Posts Tagged ‘disturbance’

Generic Name
Glatiramer (glah-TYE-ram-er)
Brand Name  Copaxone
Type of Drug
Relapsing-remitting multiple sclerosis (MS) therapy.
Prescribed For  MS.
General Information
Glatiramer is a mixture of several amino acids. It is thought to work by modifying the immune processes responsible for MS. In studies, people who took the drug for over a year were twice as likely to be relapse-free as those who took a placebo (sugar pill).
Cautions and Warnings
Do not use this drug it you are allergic or sensitive to any of its ingredients or to mannitol.
About 10% of people who self-administer glatiramer experience a post-injection reaction with symptoms that include flushing, chest pain, heart palpitations, anxiety, breathing difficulties, closing of the throat, and an itchy rash. These symptoms usually go away without treatment. This reaction generally occurs after several months of drug therapy, though it may occur earlier.
About 21 % of the people who took glatiramer in drug studies had chest pain, but the exact relationship of this pain to use of glatiramer could not be determined. Report any chest pain to your doctor at once.
Glatiramer may make you more sensitive to sunlight.
Because it interferes with immune response, glatiramer may increase your risk of developing infections and tumors.
Glatiramer may interfere with kidney function.
Possible Side Effects
V Most common: infections, weakness, pain, chest pain, flu-like symptoms, back pain, flushing, heart palpitations, anxiety, muscle stiffness or spasticity, an urgent need to urinate, swollen lymph glands, injection-site reactions
Possible Side Effects (continued)
(including pain, inflammation, itching, an unknown mass at the injection site, welts, skin marks, and bleeding), breathing difficulties, runny nose, and joint pain.
¦    Common: fever, neck pain, facial swelling, bacterial infection, migraine, rapid heartbeat, tremors, fainting, appetite loss, vomiting, general stomach disorders, vaginal infection, painful menstruation, black-and-blue marks, swelling in the arms or legs, bronchial irritation, spasm of the larynx, and ear pain.
V Less common: chills, cysts, agitation, foot drop, nervousness, rolling eyeballs, rapid eye movement, confusion, speech problems, cold sores, redness, itchy rash, skin nodules, stomach pain and irritation, and weight gain.
¦    Rare: Other side effects can occur in almost any part of the body, including the heart and blood vessels, digestive system, blood and lymph systems, muscles and bones, respiratory system, kidney, reproductive system, and eyes. Contact your doctor if you experience any side effect not listed above.
Food and Drug Interactions None known.
Usual Dose
Adult (age 18 and over): 20 mg a day by injection under the skin. Child (under age 18): not recommended.
Overdosage
Little is known about the effects of glatiramer overdose. Call you local poison control center or a hospital emergency room for information. If you seek treatment, ALWAYS bring the prescription bottle or container.
Special Information
This medication is given by injection. For information on how to properly administer this drug, see page 1242.
Store unused glatiramer in the refrigerator before it is mixed with the diluent supplied by the manufacturer. Do not use any other diluent. The mixed injection must be used right away.
Suggested injection sites are the arms, abdomen, hips. and thighs. Be sure to rotate injection sites.
Glatiramer works best if given at the same time each day.
If you forget to administer a dose, do so as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule. Do not take a double dose. Call your doctor if you miss more than 2 doses in a row.
Special Populations
Pregnancy/Breast-feeding: The safety of using glatiramer during pregnancy is not known. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
It is not known if glatiramer passes into breast milk. Nursing mothers who must take it should use infant formula.
Seniors: Seniors may use glatiramer without special restriction.

Type of Drug
Glitazone Antidiabetes Drugs
(GLIT-uh-zone)
Brand Names
Rosiglitazone Maleate Avandia
Combination Products
Pioglitazone Hydrochloride + Metformin Hydrochloride
ACTOplus Met
Pioglitazone Hydrochloride + Glimepiride Duetact
Rosiglitazone Maleate + Metformin Hydrochloride
Nnndamet
Rosiglitazone Maleate + Glimepiride Avandaryl
Prescribed For  Type 2 diabetes.
General Information
The glitazones reduce the amount of sugar produced by the liver and increase insulin sensitivity of muscle, liver, and fat cells. They may also help to control blood-fat levels, which are often elevated in diabetes. Glitazones work by affecting genes responsible for controlling the use of sugar and fat in the body, making cells more sensitive to insulin. They are effective for people with type 2 diabetes, whose cells do not respond well to insulin. Glitazones only work when insulin is present. They do not increase the amount of insulin made in the pancreas. Glitazones can be used alone or combined with other diabetes drugs. Studies have indicated that taking rosiglitazone can delay or prevent type 2 diabetes in people with pre-diabetes.
Cautions and Warnings
Do not take these drugs if you are sensitive or allergic to any of their ingredients or to related drugs. Glitazones may cause fluid retention, worsening or leading to heart failure. Some studies have indicated the risk of heart attack may be increased in people taking rosiglitazone. Other studies have shown that pioglitazone decreases the risk of heart attack. The effects of these drugs on the heart are still being investigated.
Glitazones are broken down in the liver; people with liver disease should not take them. Liver enzyme monitoring is recommended for all people taking a glitazone. People taking pioglitazone and rosiglitazone have experienced liver failure, though no direct causal effect of the drug has been established.
Glitazones may raise blood levels of cholesterol and other blood fats.
These drugs can trigger ovulation. Premenopausal women who are not ovulating may be at risk of becoming pregnant.
Glitazones can cause weight gain, which increases with dosage.
Rosiglitazone may increase the risk of broken bones in the hands, arms, or feet.
Women may achieve maximum benefit with smaller dosages.
Possible Side Effects
Pioglitazone
In studies, the side effects of pioglitazone were about the same as those for a placebo (sugar pill).
Possible Side Effects (continued)
¦    Most common: upper respiratory infections, headaches, and sinus irritation.
?    Common: muscle aches, tooth problems, and sore throat.
?    Less common: anemia and swollen legs or arms.
¦    Rare: swelling below the surface of the skin, especially around the eyes and lips; yellowing of the skin or whites of the eyes, hepatitis, and liver failure. Contact your doctor if you experience any side effect not listed above.
For additional side effects of ACTOplus Met, see Metformin (page 696). For additional side effects of Duetact, see Sulfonylurea Diabetes Drugs (page 1065).
Rosiglitazone
•    Common: upper respiratory infections, accidental injuries, and headache.
•    Less, common: swollen legs or arms, back pain.
•    Rare: swelling below the surface of the skin, especially around the eyes and lips; may also affect the hands, feet and throat. Also, hives, anemia, blurry or distorted vision, and low blood sugar. Contact your doctor if you experience any side effect not listed above.
For additional side effects of Avandamet, see Metformin (page 696). For additional side effects of Avandaryl, see Sulfonylurea Diabetes Drugs (page 1065).
Drug Interactions
•    Mixing gemfibrozil (for very high triglycerides) with a glitazone increases the amount of the glitazone absorbed into the body. A reduction in the dose of the glitazone may be needed if you start taking gemfibrozil.
•    Rifampin can reduce the amount of a glitazone that is absorbed by the body, possibly leading to higher blood sugar levels.
•    Ketoconazole may significantly increase the amount of pioglitazone in the body. Other drugs that may have a similar effect but have not yet been studied include itraconazole, erythromycin, calcium channel blockers, corticosteroids, cyclosporine, protease inhibitor anti-HIV drugs, tacrolimus, triazolam, and trimetrexate.
•    Mixing pioglitazone with atorvastatin may reduce the amount of either drug in the body.
•    Pioglitazone may reduce the effectiveness of contraceptive drugs containing norethindrone and ethinyl estradiol. Higher-dose contraceptives or another contraceptive method may be needed.
•    Pioglitazone may stimulate the breakdown of other drugs also metabolized in the liver.
•    Taking rosiglitazone and insulin may increase the risk of fluid retention and heart failure.
For additional drug interactions for Avandamet and ACTOpius Met, see Metformin (page 696). For additional drug interactions for Avandaryl and Duetact, see Sulfonylurea Diabetes Drugs (page 1065).
Food Interactions
Grapefruit juice may interfere with the breakdown of pioglitazone in the liver. Otherwise, these drugs may be taken with or without food, except for Avandaryl, which should be taken with the first meal of the day.
Usual Dose
Adult
Pioglitazone: 15-45 mg once a day.
Rosiglitazone: 8 mg once a day or in divided doses. ACTOplus Met: 15/500 mg-45/2550 mg once or twice a day. Avandamet: 2/500 mg-4/1000 mg twice a day.
Avandaryl: 4/1 mg-8/4 mg with the first meal of the day. Duetact: 30/2 mg-30/4 mg once a day.
Child: not recommended. Overdosage
Little is known about the effects of glitazone overdose. Take the victim to a hospital emergency room. ALWAYS bring the prescription bottle or container.
ISID’atial Information
Diet, calorie control, exercise, and weight loss are essential to controlling type 2 diabetes. Do not depend solely on this drug to manage your condition.
Alcohol, smoking, age, and race do not affect the way that glitazones are processed in the body.
Call your doctor if you develop symptoms Of liver disease, including nausea, vomiting, abdominal pain, fatigue, appetite loss, or dark-colored urine.
See your doctor for regular monitoring of blood sugar, glycosylated hemoglobin (a more sensitive indicator of long-term diabetes control), and liver function.
If you forget a dose of any of these medicines, take it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule.
Special Populations
Pregnancy/Breast-feeding: The safety of using glitazones during pregnancy is not known. Most experts recommend that diabetes be controlled with insulin during pregnancy.
It is not known if glitizones pass into breast milk. Nursing mothers who must take it should consider using infant formula.
Seniors: Seniors may take this drug without special restriction.

Generic Name
Guanabenz (GWAN-uh-benz) 9)
Type of Drug  Anti hypertensive.
Prescribed For  High blood pressure.
General Information
Guanabenz acetate works by depressing the central nervous system by stimulating certain receptors. Initially, guanabenz reduces blood pressure without a major effect on blood vessels; however, btAqAum use of guanabenz may result in the dilation (widening) of blood vessels and a slight slowing of pulse rate. Guanabenz may be taken alone or with a thiazide diuretic.
Cautions and Warnings
Do not take guanabenz if you are allergic or sensitive to any of its ingredients.
People with severe kidney or liver disease should take this drug with caution. Guanabenz should also be used with caution by people who have had a recent heart attack or stroke.
Drug Interactions
•    Other blood-pressure-lowering agents such as beta blockers increase the effect of guanabenz.
•    The sedating effects of guanabenz are increased by combining it with sedatives, sleeping pills, or other centralnervous-system (CNS) depressants, including alcohol.
•    People taking this drug for high blood pressure should avoid over-the-counter drugs that might aggravate their condition, including decongestants, cold and allergy remedies, and diet pills—all of which may contain stimulants.
Food Interactions
This drug is best taken on an empty stomach, but it may be taken with food if it upsets your stomach.
Usual Dose
Adult: 4 mg twice a day to start, increased gradually to a maximum dose of 32 mg twice a dwy—though doses this large are rarely needed.
Child (under age 12): not recommended.
Overdosage
Overdose causes sleepiness, lethargy, low blood pressure, irritability, pinpoint pupils, and reduced heart rate. Overdose victims should be made to vomit with ipecac syrup—available at any
swollen effects increase with dosage. siness, sedation, dry mouth, dizziness, ache.
st pain; swelling in the hands, legs, or ns or abnormal heart rhythms; stom- pain or discomfort; nausea; diarrhea; ion; anxiety; poor muscle control; de- sleeping; stuffy nose; blurred vision; ains; breathing difficulties; frequent uri- sex drive; impotence; unusual taste in ollen and painful breasts in men.
Possible Side Effects
Risk and severity of sid
• Most common: drowsiness
and headache. • Less common: ches
heart palpitation
•    or abdominal vomiting; constipation
difficulty muscle aches and pains
•    decreased the mouth; and
pharmacy—but call your doctor or poison control center first. If you must go to a hospital emergency room, ALWAYS bring the prescription bottle or container.
Special Information
Take guanabenz exactly as prescribed for maximum benefit. If any side effect becomes severe or intolerable, contact your doctor.
Guanabenz often causes tiredness or dizziness; avoid alcohol because it increases these effects. Take care when driving or doing anything that requires concentration.
Do not stop taking guanabenz without your doctor’s approval. Suddenly stopping this drug may cause a rapid increase in blood pressure. Dosage must be gradually reduced by your doctor.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the one you forgot and continue with your regular schedule. Do not take a double dose. Call your doctor if you miss 2 or more consecutive doses.
Special Populations
PregrianCylBreast-feeding, Guanabenz may affect the fetus. ii should be avoided by women who are or might be pregnant. When guanabenz is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
It is not known if guanabenz passes into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors are more sensitive to the sedating and bloodpressure-lowering effects of guanabenz.

Generic Name
Haloperidol (hal-oe-PER-ih-dol) [M
Brand Name
Haldol         Type of Drug .
Butyroqhv)mearibpsychotic.

Prescribed For
Psychotic disorders, including Tourette’s syndrome; severe behavioral problems in children; short-term treatment of hyperactive children; chronic schizophrenia; vomiting; treatment of acute psychiatric situations; and phencyclidine (PCP) psychosis.
General Information
Haloperidol is one of many nonphenothiazine agents used to treat psychosis. These drugs are equally effective when given in therapeutically equivalent doses. The major differences are in the type and severity of side effects. Some people may respond well to one and not at all to another. Haloperidol acts on a portion of the brain called the hypothalamus. It affects parts of the hypothalamus that control metabolism, body temperature, alertness, muscle tone, hormone balance, and vomiting. Haloperidol is available in liquid form for those who have trouble swallowing tablets.
Cautions and Warnings
Haloperidol should not be used by people who are allergic or sensitive to any of its ingredients.
People with very low blood pressure, Parkinson’s disease, or blood, liver, heart, or kidney disease should avoid this drug.
If you have glaucoma, epilepsy or a history of seizures, ulcers, or difficulty urinating, haloperidol should be used with caution and under strict supervision of your doctor.
If haloperidol is used to control mania in bipolar disorder, a rapid depressive mood swing may occur.
Haloperidol can upset the body’s temperature-regulating mechanism creating a risk for heat stroke or dehydration.
Haloperidol may cause dystonia, tardive dyskinesia, or neuroleptic malignant syndrome, all serious conditions.
Possible Side Effects
V Most common: drowsiness, blurred vision, constipation, diarrhea, dizziness, dry mouth, headache, loss of appetite, nausea, stomach pain, or sleeplessness.
V Less common: jaundice (yellowing of the whites of the eyes or skin), which may occur in the first 2-4 weeks. The jaundice usually goes away when the drug is discontinued, but there have been cases in which it did not. if gou notice this effect, develop fever, or generally feel unwell, contact your doctor immediately. Other less common side effects are changes in components of the blood, including anemias; raised or lowered blood pressure; abnormal heartbeat; restlessness; anxiety; euphoria (feeling “high”); depression; confusion; acne-like skin reactions; excessive salivation;
Possible Side Effects (continued)
breast engorgement; development  of breast tissue in males; vomiting; excessive sweating-, menstrual irregularities; impotence; and breathing difficulties.
¦ Rare: neurological effects such as spasms of the neck muscles, severe stiffness of the back muscles, rolling back of the eyes, convulsions, difficulty in swallowing, and symptoms associated with Parkinson’s disease. These effects usually disappear after the drug has been withdrawn; however, symptoms of the face, tongue, or jaw may persist for years, especially in seniors with a long history of brain disease. If you experience any of these effects, contact your doctor immediately. Other rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    Be cautious about taking haloperidol with barbiturates, sleeping pills, narcotics or other sedatives, tricyclic antidepressants, alcohol, or any other medication that may produce a depressive effect.
•    Combining haloperidol with carbamazepine may decrease the effectiveness of haloperidol requiring a dosage adjustment.
•    The use of azole antifungal agents (e.g. ketoconazole) may cause an increase in haloperidol side effects, possibly requiring adjustments in haloperidol doses.
•    Anticholinergic drugs may reduce the effectiveness of haloperidol and increase the risk of side effects.
•    Severe low blood pressure or heartbeat irregularities may occur if haloperidol is combined with epinephrine or dopamine.
•    Taking lithium together with haloperidol may lead to disorientation, loss of consciousness, ry uncontrolled muscle Mwments.
•    Combining fluoxetine with haloperidol may increase the effects of haloperidol.
•    Haloperidol may increase the effects of antihypertensive drugs.
•    Haloperidol may affect phenytoin levels, as well as levels of
other antipsychotic drugs.
•    Careful dosage monitoring is required if haloperidol is taken
with rifampin.
Food Interactions
Haloperidol is best taken on an empty stomach, but you may take it with food if it upsets your stomach.
Usual Dose
Psychotic disorders
Adult: starting dose-0.5-2 mg 2 or 3 times a day. Some patients may need 3-5 mg 2 or 3 times a day. Rarely, some patients may require up to 100 mg a day.
Child (age 3-12 or 33-88 lbs.): starting dose-0.5 mg a day. Dosage may be increased in 0.5-mg steps every 5-7 days. Child (under age 3): not recommended.
Tourette’s syndrome
Adult: starting dose    0.5-1.5 mg 3 times a day; up to 10 mg a day may be needed.
Child (age 3-12 or 33-88 lbs.): 0.02-0.03 mg per lb. a day. The same dosages apply to children with behavioral disorders or hyperactivity.
Overdosage
Symptoms of overdose are depression, extreme weakness, tiredness, desire to sleep, coma, lowered blood pressure, uncontrolled muscle spasms, agitation, restlessness, convulsions, fever, dry mouth, and abnormal heart rhythm. The patient should be taken to a hospital emergency room immediately. ALWAYS bring the prescription bottle or container.
Special Information
This medication may cause drowsiness. Use caution when driving or operating hazardous equipment; also, avoid alcoholic beverages while taking it.
Haloperidol may cause unusual sensitivity to the sun. It may aIF4Q WVR your urine reddish-brown or pink.
If dizziness occurs, avoid sudden changes in posture and avoid climbing stairs.
Avoid extreme heat while taking haloperidol. This medication may make you more prone to heat stroke.
If you forget to take a dose of haloperidol, take it as soon as you remember. Take the rest of the day’s doses evenly spaced throughout the day. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Serious problems have been seen in pregnant animals given large amounts of haloperidol. Although haloperidol has not been studied in pregnant women, you should avoid this drug if you are or might be pregnant.
Haloperidol passes into breast milk. Nursing mothers who must use this medication should use infant formula.
Seniors: Seniors are more sensitive to the effects of this medication and usually require 1/4-1/2 the usual adult dose. Seniors are also more likely to develop side effects.

Brand Name
Helidac
Generic Ingredients
Bismuth Subsalicylate + Metronidazole + Tetracycline
The information in this profile also applies to the following drug:
Generic Ingredients: Bismuth Subcitrate Potassium + Metronidazole + Tetracycline
Pylera
Type of Drug  Antibacterial combination.
Prescribed For  Duodenal ulcers.
General Information
Research has shown that the bacterium Helicobacter pylori is usually present in ulcer disease and some forms of gastritis. Drugs used to treat the H. pylori infection are prescribed along with a drug that alleviates ulcer symptoms by blocking stomach acid. There are a variety of approaches to treating ulcers by using combinations of various antibiotic and acid-blocking drugs. Helidac combines 3 drugs with antibacterial or antibiotic action. This combination generally works by disrupting the cell walls of the bacterium and interfering with its ability to make proteins or duplicate
itself. It is often prescribed together with ranitidine, cimetidine, or another acid Mocker. Other treatments use other drug comb-
nations.
Cautions and Warnings
Do not take Helidac if you are allergic or sensitive to any of its
ingredients.
Do not take Helidac if you have severe liver or kidney disease. People with less severe liver disease may require a reduced dosage.
Rarely, bismuth causes severe nervous system toxicity. Symptoms go away after the drug is stopped.
Bismuth subsalicylate can cause dark stools or darkening of the tongue. This darkening of stools is not dangerous; however, be aware that blood in the stool often manifests as blackening of the stool.
Children or teenagers who have or are recovering from chickenpox should not use Helidac because it contains a small amount of salicylate, which is related to aspirin. Children or teenagers who take aspirin or a salicylate may develop Reye’s syndrome: symptoms include nausea and vomiting.
Bismuth can also cause ringing in the ears, especially if taken along with another aspirin-containing drug.
Metronidazole can cause convulsive seizures and nervous system effects including numbness or tingling in the arms, legs, hands, or feet. The risk of developing these effects increases with dosage and duration of use. Call your doctor at once if you experience any of these effects.
Metronidazole should be taken with caution by people who have had blood diseases or nervous system disorders, such as seizure disorders.
Candida infections may worsen while you are taking metronidazole.
Other infections, called superinfections, can develop while you are taking tetracycline. If this happens, your doctor will discontinue Helidac and prescribe a different drug to treat your H. pylori infection, ;a% %0M as another drug to treat the superinfection.
Tetracycline should not be used in children under age 8 due to the risk of tooth discoloration.
People taking tetracycline can develop pseudotumor cerebri (pressure inside the brain), the symptoms of which are usually headache and blurred vision. Symptoms usually go away when the drug is stopped, but permanent damage can result.
Tetracycline may increase your sensitivity to the sun; use sun-
screen and wear protective clothing.
Tetracycline may make contraceptive drugs less effective. Another or additional forms of contraceptive should be used.
Possible Side Effects
?    Most common: nausea and diarrhea.
?    Less common: abdominal pain, blood in the stool, head-
ache, anal discomfort, appetite loss, dizziness, tingling in
the hands or feet, vomiting, muscle weakness, constipa-
tion, sleeplessness, pain, and respiratory infections.
For more information on possible side effects, see Metronidazole, page 718, and Tetracycline Antibiotics, page 1103.
Drug Interactions
•    Tetracycline antibiotics, which are bacteriostatic, may interfere with the action of bactericidal (bacteria-killing) agents such as penicillin. You should not take both kinds of antibiotics for the same infection.
•    Antacids, mineral supplements, and multivitamins containing bismuth, calcium, zinc, magnesium, and iron can reduce the effectiveness of tetracycline. Separate doses of your antacid, mineral supplement, vitamin with minerals, or sodium bicarbonate and Helidac by at least 2 hours.
•    Tetracycline and metronidazole may each increase the effect of anticoagulant (blood-thinning) drugs such as warfarin. An adjustment in the anticoagulant dosage may be required.
•    Cimetidine can increase metronidazole blood levels. Your metronidazole dosage may be reduced if you are also taking cimetidine.
•    Tetracycline should not be used with methoxyflurane due to the risk of a toxic interaction.
•    Tetracycline may increase blood levels of digoxin in a small number of people, leading to possible digoxin side etezks. (” %kjMt pelop% 1his’interaction with digoxin can occur for months after tetracycline has been stopped. If you are taking this combination, watch carefully for digoxin side effects and call your doctor if any develop.
•    Tetracycline may reduce diabetic insulin requirements. If you are using this combination, be sure to carefully monitor your blood-sugar level.
•    Tetracycline may increase or decrease lithium blood levels. Metronidazole raises lithium blood levels, effects, and toxicity.
•    Combining alcohol and metronidazole may cause abdominal cramps, nausea, vomiting, headaches, and flushing. Modification of the taste of alcohol has also been reported. Metronidazole should not be used if you are taking disulfiram (a drug used to maintain alcohol abstinence) because the combination can cause confusion and psychotic reactions.
•    Phenobarbital and other barbiturates can decrease metronidazole’s effectiveness.
•    Drugs that cause nervous system toxicity, such as mexiletine, ethambutol, isoniazid, lincomycin, lithium, pemoline, and long-term high-dose pyridoxine (vitamin 136) should not be taken with metronidazole because of the increased risk of nervous system side effects.
•    Metronidazole may increase phenytoin blood levels and the risk of phenytoin side effects; your doctor may need to adjust your phenytoin dosage.
Food Interactions
Do not take this drug with milk or dairy products. Helidac should be taken with meals and at bedtime.
Usual Dose
Helidac
Adult: Each dose consists of 4 pills. Take all 4 pills, 4 times a day for 14 days with a full glass of water. Take your acid blocker according to your doctor’s directions.
Child: not recommended.
Pyles
Adult: 3 pills 4 times a day for 10 days with a full glass of water. Take your acid blocker according to your doctor’s directions. Child: not recommended.
Overdosage
All 3 in(aMd1K1t ,in Helidac can be dangerous if taken in overdose, but salicylate poisoning is the most threatening. Symptoms of salicylate toxicity are rapid or heavy breathing, nausea, vomiting, ringing or buzzing in the ears, high fever, lethargy, rapid heartbeat, and confusion. Other more serious symptoms may develop. Take the victim to a hospital emergency room at once. ALWAYS bring the prescription bottle or container.
Special Information
Tetracycline can reduce the effectiveness of contraceptive drugs; you should use backup contraception while taking Helidac. Breakthrough bleeding is also possible.
Bismuth can cause a temporary darkening of your tongue or stool. This is a harmless effect. Stool darkening should not be confused with blood in the stool, which turns it black.
Avoid alcohol while taking Helidac and for 1 day after you stop taking it.
Call your doctor if you develop ringing in the ears. This can be a sign of salicylate toxicity from the bismuth.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule. Never take a double dose.
Special Populations
Pregnancy/Breast-feeding: Helidac should not be taken by pregnant women. Tetracycline affects bone and tooth development in the fetus.
Tetracycline and metronidazole pass into breast milk. Tetracycline interferes with the development of the child’s skull, bones, and teeth, and metronidazole also may cause side effects in the baby. Nursing mothers who must take Helidac should use infant formula.
Seniors: Seniors may take this drug without special restriction.

Generic Name
Clemastine (KLEH-mas-tene) A
Brand Names
DayHist-1    Tavist-1
Tavist    Tavist Allergy
Combination Pr(3dUtj
Generic Ingredients: Acetaminophen + Clemastine + Pseudoephedrine
Tavist Allergy/Sinus/Headache
Type of Drug  Antihistamine.
Prescribed For
Sneezing, stuffy and runny nose, itchy eyes, and scratchy throat caused by seasonal allergies and for other symptoms of allergies such as rash, itching, and hives.
General Information
Antihistamines generally work by blocking the release of naturally occuring histamine (a chemical released by body tissue during an allergic reaction) from cells at the H, histamine receptor site, drying up secretions of the nose, throat, and eyes. Clemastine fumarate is less sedating than most antihistamines, but not less sedating than astemizole, cetirizine, or loratadine.
Cautions and Warnings
Clemastine should not be taken if you are allergic or sensitive to any of its ingredients.
People with asthma or other deep-breathing problems, heart disease, high blood pressure, diabetes, enlarged prostate, glaucoma, stomach ulcers or other stomach problems, and hyperthyroidism should use clemastine with caution because its side effects can aggravate these problems.
Possible Side Effects
✓    Most common: drowsiness; headache; weakness; nervousness; stomach upset; nausea; vomiting; cough; stuffy nose; diarrhea; constipation; sore throat; nosebleeds; and dry mouth, nose, or throat.
✓    Less common: allergic reaction (symptoms include rash, itching, hives, and breathing difficulties), sleeplessness, menstrual irregularities, muscle aches, sweating, tingling in the hands or feet, frequent urination, visual disturbances, and ringing or buzzing in the ears.
Drug Interactions
•    Cbrnbining clemastine with alcohol, sedatives, sleeping pills, or other nervous system depressants may increase the depressant effects of clemastine. Do not combine these drugs.
•    The effects of oral anticoagulant (blood-thinning) drugs may be decreased by clemastine. Do not take this combination without your doctor’s knowledge.
Monoamine oxidase inhibitor antidepressants may increase the drying and other effects of clemastine. This combination can also worsen urinary difficulties.
e When taking antihistamines on a regular basis, notify your doctor if you are taking large amounts of aspirin. Effects of too much aspirin may be masked by the antihistamine.
Food Interactions
Clemastine is best taken on an empty stomach at least 1 hour before or 2 hours after eating; it may be taken with food if it upsets your stomach.
Usual Dose
Adult and Child (age 12 and over): 1.34 mg twice a day up to 8.04 mg of the syrup or 2.68 mg of the tablets in 24 hours.
Child (age 6-12) (syrup only): 0.67 mg twice a day or up to 4.02 mg a day.
Overdosage
Overdose is likely to cause severe side effects. Overdose victims should be given ipecac syrup—available at any pharmacy—to induce vomiting and should then be taken to a hospital emergency room for treatment. ALWAYS bring the prescription bottle or container.
Special Information
Clemastine may make it difficult for you to concentrate or perform complex tasks such as driving a car. Be sure to report any unusual side effects to your doctor
Antihistamines may occasionally produce excitability, particularly in children.
If you forget to take a dose of clemastine, take it as soon as you remember. If it is almost time for your next dose, skip the one you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
PregnancylBreast-feedj(IV. DO not take any antihistamines without WU ‘Obtlor’s knowledge if you are or might be pregnant—especially during the last 3 months of pregnancy, because newborns may have severe reactions to antihistamines.
Small amounts of clemastine pass into breast milk. Nursing mothers who must take clemastine should use infant formula.
Seniors: Seniors are more sensitive to side effects.

Generic Name
Clindamycin (klin-duh-MYE-sin)
Brand Names
Cleocin    Clindesse
Cleocin T    Clindets
Clinda-Derm    Evoclin Clindagel
Type of Drug  Antibiotic.
Prescribed For
Serious bacterial infections. The vaginal cream is used to treat bacterial vaginosis. Topical clindamycin is used to treat acne and rosacea.
General Information
Clindamycin is one of the few oral drugs that is effective against anaerobic bacteria, which grow only in the absence of oxygen and are often found in infected wounds, lung abscesses, abdominal infections, and infections of the female genital tract. It also works against bacteria usually treated with penicillin or erythromycin, including serious respiratory tract infections. Clindamycin may be useful for treating certain skin or soft tissue infections. It kills the bacteria that frequently cause acne.
Clindamycin is not used to treat vaginal fungus or yeast infections.
Cautions and Warnings
Do not take clindamycin if you are allergic or sensitive to any of its ingredients or to lincomycin, another antibiotic.
People with asthma or a history of allergies should use clindamycin capsules with caution.
Clindamycin can cause a severe intestina(kmkation called colitis, which can be fatal. Signs of colitis are diarrhea, blood in the Stool, and abdominal cramps. Any form of this drug, including products applied to the skin and the vaginal cream, can provoke colitis. Because of this, clindamycin should be reserved for serious infections or those that cannot be treated with other drugs.
Clindamycin should be used with caution if you have gastrointestinal disease or kidney or liver disease.
Possible Side Effects
Capsules
✓    Most common: stomach pain; nausea-, vomiting-, diarrhea,
in up to 20% of people; and pain when swallowing.
♦    Less common: itching; rash; signs of serious drug sensitivity, such as difficulties breathing and yellowing of the skin or the whites of the eyes; colitis, (see “Cautions and Warnings”); effects on blood components; and joint pain.
Topical Lotion
♦    Most common: dry skin, redness, burning, peeling, oily skin, and itching.
♦    Less common: diarrhea, abdominal pain, upset stomach, and colitis (see “Cautions and Warnings”).
Vaginal Cream
♦    Most common: vaginal itching or irritation; thick, white vaginal discharge; and pain during intercourse.
♦    Less common: nausea, vomiting, diarrhea, constipation, abdominal pain, dizziness, headache, vertigo, and colitis (see “Cautions and Warnings”).
Drug Interactions
•    Do not combine clindamycin and erythromycin.
•    The absorption of clindamycin capsules into the bloodstream is delayed by Kaolin-Pectin Suspension (prescribed for diarrhea). Separate these drugs by at least 1 hour.
•    clindamycin should be used with caution by people also using neuromuscular agents.
Food Interactions
Take the oral medication with a full glass of water or with food to prevent irritation of the stomach and intestine.
Usual Dose
Capsules
MUIV ) 50-450 mg every 6 hours.
Child (under age 16): 3.5-11 mg per lb. of body weight a day, in 3-4 doses. For severe infections, at least 37.5 mg 3 times a day, regardless of weight.
Foam: Dispense enough to cover the affected area(s) onto a cool surface (the foam will melt on contact with warm skin). Use fin-gertips to massage small amounts into the affected area(s) until the foam disappears.
Suppositories: Insert 1 suppository a day for 3 consecutive days.
Topical Lotion: Wash the skin and pat dry before application. Apply enough to cover the affected area(s) with a thin coat twice a day.
Vaginal Cream: Insert 1 applicator’s worth at bedtime for 7 consecutive days, except for Clindesse, which requires one applicator’s worth once at any time of day.
Overdosage
clindamycin overdose may lead to severe diarrhea and other drug side effects. Do not treat this diarrhea on your own. Discontinue use of this drug and call your local poison center for information. If you go to an emergency room for treatment, ALWAYS bring the prescription bottle or container.
Special Information
Prolonged or unsupervised use of clindamycin may lead to secondary infections from susceptible organisms. such as fungi. Take this drug for the full course of therapy as indicated by your physician.
If you develop severe diarrhea or abdominal pain, call your doctor at once. Call your doctor immediately if you experience breathing difficulties or jaundice (yellowing of the skin or whites of the eyes).
Women using the vaginal cream should not have vaginal intercourse or use other vaginal products such as tampons or douches until treatment is complete.
Use of latex condoms or diaphragms within 72 hours following treatment with the vaginal creams or suppositories is not recommended. These products may decrease the efficacy of condoms or diaphragms.
The topical lotion is for external use only. Avoid contact with your eyes or mucous membranes.
If you miss a dose of oral clindamycin, take it as soon as you rememlae~. SSW19 almost time for your next dose of clindamycin, double that dose and go back to your regular dosage schedule.
Special Populations
Pregnancy/Breast-feeding: This drug crosses into fetal blood circulation. When the drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
clindamycin passes into breast milk. Nursing mothers who must take oral clindamycin should use infant formula.
Seniors: Seniors with other illnesses may be unable to tolerate diarrhea and other clindamycin side effects.

Generic Name
Clonazepam (klon-A-zeh-pam)
Brand Name  Klonopin
Type of Drug  Anticonvulsant.
Prescribed For
Petit mal and other seizures and panic attacks; also prescribed for periodic leg movements during sleep, speaking difficulty associated with Parkinson’s disease, acute manic episodes, nerve pain, and schizophrenia.
General Information
Clonazepam is a benzodiazepine drug. Clonazepam is not used as a sedative or hypnotic. It is used only for the uses described above in people who have not responded to other drug treatments. Tolerance to the effects of clonazepam commonly develops within about 3 months of use. Your doctor may raise your clonazepam dosage periodically to maintain the drug’s effect.
Cautions and Warnings
Do not take clonazepam if you are allergic or sensitive to any of its ingredients or any other benzodiazepine.
When stopping clonazepam treatments, the drug must be discontinued gradually. Abrupt discontinuance of clonazepam may lead to drug withdrawal symptoms including severe seizures, tremors, abdominal or muscle cramps, vomiting, whet increased sweating.
IJSIF,l OfMazeparn with caution if you have a chronic respiratory illness, since the drug tends to increase salivation and other respiratory secretions and can make breathing more labored.
Avoid using clonazepam if you have severe depression, severe lung disease, sleep apnea (intermittent cessation of breathing during sleep), liver disease, alcoholism, or kidney disease. These conditions may exacerbate the depressive effects of benzodiazepines, and such effects may be detrimental to your overall
condition.
Clonazepam can aggravate narrow-angle glaucoma, but if you have open-angle glaucoma, you may take it.
Possible Side Effects
♦    Most common: drowsiness, poor muscle control, and behavioral changes.
✓    Rare: Rare side effects can occur in almost any part of the body but are most likely to affect mental function, stomach and intestines, urinary function, blood, and liver. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    The depressant effects of clonazepam are increased by sedatives, sleeping pills, narcotic pain relievers, antihistamines, alcohol, monoamine oxidase inhibitor antidepressants, tricyclic antidepressants, and other anticonvulsants.
•    Mixing valproic acid and clonazepam may produce severe petit mal seizures.
•    Smoking, phenobarbital, phenytoin, carbamazapine, and rifampin may reduce clonazepam’s effectiveness.
•    Clonazepam may increase the requirement for other anticonvulsant drugs in people who suffer from multiple types of seizures.
•    The effects of clonazepam may be prolonged when it is taken with cimetidine, contraceptive drugs, disulfiram, fluvoxamine, isoniazid, oral antifungal medications (e.g. ketoconazole), metoprolol, probenecid, propoxyphene, or propranolol.
•    Theophylline may reduce clonazepam’s sedative effects.
•    Separate antacids from y<3kwc_%1Dnazepam dose by at least 1 bZldi %prevent them from interfering with clonazepam being absorbed into the bloodstream.
•    Clonazepam may increase blood levels of digoxin and the risk of digoxin toxicity.
•    Clonazepam may decrease the effect of levodopa + carbidopa.
Food Interactions
Clonazepam is best taken on an empty stomach but may be taken with food if it upsets your stomach.
Usual Dose
Clonazepam is available in either tablets or orally disintegrating tablets, called wafers. Wafers should not be opened until immediately before the dose is to be taken. Do not push the wafer through the foil. Use dry hands to remove the wafer. The wafer will disintegrate quickly in saliva.
Seizures
Adult and Child (age 10 and over): starting dose    0.5 mg 3 times a day. The dose is increased by 0.5-1 mg every 3 days until seizures are controlled or side effects develop. The maximum daily dose is 20 mg.
Panic attacks
Adult and Child (age 10 and over): starting dose-0.25 mg twice daily. The dose is increased to 1 mg a day after 3 days. Most people do not require a higher dose.
Child (under age 10 or below 66 Ms.): starting dose-0.0220.066 mg per lb. of body weight a day in divided doses. Dosage can be increased gradually to a daily dose of 0.22-0.44 mg per lb. of body weight.
Other uses for clonazepam involve doses from 0.5-16 mg a day, depending on the condition and its severity. Clonazepam dosage must be reduced in people with impaired kidney function.
Overdosage
Overdose may cause confusion, coma, poor reflexes, sleepiness, low blood pressure, labored breathing, and other depressive effects. If the overdose is discovered within a few minutes and the victim is still conscious, it may be helpful to induce vomiting with ipecac syrup—available at any pharmacy. Overdose victims must be taken to a hospital emergency room. ALWAYS bring the prescription bottle or contai”iaT.
Special Information
Clonazepam may interfere with your ability to drive or perform other complex tasks because it can cause drowsiness and difficulty in concentrating.
Your doctor should perform periodic blood counts and liver function tests while you are taking this drug to check for possible
side effects.
Do not suddenly stop taking clonazepam—severe seizures may result. The dosage must be discontinued gradually by your doctor.
If you miss a dose by 1 hour or less, take it right away. Otherwise, skip the dose you forgot and go back to your regular schedule. Do not take a double dose.
Carry identification or wear a bracelet indicating that you have a seizure disorder for which you take clonazepam.
Special Populations
Pregnancy/Breast-feeding: Clonazepam crosses into the fetal circulation and can affect the fetus. Women who are or might be pregnant should avoid it. When the drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
Some reports suggest a strong link between anticonvulsant drugs and birth defects, though most of the information pertains to phenytoin and phenobarbital, not clonazepam. It is also possible that the epileptic condition itself or genetic factors common to people with seizure disorders may figure in the higher incidence of birth defects.
Clonazepam may pass into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors, especially those with liver or kidney disease, are more sensitive to the effects of this drug—especially dizziness and drowsiness—and may require smaller doses.

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).
I Tyr
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.
103
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).
I Vas
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.
104
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.

halothane A potent non-inflammable inhalation anaesthetic. It suppresses mucous and bronchial secretions, and reduces capillary bleeding. It has sonic muscle-relaxant properties, but in major surgery, supplementary treatment with a muscle relaxant is necessary. Halothane may cause some cardiac irregularities, but an occasional serious side-effect is severe hepatotoxicity, particularly after further exposure to the drug within periods of 441 weeks. Such susceptibility cannot yet be detected, so great care is necessary in any cases of liver dysfunction.
(Fluothane).
hamamelis An extract of witch hazel leaves referred to as harnarnelis or witch hazel water is used as a soothing application for bruises and sprains.
Hartmann’s solution An electrolyte-replacement solution containing sodium lactate, sodium chloride, potassium chloride and calcium chloride.
heparin The natural anticoagulant obtained front lung and liver tissue. It is widely used in deep-vein thrombosis and pulmonary embolism.
Dose: by i.v. injection 5000 units initially, followed by 1000-2000 units hourly by i.v. infusion, or 15000 units by s.c. injection 12-hourly under laboratory control. Prophylactic dose before surgery 5000 units, then 5000 units every 8-12 hours for 7 days. Overdosage call be controlled by the i.v. injection of prolamine sulphate. Treatment with heparin may be combined with that of oral anticoagulants such as phenindione or warfarin to provide immediate action before the slow-acting oral drugs begin to take effect. Occasional side-effects include hypersensitivity reactions and alopecia. Heparin is a complex polysaccharide, but certain fragments of that large molecule retain sonic anticoagulant activity, and are referred to as low molecular weight heparins. They are used mainly in the prophylaxis of venous thrombo-embolism, as they have a longer
action than standard heparin. They are given by once-daily s.c. injection, and laboratory control of the bleeding time is not necessary. The dose varies to some extent with the product used.
hepatitis A & 8 vaccines Inactivated hepatitis virus antigens for the protection of individuals highly exposed to the infections. Dose: see data sheets. (I iaverix A;
kncigix B; II–B–Vax).
theroin See diamorphine.
hetastarch A soluble modified starch that is used as a 6% solution with 0.9% sodium chloride as a plasma volume expander. Dose: 500-1500 nil daily by i.v. infusion, up to a maximum of 20 mltkg daily. It is excreted by the kidneys, and care must be taken to avoid circulatory overload. Not for use in congestive heart failure or renal insufficiency. Side-effects are vomiting, chills, fever and urticaria. (clol-IAES; Hespan).
hexachlorophene A slow-acting antiseptic used for skin sterilization, and present in sonic medicated soaps.
hexamine (methenamine) A formaldehyde derivative of low toxicity, occasionally used as a urinary antiseptic. Dose: 2 g daily. It is usually given as hexamine hippurate to ensure the necessary acidification ol’the urine. (Iliprex).
histamine A compound present in a bound form in all mammalian tissues; its release is probably the ultimate cause of many allergic conditions.
histamine H,-receptor antagonists See antihistamines. See page 110 and Table 2.
histamine Hz -receptor antagonists Drugs that (litter from conventional antihistamines in having a selective blocking action on receptors ill the gastric cells that secrete acid. They are widely used in the treatment of peptic ulcer and other conditions requiring a reduction in gastric acid secretion. See page 162 and Table 27.
homatropine An atropine derivative with a similar but more rapid mydriatic action (15-30 minutes), but a shorter duration of effect of about 24 hours. Eye drops
(1-2%) sometimes with cocaine.

hyaluronidase A ’spreading’ factor used to increase the absorption of large-volume s.c. injections. The injection of 1500 units of hyaluronidase, either into the injection site or mixed with the injection fluid, will promote the absorption of 500-1000 mL of electrolyte solution by s.c. drip infusion. (Hyalase).
hydralazine A vasodilator that is useful in the supplementary treatment of hypertension.
Dose: 50- 100 nig daily, usually with a IlliaUide diuretic or a beta-blocking agent. Also given in hypertensive crisis by slots, i.v. injection in doses of 5-10 mg; over-rapid injection may cause a marked fall in blood pressure. Side-effects are nausea, tachycardia and fluid retention (less likely with low doses), but a lupus erythematOSLIS- like syndromemay occur with extended high-dose therapy. (Apresoline). See page 148 and “Fable 21.
hydrochlorothiazide A thiazide diuretic that brings about it marked increase in the excretion of salts and water, and is of value in congestive heart failure and other oedematous conditions. It is also of value iii    as it reduces peripheral resistance, and potentiates the action of some other antihypertensive drugs.
Dose: 50-111(1 Ing daily initially in
oedenia; maintenance dose 25-50 mg daily or oil alternate days. III hypertension, 25-30 Ing daily according to need.
I lydrochlorolhiazidc, like other thiazid”, Increases the excretion of potassium as well as sodium, and in extended treatment supplementary treatment with potassium chloride or effervescent potassium tablets may be required. Side-effects include nausea, rash, dizziness and photosensitivity. (I lydroSaluric). See page 148
and ‘I able 21.
acute lyniphoblastic leukaemia and some lymphomas. In common with some other corticosteroids, hydrocortisone inhibits organ-transplant rejection and in high doses it is given to control incipient rejection.
Dose: varies considerably according to need: for replacement therapy, 20-30 mg daily: in shock, 100-300 mg or more by slow i.v. injection, repeated as required. Side-effects are numerous and include hypertension, oedema, mental disturbances, re-activation of peptic ulcer, muscle weakness and diabetes. Cushing’s syndrome may occur with high doses.
I I ydrocortisone, unlike cortisone, is active topically, in(] is used as eye drops 0.3% (usually with an antibiotic), ointment and cream (0.50/o and 11M, often with an antibiotic to control any secondary infection.
hydroflumethiazide A thiazide diuretic N,ith the actions, uses and side-effects of bendrofluazide.
Dose: 25- 100 nig daily in (lie morning; 25-50 Ing daily in hypertension.
ff lydrenox). See page 148.
hydrogen peroxide solution It contains 5-7% of H 02
, equivalent to about 20 volumes oJ oxygen. It has antiseptic and deodorizing properties, and is used mainly for cleaning wounds. It is also used as a mouthwash (diluted 1:7), and as ear drops (1:4 in water or 501% alcohol).
thydromorphone A potent opioid analgesic of the morphine type. Dose: in severe pain 1.3-2.6 Ing 4 t,-hourly. Walladone).
hydrotalcite Aluminium magnesium hydroxide carbonate. An antacid used in dyspepsia and related conditions.
Dose: I g as required.
55
hydrocortisone The principal corticosteroid, also known as cortisol, that is secreted by the adrenal cortex. It plays a major role in the metabolism of glucose, protein and calcium, in maintaining the electrolyte balance, and in reducing inflammatory and allergic responses. It is used in all cases of adrenocortical insufficiency, including Addison’s disease and after adrenalectomy. It is also used in anaphylactic shock, asthma, rheumatoid disease and allergic states. It is valuable in
hydroxocobalamin A derivative of eydnu,obdlaniin, and now the preferred form of vitamin B,, as it has a more prolonged action.
Dose: in pernicious anaemia and other vitamin 13, deficiency states, I Ing initially ian. repeated 5 times at intervals of 2-3 days; maintenance dose 1 mg by I’ll’
by )CC- Lion every 3 months. It is also given
prophylactically after total gastrectonly. (Cobalin-H; NCO-Cytalliell). See
page 112.

hydroxyapatite A natural substance with a mineral composition somewhat similar to that of bone. It is used as a source of calcium and phosphorus in osteoporosis and other deficiency states. Tablets of 830 mg are available. (Ossopan).
hypermotility of the gastrointestinal tract, and may be useful in spasmodic dysmenorrhoea.
Dose: 40-80 mg daily; in acute spasm, .10 mg by injection. (Buscopan).
hydroxychloroquine An antimalarial with the actions, uses and side-effects of chloroquine. It is also useful in rheumatoid arthritis in doses of 200-400mg daily, and in lupus erythematosus, but side-effects are numerous, and treatment requires expert supervision. (Plaquenil). See page 165.
hypromellose A cellulose-derivative that dissolves in water to form a viscid, colloidal solution. Such a solution is used as a base for eye drops to extend the action of a dissolved ophthalmic drug; to lubricate contact lenses; and to act as a lubricant in chronic, sore eye conditions.
5-hydroxytryptamine See serotonin.
hydroxurea (hydrocarbamide) A cytotoxic agent sometimes used in chronic myeloid leukaemia.
Dose: 20- 30 mg/kg as a single dose daily or 80 nig/kg every third day. Side-effects are nausea, skin reactions and myelo- suppression. (Hydrea). See page 122 and Table 8.
hydroxyzine A mild tranquillizer with some sedative and antihistaminic properties. It is given in the short-term treatment of anxiety, and in pruritus and dermatoses complicated by emotional tension. Dose: 50-400 mg daily. It has the side-effects of the antihistamines, and is not recommended where some sedation is undesirable. (Atarax; Ucerax). See page 117 and Table 3.
hyoscine (scopolamine) An alkaloid obtained from plants of the belladonna group. It is a powerful hypnotic and is widely used together with papaveretum for premedication before anaesthesia in doses of 300-600 pg by s.c. or i.m. injection. It has some antiemetic properties, and is useful in travel sickness and vertigo. Dose: 300 mg 30 minutes before starting the iourney, followed by up to 3 doses 6-hourly. Scopoderm is a patch of 500 pg. Thc side-effects of mouth dryness and dizziness are those of the anticholinergic drugs generally. It is contraindicated in glaucoma. It is used occasionally in terminal care for bowel colic and excessive respiratory secretions. Dose: 600 pg-2.4 mg daily by s.c. infusion.
hyoscine butylbromide A derivative of hyoscine that differs in lacking any central action. It is given in spasm and
I
ibuprofen A non-steroidal anti-inflammatory agent (NSAID) widely used in rheumatoid and arthritic conditions. It is also given as an analgesic for mild to moderate pain, but not for acute gout. Dose: 1.8 g daily initially; lly; maintenance duos, 600 lllg-L2 daily after food. A 5% cream is available for local use. The sideeflicts are those of the NSAID& generally. (BrUlen; Feribid). See page 165.
ichthammol A thick, dark brown liquid with a characteristic odour, derived from certain bituminous oils. It is a mild antiseptic and is used mainly in chronic eczema as a 100A, ointment or zinc paste. A solution (10% in glycerin) has been used oil ulcers and inflamed areas.
idarubicin A potent cytotoxic agent similar in actions and uses to doxorubicin. It is given orally and i.v. in acute nonlymphocytic leukaemia, breast cancer, and as second-line therapy in acute lymphatic leukaemia. Dose is based on skin area. (Zavedos). See page 122 and Table 8.
idoxuridine An antiviral agent now virtually superseded by acyclovir and related drugs. Used occasionally in herpes zoster skin infection by local application of a 5% solution. See page 144 and Table 19.

fosfamide A derivative of cyclophosphamide with similar actions and uses. It is effective in lung, ovary, breast and soft-tissue tumours, as well as some malignant lymphomas.

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

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