Arcoxia

Class : Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

Etoricoxib

Indications Acute & chronic treatment of osteoarthritis & RA. Treatment of ankylosing spondylitis. Treatment of acute gouty arthritis & primary dysmenorrhea. Relief of acute & chronic pain.

Dosage 120 mg 1 tab OD

Administration May be taken with or without food.

Precautions Advanced renal disease; preexisting edema, HTN or heart failure; liver dysfunction or cirrhosis; previous acute asthmatic attacks, urticaria or rhinitis precipitated by salicylates or nonselective COX inhibitors. History of CV or other thrombotic effects. Medical history of ischemic heart disease. Use at the shortest possible duration & at the lowest effective daily dose to avoid CV risk. Dehydration. History of GI perforation, ulcers & bleeding; Elderly >65 yr. When using etoricoxib in the elderly & in patients w/ renal, hepatic or cardiac dysfunction, medically appropriate supervision should be maintained. Discontinue treatment at the 1st appearance of skin rash, mucosal lesion or

63

other signs of hypersensitivity.

Adverse Drug Reactions

Immune system, nervous system, cardiac, resp, thoracic mediastinal, GI, hepatobiliary, skin & SC tissue, renal & urinary disorders. Psychiatric disorder, hypertensive crisis.Click to view ADR Monitoring Website

Interactions Warfarin, rifampin, methotrexate, ACE inhibitors, lithium, aspirin, OC, hormone replacement therapy. Diuretics, AIIA's.Click here for more Interaction Checks

ATC Classification M01AH05 - Etoricoxib ; Belongs to the class of non-steroidal antiinflammatory and antirheumatic products, coxibs. Used in the treatment of inflammation and rheumatism.

Betahistine

Class : Antivertigo Drugs

64

betahistine

Mechanism of Action

Betahistine improves the microcirculation in the labyrinth which reduces endolymphatic pressure.

Indication & Dosage Oral

REDUCTION OF SYMPTOMS OF VERTIGO IN MENIERE'S DISEASE 16 mg/tab 1 tab TID as needed for dizziness

Administration Should be taken with food.

Contraindications Phaeochromocytoma. Porphyria.

Precautions Active peptic ulcer, bronchial asthma, pregnancy and lactation.

Adverse Drug Reactions

Rash, pruritus, urticaria, dyspepsia, nausea, peptic ulcer disease, headache, dizziness, insomnia.

Interactions May antagonise antihistamines. May decrease bronchodilator effects of -2 agonists.

Class Antivertigo Drugs

65

ATC Classification N07CA01 - Betahistine ; Belongs to the class of preparations used in the treatment of vertigo.

Imdur

Class : Anti-Anginal Drugs

Contents Isosorbide-5-mononitrate

Indications Prophylactic treatment of angina pectoris. Treatment of post-myocardial infarction (MI) anginal attacks.

Dosage 60 mg ½ tab OD q HS

Administration May be taken with or without food (May be divided along the score-line. Whole tabs & divided halves must be swallowed whole, do not chew/crush. ).

Contraindications Hypersensitivity to any of the components of Imdur, shock, hypotension, constrictive cardiomyopathy and pericarditis.

Precautions Caution should be observed in patients with severe cerebral arteriosclerosis and hypotension.

66

Use in pregnancy & lactation: The safety and efficacy of Imdur during pregnancy or lactation have not been established.

Adverse Drug Reactions

Most of the adverse reactions are pharmacodynamic-mediated and dose dependent. Headache may occur when treatment is initiated, but usually disappears during continued treatment. Hypotension, with symptoms eg, dizziness and nausea with syncope in isolated cases, has occasionally been reported. These symptoms generally disappear during continued treatment.

Interactions Concomitant administration of Imdur and sildenafil (Viagra) can potentiate the vasodilatory effect of Imdur with the potential result of serious side effects as syncope or myocardial infarction. Therefore, to an existing therapy of Imdur, sildenafil may not be given additionally. The effect of food on the absorption of Imdur is not clinically significant.

Overdosage Symptoms: Pulsing headache. More serious symptoms are excitation, flushing, cold perspiration, nausea, vomiting, vertigo, syncope, tachycardia and a fall in blood pressure. Treatment: Induction of emesis, activated charcoal. In case of pronounced hypotension, the patient should first be placed in the supine position with legs

67

raised. If necessary, IV administration of fluids.

Description Imdur durule also contains excipients and coloring agents (iron oxide, titanium dioxide).

Actions Pharmacology: Pharmacodynamics: The principal pharmacological action of isosorbide-5-mononitrate, an active metabolite of isosorbide dinitrate, is relaxation of vascular smooth muscle producing vasodilatation of both arteries and veins, with the latter effect predominating. The effect of the treatment is dependent on the dose. Low plasma concentrations lead to venous dilatation, resulting in peripheral pooling of blood, decreased venous return and reduction in left ventricular end diastolic pressure (preload). High plasma concentrations also dilate the arteries reducing systemic vascular resistance and arterial pressure leading to a reduction in cardiac afterload. Isosorbide-5-mononitrate may also have a direct dilatory effect on the coronary arteries. By reducing the end diastolic pressure and volume, the preparation lowers the intramural pressure, thereby leading to an improvement in the subendocardial blood flow. The net effect when administering isosorbide-5-mononitrate is therefore a reduced workload of the heart and an improved oxygen supply/demand balance in the myocardium. In placebo-controlled studies, Imdur once daily has been shown effectively to control angina pectoris both in terms of exercise capacity and symptoms and

68

in reducing signs of myocardial ischemia. The duration of effect is at least 12 hrs, at this point the plasma concentration is at the same level as around 1 hr after dose intake (around 1300 nmol/L). Imdur has been shown to be effective in monotherapy as well as in combination with chronic β-blocker therapy. The clinical effects of nitrates may be attenuated during repeated administration owing to high and/or even plasma levels. This can be avoided by allowing low plasma levels for a certain period of dosage interval. Imdur, when administered once daily in the morning, produces a plasma profile that provides high plasma levels during daytime and low nighttime plasma levels. With Imdur 60 or 120 mg once daily, no development of tolerance with respect to antianginal effect has been observed. Rebound phenomenon between doses as described with intermittent nitrate patch therapy has not been seen with Imdur. Imdur is safe and well tolerated also when used in connection with acute myocardial infarction as shown in ISIS-4. The first dose was 30 mg and another 30 mg 12 hrs later, thereafter 60 mg once daily. Plasma concentrations after administration in acute myocardial infarction were similar to what is seen in healthy volunteers. Occasionally, protracted absorption may occur possibly due to concomitant morphine administration. Pharmacokinetics: Isosorbide-5-mononitrate is completely absorbed and is not metabolized during the first passage through the liver. This reduces the

69

intra- and interindividual variations in plasma levels and leads to predictable and reproducible clinical effects. The elimination half-life of isosorbide-5-mononitrate is around 5 hrs. The volume of distribution for isosorbide-5-mononitrate is about 0.6 L/kg and total clearance around 115 mL/min. Elimination takes place by denitration and conjugation. The metabolites are excreted mainly via the kidneys. Only about 2% of the dose given is excreted as unchanged drug via the kidneys. Impaired liver or kidney function has no major influence on the pharmacokinetic properties. Imdur is an extended-release formulation of isosorbide-5-mononitrate. The active substance is released independently of pH, over a 10-hr period. Compared to ordinary tablets, the absorption of Imdur is prolonged and the duration of effect is extended. The extent of bioavailability of Imdur is about 90% compared to immediate-release tablets. Absorption is not significantly affected by food intake. After repeated peroral administration with 60 mg once daily, a maximal plasma concentration (around 3000 nmol/L) is achieved after around 4 hrs. The plasma concentrations then gradually fall to around 500 nmol/L at the end of the dosage interval (24 hrs after dose intake).

Class Anti-Anginal Drugs

70

ATC Classification C01DA14 - Isosorbide mononitrate ; Belongs to the class of organic nitrate vasodilators. Used in the treatment of cardiac disease.

Mucosolvan

Class : Cough & Cold Preparations

Contents Ambroxol HCl

Indications Resp tract diseases associated w/ abnormal bronchial secretions, particularly in exacerbations of asthmatic bronchitis & chronic bronchitis, bronchial asthma; pre- & post-op treatment. Amp Esp suitable for the prevention of pulmonary complications in intensive medicine.

Dosage 75 mg 1 cap OD

Administration Should be taken with food (Take immediately after meals. Retard cap: Swallow whole, do not chew/crush.).

Adverse Drug Reactions

Mild GI effects & allergic reactions.

Class Cough & Cold Preparations

71

ATC Classification R05CB06 - Ambroxol ; Belongs to the class of mucolytics. Used in the treatment of wet cough.

Nasatapp

Class : Cough & Cold Preparations

Contents Per tab Brompheniramine maleate 12 mg, phenylpropanolamine HCl 15 mg. Per 5 mL syr Brompheniramine maleate 4 mg, phenylpropanolamine HCl 12.5 mg. Per mL drops Brompheniramine maleate 2 mg, phenylpropanolamine HCl 6.25 mg

Indications Allergic & vasomotor or other hyperactive nasal disorders & acute coryza. Relief of nasal congestion & hypersecretion in infants & childn up to 12 yr.

Dosage 1 tab OD

Administration May be taken with or without food.

Contraindications HTN, coronary disease. Concurrent use or use w/in 2 wk of MAOIs. Brain damage or epilepsy. Premature infants or neonates.

Precautions Hyperthyroidism, CV disorders, occlusive vascular disorders, angina pectoris, DM or close-angle glaucoma.

72

Adverse Drug Reactions

Severe HTN, drowsiness, lassitude, nausea, giddiness, dry mouth, mydriasis, increased irritability & excitement.

Interactions Actions prolonged by MAOIs. Potentiate effects of other CNS depressants.

Class Cough & Cold Preparations

ATC Classification R01BA51 - Phenylpropanolamine, combinations ; Belongs to the class of systemic sympathomimetic preparations used as nasal decongestants.

Motilium

Class : GIT Regulators, Antiflatulents & Anti-inflammatories, Antiemetics

Contents Domperidone

Indications Dyspeptic symptom complex associated w/ delayed gastric emptying, GERD, esophagitis eg epigastric sense of fullness, early satiety, feeling of abdominal distension, upper abdominal pain; bloating, eructation, flatulence; heartburn

73

w/ or w/o regurgitations of gastric contents in the mouth. Nausea & vomiting of functional, organic, infectious or dietetic origin or induced by radio- or drug therapy.

Dosage 10 mg/tab 1 tab TID

Administration Should be taken on an empty stomach (Take 15-30 mins before meals.).

Contraindications GI hemorrhage, mechanical obstruction or perforation; in patients w/ prolactin-releasing pituitary tumor (prolactinoma). Known intolerance to the drug.

Precautions Babies <1 yr. Pregnancy & lactation. Hepatic impairment, renal disorders. When antacids or antisecretory agents are used concomitantly, they should be taken after meals & not before meals. Lactose intolerance. Galactosemia or glucose/galactose malabsorption.

Adverse Drug Reactions

Rarely, increased prolactin levels. GI disorders. Very rare, transient intestinal cramps. Galactorrhea. Gynecomastia. Amenorrhea.

Interactions Antagonized by anticholinergic drugs. Antacids or antisecretory agents, CYP3A4 inhibitors.

74

Class GIT Regulators, Antiflatulents & Anti-inflammatories / Antiemetics

Poison Schedule Film-coated tab:Non-Rx;Susp:Rx;

ATC Classification A03FA03 - Domperidone ; Belongs to the class of propulsives. Used in the treatment of functional gastrointestinal disorders.

Isordil

Class : Anti-Anginal Drugs

Contents Isosorbide dinitrate

Dosage 5 mg/tab 1 tab SL OD as needed for chest pain

75

Precautions Tolerance & cross-tolerance to other nitrates & nitrites may occur. Pregnancy, lactation, childn. Patients prone to or affected by hypotension or vol depletion; severe hypotensive response; paradoxical bradycardia, increased angina may accompany nitrate induced hypotension, hypertrophic cardiomyopathy.

Adverse Drug Reactions

Flushing, vascular headache, cerebral ischemia associated w/ postural hypotension, nausea, vomiting, weakness, restlessness, pallor, perspiration & collapse; drug rash &/or exfoliative dermatitis.

Interactions Increased hypotensive effects w/ alcohol, β-blockers, phenothiazines, sildenafil, tadalafil, vardenafil.

Class Anti-Anginal Drugs

ATC Classification C01DA08 - Isosorbide dinitrate ; Belongs to the class of organic nitrate vasodilators. Used in the treatment of cardiac disease.

Vaneular

76

Class : Vitamin B-Complex / with C

Contents Nicotinic acid 25 mg, vit B1 300 mg, vit B12 250 mcg, vit B2 30 mg, vit B6 100 mg

Indications Polyneuropathy of varied etiology. Neuralgia or nerve root lesions. Conditions where it is desirable to increase blood flow. Other related conditions eg malabsorption syndrome; radiation sickness; malnutrition or deficiency diseases; severe infections.

Dosage Mild cases & for maintenance 1-2 tab daily. Moderate to severe cases Up to 4 tab daily.

Description

Actions

Class Vitamin B-Complex / with C

ATC Classification A11EA - Vitamin B-complex, plain ; Used as dietary supplements.

77