Dispensing Guidelines PDF

THE REPUBLIC OF UGANDA
MINISTRY OF HEALTH
Practical
Guideline for
Dispensing at Higher
Level Health Centres
2015
National Guidelines for Medicines

Information at HC IV and Hospitals
Published by the Ministry of Health Uganda
First Edition: 2015
Any part of these guidelines may be reproduced in any

form without the prior permission of the publisher, pro-
vided that this is not for profit and that due acknowl-
edgement is given.
Any reproduction for profit must be given prior permission
from the Ministry of Health.
Copies may be obtained from the:

Assistant Commissioner for Health Services
Pharmacy Division, Ministry of Health
Plot 6 Lourdel Road, P.O.Box 7272
Kampala, Uganda
Tel: +256-414-345322
Fax: +256-414-231572
Email: serumorries@gmail.com
Website: www.health.go.ug
Disclaimer
Every effort has been made to ensure that the information
in this book is accurate, complete, and conforms to the
current therapeutic practice. However, the publisher, edi-
tor, and contributors cannot be held responsible for any
errors, omissions, individual patient responses to recom-
mended therapies, or other consequences that may arise
from its use.
THE REPUBLIC OF UGANDA
MINISTRY OF HEALTH
Practical
Guideline for
Dispensing at Higher
Level Health Centres
2015
National Guidelines for Medicines

Information at HC IV and Hospitals
Table of Contents
Abbreviations.................................................................... 16
Foreword .......................................................................... 20
Preface .............................................................................. 22
Acknowledgements .......................................................... 24
Good Prescribing Practice................................................. 26
Good Dispensing Practice ................................................. 30
Information in Monographs ............................................. 40
MONOGRAPHS ................................................................. 49
A .................................................................................... 49
ABACAVIR (ABC) ....................................................... 49
ABACAVIR + LAMIVUDINE (ABC+3TC) ...................... 51
ACETAZOLAMIDE ...................................................... 51
ACETYLSALICYLIC ACID (ASPIRIN) ............................. 53
ACYCLOVIR (ACICLOVIR) ........................................... 55
ADENOSINE ............................................................... 57
ADRENALINE (EPINEPHRINE) .................................... 59
ALBENDAZOLE .......................................................... 59
ALBUMIN, HUMAN ................................................... 60
ALCOHOL WITH GLYCERIN ........................................ 62
ALLOPURINOL ........................................................... 63
ALPRAZOLAM............................................................ 66
AMIKACIN ................................................................. 68
AMINOPHYLLINE ....................................................... 70
AMIODARONE........................................................... 72
AMITRIPTYLINE ......................................................... 76
AMLODIPINE ............................................................. 78
Practical Guideline for Dispensing (PGD HL) 2015 1
AMOXICILLIN ............................................................. 80
AMOXICILLIN + CLAVULANIC ACID............................ 82
AMPHOTERICIN B ..................................................... 84
AMPICILLIN ............................................................... 87
AMPICILLIN + CLOXACILLIN ....................................... 89
ANTHRAX VACCINE ................................................... 90
ANTI-D IMMUNOGLOBULIN, HUMAN ...................... 91
ANTIRABIES IMMUNOGLOBULIN, HUMAN .............. 93
ANTIRABIES VACCINE, HUMAN DIPLOID .................. 95
ANTITETANUS IMMUNOGLOBULIN, HUMAN (TIG) .. 97
ANTIVENOM SERA POLYVALENT .............................. 98
ARTEMETHER ............................................................ 99
ARTEMETHER + LUMEFANTRINE ............................ 100
ARTESUNATE........................................................... 101
ARTESUNATE + AMODIAQUINE .............................. 104
ASCORBIC ACID ....................................................... 106
ASPARAGINASE ....................................................... 107
ASPIRIN (ACETYLSALICYLIC ACID)............................ 110
ATAZANAVIR + RITONAVIR (ATV/r)......................... 110
ATENOLOL ............................................................... 111
ATORVASTATIN ....................................................... 113
ATRACURIUM BESILATE .......................................... 115
ATROPINE................................................................ 118
AZATHIOPRINE ........................................................ 121
AZITHROMYCIN ....................................................... 124
B .................................................................................. 126
BCG VACCINE .......................................................... 126
BECLOMETHASONE................................................. 128
BENDROFLUMETHIAZIDE ........................................ 130
BENZATHINE BENZYLPENICILLIN............................. 131
BENZHEXOL (TRIHEXYPHENIDYL) ............................ 133
2 Practical Guideline for Dispensing (PGD HL) 2015
BENZOIC ACID + SALICYLIC ACID (WHITFIELD’S
OINTMENT) ............................................................. 135
BENZOYL PEROXIDE ................................................ 136
BENZTROPINE ......................................................... 138
BENZYL BENZOATE.................................................. 139
BENZYLPENICILLIN .................................................. 141
BETAMETHASONE................................................... 143
BISACODYL .............................................................. 146
BISMUTH SUBGALLATE COMPOUND ..................... 148
BLEOMYCIN............................................................. 149
BROMOCRIPTINE .................................................... 151
BUPIVACAINE .......................................................... 154
C .................................................................................. 156
CALAMINE............................................................... 156
CALCIUM CHLORIDE (DIHYDRATE) ......................... 157
CALCIUM FOLINATE (FOLINIC ACID) ....................... 159
CALCIUM GLUCONATE............................................ 161
CALCIUM LACTATE.................................................. 162
CANDESARTAN CILEXETIL ....................................... 163
CAPREOMYCIN ........................................................ 165
CAPTOPRIL .............................................................. 166
CARBAMAZEPINE .................................................... 168
CARBIMAZOLE ........................................................ 171
CARBOPLATIN ......................................................... 172
CARVEDILOL ............................................................ 174
CEFALEXIN (CEPHALEXIN) ....................................... 178
CEFIXIME................................................................. 180
CEFTRIAXONE ......................................................... 181
CEFUROXIME .......................................................... 184
CETIRIZINE .............................................................. 187
CETRIMIDE + CHLORHEXIDINE ................................ 188
CHARCOAL (ACTIVATED) ......................................... 189
CHLORAMBUCIL ...................................................... 190
CHLORHEXIDINE...................................................... 195
CHLOROQUINE BASE............................................... 198
CHLORPHENIRAMINE (CHLORPHENAMINE) MALEATE
................................................................................ 199
CHLORPROMAZINE ................................................. 201
CICLOSPORIN .......................................................... 203
CIPROFLOXACIN ...................................................... 208
CISATRACURIUM ..................................................... 211
CISPLATIN................................................................ 213
CLOFAZIMINE .......................................................... 217
CLOMIFENE ............................................................. 219
CLONAZEPAM ......................................................... 221
CLOTRIMAZOLE ....................................................... 223
CLOXACILLIN ........................................................... 225
COAL TAR ................................................................ 226
CODEINE PHOSPHATE ............................................. 228
COLCHICINE ............................................................ 230
CORTISONE ACETATE .............................................. 232
COTRIMOXAZOLE .................................................... 234
CYCLOPENTOLATE................................................... 236
CYCLOPHOSPHAMIDE ............................................. 238
CYCLOSERINE .......................................................... 241
CYTARABINE ............................................................ 242
D .................................................................................. 245
DACARBAZINE ......................................................... 245
DACTINOMYCIN (ACTINOMYCIN D) ........................ 247
DARROW'S SOLUTION ............................................ 249
DAPSONE ................................................................ 249
DAUNORUBICIN ...................................................... 251
DESFERRIOXAMINE MESILATE (DESFEROXAMINE
MESILATE) ............................................................... 253
DESFLURANE ........................................................... 256
DEXAMETHASONE .................................................. 258
DEXAMETHASONE + TOBRAMYCIN ........................ 261
DEXTRAN 70............................................................ 262
DEXTROSE (GLUCOSE) ............................................ 263
DIAZEPAM............................................................... 263
DICLOFENAC ........................................................... 266
DIETHYLCARBAMAZINE .......................................... 268
DIGOXIN .................................................................. 271
DIHYDROARTEMISININ + PIPERAQUINE ................. 273
DIMERCAPROL ........................................................ 275
DITHRANOL ............................................................. 277
DOBUTAMINE ......................................................... 278
DOCETAXEL ............................................................. 280
DOMPERIDONE ....................................................... 282
DOPAMINE.............................................................. 284
DOXORUBICIN (ADRIAMYCIN) ................................ 286
DOXYCYCLINE.......................................................... 288
DPT VACCINE .......................................................... 290
DPT-HepB-Hib ......................................................... 292
DROPERIDOL ........................................................... 293
E .................................................................................. 296
EFAVIRENZ (EFV) ..................................................... 296
EMTRICITABINE (FTC) ............................................. 298
ENALAPRIL .............................................................. 299
ENOXAPARIN .......................................................... 302
EPHEDRINE ............................................................. 305
EPINEPHRINE (ADRENALINE) .................................. 307
ERGOCALCIFEROL (VITAMIN D2) ............................. 309
ERGOMETRINE MALEATE ....................................... 311
ERGOTAMINE .......................................................... 312
ERYTHROMYCIN ...................................................... 314
ETHAMBUTOL (E) .................................................... 317
ETHINYLESTRADIOL + LEVONORGESTREL ............... 319
ETHINYLESTRADIOL + NORETHISTERONE ............... 319
ETHINYLESTRADIOL + NORGESTREL ....................... 319
ETHIONAMIDE ........................................................ 322
ETHOSUXIMIDE ....................................................... 324
ETOMIDATE............................................................. 326
ETONOGESTREL ...................................................... 328
ETOPOSIDE .............................................................. 330
F................................................................................... 332
FACTOR VIII CONCENTRATE (HUMAN COAGULATION
FACTOR VIII) ............................................................ 332
FACTOR IX (COAGULATION FACTORS II, VII, IX, X)
COMPLEX CONCENTRATE ....................................... 333
FENTANYL ............................................................... 334
FERROUS SALT ........................................................ 337
FERROUS SALT + FOLIC ACID................................... 339
FLUCLOXACILLIN + AMOXICILLIN ............................ 341
FLUCONAZOLE ........................................................ 342
FLUCYTOSINE .......................................................... 346
FLUMAZENIL ........................................................... 347
FLUOROURACIL ....................................................... 350
FLUOXETINE ............................................................ 352
FLUPHENAZINE DECANOATE .................................. 354
FOLIC ACID (VITAMIN B9) ........................................ 356
FRAMYCETIN ........................................................... 357
FUROSEMIDE .......................................................... 359
G .................................................................................. 362
GANCICLOVIR EYE OINTMENT ................................ 362
GANCICLOVIR SODIUM ........................................... 363
GEMCITABINE ......................................................... 365
GENTAMICIN........................................................... 368
GENTIAN VIOLET (METHYLROSANILINIUM CHLORIDE)
................................................................................ 371
GLIBENCLAMIDE ..................................................... 371
GLIMEPIRIDE ........................................................... 373
GLUCOSE (DEXTROSE) ............................................ 374
GLUTARALDEHYDE.................................................. 376
GLYCERYL TRINITRATE ............................................ 378
GLYCOPYRROLATE (GLYCOPYRRONIUM BROMIDE)380
GOSERELIN .............................................................. 382
GRANISETRON ........................................................ 384
GRISEOFULVIN ........................................................ 386
H .................................................................................. 388
HALOPERIDOL ......................................................... 388
HALOPERIDOL DECANOATE .................................... 391
HALOTHANE............................................................ 393
HEPARIN ................................................................. 394
HEPATITIS B VACCINE ............................................. 397
HYALURONIDASE .................................................... 399
HYDROGEN PEROXIDE ............................................ 404
HYDROXOCOBALAMIN (VITAMIN B12) .................... 406
HYDROXYETHYLCELLULOSE (ARTIFICIAL TEARS) .... 407
HYDROXYUREA (HYDROXYCARBAMIDE) ................ 408
HYOSCINE BUTYLBROMIDE .................................... 410
I ................................................................................... 413
IBUPROFEN ............................................................. 413
IFOSFAMIDE ............................................................ 415
IMIPRAMINE ........................................................... 416
INDOMETHACIN ...................................................... 419
INSULIN ................................................................... 421
IODINE..................................................................... 424
IODINE + POTASSIUM IODIDE ................................. 425
IRINOTECAN ............................................................ 427
ISOFLURANE............................................................ 428
ISONIAZID (H) .......................................................... 430
ISOSORBIDE DINITRATE .......................................... 433
IVERMECTIN ............................................................ 435
K .................................................................................. 436
KETAMINE ............................................................... 436
KETOCONAZOLE ...................................................... 440
L ................................................................................... 441
LABETALOL .............................................................. 441
LACTULOSE ............................................................. 444
LAMIVUDINE (3TC).................................................. 446
LAMOTRIGINE ......................................................... 448
LEVODOPA + CARBIDOPA ....................................... 452
LEVOFLOXACIN ....................................................... 454
LEVONORGESTREL .................................................. 456
LEVOTHYROXINE ..................................................... 459
LIGNOCAINE (LIDOCAINE) ....................................... 461
LISINOPRIL............................................................... 463
LITHIUM CARBONATE ............................................. 465
LOPERAMIDE........................................................... 468
LOPINAVIR/RITONAVIR (LPV/r) ............................... 469
LORAZEPAM ............................................................ 471
LOSARTAN ............................................................... 474
M ................................................................................. 476
MAGNESIUM SULPHATE ......................................... 476

MAGNESIUM TRISILICATE COMPOUND ................. 478
MALATHION............................................................ 479
MANNITOL .............................................................. 481
MEASLES VACCINE .................................................. 482
MEBENDAZOLE ....................................................... 483
MEDROXYPROGESTERONE ACETATE...................... 485
MEFLOQUINE .......................................................... 486
MELARSOPROL ....................................................... 489
MENINGOCOCCAL VACCINE CONJUGATE (A + C) ... 490
MERCAPTOPURINE ................................................. 491
MEROPENEM .......................................................... 493
METFORMIN ........................................................... 495
METHIONINE .......................................................... 497
METHOTREXATE ..................................................... 498
METHYLDOPA ......................................................... 501
METHYLPHENIDATE ................................................ 503
METHYLPREDNISOLONE SODIUM .......................... 505
SUCCINATE.............................................................. 505
METHYLROSANILINIUM CHLORIDE ........................ 508
(GENTIAN VIOLET) .................................................. 508
METHYLTHIONINIUM CHLORIDE ............................ 509
(METHYLENE BLUE) ................................................ 509
METOCLOPRAMIDE ................................................ 511
METRONIDAZOLE ................................................... 513
MICONAZOLE .......................................................... 516
MIDAZOLAM ........................................................... 518
MISOPROSTOL ........................................................ 522
MITOMYCIN ............................................................ 524
MORPHINE .............................................................. 526
MOXIFLOXACIN....................................................... 528
MULTIVITAMIN ....................................................... 530

MUSTINE (MECHLORETHAMINE)............................ 531
N .................................................................................. 533
NALIDIXIC ACID ....................................................... 533
NALOXONE .............................................................. 534
NALTREXONE .......................................................... 536
NEOMYCIN + BACITRACIN ...................................... 538
NEOMYCIN + BETAMETHASONE ............................. 539
NEOMYCIN + DEXAMETHASONE ............................ 541
NEOSTIGMINE ......................................................... 542
NEVIRAPINE (NVP) .................................................. 545
NICLOSAMIDE ......................................................... 547
NIFEDIPINE .............................................................. 548
NIFURTIMOX ........................................................... 551
NITROFURANTOIN .................................................. 552
NITROUS OXIDE ...................................................... 553
NOREPINEPHRINE (NORADRENALINE) ................... 555
NORETHISTERONE .................................................. 557
NORMAL IMMUNOGLOBULIN, HUMAN ................. 559
NYSTATIN ................................................................ 561
O .................................................................................. 563
OFLOXACIN ............................................................. 563
OLANZAPINE ........................................................... 565
OMEPRAZOLE.......................................................... 567
ORAL REHYDRATION SALTS (ORS) .......................... 569
OSELTAMIVIR PHOSPHATE ..................................... 572
OXYGEN .................................................................. 574
OXYTOCIN ............................................................... 576
P .................................................................................. 579
P-AMINOSALICYLIC ACID ........................................ 579
PANCURONIUM BROMIDE...................................... 580

PAPAVERETUM + HYOSINE ..................................... 582
PARACETAMOL ....................................................... 584
PENICILLAMINE ....................................................... 585
PENTAMIDINE ISETHIONATE .................................. 588
PETHIDINE............................................................... 590
PHENOBARBITAL..................................................... 593
PHENOXYMETHYLPENICILLIN ................................. 595
PHENYLEPHRINE EYE DROPS .................................. 597
PHENYLEPHRINE HYDROCHLORIDE ........................ 598
PHENYTOIN ............................................................. 600
PHYTOMENADIONE (VITAMIN K) ........................... 603
PILOCARPINE .......................................................... 604
PIOGLITAZONE ........................................................ 606
PIRACETAM ............................................................. 608
PNEUMOCOCCAL POLYSACCHARIDE CONJUGATE
(PCV) VACCINE ........................................................ 610
PODOPHYLLUM RESIN ............................................ 611
POLIO VACCINE ....................................................... 612
POLYGELINE SOLUTION .......................................... 614
POTASSIUM CHLORIDE ........................................... 615
POTASSIUM PERMANGANATE ............................... 617
POVIDONE IODINE .................................................. 618
PRALIDOXIME ......................................................... 621
PRAZIQUANTEL ....................................................... 623
PREDNISOLONE ...................................................... 624
PROCAINAMIDE ...................................................... 627
PROCAINE BENZYLPENICILLIN (PPF) ....................... 629
PROCARBAZINE ....................................................... 631
PROCHLOPERAZINE MALEATE ................................ 632
PROGUANIL............................................................. 634
PROMETHAZINE...................................................... 635

PROPANTHELINE ..................................................... 638
PROPOFOL .............................................................. 639
PROPRANOLOL........................................................ 642
PROTAMINE ............................................................ 645
PROTHIONAMIDE.................................................... 647
PYRAZINAMIDE (Z) .................................................. 648
PYRIDOXINE (VITAMIN B6) ...................................... 650
PYRIMETHAMINE .................................................... 651
Q .................................................................................. 654
QUININE .................................................................. 654
R .................................................................................. 657
RABEPRAZOLE ......................................................... 657
RANITIDINE ............................................................. 659
REMIFENTANIL ........................................................ 661
RETINOL (VITAMIN A) ............................................. 665
RIFAMPICIN (R) ....................................................... 667
RIFAMPICIN + CLOFAZIMINE + DAPSONE ............... 671
RIFAMPICIN + DAPSONE ......................................... 671
RIFAMPICIN + ISONIAZID ........................................ 671
RIFAMPICIN + ISONIAZID + PYRAZINAMIDE ........... 672
RIFAMPICIN + ISONIAZID + PYRAZINAMIDE +
ETHAMBUTOL ......................................................... 672
RISPERIDONE .......................................................... 672
RITUXIMAB.............................................................. 675
ROCURONIUM BROMIDE ........................................ 677
ROTAVIRUS VACCINE .............................................. 679
S................................................................................... 680
SALBUTAMOL.......................................................... 680
SALICYLIC ACID ........................................................ 683
SEVOFLURANE ........................................................ 685

SILVER NITRATE ...................................................... 686
SILVER SULPHADIAZINE .......................................... 687
SODIUM BICARBONATE .......................................... 689
SODIUM CHLORIDE ................................................. 690
SODIUM CROMOGLYCATE ...................................... 692
SODIUM HYALURONATE......................................... 693
SODIUM LACTATE COMPOUND.............................. 694
SODIUM STIBOGLUCONATE ................................... 696
SODIUM THIOSULPHATE ........................................ 698
SODIUM VALPROATE .............................................. 698
SPIRONOLACTONE .................................................. 702
STILBOESTROL (DIETHYLSTILBESTROL) ................... 704
STREPTOKINASE ...................................................... 705
STREPTOMYCIN (S) ................................................. 708
SULFADOXINE + PYRIMETHAMINE (SP) .................. 710
SULPHUR + SALICYLIC ACID .................................... 711
SURAMIN SODIUM ................................................. 712
SUXAMETHONIUM (SUCCINYLCHOLINE) ................ 714
T .................................................................................. 717
TAMOXIFEN ............................................................ 717
TEMOZOLOMIDE .................................................... 719
TENOFOVIR (TDF) ................................................... 721
TENOFOVIR + EMTRICITABINE (TDF+FTC) .............. 723
TENOFOVIR + LAMIVUDINE (TDF+3TC) .................. 723
TENOFOVIR + EMTRICITABINE + EFAVIRENZ
(TDF+FTC+EFV) ....................................................... 723
TENOFOVIR + LAMIVUDINE + EFAVIRENZ
(TDF+3TC+EFV) ....................................................... 724
TESTOSTERONE ENANTATE .................................... 724
TETANUS TOXOID (TT) ............................................ 726
TETRACAINE (AMETHOCAINE) ................................ 727
TETRACYCLINE ........................................................ 729
THALIDOMIDE ......................................................... 731
THIAMINE (VITAMIN B1) ......................................... 733
THIOGUANINE (TIOGUANINE) ................................ 734
THIOPENTAL SODIUM ............................................. 735
TIMOLOL MALEATE ................................................. 738
TINIDAZOLE ............................................................. 740
TRAMADOL ............................................................. 742
TRIAMCINOLONE ACETONIDE ................................ 743
TRIFLUOPERAZINE .................................................. 744
TOBRAMYCIN .......................................................... 747
TUBERCULIN, PURIFIED PROTEIN ........................... 748
DERIVATIVE (PPD) ................................................... 748
V .................................................................................. 749
VANCOMYCIN ......................................................... 749
VECURONIUM BROMIDE ........................................ 752
VINCRISTINE ............................................................ 754
VITAMIN A (RETINOL) ............................................. 756
VITAMIN B1 (THIAMINE) ......................................... 756
VITAMIN B6 (PYRIDOXINE) ...................................... 756
VITAMIN B9 (FOLIC ACID) ........................................ 756
VITAMIN B COMPOUND ......................................... 757
VITAMIN B COMPOUND (STRONG) ........................ 757
VITAMIN K1 (PHYTOMENADIONE) .......................... 758
W ................................................................................. 758
WARFARIN .............................................................. 758
WHITFIELD'S’OINTMENT......................................... 761
X .................................................................................. 761
XYLOMETAZOLINE................................................... 761
Y .................................................................................. 762
YELLOW FEVER VACCINE ........................................ 762
Z .................................................................................. 764
ZIDOVUDINE (AZT) .................................................. 764
ZIDOVUDINE + LAMIVUDINE .................................. 766
ZIDOVUDINE + LAMIVUDINE + NEVIRAPINE ........... 767
ZINC SULPHATE ....................................................... 767
ZUCLOPENTHIXOL DECANOATE.............................. 768
Calculation of Doses for Children ................................... 771
Integrated Management of Childhood Illness (IMCI)
Medicines ....................................................................... 775
Medicines for Integrated Community Case Management
(ICCM) of Childhood Illness ............................................ 778
UN Life Saving Commodities for Mothers and Children. 778
Adverse Drug Reaction Reporting .................................. 780
Glossary .......................................................................... 786
References ...................................................................... 800
Amendment Form .......................................................... 802
Index ............................................................................... 804
Notes............................................................................... 825

Abbreviations
Abbreviations
µg Microgram
3TC Lamivudine
ABC Abacavir
ACEI Angiotensin Converting Enzyme Inhibitor
ACT Artemisinin-based combination therapy
ADHD Attention Deficit Hyperactivity Disorder
ADR Adverse drug reaction
AIDS Acquired Immunodeficiency Syndrome
ALT Alanine Aminotransferase
APTT Activated Partial Thromboplastin Time
AST Aspartate Aminotransferase
ARV Antiretroviral medicine
ATV Atazanavir
ATV/r Atazanavir/ritonavir
AV Atrioventricular
AZT Azidothymidine (zidovudine)
BCG Bacillus Calmette-Guerin
BNF British National Formulary
BP Blood Pressure
bpm Beats per minute
BPC 73 British Pharmaceutical Codex 1973
CBC Complete Blood Count
CMV Cytomegalovirus
CNS Central Nervous System
COC Combined Oral Contraceptive
DPT Diphtheria, Pertussis and Tetanus
DVT Deep Vein Thrombosis
ECG Electrocardiogram
Abbreviations
EFV Efavirenz
eGFR estimated Glomerular Filtration Rate
ENL Erythema Nodosum Leprosum
FDC Fixed Dose Combination
FTC Emtricitabine
g Gram
GFR Glomerular Filtration Rate
GI Gastrointestinal
GnRH Gonadotropin Releasing Hormone
HBsAg Inactivated Hepatitis B surface antigen
HepB Hepatitis B vaccine
Hib Haemophilus influenza type B
HIV Human Immunodeficiency Virus
HMG-CoA 3-hydroxy-3-methylglutaryl coenzyme A
ICCM Integrated Community Case Management
IgA Immunoglobulin A
IgM Immunoglobulin G
IM Intramuscular
IMCI Integrated Management of Childhood Ill-
ness
INR International Normalized Ratio
IRIS Immune Reconstitution Inflammatory
Syndrome
IU International units
IV Intravenous
Kg Kilogram
L litre
LFTs Liver Function Tests
LPV/r Lopinavir/ritonavir
MAOI Monoamine Oxidase Inhibitor

Abbreviations
MB leprosy Multibacillary Leprosy
MDR TB Multi-Drug Resistant Tuberculosis
mg Milligram
ml millilitre
MRSA Methicillin-Resistant Staphylococcus
aureus
MTCT Mother-to-Child Transmission
MU Million Units
NADPH Nicotinamide Adenine Dinucleotide Phos-
phate, reduced form
NDA National Drug Authority
NG Nasogastric
NNRTI Non-nucleoside Reverse Transcriptase In-
hibitor
NRTI Nucleoside Reverse Transcriptase Inhibitor
NtRTI Nucleotide Reverse Transcriptase Inhibitor
NSAID Non-steroidal anti-inflammatory drug
NVP Nevirapine
ORS Oral Rehydration Salts
PB leprosy Paucibacillary Leprosy
PCA Patient-Controlled Analgesia
PCP Pneumocystis carinii pneumonia
PEP Post-exposure Prophylaxis
PI Protease Inhibitor
PID Pelvic Inflammatory Disease
PO Per os (Oral administration)
PPD Tuberculin, Purified Protein Derivative
PPE Palmar-Plantar Erythrodysesthesia
PPF Procaine benzylpenicillin
PPH Post-partum Haemorrhage

Abbreviations
PPI Proton Pump Inhibitor
PSBI Possible Serious Bacterial Infection
RHZE Rifampicin + Isoniazid + Pyrazinamide +
Ethambutol
RMNCH Reproductive, Maternal, Neonatal and
Child Health
RTV Ritonavir
SC Subcutaneous
SLE Systemic Lupus Erythematosus
SP Sulfadoxine + Pyrimethamine
SPC Summary of Product Characteristics
tab(s) Tablet(s)
TB Tuberculosis
TCI Target Controlled Infusion
TDF Tenofovir Disoproxil Fumarate
TPMT Thiopurine Methyltransferase
TT Tetanus toxoid
UCG Uganda Clinical Guidelines
UN United Nations
UNCoLSC United Nations Commission on Life-saving
commodities
WHO World Health Organisation

Foreword
Foreword
To achieve the maximum benefit of medicines, they must
be used appropriately. One cause of medicine misuse is
the lack of adequate and timely medicine information to
the patient. Poor dispensing and inadequate instructions
on how to take medicine can nullify health workers’ previ-
ous efforts to provide appropriate treatment to the pa-
tient.
Uganda for a long time lacked a reference guide dedicated
to providing medicines information to health workers and
dispensing staff. Few health workers have access to com-
monly known medicine information sources, such as the
British National Formulary (BNF) or reputable websites on
the Internet, and therefore collecting useful information
would be time intensive for health workers.
It is the mandate of the Ministry of Health and Pharmacy
Division in particular to ensure that medicines are used
appropriately and that up-to-date, unbiased, accurate, and
evidence-based information about medicines are provided
to health care professionals, patients, and any Ugandan
seeking such information.
In this regard, the Practical Guideline for Dispensing at
Higher Level health centres (PGD HL) 2015, therefore, is
well-timed to address the country’s pressing challenges of
accessing medicines information. This comes as follow-on
to the Practical Guideline for Dispensing at lower level
health facilities (PGD 2014) that was developed and dis-
seminated to all health centres II and III, but would not
serve the needs of higher level health centres, where a
wider spectrum of medicines is used.
The PGD HL 2015 target users are all health professionals
involved with prescribing, monitoring, dispensing and ad-
ministering medicines.

Foreword
The information herein has been aggregated across sever-
al reliable and evidence-based sources such as the Sum-
mary of Product Characteristics (SPCs), British National
Formulary, Martindale and World Health Organisation
Model Formulary. It has been summarised and adapted to
harmonise with the Uganda Clinical Guidelines 2012, the
Essential Medicine and Health Supplies List for Uganda
2012 and the most current treatment guidelines from the
ministry of health programmes. This information will help
the health workers ensure that patients derive optimal
benefits from medicines.
The PGD HL 2015 is easy to use, allowing the dispenser to
easily understand its information and share it with pa-
tients.
I hope the Practical Guideline for Dispensing will become
an essential reference tool for health workers in the
Ugandan health care system. As for all new documents,
there is still room for improvement. So I urge you, the user
of the guidelines, to share your experiences with the book
and suggest ways to improve the PGD HL 2015. To facili-
tate this process, a feedback form has been included at
the back of this book to propose changes to the publica-
tion.
The Ministry of Health and all those involved in the devel-
opment of these guidelines sincerely hope that the PGD
will significantly contribute to improving the dispensing
process, and ultimately, to patient safety.
Dr. Elioda Tumwesigye

Hon. Minister of Health
Ministry of Health

Preface
Preface
The Practical Guideline for Dispensing for Higher Level
Health Centres (PGD HL) 2015 is a medicine-centred refer-
ence book designed to provide dispensing staff with the
most critical information of medicines used at health cen-
tres (HC) IV and hospitals.
The PGD HL 2015 is a vital tool for all health workers and
especially dispensers to use in their daily tasks of adminis-
tering medicines. It provides information and instructions
on medicines, such as general use, dosage, side effects,
interactions, and use during pregnancy and breastfeeding.
The PGD HL also describes the dispensing procedures
needed to ensure that a patient receives the appropriate
medicine and proper instructions on its use. The PGD high-
lights the importance of analysing the prescription and
interpreting it correctly, choosing the correct medicine
and packaging it to minimise contamination and maintain
quality, correctly labelling the medicine, and providing pa-
tients with medicines information in a confidential man-
ner.
The PGD HL 2015 is not a textbook of pharmacology. It
has been designed as a rapid reference and only the
most crucial medicines information that a dispenser
needs to perform his or her duties and help patients ad-
here to their treatment has been included. The PGD HL
has been designed in a format that makes the book easy
to use and the information simple to find. The booklet’s
portable size makes it easy to consult in any circum-
stance or location and should therefore be available in all
places where dispensing of medicines takes place.
The medicines included here are those that are recom-
mended in the Uganda Clinical Guidelines (UCG) 2012,
the Essential Medicine and Health Supplies List for Ugan-
da (EMHSLU) 2012 as well the current treatment guide-
Preface
lines as provided by the various MOH programmes. This
ensures that the dispensers at those facilities can re-
trieve information about any medicine that a patient will
be prescribed.
The medicine monographs include a reference to the
EMHSLU 2012 section where the medicine is categorised.
This allows the dispenser to refer to the section in case
an alternative medicine is needed because the medicine
is unavailable or is contraindicated for a particular pa-
tient’s use.
I hope that the PGD HL–– together with the UCG and
EMHSLU –– will be a useful guideline that enables the
dispenser to correctly dispense appropriately prescribed
medicines and provide adequate instructions to the pa-
tient. The dispensers are, after all, the last health work-
ers to talk to the patients, and failure to take their re-
sponsibility seriously can compromise the effectiveness
of the medicine and patient safety.
It is the hope and expectation of the Ministry of Health
that health workers’ familiarisation with and daily use of
this book will greatly improve their practices, so that pa-
tients receive the best service possible.

Acknowledgements
Acknowledgements
The Practical Guideline for Dispensing at Higher Level
Health Centres (PGD HL) 2015 is produced by the Ministry
of Health, Pharmacy Division with technical assistance
from the U.S. Agency for International Development
(USAID)-funded Uganda Health Supply Chain (UHSC) Pro-
gram.
I would like to thank everyone who was involved in the

development of the PGD HL 2015. Special thanks go to the
health workers who took time to attend the review meet-
ing to ensure correctness and completeness of infor-
mation:
 Kenneth Tumusiime, Pharmacist, Jinja RRH
 Dr. Harriet Nambuya, Consultant, Jinja RRH
 Daniel Isabirye, Dispenser Jinja RRH
 Yusuf Mbaizwe, Clinical Officer, Bugembe HC IV Jinja
 Stella Nanyonga, Senior Pharmacist, Naguru CUFH
 Dr. Kabweru Wilberforce, Surgeon, Naguru CUFH
 Carolynn Kamakune, Pharmacist, Mengo Hospital
 Dr. Arike Joseph, Medical Officer Obongi Hospital
 Dr. Vunya George, Moyo Hospital
 Azo Margaret; Nursing Officer, Moyo Hospital
 Mondia Michael, Dispenser, Moyo Hospital
 Ndhaye Richard, Clinical Officer, Namutumba HC III
 Walujjo Emmanuel, Nursing Officer, Nsinze HC IV
 Tabu Fred, Senior Dispenser, Nsinze HC IV
 Dr. Okino David, Anyeke HC IV, Oyam
 Apio Grace, Nursing Officer, Anyeke HC IV, Oyam
 Olal Lameck, Ngal HC III, Oyam

Acknowledgements
 Okori Emmanuel, Dispenser,Anyeke HC IV, Oyam
 Nekesa Bridget, Nursing Officer, Namatala HC IV
 Lilian Nakyobe, Dispenser, Busiwu HC IV Mbale
 Kakooza Francis, Medical Officer, Kayunga Hospital
 Mulwana Johnie, Medical Officer, Kayunga Hospital
 Chemutia Patrick, Pharmacist, Kayunga Hospital
 Babirye Teddy, Nursing Officer, Kayunga Hospital
 Wolwa Micheal, Medical Officer, Nabiswera HC IV
 Kirunda Daniel, Clinical Officer, Wabigalo HC IV
 Kyakuwaire Florence, Nursing Officer, Nakasongola
 Munyaneza Louise, Dispenser, Nakasongola DLG
 Julian Abeso, Paediatrician, Mbale RRH
 Catherine Namulindwa, Pharmacist, Makerere Univer-
sity Department of Pharmacy
 Monica Amuha, Senior Technical Officer, UHSC
 Anthony Kirunda, Technical Advisor, UHSC
Special appreciation goes to Dr. Dickens Akena, Dr. Charles
Mondo, Dr. Denis Acullu, and Dr. Geoffrey Wabulembo for
their expert review of psychiatry, cardiovascular, oncology
and ophthalmology medicines.
I want to acknowledge Linacy Nampa, Juliet Kitutu and
Martin Oteba for developing the PGD HL 2015 and Kim
Hoppenworth for technical layout editing.
Lastly, I want to thank Dr. Birna Trap for valuable support
throughout the development process.
Morries Seru
Assistant Commissioner for Health Services
Ministry of Health, Pharmacy Division
Good Prescribing Practice

When medicine is required to treat a disease, the pre-
scriber must write a prescription to inform the dispenser
which medicine to dispense to the patient. A prescription
is therefore an instruction from a prescriber to a dis-
penser.
The prescriber is responsible for choosing the right medi-
cine for the patient. The dispenser is responsible for dou-
ble-checking that the prescription is appropriate and that
the patient receives the right medicine with adequate in-
formation on how to take the medicine correctly (see
Good Dispensing Practice).
The dispenser can only do his or her job if the prescription
is readable and complete (see Figure 1). A prescription is
complete if it contains the following information:
 Date of prescription
 Patient name
 Patient age
 Sex of patient
 Patient number
 Diagnosis
 Generic medicine name
 Dosage
o Dosage form
o Strength
o Amount
o Frequency
o Duration
 Name, signature, and contact/address of prescriber

Figure 1: Example of a readable and complete prescription

MINISTRY OF HEALTH M.F.5
NWOYA HEALTH CENTRE III

OUT-PATIENTS DEPARTMENT
NAME Peter Mulwale O.P NO 8567

AGE 31 years SEX Male
DATE DIAGNOSIS Malaria
TREATMENT NOTES
31/01/14 Rx
Artemether/Lumefantrine
4 tabs bd x 3/7
Paracetamol tabs
1g every 6 hours x 3/7
Drink plenty of fluids.
Dr. Kato Tadeo

Tel:0712345678
THIS FORM SHOULD BE KEPT BY THE PATIENT AND BROUGHT
AT EVERY VISIT.
An incomplete, unreadable, or inaccurate prescription

should not be dispensed. Instead, the dispenser should
return it to the prescriber for clarification, completion, or
correction.

When assessing if the medicine prescribed is appropriate
for the patient, you need to consider:
 Age or weight (especially for children) – Is the dose
right for the patient?

 Other medicines he/she is taking – Does the medi-
cine interact with other medicines that the patient is

taking?
 Pregnancy – Can the medicine be used during preg-
nancy?
 Breastfeeding – Can the medicine be used while
breastfeeding?
When reading a prescription, you should consider the fol-
lowing:
 Prescription is written by a person who is authorized
to prescribe
 Medicine prescribed is included on the essential
medicines list for Uganda

 Prescribed medicines and dosage forms are availa-
ble and recommended for use at your level of care

 If brand name or abbreviations are used, you know
(without any doubt) what the generic name of the

medicine prescribed is
 When prescription contains medicines that can po-
tentially be abused or if it is not written in ink, make

sure that no changes have been made to the pre-
scription
Prescribers commonly use abbreviations in the prescrip-
tions. The abbreviations often relate to the frequency and
duration of the treatment.

Table 1: Common and acceptable abbreviations used in pre-
scription writing
Abbreviation Meaning
bd Two times daily
od Once daily
om Every morning
on Every night
prn As needed
qds Four times daily
qqh Every four hours
stat Immediately
tds Three times daily
tid Three times daily
1/7 Corresponds to one day. Any number
out of seven indicates number of days
2/52 Corresponds to 2 weeks. Any number
out of 52 indicates number of weeks
1/12 Corresponds to one month. Any number
out of 12 indicates number of months
30 mg/kg Dose per kilogram of the patient's body
weight
25 mg/m2 Dose per square metre of patient’s body
surface area
Prescriptions can have different measurement units. They
must be interpreted correctly. Giving 1mg instead of 1µg
can be very dangerous to the patient. Table 2 is showing
the relationship between different units of measure.
Good Dispensing Practice
Table 2: Units of Measurement
Abbreviation In full Equal to
1 kg 1 kilogram 1,000 g
1g 1 gram = 1,000mg = 0.001 kg
1 mg 1 milligram = 1,000µg = 0.001 g
1 µg 1 microgram = 0.001 mg
1L 1 litre = 1,000 mL
1 mL 1 millilitre = 0.001 L
For more information on good prescribing, refer to the

introductory sections of the Uganda Clinical Guidelines
2012 (UCG), particularly pages lxi - lxxvi.

The dispenser plays a very important role in ensuring that
medicines are used appropriately and that patients benefit
from treatment. All efforts and resources to make medi-
cines available at health facilities will be wasted if the pa-
tient is not given the correct medicine, dose, and infor-
mation needed to make sure that he or she takes the med-
icines correctly. Dispensing includes all the activities that
occur between the time the dispenser receives the pre-
scription and when the dispenser hands it to the patient.
Good dispensing takes time.
Good dispensing practices ensure that each patient re-
ceives:
 His/her correct medicine
 The correct dosage and quantity

 Clear information on how to take it
 Correctly labelled, well-packaged container to main-
tain medicine quality
Good dispensing practices involve a series of steps, which
are to:
1. Receive and validate prescription
2. Understand and interpret the prescription
3. Prepare and label medicines to dispense to patient
4. Make a final check
5. Record action taken
6. Issue medicine to patient with clear instruction and
advice
Good dispensing takes time!
Do not rush the dispensing process, but

take time to avoid dispensing errors and
to ensure that the patient receives
the correct medicine and appropriate instructions.
Step 1: Receive and validate the prescription

This step is particularly important if you prepare several
prescriptions at one time before calling patients to receive
their medicines. Before dispensing medicines, you must
confirm the patient’s name, so that each patient receives
the medicine specifically prescribed for him or her.
Step 2: Understand and interpret the prescription
Understanding and interpreting the prescription can be
life-saving as it prevents patients from receiving the wrong
medicine, strength, or dose. Appropriate understanding
and interpretation include:
 Reading the prescription
 Interpreting any abbreviations
 Confirming the right medicine, dose, and duration
for the patient considering his/her disease, age or if

patient is pregnant or breastfeeding
 Calculating dose correctly (including number of tab-
lets)
 Identifying important medicine interactions
Dispensing errors can kill!
Prescribers’ unreadable handwriting can cause

dispensing errors. Guessing the wrong name or
dose can be fatal.
If you have any doubt about what is prescribed

you must crosscheck with the prescriber.
If you cannot read the prescription, if you are in doubt, or

if you identify anything that needs to be changed (e.g.

wrong dose or important interaction), you must contact
the prescriber and agree on changes to the prescription.
The dispenser or another person, if possible, must double-
check all dose calculations.
Step 3: Prepare and label medicines to dispense to patient
Preparing and labelling the package are not only central in
the dispensing process, but also a legal requirement. This
step must include double-checking or self-checking to
avoid dispensing mistakes.
Label the dispensing envelopes and then prepare to select
the medicines. See Figure 3 on page 35.
Do not select a container according to its

colour or location.
Do not have more than one container open at a
time. Close the container after collecting the med-
icine to preserve the quality of the medicine by
preventing contamination and moisture getting
into the medicine.
When preparing the prescribed medicine, you must:

 Select the stock container (pack or tin) by reading the
label properly and crosschecking the medicine’s name

and strength with the prescription. Make sure the
medicine has not expired. Dispensers should read the
container label at least twice during this process.

 Count the medicine quantity from the container. Do
not use bare hands to count; this is not hygienic and
can contaminate the medicine. Instead, use a tablet
counting tray, clean piece of paper, or a tin lid with a
spatula to count tablets and capsules.
 Pack tablets and capsules in the dispensing envelope.
Double-check that the labelling done earlier is correct.
Figure 2: Selection from a shelf: Read the label every time

Labelling should include:

 Patient name
 Medicine name (generic name in full; no ab-
breviations)
 Dosage form and strength
 When, and how long to take the medicine
 Special instructions (e.g. how to take the
medicine)
 Health facility name
 Date of dispensing
Figure 3: Properly labelled dispensing envelope

Step 4: Make a final check
This is the final check before you give the medicine to the
patient. Ideally, a different person than the one preparing
the prescription should perform this check, but self-
evaluation can be used when there is only one dispenser
at work. The final check includes:
 Reading and interpreting the prescription, including
appropriateness of dose prescribed and medicine

interactions
 Checking the dispensed medicine against the pre-
scription and the stock containers used

 Checking that label is correct and all information is
filled in
Figure 4: Final check of steps; prevent mistakes

Step 5: Record the action taken
Records of dispensed medicines are a legal requirement
and also necessary to account for and verify stocks, and
trace any problems with medicines issued to patients.
Patients usually keep their prescriptions or personal exer-

cise books and therefore, the dispenser should record the
details of the medicines dispensed in the prescription and
dispensing log (HMIS form 016) or in the antiretroviral
(ARV) dispensing log before giving the medicines to pa-
tients. All fields of the prescribing and dispensing log
should be filled out correctly. For further guidance, refer
to the Essential Medicines and Health Supplies Manual
(Part 6; pages 65-66).
The information that must be recorded in the prescribing

and dispensing log is:
 Date of dispensing
 Patient number as assigned from OPD/IPD register
 Diagnosis/symptoms
 Name of medicine
 Quantity prescribed (P) and quantity dispensed (D)
of each medicine
 Initials of the prescriber
 Initials of the dispenser
Step 6: Issue medicine to patient with clear instructions

and advice
Medicines are only effective if taken correctly. The dis-
penser is the last health care worker to talk to the patient,
so he or she must assure that the patient knows how to
take the medicine correctly.

Good dispensing takes time!
You should spend enough time issuing instructions to

the patient, and give a chance to the patient to ask
questions if they have any.
Most importantly, the patient needs to know the route of

administration, dose, how often and for how long they
should take the medicine. Further, you must also tell the
patient other information that maximizes the effect of
treatment, but which might not appear on the label. This
includes:
 When to take the medicine (e.g. with or without

food, separate from other medicines or specific
foods/drinks, time of day)
 How to take the medicine (e.g. swallow whole,
chew, with plenty of water)
 How to store the medicine (e.g. room temperature
or in fridge) and what to do with expired medicine
 When to return to the health facility (e.g. for further
check-up or in case of specific side effects)
The patient should also know why the medicine must be

taken; this can increase adherence to the treatment. In-
forming patients about common side effects and how to
handle them helps keep them from stopping treatment
early.
It is good practice to end the dispensing process with the
patient repeating how to take the medicine. This shows

the dispenser that the patient has understood the instruc-
tions.
Figure 5: Ensuring patient understanding
Treat every patient with respect. The dispensing staff must

provide privacy for having undisturbed conversations with
patients. They should be able to ask questions without
fear of being overheard.
You can ensure privacy by:
 Having the waiting patients at least 2 metres away
from the dispensing area so that they cannot
eavesdrop.
 If possible paint a line on the floor and patients
should stay behind that line until it is their turn to
be dispensed to.
All information about a patient’s diagnosis and medicine

use is confidential. This means that you should not share
information about patients to anyone else.
Information in Monographs
The monograph section includes all medicines in the Es-
sential Medicines and Health Supplies List for Uganda
(EMHSLU) 2012. There are also monographs for all the
medicines supplied by National Medical Stores, and new
medicines for various diseases adopted since EMHSLU
2012, such as medicines for multi-drug resistant tubercu-
losis.
The medicine monographs are arranged in alphabetical
order according to the generic medicine name. Different
dosage forms of the same medicine are included in the
same monograph. When more than one generic name is
commonly used, there is only one monograph, but it lists
all acceptable generic names. Fixed-dose combinations are
included in the monograph section but reference is made
to the individual medicine monographs.
For each medicine monograph, the following information
is provided:
 Name of medicine (generic and other names)
 Level of care
 Vital, Essential, Necessary (VEN) classification
 Reference to EMHSLU 2012
 Therapeutic description
 Dosage forms
 Uses
 Dosage and duration
 Preparation and reconstitution
 Contra-indications
 Side effects
 Interactions

 Patient instructions
 Use during pregnancy
 Use during breastfeeding
 Storage
 Cautions
Information provided under each sub-heading is described
in the following sections.
Figure 6: Header of medicines monographs
Name of medicine
The generic name is included in the header. Commonly
used abbreviations and other names are included in
brackets.
Level of care
The level of care indicated here is the lowest level at which
the EMHSLU 2012 recommends the medicine is used.
VEN classification
VEN classification is a method of classifying medicines
based on health impact.
VEN classification divides medicines into three groups de-
fined as:
 Vital (V) — Medicines used to manage life-
threatening diseases.
 Essential (E) — Medicines effective in managing less
severe but widespread illnesses.

 Necessary (N) — Medicines used to manage diseas-
es with less impact on the population or medicines
whose costs are high compared to their treatment
benefit.
Vital medicines have first priority in procurement as they
are lifesaving or critical for achieving targeted health out-
comes and should always be available if possible. Essential
medicines have second priority in procurement; if these
medicines are unavailable, the patient could suffer pain or
great discomfort. Necessary medicines are important and
good to have; however, they have third priority when de-
ciding how funds should be used in procurement of medi-
cines.
Reference section in EMHSLU 2012
The number in the header refers to the section(s) where
the medicine is included in the EMHSLU 2012. The refer-
ence is included for easy reference to the EMHSLU.
Therapeutic description
Therapeutic medicine group or type of medicine and a
brief explanation of how the medicine works
Dosage forms
This section lists only those dosage forms listed in EMHSLU
2012 or supplied by NMS. All dosage forms for ARVs and
priority medicines for childhood illnesses are included.
Uses
The section lists which conditions and diseases can be
treated with the medicine according to the Uganda Clinical
Guidelines (UCG) 2012. Only relevant uses of the medicine
are listed.
Dose and duration
These are the doses and duration for the medicines’ uses
as recommended in UCG 2012 or World Health Organiza-
tion (WHO) model formulary 2008 (if doses and duration
are not indicated in UCG 2012).
For each condition, dose is included for adults and children
of different ages, where appropriate. For ARVs, adoles-
cents are defined as children 15 years-old and above.
The dose includes the quantity, frequency, and duration of
therapy. Route of administration is also included, which
can be oral, intravenous (IV), intramuscular (IM), subcuta-
neous (SC), rectal, topical, or vaginal.
Preparation and reconstitution
This section is only included for medicines that need prep-
aration before use, such as dilution. Injectables, mouth-
wash, irrigations, or disinfectants may need preparation
before use.
The section includes:
 What diluents to use (and what not to use)
 How to mix
 Quantities to use
When preparing injectable medicines, you should never

mix two or more medicines in the same syringe (e.g.
ampicillin and metronidazole). This is because the med-
icines can inactivate each other or react to form com-
plexes that can be unsafe to the patient.
You should carefully examine all injectable solu-
tions/preparations before administering them to a pa-
tient. If you see a precipitate in the ampoule/vial, do
not give the injection.
Contra-indications
Contra-indications are situations where the medicine
should not be used. Contra-indications can be certain age
groups (e.g. children or elderly) or specific conditions, such
as liver disease or pregnancy. They can also be due to a
drug-drug interaction, where two medicines cannot be
used at the same time to avoid harmful effects to the pa-
tient. For easier overview of the medicines, interactions
have been listed in a separate section of the monographs.
An example is that all vaccines are contraindicated during
severe acute illness (mild illness is not a contra-indication).
When a medicine is contra-indicated, it is important to
ensure that the prescriber is aware of the contra-
indication and that he or she decides if the benefits of the
treatment outweigh the risks.
Side effects
Most medicines have unwanted effects on patients. These
effects are called side effects because they may occur
alongside the medicine’s intended effect of treating a dis-
ease.
The monographs include common side effects that occur
when the medicine is used at recommended doses. In ad-
dition, they include less common, but very serious side
effects (e.g. Stevens-Johnson syndrome). Rare side effects
and those that occur in overdose are not included.
This section uses certain terms to refer to a group of relat-
ed side effects to make the section briefer. The terms are
included in the glossary. These terms are:
 Stomach upset: Nausea, vomiting, diarrhoea, gastric

irritation and abdominal pain
 Allergic reaction: Rash, itching, sneezing, swelling of
skin, fever and joint pain

 Irregular heartbeat: Fast heartbeat, slow heartbeat
and uneven heartbeat (arrhythmias)
 Difficulty in sleeping: Insomnia and bad dreams
 Menstrual disturbances: Heavy bleeding, no bleeding,
reduced bleeding days, prolonged bleeding days and
spotting
 Blood disorders: Anaemia, low white blood cell count,
low neutrophil and low platelet count
 Electrolyte imbalance: High/low sodium, potassium,
calcium, bicarbonate and acid levels in blood
If a medicine causes a severe and specific effect, then the
monograph lists that side effect instead of or in addition to
the group term (e.g. severe nausea from metronidazole).
Interactions
Medicines can interact with other medicines or food,
which can affect the treatment outcome and patient safe-
ty.
The monograph lists medicine-medicine interactions with
a short explanation of the interaction. The interaction may
change the effect or toxicity of either or both of the medi-
cines. Only significant, negative interactions that affect the
treatment or patient safety are included.
Interactions can:
 Cancel the effect of either or both medicines
 Increase the therapeutic effect to an unwanted or
dangerous level
 Increase the medicine’s concentration in the blood,
thereby, increasing risk of side effects

 Prevent the gut’s absorption of medicine (e.g. ant-
acids)

You must make the prescriber aware of a potentially seri-
ous interaction that cannot be avoided so the prescriber
can change the prescription if alternatives exist. In these
instances, refer to the caution section, which gives infor-
mation on how to handle the interaction. Note that chang-
ing the prescription or dose due to an interaction needs to
be decided upon with the prescriber.
Patient instructions
One of the dispenser’s most significant responsibilities is
telling the patient how to take the medicine appropriately.
This section includes the most important information that
patients need to know to maximise their treatment and
reduce risks of side effects and interactions.
Patient instructions should include:
 If the medicine is to be taken with food or an empty
stomach or with plenty of water

 What to do or not do while taking the medicine
(e.g. avoid alcohol)

 What side effects to expect and what to do if they
occur
 If a serious side effect occurs, return to the
health facility as soon as possible.

 If a mild side effect occurs, continue treatment,
as the side effect will disappear.

 How to handle possible medicine-medicine interac-
tions (e.g. take antacids two hours before or after

other medicines)
 How to store medicines (e.g.in the fridge or not re-
moved from the blister pack)

You should also tell the patient that completing the
entire treatment is very important, even if symptoms
disappear, especially when taking antibiotics.

Patients should also be informed not to take more
medicine than the prescribed amount, as this could
increase side effects or potentially be fatal.
Pregnancy
Some medicines can be used throughout pregnancy, some
not at all, and others only in specific trimesters of the
pregnancy. A dispenser must be aware of recommenda-
tions for use in pregnancy because certain medicines can
have extremely hazardous effects on foetus development.
The section states if pregnant women should never take
the medicine or if they can use the medicines and in which
trimester they can be safely administered.
Some mothers must take certain medicines continuously
(i.e. in chronic diseases such as epilepsy), even though it
may affect the foetus/new-born baby. The prescriber will
weigh benefits and risks when continuing medicines for
chronic diseases in pregnant women.
Specific cautions and recommendations for use in these
special cases are included under “Caution”.
Breastfeeding
Medicines can be secreted in mothers’ milk, thereby ex-
posing infants to their mothers’ medicine treatment. Some
medicines have an insignificant effect on infants, while
others can seriously affect breastfeeding children.
This section gives advice on whether the mother can take
the medicine while breastfeeding.
Some mothers must take certain medicines continuously
during breastfeeding (i.e. in chronic diseases such as epi-
lepsy). If it is not possible for the mother to stop breast-
feeding, specific cautions and recommendations for use of
the medicine are included under cautions.
All breastfeeding mothers should be cautioned to monitor
the child for side effects, if they are taking medicine.
Storage
Most medicines should be stored below 25°C (room tem-
perature) and away from light and moisture. However,
some medicines require particular storage conditions. This
section is only included for medicines with special storage
conditions, for example those that need to be refrigerated.
For medicines that are reconstituted or diluted, the sec-
tion includes how long the diluted solution can be kept.
To ensure the quality of the medicine, medicine in blister
packages must be stored in the blister and once removed,
used immediately. For creams and ointments, the lid must
be closed immediately after use to avoid contamination.
All medicine must be stored out of children's reach and
away from light and moisture. Make sure the patient is
aware of that.
Caution
This section provides precautions unique to each medi-
cine. The caution section is marked with to draw at-
tention to this last but important section.
Cautions may include:
 Dosage adjustments if the patient has liver and kid-
ney disease or is elderly

 How to handle important interactions
 How to recognise and handle possible side effects
(especially serious side effects)

 How to recognise and treat cases of overdose
 Preferred medicine if the medicine in the mono-
graph is not the first choice treatment

 Alternative medicines that can be used in case the
medicine in the monograph is contraindicated or

unsuitable.
ABACAVIR (ABC) A
MONOGRAPHS
A
ABACAVIR (ABC) HC IV V 30.1
Nucleoside reverse transcriptase inhibitor (NRTI) antiretro-
viral medicine
Dosage forms
 Tablets: 60 mg, 300 mg
 Syrup: 20 mg/ml
Uses
 HIV/AIDS
Dose and duration

 HIV infection, first line treatment
Children < 3 years: dose as in table below (in combination

with 3TC + NVP)
Children 3–10 years or adolescents <35 kg: dose as in table
below (in combination with 3TC + EFV)
Weight (kg) Dose (Tablets of 60 mg)
3–5.9 1 tab every 12 hours
6–9.9 1½ tabs every 12 hours
10–13.9 2 tabs every 12 hours
25–34.9 Use adult dose
 HIV infection, second line treatment
Adult and children >35 kg: 300 mg every 12 hours

A MONOGRAPHS
(in combination with 3TC + LPV/r or 3TC + ATV/r)

Children < 10 years: 8 mg/kg every 12 hours
(in combination with 3TC + LPV/r)
Contra-indications
 Severe liver disease
 Chronic alcoholism
 Severe kidney disease
Side effects
 Hypersensitivity reaction
 Lactic acidosis
 Liver damage
 Rash
 Stomach upset
 Take medicine at the same time every day
 Report immediately to a health worker if any skin rash,
fever, nausea, diarrhoea, difficulty in breathing, cough,

headache, or feeling of sickness/weakness occur
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Stop the medicine immediately if any hypersensitivity
reaction occurs (usually occurs in the first 6–8 weeks). Do
not restart even after the symptoms have resolved

ABACAVIR + LAMIVUDINE (ABC+3TC) A
ABACAVIR + LAMIVUDINE (ABC+3TC) HC IV E 30.4
Combination of two NRTI antiretroviral medicines
Dosage forms
 FDC tablet: ABC 60 mg + 3TC 30 mg
 For more information, see individual medicine

monographs
ACETAZOLAMIDE RR E 21.7
Anti-glaucoma and diuretic medicine. Reduces production of
aqueous humour in the eye hence reducing intraocular pres-
sure; used as an adjunct to topical anti-glaucoma medicines
Dosage forms
 Tablets: 250 mg
Uses
 Open-angle glaucoma
 Secondary glaucoma
 Peri-operatively in angle-closure glaucoma
Dose and duration

 All uses
Adult: 0.25‒1 g daily in divided doses for as long as is

required
Contra-indications
 Chronic angle-closure glaucoma
 Hypersensitivity to sulphonamides
 Hyponatraemia
 Hypokalaemia
 Hyperchloraemic acidosis

A MONOGRAPHS
 Renal impairment
 Severe hepatic impairment
Side effects
 Stomach upset, taste disturbances, loss of appetite
 Paraesthesia (tingling feeling in hands and feet)
 Headache, dizziness
 Thirst, increased frequency of urination
 Reduced libido
 Depression
 Metabolic acidosis and electrolyte disturbances on long-
term therapy
 Rash
 Blood disorders
Interactions
 Carbamazepine (increased risk of hyponatraemia;
increased concentration of carbamazepine)

 Digoxin (hypokalaemia increases cardiac toxicity of
digoxin)
 Enalapril (enhanced hypotensive effect)
 Lidocaine (hypokalaemia antagonises action of lidocaine)
 Lithium (increased excretion of lithium)
 Do not drive or operate machinery while taking this med-
icine
 Report any unusual skin rash especially when acetazola-
mide is used for long-term therapy

Pregnancy
st
 Do not use especially in the 1 trimester

ACETYLSALICYLIC ACID (ASPIRIN) A
Breast-feeding
 Can be used
Caution
 May mask deterioration of angle-closure glaucoma
 May cause metabolic acidosis in patients with renal im-
pairment
 Reduce dose in the elderly
 Use with extreme caution in breast-feeding women
 Monitor blood cell count and electrolyte levels periodical-
ly when used for long-term therapy
ACETYLSALICYLIC ACID (ASPIRIN) 2.1, 7.1,

HC II E
12.1
Non-steroidal anti-inflammatory drug (NSAID) with analgesic
(pain relief) and antipyretic (reduces fever) properties. In low
doses, it is also an antiplatelet.
Dosage forms
 Tablet: 300 mg
 Tablet: 75 mg
Uses
 Mild pain (headache, pain of menstruation, muscle and
bone pains)
 Fever
 Rheumatic fever
 Rheumatoid arthritis
 Secondary prevention of cerebrovascular disease and
myocardial infarction
 Prophylaxis of ischaemic heart disease
 Acute migraine attacks

A MONOGRAPHS
Dose and duration

 Pain and fever
Adult: 300–600 mg every 8 hours or when necessary

for 1–3 days
 Treatment of acute migraine attacks
Adult: 300–900 mg at first attack, repeated every 4–6

hours if necessary (maximum 4 g daily)
Adult: 1.2 g every 8 hours until symptoms are relieved

(give with omeprazole 20 mg once a day if patient experi-
ence serious gastrointestinal intestinal discomfort)
 Rheumatic fever
Adult: 600–900 mg every 4–6 hours or when necessary

(maximum 4 g daily)
 Secondary prevention of cerebrovascular disease and
myocardial infarction
Adult: 75 mg once daily for life
 Ischaemic heart disease, myocardial infarction
Adult: 300 mg as a single dose

Contra-indications
 Children <16 years
 Asthmatic patients
 Allergy to aspirin or NSAID
 Peptic ulcer
 Gout
 Bleeding disorders
 Severe kidney or liver disease
Side effects
 Stomach upset
 Worsens asthma

ACYCLOVIR (ACICLOVIR) A
 Allergic reactions (rash)
 Worsens peptic ulcers
 Tinnitus (ringing in the ears)
 Increased risk of bleeding
 Reye’s syndrome (in children)
Interactions
 Warfarin (increased risk of bleeding)
 Methotrexate (increased risk of bleeding)
 NSAIDs (increased risk of side effects)
 Take with food to reduce gastrointestinal disturbances
 Take with plenty of water
Pregnancy
 Do not use
Breast-feeding
 Do not use
ACYCLOVIR (ACICLOVIR) HC IV E 6.5, 21.5

Antiviral medicine for herpes virus infections
Dosage forms
 Tablet: 200 mg
 Cream: 5%
 Eye ointment: 3%
Uses
 Herpes simplex
 Herpes zoster (varicella-zoster)
Dose and duration

 Non-genital Herpes simplex

A MONOGRAPHS
Adult and child >2 years: 200 mg every 4 hours (400

mg in immunocompromised patients) for 5 days or un-
til healing is complete
Child 1 month–2 years: 100 mg every 4 hours for 5
days or until healing is complete
 Herpes simplex infection of the eyes
Apply 1 cm of ointment every 6 hours. Continue for at

least 3 days after healing is complete
 Herpes simplex infection of lips and face (Herpes labialis)
Adult and child: treatment should ideally be started

when lesions first appear. Apply a thin film of cream to
the lesions and surrounding skin 5 times a day every 4
hour during the day for 5 days. Continue treatment for 5
more days if healing has not occurred
 Genital herpes simplex
Adult: 800 mg every 8 hours for 5 days (10 days in

immunocompromised) or until healing is complete
 Varicella and herpes zoster
Adult: 800 mg every 4 hours for 7 days or until lesions

are healed in immunocompromised patients
Child 6–12 years: 800 mg every 6 hours for 7 days
Child 2–6 years: 400 mg every 6 hours for 5 days
Child 1 month–2 years: 200 mg every 6 hours for 5
days
Side effects
 Stomach upset
 Headache, feeling of tiredness
 Rash
 Local irritation (for cream or eye ointment)

ADENOSINE A
 Take plenty of water during treatment
 Wash hands before and after applying cream
 Avoid unnecessary rubbing or touching of lesions, to
avoid aggravating or transferring infection

Pregnancy
 Can be used
Breast-feeding
 Can be used
ADENOSINE RR E 12.2
Antiarrhythmic medicine
Dosage forms
 Injection: 3 mg/ml
Uses
 Supraventricular tachycardia
 Diagnosis of supraventricular arrhythmias
Dose and duration

Give injection into a central or large peripheral vein to ensure
that the medicine reaches the systemic circulation. Follow
injection by a rapid sodium chloride 0.9% flush
 All uses
Adult and child > 12 years: initially 3 mg as a rapid IV bolus

(over 2 seconds). If necessary, give additional 6 mg after
1‒2 minutes followed by 12 mg after a further 1‒2 minutes
if necessary until tachycardia is terminated
Child 1 month‒12 years: initially 0.1 mg/kg. Repeat injec-
tion every 1‒2 minutes if necessary, increasing dose by

A MONOGRAPHS
0.05‒0.1 mg/kg until tachycardia is terminated or maxi-

mum single dose of 0.5 mg/kg (12 mg)
Child 0‒1 year: initially 0.15 mg/kg; if necessary repeat in-
jection every 1‒2 minutes increasing dose by 0.05‒0.1 mg
/kg until tachycardia is terminated or maximum single dose
of 0.3 mg/kg (12 mg) has been given
Contra-indications
 Hypersensitivity to adenosine
 Sick sinus syndrome
 Second or third degree AV (Atrioventricular) block
 Asthma
 Chronic obstructive lung disease
 Severe hypertension
 Long QT syndrome
 Decompensated states of heart failure
Side effects
 Bradycardia, sinus pause, skipped beats, AV block, atrial
arrhythmias, ventricular excitability disorders, hypoten-

sion, flushing
 Dizziness, headache
 Dyspnoea
 Nausea
 Chest pressure/pain
 Anxiety
Interactions
 Dipyridamole (increased effects/ toxicity of adenosine)
 Aminophylline (antagonise effects of adenosine)
 Theophylline (antagonise effects of adenosine)
 Antiarrhythmics (increased myocardial depression)

ADRENALINE (EPINEPHRINE) A
 Antipsychotics (increased ventricular arrhythmias when
given with antipsychotics that prolong QT interval)
 Beta-blockers (increased myocardial depression)
Pregnancy
 Do not use
Breast-feeding
 Can be used
Caution
 Cardio-respiratory resuscitation equipment must be read-
ily available if adenosine is to be used
 Patient should avoid food or drink containing xanthenes
(e.g. tea, coffee, cola, chocolate) at least 12 hours before
adenosine is to be used
ADRENALINE (EPINEPHRINE) HC II V 3
See epinephrine
ALBENDAZOLE HC I V 6.1.1
Broad spectrum antihelminthic with activity against almost all
types of intestinal worms
Dosage forms
 Tablet: 400 mg
Uses
 Intestinal worms (round worm, thread worm, hookworm,
strongyloidiasis, tapeworm, whipworm)

Dose and duration
 All worms (except strongyloidiasis)

A MONOGRAPHS
Adult and child >2 years: 400 mg single dose

Child 1–2 years: 200 mg single dose
In severe infections a 3-day course may be given to
clear worm infestation. Repeat doses every 6 months.
 Strongyloidiasis
Adult and child >10 kg: 400 mg 1–2 times daily for 3
days
Contra-indications
 Children <1 year
Side effects
 Stomach upset
 Chew tablet or swallow whole with water
Pregnancy
 Do not use
Breast-feeding
 Can be used
ALBUMIN, HUMAN RR E 11.2

A solution containing electrolytes and protein derivatives
from plasma, serum, or normal placentas of which at least
95% of the protein is albumin
Dosage forms
 Solution for intravenous infusion: 25 %
Uses
 Severe hypoalbuminaemia associated with hypovolemia
and generalised oedema where salt and water restriction

with plasma volume expansion are required

ALBUMIN, HUMAN A
 Adjunct in the treatment of hyperbilirubinaemia by
exchange transfusion in the newborn
 Paracentesis of large volume ascites associated with por-
tal hypertension
Dose and duration
 All uses
Dose should be individualized depending on severity,

patient size and continuous fluid and protein losses
Preparation
 Dilute with 5% glucose or 0.9% sodium chloride
 Do not dilute with water for injections to avoid fatal
haemolysis in patients
Contra-indications
 Cardiac failure
 Severe anaemia
 Hypersensitivity to albumin
Side effects
 Hypersensitivity reactions such as urticaria, anaphylaxis
 Headache
 Nausea, vomiting, increased salivation
 Fever
 Tachycardia, hypotension
Pregnancy
 Can be used
Breast-feeding
 Can be used
Storage
o
 Store below 30 C. Do not freeze

A MONOGRAPHS
Caution
 Do not administer through already used infusion set or
with simultaneous infusion of protein hydrolysate
 Administer slowly in cardiac and circulatory disease to
avoid rapid rise in blood pressure and cardiac failure.
Monitor cardiac and respiratory function
 Correct dehydration during administration
 Discontinue immediately on suspicion of allergic reaction
or anaphylaxis. Stop the infusion immediately in case clin-
ical signs of cardiovascular overload (headache, dysp-
noea, jugular vein congestion), increased blood pressure,
raised venous pressure or pulmonary oedema occur
 Dilution with water for injections may cause potentially
fatal haemolysis in the patient
ALCOHOL WITH GLYCERIN HC I E 15.2

Disinfectant used to kill bacteria on skin
Dosage forms
 Solution: 70% ethanol
Uses
 Disinfection of skin before injections, putting an IV cannu-
la, getting a blood sample, and surgical procedures

 Disinfection of rubber covers of infusion bottles and med-
icine vials (except those of vaccines)

 Disinfection of hands
Dose and duration

 Apply undiluted solution directly to the skin area

ALLOPURINOL A
Contra-indications
 Do not use on mucous membranes, wounds or burns as it
is painful, irritating, and slows the healing process

 Do not use on children <1 month old
Side effects
 Dry and irritated skin
Interactions
 Other disinfectants (increased risk of side effects)
Pregnancy
 Can be used
Breast-feeding
 Can be used
Storage
 Close bottles tightly to avoid evaporation of contents
Caution
 Do not use on dirty or soiled skin (with blood, body
fluids); wash skin first
 Alcohol is flammable
ALLOPURINOL H E 2.2
Xanthine-oxidase inhibitor which reduces production of uric
acid
Dosage forms
 Tablet: 100 mg
Uses
 Prophylaxis of gout
 Prophylaxis of hyperuricaemia associated with cancer

A MONOGRAPHS
chemotherapy
 Prophylaxis of hyperuricaemic nephropathy
 Enzyme disorders that lead to overproduction of urate
e.g. Lesch-Nyhan syndrome

Dose and duration
 Prophylaxis of gout, hyperuricaemic nephropathy, over-
production of urate
Adult: initially 100 mg daily after food; then increase by
100 mg weekly according to plasma or urinary uric acid
levels to a daily maintenance dose of 100–900 mg (mild
conditions 100–200 mg daily, in moderate conditions
300–600 mg daily, in severe conditions 700–900 mg dai-
ly). Give doses above 300 mg in divided doses
 Prophylaxis of hyperuricaemia associated with cancer
Adult: Maintenance doses same as above. Adjust dose

according to response. Start treatment 24 hours before
chemotherapy and continue for 7–10 days there after
Child 1 month–15 years: 10–20 mg/kg daily (max 400 mg
per day) after food
Note: In moderate renal impairment, reduce dose to100–
200 mg; in severe renal impairment, use maximum 100
mg daily
Contra-indications
 Known hypersensitivity to allopurinol
 Treatment of an acute gout attack
Side effects
 Gastrointestinal disorders
 Rash, Stevens-Johnson syndrome
 Toxic epidermal necrolysis

ALLOPURINOL A
 Haemolytic anaemia
Interactions
 Azathioprine (increased effects/toxicity of azathioprine)
 Didanosine (increased plasma concentration of didano-
sine)
 Mercaptopurine (increased toxicity of mercaptopurine)
 Take at least 2–3 litres of water daily
 Take medication after food
 May impair ability to operate machinery or drive
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Reduce dose in hepatic impairment
 Withdraw treatment if rash occurs and reintroduce it if
rash is mild: discontinue promptly if rash recurs
 Delay treatment until an acute attack has completely
subsided (i.e. 2–3 weeks after the acute attack)
 Initiation of allopurinol may precipitate an acute attack of
gout: use together with a suitable NSAID (not a salicylate
or ibuprofen), or colchicine and continue for at least 1
month after correction of hyperuricaemia
 Treat acute attacks that develop during treatment with-
out interrupting treatment with allopurinol

A MONOGRAPHS
ALPRAZOLAM RR N 24
Benzodiazepine medicine
Dosage forms
 Tablet: 0.5 mg, 0.25 mg
Uses
 Short-term treatment of anxiety
Dose and duration

 Anxiety
Adult > 18 years: 0.25–0.5 mg every 8 hours; increase if

necessary to maximum 3 mg per day for up to 4 weeks,
then review patient, and extend treatment up to a maxi-
mum of 8–12 weeks. If longer duration is required, re-
evaluate patient and consider risk of dependence
Elderly: 0.25 mg every 8–12 hours increased gradually if
required
Contra-indications
 Known hypersensitivity to benzodiazepines
 Myasthenia gravis
 Severe respiratory insufficiency
 Sleep apnoea syndrome
 Severe hepatic insufficiency
 Children < 18 years
Side effects
 Sedation, dizziness, headache, hypersomnia, insomnia,
fatigue, irritability, lethargy, memory impairment

 Confusion, disorientation, anxiety, depression
 Dysarthria (difficult or unclear articulation of speech)
 Balance disorder, abnormal coordination, tremor, ataxia
 Decreased appetite

ALPRAZOLAM A
 Decreased or increased libido, sexual dysfunction
 Blurred vision
 Nausea
 Skin irritation
 Weight loss or gain
Interactions
 Clozapine (serious adverse events when used concomi-
tantly)
 Indinavir, ritonavir (plasma concentration of alprazolam
possibly increased)
 Ensure that you have 7–8 hours of uninterrupted sleep
after taking alprazolam

 Do not drive or operate dangerous machinery until you
know how this medication affects you

Pregnancy
 Do not use (see caution)
Breast-feeding
Caution
 Do not withdraw medication abruptly. Reduce doses off
gradually i.e. not more than 0.5 mg every 3 days
 Only use in pregnancy if the clinical condition of the
patient requires treatment with alprazolam

 Give with caution in renal and hepatic impairment. May
precipitate coma in hepatic impairment.

 Do not use alprazolam alone in treatment of depression
as it may precipitate or increase risk of suicide

 Use with caution in patients with a history of alcohol or

A MONOGRAPHS
drug abuse
 May induce retrograde amnesia; patients should plan to
have 7–8 hours of uninterrupted sleep after ingestion
 Discontinue use if patient develops agitation, irritability,
aggressiveness, delusion, rages, nightmares, hallucina-
tions or other adverse psychological effects
AMIKACIN H E 6.2.4
Broad-spectrum aminoglycoside antibacterial with activity
against Pseudomonas aeruginosa and some Gram-positive
organisms
Dosage forms
 Powder for injection: 1000 mg
Uses
 Serious Gram-negative infections resistant to gentamicin
 Multi-drug resistant tuberculosis (MDR-TB)
Dose and duration

 All indications (serious Gram-negative infections resistant
to gentamicin)
Adult and child over 12 years: by IM or by slow IV injec-
tion or by infusion over 30–60 minutes, 15 mg/kg daily in
a single or 2 divided doses (max 1.5 g/ day) for 7–10 days
Child 4 weeks–12 year: by IM or slow IV, 15–20
mg/kg/day as a single dose or divided into 2 equal doses
for 7–10 days
Neonate: Give a loading dose of 10 mg/kg followed by 7.5
mg/kg every 12 hours for 7–10 days
Premature infant: by IM or IV injection or IV infusion over
1–2 hours, 7.5 mg every 12 hours for 7–10 days
AMIKACIN A
 Multi-drug resistant tuberculosis
Adult and child: 15−20 mg/kg daily. Max 750 mg in chil-
dren and 1000 mg in adults
Note: For multiple daily dose regimen, one-hour serum
concentration should not exceed 30 mg/litre; pre-dose
concentration should be less than 10 mg/litre. For once
daily dose regimen, pre-dose concentration should be
less than 5 mg/litre
Contra-indications
 History of hypersensitivity or serious toxic reactions to
aminoglycosides
 Hypersensitivity to amikacin
Side effects
 Anaphylaxis
 Ototoxicity
 Nephrotoxicity
Interactions
 Alcuronium (enhanced effects of alcuronium)
 Ciclosporin (increased risk of nephrotoxicity)
 Cisplatin (increased risk of nephrotoxicity)
 Furosemide (increased risk of ototoxicity)
 Neostigmine (antagonism of neostigmine effects)
 Pyridostigmine (antagonism of pyridostigmine effects)
 Suxamethonium (antagonism of suxamethonium effects)
 Vecuronium (enhanced effects of vecuronium)
Pregnancy
 Do not use

A MONOGRAPHS
Breast-feeding
 Can be used (see caution)
Caution
 Ensure adequate hydration of the patient during therapy
 Use with caution in pre-existing renal insufficiency, hear-
ing or vestibular damage or diminished glomerular filtra-
tion. Monitor renal, vestibular and auditory function
 Use ideal weight for height to calculate dose in obese
people to avoid excessive dosage
 Serum concentration monitoring is required especially in
the elderly, in obesity and cystic fibrosis or if high doses
are given or in renal impairment
 Parenteral treatment should not exceed 7 days if possible
to minimise side effects
 Increase dose interval in renal impairment. Reduce dose
in severe renal impairment
 For MDR-TB, amikacin can be used in pregnancy and
breastfeeding as benefits outweigh risks
AMINOPHYLLINE HC III N 25.1

Xanthine used to treat and prevent difficult breathing
Dosage forms
 Tablet: 100 mg
Uses
 Asthma
 Reversible airways obstruction (e.g. in anaphylaxis)
 Chronic bronchitis

AMINOPHYLLINE A
Dose and duration
 Acute severe asthma
Adult: 250 mg by slow IV injection (over 20 minutes)

Child: 5 mg/kg by slow IV injection (over 20 minutes)
 Asthma regular maintenance therapy
Adult: Initially, 200 mg every 12 hours; after 1 week,

increase to 400–500 mg every 12 hours
Child >3 years: Initially, 6 mg/kg every 12 hours; after
1 week, increase to 12 mg/kg every 12 hours
Some children with chronic asthma may require 13–20
mg/kg every 12 hours
 Anaphylaxis
6 mg/kg by slow IV injection (over at least 20 minutes)

Side effects
 Irregular heartbeat
 Headache, sleep disturbances
 Stomach upset
 Itchy skin rash
Interactions
 Ciprofloxacin (increased risk of side effects)
 Erythromycin, azithromycin (increased risk of side effects)
 Fluconazole (increased risk of side effects)
Pregnancy
rd
 Do not use in 3 trimester
Breast-feeding
 Do not use
Caution
 Do not use IV aminophylline in patients already taking
oral aminophylline
A MONOGRAPHS
 Rapid IV injection can cause irregular heartbeat and con-

vulsions
 Second line treatment to salbutamol
 Use ideal body weight (not actual weight) to calculate
dose in obese patients
AMIODARONE NR E 12.2
Class III anti-arrhythmic medicine
Dosage forms
 Tablet: 100 mg, 200 mg
 Sterile concentrate: 50 mg/ml
Uses
 Supraventricular arrhythmias
 Ventricular arrhythmias
 Ventricular fibrillation
 Pulseless ventricular tachycardia in cardiac arrest refrac-
tory to defibrillation
Dose and duration
 Supraventricular and ventricular arrhythmias
By mouth
Adult and child above 12 years: 200 mg every 8 hours for
1 week, then reduce to 200 mg every 12 hours for anoth-
er 1 week. Usual maintenance dose 200 mg once daily or
minimum required to control arrhythmia
Child 1 month–12 years: initially 5–10 mg/kg (max 200
mg) every 12 hours for 7–10 days, then reduce to
maintenance dose of 5–10 mg/kg once a day (max 200
mg per day)
Neonate: initially 5–10 mg/kg every 12 hours for 7–10
AMIODARONE A
days, then reduce to maintenance dose of 5–10 mg/kg
once a day
By IV infusion
Adult: initially 5 mg/kg over 20–120 minutes while moni-
toring ECG. Give subsequent infusion if required depend-
ing on response up to max 1200 mg in 24 hours
Child 1 month–18 years: initially 5–10 mg/kg over 20
minutes–2 hours then by continuous infusion 0.3
mg/kg/hour, increased according to response to maxi-
mum dose of 1.5 mg/kg/hour (max 1200 mg in 24 hours)
Neonate: initially 5 mg/kg over 30 minutes then 5 mg/kg
over 30 minutes every 12–24 hours
 Ventricular fibrillation and pulseless ventricular tachycar-
dia in cardiac arrest refractory to defibrillation (with epi-

nephrine)
Adult: by IV injection, initially 300 mg (diluted in 20 ml
glucose 5%). An additional dose of 150 mg by IV injec-
tion can be given if required after at least 15 minutes,
followed by an IV infusion of 900 mg over 24 hours
Child 1 month–18 years: 5 mg/kg (max 300 mg) over at
least 3 minutes
Neonate: 5 mg/kg over at least 3 minutes
Preparation
 Dilute with 5% glucose. Concentration of solutions for IV
infusion should not be less than 300 mg of amiodarone

per 500 ml of glucose 5% (0.6 mg/ml) for stability and
they should not exceed a concentration of 3 mg/ml
Contra-indications
 Sinus bradycardia, sino-atrial heart block or sinus node
disease in patients without pacemaker

A MONOGRAPHS
 Thyroid dysfunction or history of thyroid dysfunction

 Known iodine or amiodarone hypersensitivity
 IV use in severe respiratory failure, circulatory collapse or
severe arterial hypotension
 Bolus injection in congestive heart failure or cardiomyo-
pathy
Side effects
 Hypothyroidism, hyperthyroidism
 Dose-dependent bradycardia, torsades de pointes
 Corneal microdeposits
 Nausea, vomiting, taste disturbances
 Raised serum transaminases, acute liver failure, jaundice
 Extrapyramidal tremor
 Nightmares, sleep disorders
 Pulmonary toxicity
 Photosensitivity, skin pigmentation
 Dose dependent bradycardia, hypotension
 Increased heart rate immediately following injection
 Injection site reactions, phlebitis
Interactions
 Increased risk of arrhythmias when amiodarone is given
with:
Disopyramide, dronedarone, flecainide, erythromycin,
levofloxacin, citalopram, amitryptyline, imipramine, ar-
temether with lumefantrine, chloroquine, mefloquine
and quinine, haloperidol, chlorpromazine, trifluoperazine,
fluphenazine, atazanavir, ritonavir, lithium and pentami-
dine isethionate
 Beta blockers (increased myocardial depression)
 Diltiazem, verapamil (increased risk of bradycardia, AV

AMIODARONE A
block and myocardial depression)
 Digoxin (increased plasma concentration of digoxin)
 Colchicine (increased risk of colchicine toxicity)
 Simvastatin (increased risk of myopathy)
 Warfarin (enhanced anticoagulant effect of warfarin)
 Phenytoin (increased plasma concentration of phenytoin)
 Avoid exposure to direct sunlight during treatment and
and for several months after discontinuing amiodarone

due to possibility of photosensitivity reactions. Use a
wide spectrum sunscreen
Pregnancy
 Do not use
Breast-feeding
 Do not use (discontinue breastfeeding)
Caution
 Do not dilute with sodium chloride 0.9% solution
 Amiodarone has a very long half-life and steady state
may be achieved over many weeks or months
 Reversible corneal microdeposits develop in most pa-
tients on amiodarone. They are usually asymptomatic but
if vision is impaired or if optic neuritis or neuropathy oc-
curs, stop treatment immediately to prevent blindness
and seek expert advice.
 Amiodarone contains iodine and can cause disorders of
thyroid function. Monitor thyroid function before starting
treatment and every 6 months thereafter. Withdraw
treatment temporarily if thyrotoxicosis develops
 Monitor liver function before and every 6 months during
A MONOGRAPHS
treatment with amiodarone due to risk of hepatotoxicity.

In case of severe liver toxicity, discontinue amiodarone
 Excessive doses may lead to severe bradycardia and con-
duction disturbances
 Only use in pregnancy if there is no alternative in life-
threatening or pregnancy-threatening arrhythmias as
amiodarone may cause neonatal goiter
AMITRIPTYLINE HC III V 24
Sedating tricyclic antidepressant
Dosage forms
Uses
 Anxiety
 Depression
 Neuropathic pain
 Migraine prophylaxis
Dose and duration

 Anxiety
Adult: 25–50 mg once at night

 Depression
Adult and child >16 years: Initially, 75 mg daily in

divided doses or as a single dose at bedtime increased
gradually as necessary to 150–200 mg
Reduce dose in elderly
Initially 12.5–25 mg at night or every 12 hours depend-

ing on response

AMITRIPTYLINE A
Initially 12.5–25 mg at night, increased if necessary to
maintenance of 50–75 mg at night (max 150 mg)
Contra-indications
 Recent heart attack
 Arrhythmias
 Depression in children <16 years
 Manic phase in bipolar disorders
 Epilepsy
 Diabetes
Side effects
 Sedation
 Abdominal pain, inflammation of the mouth
 Irregular heartbeat, oedema and hypertension
 Restlessness and fatigue
 Increased size of pupils and intra-ocular pressure
Interactions
 Alcohol (increased sedative effect)
 Take at night
 Do not take with alcohol
 Drowsiness may affect ability to perform skilled tasks,
such as operating machinery or driving

Pregnancy
st rd
 Do not use in 1 and 3 trimesters
Breast-feeding
 Can be used

A MONOGRAPHS
Caution
 Overdose can lead to death. Signs of overdose are dry
mouth, blurred vision, constipation, urinary retention,
anxiety, confusion, and sleep disorders
 Reduce dose in liver disease and for elderly
 Avoid abrupt withdrawal to avoid withdrawal syndrome
AMLODIPINE RR E 12.3
Dihydropyridine calcium channel blocker which relaxes vascu-
lar smooth muscles in coronary and peripheral arteries
Dosage forms
Uses
 Hypertension
 Angina prophylaxis
Dose and duration

 Hypertension and angina prophylaxis
Adult and child above 12 years: initially 5 mg once a day

increased if necessary after 2–4 weeks to a maximum of
10 mg once a day
Hepatic impairment: initially 2.5 mg once a day
Child 1 month–12 years: initially 0.1–0.2 mg/kg once a
day, increased as is necessary at intervals of 1–2 weeks
up to 0.4 mg/kg once a day (max 10 mg once a day)
Contra-indications
 Severe hypotension
 Cardiogenic shock
 Unstable angina

AMLODIPINE A
 Significant aortic stenosis
 Hypersensitivity to amlodipine or other dihydropyridines
Side effects
 Somnolence, dizziness, headache
 Fatigue
 Abdominal pain, nausea
 Palpitation, flushing
 Ankle swelling, oedema
 Stevens-Johnson syndrome
Interactions
 Phenobarbital (probably reduced effect of amlodipine)
 Ritonavir (increased plasma concentration of amlodipine)
 Prazosin (enhanced hypotensive effect, increased risk of
first dose hypotension)

 Simvastatin (possible increased risk of myopathy)
Pregnancy
 Do not use
Breast-feeding
 Can be used
Caution
 Monitor infant if mother uses amlodipine during breast
feeding
 Avoid abrupt withdrawal to avoid exacerbation of angina
 Use caution when increasing dose in the elderly
 Use with caution in patients with cardiac failure
 Tablets containing different salts are interchangeable

A MONOGRAPHS
AMOXICILLIN HC II V 6.2.1
Broad spectrum penicillin antibacterial with good absorption
after oral administration
Dosage forms
 Dispersible tablet: 250 mg
 Tablet and capsule: 250 mg and 500 mg
 Powder for oral suspension: 125 mg/5 ml
Uses
 Acute bronchitis
 Acute kidney infection
 Bacterial tonsillitis
 Bites (human, animal or reptile)
 Bladder and upper urinary tract infections
 Cellulitis and erysipelas
 Dental abscess
 Epistaxis
 Helicobacter pylori
 Infective endocarditis (prophylaxis)
 Mouth infection
 Laryngitis
 Low to moderate severity pneumonia
 Meningitis
 Otitis media
 Peritonsillar abscess Pneumonia
 Sinus infection
 Skin infection
 Typhoid fever
 Initial pre-referral dose for severe bacterial infection in
case injectable medicines unavailable

AMOXICILLIN A
Dose and duration
 Pneumonia in children
Child 1–5 years: 500 mg twice a day for 5 days

Child 2–11 months: 250 mg twice a day for 5 days
 All other bacterial infections
Adult: 500 mg every 8 hours

Child 5–18 years: 250 mg every 8 hours
Child 1–5 years (10–19kg): 250 mg every 8 hours
Child 2–12 months (4–10kg): 125 mg every 8 hours
Child 1–<2 months (3–<4kg): 62.5 mg every 8 hours
Child <1 month (<3kg): 31.25 mg every 8 hours
In severe infections, double the dose
Use Duration
Otitis media, bladder infection, acute 5 days
bronchitis, laryngitis, dental abscess
Bacterial tonsillitis, mouth infection 6 days
Pneumonia, sinus and skin infection 7–10 days
Helicobacter pylori (as part of triple 10–14 days
therapy for peptic ulcers)
Typhoid fever, upper urinary tract 14 days
infection
Chronic typhoid fever 4–6 weeks
Acute kidney infection 10 days
Contra-indications
 Penicillin allergy
 Cephalosporin allergy (possible cross-sensitivity)
Side effects
 Stomach upset
 Allergic reactions

A MONOGRAPHS
Interactions
 Methotrexate (increased methotrexate toxicity)
 Take with food and plenty of water to reduce stomach
upset
 Use oral suspension within 1 week
 If severe skin rash occurs, stop treatment immediately
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Amoxicillin is absorbed better than ampicillin from gut
 Reduce dose in patients with severe kidney disease
AMOXICILLIN + CLAVULANIC ACID RR E 6.2.1

Broad spectrum penicillin in combination with clavulanic acid,
a beta lactamase inhibitor
Dosage forms
 Tablet: 250 mg of amoxicillin + 125 mg of clavulanic acid;
500 mg of amoxicillin + 125 mg of clavulanic acid

 Syrup: (amoxicillin 200 mg + clavulanic acid 28.5 mg)/5 ml
Uses
 Respiratory tract infections
 Otitis media
 Genitourinary infections
 Abdominal infections
 Cellulitis

AMOXICILLIN + CLAVULANIC ACID A
 Animal bites
 Severe dental infections
 Osteomyelitis due to Haemophilus influenza
 Surgical prophylaxis
Dose and duration

 All uses
Adult and child > 12 years: 375 mg every 8 hours (500

mg/125 mg every 8 hours in severe infection) for 5–14
days
Child 6–12 years:
Renal impairment: 250 mg/125 mg every 12 hours or 500
mg/125 mg every 12 hours in severe infections
Contra-indications
 Hypersensitivity to penicillins
 History of severe hypersensitivity to other beta-lactams
 History of jaundice or hepatic dysfunction associated with
penicillin- or amoxicillin- with clavulanic acid

Side effects
 Mucocutaneous candidosis
 Nausea, vomiting, diarrhoea
 Hepatitis, cholestatic jaundice
 Toxic-epidermal necrolysis, exfoliative dermatitis
Pregnancy
 Can be used
Breast-feeding
 Can be used

A MONOGRAPHS
Caution
 In renal impairment, there is a risk of crystalluria and
convulsions with high doses of amoxicillin+ clavulanic ac-
id (particularly during parenteral therapy). Reduce dose if
creatinine clearance is less than 30 ml/minute
 Maintain adequate hydration with high doses to reduce
risk of crystalluria
 Monitor liver function in liver disease
 Risk of cholestatic jaundice is more common in male pa-
tients 65 years and older. Duration of treatment should
not exceed 14 days
 Discontinue treatment if rash or feverish generalised ery-
thema with pustules occurs at initiation of treatment
AMPHOTERICIN B H V 6.3
Broad spectrum polyene antifungal used for severe systemic
and deep mycoses. It is active against Candida spp., Aspergil-
lus spp., Cryptococcus neoformans, Histoplasma capsulatum,
Blastomyces dermatitidis, Coccidioides immitis, Paracoccidioi-
des brasiliensis, Mucor, Absidia, and Phicopes spp.; it is also
active against algae Prototheca spp. and against the Leishma-
nia protozoa
Dosage forms
Uses
 Cryptococcal meningitis
 Systemic candidiasis
 Aspergillosis
 Histoplasmosis

AMPHOTERICIN B A
 Coccidioidomycosis
 Para coccidioidomycosis
 Mucormycosis
 Sporotrichosis
 Blastomycosis
 Chronic mycetoma
 Visceral leishmaniasis
 Disseminated cryptococcosis in children
Dose and duration

 Systemic fungal infections
Adult and child: Initial test dose, 1 mg over 20‒30

minutes, followed by 250 micrograms/kg daily; gradually
increased to 1 mg/kg daily. For severe infections, dose may
be increased up to 1.5 mg/kg daily or on alternate days.
Give by slow IV infusion over 4‒6 hours
Preparation
Note: Follow manufacturer’s instructions
 Mix powder with 10 ml of water for injection, shake vig-
orously to produce a colloidal solution, then dilute further

in glucose 5% to a concentration of 100 micrograms per
ml.
 Incompatible with sodium chloride 0.9% or other electro-
lyte solutions so do not use them for dilution

Contra-indications
 Hypersensitivity to amphotericin B
Side effects
 Stomach upset, anorexia
 Fever and chills
 Hypokalaemia, hyponatremia, hypomagnesaemia, hyper-

A MONOGRAPHS
glycaemia, hypocalcaemia, hyperbilirubinemia

 Headache
 Tachycardia, hypotension, vasodilation, flushing
 Shortness of breath, chest pain
 Muscle and joint pain, back pain
 Anaemia
 Impaired kidney function and toxicity
 Anaphylaxis, rash
 Pain and thrombophlebitis at injection site
Interactions
 Ciclosporin (increased risk of kidney toxicity)
 Dexamethasone (increased risk of hypokalaemia)
 Digoxin (hypokalaemia due to amphotericin B increases
cardiac toxicity of digoxin)

 Hydrocortisone (increased risk of hypokalaemia)
 Prednisolone (increased risk of hypokalaemia)
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Toxicity is common. Test dose required, and monitor pa-
tient closely for at least 30 minutes after the test dose for
anaphylaxis
 Monitor liver, kidney, blood counts and plasma electro-
lytes while using this medicine
 Avoid rapid infusions as they can lead to arrhythmias
 Do not use to treat common skin infections
 Corticosteroids may be used only if they are needed to
AMPICILLIN A
control reactions to amphotericin B
 Prolonged treatment is usually necessary to eliminate in-
fection
AMPICILLIN HC III V 6.2.1

Broad spectrum penicillin antibacterial
Dosage forms
 Powder for injection: 500 mg in vial
 Capsules: 250 mg
Uses
 Severe meningitis
 Severe pneumonia
 Septicaemia
 Mastoiditis
 Amnionitis
 Acute pyelonephritis
Dose and duration

Slow IV injection given over 3–5 minutes or IV infusion given
over 20–30 minutes
Adult: 3 g IV every 6 hours for 3 weeks (may be given

up to 6 weeks)
Child: 50 mg/kg (max 500 mg) every 6 hours for 3
weeks (may be given up to 6 weeks)
 Neonatal meningitis and septicaemia (in combination
with IV gentamicin)
Treat for 7–10 days
Neonates >7 days: 50 mg/kg every 8 hours
Neonates <7 days: 50 mg/kg every 12 hours
A MONOGRAPHS
 Severe pneumonia (first line for IMCI; in combination with

IV gentamicin)
Infant 1 week–2 months: 25–50 mg/kg every 8 hours
for at least 5 days
Neonates <7 days: 25–50 mg/kg every 12 hours for at
least 5 days
 Other uses
Adult: 2g IV every 6 hours for 10-14 days

Child: 25-50mg/kg every 6 hours for 10–14 days
Preparation
Injection: Dissolve in 5 ml water for injection
Infusion: Dissolve in 0.9% sodium chloride or 5% glucose
Contra-indications
 Cephalosporin allergy
Side effects
 Stomach upset
Interactions
 Methotrexate (increased risk of methotrexate)
Pregnancy
 Can be used
Breast-feeding
 Can be used
Storage
 Ampicillin is stable for 12 hours in 0.9% sodium chloride
and for 4 hours in 5% glucose

AMPICILLIN + CLOXACILLIN A
Caution
 In case of allergic reaction, stop treatment immediately
 Reduce dose in severe kidney disease
AMPICILLIN + CLOXACILLIN H N 6.2.1

Combination of two broad spectrum penicillin antibiotics
Dosage forms
 Capsule: Ampicillin 250 mg + Cloxacillin 250 mg
 Powder for solution for injection: Ampicillin 250 mg +
Cloxacillin 250 mg
Uses
 Post-operative wounds and skin infections
 Pulmonary infections
 Bronchopneumonia
 Acute exacerbations of chronic bronchitis
 Puerperal fever
 Bacteraemia associated with or suspected to be associat-
ed with any of the infections above

Dose and duration
 All uses
Give slow IV over 3–4 minutes for 5–14 days

Adult and child over 10 years: 500–1000 mg every 6
hours by mouth
OR 500–1000 mg every 4–6 hours by IV or IM injection
Child 2-10 years: 250–500 mg every 6 hours
OR 250-500 mg every 4–6 hours by IM or IV injection
Child < 2 years: 250 mg every 6 hours by mouth
OR 250 mg every 4–6 hours by IV/IM injection
Neonate: 90 mg every 4 hours
A MONOGRAPHS
Preparation
 For IM, dissolve 500 mg of powder in 1.5 ml of water for
injection
 For IV injection, dissolve 500 mg in 10 ml of water
 For more information, see individual medicine mono-
graphs of ampicillin and cloxacillin
ANTHRAX VACCINE RR V 19.3.2

Bacillus anthracis antigens
Dosage forms
 Suspension for injection: o.125 ml/0.5 ml
Uses
 Immunisation against anthrax
Dose and duration

 Immunisation against anthrax
Adult: By IM injection in deltoid region, initial course 3

doses of 0.5 ml given once every 3 weeks, followed by a
4th dose after another 6 months and then a booster dose
of 0.5 ml once every 12 months
By SC injection, 3 doses of 0.5 ml given once every 2
weeks, followed by 0.5 ml given at 6, 12, and 18 months.
Annual booster injections of the vaccine are recommend-
ed thereafter in patients at high risk of contact/ infection
Contra-indications
 History of anaphylaxis with anthrax vaccine
 Severe hypersensitivity
Side effects
 Injection site reactions

ANTI-D IMMUNOGLOBULIN, HUMAN A
 Fever
 Gastro-intestinal disturbances
 Headache, irritability, loss of appetite, fatigue, malaise
 Muscle pain
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Postpone immunisation in patients with acute illness
ANTI-D IMMUNOGLOBULIN, HUMAN RR E 19.2

Antibodies obtained from plasma of rhesus-negative mothers
who have been immunised against the anti-D antigen
Dosage forms
 Solution for injection: 250 micrograms/ml
Uses
 Prevent a rhesus -negative mother from forming antibod-
ies to foetal rhesus-positive cells

 Treatment of rhesus negative patients following transfu-
sion of rhesus positive blood or blood products

Dose and duration
Given as a deep IM injection into the deltoid
 Rhesus-negative woman for prevention of Rh0(D) sensiti-
zation following birth of rhesus-positive infant

Adult: 100 micrograms immediately or within 72 hours of
delivery; for transplacental bleed of over 4 ml foetal red
cells, extra 20–25 micrograms per ml of foetal red cells
A MONOGRAPHS
 Following any potentially sensitizing episode (e.g. still-

birth, abortion, amniocentesis) up to 20 weeks’ gestation
Adult: 50 micrograms per episode (after 20 weeks of gesta-
tion, give 100 micrograms) immediately or within 72 hours
 Antenatal prophylaxis
Adult: 100 micrograms given at weeks 28 and 34 of preg-

nancy; if the infant is rhesus-positive, a further dose is still
needed immediately or within 72 hours of delivery
Or a single dose of 300 microgram at 28 weeks pregnancy
 Following rhesus incompatible blood transfusion
Adult and child: 20–25 micrograms per ml of transfused

rhesus positive red blood cells (50 micrograms per 3 adult
doses of platelets)
Contra-indications
 Treatment of idiopathic thrombocytopenia purpura in
rhesus negative or splenectomised patients

 Hypersensitivity
Side effects
 Headache, malaise
 Fever
 Injection site pain and tenderness
 Allergy and anaphylaxis
Interactions
 Live virus vaccine (efficacy of vaccine may be impaired)
 Report any signs/ symptoms of allergy such as hives, urti-
caria, tightness of chest, wheezing, hypotension to your

doctor immediately

ANTIRABIES IMMUNOGLOBULIN, HUMAN A
Pregnancy
 Can be used
Breast-feeding
 Can be used
Storage
o
 Store in a refrigerator at 2–8 C. Do not freeze
Caution
 Do not administer intravenously (risk of shock)
 Do not administer to a new born infant
 Observe patient for at least 20 minutes after administra-
tion
 Discontinue immediately if allergic or anaphylactic type
reactions occur
 Immunisation with live virus vaccines should be post-
poned until 3 months after administration of anti-D
immunoglobulin
ANTIRABIES IMMUNOGLOBULIN, HUMAN H V 19.2

Immunoglobulin preparation used for passive immunisation
against rabies
Dosage forms
 Solution for injection: 150 IU/ml
Uses
 Post-exposure prophylaxis of rabies infection
Dose and duration

 Post-exposure prophylaxis of rabies infection
Adult and child: 20 IU/kg. Infiltrate as much as possible in and

around the cleaned wound(s); if wound is not visible or has
A MONOGRAPHS
healed, or if the whole volume cannot be infiltrated, give the

remainder IM into the gluteal muscle
Side effects
 Injection site swelling and pain
 Anaphylaxis
Interactions
 Live attenuated virus vaccines (may interfere with the de-
velopment of an immune response for up to 3–4 months

after immunisation.
 Serological testing (may show misleading positive)
Pregnancy
 Can be used
Breast-feeding
 Can be used
Storage
o
 Store in the original container at 2–8 C. Do not freeze
Caution
 Repeat doses should not be given
 Epinephrine should always be immediately available dur-
ing immunisation
 If administration of rabies vaccine is started before the
immunoglobulin, the immunoglobulin should be given
within 7 days of starting the course of vaccine
 If rabies vaccine and the immunoglobulin are to be ad-
ministered at the same time, use separate syringes and at
separate sites of injection

ANTIRABIES VACCINE, HUMAN DIPLOID A
ANTIRABIES VACCINE, HUMAN DIPLOID H V 19.2
Inactivated rabies virus prepared in cell culture
Dosage forms
 Powder and solvent for suspension for injection: ≥ 2.5
IU/ml after reconstitution

Uses
 Prophylactic immunisation against rabies
 Treatment of patients following suspected rabies contact
Dose and duration

 Prophylactic immunisation against rabies
Adult and child: 1 ml dose given IM or intradermally on

days 0, 7 and 28. The 3rd dose can be given earliest on day
21. In persons with continuing risk, a booster dose should
be given at 1 year and successive doses every 3–5 years
 Treatment of patients following suspected rabies contact
Adult and child: By IM route, 1 dose given on days 0, 3, 7,

14 and 28
Alternative Dosing: 2 doses on day 0 (one on each deltoid
or thigh) followed by 1 dose on days 7 and 21
Alternative Dosing: By intradermal injection, doses of 0.1
ml administered at 8 separate sites on day 0, followed by
doses of 0.1 ml in each upper arm and each lateral thigh
on day 7, and 1dose of 0.1 ml in one upper arm on days
30 and 90.
Contra-indications
Pre- exposure
 Known systemic hypersensitivity reaction to any compo-
nent of rabies Vaccine

 Febrile and/or acute disease

A MONOGRAPHS
Post-exposure
 None
Side effects
 Headache, dizziness, malaise
 Lymphadenopathy
 Nausea, diarrhoea, vomiting, abdominal pain
 Joint pain, muscle pain
 Allergic skin reactions
 Apnoea in premature infants
Interactions
 Corticosteroids and immunosuppressive treatments (may
interfere with antibody production)

Pregnancy
 Can be used
Breast-feeding
 Can be used
Storage
o
 Store at 2–8 C in a refrigerator. Do not freeze.
Caution
 The vaccine may contain traces of neomycin so it should
be administered with caution in individuals with hyper-
sensitivity to neomycin or other aminoglycosides
 Use in patients with bleeding disorders like haemophilia
or thrombocytopenia ONLY when potential benefit out-
weighs risk

ANTITETANUS IMMUNOGLOBULIN, HUMAN (TIG) A
ANTITETANUS IMMUNOGLOBULIN,
HC IV V 19.2
HUMAN (TIG)
Immunoglobulin to neutralise toxins
Dosage forms
 Injection: 500 IU
Uses
 Post-exposure prophylaxis of tetanus infection
 Treatment of tetanus infection
Dose and duration

 Post-exposure prophylaxis
Adult and child > 10 years: 250 IU by IM injection.

Dose can be increased to 500 IU in infected wounds
where treatment can’t be achieved in 24 hours or in
deep or contaminated wounds with tissue damage and
reduced oxygen supply
Child 5‒10 years: 125 IU by IM injection
Child < 5 years: 75 IU by IM injection
Double the dose if more than 24 hours have elapsed or
if there is risk of heavy contamination or after burns
 Treatment of tetanus infection
Adult and child: 150 IU/kg by IM injection given at

multiple sites
Side effects
 Swelling and pain at injection site
 Buccal ulceration
 Glossitis
 Chest tightness
Pregnancy
 Can be used

A MONOGRAPHS
Breast-feeding
 Can be used
Caution
 Use in combination with DPT or TT vaccine to prevent in-
fection
 Fully immunized patients who have had a booster in the
last 10 years do not need treatment with antitetanus
immunoglobulin
ANTIVENOM SERA POLYVALENT

H E 19.2
(EAST AND CENTRAL AFRICA)
Antivenom immunoglobulin containing mixture of 11 Bitis,
Naja, Echis and Dendroaspis species
Dosage forms
 Solution for injection: 10 ml vial
Uses
 Treatment of snake bites and spider bites
Dose and duration

 Treatment of venomous snake bites and spider bites
Consult manufacturer’s literature

Side effects
 Serum sickness
 Anaphylaxis with hypotension, urticaria, shock
 Dyspnoea
Pregnancy
 Do not use
Breast-feeding
 Can be used

ARTEMETHER A
Storage
o
 Store at 2–8 C in a refrigerator. Do not freeze.
Caution
 Resuscitation facilities should be immediately available
during use
ARTEMETHER HC III E 6.4.3

Artemisinin derivative antimalarial
Dosage forms
 Injection: 80 mg/ml, 100 mg/ml
Uses
 Severe P. falciparum malaria
 Initial treatment of uncomplicated malaria when persis-
tent vomiting prevents use of the oral route

Dose and duration
 Severe P. falciparum malaria and initial treatment of
uncomplicated malaria
Adult and child >6 months: Loading dose of 3.2 mg/kg
by IM injection on first day followed by 1.6 mg/kg once
daily for 3 days
As soon as patient can take orally, change to oral route
and give a 3-day course of first line ACT
Contra-indications
 Same as for artemether + lumefantrine
Side effects
Interactions

A MONOGRAPHS
Pregnancy
st
 Do not use in the 1 trimester
Breast-feeding
 Can be used
Caution
 Do not administer by IV route
ARTEMETHER + LUMEFANTRINE HC II V 6.4.3

Antimalarial; artemisinin-based combination therapy (ACT)
Dosage forms
 Tablets: Artemether 20 mg and lumefantrine 120 mg
Uses
 First line therapy for uncomplicated P. falciparum malaria
Dose and duration

Adult >34 kg: 4 tablets every 12 hours for 3 days
Child 25–34 kg: 3 tablets every 12 hours for 3 days
Child 15–24 kg: 2 tablets every 12 hours for 3 days
Child 5–14 kg: 1 tablet every 12 hours for 3 days
Contra-indications
 Children <4 months of age or <5 kg body weight
Side effects
 Stomach upset
 Headache and dizziness

ARTESUNATE A
Interactions
 Azithromycin and erythromycin (increased risk of irregu-
lar heartbeat)
 Ciprofloxacin (increased risk of irregular heartbeat)
 Take with a fatty meal or milk
 If vomiting occurs within one hour of administration, re-
peat the full dose

Pregnancy
st
Breast-feeding
 Can be used
Caution
 Use oral quinine in 1st trimester pregnancy and in children
<4 months of age or <5 kg body weight
 Artemether + lumefantrine should not be used for
malaria prophylaxis
ARTESUNATE HC III V 6.4.3

Artemisinin derivative antimalarial
Dosage forms
 Suppositories: 50 mg and 200 mg
 Injection: Ampoules containing 60 mg anhydrous ar-
tesunic acid with a separate ampoule of 5% sodium

bicarbonate solution
Uses
 Pre-referral treatment for severe malaria (artesunate
suppositories)
A MONOGRAPHS
 Initial treatment of uncomplicated malaria when persis-

tent vomiting precludes oral route.
 First line treatment for severe malaria (IV artesunate)
Dose and duration

 Pre-referral treatment of severe malaria
Child and adult: 10–20 mg/kg rectally as a single dose

before referring the patient. See dose in table below
 Uncomplicated malaria
Child and adult: 10–20 mg/kg rectally once daily. See

dose in table here:
Regimen
Weight Age Artesunate
50 mg 200 mg
(kg) (years) Dose (mg)
supp. supp.
5 - 8.9 0–1 50 mg 1 –
9 – 19 1 - 3½ 100 mg 2 –
20 – 29 3½ - 5 200 mg – 1
30 – 39 6 - 12 300 mg 2 1
40 – 59 >12 400 mg – 2
60 – 80 800 mg – 4
>80 1200 mg – 6
As soon as patient can take orally, change to oral route
and give a 3-day course of first line ACT
 Severe malaria
Adult and child > 20kg: 2.4 mg/kg

Child ≤ 20 kg: 3 mg/kg
Initially, give by slow IV injection over 5 minutes as in
the table below. Follow by full dose of first line ACT

ARTESUNATE A
Time of Administration
First dose: On At 0 hours
admission
Second dose At 12 hours
Third dose At 24 hours
Then: Once a day until patient is able to take orally
Preparation
 Dissolve artesunic acid powder in 5% sodium bicarbonate
solution for injection. Dilute the mixture in 5 ml of 5%

glucose or 0.9% sodium chloride solution. Solutions
should be freshly prepared prior to administration.
Side effects
 Stomach upset
 Tinnitus
 May impair ability to perform skilled tasks, such as driv-
ing or operating machinery

Pregnancy
st
Breast-feeding
 Can be used
Caution
 Buttocks should be held together for at least 1 minute to
ensure retention after rectal insertion
 If suppositories are expelled from rectum within 30
minutes of insertion, repeat the treatment

 2–3 capsules can be rectally inserted at the same time.

A MONOGRAPHS
If 4 or more capsules are needed, first insert 3 capsules,

then wait 10 minutes before inserting more
 Flush IV line with 3 ml of sodium chloride 0.9% after giv-
ing artesunate
ARTESUNATE + AMODIAQUINE HC IV E 6.4.3

Artemisinin combination therapy antimalarial. First line al-
ternative for uncomplicated malaria
Dosage forms
 Tablet: 50 mg artesunate + 153 mg amodiaquine
Uses
Dose and duration

 Uncomplicated malaria (First line alternative to arteme-
ther + lumefantrine)
Take once daily as in table below
Dosage of artesunate tablets
Age Day 1 Day 2 Day 3
5-11 months 25 mg 25 mg 25 mg
(=½ tab) (=½ tab) (=½ tab)
1-6 years 50 mg 50 mg 50 mg
(=1 tab) (=1 tab) (=1 tab)
7-13 years 100 mg 100 mg 100 mg
(=2 tabs) (=2 tabs) (=2 tabs)
>13yrs 200 mg 200 mg 200 mg

ARTESUNATE + AMODIAQUINE A
Dosage of amodiaquine
Age Day 1 Day 2 Day 3
5-11 months 76 mg 76 mg 76 mg
(=1/2 tab) (=1/2 tab) (=1/2 tab)
1-6 years 153 mg 153 mg 153 mg
(=1 tab) (=1 tab) (=1tab)
7-13 years 306 mg 306 mg 306 mg
>13yrs 612 mg 612 mg 612 mg
Contraindications
 Liver disease
Side effects
 Stomach upset
 Headache, dizziness, fatigue
 Itching
 Liver damage
 Blood disorders (low white blood cell count)
 Take plenty of fluids during treatment
Pregnancy
st
Breast-feeding
 Can be used
Caution
 Monitor for jaundice and fever, mouth ulcers or tonsillitis
that may develop during treatment
 Discontinue treatment if the above symptoms occur
A MONOGRAPHS
ASCORBIC ACID HC II N 27
Antioxidant vitamin necessary for formation of collagen to
hold cells together. Ascorbic acid improves resistance to infec-
tion and improves iron absorption
Dosage forms
 Tablet: 100 mg
Uses
 Adjunct to desferrioxamine in iron excretion
 Prevention and treatment of scurvy
 Metabolic disorders (tyrosinaemia type III, transient tyro-
sinaemia of the newborn, glutathione synthase deficiency,

Hawkinsinuria)
Dose and duration
 Adjunct to desferrioxamine in iron excretion
Start treatment 1 month after starting desferrioxamine

therapy
Adult: 200 mg once daily
Child 1 month–18 years: 100–200 mg once daily 1 hour
before food
 Prevention of scurvy

 Treatment of scurvy
Adult and child over 12 years: 500–1000 mg daily in 1–2

divided doses
Child 4–12 years: 250–500 mg daily in 1–2 divided doses
Child 1 month–4 years: 125–250 mg daily in 1–2 divided
doses
 Metabolic disorders
Child 1 month–18 years: 200–400 mg daily in 1–2 divided

ASPARAGINASE A
doses, adjusted as necessary. Up to 1 g daily may be
required
Neonate: 50–200 mg daily, adjusted as necessary
Contra-indications
 Hyperoxaluria (excessive urinary oxalate)
Side effects
 Nausea, diarrhoea
 Headache, fatigue
 Hyperoxaluria
Pregnancy
 Can be used
Breast-feeding
 Can be used
Storage
 Store in a cool dry place away from light
 Avoid contact with metal
Caution
 Avoid rapid withdrawal as it may result into deficiency due
to increased renal clearance
 Doses larger than 1 g should not be used in pregnancy
ASPARAGINASE NR N 8.2
Cytotoxic anticancer medicine. Crisantaspase is asparaginase
that is derived from Erwina chrysanthemi.
Dosage forms
 Powder for injection: 10,000 IU

A MONOGRAPHS
Uses
 Acute lymphoblastic anaemia
Dose and duration

 Acute lymphoblastic anaemia
Can be given by IV, IM or SC injection

For all patients the usual dose is 6,000 units/m2 body
surface area (200 units/kg of body weight), three times
a week for 3 weeks
Contra-indications
 History of pancreatitis related to asparaginase therapy
 Previous allergic reaction to L-asparaginase
Side effects
 Hypersensitivity (rashes, urticaria, laryngeal oedema,
bronchospasm, hypotension)
 Anaphylaxis
 Coagulation abnormalities (e.g. thromboses)
 Liver dysfunction, altered liver enzyme parameters
 Pancreatic disorders
 Lethargy, sleepiness, confusion, dizziness, neurotoxicity,
convulsions, headache
 Dyspnoea
 Diarrhoea
 Nausea and vomiting
 Fever, chills, generalised body pain
 Swelling of limbs
 Injection site reactions (pain, swelling, redness)
 Hyperglycaemia

ASPARAGINASE A
Interactions
 Methotrexate (cancelled effect of methotrexate)
 Prednisolone (decrease in fibrinogen and antithrombin III
clotting factors. Increased risk of thromboses)

 Vincristine (increased risk of anaphylaxis and toxicity)
 Report immediately to health worker if you experience
hypersensitivity or bleeding disorders

Pregnancy
 Do not use
Breast-feeding
 Do not use
Storage
 Store between 2‒8°C. Do not freeze.
Caution
 Discontinue treatment immediately if hypersensitivity oc-
curs
 Facilities for management of anaphylaxis should be readily
available
 Monitor patient closely when used in combination with
other hepatotoxic medicines
 Monitor patient closely when used in combination with
other medicines that cause bleeding disorders (warfarin,
steroids, NSAIDS)
 Monitor liver function tests during treatment
 Anticancer medicines should only be handled by health
workers trained and experienced in cytotoxic medicines

A MONOGRAPHS
ASPIRIN (ACETYLSALICYLIC ACID) HC II E 2.1

See acetylsalicylic acid
ATAZANAVIR + RITONAVIR (ATV/r) H N 30.3

Protease inhibitor (PI) antiretroviral medicines; ritonavir is a
booster that increases the effect of atazanavir.
Dosage forms
 Tablet: ATV 300 mg + RTV 100 mg
Uses
 HIV/AIDS
Dose and duration

 HIV infection, second line treatment for adults and chil-
dren 10–15 years of ≥35 kg (in combination with AZT +

3TC or ABC + 3TC or TDF + 3TC)
Adult or child >35 kg: 300 mg/100 mg ATV/r once daily
Contra-indications
Side effects
 Jaundice
 Rash
 Irregular heartbeat, chest pain
 Mouth ulcers, dry mouth, stomach upset
 Difficulty in sleeping, headache, fatigue
Interactions
 Simvastatin, atorvastatin (increased risk of muscle dam-
age)
 Rifampicin (reduced ATV efficacy)

ATENOLOL A
 Nevirapine (reduced ATV efficacy)
 Efavirenz (reduced ATV efficacy)
 Ketoconazole (increased ketoconazole level in blood)
 Omeprazole (reduced ATV efficacy)
 Antacids, e.g. magnesium sulphate compound (reduced
absorption of ATV)
 Quinine (increased risk of quinine toxicity)
 Ergometrine (increased ergometrine toxicity)
 Take with or after food
 Take magnesium sulphate compound 2 hours apart from
ATV
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Discuss therapy with HIV treatment specialist before
starting patient on ATV/r
 If patient is using oral contraceptives, advise patient to
use another method of contraception or make sure they
use formulation with 50 micrograms ethinylestradiol
ATENOLOL H V 12.1, 12.3

B-blocker with antihypertensive and antidysrhythmic activity
Dosage forms

A MONOGRAPHS
Uses
 Moderate to severe hypertension(Stage 2)
Dose and duration

 Moderate to severe hypertension (stage 2)
Adult: 25–100 mg daily

Contra-indications
 Coronary artery vasospasm (Prinzmetal’s angina)
 Hypotension
 Marked bradycardia
 Metabolic acidosis
 Second and third degree atrioventricular block
 Severe peripheral arterial disease
 Uncontrolled heart failure
 Severe asthma and severe chronic obstructive pulmonary
disease
 Untreated pheochromocytoma
Side effects
 Gastrointestinal disturbances, constipation
 Bradycardia, cold extremities
 Fatigue, sweating
 Bronchospasm
Interactions
 Alpha blockers (enhanced hypotensive effect)
 Amiodarone (AV block and myocardial depression)
 Epinephrine (severe hypertension)
 Lidocaine (increased myocardial depression)
 Nifedipine (enhanced hypotensive effect)

ATORVASTATIN A
 Procainamide (increased myocardial depression)
 Verapamil (asystole, severe hypotension, heart failure)
Pregnancy
st nd
Breast-feeding
 Can be used
Caution
 Atenolol should not be withdrawn abruptly
 Reduce dose in renal failure
 May mask the signs of hypoglycaemia and thyrotoxicosis
ATORVASTATIN H V 12.6
Lipid-lowering agent. It is a statin (3-hydroxy-3-methylglutaryl
coenzyme A (HMG-CoA) reductase inhibitor
Dosage forms
 Tablet: 10 mg
Uses
 Primary hypercholesterolemia
 Familial hypercholesterolemia
 Combined (mixed) hyperlipidaemia
 Prevention of cardiovascular events in patients at high
risk of first cardiovascular event

Dose and duration
 Primary hypercholesterolemia, combined hyperlipidaemia
Adult: 10 mg once daily increased if necessary at intervals

of at least 4 weeks to max daily dose of 80 mg once daily
Child 10–18 years: 10 mg once daily increased if neces-
sary at intervals of at least 4 weeks to max 20 mg
A MONOGRAPHS
 Familial hypercholesterolemia
Adult: 10 mg once daily increased if necessary at intervals
of at least 4 weeks up to 40 mg once daily (max 80 mg)
Child 10–18 years: same as above (max 80 mg in homo-
zygous familial hypercholesterolemia)
 Prevention of cardiovascular events
Adult: initially, 10 mg once daily adjusted according to re-

sponse
Contra-indications
 Hypersensitivity to atorvastatin
 Active liver disease or unexplained rise in serum transam-
inases exceeding 3 times the upper normal limit

Side effects
 Nasopharyngitis, epistaxis, pharyngolaryngeal pain
 Allergic reactions, anaphylaxis
 Hyperglycaemia
 Headache
 Constipation, flatulence, dyspepsia, nausea, diarrhoea
 Joint and muscle pain, spasms and swelling, back pain
 Abnormal liver function tests (LFTs)
 Depression
 Sexual dysfunction
 Interstitial lung disease
Interactions
 Clarithromycin (increased concentration of atorvastatin)
 Fusidic acid (risk of myopathy and rhabdomyolysis)
 Itraconazole, posaconazole, ciclosporin, fenofibrate (in-
creased risk of myopathy)

ATRACURIUM BESILATE A
 Seek medical attention if you develop signs of interstitial
lung disease such as: difficulty in breathing, cough and

weight loss
Pregnancy
Breast-feeding
Caution
 Manage hypothyroidism adequately before starting
treatment with a statin
 Use with caution in patients with a history of liver disease
or with a high alcohol intake. Do liver function tests be-
fore treatment, at 3 months and at 12 months of treat-
ment, and when there are signs of hepatotoxicity
 Risk of congenital anomalies when used during pregnan-
cy. Uses adequate contraception during treatment with
atorvastatin and for 1 month afterwards
 Manufacturer advises avoid use in breast-feeding
 Use with caution in haemorrhagic stroke
ATRACURIUM BESILATE H V 20
Benzylisoquinolinium non-depolarising neuromuscular block-
er with intermediate duration of neuromuscular blockade
Dosage forms
 Solution for injection: 10 mg/ml
Uses
 Neuromuscular blockade for surgery

A MONOGRAPHS
 Neuromuscular blockade during intensive care

Dose and duration
 Neuromuscular blockade during intubation and surgery
Adult and child above 1 month: by IV injection, initially

0.3–0.6 mg/kg, then 0.1–0.2 mg/kg as required
OR
Initially by IV injection, 0.2–0.6 mg/kg followed by IV in-
fusion, 0.3–0.6 mg/kg/hour adjusted according to re-
sponse
Neonate: initially by IV injection 0.3–0.5 mg/kg followed
either by IV injection, 0.1–0.2 mg/kg repeated as neces-
sary or by IV infusion, 0.3–0.4 mg/kg/hour adjusted ac-
cording to response
Adult and child above 1 month: by IV injection, initially

0.3–0.6 mg/kg then by IV infusion 0.27–1.77 mg/kg/hour
(usual dose 0.65–0.78 mg/kg/hour)
Neonate: initially by IV injection 0.3–0.5 mg/kg followed
either by IV injection, 0.1–0.2 mg/kg repeated as neces-
sary or by IV infusion, 0.3–0.4 mg/kg/hour adjusted ac-
cording to response; higher doses may be necessary
Preparation
 Dilute with sodium chloride 0.9%, glucose 5% or ringer’s
lactate solution
Contra-indications
 Hypersensitivity to atracurium
Side effects
 Flushing, transient hypotension, tachycardia, bradycardia,
hypertension

ATRACURIUM BESILATE A
 Urticaria, itching, anaphylactoid reactions
 Bronchospasm, wheezing
Interactions
 Aminoglycosides, clindamycin, polymixin B (effects of
atracurium enhanced)
 Phenytoin (effect of atracurium reduced by long-term use
of atracurium; acute use of phenytoin may increase the

effect of atracurium)
 Do not drive or operate dangerous machinery within 24
hours of administration
Pregnancy
 Can be used
Breast-feeding
Storage
o
 Store in a refrigerator at 2–8 C. Do not freeze
 Use diluted solutions immediately or store diluted solu-
tions in a refrigerator for not more than 24 hours

Caution
 Monitor infant if breast feeding is started within 24 hours
after administration of atracurium
 Only use in pregnancy when absolutely necessary
 Use with caution in patients with hypersensitivity to oth-
er neuromuscular blocking drugs due to risk of allergic
cross-reactivity
 Use lower doses in patients with myasthenia gravis or

A MONOGRAPHS
hypothermia
 In patients with burns, dose increase may be required
 Use with caution in patients with other neuromuscular
disorders and electrolyte imbalances since effect is un-
predictable
 Reduce rate of administration in patients with cardiovas-
cular disease
 In obesity, dose should be calculated on the basis of ideal
body weight to avoid excessive dosage
 Administer with adequate general anaesthesia or with
adequate sedation
 Do not administer intramuscularly
 Flush vein with normal saline after administration. If
same cannula is used for other medicines, flush the
cannula with water for injections or normal saline
ATROPINE HC IV V 1.3, 4.2, 21.8

Antimuscarinic. Antidote for organophosphate poisoning. Eye
drops are mydriatic
Dosage forms
 Eye drops: 1%
Uses
 Organophosphate poisoning
 Control side effects of anaesthetics (excessive salivation
and bronchial secretions)

 Inflammatory conditions of the eyes (iritis, uveitis)
 Cycloplegia (specialist use only)
 Control effects of neostigmine in reversal of neuro-

ATROPINE A
muscular block (specialist use only)
Dose and duration
 Organophosphate poisoning
Adult: 2 mg IM or IV (according to the severity of the poi-

soning
Child: 20 micrograms/kg per dose
Repeat dose every 20‒30 minutes until signs of atropin-
isation occur (pupil dilatation, hot dry skin, dry mouth,
fast pulse)
 Premedication before anaesthesia
Adult: by IV injection; 300‒600 micrograms immediately

before induction of anaesthesia
Child: 20 micrograms/kg (maximum 600 micrograms)
OR
By SC or IM injection;
Adult: 300‒600 micrograms 30‒60 minutes before induc-
tion of anaesthesia
Child: 20 micrograms/kg (maximum 600 micrograms)
 Intra-operative bradycardia (low heartbeat < 50
beats/minute)
Adult: 300‒600 micrograms (larger doses in emergencies)
by IV injection
Child 1‒12 years: 10‒20 micrograms/kg by IV injection
 Control effects of neostigmine in reversal neuromuscular
block (specialist use only)

Adult and child >12 years: 600‒1200 micrograms by IV
injection
Neonate and child up to 12 years: 20 micrograms/kg by
IV injection (max 600 micrograms)

A MONOGRAPHS
 Iritis, Uveitis
Adult: Apply 1 drop in the eyes every 6 hours
Child: Apply 1 drop in the eyes every 8 hours
Contra-indications
 Angle-closure glaucoma
 Pyloric stenosis
 Prostate enlargement
 Paralytic ileus
Side effects
 Dry mouth, constipation
 Blurred vision, eye irritation when looking at light
 Raised intra-ocular pressure, oedema and conjunctivitis
after prolonged use

 Dry skin
 Difficulty in urination
Interactions
 Amitriptyline (Increased side effects of atropine)
 Chlorpheniramine (Increased side effects of atropine)
 Promethazine (Increased side effects of atropine)
 Chlorpromazine (Increased side effects of atropine)
 Glyceryl trinitrate (Reduced absorption of sublingual
gylceryl trinitrate due to dry mouth)

 Metoclopramide (Reduced effect of metoclopramide)
 When using eye drops, do not drive or operate machinery
until vision is clear

Pregnancy
 Can be used

AZATHIOPRINE A
Breast-feeding
 Can be used
Caution
 Use may cause acute angle glaucoma in elderly, long-
sighted patients, and infants under 3 months
AZATHIOPRINE NR V 8.1
Immunosuppressive medicine
Dosage forms
 Tablet: 50 mg
Uses
 Psoriatic arthritis
 Suppression of transplant rejection
 Inflammatory bowel disease
 Severe refractory eczema
 Generalised myasthenia gravis
 Autoimmune diseases
 Systemic lupus erythematosus (SLE)
Dose and duration

Only use the IV route if oral route is not possible. Give IV in-
jection over 1 minute followed by 50 ml sodium chloride in-
travenous infusion
 Suppression of transplant rejection
Adult: by mouth or IV injection, up to 5 mg/kg on the day

of surgery, then reduced according to response to a
maintenance dose of 1–4 mg/kg per day or by IV infusion,

A MONOGRAPHS
1–2.5 mg/kg/day adjusted according to response.

Maintain therapy indefinitely
Child 1 month–18 years: by mouth or IV infusion
maintenance dose of 1–3 mg/kg given 1–2 times a day,
adjusted according to response
 Severe refractory eczema
Adult: by mouth, normal or high thiopurine methyl trans-
ferase (TPMT) activity, 1–3 mg/kg per day: intermediate
TPMT activity, 0.5–1.5 mg/kg per day
 Generalised myasthenia gravis (in conjunction with a
steroid)
Adult: 0.5–1 mg/kg/day increased over 3–4 weeks to 2.0–
2.5 mg/kg/day
 Other conditions
Adult: by mouth or IV infusion, 1–3 mg/kg/day adjusted
according to response
Child 1 month–18 years: by mouth, 1 mg/kg once a day,
adjusted according to response (max 3 mg/kg)
Consider withdrawal if there is no improvement within 3
months
Preparation
 Reconstitute powder according to manufacturer’s in-
structions
Contra-indications
 Hypersensitivity to azathioprine or mercaptopurine
Side effects
 Viral, fungal and bacterial infections
 Bone marrow suppression, leucopoenia, thrombocytope-
nia

AZATHIOPRINE A
 Hepatotoxicity
 Nausea, anorexia
Interactions
 Allopurinol (increased effects and toxicity of azathioprine
 Cotrimoxazole, trimethoprim (increased risk of haemato-
logical toxicity)
 Live vaccines (reduced immune response to vaccine)
 Warfarin (anticoagulant effect possibly reduced)
 Swallow your tablets at least 1 hour before or 3 hours af-
ter food or milk

 Report any signs of bone marrow suppression such as
unexplained bruising or bleeding, purpura, infection or

sore throat to your doctor
 Take with plenty of fluid
 Report immediately to health worker if jaundice occurs
Pregnancy
 Can be used
Breast-feeding
 Do not use
Caution
 Monitor full blood counts every week, or more frequently
in high doses, in renal and hepatic failure for the first 4

weeks and at least every 3 months thereafter
 Reduce dose in the elderly, when given with allopurinol
and in renal and hepatic impairment

 Withdraw treatment immediately if interstitial nephritis
occurs
A MONOGRAPHS
 Intravenous injection is alkaline and very irritant, only use

this route if oral route is not possible
 Transplant patients who become pregnant should con-
tinue with azathioprine under close supervision. It can
cause premature birth, spontaneous abortion and low
birth weight and teratogenicity
 Only use in breast feeding if likely benefit outweighs risk
AZITHROMYCIN HC II N 6.2.1
Macrolide antibacterial with fewer gastrointestinal side-effects
than erythromycin
Dosage forms
 Paediatric oral suspension: 200 mg/5 ml
Uses
 Gonococcal eye infection
 Trachoma
 Bacterial tonsillitis and bronchitis (second line to amoxicil-
lin, e.g. in penicillin-allergic patients)

 Uncomplicated genital chlamydial infections
 Non-gonococcal urethritis
 Upper respiratory tract infection
 Otitis media
 Skin and soft-tissue infection
 Lyme disease
Dose and duration

 Trachoma and gonococcal eye infection (in combination
with doxycycline and tetracycline eye ointment)

Adult >45 kg: 1 g single dose
AZITHROMYCIN A
Adult <45 kg and child >6months: 20 mg/kg single dose
 Bacterial tonsillitis and bronchitis
Adult and child >45 kg: 500 mg once daily for 3 days
Child >6 months: 10 mg/kg once daily for 3 days (Maxi-
mum 500 mg per day)
 Uncomplicated genital chlamydial infections and non-
gonococcal urethritis
Adult: 1 g single dose
Contra-indications
 Allergy to azithromycin or erythromycin
 Liver disease
 Kidney disease
Side effects
 Stomach upset, tooth and tongue discoloration, taste dis-
turbances
 Dizziness, drowsiness, headache, weakness, paraesthesia
 Leucopoenia
Interactions
 Artemether/lumefantrine (increased risk of irregular
heartbeat)
 Tablets should be taken at least 1 hour before or 2 hours
after food
 Oral suspension can be taken with food
 Give at least 2 hours apart from magnesium trisilicate
compound
Pregnancy
 Can be used

B MONOGRAPHS
Breast-feeding
 Can be used
Caution
 Avoid use in severe liver disease
 Use with caution in renal failure with eGFR less than 10
ml/minute/1.73 m2
B
BCG VACCINE HC II V 19.3.1
Live attenuated freeze-dried anti-tuberculosis vaccine
used in routine childhood immunisation
Dosage forms
 Powder for injection: 1.5 mg vial with 1.5 ml diluents
Uses
 Prevention against tuberculosis
Dose and duration

Give intradermal (just below the skin) injection into the ex-
ternal face of the right upper arm
Child <11 months: 0.05 ml as a single dose as soon after birth
as possible
Child >11 months: 0.1 ml as a single dose
Preparation
 Dissolve with entire vial of the diluents packaged along
with the vaccine. Do not use other diluents

Contra-indications
 Immunocompromised patients (e.g. patients with HIV
infection and patients on anticancer medicines)

BCG VACCINE B
 Extensive septic skin diseases
 Acute complicated malnutrition
 Severe acute febrile illness (minor infections are not
contraindications)
 Infants exposed to smear positive tuberculosis until after
they have completed 6 months of isoniazid prophylaxis

 Acute tuberculosis
Side effects
 Pain on injection site
Interactions
 All skin disinfectants (inactivate vaccine)
 The ulcer that forms at the injection site is a normal and
expected reaction that heals by itself. It should not be

covered with anything. It will leave a permanent scar
Pregnancy
 Not applicable
Breast-feeding
 Not applicable
Storage
 Keep both powder and diluent at 2–8°C; never freeze the
diluent.
 Keep the reconstituted vaccine between 2–8°C for NOT
more than 4 hours

Caution
 Clean injection site with boiled cooled water and allow air
drying. Do not use disinfectants (risk of inactivation of
vaccine)

B MONOGRAPHS
 Do not mix with other vaccines in the same syringe

 Inject the vaccine in the same place for each child to
make it easy to find the BCG scar. Avoid injecting towards
the tip of the shoulder
BECLOMETHASONE HC IV E 25.1, 28.2

Corticosteroid
Dosage forms
 Inhaler: 50 micrograms/metered dose inhalation
 Nasal spray (aqueous suspension): 50 mi-
crograms/metered spray
Uses
 Asthma
 Nasal allergy
Dose and duration

 Step 2 asthma treatment
Inhale 100‒400 micrograms every 12 hours. Double the

dose during exacerbations
Inhale 0.4‒1 mg every 12 hours

Up to 2 mg daily in divided doses

 Nasal allergy
Adult and child >6 years: 100 micrograms (2 sprays) into

each nostril every 12 hours (max 400 micrograms i.e. 8
sprays per day) until symptoms are controlled; then (50
micrograms) 1 spray into each nostril every 12 hours
Contra-indications
 Allergy to beclomethasone

BECLOMETHASONE B
Side effects
 Candidiasis of mouth and throat, throat irritation, cough
 Adrenal suppression on prolonged use of high doses
 Local side effects of nasal application include nasal dry-
ness, irritation of the nose and throat, and epistaxis

 Use the inhaler every day to ensure adequate control
of asthma
 If wheezing increases straight after inhalation, use the
salbutamol inhaler immediately to get relief. Do not

use the inhaler again and report incident to the health
worker
 After inhalation, rinse mouth with water and spit out
or clean the child’s teeth to reduce risk of oral

candidiasis
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Avoid high doses; only continue with high doses if there is
a clear benefit over the lower doses
 Instruct patient in proper use of inhaler
 Paradoxical bronchospasm may occur with an immediate
increase in wheezing after inhaling. This should be treat-
ed immediately with a fast-acting inhaled bronchodilator
(salbutamol). Discontinue use of beclomethasone imme-
diately and , and if necessary initiate alternative therapy
 Avoid nasal preparations in presence of untreated nasal
B MONOGRAPHS
infections and after nasal surgery (unless healing has

occurred) and in pulmonary tuberculosis
BENDROFLUMETHIAZIDE HC III E 16
Thiazide diuretic
Dosage forms
 Tablet: 5 mg
Uses
 Mild hypertension (stage 1)
 Moderate to severe hypertension (as part of combination
therapy)
Dose and duration
Adult: 2.5–5 mg each morning
Contra-indications
 Low plasma sodium and potassium
 High plasma calcium levels
 Gout
 Diabetes
Side effects
 Mild stomach upset
 Dehydration, dry mouth, thirst
 Weakness, drowsiness, headache
 Muscle pains or cramps
 Low blood pressure, dizziness when standing up quickly
 Electrolyte imbalance, raised blood glucose levels
 Gout

BENZATHINE BENZYLPENICILLIN B
Interactions
 Calcium salts (increased risk of high calcium blood levels)
Patient information
 Increases urination so take medicine in the morning to
avoid interfering with sleep

 If patient feels dizzy while on medicine, they should lie
down immediately, then report to health worker

 Avoid standing up suddenly to avoid dizziness
 Eat a lot of fresh fruits (bananas, mangoes, oranges)
Pregnancy
 Do not use
Breast-feeding
 Do not use
Caution
 Use low doses in elderly as they are at higher risk of side
effects
BENZATHINE BENZYLPENICILLIN HC III E 6.2.1

Broad spectrum penicillin antibacterial with prolonged action
(15 to 20 days)
Dosage forms
 Powder for injection: 2.4 MU (= 1.44 g benzyl penicillin)
Uses
 Severe streptococcal sore throat and tonsillitis
 Syphilis (except neurosyphilis
 Prophylaxis of congenital syphilis in newborn when
mother tests positive

B MONOGRAPHS
Dose and duration

Given as deep intramuscular (IM) injection
 Streptococcal sore throat and tonsillitis
Adult: 1.2 MU as single dose

Child <30 kg: 30,000 IU/kg as single dose
 Early syphilis (infection of less than 2 years)
Adult: 2.4 MU IM single dose; divide the dose into 2

injections (half dose into each buttock)
 Late syphilis (asymptomatic infection lasting more than 2
years)
Adult: 2.4 MU IM (half dose into each buttock) once
per week for 3 weeks
 Prophylaxis of congenital syphilis in newborn
Neonate: 50,000 IU/kg IM single dose; follow up every

2 weeks
Preparation
 Dissolve powder in 8 ml of water for injection; shake sus-
pension before administration

Contra-indications
 Cephalosporin allergy (cross-sensitivity may occur)
 Neurosyphilis
Side effects
 Stomach upset
 Allergic reaction
 Jarisch-herxheimer reaction in syphilis (rash, fever, feel-
ing of sickness)
Interactions
 Methotrexate (increased risk of methotrexate toxicity)

BENZHEXOL (TRIHEXYPHENIDYL) B
Patient information
 Report to the health facility immediately if skin rash de-
velops after receiving the injection

Pregnancy
 Can be used
Breast-feeding
 Can be used
Storage
 Once reconstituted, suspension must be kept refrigerated
at 2–8°C and used within 24 hours

Caution
 Never give IV injection or infusion as heart problems may
occur. Use IM route only
 Do not mix with other injections in the same syringe
 Prevent Jarisch-herxheimer reaction in syphilis with 3
doses of 20 mg oral prednisolone every 12 hours
 Benzathine penicillin should not be confused with benzyl
penicillin which has a short duration of action (6 hours)
BENZHEXOL (TRIHEXYPHENIDYL) HC II V 9, 24
Antimuscarinic that reduces extra-pyramidal Parkinson-like
symptoms caused by antipsychotic medicines. The symptoms
include movement problems, stiffness, and shaking.
Dosage forms
 Tablet: 2 mg
 Syrup: 5 mg/5 ml
Uses
 Extra-pyramidal symptoms caused by antipsychotic

B MONOGRAPHS
medicines, such as chlorpromazine and haloperidol

Dose and duration
 Medicine-induced extra-pyramidal side-effects
Adult: initially 2 mg every 12 hours, increased by 2 mg

every 3‒5 days according to response; usual mainte-
nance dose is 5‒15 mg in every 8 or 6 hours daily.
Contra-indications
 Glaucoma
 Urinary and prostate problems
 Muscle weakness and fatigue
 Intestinal obstruction
 Liver disease
 Kidney disease
 Involuntary, repetitive body movements (tardive
dyskinesia)
Side effects
 Constipation, dry mouth, stomach upset
 Blurred vision
 Urinary retention
 Problems with producing and understanding language,
awareness, reasoning, decision-making, and judgement

Interactions
 Other antimuscarinic medicines e.g. atropine (increased
risk of side effects)

 Antihistamines (increased risk of side effects)
 May impair ability to perform skilled tasks, such as driving
or operating machinery

BENZOIC ACID + SALICYLIC ACID (WHITFIELD’S OINTMENT) B
Pregnancy
 Do not use
Breast-feeding
 Do not use
Caution
 Should not be given routinely to patients receiving anti-
psychotic medicines in the absence of Parkinson-like side
effects
 Use lower doses in elderly; higher doses cause confusion
 Avoid use of benzhexol for Parkinson’s disease as it can
cause toxicity in elderly and make dementia worse
BENZOIC ACID + SALICYLIC ACID (WHIT-

HC II N 13.1
FIELD’S OINTMENT)
Benzoic acid is an antifungal and salicylic acid is a keratolytic
agent
Dosage forms
 Ointment: Benzoic acid 6% + salicylic acid 3% ointment
Uses
 Ringworm on skin and scalp
Dose and duration

 2 applications per day for 4–6 weeks depending on clini-
cal response
Contra-indications
 Wet lesions
 Open wounds
 Broken skin

B MONOGRAPHS
Side effects
 Skin irritation
Patient information
 Wash hands before and after use
 Apply a thin layer to affected area and rub in gently
 Continue applying to the area for 14 days after lesions
have resolved
 May cause skin irritation and inflammation; usually mild,
so continue treatment
 In case of contact with eyes or mucous membranes, flush
with plenty of clean water

 Do not apply to breasts if breast-feeding
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 In case of secondary bacterial infection, start appropriate
local disinfectant or systemic antibiotic before applying
Whitfield's ointment
 Use in combination with griseofulvin in the event of
severe infection
BENZOYL PEROXIDE HC IV N 13.4

Keratolytic with bacteriostatic activity against Propionibacte-
rium acnes bacteria that causes acne
Dosage forms
 Lotion/cream: 5%

BENZOYL PEROXIDE B
Uses
 Acne vulgaris
Dose and duration

 Acne
Adult and child: apply 1‒2 times daily after washing face
with soap and water until symptoms disappear. Start with
thin applications and increase amount gradually after ini-
tial irritation reduces
Contra-indications
 Wet lesions
Side effects
 Dry skin, erythema, peeling of skin, burning sensation,
itching, skin irritation

Patient information
 Wash hands before and after use
 Initial irritation of skin usually goes away so do not stop
treatment
 Benzoyl peroxide may increase sensitivity to sunlight,
avoid or minimise prolonged exposure to sunlight

 In case of contact with eyes or mucous membranes, flush

 May discolour clothing, hair and skin
Pregnancy
 Can be used
Breast-feeding
 Can be used

B MONOGRAPHS
Caution
 In severe acne, a topical or oral antibiotic should be used
along with benzoyl peroxide
BENZTROPINE HC IV E 4.2, 9
Anticholinergic that reduces extra-pyramidal Parkinson-like
symptoms caused by antipsychotic medicines. The symptoms
include movement problems, stiffness, and shaking.
Dosage forms
Uses
 Extra-pyramidal side effects of antipsychotic drugs
 Control tremors and rigidity in Parkinson’s disease
Dose and duration

Adults: 1‒2 mg IM or IV. Repeat dose if symptoms re-
appear
Contra-indications
 Glaucoma
 Urinary and prostate problems
 Alcoholics
 Children less than 3 years
Side effects
 Constipation, dry mouth, stomach upset
 Blurred vision
 Confusion, loss of memory, hallucinations
 Problems with producing and understanding language,

BENZYL BENZOATE B
awareness, reasoning, decision-making, and judgement
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Use lower doses in elderly as medicine can easily cause
confusion
 Injection used in emergency situations to provide quick
relief. For regular control of extra-pyramidal side effects,
use benzhexol tablets
BENZYL BENZOATE HC II N 13.4

Pediculocide and scabicide that kills lice and parasites that
cause scabies
Dosage forms
 Lotion for application: 25%
Uses
 Scabies
 Lice infestation
Dose and duration

No bathing while using the medicine
 Scabies
Adult: Apply undiluted lotion all over the whole body

(including scalp, neck, head, and ears) every 24 hours
for 3 days
Child: Use diluted lotion and apply as for adults

B MONOGRAPHS
Apply to affected areas of the body
Repeat after 12 hours
Wash off after 24 hours
Repeat treatment after 7–14 days to kill any lice that
may have emerged from the eggs
Note: Treat whole family
Preparation
 For use on children: Dilute lotion with an equal part of
water to give 12.5% strength

Contra-indications
Side effects
 Skin irritation, burning sensation, rashes
 Shave off hair if used for head lice. If head not shaved,
massage well into scalp.

 Avoid contact with eyes
 Avoid use on face, broken skin, open wounds, or mucous
membranes
 Apply properly in between fingers, toes, behind ears, and
under the nails

 Wash hands thoroughly before and after use
 Do not swallow; it is poisonous
Pregnancy
 Can be used
Breast-feeding
 Can be used

BENZYLPENICILLIN B
Caution
 Benzyl benzoate is second line. First line is malathion
(0.5% aqueous lotion)
BENZYLPENICILLIN HC II V 6.2.1
Broad spectrum penicillin antibacterial with rapid action and
elimination
Dosage forms
 Powder for injection: 600 mg = 1 million IU = 1 MU
Uses
 Severe otitis media
 Severe throat infections
 Septicaemia
 Tetanus
 Severe bacterial bronchiolitis
 Quinsy (peritonsillar abscess)
 Pre-referral treatment for severe bacterial infection and
possible serious bacterial infection (PSBI) in infants

Dose and duration
In severe infections, double the dose
Adult: 3–4 MU IV or IM every 4 hours for 10–14 days

Child: 100,000 IU/kg/dose for 10–14 days
Severe cases may need up to 21 days treatment
for neonates and for at least 21 days and up to 42 days
for immunosuppressed adults
 Septicaemia (given in combination with gentamicin)

B MONOGRAPHS
Infants >7 days: 50,000-75,000 IU/kg IV every 4–6

hours for 21 days
Neonates <7 days: 50,000 IU IV every 8 hours for 21
days
 Tetanus
Adult: 1–2 MU every 6 hours for 10 days

Child: 50,000–100,000 IU/kg/dose for 10 days
Neonate: 100,000 IU/kg every 12 hours for 10 days
 Severe pneumonia in infant 1 week–2 months old (in
combination with chloramphenicol)

Give first dose 50,000 IU/kg IM
Refer immediately (if at HC II)
 Pneumococcal pneumonia (with PPF)
Give 50,000 IU/kg IM every 6 hours for 2 days

 Quinsy (with amoxicillin)
Give 2 MU IM every 6 hours for 2 days

 Pre-referral treatment for severe bacterial infection and
possible serious bacterial infection in infants (PSBI) (with

chloramphenicol)
Give first dose of benzyl penicillin 50,000 IU/kg IM Re-
fer immediately (if at HC II)
If referral not possible: give 50,000 IU/kg IM every 6
hours for at least 5 days
Preparation
Dissolve powder in water for injection; shake suspension be-
fore administration
Contra-indications

BETAMETHASONE B
Side effects
 Stomach upset
Interactions
 Report to the health worker immediately if skin rash de-
velops after receiving the injection

Pregnancy
 Can be used
Breast-feeding
 Can be used
Storage
 Once reconstituted, suspension must be kept refrigerated
(2–8°C) and used within 24 hours

Caution
 In case allergic reactions occur, stop treatment immedi-
ately
 When given by IV route, give injection slowly via the infu-
sion tube or by IV infusion
 Benzylpenicillin should not be confused with benzathine
penicillin, which has a long duration of action (15–20
days)
BETAMETHASONE HC IV E 8.3, 13.3, 21.3, 28.1

Long-acting synthetic corticosteroid
Dosage forms

B MONOGRAPHS
 Cream/ointment: 0.1%
 Eye/ear drops: 0.1%
Uses
 Allergic and inflammatory conditions of skin, eyes, ears
 Foetal lung maturation in mothers with pre-term labour
 Acute allergic reactions and anaphylactic reactions
 Status asthmaticus
 Adrenal insufficiency (specialist use only)
Dose and duration

 Lung maturation in preterm births
Adult (give to mother): Slow IV injection 5.7 mg/ml as

betamethasone sodium phosphate 3.9 mg (in solution) or
betamethasone acetate 3 mg (in suspension) in an aque-
ous vehicle
 Eczema ,psoriasis and skin allergies
Apply a thin layer of cream every 12 hours until im-

provement is seen
 Eye or ear inflammation (without infection)
Apply 1‒2 drops every 2 hours until controlled; reduce

frequency to 2‒4 times daily
 Acute allergic reactions including anaphylactic reactions,
status asthmaticus, adrenal insufficiency

Adult and child over 12 years: 4–20 mg by slow IV injec-
tion over 30–60 seconds every 6–8 hours or as required
Child 6–12 years: 4 mg every 6–8 hours
Infants up to 1 year: 1 mg every 6–8 hours
Contra-indications
 Topical application in bacterial, fungal or viral infection

BETAMETHASONE B
and in glaucoma
 Otitis externa with perforated eardrum
 Systemic administration in systemic infections unless
specific anti-infective therapy
Side effects
Systemic side effects are less likely to occur in topical applica-
tion. They include:
 Growth suppression in infants, children and adolescents
 Menstrual irregularity, amenorrhoea
 Adrenal suppression on prolonged use
 Moon face, hirsutism, weight gain
 Impaired carbohydrate tolerance, sodium and water re-
tention
 Increased susceptibility and severity of infection with
suppression of clinical symptoms and signs, opportunistic

infections, recurrence of dormant tuberculosis
 Osteoporosis, vertebral and long bone fractures, tendon
rapture, proximal myopathy, avascular osteonecrosis

 Affective disorder, psychotic reactions
 Increased intra-ocular pressure and glaucoma
 Abdominal distension
 Oesophageal ulceration
 Impaired skin healing
 Hypersensitivity reactions, Stevens-Johnson syndrome
 Do not apply more than twice daily
 Keep away from eyes
 Avoid prolonged use especially on the face and in chil-
dren
B MONOGRAPHS
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Administer the lowest effective dose for the minimum
period, as a single morning dose to minimise side effects.
 Avoid prolonged use to prevent adrenal suppression
 In mild skin allergies, use hydrocortisone cream instead
 If there is infection as well, use the products that are
combined with an antibiotic e.g. neomycin
 Should not be used in management of head injury or
stroke since benefit is unlikely and may even be harmful
 Use with caution in patients with recent myocardial in-
farction because of risk of myocardial rupture, in patients
with osteoporosis, diabetes, epilepsy
 Should not be withdrawn abruptly after prolonged
treatment
BISACODYL HC III E 17.5

Stimulant laxative that increases intestinal movements
Dosage forms
 Enteric coated tablet: 5 mg
 Suppository: 5 mg
Uses
 Short term, symptomatic treatment of constipation
 Prevention of constipation in patients taking opioid anal-
gesics (e.g. morphine, codeine)

BISACODYL B
 Tape worm infestation (adjunct to antihelmitics)
Dose and duration
 Constipation
Give until patient passes stool; maximum 7 days

Adult: 10 mg once daily at night
Child: 5 mg once daily at night
 Tape worm infestation
Adult: 10 mg given 2 hours after treatment with an anti-

helminthic e.g. albendazole
Child: 5 mg 2 hours after treatment with an antihelmin-
thic
 Prevention of constipation in patients taking opioid anal-
gesics
Start 48 hours after beginning of opioid treatment and
continue until end of opioid treatment
Child: Insert suppository 5 mg once daily at night
Contra-indications
 Undiagnosed bowel pain
 Absent bowel sounds
 Haemorrhoids
Side effects
 Abdominal cramps
 Diarrhoea
 Swallow tablets whole (do not crush or chew)
 Drink plenty of water/fluids and eat lots of fruits and
vegetables

B MONOGRAPHS
 Effect of tablets is not instant; expect reaction after 6–12

hours after swallowing
Pregnancy
 Do not use
Breast-feeding
 Can be used
Caution
 In children 6 months to 3 years old, do not use oral route.
Use rectal route.
 Avoid prolonged use as it can impair normal functioning
of colon and cause low potassium levels in blood
BISMUTH SUBGALLATE COMPOUND HC IV N 17.3

Soothing astringent preparation that provides symptomatic
relief in rectal and anal disorders
Dosage forms
 Suppository: 320 mg
Uses
 Haemorrhoids
 Anal itching
Dose and duration

Insert 1 suppository rectally every 12 hours for 5 days
Contra-indications
 Undiagnosed bowel pain or bleeding
 Absent bowel sounds
 Children

BLEOMYCIN B
Side effects
 Mild local irritation
 Do not swallow the suppository
 Drink plenty of water/fluids and eat lots of fruits, fibres
and vegetables
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Avoid prolonged use as it can impair normal functioning
of colon and cause low potassium levels in blood
 Bismuth subgallate may be combined with other medi-
cines such as zinc oxide and hydrocortisone in products
such as Anusol®
BLEOMYCIN RR V 8.2
Cytotoxic anticancer
Dosage forms
Uses
 Squamous cell carcinoma
 Hodgkin’s disease and other malignant lymphomas
 Testicular teratoma
 Malignant effusions of serous cavities
Dose and duration

Consult product leaflet and patient’s treatment protocol
B MONOGRAPHS
Contra-indications
 Acute pulmonary infection
 Reduced lung function
 Previous hypersensitivity to bleomycin
Side effects
 Pulmonary toxicity (fibrosis)
 Pain at injection site
Interactions
 Clozapine (increased risk of agranulocytosis)
 Cisplatin (increased risk of pulmonary toxicity)
 Report immediately any shortness of breath or difficulty in
breathing
 Report immediately any unexplained bleeding or infection
Pregnancy
 Do not use
Breast-feeding
 Do not use
Storage
 Store at 2−8°C. Protect from light
Caution
 Reduce dose in renal impairment
 Pulmonary toxicity is dose-related and age-related, occur-
ring more commonly at cumulative doses greater than
300,000 units and in the elderly.
 Pulmonary toxicity also increased in patient receiving high
dose oxygen during surgical anaesthesia
 Use lower doses if patient is receiving concurrent

BROMOCRIPTINE B
radiotherapy to the chest
 Exercise caution when handling; irritant to tissues
BROMOCRIPTINE RR N 18.6
Ergot derived dopamine receptor agonist which also inhibits
release of prolactin and growth hormone by the pituitary
Dosage forms
 Tablet: 2.5 mg
Uses
 Parkinson’s disease
 Galactorrhoea
 Prolactinoma
 Acromegaly
 Hypogonadism
 Menstrual cycle disorders and female infertility
 Suppression or prevention of lactation
Dose and duration

Adult: 1–1.25 mg at night in the 1st week, 2–2.5 mg at

night in the 2nd week, 2.5 mg every 12 hours for the 3rd
week, 2.5 mg every 8 hours for the 4th week, then in-
creasing by 2.5mg every 3–14 days according to response
to a usual range of 10–30 mg daily
 Prevention or suppression of lactation
Adult: 2.5 mg on the day of delivery (prevention)or 2.5

mg once a day for 2–3 days (suppression);
Then 2.5 mg every 12 hours for 14 days
B MONOGRAPHS
 Hypogonadism, galactorrhoea, infertility

Adult: initially 1–1.25 mg at bedtime, increased gradually
to the usual dose of 7.5 mg (max 30 mg) daily in divided
doses (usual dose 2.5 mg every 12 hours in infertility
without hyperprolactinaemia)
 Acromegaly

at 2 to 3 day intervals as follows: 2.5 mg every 8 hours to
2.5 mg every 6 hours to 5 mg every 6 hours
child 7 years and older: titrate initial dose according to
growth hormone levels and increase dose gradually up to
a maximum dose of 10 mg in children 7–12 years and 20
mg in children 13–17 years
 Prolactinoma

at 2−3 day intervals as follows: 2.5 mg every 8 hours to
2.5 mg every 6 hours to 5 mg every 6 hours (max 30 mg
daily)
Child 7 years and older: 1 mg every 8–12 hours gradually
increasing the dose to keep plasma prolactin adequately
suppressed (max 7–12 years: 5 mg, 13–17 years: 20 mg)
Contra-indications
 Hypersensitivity to ergot alkaloids
 Long term treatment in cardiac valvulopathy
 Uncontrolled hypertension
 Pre-eclampsia, eclampsia, pregnancy induced hyperten-
sion
 Hypertension in postpartum women or in puerperium
Side effects
 Headache, drowsiness

BROMOCRIPTINE B
 Nausea, constipation
 Nasal congestion
 Take your medication during or immediately after a meal
 Avoid driving or operating machinery cautiously since you
might experience sudden onset of day time sleepiness

Pregnancy
Breast-feeding
Caution
 Use with caution in patients with Raynaud’s syndrome,
cardiovascular disease or a history of mental disorder and
peptic ulcer particularly in acromegalic patients; with-
draw treatment if gastro-intestinal bleeding occurs
 Use with caution for lactation suppression in postpartum
women on antihypertensive therapy and avoid other er-
got alkaloids
 Exclude pituitary tumour before treating a patient with
hyperprolactinaemia
 Oral contraceptives may increase prolactin concentration
 Discontinue medication immediately if hypertension,
continuous headache, or signs of CNS toxicity develop
 Breast feeding should be avoided for about 5 days if lac-
tation prevention fails
 It is advisable to withdraw bromocriptine after the first
missed menstrual period if pregnancy occurs, but due to
the risk of rapid expansion of pituitary tumors during
pregnancy, monitor patients to detect signs of pituitary
B MONOGRAPHS
extension and reintroduce bromocriptine if necessary
BUPIVACAINE H V 1.2, 21.6

Local anaesthetic with long duration of action
Dosage forms
 Injection (with preservative): 0.5% (5 mg/ml)
 Injection: 0.5% (5 mg/ml)
 Solution for injection: 0.25% (Specialist use at RR)
Uses
 Regional anaesthesia except intravenous regional anaes-
thesia
Dose and duration
 Regional anaesthesia
Adult and child over 12 years: see table below
Type of block Concentration (%) Dose (mg)

Local infiltration 0.25 max 150 (60 ml)
Peripheral nerve 0.5 max 150 (30 ml)
block
Lumbar epidural 0.5 50-100(10-20
block in surgery ml)
Lumbar epidural 0.25-0.5 60 (12 ml)
block in labour
Caudal block in 0.25-0.5 max 150 (30 ml)
surgery
Caudal block in 0.25-0.5 max 100 (20 ml)
labour

BUPIVACAINE B
Contra-indications
 Inflamed or infected skin
 Concomitant anticoagulant therapy
 Severe anaemia or heart disease
 Spinal or epidural anaesthesia in dehydrated or hypovo-
lemic patients
Side effects
 Nausea, vomiting
 Hypotension, bradycardia, cardiac arrest
 Tingling or pricking sensation and dizziness
 Respiratory depression
 Allergic reaction, anaphylactic shock
Interactions
 Propranolol (increased risk of bupivacaine toxicity)
 Lidocaine( Increased myocardial depression)
 Procainamide (Increased myocardial depression)
Pregnancy
st
Breast-feeding
 Can be used
Caution
 Bupivacaine containing preservative should not be used
for caudal, epidural or spinal block, or intravenous re-
gional anaesthesia (Bier’s block)
 Should not be applied to the middle ear due to risk of
ototoxicity
 Use lower doses in the elderly and debilitated

C MONOGRAPHS
C
CALAMINE HC II E 13.3
Topical anti-pruritic that relieves itching in many skin diseases
Dosage forms
 Lotion: 15% with zinc oxide 5%
Uses
 Chicken pox
 Severe local reaction after insect bite or sting
 Herpes zoster (shingles)
 Skin allergy
Dose and duration

Apply until symptoms reduce
 Chicken pox
Apply every 12 hours

 Severe local reaction after insect bite
Apply every 6 hours

 Herpes zoster
Apply 2–3 times daily

 Skin allergy
Apply 1–2 times daily

Contra-indications
 Wet lesions
 Superinfected skin
Side effects
 Skin irritation
 Shake the bottle well before use

CALCIUM CHLORIDE (DIHYDRATE) C
 Clean the skin well before applying the lotion
 For external use only
 In case of contact with eyes or mouth, flush immediately

 To avoid contamination, close the bottle properly imme-
diately after using

 Do not apply to breasts if breastfeeding
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 For severe skin itching, calamine lotion is often not effec-
tive. Instead, use hydrocortisone cream or chlorphenira-
mine tablets
CALCIUM CHLORIDE (DIHYDRATE) H E 26.2

Calcium salt used in electrolyte imbalances
Dosage forms
 Aqueous solution for slow intravenous infusion: 10% w/v
Uses
 Treatment of hypocalcaemic tetany
 Adjunctive therapy in severe hyperkalaemia
 Depression in magnesium sulphate overdose
Dose and duration

Given as a slow intravenous injection
 Treatment of hypocalcaemic tetany.
Adult: 500–1000 mg (5–10 ml) at intervals of 1–3 days

C MONOGRAPHS
Child : 20 mg/kg (0.2 ml/kg); max 10 ml/day

 Adjunctive therapy in severe hyperkalaemia
Adult: 500–1000 mg (5–10 ml) at intervals of 1–3 days
Child: 0.2 ml/kg (max 10 ml/day)
 Depression in magnesium sulphate overdose
Adult: 500 mg (5 ml) administered promptly
Contra-indications
 Hypercalcaemia
 Hypercalciuria
 In patients receiving cardiac glycosides like digoxin
 Renal calculi or history of renal calculi
 Hypersensitivity to any of the components
Side effects
 Rapid IV injections associated with tingling sensations,
calcium taste, hot flushes, risk of arrhythmias

 Burning sensation
 Hypertension, venous thrombosis
 Hypercalcaemia
Interactions
 Calcium channel blockers (decreased efficacy of CCBs)
 Biphosphonates (reduced absorption of biphosphonates)
 Thiazide diuretics (increase the risk of hypercalcaemia)
 Digoxin (Precipitation of arrhythmias)
 Tetracyclines (Reduced absorption of tetracyclines)
Pregnancy
 Can be used
Breast-feeding
 Can be used

CALCIUM FOLINATE (FOLINIC ACID) C
Caution
 Solutions of calcium chloride are extremely irritant and
should not be injected IM or SC
CALCIUM FOLINATE (FOLINIC ACID) RR E 4.2

Antidote to methotrexate. Counteracts folate antagonism
and speeds up recovery from methotrexate induced mucosi-
tis or myelosuppression (‘folinic acid rescue’)
Dosage forms
Uses
 Methotrexate induced mucositis and myelosuppression
 Methotrexate overdose
 Palliative treatment of advanced metastatic colorectal
cancer
Dose and duration
 Prevention of methotrexate-induced adverse effects, usu-
ally started 12‒24 hours after start of methotrexate infu-

sion
Adult and child: By IM or IV injection or by IV infusion, up
to 120 mg in divided doses over 12–24 hours, then 12–15
mg by IM injection, or 15 mg by mouth every 6 hours for
48–72 hours
 Methotrexate over dosage
Started as soon as possible, preferably within 1 hour of

administration of methotrexate,
Adult and child: by IV injection or infusion, dose equal to
or higher than that of methotrexate, at rate not exceed-
ing 160 mg/minute
C MONOGRAPHS
 Colorectal cancer (in combination with fluorouracil)

Consult specialist literature
Preparation
 Solutions for intravenous infusion may be diluted with
0.9% sodium chloride or 5% glucose

Contra-indications
 Intrathecal injection of calcium folinate
 Pernicious anaemia or other anaemias due to Vitamin B 1
deficiency (see caution)

 Known hypersensitivity to calcium folinate
Side effects
 Pyrexia after parenteral administration
Pregnancy
 Can be used
Breast-feeding
 Can be used
Storage
o
 Store at 2–8 C in a refrigerator in the original container
Caution
 Do not administer simultaneously with methotrexate
 Treatment may mask pernicious anaemia and other
anaemias resulting from vitamin B12 deficiency
 Do not inject more than 160 mg of calcium folinate per
minute

CALCIUM GLUCONATE C
CALCIUM GLUCONATE HC III E 4.2, 26.2
Antidote for magnesium sulphate toxicity
Dosage forms
 Injection: 1 g (100 mg/ml; 10% solution) in 10 ml am-
poule
Uses
 Magnesium sulphate overdose
Dose and duration

 Magnesium sulphate overdose
1–2 g by slow IV injection (over 5 minutes)

Repeat as necessary until respiratory rate increases
(above 16 breaths per minute)
Contra-indications
 Hypercalcaemia
 Severe hypercalciuria
Side effects
 Tingling sensations, feeling hot and sweaty, dizziness
 Injection site reactions (pain, abscess, death of tissue)
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Patient should lie down before the injection and remain
lying for 30–60 minutes after
 Do not give injection too fast or for prolonged periods
 Do not use if a precipitate is present in the ampoule
C MONOGRAPHS
 Do not administer by IM or SC route
CALCIUM LACTATE HC III N 27

Calcium supplement
Dosage forms
 Tablet: 300 mg
Uses
 Prevention and treatment of calcium deficiency
 Muscle cramps associated with pregnancy
Dose and duration

 Calcium deficiency
Give 300–600 mg every 8–12 hours before meals

 Muscle cramps associated with pregnancy
Give 600 mg every 8 hours for 5 days

Contra-indications
 Conditions with too much calcium in urine or blood
Side effects
 Stomach upset, dry mouth
 Increased thirst, increased urination
Interactions
 Iron salts (reduced absorption)
 Ciprofloxacin (reduced absorption)
 Furosemide (risk of kidney stones and high calcium blood
levels)
 Zinc sulphate (reduced absorption)

CANDESARTAN CILEXETIL C
 Do not take at the same time with ciprofloxacin, zinc, or
iron salts; take at least two hours apart

Pregnancy
 Can be used
Breast-feeding
 Can be used
CANDESARTAN CILEXETIL NR N 12.3

Angiotensin II receptor blocker antihypertensive medicine
Dosage forms
 Tablet: 8 mg
Uses
 Essential hypertension
 Heart failure with impaired left ventricular systolic func-
tion
Dose and duration
 Hypertension
Adult: 8 mg once a day. Dose can be increased at inter-

vals of 4 weeks if there is inadequate response, to 16 mg
once a day (max 32 mg once a day). Usual maintenance
dose 8 mg once a day
Child 6–18 years: initially 4 mg once a day increased to
maximum dose of 8 mg in patients <50 kg and 16 mg in
patients ≥ 50 kg
Intravascular volume depletion: initially, 4 mg once a day
Renal and mild to moderate hepatic impairment: initial-
ly, 4 mg once a day adjusted according to response

C MONOGRAPHS
 Heart failure
Adult: initially 4 mg once a day; doubled every 2 weeks to
a target dose of 32 mg or the highest tolerated dose
Contra-indications
 Hypersensitivity to candesartan
nd
 2 and 3rd trimesters of pregnancy
 Severe hepatic impairment and/or cholestasis
 Children below 1 year of age
 Primary hyperaldosteronism
Side effects
 Respiratory tract infections, cough, nasopharingitis, oro-
pharyngeal pain
 Dizziness, vertigo, headache
 Rash
 Sinus arrhythmia
 Nasopharingitis, oropharyngeal pain
 Pyrexia
 Hyperkalaemia
 Hypotension
Interactions
 Aliskiren (increased frequency of adverse effects: avoid
concomitant use)
 Ciclosporin, potassium sparing diuretics, aldosterone an-
tagonists, potassium salts (increased risk of hyperkalae-

mia)
 Lithium (increased plasma concentration of lithium)
Pregnancy
 Do not use

CAPREOMYCIN C
Breast-feeding
 Do not use
Caution
 Careful titration of doses and thorough monitoring of
blood pressure is required during dialysis
 Use with special caution in patients with haemodynami-
cally relevant aortic or mitral valve stenosis, or obstruc-
tive hypertrophic cardiomyopathy, renal artery stenosis,
 Can cause fetotoxicity and birth defects when used in
pregnancy
CAPREOMYCIN H E 6.2.4
Polypeptide antibiotic produced by Streptomyces capreolus
which is active against Mycobacterium tuberculosis
Dosage forms
Uses
 Multi-drug-resistant tuberculosis (MDR-TB)
 Tuberculosis (second-line)
Dose and duration

 Tuberculosis (second-line; in combination with other
medicines)
Adult: 1 g daily (max 20 mg/kg/day) by deep IM injection
only for 2–4 months followed by 1 g IM 2–3 times a week
Renal impairment: Reduce dose
Preparation
 Dissolve in 2 ml of 0.5% sodium chloride IV infusion or
water for injections. Allow 2–3 minutes for complete

C MONOGRAPHS
dissolution
Contra-indications
Side effects
 Hypersensitivity reactions e.g. urticaria, rashes
 Leukocytosis or leucopoenia
Pregnancy
 Do not use
Breast-feeding
 Can be used
Storage
0
 Store below 25 C
Caution
 Use with caution in auditory and hepatic impairment
 Monitor renal, hepatic, auditory, vestibular function and
electrolytes
 Reduce dose in renal impairment
 Only use in pregnancy if benefit outweighs risk
CAPTOPRIL H E 12.3
Angiotensin converting enzyme inhibitor (ACEI) antihyperten-
sive medicine
Dosage forms
 Tablet: 25 mg
Uses
 Congestive heart failure
 Moderate to severe hypertension(stage 2)

CAPTOPRIL C
Dose and duration
Adult: initially, 6.25–12.5 mg 2–3 times daily, and then in-

creased gradually at intervals of 2 weeks (max 150 mg daily
in divided doses)
Child 12–18 years: 12.5–25 mg 2–3 times daily (max 150
mg daily in divided doses)
Child 1 month–12 years: 0.1–0.3 mg/kg 2–3 times a day
(max 1 month–1 year, 4 mg/kg and 1–12 years, 6 mg/kg)
Neonate: 0.01–0.05 mg/kg 2–3 times daily (max 2 mg/kg
daily in divided doses or 0.3 mg/kg in neonate less than 37
weeks postmenstrual age)
 Moderate to severe hypertension (in combination with
another antihypertensive)
Adult: initially, 12.5–25 mg every 12 hours and then in-
creased gradually every 2 weeks if necessary up to maxi-
mum dose of 150 mg daily in 2 divided doses
Volume depletion, cardiac decompensation, renovascular
hypertension: initially, 6.25–12.5 mg daily as a single dose
then twice daily; (max 100 mg daily in 1–2 divided doses)
Elderly: 6.25 mg every 12 hours
Neonate and child 1 month–18 years: Dose same as in
Congestive Heart Failure
Contra-indications
 History of angioedema with previous ACEI therapy
 Hereditary or idiopathic angioneurotic oedema

nd
 2 and 3rd trimester of pregnancy
Side effects
 Sleep disorders

C MONOGRAPHS
 Persistent dry irritating cough

 Nausea, vomiting, abdominal pain, taste disturbances
 Dyspnoea
 Rash
 Angioedema
 Hyperkalaemia, hypoglycaemia
 Cardiogenic shock, cardiac arrest
Interactions
 Ciclosporin (increased risk of hyperkalaemia)
 Diuretics (increased hypotensive effect)
 Potassium-sparing diuretics and aldosterone antagonists
(increased risk of severe hyperkalaemia)

 Lithium (increased plasma levels and toxicity of lithium)
 Potassium salts (increased risk of severe hyperkalaemia)
Pregnancy
 Do not use
Breast-feeding
 Can be used
Caution
 In neonates, infants and children, a test dose of 0.15
mg/kg must be given first before initiating treatment
 Reduce dose in renal failure and in concomitant use with
potassium-sparing diuretics
CARBAMAZEPINE HC III V 5
Anticonvulsant
Dosage forms
 Tablets: 200 mg; 100 mg (chewable)

CARBAMAZEPINE C
Syrup: 100 mg/5 ml
Uses
 Epilepsy (grand mal and partial seizures)
 Nerve pain
Dose and duration

 Grand mal and temporal lobe epilepsy
Adult: Initially, 100–200 mg 1–2 times daily. Increase

as needed in 100 mg increments every 2 weeks until
reaching usual maintenance dose of 800–1200 mg in
divided doses
Child 12–18 years: Initially, 100–200 mg 1–2 times dai-
ly, increased gradually as needed to usual mainte-
nance dose of 400–600 mg two to three times daily
Child 1 month–12 years: Initially, 5 mg/kg at night or
2.5 mg/kg every 12 hours increased by 2.5–5 mg/kg
every 3–7 days if necessary. Usually maintenance dose
of 5 mg/kg 2–3 times daily; in some cases up to 20
mg/kg daily may be needed
 Nerve pain
Initially 100 mg 1–2 times daily, increased gradually
according to response. Usual dose is 200 mg 3–4 times
daily (up to 1.6 g per day may be needed)
Contra-indications
 History of bone marrow depression
 Problems with heartbeat
Side effects
 Dizziness, drowsiness, headache
 Movement disorders (staggering, shaking)

C MONOGRAPHS
 Blurred vision
 Skin rashes
 Stomach upset
Interactions
 Amitriptyline (reduced effect of carbamazepine)
 Chlorpromazine (reduced effect of carbamazepine)
 Oral contraceptives (reduced contraceptive effect)
 Erythromycin (increased risk of side effects)
 Isoniazid (increased risk of side effects and liver toxicity)
 Phenytoin (increased risk of side effects)
 Drowsiness and dizziness usually disappear. Do not drive
or operate machinery if these symptoms occur

 Report to the health worker immediately if any yellowing
of eyes or skin, rash, fever, mouth ulcers, bruising, or

bleeding occur
 Do not drink alcohol during treatment
Pregnancy
st rd
 Do not use in 1 and 3 trimester
Breast-feeding
 Can be used
Caution
 Give vitamin K to new-born baby if mother has taken car-
bamazepine during pregnancy
 Avoid sudden withdrawal as it might cause seizures

CARBIMAZOLE C
CARBIMAZOLE H V 18.8
Antithyroid drug
Dosage forms
 Tablet: 5 mg
Uses
 Management of hyperthyroidism (thyrotoxicosis)
Dose and duration

 Management of hyperthyroidism (thyrotoxicosis)
Adult: 20–60 mg daily in 2–3 divided doses until patient

becomes euthyroid. Then reduce dose gradually to a
maintenance dose of 5–15 mg once daily for 6–18
months
Or Blocking-replacement regimen: maintain dose at 20–
60 mg daily after patient is euthyroid and add L-thyroxine
to the regimen. Therapy is given for 12–18 months
Child 12–18 years: 30 mg daily in single or divided doses
until euthyroid then gradually reduce the dose to a
maintenance dose of 9–18 mg daily in single or divided
doses for 12–24 months
Neonate and child up to 12 years: 0.75 mg/kg daily in
single or divided doses until euthyroid (max 1 mg/kg daily
in neonate and 30 mg daily in child). Then gradually re-
duce the dose to a maintenance dose of 0.225–0.45
mg/kg daily in single or divided doses for 12–24 months
Contra-indications
 Severe blood disorders
 Severe hepatic disorders
Side effects
 Bone marrow depression including neutropoenia,

C MONOGRAPHS
eosinophilia, leucopoenia and agranulocytosis

 Insulin autoimmune syndrome (with pronounced decline
in blood glucose level)
 Nausea, abdominal discomfort, taste disturbance
 Fever
 Rash, pruritus
 Joint pain
 If symptoms and signs such as sore throat, mouth ulcers,
bruising, fever, malaise or non-specific illness develop,

stop the medication and consult your doctor immediately
Pregnancy
st
Breast-feeding
 Can be used
Caution
 Use with caution in mild to moderate hepatic impairment
 Use the lowest dose that can control the hyperthyroid
state in pregnancy and breast feeding
CARBOPLATIN RR E 8.2
Platinum compound anticancer
Dosage forms
 Solution for infusion: 10 mg/ml
Uses
 Ovarian cancer
 Small cell lung cancer

CARBOPLATIN C
Dose and duration
Dose depends on renal function
In previously untreated adults with normal renal function,
usual dose is 400 mg/m2, given as a single IV infusion over
15‒60 minutes.
Do not repeat therapy until at least 4 weeks after previous
dose
Contra-indications
 Severe myelosuppression
 Severe renal impairment
 Patients with bleeding tumours
 Previous allergy to platinum compounds
Side effects
 Infections and infestations
 Blood disorders and haemorrhage
 Nausea, vomiting, abdominal pain
 Kidney damage
 Liver damage
 Electrolyte disturbances
 Visual disturbance
 Ototoxicity
 Cardiovascular disorder
 Respiratory disorder
 Musculoskeletal disorder
 Urogenital disorder
 Asthenia
Interactions
 Yellow fever vaccine (risk of fatal generalised disease)

C MONOGRAPHS
 Live vaccines (risk of systemic disease)

 Aminoglycosides, polymixins, vancomycin (increased risk
of ototoxicity and nephrotoxicity)
Pregnancy
 Do not use
Breast-feeding
 Discontinue breastfeeding
Storage
 Store between 2‒8°C
Caution
 Monitor complete blood count before, during and after
therapy
 Reduce dose by 20‒25% in patients with previous myelo-
suppressive therapy
 Consider dose reduction or scheduling changes when used
in combination with other myelosuppressive medicines to
minimise side effect
 Do not use needles or giving sets made of aluminium parts
as it forms precipitates with carboplatin
CARVEDILOL RR E 12.1
Non-selective beta and alpha-1 blocker with an arteriolar
vasodilating action
Dosage forms
 Tablet: 6.25 mg, 12.5 mg

CARVEDILOL C
Uses
 Stable heart failure due to left ventricular systolic dys-
function
 Hypertension
 Angina
Dose and duration

 Hypertension
Adult: 12.5 mg once a day increased after 2 days to the

usual dose of 25 mg once a day. Dose may be increased
as is required every 2 weeks up to a maximum dose of 25
mg every 12 hours
Elderly: initially 12.5 mg once a day and the dose adjusted
according to response at intervals of 2 weeks or more
 Angina
Adult: initially, 12.5 mg every 12 hours increased after 2

days to 25 mg every 12 hours (max 50 mg every 12 hours)
Elderly: 12.5 mg every 12 hours increased after 2 days to
a maximum dose of 25 mg every 12 hours
 Heart failure (adjunct therapy)
Adult: initially, 3.125 mg every 12 hours; increased at in-

tervals of 2 weeks up to 6.25 mg every 12 hours (max 25
mg every 12 hours in severe heart or body weight < 85 kg
and 50 mg every 12 hours in patients > 85 kg))
Child 2–18 years: initially 0.05 mg/kg (max 3.125 mg)
every 12 hours, doubled at intervals of at least 2 weeks
up to 0.35 mg/kg (max 25 mg) every 12 hours
Contra-indications
 Acute or decompensated heart failure requiring intrave-
nous inotropes
 Chronic obstructive pulmonary disease with bronchial

C MONOGRAPHS
obstruction
 Clinically significant hepatic dysfunction
 Bronchial asthma
 Prinzmetal’s angina
 Marked bradycardia (< 50 bpm)
 Severe hypotension (systolic BP below 85 mmHg)

nd
 2 and 3rd degree atrio-ventricular block (unless a per-
manent pacemaker is in place)
 Hypersensitivity to carvedilol
Side effects
 Bronchitis, pneumonia, upper respiratory tract infection
 Urinary tract infection, micturition abnormalities
 Weight gain
 Hypercholesterolemia, anaemia, impaired glucose control
in patients with pre-existing diabetes

 Depression, dizziness, headache
 Visual impairment, decreased lacrimation, eye irritation
 Cardiac failure, bradycardia, hypotension
 Oedema, hypervolemia, fluid overload
 Dyspnoea, pulmonary oedema, asthma in predisposed
patients
 Nausea, diarrhoea, vomiting, dyspepsia, abdominal pain
 Pain in extremities, pain, fatigue
 Renal failure and renal function abnormalities

CARVEDILOL C
Interactions
 Adrenaline, dobutamine (increased risk of severe hyper-
tension and bradycardia)

 Ciclosporin (plasma concentration of ciclosporin in-
creased)
 Clonidine (increased risk of withdrawal hypertension)
 Prazosin, alfuzosin (enhanced hypotensive effect)
 Amiodarone, flecainide (increased risk of bradycardia,
atrio-ventricular block and myocardial depression)

 Nifedipine (risk of severe hypotension and heart failure)
 Diltiazem (increased risk of AV block and bradycardia)
 Verapamil (increased risk of asystole, severe hypotension
and heart failure)

 Take your medication for heart failure with food and
enough water
 Do not drive or operate heavy or dangerous machinery if
you feel dizzy

Pregnancy
 Do not use
Breast-feeding
 Do not use
Caution
 Avoid abrupt withdrawal of carvedilol. Withdraw gradual-
ly over 2 weeks
 When clonidine and carvedilol are used together, with-
draw carvedilol several days before slow withdrawal of
clonidine
 Monitor renal function during dose titration in heart fail-
C MONOGRAPHS
ure patients who also have renal impairment, low blood

pressure, ischaemic heart disease or vascular disease
 Carvedilol may mask symptoms of thyrotoxicosis, acute
hypoglycaemia hence need for close monitoring of dia-
betics also using carvedilol
 Reduce dose of carvedilol if bradycardia occurs
 Carvedilol may aggravate or exacerbate skin symptoms in
patients with psoriasis
 Carvedilol reduces placental perfusion hence severe ad-
verse foetal consequences in the neonate. Only use if
necessary and stop treatment 2–3 days before expected
birth and monitor new-born for the first 2–3 days of life
CEFALEXIN (CEPHALEXIN) H E 6.2.1

First generation orally active cephalosporin antibacterial
Dosage forms
 Suspension: 125 mg/ml
Uses
 Urinary tract infection (second line)
 Otitis media
 Sinusitis
 Skin and soft tissue infections`
Dose and duration

 Prophylaxis of recurrent urinary tract infection
Adult: 125 mg at night

 All other uses
Treatment should continue for 3–10 days

CEFALEXIN (CEPHALEXIN) C
Adult: 500 mg every 8–12 hours. In severe infections,
give 1–1.5 g every 6–8 hours
Child 1 month–1 year: 125 mg every 12 hours
Neonate 21–28 days: 25 mg/kg (max 125 mg) every 6
hours
Neonate 7–21 days: 25 mg/kg (max 125 mg) every 8
hours
Neonate under 7 days: 25 mg/kg (max 125 mg) every 12
hours
Contra-indications
 Porphyria
 Galactose intolerance
 Cephalosporin hypersensitivity
Side effects
 Diarrhoea, nausea, vomiting, abdominal discomfort
 Headache
 Allergy, Rash, Stevens-Johnson syndrome
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Use with caution in patient with sensitivity to beta-lactam
antibacterials: discontinue if an allergic reaction occurs
 Use with caution in impaired renal function; may require
lower doses
 Cefalexin can lead to false positive Coomb’s test

C MONOGRAPHS
CEFIXIME H N 6.2.1
Oral third generation broad-spectrum cephalosporin
antibacterial
Dosage forms
 Tablet: 200 mg
Uses
 Urethral discharge syndrome (male)
 Abnormal vaginal discharge syndrome
 Lower abdominal pain syndrome (female)
 Pelvic inflammatory disease (PID)
 Upper and lower respiratory tract infections
Dose and duration

 Urethral discharge syndrome, abnormal vaginal discharge
syndrome
Adult: 400 mg as a single dose
 Upper and lower respiratory tract infections
Adult and child over 10 years: 200–400 mg daily in 1–2

divided doses for 7 days
Child 5–10 years: 200 mg once daily for 5−7 days
Child 1–4 years: 100 mg once daily for 5−7 days
Child 6 months–1 year: 75 mg once daily for 5−7 days
 Lower abdominal pain syndrome, pelvic inflammatory
disease (PID)
Adult: 400 mg daily in 1–2 divided doses for 5–10 days
Note: In renal failure with creatinine clearance ˂20
ml/min, do not exceed 200 mg daily
Contraindications
 Hypersensitivity to cephalosporins

CEFTRIAXONE C
Side effects
 Nausea, vomiting, abdominal discomfort
 Headache
 Stevens-Johnson syndrome, allergic reaction, anaphylaxis
Interactions
 Warfarin (possibly enhanced anticoagulant effect)
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Give with caution in patients with penicillin hypersensi-
tivity due to likelihood of cross-sensitivity.
 In patients with history of cephalosporin induced hae-
molytic anaemia, avoid re-administration
 Discontinue cefixime in case acute renal failure or tubu-
lointerstitial nephritis occurs
 Reduce dose in moderate to severe renal impairment
CEFTRIAXONE HC III V 6.2.1

Third generation broad spectrum cephalosporin antibacterial
Dosage forms
 Powder for injection: 1 g
Uses
 Acute bacterial meningitis
 Septicaemia
 Pneumonia
 Abnormal vaginal/urethral discharge syndrome

C MONOGRAPHS
 Pelvic inflammatory disease

 Severe gonococcal infection
 Gonococcal eye infection in new born infant
 Dysentery
Dose and duration

IV injection should be given slowly over 2–5 minutes. Give IV
infusion over 30–60 minutes in neonates
 Meningitis (first line treatment)
Adult: 2 g IV or deep IM injection daily in 1 or 2 divided

doses for 14 days
Child: 50–100 mg/kg daily in 1 or 2 divided doses for
14 days
Neonate: 20–50 mg/kg daily in 1 or 2 divided doses
(maximum 50 mg/kg) for 14 days
 Septicaemia
Adult: 2 g IV or deep IM injection daily in 1 or 2 divided

doses for 10 days
Child: 50–100 mg/kg daily in 1 or 2 divided doses for
10 days
(max 50 mg/kg) for 10 days
 Moderate to severe pneumonia (second line to ampicillin
and gentamicin)
Adult: 1–2 g IV or deep IM injection daily in 1 or 2 di-
vided dose for 7 days
Child: 50 mg/kg daily in 1 or 2 divided doses for 7 days
(max 50 mg/kg) for 7 days
 Abnormal vaginal/urethral discharge syndrome (in com-
bination with metronidazole and doxycycline)

CEFTRIAXONE C
Adult: 1 g single dose by deep IM injection
 Pelvic inflammatory disease; persistent urethral/vaginal
discharge syndrome
Adult: 1 g once daily by deep IM injection for 3 days
 Severe gonococcal infection
Adult: 1 g by deep IM injection once daily for 7 days
 Gonococcal eye infection in new born infant (in combina-
tion with azithromycin)
25 mg/kg single dose by deep IM injection
(max 125 mg)

 Dysentery (second line for severely ill children)
50–80 mg/kg IV once daily for 3 days

Contraindications
 Allergy to cephalosporin
 Neonates with jaundice, low albumin levels, or acidosis
Side effects
 Stomach upset
 Headache
 Blood disorders
Interactions
 Calcium or calcium-containing fluids (risk of calcium-
ceftriaxone deposits in urine and lungs; see caution)

 Warfarin (increased anticoagulant effect)
Pregnancy
 Can be used
Breast-feeding
 Can be used

C MONOGRAPHS
Caution
 Rapid injection can cause severe nausea and dizziness
 Give doses of >50 mg/kg in children and >1 g in adults
by IV infusion
 IM doses of >1 g should be divided over 2 injection sites
 When used with calcium or calcium-containing fluids
(e.g. Ringer’s Lactate), there is risk of calcium-
ceftriaxone deposits in urine and lungs. Higher risk in
neonates dehydrated or immobilised patients.
 Reduce dose in patients with severe kidney and liver
disease
 Ceftriaxone is second line to ampicillin and gentamicin in
severe pneumonia
 Avoid using ceftriaxone for indications not indicated or
when first line medicines are available to avoid develop-
ment of resistance
 Give with caution in patients with penicillin sensitivity,
may have cross-sensitivity
CEFUROXIME RR N 6.2.1
Broad spectrum second generation cephalosporin
Dosage forms
 Tablet: 500 mg
 Oral suspension: 125 mg/ml
 Powder for solution for injection: 750 mg
Uses
 Urinary tract infections
 Otitis media

CEFUROXIME C
 Skin and soft-tissue infections
 Sinusitis
 Pre- and post-surgery prophylaxis
Dose and duration

 All infections
Treat for 5–10 days. Treatment may be extended to 14–

21 days in some severe cases
Adult and child above 12 years: 250 mg every 12 hours
(500 mg every 12 hours in more severe lower respiratory-
tract infections or if pneumonia suspected)
Child 2–12 years: 15 mg/kg (max 250 mg) every 12 hours
Child 3 months–2 years: 10 mg/kg (max 125 mg) every 12
hours
 Pre- and post-surgery prophylaxis
Give by deep IM or IV injection (over 3–5 minutes) or infu-

sion (over 30 to 60 minutes). In neonates or for doses
above 750 mg, use IV route only
Adult: 1.5 g by IV injection up to 30 minutes before
the procedure. 3 more doses of 750 mg IM or IV may
be given every 8 hours for high-risk procedures
Child 1 month–18 years: 50 mg/kg (max 1500 mg) up to
30 minutes before the procedure. 3 more doses of 30
mg/kg (max 750 mg) may be given by IM or IV injection
every 8 hours for high-risk procedures
 Severe infections
Adult: 750 mg every 6–8 hours ( max 1500 mg)

Child 1 month–18 years: 20 mg/kg (max 750 mg) every 8
hours (50–60 mg/kg (max 1500 mg)
Neonate 21–28 days: 25 mg/kg every 6 hours
C MONOGRAPHS
Neonate under 7 days: 25 mg/kg every 12 hours

Double the dose in very severe infections
Note: In renal failure, increase dosing interval to every 12
hours; in severe renal failure, give once daily
Contraindication
 Hypersensitivity to cephalosporin
 History of severe hypersensitivity to other beta-lactam
antibacterial agents
Side effects
 Candida overgrowth
 Eosinophilia
 Transient rise in liver enzymes
 Diarrhoea, nausea, abdominal discomfort
Interactions
 Take your medication after food for optimum absorption
 Do not crush the tablets. Swallow them whole
 Shake the reconstituted suspension well before use
 Store the reconstituted suspension in a refrigerator. Do
not freeze. Discard any remaining suspension after 10

days (3 days if stored at room temperature)
Pregnancy
 Can be used
Breast-feeding
 Can be used

CETIRIZINE C
Storage
 After reconstitution, store in a refrigerator between
2–8oC for not more than 10 days

Caution
 Reduce dose in severe renal impairment
 Use with caution in patients with non-severe hypersensitivi-
ty to penicillins and other beta-lactam agents

 Prolonged use may result in the overgrowth of other non-
susceptible microorganisms like enterococci and clostridi-

um difficile, which may require interruption of treatment
CETIRIZINE H N 3.0
Non-sedating antihistamine
Dosage forms
 Tablet: 10 mg
Uses
 Symptomatic relief of allergy
Dose and duration

 Symptomatic relief of allergy
Adult and child > 12 years: 10 mg once daily

Child 2–6 years: 2.5 mg every 12 hours
Child 1–2 years: 250 µg/kg every 12 hours
In renal failure: Reduce dose to ½ in mild failure; ½ nor-
mal dose on alternate days in moderate failure
Contraindications
 Severe renal failure
 Hypersensitivity to cetirizine or hydroxyzine

C MONOGRAPHS
Side effects
 Somnolence, headache, fatigue, dizziness
 Dry mouth
 Drowsiness may occur and affect perfomance of skilled
tasks like driving

 Avoid alcohol since it may enhance drowsiness
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Avoid in severe renal failure due to increased risk of coma
CETRIMIDE + CHLORHEXIDINE HC II N 15.1

Skin disinfectant and wound cleanser. Cetrimide cleans and
chlorhexidine disinfects
Dosage forms
 Solution: 0.15% cetrimide and 0.015% chlorhexidine
Uses
 Disinfection of wounds
Dose and duration

 Apply undiluted solution to affected area
Side effects
 Skin irritation
Interactions
 Povidone-iodine (cancelled effect)

CHARCOAL (ACTIVATED) C
 Hydrogen peroxide (cancelled effect)
 Avoid contact with eyes
 Do not use in body cavities (the organs inside the body)
 Do not use on breasts if breast-feeding
Pregnancy
 Can be used
Breast-feeding
 Can be used
CHARCOAL (ACTIVATED) HC II E 4.1

Oral antidote that binds many poisons in the stomach and
prevents their absorption into the body
Dosage forms
 Tablet: 250 mg
Uses
 Prevention of absorption of poisons
 Active elimination of some poisons after they have been
absorbed
Dose and duration
 Prevention of absorption of poisons
Adult: 50 g (200 tablets of 250 mg)

Child: 25 g (100 tablets of 250 mg); use 50 g if severe
poisoning
 Active elimination of some poisons
Give as above but repeat every 4 hours

Preparation
 Grind tablets into a fine powder before mixing with

C MONOGRAPHS
100–200 ml of water to make a suspension then drink

Contraindications
 Poisoning with kerosene
 Poisoning with acids
 Poisoning with malathion
 Alcohol poisoning
 Insecticide poisoning
 Metal salts including iron and lithium salts poisoning
Side effects
 Black stools
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 The sooner charcoal is given, the more effective it is, but
it may still be effective up to 2 hours after ingestion of
the poison
 Use with caution in a drowsy or comatose patient and in
cases of reduced gastric motility
 Treat any vomiting with an anti-emetic as vomiting may
reduce the effectiveness of the charcoal and lead to aspi-
ration of the poisoning agent
CHLORAMBUCIL RR E 8.2
Alkylating agent. Cytotoxic anticancer medicine
Dosage forms
 Tablet: 2 mg

CHLORAMBUCIL C
Uses
 Non-Hodgkin’s lymphomas
 Hodgkin’s disease
 Chronic lymphocytic leukaemia
Dose and duration

Adult and child: as a single agent: usually 0.2

mg/kg/day for 4‒8 weeks
 Non-Hodgkin’s lymphoma
Adult and child: Initially, 0.1‒0.2 mg/kg/day for 4‒8

weeks. Maintenance therapy is then given by a
reduced daily dosage or intermittent courses of treat-
ment.
Adult and child: Initially, 0.15 mg/kg/day until the to-

tal leukocyte count has fallen to 10,000 per µL. Treat-
ment may be resumed 4 weeks after the end of the
first course and continued at a dosage of 0.1
mg/kg/day.
Contra-indications
 Hypersensitivity to chlorambucil
 Patients who have just recently undergone radiotherapy
or received other cytotoxic agents

Side effects
 Rash
 Blood disorders
 Stevens-Johnson Syndrome
 Secondary haematologic malignancies e.g. especially leu-
kaemia and myelodysplastic syndrome on long-term use)

C MONOGRAPHS
 Seizures in children with nephrotic syndrome

 Nausea, vomiting, diarrhoea, abdominal pain
Interactions
 Take on an empty stomach (at least 1 hour before or 3
hours after food)

 Report immediately any rash
Pregnancy
 Do not use
Breast-feeding
 Do not use
Storage
Caution
 Men and women taking chlorambucil should use
adequate contraception
 Monitor blood counts closely
 Withdraw medicine immediately if a rash develops
 Use with caution in children with a history of seizures and
nephrotic syndrome (increased risk of seizures)

CHLORAMBUCIL C
CHLORAMPHENICOL HC III V 6.2.2, 21.1
Broad spectrum antibacterial reserved for treatment of
severe infections
Dosage forms
 Powder for injection: 1 g vial
 Ophthalmic ointment: 1%
 Eye drops: 0.5%
 Ear drops: 5%
 Capsule: 250 mg
Uses
 Meningitis
 Septicaemia
 Plague
 Typhoid
 Typhus fever
 Bronchiolitis
 Severe throat infection
 Severe breast infection
 Pre-referral treatment for pneumonia and possible seri-
ous bacterial infection (PSBI) in infants >1 week old

 Bacterial eye infection
 Ophthalmia of the new born
 Ear infections
Dose and duration

 Meningitis and septicaemia
Adult: 1 g IV every 6 hours for 14 days

Once clinical improvement occurs, reduce dose to
500–750 mg orally every 6 hours to complete the course

C MONOGRAPHS
Child: 25 mg/kg every 6 hours for 14 days

 Plague, typhoid, typhus fever, pneumonia, breast infec-
tion
Adult: 500 mg IV every 6 hours for 7–10 days
Child: 25 mg/kg per dose every 6 hours for 7–10 days
 Bronchiolitis, throat infection
Child > 2 weeks: 12.5 mg/kg every 6 hours for 5 days
 Pre-referral treatment for pneumonia and PSBI (in combi-
nation with benzyl penicillin)
Child > 1 week: 40 mg/kg IM single dose
Child < 1 week: 20 mg/kg IM single dose
Refer immediately
If referral not possible: Repeat dose every 12 hours for
5 days, then change to an appropriate oral antibiotic
to complete 10 days treatment
 Bacterial eye infections
Adult and child over 2 years: apply eye ointment 3–4
times daily for 7 days or once at night if eye drops are
used during day
Adult and child >2 years: 1 eye drop every 2 hours for
2 days then 1 drop every 4 hours for 3 more days
Neonate: apply eye drops every 30 minutes
 Ear infections
Apply 2 drops of eye/ear drops into the ear every 8
hours for 14 days
Contraindications

CHLORHEXIDINE C
Side effects
 Dry mouth, stomach upset
 Skin rash
 Unclear or temporary loss of vision
 Headache
 Anaemia
 Grey baby syndrome
Interactions
 Phenobarbital (reduced effect of chloramphenicol)
 Phenytoin (increased side effects of phenytoin)
Pregnancy
 Do not use
Breast-feeding
 Do not use
Caution
 Alternative to benzyl penicillin if secondary bacterial in-
fection is suspected
 Avoid repeated courses and prolonged use
 Grey syndrome is most likely to occur in neonates
CHLORHEXIDINE HC II E 13.2, 15.1

Topical disinfectant and anti-infective that kills microorgan-
isms and prevents infection of wounds
Dosage forms
 Cutaneous solution: 2%
 Solution: 0.05%
 Solution (as digluconate): 7.1%
 Chlorhexidine gluconate mouthwash: 0.20%

C MONOGRAPHS
 Chlorhexidine gluconate solution: 20% (equivalent to

chlorhexidine 4%)
 Cream: 5%
Uses
 Cleansing and prevention of infection of wounds, animal
bites, and skin infections

 General and pre-operative hand and skin disinfection
 Disinfection of instruments
 Oral infections
 Cleaning of umbilical cord stump of a newborn
Dose and duration

 Wounds (deep and extensive), animal bites, skin infec-
tions
Apply 0.05% solution directly to affected area after
cleaning and allowing the wound to dry
 General and pre-operative hand and skin disinfection
Rub 0.05% solution on hands and skin

 Cleaning of umbilical cord stump of newborn
Neonate: apply 7.1% solution or 4% gel to the stump im-

mediately after birth and daily during the first week of life
 Oral infections
Rinse/gargle with mouthwash every 8 hours until

symptoms disappear
 Disinfection of instruments
Soak for at least 30 minutes in 0.05% solution, then

rinse thoroughly with sterile water or 0.9% sodium
chloride
Preparation
 Dilute 5% concentrated chlorhexidine solution with

CHLORHEXIDINE C
distilled water to make required strength
 To make 1 litre of 0.05% solution, add 10 ml of 5%
concentrated solution + 990 ml of clear freshly boiled and
cooled water
Side effects
 Skin irritation
Interactions
 Soap (cancelled effect)
 In case of contact with eyes, wash with plenty of water
 Wash hands with soap and water before applying to the
umbilical cord. Do not put anything else on the cord

Pregnancy
 Can be used
Breast-feeding
 Can be used
Storage
 Use diluted solution within 1 week
Caution
 Not for use in body cavities (the organs inside the body)
 When used for umbilical cord care, it should be applied
alone; cord detachment may be prolonged for more 1–2
days

C MONOGRAPHS
CHLOROQUINE BASE HC IV E 6.4.3

Antimalarial and disease modifying antirheumatic medicine
Dosage forms
 Tablet: 150 mg
Uses
 Malaria prophylaxis in sickle cell disease
 Rheumatoid arthritis (specialist use only)
Dose and duration

 Malaria prophylaxis in sickle cell disease
Adults: 300 mg of chloroquine base once weekly

Child: 5 mg/kg once weekly
Adults: 150 mg of chloroquine base once daily

Child: 3 mg/kg once daily
Contra-indications
 Psoriatic arthritis
 Allergy to chloroquine
Side effects
 Stomach upset
 Skin reactions (rash, itching)
 Headache
 Eye damage on long term use
 Irregular heartbeat and convulsions in overdose
Interactions
 Artemether/lumefantrine
 Digoxin (increased concentration of digoxin)
 Mefloquine (increased risk of convulsions)
 Ethosuximide (reduced effect of ethosuximide)

CHLORPHENIRAMINE (CHLORPHENAMINE) MALEATE C
 Carbamazepine (reduced effect of carbamazepine)
 Halothane (increased hypotensive effect)
 Ketamine (increased hypotensive effect)
 Take after food to minimise nausea and vomiting
 Report immediately to health worker any visual disturb-
ances while on treatment

Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Chloroquine should not be used for malaria treatment as
the parasites are resistant to it
 Chloroquine can make psoriasis worse
CHLORPHENIRAMINE (CHLORPHENAMINE)
HC II E 3
MALEATE
Sedating antihistamine that relieves itching caused by several
conditions
Dosage forms
 Tablet: 4 mg
Uses
 Chicken pox
 Herpes zoster
 Snake bite
 Severe local reaction after insect bites and stings
 Eczema

C MONOGRAPHS
 Skin allergy
 Glue ear (otitis media with effusion)
 Nasal allergy
Dose and duration

 Chicken pox and herpes zoster
Adults: 4 mg every 12 hours for 3 days

Child <5 years: 1 mg every 12 hours for 3 days
 Snake bite
4 mg every 6–8 hours for 3 days

 Insect bites and stings
Give until swelling subsides

Adults: 4 mg every 6 hours; max 24 mg daily)
Child 6–12 years: 2 mg every 6 hours; max 12 mg daily
Child 2–5 years: 1 mg every 6 hours; max 6 mg daily
 Glue ear (otitis media with effusion)
Same as for insect bites for 10 days

 Nasal allergy
Same as for insect bites for 21 days

Contra-indications
 Urinary and prostate disorders
 Glaucoma
 Children <1 year old
Side effects
 Drowsiness, sedation, headache, dizziness
 Tinnitus
 Blurred vision

CHLORPROMAZINE C
Interactions
 Alcohol (increased sedation)
 Morphine (increased sedation)
 Chlorpromazine (increased sedation)
 Promethazine (increased sedation)
 Phenobarbital (increased sedation)
 Amitriptyline (increased sedation)
 Diazepam (increased sedation)
 Do not drive or operate machinery
 Do not drink alcohol
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Chlorpheniramine has no anti-emetic effect
 Less sedating than promethazine
CHLORPROMAZINE HC II V 24
Sedative antipsychotic medicine
Dosage forms
 Tablets: 100 mg; 25 mg
Uses
 Mania, delirium
 Control spasms in tetanus
 Excessive vomiting in pregnancy

C MONOGRAPHS
 Intractable hiccups
 Migraine
Dose and duration
 Mania, delirium
Adult: initially, 100–200 mg every 8 hours, then adjust

according to response. Daily doses up to 300 mg may
be given as a single dose at night
 Control spasms in tetanus (alternating with diazepam)
Adult: 100 mg every 4–6 hours by nasogastric tube

Child: 12.5–25 mg every 4–6 hours by nasogastric
tube. Continue for as long as spasms or rigidity persists
 Intractable hiccups
Adult: 25–50 mg every 6–8 hours

 Excessive vomiting in pregnancy
Adult: 25 mg repeated as needed (at most every 4

hours). If severe, give by deep IM injection every 6
hours or as required
Contra-indications
 Delirium tremens (uncontrolled shaking in acute alcohol
withdrawal)
 Parkinson's disease
Side effects
 Drowsiness, apathy, nightmares, dizziness, insomnia,
headache
 Confusion, depression
 Extra-pyramidal side effects
 Uncontrolled shaking

CICLOSPORIN C
Interactions
 Phenobarbital (increased sedation)
 Chlorpheniramine (increased sedation)
 Do not take alcohol
 Do not drive or operate machinery while on treatment
Pregnancy
rd
Breast-feeding
 Do not use
Caution
 Reduce dose to half or third in elderly patients
 Avoid abrupt withdrawal (may cause withdrawal
symptoms)
 Health workers should avoid direct contact with chlor-
promazine. Do not touch or crush the tablets, and handle
injectable solutions with care.
 Do not initiate treatment for mania and delirium; refer
patient to be seen by a specialist. Only give refill doses
 Benzhexol is used to treat extra-pyramidal side effects of
chlorpromazine
CICLOSPORIN NR N 8.1
Immunosuppressive medicine
Dosage forms
 Tablet: 25 mg

C MONOGRAPHS
 Concentrate for intravenous infusion: 50mg/ml
Uses
 Prevention of graft rejection
 Prophylaxis of graft-versus-host disease
 Nephrotic syndrome
 Psoriasis
 Atopic dermatitis
Dose and duration

Adjust dose according to plasma ciclosporin concentration
and renal function. Lower doses are required when ciclo-
sporin is used with other immunosuppressants
 Organ transplantation
Adult and child over 3 months: by mouth, 10–15 mg/kg

4–12 hours before surgery given in 2 divided doses, then
10–15 mg/kg in 2 divided doses for 1–2 weeks and reduc-
ing it gradually to a maintenance dose of 2–6 mg/kg daily
in 2 divided doses
By IV infusion: if using concentrated solution, give 1/3rd of
the corresponding dose by mouth over 2–6 hours. Same
dose as for oral administration when diluted
 Bone marrow transplantation, graft-versus-host disease
Adult and child over 3 months: by mouth, 12.5–15 mg/kg

daily in 2 divided doses for 2 weeks, starting on the day
before surgery, followed by 12.5 mg/kg daily in 2 divided
doses for 3–6 months, then gradually reduced to zero by
1 year after transplantation
By IV infusion over 2–6 hours, 3–5 mg/kg daily for 2
CICLOSPORIN C
weeks, starting on the day before surgery, followed by
maintenance doses by mouth
Adult: by mouth, initially 2.5 mg/kg every 12 hours slowly
reduced to lowest effective dose according to proteinuria
and serum creatinine measurements. Discontinue after 3
months if no improvement is observed (after 6 months in
membranous glomerulonephritis)
Child: by mouth, initially 3 mg/kg every 12 hours and ti-
trated as in the adult
Adult: by continuous IV infusion, 2 mg/kg daily over 24
hours adjusted according to blood ciclosporin concentra-
tion and response
Adult: 1.5 mg/kg every 12 hours for 6 weeks increased
gradually according to response and tolerability up to a
maximum 2.5 mg/kg every 12 hours for 6 more weeks
 Psoriasis, atopic dermatitis
Adult: initially 1.25 mg/kg (2.5 mg/kg if rapid improve-
ment is needed) every 12 hours gradually increased if
there is no improvement after 1 month (2 weeks in der-
matitis) to a maximum dose of 2.5 mg/kg every 12 hours.
Treat for 8 weeks to 1 year in dermatitis
Discontinue if there is no improvement after 6 weeks of
treatment in psoriasis
Preparation
 Dilute according to manufacturer’s directions
Contra-indications
 Porphyria

C MONOGRAPHS
 Malignancy
 Uncontrolled infections
Side effects
 Nutrition disorders such as hyperlipidaemia, anorexia
 Metabolism disorders e.g. hyperglycaemia, hyperuricae-
mia, hyperkalaemia and hypomagnesaemia

 Leucopoenia
 Tremor, paraesthesia, headache, convulsions, fever
 Hypertension, flushing
 Fatigue
 Nausea, vomiting, abdominal pain, diarrhea
 Gingival hyperplasia and peptic ulcer
 Abnormal hepatic function
 Hirsutism, acne, hypertrichosis (excessive body and/or
facial hair growth)

 Muscle pain, muscle cramps
 Renal dysfunction
Interactions
 Amikacin, amphotericin B, ciprofloxacin, gentamicin, ibu-
profen, levofloxacin, ofloxacin, silver sulfadiazine, strep-

tomycin, sulfadiazine, sulfadoxine + pyrimethamine, van-
comycin (increased risk of nephrotoxicity)
 Silver sulfadiazine, sulfadiazine, sulfamethoxazole + tri-
methoprim, trimethoprim (plasma ciclosporin concentra-

tion possibly increased)
 Amiloride (increased risk of hyperkalaemia)
 Azithromycin, chloramphenicol, doxycycline, ritonavir
(plasma concentration of ciclosporin possibly increased)

 Carbamazepine, Phenobarbital, phenytoin, rifampicin
( reduced plasma ciclosporin concentration)

CICLOSPORIN C
 Chloroquine, erythromycin, fluconazole, grape fruit juice,
levonogestrel, medroxyprogesterone, metoclopramide,
norethisterone, verapamil (increased plasma concentra-
tion and toxicity of ciclosporin)
 Oral contraceptives (Plasma ciclosporin concentration in-
creased)
 Digoxin (increased concentration and toxicity of digoxin)
 Doxorubicin (increased risk of neurotoxicity)
 Enalapril, potassium salts, spironolactone (increased risk
of hyperkalaemia)
 Methotrexate (increased toxicity)
 Simvastatin (increased risk of myopathy)
Pregnancy
 Do not use
Breast-feeding
 Do not use
Caution
 Monitor renal function. Reduce dose if dose-related in-
creases in serum creatinine and blood urea nitrogen oc-
cur during the first few weeks; exclude kidney transplant
rejection
 Monitor hepatic function. Adjust dose according to bili-
rubin and liver enzymes levels
 Monitor blood pressure and discontinue if hypertension
cannot be controlled by antihypertensives
 Monitor serum magnesium and potassium especially in
renal impairment due to risk of hyperkalaemia
 Monitor blood lipids before and during treatment
 In patients with nephritic syndrome, reduce dose by 25–
C MONOGRAPHS
50% if serum creatinine is more than 30% above baseline

at more than one measurement. Perform renal biopsies
at yearly intervals
 Monitor patients receiving the IV infusion for 30 minutes
after starting the infusion since the polyethoxylated cas-
tor oil may cause anaphylaxis in some patients
 When changing from IV to oral dose, start with similar
dose as for IV and monitor ciclosporin plasma concentra-
tion for 4–7 days
 Use in pregnancy may cause premature delivery
CIPROFLOXACIN HC II V 6.2.2, 21.1

Broad spectrum fluoroquinolone antibacterial
Dosage forms
 Tablets: 500 mg
 Solution for IV infusion: 2 mg/ml
 Eye drops: 0.3%
Uses
 Urinary bladder infection
 Brucellosis
 Anthrax
 Typhoid fever
 Pneumonia
 Bacterial dysentery
 Cholera
 Genital ulcer disease (without blisters)
 Prophylaxis of meningococcal meningitis
 Corneal ulcers

CIPROFLOXACIN C
 Superficial ocular infection
Dose and duration
 Urinary bladder infection
Adults: 500 mg single dose PO

Adult: by mouth, 750 mg every 12 hours for 7–14 days

By IV infusion over 60 minutes, 400 mg every 8–12 hours
 Brucellosis and typhoid fever
Adult: 500 mg every 12 hours for 14 days PO

In chronic typhoid fever, treat for 4–6 weeks
 Pneumonia, anthrax
Adult: by mouth, 500 mg every 12 hours for 5 days

By IV infusion over 60 minutes, 400 mg every 12 hours
 Bacterial dysentery (first line) and cholera
Adult: 1 g single dose PO

 Genital ulcer disease
Adult: 500 mg every 12 hours PO for 3 days

 Prophylaxis of meningococcal meningitis
Adult: 500 mg single dose PO

 Corneal ulcers
Adult and child over 1 year: day 1; apply 2 drops into the
affected eye every 15 minutes for the first 6 hours and
then 2 drops every 30 minutes during both day and night-
time. Day 2; apply 2 drops in the affected eye every hour.
Days 3–14; apply 2 drops in the affected eye every 4
hours (max duration of treatment 21 days)
 Superficial ocular infection
Adult and child above 1 year: apply 1–2 drops 4 times

a day; in severe infection apply every 2 hours during
C MONOGRAPHS
waking hours for 2 days, then 4 times a day for 14 days

(max duration 21 days)
Contra-indications
 Joint pain
 Hypersensitivity to quinolones
Side effects
 Stomach upset
 Joint and muscle aches
In case of ocular application,

 Corneal deposits, ocular discomfort, ocular hyperaemia
 Dysgeusia (distortion of the sense of taste)
Interactions
 Artemether/lumefantrine (increased irregular heartbeat)
 Ibuprofen (increased risk of convulsions)
 Magnesium trisilicate compound (reduced absorption)
 Iron salts (reduced absorption)
 Take at least 2 hours before or 2 hours after taking milk,
other dairy products, magnesium trisilicate compound

and iron salts
 Drink plenty of fluids during treatment
 Report immediately to the health worker if any severe
joint or muscle pains occur

 Discard remaining eye drops after 1 month from opening
 In case of transient blurring of vision with eye drops, do
not operate machinery or drive until vision clears

 Do not touch the eye drops bottle tip with bare hands

CISATRACURIUM C
Pregnancy
 Do not use
Breast-feeding
 Do not use
Caution
 Stop treatment in the event of joint pain; elderly are
more prone to joint pain
 Use half dose in case of severe kidney disease
 Give with caution to patients with epilepsy due to risk of
seizures
 Discontinue use at the first appearance of a skin rash or
any sign of hypersensitivity
CISATRACURIUM H N 20
Non-depolarising neuromuscular blocking medicine with
long-term neuromuscular blockade
Dosage forms
 Solution for injection or infusion: 2 mg/ml
Uses
 Muscle relaxation during surgery
 Muscle relaxation during intensive care
Dose and duration

 Muscle relaxant during surgery
Adult and child over 12 years: by IV injection, 0.15

mg/kg; maintenance, 0.03 mg/kg every 20 minutes
By IV infusion, 0.18 mg/kg/hour, then after stabilisation,
0.06–0.12 mg/kg/hour
Child 2–12 years: By IV injection, 0.15 mg/kg

C MONOGRAPHS
(0.08–0.1 mg/kg if not for intubation), then 0.02 mg/kg

repeated every 10 minutes as necessary
Child 1 month–2 years: By IV injection, 0.15 mg/kg,
then 0.03 mg/kg repeated every 20 minutes as neces-
sary
 Muscle relaxant during intensive care
Adult: By IV injection, 0.15 mg/kg then by IV infusion

0.18 mg/kg/hour adjusted according to response (usual
range 0.03–0.6 mg)
Preparation
 For continuous IV infusion, dilute to a concentration of
0.1–2 mg/ml with Glucose 5% or Sodium Chloride 0.9%.

Solutions of 2 mg/ml or may be infused undiluted
Side effects
 Bradycardia
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 The patient should receive sufficient concomitant inhala-
tional or IV anaesthetic or sedative medicines to prevent
awareness
 To avoid excessive dosage in obese patients, dose should
be calculated on the basis of ideal bodyweight
 Administer with caution in patients with hypersensitivity
to other neuromuscular blocking drugs, patients with
other neuromuscular disorders and those with fluid and
electrolyte disturbances
CISPLATIN C
 Reduce the rate of administration in patients with cardio-
vascular disease
 In hypothermia and myasthenia gravis, give lower doses
 The patient should always have assisted respiration until
the medicine has been inactivated or antagonised
 No dose adjustments required in renal or hepatic failure
CISPLATIN NR V 8.2
Platinum compound anticancer
Dosage forms
Uses
 Lung cancer
 Testicular cancer
 Cervical cancer
 Bladder cancer
 Head and neck cancer
 Ovarian cancer
Dose and duration

Give only as intravenous infusion over 6‒8 hours
 For monotherapy
Adult and child: 50‒120 mg/m2 body surface area eve-

ry 3‒4 weeks
OR 15‒20 mg/m2/day for 5 days every 3‒4 weeks
 In combination therapy
Reduce dose
Adult and child: usually, 20 mg/m2 body surface area
every 3‒4 weeks
NOTE: Maintain adequate hydration from 2‒12 hours
C MONOGRAPHS
prior to administration (100‒200 ml/hour, total at least 1

litre) AND until minimum 6 hours after the administra-
tion of cisplatin (100‒200 ml/hour, total at least 2 litres)
Contra-indications
 Previous hypersensitivity to platinum compounds
 Kidney impairment
 Myelosuppression
 Hearing impairment
 Previous neuropathy due to cisplatin
Side effects
 Kidney damage
 Ototoxicity
 Peripheral neuropathy
 Hypomagnesaemia
 Infections
 Respiratory failure
 Hyperuricaemia
Interactions
 Yellow fever vaccine (risk of fatal yellow fever disease)
 Aminoglycosides, cephalosporins, amphotericin B,
polymixins (increased risk of ototoxicity and nephrotoxi-

city)
 Bleomycin, methotrexate (increased risk of pulmonary
toxicity)

CISPLATIN C
 Drink plenty of fluids after receiving the medicine
 Report immediately any allergic reactions, paresthesias,
loss in sensation or hearing

Pregnancy
 Do not use
Breast-feeding
Storage
 Do not refrigerate or freeze
Caution
 Pre- and post-hydration required to prevent serious renal
dysfunction
 Do not use needles or giving sets made of aluminium
parts because aluminium forms precipitates with cisplatin
 Consider dose reduction or scheduling changes when
used in combination with other myelosuppressive
medicines to minimise side effect
 Monitor weekly: kidney and liver function, electrolytes,
CBC before, during and after treatment. Avoid repeat
doses until parameters have normalised
 Follow manufacturer’s instructions for reconstitution of
cisplatin concentrate

C MONOGRAPHS
CLINDAMYCIN H E 6.4.6
Bacteriostatic antibacterial with activity against Gram-
positive aerobes and a wide range of anaerobes
Dosage forms
 Capsules: 150 mg, 300 mg
Uses
 Pneumocystis Jiroveci pneumonia
 Toxoplasmosis
 Staphylococcal bone and joint infection
Dose and duration

 All uses
By mouth for 5 days (up to 10 days in beta-haemolytic

streptococcal infection)
Adult and child above 12 years: 150–300 mg every 6
hours, up to 450 mg every 6 hours in severe infections
Child 14 days–12 years: 3–6 mg/kg every 6 hours
Neonate under 14 days: 3–6 mg/kg every 8 hours
By deep IM injection or by IV infusion,
Adult and child over 12 years: 600–2,700 mg daily in 2–4
divided doses up to 4,800 mg in life threatening infection
Child 1 month–12 years: 3.75–6.25 mg/kg every 6 hours
increased to 10 mg/kg every 6 hours in severe infections
Total daily dose may be given 3 times daily
Contraindications
 Porphyria
 Diarrhoeal states
Side effects
 Diarrhoea, nausea, vomiting, abdominal discomfort

CLOFAZIMINE C
 Oesophagitis and oesophageal ulcers (oral formulations)
 Rash, pruritus, urticaria, Stevens- Johnson syndrome
 Stop medication immediately if diarrhoea develops and
consult your doctor

 Swallow whole with a glass of water
Interactions
 Suxamethonium (enhanced effects of suxamethonium)
 Vecuronium (enhanced muscle relaxant effect)
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Colitis may develop during or after treatment
 Avoid rapid IV administration
 Single doses exceeding 600 mg should only be given by IV
infusion and any single dose should not exceed 1,200 mg
 Monitor liver and renal function if administered for
longer than 10 days
CLOFAZIMINE HC III V 6.2.3

Anti-leprotic antibacterial
Dosage forms
Uses
 Multibacillary leprosy

C MONOGRAPHS
Dose and duration

 Multibacillary leprosy (in combination with rifampicin and
dapsone)
Take as below for 12 months
Adult and child >15 years: 300 mg once a month and
50 mg once daily
Child 10–14 years: 150 mg once a month and 50 mg
on alternate days
Child below 10 years: 6 mg/kg body weight monthly
and 1 mg/kg daily
Side effects
 Discoloration of skin, hair, cornea, tears, conjunctiva,
sweat, sputum, faeces, and/or urine

 Stomach upset
 Weight loss
 Bleeding
 Dry skin and eyes
 Rash
 The treatment lasts for 12 months. It is important to
complete the schedule to ensure complete healing

 May cause discoloration of skin, hair, tears, sweat, spu-
tum, and/or urine. This is reversible so do not worry

Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Reduce dose or increase dose interval if GI problems exist
CLOMIFENE C
before treatment is started. Discontinue treatment if gas-
trointestinal problems develop while on treatment
 Lepra reaction: Sudden increase in the activity of leprosy
with nerve pain. It should be treated promptly to prevent
permanent nerve damage and disability
 Nerve pain: Treat with oral prednisolone for 3 months
and paracetamol or acetylsalicylic acid
 Do not stop treatment for leprosy during a lepra reaction
 If lepra reactions do not resolve within 6 weeks of treat-
ment or they get worse, refer patient to a specialist
 Type 2 lepra reactions, also called erythema nodosum
leprosum (ENL), is an antibody response to dead bacteria
and occurs only in MB leprosy. Therapy includes pain
relievers, prednisolone and clofazimine.
CLOMIFENE RR N 18.6
Anti-oestrogen ovulation inducer which induces gonadotro-
phin release by occupying oestrogen receptors in the hypo-
thalamus
Dosage forms
 Tablet: 50 mg
Uses
 Female infertility due to disturbances in ovulation
Dose and duration

 Female infertility due to disturbances in ovulation
Adult: 50 mg once daily for 5 days starting within 5 days

of onset of menstruation preferably on the 2nd day. May
be started at any time if menstruation cycles have ceased
In the absence of ovulation, a second course of 100 mg
C MONOGRAPHS
once daily for 5 days may be given (see caution)

Contra-indications
 Hepatic disease or history of hepatic dysfunction
 Ovarian cysts
 Hormone dependent tumours
 Uterine bleeding of undetermined cause
Side effects
 Visual disturbances
 Ovarian hyper stimulation, hot flushes, breast tender-
ness, menstrual spotting, menorrhagia, endometriosis

 Abdominal discomfort, nausea and vomiting
 Depression, insomnia, dizziness, headache, convulsions
 Weight gain
 Rash
 Hair loss
Pregnancy
 Do not use
Breast-feeding
 Do not use
Caution
 Most patients respond to the first course. Long term cy-
clical therapy (more than 6 cycles) may increase risk of
ovarian cancer
 Discontinue treatment and initiate eye examination if
visual disturbances occur
 Discontinue treatment immediately if ovarian hyperstim-
ulation syndrome occurs
 In patients with polycystic ovary syndrome, cysts may en-
large during treatment
CLONAZEPAM C
 Risk of uterine fibroids, ectopic pregnancy and incidence
of multiple births may be increased
 Avoid use of clomifene in severe liver disease
 Use of clomifene in breast- feeding may inhibit lactation
CLONAZEPAM RR E 5
Benzodiazepine with antiepileptic activity
Dosage forms
 Tablet: 2 mg
Uses
 Treatment of all forms of epilepsy
Dose and duration

 Treatment of epilepsy
Adult and child above 12 years: 1 mg (0.5 mg in elderly)

once a day at night for 4 nights, increased according to re-
sponse over 2–4 weeks to usual maintenance dose of 4–8
mg at night. If necessary, give in 3–4 divided doses
Child 5–12 years: 0.5 mg increased as above to the usual
maintenance dose of 3–6 mg
Child 1–5 years: 0.25 mg increased as above to the usual
maintenance dose of 1–3 mg
Child up to 1 year: 0.25 mg increased as above to usual
maintenance dose of 0.5–1 mg
Contra-indications
 Acute pulmonary insufficiency
 Marked neuromuscular respiratory weakness including
myasthenia gravis
C MONOGRAPHS
 Coma
 Current alcohol or drug abuse
Side effects
 Drowsiness, fatigue, dizziness, poor concentration, rest-
lessness
 Ataxia, muscle hypotonia, co-ordination disturbances
 Confusion, amnesia
 Dependence
 Salivary or bronchial hypersecretion in infants and small
children
 Nystagmus
Interactions
 Clozapine (serious adverse events)
 Sodium oxybate (effects of sodium oxybate enhanced)
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Patients may need to be maintained on a specific brand
or generic product
 Use the lowest effctive dose for the shortest needed time
 The effect of clonazepam may decrease significantly after
weeks or months of continued therapy
 Avoid use in hepatic failure due to risk of coma
 Use lower doses in renal impairment because patients
have increased cerebral sensitivity
 Risk of neonatal withdrawal symptoms when used during
CLOTRIMAZOLE C
pregnancy. Only use if there is a clear indication such as
seizure control. High doses taken during late pregnancy
may cause neonatal hypothermia, hypotonia, and
respiratory depression
CLOTRIMAZOLE HC II E 6.3, 13.1, 28.1

Topical antifungal
Dosage forms
 Clotrimazole cream: 1%
 Clotrimazole pessary: 100 mg
 Clotrimazole solution: 1%
Uses
 Fungal skin infections
 Ringworm
 Vaginal candidiasis
 Vulval candidiasis
 Otitis externa due to fungal infection
Dose and duration

 Fungal skin infections and ring worm
Adult and child: apply cream to the lesion every 12

hours. Continue for 14 days after lesion has healed
 Vulval candidiasis
Adult and child: apply cream to area around vagina

and anus 2–3 times daily for 7–14 days
Adult and child: insert 1 pessary as a single dose high into

the vagina at bedtime for 6 days
 Otitis externa due to fungal infection
Adult and child: apply 3 drops of solution in ear 2–3

C MONOGRAPHS
times a day. Continue until discharge dries up or for a to-

tal of 8 weeks and for 14 days after clinical resolution
Contra-indications
 Hypersensitivity to fluconazole and ketoconazole
 Presence of vulvar or vaginal sores or ulcers
Side effects
 Local irritation
 Allergy
Interactions
 Nystatin pessaries (cancelled effect)
 Wash your hands before and after every application
 Apply a thin layer on the affected area and rub gently
into the skin

 Do not share towels, basins, or bathing sponges with
uninfected people
 Avoid use on broken skin or open wound
 Insert the pessary while lying on your back to ensure it
goes as high as possible into the vagina

 Do not swallow the pessary
 Do not interrupt treatment during menstruation
 Do not have sexual intercourse after inserting pessary
 Do not use applicator if pregnant
Pregnancy
 Can be used
Breast-feeding
 Can be used

CLOXACILLIN C
Caution
 Recurrent infection may be treated by inserting 1 pessary
once a week for 6 months
 Explain use of applicator to the patient if available
CLOXACILLIN HC IV E 6.2.1
Penicillin antibacterial with good activity against Gram
positive bacteria for example Staphylococcus aureus. It is not
inactivated by penicillinases produced by S. Aureus.
Dosage forms
Uses
 Severe bacterial infections
 Septicaemia
 Septic arthritis
 Severe pneumonia due to Staphylococcus aureus
 Pyomyositis
 Osteomyelitis
 Endocarditis due to Staphylococcus aureus
 Pneumonia
 Infected skin wounds
 Boils
Dose and duration

 Severe bacterial infections (in combination with
gentamicin)
Adults: 1–2 g IV every 4–6 hours for 2–3 weeks
Child > 2 years: 50 mg/kg every 4–6 hours
Child > 2 years: 25 mg/kg every 4–6 hours
C MONOGRAPHS
 Boils, infected skin wounds

Adults: 500 mg PO every 6 hours for 5–10 days
Child: 125‒250 mg every 6 hours for 5–10 days
Contra-indications
Side effects
 Stomach upset
 Allergic reaction (skin rash)
 Liver damage
Interactions
 Take at least 30 minutes before food
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Use cautiously in patients with history of liver disease and
elderly. Avoid giving for durations longer than 2 weeks
COAL TAR H N 13.4

Keratolytic agent that inhibits excessive proliferation of epi-
dermal cells
Dosage forms
 Cutaneous emulsion 5%

COAL TAR C
Uses
 Treatment of psoriasis of skin and scalp
Dose and duration

 Treatment of psoriasis of skin and scalp
Adult and child > 12 years: apply a thin layer of solution

2–3 times per day to the affected areas
Child below 12 years: apply a thin layer of solution to skin or
scalp 2–3 times per day; can be diluted with a few drops of
water before applying
Contra-indications
 Sensitivity to any of the ingredients
 Presence of folliculitis and acne vulgaris
 Disease characterised by photosensitivity
 Inflamed or broken skin
Side effects
 Skin irritation, staining of skin and hair
 Photosensitivity
 Avoid exposure to direct sunlight during treatment
 Use with care near the eyes and mouth area. If any emul-
sion accidentally enters the eye, flush with normal saline

solution or clean water
Pregnancy
 Can be used
Breast-feeding
 Can be used
Storage
 Store in tightly closed containers, protected from light

C MONOGRAPHS
Caution
 If irritation occurs, review treatment and discontinue if
necessary
 Do not apply to genital and rectal areas
CODEINE PHOSPHATE HC IV E 2.3, 17.6.2, 25.2

Opioid analgesic, antitussive and antispasmodic that reduces
intestinal motility
Dosage forms
 Tablet: 30 mg
Uses
 Mild to moderate pain
 Excessive diarrhoea (in adults only)
Dose and duration

 Persistent or chronic diarrhoea (adult only)
Adult and child > 12 years: 30 mg every 6–8 hours

(usual dosage range 15–60 mg daily)
Adult: 30‒60 mg every 6‒12 hours as needed (maxi-

mum 240 mg daily)
Child 1‒12 years: 0.5‒1 mg/kg every 4‒6 hours as
needed
Contra-indications
 Obstructive airway disease
 Acute asthma attack
 Ulcerative colitis or antibiotic-associated colitis

CODEINE PHOSPHATE C
 Paralytic ileus
Side effects
 Constipation especially after long term use
 Nausea and vomiting, dry mouth
 Respiratory depression (with large doses)
Interactions
 Alcohol (increased sedative and hypotensive effect)
 Ritonavir (increased concentration of codeine)
Pregnancy
rd
Breast-feeding
 Can be used
Caution
 Codeine is a controlled drug (narcotic) and should be
handled according to the NDA regulations
 On long term use, always give with bisacodyl to prevent
constipation
 Reduce dose in kidney and liver impairment
 Codeine is a weaker analgesic than morphine; use mor-
phine for severe pain

C MONOGRAPHS
COLCHICINE H V 2.2
Anti-inflammatory alkaloid obtained from dried corns and
seeds of the plant Colchicum autumnale
Dosage forms
 Tablet: 500 micrograms
Uses
 Acute gout
 Short-term prophylaxis during initial therapy with allopu-
rinol and uricosuric drugs

Dose and duration
 Acute gout
Adult: 1 mg initially, then 500 micrograms every 2–3

hours until pain relief is obtained or vomiting or diar-
rhoea occurs (max 6 mg). Do not repeat course within 3
days
 Short-term prophylaxis during initial therapy with allopu-
rinol or uricosuric drugs

Adult: 500 micrograms every 8–12 hours
Contra-indications
 Blood disorders
 Patients on dialysis
 Patients with renal or hepatic impairment taking
P-glycoprotein or a strong CYP3A4 inhibitor

Side effects
 Nausea, vomiting, abdominal pain, profuse diarrhoea,
gastrointestinal haemorrhage
 Skin rash
 Renal and hepatic damage

COLCHICINE C
 Bone marrow suppression on prolonged treatment
 In overdose: burning in mouth and throat, difficulty in
swallowing, nausea, vomiting, abdominal pain, and diar-
rhoea
 Delayed signs of overdose: confusion, reduced cardiac
output, arrhythmias, respiratory distress, hyperpyrexia,

bone marrow suppression, renal and hepatic impairment
Interactions
 Amiodarone, azithromycin, clarithromycin, erythromycin,
itraconazole, atazanavir, indinavir, ritonavir, diltiazem,

verapamil, grapefruit juice (increased risk of colchicine
toxicity)
 Digoxin, fenofibrate, gemfibrozil, simvastatin, atorvas-
tatin, rosuvastatin (possible increased risk of myopathy)

 Ciclosporin (increased risk of nephro- and myotoxicity)
Pregnancy
 Do not use
Breast-feeding
 Can be used
Caution
 Use with caution in hepatic impairment, elderly and de-
bilitated patients due to higher risk of cumulative toxicity
 Reduce dose or increase dosage interval if eGFR is 10–50
ml/minute/1.73 m2
 Colchicine may be teratogenic in humans
 Colchicine has a narrow therapeutic window and is very
toxic in overdose. Symptoms of toxicity may be delayed
for up to 6 hours or 1 week or longer for some features

C MONOGRAPHS
CORTISONE ACETATE RR N 18.1

Adrenal hormone
Dosage forms
 Tablet: 25 mg
Uses
 Addison’s disease
 Primary or secondary adrenal insufficiency
 Congenital adrenal hyperplasia
Dose and duration

 All uses
Adult: 12.5-37.5 mg daily in 2 divided doses

Child: 5–25 mg daily in 2 divided doses
Morning dose should be larger than the evening dose
Contra-indications
 Systemic fungal and viral infections
 Untreated acute bacterial infection
 Hypersensitivity to cortisone acetate
Side effects
Dyspepsia, peptic ulceration and haemorrhage, abdominal
distension, oesophageal candidiasis, acute pancreatitis
 Proximal myopathy, osteoporosis, bone fractures
 Sodium and water retention, hypokalaemic alkalosis
 Impaired healing, skin atrophy, bruising, striae, petechial
haemorrhage
 Suppression of hypothalamo-pituitary axis, growth sup-
pression in children and adolescents

 Menstrual disturbances, hirsutism, cushingoid faces
Interactions
 Carbamazepine, phenobarbital, phenytoin, rifamycins

CORTISONE ACETATE C
(reduced effect of cortisone)
 Amphotericin B (increased risk of hypokalaemia)
 Live vaccines (high doses of cortisone impair immune re-
sponse to vaccines)
Pregnancy
 Do not use
Breast-feeding
 Can be used
Caution
 Use with caution in the elderly due to increased risk of
side effects
 Avoid abrupt withdrawal after prolonged use. Reduce
dose gradually by 5–12.5 mg every few days
 Observe patient for side effects
 May increase susceptibility to infection. Some signs of in-
fection may be masked
 Use with caution in history of TB, severe affective disor-
ders, osteoporosis, diabetes mellitus, hypertension, glau-
coma, peptic ulceration or in epilepsy
 May cause growth retardation in infants, children and
adolescents. Treat for the shortest possible period
 Cortisone needs to be converted to its active metabolite.
Bioavailability in some liver diseases may be less reliable
 Cortisone may cause intra-uterine growth retardation.
Only use when it is clearly necessary

C MONOGRAPHS
COTRIMOXAZOLE HC II V 6.2.2
Antibacterial containing trimethoprim and sulphametho-
xazole
Dosage forms
 Tablets: 400 mg sulphamethoxazole + 80 mg trime-
thoprim
 Tablets: 100 mg sulphamethoxazole + 20 mg trime-
thoprim
 IV infusion: 96 mg/ml
Uses
 Brucellosis
 Typhoid fever
 Ear, nose, and throat infections
 Tropical ulcer
 Acute urinary tract infection
 Prophylaxis against opportunistic bacterial and protozoal
infections in HIV patients

Dose and duration
The infusion must be diluted immediately before use. It
should only be used in patients unable to take oral therapy
 Brucellosis (in combination with gentamicin)
Adult: 480 mg every 12 hours for 6 weeks

 Typhoid fever
Adult: 960 mg every 12 hours for 14 days

 Ear, nose, and throat infection, tropical ulcer

 Acute urinary tract infection

COTRIMOXAZOLE C
Child: 24 mg/kg every 12 hours for 10–14 days
 Patients unable to take oral cotrimoxazole
Adult: by IV infusion, 960 mg every 12 hours increased to

1.44 g every 12 hours in severe infections
Child: by IV infusion, 18 mg/kg every 12 hours increased
to 27 mg/kg every 12 hours in severe infections
 Prophylaxis against opportunistic bacterial infections in
HIV infection
Child: 24 mg/kg once daily
Preparation
 Can be diluted with 5% or 10% dextrose, dextran 70 or
0.9% sodium chloride solution

 5 ml of cotrimoxazole should be added to 125 ml, 10 ml
to 250 ml and 15 ml to 500 ml of infusion solution

Contra-indications
 Allergy to sulphonamides or trimethoprim
 Children <1 month
Side effects
 Allergic reactions, e.g. skin rash
 Candida overgrowth
 Hyperkalaemia
 Headache
 Nausea, diarrhoea, stomach upset

C MONOGRAPHS
Interactions
 Phenytoin (increased side effects)
 Sulfadoxine + pyrimethamine (increased side effects)
 Folic acid (cancelled effect)
 Stop treatment and report to health worker immediately
if any skin rash occurs

Pregnancy
st rd
 Can be used for prophylaxis in HIV patients as benefits
outweigh risks
Breast-feeding
 Can be used
Caution
 Cotrimoxazole is not effective for the treatment of sore
throat and should not be used
 If patient gets severe skin rash or Stevens-Johnson
syndrome, stop medicine immediately
CYCLOPENTOLATE HC IV N 21.8
Mydriatic and cycloplegic drug. Dilates the pupil and
paralyses the ciliary muscle. Duration of action is 24 hours
Dosage forms
 Eye drops: 1%
Uses
 Inflammatory conditions of iris and uveal tract (anterior

CYCLOPENTOLATE C
uveitis)
 Diagnostic fundoscopy (specialist use only)
Dose and duration
 Diagnostic fundoscopy (specialist use only)
Adult: 1 drop of 0.5% solution (1% in deeply pigmented

eyes) repeated after 15 minutes if necessary about 40
minutes before examination
Child 6–16 years: 1 drop of 1% solution into the eye,
repeated after 15 minutes if necessary about 40 minutes
before examination
Child under 6 years: 1–2 drops of 1% solution into the
eye, repeated after 15 minutes if required about 40
minutes before examination
 Uveitis and iritis
Adult and child over 16 years: 1‒2 drops into the eye
every 6 hours as needed
Child 3 months–16 years (specialist use): 1 drop every
6–12 hours in deeply pigmented eyes
Contra-indications
 Glaucoma
 Infants less than 3 months
 Paralytic ileus
 Children with congenital brain disease e.g. epilepsy
Side effects
 Stinging
 Mild irritation
 Raised intraocular pressure, acute angle glaucoma espe-
cially in elderly

C MONOGRAPHS
 Do not drive or operate machinery until vision clears
 Wash hands after use as medicine can be toxic if taken
orally
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Use with caution in young children and elderly as system-
atic side effects can easily occur
CYCLOPHOSPHAMIDE NR V 8.2
Alkylating agent anticancer medicine. It can be used alone or
in combination regimens.
Dosage forms
 Tablet: 50 mg
Uses
 Malignant lymphomas
 Multiple myeloma
 Leukaemias
 Mycosis fungiodes
 Neuroblastoma
 Ovarian adenocarcinoma
 Retinoblastoma
 Breast cancer

CYCLOPHOSPHAMIDE C
Dose and duration
Dose must be individualised depending on the therapeutic
indication, the scheme of a combination therapy, the pa-
tient's general state of health and organ function, and the
results of laboratory monitoring (in particular, blood cell
monitoring)
Usual dosage regimens are:

80‒300 mg/m2 daily as a single IV dose or in divided doses
OR 300-600 mg/m2 as a single IV dose weekly
In combination therapy with cytotoxics of similar toxicity,

reduce dose or increase dosing interval
Give IV infusion very slowly to reduce administration rate-

dependent side effects (e.g. swelling, headache)
Contra-indications
 Hypersensitivity to cyclophosphamide
 Acute infections
 Bone marrow aplasia
 Urinary tract infection
 Acute urothelial toxicity from cytotoxic agents or radia-
tion
Side effects
 Haematuria (blood in urine)
 Haemorrhagic cystitis (bladder damage)
 Immunosuppression, infections
 Anaphylaxis

C MONOGRAPHS
 Liver damage
 Alopecia (hair loss)
 Impairment of spermatogenesis
 Fever
 Asthenia
 Mucosal inflammation
Interactions
 Suxamethonium (increased effects of suxamethonium)
 Take plenty of fluids during treatment to reduce the risk
of urinary tract side effects

 Report immediately any rash or allergic reactions
Pregnancy
 Do not use
Breast-feeding
Storage
Caution
 Monitor complete blood count before, during and after
treatment
 Adequate hydration before, during and after treatment is
necessary to minimise risk of urinary tract toxicity
 Treat any infections appropriately

CYCLOSERINE C
CYCLOSERINE H E 6.2.4
Broad spectrum amino-acid antibiotic active against Myco-
bacterium tuberculosis. It is both bacteriostatic and bacteri-
cidal depending on the concentration at site of action
Dosage forms
 Capsule: 250 mg
Uses
Dose and duration

Blood-cycloserine concentration should not exceed a peak of
30 mg/litre (measured 3–4 hours after dose)
 MDR-TB (second-line; in combination with other medi-
cines)
Adult and child over 12 years: initially 250 mg every 12
hours for 14 days, increased according to blood concen-
tration and response up to max 500 mg every 12 hours
Child 2–12 years: initially 5 mg/kg(max 250 mg) every 12
hours for 14 days, adjusted according to response and
blood concentration up to max 10 mg/kg (max 500 mg)
every 12 hours
Renal impairment: If creatinine clearance <50 ml/minute,
increase dosing interval and monitor blood-cycloserine
concentration
Contra-indications
 Epilepsy
 Depression
 Severe anxiety
 Psychotic states
 Alcohol dependence

C MONOGRAPHS
Side effects
 Headache, dizziness, vertigo, drowsiness, tremor
 Convulsions, confusion, psychosis, depression
 Rashes, allergic dermatitis
Interactions
 Alcohol (increased risk of convulsions)
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Monitor renal, hepatic and haematological function
 Cycloserine crosses the placenta, only use in pregnancy if
benefit outweighs risk
 Reduce dose or discontinue if symptoms of CNS toxicity
or allergic dermatitis develop
CYTARABINE NR V 8.2
Antimetabolite anticancer
Dosage forms
Uses
 Induction of remission in acute myeloid leukaemia
 Acute leukaemias
Dose and duration

Can be given by IV infusion or injection, or SC injection
 Remission induction
a) Continuous treatment:
CYTARABINE C
i) Rapid injection: starting dose 2 mg/kg/day. Administer for
10 days. Obtain daily blood counts. If no antileukaemic ef-
fect or toxicity noted, increase to 4 mg/kg/day and maintain
until therapeutic response or toxicity is evident.
ii) 0.5‒1.0 mg/kg/day may be given in an infusion of up to 24

hours duration. After 10 days this initial daily dose may be
increased to 2 mg/kg/day subject to toxicity. Continue to tox-
icity or until remission occurs.
b) Intermittent treatment:
3‒5 mg/kg/day are administered IV on each of 5 consecutive
days. After a 2‒90 day rest period, a further course is given.
Continue until response or toxicity occurs.
Improvement usually occurs between 7‒64 days after the

beginning of therapy (mean 28 days).
Patients seem to tolerate higher doses when given by rapid

IV injection as compared with slow infusion due to the rapid
metabolism of cytarabine.
 Maintenance therapy
Remissions induced by cytarabine, or by other drugs, may be

maintained by IV or SC injection of 1 mg/kg once or twice
weekly.
Contra-indications
 Hypersensitivity to cytarabine
Side effects

C MONOGRAPHS
 Mucositis (mouth and anal)

 Fever
 Rash
 Liver damage
 CNS toxicity in high doses
Interactions
 Live vaccines (risk of developing infection by vaccine)
 Clozapine (risk of agranulocytosis)
Pregnancy
 Do not use
Breast-feeding
Storage
 Do not refrigerate
Caution
 Careful haematologic monitoring is required
 Reduce doses in liver impairment
medicine before administration

DACARBAZINE D
D
DACARBAZINE NR V 8.2
Alkylating anticancer
Dosage forms
Uses
 Hodgkin’s disease (as part of a combination regimen)
 Metastatic melanoma
 Soft tissue sarcomas (as part of a combination regimen)
Dose and duration

 Malignant melanoma
As a single agent, 200‒250 mg/m2 by IV injection for 5

days every 3 weeks
Can be given as IV infusion over 15‒30 minutes
OR 850 mg/m2 on day 1 then once every 3 weeks
 Hodgkin’s disease (in combination with doxorubicin, ble-
omycin, vinblastine)
375 mg/m2 daily by IV injection every 15 days
 Adult soft tissue sarcoma (in combination with

doxorubicin)
250 mg/m2 daily by IV injection for 5 days every 3
weeks
Contra-indications
 Hypersensitivity to dacarbazine
 Leucopoenia
 Thrombocytopenia

D MONOGRAPHS
 Kaposi Sarcoma
 Mesothelioma
Side effects
 Severe nausea and vomiting
 Myelosuppression (anaemia, leucopoenia, thrombocyto-
penia)
 Extravasation at injection site
 Liver necrosis due to hepatic vein thrombosis (rare but
can be fatal)
Interactions
 Take contraception during treatment and 6 months after
cessation of therapy
 Avoid taking alcohol while on treatment
Pregnancy
 Do not use
Breast-feeding
Storage
 Keep away from light. Protect reconstituted solution
from light during administration

Caution
 Monitor full blood counts and renal function frequently
product

DACTINOMYCIN (ACTINOMYCIN D) D
DACTINOMYCIN (ACTINOMYCIN D) NR V 8.2
Anthracycline antibiotic anticancer usually used for paediatric
cancers
Dosage forms
 Powder for injection: 500 micrograms
Uses
 Gestational trophoblastic neoplasia
 Ewing sarcoma
 Wilms’ tumour
 Rhabdomyosarcoma
 Testicular carcinoma
Dose and duration

Dose and duration will vary on tolerance of patient, size and
location of neoplasm and use of other forms of therapy. Dos-
es may be reduced in case of concurrent or previous radia-
tion and chemotherapy
 Wilms’ tumour
45 micrograms/kg by IV as per schedule by specialist

 Rhabdomyosarcoma
15 micrograms/kg by IV daily for 5 days

 Ewing’s sarcoma
1.25 mg/m2 by IV as per schedule by specialist

 Testicular carcinoma
1 mg/m2 by IV as per schedule by specialist

 Gestational trophoblastic neoplasia
12 micrograms/kg by IV daily for 5 days as a single

agent; OR 500 micrograms on days 1 and 2 in combi-
nation therapy

D MONOGRAPHS
As per patient’s treatment schedule by specialist
Contra-indications
 Hypersensitivity to dactinomycin
Side effects
 Gastrointestinal disturbances
 Liver toxicity
 Anaemia, agranulocytosis, leucopoenia, thrombocytope-
nia, neutropoenia,
 Hypersensitivity reactions
 Muscle pain
Interactions
 Radiation/X-ray (increased risk of adverse effects)
 Live vaccine (risk of systemic disease)
Pregnancy
 Do not use
Breast-feeding
Caution
 Monitor full blood count, liver and renal function fre-
quently
 Irritant to skin. Avoid contact with skin

DARROW'S SOLUTION D
DARROW'S SOLUTION HC III V 26.2
Darrow's solution is a parenteral electrolyte replacement
fluid containing potassium chloride, sodium chloride and
sodium lactate
Dosage forms
 Solution for IV infusion: ½ strength in 5% glucose
Uses
 Fluid replacement in severe dehydration
Dose and duration

 Severe dehydration (alternate with 0.9% sodium chloride)
100 ml/kg IV infusion over 4 hours

Reassess rehydration status and continue with Plan A,
B, or C as necessary (see under Oral Rehydration Salts)
Side effects
 Water overload
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Preferably use Ringer's Lactate if available
DAPSONE HC III V 6.2.3

Anti-leprotic antibacterial
Dosage forms

D MONOGRAPHS
Uses
 Paucibacillary (PB) leprosy
 Multibacillary (MB) leprosy
 Primary prophylaxis of pneumocystis carinii pneumonia
(alternative to cotrimoxazole in hypersensitivity in HIV

patients)
Dose and duration
 Paucibacillary leprosy (in combination with rifampicin)
Adult and child >15 years: 100 mg once daily for 6

months
Child 10–14 years: 50 mg once daily for 6 months
Child under 10 years: 2 mg/kg once daily for 6 months
 Multibacillary leprosy (in combination with rifampicin and
clofazimine)
Adult and child >15 years: 100 mg once daily for 12
months
Child 10–14 years: 50 mg once daily for 12 months
Child under 10 years: 2 mg/kg once daily for 12 months
 Primary prophylaxis of pneumocystis carinii pneumonia
(alternative in cotrimoxazole hypersensitivity)

Adult and child over 12 years: 100 mg by mouth once
daily
Contra-indications
 Allergy to dapsone
 Severe anaemia
Side effects
 Blood disorders
 Haemolysis
 Allergic skin rash

DAUNORUBICIN D
 Stomach upset
 Palpitations
 Headache
 Nervousness
 Treatment lasts for 6 months. It is important to complete
the schedule to ensure complete healing

 Stop the medicine and report to health worker immedi-
ately if any severe skin rash, bruising, yellowing of eyes,

or fever occur
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 If the diagnosis is not clear between PB leprosy and MB
leprosy, then the regimen for MB leprosy should be used
 See clofazimine for more cautions
 Stop the medicine in case of severe allergic reaction
DAUNORUBICIN NR V 8.2
Anthracycline. Cytotoxic antibiotic anticancer
Dosage forms
Uses
Dose and duration


D MONOGRAPHS
40‒60 mg/m2 by IV injection

Schedule according to specialist guidelines
Reduce dose by up to 50% in patients with inadequate
bone marrow reserves
Note: do not use IM route
Contra-indications
 Recent or current chicken pox or herpes zoster
 Severe infection
 Severe renal or hepatic impairment
 Myocardial insufficiency
 Recent myocardial infarction
 Severe arrhythmias
Side effects
 Myelosuppression (leucopoenia, neutropoenia, thrombo-
cytopenia)
 Cardiomyopathy (dyspnoea, cyanosis, oedema), shock
 Haemorrhage, stomatitis, mucositis
 Tissue hypoxia
 Alopecia
 Amenorrhoea
Interactions
 Radiation (increased risk of local reactions in radiation
area)
 Live vaccines (risk of developing full-blown disease)

D
MESILATE)
Pregnancy
 Do not use
Breast-feeding
Storage
 After reconstitution, store at 2‒8°C; use within 24 hours
Caution
 Monitor full blood count, liver and renal function fre-
quently. Allow patient to recover from acute toxicities
between doses (2‒3 weeks)
 Men and women have to use effective contraception
during and after treatment with docetaxel
 Irritant to skin. Avoid direct contact
DESFERRIOXAMINE MESILATE (DESFEROX-

NR N 4.2
AMINE MESILATE)
Iron and aluminium chelating antidote for iron poisoning and
chronic iron overload, and aluminium overload
Dosage forms
Uses
 Iron poisoning
 Chronic iron overload
 Diagnosis of iron storage disease and certain anaemias
 Aluminium overload

D MONOGRAPHS
Dose and duration

Give as a slow subcutaneous infusion
Only use intramuscular route when SC infusion is not feasible
 Iron poisoning
Adult and child: By continuous IV infusion, up to 15

mg/kg/hour, reduced after 4–6 hours (max 80 mg/kg in
24 hours)
By IM injection, 2 g for an adult and 1 g for a child as a
single dose
 Chronic iron overload
Adult and child: 20–60 mg/kg/day in 2–3 divided doses

by intermittent infusion or by continuous infusion over 24
hours, 3–7 times a week according to degree of iron over-
load. If serum ferritin <2000 nanogram/ml give about 25
mg/kg/day and 2000–3000 nanogram/ml about 35
mg/kg/day. Higher doses are only used if benefit to
patient outweighs the risk of unwanted effects.
Doses higher than 50 mg/kg/day should only be used
when needed in a patient who has completed growth
Maximum dose in children below 3 years 40 mg/kg/day
 Diagnosis of iron storage disease and some anaemias
Adult and child: 500 mg as an IM injection

 Aluminium overload (>150 nanogram/ml)
Adult and child: 100 mg bind 4.1 mg of aluminium ions

Preparation
 Dissolve powder in water for injections to a 10% solution
(1 ml of water for injections to 100 mg of powder or dis-

solve 500 mg of powder in 5 ml of water for injections).
This solution can then be employed in infusion solutions
such as normal saline, dextrose or dextrose-saline
D
MESILATE)
Side effects
 Headache
 Joint pain, muscle pain
 Growth retardation and bone changes with doses
> 60 mg/kg
 Infiltration and eschar or crust
 Injection or infusion site reactions
 Cataracts
Interactions
 Heparin (pharmaceutically incompatible with desferriox-
amine solution; do not mix together)

Pregnancy
 Do not use
Breast-feeding
 Do not use
Storage
 Once open, use immediately. Do not keep solutions
Caution
 Do not mix with blood or use the same IV line for admin-
istration
 Monitor ferritin levels. Reduce dose when ferritin level
falls below 1000 nanogram/ml due to increased risk of

toxicity
 Do eye and ear examinations before treatment and there
after every 3 months during treatment

 Monitor body weight and height in children at 3 month
intervals due to risk of growth retardation

 May exacerbate aluminium related encephalopathy when
used alone
D MONOGRAPHS
 Use with caution in renal impairment

 In breast feeding, only use if benefit outweighs risk
 Only use clear solutions. Discard opaque, cloudy or dis-
coloured solutions
DESFLURANE NR E 1.1
Rapid-acting volatile liquid inhalation general anaesthetic
Dosage forms
 Liquid for inhalation: 100%
Uses
 Induction of anaesthesia
 Maintenance of anaesthesia
Dose and duration

Individualise dose according to patient’s response. Give by
inhalation through a specifically calibrated vaporiser
Adult: start with 3% and increase in 0.5–1% increments

every 2–3 breaths. 4–11% concentrations usually produce
surgical anaesthesia in 2–4 minutes (max up to 15% with
oxygen at least 30% and above)
Adult: 2–6% in nitrous oxide and 2.5–8.5% in oxygen or

oxygen enriched air
Child: 5.2–10% with or without concomitant use of
nitrous oxide
Contra-indications
 All contraindications to general anaesthesia
 Known sensitivity to halogenated agents
 Known genetic susceptibility to malignant hyperthermia

DESFLURANE D
 Patients at risk of coronary artery disease
 Induction if increase in heart rate and BP is undesirable
Side effects
 Pharyngitis, breath holding
 Headache
 Conjunctivitis
 Nodal arrhythmia, bradycardia, tachycardia, hypertension
 Apnoea, cough, laryngospasm- only during induction
 Vomiting, nausea, salivary hypersecretion
 Increased creatinine phosphokinase
 Abnormal ECG
Interactions
 Doxapram, adrenaline, noradrenaline, (increased risk of
arrhythmias)
 Methylphenidate (increased risk of hypertension)
Pregnancy
 Do not use
Breast-feeding
 Can be used
Storage
 Store in an upright position with cap firmly in place
Caution
 May cause depression of neonatal respiration if used
during delivery. It is a uterine relaxant and reduces
uterine-placental blood flow
 Resume breast-feeding after sufficient recovery from an-
aesthesia
 Use with caution in cases of raised intracranial pressure

D MONOGRAPHS
 May cause hepatotoxicity in patients sensitised to halo-

genated general anaesthetics
 Monitor blood pressure and heart rate carefully during
maintenance
DEXAMETHASONE HC IV E 18.1, 21.2, 21.3

Long-acting synthetic corticosteroid hormone. Anti-
inflammatory medicine
Dosage forms
 Tablet: 0.5 mg, 4 mg
 Powder for injection: 4 mg/ml
 Eye drops: 0.1%
 Eye drops: dexamethasone 0.1% + neomycin 0.35%
 Eye drops: dexamethasone 0.1% + tobramycin 0.3%
Uses
 Suppress allergic and inflammatory disorders
 Obstructed breathing in croup
 Inflammation
 Anaphylaxis
 Adjunct in cancer treatment (specialist use only)
 Foetal lung maturation in preterm labour
Dose and duration

 Allergy
Adult: 0.5‒10 mg by mouth once daily in the morning

Child: 10‒100 micrograms once daily in the morning
 Allergy/inflammation in eye/ear
Adult and child: Apply eye drops every 30‒60 minutes

until symptoms reduce, then reduce frequency to
every 8 hours. If signs of infection are present, give
DEXAMETHASONE D
formulation with antibiotic
 Croup
Child: 150‒300 micrograms/kg IM every 6 hours as
needed
 Anaphylaxis
Adult: 0.5‒24 mg by slow IV injection or infusion

Child: 200‒400 micrograms by slow IV injection or in-
fusion
 Foetal lung maturation in preterm labour
Give 6 mg IM to mother every 6 hours for a total of 4

doses. Do not use if there are signs of infection
Contra-indications
 Untreated systemic infection
 Ocular fungal, herpes simplex and other viral, ocular tu-
berculosis or untreated purulent eye infection

Side effects
 Nausea, dyspepsia
 Irritation at injection site
 Inhibition of growth in children ( on long term use)
 Cushing syndrome (on long term use)
 Stinging, burning, redness, watering of eyes and
increased intraocular pressure (longer than 2 weeks

treatment) in ocular application
Interactions
 Live vaccines (no effect of vaccines due to impaired
immune response)
 Insulin (reduced effect of insulin)

D MONOGRAPHS
 Carbamazepine, rifampicin, phenytoin, phenobarbital

(reduced effect of dexamethasone)
 Lopinavir (reduced concentration of lopinavir)
 Methotrexate (increased risk of blood disorders)
 Take in the morning
 Do not use this medication for more than 1 week unless
you have consulted your ophthalmologist

 Do not wear contact lenses during the treatment period
 In case of transient blurring of vision, do not operate
hazardous machinery or drive until vision is clear

 Discard the remaining drops 28 days after first opening
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Can exacerbate infections e.g. tuberculosis
 Use with caution in diabetes mellitus. Can cause hyper-
glycaemia and reduce the effect of insulin
 Use with caution in severe liver disease, can exacerbate
oedema and ascites
 Avoid giving for longer than necessary durations
 Use with caution in patients with glaucoma or a family
history of glaucoma
 Do not use for longer than 1 week unless under ophthal-
mic supervision; prolonged use may lead to a rise in
intraocular pressure and secondary ocular infections

DEXAMETHASONE + TOBRAMYCIN D
DEXAMETHASONE + TOBRAMYCIN RR E 21.2
Anti-inflammatory and anti-infective medicine
Dosage forms
 Eye drops: Dexamethasone 0.10% + Tobramycin 0.3%
Uses
 Treatment of inflammation and prevention of infection
associated with cataract surgery

Dose and duration
 Treatment of inflammation and prevention of infection
associated with cataract surgery

Adult and child ≥ 2 years: instil 1 drop in the eyes every
4–6 hours while patient is awake for 14 days (max 24
days). Dosage may be increased to 1 drop every 2 hours
while patient is awake during the first 24–48 hours.
Decrease dosing frequency gradually with improvement
Contra-indications
 Herpes simplex keratitis and other viral eye diseases
 Fungal disease of the eye
 Mycobacterial infections of the eye
 Untreated purulent infections
 Hypersensitivity to dexamethasone or tobramycin
Side effects
 See monograph for dexamethasone and tobramycin
Interactions
 Do not use this medication for more than 1 week unless
you have consulted your ophthalmologist

D MONOGRAPHS
 Do not wear contact lenses during the treatment period

 In case of transient blurring of vision, do not operate haz-
ardous machinery or drive until vision is clear
 Keep bottle tightly closed. Do not let the dropper tip
touch any surface to minimise risk of infection
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
DEXTRAN 70 HC IV E 11.1
Plasma expander solution. Expands and maintains blood vol-
ume in shock arising from conditions such as septicaemia and
burns
Dosage forms
 Solution for infusion: 6%
Uses
 Short-term blood volume expansion
Dose and duration

 Short term blood volume expansion
Adult: 500‒1000 ml initially by rapid intravenous infu-

sion, followed by a further 500 ml if necessary. Total
dose should not exceed 20 ml/kg during the initial 24
hours. If needed, give 10 ml/kg daily for another 2
days. Do not use for longer than 3 days.
Child: 20 ml/kg maximum
DEXTROSE (GLUCOSE) D
Contra-indications
 Severe congestive heart failure
 Kidney failure
 Bleeding disorders e.g. thrombocytopenia
Side effects
 Fever
 Nasal congestion
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Can interfere with blood group cross matching and bio-
chemical tests (take samples before start of infusion)
 Do not use in conditions such as burns or peritonitis
when there is loss of plasma protein, water and electro-
lytes over periods of several days. Use plasma or albumin
solutions instead
DEXTROSE (GLUCOSE) HC III V 26.2

See glucose
DIAZEPAM HC II V 1.3, 5, 24
Benzodiazepine with anticonvulsant, sedative, antiepileptic,
muscle relaxant, and anxiolytic properties
Dosage forms
 Rectal tube: 2 mg/ml

D MONOGRAPHS
 Suppository: 2.5 mg
 Tablet: 5 mg
Uses
 Spasms in tetanus
 Febrile convulsions due to severe malaria, respiratory
tract infections, and urinary tract infections

 Status epilepticus
 Convulsions due to poisoning
 Anxiety
 Convulsions due to eclampsia in pregnant women
 Adjunct therapy in acute alcohol withdrawal syndrome
Dose and duration

 Control spasms in tetanus (alternating with chlorproma-
zine)
Adult: 2–3 mg/kg by NG tube every 4–6 hours
Child: 0.5–1 mg/kg by NG tube every 4–6 hours
Continue for as long as spasms last
 Febrile convulsions, status epilepticus, convulsions due to
poisoning
Adult and child > 12 years: 10‒20 mg rectally
Child 2‒12 years: 5‒10 mg rectally
Child 1 month‒2 years: 5 mg rectally
Child < 1 month: 1.25‒2.5 mg rectally
Repeat after 10 minutes if necessary
OR
Adult and child > 12 years: 10 mg by slow IV injection
(1 ml per minute)
Child < 12 years: 300‒400 micrograms/kg
(max 10 mg)
DIAZEPAM D
Repeat after 10 minutes if necessary
 Acute alcohol withdrawal
Adult: 5–20 mg repeated every 2–4 hours if necessary
 Anxiety
Adult: 5 mg 1–2 times daily; increase if necessary to

15–30 mg daily in divided doses
 Eclampsia in pregnancy
Give 10 mg by IV slowly (over 2 minutes)

Contra-indications
 Severe respiratory depression
 Acute alcohol intoxication
 Coma
 Shock
 Depression
 Obsessive psychoses
 Chronic anxiety
 Post-traumatic stress syndrome
Side effects
 Drowsiness, sedation, sleep disturbance
 Amnesia (temporary loss of memory), confusion,
excitability, irritability, hallucinations

 Hypotension, slow heartbeat
 Dependence
Interactions
 Alcohol (increased sedative effect)
 Morphine (increased sedative effect)
 Chlorpromazine (increased sedative effect)
 Chlorpheniramine (increased sedative effect)

D MONOGRAPHS
 Promethazine (increased sedative effect)

 Phenobarbital (increased sedative effect)
 Do not take alcohol while on treatment
 May cause drowsiness; do not drive or operate
machinery
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Alternative to magnesium sulphate in eclampsia
 Diazepam is addictive; avoid prolonged use (no more
than 7 days) and give the lowest possible dose for the
shortest period. Dependence and tolerance occur when
used for more than 10–15 days.
 Do not stop treatment abruptly to minimise withdrawal
effect
 Reduce dose by half in elderly and in patients with severe
kidney and liver disease
 In pregnancy, only use if benefit outweighs risk
DICLOFENAC HC IV V 2.1
Analgesic and non-steroidal anti-inflammatory medicine
Dosage forms
 Tablet: 50 mg
 Suppository: 12.5 mg, 50 mg, 100 mg

DICLOFENAC D
Gel: 1%
Uses
 Moderate to severe pain of inflammation in rheumatic
disease and other musculoskeletal disorders

 Acute gout
 Post-operative pain
 Migraine
 Local symptomatic relief of pain
Dose and duration

 Pain and inflammation
Adult: 75‒100 mg daily in 2‒3 divided doses

(max 150 mg daily)
Child: 0.3‒2 mg/kg rectally every 6‒8 hours (max. 150
mg daily)
Continue for as long as pain is there but avoid using for
long periods
 Local symptomatic relief of pain
Adult and child: apply a thin layer of gel 3–4 times daily
for 14 days (28 days in osteoarthritis)
Contra-indications
 Previous or current peptic ulcer disease
 Previous or active gastrointestinal bleeding
 Asthma
 Previous or current cerebrovascular bleeding
 Operations with high risk of haemorrhage
 Kidney disease
 Hypovolemia and dehydration

D MONOGRAPHS
Side effects
 Stomach upset, dyspepsia
 Hypersensitivity reactions (anaphylaxis, bronchospasm,
rash)
 Suppositories may cause rectal irritation
Interactions
 Other NSAIDS (increased risk of side effects)
 Anticoagulants e.g. warfarin, heparins (increased risk of
haemorrhage)
 Quinolones e.g. ciprofloxacin (possible increased risk of
convulsions)
 Take with or after food to reduce stomach irritation
Pregnancy
 Do not use
Breast-feeding
 Can be used
Caution
 Avoid using for extended periods to prevent risk of de-
veloping gastrointestinal disease
 Use lowest effective dose in elderly as they are at more
risk for side effects
DIETHYLCARBAMAZINE H N 6.1.2
Antifilarial medicine
Dosage forms
 Tablet: 50 mg

DIETHYLCARBAMAZINE D
Uses
 Systemic lymphatic filariasis and occult filariasis
 Loiasis
 Tissue nematode infections, in particular, visceral larva
migrans
Dose and duration
To be taken after meals
 Lymphatic filariasis(bancroftian)
Adult and child over 10 years: 1 mg/kg twice daily on

the first day and increased gradually over 3 days to 3
mg/kg every 12 hours (max 9 mg/kg daily in divided
doses) for 12 days
Child under 10 years: 0.5 mg/kg twice daily on the first
day and increased gradually over 3 days to 1.5 mg/kg 2
times a day for 12 days
 Lymphatic filariasis (brugian)
Adult and child over 10 years: 1 mg/kg as a single dose

on the first day, increased gradually over 3 days to 3–6
mg/kg daily, preferably in divided doses after meals, for
6–12 days
Child under 10 years: half the adult dose
For mass treatment control programmes,
Adult and child over 10 years: 3–6 mg/kg in divided dos-
es over 24 hours, 6 times at weekly or monthly intervals
Child under 10 years: half the adult dose
 Occult filariasis
Adult: 8 mg/kg once daily for 14 days, repeated as

necessary if symptoms return
 Loiasis
Adult: 1 mg/kg as a single dose on the first day, doubled

D MONOGRAPHS
on 2 successive days, then adjusted to 2–3 mg/kg 3 times

daily for a further 18 days
 Loiasis prophylaxis
Adult: 300 mg weekly for as long as exposure occurs

Contra-indications
 Pregnancy
 Co-infection with onchocerciasis
Side effects
 Immunological reactions within a few hours of the first
dose, resembling Mazzotti reaction (fever, headache,

joint pain, dizziness, anorexia, malaise, transient haema-
turia, urticaria, vomiting, and asthma in asthmatics)
 Nodules formed by recently killed worms
 Transient lymphangitis
 Exacerbation of lymphoedema
 Take your medication after food
 Complete the prescribed course as directed to minimise
reactions of dying parasites

Pregnancy
Breast-feeding
 Can be used
Caution
 Reduce dose in moderate to severe renal impairment
 Delay treatment in pregnancy until delivery

DIGOXIN D
 In case of other severe acute disease, delay diethylcar-
bamazine treatment until after recovery
 Use with caution in cardiac disorders
DIGOXIN HC IV E 12.4.1
Cardiac glycoside that increases the force of contraction of
the heart muscle and reduces conductivity within the atrio-
ventricular (AV) node. It has a slow onset of action and re-
sponse may take hours to show so it is not suitable for rapid
control of heart rate.
Dosage forms
 Tablet: 62.5 µg; 250 µg
 Injection: 250 µg/ml
Uses
 Heart failure
 Supraventricular arrhythmias: atrial fibrillation and flutter
Dose and duration

 Atrial fibrillation or flutter
Adult: For rapid digitalisation; 0.75‒1.5 mg orally in di-

vided doses over 24 hours
Child: 0.3‒2 mg/kg rectally every 6‒8 hours (max. 150
mg daily)
Maintenance dose: 125‒250 micrograms daily
 Heart failure
In urgent situations
Adult: By IV infusion, loading dose 250 micrograms
IV over at least 2 hours; give 3-4 times in the first 24 hours
Maintenance dose: 250 micrograms daily orally
Child: 10 micrograms/kg per dose as above
D MONOGRAPHS
In non-urgent situations
Adult: loading dose, 0.5-1 mg orally daily in 2-3 divided
doses for 2-3 days. Maintenance dose: 250 micrograms
orally daily
Elderly patients: 125 micrograms daily
Child: loading dose, 15 micrograms/kg orally 3-4 times dai-
ly for 2-4 days. Maintenance dose: 15 micrograms/kg daily
for 5 days
Contra-indications
 Hypertrophic obstructive cardiomyopathy
 Supraventricular arrhythmias due to accessory conduct-
ing pathways e.g. Wolff-Parkinson-White syndrome

 Ventricular tachycardia or fibrillation
 Intermittent complete heart block
 Second degree atrioventricular block
Side effects
 Stomach upset
 Irregular heartbeat, heart block
 Dizziness, headache, fatigue
Interactions
 Drugs that cause hypokalaemia e.g. acetazolamide. am-
photericin B, furosemide, hydrochlorothiazide

 Nifedipine (increased concentration of digoxin)
 Quinine (increased concentration of digoxin)
 Spironolactone (increased concentration of digoxin)
 Verapamil (increased concentration of digoxin)
 Eat foods rich in potassium e.g. bananas to prevent risk of

DIHYDROARTEMISININ + PIPERAQUINE D
side effects
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Ensure patient has not been taking digoxin in the past 14
days before digitalizing because of risk of toxicity due to
accumulation in the tissues; if they have been on digoxin,
reduce the doses recommended above
 Adjust maintenance dose based on kidney function
 Use with caution in elderly since they are more prone to
side effects
 Avoid rapid IV administration to prevent nausea and in-
creased risk of arrhythmias
 Digoxin has a long half life and maintenance doses need
to be given only once daily (although higher doses may
be divided to prevent nausea)
 Hypokalaemia increases the risk of digoxin toxicity; pa-
tient may need potassium-sparing diuretic or potassium
supplements
 If toxicity occurs, withdraw digoxin immediately and refer
for urgent specialist treatment
DIHYDROARTEMISININ + PIPERAQUINE HC IV N 6.4.3

Artemisinin-combination antimalarial medicine
Dosage forms
 Tablet: dihydroartemisinin 40 mg + piperaquine 320 mg

D MONOGRAPHS
Uses
 Uncomplicated malaria (second line treatment)
Dose and duration

Adult and child over 6 months: Dose of 40/320 mg tab-

lets as in table below:
Weight Day 1 Day 2 Day 3
(kg)
7-13 0.5 0.5 0.5
13-24 1 1 1
24-36 2 2 2
36-75 3 3 3
75-100 4 4 4
Contra-indications
 Allergy to either artemisinin or piperaquine
 History of or current arrhythmias
 Heart disease predisposing for arrhythmias
 Hypokalaemia, hypocalcaemia, hypomagnesaemia
 Children < 5 kg or 4 months
Side effects
 Stomach upset
 Irregular heart beat (fast heart beat)
 Anaemia
 Headache
 Cough
 Fever
Interactions
Increased risk of irregular heart beat/arrhythmias with:
 Antiarrhythmia drugs
 Macrolide antibacterial e.g. erythromycin, azithromycin
 Fluoroquinolones e.g. ciprofloxacin

DIMERCAPROL D
 Imidazole and triazole antifungals
 Chlorpromazine, haloperidol
 Lumefantrine
 Quinine
 Chloroquine
 Saquinavir
 Preferably take at least 3 hours before food and wait for
3 hours to take food thereafter

 Take with plenty of fluids
Pregnancy
 Do not use
Breast-feeding
 Can be used
Caution
 Do not give more than 2 courses within 12 months.
 Do not give second course within 2 months of first course
DIMERCAPROL NR N 4.2
Antidote for heavy metal poisoning
Dosage forms
 Injection in oil: 50 mg/ml
Uses
 Acute poisoning by antimony, arsenic, bismuth, gold,
mercury, possibly thallium

 Adjunct in lead poisoning
Dose and duration

 Acute poisoning and adjunct in lead poisoning

D MONOGRAPHS
(in combination with sodium calcium edetate)

Adult and child: by IM injection, 2.5–3 mg/kg every 4
hours for the first 2 days, then 3 mg/kg every 6–12 hours
on the 3rd day and 3 mg/kg every 12–24 hours for 10 days
or until the patient recovers
Contra-indications
 Iron, selenium and cadmium poisoning
 Severe hepatic impairment unless it is due to arsenic poi-
soning
 Hypersensitivity to dimercaprol
Side effects
 Hypertension, tachycardia
 Malaise, headache
 Nausea, vomiting, abdominal pain, salivation
 Lacrimation, sweating
 Burning sensation in the mouth, throat and eyes, feeling
of constriction in the throat and chest

 Muscle spasm, tingling in extremities
 Pyrexia in children
 Local pain and abscess at injection site
Interactions
 Ferrous salts (formation of toxic complexes with dimer-
caprol-avoid concomitant use)

Pregnancy
Breast-feeding
 Can be used

DITHRANOL D
Caution
 Use with caution in hypertension, pregnancy, breast-
feeding, in the elderly and in impaired renal function
 Discontinue use or use with extreme caution if renal
impairment develops during treatment with dimercaprol
 Assess any abnormal reaction such as pyrexia occurring
after initiation of treatment to rule out renal impairment
DITHRANOL H N 13.4
Keratolytic agent. Slows epidermal cell division and inhibits
excessive proliferation and keratinisation of epidermal cells
Dosage forms
 Ointment 0.10%
Uses
 Treatment of localised psoriasis vulgaris
Dose and duration

 Treatment of localised psoriasis vulgaris
Adults and children: Apply a thin layer of ointment once

daily to the affected areas for 2–4 weeks. Leave ointment
in place for 10–20 minutes before rinsing it off thorough-
ly. Gradually increase the strength from 0.1% to 2% and
contact time to 60 minutes at weekly intervals. Some
0.1–0.5% preparations are suitable for overnight use
Contraindication
 Acute eruptions
 Excessively inflamed skin
 Acute and pustular psoriasis

D MONOGRAPHS
Side effects
 Skin irritation
 Temporary staining of skin or hair
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Avoid normal skin during application
 Avoid contact with eyes due to risk of conjunctivitis
 Wear protective gloves or wash hands thoroughly with
soap and water after use
DOBUTAMINE NR V 12.4.2
Sympathomimetic cardiac stimulant which binds to β1 recep-
tors in cardiac muscle and increases contractility with little
effect on heart rate
Dosage forms
 Concentrate for IV infusion: 12.5 mg/ml
Uses
 Septic shock
 Cardiomyopathies
 Inotropic support in infarction
 Cardiac surgery
 Cardiac stress testing (see product literature)
Dose and duration

Given as a continuous IV infusion
DOBUTAMINE D
 All uses
Adult: 0.0025–0.01 mg/kg/minute adjusted according to
response (max 0.04 mg/kg/minute)
Neonate and child 1 month–18 years: initially 0.005
mg/kg/minute adjusted according to response to
0.002– 0.02 mg/kg/minute
Preparation
 Dilute to 0.5–1 mg/ml (max 5 mg/ml in fluid restriction
given with an infusion pump) with glucose 5% or sodium

chloride 0.9% (normal saline). Incompatible with
bicarbonate and strong alkaline solutions
 Higher concentrations given by central venous catheter
 For use in neonatal intensive care, dilute 30 mg/kg to a
final volume of 50 ml (infused at 0.5 ml/hour gives 0.005

mg/kg/minute)
Contra-indications
 Pheochromocytoma
 Previous hypersensitivity to dobutamine
Side effects
 Eosinophilia, inhibition of thrombocyte aggregation when
used over a number of days

 Headache, fever, exanthema
 Increase in heart rate and blood pressure, hypotension
 Arrhythmias, palpitations, vasoconstriction in previous
treatment with beta receptor blockers, chest pain, angina

pain, ventricular extra-systoles
 Bronchospasm
 Nausea
 Phlebitis at injection site

D MONOGRAPHS
Interactions
 Isoflurane(risk of ventricular arrhythmias)
 Monoamine oxidase inhibitors (MAOIs) such as selegiline
(risk of hypertensive crisis)

 Non-cardioselective beta-blockers (increased risk of se-
vere hypertension and bradycardia)

Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Use with caution in arrhythmias, acute myocardial infarc-
tion, acute heart failure, severe hypotension, marked ob-
struction of cardiac ejection and hypothyroidism
 Correct hypovolemia before starting treatment
 There is a risk of tolerance when continuous infusions are
given for longer than 72 hours
DOCETAXEL RR V 8.2
Taxane anticancer
Dosage forms
Uses
 Advanced or metastatic breast cancer
 Non-small cell lung cancer (after failure on other cytotox-
ic agents)
 Hormone-resistant prostate cancer (in combination with
prednisolone)

DOCETAXEL D
 Gastric adenocarcinoma
 Head and neck cancer
 Operable node-positive and node-negative breast cancer
Dose and duration

Administer as a one-hour infusion every 3 weeks
Dose and duration depend on the patient, the type of cancer
being treatment, neutrophil count and concurrent cytotoxic
therapy.
Pre-treat with oral dexamethasone as below
 Breast, non-small cell lung, gastric, head and neck
cancers
16 mg per day (e.g. 8 mg twice daily for 3 days, starting
on the day just before docetaxel administration
 Prostate cancer
8 mg given at 12 hours, 3 hours and 1 hour before docet-

axel infusion
Contra-indications
 Hypersensitivity to docetaxel
3
 Patients with neutrophil count < 1,500 cells/mm
 Severe liver impairment
Side effects
 Neutropenia, thrombocytopenia, anaemia
 Localised skin erythema of hands and feet
 Infections
 Dyspnoea
 Alopecia, nail disorders
 Nausea, vomiting, diarrhoea, stomatitis, constipation
 Weakness, lethargy, pain

D MONOGRAPHS
 Hypotension, hypertension, haemorrhage, fluid reten-

tion, arrhythmia
 Gastrointestinal haemorrhage, abdominal pain, anorexia
Interactions
 CYP450 enzyme inhibitors e.g. ketoconazole, itracona-
zole, clarithromycin (increased risk of adverse reactions)

Pregnancy
 Do not use
Breast-feeding
Storage
 After reconstitution, store at 2−8°C
Caution
 Pre-treatment with oral dexamethasone or prednisolone
is recommended for reducing fluid retention and hyper-
sensitivity reactions
 Men and women have to use effective contraception dur-
ing and after treatment with docetaxel
workers trained and experienced in use of cytotoxic
medicines
DOMPERIDONE H N 17.2
Dopamine receptor antagonist which stimulates gastric emp-
tying and small intestinal transit, and enhances the strength
of oesophageal sphincter contraction to stop emesis.
Dosage forms
 Tablet: 10 mg

DOMPERIDONE D
Suspension: 5 mg/5 ml
Uses
 Dyspepsia
 Gastro-oesophageal reflux
Dose and duration

 All uses
Adult and child over 12 years and body weight >35 kg:
by mouth, 10 mg every 6–8 hours (max 40 mg daily)
Child with body weight up to 35 kg: 0.25–0.5 mg/kg eve-
ry 6–8 hours (max 1.0 mg/kg daily)
Do not use for more than 7 days
Contra-indications
 Prolactinoma
 In case increased gastrointestinal motility is harmful
Side effects
 Bloating
 Skin rash, itching
 Ventricular arrhythmias, Torsades de pointes
Interactions
 Erythromycin (increased plasma concentration of
domperidone)
 Take your medicine at least 30 minutes before a meal or
2 hours after a meal

 Do not crush tablets
 Seek medical attention in case palpitations or fainting

D MONOGRAPHS
Pregnancy
 Do not use
Breast-feeding
 Can be used
Caution
 Use with caution in patients with QT-interval prolonga-
tion, concomitant use with drugs that prolong the QT-
interval, electrolyte imbalances, cardiac disease, patients
over 60 years of age, children or oral dose >30 mg daily
 Avoid use of domperidone in patients with hepatic im-
pairment. Reduce dose in renal impairment
DOPAMINE H E 12.4.2
Inotropic sympathomimetic with B1 receptor activity
Dosage forms
 Concentrate for solution for IV infusion: 40 mg/ml
Uses
 Management of vascular shock
Dose and duration

 Management of vascular shock
Adult: 0.002–0.005 mg/kg/minute increased gradually

by 0.005–0.01 mg/kg/minute increments, according to
blood pressure, cardiac output and urine output. Dose
can be increased up to 0.02–0.05 mg/kg/minute as re-
quired
Child 1 month–18 years: 0.005 mg/kg/minute adjust-
ed according to response (max 0.02 mg/kg/minute)
Neonate: 0.003 mg/kg/minute, adjusted according to

DOPAMINE D
response (max 0.02 mg/kg/minute)
Preparation
 Dilute with Glucose 5% or Sodium chloride 0.9% to a max-
imum concentration of 3.2 mg/ml.

Contra-indications
 Uncorrected atrial or ventricular tachyarrhythmia
 Ventricular fibrillation
 Hyperthyroidism
Side effects
 Anginal pain, ectopic heart beats, palpitations
 Tachycardia, vasoconstriction, hypotension
 Dyspnoea
 Headache
 Gangrene
Interactions
 MAOIs e.g. Selegiline (risk of hypertensive crisis)
 Halogenated anaesthetics; halothane (sensitization of the
myocardium)
 Phenytoin (increased risk of hypotension and brady-
cardia)
 Alpha-blockers (antagonize peripheral vasoconstriction
caused by high doses of dopamine)

 Beta-blockers (antagonize cardiac effects of dopamine)
Pregnancy
 Do not use
Breast-feeding
 Can be used

D MONOGRAPHS
Caution
 Do not use bicarbonate for dilution because dopamine
concentrate is incompatible with bicarbonate
 Reduce the dose or temporarily suspend dosage in case
of decrease in established urine flow rate, increasing
tachycardia or development of new dysrthythmias
 Patients who have been treated with MAOI prior to do-
pamine should be given reduced doses (the starting dose
should be 1/10th of the usual dose
 Avoid excess administration of potassium-free solutions
since it may result in significant hypokalaemia
 Withdraw gradually to avoid unnecessary hypotension
DOXORUBICIN (ADRIAMYCIN) NR V 8.2

Anthracycline antibiotic anticancer
Dosage forms
Uses
 Metastatic breast cancer
 Ovarian cancer (second line treatment)
 AIDS-related Kaposi’s sarcoma (second line treatment)
Dose and duration

 Metastatic breast cancer (in combination with cyclophos-
phamide) and ovarian cancer

50 mg/m2 once every 4 weeks for as long as the disease
does not process and patient can tolerate treatment

DOXORUBICIN (ADRIAMYCIN) D
30 mg/m2 depending on the regimen of concomitant
anticancers
 Kaposi’s sarcoma
20 mg/m2 every 2−3 weeks for 2−3 months
Note: Avoid intervals of less than 10 days
Contra-indications
 Children aged below 18 years
Side effects
 Erythema of palms of the hands and soles of the feet
(palmar-plantar erythrodysesthesia, PPE)

 Infusion site reactions
 Myelosuppression (leucopoenia, anaemia, neutropoenia,
thrombocytopenia)
 Heart damage, ventricular arrhythmia
 Pharyngitis
 Anorexia
 Paraesthesia
 Blurred vision
 Nose bleeding
 Hypersensitivity reactions (rash)
 Dry skin, skin discoloration
 Leg cramps, muscle pain, bone pain
 Mucositis, fever, fatigue, weakness
Pregnancy
 Do not use

D MONOGRAPHS
Breast-feeding
Storage
 After reconstitution, store at 2−8°C. Do not freeze
Caution
 Do routine ECG monitoring to detect cardiac toxicity
 If patient experiences infusion site reactions, discontinue
immediately and give appropriate premedication (antihis-
tamine and/or corticosteroid)
 Reduce dose or delay follow-on dose to manage adverse
drug reactions
 Never give doxorubicin as bolus injection or undiluted so-
lution to avoid injection site reactions
DOXYCYCLINE HC II V 6.2.2
Long-acting broad spectrum tetracycline antibacterial
Dosage forms
Uses
 Brucellosis
 Plague
 Typhus fever
 Bacterial throat infections
 Moderate pneumonia
 Cholera
 Infected bite wound

DOXYCYCLINE D
 Tropical ulcer
 Chlamydial vaginal and urethral discharge syndrome
 Anthrax
 Acute bronchitis
 Inguinal swelling (bubo)
Dose and duration
 Brucellosis (in combination with gentamicin)
Adult: 100 mg every 12 hours for 6 weeks

Child >8 years: 2 mg/kg every 12 hours for 6 weeks
 Plague

Child >8 years: 2 mg/kg every 12 hours for 7 days
 Chlamydial vaginal and urethral discharge syndrome

Treat partner as well
 Typhus fever, moderate pneumonia
Adult: 100 mg every 12 hours for 7–10 days

Child >8 years: 2 mg/kg every 12 hours for 7–10 days
 Acute bacterial throat infections, infected bite wound,
tropical ulcer
Child >8 years: 2 mg/kg every 12 hours for 5 days
 Cholera
Adult: 300 mg single dose

Child >8 years: 2 mg/kg single dose
 Inguinal swelling (bubo)

Contra-indications

D MONOGRAPHS
 Allergy to tetracycline
Side effects
 Stomach upset
 Mouth and throat ulcers
Interactions
 Zinc (reduced absorption)
 Ferrous salts, milk (reduced absorption)
 Take with meals and a full glass of water
 Take 2 hours apart from milk, iron salts, and magnesium
trisilicate compound
Pregnancy
 Do not use
Breast-feeding
 Do not use
DPT VACCINE HC II V 19.3.1

Diphtheria-pertussis-tetanus (DPT) vaccine used in routine
immunisation of children
Dosage forms
 Suspension for injection: 25 Lf Diphtheria toxoid; 6 Lf Tet-
anus toxoid; 10,000 million Bordetella pertussis in

20-dose vial (10 ml)
Uses
 Prevention of diphtheria, pertussis (whooping cough),

DPT VACCINE D
and tetanus in children
Dose and duration
Infants: 3 doses of 0.5 ml IM on the outer upper left
thigh at 6, 10, and 14 weeks from birth
Minimum interval between doses is 4 weeks
Contra-indications
 Previous severe reactions to DPT vaccine
 Severe acute febrile illness (minor illness not contra-
indication)
Side effects
 Mild reactions at injection site: swelling, pain, redness
 Fever within 24 hours of the injection
 Anaphylactic reactions
 Seizures
 Do not apply anything to the injection site
 A mild fever may develop within 24 hours of injection.
Take paracetamol if necessary. Wiping the child with a

cool sponge or cloth (with water at room temperature) is
also good for reducing fever. If fever continues after 2
doses of paracetamol, report to health facility
Storage
 Store at 2–8°C (cold storage)
 Do not freeze vaccine
 Discard reconstituted vials after 6 hours
Caution
 Do not give injection in the buttocks as this reduces

D MONOGRAPHS
vaccine efficacy
 Shake vaccine before use so that it mixes properly
DPT-HepB-Hib HC II V 19.3.1
Diphtheria-pertussis-tetanus-hepatitis B-Haemophilus influ-
enzae type B vaccine used in routine immunisation of chil-
dren
Dosage forms
 Suspension for injection: Two dose vial
Uses
 Prevention of diphtheria, whooping cough, tetanus, hep-
atitis B, and bacterial pneumonia due to H. influenza

Dose and duration
Infant: 3 doses of 0.5 ml IM in the outer upper left
thigh at 6, 10, and 14 weeks
Minimum dose interval between doses is 4 weeks
Contra-indications
 Previous severe reactions to DPT vaccine
 Severe acute febrile illness (minor illness not contra-
indication)
Side effects
 Mild reactions at injection site: swelling, pain, redness
 Fever within 24 hours of the injection
 Seizures
 Do not apply anything at the injection site
 A mild fever will develop within 24 hours of injection.

DROPERIDOL D
Take paracetamol if necessary. If fever continues after 2
doses of paracetamol, report to health worker
Storage
 Store at 2–8°C (cold storage)
 Discard reconstituted vials after 6 hours
Caution
 Do not give injection in the buttocks as this can reduce
vaccine efficacy
 Shake vaccine before use so that it mixes properly
DROPERIDOL H E 1.3
Butyrophenone which blocks dopamine receptors in the
chemoreceptor trigger zone
Dosage forms
 Injection: 2.5 mg/ml
Uses
 Postoperative nausea and vomiting
 Opioid induced nausea and vomiting in patient-controlled
analgesia (PCA)
Dose and duration
Adult: by IV injection, 0.625–1.25 mg (0.625 mg in the el-

derly) 30 minutes before end of surgery, then every 6
hours as required
Child 2–18 years: by IV injection, 0.01–0.05 mg/kg (max
1.25 mg) 30 minutes before the end of surgery, then

D MONOGRAPHS
every 6 hours as necessary

Hepatic/renal impairment: max 0.625 mg every 6 hours
as required
 Opioid induced nausea and vomiting in PCA
Adult: by IV injection, 0.015–0.05 mg per 1 mg of

morphine in PCA (max 5 mg daily)
Reduce dose in renal, hepatic impairment and elderly
Contra-indications
 Hypersensitivity to droperidol or butyrophenones
 Known or suspected QT-interval prolongation
 Hypokalaemia
 Hypomagnesaemia
 Bradycardia
 Comatose states
 Severe depression
 Known concomitant treatment leading to bradycardia
Side effects
 Drowsiness, sedation
 Hypotension
Interactions
 General anaesthetics (enhanced hypotensive effect)
 Amiodarone, disopyramide (increased risk of ventricular
arrhythmias-avoid concomitant use)

 Azithromycin, erythromycin, clarithromycin, fluoxetine,
sertraline, fluvoxamine, tamoxifen, tacrolimus (risk of

ventricular arrhythmias- avoid concomitant use)
 Amitrptyline, imipramine (possibly increased risk of

DROPERIDOL D
ventricular arrhythmias)
 Chloroquine and hydroxychloroquine, quinine, amisul-
pride, pimozide, sulpride, haloperidol, sotalol, pentami-
dine isethionate (increased risk of ventricular
arrhythmias)
 Do not drive or operate a machine within 24 hours of
droperidol administration
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Use with caution in chronic obstructive pulmonary dis-
ease or respiratory failure, electrolyte disturbances and
history of alcohol abuse
 If there is a risk of ventricular arrhythmias, continuous
pulse oximetry during and 30 minutes following admin-
istration is required
 Excreted in breast milk. Avoid repeated administration in
a breast-feeding mother
 May cause temporary neurological disturbances in infants
whose mothers used droperidol during pregnancy. Moni-
tor infant for neurological functions if used in pregnancy

E MONOGRAPHS
E
EFAVIRENZ (EFV) HC IV E 30.2
Non-nucleoside reverse transcriptase inhibitor (NNRTI) an-
tiretroviral medicine
Dosage forms
 Capsule: 200 mg
 FDC tablet: TDF 300 mg + FTC 200 mg + EFV 600 mg
 FDC tablet: TDF 300 mg + 3TC 300 mg + EFV 600 mg
Uses
 HIV/AIDS
Dose and duration

 HIV infection, first line treatment (with TDF + 3TC)

Child >3 years: As in table below; once daily at night
Weight (kg) Dose (mg)

10–13.9 200 mg once daily
>35 600 mg once daily
 HIV infection, alternative first line treatment (in combina-
tion with AZT + 3TC)
 eMTCT, first line treatment (with TDF +3TC)
EFAVIRENZ (EFV) E
Contra-indications
Side effects
 Sleep disturbances, abnormal dreams (nightmares),
 Reduced concentration, dizziness, headache
 Suicidal behaviour, depression
 Rash, Stevens-Johnson syndrome, itching
 Stomach upset
Interactions
 Lopinavir (reduced concentration of lopinavir)
 Preferably take at bedtime
 Take with a fatty meal
 Mild rash may develop, usually goes away within a
month; do not worry

 Report immediately to health worker if any severe
depression, mental disorders, or suicidal ideas occur

 Report immediately to the health worker if any severe
rash with blisters, peeling skin, mouth ulcers, or fever

occur
Pregnancy
 Do not use
Breast-feeding
 Discontinue breast-feeding

E MONOGRAPHS
Caution
 Discontinue the medicine if patient has severe rash with
blistering and fever; or if severe depression, psychoses,
and suicidal ideas occur
EMTRICITABINE (FTC) H E 30.2

Nucleoside reverse transcriptase inhibitor (NRTI) antiretrovi-
ral medicine
Dosage forms
 Capsule: 200 mg
 FDC tablet: TDF 300 mg + FTC 200 mg
Uses
 HIV/AIDS
Dose and duration

tion with TDF + EFV or TDF + NVP)

Adult and child >33kg: 200 mg once daily
Child 4 months–18 years: 6 mg/kg once daily
 HIV infection, alternative second line treatment (in com-
bination with TDF + LPV/r or TDF + ATV/r)

Adult and child >33kg: 200 mg once daily
Child 4 months–18 years: 6 mg/kg once daily
FTC can be substituted with 3TC
Contra-indications
 Allergy to emtricitabine
 Child <4 months

ENALAPRIL E
Side effects
 Lactic acidosis
 Liver damage
 Skin discoloration
 Itching
 Abnormal dreams
 Stomach upset
 Redistribution of body fat
Interactions
 Lamivudine (increased side effects)
 Report immediately to health worker in case severe nau-
sea, vomiting, abdominal pain, feeling of sickness, appe-

tite loss, rapid deep breathing, or muscle weakness occur
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Discontinue medicine in case of severe lactic acidosis or
liver damage
ENALAPRIL RR N 12.3
Angiotensin converting enzyme inhibitor antihypertensive
Dosage forms
 Tablet: 5 mg

E MONOGRAPHS
Uses
 Moderate and severe hypertension (stage 2)
 Heart failure
Dose and duration

 Hypertension stage 2 (with another antihypertensive)
Adult: 5 mg once daily. Usual maintenance dose 20 mg

once daily (max 40 mg once daily)
Child 12–18 years: 2.5 mg once daily. Usual maintenance
dose 10–20 mg daily in 1–2 divided doses (max 40 mg
daily in 1–2 divided doses if body-weight over 50 kg)
Child 1 month–12 years: 0.1 mg/kg once daily, increased
as needed to max 1 mg/kg daily in 1–2 divided doses
Neonate: 0.01 mg/kg once daily increased as necessary
up to 0.5 mg/kg daily in 1–3 divided doses
Renal failure: 2.5 mg once daily if eGFR is ˂30
ml/minute/1.73 m2
 Heart failure
Adult: 2.5 mg once daily under close medical supervision

increased gradually over 2–4 weeks to 10–20 mg, once or
twice daily if tolerated (max 40 mg)
Preparation
 For use in children, the tablet may be crushed and sus-
pended in water immediately before use

Contra-indications
 Hypersensitivity to enalapril and other ACEIs
 Angioedema
 Renovascular disease
Side effects
 Dizziness, headache, blurred vision

ENALAPRIL E
 Depression
 Hypotension, orthostatic hypotension, syncope, chest
pain, rhythm disturbances, angina pectoris, tachycardia
 Persistent dry cough, dyspnoea
 Hypersensitivity: angioneurotic oedema of face, extremi-
ties, lips, tongue, glottis and larynx

 Nausea, abdominal pain, taste alteration, diarrhoea
 Weakness, fatigue
 Hyperkalaemia, increase in serum creatinine
 Raynaud’s syndrome
Interactions
 Acetazolamide (enhanced hypotensive effect)
 Amiloride (enhance hypotensive effect)
 Furosemide (enhanced hypotensive effect)
 Hydrochlorothiazide (enhanced hypotensive effect)
 Spironolactone (enhanced hypotensive effect, increased
risk of severe hyperkalaemia)

Pregnancy
 Do not use
Breast-feeding
 Can be used
Caution
 Monitor liver function in hepatic impairment
 Avoid use in breast-feeding during the first few weeks
E MONOGRAPHS
after delivery to avoid risk of neonatal hypotension

 Concomitant use with diuretics may lead to very rapid fall
in blood pressure in volume depleted patients. Discontin-
ue high dose diuretics (furosemide ≥80 mg) 24 hours be-
fore initiation of enalapril
 Avoid enalapril during dialysis with high-flux polyacriloni-
trile membranes and during low density lipoprotein
aphaeresis with dextran
 Give with caution in patients with aortic/mitral valve
stenosis, peripheral vascular disease or atherosclerosis as
there may be clinically silent renovascular disease
ENOXAPARIN H N 10.2
Low molecular weight heparin
Dosage forms
 Sterile solution for injection: 100 mg/ml
 Sterile soolution for injection in syringe: 80 mg/0.8 ml
Uses
 Treatment of deep vein thrombosis
 Treatment of pulmonary embolism
 Prophylaxis of deep vein thrombosis
Dose and duration

Administer by subcutaneous (SC) injection
 Prophylaxis of deep vein thrombosis
Adult: 20 mg once daily for 7–10 days or until risk has

diminished. Give 2 hours pre-operatively in patients un-
dergoing surgery (40 mg once daily in orthopaedic sur-
gery, first dose given 12 hours pre-operatively)
 Prophylaxis of deep vein thrombosis in medical patients

ENOXAPARIN E
Adult: 40 mg once daily for 6–14 days
 Treatment of deep vein thrombosis, pulmonary embolism
Adult: 1.5 mg/kg once daily for at least 5 days and until
adequate oral anticoagulation is established
Child 2 months–18 years: 1 mg/kg every 12 hours
Child 1–2 months: 1.5 mg/kg every 12 hours
Neonate: 1.5–2 mg/kg every 12 hours
Pregnancy: as in table below(see caution)
Body weight Dose every 12 hours
˂50 kg 40 mg
50–70 kg 60 mg
70–90 kg 80 mg
>90 kg 100 mg
Contra-indications
 Acute bacterial endocarditis
 Active major bleeding
 Haemorrhagic stroke
 Haemophilia
 Active gastric or duodenal ulceration
 Hypersensitivity to enoxaparin, heparin or its derivatives
Side effects
 Haemorrhage
 Thrombocytosis, thrombocytopenia
 Allergic reactions, urticaria, pruritus, erythema
 Hepatic enzyme increases
 Injection site reactions (e.g. haematoma, pain)
Interactions
 Intravenous diclofenac (increased risk of haemorrhage)

E MONOGRAPHS
 Aspirin (anticoagulant effect enhanced)

 Glyceryl trinitrate (reduced anticoagulant effect)
Pregnancy
Breast-feeding
 Can be used
Caution
 Elimination is increased in pregnancy. Treatment should
be stopped at the onset of labour and specialist advice
sought on continuing therapy after birth
 Reduce dose in renal
 Increased risk of bleeding in patients with low body
weight and in renal impairment
 Withdraw enoxaparin if haemorrhage occurs
 Risk of suppression of adrenal secretion of aldosterone
leading to hyperkalaemia in conditions such as diabetes
mellitus, chronic renal failure, metabolic acidosis, hyper-
kalaemia or patients on potassium sparing medicines
 Use with extreme caution in patients with a history of
heparin-induced thrombocytopenia
 Do not interchange with other low molecular weight
heparins since they differ in their manufacturing process

EPHEDRINE E
EPHEDRINE HC IV V 1.3
Sympathomimetic vasoconstrictor. Constricts the peripheral
blood vessels and accelerates the heart rate by action on α
and β receptors respectively
Dosage forms
 Injection: 3 mg/ml, 30 mg/ml
 Nasal drops: 1%
 Nasal drops: 0.5%
Uses
 Prevention of hypotension from spinal or epidural anaes-
thesia
 Relief of nasal congestion
Dose and duration

 Prevention of hypotension from spinal or epidural anaes-
thesia
Adult and child over 12 years: by slow IV infusion, 3–6
mg (max 9 mg) repeated every 3–4 minutes as required
to a maximum cumulative dose of 30 mg
Child 1–12 years: 0.5–0.75 mg/kg or 17–25 mg/m2 every
3–4 minutes according to response(max 30 mg during
each episode)
 Relief of nasal congestion
Adult: Instil 1–2 drops of 1% strength as required in each

nostril up to a maximum of 4 times a day
Child 12–18 years: instill 1–2 drops of 0.5% strength into
each nostril up to 3 or 4 times daily when required
Do not use for more than 7 days
Contra-indications
 Known sensitivity to ephedrine

E MONOGRAPHS
 Ischaemic heart disease

 Hypertension
 Thyrotoxicosis
 Prostatic hypertrophy
Side effects
 Anorexia
 Arrhythmias, angina pain, palpitations, hypertension,
tachycardia
 Confusion, anxiety, depression, nervousness, irritability
 Weakness, insomnia, dizziness, headache
 Flushing, sweating
 Dyspnoea
 Rebound congestion
 Excessive use leads to tolerance
Interactions
 Reserpine (hypotensive effect of reserpine antagonised)
 MAOIs (risk of hypertensive crisis-avoid for at least 2
weeks after stopping MAOIs)

Pregnancy
 Can be used
Breast-feeding
 Do not use
Caution
 Ephedrine is excreted in breast milk. The breast-fed child
may experience irritability and disturbed sleep
 Ephedrine readily crosses the placental barrier. Increased
foetal heart rate reported with parenteral ephedrine
EPINEPHRINE (ADRENALINE) E
 Avoid use in severe renal impairment due to increased
CNS toxicity
 Use cautiously in hyperthyroidism, diabetes mellitus, is-
chaemic heart disease, hypertension and angle-closure
glaucoma
EPINEPHRINE (ADRENALINE) HC II V 3
Sympathomimetic agent that relieves symptoms of severe
allergic reactions, such as difficulty in breathing and lowering
in blood pressure
Dosage forms
 Injection: 1 mg/ml for IM injection
Uses
 Anaphylactic shock (acute hypersensitivity reaction)
 Severe allergic reactions
 Cardiopulmonary arrest
Dose and duration

 All uses
Adult: 0.5–1 mg IM in the outer upper thigh

Repeat every 10 minutes according to blood pressure,
pulse rate, and respiratory function until improvement
occurs
Child: Give dose according to table below in the outer
upper thigh. Repeat every 10 minutes according to
blood pressure, pulse rate, and respiratory function
until improvement occurs

E MONOGRAPHS
Age (years) Volume of Adrenaline (ml)

Normal Underweight
<1 0.05 0.05
1 0.1 0.10
2 0.2 0.10
3-4 0.3 0.15
5 0.4 0.20
6-12 0.5 0.25
> 12 0.5─1 0.5─1
Repeat adrenaline every 2–6 hours as need arises depend-

ing on the patient's progress
Side effects
 Irregular heartbeat, high blood pressure
 Shaking, sweating, headache, anxiety
 Stomach upset
Interactions
 Propranolol (cancelled effect; see caution)
 Atenolol (cancelled effect; see caution)
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Solution should be colourless; do not use any solution
with a pink or brownish colour
 Patients on propranolol and atenolol may be resistant to
the effects of epinephrine; use salbutamol IV instead
 Do not exceed indicated dose; risk of irregular heartbeat

ERGOCALCIFEROL (VITAMIN D2) E
 IM route is the first choice as there is rapid absorption
and is more reliable than SC
 The IV route should only be used if the patient has poor
circulation. Injection is given slowly (over 5 minutes)
 Adrenaline may delay 2nd stage of labour and may cause
anoxia in the foetus. Only use if benefit outweighs risk
ERGOCALCIFEROL (VITAMIN D2) NR E 24

Vitamin D supplement
Dosage forms
 Tablet: 250 microgram (10,000 IU)
Uses
 Hypocalcaemia associated with hypoparathyroidism
 Treatment of vitamin D deficiency
 Prevention of vitamin D deficiency
Dose and duration

 Prevention of vitamin D deficiency
Adult: 10 micrograms (400 IU) once daily

Child 1 month–18 years: 400–600 IU daily
Neonate: 400 IU daily
 Treatment of vitamin D deficiency
Adult: 1250 micrograms (50,000 IU) once daily for a

limited period of time
Child 12–18 years: 10,000 IU once daily
Child 6 months–12 years: 6000 IU once a day
Child 1–6 months: 75 micrograms (3000 IU) daily
 Hypocalcaemia associated with hypoparathyroidism
Adult: 2500 micrograms (100,000 IU) daily

Child: up to 1500 micrograms (60,000 IU) daily
E MONOGRAPHS
 Vitamin D deficiency in intestinal malabsorption or in

chronic liver disease
Child 12–18 years: 10,000–40,000 units daily, adjusted as
necessary
Child 1–12 years: 10,000–25,000 units daily, adjusted as
necessary
Contra-indications
 Hypercalcaemia
 Metastatic calcification
 Evidence of vitamin D toxicity
 Hypervitaminosis D
Side effects
Symptoms of over dose include
 Anorexia, weight loss
 Nausea, vomiting, diarrhoea, constipation
 Polyuria, sweating, thirst, vertigo
 Headache, lassitude
 Raised concentrations of calcium and phosphate in
plasma and urine

Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Monitor plasma-calcium concentration in patients receiv-
ing high doses and in renal impairment
 Avoid high doses in pregnancy
 High doses in breast-feeding may cause hypocalcaemia in
an infant
ERGOMETRINE MALEATE E
ERGOMETRINE MALEATE HC IV N 22.1
Oxytocic agent. Contracts uterine muscle
Dosage forms
 Injection: 500 µg/ml
Uses
 Prevention and treatment of postpartum and post-
abortion haemorrhage
Dose and duration
 Postpartum haemorrhage
Adult and adolescent: 200 micrograms by IM injection

when the anterior shoulder is delivered or immediate-
ly after birth
 Excessive uterine bleeding
Adult and adolescent: by slow IV injection, 250‒500

micrograms when the anterior shoulder is delivered or
immediately after birth
Contra-indications
 Induction of labour
 First and second stages of labour
 Vascular disease (e.g. deep vein thrombosis)
 Severe heart disease especially angina pectoris
 Sepsis
 Eclampsia
Side effects
 Headache, dizziness, tinnitus

E MONOGRAPHS
 Chest pain, palpitations, hypertension and widespread

vasoconstriction
 Difficulty in breathing
Interactions
 Efavirenz (increased risk of ergotism)
 Lopinavir/ritonavir (risk of ergometrine toxicity)
Pregnancy
 Can be used
Breast-feeding
 Can be used
Storage
 Store between 2‒8° C
Caution
 Produces faster contractions superimposed on a continu-
ous contraction
 Preferably use oxytocin if available as it is more stable
than ergometrine
 Requires cold chain transportation
ERGOTAMINE H E 7.1
Ergot alkaloid with analgesic activity
Dosage forms
Uses
Dose and duration

Adult and child over 12 years: 2 mg taken at onset of

ERGOTAMINE E
migraine. If migraine persists, 1–2 mg as required at
intervals of 30 minutes up to a maximum dose of 6 mg of
ergotamine in 24 hours and maximum of 12 mg in a week
Contraindications
 Pregnancy and nursing
 Coronary heart disease
 Peripheral vascular disease and Raynaud’s syndrome
 Obliterative vascular disease
 Inadequately controlled or severe hypertension
 Septic conditions or shock
 hyperthyroidism
 Temporal arteritis
 Acute porphyria
Side effects
 Dizziness
 Muscular cramps
 Ergotism (painful seizures, spasms, diarrhoea, paresthe-
sias, mania, headache, nausea, vomiting, peeling of toes

and fingers, peripheral neuropathy, oedema, gangrene)
Interactions
 Azithromycin, erythromycin, clarithromycin (increased
risk of ergotism)
 Ketoconazole, miconazole, fluconazole, itraconazole
(increased risk of ergotism)

 Sumatriptan (increased risk of vasospasm)
 Atazanavir (increased concentrations of ergot alkaloids)
 Efavirenz (increased risk of ergotism)
 Cimetidine (increased risk of ergotism)

E MONOGRAPHS
 Do not repeat treatment at intervals of less than 4 days
 Do not take more than 2 courses of treatment per month
 Do not exceed the recommended dose
 Stop treatment immediately if numbness or tingling of
extremities develops and contact a health worker

Pregnancy
 Do not use
Breast-feeding
 Do not use
Caution
 Not recommended for children under 12 years
 Do not administer ergotamine within 6 hours of admin-
istration of sumatriptan. Avoid sumatriptan within 24
hours of administration of ergotamine
 Avoid in renal impairment and severe hepatic impairment
ERYTHROMYCIN HC IV N 6.2.2
Macrolide antibacterial
Dosage forms
 Tablet: 250 mg
 Suspension: 125 mg/ml
Uses
 Moderate pneumonia
 Gum infection
 Post-partum haemorrhage
 Bacterial sore throat
 Breast infection

ERYTHROMYCIN E
 Cholera
 Trachoma
 Genital ulcer
 Urethral discharge syndrome
 Abnormal vaginal discharge syndrome
Dose and duration

 Moderate pneumonia, gum infection; post-partum haem-
orrhage
Child: 10–15 mg/kg every 6 hours for 5 days
 Bacterial sore throat (alternative to benzathine penicillin
or phenoxymethylpenicillin); breast infection

Child: 12.5 mg/kg every 6 hours for 10 days
 Cholera (second line treatment)
Adult and child > 12 years: 500 mg every 6 hours for 3

days
Child 6–12 years: 25–50 mg/kg every 6 hours for 3
days
Child 1–5 years: 250mg every 6 hours for 3 days
Child 4–12 months: 125mg every 6 hours for 3 days
Child 2–4 months: 62.5mg every 6 hours for 3 days
Neonate: 10 mg/kg every 6 hours for 14–21 days

 Trachoma, pelvic inflammatory disease (PID), inguinal
swelling, genital ulcer

Child: 10–15 mg/kg every 6 hours for 14 days
E MONOGRAPHS
 Urethral discharge syndrome; abnormal vaginal discharge

syndrome (alternative to doxycycline)
Treat partner
Contra-indications
 Allergy to erythromycin and other macrolides (e.g.
azithromycin)
Side effects
 Stomach upset
 Hearing damage
 Allergic reaction (rash)
Interactions
 Artemether + lumefantrine (increased risk of irregular
heartbeat)
 Carbamazepine (increased plasma concentration levels)
 Aminophylline (plasma concentration of aminophylline
increased)
 Warfarin (increased anticoagulant effect of warfarin)
 Tablets should be swallowed whole; do not crush tablets
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Reduce dose in severe liver disease (max 1.5 mg daily)

ETHAMBUTOL (E) E
ETHAMBUTOL (E) HC III V 6.2.4
Anti-tuberculosis antibacterial; abbreviated as E in treatment
regimens
Dosage forms
 FDC tablet: Rifampicin 150 mg + isoniazid 75 mg + pyra-
zinamide 400 mg + ethambutol 275 mg

 FDC tablet: isoniazid 150 mg + ethambutol 400 mg
Uses
 Tuberculosis
Dose and duration

 Initial phase (give in combination with rifampicin, isonia-
zid and pyrazinamide (RHZE)

Give once daily for 2 months
Adult and child over 12 years:
Weight (kg) Ethambutol (mg)
30–37 550
38–54 825
55–70 1100
>70 1375
Child >12 years:
4–7 100
8–11 200
12–15 300
16–24 400
>25 Use adult formulation

E MONOGRAPHS
 Continuation phase (in combination with isoniazid)

Give once daily for 4 months
30–70 800
>70 1200
Contra-indications
 Eye nerve disease
Side effects
 Visual disturbance, including red/green colour blindness
 Nerve pain, especially in legs
 Gout
 Report immediately to health facility if any visual disturb-
ances occur so as to prevent blindness

Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Do an eye examination before and during treatment
 Discontinue treatment immediately if patient reports
visual disturbances
 Give to children only in the recommended doses

ETHINYLESTRADIOL + LEVONORGESTREL E
ETHINYLESTRADIOL + LEVONORGESTREL HC I E 18.3
Combined oral contraceptive (COC). Ethinylestradiol is an
oestrogen, and levonorgestrel is a progestogen
Dosage forms
All packs contain 21 active and 7 inactive tablets
 Tablet: Ethinylestradiol 30 µg + levonorgestrel 150 µg
 Tablet: Ethinylestradiol 50 µg + levonorgestrel 250 µg
For more information, see ethinylestradiol + norgestrel

monograph
ETHINYLESTRADIOL + NORETHISTERONE HC II E 18.3

oestrogen, and norethisterone is a progestogen
Dosage forms
 Tablet: Ethinylestradiol 50 µg + norethisterone 1 mg
For more information, see ethinylestradiol + norgestrel
monograph
ETHINYLESTRADIOL + NORGESTREL HC I V 18.3

oestrogen, and norgestrel is a progestogen
Dosage forms
 Tablet: Ethinylestradiol 30 µg + norgestrel 300 µg
Uses
 Prevention of unwanted pregnancy

E MONOGRAPHS
Dose and duration

 Start contraceptive (active tablet)
− On the first day of menstruation

− Immediately after abortion
− At 21 days after child birth if the woman does not
breastfeed
Use for as long as contraception is desired
Contra-indications
 High blood pressure
 Heart disease
 Deep vein thrombosis and previous stroke
 Active liver disease
 Breastfeeding mothers (< 6 months after giving birth)
 Unexplained abnormal vaginal bleeding
 Known or suspected cervical cancer
 Undiagnosed breast lumps or breast cancer
 Migraine
 Presence of any 2: Smoker, diabetes, age >35 years
Side effects
 Spot bleeding
 Nausea
 Headache
 Weight gain
 Suppresses breast milk production
Interactions
 Rifampicin (reduced contraceptive effect)
 Carbamazepine (reduced contraceptive effect)
 Griseofulvin (reduced contraceptive effect)
 Nevirapine (reduced contraceptive effect)

ETHINYLESTRADIOL + NORGESTREL E
 Phenytoin (reduced contraceptive effect)
 Phenobarbital (reduced contraceptive effect)
 Ampicillin (reduced contraceptive effect)
 Doxycycline (reduced contraceptive effect)
 Amoxicillin (reduced contraceptive effect)
 Explain to the patient which tablets are active and inac-
tive and how to follow the arrows

 Take at the same time every day to ensure effective con-
traception; strict compliance is essential

 Warning signs for severe side effects are: severe head-
aches, blurred vision, depression, acute severe abdominal

pain, chest pain, shortness of breath and swelling or pain
in calf muscle. Report to health worker immediately
 In case of missed dose: take tablet as soon as you re-
member and continue treatment as normal. If over 12

hours have passed, add another method e.g. condoms
 If patient has had sexual intercourse within 5 days before
forgetting the tablet, take emergency contraception

 If patient wishes to get pregnant again, stop treatment;
fertility usually returns within 3–6 months

 If one menstrual period is missed and all doses were
taken on schedule, continue with the next dosing cycle. If

two consecutive menstrual periods are missed, do a
pregnancy test before beginning the next cycle
Pregnancy
 Do not use

E MONOGRAPHS
Breast-feeding
 Do not use if infant is younger than 6 months old
Caution
 Use progestogen-only contraceptive for smokers, diabe-
tes patients, and women older than 35 years
 An additional family planning method must be used dur-
ing and for at least 7 days after completion of treatment
with medicines listed under the "Interactions" section
 The preparations containing 50 µg ethinylestradiol are
recommended where effectiveness may be reduced (e.g.
when patient is taking antibiotics, such as rifampicin)
 Discontinue 4 weeks before major elective surgery and all
surgery to the legs or surgery that involves prolonged immo-
bilisation of the lower limbs. Can be restarted at the first
menses occurring at least 2 weeks after full mobilisation
ETHIONAMIDE H E 6.2.4
Antibiotic with activity against Mycobacterium tuberculosis. It
is bacteriostatic or bactericidal depending on concentration
of the medicine at the site of infection
Dosage forms
Uses
Dose and duration

 MDR-TB ( in combination with other medicines)
Adult: 15–20 mg/kg up to a usual dose of 500–1000 mg

daily depending on bodyweight and tolerance. Give in

ETHIONAMIDE E
1–2 doses daily
Child: 10–20 mg/kg in 1–2 divided doses
Contra-indications
 Hypersensitivity to ethionamide
Side effects
 Headache, dizziness, drowsiness
 Asthenia, paresthesia
 Epigastric discomfort, abdominal pain, anorexia
 Elevated serum transaminases, hepatitis, jaundice
Interactions
 Rifampicin (increased risk of hepatitis with jaundice-avoid
concomitant use)
 Isoniazid (increased serum concentration of isoniazid)
 Swallow with food to minimise gastrointestinal side
effects
Pregnancy
 Do not use
Breast-feeding
 Can be used
Caution
 Obtain baseline liver function tests prior to therapy and
monitor serum transaminases every 2–4 weeks during
therapy. Discontinue all medicines temporarily if jaundice
develops and transaminase levels exceed three times the
Upper Limit of Normal (ULN), or if transaminase levels

E MONOGRAPHS
exceed five times the ULN with or without symptoms. Re-

introduce the medicines sequentially after resolution of
laboratory abnormalities
 Give with pyridoxine (Vitamin B6) and nicotinamide (Vit-
amin B3) to prevent neurotoxic effects of ethionamide
 Monitor blood glucose and thyroid function periodically
throughout therapy
 Carry out periodic opthalmoscopy during therapy
 Monitor breast-feeding child if used in the mother
ETHOSUXIMIDE RR E 5
Antiepileptic and anticonvulsant medicine
Dosage forms
Uses
 Epilepsy (petit mal)
Dose and duration

 Epilepsy (petit mal)
Adult and child > 6 years: 250 mg every 12 hours, in-

creased by 250 mg every 4–7 days up to a usual daily
dose of 500–750 mg every 12 hours (max 2 g)
Child 1 month–6 years: 5 mg/kg (max 125 mg) every
12hours increased gradually over 2–3 weeks up to a
maintenance dose of 10–20 mg/kg (max 500 mg) every
12 hours
Contraindications
 Acute porphyria

ETHOSUXIMIDE E
Side effects
 Anorexia, weight loss, suicidal ideation
 Blood dyscrasias
 Gum hypertrophy
 Drowsiness
 Systemic lupus erythematosus
Interactions
 Isoniazid (increased plasma concentration of
ethosuximide and increased risk of toxicity)

 Phenytoin ( reduced concentration of ethosuximide)
 Mefloquine (anticonvulsant effect antagonised)
 Antipsychotic (anticonvulsant effect antagonised)
 Orlistat (possibly increased risk of convulsions)
 In case you notice symptoms such as fever, mouth ul-
cers, bruising or bleeding, consult your doctor immedi-

ately; could be a sign of blood disorders
 Seek medical advice if suicidal ideas or behaviour develop
Pregnancy
 Do not use
Breast-feeding
 Can be used
Caution
 Avoid abrupt withdrawal
 Use with caution in hepatic and renal impairment. Moni-
tor liver and renal function

 If ethosuximide is given as monotherapy, encourage

E MONOGRAPHS
breast-feeding unless adverse effects appear in the infant

or child; in which case the mother should stop breast-
feeding. Patients should not breast-feed if on multiple
drug regimens
 There is a recognised small increase in congenital mal-
formations. Weigh risk against benefit of treatment
ETOMIDATE RR E 1.1
General anaesthetic
Dosage forms
Uses
Dose and duration

Given as a slow IV injection i.e. 10 ml over 30–60 seconds
Adults: 0.15–0.3 mg/kg (max 60 mg) induces sleep for 4–

5 minutes
Child 1–18 years: 0.3 mg/kg (max 60 mg)
Elderly: 0.15–0.2 mg/kg adjusted according to the indi-
vidual (max 60 mg)
Preparation
 May be diluted with normal saline or dextrose infusion
Contraindications
Side effects
 Myoclonus, dyskinesia
 Vein pain, hypotension

ETOMIDATE E
 Apnoea, hyperventilation, stridor (high-pitched breaths)
 Rash
Interactions
 Adrenaline neurone blockers (enhanced hypotensive ef-
fect)
 Alpha blockers (enhanced hypotensive effect)
 Verapamil (enhanced hypotensive effect)
 Antipsychotics (enhanced hypotensive effect)
 Do not operate dangerous machinery or drive vehicles
during the first 24 hours after administration

Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Reduce dose in liver cirrhosis, in patients receiving neuro-
leptic, opiate or sedative agents

 Resuscitation equipment should be available
 Etomidate may depress neonatal respiration if used dur-
ing delivery
 It is not compatible with Ringer’s lactate infusion
 Do not mix with pancuronium
 Extraneous muscle movements can be minimised by an
opioid analgesic or a short-acting benzodiazepine given

just before induction
 Pain on injection can be reduced by injecting into a larger
vein or by giving an opioid analgesic just before induction

E MONOGRAPHS
 Etomidate suppresses adrenocortical function, particular-

ly during continuous administration, and it should not be
used for maintenance of anaesthesia. Use with caution in
patients with underlying adrenal insufficiency for exam-
ple, those with sepsis
ETONOGESTREL HC III V 18.3

Progestogen-only contraceptive used as a depot implant.
Provides contraception for up to 3 years
Dosage forms
 Implant: Rod containing 68 mg of etonogestrel with a
sterile disposable applicator

Uses
 Long-term prevention of unwanted pregnancy
Dose and duration

Insert rod sub-dermally (just under the skin) into the
inner side of the non-dominant arm 6–8 cm above el-
bow
Insert under local anaesthesia and aseptic conditions
If no other contraception, insert implant:
− During the first 5 days of menstruation
− Immediately after abortion
− At 21 days after child birth if the woman does not
breastfeed
− At 6 weeks after childbirth if the woman breastfeeds
If switching from another method, when switching

from:
− At 6 weeks after childbirth if the woman breastfeeds
ETONOGESTREL E
− Combined oral contraceptive: Insert implant the day
after taking the last active tablet
− Oral progestogen only contraceptive: Insert implant at
any stage of the cycle
− Injectable progestogen only contraceptive: Insert im-
plant on the day the next injection is due
− Intrauterine device: Insert implant the day of its re-
moval
Leave inserted as long as contraception is desired. Can
stay for 3 years (2 years in obese women)
Contra-indications
 Breast cancer
 Severe or recent liver disease
 Current stroke or deep vein thrombosis
Side effects
 Headache, mood changes
 Acne
 Menstrual disturbances, breast tenderness
 Weight gain
 Abdominal pain, nausea
Interactions
Same as for ethinylestradiol + norgestrel
 Warning signs for severe side effects are severe head-
aches, blurred vision, depression, acute severe abdominal

pain, chest pain, shortness of breath and swelling or pain
in calf muscle. Report to health worker immediately.
 Fertility returns rapidly after removal of implant (usually

E MONOGRAPHS
from 6 weeks onwards)

Pregnancy
 Do not use
Breast-feeding
 Can be used
Caution
with medicines listed under “Interactions”
 Do not insert the implant too deep as removal may be
difficult
 Implant should be removed under local anaesthesia and
aseptic conditions by a trained health worker
 Commonly known as Implanon®
ETOPOSIDE NR V 8.2
Topoisomerase inhibitor anticancer
Dosage forms
Uses
 Small cell lung cancer
 Refractory testicular carcinoma
 Monoblastic leukaemia (second line treatment)
Dose and duration

Give 60−120 mg/m2 by slow IV infusion (30−60 minutes)
for 5 consecutive days. Repeat course every 21 days
depending on blood count results
Do not give infusion rapidly
ETOPOSIDE E
Contra-indications
 Children aged below 12 years
 Hypersensitivity to etoposide or podophyllotoxins
Side effects
 Myelosuppression (leucopoenia, neutropenia, thrombocy-
topenia)
 Alopecia
 Nausea and vomiting, abdominal pain, constipation
 Hypotension (following rapid infusion)
 Myocardial infarction, arrhythmia
 Hepatotoxicity
 Rash, urticaria, pruritus, anaphylactic reactions
 Asthenia, malaise, dizziness
Interactions
 Ciclosporin (increased concentration of etoposide)
 Cisplatin (increased concentration of etoposide)
 Phenytoin (reduced etoposide efficacy)
 Live vaccines (risk of full-blown disease)
Pregnancy
 Do not use
Breast-feeding
Storage
 Store at 25°C. Do not refrigerate or freeze
Caution
 Treat any bacterial infections before starting etoposide

F MONOGRAPHS

F
FACTOR VIII CONCENTRATE (HUMAN CO-
NR N 11.2
AGULATION FACTOR VIII)
Plasma extract essential for blood clotting and maintenance
of effective haemostasis. Contains small quantities of von
Willebrand’s factor
Dosage forms
 Dried powder for solution for injection: 1,500 IU
Uses
 Haemophilia A
Dose and duration

Give intravenously at a rate no more than 10 ml/minute
 Prophylaxis
Adult and child: 20–40 IU/kg at intervals of 2–3 days.

Child may require higher doses or shorter dosage inter-
vals
 Control of haemorrhage
Administer according to patient’s needs
Side effects
 Allergic reactions, anaphylaxis
 In case symptoms of anaphylaxis such as hives, urticaria,

F
FACTOR IX (COAGULATION FACTORS II, VII, IX, X) COMPLEX
CONCENTRATE
wheezing, hypotension, tightness of chest develop, dis-
continue the medication immediately and contact your
doctor
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 In patients with blood groups A, B or AB, patient may de-
velop intravascular haemolysis if given large or frequently
repeated doses (less likely with high potent concentrates)
 Monitor for development of factor VIII inhibitors espe-
cially in the first 20 days of exposure; perform an assay if
expected factor VIII activity levels are not attained or
bleeding is not controlled
 Do not mix with other medicinal products and only use
the provided infusion set
FACTOR IX (COAGULATION FACTORS II, VII,

RR N 11.2
IX, X) COMPLEX CONCENTRATE
Plasma extract containing coagulation factors II, VII, IX and X
derived from fresh venous plasma
Dosage forms
 Dried powder for injection: 1000 IU
Uses
 Haemophilia B
 Bleeding due to deficiency of factors II, VII or X

F MONOGRAPHS
Dose and duration

 Haemophilia B
By slow IV infusion, according to patient’s needs and spe-

cific preparation used
 Bleeding due to deficiency of factors II, VII or X
According to patient’s needs

Contra-indications
 Disseminated intravascular coagulation
 Known history of heparin-induced thrombocytopenia
Side effects
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Patients on treatment may be at risk of thrombosis
 Stop infusion immediately if anaphylactic- type reactions
occur
 Record batch details of the preparation used to maintain
a link between the patient and batch of the product
FENTANYL H V 1.3
Opioid analgesic
Dosage forms
 Solution for injection: 50 microgram/ml
Uses
 Intra-operative analgesia

FENTANYL F
 Enhancement of analgesia
 Analgesia and respiratory depression in assisted respira-
tion in intensive care
Dose and duration
 Spontaneous respiration: analgesia and enhancement of
anaesthesia during operation

Adult and child over 12 years: initially 50–100 mi-
crograms (max 200 micrograms) by slow IV injection,
then 25–50 micrograms as required
By IV infusion, 3–4.8 micrograms/kg/hour adjusted ac-
cording to response
Child 1 month–12 years: 1–3 micrograms/kg, then 1 mi-
crogram/kg as required
 Assisted ventilation: analgesia and enhancement of an-
aesthesia during operation

Adult: initially 300–3500 micrograms by slow IV injec-
tion, then 100–200 micrograms as required
By IV infusion, initially 10 micrograms/kg over 10
minutes, then 6 micrograms/kg/hour adjusted according
to response; may require up to 180 micrograms /kg/hour
during cardiac surgery
Child 12–18 years: 1–5 micrograms/kg, then 50–200 mi-
crograms as required
Neonate and child 1 month–12 years: 1–5 mi-
crograms/kg initially, then 1–3 micrograms/kg as require
 Assisted ventilation: analgesia and respiratory depression
in intensive care
Adult: same dose as above
Child 1 month–18 years: 1–5 micrograms/kg by IV injec-
tion, then 1–6 micrograms/kg/hour by IV infusion,
F MONOGRAPHS
adjusted according to response

Contra-indications
 Obstructive airways disease
 Concurrent administration with MAOI or within 2 weeks
of their discontinuation
 Brain trauma
 Known intolerance to fentanyl, methadone, pethidine or
tramadol
 Hypersensitivity to fentanyl
Side effects
 Muscle rigidity
 Sedation, dizziness, dyskinesia
 Post-operative confusion
 Tachycardia, bradycardia, arrhythmias, hypotension, hy-
pertension, vein pain

 Laryngospasm, bronchospasm, apnoea
 Allergic dermatitis
Interactions
 Fluconazole, itraconazole (plasma concentration of fen-
tanyl possibly increased)

 Ritonavir (plasma concentration of fentanyl increased)
 Saquinavir (increased risk of ventricular arrhythmias)
 Sodium oxybate (enhanced effects of sodium oxybate)
 Do not drive unless sufficient time has elapsed since ad-
ministration of fentanyl

FERROUS SALT F
Pregnancy
 Do not use
Breast-feeding
 Do not use
Caution
 Calculate dose on basis of ideal body weight in order to
avoid excessive dosing
 Higher doses may be required in patients with chronic
opioid therapy or with a history of opioid abuse
 Repeat use may result in tolerance and dependence
 Avoid rapid bolus injections in patients with compro-
mised intracerebral compliance due to risk of reduction
of cerebral perfusion pressure
 Reduce dose in the elderly and debilitated patients
 Titrate with caution in patients with uncontrolled hypo-
thyroidism, pulmonary disease, decreased respiratory re-
serve, alcoholism or impaired renal or hepatic function.
Prolonged postoperative monitoring is often required
 Fentanyl is excreted in breast milk; the child should not
be breast-fed for24 hours following use of fentanyl
FERROUS SALT HC I N 10.1

Anti-anaemia mineral nutrient
Dosage forms
 Tablet: Ferrous sulphate 200 mg (containing 60 mg iron)
 Solution: 25 mg of iron/ml (for children)
Uses
 Iron-deficiency anaemia

F MONOGRAPHS
Dose and duration

All doses taken 1–2 divided doses for 4 months
Adult and child > 12 years: 2–3 tablets
Child 5–12 years: 2 tablets
Child 3–<5 years 1.5 tablets
Child 4 months–3 years: 1 tablet
Child 2–<4 months: 0.5 tablets
Contra-indications
 Accumulation of iron in body tissues and organs
 Anaemias not caused by iron deficiency (e.g. sickle cell
anaemia)
 Patients receiving repeated blood transfusions
Side effects
 Constipation, stomach upset
 Makes stool black
 Staining of teeth
 Accumulation of iron in the body
Interactions
 Calcium (reduced absorption)
 Zinc (reduced absorption)
 Milk (reduced absorption)
 Ciprofloxacin (reduced ciprofloxacin absorption)
 Doxycycline (reduced doxycycline absorption)
 Take with food to reduce side effects such as nausea and
gastric irritation
 Take 2 hours apart from milk, magnesium trisilicate com-
pound, calcium, zinc, ciprofloxacin, and doxycycline

FERROUS SALT + FOLIC ACID F
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Signs of overdose: Bloody diarrhoea and heart failure
 Preferably use tablets containing both ferrous salts and
folic acid
FERROUS SALT + FOLIC ACID HC I V 10.1

Anti-anaemia medicine containing ferrous salt and folic acid
Dosage forms
 Tablet: Ferrous sulphate/fumarate 150-200 mg equiva-
lent to 60 mg iron + 250-400 µg folic acid

Uses
 Prevention of anaemia in pregnancy
 Prevention of anaemia in malnutrition
 Treatment of anaemia
Dose and duration

 Prevention of anaemia in pregnancy
Adult: 1 tablet once daily throughout pregnancy

 Prevention of anaemia in malnutrition
1 tablet once daily for 3 months

 Treatment of anaemia (in combination with folic acid tab-
lets)
1 tablet once daily for 4 months
Contra-indications
 Accumulation of iron in the body tissues and organs

F MONOGRAPHS
 Anaemia not caused by iron deficiency (e.g. sickle cell

anaemia)
 Patients receiving repeated blood transfusions
Side effects
 Constipation, stomach upset
 Makes stool black
 Staining of teeth
 Accumulation of iron in the body
Interactions
Same as for ferrous salt
 Take 2 hours apart from milk, magnesium trisilicate com-
pound, calcium, zinc, ciprofloxacin, and doxycycline

 Take with food to reduce side effects such as nausea and
gastric irritation
 Compliance is very important for pregnant women as
anaemia can affect the proper development of the baby

and lead to poor health or death of the mother
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Ensure expectant mother has at least 3-month supply of
ferrous salt and folic acid
 The fixed dose combination formulation is not sufficient for
the treatment of folic acid deficiency as it has very low dose
(400 micrograms only). Use the folic acid 5 mg tablets instead

FLUCLOXACILLIN + AMOXICILLIN F
 Signs of overdose: bloody diarrhoea and heart failure
FLUCLOXACILLIN + AMOXICILLIN RR E 6.2.1

A combination of narrow spectrum beta-lactamase stable
penicillin (flucloxacillin) and broad-spectrum penicillin (amox-
icillin). Flucloxacillin has activity against beta-lactamase
producing Gram-positive bacteria but not against Methicillin-
resistant Staphylococcus aureus (MRSA)
Dosage forms
 Powder for reconstitution for injection: flucloxacillin 500
mg + amoxicillin 500 mg
Uses
 Mixed infections involving beta-lactamase producing
Staphylococci
Dose and duration
 Mixed infections involving beta-lactamase producing
Staphylococci
Adult: by slow IV injection over 3–4 minutes or by IM
injection, 500–1000 mg every 6–8 hours according to
severity of infection
Child 2–12 years: ½ adult dose
Child 1 month–2 years: ¼ adult dose
Contra-indications
 Hypersensitivity to penicillins
 History of flucloxacillin-associated jaundice or hepatic
dysfunction
Side effects
 Skin rash, urticaria, fever, pruritus, joint pain

F MONOGRAPHS
 Angioedema, anaphylaxis
 Diarrhoea, nausea, vomiting
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Use with caution in patients with porphyria and in new-
borns
 Avoid contact with skin due to risk of skin sensitisation
FLUCONAZOLE HC IV V 6.3
Triazole broad-spectrum antifungal medicine
Dosage forms
 Capsule: 50 mg, 200 mg
Uses
 Fungal skin infections
 Fungal nail infections
 Candidiasis
 Candiduria
Dose and duration

Adult and child over 16 years: 150 mg as a single dose

 Oropharyngeal and oesophageal candidiasis
Adult: 200–400 mg on day 1, then 100–200 mg once daily

for 7–21 days
FLUCONAZOLE F
Neonate and child 1 month–12 years: 3–6 mg/kg on the
1st day then 3 mg/kg (max 100 mg) once daily (once every
48 hours in neonate 2–4 weeks and once every 72 hours
in neonate under 2 weeks)
Treat for 7–14 days in oropharyngeal candidiasis (longer
in immunocompromised patients) and 14–30 days in oth-
er mucosal infections
 Candiduria
Adult: 200 –400 mg once daily for 7–21 days or longer in
immunocompromised patients
 Chronic atrophic candidiasis, chronic mucocutaneous
candidiasis
Adult and child over 12 years: 50 mg once daily (100 mg
in difficult infections) once daily 14–28 days or longer
depending on response
 Invasive candidal infections and cryptococcal infections
Adult: 400 mg on the 1st day, then 200–400 mg once daily
(max 800 mg once daily in severe life-threatening infec-
tions) for 6–8 weeks or according to response
Neonate and child 1 month–18 years: 6–12 mg/kg (max
800 mg) once daily (once every 48 hours in neonate 2–4
weeks and once every 72 hours in neonate under 2
weeks) for 6–8 weeks according to response
 Tinea pedis, corporis, cruris, pityriasis versicolor and der-
mal candidiasis
Adult: 50 mg once daily for 2–4 weeks (max 6 weeks in
tinea pedis)
Child 1 month–18 years: 3 mg/kg (max 50 mg) once daily
for 2–4 weeks (6 weeks in Tinea pedis). Maximum dura-
tion 6 weeks
F MONOGRAPHS
 Tinea capitis
Child 1 month–18 years: 6 mg/kg(max 300 mg) once daily
for 2–4 weeks
 Prophylaxis of recurrent vaginal candidiasis
Adult: 150 mg once weekly for 6 months

 Prophylaxis of cryptococcal meningitis in HIV patients
Adult: 200 mg once daily indefinitely

Child 1 month–18 years: 6 mg/kg (max 200 mg) once
daily
 Prophylaxis of other fungal infections in immunocompro-
mised patients
Adult: 50–400 mg once daily adjusted according to risk
(max 400 mg once daily in high risk infections)
Neonate and child 1 month–18 years: 3–12 mg/kg (max
400 mg) once daily (max 12 mg/kg (400 mg) in high risk
infections). Give once every 2 days in neonate 2–4 weeks
and once every 72 hours in neonate under 2 weeks
Contra-indications
 Acute porphyria
 Co-administration with terfenadine in patients receiving
fluconazole doses of 400 mg daily

 Hypersensitivity to fluconazole or other azoles
Side effects
 Nausea, abdominal and gastrointestinal pain, diarrhoea,
vomiting, flatulence
 Headache
 Increased liver enzyme levels, hepatic failure
 Torsades de pointes

FLUCONAZOLE F
Interactions
 Artemether + lumefantrine (manufactures advises avoid)
 Ciclosporin (increased concentration of ciclosporin)
 Clopidogrel (possibly reduced antiplatelet effect)
 Diazepam, midazolam (increased plasma concentration of
diazepam and midazolam-risk of prolonged sedation)

 Glibenclamide (increased concentration of glibenclamide)
 Nevirapine (increased plasma concentration of NVP)
 Phenytoin (plasma concentration of phenytoin increased)
 Rifampicin (reduced plasma concentration of fluconazole)
 Tacrolimus (increased concentration of tacrolimus)
 Zidovudine (increased risk of zidovudine toxicity)
Pregnancy
 Do not use
Breast-feeding
 Can be used
Caution
 In mild to moderate renal impairment, initiate with the
usual dose then halve subsequent doses
 Use with caution in concomitant use with hepatotoxic
medicines. Monitor liver function in high doses or
extended courses. Discontinue if signs of liver damage
occur

F MONOGRAPHS
FLUCYTOSINE RR N 6.3
Synthetic fluorinated pyrimidine antimycotic with a narrow
spectrum of antifungal activity. Mainly effective against
Cryptococcus and Candida spp
Dosage forms
Uses
 Systemic candidiasis
 Systemic yeast and fungal infections
Dose and duration

 Cryptococcal meningitis and systemic candidosis (in com-
bination with Amphotericin B in severe cases)

Adult and child: by IV infusion over 20–40 minutes, 50
mg/kg every 6 hours for up to 7 days (at least 4 months in
cryptococcal meningitis). In extremely sensitive organ-
isms, use half dose
By mouth, 50–150 mg/kg daily in divided doses
Note: In renal impairment, increase dosing intervals
Mild renal impairment: 50 mg/kg every 12 hours
Moderate renal impairment: 50 mg/kg every 24 hours
Severe renal impairment: initially 50 mg/kg, then adjust
subsequent doses based on serum concentration of flu-
cytosine to maintain plasma levels of 20–50 mi-
crograms/ml
Contra-indications
 Hypersensitivity to flucytosine
 Co-administration with antiviral nucleoside drugs like
brivudine, sorivudine
FLUMAZENIL F
Side effects
 Skin rashes
 Alteration in liver function tests
Pregnancy
 Do not use
Breast-feeding
 Do not use
Storage
o o
 Store between 18 C and 25 C (see caution)
Caution
 Monitor trough plasma concentrations. Concentrations
above 75 micrograms/ml are myelotoxic
 Precipitation may occur when flucytosine is stored below
18oC and decomposition to fluorouracil if stored at 25oC
for long periods
 Use with caution in blood disorders and if amphotericin B
is used concomitantly since both are nephrotoxic
 Monitor liver, kidney function, and blood counts before
treatment and thereafter weekly in prolonged therapy
 Carry out sensitivity testing since resistance to flucytosine
may develop during treatment
FLUMAZENIL H V 4.1
Antidote for benzodiazepine poisoning with antagonistic ac-
tivity on benzodiazepine receptors
Dosage forms
 Solution for injection: 0.1 mg/ml

F MONOGRAPHS
Uses
 Management of benzodiazepine toxicity in anaesthesia,
intensive care, and clinical procedures

Dose and duration
 Anaesthesia and clinical procedures
By IV injection
Adult: 0.2 mg over 15 seconds, then 0.1 mg at 60 second
intervals if required. Usual dose range, 0.3–0.6 mg (maxi-
mum total dose, 1 mg)
Child 1 month–18 years: 0.01 mg/kg (max 0.2 mg). Re-
peated at 1 minute intervals if required. Maximum total
dose of 0.05 mg/kg
Neonate: 0.001 mg/kg repeated at 1 minute intervals if re-
quired
If drowsiness recurs after injection,
By IV infusion,
Child 1 month–18 years: 0.002- 0.01 mg/kg/hour, adjusted
according to response. Maximum dose 0.4 mg/hour
Neonate: 0.002- 0.01 mg/kg/hour, adjusted according to
response
 Intensive care
Adult: by IV injection, 0.3 mg over 15 seconds, then 0.1 mg

at 60 second intervals if required (maximum total dose 2
mg) if drowsiness recurs either, by IV injection, 0.3 mg; or
by IV infusion of 0.1–0.4 mg/hour adjusted according to re-
sponse
Child and neonate: dose same as for anaesthesia
Preparation
 Can be used without dilution. For continuous IV infusion,
dilute with Glucose 5% or Sodium Chloride 0.9%

FLUMAZENIL F
Contra-indications
 Hypersensitivity to flumazenil
 Where benzodiazepine used for treatment of a life-
threatening condition such as status epilepticus, in-

creased intracranial pressure
Side effects
 Increased risk of panic disorders in patients with history
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Avoid breast-feeding for 24 hours after treatment with
flumazenil
 Repeat doses often required since half-life of most ben-
zodiazepines is longer than half-life of flumazenil
 Benzodiazepine dependence may precipitate withdrawal
symptoms
 Risk of convulsions when flumazenil is given to patients
on prolonged benzodiazepine therapy for epilepsy
 Ensure neuromuscular blockade has cleared before giving
 Avoid rapid injection in high-risk or anxious patients and
following major surgery
 Use cautiously in patients with head injury since rapid re-
versal of benzodiazepine sedation may cause convulsions
 Carefully titrate dose in hepatic failure

F MONOGRAPHS
FLUOROURACIL NR V 8.2
Antimetabolite anticancer medicine
Dosage forms
Uses
 Colorectal cancer
 Breast cancer
 Stomach cancer
 Cervical, prostate, ovary, endometrial cancer
 Liver tumours
 Head and neck tumours
Dose and duration

Dose and duration depend on the cancer being treated
Initial treatment: 15 mg/kg by IV infusion over 1−4 hours;

repeat daily until a total dose of 12−15 g has been reached.
Total daily dose should not exceed 1 gram
Maintenance dose: give after 4−6 weeks when side effects of

initial treatment have resolved
Contra-indications
 Hypersensitivity to fluorouracil
 Bone marrow depression
Side effects
 Erythema of hands and feet (palmar−plantar syndrome)
 Mucositis
 Diarrhoea

FLUOROURACIL F
 Alopecia
 ECG changes; angina pectoris-like pain
 CNS toxicity
Interactions
 Allopurinol
 Warfarin (increased effect of warfarin)
 Live vaccines (risk of developing disease)
Pregnancy
 Do not use
Breast-feeding
Storage
 After reconstitution, store between 2−8°C; use within 24
hours
Caution
 Reduce dose in patients with cachexia, major surgery
within 30 days, reduced bone marrow function, impaired
renal or hepatic function
 Capecitabine is a pro-drug of fluorouracil

F MONOGRAPHS
FLUOXETINE H V 24
Selective Serotonin Re-uptake Inhibitor (SSRI) with psycho-
therapeutic action
Dosage forms
 Capsules: 20 mg
Uses
 Treatment of major depression
 Treatment of Bulimia nervosa
 Treatment of obsessive compulsive disorder
Dose and duration

 Treatment of major depression
Adult over 18 years: 20 mg once daily, increased as nec-

essary after 3–4 weeks to a maximum of 60 mg once daily
Child 8–18 years: 10 mg once daily increased after 1–2
weeks if necessary to a maximum of 20 mg once daily
 Treatment of Bulimia nervosa
Adult > 18 years: 60 mg daily as a single or in divided

doses
 Treatment of obsessive compulsive disorder
Adult > 18 years: 20 mg daily increased gradually if nec-

essary to maximum 60 mg
Elderly: maximum daily dose for all uses is 40 mg
Contra-indications
 Manic phase
Side effects
 Insomnia, abnormal dreams, headache, disturbance in
attention, dizziness, lethargy, hyperhidrosis (excessive

sweating), fatigue
 Anxiety, restlessness, tension, decreased libido

FLUOXETINE F
 Dysgeusia (distortion of sense of taste)
 Blurred vision
 Palpitations, flushing
 Yawning
 Vomiting, dyspepsia, diarrhoea, nausea, dry mouth
 Anorexia with weight loss
 Rash, urticaria, pruritus
 Joint pain, tremor
 Frequent urination
 Gynaecological bleeding
 Erectile dysfunction, ejaculation disorder
 Chills
Interactions
 Acetylsalicylic acid, ibuprofen (increased risk of bleeding)
 Artemether/ Lumefantrine (risk of arrhythmias)
 Carbamazepine (increased plasma concentrations of car-
bamazepine)
 Clopidogrel (reduced antiplatelet effect of clopidogrel)
 Haloperidol (increased concentration of haloperidol)
 Lithium (increased risk of CNS effects)
 MAOI (increased CNS effects of fluoxetine)
 Phenytoin (increased concentrations of phenytoin)
 Ritonavir (increased concentrations of fluoxetine)
 Tramadol (increased risk of CNS toxicity)
 Warfarin (anticoagulant effect possibly enhanced)
Pregnancy
st rd
Breast-feeding
 Can be used

F MONOGRAPHS
Caution
 Use lowest effective dose in breast-feeding mother or
discontinue breast-feeding
 Risk of increased suicidal behaviour especially in children
and adolescents
 Avoid use in poorly controlled epilepsy and discontinue if
convulsions develop during treatment
 Fluoxetine should not be started until 2 weeks after stop-
ping a MAOI. Conversely, a MAOI should not be started
until at least 5 weeks after fluoxetine has been stopped
 Reduce dose or give on alternate days in liver impairment
FLUPHENAZINE DECANOATE H E 24
First generation, long-acting depot antipsychotic medicine
Dosage forms
 Oily solution for injection: 25 mg/ml
Uses
 Maintenance treatment of schizophrenia and other psy-
choses
Dose and duration Contraindications
 Maintenance treatment of schizophrenia and other psy-
choses
Adult: By deep IM injection into the gluteal muscle, 12.5
mg (6.25 mg in elderly) as a single test dose. Then after
4–7 days, 12.5–100 mg is given and dose is repeated at
intervals of 2–5 weeks according to response
Child: not recommended

FLUPHENAZINE DECANOATE F
Contraindications
 Comatose states
 Severe cardiac insufficiency
 Hypersensitivity to fluphenazine decanoate
 Parkinsonism
 Depression
 Existing blood dyscrasias
 Marked cerebral atherosclerosis
Side effects
 Parkinsonian symptoms: tremor, dystonia, tardive dyski-
nesia, akathisia
 Drowsiness, lethargy
 Blurred vision
 Urinary incontinence
 Mild hypotension
 Impaired judgement and mental skills
Interactions
 Amitriptyline, clomipramine (increased risk of antimusca-
rinic adverse effects)

 Artemether+ Lumefantrine (avoid concomitant use)
 Carbamazepine, ethosuximide, phenobarbital, phenytoin,
valproic acid (antagonism of anticonvulsant effect)

 Halothane, ketamine, nitrous oxide, thiopental (enhanced
hypotensive effect)
 Procainamide(increased risk of ventricular arrhythmias)
 Ritonavir (plasma concentration increased by ritonavir)

F MONOGRAPHS
Pregnancy
rd
Breast-feeding
 Can be used
Caution
 Not recommended for use in children
 Do not use in hepatic impairment due to risk of hepato-
toxicity and precipitation of coma
 Closely supervise patient during dose increments
 Withdrawal after long-term therapy should be gradual to
avoid withdrawal symptoms or relapse
 Administer a test dose since side effects are prolonged
 Do not use in the elderly to treat mild to moderate psy-
chotic symptoms due to increased risk of stroke, mortali-
ty and transient ischaemic attack
 Start with small doses in renal impairment
FOLIC ACID (VITAMIN B9) HC II N 10.1

Anti-anaemia medicine; also known as vitamin B9
Dosage forms
 Tablets: 5 mg
Uses
 Treatment of folate-deficient (megaloblastic) anaemia
(during severe malnutrition, repeated malaria attacks, in-

testinal parasite infestations, pregnancy)
 Prevention of anaemia in sickle-cell anaemia
 Prevention of spinal cord defects in foetus

FRAMYCETIN F
Dose and duration
 Treatment and prevention of anaemia
Adult and child >5 years: 5 mg once daily for 4 months

Child <5 year: 2.5 mg once daily for 4 months
 Prevention of spinal cord defects in foetus
Adult: 5 mg once daily throughout pregnancy

Interactions
 Sulfadoxine + pyrimethamine (cancel led effect)
 Co-trimoxazole (cancelled effect)
 Compliance is very important for pregnant women as
anaemia can affect the proper development of the baby

and lead to poor health or death of the mother
 When given with sulfadoxine + pyrimethamine (SP) for
IPTp, delay folic acid for 1 week after taking SP

Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 In megaloblastic anaemias, folic acid should be given with
vitamin B12
FRAMYCETIN HC III N 13.2

Topical aminoglycoside antibacterial
Dosage forms
 Impregnated gauze: 1%, supplied in sterile single pieces
of 10 cm x 10 cm or 10 cm x 30 cm
F MONOGRAPHS
Uses
 Antibacterial dressing for infected skin wounds, ulcers,
and burns
Dose and duration
Apply a single piece of dressing to the wound
If the wound is wet, change the dressing at least once
daily. Keep the dressing in place by using a bandage or
tape
Cut the dressing to the size of the affected area to
avoid contact with healthy skin
Contra-indications
 Uninfected wounds
 Allergy to gentamicin, streptomycin, lanolin, or paraffin
Side effects
 Hearing impairment (on prolonged use)
 Do not apply on breasts if breast-feeding
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Not for internal use
 Avoid prolonged use
 Avoid contact with mucosal surfaces as framycetin is very
toxic when it gets inside the body
 Apply after cleaning the wound

FUROSEMIDE F
FUROSEMIDE HC IV V 16
Loop diuretic suitable when rapid and effective diuresis is
required such as cardiac, renal, pulmonary and hepatic
oedema. Oral furosemide produces diuresis within 30–60
minutes of administration, and a maximum effect in 1–2
hours. The diuretic action lasts 4–6 hours. Intravenous furo-
semide produces diuresis within 5 minutes, and a maximum
effect in 20–60 minutes; diuresis is complete within 2 hours.
Dosage forms
 Tablet: 40 mg
Uses
 Pulmonary oedema
 Ascites
 Oliguria due to renal failure
 Oedema due to kidney or liver disorders
 Adjunct in transfusion (prevention fluid overload)
Dose and duration

 Oedema
Adult: 20‒50 mg orally, increased in 20 mg steps every 2

hours as necessary. If the effective single dose is more 50
mg, consider using slow IV infusion at a rate not exceed-
ing 4 mg/minute
Child: 0.5‒1.5 mg/kg daily (max. 20 mg daily)
 Oliguria (glomerular filtration rate < 20 ml/minute)
Adult: Initially 250 mg over 1 hour by slow IV infusion

at a rate not exceeding 4 mg/minute. If urine output is
not satisfactory during the hour after the first dose,

F MONOGRAPHS
infuse 500 mg over 2 hours, then infuse 500 mg over 2

hours; if urine output is not satisfactory after second
dose, infuse 1 g over 4 hours. If no response, consider
dialysis.
Repeat every 24 hours
Contra-indications
 Hypovolemia or dehydration
 Obstructed urinary flow e.g. in prostatic hypertrophy
 Anuria or renal failure with anuria not responding to a fu-
rosemide challenge
 Renal failure by agents that cause renal or liver failure
 Severe hypokalaemia
 Severe hyponatraemia
 Coma due to hepatic encephalopathy
 Allergy to furosemide
 Gout
Side effects
 Stomach upset (usually mild)
 Increased frequency of urination
 May inhibit breast milk production
 Dehydration
 Low blood pressure
 Electrolyte and water imbalances; low sodium, potassi-
um, magnesium, calcium and chloride levels

 Hyperuricaemia leading to gout attacks
 Tinnitus and permanent deafness when infused rapidly
 Pain at injection site when used intramuscularly
 Hyperglycaemia

FUROSEMIDE F
Interactions
 Aminoglycosides e.g. amikacin, gentamicin, streptomycin
(increased risk of ototoxicity)

 Vancomycin (increased risk of ototoxicity)
 Digoxin (increased digoxin toxicity due to hypokalaemia)
 Enalapril (enhanced hypotensive effect)
 Lidocaine (reduced effect of lidocaine due to hypokalae-
mia)
 Lithium (increased lithium concentration)
 Report to health worker immediately any signs of
increased thirst, headache, hypotension, confusion, mus-

cle cramps, muscle weakness, irregular heart beat and
stomach upset
Pregnancy
 Do not use
Breast-feeding
 Do not use
Caution
 Use lower doses in elderly as they are more prone to side
effects
 Rapid infusion of intravenous furosemide can cause tinni-
tus and permanent hearing loss
 Warning signs of electrolyte disturbances include in-
creased thirst, headache, hypotension, confusion, muscle
cramps, muscle weakness, irregular heart beat and stom-
ach upset
 May be given with a potassium-sparing diuretic to reduce
risk of hypokalaemia
G MONOGRAPHS
G
GANCICLOVIR EYE OINTMENT RR E 21.5
Antiviral medicine
Dosage forms
 Ophthalmic gel: 0.15%
Uses
 Treatment of local herpes simplex infections
Dose and duration

 Local herpes simplex infections
Adult: instil 1 drop in the eyes 5 times a day until com-

plete healing, then instil 1 drop 3 times a day for another
7 days
Contra-indications
 Hypersensitivity to ganciclovir or acyclovir
Side effects
Systemic effects unlikely after ocular instillation
 Burning sensation, brief tingling sensations
 Superficial punctuate keratitis
Interactions
 Imipenem with cilastatin (increased risk of convulsions)
 Zidovudine (profound myelosuppression)
 Discard 4 weeks since first opening
 Do not drive or operate machines if visual disturbance
occurs

GANCICLOVIR SODIUM G
Pregnancy
 Can be used
Breast-feeding
 Can be used
GANCICLOVIR SODIUM RR E 6.5

Antiviral medicine active against cytomegalovirus (CMV)
Dosage forms
Uses
 Life-threatening or sight-threatening cytomegalovirus
(CMV) infection
 Congenital cytomegalovirus infection of the CNS
 Prevention of CMV disease during immunosuppressive
therapy
Dose and duration
 Treatment of CMV infection
Adult and child: by IV infusion over 1 hour, induce with 5

mg/kg every 12 hours for 14–21 days. In patients at risk
of relapse CMV retinitis, give a maintenance dose of 6
mg/kg once daily on 5 days per week or 5 mg/kg once
daily until adequate recovery of immunity
 Prevention of CMV
Adult and child: induce with 5 mg/kg by IV infusion

every 12 hours for 7–14 days and maintenance dose as
above in treatment
 Congenital cytomegalovirus infection of the CNS
Neonate: by IV infusion, 6 mg/kg every 12 hours for 6

weeks
G MONOGRAPHS
In renal impairment:
Creatinine clearance Induction dose
≥ 70 ml/min 5 mg/kg every 12 hours
50–69 ml/min 2.5 mg/kg every 12 hours
25–49 ml/min 2.5 mg/kg/day
10–24 ml/min 1.25 mg/kg/day
< 10 ml/min 1.25 mg/kg/day after hae-
modialysis
Contra-indications
 Hypersensitivity to vanganciclovir, ganciclovir, acyclovir
or valaciclovir
 Low haemoglobin, neutrophil or platelet counts
Side effects
 Hepatic dysfunction, renal impairment
 Dyspnoea, chest pain, cough
 Headache, insomnia, convulsions, dizziness, depression,
anxiety, confusion, abnormal thinking, fatigue

 Weight loss, anorexia
 Infection, pyrexia, night sweats
 Anaemia, leucopoenia, thrombocytopenia, pancytopenia
 Myalgia, arthralgia
 Macular oedema, retinal detachment, vitreous floaters,
eye pain, ear pain

 Dermatitis, pruritus
 Injection-site reactions
Interactions
 Imipenem with cilastatin (increased risk of convulsions)

GEMCITABINE G
 Zidovudine (profound myelosuppression when used con-
comitantly; avoid concomitant use)
Pregnancy
 Do not use
Breast-feeding
 Do not use
Caution
 In pregnancy, ganciclovir is potentially teratogenic and
carcinogenic risk
 Ensure effective contraception for men and women dur-
ing treatment and for at least 3 months after treatment
 Risk of ganciclovir resistance is higher in patients with a
higher viral load or dose on long duration treatment
 Do full blood count monitoring; correct or suspend
treatment in case of severe decline in blood counts
 Use with caution in history of cytopenia and in patients
receiving radiotherapy
 Ganciclovir is a vesicant and thus should be infused into a
vein with adequate flow preferably using plastic cannula
 Use with caution in children due to possible risk of long-
term carcinogenic or reproductive toxicity
GEMCITABINE NR V 8.2
Dosage forms
Uses
Locally advanced or metastatic:

G MONOGRAPHS
 Non-small cell lung cancer

 Bladder cancer
 Adenocarcinoma of pancreas
 Epithelial ovarian carcinoma
 Breast cancer
Dose and duration
 Bladder cancer (in combination with cisplatin)
1000 mg/m2 by IV infusion over 30 minutes on day 1, 8

and 15 of each 28-day cycle. Cycle repeated and dose
reduced as necessary
 Pancreatic cancer
1000 mg/m2 by IV infusion over 30 minutes. Repeat

once weekly for up to 7 weeks followed by 1 week of
rest. Repeat once weekly for 3 consecutive weeks out
of every 4 weeks.
 Non-small cell lung cancer (monotherapy)
1000 mg/m2 by IV infusion over 30 minutes. Repeat

once weekly for 3 weeks followed by a 1-week of rest.
Repeat once weekly for 3 consecutive weeks out of
every 4 weeks
 Breast cancer (in combination with paclitaxel)
1250 mg/m2 by IV infusion over 30 minutes (given af-

ter paclitaxel infusion) on day 1 and 8 of each 21-day
cycle. Cycle repeated as necessary
 Ovarian cancer (in combination with carboplatin)
1000 mg/m2 by IV infusion over 30 minutes (given be-

fore carboplatin infusion) on day 1 and 8 of each
21-day cycle. Cycle repeated as necessary
Contra-indications

GEMCITABINE G
 Hypersensitivity to gemcitabine
Side effects
 Myelosuppression (leucopoenia, thrombocytopenia,
anaemia, neutropenia)
 Musculoskeletal pain
 Influenza-like symptoms, cough, difficulty in breathing
 Rashes
 Headache, insomnia, somnolence, fever, chills
 Haematuria, mild proteinuria
 Liver damage (worsen existing disease)
Interactions
 Radiotherapy (increased toxicity)
 Live vaccines (risk of developing disease in vaccines)
Pregnancy
 Do not use
Breast-feeding
Storage
 Do not refrigerate reconstituted gemcitabine to prevent
crystallisation. Keep at 30°C and use within 24 hours

Caution
 Monitor platelet and granulocyte counts. Patient should
have an absolute granulocyte count of at least 1500 (x
106/l) and platelet count of 100,000 (x 106/l) prior to initi-
ation of treatment
 For repeat cycles, reduce dose based on platelet and
granulocyte count as specified in product literature

G MONOGRAPHS
 Men and women should take adequate contraception

during treatment with gemcitabine
GENTAMICIN HC III V 6.2.2, 21.1

Broad spectrum aminoglycoside antibacterial
Dosage forms
 Injection: 40 mg/ml in 2 ml vial
 Solution for eye/ear drops: 0.3%
Uses
 Brucellosis
 Neonatal meningitis
 Neonatal sepsis
 Endocarditis
 Plague
 Septicaemia
 Eye infection (blepharitis, bacterial conjunctivitis)
 Ear infection (topical use)
Dose and duration

 Brucellosis (in combination with doxycycline)
Adult: 5–7 mg/kg IV once daily for 14 days

Child <8 years: 7.5 mg/kg daily in 1–3 divided doses for
14 days
 Neonatal meningitis, neonatal sepsis (in combination with
ampicillin or benzylpenicillin)
GENTAMICIN G
2.5 mg/kg IV every 12 hours for 21 days
 Plague)
1.7 mg/kg IV or IM every 8 hours for 7 days
 Septicaemia (in combination with cloxacillin or ceftriax-
one or benzylpenicillin or chloramphenicol)
Adult: 1.5–2 mg/kg IV or IM every 8 hours for 14 days
Child: 3.5–4 mg/kg IV every 8 hours for 14 days
Neonate: 3.5–4 mg/kg every 8–12 hours for 14 days
 Severe pneumonia, endocarditis (first line treatment; in
combination with ampicillin)
Adult: 5–7 mg/kg IV daily in 1–2 divided doses for 5
days
Child >7 days: 2.5 mg/kg IV every 8 hours for 5–10
days
Child <7 days: 2.5 mg/kg IV every 12 hours for 5–10
days
In moderate pneumonia, give for 7 days
In very severe pneumonia, give for 10 days
Adult: 1.5 mg/kg by slow IV injection over 3 minutes, at
least 30 minutes before procedure
Adult: 5–7 mg/kg IV daily in 2–3 doses
Child: 2.5 mg/kg every 8 hours for 7 days
 Eye or ear infection
Apply 1 drop every 2 hours, and then reduce frequen-
cy as infection is controlled. Continue for up to 48
hours after healing is complete.
In severe infection, apply 1 drop every hour.

G MONOGRAPHS
Contra-indications
 Allergy to gentamicin or streptomycin
 Severe hearing problems
Side effects
 Kidney disease
 Hearing problems
 Rash
 Local irritation with eye drops
Interactions
 Streptomycin (increased risk of side effects)
 Furosemide (increased risk of side effects)
 Report immediately to health worker if any hearing
problems or reduced urinary output occur

Pregnancy
 Do not use
Breast-feeding
 Can be used
Caution
 Reduce dose in kidney disease to 1 mg/kg/day or increase
the dosing interval
 Give with caution to the elderly; daily dose usually given
in two doses to minimise side effects
 Avoid prolonging treatment unnecessarily; whenever
possible, do not exceed 7 days
 In obese patients use ideal (not actual) body weight to

GENTIAN VIOLET (METHYLROSANILINIUM CHLORIDE) G
calculate dose
 Doxycycline is the first line for plague
 Prolonged use for eye infections may cause skin sensitisa-
tion and emergence of resistant organism including fungi;
discontinue if there is purulent discharge, inflammation
or exacerbation of pain
GENTIAN VIOLET (METHYLROSANILIN-

HC II N 13.2
IUM CHLORIDE)
See methylrosanilinium chloride
GLIBENCLAMIDE HC IV V 18.5
Sulphonylurea. Oral antidiabetic (hypoglycaemic) medicine
for non-insulin dependent diabetes
Dosage forms
 Tablet: 5 mg
Uses
 Type 2 diabetes mellitus
Dose and duration

 Diabetes mellitus
Adult: Initially 5 mg orally once daily; increased

according to response to a maximum of 15 mg.
Doses > 10 mg should be taken in 2 divided doses
Elderly: 2.5 mg orally once daily
Contra-indications
 Type 1 (insulin-dependent diabetes)
 Ketoacidosis
 Porphyria

G MONOGRAPHS
 Severe renal disease

 Allergy to sulphonylureas or sulphonamides
 Children
 Overweight patients
Side effects
 Stomach upset
 Hypoglycaemia
 Weight gain
Interactions
 Chloramphenicol (increased effect of glibenclamide)
 Fluconazole (increased concentration of glibenclamide)
 Rifampicin (Reduced effect of glibenclamide)
 Warfarin (increased hypoglycaemic effect)
 Take with or immediately after breakfast
 Do not take the medicine when you have skipped a meal
or on an empty stomach to avoid risk of low blood sugar

Pregnancy
 Do not use
Breast-feeding
 Can be used
Caution
 Use lower doses in elderly and in patients with liver or
kidney insufficiency because of the risk of hypoglycaemia
 During pregnancy, severe illness, trauma, surgery, use
insulin instead

GLIMEPIRIDE G
 Counsel patient to continue with exercise and dietary
measures of controlling blood glucose
GLIMEPIRIDE RR N 18.5
Sulfonylurea antidiabetic medicine
Dosage forms
Uses
 Type2 diabetes mellitus
Dose and duration

Adult: initially, 1 mg once daily increased by 1 mg every

1–2 weeks according to response (max 4 mg daily but in
exceptional cases, up to 6 mg may be beneficial) taken
shortly before or with the first meal of the day
Contra-indications
 Ketoacidosis
 Insulin dependent diabetes
 Diabetic coma
 Hypersensitivity to glimepiride or other sulfonylureas
 Severe renal or hepatic function disorders
Side effects
 Nausea, vomiting, diarrhoea, constipation
 Hyponatraemia
 Haemolytic anaemia in G6PD-deficiency
Interactions
 Chloramphenicol (effects of glimepiride increased)
 Fluconazole and miconazole (plasma concentration of

G MONOGRAPHS
glimepiride increased)
 If a dose is forgotten, do not increase the next dose
 Swallow the tablets whole with a glass of water with or
shortly before the first meal of the day

 Take your meals regularly to avoid hypoglycaemia
Pregnancy
 Do not use
Breast-feeding
 Can be used
Caution
 May promote weight gain; avoid in obese patients
 Ensure regular hepatic and haematological monitoring
 Use with caution in mild to moderate renal impairment
due to hypoglycaemic risk, avoid in severe impairment
 Avoid use in breast-feeding due to theoretical risk of hy-
poglycaemia in the infant
 Dose of glimepiride should be reduced timely as insulin
sensitivity may improve during treatment leading to
reduced glimepiride requirements
GLUCOSE (DEXTROSE) HC III V 26.2

Fluid replacement solution; also used to prepare injectable
medicines
Dosage forms
 Solution for IV infusion: 5% (D5%, isotonic)
 Solution for IV infusion: 50% (hypertonic)

GLUCOSE (DEXTROSE) G
Uses
 Fluid replacement (dehydration) in case of loss due to
burns, shock, diarrhoea, or vomiting

 Hypoglycaemia(low blood glucose level)
 Preparation of injectable medicines
Dose and duration

 Fluid replacement (in combination with sodium chloride
or Ringer’s Lactate)
2 litres (4 bottles of 500 ml) of 5% glucose in 24 hours.
Duration according to clinical response.
 Hypoglycaemia
1 ml/kg 50% glucose as an IV bolus (slowly over 5

minutes) diluted with an equal volume of water for in-
jections. Give by nasogastric tube if IV route is not
possible
 Preparation of injectable medicines
See relevant medicine

Side effects
 Irritation at the injection site, thrombophlebitis
 Electrolyte disturbances, high blood glucose level
 Oedema
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Glucose solutions have low sodium content and are poor
replacement fluids. Always use in combination with Ring-
er's lactate or sodium chloride
G MONOGRAPHS
 Do not use glucose to prepare phenytoin injection

 Never give by IM or SC routes
 Glucose 50% solution is very thick and sticky and can also
cause injection site reactions. Dilute 50% solution with an
equal volume of water for injection or normal saline.
 Monitor blood glucose levels every 30 minutes
 As soon as patient is able to take orally, switch to oral
glucose/sugary drinks
GLUTARALDEHYDE H N 15.2
Broad spectrum disinfectant
Dosage forms
 Solution: 2%
Uses
 High level disinfection of medical equipment
Dose and duration

 High level disinfection of medical equipment
Completely immerse the instrument in an activated 2%

solution of glutaraldehyde for 30 minutes. Then thor-
oughly rinse with sterile water
Preparation
 Activate using powder or liquid supplied by the manufac-
turer
Side effects
 Skin irritation, dermatitis, skin sensitisation
 Nausea
 Headache
 Eye irritation

GLUTARALDEHYDE G
 Respiratory tract irritation, breathlessness
 Rhinitis, occupational asthma
Storage
0
 Keep activated solution at 15–40 C and for NOT more
than 2 weeks
Caution
 Glutaraldehyde should not be inhaled, ingested or used
on skin, eyes or other mucous membranes
 Wear suitable protective clothing, gloves and eye
protection when using glutaraldehyde
 Use only in well ventilated areas
 In case of contact with eyes, immediately flush the eyes
with water and continue washing for at least 15 minutes
and then seek medical attention without delay. Do not
remove contact lenses during washing
 In case of contact with skin, immediately remove contam-
inated clothing and wash skin thoroughly with soap and
water. Seek medical attention
 In case of inhalation, move the patient to fresh air. Give
artificial respiration if it is required
 In case of ingestion, wash out mouth thoroughly with
water and drink large quantities of demulcents such as
milk. DO NOT induce vomiting. Seek medical attention
 All equipment should first be carefully cleaned to remove
dirt and organic matter before soaking in glutaraldehyde
 Discard solution if it becomes cloudy

G MONOGRAPHS
GLYCERYL TRINITRATE H V 12.1

Anti- angina nitrate with coronary vasodilator activity
Dosage forms
 Tablet (sublingual): 500 µg
Uses
 Prophylaxis of angina
 Treatment of angina
Dose and duration

Adult: 500 µg used prior to activity that may precipitate

angina
Adult: 500−1000 µg repeated as required at 5 minute in-

tervals up to a maximum of 3 doses
Contra-indications
 Hypotension, hypovolemia
 Aortic and mitral stenosis, cardiac tamponade
 Constrictive pericarditis
 Mitral stenosis
 Toxic pulmonary oedema
 Marked anaemia
 Raised intracranial pressure due to head trauma or cere-
bral haemorrhage
 Hypersensitivity to nitrates
Side effects
 Flushing, throbbing headache, postural hypotension,
tachycardia, decrease in blood pressure

GLYCERYL TRINITRATE G
 Dizziness, physical weakness
Interactions
 Heparin (anticoagulant effect of heparin reduced by
infusion of glyceryl trinitrate)

 Slidenafil, tadalafil (hypotensive effect of glyceryl
trinitrate significantly enhanced)

 Dissolve the tablet under your tongue; do not chew or
swallow
 Store the tablets in the container provided away from
moisture and light, with the cap tightly closed.

 Discard any remaining tablets after 8 weeks since first
opening of the container

 You should sit down whenever possible immediately after
or when you are taking your medication

Pregnancy
 Can be used
Breast-feeding
 Can be used
Storage
0
 Store below 25 C in a dry place protected from light. Con-
tainer should always be tightly closed and sealed

Caution
 Preferably dispense in a glass container
 Hypotension and syncope may occur more commonly in
the elderly
 Avoid concomitant use with phosphodiesterase inhibitors
e.g. theophylline, aminophylline, caffeine

G MONOGRAPHS
GLYCOPYRROLATE (GLYCOPYRRONIUM
RR V 1.3
BROMIDE)
Antimuscarinic medicine
Dosage forms
 Injection: 200 micrograms/ml
Uses
 Intra-operative bradycardia
 Bowel colic
 Excessive respiratory secretions
 Reversal of non-depolarising neuromuscular block (with
neostigmine)
Dose and duration
By IM or IV injection,
Adult and child over 12 years: 200–400 micrograms or
4–5 micrograms/kg (max 400 micrograms) before induc-
tion of anaesthesia
Child 1 month–12 years: 4–8 micrograms/kg (max 200
micrograms) before induction of anaesthesia
Neonate: 5 micrograms/kg
 Bowel colic and excessive respiratory secretions
By SC infusion
Adult and child over 12 years: 600–1200 micrograms per
24 hours given every 4 hours as is required (hourly
administration may be required in excessive respiratory
secretions)
Child 1 month–12 years: 12–40 micrograms/kg/24 hours
(max 1200 micrograms)

GLYCOPYRROLATE (GLYCOPYRRONIUM BROMIDE) G
By mouth (injection solution can be used)
Child 1 month–18 years: 40–100 micrograms/kg (max
2000 micrograms) 3–4 times daily, adjusted according to
response
By SC injection or IM injection or intravenous injection,
Child 12–18 years: 200 micrograms every 4 hours when
required
micrograms) 4 times a day when required
 Intraoperative bradycardia
By IV injection,
Adult: 200–400 micrograms or 4–5 micrograms/kg (max
400 micrograms) repeated if necessary
micrograms) repeated if necessary
Neonate: 10 micrograms/kg repeated if necessary
 Reversal of non-depolarising neuromuscular blocking
drugs (with neostigmine)

By IV injection,
Adult and child over 12 years: 200 micrograms per 1 mg
of neostigmine, or 10–15 micrograms/kg with 0.05 mg/kg
of neostigmine
Child 1 month–12 years: 10 micrograms/kg (max 500
micrograms) with 0.05 mg/kg of neostigmine
Neonate: 10 micrograms/kg
Preparation
 Injection solution can be used for oral administration
Contra-indications
 Hypersensitivity to glycopyrrolate

G MONOGRAPHS
Side effects
 Dry mouth, inhibition of sweating, constipation
 Transient bradycardia (followed by tachycardia, palpita-
tion and arrhythmias)

 Reduced bronchial secretions
 Urinary urgency and retention, difficulty in micturition
 Dilatation of pupils, loss of accommodation, photophobia
 Flushing, dryness of the skin
 Confusion (particularly in the elderly)
Pregnancy
 Do not use
Breast-feeding
 Can be used
Caution
 Use with extreme caution in patients with thyrotoxicosis,
coronary artery disease, cardiac dysrhythmias, hyperten-
sion, congestive heart failure and cardiac insufficiency
 Observe patients with raised temperature closely since
glycopyrrolate inhibits sweating
 Use with caution in patients with paralytic ileus, prostatic
hypertrophy, pyloric stenosis and closed angle glaucoma
GOSERELIN RR V 8.2
Gonadotropin releasing hormone super-agonist (GnRH)
Dosage forms
 Implant: 3.6 mg

GOSERELIN G
Uses
 Prostate cancer
 Advanced breast cancer
 Endometriosis
 Endometrial thinning
 Uterine fibroids
 Assisted reproduction
Dose and duration

One 3.6 mg capsule injected subcutaneously into the
anterior abdominal wall every 28 days
 Endometriosis: use for 6 months
 Endometrial thinning: give for 4−8 months
Contra-indications
 Children
 Undiagnosed vaginal bleeding
 Hypersensitivity to goserelin
Side effects
 Pain, hematoma, haemorrhage at injection site
 Ureteric obstruction in men
 Spinal cord compression in men
 Depression, mood changes
 Impaired glucose tolerance, weight gain
 Decreased libido, erectile dysfunction
 Paraesthesia
 Cardiac and myocardial infarction
 Hot flush
 Rash
 Alopecia, gynaecomastia
 Bone pain

G MONOGRAPHS
Interactions
 Antiarrhytmic medicines (increased risk of QT interval
prolongation)
Pregnancy
 Do not use
Breast-feeding
 Do not use
Caution
 Monitor patient closely for depression
GRANISETRON RR E 17.2
Serotonin (5HT3) receptor antagonist which blocks 5HT3
receptors in the gastro-intestinal tract and the CNS
Dosage forms
 Solution for injection: 1mg/ml
Uses
 Acute nausea and vomiting associated with chemothera-
py and radiotherapy
 Post-operative nausea and vomiting
Dose and duration

Administer as a slow IV injection over at least 30 seconds or
as a diluted IV infusion over 5 minutes
 Chemotherapy and radiotherapy-induced nausea and
vomiting
Adult and child > 12 years: prevention, 1–3 mg (0.01–
0.04 mg/kg) 5 minutes before start of chemotherapy or
radiotherapy; treatment, initially, 1–3 mg (0.01–0.04
mg/kg), then maintenance doses administered as
GRANISETRON G
required, the doses given at least 10 minutes apart from
each other (max 9 mg in 24 hours)
Child 1 month–12 years: prevention, 0.01–0.04 mg/kg
(max 3 mg) before start of chemotherapy or radiothera-
py: treatment, 0.01–0.04 mg/kg (max 3 mg) repeated at
least 10 minutes after initial dose if necessary (max 2
doses in 24 hours)
Adult: prevention, by IV injection, 1 mg (0.01 mg/kg)

before induction of anaesthesia; treatment, 1mg by slow
intravenous injection (max 3 mg in 24 hours)
Preparation
 Dilute solution for injection in 5 ml of sodium chloride
0.9% or glucose 5%
 Dilute 3 ml of solution for infusion in 20–50 ml infusion
fluid (up to 3 ml in 10–30 ml of infusion fluid for children)

Contra-indications
 Hypersensitivity to granisetron
Side effects
 Constipation, diarrhoea
 Headache
 Insomnia
 Increased liver transaminases
Pregnancy
 Do not use
Breast-feeding
 Do not use

G MONOGRAPHS
Caution
 Monitor patients with signs of sub-acute intestinal ob-
struction following administration since granisetron re-
duces lower bowel motility
 Use with caution in patients with cardiac co-morbidities
or electrolyte abnormalities
GRISEOFULVIN HC III N 6.3

Oral antifungal medicine reserved for widespread infections
of the skin, scalp, and nails and those resistant to topical
antifungal medicines
Dosage forms
 Tablets: 125 mg and 500 mg
Uses
 Fungal infection of skin, scalp, and nail
 Athletes foot
 Ringworm
Dose and duration

 Fungal infection and ringworm

Child: 10 mg/kg daily in 1–2 divided doses
Hair and skin: 2–6 weeks
Nails: 6–12 months or until nails appear normal
 Athletes foot
10 mg/kg daily (Maximum 500 mg) in 1–2 divided dos-
es. Use until response occurs
Double the dose in severe infections

GRISEOFULVIN G
Contra-indications
 Tinea versicolor
 Tinea nigra
 Candida infections
 Allergy to griseofulvin
Side effects
 Headache, dizziness, nerve pain in feet and hands
 Skin rash
 Stomach upset
 Blood disorders
Interactions
 Alcohol (enhanced alcohol effect)
 Take with food
 Avoid alcohol while on treatment
 Long duration of treatment is necessary as the fungi are
very tough to eliminate. Compliance is important to avoid

recurrence and ensure complete healing
 Avoid pregnancy while on treatment. Men should not
father children while on treatment and for at least 6

months after completion
and operating machinery

 Keep feet clean and dry
Pregnancy
 Do not use

H MONOGRAPHS
Breast-feeding
 Do not use
Caution
 Used in combination with gentian violet or clotrimazole
cream
 Effective contraception is required during treatment and
for at least 1 month after administration in women
 Do not use for prophylaxis
H
HALOPERIDOL HC IV V 24
Butyrophenone antipsychotic medicine
Dosage forms
Uses
 Delirium (acute confusional state)
 Psychosis
 Mania
 Schizophrenia
 Short term adjunctive management of psychomotor
agitation, violent behaviour and severe anxiety

Dose and duration
 Psychosis
Adult: by mouth, 5‒10 mg every 12 hours

 Mania
Adult: Initially 5‒10 mg by mouth every 12 hours then

HALOPERIDOL H
adjust according to response. Up to 30-40 mg daily
may be needed in severe or resistant cases
 Short term adjunctive management of psychomotor agi-
tation, violent behaviour and severe anxiety

Adult and child >12 years: By mouth, 1.5‒3 mg every
6‒8 hours. In severe or resistant cases, give 3‒5 mg
every 6‒8 hours
 Acute psychotic conditions
Adult and child >12 years: initially 2–10 mg by IM injec-

tion up to 18 mg in severely affected patients. Use half
the dose in elderly or debilitated patients). Give subse-
quent doses every 4–8 hours according to response (up
to every hour if necessary) up to a maximum of 18 mg
daily
Child: not recommended
 Agitation and restlessness in elderly
Initially 0.5‒1.5 mg by mouth once or twice daily

Contra-indications
 Impaired consciousness due to CNS depression
 Bradycardia
Side effects
 Extrapyramidal side effects
 Apathy, drowsiness, nightmares, dizziness, insomnia,
headache
 Confusion, depression
 Uncontrolled shaking

H MONOGRAPHS
Interactions
 Amitriptyline (increased concentration of amitriptyline
and arrhythmias)
 Artemether/ Lumefantrine
 Carbamazepine (antagonism of anticonvulsant effect)
 Ethosuximide(antagonism of anticonvulsant effect)
 Fluoxetine (increased concentration of haloperidol)
 Halothane, ketamine (increased hypotensive effect)
 Nitrous oxide (increased hypotensive effect)
 Phenobarbital (antagonism of anticonvulsant effect)
 Phenytoin, (antagonism of anticonvulsant effect)
 Rifampicin (reduced concentration of haloperidol)
 Ritonavir (increased concentration of haloperidol)
 Thiopental (increased hypotensive effect)
 Valproic acid (antagonism of anticonvulsant effect)
 Do not drive or operate machinery when taking this
medicine
Pregnancy
rd
Breast-feeding
 Can be used
Caution
 Do not withdraw medicine abruptly; reduce dose gradual-
ly to avoid relapse
 Treat extrapyramidal side effects with benzhexol
 Use lower doses in kidney impairment

HALOPERIDOL DECANOATE H
HALOPERIDOL DECANOATE RR V 24
Butyrophenones long-acting depot antipsychotic medicine
Dosage forms
 Injection (oily): 50 mg/ml/ 100 mg/ml
Uses
 Maintenance in schizophrenia and other psychoses
Dose and duration

 Maintenance in schizophrenia and other psychoses
Adult: by deep IM injection into the gluteal muscle,

initially 50 mg every 4 weeks, increased by 50 mg incre-
ments to 300 mg every 4 weeks; higher doses may be
needed in some patients.
Note: When changing a patient from another neuroleptic,
500 mg of oral chlorpromazine a day or 25 mg of
fluphenazine decanoate every 2 weeks, is equivalent to
100 mg of haloperidol decanoate monthly)
Elderly: initially 12.5–25 mg every 4 weeks, increased
according to the patient’s response
Halve dose if 2 weekly administration is preferred
Contra-indications
 Children
 Comatose states
 CNS depression
 Known hypersensitivity to haloperidol or simsim oil
 Lesions of basal ganglia
 Clinically significant cardiac disorders
 Concomitant use with other QT prolonging medicines

H MONOGRAPHS
Side effects
 Agitation, headache, insomnia, depression, psychotic dis-
order, dizziness, Torsades de pointes

 Extrapyramidal symptoms, tardive dyskinesia
 Visual disturbance, oculogyric crisis
 Hypotension including orthostatic hypotension
 Constipation, dry mouth, hypersalivation
 Rash
 Anaphylaxis
 Erectile dysfunction
 Injection site reaction
 Weight loss or gain
 Neuroleptic malignant syndrome
Interactions
 See haloperidol monograph
Pregnancy
 Do not use
Breast-feeding
 Can be used
Caution
 Do not give intravenously. No more than 3 ml should be
injected at any one injection site. Preferably use a 2–2.5
inches long needle of at least 21 gauge
 Individualise dose based on severity and amount of oral
dose required to maintain patient before depot therapy
 Use in elderly patients with dementia-related psychosis
may be fatal
HALOTHANE H
 Perform a baseline ECG prior to initiation of haloperidol
decanoate. Reduce dose if QT is prolonged during treat-
ment and discontinue if QTc exceeds 500 ms
 Do periodic electrolyte monitoring especially in patients
taking diuretics or during intercurrent illness
 Withdraw haloperidol decanoate immediately if hyper-
thermia develops as it often is an early sign of neuroleptic
malignant syndrome, and start supportive therapy
HALOTHANE HC IV V 1.1
Inhalation anaesthetic medicine
Dosage forms
 Solution for inhalation: 100%
Uses
 Induction and maintenance of anaesthesia
Dose and duration

 Induction (using a specifically calibrated vaporizer)
Adult: gradually increase inspired gas concentration to 2–

4%
Child: or 1.5–2%, in oxygen or nitrous oxide–oxygen
Adult and child: 0.5–2%

Contra-indications
 Raised intracranial pressure
 History of jaundice or fever following previous exposure
 Family history of malignant hyperthermia
Side effects
 Arrhythmias, bradycardia

H MONOGRAPHS
 Drowsiness
 Hepatic damage
 Post-operative shivering
 Severe cardiopulmonary depression
 Atony of gravid uterus
Interactions
 Adrenaline (increased risk of arrhythmias)
Pregnancy
rd
Breast-feeding
 Can be used
Caution
 Halothane is a volatile liquid at room temperature and
container should be tightly closed
 Should only be used by an experienced anaesthetist
HEPARIN H V 10.2
Anticoagulant
Dosage forms
 Injection: 5000 IU/ml
Uses
 Deep vein thrombosis (DVT)
 Pulmonary embolism
Dose and duration

 Treatment of deep vein thrombosis, pulmonary embolism
Adult: by IV injection, loading dose 5,000 IU (10,000 IU in

severe pulmonary embolism) followed by continuous IV
infusion of 18 IU/kg/hour or by SC injection of 15,000 IU
HEPARIN H
every 12 hours for 5 days. Adjust dose based on response
Child 1–18 years: loading dose, 75 IU/kg by IV injection,
then by continuous IV infusion 20 IU/kg/hour adjusted
according to activated partial thromboplastin time (APTT)
By SC injection, 250 IU/kg every 12 hours
Child 1 month–1 year: by IV injection, loading dose of 75
IU/kg then 25 IU/kg/hour by continuous IV infusion ad-
justed according to APTT
Neonate: loading dose of 75 IU/kg (50 IU/kg if under 35
weeks postmenstrual age) by IV injection, then 25
IU/kg/hour by continuous IV infusion adjusted according
to APTT
 Prophylaxis of deep vein thrombosis or pulmonary embo-
lism
Adult: by SC injection, 5000 IU 2 hours before surgery
then 5000 IU every 8–12 hours for 7 days or until patient
is able to walk around
Use same dose in medical and post- surgery patients
Child 1 month–18 years: 100 IU/kg (max 5000 IU) every
12 hours adjusted according to APTT
Pregnancy: by SC injection, 5000–10,000 IU every 12
hours
Preparation
 Dilute with glucose 5% or sodium chloride 9% for contin-
uous intravenous infusion

Contra-indications
 Hypersensitivity to unfractionated or low- molecular
weight heparin
 Haemophilia and other haemorrhagic disorders
 Thrombocytopenia and history of heparin-induced

H MONOGRAPHS
thrombocytopenia
 Peptic ulcer
 Recent cerebral haemorrhage
 Severe liver and renal disease
 Acute bacterial endocarditis
 Following major trauma or recent surgery to eye or
nervous system
Side effects
 Immune- mediated thrombocytopenia
 Haemorrhage
 Temporary rise in aminotransferases and lipase levels
 Skin necrosis
 Osteoporosis after prolonged use
Interactions
 Acetyl salicylic acid (enhanced anticoagulant effect)
 Glyceryl trinitrate (reduced anticoagulant effect)
 Intravenous diclofenac (increased risk of haemorrhage)
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Prevention of prosthetic heart-valve thrombosis in preg-
nancy requires specialist management
 Use with caution in patients requiring spinal or epidural
anaesthesia due to risk of spinal haematoma
 Elderly may require reduced doses
HEPATITIS B VACCINE H
 Monitor platelets in patients receiving treatment for
longer than 5 days. Withdraw immediately if thrombocy-
topenia is strongly suspected or confirmed
 Use with caution in patients with diabetes mellitus,
chronic renal failure, acidosis, raised plasma potassium or
those taking potassium-sparing drugs, as there is
increased risk of hyperkalaemia
 Reduce dose in hepatic and renal impairment or avoid in
severe impairment due to increased risk of bleeding
 Do not use preparations with benzyl alcohol in pregnancy
HEPATITIS B VACCINE HC IV E 19.3.2

Inactivated hepatitis B surface antigen (HBsAg) adsorbed on-
to aluminium hydroxide
Dosage forms
 Injection: single dose vial 20 micrograms/1 ml
Uses
 Vaccination against hepatitis B infection
 Prevention of perinatal hepatitis B virus transmission
Dose and duration

 Hepatitis B vaccination
Three doses: First dose, 0 months; second dose, 1

month after 1st dose; last dose, 6 months after 1st dose
Adult and child > 15 years: 0.5 ml IM on the deltoid
muscle (upper arm)
Child < 15 years: 0.5 ml IM on the deltoid muscle
For infants and younger children, give injection IM in
the anterolateral thigh

H MONOGRAPHS
Contra-indications
Side effects
 Pain, redness and swelling at injection site
 Fatigue
 Fever
 If fever develops, give a single dose of paracetamol
Pregnancy
 Can be used
Breast-feeding
 Can be used
Storage
 Store at 2–8°C
Caution
 For adults and adolescents, preferably give vaccine after
testing for hepatitis B infection (HBsAg or Anti-HBs)
 Do not give on the buttocks as there will be reduced im-
mune response (decreased protective antibody response)
 Do not give injection intradermally
 Hepatitis B vaccine is part of the fixed dose combination
of DPT, HepB + HiB vaccine which is given to children dur-
ing routine immunisation. Children therefore do not need
to be immunised again using the single HepB vaccine
 Neonates born of mothers who are Hepatitis B carriers
are given the first dose within 24 hours after birth

HYALURONIDASE H
HYALURONIDASE RR E 21.6
An enzyme that degrades hyaluronic acid. Used in soft tissue
disorders where there is need for resorption of excess fluids or
medicine
Dosage forms
 Powder for reconstitution for injection: 1,500 IU
Uses
 Enhance tissue permeation of fluids injected subcutane-
ously or intramuscularly
 Promote resorption of excess fluids and blood
Dose and duration

 With IM or SC injection
Adult: 1500 IU dissolved directly in solution to be injected

 With local anaesthetics
Adult and child: 1500 IU mixed with local anaesthetic so-

lution (15 IU/ml in ophthalmology). Hyaluronidase can be
injected into tubing of the infusion set about 2 cm back
from the needle at the start of the infusion
 Hypodermoclysis
Adult and child: 1500 IU dissolved in 1 ml water for injec-

tions or sodium chloride 0.9% injection, administered be-
fore starting 500–1000 ml infusion
 Extravasation or haematoma
Adult and child: 1500 IU dissolved in 1 ml of water or so-

dium chloride 0.9% injection, infiltrated into affected area
as soon as possible
Contra-indications
 Hypersensitivity to hyaluronidase
 Use as intravenous injection

H MONOGRAPHS
 Reduction of swelling of bites, stings, infection or malig-

nancy
 Anaesthesia in unexplained premature labour
 Direct application to the cornea
Side effects
 Oedema
 Anaphylaxis
Pregnancy
 Do not use
Breast-feeding
 Can be used
Caution
 Do not use to enhance the absorption and dispersion of
dopamine and/or alpha agonist medicines
 Solutions for subcutaneous administration should be
isotonic with extracellular fluid
HYDRALAZINE HC IV V 12.3
Vasodilator anti-hypertensive medicine
Dosage forms
 Powder for injection: 20 mg/ ml
Uses
 Hypertensive emergencies (including during pregnancy)
 Hypertension
 Heart failure
Dose and duration

 Hypertensive emergencies (including during pregnancy)

HYALURONIDASE H
Adult: 5‒10 mg diluted with 10 ml sodium chloride
0.9%, by slow IV injection over 20 minutes. Repeat after
20‒30 minutes.
Check blood pressure regularly
 Hypertension (with another antihypertensive)
Initially, 25 mg every 12 hours orally, increased if neces-

sary to maximum 50 mg every 12 hours
 Heart failure
Adult: 20 mg by slow IV injection over 20 minutes

Contra-indications
 Myocardial infarction
 Severe tachycardia
 High output heart failure
 Myocardial insufficiency due to mechanical obstruction
 Cor pulmonale
Side effects
 Tachycardia, palpitation, low blood pressure
 Fluid retention
 Stomach upset
 Dizziness
 Systemic lupus erythematosus after long term administra-
tion of 100 mg daily

Pregnancy
st nd
 Can be used. Avoid during 1 and 2 trimesters
Breast-feeding
 Can be used
Caution
 Reduce dose in kidney or liver impairment
 Oral hydralazine should only be initiated by a specialist

H MONOGRAPHS
HYDROCORTISONE HC III V 3, 13.3, 18.1

Glucocorticoid. Steroidal anti-inflammatory medicine
Dosage forms
 Injection: 100 mg hydrocortisone sodium succinate
 Cream/ointment: 1% hydrocortisone
 Eye drops: 1%
 Eye ointment: 0.5%
 Eye drops: hydrocortisone 1.5% + oxytetracycline 0.5% +
polymixin B 10,000 IU/ml

Uses
 Severe asthma
 Anaphylactic shock
 Allergic angioedema
 Allergic skin reaction
 Itching due to insect stings
 Allergic conjunctivitis
 Adrenocortical insufficiency (specialist use only)
Dose and duration

 Severe asthma (in combination with inhaled salbutamol);
anaphylactic shock (in combination with epinephrine); al-

lergic angioedema
Adult and child >12years: 200 mg IV stat
Child 6–12 years: 100 mg IM or slow IV stat
Child 1–5 years: 50 mg IM or slow IV stat
Child <1 year: 25 mg IM or slow IV stat
Repeat the dose every 4–6 hours as need arises de-
pending on the patient's response
 Allergic skin reaction and itching due to insect stings
Apply thin layer of cream to affected area every 12

HYALURONIDASE H
hours until improvement is seen
Apply 1 drop every 2 hours then reduce frequency as
infection is controlled and continue for 48 hours after
healing. At night, use the ointment as it lasts longer at
site of action
If using ointment alone, apply every 6‒8 hours
If infection present, use combination with antibiotics
Preparation
 Dissolve powder for injection in 2 ml water for injection
Contra-indications
 Untreated systemic bacterial, fungal, and viral infections
(can make infection worse)

 Untreated skin infections (can make infection worse)
 Acne
 Patients who have just received live virus vaccines (polio,
BCG, measles vaccines)

Side effects
 Fluid retention
 Cream may make local skin infection worse
 Dry and thin skin (prolonged use), skin irritation
 Eye drops may cause local irritation
Stops body's natural production of corticosteroids (after

prolonged use or with high doses) causing: increased risk
of infections, Cushing’s syndrome, muscle wasting, moon
face, acne, oedema and high blood pressure, bones easily
fracture, easy bruising, mental disturbances, diabetes
mellitus, menstrual disturbances, inhibition of growth in
children, glaucoma

H MONOGRAPHS
Interactions
 Carbamazepine, phenobarbital, phenytoin, rifamycins
(reduced effect of hydrocortisone)

 Live vaccines (high doses of hydrocortisone impair im-
mune response to vaccines)

Patient instruction
 Do not apply to eyes, broken skin, or mucous membranes
 Wash hands thoroughly before and after use
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Do not withdraw treatment suddenly after prolonged
use. Dose should be reduced gradually
 Patient on long term therapy should carry a steroid
treatment card
HYDROGEN PEROXIDE HC II N 15.1

Disinfectant solution used for cleansing and eliminating bad
smell of wounds and ulcers
Dosage forms
 Solution: 6%
Uses
 Skin disinfection (all wounds, herpes simplex lesions,
herpes zoster lesions)

HYDROGEN PEROXIDE H
 Inflammation of the gums
Dose and duration
 Skin disinfection and cleaning wounds
Apply to affected area 3 times daily for up to 3 weeks

 Inflammation of the gums
Gargle with mouth wash 3 times daily

Preparation
 Prepare mouth wash by adding 15 ml of hydrogen perox-
ide solution to 200 ml water

Side effects
 Bleach clothes
Interactions
 Chlorhexidine (cancelled effect)
 Avoid contact with healthy skin or eyes
 Can bleach clothes
 Mouthwash is not a replacement for effective brushing
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Concentrated solutions are dangerous. Avoid direct con-
tact with skin or mucous membranes.
 Never mix a leftover solution with a fresh solution
 Prepare small amounts at a time to prevent wastage
H MONOGRAPHS
 Mark on the bottle of diluted solution the name of

product, date of preparation, and date of expiry
HYDROXOCOBALAMIN (VITAMIN B12) H E 10.1

Antianaemia medicine
Dosage forms
Uses
 Treatment of megaloblastic anaemia due to vitamin B12
deficiency
 Treatment of pernicious anaemia
 Prophylaxis of macrocytic anaemia associated with
vitamin B12 deficiency

Dose and duration
All doses given by IM injection
 Treatment of pernicious anaemia and other megalo-
blastic anaemia due to vitamin B12 deficiency without

neurological involvement
Adult: 1 mg 3 times a week on alternate days for 2
weeks then 1 mg every 3 months
Child 1 month- 18 years: 0.25–1 mg 3 times a week on
alternate days for 2 weeks then 0.25 mg once a week
until blood counts are normal then maintenance dose
of 1 mg every 3 months
 Treatment of megaloblastic anaemia due to vitamin B12
deficiency with neurological involvement

Adult and child: 1 mg on alternate days until there is no
further improvement then 1 mg every 2 months
 Prophylaxis of macrocytic anaemias associated with

HYDROXYETHYLCELLULOSE (ARTIFICIAL TEARS) H
vitamin B12 deficiency
Adult and child: 1 mg every 2–3 months
Contra-indications
 Sensitivity to hydroxocobalamin
Side effects
 Nausea
 Hypokalaemia during initial stages of therapy
Pregnancy
 Do not use
Breast-feeding
 Can be used
Caution
 Do not give before confirmation of diagnosis except in
emergencies as indiscriminate use may mask exact diag-
nosis
 Doses greater than 10 µg daily may produce a haemato-
logical response in patients with folate deficiency
 Risk of cardiac arrhythmias secondary to hypokalaemia
during initial therapy
HYDROXYETHYLCELLULOSE (ARTIFICIAL
H E 21.10
TEARS)
Lubricant for eyes
Dosage forms
 Eye drops: 0.44%

H MONOGRAPHS
Uses
 Management of tear deficiency
Dose and duration

Adult and child: 1–2 drops instilled in to the affected eye

3–4 times a day or as often as is required
Side effects
 Transient mild stinging or temporarily blurred vision
 If irritation persists or worsens or continued redness oc-
curs, discontinue use and consult a doctor

Pregnancy
 Can be used
Breast-feeding
 Can be used
HYDROXYUREA (HYDROXYCARBAMIDE) NR V 8.2

Anticancer. It also prevents formation of sickle-shaped red
blood cells
Dosage forms
 Capsule: 500 mg
Uses
 Chronic myeloid leukaemia
 Cervical cancer
 Reduce rate of painful attacks in sickle-cell disease
 Polycythaemia
Dose and duration

 Sickle-cell disease

HYDROXYUREA (HYDROXYCARBAMIDE) H
Adult and child: Initially, 15 mg/kg daily, increased
every 12 weeks in steps of 2.5−5 mg/kg daily according
to response (maximum 35 mg/kg daily)
20−30 mg/kg daily or 80 mg/kg every third day

 Cervical cancer (in combination with radiation)
20−30 mg/kg daily or 80 mg/kg every third day

Contra-indications
 Severe leucopoenia
 Severe anaemia
Side effects
 Nausea, vomiting, abdominal pain, anorexia
 Mucositis, skin reactions
 Skin cancer
 Hallucination, disorientation
 Convulsions, dizziness, somnolence, headache
 Pulmonary fibrosis, oedema, dyspnoea
 Pancreatitis
 Dysuria
 Increased blood creatinine, urea, uric acid
 Fever, chills, malaise
 Reduced sperm count
Interactions
 Antiretrovirals (can cause treatment failure and toxicities)
 Live vaccines (risk of developing disease in vaccines)

H MONOGRAPHS
Pregnancy
 Do not use
Breast-feeding
Caution
 Monitor renal and hepatic function before and during
treatment
 Monitor full blood count before treatment, then every 2
weeks for the first 2 months and then every 2 months
thereafter
 Interrupt therapy if the white cell count drops below
2.5x109 L or the platelet count below 100x109/L
 Review treatment if leg ulcers develop
HYOSCINE BUTYLBROMIDE RR N 17.4

Antimuscarinic agent that reduces gastrointestinal motility
Dosage forms
Uses
 Spasm of gastrointestinal or genito-urinary disorders
 Diagnostic agent and antispasmodic in radiology
 Bowel colic
 Excessive respiratory secretions
Dose and duration

 Bowel colic and excessive respiratory secretions in
palliative care
Adult: by SC infusion, 20 mg every 4 hours but may be
given hourly in excessive respiratory secretions

HYOSCINE BUTYLBROMIDE H
(max 300 mg in bowel colic and 120 mg for excessive
respiratory secretions in 24 hours)
Child > 12 years: by IM or IV injection, 10–20 mg 3–4
times daily
Child 5–12 years: by IM or IV injection, 5–10mg 3–4 times
daily
Child 1 month–4 years: by IM or IV injection, 0.3–0.5
mg/kg (max 5 mg) 3–4 times daily
 Acute spasm and spasm in diagnostic procedures
Given by IM or slow IV injection over 1 minute
Adult and child over 12 years: 20 mg repeated after 30
minutes if necessary (may be repeated more frequently
in endoscopy). Maximum daily dose of 100 mg
Child 2–6 years: 5 mg repeated after 30 minutes if neces-
sary (may be repeated more frequently in endoscopy).
Maximum daily dose of 15 mg daily
Child 6–12 years: 5–10 mg repeated after 30 minutes if
necessary (may be repeated more frequently in endosco-
py). Maximum daily dose 30 mg daily
Preparation
 Solution for IV injection may be diluted with Glucose 5%
or Sodium Chloride 0.9%

Contra-indications
 Paralytic ileus
 Toxic megacolon
 IM injection in patients treated with anticoagulants

H MONOGRAPHS
Side effects
 Tachycardia
 Dizziness
 Hypersensitivity to hyoscine
 Consult your ophthalmologist immediately in case you
develop a red eye with loss of vision after injection with

hyoscine
Pregnancy
 Do not use
Breast-feeding
 Can be used
Caution
 Use with caution in thyrotoxicosis, cardiac insufficiency or
failure, in cardiac surgery since it may further accelerate
heart rate, pyrexia, autonomic neuropathy, intestinal and
urinary outlet obstruction and hypertension
 May cause elevation of intraocular pressure in patients
with undiagnosed and untreated angle-closure glaucoma

IBUPROFEN I
I
IBUPROFEN HC III E 2.1
Non-steroidal anti-inflammatory drug (NSAID) used to reduce
fever and relieve pain
Dosage forms
Uses
 Painful menstruation
 Headache
 Acute migraine attack
 Pain in children
 Pain due to rheumatic disease
 Muscle and joint pain
 Fever
Dose and duration

 All uses
Adult: 200–400 mg every 6–8 hours

Child 3 months–1 year: 20–40 mg/kg daily in divided
doses
Taken when necessary. Avoid prolonged use
Contra-indications
 Active peptic ulcer disease
 Children <3 months and <7 kg

I MONOGRAPHS
 Allergy to NSAIDs
 Asthma
 Rhinitis
 Angioedema
 Blood coagulation disorders
 Heart failure
 Severe malnutrition
 Uncorrected dehydration
 Shock
 Severe infection
Side effects
 Stomach upset, peptic ulcer
 Dizziness
Interactions
 Other NSAIDs (increased risk of side effects)
 Take with plenty of fluids
Pregnancy
 Do not use
Breast-feeding
 Can be used
Caution
 Reduce dose in elderly

IFOSFAMIDE I
 NSAID may cause acute asthma attacks
 Can be combined with paracetamol to increase pain relief
IFOSFAMIDE NR V 8.2
Alkylating anticancer; related to cyclophosphamide
Dosage forms
Uses
 Cancer
Dose and duration

Usually:
8−12 g/m2 as single daily doses over 3−5 days every 2−4
weeks
OR 5−6 g/m2 (maximum 10 g) given as a 24 hour infusion
every 3−4 weeks
Dose frequency determined by degree of myelosuppression
and recovery of bone marrow function
Contra-indications
 Urinary tract obstruction
 Acute infection
 Urothelial damage
 Severe bone marrow function impairment
Side effects
 Infections
 Decreased appetite

I MONOGRAPHS
 Hepatotoxicity
 Alopecia
 Haemorrhagic cystitis, haematuria
 Renal damage
 Phlebitis
Interactions
 ACE inhibitors e.g. captopril (can cause leucopoenia)
 Carboplatin, cisplatin (increased haematotoxicity and
immunosuppression)
Pregnancy
 Do not use
Breast-feeding
Caution
 Give adequate hydration before and after to minimise
urothelial toxicity (haemorrhagic cystitis)
 Use with mesna to reduce urothelial toxicity
 Men and women taking ifosfamide should use adequate
contraception during treatment
IMIPRAMINE HC IV E 24
Tri-cyclic antidepressant medicine
Dosage forms
 Tablet: 25 mg

IMIPRAMINE I
Uses
 Anxiety
 Depression
 Nocturnal enuresis in children
Dose and duration

 Anxiety
Adult: 25–50 mg at night

 Depression
Adult: Initially 25‒50 mg orally increased gradually to

150─200 mg daily
Elderly: initially 10 mg orally increased gradually to
30-50 mg
 Nocturnal enuresis in children
Child >11 years (35–54 kg): 50─75 mg just before

bedtime for not more than 3 months
Child 8–11 years (25–35 kg): 25─50 mg just before
bedtime for not more than 3 months
Child 6–7 years (20–25 kg): 25 mg just before bedtime
for not more than 3 months
Contra-indications
 Depression in children
Side effects
 Sedation, drowsiness
 Blurred vision
Interactions
 Alcohol (increased sedative effects)

I MONOGRAPHS
 General anaesthetics (increased hypotension)

 Tramadol (increased risk of CNS toxicity)
 Warfarin (increased or reduced anticoagulant effect)
 MAOI (increased risk of hypertension and CNS excitation)
 Antiepileptics (anticonvulsant effect antagonised)
 Artemether/lumefantrine (increased risk of arrhythmias)
 Antipsychotics (increased risk of arrhythmias)
 Ritonavir (increased concentration and side effects of
imipramine)
 Adrenaline and noradrenaline (increased risk of hyper-
tension and arrhythmias)

 Take at night
 Do not take alcohol while taking this medicine to avoid
increased sleepiness side effect

Pregnancy
 Do not use
Breast-feeding
 Can be used
Caution
 Reduce dose in elderly
 Do not stop treatment abruptly; may cause withdrawal
symptoms
 Do not start imipramine until 3 weeks after stopping a
MAOI

INDOMETHACIN I
INDOMETHACIN H N 2.2
Non-steroidal anti-inflammatory drug
Dosage forms
 Capsule: 25 mg
Uses
 Pyogenic (septic) arthritis
 Gout arthritis
 Osteoarthritis
 Osteomyelitis
 Nociceptive or somatic pain
 Dysmenorrhoea
Dose and duration

 All uses
Adult: 50–200 mg daily in 2–3 divided doses (maxi-

mum dose in dysmenorrhoea, 75 mg in 2–3 divided
doses a day)
Child 1 month–18 years: 0.5–1 mg/kg every 12 hours
Contra-indications
 Hypersensitivity to aspirin or other NSAIDs
 History of or active peptic ulcer disease
 Nasal polyps associated with angioneurotic oedema
 Coagulation defects
 Severe heart failure
Side effects
 Headache, dizziness, depression, vertigo, fatigue
 Nausea, anorexia, vomiting, epigastric distress, ab-
dominal pain, constipation, diarrhoea

 Angioneurotic oedema

I MONOGRAPHS
 Angiitis (inflammation of small blood vessels)

 Erythema nodosum, pruritus, urticaria, skin rash, photo-
sensitivity, Stevens-Johnson syndrome
 Rapid fall in blood pressure resembling a shock-like state
 Acute respiratory distress
 Tinnitus, hearing disturbances
Interactions
 Haloperidol (possible severe drowsiness)
 Triamterene (reduced renal function)
 Methotrexate (excretion of methotrexate reduced hence
increased risk of toxicity)

 Probenecid (reduced excretion of indomethacin,
increased plasma concentration of indomethacin)

 Aspirin and other NSAIDs (increased risk of side effects)
 Take with or immediately after food
Pregnancy
 Do not use
Breast-feeding
 Do not use
Caution
 Start with lower doses and increase gradually to reduce
incidence of headache
 Use with caution in patients with history of bronchial
asthma, psychiatric disorders, epilepsy or parkinsonism
 Increased risk of gastrointestinal bleeding and fluid
retention if used in hepatic failure
 In renal failure, use the lowest possible dose for the
shortest possible duration. If acute interstitial nephritis
INSULIN I
occurs, withdraw the medicine
 Withdraw medicine if eye changes are observed in pa-
tients with chronic rheumatoid disease
 Indomethacin may mask signs and symptoms of infection
INSULIN HC IV V 18.5
Hormone that plays a key role in regulation of carbohydrate,
fat and protein metabolism. Soluble insulin, short-acting
form, is suitable for diabetic emergencies and during surgery.
Isophane insulin is intermediate-acting insulin. Biphasic
isophane insulin is premixed with both properties of short-
and immediate-acting insulin. Insulin zinc suspension is a
long-acting insulin
Dosage forms
 Injection: Soluble insulin 100 IU/ml
 Injection: Biphasic isophane insulin; Soluble insulin 30% +
isophane insulin 70% 100 IU/ml

 Injection: Insulin isophane 100 IU/ml
 Injection: Insulin zinc suspension 100 IU/ml
Uses
 Diabetic ketoacidosis
Dose and duration

Appropriate insulin regimens should be worked out for each
patient basing on the individual blood sugar levels
Adult: Isophane insulin, 10-20 IU twice daily SC injection

Soluble insulin, 40−100 IU SC daily in 3 divided doses before
meals
I MONOGRAPHS
Child: Isophane insulin 5 - 10 IU twice daily SC injection

Soluble insulin, 40−80 IU SC daily in 3 divided doses before
meals
Note: Conventional insulin therapy often combines the two
types of insulin in mixture of 30/70 soluble to isophane insu-
lin. Usually given twice daily or once daily in elderly. A com-
mon preparation is Mixtard®
Long-acting insulin is usually given once daily
Start an IV infusion of soluble insulin, diluted and mixed

thoroughly with sodium chloride 0.9% to a concentration of 1
unit/ml; infuse at a rate of 0.1 units/kg/hour
Monitor urine and blood glucose and ketones hourly and ad-
just insulin infusion accordingly. Once blood glucose concen-
tration falls below 14 mmol/litre, give glucose 10% (into a
large vein) at a rate of 125ml/hour in addition to sodium
chloride 0.9% infusion.
Continue infusion until blood ketone concentration is below

0.3mmol/litre. If patient is able to drink and eat, ideally give
SC soluble insulin and a meal, then stop infusion 1 hour later.
Contra-indications
 Depression in children
Side effects
 Hypoglycaemia
 Local reactions and hypertrophy at injection site

INSULIN I
Interactions
 Beta blockers e.g. atenolol, propranolol (mask hypo-
glycaemic symptoms so patient cannot recognise them)

 Corticosteroids (cause insulin resistance and hyper-
glycaemia)
 Bendroflumethiazide (hypoglycaemic effect antagonised)
 Furosemide (hypoglycaemic effect antagonised)
 Oestrogens (hypoglycaemic effect antagonised)
 Always inject insulin at least 15‒30 minutes before food
 Never take the medicine when you have skipped a meal
 Avoid overdose as this will cause dangerously low blood
sugar
 Alternate injection site to avoid scarring in one site
 Symptoms of dangerously low blood sugar include: shak-
ing (tremors), tiredness, unconsciousness. Take 2 tea-

spoons of glucose or sugar or sugary soft drink as first aid,
as well as long-acting carbohydrate (e.g. bread) to restore
liver glycogen. Report to the nearest health centre
immediately
 Consider self-monitoring of blood glucose to help you be
in better control of your blood glucose levels

Pregnancy
 Can be used
Breast-feeding
 Can be used
Storage
 Store at 2–8°C (cold storage). Do not freeze

I MONOGRAPHS
Caution
 Insulin is given by subcutaneous injection into the upper
arms, thighs, buttocks, or abdomen. Teach patient how
to measure dose and inject insulin properly
 There may be increased absorption from a limb site, if
limb is used in strenuous exercise following the injection
 Use only syringes calibrated for the particular concentra-
tion of insulin administered
 Injection site should be rotated to prevent lipodystrophy
 Instruct patient how to avoid hypoglycaemia
 During pregnancy and breast-feeding, insulin require-
ments alter and doses should be assessed frequently by a
physician
 Insulin requirements may be affected by variations in life-
style (diet and exercise), concomitant use of drugs such
as corticosteroids, presence of infections, stress,
accidental or surgical trauma, puberty and pregnancy (2nd
and 3rd trimesters) which tend to increase insulin needs
 Renal or hepatic impairment and some endocrine disor-
ders (e.g. Addison disease and hypopituitarism) or coeliac
disease, usually reduce requirements
IODINE HC II N 13.2
Topical anti-infective used as a disinfectant
Dosage forms
 Solution: Iodine tincture 2%
Uses
 Disinfection of intact wounds

IODINE + POTASSIUM IODIDE I
Dose and duration
 Apply directly to the affected area 2 times daily
Contra-indications
 Burn wounds
Side effects
 Skin irritation
 Do not apply to eyes, mouth, vagina and inflamed or
broken skin
 Can stain skin and clothes
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Povidone-iodine is a better iodine preparation. Use in-
stead if available
IODINE + POTASSIUM IODIDE RR E 18.8

Antithyroid agent
Dosage forms
 Oral solution: 5% + 10%, Total iodine 130 mg/ml
Uses
 Pre-operative thyrotoxicosis
 Neonatal thyrotoxicosis

I MONOGRAPHS
Dose and duration

 Pre-operative thyrotoxicosis
Adult, child and neonate: 0.1–0.3 ml diluted well in milk

or water every 8 hours for 6 days
 Neonatal thyrotoxicosis
Neonate: 0.05–0.1 ml taken 3 times daily

Contra-indications
 Hypersensitivity to iodine or iodide
 Pregnancy
Side effects
 Hypersensitivity reactions including coryza-like symptoms
 Headache
 Lacrimation, conjunctivitis
 Pain in salivary glands, laryngitis
 Bronchitis
 Rashes
Pregnancy
 Do not use
Breast-feeding
 Do not use
Caution
 Do not use for long periods since its long-term effect
tends to diminish
 Use with caution in children
 Stop breast-feeding since iodine concentrates in breast-
milk and poses a danger of neonatal hypothyroidism

IRINOTECAN I
IRINOTECAN NR V 8.2
Topoisomerase I inhibitor anticancer
Dosage forms
 Infusion: 20 mg/ml
Uses
 Advanced colorectal cancer
Dose and duration

 Colorectal cancer (monotherapy)
350 mg/m2 as IV infusion over 30−90 minutes every 3

weeks
 Colorectal cancer (in combination with 5-fluorouracil and
folinic acid))
180 mg/m2 as IV infusion over 30−90 minutes once
every 2 weeks (given before folinic acid and fluoro-
uracil)
Contra-indications
 Chronic inflammatory bowel disease
 Bowel obstruction
 Children
 Hypersensitivity to irinotecan
 Bilirubin levels > 3 times the upper normal limit
 Severe bone marrow failure
Side effects
 Diarrhoea (can be severe), nausea and vomiting
 Dehydration
 Neutropenia, anaemia, thrombocytopenia
 Fever
 Acute cholinergic syndrome (asthenia)
 Increased liver enzyme levels (ALT, AST, ALP)

I MONOGRAPHS
 Increased bilirubin levels

Interactions
 Ketoconazole (increased effect of irinotecan)
 Atazanavir (increased risk of toxicity)
Pregnancy
 Do not use
Breast-feeding
Caution
 Monitor full blood count weekly. Reduce dose if neutro-
phil count is < 1000 cells/mm3
 If diarrhoea occurs for more than 24 hours after admin-
istration, reduce subsequent doses
ISOFLURANE HC IV V 1.1
Volatile liquid halogenated general anaesthetic
Dosage forms
 Liquid for inhalation: ≥99.9%
Uses
 General anaesthesia
Dose and duration

Adult and child: starting concentration of 0.5%. Usual

dose range of 1.3–3.0% induces surgical anaesthesia in
about 7–10 minutes
ISOFLURANE I
Adult and child: 1.0–2.5% with oxygen and nitrous oxide
or 1.5–3.5% with pure oxygen. Reduce to 0.5% at the end
of the operation or to 0% during wound closure. Use
0.5–0.75% in nitrous oxide and oxygen for caesarean
section. Ventilate air passages (when administration of
anaesthetic agents has stopped) several times with 100%
oxygen until complete awakening
Contra-indications
 Hypersensitivity to isoflurane or other halogenated an-
aesthetics
 Known or suspected susceptibility to malignant hyper-
thermia
Side effects
 Hypotension
 Arrhythmias
 Malignant hyperthermia
 Hepatic impairment
Interactions
 Doxapram (increased risk of arrhythmias)
 Isoprenaline, adrenaline, noradrenaline (increased risk of
arrhythmias)
Pregnancy
 Do not use
Breast-feeding
 Can be used

I MONOGRAPHS
Caution
 Isoflurane should be administered by a person well
equipped in its use using a specially calibrated vaporizer
 Isoflurane is a uterine relaxant, reduces uterine-placental
blood flow and may cause reproductive toxicity. Only use
if benefit outweighs risk at the lowest possible doses
 Use with caution in patients with raised intracranial pres-
sure and mitochondrial disorders
 Since isoflurane irritates mucous membranes, it is
difficult to use if inhalation anaesthesia is applied via a
mask and it may lead to laryngospasms in children
ISONIAZID (H) HC III E 6.2.4

Anti-tuberculosis antibacterial
Dosage forms
 FDC tablet: Ethambutol 400 mg + isoniazid 150 mg
 FDC tablet: Rifampicin 60 mg + isoniazid 30 mg
 FDC tablet: Rifampicin 60 mg + isoniazid 30 mg +
pyrazinamide 150 mg
pyrazinamide 150 mg
ethambutol 400 mg + pyrazinamide 275 mg

Uses
 Tuberculosis

ISONIAZID (H) I
 Prophylaxis against tuberculosis in exposed infants
Dose and duration
 Intensive phase in TB treatment (in combination with ri-
fampicin, ethambutol, and pyrazinamide)

Give once daily for 2 or 3 months as in table below
Weight (kg) Isoniazid (mg)
30–37 150
38–54 225
55–70 300
>70 375
Child <12 years:
Weight (kg) Isoniazid (mg)
4–7 50
8–11 100
12–15 150
16–24 200
Continuation phase in TB treatment
Give once daily as in table below; for 4 months with ri-
fampicin, or for 6 months with ethambutol
Weight (kg) Isoniazid (mg) Isoniazid (mg)
with Rifampicin with Ethambutol
30–37 150 300
38–54 225 300
55–70 300 300
>70 300 450

I MONOGRAPHS
Child below 12 years:

Weight (kg) Isoniazid (mg) with
Rifampicin
4–7 50
8–11 100
12–15 150
16–24 200
 Prophylaxis against tuberculosis in exposed infants
5 mg/kg once daily for 6 months

Contra-indications
Side effects
 Stomach upset, dry mouth
 Nerve pain in hands and legs
 Liver disorders
 Blood disorders
Interactions
 Phenytoin (increased effect of phenytoin)
 Carbamazepine (increased risk of liver toxicity)
 Preferably take on empty stomach
 Avoid taking alcohol while on treatment
 Report immediately to the health worker if any yellowing
of the skin or eyes, nausea, vomiting, feeling of sickness,

or tingling pain in the hands or legs occur
 Take the anti-TB medicines at the same time each day

ISOSORBIDE DINITRATE I
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 To prevent nerve pain, give pyridoxine 10 mg daily
 If the patient shows signs of liver toxicity, discontinue
treatment until symptoms resolve
ISOSORBIDE DINITRATE H N 12.1

Anti- angina nitrate vasodilator medicine
Dosage forms
 Sublingual tablet: 5 mg
Uses
 Adjunctive therapy in left ventricular failure
Dose and duration

 Prophylaxis and treatment of angina
Adult: 30-120 mg daily in 1–2 divided doses according to

individual need
 Left ventricular failure
Adult: 40-160 mg daily in divided doses up to a maxi-

mum of 240 mg dependent on individual need
Contra-indications
 Hypersensitivity to nitrates
 Hypotension, hypovolemia

I MONOGRAPHS
 Aortic stenosis
 Cardiac tamponade
 Constrictive pericarditis
 Mitral stenosis
 Marked anaemia
 Head trauma
 Cerebral haemorrhage
 Angle- closure glaucoma
Side effects
 Headache (at beginning of treatment)
 Drowsiness, weakness
 Cutaneous vasodilation, flushing, orthostatic hypoten-
sion, decrease in blood pressure, reflex tachycardia

 Peripheral oedema in patients with left ventricular failure
Interactions
 Slidenafil (hypotensive effect significantly enhanced)
 Tadalafil (hypotensive effect significantly enhanced)
Pregnancy
 Do not use
Breast-feeding
 Do not use
Caution
 Long- term use may lead to development of tolerance to
its antianginal effect. Ensure a nitrate free interval each
day (give second daily dose after 8 hours not 12 hours)
 Increase dose gradually to minimise the possibility of
nitrate headache and/ or tolerance
 Cross-tolerance to other nitrates may occur
 May cause haemolysis in patients with G6PD deficiency
IVERMECTIN I
 May precipitate intra-cardiac conduction abnormalities
when used in patients with seriously damaged myocardia
 Use with caution in severe hepatic or renal impairment,
hypothyroidism, malnutrition or hypothermia
IVERMECTIN HC III E 6.1.2

Filaricidal medicine
Dosage forms
 Tablet: 6 mg
Uses
 Lymphatic filariasis
 Onchocerciasis (River blindness)
 Hyperkeratotic scabies
Dose and duration

Adult and child over 5 years and weight >15 kg: 0.2
mg/kg as a single dose or 0.2 mg/kg/day on 2 consecutive
days for chronic strongyloidiasis
 Endemic lymphatic filariasis (suppression)
mg/kg annually for 5 years
 Onchocerciasis (suppression)
mg/kg as a single dose once a year
 Hyperkeratotic scabies (in conjunction with topical drugs)
mg/kg as a single dose

K MONOGRAPHS
Contra-indications
 Pregnancy
Side effects
 Mild ocular irritation
 Somnolence
 Raised liver enzymes
 Avoid taking food or alcohol at least 2 hours before and 2
hours after a dose

Pregnancy
 Do not use
Breast-feeding
 Can be used
Caution
 Delay treatment with ivermectin until after delivery
 Only treat mother when the infant is older than 1 week
K
KETAMINE HC IV V 1.1
General anaesthetic
Dosage forms
Uses
 Analgesia for painful procedures of short duration

KETAMINE K
Dose and duration
 Induction and maintenance of anaesthesia and analgesia
in short procedures
Adult and child over 12 years: by IM injection, 6.5–13
mg/kg adjusted according to response (10mg/kg produc-
es 12–25 minutes of surgical anaesthesia); maintenance,
50–100% of induction dose as required
In diagnostic and procedures not involving intense pain,
use 4 mg/kg
By IV injection over at least 1 minute, 1–4.5 mg/kg
adjusted according to response (2 mg/kg usually produc-
es 5–10 minutes of surgical anaesthesia); maintenance,
50–100% of induction dose as required
Neonate and child up to 12 years: by IV injection over at
least 60 seconds, 1–2 mg/kg produces 5–10 minutes of
surgical anaesthesia, adjusted according to response
 Induction and maintenance of anaesthesia and analge-
sia: longer procedures

Adult: by IV infusion with solution containing 1 mg/ml in
dextrose 5% or normal saline, total induction dose 0.5–2
mg/kg; maintenance (using microdrip infusion) 0.01–
0.045 mg/kg/minute, rate adjusted according to response
Child up to 18 years: 0.5–2 mg/kg by IV injection, fol-
lowed by continuous IV infusion of 0.01–0.045 mg/kg
/minute adjusted according to response
Neonate: 0.5–2 mg/kg by IV injection, followed by
continuous IV infusion of 0.008 mg/kg /minute adjusted
according to response. In deep anaesthesia, up to 0.03
mg/kg/minute may be used

K MONOGRAPHS
 Sedation prior to invasive or painful procedures

Child 1 month–18 years: 1–2 mg/kg as a single dose
Contra-indications
 Thyrotoxicosis
 Hypertension including pre-eclampsia or eclampsia
 Severe coronary or myocardial disease
 History of cerebrovascular accident, cerebral trauma, in-
tracerebral mass or haemorrhage or other cause of raised

intracranial pressure
 Eye injury
 Increased intraocular pressure
 Psychiatric disorders particularly hallucinations
 Porphyria
 Known hypersensitivity to ketamine
Side effects
 Hallucinations, confusion, agitation, abnormal behaviour
 Transient elevation of pulse rate and blood pressure, in-
creased respiratory rate

 Diplopia, nystagmus
 Tonic-clonic movements, hypertonia
 Rash, erythema
Interactions
 Chlorpromazine (enhanced hypotensive effect)
 Fluphenazine (enhanced hypotensive effect)
 Haloperidol (enhanced hypotensive effect)
 Verapamil (enhanced hypotensive effect and atrio-
ventricular delay)
 Memantine (increased risk of CNS toxicity)

KETAMINE K
 Do not perform any skilled tasks like driving within 24
hours of use of ketamine

 Avoid taking alcohol within 24 hours of treatment
 Do not take anything by mouth for at least 6 hours before
anaesthesia
Pregnancy
rd
Breast-feeding
 Can be used
Caution
 Ketamine crosses the placenta and depresses neonatal
respiration when used in the 3rd trimester of pregnancy
 Avoid breast-feeding for at least 12 hours after last dose
 Requires administration of antisialagogue like hyoscine,
atropine or glycopyrrolate to prevent excessive salivation
and respiratory difficulties
 Benzodiazepines such as midazolam and diazepam re-
duce incidence of emergence reactions
 Patient under recovery must remain undisturbed but un-
der observation
 Consider dose reduction in hepatic impairment
 Should be used in presence of resuscitative equipment
 Ketamine should not be used for long-term use

K MONOGRAPHS
KETOCONAZOLE HC III N 6.3

Antifungal medicine; should only be used in immune-
suppressed patients who have failed to respond to other anti-
fungals, such as clotrimazole, nystatin, and fluconazole
Dosage forms
 Tablet: 200 mg
Uses
 Chronic oral and oesophageal candidiasis
 Chronic resistant vaginal candidiasis
Dose and duration

Adult and child >30 kg: 200 mg once daily until symp-
toms have cleared
Child 15–30 kg: 100 mg once daily until symptoms clear
Contra-indications
 Liver disease
Side effects
 Stomach upset
 Liver damage
 Rash, itching
Interactions
 Nevirapine (reduced effect of ketoconazole)
 Aminophylline (increased effect of aminophylline)
 Take with food
 Stop the medicine and report to health worker immedi-
ately if signs of extreme weight loss, nausea, vomiting,

feeling of tiredness, abdominal pain, dark urine, or
yellowing of skin or eyes occur

LABETALOL L
Pregnancy
 Do not use
Breast-feeding
 Do not use
Caution
 Avoid using for longer than 10 days
 Stop medicine immediately if signs of liver damage occur
L
LABETALOL RR E 12.3
Beta adrenoceptor blocker with arteriolar vasodilatory action.
It lowers peripheral resistance, slows the heart rate and
depresses the myocardium
Dosage forms
Uses
 Severe hypertension including hypertension in pregnancy
 Hypertension following myocardial infarction
 Hypertensive crisis
Dose and duration

 Hypertension of pregnancy
Adult: by IV injection, 20 mg/hour, doubled every 30

minutes (usual max 160 mg/hour)
 Hypertension following myocardial infarction
Adult: by IV injection, 15 mg/hour gradually increased to

maximum dose of 120 mg/hour

L MONOGRAPHS
 Hypertension
Adult and child over 12 years: by IV injection, 50 mg over
at least 1 minute, repeated after 5 minutes if necessary
(max total dose 200 mg)
By IV infusion, 2 mg/minute until satisfactory response,
then discontinue (usual total dose 50– 200 mg)
Child 1 month–12 years: by IV injection, 0.25–0.5 mg/kg
as a single dose (max 20 mg)
 Hypertensive emergencies
Child 12–18 years: by IV infusion over at least 1 minute,

30–120 mg/hour adjusted at 15 minute intervals accord-
ing to response
Child 1 month–12 years: by IV infusion, initially 0.5–1
mg/kg/hour adjusted at intervals of at least 15 minutes
according to response( max 3 mg/kg/hour)
Neonate: by IV infusion, 0.5 mg/kg/hour adjusted at in-
tervals of at least 15 minutes according to response (max
4 mg/kg/hour)
Contra-indications
 Uncontrolled, early or digitalis refractory heart failure

nd
 2 or 3rd degree heart block
 Prinzmetal's angina
 History of wheezing or asthma
 Bradycardia
 Hypotension
 Hypersensitivity to labetalol

LABETALOL L
 Severe peripheral circulatory disturbances
 Where peripheral vasoconstriction suggests low cardiac
output in hypertension following infarction
Side effects
 Postural hypotension
 Tiredness, weakness, headache
 Rashes, scalp tingling
 Epigastric pain, nausea, vomiting
 Liver damage
Interactions
 Prazosin, tamsulosin, alfuzosin (enhanced hypotensive
effect)
 Amiodarone, flecainide (increased risk of AV block,
myocardial depression, bradycardia)

 Nifedipine (risk of severe hypotension and heart failure)
 Diltiazem (increased risk of AV block and bradycardia)
 Verapamil (asystole, severe hypotension, heart failure)
 Clonidine (increased risk of withdrawal hypertension)
 Epinephrine, dobutamine (increased risk of severe hyper-
tension and bradycardia)

 Avoid standing or sitting upright during and 3 hours after
intravenous administration
Pregnancy
 Do not use (except in emergency)
Breast-feeding
 Do not use

L MONOGRAPHS
Caution
 Reduce dose in renal and hepatic impairment
 Risk of severe hepatic damage after both short- and long-
term treatment. At first confirmation of liver damage,
withdraw labetalol immediately and do not restart it
 Use with caution in patients with peripheral circulatory
disorders, history of psoriasis
 Patients with ischaemic heart disease should not
discontinue labetalol abruptly
 Monitor heart rate after injection or infusion, in case of
severe bradycardia, control it using 1–2 mg of IV atropine
 Avoid use in 1st trimester of pregnancy. Labetalol crosses
placental barrier and may cause alpha and beta adreno-
ceptor blockade in the neonate, which may develop up to
2 days after birth. Labetalol is excreted in breast milk
LACTULOSE RR N 17.5
Osmotic laxative
Dosage forms
 Solution: 3.1–3.7 g/5 ml
Uses
 Hepatic encephalopathy
 Constipation
Dose and duration

Adult and child above 12 years: 30–50 ml every 8 hours.

Adjust dose to produce 2–3 soft stools per day
 Constipation
Adult: 15 ml every 12 hours

LACTULOSE L
Child 5–18 years: 5–20 ml every 12 hours
Child 1–5 years: 2.5–10 ml every 12 hours
Child 1 month–1 year: 2.5 ml every 12 hours
Adjust dose according to response
Contra-indications
 Galactosaemia
 Digestive tract perforation or risk of perforation
Side effects
 Diarrhoea, nausea, vomiting, flatulence, cramps,
abdominal discomfort
 Take with water, fruit juice or meals to reduce nausea
 Lactulose solution may be taken diluted or undiluted
 Swallow each dose of lactulose at once and should not be
kept in the mouth for an extended period of time

 Consult your doctor if constipation persists after 3 days
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Chronic use of unadjusted doses and misuse can result
into diarrhoea and disturbances in electrolyte balance
 The doses used in hepatic encephalopathy should be
taken into consideration in diabetics. Doses used in
constipation do not pose a problem to the diabetics

L MONOGRAPHS
 Defecation reflex may be disturbed during treatment in

children
LAMIVUDINE (3TC) HC IV N 30.1

ral medicine
Dosage forms
 Tablet: 150 mg
 FDC tablet: TDF 300 mg + 3TC 150 mg
 FDC tablet: AZT 300 mg + 3TC 150 mg
 FDC tablet: AZT 300 mg + 3TC 150 mg + ABC 300 mg
 FDC tablet: AZT 300 mg + 3TC 150 mg + NVP 200 mg
Uses
 HIV/AIDS
 Chronic hepatitis B
Dose and duration

 HIV infection, first line treatment in adults and eMTCT (in
combination with TDF + NVP or TDF + EFV)

Adult: 150 mg every 12 hours or 300 mg once daily
Child >35 kg: 150 mg every 12 hours
 HIV infection, alternative first line treatment in adults (in
combination with AZT + EFV or AZT + NVP or ABC + NVP

or ABC +EFV)
Adult: 150 mg every 12 hours or 300 mg once daily
Child >35 kg: 150 mg twice daily
 HIV infection, first line treatment in children
Adolescent <35 kg: 4 mg/kg every 12 hours (in combina-

LAMIVUDINE (3TC) L
tion with ABC + EFV)
Child 3–10 years: 4 mg/kg every 12 hours (in combination
with ABC + EFV)
Child <3 years: 4 mg/kg every 12 hours (in combination
with ABC + NVP)
 HIV infection, second line treatment (in combination with
AZT + ATV/r or AZT + LPV/r or ABC + ATV/r or ABC +
LPV/R or TDF + LPV/r or TDF + ATV/r)
Adult: 150–300 mg every 12 hours
Child >35 kg: 150 mg every 12 hours
Contra-indications
 Allergy to lamivudine
Side effects
 Stomach upset
 Nerve pain in hands and feet, headache, difficulty in
sleeping, Feeling of tiredness/sickness

 Pancreatitis
 Skin rash
 Lactic acidosis
 Liver damage
 Cough
 Muscle pain
Interactions
 Emtricitabine (increased side effects)
 Report immediately to health worker in case of severe

L MONOGRAPHS
nausea, vomiting, abdominal pain, feeling of sickness,

loss of appetite, rapid deep breathing, or muscle weak-
ness
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Discontinue medicine in case of severe lactic acidosis or
liver damage
 Only FDC pill with TDF + 3TC + EFV contains 300 mg of
3TC; the rest have 150 mg of 3TC
LAMOTRIGINE NR E 24
Antiepileptic medicine
Dosage forms
 Tablet: 100 mg
Uses
 Focal seizures
 Tonic-clonic seizures
 Atypical absence seizures in children
 Seizures associated with Lennox Gastaut syndrome
 Bipolar disorder
Dose and duration

 Monotherapy of seizures
Adult and child over 12 years: initially 25 mg once daily

for 14 days, increased to 50 mg once daily for 14 days,
and then increased every 7–14 days by no more than 100
LAMOTRIGINE L
mg. Usual maintenance dose 100–200 mg daily in 1–2
divided doses (up to 500 mg daily)
 Monotherapy of typical absence seizures
Child 2–12 year: initially 0.3 mg/kg daily in 1–2 divided
doses for 14 days then 0.6 mg/kg daily in 1–2 divided
doses for further 14 days, thereafter increased by max
0.6 mg/kg every 7–14 days. Usual maintenance 1–10
mg/kg daily in 1–2 divided doses (max 15 mg/kg)
 Adjunctive therapy of seizures with valproate
Adult and child over 12 years: initially 25 mg on alter-
nate days for 14 days then 25 mg once daily for more 14
days, thereafter increased by max 50 mg every 7–14
days. Usual maintenance, 100–200 mg daily in 1–2 divid-
ed doses
Child 2–12 years: initially 0.15 mg/kg once daily for 14
days (give 2 mg on alternate days if body weight is below
13 kg) then 0.3 mg/kg once daily for further 14 days,
thereafter increased by max 0.3 mg/kg every 7–14 days.
Usual maintenance 1–5 mg/kg daily in 1–2 divided doses
(max 200 mg daily in 2 divided doses)
 Adjunctive therapy of seizures (with enzyme inducing
drugs) without valproate
Adult and child over 12 years: initially 50 mg once daily
for 14 days then 50 mg every 12 hours for more 14 days,
thereafter increased by max 100 mg every 7–14 days.
Usual maintenance 100–200 mg every 12 hours (up to
700 mg daily has been required)
Child 2–12 years: initially 0.3 mg/kg every 12 hours for 14
days then 0.6 mg/kg every 12 hours for more 14 days,
thereafter increased by max 1.2 mg/kg every 7–14 days.
L MONOGRAPHS
Usual maintenance dose 2.5–7.5 mg/kg every 12 hours

(max 200 mg every 12 hours)
 Adjunctive therapy of seizures (without enzyme inducing
drugs) without valproate

Adult and child over 12 years: same as in monotherapy
for seizures above
Child 2–12 years: same as above in monotherapy of
typical absence seizures. Max 200 mg daily
 Monotherapy or adjunctive therapy of bipolar disorder
(without enzyme inducing drugs) without valproate

Adult over 18 years: initially 25 mg once daily for 14
days, then 50 mg daily in 1–2 divided doses for further 14
days, then 100 mg daily in 1–2 divided doses for further 7
days. Usual maintenance 200 mg daily in 1–2 divided
doses (max 400 mg daily)
 Adjunctive therapy of bipolar disorder with valproate
Adult over 18 years: initially 25 mg on alternate days for

14 days, then 25 mg once daily for further 14 days, then
50 mg daily in 1–2 divided doses for further 7 days. Usual
maintenance 100 mg daily in 1–2 divided doses (max 200
mg daily)
 Adjunctive therapy of bipolar disorder (with enzyme in-
ducing drugs) without valproate

Adult over 18 years: initially 50 mg once daily for 14
days, then 50 mg every 12hours for further 14 days, then
100 mg every 12 hours for further 7 days, then 150 mg
every 12 hours for further 7 days. Usual maintenance 200
mg every 12 hours
Contra-indications
 Hypersensitivity to lamotrigine

LAMOTRIGINE L
Side effects
 Nausea, vomiting, diarrhoea, dry mouth
 Aggression, agitation, headache, drowsiness, insomnia
 Tremor, ataxia, back pain, arthralgia
 Nystagmus, diplopia, blurred vision
 Skin rash, Stevens-Johnson syndrome
Interactions
 Rifampicin (plasma concentration of lamotrigine reduced)
 Tricyclic antidepressants, SSRIs, antipsychotics, meflo-
quine (anticonvulsant effect of lamotrigine antagonised)

 Valproate (increased concentration and toxicity of
lamotrigine)
 Oestrogens (reduced concentration of lamotrigine)
 Orlistat (increased risk of convulsions)
 Watch out for signs of bone marrow depression such as
anaemia, bruising and infection

Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Closely monitor and withdraw lamotrigine immediately if
signs of hypersensitivity such as rash and fever occur

 Avoid abrupt withdrawal; taper off over 2 weeks or long-
er unless a serious skin reaction occurs

 Use caution when switching between oral formulations
 Use half dose in moderate hepatic impairment and quar-
ter dose in severe impairment

L MONOGRAPHS
 Reduce dose in severe renal failure

 In pregnancy, use the lowest possible dose. Consider co-
administration of folate
 Monitor infant for side effects and avoid abrupt with-
drawal since withdrawal effects may develop in a breast-
fed infant
 Dose titration is required if restarting lamotrigine after an
interval of more than 5 days
LEVODOPA + CARBIDOPA NR E 9
Anti-parkinsonism medicine. Levodopa is an amino-acid pre-
cursor of dopamine and carbidopa is a peripheral dopa-
decarboxylase inhibitor
Dosage forms
 Tablet: Levodopa 100 mg + carbidopa 25 mg
 Tablet: Levodopa 200 mg + Carbidopa 50 mg
 Tablet: Levodopa 250 mg + carbidopa 25 mg
Uses
 Parkinsonism (specialist use only)
Dose and duration

 Parkinsonism
Consult product literature

Contra-indications
 Concurrent use of MAOI medicines
 Confirmed or suspected malignant melanoma
 Severe cardiac arrhythmia
 Acute stroke

LEVODOPA + CARBIDOPA L
Side effects
 Confusion, hallucinations, dizziness, nightmares, fatigue,
sleeplessness
 Palpitations
 Chorea, dystonia, impaired voluntary movement, extrap-
yramidal and movement disorders

 Orthostatic hypotension, syncope
 Nausea, vomiting, dry mouth, bitter taste, anorexia
Interactions
 Halothane (risk of arrhythmias)
 MAOI (risk of hypertensive crisis)
 Take your medication after meals
 Resume normal activities gradually
 Do not drive or operate machinery if dizzy or confused
Pregnancy
 Do not use
Breast-feeding
 Do not use
Caution
 Use with caution in pulmonary disease, peptic ulceration,
cardiovascular disease, previous myocardial infarction,
diabetes mellitus, osteomalacia, open-angle glaucoma,
history of melanoma), psychiatric illness and in elderly
 In long-term therapy, closely monitor hepatic, haemato-
logical, psychiatric, cardiovascular, and renal function

 Avoid rapid dose increases and abrupt withdrawal
 Usually, 70–100 mg of carbidopa daily is required to
completely inhibit peripheral dopa decarboxylase

L MONOGRAPHS
 Ensure effective contraception during use

 Present in breast milk. Levodopa may inhibit lactation
LEVOFLOXACIN RR E 6.2.2
Fluoroquinolone active against Gram-positive and Gram-
negative bacteria; usually reserved for complicated infections
Dosage forms
 Tablet: 500 mg
Uses
 Acute bacterial sinusitis
 Acute exacerbation of chronic bronchitis
 Community-acquired pneumonia
 Pyelonephritis
 Uncomplicated cystitis
 Complicated urinary tract infection
 Chronic bacterial prostatitis
 Complicated skin and soft tissue infections
 Inhalation anthrax
 MDR-TB (specialist use only)
Dose and duration

 Chronic bronchitis, pyelonephritis
Adult above 18 years: 500 mg once daily for 7–10 days

 Sinusitis
Adult: 500 mg once daily for 10–14 days

 Community acquired pneumonia, complicated urinary
tract infection, skin and soft tissue infections

Adult: 500 mg every 12–24 hours for 7–14 days
 Uncomplicated cystitis
Adult: 250 mg once daily for 5 days

LEVOFLOXACIN L
 Chronic bacterial prostatitis
Adult: 500 mg once daily for 28 days
 Anthrax
Adult: 500 mg once daily for 8 weeks

Note: In renal impairment, give normal fist dose, then the
following dose as shown in the table below
eGFR (ml/mi- Continuation dose
nute/1.73 m2)
>50 250 mg/ 24 h 500 mg/24 h 500 mg/12 h
20–50 125 mg/24 h 250 mg/24 h 250 mg/12 h
10–19 125 mg/48 h 125 mg/24 h 125mg/12h
<10 (also 125 mg/48 h 125 mg/24 h 125 mg/24 h
in dialysis)
Contra-indications
 Epilepsy
 Quinolone hypersensitivity
 History of tendon disorders related to fluoroquinolones
 Children and adolescents
 Pregnancy and breast-feeding
Side effects
 Insomnia, headache, dizziness
 Diarrhoea, vomiting, nausea
 Increased liver enzymes (ALT and AST)
Interaction
 Artemether + lumefantrine (risk of irregular heart beat)

L MONOGRAPHS
 Do not drive or operate machinery if medicine makes
you drowsy
Pregnancy
 Do not use
Breast-feeding
 Do not use
Caution
 Do not use for suspected or known Methicillin Resistant
Staphylococcus aureus due to likelihood of co-resistance
 Tendinitis and tendon rapture may occur from 48 hours
up to several months after discontinuation. Risk is higher
in patients over 60 years. Stop treatment if it occurs
 Use with caution in history of epilepsy, conditions predis-
posed to seizures, G6PD deficiency, myasthenia gravis
 Discontinue treatment if psychiatric, neurological or
hypersensitivity reactions occur
LEVONORGESTREL HC I V 18.3
Progestogen-only contraceptive
Dosage forms
 Tablet: 28 active tablets of 30 µg
 Tablet: 750 µg (Emergency contraception)
 Implant: Two rods of 75 mg with a sterile applicator
Uses
 Emergency contraception

LEVONORGESTREL L
Dose and duration
1 tablet daily; initiation as for etonogestrel.

Implant with effect for 3–5 years; insertion as for
etonogestrel
 Emergency contraception
2 tablets (750 µg) as a single dose as soon as possible

after unprotected sexual intercourse; preferably within
72 hours
Contra-indications
 Deep vein thrombosis
 History of recent stroke
 Undiagnosed breast lumps or breast cancer
Side effects
 Menstrual disturbances
 Pain in breasts
 Mood changes
 Acne
 Headaches
 Weight gain
 Blood coagulation problems
Interactions
Same as for ethinylestradiol + norgestrel
 Take tablets at the same time every day; strict compli-
ance is essential for effective contraception

L MONOGRAPHS

 Warning signs for severe side effects: severe headaches,
blurred vision, depression, acute severe abdominal pain,
chest pain, shortness of breath, swelling, pain in calf
muscle. Report to health worker immediately
 In case of missed dose: Take tablet as soon as you
remember and continue treatment as normal. If over 3

hours have passed, use condom. If patient has had sexual
intercourse within 5 days before forgetting the tablet,
take emergency contraception
 Emergency pill may cause vaginal bleeding 7 days after
ingestion
 If patient wishes to get pregnant again, stop tablet
treatment; fertility usually returns within 3–6 months

Pregnancy
 Do not use
Breast-feeding
 Can be used
Caution
 Can be used where combined oral contraceptives are not
tolerated or are contraindicated (e.g. breast-feeding
mothers, diabetes, women >35 years)
with medicines listed under Interactions. For the emer-
gency pill, double the dose to 4 tablets (3 mg).
 See etonogestrel for more cautions
 Emergency contraception is not intended to terminate an
existing pregnancy

LEVOTHYROXINE L
 Risk of treatment failure after taking emergency contra-
ception. Carry out a pregnancy test if menstruation does
not occur within 5–7 days of expected date or within 21
days after taking.
 Avoid repeated use of emergency contraception
LEVOTHYROXINE H V 18.8
Thyroid hormone for replacement therapy
Dosage forms
 Tablet: 100 micrograms
Uses
 Treatment of hypothyroidism
Dose and duration

 Treatment of hypothyroidism
Adult: 50–100 micrograms once daily before breakfast;

increased by 25–50 micrograms every 3–4 weeks accord-
ing to response, up to maintenance dose of 100–200
micrograms once daily
In cardiac disease, severe hypothyroidism and patients
over 50 years: 25 micrograms once daily increased by 25
micrograms every 4 weeks according to response up to
maintenance dose of 50–200 micrograms once daily
Child 12–18 years: 50 micrograms once daily increased as
required by 25–50 micrograms every 3–4 weeks until
metabolism is normal up to maintenance dose is 100–200
micrograms once daily
Child 2–12 years: 50 µg once daily increased by 25
micrograms every 2–4 weeks until metabolism is normal.
Maintenance dose of 75–100 micrograms daily
L MONOGRAPHS
Child 1 month– 2 years: 5 micrograms/kg once daily (max

50 µg once daily) increased in increments of 10–25
micrograms every 2–4 weeks until metabolism is normal-
ised. Maintenance dose, 25–75 micrograms once daily
Neonate: 10–15 micrograms once daily (max 50
micrograms once daily) increased in by 5 micrograms/kg
every 2 weeks or as is necessary until metabolism is
normalised. Maintenance dose, 20–50 micrograms daily
Contra-indications
 Thyrotoxicosis
Side effects
 Fever, flushing
 Weight loss
 Restlessness, excitability, insomnia, headache, sweating
 Diarrhoea, vomiting
 Angina pain, arrhythmias, palpitations, tachycardia
 Menstrual irregularities
Interactions
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Side effects usually indicate excessive dosage and often
disappear on dose reduction or withdrawal of treatment
for a few days

LIGNOCAINE (LIDOCAINE) L
 In patients with panhypopituitarism or predisposition to
adrenal insufficiency, corticosteroid therapy should be
instituted prior to levothyroxine treatment
 The dose of insulin and other antidiabetic drugs may
need to be increased
LIGNOCAINE (LIDOCAINE) HC II V 1.2, 28.2, 28.3

Local anaesthetic
Dosage forms
 Solution for injection: 2%
 Gel: 2%
 Lozenge: 4%
 Sprays: 10%, 5%
 Ointment: 5%
 Injection (preservative free): 5%
 Injection: lignocaine 1% + adrenaline 1:200,000
 Injection (dental catridge): lignocaine + adrenaline 2% +
1:80,000 (specialist use only)

 Nasal drops: lignocaine 2% +adrenaline 1:100,000
Uses
 Prevent pain before surgical procedure
 Mouth ulcers
Dose and duration

 Prevent pain before surgical procedure
3 mg/kg (max 200 mg). Usually single dose is given;

may be repeated if necessary. Anaesthesia is produced
within 2–5 minutes and lasts 1–1.5 hours
 Prevent pain before suturing wound
Use lignocaine 2%
L MONOGRAPHS
 Mouth ulcers
Apply gel inside the mouth surface when necessary
Adult: 2–3 ml
Child: 1–2 ml
 Sore throat, mouth ulcers
Apply spray or suck lozenge as needed

 Severe pain after insect bite
Infiltrate 2mL of 2% solution around the area of the bite

Contra-indications
 Allergy to lignocaine
 Skin infection
 Patients on warfarin or aspirin
 Severe anaemia
 Severe heart disease
Side effects
 Dizziness, restlessness
 Blurred vision
 Tremors
Interactions
 Atenolol (increased effect of atenolol)
 Propranolol (increased effect of propranolol)
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Use lower doses in elderly, epileptic patients, and in

LISINOPRIL L
acute illness
 Epidural injection should only be given by specialists
LISINOPRIL H E 12.3
Angiotensin converting enzyme inhibitor antihypertensive
Dosage forms
 Tablet: 10 mg
Uses
 Moderate and severe hypertension (stage 2 and 3)
 Symptomatic heart failure
 Renal disease in hypertensive patients with type II diabe-
tes mellitus
 Prophylaxis after myocardial infarction
Dose and duration

 Stage 2 hypertension (with another antihypertensive)
Adult: 10 mg once daily (2.5–5 mg in cardiac decompen-

sation or volume depletion). Usual maintenance dose is
20 mg once daily (max 80 mg once daily)
Child 12–18 years: 5 mg once daily increased to usual
maintenance dose of 10–20 mg once daily (max 80mg
once daily)
Child 6–12 years: 0.07 mg/kg (max 5 mg) once daily in-
creased at intervals of 1–2 weeks up to a maximum of 0.6
mg/kg (max 40 mg once daily)
 Heart failure
Adult and child > 12 years: 2.5 mg once daily increased

by not more than 10 mg at intervals of 2 weeks or more,
up to a maximum of 35 mg once daily if tolerated
 Renal disease in hypertensive patients with type II

L MONOGRAPHS
diabetes mellitus
Adult and child > 12 years: 2.5–5 mg once daily;
increased as required up to maintenance dose of 10–20
mg once daily
 Prophylaxis after myocardial infarction (see caution)
Adult: Systolic blood pressure ≥120 mmHg; 5 mg within

24 hours of onset, followed by 5 mg after 24 hours, then
10 mg after another 24 hours and then 10 mg once daily
for 6 weeks. Systolic blood pressure 100–120 mmHg; 2.5
mg daily increased to maintenance dose of 5 mg once
daily for 6 weeks
Contra-indications
 Hypersensitivity to lisinopril or other ACE inhibitors
 Hereditary or idiopathic angioedema
 History of angioedema associated with previous ACE in-
hibitor therapy
Side effects
 Orthostatic hypotension
 Dry cough
 Renal dysfunction
Interactions
 Diuretics (increased hypotensive effect)
 Potassium sparing diuretics, aldosterone antagonists (in-
creased risk of severe hyperkalaemia)


LITHIUM CARBONATE L
 Take your medication at approximately the same time
each day
Pregnancy
 Do not use
Breast-feeding
 Do not use
Caution
 Do not use in myocardial infarction if systolic BP is below
100 mmHg. If systolic BP drops below 100 mmHg during
treatment, reduce dose or withdraw in case of prolonged
hypotension (systolic BP less than 90 mmHg for > 1 hour)
 Side effects more likely to occur in renal failure. Reduce
dose if creatinine clearance ˂80 ml/minute
 Use with caution in patients who have volume depletion
due to risk of hypotension
 Increased risk of anaphylactoid reactions in patients
undergoing haemodialysis
LITHIUM CARBONATE NR E 24
Psychotherapeutic medicine
Dosage forms
 Tablet: 400 mg
Uses
 Acute episodes of mania or hypomania
 Prophylaxis of recurrent manic-depressive illness and bi-
polar disorder

L MONOGRAPHS
Dose and duration

 All indications

Adjust dose to achieve a serum lithium concentration of
0.4–1 mmol/litre 12 hours after a dose, on the 4th–7th day
of treatment. Then measure serum lithium concentration
every week until the dosage has remained constant for 4
weeks and every 3 months thereafter. Use the lowest
effective dose in the elderly.
Initially give in divided doses and then once daily when
serum concentration has stabilised
Contra-indications
 Impaired renal function
 Cardiac disease
 Untreated hypothyroidism
 Low body sodium levels
 Hypersensitivity to lithium
Side effects
 Fine tremor
 Polyuria, polydipsia
 Nausea
 Leukocytosis
 Weight gain and oedema
Interactions
 Acetazolamide (increased excretion of lithium)
 Amiloride, enalapril, hydrochlorothiazide, furosemide,
ibuprofen, spironolactone (reduced lithium excretion,

LITHIUM CARBONATE L
hence increased plasma concentration and toxicity)
 Fluoxetine (increased risk of CNS effects)
 Methyldopa (increased risk of neurotoxicity)
 Maintain adequate fluid intake and avoid dietary changes
which reduce or increase sodium intake.

 Seek medical attention if signs of hypothyroidism (e.g.
feeling cold, lethargy) develop; more likely in women

Pregnancy
st
Breast-feeding
 Can be used
Caution
 Avoid abrupt withdrawal, withdraw over a period of at
least 2 weeks
 Avoid use or reduce dose in renal impairment
 In a breast-feeding mother, monitor the infant for toxicity
(especially in risk of dehydration)
 Risk of teratogenicity when lithium is used in the 1st
trimester of pregnancy. Dose requirements increase in
the 2nd and 3rd trimesters but reduce abruptly to normal
on delivery. Monitor serum concentration
 Monitor renal function and thyroid function every 6–12
months since there is a risk of hypothyroidism
 Maintain adequate fluid and sodium intake. Reduce dose
or discontinue in diarrhoea, vomiting, and intercurrent in-
fection (especially if associated with profuse sweating)
 Lithium may exacerbate psoarisis
 Different preparations vary widely; change in preparation
L MONOGRAPHS
requires the same precaution as initial treatment
LOPERAMIDE H N 17.6.2
Opioid antidiarrhoeal. Reduces gastrointestinal motility
Dosage forms
 Capsule: 2 mg
Uses
 Symptomatic treatment of acute diarrhoea
 Symptomatic treatment of chronic diarrhoea
Dose and duration

 Symptomatic treatment of acute diarrhoea
Adult and child over 12 years: initially 4 mg, followed by 2

mg after each further loose stool (max 12 mg in 24 hours)
Child 8–12 years: 2 mg every 6 hours for up to 5 days
Child 4–8 years: 1 mg 3–4 times daily for up to 3
days only
 Symptomatic treatment of chronic diarrhoea
Adult: 4–8 mg daily in divided doses adjusted according

to response and given in 2 divided doses for maintenance
Child 12–18 years: 2–4 mg 2 to 4 times daily
Child 1 month–12 years: not recommended
Contra-indications
 Constipation
 Diverticular disease
 Ulcerative colitis
Side effects
 Constipation, flatulence, nausea, headache

LOPINAVIR/RITONAVIR (LPV/r) L
 Take the capsules with a liquid
 Do not exceed the recommended dose
 In case there is no improvement after 48 hours, stop
medication and see your doctor

Pregnancy
 Do not use
Breast-feeding
 Do not use
Caution
 Discontinue if constipation, abdominal distension or ileus
develop
 Patients with AIDS treated with loperamide for diarrhoea
should stop therapy at the earliest signs of abdominal
distension due to increased risk of toxic megacolon
 Discontinue if there is no improvement after 48 hours
LOPINAVIR/RITONAVIR (LPV/r) HC IV V 30.3

Protease inhibitor (PI) antiretroviral medicines. Ritonavir is a
booster that increases effect of lopinavir (LPV)
Dosage forms
 FDC capsules: LPV 100 mg + RTV 25 mg
 FDC capsules: LPV 200 mg + RTV 50 mg
 Oral solution: LPV 80 mg/mL + RTV 20 mg/mL
Uses
 HIV/AIDS
Dose and duration

 HIV infection, second line treatment

L MONOGRAPHS
Adult and adolescent >35 kg: 400 mg/100 mg LPV/r

every 12 hours (in combination with AZT + 3TC or TDF
+ 3TC or ABC + 3TC)
Child 25–35 kg: LPV/r 100/25 tablet; give 3 tablets
every 12 hours (in combination with AZT + 3TC or ABC
+ 3TC)
Child <25 kg: Use LPV/r 80/20 mg/ml syrup as in table
below (in combination with AZT + 3TC or ABC + 3TC)
Weight (kg) LPV/r 80/20 mg/ml syrup

20 – 24.9 3 ml every 12 hours
14 – 19.9 2.5 ml every 12 hours
6 – 9.9 1.5 ml every 12 hours
Contra-indications
 Allergy to lopinavir or ritonavir
Side effects
 Stomach upset, flatulence, anorexia, taste disturbance
 Liver damage, pancreatitis
 Blood disorders
 Sleep disturbance, fatigue, headache, dizziness
 Muscle pain
Interactions
 Artemether + lumefantrine (increased risk of irregular
heartbeat)
 Efavirenz (reduced effect of lopinavir)
 Nevirapine (reduced effect of lopinavir)

LORAZEPAM L
 Carbamazepine (reduced effect of lopinavir)
 Dexamethasone (reduced effect of lopinavir)
 Phenobarbital (reduced effect of lopinavir)
 Rifampicin (reduced effect of lopinavir)
 Simvastatin (increased risk of muscle pain or damage)
 Take with food
 Do not crush or open the capsules; swallow whole
 Preferably store oral solution in a refrigerator. If refriger-
ator not available, store in a cool dark place

Pregnancy
 Can be used
Breast-feeding
 Can be used
Storage
 Keep oral solution refrigerated whenever possible
Caution
 Use with caution in patients with chronic Hepatitis B or C
as they are at high risk of liver damage
LORAZEPAM H E 1.3
Short acting benzodiazepine
Dosage forms
 Tablet: 2.5 mg

L MONOGRAPHS
Uses
 Short-term use in anxiety or insomnia
 Conscious sedation pre-operatively
 Premedication before surgery or operation
Dose and duration

 Anxiety
Adult: by mouth, 1–4 mg daily in divided doses for 2–4

weeks
Elderly or debilitated: 0.5–2 mg as above
 Insomnia associated with anxiety
Adult: by mouth, 1–2 mg at bedtime for 2–4 weeks

 Acute panic attacks
Adult: by IM or slow IV injection (into a large vein),

0.025–0.03 mg/kg (usual range 1.5–2.5 mg), repeated
every 6 hours if necessary
 Premedication and conscious sedation
Adult and child over 12 years: by mouth, 2–3 mg the

night before operation then 2–4 mg 1–2 hours before
operation
By slow IV injection, 0.05 mg/kg 30–45 minutes before
operation. Dilute with an equal volume of sodium chlo-
ride 0.9% or water for injection
By IM injection, diluted as above, 0.05 mg/kg 60–90
minutes before operation
Child 1 month–12 years: by mouth, 0.05–0.1 mg/kg (max
4 mg) as above. Same dose may be given the night before
in addition to or as a replacement
By IV injection, 0.05–0.1 mg/kg (max 4 mg) 30–45
minutes before the procedure
LORAZEPAM L
 Status epilepticus, febrile convulsions and convulsions
caused by poisoning
Adult and child over 12 years: by IV injection, 4 mg as a
single dose, repeated once after 10 minutes if necessary
Neonate and child up to 12 years: by IV injection, 0.1
mg/kg (max 4 mg) as a single dose, repeated once after
10 minutes if necessary
Contra-indications
 Obsessional states
 Hypersensitivity to benzodiazepines
Side effects
 Daytime drowsiness, sedation, dizziness
 Ataxia, muscle weakness
 Asthenia (extreme tiredness), fatigue
Interactions
 Clozapine ( increased risk of serious adverse events)
 Olanzapine (increased risk of hypotension, bradycardia
and respiratory depression when parenteral lorazepam is

given with intramuscular olanzapine)
 Sodium oxybate (enhanced effects of sodium oxybate)
 Do not drink alcohol during and for 24–48 hours after
treatment with lorazepam

 Avoid driving or operating machinery while taking
lorazepam

L MONOGRAPHS
Pregnancy
st rd
Breast-feeding
 Do not use
Storage
o
 Store the solution for injection in a refrigerator at 2–8 C
Caution
 Only use the IM route when oral and IV routes are not
possible. Do not give by the IM route for convulsions
 Monitor patient for at least 8 hours and preferably over-
night
 Ensure availability of facilities for managing respiratory
depression with mechanical ventilation
 Reduce doses in mild to moderate hepatic impairment
and in renal impairment
LOSARTAN RR N 12.3
Angiotensin-II receptor antagonist antihypertensive medicine
Dosage forms
 Table: 50 mg
Uses
 Moderate and severe hypertension (stage 2)
 Chronic heart failure
Dose and duration

 Stage 2 hypertension (in combination with another anti-
hypertensive)
Adult and child >50 kg: 50 mg once daily (25 mg in intra-
vascular volume depletion) adjusted according to
LOSARTAN L
response up to a maximum of 100 mg once daily
Elderly over 75 years: 25 mg once daily
Child 6–18 years (body weight 20–50 kg): 0.7 mg/kg up
to 25 mg once daily (max 50 mg once daily). Reduce dose
in intravascular volume depletion
 Chronic heart failure
Adult: 12.5 mg once daily increased at weekly intervals to

maximum 150 mg daily if tolerated
Contra-indications
nd
 2 and 3rd trimester of pregnancy
Side effects
 Dizziness, malaise, fatigue, vertigo
 Hypotension including orthostatic hypotension
 Angioedema
 Anaemia
 Hyperkalaemia, increase in blood urea, serum creatinine
and serum potassium, hypoglycaemia

Interactions
 Diuretics (enhanced hypotensive effect)
 Potassium sparing diuretics, aldosterone antagonists
(increased risk of hyperkalaemia)

 Potassium salts (increased risk of hyperkalaemia)
 Preferably take your medication in the morning

M MONOGRAPHS
Pregnancy
 Do not use
Breast-feeding
 Do not use
Caution
 Use with caution in renal artery stenosis, aortic and mi-
tral valve stenosis, hypertrophic cardiomyopathy, severe
heart failure and in history of angioedema
 Reduce dose in mild to moderate hepatic impairment.
Not recommended in children with hepatic impairment
 Avoid in patients with severe renal impairment
 Monitor renal function regularly especially in dehydration
M
MAGNESIUM SULPHATE HC III V 5
Anticonvulsant
Dosage forms
 Solution for injection: 500 mg/ml (50%)
Uses
 Eclampsia in pregnancy
 Prevention of eclampsia (severe pre-eclampsia)
 Hypomagnesaemia
Dose and duration

 Hypomagnesaemia
Adult: by IM injection, 1 g every 6 hours for 4 doses in

mild hypomagnesaemia (In severe cases, 5 g by IV infu-

MAGNESIUM SULPHATE M
sion over 3 hours). Maintenance dose 30–60 mg/kg/day
Child: by IV/IM injection, 25–50 mg/kg every 4–6 hours
for 3–4 doses
 Treatment and prevention of eclampsia
4 g as slow IV bolus over 10–15 minutes followed by IV

infusion of 1–3 g/hour. Monitor respiration rate and
knee jerk reflexes
Preparation
 Dilute 4 g (8 ml) to make up to a total volume of 20 ml
with water for injection

 Dilute solution with normal saline or dextrose 5% to 20%
w/v for IM injection or to 20% or less for IV administra-

tion
Contra-indications
Side effects
 Warm flushes
 Thirst
 High blood magnesium levels
Interactions
 Nifedipine (risk of hypotension)
Pregnancy
 Can be used
Breast-feeding
 Can be used

M MONOGRAPHS
Caution
 Monitor respiratory rate, blood pressure, knee jerk reflex,
and urine output every 30 minutes
 Watch for signs of magnesium toxicity: low blood
pressure, drowsiness, difficulty in speaking, double vision,
confusion, irregular heartbeat, low respiratory rate (<16
breaths per minute), absent knee jerk reflex
 Calcium gluconate is the antidote for magnesium
sulphate toxicity
 Reduce dose in patients with kidney disease
MAGNESIUM TRISILICATE COMPOUND HC II E 17.1

Magnesium trisilicate and dried aluminium hydroxide antacid.
Provides symptomatic relief by reducing stomach acidity
Dosage forms
 Tablet: Magnesium trisilicate 250 mg+ dried aluminium
hydroxide 120 mg
Uses
 Peptic ulcer
 Heart burn
Dose and duration

Adult: Chew 2 tablets every 8 hours or as necessary
Up to 2 tablets per hour may be required
Contra-indications
 Undiagnosed intestinal or rectal bleeding
 Appendicitis
 Metabolic or respiratory alkalosis
 Hypophosphataemia

MALATHION M
 In patients who must control sodium intake
Side effects
 Diarrhoea, belching, constipation
Interactions
 Reduces absorption of several medicines
 More effective when tablets are chewed
 Take at least two hours apart from any other medicines
 Take between meals or at bedtime
Pregnancy
 Can be used
Breast-feeding
 Can be used
MALATHION HC II N 13.6
Pediculicide (kills lice)
Dosage forms
 Aqueous lotion: 0.5%
Uses
Dose and duration

Adult and child >2 year: Apply and leave on for 12
hours
Child 6 months–2 years: Apply and leave on for 8
hours
When removing, rinse with plenty of water
Repeat the application after 10 days to kill any lice that
M MONOGRAPHS
may have emerged from eggs

Treat the whole family
Side effects
 Scalp irritation
 When applying lotion to hair and scalp, pay attention to
the areas behind the ears and in the neck

 Never swallow! For external use only
 Avoid contact with eyes. If product enters the eye, rinse
with plenty of water

 Report to your health care worker in case of poisoning.
First signs of poisoning are: stomach pain, vomiting, and

diarrhoea. Severe poisoning: shortness of breath, sei-
zures, and coma
 Wash hands with soap after use
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Repeated applications in intervals less than 1 week or ap-
plications for more than 3 consecutive weeks should be
avoided, as it does not increase effectiveness
 Do not use for prevention

MANNITOL M
MANNITOL RR E 15
Osmotic diuretic
Dosage forms
 Intravenous infusion: 20%
Uses
 Cerebral oedema
 Raised intraocular pressure
Dose and duration

 Test dose (in oliguria or patient with poor renal function)
Adult and child: IV infusion of 200 mg/kg of 20% solution

over 3–5 minutes. Repeat test dose if urine output is less
than 30–50 ml/hour. Re-evaluate the patient if response
is inadequate after 2nd test dose
 Cerebral oedema
Adult and child: infuse rapidly 1 g/kg of 20% solution IV

repeated 1–2 times if necessary after 4–8 hours
 Raised intracranial or intraocular pressure
Adult: infuse 0.25–2 g/kg of 20% solution IV over 30–60

minutes repeated 1–2 times if necessary after 4–8 hours
Contra-indications
 Intracranial bleeding
 Anuria
 Metabolic oedema with abnormal capillary fragility
 Severe dehydration
 Renal failure unless test dose produces diuresis
Side effects
 Fluid and electrolyte imbalances, circulatory overload

M MONOGRAPHS
 Acidosis
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Monitor fluid and electrolyte balance, renal function,
pulmonary function and serum osmolality. Assess cardiac
function before and during treatment
The solution may crystallize during storage, thereby need
re-dissolution by warming prior to administration. Do not
use solution if crystals remain after warming
 IV administration sets must have a filter. Do not adminis-
ter mannitol with whole blood or pass it through the
same transfusion set as blood
 Only use in pregnancy and breast-feeding if it is essential
MEASLES VACCINE HC II V 19.3.1

Live attenuated measles virus vaccine used in routine immun-
isation of children
Dosage forms
 Powder for injection: 10 dose vial and diluents
Uses
 Prevention of measles in children
Dose and duration

 Child >9 months: 0.5 ml SC injection into left upper arm

MEBENDAZOLE M
Preparation
 Use only diluent provided to reconstitute the measles
vaccine powder
Contra-indications
 Severe acute illness
Side effects
 Pain, swelling, redness at injection site
 Fever
 Rashes
 Child may get a mild skin rash and fever; do not worry
 Do not apply anything to the injection site
Pregnancy
 Not applicable
Breast-feeding
 Not applicable
Storage
 Store at 2–8°C.
 Reconstituted vaccine may be stored between for not
more than 6 hours

 Never freeze the diluents
MEBENDAZOLE HC II E 6.1.1
Intestinal antihelminthic (dewormer)
Dosage forms
Uses
 Intestinal worms (roundworm, threadworm, hookworm,

M MONOGRAPHS
strongyloidiasis, tapeworm, whipworm)

 Echinococcosis (hydatid disease)
Dose and duration
 Intestinal worms
Adult and child >2 years: 500 mg single dose

Child <2 years: 250 mg single dose
A 3-day course may be required for severe infections
 Echinococcosis (in combination with surgery)
1.5 g every 8 hours for 6 months

Contra-indications
 Children <6 months
Side effects
 Stomach upset
 Chew the tablet or crush and mix with drinking water
 Take between meals
Pregnancy
 Do not use
Breast-feeding
 Can be used
Caution
 Preferably use albendazole as it is active against more
types of worms
 Treat all family members
 Repeat dose 2–4 weeks later as re-infection occurs easily
 All children should repeat the dose every 6 months

MEDROXYPROGESTERONE ACETATE M
MEDROXYPROGESTERONE ACETATE HC II V 18.3
Long-acting, injectable, progestogen-only contraceptive
Dosage forms
 Aqueous suspension for injection: 150 mg/ml
Uses
 Long-term (3 months) prevention of unwanted pregnancy
Dose and duration

1 injection every 12 weeks (3 months) during the first

5 days of a normal menstrual cycle or 5 days post-
partum if the mother is not breast-feeding
Initiation as for etonogestrel implant
Use for as long as contraception is desired
Contra-indications
 Breast cancer
 Uncontrolled high blood pressure
 Recent stroke
 Uncontrolled diabetes
Side effects
 Delayed return to fertility after stopping the injection
 Weight gain
 Osteoporosis

M MONOGRAPHS
 Return of fertility can be delayed after stopping use
Pregnancy
 Do not use
Breast-feeding
 Can be used
Caution
 Shake vial before use to mix the suspension well
 Medroxyprogesterone is a good alternative to oral con-
traceptives in patients on rifampicin, carbamazepine, iso-
niazid, and phenobarbital as these medicines do not af-
fect the contraceptive effectiveness
 Commonly known as Depo-Provera®
MEFLOQUINE RR N 6.4.3
Antimalarial medicine
Dosage forms
 Tablet: 250 mg
Uses
 Prophylaxis of P. falciparum malaria of multiple re-
sistance
Dose and duration
 Prophylaxis of P. falciparum malaria
Prophylaxis should start 1–3 weeks before travelling to a

malaria-endemic area and continue for 4 weeks after
leaving the area. Maximum recommended duration of
treatment is 12 months
Adult over 45 kg: 250 mg once a week
MEFLOQUINE M
Child over 5 kg: 5 mg/kg once a week
Taken on the same day each week
Weight (kg) Dose per week
5–19 ¼ tablet
20–30 ½ tablet
31–45 ¾ tablet
Adult and child >45 1 tablet
Contra-indications
 Hypersensitivity to quinine
 History of neuropsychiatric disorders including depres-
sion or convulsions
 History of blackwater fever
Side effects
 Nausea, vomiting, diarrhoea, abdominal pain, anorexia
 Headache, dizziness, vertigo, insomnia, abnormal dreams
 Anxiety, depression, suicidal ideation
 Visual impairment
 Pruritus, Stevens- Johnson syndrome
 Encephalopathy
 Atrioventricular block
Interactions
 Amiodarone (increased risk of ventricular arrhythmias)
 Artemether +Lumefantrine (avoid concomitant use)
 Carbamazepine(antagonism of anticonvulsant effect)
 Chloroquine (increased risk of convulsions)
 Citalopram (risk of ventricular arrhythmias)
 Ethosuximide (antagonism of anticonvulsant effect)

M MONOGRAPHS
 Haloperidol (increased risk of ventricular arrhythmias)

 Phenytoin (antagonism of anticonvulsant effect)
 Quinine (increased risk of convulsions )
 Rifampicin (reduced concentration of mefloquine)
 Valproic acid (antagonism of anticonvulsant effect)
 Dizziness may impair ability to perform skilled tasks for
up to 3 weeks after treatment

 Stop use and seek medical advice if symptoms such as
anxiety, paranoia, depression, hallucinations, suicidal

thoughts and psychosis occur
Pregnancy
 Do not use
Breast-feeding
 Can be used
Caution
 Intravenous quinine can still be given in severe malaria
regardless of the interaction
 Avoid pregnancy during and for 3 months after use
 Avoid use in epilepsy and cardiac conduction disorders
 Stop therapy if patient experiences signs of neuropathy
 Vaccinations with oral attenuated live bacteria should be
completed at least 3 days before the first dose of
mefloquine

MELARSOPROL M
MELARSOPROL RR N 6.4.4
Antitrypanosomal medicine with activity against Trypanoso-
ma brucei rhodesiense and Trypanosoma brucei gambiense
Dosage forms
Uses
 Treatment of the meningoencephalitic stage of Trypano-
somal infections (e.g. sleeping sickness)

Dose and duration
 Treatment of the meningoencephalitic stage of Trypano-
somal infections
Adult and child: by slow IV injection, increase dose grad-
ually from 1.2 mg/kg up to a maximum of 3.6 mg/kg daily
in courses of 3–4 days with intervals of 7–10 days be-
tween courses
Alternatively, 2.2 mg/kg daily for 10 days in T. gambiense
infection
Contra-indications
 Pregnancy
 During influenza epidemics
Side effects
 Fatal reactive encephalopathy (characterised by head-
ache, tremor, slurred speech, convulsions and coma)

 Myocardial damage, hypertension
 Hypersensitivity reactions, urticaria
 Agranulocytosis
 Dose-related renal and hepatic impairment, albuminuria
 Hyperthermia, headache

M MONOGRAPHS
Pregnancy
 Do not use
Breast-feeding
 Can be used
Caution
 Melarsoprol injection is very irritant (avoid extravasa-
tion). Patients should remain lying face upward and fast
(no food or drink) for at least 5 hours after injection
 Hospitalisation and close medical supervision is required
during the treatment period
 Suspend drug during episodes of reactive encephalopathy
 All intercurrent nfections such as pneumonia and malaria
should be treated before melarsoprol administration
 Correct malnutrition with a protein-rich diet before
treatment
 Use with caution in leprosy and G6PD deficiency
MENINGOCOCCAL VACCINE CONJU-

HC IV E 19.3.2
GATE (A + C)
Inactivated polysaccharide antigens of Neisseria meningitidis
serogroups A and C. It is recommended for individuals at high
risk for example, those in military camps, boarding schools,
travellers to endemic areas, asplenic individuals and those
with inherited immune deficiencies. It can also be used for
mass immunisation in emergency outbreaks. For routine im-
munisation of infants, Meningococcal group C conjugate vac-
cine produces a better response and should be used instead.
Dosage forms
 Injection: 0.5 ml

MERCAPTOPURINE M
Uses
 Active immunisation against meningitis and septicaemia
caused by N. meningitidis bacteria

Dose and duration
 Adult and child: 0.5 ml single dose
Route according to manufacturer’s instruction

Contra-indications
 Severe acute illness
Side effects
 Pain, swelling, redness at injection site
 Fever
Pregnancy
 Can be used
Breast-feeding
 Can be used
Storage
 Store at 2–8°C
Caution
 In children below 2 years, the response to this vaccine is
not sufficient. Use meningococcal group C vaccine if
available
MERCAPTOPURINE NR V 8.2
Dosage forms
 Tablet: 50 mg

M MONOGRAPHS
Uses
Dose and duration

 All uses
Adult and child: usual dose is 2.5 mg/kg per day or

50−75 mg/m; dose and duration depend on the other
cytotoxic agents given in conjunction with mercapto-
purine. Consult product literature
Contra-indications
 Hypersensitivity to mercaptopurine
Side effects
 Myelosuppression (leucopoenia, thrombocytopenia)
 Hepatotoxicity
Interactions
 Allopurinol (increase effects/toxicity of mercaptopurine)
 Cotrimoxazole (increased risk of haematotoxicity)
 Warfarin (reduced anticoagulant effect)
 Clozapine (agranulocytosis)
 Take at least 1 hour before or 3 hours after food or milk
Pregnancy
 Do not use
Breast-feeding

MEROPENEM M
Caution
 Reduce dose in renal or hepatic impairment
 Monitor full blood counts regularly
MEROPENEM RR V 6.2.1
Carbapenem. Broad-spectrum beta-lactam antibacterial
active against many Gram-positive and Gram-negative
bacteria and anaerobes. It also has good activity against
Pseudomonas aeruginosa
Dosage forms
 Powder for reconstitution for injection: 500 mg
Uses
 Severe hospital-acquired infections
 Septicaemia
 Severe pneumonia (hospital and ventilator-associated)
 Broncho-pulmonary infections in cystic fibrosis
 Complicated intra-abdominal infections
 Intra- and post-partum infections
 Complicated skin and soft-tissue infections
 Complicated urinary tract infections
 Acute bacterial meningitis
Dose and duration

 Aerobic and anaerobic Gram-positive and Gram-negative
infections, hospital-acquired septicaemia

By IV injection over 5 minutes or by IV infusion
Adult and child > 12 years or 50 kg: 0.5–1 g every 8 hours
Child 3 months–12 years or <50 kg: 10–20 mg/kg every 8
M MONOGRAPHS
hours
Neonate 7–28 days: 20 mg/kg every 8 hours. Double
dose in severe infection
Neonate under 7 days: 20 mg/kg every 12 hours. Double
dose in severe infection
In renal impairment: give dose as in table below
eGFR Dose
(ml/minute/1.73 m2)
26–50 Normal dose every 12 hours
10–25 ½ normal dose every 12 hours
<10 ½ normal dose every 24 hours
 Bronchopulmonary infection in cystic fibrosis, meningitis
By IV infusion,
Adult and child over 12 years or 50 kg: 2 g every 8 hours
Child 1 month–12 years or <50 kg: 40 mg/kg every 8
hours
Neonate under 7 days: 40 mg/kg every 12 hours
 Endocarditis (in combination with another antibacterial)
Adult over 18 year: 2 g every 8 hours

Preparation
 Dilute meropenem infusion dose in glucose 5% or sodium
chloride 0.9% to a final concentration of 1–20 mg/ml.

Give over 15–30 minutes
Contra-indications
 History of immediate hypersensitivity reaction to beta-
lactam antibacterials
 Hypersensitivity to meropenem or other carbapenems

METFORMIN M
Side effects
 Headache
 Thrombocythaemia
 Increased liver function tests
 Rash, pruritus, Stevens-Johnson syndrome
 Injection site inflammation, pain
Interactions
 Valproate (reduced plasma concentration of valproate)
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Use with caution in patients with sensitivity to beta-
lactam antibacterials
 Monitor liver function if used in hepatic impairment
 Only use in pregnancy if benefit outweighs risk.
METFORMIN HC IV V 18.5
Biguanide oral antidiabetic medicine. It works by decreasing
the production of glucose and increasing the utilisation of
glucose by the peripheral cells.
Dosage forms
 Tablet: 500 mg
Uses
 Type II diabetes mellitus

M MONOGRAPHS
Dose and duration

 Type II diabetes
Adult and child > 10 years: initially 500 mg with break-

fast for at least 1 week, then 500 mg with breakfast
and evening meal for at least 1 week; then 500mg with
breakfast, lunch and evening meal. Maximum 2 g daily
in divided doses
Child 8–10 years: initially 200 mg once daily adjusted
according to response at intervals of at least 1 week
(max 2 g daily in 2–3 divided doses)
Contra-indications
 Ketoacidosis
 General anaesthesia
 Iodine-containing x-ray contrast media
 Moderate to severe renal impairment
 Alcohol dependency
 Disease that may cause tissue hypoxia (e.g. heart failure,
respiratory failure, recent myocardial infarction, shock)

Side effects
 Nausea, vomiting, diarrhoea, abdominal pain, taste dis-
turbance
 Decreased vitamin B12 absorption
 Itching
 Lactic acidosis
 Continue diet restrictions and exercise recommendations
 Always take metformin with meals
 Gastro intestinal side effects usually go away as you con-
tinue taking the medicine so do not worry

METHIONINE M
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 May cause lactic acidosis in renal impairment
 Determine renal function before treatment and at least
once a year during treatment
 Suspend metformin on morning of surgery and restart
when renal function returns to normal
 Iodinated contrast media may cause kidney failure, which
can increase the risk of lactic acidosis with metformin.
Suspend metformin prior to the test; restart no earlier
than 48 hours after the test and renal function has
returned to normal
 Insulin is always required in medical and surgical
emergencies e.g. during infections
 During pregnancy, it is preferable to use insulin so as to
achieve as normal as possible blood glucose concentra-
tions
METHIONINE H N 4.2
Amino acid and antidote. In paracetamol poisoning, it
prevents paracetamol metabolites from damaging the liver
Dosage forms
 Tablet: 250 mg
Uses
 Paracetamol overdose

M MONOGRAPHS
Dose and duration

 Paracetamol overdose
Adult and child > 6 years: 2.5–3 mg/kg every 4 hours for
2 days, then 3 mg/kg every 6–12 hours on the 3rd day.
Continue with 3 mg/kg every 12–24 hours for 10 days or
until recovery
Child under 6 years: 1 g initially followed by 3 further
doses of 1 g every 4 hours
Side effects
 Drowsiness, irritability
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Use within 10–12 hours of ingestion of paracetamol and
if patient is not vomiting
 Use with caution in severe liver disease since it may pre-
cipitate hepatic encephalopathy
 Avoid concurrent use with activated charcoal
METHOTREXATE RR E 8.2
Antimetabolite anticancer; folic acid antagonist
Dosage forms
 Tablet: 2.5 mg

METHOTREXATE M
Uses
 Severe rheumatoid arthritis (unresponsive to first line
treatment)
 Severe, unresponsive psoriasis
 Acute lymphoblastic leukaemia
 Soft-tissue and osteogenic sarcomas
 Solid tumours (breast, lung, head and neck, bladder, cer-
vical, ovarian, testicular carcinoma)

Dose and duration
Adult: 7.5 mg orally once a week

 Severe psoriasis
Adult: 10−25 mg orally once a week. Adjust dose

according to patient’s response and haematotoxicity
 Cancers
Adult: Initially, give test dose of 5−10 mg IV to detect

adverse events. Then, doses not exceeding 30 mg/m2
on not more than 5 consecutive days. A rest period of
2 weeks is recommended between treatments, in
order to allow bone marrow to return to normal
 Leukaemia in children (maintenance dose)
Child: 15 mg/m2 once weekly orally

Contra-indications
 Presence of pleural effusion or ascites
 Hypersensitivity to methotrexate

M MONOGRAPHS
Side effects
 Skin reactions
 Anorexia, abdominal discomfort, dyspepsia
 Mucositis (gingivitis, pharyngitis, enteritis)
 Gastrointestinal bleeding
 Hepatic toxicity
 Renal failure
 Reduced fertility (reversible on stopping treatment)
 Pulmonary toxicity
 Headache, drowsiness, blurred vision
Interactions
 Nitric oxide (increased methotrexate antifolate effect)
 Cotrimoxazole (increased haematological toxicity)
 Pyrimethamine (increased antifolate effect)
 Cisplatin (increased pulmonary toxicity)
 Leflunomide (risk of toxicity)
 Acitretin (increased risk of hepatotoxicity)
 NSAIDS, probenecid, penicillins, ciprofloxacin, chloram-
phenicol, tetracyclines, thiazide diuretics (increased risk

of methotrexate toxicity)
 Use adequate contraception during treatment and for 3
months after therapy

 Seek medical attention if you develop cough, fever or
difficult breathing
METHYLDOPA M
Pregnancy
 Do not use
Breast-feeding
Caution
 Monitor full blood count before and during treatment
 Folinic acid given after methotrexate administration pre-
vents methotrexate-induced mucositis/myelosuppression
 Reduce dose in elderly patients
 Adjust dose based on patient’s response and haemato-
logical toxicity
 Men and women should use adequate contraception
during and for 3 months after treatment
 Reduce dose when combined with other anticancers
METHYLDOPA HC III E 12.3

Antihypertensive which lowers blood pressure
Dosage forms
 Tablet: 250 mg
Uses
 Hypertension
 Hypertension in pregnancy
Dose and duration

 Hypertension
Adult: initially, 500–750 mg/day in 2–3 divided doses

for 2 days

M MONOGRAPHS
Increase if necessary by 250 mg every 2–3 days until

the dose that causes the desired effect is reached. Do
not exceed 3 g/day
Elderly: initially, 125 mg every 12 hours, increased
gradually (max. 2 g)
Duration is according to clinical response
Contra-indications
 Active or recent liver disease
 Depression
Side effects
 Dizziness when standing up quickly, drowsiness,
 Headache, difficulty in sleeping
 Oedema
 Nausea, vomiting, diarrhoea, dry mouth
 Depression
Interactions
 Amitriptyline (increased lowering of blood pressure)
 Avoid standing up suddenly to minimise dizziness
 Report immediately to the health worker in case any
yellowing of skin or eyes or unexplained fever occur

and operating machinery

Pregnancy
 Can be used
Breast-feeding
 Can be used

METHYLPHENIDATE M
Caution
 Safest antihypertensive to use in pregnancy
 Do not stop treatment abruptly; reduce doses gradually
 Reduce dose in patients with kidney disease
 Stop treatment if haemolytic anaemia or jaundice appear
during treatment
METHYLPHENIDATE RR E 24
Central nervous system stimulant
Dosage forms
 Tablet: 5 mg
Uses
 Attention deficit hyperactivity disorder (ADHD)
Dose and duration

 Attention deficit hyperactivity disorder
Adult: 5 mg every 8–12 hours, increased if necessary at

weekly intervals according to response (max 100 mg daily
in 2–3 divided doses
Child 6–18 years: initially 5 mg every 12–24 hours,
increased if necessary at weekly intervals by 5–10 mg up
to the usual maximum dose of 60 mg daily in 2–3 divided
doses.Dose may be increased to 2.1 mg/kg daily in 2–3
divided doses (max 90 mg daily) under the direction of a
specialist. Discontinue if no response after 1 month
Child 4–6 years: 2.5 mg every 12 hours increased at
weekly intervals by 2.5 mg to a maximum of 1.4 mg/kg
daily in 2–3 divided doses. Discontinue if there is no re-
sponse after 1 month

M MONOGRAPHS
Contra-indications
 Glaucoma
 Hyperthyroidism and thyrotoxicosis
 Known sensitivity to methylphenidate
 Severe depression, psychosis
 Anorexia nervosa
 Uncontrolled bipolar disorder
 Cardiovascular disease
 Structural cardiac abnormalities
 Vasculitis
 Cerebrovascular disorders
Side effects
 Anorexia and decreased appetite
 Insomnia, nervousness, anxiety, depression, abnormal
behaviour, headache, dizziness

 Dyskinesia, psychomotor hyperactivity, arthralgia
 Arrhythmia, tachycardia, palpitations, hypertension
 Cough
 Pharyngolaryngeal pain, z
 Pyrexia
 Growth retardation during prolonged use in children
Interactions
 Halothane, isoflurane, desflurane (increased risk of
hypertension)
 MAOIs (risk of hypertensive crisis)
 Clonidine (serious adverse events when used concomi-
tantly with methylphenidate)

METHYLPREDNISOLONE SODIUM M
Pregnancy
 Do not use
Breast-feeding
 Do not use
Caution
 Do not use during treatment with non-selective irreversi-
ble MAOIs, or within a minimum of 14 days of discontinu-
ing those medicines, due to risk of hypertensive crisis
 Discontinue if frequency of seizures increases in treat-
ment of patients with epilepsy
 If effect wears off in evening (with rebound hyper-
activity), a dose at bedtime may be appropriate
METHYLPREDNISOLONE SODIUM
RR N 18.1
SUCCINATE
Corticosteroid used for severe allergic and inflammatory
conditions
Dosage forms
Uses
 Severe erythema multiforme
 Allergic and inflammatory disease
 Ulcerative colitis
 Crohn's disease
 Cerebral oedema associated with malignancy
 Rheumatic disease

M MONOGRAPHS
Dose and duration

IV doses up to 250 mg should be given over at least 5
minutes, higher doses over at least 30 minutes
 Inflammatory and allergic disorders
Adult: 500–1000 mg once daily by IV infusion for 3 days

Child 1 month–18 years: by IV injection 10–20 mg/kg or
400–600 mg/m2 (max 1000 mg) once daily for 3 days
 Other uses
Adult: dose same as in inflammatory disorders

Child 1 month–18 years: 10–30 mg/kg (max 1000 mg)
once daily for 3 days or on alternate days up to 3 courses
Preparation
 Reconstitute initially with water for injections, then
administer by continuous or intermittent or via drip

tubing in Glucose 5% or Sodium chloride 0.9%
Contra-indications
Side effects
 Acute pancreatitis
 Osteoporosis
 Growth suppression in prolonged use in children
 Hypertension
 Hypokalaemia, diabetes
 Thinning of skin
 Increased susceptibility to and severity of infections
Interactions
 Ciclosporin (high doses increase risk of convulsions)
 Vaccines (high doses cause impaired immune response)

SUCCINATE M
 Warfarin (may enhance or reduce anticoagulant effect;
high doses enhances warfarin metabolism)
 Carbamazepine, Phenobarbital, phenytoin, rifampicin
(metabolism of methylprednisolone accelerated)
 Amphotericin (increased risk of hypokalaemia)
 Avoid exposure to measles or chicken pox
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Gradual withdrawal should be considered depending on
the duration of treatment, condition being treated, and
individual patient factors. Abrupt withdrawal after a
prolonged period can lead to acute adrenal insufficiency
 In case of significant intercurrent illness, trauma, or
surgical procedure, increase dose temporarily
 May mask serious infections such as septicaemia and
tuberculosis
 Increased risk of severe chicken pox if a patient has never
had chicken pox. In case of chicken pox, increase dose of
methylprednisolone. Do not stop treatment
 Irreversible growth restriction may occur in children and
adolescents if used for prolonged periods
 Use cautiously and in lower doses in hepatic and renal
impairment
 Do not use for management of head injury or stroke; it is
unlikely to be of benefit and may even be harmful
M MONOGRAPHS
METHYLROSANILINIUM CHLORIDE
HC II N 13.2
(GENTIAN VIOLET)
Topical anti-infective with antibacterial and antifungal prop-
erties; effective in drying wet lesions of skin infections
Dosage forms
 Aqueous paint: 0.5% and 1%
Uses
 Oral candidiasis
 Mouth ulcers
 Athletes foot (wet lesions)
 Impetigo (wet lesions)
Dose and duration

 Oral candidiasis and mouth ulcers
Apply 0.5% directly to affected area every 12 hours for

5 days
 Athletes foot and impetigo
Apply 1% directly to affected area every 12 hours until

the lesion is dry
Preparation
 If 0.5% gentian violet is needed but unavailable, dilute 1%
with an equal amount of clean water to get 0.5%

Contra-indications
 Deep wounds
Side effects
 Skin irritation
 Staining of the skin and clothing

METHYLTHIONINIUM CHLORIDE M
 Do not swallow the solution
 Patient may apply cooking oil or vaseline on the skin
around the lesion to minimise staining

 Stop treatment if severe skin irritation or new ulcers
develop
 Do not use on face and deep wounds
 If product accidentally enters the eyes, rinse with plenty
of clean water
 May cause permanent staining in clothes or fabric
Pregnancy
 Can be used
Breast-feeding
 Can be used
Storage
 Do not keep diluted solution for more than one week
Caution
 Discontinue treatment if severe irritation occurs
METHYLTHIONINIUM CHLORIDE
H N 4.2
(METHYLENE BLUE)
Antidote for methaemoglobinaemia
Dosage forms
Uses
 Acute methaemoglobinaemia
Dose and duration

M MONOGRAPHS
 Acute methaemoglobinaemia
Adult and child over 3 months: by slow IV injection over
5 minutes, 1–2 mg/kg as a single dose.
Neonate and child below 3 months: by IV injection over
5 minutes, 0.3–0.5 mg/kg.
Repeat dose after 1 hour if necessary (max cumulative
dose 7 mg/kg or 4 mg/kg in aniline- or dapsone-induced
methaemoglobinaemia)
Contra-indications
 Methaemoglobinaemia due to chlorate or due to sodium
nitrite in treatment of cyanide poisoning

 Deficiency of nicotinamide adenine dinucleotide
phosphate-oxidase (NADPH) reductase enzyme

Side effects
 Hyperbilirubinaemia in infants
 Chest pain, dyspnoea
 Headache, dizziness, confusion
 Tachycardia, hypertension, hypotension, arrhythmias
Interactions
 Clomipramine, fluoxetine, sertraline, citalopram, fluvox-
amine, venlafaxine, duloxetine (risk of CNS toxicity)

 Mirtazapine, bupropion, buspirone (possible risk of CNS
toxicity)
Pregnancy
 Can be used
Breast-feeding
 Do not use

METOCLOPRAMIDE M
Caution
 Use with caution in moderate to severe renal disease,
and in G6PD deficiency due to risk of haemolytic anaemia
 Monitor blood methaemoglobin during treatment
 Avoid breast-feeding for up to 8 days after administration
of methylthioninium chloride
 Only use in pregnancy when it is clearly necessary
METOCLOPRAMIDE HC IV E 17.2
Antiemetic. It is effective against nausea and vomiting
associated with gastrointestinal disorders, migraine, after
surgery, chemotherapy and radiotherapy
Dosage forms
 Tablet: 10 mg
Uses
Dose and duration

Adult: 10 mg every 8 hours for 5 days by mouth, IV or

IM injection
Child 15-19 years and weight > 60 kg: 10 mg every 8
hours only in chemotherapy-induced nausea
Child 15-19 years and weight < 60 kg: 5 mg every 8
hours only in chemotherapy-induced nausea
Contra-indications
 Gastrointestinal obstruction, perforation, haemorrhage
 Three to four days after gastrointestinal surgery

M MONOGRAPHS
 Children
Side effects
 Extrapyramidal side effects especially in children and
young adults
 Prolonged treatment may cause tardive dyskinesia
(rhythmic, involuntary movements of tongue and face)

Interactions
 Ciclosporin (increased concentration of ciclosporin)
 Stop taking medicine if you experience tremors, restless-
ness, abnormal face and body movements

Pregnancy
 Can be used
Breast-feeding
 Do not use
Caution
 Withdraw medicine immediately in case extrapyramidal
symptoms occur
 Dose intervals should be at least 6 hours apart even if the
previous dose is vomited
 Avoid giving for longer than 5 days
 Give with caution in patients with underlying neurological
conditions and those treated with other centrally-acting
medicines
 Metoclopramide may worsen Parkinson’s disease

METRONIDAZOLE M
METRONIDAZOLE HC II V 6.2.2, 6.4.1
Antiprotozoal and antibacterial with high activity against
anaerobic bacteria
Dosage forms
 Tablet: 200 mg
 Oral suspension: 100 mg/5 ml
 Solution for injection: 500 mg/100 ml
 Pessary: 500 mg
 Gel: 0.75% w/w
Uses
 Amoebiasis
 Giardiasis
 Infection in haemorrhoids
 Tetanus
 Tropical ulcer
 Leg ulcers
 Animal bites
 Bacterial vaginosis
 Abnormal vaginal and urethral discharge syndrome
 Helicobacter pylori eradication
 Mouth and teeth infections
 Prophylaxis against anaerobic post-operative infections
 Acute inflammatory exacerbation of rosacea (gel)
 Deodorisation of smell associated with malodorous
fungating tumours (gel)

Dose and duration
 Amoebiasis
Adult: 800 mg every 8 hours for 8–10 days

M MONOGRAPHS
Child: 10 mg/kg every 8 hours for 8–10 days

 Giardiasis
Adult and child over 10 years: 2 g once daily for 3 days
Or 400 mg every 8 hours for 5 days
Child 7–10 years: 1 g once daily for 3days
Child 3–7 years: 600–800 mg once daily for 3 days
Child 1–3 years: 500 mg once daily for 3 days
 Tetanus, tropical ulcer, infection in haemorrhoids
400 mg every 8 hours for 5 days
 Bacterial vaginosis; abnormal vaginal and urethral dis-
charge syndrome
2 g single dose. Also treat partner
Also treat partner
 Helicobacter pylori eradication (in combination with
amoxicillin and omeprazole)
400 mg every 8 hours for 7–14 days
 Mouth and teeth infections
 Prophylaxis against anaerobic post-operative infections
Adult and child over 12 years: IV injection of a single
dose of 1000–1500 mg 30–60 minutes pre-operatively
Child < 12 years: 20–30 mg/kg as a single dose given
1–2 hours before surgery
Neonate with gestation age < 40 weeks: 10 mg/kg as
a single dose before operation
Or 500 mg IV immediately before, during or after
operation, then 500 mg every 8 hours for 24–48 hours

METRONIDAZOLE M
 Acute inflammatory exacerbation of rosacea (gel)
Adult and child above 12 years: apply a thin layer of
gel twice daily after washing the affected area for 3–4
months. Treatment may be considered for another
3–4 months if there is a clear benefit of therapy
 Deodorisation of smell associated with malodorous
fungating tumours (gel)
Adult: clean wound thoroughly. Apply gel to cover the
complete area and cover with a non-adherent dressing
1–2 times daily as necessary
Contra-indications
 Allergy to metronidazole
 Chronic alcohol dependence
Side effects
 Stomach upset
 Metallic taste in the mouth
 Brownish urine
 Dry skin, erythema, pruritus, skin irritation
 Worsening of rosacea (Gel)
Interactions
 Alcohol (severe nausea, vomiting, weakness can occur)
 Take with or after food to reduce side effects
 Do not take alcohol when on treatment and for 48 hours
after treatment has stopped

Pregnancy
st

M MONOGRAPHS
Breast-feeding
 Can be used
Caution
 Possible disulfiram-like reaction when taken with alcohol
(severe nausea, vomiting, weakness)
 Reduce dose in pregnancy, breastfeeding and liver
disease. Avoid prolonged use (>10 days) and monitor
 Reduce dose to one-third once daily in liver disease
MICONAZOLE HC IV N 28.3, 13.1, 6.3

Imidazole antifungal
Dosage forms
 Oral gel: 24 mg/ml (20 mg/g)
 Pessary: 400 mg
 Cream: 2%
Uses
 Oral and intestinal candidiasis
 Vaginal and vulval candidiasis
 Mycotic infections of skin and nails
Dose and duration

Adult: 5‒10 ml in the mouth after food 4 times daily,

retained near oral lesions before swallowing
Child > 6 years: 5 ml 4 times daily
Child 2‒6 years: 5 ml twice daily retained near lesions
before swallowing
Child 4 months‒2 years: 2.5 ml twice daily, smeared
around the mouth

MICONAZOLE M
Continue treatment for 48 hours after lesions have
healed
 Vaginal and vulval candidiasis
Insert 1 pessary at night for 3 days

 Mycotic infections of skin and nails
Apply to the lesions 2 times daily. Rub the cream into

the skin until it has fully penetrated for 2–6 weeks.
Continue treatment for two weeks after disappear-
ance of lesions
Contra-indications
 Impaired swallowing reflex in infants
 First 6 months of pre-term infants
 Allergy to miconazole or imidazole antifungals
Side effects
 Local irritation, itching in genitals, burning sensation
 Rash
 Stomach upset
 Dysmenorrhoea
Interactions
 Phenytoin (increased concentration of phenytoin)
 Warfarin (enhanced anticoagulant effect)
 Apply oral gel after meals
 Do not swallow oral gel immediately. Keep in mouth as
long as possible
 Pessary best inserted when you are lying on your back
Pregnancy
 Do not use oral gel

M MONOGRAPHS
Breast-feeding
 Can be used
Caution
 Can damage latex condoms and diaphragms
MIDAZOLAM RR V 1.3
Water soluble benzodiazepine medicine. Reserved for
specialist use only
Dosage forms
Uses
 Febrile convulsions
 Conscious sedation for procedures
 Sedative in combined anaesthesia
 Premedication before surgery or operation
 Sedation of patients receiving intensive care
Dose and duration

 Status epilepticus and febrile convulsions
Adult and child over 10 years: by mouth, 10 mg repeated

once after 10 minutes if required
Child 5–10 years: 7.5 mg by mouth repeated once after
10 minutes if required
Child 1–5 years: 5 mg by mouth as above
Child 3 months–1 year: 2.5 mg by mouth as above
Child under 3 months: 0.3 mg/kg (max 2.5 mg) by mouth
Neonate and child up to 18 years: by IV injection, initially
0.15–0.2 mg/kg followed by continuous IV infusion of

MIDAZOLAM M
0.06 mg/kg/hour (increased by 0.06 mg/kg/hour every 15
minutes until seizure controlled). max 0.3 mg/kg/hour
 Conscious sedation for procedures
By slow IV injection over 2–3 minutes 5–10 minutes
before procedure
Adult: initially 2–2.5 mg by slow IV injection at a rate of
about 2 mg/minute 5–10 minutes before procedure, in-
creased if necessary in steps of 1 mg up to a usual total
dose 3.5–5 mg (max 7.5 mg )
Elderly or debilitated: initially 0.5–1 mg (max 3.5 mg)
Child 1 month–18 years: by mouth, initially 0.025–0.05
mg/kg titrated in small steps up to a total dose of 7.5 mg,
10 mg and 6 mg for child 12–18 years, 6–12 years and 1
month–6 years respectively
 Sedative in combined anaesthesia
Adult: by IV injection, 0.03–0.1 mg/kg repeated as re-
quired or by continuous IV infusion, 0.03–0.1 mg/kg/hour
Use lower dose in elderly
 Premedication
Adult: by deep IM injection, 0.07–0.1 mg/kg 20–60
minutes before induction or by IV injection,1–2 mg 5–30
minutes before procedure repeated as required
Elderly or debilitated: by deep IM injection, 0.025–0.05
mg/kg 20–60 minutes before induction or by IV injection,
0.5 mg repeated slowly as required
Child 1 month–18 years: by mouth, 0.5 mg/kg (max 20
mg) 15–30 minutes before induction
 Induction (but rarely used)
Adult: by slow IV injection, 0.15–0.2 mg/kg (0.05–0.15
mg/kg in the elderly or debilitated) in divided doses (max
M MONOGRAPHS
5 mg) at intervals of 2 minutes. Max total dose 0.6 mg/kg

Child 7–18 years: initially by slow IV injection over 2–5
minutes, 0.15 mg/kg (max 7.5 mg) given in steps of 0.05
mg/kg (max 2.5 mg) every 2–5 minutes as required to a
maximum total dose of 0.5 mg/kg of 25 mg
 Sedation of patients receiving intensive care
Adult and child over 12 years: by slow IV injection, 0.03–
0.3 mg/kg given in steps of 1–2.5 mg every 2 minutes,
then by continuous IV infusion, 0.03–0.2 mg/kg/hour
Child 6 months–12 years: 0.05–0.2 mg/kg by slow IV in-
jection over at least 3 minutes followed by continuous IV
infusion of 0.03–0.12 mg/kg/hour, adjusted according to
response
Child 1–6 months: 0.06 mg/kg/hour by continuous IV
infusion adjusted according to response
Neonate: 0.06 mg/kg/hour by continuous IV infusion
adjusted according to response (reduce dose to 0.03
mg/kg/hour after 24 hours in a neonate below 32 weeks
gestational age). Treat for 4 days
Preparation
 Injection can be diluted in apple or blackcurrant juice or
cola for oral administration

 For IV injection, dilute with glucose 5% or sodium
chloride 0.9%
 Neonatal intensive care, dilute 15 mg/kg body-weight to
a final volume of 50 ml with infusion fluid. An IV infusion

rate of 0.1 ml/hour provides a dose of 0.03 mg/kg/hour
Contra-indications
 Marked neuromuscular respiratory weakness including
unstable myasthenia gravis

MIDAZOLAM M
 Severe respiratory depression
 Hypersensitivity to benzodiazepines
Side effects
 Anaphylactic shock, angioedema
 Confusion, euphoria, hallucination, agitation, amnesia
 Involuntary movements, sedation, headache, convulsions
in premature babies
 Cardiac arrest, bradycardia
 Hypotension, vasodilation, thrombosis
 Respiratory depression, apnoea
 Nausea, vomiting, constipation, dry mouth
 Rash, urticaria, pruritus
Interactions
 Clarithromycin, erythromycin, telithromycin (increased
plasma concentration of midazolam)

 Fluconazole, itraconazole, posaconazole, voriconazole
(plasma concentration of midazolam increased)

 Atazanavir, ritonavir (possibly increased concentration of
midazolam)
 Do not drive until you are certain that the medicine does
not impair your ability to drive or use machines

Pregnancy
 Can be used
Breast-feeding
 Can be used

M MONOGRAPHS
Caution
 Only use in presence of age and size-appropriate resusci-
tation facilities
 Midazolam solution for injection may be given by mouth
 Use with caution in mild to moderate hepatic impairment
and avoid use in severe impairment
 Use midazolam with caution in cardiac disease, myasthe-
nia gravis and in history of drug and alcohol abuse
 Use with caution in neonates and children especially
those with cardiovascular impairment. Risk of airways
obstruction and hypoventilation in children < 6 months
 Reduce dose in the elderly and debilitated
 Use with caution in hypovolemia, vasoconstriction and
hypothermia due to risk of severe hypotension. Reduce
or eliminate initial dose
 Avoid prolonged use and abrupt withdrawal thereafter
 Only use in pregnancy if clearly necessary
 Avoid breast-feeding for 24 hours after administration
 Midazolam is subject to abuse. Controlled storage and
use same as for narcotics is necessary
MISOPROSTOL HC II V 22.1
Synthetic prostaglandin that causes labour-like contractions
during pregnancy and ripens the cervix
Dosage forms
 Tablet: 200 µg
Uses
 Incomplete abortion and miscarriage (to expel retained
products from the uterus)

MISOPROSTOL M
 Excessive bleeding after childbirth
Dose and duration
 Incomplete abortion
600 µg swallowed orally or 400 µg sublingually

 Excessive bleeding after childbirth
800 µg (4 tablets) sublingually or 1000 µg (5 tablets)

rectally
25 µg inserted vaginally every 6 hours. If no response

after 2 doses of 25 µg, insert 50 µg every 6 hours. Do
not use more than 200 µg in 24 hours
Contra-indications
 Baby presenting abnormally in uterus
 History of caesarean section, multiple pregnancies, or
major uterine surgery

 Untreated pelvic infection
 Foetal distress
 History of difficult or traumatic pregnancy
Side effects
 Stomach upset, abdominal pain
 Fever
 Foetal distress
Interactions
 Oxytocin (increased contractions)
 Can cause stomach upset, vomiting, loose stools

M MONOGRAPHS
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 When used for termination of pregnancy, check for com-
plete uterine emptying after treatment
 If a woman vomits within 30 minutes of oral administra-
tion, administer the same dose vaginally
 Vaginal route is preferred over oral administration
 Never give a repeat dose of misoprostol even if bleeding
persists, unless very sure that it has been vomited
MITOMYCIN RR N 21.9
Anthracycline anticancer
Dosage forms
Uses
 Upper gastrointestinal cancer
 Breast cancer
 Superficial bladder tumours
Dose and duration

 All uses
Consult product literature. Usual dose interval is 6 weeks

Contra-indications
Side effects
 Myelosuppression; leucopoenia, thrombocytopenia

MITOMYCIN M
 Anorexia, nausea, vomiting
 Malaise, weight loss
 Bleeding tendency
 Anaemia
 Pulmonary oedema, interstitial pneumonia, pulmonary
fibrosis
 Anaphylaxis
Interactions
Pregnancy
 Do not use
Breast-feeding
Storage
 Store for 24 hours in a cool place after reconstitution. Do
not refrigerate or freeze

Caution
 Mitomycin is irritant to tissues. Handle with caution
 Discontinue treatment immediately if signs such as
itching, rash, hot flush, sweating, dyspnoea and de-

creased blood pressure occur
 Causes delayed bone marrow toxicity. Prolonged use may
result in permanent bone-marrow damage, lung fibrosis

and renal damage
 Avoid simultaneous use of radiotherapy
 For administration into specific tissues, mitomycin can be
given by the intra-arterial route directly into the tumours

 Because of cumulative myelosuppression, patients should

M MONOGRAPHS
be fully re-evaluated after each course and the dose

reduced if the patient has experienced any toxic effects
 If disease progression continues after two treatment
courses, stop drug as chances of response are minimal
MORPHINE HC III V 2.3

Strong, centrally acting opioid analgesic
Dosage forms
 Oral solution: 5 mg/5 ml, 50 mg/5 ml
 Concentrated oral solution: 20 mg/ml (NR)
Uses
 Severe pain (acute and chronic)
Dose and duration

SC injection is not appropriate for oedematous patients
 Acute pain
By SC or IM injection,
Adult and child over 12 years: 10 mg every 4 hours if
necessary (15 mg for heavier patients)
Child 6–12 years: 5–10 mg every 4 hours if required
Child 1–5 years: 2.5–5 mg every 4 hours if required
Infant 1 month–12 months: 200 micrograms /kg every
4 hours if required
Infant up to 1 month: 150 micrograms/kg every 4hours if
required
 Chronic pain
By mouth or by SC or IM injection
MORPHINE M
Adult: 5–20 mg regularly every 4 hours
Child: 1 mg/kg per day orally every 4 hours
Titrate the dose according to clinical response
Adjust the dose (but not the frequency) to achieve
satisfactory pain control
Contra-indications
 Asthma
 Head injuries and rib fractures
 Patients in coma or altered consciousness
 Uncontrolled epilepsy
 Prostate disorders
 Acute alcoholism
 Delayed gastric emptying
 Heart failure secondary to lung disease
 Acute respiratory depression
 Risk of paralytic ileus
Side effects
 Constipation, nausea and vomiting, dry mouth
 Euphoria, hallucinations, confusion, dependence
 Headache, sedation, drowsiness
Interactions
Increased sedation and respiratory depression can occur
with:
 Alcohol
 Diazepam
 Chlorpromazine, romethazine

M MONOGRAPHS
 Chlorpheniramine
 Phenobarbital
Pregnancy
rd
Breast-feeding
 Can be used
Storage
 Store in a locked cabinet
Caution
 To prevent constipation, always give bisacodyl
 Do not stop long-term treatment abruptly; reduce dose
slowly to avoid withdrawal symptoms
 Morphine is a controlled medicine (narcotic) and should
be handled according to the regulations
MOXIFLOXACIN H E 6.2.4
Quinolone antibacterial with activity against Gram-positive
and Gram-negative organisms
Dosage forms
 Tablet: 400 mg
Uses
Dose and duration

 MDR-TB (second-line; in combination with other medi-
cines)

MOXIFLOXACIN M
Contra-indications
 Electrolyte disturbances
 Acute myocardial infarction
 Heart failure
 Congenital long QT syndrome
 Concomitant use with other medicines that prolong QT
interval
 Bradycardia
History of symptomatic arrhythmias

 Hypersensitivity to quinolone
 History of tendon disorder due to quinolone use
Side effects
 Nausea, vomiting, abdominal pain, diarrhoea
 QT-interval prolongation, arrhythmias, palpitation,
angina, vasodilation
 Hyperlipidaemia, increase in liver transaminases
 Sweating
 Severe hepatotoxicity
 Gastritis, flatulence, constipation
 Anaphylaxis
 Toxic epidermal necrolysis
Interactions
 Amiodarone, citalopram, amitriptyline, imipramine, mizo-
lastine, pimozide, haloperidol, zuclopenthixol, chlor-

promazine, promethazine, atomoxetine, sotalol, chloro-
quine, hydroxychloroquine, parenteral erythromycin,
mefloquine, pentamidine isetionate (increased risk of
M MONOGRAPHS
 Swallow with plenty of water or other fluid
 May impair performance of some skilled tasks like driving
Pregnancy
Breast-feeding
Caution
 Use with caution in history of epilepsy or conditions that
predispose to seizures, in G6PD deficiency, myasthenia
gravis and in children and adolescents
 Avoid exposure to excessive sunlight (discontinue in case
photosensitivity occurs)
 Avoid use in severe hepatic impairment
 In MDR-TB, moxifloxacin can be used in pregnancy and
breast-feeding as benefits outweigh risks
 Other quinolones used for MDR-TB include ofloxacin and
levofloxacin
MULTIVITAMIN HC I N 27
Supplement to diet that contains various vitamins, usually A,
B1, B2, B3, C, D3
Dosage forms
 Tablet: BPC 73 formula
Uses
 Vitamin supplementation
Dose and duration

Adult: 3 tablets once daily
MUSTINE (MECHLORETHAMINE) M
Child >5 years: 2 tablets once daily
Child <5 years: 1 tablet once daily
Side effects
 Nausea
 Vomiting
 Take with food
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 In cases of real deficiency, multivitamin tablets do not
have much effect. Sufficient amounts of the specific vit-
amins needed should be used
MUSTINE (MECHLORETHAMINE) NR E 8.2

Alkylating agent anticancer. Also known as chlormethine or
nitrogen mustard
Dosage forms
Uses
 Lung cancer
 Breast cancer

M MONOGRAPHS
Dose and duration

Usually 0.4 mg/kg per day per cycle in as a single dose or
in divided doses
Contra-indications
 Hypersensitivity to mustine
Side effects
 Myelosuppression (neutropenia, anaemia, leucopoenia
thrombocytopenia)
 Tiredness, weakness, malaise
 Loss of appetite; taste changes
 Tinnitus
 Hair loss
 Loss of fertility, amenorrhoea (reversible)
 Injection site reactions (pain, redness, swelling)
 Diarrhoea
 Skin rash
 Numbness in fingers
Interactions
Pregnancy
 Do not use
Breast-feeding
Caution
 Monitor full blood count before and during treatment

NALIDIXIC ACID N
N
NALIDIXIC ACID H N 6.2.2
Quinolone antibacterial
Dosage forms
 Tablet: 500 mg
Uses
Dose and duration

Adult and child >12 years: 1 g every 6 hours for 7 days. In

chronic infections, reduce dose to 500 mg every 6 hours
Child 3 months–12 years: 12.5 mg/kg every 6 hours for 7
days reduced to 7.5 mg/kg every 6 hours in prolonged
therapy or 15 mg/kg twice daily for prophylaxis
Contra-indications
Side effects
 Nausea, vomiting, abdominal pain, diarrhoea
 Headache, dizziness, vertigo, weakness
 Rash, pruritus
 Stevens- Johnson syndrome
 Toxic psychosis

N MONOGRAPHS
Interactions
 Artemether/ Lumefantrine (increased risk of arrhythmias)
 NSAIDs (increased risk of convulsions)
 Take your medication at least one hour before a meal or
2 hours after a meal

Pregnancy
 Do not use
Breast-feeding
 Can be used
Caution
 Use with caution in liver and renal disease. Avoid if eGFR
is less than 20 ml/minute/1.73 m2
NALOXONE NR E 4.2
Antidote for narcotic analgesic poisoning
Dosage forms
 Solution for injection: 400 µg/ml
Uses
 Opioid over dosage
 Confirm if patient is opioid free before treatment with
naltrexone (Naloxone test)

Dose and duration
 Opioid over dosage
Adult and child over 12 years: by IV injection, 400 µg–

2000 µg repeated at intervals of 2–3 minutes if there is
NALOXONE N
no response; up to max 10 mg then review diagnosis
Neonate and child below 12 years: 10 µg/kg by IV injec-
tion; a subsequent dose of 100 µg/kg may be given if
there is no response then review diagnosis
In case IV injection is not possible, use the same dose as
an IM or SC injection
 Naloxone test
Adult ≥18 years: by IV administration, 0.2 mg followed by

0.6 mg if there are no withdrawal symptoms within 30
seconds. Observe patient for any withdrawal symptom
for 30 minutes
or by SC injection, 0.8 mg and observe patient for 30
minutes for any withdrawal symptoms
Contra-indications
Side effects
 Hyperventilation
 Tachycardia
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Naloxone has a shorter duration of action than many
opioids, so close monitoring and repeated injections may

be required
 Acute withdrawal syndromes may be precipitated by use

N MONOGRAPHS
of naloxone in patients with physical dependence on

opioids or in over-dosage with large doses
 Withdrawal syndrome may occur in neonates of opioid-
dependent mothers
 Naloxone also antagonises the analgesic effect of opioids
 Use with caution in patients with cardiac irritability
NALTREXONE RR E 24
Opioid receptor antagonist that precipitates withdrawal
symptoms in opioid dependent patients
Dosage forms
 Tablet: 50 mg
Uses
 Adjunct to prevent relapse in formerly opioid-dependent
patients (opioid free for at least 7–10 days)

 Adjunct to prevent relapse in formerly alcohol-
dependent patients
Dose and duration
 Relapse prevention in opioid dependence
Base treatment on result of the ‘naloxone test’ (see

naloxone)
Adult above 18 years: initially, 25 mg once daily then 50
mg once daily. Total weekly dose 350 mg may be divided
and given on 3 days of the week for improved compliance
(max dose per day 150 mg) for 3 months or longer as may
be necessary
 Relapse prevention in alcohol dependence
Adult: 25 mg on first day, increased to 50 mg daily if

tolerated
NALTREXONE N
Contra-indications
 Patients currently dependent on opioids
 Acute hepatitis and severe hepatic impairment
Side effects
 Abdominal pain, nausea, vomiting, diarrhoea
 Constipation
 Anxiety, sleep disorders, loss of appetite
 Tachycardia, palpitations, abnormal ECG
 Dizziness, headache, fatigue, restlessness, weakness
 Increased lacrimation, sweating, chills, hot flushes
 Chest pain, dyspnoea
 Rash, dermatitis, pruritus
 Delayed ejaculation, libido disorders
 Joint and muscle pain
 Thirst, increased energy, weight loss, weight gain
 Do not try to overcome effects of the medicine by over-
dosing on opioids; this will lead to acute opioid toxicity

 Do not take any opioid containing preparations like in
cough preparations and loperamide during treatment

 Swallow your tablets with water
Pregnancy
 Do not use
Breast-feeding
 Do not use
Caution
 Review treatment monthly for the first 6 months, and

N MONOGRAPHS
then at reduced intervals

 Stop naltrexone if patient continues taking alcohol for
4–6 weeks after starting treatment
 Carry out liver function tests before and during treatment
 Test for opioid dependence using naloxone before com-
mencing treatment with naltrexone
 Avoid concomitant use of opioids. In case large dose of
opioid is needed for pain, monitor patient for intoxication
 Only use in pregnancy if benefit outweighs risk; risk of
acute withdrawal with possibly serious side effects to
mother and foetus
NEOMYCIN + BACITRACIN H N 13.2

Combination of two broad spectrum topical antibiotics.
Neomycin is an aminoglycoside and bacitracin is a polypep-
tide; both have bactericidal activity against Gram-positive and
many Gram-negative organisms
Dosage forms
 Ointment: 5 mg + 250 IU/g
Uses
 Superficial bacterial infections due to Staphylococci and
Streptococci
Dose and duration
 Superficial bacterial infections due to Staphylococci and
Streptococci
Adult and child over 2 years: apply sparingly to the
affected area 3 times daily
Contra-indications
 Neonates

NEOMYCIN + BETAMETHASONE N
Side effects
 Sensitisation
 Absorption may lead to irreversible ototoxicity
 Do not apply to broken skin or mucous membranes
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Application to broken skin or large areas of the skin
increases risk of systemic absorption
 Prolonged use may lead to overgrowth of resistant
organisms
NEOMYCIN + BETAMETHASONE H E 21.2

Anti-infective and anti-inflammatory topical medicine
Dosage forms
 Eye/ear/nasal drops: 0.1% + 0.5%
Uses
 Inflammatory conditions of the eye, ear or nose where
antibiotic prophylaxis is required

Dose and duration
Give for maximum of 7 days unless under expert supervision
 Inflammatory conditions of the eye
Adult and child: apply 1–2 drops to the affected eye 3–6
times daily according to response

N MONOGRAPHS
 Inflammatory conditions of the ear or nose

Adult and child: instil 2–3 drops in the affected ear or
nostrils every 6–8 hour
Contra-indications
 Herpes simplex keratitis
 Varicella and other viral infection of the eyes
 Fungal diseases of the eyes
 Mycobacterial eye infections
 Fungal infections of ear and nose
 Perforated eardrum
Side effects
 Ocular discomfort, keratitis
 Irritation, burning, stinging, itching, dermatitis
 See your doctor if eye pain, redness, swelling or irritation
worsens or persists
 Do not wear contact lenses or remove them before
treatment and replace them 15 minutes after treatment

 Discard remaining eye drops 1 month after first opening
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Exclude ocular viral and fungal disease before use
 Discontinue if serious reactions or hypersensitivity occur
 Prolonged use may result into ocular hypertension or

NEOMYCIN + DEXAMETHASONE N
glaucoma; risk is higher in diabetic patients
 May slow corneal wound healing
 Ointments should be applied after the eye drops
NEOMYCIN + DEXAMETHASONE RR E 21.2

Anti-infective and anti-inflammatory topical medicine
Dosage forms
 Eye drops: 0.35% + 0.1%
 Eye ointment: 0.35% + 0.1%
Uses
 Inflammatory conditions of the eye requiring antibiotic
prophylaxis
Dose and duration
 Inflammatory conditions of the eye requiring antibiotic
prophylaxis
Adult and child: apply 1–2 drops up to 6 times a day
Ointment: apply a small amount of ointment into the
conjuctival sac 3–4 times a day, or once at bed time if
eye drops are used during the day
Contra-indications
 Herpes simplex keratitis
 Varicella and other viral infection of the eyes
 Fungal diseases of the eyes
 Mycobacterial eye infections
Side effects
 Ocular discomfort, keratitis, eye irritation

N MONOGRAPHS
 Only use this medicine for your eyes
 See your doctor if eye pain, redness, swelling or irritation
worsens or persists
 Do not wear contact lenses or remove them before
treatment and replace them 15 minutes after treatment

 Discard remaining eye drops 1 month after first opening
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Exclude ocular viral and fungal disease before use
 Discontinue if serious reactions or hypersensitivity occur
 Prolonged use may result into ocular hypertension or
glaucoma; risk is higher in diabetic patients
 May slow corneal wound healing
 Ointments should be applied after the eye drops
NEOSTIGMINE HC IV N 20
Cholinesterase inhibitor. Enhances neuromuscular transmis-
sion by prolonging action of acetylcholine through inhibition
of acetylcholinesterase
Dosage forms
 Tablet: 15 mg
Uses

NEOSTIGMINE N
 Reversal of non-depolarising muscle relaxants effects
 Post-operative non-obstructive urinary retention
Dose and duration
Adult and child > 12 years: by mouth, initially 15–30 mg

at suitable intervals throughout the day; gradually in-
crease until desired response is obtained. Usual total dai-
ly dose, 75–300 mg. Most patients tolerate max 180 mg
By SC or IM injection, 1–2.5 mg as required up to a total
daily dose of 5–20 mg
Child 6–12 years: by mouth, initially 15 mg, gradually
increased to a usual total daily dose of 15–90 mg given in
divided doses at appropriate intervals
By IM or SC injection, 0.2–0.5 mg as required
Child 1 month–6 years: by mouth, initially 7.5 mg. By IM
or SC injection, 0.2–0.5 mg as required
Neonate: 1–2 mg by mouth or 0.05–0.25 mg by SC or IM
injection every 4 hours, 30 minutes before feeds
 Reversal of non-depolarizing block
Adult: by IV injection over 1 minute, 2.5 mg followed by

0.5 mg supplements if required to maximum total dose of
5 mg
Child: 0.04 mg/kg (titrate using peripheral nerve stimula-
tor). Max 2.5 mg
 Postoperative urinary retention
Adult: by SC or IM injection, 0.5 mg

Contra-indications
 Recent intestinal or bladder surgery
 Intestinal or urinary tract obstruction
 After suxamethonium

N MONOGRAPHS
 Pneumonia
 Peritonitis
Side effects
 Increased salivation
 Nausea and vomiting, abdominal cramps, diarrhoea
 Overdose: increased bronchial secretions, sweating and
tear production, bronchoconstriction, miosis, nystagmus,

involuntary defecation and micturition, bradycardia,
heart block, arrhythmias, hypotension, agitation, exces-
sive dreaming and weakness
Interactions
 Amikacin, gentamicin, streptomycin, polymixins (effect of
neostigmine antagonised)
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Large doses in 3rd trimester of pregnancy may lead to ne-
onatal myasthenia
 Reduce dose in moderate and severe renal impairment
 Use with extreme caution in asthma and in patients with
bradycardia, recent coronary occlusion, hypotension,
peptic ulcer, epilepsy or parkinsonism

NEVIRAPINE (NVP) N
NEVIRAPINE (NVP) HC IV V 30.2
Non-nucleoside reverse transcriptase inhibitor (NNRTI) an-
tiretroviral medicine
Dosage forms
 Tablet: 50 mg and 200 mg
 Syrup: 10 mg/ml
Uses
 HIV/AIDS
Dose and duration

A lead-in dose of NVP 200 mg once daily should be given for
the first 14 days in new adult patients on NVP. If no rash is
observed, increase dose to twice daily. Take normal dose of
the other two ARVs in the regimen in those first 14 days.
Switch to the triple FDC tablet after 14 days if applicable.

tion with TDF + 3TC)
Adult and child >25 kg: 200 mg every 12 hours (lead-in
dose 200 mg once daily for 14 days)
Child <25 kg: Use NVP 50 mg tablet as in table below
Weight (kg) No. of NVP 50 mg tablets

N MONOGRAPHS
 HIV infection, first line treatment in children (in combi-

nation with ABC + 3TC)
Child <3 years: 4 mg/kg twice daily (lead-in dose 4
mg/kg once daily for first 14 days)
 eMTCT infant regimen (0–6 weeks)
Infant 2–2.49 kg: 10 mg once daily for 6 weeks

Infant ≥2.5 kg: 15 mg once daily for 6 weeks
Contra-indications
 CD4 count >350 cells/ml (greater risk of liver damage)
 Post-exposure prophylaxis
Side effects
 Rash, allergic reactions
 Liver damage
 Headache
 Stomach upset
Interactions
 Rifampicin (reduced effect of nevirapine)
 Efavirenz (increased risk of side effects)
 Lopinavir/ritonavir (reduced effect of lopinavir)
 Atazanavir/ritonavir (reduced effect of atazanavir)
 Ketoconazole (reduced effect of ketoconazole)
 A mild skin rash may develop within the first 6 weeks;
usually goes away on its own

 Report to health worker immediately in case any severe

NICLOSAMIDE N
skin rash, fever, feeling of sickness, weakness, muscle
pain, mouth ulcers, or swelling of face occur
 Stop taking the medicine and report to health worker
immediately in case any yellowing of skin and eyes,
swollen abdomen, or persistent nausea and vomiting
occur as this indicates liver damage
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Monitor closely for side effects of liver damage, especially
in first 18 weeks
 If liver disease occurs without allergic reactions, discon-
tinue medicine and restart after symptoms have resolved
 If liver disease occurs with allergic reactions, discontinue
medicine permanently
 Women using oral contraceptives should switch to
another contraceptive method (e.g. condoms or
medroxyprogesterone acetate depot injection)
NICLOSAMIDE HC IV N 6.1.1
Antihelminthic. Effective against adult cestode infections in
the intestines. It is not effective for neurocysticerosis.
Dosage forms
 Tablet: 500 mg
Uses
 Tapeworm infestation

N MONOGRAPHS
Dose and duration

 Tapeworm infestation
Adult and child > 6 years: 2 g single dose after a light

meal, followed after 2 hours by a laxative (bisacodyl)
Child 2‒6 years: 1 g single dose
Child < 2 years: 500 mg single dose
Contra-indications
 Chronic constipation
Side effects
 Nausea, stomach upset
 Chew the tablet thoroughly or crush then swallow down
with water
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Not effective against larval form of the worms
 Give an antiemetic before treatment
NIFEDIPINE HC III E 12.1, 12.3, 22.2

Calcium channel blocker antihypertensive. Also used in low
doses as anti-oxytocic uterine relaxant
Dosage forms
 Tablet: 20 mg (usually labelled 'R' for prolonged release)
 Tablet: 10 mg
 Immediate release capsules: 10 mg for sublingual use

NIFEDIPINE N
Uses
 Moderate and severe hypertension
 Uncomplicated threatened premature labour between
24–33 weeks of pregnancy (labour can be delayed up to

72 hours)
Dose and duration
 Moderate or severe hypertension (in combination with
other antihypertensive)
20–40 mg every 12 hours for as long as necessary
 Threatened premature labour
Initially, 10 mg (1 capsule) placed under the tongue

every 15 minutes if necessary, up to a maximum of 40
mg in the first hour. Then 60–160 mg daily in 3–4
divided doses, adjusted to uterine activity
Contra-indications
 Unstable angina
 Shock
 Recent heart attack
Side effects
 Swelling of legs, ankles, and feet
 Increased frequency of urination
 Low blood pressure, flushing
 Fast heartbeat
 Pain in the eyes
 Nausea

N MONOGRAPHS
Interactions
 Beta blockers e.g. atenolol, propranolol (possible severe
hypotension and heart failure)

 Magnesium sulphate (risk of hypotension)
 Salbutamol (risk of hypotension)
 Other calcium channel blockers e.g. amlodipine (risk of
hypotension)
 Rifampicin (reduced effect of nifedipine)
 Do not crush prolonged release tablets; swallow whole
 If sharp pain/tightness occurs in the chest, discontinue
use
Pregnancy
 Do not use for hypertension
Breast-feeding
 Can be used
Caution
 Never use the sublingual formulation (10 mg capsule) for
hypertension as it will cause excessive fall in blood
pressure and reduced blood flow to the brain and heart
 Methyldopa is the medicine of choice for treating hyper-
tension in pregnancy

NIFURTIMOX N
NIFURTIMOX RR E 6.4.4
Antitrypanosomal medicine efficacious during the early
stages of Trypanosoma cruzi
Dosage forms
 Tablet: 30 mg, 120 mg, 250 mg
Uses
 Sleeping sickness
 Chagas disease (acute American trypanosomiasis)
Dose and duration

 All uses (with aluminium hydroxide)
Adult: 2.67––3.33 mg/kg every 8 hours for 90 days

Child: 3.75–5 mg/kg every 6 hours for 90 days
Contra-indications
 Early pregnancy
Side effects
 Anorexia, weight loss
 Nausea, vomiting, gastric pain
 Insomnia, headache, vertigo, excitability
 Muscle pain, joint pain
 Avoid taking alcohol during treatment in order to reduce
incidence and severity of side effects

Pregnancy
st
Breast-feeding
 Can be used

N MONOGRAPHS
Caution
 Aluminium hydroxide reduces gastrointestinal irritation
 Use with caution in patients with history of convulsions
or psychiatric disease
NITROFURANTOIN HC II E 6.2.2
Nitrofuran antibacterial for acute and recurrent urinary tract
infections
Dosage forms
 Tablet: 100 mg
Uses
 Treatment of uncomplicated urinary tract infection
 Treatment of severe, recurrent urinary tract infection
 Prophylaxis of chronic urinary tract infection
Dose and duration

 Acute uncomplicated urinary tract infections

Child >3 months: 3 mg/kg/day every 6 hours for 7 days
 Severe recurrent urinary tract infections

If severe nausea occurs, reduce to 200 mg daily in di-
vided doses
 Prophylaxis of chronic urinary tract infections
Adult: 50–100 mg at night

Child >3 months: 1 mg/kg at night (with regular moni-
toring of lung and liver function)
Contra-indications
 Child less than 3 months

NITROUS OXIDE N
 Kidney disease
 Allergy to nitrofurantoin
Side effects
 Discolouration of urine
Patient information
 Take with food
 May colour urine yellow or darkish brown; do not worry
Pregnancy
rd
Breast-feeding
 Do not use
Caution
 May interfere with test results for urinary glucose
NITROUS OXIDE H E 1.1

Inhalation gas with weak anaesthetic action but strong
analgesic action
Dosage forms
 Medical gas: 99.999%
Uses
 Maintenance of anaesthesia in combination with other
anaesthetic agents and muscle relaxants

 Analgesia for obstetric practice
 Emergency management of injuries
 Postoperative physiotherapy
 Refractory pain in terminal illness

N MONOGRAPHS
Dose and duration

 Anaesthesia
Adult and child: nitrous oxide mixed with 25–30% oxygen

 Analgesia
Adult and child: 50% nitrous oxide with 50% oxygen

Contra-indications
 Middle ear occlusion
 Arterial air embolism
 Decompression sickness
 Chronic obstructive airway disease
 Emphysema
 Demonstrable collection of air in pleural, pericardial or
peritoneal space
Side effects
 Megaloblastic anaemia
 Reduced white cell formation on prolonged use
Interactions
 Chlorpromazine, fluphenazine, haloperidol (enhanced
hypotensive effect)
 Methotrexate (increased antifolate effect)
 Verapamil (enhanced hypotensive effect and atrioven-
tricular delay)
Pregnancy
 Can be used
Breast-feeding
 Can be used

NOREPINEPHRINE (NORADRENALINE) N
Caution
 May depress neonatal respiration if used in 3rd trimester
 Minimise staff exposure
 Give additional oxygen for several minutes after stopping
the flow of nitrous oxide to reduce risk of hypoxia
 Do not give continuously for longer than 24 hours or
more frequently than every 4 days without haematology
monitoring and close supervision
NOREPINEPHRINE (NORADRENALINE) RR V 12.4.2

Sympathomimetic medicine. Norepinephrine is a hormone
and neurotransmitter naturally produced by the body
Dosage forms
Uses
 Acute hypotension
Dose and duration

 Acute hypotension
Adult: by continuous IV infusion, via central venous cath-

eter, of a solution containing 0.04 mg/ml of noradrena-
line base (equivalent to 0.08 mg/ml of noradrenaline tar-
tarate) at an initial rate of 0.16–0.33 ml/minute, adjusted
Neonate and child: by continuous IV infusion 0.02–0.1
micrograms/kg/minute as the base (equivalent to
0.04–0.2 microgram of noradrenaline tartarate) adjusted
according to response up to a max of 1 microgram base
(2 microgram noradrenaline tartarate)/kg/minute

N MONOGRAPHS
 Preparation
For continuous IV infusion, dilute with dextrose 5% or so-
dium chloride and dextrose to a maximum concentration
of noradrenaline base 40 mg/l (i.e. 80 mg/l of noradrena-
line tartarate; higher concentrations can be used if pa-
tient is fluid-restricted) Incompatible with bicarbonate or
alkaline solutions
Contra-indications
 Hypotension due to hypovolaemia
Side effects
 Anorexia, nausea, vomiting
 Arrhythmias, peripheral ischaemia, palpitation, hyperten-
sion, bradycardia, tachycardia

 Dyspnoea, hypoxia
 Confusion, anxiety, psychosis, insomnia, headache
 Weakness, tremor
Interactions
 Halothane, desflurane, isoflurane (increased risk of
arrhythmias)
 MAOIS (risk of hypertensive crisis)
Pregnancy
 Do not use
Breast-feeding
 Do not use
Caution
 Monitor blood pressure and rate of flow frequently

NORETHISTERONE N
 Only use in conjunction with appropriate blood volume
replacement fluids
 Check infusion site frequently for extravasation, which
can cause necrosis
 Use in pregnancy may reduce placental perfusion and in-
duce foetal bradycardia
NORETHISTERONE RR E 18.7
Progesterone
Dosage forms
 Tablet: 5 mg
Uses
 Endometriosis
 Menorrhagia
 Dysfunctional uterine bleeding
 Dysmenorrhoea
 Postponement of menstruation
 Premenstrual syndrome
Dose and duration

 Endometriosis
Adult (female): by mouth, 10–15 mg daily for 4–6 months

or longer, starting on day 5 of cycle (increased to 20–25
mg daily if spotting occurs and reduced once bleeding has
stopped)
 Menorrhagia and dysfunctional uterine bleeding
Adult(female): by mouth, 5 mg every 8 hours for 10 days

to stop bleeding; followed by 5 mg every 12 hours from
day 19 to day 26 of cycle to prevent bleeding

N MONOGRAPHS
 Dysmenorrhoea
Adult (female): by mouth, 5 mg every 8 hours from day 5
to day 24 for 3–4 cycles
 Postponement of menstruation
Adult (female): by mouth, 5 mg every 8 hours starting 3

days before expected onset of menstruation
 Premenstrual syndrome
Adult (female): 5 mg every 8–12 hours from day 19–26

for several cycles
Contra-indications
 Pregnancy
 Undiagnosed vaginal bleeding
 Hepatic impairment or active liver disease
 Severe arterial disease
 Breast or genital tract cancer
 Porphyria
 History of idiopathic jaundice, severe pruritus or pemphi-
goid infestations in pregnancy

Side effects
 Headache
 Nausea
 Amenorrhoea, spotting, hypomenorrhoea
 Uterine or vaginal bleeding
 Oedema
 Cholestasis
Interactions
 Carbamazepine, griseofulvin, nevirapine, phenobarbital,
phenytoin, rifampicin (reduced noerthisterone effect)

 Atazanavir (increased concentration of norethisterone)

NORMAL IMMUNOGLOBULIN, HUMAN N
 Ciclosporin (increased plasma ciclosporin concentration)
 Warfarin (antagonism of anticoagulant effect)
 When taken for postponement of menstruation, men-
struation occurs 2–3 days after stopping

Pregnancy
 Do not use
Breast-feeding
 Do not use
Caution
 Use with caution in epilepsy, migraine, diabetes mellitus,
hypertension or cardiac or renal disease, susceptibility to
thromboembolism or depression
 Norethisterone may suppress lactation
 Should only be prescribed by a specialist (gynaecologist)
NORMAL IMMUNOGLOBULIN, HUMAN NR N 19.2

Concentrated antibodies recovered from pooled human
plasma or serum; contains immunoglobulin G and antibodies
to hepatitis A, measles, mumps, rubella, varicella or other
prevalent viruses
Dosage forms
Uses
 Protection of exposed patients against hepatitis A,
measles and rubella

Dose and duration
Give as SC infusion; if SC is not possible, give IM injection
N MONOGRAPHS
except in patients with thrombocytopenia or bleeding

disorders
 Consult manufacturer’s literature for doses
Contra-indications
 Hypersensitivity to any of the components
 IV administration
Side effects
 Anxiety
 Dizziness, migraine, tingling or pricking sensation, head-
ache, fatigue, increased sweating

 Flushing, increase in blood pressure, thromboembolic
events such as myocardial infarction, stroke, pulmonary

embolism and deep vein thrombosis, low blood pressure
 Wheezing/asthma
 Diarrhoea, mouth ulcer, abdominal pain, vomiting, nau-
sea
 Pruritus, rash, allergic reactions
 Musculoskeletal pain/ stiffness
 Chills, fever
 Joint pain, moderate low back pain
 Infusion site reactions (swelling, pain, redness, itching)
Interactions
 Live vaccine (impairment of immune response)
Pregnancy
 Can be used
Breast-feeding
 Can be used
Storage
o
 Store at 2–8 C in the dark. Do not freeze

NYSTATIN N
Caution
 Risk of shock if injection is given intravenously
 Formulations from different manufacturers vary and
should not be treated as equivalent
 Avoid use of live vaccine (except yellow fever vaccine)
during 3 weeks before or during 3 months after injection
of human normal immunoglobulin
 In exposure to hepatitis A, immunoglobulin should be
given within 14 days of exposure to a primary case,
though can still be given up to 28 days.
 In case of exposure to measles in immune compromised
individuals, give immunoglobulin immediately within 72
hours of exposure. Can still be given within 6 days
 If hepatitis A vaccine is given at the same time, it should
be injected at a different site
 Use with caution in patients with hypo- or agamma-
globulinaemia with or without IgA deficiency
 Monitor for acute renal failure and consider discontinua-
tion if renal function deteriorates.
 Always refer to the product information literature
NYSTATIN HC II E 6.3, 13.1

Antifungal medicine
Dosage forms
 Pessary: 100,000 IU
 Oral suspension: 100,000 IU/ml
 Tablet: 500,000 IU
 Cream/ointment: 100,000 IU/g

N MONOGRAPHS
Uses
 Candidiasis: Oral, oesophageal, intestinal, vaginal, skin
Dose and duration

Adult and child >12 years: Chew 500,000 IU tablet

every 6 hours for 10 days
Child 5–12 years: Chew 250,000 IU tablet every 6
hours for 10 days
Child <5 years: 100,000 IU oral suspension every 6
hours for 10 days
In immunosuppressed patients, give for 14–20 days
Insert 1 pessary vaginally each night for 10 days

Apply cream to the area around the vagina
Side effects
 Stomach upset, oral irritation
 Rash
Interactions
 Clotrimazole pessaries (cancelled effect)
 Take the tablets after food
 Do not swallow the pessaries
 For pessaries, lie on your back so as to insert pessary as
high as possible into the vagina

Pregnancy
 Can be used
Breast-feeding
 Can be used

OFLOXACIN O
Caution
 For vaginal candidiasis, preferably use clotrimazole
pessaries
 In immunocompromised (e.g. HIV/AIDS patients),
nystatin is not highly effective for candidiasis; ketocona-
zole should be used if available
O
OFLOXACIN H E 6.2.4
Fluoroquinolone antibacterial
Dosage forms
 Tablet: 200 mg
Uses
 Acute or chronic prostatitis
 Lower respiratory tract infections
 Uncomplicated gonorrhoea
 Uncomplicated genital chlamydial infection
 Non-gonococcal urethritis
 Multi-drug resistant tuberculosis (MDR-TB) (specialist use
only)
Dose and duration
Adult: by mouth, 200−400 mg once daily preferably in

the morning. May be increased if necessary in upper uri-
nary tract infections to 400 mg twice daily for 5 days
O MONOGRAPHS
 Acute or chronic prostatitis

Adult: by mouth, 200 mg twice daily for 28 days
 Lower respiratory tract infections
Adult: by mouth, 400 mg preferably in the morning for 7

days
 Uncomplicated gonorrhoea
Adult: by mouth, 400 mg as a single dose

 Uncomplicated genital chlamydial infection, non-
gonococcal urethritis
Adult: by mouth, 400 mg daily in single or divided doses
for 7 days
Adult: by mouth, 400 mg twice daily for 14 days

 Multi-drug resistant tuberculosis (MDR-TB)
Adult and child: 15-20 mg/kg daily. Maximum 800 mg

Contra-indications
 History of tendon damage due to quinolones
Side effects
 Hepatic dysfunction
 Tendon damage
 Rashes, hypersensitivity
Interactions
 Ciclosporin (increased concentration of nephrotoxicity)
 Antacids (reduced absorption of ofloxacin)

OLANZAPINE O
 Oral iron (reduced absorption of ofloxacin)
 Zinc (reduced absorption of ofloxacin)
 Theophylline (increased risk of convulsions)
 Take at least two hours apart from iron, zinc, milk, dairy
products or magnesium trisilicate mixture (antacids)

Pregnancy
 Do not use
Breast-feeding
 Do not use
Caution
 Discontinue if psychiatric, neurological or hypersensitivity
reactions occur
 For MDR-TB, ofloxacin can be used in pregnancy, breast-
feeding and children as benefits outweigh risks
OLANZAPINE RR E 24
Psychotherapeutic medicine
Dosage forms
 Tablet: 10 mg
Uses
 Schizophrenia
 Mania (monotherapy or combination therapy)
 Prevention of recurrence of bipolar disorder
Dose and duration

 Monotherapy for mania
Adult and child over 12 years: by mouth, 15 mg once

daily adjusted according to response to usual dose range
O MONOGRAPHS
of 5–20 mg once daily

In renal and hepatic impairment: initially 5 mg daily
 Other uses
Adult: by mouth, 10 mg once daily adjusted according to

response to usual dose range of 5–20 mg once daily (max
20 mg daily)
Child 12–18 years: initially, 5–10 mg once daily
In renal and hepatic impairment: initially 5 mg daily
Contra-indications
 Hypersensitivity to olanzapine
 Known risk of narrow-angle glaucoma
Side effects
 Eosinophilia, neutropenia, leucopoenia
 Elevated lipid and glucose levels, glucosuria
 Increased appetite, weight gain
 Agitation, restlessness, somnolence
 Parkinsonism, impaired voluntary movement
 Orthostatic hypotension
 Constipation and dry mouth
 Transient elevation in hepatic aminotransferases
 Rash
 Joint pain
 Erectile dysfunction, decreased libido
 Physical weakness, fatigue
 Oedema, pyrexia
 Elevated plasma prolactin levels
Interactions
 Fluvoxamine (increased concentration of olanzapine)

OMEPRAZOLE O
 Valproate (increased risk of side effects)
 Parenteral benzodiazepines (increased risk of hypoten-
sion, bradycardia and respiratory depression when co-
administered with IM olanzapine)
Pregnancy
 Can be used
Breast-feeding
 Do not use
Caution
 Only use olanzapine in pregnancy if benefit outweighs
risk. Risk of neonatal lethargy, tremor and hypertonia
when used in 3rd trimester
 May exacerbate ketoacidosis in diabetic patients
OMEPRAZOLE HC IV E 17.1
Proton-pump inhibitor (PPI). Inhibits gastric acid secretion
Dosage forms
 Tablet: 20 mg
Uses
 Peptic ulcer
 Duodenal ulcer
 Gastro-oesophageal reflux disease
 Prevention and treatment of NSAID-induced ulcers
 Helicobacter pylori eradication
 Zollinger-Ellison syndrome (specialist)
Dose and duration

 Peptic ulcer
Adult: 20 mg every 12 hours for 4 weeks; increase dose

O MONOGRAPHS
to 40 mg in severe or recurrent case

 Gastric ulcer
Adult: 20 mg once daily for 8 weeks; increase dose to 40
mg in severe or recurrent case
 NSAID- induced ulcers, gastro-oesophageal reflux disease
Adult and child > 20kg: 20 mg once daily for 4 weeks,

continue for 8 weeks if not fully healed
Child > 1 year (10‒20 kg): 10 mg once daily increased if
necessary to 20 mg
 H.pylori eradication (in combination with two antibiotics)
20 mg every 12 hours for 1 week

 Zollinger-Ellison syndrome (specialist use only)
Adult: initially 60 mg once daily. Usual dose range, 20–

120 mg daily. Uses above 80 mg should be given in 2 di-
vided doses
Contra-indications
 Allergy to omeprazole
Side effects
 Stomach upset, flatulence
 Headache, agitation
 Impotence
Interactions
 Atazanavir (reduced plasma concentration of atazanavir)
 Nelfinavir (reduced plasma concentration of nelfinavir)
 Raltegravir (increased plasma concentration of ralte-
gravir)
 Saquinavir (increased plasma concentration saquinavir)
 Clopidogrel (reduced antiplatelet effect of clopidogrel)

ORAL REHYDRATION SALTS (ORS) O
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Omeprazole is used in combination with antibacterials in
Helicobacter pylori eradication
 Use the lowest effective dose for the shortest possible
duration
 May mask symptoms of gastric cancer; thorough investi-
gations need to be carried out
 Rebound acid hypersecretion and dyspepsia may occur
after stopping prolonged treatment with omeprazole
 Use in children should be initiated by paediatrician only
 Use in Zollinger-Ellison syndrome should be initiated by
specialist only
ORAL REHYDRATION SALTS (ORS) HC I V 17.6.1, 26.1

Fluid and electrolyte replacement powder containing sodium,
potassium, citrate, and glucose. Used to prevent and treat
dehydration
Dosage forms
 Powder for solution: WHO formula
Uses
 Diarrhoea
 Prevent dehydration where it has not yet occurred
 Treatment of dehydration and electrolyte disturbances
 Supplement IV rehydration in severe dehydration

O MONOGRAPHS
Dose and duration

Give according to the treatment plans below
 Plan A: Prevention of dehydration
Adult and child >10 years: 200–400 ml after each

loose stool
Child 2–10 years: 100–200 ml after each loose stool
Child <2 years: 50–100 ml after each loose stool
 Plan B: Treatment of moderate dehydration
Give 75 ml/kg in small amounts and at regular intervals

over 4 hours
Larger amounts may be given if a child continues to
have frequent loose stools
Continue ORS as long as diarrhoea or signs of dehydra-
tion continue
 Plan C: Severe dehydration (in combination with IV rehy-
dration)
Initially 20 ml/kg per hour (while IV infusion is being
prepared), then 5 ml/kg per hour (during IV infusion
administration)
Monitor patient and continue treatment as appropriate
with plan A, B, or C
Preparation
 Dissolve 1 sachet of ORS in 1 litre of drinking water
Side effects
 Vomiting
 Dissolve one sachet in 1 L of clean, freshly boiled and
cooled drinking water

 Do not dissolve in less than 1 L of water

ORAL REHYDRATION SALTS (ORS) O
 Do not give quickly, as it will cause vomiting. If a child
vomits, stop giving for 10 minutes then resume at a slow-
er rate
 Pour away leftover solutions after 24 hours from time of
preparation, then prepare a fresh solution

 ORS should always be a free-flowing white powder. If it is
a compact mass, brownish, and insoluble, it is unfit for

use even if the expiry date is not yet reached
 Continue breastfeeding and giving food as usual
Pregnancy
 Can be used
Breast-feeding
 Can be used
Storage
 Dissolved ORS can be used for 24 hours. Pour away
leftover solution after 24 hours.

Caution
 ORS should always be given with zinc tablet to children
 Give 2 sachets of ORS to the caretaker for Plan A at
home, following rehydration at the health facility
 If IV rehydration is unavailable, use a nasogastric tube to
give ORS at a rate of 20 ml/kg every hour for 6 hours
 Reassess the child's status every 1–2 hours to classify the
degree of dehydration

O MONOGRAPHS
OSELTAMIVIR PHOSPHATE RR E 6.5

Antiviral medicine. Reduces replication of influenza A and B
viruses by inhibition of viral neuraminidase
Dosage forms
 Tablet: 75 mg
Uses
 Treatment of avian influenza type A H5N1
 Prevention of avian influenza type A H5N1
Dose and duration

 Treatment of avian influenza type A H5N1
Adult and child >13 years: 75 mg every 12 hours for 5

days
Child 1–13 years: give as below every 12 hours for 5 days
Body weight (kg) Dose every 12 hours
>40 75 mg
23–40 60 mg
15–23 45 mg
10–15 30 mg
Child 3–12 months: 3 mg/kg every 12 hours for 5 days

Child 1–3 months: 2.5 mg/kg every 12 hours for 5 days
Neonate: 2 mg/kg every 12 hours for 5 days
Renal impairment: eGFR 30–60 ml/minute/1.73 m2, 30
mg every 12 hours; eGFR 10–30 ml/minute/1.73 m2, 30
mg once daily
 Prevention of avian influenza type A H5N1
Give for 10 days in post exposure prophylaxis (PEP) or for
up to 6 weeks in an epidemic.
Adult and child over 13 years: 75 mg every 24 hours
OSELTAMIVIR PHOSPHATE O
Child 1–13 years: as in table below
Body weight (kg) Dose every 24 hours
>40 75 mg
23–40 60 mg
15–23 45 mg
10–15 30 mg
Child 3–12 months: 3 mg/kg every 24 hours for 10 days

Child 1–3 months: 2.5 mg/kg every 24 hours for 10 days
Neonate: 2 mg/kg every 24 hours for 10 days
Renal impairment: eGFR 30–60 ml/minute/1.73 m2, 30
mg once daily; eGFR 10–30 ml/minute/1.73 m2, 30 mg
every 48 hours
Contra-indications
 Hypersensitivity to oseltamivir
Side effects
 Nausea, vomiting, abdominal pain, dyspepsia
 Cough, sore throat, rhinorrhoea, bronchitis, upper respir-
atory tract infections

 Insomnia, headache
 Herpes simplex
 Pain, fatigue, dizziness, pyrexia
 Hepatic failure
Pregnancy
 Can be used
Breast-feeding
 Can be used

O MONOGRAPHS
Caution
 Do not use in renal failure if eGFR is >10 ml/minute/m2
 Give within 48 hours of exposure
 May be ineffective in neonates since they may be unable
to metabolise it to its active form. Use under supervision
 Only use in pregnancy and breast-feeding if benefit out-
weighs risk
OXYGEN HC IV V 1.1
Medical gas used to prevent and treat hypoxia. It increases
alveolar oxygen tension and decreases the work of breathing.
Dosage forms
 Medical gas for inhalation: 99.80%
Uses
 Anaphylaxis
 Maintain adequate tissue oxygenation in inhalational an-
aesthesia
 Myocardial infarction
 Severe acute asthma
 Cardiac arrest
 Other conditions causing respiratory distress (e.g. pneu-
monia, pulmonary thromboembolism, pulmonary fibro-

sis, shock, severe trauma, sepsis, anaphylaxis, severe
anaemia)
Dose and duration
The concentration of oxygen required depends on the condi-
tion being treated.
It should be prescribed to achieve normal or near-normal ox-
ygen saturation (94‒98%).
OXYGEN O
 Conditions that require high concentration oxygen
(40‒60%)
Cardiac arrest
Carbon monoxide poisoning
Severe acute asthma
Pneumonia
Shock
Anaphylaxis
Severe trauma
Myocardial infarction
 Conditions that require low oxygen concentration (to
prevent respiratory failure due to accumulation/high

carbon dioxide levels). Give oxygen initially at 28%
aiming to achieve 88‒92% oxygen saturation
Chronic pulmonary obstructive disease
Advanced cystic fibrosis
Severe lung scarring due to tuberculosis
 With inhalation anaesthetics
Concentration should not be less than 21%

Side effects
 Concentrations greater than 80% have a toxic effect on
the lungs leading to pulmonary congestion, exudation

and partial or complete lung collapse
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Oxygen may be given by mask or nasal cannula
O MONOGRAPHS
 Nasal cannula can produce drying and dermatitis on

prolonged use
OXYTOCIN HC III E 22.1

Synthetic oxytocic medicine; causes the uterus to contract
Dosage forms
Uses
 Prevention and treatment of postpartum haemorrhage or
excessive bleeding after abortion

Dose and duration
− Initially, dissolve 2.5 IU in 500 ml of normal saline and

infuse at 10 drops per minute
− Then, increase infusion rate by 10 drops per minute
every 30 minutes until a good contraction pattern is
reached (3–4 contractions every 10 minutes, each last-
ing >40 seconds). Maintain this rate until delivery is
completed
− Maximum infusion rate is 60 drops per minute
If good contraction pattern is not established at a rate of
60 drops per minute:
− Increase oxytocin concentration to 5 IU in 500 ml of
normal saline and adjust infusion rate to 30 drops per
minute
− Then, increase infusion rate by 10 drops per minute
every 30 minutes until a good contraction pattern is
reached; maximum 60 drops per minute
OXYTOCIN O
If good contraction pattern is not established using high-
er concentration:
In multigravida women and women with previous
caesarean scars; refer for delivery by C-section
In primigravida women:
− Infuse oxytocin at a higher concentration of 10 IU in
500ml. If good contractions are not there at this rate,
refer for delivery by C-section
Monitor foetal heart rate and uterine contractions
If uterine hyperactivity or foetal distress occurs, discontinue
immediately
 Prevention of postpartum haemorrhage
10 IU by slow IV injection or IM single dose when the

anterior shoulder is delivered or immediately after
birth
 Treatment of postpartum haemorrhage
10–40 IU by slow IV injection as a single dose

Preparation
 Preferably use 0.9% sodium chloride (not glucose) to give
the infusion to avoid water overload and low blood sodi-

um levels (electrolyte disturbances)
Contra-indications
 Hypertonic uterine contractions
 Mechanical obstruction to delivery
 Foetal distress
 Conditions where spontaneous labour or vaginal delivery
is not recommended
 Severe eclampsia
 Foetus with big head

O MONOGRAPHS
 Small maternal pelvis

Side effects
 Uncontrolled uterine contractions, uterine rupture
 Foetal distress
Interactions
 Misoprostol (increased contractions)
Pregnancy
 Can be used
Breast-feeding
 Can be used
Storage
 Store at 2–8°C. Do not freeze
Caution
 If vaginal misoprostol had been given, do not give oxyto-
cin until at least 8 hours have passed
 Effective dose varies for different women
 If foetal heart rate is < 100 beats per minute, stop
infusion and manage for foetal distress
 If hyperactivity of uterus occurs (any contraction lasting >
60 seconds or > 4 contractions in 10 minutes), stop
infusion and relax uterus using IV salbutamol
 Do not use oxytocin concentration of 10 IU in 500ml in
multigravida and women with previous C-section
 Women using oxytocin should never be left alone
 Oxytocin is preferable to ergometrine as it produces

P-AMINOSALICYLIC ACID P
more controlled contractions
 Avoid prolonged use in oxytocin-resistant uterine
inactivity
 Avoid IV bolus injection during labour. Give only by IV
infusion
P
P-AMINOSALICYLIC ACID H E 6.2.4
A pro-drug with activity against Mycobacterium tuberculosis
Dosage forms
 Granules: 4 g of P-aminosalicylic acid (PAS)
Uses
Dose and duration

 MDR-TB (in combination with other drugs)
Adult: 4 g every 12 hours

Child: 150 mg/kg/day (max 4 g) of PAS divided into 2
separate and equal doses given every 12 hours
Contra-indications
 Severe renal disease
 Hypersensitivity to P-aminosalicylic acid
Side effects
 Hepatitis
 Rash, exfoliative dermatitis
 Hypothyroidism, goitre, hypoglycaemia
 Malabsorption syndrome

P MONOGRAPHS
 Leucopoenia, thrombocytopenia, eosinophilia

Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Measure thyroid function at the start of treatment and
every 3 months thereafter
 Discontinue all treatment immediately at the first sign of
a rash, fever or other signs of intolerance as it may be a
sign of severe hypersensitivity that is sometimes fatal.
Desensitize patient thereafter
 Discontinue if liver toxicity occurs
 Only use in pregnancy if maternal condition justifies risk
to the foetus since some studies have suggested higher
levels of congenital defects
 If used in breast-feeding, monitor breast-fed infants
PANCURONIUM BROMIDE HC IV V 20
Aminosteroid non-depolarising neuromuscular blocker with
long duration of effect
Dosage forms
Uses
 Neuromuscular blockade during surgery
Dose and duration

 Neuromuscular blockade during surgery

PANCURONIUM BROMIDE P
Adult and child over 1 month: by IV injection, initially 0.1
mg/kg then 0.02 mg/kg as required
Neonate: initially 0.1 mg/kg, then 0.05 mg/kg repeated as
necessary
Adult: by IV injection, initially 0.1 mg/kg (optional) then

0.06 mg/kg every 60–90 minutes
Contra-indications
 Concurrent use of a depolarising neuromuscular agent
 Hypersensitivity to pancuronium
Side effects
 Prolonged post-operative apnoea (temporary cessation
of breathing)
 Tachycardia, hypertension, arrhythmias
 Salivation
 Anaphylactoid reaction
Interactions
 Gentamicin, clindamycin, polymixin B (effects of pancu-
ronium enhanced)
 Phenytoin (effect of pancuronium reduced by long-term
use of phenytoin)
Pregnancy
 Can be used
Breast-feeding
 Can be used
Storage
o
 Store at 2–8 C. Do not freeze

P MONOGRAPHS
Caution
 Risk of allergic cross-sensitivity with other neuromuscular
blocking drugs
 Use lower doses in myasthenia gravis and hypothermia
 Use with caution in patients with other neuromuscular
disorders and fluid and electrolyte disturbances
 Patients with burns may require higher doses
 There may be higher dosage requirements in hepatic
impairment and prolonged recovery time
 Use with caution in renal impairment since there may be
prolonged duration of block
 Calculate dose on basis of ideal body weight in obesity to
avoid excessive dosage
 In patients receiving magnesium sulphate for toxaemia of
pregnancy, the reversal of neuromuscular block induced
by pancuronium may be unsatisfactory because
magnesium salts enhance neuromuscular blockade
PAPAVERETUM + HYOSINE RR N 2.2

A combination of hyoscine and papaveretum (mixture of 253
parts of morphine hydrochloride, 23 parts of papaverine hy-
drochloride and 20 parts of codeine hydrochloride)
Dosage forms
 Injection: 15.4 mg/ml of papaveretum+ 0.4 mg/ml of
hyoscine
Uses
 Postoperative analgesia
 Severe chronic pain

PAPAVERETUM + HYOSINE P
Dose and duration
 All uses
All doses are expressed as papaveretum dose

Give by SC, IM or IV injection, repeated every 4 hours prn
Adult and child over 12 years: 7.7–15.4 mg
Child 6–12 years: 3.85–7.7 mg
Child 1–5 years: 1.93–3.85 mg
Child 1–12 months: 0.154 mg/kg
Child up to 1 month: 0.115 mg/kg
Elderly: initially 7.7 mg
Contra-indications
 Heart failure
 Secondary chronic lung disease
 All contraindications of morphine, hyoscine, codeine
Side effects
 Hypothermia
 All side effects of morphine, hyoscine, codeine
Interactions
 All interactions of morphine, hyoscine, codeine
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Respiratory depression and withdrawal symptoms can
occur in a neonate if used during delivery

P MONOGRAPHS
PARACETAMOL HC II E 2.1
Analgesic (relieves pain) and antipyretic (reduces fever); does
not have anti-inflammatory properties
Dosage forms
 Tablets: 500 mg
 Oral suspension: 125 mg/ml
 Rectal suppository: 125 mg
Uses
 Acute migraine attack
 Fever (including post-immunisation fever)
Dose and duration

 Mild to moderate pain, acute migraine attack, fever
Adult and child >12 years: 0.5–1 g every 4–6 hours

(maximum 4 g daily)
Child 6–12 years: 250–500 mg every 4–6 hours
Child 3 months–1 year: 60–125 mg every 4–6 hours
Child <3 months: 10 mg/kg; only when very necessary
No more than 4 doses should be given in 24 hours
Use suppositories in children who cannot swallow;
dose is the same as for oral paracetamol
Contraindications
Side effects
 Severe liver damage in overdose
 Take only for as long as pain lasts; avoid prolonged use
 Do not exceed 2 doses if used in post immunisation fever

PENICILLAMINE P
Bring the child back to the health facility if fever persists.
Wiping the child with a cool sponge or cloth (with water
at room temperature) is also good for reducing the fever
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Reduce dose in liver disease
 May be used with an NSAID to increase pain relief
PENICILLAMINE NR N 4.2
Disease modifying antirheumatic medicine and antidote to
copper and lead poisoning
Dosage forms
 Tablet: 250 mg
Uses
 Treatment of severe rheumatoid arthritis
 Copper poisoning and lead poisoning
 Wilson’s disease
 Cystinuria
Dose and duration

Adult: by mouth, initially 125–250 mg once daily before

food for 1 month, then increased by the same amounts at
intervals of at least 4 weeks to a usual maintenance dose
of 500–750 mg daily in divided doses (max 1500 mg
daily). If remission occurs after 6 months, attempt dose
P MONOGRAPHS
reduction by 125–250 mg every 12 weeks

Child 8–12 years: initially 2.5–5 mg/kg daily, gradually in-
creased at least every 4 weeks to a usual maintenance
dose of 15–20 mg/kg daily over 3–6 months
Elderly: initially 125 mg daily before food for 1 month,
then increased with the same amounts at least every 4
weeks (max 1 g daily)
 Copper and lead poisoning
Adult: 1–2 g daily in divided doses before food, until
urinary lead is stabilized at less than 500 micrograms/day
Child: 20 mg/kg/day in divided doses
 Wilson’s disease
Adult and child over 12 years: 1.5–2 g daily in divided
doses before food (max 2 g daily for 1 year), thereafter
0.75–1 g daily
Child 1 month–12 years: 2.5 mg/kg every 12 hours
before food, increased at 1–2 week intervals to 10 mg/kg
every 12 hours
Elderly: 20 mg/kg daily in divided doses adjusted
 Cystinuria
Adult and child over 12 years: therapeutic, 1000–3000
mg daily in divided doses before food, adjusted to
maintain urinary cystine below 200 mg/l
Prophylactic (maintain urinary cystine below 300 mg/l)
500 mg–1000 mg at bedtime
Child 1 month–12 years: prophylaxis, 20–30 mg/kg/day
in 2–3 divided doses adjusted to keep urinary cystine
below 200 mg/l
Elderly: lowest dose to keep urinary cystine < 200 mg/l

PENICILLAMINE P
Contra-indications
 Lupus erythematosus
 Hypersensitivity to penicillamine
Side effects
 Nausea, taste loss
 Anorexia, fever
 Proteinuria
 Rash
Interactions
 Take your medicine before food or at bedtime
 Report to your doctor immediately if signs or symptoms
of bone marrow depression such as unexplained bruising

or bleeding, purpura, infection or sore throat occur
 When used for cystinuria, take at least 3 litres of water
per day
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Monitor blood and urine throughout treatment
 Avoid concomitant use of nephrotoxic drugs , gold,
chloroquine or immunosuppressive treatment
 Avoid administration of oral iron within 2 hours of a dose

P MONOGRAPHS
 Use with caution in penicillin-sensitive patients as they

may also react to penicillamine
 Reduce dose in mild renal impairment and avoid use in
moderate to severe renal impairment
PENTAMIDINE ISETHIONATE RR E 6.4.2, 6.4.4

Antileishmaniasis and antipneumocystis medicine
Dosage forms
Uses
 Pneumocystis carinii pneumonia (PCP)
 Leishmaniasis
 Human African trypanosomiasis
Dose and duration

 Visceral leishmaniasis (unresponsive to, or intolerant of
antimonial compounds)
Adult and child: by deep IM injection or by IV infusion, 4
mg/kg 3 times a week for 5–25 weeks or longer, until
consecutive splenic aspirates taken 14 days apart are
negative
 Cutaneous leishmaniasis (infections caused by L. aethiopi-
ca or L. guyanensis)
Adult and child: by deep IM injection or by IV infusion,
3–4 mg/kg once or twice a week until the lesion is no
longer visible
 Diffuse cutaneous leishmaniasis (infections caused by L.
aethiopica)
Adult and child: by deep IM injection or by IV infusion, 3–
4 mg/kg once a week, continued for at least 4 months
PENTAMIDINE ISETHIONATE P
after parasites are no longer detectable in slit-skin smears
 Mucocutaneous leishmaniasis unresponsive to antimonial
compounds
Adult and child: by deep IM injection or by IV infusion, 4
mg/kg 3 times a week for 5–25 weeks or longer, until
lesion is no longer visible
 Treatment of pneumocystis carinii pneumonia
Adult and child: by slow IV infusion or by deep IM
injection, 4 mg/kg daily for at least 14 days
 Prophylaxis of P.carinii pneumonia
Adult and child: 4 mg/kg once every 4 weeks
 Treatment of haemolymphatic stage of T. brucei gambi-
ense infection
Adult and child: by IM injection, 4 mg/kg daily or on
alternate days for a total of 7–10 doses
 Treatment of meningoencephalitic stage of T. brucei
gambiense (prior to melarsoprol)
Adult and child: by IM injection, 4 mg/kg daily on day 1
and day 2
Preparation
 Reconstitute according to manufacturer’s instructions
Contra-indications
Side effects
 Thrombocytopenia, leucopoenia, anaemia, azotemia
 Nephrotoxicity, pancreatitis
 Hypoglycaemia, hyperglycaemia, hyperkalaemia, hy-
pocalcaemia
 Nausea, vomiting, taste disturbance, abdominal pain

P MONOGRAPHS
 Confusion, hallucinations
 Arrhythmias
 Acute hypotension with dizziness, headache, breathless-
ness, tachycardia and syncope after rapid IV injection
Pregnancy
 Do not use
Breast-feeding
 Do not use
Caution
 Establish baseline blood pressure before administration
and administer when patient is lying down due to risk of
severe hypotension. Monitor blood pressure during ad-
ministration and during treatment
 Interrupt or discontinue treatment if severe deterioration
in bone marrow, renal or pancreatic function develop
 Can be used to treat in potentially fatal visceral leishman-
iasis in pregnancy and breast feeding
PETHIDINE HC IV V 2.3
Opioid analgesic
Dosage forms
Uses
 Moderate to severe pain
 Obstetric analgesia
 Pre-operative analgesia

PETHIDINE P
Dose and duration
 Moderate to severe pain
Adult: 25‒100 mg SC or IM every 6‒8 hours or 25‒50 mg

slow IV as required
Child > 6 months: 0.5‒2 mg/kg/dose as a single dose
Elderly: 25 mg IM or SC
 Analgesia in labour
50‒100 mg IM or SC. Repeat every 1‒3 hours as

required. Maximum 400 mg in 24 hours
 Pre-operative analgesia
Adult: 50‒100 mg IM one hour before the operation

Child > 6 months: 0.5‒2 mg/kg/dose as a single dose
Contraindications
 Severe renal failure
 Head trauma or rib fracture injuries
 Chronic obstructive pulmonary disease
 Risk of paralytic ileus (e.g. in pancreatitis)
 Coma
 Acute alcoholism or delirium tremens
 Allergy to pethidine
 History of convulsive disorders (e.g. status epilepticus)
 Prostate hypertrophy
 Hypotension
Side effects

P MONOGRAPHS
 Restlessness
 Tremor
 Hypothermia
 Convulsions (in overdose)
 Pupil constriction and miosis
Interactions
 MAOIs e.g. phenelzine, moclobemide (CNS toxicity
causing hypotension or hypertension)

 Ritonavir (increased risk of pethidine toxicity)
 Selegiline (increased risk of CNS toxicity)
 Cimetidine (increased effect of pethidine)
 Phenytoin (reduced pethidine concentration; increased
risk of pethidine metabolites toxicity)

 Phenothiazine e.g. chlorpromazine, promethazine (may
induce severe hypotension)

 Do not drive or operate machinery after taking medicine
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Do not use for severe continuing pain as accumulation of
metabolites may result in neurotoxicity
 In case of overdose, use antidote naloxone 40‒80 mi-
crograms slow IV as required
 Pethidine is a controlled medicine (narcotic) and should
be handled according to the regulations
 Repeated use can cause dependence
PHENOBARBITAL P
 Avoid or reduce dose in elderly, neonates, liver and renal
impairment patients as they are more prone to
respiratory depression and other side effects
 Use during labour may cause respiratory depression in
newborn infant
PHENOBARBITAL HC II V 5
Barbiturate used as anticonvulsant and antiepileptic
Dosage forms
 Tablets: 30 mg
Uses
 Convulsions due to high fever
 Grand mal epilepsy
 Nodding disease
Dose and duration

 Convulsions and grand mal epilepsy
Adult: by mouth, 60–180 mg once daily at night

By IM or SC injection, 50–200 mg as a single dose.
May be repeated after 6 hours if necessary
Child: by mouth, 5–8 mg/kg once daily at night
By IM injection, 3–5 mg/kg as a single dose
Preparation
 For use as an intravenous injection, dilute the solution
with 10 times its volume of water for injections

Contra-indications
 Absence seizures (petit mal)

P MONOGRAPHS
Side effects
 Drowsiness, sedation
 Depression
 Movement disorders
 Allergic skin reactions
 Mood changes
 Confusion in the elderly, irritability in children
Interactions
 Chlorpheniramine (increased sedation)
 Chlorpromazine (increased sedation)
 Amitriptyline (anticonvulsant effect cancelled)
 Carbamazepine (increased risk of toxicity)
 Prednisolone (reduced prednisolone effect)
 Warfarin (reduced anticoagulant effect)
 Saquinavir, indinavir, lopinavir (reduced plasma
concentration of ARVs)
Pregnancy
st rd
Breast-feeding
 Can be used
Caution
 Do not stop treatment abruptly; reduce doses slowly to
avoid withdrawal symptoms (uncontrolled seizures)
PHENOXYMETHYLPENICILLIN P
 Identify and treat the underlying cause for convulsions
(e.g. malaria, pneumonia, etc.)
 Avoid using the injectable phenobarbital when patient
has been regularly taking oral phenobarbital to reduce
increased risk of side effects
 Decreases efficacy of oral contraceptives (advise patient
to use another method such as condoms or injectable
medroxyprogesterone)
 Give vitamin K to new born baby if mother has been
taking phenobarbital
 Reduce dose in severe liver and kidney disease
PHENOXYMETHYLPENICILLIN HC II N 6.2.1
Penicillin antibacterial also known as penicillin V
Dosage forms
 Tablet: 250 mg
Uses
 Rheumatic fever
 Rheumatic heart disease
 Bacterial tonsillitis
 Bacterial sore throat
 Mouth and teeth infection
Dose and duration

 All uses
Adult: 500 mg
Child 6– 12 years: 250 mg
Child 1–5 years: 125 mg
Child <1 year: 62.5 mg/kg
P MONOGRAPHS
Duration according to table below

Use Duration
Rheumatic fever Every 6 hours for 7 days
Rheumatic heart Every 12 hours for up to
disease 30 years of age
Bacterial tonsillitis, Every 6 hours for 10 days
sore throat, acute
kidney infection
Mouth and dental Every 6 hours for 5 days
infections
Contra-indications
 Cephalosporin allergy (possible cross-sensitivity)
Side effects
 Stomach upset
Interactions
 Methotrexate (increased methotrexate toxicity)
 Take at least 30 minutes before or 2 hours after food
 Stop taking the medicine and report to the health worker
immediately in case any skin rash occurs

Pregnancy
 Can be used
Breast-feeding
 Can be used

PHENYLEPHRINE EYE DROPS P
Caution
 Do not use for serious/severe infections. Use recom-
mended alternatives (e.g. amoxicillin, erythromycin)
 instead
PHENYLEPHRINE EYE DROPS HC IV N 21.8

Sympathomimetic mydriatic agent. Dilates pupils within
60‒90 minutes and effects last for 5‒7 hours
Dosage forms
 Eye drops: 10%
Uses
 Dilate pupil for diagnosis or pre-operative preparation
(mydriasis)
Dose and duration
 Mydriasis
Apply 1 drop to each eye. Repeat if necessary once only,

at least 1 hour after the first dose
Contra-indications
 Children and elderly (Do not use 10% solution due to risk
of systemic side effects)

 Heart disease
 Hypertension
 Hyperthyroidism
 Glaucoma
Side effects
 Pain and stinging in the eye, blurred vision, photophobia,
raised intraocular pressure

 Systemic effects: palpitations, arrhythmias, hypertension

P MONOGRAPHS
Interactions
 Antihypertensives (reversal of antihypertensive effect)
 Amitriptyline (increased risk of side effects)
 Halothane (increased risk of irregular heart beat)
 Digoxin (increased risk of arrhythmias)
 Do not drive or operate machinery until your vision
becomes clear
Pregnancy
 Do not use
Breast-feeding
 Can be used
PHENYLEPHRINE HYDROCHLORIDE H V 1.3

Sympathomimetic medicine which causes peripheral
vasoconstriction hence increasing arterial pressure
Dosage forms
Uses
 Acute hypotensive states
Dose and duration

 Treatment of hypotensive states
By SC or IM injection
Adult and child over 12 years: 2–5 mg followed by 1–10
mg if required, after at least 15 minutes
Child 1–12 years: 0.1 mg/kg every 1–2 hours as required
(max 5 mg)
By slow IV injection using a 1 mg/ml solution

PHENYLEPHRINE HYDROCHLORIDE P
Adult and child over 12 years: 0.1–0.5 mg repeated as
necessary after at least 15 minutes
Child 1–12 years: 0.005–0.02 mg/kg (max 0.5 mg)
repeated as required after at least 15 minutes
By IV infusion as a 20 micrograms/ml solution
Adult and child over 16 years: 0.18 mg/minute reduced
according to response to 0.03–0.06 mg/minute
Child 1–16 years: 0.1–0.5 mg/kg/minute, adjusted
Preparation
 For IV infusion, dissolve 10 mg in 500 ml of glucose 5% or
normal saline injection

Contra-indications
 Hyperthyroidism
 Patients taking MAOIs or within 14 days of stopping
MAOI treatment
Side effects
 Tissue necrosis
 Headache
 Vomiting
 Hypertension, tachycardia, reflex bradycardia
Interactions
 Adrenergic neurone blockers (hypotensive effect of
adrenergic neurone blockers antagonised)

 MAOIs (risk of hypertensive crisis)
Pregnancy
 Do not use

P MONOGRAPHS
Breast-feeding
 Can be used
Storage
o
 Store between 2–25 C. Protect from light
Caution
 Administration in pregnancy may cause foetal
malformations and hypoxia or bradycardia
 Monitor blood pressure and rate of flow frequently
PHENYTOIN HC II V 5
Dosage forms
Uses
 Epilepsy
 Neuropathic pain (stabbing type)
Dose and duration

 Grand mal epilepsy
Adult: Initially, 3–4 mg/kg (150–300 mg) daily as single

dose or 2 divided doses
Increase gradually at intervals of 2 weeks as necessary
to usually 200–500 mg daily
Child: Initially, 3–5 mg/kg daily in 2 divided doses In-
creased gradually according to clinical response to a
usual maintenance dose of 4–8 mg/kg daily (max 300
mg daily)

PHENYTOIN P
Adult and child over 12 years: by slow IV injection or IV
infusion, 15 mg/kg at a rate not more than 50 mg/minute
as loading dose. Maintenance dose of 100 mg by mouth
or slow intravenous infusion every 6–8 hours
Child 1 month–12 years: 20 mg/kg as a loading dose at a
rate of 1 mg/kg/minute (max 50 mg/minute).
Maintenance dose of 2.5–5 mg/kg every 12 hours
Neonate: 20 mg/kg as a loading dose at rate of 1–3
mg/kg/minute. Maintenance dose of up to 100 mg every
6–8 hours
Adult: 200–400 mg daily in 1–2 divided doses

Up to 600 mg daily may be needed
Contra-indications
 Heart block
Side effects
 Stomach upset
 Blood disorders
 Headache, sleepiness, restlessness, sedation, confusion
 Blurred vision, droopy eyelids
 Rash
 Slurred speech
 Behavioural disorders, hallucinations
 Acne
Interactions
 Amitriptyline (increased anticonvulsant effect)

P MONOGRAPHS
 Chlorpromazine (increased anticonvulsant effect)

 Carbamazepine (increased risk of side effects)
 Dexamethasone (reduced dexamethasone effect)
 Prednisolone (reduced prednisolone effect)
 Isoniazid (increased isoniazid effect)
 Protease inhibitors e.g. lopinavir (reduced plasma
concentration)
 Stop taking medicine and report to the health worker
immediately in case any sore throat, rash, mouth ulcers,

bruising or bleeding occurs
Pregnancy
st rd
Breast-feeding
 Can be used
Caution
 Do not stop medicine abruptly; reduce dose slowly to
avoid withdrawal symptoms (continuous seizures)
 Always use the lowest effective dose
 Give vitamin K to new-borns if mother has been taking
phenytoin to prevent bleeding
 Discontinue the medicine if patient develops severe
blood disorders
 Give folic acid 5mg daily to patients to minimise side
PHYTOMENADIONE (VITAMIN K) P
effect of blood disorders
 Flush intravenous line before and after administration to
prevent local venous irritation
PHYTOMENADIONE (VITAMIN K) HC II V 10.2, 27

Vitamin K and anti-haemorrhagic used to control and
prevent bleeding
Dosage forms
 Injection: 1 mg/ml; 10 mg/ml
Uses
 Prevention of neonatal bleeding in high risk neonates
 Treatment of haemorrhagic disease of the new born
 Warfarin poisoning/overdose
Dose and duration

 Prevention of neonatal bleeding in high risk neonates
1 mg IM immediately after birth as a single dose

 Treatment of haemorrhagic disease of the new born
1 mg IM every 8 hours as necessary

 Warfarin poisoning with severe or moderate bleeding
5 mg by slow IV injection as a single dose

 Warfarin poisoning with minor bleeding
5 mg orally
Side effects
 Formation of blood clot at injection site
Pregnancy
 Can be used

P MONOGRAPHS
Breast-feeding
 Can be used
Caution
 Vitamin K does not have an immediate effect; it
should not be used to stop bleeding due to trauma
 Vitamin K is not an antidote to heparin
 Reduce dose in elderly and patients with liver disease
 High risk neonates include: pre-term infants, neo-
nates with jaundice and neonatal diseases, neonate
whose mother is taking rifampicin or antiepileptics
(e.g. carbamazepine, phenytoin, phenobarbital)
PILOCARPINE RR N 21.7
Miotic with parasympathomimetic action
Dosage forms
 Eye drops: 2%, 4%
 Intracameral injection: 0.50%
Uses
 Chronic open-angle glaucoma
 Acute angle-closure glaucoma
Dose and duration

 Treatment of chronic open-angle glaucoma
Adult: apply 1–2 drops every 6 hours

 Acute angle-closure glaucoma (before surgery)
Adult and child: 1 drop of 2% solution every 10 minutes

for 30–60 minutes, then 1 drop every 1–3 hours until in-
traocular pressure subsides

PILOCARPINE P
Contraindications
 Acute iritis
 Anterior uveitis
 Acute uveitis
 Some forms of secondary glaucoma
Side effects
Systemic side-effects are rare following ocular application.
Ocular side effects include;
 Burning, itching, stinging, pain in the eyes
 Blurred vision
 Conjuctival vascular congestion
 Myopia
 Vitreous haemorrhage
 Retinal detachment
 Pupillary block
 Headache
 Brow ache
 Ciliary spasm
 Sensitisation of the eye lids
 Decreases in visual acuity in poor illumination
 Do not exceed the stated dose
 Discard any remaining solution 28 days since first
opening of container
 In case of blurred vision, do not drive until vision is
clear
 The dropper tip should not touch any surface

P MONOGRAPHS
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Do not use after angle-closure surgery because of a risk
of posterior synechiae forming
 Ophthalmic pilocarpine may be systemically absorbed
 Only use in pregnancy and breast-feeding if potential
benefit outweighs risk
 Systemic absorption may occur in patients receiving high
doses. Therefore use with caution in patients with bron-
chial asthma, peptic ulceration, urinary tract obstruction,
Parkinson's disease, acute heart failure and hypertension
 Perform a fundus examination in all patients before
starting pilocarpine therapy since retinal detachment has
been associated with the use of miotics in susceptible
patients and those with existing retinal disease
 Carry out regular monitoring of visual fields and
intra-ocular pressure in patients on long-term therapy
PIOGLITAZONE RR N 18.5
Thiazolidinedione antidiabetic medicine which reduces pe-
ripheral insulin resistance
Dosage forms
 Tablet: 30 mg
Uses

PIOGLITAZONE P
Dose and duration
 Type2 diabetes mellitus
Adult over 18 years: 15–30 mg once daily increased to 45

mg once daily according to response. Review treatment
after 3–6 months and regularly thereafter
Elderly: initiate with lowest possible dose and increase
gradually
Contra-indications
 Heart failure or history of heart failure
 Active bladder cancer
 History of bladder cancer
 Uninvestigated macroscopic haematuria
 Hypersensitivity to pioglitazone
Side effects
 Upper respiratory tract infection
 Weight gain
 Hypoesthesia (reduced sensation)
 Bone fracture
 Report to your doctor immediately if signs and symptoms
suggesting hepatic dysfunction such as nausea, vomiting,

abdominal pain, fatigue and dark urine develop
Pregnancy
 Do not use
Breast-feeding
 Do not use

P MONOGRAPHS
Caution
 Monitor cardiac function closely and discontinue treat-
ment immediately if cardiac function deteriorates
 Monitor liver function. Consider discontinuing pioglita-
zone if signs of hepatic dysfunction or jaundice develop
 Avoid use in hepatic impairment
 Assess patient for risk of bladder cancer and review
treatment after 3–6 months. Discontinue in patient with
inadequate response
PIRACETAM NR E 29.1
Nootropic medicine in the racetam group that increases brain
perfusion and metabolism thereby improving mental
functioning
Dosage forms
 Tablet: 800 mg
Uses
 Adjunctive treatment of cortical myoclonus
Dose and duration

 Adjunctive treatment of cortical myoclonus
Adult and child over 16 years: 7.2 g daily in 2–3 divided

doses, increased by 4.8 g every 3–4 days, according to
response up to a max daily dose of 24 g in 2–3 divided
doses. In acute episodes, attempt to reduce dose every 6
months; by reducing by 1.2 g every 2 -4 days

PIRACETAM P
In renal impairment:
eGFR Dosing requirement
2
(ml/min/1.73 m )
50–80 2/3 normal dose in 2–3 divided
doses
30–50 1/3 normal dose in 2 divided doses
20–30 1/6 normal dose as a single dose
Contra-indications
 Cerebral haemorrhage
 Huntington’s chorea
 Hypersensitivity to piracetam and pyrrolidone derivatives
Side effects
 Weight gain
 Nervousness
 Hyperkinesia
Pregnancy
 Do not use
Breast-feeding
Caution
 Avoid abrupt withdrawal since it may induce myoclonic
or generalised seizures in some myoclonic patients
 Use with caution in patients with gastric ulcer, history of
haemorrhagic stroke and in concomitant use of
medicines that increase bleeding
 Avoid use in severe renal failure with eGFR below 20
ml/min/1.73 m2
 Only use in pregnancy if benefit exceeds risk
P MONOGRAPHS
PNEUMOCOCCAL POLYSACCHARIDE
HC II V 19.3.1
CONJUGATE (PCV) VACCINE
Vaccine used in routine immunisation of children to prevent
pneumonia and meningitis caused by Streptococcus pneu-
moniae
Dosage forms
 Injection: 0.5 ml/dose in 2-dose vial
Uses
 Immunisation against Streptococcus pneumoniae for pre-
vention of pneumonia and meningitis

Dose and duration
Child 1–5 years: 0.5 ml IM in shoulder muscle (upper
outer arm) as a single dose
Child <1 year: 0.5 ml IM in outer upper thigh
First dose: At 6 weeks or 2 months
Second dose: At 10 weeks or 4 months
Third dose: At 14 weeks or 6 months
A booster dose may be given at 12 months
Contraindications
 Severe febrile illness
Side effects
 Pain, redness, swelling at injection site
 If fever develops, give a single dose of paracetamol (60
mg) to the child. Wiping the child with a cool sponge or

cloth (with water at room temperature) is also good for
reducing fever
 Do not apply anything at the injection site

PODOPHYLLUM RESIN P
Pregnancy
 Not applicable
Breast-feeding
 Not applicable
Storage
 Store between 2–8°C. Do not freeze
Caution
 Vaccine can be given to HIV-infected patients
PODOPHYLLUM RESIN HC IV N 13.4

Caustic antimitotic agent
Dosage forms
 Solution: 15%
Uses
 Anogenital warts
 Plantar warts
Dose and duration

 Warts
Apply to warts twice daily for 3 consecutive days. Rinse

off after 1‒6 hours. Repeat treatment at weekly
intervals but no more than 4 times in total
Contraindications
 Inflamed or bleeding lesions
 Children under 12 years
Side effects
 Local irritation (itching, burning, pain)
 Systemic effects (nausea, vomiting, diarrhoea, abdominal

P MONOGRAPHS
pain, renal failure, neurotoxicity, delirium, hearing and

visual disturbances)
 Do not apply to normal skin, face, eyes or open wounds
 Protect normal skin around wart with petroleum jelly be-
fore applying medicine

Pregnancy
 Do not use
Breast-feeding
 Can be used. Do not apply to breasts
Caution
 Application to lesions greater than 4 cm2 and genital
warts in females should be done by a trained medical
professional
 Prolonged use or use on large areas can lead to local ne-
crosis and systemic toxicity. If lesions still not resolved
after using for 4 weeks, refer for surgical removal
POLIO VACCINE HC II V 19.3.1

Live attenuated vaccine of poliomyelitis virus types 1, 2, and 3
used in routine immunisation of children
Dosage forms
 Oral solution: 20-dose vial (2 ml)
Uses
 Immunisation against polio
Dose and duration

Four doses given as below:
Polio 0: 2–3 drops orally given at birth or within the
POLIO VACCINE P
first 2 weeks of life
Polio 1: 2–3 drops orally given at 6 weeks
Booster doses may be given at 3 years of age
Contraindications
 Immunocompromised patients and their close household
contacts
 Severe acute febrile illness
Side effects
 Mild stomach upset
 Dispose of the child's faeces properly as the virus spreads
through the oral-faecal route

 Wash hands thoroughly after changing the baby's nappies
Pregnancy
 Not applicable
Breast-feeding
 Not applicable
Storage
 Store between 2–8°C
 The vaccine loses its effects once the container has been
opened; any vaccine remaining at the end of an immun-

isation schedule should be disposed
Caution
 Postpone vaccination in the event of severe acute febrile
illness (minor infections are not contraindications)
 Minimum interval between doses is 4 weeks

P MONOGRAPHS
 If child has diarrhoea or vomiting, give the vaccine and

then repeat dose 4 weeks later
 Read the manufacturer’s instructions leaflet that accom-
panies the vaccine to be sure whether to administer 2 or
3 drops in the child’s mouth
POLYGELINE SOLUTION HC IV N 11.1

Plasma expander used to expand and maintain blood volume
in shock arising from conditions such as burns or septicaemia
Dosage forms
 Solution for IV infusion: 3.5%
Uses
 Low blood volume
Dose and duration

 Low blood volume
Initially 500‒1000 ml by IV infusion. Adjust according to

patient’s response
Contra-indications
 Loss of plasma protein, water and electrolytes over sev-
eral days or weeks

Side effects
Pregnancy
 Can be used
Breast-feeding
 Can be used

POTASSIUM CHLORIDE P
Caution
 Do not use if shock is due to sodium and water depletion.
Use sodium chloride 0.9% instead
 Do not use in burns or peritonitis when there is loss of
plasma protein, water and electrolytes over several days
or weeks; use albumin solution instead
 Use cautiously in heart disease, severe liver disease or
renal impairment. Monitor urine output of the patient
closely
POTASSIUM CHLORIDE H V 26.2, 27

Potassium supplement
Dosage forms
 Sterile concentrate for dilution for injection: 150 mg/ml
 Tablet: 600 mg
Uses
 Management of potassium depletion
 Prevention of hypokalaemia
 Management of electrolyte imbalances
Dose and duration

 Management of potassium depletion
Adult: by slow IV infusion, 3000- 7500 mg daily in divided

doses after meals
 Prevention of hypokalaemia
Adult: by slow IV infusion, 2000- 4000 mg daily in divided

doses after meals
 Management of electrolyte imbalances
Adult and child: By slow IV infusion over 2- 3 hours,

P MONOGRAPHS
depending on deficit or daily maintenance requirements.

Maximum dose 150- 225 mg/kg body weight in 24 hours
Preparation
 Dilute the concentrate with NOT less than 50 times its
volume of 0.9% sodium chloride and mix well

Contraindications
 Plasma potassium concentration above 5 mmol/litre
 Hyperchloraemia
 Acute dehydration
 Heat cramps
Side effects
 Hyperkalaemia
 Cardiac toxicity on rapid infusion
 Nausea, vomiting, abdominal pain, diarrhoea, flatulence
Interactions
 Amiloride (increased risk of hyperkalaemia
 Enalapril (increased risk of severe hyperkalaemia)
 Spironolactone (risk of hyperkalaemia)
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Only administer IV potassium chloride when sufficient
potassium cannot be taken by mouth

POTASSIUM PERMANGANATE P
 Rapid infusion is toxic to the heart
 Using concentrated solution can cause instant cardiac
arrest
 Avoid routine use in moderate renal failure due to high
risk of hyperkalaemia
 Initial IV potassium should not involve glucose infusions,
because glucose may cause a further decrease in the
plasma potassium concentration
 Administer with caution in patients with cardiac disease
POTASSIUM PERMANGANATE HC IV N 13.2

Mild antiseptic with astringent properties. It has cleansing
and deodorising effects.
Dosage forms
 Aqueous solution: 0.01% (1:10,000)
Uses
 Wet lesions of ringworm and athletes foot
 Exudative eczematous lesions
 Pemphigus
 Tropical ulcers
 Impetigo
Dose and duration

 Wet lesions of skin wounds and infections
Apply 0.01% solution to affected area, followed by

debridement and removal of crusts
Change dressing 2‒3 times daily
Stop when lesions become dry
 Wet lesions of athletes foot
Soak feet in solution every 8 hours until lesions

P MONOGRAPHS
become dry
Contra-indications
 Use with occlusive dressing (airtight, water-tight dressing
that completely covers skin)

Side effects
 Local irritation especially on mucous membranes
 Can stain skin, nails and clothing
 Soak cloth in potassium permanganate solution then
gently apply on wound. Gently remove crusts.

Pregnancy
 Can be used
Breast-feeding
 Can be used
POVIDONE IODINE HC II V 15.1, 28.3

Disinfectant that removes and kills microorganisms on skin
and mucous membranes. It is effective against bacteria,
fungi, viruses, protozoa, cysts, and spores. It releases iodine
upon contact with skin.
Dosage forms
 Aqueous solution: 10% (equivalent to 1% iodine)
 Mouthwash: 1%
 Eye drops: 5%
Uses
 Cleansing of skin and mucous membranes after injuries
and bites (wounds)

 Disinfection of skin at injection site and before surgical

POVIDONE IODINE P
procedures
 Local treatment of mouth infections
 Disinfection of rubber stoppers for infusion bottles,
medicine vials, and infusion sets (do not use for vaccines)
 Cutaneous peri-ocular and conjuctival antisepsis prior to
ocular surgery
Dose and duration
 Disinfection of minor wounds and burns
Apply undiluted solution to the affected area every 12

hours after cleaning
 Antisepsis of large wounds
Prepare an irrigation (see preparation)

Irrigate the affected area, then rinse with 0.9% sodium
chloride or sterile water
 Pre- and post- operative skin disinfection
Apply undiluted solution to the skin area every 12

hours
Allow skin to dry between each application (do not dab
to make the area dry faster)
 Local treatment of mouth infections
Prepare mouthwash (see preparation)

Adult: 2 rinses all over the mouth every 12 hours
 Cutaneous peri-ocular and conjuctival antisepsis prior to
ocular surgery
Adult and child: Instil 2–3 drops of the solution into
the affected eye and leave for 2 minutes, then rinse
with sterile 0.9% solution of normal saline until the
colour of iodine disappears
Preparation
 Irrigation: Dilute 1/4 of 10% povidone iodine with 3/4 of

P MONOGRAPHS
sodium chloride 0.9% or sterile water (e.g. add 10 ml of

povidone iodine to 30 ml of normal saline)
 Mouthwash: Dilute 1 or 2 teaspoons of 10% solution in
200 ml of water
Contra-indications
 Pre-term neonates and neonates <1.5 kg
 Disinfection of vaccine bottles or skin site before vaccina-
tion (inactivates vaccines)

 Intra-ocular or peri-ocular injection
 Concomitant use with topical eye preparations containing
mercury as a preservative
Side effects
 Metabolic acidosis, high blood sodium levels, kidney
damage (after prolonged use or use on large areas)

Interactions
 Chlorhexidine-cetrimide (cancelled effect)
 Vaccines (inactivation of vaccines)
 When using mouth wash, spit out solution after rinsing;
do not swallow
 Clean the wound to remove dirt and debris before using
the solution on wounds

Pregnancy
 Can be used
Breast-feeding
 Can be used

PRALIDOXIME P
Storage
Store at 2–8oC. Use immediately once opened. Can be
stored at room temperature for 1 month
Caution
 Do not use for long periods or on large areas of skin, as
iodine will be absorbed into the body
 Disinfection effect begins after 30 seconds of contact. A
minimum contact time of 1 minute is necessary to ensure
bacteria are eliminated
 Do not use for irrigation of body cavities (organs inside
the body)
 Prolonged use may interfere with thyroid function tests
 Do not use with other medicines that are intended for
ocular administration, including other antimicrobial
agents, because of the potential for antagonism or
inactivation of povidone iodine
PRALIDOXIME RR E 4.1
Antidote for organophosphate poisoning
Dosage forms
 Powder for reconstitution for injection: 1 g
Uses
 Adjunct to atropine in organophosphate poisoning
 Adjunct to atropine in carbamate poisoning
Dose and duration

 Adjunct to atropine in organophosphate and carbamate
poisoning
Adult and child: by IV infusion, 30 mg/kg over 20 minutes

P MONOGRAPHS
followed by 8 mg/kg/hour (usual max 12 g in 24 hours)

By IV injection, loading dose 30 mg/kg over at least 5
minutes in pulmonary oedema or when IV infusion is not
possible
Preparation
 Dilute to a concentration of 50 mg/ml with water for
injection by dissolving the contents of the vial in 20 ml of

water
Contra-indications
 Poisoning with agents without anticholinesterase activity
Side effects
 Drowsiness, dizziness, headache
 Disturbances of vision
 Nausea
 Tachycardia
 Hyperventilation
 Muscular weakness
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Continue pralidoxime until the patient has not required
atropine for 12 hours
 Use with caution in renal impairment and myasthenia
gravis

PRAZIQUANTEL P
PRAZIQUANTEL HC IV E 6.1.3
Antischistosomal medicine effective against all forms of
human schistosomes e.g. liver, intestinal, lung and
urinary/bladder flukes
Dosage forms
 Tablet: 600 mg
Uses
 Schistosomiasis (bilharziasis)
Dose and duration

 Schistosomiasis
Adult: 40 mg/kg single dose

Contra-indications
 Ocular cysticercosis
Side effects
 Stomach upset
 Rectal bleeding
 May impair ability to perform skilled tasks; do not drive
or operate machinery after taking this medicine

Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Avoid breastfeeding while taking and for 72 hours after
taking this medicine

P MONOGRAPHS
 Hypersensitivity reactions may occur (due to dead and

dying parasites). Give prednisolone if reactions occur.
3, 6.2.3, 8.3,
PREDNISOLONE HC III V
18.1, 21.3, 25.1
Synthetic steroidal anti-inflammatory medicine with medium
duration of action
Dosage forms
 Tablets: 5 mg
 Eye drops: 0.5%, 1%
Uses
 Rescue course in chronic asthma
 Neuropathy due to leprosy
 Severe allergic reactions
 Anaphylaxis
 Immune reconstitution inflammatory syndrome (IRIS)
 Inflammatory reactions during treatment of roundworm,
sleeping sickness, toxocariasis, systemic tapeworm

infestation, schistosomiasis, leprosy
 Allergic eye reactions
Dose and duration

Adult: 30–60 mg single dose or in 2–3 divided doses

Child 5–15 years: up to 40 mg daily
Child <1 year: 1–2 mg/kg/day
After stabilisation, continue dose for 3 days
PREDNISOLONE P
 Rescue course in chronic asthma
Give a 3-day course
Adult: 40 mg-60 mg daily
Child <1 year: 1–2 mg/kg/day
 Severe allergic and inflammatory reactions, Stevens-
Johnson syndrome, anaphylaxis, IRIS
Up to 60 mg once daily in the morning for 5–10 days
 Allergic eye reactions
Apply 1 drop every 1‒2 hours until symptoms reduce;
then apply 1 drop every 8 hours
Contra-indications
 Active peptic ulcer disease
 Acute viral infection (e.g. hepatitis, herpes zoster, herpes
simplex)
 Untreated systemic infections
 Do not use eye drops for undiagnosed “red eye”
 Do not use eye drops for glaucoma
Side effects
 Stomach upset
 Hiccups
 Can cause or make peptic ulcers worse
 Difficulty in sleeping
 Stops body's natural production of corticosteroids (after
prolonged use or with high doses) causing: increased risk

and severity of infections, Cushing’s syndrome, muscle
wasting, moon face, acne, oedema, high blood pressure,
bones easily fractures, thinning of skin and easy bruising,
P MONOGRAPHS
mental disturbances, diabetes mellitus, menstrual dis-

turbances, inhibition of growth in children, glaucoma
Interactions
 Anti-diabetic medicines (reduced effectiveness of
anti-diabetic medicines)
 Carbamazepine (reduced prednisolone effect)
 Phenobarbital (reduced prednisolone effect)
 Phenytoin (reduced prednisolone effect)
 Rifampicin (reduced prednisolone effect)
 Live vaccines (e.g. BCG, polio, prednisolone impairs
immune response)
 Take medicine in the morning with food for the once a
day prescriptions
 Take rescue course of prednisolone provided when pa-
tient feels worsening of chronic asthma symptoms

Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Where treatment lasts more than 10 days, initial high
doses must be reduced as soon as possible
 Always use the smallest effective dose
 Give prednisolone rescue course for chronic asthma
patients for them to keep at home
 Do not stop medicine abruptly where treatment lasts
more than 21 days; reduce dose gradually
 Use hydrocortisone cream for mild allergic skin reactions
PROCAINAMIDE P
instead of prednisolone
 Use with caution in patients with hypertension and
diabetes
PROCAINAMIDE RR N 12.2
Antiarrhythmic medicine
Dosage forms
 Tablet: 250 mg
Uses
 Severe ventricular arrhythmias resistant to lidocaine or
after a myocardial infarction

 Atrial tachycardia
 Atrial fibrillation
 Maintenance of sinus rhythm after cardioversion of atrial
fibrillation
Dose and duration
 Ventricular arrhythmias
Adult: by mouth, up to 50 mg/kg daily in divided doses

every 3–6 hours, preferably controlled by monitoring
plasma procainamide concentration (therapeutic concen-
tration usually within the range of 3–10 micrograms/ml)
 Atrial arrhythmias
Adult: higher doses may be required

Contra-indications
 Torsades de pointes
 Systemic lupus erythematosus
 Heart block
 Heart failure
 Hypotension

P MONOGRAPHS
Side effects
 Anorexia
 Rash, pruritus, urticaria
 Flushing, fever
 Myocardial depression, heart failure
 Angioedema
 Depression, dizziness
 Psychosis
Interactions
 Alcuronium, suxamethonium, vecuronium (enhanced
muscle relaxant effect)

 Amitriptyline, chlorpromazine, clomipramine, fluphe-
nazine, haloperidol (increased risk of ventricular

arrhythmias)
 Artemether + lumefantrine (risk of arrhythmias)
 Atenolol, lidocaine, timolol, propranolol (increased
myocardial depression)
Pregnancy
 Do not use
Breast-feeding
 Can be used
Caution
 Use with caution in the elderly, renal impairment, hepatic
impairment, asthma and myasthenia gravis
 Avoid use or reduce dose in renal or hepatic impairment

PROCAINE BENZYLPENICILLIN (PPF) P
PROCAINE BENZYLPENICILLIN (PPF) HC III V 6.2.1
Broad spectrum penicillin antibacterial with both immediate
effect of benzylpenicillin and prolonged effect due to
procaine benzylpenicillin (12–24 hours); commonly abbrevi-
ated as PPF (procaine penicillin fortified)
Dosage forms
 Powder for injection: 3 MU procaine benzylpenicillin and
1 MU benzylpenicillin
Uses
 Severe bacterial infections
 Neurosyphilis
 Congenital syphilis
Dose and duration

 All uses
Adult: 1–1.5 MU IM once daily

Child: 50,000 IU/kg (50 mg/kg) IM once daily
Use Duration
Severe pneumonia 5–10 days
Diphtheria 7 days
Neurosyphilis 10–14 days
Congenital syphilis 10 days
Preparation
 Dissolve in water for injection
Contra-indications
 Allergy to penicillin or procaine
 Give with caution if patient has cephalosporin allergy
(cross-sensitivity may occur)

 Intravenous injection

P MONOGRAPHS
Side effects
 Stomach upset
 Seizures
 Restlessness
 Jarisch-herxheimer reaction (see caution)
Interactions
 Report to health worker immediately in case any severe
rash occurs while on treatment

Pregnancy
 Can be used
Breast-feeding
 Can be used
Storage
 Once reconstituted, use suspension immediately
Caution
 For IM injection only. Never use for IV injection or
infusion
 Give with caution to children below 1 year old as seizures
and allergy due to procaine may occur
 Jarisch-herxheimer reaction can be prevented with 3
doses of oral prednisolone 20 mg every 12 hours
 For treatment of severe bacterial infections, PPF is third
line to ampicillin and gentamicin

PROCARBAZINE P
 For acute ear infection or pneumonia, only use PPF if
azithromycin is not available or child is not able to
swallow oral medication
PROCARBAZINE NR V 8.2
Alkylating agent anticancer
Dosage forms
 Capsule: 50 mg
Uses
Dose and duration

 Hodgkin’s disease (monotherapy)
Adult and child: Initially, 50 mg by mouth, increased

daily by 50 mg up to a maximum daily dose of 250−300
mg. After the greatest remission, reduce to mainte-
nance dose of 50−150 mg daily
 Hodgkin’s disease (in combination regimen)
Adult: 100 mg/m2 daily on the 10−14 days of a 4−6

week cycle
Contra-indications
 Pre-existing leucopoenia or thrombocytopenia
 Severe hepatic damage
 Severe renal damage
Side effects
 Loss of appetite
 Infections

P MONOGRAPHS
 Reduced fertility; infertility
 Liver damage
Interactions
 Alcohol (disulfiram-like reaction)
Pregnancy
 Do not use
Breast-feeding
Caution
 Monitor full blood count during treatment. If total white
cell count falls to 3000/mm3 or platelet count to
80,000/mm3, suspend treatment until the levels recover
PROCHLOPERAZINE MALEATE HC IV E 17.2

Phenothiazine antiemetic medicine
Dosage forms
 Tablet: 5 mg
Uses
 Vertigo
 Labyrinthitis

PROCHLOPERAZINE MALEATE P
Dose and duration
Adult: 5‒10 mg orally every 8 hours

OR 12.5 mg by deep IM every 6 hours when necessary
Contra-indications
 Glaucoma
 Allergy to prochlorperazine
Side effects
 Drowsiness, sedation, headache, agitation
 Extrapyramidal symptoms
 Dry mouth
Interactions
 Alcohol (increased risk of side effects)
 Antiarrhythmics (increased risk of arrhythmias)
 Antiepileptics (reduced anticonvulsant effect)
 Causes sleepiness; do not operate machinery or drive
while taking the medicine

 Do not take larger doses than prescribed
Pregnancy
rd
Breast-feeding
 Do not use

P MONOGRAPHS
Caution
 Do not stop treatment abruptly to prevent withdrawal
symptoms. Reduce dose gradually
 Use with caution in liver disease, epilepsy, the elderly,
and children as they are more susceptible to side effects
PROGUANIL HC IV N 6.4.3
Antimalarial medicine. Tissue schizonticide
Dosage forms
 Tablet: 100 mg
Uses
 Malaria prophylaxis in non-immune visitors to malaria-
endemic countries
Dose and duration
 Malaria prophylaxis
Adult and child > 14 years:200 mg once daily

Child 9‒14 years: 150 mg once daily
Child < 1 year: 25 mg once daily
Start 1 week before entering endemic area and con-
tinue for 4 weeks after leaving
Side effects
 Stomach upset, mouth ulcers
 Take after food
 Side effects mild and usually go as treatment continues

PROMETHAZINE P
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Pregnant women must be given adequate folate supple-
ments while taking proguanil
PROMETHAZINE HC II V 3, 17.2, 24
Phenothiazine with antihistamine, anti-emetic, anti-allergic,
and sedative activity
Dosage forms
 Tablet: 25 mg
Uses
 Relieve itching in allergic reactions
 Nausea and vomiting (drug-induced, excessive vomiting
in pregnancy, post-operative nausea)

 Motion sickness
 Vertigo
Dose and duration

 Allergic reactions and itching, nausea, vomiting, vertigo
Adult: 25 mg orally at night, increased if necessary to

every 12 hours
Child: 1 mg/kg daily in 1–2 divided doses
 Excessive vomiting of pregnancy
25 mg IM once daily OR by mouth, every 8 hours prn

P MONOGRAPHS
 Motion sickness prevention

Adult: 20–25 mg orally
Take at bedtime on the night before travel and repeat
the following morning if necessary
Adult: 25–50 mg by deep IM or slow IV over 1 minute
(max 100 mg in 24 hours). Use diluted solution.
Child 5–10 years: 6.25–12.5 mg by deep IM
Child 1-5 years: 0.5 ml/kg by deep IM
Repeat dose every 8 hours for 24–48 hours
Preparation
 Dilute each 1 ml of promethazine injection 25 mg/ml with
9 ml of water for injection

Contra-indications
 Glaucoma
 Urinary and prostate disorders
Side effects
 Drowsiness, dizziness, sedation, headache
 Nightmares, confusion
 Blurred vision
 Rash
 Jaundice

PROMETHAZINE P
 Blood disorders
 Risk of limb gangrene after injection
Interactions
Increased risk of sedation and respiratory depression when
given with:
 Morphine
 Diazepam
 Alcohol
 Amitriptyline
 Take medicine preferably at night in a single dose
 Causes sleepiness; do not operate machinery or drive
while taking the medicine

 Do not take larger doses than prescribed
Pregnancy
rd
Breast-feeding
 Do not use
Caution
 Promethazine has little effect in nausea and vomiting
caused by anti-cancer medicines
 Use with caution in liver disease, epilepsy, the elderly,
and children as they are more susceptible to side effects

P MONOGRAPHS
PROPANTHELINE H N 17.4
Antimuscarinic quaternary ammonium medicine used for
smooth muscle spasms
Dosage forms
 Tablet: 15 mg
Uses
 Gastrointestinal disorders with smooth muscle spasms
 Adult enuresis
 Gustatory sweating
Dose and duration

 All uses
Adult and child over 12 years: 15 mg every 8 hours at

least 1 hour before meals and 30 mg at night (max 120
mg daily). adjust dose according to response
 Gastrointestinal disorders characterised by smooth mus-
cle spasms
Child 1 month–12 years: 0.3 mg/kg (max 15 mg) every 6–
8 hours at least 1 hour before food
Contra-indications
 Paralytic ileus
 Toxic megacolon
 Intestinal atony
 Prostatic enlargement
 Hypersensitivity to propantheline
Side effects
 Constipation
 Transient bradycardia

PROPOFOL P
 Reduced bronchial secretions
 Urinary urgency and retention
 Dilatation of pupils, loss of accommodation, photophobia
 Dry mouth
 Flushing, dryness of skin
 Take your medicine at least 1 hour before meals
 Do not drive or operate machinery if the medicine causes
drowsiness or blurring of vision

Pregnancy
 Do not use
Breast-feeding
 Do not use
Caution
 Propantheline may suppress lactation
 Use with caution in Down’s syndrome, in children and the
elderly, patients with diarrhoea, severe heart disease, ul-
cerative colitis and in gastrointestinal reflux disease
PROPOFOL H V 1.1
General anaesthetic
Dosage forms
 Emulsion for injection: 10 mg/ml
Uses
 Sedation

P MONOGRAPHS
Dose and duration

Adult under 55 years and child over 17 years: by slow IV

injection or infusion, 1.5–2.5 mg/kg at a rate of 20–40 mg
every 10 seconds until response
Adult over 55 years or debilitated: 1–1.5 mg/kg at a rate
of 20 mg every 10 seconds until response by slow IV in-
jection or IV infusion
Child 1 month–17 years: 2.5–4 mg/kg adjusted according
to age, weight and response
 Maintenance anaesthesia
Adult and child over 17 years: by IV infusion, 4–12

mg/kg/hour
By slow IV injection, 25–50 mg repeated according to
response
Child 1 month–17 years: by IV infusion, 9–15 mg/kg/hour
adjusted according to weight, age and response
Elderly and debilitated: by IV infusion, 3–6 mg/kg/hour
or 25–50 mg by slow IV injection
Pregnancy: max 6 mg/kg/hour
 Sedation of ventilated patients in intensive care
Adult and child over 16 years: by IV infusion, 0.3–4

mg/kg/hour adjusted according to response
 Induction of sedation for surgical and diagnostic proce-
dures
Adult and child over 17 years: initially by slow IV injec-
tion over 1–5 minutes, 0.5– 1 mg/kg, dose and rate of
administration adjusted according to desired level of se-
dation and response
Child 1 month–17 years: 1–2 mg/kg by slow IV injection

PROPOFOL P
over 1–5 minutes adjusted according to response
 Maintenance of sedation for surgical and diagnostic
procedures
Adult and child over 17 years: by IV infusion, 1.5–4.5
mg/kg/hour, dose and rate of administration adjusted
according to desired level of sedation and response. If
rapid increase in sedation is required, give an additional
10–20 mg by slow IV injection
Child 1 month–17 years: by IV infusion, 1.5–9
mg/kg/hour (if rapid sedation required, add by slow IV
injection, max 1 mg/kg)
Contra-indications
 Children < 16 years of age for sedation in intensive care
 Hypersensitivity to propofol
Side effects
 Pain on injection
 Transient apnoea
 Hypotension
 Bradycardia
 Headache
 Anaphylaxis
Interactions
 Suxamethonium (increased risk of myocardial depression
and bradycardia)
Pregnancy
 Can be used
Breast-feeding
 Can be used

P MONOGRAPHS
Storage
o
 Store between 2–25 C. Do not freeze
Caution
 Use with extreme caution if used for surgery of the
mouth, pharynx, larynx and in patients with acute
circulatory failure or fixed cardiac output
 Use with caution in cardiac impairment, respiratory
impairment, hypovolemia, epilepsy, hypotension, raised
intracranial pressure, renal and hepatic impairment
 Monitor blood-lipid concentration if there is risk of fat
overload or if sedation is longer than 3 days
 May depress neonatal respiration if used during delivery.
Do not use for obstetric anaesthesia unless clearly
necessary
 Patient should not breast-feed for 24 hours after use of
propofol as it is excreted in breast milk in small quantities
 Use of a microbiological filter during infusion is not
recommended
PROPRANOLOL HC IV V 7.2, 12.2,12.3

Non-selective beta –blocker antihypertensive
Dosage forms
 Tablets: 40 mg
Uses
 Hypertension
 Angina
 Arrhythmias
 Migraine
 Hyperthyroidism (specialist use only)

PROPRANOLOL P
Dose and duration
 Hypertension
Adult: 40‒80 mg every 8‒12 hours daily

 Angina
Adult: initially 40‒80 mg every 8‒12 hours daily;

maintenance 120‒240 mg daily
 Arrhythmias
Adult: initially 10‒40 mg every 6‒8 hours daily;

maintenance 120‒240 mg daily
Adult: initially 40 mg every 8‒12 hours, increased by

same amount at weekly intervals if necessary. Usual
maintenance dose is 80‒160 mg daily
Child < 12 years: 20 mg every 8‒12 hours daily
 Hyperthyroidism
Adult: 40‒80 mg every 12 hours for at least 1 month

Child: 250‒500 micrograms/kg every 6‒8 hours daily
Contra-indications
 Asthma
 Heart failure
 Marked bradycardia
 Hypotension
 AV block

P MONOGRAPHS
Side effects
 Fatigue, sleep disturbances
 Cold hands and feet, bradycardia, hypotension,
peripheral vasoconstriction, conduction disorders

 Bronchospasm
 Stomach upset
 Worsening of intermittent claudication
Interactions
 Bupivacaine (increased risk of bupivacaine toxicity)
 Chlorpromazine (enhanced hypotensive effect)
 Lidocaine (increased risk of lidocaine toxicity)
 Nifedipine (increased hypotensive effect; may be severe)
 Procainamide (increased risk of myocardial depression)
 Verapamil (severe hypotension and heart failure)
 Report to health worker in case any severe rash occurs
Pregnancy
 Do not use
Breast-feeding
 Can be used
Caution
 Can induce an asthma attack in asthmatic patients
 May mask hypoglycaemic symptoms in diabetic patients
 Patients on beta-blockers with anaphylaxis may not re-
spond to epinephrine, and epinephrine may cause severe
hypertension in these patients. Use salbutamol IV instead
 Reduce dose in liver or kidney impairment

PROTAMINE P
PROTAMINE H E 10.2
Antidote for heparin over dose
Dosage forms
Uses
 Reversal of the anticoagulant effect of unfractionated or
low molecular weight heparin

Dose and duration
 Reversal of over dosage with intravenous injection of
unfractionated heparin
Administer by slow IV injection at a rate not exceeding 5
mg/ minute (max 50 mg)
Time since Dose of protamine (adult and

heparin (min) child)
0–15 I mg neutralizes 100 IU
15–30 I mg neutralizes 100 IU
30–60 0.5–0.75 mg neutralizes 100 IU
60–120 0.375–0.5 mg neutralizes 100 IU
Over 120 0.25–0.375 mg neutralizes 100 IU
 Reversal of over dosage with intravenous infusion of
Adult: stop infusion of heparin, then administer 25–50
mg of protamine by slow IV injection
Child 1 month–18 years: dose same as for over dosage
of heparin by intravenous injection
 Reversal of over dosage with subcutaneous injection of
Adult: 1 mg of protamine neutralises 100 IU of heparin
P MONOGRAPHS
Administer 25–50 mg by slow IV injection then the

remaining dose by IV infusion over 8–16 hours
Child 1 month–18 years: 1 mg neutralises 100 IU of
heparin. Give 50–100% of total dose by IV injection then
the remainder by IV infusion over 8–16 hours
 Reversal of over dosage with subcutaneous injection of
low molecular weight heparin
Adult and child: 1 mg neutralizes 100 IU by intermittent
IV injection or by continuous IV infusion (consult
product literature)
Contra-indications
Side effects
 Back pain, tiredness
 Dyspnoea
 Bradycardia, flushing, hypotension, hypertension
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Do not administer too rapidly
 Not suitable for reversal of effects of oral anticoagulants
 Increased risk of allergic reactions in patients who have
been previously treated with protamine or protamine
insulin, patients with fish allergies and men who are
infertile or who have had a vasectomy
PROTHIONAMIDE P
 Protamine has an anticoagulant effect if used in excess
 Put into consideration the duration of action of the
heparin used
PROTHIONAMIDE H E 6.2.4
Thioamide antituberculosis medicine
Dosage forms
 Tablet: 250 mg
Uses
Dose and duration

 MDR TB (in combination with other anti-TB drugs)
Adult and child: 15–20 mg/kg (max 1 g) once daily.

Can be given in 2 divided doses to improve tolerance
Contra-indications
 Hypersensitivity to prothionamide
 Porphyria
Side effects
 Transient elevation of liver function tests
 Nausea, vomiting, diarrhoea, excessive salivation,
metallic taste, stomatitis, abdominal pain

 Anorexia
 Acute hepatitis
 Dizziness, encephalopathy, peripheral neuropathy
 Take your medicine with or after a meal to reduce
gastrointestinal adverse effects

P MONOGRAPHS
Pregnancy
 Do not use
Breast-feeding
 Do not use
Caution
 Reduce dose in severe renal impairment
 Monitor hepatic function once every 3 months during
treatment or once every month if used concomitantly
with P-aminosalicylic acid
 Monitor blood glucose in diabetic patients
PYRAZINAMIDE (Z) HC III V 6.2.4

Antituberculosis antibacterial. Abbreviated as Z in treatment
regimens
Dosage forms
 Tablet: Pyrazinamide 500 mg
pyrazinamide 150 mg
pyrazinamide 400 mg + ethambutol 275 mg

Uses
 Tuberculosis (TB)
Dose and duration

 Intensive phase TB treatment (in combination with rifam-
picin, isoniazid and ethambutol)
Give for 2–3 months as in the table below (2RHZE)

PYRAZINAMIDE (Z) P
Adult and child ≥ 12 years:
Weight (kg) Pyrazinamide (mg)
30–37 800
38–54 1200
55–70 1600
>70 2000
Child 0–12 years:
Weight (kg) Pyrazinamide (mg)
4–7 150
8–11 300
12–15 450
16–24 600
Contra-indications
Side effects
 Joint pain
 Gout
 Pain on urination
 Stomach upset
 Liver disorders (jaundice, fever, anorexia, enlarged liver,
enlarged spleen)
 Low platelet count, anaemia
 Take with a small meal or the last thing at night to reduce
risk of stomach upset

 Take plenty of fluids during treatment

P MONOGRAPHS
 Do not take alcohol during treatment

 Report to health worker immediately in case of persistent
nausea, vomiting, feeling of sickness, yellowing of skin
and eyes, or severe joint pain that does not go away after
taking paracetamol
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Pyrazinamide is not used in the continuation phase of TB
treatment
 For severe joint pain or arthralgia, change to a regimen
without pyrazinamide
PYRIDOXINE (VITAMIN B6) HC III E 27

Vitamin B6 essential for the proper functioning of nerves
Dosage forms
Uses
 Treatment of pyridoxine deficiency
 Prevention and treatment of nerve pain in hands and legs
due to isoniazid
Dose and duration
 Pyridoxine deficiency
25–50 mg every 8 hours until deficiency resolves

 Prevention of nerve pain due to isoniazid
Adult and child: 25 mg once daily

PYRIMETHAMINE P
Child <5 kg: 5 mg once daily
Give for as long as isoniazid treatment continues
 Treatment of nerve pain due to isoniazid
Adult: 50 mg every 8 hours

Child: 50 mg once daily
Take until symptoms resolve, then reduce dose to the
preventive doses for as long as isoniazid treatment
continues
Side effects
 Nerve disturbances (on prolonged use)
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Give pyridoxine to children receiving isoniazid prophylaxis
against tuberculosis
 Do not use high doses for long periods. Change to
prevention doses as soon as possible
PYRIMETHAMINE H E 6.4.5
Folate antagonist antimicrobial agent
Dosage forms
 Tablet: 25 mg
Uses
 Toxoplasmosis (with sulfadiazine)
 Malaria (with sulfadoxine)

P MONOGRAPHS
Dose and duration

 Prevention of congenital transmission of toxoplasmosis
(in 2nd and 3rd trimesters of pregnancy)

Adult: by mouth, 25 mg daily for 3–4 weeks
 Treatment of toxoplasmosis in neonates
Neonate: by mouth, 1 mg/kg daily. Continue treatment

for 6 months in overt disease or treat for 4 weeks if born
to mother infected during pregnancy, followed by further
courses if infection is confirmed
 Treatment of toxoplasmosis in immunodeficiency
Adult: by mouth, 200 mg in divided doses on day 1, fol-

lowed by 75–100 mg daily for at least 6 weeks. Continue
treatment with a suppressive dose of 25–50 mg daily
 Chorioretinitis
Adult: by mouth, 75 mg daily for 3 days, then 25 mg daily

for 4 weeks. If patient is unresponsive, give 50 mg daily
for a further 4 weeks
 Treatment of malaria (with sulfadoxine)
See sulfadoxine + pyrimethamine

Contra-indications
 History of pyrimethamine sensitivity
Side effects
 Leucopoenia, thrombocytopenia, megaloblastic anaemia
 Vomiting, nausea, diarrhoea
 Rash
Interactions
 Artemether + lumefantrine (avoid concomitant use)
 Citalopram (risk of ventricular arrhythmias)

PYRIMETHAMINE P
 Methotrexate (antifolate effect of methotrexate
increased)
 Phenytoin (antagonism of anticonvulsant effect;
increased antifolate effect)
 Silver sulfadiazine, sulfadiazine, sulfamethoxazole +
trimethoprim, trimethoprim (increased antifolate effect)
Pregnancy
st
Breast-feeding
 Can be used
Caution
 Use with caution in hepatic and renal impairment
 Pyrimethamine is present in significant amounts in breast
milk. Avoid administration of other folate antagonists to
infant. Avoid breast-feeding in toxoplasmosis treatment
 In prolonged treatment, give folate throughout and carry
out blood counts weekly (twice weekly in immuno-
compromised) and for a further 2 weeks after stopping
treatment. Discontinue treatment if signs of folate
deficiency develop and give high dose calcium folinate
 Avoid large loading doses in patients with a history of
seizures

Q MONOGRAPHS
Q
QUININE HC III E 6.4.3
Anti-malarial medicine
Dosage forms
 Tablet: 300 mg
 Injection: 300 mg/ml (600 mg quinine in 2 ml ampoule)
Uses
 Uncomplicated malaria (second line alternative to
dihydroartemisinin + piperaquine; first line for children

<5 kg or <4 months and 1st trimester pregnancy)
 Severe/complicated malaria (second line to IV
artesunate)
 Pre-referral treatment of severe malaria (second line to
rectal artesunate)
Dose and duration
Give every 8 hours for 7 days as in the table below:

Age Weight Dose every 8 hours
0–3 months <5 kg 10 mg/kg
3 months–1 year 5–10 kg 75 mg (=¼ tab)
1 year–5 years 10–18 kg 150 mg (=½ tab)
5 years–7 years 18–24 kg 225 mg (=¾ tab)
7 years–10 years 24–30 kg 300 mg (=1 tab)
10 years–13 years 30–40 kg 375 mg (1 ¼ tab)
13 years–15 years 40–50 kg 450 mg (=1 ½ tab)
15 years and over >50 kg 600 mg (=2 tabs)

QUININE Q
 Severe/complicated malaria; pre-referral treatment for
severe malaria
10 mg/kg as IV infusion over 2–4 hours
Start new infusion every 8 hours
If IV infusion is not possible, give IM quinine 10 mg/kg
every 8 hours. Use diluted solution
If IM volume required is >3 ml, give half into the front
part of the right thigh and the other half into the front
part of the left thigh
Once patient is able to take orally, change to a full course
of artemether + lumefantrine; start 8 hours after the last
quinine dose
Preparation
 Solution for IM injection
Dilute to a concentration of 100 mg/ml. For example,

for an ampoule of 600 mg/2 ml, add 4 ml of water for
injection to get 600 mg in 6 ml (=100 mg/ml)
 Solution for IV infusion
Dissolve in glucose 5% or sodium chloride 0.9%.

To prevent hypoglycaemia, preferably use glucose 5%
Contra-indications
 Tinnitus
 Presence of haemoglobin in urine
 Optic neuritis
Side effects
 Low blood glucose, hot flushed skin
 Headache
 Blurred vision
 Itching

Q MONOGRAPHS
 Stomach upset, bitter taste in the mouth

 Hearing problems
 Kidney damage
 Drink plenty of sugary fluids during treatment with qui-
nine
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 A loading dose of 20 mg/kg quinine injection is not neces-
sary as it does not provide any significant benefits over
the usual dose of 10 mg/kg
 Do not give IM quinine in the buttocks; use the outer
front part of the thigh
 WHO recommends that quinine be given with doxycy-
cline when treating malaria. Doxycycline is contraindicat-
ed in pregnant women and children <8 years; clindamycin
can be used instead
 Do not use quinine for prophylaxis against malaria
 If patient vomits within 1 hour of taking tablets, repeat
the full dose
 Do not give by IV injection as it is very fatal; always give
as IV infusion

RABEPRAZOLE R
R
RABEPRAZOLE H N 17.1
Substituted benzimidazole proton pump inhibitor that
prevents gastric acid secretion
Dosage forms
 Injection: 20 mg
Uses
Only use when oral administration is not possible and in
acute or severe attacks of:
 Active duodenal ulcer
 Active benign gastric ulcer
 Gastro-oesophageal reflux disease
Dose and duration

 All uses
Adult and child over 12 years: by slow IV injection or IV

infusion over 15–30 minutes, 20 mg once daily
Preparation
 Reconstitute with 5 ml of water for injections. Dilute with
normal saline to be used as an infusion

 Compatible with water for injections and sodium chloride
0.9% (normal saline) solutions only

Contra-indications
 Hypersensitivity to rabeprazole
Side effects
 Infection
 Insomnia, headache, dizziness
 Cough, pharyngitis, rhinitis

R MONOGRAPHS
 Diarrhoea, vomiting, nausea, abdominal pain

 Constipation, flatulence
 Non-specific pain, back pain
 General weakness, influenza-like syndrome
Interactions
 Consult your doctor if signs of hypomagnesaemia such as
fatigue, convulsions, intermittent muscular spasms

(tetany) or dizziness occur
Pregnancy
 Do not use
Breast-feeding
 Do not use
Caution
 Use with caution in severe hepatic dysfunction
 Risk of cross-sensitivity with other proton pump inhibi-
tors or substituted benzimidazoles
 Serious hypomagnesaemia requiring discontinuation of
rabeprazole and magnesium supplementation may occur
after treatment for 3 months to 1 year. Signs include
fatigue, tetany, delirium, convulsions, dizziness and
ventricular arrhythmia

RANITIDINE R
RANITIDINE H E 17.1
H2 receptor antagonist that prevents secretion of gastric acid
Dosage forms
 Tablet: 150 mg
Uses
 Gastritis
 Peptic ulcer disease
 NSAID-associated ulcer
 Reflux oesophagitis
 Prophylaxis of stress ulceration
Dose and duration

 Gastritis and peptic ulcer disease
By mouth,
Adult: 150 mg every 12 hours or 300 mg once daily at
night for 4–8 weeks in benign gastric and duodenal ulcera-
tion, up to 6 weeks in chronic episodic dyspepsia, and up
to 8 weeks in NSAID-associated ulceration (in duodenal
ulcer 300 mg can be given every 12 hours for 4 weeks to
achieve a higher healing rate)
By IM injection,
Adult: 50 mg every 6–8 hours
By slow IV injection
Adult: 50 mg diluted to 20 ml and given over at least 2
minutes, may be repeated every 6–8 hours
 Prophylaxis of NSAID-associated gastric or duodenal ulcer
Adult: 300 mg every 12 hours until completion of NSAIDs

 Prophylaxis of stress ulceration
Adult: 50 mg every 8 hours by slow IV injection over at

R MONOGRAPHS
least 2 minutes, then adjusted to 150 mg every 12 hours

by mouth when oral feeding commences
 Reflux oesophagitis
Adult: by mouth, 150 mg every 12 hours or 300 mg once

at night for up to 8–12 weeks as necessary, increased in
moderate to severe disease to 600 mg daily in 2–4 divided
doses for up to 12 weeks
Long-term treatment of healed gastro-oesophageal reflux
disease, 150 mg every 12 hours
 All uses
By mouth,
Child 12–18 years: 150 mg every 12 hours or 300 mg once
at night; increased if necessary to 300 mg every 12 hours
or 150 mg every 6 hours for up to 12 weeks in moderate
to severe gastritis
Child 3–12 years: 2–4 mg/kg (max 150 mg) every 12 hours,
increased up to 5 mg/kg (max 300 mg) every 12 hours in
severe gastritis
Child 6 months–3 years: 2–4 mg/kg every 12 hours
Child 1–6 months: 1 mg/kg every 8 hours (max 3 mg/kg
every 8 hours)
Neonate: 2 mg/kg every 8 hours (max 3 mg/kg every 8
hours)
By slow IV injection,
Child 1 month–18 years: 1 mg/kg (max 50 mg) every 6–8
hours (may be given as an intermittent infusion at a rate
of 25 mg/hour)
Neonate: 0.5–1 mg/k g every 6–8 hours
Preparation
 For slow IV injection dilute to a concentration of 2.5

REMIFENTANIL R
mg/ml with glucose 5% or sodium chloride 0.9%
Contraindication
 Porphyria
Side effects
 Abdominal pain, constipation, nausea, diarrhoea
 Headache
Interactions
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Oral absorption in neonates is not reliable
 Use half normal dose in severe renal failure
 Reduce dose in hepatic failure
REMIFENTANIL NR V 1.3
Opioid analgesic with quick onset and short duration of
action
Dosage forms
Uses
 Analgesia
 Enhancement of anaesthesia during induction

R MONOGRAPHS
 Analgesia and sedation in ventilated, intensive care

patients
Dose and duration
Adult and child over 12 years: by IV infusion, 30–60 mi-

crograms/kg/hour, with or without an initial dose by IV
injection of 0.25–1 micrograms/kg over at least 30 sec-
onds
Elderly: starting dose, ½ adult dose adjusted according to
response
 Maintenance of anaesthesia in ventilated patient
Adult and child over 12 years: initially 0.1–1 micrograms

by IV injection if required, then 3–12 mi-
crograms/kg/hour by IV infusion according to anaesthetic
technique used and adjusted according to response. In
light anaesthesia, give supplemental doses by IV injection
every 2– 5 minutes
response
Child 1 month–12 years: initially by IV injection 0.1–1
micrograms/kg over at least 30 seconds (omit if not
required) then by IV infusion 0.05–1.3 micrograms
/kg/minute according to anaesthetic technique and ad-
justed according to response. Additional doses can be
given by IV injection during infusion
Neonate: by IV infusion 0.4–1 micrograms/kg/minute.
Additional doses of 1 microgram/kg can be given by IV
injection during the infusion
 Maintenance of anaesthesia in spontaneously breathing
anaesthetized patient with a secured airway

REMIFENTANIL R
Adult: by IV infusion, initially 2.4 micrograms/kg/hour
adjusted according to response, usual dose range 1.5–6
micrograms/kg/hour
response
 Sedation and analgesia in intensive care patient on as-
sisted ventilation
Adult over 18 years: for max 3 days, by IV infusion, initial-
ly 6–9 micrograms/kg/hour adjusted according to re-
sponse in steps of 1.5 micrograms/kg/hour at intervals of
at least 5 minutes. Usual range 0.36–44.4 mi-
crograms/kg/hour. If an infusion rate of 12 mi-
crograms/kg/hour does not produce adequate sedation
add another sedative (consult product literature)
 Additional analgesia during stimulating or painful proce-
dures in intensive care patients on assisted ventilation

Adult over 18 years: by IV infusion, maintain infusion rate
of at least 6 micrograms/kg/ hour for at least 5 minutes
before procedure and adjust every 2–5 minutes accord-
ing to requirements, usual range 15–45 micrograms per
kg/hour
Preparation
 Reconstitute with infusion fluid (dextrose 5%, normal
saline or water for injections) to a concentration of 1

mg/ml then dilute further to a concentration of 20–250
micrograms/ml
 50 micrograms/ml is the recommended concentration for
general anaesthesia, 20–25 micrograms/ml for children

1–12 years and 20–50 micrograms/ml when used with
target controlled infusion (TCI) device
R MONOGRAPHS
Contra-indications
 Analgesia in conscious patients
 Epidural and intrathecal use
 Hypersensitivity to remifentanil or fentanyl analogues
 As a sole agent for induction of anaesthesia
Side effects
 Skeletal muscle rigidity
 Bradycardia, hypotension, post-operative hypertension,
AV block
 Acute respiratory depression, apnoea
 Pruritus
 Post-operative shivering
 Do not drive until you know how remifentanil affects you
Pregnancy
 Do not use
Breast-feeding
 Can be used
Storage
o
 Store below 25 C. Reconstituted solution should be used
immediately
Caution
 Calculate dose on basis of ideal body-weight in obese pa-
tients to avoid excessive dosage
 Avoid breast-feeding for 24 hours after administration
 Remifentanil should be administered in a setting fully
equipped for monitoring and support of respiratory and

RETINOL (VITAMIN A) R
cardiovascular function
 Risk of cross-sensitivity in patients hypersensitive to
other opioids of a different class
 In surgical procedures where post-operative pain is antic-
ipated, administer an analgesic prior to discontinuation of
remifentanil since residual opioid activity does not last
for more than 5–10 minutes. Allow sufficient time to
reach the therapeutic effect of the longer acting analgesic
RETINOL (VITAMIN A) HC II V 27
Vitamin required for proper functioning of the eyes
Dosage forms
 Capsule with oily liquid: 200,000 IU and 100,000 IU
Uses
 Treatment and prevention of vitamin A deficiency and
dryness of eyes due to failure to produce tears

 Treatment and prevention of xerophthalmia (dryness of
eyes due to failure to produce tears)

 Prophylactic treatment vitamin A deficiency in breast-
feeding mothers
 Prevention of complications of measles
 Prophylactic treatment in children with pneumonia,
diarrhoea, whooping cough, or malnutrition

 Supplementation in children 6 months–6 years
Dose and duration

Given as drops in the mouth
 Vitamin A deficiency, dryness of the eyes
Give 3 doses on day 1, 2, and 14

Child >12 months: 200,000 IU
R MONOGRAPHS
Child 6–12 months: 100,000 IU

Child <6 months: 50,000 IU
 Breastfeeding mothers
200,000 IU single dose immediately after delivery or

within 2 months after delivery
Give 200,000 IU
1st dose is at diagnosis
2nd dose is the next day
3rd dose is 2–4 weeks later
 Prophylactic treatment in children with whooping cough,
pneumonia, diarrhoea and malnutrition

Child 1–6 years: 200,000 IU single dose
Child 6–11 months: 100,000 IU single dose
 Supplementation in children >6 months
Child 1–6 years: 200,000 IU single dose every 6 months

Child 6–11 months: 100,000 IU single dose every 6 months
Record the dose on the child's immunisation card
Side effects
 No side effects when given in recommended doses
 Pierce a hole in the capsule carefully and give as drops in
the mouth
 Discard the shell
Pregnancy
 Do not use
Breast-feeding
 Can be used

RIFAMPICIN (R) R
Caution
 Unless specifically indicated, do not give vitamin A within
4 weeks of any previous dose the child may received
 Overdose or accumulation in the liver causes rough skin,
dry hair, and enlarged liver
 For eye dryness in pregnancy, with less severe symptoms,
use very small doses, no more than 5000–10,000 IU/day
for at least 2 weeks or 25,000 IU weekly as a single dos
 Excessive dose in pregnancy may be teratogenic. Should
not be given except on expert advice
RIFAMPICIN (R) HC III V 6.2.3,6.2.4

Antituberculosis, anti-leprotic, and antibacterial properties.
Abbreviated “R” in treatment regimens
Dosage forms
 Tablets/capsules: 150 mg and 300 mg
pyrazinamide 150 mg

 Capsule: 150 mg, 300 mg
Uses
 Paucibacillary leprosy
 Multibacillary leprosy

R MONOGRAPHS
 Tuberculosis
Dose and duration
 PB (with dapsone) and MB leprosy (with dapsone and
clofazimine)
Adult and child >15 years: 600 mg once monthly
Child 10–14 years: 450 mg once monthly
Child under 10 years: 10 mg/kg once monthly
For PB leprosy, treatment is for 6 months
For MB leprosy, treatment is for 12 months
 Tuberculosis (fixed dose combination with isoniazid,
ethambutol, pyrazinamide)
Initial phase: Dose as in tables below once daily for
2–3 months
Weight (kg) Rifampicin (mg)
30–37 300
38–54 450
55–70 600
>70 750
Child >12 years:
4–7 70
8–11 140
12–15 210
16–24 280
Continuation phase: Dose as below once daily for 4 months

RIFAMPICIN (R) R
30–37 300
38–54 450
55–70 600
>70 600
Child >12 years:
4–7 75
8–11 150
12–15 225
16–24 300
>25 Use adult doses and
formulations
Contra-indications
 Allergy to rifampicin
 Jaundice
Side effects
 Orange-red discoloration of urine, tears, saliva, sputum
 Stomach upset
 Headache, drowsiness
 Liver disorders (jaundice)
 Rash
 Fever
 Influenza-like symptoms, shortness of breath
 Shock
 Haemolytic anaemia
 Acute kidney failure

R MONOGRAPHS
Interactions
 Nevirapine (reduced effect of nevirapine)
 Fluconazole (reduced effect of fluconazole)
 Nifedipine (reduced effect of nifedipine)
 Warfarin (reduced warfarin effect)
 Phenytoin (reduced phenytoin effect)
 Prednisolone (reduced effect of prednisolone)
 Take on an empty stomach
 Report to the health worker immediately in case of
yellowing of skin or eyes, persistent nausea, vomiting and

feeling of sickness, or weakness
 May cause urine to be orange/reddish; this is harmless,
so do not worry
 Take fluconazole at least 12 hours apart from rifampicin
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 If jaundice develops, rifampicin should be discontinued
until the symptoms resolve, then re-introduced. If severe
reactions re-occur, discontinue permanently
 If patient is taking oral contraceptives, advise her to use
another method of contraception (e.g. condoms,
medroxyprogesterone injection)

RIFAMPICIN + CLOFAZIMINE + DAPSONE R
RIFAMPICIN + CLOFAZIMINE + DAPSONE HC III V 6.2.3
Anti-leprotic antibacterial used in the treatment of multibacil-
lary (MB) leprosy
Dosage forms
 FDC tablets: Rifampicin 600 mg + clofazimine 300 mg +
dapsone 100 mg (pack for 28 days)

 FDC tablets: Rifampicin 450 mg + clofazimine 150 mg +
dapsone 50 mg (pack for 28 days)

For more information, see individual medicines monographs
RIFAMPICIN + DAPSONE HC III V 6.2.3

Anti-leprotic medicines used for paucibacillary (PB) leprosy
Dosage forms
 FDC tablets: Rifampicin 600 mg + dapsone 100 mg (pack
for 28 days)
 FDC tablets: Rifampicin 450 mg + dapsone 50 mg (pack
for 28 days)
For more information, see individual medicine monographs
RIFAMPICIN + ISONIAZID HC III V 6.2.4

Anti-tuberculosis antibacterial used in the continuation phase
of the tuberculosis treatment regimen
Dosage forms
 FDC tablets: Rifampicin 600 mg + isoniazid 30 mg

R MONOGRAPHS
RIFAMPICIN + ISONIAZID + PYRA-

HC III V 6.2.4
ZINAMIDE
Fixed-dose combination of 3 anti-tuberculosis medicines used
in the intensive phase of TB treatment
Dosage forms
 FDC tablets: Rifampicin 60 mg + isoniazid 30 mg +
pyrazinamide 150 mg
For more information, see individual medicines
RIFAMPICIN + ISONIAZID + PYRA-

HC III V 6.2.4
ZINAMIDE + ETHAMBUTOL
Anti-tuberculosis antibacterial used in the intensive phase of
tuberculosis treatment
Dosage forms
 FDC tablets: Rifampicin 150 mg + isoniazid 75 mg +

RISPERIDONE NR N 24
Second generation antipsychotic medicine with dopamine D2,
5-HT2A, alpha1-adrenoceptor and histamine-1 receptor
antagonistic activity
Dosage forms
 Tablet: 2 mg
Uses
 Schizophrenia
 Moderate to severe manic episodes in bipolar disorder
 Persistent aggression in patients with moderate to severe

RISPERIDONE R
Alzheimer’s dementia
 Conduct disorder in children above 5 years and
adolescents
Dose and duration
 Schizophrenia
Adult and child over 12 years: 2 mg in 1–2 divided doses

on day 1 increased on day 2 to 4 mg daily in 1 –2 divided
doses if required. Usual dose range 4–6 mg/day. Only use
doses above 10 mg if potential benefit outweighs risk
(max 16 mg/day)
Elderly: starting dose of 0.5 mg every 12 hours increased
by increments of 1 mg/day to 1–2 mg every 12 hours
In renal and hepatic impairment: ½ adult dose, with
slower titration
 Manic episodes of bipolar disorder
Adult: 2 mg once daily increased at intervals of at least 24

hours in dose increments of 1 mg/day (max 6 mg/day)
Child 12–18 years: initially 0.5 mg once daily adjusted in
steps of 0.5–1 mg daily according to response. Usual dose
2.5 mg daily in 1–2 divided doses (max 6 mg daily)
Elderly: same dose as for schizophrenia above
 Persistent aggression in Alzheimer’s dementia
Adult: 0.25 mg every 12 hours individually increased at

intervals of at least 48 hours by increments of 0.5 mg/day
to a usual optimal dose of 0.5 mg every 12 hours (max 1
mg every 12 hours) for a max of 6 weeks
 Conduct disorder (max 6 weeks)
Child 1–18 years ≥ 50 kg: initially, 0.5 mg once daily

increased at intervals of at least 48 hours by 0.5 mg once
daily if required. Optimum dose, 1 mg once daily.
R MONOGRAPHS
Dose range 0.5–1.5 mg once daily

Child 1–18 years ≤ 50 kg: initially 0.25 mg once daily
increased by 0.25 mg at least after 48 hours, if required.
Optimum dose 0.5 mg once daily. Usual dose range
0.25–0.75 mg once daily
Contra-indications
 Hypersensitivity to risperidone
Side effects
 Hyperprolactinaemia
 Weight gain, increased appetite, decreased appetite
 Insomnia, sleep disorder, agitation and anxiety,
depression, sedation, headache

 Parkinsonism, extrapyramidal symptoms, tremor, tardive
dyskinesia
 Blurred vision, conjunctivitis
 Tachycardia, hypertension
 Pharyngolaryngeal pain, nose bleed, nasal congestion,
dyspnoea, cough, respiratory tract infections

 Muscle spasms and pain, joint pain
 Urinary incontinence
 Oedema
 General weakness, pyrexia
 Rash, anaphylactic reaction
 Do not drive until you know how risperidone affects you
Pregnancy
 Do not use

RITUXIMAB R
Breast-feeding
 Can be used
Caution
 Risperidone is excreted in breast-milk. The advantage of
breast feeding should be weighed against the potential
risk to the child
 Only use in pregnancy if potential benefit outweighs risk
 Do not withdraw abruptly. Reduce doses gradually
 Use with caution in patients with dementia with Lewy
bodies, parkinsonism, prolactin-dependent tumours,
dehydration, cataract surgery and in acute porphyria
RITUXIMAB NR E 8.2
Antilymphocyte monoclonal antibody anticancer
Dosage forms
 Concentrate for IV infusion: 10 mg/ml
Uses
 Severe rheumatoid arthritis (second-line therapy)
 Granulomatosis
 Microscopic polyangitis
Dose and duration

Usually 375 mg/m2 by IV infusion per cycle; frequency
depends on the type and severity of cancer
Refer to product literature for recommended doses
Contra-indications
 Hypersensitivity to rituximab

R MONOGRAPHS
 Severe immunocompromised state
Side effects
 Infections
 Infusion-related reactions; angioedema
 Hyperglycaemia, weight loss, oedema
 Paraesthesia, agitation, insomnia, dizziness
 Lacrimation disorder, conjunctivitis, tinnitus, ear pain
 Cardiac disorders, myocardial infarction, arrhythmias
 Hypertension, hypotension
 Bronchospasm, respiratory distress, cough, rhinitis
 Urticaria, sweating, night sweats
 Muscle , joint, back and neck pain
 Malaise, weakness, shivering, fatigue, chills, headache
 Decreased IgG levels
 Use effective contraception during and for 12 months
after treatment
Pregnancy
 Do not use
Breast-feeding
 Discontinue breastfeeding during and for 12 months after
treatment
Storage
 Store in a refrigerator at 2−8°C. Protect from light

ROCURONIUM BROMIDE R
Caution
 Pre-medication with glucocorticoid, anti-pyretic and anti-
histamine is necessary before administering rituximab
 Adequate hydration before treatment is necessary
ROCURONIUM BROMIDE H E 17.1

Aminosteroid non-depolarising neuromuscular blocker medi-
cine with quick onset and intermediate duration of action
Dosage forms
 Injection 10 mg/ml
Uses
 Neuromuscular blockade of intermediate duration for
surgery or during intensive care

Dose and duration
Dose should be individualised for each patient
 Neuromuscular blockade in surgery
Adult and child over 1 month: by IV injection, 0.6 mg/kg,

then maintenance dose of 0.15 mg/kg
By IV infusion, give a loading dose of 0.6 mg/kg, then
0.3–0.6 mg/kg/hour adjusted according to response
Elderly: loading dose of 0.6 mg, then maintenance dose
0.075–0.1 mg/kg by IV injection or 0.3–0.4 mg/kg/hour
by IV infusion
 Neuromuscular blockade in intensive care
Adult and child over 1 month: by IV injection 0.6 mg/kg,

then maintenance by IV infusion, 0.3–0.6 mg/kg/hour for
the first hour, then adjusted according to response
R MONOGRAPHS
Contra-indications
Side
 Tachycardia, hypotension
 Prolonged neuromuscular block
 Anaphylaxis
Interactions
 Aminoglycosides (increased effect of rocuronium)
 Clindamycin (increased effect of rocuronium)
 Vancomycin (increased effect of rocuronium)
 Polymixins (increased effect of rocuronium)
 Phenytoin (long term use reduces effect of rocuronium)
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Reduce dose in hepatic failure
 Reduce maintenance dose in renal failure
 To avoid excessive dosage in obese patients, calculate
doses on the basis of ideal bodyweight
 Use with caution in patients with sensitivity to other neu-
romuscular blocking medicines due to cross- sensitivity
 Use with caution in patients with neuromuscular disease
or after poliomyelitis
 In people with burns, titrate dose with response since
they often develop resistance

ROTAVIRUS VACCINE R
ROTAVIRUS VACCINE HC II V 19.3.1
Live attenuated vaccine containing rotavirus gastroenteritis
human strain. Rotavirus vaccine is used in the routine
immunisation of children
Dosage forms
 Oral suspension: 1.5 ml prefilled oral syringe
Uses
 Immunisation against rotavirus infection
Dose and duration

 Give drops in the mouth
First dose: At 6 weeks of life

Second dose: At 10 weeks
Minimal time interval between doses is 4 weeks
Contra-indications
 Immunocompromised patients
Side effects
 Mild, short-lived gastrointestinal symptoms (pain,
diarrhoea, irritation)
Interactions
 Dexamethasone (reduced effect of vaccine)
 Hydrocortisone (reduced effect of vaccine)
 Prednisolone (reduced effect of vaccine)
 Dispose of the child's faeces properly as the virus spreads
through the oral-faecal route

 Wash hands thoroughly after changing the baby's nappies
Pregnancy
 Not applicable

S MONOGRAPHS
Breast-feeding
 Not applicable
Storage
 Between 2–8°C. Do not freeze
Caution
 Postpone immunisation in infants with acute gastro-
enteritis or serious febrile illness
 Booster doses after the primary schedule are not rec-
ommended
S
SALBUTAMOL HC III V 25.1
Short-acting beta2 receptor agonist bronchodilator that
makes breathing easier
Dosage forms
 Tablet: 4 mg
 Aerosol inhalation: 100 µg/metered inhalation
 Nebuliser solution: Vial 2 mg/ml
 Respirator solution: 5 mg/ml
Uses
 Acute asthma attacks
 Asthma maintenance therapy -Step 1
 Asthma-like symptoms in anaphylaxis
 Difficulty in breathing in bronchiolitis
Dose and duration

 Acute asthma attack, asthma-like symptoms

SALBUTAMOL S
Adult: 5 mg by nebuliser OR by inhaler 2 puffs (200 µg)
every 10 minutes for 30–60 minutes
Child >18 months–12 years: 2.5 mg by nebuliser.
Monitor response 30 minutes after the dose. Repeat if
necessary
 Mild to moderate acute asthma attack
Adult: 2.5 mg by nebuliser repeated after 15 minutes

OR by inhaler 2 puffs (200 µg) every 2‒5 minutes for
20 puffs
Review every 3–4 hours and continue same dose if
necessary every 3–4 hours
Child <2 years: Tablets 100 µg/kg 3–4 times daily
Child 2–6 years: Tablets 1–2 mg 3–4 times daily
Child 6–12 years: Tablets 2 mg 3–4 times daily
 Relief of wheezing/difficulty in breathing in bronchiolitis
Child: tablets 100 µg/kg

 Chronic asthma maintenance therapy
Inhale 1‒2 puffs (100‒200 µg) when necessary

OR if inhaler not available, give tablets in doses
indicated below
Adult: 2–4 mg every 6–8 hours (Max single dose 8 mg)
Child <2 years: 100 µg/kg every 8 hours
Preparation
 Dilute salbutamol nebules with 2 ml of sodium chloride
0.9% to obtain a total volume of 4 ml in the reservoir of

the nebuliser
 Disperse diluted solution with oxygen at a flow rate of
5 to 8 L/min. Stop nebulisation when reservoir is empty

S MONOGRAPHS
 Respirator Solution is diluted with sterile sodium chloride

0.9% to contain 50-100 micrograms of salbutamol per ml
(i.e. 1-2 ml solution made up to 100ml with diluents). The
diluted solution is administered by nebuliser
Contraindications
 Allergy to salbutamol
Side effects
 Palpitations
 Shaking of hands
 Headache
Interactions
 Methyldopa (risk of acute hypotension)
 Theophylline (risk of low potassium blood level)
 Aminophylline (risk of low potassium blood level)
 Hydrocortisone (risk of low potassium blood level)
 Always report to health worker when you feel worsening
of symptoms
Pregnancy
 Can be used; preferably use inhaled route
Breast-feeding
 Can be used
Caution
 Do not use oral salbutamol for management of acute
asthma as its onset of action is 30 minutes
 Only use oral route when the inhaled route is not
possible. Inhaled route is preferred as the medicine is

SALICYLIC ACID S
delivered directly to site of action so it acts faster, and
smaller doses are used so there are less systemic side
effects
 The nebuliser should always be driven by oxygen to avoid
worsening of low oxygen levels
 Educate the patient on how to use the inhaler, and let
them demonstrate. Incorrect use of inhaler leads to
inadequate delivery of dose and hence treatment failure
SALICYLIC ACID HC II N 13.4

Keratolytic agent that removes dead skin due to excess
formation of skin
Dosage forms
 Ointment: Salicylic acid 2%
 Ointment: Salicylic acid 2% + sulphur 2%
 Ointment: Benzoic acid 6% + salicylic acid 3%
Uses
 Psoriasis
 Warts
 Ringworm
 Dandruff
 Acne
Dose and duration

 Psoriasis
Apply thin layer every 8 hours until symptoms im-

prove. Use with lotion to moisturise the skin
 Warts
Apply to wart once daily until response occurs

 Ringworm (use formulation with benzoic acid)

S MONOGRAPHS
Apply thin layer every 12 hours

Continue for 14 days after lesions has healed
 Dandruff (use formulation with sulphur), acne
See sulphur + salicylic acid

Contra-indications
 Broken skin
 Wet lesions on the skin
Side effects
 Skin irritation and inflammation
 Excessive drying of skin
 Salicylism
 When applying on warts, protect the surrounding skin by
applying Vaseline® or petroleum jelly. File warts with a

pumice stone once per week.
 Avoid contact with eyes, mouth, and mucous membranes
 Do not apply to broken or infected skin or open wounds
 Avoid application to large areas
 Wash hands thoroughly before and after using the
ointment (unless lesion is hands)

 Do not apply on breasts if breast-feeding
Pregnancy
 Can be used
Breast-feeding
 Can be used

SEVOFLURANE S
SEVOFLURANE NR V 1.1
Rapid acting volatile liquid anaesthetic
Dosage forms
 Liquid for inhalation: 100%
Uses
Dose and duration

Give in oxygen or nitrous oxide-oxygen using a specially cali-
brated vaporiser and doses adjusted according to response
Adult and child over 1 month: 0.5–1%, increasing

gradually to 8%
Neonate: up to 4%
Adult and child over 1 month: 0.5–3%

Neonate: in oxygen or, 0.5–2%
Contra-indications
 Known or suspected hypersensitivity to sevoflurane or
other halogenated anaesthetics

 History of hepatitis induced by halogenated inhalational
anaesthetic
 Genetic susceptibility to malignant hyperthermia
Side effects
 Agitation, somnolence, headache
 Bradycardia, tachycardia, hypotension, hypertension
 Nausea, vomiting, salivary hypersecretion
 Chills, pyrexia, hypothermia
 Abnormal blood glucose and liver function tests

S MONOGRAPHS
Interactions
 Levodopa, doxapram, adrenaline, noradrenaline
(increased risk of arrhythmias)

Pregnancy
 Do not use
Breast-feeding
 Can be used
Caution
 May depress neonatal respiration if used during delivery
 Breast-feeding can be resumed as soon as mother has
sufficiently recovered from anaesthesia
 Patients may require early post-operative pain relief since
emergence following sevoflurane is fairly rapid
 Use with caution in patients with coronary disease,
seizures, renal impairment or down syndrome
SILVER NITRATE HC III N 13.7

Used to remove warts on the hands and feet
Dosage forms
 Caustic pencil: 40%
Uses
 Warts on hands and feet
 Umbilical granuloma (overgrowth of tissue) in new-borns
Dose and duration

 Warts on hands and feet
Moisten the tip of the pencil with a small amount of

SILVER SULPHADIAZINE S
water and apply directly to affected area for 1–2
minutes every 24 hours. Do not use more than 3 times
 Umbilical granuloma
Apply moistened pencil tip to granuloma for 1−2
minutes. Protect surrounding skin with petroleum jelly
Contra-indications
 Warts in the genital and anal area
Side effects
 May cause burns on normal skin
 Stains skin and fabric
 Remove dead skin by gently filing before applying pencil
 Protect surrounding skin by applying Vaseline or
petroleum jelly before using the pencil

 Can stain skin and clothes
 Not suitable for use on the face, genitals or around anus
Pregnancy
 Can be used
Breast-feeding
 Can be used
SILVER SULPHADIAZINE HC III N 13.2

Topical anti-infective
Dosage forms
 Cream: 1%
Uses
Prophylaxis and treatment of
 Wound infections

S MONOGRAPHS
 Leg ulcers
 Pressure sores
 Burns
Dose and duration

 Infected burn wounds, leg ulcers, pressure sores
Apply a 3–5 mm thick layer daily

Use more frequently if volume of the fluid coming out
of the wound is large
Cover with sterile gauze after applying the cream
Continue use until satisfactory wound healing occurs
Contra-indications
 Allergy to cotrimoxazole and sulfadoxine (in SP)
 Infants <1 month
Side effects
 Skin rash, burning, itching
 Haemolytic reactions
 Wash hands thoroughly with soap and water before and
after applying the cream

 Close the jar properly immediately after use to avoid
contamination and exposure to light

 For external use only
Pregnancy
 Do not use
Breast-feeding
 Do not use

SODIUM BICARBONATE S
Caution
 Haemolytic side effects can occur when large areas of
burns are involved or during prolonged use
 Do not apply other topical treatments where silver
sulfadiazine has been applied
SODIUM BICARBONATE RR E 26.2

Sodium salt used to control metabolic acidosis (pH < 7.1)
especially that caused by loss of bicarbonate through urine or
excessive gastrointestinal losses
Dosage forms
 Solution for injection: 8.4%
Uses
 Correcting acidosis
 Alkalinisation of urine
Dose and duration

 Correcting acidosis due to volume depletion unresponsive
to fluid replacement
Adult and child: administer an amount appropriate to the
body base deficit by continuous intravenous infusion of a
weaker solution, usually 1.26% over 3−4 hours
 Correcting acidosis due to severe shock e.g. in cardiac
arrest
Adult and child: administer an amount appropriate to the
body base deficit by slow IV injection
 Alkalinisation of urine
Adult: by mouth, 3 g in water every 2 hours until urinary

pH exceeds 7; maintenance of alkaline urine 5–10 g daily

S MONOGRAPHS
Contraindications
 Hypersensitivity to sodium bicarbonate
 Metabolic or respiratory alkalosis
 Hypocalcaemia
 Hypochlorhydria
Side effects
 Stomach cramps, flatulence, vomiting, belching
 Malaise, alkalosis with prolonged use
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Mild acidosis due to volume depletion should first be
resolved by appropriate fluid replacement as acidosis
usually resolves as tissue and renal perfusion are restored
 Use with caution in patients with cardiac disease, patients
on sodium-restricted diets and the elderly
 Restrict use in impaired renal function
SODIUM CHLORIDE HC III V 26.2

Intravenous replacement fluid for replacing loss of blood,
plasma, and other extracellular fluids. Also used for
preparation of parenteral medicines
Dosage forms
 Solution for infusion: sodium chloride 0.9%

SODIUM CHLORIDE S
Also known as normal saline
Uses
 Correcting severe dehydration
 Correcting water, electrolyte, and acid-base disturbances
 Shock and hypovolemia
 Dilution of medicines for injectable use
Dose and duration

Adult: 0.5–1 L by infusion in the 1st hour and not more

than 2–3 L in 4 hours
Child >1 year: 30 ml/kg over the first 30 minutes, then
70 ml/kg over the next 2½ hours
Child <1 year: 30 ml/kg over 1 hour, then 70 ml/kg
over the next 5 hours
Reassess rehydration status and continue treatment
Plan A, B, or C as necessary (see under ORS)
 Shock
Give 20 ml/kg by fast IV infusion (over 60 minutes)

 Blood loss
Always give 3 times the estimated fluid loss

Only use if fluid loss does not exceed 1500 ml and
there is no cardiac or renal impairment
 Fluid and electrolyte imbalance (alternating with 5%
glucose)
Infusion given over 1–2 hours
Adult: 1 L/day
Child: 50 ml/day
Duration is according to patient's condition

S MONOGRAPHS
Contra-indications
 High blood pressure
 Heart failure
 Ascites
 Oedema
 Other conditions associated with sodium retention
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Always examine each bottle against light for clearness.
Discard any bottle with particles or cloudiness
 Risk of pulmonary oedema and sodium retention if
infusion is given too rapidly or when excessive amounts
are given
 For fluid replacement in severe dehydration, preferably
use Ringer's Lactate as sodium chloride 0.9% does not
contain potassium and lactate
SODIUM CROMOGLYCATE RR N 21.3

Anti-inflammatory medicine
Dosage forms
 Eye drops: 2%
Uses

SODIUM HYALURONATE S
Dose and duration
 All uses
Adult and child over 6 years: instill 1–2 drops in the eye
every 6 hours for up to 14 days
Contraindications
Side effects
 Burning, stinging
 Transient blurred vision
 Remove soft contact lenses during treatment. Other
types of contact lenses can be removed before instillation

and worn at least 15 minutes after instillation
 Seek medical attention if there is no sign of improvement
within 48 hours
 Discard any remaining solution 28 days since first opening
of container
 Do not drive until you can see clearly
 The dropper tip should not touch any surface
Pregnancy
 Can be used
Breast-feeding
 Can be used
SODIUM HYALURONATE RR N 21.7

Ophthalmic lubricant
Dosage forms
 Intraocular liquid: 12 mg/ml

S MONOGRAPHS
 Eye drops: 0.1%, 0.15%, 0.18%, 0.2%

Uses
 Eye surgery(specialist use only)
Dose and duration

Adult and child: apply as required
Contraindications
 Hypersensitivity to hyaluronate
 Wash hands well with water and soap before instillation
 Ensure the tip of the dispensing bottle does not touch the
eyelid or any part of the body or surface at any time

 Discard remaining solution after 28 days from opening
 If blurring occurs, do not drive until you can see clearly
Pregnancy
 Can be used
Breast-feeding
 Can be used
SODIUM LACTATE COMPOUND HC IV E 26.2

Intravenous replacement fluid for replacing loss of blood,
plasma, and other extracellular fluids. Commonly known as
Ringer’s Lactate or Hartmann’s Solution)
Dosage forms
 Solution for infusion: sodium chloride 0.6%, sodium
lactate 0.32%, potassium chloride 0.04%, calcium chloride

0.027%

SODIUM LACTATE COMPOUND S
Uses
 Correcting severe dehydration
 Correcting water, electrolyte, and acid-base disturbances
 Shock and hypovolaemia
Dose and duration

Adult: 0.5–1 L by infusion in the 1st hour and not more

than 2–3 L in 4 hours
Child >1 year: 30 ml/kg over the first 30 minutes, then
70 ml/kg over the next 2½ hours
Child <1 year: 30 ml/kg over 1 hour, then 70 ml/kg
over the next 5 hours
Reassess rehydration status and continue treatment
Plan A, B, or C as necessary (see under ORS)
 Shock
Give 20 ml/kg by fast IV infusion (over 60 minutes)

 Blood loss
Always give 3 times the estimated fluid loss

Only use if fluid loss does not exceed 1500 ml and
there is no cardiac or renal impairment
 Fluid and electrolyte imbalance (alternating with 5%
glucose)
Infusion given over 1–2 hours
Adult: 1 L/day
Child: 50 ml/day
Duration is according to patient's condition
Contra-indications
 Metabolic and respiratory alkalosis
 Hypocalcaemia
 Hypochlorhydria

S MONOGRAPHS
Side effects
 Oedema
 Metabolic alkalosis on excessive administration
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Monitor electrolytes and plasma pH
 Always examine each bottle against light for clearness.
Discard any bottle with particles or cloudiness
 Risk of pulmonary oedema and sodium retention if
infusion given too rapidly or when excessive amounts are
given
 In metabolic acidosis, sodium lactate may cause lactic ac-
idosis especially in seriously ill patients with poor tissue
perfusion or impaired hepatic function. Use sodium bi-
carbonate instead
SODIUM STIBOGLUCONATE RR E 6.4.2

Organic pentavalent antimony medicine for leishmaniasis
Dosage forms
Uses
 Visceral leishmaniasis (kala-azar)
 Cutaneous leishmaniasis
Dose and duration

 Visceral leishmaniasis, cutaneous leishmaniasis

SODIUM STIBOGLUCONATE S
Adult and child: 20 mg/kg daily (max 850 mg) by IM in-
jection or slow IV injection over 5 minutes for 28 days in
visceral leishmaniasis and 20 days in cutaneous infection
Contra-indications
 Moderate to severe renal impairment
 History of serious adverse reaction following sodium
stibogluconate
Side effects
 Anorexia, nausea, vomiting, abdominal pain, diarrhoea
 ECG changes
 Cough
 Headache, lethargy
 Anaphylaxis
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Filter injection immediately before administration using a
filter of 5 microns or less

 Stop IV injection if coughing or substernal pain develops
during administration as an IV injection

 Monitor ECG before and during treatment. If a patient
with heart disease develops conduction abnormalities,

withdraw medicine
 Successful treatment of mucocutaneous disease may
induce inflammation around lesions which may be life

threatening if there is pharyngeal or tracheal involvement
S MONOGRAPHS
and may require corticosteroids

 Use with caution in hepatic impairment and avoid in
significant renal impairment
 Only use in pregnancy if potential benefit outweighs risk
SODIUM THIOSULPHATE NR N 4.2

Antidote for cyanide poisoning
Dosage forms
Uses
 Cyanide poisoning
Dose and duration

 Cyanide poisoning (after sodium nitrite)
Adult and child: by slow IV injection over about 10

minutes, 12.5 g followed by 6.25 g after 30 minutes if
symptoms recur
Child: 400 mg/kg (max 12.5 g) repeated in severe
poisoning after 30 minutes
Pregnancy
 Can be used
Breast-feeding
 Can be used
SODIUM VALPROATE H V 5
Dosage forms
 Tablet (crushable): 100 mg

SODIUM VALPROATE S
Syrup: 200 mg/5 ml
Uses
 Epilepsy
 Manic episodes associated with bipolar disorder
 Nodding disease
Dose and duration

To be taken after a meal
 Treatment of epilepsy
Adult and child over 12 years: 600 mg daily in 2 divided

doses, increased by 200 mg every 3 days until control is
achieved. Usual dose range 1000–2000 mg daily i.e.
20–30 mg/kg daily (max 2500 mg per day)
daily in 1–2 divided doses; usual maintenance dose 25–30
mg/kg daily in 2 divided doses
Neonate: 20 mg/kg once daily; usual maintenance dose
10 mg/kg every 12 hours
 Manic episodes associated with bipolar disorder
Adult: 750 mg daily in 2–3 divided doses, increased

according to response, usual dose 1–2 g daily
Contraindications
 Family history of severe hepatic dysfunction
 Acute porphyria
 Active liver disease
 Pancreatitis
Side effects
 Nausea, gastric irritation, diarrhoea
 Weight gain

S MONOGRAPHS
 Thrombocytopenia, anaemia
 Transient hair loss
 Liver damage with increased liver enzymes
 Tremor, extrapyramidal disorder
 Stupor, somnolence, memory impairment, headache
 Convulsion
 Nystagmus
 Hyponatremia
 Dysmenorrhoea
 Haemorrhage
 Deafness
Interactions
 Amitriptyline (antagonism of the anticonvulsant effect)
 Chloroquine (possibly increased risk of convulsions)
 Chlorpromazine (antagonism of anticonvulsant effect)
 Clomipramine (antagonism of anticonvulsant effect)
 Fluphenazine (antagonism of anticonvulsant effect)
 Mefloquine (antagonism of anticonvulsant effect)
 Olanzapine (increased risk of side effects)
 Orlistat (possible increased risk of convulsions)
 Cimetidine (increased plasma concentration of valproate)
 Lamotrigine (increased concentration of lamotrigine)
 Haloperidol (antagonism of anticonvulsant effect)
 Imipenem (reduced plasma concentration of valproate)
 Do not remove tablets from the foil until immediately
before they are to be taken

 The crushable tablet can be crushed and mixed with cold
soft food or drink and taken immediately

SODIUM VALPROATE S
 Take your medication after a meal
 The enteric coated tablet should not be crushed or
chewed but swallowed whole with a glass of water
 Seek immediate medical attention if blood or liver
disorders signs such as loss of seizure control, weakness,
anorexia, oedema, vomiting, abdominal pain, drowsiness,
jaundice, or spontaneous bruising or bleeding develop
 Seek immediate medical attention if symptoms of
pancreatitis such as abdominal pain, nausea and vomiting
develop
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Avoid sudden withdrawal. Reduce dose gradually over at
least 1 month when stopping valproate
 Valproate is associated with the high risk congenital mal-
formations and growth delays when used in the 1st and
3rd trimesters. Only prescribe in pregnancy if there are no
safer alternatives and after careful discussion of risks
with patient. Risk of teratogenicity is greater if more than
one antiepileptic is used; folic acid may reduce risk of
neural tube defects. Give effective contraception in
women of child-bearing potential.
 Reduce dose in mild to moderate renal impairment
 Avoid use in hepatic impairment due to risk of hepatotox-
icity and hepatic failure usually in the first 6 months
 Monitor liver function before and during first 6 months of
S MONOGRAPHS
therapy in patients most at risk of hepatic impairment

 Care should be taken when switching between different
brands of valproate in the treatment of epilepsy
 Discontinue use if patient develops pancreatitis
 Assess risk of bleeding before starting, and also before
major surgery or anticoagulant therapy
 Valproate may cause false positive urine ketone tests
SPIRONOLACTONE H N 16
Potassium sparing diuretic
Dosage forms
 Tablet: 50 mg
Uses
 Oedema and ascites in hepatic cirrhosis
 Malignant ascites
 Primary aldosteronism
Dose and duration

 Oedema and ascites in liver cirrhosis
Adult: 100–400 mg daily, adjusted according to response

Child 12–18 years: 50–100 mg daily in 1–2 divided doses;
up to 9 mg/kg daily (max 400 mg daily) in resistant cases
Child 1 month–12 years: 1–3 mg/kg daily in 1–2 divided
doses; up to 9 mg/kg daily in resistant ascites
Neonate: 1–2 mg/kg daily in 1–2 divided doses; up to 7
mg/kg daily in resistant ascites
 Malignant ascites
Adult: 100–200 mg once daily, increased to 400 mg once

SPIRONOLACTONE S
daily if required; maintenance dose adjusted to response
Child and neonate: dose same as in cirrhosis
Adult: 100–200 mg once daily
 Congestive heart failure with oedema
Adult: 100 mg in single or divided doses. Dose ranges
from 25 mg to 200 mg. Maintenance dose is determined
 Moderate to severe heart failure
Adult: 25 mg once daily increased to 50 mg once daily
 Resistant hypertension
 Primary hyperaldosteronism in patients awaiting surgery
Adult: 100–400 mg daily; use lowest effective dose for
long-term maintenance
Contraindications
 Hyperkalaemia
 Acute renal insufficiency, severe renal impairment, anuria
 Concomitant use with potassium sparing diuretics
 Hypersensitivity to spironolactone
Side effects
 Hyperkalaemia
 Hyponatraemia
 Hyperchloraemic acidosis
 Dehydration

S MONOGRAPHS
Interactions
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Use in pregnancy only if benefits outweigh risks
 Start treatment with the lowest dose and titrate upwards
as required in the elderly to achieve maximum benefit
STILBOESTROL (DIETHYLSTILBESTROL) RR N 18.4

Oestrogen anticancer
Dosage forms
 Tablet: 5 mg
Uses
 Prostate cancer (third line treatment)
 Breast cancer in post-menopausal women
Dose and duration

 Prostate cancer

 Breast cancer in post-menopausal women

Side effects
 Nausea
 Fluid retention, venous and arterial thrombosis
 Jaundice
 Impotence and gynaecomastia in men

STREPTOKINASE S
 Withdrawal bleeding in women
 Bone pain
 Vaginal carcinoma (in high dose)
Pregnancy
st
Breast-feeding
Caution
 Use with caution in cardiovascular disease
 Avoid use in hepatic impairment
 When given in high doses in the 1st trimester, vaginal
carcinoma, urogenital abnormalities, and reduced fertility
in female offspring, and increased risk of hypospadias in
male offspring can occur
STREPTOKINASE RR V 10.3
Fibrinolytic medicine. Enzyme secreted by several species of
Streptococci that can bind and activate human plasminogen,
which degrades fibrin and so breaks up thrombi
Dosage forms
Uses
 Acute arterial occlusion

S MONOGRAPHS
 Central retinal venous or arterial thrombosis

Dose and duration
Adult: by IV infusion, 1,500,000 IU over 60 minutes

preferably within 1 hour of infarction, though can be
used within 12 hours
 Thrombosis
Adult and child over 12 years: by IV infusion, 250,000 IU

over 30 minutes followed by 100000 IU every hour for
12–72 hours
Child 1 month–12 years: by IV infusion, 2,500–4,000
IU/kg over 30 minutes followed by 100,000 IU every hour
for 12–72 hours
Adjust dose based on condition and monitoring
parameters
Preparation
 Reconstitute with normal saline solution and dilute
further with normal saline or dextrose 5%

Contra-indications
 Repeat use of streptokinase beyond 4 days of first use
 Recent haemorrhage, surgery (including dental),
parturition or trauma
 Heavy vaginal bleeding
 History of cerebrovascular disease
 Coma
 Coagulation defects
 Bleeding diatheses

STREPTOKINASE S
 Aortic dissection
 Risk of gastrointestinal bleeding
 Acute pancreatitis
 Acute pulmonary disease with cavitation
 Previous allergic reactions
Side effects
 Nausea, vomiting, diarrhoea, epigastric pain
 Bleeding (usually limited to site of injection)
 Hypotension, arrhythmias, tachycardia, bradycardia,
heart failure, cardiogenic shock, pericarditis

 Development of antistreptokinase antibodies
 Anaphylaxis
 Recurrent ischaemia
 Headache
 Musculoskeletal pain, chills, general weakness
Pregnancy
 Do not use
Breast-feeding
 Can be used
Storage
o
 Store below 25 C and do not freeze. Store reconstituted
solution in a refrigerator at 2–8oC for only 24 hours

Caution
 Antibodies to streptokinase appear 4 days after use, and
do not give streptokinase to the patient after this time

 Use with caution in diabetic retinopathy, abdominal an-
eurysm and recent or concurrent anticoagulation therapy

S MONOGRAPHS
 Discontinue if bleeding is serious and treat as necessary

 Can cause premature separation of placenta in first 18
weeks and possible foetal haemorrhage throughout
pregnancy
 In breast-feeding mothers, discard breast milk during the
first 24 hours following thrombolytic therapy
STREPTOMYCIN (S) HC III V 6.2.4

Broad spectrum aminoglycoside antibacterial
Dosage forms
 Powder for injection: 1 g in vial
Uses
 Plague
 Retreatment cases of tuberculosis
Dose and duration

 Plague
Adult: 1 g by deep IM injection every 12 hours for 7–10

days
Child: 15 mg/kg by deep IM injection every 12 hours
for 7–10 days. Maximum 1 g daily
 Initial phase retreatment of tuberculosis (in combination
with rifampicin, isoniazid, pyrazinamide, ethambutol)

Give daily doses as in table below for 2 months
Weight (kg) Streptomycin (mg)
5–10 250
11–30 500
31–50* 750
>50 1000

STREPTOMYCIN (S) S
*Or patient above 60 years
The total dose (for 2 months) should not exceed 60 g
Preparation
 Dissolve streptomycin powder in 5 or 10 ml of water for
injection
Contra-indications
Side effects
 Painful injection
 Abscess at injection site
 Balance impairment
 Kidney damage
 Neurotoxicity
 Hypersensitivity reactions (withdraw treatment)
 Rash
Interactions
 Furosemide (increased risk of kidney damage and hearing
impairment)
Pregnancy
 Do not use
Breast-feeding
 Can be used
Storage
 Reconstituted solution can be kept for maximum 24
hours below 25°C

S MONOGRAPHS
Caution
 Never give as IV injection
 Stop and withdraw treatment if severe nerve pain occurs
 Other aminoglycosides used in drug-resistant tuberculosis
include kanamycin and amikacin
SULFADOXINE + PYRIMETHAMINE (SP) HC II V 6.4.3

Antimalarial specifically used for prevention of malaria in
pregnancy
Dosage forms
 Tablet: Sulfadoxine 500 mg and pyrimethamine 25 mg
Uses
 Intermittent preventive treatment of malaria in pregnan-
cy (IPTp)
Dose and duration
 3 tablets taken at once, 2 times during pregnancy
First dose: Between weeks 16–24

Second dose: Between weeks 28–36
Contra-indications
 Allergy to Co-trimoxazole

st
 1 trimester pregnancy
 HIV patients on Co-trimoxazole prophylaxis
Side effects
 Stomach upset
 Blood disorders
 Rash

SULPHUR + SALICYLIC ACID S
 Sore throat, mouth ulcers
 Cough or shortness of breath
 Fatigue, headache
Interactions
 Folic acid (cancelled effect)
 Co-trimoxazole (increased risk of side effects)
 Report to health worker immediately in case of shortness
of breath
Pregnancy
st
Breast-feeding
 Can be used
Caution
 Discontinue immediately if blood disorders occur
 SP is no longer recommended for use as treatment for
P. falciparum malaria due to resistance of parasites
 When IPTp is given in pregnancy, withhold folic acid for
one week after taking SP, then resume with folic acid
SULPHUR + SALICYLIC ACID HC III N 13.1

Sulphur is bactericidal and salicylic acid is a keratolytic that
promotes peeling off of dead skin
Dosage forms
 Ointment or cream: 2% sulphur and 2% salicylic acid
Uses
 Dandruff

S MONOGRAPHS
 Acne
 Eczema
 Psoriasis
Dose and duration

 Dandruff, acne, eczema
Apply to the affected area at least 2 times per week

In severe cases, it may be applied daily for 3 days, then
twice weekly
 Psoriasis
See salicylic acid

Side effects
 Skin irritation
 Wash hands thoroughly before and after using the
ointment (unless lesions are on the hands)

 Avoid contact with eyes, mouth, and mucous membranes
Pregnancy
 Do not use
Breast-feeding
 Can be used
SURAMIN SODIUM RR N 6.4.4

Microfilaricide and antitrypanosomal for use against
Onchocerca volvulus and Trypanosoma brucei respectively
Dosage forms

SURAMIN SODIUM S
Uses
 Curative treatment of onchocerciasis (River blindness)
 Treatment of haemolytic stage of trypanosomiasis due to
T. brucei rhodesiense
Dose and duration
 Onchocerciasis
Adult: by slow IV injection, initially 3.3 mg/kg as a single

test dose (inject a few microlitres and wait for at least 1
minute, then inject the next 0.5 ml over 30 seconds and
wait for 1 minute, then inject the remainder over several
minutes), followed by incremental doses at weekly
intervals of 6.7 mg/kg, 10.0 mg/kg, 13.3 mg/kg, 16.7
mg/kg, and 16.7 mg/kg on weeks 2 to 6 respectively
(total dose, 66.7 mg/kg over 6 weeks)
 Trypanosomiasis
Adult and child: by slow IV injection, 5 mg/kg on day 1,

10 mg/kg on day 3, and 20 mg/kg on days 5, 11, 17, 23,
and 30
Preparation
 Reconstitute with water for injections to 10% solution
Contra-indications
 Previous anaphylaxis or suramin sensitivity
 Severe liver or renal function impairment
 Elderly or debilitated
Side effects
st
 Immediate and potentially fatal reaction with 1 dose
with nausea, vomiting, shock and loss of consciousness

 Albuminuria
 Abdominal pain, severe diarrhoea, stomal ulceration

S MONOGRAPHS
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 In pregnancy, delay treatment until after delivery in
onchocerciasis but treat if meningoencephalopathic
involvement in T. brucei rhodesiense is involved
 Suramin sodium is very toxic and should only be used in a
hospital under medical supervision
 There is a risk of loss of consciousness with first dose
 Maintain satisfactory food and fluid intake
 Urine tests should be done before and weekly during
treatment. Reduce dose if there is moderate albuminuria.
Discontinue immediately if severe albuminuria or casts
develops
SUXAMETHONIUM (SUCCINYLCHOLINE) HC IV V 20
Depolarising neuromuscular blocking medicine
Dosage forms
Uses
 Brief muscular paralysis during endotracheal intubation,
endoscopy and electroconvulsive therapy

Dose and duration
 Neuromuscular blockade
Adult and child over 12 years: by IV injection, 1 mg/kg

followed if necessary by supplements of 0.5–1 mg/kg at

SUXAMETHONIUM (SUCCINYLCHOLINE) S
5–10 minute intervals
Or by IV infusion for prolonged procedures, 2.5–4
mg/minute of a solution of concentration of 1–2 mg/ml
(max 500 mg/hour)
Child 1–12 years: by IV injection, 1 mg/kg followed if
necessary by supplements of 0.5–1 mg/kg at 5–10 minute
intervals
Or by IM injection, up to 4 mg/kg (max 150 mg)
Neonate and child up to 1 year: by IV injection, 2 mg/kg
Or by IM injection, up to 4–5 mg/kg
Contra-indications
 Inability to maintain clear airway
 Personal or family history of malignant hyperthermia
 Hyperkalaemia
 Major trauma
 Neurological disease involving acute wasting of muscles
 Prolonged immobilization
 Personal or family history of congenital myotonic disease
 Duchenne muscular dystrophy
 Severe burns
 Low plasma cholinesterase activity
Side effects
 Myoglobinuria, myoglobinaemia
 Prolonged apnoea
 Increased intraocular pressure
 Hyperkalaemia
 Increased intra-gastric pressure
 Flushing

S MONOGRAPHS
 Bradycardia, tachycardia
 Malignant hyperthermia
 Rash, anaphylactic reactions
Interactions
 Amikacin, clindamycin, vancomycin, polymixins
(enhanced effects of suxamethonium)

 Gentamicin, procainamide, streptomycin
(enhanced muscle relaxant effect)

 Paromomycin (enhanced effects of suxamethonium)
 Propofol (increased risk of myocardial depression and
bradycardia when given concomitantly)

Pregnancy
 Can be used
Breast-feeding
 Can be used
Storage
o
 Store between 2–8 C. Do not freeze. Protect from light
Caution
 Use with caution in hepatic impairment due to risk of
prolonged apnoea in severe liver disease
 In pregnancy, suxamethonium may mildly prolong
maternal paralysis.
 Prolonged administration or high doses produce a phase
II (dual) block associated with prolonged neuromuscular
blockade and apnoea
 Continue assisted ventilation until muscle function is
restored
 Use with caution in patients with history of sensitivity to
other neuromuscular blocking medicines
TAMOXIFEN T
T
TAMOXIFEN NR E 8.3
Oestrogen-receptor antagonist
Dosage forms
 Tablet: 20 mg
Uses
 Adjuvant treatment of estrogen-receptor-positive breast
cancer
 Anovulatory infertility
Dose and duration

 Adjuvant in breast cancer treatment
Adult: 20 mg daily in 1–2 divided doses for 5 years

Adult: 20–40 mg daily in 1–2 divided doses

 Anovulatory infertility
Adult: 20 mg daily from day 2 to day 5 of the cycle, dose

increased if necessary to 40 mg then 80 mg in subsequent
cycles. If cycles are irregular, start initial course on any
day with subsequent course 45 days later or on day 2 if
menstruation occurs
Contra-indications
 Pregnancy
 Breast-feeding
 Porphyria
 Treatment of infertility if personal or family history of idi-
opathic venous thromboembolism or genetic pre-

T MONOGRAPHS
disposition to thromboembolism
Side effects
 Hot flushes
 Vaginal bleeding discharge, suppression of menstruation
 Pruritus vulvae
 Nausea
 Headache, light-headedness
 Tumour flare
 Decreased platelet counts
 Alopecia
Interactions
 Fluoxetine, paroxetine, droperidol (metabolism of tamox-
ifen to active metabolite possibly inhibited)

 Report sudden breathlessness or pain in the calf of one
leg
Pregnancy
 Do not use
Breast-feeding
Storage
o
 Store below 25 C in original package to protect from
light. Do not refrigerate or freeze

Caution
 Monitor endometrial changes due to an increased risk of

TEMOZOLOMIDE T
hyperplasia, polyps, cancer and uterine sarcoma. Examine
patients promptly if abnormal vaginal bleeding occurs
 Increased risk of thromboembolism particularly during
and immediately after major surgery or periods of immo-
bility. Risk is increased when tamoxifen is given together
with antineoplastic drugs
 Use with caution in pre-menopausal women with cystic
ovarian swellings
 Ensure appropriate contraception in women during
treatment and for at least 2 months following treatment
 Tamoxifen suppresses lactation and should be avoided
during breast-feeding unless potential benefits risk
TEMOZOLOMIDE NR V 8.2
Alkylating agent anticancer
Dosage forms
 Capsule: 250 mg
Uses
 Glioblastoma multiforme
 Malignant glioma (brain cancer)
Dose and duration

 Glioblastoma multiforme (in combination with radio-
therapy)
Adult: 75 mg/m2 daily for 42 days (concomitant with
focal radiotherapy); followed by up to 6 cycles of
monotherapy at 150 mg/m2 for 5 days every 4 weeks.
Weekly haematological and non-haematological
T MONOGRAPHS
toxicity criteria determine dose continuation or escala-

tion
 Glioblastoma multiforme (in combination with radio-
therapy)
Adult and children > 3 years: In previously untreated
patients, 200 mg/m2 once daily for the first 5 days fol-
lowed by a 23 day treatment interruption.
In patients previously treated with chemotherapy, the
initial dose is 150 mg/m2 once daily, to be increased in
the second cycle to 200 mg/m2 once daily, for 5 days if
there is no haematological toxicity
Contra-indications
 Hypersensitivity to temozolomide
 Hypersensitivity to dacarbazine
 Severe bone marrow suppression
Side effects
 Infections
 Nausea and vomiting, anorexia, abdominal pain, stomati-
tis, constipation, diarrhoea

 Rash, allergic reaction, fever, pain
 Alopecia
 Hyperglycaemia, weight loss
 Hepatotoxicity; increased ALT
 Anxiety, insomnia, depression
 Headache, convulsions, blurred vision
 Hearing impairment, tinnitus
 Haemorrhage, oedema, thrombosis
 Dyspnoea, coughing

TENOFOVIR (TDF) T
 Urinary frequency and incontinence
 Fatigue
Interactions
Pregnancy
 Do not use
Breast-feeding
Caution
 Monitor full blood count weekly
TENOFOVIR (TDF) HC IV V 30.1

Nucleotide reverse transcriptase inhibitor (NtRTI)
anti-retroviral medicine
Dosage forms
 Tablet: 300 mg
 FDC tablet: TDF 300 mg + 3TC 300 mg
 FDC tablet: TDF 300 mg + 3TC 300 mg+ EFV 600 mg
Uses
 HIV/AIDS

T MONOGRAPHS
Dose and duration

 HIV infection, first line treatment, EMTCT (in combination
with 3TC + EFV)

Adult and adolescents: 300 mg once daily
Child 10–15 years ≥35 kg: 300 mg once daily
 HIV infection, alternative second line (in combination
with 3TC + ATV/r or 3TC + LPV/r)

Adult and adolescents: 300 mg once daily
 Hepatitis B
Adult and child over 12 years and ≥35 kg: 300 mg

once daily
Contra-indications
 Allergy to tenofovir
Side effects
 Kidney damage
 Stomach upset, flatulence
 Dizziness
 Rash
 Liver damage
 Reduced bone density
 Lactic acidosis
Pregnancy
 Can be used
Breast-feeding
 Can be used

TENOFOVIR + EMTRICITABINE (TDF+FTC) T
Caution
 Monitor kidney function every 6 months
 TDF also has activity against Hepatitis B
 For TB patients taking rifampicin, first line regimen is
composed of a triple NRTI, e.g. TDF + 3TC + AZT or AZT +
3TC + ABC
TENOFOVIR + EMTRICITABINE (TDF+FTC) HC IV V 30.4

Combination of 1 NtRTI and 1 NRTI antiretroviral medicine
Dosage forms
For more information, see individual medicine

monographs
TENOFOVIR + LAMIVUDINE (TDF+3TC) HC IV V 30.4

Combination of an NtRTI and an NRTI antiretroviral medicine
Dosage forms
 FDC tablet: TDF 300 mg + 150 mg 3TC

monographs
TENOFOVIR + EMTRICITABINE + EFAVI-

HC IV V 30.5
RENZ (TDF+FTC+EFV)
Combination of 1 NtRTI, 1 NRTI, and 1 NNRTI antiretroviral
medicine
Dosage forms

T MONOGRAPHS

monographs
TENOFOVIR + LAMIVUDINE + EFAVIRENZ

HC IV V 30.5
(TDF+3TC+EFV)
Combination of 1 NtRTI, 1 NRTI, and 1 NNRTI antiretroviral
medicines
Dosage forms

monographs
TESTOSTERONE ENANTATE RR N 18.2

Androgen for replacement therapy in hypogonadism
Dosage forms
 Oily solution for injection: 250 mg/ml
Uses
 Hypogonadism
Dose and duration

 Hypogonadism
Adult (males): by slow IM injection, initially 250 mg every

2–3 weeks. Usual maintenance 250 mg every 3–6 weeks
Contra-indications
 Breast cancer in men
 Prostate cancer
 Hypercalcaemia
 History of primary liver tumours

TESTOSTERONE ENANTATE T
Side effects
 Prostate abnormalities and prostate cancer
 Headache, depression, anxiety, physical weakness
 Gastrointestinal bleeding, nausea
 Increased haematocrit, red cell count and haemoglobin
 Cholestatic jaundice
 Changes in libido, gynaecomastia
 Paraesthesia (tingling or pricking sensation)
Interactions
Pregnancy
 Do not use
Breast-feeding
 Do not use
Caution
 Testosterone does not induce fertility
 Use with caution in treatment of boys with delayed
puberty since it can lead to hastened fusion of epiphyses
hence short stature
 Examine prostate and breasts regularly during treatment
 Monitor blood testosterone concentrations before and
during treatment
 Use with caution in hypertension, epilepsy, migraine,
diabetes mellitus or skeletal metastases
 Do not use for enhancing muscular development in
healthy individuals or for increasing physical ability

T MONOGRAPHS
TETANUS TOXOID (TT) HC II V 19.3.1

Tetanus vaccine
Dosage forms
 Suspension for injection: ≥ 40 IU/0.5 ml
Uses
 Prophylaxis in patients at risk of tetanus as a result of
contaminated wounds, bites, and burns

 Prevention of maternal and neonatal tetanus
Dose and duration

 Prophylaxis in patients at risk of tetanus
For unimmunised or never fully immunised patients:

Give a full course of vaccination
3 doses of 0.5 ml deep SC or IM at intervals of 4 weeks
Fully immunised patients but last booster >10 years
ago: Give 1 booster dose of 0.5 ml deep SC or IM
 Prophylaxis against maternal and neonatal tetanus
Give vaccine 0.5 ml IM into the left upper arm or upper

outer thigh as follows
1st dose (TT1): At first contact with the woman (e.g. 1st
antenatal visit or as early as possible during pregnancy)
2nd dose (TT2): At least 4 weeks after TT1*
3rd dose (TT3): At least 6 months after TT2*
4th dose (TT4): At least 1 year after TT3*
5th dose (TT5): At least 1 year after TT4*
*Or as early as possible during a subsequent pregnancy
Contra-indications
 Allergy to the vaccine
 Severe acute febrile illness

TETRACAINE (AMETHOCAINE) T
Side effects
 Irritation at injection site
 Fever, malaise
 Side effects may occur within 1–2 days of immunisation;
they are usually mild and should not cause worry

 Report to health worker immediately any severe allergy
Pregnancy
 Can be used
Breast-feeding
 Can be used
Storage
 Store at 2–8°C. Do not freeze
Caution
 Postpone vaccination in severe acute febrile illness (do
not postpone in case of minor illness)
 If a serious adverse event occurs following a dose of the
vaccine, subsequent doses should not be given
 Following an injury, preferably use combined diphtheria
and tetanus vaccine (DPT) to prevent both diphtheria and
tetanus
TETRACAINE (AMETHOCAINE) HC IV E 21.6

Short-acting local anaesthetic to prevent pain during minor
surgical procedures on the eyes. Anaesthesia lasts for about
15 minutes
Dosage forms
 Eye drops: 0.5%, 1%

T MONOGRAPHS
Uses
 Local anaesthesia of the cornea and conjunctiva
Dose and duration

 Anaesthesia
Adult and child: Apply 1 drop to the eye

Contra-indications
 Pre-term neonates
 Hypersensitivity to tetracaine
 Eye inflammation
 Eye infection
Side effects
 Local irritation (burning, stinging, redness)
 Temporary disruptive effect on corneal epithelium
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Avoid prolonged use as it can cause severe keratitis,
permanent corneal opacification, scarring and delayed
corneal healing
 Protect eye from dust and bacterial contamination until
sensation is fully restored

TETRACYCLINE T
TETRACYCLINE HC II V 21.1
Broad spectrum ophthalmic antibacterial used to treat
bacterial eye infections
Dosage forms
 Ointment: 1% tube
Uses
 Eye infection
 Trachoma
 Prevention of chlamydial and gonococcal neonatal eye
infection
 Stye
 Prevention of eye infection complication in measles
Dose and duration

 Eye infection, prevention of eye infection complication in
measles patients
Apply gently directly to the eye every 6–8 hours for 7
days
 Trachoma
Apply gently directly to the eye every 6–8 hours for

4–6 weeks
Apply gently directly to the eye every 6 hours for at

least 21 days
 Prevention of neonatal eye infection
1 application directly to both eyes immediately after

birth after washing eyes
 Stye
Apply gently directly to the eye every 6–12 hours until

T MONOGRAPHS
two days after symptoms have disappeared

Contra-indications
 Allergy to tetracycline
Side effects
 Wash the eyes with boiled and cooled water before each
application
 Slightly lower the lower eyelid, then apply the medicine
 Close eyelids and massage eyelid gently to aid spread of
ointment
 Avoid touching the tip of the tube and close tube properly
after use to prevent contaminating the ointment

 Use within 1 month of opening the tube
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Stop treatment immediately if any serious allergic reac-
tions occur

THALIDOMIDE T
THALIDOMIDE NR N 6.2.3, 8.2
Immunomodulatory medicine
Dosage forms
 Tablet: 50 mg
Uses
 Multiple myeloma (first line in untreated patients ≥ 65
years)
 Erythema nodosum leprosum (a complication of leprosy)
Dose and duration

 All uses
Adult over 18 years: 200 mg once daily at bedtime for

6-week cycle (max 12 cycles)
Child below 18 years: not recommended
Contraindications
 Pregnancy
 Women of child bearing potential
 Patients unable to comply with the required
contraceptive measures
Side effects
 Weakness, drowsiness, dysaesthesia, tingling or pricking
sensation, headache, dizziness

 Joint pain, muscle pain, peripheral neuropathy
 Constipation, dyspepsia, dry mouth, vomiting
 Cardiac failure, deep vein thrombosis, hypotension,
syncope
 Depression
 Dry skin, fever
 Haematuria

T MONOGRAPHS
 Hepatic disorders
 Peripheral oedema
 Pneumonia, pulmonary embolism, interstitial lung disease
 Rash, Stevens-Johnson syndrome, toxic skin eruption
 Seek medical advice if you develop fever, sore throat,
chest pain, bleeding or swelling of a limb

 Seek medical advice if signs such as paraesthesia, abnor-
mal coordination or weakness develop

Pregnancy
 Do not use
Breast-feeding
 Do not use
Caution
 Monitor white blood cell and platelet count. Reduce dose
or interrupt treatment if neutropoenia or thrombocyto-
penia develop
 Thromboprophylaxis may be required in the first 5
months in patients with other risk factors to thrombosis
 Rule out pregnancy before starting treatment. Thalido-
mide is teratogenic. Women and men must practice
effective contraception at least 1 month before, during,
and for at least 1 month after treatment
 Avoid using combined oral contraceptives and copper-
releasing intrauterine devices
 Use with caution in severe hepatic failure and severe
renal failure. Monitor liver function

THIAMINE (VITAMIN B1) T
THIAMINE (VITAMIN B1) HC IV E 27
Vitamin B
Dosage forms
 Tablet: 100 mg
Uses
 Thiamine deficiency
 Beriberi
 Wernicke’s encephalopathy(specialist use only)
Dose and duration

 Mild deficiency
Adult and child over 3 years: 25‒100 mg PO daily

 Severe deficiency
Adult and child over years: 200‒300 mg PO daily in

divided doses
OR by IV infusion over 30 minutes
 Wernicke’s encephalopathy (specialist use)
Adult and child over years: by slow IV injection over

10 minutes, 300 mg daily in divided doses
Side effects
 Anaphylaxis following parenteral administration
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Mothers with severe thiamine deficiency should not
breast feed as toxic methyl-glyoxal is present in milk
T MONOGRAPHS
THIOGUANINE (TIOGUANINE) NR V 8.2

Dosage forms
 Tablet: 40 mg
Uses
Dose and duration

Adult and child: 100−200 mg/m2 daily
Side effects
 Bone marrow suppression
 Stomatitis, gastrointestinal intolerance
 Liver toxicity
Interactions
Pregnancy
 Do not use
Breast-feeding
Caution
 Monitor liver function weekly; discontinue medicine if
liver toxicity occurs
 Do not use for long term treatment due to liver toxicity
 Men and women of child-bearing age should use
adequate contraception while taking tioguanine
THIOPENTAL SODIUM T
THIOPENTAL SODIUM HC IV V 1.1
Intravenous anaesthetic. Very short-acting barbiturate; does
not have analgesic properties
Dosage forms
Uses
 Induction of general anaesthesia
 Anaesthesia of short duration
 Reduction of raised intracranial pressure in controlled
ventilation
Dose and duration
Adult: by slow IV injection using a 25 mg/ml solution,

initially 100–150 mg over 10–15 seconds followed by
another dose if required according to response after
30–60 seconds or up to 4 mg/kg (max 500 mg)
Elderly and debilitated: reduce dose
Child 1–18 years: by slow IV injection, initially, up to 4
mg/kg, then 1 mg/kg repeated as necessary (max total
dose 7 mg/kg)
Neonate: by slow IV injection, initially up to 2 mg/kg,
then 1 mg/kg repeated as necessary (max total dose
4mg/kg)
Adult: 1.5–3 mg/kg repeated as required

Adult: by slow IV injection of a 25 mg/ml solution,

75–125 mg as a single dose

T MONOGRAPHS
Child 1 month–18 years: initially 4 mg/kg by slow IV

injection, then up to 8 mg/kg/hour by continuous IV
infusion, adjusted according to response
Neonate: initially 2 mg/kg by slow IV injection, then up to
8 mg/kg/hour by continuous IV infusion, adjusted
Preparation
 For IV injection, dilute powder to a concentration of 25
mg/ml. Dilute 500 mg with 20 ml of water for injections

 For IV infusion, dilute to a concentration of 2.5 mg/ml
with normal saline solution

Contra-indications
 Acute porphyria
 Myotonic dystrophy
 Inability to maintain airway
 Hypersensitivity to barbiturates
 Dyspnoea or obstructive respiratory disease
Side effects
 Hypotension and hiccup with rapid injection
 Arrhythmias, myocardial depression
 Laryngeal spasm
 Cough, sneezing
 Headache
 Hypersensitivity reactions, rash
 Injection-site reactions
Interactions
 Chlorpromazine, fluphenazine, haloperidol (enhanced
hypotensive effect)
 Verapamil (enhanced hypotensive effect and AV delay)

THIOPENTAL SODIUM T
 Do not perform skilled tasks such as driving for at least 24
hours after administration

 Do not take alcohol within 24 hours of administration
Pregnancy
 Can be used
Breast-feeding
 Can be used
Storage
o
 Store powder below 25 C. Store reconstituted solution
between 2−8oC and use it within 7 hours

Caution
 Sedative effects can last up to 24 hours although
awakening is rapid
 Reconstituted solution is very alkaline and extravasation
causes severe pain and tissue necrosis
 Avoid intra-arterial injection because it causes intense
pain and may result into arteriospasm
 Use with caution in cardiovascular disease, hypovolemia,
severe haemorrhage, burns, status epilepticus,
myasthenia gravis, adrenocortical insufficiency, cachexia
and raised blood urea nitrogen
 Use with caution and reduce dose in hepatic impairment
 Use with caution in severe renal impairment
 Thiopental may depress neonatal respiration when used
during delivery. Do not exceed 250 mg in pregnancy
 Large or repeated doses severely depress respiration and
delay recovery

T MONOGRAPHS
TIMOLOL MALEATE RR N 21.7

B-blocker with topical antiglaucoma activity
Dosage forms
Uses
 Open-angle glaucoma
 Ocular hypertension
 Some cases of secondary glaucoma
Dose and duration

 All uses
Adult: instil 1 drop into affected eye every 12 hours

Dose may be increased to 1 drop of 0.5% solution if
the clinical response is not adequate. Usual mainte-
nance dose is 1 drop once a day
Child: 1 drop instilled in the affected eye once a day,
titrated to a maximum of 1 drop every 12 hours
Contra-indications
 Bradycardia
 Second and third degree atrioventricular block not con-
trolled by a pace-maker
 Uncontrolled heart failure
 Reactive airway disease including bronchial asthma
 Sick sinus syndrome, sino-atrial block
 Sinus bradycardia
 Presence or history of severe chronic obstructive
pulmonary disease
 Severe peripheral circulatory disturbances

TIMOLOL MALEATE T
Side effects
 Ocular stinging, burning, pain, itching, erythema
 Dry eyes
 Diplopia, ptosis
Interactions
 Lidocaine (increased myocardial depression)
 Nifedipine (enhanced hypotensive effect)
 Procainamide (increased myocardial depression)
 Verapamil (severe hypotension and heart failure)
 Close your eyes for at least 2 minutes after instillation of
the drops
 Discard remaining solution after 28 days from opening
 Wash hands well with water and soap before instillation
 Ensure the tip of the dispensing bottle does not touch the
eyelid or any part of the body or surface at any time

 Remove soft contact lenses before instillation of timolol
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 If timolol eye drops are used till delivery, carefully
monitor neonate for the first few days of life
 Use with caution in patients with corneal diseases
 Use with caution in the elderly due to risk of keratitis
 Systemic absorption may follow topical use in the eyes

T MONOGRAPHS
 Nasolacrimal occlusion or closing the eyelids for 2–3

minutes after instillation of the eye drops reduces
systemic absorption and increases local activity
 Reassess intra-ocular pressure at four weeks after
starting treatment as response may take a few weeks to
stabilize
 In case of switch from other topical beta- blocking agents,
discontinue for 24 hours and start treatment with timolol
thereafter. For other non-beta- blocker agents,
discontinue agent after 2 doses of timolol
TINIDAZOLE H N 6.4.1, 6.4.5

Nitroimidazole antimicrobial medicine active against amoeba,
protozoa and anaerobic bacteria
Dosage forms
 Tablet: 500 mg
Uses
 Amoebiasis
 Trichomoniasis
 Bacterial vaginosis
 Giardiasis
 Anaerobic infections
Dose and duration

 Intestinal amoebiasis
Adult and child >12 years: 2 g once daily for 2–3 days
once daily for 3 days
 Amoebic involvement of the liver
Adult and child >12 years: 1500–2000 mg once daily

TINIDAZOLE T
for 3–6 days
once daily for 5 days
 Trichomoniasis, bacterial vaginosis and giardiasis
Adult and child > 12 years: 2000 mg as a single dose
Child 1 month–12 years: 50–75 mg/kg (max 2 g) as a
single dose
 Anaerobic infections
Adult: 2 g, followed by 1000 mg daily or 500 mg 2 times
daily for 6 days
Contraindications
 Blood dyscrasia or history of blood dyscrasia
 Organic neurological disorder
Side effects
 Nausea, vomiting, taste disturbances, anorexia
 Oral mucositis, furred tongue
 Take your medication during or after meal
 Do not take alcohol during and for 72 hours after
stopping this medicine

Pregnancy
st
Breast-feeding
 Can be used
Caution
 Avoid breast feeding during and for 3 days after
treatment

T MONOGRAPHS
 Stop therapy if abnormal neurological signs develop
TRAMADOL RR V 2.3
Opioid analgesic. Produces analgesia by opioid effect as well
as by enhancement of serotonergic and adrenergic pathways
Dosage forms
 Capsule: 50 mg
Uses
 Management of moderate to severe pain
Dose and duration

 Management of moderate to severe pain
Adult and child over 12 years: by mouth, 50–100 mg not

more often than every 4 hours (max 400 mg daily)
By IM injection, slow IV injection over 2–3 minutes, or IV
infusion, 50–100 mg every 4–6 hours
Adult: initially, 100 mg then 50 mg every 10–20

minutes if necessary during the first hour to a total of
250 mg (includes initial dose). Then, 50–100 mg every
4–6 hours (max 600 mg daily)
Contra-indications
 Hypersensitivity to tramadol
 Acute intoxication with alcohol, hypnotics, analgesics,
opioids or psychotropic drugs

 Patients taking MAOIs currently or in the past 2 weeks
 Epilepsy uncontrolled by treatment

TRIAMCINOLONE ACETONIDE T
Side effects
 Vertigo, headache, drowsiness, fatigue
 Sweating
Interactions
 Fluoxetine, imipramine, amitriptyline (increased risk of
CNS toxicity)
 MAOIs (increased risk of convulsions)
 Do not drive till you know how this medicine affects you
Pregnancy
 Do not use
Breast-feeding
 Can be used
Caution
 Do not use in opioid-dependent patients
 Use with caution in impaired consciousness and excessive
bronchial secretions
 Do not use for longer than is absolutely necessary
 Give bisacodyl to prevent and treat constipation
TRIAMCINOLONE ACETONIDE RR N 28.3

Corticosteroid with significant glucocorticoid activity
Dosage forms
 Oral paste: 0.10%
Uses
 Mouth sores due to injury

T MONOGRAPHS
Dose and duration

 Mouth sores due to injury
 Adult and child over 6 years: Dab or press (do not rub)
a small amount of paste onto the area to be treated
until the paste sticks forming a smooth, slippery film,
2–3 times a day after meals or at bed time
Contraindications
 Infected wounds
Side effects
 Candidiasis
 Increased susceptibility to and severity of infection
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Prolonged use predisposes the patient to risk of develop-
ing or increasing severity of infections
TRIFLUOPERAZINE H E 24
Phenothiazine psychotherapeutic medicine
Dosage forms
 Tablet: 5 mg
Uses
 Mania
 Delirium with features of psychosis
 Severe nausea and vomiting unresponsive to other

TRIFLUOPERAZINE T
antiemetics
Dose and duration
 Mania and delirium with features of psychosis
Adult and child over 12 years: 5 mg twice daily, increased

to 15 mg daily in 2 divided doses after 1 week, then at
intervals of 3 days by 5 mg increments until satisfactory
control is achieved. Then reduce dose gradually until an
effective maintenance dose is achieved
Children ˂12 years: initial oral dose should not exceed 5
mg a day in divided doses
Adult: 2–4 mg every 12 hours (max 6 mg a day)

Child 12–18 years: 1–2 mg every 12 hours (max 6 mg a
day)
Child 6–12 years: up to 2 mg every 12 hours
Child 3–5 years: up to 0.5 mg every 12 hours
Contra-indications
 Comatose states
 CNS depression
 Liver damage
Side effects
 Drowsiness, insomnia, restlessness
 Dry mouth, anorexia
 Blurred vision
 Mild postural hypotension
 Muscular weakness, parkinsonian symptoms, dystonia,
tardive dyskinesia, muscle weakness

T MONOGRAPHS
Interactions
 Amiodarone (increased risk of ventricular arrhythmias)
 Citalopram (increased risk of ventricular arrhythmias)
 Saquinavir (increased risk of ventricular arrhythmias)
Pregnancy
 Do not use
Breast-feeding
 Do not use
Caution
 Only use in pregnancy and lactation if it is essential
 Start with small doses in severe renal failure due to
increased cerebral sensitivity
 Discontinue use at the first clinical symptom of tardive
dyskinesia
 Reduce initial dose in elderly patients due to increased
sensitivity to hypotensive and extrapyramidal effects
 May mask nausea and vomiting due to organic disease
 Restlessness due to large initial doses may resemble
exacerbation of the condition being treated
 Clinical improvement may not be evident for several
weeks after starting treatment, and there may also be
delay before recurrence of symptoms after stopping
treatment.
 There is a high risk of relapse if medication is stopped af-
ter 1–2 years. Withdrawal after long-term therapy should
always be gradual and closely monitored to avoid the risk
of acute withdrawal syndromes or rapid relapse. Observe
patient for up to 2 years after withdrawal

TOBRAMYCIN T
TOBRAMYCIN RR N 21.1
Broad spectrum aminoglycoside antibiotic
Dosage forms
 Eye drops: 0.3 %
Uses
 Superficial bacterial eye infections
Dose and duration

 Superficial bacterial eye infections
Adult and child over 1 year: instill 1 drop every 12 hours

for 6–8 days; in severe infection, apply 1 drop every 6
hours on the first day, then every 12 hours for 5–7 days
Contra-indications
 Hypersensitivity to tobramycin
Side effects
 Ocular discomfort
 Ocular hyperaemia
 Eye allergy
 Eyelid pruritus
 Discard remaining solution 1 month from first opening
 Do not wear your contact lenses
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Risk of cross-hypersensitivity to other aminoglycosides

T MONOGRAPHS
 Prolonged overuse may result into over-growth of

non-susceptible organisms including fungi
 May mask clinical signs of bacterial, fungal, or viral
infections and may suppress hypersensitivity reactions
TUBERCULIN, PURIFIED PROTEIN

HC IV N 19.1
DERIVATIVE (PPD)
Heat-treated products of growth and lysis of appropriate
Mycobacterium species used for the Mantoux test, which
tests hypersensitivity to tuberculoprotein
Dosage forms
Uses
 Hypersensitivity to tuberculoprotein
Dose and duration

 Diagnosis of hypersensitivity to tuberculoprotein
Give 0.1 ml (10 IU) by intradermal injection

Contra-indications
 Do not use within 4 weeks of receiving a live viral vaccine
Side effects
 Nausea
 Rash
 Local reactions (swelling, pain, redness)
Interactions
 Live vaccines (reduced response to tuberculin)
Pregnancy
 Can be used

VANCOMYCIN V
Breast-feeding
 Can be used
Caution
 A positive tuberculin test indicates previous exposure to
mycobacterial antigens, which could have been through
infection with one of the tubercle bacilli or through BCG
vaccination
 The tuberculin test is of limited diagnostic value as it does
not distinguish between tuberculosis and other mycobac-
terial infections, between active and silent disease or
between acquired infection and BCG vaccination-induced
seroconversion
 Viral infection, sarcoidosis, corticosteroid therapy or
immunosuppression may also suppress response to the
tuberculin test
V
VANCOMYCIN RR E 6.2.1
Antibacterial agent with bactericidal activity against aerobic
and anaerobic Gram-positive bacteria including methicillin-
resistant Staphylococcus aureus (MRSA)
Dosage forms
 Powder for solution for infusion: 500 mg
Uses
 Endocarditis
 Osteomyelitis
 Pneumonia

V MONOGRAPHS
 Soft- tissue infections

 Antibiotic associated colitis
Dose and duration

 Antibiotic associated colitis
By mouth
Adult and child over 12 years: 125–500 mg every 6 hours
for 7–10 days
Child 5–12 years: 62.5 mg every 6 hours and 250 mg
every 6 hours in life threatening infections for 7–10 days
Child 1 month–5 years: 5 mg/kg every 6 hours and 10
mg/kg in life-threatening infections for 7–10 days
Adult: by slow IV infusion over at least 60 minutes, 1 g

 Other uses
By slow IV infusion over at least 60 minutes. May be

given for up to 4–6 weeks depending on condition
Adult and child above 12 years: 500 mg every six hours
or 1 g every 12 hours
Elderly > 65 years: 500 mg every 12 hours or 1 g once
daily
Neonate over 35 weeks postmenstrual age and child 1
month–12 years: 15 mg/kg every 8 hours
Neonate 29–35 weeks postmenstrual age: 15 mg/kg
every 12 hours, adjusted basing on plasma concentration
Neonate less than 29 weeks postmenstrual age: 15
mg/kg every 24 hours, adjusted according to plasma
concentration
Preparation
 Consult product literature

VANCOMYCIN V
 Injection can be used to prepare solution for oral admin-
istration
Contraindications
 Hypersensitivity to vancomycin
Side effects
 Decrease in blood pressure
 Thrombophlebitis
 Dyspnoea, stridor (high-pitched breath sound)
 Exanthema and mucosal inflammation
 Pruritus, urticaria
 Increased serum creatinine
 Redness of upper body and face
 Pain and spasm of the neck and back muscles
Interactions
 Suxamethonium (enhanced effects of suxamethonium)
 Gentamicin (increased risk of nephrotoxicity and
ototoxicity)
 Furosemide (increased risk of ototoxicity)
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 Vancomycin should not be given by mouth for systemic
infections because it is not absorbed significantly
 Avoid rapid infusions due to increased risk of
anaphylactoid reactions

V MONOGRAPHS
 Rotate infusion sites

 Avoid in patients with a history of deafness
 Monitor auditory function in elderly or in patients with
renal impairment
 Reduce dose in renal impairment and monitor renal
function regularly
 Measure plasma concentration of vancomycin after 3 or 4
doses in patients with normal renal function or earlier in
renal impairment
 Only use in pregnancy if clearly needed and after careful
risk/benefit evaluation
 If used in a breast feeding mother, consider temporarily
discontinuing breast feeding
VECURONIUM BROMIDE NR V 20
Non-depolarising neuromuscular blocking medicine belonging
to the aminosteroid group
Dosage forms
 Powder for solution for injection: 10 mg
Uses
Dose and duration

Adult and child over 1 month: initially, 0.08–0.1 mg /kg

by IV injection, then maintenance dose of 0.02–0.03
mg/kg (max 0.1 mg/kg in caesarean section) by IV
injection or 0.8–1.4 µg/kg/minute by IV infusion, adjusted
Neonate: 0.08 mg/kg by IV injection, then maintenance
VECURONIUM BROMIDE V
dose of 0.03–0.05 mg/kg by IV injection or 0.8–1.4
µg/kg/minute adjusted according to response
Preparation
 Reconstitute each vial with 5 ml water for injections to
give 2 mg/ml solution; alternatively reconstitute with up

to 10 ml glucose 5% or sodium chloride 0.9% or water for
injections
 Solutions reconstituted without water for injections are
unsuitable for further dilution

 For continuous intravenous infusion, dilute to a
concentration up to 40 micrograms/ml
Contraindications
 Hypersensitivity to rocuronium or bromide
Side effects
 Changes in vital signs
 Prolonged neuromuscular block
 Anaphylactic and anaphylactoid reactions
Interactions
 Aminoglycosides (effect of vecuronium enhanced)
Pregnancy
 Can be used
Breast-feeding
 Can be used
Storage
o
 After reconstitution, store at 2–8 C for not ≥ 24 hours
Caution
 Use with caution in significant renal failure and hepatic
impairment
V MONOGRAPHS
 Use with caution in patients with hypersensitivity to

other neuromuscular blocking medicines
 Patients with burns may require higher doses due to
resistance to vecuronium
 Use lower doses in hyperthermia and myasthenia gravis
 Calculate doses on basis of ideal body weight in obese
patients
 Duration of action is shorter in children, therefore
maintenance doses are required more frequently
 Vecuronium causes paralysis of respiratory muscles
therefore respiratory support is required until adequate
spontaneous respiration is restored
VINCRISTINE RR V 8.2
Vinca alkaloid anticancer
Dosage forms
Uses
 Leukaemias
 Lymphomas
 Breast cancer
 Lung cancer
 Head and neck carcinoma
 Soft tissue sarcomas
 Ewing’s sarcoma
 Embryonal rhabdosarcoma
 Neuroblastoma
 Wilms’ tumour
 Retinoblastoma

VINCRISTINE V
 Medulloblastoma
 Idiopathic thrombocytopenic purpura
Dose and duration
Adult: 1.4−1.5 mg/m2 (max 2mg) by IV infusion weekly
Child: 1.4−2 mg/m2 (max 2mg) by IV infusion weekly
For children < 10kg, starting dose is 0.05 mg/kg
Contra-indications
 Hypersensitivity to vincristine
 Intrathecal administration
 Demyelinating form of Charcot-Marie-Tooth syndrome
Side effects
 Alopecia
 Constipation, abdominal cramps, paralytic ileus
 Diarrhoea, weight loss, nausea, vomiting
 Leucopoenia
 Severe local reaction and extravasation
 Rash
 Neurotoxicity (nerve pain, sensory loss, paraesthesia, dif-
ficulty in walking, loss of reflexes, movement disorders)

 Hypertension, hypotension
 Shortness of breath; bronchospasm
 Muscle pain; generalised body pain
 Urinary retention, dysuria, polyuria
 Fever
 Headache
Interactions
 Itraconazole (increased risk of neurotoxicity)

V MONOGRAPHS
Pregnancy
 Do not use
Breast-feeding
Storage
 Store between 2−8°C
Caution
 Monitor white cell count weekly
 Men and women should use adequate contraception
while taking vincristine
 For intravenous use only; use of other routes is fatal
VITAMIN A (RETINOL) HC II V 27
See retinol
VITAMIN B1 (THIAMINE) HC IV E 27
See thiamine
VITAMIN B6 (PYRIDOXINE) HC III E 27

See pyridoxine
VITAMIN B9 (FOLIC ACID) HC II N 10.1

See folic acid

VITAMIN B COMPOUND V
VITAMIN B COMPOUND RR V 27
Combination tablet of vitamin B3, B2 and B1 used as a
nutritional supplement
Dosage forms
 Tablet: B3 15 mg + B2 1 mg + B1 1 mg
Uses
 Prevention of vitamin B deficiency
Dose and duration

 Vitamin B deficiency prophylaxis
1‒2 tablets daily

Side effects
 None
Pregnancy
 Can be used
Breast-feeding
 Can be used
VITAMIN B COMPOUND (STRONG) HC IV N 27

Combination tablet of vitamin B3, B6, B2 and B1
Dosage forms
 Tablet: B3 20 mg + B6 2 mg + B2 2 mg + B1 5mg
Uses
 Vitamin B deficiency
Dose and duration

 Vitamin B deficiency
1‒2 tablets every 8 hours daily

W MONOGRAPHS
Contra-indications
Side effects
 None when used in therapeutic doses
Interactions
 Levodopa (pyridoxine increases metabolism of levodopa
leading to reduced effect of levodopa)

Pregnancy
 Can be used
Breast-feeding
 Can be used
VITAMIN K1 (PHYTOMENADIONE) HC II V 27
See phytomenadione
W
WARFARIN H V 10.2
Oral anticoagulant medicine
Dosage forms
Uses
Dose and duration

 All uses
Adult: induction dose 10 mg once daily for 2 days

WARFARIN W
adjusted to meet individual requirements. Daily
maintenance dose is usually 3 to 9 mg taken at the
same time each day, determined based on the
prothrombin time
Child 1 month–18 years: 0.2 mg/kg (max 10 mg) as a
single dose on first day, reduced to 0.1 mg/kg (max 5
mg) once daily for following 3 days. If INR is still below
1.4, use 0.2 mg/kg (max 10 mg) once daily. If INR is
above 3 use 0.05 mg/kg (max 2.5 mg) once daily. If INR
is above 3.5, omit dose, then adjust according to INR,
usual maintenance 0.1–0.3 mg/kg once daily
Neonate: specialist use only
Contra-indications
 Within 48 hours post–partum
 Clinically significant active bleeding
 Within 72 hours of major surgery with risk of severe
bleeding
Side effects
 Haemorrhage
 Nausea, vomiting, diarrhoea, melaena, vomiting blood
 Jaundice, hepatic dysfunction
 Alopecia
 Fever
 Hypersensitivity, rash
Interactions
 Acetylsalicylic acid, diclofenac (increased risk of bleeding)
 Alcohol (enhanced anticoagulant effect)
 Amitriptyline, corticosteroids, nevirapine (enhanced or

W MONOGRAPHS
reduced anticoagulant effect)

 Azathioprine, mercaptopurine (anticoagulant effect pos-
sibly reduced)
 Carbamazepine, griseofulvin, phenobarbital, rifampicin,
phenytoin (reduced anticoagulant effect)
 Azithromycin, cefazolin, cefixime, ceftazidime,
ceftriaxone, doxycycline, fluorouracil, fluoxetine,
ibuprofen, levamisole (enhanced anticoagulant effect)
 Glibenclamide (possibly enhanced hypoglycaemic effect
and changes to anticoagulant effect)
 Levonorgestrel, medroxyprogesterone, norethisterone,
phytomenadione (antagonism of anticoagulant effect)
 Ritonavir (concentration possibly increased by ritonavir)
 Chloramphenicol, cimetidine, ciprofloxacin, clomipra-
mine, clopidogrel, erythromycin, fluconazole, levothyrox-
ine, metronidazole, miconazole, ofloxacin, silver sulfadia-
zine, simvastatin, sulfadoxine + pyrimethamine, sulfa-
methoxazole +trimethoprim, tamoxifen, tramadol,
testosterone (enhanced anticoagulant effect)
Pregnancy
st rd
Breast-feeding
 Can be used
Caution
 Effect takes 48–72 hours to develop fully. Use with hepa-
rin in the first 3 days to allow for warfarin effect to set in
 Females of child-bearing age on warfarin should use ef-
fective contraception during treatment
 Reduce induction dose in the elderly

WHITFIELD'S’OINTMENT X
 Avoid in severe hepatic failure especially if prothrombin
time is already prolonged
 Use with caution in mild to moderate renal failure. Avoid
use in severe renal failure
WHITFIELD'S’OINTMENT HC II N 13.1
See benzoic acid + salicylic acid
X
XYLOMETAZOLINE HC IV E 28.2
Sympathomimetic nasal decongestant medicine
Dosage forms
 Nasal drops: 0.05% (paediatric)
 Nasal drops: 0.1% (adult)
Uses
 Decongestion of nostrils
Dose and duration

 Decongestion of nostrils
Adult and child > 12 years: 2‒3 drops of 0.1% prepara-

tion into each nostril every 8 hours
Child < 12 years: 2‒3 drops of 0.05% preparation into
each nostril every 8 hours
Do not use for longer than 7 days
Contra-indications
 Hypersensitivity to xylometazoline or other sympatho-
mimetic agents

Y MONOGRAPHS
Side effects
 Nausea
 Rebound congestion with excessive/prolonged use
 Headache
 Restlessness
 Sleep disturbances
 Discard bottle within 1 month of opening
Pregnancy
 Do not use
Breast-feeding
 Can be used
Caution
 Repeated or prolonged use can cause rebound
congestion and alter the nasal environment hardening
the structures
Y
YELLOW FEVER VACCINE H N 19.3.2
Live attenuated yellow fever virus
Dosage forms
 Powder for reconstitution: ≥ 1000 IU of 17D–204 strain of
yellow fever virus with 0.5 ml diluent; single dose

Uses
 Immunisation against yellow fever

YELLOW FEVER VACCINE Y
Dose and duration
Given as a deep SC injection,
 Immunisation against yellow fever
Adult and child above 9 months: 0.5 ml

Contra-indications
 Children under 6 months
 History of thymus dysfunction
 Hypersensitivity to eggs or chicken proteins
 History of serious hypersensitivity to yellow fever vaccine
 HIV infection
 Current severe febrile illness
Side effects
 Headache
 Muscle pain
 Weakness
 Fever
Interactions
 Azathioprine (impairment of immune response; avoid
concomitant use)
 Ciclosporin (impairment of immune response; avoid
concomitant use)
 Corticosteroids (high doses of corticosteroids impair
immune response; avoid concomitant use)

Pregnancy
 Do not use
Breast-feeding
 Do not use

Z MONOGRAPHS
Storage
 Store at 2– 8°C. Do not freeze. Protect from light
 Use immediately after reconstitution
Caution
 Should not be given during pregnancy, but if significant
risk of exposure cannot be avoided, then delay vaccina-
tion to the third trimester if possible (but the need for
immunisation usually outweighs risk to the foetus)
 In breast-feeding, only use vaccine if mother is at a real
risk of yellow fever disease
 Do not mix with another vaccine or medicinal product in
the same syringe. If there is need to inject another
vaccine at the same time, use separate sites
 Do not give to HIV- positive people. Seek specialist advice
if yellow fever risk is unavoidable
 Immunity starts from 10 days after primary immunization
up to about 10 years
Z
ZIDOVUDINE (AZT) HC IV V 30.1
ral medicine
Dosage forms
 Tablet: 300 mg

ZIDOVUDINE (AZT) Z
FDC tablet: AZT 60 mg + 3TC 30 mg + NVP 20 mg
Uses
 HIV/AIDS (second line to tenofovir)
Dose and duration

tion with 3TC + NVP or 3TC + EFV)

Adult and child > 25 kg: 300 mg every 12 hours
Child < 25 kg: use tablets with 60 mg AZT tablet as in
table below:
Weight (kg) No. of AZT 60 mg Tablets
Contra-indications
 Anaemia
 Low white blood cell count
 Neonates with high blood bilirubin levels (jaundice)
Side effects
 Anaemia
 Taste disturbances, stomach upset
 Low platelet count, low white blood cell count
 Muscle aches
 Headache
 Liver damage
 Blue/black discoloration of nails and mouth
Interactions
 Stavudine (cancelled effect)

Z MONOGRAPHS
 Fluconazole (increased side effects of zidovudine)

 Report to health worker immediately if any signs of
tiredness, feeling weak and dizzy with little energy, easily

breathless occur or if you have pale palms and nails
Pregnancy
 Can be used
Breast-feeding
 Can be used
Caution
 If patient is anaemic, first correct anaemia before starting
AZT or use a regimen with TDF instead
 Discontinue medicine if severe liver disease occurs
ZIDOVUDINE + LAMIVUDINE HC IV V 30.4

Combination of 2 NRTIs antiretroviral medicines
Dosage forms

monographs

ZIDOVUDINE + LAMIVUDINE + NEVIRAPINE Z
ZIDOVUDINE + LAMIVUDINE + NEVI-
HC IV V 30.5
RAPINE
Combination of two NRTI and one NNRTI antiretroviral
medicines
Dosage forms
ZINC SULPHATE HC I V 17.6.2

Reduces severity, duration and reoccurrence of diarrhoea
Dosage forms
 Tablet: 30 mg
 Effervescent tablet: 20 mg
Uses
 Diarrhoea in children
Dose and duration

Child 6 months–5 years: 20 mg once daily for 10–14 days
Child <6 months: 10 mg once daily for 10–14 days
Side effects
 Stomach upset
 Weakness, headache
 Irritability
Interactions
 Ferrous salts(reduced absorption)
 Place ½ or 1 tablet on a teaspoon, then add a little

Z MONOGRAPHS
drinking water, ORS, or breast milk. Dissolve and give to

child
 Older children may chew the tablet and swallow with or
without drinking water
 If the child vomits within 30 minutes of taking the
medicine, give another dose
 Give at least 2 hours apart from iron medicines
Caution
 Zinc sulphate is not a replacement for ORS
 Not recommended in malnourished children taking
therapeutic food as it already contains the right amount
of zinc
ZUCLOPENTHIXOL DECANOATE RR N 24
Thioxanthene first generation antipsychotic medicine
Dosage forms
 Injection (oily): 200 mg/ml
Uses
 Maintenance in schizophrenia and paranoid psychoses
Dose and duration

 Schizophrenia and paranoid psychoses
Adult: by deep IM injection into upper buttock or lateral

thigh, test dose 100 mg, followed at least 7 days later by
200–500 mg or more, then repeat at intervals of 1–4
weeks adjusted according to response (max 600 mg
weekly)
Elderly: ¼ to ½ of usual starting dose
In hepatic and renal impairment: ½ adult dose

ZUCLOPENTHIXOL DECANOATE Z
Contra-indications
 Circulatory collapse
 Depressed level of consciousness
 Coma
 Hypersensitivity to zuclopenthixol
Side effects
Side effects are dose dependent and occur mostly in early
phase of treatment
 Weight gain or loss
 Anaphylactic reaction
 Hyperprolactinaemia
 Insomnia, somnolence
 Extrapyramidal side effects, tardive dyskinesia
 Urinary frequency or incontinence
 Weakness, muscle pain
 Vertigo
Interactions
 Amiodarone, disopyramide, parenteral erythromycin,
moxifloxacin, sotalol, vandetanib (increased risk of

 Imipramine, amitryptyline (risk of ventricular arrhythmi-
as; manufacturer advises avoid concomitant use)

 Clozapine (avoid concomitant use; cannot be withdrawn
quickly in case of neutropenia)

Z MONOGRAPHS
 Do not drive if vision is blurred or if you feel drowsy
Pregnancy
 Do not use
Breast-feeding
 Can be used
Caution
 Injection volume greater than 2 ml should be distributed
between 2 injection sites
 Consider serum-level monitoring in hepatic impairment
 Avoid concomitant use of medicines which prolong QT
interval
 Risk of extrapyramidal or withdrawal effects in neonate
when zuclopenthixol is used in the 3rd trimester of
pregnancy. Only use if benefit to patient outweighs risk
to foetus

Calculation of Doses for Children

A. Weight-for-age
For many medicines, doses for children are usually written
as mg/kg or ml/kg. The child's actual weight should be
measured and used to calculate the dose. However, if that
is not possible, the chart in Figure 8 contains mean values
for weight-by-age, which can be used to determine the
dose.

Figure 8: Weight-by-age chart

B. Body surface area in children
For some antiretroviral medicines and anticancers, the
dose recommendations for children are in mg/m2 or
ml/m2. The "m2" stands for body surface area of the per-
son. The following estimations of body weight and corre-
sponding body surface area can be used to calculate re-
quired dose.
Body Weight (kg) Surface area (m2)

1 0.10
1.5 0.13
2 0.16
2.5 0.19
3 0.21
3.5 0.24
4 0.26
4.5 0.28
5 0.30
5.5 0.32
6 0.34
6.5 0.36
7 0.38
7.5 0.40
8 0.42
8.5 0.44
9 0.46
9.5 0.47
10 0.49
11 0.53
12 0.56

Body Weight (kg) Surface area (m2)
13 0.59
14 0.62
15 0.65
16 0.68
17 0.71
18 0.74
19 0.77
20 0.79
21 0.82
22 0.85
23 0.87
24 0.90
25 0.92
26 0.95
27 0.97
28-29 1.0
30-34 1.1
35-38 1.2
39-43 1.3
44-48 1.4
49-53 1.5
54-58 1.6
59-64 1.7
65-69 1.8
70-75 1.9
76-81 2.0
82-87 2.1
88-90 2.2

Medicines
Integrated Management of Child-

hood Illness (IMCI) Medicines
This section is based on the latest IMCI guidelines rather
than the UCG 2012. Please refer to the IMCI guidelines for
further details on management of childhood illnesses.
The medicines are listed in alphabetical order. Refer to the
monographs for dosing information.
CHILDREN 2 MONTHS TO 5 YEARS
Albendazole
 Elimination of intestinal worms
Amoxicillin
 First line treatment of pneumonia, acute ear infection
 Initial pre-referral dose for severe bacterial infection in
case injectable medicines unavailable

Ampicillin
 First line treatment of severe bacterial pneumonia (in
combination with gentamicin)

Artemether + lumefantrine
 First line treatment of uncomplicated malaria
Artesunate
 First line initial pre-referral treatment of severe
malaria (rectal)
 First line treatment of severe malaria (injection)
Ceftriaxone
 First line treatment of acute bacterial meningitis
 Second line treatment of dysentery in severely ill
children

Medicines
 Second line treatment of very severe pneumonia after
failure on first line treatment

Chloramphenicol
 Pre-referral dose for possible serious bacterial infec-
tion (PSBI) when child cannot take oral antibiotic

Ciprofloxacin
 First line treatment of bacterial dysentery
Diazepam
 Febrile convulsions due to severe malaria, respiratory
tract infections and urinary tract infections

Erythromycin
 Second line treatment of cholera
Folic acid
 Anaemia in children with sickle cell disease (with
ferrous salt)
Ferrous salt
 Iron-deficiency anaemia (children without sickle-cell
disease)
Gentamicin
 First line treatment of severe bacterial pneumonia (in
combination with ampicillin)

Mebendazole
 Elimination of intestinal worms
Oral rehydration salts (ORS)

 Prevention and treatment of dehydration
Paracetamol
o
 Treatment of fever >38.5 C and/or pain
Procaine benzylpenicillin (PPF)

Medicines
 Third line treatment of acute ear infection, very severe
disease, and pneumonia
Quinine
 Second line initial pre-referral treatment of severe ma-
laria. Use only if rectal artesunate is not available

Retinol (Vitamin A)
 Prophylactic treatment in persistent diarrhoea, severe
malnutrition, pneumonia
 Dietary supplement for all children 6 months–5 years
INFANTS 0 MONTHS TO 2 MONTHS

Amoxicillin
 First line treatment of local bacterial infection
Benzylpenicillin
 Initial pre-referral dose for treatment of severe bacte-
rial infection
 Initial pre-referral treatment of PSBI (with chloram-
phenicol)
Ceftriaxone
 First line treatment of acute bacterial meningitis
 Second line treatment of dysentery in severely ill in-
fants
Chloramphenicol
 Initial pre-referral dose for pneumonia
 Initial pre-referral treatment of PSBI (in combination
with benzylpenicillin)
 If referral is not possible
Procaine penicillin
 Third line treatment of local bacterial infection

Medicines for Integrated Community Case Management
(ICCM) of Childhood Illness
Vitamin K
 Prevention of neonatal bleeding in all new-borns
Medicines for Integrated Commu-

nity Case Management (ICCM) of
Childhood Illness
The following medicines are given to village health teams
for use in ICCM. Refer to doses in the monographs for
dosage information.
1. Artemether/Lumefantrine
2. Amoxicillin
3. ORS
4. Zinc
5. Artesunate (rectal)
UN Life Saving Commodities for

Mothers and Children
In line with the recommendations of the United Nation's
Commission on Life-Saving Commodities (UNCoLSC), the
Ministry of Health has identified 13 high priority commodi-
ties to be used to save and improve mothers’ and chil-
dren’s lives. The commodities are in the areas of reproduc-
tive, maternal, neonatal, and child health (RMNCH).
Efforts are already underway to ensure that there is in-
creased access to and utilisation of these items in appro-
priate dosage forms. Refer to the monographs for dosing
information.
UN Life Saving Commodities for Mothers and Children
Reproductive health commodities
1. Female condom to prevent unwanted pregnancies
and sexually transmitted infections
2. Contraceptive implants for family planning
3. Emergency contraceptive pill to prevent unwanted
pregnancies
Maternal health commodities
4. Misoprostol for prevention and treatment of
postpartum haemorrhage (PPH)
5. Oxytocin injection for prevention and treatment of
PPH
6. Magnesium sulphate for prevention and treat-
ment of severe pre-eclampsia and eclampsia
New born health commodities
7. Antenatal corticosteroids (e.g. dexamethasone or
betamethasone) for foetal lung maturation in
preterm labour
8. Injectable antibiotics (e.g. ceftriaxone) for
neonatal sepsis
9. New born resuscitation devices to aid new born
breathing
10. Chlorhexidine for cord care to prevent umbilical
cord infections
Child health commodities
11. Oral rehydration salts for diarrhoea treatment
12. Zinc for diarrhoea treatment
13. Amoxicillin dispersible tablets for treatment of
pneumonia

Adverse Drug Reaction Reporting

Any medicine may cause unwanted or unexpected adverse
reactions. Rapid detection and recording of adverse drug
reactions (ADR) is of vital importance so that unrecognised
hazards are identified promptly and appropriate regulato-
ry action is taken to ensure medicines are used safely and
future events are prevented. Health workers are urged to
report suspected ADRs directly to the National Drug
Authority Pharmacovigilance Centre using the ADR form
bound in this book. Encourage your patients to report
suspected ADRs to you.
Suspected ADRs to any medicine should be reported (in-

cluding self-medication medicines), vaccines and herbal
products.
Adverse reactions may be prevented as follows:
 Never use a medicine unless it is indicated
 If a patient is pregnant, do not use a medicine unless it
is very necessary
 Ask the patient if they have any allergies or hypersen-
sitivity to any medicine before you give out medicines
 Ask if patient is taking other medicines including self
medication medicines, health supplements, herbal
products as interactions can occur
 Age and liver or kidney disease may affect the way
medicines behave in the body so that smaller than
usual amounts are needed
 Always prescribe as few medicines as possible
 Warn the patient if serious adverse reactions are liable
to occur
The following regional pharmacovigilance centres at regis-

tered hospitals can be contacted for further information.
The telephone number provided is for the regional phar-
macist/coordinator:
Hospital Box no. Phone no. Email
Mulago 7051 0772507017 dmh@uga.healthnet
Kampala .org
Masaka 18 0772188993
Masaka
Kabale 7 0772455173 klehosp@ ut-
Kabale lonline.co.ug
Kabarole 10 0772659531 fortportalhospi-
Fort Portal tal@yahoo.com
Hoima 5 077244276 hoimareg@utl.co.ug
Hoima
Arua 3 0782927403
Arua
Gulu 160 0790878209 guluhospital
Gulu @yahoo.co.uk
Lira 2 0704815448
Lira
Soroti 289 0775489311 shosp@utlonline.co.
Soroti ug
Mbale 921 0774123023 mbalehosp
Mbale @utlonline.co.ug
Jinja 3 0772455256 jinjahosp
Jinja @utlonline.co.ug
Mbarara 40 0782007251 mreferral. hospi-
Mbarara tal@gmail.com
Mubende 4 0704297460
Mubende
Butabika 707 0772507017 info@ butabikahos-
Kampala pital.com
Moroto 0752868699
The following NDA offices can also be contacted for further

information:
NATIONAL DRUG AUTHORITY Head Office
Plot 46/48 Lumumba Avenue
P.O.Box 23096
Kampala, Uganda
Tel. 0414255665/0414347391/0414344052
Email: ndaug@nda.or.ug
NATIONAL DRUG AUTHORITY
South-Western Regional Office
House No. 29, Mbaguta Estates Kamukuzi
P.O. Box 1886
Tel. 0485-421088
MBARARA – UGANDA
Eastern Regional Office
South Bukedi Cooperative Building
Plot No. 6 Busia Road
P.O. Box 453
Tel/Fax 045-45185
TORORO – UGANDA
Northern Region Office
Erute Road
P.O. Box 235
Tel./Fax 0473-420652
LIRA – UGANDA

South-Eastern Regional Office
Stanley Road, Jinja Municipality
P.O. Box 1710
Tel. 0465-440688
JINJA – UGANDA
Central Regional Office
Premier Complex Building
Tel. 0312-261548
NAKAWA - KAMPALA
Western Regional Office
Main Road
Tel. 0465440688
HOIMA - UGANDA
Note: Please attach additional pages to the ADR reporting

form below if necessary. Even if you do not know some
details in the form, do not be put off reporting the sus-
pected adverse event.



Glossary
Glossary
Abscess Painful collection of pus caused by
bacterial infection
Acne Skin disease characterized by scaly
red skin, swellings/nodules, black
spots, white spots, pimples, and
sometimes scars. Commonly affects
the face, upper part of chest, and
the back
Akathisia Involuntary movements induced by
antipsychotics that drive a person to
restless over activity especially as
restless legs syndrome
Allergy, allergic reac- Stimulation of the immune system
tion to produce symptoms such as itch-
ing rash, hives, sneezing, difficulty in
breathing, or shock. Occurs when
specific things are eaten, breathed
in, touched, or injected
Anaphylaxis Severe life threatening allergic reac-
tion that develops rapidly. Symp-
toms include breathing difficulty,
light-headedness, itchy skin or rash,
sometimes shock, and swelling of
certain body parts (angioedema)
Angioedema Swelling of the deeper layers of the
skin due to fluid building up. It usu-
ally affects the lips, eyes, genitals,
hands, and feet
Anorexia Lack or loss of appetite
Anorexia nervosa Psychological disorder characterised
by avoidance of food intake leading
to severe weight loss
Glossary
Antacid Medicine used to control too much
stomach acid and to calm stomach
upset
Anticholinergic A substance that blocks the action
of the neurotransmitter acetylcho-
line in nervous system
Antibiotic Medicine used to prevent or fight
bacterial infection
Antihelminthic, de- Medicine that kills or expels parasit-
wormer ic intestinal worms (helminths)
Antihistamine Medicine that inhibits the action of
histamine causing relief of allergic
symptoms
Antimicrobial Medicine used to prevent or fight
microorganisms, such as bacteria,
fungi, and viruses
Antimuscarinic Medicine that blocks the activity of
the muscarinic acetylcholine recep-
tor. This results in effects such as
dry mouth, widening of pupils, in-
creased intraocular pressure, hot
and flashed skin, constipation, uri-
nary retention, and irregular heart-
beat
Antipsychotic Medicine used to treat mental ill-
ness
Apathy Lack of interest or enthusiasm in
one’s surroundings
Arrhythmia Problem with the rhythm or rate of
the heartbeat; it can beat too fast,
too slow, or irregular
Arthralgia Severe joint paint without swelling
or other signs of arthritis
Bactericidal Antibiotic that kills bacteria

Glossary
Bacteriostatic Antibiotic that stops the growth of
bacteria
Blood disorders Anaemia, low white blood cell
count, low neutrophil count, low
platelet count
Blurred vision Not able to see objects clearly
Broad spectrum For antimicrobials, killing a wide
range of microorganisms. For anti-
biotics, killing both gram positive
and gram negative bacteria
Bulimia nervosa Episodic binge eating often followed
by behaviour designed to prevent
weight gain such as purging, fasting,
laxative use or excessive exercise
Cardiac To do with the heart
Cardiac tamponade Compression of the heart due to
collection of fluid or blood in the
pericardium
Cerebrovascular dis- Conditions that develop as a result
ease of problems with blood vessels in
the brain (e.g. stroke, transient is-
chaemic attack)
Charcot-Marie-Tooth An inherited neurologic disorder
syndrome characterised by neuropathies
without known metabolic derange-
ments
Congenital Disease or condition that is present
from birth (child was born with it)
Contraindication Situations in which a certain medi-
cine should not be used
Cross-sensitivity Situation where sensitivity to one
substance makes the person at risk
of sensitivity to another substance
that is related in chemical structure

Glossary
Croup Common childhood ailment associ-
ated with upper respiratory symp-
toms, arising from viral infection of
the larynx
Cushing’s syndrome Group of signs and symptoms
caused by prolonged use of cortico-
steroids (hydrocortisone, dexame-
thasone, prednisolone)
Delirium tremens Acute episode of severe shaking
caused by withdrawal from alcohol
Dependence Also called addiction. A compulsive
need to use drugs in order to func-
tion normally. In the absence of the
drugs, the user suffers from with-
drawal
Dermatologic To do with the skin
Difficulty in sleeping Failure to fall asleep, bad dreams,
interrupted sleep
Diluent Substance used to dilute another
substance
Disinfectant Substance that kills microorganisms
or inhibits their growth when ap-
plied to living tissues
Disulfiram-like Nausea, vomiting, skin-flushing, fast
reaction heartbeat, shortness of breath that
can occur when a person taking
metronidazole takes alcohol at the
same time
Dyscrasia An abnormal state of the body or
part of the body especially one due
to abnormal development or me-
tabolism
Dyskinesia A group of involuntary movements
that appear to be a fragmentation

Glossary
of the normal smoothly controlled
limb and facial movements
Dysphagia A condition where swallowing is
either difficult or painful
Eclampsia Serious complication of pregnancy
in which a pregnant woman with
hypertension has one or more sei-
zures
Effervescent Escape of gas/bubbles in an aque-
ous solution. Some tablets are
made to quickly dissolve in wa-
ter/diluent to form a solution that is
then drunk (e.g. zinc sulphate tab-
lets)
Effusion Abnormal, excessive collection of
fluid
Electrolyte imbalance High or low sodium, potassium, cal-
cium and acid levels in blood
Ergotism Poisoning due to ingestion of ergot,
characterised by cerebrospinal
symptoms, spasm, cramps, necrosis
of the extremities and burning pain
due to intense peripheral vasocon-
striction
Euphoria Mental and emotional condition in
which a person experiences intense
feelings of happiness, excitement,
and joy
Extrapyramidal side Parkinson-like symptoms (involun-
effects tary shaking); abnormal face and
body movements; restlessness;
rhythmic involuntary movements of
tongue, face, and jaw
Extravasation A discharge or escape of blood from

Glossary
the vessel into the tissues
Filariasis Infection with any of the several
varieties of filaria, nematode worms
in the Filariodea family
Foetus The term referred to a growing ba-
by in the womb after the embryo
stage (at about 11 weeks of preg-
nancy)
Folinic acid rescue Speeded up recovery from metho-
trexate-induced mucositis or myelo-
suppression by administration of
folinic acid to counteract the folate-
antagonist action of methotrexate
Gastric To do with the stomach
Glue ear Infection of the middle ear with flu-
id
Gout An inflammation disorder causing
severe pain in the joints due to
deposition of uric acid crystals
Grey baby syndrome Vomiting, greenish diarrhoea, swell-
ing of the abdomen, low body tem-
perature, pale and bluish skin and
mucous membranes, irregular
breathing, circulatory collapse, es-
pecially in neonates. Possible side
effect of chloramphenicol
Haemoglobinuria Presence of haemoglobin in urine
Haemolysis The breakdown of red blood cells
Hallucinations Experiences of sight, sound, smell,
taste, or touch that do not exist
outside of a person’s mind
Hawkinsinuria A rare form of tyrosinaemia with
urinary excretion of hawkinsin, a
cyclic amino acid metabolite of ty-

Glossary
rosine
Hepatitis Inflammation of the liver
Hyperoxaluria Excessive urinary excretion of oxa-
late which can lead to kidney stones
Hypersensitivity Undesirable reaction by the normal
reaction immune system involving overreac-
tion of certain body functions. Ex-
amples are allergy and autoimmune
disease (e.g. gout). Symptoms can
include rash, fever, nausea, vomit-
ing, diarrhoea, abdominal pain, dif-
ficulty in breathing, cough, feeling
of sickness and weakness, headache
and muscle pain
Hypertension High blood pressure
Hypodermoclysis Subcutaneous injection of fluids
Hypotension Low blood pressure
Hypovolemia Low blood volume
Immuno- Condition in which the immune sys-
compromised tem is weakened so the body can-
not easily fight against diseases and
the person can easily develop infec-
tion. Can occur in patients with
HIV/AIDS, on anti-cancer medicines
or during pregnancy
Immunosuppressed See immunocompromised
Inactivate To make vaccine or medicine inac-
tive and therefore prevent it from
working
Inflammation Immune system response to infec-
tion, irritation, or injury. The pro-
cess produces symptoms such as
pain, heat, redness, swelling
Interactions Situation in which a substance

Glossary
(medicine, food, condition) affects
the activity of another medicine
when both are given at the same
time. The medicine’s effects may be
increased, decreased, or eliminated;
or a new reaction may occur.
Intracranial pressure The pressure inside the skull and
hence the brain
Intramuscular Into the muscle
Intravenous Into the vein
Irregular heartbeat Fast heartbeat, slow heartbeat, un-
even heart beat
Irrigation Washing the affected area/wound
with a large amount of disinfectant
Jarisch-herxheimer Unpleasant reaction that occurs
reaction when large numbers of the bacteria
that cause syphilis are being killed
(when treatment has just started);
symptoms are feeling of sickness,
rash, fast breathing, fever. It occurs
within 1–12 hours of treatment and
resolves within 12–24 hours
Keratolytic Substance that can remove excess
skin that occurs in conditions such
as warts, psoriasis, dandruff
Lactic acidosis Condition of low pH in blood and
body tissues due to accumulation of
lactate. Signs include deep and rap-
id breathing, severe nausea and
vomiting, abdominal pain, feeling of
sickness/weakness, low blood pres-
sure and confusion. It is a possible
side effect of NRTI ARVs
Lesion Localised patch of injury to the liv-

Glossary
ing tissue or organ
Menstrual disturb- Conditions such as dysmenorrhoea
ances (painful menstruation), amenor-
rhoea (no menstruation), spotting
(light bleeding from the vagina that
occurs when it is not yet time for
the expected menstrual period),
very heavy bleeding, reduced num-
ber of bleeding days or prolonged
number of bleeding days
Monograph Piece of writing on a single subject;
a medicine monograph gives all the
details concerning a single medicine
or combination of medicines
Motion sickness Dizziness, nausea, feeling sick, and
vomiting associated with travelling
in a vehicle
Movement disorders Staggering, swaying from side to
side, involuntary shaking of body
parts
Mucous membranes Lining of the mouth, eyes, vagina
and rectum
Mucositis Inflammation of mucosa as a side-
effect of chemotherapy or radio-
therapy of the head and neck char-
acterised by burning sensation, red-
ness and sometimes ulceration
Myalgia Muscle pain
Myelosuppression Depression of bone marrow func-
tion resulting in reduced production
of all blood cells, resulting in anae-
mia, neutropenia, thrombocytope-
nia, leucopoenia
Mydriasis Widening of the pupil

Glossary
Neuritis Inflammation of a nerve. Symptoms
include pain, feeling of pins and
needles punching the skin or inside
the body, weakness in limb move-
ment, numbness, paralysis, lack of
feeling, disappearance of reflexes.
Neuropathy Damage to the nervous system
Neurotoxic Substance that can damage the
nerves
Obsessive Disorder characterised by persis-
compulsive disorder tent, intrusive and senseless
thoughts (obsessions) or compul-
sions to perform repetitive 795be-
haviours that interfere with normal
functioning
Onchocerciasis Chronic filarial worm infection
transmitted by blackfly, which caus-
es fibrous nodules in dermal tissue
which ulcerate. If often invades
eyeballs destroying the aqueous
and vitreous humour hence irre-
versible blindness
Ophthalmia Inflammation of the eyes
Optic To do with the eyes
Osteoarthritis Degenerative disease characterised
by inflamed joints which become
stiff and painful
Osteomalacia Condition of the skeleton character-
ised by softening of bones because
of reduced mineralisation usually
due to deficiency of vitamin D
Osteomyelitis Inflammation of the bone due to
infection
Osteoporosis Condition that affects the bones

Glossary
causing them to become weak, frag-
ile, and more likely to break
Panhypopituitarism Diminished or absent secretion of
all the anterior pituitary hormones
Paraesthesia Spontaneously occurring tingling
sensation, sometimes described as
pins and needles which may be due
to partial and temporary damage to
a peripheral nerve
Parenteral To be injected directly into the
body. Parenteral routes include in-
travenous, intramuscular, subcuta-
neous
Pediculicide Substance that can kill lice
Pessary Tablet/capsule meant to be inserted
into the vagina
Pheochromocytoma A tumour of tissues derived from
embryological neuroectoderm, of-
ten of the adrenal medulla
Polycythaemia An increase in packed cell volume
(haematocrit) in the blood
Porphyria Genetic disorder characterised by a
disturbance in porphyrin metabo-
lism with resultant increase in for-
mation and excretion of porphyrins
or their precursors
Pre-eclampsia Combination of pregnancy-induced
hypertension and proteinuria with
or without oedema
Prophylaxis Treatment given or action taken to
prevent disease
Quinsy Abscess between the tonsils and the
pharynx. Also known as peritonsillar
abscess.

Glossary
Renal To do with the kidneys
River blindness See onchocerciasis
Rosacea Chronic skin condition characterised
by facial redness, papules or pus-
tules and small visible spider-like
veins
Salicylism Toxic condition characterised by
ringing in the ears, nausea, vomit-
ing, and dizziness. Caused by aspirin
poisoning or prolonged treatment
of large areas of skin with salicylic
acid ointment
Scabicide Medicine that destroys the itch mite
that causes scabies
Sedative Medicine that reduces excitability
or anxiety; makes a person calm
Side effect Unwanted effect of a medicine that
occurs along with the desired effect
Stevens-Johnson Severe and potentially fatal hyper-
syndrome sensitivity disorder with mild to se-
vere skin and mucous membrane
lesions
Strongyloidiasis Infestation of small intestine with
parasitic nematode worm Strongy-
loides stercoralis
Subcutaneous Just beneath the skin
Sublingual Under the tongue. Used as a route
of administration for medicines,
which diffuse into the blood
through the tissues under the
tongue
Suppository Tablet/capsule for inserting into the
rectum
Systemic Route of administration of medicine

Glossary
so that the whole body is affected
(oral, parenteral, and rectal). Oppo-
site of topical
Tardive dyskinesia A condition characterised by invol-
untary repetitive movements of fa-
cial muscles and the tongue; usually
resembling continued chewing mo-
tions and the muscles of the limbs
Thrombocythaemia A blood disorder in which the body
produces excess platelets (throm-
bocytes)
Thrombocytosis See thrombocythaemia
Thrombosis Blood clot within a blood vessel.
Blood clots can form and block a
vein or an artery, thus obstructing
or stopping the flow of blood.
Thyrotoxicosis Excessive amounts of thyroid hor-
mones in the blood stream causing
rapid heartbeat, sweating, tremor,
anxiety, increased appetite, weight
loss and heat intolerance
Tinnitus Perception of sound coming from
within the body/head; ringing in the
ears
Tolerance Situation where a person’s response
to a medicine decreases over time,
so that they need larger and larger
doses to have the same effect
Topical Substances that are applied directly
to body surfaces, such as skin, eyes,
ears, nose, scalp, mucous mem-
branes. Medicine delivered directly
to affected parts. Opposite of sys-
temic

Glossary
Torsades de pointes Paroxysms of ventricular tachycar-
dia in which the ECG shows a steady
undulation in the QRS axis in runs of
5–20 beats and with progressive
changes in direction
Tyrosinaemia An aminoacidopathy consisting of
defective metabolism of tyrosine
and its build up in the body, as well
as urinary excretion of related me-
tabolites
Trimester The division of pregnancy into three
periods of three months each: first,
second, and third trimesters
Vertigo Feeling that the environment or
world around you is spinning. Pa-
tient may feel sick, nauseated, dizzy
and feel like falling
Visual disturbances Difficulty in seeing, unclear images,
double vision, pain in the eyes when
in bright lights
Wilson’s disease An inherited disorder of copper me-
tabolism characterised by cirrhosis,
degeneration of the basal ganglia of
the brain and deposition of a green
pigment in the periphery of cornea
Withdrawal Severe symptoms of a disease that
symptoms occur when the medicine used for
treatment is stopped abruptly.
Commonly occurs with antiepileptic
and antipsychotic medicines (e.g.
chlorpromazine, phenobarbital,
morphine, and prednisolone)
Zollinger-Ellison Disorder where there is excessive
syndrome production of gastrin

References
References
 BMJ Group and the Royal Pharmaceutical Society of
Great Britain, 2014. British National Formulary 66,
2013-2014. London, UK
 BMJ Group and the Royal Pharmaceutical Society of
Great Britain, 2014. British National Formulary for
Children 2013-2014. London, UK
 Datapharm, 2015. Summary of Product Characteris-
tics. Electronic Medicines Compendium (eMC). Data-
pharm. London, UK. Available at:
(https://www.medicines.org.uk/emc/)
 Management Sciences for Health, 2012. MDS-3:
Managing Access to Medicines and Health Technolo-
gies. Arlington, USA. Available at:
(http://www.msh.org/sites/msh.org/files/mds3-
jan2014.pdf
 Ministry of Health Uganda, 2012. Essential Medicines
and Health Supplies List of Uganda 2012. Ministry of
Health, Kampala Uganda
 Ministry of Health Uganda, 2012. Management of Medi-
cines and Health Supplies Manual, Ministry of Health,
Pharmacy Division. Kampala, Uganda.
 Ministry of Health Uganda, 2012. Uganda Clinical
Guidelines, 2012. Ministry of Health, Kampala,
Uganda.

References
 World Health Organisation, 2009. WHO Model For-
mulary 2008. Geneva, Switzerland. Available at:
(http://apps.who.int/medicineds16879e/s16879e.pd
focs/documents/)
 World Health Organisation, 2010. WHO Model For-
mulary for Children, 2010. Geneva, Switzerland.
Available at:
http://www.who.int/selection_medicines/list/WMF
 World Health Organisation, 1995. Guide to Good Pre-
scribing. Geneva, Switzerland

Amendment Form
Amendment Form
Your feedback for the Practical Guidelines for Dispensing is
very important to improve the next version. Please use the
form on the next page to propose amendments to any
part of the guidelines. The suggested amendments can
relate to inaccurate information or sections that are hard
to understand.
The amendment form should be, if necessary, submitted
with relevant supporting documentation or references.
You may use extra additional papers if needed. Submit the
form by post, fax, or e-mail to:
Ministry of Health
PO Box 7272
Kampala
Assistant Commissioner Health Services
Pharmacy Division
Tel: (+256) 772 570869
E-mail: serumorries@gmail.com
Thank you for your feedback!

Amendment Form
-------------------------------------------------------
Practical Guidelines for Dispensing for Higher Level 2015

Amendment form
Names: Position:
Phone number: Email address:
Health facility:
Medicine name/Formulation:
Suggested amendments or concerns:
-------------------------------------------------------
Index
Index
Abdominal infection, 82 AIDS, 90, 91, 446, 721,
Abnormal vaginal 765
discharge syndrome, Albendazole, 775
180, 315, 316 Alcohol dependence, 536
Abortion, 320, 328, 522, Allergic angioedema, 402
523, 576 Allergic reaction, 88, 290,
Absence seizures, 593 432, 625, 635
Acetazolamide, 301, 466 Allergic reactions, 432,
Acetylsalicylic acid, 759 625, 635
Acne, 137, 683, 684, 712 Allergic skin reaction, 96,
Acne vulgaris, 137 402
Acromegaly, 151, 152 Allergy, 187, 258
Acute bronchitis, 80, 289 Allergic angioedema, 402
Acute kidney infection, Allergic reactions, 624,
80, 81, 368, 369, 595 635
Acute lymphoblastic Allergic skin reaction,
402
anaemia, 108
Anaphylaxis, 70, 71, 623,
Acute pain, 526 624, 625, 680
Acute pyelonephritis, 87, Nasal, 200
208, 209 Skin, 156, 200
Addison's disease, 232 Allopurinol, 123, 351,
Adenocarcinoma, 366 492
Adrenal hyperplasia Aluminium overload,
Congenital, 232 253, 254
Adrenal insufficiency, Alzheimer's dementia,
144, 232 673
Adrenaline, 177, 308, Amikacin, 206, 544, 716
309, 327, 394, 418
Index
Aminophylline, 58, 316, Angina, 78, 175, 378,
440, 682 433, 642, 643
Amiodarone, 75, 112, Angle closure glaucoma,
177, 231, 443, 487, 51
529, 746, 769 Angle-closure glaucoma,
Amitriptyline, 120, 170, 378, 604
201, 355, 390, 502, Animal bites, 83, 513
594, 598, 601, 628, Anogenital warts, 611
637, 700, 759 Anovulatory infertility,
Amnionitis, 87 717
Amoebiasis, 513, 740 Anthrax, 208, 289, 455
Amoxicillin, 775, 777, Anxiety, 66, 76, 264, 265,
778, 779 417, 472
Amphotericin B, 233, Artemether, 100, 125,
259, 346, 404 198, 210, 345, 487,
Ampicillin, 89, 775 628, 652, 775, 778
Anaemia, 195, 337, 339, Arterial occlusion, 705
356, 357, 475, 776 Artesunate, 102, 775,
Macrocytic, 406 778
Pernicious, 406 Arthritis
Anaesthesia, 256, 326, Pyogenic, 419
393, 428, 436, 639, Ascites, 359
685 Ascorbic acid, 106
Anal itching, 148 Aspergillosis, 84
Analgesia, 335 Aspirin, 304, 420
Intra-operative, 334 Assisted reproduction,
Anaphylactic shock, 307, 383
402, 455, 632, 635, Asthma, 58, 70, 71, 128,
636 402, 624, 625, 680,
Anaphylaxis, 71, 94, 258, 681
259, 574, 575, 624,
678
Index
Atenolol, 113, 308, 462, Bipolar disorder, 448,
628 465, 565, 672
Athletes foot, 386, 508, Bite
617 Animal, 196, 513
Atopic dermatitis, 204 Insect, 156, 199, 200
Atrial fibrillation, 271, Snake, 199, 200
627 Bites, 80
Atrial tachycardia, 627 Bladder cancer, 213, 366
Attention deficit Bladder tumour, 524
hyperactivity disorder, Blastomycosis, 85
503 Bleeding, 54, 333, 334
Autoimmune disease, Bleomycin, 214
121 Bone marrow
Avian influenza, 572 depression, 389, 524
Azathioprine, 65, 760, Bowel colic, 380, 410
763 Bradycardia, 58, 685, 738
Azithromycin, 101, 206, Breast cancer, 238, 280,
294, 313, 760 350, 366, 524, 531,
Bacteraemia, 89 704, 717, 754
Bacterial tonsillitis, 80, Breast infection, 314
81, 124, 125, 595, 596 Bronchiolitis, 141, 193,
Bacterial vaginosis, 513, 194, 680, 681, 689,
514, 740 702
Bendroflumethiazide, Bronchitis, 70, 80, 81,
423 124, 125
Benzhexol, 203 Bronchopneumonia, 89
Benzodiazepine toxicity, Brucellosis, 208, 209,
348 234, 288, 289, 368
Benzoyl peroxide, 137 Bubo
Benzyl benzoate, 141 see Inguinal swelling,
289
Benzylpenicillin, 777
Bulimia nervosa, 352
Index
Bupivacaine, 155, 644 Cellulitis, 80, 82
Burn, 687, 688 Cerebral oedema, 481,
Burn wound, 425 505
Burns, 358, 688 Cerebrovascular disease,
Calcium deficiency, 162 53, 54
Calcium gluconate, 478 Cervical cancer, 213,
Cancer, 415, 499 408, 409
Candidiasis, 223, 342, Chagas disease, 551
562, 744 Chicken pox, 156, 199,
Oesophageal, 440 200
Oral, 440, 508, 562 Chloramphenicol, 760,
Vaginal, 440, 562 776, 777
Candiduria, 342, 343 Chlorhexidine, 195, 196,
Carbamate poisoning, 405, 779
621 Chloroquine, 199, 207,
Carbamazepine, 52, 199, 275, 295, 487, 700
206, 232, 487, 594, Chlorpromazine, 120,
602, 626, 760 170, 201, 265, 275,
Carboplatin, 416 594, 602, 644, 700,
Carcinoma 736
Head and neck, 754 Cholera, 208, 209, 288,
Cardiac arrest, 574, 575 289, 315
Cardiac stress testing, Chronic bronchitis, 70,
278 454
Cardiac surgery, 278 Chronic mycetoma, 85
Cardiogenic shock, 78, Chronic pain, 526
278 Ciclosporin, 86, 164, 168,
Cardiomyopathies, 278 177, 231, 301, 345,
Cardiopulmonary arrest, 464, 616, 751, 763
307 Ciprofloxacin, 71, 101,
Carvedilol, 178 162, 338, 776
Ceftriaxone, 775, 777
Index
Cisplatin, 69, 150, 500 Cyanide poisoning, 698
Clindamycin, 678 Cycloplegia, 118
Clotrimazole, 223 Cycloserine, 242
Cloxacillin, 89 Cystinuria, 585, 586
Coccidioidomycosis, 85 Cytomegalovirus
Codeine, 229 infection, 363
Colchicine, 75, 231 Dandruff, 683, 684, 711,
Colorectal cancer, 159, 712
160, 350, 427 Decongestion, 761
Conduct disorder, 673 Deep vein thrombosis,
Congenital syphilis, 629 302, 394, 705, 758
Congestive heart failure, Deficiency
359 Calcium, 162
Conjuctivitis, 692 Iron, 337
Conscious sedation, 472, Pyridoxine, 650
518, 519 Vitamin A, 665
Constipation, 146, 147, Dehydration, 249, 375,
444, 731 569, 570, 691, 695
Plan A, 570, 691, 695
Convulsions, 264, 593
Plan B, 570, 691, 695
Copper poisoning, 585 Plan C, 570, 691, 695
Corneal ulcers, 208, 209 Delirium, 201, 202, 388,
Cortical myoclonus, 608 744
Cotrimoxazole, 123, 236, Dental abscess, 80, 81
492 Deodorisation, 513, 515
Cramps Depression, 76, 157, 158,
Muscle, 162
417, 502
Croup, 258, 259
Dexamethasone, 86, 261,
Cryptococcal meningitis,
602, 679
84, 342, 346
Diabetes mellitus, 371,
Cutaneous leishmaniasis,
373, 421
696

Index
Diabetes Mellitus, 495, Ear infection, 193, 194,
606 368
Diarrhoea, 228, 375, 468, Echinococcosis, 484
569, 570, 660, 665, Eclampsia, 264, 265, 476,
666, 767 477
Diazepam, 201, 203, 266, Eczema, 144, 199, 712
345, 594, 637, 776 Efavirenz, 111, 312, 313
Digoxin, 52, 75, 86, 158, Electrolyte imbalance,
198, 207, 231, 273, 615
361, 598, 704 Emergency
Diphtheria, 290, 292, 629 contraception, 456,
Disinfection, 62, 188, 457
196, 376, 404, 405, Emtricitabine, 447
424, 618, 619, 621 Enalapril, 52, 207, 361,
Disseminated 616
cryptococcosis, 85 Endocarditis, 225, 368,
Dopamine, 282 494, 749
Doxorubicin, 207 Endometrial thinning,
Doxycycline, 338, 371, 383
656 Endometriosis, 383, 557
DPT-HepB-Hib, 292 Enuresis, 417
Dryness of eye, 665 Adult, 638
Duodenal ulcer, 567, 657 Ephedrine, 306
Dysentery, 182, 183, Epilepsy, 169, 221, 324,
208, 209 593, 600, 699
Dysfunctional uterine Epinephrine, 94, 112,
bleeding, 557 443, 644, 739
Dysmenorrhoea, 419, Epistaxis, 80
557, 558 Erythema multiforme,
Dyspepsia, 283 505

Index
Erythema nodosum Typhus, 193, 194, 288,
leprosum, 731 289
Erythromycin, 71, 170, Filariasis, 435
283, 776 Flucloxacillin, 341
Ethambutol, 317, 318, Fluconazole, 71, 336,
430, 431 670, 766
Ethinylestradiol, 319 Fluid replacement, 249,
Ethosuximide, 198, 390, 374, 375
487 Fluoxetine, 354, 390,
Etomidate, 327, 328 467, 718, 743
Ewing sarcoma, 247 Focal seizures, 448
Ewing's sarcoma, 754 Folic acid, 236, 711, 776
Excessive bleeding after Folinic acid, 501
childbirth, 523 Framycetin, 358
Excessive respiratory Fungal infection, 386
secretions, 380, 410 Fungal skin infections,
Extrapyramidal 223, 342
symptoms, 133 Furosemide, 69, 162,
Extravasation, 246, 248, 301, 370, 423, 709,
252, 399 751
Eye infection, 368, 729 Galactorrhoea, 151
Febrile convulsions, 264, Ganciclovir, 365
518, 776 Gastric adenocarcinoma,
Fentanyl, 337 281
Ferrous salt, 276, 290, Gastric ulcer, 568, 657
767, 776 Gastritis, 659
Ferrous sulphate, 337, Gastrointestinal cancer,
339 524
Fever, 53, 54, 208, 209, Gastro-oesophageal
413, 584, 593, 763 reflux, 283
Rheumatic, 53, 54, 595,
596
Index
Gastro-oesophageal Graft-versus-host
reflux disease, 567, disease, 204
657 Granulomatosis, 675
Genital ulcer disease, Griseofulvin, 320
208, 209 Gum infection, 314
Genitourinary infection, Gustatory sweating, 638
82 Haemophilia, 332, 333,
Gentamicin, 581, 716, 334
751, 776 Haemophilia A, 332
Giardiasis, 513, 514, 740 Haemophilia B, 333, 334
Glaucoma, 200 Haemophilus influenza,
Secondaary glaucoma, 83, 292
738 Haemophilus influenzae,
Glibenclamide, 345, 760 292
Glioblastoma Haemorrhagic disease of
multiforme, 719, 720 the newborn, 603
Glucose, 376 Haemorrhoids, 148, 513,
Glue ear, 200 514
Glutaraldehyde, 377 Haloperidol, 420, 488,
Glutathione synthase 700
Deficiency, 106 Halothane, 199, 355,
Glyceryl trinitrate, 120, 390, 394, 453, 598
396 Hawkinsinuria, 106
Gonococcal eye Head and neck cancer,
infection, 124, 182, 213, 281
183 Head and neck tumour,
Gonorrhoea, 563 350
Gout, 54, 130, 230, 267, Head and neck tumours,
419 350
Prophylaxis, 63 Headache, 195, 413, 510,
Graft rejection, 204 527, 535, 762, 763

Index
Heart burn, 478 Hodgkin's disease, 149,
Heart failure, 163, 164, 191, 531
166, 175, 271, 300, Hodkin's disease, 245,
400, 401, 463, 474, 631
702 Hyaluronidase, 399
Helicobacter pylori, 80, Hydrocortisone, 86, 679,
81, 513, 514, 567, 569 682
Heparin, 255, 379 Hydrogen peroxide, 189,
Hepatic encephalopathy, 197
444 Hyperbilirubinaemia, 61,
Hepatitis, 292 510
Hepatitis B, 397, 398, Hypercholesterolemia,
722, 723 113
Hepatitis B vaccine, 398 Hyperkalaemia, 157, 475
Herpes, 156, 199, 200, Hyperlipidaemia, 113,
404 529
Herpes labialis, 56 Hypertension, 78, 112,
Herpes simplex, 55, 362, 130, 163, 166, 175,
541 300, 400, 401, 438,
Herpes zoster, 55, 156, 441, 442, 463, 474,
199 501, 549, 642, 643,
Hiccup, 202 676
Histoplasmosis, 84 Hypertensive crisis, 441
HIV, 49, 110, 235, 296, Hyperthyroidism, 171,
298, 446, 447, 469, 642, 643
545, 546, 609, 627, Hyperuricaemia, 63
674, 721, 722, 765 Hypoalbuminaemia, 60
HIV/AIDS, 49, 110, 296, Hypocalcaemic tetany,
298, 446, 469, 545, 157
721, 765 Hypodermoclysis, 399
Hypoglycaemia, 375, 589

Index
Hypogonadism, 151, 152, Bladder, 81
724 Breast, 193, 194, 314,
Hypokalaemia, 615 315
Hypomagnesaemia, 476 Chlamydia, 124
Ear, 193, 194, 234
Hypotension, 305, 555
Eye, 124, 182, 183, 193,
Hypotensive states, 598 194, 729, 747, 750
hypothyroidism, 459 Fungal, 386
Hypothyroidism, 579 Gonococcal, 182, 183
Hypovolaemia, 691, 695 Gum, 314, 315
Ibuprofen, 210 Kidney, 80, 81, 368, 369,
Idiopathic 595, 596
thrombocytopenic Mouth, 80, 81, 513, 514,
purpura, 755 595, 596, 619
Imipramine, 769 Nose, 234
Oral, 196
Immune reconstitution
Respirarory tract, 264
inflammatory Rotavirus, 679
syndrome, 624 Sinus, 80
Immunisation, 90, 491, Skin, 80, 81, 196, 223,
610, 612, 679, 762, 386
763 Teeth, 513, 514, 595,
Yellow fever, 762 596
Impetigo, 508, 617 Throat, 141, 193, 194,
Incomplete abortion, 234, 288, 289
522, 523 Tonsillitis, 81, 124, 125,
Indomethacin, 421 595, 596
Urethritis, 125
Induction of labour, 311,
Urinary bladder, 208,
523, 576 209
Infection Urinary tract, 80, 81,
Anaerobic, 740 234, 264, 552
Bacterial, 80, 81, 141, Wound, 687
142, 193, 235, 288, Infertility, 219
289, 629
Index
Inflammation of the Ketoconazole, 111, 313,
gums, 405 428
Inflammatory bowel Labetalol, 444
disease, 121, 204, 205 Labour, 591
Influenza, 367 Labyrinthitis, 632
Inguinal swelling, 289, Lactulose, 445
315 Lamivudine, 299
Insect bite, 200 Lamotrigine, 700
Insomnia, 472, 674 Larva migrans, 269
Insulin, 259, 373, 421, Laryngitis, 80, 81
424, 497 Lead poisoning, 585
Intensive care, 348 Left ventricular failure,
Intestinal worms, 483, 433
484 Leg ulcer, 513, 688
Intra-operative Leg ulcers, 513, 688
bradycardia, 119, 380 Leishmaniasis, 588
Iodine, 424 Lennox Gastaut
Iritis, 120 syndrome, 448
Iron excretion, 106 Leprosy
Iron poisoning, 253, 254 Multibacillary, 217, 218,
Iron-deficiency anaemia, 250, 262, 667, 668,
337, 776 671
Ischaemic heart disease, Paucibacillary, 250, 667,
668, 671, 677
54
Lesch-Nyhan syndrome,
Isoflurane, 280, 430
64
Isoniazid, 170, 323, 325,
Leukaemia, 191, 242,
431, 432, 602
251, 408, 492, 499,
Itching, 105, 402, 635
531, 734, 754
Joint pain, 731
Lymphocytic, 675
Ketamine, 199, 439
Levonorgestrel, 760
Ketoacidosis, 371, 373
Lice, 139, 140, 479
Index
Lice infestation, 139, Malignant lymphoma,
140, 479 238
Lidocaine, 52, 112, 155, Malignant melanoma,
361, 644, 739 245
Liver disease, 105, 440 Mania, 201, 202, 388,
Liver tumours, 350 465, 565, 744, 745
Loiasis, 269, 270 Manic episodes, 673, 699
Lopinavir/ritonavir, 312 Mastoiditis, 87
Lower abdominal pain MDR-TB, 68, 69, 70, 165,
syndrome, 180 241, 322, 454, 528,
Lung cancer, 213, 280, 530, 564, 565, 579,
366, 531, 754 647
Lung maturation, 144, Measles, 482, 660, 665,
258 666, 729
Lyme disease, 124 Mebendazole, 776
Lymphoma, 754 Medulloblastoma, 755
Magnesium sulphate, Mefloquine, 198, 325,
550, 779 700
Magnesium sulphate Megaloblastic anaemia,
overdose, 157, 158, 554
161 Meningitis, 80, 87, 141,
Magnesium trisilicate 181, 182, 193, 491,
compound, 210, 290, 493, 610
338 Meningococcal, 89, 209
Malaria, 99, 100, 101, Neonatal, 87, 368
102, 198, 264, 356, Menorrhagia, 557
486, 634, 651, 654, Menstrual cycle
655, 710 disorders, 151
Malignant ascites, 702 Mercaptopurine, 65
Malignant effusion, 149 Metabolic disorders, 106
Malignant glioma, 719

Index
Metastatic melanoma, Motion sickness, 635,
245, 247, 248 636
Methaemoglobinaemia, Mouth sores, 743, 744
510 Mucormycosis, 85
Methotrexate, 55, 82, Mucositis, 159, 244, 287,
88, 109, 132, 143, 159, 350, 409, 500
207, 226, 236, 260, Multibacillary leprosy,
414, 596, 630, 653, 217, 218, 250, 667
711 Multiple myeloma, 238,
Methotrexate overdose, 286, 287, 731
159 Muscle cramps, 162
Methyldopa, 467, 550, Muscle pain, 763
682 Muscle relaxation, 211
Methylphenidate, 257, Myasthenia gravis, 69,
429, 686 121, 542, 543, 638
Metoclopramide, 120, Mycosis fungiodes, 238
512 Myeloid leukaemia, 492
Microscopic polyangitis, Myelosuppression, 159,
675 239, 243, 246, 252,
Midazolam, 522 287, 331, 350, 367,
Migraine, 76, 77, 202, 409, 415, 492, 631,
267, 312, 413, 584, 676, 720, 732
642, 643 Myocardial infarction,
Mild pain, 53 463, 574, 575
Miscarriage, 522 Naloxone, 534, 535, 536
Misoprostol, 578, 779 Nasal allergy, 128, 200
Mitomycin, 525 Nasal congestion, 305
Monoblastic leukaemia, Nausea, 283, 384, 511,
330 633, 744
Morphine, 201, 265, 528, Neomycin, 538
637

Index
Neonatal meningitis, 87, Norethisterone, 559
368 Nystatin, 224
Neostigmine, 69 Obsessive compulsive
Nephropathy disorder, 352
Hyperuricaemic, 64 Occult filariasis, 269
Nephrotic syndrome, Ocular hypertension, 738
204, 205, 702, 703 Oedema, 359, 702
Nerve pain, 169 Pulmonary, 359
Neuroblastoma, 238, 754 Olanzapine, 473, 700
Neuromuscular Oliguria, 359
blockade, 115, 116, Omeprazole, 111, 569
580, 581, 677, 714, Onchocerciasis, 435, 713
752 Open-angle glaucoma,
Neuropathic pain, 76, 51, 604, 738
600, 601 Ophthalmia of the new
Neuropathy, 624 born, 193, 194, 315,
Neurosyphilis, 629 729
Nevirapine, 111, 345, Opioid dependence, 536
440, 670 Opioid over dosage, 534
Nifedipine, 112, 177, Oral candidiasis, 508,
272, 443, 644, 670, 516, 562
739 Oral rehydration salts,
Nitrous oxide, 390 776, 779
Nodding disease, 593, Organophosphate
699 poisoning, 118, 119,
Non-gonococcal 621
urethritis, 124, 563 ORS, 249, 569, 570, 571,
Non-Hodgkin’s 691, 695, 768, 776,
lymphoma, 191, 499, 778
531, 675 Osteomyelitis, 83, 225,
Norepinephrine, 555 419, 749

Index
Otitis media, 80, 81, 82, Pelvic inflammatory
124, 178, 184 disease, 180, 182, 183,
Ovarian 289, 315, 513, 514,
adenocarcinoma, 238 563, 564
Ovarian cancer, 172, 213, Pemphigus, 617
286, 366 Peptic ulcer, 54, 396,
Oxygen, 575 478, 567, 659
Oxytocin, 523, 578, 779 Pethidine, 592
Pain, 53, 54, 228, 267, Pharyngitis, 287
413, 461, 526, 527, Phenobarbital, 79, 195,
582, 584, 591 201, 203, 206, 266,
Headache, 53, 413, 421 507, 595, 626
Joint, 413 Phenytoin, 117, 170,
Menstruation, 53, 413, 195, 345, 488, 581,
419 592, 626, 653
Nerve, 76, 169, 600, 650,
Pheochromocytoma,
651
279, 355, 389
P-aminosalicylic acid,
Plague, 193, 194, 288,
579, 648
289, 368, 369, 708
Pancreatic cancer, 366
Plantar warts, 611
Para coccidioidomycosis,
Pneumocystis carinii
85
pneumonia, 588
Paracentesis, 61
Pneumocystis Jiroveci
Paracetamol, 497, 498,
pneumonia, 216
776
Pneumonia, 80, 81, 87,
Paracetamol overdose,
88, 141, 142, 181, 182,
497, 498
193, 194, 208, 209,
Parkinsonism, 452
225, 288, 289, 292,
Parkinson's disease, 138,
314, 315, 368, 369,
151
575, 610, 629, 660,
Paucibacillary leprosy,
665, 666, 749
250, 667
Index
Polycythaemia, 408 Procainamide, 113, 155,
Possible serious bacterial 355, 644, 739
infection, 141, 142, Procaine benzylpenicillin,
193 776
Post-operative pain, 267, Prolactinoma, 151, 152
742 Promethazine, 120, 201,
Post-operative wounds, 266, 637
89 Propantheline, 639
Postpartum Propofol, 716
haemorrhage, 311, Propranolol, 155, 308,
576, 577 462
Postponement of Prostate cancer, 280,
menstruation, 557, 281, 383, 704
558 Prostatitis, 563
Potassium depletion, 615 Protamine, 647
PPF, 142, 629, 630, 631, Psoriasis, 204, 205, 227,
776 499, 683, 712
Prednisolone, 86, 109, Vulgaris, 277
594, 602, 670, 679 Psoriatic arthritis, 121
Pre-eclampsia, 476 Psychosis, 354, 388
Premature labour, 549 Puerperal fever, 89
Premedication, 119, 380, Pulmonary embolism,
472, 518, 519 302, 394, 705, 758
Premenstrual syndrome, Pulmonary infection, 89
557, 558 Pyelonephritis, 454
Pressure sores, 688 Pyomyositis, 225
Prevention of neonatal Pyrazinamide, 648, 649,
bleeding, 603, 778 650
Prevention of unwanted Pyridoxine, 650
pregnancy, 319, 328, Pyridoxine deficiency,
456, 485 650

Index
Pyrimethamine, 653 Rheumatoid arthritis, 53,
Quinine, 111, 272, 275, 54, 121, 198, 204, 205,
488, 777 419, 499, 585
Quinsy, 141, 142 Rifampicin, 110, 317,
Rabies 323, 345, 430, 431,
Immunisation, 95 432, 451, 488, 550,
Prophylaxis, 93 626, 648, 667, 668,
Raised intracranial 669, 671, 672
pressure, 393, 398, Ringworm, 135, 223,
735 386, 617, 683
Raised intraocular Risperidone, 675
pressure, 481 Ritonavir, 79, 229, 336,
Regional anaesthesia, 353, 355, 390, 469,
154 592, 760
Remifentanil, 664 River blindness, 713
Respiratory tract Salbutamol, 550
infection, 82, 178, 184 Salicylic acid, 683
Respiratory tract Scabies, 139, 435
infections, 180 Schistosomiasis, 623
Retinoblastoma, 238, Schizophrenia, 354, 388,
754 391, 565, 672, 673,
Retinol, 777 768
Reversible airways Scurvy, 106
obstruction, 70 Sedation, 639
Rhabdomyosarcoma, Seizures, 448, 630
247 Septic shock, 278
Rhesus, 91 Septicaemia, 87, 141,
Rhesus-negative, 91 181, 182, 193, 225,
Rheumatic fever, 53, 54, 368, 369, 491, 493
595, 596 Severe allergic reaction,
Rheumatic heart disease, 307, 624
595, 596
Index
Severe malaria, 102 Sporotrichosis, 85
Severe refractory Squamous cell
eczema, 121, 122 carcinoma, 149
Shock, 375, 575, 691, Stable heart failure, 175
695 Status asthmaticus, 144
Sickle-cell disease, 408 Status epilepticus, 264,
Sinus infection, 80 472, 473, 518, 601,
Sinusitis, 178, 185, 454 735
Skin allergy, 156, 200 Stevens-Johnson
Skin and soft tissue syndrome, 179, 235,
infections, 178 236, 301, 455, 505,
Skin infection, 80 587, 590, 624, 625
Sleeping sickness, 551 Stomach cancer, 350
Small cell lung cancer, Streptomycin, 370, 708
172, 330 Strongyloidiasis, 60, 435
Smooth muscle spasm, see worm infestation,
638 59, 60, 484
Snake bite, 199, 200 Stye, 729
Sodium chloride, 506 Sulfadoxine +
Soft tissue sarcoma, 245, pyrimethamine, 236,
754 357
Soft tissue sarcomas, Superficial bacterial
245, 754 infection, 538
Sore throat, 131, 132, Suppression of lactation,
314, 315, 462, 595, 151
596 Supraventricular
Spasms, 264 arrhythmia, 72, 271
Tetanus, 201, 202, 264 Supraventricular
Spasms in tetanus, 264 tachycardia, 57
Spironolactone, 272, Suramin sodium, 714
301, 616

Index
Surgical prophylaxis, 83, Thyrotoxicosis, 171, 425,
368, 369, 750 426, 438
Suxamethonium, 69, Tobramycin, 261
217, 240, 641, 751 Tonic-clonic seizures,
Syphilis, 131, 132 448
Congenital, 131, 132, Tonsillitis, 131, 132
629 Toxoplasmosis, 216, 651
Neurosyphilis, 629 Trachoma, 124, 315, 729
Systemic candidiasis, 84, Tramadol, 353, 418
346 Transplant rejection, 121
Systemic lupus Trichomoniasis, 740
erythematosus, 121 Trophoblastic tumour,
Systemic lymphatic 247
filariasis, 269 Tropical ulcer, 234, 289,
Tamoxifen, 719 513, 617
Tape worm, 147 Trypanosomal infection,
Tapeworm infestation, 489
547 Trypanosomiasis, 588,
Tear deficiency, 694 713
Testicular cancer, 213 Tuberculoprotein
Testicular carcinoma, Hypersensitivity, 748
247 Tuberculosis, 126, 165,
Testicular teratoma, 149 317, 430, 431, 432,
Tetanus, 141, 142, 290, 648, 668, 671, 672,
291, 292, 513, 514, 708
726 Typhoid, 193, 194, 208,
Prophylaxis, 97 209
Treatment, 97 Typhoid fever, 80, 81,
Tetanus toxoid, 290 208, 234
Thalidomide, 732 Typhus fever, 193, 194,
Thiamine, 733 288, 289
Thiamine deficiency, 733
Index
Tyrosinaemia, 106 Vascular shock, 284
Ulcer, 358 Ventricular arrhythmia,
Genital, 315 72, 627
Leg, 513, 688 Ventricular fibrillation,
Mouth, 461, 462, 508 72, 73
Peptic, 81, 478, 625 Ventricular tachycardia,
Tropical, 234, 289, 513,
72
514
Vertigo, 632, 635
Ulcerative colitis, 468,
Vincristine, 109
505
Visceral leishmaniasis,
Umbilical cord stump
Cleaning, 196
85, 588, 696
Umbilical granuloma, Vitamin A, 665, 777
686, 687 Vitamin A deficiency, 665
Uncomplicated malaria, Vitamin B
Deficiency, 757
102, 104, 274, 654
Vitamin B6, 324, 650
Urethral discharge
Vitamin D deficiency,
syndrome, 180, 181,
309, 310
182, 289, 315, 316,
Vitamin K, 603, 604, 778
513, 514
Vitamin
Urinary bladder
supplementation, 530
infection, 208, 209
Volume depletion, 689
Urinary retention, 543
Vomiting, 201, 202, 283,
Urinary tract infection,
375, 384, 511, 633,
178, 184, 533, 563
635, 744
Uterine fibroids, 383
Vulval candidiasis, 223,
Uveitis, 120, 237
516
Vaginal candidiasis, 223,
Warfarin, 123, 181, 183,
342, 562
492, 594, 603, 718
Valproate, 451, 495, 701,
Warfarin poisoning, 603
702
Vancomycin, 361, 751
Index
Warts, 611, 683, 686, Tapeworm, 59, 484, 624
687 Threadworm, 483
Wernicke's Whipworm, 59, 484
encephalopathy, 733 Wounds, 196, 358, 404,
Whooping cough, 290, 405, 424, 618, 619,
292, 660, 665, 666 688, 726
Wilms' tumour, 754 Yellow fever vaccine,
Worm infestation 173, 214
Echinococcosis, 484 Zidovudine, 345, 362,
Hookworm, 59, 483 365
Intestinal, 59, 483, 484 Zinc sulphate, 162, 768
Ringworm, 223, 386, Zollinger-Ellison
408, 683 syndrome, 567, 568,
Roundworm, 483, 624 569
Strongyloidiasis, 59, 60,
484

Notes
Notes

Notes

PGD HL 2015
Practical Guideline for Dispensing at Higher Level Health Centres

Dispensing Guidelines PDF

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Dispensing Guidelines PDF

Uploaded by

Copyright:

Available Formats

THE REPUBLIC OF UGANDA

National Guidelines for Medicines

Any part of these guidelines may be reproduced in any

Copies may be obtained from the:

National Guidelines for Medicines

8 Practical Guideline for Dispensing (PGD HL) 2015

Practical Guideline for Dispensing (PGD HL) 2015 9

10 Practical Guideline for Dispensing (PGD HL) 2015

Practical Guideline for Dispensing (PGD HL) 2015 11

12 Practical Guideline for Dispensing (PGD HL) 2015

Practical Guideline for Dispensing (PGD HL) 2015 15

Practical Guideline for Dispensing (PGD HL) 2015 17

18 Practical Guideline for Dispensing (PGD HL) 2015

Practical Guideline for Dispensing (PGD HL) 2015 19

20 Practical Guideline for Dispensing (PGD HL) 2015

Dr. Elioda Tumwesigye

Practical Guideline for Dispensing (PGD HL) 2015 21

Practical Guideline for Dispensing (PGD HL) 2015 23

I would like to thank everyone who was involved in the

24 Practical Guideline for Dispensing (PGD HL) 2015

Good Prescribing Practice

 Generic medicine name

 Name, signature, and contact/address of prescriber

26 Practical Guideline for Dispensing (PGD HL) 2015

Figure 1: Example of a readable and complete prescription

NWOYA HEALTH CENTRE III

NAME Peter Mulwale O.P NO 8567

Drink plenty of fluids.

Dr. Kato Tadeo

An incomplete, unreadable, or inaccurate prescription

Practical Guideline for Dispensing (PGD HL) 2015 27

right for the patient?

cine interact with other medicines that the patient is

medicines list for Uganda

ble and recommended for use at your level of care

(without any doubt) what the generic name of the

tentially be abused or if it is not written in ink, make

28 Practical Guideline for Dispensing (PGD HL) 2015

For more information on good prescribing, refer to the

Good Dispensing Practice

 The correct dosage and quantity

30 Practical Guideline for Dispensing (PGD HL) 2015

Good dispensing takes time!

Do not rush the dispensing process, but

Step 1: Receive and validate the prescription

 Interpreting any abbreviations

 Confirming the right medicine, dose, and duration

for the patient considering his/her disease, age or if

Dispensing errors can kill!

Prescribers’ unreadable handwriting can cause

If you have any doubt about what is prescribed

If you cannot read the prescription, if you are in doubt, or

32 Practical Guideline for Dispensing (PGD HL) 2015

Do not select a container according to its

When preparing the prescribed medicine, you must:

label properly and crosschecking the medicine’s name

Practical Guideline for Dispensing (PGD HL) 2015 33

Figure 2: Selection from a shelf: Read the label every time

34 Practical Guideline for Dispensing (PGD HL) 2015

Labelling should include:

Practical Guideline for Dispensing (PGD HL) 2015 35

appropriateness of dose prescribed and medicine

scription and the stock containers used