Posts Tagged ‘anticonvulsant’

Generic Name
Clonidine (KLAH-nih-dene)
Brand Names
Catapres-TTS-2
Catapres-TTS-1    Catapres-TTS-3
Type of Drug
Alpha receptor stimulant.
Prescribed For
High blood pressure, including hypertensive emergency (diastolic blood pressure over 120); also used for excess sweating, childhood growth delay, attention-deficit hyperactivity disorder (ADHD), Tourette’s syndrome, restless leg syndrome, schizophrenic psychosis, migraine, ulcerative colitis, painful or difficult menstruation, hot flashes related to menopause, diagnosis of pheochromocytoma (adrenal-gland tumor), kidney poisoning associated with cyclosporine, diabetic diarrhea, smoking cessation, methadone and opiate detoxification, withdrawal from alcohol and benzodiazepines such as Valium, nerve pain following herpes attack, and allergic reactions in the presence of asthma triggered by external sources.
General Information
Clonidine stimulates nerve endings in the brain called alphaadrenergic receptors. It reduces blood pressure by dilating (widening) blood vessels. Clonidine works quickly, decreasing blood pressure within 1 hour. The other uses of clonidine relate to its stimulation of alpha receptors in the body.
Cautions and Warnings
Do not take clonidine if you are allergic or sensitive to any of its ingredients.
People who have had a stroke or recent heart attack or who have cardiac insufficiency or chronic kidney failure should avoid taking clonidine.
Some people develop a tolerance of their clonidine dosage. If this happens, your blood pressure may increase and your doctor may prescribe a higher dose.
Never stop taking clonidine without your doctor’s knowledge. If you abruptly stop taking clonidine, you may experience an unusual increase in blood pressure accompanied by agitation, headache, nervousness, and severe reactions, possibly death. Restarting clonidine therapy or taking another antihypertensive can reverse these effects.
Clonidine may cause degeneration of the    See your eye doctor for regular GheCk Ups lfiyou are taking this drug.
); you require surgery, your doctor will continue your clonidine therapy until about 4 hours before surgery and resume it as soon as possible afterward.
People who develop skin sensitivity (symptoms include rash, itching, and swelling) to Catapres-TTS, the transdermal patch form of clonidine, may experience the same reactions with oral clonidine.
Possible Side Effects
Tablets
♦    Most common: dry mouth, drowsiness, dizziness, constipation, and sedation.
♦    Common: headache and fatigue. These effects tend to diminish within 4-6 weeks.
•    Less common: appetite loss, swelling or pain in the glands of the throat, nausea, vomiting, weight gain, blood-sugar elevation, breast pain or enlargement, worsening of congestive heart failure, heart palpitations, rapid heartbeat, painful blood-vessel spasm, abnormal heart rhythms, electrocardiogram changes, feeling unwell, changes in dream patterns, nightmares, difficulty sleeping, hallucinations, delirium, anxiety, depression, nervousness, restlessness, rash, hives, thinning or loss of scalp hair, difficult or painful urination, nighttime urination, retaining urine, decrease or loss of sex drive, weakness, muscle or joint pain, leg cramps, increased alcohol sensitivity, dryness and burning of the eyes, dry nose, loss of color, and fever.
Transdermal Patch
✓    Most common: dry mouth and drowsiness.
✓    Less common: constipation, nausea, changes in sense of taste, dry throat, fatigue, headache, lethargy, changes in sleep patterns, nervousness, dizziness, impotence, sexual difficulties, and mild skin reactions including itching, swelling, contact dermatitis, discoloration, burning, peeling, throbbing, white patches, and generalized rash. Rashes of the face and tongue have also occurred but cannot be specifically tied to transdermal clonidine.
Drug Interactions
•    Combining clonidine and a beta-adrenergic blocker may increase the severity of a drug-withdrawal reaction and rebound high MW pressure. This reaction may be very serious.
•    Combining verapamil and clonidine may lead to very low blood pressure and atrioventricular (AV) block (abnormality in heartbeat patterns). This reaction may be very serious.
O    Avoid alcohol, barbiturates, and sedatives because they increase the depressive effects of clonidine.
•    Tricyclic and other antidepressants, appetite suppressants, estrogens, stimulants, indomethacin and other nonsteroidal anti-inflammatory drugs (NSAIDs), and prazosin may counteract the effects of clonidine.
•    clonidine may reduce the therapeutic effects of levadopa +
carbidopa.
Food Interactions
The tablets are best taken on an empty stomach but may be taken with food if they upset your stomach.
Usual Dose
Tablets
Adult: high blood pressure-100 mcg twice a day to start; may be raised by 100 mcg a day until maximum control is achieved. Take no more than 2400 mcg a day. Other uses-100-goo mcg a day, or up to 0.8 mcg per lb. of body weight in divided doses. Seniors should start with a lower dose and increase more slowly.
Child: 50-400 mcg orally twice a day.
Transdermal Patch
Adult: 100 mcg delivered daily from a patch applied once every 7 days. Up to two 300-mcg patches may be needed to control blood pressure. Transdermal dosage exceeding 600 mcg a day has not been shown to increase effectiveness.
Child: not recommended.
Overdosage
Symptoms of overdose are slow heartbeat, central- nervous-system depression, very slow breathing, low body temperature, pinpoint pupils, seizures, lethargy, agitation, irritability, nausea, vomiting, abnormal heart rhythms, mild increases in blood pressure followed by a rapid drop in blood pressure, dizziness, weakness, loss of reflexes, and vomiting. Victims should be taken to a hospital emergency room immediately. ALWAYS bring the prescription bottle or container.
Special Information
Gk’3t1161)e causes drowsiness in about 1/3 of people who take it. Be extremely careful while driving or performing any task that requires concentration. This effect is prominent during the first few weeks of clonidine therapy and then tends to decrease.
Do not take over-the-counter cough and cold medications unless directed by your doctor.
Call your doctor it you become depressed or have vivid dreams or nightmares while taking clonidine, or if you develop swelling in your feet or legs, paleness or coldness in your fingertips or toes, or any persistent or bothersome side effect.
Apply the transdermal patch to a hairless area of skin such as the upper arm or torso. Use a different skin site each time. If the patch becomes loose, apply the supplied adhesive directly over it. If the patch falls off before 7 days are up, apply a new one. Do not remove the patch while bathing.
If you forget a dose of oral clonidine, take it as soon as possible and then go back to your regular schedule. If you miss 2 or more consecutive doses, consult your doctor; missed doses may cause blood pressure increases and severe adverse effects. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Clonidine passes into the fetal bloodstream. Animal studies show that clonidine may damage the fetus in doses as low as 1/3 the maximum dose. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
Clonidine passes into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors are more susceptible to the effects of this drug and should begin with lower doses.

Generic Name
Clopidogrel (kloe-PID-oe-grel) nQ
Brand Name  Plavix
Type lul Drug Antiplatelet.
Prescribed For
Heart attack and stroke prevention; also used for blood thinning after placement of a vascular stent.
General Information
Artery-clogging blood clots are often the cause of heart attacks and strokes. clopidogrel reduces the risk of both by helping prevent blood-clot formation. This drug thins the blood by making platelets—the cells that aggregate to form clots—less “sticky.” It starts working in as little as 2 hours after taking a single tablet. The drug’s blood-thinning effect lasts until inactivated platelets are replaced by the body. Studies suggest that clopidogrel is more effective than aspirin in preventing heart attack and stroke in people at risk. People taking clopidogrel after scent surgery usually take it for a relatively short period. Those taking it to prevent a heart attack or stroke must take it for life.
Cautions and Warnings
Do not take clopidogrel if you are allergic or sensitive to any of its ingredients or to ticlopidine, a related antiplatelet. These drugs can rarely cause a rapid drop in white-blood-cell count.
People with bleeding ulcers, brain hemorrhages, or other bleeding problems should use clopidogrel with caution.
Thrombotic thrombocytopenic purpura (TTP) is a rare but serious complication of clopidogrel, sometimes reported after less than 2 weeks of treatment. See your doctor right away if you develop a sudden fever, unusual bruising, nosebleeds, bleeding gums, or any other unusual symptoms. TTP reduces your platelet count, interfering with blood clotting, and affects white-blood-cell count.
People with liver problems should use clopidogrel with caution.
Possible Side Effects
✓    Most common: rash and other skin problems.
✓    Common: chest pain, accidents, flu-like symptoms, pain, headache, dizziness, abdominal pain, upset stomach, joint pain, back pain, black-and-blue marks, and respiratory infection.
✓    Less common: tiredness, Swollen arms or legs, high blood pressure, diarrhea, nausea, bleeding, nosebleeds, breathing difficulties, runny nose, coughing, bronchitis, high blood cholesterol, urinary infection, and depression.
✓    Rare: bleeding in the brain and stomach ulcer. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    Clopidogrel may interfere with the body’s ability to break down fluvastatin, nonsteroidal anti-inflammatory drugs (NSAIDs), phenytoin, tamoxifen, tolbutamide, torsamide, and
warfann.
•    Combining clopidogrel and NSAIDs may increase blood loss and bleeding in the stomach and intestines.
•    Do not combine clopidogrel and other antiplatelet drugs or
the anticoagulant (blood thinner) warfarin unless you are
under your doctor’s direct supervision. This interaction may
prevent normal blood clotting and lead to severe bleeding
problems.
Food Interactions
Clopidogrel may be taken without regard to food or meals.
Usual Dose
Adult: 75 mg a day.
Overdosage
Little is known about the effects of clopidogrel overdose aside from reduced blood clotting. Overdose victims should be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Minor cuts may take longer to stop bleeding during treatment with clopidogrel. If you are having surgery, make sure your doctor knows you are taking clopidogrel. You may have to stop taking the drug I week before surgery.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the forgotten dose and continue with your regular schedule.
Special Populations
Pregnancy/Breast-feeding: The safety of using clopidogrel during pregnancy is not known. Other antiplatelet drugs, tike aspirin, are not used during pregnancy due to their possible effects on Mrjlher and fetus. When this drug is considered crucial by your doctor, its benefits must be carefully weighed against its risks.
Clopidogrel may pass into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors may take this drug without special precaution.

Generic Name
Clorazepate (klor-AZ-uh-pate) 99
Brand Names
Gen-Xene    Tranxene-SD
Tranxene    Tranxene T-Tab
Type of Drug
Benzodiazepine sedative.
Prescribed For
Anxiety, tension, fatigue, and agitation; symptoms of acute alcohol withdrawal; partial seizures; also prescribed for irritable bowel syndrome and panic attacks.
General Information
Clorazepate dipotassium is a benzodiazepine. Benzodiazepines directly affect the brain. They can relax you and make you more tranquil or sleepier, or they can slow nervous system transmissions in such a way as to act as an anticonvulsant. Many doctors prefer benzodiazepines to other drugs that can be used to similar effect because they tend to be safer, have fewer side effects, and usually work as well, if not better.
Cautions and Warnings
Do not take clorazepate if you are allergic or sensitive to any of its ingredients or to another benzodiazepine drug, including clonazepam.
Clorazepate can aggravate narrow-angle glaucoma, but you may take it if you have open-angle glaucoma and are receiving therapy for it.
Other conditions in which clorazepate should be avoided are: severe depression, severe lung disease, sleep apnea (intermittent cessation of breathing during sleep), liver disease, drunkenness, and kidney diseaap_, to inOn of these conditions, the qq)NSSvve effects of clorazepate may be enhanced or could be detrimental to your overall condition.
Clorazepate should not be taken by psychotic patients because it is not effective for them and can trigger unusual excitement, stimulation, and rage.
Clorazepate is not intended to be used for more than 3-4 months at a time. Your doctor should reassess your condition before continuing your prescription beyond that time.
Clorazepate may be addictive. It should be used with caution in people with a history of drug dependence.
Drug withdrawal may develop if you stop taking it after as few as 4 weeks of regular use but is more likely after longer use. It may start with anxiety and progress to tingling in the hands or feet, sensitivity to bright light, sleep disturbances, cramps, tremors, muscle tension or twitching, poor concentration, flu-like symptoms, fatigue, appetite loss, sweating, and changes in mental state. Your dosage should always be reduced gradually to prevent drug withdrawal symptoms.
Possible Side Effects
Weakness and confusion may occur, especially in seniors and in those who are more sickly.
✓    Most common: mild drowsiness during the first few days of therapy.
✓    Less common: confusion, depression, lethargy, disorientation, headache, inactivity, slurred speech, stupor, dizziness, tremors, constipation, dry mouth, nausea, inability to control urination, sexual difficulties, irregular menstrual cycle, changes in heart rhythm, low blood pressure, fluid retention, blurred or double vision, itching, rash, hiccups, nervousness, inability to fall asleep, and occasional liver and kidney dysfunction. If you have any of these symptoms, stop taking the medicine and contact your doctor immediately.
✓    Rare: Rare side effects can affect your heart, stomach and intestines, urinary tract, blood, muscles and joints. Contact your doctor if you experience any side effects not listed above.
Drug Interactions
•    Clorazepate is a central-nervous-system depressant. Don’t mix it with alcohol, other sedatives, narcotics, barbiturates, monoamine oxidase inhibitor and other antidepressants, and antihistamines. Taking Clorazepate with these drugs may result in excessive depression, tiredness, sleepiness, breathing difficulties, or related symptoms.
•    Smoking may reduce clorazepate’s effectiveness by in-
creasing the rate at which it is broken down by the body.
•    Clorazepate’s effects may be prolonged when it is mixed with cimetidine, contraceptive drugs, disulfiram, fluoxetine, isoniazid, ketoconazole, metoprolol, probenecid, propoxyphene, propranolol, rifampin, or valproic acid. Theophylline may reduce clorazepate’s sedative effects.
•    If you take antacids, separate them from your clorazepate dose by at least 1 hour to prevent them from interfering with the absorption of clorazepate into the bloodstream.
•    Clorazepate may increase blood levels of digoxin and the chances of digoxin toxicity.
•    The effect of levodopa + carbidopa may be decreased if it is taken together with clorazepate.
•    Combining clorazepate with phenytoin may increase phenytoin blood concentrations and the chances of phenytoin toxicity.
Food Interactions
Clorazepate is best taken on an empty stomach, but it may be taken with food if it upsets your stomach.
Usual Dose
Immediate-Release
Adult and Child (age 9 and over): 15-60 mg daily. The average dose is 30 mg in divided quantities, but dosage must be adjusted to individual response for maximum effect. Maximum recommended daily dose is 90 mg. For treatment of anxiety, clorazepate may be taken as a single dose at bedtime.
Child (under age 9): not recommended.
Sustained-Release
Adult: The sustained-release form of clorazepate may be given as a single dose, either 11.25 or 22.5 mg, once every 24 hours. Sustained-release tablets are not recommended for the initial dosage.
Child: not recommended.
Overdosage
Symptoms of overdose are confusion, sleepiness, poor coordination, lack of response to pain such as a pin prick, loss of reflexes, shallow breathing, low blood pressure, and coma. The victim should be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Clorazepate can cause tiredness, drowsiness, inability to concentrate, or similar symptoms. Be careful if you are driving, operating machinery, or performing other activities that require concentration.
People taking clorazepate for more than 3 or 4 months at a time may develop drug withdrawal reactions if the medication is stopped suddenly (see “Cautions and Warnings”). Do not stop taking clorazepate or increase or decrease your dosage without first consulting your doctor.
If you forget a dose of clorazepate, 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. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Clorazepate may cause birth defects if taken during the first 3 months of pregnancy. Avoid this drug if you are or might be pregnant.
Clorazepate may pass into breast milk. Nursing mothers who must take clorazepate should use infant formula.
Seniors: Seniors, especially those with liver or kidney disease, are more sensitive to the effects of clorazepate and generally require smaller doses to achieve the same effect.

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.
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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.
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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.

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.

metronidazole An orally effective drug used in trichomoniasis, amoebiasis and in infections due to anaerobic bacteria. Dose: in bacterial and trichomonal vaginitis, 600 ing daily for 7 days, or as a single dose of 2g. In acute intestinal arnoebiasis, 2.4 g daily for 3 days. In surgical prophylaxis, and in the prophylaxis and treatment of infections caused by colonic anaerobic pathogens such as Racteriodes ftagilis, as well as infections by some Gram-negative organisms. metronidazole is given in doses of 1.2 g daily orally, or as I g suppositories. In severe infections, doses of 1.5 g are given daily by i.v. infusion, replaced by oral therapy as soon as possible. In Giardia laniblia infections, 2g daily for 3 days; 600 mg daily for 3 days in ulcerative gingivitis. Metronidazole is also valuable in pseudomembranous colitis (see clindamycin). Side-effects are mainly gastrointestinal disturbances and can be reduced by giving the close with food, but epileptiforni seizures may occur with high doses, and the drug may cause a disulfiraintype reaction if alcohol is taken. (Flagyl). Metronidazole is also used as a 0.750% gel (Metrogel; Rosex) in rosacea and as Anabact ail(] Metrotop to deodorize malodorous tumours.
metyrapone Ail inhibitor of glucocorticoid synthesis.
Dose: 750 mg 4-hourly for 6 doses as a Icst of anterior pituitary function, as following such doses the plasma concentration ofcorticosteroids falls. The fall stimulates the production of steroid pre cursors by the adrenal glands, and a rise in the urinary excretion of such precursors is indicative of an active anterior pituitary gland. Metyrapone is also used in resistant oedema due to ail increased production of aldosterone, and in the symptomatic con-I rol 01′ Cushing ’s syndrome. Nausea and vomiting are side-effects. (Metopirone).
mexiletine Ail anti-arrhythmic drug that is useful in the control of ventricular arrhythmias, particularly those following myocardial infarction, or when lignocaine is ineffective.
Dose: as a loading dose, 100-250 mg i.v. under I-I’C6 control, followed by i.v. infusion of a 0.1% solution until a further 250 mg have been given. Oral therapy: a
loading dose of 400 mg, followed by 600mgI g daily. Side-effects are nausea, drowsiness, confusion and blurred vision. Contraindicated in bradycardia, hypotension, and hepatic or renal failure. (Mexitil).
mianserin An antidepressant of the amitriptyline type, with reduced anticholinergic and cardiovascular side-effects, and well tolerated by the elderly. It is of value in all types of depression, including those associated with anxiety. Dose: 30-90 mg daily, which may be taken as a single close at night, although higher doses have been given. Care is necessary in recent myocardial infarction and heart block. Severe hepatic disease is a contraindication. Side-effects include aplastic anaemia,and blood counts during treatment are essential. The drug should be withdrawn if any signs of infection occur. See page 128 and Table 11.
miconazole An antiftingal agent of value in systemic and alimentary fungal infections. Dose: I g daily orally, or up to 1.8 g daily by i.v. infusion, and the duration of treatment largely depends on the response.
Pessaries of 100 mg and a cream (2%) are used for vaginal candidiasis. A gel is available for oral fungal infections. Side-effects after systemic use include nausea, pruritus and rash. Miconazole may potentiate the action of anticoagulant, anticonvulsant
and hypoglycaemic drugs, requiring an adjustment of close. Combined use with asternizole, terfenadine and cisapride should be avoided. (Daktarin).
midazolam A sedative of the benzodiazepine group, used mainly for sedation before and during gastroscopy, endoscopy and other investigations. The action is rapid, and an anterograde amnesia often follows.
Dose: by slow i.v. injection 70pglkg tip it) a total d2.5-7 mg. premedication, 2.5-5 mg i.m. For the induction of anaesthesia in poor-risk patients, 104-300pg1kg by slow i.v. injection. Side-effects after i.v. injection include respiratory depression and, occasionally, severe hypotension. (Hypnovel).
mifepristone An antiprogestational agent used as ail alternative to surgery for the termination of pregnancy, up to 63 days’ gestation.
Dose: a single oral dose of 600 mg. For hospital use only. (Nfifegyne).

milrinone An inhibitor of phosphodiesterase, an enzyme concerned in cardiac function. It has a digoxin-like effect on the myocardium, and may be effective in congestive heart failure not responding to other drugs.
Dose: by i.v. infusion as an initial dose of 50 pg1kg, with maintenance doses of 0.5 pg/min up to a total of 1.13 nig/kg over 24 hours. Side-effects are anginal pain, hypotension and headache. (Primacor). See enoximone, page 141 and Table 18.
minocycline A tetracycline with the general properties of that group of antibiotics, with the advantage of being useful in meningococcal prophylaxis. The absorption of minocycline is little influenced by food. It is also suitable for use when the renal function is impaired, as accumulation of the drug is unlikely.
Dose: 200 mg daily. In acne treatment half-dose should be given for 0 weeks. The side-effects are those of the tetracyclines generally, although monocychne may also cause dizziness, vertigo and rash. (Minocin).
minoxidil A vasodilator used in severe hypotension resistant to other drugs. Dose: 5-50 mg daily. Side-effects are Wright gain, breast tenderness and tachycardia. Almost all patients experience hyper1richosis, and should be warned accordingly. (Loniten). A 2% solution is used as a lotion in the local treatment of male-pattern baldness. (Regaine).
mirtazapine An alpha,-receptor antagonist. It is used in depression as it increases central noradrenergic and serotenergic neurotransmission. rot ransmission.
Dose: 15-45 nag at night for 4-6 months. Side-effects are weight gain and drowsiness. (Zispin).
misoprostol A synthetic prostaglandin with an inhibitory action on gastric secretion. It is used in the control of peptic ulcer, and in the prophylaxis of ulcers induced by non-steroidal anti-inflaniniatory drugs (NSAIDs).
Dose: 800pg daily with food, with a last dose at night, and continued for some weeks. Dose in prophylaxis, 400-800µg daily. Side-effects are usually transient, and
.    include diarrhoea, nausea and abdominal pain. (Cytotec). See page 162. Contraindicated in pregnancy.
mitobronitol A cytotoxic agent used mainly in chronic myeloid leukaemia.
Dose: 250 nag daily until the white cell count falls, then 125 mg daily according to need. May cause gastrointestinal disturbance, alopecia and bone marrow depression. Haematological control is necessary. (Myclobromal). See page 122 and Table 8.
mitomycin A cytotoxic antibiotic used in bi cast, gastrointestinal and other cancers. Dose: 4-10 mg by i.v. infusion at intervals of I-6 weeks. Great care must tic taken to avoid extravasation. Also used in bladder cancer by the weekly instillation of a solution of 10-40 nag in 20-40 nil of water. Side-effects include bone marrow and renal damage, and lung fibrosis.
mitozanitrone A cytotoxic drug related to doxorubicin, and indicated in advanced breast cancer.
Dose: 14 nighn= once i.v., repeated after 21 days, provided the white cell and platelets counts have returned to normal. It is highly irritant, and contact of the drug wid the skin must be avoided. Side-effects are nausea, vomiting, alopecia, myelosuppression and cardiac weakness. (Novantrone). See page 122 and Table 8.
mivacurium A non-depolarizing muscle relaxant with the short action and uses of atracurium.
Dose: initial dose 70-250pg/kg i.v., followed by doses of 100µg/kg/min at intervals of 15 minutes as required. Smaller doses are given by i.v. infusion. (Mivacron).
moclobemideVA short-acting, reversible inhibitor of monoamine oxidase (MAO) for the treatment of severe depression. The older MAO-inhibitors act on both the A- and B-forms of the enzyme, and have a long and irreversible action. Moclobemide has a rapid and selective action on MAO-B, but the duration is short and fades after about 24 hours, as the drug is soots    The risks of reactions with other drugs (comnlon with old MAO-inhibitors) are correspondingly reduced.
Dose: 300 mg daily initially (after withdrawal of other therapy), slowly increased up to 600 ing daily. Side-effects are dizziness and sleep disturbances. (N-lanerix). See page 128 and Table 11.

moexepril An ACE-inhibitor.
Dose: (when given alone) 7.5 mg daily initially, increasing if required up to 30 mg daily. When given as a second-line therapy with a diuretic (which should be avoided), initial dose is 3.75 mg under supervision until the blood pressure has stabilized. Side-effects are hypotension and cough. I lyperkalaernia may occur if potassium supplements or potassium sparing diuretics are also given. (Perdix). See page 148 and Table 21.
molgramostimVA recombinant form of human granulocyte macrophage colony stimulating factor (GM–CSF). It is used in the neutropenia following cytotoxic and bone marrow transplant therapy.
Dose: 60 000-100000 units by s.c. injc, tion or i.v. infusion, under haematological control. (Leucomax). See filgrastini and lenograstini.
mometasoneVA potent corticosteroid used as 0.1% creamilotion once a day in severe eczema, psoriasis and other skin conditions not responding to other therapy. (Elocon). Also used as a nasal spray in allergic rhinitis. (Nasonex).
monoamine oxidase inhibitors Monoaniine oxidase is an enzyme concerned with the breakdown of dopamine, serotonin, noradrenaline and adrenaline. Those substances are stored in many organs of the body, including the brain, where they function as transmitters of nerve impulses. The period for which they act is very short, as they are rapidly metabolized by monoamine oxidase. An inhibition of the enzyme could permit an increase in the brain levels of such amines, and on that basis sonic monoamine oxidase inhibitors (MAOIs) have been used in the
treatment of depression. Therapy is complicated by the fact that these drugs can increase the response to pressor drugs, anaesthetics and many other agents, including the mild sympathominictics present in some cough
mixtures and decongestive nasal sprays. Even certain foods, particularly cheese, may cause a dangerous rise in blood pressure during MAO] therapy and patients should always carry the MAN warning card. Great care is necessary during combined therapy, and ideally 10-14 days should elapse after ceasing
MAGI treatment before using other potent drugs. Examples of MAOIs are isocarboxazid, phenelzine and tranylcypromine. Their use has declined as more effective antidepressants of the amitriptyline type, with fewer side-effects, have become available. See moclobemide, page 128 and Table 11.
moraeAzine A potent cardiac membrane-stabilizing agent used like lignocaine to control ventricular arrhythmias.
Dose: 600-900 mg daily initially, adjusted later according to need and response. Side-effects include dizziness, palpitations and chest pain. (Ethniozinc),
tmorphine The principal alkaloid of    71 Opium. It is widely used as a narcotic analgesic for the relief of severe pain and the associated anxiety and stress, and in shock.
Dose: in acute pain, 10 mg by injection as required; in chronic pain it may be given orally or by injection according to need in doses varying from 5-10 mg. Sonic long-acting oral forms of
morphine are available (MST Continus; Oramorph SR) designed to reduce the frequency of dosing in conditions of severe pain. Side-effects include nausea and vomiting, which can often be controlled by small doses of chlorpromazine, or a similar antiemetic.
Morphine may cause respiratory depression, and severe respiratory depression is a contraindication. The possibility of tolerance to and dependence on morphine should be kept in mind if treatment is prolonged, but in terminal Conditions is of little importance.
moxisylyte (thymoxamine) An alpha,- adrenergic blocking agent, given by intracavernous injection for the induction of erection.
Dose: 10 mg not more than 3 times a week. Side-effects are drowsiness. dizziness and flushing. (Erecnos).
moxonidine A centrally acting antihypertcjisive agent of the clonidine type. It has a greater affinity for certain receptors in the brain stem that reduce the peripheral resistance and so indirectly lowers the blood pressure.

jt34vef7mn

ethinyloestradiol A synthetic oestrogen formerly used to control menopausal symptoms and other conditions where oestrogen therapy is indicated.
Dose: 10-50 pg daily. It is present with a pi ugestogen in many oral contraceptive products. See page 264 and Table 40.
othosuximide An anticonvulsant for the treatment of petit trial epilepsy (absence seizures). May be used alone, or combined with other anticonvulsants, and it is often of value in patients not responding to other drugs.
Dose: 500 nig daily initially, gradually increased if required, to a maximum of 2 g daily. Care is necessary in renal or hepatic disease. Drowsiness, headache and gastrointestinal disorders are sonic side-effects. (F meside; Zaronlin). See page 136 and Table 15.
etidronate disodium A bisphosphonate used in Paget’s disease of bone, as it slows down the rapid turnover of bone and relieves the pain of that disease.
Dose: 5 nig/kg as a single daily dose between meals for 6 months or more. Side-effects are nausea and diarrhoea; high (loses may increase bone pain and the risks of fracture. (Didronel). Didronel PMO also contains calcium carbonate, and is used in the extended treatment of vertebral osteoporosis. See clodronate and pamidronate.
include nausea, alopecia and myelosuppression. (Vespid). See page 122 and Table 8.
eusol A chlorine antiseptic solution used as lotion, or as compress. The solution should be freshly prepared. Now less popular, thought to be irritant.
evening primrose oil See gamolenic acid.
eye drops Weak solutions of drugs for the treatment of ocular conditions. They may be antibacterial, antifungal or antiviral in action, or maybe used for non-infective conditions such as glaucoma, or for diagnosis. For routine use they are supplied sterile in multiple-application containers, but are intended for individual use only. They contain preservatives, and for home use may be used for up to one month after the container has been opened. In eye Surgery, single application products should be used. Occasionally, enough of a drug may be absorbed from eye drops to have systemic effects, and corticosteroids, if used as eye drops over a prolonged period, may cause’steroid glaucoma’. Care should be taken with contact lenses, and ideally they Should not be worn during eye drop treatment. Soft contact lenses can absorb the preservatives, which may cause irritation.
etodolac A non-steroidal anti-inflammatory agent (NSAID) of the naproxen type, with similar actions, uses and side-effects. Dose: in rheumatoid conditions, 400 mg daily. (Lodine). See page 169 and
Table 29.
etomidate A short-acting i.v. hypnotic used lor the induction of anaesthesia. It causes little cardiac disturbance or hypertension, but muscle movement and pain may
occur during injection.
Dose: 300 pg/kg by i.v. injection.
f Ilypnomidate).
etoposide A cytotoxic agent used in small-cell lung cancer and resistant testicular cancers. It is given in daily doses based on skin area for 5 days, repeated after 21 days according to response.
Dose: 120-240 nighn’ daily orally; by i.v. infusion 60-120 mghn’, and care must be taken to avoid extravasation. Side-effect-,
Factor Vila A recombinant and active form of the blood coagulation Factor VII. The treatment of haemophilia with Factors Vill and IX is complicated by the development of antibodies to those factors. Factor Vila acts as a late stage in the conversion of fibrinogen to fibrin, can function independently of Factors Vill and IX, and does not induce the formation of antibodies. It is used to control serious bleeding in haemophiliac patients and during surgery, under specialist supervision.
Dose: 60-120pg initially by i.v. injection, followed by a second dose after 2-3 hours, then 4-12-hourly as required for
2-3 weeks or more. (NovoSeven).
Factor Vill Haemophilia A is caused by a deficiency of the blood clotting agent Factor Vill, and highly purified preparations of human Factor VIII as well as recombinant forms are used as replacement therapy in doses based on the degree of deficiency of that factor. (Kogenate; Monoclate P; Recombinate).
Factor IX Haemophilia B is due to a deficiency of Factor IX, and preparations of that factor, obtained by monoclonal antibody techniques, are given i.v. in doses based on the degree of efficiency of the factor. (Monomine; Replenine).
famiclovir An antiviral agent similar to acyclovir, and used in herpes zoster (shingles) and genital herpes infections. Dose: 75 mg daily for 7 days. (Panivir). See page 144 and “fable 19.
famotidine An H,-receptor antagonist with the uses and side-effects of cinictidine, but a longer action.
Dose: in benign peptic ulcer, 40 ing at night lor,1-8 weeks; 20 mg at night for the prevention of recurrence, also used in reflex oesophagitis. In Zollinger-Ellison
syndrome, doses of 20 mg 6-hourly are given. ( Pepcid). See page 162 and] *able 27.
pain and inflammation in rheumatoid arthritis and similar conditions.
Dose: 600-900 nig daily. Like other
NSAIDs, it may cause gastrointestinal disturbance and dizziness, but the incidence of rash requires withdrawal of the drug. (Leclet-fen). See page 165;uidfable 29.
fencifibrate A plasma-lipid regulating agent of the clofibrate type, with similar uses and side-effects.
Dose: 300 ing initial]),, with food, later 200-400 mg daily according to need. (Lipantil). See page 146 and Table 20.
fenoprofen A non-steroidal anti-inflammatory and anti-rheumatic agent. It is also used as a mild analgesic in a variety of painful conditions.
Dose: 900 mg-3 g daily. Side-effects include nausea, dizziness, vertigo and rash. (Fenoprofen; Progesic). See page 165 and Table 29.
fenoterol A sympathomimetic agent with the actions, uses and side-effects of salbutamol. Dose: by oral inhalation, 100-200 [Ig (1-2 puffs) up to 4 times a day. (Berotec). See page 118 and Table 6.
Fansidar Pyriniethamine, 25 mg with sulfadoxine 500 mg. Both these antimalarial drugs block the formation of folinic acid in the malarial parasite, but the combination is more effective. Mainly used with quinine in resistant filciparum malaria. (Fansidar is no longer recommended for prophylaxis, as fatalities have followed such use.)
felodipine A calcium antagonist used in the treatment of hypertension generally (see calcium channel blocking agents). Dose: 5 nig daily initially, adjusted to maintenance doses up to to mg daily. ‘I abiets should be taken in the morning, and swallowed whole with water. No adjustment of dose necessary for elderly patients, but care is required in marked hepatic impairment. Hypotension with tachycardia may occur with susceptible patients. (Plendil). See page 148 and Table 21.
felypressin A vasopressin derivative, used as a vasoconstrictor in local anaesthetic solutions for dental use, when sympathetic pressor drugs are contraindicated.
fenbufen A non-steroidal anti-inflammatory agent (NSAID) used for the relief of
fentanyl A narcotic analgesic, used mainly in thiopentone anaesthesia to increase the response and permit a reduction in dose of thiopentone, especially in poor-risk patients. It is also used with droperidol to produce a state of neuroleptanalgesia. Dose: 50-200 pg by i.v. injection.
(Subli niaze). Also used as a patch for the relief of chronic pain. (Durogesic).
fenticonazole An antifungal used in vaginal candidiasis as pessaries of 200 mg. (Lonlexin).
ferrous sulphate, fumarate, gluconate & succinate These iron salts are used in the prophylaxis and treatment of iron-deficiency anaemias. Ferrous sulphate is the standard drug, given in doses of 600 mg daily, but it may cause gastric disturbance in some patients, and ferrous fumarate, gluconate and succinate are better tolerated alternatives. Sonic better tolerated slow-release products are available, but may be less well absorbed. Ferrous sulphate tablets are potentially dangerous for small children, and death has occurred after accidental administration. See desferrioxamine.

fexofenadine An antihistamine with the general properties of that group of drugs. It is less likely to affect the ability to drive. Dose: 120 mg once daily. See
page 110 and Table 2.
fibrinolytic agents Drugs used to break up blood clots, and so are of value in thrombosis. See alteplase, anistreplase, streptokinase and urokinase.
filgrastim A recombinant form of human granulocyte colony stimulating factor (G-CSF), one of a group of natural growth factors concerned with bone marrow activity. It stimulates the development of neutrophils, the production of which is depressed during cytotoxic therapy. The neutropenia thus caused increases the risks of infection, but the neutrophil count can be restored by filgrastim. It is used mainly in the neutropenia associated with the cytotoxic treatment of non-myeloid malignancy. Dose: 500 000 units/kg daily by s.c. injection or i.v. infusion for 14 days, or until the neutrophil count return, to normal. Double doses are given after bone marrow transplanlation.The main side-effects are musculoskeletal pain and dysuria.  See lenograstini and molgrastirn.
His, and is of value in serious ventricular tachycardia and extrasystoles.
Dose: 200-400 mg daily. May he given by slow i.v. injection in doses of 2 iiig/kg in acute conditions resistant to other therapy, and under hospital control. Care is necessary in patients with pacemakers, and in renal impairment. Dizziness and visual disturbances are side-effects. (Tainhocor). See page 141 and Table 18.
flucloxacillin A derivative of cloxacillin, that is absorbed more readily when given orally. It is used mainly in infections due to penicillinase-producing penicillin-resistant staphylococci.
Dose: I g daily before food; by injection 1 -4 g daily, but larger doses arc given in very severe infections. Side-effects are those of the penicillins generally. (Floxapen). See co-fluanipicil.
fluconazole A systemically acting synthetic antifungal agent.
Dose: in oral candidiasis, 50 ing daily for 7-14 days: in vaginal candidiasis, a single dose of 1.50 mg. Dose in systemic candidiasis and cryptococcosis, 200-400 mg daily orally or by i.v. infusion. Side-effects include nausea and abdominal discomfort. Combined treatment with
asternizole, cisapride or terfenadine should be avoided. (Dillucan).
finasteride An inhibitor of the enzyme 5-alpha reductase, and so prevents the conversion of testosterone to dihydrotestosterone, the biologically active form of the male hormone. It is used for the symptomatic relief of benign prostatic hyperplasia, as prolonged therapy promotes a reduction in the size of the prostate gland.
Dose: 5 nig daily for 6 months or more. Side-elfects are reduced libido and impotence. (Proscar). See page 164 and Table 28.
flavoxate An antispasmodic of value in urinary disorders such as dysuria, frequency and related conditions. Dose: 600 mg daily. Side-effects include dry mouth and blurred vision. Contraindicated in glaucoma and bladder obstruction. (Urispas).
flecainicle An orally active anti-arrhythmic
agent of the lignocaine type. It chiefly
influences conduction in the bundle of
flucytosine An antifungal agent used in systemic yeast infections such as candidiasis and cryptococcosis.
Dose: 100-200 mg/kg daily i.v. It may Cause sonic bone marrow depression, and sensitivity tests should be carried out before and during treatment, as resistance to the drug may limit its value. Care is necessary in renal and hepatic inipairmclit. Side-effects include nausea, diarrhoea and rash. (Alcobon).
fludarabine A fluorinated cytotoxic agent used in chronic lymphocytic leukaemia (CI.L) after other treatment has failed. Dose by i.v. infusion 25 mg/in’ for 5 days a nionth. It is generally well tolerated, but myclosuppression may occur as with related drugs. (Fludara).