Posts Tagged ‘anticoagulants’

pyrazinamide An antituberculous drug that is active against the intracellular and dividing forms of M. tuberculosis, and is most effective in the early stages of die disease. It penetrates the meninges, and is Of value in tuberculous meningitis. Dose: in combination with other drugs, 2 g 3 times a week. Side-effects include fever, jaundice and hepatotoxicity. Liver function tests should be carried out before and during treatment. (Zinamide). See page 170 and Table 31.
pyridostigmine An anticholinesterase similar to neostigmine. It has a slower and more prolonged action that is useful in some cases of myasthenia graves. Dose: 300–720 mg daily. The side-effect, are similar to those of neostigmine, but may be less severe. (Mestinon).
pyridoxine (vitamin B,) This vitamin plays an essential part in protein metabolism. Apart from its use in deficiency states, which are uncommon, pyridoxine has been used in isoniazid-induced neuropathy. Dose: 2,5-150 rig daily; in some sideroblastic anaemias, up to 400 rig daily.
pyrimethamine Ail antimalarial drug used with dapsone as Maloprint or with sulphadoxine as Fansidar in the prophylaxis of malaria. The use of these mixed products is not without risk, as they may have severe and sometimes fatal side-effects.
quetiapine A new ‘atypical’ antischizophrenic drug of the clozapine type with a high affinity for serotonin (5-HT) and dopamine DI and D2 receptors.
Dose: in schizophrenia, initilal doses of 25 rig twice a day, slowly increased up to 150-750 mg daily. Initial doses may cause hypotension. Care is necessary in cardiovascular disease. Side-effects include drowsiness and dizziness. The routine blood monitoring necessary with dozapine is not required. (Sew,jud). See page 108 and Table 30.
quinagolide A dopamine agonise used in
the treatment of hyperprolactinaemia.
I Rai
Dose: 25 jig at bedtime initially, increased at 3-day intervals to 75-100µg daily. Side-effects include hypotension, and the blood pressure should be monitored after a
change of dose. (Norprolac). See brornocriptine and cabergoline.
tquinalbarbitone sodium A short-acting barbiturate. Used in mild insoninia and anxiety states.
Dose: 50-100mg. (Seconal).
quinapril Ail ACE inhibitor with the actions, use and side-effects of that group of drugs. Dose: in hypertension, 5-10 mg daily initially, slowly increased to 20-40 mg as a single daily dose. (Accupro). See ACE inhibitors, page 148, and Table 21.
quinidine Ail alkaloid of cinchona, similar to quinine, that has been used in the preventive treatment of ventricular arrhydimias, but beta-blocking agents are now preferred.
Dose: (after a test dose of 200 rig) 200-400 mg 3-4 times a day. Side-effects are tinnitus, vertigo and confusion. Treatment should be stopped if response does not occur within 10 days.
quinine The principal alkaloid of cinchona bark. It was once used extensively in the treatment of malignant tertian malaria, and recently it has regained some of its value with the emergence of chloroquineresistant malaria.
Dose: 1.8 g daily for 7 days; in serious infections it is given by i.v. infusion in doses of 10 rig/kg for up to 3 doses, followed by oral therapy. Side-effects include tinnitus, nausea, rash and visual disturbances. See specialist literature.
rattitroxedV A selective enzyme inhibitor used in the palliative treatment of advanced colorectal cancer. It has advantages over fluorouracil, as treatment is less complicated and the incidence of leucopenia, mucositosis and other side-effects is less severe. Dose: 3 mg/ni! by slow i.v. injection, repeated at intervals of 3 weeks if tolerated. Blood counts and liver function tests are necessary. (Tomudex). See page 122 and Table 8.

ramipril An ACE inhibitor with the general properties of such drugs.
Dose: in mild hypertension, L25 ing daily, increased at intervals of 1-2 weeks tip to a maximum of 10 mg, given with food and adequate fluid. Prophylactic dose after myocardial infarction 5-10 ing daily. (Tritace). See page 148 and Table 21.
ranitidine A powerful and selective histamine H, antagonist of the cimetidine type, but with a longer action. It reduces the volume, acidity and pepsin content of gastric secretion, and is of value in peptic ulcer, reflux oesophagitis and similar conditions.
Dose: 300 nig daily for at least 4 weeks, maintenance (loses, 150 mg daily. In severe conditions, 50nig by i.ma or slow i.v. injection repeated at intervals of 6-8 hours. In suspected gastric ulcer, malignancy should be excluded before treatment is commenced. (Zantac). See cimetidine, page [62 and Table 27.
ranitidine bismuth citrateV It has the general action of ranitidine, but it also has a protective effect on the ulcerated area, and inhibits digestive action of pepsin on the gastric mucosa. It is given with amoxycillin and clarithromycin to promotethe elimination of Helicobacter pylori.
Dose: 800 mg daily. (Pylorid). See page 162.
razoxane A cytotoxic agent occasionally used in the treatment of leukaemias. Dose: 150-500 nighril daily for 3-5 clays, under laboratory control. Side electsare nausea and myleosuppression. (Razoxin).
Rif
Dose: by aerosol inhalation; 0.5-1 mg
( 1 -2 puffs), repeated up to 3 times a day. Side-effects include tremor an(] mild tachycardia. (Bronchodil). See page 118 and Table 6.
resorcinol A keratolytic agent used mainly as an ointment in acne, and as a hair lotion for removing dandruff. Myxoedema has been reported following the prolonged use of resorcin preparations.
reteplase A thrombolytic agent used in acute myocardial infarction.
Dose: 10 units by slow i.v. injection within 2 hours of the infarction. A second dose may be given 36 hours later, together with heparin, to reduce the risk of rethrombosis. Side-effects are arrhythmias an(] gastrointestinal bleeding. (Rapilysin). See page 156 and Table 24.
retinol See vitamin A.
riboflavine (vitamin B2) Part of the vitamin B complex, it is concerned with the oxidation of carbohydrates and amino acids. A deficiency causes several characteristic effects, including angular stomatitis and’burning feet’.
Dose: 1-10 mg in deficiency states associated with restricted diets or poor absorption.
rifabutinV A derivative of rifampicin used in the multi-drug treatment of pulmonary tuberculosis.
Dose: 150-450 mg daily. It is also used I,i,)I,Iiyl.iclically.ig,.iiii.%t opportunistic infection with Mycobacterium avium. (Mycobutin). See page 170 and Table 31.
reboxetineV An inhibitor of noradrenaline reuptake used in depression.
Dose: 4 ing twice a day, half-doses for the elderly. Side-effects are those of other antidepressants. Care in renal/hepatic impairment. (Fdronax). See page 128 and Table 11.
remifentanilV An analgesic of the fentanyl type used as an adjunct in doses of
0.5-1 fig/kg/min for the induction of anaesthesia. Its use reduces the amount of general anaesthetic required. (Ultiva).
reproterol A bronchodilator with the actions, uses and side-effects of salbutamol.
rifampicin An antibiotic now considered to be the first-choice drug in the treatment of tuberculosis, and given together with isoniazid and pyrazinamide.
Dose: 600 mg before breakfast. It is also used with dapsone and clofazimine in the initial treatment of severe leprosy. Combined therapy is also used in brucellosis, legionnaire’s disease and severe staphylococcal infections. Side-effects include gastrointestinal disturbances, rash, an influenza-likesyndrorne and hepatic reactions. Jaundice is a contraindication. Patients should be warned that rifampicin gives a red colour to the urine, sputum and tears, and to soft contact lenses. It may decrease the response to oral anticoagulants such as warfarin, and the failure of oral contraceptives has also been reported in patients receiving rifampicin. (Rifadin; Itiniaciane), See page 170 and Table 31.
riluzoleV A new drug used only for motor neurone disease (a myotrophic lateral sclerosis-ALS). ALS is a degenerative disease and may be due to the local accumulation of the neurotransmitter glutamate, with consequent neurone damage. Riluzole slows down the progressive nature of the disease, and improves the response to mechanical ventilation. Dose: 100 mg daily. See specialist liteiawre. Milutek).
rimiterol A bronchodilator similar in actions and uses to salbutamol, but with a shorter duration of effect. It is largely free from any cardiac stimulant activity. Rimiterol is used mainly for the relief of bronchospasm in bronchitis, bronchial asthma and similar conditions.
Dose: by aerosol inhalation, 200-600 pg ( 1-3 puffs) up to a maximum of 8 puffs daily. (Pulmadil). See page 118 and Table 6.
I sac
Lip to 350 pg/min. or 10 mg by i.m. injection and continued until the contractions have ceased; then orally up to 120 mg daily to prevent relapse. Side-effects include tremor, nausea and hyj)otension. (Yutopar).
rocuronlurn A muscle relaxant similar in actions and uses to vercuronium. Dose: 600 pg/kg initially, followed by 300-600 pglkglhrly as required.
(lisincron).
ropiniroleV A potent and selective
dopamine D,-receptor agonist used in the treatment of Parkinson’s disease, a condition basically due to a deficiency of dopamine in the brain. It is well absorbed orally, and reaches the central nervous system where it functions as dopamine replacement therapy.
Dose: first week 750µg daily with food; second week 13 ing daily, third week 2.25 mg daily, then 3 ing daily. Ropinirole may be given as monotherapy or together with levodopa. Side-effects are somnolence, hypotension, leg oedema and gastrointestinal disturbances. Caution in severe cardiac, renal and hepatic conditions. (Requip). See page 160 and Table 26.
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Ringer’s solution An electrolyte replacement solution containing sodium
chloride, potassium chloride and calcium chloride.
risperidone An antischizophrenic agent of the clozapine type, with a selective affinity for serotonin and dopamine receptors. It may relieve the aggressive symptoms of
schizophrenia as well as the negative aspects such as apathy.
Dose: 6-10 mg. daily. Side-effects are headache, dizziness and agitation. Agranulocytosis is uncommon, and the close blood monitoring required with clozapine is not necessary. (Risperdal). See page 168 and Table 30.
ritonavirV An HIV-protease inhibitor used in HIV infections in association with a nucleoside analogue.
Dose: 1.2 g daily with food. (Norvir). See page 144 and Table 19.
ritodrine A beta,-adrenoceptor stimulant with a relaxant action on uterine muscle, used to inhibit premature labour.
Dose: 5opg/niin initially by i.v. infusion (avoiding fluid overload), slowly increased
ropivacaine A local anaesthetic with the actions and uses of lignocaine. (Naropin).
Rose bengal A (lye used as eye drops (M) to stain and detect damaged conjunctival cells, and in the diagnosis of dry eye.
rubella vaccine A suspension of a live, attenuated strain of rubella virus. It is used for active immunization in girls of 10-14 years, and in seronegative women of childbearing age.
Dose: 0.5 nil by s.c. injection. It is contraindicated in pregnancy, and pregnancy within 3 months of vaccination should be avoided. A combined rneasles/mUnipsit-111101,a (MMR) vaccine is now recommended for all children.
saccharin A synthetic sweetening agent widely used as a non-calorific substitute for sugar. Has been used by rapid i.v. injection (2.5 g in 4 ml) for arm-tongue circulation time.

itraconazole An orally active antifungal agent used in the treatment of vulvovaginal candidiasis, pityriasis and tinea infections. Dose: 200 mg twice a day for the I -day treatment of vulvovaginal infections; 200 nig daily for 7 days in pityriasis, 100nig daily for 15-30 days in tinea infections. Side-effects are nausea and abdominal pain. Liver disease is a contraindication. Combined treatment with astiniazole or ierfenadine should be avoided. (Sporonox).
ivermeclin A fungal derivative effective against the microfilaria causing ‘river blindness. It does not kill either the adult worms or their larvae, but prevents the growth of the latter, and treatment must be continued until the adult worms die out. Dose: 150. (Mectizan).
kanamycin An aminoglycoside antibiotic now used mainly in gentamicin-resistant infections.
Dose: I g daily by i.m. injection; 15-30 rng/ kg daily by i.v. infusion. (Kannasyn).
kaolin Aluminium silicate. Used as an absorbent in diarrhoea, colitis, food poisoning, etc., often as Kaolin and Morphine Mixture.
Dose: 10-20 nil as required. It is also used externally as Kaolin Poultice to relieve the pain of sprains, etc.
kelocyanor A specific antidote for cyanide poisoning. See dicobalt edetate.
ketamine A short-acting i.v. anaesthetic with analgesic properties.
Dose: 1-2 mg/kg i.v. over I minute, repeated as required; 4-10 nig/kg by deep Lin. injection. It is used mainly in paediatric anaesthesia, and its analgesic action is also of value in neurodiagnostic procedures, and other painful investigations. Hallucinations may occur during the recovery period. (Ketalar).
ketoconazole A broad-spectrum, orally active antifungal agent. It is of value in systemic and deep mycoses, and in severe and resistant mycoses of the gastrointestinal tract and the vagina. It is also effective in severe mycoses of the skin, but it should be used only for superficial fungal infections not responding to other treatment.
Dose: 200 mg daily with ft)od, up to a maximum of 4tH) mg daily. Side-effects include nausea, rash and pruritus. It may cause hepatitis; liver function tests may be necessary if given for more than 14 (lays. (Ki-zoral).
ketoprofen A non-steroidal anti-inflammatory and analgesic agent of the ibuprofen type. It is of value in rheumatoid arthritis, gout, spondylitis and related conditions, and in dysmenorrhoea.
Dose: 100-200 mg daily with food;
100 Ing by suppository at night, 50-100 mg by deep Lin. injection 4-hourly. Care is necessary in peptic ulcer and hepatic disease. May increase the action of anticoagulants and other drugs bound to plasma protein. (AlrheLiniat; OrUdis; Orivail). See page 165 and Table 29.
ketorolacV A potent analgesic used for the short-term reliefofacute postoperative pain.
Dose: tO mg 4-6-hourly up to 40 ing daily for not more than 7 days; dose by deep i.m. or slow i.v. injection. 10 mg initially, then 30 mg 4-6-hourly up to 90 mg daily for not more than 2 days. Side-effects are numerous; see data sheet. (Toradol). Also used as eye drops (0.51)/0 to reduce pain and inflammation after ocular surgery. (Acular).
keftotifen An antihistamine that may also have some of the properties ofsodium cromoglycate. It is used in the prophylactic treatment of asthma.
Dose: 4 mg daily with food, continued lor ,sine weeks. Other anti-asthmatic therapy should be continued for at least 2 weeks to ensure maintenance of control. Side-
effects include sedation and dryness of the mouth. (Zadi(en). See page 110 and Table 2.
Kogenate A recombinant form of the human blood Factor Vill, given i.v, as replacement therapy in the treatment of haemophilia A.

labetalol A beta - adrenocepior blocking agent with some alpha-blocking activity. Like related drugs, labetalol is indicated in all types of hypertension, including that following myocardial infarction.
Dose: 200 mg daily initially, with food, slowly increased up to a maximum of 2.4 g daily; by i.v. injection 50 mg repeated as required; for the rapid control of the hypertension of pregnancy 20-160 ing by i.v. infusion hourly. It should be used with care in asthma and heart block. Side-effects include weakness, nausea, bradycardia and postural hypotension. Liver damage has been reported. (Trandate). See page 148 and `fable 21.
lacidipine A calcium channel blocking agent with the actions and uses of nifedipine. In hypertension it is given as a single morning dose of 2 nig with food, increased up to 6 mg as the response develops over 3-4 weeks. Half doses in hepatic impairment and the elderly. Early chest pain is an indication that the drug should be withdrawn. (Motens). See page 148 and Table 21.
lactilol A semi-synthetic sugar that is not absorbed orally, and acts as an osmotic laxative by retaining water in the intestinal tract. Also inhibits ammonia-producing organisms, and is of value in hepatic encephalopathy.
Dose: as laxative 20 mg daily mixed with food, together with 2 glasses of water. Dose in hepatic encephalopathy, 500700 inglkl; daily.
lactulose An osmotic laxative. See lactilol.
laevulose Fructose. A sugar sometimes given i.v. as an alternative to glucose.
in the brain by inhibiting the influx of sodium ions. It is used both as primary treatment and as additional therapy (often with sodium valproate) for seizures not fully controlled by other drugs.
Dose: 25 ing daily initially for 14 (lays, slowly rising to 100-200 nig daily. See data sheet for details of combined therapy. (Limictal). See page 136 and Table 15.
lanolin See wool fat.
lansoprazole An inhibitor of the enzyme 11, K’-AI’Pase (the proton pump) used in the treatment of peptic ulcer.
Dose: 30 ing daily for 4-8 weeks. (Luton). See orneprazole, page 162 and Table 27.
Lasser’s paste A stiffointment containing zinc oxide, starch and white soft paraffin with 2% salicylic acid. Used as protective in eczema.
latanoprost A prostaglandin alpha-analogue used once daily as eye drops (0.00596) in glaucoma. It increases the outflow of the aqueous humour, whereas other agents reduce its secretion. Continued use may cause changes in eye colour. (Xalantan). See page 138.
lenograstimV A recombinant form of the granulocyte colony stimulating factor (G–GSF) that governs the production of neutrophils. It is used as supplementary treatment in cancer chemotherapy to stimulate neutrophil production in drug induced neutropenia.
Dose: under expert supervision by s.,:. injection, in daily doses of 150 pg/m2 Until neutrophil count is satisfactory. Also used i.v. after hone narrow transplantation. (Granocyte). See filgrastim and rinolgraniostirn. See page 122 and Table 8.
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lamivudine An antiviral agent that acts like zidovudine by inhibiting reverse transcriptase, an enzyme essential for DNA formation and viral replication. It is used in HIV infections.
Dose: 300 ing daily, preferably with food, and combined with a protease inhibitor. (Epivir). See page 144 and Table 19.
lamotrigine\” An anti-epileptic that alleviates the imbalance of neurotransmitters
letrozoleV A non-steroid inhibitor of aromatase, the enzyme that controls the conversion of testosterone to oestrogen. It acts as an anti-oestrogen and is used in advanced breast cancer that has not responded to tamoxifen or similar therapy. Dose: 2.5 mg once daily. Side-effects include musculoskeletal pain, arthralgia and hot flushes. (Fernara). See page 122 and Table 8.
leucovorin See folinic acid.

leuprorelin A synthetic hormone that indiandrogen and oestrogen production by inhibiting gonadotrophin activity. It is used in endonietriosis and
advanced prostatic cancer.
Dose: 3.73 rig by s.c. or i.m. injection every 4 weeks. Side-effects are impotence, flushing and local irritation. There may be an initial and temporary increase in pain. The injection site should be varied. (Prostap SR). See buserelin, goserelin, page 122 and Table 8.
levamisole A single-dose (150 mg) anthelmintic of value in round worm (Ascaris). It is also effective against hookworm (Ancylostoma and Necator). Dose: 2.5-5 mg1kg daily for 2-5 days.
levobunolol A beta-blocker used as eye drops 0.5% in glaucoma. (Betagaii). See carteolol.
levocabastine An antihistamine used as drops (0.05% twice a day in the symptomatic treatment of seasonal allergic conjunctivitis and rhinitis. (Livostin).
levodopa An amino acid that is converted to dopamine in the body. It is used in the treatment of Parkinson’s disease, which is associated with a reduction in brain
dopamine levels due to degeneration in the substantia nigra, thus causing an imbalance in the neurohorinonal system of the brain. Levodopa is essentially replacement therapy, but as an oral dose is metabolized to some extent in the peripheral circulation It is often given with art enzyme inhibitor such as benserazide or carbidopa. Combined therapy permits a larger dose of active drug to reach the cerebral tissues, and at the same time reduces some of the general side-effects of levodopa.
Dose: 125-300 mg initially, increased according to need and response. Side-effects include nausea and cardiovascular disturbances, but psychiatric side- effects may be (lose limiting. Close angle glaucoma is a contraindication. See page 160 and ‘I able 26.
lignocaine (lidocaine) A local anaesthetic widely used for infiltration anaesthesia as a 0.25-0.5% solution, usually with adrenaline, as well as for epidural, caudal and nerve block anaesthesia. It is the local anaesthetic present in many dental cartridges. A 2-4% solution is used for
surface anaesthesia, and a 2% gel is used to relieve the pain and discomfort of catheterization, but rapid absorption may cause side-effects. Lignocaine is also the drug of choice in the control of ventricular tachycardia following myocardial infarction. Dose: 100 mg as an i.v. bolus, followed by a dose of 4 mg/min by i.v. infusion for 3(t minutes, with subsequent doses of 2 inghnin. Side-effects include confusion, convulsions, bradycardia and I p hy oten- sion. (Xylocard). Emla cream contains lignocaine and prilocaine. It is used for local anaesthesia and to relieve the pain associated with injections, especially in children. It is applied under an occlusive dressing 1-2 hours before the injection.
lindane A pesticide used as a 1% solution for the treatment of scabies.
liothyronine (tri-iodothyronine) A thyroid hormone with it rapid action, an(] probably a precursor of thyroxine. It is given orally in severe hypothyroid conditions when a rapid action is necessary, and by injection in hypothyroid coma. Dose: 20-60 fag daily; 5-20 pg i.v.
0 ertroxin).
liquid paraffin A lubricant laxative and faecal softener.
Dose: la-mj, nil. Its extensive use is now
discouraged, as it may cause granulomatous reactions and reduce the absorption of fat-soluble vitamins.
lisinopril An ACE inhibitor similar to enalapril, but with it longer action that permits the use of a single daily dose. Dose: in the treatment of hypertension, (loses of 2.5 rig daily initially, slowly increased according to response up to 10-20 mg daily, occasionally up to 40 mg. In patients receiving diuretics, such Ilierapy should be withdrawn for 2-3 days before lisinopril therapy and resumed later if necessary. (Carace; Zesiril). See
page 148 and Table 21.
lithium carbonate Lithium carbonate and itratearc used for their mood-regulating action in the prophylaxis and treatment of mania and depressive illness, but the mode of action is not known. The therapeutic/ toxic range of lithium is very narrow, and continuous control of the plasma/lithium level is essential to avoid the many side-effects and hazards of therapy.

chymotrypsin A proteolytic enzyme of the pancreas used in ophthalmology to facilitate intracapsular lens extraction. (Zonulysin).
cidofovir An antiviral agent used in cytomegalovirus retinitis resistant to ganciclivir.
Dose: 5 nig/kg by i.v. infusion every 2 weeks. (Vistide). See page 144 and ‘['able 19.
cilastatin See imipenem.
chlorthalidone A diuretic similar in action and uses to bendrofluazide, but with a longer duration of activity that permits a single morning dose. It is also useful in diabetes insipidus.
Dose: as diuretic 50-100 mg daily or on .illci nale days; in hypertension 25-50 mg; up to 350 mg daily in diabetes insipidus. (I lygrolon ). See page 148 and Table 21.
cholecalciferol See vitamin D.
cholestyramine An exchange resin that binds with bile acids in the intestines and prevents their absorption. Such acids are essential for cholesterol synthesis, and resin-binding leads indirectly to a lowering of plasma cholesterol levels.
Dose: in hyperlipidaemia: 12-24 g daily, wilh water; similar doses in the diarrhoea of Crohn's disease. It is also used in doses of 4-8 g daily to relieve the pruritus
associated with biliary obstruction. Side-effects are rash and gastrointestinal disturbances. Cholestyramine and related agents may interfere with the absorption of anticoagulants and other drugs. iQuestrari). See page 146 and Table 20.
choline theophyllinate A bronchodilator ,ilh the actions, uses and side-effects of anlinophyllille.
Dose: 400-1600 mg daily, after food. (C'I ioledyl). See page 118 and Table 6.
chorionic gonadotrophin A gonad-stimulating hormone prepared from the Urine of pregnancy. It has bten used in anovulalory sterility, metropathia haernorrhagica, habitual abortion and undescended testis.
cilazapril A long-acting ACE inhibitor with the actions, uses and side-effects of that group of drugs.
Dose: in essential hypertension 1 mg daily initially, increased up to 5 mg daily according to need. In renovascular hypertension 0.25-0.5 mg daily. (Vascace). See page 148 and'I'able 21.
cimitidine A selective histamine H, receptor antagonist. Unlike ordinary antihistamines, it inhibits gastric secretion, and is used in the treatment of peptic ulcer and other conditions of gastric hyperacidity. Dose: 8(m) nig daily for at least 4 weeks, doubled in severe conditions. Dose by i.m. or slow i.v. injection 200 mg 4-4-hourly. The dose should be reduce(] in renal impairment. The drug may increase the effects of oral anticoagulants and phenytoi ii. Side-effects include diarrhoea, rash and dizziness. It has some anti-androgen activity, and gynaecomastia is all occasional side-effect with high closes. (Dysparneu Tagarnet; Zila). See page 162 and Table 27.
cinchor-aine A local anaesthetic used as
ointment 1% in haemorrhoids and
pruritus. (Nupercainal).
cinnarizine An antihistamine, chiefly of value in Wniere’s disease, although it is also used in travel sickness and in peripheral vascular disorders.
Dose: 45-90 ing daily. Drowsiness and gastrointestinal disturbances are side-effects. (Stugeron).
cinoxacin A quinolone derivative with actions, uses and side-effects similar to i hose of nalidixic acid.

Dose: in urinary tract infections,  daily; prophylaxis 500mg daily. Contraindicated in severe renal impairment. (Cinobac).
ciprofbrate A blood-lipid lowering agent used in diet-resistant hyperlipidaemia as a single daily dose of 100-200 mg. (Modalim). See page 146 and Table 20.
ciprofloxacin A quinolone with a wide range of activity against both Gram-positive and Gram-negative bacteria, including Pseudomonas and Fronts. It is effective in many systemic infections, as well as in bone, joint and urinary infections, and in gonorrhoea, but is indicated mainly in infections resistant to other antibacterial agents. Dose: 500 mg -1.5 g daily for 5-7 days; in gonorrhoea, a single dose of 250 mg is given. In severe infections 200-400 mg daily by i.v, infusion for 5-7 days. Side-effects include nausea, dizziness, headache, rash and pruritus. plasma levels of theophylline may be increased and should be closely controlled. Care is necessary in convulsive disorders. (Ciproxin).
cisapride A gastrointestinal stimulant given to relieve gastro-oesophageal reflex and delayed gastric emptying.
Dose: .10-40 mg daily before meals, and at night, for some weeks. Side-effects are abdominal pain and diarrhoea. Drugs that delay the excretion of cisapride and may cause arrhythmias are erythromycin and clarithromycin-antigungal agents of the ketoconazole type should also be avoided. Unlike metoclopramide, it has no central antiemetic properties. (Alimix; Prepulsin).
cisatracurium A non-depolarizing neuromuscular blocking agent with an intermediate duration of activity. It is used as a muscle- relaxing adjunct in general anaesthesia, and to facilitate tracheal ininhation. (Nimbly).
cisplatin A cytotoxic agent containing platinum bound in an organic complex. The action is linked with drug-induced changes in DNA structure that inhibit cell development. It is used in ovarian, testicular and other solid tumours, and in resistant malignant conditions, sometimes in association with other antineoplastic agents.
Dose: by i.v.  for 5 days a month, or 15-120 mgIm’ monthly. Blood tests are essential
throughout treatment. Side-effects, which may be severe, include nausea, vomiting, and oto-, nephro- anti
citalopram A selective serotoninreuptake inhibitor (SSRI).
Dose: used in depression in single daily doses of 20 ing, increased up to 40 mg daily. Treatment for at least 6 months necessary to avoid relapse. (Cipraruil). See page 128 and Table 11.
cladribine A new agent used by specialists in hairy cell leukaemia. (Leustat).
clarithronlycin A macrolide antibiotic similar to erythromycin, but with better absorption and reduced gastrointestinal side-effects.
Dose: 250 rug twice a day for 7 days, doubled in severe infections. Care in hepatic an([ renal impairment. It may potentiate the effects of warfarin and digoxin. Should not be given with astemizole or terfenadine (risk of arrhythinias). (Khricid).
clavulanic acid An inhibitor of betalactanlase. Many penicillin-resistant organisms contain that enzyme in the cell wall, which inactivates the penicillin before it call enter the cell and exert its bacterial action. clavulanic acid inhibits such enzyme activity, and so facilitates the penetration of the antibiotic into the bacterial cell. It is used in association with amoxycillin as coamoxiclav (Augmentin) and with ticarcillin as Tinientin, in the treatment of infections due to amoxycillin-resistant bacteria.
clemastine An antihistamine used in allergic rhinitis, urticaria and allergic derniatoses.
Dose: I mg twice a day. In common with other antihistamines, it may cause drowsiness, and anticholinergic side-effects such as dryness of the mouth. H avegil). See
page 110 and Table 2.
clindamycin An antibiotic used mainly in staphylococcal bone and joint infections not responding to other drugs. It is also useful in anaerobic abdominal infections.  A serious side-effect is a potentially fatal pseudomernbranous colitis, and the drug should be withdrawn immediately if diarrhoea occurs. See vancomycin and nietronidazole.