Archive for the ‘Principal Drugs A-Z’ Category

Generic Name
Glatiramer (glah-TYE-ram-er)
Brand Name  Copaxone
Type of Drug
Relapsing-remitting multiple sclerosis (MS) therapy.
Prescribed For  MS.
General Information
Glatiramer is a mixture of several amino acids. It is thought to work by modifying the immune processes responsible for MS. In studies, people who took the drug for over a year were twice as likely to be relapse-free as those who took a placebo (sugar pill).
Cautions and Warnings
Do not use this drug it you are allergic or sensitive to any of its ingredients or to mannitol.
About 10% of people who self-administer glatiramer experience a post-injection reaction with symptoms that include flushing, chest pain, heart palpitations, anxiety, breathing difficulties, closing of the throat, and an itchy rash. These symptoms usually go away without treatment. This reaction generally occurs after several months of drug therapy, though it may occur earlier.
About 21 % of the people who took glatiramer in drug studies had chest pain, but the exact relationship of this pain to use of glatiramer could not be determined. Report any chest pain to your doctor at once.
Glatiramer may make you more sensitive to sunlight.
Because it interferes with immune response, glatiramer may increase your risk of developing infections and tumors.
Glatiramer may interfere with kidney function.
Possible Side Effects
V Most common: infections, weakness, pain, chest pain, flu-like symptoms, back pain, flushing, heart palpitations, anxiety, muscle stiffness or spasticity, an urgent need to urinate, swollen lymph glands, injection-site reactions
Possible Side Effects (continued)
(including pain, inflammation, itching, an unknown mass at the injection site, welts, skin marks, and bleeding), breathing difficulties, runny nose, and joint pain.
¦    Common: fever, neck pain, facial swelling, bacterial infection, migraine, rapid heartbeat, tremors, fainting, appetite loss, vomiting, general stomach disorders, vaginal infection, painful menstruation, black-and-blue marks, swelling in the arms or legs, bronchial irritation, spasm of the larynx, and ear pain.
V Less common: chills, cysts, agitation, foot drop, nervousness, rolling eyeballs, rapid eye movement, confusion, speech problems, cold sores, redness, itchy rash, skin nodules, stomach pain and irritation, and weight gain.
¦    Rare: Other side effects can occur in almost any part of the body, including the heart and blood vessels, digestive system, blood and lymph systems, muscles and bones, respiratory system, kidney, reproductive system, and eyes. Contact your doctor if you experience any side effect not listed above.
Food and Drug Interactions None known.
Usual Dose
Adult (age 18 and over): 20 mg a day by injection under the skin. Child (under age 18): not recommended.
Overdosage
Little is known about the effects of glatiramer overdose. Call you local poison control center or a hospital emergency room for information. If you seek treatment, ALWAYS bring the prescription bottle or container.
Special Information
This medication is given by injection. For information on how to properly administer this drug, see page 1242.
Store unused glatiramer in the refrigerator before it is mixed with the diluent supplied by the manufacturer. Do not use any other diluent. The mixed injection must be used right away.
Suggested injection sites are the arms, abdomen, hips. and thighs. Be sure to rotate injection sites.
Glatiramer works best if given at the same time each day.
If you forget to administer a dose, do so as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule. Do not take a double dose. Call your doctor if you miss more than 2 doses in a row.
Special Populations
Pregnancy/Breast-feeding: The safety of using glatiramer during pregnancy is not known. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
It is not known if glatiramer passes into breast milk. Nursing mothers who must take it should use infant formula.
Seniors: Seniors may use glatiramer without special restriction.

Type of Drug
Glitazone Antidiabetes Drugs
(GLIT-uh-zone)
Brand Names
Rosiglitazone Maleate Avandia
Combination Products
Pioglitazone Hydrochloride + Metformin Hydrochloride
ACTOplus Met
Pioglitazone Hydrochloride + Glimepiride Duetact
Rosiglitazone Maleate + Metformin Hydrochloride
Nnndamet
Rosiglitazone Maleate + Glimepiride Avandaryl
Prescribed For  Type 2 diabetes.
General Information
The glitazones reduce the amount of sugar produced by the liver and increase insulin sensitivity of muscle, liver, and fat cells. They may also help to control blood-fat levels, which are often elevated in diabetes. Glitazones work by affecting genes responsible for controlling the use of sugar and fat in the body, making cells more sensitive to insulin. They are effective for people with type 2 diabetes, whose cells do not respond well to insulin. Glitazones only work when insulin is present. They do not increase the amount of insulin made in the pancreas. Glitazones can be used alone or combined with other diabetes drugs. Studies have indicated that taking rosiglitazone can delay or prevent type 2 diabetes in people with pre-diabetes.
Cautions and Warnings
Do not take these drugs if you are sensitive or allergic to any of their ingredients or to related drugs. Glitazones may cause fluid retention, worsening or leading to heart failure. Some studies have indicated the risk of heart attack may be increased in people taking rosiglitazone. Other studies have shown that pioglitazone decreases the risk of heart attack. The effects of these drugs on the heart are still being investigated.
Glitazones are broken down in the liver; people with liver disease should not take them. Liver enzyme monitoring is recommended for all people taking a glitazone. People taking pioglitazone and rosiglitazone have experienced liver failure, though no direct causal effect of the drug has been established.
Glitazones may raise blood levels of cholesterol and other blood fats.
These drugs can trigger ovulation. Premenopausal women who are not ovulating may be at risk of becoming pregnant.
Glitazones can cause weight gain, which increases with dosage.
Rosiglitazone may increase the risk of broken bones in the hands, arms, or feet.
Women may achieve maximum benefit with smaller dosages.
Possible Side Effects
Pioglitazone
In studies, the side effects of pioglitazone were about the same as those for a placebo (sugar pill).
Possible Side Effects (continued)
¦    Most common: upper respiratory infections, headaches, and sinus irritation.
?    Common: muscle aches, tooth problems, and sore throat.
?    Less common: anemia and swollen legs or arms.
¦    Rare: swelling below the surface of the skin, especially around the eyes and lips; yellowing of the skin or whites of the eyes, hepatitis, and liver failure. Contact your doctor if you experience any side effect not listed above.
For additional side effects of ACTOplus Met, see Metformin (page 696). For additional side effects of Duetact, see Sulfonylurea Diabetes Drugs (page 1065).
Rosiglitazone
•    Common: upper respiratory infections, accidental injuries, and headache.
•    Less, common: swollen legs or arms, back pain.
•    Rare: swelling below the surface of the skin, especially around the eyes and lips; may also affect the hands, feet and throat. Also, hives, anemia, blurry or distorted vision, and low blood sugar. Contact your doctor if you experience any side effect not listed above.
For additional side effects of Avandamet, see Metformin (page 696). For additional side effects of Avandaryl, see Sulfonylurea Diabetes Drugs (page 1065).
Drug Interactions
•    Mixing gemfibrozil (for very high triglycerides) with a glitazone increases the amount of the glitazone absorbed into the body. A reduction in the dose of the glitazone may be needed if you start taking gemfibrozil.
•    Rifampin can reduce the amount of a glitazone that is absorbed by the body, possibly leading to higher blood sugar levels.
•    Ketoconazole may significantly increase the amount of pioglitazone in the body. Other drugs that may have a similar effect but have not yet been studied include itraconazole, erythromycin, calcium channel blockers, corticosteroids, cyclosporine, protease inhibitor anti-HIV drugs, tacrolimus, triazolam, and trimetrexate.
•    Mixing pioglitazone with atorvastatin may reduce the amount of either drug in the body.
•    Pioglitazone may reduce the effectiveness of contraceptive drugs containing norethindrone and ethinyl estradiol. Higher-dose contraceptives or another contraceptive method may be needed.
•    Pioglitazone may stimulate the breakdown of other drugs also metabolized in the liver.
•    Taking rosiglitazone and insulin may increase the risk of fluid retention and heart failure.
For additional drug interactions for Avandamet and ACTOpius Met, see Metformin (page 696). For additional drug interactions for Avandaryl and Duetact, see Sulfonylurea Diabetes Drugs (page 1065).
Food Interactions
Grapefruit juice may interfere with the breakdown of pioglitazone in the liver. Otherwise, these drugs may be taken with or without food, except for Avandaryl, which should be taken with the first meal of the day.
Usual Dose
Adult
Pioglitazone: 15-45 mg once a day.
Rosiglitazone: 8 mg once a day or in divided doses. ACTOplus Met: 15/500 mg-45/2550 mg once or twice a day. Avandamet: 2/500 mg-4/1000 mg twice a day.
Avandaryl: 4/1 mg-8/4 mg with the first meal of the day. Duetact: 30/2 mg-30/4 mg once a day.
Child: not recommended. Overdosage
Little is known about the effects of glitazone overdose. Take the victim to a hospital emergency room. ALWAYS bring the prescription bottle or container.
ISID’atial Information
Diet, calorie control, exercise, and weight loss are essential to controlling type 2 diabetes. Do not depend solely on this drug to manage your condition.
Alcohol, smoking, age, and race do not affect the way that glitazones are processed in the body.
Call your doctor if you develop symptoms Of liver disease, including nausea, vomiting, abdominal pain, fatigue, appetite loss, or dark-colored urine.
See your doctor for regular monitoring of blood sugar, glycosylated hemoglobin (a more sensitive indicator of long-term diabetes control), and liver function.
If you forget a dose of any of these medicines, take it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule.
Special Populations
Pregnancy/Breast-feeding: The safety of using glitazones during pregnancy is not known. Most experts recommend that diabetes be controlled with insulin during pregnancy.
It is not known if glitizones pass into breast milk. Nursing mothers who must take it should consider using infant formula.
Seniors: Seniors may take this drug without special restriction.

Generic Name
Guanabenz (GWAN-uh-benz) 9)
Type of Drug  Anti hypertensive.
Prescribed For  High blood pressure.
General Information
Guanabenz acetate works by depressing the central nervous system by stimulating certain receptors. Initially, guanabenz reduces blood pressure without a major effect on blood vessels; however, btAqAum use of guanabenz may result in the dilation (widening) of blood vessels and a slight slowing of pulse rate. Guanabenz may be taken alone or with a thiazide diuretic.
Cautions and Warnings
Do not take guanabenz if you are allergic or sensitive to any of its ingredients.
People with severe kidney or liver disease should take this drug with caution. Guanabenz should also be used with caution by people who have had a recent heart attack or stroke.
Drug Interactions
•    Other blood-pressure-lowering agents such as beta blockers increase the effect of guanabenz.
•    The sedating effects of guanabenz are increased by combining it with sedatives, sleeping pills, or other centralnervous-system (CNS) depressants, including alcohol.
•    People taking this drug for high blood pressure should avoid over-the-counter drugs that might aggravate their condition, including decongestants, cold and allergy remedies, and diet pills—all of which may contain stimulants.
Food Interactions
This drug is best taken on an empty stomach, but it may be taken with food if it upsets your stomach.
Usual Dose
Adult: 4 mg twice a day to start, increased gradually to a maximum dose of 32 mg twice a dwy—though doses this large are rarely needed.
Child (under age 12): not recommended.
Overdosage
Overdose causes sleepiness, lethargy, low blood pressure, irritability, pinpoint pupils, and reduced heart rate. Overdose victims should be made to vomit with ipecac syrup—available at any
swollen effects increase with dosage. siness, sedation, dry mouth, dizziness, ache.
st pain; swelling in the hands, legs, or ns or abnormal heart rhythms; stom- pain or discomfort; nausea; diarrhea; ion; anxiety; poor muscle control; de- sleeping; stuffy nose; blurred vision; ains; breathing difficulties; frequent uri- sex drive; impotence; unusual taste in ollen and painful breasts in men.
Possible Side Effects
Risk and severity of sid
• Most common: drowsiness
and headache. • Less common: ches
heart palpitation
•    or abdominal vomiting; constipation
difficulty muscle aches and pains
•    decreased the mouth; and
pharmacy—but call your doctor or poison control center first. If you must go to a hospital emergency room, ALWAYS bring the prescription bottle or container.
Special Information
Take guanabenz exactly as prescribed for maximum benefit. If any side effect becomes severe or intolerable, contact your doctor.
Guanabenz often causes tiredness or dizziness; avoid alcohol because it increases these effects. Take care when driving or doing anything that requires concentration.
Do not stop taking guanabenz without your doctor’s approval. Suddenly stopping this drug may cause a rapid increase in blood pressure. Dosage must be gradually reduced by your doctor.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the one you forgot and continue with your regular schedule. Do not take a double dose. Call your doctor if you miss 2 or more consecutive doses.
Special Populations
PregrianCylBreast-feeding, Guanabenz may affect the fetus. ii should be avoided by women who are or might be pregnant. When guanabenz is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
It is not known if guanabenz passes into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors are more sensitive to the sedating and bloodpressure-lowering effects of guanabenz.

Generic Name
Haloperidol (hal-oe-PER-ih-dol) [M
Brand Name
Haldol         Type of Drug .
Butyroqhv)mearibpsychotic.

Prescribed For
Psychotic disorders, including Tourette’s syndrome; severe behavioral problems in children; short-term treatment of hyperactive children; chronic schizophrenia; vomiting; treatment of acute psychiatric situations; and phencyclidine (PCP) psychosis.
General Information
Haloperidol is one of many nonphenothiazine agents used to treat psychosis. These drugs are equally effective when given in therapeutically equivalent doses. The major differences are in the type and severity of side effects. Some people may respond well to one and not at all to another. Haloperidol acts on a portion of the brain called the hypothalamus. It affects parts of the hypothalamus that control metabolism, body temperature, alertness, muscle tone, hormone balance, and vomiting. Haloperidol is available in liquid form for those who have trouble swallowing tablets.
Cautions and Warnings
Haloperidol should not be used by people who are allergic or sensitive to any of its ingredients.
People with very low blood pressure, Parkinson’s disease, or blood, liver, heart, or kidney disease should avoid this drug.
If you have glaucoma, epilepsy or a history of seizures, ulcers, or difficulty urinating, haloperidol should be used with caution and under strict supervision of your doctor.
If haloperidol is used to control mania in bipolar disorder, a rapid depressive mood swing may occur.
Haloperidol can upset the body’s temperature-regulating mechanism creating a risk for heat stroke or dehydration.
Haloperidol may cause dystonia, tardive dyskinesia, or neuroleptic malignant syndrome, all serious conditions.
Possible Side Effects
V Most common: drowsiness, blurred vision, constipation, diarrhea, dizziness, dry mouth, headache, loss of appetite, nausea, stomach pain, or sleeplessness.
V Less common: jaundice (yellowing of the whites of the eyes or skin), which may occur in the first 2-4 weeks. The jaundice usually goes away when the drug is discontinued, but there have been cases in which it did not. if gou notice this effect, develop fever, or generally feel unwell, contact your doctor immediately. Other less common side effects are changes in components of the blood, including anemias; raised or lowered blood pressure; abnormal heartbeat; restlessness; anxiety; euphoria (feeling “high”); depression; confusion; acne-like skin reactions; excessive salivation;
Possible Side Effects (continued)
breast engorgement; development  of breast tissue in males; vomiting; excessive sweating-, menstrual irregularities; impotence; and breathing difficulties.
¦ Rare: neurological effects such as spasms of the neck muscles, severe stiffness of the back muscles, rolling back of the eyes, convulsions, difficulty in swallowing, and symptoms associated with Parkinson’s disease. These effects usually disappear after the drug has been withdrawn; however, symptoms of the face, tongue, or jaw may persist for years, especially in seniors with a long history of brain disease. If you experience any of these effects, contact your doctor immediately. Other rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    Be cautious about taking haloperidol with barbiturates, sleeping pills, narcotics or other sedatives, tricyclic antidepressants, alcohol, or any other medication that may produce a depressive effect.
•    Combining haloperidol with carbamazepine may decrease the effectiveness of haloperidol requiring a dosage adjustment.
•    The use of azole antifungal agents (e.g. ketoconazole) may cause an increase in haloperidol side effects, possibly requiring adjustments in haloperidol doses.
•    Anticholinergic drugs may reduce the effectiveness of haloperidol and increase the risk of side effects.
•    Severe low blood pressure or heartbeat irregularities may occur if haloperidol is combined with epinephrine or dopamine.
•    Taking lithium together with haloperidol may lead to disorientation, loss of consciousness, ry uncontrolled muscle Mwments.
•    Combining fluoxetine with haloperidol may increase the effects of haloperidol.
•    Haloperidol may increase the effects of antihypertensive drugs.
•    Haloperidol may affect phenytoin levels, as well as levels of
other antipsychotic drugs.
•    Careful dosage monitoring is required if haloperidol is taken
with rifampin.
Food Interactions
Haloperidol is best taken on an empty stomach, but you may take it with food if it upsets your stomach.
Usual Dose
Psychotic disorders
Adult: starting dose-0.5-2 mg 2 or 3 times a day. Some patients may need 3-5 mg 2 or 3 times a day. Rarely, some patients may require up to 100 mg a day.
Child (age 3-12 or 33-88 lbs.): starting dose-0.5 mg a day. Dosage may be increased in 0.5-mg steps every 5-7 days. Child (under age 3): not recommended.
Tourette’s syndrome
Adult: starting dose    0.5-1.5 mg 3 times a day; up to 10 mg a day may be needed.
Child (age 3-12 or 33-88 lbs.): 0.02-0.03 mg per lb. a day. The same dosages apply to children with behavioral disorders or hyperactivity.
Overdosage
Symptoms of overdose are depression, extreme weakness, tiredness, desire to sleep, coma, lowered blood pressure, uncontrolled muscle spasms, agitation, restlessness, convulsions, fever, dry mouth, and abnormal heart rhythm. The patient should be taken to a hospital emergency room immediately. ALWAYS bring the prescription bottle or container.
Special Information
This medication may cause drowsiness. Use caution when driving or operating hazardous equipment; also, avoid alcoholic beverages while taking it.
Haloperidol may cause unusual sensitivity to the sun. It may aIF4Q WVR your urine reddish-brown or pink.
If dizziness occurs, avoid sudden changes in posture and avoid climbing stairs.
Avoid extreme heat while taking haloperidol. This medication may make you more prone to heat stroke.
If you forget to take a dose of haloperidol, take it as soon as you remember. Take the rest of the day’s doses evenly spaced throughout the day. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Serious problems have been seen in pregnant animals given large amounts of haloperidol. Although haloperidol has not been studied in pregnant women, you should avoid this drug if you are or might be pregnant.
Haloperidol passes into breast milk. Nursing mothers who must use this medication should use infant formula.
Seniors: Seniors are more sensitive to the effects of this medication and usually require 1/4-1/2 the usual adult dose. Seniors are also more likely to develop side effects.

Brand Name
Helidac
Generic Ingredients
Bismuth Subsalicylate + Metronidazole + Tetracycline
The information in this profile also applies to the following drug:
Generic Ingredients: Bismuth Subcitrate Potassium + Metronidazole + Tetracycline
Pylera
Type of Drug  Antibacterial combination.
Prescribed For  Duodenal ulcers.
General Information
Research has shown that the bacterium Helicobacter pylori is usually present in ulcer disease and some forms of gastritis. Drugs used to treat the H. pylori infection are prescribed along with a drug that alleviates ulcer symptoms by blocking stomach acid. There are a variety of approaches to treating ulcers by using combinations of various antibiotic and acid-blocking drugs. Helidac combines 3 drugs with antibacterial or antibiotic action. This combination generally works by disrupting the cell walls of the bacterium and interfering with its ability to make proteins or duplicate
itself. It is often prescribed together with ranitidine, cimetidine, or another acid Mocker. Other treatments use other drug comb-
nations.
Cautions and Warnings
Do not take Helidac if you are allergic or sensitive to any of its
ingredients.
Do not take Helidac if you have severe liver or kidney disease. People with less severe liver disease may require a reduced dosage.
Rarely, bismuth causes severe nervous system toxicity. Symptoms go away after the drug is stopped.
Bismuth subsalicylate can cause dark stools or darkening of the tongue. This darkening of stools is not dangerous; however, be aware that blood in the stool often manifests as blackening of the stool.
Children or teenagers who have or are recovering from chickenpox should not use Helidac because it contains a small amount of salicylate, which is related to aspirin. Children or teenagers who take aspirin or a salicylate may develop Reye’s syndrome: symptoms include nausea and vomiting.
Bismuth can also cause ringing in the ears, especially if taken along with another aspirin-containing drug.
Metronidazole can cause convulsive seizures and nervous system effects including numbness or tingling in the arms, legs, hands, or feet. The risk of developing these effects increases with dosage and duration of use. Call your doctor at once if you experience any of these effects.
Metronidazole should be taken with caution by people who have had blood diseases or nervous system disorders, such as seizure disorders.
Candida infections may worsen while you are taking metronidazole.
Other infections, called superinfections, can develop while you are taking tetracycline. If this happens, your doctor will discontinue Helidac and prescribe a different drug to treat your H. pylori infection, ;a% %0M as another drug to treat the superinfection.
Tetracycline should not be used in children under age 8 due to the risk of tooth discoloration.
People taking tetracycline can develop pseudotumor cerebri (pressure inside the brain), the symptoms of which are usually headache and blurred vision. Symptoms usually go away when the drug is stopped, but permanent damage can result.
Tetracycline may increase your sensitivity to the sun; use sun-
screen and wear protective clothing.
Tetracycline may make contraceptive drugs less effective. Another or additional forms of contraceptive should be used.
Possible Side Effects
?    Most common: nausea and diarrhea.
?    Less common: abdominal pain, blood in the stool, head-
ache, anal discomfort, appetite loss, dizziness, tingling in
the hands or feet, vomiting, muscle weakness, constipa-
tion, sleeplessness, pain, and respiratory infections.
For more information on possible side effects, see Metronidazole, page 718, and Tetracycline Antibiotics, page 1103.
Drug Interactions
•    Tetracycline antibiotics, which are bacteriostatic, may interfere with the action of bactericidal (bacteria-killing) agents such as penicillin. You should not take both kinds of antibiotics for the same infection.
•    Antacids, mineral supplements, and multivitamins containing bismuth, calcium, zinc, magnesium, and iron can reduce the effectiveness of tetracycline. Separate doses of your antacid, mineral supplement, vitamin with minerals, or sodium bicarbonate and Helidac by at least 2 hours.
•    Tetracycline and metronidazole may each increase the effect of anticoagulant (blood-thinning) drugs such as warfarin. An adjustment in the anticoagulant dosage may be required.
•    Cimetidine can increase metronidazole blood levels. Your metronidazole dosage may be reduced if you are also taking cimetidine.
•    Tetracycline should not be used with methoxyflurane due to the risk of a toxic interaction.
•    Tetracycline may increase blood levels of digoxin in a small number of people, leading to possible digoxin side etezks. (” %kjMt pelop% 1his’interaction with digoxin can occur for months after tetracycline has been stopped. If you are taking this combination, watch carefully for digoxin side effects and call your doctor if any develop.
•    Tetracycline may reduce diabetic insulin requirements. If you are using this combination, be sure to carefully monitor your blood-sugar level.
•    Tetracycline may increase or decrease lithium blood levels. Metronidazole raises lithium blood levels, effects, and toxicity.
•    Combining alcohol and metronidazole may cause abdominal cramps, nausea, vomiting, headaches, and flushing. Modification of the taste of alcohol has also been reported. Metronidazole should not be used if you are taking disulfiram (a drug used to maintain alcohol abstinence) because the combination can cause confusion and psychotic reactions.
•    Phenobarbital and other barbiturates can decrease metronidazole’s effectiveness.
•    Drugs that cause nervous system toxicity, such as mexiletine, ethambutol, isoniazid, lincomycin, lithium, pemoline, and long-term high-dose pyridoxine (vitamin 136) should not be taken with metronidazole because of the increased risk of nervous system side effects.
•    Metronidazole may increase phenytoin blood levels and the risk of phenytoin side effects; your doctor may need to adjust your phenytoin dosage.
Food Interactions
Do not take this drug with milk or dairy products. Helidac should be taken with meals and at bedtime.
Usual Dose
Helidac
Adult: Each dose consists of 4 pills. Take all 4 pills, 4 times a day for 14 days with a full glass of water. Take your acid blocker according to your doctor’s directions.
Child: not recommended.
Pyles
Adult: 3 pills 4 times a day for 10 days with a full glass of water. Take your acid blocker according to your doctor’s directions. Child: not recommended.
Overdosage
All 3 in(aMd1K1t ,in Helidac can be dangerous if taken in overdose, but salicylate poisoning is the most threatening. Symptoms of salicylate toxicity are rapid or heavy breathing, nausea, vomiting, ringing or buzzing in the ears, high fever, lethargy, rapid heartbeat, and confusion. Other more serious symptoms may develop. Take the victim to a hospital emergency room at once. ALWAYS bring the prescription bottle or container.
Special Information
Tetracycline can reduce the effectiveness of contraceptive drugs; you should use backup contraception while taking Helidac. Breakthrough bleeding is also possible.
Bismuth can cause a temporary darkening of your tongue or stool. This is a harmless effect. Stool darkening should not be confused with blood in the stool, which turns it black.
Avoid alcohol while taking Helidac and for 1 day after you stop taking it.
Call your doctor if you develop ringing in the ears. This can be a sign of salicylate toxicity from the bismuth.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule. Never take a double dose.
Special Populations
Pregnancy/Breast-feeding: Helidac should not be taken by pregnant women. Tetracycline affects bone and tooth development in the fetus.
Tetracycline and metronidazole pass into breast milk. Tetracycline interferes with the development of the child’s skull, bones, and teeth, and metronidazole also may cause side effects in the baby. Nursing mothers who must take Helidac should use infant formula.
Seniors: Seniors may take this drug without special restriction.

Generic Name
Brimonidine (brim-ON-ih-dene) (9
Brand Name  Alphagan P
Type of Drug Alpha agonist.
Prescribed For
Glaucoma and ocular hypertension (high pressure inside the eye).
General Information
Brimonidine tartrate stimulates alpha-2 receptors in the eye and lowers pressure there. The maximum effect occurs 2 hours after the drops are administered. Brimonidine reduces the amount of aqueous humor (liquid) produced inside the eye and increases the rate at which fluid flows out of the eyeball. That portion of brimonidine that finds its way into the bloodstream is broken down by the liver.
Cautions and Warnings
Do not use brimonidine if you are allergic or sensitive to any of its ingredients.
People with kidney or liver disease should use this drug with caution. People with cardiovascular disease should exercise caution with this medication because it can affect blood pressure. It should be used with caution in people with depression, cerebral or coronary insufficiency, and Raynaud’s disease. Brimonidine may cause fatigue, drowsiness, and dizziness or fainting when rising from a sitting or lying position.
Brimonidine’s effectiveness may decrease over time. Your doctor should check your eye pressure periodically to make sure the drug is still working.
Possible Side Effects
✓    Most common: dry mouth; redness, burning, and stinging of the eye: headache; blurred vision; sensation of something in the eye; drowsiness; and eye allergy and itching.
♦    Common: staining or erosion of the cornea, unusual sensitivity to bright light, eyelid redness or swelling, eye pain or ache, dry eye, respiratory symptoms, dizziness, eye irritation, upset stomach, weakness, abnormal, and muscle
✓    Less common: crusty deposit on the eyelid, eye bleeding, abnormal taste sensation, sleeplessness, eye discharge, high blood pressure, anxiety, depression, heart palpitations, dry nose, and fainting.
Drug Interactions
•    Brimonidine may enhance the effects of alcohol, barbiturates, sedatives, anesthetics, beta-blocking drugs, blood-pressurelowering drugs, and cardiac glycosides.
•    Tricyclic antidepressants can increase the breakdown of brimonidine.
e    Do not combine brimonidine with monoamine oxidase inhibitor antidepressants.
Usual Dose
Adult and Child (age 2 and older): 1 drop in the affected eye every 8 hours, 3 times a day.
Child (under age 2): not recommended.
Overdosage
Little is known about the effects of accidental ingestion. Victims should be taken to a hospital emergency room for treatment. ALWAYS bring the prescription bottle or container.
Special Information
If you wear soft contact lenses, wait at least 15 minutes between the time you put the drops in your eye and when you put your lenses in.
To prevent possible infection, do not allow the dropper to touch your fingers, eyelids, or any surface. Wait at least 5 minutes before using any other eyedrops.
Brimonidine may make you drowsy. Be careful while driving or doing anything else that requires concentration while you are taking this drug.
It is important that brimonidine be used according to your doctor’s directions. If you forget to administer a dose of brimonidine, do so as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: A small amount ,31 brimonidine may 1pa’SSWAOThe circulation of the fetus. Pregnant women should use this drug with care.
It is not known if this drug passes into breast milk. Nursing mothers who must use this drug should consider using infant formula.
Seniors: Seniors may use brimonidine without special precaution.

abciximab A monoclonal antibody that inhibits platelet aggregation and thrombus formation. Used as an adjunct to heparin in percutaneous transluminal coronary angioplasty under expert supervision. (ReoPro).
glaucoma, as it decreases intraocular pres    9 sure by reducing formation of aqueous humour. It has also been used in epilepsy. Dose: 250 nig-1 g daily. In severe conditions it may be given in similar doses by i.v. injection. Side-effects are drowsiness, gastrointestinal disturbances and paraesthesia. (Dianiox). See page 138 and Table 16.
acamprosate An analogue of GAGA used in alcoholism. It assists in the maintenance of abstinence in alcohol-dependence, but prolonged treatment for a year may be required. Dose: 666 mg 3 times a day. (Campral).
acarbose An inhibitor of alpha-glucosidase, the enzyme that converts dietary carbohydrates to soluble sugars. Used in noninsulin-dependent-diabetes to reduce hyperglycaemic peaks after food. Dose: 50 mg daily initially, rising to 150 mg daily if required. Side-effects are flatulence and diarrhoea; a hypoglycaemic reaction can be treated with oral glucose. (Glucobay). See page 131 and Table 13.
ACE inhibitors See angiotensin-converting enzyme inhibitors.
acebutolol A beta-adrenergic blocking agent with the actions, uses and side-effects of propranolol, but with a more cardioselective effect and less likely to cause bronchospasm.
Dose: in hypertension, 400-800 mg daily; in severe angina, up to 1.2 g daily. It is contraindicated in cardiogenic shock, atrioventricular-block and heart failure. Care is necessary in obstructive airway disease and renal failure (Sectral). See page 148 and Table 21.
aceclofenec A non-steroidal anti-inflammatorydrug (NSAID) used for the relief of pain in arthritic and rheumatoid conditions. Dose: 200 mg daily. (Preservex). See page 131 and Table 29.
acemetacin A derivative of indomethacin with similar actions and uses, but said to be better tolerated.
Dose: 120-180 ing daily. (Finflex). See page 165 and ‘[’able 29.
acetazolamide An inhibitor of the enzyme carbonic anhydrase that has been given as a mild diuretic, as it increases the excretion of bicarbonate. Now used mainly in mild
acetomenaphthone A synthetic form of vitamin K, formerly used in prothrombin deficiency. Menadiol and phytonienadione are now preferred. Acetoinenaphtlione is present in some chilblain preparations.
acetylcholine The neurotransmitter of the parasympathetic nervous system. A 1% solution is sometimes used as a miotic to obtain rapid contraction of the pupil after cataract surgery. (Miochol).
acetylcysteine A mucolytic agent used as eye drops 5% in tear deficiency. Of value in the early treatment (10-15 hours) ofparacetarnol poisoning.
Dose: initially 150 nig/kg by slow i.v. injection, followed by smaller doses up to a total dose of 300 mg/kg over 20 hours. It is inef1ictive, and possibly harmful, if given at a later stage. (Parvolex). See methionine.
acetylsalicylic acid See aspirin. aciclovir See acyclovir.
acipimox A derivative of nicotinic acid used in hypercholesterolaemia.
Dose: 500–750 mg daily. Side-effects are hushing, erythema, nausea and malaise. (Olbetani). See page 146 and Table 20.
acitretin A vitamin A derivative (retinol) used in severe psoriasis resistant to other treatment.
Dose: 20-30 mg daily. Teratogenic - see specialist literature. (Neotigason).
aclarubicin An anthracene cytotoxic agent of the doxorubicin type used in resistant acute non-lymphatic leukaemia. (Aclacin). See specialist literature.
acrivastine one of the newer antihistamines. It is less likely to cause drowsiness, as it does not cross the blood-brain barrier to any great extent, but is correspondingly less effective in non-allergic pruritus. Dose: 24 mg daily. (Semprex). See
page 110 and Table 2.

Drug compliance
It must be admitted that relatively few patients leave the consulting room with a clear idea of the nature and dose of the prescribed medication, partly as a result of fear of th
and partly because of the difficulties of understanding complex therapy. Here, nurses can play a valuable part in reducing difficulties and misunderstandings, particularly when dealing with the elderly and/or confused patient, and it is often helpful to ask patients to repeat the directions that they believe they have been given. Misunderstandings and errors can then be cleared
up at an early stage. The containers of the dispensed medicines should bear not
only the name of the drug, but also useful additional information such as The Heart Tablets’ or ‘The Water Tablets’. Vague directions should be avoided: whenever possible definite times for administration of drugs should be arranged. Such timing can be linked with some regular activity, such as a meal time, or a favourite TV programme may be used as a memory aid for regular dosing. With multiple therapy, patients should be encouraged to set each day’s dose aside, so that a double dose of a drug will not be taken by forgetfulness. Patients should be advised that the occasional missed dose is not always important, and a missed dose should not be made up by taking a double dose later on.
Although regular dosing is important in securing patient compliance, many modern drugs have relatively long half-lives so the regular administration of full doses for long periods may lead to overdose. The ideal dose depends on many factors, including absorption, metabolism, transport and excretion, but in many cases the margin of safety is fairly wide. In the elderly, however, reduced renal efficiency may lead to the gradual accumulation of a drug with insidious toxic effects. Many elderly patients, for example, on digoxin, may become overdivitalized because of poor metabolism and excretion of the drug. It is by no
means unknown for elderly and confused patients, once admitted to hospital for observation, to make an apparently surprising recovery from an illness that was basically due to over-medication, often as a result of following blindly a misunderstood drug regimen. It is here that the community nurse has an exceptionally valuable part to play in ensuring regular and accurate medication, and reporting any incipient signs of overdose or side-effects.
Ail increasing problem of current therapy is patient compliance with prescribed treatment. It is easy for a doctor to prescribe, but to ensure that the patient takes the prescribed drugs in the right dose is a very different matter. The magnitude of the problem has increased with the rise in multiple therapy, and the reluctance on the part of some doctors to prescribe mixed products.

Notes on dosage
In this dictionary of drugs, the doses, unless otherwise stated, are average daily doses for adults, and are normally given as divided doses at suitable intervals. An indication is given of those few drugs that are taken as a single daily dose, or where
the dose is based on the surface area of the body expressed as square metres (ml).
When a dose range is indicated, a small initial dose is often followed by gradually increasing doses according to need and response, but with long-acting drugs care must be taken to avoid excessive dosage, as such drugs may then accumulate in the body and have toxic side-effects. It should be noted that the side-effects of a drug may prevent the administration of an optimum therapeutic dose, and a recommended dose is often a compromise between activity and toxicity. The gap is sometimes referred to as the ‘therapeutic window’, and the wider the gap the safer the drug.
Dosage is also influenced by the route of administration, as oral doses are normally larger than those given by intramuscular injection, and the latter are in turn larger than those given intravenously. The weight, age and sex of a patient may also have to be taken into account when assessing dosage. Renal and hepatic
-impairment may require an adjustment of dose, whereas if tolerance to a drug
develops, a larger dose may be required to evoke an adequate response. Dosage
also requires particular care during pregnancy if toxic effects on the fetus are to be avoided and, ideally, no drug should be given in pregnancy unless the need outweighs the risks.
Doses for infants also present problems. Their drug-detoxifying enzyme
systems and renal excretory capabilities are not fully developed although,
paradoxically, they have higher metabolic rates than adults, and so may sometimes require an apparently relatively high dose of a drug.

Doses for the elderly also frequently require modification, as their reduced renal efficiency may cause accumulation of the drug and increase susceptibility to toxic effects, unless reduced doses are given. Elderly patients are, in any case, more susceptible to nephrotic drugs generally. Hepatic disease may also increase drug toxicity as liver enzymes play a major part in drug metabolism, and severe liver disease may give rise to a drug toxicity that might not otherwise occur. Hyperlipidaemic drugs, fusidic acid and some antifungal agents of the ketoconazole type are examples of drugs best avoided in hepatic disease. Multiple therapy may also lead to an increased and not always appreciated incidence of drug toxicity. For further information on these important aspects of drug dosage, a book for nurses on drugs and pharmacology should be consulted.

Controlled drugs
Drugs likely to cause dependence and misuse are referred to as ‘controlled drugs’ (CDs), as they are subject to the strict prescription requirements of the Misuse of Drugs Act, 1971, and are distinguished in this book by a dagger t. They include opium, morphine, heroin (diamorphine), pethidine and other synthetic, potent analgesics/narcotics, dihydrocodeine injection, barbiturates (except intravenous anaesthetics) and amphetamines. Controlled drugs can be supplied only on receipt of a hand-written prescription from the prescriber, giving full details of the patient, the drug, the form and strength of the prescription to be dispensed, and the total amount to be supplied expressed in both words and figures. Certain weak preparations of some controlled drugs, such as Kaolin and Morphine Mixture for diarrhoea, with which misuse is unlikely, are exempt from control, and can be obtained without prescription.

vasodilators Traditional vasodilators used in the prophylaxis and treatment of angina include glyceryl trinitrate and other nitrates. They have a general effect on the venous system but newer and more selectively acting antihypertensive drugs are the betaadrenoceptor blocking agents represented by propranolol, and the calcium channel blocking agents such as nifedipine. Other vasodilator drugs are the alpha-adrenoceptor blocking agents (indorarnin, prazosin) and the ACE inhibitors (captopril). Cerebral vasodilators are represented by isoxsuprine. Peripheral vasodilators include cinnarizine and thymoxamine. See pages 114 & 148.
vasopressin A preparation of the blood pressure- raising and antidiuretic factors of the pituitary gland. It has been used in doses of 5-20 units twice daily by s.c. or i.m. injection in diabetes insipidus, but has been largely superseded by demopressin. (Pilressin).
vecuronitim A non-depolarizing muscle relaxant of the rocuronium type. It has a medium duration of action, with the advantage of not causing histamine release. Dose: 80-100fLgjkg1min initially, with supplementary doses as required. (Norcuron).
venlafaxine An antidepressant that inhibits the re-uptake of both serotonin and nor-adrenaline.
Dose: in depressive illness, 75 mg daily, rising if necessary after some weeks to 150 ing daily, or exceptionally to 375 mg daily. Prolonged treatment is necessary for an adequate response and reduce potential relapse. Reduced doses are given in hepatic disease and lite elderly. Care is necessary in epilepsy, and before and after morloaniine oxidase inhibator (MAGI) therapy. Many side-effects have been noted, but any skin reaction should be reported to the prescriber. (Ffcxor). See page 128 and Table 11.
Dose: 120-480 mg daily according to the condition and degree of response. In severe arrhythinias, 5-10 mg i.v. under ECG control. Contraindicated in bradycardia, heart failure and heart block. Side-effects include nausea, hypotension and heart block. It should be used with caution in a patient already receiving a betaadrenoceptor blocking agent. (Cordilox; Securon). See page 148 and Table 21.
vigabatrin A new anti-epileptic drug. GABA (a gamma aminobutyric acid) is an inhibitor of neurotransmission, and epileptic seizures may be linked with a GABA deficiency. Vigabatrin has an inhibitory action on the GABAmetabolizing enzyme, and so indirectly permits a rise in the brain level of GABA. It is used in the treatment of epilepsy not responding to other anticonvulsants. Dose: 2 g daily initially, with adjustments up to 4 g daily together with current antiepileptic therapy. Side effects are numerous, and include drowsiness, fatigue, dizziness and weight gain. Sudden withdrawal is inadvisable. (Sabril). See page 136 and Table 15.
viloxazine An antidepressant with the general action, uses and side-effects of amitriptyline, but with a reduced sedative activity. It is given in depression associated with apathy, and in the depression of epilepsy.
Dose: 150-400 mg daily. It may increase the action of phenytoin and antihypertensive agents. (Vivalan). See page 128 an(] Table 11.
vinblastine An alkaloid of periwinkle that has cytotoxic properties. It is used in the control of acute leukaemias, lymphomas and other malignant conditions, and in mycosis fungoides.
Dose: 100 ltrjkg weekly i.v., increased by 50 pg/ki; weekly, up to 500 µg/kg weekly according to response. Side-effects include myclosuppress.ion, neurotoxicity and abdominal disturbances. The drug should be handled with care as it is a tissue irritant. (Velbe). See page 122 and Table 8.
105
verapamil A calcium channel blocking agent that reduces the movement ofcalciurn ions in cardiac tissues. It reduces the oxygen demand as well as the contractility of the myocardium, and it is used in angina, arrhythmias and hypertension.
vincristine A vinca alkaloid with the action and uses of vinblastine, but much less likely to cause myclodepression. It is used mainly in the treatment of acute
leukaemias in children, Hodgkin’s disease and other malignant lymphomas.

Neuromuscular side-effects may limit the dose. Other side-effects are abdominal disturbance and alopecia. The injection of the drug requires care as it is a tissue irritant. (Oncovin). See page 122 and Table 8.
vindesine A vinca alkaloid with an action similar to that of vincristine. It is used mainly in acute lyniphoblastic leukaemia in children, and in other malignant conditions not responding to treatment.
Dose: 3 nig/m` weekly by i.m. injection, subsequently increased up to 5 mg/in’ according to response. The side-effects are similar to those of other vinca alkaloids, but granulocytopenia may be a close-limiting factor. Extravasation should he avoided, as it may cause considerable local irritation. (Eldesine). See page 122 and fable R.
woo
vitamin D. Calciferol.
vitamin E The vitamin in the germ of wheat, rice and other grains. Deficiency States are uncommon, but may occur in cystic fibrosis and other conditions where fat absorption is impaired. It has been used empirically in many other
conditions, but its therapeutic value is questionable.
Dose: 5-15 ing daily. Now largely replaced by the synthetic form tocopherol.
vitamin K The vitamin concerned with the formation of prothrombin, and so with blood coagulation. Given as menadiol in haemorrhagic disorders, vitamin K, or phytomenadione has a similar but more rapid and sustained action. Of no value when the prothrombin level of the blood is adequate.
106
vinorelbine A cytostatic drug of the vinca alkaloid type. It is used in non-small cell lung cancer and in advanced breast cancer resistant to other drugs.
Dose: 25-36 ing/inweekly by i.v.
infusion. Main side-effect is neutropenia. (Navelbine). See page 122.
vitamin A One of the vitamins obtained from fish-liver oils. A deficiency in the diet causes night-blindness, skin changes and a decreased resistance to infection. Dose: 2500-25 000 units daily.
vitamin B A group of water soluble vitamins obtained from yeast or rice polishings. The constituents include thiamine, riboflavine, nicotinic acid, pyridoxine, and small amounts of other factors.
vitamin B. Pyridoxine.
vitamin B,, Cynacobalamin. vitamin C Ascorbic acid.
warfarin A synthetic anticoagulant similar to phenindione, but with reduced side-effects and it is now the preferred drug. It is used mainly in deep-vein thrombosis and transient brain ischaernia, in doses based on the prothrombin time as
reported by the laboratory in terms of the International Normalized Ratio (INR). Dose: Pending INR report, 10 ing daily initially for up to 3 days. Haemorrhage is the main side-effect, and may require the use of phytornenadione to control the excessive response.
Whitfield’s ointment Benzoic acid 6%, salicylic acid 3%. Has keratolytic and fungicidal properties, and is used mainly for ringworm.
wool alcohols A water-in-oil emulsifying agent obtained from wool fat. It is used in many water-containing ointments, such as ointment of wool alcohols and hydrous ointment.
vitamin D The vitamin essential for the absorption of calcium and phosphorus and subsequent bone formation. Several forms of the vitamin are known, but it is used chiefly as calciferol. Vitamin D is activated in the liver and kidneys to more powerful derivatives such as calcitriol and alfacalcidol.
wool fat A pale yellow, waxy substance, also known as lanolin, obtained from sheep’s wool. It consists mainly of cholesterol-derivatives, and is a constituent of various water-in-oil emulsifying and emollient ointment bases. It may cause skin sensitization in some susceptible patients.

xamoterol A partial 0, adrenoceptor agonist with a cardiac stimulant action. It is given only in mild chronic heart failure to control exercise-induced symptoms. Dose: 400 ing daily. Side-effects are dizziness, headache and gastrointestinal disturbances. Contraindicated in severe heart failure, and care is necessary in asthmatic conditions. (Corwin). See page 141 and Table 18.
xipamide A long-acting diuretic and anti-hypertensive similar to chlorthalidone. Dose: in hypertension, 20 ing is given as a morning close: in oedematous states, 40-90 mg as a single dose, reduced later as necessary. (Diurexan). See page 148 and Table 21.
xylometazoline A sympathomimetic agent used as a nasal decongestant, and to relieve allergic conjuncfivitis as drops of 0.05-0.1%. Rebound congestion may be a side-effect.
Z
zalcitabineV An antiviral agent used in the suppressive treatment of AIDS patients who have become resistant to or have failed to respond to zidovudine therapy. Dose: 2.25 nig daily under expert supervision, as the drug has many side-effects including
., peripheral neuropathy. 0 livid).
zidovudine An antiviral agent effective against the human immunodeficiency virus (HIV) associated with the acquired immune deficiency syndrome (AIDS). It inhibits the enzyme reverse transcriptase and, by preventing the formation of viral DNIA, it inhibits viral development. Dose: 33 ing/kg4-hourly for some months. Side-effects include anaemia, neutropenia, nausea, fever and malaise. Liver-function tests are necessary during treatment. The chronic use of analgesics such as paracetamol may increase the risk of neutropenia. (Retrovir). See page 144 and “table 19.
zinc oxide A soft white powder widely used in dusting powders, ointments, pastes, etc., for its mild astringent and antiseptic properties. It is a constituent of Lassar’s paste, Unna’s paste, Calamine Lotion and similar preparations.
zinc sulphate Used as an astringent and stimulating lotion (1%) for indolent ulcers; and in conjunctivitis as eye drops (0.25%).
zinc undecenoate A white insoluble powder. Constituent of dusting powders and ointments for mycolic conditions.
zolmitriptan A serotonin receptor agonist used only in the treatment of acute migraine.
Dose: 2.5 ing as soon as possible after onset. .A second dose may be given not less than 2 hours later if symptoms persist. Vornig). See page 154 and Table 23.
zolpidem A mild hypnotic that acts by binding with a sub-group of benzodiazepine receptors. It has a rapid action, and is used in the short-term treatment of insomnia.
Dose: 10 mg. Side-effects are dizziness and gastrointestinal disturbance. (SI ilnoct). See page 152 and Table 22.
zopiclone A mild hypnotic that binds with a sub-group of benzodiazepine receptors, and may modulate the neurotransmitter GABA.
Dose: in insomnia and early awakening, 7.. —]S mg with initial doses of 3.75 mg for the elderly. A side-effect is a bitter or metallic after-taste. (Zimovane). See page 152.
zuclopenthixol A powerful tranquillizing drug with actions, uses and side-effects similar to those of chlorpromazine. It is of value in schizophrenia with agitation and aggression.
Dose: 20-30 mg or more up to 150 mg daily. For depot maintenance treatment, 100-200 mg or more by deep i.m. injection at intervals of 2-3 weeks, according to need and response. (Clopixol). See page 168.

triamcinolone A glucocorticosteroid with the actions, uses and side-effects of hydrocortisone, but differing by promoting sodium excretion, and so is of no value in adrenal cortex deficiency states. It is used in a wide range of inflammatory, allergic and respiratory states, and in inflammatory skin conditions.
Dose: 8-24 mg daily. It is also given as triamcinolone acetonide in doses of 40 ing by deep i.m. injection for a depot action. The acetonide is also given by iniraarticular injection in doses of 2.5-40 mg in local inflammation of the joints, and by intra-lesional injection in doses of 2-3 mg at any one site for the treatment of skin lesions. Triamcinolone actonide is also used as a 1% cream or ointment in severe inflammatory skin conditions. The side-effects are those of the corticosteroids (see hydrocortisone), but triamcinolone may also cause myopathy with high dose treatment. (Kenalog; Ledercort).
triamterene A potassium sparing diuretic, used mainly in association with more powerful drugs. It is indicated in oedematous conditions generally, and, as it causes some retention of potassium, its use avoids the need for supplementary potassium therapy.
Dose: 150-250 mg daily, with lower doses for the elderly and when given in association with other diuretics. Rash .ind gastrointestinal disturbances are ,ide-effects. (Dytac). See page 148 and Kahle 21.
tribavarin An inhibitor of viral replication used in severe viral bronchiolitis in infants.
Dose: by aerosol inhalation of a solution (20 ing/ml) for 12-18 hours daily liar 3-7 days, together with supportive therapy. (Viravid).
triclofos A derivative of chloral, with the sedative properties of the parent drug, but less irritant to the gastric mucosa.
Dose: I 2gdaily.
alternative to penicillamine in other conditions. The main side-effect is nausea.
trifluoperazine A powerful tranquillizing drug of the chlorpromazine type. It is used mainly in schizophrenia and similar psychoses, and in severe anxiety.
Dose: 10-20 nig or more daily according to need. In severe anxiety, 2-6 ing daily. In acute conditions, 1-3 mg daily by deep i.m. injection. As an antiemetic, it is given in doses of 2-4 mg or 1-3 ing by injection. The side-effects are similar to those of chlorpromazine, including extra-pyramidal symptoms, but the anticholinergic and sedative side-effects are less severe. (Stelayine). See page 168 and Table 30.
tri-iodothyronine See liothyronine.
trilostane An inhibitor of enzyme systems concerned with production of mineraloand glucocorticosteroids by the adrenal cortex, and so resembles metyrapone to some extent. It is used to control adrenal cortex hyperfunction and the excessive production of aldosterone.
Dose: 240 ing daily initially, adjusted tip to a maximum of 480 mg daily, according to the plasma corticosteroid levels. Care is necessary in liver and kidney dysfunction. (Modrenal).
trimeprazine A sedative antihistamine used in the treatment of pruritus and allergic itching conditions, and for premedication.
Dose: 30-100nig daily; pre-medication dose: 3 mg/kg. (Vallergan).
trimetaphan A short-acting ganglionic-blocking agent. It is used to produce a controllable reduction in blood pressure (luring neuro- and vascular surgery when a relatively bloodless field is necessary. Dose: by i.v. infusion, 3-4 nighnin initially, with subsequent doses carefully adjusted to the response. Side-effects are tachycardia and respiratory depression. Frequent determination of blood pressure during use is essential.
triclosan A chlorinated phenolic antiseptic, used mainly in surgical scrubs and similar preparations. (Manusept; Ster-Zac).
trientine A copper-chelating agent used in Wilson’s disease, but only for patients unable to tolerate penicillamine.
Dose: 1.2 -2.4 g daily. It is not an
trimethoprim An antibacterial agent similar in action to the sulphonamides. It is used in the prophylaxis and treatment of urinary tract and respiratory infections due to sensitive bacteria.
Dose: in chronic infections, 200-400 nig daily; prophylactic dose, 100mg daily. In severe infections, 130-250 mg twice daily by slow i.v. injection. Side-effects are nausea, vomiting,rash and pruritus, and possible bone marrow depression. (lpral;
Monotrim). See co-trimoxaole.
trimetrexateV An antibacterial agent used like atovaquone in AIDS patients with Pnettinocystis carinii pneumonia.
Dose: 45 ing/nidaily by i.v. infusion for 21 (lays, followed by calcium folinate 80 nighty daily for 28 days, orally or i.v. (Neutrexin).
I Tyr
oral antidiabetic drugs by increasing the sensitivity to endogenous insulin, and so acts as an insulin enhancer.
Dose: 200 mg daily with breakfast, increased if required by 200 mg at intervals of 2-4 weeks up to 600 mg daily. Side-effects are diarrhoea, fatigue and malaise. (Romozin). See page 131 and Table 13.
tropicamide A short-acting mydriatic agent similar to homatropine. Used as 0.5% and I% solution.
trimipramine A sedative anti-depressant with the action and side-effects of amitriptyline. It is valuable in depression complicated by anxiety.
Dose: 75-300 mg daily. (Surmontil).
triple vaccine Diphtheria, tetanus and pertussis vaccine for the primary ininitinization ofchildren.
Dose: 0.5 ml by i.m. or deep s.c. injection.
triptorelin A synthetic form of gonadorelin, used in the treatment of advanced prostatic cancer. Such cancers are testosterone-dependent, and triptorelin acts by depressing pituitary function, and so indirectly reduces the plasma level of testosterone.
Dose: It has been formulated so that a single i.m. injection of 4.2 ing depresses testosterone production for 28 days. Initially there may be a temporary flare-up of symptoms, which can be prevented by giving an anti-androgen for 3 days before treatment, and continued for 2-3 weeks. Patients should be monitored for uleric obstruction and spinal cord compression during the first months of treatment. DecapepivI Sr). See page 122.
tropisetron A 5–HT.,-receptor antagonist, similar to ondansetron bill with a longer action. It is used to control the nausea and vomiting induced by cancer chemotherapy.
Dose: initially as a 5 mg dose i.v. shortly before such therapy, and followed 1)), oral doses of 5 mg daily, I hour before food, for 5 days. Side-effects are dizziness, headache and gastrointestinal disturbance. (Navoban). See page 122.
tryparsamide Used in late trypansomiasis when the CNS is involved.
Dose: 1-3 g by injection weekly, up to a maximum Lill) of 24 g. May damage optic nerves.
tryptophan\7 An amino acid involved in the biosynthesis of serotonin. It is used in specialist centres for the treatment of severe and prolonged depression resistant to other drugs, and where a deficiency of serotonin may be a factor. (Optimax). See page 128 and Table 11.
tuberculin A product obtained from cultures of Mycobacterium tuberculosis. It is used in the diagnosis of tuberculosis. See BGC vaccine.
103
trisodium edetate A chelating or binding agent that is sometimes used in hypercalcaernia. The calcium complex so formed is excreted in the urine.
Dose: slow i.v. infusion tip to 70 rng1kg daily according to need and response, as shown by plasma calcium measurement. It is also used as a 0.4% solution for
ophthalmic use in lime burns of the eyes. Side-effects after injection are nausea, diarrhoea and cramp. Contraindicated in renal impairment. (Limclair).
troglitazone A new drug for non-insulin dependent diabetes. It differs from other
tulobuterol A selective beta,-adrenergic agonist of the salbutamol type, used in the prophylaxis and treatment of bronchospasm in asthma and related conditions. Dose: 4-6 mg daily. (Respacal). See page 118 and’fable 6.
tyrothricin A minor antibiotic used as
lozenges for mouth infections.

undecenoic acid An organic acid with useful antimycotic properties. It is used mainly as powder or ointment (5%), often with zinc undecenoate in the treatment of athlete’s foot and associated conditions.
urea An osmotic diuretic. It has been used orally in doses of 5-15 g. Applied locally as a 10% solution, it promotes granulation and reduces odour front•    foul ulcers.
urofollitrophin A preparation of human lollide-stimulating hormone (FSH) used with nienotrophin for the induction of ovulation. Dose and duration of treatment require careful control to avoid Over-stimulation. (Metrodin; Orgafol).
I Vas
allergen vaccines, used for desensitization to various allergens such as grass pollens, arc not true vaccines, but weak solutions of allergen extracts. They may precipitate allergic reactions in susceptible patients, and should be used only when emergency resuscitation measures are immediately available.
valaciclovirV A pro-drug of acyclovir used in herpes zoster. It is well absorbed orally, and quickly converted to the parent drug and promotes an improved response.
Dose: 3 g daily for 7 days, reduce([ in severe renal impairment. Dose in herpes simplex I g daily. Side-effects are headache and nausea. (Valtrcx). See page 144 and Table 19.
valproic acid (Convulex). See sodium valproate.
104
urokinase A plasmin activator obtained from human urine. It is used mainly in the thrombolysis of blocked i.v. shunts, and in the lysis of blood clots in the eye. Dose: 5000-37 500 units, instilled into the shunt; similar doses are injected into the anterior chamber of the eye for the resolution ofl)l blood clots. (Ukidan).
ursodeoxycholic acid The acid appears to be a solvent of cholesterol, and is given orally to promote the dissolution of cholesterol-containing gall stones.
Dose: 8-12 mg/kg as a single daily dose, hut prolonged treatment is required, which should be continued after the dissolution of the stones to inhibit recurrence. The dissolution of calcium-containing or radio-opaque stones is unlikely to occur. (Destolit; Ursofalk).
valsartan An angiotensin II receptor antagonist used in hypertension. It has a more selective action than the ACE-inhibitors. Dose: 80 mg daily. Combined treatment with a potassium-sparing diuretic is not advisable. (Diovan). See page 148 and Table 21.
vancomycin An antibiotic used in severe antibiotic-associated staphylococcal colitis ( pseudomembranous colitis).
Dose: 0.5 g daily for i-10 days. It is also given by injection in resistant bacterial endocarditis; I g twice a day by slow i.v. infusion over 1-2 hours, as rapid injection may cause anaphylactic shock. Blood concentrations of the antibiotic should be monitored, as the many side-effects include renal damage, ototoxicity and ncutropenia. Pruritus and upper body flushing may occur, and tinnitus is an indication that the drug should be withdrawn. (Vancocin).
vaccines Bacterial vaccines are suspensions or extracts of dead bacteria, but sonic anti-viral vaccines are also available. They may be given by s.c. or i.m. injection, and are used mainly for prophylaxis against a particular infection. The most commonly used vaccines include those for typhoid, cholera, diphtheria, influenza, tetanus and polio. Protection against mumps, measles, pertussis, rubella, yellow fever and hepatitis can also be obtained. The so-called
vasoconstrictors Drugs such as noradrenaline that constrict the peripheral vessels, and so cause a temporary rise in blood pressure. They are useful in hypotensive conditions when the blood volume is still adequate, and in controlling the fall in blood pressure that occurs in spinal and general anaesthesia.

tiaprofenic acid A non-steroidal analgesic and anti-inflammatory agent with the actions, uses and side-effects of related NSAIDs such as naproxen.
Dose: 600-800 nig daily. Mild oedema may occur with extended treatment. Peptic ulcer and asthma are contraindications. Severe cystitis is an occasional side-effect. It should not be given to patients with urinary tract disorders, and should he withdrawn at once if any
urinary symptoms develop. (Surgarn). See Page 165 and Table 29.
t1bolone A compound described as an gonadomimetic steroid as it has oestrogenic and progestogenic properties. It is used to control the vasomotor symptoms of the menopause, including those surgically induced as well as those occurring naturally.
Dose: 2.5 ing daily for some months. Similar doses in the prophylaxis of osteoporosis. Side-effects are headache, dizziness and vaginal bleeding. Treatment should be withdrawn if any thromboembolic symptoms or jaundice appear. (1,ivial).
Dose: 400 nig as a single daily dose for 12 weeks, to be taken with water at least 2 hours before or 2 hours after meals. Antacids and milk should be avoided. The improvement in serum alkaline phosphatase activity may persist, and a second course needed only after an interval of at least 6 months. Gastrointestinal side-effects are common, but renal function should be monitored regularly. (Skelid).
timolol A beta-andrenergic blocking agent of the propranolol type, used in the control of angina and hypertension. Dose: 10-60nigdaily. In the prophylactic t i catment of migraine, 10-20 ing daily. (,’are is necessary in bradycardia, cardiac insufficiency and bronchial disease. It is also of value as eye drops (0.25%-0.5%) in simple chronic glaucoma, as it reduces infra-ocular pressure by reducing the formation of the aqueous humour. (Betim; Blocadren; Timoptol). See pages 148 & 154, and Table 21.
tinidazole A drug similar to metronidazole, and used mainly in the prophylaxis and treatment of anaerobic infections and anioebiasis.
Dose: 2 g initially, followed by I g daily for 5 days. A single oral (lose of 2 g is given 12 hours before abdominal surgery, and a similar single dose is given in amoebiasis and giardiasis. Side-effects are nausea, vomiting and diarrhoea. A disulfiram-like -like reaction may occur if alcohol is taken. ( Fasigyn).
99
ticarcillin An antibiotic with an increased activity against Pseudomonas aeruginosa. In pseudomonal septicaemia, combined treatment with an aminoglycoside anti biotic such as gentamicin may evoke an increased response.
Dose: 15-20 g daily by slow i.v. injection or infusion in systemic infections; 3-4 g daily by i.m. injection in urinary infections. (Ticar). It is sometimes given together with clavulanic acid as Timentin, but it delayed post-treatment reaction with Tinientin is cholestatic jaundice, thought to be due to clavulanic acid.
tiludronic acid A bisphosphonate that inhibit., (fie [)one resorbing activity of osteoclasts, and so reduces the excessive demineralization of bone that occurs in Paget’s disease.
tinzaparin A low-molecular weight heparin ti,cd in the prevention ofthromboembolism.
Dose: by s.c. injection 2500-3000 units daily for 7-10 days. It is also used to prevent clotting in haemodialysis apparatus. (Innohep; Logiparin). See dalteparin and enoxaparin. With these products laboratory control is not necessary.
tioconazole An antifungal agent used in
tines infections of the nails by the
extended application of a 289/6 solution. Treatment for 6 months or more may be necessary. (Trosyl).
titanium dioxide A metallic oxide, similar to zinc oxide, with mild astringent properties. It is present in some sunburn protection preparations.

tizanidine A central alpha, receptor agonist use([ in the spasticity associated with multiple sclerosis and spinal injury. Dose: 2 ing weekly, increased according to response up to 24 ing daily. Monitor liver function monthly for 4 months. (Zaiiallex).
tobramycin An aminoglycoside antibiotic with the actions, uses and side-effects of gentamicin, but considered to be more active against Pseudomonas aerugi . nosa. Dose: 3-5 nig1kg daily by i.m. injection or i.v. infusion. It may be given together with a penicillin or nictroniclazole in serious mixed infections. Care is necessary to avoid the ototoxic and nephrotoxic effects of aminoglycosides. (Nebcin).
tocainide An anti-arrhythmic agent similar in action to lignocaine. It is a powerful drug, and may cause severe blood dis(urhances, and its use is largely restricted to the control of life-threatening arrhythmias not responding to other drugs.
Dose: 1.2-2.4 g daily. Blood counts during treatment are essential. Side-effects include bradycardia, hypotension, rash, tremor and aplastic anaemia. (Tonocard).
tocopherol A synthetic form of vitamin E.
tolazamide An oral hypoglycaemic agent related to tolbutamide, with similar actions, uses and side-effects.
Dose: 100-250 mg daily, increased if necessary up to a maximum dose of I g daily. (Tolanase). See page 131 and Table 13.
tolbutamide A sulphonylurea used like Jilorproparnicle in the treatment of maturity-onset diabetes, but it has a shorter action, and twice-daily doses are usually necessary. It is effective only when some insulin-secreting cells of the pancreas are still functioning, and a return to insulin therapy may be necessary during illness and infection. Tolbutarnide is not suitable for the treatment of juvenile or severe diabetes.
Dose: 0.5-2 g daily. Side-effects include hypoglycaemia, poglycaernia. rash, Jaundice and blood dyscrasias, but are uncommon with low doses. (Rastinoo). See page 131 and
Table 13.
tolcapone An inhibitor of the enzyme concerned with the biosynthesis of dopamine. It is used with other drugs in the
treatment of parkinsonism in initial doses of 100 mg 3 times a day. Side-effects are dyskinesia, nausea and sleep disturbances. (Tasmar). See page 160 and Table 26.
tolfenamic acid A non-steroidal anti-inflammatory drug (NSAID) but exceptional in being used in the treatment of migraine, on the basis that prostaglandins are involved in the pathology of migraine. Dose: 200 mg at the onset of an attack, repeated once after 2-3 hours if necessary. Close monitoring is required if anticoagulants also given; caution in peptic ulcer. (Clotani). See page 154 and Table 23.
tolmetin An anti-inflammatory analgesic agent used in rheumatoid and mUSCUIOskeletal conditions. As with related non-steroidal anti-inflammatory drugs
(NSAIDs) it may cause gastrointestinal disturbances in some patients, and should be taken after food. Hypersensitivity reactions may occur occasionally.
Dose: 0.6-1.8 g daily. (Tolectin). See page 163 and -Fable 29.
topiramateV A new anti-epileptic that differs chemically from related drugs. It is used as adjunctive therapy in partial seizure patients not adequately controlled by standard treatment.
Dose: initial (lose 100 nig daily, slowly increased at weekly intervals as required up to 800 mg daily. Patients receiving digoxin should be monitored. Not recommended for children. (Topaniax). See page 136 and Table 15.
topotecanV A new advance in cancer chemotherapy is the use of topoisomerase inhibitors. Topoisomerase I is necessary for DNA replication, and topotican acts by binding with super-coiled DNA and so preventing further DNA development. Dose: 1.5 mg/n’ by i.v. infusion daily for 5 days under expert supervision. Side-effects are myelosuppression and severe neutropenia. (Hycamptin). See page 122 and Table 8.
torasemide A loop diuretic of the
IrLISCII)i(IC type.
Dose: in oedema, 5-20 ing once daily; in pulmonary oedema 10-20 mg daily by slow i.v, injection but much larger doses are sometimes necessary. In hypertension. 5-20 mg daily. (Torero). See page 148 and Table 21.

toremitene’v” An anti-oestrogen used in h0i 11 im ie- dependent metastatic breast cancer.
Dose: 60 mg as a single daily dose. Side- effects are linked with the mode of action
aninclude hot flushes, dizziness and
sweating. Care is necessary in severe hepatic deficiency, angina and cardiac weakness. (Fareston). See page 122 and Table 8.
trannadoW An analgesic used in the short-tan) treatment of moderate to severe pain. It has reduced affinity for opioid receptors, and the action may be mediated by inhibiting the neuronal re-uptake of noradrenaline and related amines. Dose: 300-400nig; in severe pain it may he given by i.m. injection or i.v. injection/infusion in closes of 50- 100 ing 4-6-hourly. (Tramake; Zamadol; Zydol).
trandolapril An ACE inhibitor used in mild io moderate hypertension.
Dose: 500 jig daily initially, increased at intervals of 2-3 weeks up to 1-21ng once daily. If hypotension occurs, reduce supportive therapy before lowering the trandolopril dose. Prophylactic dose after myocardial infarction 500 Vg-4 mg daily. Diuretic therapy should be stopped before starting with trandolapril, to reduce the risks of initial hypotensive side-effects. (’are with monitoring in patients with renal and hepatic impairment. (Gopten; Odrik). See page 148 and Table 21.
tranexamic acid An antifibrinolytic agent used to check haemorrhage after prostactectomy, in surgery generally and in the control of menorrhagia.
Dose: 2-8 g daily; 3 g daily by slow i.v. infection. Side-effects are nausea, diarrhoea and dizziness. (Cyklokapron).
tranquillizers These drugs were once Separated into the major tranquillizers, represented by chlorpromazine, and the minor tranquillizers exemplified by diazepam, but are now often referred to as antipsychotic drugs and anxiolytics respectively. The antipsychotics are used mainly in the control of disturbed patients, and in schizophrenia, although they have some anti-anxiety properties, and long-term treatment is often necessary. The anxiolytic drugs are intended mainly for the short-term treatment of acute anxiety states, as extended use may
cause dependence. See pages H 7 & 168, and Tables 5 & 30.
Transiderm-Nitro A medicated patch containing glyceryl trinitrate designed to have an action over 24 hours in the prophylaxis of angina.
tranylcypromine A monoamine oxidase inhibitor (MACI), of use in severe depression not responding to other drugs. Dose: 20 nig daily initially, increased to .50 ing daily or more according to need. The use of tranylcypromine requires care, as the drug has a stimulant action that may complicate therapy, and phenelzine may be preferred. Side-effects are dizziness, dry mouth and insomnia. Liver damage may also occur, and a hypertensive crisis with throbbing headache requires withdrawal of the drug. Hyperthyroidism is a contraindication. (Parnate). See page 128 and Table 11.
trazodone An antidepressant chemically distinct from other drugs with a similar action, and with reduced anticholinergic and cardiovascular side-effects. It is
indicated mainly in depression associated with anxiety when a sedative action is also required.
Dose: 150-300mgd;iily.’['Iieside-effects are those of the tricyclic antidepressants such as amitriptyline. (Molipaxin). See page 128 and’I'able 11.
treosuffan A cytotoxic agent related to busulphan, but used mainly in ovarian cancer.
Dose: I g daily for 28 days, repeated after a 4-week rest period; 5-15g by i.v. injection at intervals of 1-3 weeks. In all cases the (lose is adjusted according to the
degree of bone marrow depression that occurs. Other side-effects are those of cytotoxic drugs generally. Extravasation causes pain and local tissue damage. See page 122 and Table 8.
tretinoin A derivative of vitamin A. It is used locally for acne (Retin-A) and also for the treatment of photodamage to the skin (Retinova). A new use is the induction of remission in acute promyelocytic leukaemia.
Dose: 22.5 trig/m2 twice daily with food. Combined therapy may reduce the risk of relapse (Vesanoid).

suramin A drug used in the early treatment of trypanosomiasis, but it is of no value in the later stages of the disease as it does not enter the cerebrospinal fluid.
Dose: I g i.v. weekly for 5 weeks, after a tolerance test dose of 200 mg. Side-effects are gastrointestinal disturbances, dermatitis, hyperac%thesia and kidney damage.
suxamethonium A short-acting, depolarizing muscle relaxant, with an action lasting 3-5 minutes. A preliminary injection of thiopentoric should first be given, as the initial effect of suxamethonium is a
painful muscle contraction before the relaxant action supervenes.
Dose: 20- tOO ing i.v. during surgery, with further doses according to need. Suxamethonium may also be given as a 0.1% solution by i.v. infusion. Exceptionally, the muscle relaxant action of the drug may be prolonged with marked apnoea. Unlike non-depolarizing muscle relaxants, the action of suxamethonium cannot tie reversed. Severe hepatic disease is a contraindication. (Anectine: Scoline).
sympathomimetics Drugs that have an action similar to adrenaline, and act on both alpha- and beta-adrenoceptors. More selective compounds, such as salbutamol, act on the beta,-adrenoceptors in the lungs and have an increased bronchodilator action. They also relax uterine muscle, and are used to prevent premature labour. Others such as dobutamine and dopamine have a more selective action on the beta,- receptors in the heart, and are referred to as isotropic sympathorninictics.
tacalcitol A vitamin D. derivative used in the treatment of psoriasis as an ointment containing 4 pg/g of the drug. It is applied sparingly once daily at night, and continued as required. Not more than 2 treatments over 8 weeks per year. (Curatoderm).
tacrolimusV A macrolide derivative with marked immunosuppressant properties. It is used in liver and kidney transplantation, and appears to act by suppressing T-cell activation. It may also inhibit the formation of cytotoxic lymphocytes that are concerned
Tel
with graft rejection. See Drug Data Sheet for details of dose and extensive side-effects including neurotoxicity and hypertrophic cirdiomyopathy. (Prograf).
talc A form of magnesium silicate, widely used as a skin dusting powder. It has also been used as a lubricant for surgeons’ gloves, but it may cause a talc granuloma if any reaches the tissues during operation, and glove powders prepared from starch are preferred.
tarnoxifen An oestrogen-receptor
antagonist used mainly in breast cancer, particularly when metastases are present. Dose: 20 mg daily. It is usually well tolerated, but side-effects include hot flushes, dizziness, rash, by
. percalcaciiiia and
an increase in tumour pain. Unlike other oestrogen-antagonists, tamoxifen has no androgenic properties. It has also been used in sonic forms of anovulatory sterility. (Nolvadex). See page 122 an(] Table 8.
tamsulosinV A relatively selective alpha adrenoceptor antagonist. It lowers the tone of bladder and prostatic smooth muscle, and is used in benign prostatic hyperplasia. Dose: 400 mg daily after breakfast with a glass of water. The first dose should be taken in bed to avoid postural hypotension. Other side-effects include palpitations and dizziness and hypotension. (Floniax). See page 164 and Table 28.
tazabactam An inhibitor of betalactamases. It is used in association with some antibiotics to extend the activity against resistant beta - lactamase - producing bacteria. Tazacin is a mixed product containing piperacillin and tazabactam.
tazarotene A retinoid used as an aqueous gel (0.05-0.1 %) in psoriasis. Applied once daily to the affected skin area only. (Zorac).
teicoplanin An antibiotic that acts by interfering with bacterial cell wall development. It has a wide range of activity, but is used mainly in the treatment of severe staphylococcal infections that fail to respond to other antibiotics.
Dose: loo mg initially by i.v. injection, lollowed by 200 nig as a single daily dose, which may be given by i.m. injection. Double doses in severe infections. Side-effects include gastrointestinal disturbances, dizziness, fever and rash (Targocid).

temazepam A mild hypnotic of the nitrazepain type, but with a shorter duration of action. It is useful in the insomnia of the elderly, arid is also of value as a preoperative anxiolytic agent.
Dose: 10-20 ing. Daytime drowsiness is less common than with related drugs. See page 152 and Table 22.
ternocillin A penicillin-type of antibiotic active chiefly against infections due to penicillinase-producing Gram-negative bacteria, with the notable exception of pseudomonas. It is used in respiratory and urinary tract infections due to susceptible organisms.
Dose: 2-4 g daily by injection, but in simple urinary tract infections a single daily dose off g may be effective. (Temopen).
I Tet
inie’tion. (Bricarly]). See page 118 and Table 6.
terfenadine An antihistamine with reduced sedative and other side-effects on the central nervous system. It is effective in hay fever, allergic skin conditions and other allergic states.
Dose: 120 mg daily. Best given alone, as combined use with imidazole antifungal agents or with many other drugs may cause severe reactions. See Drug Data Sheet for details. (Triludan). See page 110 and Table 2.
terlipressin A synthetic form of vasopressin, used to control bleeding from oesophageal varices.
Dose: 1-2 nig i.v., repeated if required 4-6-hourly, (Gl)j)ressin).
tenoxicam A non-steroidal anti-inflamma- tory drug (NSAID) with the actions, uses and side-effects of that group.
Dose: 20 mg as a single daily dose. (Mobillex). See page 105 arid Table 29.
terazocin An alpha-receptor antagonist used in hypertension. It produces a peripheral vasodilation by a blockade of post-synaptic alpha-receptors.
Dose: I mg tit night initially, slowly increase(] up to 10 mg as a single daily dose. Small initial doses are necessary to avoid episodes of syncope during early treatment. Reduced doses are indicated when terazocin is given with thiazide diuretics or other anti-hypertensive agents. Side-effects are dizziness, drowsiness and peripheral oedema. It is also used in benign prostatic hypertrophy.
(I lvpovase). See page 149 arld’I'able 21.
testosterone The androgenic hormone of the testes, which controls the development of the male sex characteristics. It is used mainly in the treatment of hypogonadism
by the i.m. injection of depot preparations    97 of long-acting testosterone derivatives. Subcutaneous implantation of testosterone pellets (200-600 mg) has been used in the treatment of metastatic breast cancer. Side-effects are weight gain, virilism and hypercalcaemia.
tetanus vaccines Preparations of tetanus toxin that has been modified by treatment with formaldehyde. They stimulate the formation of protective antitoxin. They are used for active immunization against tetanus, but for young children a combined diphtheria, pertussis and tetanus vaccine is usually preferred.
terbinafine An antifungal agent that acts by interfering with the synthesis of ergosterol, an essential constituent of fungal cell membranes. It is used in fungal infections of the skin and nails, but it is not effective in pityriasis (Tines versicolor).
Dose: 250 mg daily for 2-6 weeks; half-doses in severe liver or renal impairment. Side-effects are rash, loss of appetite and gastrointestinal disturbances. (I.arnisil).
terbutaline A selective beta-adrenoceptor stimulant and bronchodilator, with the actions, uses and side-effects of salbutamol.
Dose: 7.5-15 mg orally daily, by aerosol inhalation; 250-500 jig by &L, i.rn. or i.v.
tetrabenazine A drug of the haloperidal type, but used mainly in the treatment of Huntington’s chorea and similar disorders of movement.
Dose: 75-200  ing daily. It may cause drowsiness and extra-pyramidal side-effects.
tetracosactrin A synthetic form of corticotrophin.
Dose: it single injection of 250 pg as a test of adrenal cortex function, as after such an injection the level of cortisol in the plasma should rise within an hour. It is also given as single I mg i.m. depot preparation in
the 5-hour diagnostic test. (Synacthen; Synacthen Depot).

tetracycline A wide-range antibiotic very similar both chemically and pharmacologically to chlortetracycline, oxytetracycline, clomocycline, and related compounds referred to generically as the tetracyclines. They all have the same type of action against both Gram-positive and Gram-negative organisms, but exhibit certain differences in solubility, absorption and excretion. These differences are reflected in the different doses, as tetracycline is given in doses of 250 mg 4 times a day, whereas with doxycycline a single daily dose of 100 ing may be adequate. Long treatment with a tetracycline may lead to gastrointestinal disturbance owing to changes in the normal bacterial population of the intestinal tract. The use of the tetracyclines has declined with the emergence of bacterial resistance. They also have the disadvantage of being taken up and staining growing teeth and bone, and so should riot be given to children or used during pregnancy. The absorption of the tetracyclines is reduced by antacids, calcium, iron and milk. See page 249 art(] Table 35.
theophylline A bronchodilator used in the less severe forms of asthma and respiratory disease. (In severe and acute asthma arninophylline is usually preferred.) Dose: 180 nig- I g daily. Side-effects include gastrointestinal disturbances and tachycardia, but are less frequent when long-acting preparations of theophyllinc are used. Such preparations are also useful in the control of nocturnal asthma. These long-acting forms differ, and a patient stabilized on one preparation should not lie transferred to another without good cause. See page 118 and’I'able 6.
thiabendazole An anthelinintic effective against a wide range of intestinal parasites. Also useful in creeping eruption.
Dose: 2.3 iiig/kg daily, up to a maximum of 3 g daily for 2-3 days. Side-effects knore marked in the elderly) are nausea, diarrhoea, rash, yellow vision and
jaundice. Mintezol).
thiamine (vitamin Bj Essential for carbohydrate metabolism, but is used clinically in cases of deficiency, as in beri-beri, or when the diet is restricted. Also of value in the neuritis of pregnancy and alcoholism. Dose: 2-5 nig daily; therapeutic 25- 100 ing daily, in severe deficiency 200-300 nig
doily. severe allergic reactions have followed the i.v. injection of thiamine in high-dose mixed vitamin products such as Pabrinex. Anaphylactic treatment must be immediately available. (Benerva).
thiazides See diuretics and page 150.
thioguanine A cytotoxic agent similar in action and uses to nicrcaptopurine, and used to induce and maintain remission in acute myeloblastic and other leukaernias. Dose: 2 ing/kg, daily. Side-effects are bone marrow depression, nausea and jaundice. Manvis). See page 122 and Table 8.
thiopentone A widely used, short-acting I.V. anaesthetic.
Dose: 100-150 nig initially, repeated at intervals of 10-15 seconds as required. Solutions should be freshly prepared, and great care must be taken to avoid extrava&ttion, a-, the solution is very alkaline and may cause tissue necrosis. Infra-arterial injection is even more dangerous.
(Iniraval Sodium).
a’
thiorid zine A tranquillizing drug related  to chlorpromazine, and used in similar doses for the treatment of schizophrenia and other psychiatric conditions. Unlike most related drugs, it has no antiemetic properties.
Dose: 30-600 ing daily. (Melleril). See page 168 and Table 30.
thiotepa A cytotoxic agent used mainly by infra-cavity instillation, particularly for recurrent superficial tumours of the bladder.
Dose: 15-60 mg dissolved in 60 nil of water, instilled weekly for 4 weeks,
followed by a rest period of 2 weeks before lorther doses are given.
thymoxamine A peripheral vasodilator that is useful in vasospastri and other peripheral ischaemic conditions.
Dose: 160-2,10iiig daily. Side-effects such as headache and facial flushing are usually mild and transient. Treatment should be discontinued after 2 weeks if there is tit) response. (Opilon). See 111oxisylyte.
thyroxine The active constituent of thyroid, but now prepared synthetically. Thyroxine is a powerful metabolic stimulant, specific in neonatal hypothyroidism (cretinism) and myxcredenia. In the former, early diagnosis

sodium picosulphate A synthetic laxative similar to bisacodyl, but with a slower action.
Dose: 5-15 rug at night.
sodium stibogluconate An organic antimony drug use([ in the treatment of visceral leishmaniasis or kala-azar.
Dose: 20 ruglkg daily by i.m. or i.v. injection for 30 days. Side-effects include anorexia, vomiting, cough and sub-sternal pain. (Pentostain).
I sta
given by i.v. injection as a 50% solution to promote diuresis and to reduce cerebral oedema.
sotalol A beta-adrenergic blocking agent used ill the treatment of hypertension, angina, cardiac arrhythmias and thyrotoxicosis. Dose: 120 nig initially, increased as required; maintenance, 160-600 ing daily. For prophylaxis after infarction, 320 mg daily. In acute cardiac arrhythmias, 20-60 mg by slow i.v. injection under ECG control. Care is necessary in heart block, asthma, hepatic and renal impairment. (BetaCardone; Sotacor). See pages 114 & 148, and Tables 4 & 2 1.
sodium tetradecyl sulphate A venous-occluding agent used in the injection sclerotherapy of varicose veins.
Dose: 0.5-1 nil at any one site, followed by compression bandaging for sonic weeks. The local irritant action of the drug brings about an occlusive venous fibrosis at the injection site. Extra-vascular injection may cause necrosis. Care is necessary in allergic subjects.
sodium thisulphate A 50% solution is given by i.v. injection in cyanide poisoning. See sodium nitrite and kelocyanor.
sodium valproate An anticonvulsant
effective in most forms of epilepsy.
Dose: 600 mg daily in adults initially, increased if required up to a maximum of 2.5 g daily. It may also be given by slow i.v. injection in doses of,100-800ing, followed by similar doses given by i.v. infusion. Liver function tests before and during treatment are essential. Severe side-effects such as vomiting, drowsiness or jaundice require withdrawal of the drug, as does spontaneous bleeding or bruising.
(Epilim). See page 136 and Table 15.
somatropin A form of human growth hormone obtained by biosynthesis. It is used to stimulate growth in hormone-deficient young patients whilst the epiphyses are still open.
Dose: 0.07 units/kg daily by i.m. or s.c. injection. Subcutaneous injection sites should be varied. (Genotropin; Hurrialrope; Norditropin; Salzen).
spectinomycin An antibiotic used in the treatment of penicillin-resistant gonorrhoea.
Dose: 2-4g by deep Lin. injection. Side-effects include nausea, dizziness and tirlicaria. (Trobicin).
spironolactone An aldosterone antagonist which potentiates the action of thiazide and loop diuretics in sonic resistant conditions. It is of value in the oedema of liver cirrhosis, as well as in the nephrotic syndrome and congestive heart failure. Dose: 100 ing daily up to a maximum dose of 400 mg daily. Side-effects include drowsiness, gastrointestinal disturbances, gynacconiastia and an increased sensitivity to warfarin. The combined use of potassium-sparing diuretics or potassium supplements is contraindicated.
(Aldacione; Spiroctan).
SSRls See selective serotonin re-uptake inhibitors.
stanozolol An anabolic steroid with actions and uses similar to those of nandrolone. Dose: 5 ing daily. It also has fibrinolytic properties, and is used in lipoderinatosclerosis (a complication of deep-vein sclerosis), and in some forms of vasculitis. It may also be of sonic value in hereditary angioneurotic oedema and in the relief of itching due to biliary obstruction. Also used in some aplastic anaemias, 2.5-10 ing daily. Sonic androgenic side-effects may Occur, bill are usually mild and reversible Oil stopping treatment. (Stroniba).
93
sorbitol A saccharide that after absorption is converted in the liver almost entirely to laevulose. It has been used as a sugar-substitute in diabetes, and it is sometimes
starch Carbohydrate granules obtained from maize, rice, wheat or potato. Widely used as absorbent dusting powder.

stavudineV An antiviral agent that inhibits the enzyme reverse transcriptase, and so indirectly blocks the synthesis of viral DNA. It is used in HIV infections resistant to or not responding to zidovudine. Dose: 00 ing daily, I hour before food. Side-effects include malaise, peripheral neuropathy and pancreatitis. (Zerit). See page 144 and *['able 19.
sterculia A natural gum that swells in water to a gelatinous mass. It is used as a bulk laxative as when taken with plenty of water it increases faecal volume and promotes peristalsis. It is also used in diverticulitis and irritable bowel syndrome, and as an appetite suppressant. Dose: 5-10g daily but not at night. (Normacol).
Sul
Dose-. I g daily by deep i.m. injection. Its use requires care. as it k both ntotnxir and nephro(oxic, especially in full doses and in renal impairment. Measurement of the plasma concentration QfbErCplU1llV0ll P. advisable during treatment. Cutaneous sensitization has followed contact of the drug trill the skin.
sucralfate An aluminium sucrose sulphate use,] in the treatment ofpeptic ulcer. It is not an antacid, but forms a barrier over the ulcer that is resistant to peptic attack and so promotes healing.
Dose: 4g daily for at least 4 weeks. Antacids should not be taken immediately before or after sucralfate. (Antepsin). See page 162.
94
stilboestrol A synthetic oestrogen with the actions and uses of oestradiol.
Dose: 0.1-0.5 mg daily for menopausal symptoms, but it is now prescribed less frequently. Dose in breast cancer, 10-20 mg daily; in prostatic carcinoma, 3 mg daily or more, although fosfestrol is often preferred. Side-effects include nausea, fluid retention, thrombosis, impotence and gynacconlastia.
streptokinase Ali enzyme preparation obtained from cultures of haemolytic streptococci. It has fibrinolytic properties, and is of value in deep vein thrombosis, pulmonary embolism, myocardial infarction and other conditions requiring fibrinolytic therapy.
Dose: by i.v. infusion, 250000 units or more initially, followed by maintenance doses of 100000 units hourly for up to 72 hours. For myocardial infarction
1 5(10000 units over l hour. Side-effects are fever, rash, haemorrhage and allergic reactions. (Kabikinaw; Streptase).
sulconazole A synthetic antifungal agent similar in actions and uses to miconazole. Applied as a 1% cream twice daily. (Exelderin).
sulfadoxine A long-acting sulphonamide, with the general antibacterial action of the group. It has been used in the treatment of leprosy.
Dose: I-1.3f; weekly. In association with pyrimethainine, it is used in the treatment of malaria, but the use of such mixed products requires great care, as severe, sometimes fatal side-effects have occurred. It is no longer used for malaria prophylaxis. (Fansidar).
sulfametopyrazine A very long-acting sulphonamide used mainly in chronic bronchitis and urinary tract infections. Dose: 2 g once it week. Side-effects and toxic reactions, although mainly those of the sulphonamides generally, may be linked with the slow excretion of the drug. (Kelfizine).
streptokinase- streptodornase A mixture of enzymes obtained from cultures of haemolytic streptococci. It brings about the dissolution of blood clots and the liquefaction of purulent exudates, anti is used as a solution to clean foul wounds, pressure sores and ulcers. (Varidase).
streptomycin The first of the amino-glycoside antibiotics, but now used mainly as part of the multi-drug treatment of tuberculosis.
sulindaC A non-steroidal anti-inflammatory analgesic agent (NSAID) with actions, uses and side-effects similar to naproxen. It is of value in the pain and inflammation of rheumatoid disease and acute gout. Dose: 200-400 ing daily with food. It may cause gastrointestinal disturbance and occasional bleeding. (Clinoril). See
page 165 and Table 29.
sulphadiazine one of the more active and less toxic sulphonamides. It is used mainly in the treatment of severe conditions such as meningococcal meningitis.

Dose: (, 9 g daily by deep i.m. injection or i.v. infusion for 2 days, followed by 2 g or more orally daily. Dose in the prevention of rheumatic fever I g daily. Side-
effects are nausea, rash and blood dyscrasias.
sulphadimidine One of the least toxic of the sulphonamides, now used mainly in urinary infections.
Dose: 2 g initially, with maintenance of 1. - 4 g daily orally. Side-effects include nausea, drug fever, rash and leucopenia.
sulphamethoxazole A sulphonamide present with trimethaprim in co-trinioxazole.
sulphasalazine A sulphonamide derivative that is taken up selectively by the connective tissues of the intestines. It is used in the treatment and maintenance of remission in ulcerative colitis and Crohn’s disease.
Dose: 4-8g daily initially; maintenance, 1.5-2 g daily. 11 is also given as a 3 g enema and as 500 mg suppositories. Occasionally given in rheumatoid arthritis in doses of 03-3 g daily. Side-effects include nausea, rash, drug fever and blood dyscrasia. If blood dyscrasia is suspected, a blood count should be done and the drug withdrawn. (Salazopyrin). See niesalazine, olsalazine, page 172 and’I'able 32.
sulphathiazole One of the early sulphonamides, and survives in a few mixed products.
sulphinpyrazone. A uricosuric agent with the selective action of increasing the excretion of uric acid, hence used in the treatment of chronic gout and hyperuricaemia. Dose: 100-200 mginitially with food, increased according to the plasma uric acid levels up to 60(1-800 nag daily, with tower maintenance doses according to need and response. Side-effects are nausea, abdominal pain and rash. Care is necessary in peptic ulcer and renal impairment, and blood counts are necessary during, treatment. Salicylates antagonize the action of the drug. (Anturan). See
page 1.10 and Table 17.
sulphonamides A group of drugs that have an antibacterial action by preventing the uptake and use of folic acid. They are thus bacteriostatic and not bactericidal in action. The use of the sulphonamides ides has
declined, and they are now used mainly in urinary tract infections due to sulphonamide-sensitive bacteria. The side-effects of the sulphonamides include nausea, dyspepsia, diarrhoea and allergic reactions. Bone marrow depression may occur if treatment is prolonged. The uncommon Stevens-Johnson syndrome is a very serious reaction. See sulphadiazine ind co-trinioxazole.
sulphonylureas A group of orally active drugs represented by chlorpropamide that promote the release of insulin from the beta-cells of the pancreas. They are used in mild diabetes not controlled by diet, and in the late-onset diabetes of middle age, but they are not suitable for the treatment of juvenile diabetes. The presence of some still-functioning beta-cells is essential for sulphonylurea activity. Side-effects include weight gain, rash, fever and jaundice. During illness and pregnancy, insulin treatment should replace sulphonylurea therapy. See page 131 and Table 13.
sulphide An antipsychotic drug with a central action on dopaminereceptors. It is used in the treatment of acute and chronic schizophrenia, as in low doses it increases awareness in apathetic and withdrawn patients, and in larger doses controls the active forms of the illness.
Dose: 400-800 mg daily: in severe conditions up to 2.4 g daily. The side-effects are similar to those of chlorpromazine. (Dolmatil; Sulparex; Sulpitil). See
page 168 and Table 30.
sumatriptan A serotonin agonist used in
i lie treatment of acute migraine. (It is not suitable for prophylaxis.)
Dose: 50-100 mg orally as soon as possible after onset of an attack, but a second dose should not be given for the same attack, but may be repeated once if migraine symptoms recur. In severe migraine an(] cluster headache 6 mg by S.C. injection, but not more than 12 nig in 24 hours. (Pre-filled syringes and an auto-injector are available.) If should not be given until 24 hours after other antimigraine treatment, or any other drug that influences the re-uptake of serotonin. Side-effects include tingling and tightness in any part of the body, and an angina-like chest pain that may be severe. (I migran). See page 154 and Table 23.