Vadmecum

[thememove_title_section type=”2″ title=”Penicillins”]

Amoxicillin

 Dosage Forms:

  • ۲۵۰ mg and 500 mg capsules
  • ۲۵۰ mg chewable tablet
  • ۵۰۰ mg Faramox tablet
  • ۱۲۵ mg/5ml and 250 mg/5ml powder for oral suspensions

 

Drug Group: Antibiotic, Penicillins

 Mechanism: Amoxicillin is a broad spectrum antibiotic that binds to PBPs (located on the inner membrane of the bacterial cell wall), resulting in the lysis of cell wall. It is active against penicillin-sensitive gram-positive bacteria as well as E. coli, P. mirabilis, non penicillinase-producing staphylococci and H. influenzae.

Indications: Amoxicillin is given by mouth in the infections of ear, nose, throat (such as acute otitis media, pharyngitis and sinusitis), genitourinary tract, skin and soft tissues, lower respiratory tract, gonorrhea, early Lyme disease and for prevention of bacterial endocarditis.

Dosage and Administration: Adults: 250-500 mg every 8 hours up to a maximum of 4.5 g daily. Children up to 10 years of age: 125- 250 mg every 8 hours. Children under 20 kg of body weight: 20-40 mg per kg of body weight daily in divided doses. Infants less than 3 months of age: 30 mg per kg of body weight daily in divided doses every 12 hours.

Precautions and Warnings: Amoxicillin is not indicated in history of hypersensitivity to penicillins, cephalosporins and imipenem and, should not be used in patients with mononucleosis. Therapy should be continued for at least 10 days in group A beta-hemolytic streptococcal infections to help prevent the occurrence of acute rheumatic fever. In patients with renal function impairment, a reduction in dosage or increase in dosing interval is recommended. Renal, hepatic and hematologic systems should be evaluated during prolonged therapy.

Side Effects: The most frequent side effects of Amoxicillin are headache, oral and vaginal candidiasis. The less frequent are allergic reactions, anaphylaxis, exfoliative dermatitis, serum sickness-like reactions, skin rash, hives and itching.

Interactions: Bacteriostatic drugs interfere with bactericidal effect of penicillins. The efficacy of oral contraceptives may be reduced. Probenecid decreases renal tubular secretion of penicillins. False-positive urine glucose reactions may occur in non-enzymatic tests using cupric sulfate during penicillin therapy.

Pregnancy and Lactation: Pregnancy category B. Amoxicillin crosses the placenta and is distributed into breast milk. Use during pregnancy only if clearly needed.

Packaging:

  • ۱۰ capsules in one blister. 10 blisters in a box.
  • ۴ tablets in one Alu-Alu blister. 5 blisters in a box.
  • Powder for 100 ml oral suspensions.

Faramox BD

 Dosage Forms:

۲۰۰ mg/5ml and 400 mg/5ml powder for oral suspensions

Drug Group: Antibiotic, Penicillins

 Mechanism: Amoxicillin is a broad spectrum antibiotic that binds to PBPs (located on the inner membrane of the bacterial cell wall), resulting in the lysis of cell wall. It is active against penicillin-sensitive gram-positive bacteria as well as E. coli, P. mirabilis, non penicillinase-producing staphylococci and H. influenzae.

Indications: Amoxicillin is given by mouth in the infections of ear, nose, throat (such as acute otitis media, pharyngitis and sinusitis), genitourinary tract, skin and soft tissues, lower respiratory tract, gonorrhea, early Lyme disease and for prevention of bacterial endocarditis.

Dosage and Administration: 25-45 mg per kg of body weight daily in divided doses every 12 hours.

Precautions and Warnings: Amoxicillin is not indicated in history of hypersensitivity to penicillins, cephalosporins and imipenem and, should not be used in patients with mononucleosis. Therapy should be continued for at least 10 days in group A beta-hemolytic streptococcal infections to help prevent the occurrence of acute rheumatic fever. In patients with renal function impairment, a reduction in dosage or increase in dosing interval is recommended. Renal, hepatic and hematologic systems should be evaluated during prolonged therapy.

Side Effects: The most frequent side effects of Amoxicillin are headache, oral and vaginal candidiasis. The less frequent are allergic reactions, anaphylaxis, exfoliative dermatitis, serum sickness-like reactions, skin rash, hives and itching.

Interactions: Bacteriostatic drugs interfere with bactericidal effect of penicillins. The efficacy of oral contraceptives may be reduced. Probenecid decreases renal tubular secretion of penicillins. False-positive urine glucose reactions may occur in non-enzymatic tests using cupric sulfate during penicillin therapy.

Pregnancy and Lactation: Pregnancy category B. Amoxicillin crosses the placenta and is distributed into breast milk. Use during pregnancy only if clearly needed.

Packaging: Powder for 70 ml oral suspensions.

Co-Amoxiclav

Dosage Forms:

  • Co-Amoxiclav 375 tablet contains 250 mg Amoxicillin and 125 mg Clavulanic acid (as potassium).
  • Co-Amoxiclav 625 tablet contains 500 mg Amoxicillin and 125 mg Clavulanic acid (as potassium).
  • Co-Amoxiclav 156 powder for oral suspension, after reconstitution each measure (5ml) contains

۱۲۵ mg Amoxicillin and 31.25 mg Clavulanic acid (as potassium).

  • Co-Amoxiclav 312 powder for oral suspension, after reconstitution each measure (5ml) contains

۲۵۰ mg Amoxicillin and 62.50 mg Clavulanic acid (as potassium).

 

Drug Group: Antibiotic, Beta-lactam + Beta-lactamase inhibitor

 

Mechanism: Co-Amoxiclav is betalactam antibiotic that inhibits the biosynthesis of cell wall of bacteria. Clavulanic acid has a high affinity for and binds to certain betalactamases that generally inactivate amoxicillin. Co-Amoxiclav is active against H. influenzae, M. catarrhalis, S. aureus, E. coli, Klebsiella sp. and Entrobacter sp.

Indications: Co-Amoxiclav is given by mouth in the treatment of bacterial infections of lower respiratory tract, otitis media, sinusitis, recurrent tonsillitis, skin and skin structure infections and urinary tract infections.

Dosage and Administration: The following doses are based on amoxicillin:

Adults: 250-500mg every 8 hours.

Infants older than 3 months and children less than 40 kg of body weight:

– Severe infections: 40 mg per kg of body weight daily in divided doses every 8 hours.

– Less severe infections: 20 mg per kg of body weight daily in divided doses every 8 hours.

 

Precautions and Warnings: Co-Amoxiclav is not indicated in history of hypersensitivity to penicillins, cephalosporins, imipenem and betalactamase inhibitors. Co-Amoxiclav should be used with caution in patients with evidence of hepatic dysfunction and GI disease especially antibiotic-associated colitis. In renal impairment, reduction in dosage or increase in dosing interval is recommended. The suspensions contain aspartame and should not be used by phenylketonurics. Co-Amoxiclav in patients with infectious mononucleosis should not be used.

 

Side Effects: Diarrhea, hepatitis, cholestatic jaundice, pseudomembranous colitis, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis and exfoliative dermatitis have been reported.

Interactions: Probenecid prolongs the half-life of amoxicillin. Amoxicillin may also interact with bacteriostatic antibacterials. Co-Amoxiclav may reduce the efficacy of oral contraceptives. Concomitant use of allopurinol and amoxicillin should be avoided. Increases in prothrombin time have been reported in patients taking Co-Amoxiclav concurrently with anticoagulants. False-positive urine glucose reactions may occur in non-enzymatic tests using cupric sulfate in penicillin therapy.

Pregnancy and Lactation: Co-Amoxiclav crosses the placenta. Use during pregnancy only if clearly Co-Amoxiclav needed. Small amounts of amoxicillin are distributed into breast milk. The use of Co-Amoxiclav may cause diarrhea, candidiasis or allergic response in the nursing infants.

Packaging:

  • ۴ tablets in one Alu-Alu blister. 5 blisters in a box.
  • Powder for 100 ml oral suspensions

Farmentin BD

Dosage Forms:

  • Farmentin BD 228 powder for oral suspension, after reconstitution each measure (5ml) contains 200 mg Amoxicillin and 28.5 mg Clavulanic acid (as potassium).
  • Farmentin BD 457 powder for oral suspension, after reconstitution each measure (5ml) contains 400 mg Amoxicillin and 57 mg Clavulanic acid (as potassium).

 Drug Group: Antibiotic, Beta-lactam + Beta-lactamase inhibitor

 Mechanism: Co-Amoxiclav is betalactam antibiotic that inhibits the biosynthesis of cell wall of bacteria. Clavulanic acid has a high affinity for and binds to certain betalactamases that generally inactivate amoxicillin. Co-Amoxiclav is active against H. influenzae, M. catarrhalis, S. aureus, E. coli, Klebsiella sp. and Entrobacter sp.

Indications: Co-Amoxiclav is given by mouth in the treatment of bacterial infections of lower respiratory tract, otitis media, sinusitis, recurrent tonsillitis, skin and skin structure infections and urinary tract infections.

Dosage and Administration: The following doses are based on amoxicillin: Adults and children 40 kg of body weight and over: 500-875 mg twice daily.

Infants older than 3 months and children less than 40 kg of body weight:

– Severe infections: 45 mg per kg of body weight daily in divided doses every 12 hours.

– Less severe infections: 25 mg per kg of body weight daily in divided doses every 12 hours.

 

Precautions and Warnings: Co-Amoxiclav is not indicated in history of hypersensitivity to penicillins, cephalosporins, imipenem and betalactamase inhibitors. Co-Amoxiclav should be used with caution in patients with evidence of hepatic dysfunction and GI disease especially antibiotic-associated colitis. In renal impairment, reduction in dosage or increase in dosing interval is recommended. The suspensions contain aspartame and should not be used by phenylketonurics. Co-Amoxiclav in patients with infectious mononucleosis should not be used.

 

Side Effects: Diarrhea, hepatitis, cholestatic jaundice, pseudomembranous colitis, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis and exfoliative dermatitis have been reported.

Interactions: Probenecid prolongs the half-life of amoxicillin. Amoxicillin may also interact with bacteriostatic antibacterials. Co-Amoxiclav may reduce the efficacy of oral contraceptives. Concomitant use of allopurinol and amoxicillin should be avoided. Increases in prothrombin time have been reported in patients taking Co-Amoxiclav concurrently with anticoagulants. False-positive urine glucose reactions may occur in non-enzymatic tests using cupric sulfate in penicillin therapy.

Pregnancy and Lactation: Co-Amoxiclav crosses the placenta. Use during pregnancy only if clearly needed. Small amounts of amoxicillin are distributed into breast milk. The use of Co-Amoxiclav may cause diarrhea, candidiasis or allergic response in the nursing infants.

Packaging: Powder for 100 ml oral suspensions.

Farmentin ES-643

 Dosage Forms:

Farmentin ES-643 powder for oral suspension, after reconstitution each measure (5ml) contains 600 mg amoxicillin and 42.9 mg Clavulanic acid (as potassium).

 Drug Group: Antibiotic, Beta-lactam + Beta-lactamase inhibitor

 Mechanism: Farmentin ES-643 is an oral antibacterial combination consisting of the semisynthetic antibiotic amoxicillin and the β-lactamase inhibitor, clavulanate potassium (the potassium salt of clavulanic acid).  Betalactam antibiotic that inhibits the biosynthesis of cell wall of bacteria. Clavulanic acid has a high affinity for and binds to certain betalactamases that generally inactivate amoxicillin. Farmentin ES-643 is active against H. influenzae, M. catarrhalis, S. aureus, E. coli, Klebsiella sp. and Entrobacter sp.

Indications: Farmentin ES-643 is given by mouth in the treatment of bacterial infections of lower respiratory tract, otitis media, sinusitis, skin and skin structure infections, urinary tract infections, chancroid and gonorrhea

Dosage and Administration: Infants older than 3 months and children less than 40 kg of body weight:

Based on the amoxicillin component (600 mg/5mL), the recommended dose of Farmentin ES-643 is 90 mg/kg/day divided every 12 hours, administered for 10 days.

 Precautions and Warnings: Farmentin ES-643 is not indicated in history of hypersensitivity to penicillins, cephalosporins, imipenem and betalactamase inhibitors. Farmentin ES-643 should be used with caution in patients with evidence of hepatic dysfunction and history of GI diseases especially antibiotic-associated colitis. In renal impairment, reduction in dosage or increase in dosing interval is recommended. The suspensions contain aspartame and should not be used by phenylketonurics.

Farmentin ES-643 in patients with infectious mononucleosis should not be used.

Side Effects: Diarrhea, hepatitis, cholestatic jaundice, pseudomembranous colitis, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis and exfoliative dermatitis have been reported.

Interactions: Probenecid prolongs the half-life of amoxicillin. Amoxicillin may also interact with bacteriostatic antibacterials. Co-Amoxiclav may reduce the efficacy of oral contraceptives. Concomitant use of allopurinol and amoxicillin should be avoided. Increases in prothrombin time have been reported in patients taking Co-Amoxiclav concurrently with anticoagulants. False-positive urine glucose reactions may occur in non-enzymatic tests using cupric sulfate in penicillin therapy.

Pregnancy and Lactation: Farmentin ES-643 crosses the placenta. Use during pregnancy only if clearly needed. Small amounts of amoxicillin are distributed into breast milk. The use of Farmentin ES-643 may cause diarrhea, candidiasis or allergic response in the nursing infants.

Packaging: Powder for 75 ml oral suspension.

Ampicillin

 

Dosage Forms:

  • ۲۵۰ mg and 500 mg capsules
  • ۱۲۵ mg/5ml and 250 mg/5ml powder for oral suspensions

 

Drug Group: Antibiotic, Penicillins

 Mechanism: Ampicillin is a broad spectrum antibiotic that inhibits the biosynthesis of bacterial cell wall.

Indications: Ampicillin is given by mouth in the treatment of bacterial exacerbation of bronchitis, bacterial pneumonia, otitis media, sinusitis, bacterial pharyngitis, soft tissue infections, gastrointestinal infections, typhoid and paratyphoid fever, uncomplicated gonorrhea, chlamydial infections in pregnant women, bacterial urinary tract infections and prophylaxis of bacterial endocarditis.

Dosage and Administration: Adults and children 20 kg of body weight and over:  ۲۵۰ – ۱۰۰۰ mg every 6 hours up to a maximum of 4 g a day. Infants and children up to 20 kg of body weight: 12.5-25 mg per kg of body weight every 6 hours or 16.7-33.3 mg per kg of body weight every 8 hours.

Precautions and Warnings: Ampicillin is not indicated in history of hypersensitivity to penicillins, cephalosporins and imipenem. Streptococcal infections must be treated for at least 10 days. Ampicillin probably should not be used in patients with infectious mononucleosis. Ampicillin should be used with caution in patients with history of GI diseases especially antibiotic-associated colitis. In patients with severe renal impairment, reduction in dosage or increase in dosing interval is recommended.

Side Effects: Skin rashes are among the most common side effects and generally either urticarial or maculopapular. The erythematous maculopapular eruptions are characteristic of Ampicillin and often appear more than 7 days after commencing treatment. Diarrhea, nausea and vomiting occur quite frequently usually following administration of Ampicillin by mouth.

Interactions: Ampicillin may interact with bacteriostatic antibacterials. Ampicillin may reduce the efficacy of oral contraceptives. Probenecid decreases renal tubular secretion of Ampicillin. False-positive urine glucose reactions may occur in non-enzymatic tests using cupric sulfate during penicillin therapy.

Pregnancy and Lactation: Pregnancy category B. Ampicillin crosses the placenta. Use during pregnancy only if clearly needed. Small amounts of Ampicillin distributed into breast milk. The use of Ampicillin by nursing mothers may lead to sensitization, diarrhea, candidiasis and skin rash in the infant.

Packaging:

  • ۱۰ capsules in one blister. 10 blisters in a box.
  • Powder for 100 ml oral suspensions.

Cloxacillin

 Dosage Forms:

۲۵۰ mg and 500 mg capsules

 Drug Group: Antibiotic, Penicillins

 Mechanism: Cloxacillin is penicillinase-resistant penicillin that inhibits the biosynthesis of bacterial cell wall. Cloxacillin has activity against S. aureus, S. pyogenes and S. pneumoniae.

Indications: Cloxacillin is given by mouth in the treatment of mild to moderate upper respiratory tract infections, lower respiratory tract infections and localized skin and soft tissue infections.

Dosage and Administration: Adults and children 20 kg of body weight and over: 250-500 mg four times daily up to maximum of 6 g a day. Infants and children up to 20 kg of body weight: 6.25-12.5 mg per kg of body weight every six hours up to maximum of 4 g a day.

Precautions and Warnings: Cloxacillin is not indicated in history of hypersensitivity to penicillins, cephalosporins and imipenem. Streptococcal infections must be treated for at least 10 days. Cloxacillin should be taken on empty stomach. Cloxacillin should be used with caution in patients with history of GI diseases especially antibiotic-associated colitis. In the renal impairment, reduction in dosage or increase in dosing interval is recommended.

 

Side Effects: The most frequent side effects of cloxacillin are GI reactions, headache, oral and vaginal candidiasis. The less frequent are allergic reactions specifically anaphylaxis, skin rashes, hives or itching. Pseudomembranous colitis has occurred with the use of cloxacillin.

Interactions: Cloxacillin may interact with bacteriostatic antibacterials. Cloxacillin may reduce the efficacy of oral contraceptives. Probenecid decreases renal tubular secretion of cloxacillin. Cloxacillin reduces the clearance of methotrexate. False-positive urine glucose reactions may occur in non-enzymatic tests using cupric sulfate during penicillin therapy.

Pregnancy and Lactation: Cloxacillin crosses the placenta. Use during pregnancy only if clearly needed. Cloxacillin is distributed into breast milk. The use of cloxacillin by nursing mother may lead to sensitization, diarrhea, candidiasis and skin rash in the infant.

Packaging: 10 capsules in one blister. 10 blisters in a box.

Penicillin V (as benzathine)

 Dosage Forms: 200000 UI/5 ml and 400000 UI/5 ml powder for oral suspensions

 Drug Group: Antibiotic, Penicillins

 Mechanism: Penicillin V is natural penicillin that acts against penicillin-sensitive organisms. Penicillin V is a broad spectrum antibiotic that inhibits the biosynthesis of cell wall of bacteria. Penicillin V Benzathine has activity against streptococci, staphylococci, fusospirochetes, anaerobes, Borrelia burgdorferi, Actinomyces sp. and Bacillus anthracis.

Indications: Drug is given by mouth in the treatment of upper respiratory tract infections, scarlet fever, erysipelas, otitis media, Vincent’s angina, prevention of rheumatic fever and chorea, Lyme disease, anthrax, prophylaxis of bacterial endocarditis, and acute gingivitis.

Dosage and Administration: Adults and children 60 kg of body weight and over: 200,000-500,000 units every 6-8 hours. Infants and children up 60 kg of body weight: 100,000-250,000 units every 6-8 hours.

 Precautions and Warnings: Penicillin V Benzathine is not indicated in history of hypersensitivity to penicillins, cephalosporins and imipenem. Streptococcal infections must be treated for at least 10 days. Suspension contains 15 mg/5 ml aspartame (that is metabolized to phenylalanine in the GI tract) and should not be used by phenylketonurics. Penicillin V should be used with caution in patients with history of GI diseases especially antibiotic-associated colitis. In patients with severe renal function impairment, reduction in dosage or increase in dosing interval is recommended.

 

Side Effects: The side effects of Penicillin V Benzathine are GI reactions, headache, oral and vaginal candidiasis. The less frequent side effects are allergic reactions, anaphylaxis, serum sickness-like reactions, hives or itching.

Interactions: Bacteriostatic antibiotics may interfere with penicillins. Penicillin V Benzathine may reduce the efficacy of oral contraceptives.  Probenecid decreases renal tubular secretion of penicillins. Penicillins reduce the clearance of methotrexate. False-positive urine glucose reactions may occur in non-enzymatic tests using cupric sulfate during penicillin therapy.

Pregnancy and Lactation: Penicillin V crosses the placenta. Use during pregnancy only if clearly needed. Small amounts of Penicillin V appear in breast milk.

Packaging: Powder for 100 ml oral suspension.

Penicillin V Potassium

 Dosage Forms:

  • ۵۰۰ mg tablet
  • ۲۵۰ mg/5 ml powder for oral solution

 Drug Group: Antibiotic, Penicillins

 Mechanism: Penicillin V is natural penicillin that acts against penicillin-sensitive organisms. Penicillin V is a broad spectrum antibiotic that inhibits the biosynthesis of cell wall of bacteria. Penicillin V Benzathine has activity against streptococci, staphylococci, fusospirochetes, anaerobes, Borrelia burgdorferi, Actinomyces sp. and Bacillus anthracis.

Indications: Drug is given by mouth in the treatment of upper respiratory tract infections, scarlet fever, erysipelas, otitis media, Vincent’s angina, prevention of rheumatic fever and chorea, Lyme disease, anthrax, prophylaxis of bacterial endocarditis, and acute gingivitis.

Dosage and Administration: Adults and children 12 years of age and older: 125-500 mg every 6-8 hours. Infants and children up to 12 years: 2.5-8.3 mg per kg of body weight every 4 hours, 3.75 -12.5 mg per kg of body weight every 6 hours or 5-16.7 mg per kg of body weight every 8 hours.

 Precautions and Warnings: Penicillin V Potassium is not indicated in history of hypersensitivity to penicillins, cephalosporins and imipenem. Streptococcal infections must be treated for at least 10 days.

Penicillin V should be used with caution in patients with history of GI diseases especially antibiotic-associated colitis. In patients with severe renal impairment, reduction in dosage or increase in dosing interval is recommended.

Side Effects: Penicillin V Potassium is not indicated in history of hypersensitivity to penicillins, cephalosporins and imipenem. Streptococcal infections must be treated for at least 10 days.

Interactions: Bacteriostatic drugs may interfere with penicillins. Penicillin V Potassium may reduce the efficacy of oral contraceptives. Probenecid decreases renal tubular secretion of penicillins. Penicillins reduce the clearance of methotrexate. False-positive urine glucose reactions may occur in non-enzymatic tests using cupric sulfate with penicillin therapy.

Pregnancy and Lactation: Penicillin V crosses the placenta. Use during pregnancy only if clearly needed. Small amounts of Penicillin V appear in breast milk.

Packaging:

  • ۱۰ tablets in one blister. 10 blisters in a box.
  • Powder for 100 ml oral suspension.
[thememove_title_section type=”2″ title=”Cephalosporins”]

Farinat

Cefuroxime axetil

 Dosage Forms: 125 mg, 250 mg and 500 mg tablets

 Drug Group: Antibiotic, Cephalosporins

 Mechanism: Cefuroxime axetil is a second-generation cephalosporin antibiotic that inhibits biosynthesis of bacterial cell wall. Cefuroxime has activity against S. pyogenes, S. pneumoniae, H. influenzae, M. catarrhalis, H. parainfluenzae, S. aureus, E. coli, K. pneumoniae, N. gonorrhoeae, and Borrelia burgdorferi.

Indications: Cefuroxime axetil is given by mouth in treatment of pharyngitis, tonsillitis, acute otitis media, acute maxillary sinusitis, acute exacerbations of chronic bronchitis and secondary infections of acute bronchitis, skin and skin structure infections, urinary tract infections, uncomplicated gonorrhea and early Lyme disease.

Dosage and Administration: Adults and children 12 years of age and older: 125 to 500 mg based on type and severity of infection two times a day for five to twenty days.

Infants and children 3 months to 12 years of age: 10-15 mg per kg of body weight every twelve hours for ten days.

Precautions and Warnings: Cefuroxime is not indicated in patients with history of penicillins, penicillin derivatives, penicillamine and cephalosporins hypersensitivity, and porphyria. There is evidence of partial cross-allergenicity; cephalosporins cannot be assumed to the absolutely safe alternative to penicillin in the penicillin-allergic patients. Cefuroxime tablets contain phenylalanine and should not be used by phenylketonurics. Cefuroxime should be used with caution in patients with a history of GI diseases, particularly colitis. Cephalosporins may be nephrotoxic, use with caution in the presence of markedly impaired renal function.

Side Effects: Diarrhea, nausea and vomiting have occurred in some patients. Jarisch-Herxheimer reaction, rashes, pruritus and urticaria have been reported. Mild-to-moderate hearing loss reported in some pediatric patients. Hypoprothrombinemia has been reported.

Interactions: Probenecid increases cephalosporin serum concentrations, resulting prolonged elimination half-life, and increased risk of toxicity. Concurrent use of diuretics and Cefuroxime may increase the risk of adverse renal effects. The concomitantly use of Cefuroxime and an aminoglycoside may potentiate nephrotoxicity. Plasma concentration of Cefuroxime may be reduced by coadministration of H2-antagonists, decreasing the antibiotic effect. Nonsteroidal anti-inflammatory drugs [NSAIDs], salicylates, or sulfinpyrazon may increase the risk of hemorrhage. Cefuroxime axetil may produce false-positive urine glucose reactions with copper-reduction tests. Cefuroxime may cause a false-negative reaction in the ferricyanide test for blood glucose.

Pregnancy and Lactation: Cefuroxime crosses the placenta. Use only when potential benefits outweigh potential hazards to the fetus. Because Cefuroxime is distributed into milk, Cefuroxime axetil should be used with caution in nursing women.

Packaging: HDPE flacons of 20’s.

Cefixime

 Dosage Forms:

  • ۲۰۰ mg and 400 mg capsules
  • ۲۰۰ mg and 400 mg tablets
  • ۱۰۰ mg/5ml powder for oral suspension

 Drug Group: Antibiotic, cephalosporins

 Mechanism: Cefixime is an oral first-generation cephalosporin. Cephalosporins inhibit bacterial cell wall synthesis. Cefixime is a bactericidal antibiotic and is stable to hydrolysis by many beta–lactamases. It has a mode of action and spectrum of activity similar to that of third generation cephalosporin, cefotaxime, but some entrobacteriacea are less susceptible to cefixime. Haemophilus influenzae, Moraxella catarrhalis and Neisseria gonorrhoeae, including penicillinase-producing strains, are sensitive but most strains of staphylococci, enterococci, and Listeria spp. are not. Enterobacter spp., Pseudomonas aeruginosa, and Bacteroides spp. are resistant to cefixime.

Indications: Cefixime is given by mouth in the treatment of susceptible infections including gonorrhea, otitis media, pharyngitis, tonsillitis, lower respiratory tract infections such as bronchitis, urinary tract infections, enteric fever and shigellosis.

Dosage and Administration: Adults and children 50 kg of body weight and over: 200 to 400 mg daily as a single dose or in two divided doses. For uncomplicated gonorrhea, a single oral does of 400 mg is given. Infants and children 6 months to 12 years of age and up to 50 kg of body weight: 8 mg per kg of body weight once a day, or 4 mg per kg of body weight every 12 hours.

Precautions and Warnings: Cefixime should be used with caution in patients with history of GI diseases, especially ulcerative colitis, regional enteritis, or antibiotic-associated colitis. A reduced dosage is recommended in patients with renal function impairment receiving cefixime.

Side Effects: The most frequent reported adverse effects of cefixime are gastrointestinal disturbances, especially diarrhea. Cefixime should be discontinued if diarrhea is severe. Although cefixime does not have the N-methylthiotetrazole side-chain usually associated with hypoprothrombinaemia, increases in prothrombin times have occurred in a few patients. Skin rashes, urticaria, eosinophilia, fever and transient hepatitis and cholestatic jaundice have been reported.

Interactions: Care should be exercised in patients receiving anticoagulants and cefixime concomitantly due to the possibility that cefixime may increase prothrombin times. Concomitant administration of cefixime and carbamazepine or nifedipine may result in increased plasma carbamazepine or cefixime concentrations, respectively. A false-positive reaction for urine glucose may occur in non-enzymatic tests using cupric sulfate.

Pregnancy and Lactation: Cefixime crosses the placenta. Use during pregnancy only when clearly needed. Cefixime is excreted in breast milk in small quantities. Therefore, cefixime should be used with caution in nursing women, and consideration should be given to temporarily discontinuing nursing during therapy with the drug.

Packaging:

  • Blisters or PE flacons contain 10 film coated tablets.
  • ۱۰ capsules in one blister. One blister in a box.
  • Cefixime: Powder for 100 ml oral suspension.
  • Farexime: Powder for 50 ml oral suspension.

Cefalexin

 Dosage Forms:

  • ۲۵۰ mg and 500 mg capsules
  • ۱۲۵ mg/5ml and 250 mg/5ml powder for oral suspensions

 Drug Group: Antibiotic, Penicillins

 Mechanism: Cefalexin is an oral first-generation cephalosporin. Cephalosporins inhibit bacterial cell wall synthesis. Cefalexin has activity against group A beta-hemolytic streptococci, staphylococci, H. influenzae, M. catarrhalis, P. mirabilis, E. coli, Klebsiella sp. and S. pyogenes.

Indications: Cefalexin is given by mouth in the treatment of bone and joint infections, otitis media, tonsillitis, pharyngitis, skin and skin structure infections, genitourinary and urinary tract infections and prophylaxis of bacterial endocarditis.

Dosage and Administration: Adults and children 40 kg of body weight and over: 250-1000 mg based on type and severity of infection every 6, 8 or 12 hours up to a maximum 4 g per day. Children 1 year of age and older, up to 40 kg of body weight: 12.5 to 50 mg per kg of body weight based on type and severity of infection every 6, 8 or 12 hours. Infants and children 1 month to 1 year of age: 6.25 to 12.5 mg per kg of body weight every 6 hours.

Precautions and Warnings: Cefalexin is not indicated in history of cephalosporins, penicillins hypersensitivity, and porphyria. Cefalexin should be used with caution in patients with history of GI diseases, especially ulcerative colitis, regional enteritis, or antibiotic-associated colitis. Cephalosporins may be nephrotoxic, use with caution in the presence of impaired renal function.

Side Effects: The most frequent side effects of cefalexin are GI disturbances and hypersensitivity reactions including skin rashes, urticaria, eosinophilia, fever, reactions resembling serum sickness and anaphylaxis. Convulsions, transient hepatitis and cholestatic jaundice have been reported.

Interactions: Probenecid delays renal excretion of cefalexin. Cefalexin may decrease the efficacy of oral contraceptives. Loop diuretics increase the risk of nephrotoxicity of cephalosporins. Cephalosporins increase the nephrotoxicity of aminoglycoside. A false-positive reaction for urine glucose may occur in non-enzymatic tests using cupric sulfate.

Pregnancy and Lactation: Safety for use of cefalexin during pregnancy is not established. Small quantities of it are found in breast milk and should be used with caution in nursing women.

Packaging:

  • ۱۰ capsules in one blister. 10 blisters in a box.
  • Powder for 100 ml oral suspensions.
[thememove_title_section type=”2″ title=” Macrolldes & Quinolones”]

Clarithromycin

 Dosage Forms: 250 mg and 500 mg tablets.

 Drug Group: Antibiotic, Macrolide

 Mechanism: Clarithromycin is a macrolide derived from erythromycin. It reversibly binds to the P site of the 50S ribosomal subunit of susceptible organisms and may inhibit RNA-dependent protein synthesis. It may be bacteriostatic or bactericidal, depending on such factors as drug concentration.

Indications: Clarithromycin is given in the treatment of pharyngitis/tonsillitis, acute maxillary sinusitis, acute bacterial exacerbation of chronic bronchitis, pneumonia, uncomplicated skin and skin structure infections. It is also used for the prophylaxis and treatment of opportunistic mycobacterial infections and has been used in the treatment of leprosy. Clarithromycin may be given to eradicate Helicobacter pylori in treatment regimns for peptic ulcer disease.

Dosage and Administration: Adults: The usual adult dose of clarithromycin is 250 mg twice daily by mouth, increased to 500 mg twice daily if necessary in severe infection. A course is usually for 7 to 14 days. For treatment and prophylaxis of disseminated infection due to Mycobacterium Avium Complex disease, Clarithromycin may be given in a dose of 500 mg twice daily by mouth; for treatment, it should be given with other antimycobacterials. For leprosy, clarithromycin 500 mg daily by mouth has been given as part of an alternative multidrug therapy regimen.  For the eradication of H. pylori associated with peptic ulcer disease, clarithromycin, usually in a dose of 500 mg twice daily, is given with another antibacterial, for 7 to 14 days. Children: children may be given 7.5 mg/kg twice daily, up to 1000 mg per day, for 5 to 10 days.

 Precautions and Warnings: Hypersensitivity to any of the macrolide antibiotics and patients receiving astemizole, cisapride, or pimozide. Do not use clarithromycin in combination with ranitidine and bismuth citrate in patients with a history of acute porphyria. Hepatic/renal function impairment may be occurred. Clarithromycin should be used with caution in patients with pseudomembranus colitis.

Side Effects: The most frequent adverse effect is gastrointestinal disturbances but is usually mild and less frequent with clarithromycin than with erythromycin. Taste disturbances, stomatitis, glossitis, and tooth discoloration have occurred. Headache and rashes from mild skin eruptions to, rarely, Stevens-Janson syndrome have occurred. There have also been reports of transient CNS effects such as anxiety, dizziness, insomnia, hallucinations, and confusion. Hearing loss has been reported occasionally and is usually reversible. Interstitial nephritis and renal failure have been reported rarely. Other adverse effects include hypoglycemia and thrombocytopenia.

Interactions: Absorption of clarithromycin may be reduced by antacids. Azithromycin increases plasma concentration of disopyramide. Avoid concomitant use with rifabutin; increased risk of side effects including neutropenia exists when clarithromycin is given with rifabutin. Clarithromycin possibly enhances the anticoagulant effects of cumarins (warfarin). Clarithromycin possibly increase the risk of colchicine toxicity, suspend or reduce dose of colchicine. (Avoid concomitant use in hepatic or renal impairment). Clarithromycin may increase pimozide plasma concentrations and cardiotoxicity may occur. Coadministration is contraindicated. Coadministration with cisapride is contraindicated as it could lead to cardiac arrhythmias.

Pregnancy and Lactation: Pregnancy category C. Clarithromycin has adverse effects on pregnancy outcome or embryo-fetal development in monkeys, rats, mice, and rabbits. There are no adequate and well-controlled studies in pregnant women. Do not use clarithromycin in pregnant women. Clarithromycin and its active metabolite are distributed into breast milk.

Packaging: 10 tablets in one blister. 2 blisters in a box.

Erythromycin

Dosage Forms:

  • ۲۰۰ mg and 400 mg tablets
  • ۲۰۰ mg/5ml powder for oral suspension

 Drug Group: Antibiotic, macrolide

 Mechanism: Erythromycin is a macrolide antibiotic with a wide spectrum of activity. It reversibly binds to the P site of the 50S ribosomal subunit of susceptible organisms and may inhibits RNA-dependent protein. It may be bacteriostatic or bactericidal, depending on such factors as drug concentration.

Indications: Erythromycin has been used in the treatment of a wide variety of infections caused by susceptible organisms: upper respiratory tract infections (mild to moderate severity), lower respiratory tract infections (mild to moderate severity), respiratory tract infections, skin/skin structure infections (mild to moderate severity), pertussis (whooping cough), diphtheria, erythrasma, intestinal amebiasis, Pelvic inflammatory disease (PID), conjunctivitis of newborn, pneumonia of infancy, urogenital infections during uncomplicated urethral, endocervical, or rectal infections in adults, primary syphilis, legionnaire’s disease, rheumatic fever, bacterial endocarditis, Listeria monocytogenes infections.

Dosage and Administration: Adults: 400 mg every six hours; or 800 mg every twelve hours if twice a day dosing is desired. Children: 7.5 to 12.5 mg per kg of body weight every six hours; or 15 to 25 mg per kg body weight every twelve hours. For severe infections: 15 to 25 mg per kg body weight every six hours.

 Precautions and Warnings: Hypersensitivity to any of the macrolide antibiotics and patients receiving astemizole, cisapride, or pimozide. Erythromycin may aggravate the weakness of patients with myasthenia gravis. Serious allergic reactions, including anaphylaxis, have occurred with Erythromycin. Renal/Hepatic function impairment may be occurred. Erythromycin should be used with caution in patients with pseudomembranus colitis.

Side Effects: Erythromycin and its salts and esters are generally well tolerated and serious adverse effects are rare. Gastrointestinal disturbances such as abdominal discomfort and cramp, nausea, vomiting, and diarrhea are common. Hypersensitivity reactions appear to be uncommon, having been reported in about 0.5% of patients, and include pruritus, urticaria and skin rash as well as occasional cases of anaphylaxis. A hypersensitivity reaction may also be responsible for the hepatotoxicity sometimes reported in patients receiving Erythromycin or its derivatives. Hearing loss more likely to occur with administration of high doses (≥ ۴ grams per day) in patients with renal or hepatic disease and /or in elderly patients. Hearing loss is usually reversible. Other adverse effects that have been reported in patients receiving erythromycin include agranulocytosis, arrhythmias, central neurotoxicity including psychotic reactions and nightmares, a myasthenia-line syndrome, and pancreatitis.

Interactions: Erythromycins may inhibit carbamazepine and valproic acid metabolism, resulting in increased anticonvulsant plasma concentrations and toxicity. Erythromycins may displace these medications from, or prevent them from binding to, 50 S subunits of bacterial ribosomes, thus antagonizing the effects of chloramphenicol and lincomycins. It may increase cyclosporine, digoxin and buspirone plasma concentrations. It may deacrease the clearance of midazolam, triazolam, warfarin and theophylline.

Pregnancy and Lactation: Pregnancy category B. Use erythromycin only when clearly needed. Erythromycin is considered compatible with breast-feeding.

Packaging:

  • ۱۰ tablets in one blister. 10 blisters in a box.
  • Powder for 100 ml oral suspension.

Azithromycin

 Dosage Forms:

  • ۲۵۰ mg and 500 mg tablets
  • ۲۵۰ mg and 500 mg capsules
  • ۱۰۰ mg/5ml and 200 mg/5ml powder for oral suspensions

 Drug Group: Antibiotics, Macrolide

 Mechanism: It reversibly binds to the P site of the 50S ribosomal subunit of susceptible organisms and may inhibit RNA-dependent protein. It may be bacteriostatic or bactericidal, depending on such factors as drug concentration.

Indications: Respiratory-tract infections; otitis media; skin and soft-tissue infections; uncomplicated gonorrhoea (unlicensed indication), uncomplicated genital chlamydial infections and non-gonococcal urethritis, mild or moderate typhoid due to multiple-antibacterial-resistant organisms (unlicensed indication); Lyme disease (unlicensed indication); prophylaxis of group A streptococcal infection.

 Dosage and Administration: 500 mg once daily for 3 days or 500 mg on first day then 250 mg once daily for 4 days. Child over 6 months 10 mg/kg once daily for 3 days; or bodyweight 15–۲۵ kg, 200 mg once daily for 3 days; bodyweight 26–۳۵ kg, 300 mg once daily for 3 days; bodyweight 36–۴۵ kg, 400 mg once daily for 3 days. Uncomplicated genital chlamydial infections and non-gonococcal urethritis, 1 g as a single dose. Lyme disease, typhoid, 500 mg once daily for 7–۱۰ days (7 days in typhoid).

Precautions and Warnings: Hypersensitivity to any of the macrolide antibiotics or ketolide antibiotics (like telithromycin). Azithromycin should be used with caution in patients with hepatic or renal impairment. Azithromycin should not be used in patients with pneumonia who are judged to be inappropriate for oral therapy because of moderate to severe illness or risk factors. Prescribing antibiotics (including azithromycin) in the absence of a proven bacterial infection is unlikely to provide benefit to the patient and increases the risk of development or drug resistant bacteria. Azithromycin may aggravate the weakness of patients with myasthenia gravis. Azithromycin suspensions contain aspartame and should not be used by phenylkrtonurics.

 

Side Effects: Anorexia, dyspepsia, flatulence, dizziness, headache, malaise, paraesthesia, arthralgia, disturbances in taste and vision; less commonly constipation, gastritis, chest pain, oedema, anxiety, sleep disturbances, hypoaesthesia, leucopenia, photosensitivity; rarely agitation; also reported syncope, convulsions, smell disturbances, interstitial nephritis, acute renal failure, thrombocytopenia, haemolytic anaemia, tongue discoloration

 Interactions: Absorption of azithromycin may be reduced by antacids. Azithromycin increases plasma concentration of disopyramide. Avoid concomitant use with rifabutin; increased risk of side effects including neutropenia exists when azithromycin is given with rifabutin. Azithromycin possibly enhances the anticoagulant effects of cumarins (warfarin). Azithromycin possibly increase the risk of colchicine toxicity, suspend or reduce dose of colchicine. (Avoid concomitant use in hepatic or renal impairment). Azithromycin may increase pimozide plasma concentrations and cardiotoxicity may occur. Coadministration is contraindicated. Coadministration with cisapride is contraindicated as it could lead to cardiac arrhythmias.

 Pregnancy and Lactation: Category B. Azithromycin crosses the placenta but fetal plasma levels generally low. Use only when clearly needed. Breast-feeding: present in milk; use only if no suitable alternatives.

Packaging:

  • ۶ Capsules or tablets in a one blister. 1 blister in a box.
  • Powder for 30 ml oral suspensions.

 

اشكال دارويي :

  • كپسول و قرص mg 250 و mg 500
  • پودر براي تهيه سوسپانسيون خوراكي mg/5ml 100 و mg/5ml 200

دسته دارويي : آنتي بيوتيك، ماكروليد‌

 مكانيسم اثر : مهار سنتز پروتئين باکتریها

موارد مصرف : آزیترومایسین در درمان عفونت های مجاری تنفسی، التهاب گوش میانی، عفونت های پوست و بافت نرم، عفونت تناسلی بدون عارضه کلامیدیایی و التهاب غیر گنوکوکی پیشابراه مصرف می شود.

مقدار و نحوه مصرف :

  • بزرگسالان: ۵۰۰ ميلي گرم در روز اول و ۲۵۰ ميلي گرم در روزهاي دوم تا پنجم مي باشد. رژيم جايگزين عبارتست از: ۵۰۰ ميلي گرم يك بار در روز به مدت ۳ روز
  • کودکان : برای کودکان با سن بیش از ۶ ماه: ۱۰ ميلي گرم بر كيلوگرم وزن بدن در روز اول و ۵ ميلي گرم بر كيلوگرم وزن بدن در روزهاي دوم تا پنجم يك بار در روز مي باشد. رژيم جايگزين عبارتست از: روزانه ۱۰ ميلي گرم بر كيلوگرم وزن بدن به صورت یک بار در روز به مدت ۳ روز
  • کپسول آزيترومايسين را حداقل يک ساعت قبل از غذا و يا دو ساعت بعد از غذا مصرف نماييد.

 موارد منع مصرف : در صورت وجود ازدياد حساسيت به هريک از آنتي بيوتيک هاي ماکروليد و نيز در بيماراني که آستميزول، سيزاپرايد يا پيموزايد مصرف مي کنند آزيترومايسين نبايد مصرف شود. آزيترومايسين در بيماران دچار اختلال عملکرد کبدي نيز نبايد مصرف شود.

 عوارض جانبي : اختلالات گوارشي ضعيف، افزايش موقتي آنزيمهاي کبدي و بندرت يرقان انسدادی، راش، سردرد، سرگيجه و واکنشهاي ازدياد حساسيت و تغييرات موقتي در ميزان نوتروفيل بيماران

 تداخلات دارويي:  غلظت سرمی دیسوپیرامید در صورت مصرف همزمان با ماكروليدها افزایش می یابد و ممکن است موجب بروز مسمومیت و آریتمی شود. اثر وارفارین در صورت مصرف همزمان با ماكروليدها ممکن است افزایش یابد. ماكروليدها متابولیسم کاربامازپین، بروموکریپتین، تئوفیلین و سیکلوسپورین را مهار می کنند و ممکن است موجب افزایش غلظت سرمی این داروها گردند. ماكروليدها متابولیسم ترفنادین را نیز مهار می کنند و خطر بروز اریتمی در بیمار را افزایش می دهند. اثر دیگوکسین بر قلب در صورت مصرف همزمان با ماكروليدها ممکن است افزایش یابد. غلظت سرمی ماكروليدها توسط سایمتیدین افزایش می یابد و این موضوع احتمال بروز عوارض جانبی و مسمومیت، به ویژه ناشنوایی ناشی از ماكروليدها را افزایش

می دهد. البته به طور کلی تداخلات دارویی آزیترومایسین از اریترومایسین بسیار کمتر است و این به عنوان یکی از نقاط قوت این دارو می باشد.
مصرف در دوران بارداري و شيردهي:

گروهB  بارداري. اين‌ دارو در بارداري‌ و شيردهي‌ با احتياط مصرف شود.

بسته بندي :

  • يك بليستر ۶ عددي كپسول يا قرص به همراه بروشور درون يك جعبه
  • پودر جهت تهيه ۳۰ ميلي ليتر سوسپانسيون خوراکي به همراه بروشور و قاشق دارویی درون یک جعبه

Ciprofloxacin

 Dosage Forms: 250mg and 500mg tablets

Drug Group: Antibiotic, Flouroquinolons

Mechanism: It acts intracellulary by inhibiting topoisomerase II (DNA gyrase) and/or topoisomerase IV. Topoisomerases are essential bacterial enzymes that are critical catalysts in the duplication, transcription, and repair of bacterial DNA.

Indications: For the treatment of infections caused by susceptible strains of the designated microorganisms in the conditions listed below : Acute sinusitis, lower respiratory tract infections, nosocomial pneumonia, skin and skin structure infections, bone/joint infections, urinary tract infections, acute uncomplicated cystitis in females, chronic bacterial prostatitis, complicated intra-abdominal infections, infectious diarrhea, typhoid fever, sexually transmitted diseases and inhalational anthrax.

Dosage and Administration: Adult: The usual adult oral dose of ciprofloxacin ranges from 250mg to 750mg twice daily depending on the severity and nature of the infection. Children: For inhalation anthrax, ciprofloxacin may be given to children and adolescents for 60 days in a dose of 15mg/kg twice daily by mouth up to maximum of 500mg. Ciprofloxacin is not generally recommended for other uses in children and adolescents.

Precautions and Warnings: Hypersensitivity to flouroquinolons or the quinolone. The use of ciprofloxacin may result in overgrowth of nonsusceptible organisms, including fungi. If superinfection occurs, the drug should be discontinued and appropriate therapy instituted. Ciprofloxacin should be used with caution in patients with epilepsy or a history of CNS disorders. Care is necessary in patients with impaired hepatic or renal function, G6PD deficiency, or myasthenia gravis. Ciprofloxacin should be avoided in meticillin-resistant staphylococcus aureus infections because of the high level of resistance.

Side Effects: Ciprofloxacin is generally well tolerated. It most often involves the gastrointestinal tract, CNS, or skin. Gastrointestinal disturbances include nausea, vomiting, diarrhea, abdominal pain, and dyspepsia. Pseudomembranous colitis has been reported rarely. Headache, dizziness, and restlessness are among the commonest effects on the CNS. Others include tremor, drowsiness, insomnia, nightmares, and visual and other sensory disturbances.

Interactions: Increased cyclosporine toxicity with unknown mechanism had been reported. The hepatic metabolism of caffeine is decreased by ciprofloxacin. Administration of theophylline with ciprofloxacin has decreased theophylline clearance. Antacids, Iron salts, and sucralfate decreased GI absorption of quinolones.

Pregnancy and Lactation: Pregnancy category C. Ciprofloxacin crosses the placenta. Lactations: Ciprofloxacin is known to be distributed into human breast milk. If ciprofloxacin must be administered, breast-feeding is not recommended.

Packaging: 10 tablets in one blister. 2 blisters in a box.

[thememove_title_section type=”2″ title=”Supplements”]

Fefar

 Dosage Forms: Each sustained-release capsule contains 128.7 mg dried ferrous sulphate (47 mg elemental iron-Fe++) and 0.5 mg folic acid.

Drug Group: Supplement

 Mechanism: Iron is an essential mineral and an important component of proteins involved in oxygen transport and metabolism. Folic acid’s primary mechanisms of action are through its role as a one carbon donor. Folate helps in transfer of a single methyl group in various metabolic reactions in the body and in the functioning of the nervous system. It is essential for DNA synthesis. More specifically it helps in the manufacture of nucleic acids like Thymine.

Indications: Fefar is a haematinic preparation to prevent the iron and folic-acid deficiency during pregnancy and other conditions.

Dosage and Administration: Adults only: One Fefar capsule a day throughout pregnancy. Some pregnant patients may need a higher prophylactic dose of iron because of dietary or other factors.
Precautions and Warnings: Ferrous sulphate and other iron salts should not be given to patients receiving repeated blood transfusions or to patients with anemia not produced by iron deficiency unless iron deficiency is also present. Care should be taken when given to patients with iron-storage or iron-absorption diseases, haemoglobinopathies or existing gastro-intestinal disease.
Side Effects: Therapeutic doses of iron may cause gastro-intestinal discomfort, diarrhea, and vomiting. These side effects have been reported to occur in up to 20% or more of patients treated and are related to the amount of elemental iron. Although iron is better absorbed between meals, side effects can be reduced by taking it with, or immediately after, food.
Interactions: The absorption of iron salts and tetracyclines and fluroquinolones is diminished when they are taken concomitantly by mouth. If treatment with both drugs is required, the iron salt should be administered 3 hours before or 2 hours after the tetracycline and fluroquinolones. The absorption of iron salts is also decreased in the presence of antacids or when taken with tea. Iron salts appear to reduce the effects of penicillamine.

Pregnancy and Lactation: It is allowed and recommended.

 Packaging: 10 capsules in one blister. 3 blisters in a box.

Glucosamine sulfate

  Dosage Forms: 500 mg glucosamine sulfate tablet
Drug Group: Supplement

 Mechanism: Glucosamine is an amino monosaccharide found in chitin, glycoproteins and glycosaminoglycans. It may play a role in the promotion and maintenance of the structure and function of cartilage in the joints of the body.

Indications: Glucosamine sulfate supplements may helpful in management of osteoarthritis.

The usual dose used by those with osteoarthritis is l500 milligrams daily in divided doses.

Dosage and Administration: Dosage: The usual dose used by those with osteoarthritis is l500 milligrams glucosamine sulfate and 1200 milligrams chondroitin sulfate daily in divided doses.
Precautions and Warnings: Those with type 2 diabetes and those who are overweight and have problems with glucose tolerance should have their blood sugars carefully monitored if they use glucosamine sulfate supplements.

Side Effects: Side effects that have been reported are mainly mild gastrointestinal complaints such as heartburn, epigastric distress and diarrhea.
Interactions: Glucosamine sulfate may increase insulin resistance and consequently affect glucose tolerance. Diabetics who, under medical advisement, decide to use glucosamine sulfate supplements will need to monitor their blood glucose and may need to adjust the doses of the medications they take to control blood glucose.

Pregnancy and Lactation: Because of insufficient safety data, pregnant women and nursing mothers should avoid using glucosamine sulfate.

 Packaging: HDPE flacons of 60’s.

Glucosamine sulfateChondroitin sulfate 900

  Dosage Forms: Each tablet contains 500 mg glucosamine sulfate and 400 mg chondroitin sulfate
Drug Group: Supplement

 Mechanism: Both supplements are promoted as cartilage matrix enhancers which are purported to help prevent the breakdown and promote the rebuilding of cartilage.

Indications: Glucosamine sulfate and chondroitin sulfate supplements may helpful in treating:

  • Symptoms of arthritis, especially osteoarthritis.
  • Joint problems, such as joint pain, stiffness, and inflammation.

Dosage and Administration: Dosage: The usual dose used by those with osteoarthritis is l500 mg glucosamine sulfate and 1200 mg chondroitin sulfate daily in divided doses.

Precautions and Warnings: Because glucosamine is an amino sugar, people with diabetes should check their blood sugar levels more frequently when taking this supplement. In most cases, however, allergies are caused by proteins in shellfish, not chitin, a carbohydrate from which glucosamine is extracted. This supplement is similar in structure to the blood thinning drug heparin, and the combination may cause bleeding in some individuals.

Side Effects: There appear to be no adverse effects associated with taking glucosamine or chondroitin supplements. You may, however, experience some mild side effects, such as an upset stomach, nausea, diarrhea, heartburn, and indigestion.

 Interactions: This supplement is similar in structure to the blood-thinning drug heparin, and the combination may cause bleeding in some people.

Pregnancy and Lactation: Because of insufficient safety data, pregnant women and nursing mothers should avoid using glucosamine sulfate and chondroitin sulfate.

 Packaging: HDPE flacons of 60’s.

Calcium D

 Dosage Forms:

Calcium 500 mg (as carbonate) + Vitamin D3 200 UI (as cholecalciferol) tablets

Drug Group: Supplement

 Mechanism: Calcium is necessary for normal functioning of nerves, cells, muscle, and bone. If there is not enough calcium in the blood, then the body will take calcium from bones, thereby weakening bones. Vitamin D helps your body absorb calcium and phosphorus. Having the right amounts of vitamin D, calcium, and phosphorus is important for building and keeping strong bones.

Indications: This combination medication may be used to treat conditions caused by low calcium levels such as bone loss (osteoporosis), weak bones (osteomalacia/rickets), decreased activity of the parathyroid gland (hypoparathyroidism), and a certain muscle disease (latent tetany). It may also be used in certain patients to make sure they are getting enough calcium (e.g. women who are pregnant, nursing, or postmenopausal, people taking certain medications such as phenytoin, phenobarbital, or prednisone).

Dosage and Administration: These are dosages for Calcium (mg per day) and Vitamin D3 (Unit per day), respectively: Infants and children Birth to 3 years of age: 400–۸۰۰ & 300-400 4 to 10 years of age: 800 & 400, Adolescent and adult: 800–۱۲۰۰ & 200-400, Pregnant and Breast-feeding females: 1200 & 400

 

Precautions and Warnings: Do not take calcium supplements within 1 to 2 hours of taking other medicine by mouth. Do not take other medicines or dietary supplements containing large amounts of calcium, phosphates, magnesium, or vitamin D. Do not take calcium supplements within 1 to 2 hours of eating large amounts of fiber-containing foods, such as bran and whole-grain cereals or breads, especially if you are being treated for hypocalcaemia (not enough calcium in your blood). Do not drink large amounts of alcohol or caffeine-containing beverages (usually more than 8 cups of coffee a day).

Side Effects: Constipation or stomach upset, nausea/vomiting, loss of appetite, unusual weight loss, mental/mood changes, change in the amount of urine, bone/muscle pain, headache, increased thirst, increased urination, weakness, tiredness, fast/pounding heartbeat may occur. A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including rash, itching, swelling, severe dizziness, trouble breathing.

Interactions: Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: calcium channel blockers (e.g. verapamil, nifedipine), certain anti-seizure medications (e.g. phenytoin, phenobarbital), corticosteroids (e.g. prednisone), digoxin, phosphate binders, thiazide diuretics (e.g. hydrochlorothiazide). Calcium can decrease the absorption of other drugs such as tetracycline antibiotics (e.g. doxycycline, minocycline), estramustine, levothyroxine, and quinolone antibiotics (e.g. ciprofloxacin, levofloxacin).

Pregnancy and Lactation: During pregnancy, doses of calcium and vitamin D greater than the recommended dietary allowance should be used only when clearly needed. Discuss the risks and benefits with your doctor.

Packaging: HDPE flacons of 60’s.

Calcifar & Calcifar plus

 Dosage Forms:

  • Calcifar: Enteric-coated tablets containing: Ca: 800 mg, Mg: 200 mg, zinc: 8 mg, vitamin D3 (cholecalciferol): 400 IU
  • Calcifar plus: Enteric-coated tablets containing: Ca: 800 mg, Mg: 200 mg, zinc: 8 mg, vitamin D3 (cholecalciferol): 400 IU, vitamin K1: 40.25 mcg

 Drug Group: Supplement

Mechanism: Calcium, magnesium, and zinc work together in the body to enhance each other’s absorption and utilization. Calcium and magnesium are essential factors in the formation and maintenance of healthy bones, Vitamin D stimulates bone matrix formation and bone maturation. It also enhances osteoclastic activity and there are some data to suggest that it may influence differentiation of bone cell precursors. Vitamin K has an important function for the skeleton as it acts as a cofactor in the post-translational carboxylation of several bone proteins, with osteocalcin being the most abundant.

Indications: This advanced, proprietary formulation provides a comprehensive blend of nutrients which support and promote bone health. The components include the important D3 and K2 Vitamin forms along with a host of chelated mineral forms. Together, these ingredients work to promote proper bone mineralization. When used as suggested, this formula provides 100% of the daily value for calcium. When combined with a healthy diet and physical activity, calcium may reduce the risk of osteoporosis.

Dosage and Administration: As a dietary supplement for adults, take 3 tablets daily, preferably at mealtime, or as directed by a healthcare practitioner.

Precautions and Warnings: Do not take calcium supplements within 1 to 2 hours of taking other medicine by mouth. Do not take other medicines or dietary supplements containing large amounts of calcium, phosphates, magnesium, or vitamin D. Do not take calcium supplements within 1 to 2 hours of eating large amounts of fiber-containing foods, such as bran and whole-grain cereals or breads, especially if you are being treated for hypocalcaemia (not enough calcium in your blood). Do not drink large amounts of alcohol or caffeine-containing beverages (usually more than 8 cups of coffee a day).

Side Effects: Nausea, vomiting, loss of appetite, weight loss, behavioral changes, frequent urination, muscle and bone pain, headache, increased thirst, fatigue or unusual weakness, irregular heartbeat, drowsiness, pancreatitis, skin rash, increased sensitivity of eyes to light.

Interactions: Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: calcium channel blockers (e.g. verapamil, nifedipine), certain anti-seizure medications (e.g. phenytoin, phenobarbital), corticosteroids (e.g. prednisone), digoxin, phosphate binders, thiazide diuretics (e.g. hydrochlorothiazide). Calcium can decrease the absorption of other drugs such as tetracycline antibiotics (e.g. doxycycline, minocycline), levothyroxine, and quinolone antibiotics (e.g. ciprofloxacin, levofloxacin).

Pregnancy and Lactation: Discuss the risks and benefits with your doctor.

Packaging: HPDE flacons of 60’s.

Calcifar & Calcifar plus

 Dosage Forms:

  • Calcifar: Enteric-coated tablets containing: Ca: 800 mg, Mg: 200 mg, zinc: 8 mg, vitamin D3 (cholecalciferol): 400 IU
  • Calcifar plus: Enteric-coated tablets containing: Ca: 800 mg, Mg: 200 mg, zinc: 8 mg, vitamin D3 (cholecalciferol): 400 IU, vitamin K1: 40.25 mcg

 Drug Group: Supplement

Mechanism: Calcium, magnesium, and zinc work together in the body to enhance each other’s absorption and utilization. Calcium and magnesium are essential factors in the formation and maintenance of healthy bones, Vitamin D stimulates bone matrix formation and bone maturation. It also enhances osteoclastic activity and there are some data to suggest that it may influence differentiation of bone cell precursors. Vitamin K has an important function for the skeleton as it acts as a cofactor in the post-translational carboxylation of several bone proteins, with osteocalcin being the most abundant.

Indications: This advanced, proprietary formulation provides a comprehensive blend of nutrients which support and promote bone health. The components include the important D3 and K2 Vitamin forms along with a host of chelated mineral forms. Together, these ingredients work to promote proper bone mineralization. When used as suggested, this formula provides 100% of the daily value for calcium. When combined with a healthy diet and physical activity, calcium may reduce the risk of osteoporosis.

Dosage and Administration: As a dietary supplement for adults, take 3 tablets daily, preferably at mealtime, or as directed by a healthcare practitioner.

Precautions and Warnings: Do not take calcium supplements within 1 to 2 hours of taking other medicine by mouth. Do not take other medicines or dietary supplements containing large amounts of calcium, phosphates, magnesium, or vitamin D. Do not take calcium supplements within 1 to 2 hours of eating large amounts of fiber-containing foods, such as bran and whole-grain cereals or breads, especially if you are being treated for hypocalcaemia (not enough calcium in your blood). Do not drink large amounts of alcohol or caffeine-containing beverages (usually more than 8 cups of coffee a day).

Side Effects: Nausea, vomiting, loss of appetite, weight loss, behavioral changes, frequent urination, muscle and bone pain, headache, increased thirst, fatigue or unusual weakness, irregular heartbeat, drowsiness, pancreatitis, skin rash, increased sensitivity of eyes to light.

Interactions: Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: calcium channel blockers (e.g. verapamil, nifedipine), certain anti-seizure medications (e.g. phenytoin, phenobarbital), corticosteroids (e.g. prednisone), digoxin, phosphate binders, thiazide diuretics (e.g. hydrochlorothiazide). Calcium can decrease the absorption of other drugs such as tetracycline antibiotics (e.g. doxycycline, minocycline), levothyroxine, and quinolone antibiotics (e.g. ciprofloxacin, levofloxacin).

Pregnancy and Lactation: Discuss the risks and benefits with your doctor.

Packaging: HPDE flacons of 60’s.

[thememove_title_section type=”2″ title=”Anti-Hyper Cholesteroleia”]

Ezetimibe

 Dosage Forms: 10 mg tablet

Drug Group: Anti-hypercholesterolemia

Mechanism: Ezetimibe is an inhibitor of intestinal cholesterol absorption. Ezetimibe localizes and appears to act at the brush border of the small intestine and inhibits the absorption of cholesterol, leading to decrease in the delivery of intestinal cholesterol to the liver.

Indications: Primary hypercholesterolemia. Ezetimibe is indicated as adjunctive therapy to diet for the reduction of elevated total-cholesterol, LDL-C, and Apo B in patients with primary (heterozygous familial and non-familial) hypercholesterolemia and reduction of elevated sitosterol and campesterol levels in patients with homozygous familial sitosterolemia.

Dosage and Administration: Oral, 10 mg once daily with or without food.

Precautions and Warnings: When ezetimibe is co-administered with an HMG-CoA reductase inhibitor, liver function tests should be performed at initiation of therapy and according to the recommendations of the HMG-CoA reductase inhibitor. Due to the unknown effects of the increased exposure to ezetimibe in patients with moderate or severe hepatic insufficiency, ezetimibe is not recommended in these patients.

Side Effects: The most common adverse effects include headache, abdominal pain, and diarrhea; other gastro-intestinal disorders, myalgia, upper respiratory tract infection, back pain, coughing, dizziness, pharyngitis, sinusitis and urinal infection, hypersensitivity reactions including rash and angioedema, fatigue, chest pain, and arthralgia.

Interactions: Colestyramine: reduces the absorption of ezetimibe and should not be given at the same time of day. Cyclosporine: has been reported to increase the plasma concentration of ezetimibe and patients receiving both drugs should be carefully monitored. Fenofibrate: Concomitant administration increases total ezetimibe concentrations. Fibrates: Concomitant administration increases cholesterol excretion leading to cholelithiasis.

Pregnancy and Lactation: Pregnancy category C. It is not known whether ezetimibe is distributed into human breast milk. Therefore, ezetimibe should not be used in nursing mothers unless the potential benefit justifies the potential risk to the infant.

Packaging: 10 tablets in one blister. 3 blisters in a box.

[thememove_title_section type=”2″ title=”Cardivascular Agents”]

Sotalol

 Dosage Forms: 5 mg and 10 mg tablets

Drug Group: Non-Cardioselective Beta blocker

 Mechanism: It is reported to lack both intrinsic sympathomimetic and membrane  stabilizing properties. In addition to the class II antiarrhythmic activity of beta-blockers, sotalol lengthens the duration of the action potential resulting in class III antiarrhythmic activity

Indications: Sotalol is indicated for the treatment of documented ventricular arrhythmias, such as sustained ventricular tachycardia, that in the judgment of the physician are life-threatening. In patients with highly symptomatic atrial fibrilation/atrial flutter (AFIB/AFL) who are currently in sinus rhythm, sotalol is used to maintain the normal sinus rhythm

Dosage and Administration: Initial: Oral, 40 mg two times a day, the dosage being increased gradually. Maintenance: Oral, 160 to 320 mg per day, given in two or three divided doses.

Precautions and Warnings: Renal Impairment: Sotalol is eliminated principally via the kidneys through glomerular filtration and to small degree by tubular secretion. There is a direct relationship between renal function and the elimination rate of sotalol.

Side Effects: As for Beta-blockers. Torsade de pointes have been reported in patients given sotalol, usually due to prolongation of the QT interval. Drowsiness, dizziness, light-headness, headache, stomach upset may occur the first several days. Other common side effects reported include cough, decreased sexual desire, trouble sleeping, reduced concentration, altered taste, dry skin and muscle aches.

Interactions: Sotalol should not be used with other drugs that prolong the QT interval due to the increased risk of precipitating ventricular arrhythmias (such as amiodarone, disopyramide, procainamide, or quinidine, also phenothiazine antipsychotics, tricyclic antidepressants, certain antihistamines (astemizole or terfenadine), cisapride, erythromycin, and pentamidine.

Pregnancy and Lactation: Pregnancy category B. Although there are no adequate and well controlled studies in pregnant women, sotalol has been shown to cross the placenta. Therefore, sotalol should be used during pregnancy only if the potential benefit outweighs the potential risk. Sotalol is distributed into breast milk but no clinical effects were found. So it is compatible with breast feeding.

Packaging: 10 tablets in one blister. 10 blisters in a box.

Carvedilol

 Dosage Forms: 6.25 mg and 12.5 mg tablets

Drug Group: Non-selective beta receptors antagonist and selective alpha receptors antagonist.

 Mechanism: Carvedilol is a non-cardioselective beta-blocker. It has vasodilating properties, which are attributed mainly to its blocking activity at alpha receptors.

Indications: Carvedilol is used in the management of hypertension and angina pectoris, and as adjunct to standard therapy in symptomatic heart failure. It is also used to reduce mortality in patients with left ventricular dysfunction following myocardial infarction.

Dosage and Administration: In hypertension, initial dose: 12.5mg once daily or 6.25mg twice daily. After two days: 25mg- 50mg once daily or twice daily. In angina pectoris, initial dose: 12.5mg twice daily. After two days: 25mg twice daily. In heart failure, initial dose: 3.125mg twice daily. After two weeks: 6.25mg twice daily. In patients with left ventricular dysfunction following myocardial infarction, initial dose: 6.25mg twice daily. After 3 to 10 days (if tolerated): 12.5mg twice daily.

Precautions and Warnings: Since carvedilol has beta-blocking activity, it should not be discontinued abruptly, particularly in patients with ischemic heart disease. At the first sign/symptom of liver dysfunction, perform laboratory testing. Carvedilol is contraindicated in patients with NYHA class IV decompensated cardiac failure, bronchial asthma or related bronchospastic conditions, 2nd or 3rd degree AV block, sick sinus syndrome, cardiogenic shock or severe bradycardia.

Side Effects: As for beta-blockers liver function abnormalities (reversible), acute renal failure & renal abnormalities.

Interactions: Interaction of carvedilol with strong inhibitors of CYP2D6 (such as quinidine, fluoxetine, paroxetine and propafenone) has not been studied, but these drugs would be expected to increase blood levels of the carvedilol.

Pregnancy and Lactation: Pregnancy category C. Adequate and well-controlled studies in humans have not been done. It is not known whether carvedilol is distributed into breast milk.

Packaging: 10 tablets in one blister. 3 blisters in a box.

Nitroglycerin

 Dosage Forms: 2.6 mg and 6.4 mg sustained release tablets.

Drug Group: Cardiovascular drugs, Vasodilator

 Mechanism: Nitroglycerin is a vasodilator that frequently is used in the management of angina pectoris. Additionally, in patients with angina, nitroglycerin preferentially dilates blood vessels that supply the areas of the heart where there is not enough oxygen; thereby delivering oxygen to the heart tissue that needs it most.

Indications: Nitroglycerin is indicated for the acute relief of an attack or acute prophylaxis of angina pectoris due to coronary artery disease.

Dosage and Administration: 2.6-6.4 mg every 12 hours up to a maximum of 13 mg daily in divided doses every 8 or 12 hours.

Precautions and Warnings: Nitroglycerin should not be used in patients with severe hypotension, hypovolaemia, marked anaemia, heart failure due to obstruction (including constrictive pericarditis), or raised intracranial pressure due to head trauma or cerebral haemorrhage. Although it has been suggested that Nitroglycerin may increase intra-ocular pressure in patients with angle-closure glaucoma and should be avoided in such patients there appears to be no evidence for such a contra-indication. Nitroglycerin should be used with caution in patients with severe renal or severe hepatic impairment, hypothyroidism, malnutrition, or hypothermia. Metal-containing transdermal patches should be removed before cardioversion or diathermy.

Side Effects: Abdominal pain, diarrhea, dyspepsia, flatulence, nausea, vomiting, constipation,  accident household, edema, fall, pain, influenza-Like symptoms, dizziness, headache, pharyngitis, upper respiratory tract infection, coughing, pruritus, rash, Joint related signs and symptoms, musculoskeletal and connective tissue signs and symptoms, anemia, arthralgia, back pain, insomnia, micturition frequency, urinary tract infection

Interactions: Since nitroglycerin can cause hypotension, other medications which also cause hypotension may produce an unwanted additive effect. Such drugs might include medicines used to treat high blood pressure, some antidepressants; some anti-psychotics, quinidine, procainamide, benzodiazepines such as diazepam (Valium) or opiates (e.g. morphine). Alcohol also may intensify the blood pressure lowering effect of nitroglycerin. Ergot alkaloids (e.g. Cafergot) and Imitrex can oppose the vasodilatory actions of nitroglycerin and may precipitate angina. A similar effect can occur with ephedrine and the decongestants pseudoephedrine (Sudafed) and propanolamine. PDE5 inhibitors (Sildenafil, Vardenafil and Tadalafil) should not be used in patients who have taken nitroglycerin.

 

Pregnancy and Lactation: Nitroglycerin can be used during pregnancy if in the judgment of the physician the potential benefits justify the potential (though unknown) risks to the fetus. It is not known if nitroglycerin is secreted in breast milk.

Packaging:

  • Nitroglycerin 2.6: HDPE flacons of 100’s.
  • Nitroglycerin 6.4: HDPE flacons of 50’s.
[thememove_title_section type=”2″ title=”Anti-Viral”]

Acyclovir

 Dosage Forms: 200 mg and 400 mg tablets

 Drug Group: Anti-Viral

 Mechanism: Acyclovir is a synthetic purine nucleoside analogue with in vitro and in vivo inhibitory activity against Herpes Simplex Virus types 1 (HSV-1), 2 (HSV-2) and Varicella-Zoster Virus (VZV).

 Indications: Acyclovir is indicated for the treatment of Herpes Zoster infections, genital herpes and chickenpox.

 Dosage and Administration: Herpes Zoster: 800 mg every 4 hours orally, 5 times daily for 7 to 10 days. Initial Genital Herpes: 200 mg every 4 hours, 5 times daily for 10 days. Chronic Suppressive Therapy for Recurrent Disease: 400 mg 2 times daily for up to 12 months, followed by re-evaluation. Treatment of chickenpox:  ۸۰۰ mg 4 times daily for 5 days. When therapy is indicated, it should be initiated at the earliest sign or symptom of chickenpox.

Precautions and Warnings: Acyclovir is contraindicated for patients who develop hypersensitivity to acyclovir or valacyclovir. Thrombotic Thrombocytopenic Purpura/Hemolytic Uremic Syndrome (TTP/HUS), which has resulted in death, has occurred in immunocompromised patients receiving acyclovir therapy.

 Side Effects: The most frequent adverse effects are anaphylaxis, angioedema, fever, headache, pain, peripheral edema, confusion, dizziness, hallucinations, seizure, diarrhea, gastrointestinal distress, nausea and thrombocytopenia. Less frequent adverse effects are elevated liver function tests, jaundice, myalgia, erythema multiforme, photosensitive rash, pruritus, rash, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria, visual abnormalities, renal failure, elevated blood urea nitrogen and elevated creatinine.

 Interactions: Co-administration of probenecid with acyclovir has been shown to increase the mean half-life and the area under the concentration-time curve. Urinary excretion and renal clearance were correspondingly reduced.

 Pregnancy and Lactation: Pregnancy category B.  There are no adequate and well-controlled studies in pregnant women. Acyclovir should be administered to pregnant and nursing mother with caution and only when indicated.

 Packaging: HDPE flacons of 50’s.

[thememove_title_section type=”2″ title=”Phosphodiesterase”]

Tadalafil

 Dosage Forms: 10 mg and 20 mg tablets

Drug Group: Phosphodiesterase type 5 (PDE5)

 Mechanism: Tadalafil enhances erectile function by increasing the amount of cGMP. Cyclic GMP causes smooth muscle relaxation and increased blood flow into the corpus cavernosum. The inhibition of phosphodiesterase type 5 (PDE5) by tadalafil results in less cGMP breakdown. Because sexual stimulation is required to initiate the local release of nitric oxide, the inhibition of PDE5 by tadalafil has no effect in the absence of sexual stimulation.

Indications: Tadalafil is indicated for the treatment of erectile dysfunction.

Dosage and Administration: The recommended starting dose of tadalafil in most patients is 10 mg, taken prior to anticipated sexual activity. The dose may be increased to 20 mg or decreased to 5 mg, based on individual efficacy and tolerability. The maximum recommended dosing frequency is once per day in most patients. Tadalafil may be taken without regard to food.

Precautions and Warnings: Caution is advised when PDE5 inhibitors are coadministered with alpha-blockers. Tadalafil should be limited to 5 mg not more than once daily in patients with severe renal insufficiency or end-stage renal disease. In patients with mild or moderate hepatic impairment, the dose of tadalafil should not exceed 10 mg. Use of tadalafil in this group is not recommended. Tadalafil should be used with caution in patients who have conditions that might predispose them to priapism (such as sickle cell anemia, multiple myeloma, or leukemia), or in patients with anatomical deformation of the penis (such as angulation, cavernosal fibrosis, or Peyronie’s disease).

Side Effects: The followings are the clinical adverse reactions considered possibly: headache, dyspepsia, back pain, myalgia, nasal congestion, flushing, pain in limb, asthenia, face edema, fatigue, pain, angina pectoris, chest pain, hypotension, hypertension, myocardial infarction, postural hypotension, palpitations, syncope, tachycardia, abnormal liver function tests, diarrhea, dry mouth, dysphagia, esophagitis, gastroesophageal reflux, gastritis, GTP increased, loose stools, nausea, upper abdominal pain, vomiting, arthralgia, neck pain, dizziness, hypesthesia, insomnia, paresthesia, somnolence, vertigo, dyspnea, epistaxis, pharyngitis, pruritus, rash, sweating, blurred vision, changes in color vision, conjunctivitis (including conjunctival hyperemia), eye pain, lacrimation increase, swelling of eyelids, erection increased, spontaneous penile erection.

Interactions: Tadalafil is a substrate of and predominantly metabolized by CYP3A4. Studies have shown that drugs that inhibit CYP3A4 can increase tadalafil exposure. So drugs like ketoconazole, ritonavir, erythromycin, itraconazole, and grapefruit juice, would likely increase tadalafil exposure and rifampin, carbamazepine, phenytoin, and phenobarbitol, would likely decrease tadalafil exposure. Alcohol and PDE5 inhibitors, including tadalafil, are mild systemic vasodilators. When mild vasodilators are taken in combination, blood-pressure-lowering effects of each individual compound may be increased. Administration of tadalafil to patients, who are using any form of organic nitrate, is contraindicated. In clinical pharmacology studies, tadalafil was shown to potentiate the hypotensive effect of nitrates. In a patient who has taken tadalafil, where nitrate administration is deemed medically necessary in a life-threatening situation, at least 48 hours should elapse after the last dose of tadalafil before nitrate administration is considered.

Pregnancy and Lactation: Pregnancy category B. Tadalafil is not indicated for use in newborns, children, or women.

Packaging: 4 tablets in one blister. One blister in a box.

[thememove_title_section type=”2″ title=”Anti-Diabetic”]

Repaglinide

 Dosage Forms: 0.5 mg, 1 mg and 2 mg tablets

Drug Group: Anti-Diabetic drugs

 Mechanism: Repaglinide is an oral blood glucose-lowering drug of the meglitinide class used in the management of type 2 diabetes mellitus (also known as non-insulin dependent diabetes mellitus or NIDDM). Repaglinide lowers blood glucose levels by stimulating the release of insulin from the pancreas. This action is dependent upon functioning beta cells in the pancreatic islets.

Indications: Repaglinide is indicated as an adjunct to diet and exercise to lower the blood glucose in patients with type 2 diabetes mellitus (NIDDM) whose hyperglycemia cannot be controlled satisfactorily by diet and exercise alone.

Dosage and Administration: Repaglinide is given by mouth up to 30 minutes before meals, in usual initial doses of 0.5 mg; initial doses of 1 or 2 mg are usually given to patients who have had previous hypoglycaemic treatment. The dose may be adjusted, at intervals of 1 to 2 weeks, up to a maximum of 4 mg before meals; a total of 16 mg daily should not be exceeded. Repaglinide is also given with metformin or a thiazolidinedione in type 2 diabetes not adequately controlled by metformin alone.

Precautions and Warnings: Repaglinide is not indicated for use in combination with NPH-insulin. All oral blood glucose-lowering drugs are capable of producing hypoglycemia. Proper patient selection, dosage, and instructions to the patients are important to avoid hypoglycemic episodes. Hepatic insufficiency may cause elevated Repaglinide blood levels and may diminish gluconeogenic capacity, both of which increase the risk of serious hypoglycemia. Elderly, debilitated, or malnourished patients and those with adrenal, pituitary, hepatic or severe renal insufficiency may be particularly susceptible to the hypoglycemic action of glucose-lowering drugs. When a patient stabilized on any diabetic regimen is exposed to stress such as fever, trauma, infection, or surgery, a loss of glycemic control may occur. At such times, it may be necessary to discontinue Repaglinide and administer insulin.

Side Effects: The followings are the only clinical adverse reactions considered possibly: Hypoglycemia, URI, Sinusitis, Rhinitis, Bronchitis, nausea, diarrhea, constipation, vomiting, dyspepsia, arthralgia, back pain, headache, paresthesia, chest pain, urinary tract infection, tooth disorder, allergy, serious CV events, and cardiac ischemic events.

Interactions: In vitro data indicate that repaglinide metabolism may be inhibited by antifungal agents like ketoconazole and miconazole, and antibacterial agents like erythromycin. Drugs that induce the cytochrome P450 enzyme system 3A4 may increase repaglinide metabolism; such drugs include rifampin, barbiturates, and carbamezepine. In vivo data from a study that evaluated the co-administration of gemfibrozil with Repaglinide in healthy subjects resulted in a significant increase in repaglinide blood levels.

Pregnancy and Lactation: Pregnancy category C. Repaglinide should be used during pregnancy only if it is clearly needed. Repaglinide should be discontinued in nursing mothers, or if mothers should discontinue nursing.

Packaging: HDPE flacons of 100’s.

[thememove_title_section type=”2″ title=”Proton Pomp Inhibitor”]

Pantoprazole

 Dosage Forms: 20 mg and 40 mg enteric coated tablets or capsules.

Drug Group: Proton Pump inhibitor

 Mechanism: Suppresses gastric acid secretion by specific inhibition of the hydrogen–potassium ATPase enzyme system at the secretory surface of the gastric parietal cells; blocks the final step of acid production.

Indications: Short-term treatment of erosive esophagitis associated with Gastroesophageal Reflux Disease (GERD). Healing and symptomatic relief of erosive esophagitis. Long-term treatment of pathological hypersecretory conditions, including Zollinger-Ellison syndrome.

Dosage and Administration: The recommended adult oral dose is 40 mg given once daily for up to 8 weeks. For those patients who have not healed after 8 weeks of treatment, an additional 8-week course of Pantoprazole may be considered.

Precautions and Warnings: Generally, daily treatment with any acid-suppressing medications over a long period of time (eg, longer than 3 years) may lead to malabsorption of cyanocobalamin (vitamin B12) caused by hypo- or achlorhydria. Rare reports of cyanocobalamin deficiency occurring with acid-suppressing therapy.

Side Effects: The followings are the clinical adverse reactions considered possibly: Headache, Diarrhea, Flatulence, Abdominal pain, Rash, Eructation, Insomnia, Hyperglycemia, Nausea, Vomiting, anxiety, arthralgia, asthenia, back pain, bronchitis, chest pain, constipation, cough increased, dizziness, dyspepsia, dyspnea, flu syndrome, gastroenteritis, gastrointestinal disorder, hyperlipidemia, hypertonia, infection, liver function tests abnormal, migraine, neck pain, pain, pharyngitis, rectal disorder, rhinitis, SGPT increased, sinusitis, upper respiratory tract infection, urinary frequency and urinary tract infection.

Interactions: There have been post marketing reports of increased INR and prothrombin time in patients receiving proton pump inhibitors, including Pantoprazole and warfarin concomitantly. Increases in INR and prothrombin time may lead to abnormal bleeding and even death. Patients treated with proton pump inhibitors and warfarin concomitantly should be monitored for increases in INR and prothrombin time.

Because of profound and long lasting inhibition of gastric acid secretion, pantoprazole may interfere with absorption of drugs where gastric pH is an important determinant of their bioavailability (eg, ketoconazole, ampicillin esters, and iron salts).

 

Pregnancy and Lactation: Pregnancy category B. There are no adequate and well-controlled studies in pregnant women. This drug should be used during pregnancy only if clearly needed. Because Pantoprazole is excreted in human milk a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the benefit of the drug to the mother.

Packaging: PVC flacons of 14’s.

Lansoprazole

 Dosage Forms: 15 mg and 30 mg delayed release capsules.

Drug Group: Proton Pump inhibitor

 Mechanism: Suppresses gastric acid secretion by specific inhibition of the hydrogen–potassium ATPase enzyme system at the secretory surface of the gastric parietal cells; blocks the final step of acid production.

Indications: Short-term treatment (up to 4 wk) of active duodenal ulcer, short-term treatment (up to 8 wk) of gastric ulcers, short-term treatment (up to 8 wk) of GERD: Severe erosive esophagitis; poorly responsive symptomatic GERD, long-term treatment of pathological hypersecretory conditions (eg, Zollinger-Ellison syndrome, multiple adenomas, systemic mastocytosis), maintenance therapy for healing of erosive esophagitis, duodenal ulcers, eradication of Helicobacter pylori infection in patients with active or recurrent duodenal ulcers in combination with clarithromycin and amoxicillin. Short-term treatment (up to 8 wk) of symptomatic GERD and erosive esophagitis in children 1–۱۱ yr short-term treatment (up to 7 days) of all grades of erosive esophagitis when patient is unable to take oral medication (IV).

Dosage and Administration: Active duodenal ulcer: 15 mg PO daily before eating for 4 wk. For maintenance, 15 mg PO daily. Gastric ulcer: 30 mg/day PO for < 8 wk. Risk reduction of gastric ulcer with NSAIDS: 15 mg/day PO for up to 12 wk. Duodenal ulcers associated with H. pylori: 30 mg lansoprazole, 500 mg clarithromycin, 1 g amoxicillin, all given PO bid for 10–۱۴ days; or 30 mg lansoprazole and 1 g amoxicillin PO tid for 14 days. GERD: 15 mg/day PO for up to 8 wk. Erosive esophagitis or poorly responsive GERD: 30 mg PO daily before eating for up to 8 wk. An additional 8-wk course may be helpful for patients who do not heal with 8-wk therapy. Maintenance of healing of erosive esophagitis: 15 mg/day PO. Pathological hypersecretory conditions: Individualize dosage. Initial dose is 60 mg PO daily. Doses up to 90 mg bid have been used. Administer daily doses of > 120 mg in divided doses.

Precautions and Warnings: Symptomatic response to therapy with lansoprazole does not preclude the presence of gastric malignancy. Lansoprazole should be taken before eating. Lansoprazole products should not be crushed or chewed.

Side Effects: Symptomatic response to therapy with lansoprazole does not preclude the presence of gastric malignancy. Lansoprazole should be taken before eating. Lansoprazole products should not be crushed or chewed. Interactions: This supplement is similar in structure to the blood-thinning drug heparin, and the combination may cause bleeding in some people.

Interactions: There have been post marketing reports of increased INR and prothrombin time in patients receiving proton pump inhibitors, including lansoprazole and warfarin concomitantly. Increases in INR and prothrombin time may lead to abnormal bleeding and even death. Patients treated with proton pump inhibitors and warfarin concomitantly should be monitored for increases in INR and prothrombin time.

Because of profound and long lasting inhibition of gastric acid secretion, lansoprazole may interfere with absorption of drugs where gastric pH is an important determinant of their bioavailability (eg, ketoconazole, ampicillin esters, and iron salts).

 Pregnancy and Lactation: Pregnancy category B. There are, however, no adequate or well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.

 Packaging: HDPE flacons of 14’s.

[thememove_title_section type=”2″ title=”Vasodilator Anti-Platelet”]

Pentoxifylline

 Dosage Forms: 400 mg extended-release tablet

Drug Group: Blood Viscosity Reducer agent

 Mechanism: Pentoxifylline is a xanthine derivative used in the treatment of peripheral vascular disease. Although often classified as a vasodilator, its primary action seems to be a reduction in blood viscosity, probably by effects on erythrocyte deformability and platelet adhesion and aggregation.

Indications: Pentoxifylline is reported to increase blood flow to ischaemic tissues and improve tissue oxygenation in patients with peripheral vascular disease and to increase oxygen tension in the cerebral cortex and in the cerebrospinal fluid; it has been used in cerebrovascular disorders. Pentoxifylline also inhibits production of the cytokine, tumour necrosis factor alpha (TNFα), and this property is under investigation in a number of diseases.

Dosage and Administration: In the treatment of peripheral vascular disease the usual dose is 400 mg three times daily by mouth in a modified-release formulation; this may be reduced to 400 mg twice daily for maintenance or if adverse effects are troublesome. Doses should be taken with meals to reduce gastrointestinal disturbances. In severe hepatic or renal impairment, doses may need to be reduced. Beneficial effects may not be evident until after 2 to 8 weeks of treatment. Pentoxifylline may also be administered parenterally.

Precautions and Warnings: Pentoxifylline should be avoided in cerebral haemorrhage, extensive retinal haemorrhage, severe cardiac arrhythmias, and acute myocardial infarction. It should be used with caution in patients with ischaemic heart disease or hypotension. The dose of pentoxifylline may need to be reduced in patients with hepatic or renal impairment.

Side Effects: Pentoxifylline can cause nausea, gastrointestinal disturbances, dizziness, and headache. Flushing, angina, palpitations, cardiac arrhythmias, and hypersensitivity reactions may also occur. Bleeding events have been reported rarely, usually in association with bleeding risk factors.

Interactions: Pentoxifylline may potentiate the effect of antihypertensives. High parenteral doses of pentoxifylline may enhance the action of insulin and oral hypoglycaemics in diabetic patients. Pentoxifylline should not be given concomitantly with ketorolac as there is reported to be an increased risk of bleeding and/or prolongation of the prothrombin time. There may also be an increased risk of bleeding during concomitant use with meloxicam. Serum levels of theophylline may be raised by pentoxifylline.

Pregnancy and Lactation: Pregnancy category C. Teratogenic effects were not observed in animal studies. There are no adequate and well-controlled studies in pregnant women. Enters breast milk/not recommended.

Packaging: HDPE flacons of 100’s.

[thememove_title_section type=”2″ title=”Adrenoreceptor Blocker”]

Tamsulosin

 Dosage Forms: 0.4 mg capsule

Drug Group: alpha 1 adrenoceptor blocking agent

 Mechanism: Tamsulosin exhibits selectivity for alpha 1 receptors in the human prostate. At least three discrete alpha 1-adrenoceptor subtypes have been identified: alpha 1A, alpha 1B and alpha 1D; their distribution differs between human organs and tissue. Approximately 70% of the alpha 1 -receptors in human prostate are of the alpha 1A subtype. Tamsulosin HCl capsules are not intended for use as an antihypertensive drug.

Indications: Tamsulosin HCl capsules are indicated for the treatment of the signs and symptoms of benign prostatic hyperplasia (BPH). Tamsulosin HCl capsules are not indicated for the treatment of hypertension.

Dosage and Administration: Tamsulosin HCl capsules 0.4 mg once daily is recommended as the dose for the treatment of the signs and symptoms of BPH. It should be administered approximately one-half hour following the same meal each day. Tamsulosin HCl capsules are not indicated for use in pediatric populations.

Precautions and Warnings: Carcinoma of the prostate and BPH cause many of the same symptoms. These two diseases frequently co-exist. Patients should be evaluated prior to the start of Tamsulosin HCl capsules therapy to rule out the presence of carcinoma of the prostate.

Side Effects: The followings are the clinical adverse reactions considered possibly: Headache, Infection, Asthenia, Back pain, Chest Pain, Dizziness, Somnolence, Insomnia, Libido Decreased, Rhinitis, Pharyngitis, Cough Increased, Sinusitis, Diarrhea, Nausea, Tooth Disorder, Abnormal Ejaculation, Amblyopia and Orthostatic hypotension.

Interactions: Tamsulosin HCl capsules should NOT be used in combination with other alpha-adrenergic blocking agents. Cimetidine changes Tamsulosin HCl clearance (26% decrease) and AUC (44% increase). Therefore, Tamsulosin HCl capsules should be used with caution in combination with Cimetidine, particularly at doses higher than 0.4 mg.

Pregnancy and Lactation: Pregnancy category B. Tamsulosin HCl capsules are not indicated for use in women.

Packaging: 10 tablets in one blister. 3 blisters in a box.

[thememove_title_section type=”2″ title=”Analgesic”]

Fargesic

 Dosage Forms: Fargesic capsule contains Acetaminophen: 325 mg, Caffeine: 40 mg and Ibuprofen: 200 mg.

Drug Group: Analgesic, CNS stimulant, Non-Steroidal Anti-Inflammatory Drug (NSAID)

Mechanism: Fargesic capsule contains acetaminophen, a non-opiate, non-salicylate analgesic and antipyretic, caffeine a methylxanthine CNS stimulant and Ibuprofen a non-steroidal anti-inflammatory drug.

Indications: Fargesic capsules are used for the treatment of mild to moderate pain and fever.

Dosage and Administration: Because capsules contains 3 active ingredients dosage should be adjusted according to this three active. In treatment of mild to moderate pains one capsule every 8 hours should be used.

Precautions and Warnings: Patients with a history of hypersensitivity to any of Cetirizine constituents.

Side Effects: Side-effects of acetaminophen are rare and usually mild, although haematological reactions including thrombocytopenia, leucopenia, pancytopenia, neutropenia, and agranulocytosis have been reported. Skin rashes and other hypersensitivity reactions occur occasionally. Side-effects of ibuprofen are edema, dizziness, headache, nervousness, Itching, rash, fluid retention, dyspepsia, vomiting, abdominal pain/cramps/distress, heartburn, nausea, diarrhea, constipation, flatulence, epigastric pain, appetite decreased, tinnitus. Side-effects of caffeine are angina, arrhythmia (ventricular), chest pain, flushing, palpitation, sinus, tachycardia, tachycardia (supraventricular), vasodilatation, agitation, delirium, dizziness, hallucinations, headache, insomnia, irritability, psychosis, restlessness, urticaria, esophageal sphincter tone decreased, fasciculations, intraocular pressure increased (>180 mg caffeine), miosis, dieresis.

Interactions: The risk of acetaminophen toxicity may be increased in patients receiving other potentially hepatotoxic drugs or drugs that induce liver microsomal enzymes. The absorption of acetaminophen may be accelerated by drugs such as metoclopramide. Excretion may be affected and plasma concentrations altered when given with probenecid. Colestyramine reduces the absorption of acetaminophen if given within 1 hour of Acetaminophen. Like theophylline caffeine undergoes extensive metabolism by hepatic microsomal cytochrome P450 isoenzyme CYP1A2, and is subject to numerous interactions with other drugs and substances which enhance or reduce its metabolic clearance. Interactions involving NSAIDs include enhancement of the effects of oral anticoagulants (especially by azapropazone and phenylbutazone) and increased plasma concentrations of lithium, methotrexate, and cardiac glycosides.

Pregnancy and Lactation: Pregnancy category C/D. Enters breast milk/compatible.

Packaging: 10 capsules in one blister. 2 blisters in a box.

[thememove_title_section type=”2″ title=” Lipase Inhibitor”]

Orlistat

 Dosage Forms: 60 mg and 120 mg capsules

 Drug Group: Lipase inhibitor

 Mechanism: Orlistat is a lipase inhibitor for obesity management that acts by inhibiting the absorption of dietary fats.

 Indications: Orlistat is indicated for obesity management including weight loss and weight maintenance when used in conjunction with a reduced-calorie diet. Orlistat is also indicated to reduce the risk for weight regain after prior weight loss.

 Dosage and Administration: Adult over 18 years, 120 mg taken immediately before, during, or up to 1 hour after each main meal (max. 120 mg 3 times daily); continue treatment beyond 12 weeks only if weight loss since start of treatment exceeds 5% (target for initial weight loss may be lower in patients with type 2 diabetes); Child over 12 years see BNF for Children Note If a meal is missed or contains no fat, the dose of orlistat should be omitted

 Precautions and Warnings: Orlistat is contraindicated in patients with chronic malabsorption syndrome or cholestasis, and in patients with known hypersensitivity to orlistat or to any component of this product. Patients should be advised to adhere to dietary guidelines. Gastrointestinal events may increase when orlistat is taken with a diet high in fat.

Side Effects: Gastrointestinal symptoms were the most commonly observed treatment-emergent adverse events associated with the use of orlistat. These are: oily spotting, flatus with discharge, fecal urgency, fatty/oily stool, oily evacuation, increased defecation, and fecal incontinence. Other adverse effects are: influenza, upper respiratory infection, Lower Respiratory Infection, Back Pain, Pain Lower Extremities, Arthritis, Myalgia, Joint Disorder, Tendonitis, Headache, Dizziness, Fatigue, Sleep Disorder, Rash, Dry Skin, Menstrual Irregularity, Vaginitis, Urinary Tract Infection, Psychiatric Anxiety, Depression, Otitis, and Pedal Edema.

 Interactions: Preliminary data from a orlistat and cyclosporine drug interaction study indicate a reduction in cyclosporine plasma levels when orlistat was co-administered with cyclosporine. A pharmacokinetic interaction study showed a 30% reduction in beta-carotene supplement absorption when concomitantly administered with orlistat. Orlistat inhibited absorption of a vitamin E acetate supplement by approximately 60%. As vitamin K absorption may be decreased with orlistat, patients on chronic stable doses of warfarin who are prescribed orlistat should be monitored closely for changes in coagulation parameters.

Pregnancy and Lactation: Category B. There are no adequate and well-controlled studies of orlistat in pregnant women. It is not known if orlistat is secreted in human milk. Therefore, orlistat should not be taken by nursing women.

 Packaging: 10 capsules in one blister. 2 blisters in a box.

[thememove_title_section type=”2″ title=” Anti-Histamine”]

FAR-Cetirizine

 Dosage Forms: 10 mg tablet

Drug Group: Anti- histamine

Mechanism: Cetirizine inhibits the histamine-mediated early phase of the allergic reaction and also reduces the migration of inflammatory cells and the release of mediators associated with the ‘late’ allergic response. Cetirizine is a potent antihistamine with a low potential for drowsiness at pharmacologically-active doses and with additional ant allergic properties. It is a selective H1-antagonist with negligible effect on other receptors, and so is virtually free from anticholinergic and anti-serotonin effects.

Indications: Treatment of perennial allergic rhinitis, seasonal allergic rhinitis, and chronic idiopathic urticaria.

Dosage and Administration: Adults and children over 12 years: 1 tablet (10 mg) daily. There are insufficient clinical data to recommend the use of Cetirizine in children under 12 years. At present, there are no data which suggest that the dose needs be reduced in elderly patients. In patients with renal insufficiency, dosage should be reduced to ½ tablet daily.

Precautions and Warnings: Patients with a history of hypersensitivity to any of Cetirizine constituents.

Side Effects: There have been occasional reports of mild and transient side effects, e.g. Headaches, dizziness, drowsiness, agitation, dry mouth and gastrointestinal discomfort. If desired, the dose may be taken as 5 mg in the morning and 5 mg in the evening. In some individuals, hypersensitivity reactions including skin reactions and angioedema may develop.

Interactions: To date, there are no known interactions with other drugs. Studies with diazepam and Cetirizine have revealed no evidence of interactions. As with other antihistamines, it is advisable to avoid excessive alcohol consumption.

Pregnancy and Lactation: No adverse effects have been reported from animal studies. There has been little or no use of cetirizine in pregnancy should be avoided. Cetirizine is contraindicated in lactating women since the active ingredient; cetirizine is excreted in breast milk.

Packaging: 10 tablets in one blister. 3 blisters in a box.

[thememove_title_section type=”2″ title=”Non Steroidal Anti-Inflammatory Drugs(NSAID`s)”]

Meloxicam

 Dosage Forms: 7.5 mg and 15 mg tablets.

Drug Group: Analgesic and Anti-inflammatory agent

 Mechanism: Meloxicam, an oxicam derivative, is a member of the enolic acid group of nonsteroidal anti-inflammatory drugs.

Indications: Carefully consider the potential benefits and risks of meloxicam and other treatment options before deciding to use it. Use the lowest effective dose for the shortest duration consistent with individual patient treatment goal. Meloxicam is indicated for relief of the signs and symptoms of osteoarthritis and rheumatoid arthritis.

Dosage and Administration: For the relief of the signs and symptoms of osteoarthritis the recommended starting and maintenance oral dose of meloxicam is 7.5 mg once daily. Some patients may receive additional benefit by increasing the dose to 15 mg once daily. For the relief of the signs and symptoms of rheumatoid arthritis, the recommended starting and maintenance oral dose of meloxicam is 7.5 mg once daily. Some patients may receive additional benefit by increasing the dose to 15 mg once daily. The maximum recommended daily oral dose of meloxicam is 15 mg regardless of formulation.

Precautions and Warnings: Caution should be used when initiating treatment with meloxicam in patients with history of GI disease, asthma, hypertension, CVD or risk factors, fluid retention or heart failure. Monitor patients with advanced renal disease may impair ability to drive or operate machinery. Anemia is sometimes seen in patients receiving NSAIDs, including meloxicam. Rare cases of severe hepatic reactions, including jaundice and fatal fulminant hepatitis, liver necrosis and hepatic failure, some of them with fatal outcomes have been reported. If clinical signs and symptoms consistent with liver disease develop, or if systemic manifestations occur, meloxicam should be discontinued.

Side Effects: Abdominal pain, diarrhea, dyspepsia, flatulence, nausea, vomiting, constipation,  accident household, edema, fall, pain, influenza-like symptoms, dizziness, headache, pharyngitis, upper respiratory tract infection, coughing, pruritus, rash, Joint related signs and symptoms, musculoskeletal and connective tissue signs and symptoms, anemia, arthralgia, back pain, insomnia, micturition frequency, urinary tract infection

Interactions: Meloxicam may reduce effects of antihypertensivites. Increased clearance with bile acid sequestrants e.g. colestyramine. Increased risk of renal failure with diuretics; may reduce natriuretic effects of furosemide and thiazides. May increase toxicity of methotrexate. Potentially fatal: May increase plasma concentrations and toxicity of lithium. Increased risk of severe GI effects with aspirin, warfarin.

Pregnancy and Lactation: Pregnancy category C. There are no adequate and well-controlled studies in pregnant women. Meloxicam should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is not known whether this drug is excreted in human milk; because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants from meloxicam, a decision should be made whether to discontinue.

Packaging: 10 tablets in one blister. 3 blisters in a box.

Diclofenac sodium

 Dosage Forms: 100 mg extended-release capsules

Drug Group: Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Mechanism: Diclofenac sodium extended-release capsules exhibits anti-inflammatory, analgesic, and antipyretic activities in animal models. The mechanism of action of diclofenac sodium, like that of other NSAIDs, is not completely understood but may be related to cyclooxygenase inhibition.

Indications: For relief of the signs and symptoms of osteoarthritis, for relief of the signs and symptoms of rheumatoid arthritis.

Dosage and Administration: For the relief of osteoarthritis, the recommended dosage is 100 mg once daily. For the relief of rheumatoid arthritis, the recommended dosage is 100 mg once daily. In the rare patient where Diclofenac Sodium-ER 100 mg/day is unsatisfactory, the dose may be increased to 100 mg twice daily. If the benefits outweigh the clinical risks of increased side effects. After observing the response to initial therapy with Diclofenac Sodium-ER, the dose and frequency should be adjusted to suit an individual patient’s needs.

Precautions and Warnings: Diclofenac is contra-indicated in patients with severe hepatic or renal impairment. in patients with a history of hypersensitivity to aspirin or any other NSAIDs which includes those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAIDs), and in coagulation defects.

Side Effects: Gastrointestinal experiences including: abdominal pain, constipation, diarrhea, dyspepsia, flatulence, gross bleeding/perforation, heartburn, nausea, GI ulcers (gastric/duodenal) and vomiting. Abnormal renal function, anemia, dizziness, edema, elevated liver enzymes, headaches, increased bleeding time, pruritus, rashes and tinnitus, photosensitivity, sweating increased and myalgia.

Interactions: Aspirin: potential of increased adverse effects Methotrexate: enhance the toxicity of methotrexate Cyclosporine: increase cyclosporine’s nephrotoxicity ACE Inhibitors: diminish the antihypertensive effect of ACE inhibitors. Furosemide, Thiazide and Thiazide-like Diuretics: Diclofenac -XR can reduce the natriuretic effect of furosemide and thiazides. Lithium: NSAIDs have produced an elevation of plasma lithium levels and a reduction in renal lithium clearance. Warfarin: The effects of warfarin and NSAIDs on GI bleeding are synergistic, such that users of both drugs together have a risk of serious GI bleeding higher than users of either drug alone.

Pregnancy and Lactation: Pregnancy category C. Most manufacturers advise avoiding the use of NSAIDs during pregnancy or avoiding them unless the potential benefit outweighs the risk. NSAIDs should be used with caution during breast-feeding.

Packaging: 10 capsules in one blister. 3 blisters in a box.

[thememove_title_section type=”2″ title=”Anti-Depressant”]

Venlafaxine

 Dosage Forms: 37.5 mg and 75 mg tablets

Drug Group: Anti-depressant

 Mechanism: Venlafaxine is in a new class of anti-depressant medications that affects chemical messengers within the brain. These chemical messengers are called neurotransmitters, and some examples are serotonin, dopamine, and norepinephrine. Venlafaxine is believed to work by inhibiting the release or affecting the action of these neurotransmitters.

Indications: Venlafaxine is indicated in the treatment of major depressive disorder, anxiety, panic disorder and Hot flashes.

Dosage and Administration: Adults: The recommended dose for treatment of depression is initially 75 mg in a day, administered in 2-3 divided doses. The dosage may be increased, as needed and tolerated in increments up to 75 mg a day at intervals of not less than 4 days, up to 225 mg a day. Doses over 225 mg a day have not been shown to be useful in moderately depressed out patients, more severely depressed patients may respond to dosage of up to 375 mg a day, administered in 3 divided doses. Pediatric: Safety and efficacy in children up to 18 years of age have not proven.

Precautions and Warnings: In Bipolar disorder may increase likelihood of precipitation of a mixed/ manic episode in this patient. Blood pressure problems or cardiac disease may exacerbate with venlafaxine. Glaucoma, acute narrow-angle, intra ocular pressure, mydriasis should be considered with venlafaxine. In hepatic function impairment, metabolism of venlafaxine may by alter. In these patients may require dose reduction. Dizziness or light headedness may be happened, caution when getting up from allying or sitting down.

Side Effects: The following adverse reactions have been reported following the use of venlafaxine. Headache, hypertension usually asymptomatic, vision disturbances including abnormal accommodation and blurred vision. Cardiovascular effects including chest pain, palpitation, tachycardia. CNS effects including abnormal thinking, agitation, confusion, depersonalization and emotional ability, tinnitus. Dyspnea, edema, itching or skin rash, mania or hypomania menstrual changes, orthostatic hypotension, seizures. Urinary effects including impaired urination, urinary frequency, urinary incontinence, or urinary retention. Abnormal dreams, anorexia, anxiety or nervousness. asthenia, chills, constipation, diarrhea, dizziness, dryness of mouth dyspnea , increased sweating, insomnia, nausea, paresthesia, rhinitis, sexual dysfunction, somnolence, stomach pain or gas tremor, vomiting, weight loss, yawning may be observed in treatment with venlafaxine Hypertonia, taste perversion or change in sense of taste may be observed.

Interactions: Life-threatening interactions can occur in combination with MAO inhibitors such as Nardil and Parnate. MAO inhibitors and venlafaxine should not be taken together, and a waiting period of 14 days between taking these two classes of medications is strongly advised.

Pregnancy and Lactation: Pregnancy category C. This drug should be used during pregnancy only if it is clearly needed. Venlafaxine is distributed into breast milk and may cause unwanted effects in the infant; a decision should be made whether to discontinue nursing or to discontinue the drug.

Packaging: 10 tablets in one blister. 10 blisters in a box.

[thememove_title_section type=”2″ title=”Selective Serotonin Agonist”]

Rizatriptan

 Dosage Forms: 5 mg and 10 mg tablets

Drug Group: Selective agonist for serotonin 5HT1D receptor

 Mechanism: Selective agonist for serotonin 5HT1D receptor in cranial arteries to cause vasoconstriction and reduce sterile inflammation associated with antidromic neuronal transmission correlating with relief of migraine.

Indications: Rizatriptan is indicated for the acute treatment of migraine attacks with or without aura in adults. Rizatriptan is not intended for the prophylactic therapy of migraine or for use in the management of hemiplegic or basilar migraine.

Dosage and Administration: In controlled clinical trials, single doses of 5 and 10 mg of rizatriptan tablets were effective for the acute treatment of migraines in adults. There is evidence that the 10 mg dose may provide a greater effect than the 5 mg dose. Individuals may vary in response to doses of rizatriptan tablets. The choice of dose should therefore be made on an individual basis, weighing the possible benefit of the 10 mg dose with the potential risk for increased adverse events. In patients receiving propranolol, the 5-mg dose of rizatriptan should be used, up to a maximum of 3 doses in any 24-hour period.

Precautions and Warnings: Drinking alcoholic beverages can make headaches worse or cause new headaches to occur. People who suffer from severe headaches should probably avoid alcoholic beverages, especially during a headache. Some people feel drowsy or dizzy during or after a migraine, or after taking rizatriptan to relieve a migraine. As long as you are feeling drowsy or dizzy, do not drive, use machines, or do anything else that could be dangerous if you are dizzy or are not alert.

Side Effects: Serious cardiac events, including some that have been fatal, have occurred following use of 5-HT1 agonists. These events are extremely rare and most have been reported in patients with risk factors predictive of CAD. Events reported have included coronary artery vasospasm, transient myocardial ischemia, myocardial infarction, ventricular tachycardia, and ventricular fibrillation.

Interactions: Use within 24 hours of another selective 5-HT1 agonist or ergot-containing drug should be avoided due to possible additive vasoconstriction MAO inhibitors and nonselective MAO inhibitors increase concentration of rizatriptan Propranolol: Plasma concentration of rizatriptan increased 70% serotonergic reuptake inhibitors (e.g., SSRIs/SNRIs): Concurrent use of rizatriptan with these agents may increase the risk of serotonin syndrome; monitor. Serotonin agonists (e.g., triptans): Concurrent use of rizatriptan with these agents may increase the risk of serotonin syndrome; monitor.

Pregnancy and Lactation: Pregnancy category C. There are no adequate and well-controlled studies in pregnant women; therefore, rizatriptan should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when rizatriptan is administered to women who are breast-feeding.

Packaging: 10 tablets in one blister. 3 blisters in a box.

[thememove_title_section type=”2″ title=”Angiotensin Receptor Blocker”]

Valsartan

Dosage Forms: 80 mg and 160 mg capsules

 Drug Group: Angiotensin II antagonists

Mechanism: Valsartan is an angiotensin receptor blocker drug (ARBs); it is specific angiotensin II antagonists that act on the AT1 receptor subtype.

Indications: Hypertension: Valsartan is indicated for the treatment of hypertension. It may be used alone or in combination with other anti-hypertensive agents. Heart Failure: Valsartan is indicated for the treatment of heart failure (NYHA class II-IV). In clinically stable patients with left ventricular failure or left ventricular dysfunction following myocardial infarction, Valsartan is indicated to reduce cardiovascular mortality.

Dosage and Administration: The usual dose of valsartan in patients with high blood pressure is 80 to 160 mg once daily. The maximum dose is 320 mg daily. Maximum blood pressure reduction occurs within 4 weeks. For congestive heart failure, the usual dose is 40 mg twice daily. The doses may be increased to 80-160 mg twice daily. The initial dose after a heart attack is 20 mg twice daily. The dose should be increased with a target of 160 mg twice daily if tolerated without side effects.

Precautions and Warnings: Valsartan is contraindicated in patients who are hypersensitive to any component of this product. Caution should be observed when initiating therapy in patients with heart failure or post-myocardial infarction patients. As the majority of valsartan is eliminated in the bile, patients with mild-to-moderate hepatic impairment, including patients with biliary obstructive disorders, showed lower valsartan clearance (higher AUCs). Care should be exercised in administering valsartan to these patients. In studies of ACE inhibitors in hypertensive patients with unilateral or bilateral renal artery stenosis, increases in serum creatinine or blood urea nitrogen have been reported. There has been no long-term use of valsartan in patients with unilateral or bilateral renal artery stenosis, but an effect similar to that seen with ACE inhibitors should be anticipated.

 

Side Effects: Valsartan is generally well-tolerated and side effects are rare. The most common side effects include headache, dizziness, fatigue, abdominal pain, cough, diarrhea and nausea. Patients may also experience hyperkalemia, impotence, reduced renal function, and allergic reactions. Rhabdomyolysis (inflammation and destruction of muscles) and angioedema (swelling of soft tissues including those of the throat and larynx) are rare but serious side effects of valsartan.

Interactions: Coadministration of valsartan and warfarin did not change the pharmacokinetics of valsartan or the time-course of the anticoagulant properties of warfarin. Concomitant use of valsartan with other agents that block the renin-angiotensin system, potassium sparing diuretics (e.g. spironolactone, triamterene, amiloride), potassium supplements, or salt substitutes containing potassium may lead to increases in serum potassium and in heart failure patients to increases in serum creatinine. If co-medication is considered necessary, monitoring of serum potassium is advisable. Valsartan may increase serum levels of Lithium.

Pregnancy and Lactation: Pregnancy categories C (first trimester) and D (second and third trimesters).

It is not known whether valsartan is excreted in human milk, but valsartan was excreted in the milk of lactating rats. Because of the potential for adverse effects on the nursing infant, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.

Packaging: 10 capsules in one blister. 3 blisters in a box.

[thememove_title_section type=”2″ title=”Dopamine Antagonist”]

Domperidone

 Dosage Forms: 10 mg tablets

Drug Group: Dopamine antagonist

Mechanism: Domperidone is a dopamine antagonist with actions and uses similar to those of metoclopramide. It is used as an antiemetic for the short-term treatment of nausea and vomiting of various aetiologies and dyspepsia.

Indications: Domperidone is indicated for treatment of delayed gastric emptying of functional origin with gastro-oesophageal reflux and/or dyspepsia, Control of nausea and vomiting of central or local origin, as an anti-emetic in patients receiving cytostatic and radiation therapy, Facilitates radiological examination of the upper gastro-intestinal tract.

Dosage and Administration: Acute conditions (nausea, vomiting, hiccup): Adults: 20 mg 3 to 4 times per day. Children 5 to 12 years old: 10 mg 3 to 4 times per day. Chronic conditions (dyspepsia): Adults: 10 mg taken 3 times per day. Children 5 to 12 years old: ½ tablet (5 mg) 3 to 4 times per day.

Precautions and Warnings: This drug should not be used whenever stimulation of gastric motility is to be avoided or could be harmful, e.g. in the presence of gastro-intestinal haemorrhage, obstruction or perforation. Since domperidone is highly metabolised in the liver, it should be used with caution in patients with hepatic impairment (and in the elderly).

Side Effects: Allergic reactions, such as rash or urticaria and also abdominal cramps have been reported. Dystonic reactions (extra pyramidal phenomena) may occur. Reversible raised serum prolactin levels have been observed which may lead to galactorrhoea and gynaecomastia. Hypertensive crises in patients with phaeochromocytoma may occur with administration of domperidone. Where the blood brain barrier is not fully developed (mainly in young babies) or is impaired, the possible occurrence of neurological side-effects cannot be totally excluded.

Interactions: Concomitant administration of anti-cholinergic drugs may inhibit the anti-dyspeptic effects of domperidone. Anti-muscarinic agents and opioid analgesics may antagonise the effect of domperidone. Domperidone suppresses the peripheral effects (digestive disorders, nausea and vomiting) of dopaminergic agonists. Since domperidone has gastro-kinetic effects, it could influence the absorption of concomitant orally administered medicines, particularly those with sustained release or enteric coated formulations. As domperidone interferes with serum prolactin levels, it may interfere with other hypoprolactinaemic agents and with some diagnostic tests. Antacids and anti-secretory agents lower the oral bioavailability of domperidone. They should be taken after meals and not before meals, i.e. they should not be taken simultaneously with domperidone.

Pregnancy and Lactation: Pregnancy category B. Studies on pregnancy have not been done in humans. No adverse effects have been observed in breast-fed infants whose mothers were receiving domperidone, and it is usually compatible with breast feeding.

Packaging: 10 tablets in one blister. 3 blisters in a box.

[thememove_title_section type=”2″ title=”Antispasmodic”]

Mebeverine

 Dosage Forms: 200 mg extended release capsule.

Drug Group: Antispasmodic agent

 Mechanism: Mebeverine hydrochloride is an antispasmodic with a direct action on the smooth muscle of the gastrointestinal tract.

Indications: It is used in irritable bowel syndrome.

Dosage and Administration: Mebeverine is used in conditions such as irritable bowel syndrome in a usual dose of two capsules daily by mouth before meals.

Precautions and Warnings: It was suggested that Mebeverine HCl produced colonic stasis, which predisposed the patient to ulceration, but the manufacturers considered that the development of constipation and distal intestinal syndrome (meconium ileus equivalent) in this patient precipitated the development of stercoral ulceration. It was recommended that antispasmodics such as mebeverine should not be used for the symptomatic treatment of distal intestinal syndrome in cystic fibrosis. Mebeverine hydrochloride is considered to be unsafe in patients with porphyria. Don’t crash the capsules.

Side Effects: Although adverse effects appear rare, gastrointestinal disturbances, dizziness, headache, insomnia, anorexia, and decreased heart rate have been reported in patients receiving mebeverine. Cases of hypersensitivity, including erythematous rash, urticaria, and angioedema, have also been reported.

Interactions: Decreased serum levels if taken concurrently with sucralfate. Decreased serum levels of Ketoconazole, Theophylline when taken with lansoprazole. Lansoprazole appears to produce a dose dependent decrease in the absorption of cyanocobalamin.

 Pregnancy and Lactation: Pregnancy category B. Mebeverine should be used during pregnancy only if clearly needed. Mebeverine is not excreted in human milk by therapeutic doses.

Packaging: 10 capsules in one blister. 5 blisters in a box.

[thememove_title_section type=”2″ title=”Adult Cold”]

Faracold

 Dosage Forms:

Acetaminophen 500 mg, Dextromethorphan Hydrobromide 15 mg, Phenylephrine Hydrochloride 5 mg.

 Drug Group:

Analgesic, Anti- cough, Decongestant

Mechanism: Faracold tablet contains acetaminophen, dextromethorphan hydrobromide, phenylepherine hydrochloride and chlorpheniramine maleate. Acetaminophen is a non-opiate, non-salicylate analgesic and antipyretic drug that helps to reduce fever, and relieves muscle aches or headache. Acetaminophen may act by inhibiting prostaglandin synthesis in the hypothalamic heat regulation center and CNS to produce antipyretic action and to block peripheral pain impulse generation. Dextromethorphan hydrobromide is a cough suppressant for the relief of non- productive cough; it has a central action on the cough center in the medulla. Phenylepherine hydrochloride is a sympathomimetic amine with mainly direct effect predominately alpha-adrenergic activity and is without significant simulating effects on adrenergic reports. It has predominately alpha- adrenergic activity and is without significant simulating effects on the CNS at usual doses. Phenylepherine helps reduce nasal and sinus congestion.

Indications: Faracold is used to decrease symptoms caused by colds or the flu.

Dosage and Administration: Adults and children 12 years and over: Take 1 to 2 tablets every 6 hours as needed. Do not take more than 8 tablets in 24 hours. Not intended for use in children.

 Precautions and Warnings: It should not be used acetaminophen with Salicylates or other nonsteroidal anti-inflammatory for more than a few days. In epilepsy, glaucoma, prostatic hypertrophy, and urinary retention and liver disease should be used with caution. In asthma, liver failure or cough mucus should be used with caution.

Side Effects: Diarrhea, loss of appetite, nausea, vomiting, sweating.

Interactions: The following drugs may interact with Acetaminophen,  Dextromethorphan and Phenylephrine; Alcohol, hepatic enzyme inducer, other  Hepatoxoic medications, Anticoagulants cumarins or  Indandione derivatives, Non-Steroidal Anti Inflammatory Drugs (NSAIDs), Aspirin or other Salicylates, MAOIs, Clonidine, Methyldopa, CNS Depressants and Anticholinergic agents.

Pregnancy and Lactation: Pregnancy category C. It is not known whether Faracold is distributed into human breast milk. Therefore, Faracold should not be used in nursing mothers unless the potential benefit justifies the potential risk to the infant.

Packaging: 10 tablets in one blister. 2 blisters in a box.