Posts Tagged ‘diarrhoea’

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

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

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

salbutamol A selective beta,- adrenoceptor  It is widely used to relieve bronchospasm in airway obstruction, including bronchial asthma and status astliniaticus, with the advantage of being largely free from cardiac side-effects. Dose: up to 16 ing orally daily; by aerosol inhalation (in which patients should be carefully instructed) 100-200 pg ( 1-2 puffs) Lip to 4 times a day; by s.c. or i.m. injection 500 pg as required; 250 pg by i.v. injection. Salbutamol also, relaxes uterine muscle, and is given in premature labour in doses of 10 pg/inin initially by i.v. infusion, increased to 45 pg/min until contractions have ceased, when oral therapy may be given. Side-effects include tremor, headache, peripheral vasodilation and tachycardia. Care is necessary in ischacinic heart disease, hypertension pertension and hyperthyroidism. (Ventolin). See page 118 and Table 6.
salcatonin A synthetic form of calcitonin, preferred for extended use, as it is less likely to provoke allergic reactions. Dose: in hypercalcaemia, 5-10 units/kg ,fail), 1)), s.c. or Lin. injection according to need; in Paget’s disease 60 units 3 times a week up to 100 units daily. It is also used in post - menopausal osteoporosis and for the bone pain of malignancy. (C.alcynar; Miacalcic).
salicylic acid Etas useful keratolytic and fungicidal properties. Used as ointment (2%) for skin conditions, and as ointments and plasters (up to 40%) for corns and warts.
salmeterol A beta,-adrenoceptor stimulant of the salbutamol type, but with a longer action. It is used for the extended prophylaxis of asthma, bronchitis and other forms of obstructive airway disease, and together with corticosteroid therapy if required. It is not indicated in acute conditions.
Dose: 50 pg twice daily, either from a metered dose aerosol or by a ‘Disklialer’. salmeterol is well tolerated, but headache, tremor and tachycardia may occur with doses above 200 pg daily. (Serovent). See page 118 and,rable 6.
saquinavirV An antiviral agent that inhibits the enzyme HIV-protease, and prevents the development of immature virus particles into the infective virus. Used in HIV
infection together with it nucleoside analogue that has a different action.
Dose: 1.8g (laity. (Invirase). See page 1+1 ;111,1 TAIle 19.
scopolamine See hyoscine.
selective serotonin re-uptake inhibitors (SSRIS) A small group of drugs that inhibit the re-uptake ofserotonin in the central nervous system, and are used in the treatment of depression. They differ from the tricyclic antidepressants in being less likely to cause sedation or cardiac disturbances, or have anticholinergic side-effects. Care remains necessary with machine-related activities, and before and after monoamine oxidase inhibitors (MAOI) therapy. See page 128 and Table 11.
selegiline A selective enzyme inhibitor that prevents the inactivation of dopamine in the brain. It is used to supplement the action of levodopa in the treatment of parkinsonism, and combined use may give a smoother response, and permit a reduction in the dose of levodopa.
Dose: 5-10111g daily. It may cause nausea and hypotension, and may possibly increase the side-effects of levodopa. (Eldepryl). See page 160 and Table 26.
selenium sulphide Used as a shampoo in the treatment ofdandrull’. Prolonged use may cause alopecia. (Selsun).
senna The leaves and pods of Cassia sp., used as a purgative. Standardized preparations such as Senokot are now preferred.
sermorelinV A synthetic analogue of soniatorelin, the growth hormone releasing factor (GHRH). It is used in the diagnosis of growth hormone deficiency as a single i.v. dose of I pg/kg. (Geref 50).
sertindoleV An antipsychotic agent with a selective action on the limbic system, and used in acute and chronic schizophrenia. Dose: 4 nig once (laity initially, increased alter 2-4 days up to 20 mg daily according to need. Blood pressure should he monitored initially as hypotension may occur.  Contraindicated in patients receiving itraconazole, ketoconazole,  terfanidine, or any drug known to affect the QT interval. (Serdolect). See page 168 and Table 30.

serotonin A substance present in many body cells, which also acts as a neurotransmitter in the central nervous system. A reduction in the brain serotonin levels may be associated with depression and the cranial
vasodilation associated with migraine. (See page 154). Some allergic reactions may also be linked with the action of serotonin on sensitized cells (see cyproheptadine).
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colic and vomiting, but death from adder bite is very rare. If the reaction to an adder bite is severe, European viper anti-venom, if available, should be given by i.v. infu-
sion within 4 hours of the bite.
soda-lime A mixture of calcium and sodium hydroxides, used in closed-circuit anaesthetic apparatus to remove carbon dioxide.
sertraline A selective serotonin-re-uptake inhibitor (SSRI) antidepressant used both for the treatment oftlepression and the prevention of relapse.
Dose: 50 rig daily initially with food, increased at weekly intervals tip to a maximum of 2(0 mg daily. Not to be given with nionoanlilic oxidase inhibitors (MAOls). Side-effects are tremor and a dry mouth. (usual). See page 128 and Table 11.
silicones Synthetic water-repellent substances present in barrier creams and other skin protective products. Dimethicone is a silicone used as an anti-foaming agent in some antacid preparations.
silver nitrate Used mainly as silver nitrate sticks (caustic points) for cauterizing warts. It has also been used as a 0.5% lotion for suppurating lesions. It was once used prophylactically as eye drops (0.1%0) in the newborn, and is still used for that purpose in the USA.
silver sulphadiazine Sulphadiazine combined with silver. It is used topically as a I% cream for its wide-range antibacterial properties in burns and infected skin conditions, especially when an extended action is required. It is active against Pseudornonas aertiginosta and other Cram- negative organisms. (Flamazine).
simvastatin A selective inhibitor of a specific enzyme (I-IMGCOA reductase) concerned with the synthesis of cholesterol in the liver. It is used in the treatment of primary hypercholesterolaernia in patients not responding to other drugs. Dose: 10-40 mg at night. Liver function tests should be carried out regularly. Side effects include gastrointestinal disturbances. (Zocor). See page Wand Table 20.
snake-bite antivenom A bite from an adder, the only poisonous snake indigenous to the UK, can cause local pain and swelling as well as systemic effects such as
sodium acetrizoate An iodine compound used as a contrast agent in i.v. pyelography.
sodium aurothiomalate A gold compound used in the treatment of active rheumatoid arthritis. It is no value in other forms of the disease, or where bone change has already occurred.
Dose: 10 mg by deep Lin. injection weekly initially, slowly increased to 50 mg weekly. and continued until a remission occurs, or until a total dose of I g has been given.
Blood and urine tests are essential after each injection. After remission, 20-50 mg may be given every 2-1 weeks for many months. Side-effects are common, and include blood disorders, skin reactions, mouth ulcers and oedenia, anti may require withdrawal of the drug. It is contraindicated in renal and hepatic disease, blood dyscrasias and hypertension. (Myocrisin). See auranoran,
page 165 and Table 29.
sodium bicarbonate A soluble antacid, often used in association with less soluble antacids such as magnesium carbonate or trisilicate.
Dose: 1-4 g. In severe metabolic acidosis it is given by slow i.v. injection as an 8.4% solution. For alkalization of the urine, up to 3 g orally 2-hourly with further 10 g
doses daily as required.
sodium calcium edetate A chelating or binding agent used in poisoning by lead and other heavy metals.
Dose: 80 mg/kg daily by i.v. infusion in glucose/saline solution. Nausea and cramp are side-effects, and care is necessary in renal impairment. Medclair).
sodium cellulose phosphate An ion-exchange compound that binds with calcium in the intestines, and so reduces calcium absorption. Used in the oral treatment of hypercalcaemia and renal stones, and as an adjunct to low-calcium diets. Dose: 15 g daily. Diarrhoea is an occasional side-effect. (Calcisorb)•

sodium chloride An important constituent of blood and tissues. It is widely used by i.v. infusion as normal saline solution (0.9%), or as glucose-saline in the treatment of dehydration, shock and other conditions of sodium depletion. It is also useful when given orally as Sodium Chloride with Glucose Oral Powder (BNF) (after solution in water), for children with diarrhoea to offset any loss of salt. Its use as an emetic in the treatment of poisoning is no longer recommended. It is used externally as saline solution when a simple cleansing lotion is required.
sodium citrate An alkaline diuretic similar to potassium citrate and given for similar purposes.
Dose: 1-4 g. For citrating milk, 100 mg to each feed may be used. A 3% solution is used by bladder irrigation for the dissolution of blood clots.
sodium clodronate See clodronate, editronate and pamidronate.
sodium cromoglycate An antiallergic agent with a specific action and used for the prophylactic treatment of asthma by inhalation. It stabilizes mast cells and inhibits the release of histamine and other spasmogens that cause bronchospasm. Dose: by powder inhalation from a `Spinhaler* 20 mg up to 9 times a day; by aerosol inhalation, 10 mg (2 puffs) up to 8 times a day. Dose in the treatment for food allergy associated with local inflammation, 800 mg daily orally. It is also of value as eye drops (2%) and eye ointment (40/4) in allergic conjunctivitis, and as nasal drops or spray (2%) in the prophylaxis of allergic rhinitis. (Intal, Rvilacrom). See page I I O and Table 2.
sodium fluoride The fluoride present in dentifrices used to reduce dental caries. It may also be given orally when more intensive treatment is required.
Dose: 250-5001igdaily.
daily by i.v. infusion. Side-effects include nausea, rash and jaundice. Liver function tests should be carried out during treatment. (Fucidiu).
sodium hypochlorite A weak solution of sodium hypochlorite containing 0.25% of available chlorine is used as eusol, for the cleansing of wounds and ulcers. The
Solution is unstable and should be freshly prepared. Its value has recently been questioned. Stronger, stabilized solutions are used for the general disinfection of surfaces contaminated with blood and other body fluids. Their use reduces the risk of transmission of hepatitis and other viral infections.
sodium ironedetate (sodium feredetate) A soluble iron complex available as a solution containing 27.5 mg of iron per 5 nil. It is used in the oral treatment of iron-deficiency anaemias, and is of value when other iron preparations are not tolerated. Dose: 15-30 nil daily. (Sytron). See page 112 and Table 3.
sodium lactate Has been used as M/6 solution, or as Hartmann’s solution, by i.v. infusion for metabolic acidosis, but sodium bicarbonate is now preferred.
sodium nitrite A cyanide antidote.
Dose: as it 30/b solution by i.v. injection of 10 nil, followed by the slow injection of 25 nil of sodium thiosulphate solution (50%). Early treatment is essential. See kelocyanor.
sodium nitroprusside A short-acting arteriovenous vasodilator used in hypertensive crisis and for controlled hypotension during anaesthesia.
Dose: by i.v. infusion, 0.3-1 pg1kg/juin, the lower doses being used to obtain hy
, poten-
sion during surgery. It is also used in acute heart failure in doses of 10-1 5 pg/niin, increased as required to 2001ighnin.
sodium fusidate An antibiotic used mainly in penicillin- resistant staphylococcal infections, although a secondary anti-staphylococcal antibiotic is often given to increase the response and inhibit drug-resistance. It is useful in osteomyelitis and similar conditions as it penetrates into bone tissues.
Dose: 2 g daily. In severe infections, 1.5 g
sodium perborate White powder soluble in water, with antiseptic and deodorant properties similar to hydrogen peroxide. A 2% solution is used as a mouthwash.
sodium phosphate A solution of sodium phosphate with sodium acid phosphate is sometimes used by enema as a laxative.

phenazocine A synthetic morphine-like analgesic, with similar properties and uses, but with a more rapid and prolonged action. It is of value in biliary colic, as it is less likely to cause a rise in biliary pressure. Dose: 20-30 ing daily, orally or subling tially, although single doses as high as 20 mg are sometimes given. The side-effects are similar to those of morphine and related drugs, but sedation and the risk of dependence is less. (Narphen).
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Dose: oo- 180 ing daily, at night, adjusted lo need and response. In severe conditions, doses of 50-200 mg may be given by i.m. or i.v. injection. Side-effects include drowsiness and skin reactions. In the elderly it may cause confusion, and paradoxically it may give rise to hyperkinesia in some children. See page 136 and Table 15.
phenol Once widely used as a general antiseptic. Weak solutions relieve itching, and phenol is present in Calamine Lotion. A 5% solution in almond oil is used for the iniection treatment of haemorrhoids.
phenelzine A monoamine oxidase inhibitor, used in the treatment of depression. Dose: 45-60 ing daily, according to need and response. It has many side-effects, including dizziness. dry mouth and blurred vision. Very severe hypertension has been precipitated by some foods, notably clicese. Care is necessary in cardiovascular disease and epilepsy. It may also potentiate the action of other drugs on the central nervous system. (Nardil). See monoamine oxidase inhibitors, Page 128 and’I'able 11.
phenindamine An antihistamine ofinedium potency. It differs from most antihistamines in having a mild central stimulant action, and so rarely causes drowsiness.
Dose: 75-200 ing daily. IThephorin). See page I 10 and Table 2.
phenindione An orally active anticoagu last used in the control of deep-vein thrombosis.
Dose: 200 mg initially; maintenance, 25-100 mg daily, depending on laboratory reports of the prothrombin time. Side- effects include hypersensitivity reactions and haemorrhage. Patients should be warned that the drug may colour the urine. Phenindione has now been largely replaced by %varlarill, (Dindevan).
pheniramine An antihistamine similar to but less potent than chlorpheniramine. Dose: 150 ing daily. (Daneral SA). See page 110 and Table 2.
tphenobarbitone A powerful sedative, hypnotic and anticonvulsant drug. It is mainly of value in epilepsy, as it is effective in most types of seizure except petit mil (absence seizures).
phenolphthalein A synthetic laxative. It is sometimes given with emulsion of liquid paraffin.
Dose: 50-100 mg daily. It may occasion alit/ cause a rash, and its use has declined.
tphenoperidine A narcotic analgesic, often used in association with droperidol in neuroleptanalgesia. It is also used as a supplementary analgesic in general anaesthesia.
Dose: 0.5-1 mg i.v. with subsequent doses as required. It may cause respiratory depression, which can be controlled by doxapram or naloxone. (Operidine).
phenothrin An insecticide used as 0.2% lotion for head and crab lice. (Fill] Marks).
phenoxybenzamine An alpha-adrenoceptor blocking agent used in the severe, episodic hypertension associated with phaeochroniocytoma.
Dose: orally and by injection, 10–20 mg according to need and response. Side-effects include dizziness and tachycardia; rapid and marked hypotension after injection. (Dibenyline).
phenoxymethylpenicillin An orally active, acid-stable penicillin, also known as penicillin V. It is used mainly in respiratory infections in children, in tonsillitis, and to supplement injection treatment. It is not suitable for use in severe infections. Dose: I - 2 g daily, before food. Doses of .500 mg daily are given in rheumatic fever and pneumococcal prophylaxis.
tphentermine An appetite depressant given ill the short-term treatment of obesity. Dose: 13–30 mg before breakfast. (DUramine: lonamin).

phentolamine An alpha-adrenoceptor blocking agent that can temporarily reverse the vasoconstrictive action of adrenaline and noradrenaline. It is used mainly in the diagnosis and control of the episodic hypertension of phaeochromocy- toma, and during surgical removal of the tumour.
Dose: 2-5 ing i.v. repeated as required. Side-effects are tachycardia, hypotension, dizziness, nausea and diarrhoea. (Rogitine).
phenylbutazone A powerful, non-steroidal anti-inflammatory agent, formerly used in the treatment of rheumatic and arthritic conditions. Because of blood dyscrasias, which may occur suddenly, the drug is now used only for the treatment of ankylosing spondylitis under hospital supervision.
Dose: 400-600 mg daily. (Butacote). See page 165 and Table 29.
phenylephrine A vasoconstrictor similar to .”Irvildlille, but less toxic. Given in acute hypotensive states.
Dose: 5 mg by i.m. injection, or 100-500 pg by slow i.v. injection. Sometimes valuable in paroxysmal atrial tachycardia. It is also used locally as 1:400 solution as nasal decongestive, and as eye drops, 2.5-100/6.
phenylpropanolamine A sympatho11111lictic agent used with other drugs in preparations for the symptomatic relief of nasal congestion.
phenytoin An anticonvulsant used in all forms of epilepsy with the exception of petit mil (absence seizures). It has little hypnotic effect and combined treatment with phenobarbitone may evoke the best response.
Dose: 150-600 mg daily with or after food. In status epilepticus it is given under ECG control in doses of 10-15 mg/kg by slow i.v. injection. It is also given to control ventricular tachycardiac in doses of 3.5-5 mg/kg by slow i.v. injection via a cavil catheter. The side-effects of
extended treatment are numerous, and include rash, dizziness, blood dyscrasias, hirsutism and gingival hypertrophy. (Epanutin). See page 136 and Table 15.
pholcodine A cough centre depressant resembling codeine, but it lacks any analgesic properties. It is present in a range of
products used for the relief of useless cough, and has the advantage over codeine of not causing constipation.
Dose: 10-60 mg daily.
physostigmine A plant alkaloid, also known as eserine, once used as a miotic (0.25-1%) to counteract the effects of atropine.
phytomenadione Vitamin K,. The form of vitamin K used in the prophylaxis and treatment of neonatal haemorrhage due to vitamin K deficiency.
Dose: I mg by i.m. injection. It is also of value in the haemorrhage due to overdose of oral anticoagulants. Dose: 10-40 mg by slow i.v. injection. In less severe condi-
tions, 10-20 mg orally, according to the base-line prothrombin time. (Konakion).
pilocarpine A plant alkaloid with a miotic action similar to, but less intense than that of physostigmine.
Dose: in glaucoma as eye drops of 0.5-41!4,, 3-6 times a day. Occasionally given in doses of 15-30 mg daily with food to reduce the dry mouth associated with irradiation of the head and neck.
(Salagen). See page 138 and Table 16.
pimozide A tranquillizer with the actions and uses of chlorpromazine. It is used mainly in the treatment of schizophrenia, as it reduces the delusions without causing drowsiness.
Dose: 10 mg daily initially, adjusted up to a maximum of 20 ing daily, with maintenance doses according to response.
Similar doses are given in mania and psycho-motor agitation. The side-effects are similar to those of chlorpromazine. (Orap). See page 168 and Table 30.
pindotol A beta-receptor blocking agent, with actions and uses similar to those of propranolol. Less likely to cause bronchospasm.
Dose: 7.5-15 nig daily. (Visken). See page 148 and Table 2l.
piperacillin A semi-synthetic penicillin with a wide range of activity that extends to Pseudomonas and anaerobes. It call be used in association with other antibiotics in life-threatening and multiple infections. Dose: in severe infections, 200-300mg/kg daily by i.m. or slow i.v. injection or infusion, increased in life-threatening infections to 16g daily. In less severe infections, 100-150ing/ki; i.m. daily, with a maximum single dose of 2g. (Pipril). Sometimes given with the beta-lactamase inhibitor tazobactam as the mixed product Tazocin.
piperazine An effective anthelmintic against threadworms and roundworms. Dose: 2-4 years, 750 ing; 5-12 years, 1.5 g; in children over 12 years and in adults, 2 g; as a single daily dose for 7 days, repeated if necessary after I week. For roundworm, a single dose of 4 g is given, but as the worms are narcotized, and not killed, a purgative is necessary to ensure expulsion. Side-effects are nausea, diarrhoea and occasional dizziness. Care is necessary in renal impairment, epilepsy and psychiatric conditions.
I Pot
Dose: 1.5-3 nig daily. Side-effects include drowsiness, nausea, dizziness and weight gain. (Sanomigran). See page 154 and Table 23.
podophyllum resin A plant extract used topically as a paint (0.5-25% in alcohol) for anogenital and plantar warts. It is very irritant to normal tissues, and its use requires care. (Condyline; Warticon).
polygellne A modified gelatin, used with sodium chloride and other electrolytes as a [)food volume expander.
Dose: 500-1000 ml by i.v. infusion. (1-lacniaccel).
polynnyxin 8 An antibiotic used by local application for infections of the car, eye and skin. It is too toxic for systemic use.
pipothiazine A chlorpromazine-like drug, with similar uses and side-effects, but given mainly as a depot preparation for the maintenance treatment ofschizophreiiiii. Dose: Wier a test dose of 25 mg) 50-IMnig by deep i.m. injection every 4 weeks, increased if necessary up to a maximum of 200 mg per dose. (Piportil Depot)• See page 168 and Table 30.
piracetamV A new drug used for the treatment of the spasmodic condition cortical myoclonus.
Dose: 7-20 g daily. Side-effects include diarrhoea, nervousness and rash. (Nootropil).
piroxicam A non-steroidal anti-inflammatory agent (NSAID) with all extended action, and used in arthritis, spondylitis, gout and musculoskeletal disorders. Dose: 20-30 mg daily; up to 40 ring daily in gout and other acute conditions. It is also used for local application as a 3% gel. As with related drugs, side-effects include gastrointestinal disturbances of varying severity, especially with higher doses. Weldene). See page 165 and Table 29.
pivampicillin A derivative of ampicillin, with similar actions and uses. Is hydrolyzed to ampicillin after absorption, but gives higher blood levels. Much is excreted in the urine, so it is of value in urinary infections. Dose: I -2 g daily. (Pondocillin).
pizotifen A serotonin antagonist used in the prophylaxis of migraine, and vascular headache.
polymyxin E See colistin.
polystyrene resin An ion-exchange resin [or the removal of potassium in
conditions associated with hyperkalaemia, as in oliguria and anuria.
Dose: 15 g 3•4 times a day according to the plasma level of potassium. When the drug is not tolerated orally, 30 g daily as a suspension may be given per rectum. Care is required in renal or hepatic impairment. (Resonium).
polythiazide A potent diuretic with the action, uses and side-effects of the thiazide diuretics but effective in the low dose of 1-4 ing daily. (Nephril).
poractant A lung surfactant used in the respiratory distress syndrome of premature infants. It is given by endotracheal tubing with mechanical ventilation.
(Curosurf).
potassium One of the most important ions of the body, mainly present in intracellular fluid. Many diuretics increase loss of potassium as well as sodium; with extended
treatment the potassium balance may be disturbed, with acute muscle weakness, cardiac arrhythmias, and an increased sensitivity to digitalis. Potassium loss can 1-w treated with potassium chloride orally (often as Slow-K, but may cause peptic ulceration), or by effervescent potassium tablets. Mixed diuretic and potassium products are also available.

co-fluampicil -tablets of flucloxacillin and ampicillin
co-flumactone Tablets of spironolactone and hydrochlorothiazide.
colchicine The alkaloid obtained from meadow saffron. It is used in acute gout. Dose: 500mg every 2 hours until relief is obtained. A total dose of 10mg should not be exceeded, but relief of pain or the onset of vomiting or diarrhoea usually renders full doses unnecessary. It is also used prophylactically in doses ol’500pg 2 or 3 times a day during early treatment with allopurinol, probericcid and sulphiripyrazone. Gire is necessary in the elderly, and in renal impairment. See page 140 and’I'able 17.
corticotrophin The adrenocorticotrophic hormone of the anterior pituitary gland. It stimulates the production of corticosteroid hormones by the adrenal cortex. It is now used mainly as a test of adrenocortical function. See tetracosactrin.
Hydrocortisone.
cortisone one of the corticosteroids secreted by the adrenal cortex. Although it is rapidly absorbed orally, it is inactive until converted in the liver to hydrocortisone. It therefore has the actions, uses and side-effects of hydrocortisone, which is often the preferred corticosteroid. It should be noted that cortisone is of no value for topical application. See hydrocortisone, page 250 and Table 36.
colestipol An exchange resin used in hyperlipidaemia that acts by binding with bile salts in the gut and preventing their reabsorption, and so indirectly lowers the plasma level of cholesterol.
Dose: 10-30g daily. May interfere with the absorption of many drugs. (Colostid). See page 146 and Table 20.
colfoseeril A pulmonary surfactant used in the respiratory distress syndrome of the new-born. (Exosurf). See beractant.
colistin An antibiotic used mainly for bowel sterilization.
Dose: 4.5-9 mega-units daily. In systemic gram-negative infections 2 mega-units 8-hourly by injection have been used, but less toxic antibiotics are now preferred. Colonlycin).
collodion When applied to the skin, it dries to form a flexible film, and is used as a vehicle for the extended local application of drugs such as salicylic acid.
co-phenotrope tablets of diphenoxylate
and atropine. (Lomotil; Tropergen).
co-prenozide Tablets of oxprenolol and cyclopenthiazide. (Trasidex).
co-proxamol Tablets  and paracetamol. (Distalgesic).
corticosteroids Hormones secreted by the cortex of the suprarenal gland. The principal hormone is hydrocortisone but more potent synthetic derivatives such as dexamethasone are also in use.
co-tenidone Tablets of atenolol and chlorthaliclone. (Tenoretic).
co-triamterzide Tablets of hydrochlorothiazide and triannerine. (Diazide).
co-trimoxazole A mixture of trimethoprini and sulpliaiiietlioxazole. Trimethoprim, like the sulphonamides, interferes with the folic acid cycle of bacterial metabolism, but at a different point, and the mixture has an increased antibacterial action. It was once widely used, but is now advised only for Prieunjocystis carinii pneumonia. Occasionally given in acute bronchitis and urinary infections when no other drug is acceptable.
Dose: 120 nig/kf; daily lot- 14 days; 960 ing 12-hourly by i.v. infusion. (Bactrin); Septrin).
coumarins Compounds that depress the formation in the liver of prothrombin and other blood coagulation factors. See warfarin and phenindione.
counter-irritants Substances, also referred to as rubifacients, that, when applied to the skin, produce a mild, local irritation and inflammation, and give symptomatic relief in painful conditions of the muscles and joints. Creams and liniments containing methyl salicylate, turpentine, capsicum resin and menthol are examples of rubifacients.
crisantaspase Asparagine is an aminoacid essential for the development of some malignant cells. Crisantaspase is an enzyme, also known as asparaginase, that breaks down asparagine, and so has an indirect cytotoxic action. It is used to induce remission in acute lymphoblastic leukaemia in children.
Dose: (after pre-treatment with other drugs): 1000 units/kg by slow i.v. injection daily for 10 days. Side-effects include anaphylactic reactions, and skin tests to detect hypersensitivity
are essential before initial and re-treatment. (Erwinase).
crotamiton An ascaricide and antipruritiL. Used by local application as cream or lotion (10%) in the treatment of scabies and itching conditions. (Eurax).
crystal violet A dyestuffwith a selective action against Gram-positive organisms and yeasts. Used as a 0.5% solution for infected skin conditions, and for skin
preparation.
cyanocobalamin The anti-anaemic factor present III liver. It is specific in the treatment of pernicious anaemia and its neurological complications, and of value in some other anaernias due to nutritional deficiencies.
Dose: in pernicious anaemia, I Ing by i.m. injection at monthly intervals. It has been largely replaced by hydroxocobalamin, which has a more prolonged action. (Cytanien). See page 112 and’I'able 3.
cyclizine An antihistamine, used mainly in I ravel sickness and nausea generally. Also useful in vertigo.
Dose: 100-150 mg daily. Side-effects include dryness of the mouth, headache and drowsiness. (%Ialoid).
cyclopenthiazide A thiazide diuretic with the actions, uses and side-effects of bend roll tiazide.
Dose: I mg initially, 250-500mg daily or on alternate days, in the morning, according to need. (Navidrex). See page 148 and Table 21.
cyclopentolate An anticholinergic agent use(] to produce cycloplegia and mydriasis. The action is more rapid and less prolonged than atropine, particularly in children. (Mydrilate).
cyclophosphamide A widely used alkylating
cytotoxic agent, active orally and by injec-
tion. Used in I lodgkin’s disease, chronic
lymphocytic leukaemia and lymphomas. Dose: 100-300 Ing daily, orally or i.v., or 300 mg-1 g weekly. A high fluid intake is necessary, as a metabolite may cause hacm- ( )rrhagic cystitis, and it is sometimes used with mesna to reduce the risk of such cystitis. Nausea and vomiting are common side-effects, as is epilation with high doses. (Endoxana). See page 122 and Table 8.
cyclopropane An inhalation anaesthetic of high potency with which induction and recovery are rapid. It causes some respiratory depression and cardiac irregularities, and its administration requires care. It is used with closed-circuit apparatus as it forms an explosive mixture with air and oxygen. Supplied in orange-coloured cylinders.
cycloserine An antibiotic used in
pulmonary tuberculosis when standard drugs are ineffective. Occasionally used in urinary infections.
Dose: 250-750 mg daily. Side-effects include drowsiness, vertigo and rash. See page 170 and Table 31.
cyclosporin An antibiotic with a powerful inuininosuppressant action. It is used under expert control to prevent graft rejection in organ and bone marrow transplantation, and in the prevention of graft-versus-host disease (GVI-ID). Prolonged therapy over some months may be required. Side-effects may include tremor, gastrointestinal disturbance, hypertrichosis and nephrotoxicity (Neural; Sandinimun).
cyproheptadine A compound with antihistamine and antiserotonin properties. Sonic allergic reactions are due not only to histamine, but also to serotonin, and cyproheptadine is useful in conditions not responding completely to an antihistamine. Dose: 4-20 ing daily. It has been used as an appetile stimulant in doses of 12 mg daily and in refractory migraine. (11criactin). See page 110 and Table 2.
cyproterone An anti-androgen used to reduce libido in sexual deviants. Dose: 50-100 nig daily. It is also used in the palliative treatment of prostatic carcinoma, particularly in advanced cases that have become resistant to other therapy. Dose: 300 mg daily.

clobazam A benzodiazepine tranquillizer with the actions and uses of diazepam, but with reduce(] sedative effects. It is used mainly in the short-term treatment of anxiety.
Dose: 20-30 mg as a single nightly dose. III severe anxiety larger but divided doses niav be given under medical control. It is also useful in the auxiliary treatment of epilepsy. (Frkiuni). See page [ 17 and'i'able.5.
clobetasol A potent corticosteroid used as a cream or ointment (0.05%) in the short-term treatment of severe inflammatory skin conditions not responding to less powerful drugs. The application should be used sparingly as absorption with systematic and local side-effects may occur with excessive or prolonged treatment. (Dermovate).
clobetasone A locally acting corticosteroid, used as a cream or ointment (0.05%) in eczema and inflammatory skin conditions not responding to less potent drugs. (Fumovate).
be withdrawn. Clofibrate may potentiate tile action of oral anticoagulants.
clomiphene An anti-oestrogen used to stimulate ovulation in some types of anovulatory sterility.
Dose: 50 mg daily for 5 days a month, repeated if ovulation does not occur, Its use has resulted in occasional multiple births. If pregnancy does not follow tip to 6 courses, further treatment is of little use. Side-effects are hot flushes, and abdominal discomfort; visual disturbances indicate that treatment should be withdrawn. Contraindicated in hepatic disease and ovarian neoplasm. (Cloinid; Scroplictic).
clomipramine A tricyclic antidepressant with the actions, uses and side-effects of inupramine and related drugs, but with reduced sedative properties.
Dose: 30-150 mg daily orally; up to
150 nog daily by im. injection. (Anafranil). See page 128 and Table 11.
clodronate sodium A bisphosphonate used like etidronate and pamidronate in the hypercalcaemia of malignancy.
Dose: 1.6-3.2 g daily as a single dose
I hour before or after food. May also be given i.v. by infusion as a single daily dose of 300 mg for 7-10 days. Long oral treatment is necessary, and serum calcium and phosphate levels should be checked. Side-effects are nausea and diarrhoea. (Hollefos; Loron).
clofazimine An antileprotic agent given in association with dapsone and rifampicin to prevent the incidence of resistance. Dose: 300 Ing monthly; in lepra reactions, 300 ing daily for 3 months. It may cause discoloration of the urine, skin and lesions. (Lunprcric).
clofibrate A plasma lipid-regulating agent used in hyperlipidaernia in conjunction with dietary measures, to reduce excessive plasma levels of cholesterol and
t riglycerides.
Dose: 2 g daily, with regular checks on plasma lipid levels. Side-effects are transient nausea and abdominal discomfort.
It increases the biliary excretion of cholesterol, and gall stones are a contraindication. A myosins-like reaction may occur in renal impairment, and the drug should
clonazepam A benzodiazepine with a marked anticonvulsant action of value in all types of epilepsy.
Dose: I mg daily initially, increased LIP to 8 nog daily according to need. fit status epilepticus, I mg by slow i.v. injection, but apnoea and hypotension, requiring prompt treatment, may occur. Side-effects include drowsiness, dizziness and irritability and occasionally, paradoxical aggression. (Rivotril). See page 136 and Table 15.
Clonidine A centrally acting antihypertensive pertensive agent, now used less frequently.
Dose: 150-300pg daily initially, increased it required up to 1.2 mg daily. Doses of 150-300 pg have been given by slow i.v. injection. Sudden withdrawal of the drug may provoke a I P
hy ertensive crisis.
(Catapres). Clonidine is also used in doses of 100 pg daily in the prophylaxis of migraine. (Dixarit). The side-effects include sedation, dry mouth, fluid retention and bradycardia. See pages 154 andTible 21.
clorazepate A benzodiazepine tranquillizer with the actions, uses and side-effects of diazepam. Used mainly in the short-term treatment of anxiety.
Dose: 7.5-22.5 mg daily, or it single dose of I  mg at night. (Tranxene). See page 117 and Table 5.

clotrimazole An antifungal agent used local]) in vaginal candidiasis.
Dose: 104-200 mg as vaginal tablets or pessaries for nightly insertion. Also used as a 1% cream, lotion or dusting powder for fungal infections of the skin and cars. Side-effecis are local irritation and erythema. (Canestall).
cloxacillin An acid-stable, semi-synthetic penicillin that is not broken down by the enzyme penicillinase, and so is effective in infections due to penicillin-resistant staphylococci.
Dose: 2 g daily before lbod. In severe infeL bons 250-500mg by injection 6-hourly. Now largely replaced by flucloxacillin. The side-coccus are those of the penicillins generally. (Orbenin).
antibacterial action, but when given with a penicillin the antibiotic is able to
penetrate into the cell without loss of
activity. The combination is of value in    33 infections due to penicillin-resistant penicillinase-producing bacteria, including most staphylococci.
Dose: as amoxycillin 750 mg daily, doubled in severe infections, or 3-4 g daily by slow i.v. injection. The side-effects, are similar to those of arnpicillin, but a posttreatment reaction is cholestatic jaundice. (Augmentin).
co-beneldopa tablets of levodopa and henzerazide. (Madopar). See levodopa.
cocaine A local anaesthetic. Still used occasionally in ophthalmology as a 2% solution, often with homatropine.
clozapine A potent but potentially toxic dopamine-receptor blocking agent used in schizophrenia resistant to other drugs.
Dose: 12.5-50 mg daily initially (with care -risk of hypotension), slowly increased to 300 mg daily according to need. A serious side-effect is neutropenia that may lead to agranulocytosis, and treatment must be
Linder hospital supervision with regular blood monitoring. Patient, doctor and hospital pharmacist must be registered with the Clozaril (clozapine) Patient
Monitoring Service to maintain the necessary strict control of treatment. (Clozaril).
coal tar Tile black viscous liquid obtained from the distillation ofcoal. It is used mainly as Zinc and Tar Paste in psoriasis and atophic eczema.
co-amilofruse tablets of the diuretics ainiloricle and frusemide. (Fruinil; Lasoride).
co-amilozide Tablets of the diuretics amiloride and hydrochlorothiazide. (Moduretic).
co-amoxicla A mixture of clavulinic acid and amoxycillin.The resistance to penicillin by staphylococci and other organisms is due to penicillinases such as beta-lactamase in the bacterial cell wall. Those enzymes inactivate penicillin before it call enter the cell and exert its antibacterial action. Such inactivation can be prevented by inhibitors of beta-lactamase such as clavidanic acid. That acid has no
co-careldopa Tablets of levodopa and carbidopa. (Sinemet). See levodopa.
co-codamol Tablets of codeine and paracetamol.
co-codaprin Tablets of codeine and aspirin.
co-darrthramer Tablets of danthron and poloxamer.
cod-liver oil A rich source of vitamins A and 1). It is used as a dietary supplement to improve general nutrition, promote calcification and prevent rickets.
Dose: 2-10 in[ daily.
codeine One of the alkaloids of opium. It depresses the cough centre and is used in the treatment of useless cough. It also reduces intestinal motility, and is useful in the symptomatic treatment of diarrhoea. It also has mild analgesic properties, and is present with aspirin in co-codaprin and similar preparations. In large doses the constipating action may be a disadvantage. Dose: 10 60 mg.
co-dergocrine A cerebral vasodilator, sometimes used in the treatment of senile dementia.
Dose: 1.5 mg daily, but the response is unreliable. Side-effects include nausea, rash and bradycardia. (Hydergine).
co-dydramol Tablets of dihydrocodeine and paracetamol.

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

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

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.

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).

Investigating Food Intolerance

COLICKY BABIES
If you have followed the measures described on pp. 78-9 but have had little or no success in reducing colic symptoms so far, it makes sense to look into the possibility of a food sensitivity reaction (either intolerance or a mild allergy) to food proteins. This is a very different problem from lactose intolerance (an inability to digest the milk sugar, called lactose, due to a shortage of lactase - see p. 79), although the two can get entangled, creating a complex and confusing set of responses.
The complications arise because, when there is diarrhoea as a result of allergy or intolerance (or from any other cause, including infections) it temporarily strips the gut of its lactose-digesting capacity. This problem is called secondary lactase deficiency, and it will correct itself quite quickly once the real cause of the diarrhoea is eliminated.
Unfortunately, the routine medical tests for lactase deficiency do not distinguish between this temporary problem and the much rarer primary lactase deficiency, which is inherited and life-long.
So if your child has had these routine tests, and you have been told that they show primary lactase deficiency, it remains possible that the real problem is a reaction to milk proteins (or proteins from other foods), and that the lactose intolerance is an effect of this, which adds to the diarrhoea, but is not the root cause of it. If so, eliminating the offending food from the baby’s diet (or the mother’s) will produce impressive results, whereas reducing or eliminating lactose only helps a little.
The purpose of the dietary investigations described here is to discover which foods are causing problems for your baby. In the case of bottle-fed babies, the answer is usually cow’s milk – and this is often the culprit for breast-fed babies too, but not necessarily.
For a breast-fed baby it can be any food that the mother is eating. A tiny proportion of what the mother consumes goes through into the breast milk, and these few molecules of food are enough to provoke a reaction in the child.
Bottle-fed babies
For bottle-fed babies, proceed as follows:
•    Change to an alternative milk-free formula (see box on p. 66). Wait two weeks before concluding that there is no improvement – recovery can take time – and try another type of formula before you decide this is not the answer.
•    If there is no joy with alternative infant formula, consider the possibility of relactation: stimulating the flow of your own breast milk once again. Breast-feeding support groups (see page 255) can give you advice. Avoid all dairy products while breast-feeding and take a calcium supplement.
For babies who are old enough, and who have severe symptoms, early weaning is one option, but this must be done very carefully:
•    Keep all dairy products out of the baby’s diet – read labels carefully on prepared foods and know all the different names used for milk (see page 173). Test beef cautiously as it shares some proteins with milk.
•    To avoid new food sensitivities developing, keep eggs, fish. wheat, chocolate and oranges off the menu until the child’s first birthday, then introduce them gradually. Avoid peanuts and other nuts for three years if possible.
•    Keep maize (corn) out of the diet for the first six months, because it is a common ingredient in formula feeds, and the child may have become sensitive to it. Note that some medicines contain corn syrup, but this will only affect those who are very sensitive. A pharmacist can check the full list of ingredients in medicines, and suggest alternatives.
•    No food should be given to the baby every day, or in large amounts. You can use unusual starchy foods, such as sweet potatoes, yams, culnoa and millet (see p. 195), to ring the changes. These all make excellent baby foods.
•    Never force a child to eat any food that is disliked. Try serving it again, once or twice, but give up if there are still fierce objections to the smell or taste – these are often a sign of intolerance or allergy.
•    Ask your doctor to refer you to a paediatric nutritionist so that the diet can be checked. A calcium supplement will probably be needed. Other vitamins or minerals may also be lacking.
Breast-fed babies
For breast-fed babies, the approach is quite different – the main focus here is on what you, the mother, eat and drink.
Firstly, start keeping a food diary, and a record of the baby’s symptoms. Are there any detectable patterns? Does the colic get worse if you drank red wine on the previous day, for example? Note that sometimes the time-gap is more than a day, but it should be reasonably consistent for any one food.
At the same time, eliminate all items other than breast milk from the baby’s diet, including:
•    any solids (e.g. baby foods)
•    fruit juice
•    medicines or vitamin drops that contain other ingredients (e.g. colouring or corn syrup)
•    nipple creams containing arachis oil (peanut oil).
Ask your doctor or pharmacist for alternative versions of medicines or vitamins, without added ingredients. Give boiled water to make up for fruit juice. Wait a week or so to see if things improve.
For the next stage, cut out coffee, tea and all alcoholic drinks. Allow a week for this, and continue with the food/symptom diary meanwhile. If there is no improvement, go on to the next stage, while still avoiding coffee, tea and alcohol.
For the next stage, compile a list of suspect foods, based on your food diary. Add to this list:
•    cow’s milk and all milk products
•    any foods that you craved when pregnant
•    any foods that you normally eat in large amounts
•    anything you dislike but have been eating because it’s ‘good for you’ or ‘good for the baby’
•    any of the following foods if you eat them regularly: eggs, wheat, oranges and other citrus fruits (lemons, grapefruit etc.), tree nuts, peanuts, fish, chocolate, chicken and beef.
Once you have your list prepared, talk to your doctor. Say that you would like to try eliminating cow’s milk for two weeks to start with, and then – if the colic has not cleared up – all the other foods on your list as well (again, for two weeks). You will need to take a calcium supplement. If there is strong opposition to your plans, based on a fear that your diet will be inadequate, ask for a referral to a nutritionist. Obviously this needs to be arranged promptly. The fear of under-nutrition, which is dangerous for both yourself and the baby, is a very reasonable one, but with sensible precautions any mother can safely carry out this investigation.
Eat at home during this time, as you cannot possibly know all the ingredients in cafe or restaurant meals. Read the labels on packaged meals and watch out for synonyms (see pp. 172-4).
If your baby recovers, and you want to pinpoint the problem food so that your diet becomes less restricted, you can test foods individually. Wait until there has been no sign of colic for a week. Choose one food and eat a portion every day for a week. If the colic does not reappear, cut out this food again and choose a second food to test – again, eat this daily for a week. Stop eating the food sooner if the colic returns. (Foods that proved safe can be reintroduced again later, but you need a break after the testing week.) Test cow’s milk last.
Some babies get better during the exclusion phase but do not respond to any of the foods when tested. The temporary break from the problem food seems to be all they need to lose their sensitivity. In such cases, the mother can go back to an unrestricted diet, but not to exactly the kind of diet she ate before – no food should be eaten every day, nor in large quantities, or the colic may return.
Many babies get over their sensitivity after one or two months without the problem food, so it is worth testing again after a while, especially if you are eating a very restricted diet.
Where cow’s milk turns out to be the offender, goat’s milk or sheep’s milk might be tolerated, but wait until the baby is completely free of symptoms and experiment cautiously. Alternatively, drink one of the new milk substitutes now available (see p. 183).
If the baby clearly responds to a food in the mother’s diet (for example, cow’s milk or peanuts), this food should be given cautiously when first introduced to the child after weaning, in case he or she has a true allergy to it. An allergy test may be helpful in deciding whether to introduce the food at all.