Posts Tagged ‘oral therapy’

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.

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

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

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

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

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