Posts Tagged ‘symptomatic relief’

mepacrine A synthetic antimalarial. Now replaced by chloroquine and other powerful drugs. It is used occasionally in the treatment for Giardia laynblia infections. Dose: 300 mg daily for 5-8 days.
tmeprobamate A mild tranquillizer used Ili anxiety and tension states, but its extended use may lead to dependence. Dose: 1.2-2.4 g daily. Side-effects are drowsiness, headache, gastrointestinal and visual disturbances. It has been largely replaced by benzodiazepine anxiolytics. (Equallil).
meptazinol An analgesic for the relief of moderate to severe pain. It has a more rapid and extended action than morphine, and is less likely to cause respiratory depression or induce dependence.
Dose: 800-1600 nig orally daily. In severe pain, 50-100nig by injection, repeated as required; in obstetric analgesia, 2 nig/kg. The action can be partly antagonized by naloxone. Side-effects include dizziness and nausea. (IMeptid).
rinequitisizine An antihistamine used for the symptomatic relief of allergic states such as haytever and urticaria. It is less likely to Cause sedation than sonic other antihistamines.
Dose: 10 mg daily. Side-effects may include dry mouth and blurred vision. (Prinialan). See page 110 and Table 2.
mercaptopurine A cytotoxic agent used in the treatment of acute leukaemia.
Dose: 2.5 niWkg daily. Close haernatologi,al control is essential, as the drug has .1 marked niyelosuppressive action. \.lercaptopurine is also hepatotoxic, and should be withdrawn if jaundice occurs. (Puri-Nethol). See page 122 and Table 8.
meropenem An antibiotic similar to imipenem. but more resistant to breakdown by renal enzymes, so combined use with an enzyme inhibitor is unnecessary. Dose: given by i.v. infusion in doses of 500 mg-2 g 8-hourly according to the severity of the infection. Care is necessary in hepatic disease. (Meronem).
mesalazine The active metabolite of sulphasalazine. It is not suitable for oral
use as such, but can be given as a resin-drug complex, so that the drug reaches and is released in the colon unchanged. It is used both for the acute attack and for the maintenance of remission of ulcerative colitis, particularly in patients unable to tolerate sulphasalazine.
Dose: 1.2-2.4 g daily. Side-effects include gastrointestinal disturbances, and care is necessary in patients hypersensitive to salicylates. Patients should be advised to report an), bruising, bleeding or malaise. If .a blood dyscrasia is suspected, a [)food count should be done and the drug withdrawn. Lactulose should not be used as a laxative, as it may hinder the release of the active drug. Also used as enema and suppositories. (Asacol; Pentasa; Salofalk). See page 172 and Table 32.
mesna A compound used to prevent the liaemorrhagic cystitis caused by the cytotoxic drugs cyclophosphamide and ifosfamide. The reaction is caused by the metabolite acrolein, and mesna reduces the toxicity by combining with acrolein in the urinary tract.
Dose: 20%, of that of the cytotoxic drug, and should be given at the same time by i.v. injection. Subsequent supportive doses may be given orally or by injection il - 8 hours after therapy. (Uromitexan).
mesterolone An orally active androgen with the actions and uses of testosterone. It is used in androgen deficiency and male infertility but, unlike other androgens, it does not inhibit endogenous androgen production, and is less hepatotoxic. Dose: 75-100 mg daily for sonic months. (I'm Viron).
mestranol An orally active oestrogen present in some oral contraceptive products. See page 264.
metaraminol A sympathornimetic agent that increases the blood pressure by a general constriction of the peripheral blood vessels. It is used mainly in the acute hypotension that may occur with spinal anaesthesia. It has also been used in shock, but the use of vasoconstrictors has declined, as in shock the peripheral resistance may be already high, and the use of blood volume expanders and dopamine and dubotamine is now preferred.
Dose: 15-100 mg 1)), i.v. infusion. Side-effects are tachycardia and reduced renal blood How. It is contraindicated in myocardial infarction. (Aramine).
metformin An orally active biguanide hypoglycaemic agent. Its action differs from that of the sulphonylureas, as it acts by increasing the peripheral uptake of glucose. It is used mainly in non-insulindependent diabetes not controlled by diet and sulphonylurea therapy.
Dose: 1.5-3 g daily according to need and response. Side-effects include nausea and transient diarrhoea. 11 may cause lactic acidosis and it should not be used in patients with renal impairment. (Glucophage). See page 131 and Table 13.
tmethadone A morphine-like analgesic with reduced sedative effects. Ofvalue in severe pain, and in the relief of useless cough in terminal disease.
Dose: 5-10 mg orally or by i.m. or s.c. injection, in intervals according to need. Prolonged treatment carries the risk of cumulative effects and overdose.
(Physeptone).
methenamine See hexarnine.
methionine A sulphur-containing amino acid essential for nutrition. It is used mainly in paracetamol poisoning, often with acetyl cysteine, and given within 10-12 hours.
Dose: 2.5 g 4-hourly up to a total of [0 g.
methocarbamol A skeletal muscle relaxant used in muscle injury and spasm.
Dose: 6g daily orally; 1-3 g daily by slow i.v. injection. It may cause drowsiness, dizziness and allergic rash. Contraindicated in epilepsy and myasthenia gravis. (Robaxin).
methohexitone A short-acting i.v. anaesthetic similar to thiopentone. It is used mainly for the induction and maintenance of anaesthesia for short operative procedures, when the quick recovery may be an advantage. (Brietal).
methotrexate A cytotoxic agent that acts by inhibiting the synthesis of purines, and so indirectly interferes with cell proliferation. It is used chiefly for maintenance therapy in the remission of acute lymphoblastic leukaemia in children, but it has been used in choriocarcinoma as well as some lymphomas and solid tumours.
Dose: in children, I5 mg/in' weekly. It is sometimes effective in resistant psoriasis, and is given in oral doses of 10-25 nig weekly under specialist supervision. It is occasionally used in severe rheumatoid arthritis not responding to other treatment in doses of 7.5 mg once weekly. Side-effects are those of gastrointestinal toxicity, niyelodepression, rash and cirrhosis. Blood counts and liver function tests during treatment are essential. Cough and dyspnea may indicate pulmonary toxicity. Aspirin and non-steroidal anti-inflaniniatory drugs (NSAIDs) should be avoided, as they delay the excretion of methotrexate and increase its toxicity. See page 122 and Table 8.
methotrimeprazine An antipsychotic agent of the chlorpromazine type, with similar actions, Uses and side-effects. It is used in schizophrenia when a sedative effect is also required.
Dose: 25 -50 mg daily, but much larger doses, up to 1 g daily, may be required, particularly for bedfast patients. It is of value as an adjunct to other therapy in terminal illness and is sometimes given by continuous s.c. infusion in doses of 25-200 ing over 24 hours. Postural hypotension may occur in elderly ambulant patients. (Nozinan). See page 168 and Table 30.
methoxamine A sympathomimetic agent that increases the blood pressure by constriction of the peripheral vessels. It is used in the hypotension following spinal anaesthesia; to correct an excessive response to antihypertensive drugs; and to arrest supraventricular tachycardia. Dose: 5-20 mg by i.m. injection; 5-10 mg by slow i.v. injection. Care is necessary in preexisting hypertension and cardiov.iwular disease (Vasoxine).
methyl cellulose A derivative of cellulose that is used as an emulsifying agent and bulk laxative.
Dose: 1.5-6g with water, but not at night. It is sometimes given in diarrhoea, with a minimum amount of water.
methyl salicylate A pale yellow liquid with a characteristic odour. It has long been used as wintergreen liniment and ointment for the local relief of muscle pain and rheumatic conditions, but is now less popular.

methylated spirit Alcohol containing 5% of wood naphtha. Used for skin preparation and alcoholic applications. The methylated spirit used domestically differs, and is coloured violet to indicate its unsuitability for medicinal use.
methylcysteine A sputum-liquefier claimed to be of value in respiratory conditions where the sputum is viscid. Dose: 600 ing daily. (Visclair).
! Met
other pressor amines. It is used mainly in the preoperative control of adrenaline-producing tumours (pliaeochrornocytoma), and in the long-term treatment of patients unsuitable for surgery.
Dose: I g daily initially, increased if necessary up t(') 4g daily. An adequate fluid intake is essential. Side-effects include sedation, which may be marked initially, diarrhoea, which maybe severe, depression and confusion. (Dernser).
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methyidopa A centrally acting antihypertensive drug, usually given together with a diuretic. It has the advantage of being relatively safe in asthma, heart failure and pregnancy.
Dose: 750 ing-3 g daily; 250-500 mg by i.v. infusion. Side-effects are drowsiness, depression and diarrhoea. A systemic lupus crytheinatostis-like syndrome may also occur, and active liver disease is a contraindication. (Alcloinet). See page 148 an(] Table 21.
tmethylphenidate A central stimulant used occasionally under strict supervision for the treatment of hyperactive children. Dose: 5-10 mg daily. Witalin).
metoclopramide A stimulant of gastric and small intestine transport. It is used in the treatment of nausea and vomiting generally, including that induced by drugs or migraine, in non-ulcer dyspepsia, and in accelerating the passage of a barium meal.
Dose: 15-30 ing daily orally or by Lin. or i.v. injection. A single dose of 10-20 mg is given by injection 10 minutes before radiological examination. Side-effects include extra-pyramidal reactions, facial sprints and oculogyric crises, mainly in voting persons, and it is best avoided in patient., under 20 years of age. (Maxolon). Some long-acting products are also available. See page 158 and Table 25.
tmethylphenobarbitone An anticonvulsant with the actions, uses and side-effects of phenobarbitone.
Dose: in epilepsy, 100-600 ing daily. (Prominal). See page 136 and Table 15.
methylprednisolone A corticosteroid with the actions, uses and side-effects of prednisolone, and given in similar doses. (Medrone).
methysergide A synthetic drug related to ergonicirine and used in the prevention of severe and recurrent migraine not responding to other drugs.
Dose: 2-6 ing daily. It is also given fur the symptomatic treatment of the carcinoid syndrome in (loses of 12-20 ing daily. Mcthvsergide has many side-effects, including retroperitoneal and cardiac fibrosis, and its use requires expert supervision. (Des-A-ril)-See page 154 and] able 23.
metipranolol A beta-adrenoceptor blocking agent used as eye drops 0.1-0.6% for the treatment of chronic glaucoma.
metirosine An enzyme inhibitor that interferes with the synthesis of adrenaline and
metolazone A diuretic with the actions, uses and side-effects of bendrofluazide.
Dose: in hypertension, 5 mg daily I p
initially; in oedematous statcs,5-20ingor more daily may be given. The diuresis is increased by combined treatment with a loop diuretic such as ffl,lsemide, but monitoring of the response is necessary. (NIctinex). See page 148 and Table 21.
metoprolol A beta-blocking agent used in the control of angina, but also of value in hypertension and the prophylaxis of migraine.
Dose: in angina, 100-300 mg daily; in hypertension, 100-400 ing daily; in migraine prophylaxis and thyrotoxicosis 200 ing daily. It is occasionally given by slow i.v. injection in acute cardiac arrhythinias; dose 1-2 nighnin tip to a total of 10-15 mg. Care is necessary in heart block, bradycardia and pulmonary disease. (Betaloc; Lopresor). See page 114 and Table 4.
metriphonate An organophosphorus schistosornicide, but used only in infections of the hookworm Schistosonia haemobitim, which is found in the genitourinary veins.

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ethinyloestradiol A synthetic oestrogen formerly used to control menopausal symptoms and other conditions where oestrogen therapy is indicated.
Dose: 10-50 pg daily. It is present with a pi ugestogen in many oral contraceptive products. See page 264 and Table 40.
othosuximide An anticonvulsant for the treatment of petit trial epilepsy (absence seizures). May be used alone, or combined with other anticonvulsants, and it is often of value in patients not responding to other drugs.
Dose: 500 nig daily initially, gradually increased if required, to a maximum of 2 g daily. Care is necessary in renal or hepatic disease. Drowsiness, headache and gastrointestinal disorders are sonic side-effects. (F meside; Zaronlin). See page 136 and Table 15.
etidronate disodium A bisphosphonate used in Paget’s disease of bone, as it slows down the rapid turnover of bone and relieves the pain of that disease.
Dose: 5 nig/kg as a single daily dose between meals for 6 months or more. Side-effects are nausea and diarrhoea; high (loses may increase bone pain and the risks of fracture. (Didronel). Didronel PMO also contains calcium carbonate, and is used in the extended treatment of vertebral osteoporosis. See clodronate and pamidronate.
include nausea, alopecia and myelosuppression. (Vespid). See page 122 and Table 8.
eusol A chlorine antiseptic solution used as lotion, or as compress. The solution should be freshly prepared. Now less popular, thought to be irritant.
evening primrose oil See gamolenic acid.
eye drops Weak solutions of drugs for the treatment of ocular conditions. They may be antibacterial, antifungal or antiviral in action, or maybe used for non-infective conditions such as glaucoma, or for diagnosis. For routine use they are supplied sterile in multiple-application containers, but are intended for individual use only. They contain preservatives, and for home use may be used for up to one month after the container has been opened. In eye Surgery, single application products should be used. Occasionally, enough of a drug may be absorbed from eye drops to have systemic effects, and corticosteroids, if used as eye drops over a prolonged period, may cause’steroid glaucoma’. Care should be taken with contact lenses, and ideally they Should not be worn during eye drop treatment. Soft contact lenses can absorb the preservatives, which may cause irritation.
etodolac A non-steroidal anti-inflammatory agent (NSAID) of the naproxen type, with similar actions, uses and side-effects. Dose: in rheumatoid conditions, 400 mg daily. (Lodine). See page 169 and
Table 29.
etomidate A short-acting i.v. hypnotic used lor the induction of anaesthesia. It causes little cardiac disturbance or hypertension, but muscle movement and pain may
occur during injection.
Dose: 300 pg/kg by i.v. injection.
f Ilypnomidate).
etoposide A cytotoxic agent used in small-cell lung cancer and resistant testicular cancers. It is given in daily doses based on skin area for 5 days, repeated after 21 days according to response.
Dose: 120-240 nighn’ daily orally; by i.v. infusion 60-120 mghn’, and care must be taken to avoid extravasation. Side-effect-,
Factor Vila A recombinant and active form of the blood coagulation Factor VII. The treatment of haemophilia with Factors Vill and IX is complicated by the development of antibodies to those factors. Factor Vila acts as a late stage in the conversion of fibrinogen to fibrin, can function independently of Factors Vill and IX, and does not induce the formation of antibodies. It is used to control serious bleeding in haemophiliac patients and during surgery, under specialist supervision.
Dose: 60-120pg initially by i.v. injection, followed by a second dose after 2-3 hours, then 4-12-hourly as required for
2-3 weeks or more. (NovoSeven).
Factor Vill Haemophilia A is caused by a deficiency of the blood clotting agent Factor Vill, and highly purified preparations of human Factor VIII as well as recombinant forms are used as replacement therapy in doses based on the degree of deficiency of that factor. (Kogenate; Monoclate P; Recombinate).
Factor IX Haemophilia B is due to a deficiency of Factor IX, and preparations of that factor, obtained by monoclonal antibody techniques, are given i.v. in doses based on the degree of efficiency of the factor. (Monomine; Replenine).
famiclovir An antiviral agent similar to acyclovir, and used in herpes zoster (shingles) and genital herpes infections. Dose: 75 mg daily for 7 days. (Panivir). See page 144 and “fable 19.
famotidine An H,-receptor antagonist with the uses and side-effects of cinictidine, but a longer action.
Dose: in benign peptic ulcer, 40 ing at night lor,1-8 weeks; 20 mg at night for the prevention of recurrence, also used in reflex oesophagitis. In Zollinger-Ellison
syndrome, doses of 20 mg 6-hourly are given. ( Pepcid). See page 162 and] *able 27.
pain and inflammation in rheumatoid arthritis and similar conditions.
Dose: 600-900 nig daily. Like other
NSAIDs, it may cause gastrointestinal disturbance and dizziness, but the incidence of rash requires withdrawal of the drug. (Leclet-fen). See page 165;uidfable 29.
fencifibrate A plasma-lipid regulating agent of the clofibrate type, with similar uses and side-effects.
Dose: 300 ing initial]),, with food, later 200-400 mg daily according to need. (Lipantil). See page 146 and Table 20.
fenoprofen A non-steroidal anti-inflammatory and anti-rheumatic agent. It is also used as a mild analgesic in a variety of painful conditions.
Dose: 900 mg-3 g daily. Side-effects include nausea, dizziness, vertigo and rash. (Fenoprofen; Progesic). See page 165 and Table 29.
fenoterol A sympathomimetic agent with the actions, uses and side-effects of salbutamol. Dose: by oral inhalation, 100-200 [Ig (1-2 puffs) up to 4 times a day. (Berotec). See page 118 and Table 6.
Fansidar Pyriniethamine, 25 mg with sulfadoxine 500 mg. Both these antimalarial drugs block the formation of folinic acid in the malarial parasite, but the combination is more effective. Mainly used with quinine in resistant filciparum malaria. (Fansidar is no longer recommended for prophylaxis, as fatalities have followed such use.)
felodipine A calcium antagonist used in the treatment of hypertension generally (see calcium channel blocking agents). Dose: 5 nig daily initially, adjusted to maintenance doses up to to mg daily. ‘I abiets should be taken in the morning, and swallowed whole with water. No adjustment of dose necessary for elderly patients, but care is required in marked hepatic impairment. Hypotension with tachycardia may occur with susceptible patients. (Plendil). See page 148 and Table 21.
felypressin A vasopressin derivative, used as a vasoconstrictor in local anaesthetic solutions for dental use, when sympathetic pressor drugs are contraindicated.
fenbufen A non-steroidal anti-inflammatory agent (NSAID) used for the relief of
fentanyl A narcotic analgesic, used mainly in thiopentone anaesthesia to increase the response and permit a reduction in dose of thiopentone, especially in poor-risk patients. It is also used with droperidol to produce a state of neuroleptanalgesia. Dose: 50-200 pg by i.v. injection.
(Subli niaze). Also used as a patch for the relief of chronic pain. (Durogesic).
fenticonazole An antifungal used in vaginal candidiasis as pessaries of 200 mg. (Lonlexin).
ferrous sulphate, fumarate, gluconate & succinate These iron salts are used in the prophylaxis and treatment of iron-deficiency anaemias. Ferrous sulphate is the standard drug, given in doses of 600 mg daily, but it may cause gastric disturbance in some patients, and ferrous fumarate, gluconate and succinate are better tolerated alternatives. Sonic better tolerated slow-release products are available, but may be less well absorbed. Ferrous sulphate tablets are potentially dangerous for small children, and death has occurred after accidental administration. See desferrioxamine.

fexofenadine An antihistamine with the general properties of that group of drugs. It is less likely to affect the ability to drive. Dose: 120 mg once daily. See
page 110 and Table 2.
fibrinolytic agents Drugs used to break up blood clots, and so are of value in thrombosis. See alteplase, anistreplase, streptokinase and urokinase.
filgrastim A recombinant form of human granulocyte colony stimulating factor (G-CSF), one of a group of natural growth factors concerned with bone marrow activity. It stimulates the development of neutrophils, the production of which is depressed during cytotoxic therapy. The neutropenia thus caused increases the risks of infection, but the neutrophil count can be restored by filgrastim. It is used mainly in the neutropenia associated with the cytotoxic treatment of non-myeloid malignancy. Dose: 500 000 units/kg daily by s.c. injection or i.v. infusion for 14 days, or until the neutrophil count return, to normal. Double doses are given after bone marrow transplanlation.The main side-effects are musculoskeletal pain and dysuria.  See lenograstini and molgrastirn.
His, and is of value in serious ventricular tachycardia and extrasystoles.
Dose: 200-400 mg daily. May he given by slow i.v. injection in doses of 2 iiig/kg in acute conditions resistant to other therapy, and under hospital control. Care is necessary in patients with pacemakers, and in renal impairment. Dizziness and visual disturbances are side-effects. (Tainhocor). See page 141 and Table 18.
flucloxacillin A derivative of cloxacillin, that is absorbed more readily when given orally. It is used mainly in infections due to penicillinase-producing penicillin-resistant staphylococci.
Dose: I g daily before food; by injection 1 -4 g daily, but larger doses arc given in very severe infections. Side-effects are those of the penicillins generally. (Floxapen). See co-fluanipicil.
fluconazole A systemically acting synthetic antifungal agent.
Dose: in oral candidiasis, 50 ing daily for 7-14 days: in vaginal candidiasis, a single dose of 1.50 mg. Dose in systemic candidiasis and cryptococcosis, 200-400 mg daily orally or by i.v. infusion. Side-effects include nausea and abdominal discomfort. Combined treatment with
asternizole, cisapride or terfenadine should be avoided. (Dillucan).
finasteride An inhibitor of the enzyme 5-alpha reductase, and so prevents the conversion of testosterone to dihydrotestosterone, the biologically active form of the male hormone. It is used for the symptomatic relief of benign prostatic hyperplasia, as prolonged therapy promotes a reduction in the size of the prostate gland.
Dose: 5 nig daily for 6 months or more. Side-elfects are reduced libido and impotence. (Proscar). See page 164 and Table 28.
flavoxate An antispasmodic of value in urinary disorders such as dysuria, frequency and related conditions. Dose: 600 mg daily. Side-effects include dry mouth and blurred vision. Contraindicated in glaucoma and bladder obstruction. (Urispas).
flecainicle An orally active anti-arrhythmic
agent of the lignocaine type. It chiefly
influences conduction in the bundle of
flucytosine An antifungal agent used in systemic yeast infections such as candidiasis and cryptococcosis.
Dose: 100-200 mg/kg daily i.v. It may Cause sonic bone marrow depression, and sensitivity tests should be carried out before and during treatment, as resistance to the drug may limit its value. Care is necessary in renal and hepatic inipairmclit. Side-effects include nausea, diarrhoea and rash. (Alcobon).
fludarabine A fluorinated cytotoxic agent used in chronic lymphocytic leukaemia (CI.L) after other treatment has failed. Dose by i.v. infusion 25 mg/in’ for 5 days a nionth. It is generally well tolerated, but myclosuppression may occur as with related drugs. (Fludara).

dimethicone Activated dimethicone is an antifoaming agent, said to reduce flatulence and protect mucous
membranes. It is a constituent of many antacid preparations. It is also present in some water-repellent skin creams.
dipipanana A rapidly acting morphine-like analgesic of value in the sever rain 4 to -1 dk–
Dose: 30-3450 mg (fail),, but it is usually• given in association with cyclizine as Diconal. The side-effects are similar to those of morphine.
dipivefrine A pro-drug that is converted into adrenaline after absorption. It is used
in chronic open angled- glaucoma as eye
drops (0.1%). (Propine). See page 138 and Table 16.
dimethylsulphoxide (DMSO) An organic liquid, it has been used for the symptomatic relief of interstitial cystitis
(Hunner’s ulcer) by the bladder instillation of 50 ml of a 50% solution. (Rimso-50).
dinoprost Prostaglandin F,.. It has actions and uses similar to dinoprostone.
(Prostin 112).
dinoprostone A synthetic form of prostaglandin E,. It has been used to initiate contractions of the pregnant uterus. Dose: 500 pg orally to induce labour, repeated if necessary at hourly intervals; as vaginal tablets or gel, 3 mg. Side-effects are nausea, diarrhoea, shivering and dizziness. (Prostin E2; Prepidil).
dioctyl sodium sulphosuccinate See dOCUSalC.
diodone injection A solution of a complex organic iodine compound, used as a contrast agent in X-ray examination of kidneys and ureters.
diphenhydramine One of the early antihistamines, with a more sedative action, and use(] in the temporary relief of insomnia. Dose: 10-25 trig. (Medinex. Nytol). It is also present in some cough preparations and nasal decongestants.
diphenoxylate A derivative that resembles codeine III reducing intestinal activity. It is used for the symptomatic relief of diarrhoea, and is usually given with a small dose of atropine to discourage excessive dosage and to reduce the risk of dependence. Dose: 10 mg initially, then 5 nig every 6 hours as required. (Lomotil;’Fropergen).
diphenylpyraline An antihistamine used as .I decongestant in colds and sinusitis. Present in Eskornadc.
dipyridamole An inhibitor of thrombus formation by reducing the adhesiveness of blood platelets in the arterial circulation. Dose: 300-600 mg daily before food. s I
ide-effects include nausea, diarrhoea and headache. (Persantill).
disodium cromoglycate See sodium cromoglycatc.
disodium etidronate See etidronate. disodium pamidronate See pamidronate.
disopyramide A quinidine-like drug used in the treatment of cardiac arrhythmias especially after myocardial infarction. Dose: 300-800 mg daily; dose by slow i.v. injection under ECG cover, 2 nig/kg up to 150 mg, followed by oral therapy as soon as possible. By its anticholinergic action care is necessary in glaucoma and prostatic enlargement. Contraindicated in heart block. (Dirythmin; Rythmodan). See page 1;6 and “fable 24.
distigmine An inhibitor of cholinesterase similar to neostigmine but with a longer action.
Dose: in the control of myasthenia gravis 5-20 mg as a single morning dose before breakfast; in urinary retention after surgery, 5 trig daily. It is sometimes used in neurogenic bladder disorders. Side-effects are nausea, abdominal cramp, diarrhoea and weakness. (Ubretid).
disulfiram When taken with even small amounts of alcohol, disulfiram permits the accumulation of acetaldehyde in the body, with side-effects such a flushing, giddiness, vomiting and headache that may be severe. Distilfiram is used in chronic alcoholism, but prolonged treatment and co-operation of the patient are essential.

Dose: after at least 24 alcohol free hours: 800 nig on the first day, falling over 5 days to 100-200 mg daily. Acute confusion may occur if given at the same time as tucLro-
llidazole. (Antabuse).
dithranol Synthetic compound used locally in the treatment of psoriasis. It is a powerful irritant, and treatment should be commenced with a simple ointment or zinc paste containing 0.1% ofdithranol, gradually increased to 1% if well tolerated. Higher concentrations are sometimes used in ’short -contact -time’ therapy.
Dose: 100 mg/m’ by i.v. infusion over
I hour. Rapid and severe hypersensitivity reactions (hypotension, bronchospasm) may occur, and treatment must be irrnediat4y available. Reaction risks may be reduced by premedication with jexalnetha&one given the day before treatment and continued for 5 days. Rash, pruritus and neutropenia may occur, and blood counts and liver function tests are necessary. (Taxotere). See page 122 and Table 8.
docusate A surface-active agent used as a faeces -softening laxative.
Dose: ill, to 500 nig daily. (Dioctyl).
diuretics The most widely used group of diuretics is the thiazides, represented by bendrofluazide (see page 14I ). They act mainly by increasing the excretion of
sodium by inhibiting its re-absorption by the distal tubule of the kidney, and evoke a rapid response which may persist over 12-24 hours, although some, such as chlorthalidone, have a still longer action. They are given in mild cardiac failure, oedema and in hypertension, but in more severe conditions, and in pulmonary occlema, the more powerful ‘loop’ diuretics, such as frusemide, which act at a different point, are preferred. A side-effect of some thiazides is an increase in the excretion of potassium which may require the use of potassium supplements or a change to a potassium sparing diuretic such as trianiterene. Spironolactone, an aldosterone antagonist, is a more powerful diuretic, of value in resistant oedema. Osmotic diuretics such as mannitol are used mainly in cerebral oedema. Simple diuretics such as potas slum citrate arc mainly used to alkalize the urine and promote diuresis in cystitis and similar conditions. See page 141 and Table 18.
dobutamine A sympathomimetic agent similar to isoprenaline, but with a more selective stimulant action on the beta, receptors in the heart. It increases cardiac contractility but is less likely to cause tachycardia. Useful in acute heart failure and cardiogenic and septic shock. Dose: 2.5-5 pg/kg/min by i.v, infusion, carefully adjusted to need. (Dobutr= Posiject). See page 141 and Table 18.
docetaxel A potent cytotoxic agent derived from the Pacific Yew. Used in advanced breast cancer resistant to other therapy.
domperidone An antiemetic that functions as a dopamine antagonist, as it prevents dopamine from reaching the receptors in the chemoreceptor trigger zone (see antiemetics). It is mainly of value in the severe nausea and vomiting caused by cytotoxic drugs, and is also useful in fum clonal dyspepsia. It is of little value in postoperative and travel sickness.
Dose: 10-20 mg 4-8-hourly; 30-60 nig by suppository. Sedative side-effects are infrequent, as domperidone does not cross the blood-brain barrier. (Motilium). See page 77.
donepezil A reversible inhibitor of anti-cholinesterase. Alzheimer’s disease is linked with a deficiency of acetylcholine in the brain, and donepezil may relieve sonic of the symptoms of that disease by increasing brain acetylcholine.
Dose: 5-10 mg at night. Diarrhoea and muscle cramps are side-effects. (Aricept ).
dopamine A sympathomimetic agent with actions and uses similar to dobutamine. Dose: 2.5-10 pg/kg/min by slow i.v. infusion. Careful control ofdose is essential, as dopamine may cause vasoconstriction with higher doses and increase the risk of heart failure. (Intropin). Dopamine is also a central neurotransinifter, and a deficiency is associated with parkinsonism. See levodopa, page 141 and “table 18.
dopexamine A short-acting drug of the dopamine type but with a more powerful action on the 0,-receptors. It is used in heart failure during cardiac surgery.