Posts Tagged ‘release’

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

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

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

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

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

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

Generic Name
Carbamazepine (car-bam-A-zuh-pene)
Brand Names
Atretol    Tegretol
Carbatrol    Tegretol-XR
Epitol    Teril Equetro
Type of Drug
Anticonvulsant.
Prescribed For
Seizure disorders as well as other neuralgias; also  severe pain; psychiatric disorders including depression, bipolar disorder, intermittent explosive disorder, borderline personality disorder, post-traumatic stress disorder, psychotic disorders, and schizophrenia; withdrawal from alcohol, cocaine, or benzodiazepine-type drugs; restless leg syndrome; hereditary and non-hereditary chorea in children; and diabetes insipidus.
General Information
Carbamazepine was first approved for relief of the severe pain of trigeminal neuralgia. Over the years, it has gained wide use in seizure control, especially in people whose seizures are uncontrolled with phenytoin, phenobarbital, or primidone, or who have suffered severe side effects from these drugs. Carbamazepine is not a simple pain reliever and should not be taken for everyday aches and pains. It is associated with potentially fatal side effects.
Cautions and Warnings
Carbamazepine should not be used if you are allergic or sensitive to any of its ingredients or to any tricyclic antidepressant.
Carbamazepine should not be used if you have had bone marrow depression.
Carbamazepine may cause severe, possibly life-threatening blood reactions. People who have had blood reactions to other drugs are at particular risk for another reaction with carbarnazepine. Your doctor should have a complete blood count done before you start taking this drug and repeat these tests weekly during the first 3 months of treatment, and then every month for the next 2-3 years. Unexplained fever or infection may be a sign of a blood reaction.
Monoamine oxidase inhibitor (MA01) antidepressants should be discontinued 2 weeks before starting carbamazepine.
Rarely, severe, possibly fatal skin reactions can develop in a few people taking carbamazepine. Asians are 10 times more likely to develop these reactions than non-Asians.
Carbamazepine may aggravate glaucoma and should be used with caution by people with this condition. This drug may activate underlying psychosis, and, in older adults, confusion or agitation.
This drug is not for the relief of minor aches or pains.
Possible Side Effects
V Most common: dizziness, drowsiness, unsteadiness, nausea, and vomiting. Other common side effects are blurred W double vision, confusion, hostility, headache, and severe water retention.
♦ Less common: mood and behavioral changes, especially in children. Hives, itching, rash, and other allergic reactions may also occur.
your breathing, speech,function, and many
Drug Interactions
•    Carbamazepine blood levels may be increased by azoles (e.g. ketoconazole), acetazolamide, cimetidine, dalfopristin, danazol, delavirdine, diltiazem, haloperidol, isoniazid, propoxyphene, erythromycin-type antibiotics (except azithromycin), fluoxetine, fluvoxamine, loratadine, levetiracetam, macrolides, MAOls, nefazodone, niacinamide, nicotinamide, protease inhibitors, quinine, quinupristin, terfenadine, tricyclic antidepressants, valproate, verapamil, or zileuton, leading to possible carbamazepine toxicity.
•    Carbamazepine may reduce the effectiveness of contraceptive drugs and cause breakthrough bleeding.
•    Charcoal tablets or powder, clozapine, methsuximide phenobarbital and other barbiturates, phenytoin, primidone and theophylline may decrease the absorption of carbamazepine. Levels of phenobarbital, a breakdown product of primidone, may be increased by combining primidone and carbamazepine.
•    Carbamazepine reduces the effects of acetaminophen, the anticoagulant (blood thinner) warfarin, and theophylline (prescribed for asthma). Increased dosage of these drugs may be necessary. Other drugs counteracted by carbamazepine are antipsychotics (e.g. aripiprazole, clozapine, olanzapine, quetiapine, risperidone, and ziprasidone), benzodiazepines (e.g. diazepam and lorazepam), bupropion, cyclosporine, digitalis drugs, doxycycline, felodipine, lamotrigine, levothyroxine, methadone, mirtazapine, certain muscle relaxants, oxcarbazepine,  slatin drugs, tiagibine, topiramate, tramadol, and zonisamide.
•    Combining carbamazepine and other antiseizure drugs, including felbamate, hydantoins, succinimides, and valproic acid, may cause unpredictable results. Combination treatments to control seizures must be customized to each person.
Possible Side Effects (continued)
♦ Rare: Rare side effects can affect
liver function, urinary    other
parts of the body. Contact you    you any side effect not listed above.
•    Combining carbamazepine and lithium may increase nervous system side effectssuch as muscular twitching or im-
paired consciousness.
•    Carbamazepine suspension should not be combined with
other liquid medicines or diluents.
Food Interactions
Take carbamazepine with food if it causes stomach upset. Avoid taking carbamazepine with grapefruit products.
Usual Dose
Adult and Child (age 13 and over): 400-1200 mg a day, depending on the condition. Usual maintenance dose is 400-800 mg a day in 2 divided doses.
Child (age 6-12): 200-1000 mg a day, or 22-24 mg per lb. of body weight 2-3 times a day for suspension or 4 times a day for tablets. Do not exceed 1000 mg a day.
Child (under age 6): 22-24 mg per lb. of body weight 2-3 times a day for suspension or 4 times a day for tablets; dosage should not exceed 77 mg per 1b. of body weight a day.
Dosage varies according to form. Liquid carbamazepine must be taken 3 times a day, regular carbamazepine tablets twice a day, and sustained-release tablets once daily. Never change your dosage schedule without first checking with your doctor.
Overdosage
Carbamazepine is a potentially lethal drug. Overdose symptoms appear in 1-3 hours. These include irregularity or difficulty in breathing, rapid heartbeat, changes in blood pressure, shock, loss of consciousness or coma, convulsions, muscle twitching, restlessness, uncontrolled body movements, drooping eyelids, psychotic mood changes, nausea, vomiting, and reduced urination. Induce vomiting right away with ipecac syrup—available at any pharmacy. Then take the victim to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Mormation
Carbamazepine may cause dizziness and drowsiness. Take care while driving or doing any task that requires concentration.
Call your doctor at once if you experience yellowing of the skin or whites of the eyes, unusual bleeding or bruising, abdominal pain, pale stools, dark urine, impotence, mood changes, nervous system symptoms, swelling, fever, chills, sore throat, or mouth sores. These may be signs of a potentially fatal drug reaction.
If you forget a dose, skip it and go back to your regular schedule. it you miss more than I dose in a day, call your doctor. Do not stop taking this drug without first consulting your doctor.
Special Populations
Pregnancy/Breast-feeding: Carbamazepine caused birth defects in animal studies. Seizure disorder itself also increases the risk of birth defects. Pregnant women should take carbamazepine only after discussing with their doctors its potential benefits and risks.
Carbamazepine passes into breast milk. Nursing mothers who must take carbamazepine should use infant formula.
Seniors: Seniors taking this drug are more likely to develop heart Problems, confusion, or agitation.

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).