Posts Tagged ‘cephalosporin’

Type of Drug
Cephalosporin Antibiotics
(CEF-uh-loe-SPOR-in)
Brand Names
Cefaclor 91 Raniclor
Cefadroxil Duricef
Cefdinir Omnicef
Cefditoren Pivoxil
Spectracef
Cefixime Suprax
Cefpodoxime Proxetil 91 Vantin
Cefprozil Cefzil
Ceffibuten Cedax
Cefuroxime Axetil 90 Ceftin
Generic Ingredient: Cephalexin 91 Panixine Disperdose    Keflex
Prescribed For  Bacterial infections.
General Information
These antibiotics are related to cephalosporin C, which is similar to penicillin and is isolated from the Cephalosporium acremonium fungus. Of the more than 20 different antibiotic drugs derived from cephalosporin C, only those that are taken by mouth are included in The Pill Book. Most common infections can be treated with these antibiotics, but they are not interchangeable. Your doctor must select the appropriate antibiotic for a particular infection.
Cautions and Warnings
Do not take cephalosporin antibiotics if you are allergic or sensitive to any of their ingredients. Up to 15% of people allergic to penicillin may also be allergic to cephalosporins. The most common cephalosporin allergic reaction is a hive-like rash condition with redness over large aceas 0 the body. Other sensitivity reac161011S Include general rash, fever, and joint aches or pain. Such reactions generally begin after a few days of taking the antibiotic and resolve within a few days after the antibiotic is stopped.
Prolonged or repeated use of a cephalosporin may lead to a secondary infection not susceptible to the antibiotic.
Occasionally, people taking a cephalosporin develop colitis. Call your doctor if you develop severe diarrhea while taking one of these drugs.
People with poor kidney function may require less medicine to treat their infections. Rarely, people taking a cephalosporin have had a seizure, especially those with kidney disease whose dose was not reduced.
Some injectable cephalosporins have caused blood-clotting problems. This has not occurred in people taking an oral drug.
Rarely, severe anemia occurs in people taking cephalosporin antibiotics. Report any signs of anemia (such as pale skin color, weakness, tiredness, difficulty breathing, and abnormal heart rhythms) to your doctor.
Cefprozil oral suspension contains phenylalanine and cannot be taken by people with phenylketonuria (PKU disease).
Possible Side Effects
Most side effects are mild.
✓    Most common: diarrhea, headache, abdominal pain, constipation, gas, upset stomach, nausea, vomiting, itching, and rash.
✓    Less common: dizziness, tiredness, weakness, tingling in the hands or feet, confusion, appetite loss, changes in taste perception, and genital and anal itching. Colitis may develop.
Cefaclor may cause serum sickness (symptoms include fever, joint pain, and rash). cephalosporins may cause changes in blood cells, kidney problems, liver inflammation, and jaundice, but these side effects are rarely a problem with oral cephalosporins.
Drug Interactions
•    Antacids can reduce the amounts of cefaclor, cefdinir, cefditoren pivoxil, and cefpodoxime proxetil in the blood. Do not take antacids within 2 hours of these antibiotics.
•    Cimetidine, famotidine, ranitidine, or nizatidine can reduce the effectiveness of cefpodoxime proxetil, cefditoren pivoxil, and cefuroxime axetil—do not combine these drugs.
•    Iron and iron-fortified foods may interfere with the absorption of cefdinir. Separate your iron dose from the antibiotic by at least 2 hours. Iron-fortified infant formula does not have this effect.
•    Probenecid may increase blood levels of some cephalosporins.
•    Potent (loop-type) diuretics can lead to kidney damage if mixed with a cephalosporin antibiotic.
Food  Interactions
Generally, cephalosporins may be taken with food or milk if they upset your stomach. Cefditoren pivoxil should be taken with a meal. Food increases the absorption of cefpodoxime proxetil and cefuroxime axetil.
Usual Dose
Ceftibuten
Adult and Child (age 12 and over): 400 mg once a day for 10 days. Child: 4 mg per lb. of body weight, up to 400 mg, once a day.
Cefuroxime Axetil
Adult and Child (age 13 and over): 250-1000 mg a day in 1-2 doses.
Child (age 3 months-12 years): tablets-125-250 mg every
12 hours. Liquid-9-13 mg per lb. of body weight every 12 hours.
Cephalexin
Adult: 1000-4000 mg a day in divided doses, usually 250 mg every 6 hours, or 500 mg every 12 hours.
Child: 11-23 mg per lb. of body weight a day in divided doses. The dose may be increased to 46 mg per lb. of body weight for middle-ear infections.
Overdosage
Common symptoms of overdose are nausea, vomiting, and upset stomach. These can often be treated with milk or an antacid. Cephalosporin overdoses are generally not serious; contact a hospital emergency room or local poison control center for more information. If you seek treatment, ALWAYS bring the prescription bottle or container.
Special Information
Call your doctor if you develop severe abdominal cramps or diarrhea. Stop taking this drug and immediately call your doctor if you experience fever, chest tightness, breathing difficulties, redness, muscle aches, or swelling.
You must take the full course of treatment prescribed—even if you feel better in 2 or 3 days—to obtain the maximum benefit from any antibiotic.
Proper diagnosis is key to the effectiveness of an antibiotic: Do not take any antibiotic without consulting your doctor.
You should be aware that all cephalosporins may cause false results for certain urine tests for sugar. Cefuroxime may cause false results for blood sugar. Diabetics taking cephradine should not change their diet or diabetes medication without consulting their doctor.
If you miss a dose that you take once a day, take it as soon as you remember. If it is almost time for your next dose, take the dose you forgot right away and your next one 10-12 hours later. Then go back to your regular schedule. If you take the medication twice a day, take the dose you forgot right away and the next dose 5-6 hours later. Then go back to your regular schedule. If you take the medication 3 or more times a day, take the dose you missed right away and your next dose 2-4 hours later. Then go back to your regular schedule.
Most cephalosporin liquids must be kept in the refrigerator to maintain their strength. Only cefixime liquid does not require refrigeration. All of the liquid cephalosporins have a very limited shelf life. Do not keep any of these liquids beyond the 10 days-2 weeks specified on the label. Follow your pharmacist’s storage instructions.
Special Populations
Pregnancy/Breast-feeding: These drugs are considered relatively safe during pregnancy, though small amounts pass into the fetus. Little information is available about the newer members of the group. Also, cephalosporins pass more quickly out of the bodies of pregnant women. cephalosporins should only be used during pregnancy after carefully weighing their potential benefits against their risks.
Small amounts of most cephalosporin antibiotics pass into breast milk. Nursing mothers who must take a cephalosporin should use infant formula.
Seniors: Seniors may require a lower dosage if they have reduced kidney function.
Cefaclor
250 mg every 8 hours, or 375-500 mg every 12 hours.  9 mg per lb. of body weight a day, in 2-3 equal doses.
Cefadroxil
1-2 g a day. in 1-2 doses.
13 mg per lb. of body weight a day, in 1-2 doses.
Cefdinir
Adult and Child (age 13 and over): 600 mg a day, in 1-2 doses. Child (age 6 months-12 years): 6.5 mg per lb. of body weight a day in 1-2 doses.
Cefditoren Pivoxil
Adult and Child (age 12 and over): 200-400 mg twice a day for 10 days.
Cefixime
400 mg a day, in 1-2 doses.
3.5 mg per lb. of body weight a day, in 1-2 doses.
cefpodoxime Proxetil
Adult and Child (age 13 and over): 200-400 mg a day, in 1-2 doses. Child (age 5 months-12 years): 5 mg per Yo. of body weight a day
in 1-2 (dvsin. Maximum daily dose for middle-ear infections is
400 mg; 200 mg for sore throat or tonsillitis.
Cefprozil
Adult and Child (age 13 and over): 500-1000 mg a day.
Child (age 6 months-12 years): 7-13 mg per lb. of body weight a day in 1-2 doses.

oxitropium An anticholinergic bronchodilator similar to ipratropium, and used by aerosol inhalation in stable chronic asthma and related conditions.
Dose: 200-300pg (4-6 puffs) daily. . See page 118 and Table 6.

Dose: 1-3 mega-units/min by i.v. infu,ion only, with monitoring. Excessive doses may cause severe uterine contractions with the risk of fetal asphyxiation. (Syntocinon).

oxpentity1fine An aminophyline-like drug used mainly as a vasodilator in periphei at vascular disorders.
Dose: 800-1200 mg. It may cause nausea, flushing and dizziness. Care is necessary in hypotensive states. (Trental).
oxprenoW A beta- ad renoceptor blocking agent with the actions, uses and side-effects of propranolol. It also has anxiolytic properties, and may reduce the symptoms of transient stress such as tremor and palpitations.
Dose: 60-480 mg daily. (Slow- Trasicor). See page 148 and Table 21.
oxybuprocaine A local anaesthetic for ophthalmic use, including tonometry, as a 0.4% solution.
oxybutynin An anticholinergic antispasmodic that promotes relaxation of the detrusor muscle of the bladder.
Dose: in urinary incontinence, 10-20 ing daily; 10 mg daily for children with neurogenic bladder instability. Side-effects are those of anticholinergic drugs generally. (Cystrin; Ditropan). See page 174.
toxycodone A powerful narcotic analgesic with a prolonged action. Used as suppositories of 30 mg in terminal care.
oxypertine A tranquillizer with a chlorpromazine-like action, and used in anxiety neuroses, psychoses and schizophrenic states.
Dose: 30-60 mg daily in anxiety states; up to 300 nig daily in schizophrenia.In higher doses it may cause nausea, dizziness and drowsiness. See page 168 and Table 30.
paclitaxelk’ A new cytotoxic agent originally obtained from the bark of the Pacific Yew. It prevents mitosis and inhibits cell growth by stabilizing microtubule production. It is used by specialists for metastatic ovarian cancer not responding to platinum therapy. Premedication is necessary to prevent severe hypersensitivity reactions. (Taxol). See page 122 and,rable 8.
pamidronate disodium A bisphosphonate with the actions and uses of etidronate. It is used mainly in the hypercalcaemia of malignancy, as it inhibits the development of active osteoclasts.
Dose: by i.v. infusion 10-90 mg or more according to the degree of hypercalcaemia. The initial response may occur within 24-48 hours. Dose in Paget’s disease of bone, 30 nig weekly. Care is necessary in marked renal impairment. (Aredia).
pancreatin A preparation containing the pancreatic enzymes, trypsin, lipase and amylase. It is used to aid the digestion of fats, proteins and carbohydrates in cystic fibrosis and pancreatitis. Some high-strength products have caused fibrotic strictures of the large bowel.
pancuronium A non-depolarizing or competitive muscle relaxant that has little histamine-releasing or cardiovascular action.
Dose: 50-100 pg/kg i.v. initially with Supplementary doses of 10-20 pg/kg as required. (Pavulon).
oxytetracycline (Terramycin). See tetracv-
oxytocin The oxytocic fraction of pituitary extract, but now made synthetically. Used for the induction and maintenance of labour, and to control post-partum haemorrhage, either alone or in association with ergometrinc.
pantoprazoleV A proton pump inhibitor similar to omeprazole, used in peptic ulcer and reflex oesophagitis.
Dose: 40 mg daily with breakfast. The tablets must be swallowed whole with water, and not chewed or crushed. (Proteunfl. See page 162 and Table 27.
papaveretum A preparation of the alkaloids of opium, containing approximately 50% of morphine together with papaverine and codeine. Used mainly by injection, often in association with hyoscine (scopolamine) for premedication. Dose: 7.7-15.4 nig repeated as required.
papaverine One of the alkaloids of opium. It has little analgesic action, and has been used mainly as a smooth muscle relaxant in peripheral vascular diseases. More recently it has been used by intracavernosal injection in the treatment of impotence.
paracetamol A widely used mild analgesic with few side-effects except in large doses. It differs from aspirin in the absence of any anti-inflammatory action.
Dose: 2-4 g daily. Paediatric suppositories of 125 mg are available. Overdose may cause severe liver damage (see acetylcysIcinc).
paraffin A generic name for hydrocarbon mixtures. Soft paraffin is the common ointment base; liquid paraffin is a lubricant laxative. Hard paraffin was used in the wax bath treatment of rheumatic conditions.
paraldehyde A colourless liquid with a strong characteristic odour. It was once used as a chloral-like sedative causing little respiratory depression; now given by deep i.m. injection in status asthinaticus. Dose: 5-10 nil. Occasionally given in similar doses by rectUril, diluted with saline or arachis oil. Discoloured paraldehyde must not be used.
paroxetine A selective inhibitor of sero(011111 uptake in the central nervous system, and indicated in the treatment of depression.
Dose: 20 ing daily, initially in the morning, with food, slowly increased as required to 50 mg daily. It should not be given with any other drug likely to increase serotonin uptake. Side-effects are nausea, drowsiness and insomnia. Extrapyramidal reactions may occur more often with paroxetine. (Seroxat). See page 128 and Table i I.
penciclovir An antiviral agent used as a 1% cream for cold sores (Herpes kabialis). Treatment should be started as soon as possible by applying the cream every 2 hours for 4 days. (Vectavir). See page 144 anti Table 19.
penicillarnine A breakdown product of penicillin which has the power of combining with certain metals to form a water-soluble, non-toxic complex that is excreted in the urine. It is used in Wilson’s disease, which is due to the retention of copper in the body, in poisoning by lead and mercury, in chronic active hepatitis (after the condition has been controlled), in cystinuria, and in severe rheumatoid arthritis in which it has an action similar to that of gold.
Dose: in Wilson’s disease, 1.5-2 g daily before food for sonic months. In chronic hepatitis, 500 mg daily initially, slowly increased over some weeks to 1.25g daily. In rheumatoid arthritis, 125-250 trig daily initially before food, slowly increased at monthly intervals with maintenance doses of 500-750 mg daily. Patients should be warned that the response in rheumatoid arthritis is slow. In cystinuria, 1-3 g daily with adequate fluids, ad iusted later to maintain the urinary cysteine level below 200 mg/I. Dose in heavy metal poisoning, 2g daily. Side-effects include nausea, loss of taste, rash and thrombocytopenia. Blood Counts during treatment are essential and patients should be advised to report most side-effects. A late onset rash may require cessation of treatment. (Distarnine; Pendramine). See page 165 and Table 29.
penicillin, benzyl penicillin, penicillin G I lie first of the antibiotics. It acts by pre venting the development of the bacterial cell wall, but some groups of organisms vary widely in the degree of sensitivity to penicillin, and it is inactivated by penicillinase-producing organisms. Penicillin is inactive orally, and so is given by i.m. injection, but as it is rapidly excreted the action is relatively brief. Derivatives such as procaine-penicillin have a longer action (penicillin V is an orally active derivative). The main side-effect is hypersensitivity, and sensitivity to one penicillin extends to any other penicillin, and may also include sensitivity to the related cephalosporins. High doses of penicillin, especially in patients with renal insufficiency, may occasionally cause cerebral irritation and encephalopathy. Cloxacillin and amoxycillin are derivatives of penicillin active against resistant staphylococci; ampicillin has a wide range of activity against Gram-positive and Gram-negative organisms; piperacillin and ticarcillin are active against Pseudomottas acruginosa.

pentaerythitol tetranitrate A vasodilator with properties resembling those of glyceryl trinitrate, but with a more prolonged action. Used mainly in the prophylaxis of angina as side-effects are relatively infrequent.
Dose: 60-240 mg daily. (Mycardol). See page 114 and Table 4.
pentamidine A synthetic drug used in the treatment ofPneutnocystiscarinii pneumonia in AIDS and other immunocompromised patients, as an alternative to co-trimoxazole.
Dose: 4 nig/kg daily by i.v. infusion for 14 clays or more, or by inhalation of a nebulized solution. Other dosage schemes are used in the treatment of’trypaiiosomiasis and leislunaniasis. Severe reactions, particularly hypotension, may occur, and pentamidine should be used only under expert supervision. (Pentacarinao.
pentastarch A starch-derived plasma substitute used as a 10% solution in burns and septicaemia.
Dose: by i.v. infusion 500 nil-21.. (Haes.
See hetastarch.
tpentazocine A powerful analgesic of the morphine type, but less likely to cause addiction, although dependence may occur with long treatment.
Dose: 100 -400 nig daily after food, up to 360 nig daily by injection. Suppositories of 50 mg are available. Hallucinations ions are an occasional side-effect. It should be
avoided after myocardial infarction as it may increase the cardiac load. Other side effects include dizziness, nausea, tachycardia and rash. It should be avoided in opioid-dependent patients. (Fortral).
pentostatin A potent cytotoxic agent used in hairy cell leukaemia. It is an inhibitor of adenosine deaminase, and may affect RNA synthesis and cause DNA breakdown.
Dose: i.v. under specialist supervision, 4 ing/ni’every other week, continued up to 6 months unless a remission has been achieved. Side-effects include myelosuppression, leukopenia, renal and liver toxicity and rash. Blood counts are necessary during treatment. (Nipent). See page 122.
peppermint oil Aromatic carminative. Dose: 0.2 -0.4 ml. (Colpermin; Nlintec).
pergolide A dopamine agonist with a stimulating action on both D, and D, receptors. It is used in the auxiliary treatment of parkinsonism, and combined treatment may permit a reduction in the dose of levodopa and its side-effects. Dose: 100 jig daily initially, slowly increased at 3-day intervals according to response, with care taken to avoid initial hypotension. Other side-effects include nausea, diarrhoea, confusion and hallucinations. (Celance). See page 160 and
pericyazine A tranquillizer of the chlorpromazine type with similar uses and side-effects. It is used mainly in schizophrenia and severe anxiety states.
Dose: 15-75ingdaily, slowly Y increased according to need up to 300 111g. ( Neulactil). See page 168 and Table 30.
perindopril A long-acting ACE inhibitor used in the control of essential hypertension not responding to other drugs. Dose: initially, it single daily dose of 2 mg (before food), subsequently adjusted up to a maximum of 8 nig daily. Diuretic therapy should first be withdrawn for 2-3 days, and renal function should be assessed before and during treatment. It is also used as supplementary therapy in heart failure in doses of 2-4 ing. (Coversyl). See page H8 and Table 21.
permethrin An insecticide used as 1% cream for head lice, and 5% cream for scabies. (Lyclear).
perphenazine A tranquillizer with the actions, uses and side-effects of chlorpromazine, but it is less sedating, and effective in lower doses.
Dose: psychiatric and antiemetic, 12-24 nig daily. It is sometimes useful in the control of, intractable hiccup. (Fentazin). See page 168 and Table 30.
pethidine A synthetic analgesic with spasmolytic properties. Widely employed as an alternative to morphine for pre- and post-operative use. Of value in obstetrics as it has a less depressant action than morphine on the respiration.

cephamandole A cephalosporin more resistant to inactivation by penicillinases. It is of value in serious infections resistant to other antibiotics.
Dose: 2-12 g daily by i.m. or i.v. injection. : Kellidol). See page 248 and Table 34.
cephazolin A cephalosporin with the
general properties of the group.
Dose: 1-12 g daily by injection. (Kefzol). See page 248 and Table 34.
cephradine A cephalosporin active orally as well as by injection.
Dose: 1-2 g orally daily; in severe infeclions 2–8g daily by injection. (Velosef). See page 248 .
certoparin A low molecular weight form of heparin. Used in prophylaxis of venous thromboembolism.
Dose: 3000 units once a day by s.c. injection (1-2 hours before surgery) for 7-10 days. (Alphaparin). See enoxaparin.
cetirizine A slower-acting antihistamine with reduced sedative effects, as it does not pass the blood-brain barrier to any extent. The anti-cholinergic side-effects are also reduced.
Dose: 10 nigat night. (’Lirtels). See page 110 and Table 2.
cetrinnide A detergent with some antiseptic properties. It is used chiefly in association with chlorhexidine.
charcoal Activated charcoal is a powerful adsorbent, and is used in the treatment of overdose or poisoning by many toxic drugs by preventing further absorption. Dose: 50g orally. It is also used in the charcoal - haenioperfusion system to promote elimination from the circulation of sonic already absorbed poisons. Charcoal has also been used as impregnated dressings to deodorize foul smelling wounds and ulcers,
chenodeoxycholic acid A bile acid
derivative that has it solvent action on cholesterol-containing gallstones, and it is useful when surgical removal of the stones is contraindicated.
Dose: I g once daily, but prolonged treatment is necessary. Side-effects are diarrhoea and pruritus, and ursodcoxycholic acid, which has fewer side-effects, is often preferred. Chenodeoxycholic acid is not suitable for the dissolution of radio-opaque gallstones. (Chendol; Chenofalk).
chloral hydrate A water-soluble hypnotic with a rapid action that is useful in the treatment of insomnia in children and the elderly.
Dose:    g. It must be given well-diluted to reduce the gastric irritant side-effects, and is contraindicated in gastritis, and severe renal, hepatic and cardiac disease. (Notre). Chloral betaine (Well-dorm) is a less irritant alternative. See page 152 and Table 22.
chlorambucil An orally active cytotoxic drug used mainly in the treatment of lymphomas and chronic lymphocytic leukaemia.
Dose: 100-200 pgfkg daily for 4-8 weeks. It k sometimes used as an immunosuppressant in the treatment of rheumatoid arthritis in doses of 2.5-7.5 mg daily. Chloranibucil is generally well tolerated, [)of [)one marrow depression may occur, and haematological control during treatment is essential. (Leukeran). See page 122 and Table 8.
chloramphenicol A wide-range, orally active antibiotic but now used only in life-threatening infections where other drugs arc unsuitable.
Dose: 2g daily orally, but in severe infections, -So niglkg daily by i.v. injection. Care is necessary when giving chloramphenicolo infants as it may cause so-called ‘grey syndrome’. Side-effects include nausea, neuritis and aplastic anaemia. Chloromycetin is also used locally in skin, eye and ear infections. (Chloromycetin; Kcinicetine).
chlordiazepoxide A benzodiazepinc used mainly in [tic short-term treatment of anxiety and alcoholism.
Dose: 30 mg daily, increased in severe anxiety up to 100 mg daily, with half closes fix elderly patients. Withdrawal of treatment should be gradual to avoid rebound effects. Side-effects include dizziness, drowsiness and ataxia. Prolonged use carries the risk of dependence. (Librium).

chlorhexidine An antiseptic of high potency and a wide range of activity, although it is ineffective against spores and viruses. For preoperative skin preparation, a 0.5% solution in alcohol is often used; an aqueous solution (0.05%) is for general topical application. Chlorhexidine is also used as a  solution for bladder irrigation. A general purpose cream and an obstetric cream are also available. Solutions of chlorhexidine may become contaminated with Pseudomonas, and all aqueous solutions should he sterilized. (1-libitane).
irreversible retinal damage. Other side-effects are gastrointestinal disturbances, rash and prutiros. (Axioclor,). Swe page 16.3.
chlorothiazide The first of the thiazide diuretics, now largely replaced by bendrofluazide and similar drugs. Dose: 1 -2 g daily in oedematous states; 0.i-1 g daily in hypertension. Potassium supplements may be necessary with extended treatment. (Saltiric). See page 148 and Table 21.
29
chlormethiazole A sedative with anticonvul’ant properties.
Dose: in severe insomnia in the elderly, 200-400nigorally; in alcohol withdrawal conditions, 400-800 mg initially, reduced and withdrawn over a 9-day period. It may also be given by i.v. infusion as a 0.8% solution. Chlonnethiazole has also been given by injection in status epilepticus and the toxaemia of pregnancy in doses according to need and response. Side-effects are sneezing, gastrointestinal disturbances and headache. (Heminevrit) See page 136 and Table Ii.
chloroform Once widely used as a general anaesthetic, but now obsolete. Used as chloroform -water in mixtures as a preservative and flavouring agent, and for its carminative effects.
chloroquine An antimalarial drug used for both prophylaxis and treatment of benign and malignant tertian malaria. It should be noted that chloroquine- resistant strains of Plasmodiunifialciparurn are becoming increasingly common, and a return to treatment with quinine may be necessary. Dose: adult prophylaxis, 300nig once a week; (Or treatment of an attack of malaria, oWnig initially followed by 300mg daily for 2-3 days. Seriously ill or vomiting patients should be given 2(XI-300 ing by Lin. or slow i.v. injection, repeated once ifncccssary L)cfi)rc oral treatment can be tolerated. Other dosage schemes are also in use, and for details reference should be made to standard works on the treatment of malaria. It has also been used in hepatic anioebiasis, but nietronidazole is now often preferred. Chloroquinc also has an action in rheumatoid inflammatory conditions similar to that of penicillamine, dose: 150 mg daily after food. Such use requires care, as extended therapy is necessary, and the drug may cause corneal opacity and
chloroxylenol A general purpose antiseptic present in some popular products. Of no value against Pseudornonas. aeruginosa or Proteus.
chlorpheniramine An antihistamine with the action, uses and side-effects of the group, including drowsiness.
Dose: 16-24 mg daily: 10-20 mg by Lin. or .c. injection as required. (Piriton). See page 110 and Table 2.
chlorpromazine A powerful tranquillizer or antipsycholic agent with a wide range of activity on the central nervous system. It is widely used in the treatment of schizophrenia and other psychoses, in agitation and tension, and the management of refractory patients. It is also effective as an antienietic in terminal illness; in the short-term treatment of severe anxiety; and for the control of intractable hiccup.
Dose: initially 75 mg orally daily, slowly increased as required. In psychotic states, Lip to I g daily. Single doses of 25-50 mg may be given by deep imi. injection in acute conditions. Suppositories of 100 mg are also available. Side-effects include extrapyramidal and anticholinergic symptoms, drowsiness, hypotension, weight gain, rash, jaundice and haemolytic anaemia. prolonged use may cause pigmentation of the skin and eyes. Care is necessary in hepatic and renal dysfunction. Skin sensitization may occur after Contact With solutions of chlorpromazine. Margactil). See page 168 and’I'able 30.
chlorpropamide A long-acting hypoglycaemic agent of the sulphonylurea type. It is effective only if some insulin-secreting cells are still functional. It is used mainly in mild diabetes mellitus occurring in middle-aged patients not responding to dietary control. Its long action makes it unsuitable for elderly diabetics.

carbon dioxide A colourless, non-inflamniable gas. It has a stimulating effect on the respiratory centre, and a mixture of 5% of carbon dioxide in oxygen is used for respiratory depression. Solid carbon dioxide is used to destroy warts, naevi, etc.
carbonic anhydrase inhibitors These drugs, represented by acetazolamide and dichlorphenamide, have been used as diuretics as they inhibit the reabsorption of sodium and bicarbonate in the kidneys. Their use has declined as more effective diuretics have become available. They also reduce the formation of the aqueous humour and so bring about a reduction in the iruraticular pressure, and are used in the treatment of glaucoma. See page 138 and Table 16.
carboplatin An analogue of cisplatin but with generally reduced side-effects, although the myelodepression may be more severe. It is used mainly in ovarian and small-cell lung cancer.
Dose: 40 nighn’ i.v. as a single dose, repeated after 4 weeks. Blood tests during treatments are essential. Severe renal impairment is a contraindication. ( Pai aplatin). See page 122 and Table 8.
carboprost A prostaglandin with a selective action oil the myornetrium, and used in post-partum haemorrhage not responding to ergometrine.
Dose: 250 pg initially by deep i.m. injection, with subsequent doses according to need up to a total of 2 mg (not for i.v. injection). Care in asthma, epilepsy and hypertension. Nausea and vomiting are side effects. (Hemabate).
carisoprodol A muscle relaxant used in niusculoskeletal disorders and muscle spasm.
Dose: I g daily. (Carisomi).
carmustine A cytoxic agent similar to 1-viustine. It is used mainly in brain tumours, multiple myeloma and Hodgkin’s disease, often in association with other drugs.
Dose: 200 rnghii2 by slow i.v, injection, repeated at intervals of 6 weeks. Side-effects are nausea, vomiting and burning at the injection site. A delayed bone-marrow depression is often a dose-limiting factor. (BICNU). See page 122 and Table 8.
Cef
carteolof A beta-adrenaergic blocking agent used as eye drops (0.1-0.2%) in glaucoma. Some systemic absorption may occur from eye drops, and care is necessary in asthma and bradycardia. (Teoptic). See page 138.
carvedilol A non-cardiac selective betablocker with the actions and uses of propanolol.
Dose: in hypertension 12.5 mg initially, rising to 25-50 mg as a single daily dose. (hucardic). See page 148 and Table 21.
cascara A mild purgative.
Dose: dry extract 100-250 nig, liquid extract and elixir 2-5 nil.
castor oil A mild purgative.
Dose: 5-20 nil. The oil has emollient properties and is used together with zinc ointment for pressure sores and napkin rash.
catecholamines A term applied to the synipathornimetic drugs adrenaline, dopamine, noradrenaline, and related compounds, indicating that they are derivatives of catechol.
CCNU See lomustine.
cefaclor An orally active cephalosporin antibiotic used mainly in urinary and respiratory infections.
Dose: 750 ing or more, up to 4 g daily, with reduced doses in renal impairment. Nausea and diarrhoea are side-effects, but all allergic reaction indicating sensitivity may require withdrawal of the drug. (Distaclor). SeeTable 34,
cefadroxil An analogue of cephalexin. It is well absorbed orally and gives high blood levels.
Dose: 1-2 g daily, (Baran), See page 248 and Table 34.
cefatnandole See cephamandole.
cefixime A cephalosporin with the actions, uses and side-effects of the cephalosporins generally, but effective in single daily doses of 200-400 mg. (Suprax). See page 248 and Table 34.
cefodizine A cephalosporin used in lower respiratory tract infections and in urinary tract infections.
Dose: 2 g (laity by i.m. injection or i.v.

Cefotaxime A cephalosporin with an ink reased activity against many Gram-negative organisms.
Dose: 2 g daily by injection, increased in severe infections tip to 12 g daily. A single dose of 1 g is given in gonorrhoea. The side-effects are those of the cephalosporins generally. (Claforan). See page 248 and Table 34.
cefoxitin A cephaniycin with a wide range of activity and an increased potency against Gram-negative bacteria. It is of value in many infections, and is also used in surgical prophylaxis.
Dose: 3-12 g daily by Lin. or i.v. injection. (NIefoxin). See page 248 and Table 34.
cefp1ronve A beta -lactaniase- stable cephalosporin with a wide range of activity. Dose: 2 g daily i.v. (Cefrom). See
page 248 and Table 34.
cefuroxime A cephalosporin often effective against some organisms resistant to penicillin, and with increased activity
against Haemophilus inflidenzae.    27 Dose: 3-6 g daily by injection. For surgical prophylaxis and in gonorrhoea a single dose of 1.5 g. Side-effects include nausea, diarrhoea, urticaria, rash and hypersensitivity reactions. (Zinacef). cefuroxime-axetil is an orally active form. Dose: 500 mg- I g daily. (Zinnat). See page 248 and fable 34.
celiprolol A selective 0, receptor blocking agent, with some stimulating action oil receptors. The former occur mainly in the heart, the latter in the bronchi and peripheral vessels. It is used in mild hypertension, as it has a vasodilatory and cardioselective action with reduced side-effects.
Dose: 200 mg daily, at breakfast. Occasional side-effects are nausea, headache and dizziness. (Celectol). See page 148 and Table 21.
ceflaodoxime An oral cephalosporin for respiratory tract infections.
Dose: 200-400 mg daily with food. (Orelox). See page 248 and Table 34.
ceftazidime A cephalosporin resistant to most beta-lactamases, and active against a wide range of Gram-positive and Gram-negative organisms, including Pseudomonas aeruginosa, although it is less active against Staphylococcus aureus. Valuable in both single and mixed infections.
Dose: 1-6g daily by injection, reduced in cases of renal impairment. In pseudontonal lung infections associated with cystic fibrosis, 1(4-150nit
g/kg daily. Side-effects include abdominal disturbance and local reactions at the injection site. (FortUol; Ket”adirn). See page 248 and Table 34.
cettibuten An oral cephalosporin similar to cefaclor, but with a longer action. Dose: 400 nigas a single daily (lose. (Cedax t. See page 248 and Table 34.
ceftriaxone A cephalosporin of the cefaclor
Jtype given as a single daily dose of I g by eep i.m. or slow i.v. injection, doubled in severe infections. With high doses vary injection site. (Rocephin). See page 248 and Table 34.
cephalexin An orally active cephalosporin Of value in infections of the respiratory and urinary tracts, and in naso-oral and soft-tissue infections.
Dose: 1-2 g daily, but lower (loses are indicated in renal impairment. Cephalexin is usually well tolerated, but sonic gastrointestinal disturbances may occur. (Ceporex; Kellex). See page 248 and Table 34.
cephalosporins A group of antibiotics with properties similar to those of the penicillins, but having a wider range of activity. Some are active orally, others may have to be given by injection.
Cefotaxime, ceftazidime and ceftizoxime have an increased activity against Gram-negative bacteria, but are less potent against Staphylococcus aureus and Gram-positive organisms generally. Cefititoxin is active against bowel organisms. An indication of the range and dose is given in the table on page 248. The higher doses are given in severe infections; reduced doses should be given in renal impairment. The main side-effect of the cephalosporins is hypersensitivity, and cross- sensitivity to the penicillins is not uncommon. Sensitivity to one is likely to extend to all members of the group. The cephalosporins call affect blood-clotting mechanisms.