Posts Tagged ‘impairment’

nisoldipine A calcium channel blocking agent of the nifedipine type. Used in mild to moderate hypertension pertension and in the prophylaxis of chronic angina.
Dose: 10 ing once daily before breakfast with adequate fluid, slowly increased as required up to 40 mg daily. Tablets to be swallowed whole, not chewed or crushed. It may react with sonic other drugs in common use, and grapefruit juice should be avoided. (Syscor). See pages 114 & 148, and ‘Fables 4 & 21.
nitrazepam A benzodiazepine used as a mild hypnotic when some degree of daytime sedation is acceptable.
Dose: 5-10 mg at night, with reduced doses for elderly patients, and in renal and’ hepatic dysfunction. Care is necessary in respiratory depression. Some dependence on nitrazepam may occur, so extended treatment should be avoided. The combined use of alcohol increases the hypnotic action. (Mogadon; Remnos). Set: page 152 and Table 22.
Nitrocine A solution of glyceryl trinitrate, for i.v. infusion in myocardial ischaemia and refractory angina.
nitrofurantoin An antibacterial agent with a wide range of activity against the majority of urinary pathogens. It is of value in cystitis and pyelitis, and in renal infections that have become resistant to other drugs. It is also used prophylactically but extended use requires care.
Dose: 400 mg daily; 50-100 mg at night for prophylaxis. It is ineffective in an alkaline urine. Nausea, rash and peripheral neuropathy are side-effects, and acute and chronic pulmonary reactions have been reported. (Furadantin; Macrobid).
nitroglycerine See glyceryl trinitrate. nitroprusside See sodium nitroprusside.
nitrous oxide The oldest inhalation anaesthetic. Supplied in blue cylinders, it is widely used for induction and as part of a mixed anaesthetic system. It is also used as
a 50% oxygen mixture as an inhalation analgesic in obstetrics.
nizatidine A potent and selective H,-receptor antagonist chemically distinct from cimetidine or ranitidine.
Dose: in the treatment of benign duodenal and gastric ulcer, single doses of 300 mg daily, taken in the evening, or 150 mg twice a day, and continued for 4 weeks, or for s weeks in gastric ulcer including non-steroidal anti-inflammatory agent (NSAID) -induced ulceration. Occasionally given by i.v. infusion in doses of300mg daily. For prophylactic maintenance, doses of 150 mg daily may be given for up to a year. Reduced doses should be given in renal impairment. Side-effects include headache, niyalgia, cough, pruritus and abnormal dreams. (Axi& Zinga). See page 162 and “Fable 27.
non-steroidal anti-inflammatory drugs (NSAIDs) A group of drugs with analgesic anti-inflammatory properties widely used in arthritic, rheumatoid and related conditions. The response to a NSAID and the incidence and severity of side-effects such as gastric irritation and renal toxicity vary considerably, and the best NSAID for an individual patient is the one that gives optimum relief with minimal side-effects. The NSAIDs, of which aspirin is the oldest example, act by interrupting the biosynthesis of prostaglandins from arachidonic acid, in which process the enzyme cycleoxygenase (COX) plays a key role. It is now known that COX exists in two forms identified as COX-1 and COX-2. The anti-inflammatory action of the NSAIDs appears to be linked with the inhibition of COX-2, whereas the unwanted side-effects are associated with COX- I inhibition. Different NSAIDs have varying degrees of activity against the different forms of COX, which may explain the differences in the therapeutic response and the incidence of side-effects. Recently, a NSAID (meloxicain) has been introduced that has a more selective inhibitory action on COX-2, with which the incidence of side-effects appears to be lower than with the older drugs, and so may have therapeutic advantages. In general, the response to a NSAID may take 1-3 weeks to develop fully, but monitoring for gastrointestinal bleeding may be advisable if treatment is extended. A NSAID should not be given to a patient with a history of asthma or hypersensitivity, nor when peptic ulcer is suspected or present. In all cases, treatment should be commenced with the lowest recommended dose, and caution is necessary in the elderly, and when renal or hepatic function is impaired. See page 165 and Table 29.
Dose: 20 100 mg daily. It is given in nocturnal enuresis in doses of 10-20 mg nightly, but the duration of treatment should not exceed 3 months. (Allcgron). See page 128 and Table 11.
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noradrenaline (norepinephrine) The pressor hormone released at sympathetic nerve endings when such nerves are stimulated. It is also present with adrenaline in the medulla of the adrenal gland. It raises blood pressure mainly by a general vasoconstriction, whereas adrenaline acts by constricting the peripheral vessels and increasing the cardiac output. Noradrenaline is given by slow i.v. infusion in the treatment of shock, peripheral failure, and low blood pressure states, but the response may fluctuate with small variations in dose. The value of vasoconstrictors in shock is now questioned, as in shock the peripheral resistance may well be high, and the blood supply to essential organs such as the kidneys may be reduced.
Dose: 2-20 pg/niin, based on need and response. Great care must be taken to avoid extra-venous injection. (Levophed).
norethisterone An orally active progestogen. Used in amenorrhoea, functional uterine bleeding and dysmenorrhoea. Dose: 5-20 mg daily. In breast cancer, large doses up to 60 mg daily have been used. To postpone menstruation, 15 mg daily for 3 days have been used. In small doses, and in association with an oestrogen, norethisterone and related drugs are widely used as oral contraceptives. See page 264.
norfloxacin A quinolone antibacterial with the actions, uses and side-effects of cinoxacin and other quinolones.
Dose: in acute urinary tract infections, 801) mg daily for 3-10 days: in chronic infections continued for up to 12 weeks. ( I Itinor).
norgestrel (levonorgestrel) An orally active progesterone-like drug and inhibitor of ovulation. Used as a constituent of mixed oral contraceptive products, and as a ‘progestogen -only’ oral contraceptive. See page 264.
nortriptyline A tricyclic antidepressant with actions, uses and side-effects similar to those of amitriptyline, but with a reduced sedative activity.
NSAIDs See non-steroidal anti-inflamma-
tory drugs, page 168 and Table 29.
nystatin A fungicidal antibiotic, used in the treatment of intestinal, vaginal and superficial candidiasis. Oral tablets contain 500 000 units, pessaries contain 100 000 units; cream and ointment 1%. Dose: (oral) 2 million units daily. It is also used as pastilles of 100000 units for mouth infections.
octreotide A synthetic compound that inhibits the release of the growth hormone. It is used in acromegaly, which is caused by an overproduction of the growth hormone by a pituitary tumour and it is given in doses of 100-200pg 8-hourly by s.c. injection. It is also used in the symptomatic treatment of the carcinoid syndrome, in which the release of vasoactive substances by a gastro- pancreatic tumour causes flushing and severe diarrhoea.
Dose: 30 pg by s.c. injection, increased as needed up to 600 pg daily. It has no action on the cause of the syndrome. It is used occasionally in terminal care to reduce intestinal secretions and vomiting. Dose: 300-600 pg by s.c. infusion. (Sandostatin).
oestradloIlThe oestrogenic hormone controlling ovulation and menstruation. It has been used to control menopausal symptoms in doses of 10-20pg daily, but skin patches are now preferred for hormone replacement therapy (HRT). It is used occasionally as s.c. implants for long-term treatment. Oestradiol is also present in some cream preparations for menopausal atrophic vaginitis.
oestriol A natural oestrogen used in intravaginal cream to relieve the atrophic vaginitis and kraurosis vulvae associated with the menopause. Also given in doses of 1-32 mg daily for the genito-urinary symptoms linked with infections in oestrogen deficiency states. (Ovestin).

ofloxacin A fluorinated quinolone with the actions, uses and side-effects of other quinolones such as ciprofloxacin and norfloxacin. It is used mainly in urinary and lower respiratory tract infections. Dose: wii nig daily as a single morning dose. Dose in severe infections 200-400 mg daily by i.v. injection. An occasional side-effect is tendon damage with pain and inflammation, which requires immediate withdrawal of the drug. Exposure to strong sunlight should be avoided. (Tarivid). Also used as eye drops (0.3%) for superficial eye infections. (Exocin).
olanzapineV An antipsychotic agent for the treatment of schizophrenia. It has a more selective action on certain 5-H’I'- receptors, and is less likely to cause extra-pyramidal side-effects.
Dose: 10 mg as a single daily dose, slowly increased as required. Maintenance dose 5-20 mg daily. Side-effects include
sedation and weight gain. (Zyprexa). See page 168 and Table 30.
olsalazine A compound formed from mesalazine, and used in the treatment of ulcerative colitis. It is more slowly
absorbed, and reaches the colon largely unchanged, where it is broken down by intestinal bacteria to release the active metabolite mesalazine.
Dose: 1-3 g daily in acute mild ulcerative colitis; I g daily for maintenance, often for long periods. The common side-effect is a watery diarrhoea. Salicylate sensitivity is a contraindication. Patients are now advised to report any bruising, bleeding or
malaise. I( a blood dyscrasia is suspected, a blood count should be made -,in(] the drug withdrawn. (Dipentuni). See page 172 and Table 32.
ondansetron A potent antiemetic, of value in the nausea and vomiting associated with cancer chemotherapy. Such vomiting appears to be induced by the release of serotonin, which acts on receptors in the gut as well as stimulating the chernoreceptor trigger zone in the brain. Ondansetron is a specific (5—HT,) serotonin blocking agent, and is given before the commencement of cytotoxic treatment or radiotherapy.
Dose: 24 mg daily; in severe vomiting an initial dose of 8 ing is given by slow i.v. injection, followed by I ing/hrly for 24 hours by continuous i.v. infusion, followed by oral therapy. Side-effects are an initial sense of warmth, headache an(] constipation. (Zofran). See page 158.
topium The dried juice from the capsules of the opium poppy. See morphine.
orciprenaline A synipathomimetic agent with the bronchodilator properties of isoprenaline. It is used for the relief of obstructive airway conditions, although more selective drugs of the salbutarnol type are often preferred.
Dose: up to 80 ang daily; by aerosol inhalation up to 12 puffs (9mg) daily. Side-effects include tremor and tachycardia. (Ahiperil). See page 118 and Table 6.
orphenadrine A spasmolytic drug, used in the treatment of parkinsonism, and for the relief of voluntary muscle spasm. Dose: 150-400 nig daily. It may also be given by i.m. injection in doses of 60 mg. In parkinsonism it tends to control the rigidity more than the tremor. Side-effects are anticholinergic and include dryness of the mouth, dizziness and visual disturbances. Weight gain has occurred with high doses. (Disipal; Norflex). See
page 160 and Table 26.
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omeprazole An inhibitor of the enzyme I I*K’A'I’Pase.’rhat enzyme controls the final stage of gastric acid production, and its inhibition by omeprazole is of value in peptic ulcer resistant to H, receptor antagonists, and in reflux oesophagitis, where such agents are not always effective. Dose: in benign gastric and duodenal ulcer, 20-40 ing as it single daily dose for 4-8 weeks. Larger doses may be required in the Zollinger—Ellison syndrome. Side-effects such as nausea, gasiro-intestinal disturbances and headaches are usually mild. (Losec). See page 162 and Table 27.
oxazepam A benzodiazepine with the actions, uses and side-effects of diazepam. It is useful in acute anxiety and panic states.
Dose: 45-120 mg daily. See page 117 and Table 5.
oxerutins A mixture of rutosides (flavonoid derivatives) which is claimed to reduce capillary fragility and permeability. It has been used in venous disorders of the lower limbs.
Dose: 750-1000 nig daily. (Paroven).

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

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

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).
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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.

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

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

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

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