Formulary by Muhammad Shakeel Talat

ISBN: 978-969-8295-18-9

PREFACE The hospital formulary is being published for the first time by Independent University Hospital in the public interest. It will be provided free of cost to all of the hospital doctors regularly for immediate referral and prescribing medicine which will be available at the hospital pharmacy. It is to facilitate the patients to get hospital medicine. It includes the medicines according to PVMS list. It includes generic names of the medicines. The brand names have been given for simplicity & better compliance by the hospital pharmacy and doctors. It is hoped that it will improve pharmaceutical service of this hospital. The selection of drugs has been done by a team after consultation with all the specialists/Professors of this hospital. It will be updated on yearly basis. We would keep adding to the formulary during the year. The hospital pharmacists will be available to all doctors to discuss the drug uses, abuses & interactions. Please use their help in public interest. We would love to have your views for improvement in this effort, please donâ&#x20AC;&#x2122;t hesitate to suggest changes for the next edition.

Muhammad Shuja Tahir FRCS(Ed), FCPS(Hon) Professor of Surgery and Chairman Independent Foundation Trust March, 2010

CONTENTS

Sr. No.

Description

Page No.

Analgesics

Anti Bacterials

Anti Fungal Drugs

Anti Helminthics

Anti Tuberculous Drugs

Anti Protozoal Drugs

Gastro Intestinal Drugs

Cardiovascular Drugs

Anti Coagulants

Diuretics

Respiratory Drugs

Opthalmological Drugs

Gynaecological Drugs

Anti Allergic Drugs

Intravenous Fluids

Vitamins and minerals

Anti Diabetic Drugs

Vaccines

ENT Preparations

100

Metabolic Agents

102

Anti Epileptics

103

Anaesthetics

107

1- ANALGESICS

ANALGESICS (NON OPIOID) 1.1

PARACETAMOL

Antipyretic inhibits PGE 2 synthesis, no anti-inflammatory properties. INDICATIONS

Mild to moderate pain, pyrexia. CONTRA-INDICATIONS

Hepatic and renal impairment, alcohol dependence. ADVERSE EFFECTS

Adverse effects rare, but rashes, blood disorders, and acute pancreatitis reported. Important: liver damage (and less frequently renal damage). DOSAGE, FORM & STRENGTH Adults;

By mouth 500-1000mg every 4-6 hours to a maximum of 4 g daily: Children: 3 months - 1 years:

1-5 years: 6-12years:

60-120mg QDS 120-250mg 250-500mg

These doses may be repeated every 4-6 hours when necessary (maximum of 4 doses in 24 hours) Available as:

Calpol, Disprol, Duragesic, Kanamol, Panadol, Paracetamol, Provas

Independent University Hospital

FORMULARY 2010

A N A L G E S I C S

1.2. ACETYLSALICYLIC ACID inhibits COX-1 and COX-2. Also anti-platelet action by inhibiting TXA2 INDICATIONS

Pain , Fever, Anti-inflammatory, IHD and Thromboembolic CVA, Prophylaxis and acute treatment CONTRA- INDICATION

A N A L G E S I C S

Acetylsalicylic acid should not be taken by patients suffering from, Active peptic ulceration, Haemophilia allergic to aspirin asthma or in the last three months of pregnancy. < 16 years old (risk of reye`s syndrome, liver and brain damage). ADVERSE EFFECT

Nausea, dyspepsia, heartburn, epigastric discomfort. DOSAGE, FORM & STRENGTH Adults

300-900mg 4 to 6 hourly 75mg once a day for prophylaxis 300mg stat for acute MI or CVA Children:

Not recommended. Available as:

aspirin, Disprin, Ascard, Loprin, Aspro 1.3. MEFENAMIC ACID Mild strength NSAID, unselective COX inhibitor INDICATIONS

Mild to moderate pain in rheumatoid arthritis including juvenile arthritis, oseoarthrosis, and related conditions; dysmenorrhoea, menorrhagia. Independent University Hospital

FORMULARY 2010

CONTRA-INDICATIONS

Ulcerative lesions of gastro-intestinal tract. Inflammatory bowel disease. Renal or hepatic impairment. Aspirin, anti-inflammatory induced allergy. ADVERSE EFFECTS

Drowsiness; diarrhoea or rashes. Thromobocytopenia, hemolytic anaemia. Convulsions in over dosage. DOSAGE, FORM & STRENGTH Adults; Tabs: 500 mg three times daily. Children 6 months-1 year: Susp: 5ml. 2-4 Years: 1ml. 5-8 Years: 15ml. 9-12 Years: 20ml.

All eight hourly for not more than seven days. Available as:

Anapen, Forte, Fengesic, Fenstan, Fonstal, Mefgesic, Meflin, Mefnac, Mefnagen, Mefnax, Mefo-250, Meftan, Mepon, Minacid, Neomef, Neurontin, Novomic, Ponstan 1.4 DICLOFENAC SODIUM Medium strength NSAID INDICATIONS

Acute back pain, post-operative pain, pain in acute trauma and fractures, renal colic. CONTRA- INDICATIONS

Active peptic ulcer. aspirin/anti-inflammatory induced allergy. Proctitis. Independent University Hospital

FORMULARY 2010

A N A L G E S I C S

ADVERSE EFFECTS

Transient epigastric pain, G.I. disturbances, headach, oedema. Rarely blood dysheamopoiesis, peptic ulcer, abnormalities of liver and renal function, skin reaction, pain at injection site. DOSAGE Adults; oral: intramuscular: Intravenous:

50mg TDS, 75mg BD, 100mg OD 75mg in Ampule of 3 ml. 75mg in Ampule of 3 ml in 500ml normal saline

Children over 1 Year;

A N A L G E S I C S

1-3 mg/kg body wt daily in divided doses. Available as:

Athrotec, Artifen, Artinil-K, Beflam Cytopan, Dicloran, Fastaid, Fenac, Mobikare, Motaar, Voren, Sofac. Voltral 1.5 IBUPROFEN NSAID, Inseletive COX inhibitor, As well as (mild) antiinflammatory, it also has anti-pyrexial and analgesic properties. INDICATIONS

Musculoskeletal Pain, Fever Rheumatiod arthritis, juvenile rheumatoid arthritis, (JRA), ankylosing spondylitis, osteoarthritis, spondylitis, osteoarthritis, seronegative arthropathies, periarticular disorders, soft tissue injuries. Mild to moderate Gynecological pain. CONTRA INDICATIONS

Active peptic ulcer, aspirin/anti-inflammatory induce allergy. ADVERSE EFFECTS

G.I. upset or bleeding, rash. Rarely thrombocytopenia. Rarely aseptic meningitis. Independent University Hospital

FORMULARY 2010

DOSAGE Adults;

1200-1800 mg daily in divided dose. Maximum 2400mg daily. Children;

Usually, 20mg/kg body-wt. Upto 40mg/kg daily. Dose should not exceed 500mg daily for children weighing less than 30kg. Available as:

Brufen, Dolofen,Dolofam, Ibuprofen, Profen, Zefen 1.6 INDOMETHACIN Medium strength NSAID, unselective COX inhibitor INDICATIONS

Especially ankylosing spondylitis, RA, Pain and moderate to severe inflammation in rheumatic disease and other acute musculoskeletal disorders; acute gout; dysmenorrhoea; closure of ductus arteriosus. CONTRA INDICATIONS

Acute peptic ulcer, history of G.I.T. lesions, aspirine or antiinflammatory induced or allergy. Pregnancy and lactation. ADVERSE EFFECT

Frequently gastro-intestinal disturbances including diarrhoea, headache, dizziness and light-headedeness, gastro-intestinal ulceration and bleeding. Blurred vision, corneal deposits, peripheral neuropathy. On rectal administration, prritus, discomfort & bleeding. DOSAGE, FORM & STRENGTH oral: 25-50mg QDS

100gm BD (maximum dose 200mg daily). 100 mg at night and in the morning if required. Combined oral and rectal treatment: maximum total daily dose Rectal suppositories:

Independent University Hospital

FORMULARY 2010

A N A L G E S I C S

150-200mg. Available as:

Anglocid, Indacin, Indocin, Liometacen, Methacid 1.7 NAPROXEN NSAID, unselective COX inhibitor INDICATION:

RA musculoskeletal pain, Post Operative pain, acute gout, dysmenorrhoea, ADVERSE EFFECT

A N A L G E S I C S

G.I upset, G.I bleeding, rash, Thrombocytopenia DOSAGE, FORM & STRENGTH

250-500mg B.D Available as:

Apranax, Dolosyn, Flexin, Naprosyn, Naprox, Proxen, Synflex 1.8

PIROXICAM

INDICATIONS

Rheumatoid arthritis, osteoarthrosis, ankylosing spondylitis, acute musculo-skeletal disorders, acute gout, juvenile chronic arthritis (JCA). CONTRA-INDICATIONS

Aspirin. Anti-inflammatory induced allergy. Active peptic ulcer, history of recurrent ulceration. ADVERSE EFFECT

G.I. disturbancees, skin reactions, oedema,CNA effects, malaise, tinnitus. DOSAGE, FORM & STRENGTH Adults;

40-200mg daily as a single dose. Independent University Hospital

FORMULARY 2010

Children over 6 years; JCA only; under 15kg,

5mg; 16-25kg, 10mg; 26-45 kg, 15 mg;

over 46kg, 20mg. Available as:

Brexin, Feldene, Mobicam, Roxicam, Weldene

ANALGESICS (OPIOID) 1.9

CODIENE PHOSPHATE

INDICATIONS

Mild to Moderate Pain, Diarrhoea, Cough ADVERSE EFFECTS

Nausea, Vomiting, Constipation, Drowsiness, Respiratory Depression, Hypotension DOSAGE

30-60mg QDS Available as:

Codogesic,Napadoc, Paineze, Paracod, Paracodeine, Tocor, Forte 1.10

MORPHINE HYDROCHLORIDE OR SULPHATE

INDICATIONS

Acute pulmonary oedema: peri-operative analgesia, acute MI. CONTRA-INDICATIONS

Avoid in raised intra cranial pressure or head injury (in addition to interfering with respiration, it affects pupillary responses vital for neurological assessment). ADVERSE EFFECTS

Nausea and vomiting (particularly in initial stages). Constipation, and drowsiness; larger doses produce respiratory depression and hypo tension; other side-effects include difficulty in micturition. Ureteric or biliary spasm, dry mouth bardycardia, hypo tension, Independent University Hospital

FORMULARY 2010

A N A L G E S I C S

hypothermia, hallucinations, mood changes, utcaria and pruritus. DOSAGE, FORM & STRENGTH

5-50mg sub cutaneous / intramuscular 4 hourly. 2.5-10mg intravenously 4 hourly. Adults;

5-50mg sub cutaneous / intramuscular 4 hourly. 2.5-10mg intravenously 4 hourly. Children upto 1 month;

A N A L G E S I C S

150 micrograms/kg 1-12 months 200 micrograms/kg. 1-5 Years: 2.5-5mg. 6-12 Years: 5-10mg. Slow intravenous injection; quarter to half corresponding. intramuscular dose. Myocardial infarction, by slow intravenous injection (2mg/minute).

10 mg followed by a further 5-10 mg if necessary ;elderly or frail patients, reduce dose by half. Acute pulmonary oedema, by slow intravenous injection (2mg/minute). 5 mg. Chronic pain, by mouth or by subcutaneous or intramuscular injection, 5-20 mg regularly every 4 hours; dose may be increased according to needs. Oral dose: should be approximately double corresponding intramuscular dose and triple to quadruple corresponding intramuscular diamorphine dose. By rectum, as suppositories, 14-30 mg regularly every 4 hours. Available as:

Magnus, Mr Morphine, Mst Continus

Independent University Hospital

FORMULARY 2010

2- ANTI BACTERIALS 2.1

BENZYLPENICILLIN

INDICATIONS

Throat infections, otitis media, streptococcal endocarditis, meningococcal and pneumonia; prophylaxis in limb amputation, in rheumatic fever, in splenectomy and sickle cell disease. CONTRA-INDICATIONS

Penicillin hypersensitivity ADVERSE EFFECTS

Hypersensitivity reactions including urticaria, fever, joint pains; angioedema; transient leucopenia and thrombocytopenia; anaphylactic shock in hypersensitive patients; diarrhoea after administration by mouth. DOSAGE, FORM & STRENGTH Inj: 600mg=(1 million iu)in vial base. Adults; By intramuscular

or by slow intravenous injection or by infusion. 1.2 g daily in 4 divided doses, increased if necessary to 2.4g daily or more. Premature infant and neonate;

50mg/kg daily in 2 divided doses; infant 1-4 weeks, 75 mg/kg daily in 3 divided doses. Children 1 month-12 years;

100mg/kg daily in 4 divided doses. Available as:

Benzyl, Pencillin, Benzyl Pencillin Polybiotic

Independent University Hospital

FORMULARY 2010

A N T I B A C T E R I A L S

2.2

AMPICILLIN (Anhydrous, Thrihydrate, Sodium)

INDICATIONS

Urinary-tract infections, otitis media, sinusitis, chronic bronchitis, invasive salmonellosis, gonorrhoea. CONTRA- INDICATIONS

Penicillin hypersensitivity ADVERSE EFFECTS

A N T I B A C T E R I A L S

Nausea, diarrhoea; rashes (discontinue treatment); rarely, pseudo membranous colitis. DOSAGE, FORM & STRENGTH Cap or Tab: 250mg; 500mg Susp: 125mg/ml, 250mg/ml (base) Inj: 500mg in vial (base) Adults; By mouth, 0.25-1 g every 6 hours, at least 30 minutes Children under 10 Years;

Any route, half adult dose. Available as:

Omnipen, Pencit, Ampi-plus, Wilclox 2.3

AMOXYCILLIN

INDICATIONS

Respiratory, ENT, UTI and Soft tissue infections. Gonorrhoea. Dental abscess adjunct to surgical management. Prophylaxis of bacterial endocarditis. CONTRA-INDICATIONS

History of previous hypersensitivity reaction to penicillin and /or cephalosporins. Do not inject parenteral solutions into or near an artery or nerve.

Independent University Hospital

FORMULARY 2010

ADVERSE EFFECTS

Anaphylaxis. Glossitis, Stomatitis, gastritis, sore throat, dry mouth, furry tongue. Anemia. Hemorrhagic manifestation. Interstitial nephritis (e.g oligurea, hematuria), Nephrotoxicity. DOSAGE, FORM & STRENGTH Cap: 250mg, 500mg Inj: 250mg, 500mg Susp: 125mg/5ml, 250 mg/5ml Caps/Drops/Syp:

A N T I

Adults;

250-500mg three times daily. Children:

125mg 3 times daily single 3gm dose one hour before dental peocedure from which bacteraemia may arise. Repeat 6 hours later if necessary. Prophylaxis of endocarditis:

Available as:

Amoxicillin, Wymox, Amoxil, Ospamox, Supramox 2.4

FLUCLOXACILLIN

INDICATIONS

Staphy lococcal infections, otitis externa, pheumonia, cellulitis, impetigo, osteomyelitis CONTRA-INDICATIONS

history of previous hypersensitivity ADVERSE EFFECT

Cholestatic jaundice, Anaphylaxis, Glossitis, Stomatitis, gastritis, sore throat, dry mouth DOSAGE

250mg-500mg QDS maximum dose 8mg daily Independent University Hospital

FORMULARY 2010

B A C T E R I A L S

Available as:

Bactoxyl, Biflocin, Delflox, F-Clox, Flomoxin, Flucomox 2.5 CO-AMOXICLAV Mixture of amoxicillin and clavulanic acid. INDICATIONS

Respiratory tract infections, genito-urinary infections, abdominal infections cellulitis

A N T I

CONTRA-INDICATIONS

H/O Penicillin hypersensitivity ADVERSE EFFECT

hepatitis, cholestatic jaundice DOSAGE

B A C T E R I A L S

less than 40kg; more than 40kg;

250mg / 125 TDS 500mg / 125 TDS Available as:

Augmentin, calamox 2.6 CEPHALEXIN First generation cephalosporin INDICATIONS

Septicaemia; endocarditis; UTI, respiratory tract, skin and soft tissue infections. CONTRA INDICATIONS

Impaired renal function. ADVERSE EFFECTS

Hypersenseitivity reactions. G.I. disturbances, convulsions, eosinophilia, neutropenia, leucopenia, rise in liver enzymes and blood urea. Positive Coombs test. Independent University Hospital

FORMULARY 2010

DOSAGE FORM & STRENGTH Adults;

250mg 6 hourly or 500mg 8 hourly. By intramuscular injection or intravenous injection or infusion, 0.5 g every 6-12 hours. Children;

25-50 mg/kg daily (in divided doses), increased to 100 mg/kg daily in severe infections. Available as:

A N T I

Ceporex, Keflex, Zafalexin 2.7 CEPHRADINE First generation cephalosporin INDICATIONS

Infections of respiratory and gastrointestinal tracts and of skin and sofl tissues, bones and joints. Septicaemia, endocarditis, prophylaxis in surgery. UTI. CONTRA-INDICATIONS

Hypersensitivity to cephalosporins or related antibiotics. ADVERSE EFFECTS

G.I. disturbances (nausea, vomiting, diarrhoea) and hypersensitivity pneumonia. Eosinophilia, transient neutropenia. leucopenia, thrombocytopenia. Elevated SGOT and SGPT. Mild elevation in BUN. Headache, dizziness and paraesthesia. Fever and dyspnea. DOSAGE, FORM & STRENGTH Cap: 250mg Susp: 125mg/5ml Adults;

1 -2gm daily in 2 or 4 divided doses; (max, 4 gm daily). Independent University Hospital

FORMULARY 2010

B A C T E R I A L S

Children;

25-50 mg/kg daily in 2 or 4 divided doses; (maximum 4 gm daily). Available as:

Velosef, Infexin, Cephride 2.8 CEFACLOR Second generation cephalosporin INDICATIONS

A N T I

infections due to sensitive gram positive and gram-negative bacteria. CONTRA-INDICATIONS

cephalosporin hypersensitivity. ADVERSE EFFECT

B A C T E R I A L S

diarrhoea, nausea, vomiting, abdominal discomfort, headache, Allergic reactions. DOSAGE

250-500mg 8H Maximum 4gm daily. Available as:

Ceclor, Acef, Cefalor 2.9 CEFUROXIME Second generation cephalosporin INDICATIONS

infections due to sensitive gram positive and gram-negative especially haemophiles influenzas and neisseria gonorrhoea. CONTRA-INDICATIONS

cephalosporin hypersensitivity. ADVERSE EFFECT

diarrhoea, nausea, vomiting, abdominal discomfort, headache, Independent University Hospital

FORMULARY 2010

Allergic reactions. DOSAGE oral: intravenous: Prophylaxis:

250mg BD 750mg TDS 1.5gm single dose Available as:

Zinacef, Zinnat, Roxat, Roxime, Cefroxil 2.10 CEFTAZIDIME SODIUM Third generation cephalosporin INDICATIONS

Infections of the lower respiratory tract, skin and soft tissue. Septicaemia. Severe infections in immunocompromised patrients. UTI and gonorrhoea. CONTRA-INDICATIONS

Cephalosporin hypersensitivity, prophyria. ADVERSE EFFECTS

Hypersensitivity reactions. G.I. disturbances, eosinophilia, neutropenia, leucopenia, thrombocytopenia, rise in liver enzymes and blood urea. Positive Coombs test. DOSAGE, FORM & STRENGTH Inj: 500mg/lg Adults;

By deep intramuscular or slow intravenous injection or by intravenous infusion, 1-2 g every 8-10 hour increased in severe infections up to 8gm daily, in 3 divided doses. Children over 3 months;

30-60 mg/kg daily in 2-4 divided doses, increased to 100-150 mg/kg daily for sever infections. Independent University Hospital

FORMULARY 2010

A N T I B A C T E R I A L S

Available as:

Fortum, Cefcom, Epocef 2.11 CEFTRIAXONE Third generation cephalosporin INDICATIONS

Severe respiratory and genitourinary tract, bone and joint, abdominal infections, sepsis, meningitis, Surgical prophylaxis.

A N T I B A C T E R I A L S

CONTRA- INDICATIONS

Cephalosporin hypersensitivity; porphyria. ADVERSE EFFECTS

Diarrhoea and rarely pseudo membranous colitis, nausea and vomiting. Allergic reactions including rashes, pruritus, urticaria, serum sickness-like reaction with rashes, fever and arthralgia, and anaphylaxis; erythema multiform , toxic epidermal necolysis reported; eosinophilic and rarely thrombocytopenia or neutropenia; disturbances in liver enzymes, transient hepatitis and cholestatic jaundice; other side-effects reported include reversible interstitial nephritis, hyperactivity,nervousness, sleep disturbances, confusion, hypcrtonia, and dizziness. DOSAGE, FORM & STRENGTH Inj: 250mgf 500mg, IG Adults; By intramuscular injection, or by intravenous injection over 2-4 minutes, or by intravenous infusion, 1g daily as a single dose; 2-4

g daily as a single dose in severe infections; 20-50mg / kg daily. 20-80mg / kg daily.

Neonates: Children:

Surgical prophylaxis, 1 g as a single dose. Available as:

Rocephin, Norbac, Oxidil, Unitrixone, Fortexone, Trophin Independent University Hospital

FORMULARY 2010

2.12 CEFOTAXIME SODIUM Third generation cephalosporin

INDICATIONS

Infections of the respiratory tract, kidney, urinary tract and reproductive organs, including gonorrhoea, septicaemia, endocarditis, meningitis. Infections of bone joint, soft tissues and skin. Abdominal infections of ear and tliroat. Infected burns and wounds. CONTRA- INDICATIONS

Hypersensitivity to cephalosporins. ADVERSE EFFECTS

Pain at injection site, hypersensitivity reactions. G.I. disturbances, candidiasis, thrombocytopcnia, rise in liver enzymes and blood urea. Positive coomb's test. DOSAGE, FORM & STRENGTH Inj: 250mg, 500mg, Ig. Adults;

1 gm intravascular or intramuscular every 12 hours; serious infections, 3-6 gm daily in three or four divided doses; (max 12 gm daily). Use 2 gm by IV route. Neonates: 50mg/kg daily; Children: 100-150mg/kg daily. Both in two to four divided doses; max 200mg/kg daily. Available as:

Cefotax, Claforan, Zafixime 2.13

CIPROFLOXACIN

INDICATIONS

Gram-negative and Gram-positive infections, enteric fever, respiratory infection(except pneumococcal), UTI.

Independent University Hospital

FORMULARY 2010

A N T I B A C T E R I A L S

CONTRA-INDICATIONS

Children and growing adolescents except where benefits exceed risk. Pregnancy and lactation. ADVERSE EFFECTS

A N T I B A C T E R I A L S

G.I. disturbances. Dizziness, headache tremors, confusion, convulsions, sleep disorders, rashes, photosensitivity, joint pain. Judgement may be impaired. Transient increase in serum creatinine level. Haematological. hepatic and renal disturbances, vasculitis. pseudo membranous colitis, haemorrhagic bullae. Stevens-Johnson and Lyells syndrome, visual disturbances, transient hearing loss, tenosynovitis. Impaired taste, smell and tachycardia. DOSAGE, FORM & STRENGTH Tab: 250mg. 500mg. Inj: 250mg/100ml. Adults; By mouth,

250-750 mg twice daily. 500mg may be required in resistant cases. Most other infections, 500-750mg twice daily. By intravenous infusion, Prophylaxis of meningitis,

(over 30-60 minutes), 200 mg twice

daily. Urinary-tract infections, 100mg twice daily. Gonorrhoea, 100mg as a single dose. Children;

It is not recommended but where benefit outweighs risk, by mouth, 7.5-15 mg/kg daily in 2 divided doses or by intravenous infusion, 5-10 mg/kg daily in 2 divided doses.

Independent University Hospital

FORMULARY 2010

Available as:

Ciprocide, Ciproxin, Novidat, Mercip, Hipro 2.14

OFLOXACIN

INDICATIONS

UTI, lower respiratory tract infections, gonorrhoea and nongonococcal unethritis cerricitis. CONTRA-INDICATIONS

Children and growing adolescents except where benefits exceed risk. Pregnancy and lactation. ADVERSE EFFECT

transient hypotension anxiety, unsteady gait, neuropathy DOSAGE

A N T I

200-400mg BD Available as:

Tarivid, Oflox, Oflomed, Tariflox 2.15

LEVOFLOXACIN

INDICATIONS

active against gram-positive and gram-negative organism, community acquired pneumonia. CONTRA-INDICATIONS

Children and growing adolescents except where benefits exceed risk. Pregnancy and lactation. ADVERSE EFFECT

FORMULARY 2010

B A C T E R I A L S

Stevens-Johnson and Lyells syndrome, visual disturbances, transient hearing loss, tenosynovitis. Impaired taste, smell and tachycardia. DOSAGE

250-500mg BD Available as:

Dynaquin, Effiflox, Levofloxa, Qumic, Zevo

A N T I B A C T E R I A L S

2.16

NALIDIXIC ACID

INDICATIONS

Urinary tract infections. Gastro-intestinal infections due to GramNegative orgaisms. CONTRA-INDICATIONS

History of convulsive disorders. Porphyria. ADVERSE EFFECTS

G.I., CNS and visual disturbances. Skin rashes, blood dyscrasias, convulsions, photosensitivity, intracranial hypertension. DOSAGE, FORM & STRENGTH Tab: 500mg - 1000mg 4 times daily. Available as:

Negram, Uridix, Urixin 2.17

NORFLOXACIN

INDICATIONS

Cystitis, Pyelitis, Cytopyelitis, polynephritis, specially infections caused by multiple resistant problem organisms. Typhoid/paratyphoid fever and acute gastroenteritis. CONTRA-INDICATIONS

Pregnancy, lactation. Prepubertal children and growing adolescents. Independent University Hospital

FORMULARY 2010

ADVERSE EFFECTS

Nausea, headache, dizziness, rash, heartburn, abdominal cramps, diarrhoea, anorexia, sleep disturbances, anxiety, irritability, convulsions, hypersensitivity reactions, confusions, paraesthesia, hemolytic anaemia, pancreatitis, hepatitis, photosensitivity; avoid excessive sunlight.

DOSAGE, FORM & STRENGTH Tab: 400mg Adults; Urinary tract infections, 1 tab twice daily. Typhoid/paratyhoid fever and acute gastroenteritis,

1 tab thrice daily for 14 days. Children;

Not recommended. Available as:

Noroxin, Utinor 2.18

DOXYCYCLINE

INDICATIONS

PID, Pneumonia; respiratory, gastro- intestinal tract, soft tissue, ophthalmic and urinary tract infections. CONTRA-INDICATIONS

Latter half of pregnancy. Lactation. ADVERSE EFFECTS

Tooth discolouration, enamel hypoplasia, reduced fibula growth rate. Avoid use in children under 8 years, in pregnancy and lactation

unless no alternative. G.I. disturbances. Allergic reactions and Superinfections. DOSAGE, FORM & STRENGTH Cap or tab: 100mg Inj: 100mg in vial. Independent University Hospital

FORMULARY 2010

A N T I B A C T E R I A L S

Adults;

200mg with food or fluid on the first day, then l00mg daily. IV 200mg first day in one or two infusion. Available as:

Vibramycin, Wellcodox, Supramycin-100 2.19

ERYTHROMYCIN

INDICATIONS

A N T I B A C T E R I A L S

Alternative to penicillin in hypersensitive patients; campylobacler enteritis, pneumonia, legionnaires' disease, syphilis, nongonococcal uretluitis, chronic prostatitis, acne vulgaris; diphtheria and whooping cough prophylaxis. CONTRA-INDICATIONS

Porphyria; contra-indicated in liver disease ADVERSE EFFECTS

Nausea, vomiting, abdominal discomfort, diarrhoea after large doses. Urticaria, rashes and other allergic reactions. Reversible hearing loss also reported after large doses; if given for more than 14 days may occasionally cause cholestatic jaundice. DOSAGE, FORM & STRENGTH Cap or tab: 250mg; 500mg Susp: 200mg/5ml. Adult and Children over 8 years; By mouth: 250-500mg

every 6 hours or 0.5 -1g every 12 hours; Maximum 4 g daily.

Children upto 2 years; 125 mg every 6 hours, 2-8 years: 250 mg every 6 hours, By intravenous infusion. Adult and Children; Severe infections, 50 mg/kg daily by continuous

infusion

or in divided doses every 6 hours; Independent University Hospital

FORMULARY 2010

Available as:

Erythrocin, Erybron, Trycin 2.20

GENTAMICIN

INDICATIONS

Septicaemia and neonatal sepsis; meningitis and other CNS infections, biliary tract infection, acute pyelonephritis or prostatitis, endocarditis caused by Strep, Viridans or strep. Faecalis (with a penicillin). CONTRA-INDICATIONS

Pregnancy, myasthenia gravis ADVERSE EFFECTS

Vestibular and auditory damage, nephrotoxicity; rarely, hypomagnesaemia on prolonged therapy, pseudo membranous colitis. DOSAGE, FORM & STRENGTH Inj: 80mg/2ml Adults; By intramuscular or by slow intravenous injection

over at least 3 minutes or by intravenous infusion, 2-5mg/kg daily (in divided doses every 8 hours). In renal impairment the interval between successive doses should be increased to 12 hours when the creatinine clearance is 30-70 ml/minute, 24 hours for 10-30 ml/minute, 48 hours for 5-10 ml/minute, and after twice-weekly dialysis for less than 5 ml/minute. 3mg/kg every 12 hours. 2mg/kg every 8 hours.

Children up to 2 weeks; 2 weeks -12 years;

Available as:

Genticyn, Refobacin

Independent University Hospital

FORMULARY 2010

A N T I B A C T E R I A L S

2.21

LINCOMYCIN

INDICATIONS

Serious Sensitive Infection, Gram positive Cocci, Joint and bone infections. CONTRA-INDICATIONS

Clindamycin sensitivity ADVERSE EFFECTS

Persistent diarrhoea, colitis; discontinue immediately

A N T I

DOSAGE, FORM & STRENGTH Cap: 600mg Inj: 600mg Syrup: Adults;

B A C T E R I A L S

600mg three or four times daily. 0.6-4.8gm in divided daily dose. Children under 1 month;

Not recommended. Available as:

Lincocin, Mincomycin, Omicin 2.22

METRONIDAZOLE

INDICATIONS

Anaerobic infections, protozoal infections CONTRA-INDICATIONS

Hepatic encephalopathy, CNS disorders. Pregnancy, lactation. ADVERSE EFFECTS

Nausea, vomiting, unpleasant taste, and gastro- intestinal disturbances; rashes, urticaria and angioedema; rarely drowsiness, headache, dizziness, ataxia, and darkening, of urine; on prolonged or intensive therapy peripheral neuropathy, transient epileptiform seizures, and leucopenia. Independent University Hospital

FORMULARY 2010

DOSAGE, FORM & STRENGTH Tab: 200mg, 400mg. Inj: 500mg in 100ml vial

Adult; Anaerobic infections

(usually treated for 7 days), by mouth, 800mg initially then 400mg every 8 hours; by rectum, 1g every 8 hours. by intravenous infusion, 500mg every 8 hours. Children; 1-3 Years: 3-7 Years: 7-10 years:

50mg every 8 hours for 3 days. 100mg every 12 hours. 100mg every 8 hours.

Acute dental infections,

by mouth, 200mg every 8 hours for 3-7

days. by mouth, 4mg every 8 hours started 24 hours before surgery, then continued postoperatively by intravenous infusion, 500mg shortly before surgery then every 8 hours untill oral administration can be started. 7.5mg/kg every 8 hours. Surgical prophylaxis,

Available as:

Flagyl, Klint, Diazol, Metrozil 2.23

OXYTETRACYCLINE HYDROCHLORIDE

INDICATIONS

Oxytetracycline sensitive infections, by chlamydia. CONTRA-INDICATIONS

Latter half of pregnancy. Avoid use in children under 8 years, in pregnancy and lactation unless no alternative. ADVERSE EFFECTS

Tooth discolouration, en hypoplasia, reduced fibula growth rate. GI disturbances. Allergic reactions, Superinfections. Independent University Hospital

FORMULARY 2010

A N T I B A C T E R I A L S

DOSAGE, FORM & STRENGTH Cap: 250mg Susp: 125mg / 5ml Adults: 250-500mg four times daily. Children: 25-50mg/kg daily in four divided doses. Available as:

Terramycin,Oxytetracycline

A N T I B A C T E R I A L S

2.24

CO-TRIMOXAZOLE

INDICATIONS

Invasive salmonellosis, Typhoid fever, bone and joint infections due to Haemophilus Influenzae, urinary-tract infections, sinusitis, exacerbations of chronic bronchitis, gonorrhoea in pencillinallergic patients. CONTRA-INDICATIONS

Pregnancy, infants under 6 weeks (risk of kernicterus), renal or hepatic failure, jaundice, blood disorders; porphyria. ADVERSE EFFECTS

Nausea, vomiting, diarrhoea. Glossitis, rashes, erythema multiforme, epidermal necrolysis, eosinophilia, agranulocytosis, granulocytopenia, purpura, leucopenia, thrombocytopenia; megaloblastic anaemia due to trimethoprim; pseudomebranous colitis, jaundiced and hepatic necrosis reported. DOSAGE, FORM & STRENGTH Adults;

By mouth, 480-960mg every 12 hours, Maximum 1.44g. Children: Every 12 hours. 6 weeks to 5 months: 120mg. 6 months to 5 years: 240mg. 6-12 years: 480mg. Prophylaxis of recurrent urinary-tract infection; Independent University Hospital

FORMULARY 2010

480mg at night. 6-12 mg/kg at night.

Adults: Children:

Available as:

Septran, Bactrim, Nicotrim, Trimoxin 2.25

CHLORAMPHENICOL

Broad spectrum anti-biotic INDICATIONS

Typhoid fever, H. Influcnzae meningitis, severe infections when careful clinical assessment indicates no other antibiotics are effective. CONTRA-INDICATIONS

Pregnancy, breast-feeding, porphyria. ADVERSE EFFECTS

Blood disorders including irreversible aplastic anaemia (aplastic anaemia attributed to chloramphenicol has terminated in leukaemia). Peripheral neuritis, optic neuritis. erythema multiforme. Nausea, vomiting, diarrhoea and nocturnal haemoglobinuria. DOSAGE, FORM & STRENGTH Inj: 1g in vial Susp: 75mg/5ml Adults; By mouth or by intravenous injection

or infusion, 50mg/Kg

daily in 4 divided doses. Children; Infants under 2 weeks;

25 mg/kg daily in 4 divided doses.

Independent University Hospital

FORMULARY 2010

A N T I B A C T E R I A L S

2 weeks-01 year;

50mg/kg daily in 4 divided doses. Available as:

Chloramphenicol, Methachlor, Dexachlor

A N T I B A C T E R I A L S

Independent University Hospital

FORMULARY 2010

3- ANTI FUNGAL DRUGS 3.1

CLOTRIMAZOLE

INDICATIONS

Candidial and mixed candidial / trichomonal vaginal infections. CONTRA-INDICATIONS

Hypersensitivity to Clotrimazole. ADVERSE EFFECTS

Local mild burning or irritation Hypersensitivity reactions. DOSAGE, FORM & STRENGTH Vaginal cream: 1% Insert

contents of the applicator intravaginally at night as a single dose.

Vaginal tabs: Adult;

100mg. 100mg inserted nightly for six nights.

Vaginal tabs: Adults;

500mg; 1 inserted as single dose at night.

Children;

Not applicable. Available as:

Canesten, Clonil Vag, Clomazol, Gynosporin 3.2 GRISEOFULVIN Dermatophyte infections of skin, nails, scalp where topical therapy inappropriate. CONTRA-INDICATIONS

Prophyria, severe liver disease. ADVERSE EFFECTS

Drowsiness, headache, gastric distress. Urticarial reactions, photosensitivirty and rarely precipitation of SLE. Independent University Hospital

FORMULARY 2010

A N T I F U N G A L D R U G S

DOSAGE, FORM & STRENGTH Cap or tab: 125mg, 250mg, 500mg Adults;

500mg- 1gm daily, preferably in divided doses after meals. Children;

10mg/kg body-wt. daily in divided doses.

A N T I F U N G A L D R U G S

Available as:

Grifulvin, Griseofulvin 3.3

NYSTATIN

INDICATIONS

Oral, esophageal and intestinal candidiasis. CONTRA-INDICATIONS

Tuberculous or viral lesion. Hypersensitivity. ADVERSE EFFECTS

Nausea, vomiting and diarrhoea in high doses. DOSAGE, FORM & STRENGTH Tab: 500,000, iu, Syp: 200mg/5ml. Adults; Drops: Oral infections, 1ml four times daily. Intestinal infections, 5ml four times daily, Children; 1ml four times daily. Tabs: Adults: 1-2 tabs, four times daily. Available as:

Nilstat, Mycitracin, Neomycin Oint, Polymyx

Independent University Hospital

FORMULARY 2010

4- ANTI HELMINTHICS 4.1

ALBENDAZOLE

INDICATIONS

Adjunct to surgery in hydatid cyts caused by Echinococcous granulosus or E. Multi-locularies, or primary treatment if surgery is not possible. CONTRA-INDICATIONS

Pregnancy. Adequate non-hormonal contraceptive measures must be taken during, and for one month after treatment . ADVERSE EFFECT

Gastro-intestinal disturbances, headache, dizziness, changes in liver enzymes; rarely reversible alopecia; rash, fever blood disorders including leucopenia and pancytopenia allergic shock if cyts leakage; convulsions and meningism in cerebral disease. DOSAGE, FORM & STRENGTH Tab: 400mg Syp: 40mg/5ml

400mg twice daily for 3 days can be repeated after 3days E. granulosus. Adult; Adjunct in surgical treatment;

Over 60 kg, medical treatment, 800mg daily in divided doses for 28 days; 3 cycles of treatment may be given. Available as:

Zentel, Almed , Wormocid 4.1

LEVAMISOLE HCL

INDICATIONS

Intestinal worm infection by A. lumbricoidesn, Americanus, A. duodenals, E. vermicularis, T. trichiura, S. Stercorarius and T. Independent University Hospital

FORMULARY 2010

A N T I H E L M I N T H I C S

Colubriformis. CONTRA-INDICATIONS

Pregnancy and in cases of microfilaraemia. ADVERSE EFFECTS

Usually mild and transient. Nausea, vomiting, abdominal pain, giddiness, headache.

A N T I H E L M I N T H I C S

DOSAGE, FORM & STRENGTH Tab: 40mg

Single dose after meal. In severe hookworm infection, second dose after 1 to 7 days is suggested . Adults: Children 1-4 years: 5-15 years:

120mg. 40mg. 80mg. Available as:

Antiworm, Geomisole, Ketrax, Nilpar 4.3

MEBENDAZOLE

INDICATIONS

Threadworm, roundworm, whipworm and hookworm infections. CONTRA-INDICATIONS

Pregnancy ADVERSE EFFECTS

Rarely abdominal pain. Diarrhoea; hypersensetivity reactions including exantheme, rash uticaria, and angioedma. DOSAGE, FORM & STRENGTH Chewable tab: 100mg Susp: 100mg/5ml Threadworms. Adult and Children over 2 years;

100 mg as a single dose; Independent University Hospital

FORMULARY 2010

if reinfection occurs second dose may be needed after 2-3 weeks;

Children under 2 years;

Not yet recommended. Available as:

Vermox, Vermin, Deworm, Wormdox 4.4

PYRANTEL PAMOATE

INDICATIONS

Roundworm, Threadworm, and Hookworm infections. CONTRA-INDICATIONS

Hepatic dysfunction. ADVERSE EFFECTS

Anorexia, abdominal cramps, nausea, vomiting, diarrhoea; headache, dizziness, sleep disturbance; rash. DOSAGE, FORM & STRENGTH Tab: 250mg P9 250/5ml Adult and Children over 6 months;

Ascaris lumbricoides alone, a single dose of 5 mg/kg: Mixed infections involving Ascaris lumbricoidess; single dose of 10 mg.kg. Available as:

Combantrin, Pamotrine, Pirental, Pypam, Pyrentrin, Womaq 4.5 THIABENDAZOLE INDICATIONS

Strongylodiasis, cutaneous and visceral larva migrans, dracontiasis, symptoms of trichinosis; secondary treatment for threadworm infestations; adjunct in hookworm, whipworm, or roundworm.

Independent University Hospital

FORMULARY 2010

A N T I H E L M I N T H I C S

CONTRA-INDICATIONS

Pregnancy (teratogenesis in animal studies) ADVERSE EFFECTS

Anorexia, nausea, vomiting, dizziness, diarrhoea, headache, pruritus, drowsiness; hypersensitivity reactions including fever, chills, angioedema, rashes, arythema multitus, collapse parenchymal liver damage.

A N T I

DOSAGE, FORM & STRENGTH Tab: 40mg Syp: 40/5ml

25 mg/kg (maximum 1.5g) every 12 hours for 3 days.

H E L M I N T H I C S

Independent University Hospital

FORMULARY 2010

5- ANTI TUBERCULOUS DRUGS 5.1

ETHAMBUTOL

INDICATIONS

Prophylaxis and treatment of tuberculosis only in conjunction with other anti-tuberculosis drugs. CONTRA-INDICATIONS

Optic neuritis, impaired renal function. ADVERSE EFFECTS

Optic neuritis (related to dose and duration of treatment). Anaphylactic reactions. Anorexia, nausea, vomiting, abdominal distress. Fever, malaise headache dizziness. Elevated serum uric acid level. DOSAGE, FORM & STRENGTH Tab: 400mg Adults;

15mg/kg daily as a single dose. Children;

Treatment, 25mg/kg daily as a single dose for 60 days, then 15mg/kg daily as a single dose. Available as:

Myambutol, Pulmobutol 5.2

ISONIAZID

INDICATIONS

Tuberculosis, in combination with other drugs; prophylaxis. CONTRA-INDICATIONS

Drug-induced liver disease.

Independent University Hospital

FORMULARY 2010

A N T I T U B E R C U L O U S D R U G S

ADVERSE EFFECTS

Nausea, vomiting, peripheral neuritis (prophylaxes is done with high dose pyridoxine). Optic neuritis, convulsions, psychotic episodes; hyper sensitivity reactions, fever, erythema multiforme, purpura; agranulocytosis; hepatitis especially over age of 35 years; systemic lupus erythematosus, pellagra hyperglycaemia & gynaecomastia. DOSAGE, FORM & STRENGTH Tab: 100mg. By mouth or by injections. Adult: 300mg daily. Children: 5-10mg / kg daily, 300mg maximum Available as:

Aceta INH, Isonex Forte 5.3

PYRAZINAMIDE

INDICATIONS

Treatment of tuberculosis only in conjunction with other antituberculous drugs. CONTRA INDICATIONS

Liver disease, pregnancy ADVERSE EFFECTS

Hepatitis which can be minimized by dosage adjustment, photosensitivity. DOSAGE, FORM & STRENGTH Tab: 500mg Adults;

20-30mg/kg daily in divided doses, maximum 3gm daily. Children;

Not recommended. Independent University Hospital

FORMULARY 2010

Available as:

Pyrazin, Pyrazid, Pyrazinamide 5.4

RIFAMPICIN

INDICATIONS

Tuberculosis

A N T I

CONTRA-INDICATIONS

Jaundice, porphyria ADVERSE EFFECTS

Gastro-intestinal symptoms including anorexia, nausea, vomiting, diarrhoea (pseudomebranouscohti sreported). Those occurring mainly on intermittent therapy include Influenzae like syndrome (with chills, fever, dizziness, bone pain), respiratory symptoms (including shortness of breath), collapse and shock. Hemolytic anaemia, acute renal failure, thrombocytopenic purpura; alterations of liver function, jaundice; flushing, urticaria, and rashes. Other side-effects reported include oedema, muscular weakness and myopathy, leucopenia, eosinophilia, menstrual disturbances. Urine, saliva, and other body secretions coloured orange-red. DOSAGE, FORM & STRENGTH Cap or Tab: 150mg, 3(M)mg, 450mg, 600mg. Syp: 200mg/10ml.

Less than 50kg 450mg more than 50kg 600mg under 2 years: 10mg per kg

D R U G S

Available as:

Rifapin, Rifacin 5.5

STREPTOMYCIN

INDICATIONS

Broad spectrum antibiotic therapy particularly for mixed infections. Independent University Hospital

T U B E R C U L O U S

FORMULARY 2010

CONTRA-INDICATIONS

In patients who have shown previous hypersensitivity reactions. ADVERSE EFFECTS

A N T I T U B E R C U L O U S

Proteinuria. Increased SGOT, SGPT. Increased or decreased reticulocyte count. Tinnitus. Confusion, disorientation. Purpura. rash, urticaria. Numbness, skin tingling. Nausea, vomiting. Pulmonary fibrosis. DOSAGE, FORM & STRENGTH Adults: 1gm daily. Available as:

Polybiotic Streptomycin

D R U G S

Independent University Hospital

FORMULARY 2010

Dosage Guidelines Recommended by WHO For Treating TB Patients. DRUGS

DOSAGE

Rifampicin (R)

10 (8-12)

mg/kg/day

INH (H)

5 (4-6)

Ethambutol (E)

15 (15-20)

DOSAGE

DRUGS

mg/kg/day

PZA (P)

25 (20-30)

Streptomxcin (S)

15 (12-18)

Thiaocetazone (T)

2.5

Weight Category

Initial Phase Myrin-P Forte

Continuation Phase Myrin

30-39kg

2 Tablets

40-54kg

3 Tablets

55-70kg

4 Tablets

Myrin-P Forte

Rifampicin 150mg Ethambutol 275mg Isoniazid 75mg Pyrazinamide 400mg

Myrin

Rifampicin 150mg Ethambutol 275mg Isoniazid 75mg

Independent University Hospital

FORMULARY 2010

A N T I T U B E R C U L O U S D R U G S

6- ANTI PROTOZOAL DRUGS

6.1

CHLOROQUINE PHOSPHATE

INDICATIONS

Malaria, hepatic, amoebiasis, giardiasis, rheumatoid arthritis. CONTRA-INDICATIONS

A N T I P R O T O Z A L

Headache, GI distress. Skin eruptions, depigmentation, hair loss, blurred vision, corneal opacities, retinal damage. Blood disorders. DOSAGE, FORM & STRENGTH Tab: 150mg. Syp: 50mg / 5ml. Inj: Adults;

Initial dose 600mg followed by 300mg after 6 hours, 300mg daily for 2days. Children; Malaria suppressive,

5mg/kg as chloroquine base at weekly intervals. Available as:

Resochin, Nivaquine, Geniquin

D R U G S

6.2

PYRIMETHAMINE WITH SULFADOXINE

INDICATIONS.

Prevention and treatment of plasmodium falciparum malaria. CONTRA-INDICATIONS

Suplphonamide sensitivity, severe liver or kidney dysfunction, blood dyscrasias, neonales. pregnancy and lactation. ADVERSE EFFECTS

Skin rash, (discontinue immediately), pharyngitis, pruritus, G.I. disturbance, skin rashes, blood dyscrasisas, erythema multiforme, Stevens-Johnson syndrome and Lyell's syndrome. Independent University Hospital

FORMULARY 2010

DOSAGE, FORM & STRENGTH Tab: 500mg +25mg Susp: SUSPENSION Adults (Curative dose): Children (Curative single dose). Under 4 years; 4-6 years; 7-9 years; 10-14 years;

15ml in single dose. 2.5ml. 5ml. 7.5ml. 10ml.

Prophylactic dose; Adults; Non-Immune subjects, 5ml as a single dose once in a week. Semi-immune subjects, 10-15ml once every four weeks. Children; Under 4 years: 2.5ml as a single dose. 4-8 years: 5ml as a single dose. 9-14 years: 7.5ml as a single doses.

The mentioned prophylactic dose is once every 2 wks for nonimmune subjects while once every 4 weeks for semi-immune subjects. TABS. Prophylaxis Adults; Over 14 years;

1 weekly treatment 2-3 as a single dose.

Children; Under 9-14 years;

3/4 adults dose-Treatment. Available as:

Fansidar, Amalar, Melofin 6.3

ARTHEMETHER WITH LUMEFANTRINE

INDICATIONS

Treatment of uncomplicated falciparum malaria, treatment of benign matane. Independent University Hospital

FORMULARY 2010

A N T I P R O T O Z A L D R U G S

CONTRA-INDICATIONS

Arrhythmia ADVERSE EFFECT

Abdominal pain, anorexia, diarrhoea, vomiting, nausea, palpitations, cough, headache, dizziness, sleep disturbances, arthralgia pruritus rash.

A N T I

DOSAGE

20mg Tab 4 tablets initially followed by 5dose of tables each at 8,24,36,48,60 hours. Available as:

P R O T O Z A L

Amblum, Co-methe, Exafal, Falcinil, Gen-m

D R U G S

Independent University Hospital

FORMULARY 2010

7- GASTRO INTESTINAL DRUGS

ANTIULCER DRUGS 7.1

MAGNESIUM TRISILICATE

G A S T R O

INDICATIONS

Dyspepsia CONTRA-INDICATIONS

Hypophospataemia ADVERSE EFFECTS

Diarrhoea, Belching due to liberated CO2 DOSAGE, FORM & STRENGTH Tablet: 2-3 tabs 4-6 times in a day. Available as:

Gelusil, Gaviscon, Simethicone, Mucaine 7.2

SUCRALFATE

INDICATIONS

Benign gastric and duodenal ulceration; chronic gastritis. CONTRA- INDICATIONS

Renal impairment. ADVERSE EFFECTS

Constipation; diarrhoea, nausea, indigestion, gastric discomfort, dry mouth, rash, puritus, back pain, dizziness, insomnia, vertigo and drowsiness. DOSAGE, FORM & STRENGTH Tab: 1g

2g twice daily or 1g 4 times daily. 1 hour before meals and at bedtime, taken for up to 6 weeks or in resistant cases 12 weeks; maximum 8g daily. Independent University Hospital

FORMULARY 2010

I N T E S T I N A L D R U G S

Prophylaxis of stress ulceration;

suspension 1g 6 times daily

maximum 8g daily. Available as:

Crafilm, Ulcocid, Ulsanic

G A S T R O

7.3

CIMETIDINE

INDICATIONS

Benign gastric and duodenal ulceration, reflux oesophagitis, Zolinger-Ellison's syndrome. Other conditions where gastric acid reduction is beneficial. CONTRA-INDICATIONS

Impaired renal function, malignancy, pregnancy lactation.

I N T E S T I N A L D R U G S

ADVERSE EFFECTS

Altered bowel habits, dizziness, rash, tiredness; reversible confusional states, reversible liver damage, headache, decreased blood counts, muscle or joint pain, hypersensitivity. Bradycardia and AV block; interstitial nephritis and acute pancreatitis. Gynaecomastia is also an occasional problem with cimetidine but usually only in high dosage. DOSAGE, FORM & STRENGTH Tab: 400mg Inj: 200mg IM, IV. Adults; By mouth, 400mg twice daily and at night or 500mg at night. Benign gastric and duodenal ulceration for at least 4 weeks. 6 weeks in gastric ulceration. 8 weeks in NSAID -associated ulceration. Children; 20-30mg/kg daily in divided doses. By slow intravenous injections, 200mg given one at least 2 minutes; may be repeated every 4-6 hours. By intravenous infusion, 400mg in 100 ml of 0.9% sodium Independent University Hospital

FORMULARY 2010

choloride infused over 30-60 minutes (may be repeated every4-6 hour) or by continuous infusion at one average rate of 50100mg/hour over 24 hours, maximum 2.4g daily.

Available as:

Cimet, Ulcerax, Tagamet, Ulcedine 7.4

RANITIDINE

INDICATIONS

Benign gastric and duodenal ulceration, stomah ulcer, reflux oesophagitis. Zollinger-Ellison syndrome, other conditions where reduction of gastric acid is beneficial.

G A S T R O

CONTRA-INDICATIONS

Malignancy, pregnancy & lactation, ADVERSE EFFECTS

Headache, dizziness. Rarely hepatitis, thrombocytopenia, leucopenia, hypersensitivity, confusion, breast symptoms. DOSAGE, FORM & STRENGTH Tab: 150mg, 300mg Inj: 150 mg/ml Adults; By mouth,

150mg twice daily morning and night or 300mg at

I N T E S T I N A L

night, Benign gastric and duodenal ulceration for 4 to 8 weeks, 6 weeks in NSAID-associated ulceration; in duodenal ulcer 300mg can be given twice daily for 4 weeks to achieve a higher healing rate. Children; Peptic ulcer Maintenance;

2-4 mg/kg twice daily. Maximum 300 mg daily. 150mg at night.

Prophylaxis of NSAID- induced duodenal ulcer, 150mg twice daily. Independent University Hospital

FORMULARY 2010

D R U G S

Reflux oesophagitis; 150mg twice daily or 300mg at night for up to

8 weeks.

G A S T R O I N T E S T I N A L D R U G S

Zollinger-Ellison syndrome; 150mg 3 times daily increased if necessary to up to 6g daily to divided doses. Before introduction of anaesthesia; intravenous injection diluted to 20ml and given over at least 2 minutes or by mouth, 150mg 2 hours before induction of anaesthesia, and also when possible on the proceeding evening. By slow intravenous injection, 50mg diluted to 20ml and given over at least 2 minutes; may be repeated every 6-8 hours. Prophylaxis of stress ulceration, initial slow intravenous injection of 50mg then continuous infusion, 125-250 micrograms/kg per hour (may be followed by 150mg twice daily by mouth when oral feeding commences). Available as:

Zantac, Nulcer, Ranulcid, Pepticure 7.5 OMEPRAZOLE Proton pump inhibitors inhibit the secretion of gastric acid by blocking the proton pump. CONTRA-INDICATIONS

pregnancy, liver disease. ADVERSE EFFECT

nausea, vomiting, flatulence, diarrhoea, headache, dizziness, gynaecomastia. DOSAGE

20mg 00 for 4 weeks (D4) 20mg 00 for 8 weeks (G4) IV infusion 40mg 1 hours Available as:

Losec, Omega, Risek, Omezol, Teph 20 Independent University Hospital

FORMULARY 2010

7.6

KAOLIN PECTIN

INDICATIONS

Diarrhoea, dysentery CONTRA-INDICATIONS

In acute diarrhea kaolin pectin is not recommended. ADVERSE EFFECTS

No significant adverse effects are known. DOSAGE, FORM & STRENGTH Susp

10-30ml every four hours. 5ml. 10ml. 10-30ml. All every four hours.

Adults; Children under 1 year; 1-5 years; Over 5 years;

Available as:

Streptomagma, Diarhol, Kaltin 7.7

LOPERAMIDE HCL

INDICATIONS

Symptomatic treatment of acute diarrhea. CONTRA-INDICATIONS

Ulcerative colitis, anti-biotic associated diarrhea. ADVERSE EFFECTS

Abdominal cramps, dizziness, drowsiness and skin reaction. DOSAGE, FORM & STRENGTH

4mg initially followed by 2mg after each stool. Available as:

Imodium, Lomide

Independent University Hospital

FORMULARY 2010

G A S T R O I N T E S T I N A L D R U G S

ANTI-EMETICS

G A S T R O I N T E S T I N A L D R U G S

7.8 CYCLIZINE INDICATIONS Inj: for prevention and treatment of nausea and vomiting and drug-induce vomiting, especially that associated with the administration of narcotic drugs. CONTRA-INDICATIONS Contra-indicated during drive ADVERSE EFFECTS Drowsiness, occasional dry mouth and blurred vision; cyclizine may aggravate severe heart failure and counteract the haemodynamic benefits of opioids. DOSAGE, FORM & STRENGTH Tab: 50mg Syp: 12.5mg/ml Inj: 50mg/ml Adults;

1 amp IV/IM upto three times a day.

Children over 12 years; 6-12 years; 2-5 years;

4 tsp. 2 tsp. 1 tsp. All three times daily.

Adults; Children over 12 years; 6-12 years; 2-5 years;

1 tab 1 tab. Â˝ tab. 1/4 tab. All three times daily.

Available as: Marzine, Migril, Tagril

Independent University Hospital

FORMULARY 2010

7.9

DIMENHYDRINATE

INDICATIONS

Vertigo, Nausea and vomiting . Motion sickness. CONTRA-INDICATIONS

Comatose or greatly depressed state, hypersensitivity, pressure of large amounts of CNS depressants, bone marrow depression, blood dyscrasias, sub cortical brain damage, Parkinsonâ&#x20AC;&#x2122;s disease, liver damage, jaundice, renal insufficiency, cerebral arteriosclerosis, coronary disease, severe hypotension or hypertension, mitral insufficiency, pheochromocytoma. ADVERSE EFFECTS

Sedation, extra pyramidal syndrome, anticholinergic effects and orthostatic hypertension. DOSAGE, FORM & STRENGTH Tab: 50mg Inj: 50mg/ml Syp: 12.5mg/4ml Drops/ Tabs Adults;

50-100 two or three times daily.

1-6 years; 7-12 years; Children under 1 year;

12.5-25 mg. 25-50 mg; both two or three times daily. Not recommended.

Inj: By IM/IV inj (same quantitiy as mentioned above). Available as:

Gravinate, Devinate 7.10

METOCLOPRAMIDE HYDROCHLORIDE

INDICATIONS

Nausea and vomiting, particularly in gastro-intestinal disorders and treatment with cytotoxics or radiotherapy. Independent University Hospital

FORMULARY 2010

G A S T R O I N T E S T I N A L D R U G S

CONTRA- INDICATIONS

Recent gastro-intestinal surgery, prolactin-dependent breast carcinoma, phaeochromocytoma. ADVERSE EFFECTS

G A S T R O I N T E S T I N A L D R U G S

Extra pyramidal effects especially in children/young adults, hyperprolactinaemia, occasionally dysikinesia on prolonged administration, drowsiness, restlessness, diarrhoea and depression. DOSAGE, FORM & STRENGTH Tab: 10mg. Syp: 5mg/5ml. Inj: 5mg/ml. Adults; By mouth, or by intramuscular injection or by intravenous injection

over 1-2 minutes, 10mg 5mg. Young adults 15-19 years under 60 kg; Children upto 1 year or upto 10 kg; 1-3 years or 10-14 kg; 5-9 years or 20-29 kg; 9-14 years or 30 kg and over;

3 times daily. 1 mg twice daily. 1 mg 2-3 times daily. 2.5mg 3 times daily. 5mg 3 times daily.

Available as:

Metomid, Maxolon, Clopan 7.11 ONDANSETRON 5HTs antagonist which block 5HT3 receptors in the GIT and CNS INDICATIONS

Vomiting CONTRA-INDICATIONS

Pregnancy, hepatic, impairment

Independent University Hospital

FORMULARY 2010

ADVERSE EFFECT

constipation headache, flushing, hiccups DOSAGE 8mg TDS oral IV Available as: Zofran, Ondanles, Ondison, Onset, Setron 7.12 PROCHLORPERAZINE INDICATIONS Vomiting, Vertigo, Labyrinthine disorders CONTRA-INDICATIONS Pregnancy, hepatic, impairment

I N T E S T I N A L

ADVERSE EFFECT Sedation, Extra pyramidal effects. DOSAGE 5-20mg 3 times, Maximum 75-100mg Available as: Stemetil, Dometil

ANTI-SPASMODICS 7.13

ATROPINE SULPHATE

INDICATIONS

Used prior to the administration of general anaesthesia. Concomitantly with Neostigmine to counteract Muscarinic effects. As antidote for oregano-phosphorous insecticide poisoning, mushroom poisoning. CONTRA-INDICATIONS

Closed angle glaucoma, Patients with narrow angle between the iris and cornea, gastric or duodenal ulcer causing stenosis and Independent University Hospital

G A S T R O

FORMULARY 2010

D R U G S

G A S T R O I N T E S T I N A L D R U G S

significant gastric retention; urinary retention in prostate hypertrophy, paralytic ileus, debilitated patients with esophageal reflux or oesophagitis. Since heat loss through sweating is suppressed, caution in high ambient temperature as hyperpyrexia may result, Particularly in infants. ADVERSE EFFECTS

Xerostomia, altered taste perception, nausea, vomiting, dysphagia, heartburn, constipation, bloated feeling, paralytic ileus, gastrointestinal reflux. Urinary hesitancy and retention, impotence. Blurred vision, mydriasis, photo phobia, cyclophegia, increased intra ocular pressure. Palpitation, bardycardia following low dose. Headache, flushing, nervousness, drowsiness, weakness, dizziness, insomnia, fever. Suppression of lactation, nasal congestion, severe allergic reactions or drug idiosyncrasies including anaphylaxis and urticaria. DOSAGE, FORM & STRENGTH Inj: 0.5 mg/ml Adults; 0.4-0.6mg IV Children; 0.02mg/kg body of induction or IM

weight IV at the time

30 minutes before induction with a maximum dose of 0.6mg. 0.5 to 0.1 mg.

Infants below 5kg;

Available as:

Atrolate, Isopto Atropine, Motilex 7.14

HYOSCINE

INDICATIONS

Smooth muscle spasm CONTRA-INDICATIONS

Closed angle glaucoma.

Independent University Hospital

FORMULARY 2010

ADVERSE EFFECTS

Dry mouth with difficulty in swallowing and thirst, dilatation of the pupils with loss of accommodation and sensitivity to light, increased intra-ocular pressure, flushing, dry skin, bradycardia followed by tachycardia, palpitation and constipation; rarely fever, confusional states and rashes. DOSAGE, FORM & STRENGTH Tab/Injection Adults; 1 amp IM or IV 1 tab tds. Available as:

Buscopan, Spasler, Spasmogin 7.15

DOMPERIDONE

INDICATIONS

Nausea, vomiting, dyspepsia, gastroesophegeal reflex. CONTRA-INDICATIONS

renal impairment pregnancy, breast feeding, prolactinoma, hepatic impairment. ADVERSE EFFECT

GI disturbance, increased prolactin concentration, extapyramidal effects and rashes.

G A S T R O I N T E S T I N A L D R U G S

DOSAGE Adult

35kg 10-20mg 3-4 time 80mg max 85kg 250-500mg/kg 3-4 time 2.4mg/kg max daily Peridone Available as:

Motilium, Pelton, Domcin, Peridone

Independent University Hospital

FORMULARY 2010

7.16

MEBEVERINE

INDICATIONS

Adjunct in GI disorders characterized by smooth muscle spasm. CONTRA-INDICATIONS

G A S T R O I N T E S T I N A L D R U G S

paralytic ileus ADVERSE EFFECT

Allergic reaction DOSAGE Adult

130-150mg 3 times daily. Available as:

Colofac, Zeespa, Mevrin 7.17

ORAL REHYDRATION SALTS (ORS)

INDICATIONS

Fluid and electrolyte loss in diarrhoea. CONTRA-INDICATIONS

Hypertension ADVERSE EFFECTS

No significant adverse effects DOSAGE, FORM & STRENGTH

NaCl 3.5%, Trisodium citrate dehydrate 2.0% sachet. According to fluid loss, usually 200-400 ml solution after every loose motion. Infant; Children;

1-1 Â˝ times usual feed volume 200ml after every loose, motion

Independent University Hospital

FORMULARY 2010

8- CARDIOVASCULAR DRUGS 8.1

ATENOLOL

INDICATIONS

Cardiac dysrhythmias, treatment of myocardial infraction. Early and late intervention after myocardial infraction. Management of hypertension, angina pectoris. Cardiac dysrhythmias. Treatment of myocardial infraction. Early and late intervention after myocardial infraction. CONTRA- INDICATIONS

Asthma or history of obstructive airways disease, uncontrolled heart failure, sick sinus syndrome, second or third degree heart block, cardiogenic shock. ADVERSE EFFECTS

Brady cardia, heart failure, broncho spasm, peripheral vasoconstriction, gastro-intestinal disturbances, fatigue, sleep disturbances; Rare reports of rashes and dry eyes. DOSAGE, FORM & STRENGTH Tab: 50mg,100mg, Hypertension: Angina;

50 or 100mg once daily. Usually 100mg once daily or 50mg twice daily.

Dysrhythmias

Initial dose. 2.5mg IV inj over 2.5 min. can be repearetd at 5 min intervals until response observed max 10mg infusion: 0.15 mg/kg over 20 min. Oral maintenance dose 50-100 mg once daily. Myocardial infraction. Early intervention within 12 hours; 5-10mg slow IV inj. (1mg/min);

50mg orally 12 hour later; then 100mg once daily commencing 12 hours later. Independent University Hospital

FORMULARY 2010

C A R D I O V A S C U L A R D R U G S

Late Intervention: 100mg daily for long term prophylaxis of myocardial infraction. Children;

Not recommended. Available as:

C A R D I O V A S C U L A R D R U G S

Tenormin, Cartac, Pule 8.2

CAPTOPRIL

INDICATIONS

Mild to moderate hypertension as adjunct to thiazide diuretics. Severe hypertension where other measures have failed. Adjunct to diuretics and , where appropriate, digitalis in congestive cardiac failure. CONTRA- INDICATIONS

Neutropenia, agranulocytosis, proteinuria, hypotension, rash, loss of taste, cough (rare). ADVERSE EFFECTS

Neutropenia, agranulocytosis, proteinuria, hypotension, rash, loss of taste, cough (rare). DOSAGE, FORM & STRENGTH Tab: 25mg Hypertension.

Mild to moderate hypertension. Initially 12.5mg twice daily with a thiazide. Maintenance;

25-50mg twice daily increasing gradually at 2-4 week intervals. Congestive cardiac failure, initially 6.25mg or 12.5mg. Maintenance;

25mg three times daily. Maximum 150mg daily. Available as:

Capoten, Catoper Independent University Hospital

FORMULARY 2010

8.3

DIGOXIN

INDICATIONS

Digitalis therapy, particularly congestive heart failure. CONTRA-INDICATIONS

Ventricular tachycardia. Hypertrophic obstructive cardiomyopathy. Elective electro-conversion. Hypercalcaemia. ADVERSE EFFECTS

Gastrointestinal, visual and conduction disturbances. DOSAGE, FORM & STRENGTH Tab: Inj:

0.25mg 0.25mg/ml 250-500mg daily. 125-250 mg daily. Usually 10-20mcg/kg daily in single or divided doses.

Adults Maintenance; Elderly Maintenance; Children Maintenance;

Available as:

Digox, Digoxin, Doxin, Lanoxin 8.4

DILTIAZEM

INDICATIONS

C A R D I O V A S C U L A R

Angina pectoris CONTRA- INDICATIONS nd

Pregnancy. Sickness syndrome; 2 or 3 degree AV block, ankle oedema, nausea, headache, rash. DOSAGE, FORM & STRENGTH Tab: 30mg Adults;

Usually 60mg three times daily, increasing if necessary to maximum 480mg daily in divided doses. Initially 60mg twice daily.

Independent University Hospital

FORMULARY 2010

D R U G S

Not recommended.

Children;

Available as:

Herbesser, Tiazem 8.5

DOBUTAMINE HYDROCHLORIDE

INDICATIONS

C A R D I O V A S C U L A R

Inotropic support in infraction, cardiac surgery, cardiomyopathies, septic shock, and carcinogenic shock. CONTRA-INDICATIONS

Severe hypotension complicating to cardiogenic shock. ADVERSE EFFECTS

Tachycardia and marked increase in systolic blood pressure indicate over dosage. DOSAGE, FORM & STRENGTH

Inj 250mg, By intravenous infusion, 2.5-10 micrograms/kg/minute, adjusted according to response. Available as:

Dobex, Dobuject, Dobutamed 8.6

DOPAMINE HYDROCHLORIDE

INDICATIONS

D R U G S

Cardiogenic shock ininfraction or cardiac surgery. CONTRA-INDICATIONS

Tachyarrhythmia and phaeochromocytoma. ADVERSE EFFECTS

Nausea and vomiting, peripheral vasocontriction, hypotension, hypertension, tachycardia. DOSAGE, FORM & STRENGTH Inj: 200 mg/ml By intravenous infusion, 2-5 micrograms/kg/ minute initially. Independent University Hospital

FORMULARY 2010

Available as:

Dopamine, Intropin, Tropin 8.7

ENALAPRIL MALEATE

INDICATIONS

All grades of essential hypertension; congestive heart failure(adjunct). CONTRA0INDICATIONS

Hypersenitivity to ACE inhibitors: known or suspected renovasular disease, aortic stenosis or outflow tract obstruction; pregnancy; porphyria. ADVERSE EFFECTS

Persistent dry cough, throat discomfort, voice changes, dizziness. Headache, fatigue, weakness, hypertension, change of taste, sore mouth, nausea, diarrhoea, muscle cramps, rash and angioedema. Rarely pancreatitis, renal impairment; pancreatitis. DOSAGE, FORM & STRENGTH Tab: 5mg, 10mg Adults; Hypertension, initially 5mg daily;

if used in addition to diuretic, in elderly patients, or in renal impairment, initially 2.5 mg daily. Maintenance dose;

10-20mg daily; maximum 40mg daily. Heart failure (adjunct), initially 2.5mg daily Maximum 10-20mg daily. Available as:

Renitec, Ramitace, Cardace 8.8

ISOSORBIDE DINTRATE

INDICATIONS

Prophylaxis and treatment of angina; left ventricular failure. Independent University Hospital

FORMULARY 2010

C A R D I O V A S C U L A R D R U G S

CONTRA-INDICATIONS

Marked amaemia, head trauma, cerebralhaemorrhage, closedangle glaucoma. ADVERSE EFFECTS

Throbbing headache, flushing dizziness, postural hypotension, tacycardia.

C A R D I O V A S C U L A R D R U G S

DOSAGE, FORM & STRENGTH Tab: 5mg, 10mg Sublinually, 5-10mg By mouth, daily in divided doses, angina 30-120mg, left ventricu-

lar failure 40-160mg, up to 240mg if required, By intravenous infusion, 2-10mg/hour. Available as:

Isoket, Isdin, Isobid, Isocord 8.9

GLYCERYL TRINITRATE

INDICATIONS

Prophylaxis and treatment of angina; left ventricular failure. CONTRA-INDICATIONS

Marked anaemia, head trauma, cerebral hemorrhage, closedangle glaucoma. ADVERSE EFFECTS

Throbbing headache, flushing, dizziness, postural hypotension, tachycardia. DOSAGE, FORM & STRENGTH Tablets. Injection. Sublingually, 0.3-1mg. Repeated as required.

By mouth, 2.6-6.4mg as modified-release tablet, 2-3 times daily; Severe angina, 10mg 3 times daily. By intravenous infusion, 10-200 micro-grams/minute.

Independent University Hospital

FORMULARY 2010

Available as:

Angiocard, Angised, Nitronal 8.10

METHYLDOPA

INDICATIONS

Hypertension, in conjuction with diuretic; hypertensive crisis when immediate effect not necessary. CONTRA-INDICATIONS

History of depression, active liver disease, pheochromocytoma; porphyria. ADVERSE EFFECTS

Dry mouth, sedation, depression, drowsiness, diarrhoea, fluid retention, failure of ejaculation, liver damage, hemolytic anaemia, lupus erythematosus-like syndrome, parkinsonism, rashes, nasal stiffness. DOSAGE, FORM & STRENGTH Tab: 250mg Inj: 250mg Adults; By mouth, 250mg 2-3 times daily, gradually increased at intervals

of 2 or more days; maximum daily dose 3g. Elderly;

125 mg twice daily initially, gradually increased; maximum daily dose 2g. By intravenous infusion, methyl dopamine hydrochloride 250500mg, repeated after 6 hours if required. Available as:

Aldomet, Hypergen, Llskomet, Normet 8.11

NIFEDIPINE

INDICATIONS

Prophylaxis and treatment of angina; hypertension; Reynaudâ&#x20AC;&#x2122;s phenomenon. Independent University Hospital

FORMULARY 2010

C A R D I O V A S C U L A R D R U G S

CONTRA-INDICATIONS

Cardiogenic shock; advanced aortic stenosis; pregnancy; porphyria. ADVERSE EFFECTS

C A R D I O V A S C U L A R D R U G S

Headache, flushing, dizziness lethargy, also gravitational oedema, rash, nausea, increased frequency of micturition, eye pain, gum hyperplasis; depression reported; telangiecasia reported. DOSAGE, FORM & STRENGTH Cap: 10mg Adults & Elderly;

Angina and Reynaudâ&#x20AC;&#x2122;s phenomenon, initially 10mg (elderly) 3 times with or after food. Maintenance;

5-20 mg 3 times daily, for immediate effects in angina bite into capsule and retain liquid in mouth or swallow. Available as:

Adalat, Nifed, Nifelat 8.12

PROPRANOLOL HYDROCHLORIDE

INDICATIONS

Management of hypertension, angina pectoris. Prophylaxis after myocardial infraction, cardiac dysrhymais, migraine. Tremor, anxiety, prophylaxis of upper gastrointestinal bleeding in patients with portal hypertension and oesphageal varices. CONTRA-INDICATIONS

Asthma or history of obstructive airways disease, uncontrolled heart failure, sick sinus syndrome, second or third degree heart block, cardiogenic shock. ADVERSE EFFECTS

Bradycardia, heart failure, broncho spasm, peripheral Independent University Hospital

FORMULARY 2010

vasoconstricition, gastrointestinal disturbances, fatigue,sleep disturbances. Rare reports of rashes and dry eyes (reversible on withdrawal).

DOSAGE, FORM & STRENGTH Tab: 10mg, 40mg Inj: 1mg/ml

Adjust dosage according to response. Hypertension: Adults;

Usually 160-320mg daily. Angina pectoris usually 120-240mg daily. Anxiety, migraine, essential tremor: Usually 120-240mg daily. Children; Migraine: 20mg orally two or three times daily. Adults;

80-320 mg daily. Post myocardial infraction. Begin 5-21 days post infact, 40mg four times daily for 2-3 days, then 80mg twice daily or 160mg once daily. Emergency treatment of dysrhythmias: 1mg given over 1 min. May be repeated at 2 min intervals to a maximum of 10mg (concious patients) or 5 mg (under anaesthesia). Children; Dysrhythmias (as a guide):0.025-0.05mg/kg body-wt IV injection

slowly under ECG control, three or four times daily. Available as:

Inderal, Opinol, Oprinol 8.13

VERAPAMIL HYDROCHLORIDE

INDICATIONS

Treatment and prophylaxis of angina pectoris, supra ventricular tachycardia of reciprocating type assosiated with wolff Parkinson white syndrome. Independent University Hospital

FORMULARY 2010

C A R D I O V A S C U L A R D R U G S

Mild to moderate hypertension. CONTRA-INDICATIONS

C A R D I O V A S C U L A R D R U G S

Hypotension, bradycardia, second and third-degree AV block, sick sinus syndrome, cardiogenic shock, sino-atrial block. History of heart failure or significantly impaired left ventricular function, even if controlled by therapy. Atrialflutter or fibrillation complicating Wolff-Parkinson-White syndro; porphyria. ADVERSE EFFECTS

Constipation; less commonly nausea, vomiting, flushing, headache, dizziness, fatigue, ankle oedema; rarely reversibleimpairment of liver function, allergic reactions (erythema, pruritus). Rarely gynaecomastia and gingival hyperplasia after intravenous administration, hypotension, bradycardia, heart block, and asystole. DOSAGE, FORM & STRENGTH Tab: 80mg Adults; By mouth: Supra ventricular arrhythmias, 40-120mg 3 times daily. Angina, 80-120mg 3 times daily. Hypertension, 240-480 daily in 2-3 divided doses. By slow intravenous injection over 2 minutes (3 minutes in elderly), 5-

10mg (preferably with ECG monitoring); In paroxysmal Tachyarrthmia;

A further 5mg after 5-10 minutes if required.

Available as:

Calan, Isocardin Independent University Hospital

FORMULARY 2010

8.14 AMLODIPINE Calcium channel blocker.

INDICATIONS

Hypertension, Prophylaxis of angina. CONTRA-INDICATIONS

Cardiogenic shock, unstable angina, aortic stenosis. ADVERSE EFFECTS

Abdominal pain Nausea palpitation, Flushing, Edema, Headache, Dizziness, Fatigue, Sleep Disturbance. DOSAGE, FORM & STRENGTH Adults; By mouth: 5mg once a day 10mg Maximum

Available as:

Amodip, Amlodip, Norvasc

C A R D I O V A S C U L A R D R U G S

Independent University Hospital

FORMULARY 2010

9- ANTI COAGULANTS

9.1

HEPARIN

INDICATIONS

Deep-vein thrombosis and pulmonary embolism. Unstable angina, acute peripheral arterial occlusion, myocardial infarction. CONTRA-INDICATIONS

A N T I C O A G U L A N T S

Haemophilia & other haemorrhagic disorders, thrombocytopenia, peptic ulcer, cerebral aneurysm, severe hypertension, severe of eye or nervous system, hypersensitivity to heparin. DOSAGE, FORM & STRENGTH Inj: 5000iu/ml Adults; Deep-vein thrombosis and pulmonary embolism, injection, loading dose of 5000 units followed

by intravenous by continuous infusion of 18 units/kg per hours or by subcutaneous injection of 15000 units every 24 hours (both adjusted daily by laboratory monitoring). Small Adult or Child;

Lower loading dose then, 15-25 units/kg/hour by intravenous infusion, 250 units/kg every 12 hours by subcutaneous injection. Unstable angina, acute peripheral arterial occlusion, as intravenous regimen for deep-vein thrombosis and pulmonary embolism, by subcutaneous injection, 5000 units 2 hours before surgery, then every 8-12 hours for 7 days or until patient is ambulant (monitoring not needed); during pregnancy (with monitoring), 5000-10000 units every 12 hours. Available as:

Ecfast, Epsoclar, Mediparine, Multiparin

Independent University Hospital

FORMULARY 2010

9.2

TRANEXAMIC ACID

INDICATIONS

As an anti-plasm in drug in hemorrhagic disease (purpurea, aplastic anaemia, cancer, leukemia etc.) and abnormal bleeding. CONTRA-INDICATIONS

Thromoboembolic disease. ADVERSE EFFECTS

Nausea, vomiting, diarrhoea; giddiness on rapid intravenous injection. DOSAGE, FORM & STRENGTH Cap: 250mg Inj: 250mg/5ml, By mouth, 1-1.5g 2-4 times daily. I/V injection, 1g 3 times daily. Available as:

Transamin, Transcam, Tranxic, Traumax 9.3 CLOPIDROGREL Antiplatelet agent INDICATIONS

Prevention of atherosclerotic event, MI, ischemic stroke. CONTRA-INDICATIONS

Active bleeding, Renal impairment, Pregnancy. ADVERSE EFFECTS

Dyspepsia, Abdominal pain, Diarrhea, Bleeding disorders. DOSAGE, FORM & STRENGTH

75mg once a day

Acute MI 300mg once than 75mg OD Available as:

Platex, Ogrel, Clavix Independent University Hospital

FORMULARY 2010

A N T I C O A G U L A N T S

10- DIURETICS

10.1

FUROSEMIDE

INDICATIONS

Oedema, oliguria due to renal failure. CONTRA-INDICATIONS

Precomatose states associated with liver cirrhosis. ADVERSE EFFECTS

D I U R E T I C S

Hyponatraemia, hypokalaemia, hypocholaemicalkalosis, increased calcium exceryion, hypotension; less commonly nausea, gastro-intestinal disturbances, hyperuricaemia and gout; hyperglycaemia (less common than with thiazides). Temporary increased in plasma cholesterol and triglyceride concentrations; rarely rashes and bone marrow depression (withdraw treatment), pancreatitis (with large parenteral doses), tinnitus and deafness (usually with large parenteral doses and rapid administration and in renal impiration). DOSAGE, FORM & STRENGTH Tab: 40mg Inj: 20mg/2ml Adults; By mouth, oedema, initially 40mg in the morning. Maintenance 20mg daily or 40 mg on alternate days, increased in

resistant oedema to 80mg daily. Children;

1-3mg/kg daily. intravenous injection or slow intravenous injection (rate not exceeding 4mg/minute), initially 20-5mg. Children;

0.5-1.5mg/kg to maximum daily dose of 20mg.

Independent University Hospital

FORMULARY 2010

Available as:

Fusemid, Lasix 10.2

MANNITOL

INDICATIONS

Cerebral oedema. CONTRA-INDICATIONS

Congestive cardiac failure, pulmonary oedema. ADVERSE EFFECTS

Chills, fever. DOSAGE, FORM & STRENGTH Inj: 20%, 40% I/V,

By intravenous infusion, diuresis, 50-200g over 24 hour, preceded by a test dose of 200mg/kg slow intravenous injection. 10.3

SPIRONOLACTONE

INDICATIONS

Oedema and ascites in cirrhosis of the liver, malignant ascites, nephrotic syndrome, congestive heart failure; primary aldosteronism. CONTRA-INDICATIONS

Hyperkalaemia, hyponatraemia, severe renal impairment; pregnancy and bread-feeding; Addisonâ&#x20AC;&#x2122;s disease. ADVERSE EFFECTS

Gastro-intestinal disturbances, gynaecomastia; hyperkalaemia; hypotension. DOSAGE, FORM & STRENGTH Tab: 25mg, 100mg Adults;

100-200mg daily, increased to 400mg if required.

Independent University Hospital

FORMULARY 2010

D I U R E T I C S

Initially 3mg/kg daily in divided doses.

Children;

Available as:

Aldactazide, Aldactone, Spidar, Spiromide 10.4

BENDROFLUAZIDE

INDICATIONS

Edema, Hypertension CONTRA-INDICATIONS

Hypokalaemia, hyponatraemia, severe renal impairment; Hypercalcemia Addisonâ&#x20AC;&#x2122;s disease. ADVERSE EFFECTS

D I U R E T I C S

Gastro-intestinal disturbances, impotence, hypokalaemia; hypotension, hyponatraemia. DOSAGE, FORM & STRENGTH

Edema 5-10mg once daily. hypertension 2.5mg once daily. Avialable as:

Fortzaar, Hyzaar, Co-osar, Aldactazide, Moduretic

Independent University Hospital

FORMULARY 2010

11- RESPIRATORY DRUGS 11.1

AMINOPHYLINE

INDICATIONS

Asthma, bronchopenumonia, bronchitis, Cheyne-Stokes respiration, paroxysmal dyspnoea associated with left heart failure. CONTRA-INDICATIONS

Allergy to theophylline, caffeine, theobromine, ethylendiamine. ADVERSE EFFECTS

Tachycardia, palpitions, nausea, gastro-intestinal disturbances, headache, insomnia, arrhythmias, and convulsions especially if given rapidly by intravenous injection. DOSAGE, FORM & STRENGTH Tab: 100mg Inj: 250mg/ml

Loading dose 6mg/kg. 0.5mg/kg/hr IV infusion. Cardiac failure: 0.3mg/kg/hr. Liver disease. 0.2 mg/kg/hr. Both cardiac failure and liver disease: 0.1mg/kg/hr. Children; 5mg/kg six hourly SLOW I.V inj. Adults; Maintenance;

Available as:

Aminolin, Amphyll 11.2

EPHEDRINE HYDROCHLORIDE

INDICATIONS

Reversible airways obstruction. CONTRA-INDICATIONS

Hyperthyroidism, hypertension, coronary disease, prostatic hypertrophy, hyperexcitibility, closed angle glaucoma.

Independent University Hospital

FORMULARY 2010

R E S P I R A T O R Y D R U G S

ADVERSE EFFECTS

Tachycardia, anxiety, restlessness, insomnia common; also mouth, cold extremities. DOSAGE, FORM & STRENGTH Tab / Inj:

50/ml

Adults;

3 times daily; 15-60mg 3 times daily.

R E S P I R A T O R Y

Children upto 1 year; 1-5 years; 6-12years;

7.5 mg. 15mg. 30mg. Available as:

Abenol Plus, Deltarhinol, Efed, Ephedrine 11.3 SALBUTAMOL Short acting beta agonist INDICATIONS

Asthma and other conditions associated with reversible airways obstruction; premature labour. CONTRA0INDICATIONS

D R U G S

Though Salbutamol inj. are recommended for the prevention of uncomplicated premature labor associated with toxaemia of pregnancy or ante partum haemorrhage from whatever cause is contra-indicated. Threatened abortion during first or second trimester of pregnancy. History of hypersensitivity. ADVERSE EFFECTS

Fine tremor (usually hands), nervous tension, headache, peripheral vasodilation tachycardiac hypokalaemia after high doses (acsm recommends monitor plasma-potassium in severe asthma; hypersensitivity reactions including paradoxical broncho spasm, urticaria, andangioedema reported; slight pain on intramuscular injection. Independent University Hospital

FORMULARY 2010

DOSAGE, FORM & STRENGTH

oral 2mg TDS 8mg Maximum less then 2 years 100microgram 4 times daily. 1-2mg 4 times daily. 2mg 4 times daily. 500microgram 4 hourly. 5microgram Initially. 100-200microgram 3-4 times daily.

Children: 2-6 years: 6-12 years: subcutaneously: Intravenous: Inhalation:

Available as:

Ventolin, Ventomed, Bretheez-e 11.4 SALMETROL Long acting beta agonist INDICATIONS

Asthma and other conditions associated with reversible airways obstruction; premature labour. CONTRA INDICATIONS

Pregnancy and Breast Feeding ADVERSE EFFECTS

Oropharyegeal Irritation taste disturbance, Rash, insomnia, Nausea, Pruritus DOSAGE, FORM & STRENGTH

50micrograms twice daily. Available as:

Servent 11.5

BECLOMETHSONE inhaled corticosteroids

Independent University Hospital

FORMULARY 2010

R E S P I R A T O R Y D R U G S

INDICATIONS

Prophylaxis of asthma. CONTRA INDICATIONS

Tuberculosis ADVERSE EFFECTS

Hoarsness, candidiasis

R E S P I R A T O R Y D R U G S

DOSAGE, FORM & STRENGTH

50micrograms twice daily. Available as:

Becotide, Clenil 11.6 IPRATROPIUM BROMIDE Anti-muscarinic bronchodilator INDICATIONS

Reversible COPD. CONTRA INDICATIONS

BPH, Glaucoma. ADVERSE EFFECTS

Dry month, nausea, constipation, headache. DOSAGE, FORM & STRENGTH

20-40 microgram QDS Available as:

Atrovent 11.7

DEXAMETHASONE

INDICATIONS

Emergency parenteral therapy; intra-articular and soft tissue conditions. Rheumatic allergic and inflammatory conditions. Independent University Hospital

FORMULARY 2010

CONTRA-INDICATIONS

Hypertension, renal insufficiency etc. ADVERSE EFFECTS

Hypertension, sodium and water retention and potassium loss. Cushing;s syndrome with moon face, striae, and acne. Suppression of growth in children, adrenal atrophy. DOSAGE, FORM & STRENGTH Tab: 0.5mg Inj: 4mg/ml vial of 5ml Adults; By mouth, usual range 0.5-9mg daily. By intramuscular or slow intravenous injection or infusion (as dexamethasone phosphate).

Initial 0.5-20 mg. Children;

200-500micrograms/kg daily. Cerebal oedema (as dexamethasone phosphate), by intravenous injection, 10mg initially, then 4mg by intramuscular injection every

6 hours as required for 2-10 days. 11.8

HYDROCORTISONE SODIUM SUCCINATE

INDICATIONS

Adrenal failure; overwhelming infections (with chemotherapy). CONTRA-INDICATIONS

Systemic fungal infections. Known hypersensitivity to components. ADVERSE EFFECTS

Fluid and electrolyte disturbances, peptic ulceration and hemorrhage, impaired wound healing. DOSAGE, FORM & STRENGTH Inj: 250mg/2ml Adults;

R E S P I R A T O R Y

100-500mg by slow IV inj.

Independent University Hospital

FORMULARY 2010

D R U G S

Children;

11.9

Dose may be reduced according to severity of condition and response but should not fail below 25mg daily.

PREDNISOLONE

INDICATIONS

Suppression of inflammatory and allergic disorders. CONTRA-INDICATIONS

R E S P I R A T O R Y D R U G S

Peptic ulceration, hypertension, diabetes. ADVERSE EFFECTS

Hyperglycemia, osteoporosis, depression, euphoria, peptic ulceration, cushingoid changes. DOSAGE, FORM & STRENGTH Tab: 5mg Adults; By mouth,

initially, up to 10-20mg daily (severe disease, up to 60mg daily), preferably taken in the morning after breakfast; can often be reduced within a few days but may need to be continued for several weeks or months. Maintenance;

Usual range, 2.5-15mg daily, but higher doses may be needed; cushingoidside- effects increasingly likely with doses above 7.5 mg daily. By intramuscular injection prednisolone accetate, 25-100mg once or twice weekly.

EXPECTORANTS AND COUGH SYRUPS 11.10 SYP. AMINOPHYLINE 32mg Diphenhydramine 8mg; Independent University Hospital

FORMULARY 2010

Chloride 30mg Menthol 0.98mg Alcohol 5% Bottle of 450ml

11.11 SYP. AMMONIUM CHLORIDE 100mg Sod Chlorpheniramine Maleate 2mg Ephidrine HCL 7 mg. Menthol 1mg/5ml bottle of 450ml.

R E S P I R A T O R Y D R U G S

Independent University Hospital

FORMULARY 2010

Managment of Asthma

R E S P I R A T O R Y D R U G S

Step-1

Short acting beta 2 agonist

Step-2

Step-1+ inhaled corticosteroids

Step-3

Step-1+step-2+ Long acting beta 2 agonist

Step-4

Step-1+step-2+step-3+ 6weeks of leukotrine receptor antagonist oral theophylline oral beta 2 agonist

Step-5

Step1 + step 2 + step 3 + oral prednisolone Moderate Acute asthma

1. Oxygen. 2. Salbutamol/Terbutaline (Nebulise). 3. Oral Prednisolone 40-50mg. Severe Acute asthma 1. Oxygen. 2. Salbutamol/Terbutaline (Nebulise). 3. Oral Prednisolone 40-50mg or IV hydrocortisone 400mg in 4 divided doses. Life threatening Acute asthma 1. Oxygen. 2. Salbutamol/Terbutaline (Nebulise). 3. Oral Prednisolone 40-50mg. 4. IV hydrocortisone 400mg in 4 divided doses 5. Ipratropium (Nebulise). Independent University Hospital

FORMULARY 2010

12- OPTHALMOLOGICAL DRUGS 12.1

CHLORAMPHENICOL

INDICATIONS

Bacterial conjunctivitis. ADVERSE EFFECTS

O P T H A L M O L O G I C A L

Aplastic anaemia (rare). DOSAGE, FORM & STRENGTH Eye drops: 0.5% Eye ointment: 1% Adults & Children;

Ointment 1 application three to four hourly. Drops 2 drops three hourly. 12.2

GENTAMICIN

INDICATIONS

Ocular bacterial infections. ADVERSE EFFECTS

Transient irritation, Superinfections. DOSAGE FORM & STRENGTH Eye drops: 0.3% Adults; Children;

2-4 drops three times or four times daily and at night. 12.3

SULFACETAMIDE SODIUM

INDICATIONS

Acute conjunctivitis, superficial cornel ulcer, and other inflammatory conditions of the eyes. ADVERSE EFFECTS

Transient irritation. Superinfections. Independent University Hospital

FORMULARY 2010

D R U G S

DOSAGE, FORM & STRENGTH Eye ointment : 10%, Eye drops: 10%, 20%

1 drops two hourly

MIOTICS AND ANTIGLAUCOMA DRUGS

O P T H A L M O L O G I C A L D R U G S

12.4

ACETAZOLAMIDE

INDICATIONS

Congestive heart failure, oedema and toxaemia of pregnancy, pre-menstrual tension. Epilepsy, Glaucoma. CONTRA-INDICATIONS

Chronic closed angle glaucoma. Renal hyperchloraemic acidosis. Adrenal insufficiently. Sodium or potassium depletion. ADVERSE EFFECTS

F l u s h i n g, t h i r s t , h e a d a c h e , d r o w s i n e s s , p o l y u r i a , paraesthesia,blood dyscrasias, excitment, rash. DOSAGE, FORM & STRENGTH Tab: 250mg Adults;

Initially 250-375mg once daily. 125-375mg OD 5-10 days before menstruation. Epilepsy: 250mg-1mg daily in divided doses. Pre-menstrual tension:

Children under 2 years;

125mg daily; 2-12 years, 125-750mg daily in divided doses Glaucoma. Adults; Children & Infants;

12.5

1-4 daily in divided doses. Â˝ tab daily; 1/2-3 tabs daily in divided doses.

PILOCARPINE NITRATE

INDICATIONS

Glaucoma Independent University Hospital

FORMULARY 2010

CONTRA-INDICATIONS

Acute iritis. Soft contact lenses. DOSAGE, FORM & STRENGTH Eye drops: 2%, 4% Adults & Children: 2 drops

thrice daily.

MYDRIATIC / CYCLOPLEGIC DRUGS 12.6

ATROPINE

INDICATIONS

Long acting mydriatic and cycloplegic for use in uveitis and refraction. CONTRA-INDICATIONS

Narrow angle glaucoma. Soft lenses. ADVERSE EFFECTS

Transient stinging, dry mouth, blurred vision, photo phobia, tachycardia, headache. Psychotic reaction, behavioral changes. DOSAGE, FORM & STRENGTH Eye drops: 1% Adults and children Uveitis, 1 drops three times daily. Refraction, 1-2 drops one hour before examination.

12.7

HOMATROPINE HYDRO BROMIDE

INDICATIONS

Mydriatic and cycloplegic with more rapid onset and shorter duration than atropine. CONTRA-INDICATIONS

Narrow angle glaucoma. DOSAGE, FORM & STRENGTH Eye drops: 2% Independent University Hospital

FORMULARY 2010

O P T H A L M O L O G I C A L D R U G S

Adults & Children;

12.8

1 or more drops as required.

TROPICAMIDE

INDICATIONS

Mydriatic and cyclopegic (with a rapid recovery of accommodation) for refraction.

O P T H A L M O L O G I C A L D R U G S

CONTRA- INDICATIONS

Unknown intra ocular pressure. In infants put pressure over Lacrimal sac for 1 minute. ADVERSE EFFECTS

Transient sitngind, dry mouth, blurred vision, photophobia, tachycardia, headache, psychotic reactions, behavioral changes. DOSAGE, FORM & STRENGTH Eye drops: 1% Adults & Children;

1 or 2 drops of either strength at 1-5 min intervals. 12.9

CHLORAMPHENICOL+HYDROCORTISONE ACETATE

INDICATIONS

Ocular infections. CONTRA-INDICATIONS

Viral, fungal, tuberculous or purulent infections. Glaucoma. ADVERSE EFFECTS

Rise in intra-ocular pressure, corneal thinning, cataract. Aplastic anaemia(rare). DOSAGE, FORM & STRENGTH

Apply once daily to once hourly depending on severity.

Independent University Hospital

FORMULARY 2010

12.10 PREDNISOLONE

INDICATIONS

Steroid responsive inflammation of the palpebral and bulbat conjunctiva, cornea and anterior segment of the globe. CONTRA-INDICATIONS

Viral, fungle tuberculous and other infections of the eye. ADVERSE EFFECTS

Rise in intra-ocular pressure, corneal thinning cataract, fungal infection. DOSAGE, FORM & STRENGTH Eye drops: 1% Adults & Children;

1-2 drops 2-4 times daily. During initial 24-48 hours the dosage may safely be increased to 2 drops every hour.

ANTIGLAUCOMA DRUGS 12.11 BETAXOLOL HYDROCHLORIDE INDICATIONS

Ocular hypertension, chronic open-angle glaucoma. CONTRA-INDICATIONS Sinus bardycardia, cardiogenic shock, uncompensated cardiac failure, soft lenses. ADVERSE EFFECTS

Transient discomfort. Rarely decreased corneal sensitivity. Erythema, corneal punctate staining, keratitis. DOSAGE, FORM & STRENGTH Eye drops: 0.5% Adults;

1 drops twice daily.

Independent University Hospital

FORMULARY 2010

O P T H A L M O L O G I C A L D R U G S

Not recommended.

Children;

12.12 BETAMETHASONE INDICATIONS

O P T H A L M O L O G I C A L

Non-inflected inflammatory conditions of the eye. In opthalmology indications include uveitis, marginal keratitis, allergic conjuntivitis, blepharitis and episcleritis. CONTRA-INDICATIONS

Viral, fungal, tuberculous or purulent infections. Dendritic ulcer, Glaucoma. ADVERSE EFFECTS

Corneal thinning cataract, rise in intra-ocular pressure; avoid unnecessary use. DOSAGE, FORM & STRENGTH Eye drops: 0.1% Adults & Strength: 1 or 2 drops one or two hourly.

DIAGNOSTIC AGENTS 12.13 FLUORESCEIN SODIUM INDICATIONS

Detection of lesions foreign bodies.

D R U G S

Independent University Hospital

FORMULARY 2010

13- GYNAECOLOGICAL DRUGS 13.1

OXYTOCIN

INDICATIONS

Induction of labour in case of post maturity, premature rupture of membranes or preeclampsia. Primary and secondary uterineintertia. Caesarean section. Post partum uterine atomy. CONTRA-INDICATIONS

Cephalopelvic disproportion, abnormal presentation. Excessive distension of the uterus (e.g. in multiple pregnancy, hydramnios), parity greater than 4, elderly multiport, previous. Caesarean section or other surgery involving the uterus. Severe toxaemia, predisposition to amniotic fluid embolism (foetal death in utero, abruption placentae), hypertonic construction, placenta praevia. ADVERSE EFFECTS

Very occasionally prolonged or too rapid infusion of syntocinon has antidiuretic effects, which may cause transient water intoxication, with headaches and nausea. DOSAGE, FORM & STRENGTH Inj: 5 iu / ml Induction or enhancement of labour: IV drip infusion

of a 5% dextrose solution containing 1iu syntocinon per 100 ml. The initial infusions rate of 1-4mU/ min=0.1-0.4ml/min )2-8 drops/min) may be gradually increased until the desired response is achieved (maximum 20mU/min = 2ml/min = 40 drops/min) provided the foetal heart rate and the frequency and duration of contraction are carefully monitored. Third stage of labour and purpureum (hemorrhage, subinvolution of the uterus):5-10iu IM or 5iu slowly IV. Caesarean Section: 5iu intramurally after delivery of the foetus. Independent University Hospital

FORMULARY 2010

G Y N A E C O L O G I C A L D R U G S

14- ANTI ALLERGIC DRUGS

14.1

ADRENALINE

INDICATIONS

Emergency treatment of acute anaphylaxis; cardiopulmonary resuscitation.

A N T I A L L E R G I C D R U G S

CONTRA-INDICATIONS

Hyperthyroidism, diabetes mellitus, ischemic heart disease, hypertension, elderly patients. ADVERSE EFFECTS

Anxiety, tremor, tachycardia, arrhythmias, dry mouth, cold extremities. DOSAGE, FORM & STRENGTH Inj: 1 in 1000/ml Acute anaphylaxis, by intramuscular injection, see table below Important: intravenous route is for cardiac resuscitation.

These dose may be repeated every 10 minutes, according to blood pressure and pulse, until improvement occurs (may be repeated several times). Volume of adrenaline injection 1 in 1000 (1mg/ml) for intramuscular injection in anaphylactic shock. Age Adrenaline 1 in Under 1 Year 1 Year 2 Years 3-4 Years 5 Years 6-12 Years Adults

Volume of 1000 0.05 mL 0.1 mL 0.2 mL1 0.3 mL1 0.4 mL1 0.5 mL1 0.5-1 mL1

14.2 CHLOROPHENIRAMINE MALEATE INDICATIONS

Symptomatic relief of allergy such as hay fever, urticaria; emerIndependent University Hospital

FORMULARY 2010

gency treatment of anaphylactic reactions.

CONTRA-INDICATIONS

CNS depression, hypersensitivity to Chlopheniramine Maleate driving. ADVERSE EFFECTS

Drowsiness, impaired reactions Dizziness. DOSAGE, FORM & STRENGTH Tab: 4 mg Adults; By mouth, 4mg every 4-6 hours, maximum 24 mg daily.

1 mg twice daily. 2mg every 4-6 hours, maximum 12 mg daily. By slow intravenous injection over 1 minutes, 10-20mg, diluted in syring with 5-10 ml blood. Children 1-2 Years; 6-12 years;

Available as:

Avil, Flueze, Coldene 14.3

PROMETHAZINE HCL

INDICATIONS

Allergic conditions CONTRA-INDICATIONS

Hypersensitivity to promethazine HCL, driving. ADVERSE EFFECTS

Drowsiness, impaired reactions. Dizziness, disorientation, photosensitivity, Extra pyramidal reactions, convulsions (high doses) DOSAGE, FORM & STRENGTH Syp: 5mg/5ml Independent University Hospital

FORMULARY 2010

A N T I A L L E R G I C D R U G S

A N T I A L L E R G I C

Elixir/ Tabs. Adults;

10-20mg two or three times daily.

Children under 1 years; 1-5 years; Over 5 years;

Not recommended. 5-15mg. 10-25mg. If two doses in 24 hours are required, use lower amount stated. 25-50mg by deep IM inj or slow IV inj after dilution. Not recommended. 6.25-12.5mg by deep IM inj.

Adults; Children under 5 years; Over 5 years;

Available as:

Phenergan, Tixylix 14.4

CETRIZINE

INDICATIONS

Allergic conditions CONTRA-INDICATIONS

BPH, Glaucoma, Pyloroduodenal obstruction. ADVERSE EFFECTS

D R U G S

Drowsiness, impaired reactions. Dizziness, disorientation, photosensitivity, Extra pyramidal reactions, convulsions (high doses), Urinary retention, Blurred vision. DOSAGE, FORM & STRENGTH

5-10mg twice daily. Available as:

Zyrtec, Rigix, Serzine

Independent University Hospital

FORMULARY 2010

14.5

LORATIDINE

INDICATIONS

Allergic conditions, hay fever, urticaria. CONTRA-INDICATIONS

BPH, Glaucoma, Pyloroduodenal obstruction. ADVERSE EFFECTS

Drowsiness, impaired reactions. Dizziness, disorientation, photosensitivity, Extra pyramidal reactions, convulsions (high doses), Urinary retention, Blurred vision. DOSAGE, FORM & STRENGTH

5-10mg twice daily.

A L L E R G I C

Available as:

Antial, Allergat, Xalar, Lorate 14.6

A N T I

CLEMASTINE

INDICATIONS

Allergic conditions, hay fever, urticaria. CONTRA-INDICATIONS

BPH, Glaucoma, Pyloroduodenal obstruction. ADVERSE EFFECTS

Drowsiness, impaired reactions. Dizziness, disorientation, photosensitivity, Extra pyramidal reactions, convulsions (high doses), Urinary retention, Blurred vision. DOSAGE, FORM & STRENGTH

1mg twice daily (Maximum 6mg daily) Available as:

Alereas, Tandegyl

Independent University Hospital

FORMULARY 2010

D R U G S

15- INTRAVENOUS FLUIDS

BRAND NAME

F L U I D S

Electrolytes Na

(mEq/Liter)

Lactate

108.7

–

110

–

275

154

–

—

–

4.4

–

156

–

Ca Mg

2.7

–

Ringolact-D

5% Dextrose and 130 4 electrolytes injection

2.7

–

Ringolact-M

5% Dextrose and 60 20 Electrolytes Injection

–

Pladex-5

5% Dextrose Intravenous Infusion

–

Plasaline

0.9% Sodium Chloride Intravenous Infusion (Normal Saline)

150 –

–

Pladex-10

10% Dextrose Injection Infusion

–

25% Dextrose injection

25% Dextrose Injection

–

Pladexsal

5% Dextrose and 0.45% Sodium Chloride Injection

154 –

–

Pladexsal 1/2

5% Dextrose and 0.45% Sodium Chloride Injection

–

Pladexsal 1/3

3.3% Dextrose and 0.3 Sodium Chloride Injection

–

Pladexsal 1/5

0.18% Sodium Choride and 4.3% Dextrose Intravenous Infustion

0.45% Sodium Choride Injection

Nisf Normal Saline Ringer`s Solution Osmotol

–

Composed Sodium Chloride Injection 147 4 20% Mannitol Intravenous Infusion

–

Darrow`s Solution

Lactated Potassic Saline Injection

121 35

Peri Solution

Peritoneal Dialysis 140 -Solution

Independent University Hospital

Dextrose

(as monohydrate) (gms/L)

Located Ringer`s 130 4 Injection

Ringolact

I N T R A V E N O U S

GENERIC NAME

108.7

60 – 150 – –

103 53

1.5 102 43.5

– 16

FORMULARY 2010

15.1

POLYGELLINE

INDICATIONS

Blood loss, plasma loss, dehydration, hypovlaemic shock, volume losses during and after surgery, extra corporeal circulation, hematolysis, dehydration circulation states, for use in heart-lungmachines, for perfusion of isolated organs, plasma exchange, intra operative hemodilution. Carrier for low dose insulin infusion. CONTRA-INDICATIONS

No absolute contra-indications is known. In presence of relative contra-indications (e.g cardiac insufficiency, fixed hypertension, cardiogenic shock) infusion should be performed under proper supervision. ADVERSE EFFECTS

Wheal, transitory urticaria, skin reactions, temporary hypotension, raised temperature and or shivering may occur. DOSAGE, FORM & STRENGTH

Inj 35mg with electrolytes bag of 500ml with set. As per doctorâ&#x20AC;&#x2122;s advise. 50ml to be infused in one hour. In emergency cases where immediate volume replacement is needed polygeline can be infused rapidly.

Independent University Hospital

FORMULARY 2010

I N T R A V E N O U S F L U I D S

16- VITAMINS AND MINERALS

16.1

ASCORBIC ACID

INDICATIONS

Vitamin C deficiency, prevention and treatment of scurvy.

V I T A M I N S A N D

DOSAGE, FORM & STRENGTH Tab: 50mg Prophylactic;

25-75 mg daily. Therapeutic;

Not less than 250mg daily individed doses. 16.2

CALCIUM GLUCONATE.

INDICATIONS

Calcium deficiency, pregnancy and lactation. CONTRA-INDICATIONS

Conditions associated with Hypercalcaemiaandypercalciuria. ADVERSE EFFECTS

M I N E R A L S

Mild gastro- intestinal disturbances; bradycardia, arrhythmias, and irritation after intravenous injection. DOSAGE, FORM & STRENGTH Tab: 100mg Adults; By mouth, daily in divided doses, as calcium gluconate or latate. By deep intramuscular injection or by slow intravenous injection.

Acute. Hpocalcaemia. Calcium gluconate 1-2g. Children;

Obtain paediatric advice; intramuscular route not recommended. Independent University Hospital

FORMULARY 2010

16.3

CALCIUM LACTATE

INDICATIONS

Calcium deficiency, pregnancy and lactation. CONTRA-INDICATIONS

Conditions associated with hypercalcaemiaandhypercalciuria. ADVERSE EFFECTS

Mild Gastro-intestinal disturbances; bradycardia, arrhythmias, and irritation after intravenous injection. DOSAGE, FORM & STRENGTH Tab: 300mg Adults; By mouth, daily in divided doses, as calcium gluconate or lactate. By deep intramuscular injection or by slow intravenous injection,

V I T A M I N S

acute hypocalcaemia, calcium gluconate 1-2g. Children;

Obtain paediatric advice; intramuscular route not recommended. 16.4

VITAMIN COMPLEX

INDICATIONS

Neuralgia and neuritis of toxic and non-toxic origin. DOSAGE, FORM & STRENGTH Tab/Inj

Adults; 1 inj daily or no alternate days. 3 tabs daily.

VITAMINS AND HEMATINICS 16.5

A N D

FERROUS GLUCONATE

INDICATIONS

Iron deficiency anaemia. Independent University Hospital

FORMULARY 2010

M I N E R A L S

DOSAGE, FORM & STRENGTH Syp: 300mg/5ml Prophylactic; 2 tabs daily before food.

V I T A M I N S A N D M I N E R A L S

Therapeutic; 4-6 tabs daily in divided doses before food. Children6-12 years; Prophylactic and therapeutic, 1-3 tabs daily.

16.6

FERROUS SULPHATE

INDICATIONS

Iron deficiency anaemia. DOSAGE, FORM & STRENGTH Tab: 150mg

Ferrus iron. Therapeutic;

120-180 daily in divided doses. Prophylactic;

69mg daily. Children;

Therapeutic, daily in divided doses. Upto 1 year; 1-5 years; Under 1 year;

16.7

36mg. 72mg. 6-12mg.

FOLIC ACID

INDICATIONS

Megaloblastic anaemia due to folic acid deficiency. CONTRA-INDICATIONS

Megaloblastic anaemia due to vitamin B12 deficiency. Independent University Hospital

FORMULARY 2010

ADVERSE EFFECTS

Nausea, constipation. DOSAGE, FROM & STRENGTH Tab: 5mg Adults;

Initially 10-20mg daily for 14 days then 5-10mg daily. 16.8

B COMPLEX

INDICATIONS

Multi-vitamin supplement for infants. DOSAGE, FORM & STRENGTH Syp: vit B1 3mg,

Vit B2 3mg, pyridoxine 2mg nicotinamide 23mg/5ml.

Adults; Children;

1-2 tsp daily. 1tsp daily.

V I T A M I N S A N D M I N E R A L S

Independent University Hospital

FORMULARY 2010

17- ANTI DIABETIC DRUGS

17.1

GLIBENCLAMIDE

INDICATIONS

Diabetes mellitus CONTRA-INDICATIONS

A N T I D I A B E T I C D R I G S

Juvenile diabetes with ketosis; impairment of renal function; stress; pregnancyâ&#x20AC;&#x2122; diabetic coma. ADVERSE EFFECTS

Nausea and sensation of fullness are exceptional. Changes in haemopoietic systemic are rare. DOSAGE, FORM & STRENGTH Tablet,

Initially 5mg daily (elderly patients 2.5mg), adjusted according to response; maximum 15mg daily; taken with breakfast. 17.2

GLICLAZIDE

INDICATIONS

Diabetes mellitus. CONTRA-INDICATIONS

Juvenile diabetes with ketosis; impairment of renal function; stress; pregnancy; diabetic coma. ADVERSE EFFECTS

Nausea and sensation of fullness are exceptional. Change in haemopoietic system are rare. DOSAGE, FORM & STRENGTH Tablet,

Initially, 40-80mg daily, adjusted according to response; up to 160mg as a single dose, with breakfast; higher doses divided; maximum 320mg daily.

Independent University Hospital

FORMULARY 2010

17.3

METFORMIN HYDROCHLORIDE

INDICATIONS

Diabetes mellitus. CONTRA-INDICATIONS

Hepatic or renal impairment (withdraw if renal impairment suspected), predisposition to lactic acidosis, heart failure, severe infection or trauma, dehydration, alcohol dependence; pregnancy, breast-feeding. ADVERSE EFFECTS

Anorexia, nausea, vomiting, diarrhoea (usually transient), lactic acidosis (withdraw treatment), decreased vitamin B12 absorption. DOSAGE, FORM & STRENGTH Tablet,

500 mg every 8 hours or 850 mg every 12 hours with or after food; maximum 3g daily in divided doses though most physicians limit this to 2 g daily.

A N T I D I A B E T I C D R I G S

Independent University Hospital

FORMULARY 2010

18- VACCINES

18.1

TETANUS TOXOID

INDICATIONS

Tetanus vaccines stimulate the production of the protective antitoxin. DOSAGE, FORM & STRENGTH Inj: 0.5 ml

0.5 mL or as stated on the label, by intramuscular or deep subcutaneous injection followed after 4 weeks by a second dose and after a further 4 weeks by a third dose. 18.2

V A C C I N E S

HEPATITIS B VACCINE

INDICATIONS

Active immunization against hepatitis B virus. CONTRA-INDICATIONS

Severe febrile infections. ADVERSE EFFECTS

Mild transient local soreness, erythema and induration at inj site, low grade fever, malaise, nausea, dizziness. DOSAGE, FORM & STRENGTH Inj: 0.5mg/1 ml Adults & Children;

1 dose by IM inj, into the deltoid muscle, repeated 1 month and 6 month later. 18.3

RABIES VACCINES

INDICATIONS

Prophylaxis and therapy to rabies. DOSAGE, FORM & STRENGTH Inj: 50mg in vial, By SC or IM route. Independent University Hospital

FORMULARY 2010

Prophylaxis;

Day-1 1st dose. Day 7 2nd dose. Day 28 3rd dose. Booster after one year then every three years. Therapeutic;

In non-vaccinated subjects. Day-1 1st dose. Day 3 2nd dose. Day 14 3rd dose. Day 28 4th dose. Day 30 5th dose. Day 90 6th dose. (Optional) 18.4

ANTI SNAKE VENOM

INDICATIONS

The snake bite may cause local systemic effects. Local effects include pain, swelling, bruising and tender enlargement of regional lymph nodes. Systemic effects include early transient hypotension with syncope, angioedema, abdominal colic, diarrhoea, and vomiting with later persistent or recurrent hypotension. ECG abnormalities, spontaneous systemic bleeding, coagulopathy, adult respiratory distress syndrome, and acute renal failure. DOSAGE, FORM &B STRENGTH Inj: 10ml in vial.

The anti snake venum diluted with 2-3 volumes of sodium chloride intravenous infusions 0.9% and given by slow intravenous injection (not more than 2ml of diluted anti venom per minute) or by intravenous infusion. The same dose should be used for adults and children. The dose can be repeated in 1-2 hours if there is no clinical improvement. Adrenaline injection must be kept for treatment of anaphylactic anti venum injection. Independent University Hospital

FORMULARY 2010

V A C C I N E S

19- ENT PREPARATIONS

100

19.1

POLYMYXIN B SULPHATE

INDICATIONS

For the treatment of inflammatory otitis externa due to, or complicated by, bacterial infection. DOSAGE, FORM & STRENGTH

10,000 u/ml

E N T

Adults;

3 drops 3 or 4 times daily into affected ear. Children;

1 or 2 drops 3 or 4 times daily into affected ear.

P R E P R A T I O N S

19.2

POLYMYXIN B SULPHATE + LIGNOCAINE HCL

INDICATIONS

For the symptomatic relief and treatment of otitis extrena. DOSAGE, FORM & STRENGTH

10,00 u + 50mg/ml Adults;

3 drops 3 or 4 times daily into affected ear. Children;

1 or 2 drops 3 or 4 times daily into affected ear. 19.3

SODA GLYCERIN

DOSAGE, FORM & STRENGTH

Drops 2-5% 19.4

POLYMYXIN B SULPHATE + HYDROCORTISONE ACETATE + NEOMYCIN SULPHATE

INDICATIONS

For the treatment of inflammatory otitis externa due to, or complicated by, bacterial infection. Independent University Hospital

FORMULARY 2010

DOSAGE, FORM & STRENGTH

101

5mg/ml + 10mg/ml + 5mg/ml Adults; Children;

3 drops 3 or 4 times daily into affected ear. 1 or 2 drops 3 or 4 times daily into affected ear.

E N T P R E P R A T I O N S

Independent University Hospital

FORMULARY 2010

20- METABOLIC AGENTS

102

20.1

M E T A B O L I C A G E N T S

ALLOPURINOL ZYLORIC 100mg, 300mg INDICATIONS Allopurinol is indicated for reducing urate. Uric acid formation in conditions where urate/uric acid deposition has already occurred (e.g. gouty arthritis, skin tophi, nephrolithiasis) or in a predictable clinical risk (e.g. treatment of malignancy potentially leading to zinc acid nephropathy). CONTRA- INDICATION Not a treatment for acute gout but continue if attack develops when already receiving allopurinol, and treat attack separately. ADVERSE- EFFECT Rashes (withdraw therapy; if rash mild, re-introduce cautiously but discontinue immediately if recurrence occurs). Skin reactions associated with exfoliation, fever, lymphadenopthy, arthralgia, and or eosinophilia, resembling Stevens-Johnson or Lyellâ&#x20AC;&#x2122;s Syndrome, occur rarely. Gastro-intestinal disorders. Rarely malaise, headache, vertigo, drowsiness, taste disturbances, hypertension, symptomless xanthine deposits in muscle, alopecia, hepatotoxicity, paraesthesia and neuropathy. DOSAGE, FROM & STRENGTH Tab: 100mg, 300mg Children; In neoplastic conditions, enzyme disorders 10-20 mg/kg daily.

Independent University Hospital

FORMULARY 2010

21- ANTI-EPILEPTICS 21.1

103

CARBAMAZEPINE

INDICATIONS

Anti-Epileptics, Mood Stabilizer, Analgesic, Prophylaxis of maniac depressive psychosis unresponsive to lithium. Generalized tonic clonic and partial seizures, diabetic neuropathy. Trigeminal neuralgia. CONTRA-INDICATIONS

A-V conduction abnormalities unless paced. Lactation. ADVERSE EFFECTS

Vertigo, Ataxia, Gastric upset, diplopia, dry mouth, drowsiness & dizziness. Oedema & rarely hyponatraemia. Blood dyscrasias, rashes, toxic epidermal necrolysis, hair loss. Acute renal failure. Lymph-node enlargement, cardiac conduction disturbances, hepatitis, and cholestatic jaundice. DOSAGE, FORM & STRENGTH Adults & Children;

100-200mg O.D / B.D Maximum Dose 2000mg Daily Children upto 1 Year: 1-5 Year: 5-10 Year: 10-15 Year:

100-200mg. 200-400mg. 400-600mg. 600mg-1gm. All daily in divided doses. Available as:

Epilex, Seizunil, Tegral, Epitab Xr, Carbanil 21.2 DIAZEPAM Benzodiazepene long acting Independent University Hospital

FORMULARY 2010

A N T I E P I L E P T I C S

104

INDICATIONS

Short-term use in anxiety or insomnia, adjunct in acute alcohol with drawl; status epileptics, muscle spasm, peri-operative. CONTRA-INDICATIONS

Respiratory depression; acute pulmonary insufficiency: not for phobic or obsessional states, chronic psychosis; porphyria. ADVERSE EFFECT

A N T I E P I L E P T I C S

Drowsiness and lightheadedness the next day; confusion and atexia (especially in the elderly); amnesia may occur; dependence. Occasionally; headache, vertigo, hypotension, salivation changes, gastro-intestinal disturbances, rashes , visual disturbances, changes in libido urinary retention. Blood disorders and jaundice reported. On intravenous injection: pain, thromobophlebitis, and rarely apnoea or hypotension. DOSAGE, FORM & STRENGTH Adults; By mouth: Anxiety 2mg - 3 times

daily, increased if necessary, to

15-30 mg daily in divided dose. Elderly or debilitated; Half adult dose, Insomnia

associated with anxiety, 5-15mg at

bedtime. Children; Night terrors and somnambulism, 1-2 mg at bedtime.By intramuscular injection or slow intravenous injection (into a large vein, at a rate of not more than 5 mg/minute), for severe anxiety, control of acute panic attacks, and acute alcohol withdrawal, 10mg,

repeated if necessary after 4 hours. By rectum: as rectal solution, for acute anxiety and agitation. Adult and children over 3 Years;

10 mg(elderly 5 mg), repeated; after 5 minutes if necessary. Independent University Hospital

FORMULARY 2010

5mg.

Children 1-3 Year;

105

Available as:

Valium, Cerelium, Diazepam, Relax, Relaxipam 21.3

PHENYTOIN SODIUM

INDICATIONS

Status epilepticus; seizures in neuro-surgery; arrhythmias. CONTRA-INDICATION

Sinus bardycardia, sino-atrial block, and second third degree heart block; stokes-adams sydrome; prophyria. ADVERSE EFFECTS

Gum atrophy, Blood disorders, Intravenous injection may cause cardiovascular and CNS depression (particularly if injection too rapid) with arrhythmias, hypo tension, and cardiovascular collapse; alterations, in respiratory function (including respiratory arrest.) DOSAGE, FORM & STRENGTH

150-500mg / Day in 1-2 doses orally. 15mg / kg intravenous at 50mcg / min. Adults;

By slow intravenous injection (with blood pressure and ECG monitoring), status epileptic us, 15mg/kg at a rate not exceeding 50mg per minute, as a loading dose. Maintenance doses of about 100mg should be given thereafter at intervals of every 6 hours, monitored by measurement of plasma concentration; rate and dose reduced according to weight. Instramuscular injection not recommended. Available as:

Dihydan, Dilantin, Epitoin, Fentin, Phenton-s

Independent University Hospital

FORMULARY 2010

A N T I E P I L E P T I C S

106

21.4

SODIUM VALPROATE

INDICATIONS

Anti-epileptics, Mood stabilizer CONTRA-INDICATIONS

Hepatic dysfunction, Porphyrias ADVERSE EFFECT

A N T I E P I L E P T I C S

Sedation, Weight gain, hair loss, oedema, pancreatitis, hepatic failure, hyperammonaemia, thrombocytopenia, neurological effects. DOSAGE, FORM & STRENGTH Adults;

300mg B.D orally. Usual maintenance, 1-2 gm daily. Maximum 2.5 gm daily. Available as:

Dapakan, Epilim, Epival, Malprate, Orifral, Valep, Valpro, Valprox

Independent University Hospital

FORMULARY 2010

22- ANAESTHETICS

107

INHALATIONAL ANAESTHETICS 22.1 ENFLURANE Enflurane is a volatile anaesthetic similar to halothane, but is less potent, about twice the concentration being necessary for induction and maintenance INDICATIONS

Enflurane is usually given to supplement nitrous oxide-oxygen mixtures and may be given in preference to halothane when repeated anaesthesia is required. CONTRA-INDICATIONS

Avoid in porphyria ADVERSE EFFECTS

Enflurance is a powerful cardio respiratory depressant. Shallow respiration is likely to result in a rise of arterial carbon dioxide tension, but ventricular arrhythmias are uncommon. It is probably safe to use adrenaline infiltrations. Myocardial depression may result in fall in cardiac output and in arterial hypotension. DOSAGE, FORM & STRENGTH

Inhalation fluid: Using a specifically calibrated vaporizer, induction, increased gradually from 0.4% to maximum of 4.5% in air, oxygen, or nitrous oxide-oxygen, according to response. 22.2 ISOFLURANE Isoflurane is an isomer of enflurane. It has a potency intermediate between that of halothane and enflurene. Heart rhythm is gradually stable during rate may rise, particularly in younger patients. Systemic arterial pressure may fall, due to decreases in systemic vascular and with less decrease in cardiac output than occurs with halothane. Independent University Hospital

FORMULARY 2010

A N A E S T H E T I C S

108

Respiration is depressed. Muscle relaxation is produced and muscle relaxant drugs potentiated. INDICATIONS

Isoflurane is used for induction and maintenance of anaesthesia. CONTRA-INDICATIONS

Contra-indicated in patients, hypersensitivity to Isoflurane. ADVERSE EFFECTS

Cardio-respiratory depression, bradycardia, ventricular arrhythmia.

A N A E S T H E T I C S

DOSAGE, FORM & STRENGTH

Inhalation: Using a specficially calibrated vaporizer, induction, increased gradually from 0.5% to 3% in oxygen or nitrous oxideoxygen ; an additional 0.5-1% may be required when given with oxygen alone; caesarean section, 0.5-0.7% in nitrous oxideoxygen. Children; Maintenance;

1.5-2% 0.5-2%.

INTRAVENOUS ANAESTHETICS 22.3

KETAMINE

INDICATIONS

Induction & maintenance of anaesthesia. It is mainly used for paediatric anaesthesia. Particularly when repeated administrations are required. CONTRA-INDICATIONS

Ketamine is contraindicated in patients with hypertentsion and is best avoided in those prone to hallucinations. ADVERSE EFFECTS

There is cardiovascular stimulation and arterial pressure may rise with tachycardia. Independent University Hospital

FORMULARY 2010

High incidence of hallucinations. Recovery is relatively slow.

109

DOSAGE, FORM & STRENGTH Inj: 50mg/ml in 10 ml vial (base) Intramuscular injection: short procedures,

initially 6.5-13 mg/kg (10mg/kg usually produces12-25minutes of surgical anaesthesia). Diagnostic maneuvers and procedure not involving intense pain, initially 4 mg/kg. Intravenous injection: over at least 60 seconds. Short procedures, initially 1-4.5 mg/kg usually produces 5-10 minutes of surgical anaesthesia. Intravenous infusion: of a solution containing 1 mg/ml. Longer procedures & induction. Total drip infusion 10-45 micrograms/kg/minute, rate adjusted according to response. 22.4 THIOPENTAL SODIUM Thiopental sodium is an ultrashort-acting depressant of the central nervous system which induces hypnosis and anaesthesia, but notanalgesia. It produces hypnosis within 30-40 seconds of intravenous injection. Recovery after a small dose is rapid, with after a small dose is rapid. With some somnolence and retrograde amnesia. INDICATIONS

Thiopental sodium is indicated As the sole anesthetic for brief(15 minutes) procedure, For induction of anesthesia prior to administration of other anesthetic agents. To supplement regional anesthesia. To provide hypnosis during balanced anesthesia with other agents for analgesia or muscle relaxation. For the control of convulsive states during or following inhalation anesthesia, local anesthesia, or other cause. In neurosurgical patients with increased intra cranial pressure, if Independent University Hospital

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adequate ventilation is provided, and For narcoanalysis and narcosynthesis in psychiatric disorders. CONTRA-INDICATIONS

Absolute contra-indications are; Absence of suitable veins for intravenous administration. Hypersensitivity (allergy) to barbiturates. Status asthmaticus. Latent or manifest porphyria.

A N A E S T H E T I C S

Relative contra-indications are; Severe cardiovascular diseases. Hypotension or shock Conditions in which the hypnotic effect may be prolonged or potentiated, excessive premeditation, Addisonâ&#x20AC;&#x2122;s diseases, hepatic or renal dysfunction , myxedema, increased blood urea, severe anemia, asthma and myasthenia gravis. ADVERSE EFFECTS

Care should be taken in administering the drug to patients with advanced cardiac disease, increased intra cranial pressure. Asthma. Mythenia gravis. Endocrine insufficiently (pituitary, thyroid. Adrenal, pancreas). Respiratory depression which may result from either unusual responsiveness to thiopental. Laryngospasm may occur with light thiopental sodium. Narcosis at intubation, or in the absence of intubation, if foreign matter of secretions in the respiratory tract create irritation. Myocardial depression may occur with thiopental sodium. DOSAGE, FORM & STRENGTH Inj: 500mg. Intravenous injection: in fit

and pre-medicated adults, initially 100- 150 mg (4-6 ml of 2.5% solution)over 10-15 seconds, repeated if necessary according to response after 20-30 seconds; or up to 4 mg/kg Independent University Hospital

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Induction 2-7 mg/kg.

Children;

111

Available as:

Pentathal 22.5 PROPOFOL Short acting anaesthetic INDICATIONS

Intravenous anaesthesia ADVERSE EFFECT

Flushing, Transient apnoea, Thrombosis, Phlebitis CONTRA INDICATION

Pregnancy, Breast Feeding Dose;

1.5-2.5mg/kg @ of 20-40mg every 10 seconds Available as:

Diprivan, Fresofol, Pofol, Propofol, Recofol

LOCAL ANAESTHETICS 22.6 LIDOCAINE HYDROCHLORIDE Short acting and quick onset INDICATIONS

Topical anaesthesia, infilteration anaesthesia, intravenous regional anaesthesia CONTRA INDICATIONS

Hypovolaemia. Complete heart block. Avoid in porphyria. Do not use solutions containing adrenaline for anaesthesia in Independent University Hospital

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appendages. ADVERSE EFFECTS

Hypotension. Bradycardia. Cardiac arrest. CNS effects include agitation, euphoria, respiratory depression, convulsions. DOSAGE, FORM & STRENGTH Inj: 1%, 2% in vial, Inj.

A N A E S T H E T I C S

1%, 2% + Epinephrine, 1:100,000,1:200,000 in vial. 2-4% Dental cartridge 2% +Epinephrine 1:80,000 Gel 5%. Infiltration Anaesthesia:

0.25 -0.5% with adrenaline 1 in 200000, using 2-50 ml of a 0.5% solution in minor surgery and up to 60ml for extensive surgery. Nerve Blocks:

With adrenaline 1 in 200000, 1% to a maximum of 50 ml,2% to a maximum of 25 ml. Epidural and Caudal block,

With adrenaline 1 in 200000, 1% to a maximum of 50 ml, 2% to a maximum of 25 ml. Surface Anaesthesia,

Usual strengths 2-4%. Mouth throat , and upper gastro-intestinal tract, maximum 200 mg.

22.7 BUPIVICAINE Long acting and slow onset INDICATIONS

Topical anaesthesia, infilteration anaesthesia, intravenous regional anaesthesia, Spinal anaesthesia, epidural anaesthesia Independent University Hospital

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CONTRA INDICATIONS

113

Hypovolaemia. Complete heart block. Avoid in porphyria. Do not use solutions containing adrenaline for anaesthesia in appendages. ADVERSE EFFECTS

Hypotension. Bradycardia. Cardiac arrest. CNS effects include agitation, euphoria, respiratory depression, convulsions. DOSAGE, FORM & STRENGTH

0.5% 20ml, 5mg/ml for spinal anaesthesia. How to calculate safe dose of local anaesthestics

Drug concentration is expressed as percentage Percentage is measured as per 100ml Lignocaine 1%

10mg/ml

Lignocaine 2%

20mg/ml

Bupivicaine 0.25%

2.5mg/ml

Drug

Maximum Dose without adrenaline

Maximum Dose with adrenaline

Lignocaine

300mg

500mg

Bupivicaine

150mg

300mg

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114

22.8

NEOSTIGMINE METHYLSULPHATE

INDICATIONS

Neostigmine is useful in the therapy of pathological muscle weakness caused by myasthenia gravis, hemiplegia and monoplegia. Atonic constipation especially postoperative intestinal atony and urinary retention, paroxysmal tachycardia. Neostigmine antagonizes effects of synthetic curare like drugs. CONTRA-INDICATIONS

A N A E S T H E T I C S

Mechanical, intestinal or urinary obstructions. History of sensitivity to the drug. ADVERSE EFFECTS

Side effects are most commonly related to over dosage. Muscarinic effects: nausea, vomiting, diarrhea, increased salivation, abdominal cramps, fasciculation, weakness. DOSAGE, FORM & STRENGTH Inj: 05mg or 2.5mg/ml in amp. of 1 ml. Myasthenia gravis: 1.0-3.0 mg S/C or I/M daily. Postoperative intestinal atony or urinary retention: 0.25 mg

S/C or I/M prophylactically immediately after operation, repeatedly after 4 t0 6 hours. Paroxysmal tachycardia: 0.5-1.0 mg S/C or I/M. Hemiplegia , Monoplegia: 0.5-1.0 mg S/C or I/M followed by a glycerine suppository or saline enema. Flatulence of pregnancy: 0.5 mg S/C or I/M every 5 to 10 days.

NEUROMUSCULAR BLOCKING AGENTS 22.9

ATRACURIUM BESYLATE

INDICATIONS

A muscle relaxation for a wide range of procedures and to facilitate controlled ventilation. For endo-tracheal intubation where subseIndependent University Hospital

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quent muscle relaxation is required.

115

CONTRA-INDICATIONS

Hypersensitivity to atracurium besylate. ADVERSE EFFECTS

Tracrium should be administrated only with adequate general anaesthesia and under the close supervision of an experienced anaesthetist and with adequate facilities for endotracheat intubation and artificial ventilation. DOSAGE, FORM & STRENGTH Inj: 10mg/ml.

Over one minute, 0.3-0.6 mg/kg depending on the duration of full block required. This dosage provides relaxation for15-35 minutes. Full block can be prolonged with supplementary doses of 0.1-0.2 mg/kg as required. can usually be accomplished within 90 sec, from the IV inj. Of 0.5-0.6 mg/kg. As an infusion: After initial bolus dose of 0.3-0.6 mg/kg. Neuromuscular block can be maintained by administration as a continuos infusion at rates so 0.3-0.6 mg/kg hour. Endotracheal intubation

22.10 PANCURONIUM BROMIDE INDICATIONS

As an adjuvant in adult/child surgical anaesthesia to obtain surgical relaxation so that operative manipulations are facilitated. CONTRAINDICATIONS

Moderate rise of mean arterial pressure may occur. Pancuronium decreases intra ocular pressure and induces meiosis. A few cases of reactions at the site of injection have been reported. DOSAGE, FORM & STRENGTH Inj: 2mg/kg, Intravenous injection: Initially

for intubation 50-100 micrograms/kg then 10-20 micrograms/kg as required. Independent University Hospital

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Children;

Initially 60-100 micrograms/kg, then 10-20 micrograms/kg. Neonate;

30-40 micrograms/kg initially then 10-20 micrograms/kg. Intensive care, by intravenous injection, 60 micrograms/kg every 60-90 minutes. 22.11 SUXAMETHONIUM CHLORIDE INDICATIONS

A N A E S T H E T I C S

Endotracheal intubation. Short surgical interventions, especially in the abdomen, setting of fractures and dislocations, bronchoscopy, cytoscopy, etc .), gynaecological examination and interventions in obstetrics & electroconvulsive therapy. Intravenous drip for prolonged muscle relaxation in abdominal surgery. CONTRA INDICATIONS

Severe hepatic functional disorders. Pulmonary oedema. ADVERSE EFFECTS

Prolonged muscle paralysis may occur in patients with low or a typical plasma pseudocholinesterase enzymes. Prolonged paralysis also occur in dural block, which occur after repeated doses of suxamethonium and is caused by developing of a non-depolarizing block following the primary depolarizing block. DOSAGE, FORM & STRENGTH Inj: 50mg/kg.

Administration preferably by I/V inj; in special I/M inj. Drip infusion for continuous muscle relaxation.

circumstances also

Combination with all the usual anaesthesia agents is possible. Dosage according to desired degree of muscle relaxation. Dose of 0.1-0.2 mg/kg body wt usually produce muscle relaxation for 1-3 minutes without interfering with respiration.

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23- INDEX A

I N D E X

ACETAZOLAMIDE 83 ADRENALINE 89 ALBENDAZOLE 33 ALLOPURINOL 107 AMINOPHYLINE 74 AMLODIPINE 68 AMOXICILLIN 11 AMPICILLIN 11 AMINOPHYLINE SYP 80 AMMONIUM CHLORIDE SYP 80 ANAESTHETICS 112 ANALGESIC (OPIOID) 7 ANALGESICS (NON OPIOID) 1 ANTI ALLERGIC DRUGS 89 ANTI BACTERIALS 10 ANTI COAGULANTS 69 ANTI DIABETIC DRUGS 100 ANTI EMETICS 50 ANTI EPILEPTICS 108 ANTI FUNGAL DRUGS 31 ANTI HELMINTHICS 33 ANTI PROTOZAL DRUGS 42 ANTI SNAKE VENOM 103 ANTI SPASMODICS 54 ANTI TUBERCULOUS DRUGS 37 ANTICHOLINERGICS 119 ANTIGLAUCOMA DRUGS ANTIULCER DRUGS 45 ARTHEMETHER WITH LUMEFANTRINE 44 ASCORBIC ACID 96 ATENOLOL 58 ATRACURIUM BESYLATE 120 ATROPINE SULPHATE 54, 84

CALCIUM GLUCONATE CALCIUM LACTATE CAPTOPRIL CARBAMAZEPINE CARDIOVASCULAR DRUGS CEFACLOR CEFOTAXIME SODIUM CEFTAZIDIME SODIUM CEFTRIAXONE CEFUROXIME CEPHALEXIN CEPHRADINE CETRIZINE CHLORAMPHENICOL+HYDROCORTISONE ACETATE CHLORAMPHENICOL CHLORAMPHENICOL CHLOROPHENIRAMINE MALEATE CHLOROQUINE PHOSPHATE CIMETIDINE CIPROFLOXACIN CLEMASTINE CLOPIDROGREL CLOTRIMAZOLEX CO-AMOXICLAV CODIENE PHOSPHATE CO-TRIMOXAZOLE CYCLIZINE

B B COMPLEX BECLOMETHSONE

BENDROFLUAZIDE BENZYLPENICILIN BETAXOLOL HCL BUPIVICAINE

99 77

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DEXAMETHASONE DIAGNOSTIC AGENTS

73 10 86 118

96 97 59 108 58 15 18 16 17 16 13 14 91 85 29 82 90 42 46 19 92 70 31 13 7 28 50

FORMULARY 2010

DIAZEPAM DICLOFENAC SODIUM DIGOXIN DILTIAZEM DIMENHYDRINATEX DIURETICS DOBUTAMINE HCL DOMPERIDONE DOPAMINE HCL DOXYCYCLINE

ENALAPRIL MALEATE ENFLURANE ENT DRUGS EPHEDRINE HCL ERYTHOMYCIN ETHAMBUTOL EXPECTORANTS AND COUGH SYRUPS

FERROUS GLUCONATE FERROUS SULPHATE FLUCLOXACILLIN FLUORESCEIN SODIUM FOLIC ACID FUROSEMIDE

GASTRO INTESTINAL DURGS GENTAMICIN GENTAMICIN GLIBENCLAMIDE GLICLAZIDE GLYCERYL TRINITRATEX GRISEOFULVIN GYNAECOLOGICAL DRUGS

109 3 60 60 51 71 61 55 61

116

HEMATINICS 98 HEPARIN 69 HOMATROPINE HYDRO BROMIDE 84 HYDROCORTISONE SODIUM SUCCINATE 78 HYOSCINE 55

62 112 105 74 23 37 80

98 98 12 87 99 71

45 24 82 100 100 63 31 88

Independent University Hospital

IBUPROFFEN INDOMETHACIN INTRAVENOUS ANAESTHETICS INTRAVENOUS FLUIDS IPRATROPIUM ISOFLURANE ISONIAZID ISOSORBIDE DINTRATE

KAOLIN PECTIN KETAMINE

113 94 77 112 37 63

49 113

LEVAMISOLE HCL LEVOFLOXACIN LIDOCAINE HCL LINCOMYCIN LOCAL ANAESTHETICS LOPERAMIDE HCL LORATIDINE

4 5

MAGNESIUM TRISILICATE MANNITOL MEBENDAZOLE MEBEVERINE

33 21 116 25 116 49 92

45 72 34 56

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I N D E X

116

I N D E X

MEFENAMIC ACID METABOLIC AGENTS METFORMIN METHYDOPA METROCLOPRAMIDE HCL METRONIDAZOLE MIOTICS MORPHINE SULPHATE MYDRIATIC DRUGS MYRIN P MYRIN

2 107 101 64 52 26 83 8 84 41 41

NALIDIXIC ACID 21 NAPROXEN 6 NEOSTIGMINE METHYLSULPHATE 119 NEUROMUSCULAR BLOCKING AGENTS 120 NIFEDIPINE 65 NORFLOXACIN 22 NYSTATIN 32

ORS OFLOXACIN OMEPRAZOLE ONDANSETRON OPHTHALMOLOGICAL DRUGS XX OXYTETRACYCLINE HYDROCHLORIDE OXYTOCIN

PANCURONIUM BROMIDE PARACETAMOL PHENYTOIN SODIUM

56 20 48 53 82 27 88

PILOCARPINE NITRATE 84 PIROXICAM 6 POLYGELLINE 95 POLYMYXIN B SULPHATE + HYDROCORTISONE ACETATE + NEOMYCIN SULPHATE 106 POLYMYXIN B SULPHATE + LIGNOCAINE HCL 105 POLYMYXIN B SULPHATE 105 PREDNISOLONE 79 PROCHLORPERAZINE 53 PROMETHAZINE HCL 90 PROPOFOL 116 PROPRANOLOL HCL 66 PYRANTEL PAMOATE 35 PYRAZINAMIDE 38 PYRIMETHAMINE WITH SULFADOXINE 42

RABIES VACCINES RANITIDINE RESPIRATORY DRUGS RIFAMPICIN

SALBUTAMOL SALMETROL SODA GLYCERIN SODIUM VALPROATE SPIRONOLACTONE STREPTOMYCIN SUCRALFATE SULFACETAMIDE SODIUM SUXAMETHONIUM CHLORIDE

102 47 74 39

75 76 105 111 72 40 45 82 121

121 1 110

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TETANUS TOXOID THIABENDAZOLE THIOPENTALSODIUM TRANEXAMIC ACID

102 35 114 70

VACCINE VERAPAMIL H C L VITAMIN COMPLEX VITAMINE AND MINERALS

102 67 97 96

I N D E X

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