Posts Tagged ‘hypotension’

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 It should not be given to patients with urinary tract disorders, and should he withdrawn at once if any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 Treatment should be withdrawn if any thromboembolic symptoms or jaundice appear.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).
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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).

potassium permanganate Purple crystals, soluble in water. A powerful oxidizing and deodorizing agent used 1:1000 as lotion, 1:10000 to 1:5000 as mouthwash, douche, bladder washout and bath.
povidone-iodine A complex of iodine with an organic carrier. When applied to the skin it slowly releases iodine, and has an extended antiseptic action. Used for local application to the skin and mucous membranes as solution containing the equivalent of 0.75-1 % of iodine.
pralidoxime A reactivator of cholinesterase. Organophosphorus insecticides inhibit that enzyme, and poisoning by such insecticides is an occupational hazard. Their toxicity can be reversed in part by the injection of 2 mg atropine, but the enzyme can be reactivated and muscle power restored by pralidoxime (30 mglkg) given by slow i.v. injection, repeated as required. It is effective only if given within 24 hours of exposure to the insecticide.
pravastatin A blood lipid-lowering agent with the specific enzyme-inhibiting properties of simvastatin, and used in primary hypercholesterolaemia not responding to the other drugs.
Dose: 10 -40 mg daily as a single dose. Side-effects include myalgia, rash and gastrointestinal disturbances. (Lipostat). See page 146 and Table 20.
prazinquantel A schistosomicide of low toxicity, effective against Schistosonia hamratobium, S, mansoni and S. japonicum It is also active against tapeworm. Dose: 10-20nig/kg as a single oral dose. (Biltricide).
prazosin An alpha-adrenoceptor blocking agent and vasodilator used in the treatment of hypertension and congestive heart failure.
Dose: I mg daily initially, increased as required up to a maximum of 20 mg daily. The initial dose may cause marked hypotension, and it should be taken at night, in bed. prazosin is also given in benign prostatic hypertrophy in maintenance doses of 4 mg daily. Side-effects are drowsiness, nausea and postural hypotension. (Hypovase). See page 148 and Table 21.
prednisolone A glucocorticosteroid with the actions and uses of hydrocortisone, but effective in much lower doses. It is often the preferred drug for oral use, and is given in a wide range of conditions including asthma, severe allergic reactions, rheumatoid arthritis, collagen disorders and inflammatory skin conditions. prednisolone is also of value in leukaemia, ulcerative colitis, the nephrotic syndrome, pemphigus, sarcoidosis, myasthenia gravis, haemolytic anaemia, agranulocytosis and other blood dyscrasias. Large doses are given in the immunosuppressive control of transplant surgery. The dose varies with the nature and severity of the condition being treated, and in every case the lowest dose required to evoke an adequate response should be used, after which the dose should be reduced in stages. Dose: in rheumatoid arthritis, 7.5-10 ing daily initially; other conditions may require doses up to 100 mg daily. Dose by i.m. injection 25-100 ing once or twice a week. Asa retention enema, 20 mg to relieve the inflammation of colitis and Crohn’s disease; as eye drops and ear drops, 0.5% solution. The side-effects are those of the corticosteroids generally, and include salt and water retention, hypertension, muscle weakness and peptic ulcer.
prednisone A glucocorticosteroid that is converted to prednisolone in the body, and so has the actions and uses of that drug.
prilocaine A local anaesthetic with the actions, uses and side-effects of lignocaine. (Citanest).
primaquine An antimalarial drug used mainly to prevent a relapse of benign tertian malaria after treatment with chloroquine, as it kills the malarial parasites that may still be present in the liver. Dose: 13 mg daily, for 2-3 weeks after chloroquine treatment. Side-effects are nausea and abdominal pain.

primidone An anticonvulsant used in the treatment of grand mat and psychomotor epilepsy.
Dose: 125nig daily initially, slowly increased as required up to a maximum of 1.5 g daily. Side-effects include drowsiness, nausea, blurred vision and rash. (Mysoline). See page 136 and Table 15.
probenecid A uricosuric agent that
increases the excretion of uric acid, and so is useful in the treatment of gout and hv
I peruncacrina.
Dose: O.5-2 g daily. An adequate fluid intake and an alkaline urine are necessary for the best response. probenecid also delays the excretion of penicillin and sonic cephalosporins, and is given in doses of 2 g daily to raise the plasma level of those antibiotics. Side-effects include occasional nausea, flushing and dizziness. (Benernid). ,See page 140 and Table 17.
procainamide A procaine derivative occasionally of value in the treatment of ventricular arrhythmias.
Dose: till to 50 mg/kg daily. It is also given by slow i.v. injection under E’C.C, control in doses of 25-50 ing/tininute up to a maximum of I g. Side-effects are gastrointestinal disturbances, lever and rash. (Prones(vi).
severe nausea and vomiting, 20 mg orally, or 12.5 mg by deep i.m. injection. It is also used as suppositories of 25 ing. (Stemetil). See page 168 and Table 30.
procyclidine An anticholinergic drug similar to benzhexol, used mainly in the treatment of parkinsonism. Reduces rigidity more than tremor.
Dose: 73-30 mg daily. In acute states it is given by i.m. injection in (loses of-i-10 mg, or 5 mg doses i.v. (Arpicolin; Kernadrin). See page 160 and Table 26.
progesterone The hormone of the corpus luicum, responsible for the preparation of the uterus to receive a fertilized ovum. It is used in dysfunctional uterine bleeding and in the premenstrual syndrome. Dose: 200-400 nig daily per ragina on a cyclic basis. (Cyclogest). Also a constituent of sonic oral contraceptives. See dydrogesteronc and norethisterone.
proguanil hydrochloride A synthetic antimalarial of high potency and low toxicity, used in the prophylaxis and suppressive treatment of malaria, often in association with chloroquine.
Dose: 100-200 rig daily, and continued for 6 weeks after leaving the infected area. (PaILICIrinc).
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procaine A local anaesthetic now largely replaced by lignocaine.
procaine penicillin An old long-acting loan of penicillin, given together with penicillin G to obtain a high initial blood level. It is now used mainly in early syphilis. Dose: 900 mg daily by Lin. injection for 10 days. (Ificillin).
procarbazine A cytotoxic drug used mainly as part of a multi-drug treatment of Hodgkin’s disease. It is also used to treat other lymphomas no longer responding to other therapy.
Dose: 50 ing initially, increasing to a maxiintini of 300 mg daily. Side-effects include nausea, anorexia and bone marrow depression. Alcohol may cause a disulfiram reaction. (Nitulan). See page 122 and Table 8.
prochlorperazine A tranquillizer with the actions, uses and side-effects of chlorpromazine.
Dose: in schizophrenia, 25-100 Tng daily; in severe anxiety, 15-20 mg daily. In
promazine A tranquillizer with the actions, uses and side-effects of chlorpromazine, but less potent. It is used mainly to
control agitation in the elderly, and in other minor conditions of psychiatric disturbance.
Dose: 50-800 ing daily, adjusted to need .111d response; by injection 25-50 mg. (Sparine).
promethazine A long-acting antihistamine with sedative properties. It is used for the relief of a wide range of allergic conditions, in mild insomnia and for preoperative sedation. It is also of value as an antiemetic in the prophylaxis and treatment of travel sickness, vertigo and drug-induced nausea.
Dose: 25-50 mg daily; 25-100 ing by deep i.m. injection. In anaphylaxis, sometimes given by slow i.v. injection in doses up to 100 mg to supplement previously injected adrenaline. The side-effects are those of the antihistamines generally. (Phenergan). See page 110 and Table 2.

propafenone An anti-arrhythmic agent of the lignocaine type, used in the prophylaxis and treatment ofventricular arrhythmias. Dose: under ECG control 450 ing daily initially, after food, increased at 3-day intervals up to a maximum of 900 mg daily. Side-effects are dizziness, gastrointestinal disturbances and postural hypotension. (Arythniol).
propantheline An anticholinergic agent used as a spasmolytic in gastrointestinal disorders, in urinary frequency associated with bladder neck weakness, and in nocturnal enuresis.
Dose: 45-120 mg daily at least I hour before food. Side-effects include dryness of the mouth and blurred vision. (Pro- Banthine). See page 174 and Table 33.
propofol A non-irritant short-acting i.v. anaesthetic for smooth induction and maintenance of general anaesthesia for up to I hour. Dose: 2-2.5 mgft initially, followed by Supplementary doses of 0.1-0.2
ing/kg1min as required but some local pain may occur. Side-effects include mild hypotension, transient apnoea an([ bradycardia. Recovery is normally rapid and uneventful but delayed recovery, convulsions and anaphylaxis have been reported. Care is necessary in cardiovascular, respiratory or renal impairment. (Diprivan).
propranolol A beta-adrenoceptor blocking agent that reduces the cardiac response to circulating adrenaline and noracircrialine. It reduces the load on the heart during
exercise and stress, and is used in the treatment of angina, coronary insufficiency, cardiac arrhythmias, hypertension, and after myocardial infarction. It also ameliorates the tremor and palpitation of transient anxiety and stress, and is useful ill the prophylactic treatment of migraine. Dose: 160-320 mg daily according to need. In arrhythmias and thyrotoxic crisis, propranolol is given by slow i.v. injection in doses of I ing, repeated up to a maximum of 10 ing. Side-effects are bradycardia, bronchospasni and gastrointestinal disturbances. Care is necessary in renal and hepatic deficiency, asthma is a contraindication. (Inderal). See page 146 and’I'able 21.
propylthiouracil A thyroid inhibitor occasionally used as an alternative to carbiniazole in hyperthyroidism. Dose: 300-450 ing daily.
prostacyclin See epoprostenol.
prostaglandin A generic term applied to a series of closely related hormone-like fatty acid derivatives, originally extracted front the prostate gland, but now prepared
synthetically. Prostaglandins are widely distributed in animal tissues, and have a complex and varying range of biological activity.’rhus they may have a smooth muscle stimulating or relaxant action, pressor, vasodilator, inflammatory or other properties. The anti-inflammatory action of aspirin and related drugs is due to an inhibition of prostaglandin synthesis. See alprostadil, carboprost, dinoprostone and genieprost.
protamine sulphate A simple protein obtained from fish sperm. It neutralizes the anticoagulant effect of heparin, and it is used in controlling the haemorrhage i hat may occur during heparin therapy. Dose: 1% solution i.v. according to need; ling will neutralize 80-100 units of heparin.
prothionamide A second-line antitubercular drug that has been used in resistant tuberculosis. See page 170 and Table 31. It has also been used in the treatment of leprosy.
protirelin The thyrotrophin- releasing hormone (TRH) of the hypothalamus. Dose: in the diagnosis of hyperthyroidism, as a single i.v. dose ol’200 pg. It normally induces a rapid rise in the plasma levels of thyrotrophin, but in thyrotoxicosis that rise does not occur. Side-effects include nausea, flushing, a strange taste and urinary urgency.
protriptyline A tricyclic antidepressant with actions and uses similar to amitriptyline. It is used in depression associated with apathy, as it has some stimulant action. Dose: 15-40 mg daily. Side-effects are cardiovascular distu&nce, rash and photosensitivity. (Concordia). See
page 128 and Table 11.
proxymetacaine A local anaesthetic used as 0.5% drops in ophthalmology. (Oplithaine).
pseudoephedrine A drug very closely related to ephedrine, but now used mainly as a respiratory decongestant. It has been used in nocturnal enuresis, but may cause hallucinations in sonic children.

metronidazole An orally effective drug used in trichomoniasis, amoebiasis and in infections due to anaerobic bacteria. Dose: in bacterial and trichomonal vaginitis, 600 ing daily for 7 days, or as a single dose of 2g. In acute intestinal arnoebiasis, 2.4 g daily for 3 days. In surgical prophylaxis, and in the prophylaxis and treatment of infections caused by colonic anaerobic pathogens such as Racteriodes ftagilis, as well as infections by some Gram-negative organisms. metronidazole is given in doses of 1.2 g daily orally, or as I g suppositories. In severe infections, doses of 1.5 g are given daily by i.v. infusion, replaced by oral therapy as soon as possible. In Giardia laniblia infections, 2g daily for 3 days; 600 mg daily for 3 days in ulcerative gingivitis. Metronidazole is also valuable in pseudomembranous colitis (see clindamycin). Side-effects are mainly gastrointestinal disturbances and can be reduced by giving the close with food, but epileptiforni seizures may occur with high doses, and the drug may cause a disulfiraintype reaction if alcohol is taken. (Flagyl). Metronidazole is also used as a 0.750% gel (Metrogel; Rosex) in rosacea and as Anabact ail(] Metrotop to deodorize malodorous tumours.
metyrapone Ail inhibitor of glucocorticoid synthesis.
Dose: 750 mg 4-hourly for 6 doses as a Icst of anterior pituitary function, as following such doses the plasma concentration ofcorticosteroids falls. The fall stimulates the production of steroid pre cursors by the adrenal glands, and a rise in the urinary excretion of such precursors is indicative of an active anterior pituitary gland. Metyrapone is also used in resistant oedema due to ail increased production of aldosterone, and in the symptomatic con-I rol 01′ Cushing ’s syndrome. Nausea and vomiting are side-effects. (Metopirone).
mexiletine Ail anti-arrhythmic drug that is useful in the control of ventricular arrhythmias, particularly those following myocardial infarction, or when lignocaine is ineffective.
Dose: as a loading dose, 100-250 mg i.v. under I-I’C6 control, followed by i.v. infusion of a 0.1% solution until a further 250 mg have been given. Oral therapy: a
loading dose of 400 mg, followed by 600mgI g daily. Side-effects are nausea, drowsiness, confusion and blurred vision. Contraindicated in bradycardia, hypotension, and hepatic or renal failure. (Mexitil).
mianserin An antidepressant of the amitriptyline type, with reduced anticholinergic and cardiovascular side-effects, and well tolerated by the elderly. It is of value in all types of depression, including those associated with anxiety. Dose: 30-90 mg daily, which may be taken as a single close at night, although higher doses have been given. Care is necessary in recent myocardial infarction and heart block. Severe hepatic disease is a contraindication. Side-effects include aplastic anaemia,and blood counts during treatment are essential. The drug should be withdrawn if any signs of infection occur. See page 128 and Table 11.
miconazole An antiftingal agent of value in systemic and alimentary fungal infections. Dose: I g daily orally, or up to 1.8 g daily by i.v. infusion, and the duration of treatment largely depends on the response.
Pessaries of 100 mg and a cream (2%) are used for vaginal candidiasis. A gel is available for oral fungal infections. Side-effects after systemic use include nausea, pruritus and rash. Miconazole may potentiate the action of anticoagulant, anticonvulsant
and hypoglycaemic drugs, requiring an adjustment of close. Combined use with asternizole, terfenadine and cisapride should be avoided. (Daktarin).
midazolam A sedative of the benzodiazepine group, used mainly for sedation before and during gastroscopy, endoscopy and other investigations. The action is rapid, and an anterograde amnesia often follows.
Dose: by slow i.v. injection 70pglkg tip it) a total d2.5-7 mg. premedication, 2.5-5 mg i.m. For the induction of anaesthesia in poor-risk patients, 104-300pg1kg by slow i.v. injection. Side-effects after i.v. injection include respiratory depression and, occasionally, severe hypotension. (Hypnovel).
mifepristone An antiprogestational agent used as ail alternative to surgery for the termination of pregnancy, up to 63 days’ gestation.
Dose: a single oral dose of 600 mg. For hospital use only. (Nfifegyne).

milrinone An inhibitor of phosphodiesterase, an enzyme concerned in cardiac function. It has a digoxin-like effect on the myocardium, and may be effective in congestive heart failure not responding to other drugs.
Dose: by i.v. infusion as an initial dose of 50 pg1kg, with maintenance doses of 0.5 pg/min up to a total of 1.13 nig/kg over 24 hours. Side-effects are anginal pain, hypotension and headache. (Primacor). See enoximone, page 141 and Table 18.
minocycline A tetracycline with the general properties of that group of antibiotics, with the advantage of being useful in meningococcal prophylaxis. The absorption of minocycline is little influenced by food. It is also suitable for use when the renal function is impaired, as accumulation of the drug is unlikely.
Dose: 200 mg daily. In acne treatment half-dose should be given for 0 weeks. The side-effects are those of the tetracyclines generally, although monocychne may also cause dizziness, vertigo and rash. (Minocin).
minoxidil A vasodilator used in severe hypotension resistant to other drugs. Dose: 5-50 mg daily. Side-effects are Wright gain, breast tenderness and tachycardia. Almost all patients experience hyper1richosis, and should be warned accordingly. (Loniten). A 2% solution is used as a lotion in the local treatment of male-pattern baldness. (Regaine).
mirtazapine An alpha,-receptor antagonist. It is used in depression as it increases central noradrenergic and serotenergic neurotransmission. rot ransmission.
Dose: 15-45 nag at night for 4-6 months. Side-effects are weight gain and drowsiness. (Zispin).
misoprostol A synthetic prostaglandin with an inhibitory action on gastric secretion. It is used in the control of peptic ulcer, and in the prophylaxis of ulcers induced by non-steroidal anti-inflaniniatory drugs (NSAIDs).
Dose: 800pg daily with food, with a last dose at night, and continued for some weeks. Dose in prophylaxis, 400-800µg daily. Side-effects are usually transient, and
.    include diarrhoea, nausea and abdominal pain. (Cytotec). See page 162. Contraindicated in pregnancy.
mitobronitol A cytotoxic agent used mainly in chronic myeloid leukaemia.
Dose: 250 nag daily until the white cell count falls, then 125 mg daily according to need. May cause gastrointestinal disturbance, alopecia and bone marrow depression. Haematological control is necessary. (Myclobromal). See page 122 and Table 8.
mitomycin A cytotoxic antibiotic used in bi cast, gastrointestinal and other cancers. Dose: 4-10 mg by i.v. infusion at intervals of I-6 weeks. Great care must tic taken to avoid extravasation. Also used in bladder cancer by the weekly instillation of a solution of 10-40 nag in 20-40 nil of water. Side-effects include bone marrow and renal damage, and lung fibrosis.
mitozanitrone A cytotoxic drug related to doxorubicin, and indicated in advanced breast cancer.
Dose: 14 nighn= once i.v., repeated after 21 days, provided the white cell and platelets counts have returned to normal. It is highly irritant, and contact of the drug wid the skin must be avoided. Side-effects are nausea, vomiting, alopecia, myelosuppression and cardiac weakness. (Novantrone). See page 122 and Table 8.
mivacurium A non-depolarizing muscle relaxant with the short action and uses of atracurium.
Dose: initial dose 70-250pg/kg i.v., followed by doses of 100µg/kg/min at intervals of 15 minutes as required. Smaller doses are given by i.v. infusion. (Mivacron).
moclobemideVA short-acting, reversible inhibitor of monoamine oxidase (MAO) for the treatment of severe depression. The older MAO-inhibitors act on both the A- and B-forms of the enzyme, and have a long and irreversible action. Moclobemide has a rapid and selective action on MAO-B, but the duration is short and fades after about 24 hours, as the drug is soots    The risks of reactions with other drugs (comnlon with old MAO-inhibitors) are correspondingly reduced.
Dose: 300 mg daily initially (after withdrawal of other therapy), slowly increased up to 600 ing daily. Side-effects are dizziness and sleep disturbances. (N-lanerix). See page 128 and Table 11.

moexepril An ACE-inhibitor.
Dose: (when given alone) 7.5 mg daily initially, increasing if required up to 30 mg daily. When given as a second-line therapy with a diuretic (which should be avoided), initial dose is 3.75 mg under supervision until the blood pressure has stabilized. Side-effects are hypotension and cough. I lyperkalaernia may occur if potassium supplements or potassium sparing diuretics are also given. (Perdix). See page 148 and Table 21.
molgramostimVA recombinant form of human granulocyte macrophage colony stimulating factor (GM–CSF). It is used in the neutropenia following cytotoxic and bone marrow transplant therapy.
Dose: 60 000-100000 units by s.c. injc, tion or i.v. infusion, under haematological control. (Leucomax). See filgrastini and lenograstini.
mometasoneVA potent corticosteroid used as 0.1% creamilotion once a day in severe eczema, psoriasis and other skin conditions not responding to other therapy. (Elocon). Also used as a nasal spray in allergic rhinitis. (Nasonex).
monoamine oxidase inhibitors Monoaniine oxidase is an enzyme concerned with the breakdown of dopamine, serotonin, noradrenaline and adrenaline. Those substances are stored in many organs of the body, including the brain, where they function as transmitters of nerve impulses. The period for which they act is very short, as they are rapidly metabolized by monoamine oxidase. An inhibition of the enzyme could permit an increase in the brain levels of such amines, and on that basis sonic monoamine oxidase inhibitors (MAOIs) have been used in the
treatment of depression. Therapy is complicated by the fact that these drugs can increase the response to pressor drugs, anaesthetics and many other agents, including the mild sympathominictics present in some cough
mixtures and decongestive nasal sprays. Even certain foods, particularly cheese, may cause a dangerous rise in blood pressure during MAO] therapy and patients should always carry the MAN warning card. Great care is necessary during combined therapy, and ideally 10-14 days should elapse after ceasing
MAGI treatment before using other potent drugs. Examples of MAOIs are isocarboxazid, phenelzine and tranylcypromine. Their use has declined as more effective antidepressants of the amitriptyline type, with fewer side-effects, have become available. See moclobemide, page 128 and Table 11.
moraeAzine A potent cardiac membrane-stabilizing agent used like lignocaine to control ventricular arrhythmias.
Dose: 600-900 mg daily initially, adjusted later according to need and response. Side-effects include dizziness, palpitations and chest pain. (Ethniozinc),
tmorphine The principal alkaloid of    71 Opium. It is widely used as a narcotic analgesic for the relief of severe pain and the associated anxiety and stress, and in shock.
Dose: in acute pain, 10 mg by injection as required; in chronic pain it may be given orally or by injection according to need in doses varying from 5-10 mg. Sonic long-acting oral forms of
morphine are available (MST Continus; Oramorph SR) designed to reduce the frequency of dosing in conditions of severe pain. Side-effects include nausea and vomiting, which can often be controlled by small doses of chlorpromazine, or a similar antiemetic.
Morphine may cause respiratory depression, and severe respiratory depression is a contraindication. The possibility of tolerance to and dependence on morphine should be kept in mind if treatment is prolonged, but in terminal Conditions is of little importance.
moxisylyte (thymoxamine) An alpha,- adrenergic blocking agent, given by intracavernous injection for the induction of erection.
Dose: 10 mg not more than 3 times a week. Side-effects are drowsiness. dizziness and flushing. (Erecnos).
moxonidine A centrally acting antihypertcjisive agent of the clonidine type. It has a greater affinity for certain receptors in the brain stem that reduce the peripheral resistance and so indirectly lowers the blood pressure.

gelatin A protein obtained by the hydrolysis of animal tissues. Used orally as nutrient jellies, and specially refined solutions have been used as blood volume expanders (see dextran). (Gelofusine; Haemaccel).
I Gil
nephrotoxic side-effects, and dosage requires care when renal function is inadequate, and also in elderly patients. Gentarnicin is also used locally as cream or ointment (0.3%) and as eye drops (0.3%). (Cidomicin; Genticin).
gemcitabineV A cytotoxic agent related
to cytarabine, but with increased
potency and a longer action. It blocks cancer cell replication by inhibiting DNA synthesis, and may enhance the action of other agents. It is used mainly in the palliative treatment of non-small cell lung cancer.
Dose: 1000 mg/m-’ by slow i.v. infusion over 30 minutes, once a week for 3 weeks, repeated after a rest period. It is generally well tolerated, but a common side-effect is a transient influenza-like reaction. Myelosuppression is less severe than that of related cytotoxic agents. (Gemzar). See page 122 all(] Table 8.
gentian violet See crystal violet.
gestrinone An antiprogestogen used in ctidonictriosis that acts indirectly by suppressing gonadotrophin production. Dose: 2.5 ing twice weekly oil the same day,, each week for o months. Side-effects arc fluid retention, acne and voice changes. ( Dimetriose).
gestronel A synthetic progestogen used in the treatment of breast and endonietrial carcinoma and benign prostatic hypertrophy.
Dose: 200-400 ing i.m. once a week. (Depostat).
51
gemeprost A synthetic prostaglandin used to dilate the cervix uteri in first trimester abortion.
Dose: I mg, as a pessary 3 hours before surgery. Side-effects are mild uterine pain and vaginal bleeding initially, nausea and di.11 I hoc.).
gernfibrozil A plasma lipid regulating agent, with the actions and uses of hez.afibrate and clofibrate.
Dose: 901) ing-1.3 mg daily, with regular checks oil plasma lipid levels. Treatment should be withdrawn after 3 months if the response is unsatisfactory. Gernfibrozil may potentiate the action of oral anticoagulants, the dose of which should be adjusted. Side-effects include nausea, diarrhoea, abdominal pain, rash and dizziness. (Lopid). See page 146 and Table 20.
gentamicin An aminoglycoside antibiotic, active against a wide range of Gram-negative organisms, including Pseudomonas aeruginiosa, as well as against many Gram-positive bacteria, although it is not very active against anaerobic organisms. It is of great value in septicaemia and meningitis, as well as in bacterial endocarditis.
Dose: 2-3 nig/kg daily by i.m. injection or i.v. infusion. In serious or undiagnosed infections, supplementary treatment with a penicillin or metronidazole may be require(]. In common with other arninoglycosides, goitarnicin has ototoxic and
glibenclarnide An orally active hypoglycaenfic agent similar to chlorpropamide. Dose: 5-15 nig daily, according to need and response. (Daonil; Euglucon). See
page 131 and’I'able 13.
gliciazide A sulphonylurea with the actions and uses of chlorpropamide and related drugs.
Dose: 40-320 mg orally. (Diarnicron). See page 131 and Table 13.
glimepiride A sulphonylurea used in non-ill Sidi 11 -dependent (Type 11) diabetes mellitus.
Dose: 2 mg after breakfast, increased ill, to .1 mg daily. Side-effects include
transient visual disturbances, rash and urticaria. (Amaryl). See page 131 and Table 13.
glipizide A sulphonylurea, used like chlorpropamide in diabetes, but effective in much lower doses.
Dose: 5 mg initially, maintenance dose 2.5-40 nig daily. (Glibenese; Minodiab). See page 131 and Table 13.
gliquidone An oral hypoglycaemic agent similar to chlorpropamide. Effective in maturity-onset diabetes.
Dose: I5 ing initially; maintenance dose 40-60 nig daily, but up to 180 mg daily have been given. (Glurenorni). See page 131 and Table 13.

glucagon A hormone of the alpha cells of the pancreas which raises the blood sugar level by mobilizing liver glycogen. Used in acute hypoglycaemia.
Dose: 0.5-1 mg by s.c., i.m. or i.v. iniection. (GlucaGen). Give i.v. glucose if there is no response within 10 minutes.
glucocorticoids Those corticostcroids with an anti-inflammatory action similar to hydrocortisone, as distinct from the mmerailocorticoids, such as fludrocortisone, used in Addison’s disease. Thel, differ in anti-inflammatory potency, and 0.75 mg of dexamethasone is considered equivalent to 20 mg of hydrocortisone. See Table 36.
glucose Also known as dextrose. A readily absorbed carbohydrate present in many
man
sweet fruits, but obtained commercially by the hydrolysis of starch. It is given orally as a dietary supplement; in acidosis; and to raise the glycogen reserves of the liver in hepatic damage. Given by i.v. infusion as a 5% solution, or as a glucose-saline infusion in dehydration and shock, and after surgery until fluids call be taken by mouth.
glutaraldehyde A disinfectant of the formaldehyde type, but with a more rapid and powerful action. Effective against a wide range of organisms, including
viruses. Used mainly for instrument sterilization as a 2% solution. Usually activated before use by the addition of a corrosion inhibitor. Such activated solutions are stable for about 2 weeks. It is also used as a 10% solution for the removal of plantar warts.
glycerin (glycerol) A clear syrupy liquid used as a sweetening agent in mixtures and linctuses. It promotes drainage when applied to inflamed areas, and is used as a paste with magnesium sulphate for boils. It is also used as suppositories for constipation.
Dose: sometimes given orally in doses of ]- 1.5 g/kg in glaucoma and before surgery to lower the intraocular pressure.
glyceryl trinitrate A powerful but short-acting vasodilator used in the control of angina pectoris. See page 114.
Dose: 300, 500 or 600 pg tablets which should be dissolved under the tongue for a rapid response. An aerosol spray (400g per
dose), as well as long-acting tablets are also available. Tolerance may occur with prolonged therapy. Side-effects are a throbbing headache, flushing and tachycardia. It is also used locally for all extended action, particularly at night, as ointment and medicated patches. Also given by i.v. infusion to control hypertension and ischaemia during cardiovascular surgery and in left ventricular failure. Dose: 10-200 pg/min in dextrose-saline. A new use of the drug is as an ointment (0.2%) to promote healing of anal Fissure. See page 1] 4 and Table 4.
glycopyrronium A synthetic atropine-like antispasmodic used for preoperative medication.
Dose: 200-400 pg by Lill. or i.v. injection. I i has the side-effects of anticholinergic drugs such as dryness of the mouth and blurred vision. Contraindicated in glaucoma. (Robinul).
GM-CSF Granulocyte-macrophage colony stimulating factor. See molgramostim. gold therapy See sodium aurothionialate.
gonadotrophins The follicle-stimulating hormone (FSH) and the luteinizing hormone (1-11) of the anterior pituitary gland. They stimulate ovarian development and the production of oestrogens; ill the male LH controls the formation of androgens. See gonadorclin.
gonadorefin A synthetic form of the gonadot roph in -releasing hormone of the pituitary gland (M-111-1). It is used to assess pituitary function.
Dose: 100 pg by i.v. injection normally
rise to a rapid rise in the plasma level of the luteinizingand follicle-stimulating hormones. In amenorrhoea and infertility due to gonadorelin insufficiency, it is given by pulsed s.c. infusion in doses of 1-20pg every 90 minutes, day and night. Treatment for up to 6 months may be required. Side-effects are uncommon. (Fertiloli Relefact). Sonic analogues of gonadorelin are used in remain cancers. See page 122.
goserelin A synthetic analogue of the hypothalamic hormone (LH-RH). It
suppresses the production of testosterone, d
anis used in the treatment of hormone-
dependent carcinoma of the prostate. It is also used in endometriosis and postmenopausal breast cancer.

Dose: 3.6 ing by s.c. injection every 28 days or as an implant. Side-effects include impotence, hot flushes, rash, breast swelling and tenderness. (Zoladex). See page 122 and ‘I able 8.
gramicidin A mixture of antibiotics effective against many Gram-positive organisms, but it is too toxic for syitenii, use. Used topically in infected skin conditions, usually in association with neomycin and hydrocortisone.
granisetron A scrotonin (5—HT) antagonist with a highly selective and powerful antiernetic action mediated by its effects on the 5-4-11′, receptors. It is used in the prevention and treatment of the severe nausea and vomiting induced by potent cytotoxic drugs such as cisplatin.
Dose: I mg I hour before treatment, then I ing twice daily, or by i.v. infusion in doses of 3 mg, repeated up to 3 times over 24 hours. For prophylaxis, a dose of 3 mg should be given before chemotherapy is commenced. Headache, rash and consti pation are common side-effects. (Kytril). See page 158.
griseofulvin An orally effective but slow
acting antifungal antibiotic that is
deposited selectively in the skin, hair and nails. It is used in the systemic treatment of ringworm and other dermatophyte infections of the keratin-containing tissues, but only when local treatment has failed.
Dose: 0.5-1 g daily, but prolonged therapy is required. Side-effects are headache, nausea, dizziness, rash and photosensitivity. 11 may also reduce the effects of oral contraceptives. (Fulcin; Grisovin).
growth hormone See soma(ropin.
guanethidine An anti-hypertensive drug that [)rings about a reduction in blood pressure by blocking transmission in adrenergic nerves, and preventing the release of noradrenaline. It has been used in the treatment of hypertension, often with a thiazide diuretic, but its use has declined as it may cause postural hypotension. Still used as part of combined therapy in resistant hypertension.
Dose: 20 mg daily, increased by 10 ing at weekly intervals according to response, up to 50 mg daily, although sometimes larger doses are required. Dose by i.m. injection,
10-20 nig as required. Diarrhoea, weakness, nasal congestion and bradycardia are common side-effects. (Ismelin). See page 148 and Table 21. Guanethidine is occasionally used as eye drops (1-3%) in glaucoma. (Ganda). See page 138 and Table 16.
guar gum A vegetable gum that, when taken with food, appears to retard the absorption of carbohydrates. It is used in the supplementary treatment of diabetes mellitus.
Dose: up to 15 g daily, usually sprinkled mi food. It is essential that a dose should he taken with an adequate fluid intake, and that the final dose is not taken at bedtime. Side-effects are flatulence and abdominal distension. (Guarem). See page 131 and Table 13.
halcinonide A powerful corticosteroid used iii severe inflammatory skin conditions not responding to other corticosteroids. It is applied sparingly as a 0.1% cream. (Halciderin).
halibut-liver oil A rich source of vitamins A ‘Ind 1).
Dose: 0.2-0.5 mi.
halofantrine An antimalarial, acting at the erythrocytic stage of the life cycle of plasmodium, and useful in chloroquine 01 MUlti-drug resistant malaria.
Dose: 500 nig 6-hourly for 3 doses between meals. Side-effects are nausea, vomiting and diarrhoea. It must not be given with or after mefloquine (risks of fatal arrhythmias). Contraindicated in pregnancy. 0 lalfan).
haloperidol A powerful tranquillizer used in schizophrenia, mania and psychoses. Dose: 5-20 ing daily, up to a maximum of 200 mg, reduced later according to
response. Dose by i.m. injection for rapid control of hyperactive psychotic patients, 5-30 mg initially, followed by 5 ing or more as required. For depot treatment, it is given as haloperidol decanoate, 50-300 mg by deep i.m. injection every 4 weeks. It is also given orally in doses of 500 g twice daily in severe anxiety. Doses of 1.5 nig

jt34vef7mn

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

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

dornase alfa A recombinant form of human deoxyribonuclease (rhDNase) used in cystic fibrosis. The viscous purulent airways secretion of that disease is due to the presence of large amounts of extra-cellular DNA from degenerating leucocytes. Dornase alfa breaks down the DNA and reduces the sputum viscosity. Dose: 2500 units daily by inhalation from it jet nebulizer. Daily treatment is necessary to maintain the response. (Ptilillozvme).
dorzolamide An inhibitor of carbonic anhydrase that reduces the amount of sodium bicarbonate in the aqueous humour of the eye. It is used as eye drops (2%) 2 or 3 times a day as adjunctive therapy in ocular hypertension when beta-blockers are unsuitable or ineffective. (Trusopt). See page 138 and Table 16.
dothiepin (dosulepin) A tricyclic antidepressant with the uses and side-effects of antitriptyline. It is used in the treatment of depression when a sedative action is also indicated.
Dose: 75-150 mg daily. It may also be given as a single nightly dose to reduce daytime drowsiness. (Prothiaden). See page 128 and Table 11.
doxapram A respiratory stimulant useful in postoperative respiratory failure under expert control.
Dose: by i.v. injection 1-1.5 nig1kg according to need. It is also given by i.v. infusion in doses controlled by arterial food gas studies. Side-effects include hypertension, Ypertension, bronchospasin and tachycardia. (Dopram).
doxepin An antidepressant with the actions, uses and side-effects of dothiepin.
Dose: 30–300 nig daily; a single dose of I Ito mg is sometimes given at night. (Sinequan). See page 128 and Table 11.
doxorubicin A cytotoxic antibiotic widely used in leukaemia, lymphosarcoma, breast and lung cancer.
Dose: by fast i.v. infusion 60-75 nigIm’ at intervals of 3 weeks, or 20-25 mg/m’ daily for 3 days. It is also used by bladder installation (50 mg in 50 nil of saline solution) for superficial bladder tumours. Side-effects include bone marrow depression, cardiac damage, alopecia, buccal ulceration and nausea. Doxorubicin is it skin irritant, and should he handled with care. See page 122 and Table 8.
doxycycline A long-acting tetracycline. Dose: 200 mg initially, followed by 100 ing its a single daily (lose. In acne, a dose of 50 mg daily is given for some weeks. It should be taken with adequate fluid, with the patient in a sitting or standing position. (Nordox; Vibramycin).
droperidol A tranquillizer with unusual properties. It is given in severe psychotic conditions such as mania, in drug-induced nausea and vomiting and for preoperative sedation. It is also given with fentanyl to produce a state of detachment (neuroleptanalgesia).
Dose: 20-120 ing daily; 5-10 ing by injection; in cancer therapy induced vomiting (loses of 1-3 nig/hr have been given by continuous i.v. infusion. Side-effects are those of chlorpromazine and haloperidol. (Droleptan).
doxazocin An alpha-adrenoceptor blocking agent of the prazosin type, but with a longer action that permits a single daily dose.
Dose: in hypertension I mg initially, slowly increased after 7-14 days to 2 mg daily, up to a daily maximum of 16 ing, usually in association with other amihypertensive drugs. It is also used in Iliesymptcunitic treatment ofbenign prostatic . P
hy erplasia. Side-effects are
dydrogesterone An orally active progestogen that is virtually free from
any oestrogenic or androgenic side-effects. It is used in amenorrhoea, endometriosis, functional uterine bleeding, and threatened abortion.
Dose: 10-30 mg daily. (Ouphastort).

econazole An antifungal agent similar in actions and uses to clotrimazole. (Ecostatin; Pcvaryl).
ecothiopate A potent and long-acting iniotic that has been used in glaucoma as eye drops of 0.03-0.25%. It may cause cataract; its availability is strictly limited.
edrophonium A very short-acting drug of the neostigniine type. It is used in the diagnosis of myasthenia gravis.
Dose: 2-10 nig by i.v. injection, which causes a marked but transient increase in muscle power if myasthenia gravis is present.
eformoterol A selective P2 stimulant (agonist) with a rapid initial action, used as supplementary treatment in patients receiving other bronchodilator therapy for reversible airway obstruction.
Dose: by inhalation: 12µg twice daily, doubled if necessary. (.are is necessary in ischaernic heart disease and diabetes. Not to be used for acute attacks. (Foradil). Sec page 118 and Table 6.
enalapril An ACE inhibitor used in the treatment of all types of hypertension, and in congestic heart failure, often together with a diuretic.
Dose: i ing daily initially, increase(] as required up to 40 mg daily, and often given as a single dose. Dizziness, hypotension and loss of taste are some side-effects. ! I imov.i, :. See page 148 and Table 21.
enflurane An inhalation anaesthetic with the actions and uses of halothane, but less potent.
epoetin alfa and beta Recombinant fornis of human erythropoietin. (Eprex; Recormon). See erythropoietin.
epoprostenol A prostaglandin present in the walls of blood vessels that inhibits platelet aggregation. It is used to prevent platelet aggregation during cardiopulmonary bypass and charcoal haemoperfusion, and as an alternative to heparin in renal dialysis.
Dose: 10-20 ng1kShnin by continuous i.v. infusion. Smaller doses in renal dialysis. It is also a vasodilator, and side-effects are flushing and hypotension. (Flolan).
enoxaparin A low-molecular weight and longer acting form of heparin. It has the general properties of heparin, but with less effect on blood platelet activity. It is used in the prevention of venous thrombosis. Dose: 20 mg by sx. injection once daily ( I hour before surgery) for 7-10 days. (Clexane). See certoparin, dalteparin and tinzaparin.
enoximone An inhibitor of the enzyme phosphodiesterase. It has a digoxin-like action on the myocardium and is used in
eptacog alfa See Factor VIIa.
ergocalciferol See calciferol.
ergometrine The principal alkaloid of ergot. It promotes uterine contraction and is used for the rapid control of postpartum haemorrhage. Dangerous in the early stages of labour.
Dose: 05-1 nig orally; or 200-500 jig by injection. It is often used together with oxycytocin as Syntometrine. Side-effects are nausea and transient hypertension.

ergot A fungus that develops in rye and replaces the normal grain. The active principles include ergometrine and ergotamine. Chronic toxic effects characterized by gangrene of the extremities have followed the use of ergot-contaminated rye bread.
ergotamine Air alkaloid of ergot that constricts the cranial arteries, and is used solely for the relief of migraine not responding to analgesic therapy. Early treatment evokes the best response.
Dose: 2 mg initially up to 6 ing during an attack, not to be repeated until after an interval of some days.”I oral dose in I week: 10– 12 mg. It is also given by oral inhalation in doses of 360pg ( I puff), repeated after 5 minutes, up to a maximum of 6 puffs daily. Side-effects include headache and nausea, and the drug should be withdrawn if tingling of the extremities occurs.
trot suitable for prophylaxis because of the risks of toxicity. (Lingriine). Sec page 154
erythromycin Air antibiotic, resembling penicillin in its general range of activity, with the advantage of being active orally. It is useful in streptococcal and respiratory infections and in penicillin-resistant staphylococcal infections. Erythromycin is also of value in penicillin-sensitive patients. It is also given as a prophylactic before dental surgery. Dose: up to 4 g daily; in severe infections it may lie given by slow i.v. infusion in closes of 50 mg/kg daily. Side-effects include nausea and vomiting, and diarrhoea may occur after high doses. Gore is necessary in hepatic impairment. Preparations of erythromycin estolate are contraindicated in liver disease. Erythromycin may potentiate the action of warfarin. It should not be given with aslenii/.ole or terfenadine.
erythropoietin (epoetin) A renal hormone that regulates blood cell production in the bone marrow. Patients with renal failure maintained by haemodialysis do not
produce epoetin, and so become anaemic. A recombinant form of erythropoietin is available for replacement therapy.
Dose: 20-50 units/kg 3 times a week by s.c. or i.v. injection under haematological control. Side-effects include headache and hypertension, but a sudden migraine-like pain may indicate air impending hypertensive crisis. (Eprex; Itecormon).
eserine See physotiginine.
esmolol A very short-acting betaadrenoceptor blocker used in the emergency treatment of supra-ventricular arrhythmias, tachycardia and perioperative hypertension.
Dose: by i.v. infusion 50-200pg/kg/rniri under close control. (Brevibloc).
estramustine A compound of oestradiol and inustine, designed to release mustinc at oestrogen-receptor sites. It has a more localized action and so causes less myelodepression. It is used mainly in prostatic carcinoma, especially when resistant to other therapy.
Dose: 0.56-1.4 g daily. It should not be taken with food or milk products. Side-effects include gastrointestinal disturbances, nausea and gynaccomastia. (Fstracyt). See page 122 and Table 8.
ethacrynic acid A loop diuretic with a rapid and intense action used mainly in oliguria due to renal failure.
Dose: 50 ing daily initially, increased as required up to a maximum of400rng daily or on alternate days. Ethacrynic acid is also given by slow i.v. iniection in doses of 50-100 mg in acute or refractory conditions. Side-effects include nausea, diarrhoea and deafness. Some hypotension may occur initially. (Edecrin).
ethambutol An antitubercular drug.
Dose: 15 mg/kg daily, together with i i lo i i ipic in or isoniazid. Lower doses should be given in renal damage. It may cause visual disturbances with loss of acuity, but recovery is usually complete on withdrawal of the drug. (Myarnbutol). See page 170 and Table 31.
ethamsylate A haemostatic used in the prophylaxis and treatment of periventricular haemorrhage in low birth-weight infants.
Dose: 12.5 mg/kg by injection 6-hourly within 2 hours of birth and continued for 4 days. It is also used orally in menorrhagia. Dose: 2g daily. (Dicynene).
ethanolamine oleate A sclerosing agent used for varicose veins and bleeding oesophageal varices.
Dose: by local i.v. injection, 2-5 nil.
ether A colourless inflammable liquid, once widely used as a general anaesthetic but now replaced by halothane.

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.

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).

bezafibrate A plasma-lipid regulating agent with an action similar to clofibrate, and used in the treatment of hyperlipidaemia not responding to diet.
Dose:daily with food. Contraindicated in renal or hepatic dysfunction. May potentiate oral anticoagulants. Side-effects are nausea, pruritus and urticaria. (Bezalip). See page 146 and Table 20.
Dose: It is given in hypertension and angina in doses of 5-20 nig daily. (Enicor; Monocor). See pages 114 & 148, and fables 4 & 21.
bisphosphonates Substances used in Paget’s disease of bone and hypercalcaemia of malignancy. See alendronate, disodium etidronate, disodium pamidronate and sodium clodronate.
bicalutamide A nonsteroidal anti-androgen that binds, selectively with androgen receptors. It is used with an LH-111-1 analogue such as goserelin in advanced prostatic cancer in doses of 50 mg daily. (Casodex). See page 122 and Table 8.
bipetiden An antispasmodic and parasympatholytic drug used chiefly to control the rigidity and excessive salivation of parkinsonism. It has less effect on tremor.
Dose: 2 ing daily initially, increased, as required, up to 0 mg or more daily. If necessary it may be given by i.m. or slow i.v. injection in doses of 5-20 mg daily. Side-effects include dizziness, blurred vision and drowsiness. (Akineton). See page 160 and Table 26.
BIPP A mixture of bismuth subnitrate, iodoform and liquid paraffin, used occasionally as an antiseptic dressing.
bisacodyl A synthetic laxative that exerts its action by a direct stimulating effect on Ilse nerve endings of the colon.
Dose: 10 mg orally, or as a suppository. Abdominal cramp is an occasional side-effect. It should not be used in intestinal obstruction.
bismuth chelate A potassium-bismuthcitrate complex used to promote the healing of peptic ulcers, mainly by a protective action.
Dose: 480 nig daily for 28 days, repeated if* necessary at monthly intervals. Not to be given with food. It may blacken the faeces. (Dc-NoltalO.
bismuth subgallate A yellow insoluble powder with astringent properties. Used as dusting powder, and as suppositories for rectal conditions.
bisoprolol A beta-blocking agent with the actions, uses and side-effects of propranolol.
bleomycin A cytotoxic antibiotic, exceptional in causing little or any disturbance of bone marrow activity. Used mainly in skin tumours, lymphomas and mycosis fungoides.
Dose: 15-30 ing twice-weekly by i.m. or i.v. injection up to a total dose of 500 ing. The onset of stomatitis is an indication of the maximum tolerated close. Pigmentation of the skin may occur, but a severe close-related, delayed reaction is
pulmonary fibrosis, requiring immediate withdrawal of the drug. There is a risk of respiratory failure during general anaesthesia associated with a high oxygen intake. See page 122 and ‘rable 8.
botulinum toxin complex Botulinuin toxin causes severe respiratory muscle paralysis, but a modified form has a local action. The complex is used in severe blepharospasm and given by injection into the ocular muscle. Response is slow (1-2 weeks) and treatment may need to be repeated at intervals of 8 weeks. (Botox; Dysport).
bretylium An antihypertensive agent, now used on[), in the control of resistant ventricular arrhythmias.
Dose: i mg/kg, i.m., 6-8-hourly. It may also be given by slow i.v. injection in doses of 5-10 mg/kg, repeated as required. Side-effects include nausea, vomiting and severe hypotension. (Bretylate).
brimonidine A selective alpha,-andrenergic receptor agonist. It is used in the treatment of glaucoma when bcta-blockers are not suitable or not tolerated.
Dose: one drop of a 0.2% solution in the eye or eyes twice daily. Some initial burning and stinging may occur, and an ocular allergic reaction may occur with prolonged therapy. (Alphagan).
bromazepam A benzodiampine used mainly
in the short-term treatment of anxiety.

Dose: 9-18 mg daily. Contraindicated in respiratory depression and phobic states. (I-exotan). See page 117 and fable 5.
bromocriptine An inhibitor of the release of prolactin from the pituitary gland. It is used to prevent or suppress lactation when other measures have failed.
Dose: 1-1.5 mg daily initially for a few days, then twice daily for 14 days. It also stimulates dopamine receptors in the brain and is used in parkinsonism, mainly in patients unable to tolerate levodopa, to stimulate any surviving dopamine receptors. Dose: 1.25 mg at night initially, with food, slowly increased according to response up to 40 mg. The use of the drug requires care, as it has many side-effects, including early hypotensive reactions. Bromocriptine is also used in some condi- tions of pituitary dysfunction such as acromegaly. (Pardolcl). See page 160 an(] Table 26.
brompheniramine An antihistamine similar to promethazine, but with shorter action and reduced side-effects. It also has some antitussive properties.
Dose: 12-32 mg daily. (Dimotane). See pate 110 and Table 2.
budesonide A steroid similar to beclomethasone, and used by oral aerosol inhalation in chronic airway obstruction and other asthmatic conditions.
Dose: 200800 pglkg (1-4 puffs) according it) need. A long-acting form (Entocort) is used in the treatment of Crohn’s disease. Dose: 9 nig daily before breakfast for up to 8 weeks. Also used locally as a cream (0.025%) in eczema, psoriasis and
dermatitis. (Pulmocort; Preferid).
bumetanide A rapidly acting loop diuretic similar to frusemide, with comparable actions, uses and side-effects.
Dose: 1-5 mg daily. Much larger doses may be needed when renal function is impaired. In acute pulmonary and cardiac oedema, 1-2 mg may be given i.v. Morirxx). See page 148 and “fable 21.
bupivacaine A local anaesthetic related to lignocaine but characterized by its increased potency and long duration of action which may be tip to 8 hours when used for nerve blocks. It is also of value in continuous epidural analgesia. It is used as a 0.25% to 0.5% solution in doses
according to requirements with or without adrenaline. The side-effects are those of lignocaine, but it may cause more severe myocardial depression. (Marcain).
bupronorphine A powerful analgesic, related to morphine, but less likely to cause dependence. Valuable in pain of terminal cancer, after operation or myocardial infarction.
Dose: 200-100 Vg 6-8-hourly as sublingual tablets, or 300-600 pg by i. in. or slow i.v. injection at intervals of 6-8 hours according to need. Side-effects include drowsiness, nausea and dizziness. Naxolone is only a partial antagonist. f *1 enigesic).
buserelin A synthetic gonadotrophinreleasing hormone that indirectly depresses androgen and oestrogen synthesis. It is used in the treatment of testosterone-sensitive prostatic carcinoma.
Dose: 500 Vg by s.c. injection 8-hourly for 7 clays, followed of    bv intranasal mainte- nonce dosesdoseso100 pg’6 times a day. Patients should be warned that an
increase in pain may occur initially. Side-effects are hot flushes and loss of libido. (Suprefact). It is also used its a nasal spray in the long-term treatment of endometriosis in doses of 900 pg daily. Side-effects are menstrual-like bleeding and mood changes. (Suprecur). See goserelin, lcuprorelin and nafarelin.
buspirone A drug for the treatment of anxiety. It acts more selectively than the benzod iazepi ties on serotonin receptors in the brain, but the full response may take 1-2 weeks.
Dose: 10-15 mg daily initially, slowly
in, ceased as required up to a maximum of 45 mg daily. Side-effects are nausea, dizziness and drowsiness. Benzod  must be withdrawn slowly before transfer to buspirone. ( Ruspar). See page 117 and “fable 5.
busulphan A cytotoxic compound used in the palliative treatment of chronic myeloid leukaemia. Close haernatological control is essential during treatment as remission of symptoms may not be complete for some weeks and overdose may cause irreversible myelodepression.
Dose: 0.5-4 mg daily. Side-el’16:ts include pigmentation of the skin. (vIvIeran).

atenolol A long-acting beta-adrenoceptor blocking agent of the propranolol type, but with a more cardioselective action. Used mainly in hypertension pertension and angina.
Dose: 50-100 mgdaily. Also given by slow 6. injection in arrhythmias in doses ill, to 10 mg. The side-effects are similar to propranolol, although atenolol may cause fewer sleep disturbances. (”Fenormin). See pages 114 & 148, and Tables 4 & 21.
atorvastatin A lipid-lowering agent with an enzyme-inhibitory action on cholesterol synthesis used in hyperlipidaemia. Dose: 10 mg daily initially, up to a maximum of 80 ing daily. Liver function tests are necessary before and during treatment. (Lipitor). See page 146 and Table 20.
atovaquone An antibacterial agent used in Prietintocyslis carinii pneumonia resistant to co-trimoxazole.
Dose: 750 ing daily with food for 21 days. Side-effects are rash, nausea and diarrhoea. (Welivolle).
atracurium A non-depolarizing muscle relaxant of the gallamine type, but causing less histamine release.
Dose: 30f1-600 pglkg i.v. initially followed by doses of 100-200 µg/kg at intervals as required. Its action can be reversed, if nec- essary, with neostiginine. Arninoglycoside antibiotics may increase the response and require all adjustment of dose. (Tracrium).
atropine An alkaloid with anticholinergic properties obtained from belladonna, hyoscymus and other plants. It is often given in doses of 300-600 pg by injection with morphine for preoperative sedation and to reduce bronchial secretion. Is also of value in gastrointestinal smooth muscle spasm.
Dose: 0.23-2 mg daily. It is used as eye drops (Vyl)) to dilate the pupil, but such use in the elderly requires care, as the long action may precipitate glaucoma. It is also used with neostigmine in doses of 600 pg-1.2 ing to reverse the action of the vecuronium-type muscle-relaxants. Side-effects include dryness of the mouth, disturbed vision, an(] bradycardia followed by tachycardia. Care is necessary in prostatic enlargement and urinary disturbances, and glaucoma is a contraindication.
augmentin See co-amoxiclay.
auranofin An orally active gold compound used in the treatment of active rheumatoid arthritis not relieved by non-steroidal anti-inflammatory drugs (NSAIDs).
Dose: 6 nig daily, increased if necessary .titer 6 months to 9 ing daily. It should be withdrawn if the response is inadequate after 9 months. Side-effects are nausea and diarrhoea. See sodium aurothiomalate for the systemic side-effects of gold therapy. (Ridaura). See page 165 and Table 29.
avomine Derivative of promethazine used in travel sickness, nausea and vomiting. Dose: 25-150 mg daily.
azapropazone A non-steroidal anti-inflammatory agent (NSAID) with actions and uses similar to those of naproxen and used when other NSAIDs are unsuitable. Dose: 1.2 g daily, but in acute gout an initial, divided, dose of 1.8 g is given. Side-effects include rash and occasional photosensitivity, and care is necessary in peptic ulcer. Azapropazone may potentiate the action of warfarin and phenytoin, and require all adjustment of dose
(Rheuniox). See page 165 and *]’able 29.
azatadine An antihistamine with the actions and uses of promethazine.
Dose: 1-2 ing twice daily. (Optimise). See page 110 and Table 2.
azathioprine An immunosuppressive agent mainly used to inhibit rejection after organ transplant surgery. It has also been used in some auto-immune conditions and in
resistant ulcerative colitis.
Dose: 1-5 niglkg daily, but (lose and duration vary according to need and response. Side-effects include depression of bone marrow function, gastrointestinal disturbances, hepatotoxicity and rash. Severe secondary infections may occur as a result of the inunlU1lOSllppreS!aOu, and the use of the drug requires close control. (Az,aniinc).
azoolic acid An organic acid with some antibacterial properties. Used as 20% cream for acne vulgaris. (Skinoren).
azelastine An antihistamine used as a nasal spray 0.1% in allergic rhinitis. (Rhinolast).
azidothymidine See zidovudine.

azithromycin A macrolide antibiotic with a longer action than erythromycin or clarithromycin, used chiefly in respiratory tract infections.
Dose: 500 mg daily for 3 days, I hour before or 2 hours after food or antacids. Side-effects include nausea, abdominal discomfort and diarrhoea. Not to be given with astemizole or terfenadine ( risk of arrhythmias). Vithrornax).
azlocillln A broad-spectrum antibiotic with exceptional activity against Pseudomonas. Of value in respiratory and urinary infections, and in septicaemia.
Dose: in life-threatening infections, 5 g by i.x. infusion 8-hourly. Doses of 2 g 8-hourly may be given in less severe infer lions. III patients with impaired renal function, doses should be given 12-hourly. Allergy to penicillins or cephalosporins is a contraindication. (Securopen).
AZT See zidovudine.
aztreonam An antibiotic that is exceptional in being resistant to breakdown by beta-lactamases. It has a selective action against Gram-negative aerobes, and it is given in urinary, respiratory, bone and other infections caused by susceptible bacteria. When given in association with an aminoglycoside, the activity of aztreonam against Pseudomonas aeruginosa may be increased.
Dose: 4 g daily by i.m. injection and up to 8 e daily i.v. in severe infections. Reduced doses are indicated in renal impairment. Side-effects are skin reactions, nausea, jaundice, blood disorders, and malaise. (Azactam).
is given by intrathecal injection in small doses via an implantable pump, but treatment requires specialist supervision. (Lioresal).
BAL See dimercaprol.
balsalazide A melsalazine complex used in ulcerative colitis. It reaches the colon unchanged, where it is broken down to release active melsalazine.
Dose: 9g daily until remission or for 12 weeks. Side-effects are those of melsalazine. See page 172 and Table 32.
bambuterol A prodrug of terbutaline, with .I similar but more prolonged bronchodilator action.
Dose: 10-20 mg at night. (Bambec). See page 118 and Table 6.
barbiturates A group of hypnotic drugs exemplified by butobarbitone. Once widely used, but their value has declined sharply and safer drugs such as nitrazepam are now preferred.
barium sulphate A very insoluble powder, given orally or rectally as an aqueous suspension as contrast agent for X-ray examination of the alimentary system.
BCG vaccine A preparation of the Calniette-Guerin strain of Mycobacterium tuberculosis. It is used for active immunization against tuberculosis. particularly for individuals likely to be exposed to
infection.
Dose: 0.1 111[. by int radermal injection. A product obtained from an isoniazidresistant strain of the organism is also used for the immunization of individuals receiving prophylactic treatment with isoniazid.
baclofen A muscle relaxant that acts on the spinal end of some motor neurones. Useful in multiple sclerosis and muscle spasms caused by spinal lesions.
Dose: 15 nig daily initially gradL1.111), increased, as required, up to a maximum of 100 mg daily. Side-effects include nausea, fatigue and hypotension. Care is necessary in epilepsy and psychiatric disorders. Withdrawal of treatment is slow over 1-2 weeks to avoid serioius side-effects. In severe spasticity and spinal injury, baclofen
beclomethasone A potent corticosteroid used in the control of asthma and bronchospasin not responding to other drugs. Dose: by oral aerosol inhalation, too pg (two puffs) repeated up to 4 times a day according to need and response. Dose: by powder inhalation 800 pg daily. Hoarseness may develop as a side-effect, and oral candidiasis may occur with high doses. Beclornethasone is also used as a cream or ointment (0.025%) in severe inflammatory skin conditions not responding to less Potent corticosteroids. (Becotide; Propaderm).