Posts Tagged ‘hypersensitivity reactions’

tiaprofenic acid A non-steroidal analgesic and anti-inflammatory agent with the actions, uses and side-effects of related NSAIDs such as naproxen.
Dose: 600-800 nig daily. Mild oedema may occur with extended treatment. Peptic ulcer and asthma are contraindications. Severe cystitis is an occasional side-effect. It should not be given to patients with urinary tract disorders, and should he withdrawn at once if any
urinary symptoms develop. (Surgarn). See Page 165 and Table 29.
t1bolone A compound described as an gonadomimetic steroid as it has oestrogenic and progestogenic properties. It is used to control the vasomotor symptoms of the menopause, including those surgically induced as well as those occurring naturally.
Dose: 2.5 ing daily for some months. Similar doses in the prophylaxis of osteoporosis. Side-effects are headache, dizziness and vaginal bleeding. Treatment should be withdrawn if any thromboembolic symptoms or jaundice appear. (1,ivial).
Dose: 400 nig as a single daily dose for 12 weeks, to be taken with water at least 2 hours before or 2 hours after meals. Antacids and milk should be avoided. The improvement in serum alkaline phosphatase activity may persist, and a second course needed only after an interval of at least 6 months. Gastrointestinal side-effects are common, but renal function should be monitored regularly. (Skelid).
timolol A beta-andrenergic blocking agent of the propranolol type, used in the control of angina and hypertension. Dose: 10-60nigdaily. In the prophylactic t i catment of migraine, 10-20 ing daily. (,’are is necessary in bradycardia, cardiac insufficiency and bronchial disease. It is also of value as eye drops (0.25%-0.5%) in simple chronic glaucoma, as it reduces infra-ocular pressure by reducing the formation of the aqueous humour. (Betim; Blocadren; Timoptol). See pages 148 & 154, and Table 21.
tinidazole A drug similar to metronidazole, and used mainly in the prophylaxis and treatment of anaerobic infections and anioebiasis.
Dose: 2 g initially, followed by I g daily for 5 days. A single oral (lose of 2 g is given 12 hours before abdominal surgery, and a similar single dose is given in amoebiasis and giardiasis. Side-effects are nausea, vomiting and diarrhoea. A disulfiram-like -like reaction may occur if alcohol is taken. ( Fasigyn).
99
ticarcillin An antibiotic with an increased activity against Pseudomonas aeruginosa. In pseudomonal septicaemia, combined treatment with an aminoglycoside anti biotic such as gentamicin may evoke an increased response.
Dose: 15-20 g daily by slow i.v. injection or infusion in systemic infections; 3-4 g daily by i.m. injection in urinary infections. (Ticar). It is sometimes given together with clavulanic acid as Timentin, but it delayed post-treatment reaction with Tinientin is cholestatic jaundice, thought to be due to clavulanic acid.
tiludronic acid A bisphosphonate that inhibit., (fie [)one resorbing activity of osteoclasts, and so reduces the excessive demineralization of bone that occurs in Paget’s disease.
tinzaparin A low-molecular weight heparin ti,cd in the prevention ofthromboembolism.
Dose: by s.c. injection 2500-3000 units daily for 7-10 days. It is also used to prevent clotting in haemodialysis apparatus. (Innohep; Logiparin). See dalteparin and enoxaparin. With these products laboratory control is not necessary.
tioconazole An antifungal agent used in
tines infections of the nails by the
extended application of a 289/6 solution. Treatment for 6 months or more may be necessary. (Trosyl).
titanium dioxide A metallic oxide, similar to zinc oxide, with mild astringent properties. It is present in some sunburn protection preparations.

tizanidine A central alpha, receptor agonist use([ in the spasticity associated with multiple sclerosis and spinal injury. Dose: 2 ing weekly, increased according to response up to 24 ing daily. Monitor liver function monthly for 4 months. (Zaiiallex).
tobramycin An aminoglycoside antibiotic with the actions, uses and side-effects of gentamicin, but considered to be more active against Pseudomonas aerugi . nosa. Dose: 3-5 nig1kg daily by i.m. injection or i.v. infusion. It may be given together with a penicillin or nictroniclazole in serious mixed infections. Care is necessary to avoid the ototoxic and nephrotoxic effects of aminoglycosides. (Nebcin).
tocainide An anti-arrhythmic agent similar in action to lignocaine. It is a powerful drug, and may cause severe blood dis(urhances, and its use is largely restricted to the control of life-threatening arrhythmias not responding to other drugs.
Dose: 1.2-2.4 g daily. Blood counts during treatment are essential. Side-effects include bradycardia, hypotension, rash, tremor and aplastic anaemia. (Tonocard).
tocopherol A synthetic form of vitamin E.
tolazamide An oral hypoglycaemic agent related to tolbutamide, with similar actions, uses and side-effects.
Dose: 100-250 mg daily, increased if necessary up to a maximum dose of I g daily. (Tolanase). See page 131 and Table 13.
tolbutamide A sulphonylurea used like Jilorproparnicle in the treatment of maturity-onset diabetes, but it has a shorter action, and twice-daily doses are usually necessary. It is effective only when some insulin-secreting cells of the pancreas are still functioning, and a return to insulin therapy may be necessary during illness and infection. Tolbutarnide is not suitable for the treatment of juvenile or severe diabetes.
Dose: 0.5-2 g daily. Side-effects include hypoglycaemia, poglycaernia. rash, Jaundice and blood dyscrasias, but are uncommon with low doses. (Rastinoo). See page 131 and
Table 13.
tolcapone An inhibitor of the enzyme concerned with the biosynthesis of dopamine. It is used with other drugs in the
treatment of parkinsonism in initial doses of 100 mg 3 times a day. Side-effects are dyskinesia, nausea and sleep disturbances. (Tasmar). See page 160 and Table 26.
tolfenamic acid A non-steroidal anti-inflammatory drug (NSAID) but exceptional in being used in the treatment of migraine, on the basis that prostaglandins are involved in the pathology of migraine. Dose: 200 mg at the onset of an attack, repeated once after 2-3 hours if necessary. Close monitoring is required if anticoagulants also given; caution in peptic ulcer. (Clotani). See page 154 and Table 23.
tolmetin An anti-inflammatory analgesic agent used in rheumatoid and mUSCUIOskeletal conditions. As with related non-steroidal anti-inflammatory drugs
(NSAIDs) it may cause gastrointestinal disturbances in some patients, and should be taken after food. Hypersensitivity reactions may occur occasionally.
Dose: 0.6-1.8 g daily. (Tolectin). See page 163 and -Fable 29.
topiramateV A new anti-epileptic that differs chemically from related drugs. It is used as adjunctive therapy in partial seizure patients not adequately controlled by standard treatment.
Dose: initial (lose 100 nig daily, slowly increased at weekly intervals as required up to 800 mg daily. Patients receiving digoxin should be monitored. Not recommended for children. (Topaniax). See page 136 and Table 15.
topotecanV A new advance in cancer chemotherapy is the use of topoisomerase inhibitors. Topoisomerase I is necessary for DNA replication, and topotican acts by binding with super-coiled DNA and so preventing further DNA development. Dose: 1.5 mg/n’ by i.v. infusion daily for 5 days under expert supervision. Side-effects are myelosuppression and severe neutropenia. (Hycamptin). See page 122 and Table 8.
torasemide A loop diuretic of the
IrLISCII)i(IC type.
Dose: in oedema, 5-20 ing once daily; in pulmonary oedema 10-20 mg daily by slow i.v, injection but much larger doses are sometimes necessary. In hypertension. 5-20 mg daily. (Torero). See page 148 and Table 21.

toremitene’v” An anti-oestrogen used in h0i 11 im ie- dependent metastatic breast cancer.
Dose: 60 mg as a single daily dose. Side- effects are linked with the mode of action
aninclude hot flushes, dizziness and
sweating. Care is necessary in severe hepatic deficiency, angina and cardiac weakness. (Fareston). See page 122 and Table 8.
trannadoW An analgesic used in the short-tan) treatment of moderate to severe pain. It has reduced affinity for opioid receptors, and the action may be mediated by inhibiting the neuronal re-uptake of noradrenaline and related amines. Dose: 300-400nig; in severe pain it may he given by i.m. injection or i.v. injection/infusion in closes of 50- 100 ing 4-6-hourly. (Tramake; Zamadol; Zydol).
trandolapril An ACE inhibitor used in mild io moderate hypertension.
Dose: 500 jig daily initially, increased at intervals of 2-3 weeks up to 1-21ng once daily. If hypotension occurs, reduce supportive therapy before lowering the trandolopril dose. Prophylactic dose after myocardial infarction 500 Vg-4 mg daily. Diuretic therapy should be stopped before starting with trandolapril, to reduce the risks of initial hypotensive side-effects. (’are with monitoring in patients with renal and hepatic impairment. (Gopten; Odrik). See page 148 and Table 21.
tranexamic acid An antifibrinolytic agent used to check haemorrhage after prostactectomy, in surgery generally and in the control of menorrhagia.
Dose: 2-8 g daily; 3 g daily by slow i.v. infection. Side-effects are nausea, diarrhoea and dizziness. (Cyklokapron).
tranquillizers These drugs were once Separated into the major tranquillizers, represented by chlorpromazine, and the minor tranquillizers exemplified by diazepam, but are now often referred to as antipsychotic drugs and anxiolytics respectively. The antipsychotics are used mainly in the control of disturbed patients, and in schizophrenia, although they have some anti-anxiety properties, and long-term treatment is often necessary. The anxiolytic drugs are intended mainly for the short-term treatment of acute anxiety states, as extended use may
cause dependence. See pages H 7 & 168, and Tables 5 & 30.
Transiderm-Nitro A medicated patch containing glyceryl trinitrate designed to have an action over 24 hours in the prophylaxis of angina.
tranylcypromine A monoamine oxidase inhibitor (MACI), of use in severe depression not responding to other drugs. Dose: 20 nig daily initially, increased to .50 ing daily or more according to need. The use of tranylcypromine requires care, as the drug has a stimulant action that may complicate therapy, and phenelzine may be preferred. Side-effects are dizziness, dry mouth and insomnia. Liver damage may also occur, and a hypertensive crisis with throbbing headache requires withdrawal of the drug. Hyperthyroidism is a contraindication. (Parnate). See page 128 and Table 11.
trazodone An antidepressant chemically distinct from other drugs with a similar action, and with reduced anticholinergic and cardiovascular side-effects. It is
indicated mainly in depression associated with anxiety when a sedative action is also required.
Dose: 150-300mgd;iily.’['Iieside-effects are those of the tricyclic antidepressants such as amitriptyline. (Molipaxin). See page 128 and’I'able 11.
treosuffan A cytotoxic agent related to busulphan, but used mainly in ovarian cancer.
Dose: I g daily for 28 days, repeated after a 4-week rest period; 5-15g by i.v. injection at intervals of 1-3 weeks. In all cases the (lose is adjusted according to the
degree of bone marrow depression that occurs. Other side-effects are those of cytotoxic drugs generally. Extravasation causes pain and local tissue damage. See page 122 and Table 8.
tretinoin A derivative of vitamin A. It is used locally for acne (Retin-A) and also for the treatment of photodamage to the skin (Retinova). A new use is the induction of remission in acute promyelocytic leukaemia.
Dose: 22.5 trig/m2 twice daily with food. Combined therapy may reduce the risk of relapse (Vesanoid).

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

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

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

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

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

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

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.

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

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