Posts Tagged ‘rheumatoid’

Over-the-Counter Remedies Vitamin E
Vitamin E, once considered a potential super-nutrient, has fallen out of favor as a preventive for heart disease or cancer viagra comercial with vcr . But back when it still looked ever so promising, a group of Italian dermatologists conducted a study to see if vitamin E could improve symptoms of eczema ecstacy lexapro . 295 It was single-blind; that is, the patients did not know who was getting the active treatment, but the doctors did sources side effects zoloft . The patients ranged in age Vita
This fat-soluble vitamin has been disappointing in studies of cancer or heart disease prevention stopped procardia labor . The natural form of vitamin E used in this study (alpha-tocopherol at 400 IU daily) was surprisingly effective in reducing the lesions and itching of eczema ibuprofen urticaria .
Side effects: Minor digestive upset is possible, but unlikely prescription plans that will cover valtrex . Downside: There has been only one study of this therapy for eczema biaxin pack description . Although vitamin E is inexpensive and relatively nontoxic, more studies to substantiate the benefit would be desirable does lipitor cause skin rash .
Cost: Approximately $3 to $8 a month
from 10 to 60 years old, and all had itching that had not been well controlled by their previous therapies how does naproxen sodium work .
The study lasted 8 months, and over the course of that time, the skin of fewer than 10 percent of the people taking vitamin E (400 IU daily) got worse pseudoephedrine hci 60mg . The skin of more than three-fourths of those on placebo had worsened antabuse breath odor . Conversely, almost half of the patients on vitamin E had excellent improvement, compared to only 1 (of 46) of those on placebo baby cannot keep prednisolone down . The investigators noted that the patients who had good results clinically also had marked reduction in the IgE levels that indicate allergic arousal of the immune system wat is lithium . They concluded that vitamin E might prove to be an excellent therapy for atopic dermatitis sie affects of drug diovan . Unfortunately, there are no other studies to confirm or refute these findings de effects of norvasc .
Topical Creams
Over the years, we have learned of a number of surprising remedies for itchy eczema facts and comparison of zyrtec . One is the old-fashioned moisturizing cleanser Noxzema west palm beach lasix center . Many people have written to say they had success easing the itching and even clearing up the rash after applying Noxzema to their eczema cellcept batten disease . Of course, nothing works for eczema all the time separating codeine from promethazine . But Noxzema is relatively low risk remeron tab . We suspect the herbal oils it contains may contribute to its effect clinical trial exelon . According to the manufacturer, camphor, menthol, and eucalyptus have given Noxzema “its redolent signature since 1914 buy accutane online .”
O fosinopril sodiun . I just had to let you know the success I’ve had with your suggestion to use Noxzema for eczema will lasix help with blood test . My 3year-old son has suffered with this skin condition on his legs and feet for 2 years caffeine gum addiction .
We treated it successfully with the prescription drug Elidel, but after learning of safety concerns, we checked with his doctor and stopped using it metronidazole for catas .
I tried many moisturizing creams to soothe his skin, but he cried and said they hurt levothyroxine purchasing . I started using Noxzema the day I read your article, and there were no tears 5 how sildenafil works .
His skin responded quickly and after 3 weeks almost aft traces of eczema are gone viagra vs kamagra . This advice has changed my young son’s life clozapine adverse event reporting post marketing .
A zoloft memory loss . We are certainly pleased to learn of your success toradol breastfeeding side effects . Lore has it that the name Noxzema was given after the product helped an early customer “knock” her eczema wellbutrin anger .
• 0 •
The mainstay of eczema treatment is a topical corticosteroid order tadalafil no prescription . In most cases, the doctor will prescribe a mild cream for
*** Noxzema
The brand now includes a number of different cleansers, but the one you want is the original, in the blue jar viagra paperweight . Apply it to the affected areas like you would a moisturizing cream olmesartan medoxomil . The herbal ingredients, camphor, menthol, and eucalyptus, may be helpful against itch, and the base cream is a good moisturizer allergic reaction to levaquin levaquin medication .
Side effects: Uncommon mucinex with clonidine . Discontinue use if it irritates the skin evista comprimidos .
Downside: There’s no scientific proof that this product will help eczema buy clonidine without prescription .
Cost: Approximately $4 to $6 for 14 ounces
Topical Hydrocortisone I Percent
Topical corticosteroid lotions, creams, and ointments are the mainstay of eczema treatment any difference between methocarbamol flexeril . This is the one that is available without a prescription, because it is less potent than prescription products carisoprodol china production . clozapine vs clozaril . It probably will help mild eczema sertraline hcl 100mg side effects . It may not be strong enough for moderate or severe conditions tetracycline 500mg strength .
The best way to use thislotion or cream is to apply it conscientiously for 3 to 7 days at a time rechargable aa lithium ion . Then take a break for several days amiodarone thyroid australia .
Side effects: Uncommon, but burning, itching, irritation, or dryness could occur where the product is applied does aygestin stop your period . Downside: Long-term use could lead to thinning of the skin novo levofloxacin side effects . This is a small -risk with the over-the-counter creams, but it should be kept in mind ibuprofen slow release r .
Cost: Approximately $3 to for a 1-ounce tube
use on the face and a more potent one for use elsewhere on the body carbatrol versus lamictal . Hydrocortisone 1 percent is available without a prescription and can be used for eczema cis diagnosis lipitor . We don’t suggest longterm use without checking in with the doctor, though lawsuits lithium heart failure valve damage . Even though the nonprescription cream is not very strong, it could still cause some thinning of the skin if it were used for many months flagyl use in cats .
Those who would prefer to avoid hydrocortisone cream may want to check out a product called CamoCare Soothing Cream order ivermectin merck online . It contains extract of chamomile flowers in an emollient base and has been helpful against eczema in one stud y gatifloxacin ophthalmic solution .296 Apparently, it has an effect comparable to low-dose hydrocortisone cream (0 effects side zyrtec .25 to 0 prednisone indications for use .5 percent), although it does not contain any steroid armada 4100 4200 lithium battery .
Another nonprescription ointment that has been put through a clinical trial is a homemade mixture of honey, beeswax, and olive Oil diamox hearing loss .297 This study was not as rigorous as we would like—not by a long shot how much caffeine in go fast . And honey, beeswax, and olive oil might just be too messy to be practical naltrexone and sertraline . But the Dubai dermatologist who ran the trial found that it had benefit for about 80 percent of the patients with eczema soma cruz genya arikado yaoi . That is almost the same as the percentage who respond well to topical steroid creams compazine box . So if you are in the mood for an experiment, get Soothing Cream
CamoCare his cream apparently was developed in Germany and is better known in Europe than in the United States natural sources of penicillin . German chamomile (Matricaria chamomille) contains an lithium grease plastic lubricant .oil called bisabolol that has been shown to have powerfulanti-inflam-matory action, comparable to that of the drug indomethacin imipramine 150 mg . That might explain its improvement of skin irritation drug recall china methotrexate .
Side effects: Some people are allergic to chamomile precose 50mg . Since individuals with atopic dermatitis may be especially susceptible to developing allergies, discontinue use immediately if the rash gets worse common side effects of paxil .
Downside: We know of only one study of CamoCare for eczema prevacid and children . In addition, it is relatively expensive is hydrochlorothiazide .
Cost: Approximately $10 to $14 for a 1-ounce tube lexapro withdrawal migrains .
out the blender and mix together equal amounts of honey, beeswax, and olive oil maximum dose topiramate 1600mg per day . Then see what it does for you psms and spironolactone . It should have no side effects, other than being sticky president ceo tricor systems inc . And it should not be overly expensive what is piroxicam .
Prescription Options
Doctors are most likely to prescribe some form of corticosteroid (cortisone-like) cream or ointment for eczema bipolar zyprexa . That’s because around 80 percent of patients with atopic dermatitis seem to respond well to these prescription creams pseudoephedrine extraction method . Fewer than 40 percent of those patients improve on a placebo cream or ointment 298 That’s why topical corticosteroids are so widely used avapro high blood pressure medicine .
If your doctor has given you a prescription fora corticosteroid, be sure to get the details on how to use it ivax pharm prozac . Using too strong a preparation on the face can have negative consequences zoloft theraputic level . The skin may become thin and tear or bruise easily, and blood vessels may become prominent guidelines for warfarin therapy . In fact, some people with eczema need two different formulations—a fairly strong one for hard-to-treat areas like the hands and a relatively mild one for eczema on the face fentanyl interaction with ultram . Keep in mind, too, that overuse of topical corticosteroids can thin the skin goldline enteric asprin 81mg .
People sometimes worry about steroid side effects from such creams jshua and abilify . It’s not impossible that side effects typically as-
**** Topical Steroids
One or more topical steroid preparations—a cream or an ointment—will probably be the dermatologist’s first choice to control eczema ld50 asprin . It helps significantly in most cases manufacturer information on prednisone .
Follow the directions carefully soma heightened climax . The cream may need to be applied two or three times daily diclofenac sodium 75mg 3ml injection . Do not put a strong steroid on the face, or any steroid cream near the eyes is kamagra illegal uk . Ask your doctor about “pulsing” the use of cream—applying it for 3 to 7 consecutive days and then stopping for several days 17 b estradiol . Adults may be able to use such products for just a few days a week levaquin and colstridium .
Side effects: Stinging, burning, irritation, itching, peeling Downside: Long-term use or application over a large part of the body, especially under a close covering, could thin the skin, lead to marks on the skin, or (most serious) result in side effects similar to those from oral prednisone lithium 450 mg 900 mg .
Cost: Depends upon the specific steroid the doctor selects cephalexin dose for dogs . These drugs can be expensive lamisil and exacerbation of psoriasis . Inquire about a generic version, which may cost much less amoxicillin and indications and uses .
sociated with steroid use might occur, but it is very unlikely unless the area treated is large and has been covered with some kind of bandage or “occlusive dressing withdrawel from zoloft .” Be very careful in applying this kind of treatment barringer wc and minocycline . It may indeed help the skin, but it must not be overdone prevacid for oral suspension ingredients .
Atopiclair
In 2005, the FDA approved a nonsteroidal cream for eczema excellent results taking effexor . Atopiclair is a prescription product that contains a number of botanical extracts in an emollient base taylor lithium scale . Like CamoCare, it contains bisabolol, but Atopiclair also contains a vitamin E—like compound, a licorice root derivative, and an extract of grapeseed, along with shea nut butter celecoxib evaluation . A gel containing licorice extract had earlier shown promise for treating atopic dermatitiS testosterone mesterelone .299
Elidel and Protopic
The frustration of trying to control eczema, a condition that may not respond to the usual anti-inflammatory treatments, has led doctors to explore other treatment options cholesterol pravachol . The de-Clair
This nonsteroidal cream is significantly better than a simple moisturizer at alleviating itch and reducing rash gabapentin and erection problems . It should be applied two or three times a day shell shrimp cytoxan .
Side effects: Local irritation
Downside: People allergic to any of the ingredients, including nuts, should avoid Atopiclair does citalopram .
Cost: Approximately $85 to $95 for lMgram tube
velopment of immune-modulating treatments to prevent the rejection of transplants led some dermatologists to think about modulating the immune reaction at the level of the skin carisoprodol 2444 imprint . After all, eczema does seem to be linked to an immune reaction gone a bit haywire, comparable to hay fever allegra versace 2007 . It turns out that there are two compounds that can be applied topically to dampen the immune response allegra of ri . They are Elidel (pimecrolimus) and Protopic (tacrolimus) seroquel xr versus seroquel .
Parents of children with eczema were very pleased to have these effective treatments made available so they would not have to rely so heavily on potent corticosteroid creams to keep their youngsters comfortable meloxicam taken with tylenol . They were alarmed, however, when the FDA issued a warning that these immune-suppressing drugs might increase the risk of children developing cancer, especially lymphoma order tadalafil ups online . Such cancers are rare in kids, so it will probably be years before it is possible to assess how serious this potential risk really is no prescription german pharmacy prednisone . But weighing red, itchy skin against a potentially lethal disease suggests that these drugs should be used only when other treatments have not worked bupropion high .
Another topical cream for treating eczema is called MimyX cream diflucan used to treat tenia capitas . It is available by prescription, but does not contain a steroid homotaurine campral gabapentin . Clinical trials showed that it can reduce the size of areas affected by eczema and extend the period between flare-ups seroquel too sedating for bipolar . Side effects appear to be local, such as irritation or itching viagra lawsuit . The manufacturer, Stiefel Laboratories, suggests that MimyX could be used on a regular basis without danger prednisone for t12 to l2 fracture . Because it was approved relatively recently, however, there are no good long-term safety data hydroxyzine withdrawl .
This immune-suppressing cream is significantly better than a simple moisturizer asprin 110mg . It is approved for use in adults and in children older than age 2 gabapentin and migraine .
Side effects: Local irritation, burning, stinging, itching, infections, seizures
Downside: Long-term use is discouraged because there is a possibility that it increases the risk of cancer cheap no prescription tramadol . When application of the cream is discontinued, however, a high proportion of patients regress to pretreatment condition,
Cost: Approximately $65 to $80 for a 30-gram tube of 0 phytosterol testosterone .03 percent ointment, the only strength approved for use in children
Other Approaches
A number of other possible treatments may have some benefit for people suffering from atopic dermatitis generic ultram tramadol 50 mg . Some of them are pretty straightforward and well accepted, whereas others are on the wacky side find how to use viagra . Here’s a brief summary:
1 terbutaline ol1 inhalation compounding pharmacy . Heliotherapy can you take zoloft with lorpressor . This means: Get some sunshine on your skin tramadol ultram hci . Sunburn is bad, of course, but a couple of weeks of moderate sun exposure seems to make eczema better combivir indications . 300 This almost sounds like a prescription for a tropical vacation! Be forewarned, though, that some of the medicines used to treat eczema could make skin more sensitive to sunburn clomid and ovulating pain twin . This is a worry particularly with Elidel and Pro-topic paxil cr 125 mg .
2 trazodone and insomnia . Ultraviolet light therapy carisoprodol b carisoprodol . This probably explains why sunshine is beneficial jeffery m allegra . Exposure to ultraviolet A in the dermatologist’s office can help alleviate eczema symptoms treatment rheumatoid arthritis sulfasalazine . Stubborn cases may improve with the addition of a psoralen gel or bath before the light exposure generic drugs atorvastatin . This is similar to a standard treatment for psoriasis buy cheap kamagra . The dermatologist will probably recommend it if she thinks it will be helpful caverta side effect . Although it is usually administered in the office or hospital, a portable unit used at home can be equally effective concerta adhd caffeine adhd theadhdspecialist com .- 301
3 dilantin and lasiz . Balneotherapy digoxin and elderly . Immersion in salts derived from the Dead Sea, followed by exposure to ultraviolet B, can be helpful, especially if eczema is chronic and widespread interactions of imitrex and celexa . This effect was first observed in people actually bathing in the Dead Sea, but it is no longer necessary to go there lithium cr123a . Some dermatologists offer this type of therapy in their treatment suites clindamycin doxycycline bordatella . One big drawback is that it takes a lot of time zoloft seroxat side effects .302,303
4 order sumatriptan mail . Hypnotherapy claritin acrylic coffee cup price . Both hypnosis and self-hypnosis can help 3 people cope with eczema, especially with its terrible itch excessive testosterone acne .
5 ditropan $4 . Music bioidentical testosterone cream for women . Listening to Mozart—but, oddly enough, not to Beethoven—reduced the size of a wheal that rose on the skin in response to a specific allergen challenge in people with eczema and latex allergy allegra’s window songs . 305 This is probably the most peculiar of the therapies we have come across, but the study used quite objective measures (IgE production, size of wheal) that presumably are not easily manipulated availability of viagra in new zealand .
Conclusions
Eczema, or more precisely atopic dermatitis, is an itchy skin condition that is often chronic testosterone and vaginal cancer . Besides the itch, skin affected by eczema may develop a rash with liquid-filled bumps cymbalta lower dosages . Skin-fold areas, such as the back of the knees, seem to be especially susceptible to the rash ct angiogram lopressor san antonio . Eczema is often accompanied by generalized dry skin, and the patient may also have asthma or hay fever domperidone in infants .
There’s no cure for eczema, although sometimes it does go away for a period of time levothroid interactions . No treatment works all the time or for everyone, so people are understandably on the lookout for something that might work better than what they have already tried 18 v lithium ion . Eczema is quite common in young children, and parents need to be especially vigilant in weighing the benefits against the risks of various therapies they might use for their kids nexium and polyps .
• Avoid prolonged exposure to water or any irritating chemicals, including soap or detergent caffeine birth defect . After washing hands or bathing, apply a moisturizer within 3 minutes of patting the skin dry acomplia price .
• A person with a documented food allergy that makes eczema worse should avoid that food paxil vs effexor . Eggs may be a culprit for young children what’s anastrozole .
• Probiotics can help in some instances 1967 neonatal exposure to depo provera . Look for a high-quality supplement with viable organisms price cefpodoxime compare . Lactobacillus GG and L pravastatin 20mg . fermentum have done well in studies aleve competitor .
• Fatty acid supplements providing gamma-linolenic acid (such as evening primrose oil, borage oil, or black currant seed oil) help some individuals, but have not performed well in clinical trials insomnia paxil cr . One exception is hemp seed oil, although the data on it are limited to one study topamax and glaucoma . It might be worth a try effect of ibuprofen on blood pressure .
• Cut table sugar and simple starches out of your diet vasotec blood pressure medicine . A low-glycemic-index approach might be worth trying, though will
there is no scientific evidence that it wicontrol eczema female zantac de .
• According to anecdotal reports, eating salsa may ease eczema symptoms increase of depression with zoloft . If you like spicy foods, go for it can lamictal help depression .
• Drinking 4 cups of oolong tea daily was shown in one study to help eczema that wasn’t responding to other treatments albuterol and nebulizer . It is easy and nontoxic, so it would be worth a try woman on viagra .
• Vitamin E capsules did very well in one study of people with atopic dermatitis caffeine levels pop . Check with your doctor first if you are a smoker or at high risk of heart disease; some large studies suggest vitamin E might increase your risk of serious complications claritin dose . For others, there is very little risk in a short-term personal trial to see if it helps your skin tobacco and depakote .
• Apply Noxzema—the original formula in the blue jar—to the affected areas clomid use after laproscopy . The herbal ingredients, camphor, menthol, and eucalyptol, may soothe itching what is citalopram hydrobromide . Be alert for increased irritation, though avandia image .
• Over-the-counter hydrocortisone cream (0 promethazine hcl suppository .5 or 1 percent) may help if the eczema is mild lithium etek .
• CamoCare Soothing Cream is available without a prescription and may ease itching, redness, and inflammation toradol opiod .
• Blend up a batch of honey, beeswax, and olive oil for a homemade salve that may help celexa anxiety depression . It sounds sticky, though yaz spironolactone .
• Use prescription steroid creams according to the physician’s instructions effects of gabapentin and alchohol . Don’t use a potent steroid on the face, or for too long a time health and wellness caffeine health product . “Pulsing” the dose—applying the cream for 3 to 7 days straight, then not using it for a time—may help zyrtec over the counter patenet . Ask your doctor azithromycin pharmacy .
• Drugs such as Protopic (tacrolimus) or Elidel (pimecrolimus) may be helpful as back-up treatment if the steroid creams stop working or don’t work well enough long term use of carisoprodol .

sodium picosulphate A synthetic laxative similar to bisacodyl, but with a slower action.
Dose: 5-15 rug at night.
sodium stibogluconate An organic antimony drug use([ in the treatment of visceral leishmaniasis or kala-azar.
Dose: 20 ruglkg daily by i.m. or i.v. injection for 30 days. Side-effects include anorexia, vomiting, cough and sub-sternal pain. (Pentostain).
I sta
given by i.v. injection as a 50% solution to promote diuresis and to reduce cerebral oedema.
sotalol A beta-adrenergic blocking agent used ill the treatment of hypertension, angina, cardiac arrhythmias and thyrotoxicosis. Dose: 120 nig initially, increased as required; maintenance, 160-600 ing daily. For prophylaxis after infarction, 320 mg daily. In acute cardiac arrhythmias, 20-60 mg by slow i.v. injection under ECG control. Care is necessary in heart block, asthma, hepatic and renal impairment. (BetaCardone; Sotacor). See pages 114 & 148, and Tables 4 & 2 1.
sodium tetradecyl sulphate A venous-occluding agent used in the injection sclerotherapy of varicose veins.
Dose: 0.5-1 nil at any one site, followed by compression bandaging for sonic weeks. The local irritant action of the drug brings about an occlusive venous fibrosis at the injection site. Extra-vascular injection may cause necrosis. Care is necessary in allergic subjects.
sodium thisulphate A 50% solution is given by i.v. injection in cyanide poisoning. See sodium nitrite and kelocyanor.
sodium valproate An anticonvulsant
effective in most forms of epilepsy.
Dose: 600 mg daily in adults initially, increased if required up to a maximum of 2.5 g daily. It may also be given by slow i.v. injection in doses of,100-800ing, followed by similar doses given by i.v. infusion. Liver function tests before and during treatment are essential. Severe side-effects such as vomiting, drowsiness or jaundice require withdrawal of the drug, as does spontaneous bleeding or bruising.
(Epilim). See page 136 and Table 15.
somatropin A form of human growth hormone obtained by biosynthesis. It is used to stimulate growth in hormone-deficient young patients whilst the epiphyses are still open.
Dose: 0.07 units/kg daily by i.m. or s.c. injection. Subcutaneous injection sites should be varied. (Genotropin; Hurrialrope; Norditropin; Salzen).
spectinomycin An antibiotic used in the treatment of penicillin-resistant gonorrhoea.
Dose: 2-4g by deep Lin. injection. Side-effects include nausea, dizziness and tirlicaria. (Trobicin).
spironolactone An aldosterone antagonist which potentiates the action of thiazide and loop diuretics in sonic resistant conditions. It is of value in the oedema of liver cirrhosis, as well as in the nephrotic syndrome and congestive heart failure. Dose: 100 ing daily up to a maximum dose of 400 mg daily. Side-effects include drowsiness, gastrointestinal disturbances, gynacconiastia and an increased sensitivity to warfarin. The combined use of potassium-sparing diuretics or potassium supplements is contraindicated.
(Aldacione; Spiroctan).
SSRls See selective serotonin re-uptake inhibitors.
stanozolol An anabolic steroid with actions and uses similar to those of nandrolone. Dose: 5 ing daily. It also has fibrinolytic properties, and is used in lipoderinatosclerosis (a complication of deep-vein sclerosis), and in some forms of vasculitis. It may also be of sonic value in hereditary angioneurotic oedema and in the relief of itching due to biliary obstruction. Also used in some aplastic anaemias, 2.5-10 ing daily. Sonic androgenic side-effects may Occur, bill are usually mild and reversible Oil stopping treatment. (Stroniba).
93
sorbitol A saccharide that after absorption is converted in the liver almost entirely to laevulose. It has been used as a sugar-substitute in diabetes, and it is sometimes
starch Carbohydrate granules obtained from maize, rice, wheat or potato. Widely used as absorbent dusting powder.

stavudineV An antiviral agent that inhibits the enzyme reverse transcriptase, and so indirectly blocks the synthesis of viral DNA. It is used in HIV infections resistant to or not responding to zidovudine. Dose: 00 ing daily, I hour before food. Side-effects include malaise, peripheral neuropathy and pancreatitis. (Zerit). See page 144 and *['able 19.
sterculia A natural gum that swells in water to a gelatinous mass. It is used as a bulk laxative as when taken with plenty of water it increases faecal volume and promotes peristalsis. It is also used in diverticulitis and irritable bowel syndrome, and as an appetite suppressant. Dose: 5-10g daily but not at night. (Normacol).
Sul
Dose-. I g daily by deep i.m. injection. Its use requires care. as it k both ntotnxir and nephro(oxic, especially in full doses and in renal impairment. Measurement of the plasma concentration QfbErCplU1llV0ll P. advisable during treatment. Cutaneous sensitization has followed contact of the drug trill the skin.
sucralfate An aluminium sucrose sulphate use,] in the treatment ofpeptic ulcer. It is not an antacid, but forms a barrier over the ulcer that is resistant to peptic attack and so promotes healing.
Dose: 4g daily for at least 4 weeks. Antacids should not be taken immediately before or after sucralfate. (Antepsin). See page 162.
94
stilboestrol A synthetic oestrogen with the actions and uses of oestradiol.
Dose: 0.1-0.5 mg daily for menopausal symptoms, but it is now prescribed less frequently. Dose in breast cancer, 10-20 mg daily; in prostatic carcinoma, 3 mg daily or more, although fosfestrol is often preferred. Side-effects include nausea, fluid retention, thrombosis, impotence and gynacconlastia.
streptokinase Ali enzyme preparation obtained from cultures of haemolytic streptococci. It has fibrinolytic properties, and is of value in deep vein thrombosis, pulmonary embolism, myocardial infarction and other conditions requiring fibrinolytic therapy.
Dose: by i.v. infusion, 250000 units or more initially, followed by maintenance doses of 100000 units hourly for up to 72 hours. For myocardial infarction
1 5(10000 units over l hour. Side-effects are fever, rash, haemorrhage and allergic reactions. (Kabikinaw; Streptase).
sulconazole A synthetic antifungal agent similar in actions and uses to miconazole. Applied as a 1% cream twice daily. (Exelderin).
sulfadoxine A long-acting sulphonamide, with the general antibacterial action of the group. It has been used in the treatment of leprosy.
Dose: I-1.3f; weekly. In association with pyrimethainine, it is used in the treatment of malaria, but the use of such mixed products requires great care, as severe, sometimes fatal side-effects have occurred. It is no longer used for malaria prophylaxis. (Fansidar).
sulfametopyrazine A very long-acting sulphonamide used mainly in chronic bronchitis and urinary tract infections. Dose: 2 g once it week. Side-effects and toxic reactions, although mainly those of the sulphonamides generally, may be linked with the slow excretion of the drug. (Kelfizine).
streptokinase- streptodornase A mixture of enzymes obtained from cultures of haemolytic streptococci. It brings about the dissolution of blood clots and the liquefaction of purulent exudates, anti is used as a solution to clean foul wounds, pressure sores and ulcers. (Varidase).
streptomycin The first of the amino-glycoside antibiotics, but now used mainly as part of the multi-drug treatment of tuberculosis.
sulindaC A non-steroidal anti-inflammatory analgesic agent (NSAID) with actions, uses and side-effects similar to naproxen. It is of value in the pain and inflammation of rheumatoid disease and acute gout. Dose: 200-400 ing daily with food. It may cause gastrointestinal disturbance and occasional bleeding. (Clinoril). See
page 165 and Table 29.
sulphadiazine one of the more active and less toxic sulphonamides. It is used mainly in the treatment of severe conditions such as meningococcal meningitis.

Dose: (, 9 g daily by deep i.m. injection or i.v. infusion for 2 days, followed by 2 g or more orally daily. Dose in the prevention of rheumatic fever I g daily. Side-
effects are nausea, rash and blood dyscrasias.
sulphadimidine One of the least toxic of the sulphonamides, now used mainly in urinary infections.
Dose: 2 g initially, with maintenance of 1. - 4 g daily orally. Side-effects include nausea, drug fever, rash and leucopenia.
sulphamethoxazole A sulphonamide present with trimethaprim in co-trinioxazole.
sulphasalazine A sulphonamide derivative that is taken up selectively by the connective tissues of the intestines. It is used in the treatment and maintenance of remission in ulcerative colitis and Crohn’s disease.
Dose: 4-8g daily initially; maintenance, 1.5-2 g daily. 11 is also given as a 3 g enema and as 500 mg suppositories. Occasionally given in rheumatoid arthritis in doses of 03-3 g daily. Side-effects include nausea, rash, drug fever and blood dyscrasia. If blood dyscrasia is suspected, a blood count should be done and the drug withdrawn. (Salazopyrin). See niesalazine, olsalazine, page 172 and’I'able 32.
sulphathiazole One of the early sulphonamides, and survives in a few mixed products.
sulphinpyrazone. A uricosuric agent with the selective action of increasing the excretion of uric acid, hence used in the treatment of chronic gout and hyperuricaemia. Dose: 100-200 mginitially with food, increased according to the plasma uric acid levels up to 60(1-800 nag daily, with tower maintenance doses according to need and response. Side-effects are nausea, abdominal pain and rash. Care is necessary in peptic ulcer and renal impairment, and blood counts are necessary during, treatment. Salicylates antagonize the action of the drug. (Anturan). See
page 1.10 and Table 17.
sulphonamides A group of drugs that have an antibacterial action by preventing the uptake and use of folic acid. They are thus bacteriostatic and not bactericidal in action. The use of the sulphonamides ides has
declined, and they are now used mainly in urinary tract infections due to sulphonamide-sensitive bacteria. The side-effects of the sulphonamides include nausea, dyspepsia, diarrhoea and allergic reactions. Bone marrow depression may occur if treatment is prolonged. The uncommon Stevens-Johnson syndrome is a very serious reaction. See sulphadiazine ind co-trinioxazole.
sulphonylureas A group of orally active drugs represented by chlorpropamide that promote the release of insulin from the beta-cells of the pancreas. They are used in mild diabetes not controlled by diet, and in the late-onset diabetes of middle age, but they are not suitable for the treatment of juvenile diabetes. The presence of some still-functioning beta-cells is essential for sulphonylurea activity. Side-effects include weight gain, rash, fever and jaundice. During illness and pregnancy, insulin treatment should replace sulphonylurea therapy. See page 131 and Table 13.
sulphide An antipsychotic drug with a central action on dopaminereceptors. It is used in the treatment of acute and chronic schizophrenia, as in low doses it increases awareness in apathetic and withdrawn patients, and in larger doses controls the active forms of the illness.
Dose: 400-800 mg daily: in severe conditions up to 2.4 g daily. The side-effects are similar to those of chlorpromazine. (Dolmatil; Sulparex; Sulpitil). See
page 168 and Table 30.
sumatriptan A serotonin agonist used in
i lie treatment of acute migraine. (It is not suitable for prophylaxis.)
Dose: 50-100 mg orally as soon as possible after onset of an attack, but a second dose should not be given for the same attack, but may be repeated once if migraine symptoms recur. In severe migraine an(] cluster headache 6 mg by S.C. injection, but not more than 12 nig in 24 hours. (Pre-filled syringes and an auto-injector are available.) If should not be given until 24 hours after other antimigraine treatment, or any other drug that influences the re-uptake of serotonin. Side-effects include tingling and tightness in any part of the body, and an angina-like chest pain that may be severe. (I migran). See page 154 and Table 23.

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.
76
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.
77
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).

lithium succinate Lithium succinate appears to have sonic antifungal and anti-inflammatory properties, and is used as an 8% ointment for seborrhoeic dermatitis. (Ftalith).
lodoxamide A mast cell stabilizer similar to sodium cromoglycate. Used as eye drops (0.1%) in allergic conjunctivitis. (Alomide).
Dose: in acute diarrhoea, 4 mg initially, followed by 2 nig as required, up to a maximum of 16 ing daily. In chronic diarrhoea, 4-8 nig daily, but care is necessary in the elderly to avoid faecal impaction. Loperamide is not suitable for children under 4 years of age, nor in patients with liver disease, as it may cause undesirable sedation. (Iniodium).
loprazolam A benzodiazepine hypnotic used mainly in the short-term treatment of insomnia and nocturnal arousal. Dose: 1-2 nig at bedtime. Side-effects include drowsiness, dizziness, dry mouth and headache. See page 152 and Table 22.
loratadine An antihistamine with the general action of that group of drugs, but with reduced sedative side-effects.
Dose: 10 nig dailv. (Clarityn). See page I 10 and Table 2.
63
lofepramine An antidepressant of the irnipramine group, with similar actions and uses, but reduced sedative and anticholinergic side-effects.
Dose: 140-210 nig daily. (Gamanil). See page 128 and Table 11.
lofexidine A narcotic antagonist. It has a selective blocking action on brain nor-adrenaline, and is used for the rapid relief of opioid withdrawal symptoms associated with central sympathetic activity.
Dose: 200 pg twice a day, slowly increased as required over 7-10 days, before withdrawal over 2-4 days. Care is necessary in cardiac insufficiency and bradycardia. (Britl.olex).
lomotil A preparation of diphenoxylate with atropine, for the rapid control of diarrhoea. Dose: 2 tablets 6-hourly.
lomustine A slow-acting cytotoxic agent used in Hodgkin’s disease and solid tumours.
Dose: 130 ing/ni’body surface at intervals of (> 8 weeks. Side-effects, include anorexia. nausea, liver damage and niyelodeprm ion. Dosage should not be repeated until white cell and platelet counts have returned to an acceptable level. Reduced doses are given
when lomustine forms part of a multi-drug dosage scheme. (CCNU). See page 122 and Table 8.
loperamide A synthetic inhibitor of peristalsis.
lorazepam A short-acting anxiolytic/ hypnotic similar to diazepam, but less likely to cause next-day drowsiness. Dose: 1-4 mgdaily. It is also given in similar oral closes or by slow i.v. injection in doses of 50 pglkg for preoperative sedation and anuiesia. Occasionally used i.v. in status epilepticus in doses of 4 nig, but apnoea and hypotension are side-effects that may require resuscitation. fAtivan). See page 152 and Table 22.
lormetazepam A short-acting benzodiazepine hypnotic. It is useful in the treatment of insomnia in the elderly, but is less suitable for insomnia associated with early awakening.
Dose: 500 fig I nig at night. See page 152 and ‘]’able 22.
losartanV An angiotensin 11 receptor antagonist used in the treatment of hypertension.
Dose: 50ing daily The use of potassium-sparing diuretics should be avoided with losartan. It has the advantage of not causing the persistent dry cough associated with ACE inhibitors. (Cozaar). See page 148 and Table 21.
low molecular weight heparins See heparin.
loxapine Antipsychotic agent with the actions and uses of chlorpromazine. Dose: in acute and chronic psychoses, 25-50 mg daily, slowly increased as required. Maintenance doses range from 20-100111g daily. Side-effects are those of other anti-psychotic agents. but loxapine may cause nausea, vomiting and weight changes. f .oxapac). See page 168 and Table 30.
I Mob
magnesium hydroxide A mild antacid laxative, usually given in aqueous suspension as Cream of Magnesia, although tablet forms are also available. Cream of Magnesia is a useful antidote in mineral acid poisoning.
64
Lugol’s solution An aqueous solution of iodine 5% and potassium iodide 10%. Used in the preoperative treatment of t hyrotoxicosis.
Dose: 0.3-1 ml.
lymecycline A soluble complex of tetracycline and lysine. It has the action and uses and side-effects of tetracycline, but is absorbed more readily.
Dose: 800 mg daily. (Tetralysal).
typressin An analogue of vasopressin used to control the polyuria of pituitary diabetes insipidus.
Dose: 2.5-10 units several times a day by nasal spray. Side-effects include nausea and abdominal pain. I.ypressin has some vasoconstrictor properties, and desmopressin is sometimes prellcrred. (Syntopressin).
lysuride (lisuride) A bromocriptine-like drug for the treatment of parkinsonism. II acts by stimulating any surviving dopamine receptors in the brain.
Dose: 200 pg at night with food,
irk ceased at weekly intervals according to response up to a maximum of 5 mg daily. Side-effects include nausea, dizziness and initial hypotensive reactions which may affect driving ability. (Revanil). See
page 160 and Table 26.
magnesium sulphate Epsom salts. A powerful saline aperient, producing loose stools by preventing the reabsorption of water.
Dose: 5- 15 g before breakfast. Used externally for the treatment of boils and carbuncles as a paste with glycerin. A marked loss of plasma magnesium may occur after severe diarrhoea or drug-induced diuresis, and may require the i.v. infection of magnesium sulphate in doses based on the degree of hypoinagnesacmia. It has also been given i.v. in a dose of 8 mmol in the emergency treatment of severe;U’rhythinias associated with hypokalaemia.
magnesium trisilicate A white insoluble powder, with mild but prolonged antacid effects. It was formerly widely used in the symptomatic treatment of peptic ulcer;
now used chiefly for dyspepsia.
Dose: 0.3-2 g.
malathion An organophosphorus insecticide. Used as a lotion 0.5% for lice and scabies as alternative to lindane or carbaryl.
mannitol A sugar that is not metabolized, and is used mainly as an osmotic diuretic. Dose: (after a test dose of 200 mg/kg) 50-200 g by slow i.v. infusion over 24 hours. Mannitol has also been used by i.v. infusion as a short-term ocular hypotensive agent in the treatment of glaucoma. It is also useful in cerebral oedema, given by rapid i.v. injection in a dose of I g/kg as a 2044, solution.
macrolides A group of antibiotics that differ chemically from the penicillins, yet have a similar pattern of activity. They are active orally and are useful in the treatment of penicillin-sensitive patients. Erythromycin is the most widely used member of the group, with clarithromycin and azithromycin as more recent introductions.
magnesium carbonate A white, insoluble powder with antacid and laxative properties.
Dose: 0J-4 g daily.
maprotiline A sedative antidepressant with a general action similar to that of the tricyclic drugs represented by amitriptyline. Dose: 25-150 mg daily. If given at night as a single dose, the sedative action may reduce the need for other drugs. It has milder anticholinergic side-effects than some related compounds, although skin rash is more common. (I udionlil). See page 128 and Table 11.
mebendazole An anthelmintic effective against most intestinal worms.

Dose: 100 mg once for threadworm, and 100 mg twice daily for 2 days against other infestations. Generally well tolerated, but it should not be given to children under 2 years of age. (Verniox).
I Men
in oedematous states. A potassium supplement may be required. Care is necessary in renal and hepatic deficiency.
(KiYcaron). See page 148 and Table 21.
mebeverine An antispasmodic agent which, unlike the anticholinergic drugs, appears to have a direct action on the intestinal smooth muscle. It is useful in the treatment of gastrointestinal spasm and in the irritable bowel syndrome. Dose: .100 mg daily, before food. As with other antispasmodics, mebeverine should not be used in paralytic ileus. (Colofac).
medroxyprogesterone A synthetic progestogen.
Dose: in endometriosis 30 mg daily for 90 days; in dysfunctional uterine bleeding and secondary amenorrhoea: 2.3-10 mg daily for 5-10 days, starling on l6th-2 Ist day of cycle and repeated for 2-3 cycles. Large doses of 400 mg-1.5 g daily are given in breast, endometrial, prostate and other hormone-dependent cancers, or 250mg– I g weekly by deep i.m. inJection. (Farlutal; proves). Depot-proves is a long-acting product used by i.m. injection is a contraceptive. but only after fit][ counselling.
megestrol An orally active progestogen. It is used in oestrogen-dependent breast cancer, and acts by suppressing the uptake of oestrogens by the cancer cells.
Dose: 160 mg daily. Nausea and fluid retention with weight gain are occasional side-effects. (Megace). See page 122.
meloxicarn A recently introduced non-steroidal anti-inflammatory drug (NSAID) indicated in the short-term treatment of acute osteo-arthritis and the longer-term treatment of rheumatoid conditions. Dose: 7.5-15 mg once daily with food; half doses for the elderly. Suppositories of 15 mg are also available. The side-effects are basically those of the NSAI Ds in general. Meloxicam has a more selective action on cyclo-oxygenase, the enzyme involved in the biosynthesis of prostaglandins, and is less likely to cause gastrointestinal disturbance, but it has no cytoprotective action, and is not suitable for patients with peptic ulcer. (Niobic). See page 165 and Table 29.
65
mefenamic acid A non-steroidal anti-inflammatory analgesic agent used to relieve moderate pain in arthritic and rheumatoid conditions, and other states requiring mild analgesic therapy such as dysmenorrhoea. Dose: 1.5 g daily after food. Side-effects are drowsiness an(] haemolytic anaemia. Diarrhoea is an indication that the drug should be withdrawn. (Ponstan). See page 165 and Table 29.
rnefloquine A drug for the prophylaxis and treatment ofchloroquine-resistant malaria. Dose: lot- short -term prophylaxis 250 mg weekly, starting 1 week before exposure and for 4 weeks after return. Doses for treatment require specialist advice. Side-effects include gastrointestinal disturbances, dizziness and weakness. It is contraindicated in patients with a history of neu ro- psych iatric disturbance, and is not suitable for use in severe renal or hepatic impairment. (Lirium). See halofantrine.
mefruside A diuretic useful in the treatment of hypertension and oedema. Dose: 25-50 mg daily in the morning, according to need and response; 25-100 mg
melphalan An alkylating agent of the mustine type. Used mainly in myelomas, lymphomas and some solid tumours. Dose: 150-300 gg/kg daily for 4-6 days, repeated after 1-2 months. In myeloma it is also given by regional perfusion. The injection solution is highly irritant and contact should be avoided. Side-effects include myelo-depression, nausea, rash and pruritus. (Alkeran). See page 122 and ‘rabic 8.
menadiol A water-soluble form of vitamin K. Dose: 10 ing daily. (Synkavit) Phytorneii,dionc i.% now preferred.
menotrophin Human menopausal gonadotrophin containing follicle-stimulating hormone and luteinizing hormone. It is used in the treatment of anovulatory sterility. The dose depends on individual hormone assays and response. The use of the drug has resulted in multiple births. It is also given to males to stimulate spermatogenesis. (Humegon; Normegon).
menthol Colourless crystals obtained from oil of peppermint. Used as spray or drops for nasopharyngeal inflammation.

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

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

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

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.

Elimination diet
An elimination diet is a method of diagnosing idiopathic food intolerance (see p. 74) and certain other

forms of food sensitivity where indirect tests, such as skin tests, are unhelpful. The principle of the

elimination diet is very simple. It begins by removing from the body every food that could possibly

cause a reaction, and seeing if this produces a symptom-free state. If it does, the elimination diet

then presents the body with different foods, each in its pure form, to see which ones cause symptoms.
While the principle is simple, the practicalities of the elimination diet can be much more complex, and

it is vital to understand the details fully before you start. There is absolutely no room for

‘cheating’ with this diet – one mouthful of cake is enough to ruin the whole thing. You need forward

planning and a lot of self-discipline, backed up by a good stock of the permitted foods for moments

when hunger overcomes you. Some cooked foods, stored in the freezer in individual portions for quick

defrosting, are a great help.
Doing an elimination diet incorrectly is not just a waste of time. Some people acquire new

sensitivities during the diet, which may make it very much more difficult to do a second elimination

diet. So plan ahead and get it right first time.
The planning stage
First of all, start an accurate symptom diary. This will give you a precise picture of how bad things

are now, before you try any dietary measures. A detailed daily symptom record, covering a period of

about two weeks, can be very useful, whether or not you actually do an elimination diet. It can serve
as a baseline against which to judge the effects of any future treatment.
Before you begin an elimination diet, you must see your doctor and ask if it is safe for you to do the

diet. Read through the next four pages first – the more you know about elimination diets, before

talking to your doctor, the better.
There are some conditions where, although an elimination diet can be very helpful, it should not be

attempted without full medical supervision. Two main causes for concern exist:
•    For people who are undernourished to start with, the elimination diet may be too demanding – it

is difficult to eat enough calories during the first few weeks of the diet, unless an elemental diet is

used as a supplement (see box on p. 196). If you are underweight, or have rheumatoid arthritis or

Crohn’s disease, the possible use of elemental diets is something you should discuss with your doctor.
•    With certain diseases (see list that follows), the testing stage may induce severe symptoms.

Sometimes these can be life-threatening and need immediate medical attention.
Medical supervision during food testing is recommended for anyone with these conditions:
•    Crohn’s disease – testing can bring on a prolonged relapse. Very small amounts of food should

be tested initially, and the quantity slowly increased.
•    Brittle asthma – after a period of avoidance, a culprit food can bring on a severe and possibly

life-threatening asthma attack.
•    Atopic eczema – the risk of reactions is higher if skin tests are positive (see p. 198).
•    Chronic urticaria – occasionally there is an immediate reaction to an offending food. It is

advisable to test foods in very small portions oust a mouthful) at first. If there is no reaction

whatever after four hours, a normal portion can be tested.
Note that an elimination diet is not suitable for anyone with true food allergy (see p. 62). If you

have ever had an immediate reaction to any food, or any symptoms in the lips or mouth, testing foods

can be dangerous. Caution is also necessary if you have ever reacted to a food with violent vomiting

and/or diarrhoea some hours after eating. This could be due to an infection, of course, but such

symptoms can also, very rarely, result from true food allergy (see p. 64). Finally, if you have ever

suffered anaphylaxis from any cause – not just food –the testing phase of an elimination diet might be

risky. Ask your doctor’s advice.
Once you have your doctor’s permission to try the diet, work out how the stages of the diet will fit in

with your life over the weeks or months ahead. Until it is over, eating food made by other people is

virtually out of the question. When eating away from home, you must either take prepared food with you,

or just eat very simple foods – such as permitted fruits or nuts. Think about the practicalities of

carrying food for meals away from home.
Finally, devise the diet you will follow during the exclusion phase (see right), locate shops that sell

the more unusual foods, and stock up on everything required.
You will continue to eat a lot of these foods for the first few weeks of the testing stage, so you may

want to buy extra stocks and refrigerate them for
longer storage, especially if the sources of supply are some distance from your home.
Note that food ingredients in medication could interfere with the results of the elimination diet. For

example, if you are very sensitive to maize (corn), the cornflour that is added to many antihistamines

and other drugs could create much confusion. Food-free medicines are available – talk to your

pharmacist about this initially, then to your doctor if you need a different prescription.
The exclusion phase
During the first part of an elimination diet, you exclude all the foods that you normally eat, plus any

closely related foods. For example, if you normally eat oranges, you should avoid all other citrus

fruits, including lemon, limes and grapefruit, even though you do not normally eat these. If you

normally eat plenty of broccoli, you should omit all its relatives, such as cabbage, kale, spring

greens and cress.
The best way to conduct the exclusion phase is not to follow a set menu, such as the well-known

‘Iamb-and-pears’ diet, but to draw up your own list of permitted foods. This can include foods that you

have never eaten before, and those you eat rarely.
The list should run to at least ten items. One problem with an exclusion phase that consists of only

two foods (as in the ‘Iamb-and-pears’ diet) is that you are bound to eat a huge amount of these foods.

This is asking for trouble if you have a tendency to food intolerance, because you can quite quickly

become sensitive to new foods if eating them in large amounts.
Your list of permitted foods should include:
Some starchy items. These are essential for keeping hunger at bay: try some of the more exotic root

crops, such as sweet potatoes, yams, dasheen and cassava. These are available in large supermarkets and

in small shops catering to Indian, African, Chinese and Caribbean communities. (Cook them as you would

potatoes. In the case of cassava, it must be boiled, not baked.) You can also eat parsnips, turnips,

chestnuts and pumpkin. Tapioca, sago, buckwheat, millet, quinoa and sorghum are other possibilities: a

health-food shop is a good source of some of these. Use rice if it is not normally part of your diet.

Do not include sweetcorn or maize meal, even though you do not normally eat these –corn products are

very widely used in packaged food, and sensitivity to corn is not uncommon.
Several fruits and vegetables that you don’t normally eat. Exotic produce such as mangoes and okra can

help a lot in keeping the diet tasty. Avocados, which are very rich and nutritious, can be included if

you don’t eat them often.
Some protein items. For carnivores, this is the easy part – any meat that you don’t normally eat is

suitable. Consider turkey, rabbit, pigeon or game, for example. (Soak rabbit meat in salt water

overnight to get rid of the strong taste, if you dislike this.) Strict vegetarians have more problems

here, since goat’s milk, sheep’s milk and all birds’ eggs are disallowed – their proteins are much too

similar to those of normal milk and eggs. Soya products such as tofu should definitely be avoided, as

should other pulses initially, because sensitivity to these is a possibility among vegetarians. Quorn,

or mycoprotein, could affect anyone sensitised to yeast, and should not be included. Fortunately the

exclusion phase is fairly brief, so a low intake of protein will not be disastrous. Including some nuts

on your list of permitted foods will help, as these contain protein. If nuts are part of your normal

diet, you may have to resort to rarely eaten kinds such as macadamias, cashews or pistachios.
Elemental diets
An elemental diet is a powder that contains all the nutrients the human body needs but is free from the

substances in food that provoke allergic and intolerance reactions. It is mixed with water to create a

complete substitute for food. Originally designed for space travel, this totally synthetic form of

sustenance is also known as ‘the astronaut’s diet’.
Used alone during the exclusion phase, elemental diets are the basis for the ultimate – and

theoretically foolproof – elimination diet. They sustain you through the exclusion phase, and continue

to provide your basic diet during the testing phase.
For anyone with multiple food sensitivity, using an elemental diet circumvents the problem of finding

ten or more safe foods with which the elimination diet can begin.
Those who are underweight can also benefit from using an elemental diet, simply as a calorie-boosting

supplement during the exclusion phase and testing phase.
Unfortunately, elemental diets taste fairly unpleasant and are quite expensive. You
may need a prescription, so talk to your doctor. Ideally you should get an elemental diet that does not

contain sucrose (sugar).
Some items that make good snacks. Nuts, pumpkin seeds, sunflower seeds, fresh fruit and dried fruit are

all useful for times when you are away from home, or feel hungry between meals. At the outset of the

diet, use only unsulphured dried fruit –available from health-food shops. At a later stage, you can

test ordinary dried fruit (all of which is treated with sulphur preservatives – see box on p. 207).
A cooking oil, preferably one that you have not used much in the past. Use this fairly liberally, to

keep the calorie content of your diet at a reasonable level
Note that this is a very plain diet – you eat the permitted foods and absolutely nothing else. You

cannot use spices, herbs or other flavourings. Salt is allowed, but sugar is out, as are tea, coffee,

alcohol and all soft drinks. You must drink only mineral water and pure juices from permitted fruits.
Don’t use canned or packaged versions of the permitted foods. Buy raw food and cook it yourself. The

idea is to avoid food additives and other contaminants, such as those from the linings of cans.
Throughout this phase, and the next, you must be very careful not to eat too much of any one food.

Never eat any food every day, and stay away from any food that you begin to develop a real passion for

– this is always a bad sign in people with food intolerance. It is better to go a little hungry

(assuming you are not underweight to start with) rather than binge on any of the permitted foods.

Acquiring new sensitivities is all too easy.
Assuming you do have food intolerance, and you have excluded all the foods that affect you, there

should be a complete clearance of symptoms within 7-10 days. The response is usually unmistakable. A

partial or slight response is probably just a coincidence, and should be discounted, except for those

with rheumatoid arthritis (see below).
Be warned that you may feel a great deal worse before you get better. For those who do have idiopathic

food intolerance, the first 5-6 days of the diet can be very unpleasant – usually they suffer the same

symptoms as before the diet, but far more severe.
Some conditions, such as Crohn’s disease and rheumatoid arthritis, may require a longer exclusion

phase, but there is no point in continuing beyond three weeks. Bear in mind that long-term structural

damage to arthritic joints may prevent a complete recovery. A partial but sustained improvement in the

joints, accompanied by a distinct improvement in general health, suggests that food could well be

playing a part in causing the disease, and that it is worth going on to the testing phase.
Symptoms that are only intermittent, such as chronic urticaria or migraine, pose a special problem. You

need to decide, before starting the diet, how long the exclusion phase should continue in order to give

you a clear sign that your state of health is improved. A symptom diary is vital here. If, for example,

your symptom diary shows that you sometimes have a week that is symptom-free but you never get through

two weeks without an attack, then your exclusion phase should continue for two weeks.
You should only go on to the testing phase if you improve during the exclusion phase. If you do not

improve, you have excluded the possibility of food intolerance, and can give up the diet.
The testing phase
This part of the diet, which is sometimes called the reintroduction phase, takes about eight weeks. It

requires careful observation of your symptoms, and constant self-discipline about everything you eat.

You should not stop or delay the testing unless you are ill – it is vitally important to complete it as

quickly as possible.
Foods have to be reintroduced one at a time, with a space between in which symptoms can be observed. It

sounds simple, but this is where errors can easily occur.
During this phase, as well as noting your symptoms daily, you should also record absolutely everything

you eat.
For the first 2-3 weeks you should test foods that are unlikely to cause symptoms. Start by testing

fruits, vegetables and meats that you do not eat very often normally, but which you do like. If they

pass the test, you can use them to vary your diet. This will make life much easier and reduce the risk

of developing new sensitivities.
Next test foods that you do eat reasonably often, but not every day. Leave the most likely culprits –

the foods you eat very regularly, such as wheat and milk products – until you have established a safe

diet that contains at least 25 different foods. This safe and relatively varied diet should be the

backdrop against which you test staple foods.
The testing procedure changes over time, because your sensitivity may decline as the diet progresses.

During the first eight weeks, you should test one food each day, eating a normal-sized portion for

lunch or supper. A reaction to the food might occur quite soon after the meal, or some hours later. Any

symptoms that occur within the following 24 hours should be provisionally attributed to that food.
Unfortunately, bowel symptoms can sometimes take longer to develop – up to 48 hours. This can confuse

things when a new food is being tested every day.
There may also be uncertainty about intermittent conditions such as chronic urticaria. You may not be

absolutely sure that the problem really responded to the exclusion phase. If so, when the symptoms

recur during the testing phase, this may be due to a food, or it may just be coincidence.
Should there be any doubt about which food caused a particular set of symptoms, cut out all the suspect

foods for now, and retest them after a couple of weeks, using a three-day testing procedure (see

below).
When a reaction does occur to a food, stop all testing and go back to the safe diet until you feel

completely better. But don’t wait too long before resuming testing. You need to get through most of the

testing within eight weeks because, for some people, intolerance to the foods begins to fade after

that.
This does not mean that the intolerance has been ‘cured’, unfortunately. A period of eating the food

regularly will soon bring the problem back.
If you are still testing foods after eight weeks, you must change to three-day testing – eat a normal

portion of the food every day for three days, stopping only if you get symptoms. Should you have no

reaction to the food by the end of the fourth day, you can consider it safe. (But leave it out of your

diet for at least another four days.)
There are some special procedures for testing certain foods:
•    When you test wheat, even if it is quite early on, use the three-day test procedure (see

above). Reactions to wheat can be very slow. (If you have rheumatoid arthritis, you should spend a full

five days testing wheat, and eat it at least twice a day.) Don’t use bread to test wheat because this

also contains yeast and other ingredients. Use a pure wheat cereal such as Shredded Wheat – moisten it

with fruit juice if you cannot have milk. Note that some people who react to whole-wheat are sensitive

to the wheat germ, and can tolerate refined wheat, as in white bread and flour. For others only white

flour is a problem – they are usually reacting to additives in the white flour. Careful testing will

sort out these issues.
•    Test milk before cheese and butter. You may react to one but not the others. If you react to

fresh milk, wait a few weeks, then test evaporated milk. Later, you can test goat’s milk and then

sheep’s milk. Some people can tolerate these, but must be very careful not to consume too much of them.
•    You can test yeast using Marmite or yeast-based B-vitamin tablets. Do this before you test

mushrooms, •    At some point, test a canned food. This is to check for reactions to the lining

material used on cans. Choose something that contains no other ingredients or additives, such as

carrots. Test it first in a frozen or fresh form, so that you are sure you don’t have a reaction to the

food itself.
•    Throughout the testing period, continue with cooking all your own food from scratch. At a

fairly late stage in the testing, when you have tested most foods, spend three days eating packaged

food. The idea is to eat a wide range of different food additives all at once. Read the labels

carefully (see p. 172) to check that all the food ingredients are ones which you have already tested

and found safe. You are unlikely to react to these packaged foods, but if you do, you should then

conduct tests with all the individual food additives. You may need some help from a dietitian for this

(see p. 201).
Testing becomes more and more uncertain after 12 weeks. If you
have not completed it by then, reintroduce all the untested foods.
Should your symptoms come back, cut out all those foods again,
then test them individually.
What next?
For anyone who recovers during an elimination diet, and successfully identifies their problem foods, a

period of complete abstinence from those foods follows. After about a year, it is worth testing the

foods again, as the sensitivity may have subsided. (Don’t do this if you have rheumatoid arthritis –

see p. 23.)
If, after a year or two, you find that a food no longer makes you ill, don’t go back to your old ways –

remember that you must only eat the food occasionally. Once every three or four bays is a good rule of

thumb for a food to which you were previously intolerant. You might get away with having it slightly

more often than this, but never go back to eating it daily. If it starts to become your ‘favourite

food’ again – the thing you fancy more often than anything else – watch out.
Good nutrition is an important issue for anyone avoiding certain key foods. If you have cut out all

milk products, for example, you should probably be taking a calcium supplement, unless you eat a lot of

other calcium-rich foods. Ask your doctor to refer you to a dietician or nutritionist if you feel you

need help.
An elimination diet for children with eczema
Before putting your child on any kind of restrictive diet, it is vital that you talk to your doctor.

The risks of malnutrition are far higher for children, and there can be serious long-term consequences,

such as stunted growth or impaired intelligence. You must therefore have medical consent and

supervision for an elimination diet.
For young children with atopic eczema, there is rarely any need for a stringent elimination diet, such

as that described on pp. 194-7. Children are usually sensitised to only one or two commonly eaten

foods.
In the case of recently weaned infants, it is enough to simply cut out individual foods, one at a time.

Avoid each food for two weeks, while observing symptoms carefully.
For older children a simple elimination diet, with an exclusion phase which avoids just the most likely

culprits, works well. The foods that you should exclude at the outset are:
•    any food which has given a positive skin-prick test (see p. 69)
•    any food which you think may have caused digestive symptoms, such as diarrhoea, either now or

in the past
•    eggs, milk and all milk products
•    beef and chicken
•    citrus fruits (oranges, lemons etc.)
•    food additives.
If the child’s skin is no better after a week of this diet, cut out the following foods as well:
•    peanuts and other nuts
•    soya
•    fish
•    wheat and maize (corn)
•    tomatoes
•    lamb.
If there is no response after another week, food is unlikely to be contributing to the eczema.
For the testing phase, use three-day testing, as described on p. 197, if you have fewer than ten foods

to test. Use one-day testing if you have more than ten foods to test.
You should begin by testing a very small amount of the food. Wait ten minutes for any symptoms (not

just skin symptoms – the mouth or stomach may also be affected) then give a little more if nothing has

happened. Build up gradually to testing a normal portion of the food.
A more cautious approach is required for children who give positive skin-prick tests to foods, or have

a history of symptoms in the mouth or digestive tract. They are more likely to suffer severe symptoms

in the lips, mouth and throat – the type of reaction associated with food allergy. Emergency medical

treatment may be needed. You can see if there is any likelihood of a severe immediate reaction to foods

by starting with a test on the face, and then the outer lip (see box on p. 23). If nothing happens, it

is probably safe to go on to the next stage – giving the child a very small amount of the food to eat.

However, you should have medical supervision for Rare reactions
Very occasionally, atopic eczema sufferers on milk-avoidance diets develop a sensitivity reaction to

calcium supplements. There is no scientific explanation for this, but it has been very well documented

in two children. Should you encounter this problem, the answer may be some alternative natural source

of calcium: sardines or other small fish, eaten whole, are one possibility, assuming your child will

eat fish. A dietician can advise on how much is needed per day.
There has also been one well-documented report of a child reacting to mineral water. When the water she

usually drank was changed to another brand, her eczema cleared up. This is very unlikely to be a common

problem.
this procedure in the case of foods that gave positive skin tests. If your child has both severe eczema

and additional symptoms (such as nettle rash, or symptoms in the mouth or digestive tract) it may be

advisable to have medical supervision when testing all foods.
Bear in mind that atopic eczema naturally fluctuates a great deal. To observe the effects of trying out

a food, you need the child’s skin to be in a steady state. That means being absolutely consistent about

applying steroids and moisturisers, avoiding (for the period of testing) any stressful situations that

could provoke a flare-up, not exposing the skin to sudden doses of irritants or airborne allergens, and

keeping scratching under control. Be aware of other factors that could muddy the waters by provoking a

flare-up of eczema – such as teething, or a cold (see p. 44).
If certain foods are identified as provoking eczema symptoms, and you decide to cut the food from your

child’s diet, a nutritional supplement may well be needed. Ask your doctor to refer you to a

nutritionist or dietician.
Other diagnostic diets
These diets are not used by (or even known to) the majority of doctors. While some, such as the

low-nickel diet, have been subjected to rigorous scientific testing and have shown their worth, others

have not been tested scientifically. The evidence in favour of them is purely anecdotal – in other

words, doctors have used these treatments repeatedly and observed good results with some of their

patients. That is not hard science, but it is how innovations in medicine often begin.
There are few risks with any of these diets – the number of foods to be avoided is small, and you are

most unlikely to become malnourished. Your doctor should not object to you trying any of these diets,

however sceptical he or she may be about its possible benefits.
Low-nickel diet
This diet is sometimes of benefit to adults with eczema. There are various pointers which indicate that

the diet may help, as described on pp. 55-6.
Make sure that you have absolutely no contact with any nickel (e.g. in jewellery, jeans studs, watches

or hair clips) throughout this diet, and for at least two weeks before starting it.
Ideally you should also stop treatment with steroids or antihistamines a week or so before starting the

diet. This allows any improvement to be easily observed. Obviously you should get your doctor’s

permission to do this.
The diet could take anything from six weeks to six months to take full effect. Some people have a

complete clearance of their eczema, while for others there is a partial but distinct improvement.
The foods with a high nickel content, which should be avoided as far as possible, are:
•    shellfish
•    green beans and peas
•    beansprouts and lucerne sprouts
•    dry beans and lentils (pulses) of all kinds; soya protein and products containing it (e.g.

vegetarian sausages and burgers)
•    spinach and kale
•    lettuce, leeks
•    wheat bran (avoid bran cereals and other products; replace wholemeal bread with white bread, or

eat it in moderation only – you can get plenty of fibre from fruits and vegetables; do not eat

multi-grain breads at all)
•    oatmeal, millet and buckwheat
•    raspberries, prunes, pineapple, figs
•    chocolate and cocoa
•    tea from drinks dispensers (restrict intake of other tea and coffee, and don’t make them too

strong)
•    peanuts, hazelnuts, almonds and marzipan
•    liquorice
•    sunflower seeds, linseed
•    baking powder, in large amounts
•    vitamin or mineral preparations that contain nickel (check the label carefully), Nickel is also

found in drinking water, and absorbed from certain cooking utensils, so:
•    Do not use items plated with nickel (e.g. tea balls, some tea strainers, egg beaters). The

extremely shiny appearance of nickel makes these easy to recognise.
•    Do not cook acid fruits in stainless steel pans, since the acid leaches some nickel out of the

stainless steel. An enamel cooking pot is safe.
•    Minimise the amount of tinned food that you eat.
•    In the morning, run off the first litre of water from the tap, as this may contain nickel

released from the tap itself.
Several other foods and drinks seem to aggravate the skin of nickel-sensitive people, even though the

foods are not rich in nickel. These foods and drinks should also be avoided:
•    beer, wine
•    herring, mackerel, tuna
•tomatoes, carrots, onions, apples; oranges and other citrus fruits, including their juices.
Low-chromium and low-cobalt diets
Skin sensitivity to chromium or cobalt can, very occasionally, result in a tendency to react to these

same metals when consumed in food or drink (see pp. 56).
Unfortunately, both chromium and cobalt are essential for good nutrition, so avoiding them is fraught

with problems. You would need the help of a really good dietician, or a doctor with a particular

interest in nutritional problems, to guide you through a diet of this kind.
The only measure you can safely take at home is to cut down on excessive consumption of these metals,

for three weeks only, to see if this produces any improvement in your symptoms. If it does, that should

encourage you to seek expert help for a more thorough avoidance diet.
In the case of cobalt sensitivity avoid:
•    all canned and bottled beer.
In the case of chromium sensitivity avoid:
•    beer, wine and cider
•    yeast extract and yeast tablets
•    black pepper
•    calf’s liver
•    wheatgerm and wholemeal bread
•    cheese.
If you also have nickel sensitivity, avoid nickel-rich foods (see p. 199) at the same time.
Low-histamine diet
Histamine in food is mostly produced by bacterial action. The majority of people can break down any

histamine they eat, as long as the amount is not excessive (see box on p. 67).
Temporary susceptibility to histamine may accompany viral hepatitis or other liver conditions.
A permanently impaired ability to detoxify histamine is relatively unusual. When it does occur it can

result in symptoms such as chronic urticaria, migraine or recurrent headaches. A low-histamine diet may

help in these cases. All of the following should be avoided:
Very high histamine content:
•    red wine, champagne
•    tuna, sardines
•    Emmenthal and Camembert cheeses.
High histamine content:
•    beer, white wine
•    anchovies
•    Gouda, Roquefort, Stilton and all other well-matured cheeses
•    salami and other well-matured sausages, Westphalian ham
•    sauerkraut
•    spinach
•    tomato ketchup.
If you improve only partially on this diet, this may indicate that you are on the right track

(histamine is indeed the problem) but that the bacteria in your gut are undermining your efforts with

the additional histamine which they generate. You can investigate this possibility by trying a

low-carbohydrate diet, as described on p. 53.
Low-amine diet
Naturally occurring substances called amines, found in many different foods, can have a drug-like

effect on the blood vessels, making them open up a little and so increasing the blood flow. The effect

is usually small, but some people are more susceptible than others. A low-amine diet is worth trying if

you have chronic urticaria or migraines, and have not improved with other treatments. A low-amine diet

can also be useful in atopic eczema: amines in food are not a basic cause of eczema, but they can

aggravate the rash by increasing blood flow to the skin. To begin with, cut out all foods listed below:
Very high amine content:
•    all cheeses except cottage cheese
•    dark or plain chocolate
•    yeast extract (Marmite etc.), miso, tempeh, tomato paste, tandoori spice mix, stock cubes,

ready-made sauces •    cola drinks, orange juice, tomato juice
•    any dried, pickled or smoked fish
•    sausages, pies and smoked meats, beef liver, chicken skin
•    broad beans, spinach
•    sauerkraut
•    almonds.
High or moderate amine content:
•    milk chocolate
•    soy sauce
•    beer, wine and cider
•    pork, including bacon and ham, salami, chicken liver, offal
•    all fresh or tinned fish, except white fish
•    all nuts except chestnuts and cashews
•    sesame seeds, sunflower seeds
•    avocados, aubergines, mushrooms, tomatoes, broccoli, cauliflower
•    olives and olive oil
•    oranges, lemons and other citrus fruits
•    pineapples, bananas, raspberries, strawberries, pineapples, plums, grapes, dates, figs, kiwi

fruit, passion fruit.
Continue for at least three weeks, and longer if your symptoms are normally intermittent. if you

improve, you can then experiment with reintroducing small portions of foods from the second list, three

or four times a week. Gradually build up to a higher intake, but cut back if your symptoms return.
Organic diet
The objective here is to avoid pesticides, i.e. chemical sprays applied to kill fungi and insect pests.

This may be helpful for people with chemical intolerance (see p. 84).
`Chemical-free’ or ‘unsprayed’ food (crops grown without pesticides) will do just as well as 100%

organic food (which is grown without either pesticides or artificial fertilisers).
The highest intake of pesticides is from fresh fruit and vegetables, so if your budget is tight,

concentrate on buying organic or chemical-free versions of these. If you have a garden, growing some of

your own food will reduce the cost.
You can also reduce the pesticide content of ordinary fruits and vegetables by:
•    Storing them for as long as possible before using them, because the pesticides break down quite

quickly
•    Always peeling them. With difficult-to-peel items such as peaches and tomatoes, pour boiling

water over them and leave them to stand for a few minutes first, as this loosens the skin. Rinse in

cold water, then peel.
•    If peeling is not possible, washing them very well with soap or detergent, then rinsing them

thoroughly
•    Cooking them, as this drives off some of the pesticides; avoid inhaling the steam and ventilate

the kitchen well while doing this.
You should drink mineral water from a reputable source, or use a very high-quality water filter (not a

jug filter).
Additive-free diet
Food additives are occasionally the culprit in chronic urticaria (see p. 53). At the same time as

avoiding additives, people with chronic urticaria should cut out other potential culprits – alcohol,

spices and all aspirin-like drugs (see box on p. 151).
An additive-free diet may also be of value for some people with chemical intolerance (see p. 84).
In the case of children with Attention Deficit Disorder (ADD), also called Hyperkinetic Syndrome, the

role of additive-free diets is a contentious issue (see p. 81).
An additive-free diet is very healthy but quite hard work. It means making all your own food from 100%

fresh, unmodified produce (you cannot have bacon or ham, and even things like cooked chicken and

ready-to-eat salad can contain some additives; so does most restaurant food). Note that wines, beers

and other alcoholic drinks can contain many additives without declaring them on the label. (German

bottled beer is an exception here.) Baked goods sold unwrapped can also contain many additives without

declaring them.
Stop using toothpaste unless it is an additive-free brand. You can buy such toothpaste from a

health-food shop – or use sodium bicarbonate powder instead. Drink mineral water or filtered water (you

need a good-quality filter for this, not a jug filter).
Medicinal drugs can contain colourings and other additives, so you should try to get additive-free

versions. Talk to your pharmacist about this initially.
Assuming the symptoms clear up, testing can begin, but you will probably need medical help to work out

exactly which additives are at fault. It is difficult to organise these tests at home, because most

foods contain such a mixture of additives.
With chronic urticaria, there is the possibility of quite severe reactions on testing, so medical

supervision is desirable. You can undertake cautious testing with small amounts of tap water, spices

and alcohol at home, but make sure you are in a position to get emergency medical help if you need it.

Aspirin or aspirin-like drugs should not be tested at home. Life-threatening reactions are common in

sensitive individuals, and temporary avoidance can heighten your reaction.