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DRUG INDEX AS OF APRIL 11, 2014

Clonidine (Catapres)

Omeprazole

Gabriel Gerardo N. Cortez (Batch 2015)

Nimodipine

Bisacodyl (Dulcolax)

Levitiracetam (Keppra)

Furosemide

Insulin Glargine (Lantus)

Diazepam (Valium)

Acetylcysteine (Fluimucil)

Nicardipine

Citicoline

Verapamil

Heparin

Lactulose

Rosuvastatin

Warfarin (Coumadin)

Atorvastatin

Ivabradine (Coralan)

Amlodipine

Piperacillin-Tazobactam

Tramadol

Fondaparinux

Cefuroxime

Neuropeptide (Cerebrolysin)

Enoxaparin

Dexamathasone

Mannitol

Pantoprazole

Paracetamol (Biogesic)

DRUGS
LEVETIRACETAM
(Keppra)

MOA
Anticonvulsant used in the
treatment of partial seizures.
The precise mechanism of
anticonvulsant effect is
unknown.

INDICATION
Monotherapy in the
treatment of partial
onset seizures w/ or
w/o secondary
generalization in
patients 16 yr w/
newly diagnosed
epilepsy. Adjunctive
therapy in the
treatment of partial
onset seizures w/ or
w/o secondary
generalization in
adults & childn 4 yr
w/ epilepsy;
myoclonic seizures in
adults & adolescents
12 yr w/ juvenile
myoclonic epilepsy &
primary generalized
tonic-clonic seizures
in adults & childn 4
yr w/ idiopathic
generalized epilepsy.

DIAZEPAM
(Valium)

Diazepam is a long-acting
benzodiazepine with
anticonvulsant, anxiolytic,
sedative, muscle relaxant
and amnestic properties. It
increases neuronal
membrane permeability to

Tab: Symptomatic
relief of anxiety,
agitation & tension
due to psychoneurotic
states & transient
situational
disturbances.

DOSAGE
Monotherapy Adult &
adolescent 16 yr Initially
250 mg bid, increased to
500 mg bid after 2 wk. May
be further increased by 250
mg bid 2 wkly. Max: 1,500
mg bid. Add-on
therapy Adult (18 yr) &
adolescent 12-17 yr 50
kg Initially 500 mg bid, may
be increased up to 1,500
mg bid. Dose may be
titrated by
increment/decrement of
500 mg bid 2-4 wkly. Childn
& adolescent 50 kg Adult
dose, 4-17 yr <50
kg Initially 10 mg/kg bid,
may be increased up to 30
mg/kg bid. Dose
increment/decrement
should not be >10 mg/kg
bid 2 wkly. Childn 25
kg Start the treatment w/
100 mg/mL oral soln.
Tab Adult 5-20 mg
daily. Elderly the usual
adult dose. Childn 0.1-0.3
mg/kg body wt
daily. InjIndividualized
dosage.

CONTRAINDICATION
Hypersensitivity to
levetiracetam or
other pyrrolidone
derivatives.

ADVERSE EFFECTS
Nasopharyngitis,
somnolence, headache,
fatigue & dizziness.
Anorexia; depression,
hostility/aggression,
anxiety, insomnia,
nervousness/irritability;
convulsion, balance
disorder, tremor,
lethargy; vertigo; cough;
abdominal pain,
diarrhea, dyspepsia,
vomiting, nausea; rash;
asthenia.

Dependence on
other substances
including alcohol
except in
management of
acute w/drawal
reactions. Severe

Blurred vision, urinary


retention (infrequent).
Paradoxical reactions.
Dependence, w/drawal
symptoms.

chloride ions by binding to


stereospecific
benzodiazepine receptors on
the postsynaptic GABA
neuron within the CNS and
enhancing the GABA
inhibitory effects resulting in
hyperpolarisation and
stabilisation.

CITICOLINE Na

Citicoline increases blood

Adjunctively in major
mental & organic
disorders. Adjunct for
the relief of reflex
muscle spasm due to
local trauma. To
combat spasticity
arising from damage
to spinal &
supraspinal
interneurons. Inj:
Basal sedation before
stressful therapeutic
measures or
interventions. For preop medication of
anxious or tense
patients. In
psychiatry, treatment
of excitation states
associated w/ acute
anxiety & panic.
Motor unrest &
delirium tremens.
Status epilepticus &
other convulsive
states. Adjunct for
relief of reflex muscle
spasm due to local
trauma. To combat
spasticity arising from
damage to spinal &
supraspinal
interneurons.
Acute and recovery

chronic
hypercapnia.

Tablet: Usual Dose: 500 mg

Patients with

Gastrointestinal

LACTULOSE

flow and O2 consumption in


the brain. It is also involved
in the biosynthesis of lecithin.

phase of cerebral
infarction (eg,
ischemia due to
stroke). Cognitive
dysfunction due to
degenerative (ie,
Alzheimer's disease)
and cerebrovascular
disease. Cerebral
insufficiency (eg,
dizziness, memory
loss, poor
concentration,
disorientation) due to
head trauma or brain
injury.

Lactulose promotes
peristalsis by producing an
osmotic effect in the colon
with resultant distention. In
hepatic encephalopathy, it
reduces absorption of
ammonium ions and toxic
nitrogenous compounds,
resulting in reduced blood
ammonia concentrations.

Relief of constipation
including chronic
constipation. Portal
systemic
encephalopathy:
Hepatic coma or
precoma stages
where
hyperammonemia is
present.

once or twice daily.


Drops: Usual Dose: 100-200
mg (1-2 mL) twice or thrice
daily.
Ampoule: 125 mg/mL:
Usual Dose: 1-2 injections
daily. 250 mg/mL: Usual
Dose: 1 injection daily.
Adjust dose according to
disease severity. Can be
administered through IM or
IV (3-5 min) route and IV
drip (infusion rate of 40-60
drops/min). Direct IV
administration should be
made very slowly to
prevent episodes of
hypotension. Cholinerv is
compatible with hypertonic
glucose solution and all IV
isotonic solutions.
Constipation: Dosage can
vary widely with the
severity of the condition. A
relatively large initial dose
should be followed by a
smaller maintenance dose
after the first 3 days of
treatment. Only 1 daily
dose needs to be taken,
preferably after breakfast.
Adults: Initially 15-30 mL as
a single dose or in 2 divided
doses. Children 5-10
years: 10 mL twice

hypertonia of the
parasympathetic
nervous system.

disorders (ie, stomach


pain, diarrhea). Vascular
side effects (ie,
hypotension,
tachycardia,
bradycardia).

Patients who require


a low lactose diet;
with galactosemia
or disaccharide
deficiency; with
intestinal
obstruction.

Initial doses of lactulose


may cause abdominal
discomfort associated
with flatulence and
intestinal cramps. These
symptoms normally
disappear under
continued therapy.
Nausea and vomiting
have occasionally been
reported following high
doses.
Prolonged use or
excessive dosage can

ATORVASTATIN Ca
(Avamax)

Atorvastatin competitively
inhibits HMG-CoA reductase,
the enzyme that catalyses
the conversion of HMG-CoA
to mevalonic acid. This
results in the induction of the
LDL receptors, leading to
lowered LDL-cholesterol
concentration.

Reduces LDLcholesterol,
apolipoprotein B &
triglycerides;
increases HDLcholesterol in the
treatment of
hyperlipidemias.
Adjunct therapy in
patients w/
homozygous familial
hypercholesterolemia
who have some LDLreceptor function.
Primary prophylaxis of
CV events in patients
w/ multiple risk
factors.

PIPERACILLINTAZOBACTAM

Piperacillin has an
antimicrobial activity against
a wide range of gm-ve
organisms including K.
pneumoniae, P.
aeruginosa,Enterobacteriacea
e and against gm+ve

Treatment of
documented
multidrug resistant
gm -ve infections due
to organisms proven
or suspected to be
susceptible to

daily; 1-5 years: 5 mL


twice daily.
Hepatic
Encephalopathy: 30-50 mL
3 times a day, subsequently
adjusted to produce 2 or 3
soft stools daily.
Dose range: 10-80 mg once
daily. Doses may be given
any time of the day. Dosage
should be individualized
according to baseline LDLcholesterol levels, goal of
therapy & patient
response.Primary
hypercholesterolemia &
combined
hyperlipidemia 10 mg once
daily. Homozygous familial
hypercholesterolemia 80
mg.

Adult 4 g/500 mg 8 hrly.


May be increased up to 4
g/500 mg 6 hrly. Childn >12
yr 240 mg/30 mg to 320
mg/40 mg/kg/day in 3-4
divided doses.

lead to diarrhea with


potential complications
eg, loss of fluids,
hypokalemia and
hyponatremia.

Active liver disease


or unexplained
persistent
elevations of serum
transaminases.
Pregnancy, women
of childbearing
potential, lactation.

Hypersensitivity to
-lactams including
penicillins &
cephalosporins or lactamase
inhibitors.

Chest pain, face edema,


fever, neck rigidity,
malaise, photosensitivity
reaction, generalized
edema. Nausea &
vomiting,
gastroenteritis, colitis,
gastritis, dry mouth.
Arthritis, leg cramps,
bursitis, tenosynovitis,
myasthenia, tendinous
contracture, myositis.
Anaphylaxis,
angioneurotic edema,
bullous rashes (including
erythema multiforme,
Stevens-Johnson
syndrome, toxic
epidermal necrolysis),
rhabdomyolysis &
fatigue.
Hypotension; diarrhea,
nausea, vomiting; rash,
erythema, pruritus,
urticaria; arthralgia,
muscle weakness,
myalgia.

organisms eg E.
faecalis and B. fragilis.
Tazobactam is a penicillanic
acid sulfone derivative with
beta-lactamase inhibitory
properties. In combination,
tazobactam enhances the
activity of piperacillin against
beta-lactamase-producing
bacteria.

CEFUROXIME

Cefuroxime binds to one or


more of the penicillin-binding
proteins (PBPs) which inhibits
the final transpeptidation
step of peptidoglycan
synthesis in bacterial cell
wall, thus inhibiting
biosynthesis and arresting
cell wall assembly resulting in
bacterial cell death.

DEXAMETHASONE

Dexamethasone is a
synthetic glucocorticoid
which decreases
inflammation by inhibiting
the migration of leukocytes
and reversal of increased
capillary permeability. It

piperacillintazobactam except
CNS infections;
polymicrobial
infections eg mixed
aerobic & anaerobic
infections except CNS
infections in which
other agents have
insufficient activity or
are contraindicated
due to toxic potential.
Treatment of
susceptible infections
which include bone &
joint infections,
bronchitis & other
lower resp tract
infections, gonorrhea,
meningitis, otitis
media, peritonitis,
pharyngitis, sinusitis,
skin infections
(including soft tissue
infections) & UTI. Inj:
Prophylaxis for
surgical infection.
Inflammatory &
allergic conditions
responsive to
corticosteroid therapy
eg skin diseases,
collagen diseases,
blood dyscrasia,

Oral susp Otitis


media Childn >2 yr 250 mg
or 15 mg/kg bid. Max: 500
mg daily. Childn >3
mth 125 mg or 10 mg/kg
bid. Max: 250 mg
daily. IV/IM Adult 750 mg
tid, may be increased to 1.5
g tid IV in severe infections.
Administration may be
increased to 6 hrly, if
necessary. Total dose: 3-6 g
daily.Infant & childn 30-60
mg/kg/day, may be
increased to 100 mg/kg
daily in 3-4 divided doses.
RA, chronic bronchial
asthma Tab 1-2 tab
daily. Forte tab - tab
every other
day. Disseminated lupus
erythematosus, pemphigus,
sarcoidosis Tab 4-9 tab

Hypersensitivity to
cephalosporins.

Diarrhea & nausea. Oral


susp: Vomiting. Mild to
moderate hearing loss.
Inj: Transient pain at IM
inj site; skin rashes
(maculopapular &
urticaria), drug fever;
pseudomembranous
colitis; decreased Hb
conc &/or eosinophilia,
leukopenia &
neutropenia; transient
rise in SGOT, SGPT &
bilirubin.

Tablet/Forte
Tablet: Hypersensiti
vity to prednisolone
or to any of the
excipients of
Decilone/Decilone
Forte.

Excessive mental
stimulation, increase
appetite, muscle
twitching, wt gain,
tachycardia, insomnia &
psychic disturbances.

PANTOPRAZOLE
(Prazole IV)

CLONIDINE HCl
(Catapres)

suppresses normal immune


response.

certain neoplastic
disease &
adrenocortical
insufficiency.

daily. Forte tab 1-2 tab


every other day.Acute
rheumatic fever, severe
allergic reactions Tab 8-20
tab daily. Forte tab 2-5 tab
every other day. Acute
leukemia, nephrotic
syndrome, acute
pemphigus Tab 20-30 tab
daily. Forte tab 5-7 tab
every other day.

Pantoprazole is a substituted
benzimidazole, and also
known as PPI due to its
property to block the final
step of acid secretion by
inhibiting H+/K+ ATPase
enzyme system in gastric
parietal cell. Both basal and
stimulated acid are inhibited.
Clonidine stimulates alpha-2
receptors in brain stem which
results in reduced
sympathetic outflow from the
CNS and a decrease in
peripheral resistance leading
to reduced BP and pulse rate.
It does not alter normal
haemodynamic response to
exercise at recommended
dosages.

Treatment of GERD,
duodenal & gastric
ulcer.

40 mg IV once daily for 7


days.

HTN of any etiology


except the
pheochromocytoma
form.

Tab Mild to moderate


HTN 75-150 mcg
bid. Severe HTN Increase
single dose to 300 mcg.
Could be repeated up to tid
(900 mcg). Infusion 0.2
mcg/kg/min IV infusion, not
>150 mcg/infusion.

Systemic fungal
infections;
gastrointestinal
ulcer; acute or
chronic infections;
osteoporosis,
diabetes mellitus;
renal insufficiency;
hypertension;
history of psychotic
illness; immediately
before prophylactic
immunization.
Occasionally headache
or diarrhea. Isolated
cases of edema, blurred
vision, fever, dizziness,
thrombophlebitis,
depression or myalgia
subsiding after
termination of therapy.
Sick sinus
syndrome.

Dizziness, headache,
paresthesia, sedation,
gynecomastia, confusion
state, delusional
perception, depression,
hallucination, decreased
libido, nightmare, sleep
disorder,
accommodation
disorder, decreased
lacrimation, AV block,
bradyarrhythmia, sinus
bradycardia, orthostatic

NIMODIPINE

Nimodipine inhibits inflow of


calcium ions into cells by
blocking calcium channels or
select voltage-sensitive areas
resulting in relaxation of
vascular smooth muscle.
Nimodipine has greater
action on the cerebral vessels
because of its high
lipophilicity.

Prevention &
treatment of ischemic
neurological deficits
following aneurysmal
subarachnoid
hemorrhage.

Initially 1 mg/hr for 2 hr,


increased to 2 mg/hr
(provided that no severe
hypotension
occurs). Patients weighing
<70 kg, w/ unstable BP &
hepatic impairment 500
mcg/hr or lower if
necessary. Continue for at
least 5-14 days. Doses to
be given via bypass into a
running IV infusion into a
central vein.

FUROSEMIDE

Furosemide inhibits
reabsorption of Na and
chloride mainly in the
medullary portion of the
ascending Loop of Henle.
Excretion of potassium and
ammonia is also increased
while uric acid excretion is
reduced. It increases plasma-

Treatment of edema
associated w/ heart
failure including
pulmonary edema &
w/ renal & hepatic
disorders.

IM/IV Max infusion rate: 4


mg/min. Edema 20-50 mg,
increased by 20 mg
increments not >2 hrly.
Doses >50 mg may be
given by slow IV
infusion. Pulmonary
edema Initially 40 mg slow
IV, increased to 80

Renal failure
associated w/
hepatic coma &
caused by
nephrotoxic or
hepatotoxic drugs.
Precomatose states
associated w/ liver
cirrhosis.

hypotension. Raynaud's
phenomenon, nasal
dryness, alopecia,
pruritus, rash, urticaria,
erectile dysfunction,
fatigue, malaise, colonic
pseudo-obstruction,
constipation, dry mouth,
nausea, salivary gland
pain, vomiting.
Dizziness, flushing,
headache, hypotension,
peripheral edema,
tachycardia,
palpitations; nausea,
other GI disturbances,
increased micturition
frequency, lethargy, eye
pain, visual
disturbances; mental
depression; rashes,
fever, liver function
abnormalities including
cholestasis; gingival
hyperplasia, myalgia,
tremor, impotence.
Fluid & electrolyte
imbalance including
hyponatremia,
hypokalemia &
hypochloremic alkalosis;
increased urinary
excretion of Ca;
nephrocalcinosis in
preterm infants.

ACETYLCYSTEINE
(Fluimucil)

VERAPAMIL

renin levels and secondary


hyperaldosteronism may
result. Furosemide reduces
BP in hypertensives as well
as in normotensives. It also
reduces pulmonary oedema
before diuresis has set in.
Acetylcysteine may decrease
the viscosity of secretions by
splitting of disulphide bonds
in mucoproteins. It also
promotes the detoxification
of an intermediate
paracetamol metabolite
which is used in the
management of paracetamol
overdosage.

Verapamil inhibits entry of


calcium ions into arterial
smooth muscle cells as well
as the myocytes and
conducting tissue. These
actions lead to reversal and
preventions of coronary
artery spasm, reduction in
afterload through peripheral
vasodilatation and reduction

mg. Childn 0.5-1.5 mg/kg


daily. Max: 20 mg daily.

Acute & chronic resp


tract infections w/
abundant mucus
secretions due to
acute bronchitis,
chronic bronchitis &
its exacerbations,
pulmonary
emphysema,
mucoviscidosis &
bronchiectasis.

Control of
supraventricular
arrhythmias &
management of
angina pectoris &
HTN.

Effervescent tab/Oral
soln Adult 600 mg daily
(preferably in the evening)
or 200 mg bidtid. Childn100 mg bid-qid
according to age. Dissolve
the tab or content of sachet
in a glass of water (75
mL).Inhalant Nebulize 1
amp once-bid for 5-10
days. IM inj 1 amp oncebid. Small childn adult
dose.IV Adult 1 amp bid up
to 2-3 amp bid-tid. Childn 11 amp bid-tid. It is
recommended to dilute IV
inj w/ 0.9% NaCl soln or a
5% glucose soln.
Adult & adolescent >50 kg
body wt CHD, paroxysmal,
supraventricular
tachycardia, atrial
fibrillation/flutter -1 tab
bid. HTN 1 tab in the
morning, may add -1 tab
in the evening if not
sufficient. Max: 480 mg
daily (long-term therapy).

Effervescent
tab/Oral soln:
Phenylketonurics.

Rarely, urticaria,
bronchospasm, nausea,
vomiting. Inhalant:
Rhinitis, stomatitis.

CV shock, acute MI
w/ complications eg
bradycardia,
hypotension, leftsided heart failure,
pronounced
conduction
disturbances eg
2nd- & 3rd-degree
SA or AV block, sick

Nausea, bloating,
constipation. Fatigue,
nervousness; vertigo or
somnolence,
paresthesia, neuropathy,
tremor; development or
exacerbation of cardiac
insufficiency, excessive
fall in BP &/or orthostatic
dysregulation, sinus

in ventricular rate in patients


with chronic atrial flutter or
fibrillation and reduction in
the occurrence of paroxysmal
supraventricular tachycardia.
Verapamil reduces BP,
relieves angina and slows AV
conduction.

ROSUVASTATIN

Rosuvastatin is a selective
and competitive inhibitor of
HMG-CoA reductase, the ratelimiting enzyme in
cholesterol synthesis. It
increases the number of
hepatic LDL receptors on the
cell surface, enhancing
uptake and catabolism of
LDL. It also decreases
apolipoprotein B,
triglycerides and increases

Prevention of CV
events eg CV death,
stroke, MI, unstable
angina or arterial
revascularization;
primary
hypercholesterolemia
(heterozygous familial
& nonfamilial); mixed
dyslipidemia
(Fredrickson types IIa
& IIb); homozygous

Usual dose: 10-40 mg once


daily. Adult Primary
hypercholesterolemia
(including heterozygous
familial
hypercholesterolemia),
mixed dyslipidemia,
dysbetalipoproteinemia,
isolated
hypertriglyceridemia &
treatment of
atherosclerosis Usual

sinus syndrome,
manifest cardiac
insufficiency, atrial
fibrillation/flutter &
simultaneous
existing WolffParkinson-White
syndrome. Angina
pectoris <7 days
after acute MI.
Concurrent use w/
IV -blockers.
Galactose &
fructose
intolerance, lactase
& saccharaseisomaltase
deficiency or
glucose-galactose
malabsorption.
Pregnancy (1st &
2nd trimester) &
lactation.
Active liver disease.
Women of
childbearing
potential not using
appropriate
contraceptive
measures.
Pregnancy &
lactation.

bradycardia, 1st-degree
AV block, swollen ankle,
flushing, skin reddening
& warm sensation;
allergic reactions eg
erythema, pruritus,
urticaria, maculopapular
exanthema,
erythromelalgia;
headache.

Headache, myalgia,
asthenia, constipation,
dizziness, nausea,
abdominal pain.

IVABRADINE
(Coralan)

HDL.

familial
hypercholesterolemia
as an adjunct to diet
& other lipid-lowering
treatments or as
monotherapy;
heterozygous familial
hypercholesterolemia.
Treatment of primary
dysbetalipoproteinemi
a (Fredrickson type III
hyperlipoproteinemia
& isolated
hypertriglyceridemia
(Fredrickson type IV
hyperlipidemia). Slow
or delay progression
of atherosclerosis.

Ivabradine is a heart rate


lowering agent that works
through selective and specific
inhibition of the cardiac
pacemaker If current. Ifcurren
t controls the spontaneous
diastolic depolarisation in the
sinus node and regulate
heart rate.

Treatment of CAD:
Symptomatic
treatment of chronic
stable angina pectoris
in CAD patients w/
normal sinus rhythm.
Patients unable to
tolerate or w/ a CI to
the use of -blockers;
or in combination w/
-blockers in patients

starting dose: 10 mg once


daily.Special patient
population Starting dose: 5
mg. Patients w/ severe
hypercholesterolemia
(including heterozygous
familial
hypercholesterolemia) Start
ing dose: 20
mg. Homozygous familial
hypercholesterolemia Starti
ng dose: 20 mg once
daily. Childn & adolescent
10-17 yrHeterozygous
familial
hypercholesterolemia Usual
dose: 5-20 mg/day. Severe
renal & hepatic
impairment Max: 10
mg/day. Asian
patients Starting dose: 5
mg. Concomitant use w/
gemfibrozilMax: 20 mg
once daily.
5 mg bid. After 1 mth,
increase to 7.5 mg
bid. Elderly 2.5 mg morning
& evening.

Resting heart rate


<60 bpm prior to
treatment,
cardiogenic shock,
heart rhythm
disorder, acute MI,
severe hypotension
(<90/50 mmHg),
unstable angina,
heart failure which
has recently

Luminous visual
phenomena
(phosphenes), blurred
vision, bradycardia
(particularly w/in 1st 2-3
mth of initiation), 1stdegree AV block,
ventricular
extrasystoles,
uncontrolled BP,
headache, dizziness.

TRAMADOL

Tramadol inhibits reuptake of


norepinephrine, serotonin
and enhances serotonin
release. It alters perception
and response to pain by
binding to mu-opiate
receptors in the CNS.

NEUROPEPTIDE
(Cerebrolysin)

The peptide fraction


stimulates cell differentiation,
bolsters nerve cell function
and induces mechanisms of
protection and
repair. Cerebrolysin directly
influences neuronal and
synaptic plasticity, thus

inadequately
controlled w/ an
optimal -blocker
dose & whose heart
rate is >60 beats/min.
Treatment of chronic
heart failure:
Reduction of CV
events (CV mortality
or hospitalization for
worsening heart
failure) in adults in
sinus rhythm w/
symptomatic chronic
heart failure & whose
heart rate is 70
beats/min.
Moderate to severe
pain & post-op pain.

Neurotrophic agent
for the treatment of
acute ischemic stroke,
dementia & traumatic
brain injury.

become worse,
severe hepatic
insufficiency,
pacemakerdependent patient.
Concomitant potent
CYP3A4 inhibitors.
Pregnancy &
lactation. Childn
<18 yr.

IM or IV inj (over 2-3 min) or


IV infusion Moderate to
severe pain 50-100 mg 4-6
hrly. Post-op painInitial dose
100 mg, followed by 50 mg
every 10-20 min. Max: 250
mg in the 1st hr including
initial dose. 50-100 mg 4-6
hrly; max 600 mg daily
thereafter.
Acute ischemic stroke &
brain trauma Mild: 30 mL,
severe: 50
mL. Rehabilitation after
acute stroke & brain
trauma Mild: 10 mL, severe:
30 mL. Mild to moderate
dementia w/ predominant

Acute alcohol
intoxication.
Hypnotics, centrallyacting analgesics,
opioids or
psychotropic drugs.
Treatment w/ MAOIs
or w/in 2 wk from
w/drawal. Childn
<12 yr.
Epilepsy & severe
renal impairment.

Nausea, vomiting,
diarrhea, constipation.
Tiredness, drowsiness,
dizziness, headache,
confusion,
hallucinations. Skin
rashes, tachycardia,
orthostatic hypotension,
bradycardia, flushing,
allergic reactions.
Aserythema, pruritus &
burning.

MANNITOL

improving learning. This has


been shown in young, adult
and aged animals with
reduced cognitive abilities. In
models of cerebral ischemia,
Cerebrolysin reduced infarct
volume, inhibited edema
formation, stabilized
microcirculation, doubled the
survival rate, and normalized
lesion-related neurological
failure and learning deficits.
Positive results were also
obtained using models of
Alzheimer's disease. In
addition to its direct effects
on neurons, Cerebrolysin
appears to significantly
increase the number of
glucose transport molecules
in the blood-brain barrier,
thereby balancing out the
critical energy deficit
associated with this disease.
Mannitol increases urinary
output by inhibiting tubular
reabsorption of water and
electrolytes. It raises the
osmotic pressure of the
plasma allowing water to be
drawn out of body tissues.

cognitive deficits 10
mL. Severe dementia w/
predominant behavioral
deficits Duration of infusion:
30-50 mL/day up to 20
days, diluted in 50-100 mL
sterile normal saline soln,
30 min to 1 hr infusion
time.

Increase urine flow in


patients w/ acute
renal failure, reduce
raised intracranial
pressure & treat
cerebral edema.
Short-term
management of
glaucoma especially
to reduce IOP prior to
ophth surgery & to

IV infusion Adult 50-100


g. Childn 0.25-2 g/kg body
wt. Reduction of intracranial
or intraocular
pressure 0.25-2 g/kg body
wt over 3-60 min. Renal
failure 200 mg/kg body wt
over 3-5 min.

Pulmonary
congestion or
pulmonary edema,
intracranial
bleeding, heart
failure, renal failure.

Fluid & electrolyte


imbalance.

PARACETAMOL

Paracetamol exhibits
analgesic action by
peripheral blockage of pain
impulse generation. It
produces antipyresis by
inhibiting the hypothalamic
heat-regulating centre. Its
weak anti-inflammatory
activity is related to inhibition
of prostaglandin synthesis in
the CNS.

OMEPRAZOLE

Omeprazole is a substituted
benzimidazole gastric
antisecretory agent and is
also known as PPI. It blocks
the final step in gastric acid
secretion by specific
inhibition of H+/K+ ATPase
enzyme system present on
the secretory surface of the
gastric parietal cell. Both
basal and stimulated acid are
inhibited.

excrete toxic
substances by forced
diuresis.
Relief of fever, minor
aches & pains.

Conditions where
inhibition of gastric
acid secretion may be
beneficial including
aspiration syndromes,
dyspepsia, GERD,
PUD, Zollinger-Ellison
syndrome.

Tab Adult & childn >12 yr 12 tab 4-6 hrly as needed.


Max: 8 tab in 24 hr. 250
mg/5 mL susp Childn 7-12
yr 5-7.5 mL (1-1 tsp), 3-6
yr 2.5-5 mL (-1 tsp), 1-2
yr 2.5 mL ( tsp) 4
hrly. 120 mg/5 mL
susp Childn 7-12 yr 10-15
mL (2-3 tsp), 3-6 yr 5-10 mL
(1-2 tsp), 1-2 yr 5 mL (1
tsp) 4 hrly. DropsChildn 1-2
yr 1-1.2 mL, 7 mth to 1 yr 1
mL, 4-6 mth 0.6-1 mL, 0-3
mth 0.3-0.6 mL 4 hrly. Susp
& Drops Max: 5 doses/24 hr.
Dyspepsia 10-20 mg daily
for 2-4 wk. GERD 20 mg
once daily for 4-12 wk.
Maintenance: 20 mg once
daily. Refractory
esophagitis 40 mg daily.
Maintenance: 20 mg once
daily & 10 mg for acid
reflux.Peptic ulcer 20-40 mg
single dose for severe
cases. Continue for 4 wk for
duodenal ulcer, 8 wk for
gastric ulcer. Maintenance:
10-20 mg once
daily. NSAID-associated
ulceration 20 mg

Anemia, cardiac &


pulmonary disease.
Hepatic or severe
renal disease.

Allergic skin reactions &


GI disturbances.

Headache, diarrhea &


skin rash.

BISACODYL
(Dulcolax)

Bisacodyl acts mainly in the


large intestine by increasng
its motility to effect bowel
evacuation.

INSULIN GLARGINE
(Lantus)

Insulin glargine, a long-acting


analog of human insulin,
regulates carbohydrate,
protein and fat metabolism
by inhibiting hepatic glucose
production and lipolysis, and
enhancing peripheral glucose
disposal.

NICARDIPINE

Nicardipine is a
dihydropyridine calciumchannel blocker. It inhibits
calcium ion from entering the
slow channels or select
voltage-sensitive areas of
vascular smooth muscle and
myocardium during
depolarisation, producing a
relaxation of coronary
vascular smooth muscle and

Constipation. Prep for


radiography;
antepartum &
postpartum care; prep
for sigmoidoscopy or
proctoscopy;
colonoscopy;
hemorrhoids & anal
fissures. All conditions
which require
defecation to be
facilitated.
DM, adults,
adolescents &
childn 2 yr, where
treatment w/ insulin is
required.

daily.Zollinger-Ellison
syndrome 60 mg once daily.
Constipation Adult 1-2 tab,
4-10 tab, relief in 6-12
hr. Adult/Ped supp Relief in
15-30 min. For complete
bowel clearance Adult &
childn >10 yr 2-4 tab the
night before & 1 adult supp
on the day of the
procedure; <10 yr 1 tab the
night before & 1 ped supp
on the day of the
procedure.
Administer SC once daily at
the same time every day.
Dose & timing of dose
should be individually
adjusted.

Prophylaxis of angina.
2 mg/2 mL inj:
Management of mild
to moderate HTN. 10
mg/10 mL inj:
Management of
moderate to severe
HTN where immediate
correction of BP is
required; pre- & postop HTN.

IV infusion Dilute to 10-20


mg/100 mL (conc of 1.010.02%). Initial infusion rate:
5 mg/hr; titrate dose up to
15 mg/hr until desired
therapeutic response is
achieved (DBP <95 mmHg,
SBP <140 mmHg).
Maintenance rate: Can be
tapered down to 10
mg/hr. IV bolus inj 2-7 mg

Ileus, intestinal
obstruction, acute
surgical abdominal
conditions; severe
dehydration.
Appendicitis &
acute inflammatory
bowel diseases.

Rarely, abdominal
discomfort & diarrhea.

Hypersensitivity to
insulin glargine or to
any of the
excipients of
Lantus.

Hypoglycemia,
temporary visual
impairment,
lipohypertrophy, inj site
& allergic reactions
including redness, pain,
itch, hives, swelling or
inflammation. Rarely,
sodium retention &
edema.
Peripheral edema,
headache, tachycardia,
palpitations, localized
thrombophlebitis &
hypotension.

Patients who do not


have complete
hemostasis
following
intracranial
hemorrhage.
Increased
intracranial
pressure during
acute phase of a
stroke.

HEPARIN

WARFARIN
(Coumadin)

coronary vasodilatation. It
also increases myocardial
oxygen delivery in patients
with vasospastic angina.
Heparin increases the
inhibitory action of
antithrombin III (AT III) on
clotting factors XIIa, XIa, IXa,
Xa and thrombin. This inhibits
the conversion of
prothrombin to thrombin and
fibrinogen to fibrin. It also
inhibits platelet function. It
may reduce the activity of
ATIII at very high doses.

Warfarin inhibits synthesis of


vit K-dependent coagulation
factors VII, IX, X and II and
anticoagulant protein C and
its cofactor protein S. No

w/o dilution given over 1-2


min.

Treatment &
prophylaxis of
thromboembolic
disorders.

Prophylaxis &
treatment of venous
thrombosis, atrial
fibrillation w/
embolization,

Deep SC inj Initial dose: IV


inj 5,000 u followed by SC
conc soln 10,000-20,000 u.
Dose: Conc soln 8,00010,000 u 8 hrly or 15,00020,000 u 12
hrly. Intermittent IV
inj Initial dose: 10,000 u.
Dose: 5,000-10,000 u.
Doses may either be
undiluted or in 50-100 mL
isotonic NaCl. IV
infusion Initial dose: IV inj
5,000 u. 20,000-40,000 u in
1,000 mL isotonic
continuous NaCl soln for
infusion/day.Heart & blood
vessel surgery Initial dose:
150 u/kg for <60 min or
400 u/kg for >60 min. Blood
transfusion Addition of 400600 u/100 mL whole
blood. Laboratory
sample Addition of 70-150
u/10-20 mL sample of
whole blood.
Individualized dosage &
duration of treatment.
Initially 2-5 mg daily.
Maintenance: 2-10 mg daily.

Hypersensitivity.
Severe
thrombocytopenia

Hemorrhage, local
irritation, erythema, mild
pain, hematoma or
ulceration. Generalized
hypersensitivity, chills,
fever, urticaria, asthma,
rhinitis, lacrimation &
anaphylactoid reactions.
Osteoporosis,
aldosterone synthesis
suppression, delayed
transient alopecia, &
priapism & rebound
hyperlipidemia on
discontinuation.

Hypersensitivity.
Hemorrhagic
tendency or blood
dyscrasias. Recent
or contemplated

Fatal or non-fatal
hemorrhage, bleeding,
necrosis of skin & other
tissues.

AMLODIPINE
(Norvasc)

effects on established
thrombus but further
extension of the clot can be
prevented. Secondary
embolic phenomena are
avoided.

pulmonary embolism,
adjunct in prophylaxis
of systemic embolism
after MI & in
treatment of coronary
occlusion.

Amlodipine relaxes peripheral


and coronary vascular
smooth muscle. It produces
coronary vasodilation by

HTN, angina,
myocardial ischemia.
Reduce the risk of
coronary

HTN & angina Initially 5 mg


once daily which may be
increased to a max dose of
10 mg depending on

surgery of CNS, eye


or traumatic surgery
resulting in large
open surfaces.
Bleeding tendencies
associated w/ active
ulceration or overt
bleeding of GI,
genitourinary or
resp tracts;
cerebrovascular
hemorrhage;
cerebral aneurysms,
dissecting aorta;
pericarditis &
pericardial
effusions; bacterial
endocarditis.
Threatened
abortion, eclampsia
& preeclampsia.
Unsupervised
patients w/ senility,
alcoholism,
psychosis or lack of
patient cooperation.
Spinal puncture.
Major regional,
lumbar block
anesth, malignant
HTN. Pregnancy.
Known sensitivity to
dihydropyridines.

Headache, edema,
fatigue, somnolence,
nausea, abdominal pain,
flushing, palpitations,

AMLODIPINE +
ATORVASTATIN
(Norgesic Protect)

inhibiting the entry of Ca ions


into the voltage-sensitive
channels of the vascular
smooth muscle and
myocardium during
depolarisation. It also
increases myocardial
O2 delivery in patients with
vasospastic angina.
Amlodipine is a
dihydropyridine calcium
channel blocker which
relaxes peripheral and
coronary vascular smooth
muscle. It produces coronary
vasodilation by inhibiting the
entry of Ca ions into the
voltage-sensitive channels of
the vascular smooth muscle
and myocardium during
depolarisation. It reduces
peripheral vascular
resistance and hence
resulting in a reduction of
blood pressure. In
vasospastic angina,
Amlodipine also inhibits
coronary spasm in patients
with vasopastic angina.
Atorvastatin selectively and
competitively inhibits HMGCoA reductase, the enzyme
that catalyses the conversion
of HMG-CoA to mevalonate
which is a rate-limiting step

revascularization,
fatal CHD, non-fatal
MI & stroke.

patient's response. CAD 510 mg/day. Childn 6-17


yr 2.5-5 mg/day.

Treatment of patients
at increased CV risk
due to concomitant
HTN & dyslipidemia;
symptomatic CHD
expressed as angina
w/ dyslipidemia.
Prevention of CV
complications in
hypertensive patients.

Per 5 mg/10 mg
tab Amlodipine besilate 5
mg, atorvastatin Ca 10
mg. Per 10 mg/10 mg
tabAmlodipine besilate 10
mg, atorvastatin Ca 10 mg
Individualized starting &
maintenance doses. Dose
range: 5 mg/10 mg to max
of 10 mg/10 mg once daily.

dizziness. Asthenia,
vasodilatation &
epistaxis..

Hypersensitivity to
amlodipine besilate,
atorvastatin Ca &
dihydropyridines.
Active liver disease
or unexplained
persistent
elevations of serum
transaminases
exceeding 3 times
the upper limit of
normal. Women of
childbearing
potential. Pregnancy
& lactation.

Amlodipine: Headache,
dizziness, somnolence,
palpitations, flushing,
abdominal pain, nausea,
edema & fatigue.
Atorvastatin:
Nasopharyngitis,
hyperglycemia,
pharyngeal pain,
epistaxis, diarrhea,
dyspepsia, nausea,
flatulence, abnormal
liver function tests,
increased blood
creatinine
phosphokinase,
arthralgia & myalgia.

FONDAPARINUX

in cholesterol biosynthesis.
Fondaparinux, a synthetic
pentasaccharide, acts as a
selective inhibitor of
activated factor X. It works by
binding selectively to ATIII,
and potentiates the
neutralisation of Factor Xa.
This will interrupt the blood
coagulation cascade and
inhibit both thrombin
formation and thrombus
development. At the
recommended dosage,
fondaparinux does not affect
fibrinolytic activity or platelet
function. It cannot lyse
established thrombi and does
not affect clotting function
tests (e.g. aPPT, INR).

Prevention of venous
thromboembolic
events (VTE) in
patients undergoing
major orthopedic
surgery of the lower
limbs eg hip fracture
including extended
prophylaxis, knee &
hip replacement
surgery; abdominal
surgery at risk of
thromboembolic
complications,
restricted mobility
during acute illness
who are at risk of
thromboembolic
complications.
Treatment of acute
DVT & pulmonary
embolism (PE),
unstable angina or
non-ST segment
elevation MI
(UA/NSTEMI) acute
coronary syndrome
for the prevention of
death, MI & refractory
ischemia; ST segment
elevation MI (STEMI)
acute coronary
syndrome for the
prevention of death &

Adult Prevention of VTE in


orthopedic & abdominal
surgery 2.5 mg SC once
daily, starting not <6 hr
post-op & after hemostasis
is established for at least 59 days, up to an additional
24 days in hip
fracture. Patients at risk of
thromboembolic
complications 2.5 mg SC
once daily for 6-14
days. DVT & PE >100 kg
body wt 10 mg, 50-100 kg
body wt 7.5 mg, <50 kg
body wt 5 mg. Doses to be
administered SC once daily
for at least 5 days & until
adequate oral anticoagulant
is established (INR 2-3).
Initiate concomitant
treatment w/ vit K
antagonists w/in 72 hr.
Duration: 5-9
days.UA/NSTEMI 2.5 mg SC
once daily for up to 8 days
or until hospital
discharge. STEMI 2.5 mg
once daily, 1st dose to be
given IV & subsequent
doses given SC for up to 8
days or until hospital
discharge.

Hypersensitivity.
Active clinically
significant bleeding,
acute bacterial
endocarditis.

Anemia, bleeding,
purpura; edema.

ENOXAPARIN

Enoxaparin is a low molecular


weight heparin with
anticoagulant properties. It
acts by enhancing the
inhibition rate of activated
clotting factors including
thrombin and factor Xa
through its action on
antithrombin III.

myocardial reinfarction in patients


who are managed w/
thrombolytics or who
initially are to receive
no other form of
reperfusion therapy.
Prophylaxis of VTE
disease, in particular
those which may be
associated w/
orthopedic or general
surgery. Prophylaxis of
VTE in medical
patients bedridden
due to acute illnesses
including cardiac
insufficiency, resp
failure, severe
infections, rheumatic
diseases. Treatment of
deep vein thrombosis
w/ or w/o pulmonary
embolism; prevention
of thrombus formation
in extracorporeal
circulation during
hemodialysis;
treatment of unstable
angina & non-Q wave
MI, administered
concurrently w/
aspirin.

Prophylaxis of venous
thrombosis In surgical
patients, give 1st inj 2 hr
before surgical procedure.
In orthopedic surgery, give
initial dose 12 hr preop. Patient w/ moderate risk
of thromboembolism 20 mg
SC once daily. Patient w/
high risk of
thromboembolism 40 mg
SC once daily. Ave duration:
7-10 days. May continue
therapy at 40 mg once daily
for 3 wk esp in orthopedic
surgery. Prophylaxis of VTE
in medical patients 40 mg
once daily by SC inj for a
min of 6 days & continued
until return to full
ambulation. Max: 14
days. Treatment of DVT w/
or w/o pulmonary
embolism By SC inj 1.5
mg/kg once daily or 1
mg/kg bid. Complicated
thromboembolic disorders 1
mg/kg bid. Ave duration: 10

Conditions w/ a high
risk of uncontrolled
hemorrhage
including major
bleeding disorders.
Hypersensitivity to
enoxaparin Na,
heparin or its
derivatives
including other low
MW heparins.

Hemorrhage.
Thrombocytopenia. Local
reactions (exceptionally
small local hematoma).
Exceptional cases of skin
necrosis (discontinue
treatment). Rarely,
cutaneous or systemic
allergic reactions.
Increase in liver
enzymes, platelet
counts. Hypersensitivity
cutaneous vasculitis.

ERDOSTEINE
(Ectrin)

Erdosteine contains two


sulfhydryl groups, which are
freed after metabolic
transformation in the liver.
The liberated sulfhydryl
groups break the disulphide
bonds, which hold the
glycoprotein fibres of mucus
together. This makes the
bronchial secretions more
fluid and enhances
elimination.

Acute bronchitis,
chronic bronchitis &
its exacerbations.
Resp disorders
characterised by
abnormal bronchial
secretions & impaired
mucus transport.

days. Prevention of
extracorporeal thrombus
during hemodialysis 1
mg/kg introduced into the
arterial line of the circuit
prior to hemodialysis,
sufficient for a 4-hr session.
For longer sessions,
additional dose of 0.5-1
mg/kg may be given. For
patients w/ high risk of
hemorrhage, dose reduced
to 0.5 mg/kg for double
vascular access or 0.75
mg/kg for single vascular
access. Treatment of
unstable angina & non-Qwave MI 1 mg/kg 12 hrly by
SC inj w/ aspirin (100-325
mg orally) for min of 2 days
& continue until clinically
stabilized (usual duration of
treatment is 2-8 days).
Cap 1 cap bidtid. Susp Adult & childn >30
kg 10 mL bid, 20-30 kg 5
mL tid, 15-19 kg 5 mL bid.

Hepatic cirrhosis &


cystathioninesynthetase enzyme
deficiency.
Phenylketonuria
(susp only).

No gastrointestinal nor
systemic side effects
due to Ectrin have been
observed..

PARACETAMOL +
ORPHENADRINE
(Norgesic/ Norgesic
Forte)

RACECADOTRIL

CARBIMAZOLE

Paracetamol, a paraaminophenol derivative, is a


peripherally acting analgesic
with antipyretic and weak
anti-inflammatory activity.
Orphenadrine, an analog of
diphenhydramine, is a
skeletal muscle relaxant and
is postulated to act on
cerebral motor center or on
the medulla through an
atropine-like central action. It
has anticholinergic, local
anaesthetic effects and some
antihistaminic effects.
Orphenadrine is used either
as the hydrochloride or the
citrate and doses are
expressed in terms of the
relevant salt.
Racecadotril increases the
availability of endogenous
opioids (enkephalins) by
inhibiting the membranebound enkephalinase. These
enkephalins activate -opioid
receptors in the GI tract. This
leads to a reduction in cAMP
mucosal levels, resulting in a
reducted secretion of water
and electrolytes in the
intestinal lumen.
Carbimazole is metabolised
to methimazole which is
responsible for its antithyroid

Acute or chronic
painful muscular
conditions, nonarticular rheumatism,
whiplash injury, acute
torticollis, tension
headache,
dysmenorrhea.

Per Norgesic
tab Orphenadrine citrate 35
mg, paracetamol 450
mg. Per Norgesic Forte
tabOrphenadrine citrate 50
mg, paracetamol 650 mg

Glaucoma;
myasthenia gravis;
prostatic
hypertrophy or
bladder neck
obstruction. Childn
<12 yr.

Nausea, dry mouth,


blurred vision, dizziness
& restlessness.

Cap: Treatment of
acute diarrhea. Powd:
Adjunct to oral or
parenteral rehydration
in the treatment of
acute watery diarrhea
in infants & childn.

Cap Adult Initiate 100 mg


as a single dose. Further
treatment approx 8 hrly
until cessation of diarrhea.
Max: 300 mg daily. Duration
of treatment: 7
days. Powd Childn &
infant 1.5 mg/kg/dose, w/ 1
initial dose & 3 daily divided
doses.

Hypersensitivity.
Powd: Renal or
hepatic impairment.
Fructose
intolerance, glucose
& galactose
malabsorption
syndrome or
sucrase isomaltase
deficiency.

Drowsiness.

Management of
hyperthyroidism;
treatment of Grave's

Adult Initially 15-40 mg


daily, continue until patient
is euthyroid. Maintenance:

Pregnancy &
lactation.

Nausea, vomiting,
gastric discomfort,
headache, arthralgia,

Norgesic 1-2 tab


tid. Norgesic Forte 1 tab tid.
Max: 2 tab tid.

action. It blocks the


production of thyroid
hormones by inhibiting
thyroid peroxidase.

TRIMETAZIDINE
(Vastarel MR)

ISOSORBIDE
DINITRATE (Isoket
5/Isoket 10/ Isoket
Retard 20/ Isoket
Retard 40)

Trimetazidine is a cellular
acting anti-ischaemic agent.
It has 3 main properties by
which it acts as a
cytoprotective agent. It
inhibits the anaerobic
glycolysis and fatty acid
metabolism, thus allowing
only aerobic glycolysis. This
action helps to restore the
energy balance in the cell. It
inhibits acidosis and free
radical accumulation in the
cell. All these action help the
cell to restore the normal
ionic and metabolic balance.
Isosorbide dinitrate relaxes
vascular smooth muscles by
stimulating cyclic-GMP. It
decreases left ventricular
pressure (preload) and
arterial resistance (afterload).

disease; preparation
of hyperthyroid
patients for
thyroidectomy.
Adjunct to radioiodine therapy &
treatment of thyroid
storm.
Preventive treatment
of episodes of angina
pectoris. Adjuvant
symptomatic
treatment of vertigo &
tinnitus. Adjuvant
treatment of visual
disorders of
circulatory origin.

5-15 mg daily.

1 tab morning & evening.

Hypersensitivity.
Parkinson's disease,
parkinsonian
symptoms, tremors,
restless leg
syndrome & other
related movement
disorders. Severe
renal impairment
(CrCl <30 mL/min).
Lactation. Childn.

Isoket 5/10 Treatment


& prevention of
angina pectoris
attacks. Maintenance
therapy after MI.
Fresh MI w/ left
ventricular failure.
Acute left ventricular
failure of other
origins. Long-term
treatment of chronic

Isoket 5/10 tab To control


anginal attacks 1 tab
sublingually. To prevent
anginal attacks 3-4 tab
daily. Isoket Retard 20/40
tab 1 tab bid.

Hypersensitivity to
isosorbide dinitrate,
nitrates or nitrites.
Low-filling pressure,
hypertrophic
obstructive
cardiomyopathy,
constrictive
pericarditis, cardiac
tamponade,
cardiogenic shock,

skin rashes, pruritus,


hair loss; bone marrow
depression, mild
leukopenia. Fever, lupuslike syndrome,
myopathy, vasculitis &
nephritis, taste
disturbance.
Commonly, dizziness,
headache, abdominal
pain, diarrhea,
dyspepsia, nausea,
vomiting, rash, pruritus,
urticaria, asthenia.
Rarely, palpitations,
extrasystoles,
tachycardia, arterial
hypotension, orthostatic
hypotension that may be
associated w/ malaise,
dizziness or fall, in
particular in patients
taking antihypertensive
treatment, flushing.
Headache. Dizziness,
lightheadedness in
upright position,
drowsiness; reflex
tachycardia; orthostatic
hypotension; feeling of
weakness.

EPERISONE
(Myonal)

Eperisone is centrally-acting
skeletal muscle relaxant used
to improve myotonic
symptoms.

CHF. Chronic right


ventricular failure,
chronic cor
pulmonale. Isoket
Retard 20 Angina
pectoris, prevention &
subsequent treatment
of MI. Isoket Retard
40 Long-term
treatment of CHD.
Long-term prevention
of anginal attacks.
Condition after MI.
Chronic CHF, right
heart failure & cor
pulmonale.
Spastic paralysis in
cerebrovascular
diseases, spastic
spinal paralysis,
cervical spondylosis,
post-op sequelae
(including
cerebrospinal tumor),
sequelae to trauma
(spinal trauma, head
injury), amyotrophic
lateral sclerosis,
cerebral palsy,
spinocerebellar
degeneration, spinal
vascular diseases,
other
encephalomyelopathi
es. Improvement of

circulatory collapse,
shock, aortic &/or
mitral valve
stenosis, severe
hypotension,
disease associated
w/ an increased
intracranial
pressure, marked
anemia,
hypovolemia,
closed-angle
glaucoma.
Concomitant use w/
phosphodiesterase
inhibitors.
1 tab tid.

Weakness, dizziness,
insomnia, drowsiness,
numbness in the
extremities, hepatic &
renal dysfunction,
hematological changes,
rashes, GI disturbances,
urinary disorders.

TRAMADOL +
PARACETAMOL
(Dolcet)

TRAMADOL +
PARACETAMOL
(Algesia)

Tramadol is a centrally acting


opioid analgesic which binds
to mu-opioid receptors and
weakly inhibits the reuptake
of norepinephrine and
serotonin. Paracetamol, a
para-aminophenol derivative,
has analgesic, antipyretic and
weak anti-inflammatory
activity. Used together,
tramadol and paracetamol
combination has a faster
onset of action compared to
tramadol alone and longer
duration of action compared
to paracetamol alone.
Tramadol is a centrally acting
opioid analgesic which binds
to mu-opioid receptors and
weakly inhibits the reuptake
of norepinephrine and
serotonin. Paracetamol, a
para-aminophenol derivative,
has analgesic, antipyretic and
weak anti-inflammatory
activity. Used together,
tramadol and paracetamol
combination has a faster
onset of action compared to

myotonic symptoms
in cervical syndrome,
periarthritis of the
shoulders & lumbago,
tension-type
headache.
Moderate to severe
pain.

Tramadol HCl 37.5 mg,


paracetamol 325 mg
Adult & childn >16 yr 1-2
tab 4-6 hrly. Max: 8 tab/day.

Moderate to severe
pain.

Tramadol HCl 37.5 mg,


paracetamol 325 mg
Adult & childn >16 yr 1-2
tab 4-6 hrly. Max: 8 tab/day.

Acute intoxication
w/ alcohol,
hypnotics,
narcotics, centrallyacting analgesics,
opioids or
psychotropic drugs.
Hypersensitivity.

CNS & GI disturbances.


Nausea, dizziness,
somnolence. Asthenia,
fatigue, hot flushes,
constipation, diarrhea,
flatulence, dry mouth,
pruritus, increased
sweating, tinnitus.

Hypersensitivity to
codeine or opioids.
Acute intoxication
w/ alcohol,
hypnotics,
narcotics, centrallyacting analgesics,
opioids or
psychotropic drugs.
Opioid-dependent
patients, chronic
alcoholism.
Lactation.

Dizziness, nausea,
somnolence. Asthenia,
fatigue, hot flushes,
headache, tremor,
abdominal pain,
constipation, diarrhea,
dyspepsia, flatulence,
dry mouth, vomiting,
anorexia, anxiety,
confusion, euphoria,
insomnia, nervousness,
pruritus, rash, increased
sweating.

PANTOPRAZOLE +
DOMPERIDONE
(Prazole Plus)

REBAMIPIDE
(Mucosta)

tramadol alone and longer


duration of action compared
to paracetamol alone.
Pantoprazole is a substituted
benzimidazole, and also
known as PPI due to its
property to block the final
step of acid secretion by
inhibiting H+/K+ ATPase
enzyme system in gastric
parietal cell. Both basal and
stimulated acid are inhibited.
Domperidone is a peripheral
dopamine-receptor blocker. It
increases oesophageal
peristalsis, lower
oesophageal sphincter
pressure, gastric motility and
peristalsis, thus facilitating
gastric emptying and
decreasing small bowel
transit time.
Rebamipide is a mucosal
protective agent and is
postulated to increase gastric
blood flow, prostaglandin
biosynthesis and decrease
free oxygen radicals.

Symptomatic
management of
burning in various
acid peptic disorders
associated w/ nausea
& vomiting; GERD,
reflux esophagitis,
non-ulcer dyspepsia,
gastroparesis &
idiopathic hiccup or
any other peptic
disease accompanied
by nausea &/or
vomiting eg acute
gastritis including that
induced by NSAIDs.

1 cap daily.

Treatment of gastric
mucosal lesions
(erosion, bleeding,
redness & edema) in
acute gastritis &
exacerbation of
chronic gastritis;
gastric ulcer.
Prevention of NSAIDinduced gastropathy.

Gastric mucosal lesions in


acute gastritis &
exacerbation of chronic
gastritis & gastric ulcer 1
tab tid to be taken in the
morning, evening & before
bedtime.

Pregnancy &
lactation.

Headache, diarrhea, skin


rashes. Pantoprazole:
Pruritus & dizziness.
Domperidone:
Galactorrhea (in
females) &
gynecomastia (in
males); dry mouth,
thirst, nervousness,
drowsiness & itching.

Rarely hypersensitivity
reactions; GI
disturbances; increased
SGOT, SGPT, -glutamyl
transferase, alkaline
phosphatase & BUN
levels; leukopenia;
mammary gland
expansion, nonpuerperal
lactation, menstrual
disorder, dizziness,
edema & foreign body
feeling in the pharynx.

BETAHISTINE (Serc)

Betahistine improves the


microcirculation in the
labyrinth which reduces
endolymphatic pressure.

NIFEDIPINE
(Calcibloc)

Nifedipine blocks the slow


calcium channels thus
preventing the flow of
calcium ions into the cell. It
produces peripheral and
coronary vasodilatation,
reduces afterload, peripheral
resistance and BP, increases
coronary blood flow and
causes reflex tachycardia. It
has little or no effect on
cardiac conduction and rarely
has negative inotropic
activity.
Losartan is an angiotensin II
receptor antagonist. The drug
and its active metabolite
selectively block the
vasoconstrictor and
aldosterone-secreting effects
of angiotensin II by
selectively antagonising its
binding to AT1 receptors.

LOSARTAN (Lifezar)

Meniere's disease,
Meniere-like
syndrome
characterized by
attacks of vertigo,
tinnitus &
sensorineural
deafness, peripheral
vertigo.
All forms of HTN; HTN
in pregnancy;
coronary insufficiency
w/ or w/o angina;
vasospastic angina, to
increase heart rate in
sinus bradycardia &
sick sinus syndrome.

Adult 24-48 mg/day in


divided doses. 8-mg tab 1-2
tab tid; 16-mg tab -1 tab
tid. 24-mg tab 1 tab bid.

Hypersensitivity.

Mild gastric complaints.

Adult 5-10 mg bid-tid.

Acute MI.

Infrequently, flushing,
nausea, dizziness,
headache, tiredness,
sedation; leg edema.

Treatment of HTN,
alone or in
combination w/ other
antihypertensives.

Adult Initially 50 mg once


daily. Maintenance: 25-100
mg once or in 2 divided
doses daily.

Pregnancy.

Facial edema, fever,


orthostatic effects,
syncope. CV effects.
Diarrhea, dyspepsia,
anorexia, constipation,
dental pain, anemia,
gout; muscle cramps,
joint pains; CNS
disorders; cough,
dyspnea, bronchitis, resp
congestion; alopecia,
dermatitis, urticaria;

LOSARTAN +
HYDROCHLOROTHI
AZIDE (Combizar)

Hydrochlorothiazide
increases renal excretion of
sodium and chloride and
reduces cardiac load.
Losartan is an angiotensin II
receptor (type AT1)
antagonist antihypertensive
which acts by blocking the
actions of angiotensin II of
renin-angiotensin-

Management of HTN.

CLONAZEPAM
(Rivotril)

Clonazepam is an effective
anticonvulsant. It raises the
threshold for propagation of
seizure activity and prevents
generalisation of focal or
local activity. Clinically, it
improves focal epilepsy and
generalised seizures. It is also
believed to enhance the
activity of GABA, and acts as
anxiolytic.

Epilepsy in infant &


childn esp typical &
atypical absences,
nodding spasms,
generalized tonicclonic seizures. Status
epilepticus. Epilepsy
of adult & in focal
seizures.

SALMETEROL +
FLUTICASONE
(Seretide)

Salmeterol, a long acting 2agonist which acts locally in


the lung to mediate

Regular treatment of
reversible obstructive
airways disease

Per 50/12.5 mg
tab Losartan K 50 mg,
hydrochlorothiazide 12.5
mg. Per 100/25 mg
tab Losartan K 100 mg,
hydrochlorothiazide 25 mg
50/12.5-mg 1 tab. Max
dose: 50/12.5-mg 2 tab
or 100/25-mg 1 tab.
Antihypertensive effect is
achieved w/in 3 wk.
Initial treatment: Adult &
childn >10 yr (>30 kg body
wt) 1-2 mg/day. Infant &
childn <10 yr (30 kg body
wt) Initially 10-30 mcg/kg
body wt/day.
Maintenance: Adult 2-4
mg/day. Max dose: 20
mg/day.Childn 10-16 yr 1.53 mg/day. Infant & childn
<10 yr 50-100 mcg/kg body
wt/day.

100 Diskus Salmeterol


xinafoate 50 mcg,
fluticasone propionate 100

Hypersensitivity to
sulfonamides.
Patients w/ anuria &
depleted
intravascular vol.
Pregnancy.

Hypersensitivity.
Resp insufficiency.
Neonates.

Hypersensitivity.

visual disturbances,
taste perversion,
tinnitus; impotence,
nocturia, UTI.
Abdominal pain, edema,
asthenia, headache;
palpitation; diarrhea,
nausea; back pain;
dizziness; dry cough,
sinusitis, bronchitis,
pharyngitis, upper resp
infection. Rash.

Fatigue, somnolence,
muscular hypotonia,
coordination
disturbances, salivary or
bronchial hypersecretion
in infants & small childn;
aggressiveness,
irritability or agitation.
Muscle weakness,
restlessness, confusion,
disorientation,
depression, paradoxical
reactions, nervousness,
hostility, anxiety, sleep
disturbance, nightmares,
vivid dreams.
Headache; mouth &
throat candidiasis,
pneumonia (in COPD

bronchodilation. Fluticasone,
a corticosteroid with mainly
glucocorticoid activity,
reduce symptoms and
exacerbations of asthma.

IPATROPIUM
BROMIDE +
SALBUTAMOL

Ipratropium bromide is an
anticholinergic agent that
inhibits vagally-mediated

(ROAD) including
asthma where use of
combination therapy
(bronchodilator &
inhaled corticosteroid)
is appropriate; COPD
including chronic
bronchitis &
emphysema.

Management of
reversible
bronchospasm

mcg. 250 Diskus Salmeterol


xinafoate 50 mcg,
fluticasone propionate 250
mcg. 500 Diskus Salmeterol
xinafoate 50 mcg,
fluticasone propionate 500
mcg. 25/50 MDI Salmeterol
xinafoate 25 mcg,
fluticasone propionate 50
mcg. 25/125
MDI Salmeterol xinafoate
25 mcg, fluticasone
propionate 125
mcg. 25/250 MDI
Diskus ROAD Adult &
adolescent 12 yr 1
inhalation of Seretide 100
or 250 or 500 bid. Childn
4 yr1 inhalation of
Seretide 100
bid. COPD Adult 1 inhalation
of Seretide 250-500
bid. MDI ROAD Adult &
adolescent 12 yr 2
inhalations of Seretide
25/50 or 25/125 or 25/250
bid. Childn 4 yr 2
inhalations of Seretide
25/50 bid. COPD Adult 2
inhalations of Seretide
25/125 or 25/250 bid.
Per 2.5 mL
pulmoneb Ipratropium Br
500 mcg, salbutamol

patients),
hoarseness/dysphonia,
muscle cramps,
arthralgia.

Hypertrophic
obstructive
cardiomyopathy or

Headache, pain,
influenza, chest pain;
nausea. Bronchitis,

SULFATE (Duavent)

MONTELUKAST NA
+ LEVOCETIRIZINE
DIHYDROCHLORIDE
(Zykast)

HYDROXYZINE
(Iterax)

reflexes by antagonising the


action of acetylcholine. It
prevents the increases in
intracellular concentration of
cyclic guanosine
monophosphate (cyclic GMP)
which are brought about by
interaction of acetylcholine
with the muscarinic receptors
on bronchial smooth muscle.
Salbutamol is a direct-acting
2-adrenergic agent. It acts
on the airway smooth muscle
resulting in bronchodilation.

associated w/
obstructive airway
diseases eg bronchial
asthma, COPD.

Montelukast is a selective
leukotriene receptor
antagonist that blocks the
effects of cysteinyl
leukotrienes in the airways.
Levocetirizine, an active
isomer of cetirizine,
selectively inhibits histamine
H1-receptors.
Hydroxyzine blocks histamine
H1-receptors on effector cells
of the GI tract, blood vessels
and respiratory tract; a
sedating anihistamine with
antimuscarinic and significant
sedative properties. It also
possesses skeletal muscle
relaxing, bronchodilator,
antiemetic and analgesic
properties.

Relief of symptoms
associated w/
seasonal & persistent
allergic rhinitis.

Symptomatic
treatment of anxiety,
pruritus of allergic
origin; premed to
general anesth.

sulfate 2.5 mg. Per


actuation Ipratropium Br 21
mcg, salbutamol sulfate
120 mcg
Pulmoneb Adult, adolescent
>12 yr & elderly Treatment
of acute attacks 1-2
pulmoneb. Maintenance: 1
pulmoneb 6-8 hrly. Childn 212 yr 3 drops/kg/dose. Max:
2.5 mg of salbutamol 6-8
hrly. MDI Adult & childn >12
yr 2 actuations 6 hrly. Max:
12 actuations in 24 hr.
Levocetirizine diHCl 5 mg,
montelukast Na 10 mg
Adult & childn >15 yr 1 tab
daily.

Anxiety Adult 50 mg/day in


3 divided doses (12.5, 12.5,
25 mg). Severe cases: 300
mg/day. PruritusAdult Initiall
y 25 mg before bedtime,
followed w/ 25 mg tidqid. Childn >6 yr 1-2
mg/kg/day in divided
doses; 12 mth-6 yr 1-2.5
mg/kg/day in divided
doses. Premed before

tachyarrhythmia.
Hypersensitivity to
soya lecithin or
related food
products (for MDI).

dyspnea, coughing,
pneumonia,
bronchospasm,
pharyngitis, sinusitis,
rhinitis.

Severe renal (CrCl


<10 mL/min) or
hepatic impairment.
Childn 6-11 yr w/
renal impairment.
Pregnancy &
lactation.

Asthenia, fatigue, fever,


abdominal pain, trauma,
dyspepsia, infectious
gastroenteritis, dental
pain, dizziness,
headache, nasal
congestion, cough &
influenza.

Hypersensitivity to
hydroxyzine,
cetirizine & other
piperazine
derivatives,
aminophylline or
ethylenediamine.
Porphyria;
preexisting
prolonged QT
interval. Pregnancy

Somnolence, headache,
fatigue, dry mouth.

LEVODROPROPIZIN
E (Levopront)

Levodropropizine is a cough
suppressant that exerts
peripheral action in
nonproductive cough.

Symptomatic
treatment of cough.

CLOPIDOGREL
(Plavix)

Clopidogrel inhibits
adenosine diphosphate (ADP)
from binding to its receptor
sites on the platelets and
subsequent activation of
glycoprotein GP IIb/IIIa
complex thus preventing
fibrinogen binding, platelet
adhesion and aggregation.

For the reduction of


atherosclerotic events
in peripheral arterial
disease or w/in 35
days of MI or w/in 6
mth of ischemic
stroke. For the
treatment of patients
suffering from non-ST
segment elevation
acute coronary
syndrome (unstable
angina or non-Q wave
MI), including patients

surgery Adult 50-200


mg/day in 1-2 divided doses
(single dose 1 hr before
surgery, preceded by 1
dose the night before
anesth). Max: 200 mg as
single dose & 300 mg daily
dose. Childn 12 mth 1
mg/kg as single dose 1 hr
before surgery, preceded by
1 mg/kg the night before
anesth.
Adult & childn >12 yr 10
mL, >2 yr 1 mg/kg, 20-30
kg 5 mL, 10-20 kg 3 mL. All
doses to be taken tid.

Adult & elderly Non-ST


segment elevation acute
coronary syndrome Loading
dose: 300 mg then
continued at 75 mg once
daily w/ acetylsalicylic acid
(ASA) 75-325 mg daily. ST
segment elevation acute
MI 75 mg as a single daily
dose in combination w/ ASA
w/w/o thrombolytics.
Maintenance: 75 mg as a
single daily dose.

& lactation.

Patients w/
excessive discharge
of mucus, w/ limited
mucociliary
function, severe
liver dysfunction.
Pregnancy &
lactation. Childn
<24 mth.
Severe liver
impairment. Peptic
ulcer & intracranial
hemorrhage.
Galactose
intolerance, Lapplactase deficiency
or glucosegalactose
malabsorption.

GI effects, exhaustion,
faintness, somnolence,
clouding of
consciousness,
numbness, dizziness,
headache, palpitations.
Rarely, allergic
reactions.
GI hemorrhage,
diarrhea, abdominal
pain, dyspepsia;
haematoma; epistaxis;
bruising; bleeding at
puncture site.

PIROXICAM
(Feldene/ Feldene
Flash)

Piroxicam is a NSAID,
belonging to the oxicam
group. It inhibits
prostaglandin synthesis,
reduces fever by acting on
the heat-regulating center of
the hypothalamus, inhibits
platelet-aggregating
substance thromboxane
A2 and reduces pain receptor
sensitivity. It also exerts antiinflammatory effect by
lysosomal stabilisation, kinin
and leukotriene production,
alteration of chemotactic
factors and neutrophil
activation inhibition.`

undergoing a stent
placement following
percutaneous
coronary intervention
in combination w/ ASA
in medically-treated
patients eligible for
thrombolytic therapy.
Variety of conditions
requiring antiinflammatory and/or
analgesic activity eg,
rheumatoid arthritis,
juvenile rheumatoid
arthritis, osteoarthritis
(arthrosis and
degenerative joint
disease), ankylosing
spondylitis, acute
musculoskeletal
disorders, acute gout,
pain after operative
intervention and
following acute
trauma.
Treatment of primary
dysmenorrhea in
patients 12 years.
Relief of fever and
pain associated with
acute upper
respiratory tract
inflammation.

RA, OA, ankylosing


spondylitis 20 mg once
daily. Acute musculoskeletal
disorders, post-op &
posttraumatic pain Initially
40 mg daily for 1st 2 days
in single or divided doses,
then reduce to 20 mg once
daily up to 7-14 days. Acute
gout Initially 40 mg on 1st
day followed by 40 mg in
single or divided doses on
the next 4-6 days. Not
indicated for long-term
management of
gout. DysmenorrheaInitially
40 mg given as a single
daily dose for the 1st 2
days. Continue thereafter
w/ a single daily dose of 20
mg for next 1-3 days as
necessary. Juvenile RA >46
kg body wt 20 mg/day, 2645 kg body wt 15
mg/day, 16-25 kg body
wt 10 mg/day, <15 kg body
wt 5 mg/day.

Hypersensitivity to
aspirin & NSAIDs.
CVA, MI, CABG,
uncontrolled HTN,
CHF (NYHA II-IV).
Active peptic
ulceration. Severe
renal & hepatic
failure. Severe heart
failure. Pregnancy &
lactation.

GI symptoms. Ankle
edema (occasional). CNS
effects (rare). Swollen
eyes, blurred vision &
eye irritations, tinnitus.
Malaise. Skin rash &
pruritus. Anemia,
vasculitis. Rarely severe
hepatic reactions.
Hypersensitivity.
Decreased female
fertility.

ETORICOXIB
(Arcoxia/ Arcoxia
AC)

Etoricoxib selectively inhibits


cyclooxygenase 2 (COX-2).

Acute & chronic


treatment of signs &
symptoms of OA & RA.
Treatment of
ankylosing
spondylitis, acute
gouty arthritis &
primary
dysmenorrhea. Relief
of acute pain.
Moderate to severe
acute post-op pain
associated w/ dental
surgery & abdominal
gynecological surgery.

OA 30 or 60 mg. RA,
ankylosing spondylitis &
post-op dental pain 90
mg. Acute pain & post-op
gynecological pain 90 or
120 mg. Acute gouty
arthritis & primary
dysmenorrhea 120 mg,
limited to a max of 8 days
treatment. Mild hepatic
insufficiency (Child-Pugh
score 5-6) 60 mg. All doses
to be taken once
daily. Moderate hepatic
insufficiency (Child-Pugh 79) Dose should be reduced,
should not exceed 60 mg
every other day. The dose
for post-op acute dental &
gynecological surgery pain
should not exceed 90 & 120
mg/day, respectively.

Allergy to NSAIDs &


those w/ asthma.
Active peptic
ulceration or GI
bleeding. Previous
history of
bronchospasm,
acute rhinitis, nasal
polyps,
angioneurotic
edema, urticaria or
allergic-type
reactions after
taking aspirin or
NSAIDs including
COX-2 inhibitors.
Severe hepatic
dysfunction (serum
albumin <25 g/L or
Child-Pugh score
10). Estimated
renal CrCl <30
mL/min.
Inflammatory bowel
disease. CHF (NYHA
II-IV). Established
ischemic heart
disease, peripheral
arterial &/or
cerebrovascular
disease.
Inadequately
controlled HTN.
Pregnancy &
lactation. Childn &

Asthenia/fatigue,
dizziness, lower
extremity edema, HTN,
dyspepsia, heartburn,
nausea, increased ALT &
AST. Thrombocytopenia,
hypersensitivity
reactions including
anaphylactic/anaphylact
oid reactions including
shock; hyperkalemia,
anxiety, insomnia,
confusion,
hallucinations,
depression, restlessness;
dysgeusia, somnolence,
blurred vision, CHF,
palpitations, angina,
arrhythmia,
hypertensive crisis,
bronchospasm,
abdominal pain, oral
ulcers, peptic ulcer
including perforation or
bleeding (elderly),
vomiting, diarrhea,
hepatitis, jaundice;
hepatic failure,
angioedema, pruritus,
erythema, rash,
Stevens-Johnson
syndrome, toxic
epidermal necrolysis,
urticaria; fixed-drug
eruption, renal

adolescent <16 yr.


CEFIXIME (Tergecef)

Cefixime binds to one or


more of the penicillin-binding
proteins (PBPs) which inhibits
the final transpeptidation
step of peptidoglycan
synthesis in bacterial cell
wall, thus inhibiting
biosynthesis and arresting
cell wall assembly resulting in
bacterial cell death.

Acute bronchitis,
bronchiectasis w/
infection, secondary
infections of chronic
resp tract diseases,
pneumonia.
Pyelonephritis,
cystitis, gonococcal
urethritis.
Cholecystitis,
cholangitis, sinusitis,
tonsillitis, pharyngitis.
Scarlet fever.

SITAGLIPTIN
(Januvia)

Sitagliptin inhibits dipeptidyl


peptidase IV (DPP-IV),
resulting in prolonged active
incretin levels. Incretin
hormones increases insulin
synthesis and release from
pancreatic -cells and
reduces glucagon secretion
from pancreatic -cells.
Reduced glucagon secretion
leads to decreased hepatic
glucose production.

Monotherapy: Adjunct
to diet & exercise to
improve glycemic
control in patients w/
type 2 DM.
Combination therapy:
PPAR- agonist (eg
thiazolidinediones) or
metformin as initial
therapy or when the
single agent alone, w/
diet & exercise does
not provide adequate

Cap Adult & childn >12 yr


(>50 kg) 400 mg once daily
or 200 mg 12 hrly. Childn 712 yr 200-300 mg once a
day or 100 mg 12 hrly.
Treatment duration: 7-14
days. Uncomplicated
cervical/urethral gonococcal
infections 400
mg. Susp Adult & childn
>12 yr 20 mL once daily or
10 mL 12 hrly.Childn 7-12
yr 10-15 mL once daily or 57.5 mL 12 hrly, 3-6 yr 5-10
mL once daily or 2.5-5 mL
12 hrly, 1-2 yr 2.5-5 mL
once daily or 1.25-2.5 mL
12 hrly. Oral drops Infants
6-11 mth 2.5-5 mL once
daily or 1.25-2.5 mL 12 hrly.
Monotherapy or
combination therapy w/
metformin, sulfonylurea,
insulin (w/ or w/o
metformin), PPAR agonist,
metformin plus sulfonylurea
or metformin plus PPAR
agonist 100 mg once
daily.Patients w/ renal
insufficiency Moderate renal
insufficiency (CrCl 30-<50
mL/min, approx
corresponding to serum

Hypersensitivity to
cephalosporins,
penicillins.

Type 1 DM, diabetic


ketoacidosis.

insufficiency including
renal failure.
Hypersensitivity
reactions; GI, hepatic,
renal & CNS effects;
hematologic & lymphatic
systems disorders.

Hypoglycemia (based on
all reports of
symptomatic
hypoglycemia,
concurrent glucose
measurement was not
required); abdominal
pain, nausea, vomiting,
diarrhea, dyspepsia,
flatulence;
hypersensitivity
reactions including
anaphylaxis,

METFORMIN Hcl +
SITAGLIPTIN
(Janumet)

The exact mechanism of


action of metformin is
unclear but it appears to
reduce glucose absorption
from the GI tract, reduce
gluconeogenesis and
enhance insulin sensitivity by

glycemic control.
Combination w/ a
sulfonylurea: Patients
w/ type 2 DM to
improve glycemic
control when
treatment w/ single
agent alone, w/ diet &
exercise, does not
provide adequate
glycemic control.
Combination w/
metformin & a
sulfonylurea or
metformin & PPAR-
agonists: Patients w/
type 2 DM to improve
glycemic control when
dual therapy w/ these
agents, does not
provide adequate
glycemic control.
Combination w/
insulin: Adjunct to diet
& exercise to improve
glycemic control in
combination w/ insulin
(w/ or w/o metformin).
Type 2 DM as initial
therapy to improve
glycemic control when
diet & exercise alone
do not provide
adequate glycemic
control. Type 2 DM as

creatinine levels of >1.7-<3


mg/dL in men & >1.5-2.5
mg/dL in women): 50 mg
once daily. Severe renal
insufficiency CrCl <30
mL/min, approx
corresponding to serum
creatinine level of >3
mg/dL in men & >2.5 mg/dL
in women or end-stage
renal disease (ESRD)
requiring hemodialysis or
peritoneal dialysis: 25 mg
once daily. May be
administered w/o regards to
the timing of dialysis.
Because there is a dosage
adjustment based upon
renal function, assessment
of renal function is
recommended prior to
initiation of Januvia &
periodically thereafter.

Individualized dosing. Initial


therapy: Starting dose 50
mg/500 mg bid. May be
titrated w/ sitagliptin 50 mg
+ metformin 1,000 mg
bid. Patients inadequately
controlled on metformin

angioedema, rash,
urticaria, cutaneous
vasculitis & exfoliative
skin conditions including
Stevens-Johnson
syndrome; influenza,
headache, acute
pancreatitis including
fatal & nonfatal
hemorrhagic &
necrotizing pancreatitis,
worsening renal
function, upper resp
tract infection, fungal
skin infection, peripheral
edema, nasopharyngitis,
constipation, arthralgia,
myalgia, pain in
extremity, back pain.

Renal disease or
dysfunction, which
may also result from
conditions eg CV
collapse (shock),
acute MI &
septicemia. Acute or

Hypoglycemia,
dyspepsia, flatulence,
nausea, vomiting,
diarrhea, abdominal
pain, loss of appetite,
metallic taste, upper
resp tract infection,

increasing peripheral glucose


uptake and utilisation.
Sitagliptin inhibits dipeptidyl
peptidase IV (DPP-IV),
resulting in prolonged active
incretin levels. Incretin
hormones increases insulin
synthesis and release from
pancreatic -cells and
reduces glucagon secretion
from pancreatic -cells.
Reduced glucagon secretion
leads to decreased hepatic
glucose production.

adjunct to diet &


exercise to improve
glycemic control in
patients cannot be
controlled w/
metformin or
sitagliptin alone or in
patients already being
treated w/
combination of
sitagliptin &
metformin. Type 2 DM
as an adjunct to diet
& exercise to improve
glycemic control in
combination w/
insulin; sitagliptin &
metformin. As part of
triple combination
therapy w/ a
sulfonylurea or w/ a
PPAR- agonist (ie
thiazolidinediones) as
an adjunct to diet &
exercise in patients w/
type 2 DM
inadequately
controlled w/ any 2 of
3 agents: Metformin,
sitagliptin or a
sulfonylurea alone or
a PPAR- agonist
alone.

monotherapySitagliptin 50
mg bid + metformin
already taken. Patients
inadequately controlled on
sitagliptin monotherapy 50
mg/500 mg tab bid. May be
titrated up to 50 mg/1,000
mg tab bid. Patients
switching from sitagliptin
co-administered w/
metformin Initiate w/ dose
of sitagliptin & metformin
already being
taken. Patients
inadequately controlled on
dual combination therapy
w/ any 2 of the following 3
antihyperglycemic agents:
Sitagliptin, metformin or
sulfonylurea Sitagliptin 50
mg bid + metformin dose
based on glycemic control
level. Patients currently on
or initiating sulfonylurea
may require lower doses of
sulfonylurea doses to
reduce the risk of
sulfonylurea-induced
hypoglycemia. Gradual
dose escalation to reduce
GI effects associated w/
metformin. Patients
inadequately controlled on
dual combination therapy
w/ any 2 of the following 3

chronic metabolic
acidosis including
diabetic
ketoacidosis, w/ or
w/o coma. Lactic
acidosis.
Discontinue
treatment in
patients undergoing
radiologic studies.
Type 1 diabetes.
Pregnancy &
lactation.

headache, cough, fungal


skin infection, peripheral
edema. Worsening renal
function. Constipation.
Pancreatitis.

antihyperglycemic agents:
Sitagliptin, metformin or
insulin Sitagliptin 50 mg bid
+ metformin dose based on
glycemic control level &
current dose (if any) of
metformin. Gradual dose
escalation to reduce the GI
side effects associated w/
metformin should be
considered. Patients
currently on or initiating
insulin therapy may require
lower doses of insulin to
reduce the risk of
hypoglycemia. Patients
inadequately controlled on
dual combination therapy
w/ any 2 of the following 3
antihyperglycemic agents:
Sitaglipin, metformin or a
PPaR- agonist Usual
starting dose of Janumet
should provide sitagliptin
dosed as 50 mg bid (100
mg total daily dose). In
determining the starting
dose of the metformin
component, the patient's
level of glycemic control &
current dose (if any) of
metformin should be
considered.Patients
inadequately controlled on
dual combination therapy

w/ any 2 of the following 3


antihyperglycemic agents:
Sitaglipin, metformin or
insulin Usual starting dose
of Janumet should provide
sitagliptin dosed as 50 mg
bid (100 mg total daily
dose). Patients currently on
or initiating insulin therapy
may require lower doses of
insulin to reduce the risk of
hypoglycemia.