycophenolate during pregnancy.
Diarrhoea, viral, bacterial & fungal infections, anaemia, thrombocytopenia, headache, cough,
abdominal distension, abdominal pain, abdominal tenderness, dyspepsia, flatulence, gastritis, loose
stools, nausea, vomiting, fatigue, pyrexia, abnormal hepatic function tests, increased blood
creatinine
Contraindications:
Hypersensitivity, pregnancy, hypersensitivity to mycophenolate sodium, mycophenolic acid,
mycophenolate mofetil or any other component of the product
Interactions:
Azathioprine, live vaccines, aciclovir, antacids with aluminium and magnesium hydroxides,
cholestyramine and drugs that interfere with enterohepatic circulation, ganciclovir, tacrolimus, oral
contraceptives and cyclosporin
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250
Adverse Reaction:
Hypertension, angina, tachycardia, pleural and pericardial effusion, hypotension, arrhythmias,
ventricular or septal hypertrophy, cardiomyopathy, gastrointestinal disturbances, headache, tremor,
dizziness, anxiety, confusion and infection
Contraindications:
Hypersensitivity to tacrolimus products, macrolides, polyoxyethylated castor oil (parenteral
formulation) or structurally related compounds, pregnancy and lactation
Interactions:
Aminoglycosides, cisplatin, amphotericin B, additive or synergistic renal function impairment.
Spironolactone, hyperkalaemia. NSAIDs, acute renal failure. Live vaccines, risk of infection in
immunocompromised hosts, reduced effectiveness of vaccine. Fluconazole, nifedipine, diltiazem,
clarithromycin, erythromycin, chloramphenicol, increased risk of tacrolimus toxicity (nephrotoxicity,
hyperglycaemia, hyperkalaemia)
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251
Interactions:
Etoposide, statins, vaccines, immunosuppressive drugs except corticosteroids, live vaccines,
nephrotoxic drugs, NSAIDs, hepatic enzyme inducers. Increased ciclosporin level by diltiazem,
doxycycline, erythromycin, ketoconazole, nicardipine, verapamil, oral contraceptives. Drugs which
reduce ciclosporin level are carbamazepine, isoniazid, phenobarbitone, phenytoin and rifampicin.
Increased risk of convulsion when used concurrently with high-dose methylprednisolone
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252
Interactions :
Etoposide, statins,vaccines, immunosuppressive drugs except corticosteroids, live vaccines,
nephrotoxic drugs, NSAIDs, hepatic enzyme inducers. Increased ciclosporin level by diltiazem,
doxycycline, erythromycin, ketoconazole, nicardipine, verapamil, oral contraceptives. Drugs which
reduce ciclosporin level are carbamazepine, isoniazid, phenobarbitone, phenytoin and rifampicin.
Increased risk of convulsion when used concurrently with high-dose methylprednisolone
----------------------------------------------------------------------------------------------------------------
253
14. HAEMATOLOGY / ONCOLOGY
Cytotoxic drugs
Sex hormones and hormone antagonists in malignant disease
Bleeding disorder
Miscellaneous Haematology / Oncology
254
Actinomycin D (Dactinomycin) 500 mcg/ml Injection A
Trade Name : Cosmegen
Indication :
i) For solid tumours ii) Gestational trophoblastic disease
Dosage :
ADULT: 500 mcg IV daily for max of 5 days. CHILD: 1.5 mg/m2 once every 3 weeks (if weight less than
10 kg, 50 mcg/kg) ii) 500 mcg IV on Days 2, 4, 6, 8, 10, repeat every 7 - 10 days or 500 mcg IV bolus
on Days 1 and 2, repeat every 15 days
Precautions:
Avoid extravasation, severe soft tissue damage. Concomitant radiation therapy may exaggerate
dactinomycin toxicity
Adverse Reaction:
Myelosuppression, nausea, vomiting, mucositis, alopecia, rash, radiation recall reactions, hepatitis.
Malaise, fatigue, fever, myalgia, gastrointestinal, haematologic and dermatologic effects
Contraindications:
Pregnancy, lactation, chickenpox or herpes zoster infection
Interactions:
Live vaccines may result in an increase risk of infection, radiation therapy, possibly reduced
absorption of phenytoin
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255
Bleomycin HCl 15 mg Injection A
Trade Name : Bleocin
Indication :
Squamous cell carcinoma, germ cell tumours, lymphomas. Routes: SC, IM, IV (either as bolus or as
infusion over 24 hours), intra-arterial, intra-pleural
Dosage :
15 - 60 mg weekly in divided doses or 10 - 20 mg/m2 once or twice weekly or 10 mg/m2 slow bolus
in 15 minutes D1 and D15. Max: 400 mg. CHILD: 10 - 15 mg/m2 over 6 hours every 3 - 4 weeks
Precautions:
Beware of increased risk of pulmonary fibrosis in elderly patients (more than 70 years), if
radiotherapy has been given to the chest, if cumulative lifetime doses of bleomycin are exceeded or
if high concentrations of oxygen is given after bleomycin therapy. Monitor lung function. Risk of
anaphylatic reaction is higher in patients with lymphoma receiving bleomycin. Reconstitute in 0.9%
sodium chloride or sterile water. Should not reconstitute in dextrose-containing solutions
Adverse Reaction:
Erythema, hyperpigmentation of skin, nail changes, mucositis, chills, fever, pneumonitis, pulmonary
fibrosis, Raynaud's phenomenon, hyperpyrexia, hyperkeratosis, striae, stomatitis
Contraindications:
Hypersensitivity to bleomycin, severe pulmonary disease, pregnancy, lactation
Interactions:
Phenothiazines, cisplatinum, radiotherapy, zidovudine
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256
Dosage :
360 - 400 mg/m2 BSA, by IV infusion over 15 mins to 1 hour on Day 1 every 4 weeks. Alternatively,
prescription may be based on Area Under Curve (AUC) calculations. CHILD: 500-600 mg/m2 over 1
hour once every 3 weeks. Salvage regimes in lymphomas - refer to specific protocols
Precautions:
Myelosuppression, renal impairment. Monitor blood counts and renal function. Do not use infusion
sets or needles containing aluminium, avoid extravasation
Adverse Reaction:
Myelosuppression, alopecia, mucositis, electrolyte disturbances, nausea and vomiting,
nephrotoxicity, ototoxicity, peripheral neuropathy
Contraindications:
Hypersensitivity to cisplatin/ platinum products or mannitol, pregnancy, lactation, severe
myelosuppression
Interactions:
Nephrotoxic and ototoxic drugs, phenytoin. If platinum compound is used with taxane, to be given
after taxane. Increased risk of infection by live vaccines, zidovudine
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Chlorambucil 2 mg Tablet A
Trade Name : Leukeran
Indication :
Low grade lymphoma, chronic lymphocytic leukaemia. Ovarian cancer
Dosage :
200 mcg/kg body weight daily for 4 - 8 weeks
Precautions:
Myelosuppression. Monitor blood counts. History of seizures. If generalised skin rash develops
during treatment, to stop therapy to avoid progressing to erythema multiforme, toxic epidermal
necrolysis or Stevens-Johnson syndrome
Adverse Reaction:
Myelosuppression, azoospermia/amenorrhoea, rash, allergic reactions, seizures, nausea and
vomiting, diarrhoea, stomatitis, interstitial pneumonitis, pulmonary fibrosis, transient elevation of
liver enzymes, secondary malignancies
Contraindications:
Hypersensitivity to chlorambucil, pregnancy
Interactions:
Ciclosporin, phenobarbital, phenytoin, allopurinol, live vaccines
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257
Adverse Reaction:
Acute renal failure, chronic renal insufficiency, myelosuppression, severe nausea and vomiting,
ototoxicity, peripheral neuropathy, autonomic neuropathy, electrolyte disturbances (eg
hypokalemia, hypomagnesemia), bone marrows and ears, seizures, loss of hearing, deafness or
vestibular toxicity
Contraindications:
Hypersensitivity to cisplatin/platinum-containing products, pre-exisiting renal insufficiency,
myelosuppression, hearing impairment. Pregnancy, lactation, peripheral neuropathy, severe bone
marrow suppression
Interactions:
Sodium thiosulphate, bleomycin. If platinum compound is used with taxane, to be given after
taxane, live vaccine, azidamfenicol, aminoglycosides
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Cyclophosphamide 1 g Injection A
Trade Name : Endoxan
Indication :
i) Solid tumours (adult and paediatric), leukaemia, non-Hodgkin's lymphoma, multiple myeloma ii)
Severe lupus nephritis (Class III and IV) iii) Other systemic vasculitis iv) Systemic lupus
erythematosus, rheumatoid arthritis, polyarteritis nodosa, wegener granulomatosis v) Pemphigus
vulgaris
Dosage :
i) ADULT: 600 - 750 mg/m2 IV once every 3 weeks as part of combination regime. CHILD: Dose
variable depending on disease and protocol. Range 600 mg/m2 to 2 g/m2 infusion over 1 hour to 6
hours (lower doses can be given as bolus). Care with pre and post-hydration. Mesna to be given with
doses more than 1 g/m2. Higher doses are used in haematopoetic stem cell transplant-refer to
specific protocols ii) 750 mg/m2 BSA monthly for 18 months iii) 750 mg/m2 BSA monthly for 6
months. Dose can be adjusted up to 1,000 mg/m2 BSA to achieve adequate leucocyte suppression
iv) 500 - 1000 mg intravenously (Regime varies according to indication). Starting dose may be given
fortnightly then at monthly intervals followed by 3 monthly intervals v) 500 mg infusion on the 2nd
day of the dexamethasone-cyclophosphamide pulsed regime, the cycle is repeated every 4 weeks up
to 6 cycles or till remission followed by oral cyclophosphamide
Precautions:
Myelosuppression, renal/hepatic impairment, elderly patients
Adverse Reaction:
Myelosuppression, syndrome of inappropriate ADH secretion, haemorrhagic cystitis, fibrosis of
bladder, alopecia, nausea and vomiting, anorexia, diarrhoea, headache, rash, flushing of face.
Adverse reactions with high doses of cyclophophamide include heart failure and interstitial
pneumonitis
Contraindications:
Hypersensitivity to cyclophosphamide. Pregnancy, lactation
Interactions:
Doxorubicin, cimetidine, thiazide diuretics. Succinyl choline, halothane, nitrous oxide. Increased
bone marrow depression with allopurinol, barbiturates, phenytoin, corticosteroids, chloramphenicol,
interferon alfa. Radiotherapy, live vaccines
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258
Cyclophosphamide 50 mg Tablet A
Trade Name : Endoxan
Indication :
i) Solid tumours, leukaemia, lymphoma, autoimmune disorders, autoimmune bullous diseases,
connective tissue disease, pyoderma gangrenosum ii) For severe lupus nephritis (Class III & IV),
systemic vasculitis and steroid resistant/dependent nephrotic syndrome iii) Systemic lupus
erythematosus (SLE), rheumatoid arthritis, polyarteritis nodosa, wegener granulomatosis
Dosage :
i) Solid tumours, leukaemia, lymphoma, autoimmune disorders, autoimmune bullous diseases,
connective tissue disease, pyoderma gangrenosum ii) For severe lupus nephritis (Class III & IV),
systemic vasculitis and steroid resistant/dependent nephrotic syndrome iii) Systemic lupus
erythematosus (SLE), rheumatoid arthritis, polyarteritis nodosa, wegener granulomatosis
Precautions:
Myelosuppression, renal/hepatic impairment, elderly patients
Adverse Reaction:
Myelosuppression, syndrome of inappropriate ADH secretion, haemorrhagic cystitis, fibrosis of
bladder, alopecia, nausea and vomiting, anorexia, diarrhoea, headache, rash, flushing of face
Contraindications:
Hypersensitivity to cyclophosphamide. Pregnancy, lactation
Interactions:
Doxorubicin, cimetidine, thiazide diuretics. Radiotherapy, live vaccines. Succinyl choline, halothane,
nitrous oxide. Increased bone marrow depression with allopurinol, barbiturates, phenytoin,
corticosteroids, chloramphenicol, interferon alfa
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259
Contraindications:
Hypersensitivity to cytarabine products. Pregnancy, lactation
Interactions:
Increased cytotoxicity when radiotherapy, alkylating agents, methotrexate and purine analogues are
given together with cytarabine. Increased ototoxicity if used concurrently with cisplatin
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260
Docetaxel 20 mg/0.5 ml Injection A*
Trade Name : Taxotere
Indication :
i)Adjuvant treatment of patients with high risk node-positive breast cancer in combination with
doxorubicin and cyclophosphamide ii) Breast cancer, locally advanced or metastatic, not previously
on cytotoxic therapy, in combination with doxorubicin iii) First line therapy in non small cell lung
cancer in stage 3- 4 and performance status 0 ? 1, in combination with cisplatin iv) Inoperable locally
advanced squamous cell carcinoma of head and neck, in combination with cisplatin and 5-FU for
induction treatment v) Prostate cancer, in combination with prednisolone
Dosage :
i) 75 mg/m2 IV over 1 hour after doxorubicin 50 mg/m2 and cyclophosphamide 500 mg/m2 every 3
weeks for 6 cycles ii) 75 mg/m2 IV over 1 hour every 3 week in combination with doxorubicin 50
mg/m2 iii) Administer IV over 1 hour every 3 weeks. Chemotherapy-naive patients 75 mg/m2
immediately followed by 75 mg/m2 cisplatin over 30-60 mins or carboplatin (AUC 6 mg/mL/min)
over 30-60 minutes. Monotherapy of non small cell lung cancer (NSCLC) after failure of prior
platinum-based chemotherapy 75 mg/m2 iv) 100 mg/m2 IV over 1 hour every 3 weeks v) 60-75
mg/m2 IV over 1 hour every 3 weeks, administer with oral prednisolone 5 mg twice daily given
continuously
Precautions:
All patients should receive premedication with corticosteroids against hypersensitivity reactions.
Monitor blood counts, liver function tests. Avoid extravasation
Adverse Reaction:
Fluid retention syndrome, hypersensitivity reactions. rash, alopecia, oedema, peripheral neuropathy,
myelosuppression, elevation of liver enzymes, nausea, vomiting, stomatitis, diarrhoea, fatigue,
weakness, paroxysmal atrial tachycardia, atrial flutter, dysrrhythmia, hypertension and heart failure
Contraindications:
Hypersensitivity to docetaxel or Polysorbate 80, neutrophil count less than 1500 cells/mm³. Severe
liver impairment. Pregnancy and lactation
Interactions:
Increased risk of infection by the live vaccine. Drugs which affect liver cytochrome P450 enzyme
system may affect the antitumour and toxic effects of docetaxel. Less toxicity if taxanes given before
platinum compounds if combination of taxane and platinum is used
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261
Adverse Reaction:
Alopecia, myelosuppression, mucositis, diarrhoea, hyperpigmentation of skin and nails, arrhythmias,
congestive heart failure, nausea, vomiting, discolouration of urine, palmar-plantar
erythrodysethesia, pericardial effusion, cardiomyopathy, radiation recall reactions, second
malignancy
Contraindications:
Hypersensitivity to doxorubicin, marked myelosuppression induced by previous chemotherapy or
radiotherapy. Previous treatment with tolerance doses of anthracyclines, significantly impaired
cardiac function, angina pectoris, cardiac arrhythmias or recent myocardial infarction.
Interactions:
Live vaccines, phenytoin, radiation therapy, mitomycin C, 6-mercaptopurine, cyclophosphamide, 5-
fluorouracil, ciclosporin, digoxin, paclitaxel, phenobarbital, trastuzumab, stavudine, zidovudine
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Epirubicin 50 mg Injection A*
Trade Name : Adriamycin
Indication :
Breast cancer, Non-Hodgkin's lymphoma, Leukaemia (ALL induction), gastric cancer, ovarian cancer
Dosage :
60 - 100 mg/m2 body area injected IV in 3 - 5 min, repeated at 21 day intervals. CHILD: 50 mg/m2
over 6 hours. Schedule depends on protocol
Precautions:
Pre-existing cardiac disease, renal or liver impairment, previous radiotherapy, elderly patients. Avoid
extravasation. Avoid cumulative doses beyond 900 mg/m2
Adverse Reaction:
Myelosuppression, leukopenia, thrombocytopenia, nausea, vomiting, cardiotoxicity (arrhythmias,
conduction disturbances, myopericarditis syndrome, dilated cardiomyopathy, congestive cardiac
failure), alopecia, mucositis, vesicant, rash, hyperpigmentation of skin and nails, radiation recall
reaction, discolouration of urine
Contraindications:
Hypersensitivity to anthracyclines, severe cardiac impairment, recent myocardial infarct, severe liver
dysfunction, pregnancy, lactation
Interactions:
Paclitaxel and other anthracyclines, Cimetidine, cyclophophamide, 5-fluorouracil, heparin, live
vaccines, trastuzumab, zidovudine
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262
Precautions:
Use with caution in hepatic or renal impairment, myelosuppression. Administer intravenously over
30 to 60 minutes to reduce risk of hypotension. Anaphylaxis following IV administration to be
anticipated and treated appropriately
Adverse Reaction:
Myelosuppression, nausea and vomiting, alopecia, hypersensitivity reaction, local inflammatory
reaction at site of injection, radiation recall reaction, secondary malignancy
Contraindications:
Hypersensitivity to podophyllins, severe hepatic dysfunction, pregnancy, lactation
Interactions:
Ciclosporin, calcium antagonists, methotrexate, warfarin. Increased risk of infection by the live
vaccine
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263
minutes IV infusion day 1 & 8 of each 21-day cycle followed by carboplatin on day 1 to attain a target
AUC of 4 mg/ml/minute iv) 1250 mg/m2 on days 1 and 8 of each 21-day cycle with paclitaxel 175
mg/m2 given as a 3-hour infusion before gemcitabine on day 1 of each 21-day cycle
Precautions:
Caution in hepatic dysfunction, myelosuppression, renal impairment. Avoid prolonging infusion
times more than 60 minutes
Adverse Reaction:
Flu-like symptoms, proteinuria, nausea, vomiting, myelosuppression, oral soreness, rash, pruritus,
elevation of liver enzymes, haematuria, dyspnoea, allergic reactions, myalgia, alopecia, diarrhoea,
haemolytic uraemic syndrome, adult respiratory distress syndrome
Contraindications:
Hypersensitivity to gemcitabine. Pregnancy, lactation
Interactions:
Increased risk of infection by live vaccines. Cisplatin, etoposide, radiotherapy
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Idarubicin 10 mg Injection A*
Trade Name : Zavedos
Indication :
i) Acute promyelocytic leukaemia ii) Relapse Acute myeloid leukemia (with sibling match) iii) Acute
myeloid leukemia, acute lymphoblastic leukemia (salvage therapy)
Dosage :
i) Induction phase: 12 mg/m2 IV slow bolus on Days 3, 5 and 7. Consolidation phase, month 1: 12
mg/m2 IV on Days 1 and 2. Repeat monthly for 3 courses ii) 12 mg/m2 D1-3 iii) 12 mg/m2 D1-3 as
part of FLAG-IDA regimen
Precautions:
Risk for cardiotoxicity increased in elderly, hypertension, heart disease, previous treatment with
anthracyclines, previous chest radiotherapy. Cumulative doses more than 150 mg/m2 are associated
with decreased left ventricular ejection fraction. Monitor cardiac function. Caution against sun
exposure. Avoid extravasation. Anticipate and prevent tumour lysis syndrome. Caution with
abnormal liver function tests
Adverse Reaction:
Cardiotoxicity, myelosuppression, nausea, vomiting, diarrhoea, mucositis, alopecia, rash,
photosensitivity, hyperpigmentation, vesicant, discolouration of urine, leukopenia,
thrombocytopenia
Contraindications:
Hypersensitivity to idarubicin and other anthracyclines. Pregnancy, lactation, cardiac impairment,
renal and hepatic impairment
Interactions:
Probenecid, sulfinpyrazone, heparin. Live vaccine, other myelosuppressants, azidamfenicol,
chloramphenicol, ciclosporin, trastuzumab
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Ifosfamide 1 g Injection A*
Trade Name : Holoxan
Indication :
i) Solid tumours ii) Leukaemia iii) Lymphoma
Dosage :
i) 1.2 - 2.4 g/m2/day for 3 - 7 days as a 30 - 120 minutes infusion. Alternatively, can also be given as a
single high dose, eg. 5 g/m2 in a 24 hour infusion. Cycles may be repeated every 3 - 4 weeks ii)
CHILD: 400 - 3000 mg/m2/day for 3 - 5 days according to protocol iii) Refer to protocols
264
Precautions:
Brain metastases, electrolyte imbalance, hepatic and renal impairment. Hydration required. Renal
function should be checked prior to administration. Co-administration with mesna, which is a
urothelial protective agent is mandatory
Adverse Reaction:
Alopecia, myelosuppression, nausea and vomiting, diarrhoea, mucositis, transient abnormalities of
liver enzymes, acute hepatocellular injury (not common at standard doses), erythematous rash,
pruritis, pigmentary changes, photosensitivity, acute renal failure (high dose), headache, drowsiness,
dizziness, encephalopathy/ acute confusion (high dose)
Contraindications:
Hypersensitivity to ifosfamide, pregnancy, lactation. Severe myelosupression
Interactions:
Phenobarbital, carbamazepine, phenytoin
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265
Dosage :
i) 5,000 iu/m2 for 10 days during induction, 10,000 iu/m2 also used with high dose methotrexate
rescue in consolidation phase of acute lymphoblastic leukemia ii) CHILD: 5,000 - 25,000 iu/m2 per
dose depending on protocol
Precautions:
Haematologic, renal and hepatic dysfunction, pregnancy. Monitor for severe allergic reactions,
caution in underlying coagulopathy and lactation
Adverse Reaction:
Hypersensitivity reactions (urticaria, chills, fever, anaphylaxis), hyperglycaemia, lethargy, depression,
confusion, coagulopathy, anorexia, mild nausea and vomiting, acute pancreatitis, coma,
myelosuppression (usually mild), hepatic dysfunction, renal dysfunction, somnolence, hallucination,
central nervous system disturbances including depression, coma, transient bone-marrow depression
Contraindications:
Hypersensitivity to L-Asparaginase, history of pancreatitis
Interactions:
Vincristine, cyclophosphamide, methotrexate, steroids, live vaccine
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Melphalan 2 mg Tablet A
Trade Name : Alkeran
Indication :
i) Multiple myeloma ii) Neuroblastoma, rhabdomyosarcoma iii) Recurrent neuroblastoma (palliative)
Dosage :
i) 8 - 10 mg/m2 for 4 days every 4 weeks ii) 10 - 35 mg/m2 once every month For dose regimes, refer
to protocols
Precautions:
Use with caution in renal impairment and elderly. Dose adjustment with blood count. To be taken on
empty stomach 1 hour before or 2 hours after meals
Adverse Reaction:
Bone marrow depression, mild gastrointestinal effects, diarrhoea, pulmonary fibrosis, interstitial
pneumonitis, alopecia, syndrome of inappropriate ADH secretion, secondary malignancy
Contraindications:
Lactation, pregnancy, hypersensitivity to melphalan, severe myelosuppression
Interactions:
Ciclosporine, steroid, cimetidine
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Mercaptopurine 50 mg Tablet A
Trade Name : Puri-Nethol
Indication :
i) Langerhan's cell histocytosis ii) Acute lymphoblastic leukaemia iii) Acute promyelocytic leukaemia
APML (maintenance)
Dosage :
ADULT: Maintenance therapy: 60 - 75 mg/m2 body surface area once daily. Adjust doses depending
on peripheral blood counts. CHILD: 2.5 mg/kg body weight or 25 - 100 mg/m2 body surface area
once daily according to protocol. Refer to protocols
Precautions:
Dose reduction with an abnormal liver or renal function. Myelosuppression (temporarily discontinue
treatment with an abnormally large fall in any formed blood element), inherited deficiency of the
enzyme thioguanine methyltransferase (TPMT), hepatotoxicity, reduce dosage when administered
with allopurinol, pregnancy. Take on an empty stomach
266
Adverse Reaction:
Bone marrow depression, nausea and vomiting, hepatotoxicity, rash, hyperpigmentation,
hyperuricaemia
Contraindications:
Lactation, pregnancy, severe bone marrow suppression, severe liver disease, hypersensitivity to
mercaptopurine
Interactions:
Allopurinol, methotrexate, warfarin, decreased anticoagulant effectiveness, sulfasalazine
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Methotrexate 50 mg Injection A
Indication :
i) Solid tumours ii) Gestational trophoblastic disease iii) Acute leukaemia/lymphomas iv) Rheumatoid
arthritis, psoriatic arthropathy, severe/erythrodermic psoriasis
Dosage :
i) 50 mg/m2 once every 2 - 3 weeks in combination with other drugs ii) 50 mg IV Day 1, 3, 5, 9 every
3 weeks. For high risk gestational trophoblastic disease, use 100 mg/m2 as part of EMA-CO regime
iii) High dose regimes: 500 - 3000 mg/m2 per dose may be used, employing the 500 mg
preparations. CHILD: Central nervous system prophylaxis for acute leukaemia 2 gm/m2 over 24
hours with folinic acid rescue, 3 doses for B-cell lineage. 4 doses for T-lineage all every 3 weeks.
Relapse acute lymphoblastic leukaemia (ALL): 1 gm/m2 over 36 hours with folinic acid rescue every 3
weeks for 9 doses, maintenance: 50 mg/m2 every 2 weeks. B-cell lymphoma: 3 gm/m2 over 3 hours
with folinic acid rescue for three doses. Methotrexate level monitoring recommended when using
high dose regimens. The 500 mg strength is not for intrathecal (IT) use. Dosage for intrathecal
treatment and prophylaxis in leukaemia: less than 1 year: 5 mg, 1 - 2 years: 7.5 mg, 2 - 3 years: 10
mg, more than 3 years: 12.5 mg. IT preparation must be clearly stated/verified. ENSURE THAT
PREPARATION IS SUITABLE FOR INTRATHECAL USE iv) Dose used by rheumatologist: 10 - 15 mg IM
injection or oral weekly. Dose used by dermatologist: 10 - 25 mg IM injection weekly
Precautions:
Patients with a creatinine clearance of less than 60 ml/minute, impaired renal function, pleural
effusion, ascitis and poor nutritional status should not receive high-dose methotrexate. High-dose or
intrathecal methotrexate therapy must NOT be formulated with diluents containing preservatives.
High-dose methotrexate therapy requires the use of leucovorin rescue. Myelosuppression, acute or
chronic hepatotoxicity (elevated transaminases, fibrosis, cirrhosis), pulmonary toxicity (dry cough,
pneumonitis). Women of child-bearing potential, gastrointestinal toxicity (vomiting, diarrhoea,
stomatitis), tumour lysis syndrome in patients with rapidly growing tumors, severe and sometimes
fatal skin reactions, potentially fatal infections (especially pneumocystis carinii pneumonia),
neurotoxicity (leukoencephalophathy, seizures), care should be taken in handling the body fluids of
persons receiving antineoplastic agents
Adverse Reaction:
Myelosuppression, nausea, vomiting, diarrhoea, mucositis, transient abnormalities in serum levels of
liver enzymes, acute hepatocellular injury (not common at standard dose), erythematous rash,
pruritis, pigmentary changes, photosensitivity, acute renal failure (high dose), headache, drowsiness,
dizziness, acute confusion (high dose), interstitial pneumonitis, myelosuppression, interstitial
pneumonitis
Contraindications:
Pregnancy, lactation, severe myelosuppression, serious renal and liver impairment, increase risk of
toxicity in the presence of third space fluid (pleural effusion, ascites)
Interactions:
Alcohol, aminophenazone, amiodarone, amitriptyline, antibiotics, cisplatinum, ciclosporin, cytosine
arabinoside, diclofenac, etoposide, etretinate, 5-fluorouracil, NSAIDs, salicylates, nephrotoxic drugs,
sulfonamides, tetracyclines, teniposide, warfarin, folic acid
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Mitomycin-C 10 mg Injection A*
Trade Name : Mitomycin-C
Indication :
i) Gastrointestinal, lung, breast, cervical cancers ii) Bladder tumours iii) Opthalmological conditions:
conjunctival squamous neoplasia, squamous cell carcinoma of conjunctiva, trabeculectomy chronic
lymphocytic leukaemia, chronic myelogenous leukaemia. Gastric, colorectal, lung cancer
268
Dosage :
i) 10 - 20 mg/m2 body surface area (BSA) given as a single dose through a running IV infusion
repeated every 6 - 8 weeks. The whole schedule may be repeated depending on the bone marrow ii)
10 - 40 mg daily or every other day (intravesical) iii) 0.4 mg topically as a single application for
opthalmological conditions, duration: 1 to 3 minutes
Precautions:
Bleeding tendency, radiotherapy, extravasation, hepatic dysfunction, myelosuppression, renal
impairment
Adverse Reaction:
Nephrotoxicity, delayed myelosuppression, nausea and vomiting, alopecia, congestive heart failure,
fever, haemolytic uraemic syndrome-risk increase when cumulative dose more than 50 mg/m2,
interstitial pneumonitis
Contraindications:
Thrombocytopenia, coagulation disorders, pregnancy, lactation, hypersensitivity to mitomycin,
hepatotoxicty
Interactions:
Vinblastine, vince alkaloids may increase risk of cardiotoxicity when given together with mitomycin C
----------------------------------------------------------------------------------------------------------------------------------
Oxaliplatin 50 mg Injection A*
Trade Name : Eloxatin
Indication :
Only for patients with colorectal cancer who: i) have relapsed within 6 months after the end of
adjuvant chemotherapy with 5-fluorouracil-based regime ii) have progressive disease despite 5-
269
fluorouracil chemotherapy for advanced disease iii) good performance status (WHO of 2 or less). The
treatment must be given in a tertiary oncology centre or have clearance in writing by an oncologist
Dosage :
85 mg/m2 IV repeated every 2 weeks
Precautions:
Presence or history of peripheral neuropathy, pre-existing renal or hepatic impairment, significant
bone marrow suppression may cause pulmonary fibrosis, avoid extravasation
Adverse Reaction:
Anaphylactic, anaemia, dyspnoea, febrile neutropenia, thrombocytopenia, fatigue, fever, nausea,
diarrhoea, colitis, increased liver enzymes, dyspnoea
Contraindications:
Hypersensitivity to oxaliplatin, pregnancy, lactation, bone marrow suppression, hepatic impairment
Interactions:
Drugs with potential neurological toxicity, docetaxel, paclitaxel, aminoglycosides
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270
Precautions:
Intrathecal administration can be fatal. Should not be injected into an extremity with impaired
circulation. Patients carefully monitored for infection until white cell count has return to normal
levels if leukopenia with less than 2000 white blood cells per mm3 occurs following dose
Adverse Reaction:
Myelosuppression, nausea, vomiting, anorexia, generalized fatigue, constipation, alopecia,
dermatitis, vesicant, neurotoxicity, syndrome of inappropriate secretion of anti-diuretic hormone
Contraindications:
Hypersensitivity to vinblastine. Pregnancy, lactation. Leukopenia, presence of bacterial infection
Interactions:
Mitomycin C, phenytoin. Drugs which inhibit cytochrome P450 enzymes, voriconazole, itraconazole
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Anastrozole 1 mg Tablet A*
Trade Name : Arimidex
Indication :
Treatment of hormone responsive metastatic or locally advanced breast cancer after failure of
tamoxifen
Dosage :
1 mg daily
Precautions:
Hyperlipidemia, moderate to severe hepatic impairment, severe impairment of renal function
(creatinine clearance less than 20 mL/min). Lowers circulating oestrogen levels which may cause a
reduction in bone mineral density
271
Adverse Reaction:
Hot flashes, asthenia, peripheral oedema, vaginal bleeding, deep vein thrombosis, arthralgia,
backpain, cough, dypsnea, headache, nausea, rash, hypercholesterolaemia
Contraindications:
Hypersensitivity to anastrazole, pregnancy. Not indicated for premenopausal women
Interactions:
Oestrogens, tamoxifen
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272
Interactions:
Warfarin, allopurinol, ciclosporin, bromocriptine, rifampicin, clopidogrel, cyclophosphamide,
fluorouracil, methotrexate, mitomycin, concurrent use with letrozole may result in reduced letrozole
serum concentrations, aminoglutethimide may decrease tamoxifen plasma concentrations
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273
Contraindications:
Hypersensitivity to imatinib or any component of the product. Avoid pregnancy and lactation
Interactions:
Alfuzosin, aprepitant, carbamazepine, dexamethasone, ketoconazole, levothyroxine, phenobarbital,
phenytoin, rifampin, simvastatin, St John's Wort, warfarin, ciclosporin and paracetamol
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274
hepatic decompensation. Perform standard haematological and biochemical tests before and
periodically during therapy. May impair ability to drive or operate machinery
Adverse Reaction:
Headache, alopecia, dermatitis, nausea, vomiting, abdominal pain, neutropenia, anaemia, dyspnoea,
myalgia, fatigue, rigors, fever, depression, arthralgia, gastrointestinal disturbances, irritability, flu-
like symptoms, insomnia, asthenia, pharyngitis, weight loss, anorexia, dizziness, granulocytopenia,
thrombocytopenia, injection site and acute hypersensitivity reactions
Contraindications:
Hypersensitivity, autoimmune hepatitis, decompensated cirrhosis, severe psychiatric disorder,
pregnancy and lactation. Neonate and infant three years and below
Interactions:
ACEI, fluorouracil, melphalan, prednisolone, theophylline, warfarin, zidovudine, didanosine
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275
16. NUTRITION AND BLOOD DISORDER
Fluids and electrolytes
Intravenous nutrition
Minerals
Vitamins
Miscellaneous Nutrition and blood disorder
276
Continuous Ambulatory Peritoneal Dialysis Solution containing 1.5% Dextrose B
Continuous Ambulatory Peritoneal Dialysis Solution containing 2.5% Dextrose B
Continuous Ambulatory Peritoneal Dialysis Solution containing 4.25% Dextrose B
Indication :
For chronic renal diseases requiring dialysis and acute therapy-resistance renal
failure eg. prior to transfer to a dialysis centre
Dosage :
Dose depending on clinical cases
Precautions:
Abdominal sepsis, previous abdominal surgery or severe inflammatory bowel disease. Dialysis
solutions should be warmed to body temperature with dry heat because wet heat carries a risk of
microbial contamination
Adverse Reactions:
Peritonitis, hernias, hyperglycaemia, protein malnutrition and catheter complications. Long-term
peritoneal dialysis results in progressive structural changes to the peritoneal membrane ultimately
resulting in dialysis failure
Contraindications:
Not known
Interactions:
Drug with low molecular weight, high water solubility, low volume of distribution, low protein
binding and high renal clearance are most extensively removed by dialysis e.g. aminoglycosides.
Dialysis-induced changes in fluids and electrolytes
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277
Human Albumin Injection B
Indication :
i) Acute hypovolemic shock ii) Hypoproteinaemia iii) Neonatal hyperbilirubinaemia
Dosage :
i) ADULT 25 g. CHILD 0.6 g/kg body weight ii) Maximum daily dose is 2g iii) 1 g/kg
before exchange transfusion. Dose is given at rate of 1 ml of 25% solution per
minute
Precautions:
Hepatic or renal failure due to protein load; rapid infusion of albumin solutions may cause vascular
overload
Adverse Reactions:
CHF precipitation, oedema, hypertension, hypervolemia, hypotension, tachycardia,chills, fever,
headache, pruritus, rash, urticaria, nausea, vomiting, bronchospasm, pulmonary oedema,
anaphylaxis
Contraindications:
Hypersensitivity to albumin; patients at risk for acute circulatory overload (cardiac failure,
pulmonary edema, severe anemia)
Interactions:
ACE inhibitors: May have increased risk of atypical reactions; withhold ACEIs for at least 24 hours
prior to plasma exchanges using large volumes of albumin
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279
Ringer's Solution Injection B
(contained sodium chloride, potassium chloride and calcium chloride)
Indication :
As a source of electrolytes and water for hydration/replenishing of chloride
Dosage :
According to the needs of the patient
Precautions:
Congestive heart failure, circulatory insufficiency, kidney dysfunction, hypoproteinaemia, cirrhotic
disease, hypervolaemia, urinary tract obstruction and patients receiving drugs that cause sodium
retention, eg corticosteroids or corticotropin
Adverse Reactions:
Nausea, vomiting, diarrhoea, abdominal cramps, congestive heart failure, hypertension, tachycardia,
fluid accumulation, irritability, restlessness, weakness, headache, dizziness, obtundation, convulsions
Contraindications:
Hypernatraemia or fluid retention, hypersensitivity, sodium chloride solutions with preservatives in
newborns for injection or flushing of intravenous lines or mixing medications, hypertonic saline
abortifacient in pregnancies less than 15 weeks
Interactions:
Not known
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280
Precautions:
Restrict intake in impaired renal function, cardiac failure, hypertension, peripheral and pulmonary
oedema, toxaemia of pregnancy. Diabetes mellitus or carbohydrate intolerance and hyperglycaemia
may accentuate neurologic damage for an ischaemic insult. Patients at risk for cerebral ischaemia,
acute stroke, impending cardiac arrest or severe hypotension unless hypoglycaemia is suggested or
until glucose is determined
Adverse Reactions:
Thrombophlebitis, rebound hypoglycaemia, hypokalaemia, sodium accumulation and oedema
Contraindications:
Hypernatraemia or fluid retention, hypersensitivity (ophthalmic products), sodium chloride solutions
with preservatives in newborns, for injection or flushing of intravenous lines or mixing medications,
hypertonic saline abortifacient in pregnancies less than 15 weeks
Interactions:
Not known
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281
Contraindications:
Hypernatraemia or fluid retention, hypersensitivity (ophthalmic products), sodium chloride solutions
with preservatives in newborns, for injection or flushing of intravenous lines or mixing medications,
hypertonic saline abortifacient in pregnancies less than 15 weeks
Interactions:
During therapy with corticosteroids or ACTH there may be an increased retention of sodium and
chloride. Decreased levels of lithium
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282
Water for Injection C
Indication :
As a diluent and vehicle for the administration of medications
Dosage :
According to the needs of the patient
Precautions:
The stability of any medicament prepared should be checked
Adverse Reactions:
Not known
Contraindications:
Not known
Interactions:
Not known
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283
Trace Elements and Electrolytes (Adult) Solution A*
Trade Name : Addamel Solution
Indication :
Only to be used to cover daily loss of electrolyte and trace elements for patient on parenteral
nutrition
Dosage :
10 ml added to 500-1000 ml solution, given by IV infusion
Precautions:
Impaired biliary or renal function, liver dysfunction (especially cholestasis. Manganese blood levels
and liver function should be monitored regularly (monthly). Should be stopped if manganese levels
rise into the potentially toxic range
Adverse Reactions:
Not known
Contraindications:
Total biliary obstruction. Should not be given undiluted
Interactions:
Not known
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284
Contraindications:
Hypercalcaemia, hypercalciurea, severe renal failure, patients treated with digitalis
Interactions:
Increased inotropic and toxic effects when used with cardiac glycosides. Complex formation with
tetracyclines
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285
Magnesium Sulphate 50% Injection C
Indication :
Treatment and prophylaxis of hypomagnesaemia. Prevention and treatment of life-threatening
seizures in the treatment of toxemias of pregnancy (pre-eclampsia and eclampsia)
Dosage :
ADULT 5-10 ml by IM. CHILD 20-40 mg/kg body weight as a 20% solution by IM. Hypomagnesaemia:
0.5-1 mmol/kg body weight up to 160 mmol magnesium over to 5 days. Eclampsia: IV 4 g over up to
20 minutes followed by IV infusion at rate of 1 g every hour. Recurrent seizures may require an
additional IV bolus of 2-4 g (4 g if body weight over 70 kg)
Precautions:
Impaired renal function and those receiving digitalis glycosides. Pregnancy and lactation. Product
contains aluminum therefore increasing the risk of aluminum toxicity
Adverse Reactions:
Hypotension, flushing, sweating, depression of reflexes, flaccid paralysis, hypothermia, circulatory
collapse, depression of cardiac function, central nervous system depression, abnormal ECG, heart
block, hypotension, vasodilatation, blood coagulation disorder with prolonged bleeding time
Contraindications:
Heart block, myocardial damage
Interactions:
Additive central depressant effects with central nervous system depressants. Neuromuscular
blocking agents, cardiac glycosides, nifedipine
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286
Precautions:
Take care to ensure correct dose to infants, monitor plasma calcium and creatinine during dosage
titration
Adverse Reactions:
Hypercalcaemia, nausea, vomiting, polydipsia, polyuria
Contraindications:
Hypercalcaemia, metastatic calcification, vitamin D toxicity and hypersensitivity to calcitriol products
Interactions:
Antiepileptics, diuretics, barbiturates
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287
Ascorbic Acid 100 mg Tablet C
Indication :
Vitamin C deficiency
Dosage :
ADULT: 100-250 mg once or twice daily CHILD: 100 mg three times daily for one week followed by
100mg daily until symptoms abate.
Precautions:
Use cautiously in patients with preexisting kidney stone disease, erythrocyte G6PD deficiency,
haemochromatosis, thalassaemia or sideroblastic anaemia and avoid rapid intravenous injections
Adverse Reactions:
In large doses, gastrointestinal disturbances, renal calcium oxalate calculi formation
Contraindications:
History of hyperoxaluria
Interactions:
Antacids, aspirin, contraceptives combination, cyanocobalamin, deferoxamine, gentamicin,
haloperidol, iron, levodopa, methotrexate, warfarin
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288
Precautions:
Monitor serum calcium, phosphorus, magnesium and alkaline phosphatase, urinary calcium and
phosphorus. Patients on digitalis. Pregnancy and lactation.Take care to ensure correct dose to
infants, monitor plasma calcium and creatinine during dosage titration
Adverse Reactions:
Hypercalcaemia, nausea, vomiting, polydipsia, polyuria, weakness, headache, somnolence, dry
mouth, constipation, muscle pain, bone pain, metallic taste
Contraindications:
Hypercalcaemia, metastatic calcification, vitamin D toxicity and hypersensitivity to calcitriol products
Interactions:
Cytochrome P450 effect. Cholestyramine, thiazides diuretics, corticosteroids, magnesium-containing
antacids, digitalis
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Cyanocobalamin 1 mg Injection B
Indication :
i) Prophylaxis of anaemia associated with Vitamin B12 deficiency ii) Uncomplicated pernicious
anaemia or Vitamin B12 malabsorption
Dosage :
i) Prophylaxis of anaemia: 250-1000 mcg IM every month ii) Uncomplicated pernicious anaemia or
Vitamin B12 malabsorption: Initial 100 mcg daily for 5-10 days followed by 100-200 mcg monthly
until complete remission is achieved. Maintenance: 100 mcg monthly. CHILD 30-50 mcg daily for 2 or
more weeks (to a total dose of 1-5mg). Maintenance: 100 mcg monthly to sustain remission
Precautions:
Hereditary optic atrophy, vitamin B12 therapy can mask folic acid deficiency, hypokalaemia and risk
of gastric cancer is higher in patients with pernicious anaemia
Adverse Reactions:
Diarrhoea, urticaria, pruritus, skin rash, hypokalaemia, polycythemia vera, volume overload
Contraindications:
Hypersensitivity to any component of cyanocobalamin or hydroxycobalamin formulations
Interactions:
Neomycin, aminosalicylic acid, histamine H2 receptor antagonists, colchicine, oral contraceptives,
chloramphenicol
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Multivitamin Injection B
Trade Name : Parentrovite
Indication :
For prevention and treatment of vitamin deficiencies
Dosage :
Initially 2 - 4 pairs IV 4 - 8 hourly, reducing to 1 pair IV daily. For less serious cases, 1 pair IV 1 - 2
times daily or based on individual requirements
Precautions:
Severe renal or liver failure
Adverse Reactions:
Hypervitaminosis, high doses may induce paraesthesia and hypotension
Contraindications:
Hypersensitivity to product components
289
Interactions:
Pyridoxine will antagonise the therapeutic effect of levodopa (should not be administered
concurrently), vitamin B6 reduces the plasma levels of phenobarbitone and phenytoin, ascorbic acid
increases plasma level of ethinyloestradiol
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Multivitamin Syrup C
Indication :
For prevention and treatment of vitamin deficiencies
Dosage :
CHILD 5 ml daily or based on manufacturer
Precautions:
Severe renal or liver failure
Adverse Reactions:
Hypervitaminosis
Contraindications:
Hypersensitivity to product components
Interactions:
Pyridoxine will antagonise the therapeutic effect of levodopa (should not be administered
concurrently), vitamin B6 reduces the plasma levels of phenobarbitone and phenytoin, ascorbic acid
increases plasma level of ethinyloestradiol
--------------------------------------------------------------------------------------------------------------------------------------
Multivitamin Tablet B
Indication :
For prevention and treatment of vitamin deficiencies
Dosage :
1 - 2 tablets daily or based on individual requirements
Precautions:
Severe renal or liver failure
Adverse Reactions:
Hypervitaminosis
Contraindications:
Hypersensitivity to product components
Interactions:
Not known
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290
Adverse Reactions:
Peripheral sensory neuropathy, hypotonia, respiratory difficulties, nausea and other gastrointestinal
complaints, photosensitivity, vesicular lesions and bullous lesions
Contraindications:
Hypersensitivity to pyridoxine or any component of preparation
Interactions:
Levodopa, penicillamine, selegiline, phenytoin
--------------------------------------------------------------------------------------------------------------------------------------
Riboflavine 3 mg Tablet C
Indication :
For prevention and treatment of riboflavine deficiency
Dosage :
CHILD: 2.5-10 mg/day in divided doses. ADULT: 5-30 mg/day in divided doses
Precautions:
Riboflavin deficiency often occurs in the presence of other vitamin B deficiencies. High content of
riboflavin and pyridoxine in some commercial infant formula
Adverse Reactions:
Urine discoloration
Contraindications:
Hypersensitivity to riboflavin products
Interactions:
Decreased absorption with probenecid
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291
Precautions:
Use with caution with parenteral route (especially IV) of administration
Adverse Reactions:
Pain on injection, contact dermatitis, chronic pigmented purpura
Contraindications:
Hypersensitivity to thiamine or any component
Interactions:
Alkaline solutions, bicarbonates, carbonates, citrates, erythromycin lactobionate, iron salts,
methohexital, neutral solutions, alkaline barbiturate solutions (eg phenobarbital, thiopental)
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292
Precautions:
Photolysis. Repeated injection at the same site should be avoided. Care should be exercised when
administering to neonates, premature infants, infants and children. The course of nerves should be
avoided for the site of injection. If the patient complaints of pain or if blood reflux occurs when the
needle is stuck, withdraw it immediately and try at a different site
Adverse Reactions:
Pain and induration at site of injection, headache, sweating or hot sensation
Contraindications:
Not known
Interactions:
High vitamin B6 dose decreases action of Levodopa
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293
Vitamin K1 10 mg/ml Injection B
Trade Name : Konakion
Indication :
Haemorrhage associated with hypoprothrombinaemia caused by overdose of anticoagulants
Dosage :
0.5 - 20 mg by very slow IV at a rate not exceeding 1 mg per minute
Precautions:
IV or IM administration only when necessary (risk of anaphylaxis). Hypersensitivity reactions possible
even at first administration. The anticoagulant action of heparin not counteracted by
phytomenadione Vitamin K. Reduce dose in elderly, liver impairment
Adverse Reactions:
Anaphylactic reactions during intravenous administration, dermatitis at injection site, haemolytic
anaemia
Contraindications:
Hypersensitivity to Vitamin K, menadione (K3) administration in glucose-6-phosphate
dehydrogenase deficiency
Interactions:
Decreases the effects of oral anticoagulants, fatty foods
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294
Dosage :
25 mg/kg 3 times a day for total daily dose of 75 mg/kg. Doses greater 100 mg/kg are not
recommended
Precautions:
In case of persistent arthropathy, deferiprone therapy should be discontinued. Monitor neutrophil
counts weekly. Interrupt therapy if patient develops an infection
Adverse Reactions:
Genotoxicity, neutropenia, agranulocytosis, tachycardia, vasculitis, weight gain, zinc deficiency,
abdominal pain, urine discoloration, hepatotoxicity, visual impairment, joint problems, ototoxicity
and skin rash
Contraindications:
Severe liver dysfunction, existing neutropenia, agranulocytosis, pregnancy and lactation
Interactions:
Aluminium containing antacids. Due to the risk of additive toxicity, use with drugs that may cause
neutropenia or agranulocytosis is not recommended
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295
Dosage :
i) ADULT by IV injection over 1-5 minutes, initially 50 units/kg 3 times weekly adjusted according to
response in step of 25 units/kg 3 times weekly at interval of at least 4 weeks. CHILD initially as for
adult. Maintenance, bodyweight under 10 kg usually 75-150 units/kg 3 times weekly, bodyweight
10-30 kg usually 60-150 units/kg 3 times weekly, bodyweight over 30 kg usually 30-100 units/kg 3
times weekly ii) ADULT by SC injection (max. 1 ml per injection site), initially 150 units/kg 3 times
weekly, increased if appropriate rise in haemoglobin not achieved after 4 weeks to 300 units/kg 3
times weekly. Discontinue if inadequate response after 4 weeks at higher dose
Precautions:
To minimize the risk of hypertension, the rate of increase in haemoglobin should not exceed 2
g/dL/month. Measure haemoglobin levels once weekly until levels stabilise and periodically
thereafter, more frequent monitoring should be done in patients with a baseline haemoglobin of
more than 14 g/dL. History of seizures, gout, porphyria. Conditions associated with thrombotic or
vascular events, hepatic dysfunction. Monitor platelet count during first 8 week of therapy. Evaluate
ferrous stores during therapy. Ferrous substitution is recommended for patients whose serum
ferritin levels are 15 g/dL. Ischaemic heart disease, chronic heart failure. Pregnancy and lactation
Adverse Reactions:
Dizziness, drowsiness, headache, arthralgia, myalgia, increased blood pressure, hypertensive crisis,
thrombocytosis, skin reactions at injection site (SC). Hyperkalaemia, hyperphosphataemia, increased
BUN and uric acid, increased creatinine (especially in chronic renal failure patients)
Contraindications:
Uncontrolled hypertension. In elective surgery patients not participating in an autologous blood pre-
donation programme who have severe coronary, peripheral, arterial, carotid or cerebrovascular
diseases including patients with recent myocardial infarction or cerebrovascular accident
Interactions:
Potentiated by hematinic agents. Dose adjustment required if given together with ciclosporin
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296
Ferrous Fumarate 200 mg Tablet C
Indication :
Prevention and treatment of iron-deficiency anaemias
Dosage :
Prophylactic 200 mg daily. Therapeutic 200 mg 2 times daily. CHILD up to 6 years 80-140 mg 2 times
daily
Precautions:
Avoid in patients with peptic ulcer, enteritis, receiving frequent blood transfusions or ulcerative
colitis. Administration of iron for more than 6 months should be avoided except in patients with
continuous bleeding or menorrhagia
Adverse Reactions:
Abdominal cramps, nausea, vomiting, diarrhoea or constipation, dark stools, heartburn, temporary
teeth staining and discolouration of urine
Contraindications:
Haemochromatosis, haemolytic anaemia, known hypersensitivity to iron salts
Interactions:
Concurrent administration with Vitamin C increases absorption of oral iron. Given with tetracycline,
decreased tetracycline and iron effectiveness. Fluoroquinolones, levodopa, methyldopa,
penicillamine, antacids, H2 blockers, proton pump inhibitors, chloramphenicol. Dairy foods,
decreased iron bioavailability. Aluminium, calcium or magnesium containing products, decreased
iron effectiveness
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297
Precautions:
Anaphylaxis has occurred with parenteral iron dextran. Patients with history of allergic disorders,
asthma, rheumatoid arthritis, inflammatory disorders such as lupus erythematosus
Adverse Reactions:
Anaphylactic reactions, chest pain, hypertension, urticaria, pruritus, rash, abdominal pain, nausea,
vomiting, diarrhoea, leucocytosis, arthralgias, arthritis, convulsions, seizures, headache, respiratory
arrest, dyspnoea, haematuria
Contraindications:
Haemachromatosis, haemosiderosis, haemolytic anaemia and all anaemias other than iron
deficiency anaemia, hypersensitivity to product or any of its components and parenteral preparation
is not for subcutaneous administration
Interactions:
Mycophenolate mofetil, decreased mycophenolate mofetil efficacy. Chloramphenicol, decreased
iron effectiveness
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298
17. RHEUMATOLOGY
Antirheumatic
Gout
Drugs used in neuromuscular disorders
Drugs for the relief of soft-tissue inflammation
Miscellaneous rheumatology
299
Celecoxib 200 mg Capsule A*
Trade Name : Celebrex
Indication :
i) Osteoarthritis ii) Rheumatoid Arthritis iii) Acute pain iv) Ankylosing Spondylitis
Dosage :
i) ADULTS: 200 mg once daily. CHILD not recommended ii) 100mg twice daily, increased if necessary
to 200 mg 2 times daily; CHILD not recommended iii) 400mg as a single dose on first day followed by
200mg once daily on subsequent days iv) Initial, 200 mg once daily or 100 mg twice daily; if no effect
after 6 weeks, may increase to max. 400 mg daily in 1-2 divided doses. If no response following 2
weeks of treatment with 400 mg/day, consider discontinuation and alternative treatment.
Precautions:
Hypertension, cardiac conditions, liver/renal dysfunction, elderly, fluid retention, children,
asthmatic, coagulation defects, pregnancy (third trimester).
Adverse Effects:
GI disorders, flatulence, insomnia, pharyngitis, sinusitis, dizziness, vertigo, hearing disturbance,
photosensitivity, blood disorder, fluid retention, renal failure, hepatic impairment, Steven-Johnson
syndrome, allergic reactions, chest pain, oedema, hot flushes, flu-like symptoms. Gastric side effects
are lesser with this drug as compared to other NSAIDs.
Contraindications:
Hypersensitivity to celecoxib, allergic-type reaction to sulphonamides, aspirin or other nonsteroidal
anti-inflammatory agents, ischaemic heart disease and stroke patient.
Interactions:
Diuretics, anti-coagulants, sulphonylureas, captopril, phenytoin, digoxin, fluconazole, lithium,
antacids, aspirin, glucocorticoids, warfarin.
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Etoricoxib 60 mg Tablet A*
Etoricoxib 90 mg Tablet A*
Etoricoxib 120 mg Tablet A*
Trade Name : Arcoxia
Indication :
i)Acute and chronic treatment of signs and symptoms of osteoarthritis (OA) and rheumatoid arthritis
(RA) ii)Acute gouty arthritis iii)Acute pain
Dosage :
i) OA: 60 mg once daily. RA: 90 mg once daily ii & iii) Acute gouty arthritis and acute pain: 120 mg
once daily (Given the exposure to COX-2 inhibitors, doctors are advised to use the lowest effective
dose for the shortest possible duration of treatment)
Precautions:
Bleeding disorders, liver disease, renal impairment , hypertension, recent myocardial infarct,
cardiovascular disease, hyperlipidaemia, diabetes, smoking, peripheral arterial disease.
Adverse Effects:
Small increase in blood pressure, increased risk of thrombotic complication, headache, dizziness,
fatigue, insomnia, nausea, vomiting, diarrhoea, heartburn, taste disturbance, decreased appetite
and flatulence.
Contraindications:
Patients who experienced asthma, urticaria or allergic type of reaction after taking aspirin or NSAIDs,
acute peptic ulcer, severe renal or hepatic disease,ischaemic heart disease and stroke, hypertensive
patient whose blood pressure is not under control.
Interactions:
Warfarin, ACEIs, lithium, methotrexate, oral contraceptives, rifampicin, aspirin, SSRIs.
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Hydroxychloroquine Sulphate 200 mg Tablet A
Trade Name : Plaquenil
Indication :
i) SLE and mixed connective tissue disease for skin, joint and serosa ii) Second line therapy for acute
rheumatoid arthritis
Dosage :
i) Initially 400 mg daily in divided dose. Maintenance : 200 - 400 mg daily ii) ADULT : 400 - 600 mg
daily. Maintenance: 200 - 400 mg daily. CHILD : up to 6.5 mg/kg daily (maximum 400mg daily)
Precautions:
Liver disease, alcoholism or concurrent administration with known hepatotoxic drugs. G6PD
deficiency, renal impairment or metabolic acidosis, patients with psoriasis or porphyria,
haematologic disorders. If patient develops pigmentary abnormality or visual field defect,
discontinue drug.
Adverse Effects:
Gastrointestinal disturbances, nausea, vomiting and diarrhea, headache, skin reactions, bleaching of
hair, alopecia, blurred vision, difficulty in focusing, blood dyscrasias, drug-induced myopathy,
disorder of cornea, cardiovascular: Torsades de pointes, agranulocytosis, retinopathy, ototoxicity
(rare).
Contraindications:
Pre-existing maculopathy, pregnancy, hypersensitivity to 4-aminoquinoline compound, long-term
use in children, retinal or visual field changes from prior 4-aminoquinoline compound.
Interactions:
Digoxin - increase level, metoprolol.
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Leflunomide 10 mg Tablet A*
Trade Name : Arava
Indication :
i) Persistent active rheumatoid arthritis ii) Active psoriatic arthritis
Dosage :
Loading dose: 100 mg once daily for 3 days. Maintenance: 10-20 mg once daily
Precautions:
Patients who are taking other drugs that can cause liver injury. Liver enzymes should be monitored
at least monthly for three months after starting leflunomide and at least quarterly thereafter. If the
alanine aminotransferase (ALT) rises to greater than two times the upper limit of normal while the
patient is on leflunomide, leflunomide should be stopped, cholestyramine washout begun to speed
the removal of leflunomide from the body and follow-up liver function tests conducted at least
weekly until the ALT value is within normal range. Renal impairment, anaemia, leucopenia,
thrombocytopenia, history of tuberculosis.
Adverse Effects:
Gastrointestinal disturbances, anorexia, oral mucosa ulceration, elevation of liver parameters,
headache, dizziness, paraesthesias, increase blood pressure, weight loss, increase hair loss, eczema,
dry skin, mild allergic reactions, leucopenia, mild hyperlipidaemia. Rarely, Stevens-Johnson
syndrome, toxic epidermal necrolysis, erythema multiforme.
Contraindications:
Patients with pre-existing liver disease. Patients with elevated liver enzymes (alanine
aminotransferase greater than two times the upper limit of normal). Severe immunodeficiency state,
serious infection, severe hypoproteinaemia, pregnant women or women of childbearing potential
who are not using reliable contraception, lactation, significantly impaired bone marrow function or
significant anaemia, leucopenia, neutropenia or thrombocytopenia.
301
Interactions:
Other antirheumatic or immuno-suppressive agents, alcohol, phenytoin, warfarin, tolbutamide.
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302
Allopurinol 300 mg Tablet B
Trade Name : Zyloric
Indication :
Gout or uric acid and calcium oxalate renal stones
Dosage :
Initial dose : 100-300 mg daily. Maintenance : 300-600 mg daily. Maximum: 900 mg daily
Precautions:
Renal/hepatic dysfunction, asymptomatic hyperuricaemia, Hypersensitivity and pregnancy.
Adverse Effects:
Skin rash, maculopapular, pruritic, Stevens-Johnson Syndrome, peripheral neuritis, alopecia, GI
upset, toxic epidermal necrolysis. Acute attack of gouty arthritis in early stages of therapy. Skin
reactions (discontinue immediately at first sign of rash). Very rarely, granulomatous hepatitis.
Occasionally; thrombocytopenia, agranulocytosis, & aplastic anaemia in patients with impaired renal
function.
Contraindications:
Hypersensitivity to allopurinol, pregnancy, lactation, acute gout, asymptomatic hyperuricaemia.
Interactions:
Oral anticoagulants, azathioprine, antidiabetics, mercaptopurine.Use only quarter of the usual dose
of 6-mercaptopurine or azathioprine when given concurrently. Increases plasma half-life of adenine
arabinoside. Effects decreased by uricosurics & large doses of salicylates.
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Prolase Tablet B
Trade Name : Papase
Indication :
Oedema and inflammation in conjunction with other physical or chemotherapeutic measures
Dosage :
2 tablet 4 times daily
Precautions:
Renal or hepatic dysfunction and pregnancy.
Adverse Effects:
Skin rash, vertigo and gastrointesinal upsets.
Contraindications:
303
Blood clotting disease.
Interactions:
No known.
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304
18. OPHTHALMOLOGY
Anti-infective eye preparations
Anti-infective with steroids
Corticosteroids
Corticosteroids and other anti-inflammatory preparations
Antiviral
Mydristics and cycloplegics
Treatment of glaucoma
Local anaesthetics
Miscellaneous ophthalmology
305
Amphotericin B 0.15% Eye Drops A
Indication :
Fungal infection of the cornea
Dosage :
1 drop hourly or 2 hourly
Precautions :
Renal impairment.
Adverse Effects :
Nausea and vomiting, anaemia, thrombocytopenia.
Contraindications :
Hypersensitivity to Amphotericin B.
Interactions :
Cyclosporin, digitalis glycosides, non-depolarizing neuromuscular blockers.
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306
Ciprofloxacin HCl 0.3% Ophthalmic Solution A*
Trade Name : Ciloxan
Indication :
i)For corneal ulcer
ii) For bacterial conjunctivitis
Dosage :
i) 2 drops every 15 minutes for first 6 hours, then 2 drops every 30 minutes for the rest of the day.
Second day : 2 drops every hour. Subsequent days (3rd - 14th day) : 2 drops every 4 hours.
ii) 1 - 2 drops 2 hourly into the conjunctival sac while awake for 2 days and 1-2 drops 4 hourly while
awake for the next 5 days
Precautions :
Prolonged use may result in overgrowth of nonsusceptible organisms. Discontinue use at first
appearance of skin rash or other sign of hypersensitivity reactions. Children less than 1 year
Adverse Reactions :
Local burning or discomfort, itching, lid oedema, tearing, white crystalline precipitates which resolve
Contraindications :
History of hypersensitivity to ciprofloxacin or other quinolones
Interactions :
Not known
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307
Adverse Effects :
Non-specific conjunctivitis, conjunctival epithelial defect and hyperemia, temporary burning
sensation (rare), irritation, stinging, itching and dermatitis,hypokalemia, hypomagnesemia,
hypocalcemia.
Contraindications :
Hypersensitivity to Gentamicin or aminoglycosides products.
Interactions :
Not known.
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308
Moxifloxacin 0.5% Ophthalmic Solution A*
Trade Name : Vigamox
Indication :
Treatment of conjunctivitis caused by susceptible organism
Dosage :
CHILD more than 1 year and ADULT: 1 drop to affected eye(s) 3 times daily for 7 days
Precautions :
Not to be injected subconjuctivally or introduced directly to the anterior chamber of the eye,
prolong use, pregnancy and lactation.
Adverse Effects :
Conjunctivitis, decreased visual acuity, dry eye, keratitis, ocular discomfort, hyperemia, pain and
pruritus, subconjunctival hemorrhage, tearing.
Contraindications :
Hypersensitivity to moxifloxacin and quinolone.
Interactions :
Warfarin, concomitant use with QT prolonging agents (eg. Class 1a and class III antiarrythmic,
erythromycin, cisapride, antipsychotic, cyclic antidepressant), antacid, sucralfate.
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309
Contraindications :
Hypersensitivity to its component, viral, fungal, tuberculosis and other infections of the eye.
Interactions :
Not known.
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Antazoline HCl, Tetrahydrozoline HCl and Benzalkonium Cloride Eye Drops A/KK
Trade Name : Spersallerg
Indication :
Hay fever, conjunctivitis, allergic conjunctivitis, vernal keratoconjunctivitis and eczematosa
Dosage :
ADULT : Instill 1 drop, 3 - 4 times daily, into the lower eyelid. CHILD 2 - 12 years : Instill 1 drop daily
or twice daily
Precautions :
Transient irritation may occur immediately after instillation.
Adverse Effects :
Mild burning sensation, headache, and sleepiness, tachycardia, blurred vision.
Contraindications :
Hypersensitivity to any of the components of product, dry eyes; especially keratoconjunctivitis sicca,
risk of narrow angle glaucoma, receiving monoamine oxidase inhibitors or within 14 days of its
treatment, children under two years of age; due to the greater incidence of systemic absorption and
effects.
Interactions :
Not known.
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310
Adverse Effects :
Burning or stinging, ocular irritation, unpleasant taste, blurred vision, increased intra-ocular
pressure, glaucoma, cataract, corneal thinning.
Contraindications :
Hypersensitivity to its component, ocular viral or fungal or tuberculosis infection, contact lense use.
Interactions :
Not known.
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311
Precautions :
May impair ability to drive or operate machinery
Adverse Effects :
Mild tachycardia, secretion decrease and action on the CNS, blurred vision, increased intraocular
pressure, allergic reactions
Contraindications :
Narrow-angle glaucoma
Interactions :
Cyclopentolate may interfere with antiglaucoma action of carbachol or pilocarpine
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312
Contraindications :
Narrow-angle glaucoma, infant, elderly with severe arteriosclerotic, cardiovascular or
cerebrovascular disease. During intraocular operative procedures when corneal epithelial barrier is
disturbed. Not recommended for use in low birth weight infants.
Interactions :
Tricyclic antidepressants, propranolol.
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313
Acetazolamide 500 mg Injection B
Trade Name : Diamox
Indication :
Reduction of intra-ocular pressure in open-angle glaucoma, secondary glaucoma and peri-
operatively in angle-closure glaucoma
Dosage :
250 - 500 mg given by IM or IV
Precautions :
Not generally recommended for prolonged use but if given monitor blood count and plasma
electrolyte concentration, pulmonary obstruction (risk of acidosis), elderly, pregnancy and lactation,
Stevens-Johnson syndrome, toxic epidermal necrosis, high-dose aspirin, high dose may decrease
diuresis and may increase drowsiness, pulmonary obstruction or emphysema.
Adverse Effects :
Nausea, vomiting, diarrhoea, taste disturbances, loss of appetite, paraesthesia, flushing, headache,
dizziness, fatigue, irritability, depression, thirst, polyuria, reduced libido, metabolic acidosis and
electrolyte disturbances on long-term therapy.
Contraindications :
Hypokalaemia, hyponatraemia, hyperchloraemic acidosis, severe hepatic impairment, renal
impairment, sulphonamide hypersensitivity.
Interactions :
Aspirin, cyclosporin, digitalis , digoxin, lithium, phenytoin, quinidine, topiramate.
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314
Adverse Effects :
Oral dryness, ocular hyperemia, burning and stinging, headache, blurring, foreign body sensation,
fatigue, drowsiness, conjunctival follicles, ocular pruritus.
Contraindications :
Hypersensitivity to brimonidine, concomitant MAOI therapy.
Interactions :
Alcohol, sedative, barbiturates, opiates, anaesthesia, tricyclic antidepressant, beta blocker,
antihypertensive.
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315
Adverse Effects :
Slight discomfort, mild to moderate conjunctival hyperaemia, transient punctate ephitelial erosions,
increased pigmentation of iris, rash.
Contraindications :
Known hypersensitivity to any component of the products.
Interactions :
Effects additive to beta-adrenergic antagonist, adrenergic agonists, carbonic anhydrase inhibitors
and cholinergic agonists. Other eye preparation containing thiomersal.
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316
Interactions :
Cathecolamine-depleting drugs. Concurrent administration of oral or systemic beta-adrenergic
blockers. Concurrent use of beta-blockers and digitalis with diltiazem or verapamil may have additive
effects in prolonging atrioventricular conduction time. Quinidine.
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317
Precautions :
Self-prescribed use as an ocular lubricant should not exceed 3 days, avoid contamination of
the applicator tip through contact, remove viscoelastic solutions form the anterior chamber at
the end of the surgical procedure, treat emergent elevations of intraocular pressure
Adverse Effects :
Increases in intraocular pressure, blurred vision
Contraindications :
Hypersensitivity to hydroxypropyl methylcellulose
Interactions :
Not known
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318
Sodium Chloride 0.9% Eye Drops C
Indication :
Irrigation of conjunctival sac
Dosage :
1 - 2 drops every 3 - 4 hours
Precautions :
Not known
Adverse Effects :
Can cause temporary burning and irritation
Contraindications :
Hypersensitivity
Interactions :
Not known
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319
19. EAR, NOSE AND OROPHARYNX
Ear preparations
Nose preparations
Oropharynx preparations
Antihistamies, hyposensitisation and allergic emergencies
Mucolytics
Aromatic inhalations
Cough preparations
Systemic nasal decongestants
Miscellaneous ear, nose and oropharynx
320
Betamethasone Disodium Phoshate 0.1% Ear Drops B
Betamethasone Disodium Phoshate 0.5% Ear Drops B
Trade Name : Betnesol
Indication :
Non-infected inflammatory conditions
Dosage :
Apply 2 - 3 drops every 2 - 3 hours, reduce frequency when relief obtained
Precautions :
Prolonged use in infants, pregnancy, may result in secondary fungal infections.
Adverse Reactions :
Local sensitivity reactions.
Contraindications :
Viral, fungal, tuberculosis, purulent eye infection, glaucoma, herpetic keratitis, otitis media, history
of perforation of the ear drum.
Interactions :
As general with other corticosteroids.
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Framycetin Sulphate 0.5%, Dexamethasone 0.05% and Gramicidin 0.005% Ear Drops A/KK
Trade Name : Sofradex
Indication :
Otitis externa
Dosage :
Apply 2 - 3 drops 3 to 4 times daily
Precautions :
Glaucoma, pregnancy, prolonged use in infants.
Adverse Reactions :
Sensitivity reactions.
Contraindications :
Herpes simplex infection, viral diseases of cornea and conjuctiva, tuberculosis and fungal diseases of
eyes, herpetic keratitis.
321
Interactions :
Can increase nephrotocixity with amphotericin, cyclosporine.
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322
Interactions :
Not known.
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323
Precautions :
Presence of untreated localized infection involving the nasal mucosa, recent nasal surgery or trauma,
pregnancy, infection e.g. tuberculosis, infection of the respiratory tract, untreated systemic fungal,
bacterial, viral or parasitic infections or ocular herpes simplex, systemic effects e.g. hypercorticism,
reduced bone mineral density and adrenal suppression, untreated systemic infections.
Adverse Reactions :
Headache, pharyngitis, cough epistaxis, viral infection, chest pain, dysmenorrhoea, vomiting, nausea,
diarrhoea, dyspepsia.
Contraindications :
Severe nasal infections especially candidiasis, patients with haemorrhagic diathesis or a history of
recurrent nasal bleeding, fungal, viral or tubercular skin lesions, herpes simplex or zoster,
hypersensitivity to mometasone or other corticosteroids, status asthmaticus or other acute episodes
of asthma (oral inhalation).
Interactions :
CYP3A4, amphotericin, antidiabetic agents, antifungal agents (imidazole), diuretics, potassium-
wasting (loop or thiazide), fluoroquinolones.
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324
After local use of oxymetazoline transient irritation may occur. Rebound congestion may occur after
frequent or prolonged nasal use. Systemic effects have occurred after local administration, burning,
sneezing, nasal dryness, hypertension.
Contraindications :
Skin and mucosal inflammation of the nasal vestibules with incrustation, narrow angle glaucoma,
hypersensitivity to oxymetazoline or other adrenergic agents.
Interactions :
Anticholinergic, beta blockers, linezolid, methylphenidate, tricyclic antidepressants, hypertensive
crisis if used during treatment with MAOI.
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325
Dosage :
Apply to area 4 times daily
Precautions :
Excessive use can lead to salicylate poisoning. During therapy, do not give aspirin to children 16 year.
Co-administration with drugs for blood clots and gout. Stomach ulcer. Pregnancy.
Adverse Reactions :
Not known.
Contraindications :
Infants less than 4 months or in patients with a history of salicylate sensitivity. Preparations
containing aspirin should not be given to young children during treatment to avoid any risk of
excessive salicylate levels.
Interactions :
Not known.
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Glycerin B
Indication :
As a lubricant and osmotic dehydrating agent
Dosage :
Apply to area when required
Precautions :
Cause irritation when given locally, local anesthetic may be used before application
Adverse Reactions :
Mainly due to dehydration action, irritation
Contraindications :
Not known
Interactions :
Not known
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326
Precautions :
Tuberculosis, peptic ulcer, diabetes mellitus, pregnancy.
Adverse Reactions :
Prolonged use may lead to possible absorption.
Contraindications :
Hypersensitivity to any of its components, fungal or bacterial infections of the mouth or throat,
herpetic lesions of known viral origin or intraoral lesions.
Interactions :
Minor interaction with hypoglycaemic agents.
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327
Chlorpheniramine Maleate 2 mg/5 ml Syrup C
Trade Name : Piriton
Indication :
Symptomatic treatment of allergic conditions responsive to antihistamine
Dosage :
CHILD 1 - 2 years : 1 mg twice daily, 2 - 5 years : 1 mg every 4 - 6 hours (maximum 6 mg daily), 6 - 12
years : 2 mg every 4 - 6 hours (maximum 12 mg daily)
Precautions :
Porphyria, pregnancy, asthma, glaucoma, avoid operating vehicles or machinery.
Adverse Reactions :
Drowiness, dizziness, hypotension, CNS stimulation, tinnitus, blurred vision, irritability, lassitude.
Contraindications :
Hypersensitivity to chlorpheniramine.
Interactions :
Alcohol pontentiate CNS depressants, actions prolonged by MAOIs, anticholigernic drugs.
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Desloratadine 5 mg Tablet A*
Trade Name : Aerius
Indication :
Allergic rhinitis and chronic idiopathic urticaria
Dosage :
ADULT & CHILD more than 12 years : 5 mg once daily. CHILD: 6-11 yr: 2.5 mg; 1-5 yr: 1.25 mg; 6-11
mth: 1 mg. Doses to be taken once daily
Precautions :
Phenylketonuric patient, severe renal or hepatic failure; children less than 6 month, elderly,
epilepsy, preg-nancy and lactation.
Adverse Reactions :
Fatigue, headache and dry mouth.
Contraindications :
Hypersensitivity to desloratadine or loratadine.
328
Interactions :
Amphetamines, alcohol, betahistine, CNS depressants, acetylcholinesterase Inhibitors.
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329
Loratadine 1 mg/ml Syrup A
Trade Name : Clarityne
Indication :
Allergic rhinitis, chronic urticaria and other allergic dermatological disorders
Dosage :
ADULT and CHILD over 6 years : 10 mg once daily. CHILD 2 - 6 years: 5 mg once daily
Precautions :
Impaired liver and renal function (use lower dose). Should not take with alcohol and avoid operating
vehicle and machinery.
Adverse Reactions :
Headache, nervousness, sedation.
Contraindications :
Hypersensitivity to loratadine.
Interactions :
Cimetidine, erythromycin, ketoconazole and other hepatic enzyme inhibitors.
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Loratadine 10 mg Tablet B
Trade Name : Clarityne
Indication :
Allergic rhinitis and allergic dermatoses
Dosage :
ADULT and CHILD over 6 years 10 mg once daily. CHILD 2 - 6 years: 5 mg once daily
Precautions :
Impaired liver and renal function (use lower dose). Should not take with alcohol and avoid operating
vehicle and machinery.
Adverse Reactions :
Headache, sedation, nervousness.
Contraindications :
Hypersensitivity to loratadine.
Interactions :
Cimetidine, erythromycin, ketoconazole and other hepatic enzyme inhibitors.
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330
Interactions :
Loratadine is metabolised by cytochrome P450 isoenzymes CYP3A4 and CYP2D6. Therefore
concomitant administration of other drugs that inhibit or are metabolised by these hepatic enzymes
may result in changes in plasma concentrations of either drug, bromocriptine, hydrocodone,
selegiline.
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331
Bromhexine HCl 4 mg/2 ml Injection A
Trade Name : Bisolvon
Indication :
Secretolytic therapy in acute and chronic bronchopulmonary diseases associated with abnormal
mucous secretion and impaired mucous transport
Dosage :
4 mg SC, IM or IV 2 - 3 times daily
Precautions :
Gastrointestinal ulceration, pregnancy and lactation.
Adverse Reactions :
Occasionally gastrointestinal effects, skin rashes very rarely. Gastrointestinal disturbances,
headache, dizziness, sweating, skin rash, transient rise in serum transaminase.
Contraindications :
Hypersensitivity to bromhexine.
Interactions :
May lead to higher antibiotic concentration in lung tissue. Oral anticoagulants.
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332
Ammonium Bicarbonate, Tincture Ipecac, etc Mixture C
Trade Name : Expect Stimulant
Indication :
Cough
Dosage :
10 - 20 ml 3 times daily
Precautions :
Can be irritant to mucous membrane.
Adverse Reactions :
If consumed in very large dose can cause nausea and vomiting.
Contraindications :
Hepatic or renal impairment.
Interactions :
Not known.
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333
Interactions :
Additive effects if use with hypnotics, sedatives, tranquilizers. Actions prolonged by MAOIs.
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334
Cinnarizine 25 mg Tablet B
Trade Name : Stugeron
Indication :
Vestibular disorders
Dosage :
One tablet 3 times daily
Precautions :
Pregnancy, Parkinson's disease. May affect ability to drive or operate machinery.
Adverse Reactions :
Gastrointestinal disturbances, epigastric pain, nausea and vomiting, tinnitus, lupus erythematosus.
Contraindications :
Avoid in porphyria.
Interactions :
Alcohol, CNS depressants.
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335
21. DERMATOLOGY
Emollient and barrier preparation
Topical local anaesthetics and antipruritics
Topical corticosteroids
Preparations for eczema and psoriasis
Acne and rosacea
Preparations for warts and calluses
Shampoos and other preparations for scalp conditions
Anti-infective skin preparations
Disinfectants, skin cleaners & antiseptics
Miscellaneous dermatology
336
Aqueous Cream C
Indication :
Dry skin
Dosage :
As a soap or apply to the skin as an emollient cream
Precautions:
It should not be used before phototherapy or in phototesting procedures
Adverse Reaction:
Not known
Contraindications:
Not known
Interactions:
Not known
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Calamine Cream C
Indication :
Prickly heat or insect bites
Dosage :
Apply to the affected area as required
Precautions:
Avoid contact with eyes and other mucous membranes
Adverse Reaction:
Rash or irritation
Contraindications:
Not known
Interactions:
Not known
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Calamine Lotion C
Indication :
Prickly heat or insect bites
Dosage :
Apply to the skin as required and allow to dry, 1-3 times daily
Precautions:
Avoid contact with eyes and other mucous membranes
Adverse Reaction:
Rash or irritation
Contraindications:
Not known.
Interactions:
Not known.
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337
Precautions:
Avoid contact with eyes and other mucous membranes. Do not use on children under 2 years
without consulting a physician
Adverse Reaction:
Rash or irritation
Contraindications:
Not known
Interactions:
Not known
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Emulsificants Ointment C
Indication :
Xerosis and ichthyosis
Dosage :
Use as a soap and emollient
Precautions:
Should not be used before phototherapy or in phototesting procedures
Adverse Reaction:
Not known
Contraindications:
Hypersensitivity to any component
Interactions:
Not known
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338
24 - 48 hours. For resistant scabies, treatment (2 applications at 24 hour interval) may be repeated
after 1 week
Precautions:
Avoid contact with eyes, face, mouth and mucous membranes. Pregnancy. Avoid applying to
inflamed skin or raw, oozing skin surfaces. Discontinue use of crotamiton if severe skin irritation
develops
Adverse Reaction:
Local skin irritation or contact allergy
Contraindications:
Do not apply on nipples when breastfeeding, hypersensitivity to crotamiton
Interactions:
Not known
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Miconazole 2% Cream B
Trade Name : Daktarin
Indication :
i) Fungal infections: Tinea pedis, Tinea corporis, Tinea capitis and other dermatophyte infections
caused by Trichophyton and Epidermophyton species ii) Antifungal agent that has been in various
candida infections including vaginal candidiasis
Dosage :
i) Skin Infection: Apply sparingly and rub gently onto affected area 1-2 times daily continuing for 10
days after lesions have healed ii) Apply twice daily continuing for 10 days after lesions have healed
Precautions:
First trimester of pregnancy, lactation. Local sensitization or irritation, to discontinue use
Adverse Reaction:
Ocassional skin irritation or sensitivity, contact dermatitis, vaginal burning due to cream base
Contraindications:
Children less than 2 year. Hypersensitivity to manizole products
Interactions:
Not known
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339
Interactions:
Not known
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340
Precautions:
Infants and children, prolonged and continuous use, pregnancy. Discontinue if secondary infection
develops, avoid prolonged application to face
Adverse Reaction:
Hypersensitivity to clobetasone or other corticosteriods. Transient adrenal suppression. Pigmentary
changes and hypertrichosis
Contraindications:
Skin lesions caused by viral, fungal and bacterial infections. Hypersensitivity to clobetasone or other
corticosteroids
Interactions:
Not known
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Hydrocortisone 1% Cream B
Indication :
Inflammatory and pruritic manifestations of corticosteroid responsive dermatoses
Dosage :
Apply sparingly to affected area 2 - 3 times daily until condition improve, then reduce frequency
Precautions:
Prolonged use in infants and children, ulceration at infection site, diabetes mellitus
Adverse Reaction:
Local atrophic skin changes, impaired skin healing
Contraindications:
Fungal and bacterial infections, tuberculosis of the skin, viral disease of the skin, acne vulgaris,
rosacea, perioral dermatitis. Hypersensitivity to hydrocortisone
Interactions:
Not known
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341
Acitretin 25 mg Capsule A*
Trade Name : Neotigason
Indication :
Generalised pustular and or erythrodermic psoriasis, pityriasis rubra pilaris, Darier's Disease,
Icthyosiform Erythrodermas - Bullous and non-bullous forms, extensive naevus verrucosus, extensive
psoriasis
Dosage :
ADULT: initially 25-30 mg daily for 2-4 weeks, then adjusted according to response, usually within
range 25-50 mg daily for further 6-8 weeks (max: 75 mg daily). CHILD: 500 mcg/kg daily occasionally
up to 1 mg/kg daily to a max. 35 mg daily for limited periods
Precautions:
Long-term treatment, diabetes, obesity, alcoholism, disturbances of lipid metabolism
Adverse Reaction:
Symptoms of hypervitaminosis A, localized but reversible hair loss, thinning and scaling of the skin,
paronychia, muscle and joint pain
Contraindications:
Pregnancy and lactation, liver and kidney insufficiency, hypervitaminosis A, excessively elevated
blood lipid values
Interactions:
Oral contraceptives, progestogen may result in loss of contraceptive effectiveness. Ethanol may
result in a prolonged risk of teratogenicity. Possible hypervitaminosis with vitamin A. Reduces
protein binding of Phenytoin
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342
Precautions:
Should not be used on the face since the ointment formulation may give rise to irritation of the facial
skin. Careful handwashing after use is recommended
Adverse Reaction:
Transient local irritation and very rarely, facial dermatitis may occur, hypercalcaemia
Contraindications:
Hypersensitivity to any constituents of the calcipotriol. Disorders of calcium metabolism
Interactions:
Not known
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Carbamide (Urea) 10 % Cream B
Trade Name : Calmurid
Indication :
Contact irritant dermatitis, infantile eczemas, acute and chronic allergic eczemas, icthyosis,
hyperkeratotic
Dosage :
Apply sparingly and rub into affected area 2 - 3 times daily and when required after cleansing skin
Precautions:
Avoid contact with eyes, discontinue use if oral inflammation persists or worsens. Use with caution
on inflammed skin or exudative lesions: irritation may results
Adverse Reaction:
Skin irritation, rash and ischaemic skin necrosis
Contraindications:
Hypersensitivity to urea or any component
Interactions:
Not known
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344
Interactions:
Not known
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345
Precautions:
Do not apply to acutely inflammed skin. Avoid contact with eyes, do not apply coal tar preparations
(other than bath emulsions) to genital or rectal areas
Adverse Reaction:
Skin ulcerations and hypersensitivity reactions including allergic contact dermatitis, the use of
ultraviolet light and coal tar may produce or aggravate folliculitis erythema and a smarting reaction
Contraindications:
Folliculitis and acne vulgaris, weeping eczema, erythrodermic, generalized pustular psoriasis and
photosensitivity
Interactions:
Not known
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346
Dosage :
Apply twice daily. Treatment should not exceed 6 months
Precautions:
Avoid contact with eyes. May cause hypopigmentation. Should not use with occlusive dressings or
wrappings
Adverse Reaction:
Occasionally, local skin irritation, pruritus, tingling feeling, burning or stinging
Contraindications:
Hypersensitivity to propylene glycol and azelaic acid products
Interactions:
Not known
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Isotretinoin 10 mg Capsule A*
Isotretinoin 20 mg Capsule A*
Trade Name : Roaccutane
Indication :
Only for treatment of i) Severe nodulo-cystic acne ii) Acne conglobata iii) Acne fulminans iv) Severe
acne vulgaris failing conventional treatment WARNING: THIS DRUG IS TERATOGENIC
Dosage :
Initially: 0.5 mg/kg body weight daily (in one to or two divided doses) with food once. Maintenance:
0.1 - 1 mg/kg daily body weight
Precautions:
Diabetes, obesity, alcoholism, disturbances of lipid metabolism and childbearing potential,
hepatotoxicity, inflammatory bowel disease, nursing mothers, visual problems, corneal opacities
Adverse Reaction:
Dry mucosa, dermatitis facialis, pruritus, sweating. Occasionally, reversible alopecia, muscle and
joint pain. Rarely, inflammatory bowel disease, hyperuricaemia, benign intracranial hypertension,
visual disturbances and photosensitivity reactions. Haematuria or proteinuria, hirsutism,
pancreatitis, lymphadenopathy
Contraindications:
Pregnancy and lactation. Hepatic or renal insufficiency. Hypervitaminosis A. Patients with excessively
elevated blood lipid values. Concomitant tetramycin therapy. Hypersensitivity to isotretinoin
products or paraben
347
Interactions:
Concurrent use with vitamin A intensifies symptoms of hypervitaminosis A. Doxycycline,
minocycline, tetracycline may result in pseudotumour cerebri. Ethanol - a disulfiram-like reaction.
Food - Increases its bioavailability
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Ketoconazole 2% Shampoo A
Trade Name : Nizoral
Indication :
Resistant dandruff only
Dosage :
Apply twice weekly for 2 - 4 weeks. Prophylaxis: Once every 1 - 2 weeks
Precautions:
After prolonged treatment with topical corticosteroids
348
Adverse Reaction:
Local irritation, pruritus, alopecia and photosensitivity
Contraindications:
Known hypersensitivity to ketoconazole products
Interactions:
Concurrent use with ethanol may result in a disulfiram-like reaction (flushing, vomiting, increased
respiratory rate, tachycardia)
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Acyclovir 5% Cream A*
Trade Name : Zovirax
Indication :
Herpes simplex infections of the skin, including initial and recurrent labial and genital herpes simplex
infections
Dosage :
Apply every 4 hours for 5 - 10 days
Precautions:
Application to mucous membranes, pregnancy, lactation. Should not be used in the eyes
Adverse Reaction:
Transient burning or stinging or erythema, mild drying or flaking of the skin
Contraindications:
Hypersensitivity to acyclovir or valacyclovir
Interactions:
Not known
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349
Dosage :
Apply to affected nail once or sometimes twice a week after filling and cleansing, allow to dry, treat
finger nail for 6 months, toe nail for 9 - 12 months (review at intervals of 3 months)
Precautions:
Avoid contact with eyes, previous hypersensitivity or intolerance to other topical antifungal agents
Adverse Reaction:
Slight transient burning sensation
Contraindications:
Hypersensitivity to amorolfine
Interactions:
Not known
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Clotrimazole 1% Cream B
Trade Name : Canesten
Indication :
Cutaneous candidiasis, Tinea corporis, Tinea cruris, Tinea pedis and Tinea versicolor
Dosage :
Rub in gently onto affected and surrounding skin 2 or 3 times daily continuing for about 2 weeks
beyond the dissapearance of all symptoms
Precautions:
Contact with eyes and mucous menbranes should be avoided
Adverse Reaction:
Skin reactions, contact dermatitis, pruritis
Contraindications:
Hypersensitivity to clotrimazole
Interactions:
Not known
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Interactions:
Not known
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Mupirocin 2% Ointment A
Trade Name : Bactroban
Indication :
For MRSA infections only
Dosage :
ADULT and CHILD: Apply up to three times daily for 3 - 5 days
352
Precautions:
Not for ophthalmic or intranasal use. Use with caution if there is evidence of moderate or severe
renal impairment
Adverse Reaction:
Stinging or burning, pruritus
Contraindications:
Hypersensitivity to mupirocin products
Interactions:
Avoid products with polyethylene glycol
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353
Precautions:
May exacerbate pruritus, oedema and erythema
Adverse Reaction:
Swelling, erythema, pruritus, rash, stinging of skin, burning sensation
Contraindications:
Hypersensitivity to permethrin and other synthetic pyrethrin
Interactions:
Not known
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354
Sodium Thiosulphate 10-20% Solution C
Indication :
Fungicides. For the treatment of pityriasis versicolor
Dosage :
Apply to all affected parts of the body and face with a brush after a bath once daily or twice daily or
3 times daily
Precautions:
Discontinue topical use if irritation or sensitivity occurs, rapid IV infusion has caused transient
hypotension
Adverse Reaction:
Hypotension, coma, psychosis, confusion, contact dermatitis, local irritation, neuromuscular and
skeletal weakness, tinnitus, diarrhoea (following large accidental ingestion)
Contraindications:
Hypersensitivity to sodium thiosulphate or any component of the formulation
Interactions:
Not known
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355
Cetrimide 1-2% Lotion. C
Trade Name : Cetavlon
Indication :
As shampoo and cleansing agent
Dosage :
Apply to affected area
Precautions:
Contact with the eyes, brain, meninges, and middle ear should be avoided. Cetrimide should not be
used in body cavities or as an enema
Adverse Reaction:
Cutaneous irritation and local effects
Contraindications:
Hypersensitivity to cetrimide
Interactions:
Not known
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356
Interactions:
Avoid cemented glass components
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357
Adverse Reaction:
Irritant to tissues and stain skin brown
Contraindications:
Hypersensitivity to any component
Interactions:
Not known
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358
concurrently with simvastatin. Potential risk of severe drug interactions, including death in certain
patients treated with colchicine and concomitant P-glycoprotein or strong CYP3A4 inhibitors such as
clarithromycin, ciclosporin, erythromycin, calcium channel antagonists (verapamil, diltiazem),
telithromycin, ketoconazole, itraconazole, HIV protease inhibitors and nefazodone. P-glycoprotein or
strong CYP3A4 inhibitors are not to be used in patients with renal or hepatic impairment who are
taking cochicine. A dose reduction or interruption of colchicine treatment should be considered in
patients with normal renal and hepatic function if treatment with a P-glycoprotein or a strong
CYP3A4 inhibitors required. Avoid consuming grapefruit and grapefruit juice while using colchicines
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359
Adverse Reaction:
Allergic skin reactions
Contraindications:
Hypersensitivity to any component
Interactions:
Not known
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360
22. IMMUNOLOGICAL PRODUCTS AND VACCINES
Vaccines and antisera
Immunoglobulins
361
BCG Vaccine Freeze-Dried Injection C
Indication :
For the prevention of tuberculosis
Dosage :
0.1 ml by intradermal injection. INFANT under 12 months: 0.05 ml
Precautions :
Children born to HIV positive mothers, pregnancy.
Adverse Effects :
Superficial, self healing ulceration, injection site reaction, lymphadenopathy.
Contraindications :
Congenital or acquired cell-mediated immune deficiencies (including HIV), patients with systemic
corticosteroid/ immunosuppressive treatment, malignant condition, pyrexia, generalised infected
dermatoses, organ abnormalities.
Interactions :
Not known.
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362
Meningococcal A, C, Y, W 135 Vaccine Injection B
Indication :
Immunisation against meningococcal diseases caused by Neisseria meningitis Group A, Group C,
Group Y or Group W-135
Dosage :
Prophylaxis: 0.5 ml subcutaneously
Precautions :
Infants less than 18 months have a lower rate of seroconversion to C, Y and W135.
Adverse Effects :
Temporary hyperthermia and mild erythema at injection site.
Contraindications :
Hypersensitivity to thiomersal or any component of the form.
Interactions :
Decreased effect with administration of immunoglobulin within 1 month.
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363
Tetanus Toxoid Injection C
Trade Name : ATT
Indication :
Immunization against tetanus infection
Dosage :
0.5 ml at 2 months followed by second dose after 4 weeks and third dose after another 4 weeks.
Booster every 10 years
Precautions :
Not recommended for children less than 7 years.
Adverse Effects :
Local reaction, fever, headache and malaise, brachial (cervical) neuritis, Guillain-Barre syndrome,
nausea, arthralgia, anaphylaxis, Arthus type urticaria.
Contraindications :
Hypersensitivity to any component of the vaccine, febrile illness or acute infection.
Interactions :
Chloramphenicol.
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364
Precautions :
Discontinue maintenance chemotherapy equal or less than 1 week prior to injection and
recommence therapy after equal or more than 1 week after injection. Malignant solid tumours,
women of child-bearing potential should practise adequate contraceptive measures 1 month prior to
vaccination and 2 month after vaccination. Cardiovascular, kidney, liver, haematological or
developmental abnormalities. History of seizures, diagnosed immunodeficiency states, abnormal
immune system function. Concomitant immunosupressive therapy. Vaccine may not effective in
patients receiving blood or gamma-globulin preparation within 3 month prior to vaccination. Other
live viral vaccines should only be given equal or more than 4 weeks after Okavax.
Adverse Effects :
Fever, rash, urticaria, erythema, pruritus. Rarely, local reaction, anaphylactoid symptoms.
Contraindications :
Reinforcement therapy for leukaemia or extensive therapy using strong immunosuppressives. Acute
myelogenous leukaemia or malignant lymphoma.
Interactions :
Transfusion and administration of gamma-globulin preparations: The vaccine may not be effective in
those receiving blood or gamma-globulin preparation within 3 month before vaccination.
Vaccination of such individuals should be delayed until equal or more than 3 months has elapsed.
For those receiving high dose gamma-globulin therapy, ie equal or more than 200 mg/kg, eg patients
with Kawasaki disease or acute immune thrombocytopenic purpura (ITP), vaccination should be
delayed until equal or more than 6 months has elapsed. If gamma-globulin is administered within 14
days after administration of the vaccine, the vaccine may not be effective. Such individuals should be
re-vaccinated equal or more than 3 months after the initial vaccination. Other live vaccine
preparations: Those receiving other live vaccines, eg oral polio, measles, mumps, rubella, BCG or
yellow fever vaccine, are advised to wait until equal or more than 4 weeks has elapsed before being
vaccinated. Incompatibilities: The vaccine should not be mixed with other vaccines or medications in
the same syringe.
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Anti RhD Gamma Globulin 250 mcg/2 ml Injection (500 units=100 mcg) B
Trade Name : Rhogam
Indication :
Prevention of Rh(D) sensitisation by IM injection to rhesus-negative woman after delivery of rhesus-
positive infant
Dosage :
50 - 100 mcg within 72 hours after incompatible blood transfusion: 25 mcg (125 units) per ml
transfused blood, up to 1000 mcg
Precautions :
Never administer by IV or to infant. IgA deficiency. Hypersensitivity to thiomersal or human Ig.
Adverse Effects :
Pain at injection site. Slight temperature elevation.
Contraindications :
RhD positive mother.
Interactions :
Live virus vaccines.
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365
Hepatitis B Immunoglobulin (Human) Injection A
Trade Name : Hyperhep/Hepabig
Indication :
i) For post-exposure prophylaxis of hepatitis B ii) Prophylaxis against recurrence of hepatitis B
infection in chronic hepatitis B post liver transplantation
Dosage :
i) Recommended dose in ADULT and CHILD more than 10 years: A single dose of 500 units IM within
48 hours and not more than 1 week after exposure ii) Different regimens depending on hepatitis B
virus (HBV) DNA positivity
Precautions :
Extreme hypogammaglobulinaemia, severe thrombocytopenia, bleeding disorders.
Adverse Effects :
Local reaction at injection site, headache, malaise, fever, nephrotic syndrome.
Contraindications :
Selective IgA deficiencies.
Interactions :
Live vaccines.
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366
20. ANAESTHESIA
Induction / Maintenance
Neuromuscular blocker
Topical anaesthesia
Local anaesthesia
Miscellaneous anaesthesia
367
Dexmedetomidine HCl 100 mcg/ml Injection A*
Trade Name : Precedex
Indication :
Sedation of intubated and mechanically ventilated ICU patients. For use only by specialist
anaesthetist
Dosage :
Not to be infused for more than 24 hours, 1 mcg/kg over 10 minutes as loading dose. Maintenance
dose: 0.2 - 0.7 mcg/kg/hr
Precautions :
Significant cardiovascular dysfunction, advanced heart block, renal and hepatic impairment, elderly
more than 65 years, pregnancy, lactation, diabetes mellitus, chronic hypertension.
Adverse Reactions:
Hypotension (more frequent), hypertension, cardiovascular disease, nausea, dry mouth, hypoxia,
somnolence.
Contraindications:
Hypersensitivity to dexmedetomidine.
Interactions:
Enhances effects of anaesthesia, sedative, hypnotics and other CNS depressants, opiods.
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Isoflurane Liquid B
Trade Name : Forane
Indication :
i) Induction and ii) Maintenance of anaesthesia
Dosage :
i) Induction- Initiate at a concentration of 0.5 % ii) Maintenance- 1 - 2.5 % in oxygen or nitrous oxide
mixture. 0.5 - 0.75 % with oxygen and nitrous oxide for Caesarian section
368
Precautions :
Uterine curettage, raised intracranial pressure, cardiac, respiratory, renal or hepatic impairment.
Elderly or obese patients. May impair ability to drive or operate machinery. Avoid alcohol.
Concomitant use with adrenaline or other sympathomimetics. Pregnancy and lactation.
Adverse Reactions:
Cardio-respiratory depression, hepatic injury, hepatotoxicity, jaundice, malignant hyperthermia,
gastrointestinal upset, ileus, post-operation shivering. Hypotension, arrhythmias, transient rise in
cerebrospinal fluid pressure.
Contraindications:
Hypersensitivity to isoflurane, halogenated agents. Genetic susceptibility to malignant hyperthermia.
Porphyria.
Interactions:
Potentiates action of nondepolarising muscle relaxants. Enhance effects of neuromuscular blockers,
central nervous system depressants. Enhanced hypotensive effects of ACE inhibitors, tricyclic
antidepressants (TCAs), MAOIs, antihypertensives, antipsychotics, beta-blockers
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369
Pre-operative sedation, induction of general anaesthesia, premedication and sedation in ICU and
sedation for minor procedures
Dosage :
Usual sedative range 2.5 - 7.5 mg (about 70 mcg/kg by IV injection over 30 seconds). Premedication
by IM injection 70 - 100 mcg/kg 30 -60 minutes before surgery; ELDERLY: 1 - 1.5 mg/kg. Induction:
Induction by slow IV infusion 200 - 300 mcg/kg (ELDERLY 100 - 200 mcg/kg. CHILD over 7 years 150 -
200 mcg/kg); Maximum: 0.35mg/kg. Sedation in ICU 0.03 - 0.2 mg/kg/hour
Precautions :
Elderly, COPD, congestive heart failure, respiratory failure, severe electrolyte and fluid disturbances,
pregnancy and lactation, hepatic and renal impairment, labor and delivery, prolonged use and
abrupt withdrawal, moderate lowering of intraocular pressure in ophthalmic. Children under 15 kg
not to exceed 1 mg/ml.
Adverse Reactions:
Muscle stiffness, induration of veins, pain, redness, headache, apnoea, nausea, coughing, vomitting,
drowsiness, respiratory depression, phlebitis, gastrointestinal disturbances, increased appetite,
jaundice, hypotension, bronchospasm, pain at the site of injection.
Contraindications:
Acute narrow angle glaucoma, hypersensitivity to midazolam products, acute alcohol intoxication,
shock, lactation.
Interactions:
Neuroleptics, tranquilizer, antidepressant, hypnotics, analgesics, anaesthetics, antipsychotics,
anxiolytics, antiepiletics, antihistamines, erythromycin, clarithromycin, cimetidine, omeprazole,
diltiazem, efavirenz, indinavir, nelfinavir, ritonavir, saquinavir, fluvoxamine, halothane, sevoflurane,
thiopental, itraconazole, theophylline, atorvastatin.
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370
Propofol 1 % Injection A*
Trade Name : Diprivan
Indication :
Induction & maintenance of general anaesthesia. Sedation of ventilated ICU patients
Dosage :
Induction: 1.5-2.5mg/ kg at the rate of 20-40 mg every 10 seconds. CHILD more than 8 years: usually
2.5mg/ kg. Maintenance: IV 25-50 mg repeated according response. IV infusion: 4-12mg/kg/hour;
CHILD more than 3 years: 9-15 mg/kg/ hour. Sedation: 0.3 - 4 mg/kg/hour up to 3 days
Precautions :
Monitor blood lipid concentration in patients at risk for fat overload, risk of convulsion in epileptic
patients, monitor signs of hypotension, airway obstruction and oxygen desaturation. Cardiac,
respiratory, renal or hepatic impairment; hypovolaemic or debilitated patients; disorders of fat
metabolism or conditions where lipid emulsions should be used cautiously. Do not use in pregnancy,
do not use for obstetric anaesthesia. Avoid in lactation, has been used for termination in 1 st
trimester. Ability to drive or operate machinery may be affected. Bradycardia. Contains EDTA which
chelates metal ions, including zinc. Hence, consider need for supplemental zinc during prolonged
administration especially in patients predisposed to zinc deficiency eg. patients with burns,
diarrhoea, major sepsis. Contains no antimicrobial preservatives. When aspirated, must be drawn
aseptically into sterile syringe or giving set immediately after opening ampoule or breaking vial seal.
Administration must commence with or without delay. Asepsis must be maintained for Diprivan &
infusion instrument throughout infusion period. Any fluids added to Diprivan line must be
administered close to cannula site. Diprivan must not be administered via microbiological filter.
Single infusion must not exceed 12 hour. At the end of the procedure or at 12 hours, whichever is
sooner, both reservoir & infusion line must be discarded & replaced as appropriate.
Adverse Reactions:
Very common: Local pain on induction. Common: Hypotension, bradycardia, transient apnoea during
induction, nausea & vomiting & headache during recovery phase, withdrawal symptoms in children,
flushing in children. Uncommon: Thrombosis & phlebitis. Rare: Epileptiform movements, including
convulsions & opisthotonus during induction, maintenance & recovery. Very rare: Rhabdomyolysis,
pancreatitis, post-operative fever, discoloration of urine following prolonged administration,
anaphylaxis - may include angioedema, bronchospasm, erythema & hypotension - sexual
disinhibition, pulmonary oedema, post-operative unconsciousness.
Contraindications:
Children less than 3 years and obstetric anaesthesia.
Interactions:
Bupivacaine, lidocaine, succinylcholine. Diprivan has been used in association with spinal and
epidural anaesthesia and with commonly used premedicants, neuromuscular-blocking drugs,
inhalational agents and analgesic agents; no pharmacological incompatibility has been encountered.
Lower doses of Diprivan may be required where general anaesthesia is used as an adjunct to
regional anaesthetic techniques. Incompatibilities: Diprivan should not be mixed prior to
administration with injections or infusion fluids other than with 5% Dextrose in PVC bags or glass
infusion bottles or lignocaine injection or alfentanil injection in plastic syringes. The neuromuscular-
blocking agents, atracurium and mivacurium should not be given the same IV line as Diprivan
without prior flushing.
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Sevoflurane Liquid A*
Trade Name : Sevorane
Indication :
To be used only for i) induction and ii) maintenance of anaesthesia
371
Dosage :
i) Up to 8% in oxygen or nitrous oxide-oxygen mixture ii) maintenance: 1 - 3%
Precautions :
Avoid the use of flow rates of less than 2 litres/minute with soda lime in patients with renal disease.
Raised intracranial pressure, cardiac, respiratory, renal or hepatic impairment, elderly or obese
patients. Maintenance of haemodynamic stability is important in patients with coronary artery
disease. Concomitant use with adrenaline or other sympathomimetics. Pregnancy and lactation.
Adverse Reactions:
Cardiorespiratory depression, hypotension, malignant hyperthermia, agitation, laryngospasm,
increased cough, salivation, acute renal failure, shivering, nausea, vomiting, rarely dystonic
movements in children, postoperative hepatitis and seizure-like activity.
Contraindications:
Hypersensitivity to sevoflurane/halogenated anaesthetics, malignant hyperthermia.
Interactions:
Isoniazid, nitrous oxide, thiopental, midazolam, phenobarbital, primidone, rocuronium, vecuronium,
atracurium, succinylcholine, tubocurarine, verapamil. Potentiates action of non-depolarising muscle
relaxants.
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372
ADULT and CHILD more than 1 month: Initially 300 - 600 mcg/kg IV injection. Subsequent doses of 80
- 200 mcg/kg may be given as necessary. IV infusion: 5 - 10 mcg/kg/minute (300 - 600 mcg/kg/hour)
Precautions :
Other neuromuscular disease, severe cardiovascular disease, myasthenia gravis & severe electrolyte
disorders.
Adverse Reactions:
Tachycardia, flushing, skin and allergic reactions.Transient hypotension attributed to histamine
release. Rarely, bronchospasm, anaphylactoid reactions.
Contraindications:
Not known.
Interactions :
Effect enhanced by inhalation anaesthesia, aminoglycoside, polymyxins, lithium, magnesium salts,
procainamide and quinidine.
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373
hypocalcaemia, hypoproteinaemia, dehydration, acidosis, hypercapnia, cachexia increases effects.
Not recommended to drive or operate machinery within 24 hour after full recovery.
Adverse Reactions:
Minimal histamine-releasing and cardiovascular effects, high doses produce mild vagolytic activity.
Rare anaphylactic reactions. Itching and erythematous reactions at the site of injection and or
generalized histaminoid reactions example bronchospasm and cardiovascular changes.
Contraindications:
Hypersensitivity to rocuronium products.
Interactions:
Anaesthetics, other non-depolarising neuromuscular blocking agents, neostigmine, edrophonium,
pyridostigmine, aminopyridine derivatives, phenytoin or carbamazepine, noradrenaline,
azathioprine, theophylline and calcium chloride.
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374
Adverse Reactions :
Transient hypertension, narcosis, vomiting and coma. Thawing of frozen tissue after surgery may be
painful. Chemical frostbite may occur following prolonged spraying onto the skin. Nephrotoxicity or
hepatotoxicity (long-term exposure)
Contraindications:
Hypersensitivity to ethyl chloride products and vascular impairment of the extremities. Porphyria.
Application on broken skin or mucous membranes
Interactions :
Cisatracurium, St John's Wort
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375
Interactions :
Potentiation of cardiac effects antiarrhythmias. Lidocaine should be used with caution with dental
injection anaesthesia, other local anaesthetics or class intrabursal (IB) antiarrhythmic drugs, as the
toxic effects are additive. Tocainide and drugs that reduce the clearance of lidocaine (eg, cimetidine
or β-blockers) may cause potentially toxic plasma concentrations when lidocaine is given in repeated
high doses over a long time period
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Lignocaine 2% Jelly B
Trade Name : Xylocaine
Indication :
Use for endotracheal tubes and instruments, painful procedures in the ear, nose and throat, burns,
wounds, abrasions, lacerations; catheterisation of the male and female urethra and for symptomatic
treatment of cystitis and urethritis
Dosage :
Apply to affected area 10 mins before catheterization, etc
Precautions :
Traumatised mucosa and sepsis in the region of application, chronic heart failure, bradycardia or
respiratory depression, hepatic insufficiency. Should not be used as ophthalmic drug. Presence of
sepsis or severely traumatized mucosa in area of application. When used for endotracheal tube
lubrication, avoid introducing into the lumen of the tube. Closely supervise patients being treated
with class III antiarrhythmic drugs eg amiodarone and monitor ECG due to the additive effects.
Adverse Reactions:
Allergic reactions. Intoxication, cutaneous and hypersensitivity symptoms. Sore throat. Central
nervous system excitation followed by depression with drowsiness, respiratory failure and coma,
numbness of tongue and perioral region, myocardial depression, peripheral vasodilation,
hypotension, bradycardia, arrhythmia, cardiac arrest. Prolonged use in the eye may lead to severe
contact keratitis and corneal damage.
Contraindications:
Hypersensitivity to lidocaine or amide type of local anaesthetics. Hypovolaemia, heart block or other
conduction disturbances.
Interactions:
Potentiation of cardiac effects antiarrhythmias. Drugs structurally related to local anaesthesia.
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376
Contraindications:
Hypovolaemia, complete heart block, intravenous regional anaesthesia (Bier's block). Acute active
disease of the CNS eg meningitis, tumours, poliomyelitis & cranial haemorrhage, active TB or
metastatic lesions in the vertebral column. Septicaemia. Pernicious anaemia with subacute
combined degeneration of the spinal cord. Pyrogenic infection of the skin at or adjacent to the site
of puncture. Cardiogenic or hypovolaemic shock. Coagulation disorders or ongoing anticoagulant
treatment.
Interactions:
Hyaluronidase, propofol, rapacuronium, verapamil, antiarrhythmias.
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377
frequently follows paracervical block with some amide type local anesth & may be associated with
fetal acidosis & hypoxia. Added risk in prematurity, toxaemia of pregnancy & fetal distress. Monitor
fetal heart rate. Pregnancy. Allergic type reactions including anaphylactic type symptoms & life-
threatening or less severe asthmatic episodes in certain susceptible people. Extreme caution in
patients with severe or untreated hypertension, poorly controlled thyrotoxicosis, ischaemic heart
disease, heart block, cerebrovascular insufficiency, advanced diabetes & any other pathological
condition that might be aggravated by effects of adrenaline. Adrenaline may induce anginal pain in
patients suffering from ischaemic heart disease. Ventricular fibrillation, prefibrillatory rhythm,
tachycardia, myocardial infarction, phenothiazine-induced circulatory collapse & prostatic
hypertrophy.
Adverse Reactions:
Light headedness, nervousness, apprehension, euphoria, confusion, drowsiness, tinnitus, blurred
vision, diplopia, nausea, vomiting, sensations of heat, cold or numbness, urinary retention,
paraesthesia circumoral, hyperacusis, twitching, tremors, convulsions, unconsciousness, resp
depression &/or arrest, agitation, numbness of the tongue, difficulty in swallowing & slurred speech.
CV: bradycardia, hypotension: Haemodynamic: maternal hypotension. Neurologic: spinal block of
varying magnitude (including total spinal block), hypotension secondary to spinal motor, sensory
&/or autonomic (sphincter control) deficit of some lower spinal segment w/ slow recovery (several
mth) or incomplete recovery in rare instances when caudal or lumbar epidural block has been
attempted. Backache & headache. Neuropathy, peripheral nerve injury & arachnoiditis. Inadvertent
subarachnoid inj may lead to CNS depression, resp arrest & CV collapse. Allergic: cutaneous lesions,
urticaria, oedema or anaphylactoid reactions.
Contraindications:
Allergy or hypersensitivity to amide type local anesth. Epidural or spinal anesth in patients with
uncorrected hypotension. Infection and/or septicaemia. Obstetric paracervical block, IV regional
anesth (Bier's block). Thyrotoxicosis; regions with compromised blood supply, extremities. severe
hemorrhage, severe hypotension or shock and arrhythmias, such as complete heart block, which
severely restrict cardiac output (spinal anesthesia).
Interactions:
May potentiate the cardiac effects of antiarrhythmics (eg mexiletine & lignocaine). CNS acting drugs:
tricyclic antidepressants or MAOIs, phenothiazines & butyrophenones. Oxytocic drugs of the ergot
type. Adrenergic neuron blocking agents eg guanethidine, debrisoquine, bethanidine. β-blocker eg
propranolol. Inhalation anesth eg chloroform, halothane, cyclopropane, trichloroethylene or other
halogenated cmpds. Cardiac glycosides, quinidine, hypoglycaemics.
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378
Interactions:
St John's Wort.
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379
Ropivacaine HCl 2 mg/ml Injection A*
Ropivacaine HCl 7.5 mg/ml Injection A*
Trade Name : Naropin
Indication :
i) Surgical anaesthaesia including obstetrics ii) Acute pain management
Dosage :
Dose adjusted according to patient physical status and nature of procedure. i) Lumbar epidural: 15-
25 ml of 7.5 mg/ml solution; Caesarean section, 15-20 ml of 7.5 mg/ml solution in incremental doses
( max . total dose 150 mg). ii) lumbar epidural: 10-20 ml of 2mg/ml solution followed by 10-15 ml of
2 mg/ml solution at interval at of least 30 minutes. Labour pain 6-10 ml/hour of 2mg/ml solution
Precautions :
Severe liver disease, acidosis, chronic renal disease. Resuscitative equipment and drugs for treating
toxic reactions should be immediately available.
Adverse Reactions:
Confusion, respiratory depression and convulsion, hypersensitivity, tachycardia, nausea, backache,
Horner's syndrome. Bradycardia, vomiting, paraesthesia, temperature elevation, headache, urinary
retention, dizziness, hypertension, hypotension, rigors, tachycardia, anxiety, hypoesthesia.
Contraindications:
Hypovolaemia, hypersensitivity to ropivacaine/amide-type anaesthetics, severe hypotension,
complete heart block. General contraindications related to epidural anaesthesia, regardless of the
local anaesthetic used, should be taken into account.
Interactions:
Hyaluronidase, propofol, rapacuronium, verapamil, antiarrhythmias, fluvoxamine, imipramine,
theophylline and enoxacin. Concomitant use with other related amide-type local anaesthetic.
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380
Contraindications:
Hypersensitivity to atropine or anticholinergics, narrow-angle glaucoma, reflux oesophagitis,
obstructive gastrointestinal disease/uropathy, ulcerative colitis or toxic megacolon, unstable
cardiovascular status in acute haemorrhage or thyrotoxicosis.
Interactions:
Loss of cisapride efficacy, procainamide coadministered with atropine may result in additive
antivagal effects on atrioventricular nodal conduction Major interaction with potassium, topiramate,
effect of atropine and other antimuscuranic may be enahnced by concomitant administration of
drug with antimuscuranic properties. MAOIs may enhance atropine effect. Reduce GIT motality may
affect other oral drug absorption.
-----------------------------------------------------------------------------------------------------------------------------------
381
22. DIAGNOSTIC
Radiocontrast media
Diagnostic aids and test preparation
382
Barium Sulphate Suspension B
Trade Name : Baritop, Barytgen
Indication :
For x-ray examination of the alimentary tract:
i) Oesophagus
ii) Stomach and duodenum
iii) Colon
Dosage :
i) Up to 150 ml of a 50% - 200% suspension orally
ii) Up to 300 ml of a 30% - 200% suspension orally
iii) Up to 2 litre of a 30% - 200% suspension orally
Precautions :
Intestinal obstruction, pyloric stenosis or lesions which may predispose to obstruction, conditions
which may predispose to perforation such as acute ulcerative colitis and acute diverticulitis.
Adequate hydration should be ensured after the procedure to prevent severe constipation, history
of bronchial asthma or allergy, previous reaction to a contrast agent, hypertension, advanced cardiac
disease, intussusception with symptoms of more than 24 hours duration, tracheoesophageal fistula
Adverse Reactions :
Hypersensitivity reactions, constipation, aspiration pneumonia if aspirated, ventricular fibrillation,
bradycardia, asystole, electrocardiographic changes, and hypotension, urticaria, pruritus, erythema
and generalized rashes, dysphagia, constipation, diarrhea, acute pritonitis, anaphylactic reactions,
headache, dyspnea
Contraindications :
Gastrointestinal perforation, acute bleeding from gastrointestinal tract, peritonitis, pneumatosis
intestinalis, gross intestinal obstruction, known or suspected perforation, hypersensitivity to
anything in the barium sulfate suspension
Interactions :
Not known
--------------------------------------------------------------------------------------------------------
383
Hydroxyethyl Cellulose Jelly B
Trade Name : KY Jelly
Indication :
For lubricating purpose
Dosage :
Apply sufficiently for lubricating purpose
Precautions:
Not known
Adverse effects:
Not known
Contraindications:
Not known
Interactions:
Not known
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384
23. MISCELLANEOUS
General disinfectant
Other disinfectant
Diagnostic radiopharmaceuticals
Therapeutic radiopharmaceutials
385
Ether Solvent C
Indication :
To remove adhesive plaster from the skin
Dosage :
Dose depending on the route and procedure
Precautions:
Not known
Adverse Reactions:
Not known
Contraindications:
Hypersensitivity to iohexol/iopromide products, intrathecal corticosteroids, immediate repeat
myelography, local or systemic infection
Interactions:
Not known
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386
INDEX
387
3TC, 193 Alphanine, 75
5-FU, 263 Alprazolam 0.25 mg Tablet, 112
Abilify, 113 Alprim, 184
Acarbose 50 mg Tablet, 205 Alprostadil 500 mcg/ml Injection, 81
Acetazolamide 250 mg Tablet, 313 Amantadine HCl 100 mg Capsule, 144
Acetazolamide 500 mg Injection, 314 Amikacin 250 mg/2 ml Injection, 158
Acetylcysteine 200mg/ml, 9 Amikacin 500 mg/2 ml Injection, 158
Acetylsalicylic Acid 100 mg, Glycine 45 mg Amikin, 158
Tablet, 71 Amiloride HCl 5 mg & Hydrochlorothiazide 50
Acetylsalicylic Acid 300 mg Soluble Tablet, 96 mg Tablet, 42
Acitretin 25 mg Capsule, 342 Amino Acids Injection, 283
Acriflavine 0.1% Lotion, 355 Aminophylline 25 mg/ml Injection, 83
Act-Hib, 362 Amiodarone 150mg/3 ml Injection, 46
Actifed, 334 Amiodarone 200 mg Tablet, 46
Actinomycin D (Dactinomycin) 500 mcg/ml Amitriptyline HCl 25 mg Tablet, 124
Injection, 255 Amlodipine 10 mg Tablet, 60
Actrapid, 208, 209 Amlodipine 5 mg and Valsartan 160 mg
Acular, 318 Tablet, 60
Acyclovir 200 mg Tablet, 190 Amlodipine 5 mg Tablet, 60
Acyclovir 250 mg Injection, 191 Ammonium Bicarbonate, Tincture Ipecac, etc
Acyclovir 3% Eye Ointment, 311 Mixture, 333
Acyclovir 5% Cream, 349 Amorolfine 5 % Nail Lacquer, 349
Acyclovir 800 mg Tablet, 190 Amoxicillin & Clavulanate 228 mg/5 ml Syrup,
Adalat, 63 158
Adapalene 0.1% Gel, 346 Amoxicillin 1 g & Clavulanate 200 mg
Addamel Solution, 284 Injection, 158
Adenocor, 45 Amoxicillin 250 mg Capsule, 159
Adenosine 3 mg/ml Injection, 45 Amoxicillin 500 mg & Clavulanate 125 mg
Adrenaline Acid (Epinephrine) Tartrate 1 Tablet, 159
mg/ml Injection, 66 Amoxicillin Trihydrate 125 mg/5 ml Syrup, 160
Adriamycin, 261, 262 Amphotericin B 0.15% Eye Drops, 306
Aerius, 328 Amphotericin B 50 mg Injection, 185
Afrin, 324 Ampicillin Sodium 1g & Sulbactam Sodium
Albendazole 200 mg Tablet, 202 500mg Injection, 160
Albendazole 200 mg/5 ml Suspension, 202 Ampicillin Sodium 500 mg Injection, 160
Alcaine, 317 Ampicillin Trihydrate 125 mg/5 ml
Alcohol 70% Solution, 355 Suspension, 161
Aldactone, 45 Anastrozole 1 mg Tablet, 271
Aldomet, 54 Anexate, 13
Alendronate Sodium 70mg and Cholecalciferol Angised, 62
2800 IU Tablet, 222 Antazoline HCl, Tetrahydrozoline HCl and
Alfacalcidol 0.25 mcg Capsule, 286 Benzalkonium Cloride Eye Drops, 310
Alfacalcidol 1 mcg Capsule, 286 Anti RhD Gamma Globulin 250 mcg/2 ml
Alfacalcidol 2 mcg/ml Drops, 287 Injection (500 units=100 mcg), 365
Alfacalcidol 2 mcg/ml Injection, 287 Antilymphocyte/Antithymocyte
Alkaline Nasal Douche, 322 Immunoglobulin (from Horse) Injection,
Alkeran, 266 249
Allopurinol 300 mg Tablet, 303 Antivenene Malaysian Pit Viper Injection, 9
All-Trans Retinoic Acid 10 mg Capsule, 255 Antivenene Serum (Cobra) Injection, 9
Alphagan P, 314 Antivenene Serum (Sea snake) 1000
Alphanate, 76 units/26.3 ml Injection, 10
388
Antivenene Serum Snake polyvalent Injection, Becotide, 90
10 Benadryl, 333
Anusol, 29 Benzathine Penicillin 2.4 mega units Injection
Anzatax, 270 (1.8 g), 162
Aprepitant 125 mg Capsule, 33 Benzhexol 2 mg Tablet, 144
Aprovel, 52 Benzoic Acid Compound Ointment, 350
Aqueous Cream, 337 Benzoyl Peroxide 5% Gel, 347
Arava, 301 Benzydamine HCl 0.15% Solution, 325
Aredia, 224 Benzyl Benzoate 25 % Emulsion (Adult), 350
Aricept, 151 Benzylpenicillin 1 mega unit (600 mg)
Arimidex, 271 Injection, 163
Aripiprazole 10mg Tablet, 113 Benzylpenicillin 5 mega units (3 g) Injection,
Aripiprazole 15mg Tablet, 113 163
AripMT, 113 Beractant Intratracheal Suspension (200 mg
Arixtra, 68 phospholipids in 8 ml vial), 93
Artane, 144 Betahistine Dihydrochloride 24 mg Tablet,
A-Scabs, 353 153, 334
Ascorbic Acid 100 mg Tablet, 288 Betaloc, 49
Aspirin Soluble, 96 Betamethasone Disodium Phoshate 0.1% Ear
Atarax, 329 Drops, 321
Atenolol 100 mg Tablet, 47 Betamethasone Disodium Phoshate 0.5% Ear
Atgam, 249 Drops, 321
Ativan, 113 Betamethasone Disodium Phosphate 0.1%
Atomoxetine HCl 10 mg Capsule, 152 Eye/Ear Drops, 309
Atomoxetine HCl 18 mg Capsule, 152 Betaserc, 153, 334
Atorvastatin 20 mg Tablet, 77 Betnesol, 309, 321
Atracurium Besylate 25 mg/2.5 ml Injection, B-Hepa, 362
372 Bimatoprost 0.03% Ophthalmic Solution, 314
Atropine Sulphate 1% Eye Drops, 311 BIPP, 323
Atropine Sulphate 1mg/ml Injection, 380 Bisacodyl 10 mg Suppository, 27
Atrovent, 83, 85 Bisacodyl 5 mg Tablet, 28
ATT, 364 Bismuth Subgallate and Benzyl Benzoate
Augmentin, 158 Suppository, 29
Aurorix, 128 Bismuth Subnitrate, Iodoform and Liquid
Avandia, 211 Paraffin Paste, 323
Avodart, 244 Bisolvon, 332
Azathioprine 50 mg Tablet, 249 Bisoprolol Fumarate 2.5 mg Tablet, 47
Azelaic Acid 20% Cream, 346 Bisoprolol Fumarate 5 mg Tablet, 47
Azithromycin 250 mg Tablet, 161 Bleocin, 256
Azithromycin 500 mg Injection, 161 Bleomycin HCl 15 mg Injection, 256
Bacampicillin 400 mg Tablet, 162 Bonjela, 325
Baclofen 10 mg Tablet, 153 Bonviva, 223
Bactrim, 183, 184 Botox, 154
Bactroban, 352 Bricanyl, 87, 88, 89
Balanced Salt Solution, 317 Brimonidine Tartrate 0.15% Ophthalmic, 314
Baraclude, 193 Bromhexine HCl 4 mg/2 ml Injection, 332
Baritop, 383 Bromhexine HCl 8 mg Tablet, 332
Barium Sulphate Suspension, 383 Bromocriptine Mesilate 2.5 mg Tablet, 225
Barytgen, 383 Brufen, 108
BCG Vaccine Freeze-Dried Injection, 362 BSS, 317
Beclomethasone Dipropionate 100 mcg/dose Budesonide 1 mg/2 ml Nebulising Solution, 91
Inhalation, 90
389
Budesonide 160 mcg and Formoterol 4.5 mcg Cardura XL, 244
Inhalation, 94 Carminative, 19
Budesonide 200 mcg/dose Inhalation, 91 Carvedilol 25 mg Tablet, 48
Budesonide 500 mcg/2 ml Nebulising Carvedilol 6.25 mg Tablet, 48
Solution, 91 Caspofungin Acetate 50 mg Injection, 186
Bumetanide 0.5 mg/ml Injection, 43 Caspofungin Acetate 70 mg Injection, 186
Bupivacaine 0.5 % Heavy Injection, 376 Cefazolin Sandoz, 163
Bupivacaine 0.5 % Injection, 377 Cefazolin Sodium 1 g Injection, 163
Bupivacaine 0.5 % with Adrenaline 1:200,000 Cefepime 1 g Injection, 163
Injection, 377 Cefobid, 164
Burinex, 43 Cefoperazone Sodium 1 g Injection, 164
Buscopan, 20 Cefoperazone Sodium 500 mg & Sulbactam
Ca Disod. Versenate, 11 Sodium 500 mg Injection, 164
Cabergoline 0.5 mg Tablet, 226 Cefotaxime 1 g Injection, 165
Calamine Cream, 337 Ceftazidime 1 g Injection, 165
Calamine Lotion, 337 Ceftazidime 2 g Injection, 165
Calamine with 2 - 6% Precipitated Sulphur Ceftriaxone 0.25mg Injection, 165
Lotion, 337 Ceftriaxone 1g Injection, 166
Calcijex, 288 Cefuroxime Axetil 125 mg Tablet, 167
Calcipotriol 50 mcg/g Cream, 342 Cefuroxime Axetil 125 mg/5 ml Suspension,
Calcipotriol 50 mcg/g Ointment, 342 167
Calcipotriol 50 mcg/ml Scalp Solution, 343 Cefuroxime Sodium 1.5 g Injection, 167
Calcipotriol Hydrate 50 mcg/g & Cefuroxime Sodium 750 mg Injection, 167
Betamethasone Dipropionate, 343 Celebrex, 106, 300
Calcitonin (synthetic Salmon) 100 IU Injection, Celecoxib 200 mg Capsule, 106, 300
223 Cellcept, 253
Calcitonin (Synthetic Salmon) 200 IU Nasal Cephalexin Monohydrate 125 mg/5 ml Syrup,
Spray, 223 168
Calcitriol 0.25 mcg Capsule, 288 Cephalexin Monohydrate 250 mg Capsule,
Calcitriol 1 mcg/ml Injection, 288 168
Calcium Carbonate 500 mg Tablet, 284 Ceporex, 168
Calcium Disodium Edetate 200 mg Injection, Cerubidin, 260
11 Cervagem, 236
Calcium Gluconate 10% Injection, 284 Cetirizine HCl 10 mg Tablet, 327
Calcium Polystyrene Sulphonate Powder, 11 Cetrimide 1-2% Lotion., 356
Calmurid, 344 Charcoal, Activated 250 mg Tablet, 12
Campto, 265 Chirocaine, 378
Cancidas, 186 Chloral Hydrate 200 mg/5 ml Mixture, 112
Candid Ear Drops, 186 Chlorambucil 2 mg Tablet, 257
Canesten, 351 Chloramphenicol 0.5% Eye Drops, 306
Capecitabine 500 mg Tablet, 256 Chloramphenicol 1% Eye Ointment, 306
Capoten, 50 Chloramphenicol 5% w/v Ear Drops, 321
Captopril 25 mg Tablet, 50 Chloramphenicol Sodium Succinate 1 g
Carbamazepine 100 mg/5 ml (2% w/v) Syrup, Injection, 169
133 Chlorhexidine Gluconate 0.2 % Mouthwash,
Carbamazepine 200 mg CR Tablet, 133 325
Carbamazepine 200 mg Tablet, 134 Chlorhexidine Gluconate 4% Scrub, 356
Carbamide (Urea) 10 % Cream, 344 Chlorhexidine Gluconate 5% Solution, 356
Carbimazole 5 mg Tablet, 212 Chlorinated Lime Powder, 386
Carboplatin 450 mg Injection, 256 Chlorinated Lime Solution & Buffered Acetate
Carboprost Tromethamine 250 mcg Injection, Solution, 357
235 Chloromycetin, 169, 306, 321
390
Chloroquine Phosphate 250 mg Tablet (150 Coal Tar 20% Solution, 344
mg Chloroquine base), 200 CoAprovel, 52
Chlorpheniramine Maleate 10 mg/ml Cocaine 10% Solution, 335
Injection, 327 Cocois Co. Ointment, 344
Chlorpheniramine Maleate 2 mg/5 ml Syrup, Co-Diovan, 59
328 Colchicine 0.5 mg Tablet, 358
Chlorpheniramine Maleate 4 mg Tablet, 328 Combivent, 84
Chlorpromazine HCl 100 mg Tablet, 114 Combivir, 199
Chlorpromazine HCl 25 mg Tablet, 114 Comtan, 145
Choline Salicylate 8.7%, Cetylkonium Chloride Concor, 47
0.01% Dental Gel, 325 Conjugated Oestrogens 0.625 mg &
Chorionic Gonadotrophin Human (HCG) 5000 Medroxyprogesterone Acetate 2.5 mg, 229
IU Injection, 233 Conjugated Oestrogens 0.625 mg Tablet, 229
Ciclosporin 100 mg/ml Drink Solution, 252 Conjugated Oestrogens 0.625 mg/g Cream,
Ciclosporin 25 mg Capsule Microemulsion, 238
251 Continuous Ambulatory Peritoneal Dialysis
Cinnarizine 25 mg Tablet, 335 Solution containing 1.5% Dextrose, 277
Ciprobay, 169 Continuous Ambulatory Peritoneal Dialysis
Ciprofloxacin 100 mg/50 ml Injection, 169 Solution containing 2.5% Dextrose, 277
Ciprofloxacin 250 mg Tablet, 169 Continuous Ambulatory Peritoneal Dialysis
Cisplatin (Cis-Platinum) 50 mg Injection, 257 Solution containing 4.25% Dextrose, 277
Claforan, 165 Controloc, 23, 24
Clarinase, 330 Cordarone, 46
Clarithromycin 250 mg Tablet, 170 Cosmegen, 255
Clarityne, 330 Coumadin, 70
Clexane, 67 Coversyl, 56
Clindamycin HCl 300 mg Capsule, 170 Coversyl Plus, 55
Clobetasol Propionate 0.05% Cream, 339 Cozaar, 52
Clobetasol Propionate 0.05% Ointment, 340 Cravit, 177
Clobetasone Butyrate 0.05% Cream, 340 Crestor, 80
Clobetasone Butyrate 0.05% Ointment, 340 Crinone, 218
Clomid, 234 Crixivan, 193
Clomifene Citrate 50 mg Tablet, 234 Crotamiton 10 % Cream, 338
Clonazepam 2 mg Tablet, 135 Cuprimine, 12
Clopidogrel 75 mg Tablet, 71 Cyanocobalamin 1 mg Injection, 289
Clopixol - Acuphase, 122 Cyclogyl, 311
Clopixol Depot, 122 Cyclopentolate 1% Eye Drops, 311
Clorox, 386 Cyclophosphamide 1 g Injection, 258
Clostridium Botulinum Toxin Type A 100 units, Cyclophosphamide 50 mg Tablet, 259
154 Cyklokapron, 76
Clostridium Botulinum Toxin Type A 500 units, Cymbalta, 125
154 Cyproterone Acetate 2 mg & Ethinyloestradiol
Clotrimazole 1% Cream, 351 0.035 mg Tablet, 238
Clotrimazole 1% Ear Drop, 186 Cytarabine 100 mg Injection, 259
Clotrimazole 500 mg Vaginal Tablet, 237 Cytosar, 259
Cloxacillin Sodium 125 mg/5 ml Suspension, Dabigatran Etexilate 110 mg Capsule, 70
171 Dacarbazine 100 mg Injection, 260
Cloxacillin Sodium 250 mg Capsule, 171 Dacrolux, 317
Cloxacillin Sodium 250 mg Injection, 172 Daflon, 31
Cloxacillin Sodium 500 mg Injection, 172 Daivobet, 343
Clozapine 100 mg Tablet, 114 Daivonex, 342
Clozaril, 114 Daktarin, 339
391
Danazol 200 mg Capsule, 226 Digoxin 50 mcg/ml Elixir, 40
Daonil, 205 Digoxin 500 mcg/2 ml Injection, 41
Dapsone 100 mg Tablet, 172 Dihydrocodeine Tartrate 30 mg Tablet, 98
Daunorubicin HCl 20 mg Injection, 260 Dilantin, 139, 140
Decadron, 215 Dilatrend, 48
Deferasirox 125 mg Dispersible Tablet, 294 Diltiazem HCl 30 mg Tablet, 61
Deferasirox 500 mg Dispersible Tablet, 294 Dinoprostone (Prostagladine E2) 3 mg Vaginal
Deferiprone 500 mg Tablet, 294 Tablet, 235
Dermovate, 339, 340 Diosmin 450 mg and Hesperidin 50 mg Tablet,
Desferal, 295 31
Desferrioxamine B Methanesulphonate 0.5 g Diovan, 59
Injection, 295 Diphenhydramine HCl 10 mg/5 ml Elixir, 333
Desloratadine 5 mg Tablet, 328 Diphenhydramine HCl 14 mg/5 ml and
Desmopressin 0.1 mg Tablet, 219 Ammonium Chloride 135 mg/5 ml
Desmopressin 0.2 mg Tablet, 219 Expectorant, 333
Desmopressin 100 mcg/ml Nasal Spray, 219 Diphenoxylate with Atropine Sulphate Tablet,
Desmopressin Acetate 4 mcg/ml Injection, 27
220 Diprivan, 371
Desogestrol 150 mcg & Ethinyloestradiol 30 Dipyridamole 75 mg Tablet, 72
mcg Tablet, 239 Dobutamine HCl 250 mg/20 ml Injection A,
Detrusitol SR, 246 41
Dexamethasone 0.5 mg Tablet, 215 Dobutrex, 41
Dexamethasone and Neomycin Sulphate and Docetaxel 20 mg/0.5 ml Injection, 261
Polymyxin B Eye Ointment, 310 Dogmatil, 120
Dexamethasone and Neomycin Sulphate and Domperidone 1 mg/ml Suspension, 19
Polymyxin B Sulphate, 309 Domperidone 10 mg Tablet, 19
Dexamethasone Sodium Phosphate 8 mg/2 ml Donepezil HCl 5 mg Tablet, 151
Injection, 215 Dopamine HCl 40 mg/ml Injection, 42
Dexmedetomidine HCl 100 mcg/ml Injection, Dormicum, 369, 370
368 Dorzolamide HCl 2% Ophthalmic Solution, 315
Dextrose 50% Injection, 277 Dostinex, 226
Dextrose Powder, 205 Dothiepin HCl 75 mg Tablet, 124
DF 118, 98 Doxazosin Mesilate 4 mg CR Tablet, 244
Diamicron, 206 Doxorubicin HCl 50 mg Injection, 261
Diamicron MR, 206 Doxycycline 100 mg Capsule, 172
Diamox, 313, 314 D-Penicillamine 0.25 g Capsule, 12
Diane 35, 238 Dulcolax, 27, 28
Diavonex, 343 Duloxetine 30 mg Capsule, 125
Diazepam 10 mg/2 ml Injection, 135 Duloxetine 60 mg Capsule, 125
Diazepam 5 mg Rectal Solution, 136 Duphalac, 28
Diazepam 5 mg Tablet, 154 Duphaston, 230
Diclofenac 1% Emulgel, 106 Durogesic, 99
Diclofenac Sodium 12.5 mg Suppository, 107 Duspatalin, 21
Diclofenac Sodium 25 mg Suppository, 107 Dutasteride 0.5 mg Capsule, 244
Diclofenac Sodium 50 mg Suppository, 107 Dydrogesterone 10 mg Tablet, 230
Diclofenac Sodium 50 mg Tablet, 107 Dynastat, 98
Diclofenac Sodium 75 mg/3 ml Injection, 108 EES, 173
Didanosine 2 g Oral Solution (ddI), 192 Efavirenz 600 mg Tablet, 192
Differin, 346 Efexor XR, 129
Difflam, 325 Elomet, 341
Diflucan, 186, 187 Eloxatin, 269
Digoxin 0.25 mg Tablet, 40 Emend, 33
392
Emla, 375 Evista, 242
Emulsificants Ointment, 338 Exelon, 151
Enalapril 10 mg Tablet, 51 Exelon® patch 5, 152
Enalapril 20 mg Tablet, 51 Exelon®patch 10, 152
Enalapril 5 mg Tablet, 51 Exforge, 60
Endoxan, 258, 259 Exjade, 294
Enoxaparin Sodium 40 mg Injection, 67 Expect Stimulant, 333
Enoxaparin Sodium 60 mg Injection, 67 Ezetimibe 10 mg & Simvastatin 20 mg Tablet,
Entacapone 200 mg Tablet, 145 77
Entecavir 0.5 mg Tablet, 193 Ezetimibe 10 mg Tablet, 78
Eperisone HCl 50 mg Tablet, 303 Ezetrol, 78
Ephedrine HCl 30 mg/ml Injection, 66 Factor IX Injection, 75
Epilim, 141, 142 Factor VIIa (Recombinant) eptacog alfa
Epirubicin 50 mg Injection, 262 (activated) 60 KIU (1.2 mg) Injection, 75
Eprex, 295 Factor VIII Inhibitor Bypassing Activity
Ergometrine Maleate 0.5 mg/ml Injection, 236 Injection, 74
Erythrocin, 173, 174 Factor VIII Injection, 76
Erythromycin Ethylsuccinate 200 mg/5 ml Fansidar, 202
Suspension, 173 Farlutal, 232, 240
Erythromycin Ethylsuccinate 400 mg Tablet, Fat Emulsion 20% for IV Infusion, 283
173 Feiba, 74
Erythromycin Lactobionate 500 mg Injection, Felodipine 10 mg Tablet, 61
174 Felodipine 5 mg Tablet, 61
Erythropoietin Human Recombinant 2000 Femara, 272
IU/0.5ml Injection, 295 Femoston 1/10, 230
Escapelle, 239 Femoston Conti, 231
Escitalopram 10 mg Tablet, 125 Fentanyl 25 mcg/h Transdermal Patch, 99
Esmeron, 373 Fentanyl 50 mcg/h Transdermal Patch, 99
Esomeprazole 20 mg Tablet, 21 Fentanyl Citrate 50 mcg/ml Injection, 99
Esomeprazole 40 mg Injection, 22 Ferric Ammonium Citrate 800 mg/10 ml
Esomeprazole 40 mg Tablet, 21 Paediatric Mixture, 296
Essential Phospholipids Capsule, 31 Ferriprox, 294
Essentiale, 31 Ferrous Fumarate 200 mg Tablet, 297
Estradiol 1 mg (14 tablet) & Estradiol 1 mg Filgrastim (G-CSF) 30 MU/ml Injection, 273
with Dydrogesterone 10 mg, 230 Finasteride 5 mg Tablet, 244
Estradiol 1 mg with Dydrogesterone 5 mg Flagyl, 178
Tablet, 231 Flamazine, 354
Estradiol Valerate 1 mg Tablet, 231 Flarex ophth Susp, 310
Estradiol Valerate 2 mg and Norgestrel 500 Flavoxate HCl 100 mg Tablet, 246
mcg with Estradiol Valerate, 231 Fleet solution, 33
Ethambutol HCl 400 mg Tablet, 174 Fluanxol, 115
Ether Solvent, 386 Fluconazole 100 mg Capsule, 186
Ethyl Chloride Spray, 374 Fluconazole 2 mg/ml Injection, 187
Etomidate 20 mg/10 mg Injection, 368 Flumazenil 0.5 mg/5 ml Injection, 13
Etomidate Lipuro, 368 Flunarizine HCl 5 mg Capsule, 132
Etoposide 100 mg/5 ml Injection, 262 Fluorescein 1 mg Ophthalmic Strip, 383
Etoricoxib 120 mg Tablet, 300 Fluorets, 383
Etoricoxib 60 mg Tablet, 300 Fluorometholone 0.1% Ophthalmic
Etoricoxib 90 mg Tablet, 300 Suspension, 310
Eumovate, 340 Fluorouracil 250 mg/5 ml Injection, 263
Eurax, 338 Fluoxetine HCl 20 mg Capsule, 126
Eusol-T, 357
393
Flupenthixol Decanoate Depot 20 mg/ml Gliclazide 30 mg Modified Release Tablet, 206
lnjection, 115 Gliclazide 80 mg Tablet, 206
Fluvoxamine 100 mg Tablet, 126 Glivec, 273
Fluvoxamine 50 mg Tablet, 126 Glucagen, 207
FML liquifilm, 310 Glucagon (Lyophilised) 1 mg/ml Injection, 207
Folic Acid 5 mg Tablet, 297 Glucobay, 205
Follitropin Alpha (Recombinant Human FSH) Glucophage, 211
75 IU Injection, 234 Glucophage XR, 210
Fondaparinux Sodium 2.5 mg/0.5 ml Injection, Glucovance, 210
68 Glycerin, 326
Forane, 368 Glycerin 25% and Sodium Chloride 15%
Fortum, 165 Enema, 28
Fosamax Plus, 222 Glyceryl Trinitrate 0.5 mg Tablet, 62
Fosrenol, 285 Glyceryl Trinitrate 25 mg/5 ml Injection, 62
Framycetin Sulphate 0.5%, Dexamethasone Glycopyrrolate 200 mcg/ml Injection, 381
0.05% and Gramicidin 0.005% Ear Drops, Glypressin, 221
321 Gonal F, 234
Fucicort, 351 Goserelin 3.6 mg Depot Injection, 227
Fucidin, 175, 351, 354 Granisetron HCl 1 mg Tablet, 34
Fucithalmic, 307 Granisetron HCl 3 mg/3 ml Injection, 34
Fulcin, 188 Griseofulvin (Ultramicrosize 125 mg = 250 mg
Fuller's Earth, 13 Microsize) Tablet, 188
Fuller's Earth 30% Suspension, 13 Haemophilus Influenzae Type B Conjugate 10
Fungizone, 185 mcg Vaccine, 362
Furadantin, 179 Haloperidol 1.5 mg Tablet, 116
Furosemide 20 mg/2 ml Injection, 43 Haloperidol 5 mg Tablet, 116
Furosemide 40 mg Tablet, 43 Haloperidol 5 mg/ml Injection, 116
Fusafungine 1% Nasal Spray, 323 Harnal® OCAS, 245
Fusidic Acid 1% Eye Drops, 307 Hemabate, 235
Fusidic Acid 2% Cream, 351 Hemofil M, 76
Fusidic Acid 2% in Betamethasone Valerate Hepabig, 366
0.1% Cream, 351 Heparin 1000 units/ml Injection, 69
Fusidic Acid 500 mg Injection, 175 Heparin 5000 units/ml Injection, 69
Gabapentin 300 mg Capsule, 136 Heparin Sodium 50 units in Sodium Chloride
Gabapentin 600 mg Tablet, 136 Injection, 69
Gamma Benzene Hexachloride 0.1 % Lotion, Hepatitis B Immunoglobulin (Human)
352 Injection, 366
Garamycin, 175, 307, 308, 352 Hepatitis B Vaccine Injection, 362
Gardenal, 138 Hepsal, 69
Gemcitabine HCl 1 g Injection, 263 Herbesser, 61
Gemeprost (Prostagladin E1 Synthetic Hibiscrub, 356
Analogue) 1 mg Pessary, 236 Hibitane, 325, 356
Gemfibrozil 300 mg Capsule, 78 Holoxan, 264
Gemzar, 263 Homatropine 2% Eye Drops, 312
Gentamicin 0.1% Cream, 352 Human Albumin Injection, 278
Gentamicin 0.3% Eye Drops, 307 Humulin, 208
Gentamicin 0.3% Eye Ointment, 308 Hydralazine HCl 20 mg Injection, 51
Gentamicin 3% Fortified Eye Drops, 308 Hydrea, 345
Gentamicin Sulphate 80 mg/2 ml Injection, Hydrochlorothiazide 50 mg Tablet, 44
175 Hydrocortisone 1% Cream, 341
Genteal Gel, 318 Hydrocortisone 10 mg Tablet, 216
Glibenclamide 5 mg Tablet, 205 Hydrocortisone Enema 0.1%, 29
394
Hydrocortisone Sodium Succinate 100 mg Ipratropium Bromide 0.025% Inhalation
Injection, 216 Solution (250 mcg/ml), 83
Hydrogen Peroxide 20 volume Solution, 357 Ipratropium Bromide 0.5 mg and Salbutamol
Hydroxychloroquine Sulphate 200 mg Tablet, 2.5 mg per UDV, 84
301 Ipratropium Bromide 20 mcg and Salbutamol
Hydroxyethyl Cellulose Jelly, 384 base 100 mcg/dose Inhalation, 84
Hydroxyurea 500 mg Capsule, 345 Ipratropium Bromide 20 mcg/dose Inhalation,
Hydroxyzine HCl 25 mg Tablet, 329 85
Hyoscine N-Butylbromide 10 mg Tablet, 20 Irbesartan 150 mg Tablet, 52
Hyoscine N-Butylbromide 20 mg/ml Injection, Irbesartan 300 mg & Hydrochlorothiazide 12.5
20 mg Tablet, 52
Hyperhep, 366 Irbesartan 300 mg Tablet, 52
Hyper-Tet, 366 Irinotecan HCl Trihydrate 100 mg/5ml
Hypromellose 0.3% Eye Drops, 317 Injection, 265
Hypromellose 0.3%, Carbomer 980 Iron Dextran 50 mg Fe/ml Injection, 297
Ophthalmic Gel, 318 Iron Sucrose 100 mg/5 ml Injection, 298
Hytrin, 245 Isoflurane Liquid, 368
Hyzaar, 53, 54 Isoniazid 100 mg Tablet, 176
Ibandronic Acid 150 mg Tablet, 223 Isoniazid 400 mg Tablet, 176
Ibuprofen 200 mg Tablet, 108 Isoptin, 65
Idarubicin 10 mg Injection, 264 Isordil, 63
Ifosfamide 1 g Injection, 264 Isosorbide Dinitrate 10 mg Tablet, 63
Iliadin, 324 Isosorbide-5-Mononitrate 30 mg SR Tablet, 63
Imatinib Mesylate 100 mg Tablet, 273 Isotretinoin 10 mg Capsule, 347
Imatinib Mesylate 400 mg Tablet, 273 Isotretinoin 20 mg Capsule, 347
Imdur, 63 Itraconazole 10 mg/ml Oral Solution, 188
Imipenem 500 mg and Cilastatin 500 mg Itraconazole 100 mg Capsule, 189
Injection, 176 Januvia, 212
Imorab, 363 Jumex, 150
Imuran, 249 Kaletra, 194, 195
Inderal, 49 Kalimate, 11
Indinavir Sulfate 400 mg Capsule, 193 Kemadrin, 149
Indocid, 109 Kenacort-A, 218
Indomethacin 25 mg Capsule, 109 Kenalog in Orabase, 326
Insulatard, 208 Keppra, 137
Insulin Aspart 100 IU/ml Injection, 207 Ketalar, 369
Insulin Glargine 300 IU/3ml Injection, 208 Ketamine 10 mg/ml Injection, 369
Insulin Recombinant Neutral Human short- Ketoconazole 2% Shampoo, 348
acting 100 IU/ml Injection in 10ml vial, 208 Ketoconazole 200 mg Tablet, 189
Insulin Recombinant Synthetic Human, Ketoprofen 2.5% Gel, 109
intermediate-acting 100 IU/ml Penfill and Ketoprofen 30 mg Transdermal Plaster, 109
Refill, 208 Ketorolac Tromethamine 0.5% Eye drops, 318
Insulin Recombinant Synthetic Human, pre- Ketorolac Tromethamine 30 mg/ml Injection,
mixed 100 IU/ml Penfill and Refill, 209 96
Insulin Recombinant Synthetic Human, short- Ketotop, 109
acting 100 IU/ml Penfill and Refill, 209 Klacid, 170
Intralipid, 283 Konakion, 293, 294
Intropin, 42 KY Jelly, 384
Invega, 123 Kytril, 34
Iodine and Potassium Iodide Solution, 213 Labetalol HCl 100 mg Tablet, 48
Ipratropium Bromide 0.0125% Inhalation Labetalol HCl 100 mg/20 ml Injection, 49
Solution (125 mcg/ml), 83 Lactulose 3.35 g/5 ml Liquid, 28
395
Ladogal, 226 Lignocaine, Aluminium Acetate, Zinc Oxide
Lamictal, 137 and Hydrocortisone Ointment, 30
Lamisil, 190 Lignocaine, Aluminium Acetate, Zinc Oxide
Lamivudine 10 mg/ml Oral Solution, 193 and Hydrocortisone Suppository, 30
Lamivudine 100 mg Tablet, 194 Lincocin, 170
Lamivudine 150 mg Tablet, 194 Lindane, 352
Lamotrigine 100 mg Tablet, 137 Linezolid 2 mg/ml Injection, 177
Lamotrigine 50 mg Tablet, 137 Lioresal, 153
Lanoxin, 40, 41 Lipitor, 77
Lansoprazole 30 mg Tablet, 22 Liquid Paraffin, 29
Lanthanum Carbonate 1000mg Chewable Lithium Carbonate 300 mg Tablet, 117
Tablet, 285 Livial, 233
Lantus, 208 Locabiotal, 323
Largactil, 114 Loceryl, 349
Laroxyl, 124 Lomotil, 27
Lasix, 43 Loniten, 55
L-Asparaginase 10,000 IU Injection, 265 Lopid, 78
Latanoprost 0.005% Eye Drops, 315 Lopinavir 200 mg and Ritonavir 50 mg Tablet,
Leflunomide 10 mg Tablet, 301 194
Letrozole 2.5 mg Tablet, 272 Lopinavir/Ritonavir Oral Solution, 195
Leucovorin Calcium, 274 Loratadine 1 mg/ml Syrup, 330
Leucovorin Calcium (Calcium Folinate) 50 mg Loratadine 10 mg Tablet, 330
Injection, 274 Loratadine 5 mg and Pseudoephedrine
Leukeran, 257 Sulphate 120 mg Tablet, 330
Leunase, 265 Lorazepam 1 mg Tablet, 113
Levetiracetam 500 mg Tablet, 137 Losartan 50 mg Tablet, 52
Levobupivacaine 5mg/ml Injection, 378 Losartan Potassium 100 mg and
Levocetirizine Dihydrochloride 5 mg Tablet, Hydrochlorothiazide 12.5 mg Tablet, 53
329 Losartan Potassium 50 mg and
Levodopa 100 mg and Carbidopa 25 mg Hydrochlorothiazide 12.5 mg Tablet, 54
Tablet, 147 Losec, 23
Levodopa 100 mg, Benserazide 25 mg HBS Lovastatin 20 mg Tablet, 79
capsule, 145 Loxof, 177
Levodopa 200 mg, Benserazide 50 mg Tablet, Lugol's Solution, 213
146 Lumigan, 314
Levodopa 250 mg and Carbidopa 25 mg Luminal, 138
Tablet, 147 Luvox, 126
Levofloxacin 500 mg Tablet, 177 Maalox Plus, 31
Levonorgestrel 1.5mg Tablet, 239 Mabthera, 275
Levonorgestrel Releasing Intrauterine System, Madopar, 145, 146
240 Magnesium Sulphate 45% Paste, 359
Levophed, 67 Magnesium Sulphate 50% Injection, 286
Levothyroxine Sodium 100 mcg Tablet, 213 Magnesium Trisilicate Mixture, 18
Levothyroxine Sodium 25 mcg Tablet, 214 Magnesium Trisilicate Tablet, 18
Lexapro, 125 Magnesium, Aluminium Hydroxide and
Lidocaine 25mg and Prilocaine 25mg Cream, Simethicone Suspension, 31
375 Mannitol 10% Injection (10 g/100 ml), 44
Lignocaine 10 % w/w Spray, 375 Mannitol 20% Injection (20 g/100 ml), 44
Lignocaine 2% Jelly, 376 Marcaine, 377
Lignocaine 2% Viscous Solution, 379 Marcaine Spinal Heavy, 376
Lignocaine HCl (Lidocaine) 2% Injection, 379 Marcaine-Adrenaline, 377
Marvelon, 239
396
Maxipime, 163 Micardis, 58
Maxitrol, 309, 310 Micardis Plus. See
Maxolon, 35, 36 Miconazole 2% Cream, 339
Mebeverine HCl 135 mg Tablet, 21 Midazolam 5 mg/ml Injection, 369
Meclozine HCl 25 mg and Pyridoxine 50 mg Midazolam 7.5 mg Tablet, 370
Tablet, 35 Milton, 386
Mecobalamin 500 mcg Tablet, 155 Minipress, 57
Medroxyprogesterone Acetate 150 mg/3 ml Minirin, 219, 220
Injection, 240 Minoxidil 5 mg Tablet, 55
Medroxyprogesterone Acetate 5 mg Tablet, Mirena, 240
232 Mirtazapine 15 mg Orodispersible Tablet, 127
Mefenamic Acid 250 mg Tablet, 110 Mirtazapine 30 mg Orodispersible Tablet, 127
Meloxicam 7.5 mg Tablet, 302 Mist Carminative Paed, 18
Melphalan 2 mg Tablet, 266 Mitomycin-C, 268
Meningococcal A, C, Y, W 135 Vaccine Mitomycin-C 10 mg Injection, 268
Injection, 363 Mitoxantrone 20 mg/10ml Injection, 269
Menthol 1.6% in Industrial Methylated Spirit Mixtard, 209
Inhalation, 332 Mobic, 302
Mercaptopurine 50 mg Tablet, 266 Moclobemide 150 mg Tablet, 128
Meronem, 178 Moduretic, 42
Meropenem 1 g Injection, 178 Mometasone Furoate 0.1% Cream, 341
Meropenem 500 mg Injection, 178 Mometasone Furoate 50 mcg Aqueous Nasal
Mesalazine 500 mg Tablet, 32 Spray, 323
Mesna 400 mg/4 ml Injection, 14 Montelukast Sodium 10 mg Tablet, 92
Mestinon, 156 Montelukast Sodium 4 mg Oral Granules, 92
Metalyse, 73 Montelukast Sodium 5 mg Chewable Tablet,
Metformin 500 mg and Glibenclamide 2.5 mg 93
Tablet, 210 Morphine HCl 10 mg/5 ml Solution, 100
Metformin 500 mg and Glibenclamide 5 mg Morphine Sulphate 10 mg Controlled Release
Tablet, 210 Tablet, 100
Metformin HCl 500 mg Extended Release Morphine Sulphate 10 mg/ml Injection, 101
Tablet, 210 Morphine Sulphate 30 mg Controlled Release
Metformin HCl 500 mg Tablet, 211 Tablet, 100
Methadone 5mg/ml Syrup, 150 Motilium, 19
Methotrexate 2.5 mg Tablet, 267 Moxifloxacin 0.5% Ophthalmic Solution, 309
Methotrexate 50 mg Injection, 268 MST Continus, 100
Methyl Salicylate 25% Ointment, 110 Multivitamin Injection, 289
Methylcobal, 155 Multivitamin Syrup, 290
Methyldopa 250 mg Tablet, 54 Multivitamin Tablet, 290
Methylene Blue 1% Injection, 14 Mupirocin 2% Ointment, 352
Methylphenidate HCl 10 mg Tablet, 129 Myambutol, 174
Methylprednisolone Sodium Succinate 0.5 g Mycophenolate Mofetil 250 mg tablet, 253
Injection, 216 Mycophenolate Mofetil 500 mg tablet, 253
Metoclopramide HCl 10 mg Tablet, 35 Mycophenolate Sodium 360mg Tablet, 250
Metoclopramide HCl 10 mg/2 ml Injection, 36 Mycostatin, 189, 353
Metoclopramide HCl 5 mg/5 ml Syrup, 36 Mydfrin, 312
Metoprolol Tartrate 100 mg Tablet, 49 Mydriacyl, 313
Metrogyl, 178 Myfortic, 250
Metronidazole 200 mg Tablet, 178 Myonal, 303
Metronidazole 500 mg/100 ml Injection, 178 Nalbuphine HCl 10 mg/ml Injection, 102
Mevacor, 79 Naloxone HCl 0.4 mg/ml Injection, 14
Miacalcic, 223 Naproxen Sodium 275 mg Tablet, 302
397
Narcan, 14 Ondansetron, 37
Naropin, 380 One-alpha, 286
Nasonex, 323 One-Alpha, 287
Navidoxine, 35 Opticrom, 319
Neo-mercazole, 212 Oral Rehydration Salt, 278
Neomycin 0.5% Cream, 353 Orbenin, 171, 172
Neostigmine Methylsulphate 2.5 mg/ml Oroxine, 213
Injection, 155 Orudis, 109
Neotigason, 342 Oxaliplatin 50 mg Injection, 269
Netilmicin Sulphate 150mg/2ml Injection, 179 Oxycodone HCl 10 mg Immediate Release
Netromycin, 179 Capsules, 103
Neupogen, 273 Oxycodone HCl 10 mg Prolonged Release
Neurobion, 292, 293 Tablet, 102
Neurontin, 136 Oxycodone HCl 20 mg Prolonged Release
Nevirapine 200 mg Tablet, 195 Tablet, 102
Nexium, 21, 22 Oxycodone HCl 5 mg Immediate Release
Nifedipine 10 mg Tablet, 63 Capsules, 103
Nimodipine 10 mg/50 ml Infusion Solution, 64 Oxycontin, 102
Nimotop, 64 Oxymetazoline HCl 0.025% (Paediatric) Nasal
Nipride, 57 Spray, 324
Nitro-bid, 62 Oxymetazoline HCl 0.05% (Adult) Nasal Spray,
Nitrofurantoin 100 mg Tab, 179 324
Nizoral, 189, 348 Oxynorm, 103
Nolvadex, 272 Oxytocin 10 units/ml Injection, 236
Nootropil, 147, 153 Oxytocin 5 units & Ergometrine Maleate 0.5
Noradrenaline Acid Tartrate (Norepinephrine mg/ml Injection, 237
Bitartrate) 4 mg/4 ml Injectio, 67 Paclitaxel 30 mg/5 ml Injection, 270
Norethisterone 0.35mg Tablet, 241 Paliperidone 3mg Extended Release Tablet,
Norethisterone Enanthate 200 mg/ml 123
Injection, 241 Paliperidone 6mg Extended Release Tablet,
Noriday, 241 123
Noristerat, 241 Palivizumab 100mg Injection, 196
Norvasc, 60 Pamidronate Disodium 30 mg Injection, 224
Norvir, 196 Panadol, 97
Novantrone, 269 Pancuronium Bromide 4 mg/2 ml lnj, 373
Novonorm, 211 Panoxyl, 347
Novorapid, 207 Pantoprazole 40 mg Injection, 23
Novoseven, 75 Pantoprazole 40 mg Tablet, 24
Nubain, 102 Papase, 303
Nuelin, 89 Paracetamol 120 mg/5 ml Syrup, 97
Nuelin SR, 89 Paracetamol 125 mg Suppository, 97
Nystatin 100,000 units/g Cream, 353 Paracetamol 250 mg Suppository, 97
Nystatin 100,000 units/ml Suspension, 189 Paracetamol 500 mg Tablet, 97
Octreotide 0.1 mg/ml Injection, 220 Paraffin, White Soft, 338
Ofloxacin 0.3% Otic Solution, 322 Paraffin, Yellow Soft, 338
Ofloxacin 100 mg Tablet, 180 Paraplatin, 256
Okavax, 364 Parecoxib Sodium 40mg Injection, 98
Olanzapine 10mg Disintegrating Tablet, 117 Parentrovite, 289
Olanzapine 5mg Disintegrating Tablet, 117 Pariet, 24
Omeprazole 20 mg Capsule, 23 Parlodel, 225
Omeprazole 40 mg Injection, 23 Parvolex, 9
Oncovin, 271 Pavulon, 373
398
Pegasys, 274 Potassium Dihydrogen Phosphate Injection,
Peginterferon Alpha-2a 180 mcg Prefilled 286
Syringe, 274 Potassium Permanganate 1:10,000 Solution,
Penadur L.A, 162 357
Penbritin, 160, 161 Povidone Iodine 10% (equivalent to 1%
Penglobe, 162 iodine) Solution, 358
Penicillin V, 180 Pradaxa, 70
Pentothal, 372 Pralidoxime 0.5 g/20 ml Injection, 15
Pentoxifylline 400 mg Tablet, 64 Pramipexole Dihydrochloride 0.125 mg Tablet,
Perindopril 4 mg and Indapamide 1.25 mg 148
Tablet, 55 Pravachol, 79
Perindopril 4 mg Tablet, 56 Pravastatin Sodium 20 mg Tablet, 79
Perindopril 8 mg Tablet, 56 Prazosin HCl 1 mg Tablet, 57
Permethrin 5% w/v Lotion, 353 Prazosin HCl 2 mg Tablet, 57
Perphenazine 4 mg Tablet, 118 Precedex, 368
Persantin, 72 Prednisolone 3 mg/5 ml Syrup, 217
Pethidine HCl 100 mg/2 ml Injection, 104 Prednisolone 5 mg Tablet, 217
Pethidine HCl 50 mg/ml Injection, 104 Prednisone, 217
Phenergan, 331 Pregnyl, 233
Phenobarbitone 30 mg Tablet, 138 Premarin, 229, 231, 238
Phenobarbitone Sodium 200 mg/ml Injection, Premelle 2.5, 229
138 Prevacid, 22
Phenoxymethyl Penicillin 125 mg Tablet, 180 Primaquine 7.5 mg base Tablet, 200
Phenylephrine HCI 2.5% Eye Drops, 312 Procaine Benzylpenicillin Aqueous 4 mega
Phenytoin Sodium 100 mg Capsule, 139 units (4 g) Injection, 181
Phenytoin Sodium 125 mg/5ml Suspension, Prochlorperazine Maleate 5mg Tablet, 37
139 Prochlorperazine Mesylate 12.5 mg/ml
Phenytoin Sodium 250 mg/5ml Injection, 140 Injection, 38
Pilocarpine 2% Eye Drops, 316 Procyclidine HCl 10 mg/2 ml Injection, 149
Piperacillin 4 g & Tazobactam 500 mg Injectio, profilnine, 75
181 Progesterone 8% Vaginal Gel, 218
Piracetam 1 g Injection, 153 Prograf, 250
Piracetam 1.2 g Tablet, 147 Progyluton, 231
Piribedil 50 mg Tablet, 148 Progynova, 231
Piriton, 327, 328 Prolase Tablet, 303
Pitocin, 236 Promethazine HCl 25 mg/ml Injection, 331
Pitressin, 222 Promethazine HCl 5 mg/5 ml Syrup, 331
Pizotifen 0.5 mg Tablet, 132 Proparacaine HCI 0.5% Ophthalmic Drops, 317
Plaquenil, 301 Propofol 1 % Injection, 371
Platinul, 257 Propranolol HCl 40 mg Tablet, 49
Plavix, 71 Propylthiouracil 50 mg Tablet, 214
Plendil, 61 Proscar, 244
Pneumo 23, 363 Prostigmine, 155
Pneumococcal Vaccine (Polyvalent), 363 Prostin E2, 235
Podophyllum 10 - 20% Paint, 348 Prostin VR, 81
Polytar, 345 Protamine Sulphate 50 mg/5 ml Injection, 15
Ponstan, 110 Prothiaden, 124
Potassium Chloride 1 g/10 ml Injection, 278 Protopam, 15
Potassium Chloride 1 g/15 ml Mixture, 279 Provera, 232, 240
Potassium Chloride 600 mg SR Tablet, 279 Prozac, 126
Potassium Citrate 3 g/10 ml and Citric Acid Pulmicort, 91
Mixture, 246 Puri-Nethol, 266
399
Pyrazinamide 500 mg Tablet, 182 Rosiglitazone 8 mg Tablet, 211
Pyridostigmine Bromide 60 mg Tablet, 156 Rosuvastatin 10 mg Tablet, 80
Pyridoxine HCl 10 mg Tablet, 290 Rosuvastatin 20 mg Tablet, 80
Quetiapine Fumarate 300 mg Extended Salazopyrin, 32
Release Tablet, 119 Salbutamol 0.5 % Inhalation Solution, 85
Quetiapine Fumarate 400 mg Extended Salbutamol 0.5 mg/ml Injection, 85
Release Tablet, 119 Salbutamol 100 mcg/dose Inhalation, 86
Quinine Dihydrochloride 600 mg/2 ml Salbutamol 2 mg Tablet, 86
Injection, 201 Salbutamol 200 mcg Inhalation Powder, 87
Quinine Sulphate 300 mg Tablet, 201 Salbutamol 5 mg/5 ml Injection, 242
Rabeprazole Sodium 20 mg Tablet, 24 Salicylazosulphapyridine (Sulfasalazine) 500
Rabies Human Diploid Cell Vaccine mg Tablet, 32
(Lyophilised) Injection, 363 Salicylic Acid 2 - 10% Ointment, 345
Raloxifene HCl 60 mg Tablet, 242 Salmeterol 25 mcg and Fluticasone
Ramipril 5 mg Tablet, 57 Propionate 125 mcg Inhalation, 94
Ranitidine 150 mg Tablet, 25 Salmeterol 50 mcg and Fluticasone
Ranitidine 150 mg/10 ml Syrup, 25 Propionate 250 mcg Inhalation, 94
Ranitidine 300 mg Table, 25 Salofalk, 32
Ranitidine 50 mg/2 ml Injection, 26 Sandimmum Neoral, 252
Ravin, 28 Sandimmun Neoral, 251
Renitec, 51 Sandomigran, 132
Repaglinide 2 mg Tablet, 211 Sandostatin, 220
Requip, 149 Scoline, 374
Retin-A, 348 Sebivo, 197
Retrovir, 198, 199 Selegiline HCl 5 mg Tablet, 150
Rhogam, 365 Selenium Sulphide 2.5% Shampoo, 349
Riboflavine 3 mg Tablet, 291 Selsun, 349
Rifadin, 182 Serenace, 116
Rifampicin 150 mg Capsule, 182 Seretide, 94
Rifampicin 300 mg Capsule, 182 Seroquel XR, 119
Ringer's Solution Injection (contained sodium Sertraline HCI 50 mg Tablet, 128
chloride, potassium chloride and calcium Sevoflurane Liquid, 371
chloride), 280 Sevorane, 371
Risperdal, 119 Sibelium, 132
Risperidone 1 mg Tablet, 119 Sifrol, 148
Risperidone 2 mg Tablet, 119 Silver Sulfadiazine 1% Cream, 354
Ritalin, 129 Simvastatin 20 mg Tablet, 80
Ritonavir 100 mg Capsule, 196 Simvastatin 40 mg Tablet, 80
Rituximab 500 mg/50 ml Injection, 275 Didasine 100 mg Tablet (ddI), 191
Rivastigmine 1.5 mg Capsule, 151 Sinemet, 147
Rivastigmine 4.6mg/24hr Transdermal Patch, Singulair, 92, 93
152 Sitagliptin 100 mg Tablet, 212
Rivastigmine 9.5 mg/24hr Transdermal Patch, Skinoren, 346
152 SLN 40, 197
Rivotril, 135 Slow-K, 279
Roaccutane, 347 Sodium Bicarbonate 5% w/v Ear Drops, 322
Rocaltrol, 288 Sodium Bicarbonate 8.4% (1 mmol/ml)
Rocephin, 165, 166 Injection, 280
Rocuronium Bromide 10 mg/ml Injection, 373 Sodium Bicarbonate Mixture (Paediatric), 18
Ropinirole HCl 0.25 mg Tablet, 149 Sodium Bicarbonate, Citric Acid, Sodium
Ropivacaine HCl 2 mg/ml Injection, 380 Citrate and Tartaric Acid - 4 g per sachet,
Ropivacaine HCl 7.5 mg/ml Injection, 380 247
400
Sodium Bicarbonate, Magnesium Carbonate, Sulperazon, 164
Tincture Cardamom Compound Mixture, 19 Sulphamethoxazole 200 mg & Trimethoprim
Sodium Biphosphate 16%, Sodium Phosphate 40 mg/5ml Suspension, 183
6% Solution, 33 Sulphamethoxazole 400 mg & Trimethoprim
Sodium Chloride 0.18% with Dextrose 10% 80 mg Injection, 183
Injection, 280 Sulphamethoxazole 400 mg & Trimethoprim
Sodium Chloride 0.18% with Dextrose 4.23% 80 mg Tablet, 184
Injection, 280 Sulpiride 200 mg Tablet, 120
Sodium Chloride 0.45% Injection, 281 Survanta, 93
Sodium Chloride 0.45% with Dextrose 10% Suxamethonium Chloride 50 mg/ml lnj, 374
Injection, 280 Symbicort, 94
Sodium Chloride 0.45% with Dextrose 5% Symmetrel, 144
Injection, 280 Synacthen, 221
Sodium Chloride 0.9% Eye Drops, 319 Synagis, 196
Sodium Chloride 0.9% with Dextrose 5% Synthetic ACTH (Tetracosactrin Acetate) 250
Injection, 280 mcg/ml Injection, 221
Sodium Chloride 20% Injection, 281 Syntometrine, 237
Sodium Chloride 3% Injection, 282 Tacrolimus 0.5 mg Capsule, 250
Sodium Cromoglycate 2% Eye Drops, 319 Tacrolimus 1 mg Capsule, 250
Sodium Fusidate 2% Ointment, 354 Tamoxifen Citrate 20 mg Tablet, 272
Sodium Hypochlorite Solution, 386 Tamsulosin HCl 400 mcg Extended Release
Sodium Lactate Compound (Hartmanns Tablet, 245
Solution/Ringer-lactate], 282 Tar, Coal Tar and Oleyl Alcohol Liquid, 345
Sodium Nitroprusside 50 mg/5 ml Injection, Tarivid, 180, 322
57 Taxol, 270
Sodium Thiosulphate 10-20% Solution, 355 Taxotere, 261
Sodium Thiosulphate 500 mg/ml Injection, 16 Tazocin 4.5g, 181
Sodium Valproate 200 mg Tablet, 141 Tegretol, 133, 134
Sodium Valproate 200 mg/5 ml Syrup. See Tegretol CR, 133
Sodium Valproate 400 mg Injection, 142 Telbivudine 600 mg Tablet, 197
Sofradex, 321 Telmisartan 40 mg Tablet, 58
Solu-Cortef, 216 Telmisartan 80 mg & Hydrochlorothiazide
Solu-Medrol, 216 12.5 mg Tablet, 58
Spersallerg, 310 Telmisartan 80 mg Tablet, 58
Spiriva, 90 Tenecteplase 10,000 unit (50 mg) Injection, 73
Spironolactone 25 mg Tablet, 45 Tenormin, 47
Sporanox, 188, 189 Terazosin HCl 1 mg Tablet, 245
Stavudine 30 mg Capsule, 196 Terazosin HCl 2 mg Tablet, 245
Stavudine 40 mg, Lamivudine 150 mg & Terbinafine HCl 250 mg Tablet, 190
Nevirapine 200 mg Tablet, 197 Terbutaline Sulphate 0.3 mg/ml Syru, 87
Stelazine, 121 Terbutaline Sulphate 0.5 mg/ml Injection, 88
Stemetil, 37, 38 Terbutaline Sulphate 10 mg/ml Inhalation
Stesolid, 136 Solution, 88
Stocrin, 192 Terbutaline Sulphate 2.5 mg Tablet, 89
Strattera, 152 Terlipressin 1 mg Injection, 221
Streptase, 73 Testosterone 250 mg/ml Injection, 218
Streptokinase 1,500,000 IU Injection, 73 Testoviron-Depot, 218
Streptomycin Sulphate 1 g Injection, 182 Tetanus Immunoglobulin Human 250
Stugeron, 335 Units/Vial Injection, 366
Sucralfate 1 g Tablet, 26 Tetanus Toxoid Injection, 364
Sulfadoxine 500 mg and Pyrimethamine 25 Theophylline 125 mg Tablet, 89
mg Table, 202 Theophylline 250 mg Long Acting Tablet, 89
401
Thiamine HCl 100 mg/ml Injection, 291 Uromitexan, 14
Thiamine Mononitrate 10 mg Tablet, 291 Ursodeoxycholic Acid 250 mg Capsule, 30
Thiopental Sodium 500 mg Injection, 372 Ursofalk, 30
Thymol Compound Gargle, 326 Valium, 135, 154
Tibolone 2.5 mg Tablet, 233 Valsartan 80 mg and Hydrochlorothiazide 12.5
Ticlid, 72 mg Tablet, 59
Ticlopidine HCl 250 mg Tablet, 72 Valsartan 80 mg Tablet, 59
Tienam, 176 Vancocin, 185
Timo-comod, 316 Vancomycin HCL 500mg Injection, 185
Timolol Maleate 0.5% Eye Drops, 316 Varicella Virus Vaccine Live Attenuated
Timoptol, 316 Injection, 364
timoptol-XE, 316 varilrix, 364
Tiotropium Bromide Inhalation 18 mcg varivax, 364
Capsules, 90 Vaseline, 338
Tolterodine Tartrate ER 2 mg Capsule, 246 Vasopressin 20 units/ml Injection, 222
Topamax, 143 Vastarel, 81
Topiramate 15 mg Capsule Sprinkle, 143 Vastarel MR, 81
Topiramate 25 mg Tablet, 143 Velbe, 270
Topiramate 50 mg Tablet, 143 Venlafaxine HCl 75 mg Extended Release
Toradol, 96 Capsule, 129
Trace Elements and Electrolytes (Adult) Venofer, 298
Solution, 284 Ventolin, 85, 86, 242
Tracrium, 372 Vepesid, 262
Tramadol HCl 50 mg Capsule, 104 Verapamil HCl 40 mg Tablet, 65
Tramadol HCl 50 mg/ml Injection, 105 Verapamil HCl 5 mg/2 ml Injection, 65
Tramal, 104, 105 Vesanoid, 255
Trandate, 48, 49 Vibramycin, 172
Tranexamic Acid 100 mg/ml Injection, 76 Videx, 191, 192
Tranexamic Acid 250 mg Capsule, 76 Vigamox, 309
Transamin, 76 Vinblastine Sulphate 10 mg Injection, 270
Trental, 64 Vincristine Sulphate 1 mg Injection, 271
Tretinoin 0.05% Cream, 348 Vitamin B Complex 10 ml Injection, 292
Triamcinolone Acetonide 0.1% Oral Paste, 326 Vitamin B Complex Tablet, 292
Triamcinolone Acetonide 40 mg/ml Injection, Vitamin B1, B6, B12 Injection, 292
218 Vitamin B1, B6, B12 Tablet, 293
Trifluoperazine HCI 5 mg Tablet, 121 Vitamin K1 1 mg/ml Injection, 293
Trimetazidine 20 mg Tablet, 81 Vitamin K1 10 mg/ml Injection, 294
Trimetazidine 35 mg MR Tablet, 81 Voltaren, 106, 107, 108
Trimethoprim 300 mg Tablet, 184 Vytorin, 77
Triprolidine HCl 2.5 mg and Pseudoephedrine Warfarin Sodium 1 mg Tablet, 70
HCl 60 mg Tablet, 334 Warfarin Sodium 2 mg Tablet, 70
Tritace, 57 Warfarin Sodium 3 mg Tablet, 70
Trivastal Retard, 148 Warfarin Sodium 5 mg Tablet, 70
Tropicamide 1% Eye Drops, 313 Water for Injection, 283
Trusopt, 315 Whitfields, 350
Tuberculine, 364 Xalatan, 315
Tuberculine PPD Injection, 364 Xanax, 112
Unasyn 1.5, 160 Xeloda, 256
Ural, 247 Xylocaine, 376, 379
Urispas, 246 Xyloproct, 30
Urokinase, 74 Xyzal, 329
Urokinase 6000 IU Injection, 74 Zantac, 25, 26
402
Zavedos, 264 Zofran, 37
Zeffix, 194 Zoladex, 227
Zeldox, 123 Zoledronic Acid 4 mg Injection, 225
Zentel, 202 Zoloft, 128
Zerit, 196 Zometa, 225
Zidovudine 1% Injection, 198 Zovirax, 190, 191, 311, 349
Zidovudine 10 mg/ml Syrup, 198 Zuclopenthixol Acetate 50 mg/ml Injection,
Zidovudine 100 mg Capsule, 199 122
Zidovudine 300 mg & Lamivudine 150 mg Zuclopenthixol Decanoate 200 mg/ml
Tablet, 199 Injection, 122
Zinacef, 167 Zydis, 117
Zinc Oxide Cream, 346 Zyloric, 303
Zinnat, 167 Zyprexa, 117
Ziprasidone 20mg/ml Injection, 123 Zyrtec, 327
Zithromax, 161 Zyvox, 177
Zocor, 80
403