Posts Tagged ‘monoamine oxidase inhibitors’

Conception is a complex process that depends on everything working properly at a number of stages. Firstly, your hormone balance must be correct so that the egg develops normally. Secondly, you must be ovulating so that the egg is released. Thirdly, you must have sex at the right time in your cycle (there may be only two or three days a month when you are fertile). In addition, your partner must have a good sperm count and possess healthy sperm, which are capable of penetrating your cervical mucus to reach the egg. Then the egg has to be captured by the fallopian tube and be fertilised. Finally, once the egg has been fertilised, the embryo has to implant securely in the lining of the womb, which needs the right levels of the hormone progesterone to maintain the pregnancy. No wonder they talk about the miracle of life!
It’s daunting to think about the number of things that can go wrong. But, as we have seen, there are many simple ways in which you can dramatically improve your chances of getting pregnant.
In this section of the book I outline all the different factors that can undermine your fertility.The list may seem long but it is important to identify the particular combination of factors that may be undermining your and your partner’s health and wellbeing.
You may have been given the impression that there is no medical reason – and therefore no Solution – for your problem. But when you read this section you will realise that nothing could be further from the truth.

Nutrition
You are what you eat. Or, to put it another way, if you put poor-quality petrol in a high-performance car, like a Rolls-Royce or a Porsche, it may run for a while but eventually it will become less productive and less efficient. It is exactly the same with the human body.You need top-grade `fuel’ to function properly, and to produce healthy eggs or sperm. To a very large extent, your fertility depends on what you eat.
Food Isn’t What it Used to Be
One of the problems is that nowadays we eat a lot of convenience and refined foods that have been stripped of essential nutrients during manufacturing. For example, 80 per cent of zinc is removed from wheat during the milling process to ensure that a loaf of bread has a longer shelf life.’
The soil our food is grown on is so lacking in nutrients due to overuse and commercial farming methods, that even what we regard as ‘healthy’ foods — vegetables, for instance — may not contain the amounts of minerals we expect to get from them. If you have been dieting for a number of years (either restricting your food intake or trying different diet drinks or pills), you could well be deficient in a number of vitamins and minerals.
The well-balanced diet is a myth. We simply do not get all the nutrients we need from our food. This was confirmed by a National Food Survey conducted in 1995 which found that the average person in Britain was grossly deficient in six out of the eight vitamins and minerals surveyed. Fewer than one in ten people received the RDA (Recommended Daily Allowance) for zinc, which is the most important mineral for both male and female fertility.

Put this lack of nutrients together with all the additives, preservatives and pesticides (see Chapters 4 and 5) in your food and you can see that your fertility may well be compromised on a daily basis. Chemicals like pesticides are known to affect fertility, others will affect your general health, and this in turn can reduce your ability to conceive. Scientists may know the toxic effects of one particular chemical but what they don’t and can’t know for certain is the effect of being exposed to a cocktail of these substances.
Balancing the Scales
Your weight is crucial for your fertility. Being very underweight or very overweight can make conception difficult or impossible. So it’s important that your weight is within a certain range in order to give you the best chance of conceiving.
Nature gave women proportionately more body fat for a specific purpose, in order to reproduce and then feed our young. That is why fat accounts for 27 per cent of an average woman’s body weight, while it is only 15 per cent for a man.
Fat is essential to fertility and it is necessary in order to ovulate.Young girls do not begin to menstruate until their bodies are composed of at least 17 per cent fat.
Underweight
If a woman’s body fat drops too low, then her periods can stop. This low level of body fat may be caused by excessive exercise, as sometimes happens with ballet dancers or athletes who have very tough physical regimes.’
Infertility can also be caused by excessive dieting. When a woman is anorexic, for instance, her periods stop.’ With so much publicity about anorexia and an increasing number of young women falling victim to the ,slimmer’s disease’, the long-term damage to fertility caused by drastic weight loss is well-known. But not so many people realise that being overweight can also affect fertility.
Overweight
If a woman is overweight it can stop her ovulating. Studies have shown that just losing a small amount of weight, 10 per cent, for instance, can be enough to increase fertility by stimulating ovulation, improving hormone balance and making periods more regular.”‘
In another study, on women who previously did not ovulate, 11 out of 12 conceived naturally after exercising and dieting over a period of six months to get their weight down.”
Fortunately your dietary intake is fully within your control, and eating the right food may be the single most important thing you can do to achieve a successful pregnancy. Later (in Chapter 7) I will explain how the right  fertility. -Ig it nutrition can give you and your partner optinitini health and fertility.

Alcohol, Smoking and Drugs
Most of us know that smoking and drinking alcohol when pregnant can be very harmful to the baby. But what most couples don’t realise is that smoking and alcohol could actually be stopping them conceiving a baby because it reduces their fertility. The good news is that the negative effects are not permanent and simply stopping will dramatically improve your chances.
Alcohol
Research has shown that drinking alcohol causes a decrease in sperm count, an increase in abnormal sperm and a lower proportion of motile
sperm.12
Alcohol also affects a man’s fertility by changing his hormone levels because it can alter the way testosterone is produced and then released.” Because alcohol affects the liver (the organ which normally clears out any excess hormones), a man who drinks alcohol may accumulate small amounts of female hormones (men produce `female’ hormones, just as women produce testosterone). These female hormones can lower sperm production and potency.
In addition, alcohol stops absorption of nutrients like zinc which is one of the most important minerals for male fertility. Zinc is found in high concentrations in the sperm. Adequate levels of zinc are needed to make the outer layer and tail and are therefore essential for healthy sperm. If you reduce the amount of zinc in a man’s diet, his sperm count goes down.”
Finally, alcoliol reduces fertility in nianirrials, and studies show that women who drink heavily may stop ovulating and menstruating, and take longer to conceive.”

How Much is Too Much?
A study of 430 women demonstrated that drinking more than 5 units of alcohol (equal to five glasses of wine) a week could stop women conceiving. Researchers discovered that the women in the survey who drank less than 5 units a week were twice as likely to get pregnant within six months compared with those who drank more. A study published in the British !Medical Journal concluded that women should be ‘warned to avoid alcohol when trying to conceive’.”
The fact is that drinking any alcohol can reduce your fertility by half— and the more you drink, the worse the impact on your chances of conception.”
Studies have also shown a strong relationship between alcohol and miscarriages. Women who have a drink every day have a much higher risk of miscarriage (2.5 times more) than non-drinkers.” The same study found that if the woman was a drinker and a smoker her chance of a miscarriage was four times higher.
Smoking
There is so much information available nowadays about the risks of lung cancer, emphysema and other life-threatening conditions and most people are aware of the detrimental effects of smoking when pregnant. I know how shocked many of us feel when we see a heavily pregnant woman standing with a cigarette in her hand.Yet most people are not aware of the impact smoking can have on a couple’s fertility. It’s not surprising that tobacco has such an effect — it contains more than 4,000 compounds, including carbon monoxide, oxide of nitrogen, ammonia, aromatic hydrocarbons, hydrogen cyanide, vinylchloride, nicotine, lead and cadmium.
Although many women smokers resolve to give up when they get pregnant, they don’t realise that by smoking they are reducing their chances of getting pregnant in the first place. Not only that but you don’t usually know that you are pregnant for the first couple of weeks and the baby will be taking in all that tobacco smoke in the meantime.
The man’s fertility is also affected by smoking — it decreases his sperm Count, makes his sperm more sluggish, increases the number of abnormal sperm and reduces his testosterone levels.
In addition, smoking reduces the level of vitamin C in the bloodstream. Lack of vitamin C encourages sperm to clump together (a process known Alcohol, Smoking and Dru
as agglutination) instead of moving forward to fertilise the egg. One study showed how male fertility was improved by giving men 500mg of vitamin C twice a day.”
Smoking has definitely been linked with infertility in women.” It can even bring on an early menopause, which is an especially important consideration for older women trying to conceive who may be racing against time.” If you are a smoker, you should ask yourself why you are taking something into your body that is bringing you nearer to the menopause
—and infertility?
Recreational Drugs
The use of marijuana and cocaine has increased steadily over the years to the point where, for some people, it is part of everyday life. Although still illegal, recreational drug use is increasingly socially acceptable. That does not mean it is healthy or safe. The fact is that these drugs can compromise both your and your partner’s fertility. But, as with alcohol and tobacco, you can stop using recreational drugs and negate the damage to your fertility in a relatively short space of time.
If you continue to use them during a pregnancy, of course, it can have disastrous effects on your developing baby.
The Effects of Some Common Recreational Drugs
•    Marijuana can lower a man’s levels of FSH and LH, two hormones needed to produce sperm. It can also lower his libido.” For the woman, marijuana can lead to irregular periods, reducing fertility and sometimes even stopping ovulation.”
•    Cocaine users will have a lower sperm count, poorly moving sperm and a high rate of abnormal sperm.21
•    Heroin can cause a decrease in testosterone levels.2`
•    Cocaine and heroin, taken together, will make it harder for a woman to conceive and she is more likely to have a miscarriage, a stillbirth or a baby born with a malformation.21

Medicines
If you or your partner are taking medication while you are trying to conceive you should speak to your doctor about which drugs are medically essential and which are not. Some drugs have a direct effect on fertility and you do need to discuss this with your GR
Many drugs can affect not only the man’s sperm but also his ejaculatory function and libido. Some medicines may even cause impotence. These drugs can include sulphasalazine (used to treat irritable bowel), nitrofti•antoln, tetracyclines, cimetidine, ketoconazole, tricyclic antidepressants, monoamine oxidase inhibitors and propranol.”
In addition, medication given for conditions like gout or high blood
pressur can interfere with fertility. And non-steroidal anti-infianiniatory drugs (often used for arthritis) can stop ovulation.”

salbutamol A selective beta,- adrenoceptor  It is widely used to relieve bronchospasm in airway obstruction, including bronchial asthma and status astliniaticus, with the advantage of being largely free from cardiac side-effects. Dose: up to 16 ing orally daily; by aerosol inhalation (in which patients should be carefully instructed) 100-200 pg ( 1-2 puffs) Lip to 4 times a day; by s.c. or i.m. injection 500 pg as required; 250 pg by i.v. injection. Salbutamol also, relaxes uterine muscle, and is given in premature labour in doses of 10 pg/inin initially by i.v. infusion, increased to 45 pg/min until contractions have ceased, when oral therapy may be given. Side-effects include tremor, headache, peripheral vasodilation and tachycardia. Care is necessary in ischacinic heart disease, hypertension pertension and hyperthyroidism. (Ventolin). See page 118 and Table 6.
salcatonin A synthetic form of calcitonin, preferred for extended use, as it is less likely to provoke allergic reactions. Dose: in hypercalcaemia, 5-10 units/kg ,fail), 1)), s.c. or Lin. injection according to need; in Paget’s disease 60 units 3 times a week up to 100 units daily. It is also used in post - menopausal osteoporosis and for the bone pain of malignancy. (C.alcynar; Miacalcic).
salicylic acid Etas useful keratolytic and fungicidal properties. Used as ointment (2%) for skin conditions, and as ointments and plasters (up to 40%) for corns and warts.
salmeterol A beta,-adrenoceptor stimulant of the salbutamol type, but with a longer action. It is used for the extended prophylaxis of asthma, bronchitis and other forms of obstructive airway disease, and together with corticosteroid therapy if required. It is not indicated in acute conditions.
Dose: 50 pg twice daily, either from a metered dose aerosol or by a ‘Disklialer’. salmeterol is well tolerated, but headache, tremor and tachycardia may occur with doses above 200 pg daily. (Serovent). See page 118 and,rable 6.
saquinavirV An antiviral agent that inhibits the enzyme HIV-protease, and prevents the development of immature virus particles into the infective virus. Used in HIV
infection together with it nucleoside analogue that has a different action.
Dose: 1.8g (laity. (Invirase). See page 1+1 ;111,1 TAIle 19.
scopolamine See hyoscine.
selective serotonin re-uptake inhibitors (SSRIS) A small group of drugs that inhibit the re-uptake ofserotonin in the central nervous system, and are used in the treatment of depression. They differ from the tricyclic antidepressants in being less likely to cause sedation or cardiac disturbances, or have anticholinergic side-effects. Care remains necessary with machine-related activities, and before and after monoamine oxidase inhibitors (MAOI) therapy. See page 128 and Table 11.
selegiline A selective enzyme inhibitor that prevents the inactivation of dopamine in the brain. It is used to supplement the action of levodopa in the treatment of parkinsonism, and combined use may give a smoother response, and permit a reduction in the dose of levodopa.
Dose: 5-10111g daily. It may cause nausea and hypotension, and may possibly increase the side-effects of levodopa. (Eldepryl). See page 160 and Table 26.
selenium sulphide Used as a shampoo in the treatment ofdandrull’. Prolonged use may cause alopecia. (Selsun).
senna The leaves and pods of Cassia sp., used as a purgative. Standardized preparations such as Senokot are now preferred.
sermorelinV A synthetic analogue of soniatorelin, the growth hormone releasing factor (GHRH). It is used in the diagnosis of growth hormone deficiency as a single i.v. dose of I pg/kg. (Geref 50).
sertindoleV An antipsychotic agent with a selective action on the limbic system, and used in acute and chronic schizophrenia. Dose: 4 nig once (laity initially, increased alter 2-4 days up to 20 mg daily according to need. Blood pressure should he monitored initially as hypotension may occur.  Contraindicated in patients receiving itraconazole, ketoconazole,  terfanidine, or any drug known to affect the QT interval. (Serdolect). See page 168 and Table 30.

serotonin A substance present in many body cells, which also acts as a neurotransmitter in the central nervous system. A reduction in the brain serotonin levels may be associated with depression and the cranial
vasodilation associated with migraine. (See page 154). Some allergic reactions may also be linked with the action of serotonin on sensitized cells (see cyproheptadine).
I Sod
colic and vomiting, but death from adder bite is very rare. If the reaction to an adder bite is severe, European viper anti-venom, if available, should be given by i.v. infu-
sion within 4 hours of the bite.
soda-lime A mixture of calcium and sodium hydroxides, used in closed-circuit anaesthetic apparatus to remove carbon dioxide.
sertraline A selective serotonin-re-uptake inhibitor (SSRI) antidepressant used both for the treatment oftlepression and the prevention of relapse.
Dose: 50 rig daily initially with food, increased at weekly intervals tip to a maximum of 2(0 mg daily. Not to be given with nionoanlilic oxidase inhibitors (MAOls). Side-effects are tremor and a dry mouth. (usual). See page 128 and Table 11.
silicones Synthetic water-repellent substances present in barrier creams and other skin protective products. Dimethicone is a silicone used as an anti-foaming agent in some antacid preparations.
silver nitrate Used mainly as silver nitrate sticks (caustic points) for cauterizing warts. It has also been used as a 0.5% lotion for suppurating lesions. It was once used prophylactically as eye drops (0.1%0) in the newborn, and is still used for that purpose in the USA.
silver sulphadiazine Sulphadiazine combined with silver. It is used topically as a I% cream for its wide-range antibacterial properties in burns and infected skin conditions, especially when an extended action is required. It is active against Pseudornonas aertiginosta and other Cram- negative organisms. (Flamazine).
simvastatin A selective inhibitor of a specific enzyme (I-IMGCOA reductase) concerned with the synthesis of cholesterol in the liver. It is used in the treatment of primary hypercholesterolaernia in patients not responding to other drugs. Dose: 10-40 mg at night. Liver function tests should be carried out regularly. Side effects include gastrointestinal disturbances. (Zocor). See page Wand Table 20.
snake-bite antivenom A bite from an adder, the only poisonous snake indigenous to the UK, can cause local pain and swelling as well as systemic effects such as
sodium acetrizoate An iodine compound used as a contrast agent in i.v. pyelography.
sodium aurothiomalate A gold compound used in the treatment of active rheumatoid arthritis. It is no value in other forms of the disease, or where bone change has already occurred.
Dose: 10 mg by deep Lin. injection weekly initially, slowly increased to 50 mg weekly. and continued until a remission occurs, or until a total dose of I g has been given.
Blood and urine tests are essential after each injection. After remission, 20-50 mg may be given every 2-1 weeks for many months. Side-effects are common, and include blood disorders, skin reactions, mouth ulcers and oedenia, anti may require withdrawal of the drug. It is contraindicated in renal and hepatic disease, blood dyscrasias and hypertension. (Myocrisin). See auranoran,
page 165 and Table 29.
sodium bicarbonate A soluble antacid, often used in association with less soluble antacids such as magnesium carbonate or trisilicate.
Dose: 1-4 g. In severe metabolic acidosis it is given by slow i.v. injection as an 8.4% solution. For alkalization of the urine, up to 3 g orally 2-hourly with further 10 g
doses daily as required.
sodium calcium edetate A chelating or binding agent used in poisoning by lead and other heavy metals.
Dose: 80 mg/kg daily by i.v. infusion in glucose/saline solution. Nausea and cramp are side-effects, and care is necessary in renal impairment. Medclair).
sodium cellulose phosphate An ion-exchange compound that binds with calcium in the intestines, and so reduces calcium absorption. Used in the oral treatment of hypercalcaemia and renal stones, and as an adjunct to low-calcium diets. Dose: 15 g daily. Diarrhoea is an occasional side-effect. (Calcisorb)•

sodium chloride An important constituent of blood and tissues. It is widely used by i.v. infusion as normal saline solution (0.9%), or as glucose-saline in the treatment of dehydration, shock and other conditions of sodium depletion. It is also useful when given orally as Sodium Chloride with Glucose Oral Powder (BNF) (after solution in water), for children with diarrhoea to offset any loss of salt. Its use as an emetic in the treatment of poisoning is no longer recommended. It is used externally as saline solution when a simple cleansing lotion is required.
sodium citrate An alkaline diuretic similar to potassium citrate and given for similar purposes.
Dose: 1-4 g. For citrating milk, 100 mg to each feed may be used. A 3% solution is used by bladder irrigation for the dissolution of blood clots.
sodium clodronate See clodronate, editronate and pamidronate.
sodium cromoglycate An antiallergic agent with a specific action and used for the prophylactic treatment of asthma by inhalation. It stabilizes mast cells and inhibits the release of histamine and other spasmogens that cause bronchospasm. Dose: by powder inhalation from a `Spinhaler* 20 mg up to 9 times a day; by aerosol inhalation, 10 mg (2 puffs) up to 8 times a day. Dose in the treatment for food allergy associated with local inflammation, 800 mg daily orally. It is also of value as eye drops (2%) and eye ointment (40/4) in allergic conjunctivitis, and as nasal drops or spray (2%) in the prophylaxis of allergic rhinitis. (Intal, Rvilacrom). See page I I O and Table 2.
sodium fluoride The fluoride present in dentifrices used to reduce dental caries. It may also be given orally when more intensive treatment is required.
Dose: 250-5001igdaily.
daily by i.v. infusion. Side-effects include nausea, rash and jaundice. Liver function tests should be carried out during treatment. (Fucidiu).
sodium hypochlorite A weak solution of sodium hypochlorite containing 0.25% of available chlorine is used as eusol, for the cleansing of wounds and ulcers. The
Solution is unstable and should be freshly prepared. Its value has recently been questioned. Stronger, stabilized solutions are used for the general disinfection of surfaces contaminated with blood and other body fluids. Their use reduces the risk of transmission of hepatitis and other viral infections.
sodium ironedetate (sodium feredetate) A soluble iron complex available as a solution containing 27.5 mg of iron per 5 nil. It is used in the oral treatment of iron-deficiency anaemias, and is of value when other iron preparations are not tolerated. Dose: 15-30 nil daily. (Sytron). See page 112 and Table 3.
sodium lactate Has been used as M/6 solution, or as Hartmann’s solution, by i.v. infusion for metabolic acidosis, but sodium bicarbonate is now preferred.
sodium nitrite A cyanide antidote.
Dose: as it 30/b solution by i.v. injection of 10 nil, followed by the slow injection of 25 nil of sodium thiosulphate solution (50%). Early treatment is essential. See kelocyanor.
sodium nitroprusside A short-acting arteriovenous vasodilator used in hypertensive crisis and for controlled hypotension during anaesthesia.
Dose: by i.v. infusion, 0.3-1 pg1kg/juin, the lower doses being used to obtain hy
, poten-
sion during surgery. It is also used in acute heart failure in doses of 10-1 5 pg/niin, increased as required to 2001ighnin.
sodium fusidate An antibiotic used mainly in penicillin- resistant staphylococcal infections, although a secondary anti-staphylococcal antibiotic is often given to increase the response and inhibit drug-resistance. It is useful in osteomyelitis and similar conditions as it penetrates into bone tissues.
Dose: 2 g daily. In severe infections, 1.5 g
sodium perborate White powder soluble in water, with antiseptic and deodorant properties similar to hydrogen peroxide. A 2% solution is used as a mouthwash.
sodium phosphate A solution of sodium phosphate with sodium acid phosphate is sometimes used by enema as a laxative.

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

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

imipenem An antibiotic with a range of activity that includes Gram-positive and Gram-negative bacteria, as well as aerobes and anaerobes, and is indicated in infections due to such organisms. It is given by i.v. infusion in doses of 1-2 g daily. Also used in surgical prophylaxis. As it is inactivated to some extent by kidney enzymes, it is always given together with the specific enzyme inhibitor cilastatin. The side-effects are numerous and include those common to other antibiotics. Care is necessary in hypersensitivity to the penicillins, cephalosporins and related antibiotics, and in epilepsy. (Prinlaxin).
imipramine A tricyclic antidepressant with the general action, uses and side-effects of amitriptyline, but with a reduced sedative action. It has been widely used in acute
endogenous depression, although the initial response may be slow, and long treatment may be required.
Dose: 7; ing daily, increased up to 200 mg. A single (lose of 150 mg may be given at night. It is sometimes used in the treatment of enuresis in closes of 25-50 mg. liniprarnine should not be given in association with or soon after monoamine oxidase inhibitors, as the effects of both drugs may be increased. Innipramine may also reduce the response to some anti-hypertensive drugs. (Tofranil). See
page 128 and Table 11.
immune defence system of the body, their use requires care. The systemically acting corticosteroids such as prednisolone also have valuable immunosuppressant
properties. Cyclosporin has a powerful immunosuppressant action with little myelotoxicity, and is also used in the prophylaxis of graft-versus-host disease (GVEID). Tacrolinus is a new product with the actions and uses of cyclosporin.
indapamide A slow-acting thiazide- related
drug used in hypertension.    57 Dose: 2.5 nig daily, continued for some months, until a maximum response has been obtained. Combined treatment with beta-blocking agents and other drugs may increase the response, but saluretic diuretics are not recommended as they may cause hypokalaemia. (Natrilix). See page 1,18and’I able 21.
indigo carmine A blue dye that has been used as a 0.4% solution by injection as a renal function test. Normally the urine is coloured blue in 10 minutes or so.
indinavirV An antiviral agent that functions as all inhibitor of HIV-protease. It prevents the development of immature virus particles into infective virus. It is best given in combination with another antiviral agent such as acyclovir which acts by a different mechanism.
Dose: 2A g daily, with ample fluid between meals. Care is necessary in hepatic impairment. (Crixivan). See page’ 144 and Table 19.
immunoglobulin The normal product obtained from plasma is given for protection against hepatitis, measles, rubella and hepatitis A in susceptible patients. More specific products are hepatitis B immunoglobulin, tetanus human immunoglobulin (H’1′1(;) and varicella-zoster immunoglobulin (VZIG). Anti-D(Rh) immunoglobulin is used to prevent a rhesus-negative mother from forming antibodies to fetal rhesus-positive cells that may reach the maternal circulation, and so protect any further child from the risks of haemolytic disease.
immunosuppressants Drugs such as azathioprine that suppress the normal immune response are used in transplant surgery to prevent tissue rejection, but as their action includes depression of the
indomethacin A non-steroidal anti-inflammatory and analgesic agent (NSAID) of value in arthritic and rheumatoid conditions, and in acute gout. Dose: 50-200 mg daily with loud. Suppositories 100 mg are useful at night to reduce morning stiffness. Dose in dysmenorrhoea, up to 75gdaily. Side-effects are numerous and include gastrointestinal disturbances, which may be severe and cause bleeding,
dizziness and confusion. Hypersensitivity I PC
reactions with blood disorders have been reported, and blurred vision with corneal deposits may occur with prolonged treatment. Indornethacin is also used by i.v.
injection for the closure of the patent ductus arteriosus in premature babies, but the dose requires careful assessment under specialist supervision. (Iriclocid; Inibrilon). See page 161 and Table 29.

indoramin An alpha-adrenoceptor blocking agent used in hypertension. It has a selective action on the alpha- receptors, and by preventing the release of noradrenaline it reduces peripheral resistance and lowers the blood pressure. The response may be increased by combined treatment with a thiazide diuretic or a beta-blocking agent. Dose: 30 nig initially daily, increased, if required, up to 200 nig daily. Side-effects include drowsiness, dizziness and some anticholinergic reactions such as dryness of the mouth. (Baratol). It is also used for the symptomatic reliefofbenign prostatic hypertrophy in doses of 40-100 mg daily, although in elderly patients small doses of 20 nig at night may be effective.
(Doralese). See page 148 and Table 21.
inosine pranobex A complex containing the pinkie metabolite inosine. The complex has antiviral properties, and may act more by stimulating the immune system than by a direct action on viral replication. Indicated in herpes simplex virus infections of the skin and mucous membranes.
Dose: 4 g daily for 1-2 weeks. (,are is necessary in renal impairment, gout or hyperuricaernia. flinintmovir).
inositol nicotinate A vasodilator agent used mainly in peripheral vascular disorders such as Raynaud’s disease, and acrocyanosis.
Dose: 1-4 g daily. (Hexopal).
insulin The antidiabetic principle of the pancreas, regulating the metabolism of carbohydrates and fats. It is widely used in the treatment of diabetes mellitus by s.c. injection in doses adjusted to individual need. Many modified insulin products are available, designed to extend the duration of action and reduce the frequency of injections, and so simulate the effects of the natural hormone more closely. Human insulins, obtained by the modification of pork insulin (erne) or by biosynthesis (crb) are also available, and are used routinely to an increasing extent. A transfer front animal to human insulin requires monitoring, and patients should be warned that the usual early symptoms of hypoglycaemia may be less marked. In diabetic emergency, soluble insulin remains the preparation of choice. See page 131 ;in(] Table 12.
interferons Protective proteins formed in
mammalian cells in response to viral
invasion. Interferon alfa, obtained by DNA technology, has cytotoxic properties, and is used in hairy cell leukaemia and renal cell carcinoma. Interferon gamma is used with antibiotics in chronic granulomatous disease.
Dose: sec data sheets.
interleukin See aldesleukin.
iodine Powerful antiseptic used as povidoneiodine for skin preparation. Hypersensitivity to iodine skin applications is not unknown. Given orally in preoperative Treatment of thyrotoxicosis.
Dose: as Aqueous Iodine Solution
I IA1g0l’S solution) 0.3-1 nil diluted with milk or water.
iodized oil Poppy-seed oil containing 40% iodine in combination. Used as a contrast agent in lymphangiography, hysterosalpingography, and other radiological
examinations.
iodoform Yellow powder with strong odour. Ni ill antiseptic used occasionally as BIPP.
iopanoic acid A radio-opaque substance used as a contrast agent in cholecystography. It is largely excreted in the bile when given orally.
Dose: 2-6g.
iophendylate An oily liquid containing 300,’o of combined iodine. It is mainly used as a contrast agent in myelography. Dose: 6-9 nil by injection into the subarachnoid space. Before intrauterine blood transfusion, 9 nil have been injected into the amniotic sac to outline the fetus. Shock and violent coughing may occur if any iophendylate reaches the circulation.
ipecacuanha The dried root front which enietine is obtained. It has emetic properties, and is used mainly as Ipecacuanha Emetic Mixture in some forms of
Poisoning.
Dose: 30 ml in adults; 10-13 nil in
children.
ipratropium An anticholinergic agent with hronchodilator properties. Of value in bronchoconstrictive states not responding to selective beta,-receptor stimulants represented by salbutamol. It is relatively free front the side-eficcts associated with anticholinergic drugs.

Dose: by aerosol inhalation, 20-40pg (1-2 puffs) 4 times a day. Similar doses are given by nasal spray in watery rhinorrhoca. (Atrovent). See page I IS and Table 3.
irbisartan An angimensin 11-receptor antagonist used in hypertension. It acts at a later stage than the ACE-inhibitors, and is less likely to cause drug-induced cough. Dose: 150-300 mg once a day. (Aprovel See page 148 and Table 21.
irinotecanV An inhibitor of topoisomerase 1, an enzyme involved in DNA replication. Used in colorectal cancer. Dose: 150-350 nighn’by i.v. infusion. Side-effects are neutropenia and diarrhoea. (C.-arripto). See page 122.
iron-sorbitol An injectable iron product for me when oral iron therapy is not possible or not effective. It is given by deep i.m. injection, taking care to prevent leakage back along the injection track to avoid staining the skin, in doses based on the degree of iron deficiency. (Jectofer). See page 112 and Table 3.
iron salts See ferrous sulphate.
isocarboxazid A monoamine oxidase inhibitor with the antidepressant action, uses and side-effects of phenelzine. Dose: 30 mg initially daily, subsequently increased if necessary up to 60 mg daily, reduced later to 10-20 mg daily according to need. (Marplan). See page 128 and Table 11.
isoconazole An antifungal agent similar to miconazole. Used tot the single-dose local treatment of candidal and trichomonal vaginal infections.
Dose: 600 mg as 2 vaginal pessaries. I r.i\ogvn,.
isofluorane An inhalation anaesthetic with the action and uses of halothane and enllurane. It is given as a 0.5-3% oxygen-nitrous oxide mixture from a calibrated vaporizer.
isonlazid A pyridine derivative with a specific action against Mycobacterium tuberculosis. Widely used in the treatment of tuberculosis, but as bacterial resistance soon develops combined treatment with other drugs such as rifampicin is essential. Dose: 300 mg daily, or 1 g twice it week,
I tar
and Mien continued for some months. Side-effects include nausea and peripheral neuritis, rash and psychotic episodes. See page 170 and Table 31.
isoprenaline An old adrenaline-like beta-receptor agonist. It is used occasionally for the short-term treatment of severe heart block and bradycardia.
Dose: 5-10 lighnin by i.v. injection. Also used in airways obstructive conditions by aerosol inhalation in doses of 80-240 pg ( 1-3 puffs) as required. (Saventrine).
isosorbide dinitrate A vasodilator with
the actions, uses and side-effects of
glyceryl trinitrate, but with a more prolonged action.
Dose: in acute angina, 5-10 mg, sublingually; for extended treatment 30-120 mg orally daily; in left ventricular failure tip to 240 nig daily; by i.v. infusion, 2-10 mg/hr. See page 114 and Table 4.
isosorbide mononitrate The active metabolite of the dinitrate. It escapes first-pass loss in the liver, and has a more rapid action. May cause peripheral vasodilatation and headache.
Dose: 40-120 mg daily. See page 114 and
isotretinoin A potent, orally active derivative of vitamin A. It is used for severe acne not responding to other treatment, and brings about a prolonged remission of symptoms.
Dose: iOo pg/kg daily for 4 weeks to assess response, followed by treatment for 8-10 weeks. An exacerbation of symptoms is common after 2-8 weeks which usually subsides later. Side-effects include dryness of mucous membranes, conjunctivitis, nausea and muscle pain. Isotretinoin is teratogenic so pregnancy must be avoided. Its use requires care under expert supervision. (Roaccutime).
ispaghula The husk of ispaghula seed. It swells in water and is used as a bulk laxative It is also useful in irritable bowel syndrome and diverticulitis.
Dose: 3–,g daily.
isradipine A calcium channel blocking agent used in hypertension.
Dose: 5 mg daily initially

A-Z Principal Drugs (antidepressants - astemizole)
antidepressants The drugs used in the treatment of depression fall into two main groups, the so-called tricyclic antidepressants and the monoamine oxidase inhibitors (MA01s). (Unrelated drugs include lithium carbonate, used only for the prophylaxis and treatment of manic depressive illness.) The tricyclic group, which also includes sonic other compounds with a similar action, appear to act by blocking the neuronal uptake of central transmitters such as noradrenaline and serotonin. They are more widely used than the MAOIs because they are more generally effective, and interact less extensively with other drugs and certain foods. The tricyclic drugs are widely used in endogenous depression, particularly when sleep disturbances are present, but the onset of action is slow, and improvement may not commence until after 2-4 weeks of treatment. Extended therapy is usually required to avoid the risk of a relapse, and patients should be advised accordingly. Sonic tricyclic antidepressants, such as amitriptyline, have a sedative action of value when anxiety is a complicating factor, whereas a less sedating drug such as imipramine may be useful in patients exhibiting apathy and withdrawal. Some of the side-effects, such as dryness of the mouth, are linked with their anti-
cholinergic activity, but tolerance may develop with continued treatment. They also influence the cardio-vascular system and may cause arrhythmias, tachycardia and hypotension, and may interfere with the action of some antihypertensive drugs, although the response to beta-blocking agents is unaffected. Care is necessary in cardiac disease, and with the elderly initial doses should be low. The use of tricyclic antidepressants in epileptic patients may result in a lowering of the convulsive threshold. See page 128 and Table 11.
antidiabetic agents Diabetes mellitus is a deficiency disease due to a lack of insulin, and is characterized by an excessive level of glucose in the blood and urine. Treatment is either replacement therapy with daily injection of insulin, or orally by hypoglycaemic agents such as chlorpropamide. Such agents act by stimulating insulin secretion and release by the beta-cells of the pancreas, and are ineffective in the absence of such cells. See page 132 and Tables 12 & 13.
anti-D(Rh.) immunoglobulin An ininiurioglobulin that is given to a rhesus-negative mother to prevent her forming anti-bodies against fetal rhesus-positive cells which may pass into the maternal circulation during childbirth or abortion and which, in a later pregnancy, could cause haemolytic disease.
Dose: 504) units Lin. within 60-72 hours of delivery or abortion. Doses of 1250 units are given prophylactically. It is of no value it’given after anti-D antibodies have been formed. The inimunoglobulin has also been given after the transfusion of rhesus-incompatible blood. (Partobulin).
antiemetics Nausea and vomiting may be due to several causes, including stimulation of the chemoreceptor trigger zone in the reticular formation of the brain. Man), antiemetics have some degree of central activity, and in some cases their action may be mediated by blocking the effects of dopamine on the trigger zone. Effective drugs include some antihistamines and sonic phenothiazine-based tranquillizers such as prochlorperazine. The alkaloid hyoscine is widely used in travel sickness. More powerful drugs such as domperidone, metoclopramide, nabilone and ondansetron, are of value in the control of the severe nausea and vomiting induced by cytotoxic drugs. The use of antiemetics in early pregnancy requires great care, and is seldom essential.
antiepileptics See anticonvulsants, page 136 and’] able 15.
antihistamines Drugs such as promethazine are of value in conditions associated with the release of histamine from mast cells, such as hayfever, rhinitis, urticaria, pruritus, insect bites and stings. They are also useful in drug allergies. Some antihistamines also have antienietic properties, and are useful in travel sickness. Although all antihistamines have the same basic action, the degree and duration of response and the severity of side-effects may vary. Some antihistamines pass easily into the central nervous system arid are more likely to cause drowsiness. Others may have reduced anticholinergic properties, and cause less dryness of the mouth and blurring of vision. Care is necessary in epilepsy, glaucoma, hepatic disease or prostatic enlargement. See page 110 and Table 2.

antihypertensive agents See page 148 and Table 2 1.
anti-inflammatory agents See non-steroidal anti-inflammatory drugs (NSAIDS) and page 165 and Table 29.
antimetabolites Cytotoxic drugs that appear to act by combining irreversibly with cell enzymes, and so prevent cell division. Methotrexate and mercaptopurine are examples. See page 122 and Table 8.
dermatology and pruritus as oily calamine lotion. Arachis oil enema is used to soften impacted faeces.
argipressin A synthetic form of vasopressin.
artificial tears Some chronic sore eye con clitions may occur in rheumatoid arthritis, and may be due to tear deficiency. Solutions of itypromellose or polyvinylalcohol, sometimes referred to as’artificial tears’, are useful as a bland lubricant to replace the tear deficiency. (Isopto; Hypotears).
antimuscarinic agents See anticholinergic agent” page 160 and Table 26.
antineoplastic agents Anti-cancer drugs. See page 122 and ‘rabic 8.
antipsychotic agents See pages 117 & 1(,8, and Tables 5 & 30.
antitetanus immunoglobulin aulloglobulin obtained from plasma is used in injured patients who have not previously been immunized, and when tetanus is a definite risk. Dose: 250 units jan. A course of tetanus vaccine should also be commenced,
antitubercular agents See rifampicin, page 170 and I able 31.
antiviral agents See page 144 and Table 19.
anxiolytics See page H 7 and Table 5.
apomorphine A morphine derivative formerly used as a powerful emetic, but now considered to be too toxic. Occasionally used in the hospital treatment of parkinsonism. (Britaject).
apraclorildine A clonidine derivative used as eye drops I 9A, to control intraocular
pressure during ophthalmic surgery. Some absorption may occur, so care is necessary in severe cardiovascular disease. (lopidine).
aprotinin An inhibitor of the proteolytic enzyme plasmin, obtained from bovine lung tissue. It is used in the severe haemorrhage due to hyperplasminaemia.
Dose: 500 000-1 000 000 units by i.v. infu.ioll. (Trasylol).
arachis oil Groundnut or peanut oil. It has
emollient properties, and is used in
ascorbic acid (vitamin C) Present in many citrus fruits. Deficiency is not uncommon in the elderly receiving inadequate diets. Severe deficiency causes scurvy, once the bane of seafarers.
Dose: for prophylaxis 25-75 mg daily; therapeutic dose 200-500 mg daily. Doses of 4 g daily are given for acidification of the urine. Claims that vitamin C prevents colds are unproven.
asparaginase Crisantaspase. See page 122 and Table 8.
aspirin (acetylsalicylic acid) Widely used as a mild analgesic and anti-inflammatory agent, often in association with other drugs such as paracetamol and codeine. Dose: 1.2-4 g daily, but in acute rheumatoid conditions doses of 4-8 g daily have been given. Long-term treatment with (loses of 75 mg daily are given liar the prophylaxis of cardiovascular disease. Side-effects include gastric irritation with some blood loss, hyperventilation, and bonitos, with the risk of deafness, may occur with high doses. Aspirin may cause rash and bronchospasm in asthmatic and other sensitive patients. As aspirin is now thought to be associated with Reye’s syndrome, the drug should not be given to children under 12 years of age unless specifically indicated. Aspirin may increase the effects of certain hypoglycaemic and anticoagulant drugs.
astemizole An antihistamine with an extended action and reduced sedative effects.
Dose: Wring once daily before food, and must not be exceeded. Higher doses may cause cardiotoxic side-effects such as ventricular tachycardia. Arrhythmias may follow combined treatment with many other drugs. (Hismanol; Pollen-ese). See page 110 and Table 2.