Posts Tagged ‘muscle relaxant’

Generic Name
Buspirone (bue-SPYE-rove) OG
Brand Name  BuSpar
Type of Drug
Minor sedative and antianxiety drug.
Prescribed For
Anxiety and generalized anxiety disorders; also prescribed for the aches, pains, fatigue, and cramps of premenstrual syndrome (pMS).
General Information
Buspirone hydrochloride has a potent antianxiety effect. It is approved by the Food and Drug Administration (FDA) for short-term relief of anxiety, but it may apparently be used safely for more than 4 weeks. The exact way in which buspirone works is not known, but it seems to lack the addiction dangers associated with other antianxiety drugs, including benzodiazepines. It neither severely depresses the nervous system nor acts as an anticonvulsant or muscle relaxant, as other antianxiety drugs do. Minor improvement will be apparent after only 7-10 days of drug treatment, but the maximum effect does not occur for 3 or 4 weeks.
Cautions and Warnings
Do not take buspirone if you are allergic or sensitive to any of its ingredients.
Buspirone should be used cautiously by people with timer or kidney disease.
Buspirone does not have any antipsychotic effect and should not be taken for symptoms of psychosis.
Although buspirone has not shown a potential for drug abuse, you should be aware of this possibility.
Buspirone should not be used with monamine oxidase inhibitor (MAGI) antidepressants.
Possible Side Effects
♦    Most common: dizziness, drowsiness, nausea, and head-
ache.
•    Common: fatigue, nervousness, lightheadedness, excite-
ment, dry mouth, and insomnia.
•    Less common: heart palpitations, muscle aches and pains, tremors, rash, sweating, clamminess, rapid heartbeat, dif-
ficulty concentrating, anger or hostility, depression, loss of interest, diarrhea, constipation, vomiting, and blurred vision.
♦    Rare: Rare side effects can occur in almost any part of the
body. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    Combining buspirone with an MAGI antidepressant may produce severe hypertension and may be dangerous.
•    The effects of combining buspirone with other drugs that work in the central nervous system (CNS) are not known. Do not take other sedatives or antianxiety or psychoactive drugs with buspirone unless prescribed by a doctor familiar with your complete medical history.
•    Erythromycin, itraconazole, ketoconazole, clarithromycin, diltiazem, verapamil, fluvoxamine, and ritonavir may increase blood levels of buspirone. When used in combination, your buspirone dosage may need to be adjusted.
•    Buspirone may increase the side effects of haloperidol and diazepam.
•    Studies show that buspirone is not affected by alcohol, but this combination should still be used with caution because buspirone causes drowsiness and dizziness.
•    The combination of buspirone and trazodone may cause liver inflammation.
•    Combining rifampin with buspirone may decrease buspirone’s effectj\18″eSS.
Food Interactions
This drug may be taken either with or without food, but for the most consistent results, always take your dose at the same time of day in the same way—that is, with or without food. Avoid drinking large amounts of grapefruit juice with this drug.
Usual Dose
Adult: starting dosage-7.5 mg twice a day. Dosage may be increased gradually to 60 mg a day.
Overdosage
Symptoms of overdose are nausea, vomiting, dizziness, drowsiness, pinpointed pupils, and upset stomach. The overdose victim should be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Buspirone may cause CNS depression, drowsiness, and dizziness. Be careful while driving or operating hazardous equipment. Avoid other CNS drugs and alcoholic beverages because they will enhance buspirone’s effects.
Contact your doctor if you become restless, develop uncontrolled or repeated movements of the head, face, or neck, or have any intolerable side effects.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and go back to your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Though buspirone has not been found to cause birth defects, be sure to inform your doctor if you are or might be pregnant while taking this drug. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
It is not known how much buspirone passes into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Several hundred seniors participated in drug evaluation studies without any unusual problems. However, the effect of this drug in seniors is not well known, and special problems may surface, particularly in those with kidney or liver disease.

vasodilators Traditional vasodilators used in the prophylaxis and treatment of angina include glyceryl trinitrate and other nitrates. They have a general effect on the venous system but newer and more selectively acting antihypertensive drugs are the betaadrenoceptor blocking agents represented by propranolol, and the calcium channel blocking agents such as nifedipine. Other vasodilator drugs are the alpha-adrenoceptor blocking agents (indorarnin, prazosin) and the ACE inhibitors (captopril). Cerebral vasodilators are represented by isoxsuprine. Peripheral vasodilators include cinnarizine and thymoxamine. See pages 114 & 148.
vasopressin A preparation of the blood pressure- raising and antidiuretic factors of the pituitary gland. It has been used in doses of 5-20 units twice daily by s.c. or i.m. injection in diabetes insipidus, but has been largely superseded by demopressin. (Pilressin).
vecuronitim A non-depolarizing muscle relaxant of the rocuronium type. It has a medium duration of action, with the advantage of not causing histamine release. Dose: 80-100fLgjkg1min initially, with supplementary doses as required. (Norcuron).
venlafaxine An antidepressant that inhibits the re-uptake of both serotonin and nor-adrenaline.
Dose: in depressive illness, 75 mg daily, rising if necessary after some weeks to 150 ing daily, or exceptionally to 375 mg daily. Prolonged treatment is necessary for an adequate response and reduce potential relapse. Reduced doses are given in hepatic disease and lite elderly. Care is necessary in epilepsy, and before and after morloaniine oxidase inhibator (MAGI) therapy. Many side-effects have been noted, but any skin reaction should be reported to the prescriber. (Ffcxor). See page 128 and Table 11.
Dose: 120-480 mg daily according to the condition and degree of response. In severe arrhythinias, 5-10 mg i.v. under ECG control. Contraindicated in bradycardia, heart failure and heart block. Side-effects include nausea, hypotension and heart block. It should be used with caution in a patient already receiving a betaadrenoceptor blocking agent. (Cordilox; Securon). See page 148 and Table 21.
vigabatrin A new anti-epileptic drug. GABA (a gamma aminobutyric acid) is an inhibitor of neurotransmission, and epileptic seizures may be linked with a GABA deficiency. Vigabatrin has an inhibitory action on the GABAmetabolizing enzyme, and so indirectly permits a rise in the brain level of GABA. It is used in the treatment of epilepsy not responding to other anticonvulsants. Dose: 2 g daily initially, with adjustments up to 4 g daily together with current antiepileptic therapy. Side effects are numerous, and include drowsiness, fatigue, dizziness and weight gain. Sudden withdrawal is inadvisable. (Sabril). See page 136 and Table 15.
viloxazine An antidepressant with the general action, uses and side-effects of amitriptyline, but with a reduced sedative activity. It is given in depression associated with apathy, and in the depression of epilepsy.
Dose: 150-400 mg daily. It may increase the action of phenytoin and antihypertensive agents. (Vivalan). See page 128 an(] Table 11.
vinblastine An alkaloid of periwinkle that has cytotoxic properties. It is used in the control of acute leukaemias, lymphomas and other malignant conditions, and in mycosis fungoides.
Dose: 100 ltrjkg weekly i.v., increased by 50 pg/ki; weekly, up to 500 µg/kg weekly according to response. Side-effects include myclosuppress.ion, neurotoxicity and abdominal disturbances. The drug should be handled with care as it is a tissue irritant. (Velbe). See page 122 and Table 8.
105
verapamil A calcium channel blocking agent that reduces the movement ofcalciurn ions in cardiac tissues. It reduces the oxygen demand as well as the contractility of the myocardium, and it is used in angina, arrhythmias and hypertension.
vincristine A vinca alkaloid with the action and uses of vinblastine, but much less likely to cause myclodepression. It is used mainly in the treatment of acute
leukaemias in children, Hodgkin’s disease and other malignant lymphomas.

Neuromuscular side-effects may limit the dose. Other side-effects are abdominal disturbance and alopecia. The injection of the drug requires care as it is a tissue irritant. (Oncovin). See page 122 and Table 8.
vindesine A vinca alkaloid with an action similar to that of vincristine. It is used mainly in acute lyniphoblastic leukaemia in children, and in other malignant conditions not responding to treatment.
Dose: 3 nig/m` weekly by i.m. injection, subsequently increased up to 5 mg/in’ according to response. The side-effects are similar to those of other vinca alkaloids, but granulocytopenia may be a close-limiting factor. Extravasation should he avoided, as it may cause considerable local irritation. (Eldesine). See page 122 and fable R.
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vitamin D. Calciferol.
vitamin E The vitamin in the germ of wheat, rice and other grains. Deficiency States are uncommon, but may occur in cystic fibrosis and other conditions where fat absorption is impaired. It has been used empirically in many other
conditions, but its therapeutic value is questionable.
Dose: 5-15 ing daily. Now largely replaced by the synthetic form tocopherol.
vitamin K The vitamin concerned with the formation of prothrombin, and so with blood coagulation. Given as menadiol in haemorrhagic disorders, vitamin K, or phytomenadione has a similar but more rapid and sustained action. Of no value when the prothrombin level of the blood is adequate.
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vinorelbine A cytostatic drug of the vinca alkaloid type. It is used in non-small cell lung cancer and in advanced breast cancer resistant to other drugs.
Dose: 25-36 ing/inweekly by i.v.
infusion. Main side-effect is neutropenia. (Navelbine). See page 122.
vitamin A One of the vitamins obtained from fish-liver oils. A deficiency in the diet causes night-blindness, skin changes and a decreased resistance to infection. Dose: 2500-25 000 units daily.
vitamin B A group of water soluble vitamins obtained from yeast or rice polishings. The constituents include thiamine, riboflavine, nicotinic acid, pyridoxine, and small amounts of other factors.
vitamin B. Pyridoxine.
vitamin B,, Cynacobalamin. vitamin C Ascorbic acid.
warfarin A synthetic anticoagulant similar to phenindione, but with reduced side-effects and it is now the preferred drug. It is used mainly in deep-vein thrombosis and transient brain ischaernia, in doses based on the prothrombin time as
reported by the laboratory in terms of the International Normalized Ratio (INR). Dose: Pending INR report, 10 ing daily initially for up to 3 days. Haemorrhage is the main side-effect, and may require the use of phytornenadione to control the excessive response.
Whitfield’s ointment Benzoic acid 6%, salicylic acid 3%. Has keratolytic and fungicidal properties, and is used mainly for ringworm.
wool alcohols A water-in-oil emulsifying agent obtained from wool fat. It is used in many water-containing ointments, such as ointment of wool alcohols and hydrous ointment.
vitamin D The vitamin essential for the absorption of calcium and phosphorus and subsequent bone formation. Several forms of the vitamin are known, but it is used chiefly as calciferol. Vitamin D is activated in the liver and kidneys to more powerful derivatives such as calcitriol and alfacalcidol.
wool fat A pale yellow, waxy substance, also known as lanolin, obtained from sheep’s wool. It consists mainly of cholesterol-derivatives, and is a constituent of various water-in-oil emulsifying and emollient ointment bases. It may cause skin sensitization in some susceptible patients.

xamoterol A partial 0, adrenoceptor agonist with a cardiac stimulant action. It is given only in mild chronic heart failure to control exercise-induced symptoms. Dose: 400 ing daily. Side-effects are dizziness, headache and gastrointestinal disturbances. Contraindicated in severe heart failure, and care is necessary in asthmatic conditions. (Corwin). See page 141 and Table 18.
xipamide A long-acting diuretic and anti-hypertensive similar to chlorthalidone. Dose: in hypertension, 20 ing is given as a morning close: in oedematous states, 40-90 mg as a single dose, reduced later as necessary. (Diurexan). See page 148 and Table 21.
xylometazoline A sympathomimetic agent used as a nasal decongestant, and to relieve allergic conjuncfivitis as drops of 0.05-0.1%. Rebound congestion may be a side-effect.
Z
zalcitabineV An antiviral agent used in the suppressive treatment of AIDS patients who have become resistant to or have failed to respond to zidovudine therapy. Dose: 2.25 nig daily under expert supervision, as the drug has many side-effects including
., peripheral neuropathy. 0 livid).
zidovudine An antiviral agent effective against the human immunodeficiency virus (HIV) associated with the acquired immune deficiency syndrome (AIDS). It inhibits the enzyme reverse transcriptase and, by preventing the formation of viral DNIA, it inhibits viral development. Dose: 33 ing/kg4-hourly for some months. Side-effects include anaemia, neutropenia, nausea, fever and malaise. Liver-function tests are necessary during treatment. The chronic use of analgesics such as paracetamol may increase the risk of neutropenia. (Retrovir). See page 144 and “table 19.
zinc oxide A soft white powder widely used in dusting powders, ointments, pastes, etc., for its mild astringent and antiseptic properties. It is a constituent of Lassar’s paste, Unna’s paste, Calamine Lotion and similar preparations.
zinc sulphate Used as an astringent and stimulating lotion (1%) for indolent ulcers; and in conjunctivitis as eye drops (0.25%).
zinc undecenoate A white insoluble powder. Constituent of dusting powders and ointments for mycolic conditions.
zolmitriptan A serotonin receptor agonist used only in the treatment of acute migraine.
Dose: 2.5 ing as soon as possible after onset. .A second dose may be given not less than 2 hours later if symptoms persist. Vornig). See page 154 and Table 23.
zolpidem A mild hypnotic that acts by binding with a sub-group of benzodiazepine receptors. It has a rapid action, and is used in the short-term treatment of insomnia.
Dose: 10 mg. Side-effects are dizziness and gastrointestinal disturbance. (SI ilnoct). See page 152 and Table 22.
zopiclone A mild hypnotic that binds with a sub-group of benzodiazepine receptors, and may modulate the neurotransmitter GABA.
Dose: in insomnia and early awakening, 7.. —]S mg with initial doses of 3.75 mg for the elderly. A side-effect is a bitter or metallic after-taste. (Zimovane). See page 152.
zuclopenthixol A powerful tranquillizing drug with actions, uses and side-effects similar to those of chlorpromazine. It is of value in schizophrenia with agitation and aggression.
Dose: 20-30 mg or more up to 150 mg daily. For depot maintenance treatment, 100-200 mg or more by deep i.m. injection at intervals of 2-3 weeks, according to need and response. (Clopixol). See page 168.

suramin A drug used in the early treatment of trypanosomiasis, but it is of no value in the later stages of the disease as it does not enter the cerebrospinal fluid.
Dose: I g i.v. weekly for 5 weeks, after a tolerance test dose of 200 mg. Side-effects are gastrointestinal disturbances, dermatitis, hyperac%thesia and kidney damage.
suxamethonium A short-acting, depolarizing muscle relaxant, with an action lasting 3-5 minutes. A preliminary injection of thiopentoric should first be given, as the initial effect of suxamethonium is a
painful muscle contraction before the relaxant action supervenes.
Dose: 20- tOO ing i.v. during surgery, with further doses according to need. Suxamethonium may also be given as a 0.1% solution by i.v. infusion. Exceptionally, the muscle relaxant action of the drug may be prolonged with marked apnoea. Unlike non-depolarizing muscle relaxants, the action of suxamethonium cannot tie reversed. Severe hepatic disease is a contraindication. (Anectine: Scoline).
sympathomimetics Drugs that have an action similar to adrenaline, and act on both alpha- and beta-adrenoceptors. More selective compounds, such as salbutamol, act on the beta,-adrenoceptors in the lungs and have an increased bronchodilator action. They also relax uterine muscle, and are used to prevent premature labour. Others such as dobutamine and dopamine have a more selective action on the beta,- receptors in the heart, and are referred to as isotropic sympathorninictics.
tacalcitol A vitamin D. derivative used in the treatment of psoriasis as an ointment containing 4 pg/g of the drug. It is applied sparingly once daily at night, and continued as required. Not more than 2 treatments over 8 weeks per year. (Curatoderm).
tacrolimusV A macrolide derivative with marked immunosuppressant properties. It is used in liver and kidney transplantation, and appears to act by suppressing T-cell activation. It may also inhibit the formation of cytotoxic lymphocytes that are concerned
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with graft rejection. See Drug Data Sheet for details of dose and extensive side-effects including neurotoxicity and hypertrophic cirdiomyopathy. (Prograf).
talc A form of magnesium silicate, widely used as a skin dusting powder. It has also been used as a lubricant for surgeons’ gloves, but it may cause a talc granuloma if any reaches the tissues during operation, and glove powders prepared from starch are preferred.
tarnoxifen An oestrogen-receptor
antagonist used mainly in breast cancer, particularly when metastases are present. Dose: 20 mg daily. It is usually well tolerated, but side-effects include hot flushes, dizziness, rash, by
. percalcaciiiia and
an increase in tumour pain. Unlike other oestrogen-antagonists, tamoxifen has no androgenic properties. It has also been used in sonic forms of anovulatory sterility. (Nolvadex). See page 122 an(] Table 8.
tamsulosinV A relatively selective alpha adrenoceptor antagonist. It lowers the tone of bladder and prostatic smooth muscle, and is used in benign prostatic hyperplasia. Dose: 400 mg daily after breakfast with a glass of water. The first dose should be taken in bed to avoid postural hypotension. Other side-effects include palpitations and dizziness and hypotension. (Floniax). See page 164 and Table 28.
tazabactam An inhibitor of betalactamases. It is used in association with some antibiotics to extend the activity against resistant beta - lactamase - producing bacteria. Tazacin is a mixed product containing piperacillin and tazabactam.
tazarotene A retinoid used as an aqueous gel (0.05-0.1 %) in psoriasis. Applied once daily to the affected skin area only. (Zorac).
teicoplanin An antibiotic that acts by interfering with bacterial cell wall development. It has a wide range of activity, but is used mainly in the treatment of severe staphylococcal infections that fail to respond to other antibiotics.
Dose: loo mg initially by i.v. injection, lollowed by 200 nig as a single daily dose, which may be given by i.m. injection. Double doses in severe infections. Side-effects include gastrointestinal disturbances, dizziness, fever and rash (Targocid).

temazepam A mild hypnotic of the nitrazepain type, but with a shorter duration of action. It is useful in the insomnia of the elderly, arid is also of value as a preoperative anxiolytic agent.
Dose: 10-20 ing. Daytime drowsiness is less common than with related drugs. See page 152 and Table 22.
ternocillin A penicillin-type of antibiotic active chiefly against infections due to penicillinase-producing Gram-negative bacteria, with the notable exception of pseudomonas. It is used in respiratory and urinary tract infections due to susceptible organisms.
Dose: 2-4 g daily by injection, but in simple urinary tract infections a single daily dose off g may be effective. (Temopen).
I Tet
inie’tion. (Bricarly]). See page 118 and Table 6.
terfenadine An antihistamine with reduced sedative and other side-effects on the central nervous system. It is effective in hay fever, allergic skin conditions and other allergic states.
Dose: 120 mg daily. Best given alone, as combined use with imidazole antifungal agents or with many other drugs may cause severe reactions. See Drug Data Sheet for details. (Triludan). See page 110 and Table 2.
terlipressin A synthetic form of vasopressin, used to control bleeding from oesophageal varices.
Dose: 1-2 nig i.v., repeated if required 4-6-hourly, (Gl)j)ressin).
tenoxicam A non-steroidal anti-inflamma- tory drug (NSAID) with the actions, uses and side-effects of that group.
Dose: 20 mg as a single daily dose. (Mobillex). See page 105 arid Table 29.
terazocin An alpha-receptor antagonist used in hypertension. It produces a peripheral vasodilation by a blockade of post-synaptic alpha-receptors.
Dose: I mg tit night initially, slowly increase(] up to 10 mg as a single daily dose. Small initial doses are necessary to avoid episodes of syncope during early treatment. Reduced doses are indicated when terazocin is given with thiazide diuretics or other anti-hypertensive agents. Side-effects are dizziness, drowsiness and peripheral oedema. It is also used in benign prostatic hypertrophy.
(I lvpovase). See page 149 arld’I'able 21.
testosterone The androgenic hormone of the testes, which controls the development of the male sex characteristics. It is used mainly in the treatment of hypogonadism
by the i.m. injection of depot preparations    97 of long-acting testosterone derivatives. Subcutaneous implantation of testosterone pellets (200-600 mg) has been used in the treatment of metastatic breast cancer. Side-effects are weight gain, virilism and hypercalcaemia.
tetanus vaccines Preparations of tetanus toxin that has been modified by treatment with formaldehyde. They stimulate the formation of protective antitoxin. They are used for active immunization against tetanus, but for young children a combined diphtheria, pertussis and tetanus vaccine is usually preferred.
terbinafine An antifungal agent that acts by interfering with the synthesis of ergosterol, an essential constituent of fungal cell membranes. It is used in fungal infections of the skin and nails, but it is not effective in pityriasis (Tines versicolor).
Dose: 250 mg daily for 2-6 weeks; half-doses in severe liver or renal impairment. Side-effects are rash, loss of appetite and gastrointestinal disturbances. (I.arnisil).
terbutaline A selective beta-adrenoceptor stimulant and bronchodilator, with the actions, uses and side-effects of salbutamol.
Dose: 7.5-15 mg orally daily, by aerosol inhalation; 250-500 jig by &L, i.rn. or i.v.
tetrabenazine A drug of the haloperidal type, but used mainly in the treatment of Huntington’s chorea and similar disorders of movement.
Dose: 75-200  ing daily. It may cause drowsiness and extra-pyramidal side-effects.
tetracosactrin A synthetic form of corticotrophin.
Dose: it single injection of 250 pg as a test of adrenal cortex function, as after such an injection the level of cortisol in the plasma should rise within an hour. It is also given as single I mg i.m. depot preparation in
the 5-hour diagnostic test. (Synacthen; Synacthen Depot).

tetracycline A wide-range antibiotic very similar both chemically and pharmacologically to chlortetracycline, oxytetracycline, clomocycline, and related compounds referred to generically as the tetracyclines. They all have the same type of action against both Gram-positive and Gram-negative organisms, but exhibit certain differences in solubility, absorption and excretion. These differences are reflected in the different doses, as tetracycline is given in doses of 250 mg 4 times a day, whereas with doxycycline a single daily dose of 100 ing may be adequate. Long treatment with a tetracycline may lead to gastrointestinal disturbance owing to changes in the normal bacterial population of the intestinal tract. The use of the tetracyclines has declined with the emergence of bacterial resistance. They also have the disadvantage of being taken up and staining growing teeth and bone, and so should riot be given to children or used during pregnancy. The absorption of the tetracyclines is reduced by antacids, calcium, iron and milk. See page 249 art(] Table 35.
theophylline A bronchodilator used in the less severe forms of asthma and respiratory disease. (In severe and acute asthma arninophylline is usually preferred.) Dose: 180 nig- I g daily. Side-effects include gastrointestinal disturbances and tachycardia, but are less frequent when long-acting preparations of theophyllinc are used. Such preparations are also useful in the control of nocturnal asthma. These long-acting forms differ, and a patient stabilized on one preparation should not lie transferred to another without good cause. See page 118 and’I'able 6.
thiabendazole An anthelinintic effective against a wide range of intestinal parasites. Also useful in creeping eruption.
Dose: 2.3 iiig/kg daily, up to a maximum of 3 g daily for 2-3 days. Side-effects knore marked in the elderly) are nausea, diarrhoea, rash, yellow vision and
jaundice. Mintezol).
thiamine (vitamin Bj Essential for carbohydrate metabolism, but is used clinically in cases of deficiency, as in beri-beri, or when the diet is restricted. Also of value in the neuritis of pregnancy and alcoholism. Dose: 2-5 nig daily; therapeutic 25- 100 ing daily, in severe deficiency 200-300 nig
doily. severe allergic reactions have followed the i.v. injection of thiamine in high-dose mixed vitamin products such as Pabrinex. Anaphylactic treatment must be immediately available. (Benerva).
thiazides See diuretics and page 150.
thioguanine A cytotoxic agent similar in action and uses to nicrcaptopurine, and used to induce and maintain remission in acute myeloblastic and other leukaernias. Dose: 2 ing/kg, daily. Side-effects are bone marrow depression, nausea and jaundice. Manvis). See page 122 and Table 8.
thiopentone A widely used, short-acting I.V. anaesthetic.
Dose: 100-150 nig initially, repeated at intervals of 10-15 seconds as required. Solutions should be freshly prepared, and great care must be taken to avoid extrava&ttion, a-, the solution is very alkaline and may cause tissue necrosis. Infra-arterial injection is even more dangerous.
(Iniraval Sodium).
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thiorid zine A tranquillizing drug related  to chlorpromazine, and used in similar doses for the treatment of schizophrenia and other psychiatric conditions. Unlike most related drugs, it has no antiemetic properties.
Dose: 30-600 ing daily. (Melleril). See page 168 and Table 30.
thiotepa A cytotoxic agent used mainly by infra-cavity instillation, particularly for recurrent superficial tumours of the bladder.
Dose: 15-60 mg dissolved in 60 nil of water, instilled weekly for 4 weeks,
followed by a rest period of 2 weeks before lorther doses are given.
thymoxamine A peripheral vasodilator that is useful in vasospastri and other peripheral ischaemic conditions.
Dose: 160-2,10iiig daily. Side-effects such as headache and facial flushing are usually mild and transient. Treatment should be discontinued after 2 weeks if there is tit) response. (Opilon). See 111oxisylyte.
thyroxine The active constituent of thyroid, but now prepared synthetically. Thyroxine is a powerful metabolic stimulant, specific in neonatal hypothyroidism (cretinism) and myxcredenia. In the former, early diagnosis

mupirocin An antibacterial agent that is effective against most of the pathogens responsible for skin infections. It is used as a 2% ointment in impetigo, folliculitis and similar conditions. It should not be used for longer than 10 days to avoid the development of resistance. (Bactroban).
mustine A cytotoxic drug used mainly in the treatment of Hodgkin’s disease and related conditions.
Dose: 0.1 mg/kg daily for 3 days as a fast-running i.v. infusion, or as a single dose of oA ing/kg. The solution is highly irritant, and extra venous injection causes very severe local necrosis. Side-effects include severe vomiting, bone marrow depression and alopecia. Close haematologicalcontrol during treatment is essential. Now in less frequent use. See page 122 and Tabl’. 8.
nabumetone A non-acidic anti-inflammatory agent of the naproxen type. It is effective in rheumatoid and osteoarthritis and has reduced gastric irritant properties. Dose: I g at night. Reduced closes are necessary in renal impairment, and the dose of any oral anticoagulant or hypoglycaemic agent may require adjustment. (Relifex). See page 165 and Table 29.
nadolol A beta-blocking agent with the
actions and uses of propranolol.
Dose: in angina, 40 mg daily, or more; in hypertension, 80 mg daily, increased slowly as required; in the prophylaxis and treatment of migraine, 80-160 mg daily. Maximum daily dose 240 mg. (Corgard). See pages 114 & 148, and Tables 4 & 21.
nafarelin A synthetic suppressant of steroid production by the gonads, and used in the treatment of endometriosis.
Dose: given as it once-only course of treatment by nasal spray in doses of 200 pg twice a day, starting between 2 and 4 days of the menstrual cycle, and continued for up to 6 months. Side-effects are numerous and of the menopausal type. (Synarel). See buserelin, goserelin and leuprorelin.
mycophenolate mofetil An immunosuppressant used together with cyclosporin and corticosteroids to prevent acute renal transplant rejection. It acts on a specific enzyme concerned with”]’- and B-lymphocyte proliferation, as well as inhibiting antibody formation.
Dose: 2 g daily, starting within 24 hours (d transplantation. Blood counts are necessary during treatment, and, as with other immunosuppressants, there is an increased risk of opportunistic infection. (CellCept).
nabilone A cannabinoid antiemetic used in the treatment of nausea and vomiting associated with cancer chemotherapy. Dose: 2-4 ing daily, beginning the day before cytotoxic treatment is commenced, and continued for a day after the end of the course. Side-effects are drowsiness, confusion and tremor. Care is necessary in liver dysfunction or any history of psychotic illness. See page 158.
naftidrofuryl A peripheral and cerebral vasodilator. Claimed to be of value in cerebrovascular disorders.
Dose: 300-600 ing daily. (Praxilene).
nalbuphine An opioid analgesic, comparable with morphine in potency, but with reduced side-effects and a reduced dependence potential.
Dose: by injection, 10-20 ingas required. It may cause nausea and dizziness, and care is necessary in respiratory, renal or hepatic dysfunction. (Nubain).
nalidixic acid A quinolone antibacterial agent used in cystitis and infections of the lower urinary tract, especially those due to Gram-negative bacteria (except Pseudornoricts). It is not suitable for systemic infections as the blood levels reached with nalidixic acid are too low to be effective.
Dose: 4 g daily for 7 days, with subsequent doses of 2 g daily. Side-effects arc nausea, visual disturbance, rash, jaundice and phototoxicity. Exposure to sunlight should be avoided; epilepsy is a contraindication. (Mictral; Negrain). See ciprotloxacin and norfloxacin.

naloxone A powerful and rapidly acting opioid narcotics antagonist. It is used immediately after operation to reduce any narcotic-induced respiratory depression. Dose: 100-200µg i.v. initially, followed by 100 µg at 2- minute intervals, as required. For neonates, 10 pglkg by iniection are given. In narcotic analgesic overdose, 800 lig-2 nig may be given, 111, to a total dose of 1 0 ing. (Narcan).
naltrexone A long-acting narcotic antagonist used only to prevent relapse and maintain recovery after treatment for opioid addiction. It prevents re-addiction only whilst the drug is being taken. Dose: 25 ing initially, later up to 50 mg daily. It must not be given to patients who are still opioid-dependent as an acute withdrawal syndrome may be precipitated. (Nalorex).
nandrolone An anabolic steroid related to testosterone, with markedly reduced virilizing properties. It has anabolic or tissue-building properties and has been used in postoperative convalescence, osteoporosis and wasting diseases but the response is poor. It is sometimes effective in aplastic anaemia.
Dose: 50 ing by deep Lin. injection every 3 weeks. (Deca-Durabolin).
the prophylactic treatment of asthma, but it is not effective in an established attack. Dose: by aerosol inhalation, 8 mg (4 pulls) daily. Side-effects are transient nausea and headache. (Tiladc). See page 118. It is also used as eye drops in allergic conjunctivitis. (Rapitil). See page 118 and Table 2.
nefazodoneV A new antidepressant of the selective serotonin-re-uptake inhibitor (SSRI) type.
Dose: 200-600 mg daily. (Dutonin).
nefopam An analgesic for moderate, acute and chronic pain before using more potent drugs. Dose: 90-270 ing daily; 20 mg by i.m. injection. Side-effects include drowsiness, headache and tachycardia. Care is necessary in hepatic or renal disease. (Acupan).
neomycin An antibiotic with a wide range of activity against Gram-positive and Gram-negative bacteria, but it is too toxic for systemic use. It is used mainly as an
ointment or cream (0.5%), often with an anti-inflammatory steroid, in infected skin conditions. It is also used locally for ear and eye infections as drops (0.5%), and it is occasionally given orally in doses of 6 g daily before bowel surgery. Extended local use may cause allergic reactions, and occasionally ototoxicity. (Mycifradin; Nivemycin).
73
naproxen A widely used non-steroidal anti-inflammatory agent (NSAID) for the relief of rheumatic and musculoskeletal
disorders and acute gout.
Dose: 10-1 g daily, increased up to 2g daily in severe conditions. Suppositories of 500 ing are useful at night to reduce morning stiffness. Side-effects include headache, dizziness, and dyspepsia with occasional bleeding. Blurred vision may also occur, as well as I p hy ersensitivity reactions such as rash and bronchospasm. Care is necessary in renal and hepatic impairment; peptic ulcer is a contraindication. (Naprosyn; Syntlex). See page 165 and Table 29.
naratriptanVA serotonin (5-H’I',) receptor agonist for the treatment of acute migraine. Dose: 2.5 mg. A second dose may be given after at least 4 hours if the symptoms recur. (Nararnig). See page 154 and Table 23.
nedocromil An inhibitor of the release of inflammatory mediators in the respiratory tract. It is used like sodium cromoglycate in
neostigmine An inhibitor of cholinesterase which thus indirectly prolongs the action of acetylcholine released at nerve endings. It is used mainly in the treatment of myasthenia gravis.
Dose: 75-300 mg daily; 1-23 mg by injection. Side-effects are nausea, salivation, diarrhoea and abdominal cramp, and supplementary treatment with an anticholinergic drug may be required. It is also used postoperatively to antagonize the residual effects of muscle relaxants. Dose: 1-5 mg i.v., after a preliminary iniection of 0.3-1 nig of atropine. It is contraindicated in urinary or intestinal obstruction. (Prostiginio).
netilmidn An aminoglycoside antibiotic, less toxic than related drugs. Used mainly in severe infections of the urinary and respiratory tracts that are resistant to gentamicin. Dose: 4-6 mg1kg daily by i.v. injection; in urinary tract infections a single oral daily dose of 150 mg is given for 5 days. Side-’ effects are dizziness, vertigo, malaise and rash; ototoxicity may also occur. (Netillin).

neuromuscular blocking agents Drugs used to induce adequate muscle relaxation under a light plane of anaesthesia to facilitate surgery. The non-depolarizing agents such as vercuronium compete with acetylcholine at the neuromuscular receptor site, and have a relatively long action that can be reversed by neostigmine. The depolarizing relaxants, such as suxamethonium, have an acetylcholine-like action oil the receptor site, but as they are broken down less rapidly than acetylcholine, they delay the return of the ability of the muscle to contract again. The action of suxamethonium cannot be reversed by neostigmine.
niacin See nicotinic acid.
nicardipine A calcium channel blocking agent with it coronary vasodilator action similar to that ofverapaiiiii, but with reduced anti-arrhythmic activity. It is used mainly in angina and hypertension, and unlike verapamil it may be given to patients already receiving beta-blockers. Dose: 60-120 ing daily. Side-effects arc dizziness, flushing, nausea and palpita-
tions. If chest pain occurs early, the drugshould be withdrawn. Marked aortic
stenosis is a contraindication. (Cardene). See page I H and ‘]’able 4.
niclosamide A synthetic anthelmintic of value in the elimination of tapeworm. Dose: after lasting 2 g followed 2 hours later by a purge. The tablets should be chewed or crushed, and taken with a glass of water. Side-effects are nausea and abdominal pain, and occasionally pruritus. (Yoniesan).
nicorandil A cardiac drug that has an action mediated by the activation of potassium channels. It reduces the excitability of cardiac muscle and promotes coronary circulation, and is used in the prophylaxis and treatment of angina.
Dose: 5 10ing twice daily initially, rising to a maxintuin of6onig daily. Side-effects are initial headache, palpitations, dizziness. (lkorel). See page 114 and Table 4.
nicotinarnide A compound derived from nicotinic acid, possessing similar properties, but differing in that it has little vasodilator action. It is useful in
deficiency states as well as in pellagra when the vasodilator action of nicotinic
acid limits the dose. It is also used locally as a 4% gel (Papulex) for the treatment of inflammatory acne vulgaris.
nicotinic acid An essential food factor, occurring in yeast, liver, etc., but now prepared synthetically. It is a specific in the treatment of pellagra. It causes vasodilation, and has been used in Wni&e’s disease and chilblains, but with variable results. In large doses it reduces the plasma levels of some lipoproteins. Dose: 10-30 mg daily for prophylaxis; therapeutic dose in pellagra, 250-500 mg daily. In hyperlipidacinia up to 6 g daily have been given. Side-effects include flushing, dizziness and pruritus, which may sometimes lie reduced by taking aspirin 75 mg half an hour before a dose. See page 146,
nicotinyl alcohol A derivative with the vasodilator properties of nicotinic acid, but they are less intense. Useful in peripheral circulatory disturbances such as Raynaud’s disease and acrocyanosis. Dose: 100-200 mg daily. (Ronicol).
nicournalone A synthetic anti-coagulant similar to warfarin, and used mainly in the treatment of deep-vein thrombosis. Dose: 8-12 ing initially; subsequent doses are based on the response, as shown by determination of the blood prothrombin time, expressed as the International Normalized Ratio (INR). Haemorrhage is a potential side-effect. (Sinthrome).
nifedipine A calcium channel blocking agent similar to verapamil, but with a more powerful peripheral and coronary vasodilator action. It is used in the treatment of angina, hypertension and Raynatid’s disease, and may be given if required in association with a beta-blocking agent.
Dose: in angina, 15-60 mg daily; in hypertension 40-80 mg daily. Side-effects are flushing and headache, which are usually transient, and some ankle oedema may occur. It should be withdrawn if anginal pain develops. Severe aortic stenosis is a contraindication. (Adalat• Coracten; Nifensar). See pages 114 & 148, and “fables 4 & 21.
nimodipine A calcium channel blocking agent that acts preferentially on the cerebral vessels. It is used in subarachnoid haemorrhage to prevent ischaemic sequelae.

flumazenil A benzodiazepine antagonist used in anaesthesia to reverse the sedative effects of benzodiazepines.
Dose: 200µg initially by i.v. injection, with subsequent doses of 100 pg at I -minute intervals, up to a maximum of I mg. Further doses may be given by i.v. infusion if drowsiness returns, as the action of flumazenil is brief. ( Anexate).
flunisolide A potent corticosteroid used locally in the more severe forms of hay fever and other nasal allergies.
Dose: 1)), nasal inhalation, 50pg (2 sprays), 2 or 3 times a day, continued for 2-3 weeks, or longer if required. (Syntaris).
flunitrazepam A benzodiazepine with a hypnotic action used for the short-term treatment of insomnia.
Dose: 0.5-2 nig. Side-effects include drowsiness, ataxia and visual disturbances. (Rohypnol). See page 152 and Table 22.
fluocinolone A topically active potent corticosteroid. Used as cream, ointment or gel (0.00625-0.025%) in severe, inflamed, corticosteroid-responsive skin disorders. Excessive application should be avoided. (Synalar).
fluocino”ide A potent locally effective anti-inflammatory steroid similar to fluocinolone, used as cream, ointment or lotion (0.05%). (Metosyn).
fluocortolone A locally acting corticosteroid used as cream or ointment (0.25%) in severe, inflamed skin conditions. (Ultralanum).
fluorouracil A cytotoxic agent used in the palliative treatment of carcinoma of the breast and gastrointestinal tract and other solid tumours.
Dose: 15 ingft orally or by i.v. infusion weekly, up to a total dose of 12-25 g. Side-effects include alopecia and dermatitis, but haeniatotoxicity, severe gastrointestinal disturbance and haemorrhage may limit treatment. Fluorouracil is used locally as a 5% cream (Efudix) in malignant skin lesions.
fluoxetine An antidepressant that acts by selectively inhibiting the uptake of serotonin. Given in single daily doses of 20 mg. Dose: 60 mg daily are given in bulimia nervosa. Side-effects are gastrointestinal disturbances, dizziness and anorexia; rash is an indication of withdrawal. It should not be used with other drugs that influence serotonin uptake. (Prozac). See page 128 and Table 11.
flupenthixol A tranquillizer similar to fluphenazine and used in the treatment of schizophrenia with apathy and withdrawal. It also has an antidepressant action.
Dose: 6-18 ing daily initially, with subsequent adjustment according to need. It may cause some restlessness and insomnia. Dose by deep i.m. injection, 20-40 mg every 2-4 weeks. Dose in depression: 500 pg 31ngdaily.The side-effects are similar to those of chlorpromazine. (Depixol; Fluanoxol). See page 168 and Table 30.
fluphenazine An antipsychotic drug with the actions and uses of chlorpromazine, but with reduced sedative and anticholinergic side-effects, although extra-pyramidal symptoms may be increased. Dose: 2- 10 mg initially in schizophrenia adjusted up to 20 ing daily. In severe anxiety states 1-4 mg. For depot treatment, 12.5-100 ntg of the decanoate by deep i.m. injection every 12-14 days according to response. (Modecate; Moditen). See page 168 and Table 30.
fluorescein An orange-red dye; solutions have a strong green fluorescence. Used as eye drops (1-2%) for detecting corneal lesions, as areas of cornea denuded of epithelium stain green.
fluorometholone A corticosteroid used as eye drops (0.10%) for inflammatory conditions of the eye. (FML).
flurandrenolone A potent locally acting corticosteroid used as a cream or ointment (0.0125%) in severe skin disorders not responding to other therapy. (Haelan). An adhesive tape is used for small resistant dermatoses.
flurazepam A benzodiazepine hypnotic for
the short-term treatment of insomnia.

flurbiprofen A non-steroid anti-inflammatory drug with the actions, uses and side-effects of naproxen. It is used in the relief of pain and inflammation in rheumatoid and arthritic conditions, and in other
nitisculoskeletal disorders.
Dose: 150 mg daily, after food, increased tip to 300 mg daily if necessary. Suppositories of 100 nig are available. Care is necessary in peptic ulcer and in aspirin-sensitive asthmatic patients. (Froben). See page 165 and’I'able 29.
flutamide An androgen blocking agent that inhibits the action of androgens on target organs. It is used in advanced prostatic cancer not responding to other drugs, usually in association with goserelin or related agents.
Dose: 750 mg daily. Side-effects include gynacconiastia, and liver function should be checked. (Drogenil). See page 122 and Table 8.
folic acid A constituent of the vitamin B group. It is essential for cell division and the growth and development of normal red blood cells. The main therapeutic use is in the treatment of megaloblastic anaemias due to folic acid deficiency. Dose: 5 ing daily for 4 months initially;
ing weekly may be adequate after the haematological response has been obtained. Sometimes given with anti-epileptic drugs, as long-term therapy may cause a folic acid deficiency. Small doses are present in many iron preparations to prevent the inegaloblastic anaemia that may occur in later stages of pregnancy. It must not be used alone in pernicious anaemia, as it cannot prevent the degeneration of the central nervous system associated with that disease.
folinic acid A methotrexate antidote. It is given ai the end of a course of methotrexate to reduce the toxic effects on normal cells and in methotrexate-overdose. Dose: up to 120 mg over 24 hours by i.m. injection (or i.v.), with 60 mg orally for another 48-72 hours.
49
fluticasone A corticosteroid of increased potency. Used as a metered dose pump for the prophylaxis and treatment of seasonal allergic rhinitis and hay fever.
Dose: 100 pg (2 sprays) into each nostril mice a day in the morning. Maximum reliefmay not be obtained for 3-4 days. Systemic absorption extremely low. (Nixonaw.
fluvastatinV An inhibitor of the enzyme I I N46-CoA-reductase used in the treatment of hyperlipidaemia.
Dose: 20-40 ing daily in the evening. (Lescol). See page 146,’I'able 20 and atorvastatin, provastatin and ‘inivastatin.
fluvoxamine An antidepressant that acts by inhibiting the central re-uptake of serotonin. It is used mainly for maintenance treatment during depressive illness. Dose: 100-300 mg, daily in the evening; a steady plasma level is normally reached within 10-14 days. Side-effects after initial nausea may include somnolence, constipation and agitation. It should not be used with other drugs that increase scrotonin uptake, or with aminophylline or theophylline. (Faverin). See page 128 and Table 11.
follitropin A recombinant form of the follicle stimulating hormone used in some forms of infertility. It is given by injection in doses dependent on the degree of ovarian response. (Puregon).
formaldehyde A powerful but toxic germicide used mainly in the disinfection of rooms, and as’formalsaline’ (5% in normal saline) for the preservation of pathological specimens. Warts have been treated with a 3% solution.
formestane An inhibitor of aromatase, the enzyme that converts androgens to oestrogens. It is used in advanced postmenopausal breast cancer, as it has a cytotoxic action mediated by causing an oestrogen deficiency state.
Dose: 250 mg by deep intragluteal injection at intervals of 2 weeks, with variations of the injection site. Side-effect are rash, pruritus and occasional vaginal bleeding. Mentaron). See page 122 and Table 8.
foscarnet An antiviral agent for the treatment of sight-damaging cytomegalovirus retinitis in AIDS patients as an alternative to ganciclovir.
Dose: 60 mg/kg daily by i.v. infusion for 2-3 weeks, with subsequent infusion at a rate dependent on renal function. (Foscavir). See page 144 and,ribic ig.
fosfestrol A water-soluble derivative of stilboestrol. It is metabolized by the enzyme acid phosphatase to liberate stilboestrol in tissues rich in that enzyme, and so it is of value in prostatic carcinoma.
Dose: 1)), slow i.v. injection, 600-1200 rni, daily for 5 days or more. Oral maintenance dose: 120-360 nig daily. perinea) pain is a side-effect. (I lonvan). See page 122 and Table 8.
fosfomycin A phosphorus-containing antibiotic used mainly for infections of the lower urinary tract.
Dose: 3 g nightly after voiding the
bladder. Also used prophylactically before prostatectomy. Rash, nausea and diarrhoea are side-effects. (Monuril).
fosinopril An ACE inhibitor indicated in hypertension when standard therapy is ineffective or unsuitable.
Dose: 10 mg daily initially, adjusted after •1 weeks up to 40 nig according to need. It is eliminated by the liver as well as the kidneys, and may have some advantages in renal impairment. (Staril). See ACE inhibitors, page 148 and Table 21.
framycetin An antibiotic resembling neomycin in general properties. Used in eye infections as drops or ointment 0.5%. (Soframycin).
friar’s balsam Contains benzoin, storax, aloes, balsam of tolu. Official name Compound Tincture of Benzoin. See benzoin.
frusemide A loop diuretic with a powerful and intense action of short duration. Often effective in conditions no longer responding to thiazide diuretics.
Dose: 20-40 mg daily or on alternate days, or 20-50 mg i.ma or i.v. Much larger oral doses, varying front 250 nie, up to a single maximum dose of 2g may be required in renal failure and oliguria. Side-effects include nausea, diarrhoea and cramp. Masix). See page 141 and’Fable 18.
fusidic acid See sodium fusidate.
gabapentin An anticonvulsant used in the L11111101 of the partial seizures of epilepsy, although the mode of action is not yet clear. Dose: 300 mg initially, slowly increased to 1.2 g daily according to need. Drowsiness, tremor and weight gain are some side-effects. Withdrawal is with slowly reduced doses over 2-3 weeks. (Neurontin). See page 136 and Table I5.
gallamine A synthetic non-depolarizing (competitive) muscle relaxant.
Dose: 80-120 mg initially i.v. with small subsequent doses according to need and response. The action of the drug may be terminated by the injection of neostigmine, 2.5-5 mg, together with atropine, 0.5-1 mg. (Flaxedil). Now used less frequently as tachycardia is a side-effect.
gamolinic acid A derivative of linoleic acid present in evening primrose oil. It is said to be of value in atopic eczema.
Dose: 320-480 mg daily. It is also used in mastalgia (breast pain) in doses of
240-320 mg daily, but the response is slow (8-12 weeks). (Epogam; Ffarnast).
gammaglobulin See immunoglobulin.
ganciclovir An antiviral agent similar to aciclovir, but more toxic. It is used only in sight- and life- threatening infections with cytomegalovirus (CMV) in immunocompromised patients.
Dose: by i.v. infusion, 5 mg/kg every 12 hours for 14-21 days, with mainte nance (lose of 5 mg/kg daily. Later oral dose 3 g daily. The solution is very alkaline, and injection requires care. Regular blood counts are essential. (Cvnievene). See page 144 an(Frable 19.
G-CSF human urnan granulocyte colony stimulating factor. See filgrastim and lenograstim.
fusafungine An antibiotic with anti-inflammatory properties used for upper respiratory tract infections.
Dose: as aerosol spray 123 jig 5 boles  day. (Locabiotal).
Gee’s linctus A soothing cough linctus containing camphorated tincture of opium, oxymcl of squill and syrup of tolu.

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

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

cytarabine A cytotoxic agent that prevents cell development by inhibiting the formation of nucleic acid. It is used mainly in the control of acute mycloblastic leukaemia.
Dose: 0.5-3 mg/kg daily by i.v. or s.c. injection. Close haematological control is essential as the drug is a powerful myclodepressant. Other side-effects are those of the cytotoxic drugs, generally, but fever, myalgia and bone pain may also occur. Alexan; Cv cos: r).
Dose:    nig/kg, daily for 10 days, repeated after 4 weeks. Side-effects are severe nausea, bone marrow depression and an influenza-like syndrome. The drug should be handled with care, as it is a tissue irritant. (DTIC).
dactinomycin See actinomycin D.
dalteparin A low-molecular weight heparin given by s.c. injection for pre- and postoperative thrombo-embolic prophylaxis. Dose: 2500 units daily for 5 (lays. (Fragmin). See enoxaprin and tinzaparin.
cytotoxic drugs A term applied to drugs that can kill cancer cells. In practice, many factors influence their therapeutic value. They are rarely selective, and therapeutic doses usually have a toxic effect on sonic normal cells. They may attack cancer cells at different stages of development, as actively dividing cells are more susceptible than resting cells. They may not reach the cancer cells in adequate concentration, or resistance to the drug may develop. The dose may also depend to some extent on the patient’s tolerance of the drug, and combined treatment with two or more drugs may have the advantages of increased potency with reduced toxicity. All cytotoxic drugs, with the exception of bleomycin and vincristine, bring about a depression of the bone marrow, which may be severe, and some degree of hair loss, which is usually reversible. Severe nausea and vomiting are also common, and early use of powerful antiemetics is essential. Many cytotoxic agents are tissue irritants, and with i.v. treatment great care must be taken to avoid extravasation, as severe local tissue damage can occur. See alkylating agents and antimetabolites. See page 122.
clacarbazine A cytotoxic drug that appears to depress purine metabolism and the formation of DNA. It is used mainly in malignant melanoma, and in combination with other agents it is of value in other malignant conditions.
clanazol A derivative of ethisterone that inhibits the release of pituitary gonadotrophins. Used in conditions such as endometriosis and gynaecomastia. Dose: 200-800 ing daily, starting during menstruation. Side-effects are nausea, dizziness, rash, flushing and hair loss. Care is necessary in cardiac, renal or hepatic impairment, and in epilepsy and diabetes. (Danol).
danthron A synthetic anthraquinone laxative used mainly for constipation in the aged, and in drug-induced constipation in the terminally ill. Not suitable for routine use by other patients.
Dose: given in doses of 25–25 mg as codanthramer, and acts within 6-12 hours. the urine may be coloured red.
dantrolene A skeletal muscle relaxant that acts on the muscle fibre, and not at the myoneural junction. The action may be linked with an interference with the movement of calcium ions. It is used in the severe and chronic spastic states that occur after stroke, spinal cord injury, and in multiple sclerosis.
Dose: 21 ing daily initially, increased at weekly intervals up to a maximum of 400 mg daily, as the response is slow and May be inadequate. The side-effects of weakness and Gangue are mild, and often transient, but liver function tests during treatment are essential. Dantrolene is also of value in malignant hyperthermia, a rare but serious complication of anaesthesia, and is given in doses of I mg/kg by i.v. injection as soon as the condition is diagnosed,

dapsone A sulphone compound used in the ti,atnient of leprosy.
Dose: 25-400 mg orally twice weekly and continued for some years. Resistance to dapsone may occur, and combined treatment with clofazimitic and rifarnpicin may lie necessary. Dapsone is sometimes given with pyrimetharnine in chlotoquine-resistaut malaria. Side-effects are nausea, rash, neuropathy and myelodepression.
duration of action. Used in the diagnosis and control of diabetes insipidus, and in the treatment of nocturnal eneuresis. Dose: 10-20pg intranasally once or twice
a day; 1-4 pg daily by injection. IMAM.
desoxymethasone A corticosteroid, for local application in acute inflammatory and allergic skin conditions. Used as oily cream 0.25%. (Stiedex).
daunorubicin See doxorubicin.
debrisoquine An adrenergic neurone blocking agent with the actions, uses and side-effects of guanethidine, except that it is less likely to cause diarrhoea. It is used mainly in resistant hypertension, in association with other drugs. (Declinax).
See page 148 and Table 21.
deflazacort A glucocorticoid with the actions and uses of related drugs, and comparable in activity with prednisolone. Dose: initially in acute conditions up to 120 mg daily; maintenance dose 3-18 mg daily. (Calcort). See hydrocortisone, page 55 and Table 36.
demeclocycline An antibiotic with the actions, uses and side-effects of tetracycline, but more likely to cause photo-allergic reactions.
Dose: 600 mg daily. Used occasionally in hyponatraemia due to overactivity of the antidiuretic hormone. (Ledermycin).
desferrioxamine A chelating agent that combines with iron salts to form a soluble non-toxic complex. Of great value in acute ferrous sulphate poisoning in children. Dose: 2 g immediately by i.m. injection, together with gastric lavage (2 g of desferrioxamine/1) followed by a single oral dose of 10 g. It may also be given by continuous i.v. infusion, 15 mg/kg hourly up to a maximum of 80 mg/kg. It may cause hypotension if the infusion is given too rapidly. It is also useful in the treatment of iron-overload caused by repeated blood transfusions, and for aluminium overload in patients On dialysis. (Desferal).
desflurane An inhalation anaesthetic
similar to CuflUrane. (Suprane).
desmopressin A derivative of vasopressin, with increased potency and longer
dexamethasone A potent synthetic corticosteroid, with reduced salt-retaining properties. Useful in all conditions requiring systemic corticosteroid therapy (except Addison’s disease), including inflammatory and allergic disorders, shock, cerebral oedema and adrenal hyperplasia.
Dose: 0.5-2 mg daily up to a MaXiMUM Of’ 15 mg daily; in shock, 5-20 mg by slow i.v. injection or infusion; in cerebral oedema, 10 ing initially by i.v. injection, followed by 4 mg i.m. 6-hourly. Dexamethasone is also given by infra-articular injection for local inflammation of joints in doses of
0.4-4 mg. It is also used as eye drops (0.1%)
in uveitis, but care is necessary with prolonged treatment as with some patients a ’steroid glaucoma’ may be precipitated. (Decadron). See page M and Table 36.
dexamphetamine sulphate A central nervous system stimulant. It is used in the treatment of narcolepsy and, paradoxically, it is sometimes useful in hyperkinesia in children.
Dose: in narcolepsy, 20-60 mg daily; in hyperkinesia 2.5 mg initially, slowly increased up to a maximunl’of 20 mg daily. Side-effects are insomnia, anorexia and agitation. Dependence and tolerance may occur early. (Dexedrine).
dextran A blood-plasma substitute
obtained from sucrose solutions by bacterial action, and used as solutions of varying molecular weight (dextran 40, 70). Dextran 70 is used as a blood volume expander by i.v. injection in some cases of shock; dextran 40 is used mainly to improve postoperative peripheral circulation, reduce blood viscosity, and to prevent thrombo-embolism. Care must be taken to adjust dose to avoid overloading the circulation. Any blood-matching should be carried out before giving dextran. (Gentran; Macrodex; Rheomacroclex).

carbon dioxide A colourless, non-inflamniable gas. It has a stimulating effect on the respiratory centre, and a mixture of 5% of carbon dioxide in oxygen is used for respiratory depression. Solid carbon dioxide is used to destroy warts, naevi, etc.
carbonic anhydrase inhibitors These drugs, represented by acetazolamide and dichlorphenamide, have been used as diuretics as they inhibit the reabsorption of sodium and bicarbonate in the kidneys. Their use has declined as more effective diuretics have become available. They also reduce the formation of the aqueous humour and so bring about a reduction in the iruraticular pressure, and are used in the treatment of glaucoma. See page 138 and Table 16.
carboplatin An analogue of cisplatin but with generally reduced side-effects, although the myelodepression may be more severe. It is used mainly in ovarian and small-cell lung cancer.
Dose: 40 nighn’ i.v. as a single dose, repeated after 4 weeks. Blood tests during treatments are essential. Severe renal impairment is a contraindication. ( Pai aplatin). See page 122 and Table 8.
carboprost A prostaglandin with a selective action oil the myornetrium, and used in post-partum haemorrhage not responding to ergometrine.
Dose: 250 pg initially by deep i.m. injection, with subsequent doses according to need up to a total of 2 mg (not for i.v. injection). Care in asthma, epilepsy and hypertension. Nausea and vomiting are side effects. (Hemabate).
carisoprodol A muscle relaxant used in niusculoskeletal disorders and muscle spasm.
Dose: I g daily. (Carisomi).
carmustine A cytoxic agent similar to 1-viustine. It is used mainly in brain tumours, multiple myeloma and Hodgkin’s disease, often in association with other drugs.
Dose: 200 rnghii2 by slow i.v, injection, repeated at intervals of 6 weeks. Side-effects are nausea, vomiting and burning at the injection site. A delayed bone-marrow depression is often a dose-limiting factor. (BICNU). See page 122 and Table 8.
Cef
carteolof A beta-adrenaergic blocking agent used as eye drops (0.1-0.2%) in glaucoma. Some systemic absorption may occur from eye drops, and care is necessary in asthma and bradycardia. (Teoptic). See page 138.
carvedilol A non-cardiac selective betablocker with the actions and uses of propanolol.
Dose: in hypertension 12.5 mg initially, rising to 25-50 mg as a single daily dose. (hucardic). See page 148 and Table 21.
cascara A mild purgative.
Dose: dry extract 100-250 nig, liquid extract and elixir 2-5 nil.
castor oil A mild purgative.
Dose: 5-20 nil. The oil has emollient properties and is used together with zinc ointment for pressure sores and napkin rash.
catecholamines A term applied to the synipathornimetic drugs adrenaline, dopamine, noradrenaline, and related compounds, indicating that they are derivatives of catechol.
CCNU See lomustine.
cefaclor An orally active cephalosporin antibiotic used mainly in urinary and respiratory infections.
Dose: 750 ing or more, up to 4 g daily, with reduced doses in renal impairment. Nausea and diarrhoea are side-effects, but all allergic reaction indicating sensitivity may require withdrawal of the drug. (Distaclor). SeeTable 34,
cefadroxil An analogue of cephalexin. It is well absorbed orally and gives high blood levels.
Dose: 1-2 g daily, (Baran), See page 248 and Table 34.
cefatnandole See cephamandole.
cefixime A cephalosporin with the actions, uses and side-effects of the cephalosporins generally, but effective in single daily doses of 200-400 mg. (Suprax). See page 248 and Table 34.
cefodizine A cephalosporin used in lower respiratory tract infections and in urinary tract infections.
Dose: 2 g (laity by i.m. injection or i.v.

Cefotaxime A cephalosporin with an ink reased activity against many Gram-negative organisms.
Dose: 2 g daily by injection, increased in severe infections tip to 12 g daily. A single dose of 1 g is given in gonorrhoea. The side-effects are those of the cephalosporins generally. (Claforan). See page 248 and Table 34.
cefoxitin A cephaniycin with a wide range of activity and an increased potency against Gram-negative bacteria. It is of value in many infections, and is also used in surgical prophylaxis.
Dose: 3-12 g daily by Lin. or i.v. injection. (NIefoxin). See page 248 and Table 34.
cefp1ronve A beta -lactaniase- stable cephalosporin with a wide range of activity. Dose: 2 g daily i.v. (Cefrom). See
page 248 and Table 34.
cefuroxime A cephalosporin often effective against some organisms resistant to penicillin, and with increased activity
against Haemophilus inflidenzae.    27 Dose: 3-6 g daily by injection. For surgical prophylaxis and in gonorrhoea a single dose of 1.5 g. Side-effects include nausea, diarrhoea, urticaria, rash and hypersensitivity reactions. (Zinacef). cefuroxime-axetil is an orally active form. Dose: 500 mg- I g daily. (Zinnat). See page 248 and fable 34.
celiprolol A selective 0, receptor blocking agent, with some stimulating action oil receptors. The former occur mainly in the heart, the latter in the bronchi and peripheral vessels. It is used in mild hypertension, as it has a vasodilatory and cardioselective action with reduced side-effects.
Dose: 200 mg daily, at breakfast. Occasional side-effects are nausea, headache and dizziness. (Celectol). See page 148 and Table 21.
ceflaodoxime An oral cephalosporin for respiratory tract infections.
Dose: 200-400 mg daily with food. (Orelox). See page 248 and Table 34.
ceftazidime A cephalosporin resistant to most beta-lactamases, and active against a wide range of Gram-positive and Gram-negative organisms, including Pseudomonas aeruginosa, although it is less active against Staphylococcus aureus. Valuable in both single and mixed infections.
Dose: 1-6g daily by injection, reduced in cases of renal impairment. In pseudontonal lung infections associated with cystic fibrosis, 1(4-150nit
g/kg daily. Side-effects include abdominal disturbance and local reactions at the injection site. (FortUol; Ket”adirn). See page 248 and Table 34.
cettibuten An oral cephalosporin similar to cefaclor, but with a longer action. Dose: 400 nigas a single daily (lose. (Cedax t. See page 248 and Table 34.
ceftriaxone A cephalosporin of the cefaclor
Jtype given as a single daily dose of I g by eep i.m. or slow i.v. injection, doubled in severe infections. With high doses vary injection site. (Rocephin). See page 248 and Table 34.
cephalexin An orally active cephalosporin Of value in infections of the respiratory and urinary tracts, and in naso-oral and soft-tissue infections.
Dose: 1-2 g daily, but lower (loses are indicated in renal impairment. Cephalexin is usually well tolerated, but sonic gastrointestinal disturbances may occur. (Ceporex; Kellex). See page 248 and Table 34.
cephalosporins A group of antibiotics with properties similar to those of the penicillins, but having a wider range of activity. Some are active orally, others may have to be given by injection.
Cefotaxime, ceftazidime and ceftizoxime have an increased activity against Gram-negative bacteria, but are less potent against Staphylococcus aureus and Gram-positive organisms generally. Cefititoxin is active against bowel organisms. An indication of the range and dose is given in the table on page 248. The higher doses are given in severe infections; reduced doses should be given in renal impairment. The main side-effect of the cephalosporins is hypersensitivity, and cross- sensitivity to the penicillins is not uncommon. Sensitivity to one is likely to extend to all members of the group. The cephalosporins call affect blood-clotting mechanisms.

bendrofluazide A widely used diuretic of the thiazide group, with a powerful and prolonged action. It is used in congestive heart failure, oedema and mild hypertension. In more severe hypertension it is given together with other drugs to increase the overall response.
Dose: 2.5-10 ing daily. It causes some loss of potassium, so potassium supplements are required if treatment is prolonged. Side-CffeCtS include rash and thrombocytopenia. Renal failure is a contraindication. (Aprin= Neo-Naclex). See page 1,18 and fable 21.
benorylate A compound of aspirin and paracetamol, with the general properties of both drugs, but generally better tolerated than aspirin. Used in arthritic conditions and for the relief of painful musculoskeletal disorders.
Dose: 3-6 g daily. Like aspirin, it may cause gastrointestinal disturbances and increase the action of oral anticoagulants. (Benoral).
benperidol A tranquillizer of the haloperidol type with similar side-effects, but used to control antisocial sexual behaviour in adults.
Dose: 0.25-1.5ingdaily. (Anquil).
benserazide An enzyme inhibitor used with Ivvodopa in parkinsonism. It inhibits the breakdown of levodopa to dopamine, enabling large amounts to reach the brain, and so permits a reduction in dose and a smoother response. Some of the side-effects of levodopa, such as nausea and vomiting, may also be reduced, although the incidence of involuntary movements may increase.
Dose: 12.5 mg with 50 ing of levodopa. (N-ladopan). See page 160 and Table 26.
benzalkonium chloride A detergent with antiseptic properties present in various skin preparations. It is also used as a preservative in cyc drops.
benzhexol A spasmolytic drug used mainly to relieve the tremor and rigidity of parkinsonism.
Dose: I mg initially, slowly increased to 5-15 mg daily according to need. Side-effects include mouth dryness, dizziness and blurred vision. Care is necessary with high doses as some psychiatric disturbances may occur anti    withdrawal of the
drug, but abrupt discontinuance of treatment should be avoided. Benzhexol should be used with care in cases of glaucoma, hepatic and cardiac disease or urinary disturbances. (Arcane; Broflex). See
page 160 and Table 26.
benzocaine A local anaesthetic for topical .ipplication. Used as lozenges (100 mg) for painful oral conditions; ointment
(5- 1 0(y.); suppositories 200 mg.
benzodiazepines A widely used group of drugs with a powerful action on the central nervous system. ‘rhey appear to have a selective action on certain seroionin receptors. The type of action varies within the group, and they may be used as sedatives, hypnotics, anxiolytics, anticonvul&-ints or muscle relaxants. As hypnotics they have virtually replaced the barbiturates, as they have a wide margin of safety and are less dangerous in overdose. Prolonged use should he avoided as dependence remains a possibility. The withdrawal of treatment with benzodiazepines should be gradual, as otherwise confusion, convulsions and toxic psychoses may occur. Nitrazepam has a relatively long action as a hypnotic, whereas flunitrazepam has a shorter action. Diazepam is the preferred drug for controlling the spasms of tetanus. Hypnotic pnotic benzodiazepines include flunitrazepam, flurazepam, loprazolam, lormetazepam, nitrazeparnand temazepam.Those used as anxiolytics are alprazolam, bromazepam, chlordiazepoxide, clobazam, clorampate, diazepam, ketazolam, lorazepam, medazepam and oxazepam. Most of these diazepines are referred to briefly under the above names. See page 117 and,rable 5.
benzoic acid It has fungistatic properties similar to salicylic acid, and has been used as Whitfield’s ointment (Compound Benzoic Acid Ointment) for the treatment of ringworm.
bemoan A balsamic resin used mainly as Compound Tincture of Bemoan for pressure sores and stoma care.
benzoyl peroxide An antifungal agent used locally for superficial fungal infections. It is also used, together with sulphur, as a cream or gel for acne.
benzthiazide A thiazide diuretic present with trianiterene in Dytide.

benztropine An anticholinergic drug, used to relieve the rigidity, tremor and salivation of Parkinson’s disease. It also has some sedative action, and in some cases may be preferred to benzhexol. Like benzhexol, it is sometimes useful in the control of drug-induced extrapyramidal svillptoms.
Dose: 0.5-6 mg daily. In severe conditions, it may be given by injection of
1-2 mg, repeated according to response. The side-effects are those of the anticholinergic drugs generally. (Cogentin). See page 160 and Table 26.
benzydamine A mild analgesic used as a mouthwash (0.15%) for painful conditions of the mouth and throat, and as a cream (31YO for musculoskeletal pain.
benzyl benzoate A clear liquid with an aromatic odour. It is used as an emulsion in the treatment of scabies by two applications to the whole of the body except the head.
benzyl penicillin See penicillin.
beta-Mockers in cardiac failure, heart block and bradycardia. See pages 114 & 148, and Tables 4 & 21.
betahistine A vasodilator with some of the properties of histamine. Used to reduce the vertigo of N!6ni&e’s disease. Should be used with care in asthmatics and in peptic ulcer.
Dose: 16-48 ing daily. (Sere).
betarnethasone A corticosteroid characterized by its low dose, increased anti-inflammatory action, and reduced side-effects. It has virtually no salt-retaining properties, and causes little increase in the urinary excretion of potassium. It is indicated in all inflammatory, allergic and other conditions requiring corticosteroid therapy - with the exception of Addison’s disease and after adrenalectomy when a salt-retaining steroid is required.
Dose: 0.5-5 mg daily; in cerebral oedema, 5 20 mg by Lin. or i.v. injection. In asthmatic states, oral aerosol inhalation of M)pg (eight puffs) daily; for inflaninialory conditions of the eye, car and nose, a 0, PN, solution is used locally. (Belnesol).
beractant A pulmonary surfactant used in the respiratory distress syndrome of premature infants, by endotracheal tubing within 8 hours of birth. Monitor heart rate and arterial oxygenation. (Survanta). See also colfesceril, poractant and pumactant.
beta-adrenoceptor blocking agents Adrenaline and related catecholamines are released into the circulation during exercise and stress, and stimulate cardiac output by acting oil the beta-adrenoceptor sites in the heart. When such stimulation is excessive the increased oxygen demand of the heart may cause myocardial insufficiency and angina. Drugs such as propranolol block these receptor sites and so indirectly reduce cardiac stimulation, and are of value in the control of angina, cardiac arrhythmias and hypertension. Some blocking agents also act on other receptor sites and may cause bronchospasm by releasing histamine. Newer drugs, represented by acebutolol and nicroprolol, are more cardioselective, and others such as sotalol are of more value in hypertension. Sonic of these blocking agents,such as atenolol, are less likely to reach the central nervous system and so may cause fewer sleep disturbances. By their nature and depressant action on the myocardium, care is necessary when giving
betaxolol A beta-adrenoceptor blocking agent of the propranolol type, with similar properties and side-effects, but with a more cardioselective action. It is used mainly in the treatment of hypertension. Dose: 20 mg once daily. Betaxolol is also used as eye drops (0.5%) in ocular hypertension and glaucoma. (Betoptic-, Kerlone). See page 148 and Table 21.
bethanechol A parasympathominictic agent used in reflex oesophagitis, paralytic ileus and postoperative urinary retention. Dose: 30-120 mg daily before food. Side-effects are nausea, bradycardia and colic. Care is necessary in asthma and cardiovasculardiscase. (Myotoninc).
bethanidine A blocking agent that has an anfihypcttcnsivc action by inhibiting the release of noradrenaline from post-ganglionic adrenergic nerve endings. It is useful in resistant hypertension, and when other agents are not well tolerated, and is usually given in association with a thiazide diuretic or a beta-Mocker.
Dose: 20-200 ing daily. Postural hypotension, nasal congestion and diarrhoea are side-effects. (Bendogen).

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

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