Posts Tagged ‘tranquillizer’

potassium permanganate Purple crystals, soluble in water. A powerful oxidizing and deodorizing agent used 1:1000 as lotion, 1:10000 to 1:5000 as mouthwash, douche, bladder washout and bath.
povidone-iodine A complex of iodine with an organic carrier. When applied to the skin it slowly releases iodine, and has an extended antiseptic action. Used for local application to the skin and mucous membranes as solution containing the equivalent of 0.75-1 % of iodine.
pralidoxime A reactivator of cholinesterase. Organophosphorus insecticides inhibit that enzyme, and poisoning by such insecticides is an occupational hazard. Their toxicity can be reversed in part by the injection of 2 mg atropine, but the enzyme can be reactivated and muscle power restored by pralidoxime (30 mglkg) given by slow i.v. injection, repeated as required. It is effective only if given within 24 hours of exposure to the insecticide.
pravastatin A blood lipid-lowering agent with the specific enzyme-inhibiting properties of simvastatin, and used in primary hypercholesterolaemia not responding to the other drugs.
Dose: 10 -40 mg daily as a single dose. Side-effects include myalgia, rash and gastrointestinal disturbances. (Lipostat). See page 146 and Table 20.
prazinquantel A schistosomicide of low toxicity, effective against Schistosonia hamratobium, S, mansoni and S. japonicum It is also active against tapeworm. Dose: 10-20nig/kg as a single oral dose. (Biltricide).
prazosin An alpha-adrenoceptor blocking agent and vasodilator used in the treatment of hypertension and congestive heart failure.
Dose: I mg daily initially, increased as required up to a maximum of 20 mg daily. The initial dose may cause marked hypotension, and it should be taken at night, in bed. prazosin is also given in benign prostatic hypertrophy in maintenance doses of 4 mg daily. Side-effects are drowsiness, nausea and postural hypotension. (Hypovase). See page 148 and Table 21.
prednisolone A glucocorticosteroid with the actions and uses of hydrocortisone, but effective in much lower doses. It is often the preferred drug for oral use, and is given in a wide range of conditions including asthma, severe allergic reactions, rheumatoid arthritis, collagen disorders and inflammatory skin conditions. prednisolone is also of value in leukaemia, ulcerative colitis, the nephrotic syndrome, pemphigus, sarcoidosis, myasthenia gravis, haemolytic anaemia, agranulocytosis and other blood dyscrasias. Large doses are given in the immunosuppressive control of transplant surgery. The dose varies with the nature and severity of the condition being treated, and in every case the lowest dose required to evoke an adequate response should be used, after which the dose should be reduced in stages. Dose: in rheumatoid arthritis, 7.5-10 ing daily initially; other conditions may require doses up to 100 mg daily. Dose by i.m. injection 25-100 ing once or twice a week. Asa retention enema, 20 mg to relieve the inflammation of colitis and Crohn’s disease; as eye drops and ear drops, 0.5% solution. The side-effects are those of the corticosteroids generally, and include salt and water retention, hypertension, muscle weakness and peptic ulcer.
prednisone A glucocorticosteroid that is converted to prednisolone in the body, and so has the actions and uses of that drug.
prilocaine A local anaesthetic with the actions, uses and side-effects of lignocaine. (Citanest).
primaquine An antimalarial drug used mainly to prevent a relapse of benign tertian malaria after treatment with chloroquine, as it kills the malarial parasites that may still be present in the liver. Dose: 13 mg daily, for 2-3 weeks after chloroquine treatment. Side-effects are nausea and abdominal pain.

primidone An anticonvulsant used in the treatment of grand mat and psychomotor epilepsy.
Dose: 125nig daily initially, slowly increased as required up to a maximum of 1.5 g daily. Side-effects include drowsiness, nausea, blurred vision and rash. (Mysoline). See page 136 and Table 15.
probenecid A uricosuric agent that
increases the excretion of uric acid, and so is useful in the treatment of gout and hv
I peruncacrina.
Dose: O.5-2 g daily. An adequate fluid intake and an alkaline urine are necessary for the best response. probenecid also delays the excretion of penicillin and sonic cephalosporins, and is given in doses of 2 g daily to raise the plasma level of those antibiotics. Side-effects include occasional nausea, flushing and dizziness. (Benernid). ,See page 140 and Table 17.
procainamide A procaine derivative occasionally of value in the treatment of ventricular arrhythmias.
Dose: till to 50 mg/kg daily. It is also given by slow i.v. injection under E’C.C, control in doses of 25-50 ing/tininute up to a maximum of I g. Side-effects are gastrointestinal disturbances, lever and rash. (Prones(vi).
severe nausea and vomiting, 20 mg orally, or 12.5 mg by deep i.m. injection. It is also used as suppositories of 25 ing. (Stemetil). See page 168 and Table 30.
procyclidine An anticholinergic drug similar to benzhexol, used mainly in the treatment of parkinsonism. Reduces rigidity more than tremor.
Dose: 73-30 mg daily. In acute states it is given by i.m. injection in (loses of-i-10 mg, or 5 mg doses i.v. (Arpicolin; Kernadrin). See page 160 and Table 26.
progesterone The hormone of the corpus luicum, responsible for the preparation of the uterus to receive a fertilized ovum. It is used in dysfunctional uterine bleeding and in the premenstrual syndrome. Dose: 200-400 nig daily per ragina on a cyclic basis. (Cyclogest). Also a constituent of sonic oral contraceptives. See dydrogesteronc and norethisterone.
proguanil hydrochloride A synthetic antimalarial of high potency and low toxicity, used in the prophylaxis and suppressive treatment of malaria, often in association with chloroquine.
Dose: 100-200 rig daily, and continued for 6 weeks after leaving the infected area. (PaILICIrinc).
85
procaine A local anaesthetic now largely replaced by lignocaine.
procaine penicillin An old long-acting loan of penicillin, given together with penicillin G to obtain a high initial blood level. It is now used mainly in early syphilis. Dose: 900 mg daily by Lin. injection for 10 days. (Ificillin).
procarbazine A cytotoxic drug used mainly as part of a multi-drug treatment of Hodgkin’s disease. It is also used to treat other lymphomas no longer responding to other therapy.
Dose: 50 ing initially, increasing to a maxiintini of 300 mg daily. Side-effects include nausea, anorexia and bone marrow depression. Alcohol may cause a disulfiram reaction. (Nitulan). See page 122 and Table 8.
prochlorperazine A tranquillizer with the actions, uses and side-effects of chlorpromazine.
Dose: in schizophrenia, 25-100 Tng daily; in severe anxiety, 15-20 mg daily. In
promazine A tranquillizer with the actions, uses and side-effects of chlorpromazine, but less potent. It is used mainly to
control agitation in the elderly, and in other minor conditions of psychiatric disturbance.
Dose: 50-800 ing daily, adjusted to need .111d response; by injection 25-50 mg. (Sparine).
promethazine A long-acting antihistamine with sedative properties. It is used for the relief of a wide range of allergic conditions, in mild insomnia and for preoperative sedation. It is also of value as an antiemetic in the prophylaxis and treatment of travel sickness, vertigo and drug-induced nausea.
Dose: 25-50 mg daily; 25-100 ing by deep i.m. injection. In anaphylaxis, sometimes given by slow i.v. injection in doses up to 100 mg to supplement previously injected adrenaline. The side-effects are those of the antihistamines generally. (Phenergan). See page 110 and Table 2.

propafenone An anti-arrhythmic agent of the lignocaine type, used in the prophylaxis and treatment ofventricular arrhythmias. Dose: under ECG control 450 ing daily initially, after food, increased at 3-day intervals up to a maximum of 900 mg daily. Side-effects are dizziness, gastrointestinal disturbances and postural hypotension. (Arythniol).
propantheline An anticholinergic agent used as a spasmolytic in gastrointestinal disorders, in urinary frequency associated with bladder neck weakness, and in nocturnal enuresis.
Dose: 45-120 mg daily at least I hour before food. Side-effects include dryness of the mouth and blurred vision. (Pro- Banthine). See page 174 and Table 33.
propofol A non-irritant short-acting i.v. anaesthetic for smooth induction and maintenance of general anaesthesia for up to I hour. Dose: 2-2.5 mgft initially, followed by Supplementary doses of 0.1-0.2
ing/kg1min as required but some local pain may occur. Side-effects include mild hypotension, transient apnoea an([ bradycardia. Recovery is normally rapid and uneventful but delayed recovery, convulsions and anaphylaxis have been reported. Care is necessary in cardiovascular, respiratory or renal impairment. (Diprivan).
propranolol A beta-adrenoceptor blocking agent that reduces the cardiac response to circulating adrenaline and noracircrialine. It reduces the load on the heart during
exercise and stress, and is used in the treatment of angina, coronary insufficiency, cardiac arrhythmias, hypertension, and after myocardial infarction. It also ameliorates the tremor and palpitation of transient anxiety and stress, and is useful ill the prophylactic treatment of migraine. Dose: 160-320 mg daily according to need. In arrhythmias and thyrotoxic crisis, propranolol is given by slow i.v. injection in doses of I ing, repeated up to a maximum of 10 ing. Side-effects are bradycardia, bronchospasni and gastrointestinal disturbances. Care is necessary in renal and hepatic deficiency, asthma is a contraindication. (Inderal). See page 146 and’I'able 21.
propylthiouracil A thyroid inhibitor occasionally used as an alternative to carbiniazole in hyperthyroidism. Dose: 300-450 ing daily.
prostacyclin See epoprostenol.
prostaglandin A generic term applied to a series of closely related hormone-like fatty acid derivatives, originally extracted front the prostate gland, but now prepared
synthetically. Prostaglandins are widely distributed in animal tissues, and have a complex and varying range of biological activity.’rhus they may have a smooth muscle stimulating or relaxant action, pressor, vasodilator, inflammatory or other properties. The anti-inflammatory action of aspirin and related drugs is due to an inhibition of prostaglandin synthesis. See alprostadil, carboprost, dinoprostone and genieprost.
protamine sulphate A simple protein obtained from fish sperm. It neutralizes the anticoagulant effect of heparin, and it is used in controlling the haemorrhage i hat may occur during heparin therapy. Dose: 1% solution i.v. according to need; ling will neutralize 80-100 units of heparin.
prothionamide A second-line antitubercular drug that has been used in resistant tuberculosis. See page 170 and Table 31. It has also been used in the treatment of leprosy.
protirelin The thyrotrophin- releasing hormone (TRH) of the hypothalamus. Dose: in the diagnosis of hyperthyroidism, as a single i.v. dose ol’200 pg. It normally induces a rapid rise in the plasma levels of thyrotrophin, but in thyrotoxicosis that rise does not occur. Side-effects include nausea, flushing, a strange taste and urinary urgency.
protriptyline A tricyclic antidepressant with actions and uses similar to amitriptyline. It is used in depression associated with apathy, as it has some stimulant action. Dose: 15-40 mg daily. Side-effects are cardiovascular distu&nce, rash and photosensitivity. (Concordia). See
page 128 and Table 11.
proxymetacaine A local anaesthetic used as 0.5% drops in ophthalmology. (Oplithaine).
pseudoephedrine A drug very closely related to ephedrine, but now used mainly as a respiratory decongestant. It has been used in nocturnal enuresis, but may cause hallucinations in sonic children.

oxitropium An anticholinergic bronchodilator similar to ipratropium, and used by aerosol inhalation in stable chronic asthma and related conditions.
Dose: 200-300pg (4-6 puffs) daily. . See page 118 and Table 6.

Dose: 1-3 mega-units/min by i.v. infu,ion only, with monitoring. Excessive doses may cause severe uterine contractions with the risk of fetal asphyxiation. (Syntocinon).

oxpentity1fine An aminophyline-like drug used mainly as a vasodilator in periphei at vascular disorders.
Dose: 800-1200 mg. It may cause nausea, flushing and dizziness. Care is necessary in hypotensive states. (Trental).
oxprenoW A beta- ad renoceptor blocking agent with the actions, uses and side-effects of propranolol. It also has anxiolytic properties, and may reduce the symptoms of transient stress such as tremor and palpitations.
Dose: 60-480 mg daily. (Slow- Trasicor). See page 148 and Table 21.
oxybuprocaine A local anaesthetic for ophthalmic use, including tonometry, as a 0.4% solution.
oxybutynin An anticholinergic antispasmodic that promotes relaxation of the detrusor muscle of the bladder.
Dose: in urinary incontinence, 10-20 ing daily; 10 mg daily for children with neurogenic bladder instability. Side-effects are those of anticholinergic drugs generally. (Cystrin; Ditropan). See page 174.
toxycodone A powerful narcotic analgesic with a prolonged action. Used as suppositories of 30 mg in terminal care.
oxypertine A tranquillizer with a chlorpromazine-like action, and used in anxiety neuroses, psychoses and schizophrenic states.
Dose: 30-60 mg daily in anxiety states; up to 300 nig daily in schizophrenia.In higher doses it may cause nausea, dizziness and drowsiness. See page 168 and Table 30.
paclitaxelk’ A new cytotoxic agent originally obtained from the bark of the Pacific Yew. It prevents mitosis and inhibits cell growth by stabilizing microtubule production. It is used by specialists for metastatic ovarian cancer not responding to platinum therapy. Premedication is necessary to prevent severe hypersensitivity reactions. (Taxol). See page 122 and,rable 8.
pamidronate disodium A bisphosphonate with the actions and uses of etidronate. It is used mainly in the hypercalcaemia of malignancy, as it inhibits the development of active osteoclasts.
Dose: by i.v. infusion 10-90 mg or more according to the degree of hypercalcaemia. The initial response may occur within 24-48 hours. Dose in Paget’s disease of bone, 30 nig weekly. Care is necessary in marked renal impairment. (Aredia).
pancreatin A preparation containing the pancreatic enzymes, trypsin, lipase and amylase. It is used to aid the digestion of fats, proteins and carbohydrates in cystic fibrosis and pancreatitis. Some high-strength products have caused fibrotic strictures of the large bowel.
pancuronium A non-depolarizing or competitive muscle relaxant that has little histamine-releasing or cardiovascular action.
Dose: 50-100 pg/kg i.v. initially with Supplementary doses of 10-20 pg/kg as required. (Pavulon).
oxytetracycline (Terramycin). See tetracv-
oxytocin The oxytocic fraction of pituitary extract, but now made synthetically. Used for the induction and maintenance of labour, and to control post-partum haemorrhage, either alone or in association with ergometrinc.
pantoprazoleV A proton pump inhibitor similar to omeprazole, used in peptic ulcer and reflex oesophagitis.
Dose: 40 mg daily with breakfast. The tablets must be swallowed whole with water, and not chewed or crushed. (Proteunfl. See page 162 and Table 27.
papaveretum A preparation of the alkaloids of opium, containing approximately 50% of morphine together with papaverine and codeine. Used mainly by injection, often in association with hyoscine (scopolamine) for premedication. Dose: 7.7-15.4 nig repeated as required.
papaverine One of the alkaloids of opium. It has little analgesic action, and has been used mainly as a smooth muscle relaxant in peripheral vascular diseases. More recently it has been used by intracavernosal injection in the treatment of impotence.
paracetamol A widely used mild analgesic with few side-effects except in large doses. It differs from aspirin in the absence of any anti-inflammatory action.
Dose: 2-4 g daily. Paediatric suppositories of 125 mg are available. Overdose may cause severe liver damage (see acetylcysIcinc).
paraffin A generic name for hydrocarbon mixtures. Soft paraffin is the common ointment base; liquid paraffin is a lubricant laxative. Hard paraffin was used in the wax bath treatment of rheumatic conditions.
paraldehyde A colourless liquid with a strong characteristic odour. It was once used as a chloral-like sedative causing little respiratory depression; now given by deep i.m. injection in status asthinaticus. Dose: 5-10 nil. Occasionally given in similar doses by rectUril, diluted with saline or arachis oil. Discoloured paraldehyde must not be used.
paroxetine A selective inhibitor of sero(011111 uptake in the central nervous system, and indicated in the treatment of depression.
Dose: 20 ing daily, initially in the morning, with food, slowly increased as required to 50 mg daily. It should not be given with any other drug likely to increase serotonin uptake. Side-effects are nausea, drowsiness and insomnia. Extrapyramidal reactions may occur more often with paroxetine. (Seroxat). See page 128 and Table i I.
penciclovir An antiviral agent used as a 1% cream for cold sores (Herpes kabialis). Treatment should be started as soon as possible by applying the cream every 2 hours for 4 days. (Vectavir). See page 144 anti Table 19.
penicillarnine A breakdown product of penicillin which has the power of combining with certain metals to form a water-soluble, non-toxic complex that is excreted in the urine. It is used in Wilson’s disease, which is due to the retention of copper in the body, in poisoning by lead and mercury, in chronic active hepatitis (after the condition has been controlled), in cystinuria, and in severe rheumatoid arthritis in which it has an action similar to that of gold.
Dose: in Wilson’s disease, 1.5-2 g daily before food for sonic months. In chronic hepatitis, 500 mg daily initially, slowly increased over some weeks to 1.25g daily. In rheumatoid arthritis, 125-250 trig daily initially before food, slowly increased at monthly intervals with maintenance doses of 500-750 mg daily. Patients should be warned that the response in rheumatoid arthritis is slow. In cystinuria, 1-3 g daily with adequate fluids, ad iusted later to maintain the urinary cysteine level below 200 mg/I. Dose in heavy metal poisoning, 2g daily. Side-effects include nausea, loss of taste, rash and thrombocytopenia. Blood Counts during treatment are essential and patients should be advised to report most side-effects. A late onset rash may require cessation of treatment. (Distarnine; Pendramine). See page 165 and Table 29.
penicillin, benzyl penicillin, penicillin G I lie first of the antibiotics. It acts by pre venting the development of the bacterial cell wall, but some groups of organisms vary widely in the degree of sensitivity to penicillin, and it is inactivated by penicillinase-producing organisms. Penicillin is inactive orally, and so is given by i.m. injection, but as it is rapidly excreted the action is relatively brief. Derivatives such as procaine-penicillin have a longer action (penicillin V is an orally active derivative). The main side-effect is hypersensitivity, and sensitivity to one penicillin extends to any other penicillin, and may also include sensitivity to the related cephalosporins. High doses of penicillin, especially in patients with renal insufficiency, may occasionally cause cerebral irritation and encephalopathy. Cloxacillin and amoxycillin are derivatives of penicillin active against resistant staphylococci; ampicillin has a wide range of activity against Gram-positive and Gram-negative organisms; piperacillin and ticarcillin are active against Pseudomottas acruginosa.

pentaerythitol tetranitrate A vasodilator with properties resembling those of glyceryl trinitrate, but with a more prolonged action. Used mainly in the prophylaxis of angina as side-effects are relatively infrequent.
Dose: 60-240 mg daily. (Mycardol). See page 114 and Table 4.
pentamidine A synthetic drug used in the treatment ofPneutnocystiscarinii pneumonia in AIDS and other immunocompromised patients, as an alternative to co-trimoxazole.
Dose: 4 nig/kg daily by i.v. infusion for 14 clays or more, or by inhalation of a nebulized solution. Other dosage schemes are used in the treatment of’trypaiiosomiasis and leislunaniasis. Severe reactions, particularly hypotension, may occur, and pentamidine should be used only under expert supervision. (Pentacarinao.
pentastarch A starch-derived plasma substitute used as a 10% solution in burns and septicaemia.
Dose: by i.v. infusion 500 nil-21.. (Haes.
See hetastarch.
tpentazocine A powerful analgesic of the morphine type, but less likely to cause addiction, although dependence may occur with long treatment.
Dose: 100 -400 nig daily after food, up to 360 nig daily by injection. Suppositories of 50 mg are available. Hallucinations ions are an occasional side-effect. It should be
avoided after myocardial infarction as it may increase the cardiac load. Other side effects include dizziness, nausea, tachycardia and rash. It should be avoided in opioid-dependent patients. (Fortral).
pentostatin A potent cytotoxic agent used in hairy cell leukaemia. It is an inhibitor of adenosine deaminase, and may affect RNA synthesis and cause DNA breakdown.
Dose: i.v. under specialist supervision, 4 ing/ni’every other week, continued up to 6 months unless a remission has been achieved. Side-effects include myelosuppression, leukopenia, renal and liver toxicity and rash. Blood counts are necessary during treatment. (Nipent). See page 122.
peppermint oil Aromatic carminative. Dose: 0.2 -0.4 ml. (Colpermin; Nlintec).
pergolide A dopamine agonist with a stimulating action on both D, and D, receptors. It is used in the auxiliary treatment of parkinsonism, and combined treatment may permit a reduction in the dose of levodopa and its side-effects. Dose: 100 jig daily initially, slowly increased at 3-day intervals according to response, with care taken to avoid initial hypotension. Other side-effects include nausea, diarrhoea, confusion and hallucinations. (Celance). See page 160 and
pericyazine A tranquillizer of the chlorpromazine type with similar uses and side-effects. It is used mainly in schizophrenia and severe anxiety states.
Dose: 15-75ingdaily, slowly Y increased according to need up to 300 111g. ( Neulactil). See page 168 and Table 30.
perindopril A long-acting ACE inhibitor used in the control of essential hypertension not responding to other drugs. Dose: initially, it single daily dose of 2 mg (before food), subsequently adjusted up to a maximum of 8 nig daily. Diuretic therapy should first be withdrawn for 2-3 days, and renal function should be assessed before and during treatment. It is also used as supplementary therapy in heart failure in doses of 2-4 ing. (Coversyl). See page H8 and Table 21.
permethrin An insecticide used as 1% cream for head lice, and 5% cream for scabies. (Lyclear).
perphenazine A tranquillizer with the actions, uses and side-effects of chlorpromazine, but it is less sedating, and effective in lower doses.
Dose: psychiatric and antiemetic, 12-24 nig daily. It is sometimes useful in the control of, intractable hiccup. (Fentazin). See page 168 and Table 30.
pethidine A synthetic analgesic with spasmolytic properties. Widely employed as an alternative to morphine for pre- and post-operative use. Of value in obstetrics as it has a less depressant action than morphine on the respiration.

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).
so
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.

gelatin A protein obtained by the hydrolysis of animal tissues. Used orally as nutrient jellies, and specially refined solutions have been used as blood volume expanders (see dextran). (Gelofusine; Haemaccel).
I Gil
nephrotoxic side-effects, and dosage requires care when renal function is inadequate, and also in elderly patients. Gentarnicin is also used locally as cream or ointment (0.3%) and as eye drops (0.3%). (Cidomicin; Genticin).
gemcitabineV A cytotoxic agent related
to cytarabine, but with increased
potency and a longer action. It blocks cancer cell replication by inhibiting DNA synthesis, and may enhance the action of other agents. It is used mainly in the palliative treatment of non-small cell lung cancer.
Dose: 1000 mg/m-’ by slow i.v. infusion over 30 minutes, once a week for 3 weeks, repeated after a rest period. It is generally well tolerated, but a common side-effect is a transient influenza-like reaction. Myelosuppression is less severe than that of related cytotoxic agents. (Gemzar). See page 122 all(] Table 8.
gentian violet See crystal violet.
gestrinone An antiprogestogen used in ctidonictriosis that acts indirectly by suppressing gonadotrophin production. Dose: 2.5 ing twice weekly oil the same day,, each week for o months. Side-effects arc fluid retention, acne and voice changes. ( Dimetriose).
gestronel A synthetic progestogen used in the treatment of breast and endonietrial carcinoma and benign prostatic hypertrophy.
Dose: 200-400 ing i.m. once a week. (Depostat).
51
gemeprost A synthetic prostaglandin used to dilate the cervix uteri in first trimester abortion.
Dose: I mg, as a pessary 3 hours before surgery. Side-effects are mild uterine pain and vaginal bleeding initially, nausea and di.11 I hoc.).
gernfibrozil A plasma lipid regulating agent, with the actions and uses of hez.afibrate and clofibrate.
Dose: 901) ing-1.3 mg daily, with regular checks oil plasma lipid levels. Treatment should be withdrawn after 3 months if the response is unsatisfactory. Gernfibrozil may potentiate the action of oral anticoagulants, the dose of which should be adjusted. Side-effects include nausea, diarrhoea, abdominal pain, rash and dizziness. (Lopid). See page 146 and Table 20.
gentamicin An aminoglycoside antibiotic, active against a wide range of Gram-negative organisms, including Pseudomonas aeruginiosa, as well as against many Gram-positive bacteria, although it is not very active against anaerobic organisms. It is of great value in septicaemia and meningitis, as well as in bacterial endocarditis.
Dose: 2-3 nig/kg daily by i.m. injection or i.v. infusion. In serious or undiagnosed infections, supplementary treatment with a penicillin or metronidazole may be require(]. In common with other arninoglycosides, goitarnicin has ototoxic and
glibenclarnide An orally active hypoglycaenfic agent similar to chlorpropamide. Dose: 5-15 nig daily, according to need and response. (Daonil; Euglucon). See
page 131 and’I'able 13.
gliciazide A sulphonylurea with the actions and uses of chlorpropamide and related drugs.
Dose: 40-320 mg orally. (Diarnicron). See page 131 and Table 13.
glimepiride A sulphonylurea used in non-ill Sidi 11 -dependent (Type 11) diabetes mellitus.
Dose: 2 mg after breakfast, increased ill, to .1 mg daily. Side-effects include
transient visual disturbances, rash and urticaria. (Amaryl). See page 131 and Table 13.
glipizide A sulphonylurea, used like chlorpropamide in diabetes, but effective in much lower doses.
Dose: 5 mg initially, maintenance dose 2.5-40 nig daily. (Glibenese; Minodiab). See page 131 and Table 13.
gliquidone An oral hypoglycaemic agent similar to chlorpropamide. Effective in maturity-onset diabetes.
Dose: I5 ing initially; maintenance dose 40-60 nig daily, but up to 180 mg daily have been given. (Glurenorni). See page 131 and Table 13.

glucagon A hormone of the alpha cells of the pancreas which raises the blood sugar level by mobilizing liver glycogen. Used in acute hypoglycaemia.
Dose: 0.5-1 mg by s.c., i.m. or i.v. iniection. (GlucaGen). Give i.v. glucose if there is no response within 10 minutes.
glucocorticoids Those corticostcroids with an anti-inflammatory action similar to hydrocortisone, as distinct from the mmerailocorticoids, such as fludrocortisone, used in Addison’s disease. Thel, differ in anti-inflammatory potency, and 0.75 mg of dexamethasone is considered equivalent to 20 mg of hydrocortisone. See Table 36.
glucose Also known as dextrose. A readily absorbed carbohydrate present in many
man
sweet fruits, but obtained commercially by the hydrolysis of starch. It is given orally as a dietary supplement; in acidosis; and to raise the glycogen reserves of the liver in hepatic damage. Given by i.v. infusion as a 5% solution, or as a glucose-saline infusion in dehydration and shock, and after surgery until fluids call be taken by mouth.
glutaraldehyde A disinfectant of the formaldehyde type, but with a more rapid and powerful action. Effective against a wide range of organisms, including
viruses. Used mainly for instrument sterilization as a 2% solution. Usually activated before use by the addition of a corrosion inhibitor. Such activated solutions are stable for about 2 weeks. It is also used as a 10% solution for the removal of plantar warts.
glycerin (glycerol) A clear syrupy liquid used as a sweetening agent in mixtures and linctuses. It promotes drainage when applied to inflamed areas, and is used as a paste with magnesium sulphate for boils. It is also used as suppositories for constipation.
Dose: sometimes given orally in doses of ]- 1.5 g/kg in glaucoma and before surgery to lower the intraocular pressure.
glyceryl trinitrate A powerful but short-acting vasodilator used in the control of angina pectoris. See page 114.
Dose: 300, 500 or 600 pg tablets which should be dissolved under the tongue for a rapid response. An aerosol spray (400g per
dose), as well as long-acting tablets are also available. Tolerance may occur with prolonged therapy. Side-effects are a throbbing headache, flushing and tachycardia. It is also used locally for all extended action, particularly at night, as ointment and medicated patches. Also given by i.v. infusion to control hypertension and ischaemia during cardiovascular surgery and in left ventricular failure. Dose: 10-200 pg/min in dextrose-saline. A new use of the drug is as an ointment (0.2%) to promote healing of anal Fissure. See page 1] 4 and Table 4.
glycopyrronium A synthetic atropine-like antispasmodic used for preoperative medication.
Dose: 200-400 pg by Lill. or i.v. injection. I i has the side-effects of anticholinergic drugs such as dryness of the mouth and blurred vision. Contraindicated in glaucoma. (Robinul).
GM-CSF Granulocyte-macrophage colony stimulating factor. See molgramostim. gold therapy See sodium aurothionialate.
gonadotrophins The follicle-stimulating hormone (FSH) and the luteinizing hormone (1-11) of the anterior pituitary gland. They stimulate ovarian development and the production of oestrogens; ill the male LH controls the formation of androgens. See gonadorclin.
gonadorefin A synthetic form of the gonadot roph in -releasing hormone of the pituitary gland (M-111-1). It is used to assess pituitary function.
Dose: 100 pg by i.v. injection normally
rise to a rapid rise in the plasma level of the luteinizingand follicle-stimulating hormones. In amenorrhoea and infertility due to gonadorelin insufficiency, it is given by pulsed s.c. infusion in doses of 1-20pg every 90 minutes, day and night. Treatment for up to 6 months may be required. Side-effects are uncommon. (Fertiloli Relefact). Sonic analogues of gonadorelin are used in remain cancers. See page 122.
goserelin A synthetic analogue of the hypothalamic hormone (LH-RH). It
suppresses the production of testosterone, d
anis used in the treatment of hormone-
dependent carcinoma of the prostate. It is also used in endometriosis and postmenopausal breast cancer.

Dose: 3.6 ing by s.c. injection every 28 days or as an implant. Side-effects include impotence, hot flushes, rash, breast swelling and tenderness. (Zoladex). See page 122 and ‘I able 8.
gramicidin A mixture of antibiotics effective against many Gram-positive organisms, but it is too toxic for syitenii, use. Used topically in infected skin conditions, usually in association with neomycin and hydrocortisone.
granisetron A scrotonin (5—HT) antagonist with a highly selective and powerful antiernetic action mediated by its effects on the 5-4-11′, receptors. It is used in the prevention and treatment of the severe nausea and vomiting induced by potent cytotoxic drugs such as cisplatin.
Dose: I mg I hour before treatment, then I ing twice daily, or by i.v. infusion in doses of 3 mg, repeated up to 3 times over 24 hours. For prophylaxis, a dose of 3 mg should be given before chemotherapy is commenced. Headache, rash and consti pation are common side-effects. (Kytril). See page 158.
griseofulvin An orally effective but slow
acting antifungal antibiotic that is
deposited selectively in the skin, hair and nails. It is used in the systemic treatment of ringworm and other dermatophyte infections of the keratin-containing tissues, but only when local treatment has failed.
Dose: 0.5-1 g daily, but prolonged therapy is required. Side-effects are headache, nausea, dizziness, rash and photosensitivity. 11 may also reduce the effects of oral contraceptives. (Fulcin; Grisovin).
growth hormone See soma(ropin.
guanethidine An anti-hypertensive drug that [)rings about a reduction in blood pressure by blocking transmission in adrenergic nerves, and preventing the release of noradrenaline. It has been used in the treatment of hypertension, often with a thiazide diuretic, but its use has declined as it may cause postural hypotension. Still used as part of combined therapy in resistant hypertension.
Dose: 20 mg daily, increased by 10 ing at weekly intervals according to response, up to 50 mg daily, although sometimes larger doses are required. Dose by i.m. injection,
10-20 nig as required. Diarrhoea, weakness, nasal congestion and bradycardia are common side-effects. (Ismelin). See page 148 and Table 21. Guanethidine is occasionally used as eye drops (1-3%) in glaucoma. (Ganda). See page 138 and Table 16.
guar gum A vegetable gum that, when taken with food, appears to retard the absorption of carbohydrates. It is used in the supplementary treatment of diabetes mellitus.
Dose: up to 15 g daily, usually sprinkled mi food. It is essential that a dose should he taken with an adequate fluid intake, and that the final dose is not taken at bedtime. Side-effects are flatulence and abdominal distension. (Guarem). See page 131 and Table 13.
halcinonide A powerful corticosteroid used iii severe inflammatory skin conditions not responding to other corticosteroids. It is applied sparingly as a 0.1% cream. (Halciderin).
halibut-liver oil A rich source of vitamins A ‘Ind 1).
Dose: 0.2-0.5 mi.
halofantrine An antimalarial, acting at the erythrocytic stage of the life cycle of plasmodium, and useful in chloroquine 01 MUlti-drug resistant malaria.
Dose: 500 nig 6-hourly for 3 doses between meals. Side-effects are nausea, vomiting and diarrhoea. It must not be given with or after mefloquine (risks of fatal arrhythmias). Contraindicated in pregnancy. 0 lalfan).
haloperidol A powerful tranquillizer used in schizophrenia, mania and psychoses. Dose: 5-20 ing daily, up to a maximum of 200 mg, reduced later according to
response. Dose by i.m. injection for rapid control of hyperactive psychotic patients, 5-30 mg initially, followed by 5 ing or more as required. For depot treatment, it is given as haloperidol decanoate, 50-300 mg by deep i.m. injection every 4 weeks. It is also given orally in doses of 500 g twice daily in severe anxiety. Doses of 1.5 nig

clobazam A benzodiazepine tranquillizer with the actions and uses of diazepam, but with reduce(] sedative effects. It is used mainly in the short-term treatment of anxiety.
Dose: 20-30 mg as a single nightly dose. III severe anxiety larger but divided doses niav be given under medical control. It is also useful in the auxiliary treatment of epilepsy. (Frkiuni). See page [ 17 and'i'able.5.
clobetasol A potent corticosteroid used as a cream or ointment (0.05%) in the short-term treatment of severe inflammatory skin conditions not responding to less powerful drugs. The application should be used sparingly as absorption with systematic and local side-effects may occur with excessive or prolonged treatment. (Dermovate).
clobetasone A locally acting corticosteroid, used as a cream or ointment (0.05%) in eczema and inflammatory skin conditions not responding to less potent drugs. (Fumovate).
be withdrawn. Clofibrate may potentiate tile action of oral anticoagulants.
clomiphene An anti-oestrogen used to stimulate ovulation in some types of anovulatory sterility.
Dose: 50 mg daily for 5 days a month, repeated if ovulation does not occur, Its use has resulted in occasional multiple births. If pregnancy does not follow tip to 6 courses, further treatment is of little use. Side-effects are hot flushes, and abdominal discomfort; visual disturbances indicate that treatment should be withdrawn. Contraindicated in hepatic disease and ovarian neoplasm. (Cloinid; Scroplictic).
clomipramine A tricyclic antidepressant with the actions, uses and side-effects of inupramine and related drugs, but with reduced sedative properties.
Dose: 30-150 mg daily orally; up to
150 nog daily by im. injection. (Anafranil). See page 128 and Table 11.
clodronate sodium A bisphosphonate used like etidronate and pamidronate in the hypercalcaemia of malignancy.
Dose: 1.6-3.2 g daily as a single dose
I hour before or after food. May also be given i.v. by infusion as a single daily dose of 300 mg for 7-10 days. Long oral treatment is necessary, and serum calcium and phosphate levels should be checked. Side-effects are nausea and diarrhoea. (Hollefos; Loron).
clofazimine An antileprotic agent given in association with dapsone and rifampicin to prevent the incidence of resistance. Dose: 300 Ing monthly; in lepra reactions, 300 ing daily for 3 months. It may cause discoloration of the urine, skin and lesions. (Lunprcric).
clofibrate A plasma lipid-regulating agent used in hyperlipidaernia in conjunction with dietary measures, to reduce excessive plasma levels of cholesterol and
t riglycerides.
Dose: 2 g daily, with regular checks on plasma lipid levels. Side-effects are transient nausea and abdominal discomfort.
It increases the biliary excretion of cholesterol, and gall stones are a contraindication. A myosins-like reaction may occur in renal impairment, and the drug should
clonazepam A benzodiazepine with a marked anticonvulsant action of value in all types of epilepsy.
Dose: I mg daily initially, increased LIP to 8 nog daily according to need. fit status epilepticus, I mg by slow i.v. injection, but apnoea and hypotension, requiring prompt treatment, may occur. Side-effects include drowsiness, dizziness and irritability and occasionally, paradoxical aggression. (Rivotril). See page 136 and Table 15.
Clonidine A centrally acting antihypertensive pertensive agent, now used less frequently.
Dose: 150-300pg daily initially, increased it required up to 1.2 mg daily. Doses of 150-300 pg have been given by slow i.v. injection. Sudden withdrawal of the drug may provoke a I P
hy ertensive crisis.
(Catapres). Clonidine is also used in doses of 100 pg daily in the prophylaxis of migraine. (Dixarit). The side-effects include sedation, dry mouth, fluid retention and bradycardia. See pages 154 andTible 21.
clorazepate A benzodiazepine tranquillizer with the actions, uses and side-effects of diazepam. Used mainly in the short-term treatment of anxiety.
Dose: 7.5-22.5 mg daily, or it single dose of I  mg at night. (Tranxene). See page 117 and Table 5.

clotrimazole An antifungal agent used local]) in vaginal candidiasis.
Dose: 104-200 mg as vaginal tablets or pessaries for nightly insertion. Also used as a 1% cream, lotion or dusting powder for fungal infections of the skin and cars. Side-effecis are local irritation and erythema. (Canestall).
cloxacillin An acid-stable, semi-synthetic penicillin that is not broken down by the enzyme penicillinase, and so is effective in infections due to penicillin-resistant staphylococci.
Dose: 2 g daily before lbod. In severe infeL bons 250-500mg by injection 6-hourly. Now largely replaced by flucloxacillin. The side-coccus are those of the penicillins generally. (Orbenin).
antibacterial action, but when given with a penicillin the antibiotic is able to
penetrate into the cell without loss of
activity. The combination is of value in    33 infections due to penicillin-resistant penicillinase-producing bacteria, including most staphylococci.
Dose: as amoxycillin 750 mg daily, doubled in severe infections, or 3-4 g daily by slow i.v. injection. The side-effects, are similar to those of arnpicillin, but a posttreatment reaction is cholestatic jaundice. (Augmentin).
co-beneldopa tablets of levodopa and henzerazide. (Madopar). See levodopa.
cocaine A local anaesthetic. Still used occasionally in ophthalmology as a 2% solution, often with homatropine.
clozapine A potent but potentially toxic dopamine-receptor blocking agent used in schizophrenia resistant to other drugs.
Dose: 12.5-50 mg daily initially (with care -risk of hypotension), slowly increased to 300 mg daily according to need. A serious side-effect is neutropenia that may lead to agranulocytosis, and treatment must be
Linder hospital supervision with regular blood monitoring. Patient, doctor and hospital pharmacist must be registered with the Clozaril (clozapine) Patient
Monitoring Service to maintain the necessary strict control of treatment. (Clozaril).
coal tar Tile black viscous liquid obtained from the distillation ofcoal. It is used mainly as Zinc and Tar Paste in psoriasis and atophic eczema.
co-amilofruse tablets of the diuretics ainiloricle and frusemide. (Fruinil; Lasoride).
co-amilozide Tablets of the diuretics amiloride and hydrochlorothiazide. (Moduretic).
co-amoxicla A mixture of clavulinic acid and amoxycillin.The resistance to penicillin by staphylococci and other organisms is due to penicillinases such as beta-lactamase in the bacterial cell wall. Those enzymes inactivate penicillin before it call enter the cell and exert its antibacterial action. Such inactivation can be prevented by inhibitors of beta-lactamase such as clavidanic acid. That acid has no
co-careldopa Tablets of levodopa and carbidopa. (Sinemet). See levodopa.
co-codamol Tablets of codeine and paracetamol.
co-codaprin Tablets of codeine and aspirin.
co-darrthramer Tablets of danthron and poloxamer.
cod-liver oil A rich source of vitamins A and 1). It is used as a dietary supplement to improve general nutrition, promote calcification and prevent rickets.
Dose: 2-10 in[ daily.
codeine One of the alkaloids of opium. It depresses the cough centre and is used in the treatment of useless cough. It also reduces intestinal motility, and is useful in the symptomatic treatment of diarrhoea. It also has mild analgesic properties, and is present with aspirin in co-codaprin and similar preparations. In large doses the constipating action may be a disadvantage. Dose: 10 60 mg.
co-dergocrine A cerebral vasodilator, sometimes used in the treatment of senile dementia.
Dose: 1.5 mg daily, but the response is unreliable. Side-effects include nausea, rash and bradycardia. (Hydergine).
co-dydramol Tablets of dihydrocodeine and paracetamol.

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

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