Posts Tagged ‘Bradycardia’

Generic Name
Carvedilol (car-VAY-dih-lol)
Brand Names
Coreg    Coreg CR
Type of Drug  Alpha-beta-adrenergic blocker.
Prescribed For
Heart failure, high blood pressure, angina pain, and cardiomyopathy.
General Information
Carvedilol was the first beta blocker approved for heart failure. It is also the only beta blocker approved for severe heart failure.
Carvedilol blocks both the alpha- and beta-adrenergic portions of the central nervous system. This dual action reduces the amount of blood pumped with each heartbeat and also decreases the risk of tachycardia (very rapid heartbeat). Carvedilol’s beta-blocking effects begin within an hour of taking the first dose; maximum blood-pressure-lowering occurs after 1 or 2 weeks. The drug also causes blood vessels to dilate (widen), allowing the heart to pump blood more efficiently.
Cautions and Warnings
Do not take carvedilol if you are allergic or sensitive to any of its ingredients, or if you have AV block, sick sinus syndrome or severe bradycardia (slow heart rate) without the use of a pacemaker.
Carvedilol should not be taken 13y patients with bronchial disease, qQQkVaS thronic bronchitis, emphysema, or asthma.
Carvedilol therapy should not be stopped suddenly due to the risk of worsening the heart condition.
In studies, carvedilol caused mild and reversible liver injury in about 1 of every 100 people who took it. Those with severe liver disease should not take this medication. Call your doctor at once if you develop signs of liver damage (symptoms include severe itching, dark-colored urine, flu-like symptoms, appetite loss, and yellowing of the skin or whites of the eyes).
Check with your doctor about continuing carvedilol if you are to receive general anesthesia; heart function that is depressed by anesthetics can worsen if carvedilol is used at the same time.
Make sure your doctor knows if you have diabetes. Carvedilol can mask signs of low blood sugar and may increase the effects of insulin or oral antidiabetes drugs, making it more difficult to recover from the effects of low blood sugar.
Carvedilol can mask symptoms of an overactive thyroid gland. Abruptly stopping carvedilol can trigger an attack of hyperthyroidism.
Possible Side Effects
Most side effects are considered mild or moderate.
✓    Most common: dizziness, sleepiness or sleeplessness, diarrhea, abdominal pain, slow heartbeat, dizziness when rising from a sitting or lying position, swelling of the hands or feet, sore throat, breathing difficulties, tiredness, back pain, urinary infection, and viral infection.
✓    Less common: extra heartbeats; palpitations; blood-pressure changes; fainting; reduced blood supply to the arms and legs (symptoms include aches, cramps, pain, or tiredness on walking, or pain in the foot, thigh, hip, or buttocks); tingling in the hands or feet; reduced sensation; depression; nervousness; constipation; gas; liver irritation; cough; impotence and reduced sex drive in men; itching; rash; visual difficulties; ringing or buzzing in the ears; high blood cholesterol, sugar, or uric acid; anemia; weakness; hot flushes; leg cramps; dry mouth; not feeling well; sweating; and muscle ache.
✓    Rare: Rare side effects can affect the heart, mental status, the respiratory tract, the urinary tract, and the kidney. It can also cause hair loss, weight gain, high blood-triglyceride levels, low blood-platelet counts, and sugar in the urine. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    Carvedilol increases the effects of insulin and oral antidiabetes drugs. People taking this combination must monitor their blood sugar levels regularly. Call your doctor if there is any change from your normal pattern.
•    Carvedilol increases the effects of verapamil, diltiazem, and similar calcium-channel blocking drugs.
•    Monoamine oxidase inhibitor antidepressants may increase the effects of carvedilol.
•    Carvedilol increases the blood-pressure-lowering effect of clonidine. People taking this combination may need less clonidine to control their pressure.
•    Carvedilol increases the amount of digoxin in the blood by about 15%. Your digoxin dosage may have to be adjusted.
•    Cimetidine increases the amount of carvedilol absorbed into the blood by about 30%, but the importance of this interaction is not clear.
•    Rifampin reduces the amount of carvedilol in the blood by about 70%. Dosage adjustment is necessary.
•    Do not consume alcohol (including medicines that contain alcohol) within 2 hours of taking carvedilol.
Food Interactions
Take carvedilol with food to reduce the risk of dizziness or fainting.
Usual Dose
Heart Failure
Adult: 3.125 mg twice a day for 2 weeks. Dose may be doubled every 2 weeks to the highest level tolerated. Maximum daily dosage is 25 mg twice a day in people weighing less than 187 lbs., and 50 mg twice a day in people who weigh more.
High Blood Pressure and Cardlomyopathy
Adult: 6.25 mg twice a day to start, increased to 25 mg twice a day if needed.
Senior: Seniors may require smaller doses than younger adults. Child (under age 18): not recommended.
Overdosage
~3%rdose may lead to very low blood pressure (symptoms include dizziness and fainting), slow heartbeat and other cardiac symptoms, including shock and heart attack, breathing difficulties, bronchial spasm, vomiting, periods of unconsciousness, and seizures. Overdose victims must be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Carvedilol should be taken continuously. Do not stop taking it without your doctor’s knowledge, because abrupt withdrawal may cause chest pain, breathing difficulties, increased sweating, and unusually fast or irregular heartbeat. The dose should be gradually reduced over a period of about 2 weeks.
People taking carvedilol may become dizzy or faint when rising quickly from a sitting or lying position. If this happens to you, sit or lie down until you feel better. Carvedilol can also cause drowsiness, lightheadedness, or blurred vision. Be careful when driving or doing any task that requires concentration.
Contact lens wearers are more likely to experience dry eyes with carvedilol.
Swallow extended-release tablets whole; do not crush or break them.
It is best to take carvedilol at the same time each day. If you forget a dose, take it as soon as you remember. If it is within 4 hours of 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: Animal studies indicate that carvedilol passes into the fetal bloodstream and may interfere with pregnancy. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
It is not known if carvedilol passes into human breast milk, though it passes into rat breast milk. Beta-blocking drugs like carvedilol may affect babies’ hearts. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors are more likely to develop dizziness and may require reduced dosage.

gelatin A protein obtained by the hydrolysis of animal tissues. Used orally as nutrient jellies, and specially refined solutions have been used as blood volume expanders (see dextran). (Gelofusine; Haemaccel).
I Gil
nephrotoxic side-effects, and dosage requires care when renal function is inadequate, and also in elderly patients. Gentarnicin is also used locally as cream or ointment (0.3%) and as eye drops (0.3%). (Cidomicin; Genticin).
gemcitabineV A cytotoxic agent related
to cytarabine, but with increased
potency and a longer action. It blocks cancer cell replication by inhibiting DNA synthesis, and may enhance the action of other agents. It is used mainly in the palliative treatment of non-small cell lung cancer.
Dose: 1000 mg/m-’ by slow i.v. infusion over 30 minutes, once a week for 3 weeks, repeated after a rest period. It is generally well tolerated, but a common side-effect is a transient influenza-like reaction. Myelosuppression is less severe than that of related cytotoxic agents. (Gemzar). See page 122 all(] Table 8.
gentian violet See crystal violet.
gestrinone An antiprogestogen used in ctidonictriosis that acts indirectly by suppressing gonadotrophin production. Dose: 2.5 ing twice weekly oil the same day,, each week for o months. Side-effects arc fluid retention, acne and voice changes. ( Dimetriose).
gestronel A synthetic progestogen used in the treatment of breast and endonietrial carcinoma and benign prostatic hypertrophy.
Dose: 200-400 ing i.m. once a week. (Depostat).
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gemeprost A synthetic prostaglandin used to dilate the cervix uteri in first trimester abortion.
Dose: I mg, as a pessary 3 hours before surgery. Side-effects are mild uterine pain and vaginal bleeding initially, nausea and di.11 I hoc.).
gernfibrozil A plasma lipid regulating agent, with the actions and uses of hez.afibrate and clofibrate.
Dose: 901) ing-1.3 mg daily, with regular checks oil plasma lipid levels. Treatment should be withdrawn after 3 months if the response is unsatisfactory. Gernfibrozil may potentiate the action of oral anticoagulants, the dose of which should be adjusted. Side-effects include nausea, diarrhoea, abdominal pain, rash and dizziness. (Lopid). See page 146 and Table 20.
gentamicin An aminoglycoside antibiotic, active against a wide range of Gram-negative organisms, including Pseudomonas aeruginiosa, as well as against many Gram-positive bacteria, although it is not very active against anaerobic organisms. It is of great value in septicaemia and meningitis, as well as in bacterial endocarditis.
Dose: 2-3 nig/kg daily by i.m. injection or i.v. infusion. In serious or undiagnosed infections, supplementary treatment with a penicillin or metronidazole may be require(]. In common with other arninoglycosides, goitarnicin has ototoxic and
glibenclarnide An orally active hypoglycaenfic agent similar to chlorpropamide. Dose: 5-15 nig daily, according to need and response. (Daonil; Euglucon). See
page 131 and’I'able 13.
gliciazide A sulphonylurea with the actions and uses of chlorpropamide and related drugs.
Dose: 40-320 mg orally. (Diarnicron). See page 131 and Table 13.
glimepiride A sulphonylurea used in non-ill Sidi 11 -dependent (Type 11) diabetes mellitus.
Dose: 2 mg after breakfast, increased ill, to .1 mg daily. Side-effects include
transient visual disturbances, rash and urticaria. (Amaryl). See page 131 and Table 13.
glipizide A sulphonylurea, used like chlorpropamide in diabetes, but effective in much lower doses.
Dose: 5 mg initially, maintenance dose 2.5-40 nig daily. (Glibenese; Minodiab). See page 131 and Table 13.
gliquidone An oral hypoglycaemic agent similar to chlorpropamide. Effective in maturity-onset diabetes.
Dose: I5 ing initially; maintenance dose 40-60 nig daily, but up to 180 mg daily have been given. (Glurenorni). See page 131 and Table 13.

glucagon A hormone of the alpha cells of the pancreas which raises the blood sugar level by mobilizing liver glycogen. Used in acute hypoglycaemia.
Dose: 0.5-1 mg by s.c., i.m. or i.v. iniection. (GlucaGen). Give i.v. glucose if there is no response within 10 minutes.
glucocorticoids Those corticostcroids with an anti-inflammatory action similar to hydrocortisone, as distinct from the mmerailocorticoids, such as fludrocortisone, used in Addison’s disease. Thel, differ in anti-inflammatory potency, and 0.75 mg of dexamethasone is considered equivalent to 20 mg of hydrocortisone. See Table 36.
glucose Also known as dextrose. A readily absorbed carbohydrate present in many
man
sweet fruits, but obtained commercially by the hydrolysis of starch. It is given orally as a dietary supplement; in acidosis; and to raise the glycogen reserves of the liver in hepatic damage. Given by i.v. infusion as a 5% solution, or as a glucose-saline infusion in dehydration and shock, and after surgery until fluids call be taken by mouth.
glutaraldehyde A disinfectant of the formaldehyde type, but with a more rapid and powerful action. Effective against a wide range of organisms, including
viruses. Used mainly for instrument sterilization as a 2% solution. Usually activated before use by the addition of a corrosion inhibitor. Such activated solutions are stable for about 2 weeks. It is also used as a 10% solution for the removal of plantar warts.
glycerin (glycerol) A clear syrupy liquid used as a sweetening agent in mixtures and linctuses. It promotes drainage when applied to inflamed areas, and is used as a paste with magnesium sulphate for boils. It is also used as suppositories for constipation.
Dose: sometimes given orally in doses of ]- 1.5 g/kg in glaucoma and before surgery to lower the intraocular pressure.
glyceryl trinitrate A powerful but short-acting vasodilator used in the control of angina pectoris. See page 114.
Dose: 300, 500 or 600 pg tablets which should be dissolved under the tongue for a rapid response. An aerosol spray (400g per
dose), as well as long-acting tablets are also available. Tolerance may occur with prolonged therapy. Side-effects are a throbbing headache, flushing and tachycardia. It is also used locally for all extended action, particularly at night, as ointment and medicated patches. Also given by i.v. infusion to control hypertension and ischaemia during cardiovascular surgery and in left ventricular failure. Dose: 10-200 pg/min in dextrose-saline. A new use of the drug is as an ointment (0.2%) to promote healing of anal Fissure. See page 1] 4 and Table 4.
glycopyrronium A synthetic atropine-like antispasmodic used for preoperative medication.
Dose: 200-400 pg by Lill. or i.v. injection. I i has the side-effects of anticholinergic drugs such as dryness of the mouth and blurred vision. Contraindicated in glaucoma. (Robinul).
GM-CSF Granulocyte-macrophage colony stimulating factor. See molgramostim. gold therapy See sodium aurothionialate.
gonadotrophins The follicle-stimulating hormone (FSH) and the luteinizing hormone (1-11) of the anterior pituitary gland. They stimulate ovarian development and the production of oestrogens; ill the male LH controls the formation of androgens. See gonadorclin.
gonadorefin A synthetic form of the gonadot roph in -releasing hormone of the pituitary gland (M-111-1). It is used to assess pituitary function.
Dose: 100 pg by i.v. injection normally
rise to a rapid rise in the plasma level of the luteinizingand follicle-stimulating hormones. In amenorrhoea and infertility due to gonadorelin insufficiency, it is given by pulsed s.c. infusion in doses of 1-20pg every 90 minutes, day and night. Treatment for up to 6 months may be required. Side-effects are uncommon. (Fertiloli Relefact). Sonic analogues of gonadorelin are used in remain cancers. See page 122.
goserelin A synthetic analogue of the hypothalamic hormone (LH-RH). It
suppresses the production of testosterone, d
anis used in the treatment of hormone-
dependent carcinoma of the prostate. It is also used in endometriosis and postmenopausal breast cancer.

Dose: 3.6 ing by s.c. injection every 28 days or as an implant. Side-effects include impotence, hot flushes, rash, breast swelling and tenderness. (Zoladex). See page 122 and ‘I able 8.
gramicidin A mixture of antibiotics effective against many Gram-positive organisms, but it is too toxic for syitenii, use. Used topically in infected skin conditions, usually in association with neomycin and hydrocortisone.
granisetron A scrotonin (5—HT) antagonist with a highly selective and powerful antiernetic action mediated by its effects on the 5-4-11′, receptors. It is used in the prevention and treatment of the severe nausea and vomiting induced by potent cytotoxic drugs such as cisplatin.
Dose: I mg I hour before treatment, then I ing twice daily, or by i.v. infusion in doses of 3 mg, repeated up to 3 times over 24 hours. For prophylaxis, a dose of 3 mg should be given before chemotherapy is commenced. Headache, rash and consti pation are common side-effects. (Kytril). See page 158.
griseofulvin An orally effective but slow
acting antifungal antibiotic that is
deposited selectively in the skin, hair and nails. It is used in the systemic treatment of ringworm and other dermatophyte infections of the keratin-containing tissues, but only when local treatment has failed.
Dose: 0.5-1 g daily, but prolonged therapy is required. Side-effects are headache, nausea, dizziness, rash and photosensitivity. 11 may also reduce the effects of oral contraceptives. (Fulcin; Grisovin).
growth hormone See soma(ropin.
guanethidine An anti-hypertensive drug that [)rings about a reduction in blood pressure by blocking transmission in adrenergic nerves, and preventing the release of noradrenaline. It has been used in the treatment of hypertension, often with a thiazide diuretic, but its use has declined as it may cause postural hypotension. Still used as part of combined therapy in resistant hypertension.
Dose: 20 mg daily, increased by 10 ing at weekly intervals according to response, up to 50 mg daily, although sometimes larger doses are required. Dose by i.m. injection,
10-20 nig as required. Diarrhoea, weakness, nasal congestion and bradycardia are common side-effects. (Ismelin). See page 148 and Table 21. Guanethidine is occasionally used as eye drops (1-3%) in glaucoma. (Ganda). See page 138 and Table 16.
guar gum A vegetable gum that, when taken with food, appears to retard the absorption of carbohydrates. It is used in the supplementary treatment of diabetes mellitus.
Dose: up to 15 g daily, usually sprinkled mi food. It is essential that a dose should he taken with an adequate fluid intake, and that the final dose is not taken at bedtime. Side-effects are flatulence and abdominal distension. (Guarem). See page 131 and Table 13.
halcinonide A powerful corticosteroid used iii severe inflammatory skin conditions not responding to other corticosteroids. It is applied sparingly as a 0.1% cream. (Halciderin).
halibut-liver oil A rich source of vitamins A ‘Ind 1).
Dose: 0.2-0.5 mi.
halofantrine An antimalarial, acting at the erythrocytic stage of the life cycle of plasmodium, and useful in chloroquine 01 MUlti-drug resistant malaria.
Dose: 500 nig 6-hourly for 3 doses between meals. Side-effects are nausea, vomiting and diarrhoea. It must not be given with or after mefloquine (risks of fatal arrhythmias). Contraindicated in pregnancy. 0 lalfan).
haloperidol A powerful tranquillizer used in schizophrenia, mania and psychoses. Dose: 5-20 ing daily, up to a maximum of 200 mg, reduced later according to
response. Dose by i.m. injection for rapid control of hyperactive psychotic patients, 5-30 mg initially, followed by 5 ing or more as required. For depot treatment, it is given as haloperidol decanoate, 50-300 mg by deep i.m. injection every 4 weeks. It is also given orally in doses of 500 g twice daily in severe anxiety. Doses of 1.5 nig

dextromoramide A powerful synthetic analgesic with a shorter and less sedating action than morphine. Of value in severe and intractable pain, and in terminal disease.
Dose: 5 ing or more either orally or by injection, according to need and response. Care is necessary in liver dysfunction and respiratory depression. (Palfitunt).
dextropropoxyphene An orally effective analgesic. Of value in many painful conditions, and in malignant disease its use may delay the need to resort to the opiate analgesics.
Dose: 250 ing or more daily, but doses in excess of 700 mg daily may cause toxic psychoses and convulsions. (Doloxene). See co-proxaniol.
dextrose See glucose.
diazoxide An inhibitor of insulin secretion. Dose: given orally in doses of 5 ing/kg or more daily in severe hypoglycaemia. Also of value in severe hypertensive crisis, in
doses up to 150 mg by rapid i.v. injection. Side-effects arc nausea, tachycardia and oedema. (Eudernine).
diclofenac A non-steroidal anti-inflammatory drug (NSAID) of the naproxen type, pe, and used in rheumatoid, arthritic and similar conditions.
Dose: 75-150 ing daily, after food. Suppositories of 100 nigare useful at night, but may cause local irritation. In acute conditions and in postoperative pain, doses of 75 mg once or twice a day by deep i.m. injection for not more than 2 days. (Diclomax; Voltarol). Like other NSAIDs, diclofenac may cause gastric disturbance and hypersensitivity reactions. See page 165 and Table 29.
diamorphine A derivative of morphine with a more powerful analgesic an(] cough-suppressant action. It is also less liable to cause nausea. Valuable for the relief of severe pain and the suppression of useless cough. Addiction is a constant risk owing to the euphoric effects of the drug.
Dose: 5-10 nig orally or by injection, repeated as required. For severe pain in the terminally ill, addiction is of no consequence, and much larger doses are given according to need: if necessary, by continuous infusion or a syringe-pump device.
diazepam A benzodiazepine of value in anxiety states, insomnia, acute alcoholic withdrawal, and for premedication. It also has a muscle relaxant action, and is valuable when given by injection in status epilepticus and in the control of the spasm of tetanus.
Doses: 5-30 mg daily, 10-20 mg by slow i.v. injection as required, up to a maximum of 3 mg1kg in 24 hours. Absorption after Lin. injection is unreliable. It is sometimes given as suppositories of 5-10 ing. Side-effects are drowsiness, dizziness, respiratory depression and hypersensitivity reactions. Care is IICLL’N nary in glaucoma and renal and hepatic impairment. Fxterided treatment may lead to dependence and addiction, and withdrawal should be slow to avoid the risks of precipitating toxic psychosis, confusion and convulsions. (Stesolid; Valium). See pages 177 & 136, an(] Tables 5 & 15.
dicobalt edetate A specific antidote in acute cyanide poisoning; toxic in other conditions.
Dose: 300 mg by slow i.v. injection, followed by 50 ml of glucose solution 50%, repeated if required. (Kelocyanor). Sec .odium nitrite.
dicyclomine An anticholinergic agent used to reduce gastric hyperacidity and the smooth muscle spasm of gastrointestinal disorders.
Dose: 30-60 mg daily. Side-effects
include dryness of the mouth and blurred vision. (Ivlcrbcnlyl).
didanosine An antiviral agent used in HIV infections not responding to zidovudine. Dose: 400 mg daily before food. Diarrhoea, vomiting and peripheral neuropathy are side-effects. (Videx contains didanosine with antacids). See page 144 and Table 19.
dienoes A synthetic oestrogen used as a 0.025% cream for senile or atrophic vaginitis.
diethylcarbamazine A synthetic drug used in filariasis but long-term treatment is necessary.
Dose: I mg/kg daily initially, slowly increased to 6 mg/kg daily, and continued for 21 days. Low initial doses are necessary to reduce allergic reactions due to proteins released front dead %vornis. Side-effects include headache, nausea, rash and conjunctivitis. (I letrazan). See ivermectin.

diflucortolone A corticosteroid used topically as a 0.13′0 or 0.3% cream or ointment in steroid-responsive dermatoses. Of value in resistant conditions. (Nerisone).
diflunisal An anti-inflammatory and analgesic drug (NSAID), chemically related to aspirin, but with actions and uses similar to napmxen.
Dose: 500 ilig– I g daily. Care is necessary in aspirin-sensitive patients, and in peptic ulcer. (Dolobid). See page 163 and Table 29.
Digibind A highly purified preparation of sheep-derived digoxin-specific antibodies, given by i.v. infusion in digoxin overdose or poisoning. It mobilizes digoxin from cardiac receptor sites and binds it as an inert complex which is excreted into the urine, and symptoms of digoxin toxicity subside within an hour.
Dose: depends oil the amount of digoxin absorbed; 40nigcan neutralize about 600ligofdigoxiii.
I Dim
250-500 jig initially according to need. Nausea and vomiting are often signs of overdose. If the heart rate falls below 60 beats per minute, dosage rcquiresadill.ltmclit. See page 1.11 and Table 18.
digoxin- specific antibody See Digibind.
dihydrocodeine An analgesic derived from codeine, but with a more powerful action. Of value in many painful conditions where mild analgesics are inadequate. Dose: 30 mg orally after food, or 50 ing
by i.m. or deep s.c. injection at intervals of 4-6 hours according to need. Dizziness and constipation are side-effects. MIA 18).
dihydrotachysterol A sterol related to calciterol, but with more rapid calcium-mobilizing properties. It is used mainly in hypocalcaemia and parathyroid tetany, but is sometimes effective in calciferolresistant rickets.
Dose: 200 jig daily, adjusted to need according to plasma calcium levels as a solution in oil. (AT 10).
39
digitalis The dried leaf of the foxglove. It has a powerful strengthening and regulatory action oil the heart, but is now used as digoxin.
digitoxin The most powerful cardiac glycoside of digitalis and of value in heart failure and atrial fibrillation. Absorption is rapid but excretion, which depends on metabolism by the liver, is very slow, and cumulative effects may occur.
Dose: (maintanence) requires careful .iditminent, varying from 50-200 f.ig daily.
digoxin The principal cardiac glycoside obtained from digitalis leaf. It is rapidly absorbed orally, and is widely used in cardiac failure, paroxysmal tachycardia and atrial fibrillation. The diuresis of digoxin therapy is a secondary effect following on the improvement in the renal circulation.
Dose: for rapid digitalization, 1-1.5 mg initially over 24 hours: subsequent maintenance close 62.5-500 pg daily. For slow digitalization, 250-500 pg may be given daily for about a week, with subsequent closes based on the response. Elderly patients and children respond adequately to smaller doses, and tablets of 62.5 pg (Lanoxin-111G) are available for such patients. In emergency, digoxin call be given by slow i.v. injection in closes of
diloxanide A well-tolerated aniciellicide used in chronic intestinal anicielliasis when only cysts are present in the faeces. It is also used in acute infections, 5 days after a course of metronidazole.
Dose: 1.5 g daily for 10 days. (Furamide).
diltiazem A calcium channel blocking agent, used in the prophylaxis and treatment of angina, and useful when beta-blocking agents are unsuitable or ineffective.
Dose: 180-360 nig daily, reduced in renal impairment. It may cause bradycardia, ankle oedema and hypotension. potension. (Adizen; Tildiern). Sonic long-acting products with various brand mantes are used in hypertension. They should not be regarded as interchangeable, as the duration of action may vary. See page 114 and Table 4.
dimenhydrinate An antihistamine used mainly as all antiemetic in nausea, travel sickness and vertigo.
Dose: 100-300 ing daily. It may cause more drowsiness than sonic related drugs. (Dramamine).
dimercaprol (SAL) A specific drug for the treatment of poisoning by arsenic, mercury, gold and other heavy metals.

butobarbitone A barbiturate of medium clisityand rapidity of onset.
Dose: 60-200 mg. (Soneryl).
cabergoline A dopamine similar to bromocriptine, but with a longer .1, 1 ioli.
Dose: for suppression of lactation I mg, followed by doses of 0.25 ing for 2 days. Nausea, dizziness and breast pain are side effects. (Cabaser; Dostinex).
cadexomer iodine A modified starch powder containing 0.9% of iodine in a slow release form. It is used as an antiseptic application for venous ulcers and pressure sores. It should not be used during prenancy or lactation, during thyroid investigations or in patients sensitive to iodine. (lodosorb).
caffeine The central nervous system stimulant present in tea and coffee. It is used with paracetamol and other mild analgesics.
calamine Zinc carbonate. It has a mild astringent and soothing action and is widely used as Calamine Lotion for skin irritation and as Oily Calamine Lotion in eczema.
calciferol (vitamin D 2) form of vitamin 1) used in the prophylaxis and treatment of deficiency states such as rickets in children and osteomalacia in adults, and in other bone disorders. Dose: prophylactic 800 units daily; therapeutic 5000-50 000 units daily. In resistant rickets and parathyroid deficiency, higher doses may be required, but such therapy requires care, as hypercalcaemia percalcaernia and irreversible renal damage may occur. See ako alfacalcidol and calcitriol.
calcipotriol An analogue of vitamin D with a selective inhibitory action on the proliferation of keratinocytes. Used in the treatment of psoriasis as a 0.005% cream or ointment twice a day. Not more than 100 g/week. (Dovonex).
calcitonin Pork-derived calcitonin is a hormone that has an action similar to that
of the parathyroid gland in regulating blood calcium levels. It is used in the hypercalcaemia associated with malignancy, and in osteoporosis. It is also of value in Paget’s disease of bone, in which it relieves bone pain and reduces the neurological symptoms.
Dose: 10-160 units daily by s.c. or i.m. injection according to need and response. In Paget’s disease, prolonged treatment for some months may he required. Side-effects are nausea, flushing and paraesthesia, and local reactions may also occur. (Calcynar; Calcitare; Miacalcic). See salcatonin.
calcitrol The metabolite formed in the kidney from calciferol. It is the most powerful and rapidly acting metabolite with vitamin L) activity. It is of value in chronic renal deficiency states when the normal metabolism of calcium and phosphorus is impaired, as in renal osteodystrophy. Dose: 1-2 pg daily under biochemical control. Side-effects, such as hypercal-
caemia and hypercalciuria, are usually , P
reversible on withdrawing the drug. (Rocaltrol).
calcium channel blocking agents The movement of calcium ions through the calcium channels of the myocardium plays an essential role in cardiac activity. The inhibition of such movement by channel blocking agents reduces myocardial contractility and lowers the tone of the cardiovascular system. Such a reduction is of value in angina, hypertension and cardiac arrhythmias, and can be obtained by the use of calcium channel blocking agents such as diltiazem, felodipine, isradipine, nicardipine, nifedipine, nimidopine and verapamil. These compounds exhibit certain differences in action and in therapeutic applications, and their use requires care. Nifedipine and veraparail have been used in the prophylactic treatment of migraine. Their side-effects include nausea, oedema, rash and bradycardia. See pages 114 & 148, and Tables 4 & 21.
calcium carbonate A time honoured antacid now used less frequently. It also acts as a phosphate binder, and is used in hyperphosphatacinia.
calcium chloride The calcium salt present In various intravenous electrolyte solutions.

calcium folinate See folinic acid.
calcium gluconate A soluble and well-tolerated calcium salt used in many condi- tions associated with calcium deficiency such &i rickets, coeliac disease and parathyroid deficiency; also during pregnancy and lactation often in association with vitamin D. Calcium gluconate is also given in chilblains, urticaria and allergic reactions. Dose: usually given in (loses of 0.5-2g, but ill hypocalcaemic tetany it is given by slow i.v. injection in doses of 10 ml of a 100% solution, with laboratory control of the blood calcium levels. Calcium gluconate is also given i.v. in the early
treatment of toxic hyperkalaemia.
calcium lactate The calcium salt most commonly given orally in mild deficiency states.
Dose: 1-5 g.
Calcium Resonium An ion-exchange resin that take, up potassium in exchange for calcium. Used in hyperkailatentia associated with anuria and haernodialysis. Should be used only when potassium and calcium serum levels are under biochemical control. Dose: 15- 30g 3 or 4 times a day. In children, 0.5-1 g/kg daily. It is sometimes given as a retention enema.
are given in heart failure. Side-effects include proteinuria, neutropenia, agranulocytosis, rash and loss of taste. (Acepril; Capotin). See ACE inhibitors, page 148 and Table 21.
carbachol A parasympathomimetic agent used orally and by injection in the treatment of postoperative atony and retention of urine, and occasionally as eye drops (3%) in i the treatment ofglaucoma. Dose: 2-4 ing orally, 250 pg by s.c. injection. Side-effects include nausea, bradycardia and colic.
carbamazepine An anticonvulsant effective in all types of epilepsy except petit mat (absence seizures). It is also of value in trigeminal neuralgia and is given prophylactically in manic-depressive states. Dose: 200-400 ing daily initially, slowly increased up to 1.8 g daily if required. Suppositories of 125-250 mg are available. Carbamazepine has some antidiuretic properties, and has been used in diabetes insipidus in doses of 100-2M mg daily. Side-effects include dizziness, gastrointestinal disturbances and all erythematous rash. (Tegretol). See page 136 andTable 15.
carbaryl An insecticide used as it lotion and shampoo in pediculosis.
canrenoate A steroid-derived aldosterone antagonist with the actions and uses of spironolactone.
Dose: given in oedema by slow i.v, inject ion or infusion in doses of 200-400 mg daily. Nausea and vomiting are high-dose side-effects. (Spiroctan-M).
capreomycin An antibiotic of value in resistant i uberculosis or when other drugs are not tolerated.
Dose: I g daily by i.m. injection. It may cause tinnitus, deafness, renal damage and allergic reactions. (Capastat).
captopril An inhibitor of the angiownsin converting enzyme. It is used in the treatment of hypertension, including that resistant to other therapy, but care is necessary as the initial dose may cause marked hypotension, and so is best taken ill bed. It is often given with a thiazide diuretic to improve the response, and with a beta-blacker to maintain the effect. Dose: 25 mg initially, slowly increased, as required, up to 450 mg daily. Similar doses
carbenoxcilone A cytoprotectant derived front liquorice, used for mouth ulcers. (Bioplex; Bioral). See Table 27.
carbidopa An enzyme inhibitor used with ievodopa in parkinsonism. It prevents the breakdown of levodopa, thus permitting a larger amount to reach the brain. See
page 160.
carbimazole An antithyroid drug. It inhibits the formation of thyroxine and is valuable in the treatment of thyrotoxicosis and in preparation for thyroidectomy. Dose: 30-60 mg, daily initially; maintenance dose, 5-20 ing daily. It is sometimes given together with thyroxine it) the’blockage replacement’ treatment of hyperthyroidism. Side-effects are nausea, rash and pruritus; alopecia and agranulcytosis have been reported. (Neo-Mercazole).
carbocisteine A mucolytic agent used to reduce the production and viscosity of sputum in respiratory disorders.
Dose: 1.5 g daily. (Mucodyne).

bendrofluazide A widely used diuretic of the thiazide group, with a powerful and prolonged action. It is used in congestive heart failure, oedema and mild hypertension. In more severe hypertension it is given together with other drugs to increase the overall response.
Dose: 2.5-10 ing daily. It causes some loss of potassium, so potassium supplements are required if treatment is prolonged. Side-CffeCtS include rash and thrombocytopenia. Renal failure is a contraindication. (Aprin= Neo-Naclex). See page 1,18 and fable 21.
benorylate A compound of aspirin and paracetamol, with the general properties of both drugs, but generally better tolerated than aspirin. Used in arthritic conditions and for the relief of painful musculoskeletal disorders.
Dose: 3-6 g daily. Like aspirin, it may cause gastrointestinal disturbances and increase the action of oral anticoagulants. (Benoral).
benperidol A tranquillizer of the haloperidol type with similar side-effects, but used to control antisocial sexual behaviour in adults.
Dose: 0.25-1.5ingdaily. (Anquil).
benserazide An enzyme inhibitor used with Ivvodopa in parkinsonism. It inhibits the breakdown of levodopa to dopamine, enabling large amounts to reach the brain, and so permits a reduction in dose and a smoother response. Some of the side-effects of levodopa, such as nausea and vomiting, may also be reduced, although the incidence of involuntary movements may increase.
Dose: 12.5 mg with 50 ing of levodopa. (N-ladopan). See page 160 and Table 26.
benzalkonium chloride A detergent with antiseptic properties present in various skin preparations. It is also used as a preservative in cyc drops.
benzhexol A spasmolytic drug used mainly to relieve the tremor and rigidity of parkinsonism.
Dose: I mg initially, slowly increased to 5-15 mg daily according to need. Side-effects include mouth dryness, dizziness and blurred vision. Care is necessary with high doses as some psychiatric disturbances may occur anti    withdrawal of the
drug, but abrupt discontinuance of treatment should be avoided. Benzhexol should be used with care in cases of glaucoma, hepatic and cardiac disease or urinary disturbances. (Arcane; Broflex). See
page 160 and Table 26.
benzocaine A local anaesthetic for topical .ipplication. Used as lozenges (100 mg) for painful oral conditions; ointment
(5- 1 0(y.); suppositories 200 mg.
benzodiazepines A widely used group of drugs with a powerful action on the central nervous system. ‘rhey appear to have a selective action on certain seroionin receptors. The type of action varies within the group, and they may be used as sedatives, hypnotics, anxiolytics, anticonvul&-ints or muscle relaxants. As hypnotics they have virtually replaced the barbiturates, as they have a wide margin of safety and are less dangerous in overdose. Prolonged use should he avoided as dependence remains a possibility. The withdrawal of treatment with benzodiazepines should be gradual, as otherwise confusion, convulsions and toxic psychoses may occur. Nitrazepam has a relatively long action as a hypnotic, whereas flunitrazepam has a shorter action. Diazepam is the preferred drug for controlling the spasms of tetanus. Hypnotic pnotic benzodiazepines include flunitrazepam, flurazepam, loprazolam, lormetazepam, nitrazeparnand temazepam.Those used as anxiolytics are alprazolam, bromazepam, chlordiazepoxide, clobazam, clorampate, diazepam, ketazolam, lorazepam, medazepam and oxazepam. Most of these diazepines are referred to briefly under the above names. See page 117 and,rable 5.
benzoic acid It has fungistatic properties similar to salicylic acid, and has been used as Whitfield’s ointment (Compound Benzoic Acid Ointment) for the treatment of ringworm.
bemoan A balsamic resin used mainly as Compound Tincture of Bemoan for pressure sores and stoma care.
benzoyl peroxide An antifungal agent used locally for superficial fungal infections. It is also used, together with sulphur, as a cream or gel for acne.
benzthiazide A thiazide diuretic present with trianiterene in Dytide.

benztropine An anticholinergic drug, used to relieve the rigidity, tremor and salivation of Parkinson’s disease. It also has some sedative action, and in some cases may be preferred to benzhexol. Like benzhexol, it is sometimes useful in the control of drug-induced extrapyramidal svillptoms.
Dose: 0.5-6 mg daily. In severe conditions, it may be given by injection of
1-2 mg, repeated according to response. The side-effects are those of the anticholinergic drugs generally. (Cogentin). See page 160 and Table 26.
benzydamine A mild analgesic used as a mouthwash (0.15%) for painful conditions of the mouth and throat, and as a cream (31YO for musculoskeletal pain.
benzyl benzoate A clear liquid with an aromatic odour. It is used as an emulsion in the treatment of scabies by two applications to the whole of the body except the head.
benzyl penicillin See penicillin.
beta-Mockers in cardiac failure, heart block and bradycardia. See pages 114 & 148, and Tables 4 & 21.
betahistine A vasodilator with some of the properties of histamine. Used to reduce the vertigo of N!6ni&e’s disease. Should be used with care in asthmatics and in peptic ulcer.
Dose: 16-48 ing daily. (Sere).
betarnethasone A corticosteroid characterized by its low dose, increased anti-inflammatory action, and reduced side-effects. It has virtually no salt-retaining properties, and causes little increase in the urinary excretion of potassium. It is indicated in all inflammatory, allergic and other conditions requiring corticosteroid therapy - with the exception of Addison’s disease and after adrenalectomy when a salt-retaining steroid is required.
Dose: 0.5-5 mg daily; in cerebral oedema, 5 20 mg by Lin. or i.v. injection. In asthmatic states, oral aerosol inhalation of M)pg (eight puffs) daily; for inflaninialory conditions of the eye, car and nose, a 0, PN, solution is used locally. (Belnesol).
beractant A pulmonary surfactant used in the respiratory distress syndrome of premature infants, by endotracheal tubing within 8 hours of birth. Monitor heart rate and arterial oxygenation. (Survanta). See also colfesceril, poractant and pumactant.
beta-adrenoceptor blocking agents Adrenaline and related catecholamines are released into the circulation during exercise and stress, and stimulate cardiac output by acting oil the beta-adrenoceptor sites in the heart. When such stimulation is excessive the increased oxygen demand of the heart may cause myocardial insufficiency and angina. Drugs such as propranolol block these receptor sites and so indirectly reduce cardiac stimulation, and are of value in the control of angina, cardiac arrhythmias and hypertension. Some blocking agents also act on other receptor sites and may cause bronchospasm by releasing histamine. Newer drugs, represented by acebutolol and nicroprolol, are more cardioselective, and others such as sotalol are of more value in hypertension. Sonic of these blocking agents,such as atenolol, are less likely to reach the central nervous system and so may cause fewer sleep disturbances. By their nature and depressant action on the myocardium, care is necessary when giving
betaxolol A beta-adrenoceptor blocking agent of the propranolol type, with similar properties and side-effects, but with a more cardioselective action. It is used mainly in the treatment of hypertension. Dose: 20 mg once daily. Betaxolol is also used as eye drops (0.5%) in ocular hypertension and glaucoma. (Betoptic-, Kerlone). See page 148 and Table 21.
bethanechol A parasympathominictic agent used in reflex oesophagitis, paralytic ileus and postoperative urinary retention. Dose: 30-120 mg daily before food. Side-effects are nausea, bradycardia and colic. Care is necessary in asthma and cardiovasculardiscase. (Myotoninc).
bethanidine A blocking agent that has an anfihypcttcnsivc action by inhibiting the release of noradrenaline from post-ganglionic adrenergic nerve endings. It is useful in resistant hypertension, and when other agents are not well tolerated, and is usually given in association with a thiazide diuretic or a beta-Mocker.
Dose: 20-200 ing daily. Postural hypotension, nasal congestion and diarrhoea are side-effects. (Bendogen).

atenolol A long-acting beta-adrenoceptor blocking agent of the propranolol type, but with a more cardioselective action. Used mainly in hypertension pertension and angina.
Dose: 50-100 mgdaily. Also given by slow 6. injection in arrhythmias in doses ill, to 10 mg. The side-effects are similar to propranolol, although atenolol may cause fewer sleep disturbances. (”Fenormin). See pages 114 & 148, and Tables 4 & 21.
atorvastatin A lipid-lowering agent with an enzyme-inhibitory action on cholesterol synthesis used in hyperlipidaemia. Dose: 10 mg daily initially, up to a maximum of 80 ing daily. Liver function tests are necessary before and during treatment. (Lipitor). See page 146 and Table 20.
atovaquone An antibacterial agent used in Prietintocyslis carinii pneumonia resistant to co-trimoxazole.
Dose: 750 ing daily with food for 21 days. Side-effects are rash, nausea and diarrhoea. (Welivolle).
atracurium A non-depolarizing muscle relaxant of the gallamine type, but causing less histamine release.
Dose: 30f1-600 pglkg i.v. initially followed by doses of 100-200 µg/kg at intervals as required. Its action can be reversed, if nec- essary, with neostiginine. Arninoglycoside antibiotics may increase the response and require all adjustment of dose. (Tracrium).
atropine An alkaloid with anticholinergic properties obtained from belladonna, hyoscymus and other plants. It is often given in doses of 300-600 pg by injection with morphine for preoperative sedation and to reduce bronchial secretion. Is also of value in gastrointestinal smooth muscle spasm.
Dose: 0.23-2 mg daily. It is used as eye drops (Vyl)) to dilate the pupil, but such use in the elderly requires care, as the long action may precipitate glaucoma. It is also used with neostigmine in doses of 600 pg-1.2 ing to reverse the action of the vecuronium-type muscle-relaxants. Side-effects include dryness of the mouth, disturbed vision, an(] bradycardia followed by tachycardia. Care is necessary in prostatic enlargement and urinary disturbances, and glaucoma is a contraindication.
augmentin See co-amoxiclay.
auranofin An orally active gold compound used in the treatment of active rheumatoid arthritis not relieved by non-steroidal anti-inflammatory drugs (NSAIDs).
Dose: 6 nig daily, increased if necessary .titer 6 months to 9 ing daily. It should be withdrawn if the response is inadequate after 9 months. Side-effects are nausea and diarrhoea. See sodium aurothiomalate for the systemic side-effects of gold therapy. (Ridaura). See page 165 and Table 29.
avomine Derivative of promethazine used in travel sickness, nausea and vomiting. Dose: 25-150 mg daily.
azapropazone A non-steroidal anti-inflammatory agent (NSAID) with actions and uses similar to those of naproxen and used when other NSAIDs are unsuitable. Dose: 1.2 g daily, but in acute gout an initial, divided, dose of 1.8 g is given. Side-effects include rash and occasional photosensitivity, and care is necessary in peptic ulcer. Azapropazone may potentiate the action of warfarin and phenytoin, and require all adjustment of dose
(Rheuniox). See page 165 and *]’able 29.
azatadine An antihistamine with the actions and uses of promethazine.
Dose: 1-2 ing twice daily. (Optimise). See page 110 and Table 2.
azathioprine An immunosuppressive agent mainly used to inhibit rejection after organ transplant surgery. It has also been used in some auto-immune conditions and in
resistant ulcerative colitis.
Dose: 1-5 niglkg daily, but (lose and duration vary according to need and response. Side-effects include depression of bone marrow function, gastrointestinal disturbances, hepatotoxicity and rash. Severe secondary infections may occur as a result of the inunlU1lOSllppreS!aOu, and the use of the drug requires close control. (Az,aniinc).
azoolic acid An organic acid with some antibacterial properties. Used as 20% cream for acne vulgaris. (Skinoren).
azelastine An antihistamine used as a nasal spray 0.1% in allergic rhinitis. (Rhinolast).
azidothymidine See zidovudine.

azithromycin A macrolide antibiotic with a longer action than erythromycin or clarithromycin, used chiefly in respiratory tract infections.
Dose: 500 mg daily for 3 days, I hour before or 2 hours after food or antacids. Side-effects include nausea, abdominal discomfort and diarrhoea. Not to be given with astemizole or terfenadine ( risk of arrhythmias). Vithrornax).
azlocillln A broad-spectrum antibiotic with exceptional activity against Pseudomonas. Of value in respiratory and urinary infections, and in septicaemia.
Dose: in life-threatening infections, 5 g by i.x. infusion 8-hourly. Doses of 2 g 8-hourly may be given in less severe infer lions. III patients with impaired renal function, doses should be given 12-hourly. Allergy to penicillins or cephalosporins is a contraindication. (Securopen).
AZT See zidovudine.
aztreonam An antibiotic that is exceptional in being resistant to breakdown by beta-lactamases. It has a selective action against Gram-negative aerobes, and it is given in urinary, respiratory, bone and other infections caused by susceptible bacteria. When given in association with an aminoglycoside, the activity of aztreonam against Pseudomonas aeruginosa may be increased.
Dose: 4 g daily by i.m. injection and up to 8 e daily i.v. in severe infections. Reduced doses are indicated in renal impairment. Side-effects are skin reactions, nausea, jaundice, blood disorders, and malaise. (Azactam).
is given by intrathecal injection in small doses via an implantable pump, but treatment requires specialist supervision. (Lioresal).
BAL See dimercaprol.
balsalazide A melsalazine complex used in ulcerative colitis. It reaches the colon unchanged, where it is broken down to release active melsalazine.
Dose: 9g daily until remission or for 12 weeks. Side-effects are those of melsalazine. See page 172 and Table 32.
bambuterol A prodrug of terbutaline, with .I similar but more prolonged bronchodilator action.
Dose: 10-20 mg at night. (Bambec). See page 118 and Table 6.
barbiturates A group of hypnotic drugs exemplified by butobarbitone. Once widely used, but their value has declined sharply and safer drugs such as nitrazepam are now preferred.
barium sulphate A very insoluble powder, given orally or rectally as an aqueous suspension as contrast agent for X-ray examination of the alimentary system.
BCG vaccine A preparation of the Calniette-Guerin strain of Mycobacterium tuberculosis. It is used for active immunization against tuberculosis. particularly for individuals likely to be exposed to
infection.
Dose: 0.1 111[. by int radermal injection. A product obtained from an isoniazidresistant strain of the organism is also used for the immunization of individuals receiving prophylactic treatment with isoniazid.
baclofen A muscle relaxant that acts on the spinal end of some motor neurones. Useful in multiple sclerosis and muscle spasms caused by spinal lesions.
Dose: 15 nig daily initially gradL1.111), increased, as required, up to a maximum of 100 mg daily. Side-effects include nausea, fatigue and hypotension. Care is necessary in epilepsy and psychiatric disorders. Withdrawal of treatment is slow over 1-2 weeks to avoid serioius side-effects. In severe spasticity and spinal injury, baclofen
beclomethasone A potent corticosteroid used in the control of asthma and bronchospasin not responding to other drugs. Dose: by oral aerosol inhalation, too pg (two puffs) repeated up to 4 times a day according to need and response. Dose: by powder inhalation 800 pg daily. Hoarseness may develop as a side-effect, and oral candidiasis may occur with high doses. Beclornethasone is also used as a cream or ointment (0.025%) in severe inflammatory skin conditions not responding to less Potent corticosteroids. (Becotide; Propaderm).

A-Z Principal Drugs (Alprazolam - Aminophylline)

alprazolam

A benzodiazepine used in the shors-term treatment of anxiety and anxiety with depression.
Dose: 0.75-3 mg daily. Side-effects include dizziness and ataxia. Care is necessary in pulmonary insufficiency. (Xanax). See page H 7 and Table 5.
alprostadil A preparation of prostaglandin li, for i.v. use in maintaining the patency of the ductus arteriosus in neonates with congenital heart lesions requiring surgical correction. The improvement in circulation so obtained permits diagnosis while surgery is being considered.
Dose: 50-100 ng/kg/min i.v. under strict control. Apnoea may occur, usually within an hour of the injection, requiring immediate ventilatory assistance. Bradycardia and hypotension may also occur. (Prostin VR).
alteplase A form of human plasminogen activator with a selective fibrinolytic action on blood-clot-bound plasminogen. It is of value in the early treatment (6 hours) of acute thrombosis, myocardial infarction and pulmonary embolism.
Dose: 10 mg initially by slow i.v. injection; then 90 mg over 3 hours by i.v. infusion. Side-effects are nausea, vomiting and local bleeding. (Actilyse). See streptokinase.
aluminium The powdered metal is used as a skin protective in ileostomy, as Baltimore paste, also known as Compound Aluminium Paste.
aluminium acetate An astringent used as an 8% solution for ear drops in otitis externs. A weak solution (0.65%) is used as a lotion in exudative eczematous states and in suppurative conditions.
aluminium chloride An antiperspirant used in the treatment of axillary hyperhydrosis by the local application of a 20% alcoholic solution. Over-use may cause skin irritation. (Anhydrol; Driclor).
aluminium hydroxide An antacid with a prolonged action.
Dose: as a gel, 7.4-15 ml, or as 500 mg tablets, to be chewed or crushed before swallowing. Best given between meals and at night. May interfere with the absorption of some other drugs. (Aludrox).
alverine An antispasmodic with a local action on intestinal smooth muscle.
Dose: used in irritable bowel syndrome in doses of 60-360 ing daily. (Spasmonal). See page 134 and “Cable 14.
amantadine An antiviral drug thought to act by inhibiting the penetration of the virus into the host cell, and used for the prophylaxis and treatment of influenza. It is also used with levodopa in the treatment of parkinsonism, but it may relieve the rigidity more than the tremor.
Dose: 200 mg daily. Many side-effects are dose-related. (Synimetrel). See page 160 and Table 26.
amethocaine Powerful local anaesthetic, used [or anaesthetic of mucous
membranes 1-2% solution, eve drops 0.25-1 %. As spray for throat before endoscopy, etc, a 0.5% solution may be used. Hypersensitivity and allergic reactions may occur as with other local anaesthetics. Also used as 1% cream for pruritus ,i nd other skin conditions.
amifostine An organic thiophosphoric acid used to reduce neut ropen ia -associated risks of infection after cyclophosphamide and platinum treatment of ovarian cancer. Dose: by i.v. infusion 910 mg/m: daily .10 minutes before chemotherapy.
I lypotension is a side-effect that may limit treatment. (Ethyol).
amikacin A semi-synthetic antibiotic similar in actions and uses to gentamicin, but more resistant to enzyme inactivation. Mainly used in the short-term treatment of serious infections due to Gram-negative, gen tain ici it -resistant organisms.
Dose: 15 ing/kg daily by i.m. injection or i.v. infusion, up to a total treatment dose of 15 g. Side-effects include ototoxicity, drug fever, rash and nausea. Dose should be reduced in renal impairment. (Amikin).
amiloride A potassium-conserving diuretic ,,uh an action on the distal tubule similar to that of spironolactone, although it is not an inhibitor of aldosterone. It is used in
hypertension and heart failure, often with a thiazide diuretic to obtain a more balanced response.
Dose: 5-20 ing daily. Rash is an occasional side effect. See page 148 and Table 2I.
amino acids Certain amino acids are essential for the formation of protein. When oral nutrition is not possible, amino acid preparations may be given by i.v. i ritusion. and such therapy call be extended if necessary to provide total parenteral nutrition by the addition of glucose, electrolytes, fats and vitamins as specially prepared solutions. [it hospitals, a 24-hour supply for total parenteral nutrition can be provided in a single large container and patients may be taught to administer total parenteral nutrition at home. Representative amino-acid products for i.v. infusion are Aminoplex, Perfusin, Synthamin and Varnin.
arninobenzoic acid An absorbent of some of Elie erythema-producing ultra-violet light waves of sunlight. it is present in sonic suit screen preparations.
aminoglutethimide An inhibitor of adrenal steroid and oestrogen biosynthesis. It is used in the control of post-menopausal oestrogen-dependent mammary carcinoma and in the treatment of advanced prostatic carcinoma.
Dose: 250 mg daily, increased, if necessary, to I g daily. Supplementary corticosteroid therapy is essential. Side-effects include drowsiness, rash and drug fever. (()j iineten). See page 122 and Table 8.
aminoglycosides A group of antibiotics that includes amikacin, gentamicin, netilmicin, lobramycin, kanamycin, streptomycin, neomycin and framycetin. They act mainly against Gram-negative bacilli, although they are also active against some Gram-positive organisms. Kanamycin and streptomycin are also active against Mycobacterhan tuberciaosis.'rhe aminoglycosides are not absorbed orally and when injected they are more toxic than most other antibiotics, and in renal impairment care is necessary, as the plasma concentration of the antibiotic may rise to an ototoxic or nephrotoxic level. The toxicity may also be increased by diuretics of the frusemide type. Measurement of plasma levels is essential in high dosage or continued therapy. Gentamicin is the most widely used aminoglycoside for systemic infections, and neomycin and framycetin, being too toxic for systemic use, are of value in skin infections.
may be given by slow i.v. injection. It is not suitable for Liu. administration. Sustained release oral products available cause less gastric disturbance. (Pecram; I'llyllocontin). See page 118 and 'rable 6.
amiodarone An iodine-containing anti-arrhythmic agent of value in all types of paroxysmal tachycardia, especially when the condition is resistant to other drugs. Dose: 600 ing daily for I week; maintenance (lose: 200 ing or less daily. When a rapid response is required, 5 mg/kg may be given by i.v. infusion under cardiac monitoring. it is contraindicated in bradycardia, pregnancy and thyroid disorders, and care is necessary in hepatic impairment. Pulmonary alveolitis, corneal microdeposits and photosensitivity have been reported as side-effects. (Cordarone).
amitriptyline A tricyclic antidepressant similar in action to imipramine, but it also has anxiolytic and sedative properties. Dose: in depression complicated by anxiety, 30-150 mg daily initially; maintenance dose: 20-100 mg daily; sometimes as a single nightly dose to reduce daytime sedation. Lower doses are often adequate in elderly patients. Dose by injection, 40-80 nig daily. Full benefit may not be achieved for some weeks and prolonged therapy may be necessary to avoid relapse. Withdrawal of the drug should be gradual. Atnitriptyline is also used in nocturnal eneuresis in children. Dose: 25-50 mg daily. Side-effects include dryness of the mouth, sedation and cardiac arrhythinias. It is contraindicated in glaucoma, prostatic hypertrophy and after recent myocardial infarction. Mcnti7o];Tryptizol). See page 128 and Table 11.
amlodipine A calcium channel blocking agent used in hypertension and myocardial ischaemia associated with angina.
Dose: 5-10 mg as a single daily (lose. Side-effects are headache, dizziness, flushing and oedema. Care is necessary in renal impair nient. (Istin). See page 148 and Table 21.
ammonium chloride A mild expectorant present in Ammonia and Ipecacuanha Mixture.
aminophylline A derivative of theophylline with a similar bronchodilater action. It i,, used chiefly in asthma, cardiac oedema and congestive heart failure.
Dose: 300 nig-1.2g orally daily; 5 nig/kg