Professional Documents
Culture Documents
Profiles of 50 Drugs
- Effect of the drug under consideration increases.
¯
- Effect of the drug under consideration decreases.
s- Effect of other drugs (those mentioned under the column “Drugs/Drug Class”) increases.
Any one of the above-mentioned four symbols may be present for each drug interaction under the column
“Effects”. When none is applicable, the column is left blank and explanation of the interaction is given under
the column “Notes”.
It has a constipating effect and is therefore combined with magnesium-containing antacids (magnesium
hydroxide, magnesium trisilicate) which have a laxative effect and thus they cancel each other’s unwanted
effect.
Fixed-dose combinations of aluminium hydroxide with any other drug besides magnesium antacids is
considered unnecessary.
Dosage Adults 300-600 mg (1-2 tablets OR 1-2 teaspoonful) 3-6 times daily
Stomach keeps on emptying itself and the action of the antacid lasts only for a short while, irrespective of
the dose taken. Hence it is important to take an antacid at frequent intervals as well as delay stomach
emptying. Food delays stomach emptying and prolongs the duration of antacid action.
It is best taken between meals and at bedtime. For continuous effect, take 1 hour after eating, followed by a
sip of water.
Tablets should be well chewed. Suspension should be shaken well before use. Do not swallow the tablet
whole.
Be sure to tell your doctor if you have (i) long-term kidney problems (ii) constipation
(iii) bone disease
Do not swallow chewable tablets and shake all liquid preparations of antacids.
Do not take this drug for more than 2 weeks without physician’s guidance. During long-term use,
measurements of blood calcium and phosphorous levels should be done.
Breast feeding: This drug passes into breast milk. Avoid drug or refrain from nursing.
Infants and Children: Not recommended in children under 6 years except on the advice of a doctor.
Food: Maintain regular intake of high-phosphate foods such as meat, fish, eggs, milk and milk products.
Interactions
Decreased levels of blood phosphates resulting in loss of calcium and phosphate from bone with weakening
AMOXYCILLIN
It is used to treat infections of ear, nose and throat, respiratory tract infections, cystitis (inflamation of the
bladder, usually urinary bladder), gonorrhoea (a sexually transmitted disease) and soft tissue infections.
Amoxycillin is preferred over ampicillin, when it is to be given by mouth, since it is absorbed better and can be
given thrice a day. Incidence of diarrhoea with amoxycillin is less.
It destroys the infecting bacteria by interfering with their ability to multiply and grow.
Available Dosage Forms: Capsules, tablets, injections, dry syrup, kid tablets.
Take as soon as possible. This will help to keep a constant amount of medicine in the blood/urine and enable
it to work well. Space the missed dose and the next dose 8 hours apart.
Do not stop using this drug without consulting your doctor, even if you feel better in a few days.
Precautions
Infants and Children: If it is given during an episode of infectious mononucleosis (a condition marked by fever,
sore throat, etc.), it may cause rash. The drug must be discontinued if it causes diarrhoea.
Diabetics: This drug may cause false positive test results with some urine sugar tests. Check with your doctor
before changing your diet/dose of medicine.
Others: If diarrhoea occurs (as a side-effect of this drug), do not take any diarrhoea medicine without
checking with your doctor.
Interactions
AMPICILLIN
It is used to treat variety of infections such as that of soft tissues, respiratory tract, intestine (eg., typhoid)
and urinary tract. It is also used to treat certain types of meningitis.
It destroys the infecting bacteria by interfering with their ability to multiply and grow.
Note: The dose, often depends on the severity of infection and body weight of patients and not on body weight alone.
Dose in Meningitis: Adults: 6-12 gm/day in 4 divided doses. Children: 200-400 mg/kg a day.
Dose in Typhoid Carrier Stage: 1.5 gm 4 times a day for 1-3 months.
Dose in Gonorrhoea: Adults: 3.5 gm single dose preceded by 1 gm of probenecid half an hour before.
Take as soon as possible. This will help to keep a constant amount of medicine in the blood/urine and enable
it to work well. Space the missed dose and the next dose 5-6 hours apart.
Precautions
- bleeding problems
- kidney disease
- penicillin allergy
Infants and Children: If it is given during an episode of infectious mononucleosis, it may cause rash.
Diabetics: This drug may cause false positive test results with some urine sugar tests. Check with your doctor
before changing your diet/dose of medicine.
Others: If diarrhoea occurs (as a side-effect of this drug), do not take any diarrhoea medicine without
checking with your doctor.
Skin rash, hives, itching Common Discuss with your doctor only if severe.
Irritations of mouth & tongue " "
Black tongue " "
Nausea " "
Vomiting " "
Diarrhoea " Discuss with your doctor as soon as possible.
Drug fever " "
Swollen painful joints " "
Note: Black tongue is temporary and will go away as soon as you stop taking this drug.
Interactions
It relieves pain, lowers fever, reduces swelling and relieves rheumatic fever. Not to be given in children under
12 years.
It reduces the amount of chemicals which produce swelling and pain in the body. It alters those centres in the
brain that regulate body temperature and also causes sweating which leads to reduction of fever. It prevents
aggregation (coming together) of blood platelets/blood vessels, thus preventing clotting of blood.
Adults: For pain/fever: 300-600 mg (1-2 tablets) as and when required or at an interval of 4 hours. Do not
exceed 6 gms in a day.
Children (over 12 years only): For pain/fever: 10-15 mg/kg as and when required or at an interval of 4-6 hours.
Do not exceed 3.6 gm in a day
For rheumatic fever : 100 mg/kg daily in 4-6 divided doses for 1-2 weeks and then 60-75 mg/kg daily as long as
needed (or for 3-6 weeks).
Note: Take it regularly. The full effects of this medicine will be seen after 2-3 weeks.
Enteric-coated tablets (aspirin tablets may have a enteric-coating so that they do not cause stomach
irritation) should not be crushed before use.
If restlessness, stomach pain, ringing noises in ears, blurred vision, breathing problems, fits or vomiting
occurs, seek medical help immediately.
- asthma - gout
Breast feeding: The drug passes into the breast milk, but at normal doses adverse effects on the baby are
unlikely.
Infants and Children: Not to be used for children under 12 years except in juvenile rheumatoid (resembling
rheumatism) arthritis and rheumatic fever.
Over 60: Increased incidence of side-effects especially bleeding from stomach and anemia. Use cautiously.
Interactions
Except when prescribed for prevention of heart attack, aspirin should not be taken for longer than 10 days in
a row.
ATROPINE
Atropine (as Sulphate) is useful in relieving pain in the stomach arising due to spasms (frequent contractions)
of the intestine/muscles of the urinary tract or due to dysentery/diarrhoea. It reduces frequency/urgency
of urination. It is also used to relieve pain associated with stomach ulcer, along with antacids like aluminium
hydroxide or magnesium trisilicate. It is used in patients suffering from insecticide poisoning. It is used as eye
drops to dilate pupil before eye checkup and to treat certain eye conditions such as allergy/corneal burns.
It is also used in patients with non-ulcer dyspepsia, irritable bowel syndrome and diverticular disease
(diverticulum is a pouch or sac opening from any organ resembling a tube or a sac such as gut or bladder).
It blocks the action of the chemical ‘acetylcholine’, thus preventing the contraction of muscles and secretion
of the glands in the organs involved. This leads to prevention or relief of muscle spasms (hence called
anticholinergic).
Available Dosage Forms: Tablets 0.25 and 0.5 mg, injections 0.5 mg/ml
Usual Dosage Range for Pain: Adults: 0.6 mg as required
Children: 0.3 mg as required
For Insecticide Poisoning: According to severity of poisoning
For eye: 1-2 drops, 2-3 times daily
For tablets : It should be taken 30-60 minutes before eating so that maximum drug is absorbed in the blood.
Take the tablet with a full glass of water.
Take as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your
regular dosing schedule.
The symptoms include enlarged eye, vision problems, dry mouth and throat, increased heart rate, urinary
problems, high fever, confusion, fits, profound unconsciousness. Seek immediate medical advice.
Do not stop without consulting your doctor as the dose may have to be gradually reduced.
Precautions
Pregnancy: Avoid the drug as safety in pregnancy is not established. Avoid completely in the first 3 months of
pregnancy.
Breast feeding: The drug passes into the breast milk and may affect the baby. Avoid the drug as far as possible.
Not prescribed for children under 2 years of age. Dose is increased gradually as needed and tolerated in older
children.
Over 60: This drug can increase urinary problems associated with prostate gland enlargement (a common
disorder in elderly men).
Driving and Hazardous Activities: It may cause blurred vision and impaired concentration. Avoid such
activities until you know how you react to this drug.
Diet: Avoid food that causes constipation. Avoid large amounts of tea.
Interactions
Principal Uses
It is used to treat mild superficial fungal infections, ringworm infections, particularly tinea corporis (tinea
circinata).
Benzoic acid and salicyclic acid when used together give beneficial effects as compared to their effects when
used alone. Salicyclic acid sheds off the dead skin. This suppresses the fungal growth and also aids in the
penetration of benzoic acid, which exerts antifungal action (destroys the fungus).
Continue using this medicine till the infection is completely cured. Do not stop the treatment in-between or
else the infection may return.
Precautions
Others Avoid use on inflamed skin, moles, birthmarks, unusual warts with hair growing on them or warts on
the face.
It should be used to treat scabies and sometimes in treatment against body lice. If skin infection is also
present along with scabies or develops, then it may be used with sulphadimidine.
When applied to the body, it kills the itch mite, a tiny insect that causes scabies. The itch mite usually resides
between the fingers, on the wrist flexures and in between the buttocks. It is also found in palms, soles, breasts
and the penis and causes sores with intense itching. Scabies is a disease caused by unhygienic conditions and
spreads through close body contact and infected clothes.
Apply over the whole body below the neck preferably after a hot scrub/bath. Paint the application on the dry
skin and leave for 24 hours. Every time the hands are washed, apply the emulsion again. Repeat once, without
a further bath. At the end of two days, all the lotion is scrubbed off in a hot water bath.
Precautions
Others: All members in the patient’s family or at least those sharing the patient’s bed should be treated at the
same time. It is necessary to cover the body below the neck with benzyl benzoate to ensure complete cure.
The itch may sometimes persist for as long as 3 weeks but the application must not be repeated during the
period. (Your doctor may give you medicine like chloropheniramine to control itching). All infected clothing
and bedding should be disinfected by boiling, steaming or airing in the hot sun. Avoid getting benzyl
benzoate in the eyes. Any secondary infection or complications have to be treated after basic treatment is
over.
BETAMETHASONE
Drug Group: Corticosteroid
Principal Uses
It is used to treat a variety of conditions caused by allergy/inflammation, such as skin problems, asthma or
arthritis.
Replaces corticosteroid deficiencies. It may be given by mouth to treat corticosteroid deficiency. Your body
naturally produces certain cortisone-like hormones which are necessary to maintain good health. If your
body does not produce enough, which may be due to pituitary or adrenal gland disorders, then your doctor
may prescribe this medicine to help make up the differences).
It stimulates the production of certain chemicals (enzymes) in the body, which are responsible for reducing
the body response to inflammation and thus prevent its symptoms (swelling, pain, redness).
Cream - Be careful that this medicine does not enter your eyes.
Do not bandage or wrap the affected area. If your doctor has ordered an occlusive (closed) dressing, make
sure how you apply it. Since occlusive dressings increase the amount of medicine absorbed through your skin
and the possibility of side-effects, so use them only as directed.
Every other day - take as soon as possible if you remember it the same morning, then go back to your regular
dosing schedule. If you do not remember, the missed dose until later, wait and take it the following morning.
Then skip a day and start your regular dosing schedule again.
Once a day - take as soon as possible, then go back to your regular dosing schedule. If you do not remember
until the next day, skip the missed dose and do not double the next one.
Several times a day - take as soon as possible, then go back to your regular dosing schedule. If you do not
remember until your next dose is due, double the next dose.
For cream: Apply as soon as possible. If almost time for next dose, skip the missed dose and apply the next
dose.
Headache, convulsions, heart failure are some of the symptoms. Seek immediate medical help.
Do not stop the tablets without consulting your doctor, who may supervise a gradual reduction in dosage.
Sudden stopping of long-term treatment may cause adrenal collapse. Drug affects your response to surgery,
illness, injury or stress for 2 years after discontinuing. Inform your doctor within 2 years.
Precautions
Pregnancy: Avoid. It may cause the baby to have problems after birth such as slower growth. Risk to unborn
child outweighs drug benefits.
Breast feeding: It passes into the breast milk and may cause problems with growth or other unwanted effects in
infants or mothers taking this medicine. Avoid drug or refrain from nursing.
For creams: The doctor must observe the child closely since this medicine may be absorbed through the skin
and affect the child’s growth.
If this medicine is used in the diaper area, avoid using tight fitting diapers/plastic pants on the child as it may
increase the absorption of this drug and cause side-effects.
Over 60: Reduced dose may be necessary. May aggravate edema, diabetes or ulcers and may cause cataracts
and osteoporosis.
Diet: Your doctor may want you to follow a low-salt and/or potassium rich diet.
Diabetics: It may cause your blood sugar levels to rise. Consult your doctor if you have any problems regarding
this.
Others: While taking this medicine, and after you stop taking it, do not have any immunizations without your
doctor’s approval. Also, other people living in your home should not receive oral polio vaccine, since there is
a chance they could pass the polio virus onto you. Also, avoid close contact with other people at school/work
who have recently taken oral polio vaccine.
If you have taken an injection in your joint, be careful not to put too much stress or strain on it for a while,
even if it begins to feel better.
False sense of well being Common Discuss with your doctor only if severe
Increase in appetite " "
Indigestion " "
Nervousness " "
Trouble with sleeping " "
Darkening/Lightening of skin Rare "
colour
Dizziness/Lightheadedness " "
Headache " "
Increase in hair growth on body/ " "
face
Vision problems " Discuss with your doctor as soon as possible
Slow growth (in children) " "
Frequent urination " "
Increased thirst " "
Mood changes " “
Mental depression " "
Skin rash " "
Acne " "
Bloody/black stools " Stop drug now. Discuss with your doctor immediately.
Stomach/Back pain May occur Discuss with your doctor immediately.
Fainting even after
Continuous loss of appetite immediately
Continuous Headache you stop
Muscle weakness taking the
Weight loss drug
For Cream :
Irritation on skin Rare Discuss with your doctor as soon as possible
Pain redness, blisters " "
BISACODYL
It is used, on the advice and supervision of a doctor, to relieve constipation by causing complete evacuation of the
bowels. The evacuation is invariably associated with griping. The fully evacuated bowels become inactive (atonic)
and constipation usually follows for which a milder purgative is again needed. For this reason, it should not be
used in habitual treatment of constipation. It may be used to provide relief: (i) in case of worm infestations along
with the drugs that kill worm, (ii) during pregnancy, (iii) for a few days after child birth,
(iv) during preparation for examination or surgery, (v) for constipation of bed-fast patients, and (vi) following
surgery or other medical problems (heart disease, high blood pressure and hernia) when straining should be
avoided. All these are however indications for an emollient (soothing to skin) purgative like liquid paraffin.
Bisacodyl is preferably avoided in pregnancy.
Before prescribing laxatives it is important to be sure that the patient is constipated and that the
constipation is not secondary to an underlying undiagnosed complaint.
It is also important for those who complain of constipation to understand that bowel habit can vary
considerably in frequency without doing harm. Some people tend to consider themselves constipated
if they do not have a bowel movement each day. A useful definition of constipation is the passage of
hard stools less frequently than the patient’s own normal pattern and this can be explained to the
patient. Misconception about bowel habits have led to excessive laxative use. Abuse may lead to
hypokalaemia (low potassium) and an atonic (relaxed, free of normal tension), non-functioning
colour.
Thus laxatives should be generally avoided except where straining will exacerbate a condition (such as
angina) or increase the risk of anal bleeding as in piles. Laxatives are also of value in drug induced
constipation, for the expulsion of parasites after anthelminthic treatment and to clear alimentary tract
before surgery and radiological procedures. Prolonged treatment of constipation is seldom necessary
except occasionally in the elderly.
Children: The use of laxatives in children is undesirable and the introduction of fruit into diet may be
sufficient to regulate bowel action. In infants, constipation is often remedied by adjustment of the
diet.
Stimulant laxatives: Should seldom be needed. It is important to recognise that improved mobility
and provision of time and privacy for going to the toilet may be all that is required.
Source: BNF, Number 26 Sept. 1993. pp nos. 39-41
Note: Although there are products that contain more than one laxative in combination, such products are not as
advantageous. Moreover, combination products are more likely to cause side-effects.
It encourages bowel movements by acting on the intestinal wall. It increases the muscle contractions that
help to propel the stool mass.
Available Dosage Forms: Tablets of 5 mg, suppositories of 5 and 10 mg, liquids. Tablets act in 10-12 hours and
suppositories in 20-60 minutes.
It is taken at bedtime (to produce results, the next morning) with water. It is advisable to drink plenty of water
during constipation so as to make the stool softer.
Bisacodyl tablets are often coated to allow them to work properly without causing irritation and/or nausea
(enteric coated). To protect this coating, do not chew, crush or take the tablets within an hour of milk or
medicines used for acidity.
If taken on empty stomach it may cause intestinal cramping as it causes increased intestinal motility.
Precautions
Bisacodyl (enteric coated) tablets should not be given to children up to 6 years of age, as they may chew the
tablet leading to stomach irritation.
- in intestinal obstructions.
- for more than one or two days without medical advice (even if you have had no results from it).
- within 2 hours of taking other medicine since the desired effect of other medicine is reduced.
- just to clean out your system.
- if you miss a bowel movement for a day or two.
- if you have signs of appendicitis (lower stomach pain, mild fever vomiting, bloating).
Inform your doctor if you notice a sudden change in bowel habits or function that lasts longer than 2 weeks
or that keeps returning off and on.
Pregnancy: It may cause unwanted effects in a pregnant women if improperly used. Consult your doctor
before using.
Over 60: Weakness and lack of coordination may increase on repeated use of laxatives.
Except griping, rebound constipation and occasional diarrhoea, bisacodyl is relatively non-toxic. Above
mentioned adverse drug effects are very very rare.
Interactions
It leads to dependence on the laxative action to produce bowel movement ("laxative habit"). In severe cases,
over use of some laxatives may damage the nerves, muscles, and tissues of the intestine and bowel.
Principal Uses
It is used to produce a soothing and protective effect on skin lesions caused by sun burn, eczema or allergic
rash, for itching and irritant conditions of skin. It my be applied to insect bites or stings for its smoothing
effect. It is not effective in fungal infections.
It protects and soothens the affected skin. The lotion is initially watery. When it is applied to the skin, the
evaporation of water produces a cooling effect, and oozing of pus is reduced.
Available Dosage Forms: Pink-coloured lotion containing 15 gm calamine, 5 gm zinc oxide, 3 gm bentonite, 0.5
gm sodium citrate, 0.5 gm liquified phenol and 5 ml glycerol in 100 ml freshly boiled and cooled water.
Apply to the affected area with clean cotton, without rubbing. If pus is oozing from the skin, the lotion
should be applied repeatedly, so that the skin does not become excessively dry.
Precautions
Effective against a wide range of bacteria, some fungi and some viruses. It is used to treat superficial skin
infections such as superficial ulcers, and abrasions. It is used as an antiseptic solution to clean the skin, for
example, in the cleaning of the vulva and perineum (the area between vulva and anus in females) during
labour. It can also be used for gingivitis (swollen gums) and the prevention of plaque, mouth washes and for
the washing of hands before carrying out any surgical procedures.
It is an antiseptic and is effective against many bacteria. Thus it is useful for treating or preventing skin
infections. It is not effective against bacteria that cause TB as well as against fungus, eg., ringworm infections.
For general disinfectant purposes, chlorhexidine gluconate is commonly used in combination with
cetrimide.
Available Dosage Forms: Mouthwash, dental gel, oral spray, powder form
Dosage
For ulcers and skin-infections: 1% solution or powder/ointment as needed. For cleaning the skin and washing
hands before surgery: 0.5%.
For bathing mothers and babies in maternity units and for cleaning wounds: 0.02%
Hospital concentrate solution of 20% or powder form are available. The solutions of the required strength
(which varies as per use) are made and used. The dilutions from 20% concentrate are made as follows:
0.02% : dilute one part 0.5% solution with 24 volumes of clean water
Note: Always use freshly boiled and cooled water for preparation of the solution. Old solutions lose potency.
Precautions
Others: At least 30 minutes should be allowed to elapse between the use of tooth paste and oral chlorhexidine.
Do not swallow.
Do not mix it with soap.
Do not store the diluted solution for more than 2 days.
Do not use cork/cork liners to close the containers containing chlorhexidine
Do not use it in the ears of patients with perforated ear drums.
Allergic rash Rare Discontinue use. Discuss with your doctor immediately.
Irritation of the mucous Rare "
membranes
CHLOROQUINE PHOSPHATE
It is highly effective in most cases of malaria. In a few cases, it can fail. This occurs when the malaria parasites
are resistant to chloroquine. It is also used to treat lepra (related to leprosy) reactions, rheumatoid (like
rheumatism) arthritis and lupus erythematosus (see Glossary), not controlled by other drugs.
Dosage
Adults: 600 mg base (4 tablets to be given immediately followed by 300 mg base (2 tablets) after six hours.
Then 300 mg base (2 tablets) to be given for two subsequent days in the morning.
Prevention: 300 mg base (2 tablets) to be taken once in a week (e.g., on every Sunday).
Children: First day 10 mg/kg followed by 5 mg/kg after six hours. Second and third day: 5 mg/kg/day as single
dose.
Prevention: 5 mg base/kg/week.
Lepra Reactions: 150 mg base (one tablet) three times a day for two weeks. (Clofazimine/aspirin is preferred
over chloroquine).
Rheumatoid Arthritis: 150 mg base (one tablet) daily for 6-12 months or longer. Chloroquine is to be used when
other drugs are ineffective or when they cannot be used. Preferred drug is hydroxychloroquine sulphate to be
given in a dose of 400-600 mg initially for 1-3 months and then in the dose of 200-400 mg.
How and When to Take
Take after meals or with milk to avoid nausea and vomiting due to stomach irritation.
What if you Exceed the Dose
The symptoms include vision problems, excitability, fits, loss consciousness (can even lead to death within 2
hours) Seek immediate medical help in all cases.
How to Stop Using this Drug
Keep taking this medicine for the full course of treatment even if you begin to feel better after a few doses.
Precautions
Be sure to tell your doctor if you have :
- alcohol habit - any blood disease
- vision problems - G-6PD deficiency
- liver disease - nerve/brain disease (e.g., fits)
- porphyria (a disorder of porphyrin metabolism)
- psoriasis (a condition characterised by reddish lesions on elbows, trunk, etc.)
Pregnancy: Can be used.
Breast feeding: Although it passes into the breast-milk, it can be safely used, in nursing mothers.
Infants and Children: Reduced dose necessary as per schedule.
Driving and Hazardous Activities: This drug causes dizziness and vision problems when taken in high doses.
Avoid such activities during therapy.
Alcohol: Avoid. Liver problems are likely to occur when you drink alcohol while taking this drug.
Pain abdomen Chloroquine, In malaria, particularly Drug induced pain can be managed
Drug induced gastritis Quinine, falciparum, there may be acute with antacids or H2 receptor blockers
causes mild Mefloquine, pain over upper abdomen or right
discomfort and very Primaquine lower abdomen, mimicking acute
rarely abdominal abdominal syndromes.
cramps
Altered behaviour, Chloroquine, These symptoms can be due to Watchful expectancy; if needed,
hallucinations, etc. Quinine, severe falciparum infection or due tranquilizers like Haloperidol can be
Drug induced alterations Mefloquine to high grade fever in any type of used.
in behaviour and malaria. If these problems are
changes in the level of caused by severe infection, then
consciousness usually peripheral blood should show
appear after 24-48 hrs of falciparum infection, high degree
starting tt. By then the of parasitemia and the patient may
fever and presence of have other symptoms and signs of
malarial parasites may be severe malaria viz. anemia,
lower. And this can hyperpyrexia, jaundice etc.
occur on treatment for
any type of malaria.
Coma Quinine can In cerebral malaria, coma persists 25-50% dextrose, 50-100 ml
cause even after infusion of 50% intravenously.
hypoglycemia, dextrose.
which may
present as
coma.
Quinine In severe falciparum malaria, 25-50% dextrose, 50-100 ml
Hypoglycemia
especially in pregnancy and intravenously.
children, hypoglycemia can occur
even without quinine therapy.
Primaquine: It Anemia is a common feature in Usually self-limiting; withdraw the
Anemia can cause malaria, especially in children. drug; blood or packed cell
massive transfusion if needed.
hemolysis in
patients with
Glucose 6-
phosphate
dehydrogenase
deficiency
Jaundice Primaquine Severe malaria can cause Withdraw the drug.
may cause hemolytic jaundice, or rarely
hemolytic malarial hepatitis.
jaundice in
patients with
Glucose 6-
phosphate
dehydrogenase
deficiency
Hemoglobinuria Primaquine
(same group
as above)
Fever Artemisinin In cases of resistant malaria, with Self-limiting, disappears after the
Continuing even after derivatives the continuation of fever, the drug is stopped.
improvement in general general condition deteriorates
condition and significant and malarial parasite count
reduction in malarial increases.
parasites.
Source: <http://www.malariasite.com/malaria/DrugProblems.htm>
It is used to treat symptomatic relief of allergies (itching, swelling, redness) such as hay fever, urticaria,
hives, allergic swelling and allergic conjunctivitis (itching and redness of eyes).
It reduces sneezing and runny nose and depresses mucus secretion and thus provides relief in common cold
and cough. (It does not cure common cold.)
Other Uses
It may be used to treat allergic reactions to blood transfusions or x-ray contrast material and along with
adrenaline injection to treat acute allergic shock.
Its combination with pain killers, antidiarrhoeals, tranquilisers (sleeping drugs) steroids and other anti-
allergics are considered to be irrational.
It works by preventing the effects of a substance called histamine, which when produced in abnormal
amounts, in the body, may give rise to skin irritation, swelling and other symptoms of allergy.
Dosage
Adults: 4 mg ( 1 tablet or 1 teaspoonful) every 6 hours daily, but adjust the schedule to waking/sleeping
pattern.
Children: Above 6 years: 2 mg ( 2.5 ml or 1/2 teaspoonful) every 6 hours daily. Under 6 years: 1 mg ( 1.25 ml or
1/4 teaspoonful) every 6 hours daily.
Take as soon as you remember. If your next dose is due within 2 hours take a single dose now and skip the
next. Do not double the doses.
- drowsiness or agitation
- feeling faint
- flushing redness of face seeing, hearing or feeling things that are not there
Precautions
- long term liver problems, epileptic fits, glaucoma, urinary difficulties asthma, enlarged prostate, to
undergo any skin tests for allergies (the results of the tests may be affected).
Do not use this drug in premature/new born infants as serious side-effects may occur in to them.
Breast feeding: Drug passes into the breast milk, and may cause unusual excitement or irritability in the infant.
It also tends to decrease the flow of breast milk sometimes. Use is not recommended.
Over 60: Reduced dose may be necessary. Increased likelihood of adverse effects.
Driving and Hazardous Activities: Machine operation should be avoided as this drug causes some people to
become drowsy and less alert.
Alcohol: Should be avoided as this drug adds up to the sedative (drowsy) effects of alcohol and other sedative
drugs.
Others: This drug may cause dryness of mouth, nose and throat. If dry mouth continues for more than 2
weeks, check with your dentist since it may increase the chance of dental disease.
Sore throat and Fever Rare Discuss with your doctor immediately.
Unusual bleeding /bruising " "
Unusual weakness " "
Excitation (children) " Discuss with your doctor immediately and stop drug now.
Rash " "
Drowsiness Common Discuss with your doctor only if severe (reduce dose)
Change in vision Rare "
Urinary difficulties " "
Dry mouth, nose, throat " "
Loss of appetite " "
Stomach upset " "
Shaking / Tremor " "
Ringing or buzzing sound in ears " "
Thickening of bronchial Common "
secretions
Increased sensitivity to Sun Rare "
Increased sweating " "
Fast heartbeat " "
Interactions
All medicines that have toxic Toxic effects like ringing in ears, dizziness,
action on ear (e.g., aspirin in etc., are covered up by this drug.
large doses).
CNS depressants or s Increased drowsiness
(Medicines that slow down the
nervous system, possibly
causing drowsiness).
Furazolidone, isocarboxazid, Concurrent use not recommended.
pargyline, phenelzine,
procarbazine, tranylcypromine)
The effect of the drug may become weaker with prolonged use over a period of weeks or months as the body gets
used to it. A different anti-allergic (antihistamine) may be recommended by your doctor.
CO-TRIMOXAZOLE
Principal Uses
Co-trimoxazole (trimethoprim plus sulphamethoxazole) is used in the treatment of urinary tract infections,
in acute respiratory infections, in the treatment of bacillary dysentery caused by bacteria, in abscess and skin
infections, in chancroid (a sexually transmitted disease), and in the treatment of typhoid.
It is a mixture of two drugs: 5 parts of sulphamethoxazole (a sulfa drug) and 1 part of trimethoprim. They
work synergistically by preventing the growth and multiplication of the bacteria that cause the infection and
thus cure the infection.
The combination is not effective in virus infections such as common cold and flu.
Dosage
Adults: 800 mg sulphamethoxazole and 160 mg trimethoprim every 12 hours for 7 to 10 days.
It is best taken with a full glass of water. Drinking lots of extra water every day will help to prevent its
unwanted effects.
Take as soon as you remember. Then take next dose after 12 hours.
The signs include abdominal pain, vomiting, dizziness and confusion. Notify your doctor as soon as
possible.
Take the full course even if you feel better within a few days. Do not stop without consulting your doctor.
Precautions
Breast feeding: Drug passes into breast milk. At normal doses it is safe but discuss with your doctor.
Interactions
Principal Uses
It is used to relieve mild to moderate pain. It is also used to suppress dry irritating cough.
It suppresses the perception to pain and calms the emotional response to pain. It also reduces the sensitivity
of the cough reflex.
Dosage
Adults: Pain killer: 15-60 mg every 3-6 hours as needed. Cough Suppressant : 10-12 mg every 4-6 hours.
Children: Pain-killer: 0.5 mg/kg body weight/dose, 4 times daily. Cough-Suppressant (liquid preparations 15
mg /5 ml) : 3mg/kg per day in 3-4 divided doses. Not generally recommended in children. Should be avoided
in children under one year altogether.
Overdosage
Symptoms include drowsiness, restlessness, agitation, nausea, vomiting, dry mouth, vertigo, weakness,
lethargy, coma, seizures. Consult your doctor immediately as overdose may lead to unconsciousness or
death.
Precautions
Over 60: Reduced dose may be necessary as they are more susceptible to adverse effects.
Driving and Hazardous Activities: This drug may cause dizziness and drowsiness. Avoid hazardous activities
accordingly.
Alcohol: Avoid. Alcohol may increase the sedative (depressing) effects of this drug.
Others: It may cause dryness of mouth. If it continues for more than 2 weeks, check with your dentist as dry
mouth may increase the chance of dental disease.
Possible Side-effects
Interactions
Psychological and physical dependence as well as chronic constipation may occur. It should be preferably
used for short term only.
Although, it is a constipating drug and is used in short term control of diarrhoea, this use is irrational. It
delays the elimination of the germs that cause diarrhoea by slowing down the movement of intestinal tract.
This may lead to serious reactions in children. It is used as a constipating drug in selected circumstances.
DAPSONE
It helps the body to overcome leprosy (Hansen’s disease) and to help control dermatitis herpetiformis, a skin
problem.
It inhibits the growth and multiplication of micro-organisms (germs) that cause leprosy.
Dosage
Taken along with ethambutol, clofazimine and/or rifampicin depending on the nature of leprosy. A daily
dose of 100 mg may continue up to 6 months or 2 years depending on the treatment regimen.
To help clear up leprosy completely and permanently, it is important to take this medicine every day for the
full time of treatment (6 months or 2 years depending on the nature of infection).
It is best to take each dose at the same time every day, so you do not miss any doses.
Precautions
Diet: For dermatitis herpetiformis : Your doctor may want you to follow a “gluten-free” diet. Discuss with
your doctor.
DIAZEPAM
It is used to relieve nervousness or tension, to treat anxiety and anxiety related sleeplessness, to relax muscles
or to relieve muscle spasms, to treat epilepsy (convulsions) to relieve the symptoms of acute alcohol
withdrawal and to sedate (induce sleep in) people undergoing certain medical procedures like anaesthesia.
It depresses activity in the part of the brain that controls emotion, by promoting the action of a chemical
nerve transmitter (GABA) which in turn prevents excessive brain activity that causes anxiety.
Dosage Range
Note: Dose may be increased cautiously as needed and tolerated. Total daily dose should not exceed 60 mg. Actual dosage and
administration schedule must be determined by the physician for each patient individually.
May be taken on empty stomach or with food or milk. The prolonged action capsule should not be opened
before administration.
Take it immediately if you remember within one hour. However, if you remember later, skip the missed dose
and go back to your regular schedule. Do not double your dose.
The symptoms include severe drowsiness and weakness, staggering, slurred speech, unusually slow heart
rate and troubled breathing. Notify your doctor immediately. Commoner with injection.
Do not discontinue the drug abruptly if taken continuously for more than 4 weeks. Dosage should be
reduced gradually, so as to prevent withdrawal syndrome that include depression, confusion, tremor,
seizures, muscle cramping, sweating and vomiting.
Precautions
Breast feeding: It passes into the breast-milk and causes drowsiness or breathing problems in babies of
mothers taking this drug. Avoid drug or refrain from nursing.
Over 60: Increased chances of adverse effects. Reduced dose may be necessary.
Others: It produces psychological and/or physical dependence if used in large doses for long time.
Possible Side-effects
Regular use of this drug over several weeks can lead to a reduction in its effect as the body gets used to it. It
may be habit forming when taken for very long periods.
Principal Uses
It is given in the treatment of congestive heart failure and in the maintenance of normal heart rate and
rhythm. It should be used only under doctor’s supervision.
Dosage
Adults: 0.125-0.25 mg daily divided in 2-3 doses given 6-8 hours in one day.
Dose: 10-20 mg/kg body weight every 6 hours. Maintenance : 10-20 mg/kg body weight in single/divided
doses.
Note: Actual dosage and administration schedule should be determined by the doctor for each patient individually.
Take at the same time each day or preferably on an empty stomach. It may be taken with or after food (but not
milk and milk products).
For digoxin: To be taken by mouth. The amount to be taken is to be measured accurately with a specially
marked dropper.
Take as soon as you remember. If your next dose is due within four hours, take both doses now and skip the
next. Return to your normal schedule the next day.
The amount needed to help most people is very close to the amount that could cause serious problems from
overdose. The symptoms include loss of appetite, nausea, vomiting, diarrhoea, headache, confusion,
disturbances of heart rate and rhythm, severe weakness, chest pain, loss of consciousness.
Do not discontinue without consulting your doctor. Stopping suddenly may cause a serious change in heart
function.
Precautions
Be sure to tell your doctor if you have kidney/liver the following problems: thyroid, lung, heart attack,
rheumatic fever, plan to undergo any surgery; large amount of fiber, such as bran in your diet.
Pregnancy: This medicine passes from mother to fetus. Safety not established.
Breast feeding: Small amount of drug passes into the breast milk. Although at normal doses, effects on the baby
are unlikely, discuss with your doctor, Monitor nursing infant for adverse effects and discontinue dry or
refrain from nursing.
Infants and Children: Reduced dose necessary. Observe for irregular heart rate and rhythm in case of overdose,
as other signs are not clearly seen in children.
Over 60 years: Increased likelihood of adverse effects. Reduced dose may therefore be necessary.
Driving and Hazardous Activities: Do not drive until you know how this drug affects you. It can cause
drowsiness and mental confusion.
Diet: Avoid milk and milk products for 2 hours before and after taking this drug.
This drug may be more toxic if potassium levels fall. Hence include fruit and vegetables in your diet.
Tobacco: It can lead to serious disturbances of the heart rhythm. Avoid all forms of tobacco.
Interactions
Antacids ¯
Bleomycin ¯
Carmustine ¯
Cholestyramine ¯
Colestipol ¯
Cyclophosphamide ¯
Cytarabine ¯
Doxorubicin ¯
Methotrexate ¯
Penicillamine ¯
Procarbazine ¯
Thyroid hormones ¯
Vincristine ¯
Note: Since many drugs interact with digoxin, do not take any medication along with digoxin, without your doctor’s advice.
DIPHENHYDRAMINE
Principal Uses
It is used to treat allergies like allergic rhinitis (cold due to allergy), skin allergies (hives), and adverse effects
due to food, drug or insect stings.
It is being used in the treatment of Parkinson’s disease and movement disorders. Reduces stiffness and
tremors in Parkinson’s disease.
It is used to treat vomiting and vertigo. It also relieves nausea and vomiting, motion sickness. It is thought to
relieve cough also. (It does not treat ‘cough’). Used as a sedative.
It is combination with painkillers, antidiarrhoeals, tranquilizers (sleeping drugs), steroids and other
antiallergics are considered to be irrational.
It works by preventing the effects of a substance called histamine, which when produced in abnormal
amounts, in the body may give rise to skin irritation, swelling and symptoms of allergy.
Its natural side-effects are used to advantage: it’s atropine-like effects are used in management of motion
sickness and Parkinsonism, while it’s sedative effects are used to induce drowsiness/sleep.
Dosage
Adults: 25-50 mg/every 4-6 hours till symptoms are relieved, then 25-50 mg daily.
Note: Actual dosage and administration schedule must be determined by the physician for each patient individually.
For motion sickness: Take at least 30 minutes, (preferably 1 to 2 hours) before you begin to travel.
Take as soon as you remember. If your next dose is due within 2 hours take a single dose and skip the next.
The symptoms include severe drowsiness, confusion in coordination, unsteadiness, muscle tremors,
agitation, fever, flushed face, dilated eyes, weak pulse, difficult breathing, profound unconsciousness.
Notify your doctor as soon as possible.
Precautions
Breast feeding: This drug passes into the breast-milk. Its use is not recommended, since there are chances it
may cause unusual excitement or irritability in the infant. Besides, it decreases the secretions of the body and
hence it is possible that the flow of breast milk may also be reduced. Avoid drug or refrain from nursing.
Infants and Children: Not given to premature and newborn infants. Reduced dose necessary. Not used in
children with chicken pox, flu-like infection or Reye’s syndrome (a condition in children marked by loss of
consciousness, and possible death).
Over 60: Reduced dose may be necessary. Increased likelihood of adverse effects. Such as urination difficulty,
diminished alertness and other brain and nervous system symptoms.
Alcohol: Avoid. Alcohol may increase the sedative (drowsy, sleepy) effects of this drug.
Driving and Hazardous Activities: Avoid such activities until you know how the drug affects you because the
drug can cause drowsiness.
Others: Discontinue this drug five days before diagnostic skin testing procedures in order to prevent false
negative test results. Do not use this drug if you have asthma or other lung problems, because it thickens the
secretions in the lung and makes it more difficult to remove (by absorption/ coughing). This drug may make
you more sensitive to sun. Use cautiously. This drug causes dry mouth. If this continues for more than 2
weeks, check with your dentist since dry mouth may lead to dental disease.
Possible Side-effects
Interactions
Drugs/Drug Class Effects Notes
All medicines with sedative s Oversedation
(drowsy, sleepy effect)
Atropine and Atropine-like s
medicines
MAO-inhibitors Elimination of this drug is delayed and thus its
(eg., furazolidone, action is prolonged.
isocarboxazid, pargyline,
phenelzine, tranylcypromine)
The effect of this drug may become weaker with prolonged use over a period of weeks or months as the body
adapts.
EPHEDRINE
Drug Group: Bronchodilators
Principal Uses
It is used in the treatment and prevention of asthma, in mild cases of allergic rash and itching and as nasal
spray to relieve the blocking of nostrils occurring during an attack of common cold. It may be used to treat
low blood pressure certain mental depression and narcolepsy (uncontrolled desire to sleep.)
Note: Continuous use of nasal sprays may worsen the condition leading to rebound congestion. Although it is effective in asthma, its
continual use may lead to development of tolerance. Hence it is better if other drugs for asthma (eg., salbutamol, aminophylline, etc. which
have lesser side-effects but are costlier) are taken in rotation during successive weeks. Fixed-dose combination with other bronchodilators
must be avoided.
It opens up the bronchial tubes (air ways) of the lungs by relaxing the muscles around them and thus
Take the last dose a few hours before bed time to avoid sleeplessness. For asthma - take the tablet at bed time
to avoid asthma attack at night. Diazepam is usually given along with it to avoid sleeplessness.
Use it as soon as possible. Then use any remaining doses for that day at regularly-spaced intervals.
Signs (not all of them will occur). Blue coloured skin, chest pain, chills, fever, fits, dizziness high/low BP,
headache (severe), irregular heart beat, muscle cramps, troubled breathing, nausea, anxiety, large pupils,
vision problems, pale cold skin and weakness.
If you have exceeded a total dose of 240 mg/day and/or the above signs are observed, notify your doctor
immediately.
Precautions
Breast feeding: Safety for use has not been established. Do not use the drug it refrain from nursing.
Over 60: Avoid. It causes retention of urine. Also do not use to treat asthma on elderly who develops
breathing difficulty for the first time, especially if he has chest pain and is sweating since he may be having a
heart attack and must be referred to the doctor immediately.
Interactions
For asthma: Tolerance may develop to this drug. For nasal blockade: Rebound congestion (i.e., symptoms
may return after sometime in an aggravated condition).
Principal Uses
It is used to treat migraine headaches and some kinds of throbbing headaches. It is not used to prevent
headaches but is used to treat an attack once it has started. It is most effective if taken at the first sign of that a
migraine is going to occur. Once headache and nausea are established, it is less likely to be effective and may
cause a stomach upset and increase the nausea of migraine.
It is used along with caffeine to increase its effectiveness but a fixed dose combination is not required. Its
fixed dose combination with other medicines (for vomiting, depression, etc.) are not rational.
When the blood vessels in the head dilate (expand) they release certain chemicals which produce pain.
Ergotamine relieves pain by narrowing the dilated blood vessels.
Dosage
Adults: 1-2 mg (2 tablets) daily, subsequently every 30 minutes, until complete relief is obtained. Not more
than 6 tablets daily.
Note: It should not be used prophylactically (for prevention of migraine). Use carefully under physician’s guidance. Overdose is dangerous.
Lie down in a quiet, dark room for at least 2 hours after taking it.
For sublingual (under-the-tongue) tablets: Dissolve the tablet under your tongue. The sublingual tablet should not
be chewed or swallowed since it works much faster when absorbed through the lining of the mouth.
Regular doses of this drug are not necessary and may be dangerous. Take only when you have symptoms of
migraine.
Symptoms such as nausea, vomiting, diarrhoea, cold skin, numb and painful hands or feet, gangrene (tissue
death) of fingers or toes, loss of limbs, confusion, seizures, profound unconsciousness (coma) may occur.
Notify your doctor as soon as possible.
If you have used it for a very long time (although it should not be used do not stop taking it without checking
with your doctor. If stopped suddenly, your headaches may return or worsen.
Precautions
Breast feeding: It passes into the milk and may have adverse effects on the baby. It may also reduce the milk
supply.
Over 60: Use with caution. Hidden heart or circulatory problems may be aggravated.
Alcohol: Best avoided. Alcohol can make headaches worse. Besides some drinks provoke migraine in some
people and alcohol may be one of those drinks.
Tobacco: Best avoided as it may increase the harmful effects of this medicine.
Diet: Changes in diet do not affect the action of this drug but certain foods may provoke migraine attacks in
some people.
Others: Your doctor may want to evaluate the circulation (blood flow) to your hands and feet.
Interactions
Headaches (after drug is discontinued following long term use) and poor circulation (blood flow) to hands
and feet.
It is used to treat a broad variety of common infections. The important ones are (i) skin infections (ii) throat,
middle ear and chest infections, including some rare types of pneumonia such as mycoplasma pneumonia
and Legionnaires disease and (iii) in treatment of diphtheria, (iv) gonorrhoea, chlamydial infections, syphilis
and other sexually transmitted diseases (v) amoebic dysentery, (vi) for long-term prevention of recurrences
of rheumatic fever.
This drug prevents the growth and multiplication of susceptible organisms by interfering with their
formation of essential proteins.
Dosage : Adults: 250 mg to 1000 mg every 6 hours, according to severity and nature of infection.
Note: Actual dosage and administration schedule must be determined by the physician for each patient individually.
It is best taken with a full glass of water on an empty stomach (eg., 1 hour before or 3/4 hours after meals).
However, certain brands of erythromycin such as erythromycin estolate and erythromycin ethyl succinate or
enteric-coated tablets should be taken on full or empty stomach (without regard to food).
Take it as soon as possible. This will help to keep a constant amount of medicine in the blood. However, if it
is almost time for your next dose and your dosing schedule is:
- 2 doses a day, space the missed dose and the next dose 5-6 hours apart
- 3 or more doses a day - space the missed dose and the next dose 2-4 hours apart or double your next dose.
Possible nausea, vomiting, diarrhoea and stomach upset are the symptoms of overdose. Notify your doctor.
Take the full course. Even if you feel better, the original infection may still be present and symptoms may
recur if treatment is stopped soon.
Precautions
Pregnancy: Generally thought to be safe during pregnancy, except for erythromycin estolate which can cause
toxic liver reactions and hence should be avoided.
Breast feeding: This drug passes into the breast milk. Monitor nursing infant closely and discontinue drug or
nursing if adverse effect develop.
Infants and Children: More prone to stomach irritation. Reduced dose necessary.
Over 60: Itching reactions in the genital and anal regions as well as loss of hearing may occur.
Beverages: Avoid fruit juices and carbonated beverages for 1 hour after taking any nonenteric coated
preparation. May be taken with milk.
Driving and Hazardous Activities: This drug may cause nausea and/or diarrhoea. Restrict activities as
necessary.
Others: Your doctor may want to check your liver function by performing a test if you are being given
erythromycin estolate.
Interactions
Courses of longer than 10 days may increase the risk of liver damage.
It is used in the treatment of tuberculosis. Given in conjunction with other antitubercular drugs, it helps to
boost their effect.
It prevents the growth and multiplication of the germs that cause tuberculosis (TB).
Available Dosage Forms: Tablets, capsules (singly or in combination with other anti-tuberculosis drugs).
Dosage
Re-treatment: 25 mg/kg body weight as a single dose for 60 days and then 15 mg/kg body weight.
Continue regular dose as soon as you remember. If the next dose is within 4 hours, take the next dose now,
and skip the next dose.
Take this medicine for full time of treatment. Do not stop using it even if you begin to feel better after a few
weeks. You may have to take every day for as long as 1 to 2 years or more.
Large overdoses may cause headache and abdominal pain. Consult your doctor.
Precautions
Breast feeding: It passes into the breast milk, but at normal doses adverse effects on the baby are unlikely.
Discuss with your doctor.
Over 60: Increased likelihood of adverse effects. Reduced dose may be necessary. Have periodic eye-checks.
Driving and Hazardous Activities: This medicine may cause vision problems and dizziness. Be sure how you
react to this medicine before performing such activities.
Interactions
Principal Uses
Iron salts should be given by mouth unless there are good reasons for using another route. Ferrous salts
show only marginal differences between one another in efficiency of absorption of iron. The oral dose of
elemental iron for deficiency should be 100 to 200 mg daily. It is customary to give this as dried ferrous
sulphate.
1. It is used in the treatment of iron deficiency anemia.
2. It is also used to prevent anemia in pregnant women, young children and in women who complain of
heavy blood loss during menstruation. It is often available in combination with folic acid, Vitamin B12 and
other vitamins/minerals. It’s combination with folic acid is used especially in anemia resulting from under
nutrition/pregnancy/lactation. Combinations of iron with other vitamins and minerals are irrational
and only add to cost and toxicity.
Note: The actual cause of anemia must be determined and treated accordingly.
It contains iron, which is necessary for the production of hemoglobin (Hb), which gives red colour to the
blood. Deficiency of iron causes deficiency of hemoglobin resulting in anemia. This medicine corrects this
deficiency and cures the anemia.
The iron-deficiency may occur due to undernutrition, bleeding piles, stomach ulcer, hookworm infection,
loss of blood during menstruation, repeated pregnancies.
Available Dosage Forms: Tablets, capsules and liquids (in combination with other drugs).
Prevention
Adults : 1 tablet (200 mg of ferrous sulphate) daily; begin with 1 tablet daily, then increase the dose depending
upon tolerance.
It is best taken with water 1 hour before or 2 hours after meals. However if stomach upset occurs, take with
food or immediately after meals.
While using liquid-form of iron, dilute the dose, if desired, in water. Avoid staining your teeth with the iron
medicine by placing the spoon/dropper well back on the tongue. Iron stains can be removed by brushing
with baking soda or medicinal peroxide.
Skip the missed dose and go back to your regular dosing schedule. Do not double the doses.
The signs include diarrhoea (may contain blood), blue-lips and finger-nails, drowsiness, pale cleaning skin,
weakness, rapid heartbeat, shallow breathing, convulsions, coma.
Early signs of overdose may not appear for up to 60 minutes. Do not wait for the signs to appear. Get
emergency help immediately.
Precautions
Pregnancy: During the first 3 months, a proper diet provides enough iron. During the last 6 months, in order to
meet the increased needs of the developing baby an iron supplement may be recommended.
Breast feeding: Although it passes in to the breast milk it is not known to cause problems. Discuss with your
doctor before using it.
Over 60: May need larger doses than usual. Ask doctor’s advice.
Diet: Avoid the following foods or take in very small amount at least 1 hour before or 2 hours after taking iron.
Do not take them simultaneously with iron
Others: Insist on taking tablets. The belief that iron injectables may cause rapid response is baseless
and besides being painful, they are costly and cause serious adverse effects. The so called slow-
release iron tablets are also not justified and must be avoided.
Iron medicine colour the stools black. This effect ceases once you stop using the medicine.
FOLIC ACID
Folic acid has few indications for long-term therapy since most causes of folate deficiency are self-limiting
or can yield to a short course of treatment. It should not be used in undiagnosed megaloblastic anemia (a type
of severe anemia) unless Vitamin B12 is administered concurrently.
It is used to treat folic acid deficiency which leads to a particular type of anemia. The main symptoms are
fatigue. Loss of appetite nausea, vomiting, hair loss and mouth sores. It may also lead to poor growth in
infants and children.
It is also given along with iron during pregnancy and lactation to prevent anemia (since pregnant women and
lactating mothers are prone to get anemia).
Additional folic acid supplements are to be given in the following conditions/ patients:
- Patient with blood disorders/psoriasis/other condition in which absorption of nutrients from intestine
is impaired
- Patients who are taking anticonvulsants (medicine for tremors/fits) deplete folic acid during pregnancy
to prevent a particular defect in the developing baby.
Note: Although folic acid and iron correct anemia, the actual cause of anemia must be found out and corrected by the doctor.
Available Dosage Forms : Tablets, syrup (either singly or in combination with iron sulphate, etc.)
Dosage
- For folic acid deficiency and malnutrition: 5 mg (1 tablet) thrice daily for 3 weeks and then 5 mg (1 tablet)
daily for another 2 weeks.
- For preventing anemia in pregnancy and lactation: 0.5 mg daily from the 4th month onwards in
combination with 200 mg of ferrous sulphate (iron).
Although some people believe that taking very large doses of vitamin is useful for treating certain medical
conditions, it is not true. Large doses should be taken only under doctor’s directions.
Precautions
Pregnancy: It is important that you receive the right amount of vitamins, especially folic acid throughout your
pregnancy.
Breast feeding: It is important that you receive the right amount of vitamins so that your baby will also get the
vitamins needed to grow properly.
Diet: The best sources are green leafy vegetables, mushrooms, liver, root vegetables, oranges, nuts, dried
pulses and egg yolks.
A balanced diet should provide all vitamins you need. Take supplements only if you cannot get enough
vitamins from your diet. You need proteins, minerals, carbohydrates and fat (found in food) for the vitamins
to work properly.
It is used primarily to increase the volume of urine and thereby relieve the body of excessive water retention
(edema) that is commonly associated with heart failure and some form of liver disease and kidney disease. It
can be used to treat high blood pressure (BP) but along with other medicines for high BP that lower BP. A less
frequent use is to increase the amount of calcium excreted in the urine when the blood level of calcium is
abnormally high.
It is particularly useful for people with kidney problems because they do not respond to other diuretics
(water pills).
It acts on the kidneys, and increases the flow of urine. By doing so, it increases the elimination of salt
(sodium) and water from the body. Thus it reduces the volume of fluid in the blood and body tissues and
lowers the sodium content in the body. These changes also help to lower the blood pressure.
Dosage
Adults: To relieve water retention: 20-80 mg as a single dose initially, if necessary, increase the dose by 20-40
mg/6-8 hours. Do not exceed 600 mg per day.
For patients with kidney problems: High dose (up to 2 gm daily) may be required.
May be taken with or following meals to reduce stomach irritation. To avoid night time urination, take it in the
morning, if you are taking a single dose daily. Or take the last dose no late than 6 pm, if you are taking more
than one dose daily.
Take as soon as you remember. If it is time for the next dose, skip the missed dose and go back to regular
dosing schedule.
The symptoms include dry mouth, thirst, lethargy, weakness, muscle cramping; nausea, vomiting, diarrhoea,
drowsiness, profound unconsciousness.
Do not stop the drug without consulting your doctor; symptoms may return.
Precautions
- diabetes - gout
- kidney disease - liver disease
- pancreatic disease - hearing problems
- prostate trouble - plan to have surgery in the near future
Pregnancy: It should not be used in pregnancy unless it has to be used for some serious complications. Avoid
completely during the first 3 months.
Breast feeding: It passes into the breast milk. Avoid drug or refrain from nursing.
Infants and Children: Avoid overdosage that could cause serious dehydration. Reduced dose necessary.
Over 60: Increased likelihood of adverse effects. Reduced dose may therefore be necessary.
Driving and Hazardous Activities: This drug causes vision problems and dizziness. Make sure how you react to
the drug before doing such activities.
Alcohol: It increases the likelihood of dehydration and hangovers after drinking alcohol. Avoid as far as
possible.
Sun: Some people become more sensitive to sun while using this drug. Avoid too much sun.
Diet: This drug may cause a loss of potassium from your body resulting in nausea, loss of appetite, weakness,
confusion. To help prevent this, eat or drink foods that have high potassium content (e.g., orange or other
citrus fruit juices).
Note: Discuss your diet with your doctor. This is important if you are already on a special diet (as for diabetes) or if you are taking a
potassium supplement or a medicine to reduce potassium loss. Extra potassium may not be necessary in some cases, too much potassium could
be harmful.
Possible Side-effects
Interactions
Serious problems are unlikely, but levels of salts, such as potassium, sodium and calcium, may occasionally
become depleted during prolonged use.
GENTIAN VIOLET
Drug Group: Antifungals
Antiseptic
Principal Uses
Gentian violet (or crystal violet) is used on the skin or inner lining of the mouth to treat some types of fungal
infections inside the mouth (thrush) and of the skin (e.g., boils, burns), as antiseptic in boils, impetigo (a
contagious skin infection), etc.
Using a cotton swab, apply enough gentian violet to cover only the affected area. Not to be swallowed. While
applying to a child’s mouth, take care that it is not swallowed. Do not apply an occlusive dressing/airtight
covering since it may cause irritation of the skin.
Apply it as soon as possible. If time for next dose, skip the missed dose and go back to regular dosing
schedule.
To help clear up infection completely, keep using this medicine for the full time of treatment even though
your condition may have improved.
Precautions
It will stain the skin and clothing. Avoid getting the medicine on your clothes. In the UK it is now restricted to
application to unbroken skin because of concern about animal carcinogenicity and is no longer
recommended for application to mucous membranes or open wounds. Restrictions do not apply however
for skin marking prior to surgery.
GLIBENCLAMIDE
It is used to control certain types of diabetes mellitus (sugar diabetes). It is usually used only by adults who
develop diabetes after 30 years of age and whose diabetes cannot be controlled by diet alone and who do not
require insulin injections (or who do not require more than 20 units of insulin a day) to control their
condition. This type is called non-insulin dependent diabetes mellitus/maturity onset/adult diabetes.
It stimulates the production of a substance called insulin from pancreas (an organ in the body) which is
responsible for the uptake of sugar in the body cells. Thus it lowers the blood sugar levels and controls
diabetes (or disorder where blood sugar levels rise).
Take the medicine daily with breakfast. If maintenance dose is 10 mg or more, divide into 2 equal doses: one
with morning meal and one with evening meals.
Take before your next meal. If it is almost time for next dose, skip the missed dose and follow regular dosing
schedule.
Seek immediate medical advice in all cases. If early warning symptoms of excessively low blood sugar such as
faintness, sweating, trembling, confusion, weakness, nausea or headache occur, eat or drink something
sugary. Take emergency action if fits or loss of consciousness occur.
Do not stop using this drug without consulting your doctor; stopping the drug suddenly may lead to
worsening of diabetes.
Precautions
Pregnancy: Should not be used because poor diabetic control. May lead to birth defects or death of foetus.
Insulin is substituted as it gives better diabetic control.
Breast feeding: It is thought that it passes into the breast milk. Avoid drug or refrain from nursing.
Over 60: Reduced dose may be necessary. Your doctor should check your progress regularly. Blood sugar
levels should be taken so as to prevent any adverse effects (brain damage) due to fall in blood sugar level.
Driving and Hazardous Activities: Avoid these activities if you have warning signs of low blood sugar.
Sun: Use caution. Some people find their skin to be more sensitive to direct sunlight because of this
medicine.
Diet: A low carbohydrate, low fat diet must be maintained by diabetic patients. Many diabetic patients are
able to control their condition by following the advice of their doctors. In order for the drug to be fully
effective, diet and exercise advice should be properly followed.
Others: This drug may loose its effectiveness after certain period of time. Test for sugar in your blood/urine
as directed by the doctor to make sure your diabetes is being controlled.
Eat or drink something containing sugar if sign of low blood sugar occur.
Signs of low blood sugar include: Sweating, confusion, drowsiness, weakness, hunger, headache, nausea.
These signs occur if you - skip/delay meals, exercise much more than usual, cannot eat because of nausea,
drink significant amount of alcohol.
Interactions
Reduced function of the thyroid gland. It is thought that it may cause heart and blood disorders (although
such reports are not conclusive).
GLYCERYL TRINITRATE
It is used to relieve the pain of angina attacks. It is not a cure for heart disease; it can only relieve symptoms,
and it may have to be taken for long periods of time.
The slow-release form of this medicine is used to prevent the development of angina.
It relaxes the blood vessels and increases the supply of blood and oxygen to the heart while reducing its work
load. It thus prevents angina attacks from occurring.
Dosage
Transdermal patch (delivery 5 mg or 10 mg per 24 hours): Initially TTS-5 once daily. Increase if required
gradually up to TTS-10 twice daily.
Capsules: Take this medicine with a full glass of water on an empty stomach. If taken either 1 hour before or
2 hours after meals, it will start working sooner. Tablets should not be crushed or chewed and capsules
should not be opened before swallowing if the tablets/capsules are sustained release.
Ointment: Before applying a new dose of ointment, remove any ointment remaining on the skin from a
previous dose to allow the fresh ointment to release the drug properly.
- Use a paper (cut as per the length mentioned in the dose) to measure the length of ointment.
- Do not rub or massage the ointment into the skin. Spread in a thin, even layer, covering an area of the
same size each time it applied.
- Apply to skin that has little or no hair.
- Apply each dose to a different area of skin to prevent skin problems.
Transdermal Patch: Do not try to trim or cut the adhesive patch to adjust the dosage.
- Apply the patch to a clean, dry skin area with little or no hair and free of scars, cuts or irritation. Remove
the previous patch before applying a new one.
- Apply a new patch if the first one becomes loose or falls off.
- Each dose is best applied to a different area to avoid skin problems.
Capsules/tablets (regular, sustained release): Take it as soon as possible. However, if the next scheduled
dose is within 2 hours (or within 6 hours for extended release capsules/tablets) skip the missed dose and go
back to your regular dosing schedule. Do not double doses.
Ointment: Apply as soon as possible unless the next scheduled dose is within 2 hours. Then go back to your
regular dosing schedules.
Large overdoses may cause dizziness, vomiting, severe headache, fits or loss of consciousness. Notify your
doctor.
Do not stop using this drug after long-term use without asking your doctor. The dose is gradually reduced
over 4-6 weeks.
Precautions
Be sure to tell your doctor if you have anemia (blood disorders), glaucoma, intestinal problems, overactive
thyroid, low blood pressure, had an heart attack recently.
Breast feeding: The drug passes into the breast milk and may affect the baby. Discuss with your doctor.
Over 60: They are more susceptible to the development of flushing, headache, dizziness, “black-out” spells,
fainting and falling.
Driving and Hazardous Activities: This drug may cause dizziness or faintness. Restrict activities as necessary.
Alcohol: Avoid. Alcohol may increase dizziness due to lowered blood pressure.
Others: The dizziness or fainting caused by this drug is more likely to occur when you get up quickly from a
lying or sitting position, to stand for long time, exercise or if the weather is hot, so be cautious.
Your doctor may want to check your blood pressure and internal eye pressure as well as test your blood for
iron (hemoglobin) while you are using this drug for long time so as to check the effectiveness of this drug.
Interactions
IBUPROFEN
It relieves pain, stiffness and inflammation, that may accompany a number of disorders. It is used to provide
relief in rheumatoid arthritis, osteoarthritis, and gout (although it does not cure it). It relieves mild to
moderate headaches, menstrual pains, sprains, pain from injuries of muscles/bones and pain following
operations. It reduces fever also.
It is similar to aspirin in the way it can be used. Unlike aspirin, it rarely causes bleeding in the stomach.
It is thought that it reduces the amount of chemicals involved in the production of inflammation (swelling)
and pain.
May be taken with food or milk to prevent stomach irritation. Take with a full glass of water and remain
upright (do not lie down) for 30 minutes.
Note: If taken 30 minutes before meals or 2 hours after meals, it will get into the blood more quickly.
Take as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and go
back to your regular dosing schedule.
Drowsiness, dizziness, ringing in ears, stomach upset, unsteadiness and finally profound unconsciousness
are the symptoms. Notify your doctor as soon as possible.
When taken for short term pain relief, it can be safely stopped as soon as you no longer need it. If prescribed
for long term use (for arthritis), do not stop taking this drug without consulting your doctor (in case of
arthritis, it may take one week or even more, for severe cases, before you begin to feel better).
Precautions
Pregnancy: It may cause defects in the unborn baby and may prolong labour. Discuss with your doctor.
Breast feeding: It does pass into the breast milk in minute amounts. It is better to avoid drug or refrain from
nursing.
Over 60: Increased likelihood of adverse effects. Reduced doses may be necessary.
Driving and Hazardous Activities: This drug may cause drowsiness or dizziness. Restrict activities as necessary.
Sun: It is thought that it may make some people sensitive to sunlight. Use caution.
Others: Check with your doctor. If your fever does not improve within 3 days or returns (when used to bring
down fever) if the painful area becomes red or swollen.
Bleeding/bruising Rare Discuss with your doctor in all cases as soon as possible
Interactions
Insulin is the only effective treatment in juvenile (insulin-dependent) type of diabetes. It may also be
prescribed in adult (maturity-onset) diabetes. It is to be used only under doctor’s observation.
When used along with a special meal plan and exercise, it can effectively control diabetes.
Not completely known. It facilitates the transport of sugar to the place where it is utilized. This occurs
primarily in the brain, the voluntary muscles, the heart muscle and the liver.
There are some drugs like sodium valproate that give false urine positive test. It is advisable to do blood
glucose estimation before adjusting insulin dose.
Dosage
Adults: The dose ( and type) of insulin is determined according to the needs of the individual patient.
Inject insulin subcutaneously (under the skin) according to the schedule prescribed by your doctor. The
timing and frequency of injections will vary with the type of insulin prescribed. The table overleaf of insulin
action will help you understand the treatment schedule prescribed to you.
Hypoglycaemia (lowering of blood sugar levels) may occur. Its symptoms include fatigue, weakness,
headache, nervousness, irritability, sweating, tremors, hunger, confusion, abnormal behaviour (resembling
alcoholic intoxication), loss of consciousness, fits, lack of concentration.
Do not discontinue using this drug without consulting your doctor. Diabetes that is insulin-dependent
requires continual treatment on a regular basis. Omission of insulin may result in life-threatening coma
(profound unconsciousness).
Precautions
Pregnancy: Insulin is the drug of choice for managing diabetes during pregnancy. To preserve the health of the
mother and the welfare of the fetus every effort must be made to establish the optimal dosage of insulin
necessary for “good control” and to prevent episodes of hypoglycaemia. Poor control of diabetes increase
the risk of birth defects.
Insulin treatment of the mother has no adverse effects on the nursing infant.
Over 60: Insulin requirement may change with aging. The aging brain adapts well to higher blood sugar levels.
Attempts to maintain strict normal blood sugar levels may cause a fall in blood sugar levels, which on
repeatedly occurring may cause brain damage.
Driving and Hazardous Activities: Usually no problem, but strenuous exercise alters your insulin and sugar
requirements. Avoid these activities if your blood sugar is not well controlled.
Alcohol: Avoid. It may cause low blood sugar and upset diabetic control.
Diet: The success of your treatment depends on your closely following the diet of your doctor.
Exercise: Your doctor may tell you what kind of exercise to do, the best time of day to do it, and how much you
should do daily.
Tobacco: Regular smoking increases insulin requirements. Try to avoid smoking, once you are on insulin
therapy. If you have not quit smoking initially and decide to quit smoking long after having started insulin
therapy, first consult your doctor who may want to change your insulin dose.
Others: Special care of your feet will help to prevent possible future trouble.
Urine tests: These tests are used to guide you in the control of your condition and must be done properly. Two
urine tests for sugar are widely used: the tablet urine test and the paper-strip urine test. Your doctor may want
you to test your urine for acetone.
Blood tests: Many patients have learned to measure their own blood sugar levels. If you are taking blood tests,
follow directions carefully.
The symptoms of hypoglycaemia (low blood sugar) may develop suddenly and may result from:
The symptoms include anxiety chills, confusion, cold sweats difficulty in concentration, excessive hunger,
headache, vision problems, drowsiness. To treat these symptoms always keep a readily available form of
The symptoms of hyperglycaemia (high blood sugar) occur more slowly than those of hypoglycaemia. They
are dry mouth, drowsiness, dry skin, increased urination, loss of appetite, stomach ache, vomiting, troubled
breathing, rapid weight loss, unusual thirst, tiredness.
These symptoms occur if you do not take enough insulin, if you skip a dose, you overeat or do not follow a
proper diet or have fever/infection.
If you become sick, especially with vomiting, diarrhoea or fever, you still need insulin. So continue taking
your insulin and try to stay on a regular diet. If you can’t eat solid foods then drink fruit juices/soups, etc. ( to
avoid low blood sugar). Consult your doctor.
Regular monitoring of sugar levels in the urine and/or blood is required. Improvement in vision may occur
initially during the insulin treatment. Defer examination for spectacles for 6 weeks after starting insulin.
Interactions
1. Organise everything in one place, i.e., insulin, alcohol, and cotton ball. Note syringe marking units: 40 or
100 units.
3. Put syringe, plunger and needle in a strainer or wrap in a clean napkin and place in saucepan with water and
cover with a lid. Boil for five minutes.
4. Remove the articles from the saucepan. When they have cooled, insert the plunger in the barrel and fasten
needle to syringe with a slight twist.
5. Push the plunger in and out several times until all the water is completely removed from the syringe, Now
place these on the inverted cover of the saucepan.
Preferably use disposable syringe (which is discarded after each use) that are now available in India. (With the
use of disposable syringe steps 3,4,5 are not necessary.)
2. Gently roll the insulin bottle several times by holding in both hands.
3. Wipe the top of the stopper of bottle with a cotton swab moistened with alcohol.
4. Take up the syringe once again. By pulling back the plunger, take air into to syringe, equal to the dose of
insulin required.
6. In case air bubbles are present in the syringe, gently tap the syringe so that all the air bubbles collect
together and then with the syringe still pointing upward, plush the plunger to expel the air.
8. If using combination, withdraw intermediate or long acting insulin first and follow the same
procedure for withdrawing plain or quick acting insulin.
1. Cleanse the skin where the injection is to be made, i.e., the thigh or abdomen or arm (best site is
abdomen, then thigh, then arm.)
2. With one hand, stabilise the skin by spreading it or pinching up a large area of skin.
3. Pick up syringe with other hand and hold it as you would a pencil. Insert the needle straight into the
skin (900 angle). Be sure to insert needle all the way.
4. Now withdraw the plunger. If blood comes into the syringe, change the site of injection. If not,
inject the insulin by pushing the plunger all the way down.
5. Hold alcohol swab near the needle and pull the needle straight out of the skin. Press alcohol swab
over injection site for several seconds.
6. To avoid tissue changes, always change the site for each injection.
It is used to treat the development of active tuberculosis disease. It is used in combination with other
medicines such as rifampicin, pyrazinamide, ethambutol (which work in a way different from isoniazid), for
the treatment of TB. It is not to be used alone.
It is thought that this drug destroys susceptible TB germs by disrupting their cell wall.
Available Dosage Forms: 100 mg, 300 mg tablets. Also in combination with rifampicin, pyrazinamide and
ethambutol. Also with thiacetazone.
Dosage
Adults: 300 mg daily; child 10 mg/kg to 20 mg/kg daily (max. 300 mg) daily. Isoniazid to be taken along with
rifampicin and pyrazinamide (and if necessary with ethambutol) to avoid rapid development of resistance
and as advised by physician.
Take the full course (you may have to take it every day for as long as 6 -12 months). Do not stop using it
without consulting your doctor, even if you feel better, since the infection may return if treatment is stopped
too soon.
Take as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and go
back to your regular dosing schedule.
The symptoms include nausea, vomiting, dizziness, blurred vision, slurred speech, breathing difficulties, fits
and loss of consciousness. Notify your doctor immediately.
Infants and Children: Use cautiously in children who get fits. Reduced dose necessary.
Driving and Hazardous Activities: Be sure how you react to this medicine before performing such activities.
Diabetes: This medicine may cause false test results with some urine sugar tests. Check with your doctor
before changing your diet or the dosage of your diabetes medicine.
Others: Your doctor may want to check your blood, eye and liver functions while you are on this drug.
Anticonvulsants s
(Medicine for fits/convulsions
e.g., carbamazepine, phenytoin)
Cortisone medicines
Vitamin B-6 (pyridoxine) deficiency may occur and lead to nerve damage. Supplements of Vitamin B-6 in the
dose of 10 mg daily are given, particularly in patients who are -
- diabetic
- alcoholic
- malnourished
- suffering from renal failure
LOPERAMIDE
It is used along with other measures to treat severe diarrhoea. However, it is not recommended for diarrhoea caused by
infection because it may delay the expulsion of harmful substances (which have caused diarrhoea) from the bowels.
It is often used for people with colostomies or ileotomies (cutting into the colon/ileum) to reduce the fluid
loss from the stomach (outlet).
It reduces the loss of water and salts from the bowel and slows bowel activity (movement and contraction)
resulting in the passage of firmer bowel movements at less frequent intervals and thus relieving diarrhoea
and stomach cramping.
Adults: Acute diarrhoea: 4 mg initially, then 2 mg after each loose motion until diarrhoea is not controlled.
Children: In divided doses at 0.48 mg/kg body weight and only after a loose motion.
Note: Use cautiously (only on physician’s guidance) for children. It should not be given to children below 2 years of age.
Do not take the missed dose. Go back to your regular dosing schedule.
The symptoms include drowsiness, lethargy, depression, dry mouth, vomiting. Notify your doctor as soon as
possible.
Precautions
- are taking antibiotics (some antibiotics may cause diarrhoea. This medicine may make the diarrhoea caused by
antibiotics worse or make it last longer).
Breast feeding: It is thought that it passes into the breast milk and could affect the baby. So avoid drug or refrain from
nursing.
Infants and Children: In babies and children, fluid loss caused by diarrhoea may result in severe condition. So avoid
giving this medicine. Do not use at all for children under 2 years of age.
Note: ORS (Oral Rehydration Salt) is the best measure to treat diarrhoea in children.
Over 60: Use with caution. There is an increased risk of blockage of the intestine. Besides in persons over 60 years
Driving and Hazardous Activities: This drug may cause drowsiness or dizziness. Restrict activities as necessary.
Others: Check with your doctor if your diarrhoea does not stop after a few days or if you develop fever.
Interactions
This drug is not usually taken for prolonged periods (except for persons with ileotomies) but special
problems are not expected during long-term use.
Driving and Hazardous Activities: Be sure how you react to this drug before performing such activities since this
drug may produce dizziness.
Others: Pinworms may be easily passed from one person to another, especially in a household. Therefore all
household members may have to be treated at the same time. This helps to prevent infection or reinfection
of other household members.
For hookworms and whipworm infestation: Anemia may also develop for which your doctor may prescribe iron
supplements for you. You may have to take iron regularly for as long as 6 months after you stopped taking
mebendazole.
It is used to treat varying degrees (moderate to severe) of blood pressure. Medicines like water pills (to
reduce fluid retention) or other medicines that lower BP are used along with it to enhance its effect. Since it
does not reduce blood flow to the kidneys, it is given to people with kidney disorders. It should not be used in
case of mild and uncomplicated rise in BP.
High blood pressure adds to the workload of the heart and blood vessels (that carry blood). If this continues
for long time, the heart and blood vessels stop working properly. This can damage blood vessels of the brain,
heart and kidneys. It may also lead to heart attack or kidney failure. Hence it is necessary to control blood
pressure.
This medicine works by controlling nerve impulses. As a result, it relaxes blood vessels so that blood passes
through them more easily. This helps to lower blood pressure.
Dosage
Adults: Initially 250 mg, 2/3 times a day for 2 days; then adjust dose as required.
Take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back
to your regular dosing schedule.
The symptoms include marked drowsiness, weakness, confusion, nausea, vomiting, profound
unconsciousness. Notify your doctor immediately.
Do not stop using this drug without consulting your doctor, who may reduce the dose gradually. Stopping
the drug suddenly may cause increase in BP.
Your doctor may want you to stop using the drug 5-7 days before surgery (under general anesthesia). Inform
your surgeon that you are on this drug and ask for guidance for stopping this drug.
Precautions
Pregnancy: It is to be used only if clearly needed. Use the minimum effective dose.
Breast feeding: It passes into the breast milk. Avoid as far as possible. If drug is necessary, use cautiously.
Observe infants for drowsiness, inadequate feeding or any adverse effects. Then stop drug or refrain from
nursing.
Over 60: Use cautiously. Adverse effects like drowsiness, reduced mental activity, nasal congestion, dry
mouth are common. This drug can cause Parkinsonism (motion sickness) or intensify the existing
Parkinsonism.
Alcohol: Avoid. It can cause marked sedation (sleeping effect) and excessive fall in BP.
Others: Your doctor may want to check your blood pressure as well as check your blood and urine regularly
while you are on this drug.
Interactions
Liver and blood problems may occur (rarely). Water retention may occur (if not taken with a water pill).
It is used to treat certain infections of the vagina, abdomen, pelvis and gums. It is also used to treat
septicaemia (marked by fever and pus forming organisms in blood), infected leg ulcers and pressure sores. It
may prevent and treat infections following surgery.
In high doses, it can enter the brain and is used to treat abscesses occurring there.
It destroys essential components that are necessary for the cell life and growth of infecting organisms.
Dosage
Adults: For amoebic dysentery: 600 mg twice daily for 5-10 days.
For giardiasis: 600 mg twice daily for 5-10 days or 2 gm once daily for 3 days.
For vaginal infection/genito-urinary infection: one-day course - 2 gm as single dose or 1 gm twice every 12
hours. Seven-day course: 200 mg thrice daily for 7 days.
May be taken with or following food, to avoid stomach irritation. If you are taking multiple doses, try to take
at evenly spaced time intervals to keep a constant amount of medicine in the blood.
Take as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to
your regular dosing schedule. Do not double the doses.
The symptoms include weakness, stomach irritation, nausea, vomiting, confusion, disorientation,
numbness/tingling. Notify your doctor as soon as possible.
Take the full course. Even if you feel better the infection may still be present and symptoms may return if
treatment is stopped too soon.
Precautions
Pregnancy: Safety is not established. Discuss with your doctor. Avoid completely in the first three months of
pregnancy.
Breast feeding: It passes into the breast milk and causes adverse effects in the baby. Avoid drug or refrain from
nursing.
Note: If you refrain from nursing, the breast milk must be squeezed out or sucked out with a breast pump and thrown away.
Resume breast feeding after one or two days after you stop taking this drug.
Infants and children: Reduced dose necessary. Avoid in children with blood disorders.
Over 60: Infections in the genital and anal regions may occur. Report the development of rashes and itching
promptly to your doctor.
Driving and Hazardous Activities: This drug may cause dizziness or light-headedness. Restrict activities as
necessary.
Alcohol: Avoid. When taken along with metronidazole, it may cause flushing, nausea, vomiting, abdominal
pain and headache.
Others: It may cause dryness of mouth, an unpleasant or sharp metallic taste, and a change in taste sensation.
For temporary relief, use gum/candy/ice bits. If dry mouth continues for more than 2 weeks, check with
your dentist since it may increase the chances of dental disease. While using this medicine for vaginal
infection (trichomoniasis) your sexual partner must also be treated even if he has no symptoms. Also, it may
be desirable for your partner to wear a condom during intercourse.
This will help keep you from getting the infection back again.
Note: This drug may cause dark urine. This is only temporary and will go away when you stop this medicine.
Interactions
Not usually used for longer than 10 days. Prolonged use may cause temporary loss of sensation in the hands
and feet and may reduce the reduction of white blood cells.
It is used to treat certain fungal infections, including fungal infections of the skin. It is a safe antifungal
agent.
It destroys/may prevent the growth and multiplication of the fungus which causes the infection.
Dosage
Apply twice daily over affected area (covering it completely) and by rubbing it gently.
Do not cover it with any occlusive (closed) dressing or airtight covering. For nail infections: Clip nails as
short as possible. Apply cream and cover them with non-perforated occlusive dressing for 24 hours.
Apply it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back
to your regular dosing schedule.
Do not stop using it without consulting your doctor. Keep using this medicine for the full time of treatment
(1 week to 1 month, depending on infection) even though your condition may have improved because
sudden stopping may cause return of symptoms.
Precautions
Keep this medicine away from the eyes. If your skin problem has not improved after you have used
miconazole for 4 weeks, check with your doctor.
On local application
Skin rash, blistering, redness Rare Discuss with your doctor as soon as
or other signs of skin irritation possible.
(not present before using the
cream form of this medicine)
On systemic use
Fever and chills Common "
Skin rash/itching " "
Unusual bleeding/bruising Rare "
Unusual tiredness/weakness " "
Wheezing/troubled breathing " "
Nausea/vomiting Common Discuss with your doctor only if severe
Diarrhoea Rare "
Drowsiness " "
Flushing/redness of face/skin " "
Loss of appetite " "
Interactions
This drug is considered a very effective method of preventing pregnancy. It is also used in the treatment of
conditions that benefit from added hormones, such as menstrual irregularity, heavy menstrual flow and
some problems of the uterus, menstrual and menopausal disorders.
When the combination of an estrogen and a progesterone (hormones which occur naturally in the female
body) are taken in correct dosage regularly, the levels of hormones increase to those levels that occur during
pregnancy. This, in turn, prevents the ovulation (formation and release of an egg from the ovary). Besides it
also leads to resistance to the passage of sperm as well as resistance to implantation (placement) of the egg
(if at all ovulation occurs). All these factors lead to prevention of pregnancy.
Start treatment with the first tablet on the fifth day after the onset of menstruation (periods). Follow with 1
tablet daily (taken at the same time each day) for 21 consecutive days. Resume the treatment on eight day
following the last tablet taken during the preceding cycle. The schedule is to take the drug daily for three
weeks and to omit it for one week.
The tablet may be taken with or after food to avoid stomach irritation/vomiting.
For 1 day: Take as soon as you remember. If you do not remember until the next day, take the missed tablet
plus the tablet that is regularly scheduled for that day (2 tablets on the same day). Then continue your regular
dosing schedule.
For 2 days in a row: Take 2 tablets a day for each of the next 2 days, then continue your regular dosing
schedule. In addition, use a second method of birth control to make sure that you are fully protected for the
rest of the cycle.
The symptoms include headache, drowsiness, nausea, vomiting, fluid retention, abnormal vaginal bleeding, breast
enlargement and discomfort.
Do not discontinue this drug if spotting occurs. If it continues for more than one week, consult your physician. A
preparation with a higher estrogen content may be required.
Omitting this drug for only 1 day may not cause pregnancy. It is advisable to avoid pregnancy for 3 to 6 months,
after discontinuing this medicine.
Precautions
- heart problems, angina (heart pain), blood circulation problems, high BP, heart attack.
- mental depression or any other psychiatric problem
- family history of ischaemic heart disease, ischaemic cerebral vascular accident
- liver problems - kidney problems
- asthma - diabetes
- cancer - abnormal vaginal bleeding
- gallstones - migraine headaches
- menstrual problems - problems of uterus
- epilepsy (fits) - lumps in breasts
- planned to undergo surgery - varicose veins
- long-term immobilisation - Crohn’s disease
Pregnancy: Avoid this medicine completely during pregnancy. It may cause defects in the child.
Breast feeding: It passes into the breast milk and reduces the quality and quantity of milk. Avoid drug during
lactational amenorrhoea.
Your doctor may allow to use this medicine after you have been breast feeding for a while. Discuss this
thoroughly with your doctor. Prefer other methods of contraception.
Diet: Avoid excessive intake of salt if fluid retention, swelling of hands and feet occurs.
Tobacco: Avoid smoking cigarettes or use of tobacco in any other form completely during the use of this drug.
Exposure to Sun: A few people may become more sensitive to sunlight while on the pill. Avoid too much
sun/sunlight until you know how you react to it.
If you develop brown blotchy spots on exposed areas, do not worry as they will disappear slowly when you
stop the medicine.
Others: Once you begin this medicine, your body will require at least 7 days to adjust before pregnancy will be
prevented; therefore you should use a second method of birth control for the first cycle (or 3 weeks) to
ensure full protection.
Diarrhoea lasting more than a few hours can impair the effectiveness of this medicine. So adopt another
method of birth control.
- if you have not taken the medicine exactly as scheduled (pregnancy may be a possibility).
- if you have taken this medicine for a long time (2 years or more) and then stopped the use.
Tablet should be taken at approximately same time each day. If delayed by longer than 12 hours
contraception protection may be lost.
Check with your doctor if you miss a period so that the cause can be determined.
When you stop using this medicine, it is very important that you wait at -least 3 months before becoming
pregnant. (Use another method of birth control that time). It takes some time for the effects of this drug to
wear off even after you stop using it. Hence it may cause birth defects in the child of a woman who gets
pregnant immediately after stopping the drug.
Coughing up blood Rare Stop drug now. Get emergency help now.
Headache (severe and sudden) “ "
Loss of co-ordination " "
Vision problems " "
Pains in chest/groin/leg " "“
Interactions
High blood pressure, gall bladder, disease with stones, growths/tumors in uterus, menstrual problems,
infertility.
Emergency Contraception
Hormonal method: The hormonal (yuzpe) method of emergency contraception is suitable for occasional
use. It involves taking two tablets each containing ethinyloestradiol 50 micrograms (mcg) and levonorgestrel
25 mcg, followed 12 hours later by a further two tablets. The method has only been established as effective if
the first dose is taken within 72 hours (3 days) of the unprotected intercourse. If vomiting occurs within 3
hours of taking the tablets, two replacement tablets can be given with an anti-emetic.
Oral rehydration salts (ORS) are specifically intended for the replacement of water and salts lost in acute
diarrhoea. It is vital that these losses are rectified as rapidly as possible, particularly in infants and young
children.
A person who passes frequent watery stools loses a large amount of water and salts from the body. Sudden
loss of water and salt (dehydration) causes marked weakness, thirst and sunken eye-balls. Severe diarrhoea
causes decreased urine output, increased pulse rate and unconsciousness resulting in death. It is estimated
that about one out of every 10 children born in developing countries dies of diarrhoea before reaching the
age of 5. Oral rehydration salts (ORS) contain sugar and mineral salts needed by the body. When taken
dissolved in water, they promptly replace the water and salts lost during diarrhoea and correct dehydration.
Initial Treatment
The degree of dehydration is determined from the general appearance of the child and the following signs:
The maximum rate of fluid replacement for small children is about 300 ml per hour.
When intravenous infusion is not possible an attempt can be made to administer ORS by mouth using a
dropper at a rate of about 20 ml/kg body weight an hour.
- Plus the normal fluid intake, either as breast feeds or as a supplement of equal volumes of milk and clean
water.
Up to one third of the total fluid intake can be given as equal volumes of milk and clean water.
The child should be offered its normal food as soon as possible. Infants over 4 months should be started on
semisolid foods. Fruit juices, bananas or coconut-water are particularly useful in repairing losses of
potassium.
1. If the preformulated ORS packets as above are not available, ORS solution can also be prepared from
home ingredients mentioned above - common salt, baking soda and sugar. Instead of glucose, use
sucrose (common table sugar) or even crude sugar called gur or jaggery. 40 gm of table sugar (about 8
teaspoons) is equivalent to 20 gm (4 teaspoons) of glucose. Mix 8 teaspoonful of sugar with 1
teaspoonful of baking soda together with 1 litre of boiled and cooled water or clean drinking water. Give
to child as indicated for packaged ORS.
As potassium chloride is not usually available, give the child any one of the following every 24 hours:
2. If the above things are not available, prepare the solution with ordinary salt and sugar. For this take salt in
a teaspoon. Level it with a knife or a flat object. Add one level spoonful of salt to one litre of water and
mix. Taste the mixture. If it tastes more salty than tears, pour away and make it again with less salt. Finally
add 8 level teaspoons full of sugar and mix it well. Even rice water can be used in place of sugar.
3. For making the solution, boiled water is preferable, if available. If not, use clean drinking water.
4. Give instructions to the relatives regarding the preparation and administration of ORS solution.
Dissolve, immediately before use, one packet in one litre of clean, boiled cooled water, or, because the
sizes of packets vary, in the quantity of water indicated on the packet. If a litre measure is not available,
use a glass. Average medium size glass has about 180-200 ml capacity. Sometimes soft drink bottles (for
example, Thums-Up or milk bottles) with known capacity may be available. The volume of fluid required
and the rate at which it should be given depend upon:
Others
1. The solution should be prepared fresh every day using a clean utensil and spoons and after washing hands
thoroughly. It should be kept covered in a cool place.
2. During ORS administration, measure the amount of urine passed. A patient who has received adequate
amounts of ORS will pass the normal (usual) amount (1500-2000 ml) of urine daily. Failure to increase
urine output suggests a need for administering more ORS. Continue ORS therapy till the diarrhoea stops
or the patient is referred to the doctor.
3. If ORS packets are stored at high temperature (more than 30 °C) and high humidity for a long time, the
product is likely to cake. If you have a limited supply of ORS, do not throw away ORS that has become
caked. It can still be used provided it dissolves completely in water. If the ORS has turned to a brown
colour it should not be used.
4. All cases of moderate or severe dehydration should be started on ORS fluid as mentioned above and
referred to the doctor.
5. Examples of fluids which are potentially dangerous and should be avoided: commercial soft drinks,
sweetened fruit drinks, sweetened tea, coffee, purgatives, medicinal teas or infusions.
Paracetamol (acetaminophen) is used to relieve mild to moderate pain and to reduce fever. Unlike aspirin, it
is not useful in treating the swelling of joints. It does not cause stomach upset or bleeding problems, like
aspirin, and is therefore an useful alternative.
It reduces the formation of chemicals (prostaglandins) that produce pain and fever.
The effects include vomiting, stomach pain, drowsiness, lethargy, violent contractions of muscles, liver
damage, profound unconsciousness (in 2-5 days after large overdose). Seek immediate medical advice in all
cases.
Precautions
Be sure to tell your doctor if you have kidney/liver problems. Do not take this drug for more than 10 days in
a row, if you are an adult or for more than 5 days in a row, in case of children up to 12 years of age.
Over 60: Do not exceed a total dose of 2500 mg per day since excessive doses may cause liver and kidney
damage.
Alcohol: Prolonged heavy intake of alcohol with paracetamol may increase the risk of liver injury.
Acute over dose produces liver damage. Chronic intake may produce drug-induced liver damage.
Note: Although it is often combined with other painkillers and medicines used to treat allergy, cold and muscular pain, such combinations
are not rational and should be avoided as far as possible. See also Annexures 4 and 5, Chapter 3, Section 1 of this book.
It is to relieve or prevent the symptoms of rhinitis and other types of allergy. It is used to reduce itching in a
variety of skin conditions including urticaria (hives), chickenpox and eczema. It prevents motion sickness,
nausea, vomiting, diarrhoea, and produces sleep in some people when used as nighttime sedation.
Also used as anti-tussive (anticough) in children, and as a preanaesthetic medication. Used in psychiatry as an
antipsychotic.
It blocks the actions of histamine (chemical producing allergy). It slows down the activity of the vomiting
center in the brain.
Dosage
Note: Actual dose must be determined by the physician for each patient individually.
Take with or following food to reduce stomach irritation. For motion sickness, take 1-2 hours before travel,
then every 4-6 hours as necessary.
Take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back
to your regular dosing schedule.
The symptoms include marked drowsiness, weakness, unsteadiness, agitation, deep sleep, fits, coma
(profound unconsciousness). Seek medical help immediately.
Pregnancy: Avoid use of this drug during the first and last 3 months; it can cause jaundice/muscle tremor, bleeding
in the newborn infant.
Breast feeding: It passes into the breast milk. Avoid drug or refrain from nursing.
Infants and Children: Reduced dose necessary. It should not be used in newborn infants. It should not be used to
control vomiting in children with flu/measles/chicken pox or other infections since it may cause muscle pain of
face, neck, back, legs and hands in such children.
Over 60: Increased likelihood of adverse effect such as drowsiness, dizziness, lethargy and impaired thinking
judgement and memory. This drug can increase the symptoms of prostatism.
Driving and Hazardous Activities: This drug can cause drowsiness, so avoid activities until you know how you react to
this drug.
Alcohol: Avoid. Alcohol may increase the sedative effects of this drug.
Sun: This drug may cause some people to become sensitive to sun. Avoid exposure to excessive sunlight until you
know how you react to this drug.
Others: It may cause dryness of the mouth, nose and throat. For temporary relief, use sugar/ice-bits in your
mouth. If dry mouth lasts for more than 2 weeks, check with your doctor since it can lead to dental disease. The
property is utilised for drying secretions in nasal cattarh (simple inflammation of mucous membrane). The drug is
preferred at bed time.
Interactions
Long-term use of this drug is unnecessary. If taken for long time, it may cause abnormal movements of face
and limbs (Parkinsonism) which disappears when drug is stopped. Long-term use may lead to loss of
effectiveness of this drug.
It is used to treat raised blood pressure, angina and abnormal heart rhythms. It is also useful in controlling fast
heart rate, symptoms of overactive thyroid gland, symptoms of anxiety and nervous tension (such as sweating
and tremors), preventing migraine headaches and in treatment of chronic alcoholism.
It works by affecting the response to some nerve impulses in certain parts of the body. As a result, they decrease
the need of blood and oxygen by the heart by reducing its workload. They also help the heart to beat more
regularly.
Dosage
Preferably taken soon after eating to maximize absorption of drug into the blood. Food enhances the absorption
of propranolol. To prevent harmless possible numbing effect, mix with soft food and swallow promptly. Do not
crush, break or chew before swallowing. Swallow the tablet or capsule whole.
Take it as soon as possible. However if your next dose is within 4 hours (8 hours for slow-release/prolonged
action capsules), skip the missed dose and go back to your regular dosing schedule). Do not double the doses.
The symptoms include irregular heart beat, dizziness, difficulty in breathing, bluish-coloured fingernails,
cold and sweaty skin, low BP, difficulty in breathing, seizures (fits), fainting, collapse or profound
unconsciousness.
Do not stop the drug without consulting your doctor. Abrupt stopping may lead to worsening of the
underlying condition. A gradual reduction of dose over a period of 2 weeks is recommended.
Precautions
Pregnancy: Safety in pregnancy not established. Avoid completely in the first three months of pregnancy.
Discuss with your doctor for use in the other six months of pregnancy.
Breast feeding: The drug passes into the breast milk. The nursing infant must be closely observed by the doctor.
Discontinue drug or nursing if adverse effects develop.
Infants and Children : Safety and effectiveness is not established for children under 12 years of age.
Over 60: Increased risk of adverse effects. Use caution. Their progress must be regularly observed (
monitored) by the doctor.
Alcohol: Use cautiously. Alcohol may increase the drug’s ability to lower the blood pressure and may increase
its mild sedative effect.
Tobacco: It may reduce the drug’s efficiency in treating heart disorders and also reduce drug’s blood levels
Driving and Hazardous Activities: This drug may cause dizziness and fall in blood pressure. So determine how
you react to this drug before performing such activities.
Others: Avoid hot environment; it enhances the fall in blood pressure due to this drug.
Avoid cold environments, it enhances the loss of circulation to hands and feet due to this drug.
Avoid exercise and exertion that produces light-headedness, excessive fatigue, or muscle cramping.
Interactions
Rarely in patients with advanced heart disease, eventual heart failure may occur. Reduced heart reserve and
eventual heart failure in susceptible individuals with advanced heart disease.
This combination is used only in the treatment of falciparum malaria that is resistant to (not cured by)
chloroquine. It should not be used for long-term or regular prophylaxis (prevention) of malaria or for vivax
malaria.
It interferes with and inhibits the growth of the germs that cause malaria.
Dosage
Adults: 3 tablets (each tablet contains 25 mg pyrimethamine and 500 mg sulfadoxine) as a single dose.
Precautions
Pregnancy: Avoid.
Interactions
Long-term use not advisable (may lead to serious skin and blood disorders).
Dosage
or
I.V. Infusion: 20 mg/kg quinine diluted in other fluid (like dextrose) is infused for 4 hours, then 10 mg/kg is
infused every 8 hours, till the patient is able to take the tablet.
Children: 10 mg/kg body weight thrice daily for seven days followed if necessary by
pyrimethamine/sulfadoxine tablets.
Take medical advice immediately if breathing problems, fits or loss of consciousness occurs.
For malaria - Do not stop without consulting your doctor. To help clear up the infection completely take the
full course even if you begin to feel better within a few days.
Precautions
Breast feeding: Although it passes into the breast milk, the quantity is too little to affect the child.
Driving and Hazardous Activities: This drug causes blurring of vision, and may impair those activities.
Interactions
It is used in the prevention and treatment of peptic ulcer. It is also used in a disease called Zollinger-Ellison
syndrome, in which the stomach produces too much acid. Unlike cimetidine, a similar drug, ranitidine does
not affect the actions of certain enzymes in the liver, whereby many drugs are broken down. This means that
ranitidine can be taken with other drugs without causing an interaction that may reduce the effectiveness of
treatment.
It acts by reducing the amount of acid produced by the stomach, allowing the ulcers to heal.
Available Dosage Forms: Tablets 150 mg and 300 mg orally in single dose and syrup ranitidine hydrochloride
50 mg/2 ml orally and IV slowly.
Dosage
The drug should be taken with or immediately following meals, preferably at bed time, so as to obtain the
longest period of stomach acid reduction.
Take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back
to your regular dosing schedule.
The symptoms include confusion, delirium, slurred speech, flushing, sweating, drowsiness, muscle
twitching, fits and profound unconsciousness. Notify your doctor as soon as possible.
Do not stop the drug without consulting your doctor; symptoms may recur.
Precautions
Breast feeding: The drug passes into the breast milk. It is advisable to avoid the drug or refrain from nursing.
Infants and children: Not usually prescribed since safety and effectiveness is not established.
Over 60: They must be observed for the development of nervous agitation or confusion. This drug may also
lead to the formation of masses of undigested vegetable fibers (patients with poor chewing ability/missing
teeth and those who have had stomach surgery are more prone to this and may show symptoms such as loss
of appetite, stomach fullness, nausea and vomiting).
Diet: Protein-rich foods produce maximal stomach acid secretion and hence should be avoided. Certain
food and drinks that irritate the stomach may make your problem worse.
Driving and Hazardous Activities: This drug may cause dizziness. Restrict activities as necessary.
Alcohol: Avoid. It may increase the stomach acidity and reduce the effectiveness of this drug.
Tobacco: Avoid completely or at least after taking the last dose of the day since it reduces the drug’s
effectiveness.
Others: If you have been using the drug for a long time, your doctor may want to check your blood and liver
function.
Constipation Rare D i s c u s s w i t h yo u r d o c t o r o n l y i f s e ve r e /
bothersome
Stomach pain " Discuss with your doctor as soon as possible
Confusion " "
Sore throat and fever " "
Unusual bleeding or bruising " "
Irregular heart beat " "
Unusual tiredness/weakness, " "
sexual impotence
Interactions
Courses of longer than 8 weeks are not usually necessary although repeat courses may be required in case the
symptoms return.
Continuous use of the drug for longer than 1 year is not recommended except in exceptional circumstances
because the safety of this drug for prolonged use has not yet been confirmed.
Used primarily as a Step 2 medicine to control high BP (the treatment of hypertension is done in a step-by-
step method. It is started with a Step 1 medicine and then other medicines, that is, Step 2, 3 and 4 medicines,
are added one after the other depending upon the response and severity of symptoms.)
Because of high incidence of adverse effects with reserpine, it is used only in those cases in which
methyldopa, clonidine or propranolol are ineffective or produce adverse effects. Its use should be restricted.
It works by controlling nerve impulses along certain nerve pathways. As a result, it acts on the heart and
blood vessels to lower blood pressure.
Dosage
Take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back
to your regular dosing schedule.
Marked drowsiness, flushed skin, incoordination, tremors, slow pulse, breathing problems, diarrhoea,
profound unconsciousness.
This medicine does not cure high BP but it does control it. So one must continue to take it as directed if you
expect to lower your BP and keep it down. You may have to take this medicine for the rest of your life.
Precautions
Pregnancy: Use of this drug during the last month of pregnancy can cause lethargy, nasal congestion,
breathing problems and poor feeding in the new born infant.
Avoid this drug during the first 3 months and the last month. Use it only if clearly needed after discussing
with your doctor.
Breast feeding: This drug passes into the breast milk. Avoid drug or refrain from nursing.
Infants and Children: They must be observed carefully for excessive drowsiness, emotional instability on
gastrointestinal disturbances.
Over 60: Increased likelihood of adverse effects. Use caution. Avoid exposure to cold.
Driving and Hazardous Activities: This drug may impair mental alertness and judgement. Restrict activities as
necessary.
Alcohol: Avoid. This drug can increase the intoxicating effects of alcohol and eventually depress brain
function.
Interactions
Rifampicin (rifampin) is used to treat tuberculosis (TB). It is given in combination with other drugs to
enhance its effectiveness.
It is used for leprosy in combination with other drugs such as dapsone and clofazimine.
It may be occasionally used in serious infections such as artificial heart valve infections (endocarditis) and
bone infections (osteomyelitis) along with other antibiotics so as to prevent the development of bacteria that
will resist the actions of the drug.
It is best taken with a full glass (8 ounces) of water on an empty stomach either 1 hour before or 2 hours after
eating. However if it upsets your stomach, you may take it with food.
Take the full course (which can be several months to years). Even if you feel better, the original infection may
still be present and the symptoms may return if treatment is stopped too soon.
Precautions
Over 60: Increased likelihood of adverse effects. Reduced dose may be necessary.
Infants and Children: Must be observed closely for possible liver toxicity or blood problems. Reduced dose may
be necessary.
Others: You may have to take this medicine everyday for as long as prescribed. It is important that you do not
miss any doses.
It causes urine, stool, saliva, sputum, sweat, semen and tears to turn reddish-orange or reddish-brown
colour. It also colours soft contact lenses permanently. So wear hard contact lenses instead of soft contact
lenses.
Note: Some adverse effects are more common with intermittent therapy or after restarting interrupted
treatment.
Prolonged use may cause liver damage. Fungal infection of mouth/tongue may also occur.
It is used in the treatment of asthma and other breathing disorders such as bronchitis and emphysema.
Unlike similar drugs, it does not have any unwanted effects on the heart or blood pressure. It is also used in
delaying of premature labour.
It relaxes the muscles surrounding the bronchioles (air ways in the lung) and thus facilitate easy breathing. It
relaxes the muscles of the uterus, and is thus used in the delaying of labour.
Dosage
Inhalers Adults: 400-800 micrograms daily (i.e. 1-2 inhalations, 3-4 times daily)
For inhalation: Keep spray away from eyes because it may cause irritation. Do not take more than 2 inhalations
of the medicine at any one time, unless your doctor has asked you to do so. Allow 1-2 minutes after the first
inhalation to make certain that a second inhalation is necessary.
Take it as soon as possible. Then use any regular doses for that day at regularly-spaced intervals.
Pregnancy: Avoid this drug. Safety is not established. Although it can delay labour, it cannot prevent or stop
the labour completely.
Breast feeding: It passes into the breast milk, but does not cause any adverse effect on the nursing baby.
Discuss with your doctor.
Over 60: Increased likelihood of adverse effects. Reduced dose may therefore be necessary.
Driving and Hazardous Activities: Avoid such drugs until you know how the drug affects you before performing
such activities because this drug causes tremors.
Interactions
It is used in the treatment of certain infections like rickettsial infections, cholera, brucellosis plague,
sexually transmitted diseases (STDs) such as gonorrhoea, and syphilis (when penicillin cannot be used),
pimples and respiratory tract infections (not responding to other antimicrobials). It is used along with other
drugs to treat malaria when chloroquine is not effective as well as problems of the eye such as trachoma,
conjunctivitis and sty.
Tetracycline kills bacterial organisms. Increasingly tetracycline resistant bacteria are seen. Doxycycline is the
preferred alternative.
Dosage
Eye Ointment
Take with lot of water at least 1 hour before or 2 hours after meals.
Eye ointment: The eye should be thoroughly cleaned with water before every fresh application of ointment.
Do not touch the tip of the applicator to the eye. The tube used for one patient should not be used for
another patient to avoid cross infections.
Take as soon as you remember. Space the missed dose and the next dose 6 hours apart.
Do not stop taking this drug without consulting your doctor. It is necessary to take the full course of
treatment even if you feel better within a few days.
Precautions
- kidney problems
- liver problems.
Pregnancy: Avoid. It discolours the teeth of the developing baby. Discuss with your doctor.
Breast feeding: It passes into the breast milk and may discolour the infant’s teeth.
Infants and Children: Not recommended for children below 12 years of age.
Diet: Do not take milk or milk products within 1-2 hours of the time you take this drug by mouth since it may
keep this medicine from working well.
Sun: Avoid too much sun or sunlamp unless you know how you react to the sun especially if you tend to burn
as easily. Sun-sensitivity may continue for several months after you stop taking this drug. Consult your doctor
if severe reaction occurs.
Others: Do not use improperly stored preparations or preparations after expiry date.
VITAMIN A
Symptoms of deficiency : Night blindness (difficulty in seeing in dim light) is an early sign. Others are dry,
rough skin, loss of appetite, diarrhoea, low resistance to diseases, dry and swollen eyes. Severe deficiency
leads to blindness (due to ulcers in the eye) weak bones and teeth.
Night-blindness is the commonest cause of blindness in India and therefore judicious prophylactic
(preventive) use of Vitamin A can reduce the incidence of blindness in India. The government programme
advocates Vitamin A drops every six month till child reaches 5 years of age. It is used as a supplement in the
following conditions when the Vitamin A requirement increases above normal: cystic fibrosis, chronic
diarrhoea, obstruction of bile duct, overactive thyroid gland, long-term and use of lipid (fat) - lowering
drugs.
(W H O Guidelines)