Posts Tagged ‘dopamine’

Generic Name
Bupropion (bue-PROE-pee-on) M
Brand Names
Budeprion    Wellbutrin SR
Budeprion XL    Wellbutrin XL
Wellbutrin    Zyban
Type of Drug
Antidepressant and smoking deterrent.
Prescribed For
Depression, seasonal affective disorder, and nicotine addiction.
General Information
Bupropion is used for major depression and seasonal affective disorder, and may work as a smoking deterrent by acting on key hormone systems in the brain. It works primarily on dopamine and noradrenaline, unlike the SSRI antidepressants, which primarily work on serotonin. Bupropion may not act until you have taken it for 2-4 weeks. The drug clears your system about 2 weeks after you stop taking it.
Cautions and Warnings
Do not take bupropion if you are allergic or sensitive to any of its ingredients.
Antidepressants have been associated with an increased risk of suicide, especially in children and teenagers. Suicide is always a risk in depressed people, who should only be allowed to have minimal quantities of medication in their possession. Clinical worsening of a depressed person’s condition may also occur early
therapy with anticlepressa”kS.
People with seizure disorders, people who have had a seizure in the past, and people with bulimia or anorexia nervosa should be very careful about taking bupropion because they are at a higher risk of having a seizure. About 4 in 1000 people taking bupropion in dosages up to 450 mg a day develop a seizure. The risk of developing a seizure increases by about 10 times with dosages between 450 and 600 mg a day. About half of the people who developed a seizure on bupropion had a risk factor such as a history of head injury, a previous seizure, or a nervous system tumor, or were taking another drug associated with increased seizure risk.
People with unstable heart disease or those who have had a recent heart attack should take this drug with caution because of possible side effects.
Many people taking bupropion experience some restlessness, agitation, anxiety, and sleeplessness, especially soon after they start taking the drug. Some even require sleeping pills to counter this effect, and others find the stimulation so severe that they have to stop taking bupropion.
Bupropion may trigger a manic episode in those with depression or bipolar disorder.
People taking bupropion may experience hallucinations, delusions, or psychotic episodes. Dosage reduction or drug withdrawal is usually necessary to manage these reactions.
One-quarter of those who take bupropion lose their appetite and 5 or more lbs. of body weight. People who have lost weight due to their depression should be cautious about taking bupropion.
People switching from bupropion to a monoamine oxidase inhibitor (MA01) antidepressant, or vice versa, should allow at least 2 weeks to pass between stopping one drug and starting the other.
People with kidney or liver disease require less bupropion at the beginning of treatment. Dosage should be increased cautiously.
An antidepressant other than bupropion should be seriously considered for people with a history of drug abuse because of the mild stimulation bupropion causes. These people may require larger-than-usual dosages, but they are still susceptible to seizures at these higher dosages.
Possible Side Effects
About 10% of people stop taking bupropion due to side effects.
♦ Most common: dry mouth; dizziness; rapid heartbeat; headache, including migraine; excessive sweating; nausea; vomiting; constipation; appetite loss; weight changes: sedation; agitation; sleeplessness; and tremors.
Possible Side Effects (continued)
V Less common’. upset stomach, diarrhea, increased appetite, menstrual complaints, impotence, urinary difficulties, slowness of movement, salivation, muscle spasms, warmth, uncontrolled muscle movement, compulsion to move around or change positions, abnormal heart rhythms, blood-pressure changes, heart palpitations, fainting, itching, redness and rash, confusion, hostility, loss of concentration, reduced sex drive, anxiety, delusions, euphoria (feeling “high”), fatigue, joint pain, fever or chills, respiratory infection, and visual, taste, and hearing disturbances.
Drug Interactions
•    Phenelzine (an MAGI) increases the risk of bupropion side effects. Allow at least 2 weeks to pass between stopping an MAGI and starting bupropion. Serious side effects can occur.
•    Carbamazepine may reduce blood concentrations of bupropion.
•    People taking both bupropion and levodopa + carbidopa or amantadine experience increased side effects. People taking these drugs should have their bupropion dosage increased gradually.
•    Ritonavir may significantly increase bupropion blood levels and the risk of side effects.
•    Don’t mix bupropion with other drugs that increase the risk of seizures—including tricyclic antidepressants, haloperidol, lithium, loxapine, molindone, phenothiazine sedatives, and thioxanthene sedatives.
•    Combining bupropion with a nicotine replacement drug can cause high blood pressure.
•    Combining bupropion with warfarin can increase the risk of side effects.
•    Do not comtImP. INO~bujfin and Zyban, as they contain the same active ingredient.
•    Alcohol should be avoided by people taking bupropion.
Food Interactions
Bupropion may be taken with food if it upsets your stomach.
Usual Dose
Depression
Adult: 200-450 mg a day; normal daily dosage is 300 mg. Child (under age 18): not recommended.
Smoking Cessation
Adult: 150 mg twice a day. Begin treatment while you are still
smoking.
Child (under age 18): not recommended.
Overdosage
Symptoms of overdose are likely to include severe side effects, such as seizures—present in a third of overdoses—hallucinations, loss of consciousness, and abnormal heart rhythms. Overdose victims should be taken to a hospital emergency room at once. ALWAYS bring the prescription bottle or container.
Special Information
Do not stop taking bupropion without your doctor’s knowledge. Suddenly stopping the drug may cause withdrawal reactions and side effects.
Call your doctor if you experience agitation or excitement, restlessness, confusion, difficulty sleeping, anxiety, panic attacks, sleeplessness, irritability, hostility, aggressiveness, acting impulsively, a manic reaction, deepening depression, suicidal thinking, fast or abnormal heart rhythm, severe headache, seizure, rash, fainting, or any unusual or persistent side effect.
Bupropion may make you tired, dizzy, or lightheaded. Be careful when driving or doing any task that requires concentration.
Alcohol, sedatives, and other nervous system depressants increase the depressant effects of this drug. Alcohol also increases the risk of a seizure.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose and you take it several times a day, take 1 dose as soon as you remember and another in 3 or 4 hours, then go back to your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: The safety of using bupropion during pregnancy is not known. When your doctor considers this drug crucial, its potential benefits must be carefully weighed against its risks. Pregnant women trying to quit smoking should use non-drug methods until their pregnancy is completed.
Bupropion passes into breast milk. Nursing mothers who must use bupropion should use infant formula.
Seniors: Seniors with reduced kidney or liver function may require reduced dosage.

pyrazinamide An antituberculous drug that is active against the intracellular and dividing forms of M. tuberculosis, and is most effective in the early stages of die disease. It penetrates the meninges, and is Of value in tuberculous meningitis. Dose: in combination with other drugs, 2 g 3 times a week. Side-effects include fever, jaundice and hepatotoxicity. Liver function tests should be carried out before and during treatment. (Zinamide). See page 170 and Table 31.
pyridostigmine An anticholinesterase similar to neostigmine. It has a slower and more prolonged action that is useful in some cases of myasthenia graves. Dose: 300–720 mg daily. The side-effect, are similar to those of neostigmine, but may be less severe. (Mestinon).
pyridoxine (vitamin B,) This vitamin plays an essential part in protein metabolism. Apart from its use in deficiency states, which are uncommon, pyridoxine has been used in isoniazid-induced neuropathy. Dose: 2,5-150 rig daily; in some sideroblastic anaemias, up to 400 rig daily.
pyrimethamine Ail antimalarial drug used with dapsone as Maloprint or with sulphadoxine as Fansidar in the prophylaxis of malaria. The use of these mixed products is not without risk, as they may have severe and sometimes fatal side-effects.
quetiapine A new ‘atypical’ antischizophrenic drug of the clozapine type with a high affinity for serotonin (5-HT) and dopamine DI and D2 receptors.
Dose: in schizophrenia, initilal doses of 25 rig twice a day, slowly increased up to 150-750 mg daily. Initial doses may cause hypotension. Care is necessary in cardiovascular disease. Side-effects include drowsiness and dizziness. The routine blood monitoring necessary with dozapine is not required. (Sew,jud). See page 108 and Table 30.
quinagolide A dopamine agonise used in
the treatment of hyperprolactinaemia.
I Rai
Dose: 25 jig at bedtime initially, increased at 3-day intervals to 75-100µg daily. Side-effects include hypotension, and the blood pressure should be monitored after a
change of dose. (Norprolac). See brornocriptine and cabergoline.
tquinalbarbitone sodium A short-acting barbiturate. Used in mild insoninia and anxiety states.
Dose: 50-100mg. (Seconal).
quinapril Ail ACE inhibitor with the actions, use and side-effects of that group of drugs. Dose: in hypertension, 5-10 mg daily initially, slowly increased to 20-40 mg as a single daily dose. (Accupro). See ACE inhibitors, page 148, and Table 21.
quinidine Ail alkaloid of cinchona, similar to quinine, that has been used in the preventive treatment of ventricular arrhydimias, but beta-blocking agents are now preferred.
Dose: (after a test dose of 200 rig) 200-400 mg 3-4 times a day. Side-effects are tinnitus, vertigo and confusion. Treatment should be stopped if response does not occur within 10 days.
quinine The principal alkaloid of cinchona bark. It was once used extensively in the treatment of malignant tertian malaria, and recently it has regained some of its value with the emergence of chloroquineresistant malaria.
Dose: 1.8 g daily for 7 days; in serious infections it is given by i.v. infusion in doses of 10 rig/kg for up to 3 doses, followed by oral therapy. Side-effects include tinnitus, nausea, rash and visual disturbances. See specialist literature.
rattitroxedV A selective enzyme inhibitor used in the palliative treatment of advanced colorectal cancer. It has advantages over fluorouracil, as treatment is less complicated and the incidence of leucopenia, mucositosis and other side-effects is less severe. Dose: 3 mg/ni! by slow i.v. injection, repeated at intervals of 3 weeks if tolerated. Blood counts and liver function tests are necessary. (Tomudex). See page 122 and Table 8.

ramipril An ACE inhibitor with the general properties of such drugs.
Dose: in mild hypertension, L25 ing daily, increased at intervals of 1-2 weeks tip to a maximum of 10 mg, given with food and adequate fluid. Prophylactic dose after myocardial infarction 5-10 ing daily. (Tritace). See page 148 and Table 21.
ranitidine A powerful and selective histamine H, antagonist of the cimetidine type, but with a longer action. It reduces the volume, acidity and pepsin content of gastric secretion, and is of value in peptic ulcer, reflux oesophagitis and similar conditions.
Dose: 300 nig daily for at least 4 weeks, maintenance (loses, 150 mg daily. In severe conditions, 50nig by i.ma or slow i.v. injection repeated at intervals of 6-8 hours. In suspected gastric ulcer, malignancy should be excluded before treatment is commenced. (Zantac). See cimetidine, page [62 and Table 27.
ranitidine bismuth citrateV It has the general action of ranitidine, but it also has a protective effect on the ulcerated area, and inhibits digestive action of pepsin on the gastric mucosa. It is given with amoxycillin and clarithromycin to promotethe elimination of Helicobacter pylori.
Dose: 800 mg daily. (Pylorid). See page 162.
razoxane A cytotoxic agent occasionally used in the treatment of leukaemias. Dose: 150-500 nighril daily for 3-5 clays, under laboratory control. Side electsare nausea and myleosuppression. (Razoxin).
Rif
Dose: by aerosol inhalation; 0.5-1 mg
( 1 -2 puffs), repeated up to 3 times a day. Side-effects include tremor an(] mild tachycardia. (Bronchodil). See page 118 and Table 6.
resorcinol A keratolytic agent used mainly as an ointment in acne, and as a hair lotion for removing dandruff. Myxoedema has been reported following the prolonged use of resorcin preparations.
reteplase A thrombolytic agent used in acute myocardial infarction.
Dose: 10 units by slow i.v. injection within 2 hours of the infarction. A second dose may be given 36 hours later, together with heparin, to reduce the risk of rethrombosis. Side-effects are arrhythmias an(] gastrointestinal bleeding. (Rapilysin). See page 156 and Table 24.
retinol See vitamin A.
riboflavine (vitamin B2) Part of the vitamin B complex, it is concerned with the oxidation of carbohydrates and amino acids. A deficiency causes several characteristic effects, including angular stomatitis and’burning feet’.
Dose: 1-10 mg in deficiency states associated with restricted diets or poor absorption.
rifabutinV A derivative of rifampicin used in the multi-drug treatment of pulmonary tuberculosis.
Dose: 150-450 mg daily. It is also used I,i,)I,Iiyl.iclically.ig,.iiii.%t opportunistic infection with Mycobacterium avium. (Mycobutin). See page 170 and Table 31.
reboxetineV An inhibitor of noradrenaline reuptake used in depression.
Dose: 4 ing twice a day, half-doses for the elderly. Side-effects are those of other antidepressants. Care in renal/hepatic impairment. (Fdronax). See page 128 and Table 11.
remifentanilV An analgesic of the fentanyl type used as an adjunct in doses of
0.5-1 fig/kg/min for the induction of anaesthesia. Its use reduces the amount of general anaesthetic required. (Ultiva).
reproterol A bronchodilator with the actions, uses and side-effects of salbutamol.
rifampicin An antibiotic now considered to be the first-choice drug in the treatment of tuberculosis, and given together with isoniazid and pyrazinamide.
Dose: 600 mg before breakfast. It is also used with dapsone and clofazimine in the initial treatment of severe leprosy. Combined therapy is also used in brucellosis, legionnaire’s disease and severe staphylococcal infections. Side-effects include gastrointestinal disturbances, rash, an influenza-likesyndrorne and hepatic reactions. Jaundice is a contraindication. Patients should be warned that rifampicin gives a red colour to the urine, sputum and tears, and to soft contact lenses. It may decrease the response to oral anticoagulants such as warfarin, and the failure of oral contraceptives has also been reported in patients receiving rifampicin. (Rifadin; Itiniaciane), See page 170 and Table 31.
riluzoleV A new drug used only for motor neurone disease (a myotrophic lateral sclerosis-ALS). ALS is a degenerative disease and may be due to the local accumulation of the neurotransmitter glutamate, with consequent neurone damage. Riluzole slows down the progressive nature of the disease, and improves the response to mechanical ventilation. Dose: 100 mg daily. See specialist liteiawre. Milutek).
rimiterol A bronchodilator similar in actions and uses to salbutamol, but with a shorter duration of effect. It is largely free from any cardiac stimulant activity. Rimiterol is used mainly for the relief of bronchospasm in bronchitis, bronchial asthma and similar conditions.
Dose: by aerosol inhalation, 200-600 pg ( 1-3 puffs) up to a maximum of 8 puffs daily. (Pulmadil). See page 118 and Table 6.
I sac
Lip to 350 pg/min. or 10 mg by i.m. injection and continued until the contractions have ceased; then orally up to 120 mg daily to prevent relapse. Side-effects include tremor, nausea and hyj)otension. (Yutopar).
rocuronlurn A muscle relaxant similar in actions and uses to vercuronium. Dose: 600 pg/kg initially, followed by 300-600 pglkglhrly as required.
(lisincron).
ropiniroleV A potent and selective
dopamine D,-receptor agonist used in the treatment of Parkinson’s disease, a condition basically due to a deficiency of dopamine in the brain. It is well absorbed orally, and reaches the central nervous system where it functions as dopamine replacement therapy.
Dose: first week 750µg daily with food; second week 13 ing daily, third week 2.25 mg daily, then 3 ing daily. Ropinirole may be given as monotherapy or together with levodopa. Side-effects are somnolence, hypotension, leg oedema and gastrointestinal disturbances. Caution in severe cardiac, renal and hepatic conditions. (Requip). See page 160 and Table 26.
89
Ringer’s solution An electrolyte replacement solution containing sodium
chloride, potassium chloride and calcium chloride.
risperidone An antischizophrenic agent of the clozapine type, with a selective affinity for serotonin and dopamine receptors. It may relieve the aggressive symptoms of
schizophrenia as well as the negative aspects such as apathy.
Dose: 6-10 mg. daily. Side-effects are headache, dizziness and agitation. Agranulocytosis is uncommon, and the close blood monitoring required with clozapine is not necessary. (Risperdal). See page 168 and Table 30.
ritonavirV An HIV-protease inhibitor used in HIV infections in association with a nucleoside analogue.
Dose: 1.2 g daily with food. (Norvir). See page 144 and Table 19.
ritodrine A beta,-adrenoceptor stimulant with a relaxant action on uterine muscle, used to inhibit premature labour.
Dose: 5opg/niin initially by i.v. infusion (avoiding fluid overload), slowly increased
ropivacaine A local anaesthetic with the actions and uses of lignocaine. (Naropin).
Rose bengal A (lye used as eye drops (M) to stain and detect damaged conjunctival cells, and in the diagnosis of dry eye.
rubella vaccine A suspension of a live, attenuated strain of rubella virus. It is used for active immunization in girls of 10-14 years, and in seronegative women of childbearing age.
Dose: 0.5 nil by s.c. injection. It is contraindicated in pregnancy, and pregnancy within 3 months of vaccination should be avoided. A combined rneasles/mUnipsit-111101,a (MMR) vaccine is now recommended for all children.
saccharin A synthetic sweetening agent widely used as a non-calorific substitute for sugar. Has been used by rapid i.v. injection (2.5 g in 4 ml) for arm-tongue circulation time.

mepacrine A synthetic antimalarial. Now replaced by chloroquine and other powerful drugs. It is used occasionally in the treatment for Giardia laynblia infections. Dose: 300 mg daily for 5-8 days.
tmeprobamate A mild tranquillizer used Ili anxiety and tension states, but its extended use may lead to dependence. Dose: 1.2-2.4 g daily. Side-effects are drowsiness, headache, gastrointestinal and visual disturbances. It has been largely replaced by benzodiazepine anxiolytics. (Equallil).
meptazinol An analgesic for the relief of moderate to severe pain. It has a more rapid and extended action than morphine, and is less likely to cause respiratory depression or induce dependence.
Dose: 800-1600 nig orally daily. In severe pain, 50-100nig by injection, repeated as required; in obstetric analgesia, 2 nig/kg. The action can be partly antagonized by naloxone. Side-effects include dizziness and nausea. (IMeptid).
rinequitisizine An antihistamine used for the symptomatic relief of allergic states such as haytever and urticaria. It is less likely to Cause sedation than sonic other antihistamines.
Dose: 10 mg daily. Side-effects may include dry mouth and blurred vision. (Prinialan). See page 110 and Table 2.
mercaptopurine A cytotoxic agent used in the treatment of acute leukaemia.
Dose: 2.5 niWkg daily. Close haernatologi,al control is essential, as the drug has .1 marked niyelosuppressive action. \.lercaptopurine is also hepatotoxic, and should be withdrawn if jaundice occurs. (Puri-Nethol). See page 122 and Table 8.
meropenem An antibiotic similar to imipenem. but more resistant to breakdown by renal enzymes, so combined use with an enzyme inhibitor is unnecessary. Dose: given by i.v. infusion in doses of 500 mg-2 g 8-hourly according to the severity of the infection. Care is necessary in hepatic disease. (Meronem).
mesalazine The active metabolite of sulphasalazine. It is not suitable for oral
use as such, but can be given as a resin-drug complex, so that the drug reaches and is released in the colon unchanged. It is used both for the acute attack and for the maintenance of remission of ulcerative colitis, particularly in patients unable to tolerate sulphasalazine.
Dose: 1.2-2.4 g daily. Side-effects include gastrointestinal disturbances, and care is necessary in patients hypersensitive to salicylates. Patients should be advised to report an), bruising, bleeding or malaise. If .a blood dyscrasia is suspected, a [)food count should be done and the drug withdrawn. Lactulose should not be used as a laxative, as it may hinder the release of the active drug. Also used as enema and suppositories. (Asacol; Pentasa; Salofalk). See page 172 and Table 32.
mesna A compound used to prevent the liaemorrhagic cystitis caused by the cytotoxic drugs cyclophosphamide and ifosfamide. The reaction is caused by the metabolite acrolein, and mesna reduces the toxicity by combining with acrolein in the urinary tract.
Dose: 20%, of that of the cytotoxic drug, and should be given at the same time by i.v. injection. Subsequent supportive doses may be given orally or by injection il - 8 hours after therapy. (Uromitexan).
mesterolone An orally active androgen with the actions and uses of testosterone. It is used in androgen deficiency and male infertility but, unlike other androgens, it does not inhibit endogenous androgen production, and is less hepatotoxic. Dose: 75-100 mg daily for sonic months. (I'm Viron).
mestranol An orally active oestrogen present in some oral contraceptive products. See page 264.
metaraminol A sympathornimetic agent that increases the blood pressure by a general constriction of the peripheral blood vessels. It is used mainly in the acute hypotension that may occur with spinal anaesthesia. It has also been used in shock, but the use of vasoconstrictors has declined, as in shock the peripheral resistance may be already high, and the use of blood volume expanders and dopamine and dubotamine is now preferred.
Dose: 15-100 mg 1)), i.v. infusion. Side-effects are tachycardia and reduced renal blood How. It is contraindicated in myocardial infarction. (Aramine).
metformin An orally active biguanide hypoglycaemic agent. Its action differs from that of the sulphonylureas, as it acts by increasing the peripheral uptake of glucose. It is used mainly in non-insulindependent diabetes not controlled by diet and sulphonylurea therapy.
Dose: 1.5-3 g daily according to need and response. Side-effects include nausea and transient diarrhoea. 11 may cause lactic acidosis and it should not be used in patients with renal impairment. (Glucophage). See page 131 and Table 13.
tmethadone A morphine-like analgesic with reduced sedative effects. Ofvalue in severe pain, and in the relief of useless cough in terminal disease.
Dose: 5-10 mg orally or by i.m. or s.c. injection, in intervals according to need. Prolonged treatment carries the risk of cumulative effects and overdose.
(Physeptone).
methenamine See hexarnine.
methionine A sulphur-containing amino acid essential for nutrition. It is used mainly in paracetamol poisoning, often with acetyl cysteine, and given within 10-12 hours.
Dose: 2.5 g 4-hourly up to a total of [0 g.
methocarbamol A skeletal muscle relaxant used in muscle injury and spasm.
Dose: 6g daily orally; 1-3 g daily by slow i.v. injection. It may cause drowsiness, dizziness and allergic rash. Contraindicated in epilepsy and myasthenia gravis. (Robaxin).
methohexitone A short-acting i.v. anaesthetic similar to thiopentone. It is used mainly for the induction and maintenance of anaesthesia for short operative procedures, when the quick recovery may be an advantage. (Brietal).
methotrexate A cytotoxic agent that acts by inhibiting the synthesis of purines, and so indirectly interferes with cell proliferation. It is used chiefly for maintenance therapy in the remission of acute lymphoblastic leukaemia in children, but it has been used in choriocarcinoma as well as some lymphomas and solid tumours.
Dose: in children, I5 mg/in' weekly. It is sometimes effective in resistant psoriasis, and is given in oral doses of 10-25 nig weekly under specialist supervision. It is occasionally used in severe rheumatoid arthritis not responding to other treatment in doses of 7.5 mg once weekly. Side-effects are those of gastrointestinal toxicity, niyelodepression, rash and cirrhosis. Blood counts and liver function tests during treatment are essential. Cough and dyspnea may indicate pulmonary toxicity. Aspirin and non-steroidal anti-inflaniniatory drugs (NSAIDs) should be avoided, as they delay the excretion of methotrexate and increase its toxicity. See page 122 and Table 8.
methotrimeprazine An antipsychotic agent of the chlorpromazine type, with similar actions, Uses and side-effects. It is used in schizophrenia when a sedative effect is also required.
Dose: 25 -50 mg daily, but much larger doses, up to 1 g daily, may be required, particularly for bedfast patients. It is of value as an adjunct to other therapy in terminal illness and is sometimes given by continuous s.c. infusion in doses of 25-200 ing over 24 hours. Postural hypotension may occur in elderly ambulant patients. (Nozinan). See page 168 and Table 30.
methoxamine A sympathomimetic agent that increases the blood pressure by constriction of the peripheral vessels. It is used in the hypotension following spinal anaesthesia; to correct an excessive response to antihypertensive drugs; and to arrest supraventricular tachycardia. Dose: 5-20 mg by i.m. injection; 5-10 mg by slow i.v. injection. Care is necessary in preexisting hypertension and cardiov.iwular disease (Vasoxine).
methyl cellulose A derivative of cellulose that is used as an emulsifying agent and bulk laxative.
Dose: 1.5-6g with water, but not at night. It is sometimes given in diarrhoea, with a minimum amount of water.
methyl salicylate A pale yellow liquid with a characteristic odour. It has long been used as wintergreen liniment and ointment for the local relief of muscle pain and rheumatic conditions, but is now less popular.

methylated spirit Alcohol containing 5% of wood naphtha. Used for skin preparation and alcoholic applications. The methylated spirit used domestically differs, and is coloured violet to indicate its unsuitability for medicinal use.
methylcysteine A sputum-liquefier claimed to be of value in respiratory conditions where the sputum is viscid. Dose: 600 ing daily. (Visclair).
! Met
other pressor amines. It is used mainly in the preoperative control of adrenaline-producing tumours (pliaeochrornocytoma), and in the long-term treatment of patients unsuitable for surgery.
Dose: I g daily initially, increased if necessary up t(') 4g daily. An adequate fluid intake is essential. Side-effects include sedation, which may be marked initially, diarrhoea, which maybe severe, depression and confusion. (Dernser).
so
methyidopa A centrally acting antihypertensive drug, usually given together with a diuretic. It has the advantage of being relatively safe in asthma, heart failure and pregnancy.
Dose: 750 ing-3 g daily; 250-500 mg by i.v. infusion. Side-effects are drowsiness, depression and diarrhoea. A systemic lupus crytheinatostis-like syndrome may also occur, and active liver disease is a contraindication. (Alcloinet). See page 148 an(] Table 21.
tmethylphenidate A central stimulant used occasionally under strict supervision for the treatment of hyperactive children. Dose: 5-10 mg daily. Witalin).
metoclopramide A stimulant of gastric and small intestine transport. It is used in the treatment of nausea and vomiting generally, including that induced by drugs or migraine, in non-ulcer dyspepsia, and in accelerating the passage of a barium meal.
Dose: 15-30 ing daily orally or by Lin. or i.v. injection. A single dose of 10-20 mg is given by injection 10 minutes before radiological examination. Side-effects include extra-pyramidal reactions, facial sprints and oculogyric crises, mainly in voting persons, and it is best avoided in patient., under 20 years of age. (Maxolon). Some long-acting products are also available. See page 158 and Table 25.
tmethylphenobarbitone An anticonvulsant with the actions, uses and side-effects of phenobarbitone.
Dose: in epilepsy, 100-600 ing daily. (Prominal). See page 136 and Table 15.
methylprednisolone A corticosteroid with the actions, uses and side-effects of prednisolone, and given in similar doses. (Medrone).
methysergide A synthetic drug related to ergonicirine and used in the prevention of severe and recurrent migraine not responding to other drugs.
Dose: 2-6 ing daily. It is also given fur the symptomatic treatment of the carcinoid syndrome in (loses of 12-20 ing daily. Mcthvsergide has many side-effects, including retroperitoneal and cardiac fibrosis, and its use requires expert supervision. (Des-A-ril)-See page 154 and] able 23.
metipranolol A beta-adrenoceptor blocking agent used as eye drops 0.1-0.6% for the treatment of chronic glaucoma.
metirosine An enzyme inhibitor that interferes with the synthesis of adrenaline and
metolazone A diuretic with the actions, uses and side-effects of bendrofluazide.
Dose: in hypertension, 5 mg daily I p
initially; in oedematous statcs,5-20ingor more daily may be given. The diuresis is increased by combined treatment with a loop diuretic such as ffl,lsemide, but monitoring of the response is necessary. (NIctinex). See page 148 and Table 21.
metoprolol A beta-blocking agent used in the control of angina, but also of value in hypertension and the prophylaxis of migraine.
Dose: in angina, 100-300 mg daily; in hypertension, 100-400 ing daily; in migraine prophylaxis and thyrotoxicosis 200 ing daily. It is occasionally given by slow i.v. injection in acute cardiac arrhythinias; dose 1-2 nighnin tip to a total of 10-15 mg. Care is necessary in heart block, bradycardia and pulmonary disease. (Betaloc; Lopresor). See page 114 and Table 4.
metriphonate An organophosphorus schistosornicide, but used only in infections of the hookworm Schistosonia haemobitim, which is found in the genitourinary veins.

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

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