1- - 04:00 Antihistamine Drugs 04:04 First Generation Antihistamines Carbinoxamine/Pseudoephedrine-“Rotec” (OROTE) Indication: Allergic rhinitis Contraindication: Acute asthma attack; hypersensitivity to carbinoxamine or other ethanolamine antihistamines; MAOI therapy; narrow-angle glaucoma; peptic ulcer; severe coronary artery disease; severe hypertension; urinary retention Adverse effect: Contact dermatitis; xerostomia; dizziness, headache, sedated, somnolence; nasal mucosa dry Dose: Adults and Children ＞ 12 yrs: 1-2 tab TID-QID Supply: Tab pseudoephedrine HCI 60 mg/ carbinoxamine maleate 4 mg Chlorpheniramine Maleate-“CTM” (OCTM) ［ C ］ Indication: Rhinitis, pruritus and urticaria, hay fever, contact dermatitis, drug sensitization. Contraindication: Low respiratory tract disease; newborn or premature infants; nursing mother. Adverse effect: Nausea, headache, drowsiness, dizziness and irritability, disturbance of vision. Dosage: Adults and Children ＞ 12 yrs: oral 4 mg every 4-6 hours, maximum dose 24 mg/day. Children: 6-12 yrs: 2 mg every 4-6 hours, maximum dose 12 mg/day; 2- 6 yrs: 1 mg every 4-6 hours, maximum dose 6 mg/day. Supply: Tab 4 mg Cyproheptadine HCI-“Periactin (Syrup)” (OCYPR) (BPERI) ［ B ］ Indication: Pruritus, eczema, urticaria, appetite stimulant, migraine headache. Contraindication: Patient with glaucoma; it should not be prescribed for elderly debilitated. Adverse effect: Dry mouth, dizziness, drowsiness, nausea and irritability. 2 - - 3 - - Dosage: Allergy: Adults: 4 mg TID (Max 0.5 mg/kg/day); Children: 2- 6 yrs: 2 mg BID or TID (Max 12 mg/day); 7-14 yrs: 4 mg BID or TID (Max. 16 mg/day) Stimulation of appetite: Adults: 2-4 mg TID or QID, Children: 2-6 yrs: 2 mg BID or TID (Max. 8 mg/day) Supply: Tab 4 mg; Syrup 0.4 mg/ml, 60 ml/bot Diphenhydramine HCI-“ Diphenhydramin” (IDIPH)( 專 ) “Benamine”(OBENA) ［ B ］ Indication: Allergies such as urticaria, vasomotor rhinitis, hay fever, motion sickness, and Parkinsonism (including drug induced) Contraindication: Newborn or premature infants, nursing mother, patient on MAO inhibitor therapy and lower respiratory tract disease. Adverse effect: Dry mouth, sedation, dizziness, and irritability, thicken of bronchial secretions. Dosage: Adults: 25-50 mg PO TID or QID. Deep IM or IV as an antihistamine, or for allergic reactions to blood or plasma, motion sickness, adjunctive treatment of anaphylaxis, or Parkinsonism 10-50 mg/dose, to a maximum of 400mg/day. Pediatrics: PO as an antihistamine 5 mg/kg/day, or ( ≦ 9kg) 6.25-12.5 mg TID-QID; ( ＞ 9kg) 12.5-25 mg TID-QID, to a MAX dose of 25 mg/day; (6-12 yrs) 12.5 mg Q4H, to a MAX dose of 75 mg/day. Deep IM or IV 5 mg/kg/day in 4 divided doses, to a MAX dose of 300 mg/day. Stability: Reconstituted in D5W or NS 100mg/L solution is physically compatible. Supply: Cap 50 mg; Inj 30 mg/1 ml/amp 04:08 Second Generation Antihistamines Cetirizine HCI- “Cetimin” (OCETI) “Zyrtec” (BZYRT) ［ B ］ Indication: It has been used in allergic rhinitis, perennial allergic rhinitis, and chronic urticaria. Pharmacology: Cetirizine, a metabolite of hydroxyzine, is H1-receptor antagonist with minimal anticholinergic or central nervous system activity Pharmacokinetics: Drugs that inhibit cytochrome P-450 enzymes (i.e., azithromycin, ketoconazole, and erythromycin) do not interfere with the pharmacokinetic disposition of cetirizine. Contraindication: Hypersensitivity to cetirizine or hydroxyzine; Avoid concurrent use of central nervous system depressants or patient with renal insufficiency or hepatic dysfunction. Adverse effect: Generally, cetirizine is well tolerated, but somnolence, fatigue, and dry mouth are the common side effects. Doses greater than 10 milligrams may be associated with a higher frequency of side effects, especially sedation. Dosage: Adults: 10 mg PO QD. Pediatrics: ≧ 6 yrs, 5~10 mg once daily; 2~5 yrs: 2.5~5 mg once daily; 6~23 months: 5 mg once daily Supply: Tab 10 mg; Sol 0.1% 60 ml/bot Cetirizine/Pseudoephedrine- “Cetipo” (OCETIP) ［ B ］ Indication: Allergic rhinitis Contraindication: Hypersensitivity to cetirizine or pseudoephedrine; MAOI use within 14 days; narrow-angle glaucoma; severe coronary artery disease; severe hypertension; urinary retention Adverse effect: Generally, cetirizine is well tolerated, but somnolence, fatigue, and dry mouth are the common side effects. Doses greater than 10 milligrams may be associated with a higher frequency of side effects, especially sedation. Dosage: 1 tab BID. Supply: Tab cetirizine 5 mg/pseudoephedrine 120 mg Fexofenadine-“Nasaga”(ONASA) ［ C ］ Indication: Fexofenadine is effective for the treatment of seasonal allergic rhinitis and chronic idiopathic urticaria. Place in therapy: Compare with terfenadine, fexofenadine is not dependent on the cytochrome P450 2 - - 3 - - Dosage: Allergy: Adults: 4 mg TID (Max 0.5 mg/kg/day); Children: 2- 6 yrs: 2 mg BID or TID (Max 12 mg/day); 7-14 yrs: 4 mg BID or TID (Max. 16 mg/day) Stimulation of appetite: Adults: 2-4 mg TID or QID, Children: 2-6 yrs: 2 mg BID or TID (Max. 8 mg/day) Supply: Tab 4 mg; Syrup 0.4 mg/ml, 60 ml/bot Diphenhydramine HCI-“ Diphenhydramin” (IDIPH)( 專 ) “Benamine”(OBENA) ［ B ］ Indication: Allergies such as urticaria, vasomotor rhinitis, hay fever, motion sickness, and Parkinsonism (including drug induced) Contraindication: Newborn or premature infants, nursing mother, patient on MAO inhibitor therapy and lower respiratory tract disease. Adverse effect: Dry mouth, sedation, dizziness, and irritability, thicken of bronchial secretions. Dosage: Adults: 25-50 mg PO TID or QID. Deep IM or IV as an antihistamine, or for allergic reactions to blood or plasma, motion sickness, adjunctive treatment of anaphylaxis, or Parkinsonism 10-50 mg/dose, to a maximum of 400mg/day. Pediatrics: PO as an antihistamine 5 mg/kg/day, or ( ≦ 9kg) 6.25-12.5 mg TID-QID; ( ＞ 9kg) 12.5-25 mg TID-QID, to a MAX dose of 25 mg/day; (6-12 yrs) 12.5 mg Q4H, to a MAX dose of 75 mg/day. Deep IM or IV 5 mg/kg/day in 4 divided doses, to a MAX dose of 300 mg/day. Stability: Reconstituted in D5W or NS 100mg/L solution is physically compatible. Supply: Cap 50 mg; Inj 30 mg/1 ml/amp 04:08 Second Generation Antihistamines Cetirizine HCI- “Cetimin” (OCETI) “Zyrtec” (BZYRT) ［ B ］ Indication: It has been used in allergic rhinitis, perennial allergic rhinitis, and chronic urticaria. Pharmacology: Cetirizine, a metabolite of hydroxyzine, is H1-receptor antagonist with minimal anticholinergic or central nervous system activity Pharmacokinetics: Drugs that inhibit cytochrome P-450 enzymes (i.e., azithromycin, ketoconazole, and erythromycin) do not interfere with the pharmacokinetic disposition of cetirizine. Contraindication: Hypersensitivity to cetirizine or hydroxyzine; Avoid concurrent use of central nervous system depressants or patient with renal insufficiency or hepatic dysfunction. Adverse effect: Generally, cetirizine is well tolerated, but somnolence, fatigue, and dry mouth are the common side effects. Doses greater than 10 milligrams may be associated with a higher frequency of side effects, especially sedation. Dosage: Adults: 10 mg PO QD. Pediatrics: ≧ 6 yrs, 5~10 mg once daily; 2~5 yrs: 2.5~5 mg once daily; 6~23 months: 5 mg once daily Supply: Tab 10 mg; Sol 0.1% 60 ml/bot Cetirizine/Pseudoephedrine- “Cetipo” (OCETIP) ［ B ］ Indication: Allergic rhinitis Contraindication: Hypersensitivity to cetirizine or pseudoephedrine; MAOI use within 14 days; narrow-angle glaucoma; severe coronary artery disease; severe hypertension; urinary retention Adverse effect: Generally, cetirizine is well tolerated, but somnolence, fatigue, and dry mouth are the common side effects. Doses greater than 10 milligrams may be associated with a higher frequency of side effects, especially sedation. Dosage: 1 tab BID. Supply: Tab cetirizine 5 mg/pseudoephedrine 120 mg Fexofenadine-“Nasaga”(ONASA) ［ C ］ Indication: Fexofenadine is effective for the treatment of seasonal allergic rhinitis and chronic idiopathic urticaria. Place in therapy: Compare with terfenadine, fexofenadine is not dependent on the cytochrome P450 4 - - 5 - - enzyme system; therefore, it may be useful in a broader range of patients (liver dysfunction, concomitant administration of cytochrome P450 inhibitors). Pharmacokinetics: Maximal effects are observed at 2 to 3 hours, and therapeutic effects persist for at least 12 hours. Food decreases oral absorption. AUC of fexofenadine was decreased by 41% and Cmax by 43% when concomitant administered with antacid, separate administration is recommended. Contraindication: Hypersensitivity to fexofenadine Adverse effect: Headache, dizziness, somnolence, dyspepsia Dosage: Adults (or >12 y/o): 60 mg PO BID or 180 mg PO QD. Children (6-11 y/o): 30 mg PO BID. Supply: Tab 60mg Loratadine-“Genadine”(OGENA) ［ B ］ Indication: Loratadine is a long-acting, non-sedating antihistamine. It is an effective antihistamine for the treatment of allergic rhinitis. Contraindication: Hypersensitivity, caution in patients who are at risk for drowsiness, asthma, or syncope. Adverse effect: Loratadine is well tolerated. The most common si de effects reported i n cl i ni cal tri al s are headache and nausea. Other si de effects i ncl udes sedat i on, di zzi ness, dr y mout h, f at i gue. When coadministrate with erythromycin, cimetidine or ketoconazole, the serum levels of these drugs were elevated, but no QT interval prolongation observed. Dosage: Adults and Children ＞ 6 yr : 10 mg PO QD on an empty stomach. Children (2-6 yrs): 5 mg PO QD. Supply: Tab 10mg Loratadine/Pseudoephedrine- “Clarinase” (OCLARI) ［ B ］ Indication: Loratadine/pseudoephedrine is indicated for the relief of symptoms of seasonal allergic rhinitis. It is also used in asthmatic patients with allergic rhinitis. Contraindication: Hypersensitivity to this medication or any of its ingredients; concomitant use of monoamine oxi dase i nhi bi tor therapy or use wi thi n 14 days of stopping these agents; narrow-angle glaucoma; severe coronary artery disease; urinary retention Adverse effect: Adverse effects include insomnia, dry mouth, and headache. Dosage: Adults and children over 12: seasonal allergic rhinitis: loratadine/pseudoephedrine 5/120 mg 1 tablet PO BI D; decrease dosages are recommended i n patients with glomerular filtration rates of less than 30 milliliters/minute Pharmacokinetics: Coadministration of loratadine and pseudoephedrine do not affect the pharmacokinetics of each drug separately. The half-life of loratadine is 8.4 hours and the half-life of pseudoephedrine is 6.3 hours. Supply: Tab loratadine 5 mg/pseudoephedrine 120 mg Ebastine - “Ebastin” (OEBAS) Indication: Insect bite; prophylaxis; perennial allergic rhinitis; seasonal allergic rhinitis Contraindication: Prior hypersensitivity to ebastine Adverse effect: Headache, i mpai red psychomotor performance, somnolence; dry mouth; QT interval - finding Dosage: Adults and Children ＞ 12 yrs: oral 10-20 mg QD. Children: 2-12 yrs: 5-10 mg QD Supply: Tab 10 mg Levocetirizine-“Xyzal”(OXYZA) ［ B ］ Indications: Seasonal allergic rhinitis, perennial allergic rhinitis, and chronic urticaria. Pharmacologpy: Levocetirizine is the active levo form of cetirizine, mediated its principal anti-histaminic actions through selective inhibition of peripheral histamine H1-receptors, and its anti-inflammatory actions via inhibition of eosinophil migration and V-CAM 1 expressions, reducing mucosal inflammation. Pharmacokinetics: Onset: within 1hr; oral bioavailability: ＞ 85%; protein binding: 98%; minimally metabolized by 4 - - 5 - - enzyme system; therefore, it may be useful in a broader range of patients (liver dysfunction, concomitant administration of cytochrome P450 inhibitors). Pharmacokinetics: Maximal effects are observed at 2 to 3 hours, and therapeutic effects persist for at least 12 hours. Food decreases oral absorption. AUC of fexofenadine was decreased by 41% and Cmax by 43% when concomitant administered with antacid, separate administration is recommended. Contraindication: Hypersensitivity to fexofenadine Adverse effect: Headache, dizziness, somnolence, dyspepsia Dosage: Adults (or >12 y/o): 60 mg PO BID or 180 mg PO QD. Children (6-11 y/o): 30 mg PO BID. Supply: Tab 60mg Loratadine-“Genadine”(OGENA) ［ B ］ Indication: Loratadine is a long-acting, non-sedating antihistamine. It is an effective antihistamine for the treatment of allergic rhinitis. Contraindication: Hypersensitivity, caution in patients who are at risk for drowsiness, asthma, or syncope. Adverse effect: Loratadine is well tolerated. The most common si de effects reported i n cl i ni cal tri al s are headache and nausea. Other si de effects i ncl udes sedat i on, di zzi ness, dr y mout h, f at i gue. When coadministrate with erythromycin, cimetidine or ketoconazole, the serum levels of these drugs were elevated, but no QT interval prolongation observed. Dosage: Adults and Children ＞ 6 yr : 10 mg PO QD on an empty stomach. Children (2-6 yrs): 5 mg PO QD. Supply: Tab 10mg Loratadine/Pseudoephedrine- “Clarinase” (OCLARI) ［ B ］ Indication: Loratadine/pseudoephedrine is indicated for the relief of symptoms of seasonal allergic rhinitis. It is also used in asthmatic patients with allergic rhinitis. Contraindication: Hypersensitivity to this medication or any of its ingredients; concomitant use of monoamine oxi dase i nhi bi tor therapy or use wi thi n 14 days of stopping these agents; narrow-angle glaucoma; severe coronary artery disease; urinary retention Adverse effect: Adverse effects include insomnia, dry mouth, and headache. Dosage: Adults and children over 12: seasonal allergic rhinitis: loratadine/pseudoephedrine 5/120 mg 1 tablet PO BI D; decrease dosages are recommended i n patients with glomerular filtration rates of less than 30 milliliters/minute Pharmacokinetics: Coadministration of loratadine and pseudoephedrine do not affect the pharmacokinetics of each drug separately. The half-life of loratadine is 8.4 hours and the half-life of pseudoephedrine is 6.3 hours. Supply: Tab loratadine 5 mg/pseudoephedrine 120 mg Ebastine - “Ebastin” (OEBAS) Indication: Insect bite; prophylaxis; perennial allergic rhinitis; seasonal allergic rhinitis Contraindication: Prior hypersensitivity to ebastine Adverse effect: Headache, i mpai red psychomotor performance, somnolence; dry mouth; QT interval - finding Dosage: Adults and Children ＞ 12 yrs: oral 10-20 mg QD. Children: 2-12 yrs: 5-10 mg QD Supply: Tab 10 mg Levocetirizine-“Xyzal”(OXYZA) ［ B ］ Indications: Seasonal allergic rhinitis, perennial allergic rhinitis, and chronic urticaria. Pharmacologpy: Levocetirizine is the active levo form of cetirizine, mediated its principal anti-histaminic actions through selective inhibition of peripheral histamine H1-receptors, and its anti-inflammatory actions via inhibition of eosinophil migration and V-CAM 1 expressions, reducing mucosal inflammation. Pharmacokinetics: Onset: within 1hr; oral bioavailability: ＞ 85%; protein binding: 98%; minimally metabolized by 6 - - 7 - - liver, at least 85% of the dose is excreted unchanged via urine. Contraindications: History of hypersensitivity to levocetirizine or to any piperazine derivatives. Patients with severe renal impairment (ClCr ＜ 10 ml/min) Adverse effects: Dry mouth, headache, fatigue, and somnolence. Dosage: Adults and children( ＞ 6 yrs): 5 mg once daily. Supply: Tab 5 mg 08:00 Anti-Infective agents 08.08 Anthelmintics Mebendazole-“Conquer”(OCONQ) ［ C ］ ( 專 ) Indication: Roundworm, hookworm, whipworm, pinworm Adverse effect: GI disturbances Dosage: Whipworm, roundworm, and hookworm: 1 tab bid for 3 days. Pinworm: 1 tab as single dose. Round (mass extermination) 2-3 tab daily. Supply: Tab 100 mg 08:12 Antbacterials 08:12.02 Aminoglycosides Amikacin sulfate-“Aminfec” (IAMINF) ［ D ］ Indication: Antimicrobial activity similar to gentamicin, and effective against organisms resistant to gentamicin, tobramycin and kanamycin. Contraindication: Hypersensitivity to amikacin or other amino-glycosides antibiotics. It should be given with care to patient with impaired renal function. Adverse effect: Ototoxicity, nephrotoxicity, neurotoxicity. Dosage: Normal Dosage: IM or IV 15-20 mg/kg/day in divided doses Q8H or Q12H, maximum dose 1.5 g/day. Supply: Inj 250 mg/2 ml/vial Gentamicin sulfate-“Gentamycin 生達 (IGEN8) 、壽元 (IGENTA)” ［ D ］ Indication: Bactericidal against many strains of Gram (-) including E. coli, Klebsiella, Enterobacter, Serratia, Shigella, Pseudomonas aeruginosa, and some Proteus. Among Gram (+) organisms: Staphylococcus aureus is high sensitive. Contraindication: Hypersensitivity or toxic reaction to gentamicin. It should be given with care to patients with impaired renal function or with ototoxicity symptoms occur. Adverse effect: Nephrotoxicity, ototoxicity (vestibular damage is more common than hearing loss), allergy reaction. Dosage: Usual daily dose: 3 mg/kg in divided doses, IM or IV. Usual dose range: 1-5 mg/kg/day, maximum dose: 8 mg/kg/day. Supply: Inj 80 mg/2 ml/vial. Neomycin sulfate (ONEOM) ［ D ］ Indication: Bactericidal, effective against Staphylococci and a wide range of Gram (-) bacteria including: E.coli, Klebsiella, Haemophilus influenzae, Proteus, Salmonella and Shigella. It can use bowel preparation for surgery, hepat i c coma and di ar r hea caused by i nt est i nal pathogenic E. coli. Contraindication: Intestinal disinfection when an obstruction is present and in patients with a known history of allergy. It should be used with care in patients with kidney or liver disease and in those with impaired hearing. Adverse effect: Nephrotoxicity, ototoxicity, skin rash, intestinal malabsorption & superinfection. Dosage: For preoperative use: 1 g Q4H for 6 doses, and for no longer than 3 days. For infectious diarrhea: 50 mg/kg/day in divided doses for 2 - 3 days. For hepatic coma: 5-12 g/day in divided doses, for 5 - 6 days. Pharmacokinetics: Approximately 0.6% to 0.8% of the dose is absorbed in oral dosage; prolonged absorption 6 - - 7 - - liver, at least 85% of the dose is excreted unchanged via urine. Contraindications: History of hypersensitivity to levocetirizine or to any piperazine derivatives. Patients with severe renal impairment (ClCr ＜ 10 ml/min) Adverse effects: Dry mouth, headache, fatigue, and somnolence. Dosage: Adults and children( ＞ 6 yrs): 5 mg once daily. Supply: Tab 5 mg 08:00 Anti-Infective agents 08.08 Anthelmintics Mebendazole-“Conquer”(OCONQ) ［ C ］ ( 專 ) Indication: Roundworm, hookworm, whipworm, pinworm Adverse effect: GI disturbances Dosage: Whipworm, roundworm, and hookworm: 1 tab bid for 3 days. Pinworm: 1 tab as single dose. Round (mass extermination) 2-3 tab daily. Supply: Tab 100 mg 08:12 Antbacterials 08:12.02 Aminoglycosides Amikacin sulfate-“Aminfec” (IAMINF) ［ D ］ Indication: Antimicrobial activity similar to gentamicin, and effective against organisms resistant to gentamicin, tobramycin and kanamycin. Contraindication: Hypersensitivity to amikacin or other amino-glycosides antibiotics. It should be given with care to patient with impaired renal function. Adverse effect: Ototoxicity, nephrotoxicity, neurotoxicity. Dosage: Normal Dosage: IM or IV 15-20 mg/kg/day in divided doses Q8H or Q12H, maximum dose 1.5 g/day. Supply: Inj 250 mg/2 ml/vial Gentamicin sulfate-“Gentamycin 生達 (IGEN8) 、壽元 (IGENTA)” ［ D ］ Indication: Bactericidal against many strains of Gram (-) including E. coli, Klebsiella, Enterobacter, Serratia, Shigella, Pseudomonas aeruginosa, and some Proteus. Among Gram (+) organisms: Staphylococcus aureus is high sensitive. Contraindication: Hypersensitivity or toxic reaction to gentamicin. It should be given with care to patients with impaired renal function or with ototoxicity symptoms occur. Adverse effect: Nephrotoxicity, ototoxicity (vestibular damage is more common than hearing loss), allergy reaction. Dosage: Usual daily dose: 3 mg/kg in divided doses, IM or IV. Usual dose range: 1-5 mg/kg/day, maximum dose: 8 mg/kg/day. Supply: Inj 80 mg/2 ml/vial. Neomycin sulfate (ONEOM) ［ D ］ Indication: Bactericidal, effective against Staphylococci and a wide range of Gram (-) bacteria including: E.coli, Klebsiella, Haemophilus influenzae, Proteus, Salmonella and Shigella. It can use bowel preparation for surgery, hepat i c coma and di ar r hea caused by i nt est i nal pathogenic E. coli. Contraindication: Intestinal disinfection when an obstruction is present and in patients with a known history of allergy. It should be used with care in patients with kidney or liver disease and in those with impaired hearing. Adverse effect: Nephrotoxicity, ototoxicity, skin rash, intestinal malabsorption & superinfection. Dosage: For preoperative use: 1 g Q4H for 6 doses, and for no longer than 3 days. For infectious diarrhea: 50 mg/kg/day in divided doses for 2 - 3 days. For hepatic coma: 5-12 g/day in divided doses, for 5 - 6 days. Pharmacokinetics: Approximately 0.6% to 0.8% of the dose is absorbed in oral dosage; prolonged absorption 8 - - 9 - - by irrigation across the pleura, peritoneum, and wound site can result in toxicity. Supply: Cap 250 mg Streptomycin sulfate–“Streptomycin”(ISM) ［ D ］ Indication: Particularly against Mycobacterium tuberculosis, and Gram (-) bacteria including: E. coli, Klebsiella pneumoniae, Enterobacter spp., Neisseria gonorrhoeae, N. meningitides, Salmonella, Shigella and some species of Proteus. It is also effective against Yersinia pestis, Francisells tularensis, Brucella spp. and H. influenzae. Contraindication: Hypersensitivity; it should not be given to patient with disease of ear or with impaired liver or kidney function. Adverse effect: Paraesthesia, vertigo, headache, allergy reaction, ototoxicity, nephrotoxicity. Dosage: Usual adult: 1-2 g daily in divided doses every 6-12 hours. Dosage of streptomycin generally should not exceed 2 g per day. Children: 20-40 mg/kg daily, given in divided doses every 6-12 hours. Particular care should be taken to avoid excessive dosage in children. Supply: Inj 1 g/vial. Tobramycin sulfate-“Tobra”(ITOB8) ［ D ］ Indication: Tobramycin sulfate is used for the treatment of serious infections, including septicemia, low respiratory tract infections, CNS infections (meningitis), intraabdominal infections (including peritonitis), bone infections, skin infections, and complicated and recurrent urinary tract infections caused by susceptible. Contraindication: Hypersensitivity Adverse effect: Neuromuscul ar bl ockade f i ndi ng; ototoxicity; nephrotoxicity; respiratory tract paralysis, concomitant anesthesia, muscle relaxants Dosage: Adult: traditional dosing, 3-6 mg/kg/day IV/IM divided every 8 h; once-daily dosing, 4-7 mg/kg IV every 24 hr. Supply: Inj 80 mg/2 ml/vial 08:12.06 Cephalosporins 08:12.06.04 First Generation Cephalosporins Cefadroxil monohydrate-“Cefadroxil” (OCEFA) ［ B ］ Indication: Cefadroxil is indicated for infections caused by suscept i bl e organi sms i n t he f ol l owi ng cl i ni cal situations: Urinary tract infections caused by E coli, P mirabilis, and Klebsiella species; skin and skin-structure infections caused by staphylococci and/or streptococci, and pharyngi t i s and t onsi l l i t i s caused by group A beta-hemolytic streptococci. Place in therapy: Cefadroxil is not the drug of choice for suscepti bl e bacteri al i nfecti ons (mi l d to moderati on respiratory tract, urinary tract, skin and skin-structure infections) since there are other less expensive drugs available, unless resistance is a problem with these other referred drugs. Contraindication: Hypersensitivity to cefadroxil or cephalosporin antibiotics Adverse effect: The most frequently reported adverse effects are nausea and vomiting. Dosage: Adults: 1-2 g PO QD or BID; Children: 30 mg/kg/day in divided doses Q12H Pharmacokinetics: Half-life is 1-2 hr; in renal failure, half-life increases to 20-25 hr Supply: Cap 500 mg Cefazolin sodium-“Veterin”(ICEFA) “Winzolin” (IWINZ) ［ B ］ Indication: Active against Staphylococci, Streptococci, Neisseria, Salmonella, Shigella spp, Bordetella pertussis, Klebsiella pneumoniae, Proteus mirabilis and some strains of E. coli and Haemophilus influenzae. Contraindication: Use with great care in patients allergic to penicillin and taking anticoagulants. Adverse effect: Allergic reaction, elevated SGOT, 8 - - 9 - - by irrigation across the pleura, peritoneum, and wound site can result in toxicity. Supply: Cap 250 mg Streptomycin sulfate–“Streptomycin”(ISM) ［ D ］ Indication: Particularly against Mycobacterium tuberculosis, and Gram (-) bacteria including: E. coli, Klebsiella pneumoniae, Enterobacter spp., Neisseria gonorrhoeae, N. meningitides, Salmonella, Shigella and some species of Proteus. It is also effective against Yersinia pestis, Francisells tularensis, Brucella spp. and H. influenzae. Contraindication: Hypersensitivity; it should not be given to patient with disease of ear or with impaired liver or kidney function. Adverse effect: Paraesthesia, vertigo, headache, allergy reaction, ototoxicity, nephrotoxicity. Dosage: Usual adult: 1-2 g daily in divided doses every 6-12 hours. Dosage of streptomycin generally should not exceed 2 g per day. Children: 20-40 mg/kg daily, given in divided doses every 6-12 hours. Particular care should be taken to avoid excessive dosage in children. Supply: Inj 1 g/vial. Tobramycin sulfate-“Tobra”(ITOB8) ［ D ］ Indication: Tobramycin sulfate is used for the treatment of serious infections, including septicemia, low respiratory tract infections, CNS infections (meningitis), intraabdominal infections (including peritonitis), bone infections, skin infections, and complicated and recurrent urinary tract infections caused by susceptible. Contraindication: Hypersensitivity Adverse effect: Neuromuscul ar bl ockade f i ndi ng; ototoxicity; nephrotoxicity; respiratory tract paralysis, concomitant anesthesia, muscle relaxants Dosage: Adult: traditional dosing, 3-6 mg/kg/day IV/IM divided every 8 h; once-daily dosing, 4-7 mg/kg IV every 24 hr. Supply: Inj 80 mg/2 ml/vial 08:12.06 Cephalosporins 08:12.06.04 First Generation Cephalosporins Cefadroxil monohydrate-“Cefadroxil” (OCEFA) ［ B ］ Indication: Cefadroxil is indicated for infections caused by suscept i bl e organi sms i n t he f ol l owi ng cl i ni cal situations: Urinary tract infections caused by E coli, P mirabilis, and Klebsiella species; skin and skin-structure infections caused by staphylococci and/or streptococci, and pharyngi t i s and t onsi l l i t i s caused by group A beta-hemolytic streptococci. Place in therapy: Cefadroxil is not the drug of choice for suscepti bl e bacteri al i nfecti ons (mi l d to moderati on respiratory tract, urinary tract, skin and skin-structure infections) since there are other less expensive drugs available, unless resistance is a problem with these other referred drugs. Contraindication: Hypersensitivity to cefadroxil or cephalosporin antibiotics Adverse effect: The most frequently reported adverse effects are nausea and vomiting. Dosage: Adults: 1-2 g PO QD or BID; Children: 30 mg/kg/day in divided doses Q12H Pharmacokinetics: Half-life is 1-2 hr; in renal failure, half-life increases to 20-25 hr Supply: Cap 500 mg Cefazolin sodium-“Veterin”(ICEFA) “Winzolin” (IWINZ) ［ B ］ Indication: Active against Staphylococci, Streptococci, Neisseria, Salmonella, Shigella spp, Bordetella pertussis, Klebsiella pneumoniae, Proteus mirabilis and some strains of E. coli and Haemophilus influenzae. Contraindication: Use with great care in patients allergic to penicillin and taking anticoagulants. Adverse effect: Allergic reaction, elevated SGOT, 10 - - 11 - - increased prothrombin time, neurological disturbances, super-infection, acute and potentially fatal renal failure. Dosage: Adult 0.5 – 2 g Q6-12H, in severe infections 6 g/day; maximum daily dose: 6 – 12 g. Children: 25 - 50 mg/kg/day in divided doses. Supply: Inj 500 mg/vial (Veterin), 1gm/vial (Winzolin) Cephalexin monohydrate-“Ceflexin”(OCEF5) “Winlex” (OWINL) “Cephalexin”(ICEPH) ［ B ］ Indication: Against both gram positive and negative organisms, but less potent Contraindication: Same as cefazolin. Adverse effect: Nausea, vomiting, diarrhea and abdominal discomfort. Skin rashes, eosinophilia and neutropenia, rise in serum aminotransferases, superinfection (particularly candida). Dosage: Adults: 250-500 mg orally Q6H, maximum dose up to 4 g/day. Children: 25-100 mg/kg/day divided into 4 doses, maximum dose up to 3 g/day. Supply: Cap 500 mg; Inj 1 gm/vial Cephradine-“S-60”(IS60) ［ B ］ Indication: First-generation cephalosporin for gram-positive and gram-negative infections in the respiratory tract, skin and soft tissue, urinary tract and otitis media. Contraindication: Hypersensitivity to cephradine or cephalosporin antibiotics Adverse effect: Leukopenia, neutropenia, eosinophilia, thrombophlebitis, nausea, vomiting, diarrhea, abdominal pain, pseudomembranous colitis, and cutaneous and allergic reactions. Dosage: Adults: 0.5 g~1 g Q6H, IV/IM. (MAX: 8 gm/day). Children: 50-100 mg/kg/day in 4 divided doses, MAX: 4 gm/day. Supply: Inj 1g/vial 08:12.06.08 Second Generation Cephalosporins Cefuroxime sodium-“Cefuroxime” (ICEF7) ［ B ］ Indication: Lower respiratory tract infections (including pneumonia), serious skin and skin structure infections, genitourinary tract infections, bone and joint infections, septicemia, and meningitis caused by susceptible organisms. Contraindication: Hypersensitivity to cephalosporin antibiotics Adverse effect: Eosinophilia; erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis; thrombocytopenia; anaphylaxis, hypersensitivity reaction; interstitial nephritis Dosage: Adult: 750 mg to 1.5 g IV/IM Q8H. Children (>3 months): 50-240 mg/kg/day IV/IM Q6-8H Supply: Inj 750 mg/vial 08:12.06.12 Third Generation Cephalosporins Ceftazidime - “Sintum”(ISINTU) ［ B ］ Indication: Ceftazidime is used for the treatment of lower respiratory tract, skin, urinary tract, bone and joint infections; gynecologic infection, intra-abdominal infection, septicemia and CNS infection. Place in therapy: Ceftazidime should be added to the hospital formulary due to its equivalent or better activity than other third-generation agents against Enterobacteriaceae and superior activity against Pseudomonas aeruginosa. Contraindication: Patients with known hypersensitivity to cephalosporins. Adverse effect: Allergic reaction, diarrhea, nausea, vomiting, abdominal pain and metallic taste, eosinophilia, thrombocytosis. Dosage: Adult: 0.5-2 g IV/IM Q8H. Children: 1 month-12years 30 to 50 mg/kg IV Q8H, MAX 6 g/day; 0-4 weeks 30 mg/kg IV Q12H Supply: Inj 1 gm/vial 10 - - 11 - - increased prothrombin time, neurological disturbances, super-infection, acute and potentially fatal renal failure. Dosage: Adult 0.5 – 2 g Q6-12H, in severe infections 6 g/day; maximum daily dose: 6 – 12 g. Children: 25 - 50 mg/kg/day in divided doses. Supply: Inj 500 mg/vial (Veterin), 1gm/vial (Winzolin) Cephalexin monohydrate-“Ceflexin”(OCEF5) “Winlex” (OWINL) “Cephalexin”(ICEPH) ［ B ］ Indication: Against both gram positive and negative organisms, but less potent Contraindication: Same as cefazolin. Adverse effect: Nausea, vomiting, diarrhea and abdominal discomfort. Skin rashes, eosinophilia and neutropenia, rise in serum aminotransferases, superinfection (particularly candida). Dosage: Adults: 250-500 mg orally Q6H, maximum dose up to 4 g/day. Children: 25-100 mg/kg/day divided into 4 doses, maximum dose up to 3 g/day. Supply: Cap 500 mg; Inj 1 gm/vial Cephradine-“S-60”(IS60) ［ B ］ Indication: First-generation cephalosporin for gram-positive and gram-negative infections in the respiratory tract, skin and soft tissue, urinary tract and otitis media. Contraindication: Hypersensitivity to cephradine or cephalosporin antibiotics Adverse effect: Leukopenia, neutropenia, eosinophilia, thrombophlebitis, nausea, vomiting, diarrhea, abdominal pain, pseudomembranous colitis, and cutaneous and allergic reactions. Dosage: Adults: 0.5 g~1 g Q6H, IV/IM. (MAX: 8 gm/day). Children: 50-100 mg/kg/day in 4 divided doses, MAX: 4 gm/day. Supply: Inj 1g/vial 08:12.06.08 Second Generation Cephalosporins Cefuroxime sodium-“Cefuroxime” (ICEF7) ［ B ］ Indication: Lower respiratory tract infections (including pneumonia), serious skin and skin structure infections, genitourinary tract infections, bone and joint infections, septicemia, and meningitis caused by susceptible organisms. Contraindication: Hypersensitivity to cephalosporin antibiotics Adverse effect: Eosinophilia; erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis; thrombocytopenia; anaphylaxis, hypersensitivity reaction; interstitial nephritis Dosage: Adult: 750 mg to 1.5 g IV/IM Q8H. Children (>3 months): 50-240 mg/kg/day IV/IM Q6-8H Supply: Inj 750 mg/vial 08:12.06.12 Third Generation Cephalosporins Ceftazidime - “Sintum”(ISINTU) ［ B ］ Indication: Ceftazidime is used for the treatment of lower respiratory tract, skin, urinary tract, bone and joint infections; gynecologic infection, intra-abdominal infection, septicemia and CNS infection. Place in therapy: Ceftazidime should be added to the hospital formulary due to its equivalent or better activity than other third-generation agents against Enterobacteriaceae and superior activity against Pseudomonas aeruginosa. Contraindication: Patients with known hypersensitivity to cephalosporins. Adverse effect: Allergic reaction, diarrhea, nausea, vomiting, abdominal pain and metallic taste, eosinophilia, thrombocytosis. Dosage: Adult: 0.5-2 g IV/IM Q8H. Children: 1 month-12years 30 to 50 mg/kg IV Q8H, MAX 6 g/day; 0-4 weeks 30 mg/kg IV Q12H Supply: Inj 1 gm/vial 12 - - 13 - - Ceftriaxone sodium-“Rocephin”(IROCE) “Sintrix”(ISINT) ［ B ］ Indication: Ceftriaxone is used for the treatment of respiratory tract infections, pneumonia, ear, nose and throat infections, renal and urinary tract infections, meningitis. Contraindication: Hypersensitivity to cephalosporins. Adverse effect: Diarrhea, nausea, vomiting, allergic dermatitis, eosinophilia, hematoma or bleeding, thrombocytopenia, leukopenia. Dosage: Adult: 1 - 2 g once daily or in divided doses twice a day, maximum 4 g/day. Children: 50 – 75 mg/kg/day Q12H, maximun 2 g/day Supply: Inj 500 mg/vial (Rocephin), 1 gm/vial (Sintrix) 08:12.06.16 Fourth Generation Cephalosporins Cefepime-“Maxipime”(IMAXI) “Antifect” (IANTI) ［ B ］ Indication: It has good Gram (-) coverage similar to third generation cephalosporins but better Gram (+) coverage. Place in therapy: Cefepime may prove useful as an alternative to existing third-generation cephalosporins. Contraindication: Hypersensitivity to cefepime or other cephalosporin antibiotics. Adverse effect: Phlebitis may occur and resolves upon discontinuation of therapy. Headache, blurred vision, lightheadedness, dyspepsia, and antibiotic-associated diarrhea may occur. Although transient elevations in serum transaminases may occur, no clinical hepatotoxicity has been reported. Dosage: Adults: 1 g-2 g IV Q12H. Children: 50 mg/kg Q12H, MAX 2 g/dose. Pharmacokinetics: Cefepime penetrates into inflammatory fluid at concentrations approximately 80% of serum levels, and into bronchial mucosa at levels approximately 60% of those reached in the plasma. Supply: Inj 500mg/vial (Maxipime), 1 g/vial (Antifect) 08:12.07 Miscellaneous β -Lactam Antibiotics 08:12.07.08 Carbapenems Ertapenem-“Invanz” (IINVA) ［ B ］ Indication: Entapenem is used for treatment of moderate to severe infections, including complicated intra-abdominal and acute pelvic infections, complicated skin and skin structure infections, community-acquired pneumonia, and complicated urinary tract infections, caused by susceptible organisms. Place in therapy: It should be considered mainly in patients with severe infections due to resistant gram-negative pathogens, particularly multiresistant Enterobacteriaceae. Ertapenem is not indicated in pseudomonal or enterococcal infections. Adverse effect: Diarrhea, infused vein complication, nausea, headache, vaginitis, phlebitis or thrombophlebitis, and vomiting. Dosage: Adult: 1 g IV/IM QD. Children: 3 months-12 years 15 mg/kg IM/IV Q12H, MAX 1 g/day Supply: Inj 1 gm/vial Imipenem/cilastatin-“Tienam”(ITIE5) ［ C ］ Indication: Imipenem is indicated in treating severe infections due to multi-resistant organisms. Alone, or in combination with an aminoglycoside, it can be used for serious mixed infections including pulmonary, intra-abdominal and soft-tissue infections. Imipenem is more potent than third generation cephalosporins against Pseudomonas aeruginosa. Contraindication: Use with caution in patients with a history of hypersensitivity reaction to penicillins. Adverse effect: Increment in hepatic function tests occurred commonl y; but no reports of defi ni te l i ver damage have been observed. Dosage: IV Infusion, 250 mg-1 gm q6-8h, maxium 50 mg/kg/day or 4 g/day, the infusion time of 250 or 500 mg is over 20-30 mins and 1 g is over 40-60 mins 12 - - 13 - - Ceftriaxone sodium-“Rocephin”(IROCE) “Sintrix”(ISINT) ［ B ］ Indication: Ceftriaxone is used for the treatment of respiratory tract infections, pneumonia, ear, nose and throat infections, renal and urinary tract infections, meningitis. Contraindication: Hypersensitivity to cephalosporins. Adverse effect: Diarrhea, nausea, vomiting, allergic dermatitis, eosinophilia, hematoma or bleeding, thrombocytopenia, leukopenia. Dosage: Adult: 1 - 2 g once daily or in divided doses twice a day, maximum 4 g/day. Children: 50 – 75 mg/kg/day Q12H, maximun 2 g/day Supply: Inj 500 mg/vial (Rocephin), 1 gm/vial (Sintrix) 08:12.06.16 Fourth Generation Cephalosporins Cefepime-“Maxipime”(IMAXI) “Antifect” (IANTI) ［ B ］ Indication: It has good Gram (-) coverage similar to third generation cephalosporins but better Gram (+) coverage. Place in therapy: Cefepime may prove useful as an alternative to existing third-generation cephalosporins. Contraindication: Hypersensitivity to cefepime or other cephalosporin antibiotics. Adverse effect: Phlebitis may occur and resolves upon discontinuation of therapy. Headache, blurred vision, lightheadedness, dyspepsia, and antibiotic-associated diarrhea may occur. Although transient elevations in serum transaminases may occur, no clinical hepatotoxicity has been reported. Dosage: Adults: 1 g-2 g IV Q12H. Children: 50 mg/kg Q12H, MAX 2 g/dose. Pharmacokinetics: Cefepime penetrates into inflammatory fluid at concentrations approximately 80% of serum levels, and into bronchial mucosa at levels approximately 60% of those reached in the plasma. Supply: Inj 500mg/vial (Maxipime), 1 g/vial (Antifect) 08:12.07 Miscellaneous β -Lactam Antibiotics 08:12.07.08 Carbapenems Ertapenem-“Invanz” (IINVA) ［ B ］ Indication: Entapenem is used for treatment of moderate to severe infections, including complicated intra-abdominal and acute pelvic infections, complicated skin and skin structure infections, community-acquired pneumonia, and complicated urinary tract infections, caused by susceptible organisms. Place in therapy: It should be considered mainly in patients with severe infections due to resistant gram-negative pathogens, particularly multiresistant Enterobacteriaceae. Ertapenem is not indicated in pseudomonal or enterococcal infections. Adverse effect: Diarrhea, infused vein complication, nausea, headache, vaginitis, phlebitis or thrombophlebitis, and vomiting. Dosage: Adult: 1 g IV/IM QD. Children: 3 months-12 years 15 mg/kg IM/IV Q12H, MAX 1 g/day Supply: Inj 1 gm/vial Imipenem/cilastatin-“Tienam”(ITIE5) ［ C ］ Indication: Imipenem is indicated in treating severe infections due to multi-resistant organisms. Alone, or in combination with an aminoglycoside, it can be used for serious mixed infections including pulmonary, intra-abdominal and soft-tissue infections. Imipenem is more potent than third generation cephalosporins against Pseudomonas aeruginosa. Contraindication: Use with caution in patients with a history of hypersensitivity reaction to penicillins. Adverse effect: Increment in hepatic function tests occurred commonl y; but no reports of defi ni te l i ver damage have been observed. Dosage: IV Infusion, 250 mg-1 gm q6-8h, maxium 50 mg/kg/day or 4 g/day, the infusion time of 250 or 500 mg is over 20-30 mins and 1 g is over 40-60 mins 14 - - 15 - - Supply: Inj imipenem 500 mg/cilastatin 500 mg Meropenem trihydrate-“Mepem”(IMEPE) ［ B ］ Indication: Meropenem has demonstrated effi cacy comparable to that of imipenem/cilastatin in intraabdominal and soft tissue infections; it has also shown usefulness in febrile neutropenia, urinary tract infections, and Pseudomonas meningitis. Place in therapy: The primary indications for meropenem will be for the treatment of mixed infections usually requiring antibiotic combinations (eg, intra-abdominal infections, pulmonary infections) and infections caused by multidrug-resistant Gram (-) pathogens, including Pseudomonas aeruginosa. Contraindication: Hypersensitivity to meropenem; use with caution to patient with renal impairment or epileptic patients and patients with neurological disorders or liver dysfunction (possible hepatotoxic effects) Adverse effect: Headache, nausea, abdominal pain, diarrhea, and liver function test abnormalities have been reported with meropenem; there is some evidence that meropenem may be less likely than imipenem to induce seizures. Dosage: Adults: 0.5-1 g IV Q8H; for meningitis 2 g IV Q8H. Children: IV 20 mg/kg Q8H intra-abdominal infections; 40 mg/kg Q8H for meningitis. Supply: Inj 250 mg/vial 08:12.07.12 Cephamycins Flomoxef sodium-“Flumarin” (IFLUM) Indication: Meningitis; neonatal infectious disorder; respiratory tract infection; urinary tract infectious disease Place in therapy: Flomoxef has broad spectrum of activity suggests that it may be of considerable value in the treatment of a variety of serious infections, including those caused by gram-positive, gram-negative, and anaerobic bacteria. It is ineffective against Pseudomonas spp or other gram-negative nonfermenter. In addition, flomoxef may be an attractive alternative to other beta-lactam antibiotics because of its relative lack of influence on coagulation parameters and platelet function compared to some similar agents. In addition, it appears to induce less production of chromosomal-mediated beta-lactamases than other cephalosporins, and may be useful in controlling methicillin-resistant Staphylococcus aureus. Contraindication: Patient hypersensitivity to flomoxef and other beta-lactam antibiotics Adverse effect: Laboratory abnormality of flomoxef include transient eosinophilia, thrombocytosis, slight reductions in erythrocyte count, hemoglobin, hematocrit, leukocyte count and elevation in serum hepatic transaminases have been reported rarely. Flomoxef has not been associated with bleeding disorders. Other adverse effects include loose stools, stomatitis, and numbness of the tongue have occurred in some patients. Hepatotoxicity has not been reported. Rash and urticaria have occurred. Flomoxef has not been shown to interfere with ethanol metabolism or to cause disulfiram-like reactions. Dosage: Adults: 1-2 g IV BID. Children: 20 to 150 mg/kg IV 3 times daily Pharmacokinetics: Flomoxef distributes well into soft tissues, middle ear tissues, sputum, and cerebrospinal fluid Supply: Inj 0.5 g/vial Cefoxitin -“Lofatin”(ILOFA) ［ B ］ Indication: It is primarily effective for mixed aerobic and anaerobic bacterial infections where Bacteroides fragilis may be present, such as lower respiratory tract infections, intra-abdominal infections, and gynecologic infections. Contraindication: Hypersensitivity reactions to cefoxitin or other cephalosporin antibiotics should not receive the drug. 14 - - 15 - - Supply: Inj imipenem 500 mg/cilastatin 500 mg Meropenem trihydrate-“Mepem”(IMEPE) ［ B ］ Indication: Meropenem has demonstrated effi cacy comparable to that of imipenem/cilastatin in intraabdominal and soft tissue infections; it has also shown usefulness in febrile neutropenia, urinary tract infections, and Pseudomonas meningitis. Place in therapy: The primary indications for meropenem will be for the treatment of mixed infections usually requiring antibiotic combinations (eg, intra-abdominal infections, pulmonary infections) and infections caused by multidrug-resistant Gram (-) pathogens, including Pseudomonas aeruginosa. Contraindication: Hypersensitivity to meropenem; use with caution to patient with renal impairment or epileptic patients and patients with neurological disorders or liver dysfunction (possible hepatotoxic effects) Adverse effect: Headache, nausea, abdominal pain, diarrhea, and liver function test abnormalities have been reported with meropenem; there is some evidence that meropenem may be less likely than imipenem to induce seizures. Dosage: Adults: 0.5-1 g IV Q8H; for meningitis 2 g IV Q8H. Children: IV 20 mg/kg Q8H intra-abdominal infections; 40 mg/kg Q8H for meningitis. Supply: Inj 250 mg/vial 08:12.07.12 Cephamycins Flomoxef sodium-“Flumarin” (IFLUM) Indication: Meningitis; neonatal infectious disorder; respiratory tract infection; urinary tract infectious disease Place in therapy: Flomoxef has broad spectrum of activity suggests that it may be of considerable value in the treatment of a variety of serious infections, including those caused by gram-positive, gram-negative, and anaerobic bacteria. It is ineffective against Pseudomonas spp or other gram-negative nonfermenter. In addition, flomoxef may be an attractive alternative to other beta-lactam antibiotics because of its relative lack of influence on coagulation parameters and platelet function compared to some similar agents. In addition, it appears to induce less production of chromosomal-mediated beta-lactamases than other cephalosporins, and may be useful in controlling methicillin-resistant Staphylococcus aureus. Contraindication: Patient hypersensitivity to flomoxef and other beta-lactam antibiotics Adverse effect: Laboratory abnormality of flomoxef include transient eosinophilia, thrombocytosis, slight reductions in erythrocyte count, hemoglobin, hematocrit, leukocyte count and elevation in serum hepatic transaminases have been reported rarely. Flomoxef has not been associated with bleeding disorders. Other adverse effects include loose stools, stomatitis, and numbness of the tongue have occurred in some patients. Hepatotoxicity has not been reported. Rash and urticaria have occurred. Flomoxef has not been shown to interfere with ethanol metabolism or to cause disulfiram-like reactions. Dosage: Adults: 1-2 g IV BID. Children: 20 to 150 mg/kg IV 3 times daily Pharmacokinetics: Flomoxef distributes well into soft tissues, middle ear tissues, sputum, and cerebrospinal fluid Supply: Inj 0.5 g/vial Cefoxitin -“Lofatin”(ILOFA) ［ B ］ Indication: It is primarily effective for mixed aerobic and anaerobic bacterial infections where Bacteroides fragilis may be present, such as lower respiratory tract infections, intra-abdominal infections, and gynecologic infections. Contraindication: Hypersensitivity reactions to cefoxitin or other cephalosporin antibiotics should not receive the drug. 16 - - 17 - - Adverse effect: Eosinophilia, hemolytic anemia, granulocytopenia, thrombocytopenia, thrombophlebitis, central nervous system effects (dizziness, vertigo), gastrointestinal effects (nausea, vomiting, diarrhea, stomatitis, pseudomembranous colitis), nephrotoxicity, increased serum transaminases, dermatologic effects, and hypersensitivity reactions. Dosage: Adult: 1 – 2 g IV or IM Q6 - 8H. In severe infections: 2 g IV Q4H or 3 g IV Q6H. Children (>3 months): 80 to 160 mg/kg/day Q4-6H, maximum dosage 12 g/day. Supply: Inj 1 gm/vial 08.12.08 Chloramphenicol Chloramphenicol-“Chlormycin” (OCHLO) ( 專 )“Chloramphenicol”(ILYOK) ［ C ］ Indication: Against a wide range of Gram (-) and (+) organisms, including Salmonella typhi, Haemophilus i nfl uenzae, Nei sseri a meni ngi ti des, and Bordetel l a pertussis. Contraindication: Hypersensitivity or toxic reactions, reduce doses to patients with impaired liver function, enhances the effects of coumarin anticoagulants, some hypoglycemic agents and phenytoin. Adverse effect: Depression of the bone marrow, irreversible aplastic anemia, haemolytic anemia. Dosage: Adults: 500 mg Q6H or 50 mg/kg/day continued for 2 or 3 days. Children: 25 - 50 mg/kg/day Q6H, up to 100 mg/kg/day. Supply: Cap 250 mg; Inj 1 gm/vial 08:12.12 Macrolides Erythromycin estolate-“Erymycin”(OERYT) ［ B ］ Indication: Active against most G(+)and some G(-) bacteria, including Mycoplasma pneumoniae, Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Hemolytic Streptococci, Diphtheria bacillus are sensitive. Contraindication: Pregnancy and hypersensitivity, use with caution to patient with pre-existing liver disease. Adverse effect: Allergic reaction, GI upsets, cholestatic hepatitis. Dosage: Adults: 250 – 500 mg Q6H, up to 4 g/day. Children: 30 - 50 mg/kg/day PO Q6H Supply: Cap 250 mg Azithromycin-“Zithromax”(OZITH) ［ B ］ Indication: It is effective in treating uncomplicated skin infections, upper and lower urinary tract infections, atypical and community acquired pneumonia. Place in therapy: A major advantage over erythromycin is the clinical efficacy of single-dose azithromycin in uncomplicated urethritis or cervicitis due to Chlamydia trachomatis. Contraindication: Hypersensitivity to azithromycin or other macrolide antibiotics. Caution in patients with impaired liver function. Adverse effect: Abdominal pain, diarrhea, and nausea occur in high dose. Dosage: Adults: 500 mg PO QD for 3 days. Children: 10 mg/kg PO QD Supply: Tab 250 mg Clarithromycin – “K-mycin”(OCLA2) ［ C ］ Indication: It has a similar spectrum of activity as erythromycin. It is effective for the treatment of upper and lower respiratory tract infections. It is also approved for use in skin and skin structure infections, and infections caused by Mycobacterium avium complex. Place in therapy: Triple therapy including omeprazole in combination with clarithromycin plus a third antimicrobial (eg, amoxicillin, metronidazole, or tinidazole) or with bismuth subsalicylate, metronidazole, and tetracycline result in higher Helicobacter pylori eradication rates than 16 - - 17 - - Adverse effect: Eosinophilia, hemolytic anemia, granulocytopenia, thrombocytopenia, thrombophlebitis, central nervous system effects (dizziness, vertigo), gastrointestinal effects (nausea, vomiting, diarrhea, stomatitis, pseudomembranous colitis), nephrotoxicity, increased serum transaminases, dermatologic effects, and hypersensitivity reactions. Dosage: Adult: 1 – 2 g IV or IM Q6 - 8H. In severe infections: 2 g IV Q4H or 3 g IV Q6H. Children (>3 months): 80 to 160 mg/kg/day Q4-6H, maximum dosage 12 g/day. Supply: Inj 1 gm/vial 08.12.08 Chloramphenicol Chloramphenicol-“Chlormycin” (OCHLO) ( 專 )“Chloramphenicol”(ILYOK) ［ C ］ Indication: Against a wide range of Gram (-) and (+) organisms, including Salmonella typhi, Haemophilus i nfl uenzae, Nei sseri a meni ngi ti des, and Bordetel l a pertussis. Contraindication: Hypersensitivity or toxic reactions, reduce doses to patients with impaired liver function, enhances the effects of coumarin anticoagulants, some hypoglycemic agents and phenytoin. Adverse effect: Depression of the bone marrow, irreversible aplastic anemia, haemolytic anemia. Dosage: Adults: 500 mg Q6H or 50 mg/kg/day continued for 2 or 3 days. Children: 25 - 50 mg/kg/day Q6H, up to 100 mg/kg/day. Supply: Cap 250 mg; Inj 1 gm/vial 08:12.12 Macrolides Erythromycin estolate-“Erymycin”(OERYT) ［ B ］ Indication: Active against most G(+)and some G(-) bacteria, including Mycoplasma pneumoniae, Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Hemolytic Streptococci, Diphtheria bacillus are sensitive. Contraindication: Pregnancy and hypersensitivity, use with caution to patient with pre-existing liver disease. Adverse effect: Allergic reaction, GI upsets, cholestatic hepatitis. Dosage: Adults: 250 – 500 mg Q6H, up to 4 g/day. Children: 30 - 50 mg/kg/day PO Q6H Supply: Cap 250 mg Azithromycin-“Zithromax”(OZITH) ［ B ］ Indication: It is effective in treating uncomplicated skin infections, upper and lower urinary tract infections, atypical and community acquired pneumonia. Place in therapy: A major advantage over erythromycin is the clinical efficacy of single-dose azithromycin in uncomplicated urethritis or cervicitis due to Chlamydia trachomatis. Contraindication: Hypersensitivity to azithromycin or other macrolide antibiotics. Caution in patients with impaired liver function. Adverse effect: Abdominal pain, diarrhea, and nausea occur in high dose. Dosage: Adults: 500 mg PO QD for 3 days. Children: 10 mg/kg PO QD Supply: Tab 250 mg Clarithromycin – “K-mycin”(OCLA2) ［ C ］ Indication: It has a similar spectrum of activity as erythromycin. It is effective for the treatment of upper and lower respiratory tract infections. It is also approved for use in skin and skin structure infections, and infections caused by Mycobacterium avium complex. Place in therapy: Triple therapy including omeprazole in combination with clarithromycin plus a third antimicrobial (eg, amoxicillin, metronidazole, or tinidazole) or with bismuth subsalicylate, metronidazole, and tetracycline result in higher Helicobacter pylori eradication rates than 18 - - 19 - - that reported with dual therapy regimens. Contraindication: Hypersensitive to erythromycin and use with caution in patients with marked renal or hepatic impairment. Adverse effect: Eosinophilia, prolong prothrombin time, decreased white blood cell, thrombocytopenia, headache, epigastritis, nausea, vomiting, diarrhea, taste disturbance, hemauria, proteinuria, rash urticaria. Dosage: Adults: 250 to 500 mg BID. Children: 5 to 10 mg/kg/day. Supply: Tab 250 mg 08:12.16 Penicillins Penicillin G sodium-“Penicillin G”(IPEN3) ［ B ］ Indication: Organisms that sensitive to penicillin G: Actinomyces israelii, Bacillus anthracis, Clostridium spp., Corynebacterium diphtheriae, Erysipelothrix rhusiopathiae, Neisseria spp., Leptospira monocytogenes, Spirillum minus, Streptobacillus moniliformis, Treponema spp., and some Staphylococci, Streptococci and a few of the large viruses. Contraindication: Hypersensitivity to penicillin Adverse effect: Hypersensitivity reaction, hemolytic anemia, prolongation of bleeding time and defective platelet function, CNS toxicity. Dosage: Normal Dosage: For mild and moderate infections: 4 –12 MU/day. For severe infections: 6-40 MU/day in divided dose. Supply: Inj 3MU/vial Benzathine benzyl penicillin-“Retarpen”(ITRIC) ［ B ］ Indication: Streptococcal infections (group A without bacteremia), mild to moderate infections of the upper respiratory tract, Venereal infections, prophylaxis of rheumatic fever and/or chorea, also prophylactic therapy for rheumatic heart disease and acute glomerulonephritis. Contraindication: Hypersensitivity to penicillins. Adverse effect: Hypersensitivity reactions, rash, leukopenia, hemolytic anemia, thrombocytopenia, neuropathy, nephropathy. Dosage: IM only. For URI, adults: 1,200,000 U as a single dose. Children (> 27.3kg): 900,000 U as a single dose, children & infants (< 27.3kg): 300,000-600,000 U as a single dose. For syphilis, adult: 2,400,000 U as a single dose for early syphilis, 2,400,000-3,000,000 U once a week for 2-3 weeks; congenital syphilis: Infants & children up to 2 yrs of age, 50,000 U/kg as a single dose, children 2-12 yrs of age, adjust dosage on the basis of usual adult dose. Streptococcal prophylaxis: 1,200,000 U/month, or 600,000 U/2 weeks. Supply: Inj 2.4 MU/vial Amoxicillin-“Supercillin” (OSUPE) ［ B ］ Indication: Same as ampicillin, bactericidal slightly more active than ampicillin against some Streptococci and Salmonella spp, but less active agaisnt Shigella spp. Contraindication: Same as ampicillin. Adverse effect: Same as ampicillin. Dosage: Adults: PO 250 – 500 mg Q8H; maximum daily dose: 4.5 g; Children: under 20 kg, 20 – 40 mg/kg/day in 3 divided doses. Supply: Cap 250 mg Amoxicillin/clavulanate-“Augmentin (Syrup)” (OAUGM)(BAUGME)“Augcin”(IAMOX)“Amoclavunin” (IAMOC) ［ B ］ Indication: Infections caused by susceptible organisms same as amoxicillin in addition to beta-lactamase producing M catarrhalis, H. influenzae, N. gonorrhoeae, and S. aureus (not MRSA) Contraindication: Hypersenstivity to amoxicillin, clavulanic acid or penicillin; concomitant use of alcohol. Adverse effects: Headache, rash, urticaria, nausea, vomiting pseudomembranous colitis, vaginal candidiasis, diarrhea (9%). 18 - - 19 - - that reported with dual therapy regimens. Contraindication: Hypersensitive to erythromycin and use with caution in patients with marked renal or hepatic impairment. Adverse effect: Eosinophilia, prolong prothrombin time, decreased white blood cell, thrombocytopenia, headache, epigastritis, nausea, vomiting, diarrhea, taste disturbance, hemauria, proteinuria, rash urticaria. Dosage: Adults: 250 to 500 mg BID. Children: 5 to 10 mg/kg/day. Supply: Tab 250 mg 08:12.16 Penicillins Penicillin G sodium-“Penicillin G”(IPEN3) ［ B ］ Indication: Organisms that sensitive to penicillin G: Actinomyces israelii, Bacillus anthracis, Clostridium spp., Corynebacterium diphtheriae, Erysipelothrix rhusiopathiae, Neisseria spp., Leptospira monocytogenes, Spirillum minus, Streptobacillus moniliformis, Treponema spp., and some Staphylococci, Streptococci and a few of the large viruses. Contraindication: Hypersensitivity to penicillin Adverse effect: Hypersensitivity reaction, hemolytic anemia, prolongation of bleeding time and defective platelet function, CNS toxicity. Dosage: Normal Dosage: For mild and moderate infections: 4 –12 MU/day. For severe infections: 6-40 MU/day in divided dose. Supply: Inj 3MU/vial Benzathine benzyl penicillin-“Retarpen”(ITRIC) ［ B ］ Indication: Streptococcal infections (group A without bacteremia), mild to moderate infections of the upper respiratory tract, Venereal infections, prophylaxis of rheumatic fever and/or chorea, also prophylactic therapy for rheumatic heart disease and acute glomerulonephritis. Contraindication: Hypersensitivity to penicillins. Adverse effect: Hypersensitivity reactions, rash, leukopenia, hemolytic anemia, thrombocytopenia, neuropathy, nephropathy. Dosage: IM only. For URI, adults: 1,200,000 U as a single dose. Children (> 27.3kg): 900,000 U as a single dose, children & infants (< 27.3kg): 300,000-600,000 U as a single dose. For syphilis, adult: 2,400,000 U as a single dose for early syphilis, 2,400,000-3,000,000 U once a week for 2-3 weeks; congenital syphilis: Infants & children up to 2 yrs of age, 50,000 U/kg as a single dose, children 2-12 yrs of age, adjust dosage on the basis of usual adult dose. Streptococcal prophylaxis: 1,200,000 U/month, or 600,000 U/2 weeks. Supply: Inj 2.4 MU/vial Amoxicillin-“Supercillin” (OSUPE) ［ B ］ Indication: Same as ampicillin, bactericidal slightly more active than ampicillin against some Streptococci and Salmonella spp, but less active agaisnt Shigella spp. Contraindication: Same as ampicillin. Adverse effect: Same as ampicillin. Dosage: Adults: PO 250 – 500 mg Q8H; maximum daily dose: 4.5 g; Children: under 20 kg, 20 – 40 mg/kg/day in 3 divided doses. Supply: Cap 250 mg Amoxicillin/clavulanate-“Augmentin (Syrup)” (OAUGM)(BAUGME)“Augcin”(IAMOX)“Amoclavunin” (IAMOC) ［ B ］ Indication: Infections caused by susceptible organisms same as amoxicillin in addition to beta-lactamase producing M catarrhalis, H. influenzae, N. gonorrhoeae, and S. aureus (not MRSA) Contraindication: Hypersenstivity to amoxicillin, clavulanic acid or penicillin; concomitant use of alcohol. Adverse effects: Headache, rash, urticaria, nausea, vomiting pseudomembranous colitis, vaginal candidiasis, diarrhea (9%). 20 - - 21 - - Dosage: Adults & children >12 y/o: PO 1 Tab TID; inj 1.2 g Q8-6H. Children 7-12 y/o: 10 ml Syr BID, 2-6 y/o: 5 ml Syr BID, 2 months-2 years: 25-45 mg/kg/day Syr BID. Supply: Tab 250 mg amoxicillin + 125 mg potassium clavulanate (Augmentin); Syr each 5 ml contains 400 mg amoxicillin + 57 mg potassium clavulanate, 35ml/bot; Inj 1.2 gm: each vial contain 1gm amoxicillin + 200 mg potassium clavulanate (Augcin), Inj 0.6 gm: each vial contain 0.5 gm amoxicillin + 100 mg potassium clavulanate (Amoclavunin) Ampicillin-“Ampicillin”(OAMP5)“Ampolin”(IAMPI) ［ B ］ Indication: Bactericidal against Gram (+) organisms, including Streptococcus faecalis, Streptococcus pneumoniae, Haemophilus influenzae, Salmonella, E. coli, Neisseria gonorrhoeae, Neisseria meningitides, Proteus mirabilis, Brucella spp, Shigella. Contraindication: Not to be used in patients sensitive to penicillins. Adverse effect: Allergic reaction, skin rashes, urticaria, maculopapular, diarrhea, nausea, vomiting, raised serum aminotransferase, pseudomembranous colitis, superinfections with Pseudomonas and Candida. Dosage: Normal Dosage: Infection due to Gram (+) organisms & Haemophilis influenzae: 250 – 500 mg Q6H. GI and urinary tract infection due to G (-) organisms: 500 – 750 mg Q6 - 8H. Enteric infection: 1 – 2 g Q6H. Supply: Cap 500 mg; Inj 500 mg/vial Ampicillin/sulbactam-“Unasyn”(IUNA1) “Ansullina” (IANSU) “Subacillin” (ISUBA) ［ B ］ Indication: It is an antibiotic combination, comprised of ampicillin and a beta-lactamase inhibitor-sulbactam. Besides the inhibition effects of ampicillin sensitive microorganisms, the resistant strains: S. aureus, S. epidermidis, H. influenzae, Moraxella catarrhalis, N. gonorrhea, Klebsiella spp. E coli, E aerogenes, Proteus spp, and Acinetobacter calcoaceticus are inhibited. Contraindication: Severe hypersensitivity to penicillin. Adverse effect: Similar to those seen with ampicillin alone, the most common of which are diarrhea and maculopapular rash. Dosage: Adults: 1.5-12 g/day, in divided Q6-8H. Children: 150 mg/kg/day, in divided Q6-8H Supply: Inj 1.5 g/vial: ampicillin 1000mg + sulbactam 500mg Cloxacillin-“Cloxacillin” (OCLOX) ［ B ］ Indication: Active against most Gram (+) organisms and Neisseria spp. Activity is less than other penicillins. Effective to those infections caused by penicilln-resistant Staphylococci and Streptococci. Contraindication: Hypersensitivity to penicillins, used with caution in jaundiced neonates. Adverse effect: As for benzylpenicillin. Febrile reaction. Dosage: 500 mg Q6H. Supply: Cap 250 mg (0.6 mEq of Na/Cap) Oxacillin Sodium-“Prostaphlin”(IPROS) ［ B ］ Indication: Similar to cloxacillin. Contraindication: Same as cloxacillin. Adverse effect: As for benzyl penicillin, increased serum SGOT and SGPT, neutropenia, haematuria, albuminuria and uraemia occurred in infants. Dosage: Adult, IM or IV 0.25-1 g Q4-6H; maximum dose: 6 g/day. Newborn and premature infants: 25 mg/kg/day in divided doses. Supply: Inj 500 mg/vial Flucloxacillin sodium-“Flucloxacillin”(IFLUC) Indication: Similar to cloxacillin. Contraindication: Hypersensitivity to penicillins. Adverse effect: Hypersensitivity reactions, nausea, vomiting, diarrhea & antibiotic-associated colitis, hepatitis & cholestatic jaundice. Dosage: Adult: IM 250-500 mg Q6H; slow IV inj or IV 20 - - 21 - - Dosage: Adults & children >12 y/o: PO 1 Tab TID; inj 1.2 g Q8-6H. Children 7-12 y/o: 10 ml Syr BID, 2-6 y/o: 5 ml Syr BID, 2 months-2 years: 25-45 mg/kg/day Syr BID. Supply: Tab 250 mg amoxicillin + 125 mg potassium clavulanate (Augmentin); Syr each 5 ml contains 400 mg amoxicillin + 57 mg potassium clavulanate, 35ml/bot; Inj 1.2 gm: each vial contain 1gm amoxicillin + 200 mg potassium clavulanate (Augcin), Inj 0.6 gm: each vial contain 0.5 gm amoxicillin + 100 mg potassium clavulanate (Amoclavunin) Ampicillin-“Ampicillin”(OAMP5)“Ampolin”(IAMPI) ［ B ］ Indication: Bactericidal against Gram (+) organisms, including Streptococcus faecalis, Streptococcus pneumoniae, Haemophilus influenzae, Salmonella, E. coli, Neisseria gonorrhoeae, Neisseria meningitides, Proteus mirabilis, Brucella spp, Shigella. Contraindication: Not to be used in patients sensitive to penicillins. Adverse effect: Allergic reaction, skin rashes, urticaria, maculopapular, diarrhea, nausea, vomiting, raised serum aminotransferase, pseudomembranous colitis, superinfections with Pseudomonas and Candida. Dosage: Normal Dosage: Infection due to Gram (+) organisms & Haemophilis influenzae: 250 – 500 mg Q6H. GI and urinary tract infection due to G (-) organisms: 500 – 750 mg Q6 - 8H. Enteric infection: 1 – 2 g Q6H. Supply: Cap 500 mg; Inj 500 mg/vial Ampicillin/sulbactam-“Unasyn”(IUNA1) “Ansullina” (IANSU) “Subacillin” (ISUBA) ［ B ］ Indication: It is an antibiotic combination, comprised of ampicillin and a beta-lactamase inhibitor-sulbactam. Besides the inhibition effects of ampicillin sensitive microorganisms, the resistant strains: S. aureus, S. epidermidis, H. influenzae, Moraxella catarrhalis, N. gonorrhea, Klebsiella spp. E coli, E aerogenes, Proteus spp, and Acinetobacter calcoaceticus are inhibited. Contraindication: Severe hypersensitivity to penicillin. Adverse effect: Similar to those seen with ampicillin alone, the most common of which are diarrhea and maculopapular rash. Dosage: Adults: 1.5-12 g/day, in divided Q6-8H. Children: 150 mg/kg/day, in divided Q6-8H Supply: Inj 1.5 g/vial: ampicillin 1000mg + sulbactam 500mg Cloxacillin-“Cloxacillin” (OCLOX) ［ B ］ Indication: Active against most Gram (+) organisms and Neisseria spp. Activity is less than other penicillins. Effective to those infections caused by penicilln-resistant Staphylococci and Streptococci. Contraindication: Hypersensitivity to penicillins, used with caution in jaundiced neonates. Adverse effect: As for benzylpenicillin. Febrile reaction. Dosage: 500 mg Q6H. Supply: Cap 250 mg (0.6 mEq of Na/Cap) Oxacillin Sodium-“Prostaphlin”(IPROS) ［ B ］ Indication: Similar to cloxacillin. Contraindication: Same as cloxacillin. Adverse effect: As for benzyl penicillin, increased serum SGOT and SGPT, neutropenia, haematuria, albuminuria and uraemia occurred in infants. Dosage: Adult, IM or IV 0.25-1 g Q4-6H; maximum dose: 6 g/day. Newborn and premature infants: 25 mg/kg/day in divided doses. Supply: Inj 500 mg/vial Flucloxacillin sodium-“Flucloxacillin”(IFLUC) Indication: Similar to cloxacillin. Contraindication: Hypersensitivity to penicillins. Adverse effect: Hypersensitivity reactions, nausea, vomiting, diarrhea & antibiotic-associated colitis, hepatitis & cholestatic jaundice. Dosage: Adult: IM 250-500 mg Q6H; slow IV inj or IV 22 - - 23 - - infusion 250 mg-2 g Q6H. Supply: Inj 500 mg/vial Piperacillin Sodium-“Pitamycin” (IPITA) ［ B ］ Indication: Piperacillin has been effective in the treatment of a variety of gram-positive, gram-negative, and Pseudomonal infections. The primary use of piperacillin is in the treatment of serious Pseudomonal infections resistant to carbenicillin or ticarcillin, in combination with an aminoglycoside. Place in therapy: Piperacillin should be reserved for carbenicillin or ticarcillin-resistant Pseudomonas aeruginosa infections in combination with an aminoglycoside. Contraindication: Hypersensitivity to any of the penicillins Adverse effect: Adverse effects include neutropenia, eosinophilia, hypokalemia, diarrhea, nausea, vomiting, abdominal pain, nephrotoxicity, elevated serum transaminases, and hypersensitivity reactions. Dosage: Adults: 2-4 g, IVQ6-8H Pharmacokinetics: Elimination half-life ranges from 0.5 to 1.5 h, and increases in patients with renal failure. Supply: Inj 2 g/vial Piperacillin/tazobactam-“Tapimycin”(ITAPI) ［ B ］ Indication: Piperacillin sodium/tazobactam sodium has a wide spectrum of activity to against many gram-positive, -negative and anaerobic bacteria. In vitro studies, piperacillin sodium/tazobactam sodium dose not result in synergism against Pseudomonas aeruginosa and that the currently recommended dosage generally are too low to be effective in the treatment of Pseudomonas aeruginosa. Place in therapy: It has been successfully used in the treatment of infections such as cellulites, appendicitis, community-acquired pneumonia, and gynecologic infections. It is ineffective against MRSA and does not offer any major advantages in the treatment of Gram (+) organisms. Contraindication: Patients with a prior history of hypersensitivity to beta-lactam antibiotics or to beta-lactamase inhibitors. Adverse effect: The most frequent adverse effects reported are GI effects (diarrhea, nausea, constipation, headache, and dermatological reactions (rash, pruritus, and fever). In some cases, leukopenia and neutropenia occurred after 21 days of therapy. Dosage: Adults: 12 g-15 g/day IV in divided doses. Supply: Inj 2.25 gm/vial, each vial contains Piperacillin sodium 2 gm and Tazobactam sodium 0.25 gm 08.12.18 Quinolones Ciprofloxacin-“Ciproxin”(OCIPRO)(ICIP1) “Superocin”(OCIP2) “Cinolone”(ICINO) ［ C ］ Indication: Bacterial infections caused by Ciprofloxacin sensitive pathogens Pharmacology: Ciprofloxacin is a fluoroquinolone with a broad antibacterial spectrum. Fluoroquinolones inhibit bacterial DNA gyrase, an enzyme essential for DNA replication, and thus inhibit DNA supercoiling. Contraindication: Hypersensitivity to ciprofloxacin or other quinolones. Ciprofloxacin can cause arthropathy in immature animal; it should not be used in children or adolescents (younger than 16-18 years of age). Adverse effect: Headache (I.V. administration), restlessness (I.V. administration), rash, nausea, diarrhea, vomiting, ALT/AST increased. Administration: Oral: May administer with food to minimize GI upset; avoid antacid use; administer ciprofloxacin at least 2 hrs before or 6 hrs after antacids or other products containing calcium, iron, or zinc. Parenteral: administer by slow I.V. infusion over 60 minutes to reduce the risk of venous irritation (burning, pain, erythema, and swelling). Dosage: For urinary tract infections: Oral, 250-500mg q12h for 7-14 days; IV infusion over 60 mins, 200-400mg 22 - - 23 - - infusion 250 mg-2 g Q6H. Supply: Inj 500 mg/vial Piperacillin Sodium-“Pitamycin” (IPITA) ［ B ］ Indication: Piperacillin has been effective in the treatment of a variety of gram-positive, gram-negative, and Pseudomonal infections. The primary use of piperacillin is in the treatment of serious Pseudomonal infections resistant to carbenicillin or ticarcillin, in combination with an aminoglycoside. Place in therapy: Piperacillin should be reserved for carbenicillin or ticarcillin-resistant Pseudomonas aeruginosa infections in combination with an aminoglycoside. Contraindication: Hypersensitivity to any of the penicillins Adverse effect: Adverse effects include neutropenia, eosinophilia, hypokalemia, diarrhea, nausea, vomiting, abdominal pain, nephrotoxicity, elevated serum transaminases, and hypersensitivity reactions. Dosage: Adults: 2-4 g, IVQ6-8H Pharmacokinetics: Elimination half-life ranges from 0.5 to 1.5 h, and increases in patients with renal failure. Supply: Inj 2 g/vial Piperacillin/tazobactam-“Tapimycin”(ITAPI) ［ B ］ Indication: Piperacillin sodium/tazobactam sodium has a wide spectrum of activity to against many gram-positive, -negative and anaerobic bacteria. In vitro studies, piperacillin sodium/tazobactam sodium dose not result in synergism against Pseudomonas aeruginosa and that the currently recommended dosage generally are too low to be effective in the treatment of Pseudomonas aeruginosa. Place in therapy: It has been successfully used in the treatment of infections such as cellulites, appendicitis, community-acquired pneumonia, and gynecologic infections. It is ineffective against MRSA and does not offer any major advantages in the treatment of Gram (+) organisms. Contraindication: Patients with a prior history of hypersensitivity to beta-lactam antibiotics or to beta-lactamase inhibitors. Adverse effect: The most frequent adverse effects reported are GI effects (diarrhea, nausea, constipation, headache, and dermatological reactions (rash, pruritus, and fever). In some cases, leukopenia and neutropenia occurred after 21 days of therapy. Dosage: Adults: 12 g-15 g/day IV in divided doses. Supply: Inj 2.25 gm/vial, each vial contains Piperacillin sodium 2 gm and Tazobactam sodium 0.25 gm 08.12.18 Quinolones Ciprofloxacin-“Ciproxin”(OCIPRO)(ICIP1) “Superocin”(OCIP2) “Cinolone”(ICINO) ［ C ］ Indication: Bacterial infections caused by Ciprofloxacin sensitive pathogens Pharmacology: Ciprofloxacin is a fluoroquinolone with a broad antibacterial spectrum. Fluoroquinolones inhibit bacterial DNA gyrase, an enzyme essential for DNA replication, and thus inhibit DNA supercoiling. Contraindication: Hypersensitivity to ciprofloxacin or other quinolones. Ciprofloxacin can cause arthropathy in immature animal; it should not be used in children or adolescents (younger than 16-18 years of age). Adverse effect: Headache (I.V. administration), restlessness (I.V. administration), rash, nausea, diarrhea, vomiting, ALT/AST increased. Administration: Oral: May administer with food to minimize GI upset; avoid antacid use; administer ciprofloxacin at least 2 hrs before or 6 hrs after antacids or other products containing calcium, iron, or zinc. Parenteral: administer by slow I.V. infusion over 60 minutes to reduce the risk of venous irritation (burning, pain, erythema, and swelling). Dosage: For urinary tract infections: Oral, 250-500mg q12h for 7-14 days; IV infusion over 60 mins, 200-400mg 24 - - 25 - - q12h. For respiratory tract, skin or bone and joint infections: Oral, 500-750mg q12h; IV infusion over 60 mins, 400mg q12h f or 4-6wks. For i nf ect i ous di arrhea: Oral, 500mg q12h for 5-7 days Supply: Tab 250 mg (Ciproxin; Superocin); Inj 200 mg/100 ml/bot (Ciproxin; Cinolone) Levofloxacin -“Cravit”(OCRA5) (ICRAV) ［ C ］ Indication: Treatment of urinary tract infections, chronic bronchitis, community-acquired pneumonia (including penicillin-resistant Streptococcus pneumoniae), skin and skin structure infections, and maxillary sinusitis. Pharmacology: Levofloxavin is the active L-isomer of ofloxacin that allow higher dosages of the active form to be given with fewer side effects. Contraindication: Hypersensitivity to levofloxacin, other fluoroquinolones Adverse effect: Nausea, headache, diarrhea, insomnia, dizziness, and constipation. Dosage: Adults: 500 mg IV or ORALLY every 24 hr for 7~14 days. Administration: IV; infuse over at least 60 minutes (250 mg and 500 mg) or 90 minutes (750 mg). Oral tablets; may take with or without food, do NOT give within 2 hr of antacids, sucralfate, iron, or zinc. Supply: Tab 500 mg; Inj 500 mg/100 ml/bot Moxifloxacin -“Avelox”(OAVEL) (IAVEL) ［ C ］ Indication: Respiratory tract infections, skin and soft tissue infections Pharmacology: Moxifloxacin is a fluoroquinolone with a broad spectrum of antimicrobial activity including G(+) and G(-) organisms, Chlamydia spp, anaerobes, and Mycobacterium tuberculosis, it inhibits bacterial DNA topoisomerases required for bacterial DNA replication, transcription, repair, and recombination. Contraindication: Hypersensitivity to moxifloxacin or quinolones. Adverse effect: Nausea, diarrhea, hypertension, palpitation, QT interval prolongation, skin rash. Administration: Oral: can be given concurrently with food; but not with antacids containing magnesium or aluminum or preparations containing sucralfate, metal cations such as iron, or zinc; Oral doses should be given at least 4 hours before or 8 hours after antacids. Parenteral: administer by slow I.V. infusion over 60 minutes. Dosage: Adults: Oral, I.V.: 400 mg every 24 hrs. Pediatric: safety and efficacy in children less than 18 years of age have not been established. No dosage adjustment in renal impairment, including patients on hemodialysis or CAPD. Not recommended in patients with severe hepatic insufficiency. Stability: Do not refrigerate; intravenous solution precipitates upon refrigeration Supply: Tab 400 mg; inj 400 mg /250 ml/bottle Pipemidic acid -“Dolcol”(ODOLC) Indication: Pyelonephritis, pyelitis, cystitis, urethritis, prostatitis shigellosis, enteritis, otitis media, sinusitis Contraindication: Hypersensitivity, children, pregnancy & lactation. Adverse effect: GI symptoms. CNS and skin reactions. Dosage: 500 mg-2 g/day Supply: Tab 250 mg 08.12.20 Sulfonamides Co-trimoxazole-“Baktar” (OBAKT) “Sevatrim”(ISEVA) ［ C ］ Indication: It is used for the treatment of urinary tract infections caused by susceptible strains of E. coli, Proteus (indole positive or negative), Klebsiella, Enterobacter, Haemophilus influenzae, Streptococcus pneumoniae, Shigella spp. and also active against Pneumocystis carinii. Contraindication: Pregnancy, infants younger than 2 24 - - 25 - - q12h. For respiratory tract, skin or bone and joint infections: Oral, 500-750mg q12h; IV infusion over 60 mins, 400mg q12h f or 4-6wks. For i nf ect i ous di arrhea: Oral, 500mg q12h for 5-7 days Supply: Tab 250 mg (Ciproxin; Superocin); Inj 200 mg/100 ml/bot (Ciproxin; Cinolone) Levofloxacin -“Cravit”(OCRA5) (ICRAV) ［ C ］ Indication: Treatment of urinary tract infections, chronic bronchitis, community-acquired pneumonia (including penicillin-resistant Streptococcus pneumoniae), skin and skin structure infections, and maxillary sinusitis. Pharmacology: Levofloxavin is the active L-isomer of ofloxacin that allow higher dosages of the active form to be given with fewer side effects. Contraindication: Hypersensitivity to levofloxacin, other fluoroquinolones Adverse effect: Nausea, headache, diarrhea, insomnia, dizziness, and constipation. Dosage: Adults: 500 mg IV or ORALLY every 24 hr for 7~14 days. Administration: IV; infuse over at least 60 minutes (250 mg and 500 mg) or 90 minutes (750 mg). Oral tablets; may take with or without food, do NOT give within 2 hr of antacids, sucralfate, iron, or zinc. Supply: Tab 500 mg; Inj 500 mg/100 ml/bot Moxifloxacin -“Avelox”(OAVEL) (IAVEL) ［ C ］ Indication: Respiratory tract infections, skin and soft tissue infections Pharmacology: Moxifloxacin is a fluoroquinolone with a broad spectrum of antimicrobial activity including G(+) and G(-) organisms, Chlamydia spp, anaerobes, and Mycobacterium tuberculosis, it inhibits bacterial DNA topoisomerases required for bacterial DNA replication, transcription, repair, and recombination. Contraindication: Hypersensitivity to moxifloxacin or quinolones. Adverse effect: Nausea, diarrhea, hypertension, palpitation, QT interval prolongation, skin rash. Administration: Oral: can be given concurrently with food; but not with antacids containing magnesium or aluminum or preparations containing sucralfate, metal cations such as iron, or zinc; Oral doses should be given at least 4 hours before or 8 hours after antacids. Parenteral: administer by slow I.V. infusion over 60 minutes. Dosage: Adults: Oral, I.V.: 400 mg every 24 hrs. Pediatric: safety and efficacy in children less than 18 years of age have not been established. No dosage adjustment in renal impairment, including patients on hemodialysis or CAPD. Not recommended in patients with severe hepatic insufficiency. Stability: Do not refrigerate; intravenous solution precipitates upon refrigeration Supply: Tab 400 mg; inj 400 mg /250 ml/bottle Pipemidic acid -“Dolcol”(ODOLC) Indication: Pyelonephritis, pyelitis, cystitis, urethritis, prostatitis shigellosis, enteritis, otitis media, sinusitis Contraindication: Hypersensitivity, children, pregnancy & lactation. Adverse effect: GI symptoms. CNS and skin reactions. Dosage: 500 mg-2 g/day Supply: Tab 250 mg 08.12.20 Sulfonamides Co-trimoxazole-“Baktar” (OBAKT) “Sevatrim”(ISEVA) ［ C ］ Indication: It is used for the treatment of urinary tract infections caused by susceptible strains of E. coli, Proteus (indole positive or negative), Klebsiella, Enterobacter, Haemophilus influenzae, Streptococcus pneumoniae, Shigella spp. and also active against Pneumocystis carinii. Contraindication: Pregnancy, infants younger than 2 26 - - 27 - - months, lactation; hypersensitivity to sulfonamides or trimethoprim, patients with impaired renal or hepatic function. Adverse effect: Agranulocytosis, aplastic and megaloblastic anemia, nausea, erythema multiform, headache, and mental depression. Dosage: Adults: 2 tab Q12H for 10-14 days in urinary tract infection, MAX dose: trimethoprin 640mg, sulfamethoxazole 3.2g; Children: 8 mg/kg trimethoprim and 40 mg/kg sulfamethoxazole daily, give in 2 divided dose Q12H. IV dosage: 8-10 mg/kg/day of TMP and 40-50 mg/kg/day of SMZ, in 2-4 equally divided doses, every 6-12 hrs for 5 days for shigellosis and up to 14 day for severe UTI. Supply: Tab sulfamethoxazole 400 mg & trimethoprim 80 mg; Inj sulfamethoxazole 400 mg & trimethoprim 80 mg/5 ml/amp Sulfasalazine-“Salazopyrin”(OSALA) ［ B ］ Indication: Mild to moderate ulcerative colitis, adjunctive therapy in severe ulcerative colitis; juvenile rheumatoid arthritis, poly-articular course; rheumatoid arthritis Contraindication: Hypersensitivity to sulfonamide or salicylates; in infants under 2 yrs, intestinal and urinary obstruction, patients with porphyria. Adverse effect: Headache, blood dyscrasia, skin eruptions, Steven-Johnson syndrome, hypersensitivity reactions. Dosage: Ulcerative colitis: Adults: initial, 3-4 g/day divided into equally doses, then 500mg QID maintenance. Children: initial, 40-60 mg/kg/day in 3-6 equally divided doses, then 30mg/kg/day divided into 4 doses. Rheumatoid arthritis: Adults: initial, 0.5-1 gm/day, then 1gm BD maintenance. Juvenil Rheumatoid arthritis(Children ＞ 6 yrs): 30-50 mg/kg/day in 2 equally divided doses. Administer with or after meals Supply: Tab 500 mg Spasmo-Euvernil (OSPAS) Indication: Acute infections of the urinary tract with micturition compl ai nt s and t enesmus, prevent i nf ect i on f rom instrumentation, prophylaxis in case of chronically recurring infections of urinary passages. Contraindication: Pregnancy, nephritis, anuria, uremia and damage to the liver parenchyma. Adverse effect: Allergic reaction. Dosage: Usual dose 2 tab TID, daily dose should not be exceeded 10 Tabs. The minimum treatment time for primary infection is 2 Tabs TID for 10 days, continue treatment of secondary infection is followed by a 20 days. Supply: Tab sulfacarbamide 500 mg/ phenazopyridine 50 mg 08:12.24 Tetracyclines Tetracycline HCI-“Tetracycline” (OACHR) ［ D ］ Indication: Acne vulgarism, bacterial infections, anthrax, chlamydial infection, cholera, syphilis. Pharmacology: Tetracyclines are broad-spectrum bacteriostatic compounds that inhibit protein synthesis at the 30S ribosomal subunit. Activity includes G (+), G (-), aerobic, and anaerobic bacteria, as well as spirochetes, mycoplasmas, rickettsiae, chlamydiae, and some protozoa. Contraindication: Hypersensitivity to any tetracycline products, last half of pregnancy, infancy, and childhood up to 8 years of age Adverse effect: Photosensitivity, rash, nausea, diarrhea, discoloration of teeth and enamel hypoplasia especially during growth. Administration: Avoid concomitant administration of aluminum, calcium, and magnesium, which can impair absorption of tetracycline. Take 1 hr before or 2 hr after meals Dosage: Adults: 250-500 mg orally every 6 hours. Children >8 years: 25-50 mg/kg/day in divided doses every 6 hours. In renal impairment: reduced doses or 26 - - 27 - - months, lactation; hypersensitivity to sulfonamides or trimethoprim, patients with impaired renal or hepatic function. Adverse effect: Agranulocytosis, aplastic and megaloblastic anemia, nausea, erythema multiform, headache, and mental depression. Dosage: Adults: 2 tab Q12H for 10-14 days in urinary tract infection, MAX dose: trimethoprin 640mg, sulfamethoxazole 3.2g; Children: 8 mg/kg trimethoprim and 40 mg/kg sulfamethoxazole daily, give in 2 divided dose Q12H. IV dosage: 8-10 mg/kg/day of TMP and 40-50 mg/kg/day of SMZ, in 2-4 equally divided doses, every 6-12 hrs for 5 days for shigellosis and up to 14 day for severe UTI. Supply: Tab sulfamethoxazole 400 mg & trimethoprim 80 mg; Inj sulfamethoxazole 400 mg & trimethoprim 80 mg/5 ml/amp Sulfasalazine-“Salazopyrin”(OSALA) ［ B ］ Indication: Mild to moderate ulcerative colitis, adjunctive therapy in severe ulcerative colitis; juvenile rheumatoid arthritis, poly-articular course; rheumatoid arthritis Contraindication: Hypersensitivity to sulfonamide or salicylates; in infants under 2 yrs, intestinal and urinary obstruction, patients with porphyria. Adverse effect: Headache, blood dyscrasia, skin eruptions, Steven-Johnson syndrome, hypersensitivity reactions. Dosage: Ulcerative colitis: Adults: initial, 3-4 g/day divided into equally doses, then 500mg QID maintenance. Children: initial, 40-60 mg/kg/day in 3-6 equally divided doses, then 30mg/kg/day divided into 4 doses. Rheumatoid arthritis: Adults: initial, 0.5-1 gm/day, then 1gm BD maintenance. Juvenil Rheumatoid arthritis(Children ＞ 6 yrs): 30-50 mg/kg/day in 2 equally divided doses. Administer with or after meals Supply: Tab 500 mg Spasmo-Euvernil (OSPAS) Indication: Acute infections of the urinary tract with micturition compl ai nt s and t enesmus, prevent i nf ect i on f rom instrumentation, prophylaxis in case of chronically recurring infections of urinary passages. Contraindication: Pregnancy, nephritis, anuria, uremia and damage to the liver parenchyma. Adverse effect: Allergic reaction. Dosage: Usual dose 2 tab TID, daily dose should not be exceeded 10 Tabs. The minimum treatment time for primary infection is 2 Tabs TID for 10 days, continue treatment of secondary infection is followed by a 20 days. Supply: Tab sulfacarbamide 500 mg/ phenazopyridine 50 mg 08:12.24 Tetracyclines Tetracycline HCI-“Tetracycline” (OACHR) ［ D ］ Indication: Acne vulgarism, bacterial infections, anthrax, chlamydial infection, cholera, syphilis. Pharmacology: Tetracyclines are broad-spectrum bacteriostatic compounds that inhibit protein synthesis at the 30S ribosomal subunit. Activity includes G (+), G (-), aerobic, and anaerobic bacteria, as well as spirochetes, mycoplasmas, rickettsiae, chlamydiae, and some protozoa. Contraindication: Hypersensitivity to any tetracycline products, last half of pregnancy, infancy, and childhood up to 8 years of age Adverse effect: Photosensitivity, rash, nausea, diarrhea, discoloration of teeth and enamel hypoplasia especially during growth. Administration: Avoid concomitant administration of aluminum, calcium, and magnesium, which can impair absorption of tetracycline. Take 1 hr before or 2 hr after meals Dosage: Adults: 250-500 mg orally every 6 hours. Children >8 years: 25-50 mg/kg/day in divided doses every 6 hours. In renal impairment: reduced doses or 28 - - 29 - - extended intervals are recommended Supply: Cap 250 mg Doxycycline-“Doxymycin” (ODOXY) ［ D ］ Indication: Bacterial infections, anthrax, chlamydial infection, cholera, syphilis. Pharmacology: Tetracycl i nes are broad-spectrum bacteriostatic compounds that inhibit protein synthesis at the 30S ribosomal subunit. Activity includes G (+), G (-), aerobic, and anaerobic bacteria, as well as spirochetes, mycoplasmas, rickettsiae, chlamydiae, and some protozoa. Contraindication: Hypersensitivity to any tetracycline products, last half of pregnancy, infancy, and childhood up to 8 years of age (except anthrax). Adverse effect: Nausea, diarrhea, may cause discoloration of teeth in children especially during growth. Dosage: Adult :Oral, 100-200 mg/day in 1-2 divided dose, dosage adjustments are not required for patients with renal impairment. May give with meals to decrease GI upset. Supply: Cap 100 mg Minocycline HCI-“Minocin (Mirosin)” (IMINO) ［ D ］ Indication: Similar to tetracycline, but is more active against many species, including tetracycline-resistant Staphylococci, Streptococci, E. coli and H. influenzae. Contraindication: Same as tetracycline. Adverse effect: Same as tetracycline. Dosage: 200 mg PO or IV initially, then 100 mg Q12H (IV should not exceed 400 mg in 24 hours). Supply: Inj 100 mg/vial 08:12.24.12 Glycylcyclines Tigecycline-“Tygacil”(ITYGA) ［ D ］ Indication: Treatment of complicated skin & skin structure infections or complicated intra-abdominal infections caused by susceptible organisms in patients >18 y/o. Place in therapy: It is a broad-spectrum gram positive and gram-negative antibiotic. Activity includes tetracycline-resistant and multidrug-resistant organisms. Tigecycline’s role in therapy is an alternative treatment for severely ill patients, especially with resistant infections. Unfortunately, in vitro studies demonstrate that tigecycline is not active against Pseudomonas aeruginosa, Proteus mirabilis, and Providencia species Contraindication: Hypersensitivity Adverse effect: Nausea, vomiting, diarrhea, local reactions at inj site, abdominal pain, fever, headache, thrombocythemia, anemia, leukocytosis. Adverse effects similar to those of tetracyclines may potentially orrur. Dosage: Adult >18 y/o: initial dose of 100 mg IV followed by 50 mg Q12H for 5-14 days. Supply: Inj 50 mg/vial 08:12.28 Miscellaneous Antibacterials Vancomycin HCI-“Vanco”(IVANC) “U-Vanco” (IUVAN) ［ C ］ Indication: Treatment of serious or severe infections caused by susceptible strains of methicillin-resistant ( β -lactamase-resistant) Staphylococci. Contraindication: Patients with known hypersensitivity to the drug. Adverse effect: Ototoxicity, nephrotoxicity, rapid infusion may develop anaphylactoid reactions, including red man syndrome, hypotension, urticaria; reversible neutropenia. Dosage: Adults: IV infusion, 500mg over 1hr q6h. Each gram should be administered over a period of at least 60 minutes. Older infants and children: IV 40mg/kg/day in 2-4 divided doses. In neonates: an initial dose of 15mg/kg is suggested followed by 10mg/kg every 12 hours in the first week of life and every 8 hours thereafter up to the age of one month. Treatment of antibiotic-associated pseudomembranous colitis, the usual adult daily dosage is 500 mg to 2 g orally in 3 or 4 divided doses for 7 to 10 28 - - 29 - - extended intervals are recommended Supply: Cap 250 mg Doxycycline-“Doxymycin” (ODOXY) ［ D ］ Indication: Bacterial infections, anthrax, chlamydial infection, cholera, syphilis. Pharmacology: Tetracycl i nes are broad-spectrum bacteriostatic compounds that inhibit protein synthesis at the 30S ribosomal subunit. Activity includes G (+), G (-), aerobic, and anaerobic bacteria, as well as spirochetes, mycoplasmas, rickettsiae, chlamydiae, and some protozoa. Contraindication: Hypersensitivity to any tetracycline products, last half of pregnancy, infancy, and childhood up to 8 years of age (except anthrax). Adverse effect: Nausea, diarrhea, may cause discoloration of teeth in children especially during growth. Dosage: Adult :Oral, 100-200 mg/day in 1-2 divided dose, dosage adjustments are not required for patients with renal impairment. May give with meals to decrease GI upset. Supply: Cap 100 mg Minocycline HCI-“Minocin (Mirosin)” (IMINO) ［ D ］ Indication: Similar to tetracycline, but is more active against many species, including tetracycline-resistant Staphylococci, Streptococci, E. coli and H. influenzae. Contraindication: Same as tetracycline. Adverse effect: Same as tetracycline. Dosage: 200 mg PO or IV initially, then 100 mg Q12H (IV should not exceed 400 mg in 24 hours). Supply: Inj 100 mg/vial 08:12.24.12 Glycylcyclines Tigecycline-“Tygacil”(ITYGA) ［ D ］ Indication: Treatment of complicated skin & skin structure infections or complicated intra-abdominal infections caused by susceptible organisms in patients >18 y/o. Place in therapy: It is a broad-spectrum gram positive and gram-negative antibiotic. Activity includes tetracycline-resistant and multidrug-resistant organisms. Tigecycline’s role in therapy is an alternative treatment for severely ill patients, especially with resistant infections. Unfortunately, in vitro studies demonstrate that tigecycline is not active against Pseudomonas aeruginosa, Proteus mirabilis, and Providencia species Contraindication: Hypersensitivity Adverse effect: Nausea, vomiting, diarrhea, local reactions at inj site, abdominal pain, fever, headache, thrombocythemia, anemia, leukocytosis. Adverse effects similar to those of tetracyclines may potentially orrur. Dosage: Adult >18 y/o: initial dose of 100 mg IV followed by 50 mg Q12H for 5-14 days. Supply: Inj 50 mg/vial 08:12.28 Miscellaneous Antibacterials Vancomycin HCI-“Vanco”(IVANC) “U-Vanco” (IUVAN) ［ C ］ Indication: Treatment of serious or severe infections caused by susceptible strains of methicillin-resistant ( β -lactamase-resistant) Staphylococci. Contraindication: Patients with known hypersensitivity to the drug. Adverse effect: Ototoxicity, nephrotoxicity, rapid infusion may develop anaphylactoid reactions, including red man syndrome, hypotension, urticaria; reversible neutropenia. Dosage: Adults: IV infusion, 500mg over 1hr q6h. Each gram should be administered over a period of at least 60 minutes. Older infants and children: IV 40mg/kg/day in 2-4 divided doses. In neonates: an initial dose of 15mg/kg is suggested followed by 10mg/kg every 12 hours in the first week of life and every 8 hours thereafter up to the age of one month. Treatment of antibiotic-associated pseudomembranous colitis, the usual adult daily dosage is 500 mg to 2 g orally in 3 or 4 divided doses for 7 to 10 30 - - 31 - - days, the total daily dosage should not be exceeded 2 g. Supply: Inj 500 mg/vial (Vanco), 1 g/vial (U-Vanco) Teicoplanin-“Targocid”(ITARG) Indication: It is used in the treatment of serious gram-positive infections. It has been used empirically in neutropenic patients. Place in therapy: Compared to vancomycin, teicoplanin possesses an extended elimination half-life and can be dosed once daily. Additionally, the severe pain and necrosis that is associated with intramuscular injections of vancomycin have not been reported with teicoplanin. Contraindication: Hypersensitivity to this drug. Adverse effect: Pain on injection, thrombophlebitis, neutropenia, rash, bronchospasm, eosinophilia, and rare cases of ototoxicity. Dosage: Adults: loading dose of 400 to 800 mg, maintenance doses of 200 to 600 mg QD; IM as maintenance doses of 200 to 600 mg following an intravenous loading dose; Children: 3-6 mg/kg/day. Supply: Inj 200 mg/3 ml/vial Clindamycin-“Clindamycin”(OCLIN) “Clincin”(ICLIN) ［ B ］ Indication: Infections caused by anaerobes, Streptococci, Staphylococci or pneumococci. Contraindication: Hypersensitivity, diarrhea states. Adverse effect: Diarrhea, Pseudomembranous colitis, hypersensitivity reactions, agranulocytosis, thrombocytopenia. Dosage: Adults: 150-300 mg Q6H PO, severe infection: 450 mg Q6H PO, 0.6-2.7 g/day in divided doses IM or slow IV. Children: 8-16 mg/kg/day in 4 divided dose up to 20 mg/kg/day PO, 15-40 mg/kg/day in divided doses IM or slow IV, maximum dose: 2.7-4.8 g/day Supply: Cap 150 mg; Inj 300 mg/2 ml/amp Na Fusidate-“Fucidin” (OFUCI) ［ A ］ Indication: Treatment of infections caused by susceptible organisms especially Staph eg osteomyelitis, septicaemia, endocarditis, pneumonia, cutaneous infections, surgical & traumatic wound infections. Also other Staph infections including MRSA Contraindication: Hypersensitivity to fusidic acid and/or its salt. Adverse effect: GI disturbances. Dosage: Adult: 2 tab TID; skin & soft tissue infections 1-2 tab BID. Supply: Tab 250 mg 08:14 Antifungals Terbinafine HCI-“Lamisil” (OLAMIS) ［ B ］ Indication: Treatment of onychomycosis and moccasin-type tinea pedis, cutaneous candidiasis. Place in therapy: Terbinafine appears to be as effective as griseofulvin for the treatment of tinea crucis and corporis, but is more effective for onychomycosis, and moccasin-type tinea pedis. Contraindication: Previous hypersensitivity to terbinafine or naftifine. For patients with pre-existing liver disease or renal impairment, it is not recommended. Adverse effect: Fatigue, headache, dizziness, gastrointestinal disturbances, skin rash, pruritus, alopecia, and elevation of hepatic function tests. Dosage: Onychomycosis: 250 mg QD for 6-12 wks, tinea capitis: 250 mg QD for 4-6 wks, tinea corporis: 250 mg QD for 2-4 wks, tinea cruris: 250 mg QD for 2-4 wks Supply: Tab 250 mg Fluconazole-“Diflucan”(ODIFL) (IDIFL) ［ C ］ Indication: Fluconazole is a triazole antifungal agent suitable for once daily oral administration. It is used primarily for acquired immunodeficiency syndrome patients with cryptococcal meningitis, as suppressive 30 - - 31 - - days, the total daily dosage should not be exceeded 2 g. Supply: Inj 500 mg/vial (Vanco), 1 g/vial (U-Vanco) Teicoplanin-“Targocid”(ITARG) Indication: It is used in the treatment of serious gram-positive infections. It has been used empirically in neutropenic patients. Place in therapy: Compared to vancomycin, teicoplanin possesses an extended elimination half-life and can be dosed once daily. Additionally, the severe pain and necrosis that is associated with intramuscular injections of vancomycin have not been reported with teicoplanin. Contraindication: Hypersensitivity to this drug. Adverse effect: Pain on injection, thrombophlebitis, neutropenia, rash, bronchospasm, eosinophilia, and rare cases of ototoxicity. Dosage: Adults: loading dose of 400 to 800 mg, maintenance doses of 200 to 600 mg QD; IM as maintenance doses of 200 to 600 mg following an intravenous loading dose; Children: 3-6 mg/kg/day. Supply: Inj 200 mg/3 ml/vial Clindamycin-“Clindamycin”(OCLIN) “Clincin”(ICLIN) ［ B ］ Indication: Infections caused by anaerobes, Streptococci, Staphylococci or pneumococci. Contraindication: Hypersensitivity, diarrhea states. Adverse effect: Diarrhea, Pseudomembranous colitis, hypersensitivity reactions, agranulocytosis, thrombocytopenia. Dosage: Adults: 150-300 mg Q6H PO, severe infection: 450 mg Q6H PO, 0.6-2.7 g/day in divided doses IM or slow IV. Children: 8-16 mg/kg/day in 4 divided dose up to 20 mg/kg/day PO, 15-40 mg/kg/day in divided doses IM or slow IV, maximum dose: 2.7-4.8 g/day Supply: Cap 150 mg; Inj 300 mg/2 ml/amp Na Fusidate-“Fucidin” (OFUCI) ［ A ］ Indication: Treatment of infections caused by susceptible organisms especially Staph eg osteomyelitis, septicaemia, endocarditis, pneumonia, cutaneous infections, surgical & traumatic wound infections. Also other Staph infections including MRSA Contraindication: Hypersensitivity to fusidic acid and/or its salt. Adverse effect: GI disturbances. Dosage: Adult: 2 tab TID; skin & soft tissue infections 1-2 tab BID. Supply: Tab 250 mg 08:14 Antifungals Terbinafine HCI-“Lamisil” (OLAMIS) ［ B ］ Indication: Treatment of onychomycosis and moccasin-type tinea pedis, cutaneous candidiasis. Place in therapy: Terbinafine appears to be as effective as griseofulvin for the treatment of tinea crucis and corporis, but is more effective for onychomycosis, and moccasin-type tinea pedis. Contraindication: Previous hypersensitivity to terbinafine or naftifine. For patients with pre-existing liver disease or renal impairment, it is not recommended. Adverse effect: Fatigue, headache, dizziness, gastrointestinal disturbances, skin rash, pruritus, alopecia, and elevation of hepatic function tests. Dosage: Onychomycosis: 250 mg QD for 6-12 wks, tinea capitis: 250 mg QD for 4-6 wks, tinea corporis: 250 mg QD for 2-4 wks, tinea cruris: 250 mg QD for 2-4 wks Supply: Tab 250 mg Fluconazole-“Diflucan”(ODIFL) (IDIFL) ［ C ］ Indication: Fluconazole is a triazole antifungal agent suitable for once daily oral administration. It is used primarily for acquired immunodeficiency syndrome patients with cryptococcal meningitis, as suppressive 32 - - 33 - - therapy and for acute treatment. It is also used for the treatment of oropharyngeal and esophageal candidiasis, systemic candidal infections, urinary tract infections, pneumonia, and peritonitis. Contraindication: Hypersensitivity, close monitoring liver function Adverse effect: Nausea, vomiting, and elevation in liver function tests; hypokalemia has been observed in patients with myeloid leukemia; endocrine adverse effects appear to be less frequent as compared to ketoconazole. Dosage: Cryptococcal meningitis: 400mg qd on the first day then 200-400 mg daily for at least 10-12 wks after the CSF is sterile, oropharyngeal candidiasis: 200 mg qd on the first day then 100 mg QD for at least 2 wks, esophageal candidiasis: 200 mg QDon the first day then 100 mg QD for at least 3 wks and for at least 2 wks following the resolution of symptoms, systemic candidiasis: 400 mg QD on the first day then 200 mg QD for at least 4 wks and for at least 2 wks following the resolution of symptoms Supply: Cap 50 mg; Inj 100 mg/50 ml/vial Ketoconazole-“Ketazole” (OKETO) ( 專 ) ［ C ］ Indication: Treatment of fungal infections caused by ermatophytes. Ketoconazole has been effective in the treatment of superficial and systemic fungal infections, and has been evaluated in the treatment of advanced prostate cancer, Cushing’s syndrome, and hyperandrogenism. Place in therapy: Ketoconazol e has demonstrated efficacy in a wide variety of deep fungal infections, as well as superficial infections such as candidiasis, dermatomycosis, and tinea versicolor. However, the increasing incidence of hepatitis and effects on testosterone synthesis may limit the use in therapy. Contraindication: Patients with known hypersensitivity to the drug. Ketoconazole should be used with caution in patients with impaired hepatic function or adrenal reserve. Adverse effect: Nausea, vomiting, abdominal pain, constipation, flatulence, GI bleeding diarrhea, gynecomastia, hyperuricemia, hypothyroidism. Dosage: Adult dose: 200-400 mg PO QD, maximum dose: 1-1.2 g/day. Children older than 2 year of age: 3.3-6.6 mg/kg PO QD. Supply: Tab 200 mg Amphotericin B-“Fungizone” (IFUNG) ［ B ］ Indication: Fungistatic, against Aspergillus fumigatus, Blastomyces dermatitidis, Candida spp., Coccidioides immitis, Cryptococcus neoformans, Histoplasma capsulatum, Microsporum audouinii, Paracoccidioides brasiliensis, Rhizopus spp., Sporothrix schenckii and Trichophyton spp. Place in therapy: The addition of granulocyte colony-stimulating factor (G-CSF) to amphotericin B to treat a presumed deep-seated fungal infection in neutropenic patients is more cost-effective than using amphotericin B alone. Amphotericin B cholesteryl sulfate complex has an improved therapeutic index compared to conventional amphotericin B, and has been used safely in patients with amphotericin B-related nephrotoxicity; however, continued decline of renal function has occurred in some of these patients Contraindication: Concomitant administration of other nephrotoxic drugs and antineoplastic agents should be avoided, enhance the effects of muscle relaxants and increase digitalis toxicity, corticosteroids may enhance the depletion of potassium. Adverse effect: Thrombophlebitis, anorexia, nephrotoxic, anaemia and hypokalaemia. The primary adverse effect of intravenous amphotericin B cholesteryl sulfate complex is an infusion reaction (chills, fever, rigors, nausea), which can be severe; it tends to subside with continued therapy. Other effects include hypotension, tachycardia, headache, gastrointestinal symptoms, liver function test abnormalities, thrombocytopenia, hypokalemia, hypomagnesemia, dyspnea, and diaphoresis. 32 - - 33 - - therapy and for acute treatment. It is also used for the treatment of oropharyngeal and esophageal candidiasis, systemic candidal infections, urinary tract infections, pneumonia, and peritonitis. Contraindication: Hypersensitivity, close monitoring liver function Adverse effect: Nausea, vomiting, and elevation in liver function tests; hypokalemia has been observed in patients with myeloid leukemia; endocrine adverse effects appear to be less frequent as compared to ketoconazole. Dosage: Cryptococcal meningitis: 400mg qd on the first day then 200-400 mg daily for at least 10-12 wks after the CSF is sterile, oropharyngeal candidiasis: 200 mg qd on the first day then 100 mg QD for at least 2 wks, esophageal candidiasis: 200 mg QDon the first day then 100 mg QD for at least 3 wks and for at least 2 wks following the resolution of symptoms, systemic candidiasis: 400 mg QD on the first day then 200 mg QD for at least 4 wks and for at least 2 wks following the resolution of symptoms Supply: Cap 50 mg; Inj 100 mg/50 ml/vial Ketoconazole-“Ketazole” (OKETO) ( 專 ) ［ C ］ Indication: Treatment of fungal infections caused by ermatophytes. Ketoconazole has been effective in the treatment of superficial and systemic fungal infections, and has been evaluated in the treatment of advanced prostate cancer, Cushing’s syndrome, and hyperandrogenism. Place in therapy: Ketoconazol e has demonstrated efficacy in a wide variety of deep fungal infections, as well as superficial infections such as candidiasis, dermatomycosis, and tinea versicolor. However, the increasing incidence of hepatitis and effects on testosterone synthesis may limit the use in therapy. Contraindication: Patients with known hypersensitivity to the drug. Ketoconazole should be used with caution in patients with impaired hepatic function or adrenal reserve. Adverse effect: Nausea, vomiting, abdominal pain, constipation, flatulence, GI bleeding diarrhea, gynecomastia, hyperuricemia, hypothyroidism. Dosage: Adult dose: 200-400 mg PO QD, maximum dose: 1-1.2 g/day. Children older than 2 year of age: 3.3-6.6 mg/kg PO QD. Supply: Tab 200 mg Amphotericin B-“Fungizone” (IFUNG) ［ B ］ Indication: Fungistatic, against Aspergillus fumigatus, Blastomyces dermatitidis, Candida spp., Coccidioides immitis, Cryptococcus neoformans, Histoplasma capsulatum, Microsporum audouinii, Paracoccidioides brasiliensis, Rhizopus spp., Sporothrix schenckii and Trichophyton spp. Place in therapy: The addition of granulocyte colony-stimulating factor (G-CSF) to amphotericin B to treat a presumed deep-seated fungal infection in neutropenic patients is more cost-effective than using amphotericin B alone. Amphotericin B cholesteryl sulfate complex has an improved therapeutic index compared to conventional amphotericin B, and has been used safely in patients with amphotericin B-related nephrotoxicity; however, continued decline of renal function has occurred in some of these patients Contraindication: Concomitant administration of other nephrotoxic drugs and antineoplastic agents should be avoided, enhance the effects of muscle relaxants and increase digitalis toxicity, corticosteroids may enhance the depletion of potassium. Adverse effect: Thrombophlebitis, anorexia, nephrotoxic, anaemia and hypokalaemia. The primary adverse effect of intravenous amphotericin B cholesteryl sulfate complex is an infusion reaction (chills, fever, rigors, nausea), which can be severe; it tends to subside with continued therapy. Other effects include hypotension, tachycardia, headache, gastrointestinal symptoms, liver function test abnormalities, thrombocytopenia, hypokalemia, hypomagnesemia, dyspnea, and diaphoresis. 34 - - 35 - - Dosage: 10 μg/ml in dextrose inj, 0.25 – 1 mg/kg/day. For Amphotericin B cholesteryl sulfate complex for invasive mycoses in adults and children 3-4 mg/kg/day IV (1 mg/kg/hr), dose may up to 7.5 mg/kg/day Supply: Inj 50 mg/vial Nystatin-“Mycostatin” (EMYCO) (BMYCO) ［ C ］ Indication: Fungistatic and fungicidal antibiotic against Candida spp, Coccidioides immitis, Cryptococcus neoformans, Hi stopl asma capsul atum, Bl astomyces dermatiditis. Contraindication: Hypersensitivity to nystatin. Adverse effect: Nausea, vomiting and diarrhea. Dosage: Vag 1 tab qd-bid for 2 wks; Powder, apply qid to affected area of mouth, retaining the drug as long as possible before swallowing Supply: Vag Tab 100,000 U; Susp 100,000 U/ml, 24 ml/bot 08:16 Antimycobacterials Ethambutol HCI-“Ebutol” (OEMB4) ［ B ］ Indication: Bacteriostatic and is active against organisms of Mycobacterium tuberculosis, M. bovis, M. marinum and some strains of M. kansasii, M. avium,M. fortuiturn and M. intracellulare. Contraindication: Hypersensitivity, pregnancy, optic neuritis, ocular defects and patients with impaired renal functions. Adverse effect: Decrease in visual acuity, hyperuricemia. Dosage: Initial treatment: 15 mg/kg/day in a single dose (range 500mg-1.5g), continued treatment: 25mg/kg/day for 60 days then 15mg/kg/day (range: 900mg-2.5g) Supply: Tab 400 mg Isoniazid-“INAH”(OINAH) ［ A ］ Indication: Bacteriostatic or bactericidal against Mycobacterium tuberculosis, used for pulmonary and extrapulmonary tuberculosis disease. Contraindication: Pregnancy, lactation, patients with chronic liver disease, severe renal impairment, daily users of alcohol. Adverse effect: Peripheral neuritis, hypersensitivity, hepatic injury, GI upsets, Vit B6 deficiency. Dosage: Use in conjunction with at least one other antituberculosis agent. Usual dose: 5-10 mg/kg/day (up to 300 mg/day) in a single dose. Supply: Tab 100 mg Pyrazinamide –“P.Z.A”(OPZA) ［ C ］ Indication: Use in conjunction with at least one other antituberculosis agent in the treatment of clinical tuberculosis. Contraindication: Patients with severe hepatic damage, renal failure, gout. Adverse effect: Hepatotoxicity, hyperuricemia, nausea, vomiting, anorexia. Dosage: The treatment of clinical tuberculosis, pyrazinamide should not be given alone. The ususal adult dosage is 20-35 mg/kg/day in 3-4 divided doses. Maximum dosage: 3 g/day. The usual children dosage is 15-30 mg/kg/day and a maximum dosage is 2 g/day. Supply: Tab 500 mg Rifampicin- “Rifampin” (ORIF4) ［ C ］ Indication: Bactericidal and active against Mycobacterium tuberculosis, M. bovis, M. marinum, M. kansasii, and gram positive and negative bacteria including Neisseria, Staphylococcus aureus, Haemophilus influenzae, Legionella pneumophilia. Contraindication: Hypersensitivity, pregnancy, lactation, liver disease. Adverse effect: GI disturbances, hypersensitivity reaction, headache, drowsiness, fatigue, ataxia, visual disturbances, and mental confusion. Dosage: PO 1 hour before or 2 hour after meals. For 34 - - 35 - - Dosage: 10 μg/ml in dextrose inj, 0.25 – 1 mg/kg/day. For Amphotericin B cholesteryl sulfate complex for invasive mycoses in adults and children 3-4 mg/kg/day IV (1 mg/kg/hr), dose may up to 7.5 mg/kg/day Supply: Inj 50 mg/vial Nystatin-“Mycostatin” (EMYCO) (BMYCO) ［ C ］ Indication: Fungistatic and fungicidal antibiotic against Candida spp, Coccidioides immitis, Cryptococcus neoformans, Hi stopl asma capsul atum, Bl astomyces dermatiditis. Contraindication: Hypersensitivity to nystatin. Adverse effect: Nausea, vomiting and diarrhea. Dosage: Vag 1 tab qd-bid for 2 wks; Powder, apply qid to affected area of mouth, retaining the drug as long as possible before swallowing Supply: Vag Tab 100,000 U; Susp 100,000 U/ml, 24 ml/bot 08:16 Antimycobacterials Ethambutol HCI-“Ebutol” (OEMB4) ［ B ］ Indication: Bacteriostatic and is active against organisms of Mycobacterium tuberculosis, M. bovis, M. marinum and some strains of M. kansasii, M. avium,M. fortuiturn and M. intracellulare. Contraindication: Hypersensitivity, pregnancy, optic neuritis, ocular defects and patients with impaired renal functions. Adverse effect: Decrease in visual acuity, hyperuricemia. Dosage: Initial treatment: 15 mg/kg/day in a single dose (range 500mg-1.5g), continued treatment: 25mg/kg/day for 60 days then 15mg/kg/day (range: 900mg-2.5g) Supply: Tab 400 mg Isoniazid-“INAH”(OINAH) ［ A ］ Indication: Bacteriostatic or bactericidal against Mycobacterium tuberculosis, used for pulmonary and extrapulmonary tuberculosis disease. Contraindication: Pregnancy, lactation, patients with chronic liver disease, severe renal impairment, daily users of alcohol. Adverse effect: Peripheral neuritis, hypersensitivity, hepatic injury, GI upsets, Vit B6 deficiency. Dosage: Use in conjunction with at least one other antituberculosis agent. Usual dose: 5-10 mg/kg/day (up to 300 mg/day) in a single dose. Supply: Tab 100 mg Pyrazinamide –“P.Z.A”(OPZA) ［ C ］ Indication: Use in conjunction with at least one other antituberculosis agent in the treatment of clinical tuberculosis. Contraindication: Patients with severe hepatic damage, renal failure, gout. Adverse effect: Hepatotoxicity, hyperuricemia, nausea, vomiting, anorexia. Dosage: The treatment of clinical tuberculosis, pyrazinamide should not be given alone. The ususal adult dosage is 20-35 mg/kg/day in 3-4 divided doses. Maximum dosage: 3 g/day. The usual children dosage is 15-30 mg/kg/day and a maximum dosage is 2 g/day. Supply: Tab 500 mg Rifampicin- “Rifampin” (ORIF4) ［ C ］ Indication: Bactericidal and active against Mycobacterium tuberculosis, M. bovis, M. marinum, M. kansasii, and gram positive and negative bacteria including Neisseria, Staphylococcus aureus, Haemophilus influenzae, Legionella pneumophilia. Contraindication: Hypersensitivity, pregnancy, lactation, liver disease. Adverse effect: GI disturbances, hypersensitivity reaction, headache, drowsiness, fatigue, ataxia, visual disturbances, and mental confusion. Dosage: PO 1 hour before or 2 hour after meals. For 36 - - 37 - - treatment of tuberculosis, use in combination with at least one other antituberculosis agent, usual adult dose: 600 mg/day as a single dose. Children > 5 years, 10-20 mg/kg/day, daily dose should not exceed 600 mg. Supply: Cap 450 mg Rifampicin/Isoniazid – “Rifinah” (ORIFI) ［ C ］ Indication: Tuberculosis Contraindication: Hypersensitivity to rifampin, isoniazid, or any component of the formulation; acute or chronic liver disease; jaundice Adverse effect: G-I irritation, nausea, vomiting, loss of appetite, hepatitis, flu-like headache, dizziness, fatigue, peri pheral neuropathy, convul si on, sl urred speech, lethargy, hyperreflexia, toxic encephalophathy, psychosis, hypersensitivity. Dosage: Tuberculosis: patients weighing 50 kg or greater: 2 tab orally as single daily dose. Take it at least 30 min before a meal or 2 hr after a meal Supply: Tab rifampicin 300 mg & isoniazid 150 mg 08:18 Antivirals 08:18.04 Adamantanes Amantadine – “Amanda” (OAMAND) ［ C ］ Indication: Amantadine is an antiviral agent. In addition, amantadine may be useful in the treatment of Parkinsonism, in the management of multiple sclerosis symptoms, and in combination with interferon for chronic hepatitis C. Place in therapy: Amantadine alone or with levodopa is useful in alleviating Parkinsonian symptoms; however, when used alone it does not appear to be as effective as levodopa or trihexyphenidyl. Contraindication: Hypersensitivity to amantadine; In Parkinson’s disease patients, abrupt discontinuation may result in Parkinsonian crisis. Adverse effect: Adverse effects include anticholinergic effects, confusion, disorientation, depression, nervousness, insomnia, and dermatologic reactions. Dosage: Adults: Extrapyramidal Reactions: 200-300 mg/day in divided doses for controlling drug-induced extrapyramidal reactions. Influenza A: 200 mg PO QD. Children: 1 to 9 years: 4.4 to 8.8 mg/kg/day to a maximum of 150 mg/day QD or BID. 10 years and older: 100 mg BID; however, for children weighing less than 40 kg, prescribing 5 milligrams/kilogram/day, regardless of age, is advisable Supply: Tab 100 mg 08:18.08 Antiretrovirals 08:18.08.20 Nucleoside and Nucleotide Reverse Transcriptase Inhibitors Lamivudine (3TC)-“Zeffix”(OZEFF) ( 專 ) ［ C ］ Indication: Lamivudine is a dideoxynucleoside analogue with antiretroviral activity. It is used for the treatment of human i mmunodefi ci ency vi rus (HIV) i nfecti on and acquired immunodeficiency syndrome (AIDS). Lamivudine is indicated for the treatment of chronic hepatitis B associated with evidence of hepatitis B viral replication and active liver inflammation. Place in therapy: Data suggest significant and sustained benefits of a combined regimen of lamivudine and zidovudine in patients with advanced HIV infection and limited exposure to zidovudine, as well as in patients who had previously received zidovudine for 6 months or longer. For combi nati on use wi th zi dovudi ne, i t shoul d be considered in patients with CD4+ cell counts of less than 500/mm3, either as first-line treatment or in those responding poorly to zidovudine alone. Lamivudine improves liver histology, increases hepatitis B antigen seroconversion, increases hepatitis B antibody, and normalizes serum alanine aminotransferase in patients 36 - - 37 - - treatment of tuberculosis, use in combination with at least one other antituberculosis agent, usual adult dose: 600 mg/day as a single dose. Children > 5 years, 10-20 mg/kg/day, daily dose should not exceed 600 mg. Supply: Cap 450 mg Rifampicin/Isoniazid – “Rifinah” (ORIFI) ［ C ］ Indication: Tuberculosis Contraindication: Hypersensitivity to rifampin, isoniazid, or any component of the formulation; acute or chronic liver disease; jaundice Adverse effect: G-I irritation, nausea, vomiting, loss of appetite, hepatitis, flu-like headache, dizziness, fatigue, peri pheral neuropathy, convul si on, sl urred speech, lethargy, hyperreflexia, toxic encephalophathy, psychosis, hypersensitivity. Dosage: Tuberculosis: patients weighing 50 kg or greater: 2 tab orally as single daily dose. Take it at least 30 min before a meal or 2 hr after a meal Supply: Tab rifampicin 300 mg & isoniazid 150 mg 08:18 Antivirals 08:18.04 Adamantanes Amantadine – “Amanda” (OAMAND) ［ C ］ Indication: Amantadine is an antiviral agent. In addition, amantadine may be useful in the treatment of Parkinsonism, in the management of multiple sclerosis symptoms, and in combination with interferon for chronic hepatitis C. Place in therapy: Amantadine alone or with levodopa is useful in alleviating Parkinsonian symptoms; however, when used alone it does not appear to be as effective as levodopa or trihexyphenidyl. Contraindication: Hypersensitivity to amantadine; In Parkinson’s disease patients, abrupt discontinuation may result in Parkinsonian crisis. Adverse effect: Adverse effects include anticholinergic effects, confusion, disorientation, depression, nervousness, insomnia, and dermatologic reactions. Dosage: Adults: Extrapyramidal Reactions: 200-300 mg/day in divided doses for controlling drug-induced extrapyramidal reactions. Influenza A: 200 mg PO QD. Children: 1 to 9 years: 4.4 to 8.8 mg/kg/day to a maximum of 150 mg/day QD or BID. 10 years and older: 100 mg BID; however, for children weighing less than 40 kg, prescribing 5 milligrams/kilogram/day, regardless of age, is advisable Supply: Tab 100 mg 08:18.08 Antiretrovirals 08:18.08.20 Nucleoside and Nucleotide Reverse Transcriptase Inhibitors Lamivudine (3TC)-“Zeffix”(OZEFF) ( 專 ) ［ C ］ Indication: Lamivudine is a dideoxynucleoside analogue with antiretroviral activity. It is used for the treatment of human i mmunodefi ci ency vi rus (HIV) i nfecti on and acquired immunodeficiency syndrome (AIDS). Lamivudine is indicated for the treatment of chronic hepatitis B associated with evidence of hepatitis B viral replication and active liver inflammation. Place in therapy: Data suggest significant and sustained benefits of a combined regimen of lamivudine and zidovudine in patients with advanced HIV infection and limited exposure to zidovudine, as well as in patients who had previously received zidovudine for 6 months or longer. For combi nati on use wi th zi dovudi ne, i t shoul d be considered in patients with CD4+ cell counts of less than 500/mm3, either as first-line treatment or in those responding poorly to zidovudine alone. Lamivudine improves liver histology, increases hepatitis B antigen seroconversion, increases hepatitis B antibody, and normalizes serum alanine aminotransferase in patients 38 - - 39 - - who had compensated chronic hepatitis B with evidence of viral replication and active liver inflammation. Contraindication: Hypersensitivity to lamivudine Adverse effect: Adverse effects of lamivudine include di arrhea and ot her gast roi nt est i nal di st urbances, headache, fatigue, insomnia, arthralgias, myalgias, elevated liver enzymes, skin rash, ear, nose, and throa infections. Neutropenia has not been frequent with recommended doses of lamivudine. Lactic acidosis and severe hepatomegaly with steatosis, including fatalities, have been reported. Dosage: Human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS): Adults 150 mg PO BID; Children (3 months up to 16 years): 4 mg/kg PO BID (up to a maximum dose of 150 mg BID); chronic hepatitis B: 100 mg PO QD Supply: Tab 100 mg 08:18.20 Interferons Peginterferon α - 2b-“Peg-Intron”(IPEGI)( 專 ) ［ C ］ Indication: Chronic Hepatitis C, patients with compensated liver disease who have not received interferon alfa therapy Pharmacology: Peginterferon alfa-2b is a covalent conjugate of straight-chain polyethylene glycol and recombinant interferon alfa-2b. Pegylation reduces the clearance of interferon alpha and may enhance its efficacy due to more prolonged exposure. Interferon alfa-2b has antiviral, immunomodulatory, and antiproliferative activity. Contraindication: Hypersensitivity to Peg-Intron or its components; autoimmune hepatitis, de-compensated liver disease Adverse effect: Headache, insomnia, anxiety, myalgia, alopecia, fatigue, fever, influenza-like illness Dosage: Chronic Hepatitis C: monotherapy, 1 mcg/kg/week (based on body weight) SC once weekly for 1 yr. Chronic Hepatitis C: combination therapy, 1.5 mcg/kg/week SC for 48 weeks in combination with oral ribavirin 400 mg twice daily. Peginterferon alfa-2b used alone or in combination with ribavirin should be discontinued after 6 months if HCV levels remain high. Preparation: Lyophilized powder should be reconstituted with 0.7 ml of the 1 ml sterile water diluent provided. Reconstituted solutions should be used immediately. Storage: Store at 2-8 ℃ ; do not freeze; do not shake. Supply: Inj 120 mcg/vial 08:18.28 Neuraminidase Inhibitors Oseltamivir-“Tamiflu”(OTAMF 自費 ) (OTAMI) ［ C ］ Indication: Influenza in adults and children 12 years and older Pharmacology: Oseltamivir phosphate is the ethyl ester prodrug of oseltamivir carboxylate, which selectively inhibits neuraminidases of influenza viruses of both types A and B. Contraindication: Hypersensitivity to oseltamivir products. Adverse effect: Nausea and vomiting in about 10% of patients. Bronchitis, insomnia, and vertigo occur occasionally. Dosage: Start within 48 hrs of onset of symptoms. Adult patients with ClCr >30 ml/min : 75 mg bid for 5 days; in renal insufficiency （ ClCr 10-30 ml/min ） : 75 mg /day for 5 days. There is no dosage information for ClCr ＜ 10 ml/min. In pediatrics, children ＞ 1 y/o and 15 kg or less, 30 mg bid for 5 days; children 15-23 kg, 45 mg bid for 5 days; children 23-40 kg, 60 mg bid for 5 days; children ＞ 40 kg, 75 mg bid for 5 days. Supply: Cap 75 mg Zanamivir-“Relenza” (ERELE) ［ C ］ Indication: Treatment of influenza A & B in adults & children > 7 years Contraindication: Hypersensitivity to zanamivir or any 38 - - 39 - - who had compensated chronic hepatitis B with evidence of viral replication and active liver inflammation. Contraindication: Hypersensitivity to lamivudine Adverse effect: Adverse effects of lamivudine include di arrhea and ot her gast roi nt est i nal di st urbances, headache, fatigue, insomnia, arthralgias, myalgias, elevated liver enzymes, skin rash, ear, nose, and throa infections. Neutropenia has not been frequent with recommended doses of lamivudine. Lactic acidosis and severe hepatomegaly with steatosis, including fatalities, have been reported. Dosage: Human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS): Adults 150 mg PO BID; Children (3 months up to 16 years): 4 mg/kg PO BID (up to a maximum dose of 150 mg BID); chronic hepatitis B: 100 mg PO QD Supply: Tab 100 mg 08:18.20 Interferons Peginterferon α - 2b-“Peg-Intron”(IPEGI)( 專 ) ［ C ］ Indication: Chronic Hepatitis C, patients with compensated liver disease who have not received interferon alfa therapy Pharmacology: Peginterferon alfa-2b is a covalent conjugate of straight-chain polyethylene glycol and recombinant interferon alfa-2b. Pegylation reduces the clearance of interferon alpha and may enhance its efficacy due to more prolonged exposure. Interferon alfa-2b has antiviral, immunomodulatory, and antiproliferative activity. Contraindication: Hypersensitivity to Peg-Intron or its components; autoimmune hepatitis, de-compensated liver disease Adverse effect: Headache, insomnia, anxiety, myalgia, alopecia, fatigue, fever, influenza-like illness Dosage: Chronic Hepatitis C: monotherapy, 1 mcg/kg/week (based on body weight) SC once weekly for 1 yr. Chronic Hepatitis C: combination therapy, 1.5 mcg/kg/week SC for 48 weeks in combination with oral ribavirin 400 mg twice daily. Peginterferon alfa-2b used alone or in combination with ribavirin should be discontinued after 6 months if HCV levels remain high. Preparation: Lyophilized powder should be reconstituted with 0.7 ml of the 1 ml sterile water diluent provided. Reconstituted solutions should be used immediately. Storage: Store at 2-8 ℃ ; do not freeze; do not shake. Supply: Inj 120 mcg/vial 08:18.28 Neuraminidase Inhibitors Oseltamivir-“Tamiflu”(OTAMF 自費 ) (OTAMI) ［ C ］ Indication: Influenza in adults and children 12 years and older Pharmacology: Oseltamivir phosphate is the ethyl ester prodrug of oseltamivir carboxylate, which selectively inhibits neuraminidases of influenza viruses of both types A and B. Contraindication: Hypersensitivity to oseltamivir products. Adverse effect: Nausea and vomiting in about 10% of patients. Bronchitis, insomnia, and vertigo occur occasionally. Dosage: Start within 48 hrs of onset of symptoms. Adult patients with ClCr >30 ml/min : 75 mg bid for 5 days; in renal insufficiency （ ClCr 10-30 ml/min ） : 75 mg /day for 5 days. There is no dosage information for ClCr ＜ 10 ml/min. In pediatrics, children ＞ 1 y/o and 15 kg or less, 30 mg bid for 5 days; children 15-23 kg, 45 mg bid for 5 days; children 23-40 kg, 60 mg bid for 5 days; children ＞ 40 kg, 75 mg bid for 5 days. Supply: Cap 75 mg Zanamivir-“Relenza” (ERELE) ［ C ］ Indication: Treatment of influenza A & B in adults & children > 7 years Contraindication: Hypersensitivity to zanamivir or any 40 - - 41 - - component of the product including lactose (milk proteins) Adverse effect: Very rarely, allergic-type reactions, including oropharyngeal edema, bronchospasm, dyspnea, rash, urticaria. Dosage: Adult & children >12 y/o: 2 inhalations BID for 5 days, providing a total inhaled dose of 20 mg/day. Treatment should begin as soon as possible (preferably within 2 days) after onset of symptoms. Supply: Rotadisk 5 mg zanamivir+20 mg lactose/dose, 4*5 dose/bx 08:18.32 Nucleosides and Nucleotides Acyclovir-“Zovirax” (IZOVI) ［ B ］ Indication: Treatment of herpes simplex infections in immuno-compromised patients. Contraindication: Hypersensitivity, use with caution in patients with abnormal renal function. Adverse effect: Severe inflammation sometimes leading to ulceration has resulted from accidental infusion into the tissue extravascularly. Dosage: Slow IV infusion 5 mg/kg over 1 hour Q8H, maximum daily dose: 30 mg/kg or 1.5 g/m 2 . Supply: Inj 250mg/vial Valaciclovir-“Valtrex” (OVALT) ［ B ］ Indication: Valacyclovir is indicated for the treatment of herpes zoster and episodic treatment of initial and recurrent genital herpes in immunocompetent adults. It is also indicated for the suppression of recurrent genital herpes. Contraindication: Valacyclovir is contraindicated in patients with hypersensitivity to acyclovir or valacyclovir products. Adverse effect: Headache, nausea, diarrhea, vomiting, constipation, weakness, dizziness, abdominal pain, and anorexia. Dosage: Herpes zoster: 1 g PO TID for 7 days; recurrent genital herpes: 500 mg PO BID for 5 days Supply: Tab 500 mg Ribavirin – “Robatrol”(OROBA) ( 專 ) ［ X ］ Indication: In combination with interferon α for treatment of chroni c hepati ti s C i n adul t pati ents who are α -i nterferonnai ve or who have rel apsed fol l owi ng α -interferon therapy. Contraindication: Hypersensitivity to ribavirin products; pregnancy or pregnant partner of male patient; Clcr ＜ 50 ml / mi n; ri bavi ri n as monot herapy f or hepat i t i s C; significant or unstable cardiac disease; patients with hemoglobinopathies; autoimmune hepatitis (in combination with peginterferon alfa-2a); hepatic decompensation Adverse effect: Headache, fatigue, pruritus, rash, dyspepsia, nausea, loss of appetite, anemia Dosage: Adults, chronic hepatitis C in combination with interferon alfa-2b: Body Weight < 75 kg, 400 mg PO in morning and 600 mg in evening; BW> 75 kg, 600 mg twice a day. Pediatrics( ≧ 3 yrs): chronic hepatitis C in combination with interferon alfa-2b: BW 25- 36 kg, 200 mg PO twice a day; BW 37 - 49 kg, 200 mg every morning and 400 mg every evening; BW 50- 61 kg, 400 mg twice a day; BW> 61 kg, use adult dosing. Supply: Cap 200 mg Entecavir-“Baraclude” (OBARA)( 專 ) ［ C ］ Indication: Treatment of chronic hepatitis B virus infection in adults with evidence of active viral replication & either evidence of persistent elevations in serum aminotransferases (ALT or AST) or histologically active disease. Contraindication: Hypersensitivity to entecavir or to any component of the product Adverse effect: Headache, fatigue, dizziness, nausea. Dosage: Take on an empty stomach at least 2 hr after a meal & 2 hr before the next meal. 40 - - 41 - - component of the product including lactose (milk proteins) Adverse effect: Very rarely, allergic-type reactions, including oropharyngeal edema, bronchospasm, dyspnea, rash, urticaria. Dosage: Adult & children >12 y/o: 2 inhalations BID for 5 days, providing a total inhaled dose of 20 mg/day. Treatment should begin as soon as possible (preferably within 2 days) after onset of symptoms. Supply: Rotadisk 5 mg zanamivir+20 mg lactose/dose, 4*5 dose/bx 08:18.32 Nucleosides and Nucleotides Acyclovir-“Zovirax” (IZOVI) ［ B ］ Indication: Treatment of herpes simplex infections in immuno-compromised patients. Contraindication: Hypersensitivity, use with caution in patients with abnormal renal function. Adverse effect: Severe inflammation sometimes leading to ulceration has resulted from accidental infusion into the tissue extravascularly. Dosage: Slow IV infusion 5 mg/kg over 1 hour Q8H, maximum daily dose: 30 mg/kg or 1.5 g/m 2 . Supply: Inj 250mg/vial Valaciclovir-“Valtrex” (OVALT) ［ B ］ Indication: Valacyclovir is indicated for the treatment of herpes zoster and episodic treatment of initial and recurrent genital herpes in immunocompetent adults. It is also indicated for the suppression of recurrent genital herpes. Contraindication: Valacyclovir is contraindicated in patients with hypersensitivity to acyclovir or valacyclovir products. Adverse effect: Headache, nausea, diarrhea, vomiting, constipation, weakness, dizziness, abdominal pain, and anorexia. Dosage: Herpes zoster: 1 g PO TID for 7 days; recurrent genital herpes: 500 mg PO BID for 5 days Supply: Tab 500 mg Ribavirin – “Robatrol”(OROBA) ( 專 ) ［ X ］ Indication: In combination with interferon α for treatment of chroni c hepati ti s C i n adul t pati ents who are α -i nterferonnai ve or who have rel apsed fol l owi ng α -interferon therapy. Contraindication: Hypersensitivity to ribavirin products; pregnancy or pregnant partner of male patient; Clcr ＜ 50 ml / mi n; ri bavi ri n as monot herapy f or hepat i t i s C; significant or unstable cardiac disease; patients with hemoglobinopathies; autoimmune hepatitis (in combination with peginterferon alfa-2a); hepatic decompensation Adverse effect: Headache, fatigue, pruritus, rash, dyspepsia, nausea, loss of appetite, anemia Dosage: Adults, chronic hepatitis C in combination with interferon alfa-2b: Body Weight < 75 kg, 400 mg PO in morning and 600 mg in evening; BW> 75 kg, 600 mg twice a day. Pediatrics( ≧ 3 yrs): chronic hepatitis C in combination with interferon alfa-2b: BW 25- 36 kg, 200 mg PO twice a day; BW 37 - 49 kg, 200 mg every morning and 400 mg every evening; BW 50- 61 kg, 400 mg twice a day; BW> 61 kg, use adult dosing. Supply: Cap 200 mg Entecavir-“Baraclude” (OBARA)( 專 ) ［ C ］ Indication: Treatment of chronic hepatitis B virus infection in adults with evidence of active viral replication & either evidence of persistent elevations in serum aminotransferases (ALT or AST) or histologically active disease. Contraindication: Hypersensitivity to entecavir or to any component of the product Adverse effect: Headache, fatigue, dizziness, nausea. Dosage: Take on an empty stomach at least 2 hr after a meal & 2 hr before the next meal. 42 - - 43 - - Supply: Tab 0.5 mg 08:30 Antiprotozoals 08:30.08 Antimalarials Hydroxychloroquine sulfate-“Plaquenil” (OPLAQ)“Geniquin”(OGENI) ［ D ］ Indication: For the suppressive and chemoprophylaxis treatment of acute attacks of malaria, discoid, systemic lupus erythematous and rheumatic arthritis. Contraindication: In the presence of retinal or visual field change attributable with known 4-aminoquinoline compounds, patients with known hypersensitivity to 4-aminoquinoline compounds, for long- term therapy in children. Adverse effect: Mild and transient headache, dizziness and GI complain (diarrhea, anorexia, nausea, abdominal cramps, rarely vomiting) may occur. Dosage: Adults: For malaria, as a suppressive 400 mg QW; for therapy, initially 800 mg, followed by 400 mg in 6-8 hours, and 400 mg QD on 2nd and 3rd days. For lupus erythematous: 200 – 400 mg QD or BID. For rheumatoid arthritis: 400-600 mg QD to start taken with food or milk, until remission occurs, then 200-400 mg QD for maintenance. Children: For malaria, as suppressive: 5 mg (calculated as base)/kg, not exceed the adult dose regardless of weight, for therapy: initially 10 mg/kg be taken in two divided doses 6 hours apart. The suppressive therapy should be continued for 8 weeks after leaving the endemic area. Supply: Tab 200 mg 08:30.92 Miscellanous Antiprotozoals Metronidazole-“Metrozole” (OMETR 專 ) “Medazole” (IMADA) ［ B ］ Indication: It has bactericidal, amebicidal and trichomonacidal action, active against most obligately anaerobic bacteria, trichomonas vaginalis, Entamoeba histolytic, Giardia lamblia. Contraindication: First trimester of pregnancy, hypersensitivity, patients with blood dyscrasia, severe hepatic impairment. Adverse effect: Metallic taste in mouth and GI complaints (high dosage); headache, anorexia, dry mouth, dizziness, vertigo, peripheral neuropathy, reversible leukopenia, skin rash; Disulfiram-like reaction. (if alcohol is taken during therapy). Dosage: For trichomoniasis: PO 2 g as a single dose or 250 mg TID for 7 days. For amebiasis: adults: PO 750 mg TID for 5-10 days; Children: PO 35-50 mg/kg/day in 3 divided dose for 5-10 days, MAX dose 2.4 g/day. For giardiasis: adults: 250 mg TID for 5-7 days, children: 15 mg/kg/day in 3 divided dose for 5 days. For anaerobic infection: PO or IV, initial dose 15 mg/kg, followed by maintenance dose 7.5 mg/kg/Q6H, MAX dose 4 g/day. Supply: Tab 250 mg; Inj 500 mg/100 ml/vial 10:00 Antineoplastic Agents Cisplatin – “Platinex” (ICIS5) ［ D ］ Indication: Ovarian carcinoma, squamous cell carcinoma of head and neck, lymphoma. Contraindication: Patients with renal and hearing impairment. Adverse effect: Severe nausea, vomiting, renal failure, peripheral neuropathy, ototoxicity, hypomagnesaemia. Dosage: 100mg/m2 IV infusion over 12 hours, alternative schedule 20 mg/m2/day for 5 days every 3 week for 3 courses, in combination with bleomycin & vinblastine. Stability: D5W with cisplatin 50 mg/L, reconstituted in sterile water for injection, stated to have a utility time of 8 hours at 25 ℃ or 24 hours at 4 ℃ in a glass container under fluorescent light. NS with cisplatin 1.25 mg/mL is stable for 48 hours in polyvinylchloride containers. Supply: Inj 50 mg/vial 42 - - 43 - - Supply: Tab 0.5 mg 08:30 Antiprotozoals 08:30.08 Antimalarials Hydroxychloroquine sulfate-“Plaquenil” (OPLAQ)“Geniquin”(OGENI) ［ D ］ Indication: For the suppressive and chemoprophylaxis treatment of acute attacks of malaria, discoid, systemic lupus erythematous and rheumatic arthritis. Contraindication: In the presence of retinal or visual field change attributable with known 4-aminoquinoline compounds, patients with known hypersensitivity to 4-aminoquinoline compounds, for long- term therapy in children. Adverse effect: Mild and transient headache, dizziness and GI complain (diarrhea, anorexia, nausea, abdominal cramps, rarely vomiting) may occur. Dosage: Adults: For malaria, as a suppressive 400 mg QW; for therapy, initially 800 mg, followed by 400 mg in 6-8 hours, and 400 mg QD on 2nd and 3rd days. For lupus erythematous: 200 – 400 mg QD or BID. For rheumatoid arthritis: 400-600 mg QD to start taken with food or milk, until remission occurs, then 200-400 mg QD for maintenance. Children: For malaria, as suppressive: 5 mg (calculated as base)/kg, not exceed the adult dose regardless of weight, for therapy: initially 10 mg/kg be taken in two divided doses 6 hours apart. The suppressive therapy should be continued for 8 weeks after leaving the endemic area. Supply: Tab 200 mg 08:30.92 Miscellanous Antiprotozoals Metronidazole-“Metrozole” (OMETR 專 ) “Medazole” (IMADA) ［ B ］ Indication: It has bactericidal, amebicidal and trichomonacidal action, active against most obligately anaerobic bacteria, trichomonas vaginalis, Entamoeba histolytic, Giardia lamblia. Contraindication: First trimester of pregnancy, hypersensitivity, patients with blood dyscrasia, severe hepatic impairment. Adverse effect: Metallic taste in mouth and GI complaints (high dosage); headache, anorexia, dry mouth, dizziness, vertigo, peripheral neuropathy, reversible leukopenia, skin rash; Disulfiram-like reaction. (if alcohol is taken during therapy). Dosage: For trichomoniasis: PO 2 g as a single dose or 250 mg TID for 7 days. For amebiasis: adults: PO 750 mg TID for 5-10 days; Children: PO 35-50 mg/kg/day in 3 divided dose for 5-10 days, MAX dose 2.4 g/day. For giardiasis: adults: 250 mg TID for 5-7 days, children: 15 mg/kg/day in 3 divided dose for 5 days. For anaerobic infection: PO or IV, initial dose 15 mg/kg, followed by maintenance dose 7.5 mg/kg/Q6H, MAX dose 4 g/day. Supply: Tab 250 mg; Inj 500 mg/100 ml/vial 10:00 Antineoplastic Agents Cisplatin – “Platinex” (ICIS5) ［ D ］ Indication: Ovarian carcinoma, squamous cell carcinoma of head and neck, lymphoma. Contraindication: Patients with renal and hearing impairment. Adverse effect: Severe nausea, vomiting, renal failure, peripheral neuropathy, ototoxicity, hypomagnesaemia. Dosage: 100mg/m2 IV infusion over 12 hours, alternative schedule 20 mg/m2/day for 5 days every 3 week for 3 courses, in combination with bleomycin & vinblastine. Stability: D5W with cisplatin 50 mg/L, reconstituted in sterile water for injection, stated to have a utility time of 8 hours at 25 ℃ or 24 hours at 4 ℃ in a glass container under fluorescent light. NS with cisplatin 1.25 mg/mL is stable for 48 hours in polyvinylchloride containers. Supply: Inj 50 mg/vial 44 - - 45 - - Cyclophosphamide-“Endoxan-Asta (Syklofosfamid) (ISYKL)” ［ D ］ Indication: Acute leukemia, lymphomas, Hodgkin’s disease, endometrial carcinoma, breast cancer, sarcomas. Contraindication: Hemorrhagic cystitis, diabetes mellitus, renal and hepatic failure. Adverse effect: Leukopenia, thrombocytopenia, alopecia, cystitis, nausea, vomiting, pulmonary fibrosis, cardiotoxicity, skin rash. Dosage: Initial: IV 2.5mg/kg/day; maintenance: 2.5mg/kg twice week, oral 2.5mg/kg/day. Stability: Cyclophosphamide 100 mg/L or 3.1 g/L in D5W, 1.5% or less cyclophosphamide decomposition in 8 hours at 24 to 27 ℃ or 6 days at 5 ℃ . Cyclophosphamide 4 g/L in Sodium Chloride 0.9%, 3.5% cyclophosphamide decomposition in 24 hours at room temperature and 1% decomposition in 4 weeks under refrigeration. Supply: Inj 200 mg/vial Fluorouracil-“5-FU” (I5FU5)( 專 ) ［ X ］ Indication: Carcinoma of the colon, rectum, breast, stomach and pancreas. Contraindication: Poor nutritional state, depressed bone marrow function, azotemia, impaired liver function, and serious infections. Adverse effect: Nausea, stomatitis, diarrhoea, thrombocytopenia, leucopenia, alopecia. Dosage: IV push, infusion, IA, IP. 15mg/kg/day for 3 days, maximum dose: 800 mg/day Stability: Dextrose 5% in water with fluorouracil 8.3 g/L in a polyvinylchloride container, 10% decrease in fluorouracil concentration in 43 hours at room t emperat ure. Fl uorouraci l 500mg/ L D5W or NS i s compatible for 24 hours in glass or polyolefin containers. Supply: Inj 500mg/10ml/vial. Gemcitabine HCL – “Gemzar” (IGEMC) (IGEMCI)( 專 ) ［ D ］ Indication: It can be used in advanced breast cancer, non-small-cell lung cancer, pancreatic carcinoma, and ovarian carcinoma. Place in therapy: A greater intracellular accumulation of active metabolites is achieved with gemcitabine relative to cytarabine, and it may process superior antitumor activity than cytarabin. Contraindication: Hypersensitivity to gemcitabine; use carefully in patients with hepatic dysfunction, myelosuppression, pregnancy, renal impairment, and avoid infusion times longer than 60 minutes. Monitor CBC prior to each dose. Adverse effect: The adverse effects include: myelosuppression (dose limiting), flu-like symptoms (occasionally dose-limiting), fatigue, fever, peripheral edema, proteinuria, cutaneous reactions, and gastrointestinal effects. Dosage: Pancreatic cancer: 1000 mg/m 2 IV once weekly for 7 consecutive doses non-small-cell lung cancer: 1000 mg/m 2 IV for 3 consecutive doses per cycle. Infusion time more than 30 min may induce further adverse effects. Dosage adjustment according to monitoring of the platelet, WBC and agranulocytosis: Agranulaocyte (x 10 6 /L) Platelet count (x 10 6 /L) % of Total Dose >1000 And >100000 100 500-1000 Or 50000-100000 75 <500 Or <50000 Hold Stability: The reconstituted solution is prepared with 5 ml NS. The maximum concentration of reconstituted solution is 40 mg/ml. The further diluted solution is stable for 24 hours at 15-30 ℃ . Supply: Inj 200 mg/vial Methotrexate-“ MTX” (OMTX)“Abitrexate” (IMTX) ( 專 ) ［ X ］ Indication: Low dose therapy: choriocarcinoma, lymphotic leukemia, breast carcinoma. High dose therapy: malignant melanoma, osteogenic sarcoma, epidermoid 44 - - 45 - - Cyclophosphamide-“Endoxan-Asta (Syklofosfamid) (ISYKL)” ［ D ］ Indication: Acute leukemia, lymphomas, Hodgkin’s disease, endometrial carcinoma, breast cancer, sarcomas. Contraindication: Hemorrhagic cystitis, diabetes mellitus, renal and hepatic failure. Adverse effect: Leukopenia, thrombocytopenia, alopecia, cystitis, nausea, vomiting, pulmonary fibrosis, cardiotoxicity, skin rash. Dosage: Initial: IV 2.5mg/kg/day; maintenance: 2.5mg/kg twice week, oral 2.5mg/kg/day. Stability: Cyclophosphamide 100 mg/L or 3.1 g/L in D5W, 1.5% or less cyclophosphamide decomposition in 8 hours at 24 to 27 ℃ or 6 days at 5 ℃ . Cyclophosphamide 4 g/L in Sodium Chloride 0.9%, 3.5% cyclophosphamide decomposition in 24 hours at room temperature and 1% decomposition in 4 weeks under refrigeration. Supply: Inj 200 mg/vial Fluorouracil-“5-FU” (I5FU5)( 專 ) ［ X ］ Indication: Carcinoma of the colon, rectum, breast, stomach and pancreas. Contraindication: Poor nutritional state, depressed bone marrow function, azotemia, impaired liver function, and serious infections. Adverse effect: Nausea, stomatitis, diarrhoea, thrombocytopenia, leucopenia, alopecia. Dosage: IV push, infusion, IA, IP. 15mg/kg/day for 3 days, maximum dose: 800 mg/day Stability: Dextrose 5% in water with fluorouracil 8.3 g/L in a polyvinylchloride container, 10% decrease in fluorouracil concentration in 43 hours at room t emperat ure. Fl uorouraci l 500mg/ L D5W or NS i s compatible for 24 hours in glass or polyolefin containers. Supply: Inj 500mg/10ml/vial. Gemcitabine HCL – “Gemzar” (IGEMC) (IGEMCI)( 專 ) ［ D ］ Indication: It can be used in advanced breast cancer, non-small-cell lung cancer, pancreatic carcinoma, and ovarian carcinoma. Place in therapy: A greater intracellular accumulation of active metabolites is achieved with gemcitabine relative to cytarabine, and it may process superior antitumor activity than cytarabin. Contraindication: Hypersensitivity to gemcitabine; use carefully in patients with hepatic dysfunction, myelosuppression, pregnancy, renal impairment, and avoid infusion times longer than 60 minutes. Monitor CBC prior to each dose. Adverse effect: The adverse effects include: myelosuppression (dose limiting), flu-like symptoms (occasionally dose-limiting), fatigue, fever, peripheral edema, proteinuria, cutaneous reactions, and gastrointestinal effects. Dosage: Pancreatic cancer: 1000 mg/m 2 IV once weekly for 7 consecutive doses non-small-cell lung cancer: 1000 mg/m 2 IV for 3 consecutive doses per cycle. Infusion time more than 30 min may induce further adverse effects. Dosage adjustment according to monitoring of the platelet, WBC and agranulocytosis: Agranulaocyte (x 10 6 /L) Platelet count (x 10 6 /L) % of Total Dose >1000 And >100000 100 500-1000 Or 50000-100000 75 <500 Or <50000 Hold Stability: The reconstituted solution is prepared with 5 ml NS. The maximum concentration of reconstituted solution is 40 mg/ml. The further diluted solution is stable for 24 hours at 15-30 ℃ . Supply: Inj 200 mg/vial Methotrexate-“ MTX” (OMTX)“Abitrexate” (IMTX) ( 專 ) ［ X ］ Indication: Low dose therapy: choriocarcinoma, lymphotic leukemia, breast carcinoma. High dose therapy: malignant melanoma, osteogenic sarcoma, epidermoid 46 - - 47 - - carcinoma of neck and head, small cell carcinoma of lung. Contraindication: Psoriatic patients with severe renal or hepatic disorder, blood dyscrasia, pregnant women. Adverse effect: Nausea, vomiting, leukopenia, thrombocytopenia, stomatitis, diarrhoea, hepatic and lung fibrosis. Dosage: 2.5-5 mg/day or 15-50 mg/m 2 every 1-2 weeks, IM, IT, PO; 12mg/m 2 twice weekly, IT. Pharmacokinetics and Biopharmaceutics: Serum levels: Following high dose therapy, a threshold for bone-marrow and mucosal toxicity approximates 1.0 X 10 -6 mol/L 48 hours after dosing. To prevent toxicity, palsma levels should be keep below 10 -5 mol/L at 24 hours, 5 X 10 -7 mol/L at 48 hours and 5 X 10 -8 mol/L at 72 hours. PO and IM absorption are rapid, peaking at 1-2 and 0.1-1 hour, respectively. Following IT dosing there is slow diffusion of drug into the blood stream. PO and IM doses less than 30 mg/m 2 are completely absorbed, larger doses are only about 50-70% absorbed. Protein binding is 60-70%, Vd is 0.5-1.0 L/Kg. Elimination Half-life: (t1/2) Initial half-life: 2-4 hours; terminal half-life: 8-15 hours. Stability: D5W with methotrexate 50mg/L is compatible for 24 hours in glass or polyolefin containers; conditions not specified. Methotrexate 50mg/mL in Sodium Chloride 0.9%, chemically is stable for at least 1 week at 22 to 25 ℃ . Supply: Tab 2.5mg; Inj 50mg/2 ml Tegafur/Uracil – “Ufur” (OUFUR) ［ D ］ Indication: Ufur is approved for treatment of stomach cancer, breast cancer, and colon cancer. Place in therapy: Oral tegafur has offered hope of a more convenient method of administering 5-fluorouracil, and the minimal hematologic toxicity observed with oral tegafur has suggested its use in combination with other myelosuppressive agents without the need for significant dose reduction. Uracil mustard is of value in the palliative treatment of certain neoplasms such as chronic lymphocytic leukemia, non-Hodgkin’s lymphoma, and chronic myelogenous leukemia. Uracil mustard is not effective in acute lymphomas. Contraindication: Hypersensitivity to tegafur or uracil; patient take sorivudine Adverse effect: The toxicity profile of tegafur differs from 5-fluorouracil; nausea, vomiting, stomatitis, diarrhea, skin rash, and neurotoxicity (dizziness, confusion, ataxia) are the most frequent adverse events, which are minimized by administration of the drug orally in continuous low-dose regimens. Bone marrow depression is the dose-limiting effect of uracil mustard therapy. At an accumulated dose of 1 mg/kg, the risk of irreversible bone marrow damage is high. Dosage: 5-8 cap (tegafur 500-800 mg, 300-350 mg/m 2 /day) PO in 2-3 divided doses Supply: Cap tegafur 100mg & uracil 224 mg Bleomycin Hydrochloride-“Bleocin”(IBLEO) ( 專 ) ［ D ］ Indication: Squamous cell carcinoma of neck and head, cervix vulvovaginal area, skin, penis and rectum; Hodgkin’s and non-Hodgkin’s lymphoma, mycosis fugoids, testicular tumor, lung cancer. Contraindication: Lymphomas, renal impairment, pulmonary disease. Adverse effect: Stomatitis, alopecia, edema fingers, skin hyperpigmentation, lung fibrosis, thrombophlebitis, anorexia. Dosage: IM, SC, IV push, in intermittent infusion: 7.5-15 mg/m 2 /day for 5 days, total maximum dose: 225-400U. Stability: Bleomycin 300 U/L in D5W in a glass container, 10% reduction is observed in 11 hours at 25 ℃ , but little further reduction in 24 hours. Bleomycin 0.3 U/mL (or Bleomycin 3 U/mL) reconstituted with NS injection, no decrease in bleomycin concentration for 24 hours when stored at 22 to 25 ℃ in both glass and polyvinylchloride containers. Supply: Inj 5 mg/vial 46 - - 47 - - carcinoma of neck and head, small cell carcinoma of lung. Contraindication: Psoriatic patients with severe renal or hepatic disorder, blood dyscrasia, pregnant women. Adverse effect: Nausea, vomiting, leukopenia, thrombocytopenia, stomatitis, diarrhoea, hepatic and lung fibrosis. Dosage: 2.5-5 mg/day or 15-50 mg/m 2 every 1-2 weeks, IM, IT, PO; 12mg/m 2 twice weekly, IT. Pharmacokinetics and Biopharmaceutics: Serum levels: Following high dose therapy, a threshold for bone-marrow and mucosal toxicity approximates 1.0 X 10 -6 mol/L 48 hours after dosing. To prevent toxicity, palsma levels should be keep below 10 -5 mol/L at 24 hours, 5 X 10 -7 mol/L at 48 hours and 5 X 10 -8 mol/L at 72 hours. PO and IM absorption are rapid, peaking at 1-2 and 0.1-1 hour, respectively. Following IT dosing there is slow diffusion of drug into the blood stream. PO and IM doses less than 30 mg/m 2 are completely absorbed, larger doses are only about 50-70% absorbed. Protein binding is 60-70%, Vd is 0.5-1.0 L/Kg. Elimination Half-life: (t1/2) Initial half-life: 2-4 hours; terminal half-life: 8-15 hours. Stability: D5W with methotrexate 50mg/L is compatible for 24 hours in glass or polyolefin containers; conditions not specified. Methotrexate 50mg/mL in Sodium Chloride 0.9%, chemically is stable for at least 1 week at 22 to 25 ℃ . Supply: Tab 2.5mg; Inj 50mg/2 ml Tegafur/Uracil – “Ufur” (OUFUR) ［ D ］ Indication: Ufur is approved for treatment of stomach cancer, breast cancer, and colon cancer. Place in therapy: Oral tegafur has offered hope of a more convenient method of administering 5-fluorouracil, and the minimal hematologic toxicity observed with oral tegafur has suggested its use in combination with other myelosuppressive agents without the need for significant dose reduction. Uracil mustard is of value in the palliative treatment of certain neoplasms such as chronic lymphocytic leukemia, non-Hodgkin’s lymphoma, and chronic myelogenous leukemia. Uracil mustard is not effective in acute lymphomas. Contraindication: Hypersensitivity to tegafur or uracil; patient take sorivudine Adverse effect: The toxicity profile of tegafur differs from 5-fluorouracil; nausea, vomiting, stomatitis, diarrhea, skin rash, and neurotoxicity (dizziness, confusion, ataxia) are the most frequent adverse events, which are minimized by administration of the drug orally in continuous low-dose regimens. Bone marrow depression is the dose-limiting effect of uracil mustard therapy. At an accumulated dose of 1 mg/kg, the risk of irreversible bone marrow damage is high. Dosage: 5-8 cap (tegafur 500-800 mg, 300-350 mg/m 2 /day) PO in 2-3 divided doses Supply: Cap tegafur 100mg & uracil 224 mg Bleomycin Hydrochloride-“Bleocin”(IBLEO) ( 專 ) ［ D ］ Indication: Squamous cell carcinoma of neck and head, cervix vulvovaginal area, skin, penis and rectum; Hodgkin’s and non-Hodgkin’s lymphoma, mycosis fugoids, testicular tumor, lung cancer. Contraindication: Lymphomas, renal impairment, pulmonary disease. Adverse effect: Stomatitis, alopecia, edema fingers, skin hyperpigmentation, lung fibrosis, thrombophlebitis, anorexia. Dosage: IM, SC, IV push, in intermittent infusion: 7.5-15 mg/m 2 /day for 5 days, total maximum dose: 225-400U. Stability: Bleomycin 300 U/L in D5W in a glass container, 10% reduction is observed in 11 hours at 25 ℃ , but little further reduction in 24 hours. Bleomycin 0.3 U/mL (or Bleomycin 3 U/mL) reconstituted with NS injection, no decrease in bleomycin concentration for 24 hours when stored at 22 to 25 ℃ in both glass and polyvinylchloride containers. Supply: Inj 5 mg/vial 48 - - 49 - - Mitomycin-“Mitomycin”(IMIT1)( 專 ) ［ D ］ Indication: Adenocarcinoma of stomach, pancrease, colon or breast; head and neck cancers; advanced biliary ovarian; lung and cervical, squamous cell carcinomas; transitional cell carcinoma of the urinary bladder. Contraindication: Thrombocytopenia, coagulation disorders. Adverse effect: Nausea, vomiting, thrombocytopenia, leukopenia, stomatitis, alopecia. Dosage: 10mg/m 2 IV, every 3-4 weeks. Stability: D5W with mitomycin 20 to 40 mg/L is stable for 3 hours at room temperature. Mitomycin 40 mg/L in NS is reported less than 10% mitomycin loss reported in 24 hours at 25 ℃ . Supply: Inj 10mg/vial Epirubicin HcI-“Pharmorubicin” (IPHAR) ( 專 ) ［ D ］ Indication: Breast carcinoma, malignant lymphomas, soft tissue sarcomas, gastric and ovarian carcinomas. Contraindication: Myelodepression, severe heart disease, previous treatments with maximal cumulative doses of adriamycin or daunoblastin. Adverse effect: Cardiac toxicity, alopecia, mucositis, gastro-intestinal disorders, hematologic toxicity. Dosage: The recommended dose for single agent in adult is 75-90 mg/m 2 body surfaces, as 3-5 minutes IV injections 3 weekly when compatible with extent bone marrow function. Supply: Inj 10 mg Tamoxifen-“Tamoplex”(OTAMO) ［ D ］ Indication: Advanced breast cancer. Contraindication: Hypersensitivity to tamoxifen, patients with leukopenia or thrombocytopenia; pregnancy. Adverse effect: Peripheral edema, reduced hemoglobulin, gynecological problems (vaginal bleeding, menstrual irregularities). Dosage: 10-20 mg PO BID. Supply: Tab 10 mg Cyproterone-“Androcur”(OANDR) Indication: Cyproterone acetate is an antiandrogen with progestogenic activity. Use alone or in combination with estrogens has demonstrated some degree of efficacy in a variety of conditions, including advanced prostatic carcinoma, hypersexual behavior disorders, endometriosis, hirsutism, acne, post-orchiectomy hot flashes, and lupus erythematosus Contraindication: Previous hypersensitivity to cyproterone acetate; malignant diseases other than prostatic carcinoma; history of thromboembolic disorders; acute liver disease Adverse effect: Impotence, inhibition of spermatogenesis, headache, lassitude, menstrual irregularities, gynecomastia, galactorrhea, weight gain, lipid abnormalities, gastrointestinal disturbances, and anemia. Cardiovascular toxicity including fluid retention, venous thromboembolism, myocardial ischemia, and cerebrovascular accidents has occurred in 10% of prostate cancer patients treated with the drug; breathlessness has also been reported in prostate cancer patients. Skin reaction, weight change, headache, anaemia, gynaecomastia, abnormal spermatozoa, nausea, hair pattern, infertility, and gastrointestinal disturbance, decrease renal function. Dosage: 50 mg BID, if necessary after 4 weeks, increase to 200-300 mg/day Supply: Tab 50 mg Bicalutamide – “Casodex” (OCASO) ［ X ］ Indication: Bicalutamide is a pure nonsteroidal antiandrogen. It is indicated for use in combination therapy with a luteinizing hormone-releasing hormone (LHRH) analogue for the treatment of Stage D 2 metastatic carcinoma of the prostate. 48 - - 49 - - Mitomycin-“Mitomycin”(IMIT1)( 專 ) ［ D ］ Indication: Adenocarcinoma of stomach, pancrease, colon or breast; head and neck cancers; advanced biliary ovarian; lung and cervical, squamous cell carcinomas; transitional cell carcinoma of the urinary bladder. Contraindication: Thrombocytopenia, coagulation disorders. Adverse effect: Nausea, vomiting, thrombocytopenia, leukopenia, stomatitis, alopecia. Dosage: 10mg/m 2 IV, every 3-4 weeks. Stability: D5W with mitomycin 20 to 40 mg/L is stable for 3 hours at room temperature. Mitomycin 40 mg/L in NS is reported less than 10% mitomycin loss reported in 24 hours at 25 ℃ . Supply: Inj 10mg/vial Epirubicin HcI-“Pharmorubicin” (IPHAR) ( 專 ) ［ D ］ Indication: Breast carcinoma, malignant lymphomas, soft tissue sarcomas, gastric and ovarian carcinomas. Contraindication: Myelodepression, severe heart disease, previous treatments with maximal cumulative doses of adriamycin or daunoblastin. Adverse effect: Cardiac toxicity, alopecia, mucositis, gastro-intestinal disorders, hematologic toxicity. Dosage: The recommended dose for single agent in adult is 75-90 mg/m 2 body surfaces, as 3-5 minutes IV injections 3 weekly when compatible with extent bone marrow function. Supply: Inj 10 mg Tamoxifen-“Tamoplex”(OTAMO) ［ D ］ Indication: Advanced breast cancer. Contraindication: Hypersensitivity to tamoxifen, patients with leukopenia or thrombocytopenia; pregnancy. Adverse effect: Peripheral edema, reduced hemoglobulin, gynecological problems (vaginal bleeding, menstrual irregularities). Dosage: 10-20 mg PO BID. Supply: Tab 10 mg Cyproterone-“Androcur”(OANDR) Indication: Cyproterone acetate is an antiandrogen with progestogenic activity. Use alone or in combination with estrogens has demonstrated some degree of efficacy in a variety of conditions, including advanced prostatic carcinoma, hypersexual behavior disorders, endometriosis, hirsutism, acne, post-orchiectomy hot flashes, and lupus erythematosus Contraindication: Previous hypersensitivity to cyproterone acetate; malignant diseases other than prostatic carcinoma; history of thromboembolic disorders; acute liver disease Adverse effect: Impotence, inhibition of spermatogenesis, headache, lassitude, menstrual irregularities, gynecomastia, galactorrhea, weight gain, lipid abnormalities, gastrointestinal disturbances, and anemia. Cardiovascular toxicity including fluid retention, venous thromboembolism, myocardial ischemia, and cerebrovascular accidents has occurred in 10% of prostate cancer patients treated with the drug; breathlessness has also been reported in prostate cancer patients. Skin reaction, weight change, headache, anaemia, gynaecomastia, abnormal spermatozoa, nausea, hair pattern, infertility, and gastrointestinal disturbance, decrease renal function. Dosage: 50 mg BID, if necessary after 4 weeks, increase to 200-300 mg/day Supply: Tab 50 mg Bicalutamide – “Casodex” (OCASO) ［ X ］ Indication: Bicalutamide is a pure nonsteroidal antiandrogen. It is indicated for use in combination therapy with a luteinizing hormone-releasing hormone (LHRH) analogue for the treatment of Stage D 2 metastatic carcinoma of the prostate. 50 - - 51 - - Place in therapy: Its long half-life enables once-daily dosing, an advantage over flutamide; it may also be less toxic than flutamide. Contraindication: Hypersensitivity to bicalutamide; pregnancy; women Adverse effect: Bicalutamide should not be used in women, especially in women who are or may become pregnant. Severe liver injury resulting in death has been reported. The predominant adverse effects of bicalutamide are hot flashes, breast tenderness, gynecomastia, pain (general, back, pelvic) asthenia and constipation. Loss of libido and impotence are relatively infrequent. Bicalutamide is not peripherally selective; increased luteinizing hormone and serum testosterone levels occur during therapy. Dosage: Adults: 50 mg PO QD Pharmacokinetics: Oral absorption is slow from the GI tract, with peak serum levels occurring 16 hours after doses of 50 mg; significant accumulation (tenfold) occurs with repeat daily doses. Supply: Tab 50 mg Flutamide-“Fuprostate” (OFUPR) ［ D ］ Indication: Treatment of metastatic prostatic carcinoma Place in therapy: Flutamide is a non-steroidal non-hormonal antiandroge. In treating prostate cancer, flutamide compares favorably to DES and leuprolide monotherapy. Flutamide represents a less toxic alternative to DES or surgical orchiectomy and provides additional benefit when used in combination with leuprolide in patients with carcinoma of the prostate and as such will be a useful formulary addition. Contraindication: Hypersensitivity to flutamide; severe hepatic impairment Adverse effect: Gynecomastia and galactorrhea are the most frequently reported adverse effects. Other adverse effects include diarrhea, which has resulted in non-compliance, nausea, and vomiting and transient serum transaminase elevations. Dosage: 250 mg PO TID; Doses of 1.5 g/day have also been effective, without increased toxicity. Pharmacokinetics: Flutamide is rapidly and completely absorbed after oral administration; the elimination half-life is 5 to 6 hours. Supply: Tab 250 mg Leuprorelin acetate-“Leuplin Depot” (ILEUP)( 專案 )(IZOLA)( 自費 ) ［ X ］ Indication: Palliative treatment of advanced prostatic carcinoma, central precocious puberty, endometriosis. Place in therapy: The drug appears to be as effective as diethylstilbestrol (3 mg daily) in the palliative treatment of metastatic prostate cancer, but with a lower order of toxicity. The effectiveness in the treatment of endometriosis is equivalent to danazol. It has also been used to ovarian stimulation for in vitro fertilization-embryo transfer procedure. Contraindication: Hypersensitivity to leuprolide, GnRH, or GnRH analogs; spinal-cord compression (orchiectomy suggested); pregnancy; undiagnosed abnormal vaginal bleeding; breast-feeding. Adverse effect: Vasomotor hot flashes, edema, gynecomastia, bone pain, thrombosis, and GI disturbances. Dosage: Prostatic cancer: 3.75 mg SC or IM once a month; endometriosis: 3.75 mg SC or IM once a month, initiate at 1st-5th day after the start of menstrual period; central precocious puberty: 300 μg/kg/dose IM every 28 days (minimum dose: 7.5 mg). Stability: The Leuprorelin vials should be avoided freezing the product and protected from light and stored in the carton until used. The potency of the reconstituted suspension has been shown to be stable for 24 hours. Supply: Depot inj 3.75 mg/vial 12:00 Autonomic Drugs 50 - - 51 - - Place in therapy: Its long half-life enables once-daily dosing, an advantage over flutamide; it may also be less toxic than flutamide. Contraindication: Hypersensitivity to bicalutamide; pregnancy; women Adverse effect: Bicalutamide should not be used in women, especially in women who are or may become pregnant. Severe liver injury resulting in death has been reported. The predominant adverse effects of bicalutamide are hot flashes, breast tenderness, gynecomastia, pain (general, back, pelvic) asthenia and constipation. Loss of libido and impotence are relatively infrequent. Bicalutamide is not peripherally selective; increased luteinizing hormone and serum testosterone levels occur during therapy. Dosage: Adults: 50 mg PO QD Pharmacokinetics: Oral absorption is slow from the GI tract, with peak serum levels occurring 16 hours after doses of 50 mg; significant accumulation (tenfold) occurs with repeat daily doses. Supply: Tab 50 mg Flutamide-“Fuprostate” (OFUPR) ［ D ］ Indication: Treatment of metastatic prostatic carcinoma Place in therapy: Flutamide is a non-steroidal non-hormonal antiandroge. In treating prostate cancer, flutamide compares favorably to DES and leuprolide monotherapy. Flutamide represents a less toxic alternative to DES or surgical orchiectomy and provides additional benefit when used in combination with leuprolide in patients with carcinoma of the prostate and as such will be a useful formulary addition. Contraindication: Hypersensitivity to flutamide; severe hepatic impairment Adverse effect: Gynecomastia and galactorrhea are the most frequently reported adverse effects. Other adverse effects include diarrhea, which has resulted in non-compliance, nausea, and vomiting and transient serum transaminase elevations. Dosage: 250 mg PO TID; Doses of 1.5 g/day have also been effective, without increased toxicity. Pharmacokinetics: Flutamide is rapidly and completely absorbed after oral administration; the elimination half-life is 5 to 6 hours. Supply: Tab 250 mg Leuprorelin acetate-“Leuplin Depot” (ILEUP)( 專案 )(IZOLA)( 自費 ) ［ X ］ Indication: Palliative treatment of advanced prostatic carcinoma, central precocious puberty, endometriosis. Place in therapy: The drug appears to be as effective as diethylstilbestrol (3 mg daily) in the palliative treatment of metastatic prostate cancer, but with a lower order of toxicity. The effectiveness in the treatment of endometriosis is equivalent to danazol. It has also been used to ovarian stimulation for in vitro fertilization-embryo transfer procedure. Contraindication: Hypersensitivity to leuprolide, GnRH, or GnRH analogs; spinal-cord compression (orchiectomy suggested); pregnancy; undiagnosed abnormal vaginal bleeding; breast-feeding. Adverse effect: Vasomotor hot flashes, edema, gynecomastia, bone pain, thrombosis, and GI disturbances. Dosage: Prostatic cancer: 3.75 mg SC or IM once a month; endometriosis: 3.75 mg SC or IM once a month, initiate at 1st-5th day after the start of menstrual period; central precocious puberty: 300 μg/kg/dose IM every 28 days (minimum dose: 7.5 mg). Stability: The Leuprorelin vials should be avoided freezing the product and protected from light and stored in the carton until used. The potency of the reconstituted suspension has been shown to be stable for 24 hours. Supply: Depot inj 3.75 mg/vial 12:00 Autonomic Drugs 52 - - 53 - - 12:04 Parasympathomimetic (Cholinergic) Agents Neostigmine methylsulfate -“Neostigmine” (INEOS)( 特 )[C] Indication: Myasthenia gravis (diagnosis and treatment) antidote for tubocurarine, postoperative urinary retention and distension. Contraindication: Mechanical intestinal or urinary obstruction, bradycardia, bronchial asthma, coronary occlusion, epilepsy, hypotension, Pparkinsonism. Adverse effect: Nausea, vomiting, abdominal cramps and diarrhea, salivation, sweating, miosis, anorexia, increased bronchial secretion, bronchoconstriction, bradycardia, and hypotension Dosage: Myasthenia gravis: 0.5 mg Q4-6H, IM or SC; Antidote of tubocurarine: 0.5-2 mg with atropine sulfate (0.6-1.2 mg) by slow IV injection. Supply: Inj 0.5 mg/ml/amp Pyridostigmine bromide-“Mestinon” (OMEST) ［ C ］ Indication: Myasthenia gravis, reversal of nondepolarizing muscle relaxants, intestinal atony, atonic constipation. Contraindication: Hypersensitivity, mechanical intestinal or urinary obstruction, bronchial asthma, coronary occlusion, history of reaction to bromide. Adverse effect: Nausea, vomiting, abdominal cramps, miosis, increase salivation and bronchial secretion, bradycardia, hypotension. Dosage: Myasthenia gravis: 60-80 mg BID-QID. Intestinal atony, atonic constipation: 60 mg as required (Q4H) Supply: Tab 60 mg. Bethanechol-“Dampurine”(ODAMP) ［ C ］ Indication: Post-op urinary retention & atony of the bladder, post-partum urinary retention. Post-op abdominal distention, and congenital megacolon. Contraindication: Avoid use when the strength or integrity of the GI or bladder wall is compromised or in the presence of mechanical obstruction. Hyperthyroidism, peptic ulcer, latent or active bronchial asthma, pronounced bradycardi a, hypot ensi on, vasomot or instability, coronary artery disease, epilepsy & Parkinsonism. Adverse effect: Abdominal cramps or discomfort, flushing of the skin, sweating. Malaise, headache, fall in BP. Colicky pain, diarrhea, urinary urgency, bronchial constriction. Nausea & belching. Dosage: 10-50 mg/day in 3-4 divided doses. Supply: Tab 25 mg Donepezil – “Aricept” (OARIC 自費 ) (OARIC 專案 ) ［ C ］ Indication: Donepezil is a centrally active acetylcholinesterase inhibitor. It has efficacy in mild-to-moderate Alzheimer’s disease when given once daily. Place in therapy: Donepezil possesses a high degree of selectivity for central nervous system acetylcholinesterase, with a low propensity for peripheral activity. Contraindication: Hypersensitivity to donepezil or piperidine derivatives. Use with caution in patients with active gastrointestinal diseases, asthma, COPD, seizure, and sick sinus syndrome. Adverse effect: Adverse effects are nausea, vomiting, diarrhea, muscle cramps, insomnia, fatigue, and anorexia. Dosage: Adults: mild-to-moderate Alzheimer’s disease: 5 or 10 mg PO QD Supply: Tab 5 mg Rivastigmine – “Exelon” (OEXEL 專案 ) ［ B ］ Indication: Rivastigmine is a carbamate acetylcholinesterase inhibitor with regional selectivity for the hippocampus and cortex. It is indicated for the treatment of mild to moderate dementia of the 52 - - 53 - - 12:04 Parasympathomimetic (Cholinergic) Agents Neostigmine methylsulfate -“Neostigmine” (INEOS)( 特 )[C] Indication: Myasthenia gravis (diagnosis and treatment) antidote for tubocurarine, postoperative urinary retention and distension. Contraindication: Mechanical intestinal or urinary obstruction, bradycardia, bronchial asthma, coronary occlusion, epilepsy, hypotension, Pparkinsonism. Adverse effect: Nausea, vomiting, abdominal cramps and diarrhea, salivation, sweating, miosis, anorexia, increased bronchial secretion, bronchoconstriction, bradycardia, and hypotension Dosage: Myasthenia gravis: 0.5 mg Q4-6H, IM or SC; Antidote of tubocurarine: 0.5-2 mg with atropine sulfate (0.6-1.2 mg) by slow IV injection. Supply: Inj 0.5 mg/ml/amp Pyridostigmine bromide-“Mestinon” (OMEST) ［ C ］ Indication: Myasthenia gravis, reversal of nondepolarizing muscle relaxants, intestinal atony, atonic constipation. Contraindication: Hypersensitivity, mechanical intestinal or urinary obstruction, bronchial asthma, coronary occlusion, history of reaction to bromide. Adverse effect: Nausea, vomiting, abdominal cramps, miosis, increase salivation and bronchial secretion, bradycardia, hypotension. Dosage: Myasthenia gravis: 60-80 mg BID-QID. Intestinal atony, atonic constipation: 60 mg as required (Q4H) Supply: Tab 60 mg. Bethanechol-“Dampurine”(ODAMP) ［ C ］ Indication: Post-op urinary retention & atony of the bladder, post-partum urinary retention. Post-op abdominal distention, and congenital megacolon. Contraindication: Avoid use when the strength or integrity of the GI or bladder wall is compromised or in the presence of mechanical obstruction. Hyperthyroidism, peptic ulcer, latent or active bronchial asthma, pronounced bradycardi a, hypot ensi on, vasomot or instability, coronary artery disease, epilepsy & Parkinsonism. Adverse effect: Abdominal cramps or discomfort, flushing of the skin, sweating. Malaise, headache, fall in BP. Colicky pain, diarrhea, urinary urgency, bronchial constriction. Nausea & belching. Dosage: 10-50 mg/day in 3-4 divided doses. Supply: Tab 25 mg Donepezil – “Aricept” (OARIC 自費 ) (OARIC 專案 ) ［ C ］ Indication: Donepezil is a centrally active acetylcholinesterase inhibitor. It has efficacy in mild-to-moderate Alzheimer’s disease when given once daily. Place in therapy: Donepezil possesses a high degree of selectivity for central nervous system acetylcholinesterase, with a low propensity for peripheral activity. Contraindication: Hypersensitivity to donepezil or piperidine derivatives. Use with caution in patients with active gastrointestinal diseases, asthma, COPD, seizure, and sick sinus syndrome. Adverse effect: Adverse effects are nausea, vomiting, diarrhea, muscle cramps, insomnia, fatigue, and anorexia. Dosage: Adults: mild-to-moderate Alzheimer’s disease: 5 or 10 mg PO QD Supply: Tab 5 mg Rivastigmine – “Exelon” (OEXEL 專案 ) ［ B ］ Indication: Rivastigmine is a carbamate acetylcholinesterase inhibitor with regional selectivity for the hippocampus and cortex. It is indicated for the treatment of mild to moderate dementia of the 54 - - 55 - - Alzheimer’s type. Place in therapy: Rivastigmine appears to have greater central than peripheral activity, which may result in fewer peripheral adverse events. Donepezil and rivastigmine were found to be equally effective in providing cognitive improvement in patients with mild to moderate Alzheimer’s disease. Contraindication: Hypersensitivity to rivastigmine or carbamate derivatives Adverse effect: Use of rivastigmine is associated with significant gastrointestinal effects including nausea, vomiting, anorexia, and weight loss. Other frequently occurring adverse effects include fatigue, asthenia, dizziness, headache, diarrhea, dyspepsia, insomnia and confusion. Dosage: Adults: Initially 1.5 mg PO BID then titrated to 6-12 mg daily; do not exceed 12 mg/day Pharmacokinetics: Inhibition of plasma cholinesterase is observed for up to 10 hours. Supply: Cap 1.5 mg Galantamine HBr-“Reminyl”(OREMI 專案 ) ［ B ］ Indication: Mild to moderately severe dementia of the Alzheimer type. Contraindication: Hypersensitivity to galantamine or any component of the product Adverse effect: Nausea, vomiting, diarrhea, abdominal pain, dyspepsia, anorexia, fatigue Dosage: Initially 8 mg/day for 4 weeks, maintenance 16 mg/day for least 4 weeks, may be increased to MAX of 24 mg/day. Supply: Tab 8 mg 12:08 Anticholinergic Agents 12:08.08 Antimuscarinics/Antispasmodics Atropine sulfate (IATRO) ［ C ］ Indication: Antisecretory, antispasmodics, treatment of acute poisoning of parasympathomimetic agents. Contraindication: Prostatic enlargement, paralytic ileus, pyloric stenosis, glaucoma, tachycardia. Adverse effect: Tachycardia, increasing ocular tension, pupil’s dilatation, dry mouth, blurred vision, dysurea, headache, weakness, nausea, vomiting, restlessness, and rash. Dosage: Anticholinergic: 0.4-0.6 mg IV, SC. Preanesthetic medication: 0.3-0.6 mg, SC, IM or IV. Antidote of cholinesterase inhibitor: 2-4 mg IV then 2 mg, every 5-10 min, IM, until muscarinic symptoms disappear or atropine toxicity appear. Stability: Atropine is incompatible with alkaline solution; decomposition reported. Supply: Inj 1mg/ml/amp Hyoscyamine-“Buwecon” (OBUWE) ［ C ］ Indication: Gastric ulcers, gastric hypersecretion, visceral spasm & hypermotility in spastic colitis, spastic bladder, pylorospasm, vomiting during pregnancy, cystitis & dysmenorrhoea. Contraindication: Glaucoma, obstructive uropathy, obstructive disease of the GIT, paralytic ileus, intestinal atony of elderly or debiliated patients, unstable CV status in acute haemorrhage, severe ulcerative colitis, toxic megacolon complicating ulcerative colitis, myasthenia gravis. Adverse effect: Dry mouth, urinary hesitancy & retention, blurred vision, tachycardia, palpitation, mydriasis, cycloplegia, increased ocular tension, loss of taste, headache, nervousness, drowsiness, weakness, dizziness, insomnia, nausea, vomiting, impotence, suppression of lactation, constipation, bloated feeling, urticaria, ataxia, speech disturbance, mental confusion &/or excitement & decreased sweating. Dosage: Adult & children >12 years 1-2 tab 4 hrly. Max: 54 - - 55 - - Alzheimer’s type. Place in therapy: Rivastigmine appears to have greater central than peripheral activity, which may result in fewer peripheral adverse events. Donepezil and rivastigmine were found to be equally effective in providing cognitive improvement in patients with mild to moderate Alzheimer’s disease. Contraindication: Hypersensitivity to rivastigmine or carbamate derivatives Adverse effect: Use of rivastigmine is associated with significant gastrointestinal effects including nausea, vomiting, anorexia, and weight loss. Other frequently occurring adverse effects include fatigue, asthenia, dizziness, headache, diarrhea, dyspepsia, insomnia and confusion. Dosage: Adults: Initially 1.5 mg PO BID then titrated to 6-12 mg daily; do not exceed 12 mg/day Pharmacokinetics: Inhibition of plasma cholinesterase is observed for up to 10 hours. Supply: Cap 1.5 mg Galantamine HBr-“Reminyl”(OREMI 專案 ) ［ B ］ Indication: Mild to moderately severe dementia of the Alzheimer type. Contraindication: Hypersensitivity to galantamine or any component of the product Adverse effect: Nausea, vomiting, diarrhea, abdominal pain, dyspepsia, anorexia, fatigue Dosage: Initially 8 mg/day for 4 weeks, maintenance 16 mg/day for least 4 weeks, may be increased to MAX of 24 mg/day. Supply: Tab 8 mg 12:08 Anticholinergic Agents 12:08.08 Antimuscarinics/Antispasmodics Atropine sulfate (IATRO) ［ C ］ Indication: Antisecretory, antispasmodics, treatment of acute poisoning of parasympathomimetic agents. Contraindication: Prostatic enlargement, paralytic ileus, pyloric stenosis, glaucoma, tachycardia. Adverse effect: Tachycardia, increasing ocular tension, pupil’s dilatation, dry mouth, blurred vision, dysurea, headache, weakness, nausea, vomiting, restlessness, and rash. Dosage: Anticholinergic: 0.4-0.6 mg IV, SC. Preanesthetic medication: 0.3-0.6 mg, SC, IM or IV. Antidote of cholinesterase inhibitor: 2-4 mg IV then 2 mg, every 5-10 min, IM, until muscarinic symptoms disappear or atropine toxicity appear. Stability: Atropine is incompatible with alkaline solution; decomposition reported. Supply: Inj 1mg/ml/amp Hyoscyamine-“Buwecon” (OBUWE) ［ C ］ Indication: Gastric ulcers, gastric hypersecretion, visceral spasm & hypermotility in spastic colitis, spastic bladder, pylorospasm, vomiting during pregnancy, cystitis & dysmenorrhoea. Contraindication: Glaucoma, obstructive uropathy, obstructive disease of the GIT, paralytic ileus, intestinal atony of elderly or debiliated patients, unstable CV status in acute haemorrhage, severe ulcerative colitis, toxic megacolon complicating ulcerative colitis, myasthenia gravis. Adverse effect: Dry mouth, urinary hesitancy & retention, blurred vision, tachycardia, palpitation, mydriasis, cycloplegia, increased ocular tension, loss of taste, headache, nervousness, drowsiness, weakness, dizziness, insomnia, nausea, vomiting, impotence, suppression of lactation, constipation, bloated feeling, urticaria, ataxia, speech disturbance, mental confusion &/or excitement & decreased sweating. Dosage: Adult & children >12 years 1-2 tab 4 hrly. Max: 56 - - 57 - - 12 tab/day. Children 2-12 years 0.5-1 tab 4 hrly. Max: 6 tab/day. Supply: Tab 0.125 mg Hyoscine-N-butylbromide-“Buscopan” (IBUSC) ( 專 )(OBUSC)[C] Indication: Gastric and duodenal ulcer, intestinal colic, cholelithicolic, claming delirium. Contraindication: Hypersensitivity, glaucoma, tachycardia, GI obstructive, mega colon, ulcerative colitis, and myasthenia gravis. Adverse effect: Dry mouth, urinary hesitancy, blurred vision, constipation, tachycardia, drowsiness, dizziness, nausea, vomiting, headache, flushing. Dosage: Oral, 10-20mg TID-QID; IM, IV, SC, 20 mg several times daily Supply: Inj 20 mg/ml/amp; Tab 10 mg Ipratropium bromide-“Atrovent (MDI)” (EATRO)(EATROV)“Ipratran”(EIPRA) ［ B ］ Indication: Bronchospasm associated with COPD, asthma, bronchitis, and emphysema Pharmacology: Ipratropium is an anticholinergic bronchodilator. Contraindication: Hypersensitivity; caution in patients with acute narrow-angle glaucoma, prostatic hypertrophy, bladder-neck obstruction. Adverse effect: Dryness (25%), bitter or bad taste in the mouth, paradoxical deterioration in pulmonary function resulting in bronchoconstriction. Dosage: Inhalation, 1-2 puffs TID-QID, MAX 12 puffs/day; Nebulization, 1 vial TID-QID, the next vial should be inhaled at least 2 hours later, Max 2 mg/day Supply: Nebular solution 0.5 mg/2 ml/vial (Atrovent; Ipratran); Inhaler 0.02 mg/puff, 200 puffs/set Tiotropium-“Spiriva”(ESPIR) ［ C ］ Indication: Maintenance treatment of bronchospasm associated with COPD (bronchitis and emphysema). Pharmacology: Blockade of muscarinic receptor subtypes M1 and M3, facilitating bronchodilation and reducing mucus secretion. Pharmacokinetics: Poorly absorbed from GI tract, systemic absorption may occur from lung. Protein binding 72%; following inhalation, time to peak plasma: 5 min; bioavailability 19.5%; elimination half-life 5-6 days. Contraindications: Hypersensitivity to atropine or its derivatives, tiotropium, ipratropium, or any component of the formulation (contains lactose); not for use as an acute (“rescue”) bronchodilator. Adverse effect: Increased heart rate, constipation, xerostomia, blurred vision, glaucoma, difficulty passing urine, upper respiratory tract infection, sinusitis; pharyngeal irritation. Dosage: Oral inhalation: one capsule (18 mcg) inhaled once daily using HandiHaler ® inhalation device. Plasma concentrations increase in renal impairment, use caution; no specific dosage adjustment recommended. Supply: Powder for oral inhalation 18 mcg/capsule [packaged in 30s with HandiHaler ® device] Pinaverium – “Delibs”(ODELI) Indication: Pinaverium is a calcium channel-blocking agent (spasmolytic) used for the treatment of gastrointestinal disorders. Contraindication: Hypersensitivity to pinaverium bromide or bromides Adverse effect: The adverse effects of pinaverium include epigastric pain and/or fullness, heartburn, constipation, abdominal distention, dry mouth, headache, and drowsiness. Dosage: Irritable bowel syndrome: 50 mg PO TID; Give with food to minimize irritation of esophageal mucosa. Pharmacokinetics: Elimination half-life of approximately 1.5 hour Supply: Tab 50 mg 56 - - 57 - - 12 tab/day. Children 2-12 years 0.5-1 tab 4 hrly. Max: 6 tab/day. Supply: Tab 0.125 mg Hyoscine-N-butylbromide-“Buscopan” (IBUSC) ( 專 )(OBUSC)[C] Indication: Gastric and duodenal ulcer, intestinal colic, cholelithicolic, claming delirium. Contraindication: Hypersensitivity, glaucoma, tachycardia, GI obstructive, mega colon, ulcerative colitis, and myasthenia gravis. Adverse effect: Dry mouth, urinary hesitancy, blurred vision, constipation, tachycardia, drowsiness, dizziness, nausea, vomiting, headache, flushing. Dosage: Oral, 10-20mg TID-QID; IM, IV, SC, 20 mg several times daily Supply: Inj 20 mg/ml/amp; Tab 10 mg Ipratropium bromide-“Atrovent (MDI)” (EATRO)(EATROV)“Ipratran”(EIPRA) ［ B ］ Indication: Bronchospasm associated with COPD, asthma, bronchitis, and emphysema Pharmacology: Ipratropium is an anticholinergic bronchodilator. Contraindication: Hypersensitivity; caution in patients with acute narrow-angle glaucoma, prostatic hypertrophy, bladder-neck obstruction. Adverse effect: Dryness (25%), bitter or bad taste in the mouth, paradoxical deterioration in pulmonary function resulting in bronchoconstriction. Dosage: Inhalation, 1-2 puffs TID-QID, MAX 12 puffs/day; Nebulization, 1 vial TID-QID, the next vial should be inhaled at least 2 hours later, Max 2 mg/day Supply: Nebular solution 0.5 mg/2 ml/vial (Atrovent; Ipratran); Inhaler 0.02 mg/puff, 200 puffs/set Tiotropium-“Spiriva”(ESPIR) ［ C ］ Indication: Maintenance treatment of bronchospasm associated with COPD (bronchitis and emphysema). Pharmacology: Blockade of muscarinic receptor subtypes M1 and M3, facilitating bronchodilation and reducing mucus secretion. Pharmacokinetics: Poorly absorbed from GI tract, systemic absorption may occur from lung. Protein binding 72%; following inhalation, time to peak plasma: 5 min; bioavailability 19.5%; elimination half-life 5-6 days. Contraindications: Hypersensitivity to atropine or its derivatives, tiotropium, ipratropium, or any component of the formulation (contains lactose); not for use as an acute (“rescue”) bronchodilator. Adverse effect: Increased heart rate, constipation, xerostomia, blurred vision, glaucoma, difficulty passing urine, upper respiratory tract infection, sinusitis; pharyngeal irritation. Dosage: Oral inhalation: one capsule (18 mcg) inhaled once daily using HandiHaler ® inhalation device. Plasma concentrations increase in renal impairment, use caution; no specific dosage adjustment recommended. Supply: Powder for oral inhalation 18 mcg/capsule [packaged in 30s with HandiHaler ® device] Pinaverium – “Delibs”(ODELI) Indication: Pinaverium is a calcium channel-blocking agent (spasmolytic) used for the treatment of gastrointestinal disorders. Contraindication: Hypersensitivity to pinaverium bromide or bromides Adverse effect: The adverse effects of pinaverium include epigastric pain and/or fullness, heartburn, constipation, abdominal distention, dry mouth, headache, and drowsiness. Dosage: Irritable bowel syndrome: 50 mg PO TID; Give with food to minimize irritation of esophageal mucosa. Pharmacokinetics: Elimination half-life of approximately 1.5 hour Supply: Tab 50 mg 58 - - 59 - - Timepidium bromide-“Sesden”(OSESD) Indication: Relief of pain due to spasm of smooth muscle and pain due to physical motion disorder associated with the following diseases: Gastritis, gastric and duodenal ulcer, enteritis, gallbladder and bile-duct disease, and lithangiuria. Relief of pain caused by pancreatitis. Contraindication: Glaucoma, dysuria caused by prostatomegaly, severe cardiac disease, paralytic ileus, history of hypersensitivity to this drug. Adverse effect: Photophobia, headache, vertigo, sleeping, thirst, constipation, anorexia palpitation, eruption, dysuria, nausea. Dosage: Adults: PO 1 Cap TID Supply: Cap 30 mg Alverine citrate-“ Soverine”(OSOVE) Indication: Dysmenorrhea & pre-menstrual pain; selective muscle spasmolytic in conditions eg. Irritable bowel syndrome, painful diverticular disease of the colon. Contraindication: Paralytic ileus. Dosage: 1 or 2 cap once-tid. Supply: Cap 60 mg Mebeverine HCI - “Bebenline”(OBEBE)( 專 ) Indication: Antispasmodic in GI disorders. Contraindication: No contraindication with glaucoma or prostatic hypertrophy. Adverse effect: Prolonged use may lower blood pressure. Dosage: 135 mg TID Supply: Tab 135 mg 12:12 Sympathomimetic (Adrenergic) Agents 12:12.04 α -Adrenergic Agonists Midodrine HCI-“Midorine” (OMIDO) ［ C ］ Indication: Treatment of symptomatic orthostatic hypotension. Adjunct in the management of urinary incontinence. Contraindication: Severe organic heart disease, acute renal disease, urinary retention, pheochromocytoma, t hyrotoxicosis. Adverse effect: Supine hypertension (discontinue), paresthesia, pruritus, goosebumps, chills, dysuria. Dosage: 1-2 tab bid-tid Supply: Tab 2.5 mg 12:12.08 β −Adrenergic Agonists 12:12.08.04 non-selective β -adrenergic agonists Isoproterenol-“Proternol-L” (IPROT) ［ C ］ Indication: Bronchial spasm. Contraindication: Acute coronary disease, cardiac arrhythmia, hyperthyroidism, digitalis intoxication, hypertension, do not use with adrenaline at the same time, but may be used alternately. Adverse effect: Tachycardia, palpitation, hypotension, headache, precordial pain, flushing, nervousness, tremor, weakness. Dosage: IV drip 0.5-5 mcg/min, dosage must be monitoring. Supply: Inj 0.2 mg/ml/amp 12:12.08.08 selective β 1 −adrenergic agonists Dopamine HCI-“Dopamin” (IDOPA) ［ C ］ Indication: Correction of hemodynamic imbalance present in shock acute renal failure, poor perfusion of vital organs, low cardiac output, and hypotension. Contraindication: Pheochromocytoma, uncorrected tachycardias, or ventricular fibrillation. Adverse effect: Nausea, vomiting, ectropic beats, palpitation tachycardia, angina pain, dyspnea, headache, excessive vasoconstriction, hypertension. 58 - - 59 - - Timepidium bromide-“Sesden”(OSESD) Indication: Relief of pain due to spasm of smooth muscle and pain due to physical motion disorder associated with the following diseases: Gastritis, gastric and duodenal ulcer, enteritis, gallbladder and bile-duct disease, and lithangiuria. Relief of pain caused by pancreatitis. Contraindication: Glaucoma, dysuria caused by prostatomegaly, severe cardiac disease, paralytic ileus, history of hypersensitivity to this drug. Adverse effect: Photophobia, headache, vertigo, sleeping, thirst, constipation, anorexia palpitation, eruption, dysuria, nausea. Dosage: Adults: PO 1 Cap TID Supply: Cap 30 mg Alverine citrate-“ Soverine”(OSOVE) Indication: Dysmenorrhea & pre-menstrual pain; selective muscle spasmolytic in conditions eg. Irritable bowel syndrome, painful diverticular disease of the colon. Contraindication: Paralytic ileus. Dosage: 1 or 2 cap once-tid. Supply: Cap 60 mg Mebeverine HCI - “Bebenline”(OBEBE)( 專 ) Indication: Antispasmodic in GI disorders. Contraindication: No contraindication with glaucoma or prostatic hypertrophy. Adverse effect: Prolonged use may lower blood pressure. Dosage: 135 mg TID Supply: Tab 135 mg 12:12 Sympathomimetic (Adrenergic) Agents 12:12.04 α -Adrenergic Agonists Midodrine HCI-“Midorine” (OMIDO) ［ C ］ Indication: Treatment of symptomatic orthostatic hypotension. Adjunct in the management of urinary incontinence. Contraindication: Severe organic heart disease, acute renal disease, urinary retention, pheochromocytoma, t hyrotoxicosis. Adverse effect: Supine hypertension (discontinue), paresthesia, pruritus, goosebumps, chills, dysuria. Dosage: 1-2 tab bid-tid Supply: Tab 2.5 mg 12:12.08 β −Adrenergic Agonists 12:12.08.04 non-selective β -adrenergic agonists Isoproterenol-“Proternol-L” (IPROT) ［ C ］ Indication: Bronchial spasm. Contraindication: Acute coronary disease, cardiac arrhythmia, hyperthyroidism, digitalis intoxication, hypertension, do not use with adrenaline at the same time, but may be used alternately. Adverse effect: Tachycardia, palpitation, hypotension, headache, precordial pain, flushing, nervousness, tremor, weakness. Dosage: IV drip 0.5-5 mcg/min, dosage must be monitoring. Supply: Inj 0.2 mg/ml/amp 12:12.08.08 selective β 1 −adrenergic agonists Dopamine HCI-“Dopamin” (IDOPA) ［ C ］ Indication: Correction of hemodynamic imbalance present in shock acute renal failure, poor perfusion of vital organs, low cardiac output, and hypotension. Contraindication: Pheochromocytoma, uncorrected tachycardias, or ventricular fibrillation. Adverse effect: Nausea, vomiting, ectropic beats, palpitation tachycardia, angina pain, dyspnea, headache, excessive vasoconstriction, hypertension. 60 - - 61 - - Dosage: IV drip 5-10 mcg/kg/min as needed, do not add to alkali solution. Stability: D5W with dopamine 400 mg/L is compatible for 24 hours in glass or polyolefin container. D5W in 0.9% NS with dopamine 800 mg/L is less than 5% decomposed for 48 hours at 25 ℃ in glass container. Supply: Inj 40 mg/ml, 5 ml/amp Dobutamine HCI-“Dobuject’ (IDOBU) ［ B ］ Indication: Used to increase cardiac output in the short-term treatment of patients with cardiac decompensation caused by depressed contractility from organic heart disease or cardiac surgical procedures. Contraindication: Patients with idiopathic hypertropic subaortic stenosis. Adverse effect: Ectopic heartbeats, increased heart rate, angina, chest pain, palpitation, and elevations in blood pressure. Dosage: The rate of infusion needed to increase cardiac output is 2.5-10 mcg/kg/min. On rare occasions infusion rates up to 40 mcg/kg/min have been required to obtain the desired effect. Stability: In D5W 250 mg/L it is stable for 48 hours at 25 ℃ , and no decomposition in 7 days at 5 ℃ . In NS 2 g/L it is visually compatible for 24 hours. Supply: Inj 250 mg/5 ml/amp 12:12.08.12 selective β 2 −adrenergic agonists Albuterol (Salbutamol)-“Ventolin” (EVENT) (EVENI)(OVENT)“Buventol”(EBUVE)( 專 ) ［ C ］ Indication: Bronchial asthma, chronic bronchitis and emphysema. Contraindication: Thyrotoxicosis, hypersensitivity to sympatho-mimetic amines. Adverse effect: Headache, dizziness, nausea, tremor, palpitation, nervousness, leg cramps. Dosage: Metered dose inhaler 100-200 μg 3-4 times daily, a minimum of 3 hrs is required between doses. Solution for inhalation, a dose of 2.5 mg diluted to 3 ml with normal saline, 3-4 times daily by nebulization. Supply: Nebules 5 mg/2.5 ml; Inhaler 100 μg/actuation, 200 actuation/box; Tab 2 mg; Easyhaler 200 μg/dose, 200 dose/box Bambuterol-“Baburol” (OBABU) ［ B ］ Indication: Bambuterol is a prodrug of terbutaline. Bambuterol enables once-daily oral dosing of terbutaline for the treatment of asthma, but long-term studies involving larger patient populations are required to confirm its efficacy and ultimate place in therapy. Contraindication: Hypersensitivity to bambuterol, terbutaline, or other sympathomimetic amines. Adverse effect: Tremor, palpitations, headache, uneasiness, and increases in heart rate have been reported. Dosage: Asthma: 20-30 mg PO QD Pharmacokinetics: Bambuterol is slowly hydrolyzed to terbutaline in the plasma by cholinesterase. Stable terbutaline plasma levels and adequate bronchodilation have been reported for 24 hours with once-daily doses of bambuterol; the elimination half-life of terbutaline after bambuterol administration is extended to approximately 20 hours, compared to 3 to 4 hours following oral doses of conventional terbutaline tablets. Supply: Tab 10 mg Procaterol HCI-“Meptin”(BMEPL) Indication: Procaterol is indicated primarily in the treatment of asthma. Place in therapy: Procaterol appears to be at least as effective as albuterol, similar in efficacy to metaproterenol, and less effective than terbutaline. Contraindication: Hypersensitivity to procaterol. Adverse effect: Side effects include: nervousness, tremor and headache; EKG changes, tachycardia and 60 - - 61 - - Dosage: IV drip 5-10 mcg/kg/min as needed, do not add to alkali solution. Stability: D5W with dopamine 400 mg/L is compatible for 24 hours in glass or polyolefin container. D5W in 0.9% NS with dopamine 800 mg/L is less than 5% decomposed for 48 hours at 25 ℃ in glass container. Supply: Inj 40 mg/ml, 5 ml/amp Dobutamine HCI-“Dobuject’ (IDOBU) ［ B ］ Indication: Used to increase cardiac output in the short-term treatment of patients with cardiac decompensation caused by depressed contractility from organic heart disease or cardiac surgical procedures. Contraindication: Patients with idiopathic hypertropic subaortic stenosis. Adverse effect: Ectopic heartbeats, increased heart rate, angina, chest pain, palpitation, and elevations in blood pressure. Dosage: The rate of infusion needed to increase cardiac output is 2.5-10 mcg/kg/min. On rare occasions infusion rates up to 40 mcg/kg/min have been required to obtain the desired effect. Stability: In D5W 250 mg/L it is stable for 48 hours at 25 ℃ , and no decomposition in 7 days at 5 ℃ . In NS 2 g/L it is visually compatible for 24 hours. Supply: Inj 250 mg/5 ml/amp 12:12.08.12 selective β 2 −adrenergic agonists Albuterol (Salbutamol)-“Ventolin” (EVENT) (EVENI)(OVENT)“Buventol”(EBUVE)( 專 ) ［ C ］ Indication: Bronchial asthma, chronic bronchitis and emphysema. Contraindication: Thyrotoxicosis, hypersensitivity to sympatho-mimetic amines. Adverse effect: Headache, dizziness, nausea, tremor, palpitation, nervousness, leg cramps. Dosage: Metered dose inhaler 100-200 μg 3-4 times daily, a minimum of 3 hrs is required between doses. Solution for inhalation, a dose of 2.5 mg diluted to 3 ml with normal saline, 3-4 times daily by nebulization. Supply: Nebules 5 mg/2.5 ml; Inhaler 100 μg/actuation, 200 actuation/box; Tab 2 mg; Easyhaler 200 μg/dose, 200 dose/box Bambuterol-“Baburol” (OBABU) ［ B ］ Indication: Bambuterol is a prodrug of terbutaline. Bambuterol enables once-daily oral dosing of terbutaline for the treatment of asthma, but long-term studies involving larger patient populations are required to confirm its efficacy and ultimate place in therapy. Contraindication: Hypersensitivity to bambuterol, terbutaline, or other sympathomimetic amines. Adverse effect: Tremor, palpitations, headache, uneasiness, and increases in heart rate have been reported. Dosage: Asthma: 20-30 mg PO QD Pharmacokinetics: Bambuterol is slowly hydrolyzed to terbutaline in the plasma by cholinesterase. Stable terbutaline plasma levels and adequate bronchodilation have been reported for 24 hours with once-daily doses of bambuterol; the elimination half-life of terbutaline after bambuterol administration is extended to approximately 20 hours, compared to 3 to 4 hours following oral doses of conventional terbutaline tablets. Supply: Tab 10 mg Procaterol HCI-“Meptin”(BMEPL) Indication: Procaterol is indicated primarily in the treatment of asthma. Place in therapy: Procaterol appears to be at least as effective as albuterol, similar in efficacy to metaproterenol, and less effective than terbutaline. Contraindication: Hypersensitivity to procaterol. Adverse effect: Side effects include: nervousness, tremor and headache; EKG changes, tachycardia and 62 - - 63 - - ventricular arrhythmias have also been reported. Dosage: Adult: 50-100 μg PO BID. Children: >6 years old, 25 μg PO QN or BID; <6 years old, 10-15 μg PO QD. Supply: Solution 5 μg/ml, 60 ml/bot Trimetoquinol HCI-“Inolin”(OINOL) Indication: Bronchial asthma, pulmonary emphysema, and bronchitis. Contraindication: Acute coronary disease, cardiac asthma, hyperthyroidism and diabetes mellitus. Adverse effect: Tachycardia, palpitation, pericardial pain, dizziness, tremor, weakness, nausea, vomiting, rash. Dosage: 1 Tab BID or TID. Supply: Tab 3 mg Salmeterol/fluticasone – “Seretide 250” (ESERT) “Seretide 100”(ESER1)( 專 ) ［ C ］ Indication: Chronic obstructive pulmonary disease, asthma. Pharmacology: Salmeterol is a selective long-acting β 2 agonist and offers effective protection against histamine-induced broncho-constriction and produces a longer duration of broncho-dilation, lasting for at least 12 hours. Fluticasone propionate has a potent glucocorticoid anti-inflammatory action within the lung, resulting in reduced symptom and exacerbations of asthma. Contraindication: Hypersensitivity to fluticasone, salmeterol, or any component of the formulation; status asthmaticus; acute episodes of asthma Adverse effect: Upper respiratory tract infection (21% to 27%), headache (12% to 13%), serum glucose increased, serum potassium decreased, hoarseness/dysphonia (2-5%), oral candidiasis (1-4%) Dosage: Adults (COPD): Seretide-250 Accuhaler one inhalation twice daily, 12 hours apart. Supply: Each single Seretide-250 Accuhaler provides 50 mcg Salmeterol and 250 mcg Fluticasone, 60 inhalations; single Seretide-100 Accuhaler provides 50 mcg Salmeterol and 100 mcg Fluticasone, 60 inhalations. Formoterol/Budesonide-“Symbicort” (ESYMB) ［ C ］ Indication: Combined formoterol/budesonide is indicated in asthmatic patients experiencing persistent symptoms on inhaled glucocorticoids alone. Place in therapy: Combined formoterol/ budesonide (fixed-dose combination or separate agents) appears useful in this setting; the fixed combination offers improved compliance and greater patient convenience, although separate administration of these agents may be indicated for optimal symptom control. Contraindication: Prior hypersensitivity to budesonide or formoterol Adverse effect: Adverse effects are tremor, insomnia, restlessness, headache, hypokalemia, nausea, and dry mouth; cardiovascular effects are minimal with therapeutic doses. Headache, insomnia, dyspepsia, dry mouth, abdominal pain, oral candidiasis, dysphonia, and respiratory infection have been observed with budesonide inhalation. Adrenal suppression is uncommon with inhaled budesonide in daily doses of less than 800μg. Dosage: Adults: Inhalation 1-2 doses BID Pharmacokinetics: Both agents are metabolized in the liver; urinary excretion is about 25% for formoterol (unchanged) and 60% for budesonide (as metabolites). Budesonide has an elimination half-life of 2 to 3 hours. Supply: Inhalation 160 mcg budesonide/4.5 mcg formoterol in each dose, 120 doses/Device Ipratropium/Salbutamol-“Combivent” (ECOMB) ［ C ］ Indication: Ipratropium/albuterol is a fixed-dose combination of ipratropium (an anticholinergic) and albuterol (a beta-2 agonist). It is effective in treating moderate-to-severe COPD Contraindication: Hypersensitivity to ipratropium/other 62 - - 63 - - ventricular arrhythmias have also been reported. Dosage: Adult: 50-100 μg PO BID. Children: >6 years old, 25 μg PO QN or BID; <6 years old, 10-15 μg PO QD. Supply: Solution 5 μg/ml, 60 ml/bot Trimetoquinol HCI-“Inolin”(OINOL) Indication: Bronchial asthma, pulmonary emphysema, and bronchitis. Contraindication: Acute coronary disease, cardiac asthma, hyperthyroidism and diabetes mellitus. Adverse effect: Tachycardia, palpitation, pericardial pain, dizziness, tremor, weakness, nausea, vomiting, rash. Dosage: 1 Tab BID or TID. Supply: Tab 3 mg Salmeterol/fluticasone – “Seretide 250” (ESERT) “Seretide 100”(ESER1)( 專 ) ［ C ］ Indication: Chronic obstructive pulmonary disease, asthma. Pharmacology: Salmeterol is a selective long-acting β 2 agonist and offers effective protection against histamine-induced broncho-constriction and produces a longer duration of broncho-dilation, lasting for at least 12 hours. Fluticasone propionate has a potent glucocorticoid anti-inflammatory action within the lung, resulting in reduced symptom and exacerbations of asthma. Contraindication: Hypersensitivity to fluticasone, salmeterol, or any component of the formulation; status asthmaticus; acute episodes of asthma Adverse effect: Upper respiratory tract infection (21% to 27%), headache (12% to 13%), serum glucose increased, serum potassium decreased, hoarseness/dysphonia (2-5%), oral candidiasis (1-4%) Dosage: Adults (COPD): Seretide-250 Accuhaler one inhalation twice daily, 12 hours apart. Supply: Each single Seretide-250 Accuhaler provides 50 mcg Salmeterol and 250 mcg Fluticasone, 60 inhalations; single Seretide-100 Accuhaler provides 50 mcg Salmeterol and 100 mcg Fluticasone, 60 inhalations. Formoterol/Budesonide-“Symbicort” (ESYMB) ［ C ］ Indication: Combined formoterol/budesonide is indicated in asthmatic patients experiencing persistent symptoms on inhaled glucocorticoids alone. Place in therapy: Combined formoterol/ budesonide (fixed-dose combination or separate agents) appears useful in this setting; the fixed combination offers improved compliance and greater patient convenience, although separate administration of these agents may be indicated for optimal symptom control. Contraindication: Prior hypersensitivity to budesonide or formoterol Adverse effect: Adverse effects are tremor, insomnia, restlessness, headache, hypokalemia, nausea, and dry mouth; cardiovascular effects are minimal with therapeutic doses. Headache, insomnia, dyspepsia, dry mouth, abdominal pain, oral candidiasis, dysphonia, and respiratory infection have been observed with budesonide inhalation. Adrenal suppression is uncommon with inhaled budesonide in daily doses of less than 800μg. Dosage: Adults: Inhalation 1-2 doses BID Pharmacokinetics: Both agents are metabolized in the liver; urinary excretion is about 25% for formoterol (unchanged) and 60% for budesonide (as metabolites). Budesonide has an elimination half-life of 2 to 3 hours. Supply: Inhalation 160 mcg budesonide/4.5 mcg formoterol in each dose, 120 doses/Device Ipratropium/Salbutamol-“Combivent” (ECOMB) ［ C ］ Indication: Ipratropium/albuterol is a fixed-dose combination of ipratropium (an anticholinergic) and albuterol (a beta-2 agonist). It is effective in treating moderate-to-severe COPD Contraindication: Hypersensitivity to ipratropium/other 64 - - 65 - - atropine derivatives, albuterol, or soya lecithin or related food products Adverse effect: The most common adverse events in clinical trials have been bronchitis, upper respiratory tract symptoms/disorders, and headache. Dosage: Adults: 2 inhalations QID maximum 12 inhalations daily; Children: No experience on age under 12 y/o Pharmacokinetics: Approximately 27% of an inhaled dose of the combination appears unchanged in the urine (mainly as albuterol). Supply: Metered aerosol inhalation Ipratropium 20 μg/Albuterol (Salbutamol) 120 μg for each dose, 200 inh/set Ritodrine HCI-“Yutopar” (IYUTO)(OYUTO) ［ B ］ Indication: Premature labour (after 20th week), prevention of premature labour after gynecological operations; acute fetal distress during labour if caused by hypermotility of the uterus or compression of the umbilical cord. Place in therapy: Ritodrine is used for the inhibition of premature labor. Ritodrine is most likely to be successful in patients with intact amniotic membranes and when therapy is initiated as soon as the diagnosis of preterm labor is established. Contraindication: Patients with heavy blood loss per vaginam, maternal cardiac disease, chorioamnionitis. Adverse effect: Ritodrine administration has resulted in fetal and maternal tachycardia, plus increased blood pressure, lethargy, sleepiness, ketoacidosis, pulmonary edema, and erythema. Dosage: Premature labor: IV, initial dose 0.05 mg/min to be gradually increased according to the results by 0.05 mg/min every 10 minutes. The effective dosage: 0.15-0.35 mg/min. The infusion should be continued for 12 to 48 hours after the uterine contraction have ceased. Oral maintenance: 40 mg may be given 30-60 minutes before termination of IV therapy, the usual dosage 40 mg slow release capsule 3 times a day. Stability: D5W or NS is recommended as a diluent for ritodrine at concentration of 300mg/L. Supply: Inj 50 mg/5 ml/amp; Tab 10 mg 12:12.12 α - and β -adrenergic agonists Ephedrine HCI (IEPHE)( 專 ) ［ C ］ Indication: Ephedrine is a sympathomimetic agent with alpha-adrenergic and beta-adrenergic activity. The drug is used for the treatment of idiopathic orthostatic hypotension and in mild cases of stress incontinence. Place in therapy: Ephedrine is an effective sympathomimetic agent and was previously used for bronchodilation in the treatment of asthma. However, newer agents with selective beta-2 activity are now available and are much more effective when given orally. Ephedrine also possesses a greater degree of toxicity than the newer beta-adrenergic agonists. Contraindication: Anesthesia with cyclopropane or halothane; diabetes (for ephedrine injection); hypersensitivity to ephedrine or other sympathomimetic amines; hypertension or other cardiovascular disorders; obstetrical procedures with maternal blood pressure exceeding 130/80; thyrotoxicosis Adverse effect: Palpitations, hypertension, nervousness, tremors, anxiety, psychosis, hallucinations, depression, paranoia, seizures, urinary retention, hypersensitivity, and physical addiction Dosage: Adults: IM or SC, 25-50 mg, or IV 10-25 mg. Children: IM or IV 0.2-0.3 mg/kg Q4-6H; SC 3 mg/kg/day or 25-100 mg/m2/day in divided doses Q 4-6 H Supply: Inj 40 mg/1ml/amp Adrenalin HCI “ Epinephrine”(IEPIN) ［ C ］ Indication: Bronchial spasm, restoring cardiac rhythm in cardiac arrest, anaphylactic shock, angioneurotic edema, prolonged the action of infiltration anesthetics. 64 - - 65 - - atropine derivatives, albuterol, or soya lecithin or related food products Adverse effect: The most common adverse events in clinical trials have been bronchitis, upper respiratory tract symptoms/disorders, and headache. Dosage: Adults: 2 inhalations QID maximum 12 inhalations daily; Children: No experience on age under 12 y/o Pharmacokinetics: Approximately 27% of an inhaled dose of the combination appears unchanged in the urine (mainly as albuterol). Supply: Metered aerosol inhalation Ipratropium 20 μg/Albuterol (Salbutamol) 120 μg for each dose, 200 inh/set Ritodrine HCI-“Yutopar” (IYUTO)(OYUTO) ［ B ］ Indication: Premature labour (after 20th week), prevention of premature labour after gynecological operations; acute fetal distress during labour if caused by hypermotility of the uterus or compression of the umbilical cord. Place in therapy: Ritodrine is used for the inhibition of premature labor. Ritodrine is most likely to be successful in patients with intact amniotic membranes and when therapy is initiated as soon as the diagnosis of preterm labor is established. Contraindication: Patients with heavy blood loss per vaginam, maternal cardiac disease, chorioamnionitis. Adverse effect: Ritodrine administration has resulted in fetal and maternal tachycardia, plus increased blood pressure, lethargy, sleepiness, ketoacidosis, pulmonary edema, and erythema. Dosage: Premature labor: IV, initial dose 0.05 mg/min to be gradually increased according to the results by 0.05 mg/min every 10 minutes. The effective dosage: 0.15-0.35 mg/min. The infusion should be continued for 12 to 48 hours after the uterine contraction have ceased. Oral maintenance: 40 mg may be given 30-60 minutes before termination of IV therapy, the usual dosage 40 mg slow release capsule 3 times a day. Stability: D5W or NS is recommended as a diluent for ritodrine at concentration of 300mg/L. Supply: Inj 50 mg/5 ml/amp; Tab 10 mg 12:12.12 α - and β -adrenergic agonists Ephedrine HCI (IEPHE)( 專 ) ［ C ］ Indication: Ephedrine is a sympathomimetic agent with alpha-adrenergic and beta-adrenergic activity. The drug is used for the treatment of idiopathic orthostatic hypotension and in mild cases of stress incontinence. Place in therapy: Ephedrine is an effective sympathomimetic agent and was previously used for bronchodilation in the treatment of asthma. However, newer agents with selective beta-2 activity are now available and are much more effective when given orally. Ephedrine also possesses a greater degree of toxicity than the newer beta-adrenergic agonists. Contraindication: Anesthesia with cyclopropane or halothane; diabetes (for ephedrine injection); hypersensitivity to ephedrine or other sympathomimetic amines; hypertension or other cardiovascular disorders; obstetrical procedures with maternal blood pressure exceeding 130/80; thyrotoxicosis Adverse effect: Palpitations, hypertension, nervousness, tremors, anxiety, psychosis, hallucinations, depression, paranoia, seizures, urinary retention, hypersensitivity, and physical addiction Dosage: Adults: IM or SC, 25-50 mg, or IV 10-25 mg. Children: IM or IV 0.2-0.3 mg/kg Q4-6H; SC 3 mg/kg/day or 25-100 mg/m2/day in divided doses Q 4-6 H Supply: Inj 40 mg/1ml/amp Adrenalin HCI “ Epinephrine”(IEPIN) ［ C ］ Indication: Bronchial spasm, restoring cardiac rhythm in cardiac arrest, anaphylactic shock, angioneurotic edema, prolonged the action of infiltration anesthetics. 66 - - 67 - - Contraindication: Glaucoma, hypertension, cardiac diseases, hyperthyroidism, organic brain damage, shock with halogenated hydrocarbons or cyclopropane. Adverse effect: Anxiety, headache, restless, tremor, dizziness, respiratory difficulty, palpitation and ventricular arrhythmias. Dosage: IM 0.2-1mg, SC 0.2-0.5mg, repeated as necessary. Stability: D5W or NS with epinephrine 1mg/L, its potency retained for 24 hours at 5 ℃ . Supply: Inj 1mg/ml/amp Norepinephrine bitartrate – “Levophed” (ILEVO) ［ C ］ Indication: Hypotension, cardiac arrest and profound hypotension. Contraindication: Hypotension with blood volume deficiency, mesenteric or peripheral vascular thrombosis, pregnancy, patient under cyclopropane anesthesia. Adverse effect: Anxiety, transient headache, palpitation, respiratory difficulty, bradycardia, photophobia, sweating, vomiting, retrosternal pain, cardiac arrhythmia. Dosage: IV drip 8-12 mcg/min, according to the patient’s blood pressure. Stability: With D5W at concentration 8 mg/L, it is physically or chemically stable for 36 hours With NS at concentration of 4 or 8 mcg/ml, it is stable for 24 hours at 25 ℃ . Supply: Inj 1mg/ml, 4 ml/amp Metaraminol-“Aramin”(IARAM) Indication: Hypotension and shock Contraindication: Hypersensitivity to metaraminol; use with cyclopropane or halothane anesthesia Adverse effect: Chest pain, Hypertension, Palpitations Dosage: IM/SC 2-10 mg; IV infusion 15-100 mg 12:16 Synpatholytic (Adrenergic blocking) Agents Dihydroergotamine methanesulphonate -“Seglor Retard” (OSEGL) ［ X ］ Indication: Treatment of vascular headaches including migraine and cluster headaches, postural hypotension. Contraindication: Peripheral vascular disease, coronary heart disease, hypertension, impaired hepatic or renal function, pregnancy. Adverse effect: Localized edema, itching, transient tachycardia or bradycardia, weakness in the legs, dizziness. Dosage: PO 1 Cap BID with meals. Supply: Cap 5mg Co-dergocrine mesylate-“Hodrin”(OHYDE) Indication: Confusion, dizziness, mood-depression, unsociability. Contraindication: Hypersensitivity to dihydroergotoxine, and in patients with acute or chronic psychosis regardless of etiology. Adverse effect: Ergotism, sinus bradycardia, orthostatic hypotension, flushing, porphyria, transient nausea, nasal stuffiness, blurred vision. Dosage: 3-6 mg daily in divided doses. Stability: Ergoloid mesylates is unstable in the presence of light, moisture, or temperature above 30 ℃ . Supply: Tab 1.5 mg Dihydroergotoxine mesylate- “Elmesatt” (OELME) Indication: Adjunct in treating symptoms of mild to moderate dementia in eh elderly. Contraindication: Hypersensitivity to dihydroergotoxine, and in patients with acute or chronic psychosis regardless of etiology. Adverse effect: Abdominal cramps, nausea, vomiting, headache, blurred vision, skin rashes, nasal congestion, 66 - - 67 - - Contraindication: Glaucoma, hypertension, cardiac diseases, hyperthyroidism, organic brain damage, shock with halogenated hydrocarbons or cyclopropane. Adverse effect: Anxiety, headache, restless, tremor, dizziness, respiratory difficulty, palpitation and ventricular arrhythmias. Dosage: IM 0.2-1mg, SC 0.2-0.5mg, repeated as necessary. Stability: D5W or NS with epinephrine 1mg/L, its potency retained for 24 hours at 5 ℃ . Supply: Inj 1mg/ml/amp Norepinephrine bitartrate – “Levophed” (ILEVO) ［ C ］ Indication: Hypotension, cardiac arrest and profound hypotension. Contraindication: Hypotension with blood volume deficiency, mesenteric or peripheral vascular thrombosis, pregnancy, patient under cyclopropane anesthesia. Adverse effect: Anxiety, transient headache, palpitation, respiratory difficulty, bradycardia, photophobia, sweating, vomiting, retrosternal pain, cardiac arrhythmia. Dosage: IV drip 8-12 mcg/min, according to the patient’s blood pressure. Stability: With D5W at concentration 8 mg/L, it is physically or chemically stable for 36 hours With NS at concentration of 4 or 8 mcg/ml, it is stable for 24 hours at 25 ℃ . Supply: Inj 1mg/ml, 4 ml/amp Metaraminol-“Aramin”(IARAM) Indication: Hypotension and shock Contraindication: Hypersensitivity to metaraminol; use with cyclopropane or halothane anesthesia Adverse effect: Chest pain, Hypertension, Palpitations Dosage: IM/SC 2-10 mg; IV infusion 15-100 mg 12:16 Synpatholytic (Adrenergic blocking) Agents Dihydroergotamine methanesulphonate -“Seglor Retard” (OSEGL) ［ X ］ Indication: Treatment of vascular headaches including migraine and cluster headaches, postural hypotension. Contraindication: Peripheral vascular disease, coronary heart disease, hypertension, impaired hepatic or renal function, pregnancy. Adverse effect: Localized edema, itching, transient tachycardia or bradycardia, weakness in the legs, dizziness. Dosage: PO 1 Cap BID with meals. Supply: Cap 5mg Co-dergocrine mesylate-“Hodrin”(OHYDE) Indication: Confusion, dizziness, mood-depression, unsociability. Contraindication: Hypersensitivity to dihydroergotoxine, and in patients with acute or chronic psychosis regardless of etiology. Adverse effect: Ergotism, sinus bradycardia, orthostatic hypotension, flushing, porphyria, transient nausea, nasal stuffiness, blurred vision. Dosage: 3-6 mg daily in divided doses. Stability: Ergoloid mesylates is unstable in the presence of light, moisture, or temperature above 30 ℃ . Supply: Tab 1.5 mg Dihydroergotoxine mesylate- “Elmesatt” (OELME) Indication: Adjunct in treating symptoms of mild to moderate dementia in eh elderly. Contraindication: Hypersensitivity to dihydroergotoxine, and in patients with acute or chronic psychosis regardless of etiology. Adverse effect: Abdominal cramps, nausea, vomiting, headache, blurred vision, skin rashes, nasal congestion, 68 - - 69 - - flushing of the skin, dizziness, bradycardia, & orthostatic hypotension. Dosage: 1 mg TID Supply: Tab 2 mg Nicergoline-“Seromin”(OSERO) “Acerine” (OACERI) Indication: Intellective, affective, behavioural & somatic symptoms associated with cerebral decay (including dementia & Parkinsonism), memory disorders, reduced vigilance & conc, mood depression, apathy, unsociability, indifference to surroundings, loss of self-care, asthenia, anorexia and tinnitus. Adjuvant to neurological rehabilitation in after stroke hemiplegic patients. Contraindication: Acute hemorrhage; arterial hypotension; concurrent use of alpha or beta receptor agonists; hypersensitivity to nicergoline; recent myocardial infarction; severe bradycardia Adverse effect: Slight GI disturbances; flushing; drowsiness; insomnia. Dosage: 5-10 mg TID Supply: Tab 10 mg (Seromin), 5 mg (Acerine) 12:20 Skeletal Muscle Relaxants 12:20.04 Centrally Acting Skeletal Muscle Relaxants Chlorzoxazone-“Soxazone”(OSOXA) ［ C ］ Indication: Symptomatic relief of muscular spasm, chorea, athetosis, tetanus. This drug is ineffective in the treatment of skeletal muscle hyperactivity secondary to chronic disorders, such as cerebral palsy, and other dyskinesias. Contraindication: Patients with impaired liver function, intolerance. Adverse effect: Nausea, vomiting, heartburn, constipation, abdominal discomfort, drowsiness, dizziness, headache, jaundice. Dosage: 250 mg TID or QID. Supply: Tab 250 mg Carisoprodol/Acetaminophen- “Relax” (ORELA) ［ C ］ Indication: Disorder of musculoskeletal system Contraindication: Acute intermittent porphyria; hypersensitivity reaction to a carbamate such as meprobamate Adverse effect: Drug abuse and dependence; seizure; withdrawal sign or symptom Dosage: 1 cap TID Supply: Cap carisoprodol 175 mg/acetaminophen 350 mg Tizanidine HCI-“Tizan” (OTIZA) ［ C ］ Indication: Spasticity due to neurological disorders, painful muscle spasm. Adverse effect: At low dose: drowsiness, fatigue, dizziness, dry mouth, nausea & slight reduction in BP. At high dose: muscle weakness, insomnia, hypotension, bradycardia, and transient increase in serum transaminases. Dosage: Painful muscle spasm: 2-4 mg TID-QID; spasticity due to neurological disorders: initially <6 mg daily, 2-4 mg titration every 3-7 days. Optimum daily dose: 12-24 mg. Max: <36 mg/day Supply: Tab 2 mg 12:20.12 GABA-derivative Skeletal Muscle Relaxants Baclofen- “Baclon”(OBACL)[C] Indication: Baclofen is a muscle relaxant and is a derivative of gamma-aminobutyric acid. Place in therapy: Baclofen has proven useful in the treatment of muscular spasm due to conditions such as multiple sclerosis and spinal cord lesions. It is ineffective in patients with cerebral lesions Contraindication: Hypersensitivity to baclofen products Adverse effect: Hypotension, sedation, dizziness, 68 - - 69 - - flushing of the skin, dizziness, bradycardia, & orthostatic hypotension. Dosage: 1 mg TID Supply: Tab 2 mg Nicergoline-“Seromin”(OSERO) “Acerine” (OACERI) Indication: Intellective, affective, behavioural & somatic symptoms associated with cerebral decay (including dementia & Parkinsonism), memory disorders, reduced vigilance & conc, mood depression, apathy, unsociability, indifference to surroundings, loss of self-care, asthenia, anorexia and tinnitus. Adjuvant to neurological rehabilitation in after stroke hemiplegic patients. Contraindication: Acute hemorrhage; arterial hypotension; concurrent use of alpha or beta receptor agonists; hypersensitivity to nicergoline; recent myocardial infarction; severe bradycardia Adverse effect: Slight GI disturbances; flushing; drowsiness; insomnia. Dosage: 5-10 mg TID Supply: Tab 10 mg (Seromin), 5 mg (Acerine) 12:20 Skeletal Muscle Relaxants 12:20.04 Centrally Acting Skeletal Muscle Relaxants Chlorzoxazone-“Soxazone”(OSOXA) ［ C ］ Indication: Symptomatic relief of muscular spasm, chorea, athetosis, tetanus. This drug is ineffective in the treatment of skeletal muscle hyperactivity secondary to chronic disorders, such as cerebral palsy, and other dyskinesias. Contraindication: Patients with impaired liver function, intolerance. Adverse effect: Nausea, vomiting, heartburn, constipation, abdominal discomfort, drowsiness, dizziness, headache, jaundice. Dosage: 250 mg TID or QID. Supply: Tab 250 mg Carisoprodol/Acetaminophen- “Relax” (ORELA) ［ C ］ Indication: Disorder of musculoskeletal system Contraindication: Acute intermittent porphyria; hypersensitivity reaction to a carbamate such as meprobamate Adverse effect: Drug abuse and dependence; seizure; withdrawal sign or symptom Dosage: 1 cap TID Supply: Cap carisoprodol 175 mg/acetaminophen 350 mg Tizanidine HCI-“Tizan” (OTIZA) ［ C ］ Indication: Spasticity due to neurological disorders, painful muscle spasm. Adverse effect: At low dose: drowsiness, fatigue, dizziness, dry mouth, nausea & slight reduction in BP. At high dose: muscle weakness, insomnia, hypotension, bradycardia, and transient increase in serum transaminases. Dosage: Painful muscle spasm: 2-4 mg TID-QID; spasticity due to neurological disorders: initially <6 mg daily, 2-4 mg titration every 3-7 days. Optimum daily dose: 12-24 mg. Max: <36 mg/day Supply: Tab 2 mg 12:20.12 GABA-derivative Skeletal Muscle Relaxants Baclofen- “Baclon”(OBACL)[C] Indication: Baclofen is a muscle relaxant and is a derivative of gamma-aminobutyric acid. Place in therapy: Baclofen has proven useful in the treatment of muscular spasm due to conditions such as multiple sclerosis and spinal cord lesions. It is ineffective in patients with cerebral lesions Contraindication: Hypersensitivity to baclofen products Adverse effect: Hypotension, sedation, dizziness, 70 - - 71 - - drowsiness, euphoria, depression, hallucinations, seizures, encephalopathy, nausea, vomiting, urinary incontinence, hepatotoxicity, muscular weakness, blurred vision, and allergic reactions. Dosage: Initial 5 mg PO TID increase to 20 mg PO TID if necessary Pharmacokinetics: Since over 85% of an orally administered dose of baclofen is mainly recovered with unchanged form in the urine, dose reductions may be required in patients with renal insufficiency Supply: Tab 10 mg 12:20.20 Neuromuscular Blocking Agents Atracurium besylate-“Tracrium” (ITRAC) ［ C ］ Indication: To relax skeletal muscle atracurium is used as an adj unct t o general anest hesi a, t o f aci l i t at e endotracheal intubation, and to provide skeletal muscle relaxation during surgery or mechanical ventilation. Contraindication: Hypersensitivity to atracurium or benzoyl alcohol; due to excessive tissue irritation, do not give atracurium intramuscularly Adverse effect: Histamine release, transient hypotension, flushing, peripheral vasodilation, decreases in mean arterial pressure, and wheezing. Dosage: IV 0.3-0.6 mg/kg Stability: D5W or NS with 200, 500 mg/L, or 1, 5 g/L is stable for 24 hours at 25 ℃ . Supply: Inj 25 mg/2.5 ml/amp(*refrigerate) Pancuronium bromide-“Pavulon” (IPAVU) ［ C ］ Indication: An adjunct to anesthesia to induce skeletal muscle relaxation, to facilitate the management of patients undergoing mechanical ventilation. Contraindication: Hypersensitivity to the drug or to the bromide. Adverse effect: Profound and prolonged skeletal muscle relaxation resulting in respiratory insufficiency or apnea, increase in pulse rate and blood pressure; salivation and sweating may occur. Dosage and administration: Adults: Initial IV dosage range is 0.04-0.1 ml/kg, later increment dose starting at 0.01 mg/kg may be used. For endotracheal intubation: 0.06-0.1 mg/kg. Children: The same as for adults. Neonates: A test dose of 0.02 mg/kg be given first to measure responsiveness. Stability: Pancuronium bromide reconstituted with D5W or NS is stable for 48 hours. Supply: Inj 4 mg/2 ml/amp Rocuronium-“Esmeron”(IESME)( 特 ) ［ C ］ Indication: Rocuronium is a nondepolarizing neuromuscular blocking agent. It can be used in rapid sequence intubation. Place in therapy: The duration of rocuronium is comparable to that of vecuronium, and it may replace vecuronium for clinical use if further studies demonstrate lack of significant cardiovascular effects. The potency of rocuronium is enhanced by enflurane but not halothane. Contraindication: Hypersensitivity to rocuronium Adverse effect: Increases in heart rate, arrhythmias, tachycardia, or abnormal electrocardiograms (<1%for all cardiovascular effect) have been reported, and other adverse effects are nausea, vomiting, asthma, hiccups Rocuronium has not been associated with significant histamine release Dosage: Adults: for intubation 600 μg/kg IV; repeat 75-225 μg/kg IV used for maintenance of relaxation during surgery. Children: 1-5 years with nitrous oxide-halothane anesthesia, the 50% depression of neuromuscular function is 179 μg/kg and 303 μg/kg for 95% neuromuscular function depression Pharmacokinetics: Elimination appears primarily due to biliary excretion. Up to 33% of a dose has been recovered unchanged in the urine; the elimination half-life of rocuronium has ranged from 71 to 203 minutes. 70 - - 71 - - drowsiness, euphoria, depression, hallucinations, seizures, encephalopathy, nausea, vomiting, urinary incontinence, hepatotoxicity, muscular weakness, blurred vision, and allergic reactions. Dosage: Initial 5 mg PO TID increase to 20 mg PO TID if necessary Pharmacokinetics: Since over 85% of an orally administered dose of baclofen is mainly recovered with unchanged form in the urine, dose reductions may be required in patients with renal insufficiency Supply: Tab 10 mg 12:20.20 Neuromuscular Blocking Agents Atracurium besylate-“Tracrium” (ITRAC) ［ C ］ Indication: To relax skeletal muscle atracurium is used as an adj unct t o general anest hesi a, t o f aci l i t at e endotracheal intubation, and to provide skeletal muscle relaxation during surgery or mechanical ventilation. Contraindication: Hypersensitivity to atracurium or benzoyl alcohol; due to excessive tissue irritation, do not give atracurium intramuscularly Adverse effect: Histamine release, transient hypotension, flushing, peripheral vasodilation, decreases in mean arterial pressure, and wheezing. Dosage: IV 0.3-0.6 mg/kg Stability: D5W or NS with 200, 500 mg/L, or 1, 5 g/L is stable for 24 hours at 25 ℃ . Supply: Inj 25 mg/2.5 ml/amp(*refrigerate) Pancuronium bromide-“Pavulon” (IPAVU) ［ C ］ Indication: An adjunct to anesthesia to induce skeletal muscle relaxation, to facilitate the management of patients undergoing mechanical ventilation. Contraindication: Hypersensitivity to the drug or to the bromide. Adverse effect: Profound and prolonged skeletal muscle relaxation resulting in respiratory insufficiency or apnea, increase in pulse rate and blood pressure; salivation and sweating may occur. Dosage and administration: Adults: Initial IV dosage range is 0.04-0.1 ml/kg, later increment dose starting at 0.01 mg/kg may be used. For endotracheal intubation: 0.06-0.1 mg/kg. Children: The same as for adults. Neonates: A test dose of 0.02 mg/kg be given first to measure responsiveness. Stability: Pancuronium bromide reconstituted with D5W or NS is stable for 48 hours. Supply: Inj 4 mg/2 ml/amp Rocuronium-“Esmeron”(IESME)( 特 ) ［ C ］ Indication: Rocuronium is a nondepolarizing neuromuscular blocking agent. It can be used in rapid sequence intubation. Place in therapy: The duration of rocuronium is comparable to that of vecuronium, and it may replace vecuronium for clinical use if further studies demonstrate lack of significant cardiovascular effects. The potency of rocuronium is enhanced by enflurane but not halothane. Contraindication: Hypersensitivity to rocuronium Adverse effect: Increases in heart rate, arrhythmias, tachycardia, or abnormal electrocardiograms (<1%for all cardiovascular effect) have been reported, and other adverse effects are nausea, vomiting, asthma, hiccups Rocuronium has not been associated with significant histamine release Dosage: Adults: for intubation 600 μg/kg IV; repeat 75-225 μg/kg IV used for maintenance of relaxation during surgery. Children: 1-5 years with nitrous oxide-halothane anesthesia, the 50% depression of neuromuscular function is 179 μg/kg and 303 μg/kg for 95% neuromuscular function depression Pharmacokinetics: Elimination appears primarily due to biliary excretion. Up to 33% of a dose has been recovered unchanged in the urine; the elimination half-life of rocuronium has ranged from 71 to 203 minutes. 72 - - 73 - - Stability: At room temperature rocuronium injection should be used within 30 days. This reconstituted solution should be used within 24 hours of preparation. Supply: Inj 50 mg/5ml Succinlycholine-“Lysthenon”(ILYST)( 特 ) “Relaxin” (ISUCC)( 特 ) ［ C ］ Indication: An adjunct to anesthesia to induce skeletal muscle relaxation. May be employed to reduce the intensity of muscle contraction of pharmacologically or electrically induced convulsion. Contraindication: Hypersensitivity, respiratory paralysis, severe liver disease. Adverse effect: Cardiac arrest, arrhythmias, apnea, hyperthermia, increase ocular pressure, muscle fasciculation, excessive salivation, myoglobinemia. Dosage and administration: Surgical and anesthetic procedure: IV, adults: 25-75 mg, children: 1-2 mg/kg. Prolonged muscular relaxation: IV infusion: 2.5 mg/min (used diluted soln 0.1 or 0.2% with N/S or D5W); IM 2.5 mg/kg. Stability: D5W with 2g/L succinylcholine is physically compatible. NS with 1g/L succinyl choline is stable for 24 hours at 5 ℃ . Supply: Inj 500 mg/25 ml/Vial Note: Preparation of solution: only freshly prepared solutions should be used. Succinylcholine is rapid hydrolyzed, quickly loses potency and may caused a precipitate to form when mixed with alkaline solution of other drugs. 12:20.92 Skeletal Muscle Relaxants, Miscellaneous Orphenadrine citrate-“Norflex”(ONORF) ［ C ］ Indication: Reduces muscle rigidity; Parkinsonism, extrapyramidal dysfunction Contraindication: Cardiospasm (mega-esophagus), tachycardia, glaucoma, urinary retention, myasthenia gravis, pyloric duodenal obstruction, bladder neck obstruction, stenosing peptic ulcer, prostatic hypertrophy. Adverse effect: Aplastic anemia, tachycardia, palpitations, anaphylaxis, lightheadedness, syncope, dizziness, mental confusion, drowsiness, hallucinations, agitation, tremor, nausea, dry mouth, constipation, abdominal distention, vomiting, fecal impaction, urinary retention, blurred vision, mydriasis, pruritus, and urticaria Dosage: 1 tab BID Supply: Tab 100mg Norgesic (ONORG) ［ C ］ Indication: Tension headache, occipital headaches associated with spasm of skeletal muscles in the region of the head & neck. Acute & traumatic conditions of the limbs & trunk; sprains, strains, whiplash injuries, acute torticollis; prolapsed intervertebral disc. Contraindication: Glaucoma; myasthenia gravis; prostatic hypertrophy or bladder neck obstruction. Adverse effect: Nausea, dry mouth, blurred vision. Rarely rash, drowsiness. Dosage: 2 tab TID Supply: Tab orphenadrine citrate 35 mg/acetaminophen 450 mg Tolperisone - “Mydocalm” (OMYDO) ［ D ］ Indication: Conditions associated with increased tones of striated muscles, Parkinson’s disease, obliterative vascular disease, conditions caused by disorders of vascular innervation. Contraindication: Myasthenia gravis Adverse effect: Head tenseness, transient physical asthenia. Somnolence & muscular weakness in children, diarrhea. Dosage: 2 tab bid-tid. Supply: Tab 150 mg 72 - - 73 - - Stability: At room temperature rocuronium injection should be used within 30 days. This reconstituted solution should be used within 24 hours of preparation. Supply: Inj 50 mg/5ml Succinlycholine-“Lysthenon”(ILYST)( 特 ) “Relaxin” (ISUCC)( 特 ) ［ C ］ Indication: An adjunct to anesthesia to induce skeletal muscle relaxation. May be employed to reduce the intensity of muscle contraction of pharmacologically or electrically induced convulsion. Contraindication: Hypersensitivity, respiratory paralysis, severe liver disease. Adverse effect: Cardiac arrest, arrhythmias, apnea, hyperthermia, increase ocular pressure, muscle fasciculation, excessive salivation, myoglobinemia. Dosage and administration: Surgical and anesthetic procedure: IV, adults: 25-75 mg, children: 1-2 mg/kg. Prolonged muscular relaxation: IV infusion: 2.5 mg/min (used diluted soln 0.1 or 0.2% with N/S or D5W); IM 2.5 mg/kg. Stability: D5W with 2g/L succinylcholine is physically compatible. NS with 1g/L succinyl choline is stable for 24 hours at 5 ℃ . Supply: Inj 500 mg/25 ml/Vial Note: Preparation of solution: only freshly prepared solutions should be used. Succinylcholine is rapid hydrolyzed, quickly loses potency and may caused a precipitate to form when mixed with alkaline solution of other drugs. 12:20.92 Skeletal Muscle Relaxants, Miscellaneous Orphenadrine citrate-“Norflex”(ONORF) ［ C ］ Indication: Reduces muscle rigidity; Parkinsonism, extrapyramidal dysfunction Contraindication: Cardiospasm (mega-esophagus), tachycardia, glaucoma, urinary retention, myasthenia gravis, pyloric duodenal obstruction, bladder neck obstruction, stenosing peptic ulcer, prostatic hypertrophy. Adverse effect: Aplastic anemia, tachycardia, palpitations, anaphylaxis, lightheadedness, syncope, dizziness, mental confusion, drowsiness, hallucinations, agitation, tremor, nausea, dry mouth, constipation, abdominal distention, vomiting, fecal impaction, urinary retention, blurred vision, mydriasis, pruritus, and urticaria Dosage: 1 tab BID Supply: Tab 100mg Norgesic (ONORG) ［ C ］ Indication: Tension headache, occipital headaches associated with spasm of skeletal muscles in the region of the head & neck. Acute & traumatic conditions of the limbs & trunk; sprains, strains, whiplash injuries, acute torticollis; prolapsed intervertebral disc. Contraindication: Glaucoma; myasthenia gravis; prostatic hypertrophy or bladder neck obstruction. Adverse effect: Nausea, dry mouth, blurred vision. Rarely rash, drowsiness. Dosage: 2 tab TID Supply: Tab orphenadrine citrate 35 mg/acetaminophen 450 mg Tolperisone - “Mydocalm” (OMYDO) ［ D ］ Indication: Conditions associated with increased tones of striated muscles, Parkinson’s disease, obliterative vascular disease, conditions caused by disorders of vascular innervation. Contraindication: Myasthenia gravis Adverse effect: Head tenseness, transient physical asthenia. Somnolence & muscular weakness in children, diarrhea. Dosage: 2 tab bid-tid. Supply: Tab 150 mg 74 - - 75 - - 12:92 Autonomic Drugs, Miscellaneous Nicotine-“Nicorette (freshmint) (inhaler)” (ONICO2)( 專 ) (ONICO2) (ENICO)”Nicotinell TTS”(ENIC20)( 專 ) ［ D ］ Indication: Nicotine replacement therapy is used as an adjunct to smoking cessation programs. Place in therapy: Patches are preferred for maintenance therapy during smoking cessation programs. Gum or nasal spray may be useful for intermittent treatment or for patients allergic to the patches. Contraindication: Allergy to nicotine or any component of a nicotine delivery system; patients with life-threatening arrhythmias; patients with severe or worsening angina pectoris; use in patients during the immediate post-myocardial infarction period Adverse effect: The most common adverse effect of transdermal nicotine patches is skin irritation, characterized by erythema, pruritus, and edema. Gastrointestinal effects include: decreased lower esophageal sphincter pressure, diarrhea, dry mouth, dyspepsia, gastrointestinal discomfort, hiccups and nausea. Adverse respiratory effects of nicotine include: bronchitis, coughing, throat irritation, and rhinitis. Reported cardiac effects are chest pain, hypertension, and tachycardia. Dosage: Adults: transdermal nicotine patches up to 21 mg/day QD 6-10 weeks Pharmacokinetics: Nicotine and its metabolites are rapidly excreted via the kidneys; renal clearance is pH-dependent. The elimination half-life of nicotine following transdermal administration is 4 hours. Supply: Chewable tab 2 mg; Inhaler 10 mg/cartridge, 18 cartridges/bot; Nicotine patch: Nicotinell TTS 20: 14 mg/24 hours/patch 16:00 Blood Derivatives Albumin (IALB20) ［ C ］ Indication: Hypoproteinemia with or without edema, burns, shock, unless the pathology responsible for hypoproteinemia can be corrected, albumin in any form can afford only symptomatic or supportive relief. Contraindication: Severe anemia, cardiac failure, patient on cardiopulmonary bypass, or in presence of normal or increased intravascular volume. Adverse effect: Rapid infusion results in hypotension, allergic or pyrogenic reaction, and tachycardia. Dosage: Shock: initially 100 ml IV given as rapidly as tolerated. If response within 30 mins is inadequate, an additional 100 ml may be given. Acute hypoproteinemia: 250-350 ml given at <3 ml/min. Individualized dosage. Supply: Inj 20% 50 ml/bot 20:00 Blood Formation, Coagulation, and Thrombosis 20:04 Antianemic Agents Iron salt-“Putan (Chewable Tablet)” (OFERC)“Desman”(IIRON) ［ C ］ Indication: Iron deficiency due to chronic blood loss, pregnancy, premature babies, severe pernicious anemia. Contraindication: Patients receiving repeated blood transfusions or with anemias not produced by iron deficiency; with iron-storage or iron-absorption diseases, haemoglobinopathies, or exisitng GI disease. Adverse effect: Therapeutic dose may cause mild GI discomfort, diarrhea, vomiting; side effect is reduced by taking it with or immediately after food; constipation (large dose > 180mg iron/day), irritant and corrosive effects on GI mucosa, and necrosis and perforation may occur. Dosage: PO 1 QD-BID Supply: Chewable tab ferric hydroxide polymaltose complex 100 mg; Inj ferric dextran 100 mg/2 ml/amp 74 - - 75 - - 12:92 Autonomic Drugs, Miscellaneous Nicotine-“Nicorette (freshmint) (inhaler)” (ONICO2)( 專 ) (ONICO2) (ENICO)”Nicotinell TTS”(ENIC20)( 專 ) ［ D ］ Indication: Nicotine replacement therapy is used as an adjunct to smoking cessation programs. Place in therapy: Patches are preferred for maintenance therapy during smoking cessation programs. Gum or nasal spray may be useful for intermittent treatment or for patients allergic to the patches. Contraindication: Allergy to nicotine or any component of a nicotine delivery system; patients with life-threatening arrhythmias; patients with severe or worsening angina pectoris; use in patients during the immediate post-myocardial infarction period Adverse effect: The most common adverse effect of transdermal nicotine patches is skin irritation, characterized by erythema, pruritus, and edema. Gastrointestinal effects include: decreased lower esophageal sphincter pressure, diarrhea, dry mouth, dyspepsia, gastrointestinal discomfort, hiccups and nausea. Adverse respiratory effects of nicotine include: bronchitis, coughing, throat irritation, and rhinitis. Reported cardiac effects are chest pain, hypertension, and tachycardia. Dosage: Adults: transdermal nicotine patches up to 21 mg/day QD 6-10 weeks Pharmacokinetics: Nicotine and its metabolites are rapidly excreted via the kidneys; renal clearance is pH-dependent. The elimination half-life of nicotine following transdermal administration is 4 hours. Supply: Chewable tab 2 mg; Inhaler 10 mg/cartridge, 18 cartridges/bot; Nicotine patch: Nicotinell TTS 20: 14 mg/24 hours/patch 16:00 Blood Derivatives Albumin (IALB20) ［ C ］ Indication: Hypoproteinemia with or without edema, burns, shock, unless the pathology responsible for hypoproteinemia can be corrected, albumin in any form can afford only symptomatic or supportive relief. Contraindication: Severe anemia, cardiac failure, patient on cardiopulmonary bypass, or in presence of normal or increased intravascular volume. Adverse effect: Rapid infusion results in hypotension, allergic or pyrogenic reaction, and tachycardia. Dosage: Shock: initially 100 ml IV given as rapidly as tolerated. If response within 30 mins is inadequate, an additional 100 ml may be given. Acute hypoproteinemia: 250-350 ml given at <3 ml/min. Individualized dosage. Supply: Inj 20% 50 ml/bot 20:00 Blood Formation, Coagulation, and Thrombosis 20:04 Antianemic Agents Iron salt-“Putan (Chewable Tablet)” (OFERC)“Desman”(IIRON) ［ C ］ Indication: Iron deficiency due to chronic blood loss, pregnancy, premature babies, severe pernicious anemia. Contraindication: Patients receiving repeated blood transfusions or with anemias not produced by iron deficiency; with iron-storage or iron-absorption diseases, haemoglobinopathies, or exisitng GI disease. Adverse effect: Therapeutic dose may cause mild GI discomfort, diarrhea, vomiting; side effect is reduced by taking it with or immediately after food; constipation (large dose > 180mg iron/day), irritant and corrosive effects on GI mucosa, and necrosis and perforation may occur. Dosage: PO 1 QD-BID Supply: Chewable tab ferric hydroxide polymaltose complex 100 mg; Inj ferric dextran 100 mg/2 ml/amp 76 - - 77 - - 20:12 Antithrombotic Agents 20:12.04 Anticoagulants Heparin sodium - “Agglutex”(IHEPA) ［ C ］ Indication: Low doses for prophylaxis of postoperative venous thrombosis, high doses to treat established thrombosis. Contraindication: Tendency of bleeding, in the presence of active peptic ulceration, or severe indigestion, in severe renal or heaptic disease. Hypertension increases the risk of cerebral haemorrhage. In subacute bacterial endocarditis, embolism is not prevented, and may be accompanied by haemorrhage, especially in the brain. Adverse effect: Bleeding (after surgery), transient alopecia, allergy (rare), mild thrombocytopenia. Dosage: SC, intermittent IV infusion, continuous IV infusion. Established thrombosis: IV 5000 IU, followed by either 1500 IU per hour given by constant rate infusion pump or alternatively 35000 IU in one liter N/S (stable for 24 hours) infused over 24 hours. i.e. a daily dose of about 4000 IU or 10000 IU through an indwelling IV cannula Q6H. Prevention of thrombosis: 5000 IU SC 2 hours before operation, repeated Q8-12H until patient is ambulatory. Stability: D5W or NS with Heparin 1000 or 4000 U/L is visually compatible. Supply: Inj. 25000 IU/5ml/vial Warfarin sodium-“Coumadin” (OCOUM) ［ X ］ Indication: Venous thrombosis or pulmonary embolism, and in patients with atrial fibrillation, prosthetic heart valves, rheumatic valvular disease and transient ischaemic attacks, prevention of postoperative deep vein thrombosis. Dosage: PO: Initial daily dosage is 2-5 mg, titrate to therapeutic INR; the average maintenance dose is 2-10 mg daily, patient’s prothrombin time response at a value of 1.2-2 times control (INR 1.5-5.0; 2.0-3.0 for most indications). Supply: Tab 5 mg Enoxaparin-“Clexane”(ICLEX) ［ B ］ Indication: Enoxaparin is a low molecular weight fraction of heparin used clinically for its antithrombotic properties. It has been shown to be effective in the prevention of thromboembolism in patients undergoing various major surgical procedures including total hip arthroplasty, major knee surgery, and abdominal and gynecologic surgery. Place in therapy: Enoxaparin has not been conclusively found to be superior to heparin in safety and efficacy equivalency. Contraindication: Active major bleeding, hypersensitivity to heparin or pork products, thrombocytopenia associated with positive antiplatelet antibody test in vitro induced by enoxaparin Adverse effect: Hemorrhagic complications are the most frequent adverse effects associated with enoxaparin. Carefully monitor patients for possible spinal or epidural bleeding and if neurological impairment is detected, treat immediately. Dosage: Adults: 30mg SC Q12H; Children: thromboembolic disorders: 1 mg/kg Q12H; newborn infants less than 2 months of age required higher doses of enoxaparin: 1.64 mg/kg Q12H. Pharmacokinetics: Absorption of enoxaparin given subcutaneously is virtually complete; onset of anticoagulant effect is approximately 3 hours; the half-life is 4.5 hours; primary route of elimination appears to be renal. Supply: Inj 20 mg/0.2 ml 20:12.18 Platelet-aggregation Inhibitors Ticlopidine-“Licodin”(OLICO) ［ B ］ Indication: Ticlopidine is an antiplatelet drug with a mechanism of action different from that of aspirin or other 76 - - 77 - - 20:12 Antithrombotic Agents 20:12.04 Anticoagulants Heparin sodium - “Agglutex”(IHEPA) ［ C ］ Indication: Low doses for prophylaxis of postoperative venous thrombosis, high doses to treat established thrombosis. Contraindication: Tendency of bleeding, in the presence of active peptic ulceration, or severe indigestion, in severe renal or heaptic disease. Hypertension increases the risk of cerebral haemorrhage. In subacute bacterial endocarditis, embolism is not prevented, and may be accompanied by haemorrhage, especially in the brain. Adverse effect: Bleeding (after surgery), transient alopecia, allergy (rare), mild thrombocytopenia. Dosage: SC, intermittent IV infusion, continuous IV infusion. Established thrombosis: IV 5000 IU, followed by either 1500 IU per hour given by constant rate infusion pump or alternatively 35000 IU in one liter N/S (stable for 24 hours) infused over 24 hours. i.e. a daily dose of about 4000 IU or 10000 IU through an indwelling IV cannula Q6H. Prevention of thrombosis: 5000 IU SC 2 hours before operation, repeated Q8-12H until patient is ambulatory. Stability: D5W or NS with Heparin 1000 or 4000 U/L is visually compatible. Supply: Inj. 25000 IU/5ml/vial Warfarin sodium-“Coumadin” (OCOUM) ［ X ］ Indication: Venous thrombosis or pulmonary embolism, and in patients with atrial fibrillation, prosthetic heart valves, rheumatic valvular disease and transient ischaemic attacks, prevention of postoperative deep vein thrombosis. Dosage: PO: Initial daily dosage is 2-5 mg, titrate to therapeutic INR; the average maintenance dose is 2-10 mg daily, patient’s prothrombin time response at a value of 1.2-2 times control (INR 1.5-5.0; 2.0-3.0 for most indications). Supply: Tab 5 mg Enoxaparin-“Clexane”(ICLEX) ［ B ］ Indication: Enoxaparin is a low molecular weight fraction of heparin used clinically for its antithrombotic properties. It has been shown to be effective in the prevention of thromboembolism in patients undergoing various major surgical procedures including total hip arthroplasty, major knee surgery, and abdominal and gynecologic surgery. Place in therapy: Enoxaparin has not been conclusively found to be superior to heparin in safety and efficacy equivalency. Contraindication: Active major bleeding, hypersensitivity to heparin or pork products, thrombocytopenia associated with positive antiplatelet antibody test in vitro induced by enoxaparin Adverse effect: Hemorrhagic complications are the most frequent adverse effects associated with enoxaparin. Carefully monitor patients for possible spinal or epidural bleeding and if neurological impairment is detected, treat immediately. Dosage: Adults: 30mg SC Q12H; Children: thromboembolic disorders: 1 mg/kg Q12H; newborn infants less than 2 months of age required higher doses of enoxaparin: 1.64 mg/kg Q12H. Pharmacokinetics: Absorption of enoxaparin given subcutaneously is virtually complete; onset of anticoagulant effect is approximately 3 hours; the half-life is 4.5 hours; primary route of elimination appears to be renal. Supply: Inj 20 mg/0.2 ml 20:12.18 Platelet-aggregation Inhibitors Ticlopidine-“Licodin”(OLICO) ［ B ］ Indication: Ticlopidine is an antiplatelet drug with a mechanism of action different from that of aspirin or other 78 - - 79 - - nonsteroidal antiinflammatory drugs. Ticlopidine decreases platelet aggregation, and prolongs bleeding time. It may be useful in the prevention of thromboembolic disorders, cardiovascular mortality, stroke, myocardial infarction, and vaso-occlusive sickle cell crisis. Contraindication: Hypersensitivity, active bleeding disorders, neutropenia or thrombocytopenia; severe liver impairment. Ticlopidine should be discontinued if the absolute neutrophil count falls below 1200/mm3 or if the platelet count falls below 80,000/mm3. Adverse effect: Neutropenia, thrombocytopenia, leukopenia, agranulocytosis, pancytopenia, thrombocytopenic purpura, hemorrhage, ecchymosis, epostaxis, menorrhagia, gastro-intestinal bleeding, dizziness, nausea, vomiting, abdominal cramps, dyspepsia, flatulence, anorexia, liver damage, rash, urticaria. Dosage: PO 250 mg BID, maintain patency in patients on hemodialysis: 200 mg QD, duration ranged from 9 days (post-operative thrombosis) to 6 months. Supply: Tab 100 mg Clopidogrel – “Plavix” (OPLAV) ［ B ］ Indication: Clopidogrel bisulfate is a platelet aggregation inhibitor. Clopidogrel is indicated for the reduction of atherosclerotic events in patients with atherosclerosis documented by recent stroke, recent myocardial infarction, or established peripheral arterial disease. Place in therapy: Clopidogrel is less likely than ticlopidine to induce severe neutropenia and is second-line in aspirin-intolerant patients and in aspirin failures; third-line in patients intolerant of ticlopidine. Contraindication: Hypersensitivity to clopidogrel Adverse effect: Gastrointestinal hemorrhage (2.0%), intracranial hemorrhage (0.4% compared to 0.5% for aspirin), neutropenia (0.8%) or agranulocytosis, peptic, gastric or duodenal ulcers (1.2%), other GI symptoms including abdominal pain, dyspepsia, gastritis and constipation. Dosage: Adults: 75 mg PO QD without regard to food Pharmacokinetics: Discontinue clopidogrel 7 days prior to surgery or any event when a normal platelet effect is needed. Supply: Tab 75 mg Tirofiban – “Aggrastat” (IAGGR) ［ B ］ Indication: Tirofiban is an antiplatelet agent that binds to the platelet receptor glycoprotein IIb/IIIa and inhibits platelet aggregation for the treatment of coronary angioplasty patients with acute coronary syndrome (unstable angina/non-Q-wave or elevated ST segment myocardial infarction). Place in therapy: Combined with heparin and aspirin, tirofiban is useful in the early prevention of adverse thromboembolic phenomena in patients with unstable angina or acute myocardial infarction, but no effect after 6 months. Contraindication: Active internal bleeding or bleeding diathesis within previous 30 days, acute pericarditis, aortic dissection, concomitant use of any other parenteral glycoprotein IIb/IIIa receptor, history of arteriovenous malformation or aneurysm, history of intracranial hemorrhage or neoplasm, major surgery or severe trauma within the previous month, Severe hypertension, stroke in previous 30 days or previous, thrombocytopenia Adverse effect: Bleeding has occurred, especially with higher doses. Thrombocytopenia has also been reported. Dosage: Adults: 50 mcg/ml IV at an initial rate of 0.4 mcg/kg/min for 30 min followed by a continuous infusion of 0.1 mcg/kg/min. Diluted 50 ml of Tirofiban solution in 200 ml normal saline or 5% dextroxe solution Pharmacokinetics: Platelet aggregation is inhibited as early as 5 minutes after initiation of intravenous administration; bleeding times return to normal 3 to 8 hours after discontinuation of an intravenous infusion. Stability: Do not allow the solution to freeze and protect it 78 - - 79 - - nonsteroidal antiinflammatory drugs. Ticlopidine decreases platelet aggregation, and prolongs bleeding time. It may be useful in the prevention of thromboembolic disorders, cardiovascular mortality, stroke, myocardial infarction, and vaso-occlusive sickle cell crisis. Contraindication: Hypersensitivity, active bleeding disorders, neutropenia or thrombocytopenia; severe liver impairment. Ticlopidine should be discontinued if the absolute neutrophil count falls below 1200/mm3 or if the platelet count falls below 80,000/mm3. Adverse effect: Neutropenia, thrombocytopenia, leukopenia, agranulocytosis, pancytopenia, thrombocytopenic purpura, hemorrhage, ecchymosis, epostaxis, menorrhagia, gastro-intestinal bleeding, dizziness, nausea, vomiting, abdominal cramps, dyspepsia, flatulence, anorexia, liver damage, rash, urticaria. Dosage: PO 250 mg BID, maintain patency in patients on hemodialysis: 200 mg QD, duration ranged from 9 days (post-operative thrombosis) to 6 months. Supply: Tab 100 mg Clopidogrel – “Plavix” (OPLAV) ［ B ］ Indication: Clopidogrel bisulfate is a platelet aggregation inhibitor. Clopidogrel is indicated for the reduction of atherosclerotic events in patients with atherosclerosis documented by recent stroke, recent myocardial infarction, or established peripheral arterial disease. Place in therapy: Clopidogrel is less likely than ticlopidine to induce severe neutropenia and is second-line in aspirin-intolerant patients and in aspirin failures; third-line in patients intolerant of ticlopidine. Contraindication: Hypersensitivity to clopidogrel Adverse effect: Gastrointestinal hemorrhage (2.0%), intracranial hemorrhage (0.4% compared to 0.5% for aspirin), neutropenia (0.8%) or agranulocytosis, peptic, gastric or duodenal ulcers (1.2%), other GI symptoms including abdominal pain, dyspepsia, gastritis and constipation. Dosage: Adults: 75 mg PO QD without regard to food Pharmacokinetics: Discontinue clopidogrel 7 days prior to surgery or any event when a normal platelet effect is needed. Supply: Tab 75 mg Tirofiban – “Aggrastat” (IAGGR) ［ B ］ Indication: Tirofiban is an antiplatelet agent that binds to the platelet receptor glycoprotein IIb/IIIa and inhibits platelet aggregation for the treatment of coronary angioplasty patients with acute coronary syndrome (unstable angina/non-Q-wave or elevated ST segment myocardial infarction). Place in therapy: Combined with heparin and aspirin, tirofiban is useful in the early prevention of adverse thromboembolic phenomena in patients with unstable angina or acute myocardial infarction, but no effect after 6 months. Contraindication: Active internal bleeding or bleeding diathesis within previous 30 days, acute pericarditis, aortic dissection, concomitant use of any other parenteral glycoprotein IIb/IIIa receptor, history of arteriovenous malformation or aneurysm, history of intracranial hemorrhage or neoplasm, major surgery or severe trauma within the previous month, Severe hypertension, stroke in previous 30 days or previous, thrombocytopenia Adverse effect: Bleeding has occurred, especially with higher doses. Thrombocytopenia has also been reported. Dosage: Adults: 50 mcg/ml IV at an initial rate of 0.4 mcg/kg/min for 30 min followed by a continuous infusion of 0.1 mcg/kg/min. Diluted 50 ml of Tirofiban solution in 200 ml normal saline or 5% dextroxe solution Pharmacokinetics: Platelet aggregation is inhibited as early as 5 minutes after initiation of intravenous administration; bleeding times return to normal 3 to 8 hours after discontinuation of an intravenous infusion. Stability: Do not allow the solution to freeze and protect it 80 - - 81 - - from exposure to light during storage. Discard any unused diluted solution. Supply: Inj 12.5 mg/50 ml Cilostazol-“Pletaal”(OPLET) “Plestar” (OPLES) Indication: Intermittent claudication Pharmacology: Inhibition of platelet aggregation (phosphodiesterase III inhibitor) Pharmacokinetics: Onset of action: 2-4 weeks, may require up to 12 weeks. Bioavailability is 87 to 100%; high fat meal increases absorption; protein binding 95-98%; metabolized in liver primarily via CYP3A4 and lesser CYP2C19; elimination half- life 11-13 hr Contraindication: Hypersensitivity to cilostazol, CHF of any severity Adverse effect: Headache, dizziness, vertigo, diarrhea, infection, peripheral edema, palpitation, back pain, myalgia Dosage: 100 mg BID, give 30 min before or at least 2 hours after food. Dosage should be reduced to 50 mg twice daily during concurrent therapy with inhibitors of CYP3A4 or CYP2C19 (e.g., diltiazem, ketoconazole, itraconazole, erythromycin, omeprazole) Supply: Tab 50 mg (Pletaal), 100 mg (Plestar) 20:12.20 Thrombolytic Agents Alteplase, Recombinant (rt-PA)-‘Actilyse” (IACTI) ［ C ］ Indication: Actilyse is a thrombolytic agent for producing recanalization of occluded coronary arteries following acute myocardial infarction. Contraindication: Patients with active internal bleeding, history of cerebrovascular accident, intracranial neoplasm, aneurysm, or recent (within 2 months) intracranial or intraspinal surgery or trama. Adverse effect: Bleeding complications, reperfusion arrhythmias and reinfarction are the primary concerns of therapy; systemic fibrinolysis is less than that seen with streptokinase. Dosage: IV infusion for post myocardial infarction clot lysis: 15 mg as a bolus, followed by 0.75 mg/kg (up to 50 mg) over 30 min, then 0.5 mg/kg (up to 35 mg) over the next 60 min. Supply: Inj 50 mg/50 ml/vial Urokinase (IUROK) (IUK6) ( 專 ) ［ B ］ Indication: Peripheral artery/vein thrombosis, pulmonary embolism, coronary artery occlusion, myocardial infarction, cerebrovascular thrombosis, and retinal artery/vein thrombosis. Contraindication: Active internal bleeding or cerebrovascular accident within the last 2 months, surgery within 10 days, recent serious GI bleeding, recent trauma & severe hypertension, bacterial endocarditis, severe hepatic or renal disease, uncontrolled hypocoagulable state, chronic lung disease with cavitation. Adverse effect: Shock, bleeding tendency, hypersensitivity, nausea, vomiting, anorexia, abnormalities in hepatic function test. Administration: IV For cerebrovascular disease, peripheral artery/vein thrombosis, myocardial infarction and pulmonary embolism: 4,400 IU/kg as a loading dose over 10 minutes, followed by a maintenance dose of 4,400 IU/kg/hr for 12 hrs. Supply: Inj 60,000 IU/vial, 6,000 IU/vial 20:16 Hematopoietic Agents Darbepoetin alfa-“Aranesp” (IARAN) ［ C ］ Indication: Treatment of anemia associated with chronic renal failure (CRF), anemia associated with chemotherapy for nonmyeloid malignancies. Pharmacology: Induces erythropoiesis by stimulating the division and differentiation of committed erythroid progenitor cells; induces the release of reticulocytes from the bone marrow into the bloodstream, where they 80 - - 81 - - from exposure to light during storage. Discard any unused diluted solution. Supply: Inj 12.5 mg/50 ml Cilostazol-“Pletaal”(OPLET) “Plestar” (OPLES) Indication: Intermittent claudication Pharmacology: Inhibition of platelet aggregation (phosphodiesterase III inhibitor) Pharmacokinetics: Onset of action: 2-4 weeks, may require up to 12 weeks. Bioavailability is 87 to 100%; high fat meal increases absorption; protein binding 95-98%; metabolized in liver primarily via CYP3A4 and lesser CYP2C19; elimination half- life 11-13 hr Contraindication: Hypersensitivity to cilostazol, CHF of any severity Adverse effect: Headache, dizziness, vertigo, diarrhea, infection, peripheral edema, palpitation, back pain, myalgia Dosage: 100 mg BID, give 30 min before or at least 2 hours after food. Dosage should be reduced to 50 mg twice daily during concurrent therapy with inhibitors of CYP3A4 or CYP2C19 (e.g., diltiazem, ketoconazole, itraconazole, erythromycin, omeprazole) Supply: Tab 50 mg (Pletaal), 100 mg (Plestar) 20:12.20 Thrombolytic Agents Alteplase, Recombinant (rt-PA)-‘Actilyse” (IACTI) ［ C ］ Indication: Actilyse is a thrombolytic agent for producing recanalization of occluded coronary arteries following acute myocardial infarction. Contraindication: Patients with active internal bleeding, history of cerebrovascular accident, intracranial neoplasm, aneurysm, or recent (within 2 months) intracranial or intraspinal surgery or trama. Adverse effect: Bleeding complications, reperfusion arrhythmias and reinfarction are the primary concerns of therapy; systemic fibrinolysis is less than that seen with streptokinase. Dosage: IV infusion for post myocardial infarction clot lysis: 15 mg as a bolus, followed by 0.75 mg/kg (up to 50 mg) over 30 min, then 0.5 mg/kg (up to 35 mg) over the next 60 min. Supply: Inj 50 mg/50 ml/vial Urokinase (IUROK) (IUK6) ( 專 ) ［ B ］ Indication: Peripheral artery/vein thrombosis, pulmonary embolism, coronary artery occlusion, myocardial infarction, cerebrovascular thrombosis, and retinal artery/vein thrombosis. Contraindication: Active internal bleeding or cerebrovascular accident within the last 2 months, surgery within 10 days, recent serious GI bleeding, recent trauma & severe hypertension, bacterial endocarditis, severe hepatic or renal disease, uncontrolled hypocoagulable state, chronic lung disease with cavitation. Adverse effect: Shock, bleeding tendency, hypersensitivity, nausea, vomiting, anorexia, abnormalities in hepatic function test. Administration: IV For cerebrovascular disease, peripheral artery/vein thrombosis, myocardial infarction and pulmonary embolism: 4,400 IU/kg as a loading dose over 10 minutes, followed by a maintenance dose of 4,400 IU/kg/hr for 12 hrs. Supply: Inj 60,000 IU/vial, 6,000 IU/vial 20:16 Hematopoietic Agents Darbepoetin alfa-“Aranesp” (IARAN) ［ C ］ Indication: Treatment of anemia associated with chronic renal failure (CRF), anemia associated with chemotherapy for nonmyeloid malignancies. Pharmacology: Induces erythropoiesis by stimulating the division and differentiation of committed erythroid progenitor cells; induces the release of reticulocytes from the bone marrow into the bloodstream, where they 82 - - 83 - - mature to erythrocytes. There is a dose response relationship with this effect. Pharmacokinetics: Onset of action: 2-6 weeks after initiating treatment; Bioavailability (SC): ~37% (range: 30% to 50%); Elimination half-life: 21 hr (IV), 49 hr (SC); Half-life is ~3 times as long as epoetin alfa. Contraindication: Hypersensitivity to darbepoetin or any component of the formulation (including polysorbate 80 and/or albumin); uncontrolled hypertension Adverse effect: Hypertension, hypotension, edema, fatigue, seizure, fever, headache, dizziness, diarrhea, vomiting, abdominal pain, nausea, dyspnea, infection, thrombosis, rash, pruritus. Dosage: Anemia of CRF: initial 0.45 mcg/kg once weekly, titration to response; some patients may respond to doses given once every 2 weeks Storage: Store at 2-8 ℃ , and do not freeze or shake Supply: Inj 25 mcg/1 ml/vial Lenograstim-“Granocyte”(IGRAN)( 專 ) Indication: Increase in neutrophil count after bone marrow transplantation; cancer chemotherapy-induced neutopenia; myelodysplastic syndromes Precautions: Serious liver, renal or cardiopulmonary dysfunction. Pregnancy. Adverse effect: Anorexia, bone pain, low back pan, chest pain, headache, and fever Dosage: Adult: 2 mcg/kg SC or 5 mcg/kg IV once daily; children: 2 mcg/kg SC or IV once daily. Supply: Inj 250 mcg/vial 20:24 Hemorrheologic Agents Pentoxifylline-“Trental”(OTRE4) “Fylin”(OFYLI) “Ceretal” (OCER4) ［ C ］ Indication: Treatment of peripheral vascular circulatory disorder. Contraindication: Recent myocardial infarction. Adverse effect: Nausea, dizziness, and flushing. Dosage: PO: 400 mg 3 times/day with meals, may reduce to 400 mg twice daily if GI or CNS side effects occur. IV: initially 100 mg in 250-500 ml N/S or Dextrose given over 1.5-3 hours, increased by 50 mg every day until a daily dose of 400 mg is reached. Supply: Tab 400 mg 20:28 Antihemorrhagic Agents 20:28.08 Antiheparin Agents Protamine sulphate (IPROTA) ［ C ］ Indication: Heparin antagonists, heparin effects wear off so rapidly that an antagonist is seldom required except after perfusion for open- heart surgery. Contraindication: It is unwise to give more than 100mg over a short period unless there is certain knowledge of a large requirement. Patients with a history of allergy to fish may develop hypersensitivity reactions of protamine. Adverse effect: A sudden fall in blood pressure, bradycardia, dyspnea, transitory flushing, and feeling of warmth. Dosage: Protamine 1mg neutralized 100 IU of heparin. In heparin overdose: it can be given as a loading of 25-50 mg by slow IV injection, with the rest of calculated dose over 8-16 hrs. Supply: Inj 50 mg/5 ml/amp 20:28.16 Hemostatics Tranexamic acid-“Transamin”(OTRANS) “Tren”(ITREN) ［ B ］ Indication: Antiplasmin (antifibrinolytic) agent. Used in haemorrhage caused by administration of plasminogen activators (streptokinase, urokinase), obstetric complications, and in hyperplasminaemic states. Contraindication: Active intravascular clotting process, 82 - - 83 - - mature to erythrocytes. There is a dose response relationship with this effect. Pharmacokinetics: Onset of action: 2-6 weeks after initiating treatment; Bioavailability (SC): ~37% (range: 30% to 50%); Elimination half-life: 21 hr (IV), 49 hr (SC); Half-life is ~3 times as long as epoetin alfa. Contraindication: Hypersensitivity to darbepoetin or any component of the formulation (including polysorbate 80 and/or albumin); uncontrolled hypertension Adverse effect: Hypertension, hypotension, edema, fatigue, seizure, fever, headache, dizziness, diarrhea, vomiting, abdominal pain, nausea, dyspnea, infection, thrombosis, rash, pruritus. Dosage: Anemia of CRF: initial 0.45 mcg/kg once weekly, titration to response; some patients may respond to doses given once every 2 weeks Storage: Store at 2-8 ℃ , and do not freeze or shake Supply: Inj 25 mcg/1 ml/vial Lenograstim-“Granocyte”(IGRAN)( 專 ) Indication: Increase in neutrophil count after bone marrow transplantation; cancer chemotherapy-induced neutopenia; myelodysplastic syndromes Precautions: Serious liver, renal or cardiopulmonary dysfunction. Pregnancy. Adverse effect: Anorexia, bone pain, low back pan, chest pain, headache, and fever Dosage: Adult: 2 mcg/kg SC or 5 mcg/kg IV once daily; children: 2 mcg/kg SC or IV once daily. Supply: Inj 250 mcg/vial 20:24 Hemorrheologic Agents Pentoxifylline-“Trental”(OTRE4) “Fylin”(OFYLI) “Ceretal” (OCER4) ［ C ］ Indication: Treatment of peripheral vascular circulatory disorder. Contraindication: Recent myocardial infarction. Adverse effect: Nausea, dizziness, and flushing. Dosage: PO: 400 mg 3 times/day with meals, may reduce to 400 mg twice daily if GI or CNS side effects occur. IV: initially 100 mg in 250-500 ml N/S or Dextrose given over 1.5-3 hours, increased by 50 mg every day until a daily dose of 400 mg is reached. Supply: Tab 400 mg 20:28 Antihemorrhagic Agents 20:28.08 Antiheparin Agents Protamine sulphate (IPROTA) ［ C ］ Indication: Heparin antagonists, heparin effects wear off so rapidly that an antagonist is seldom required except after perfusion for open- heart surgery. Contraindication: It is unwise to give more than 100mg over a short period unless there is certain knowledge of a large requirement. Patients with a history of allergy to fish may develop hypersensitivity reactions of protamine. Adverse effect: A sudden fall in blood pressure, bradycardia, dyspnea, transitory flushing, and feeling of warmth. Dosage: Protamine 1mg neutralized 100 IU of heparin. In heparin overdose: it can be given as a loading of 25-50 mg by slow IV injection, with the rest of calculated dose over 8-16 hrs. Supply: Inj 50 mg/5 ml/amp 20:28.16 Hemostatics Tranexamic acid-“Transamin”(OTRANS) “Tren”(ITREN) ［ B ］ Indication: Antiplasmin (antifibrinolytic) agent. Used in haemorrhage caused by administration of plasminogen activators (streptokinase, urokinase), obstetric complications, and in hyperplasminaemic states. Contraindication: Active intravascular clotting process, 84 - - 85 - - acquired defective color vision, subarachnoid hemorrhage, and hypersensitivity to tranexamic acid. Adverse effect: Diarrhea, headache, hypotension, heartburn, dizziness, pruritus, erythema, skin rash, nausea, nasal stuffiness, diuresis, muscle pain, weakness, intrarenal obstruction. Dosage: PO 1-1.5 gm BID-TID, dosage reduced in renal failure. IV, usual dose is 0.5 to 1 g (10 to 15 mg/kg) given 2 to 3 times daily, starting immediately after surgery; and after a few days, 1 to 1.5 g orally 3 to 4 times daily. Supply: Cap 250 mg; Inj 500 mg/5ml/amp Tissucol Duo Quick (ITISS) Indication: Topical hemostatic agent in the redo cardiovascular operations. Contraindication: Hypersensitivity to bovine protein. Avoid inj to nasal mucus membrane. Arterial & strong venous bleeding. Adverse effect: Rarely, anaphylactic or anaphylactic reactions. Dosage: Individualized dosage. Supply: Each ml contain: clottable protein 75-115 mg, fibrinogen 70-110 mg, plasma fibronectin 2-9 mg, factor XIII 10-50 U, plasminogen 0.04-0.12 mg, aprotinin (bovine) 3,000 KIU, lyophilized human thrombin thrombin with thrombin activity 500 IU, CaCl2 soln 40 micromole. 24:00 Cardiovascular Drugs 24:04 Cardiac Drugs 24:04.04 Antiarrhythmic Agents 24:04.04.04 Class Ia Antiarrhythmics Quinidine sulfate (OQUIN) ［ C ］ Indication: Cardiac arrhythmias; supraventricular tachycardias Contraindication: Complete heart block; lactation. Adverse effect: GI irritation with nausea, vomiting & diarrhoea; hypersensitivity reactions, granulomatous hepatitis & lupus-like syndrome; cinchonism with tinnitus, impaired hearing, visual disturbances, headache, confusion, vertigo, vomiting & abdominal pain; hyoptension, ventricular arrhythmias. Dosage: Management of cardiac arrhythmias 200-400 mg TID or QID. Treatment of supraventricular trachycardias: up to 600 mg every 2-4 hr, max 4 g/day. Supply: Cap 200 mg 24:04.04.08 Class Ib Antiarrhythmics Lidocaine HCl – “Xylocaine”(IXYL2) (IXYLE)( 特 ) (IORA)(EXY10)(IXYLI)(IXYL4) ( 特 )(EXYLJ)( 特 ) ［ B ］ Indication: Local anesthesia, acute management of cardiac arrhythmia. Contraindication: Hypersensitivity to local anesthetics of the amide type, Adam’s-stokes syndrome, sinoatrial, atrioventricular or intraventricular heart block, hypovolemia. Adverse effect: Less tolerant to local anesthetics, excitation of the CNS, arrhythmias and cardiac arrest may occur. Dosage: Direct IV, adults: 50-100 mg, rate 25-50 mg/min, repeat if necessary, in one hour period 200-300 mg. IV infusion, adults: 20-50 mcg/kg/min, ECG monitoring. Usual initial adult dose: without epinephrine not exceed 300 mg, with epinephrine not exceed 500 mg. Children, use of 0.5 or 1% solution. Supply: 1) Local anesthesics (Local use): Inj 2% 20 ml/vial 2) 2% with epinephrine (1: 80,000) 20 ml/vial 3) 2% with epinephrine (1:73000) 1.8 ml/cartridge 4) Spray: 10% 50 ml/bot 5) Antiarrythmics (Inj for IV): 2% 5 ml 6) 4% 30 ml/vial 7) Jelly 2%, 30 g 84 - - 85 - - acquired defective color vision, subarachnoid hemorrhage, and hypersensitivity to tranexamic acid. Adverse effect: Diarrhea, headache, hypotension, heartburn, dizziness, pruritus, erythema, skin rash, nausea, nasal stuffiness, diuresis, muscle pain, weakness, intrarenal obstruction. Dosage: PO 1-1.5 gm BID-TID, dosage reduced in renal failure. IV, usual dose is 0.5 to 1 g (10 to 15 mg/kg) given 2 to 3 times daily, starting immediately after surgery; and after a few days, 1 to 1.5 g orally 3 to 4 times daily. Supply: Cap 250 mg; Inj 500 mg/5ml/amp Tissucol Duo Quick (ITISS) Indication: Topical hemostatic agent in the redo cardiovascular operations. Contraindication: Hypersensitivity to bovine protein. Avoid inj to nasal mucus membrane. Arterial & strong venous bleeding. Adverse effect: Rarely, anaphylactic or anaphylactic reactions. Dosage: Individualized dosage. Supply: Each ml contain: clottable protein 75-115 mg, fibrinogen 70-110 mg, plasma fibronectin 2-9 mg, factor XIII 10-50 U, plasminogen 0.04-0.12 mg, aprotinin (bovine) 3,000 KIU, lyophilized human thrombin thrombin with thrombin activity 500 IU, CaCl2 soln 40 micromole. 24:00 Cardiovascular Drugs 24:04 Cardiac Drugs 24:04.04 Antiarrhythmic Agents 24:04.04.04 Class Ia Antiarrhythmics Quinidine sulfate (OQUIN) ［ C ］ Indication: Cardiac arrhythmias; supraventricular tachycardias Contraindication: Complete heart block; lactation. Adverse effect: GI irritation with nausea, vomiting & diarrhoea; hypersensitivity reactions, granulomatous hepatitis & lupus-like syndrome; cinchonism with tinnitus, impaired hearing, visual disturbances, headache, confusion, vertigo, vomiting & abdominal pain; hyoptension, ventricular arrhythmias. Dosage: Management of cardiac arrhythmias 200-400 mg TID or QID. Treatment of supraventricular trachycardias: up to 600 mg every 2-4 hr, max 4 g/day. Supply: Cap 200 mg 24:04.04.08 Class Ib Antiarrhythmics Lidocaine HCl – “Xylocaine”(IXYL2) (IXYLE)( 特 ) (IORA)(EXY10)(IXYLI)(IXYL4) ( 特 )(EXYLJ)( 特 ) ［ B ］ Indication: Local anesthesia, acute management of cardiac arrhythmia. Contraindication: Hypersensitivity to local anesthetics of the amide type, Adam’s-stokes syndrome, sinoatrial, atrioventricular or intraventricular heart block, hypovolemia. Adverse effect: Less tolerant to local anesthetics, excitation of the CNS, arrhythmias and cardiac arrest may occur. Dosage: Direct IV, adults: 50-100 mg, rate 25-50 mg/min, repeat if necessary, in one hour period 200-300 mg. IV infusion, adults: 20-50 mcg/kg/min, ECG monitoring. Usual initial adult dose: without epinephrine not exceed 300 mg, with epinephrine not exceed 500 mg. Children, use of 0.5 or 1% solution. Supply: 1) Local anesthesics (Local use): Inj 2% 20 ml/vial 2) 2% with epinephrine (1: 80,000) 20 ml/vial 3) 2% with epinephrine (1:73000) 1.8 ml/cartridge 4) Spray: 10% 50 ml/bot 5) Antiarrythmics (Inj for IV): 2% 5 ml 6) 4% 30 ml/vial 7) Jelly 2%, 30 g 86 - - 87 - - Mexiletine HCI-“Mexitil”(OMEXI) ［ C ］ Indication: Prevention and treatment of ventricular arrhythmia. Contraindication: Sinus node dysfunction; conduction defect; bradycardia, hypotension; cardiac, renal or hepatic failure. Adverse effect: Nausea, vomiting, indigestion, unpleasant taste, hiccups, lightheadedness, drowsiness, confusion, dizziness, diplopia, blurred vision, nystagmus, dysarthria, ataxia, tremor, paraesthesia, convulsions, sinus bradycardia, hypotension, atrial fibrillation, palpitations. Dosage: PO initial: 400-600mg, followed by 200-250mg TID-QID, starting 2 hrs after the loading dose. Maintenance dose: 600-800 mg/day in divided dose. Pharmacokinetics: Half-life is 9 to 16 hours; Absorption may be delayed by concurrent use of anticholinergics or opiates and enhanced by concurrent use of metoclopramide. Supply: Cap 100mg 24:04.04.12 Class Ic Antiarrhythmics Propafenone HCI-“Rytmonorm”(ORYTM) ［ C ］ Indication: Ventricular and superventricular arrhythmias. Place in therapy: Preliminary comparative trials suggest that propafenone is at least as effective as disopyramide, quinidine, and lidocaine in treating ventricular arrhythmias and slightly less effective than tocainide. Contraindication: Following condition is contraindicated to the patient: known hypersensitivity, uncontrolled congestive heart, cardiogenic shock, conduction disorders (e.g. sick sinus syndrome, AV block) in the absence of an artificial pacemaker, bradycardias, severe hypotension, bronchospastic disorders, electrolyte imbalances. Adverse effect: Adverse effects occur most frequently in the CNS, cardiovascular, and GI system. The most common effects including: dizziness, unusual taste, intraventricular conduction delay, nausea, vomiting, and constipation. Dypnea, CHF, hepatotoxicity, agranulocytosis, leukopenia, and sexual dysfunction have been reported. Dosage: PO 150 mg Q8H, titration to 900 mg/day Supply: Tab 150 mg 24:04.04.20 Class III Antiarrhythmics Amiodarone HCI-“Cordarone “(OCORD) (ICORD) ［ D ］ Indication: Amiodarone is effective for the treatment of life-threatening recurrent ventricular fibrillation and tachycardia that has been unresponsive to adequate dose of other antiarrhythmic agents. It is also effective in refractory supraventricular arrhythmias. Contraindication: Bradycardia, impairment of A-V conduction, heart failure, patient with iodine sensitivity, disorders of the thyroid gland, exposure to sunlight. Can’t be used with MAO inhibitors, β -blockers or calcium antagonists. Adverse effect: Benign yellowish-brown corneal microdepositis, photosensitivity, severe bradycardia, conduction disturbances, hypotension, hypo- or hyperthyroidism, peripheral neuropathy, tremor, ataxia, paresthesia, anorexia, nausea, vomiting, constipation, nightmares, and fatigue. The most common adverse effects requiring discontinuance of oral amiodarone are pulmonary infiltrates or fibrosis, paroxysmal ventricular tachycardia, congestive heart failure, and elevations of serum hepatic enzyme concentrations. Dosage: Initial dose: 800-1600 mg PO daily for 1-3 weeks. After adequate control: 600-800 mg daily for one month then 400 mg daily. IV loading dose: 150 mg at rate of 15 mg/min over 10 min, then 360 mg at rate of 1mg/min (over 6 hrs). IV maintenance dose: 540 mg at rate of 0.5 mg/min (over 18 hrs), after first 24 hrs the maintenance infusion rate of 0.5 mg/min (720 mg over 24 hrs) should be continued. 86 - - 87 - - Mexiletine HCI-“Mexitil”(OMEXI) ［ C ］ Indication: Prevention and treatment of ventricular arrhythmia. Contraindication: Sinus node dysfunction; conduction defect; bradycardia, hypotension; cardiac, renal or hepatic failure. Adverse effect: Nausea, vomiting, indigestion, unpleasant taste, hiccups, lightheadedness, drowsiness, confusion, dizziness, diplopia, blurred vision, nystagmus, dysarthria, ataxia, tremor, paraesthesia, convulsions, sinus bradycardia, hypotension, atrial fibrillation, palpitations. Dosage: PO initial: 400-600mg, followed by 200-250mg TID-QID, starting 2 hrs after the loading dose. Maintenance dose: 600-800 mg/day in divided dose. Pharmacokinetics: Half-life is 9 to 16 hours; Absorption may be delayed by concurrent use of anticholinergics or opiates and enhanced by concurrent use of metoclopramide. Supply: Cap 100mg 24:04.04.12 Class Ic Antiarrhythmics Propafenone HCI-“Rytmonorm”(ORYTM) ［ C ］ Indication: Ventricular and superventricular arrhythmias. Place in therapy: Preliminary comparative trials suggest that propafenone is at least as effective as disopyramide, quinidine, and lidocaine in treating ventricular arrhythmias and slightly less effective than tocainide. Contraindication: Following condition is contraindicated to the patient: known hypersensitivity, uncontrolled congestive heart, cardiogenic shock, conduction disorders (e.g. sick sinus syndrome, AV block) in the absence of an artificial pacemaker, bradycardias, severe hypotension, bronchospastic disorders, electrolyte imbalances. Adverse effect: Adverse effects occur most frequently in the CNS, cardiovascular, and GI system. The most common effects including: dizziness, unusual taste, intraventricular conduction delay, nausea, vomiting, and constipation. Dypnea, CHF, hepatotoxicity, agranulocytosis, leukopenia, and sexual dysfunction have been reported. Dosage: PO 150 mg Q8H, titration to 900 mg/day Supply: Tab 150 mg 24:04.04.20 Class III Antiarrhythmics Amiodarone HCI-“Cordarone “(OCORD) (ICORD) ［ D ］ Indication: Amiodarone is effective for the treatment of life-threatening recurrent ventricular fibrillation and tachycardia that has been unresponsive to adequate dose of other antiarrhythmic agents. It is also effective in refractory supraventricular arrhythmias. Contraindication: Bradycardia, impairment of A-V conduction, heart failure, patient with iodine sensitivity, disorders of the thyroid gland, exposure to sunlight. Can’t be used with MAO inhibitors, β -blockers or calcium antagonists. Adverse effect: Benign yellowish-brown corneal microdepositis, photosensitivity, severe bradycardia, conduction disturbances, hypotension, hypo- or hyperthyroidism, peripheral neuropathy, tremor, ataxia, paresthesia, anorexia, nausea, vomiting, constipation, nightmares, and fatigue. The most common adverse effects requiring discontinuance of oral amiodarone are pulmonary infiltrates or fibrosis, paroxysmal ventricular tachycardia, congestive heart failure, and elevations of serum hepatic enzyme concentrations. Dosage: Initial dose: 800-1600 mg PO daily for 1-3 weeks. After adequate control: 600-800 mg daily for one month then 400 mg daily. IV loading dose: 150 mg at rate of 15 mg/min over 10 min, then 360 mg at rate of 1mg/min (over 6 hrs). IV maintenance dose: 540 mg at rate of 0.5 mg/min (over 18 hrs), after first 24 hrs the maintenance infusion rate of 0.5 mg/min (720 mg over 24 hrs) should be continued. 88 - - 89 - - Stability: Amiodarone is stable for 5 days when stored in glass bottles. A 40% loss over 120 hours occurred when stored in PVC bags or infused through polyvinylchloride IV administration sets. Use only dextrose solution as solvent. Concentrations weaker than 300 mg in 500 ml are not stable. Supply: Tab 200 mg; Inj 150 mg/3 ml/amp 24:04.04.24 Class IV Antiarrhythmics Adenosine-“Adenocor” (IADEN) ［ C ］ Indication: Treatment of paroxysmal supraventricular tachycardias. Diagnostic in narrow & broad-complex tachycardias. Contraindication: 2nd and 3rd degree AV block (except in patients with a functioning artifical pacemaker); sick sinus syndrome (except in patients with a functioning artificial pacemaker); asthma. Adverse effect: Facial flush, dyspnoea, a feeling of thoracic constriction, nausea, and light headedness Dosage: Initially 3 mg by rapid IV bolus inj over 2 seconds. If required, a 2nd dose of 6 mg & 3rd dose of 12 mg at 1-2 min intervals may be given. Supply: Inj 6 mg/2 ml/vial 24:04.08 Cardiotonic Agents Digoxin – “Lanoxin”(ODIGO)(IDIG2) ［ C ］ Indication: Congestive heart failure, atrial fibrillation, atrial flutter, paroxysmal atrial tachycardia, cardiogenic shock. Contraindication: Ventricular fibrillation, digitalis intoxication. Adverse effect: GI disturbance, anorexia (the earliest symptom of digoxin overdose), cardiac arrhythmia, and conduction defect. Dosage: Adults: Oral: rapid digitalization: 0.75-1.5 mg, maintenance dose: 0.125-0.25 mg; IV: rapid digitalization: 0.75 mg initially, 0.25 mg Q2-4H, maximum dose: 1.0-1.5 mg. Infants and Children: 10-20 mcg/kg/day by mouth or by injection. Supply: Tab 0.25 mg; Inj 0.5 mg/2 ml/amp Milrinone-“Primacor”(IMILR) ［ C ］ Indication: Milrinone is a phosphodiesterase inhibitor with positive inotropic and vasodilator activity. Place in therapy: The primary usefulness of milrinone is limited to the short-term intravenous treatment of congestive heart failure; milrinone does not arrest the natural progression of the disease, and may actually worsen CHF and shorten patient survival. Contraindication: Hypersensitivity; use with caution on patient of atrial fibrillation/flutter, electrolyte abnormalities, hypotension, proarrhythmic effects, recent myocardial infarction, renal disease Adverse effect: Exacerbation of ventricular arrhythmias and angina have been reported with milrinone; patients may also experience headache with the drug. Dosage: Adults: IV bolus 50 mcg/kg administered slowly over 10 minutes. Maintenance dosing is a continuous infusion of 0.375-0.75 mcg/kg/minute Pharmacokinetics: Elimination half-life is 1-2 hours; 80% to 85% of the drug is excreted unchanged in the urine within 24 hours Supply: Inj 10 mg/10 ml/amp 24:06 Antilipemic Agents 24:06.06 Fibric Acid Derivatives Fenofibrate – “Lipolin”(OLIPO) “Fenofibrate ( 十全 )”(OFEN1) “Fenolip”(OFENO) “Lipanthyl” (OLIPA) Indication: Fenofibrate is used in the treatment of hyperlipoproteinemia, and to increase high-density lipoprotein cholesterol concentrations. Place in therapy: Fenofibrate may be more effective 88 - - 89 - - Stability: Amiodarone is stable for 5 days when stored in glass bottles. A 40% loss over 120 hours occurred when stored in PVC bags or infused through polyvinylchloride IV administration sets. Use only dextrose solution as solvent. Concentrations weaker than 300 mg in 500 ml are not stable. Supply: Tab 200 mg; Inj 150 mg/3 ml/amp 24:04.04.24 Class IV Antiarrhythmics Adenosine-“Adenocor” (IADEN) ［ C ］ Indication: Treatment of paroxysmal supraventricular tachycardias. Diagnostic in narrow & broad-complex tachycardias. Contraindication: 2nd and 3rd degree AV block (except in patients with a functioning artifical pacemaker); sick sinus syndrome (except in patients with a functioning artificial pacemaker); asthma. Adverse effect: Facial flush, dyspnoea, a feeling of thoracic constriction, nausea, and light headedness Dosage: Initially 3 mg by rapid IV bolus inj over 2 seconds. If required, a 2nd dose of 6 mg & 3rd dose of 12 mg at 1-2 min intervals may be given. Supply: Inj 6 mg/2 ml/vial 24:04.08 Cardiotonic Agents Digoxin – “Lanoxin”(ODIGO)(IDIG2) ［ C ］ Indication: Congestive heart failure, atrial fibrillation, atrial flutter, paroxysmal atrial tachycardia, cardiogenic shock. Contraindication: Ventricular fibrillation, digitalis intoxication. Adverse effect: GI disturbance, anorexia (the earliest symptom of digoxin overdose), cardiac arrhythmia, and conduction defect. Dosage: Adults: Oral: rapid digitalization: 0.75-1.5 mg, maintenance dose: 0.125-0.25 mg; IV: rapid digitalization: 0.75 mg initially, 0.25 mg Q2-4H, maximum dose: 1.0-1.5 mg. Infants and Children: 10-20 mcg/kg/day by mouth or by injection. Supply: Tab 0.25 mg; Inj 0.5 mg/2 ml/amp Milrinone-“Primacor”(IMILR) ［ C ］ Indication: Milrinone is a phosphodiesterase inhibitor with positive inotropic and vasodilator activity. Place in therapy: The primary usefulness of milrinone is limited to the short-term intravenous treatment of congestive heart failure; milrinone does not arrest the natural progression of the disease, and may actually worsen CHF and shorten patient survival. Contraindication: Hypersensitivity; use with caution on patient of atrial fibrillation/flutter, electrolyte abnormalities, hypotension, proarrhythmic effects, recent myocardial infarction, renal disease Adverse effect: Exacerbation of ventricular arrhythmias and angina have been reported with milrinone; patients may also experience headache with the drug. Dosage: Adults: IV bolus 50 mcg/kg administered slowly over 10 minutes. Maintenance dosing is a continuous infusion of 0.375-0.75 mcg/kg/minute Pharmacokinetics: Elimination half-life is 1-2 hours; 80% to 85% of the drug is excreted unchanged in the urine within 24 hours Supply: Inj 10 mg/10 ml/amp 24:06 Antilipemic Agents 24:06.06 Fibric Acid Derivatives Fenofibrate – “Lipolin”(OLIPO) “Fenofibrate ( 十全 )”(OFEN1) “Fenolip”(OFENO) “Lipanthyl” (OLIPA) Indication: Fenofibrate is used in the treatment of hyperlipoproteinemia, and to increase high-density lipoprotein cholesterol concentrations. Place in therapy: Fenofibrate may be more effective 90 - - 91 - - than clofibrate in lowering low-density lipoprotein (LDL)-cholesterol, and its efficacy can be enhanced by combination with other hypolipidemic agents that have a different mechanism of action. Contraindication: Preexisting gallbladder disease; hepatic dysfunction, including primary biliary cirrhosis and unexplained persistent liver function abnormality; hypersensitivity; severe renal dysfunction Adverse effect: Skin rash, transient elevations in serum transaminases have been reported. Dosage: Adults: 67mg PO QD with food, maximum 201mg/day; micronized capsules 67mg are bioequivalent to 100-mg non-micronized fenofibrate capsules; 200mg micronized capsule is equivalent to 3 capsules of 67mg micronized capsules. Pharmacokinetics: Over 90% of micronized fenofibrate is absorbed when taken with meals; it is hydrolyzed to its active form, fenofibric acid, and extensively protein bound. Supply: Cap 100 mg (Lipolin; Fenofibrate 十全 ), 200 mg (Fenolip, Lipanthyl) Gemfibrozil – “Lipdown” (OLIPD) ［ C ］ Indication: Dyslipidemia type Iia, Iib, III, IV & V. reduces risk of CHD Contraindication: Gallbladder disease, hepatic, and renal dysfunction including primary cirrhosis. Adverse effect: GI upset, rash, pruritus, headache, dizziness, and hematopoietic disorders. Dosage: 1200 mg daily in 2 divided doses. Supply: Cap 300 mg 24:06.08 HMG-CoA Reductase Inhibitors Simvastatin – “Zocor” (OZOC4) “Simvatin” (OSIM2) ［ X ］ Indication: Primary hypercholesterolemia (heterozygous familial and nonfamilial) and mixed dyslipidemia (Frederickson types IIa and IIb). Simvastatin is also indicated for patients with coronary heart disease and hypercholesterolemia to reduce the risk of coronary death, nonfatal myocardial infarction, myocardial revascularization procedures, and stroke. Contraindication: Patients with active liver disease, unexplained elevations of serum transaminases, hypersensitivity, pregnancy, and lactation. Adverse effect: Headache and gastrointestinal complaints. Elevations in transaminases greater than 3 times the upper limit of normal were reported in 1% of patients. Elevations in creatine phosphokinase have also been reported. Dosage: Adults: 5-40 mg PO QD, administered in the evening Pharmacokinetics: Simvastatin is administered as a prodrug, which is hydrolyzed in the liver to its active form. Peak serum levels of active drug occur 1 to 2 hours after oral administration; excretion is primarily via the biliary tract. Supply: Tab 40 mg (Zocor), 20 mg (Simvatin) Fluvastatin – “Lescol”(OLESC) ［ X ］ Indication: As an adjunct to diet for the reduction of elevated total-C, LDL-C, apo B & TG levels & for the increase of HDL-C in patients with primary hypercholesterolaemia & mixed dyslipidemia. To slow the progression of coronary atherosclerosis in primary or mild forms of hypercholesterolaemia & CHD. Secondary prevention of major adverse cardiac events (cardiac death, non-fatal myocardial infarction & coronary revascularisation) in patients with CHD after coronary transcatheter therapy. Contraindication: Active liver disease, unexplained persistent elevations in serum transaminases. Adverse effect: The most commonly reported adverse drug reactions are minor GI symptoms, insomnia and headache, elevation of transaminase levels. Rarely, hypersensitivity reactions. Dosage: 40-80 mg once daily Supply: Cap 40 mg 90 - - 91 - - than clofibrate in lowering low-density lipoprotein (LDL)-cholesterol, and its efficacy can be enhanced by combination with other hypolipidemic agents that have a different mechanism of action. Contraindication: Preexisting gallbladder disease; hepatic dysfunction, including primary biliary cirrhosis and unexplained persistent liver function abnormality; hypersensitivity; severe renal dysfunction Adverse effect: Skin rash, transient elevations in serum transaminases have been reported. Dosage: Adults: 67mg PO QD with food, maximum 201mg/day; micronized capsules 67mg are bioequivalent to 100-mg non-micronized fenofibrate capsules; 200mg micronized capsule is equivalent to 3 capsules of 67mg micronized capsules. Pharmacokinetics: Over 90% of micronized fenofibrate is absorbed when taken with meals; it is hydrolyzed to its active form, fenofibric acid, and extensively protein bound. Supply: Cap 100 mg (Lipolin; Fenofibrate 十全 ), 200 mg (Fenolip, Lipanthyl) Gemfibrozil – “Lipdown” (OLIPD) ［ C ］ Indication: Dyslipidemia type Iia, Iib, III, IV & V. reduces risk of CHD Contraindication: Gallbladder disease, hepatic, and renal dysfunction including primary cirrhosis. Adverse effect: GI upset, rash, pruritus, headache, dizziness, and hematopoietic disorders. Dosage: 1200 mg daily in 2 divided doses. Supply: Cap 300 mg 24:06.08 HMG-CoA Reductase Inhibitors Simvastatin – “Zocor” (OZOC4) “Simvatin” (OSIM2) ［ X ］ Indication: Primary hypercholesterolemia (heterozygous familial and nonfamilial) and mixed dyslipidemia (Frederickson types IIa and IIb). Simvastatin is also indicated for patients with coronary heart disease and hypercholesterolemia to reduce the risk of coronary death, nonfatal myocardial infarction, myocardial revascularization procedures, and stroke. Contraindication: Patients with active liver disease, unexplained elevations of serum transaminases, hypersensitivity, pregnancy, and lactation. Adverse effect: Headache and gastrointestinal complaints. Elevations in transaminases greater than 3 times the upper limit of normal were reported in 1% of patients. Elevations in creatine phosphokinase have also been reported. Dosage: Adults: 5-40 mg PO QD, administered in the evening Pharmacokinetics: Simvastatin is administered as a prodrug, which is hydrolyzed in the liver to its active form. Peak serum levels of active drug occur 1 to 2 hours after oral administration; excretion is primarily via the biliary tract. Supply: Tab 40 mg (Zocor), 20 mg (Simvatin) Fluvastatin – “Lescol”(OLESC) ［ X ］ Indication: As an adjunct to diet for the reduction of elevated total-C, LDL-C, apo B & TG levels & for the increase of HDL-C in patients with primary hypercholesterolaemia & mixed dyslipidemia. To slow the progression of coronary atherosclerosis in primary or mild forms of hypercholesterolaemia & CHD. Secondary prevention of major adverse cardiac events (cardiac death, non-fatal myocardial infarction & coronary revascularisation) in patients with CHD after coronary transcatheter therapy. Contraindication: Active liver disease, unexplained persistent elevations in serum transaminases. Adverse effect: The most commonly reported adverse drug reactions are minor GI symptoms, insomnia and headache, elevation of transaminase levels. Rarely, hypersensitivity reactions. Dosage: 40-80 mg once daily Supply: Cap 40 mg 92 - - 93 - - Atorvastatin calcium – “Lipitor” (ILIP4) ［ X ］ Indication: Atorvastatin is effective in the treatment of hypercholesterolemia and hypertriglyceridemia. Place in therapy: It appears to be more potent than the currently available HMG-CoA reductase inhibitors. Atorvastatin decreases low-density-lipoprotein cholesterol by 50% to 60% compared to 30% to 40% for older statins; greater reductions in triglycerides have also been reported with atorvastatin. Contraindication: Active liver disease; unexplained, persistent elevation of serum transaminases; pregnancy and lactation; hypersensitivity to atorvastatin Adverse effect: Headache has been the most common adverse effect with atorvastatin; other adverse effects include diarrhea, flatulence, and mild elevations in liver enzymes. The risk of myopathy and or rhabdomyolysis is increased when atorvastatin is taken concomitantly with cyclosporine, gemfibrozil, niacin, erythromycin, or azole antifungals. Dosage: Adults: 10-80 mg PO QD Pharmacokinetics: Maximal reduction in plasma cholesterol and triglycerides occurs after approximately 2 weeks of therapy. Supply: Tab 40 mg Lovastatin-“Lovasta”(OLOVAS) ［ X ］ Indication: Hypercholesterolemia Contraindication: Active liver disease Adverse effect: GI upsets; headache; skin rashes; fatigue; dry mouth. Monitor for myopathy. Dosage: 20 mg daily Supply: Tab 20 mg Rosuvastatin-“Crestor”(OCRES) ［ X ］ Indication: Treatment of primary hypercholesterolaemia (type IIa including heterozygous familial hypercholesterolaemia) or mixed dyslipidaemia (type IIb) as an adjunct to diet when response to diet & other non-pharmacological measures are inadequate. Treatment of homozygous familial hypercholesterolaemia, either alone or as an adjunct to diet & other non-pharmacological (e.g. exercise, weight reduction) is inadequate. Homozygous familial hypercholesterolaemia as an adjunct to diet and other lipid lowering treatments (e.g. LDL apheresis) or if such treatments are not appropriate. Contraindication: Active liver disease; unexplained, persistent elevation of serum transaminases; hypersensitivity to rosuvastatin Adverse effect: Constipation, nausea, abdominal pain, headache, dizziness, myalgia, asthenia. Dosage: initially 10 mg once daily. Max: 20 mg/day. Supply: Tab 10 mg Amlodipine/Atorvastatin-“Caduet”(OCADU) ［ C ］ Indication: Hyperlipidemia - Hypertension Contraindication: Active liver disease or unexplained persistent elevations of serum transaminases; hypersensitivity to amlodipine, atorvastatin or any comeonent of the product Adverse effect: Edema, abdominal pain, constipation, flatulence, indigestion, dizziness, and headache. Dosage: Amlodipine 5-10 mg once daily, MAX 10 mg/day; atorvastatin 10-20 mg once daily, maintenance 10-80 mg, MAX 80 mg/day. Supply: Tab amlodipine 5 mg/atorvastatin 10 mg 24:08 Hypotensive Agents 24:08.20 Direct Vasodilators Hydralazine Hydrochloride-“Apresoline” (OAPR5) ［ C ］ Indication: Moderate to severe hypertension. Contraindication: Coronary artery disease, hypersensitivity, mitral valve rheumatic heart disease. Adverse effect: GI disturbance, anorexia, palpitation, 92 - - 93 - - Atorvastatin calcium – “Lipitor” (ILIP4) ［ X ］ Indication: Atorvastatin is effective in the treatment of hypercholesterolemia and hypertriglyceridemia. Place in therapy: It appears to be more potent than the currently available HMG-CoA reductase inhibitors. Atorvastatin decreases low-density-lipoprotein cholesterol by 50% to 60% compared to 30% to 40% for older statins; greater reductions in triglycerides have also been reported with atorvastatin. Contraindication: Active liver disease; unexplained, persistent elevation of serum transaminases; pregnancy and lactation; hypersensitivity to atorvastatin Adverse effect: Headache has been the most common adverse effect with atorvastatin; other adverse effects include diarrhea, flatulence, and mild elevations in liver enzymes. The risk of myopathy and or rhabdomyolysis is increased when atorvastatin is taken concomitantly with cyclosporine, gemfibrozil, niacin, erythromycin, or azole antifungals. Dosage: Adults: 10-80 mg PO QD Pharmacokinetics: Maximal reduction in plasma cholesterol and triglycerides occurs after approximately 2 weeks of therapy. Supply: Tab 40 mg Lovastatin-“Lovasta”(OLOVAS) ［ X ］ Indication: Hypercholesterolemia Contraindication: Active liver disease Adverse effect: GI upsets; headache; skin rashes; fatigue; dry mouth. Monitor for myopathy. Dosage: 20 mg daily Supply: Tab 20 mg Rosuvastatin-“Crestor”(OCRES) ［ X ］ Indication: Treatment of primary hypercholesterolaemia (type IIa including heterozygous familial hypercholesterolaemia) or mixed dyslipidaemia (type IIb) as an adjunct to diet when response to diet & other non-pharmacological measures are inadequate. Treatment of homozygous familial hypercholesterolaemia, either alone or as an adjunct to diet & other non-pharmacological (e.g. exercise, weight reduction) is inadequate. Homozygous familial hypercholesterolaemia as an adjunct to diet and other lipid lowering treatments (e.g. LDL apheresis) or if such treatments are not appropriate. Contraindication: Active liver disease; unexplained, persistent elevation of serum transaminases; hypersensitivity to rosuvastatin Adverse effect: Constipation, nausea, abdominal pain, headache, dizziness, myalgia, asthenia. Dosage: initially 10 mg once daily. Max: 20 mg/day. Supply: Tab 10 mg Amlodipine/Atorvastatin-“Caduet”(OCADU) ［ C ］ Indication: Hyperlipidemia - Hypertension Contraindication: Active liver disease or unexplained persistent elevations of serum transaminases; hypersensitivity to amlodipine, atorvastatin or any comeonent of the product Adverse effect: Edema, abdominal pain, constipation, flatulence, indigestion, dizziness, and headache. Dosage: Amlodipine 5-10 mg once daily, MAX 10 mg/day; atorvastatin 10-20 mg once daily, maintenance 10-80 mg, MAX 80 mg/day. Supply: Tab amlodipine 5 mg/atorvastatin 10 mg 24:08 Hypotensive Agents 24:08.20 Direct Vasodilators Hydralazine Hydrochloride-“Apresoline” (OAPR5) ［ C ］ Indication: Moderate to severe hypertension. Contraindication: Coronary artery disease, hypersensitivity, mitral valve rheumatic heart disease. Adverse effect: GI disturbance, anorexia, palpitation, 94 - - 95 - - tachycardia, angina pectoris, and headache. Dosage: PO: Adults: 10-50 mg QID, up to 300 mg/day. Children: 0.75 mg/kg/day initially in 4 divided doses; the initial dose should not exceed 25 mg, increase gradually to a MAX of 5 (infants)- 7.5 (children) mg/kg/day or 200 mg/day. Supply: Tab 50 mg Hydralazine/reserpine/hydrochlorothiazide-“Esidri” (OESID) ［ C ］ Indication: Hypertension Contraindication: History of mental depression; active peptic ulcer, ulcerative colitis; comedication with MAOIs; Parkinson’s disease. Adverse effect: Depression, anxiety states, mild CNS disturbances; GI disturbances, postural hypotension; disturbances of potency. Dosage: 3-6 tab dialy to be taken bid-tid. Supply: Tab reserpine 0.1 mg/hydrochlorothiazide 10 mg/hydralazine 10 mg 24:12 Vasodilating Agents 24:12.08 Nitrates and Nitrites Isosorbide mononitrate-“ISMO-20” (OISMO) ［ C ］ Indication: Long-term treatment of circulation disorders of the coronary blood vessels and for preventing attacks of angina pectoris, post-myocardial infarction therapy. Contraindication: Patients with marked low blood pressure, circulatory collapse, states of shock and acute myocardial infarction with low filling pressure. Adverse effect: Nitrate headaches, decrease blood pressure, slight states of dizziness, increase of the heart rate, temporary reddening of the face, weakness, nausea, vomiting. Dosage: 1 Tab BID; Controlled release tab 30-240mg PO QD Supply: Tab 20mg Note: Asymmetrical dosing regimen of 7 AM and 3 PM or 9 AM and 5 PM to allow for a nitrate-free dosing interval to minimize nitrate tolerance Nitroglycerin (Glyceryl trinitrate)-“N.T.G.” (ONTG) “ Millisrol”(IMILL) ［ C ］ Indication: Prophylatic treatment and management of angina pectoris. Contraindication: Patient with marked anemia, head trauma, or cerebral hemorrhage. Adverse effect: Headache, vertigo, weakness, palpitation, dizziness, flushing, nausea, vomiting, tachycardia, and postural hypotension. Dosage: 1 Tab sublingual every 5 minutes prn, up to 3 doses in 15 min. IV infusion, initial 5 mcg/min then increased by 5 mcg/min at 3-5 min intervals until a response is noted or the rate is 20 mcg/min Supply: Sublingual tab 0.6mg, Inj 5 mg/10 ml/amp Note: 1.Tab: Preserve in tight glass containers 2.Inj: It should be diluted (D 5 W or NS) before use, glass containers and special Nitroglycerin IV sets (non-PVC) should be used Isosorbide dinitrate-“Isoket” (IISOK) ［ C ］ Indication: Angina pectoris. Contraindication: Idiosyncracy. Adverse effect: Headache, transient dizziness, weakness, and flushing. Dosage: IV infusion 2-7 mg/hr, up to 10 mg/hr Supply: Inj 10mg/10 ml/amp Nicorandil-“Sigmart” (OSIGM) Indication: Angina pectoris Contraindication: Coadministration with phosphodiesterase type (PDE5) inhibitors Adverse effect: Palpitations, facial flush; throbbing 94 - - 95 - - tachycardia, angina pectoris, and headache. Dosage: PO: Adults: 10-50 mg QID, up to 300 mg/day. Children: 0.75 mg/kg/day initially in 4 divided doses; the initial dose should not exceed 25 mg, increase gradually to a MAX of 5 (infants)- 7.5 (children) mg/kg/day or 200 mg/day. Supply: Tab 50 mg Hydralazine/reserpine/hydrochlorothiazide-“Esidri” (OESID) ［ C ］ Indication: Hypertension Contraindication: History of mental depression; active peptic ulcer, ulcerative colitis; comedication with MAOIs; Parkinson’s disease. Adverse effect: Depression, anxiety states, mild CNS disturbances; GI disturbances, postural hypotension; disturbances of potency. Dosage: 3-6 tab dialy to be taken bid-tid. Supply: Tab reserpine 0.1 mg/hydrochlorothiazide 10 mg/hydralazine 10 mg 24:12 Vasodilating Agents 24:12.08 Nitrates and Nitrites Isosorbide mononitrate-“ISMO-20” (OISMO) ［ C ］ Indication: Long-term treatment of circulation disorders of the coronary blood vessels and for preventing attacks of angina pectoris, post-myocardial infarction therapy. Contraindication: Patients with marked low blood pressure, circulatory collapse, states of shock and acute myocardial infarction with low filling pressure. Adverse effect: Nitrate headaches, decrease blood pressure, slight states of dizziness, increase of the heart rate, temporary reddening of the face, weakness, nausea, vomiting. Dosage: 1 Tab BID; Controlled release tab 30-240mg PO QD Supply: Tab 20mg Note: Asymmetrical dosing regimen of 7 AM and 3 PM or 9 AM and 5 PM to allow for a nitrate-free dosing interval to minimize nitrate tolerance Nitroglycerin (Glyceryl trinitrate)-“N.T.G.” (ONTG) “ Millisrol”(IMILL) ［ C ］ Indication: Prophylatic treatment and management of angina pectoris. Contraindication: Patient with marked anemia, head trauma, or cerebral hemorrhage. Adverse effect: Headache, vertigo, weakness, palpitation, dizziness, flushing, nausea, vomiting, tachycardia, and postural hypotension. Dosage: 1 Tab sublingual every 5 minutes prn, up to 3 doses in 15 min. IV infusion, initial 5 mcg/min then increased by 5 mcg/min at 3-5 min intervals until a response is noted or the rate is 20 mcg/min Supply: Sublingual tab 0.6mg, Inj 5 mg/10 ml/amp Note: 1.Tab: Preserve in tight glass containers 2.Inj: It should be diluted (D 5 W or NS) before use, glass containers and special Nitroglycerin IV sets (non-PVC) should be used Isosorbide dinitrate-“Isoket” (IISOK) ［ C ］ Indication: Angina pectoris. Contraindication: Idiosyncracy. Adverse effect: Headache, transient dizziness, weakness, and flushing. Dosage: IV infusion 2-7 mg/hr, up to 10 mg/hr Supply: Inj 10mg/10 ml/amp Nicorandil-“Sigmart” (OSIGM) Indication: Angina pectoris Contraindication: Coadministration with phosphodiesterase type (PDE5) inhibitors Adverse effect: Palpitations, facial flush; throbbing 96 - - 97 - - headache, dizziness; rash; GI disturbances; increase in liver enzymes; cervical pain; diplopia. Dosage: 5 mg TID Supply: Tab 5 mg 24:12.12 Phosphodiesterase Inhibitors Sildenafil-“Viagra”(OVIA5)( 專 ) (OVIAG1)( 專 ) ［ B ］ Indication: Sildenafil is a phosphodiesterase inhibitor. Sildenafil indicated for the treatment of erectile dysfunction. Contraindication: Contraindicated in patients with nitroglycerin or other organic nitrates, hypersensitivity to sildenafil; use with caution in patient with anatomical deformation of the penis (angulation, cavernal fibrosis, Peyronie’s disease) or patients with conditions predisposing them to priapism (sickle cell anemia, multiple myeloma, or leukemia) or patients with bleeding disorders or active peptic ulceration or patient with retinitis pigmentosa Adverse effect: Adverse effects in clinical trials have included headache (11%), flushing (4%), dyspepsia (less than 4%), and musculoskeletal pain, most mild and transient; withdrawal rate due to adverse events is 5%. Dosage: Adults: 50 mg PO approximately 1 hour before sexual activity, Doses range from 25-100 mg daily Pharmacokinetics: Onset of penile tumescence occurred within 10 min of visual sexual stimulation or about 40 min after sildenafil administration. Supply: Tab 50 mg, 100mg Tadalafil-“Cialis” (OCIAL)( 專 ) Indication: Treatment of erectile dysfunction. Pharmacology: Tadalafil is a reversible, selective phosphodiesterase type 5 (PDE5) inhibitor, increased levels of c-GMP in the corpus cavernosum, resulting in smooth muscle relaxation and inflow of blood to the corpus cavernosum. Pharmacokinetics: Onset: within1 hour; Time to peak: 2hr; Duration: Up to36 hrs; Protein binding: 94%; Metabolism: Hepatic via CYP3A4; Elimination half-life: 17.5 hr; Excretion: Feces (61%, as metabolites), urine (36%, as metabolites). Contraindication: Hypersensitivity to tadalafil, concurrent use of organic nitrates (nitroglycerin) in any form, concurrent use of alpha-blockers other than 0.4 mg tamsulosin Adverse effect: Headache, dyspepsia, flushing, CPK increased, myalgia, abnormal liver function tests, blurred vision, dizziness, fatigue, insomnia, postural hypotension, GTP increase. Dosage: 5-20 mg to be given as one single dose and not given more than once daily. Take prior to anticipated sexually activity (Note: Erectile function may be improved for up to 36 hours following a single dose; adjust dose). Supply: Tab 20mg Vardenafil-“Levitra”(OLEVI)( 專 ) Indication: Treatment of erectile dysfunction. Pharmacology: Vardenafil is a phosphodiesterase-5 enzyme inhibitor, which increased levels of c-GMP in the corpus cavernosum, resulting in smooth muscle relaxation and inflow of blood to the corpus cavernosum. Pharmacokinetics: Time to peak:0.5- 2hrs; Bioavailability: 15%, elderly( ＞ 65yrs): 52%; Metabolism: Hepatic via CYP3A4 (major), forms active metabolite; elimination half-life:4-5 hours; Excretion: feces (91-95%, as metabolites), urine (2-6%). Contraindication: Hypersensitivity to vardenafil, concurrent use of organic nitrates (nitroglycerin) in any form. Adverse effect: Headache, dyspepsia, flushing, CPK increased, myalgia, rhinitis, vision changes (including blurred vision, color changes, dimming), dizziness, fatigue, postural hypotension, GTP increase. Dosage: 10 mg orally 1 hour prior to sexual activity, to be 96 - - 97 - - headache, dizziness; rash; GI disturbances; increase in liver enzymes; cervical pain; diplopia. Dosage: 5 mg TID Supply: Tab 5 mg 24:12.12 Phosphodiesterase Inhibitors Sildenafil-“Viagra”(OVIA5)( 專 ) (OVIAG1)( 專 ) ［ B ］ Indication: Sildenafil is a phosphodiesterase inhibitor. Sildenafil indicated for the treatment of erectile dysfunction. Contraindication: Contraindicated in patients with nitroglycerin or other organic nitrates, hypersensitivity to sildenafil; use with caution in patient with anatomical deformation of the penis (angulation, cavernal fibrosis, Peyronie’s disease) or patients with conditions predisposing them to priapism (sickle cell anemia, multiple myeloma, or leukemia) or patients with bleeding disorders or active peptic ulceration or patient with retinitis pigmentosa Adverse effect: Adverse effects in clinical trials have included headache (11%), flushing (4%), dyspepsia (less than 4%), and musculoskeletal pain, most mild and transient; withdrawal rate due to adverse events is 5%. Dosage: Adults: 50 mg PO approximately 1 hour before sexual activity, Doses range from 25-100 mg daily Pharmacokinetics: Onset of penile tumescence occurred within 10 min of visual sexual stimulation or about 40 min after sildenafil administration. Supply: Tab 50 mg, 100mg Tadalafil-“Cialis” (OCIAL)( 專 ) Indication: Treatment of erectile dysfunction. Pharmacology: Tadalafil is a reversible, selective phosphodiesterase type 5 (PDE5) inhibitor, increased levels of c-GMP in the corpus cavernosum, resulting in smooth muscle relaxation and inflow of blood to the corpus cavernosum. Pharmacokinetics: Onset: within1 hour; Time to peak: 2hr; Duration: Up to36 hrs; Protein binding: 94%; Metabolism: Hepatic via CYP3A4; Elimination half-life: 17.5 hr; Excretion: Feces (61%, as metabolites), urine (36%, as metabolites). Contraindication: Hypersensitivity to tadalafil, concurrent use of organic nitrates (nitroglycerin) in any form, concurrent use of alpha-blockers other than 0.4 mg tamsulosin Adverse effect: Headache, dyspepsia, flushing, CPK increased, myalgia, abnormal liver function tests, blurred vision, dizziness, fatigue, insomnia, postural hypotension, GTP increase. Dosage: 5-20 mg to be given as one single dose and not given more than once daily. Take prior to anticipated sexually activity (Note: Erectile function may be improved for up to 36 hours following a single dose; adjust dose). Supply: Tab 20mg Vardenafil-“Levitra”(OLEVI)( 專 ) Indication: Treatment of erectile dysfunction. Pharmacology: Vardenafil is a phosphodiesterase-5 enzyme inhibitor, which increased levels of c-GMP in the corpus cavernosum, resulting in smooth muscle relaxation and inflow of blood to the corpus cavernosum. Pharmacokinetics: Time to peak:0.5- 2hrs; Bioavailability: 15%, elderly( ＞ 65yrs): 52%; Metabolism: Hepatic via CYP3A4 (major), forms active metabolite; elimination half-life:4-5 hours; Excretion: feces (91-95%, as metabolites), urine (2-6%). Contraindication: Hypersensitivity to vardenafil, concurrent use of organic nitrates (nitroglycerin) in any form. Adverse effect: Headache, dyspepsia, flushing, CPK increased, myalgia, rhinitis, vision changes (including blurred vision, color changes, dimming), dizziness, fatigue, postural hypotension, GTP increase. Dosage: 10 mg orally 1 hour prior to sexual activity, to be 98 - - 99 - - given as one single dose, MAX dose 20 mg. Supply: Tab 10mg 24:12.92 Vasodilating Agents, Miscellaneous Alprostadil (Prostaglandin E 1 , PGE 1 ) - “Promostan”(IPROM) “Caverject”(ICAVE) Indication: Patent ductus arteriosus, Buerger’s disease, arteriosclerosis obliterans, pulmonary atresia, Raynaud’s disease, peripheral vascular disease, and ischemic leg ulcer due to chronic arterial occlusion. Contraindication: Neonates with respiratory distress syndrome; intracavenous injection is contraindicated in men who might be predisposed to priapism; sickle cell anemia, multiple myeloma; leukemia; intracavenous injection should not be used in men for whom sexual activity is inadvisable or contraindicated; hypersensitivity; Adverse effect: Flushing, nausea, abdominal cramps, tachycardia, hypotension, general malaise, and/or edema. In the newborn the most frequent adverse effects of alprostadil are apnea (10 to 12%), fever (14%), flushing (10%), bradycardia (7%), and seizures. Dosage: Raynaud’s phenomenon: 6-10 ng/kg/min IV for 12-72 hours. Angina: 5-30 ng/kg/min IV for 24-72 hours. Dilation of ductus arteriosus: 0.05-0.1 mcg/kg/min. Erectile dysfunction: 2.5-60 mcg intracavernosal injection. Supply: Inj 20 μg Dipyridamole-“ Persantin”(OPERS)“Sancin” (OSANC)“Peysan”(OPEYS) ［ C ］ Indication: Dipyridamole is a phosphodiesterase inhibitor, which inhibits platelet aggregation. Management of chronic angina pectoris thromboembolic disease; Dipyridamole is useful in preventing thromboembolism in patients who have received prosthetic heart valves. Contraindication: Hypersensitivity to dipyridamole; acute myocardial infarction. Adverse effect: Adverse effects reported including headache, dizziness, nausea, skin rash. Dosage: As antithrombotics: 400-600 mg/day before meal. For angina pectories: 50 mg TID, maximum dose: 400 mg/day Supply: Tab 25 mg (Persantin), 50 mg (Sancin), 75 mg (Peysan) Buflomedil – “Misudin”(OMISU) Indication: Treatment of peripheral vascular disease. Contraindication: Severe arterial bleeding; immediately postpartum. Adverse effect: GI disturbances, headache, vertigo, dizziness, nausea, cutaneous flushing Dosage: 300-600 mg daily Supply: Tab 150 mg Nicametate citrate-“Euclidan” (OEUCL) Indication: Treatment of peripheral vascular disorders. Contraindication: Same as nicotinic acid. Adverse effect: Transient palpitation, flushing of face. Dosage: 300 mg/day Supply: Tab 50 mg 24:20 α -Adrenergic Blocking Agents Doxazosin-“Dosabin” (ODOSA)“Doxaben (XL)” (ODOXA)(ODOXX) ［ C ］ Indication: Benign prostatic hyperplasia, hypertension Pharmacology: Doxazosin is a selective long-acting α -1-adrenergic antagonist, with a similar structure to prazosin. Once daily dose is effective alone or in combination with other antihypertensive agents in controlling mild to moderate essential hypertension. Contraindication: Hypersensitivity to quinazolines such as prazosin and terazosin Adverse effect: Orthostatic hypotension, dizziness, vertigo, and headaches are the most common adverse 98 - - 99 - - given as one single dose, MAX dose 20 mg. Supply: Tab 10mg 24:12.92 Vasodilating Agents, Miscellaneous Alprostadil (Prostaglandin E 1 , PGE 1 ) - “Promostan”(IPROM) “Caverject”(ICAVE) Indication: Patent ductus arteriosus, Buerger’s disease, arteriosclerosis obliterans, pulmonary atresia, Raynaud’s disease, peripheral vascular disease, and ischemic leg ulcer due to chronic arterial occlusion. Contraindication: Neonates with respiratory distress syndrome; intracavenous injection is contraindicated in men who might be predisposed to priapism; sickle cell anemia, multiple myeloma; leukemia; intracavenous injection should not be used in men for whom sexual activity is inadvisable or contraindicated; hypersensitivity; Adverse effect: Flushing, nausea, abdominal cramps, tachycardia, hypotension, general malaise, and/or edema. In the newborn the most frequent adverse effects of alprostadil are apnea (10 to 12%), fever (14%), flushing (10%), bradycardia (7%), and seizures. Dosage: Raynaud’s phenomenon: 6-10 ng/kg/min IV for 12-72 hours. Angina: 5-30 ng/kg/min IV for 24-72 hours. Dilation of ductus arteriosus: 0.05-0.1 mcg/kg/min. Erectile dysfunction: 2.5-60 mcg intracavernosal injection. Supply: Inj 20 μg Dipyridamole-“ Persantin”(OPERS)“Sancin” (OSANC)“Peysan”(OPEYS) ［ C ］ Indication: Dipyridamole is a phosphodiesterase inhibitor, which inhibits platelet aggregation. Management of chronic angina pectoris thromboembolic disease; Dipyridamole is useful in preventing thromboembolism in patients who have received prosthetic heart valves. Contraindication: Hypersensitivity to dipyridamole; acute myocardial infarction. Adverse effect: Adverse effects reported including headache, dizziness, nausea, skin rash. Dosage: As antithrombotics: 400-600 mg/day before meal. For angina pectories: 50 mg TID, maximum dose: 400 mg/day Supply: Tab 25 mg (Persantin), 50 mg (Sancin), 75 mg (Peysan) Buflomedil – “Misudin”(OMISU) Indication: Treatment of peripheral vascular disease. Contraindication: Severe arterial bleeding; immediately postpartum. Adverse effect: GI disturbances, headache, vertigo, dizziness, nausea, cutaneous flushing Dosage: 300-600 mg daily Supply: Tab 150 mg Nicametate citrate-“Euclidan” (OEUCL) Indication: Treatment of peripheral vascular disorders. Contraindication: Same as nicotinic acid. Adverse effect: Transient palpitation, flushing of face. Dosage: 300 mg/day Supply: Tab 50 mg 24:20 α -Adrenergic Blocking Agents Doxazosin-“Dosabin” (ODOSA)“Doxaben (XL)” (ODOXA)(ODOXX) ［ C ］ Indication: Benign prostatic hyperplasia, hypertension Pharmacology: Doxazosin is a selective long-acting α -1-adrenergic antagonist, with a similar structure to prazosin. Once daily dose is effective alone or in combination with other antihypertensive agents in controlling mild to moderate essential hypertension. Contraindication: Hypersensitivity to quinazolines such as prazosin and terazosin Adverse effect: Orthostatic hypotension, dizziness, vertigo, and headaches are the most common adverse 100 - - 101 - - effects. Dosage: Initial: 1 mg daily and slowly titrated up to a maximum of 16 mg QD or until blood pressure is adequately controlled. No dosing adjustments are required in elderly or renal failure patients. Supply: Tab 2 mg, 4 mg Terazosin-“Weson”(OWESO) “Tezopin”(OTEZO) ［ C ］ Indication: Hypertension, benign prostatic hypertrophy, and heart failure. Place in therapy: All of the available selective α -1-receptor blockers appear to be equally effective for the treatment of hypertension. Since α -1-adrenergic blockers may be safely used in patients with diabetes, congestive heart failure, asthma, and hyperlipidemia, they may be preferred initial agents. For benign prostatic hyperplasia, surgical (transurethral prostatectomy) treatment is associated with an 85% improvement in symptoms, α -blockers reduce symptoms by 51%, and treatment with the 5- α -reductase inhibitor finasteride improves symptoms by 31%. Contraindication: Hypersensitivity. Adverse effect: The first-dose syncope and postural hypotension frequently occur. Other adverse effects include dizziness, faintness, fatigue and headache; tachycardia has also been observed. Dosage: Adults: initial dose 1 mg PO HS, then titrate to 5 mg PO QD; some patients may require 10-20 mg PO QD. Dosing adjustments are not required in elderly patients but escalation should be slower. Supply: Tab 2mg Tamsulosin-“Tamso SR” (OTAMS)“Harnalidge D” (OHARD) Indication: Tamsulosin is a selective alpha-1A adrenoceptor antagonist with claimed selectivity for the genitourinary tract. Place in therapy: The selective alpha-1 adrenergic blockers have been shown to significantly increase urinary flow rates and decrease outflow obstruction and irritation symptoms, such as frequency, nocturia, urgency, and urge incontinence, associated with benign prostatic hyperplasia (BPH). Contraindication: Hypersensitivity to tamsulosin Adverse effect: Oral tamsulosin has been well tolerated, and alterations in blood pressure or heart rate have not been significant; abnormal ejaculation, dizziness, headache, nausea, diarrhea, rhinitis, and slight reductions in hemoglobin have been reported. Dosage: Adults: for benign prostatic hyperplasia: 0.4mg PO QD; Dosing adjustments is suggested in patients with severe liver dysfunction. Pharmacokinetics: It has an elimination half-life of 9-15 hours. Supply: Cap 0.2 mg; Tab 0.2 mg Alfuzosin – “Xatral XL” (OXAT1) Indication: Benign prostatic hypertrophy. Contraindication: Orthostatic hyoptension; impaired liver function; severely impaired kidney function (creatinine clearance < 30 ml/min); intestinal occlusion (due to the presence of castor oil). Adverse effect: GI disturbances, lightheadedness, dizziness, feeling faint, and headaches. Dosage: 10 mg daily. Supply: Tab 10 mg. 24:24 β -Adrenergic Blocking Agents Acebutolol-“Sectral” (OSECT) ［ B ］ Indication: Acebutolol is effective in angina pectoris, hypertension and ventricular arrhythmias. Place in therapy: All currently available β -blockers appear to be equally effective for the treatment of hypertension; however, β -blockers with cardioselectivity (i.e. atenolol, acebutolol) may be particularly effective in 100 - - 101 - - effects. Dosage: Initial: 1 mg daily and slowly titrated up to a maximum of 16 mg QD or until blood pressure is adequately controlled. No dosing adjustments are required in elderly or renal failure patients. Supply: Tab 2 mg, 4 mg Terazosin-“Weson”(OWESO) “Tezopin”(OTEZO) ［ C ］ Indication: Hypertension, benign prostatic hypertrophy, and heart failure. Place in therapy: All of the available selective α -1-receptor blockers appear to be equally effective for the treatment of hypertension. Since α -1-adrenergic blockers may be safely used in patients with diabetes, congestive heart failure, asthma, and hyperlipidemia, they may be preferred initial agents. For benign prostatic hyperplasia, surgical (transurethral prostatectomy) treatment is associated with an 85% improvement in symptoms, α -blockers reduce symptoms by 51%, and treatment with the 5- α -reductase inhibitor finasteride improves symptoms by 31%. Contraindication: Hypersensitivity. Adverse effect: The first-dose syncope and postural hypotension frequently occur. Other adverse effects include dizziness, faintness, fatigue and headache; tachycardia has also been observed. Dosage: Adults: initial dose 1 mg PO HS, then titrate to 5 mg PO QD; some patients may require 10-20 mg PO QD. Dosing adjustments are not required in elderly patients but escalation should be slower. Supply: Tab 2mg Tamsulosin-“Tamso SR” (OTAMS)“Harnalidge D” (OHARD) Indication: Tamsulosin is a selective alpha-1A adrenoceptor antagonist with claimed selectivity for the genitourinary tract. Place in therapy: The selective alpha-1 adrenergic blockers have been shown to significantly increase urinary flow rates and decrease outflow obstruction and irritation symptoms, such as frequency, nocturia, urgency, and urge incontinence, associated with benign prostatic hyperplasia (BPH). Contraindication: Hypersensitivity to tamsulosin Adverse effect: Oral tamsulosin has been well tolerated, and alterations in blood pressure or heart rate have not been significant; abnormal ejaculation, dizziness, headache, nausea, diarrhea, rhinitis, and slight reductions in hemoglobin have been reported. Dosage: Adults: for benign prostatic hyperplasia: 0.4mg PO QD; Dosing adjustments is suggested in patients with severe liver dysfunction. Pharmacokinetics: It has an elimination half-life of 9-15 hours. Supply: Cap 0.2 mg; Tab 0.2 mg Alfuzosin – “Xatral XL” (OXAT1) Indication: Benign prostatic hypertrophy. Contraindication: Orthostatic hyoptension; impaired liver function; severely impaired kidney function (creatinine clearance < 30 ml/min); intestinal occlusion (due to the presence of castor oil). Adverse effect: GI disturbances, lightheadedness, dizziness, feeling faint, and headaches. Dosage: 10 mg daily. Supply: Tab 10 mg. 24:24 β -Adrenergic Blocking Agents Acebutolol-“Sectral” (OSECT) ［ B ］ Indication: Acebutolol is effective in angina pectoris, hypertension and ventricular arrhythmias. Place in therapy: All currently available β -blockers appear to be equally effective for the treatment of hypertension; however, β -blockers with cardioselectivity (i.e. atenolol, acebutolol) may be particularly effective in 102 - - 103 - - hypertension with asthma or diabetes. Since acebutolol has intrinsic sympathomimetic activity, it does not increase serum triglyceride levels or decrease HDL cholesterol, acebutolol may be useful in patients with dyslipidemia. Contraindication: Persistently severe bradycardia, second degree and third degree heart block, overt cardiac failure, cardiogenic shock, avoid use with verapamil concomitantly. Adverse effect: Hypotension, bradycardia, congestive heart failure, fatigue, headache, GI toxicity, decrease in FEV-1 in asthmatics, lupus-like reactions appear more commonly than with other β -blockers. Dosage: Hypertension: 400-800 mg QD or divided to BID use, stable angina: 600-1600 mg daily. Supply: Tab 400 mg Atenolol -“Tenolol”(OATEO) “Tenormin” (OTENO) ［ D ］ Indication: Hypertension, angina pectoris. Contraindication: Sinus bradycardia, cardiac shock, symptomatic CHF. Adverse effect: Cold extremeties, muscular fatigue. Dosage: 50-100 mg QD. Supply: Tab 100 mg Carvedilol-“Dilatrend” (ODIL6)(ODILAT) “Longcardio”(OLONG) Indication: Carvedilol is a nonselective beta-adrenergic blocking agent with alpha-1 blocking activity, moderate membrane stabilizing activity, no intrinsic sympathomimetic activity, and high lipid solubility. Carvedilol is effective in the treatment of mild-to-moderate hypertension, angina, and congestive heart failure. Place in therapy: Numerous studies have shown that oral carvedilol is effective in the treatment of mild to moderate hypertension. Carvedilol has been shown to reduce infarct size in animals. Carvedilol may be given as adjunctive therapy with diuretics, angiotensin-converting- enzyme inhibitors, and with or without digoxin in patients with CHF. Carvedilol has been shown to be effective in the treatment of angina pectoris. The ability of carvedilol to reduce afterload may improve left ventricular function in patients with angina. Contraindication: Bronchial asthma or chronic obstructive pulmonary disease, cardiogenic shock, hypersensitivity, overt cardiac failure, second and third degree AV block, severe sinus bradycardia, sick sinus syndrome, and severe liver failure Adverse effect: The most common adverse effect is dizziness; other adverse effects include fatigue, hypotension, bradycardia, headache, bronchospasm, and skin rash. Dosage: Adults: Hypertension, 6.25 mg PO BID may be increase to 12.5-25 mg BID; CHF, 3.125 mg PO BID may be doubled every 2 weeks up to a maximum dose of 25-50 mg BID; dose reductions are suggested in liver disease Pharmacokinetics: The drug is extensively metabolized in the liver and primarily excreted via the feces; the elimination half-life of carvedilol is 6 to 8 hours. Supply: Tab 6.25 mg, 25 mg Labetalol HCI–“Trandate”(OTRAND)(ITRA5) ( 專 ) ［ C ］ Indication: All grades of hypertension. Contraindication: Overt heart failure or atrioventricular block, bronchial asthma or chronic obstructive pulmonary disease, cardiogenic shock, and severe sinus bradycardia Adverse effect: Postural hypotension, scalp tingling, insomnia, GI discomfort, nasal stiffness, vivid dreams. Dosage: PO: 200-400 mg BID; IV: initial dose 50 mg , if necessary, doses of 50 mg may be repeated at 5 minutes interval until a satisfactory response occurs. Stability: When the concentration at 1.25, or 3.75 mg/ml either D5W or NS solution is stable for 72 hours at 4 or 24 ℃ . 102 - - 103 - - hypertension with asthma or diabetes. Since acebutolol has intrinsic sympathomimetic activity, it does not increase serum triglyceride levels or decrease HDL cholesterol, acebutolol may be useful in patients with dyslipidemia. Contraindication: Persistently severe bradycardia, second degree and third degree heart block, overt cardiac failure, cardiogenic shock, avoid use with verapamil concomitantly. Adverse effect: Hypotension, bradycardia, congestive heart failure, fatigue, headache, GI toxicity, decrease in FEV-1 in asthmatics, lupus-like reactions appear more commonly than with other β -blockers. Dosage: Hypertension: 400-800 mg QD or divided to BID use, stable angina: 600-1600 mg daily. Supply: Tab 400 mg Atenolol -“Tenolol”(OATEO) “Tenormin” (OTENO) ［ D ］ Indication: Hypertension, angina pectoris. Contraindication: Sinus bradycardia, cardiac shock, symptomatic CHF. Adverse effect: Cold extremeties, muscular fatigue. Dosage: 50-100 mg QD. Supply: Tab 100 mg Carvedilol-“Dilatrend” (ODIL6)(ODILAT) “Longcardio”(OLONG) Indication: Carvedilol is a nonselective beta-adrenergic blocking agent with alpha-1 blocking activity, moderate membrane stabilizing activity, no intrinsic sympathomimetic activity, and high lipid solubility. Carvedilol is effective in the treatment of mild-to-moderate hypertension, angina, and congestive heart failure. Place in therapy: Numerous studies have shown that oral carvedilol is effective in the treatment of mild to moderate hypertension. Carvedilol has been shown to reduce infarct size in animals. Carvedilol may be given as adjunctive therapy with diuretics, angiotensin-converting- enzyme inhibitors, and with or without digoxin in patients with CHF. Carvedilol has been shown to be effective in the treatment of angina pectoris. The ability of carvedilol to reduce afterload may improve left ventricular function in patients with angina. Contraindication: Bronchial asthma or chronic obstructive pulmonary disease, cardiogenic shock, hypersensitivity, overt cardiac failure, second and third degree AV block, severe sinus bradycardia, sick sinus syndrome, and severe liver failure Adverse effect: The most common adverse effect is dizziness; other adverse effects include fatigue, hypotension, bradycardia, headache, bronchospasm, and skin rash. Dosage: Adults: Hypertension, 6.25 mg PO BID may be increase to 12.5-25 mg BID; CHF, 3.125 mg PO BID may be doubled every 2 weeks up to a maximum dose of 25-50 mg BID; dose reductions are suggested in liver disease Pharmacokinetics: The drug is extensively metabolized in the liver and primarily excreted via the feces; the elimination half-life of carvedilol is 6 to 8 hours. Supply: Tab 6.25 mg, 25 mg Labetalol HCI–“Trandate”(OTRAND)(ITRA5) ( 專 ) ［ C ］ Indication: All grades of hypertension. Contraindication: Overt heart failure or atrioventricular block, bronchial asthma or chronic obstructive pulmonary disease, cardiogenic shock, and severe sinus bradycardia Adverse effect: Postural hypotension, scalp tingling, insomnia, GI discomfort, nasal stiffness, vivid dreams. Dosage: PO: 200-400 mg BID; IV: initial dose 50 mg , if necessary, doses of 50 mg may be repeated at 5 minutes interval until a satisfactory response occurs. Stability: When the concentration at 1.25, or 3.75 mg/ml either D5W or NS solution is stable for 72 hours at 4 or 24 ℃ . 104 - - 105 - - Supply: Tab 200 mg; Inj 25 mg/5 ml/amp Propranolol HCI-“Inderal” (Cardolol)(OIND1 OIND4) ［ C ］ Indication: Hypertension, angina pectoris, cardiac arrhythmia, prophylaxis of migraine, hypertrophic subaortic stenosis. Contraindication: Second to third degree heart block, bronchial asthma, cardiogenic shocks, sinus bradycardia, allergic rhinitis during the pollen season, hypoglycemia, metabolic acidosis. Dosage: PO 10-40 mg TID or QID, maintenance dose: 160-480 mg/day. For emergency of cardiac arrhythmia: IV 1-3 mg (less than 1 mg/min), maximum dose: 10 mg. Stability: In 0.5 or 20 mg/L either NS or D5W solution, the stability is retained for 24 hours at 25 ℃ in PVC or Polyolefin container. Supply: Tabs 10 mg, 40 mg Bisoprolol-“Concor” (OCONC)(OCON1) “Biso”(OBISO5) ［ D ］ Indication: Management of hypertension, angina pectoris & stable, chronic moderate to severe heart failure with reduced systolic ventricular function. Contraindication: Acute heart failure or during episodes of heart failure decompensation requiring IV inotropic therapy, cardiogenic shock, AV block of grades II & III, sick sinus syndrome, SA block, bradycardia with <60 beats/min; severe bronchial asthma or severe COPD, hypotension (systolic BP <100 mmHg), advanced stages of peripheral arterial circulatory disturbance & Raynaud’s syndrome, untreated pheochromocytoma, metabolic acidosis. Adverse effect: Feeling of coldness or numbness in the extremities, nausea, vomiting, diarrhea, constipation. Tiredness, exhaustion, dizziness, headache (occur at the beginning of the therapy & usually disappear within 1-2 weeks) Dosage: Hypertension, angina pectoris: 5-10 mg once daily. Stable chronic heart failure: 1.25 mg once daily for 1 week, if well tolerated then increase to 2.5 mg once daily for 1 week, then 3.75 mg once daily for 1 week, then 5 mg once daily for 4 weeks, then 7.5 mg once daily for 4 weeks, then 10 mg once daily as maintenance therapy. Max: 10 mg daily. Supply: Tab 1.25 mg, 5 mg Betaxolol-“Bexolo”(OBEXO) ［ D ］ Indication: Hypertension, angina pectoris. Contraindication: Cardiogenic shock, uncontrolled congestive cardiac failure, 2nd or 3rd degree AV block if no pacemaker is present. Marked bradycardia (heart rate <50 beats/minute) Adverse effect: Lassitude, exacerbation of Raynaud’s disease or intermittent claudication & paraethesia of extremities. Marked bradycardia, hypertension, AV block, cardiac insufficiency & bronchospasm. Dosage: Adult 20 mg daily may be increased to 40 mg if response is inadequate. Elderly patients or those with a history of bronchospasm 10 mg daily. Supply: Tab 20 mg Esmolol-“Brevibloc”(IESMO)( 特 ) ［ C ］ Indication: Rapid control of ventricular rate in patients with atrial fibrillation or atrial flutter in peri-op, post-op or other emergent circumstances. Noncompensatory sinus tachycardia. Treatment of tachycardia & hypertension that occur during induction, tracheal intubation, during surgery, on emergence from anesth & in the post-op period. Contraindication:sinus bradycardia, heart block >1st degree, cardiogenic shock or overt heart failure. Adverse effect: Hypotension, dizziness, somnolence, confusion, headache, agitation, fatigue, nausea, vomiting. Dosage: Supraventricular trachycardia: 50-200 mcg/kg/min. Intra-op & post-op tachycardia &/or hypertension: immediate control—80 mg bolus dose over 30 seconds followed by a 150 mcg/kg/min infusion; 104 - - 105 - - Supply: Tab 200 mg; Inj 25 mg/5 ml/amp Propranolol HCI-“Inderal” (Cardolol)(OIND1 OIND4) ［ C ］ Indication: Hypertension, angina pectoris, cardiac arrhythmia, prophylaxis of migraine, hypertrophic subaortic stenosis. Contraindication: Second to third degree heart block, bronchial asthma, cardiogenic shocks, sinus bradycardia, allergic rhinitis during the pollen season, hypoglycemia, metabolic acidosis. Dosage: PO 10-40 mg TID or QID, maintenance dose: 160-480 mg/day. For emergency of cardiac arrhythmia: IV 1-3 mg (less than 1 mg/min), maximum dose: 10 mg. Stability: In 0.5 or 20 mg/L either NS or D5W solution, the stability is retained for 24 hours at 25 ℃ in PVC or Polyolefin container. Supply: Tabs 10 mg, 40 mg Bisoprolol-“Concor” (OCONC)(OCON1) “Biso”(OBISO5) ［ D ］ Indication: Management of hypertension, angina pectoris & stable, chronic moderate to severe heart failure with reduced systolic ventricular function. Contraindication: Acute heart failure or during episodes of heart failure decompensation requiring IV inotropic therapy, cardiogenic shock, AV block of grades II & III, sick sinus syndrome, SA block, bradycardia with <60 beats/min; severe bronchial asthma or severe COPD, hypotension (systolic BP <100 mmHg), advanced stages of peripheral arterial circulatory disturbance & Raynaud’s syndrome, untreated pheochromocytoma, metabolic acidosis. Adverse effect: Feeling of coldness or numbness in the extremities, nausea, vomiting, diarrhea, constipation. Tiredness, exhaustion, dizziness, headache (occur at the beginning of the therapy & usually disappear within 1-2 weeks) Dosage: Hypertension, angina pectoris: 5-10 mg once daily. Stable chronic heart failure: 1.25 mg once daily for 1 week, if well tolerated then increase to 2.5 mg once daily for 1 week, then 3.75 mg once daily for 1 week, then 5 mg once daily for 4 weeks, then 7.5 mg once daily for 4 weeks, then 10 mg once daily as maintenance therapy. Max: 10 mg daily. Supply: Tab 1.25 mg, 5 mg Betaxolol-“Bexolo”(OBEXO) ［ D ］ Indication: Hypertension, angina pectoris. Contraindication: Cardiogenic shock, uncontrolled congestive cardiac failure, 2nd or 3rd degree AV block if no pacemaker is present. Marked bradycardia (heart rate <50 beats/minute) Adverse effect: Lassitude, exacerbation of Raynaud’s disease or intermittent claudication & paraethesia of extremities. Marked bradycardia, hypertension, AV block, cardiac insufficiency & bronchospasm. Dosage: Adult 20 mg daily may be increased to 40 mg if response is inadequate. Elderly patients or those with a history of bronchospasm 10 mg daily. Supply: Tab 20 mg Esmolol-“Brevibloc”(IESMO)( 特 ) ［ C ］ Indication: Rapid control of ventricular rate in patients with atrial fibrillation or atrial flutter in peri-op, post-op or other emergent circumstances. Noncompensatory sinus tachycardia. Treatment of tachycardia & hypertension that occur during induction, tracheal intubation, during surgery, on emergence from anesth & in the post-op period. Contraindication:sinus bradycardia, heart block >1st degree, cardiogenic shock or overt heart failure. Adverse effect: Hypotension, dizziness, somnolence, confusion, headache, agitation, fatigue, nausea, vomiting. Dosage: Supraventricular trachycardia: 50-200 mcg/kg/min. Intra-op & post-op tachycardia &/or hypertension: immediate control—80 mg bolus dose over 30 seconds followed by a 150 mcg/kg/min infusion; 106 - - 107 - - gradual control—initially 50 mcg/kg/min for 1 min followed by a 4 –min maintenance infusion of 500 mcg/kg/min. Supply: Inj 100 mg/10 ml/vial. 24:28 Calcium-Channel Blocking Agents 24:28.08 Dihydropyridines Amlodipine -“Norvasc”(ONORV) “Amcopine” (OAMCO) ［ C ］ Indication: Amlodipine is effective as once daily monotherapy in hypertension and angina pectoris. Contraindication: Patient with hypersensitivity to amlodipine or symptomatic hypotension (systolic pressure < 90 mmHg), or patient with advanced aortic stenosis. Adverse effect: Dose related peripheral edema; headache, flushing, palpitations and GI disturbances. Dosage: 5 to 10 mg QD. Dose reductions may be indicated in the elderly or those with hepatic failure, but are not necessary in renal impairment. Supply: Tab 5 mg (Norvasc), 10 mg (Amcopine) Felodipine-“Plendil” (OPLEN) “Felopine SR”(OFELS) ［ C ］ Indication: Felodipine is effective as monotherapy in mild to moderate hypertension. It may be useful in angina, congestive heart failure, and pulmonary hypertension. Place in therapy: Felodipine produces less disruption of left ventricular function than do verapamil and diltiazem and may be preferred in patients with concomitant sinus bradycardia, conduction disturbances and compromised cardiac function. As monotherapy, response was seen in 60% to 65% of patients on felodipine 5 to 10mg daily or nifedipine 10mg twice daily. Contraindication: Hypersensitivity to calcium channel antagonist, symptomatic hypotension, any degree of A-V block, use caution in patients with previous left ventricular dysfunction. Adverse effect: Dizziness, headache, peripheral edema (worse than with verapamil and diltiazem), flushing, rash, and gingival hyperplasia. Dosage: Adults: Initial PO 5 mg QD; adjusted at 2 week intervals; 20 mg QD has been used; for elderly and impaired liver function, should not receive more than 10 mg/day. Children: PO 0.18 to 0.56 mg/kg QD were used to control hypertension or renal artery stenosis. Supply: Tab 5 mg Nifedipine-“Alonix-S” (OALON)“Adalat OROS” (OADAO) “Nifecardia SR” (ONIFE)“Nedipin” (OSUFE) “Coracten” (OCORA) ［ C ］ Indication: Vasospastic angina, chronic angina, migraine headache, Raynaud’s disease, and hypertension Contraindication: Hypersensitivity to this or other calcium channel antagonists, advanced aortic stenosis, unstable angina pectoris, acute myocardial infarction (within 4 weeks) Adverse effect: Dizziness, headache, peripheral edema (worse than with verapamil and diltiazem), flushing, rash, and gingival hyperplasia are the most common adverse events seen with the dihydropyridine derivative calcium channel antagonists including nifedipine. Pharmacokinetics: The distribution and elimination half-lives are 2.5 to 3 hours and 3 to 4 hours, respectively. Dosage: Angina and hypertension: 10-20 mg PO TID or 30-60 mg extended release PO QD; doses above 180 mg/day regular release or 90-120 mg extended release are not recommended. Supply: Soft cap 5 mg (Alonix-S); Cap 10 mg (Nedipin), 20 mg (Coracten); Extended release Tab 30 mg (Adalat OROS, Nifecardia SR) 106 - - 107 - - gradual control—initially 50 mcg/kg/min for 1 min followed by a 4 –min maintenance infusion of 500 mcg/kg/min. Supply: Inj 100 mg/10 ml/vial. 24:28 Calcium-Channel Blocking Agents 24:28.08 Dihydropyridines Amlodipine -“Norvasc”(ONORV) “Amcopine” (OAMCO) ［ C ］ Indication: Amlodipine is effective as once daily monotherapy in hypertension and angina pectoris. Contraindication: Patient with hypersensitivity to amlodipine or symptomatic hypotension (systolic pressure < 90 mmHg), or patient with advanced aortic stenosis. Adverse effect: Dose related peripheral edema; headache, flushing, palpitations and GI disturbances. Dosage: 5 to 10 mg QD. Dose reductions may be indicated in the elderly or those with hepatic failure, but are not necessary in renal impairment. Supply: Tab 5 mg (Norvasc), 10 mg (Amcopine) Felodipine-“Plendil” (OPLEN) “Felopine SR”(OFELS) ［ C ］ Indication: Felodipine is effective as monotherapy in mild to moderate hypertension. It may be useful in angina, congestive heart failure, and pulmonary hypertension. Place in therapy: Felodipine produces less disruption of left ventricular function than do verapamil and diltiazem and may be preferred in patients with concomitant sinus bradycardia, conduction disturbances and compromised cardiac function. As monotherapy, response was seen in 60% to 65% of patients on felodipine 5 to 10mg daily or nifedipine 10mg twice daily. Contraindication: Hypersensitivity to calcium channel antagonist, symptomatic hypotension, any degree of A-V block, use caution in patients with previous left ventricular dysfunction. Adverse effect: Dizziness, headache, peripheral edema (worse than with verapamil and diltiazem), flushing, rash, and gingival hyperplasia. Dosage: Adults: Initial PO 5 mg QD; adjusted at 2 week intervals; 20 mg QD has been used; for elderly and impaired liver function, should not receive more than 10 mg/day. Children: PO 0.18 to 0.56 mg/kg QD were used to control hypertension or renal artery stenosis. Supply: Tab 5 mg Nifedipine-“Alonix-S” (OALON)“Adalat OROS” (OADAO) “Nifecardia SR” (ONIFE)“Nedipin” (OSUFE) “Coracten” (OCORA) ［ C ］ Indication: Vasospastic angina, chronic angina, migraine headache, Raynaud’s disease, and hypertension Contraindication: Hypersensitivity to this or other calcium channel antagonists, advanced aortic stenosis, unstable angina pectoris, acute myocardial infarction (within 4 weeks) Adverse effect: Dizziness, headache, peripheral edema (worse than with verapamil and diltiazem), flushing, rash, and gingival hyperplasia are the most common adverse events seen with the dihydropyridine derivative calcium channel antagonists including nifedipine. Pharmacokinetics: The distribution and elimination half-lives are 2.5 to 3 hours and 3 to 4 hours, respectively. Dosage: Angina and hypertension: 10-20 mg PO TID or 30-60 mg extended release PO QD; doses above 180 mg/day regular release or 90-120 mg extended release are not recommended. Supply: Soft cap 5 mg (Alonix-S); Cap 10 mg (Nedipin), 20 mg (Coracten); Extended release Tab 30 mg (Adalat OROS, Nifecardia SR) 108 - - 109 - - Nicardipine HCI-“Nicarpine” (ONICA) “Perdipine” (IPERD) Indication: Cerebral blood flow disturbances and hypertension Contraindication: Incomplete hemostasis following intracranial hemorrhage; acute cerebral apoplexy, elevated intracranial pressure. Adverse effect: Infrequently, anorexia, nausea, vomiting; flushing; palpitation; headache. Rarely, granulocytopenia, dry mouth, constipation, diarrhea, peripheral edema, and rash Dosage: Cerebral blood flow disturbances: 20 mg TID; essential hypertension 10-20 mg tid; short-term therapy of hypertension or of unusual hypertension during surgery: 2-10 mcg/kg/min. Supply: Tab 20 mg; Inj 1 mg/ml/amp. Nimodipine-“Nimotop”(INIMO)( 專 ) (ONIMO)( 專 )[C] Indication: Nimodipine is a calcium channel antagonist for the improvement of neurological deficits due to cerebral artery spasm following subarachnoid hemorrhage. Therapy should commence within 96 hours of the subarachnoid hemorrhage. Place in therapy: Nimodipine differs from the currently used calcium channel blockers in its cerebrovascular selectivity. Nimodipine is effective in improving outcomes due to cerebral artery spasm and subsequent neurologic deficits in patients with subarachnoid hemorrhage (SAH) and ruptured cerebral aneurysms, but not necessarily improving the mortality. Contraindication: Patients with hypersensitivity to nimodipine and patients with cardiovascular surgery. Intravenous doses of nimodipine greater than 1 mcg/kg/min (0.06 mg/kg/hr) may cause significant decreases in blood pressure and should be used with caution. Adverse effect: Primary side effects are GI disturbance (diarrhea, nausea, and abdominal cramps). Reduction in blood pressure may also occur. Dosage: For subarachnoid hemorrhage, initial rate of 1 mg/hr for 2 hours, then 1-3 mg/hr (24-72 mg daily) for 1-2 weeks has been used. For oral use, 20-90 mg (usually 60 mg) daily has been used. Dosage should reduce in patients with hepatic function impairment and renal impairment. Stability: Nimodipine is sensitive to light. All syringes and catheters used for infusing should be protected from light with a suitable covering, such as aluminum or silver foil. Nimodipine solution can bind to polyvinyl chloride (PVC) tubing; non-PVC infusion equipment should be used. Supply: Inj 0.02% 50 ml/bot; Tab 30 mg Lercanidipine-“Zanidip”(OLERC) Indication: Hypertension Contraindication: Known sensitivity to dihydropyridines. Adverse effect: Flushing, peripheral edema, palpitation, headache, dizziness. Dosage: 10 mg once daily. May increase to 20 mg Supply: Tab 10 mg Flunarizine-“Sibelium” (OSIBE) “Fluzine” (OFLUZ) Indication: Migraine, prophylaxis and treatment of vertigo and peripheral vascular disease. Contraindication: Patient hypersensitive to flunarizine. Adverse effect: Drowsiness, headache, insomnia, nausea, dry mouth. Dosage: Migraine, headache prophylaxis and peripheral vascular disease: PO 10mg daily as a single dose. Vertigo: PO 20mg TID. Supply: Cap 5 mg (Sibelium); Tab 5 mg (Fluzine) 24:28.92 Calcium-Channel Blocking Agents, Miscellaneous Diltiazem HCI-“Herbesser” (OHERB)(IHERB) “Cardizem” (OCAR1) ［ C ］ Indication: Treatment of coronary artery spasm, angina 108 - - 109 - - Nicardipine HCI-“Nicarpine” (ONICA) “Perdipine” (IPERD) Indication: Cerebral blood flow disturbances and hypertension Contraindication: Incomplete hemostasis following intracranial hemorrhage; acute cerebral apoplexy, elevated intracranial pressure. Adverse effect: Infrequently, anorexia, nausea, vomiting; flushing; palpitation; headache. Rarely, granulocytopenia, dry mouth, constipation, diarrhea, peripheral edema, and rash Dosage: Cerebral blood flow disturbances: 20 mg TID; essential hypertension 10-20 mg tid; short-term therapy of hypertension or of unusual hypertension during surgery: 2-10 mcg/kg/min. Supply: Tab 20 mg; Inj 1 mg/ml/amp. Nimodipine-“Nimotop”(INIMO)( 專 ) (ONIMO)( 專 )[C] Indication: Nimodipine is a calcium channel antagonist for the improvement of neurological deficits due to cerebral artery spasm following subarachnoid hemorrhage. Therapy should commence within 96 hours of the subarachnoid hemorrhage. Place in therapy: Nimodipine differs from the currently used calcium channel blockers in its cerebrovascular selectivity. Nimodipine is effective in improving outcomes due to cerebral artery spasm and subsequent neurologic deficits in patients with subarachnoid hemorrhage (SAH) and ruptured cerebral aneurysms, but not necessarily improving the mortality. Contraindication: Patients with hypersensitivity to nimodipine and patients with cardiovascular surgery. Intravenous doses of nimodipine greater than 1 mcg/kg/min (0.06 mg/kg/hr) may cause significant decreases in blood pressure and should be used with caution. Adverse effect: Primary side effects are GI disturbance (diarrhea, nausea, and abdominal cramps). Reduction in blood pressure may also occur. Dosage: For subarachnoid hemorrhage, initial rate of 1 mg/hr for 2 hours, then 1-3 mg/hr (24-72 mg daily) for 1-2 weeks has been used. For oral use, 20-90 mg (usually 60 mg) daily has been used. Dosage should reduce in patients with hepatic function impairment and renal impairment. Stability: Nimodipine is sensitive to light. All syringes and catheters used for infusing should be protected from light with a suitable covering, such as aluminum or silver foil. Nimodipine solution can bind to polyvinyl chloride (PVC) tubing; non-PVC infusion equipment should be used. Supply: Inj 0.02% 50 ml/bot; Tab 30 mg Lercanidipine-“Zanidip”(OLERC) Indication: Hypertension Contraindication: Known sensitivity to dihydropyridines. Adverse effect: Flushing, peripheral edema, palpitation, headache, dizziness. Dosage: 10 mg once daily. May increase to 20 mg Supply: Tab 10 mg Flunarizine-“Sibelium” (OSIBE) “Fluzine” (OFLUZ) Indication: Migraine, prophylaxis and treatment of vertigo and peripheral vascular disease. Contraindication: Patient hypersensitive to flunarizine. Adverse effect: Drowsiness, headache, insomnia, nausea, dry mouth. Dosage: Migraine, headache prophylaxis and peripheral vascular disease: PO 10mg daily as a single dose. Vertigo: PO 20mg TID. Supply: Cap 5 mg (Sibelium); Tab 5 mg (Fluzine) 24:28.92 Calcium-Channel Blocking Agents, Miscellaneous Diltiazem HCI-“Herbesser” (OHERB)(IHERB) “Cardizem” (OCAR1) ［ C ］ Indication: Treatment of coronary artery spasm, angina 110 - - 111 - - pectoris, essential hypertension, supraventricular arrhythmia. Adverse effect: A-V nodal block, hypotension, headache, and GI disturbance. Dosage: 30-50 mg TID, maximum dose: 360 mg/day in 3-4 doses; 120-180 mg PO QD with sustain-release tab; IV 10 mg as single dose over a period of 3 mins. Supply: Tab 30 mg (Herbesser), and 180 mg (prolonged release) (Cardizem); Inj 50 mg/amp (Herbesser) Verapamil HCI-“Isoptin” (IISOP)( 專 ) Verelan” (OVERE) ［ C ］ Indication: Control of supraventricular arrhythmia, angina pectoris, chronic coronary insufficiency, hypertension. Contraindication: Hypotension, associated with cardiac shock, patients in digitalis intoxication, marked bradycardia, partial of complete A-V block, acute myocardial infarction, concomitant use with β -blockers and cardiac depressants. Adverse effect: Severe hypotension, bradycardia, constipation, flushing, bronchospasm. Administration: PO: 40-120 mg TID AC, maximal dose 480 mg /day; IV infusion: 75-150 mcg/kg in normal saline or dextrose solution at a rate of 5-10 mg/hr. Stability: NS or D5W with verapamil HCl 40 mg/L or 160 mg/L is physically compatible and chemically stable for 48 hours at 25 ℃ . Supply: Inj 5 mg/2ml/amp (Isoptin); Cap 120 mg (Verelan) 24:32 Renin-Angiotensin-Aldosterone System Inhibitors 24:32.04 Angiotensin-Converting Enzyme Inhibitors Captopril-“Capoten”(OCAPO) ［ C/D ］ Indication: Captopril is indicated for initial therapy in patients with all degrees of hypertension and is effective alone or in combination with other antihypertensives. It also can be used for treatment of diabetic nephropathy in patients with Type I insulin-dependent diabetes mellitus with retinopathy, congestive heart failure, myocardial infarction to reduce the risk of death and prevent development of congestive heart failure. Contraindication: Hypersensitivity to captopril other ACEIs, history of angioedema, bilateral renal artery stenosis Adverse effect: Skin rash, pruritus, taste disturbance, proteinuria (renal disease history); serum potassium concentration may be raised. Dosage: Adults: Usual dose: 25-150 mg TID, 1 hour AC; maximum dose: 450 mg/day. Children: Usual dose: 1 mg/kg/day, maximum dose: 6 mg/kg/day. Supply: Tab 25 mg Enalapril maleate-“Renitec” (OREN5)(OREN2) “Fonitec”(OFONI) ［ C/D ］ Indication: Enalapril is an angiotensin converting enzyme inhibitor. It has been used in hypertension, chronic heart failure. Theoretically, enalapril has advantages over captopril with respect to increase potency, longer duration of action, and possibly a reduction in side effects due to a lack of sulfhydryl moeity. Contraindication: Hypersensitivity to enalapril or enalaprilat and history of angioedema induced by other ACE inhibitors. Adverse effect: The most frequent adverse effects are headache, dizziness, and fatigue. Other adverse effects include diarrhea, rash, hypotension, cough, nausea, and orthostasis. Dosage: Hypertension: 5 mg QD, blood pressure control: 10-40 mg daily; the dosage should be adjusted in patients with renal failure; maximum dose: 40 mg/day Supply: Tab 5 mg (Renitec), 20 mg (Renitec, Fonitec) Ramipril-“Ramitace” (ORAMI) ［ C/D ］ Indication: Hypertension, CHF. Treatment of patients who within the 1st few days after an acute MI, have 110 - - 111 - - pectoris, essential hypertension, supraventricular arrhythmia. Adverse effect: A-V nodal block, hypotension, headache, and GI disturbance. Dosage: 30-50 mg TID, maximum dose: 360 mg/day in 3-4 doses; 120-180 mg PO QD with sustain-release tab; IV 10 mg as single dose over a period of 3 mins. Supply: Tab 30 mg (Herbesser), and 180 mg (prolonged release) (Cardizem); Inj 50 mg/amp (Herbesser) Verapamil HCI-“Isoptin” (IISOP)( 專 ) Verelan” (OVERE) ［ C ］ Indication: Control of supraventricular arrhythmia, angina pectoris, chronic coronary insufficiency, hypertension. Contraindication: Hypotension, associated with cardiac shock, patients in digitalis intoxication, marked bradycardia, partial of complete A-V block, acute myocardial infarction, concomitant use with β -blockers and cardiac depressants. Adverse effect: Severe hypotension, bradycardia, constipation, flushing, bronchospasm. Administration: PO: 40-120 mg TID AC, maximal dose 480 mg /day; IV infusion: 75-150 mcg/kg in normal saline or dextrose solution at a rate of 5-10 mg/hr. Stability: NS or D5W with verapamil HCl 40 mg/L or 160 mg/L is physically compatible and chemically stable for 48 hours at 25 ℃ . Supply: Inj 5 mg/2ml/amp (Isoptin); Cap 120 mg (Verelan) 24:32 Renin-Angiotensin-Aldosterone System Inhibitors 24:32.04 Angiotensin-Converting Enzyme Inhibitors Captopril-“Capoten”(OCAPO) ［ C/D ］ Indication: Captopril is indicated for initial therapy in patients with all degrees of hypertension and is effective alone or in combination with other antihypertensives. It also can be used for treatment of diabetic nephropathy in patients with Type I insulin-dependent diabetes mellitus with retinopathy, congestive heart failure, myocardial infarction to reduce the risk of death and prevent development of congestive heart failure. Contraindication: Hypersensitivity to captopril other ACEIs, history of angioedema, bilateral renal artery stenosis Adverse effect: Skin rash, pruritus, taste disturbance, proteinuria (renal disease history); serum potassium concentration may be raised. Dosage: Adults: Usual dose: 25-150 mg TID, 1 hour AC; maximum dose: 450 mg/day. Children: Usual dose: 1 mg/kg/day, maximum dose: 6 mg/kg/day. Supply: Tab 25 mg Enalapril maleate-“Renitec” (OREN5)(OREN2) “Fonitec”(OFONI) ［ C/D ］ Indication: Enalapril is an angiotensin converting enzyme inhibitor. It has been used in hypertension, chronic heart failure. Theoretically, enalapril has advantages over captopril with respect to increase potency, longer duration of action, and possibly a reduction in side effects due to a lack of sulfhydryl moeity. Contraindication: Hypersensitivity to enalapril or enalaprilat and history of angioedema induced by other ACE inhibitors. Adverse effect: The most frequent adverse effects are headache, dizziness, and fatigue. Other adverse effects include diarrhea, rash, hypotension, cough, nausea, and orthostasis. Dosage: Hypertension: 5 mg QD, blood pressure control: 10-40 mg daily; the dosage should be adjusted in patients with renal failure; maximum dose: 40 mg/day Supply: Tab 5 mg (Renitec), 20 mg (Renitec, Fonitec) Ramipril-“Ramitace” (ORAMI) ［ C/D ］ Indication: Hypertension, CHF. Treatment of patients who within the 1st few days after an acute MI, have 112 - - 113 - - demonstrated clinical signs of CHF. Preventions of MI, stroke or CV death & reduction of need for revascularization procedures in patients with an increased CV risk such as manifest coronary heart disease (with or without a history of MI), a history of stroke, or a history of peripheral vascular disease. Prevention of MI, stroke or CV death in diabetic patients. Contraindication: Hereditary angioneurotic edema. Pregnancy; lactation. Adverse effect: Nausea, dizziness & heasache, dry cough. Hypersensitivity reactions including pruritus, rash & fever. Dosage: 2.5-5 mg daily. Supply: Cap 2.5 mg Fosinopril sodium-“Monopril” (OMONO) ［ C/D ］ Indication: Hypertension, and as adjunctive management of congestive heart failure, improving survival following acute myocardial infarction, and reducing proteinuria in patients with diabetic nephropathy. Place in therapy: ACE inhibitors may be preferred initial agents in patients with heart failure complicating hypertension, or diabetic renal disease with proteinuria. The major clinically relevant differences of fosinopril among ACE inhibitors are the duration of hypotensive effect and route of elimination. Contraindication: Hypersensitivity to the drug or any other ACE inhibitor; history of angioedema; pregnancy. Adverse effect: Headache; a dry, non-productive cough; dizziness, diarrhea, fatigue, nausea/vomiting, and sexual dysfunction; hypotension in volume/salt depleted patients; Transient increases in serum potassium to 10% above normal upper limits occur in up to 2.6% of patients treated with fosinopril. Dosage: Adults: PO 5-40 mg QD, in patients of end-stage renal disease, start at PO 7.5 mg QD. Supply: Tab 10 mg Lisinopril dihydrate-“Zestril”(OZEST) “Noprisil”(ONOPR) ［ D ］ Indication: Lisinopril is effective in reducing blood pressure in patients with essential or renovascular hypertension, and is indicated as adjunctive therapy in patients with congestive heart failure. Contraindication: Hypersensitivity, history of angioedema induced by other ACE inhibitors and pregnancy. Adverse effect: Blood dyscrasias, hypotension, headache, fatigue, insomnia, hyperkalemia, nausea, diarrhea, taste disturbances, renal dysfunction, dry cough. Dosage: 5-10 mg daily; max. 80 mg/day. Supply: Tab 10 mg Perindopril-“Acertil” (ACER) Indication: Perindopril is a long-acting angiotensin converting enzyme inhibitor. It is approved for treatment of mild to moderate hypertension. Contraindication: Angioedema induced by other ACE inhibitors, hypersensitivity to this or any other ACE inhibitor, pregnancy Adverse effect: Headache, asthenia, and dizziness (as reasons for discontinuation), nausea, epigastric pain, taste disturbances, skin rash, sexual dysfunction, and proteinuria; deterioration of renal function may occur in patients with chronic renal insufficiency. Dosage: Mild-to-moderate hypertension: 4-8 mg PO QD Pharmacokinetics: Perindopril is a prodrug and is hydrolyzed in the liver and possibly other sites to its active metabolite, perindoprilat, following oral administration. Approximately 75% of an oral dose of perindopril is recovered in the urine, with up to 10% and 20% appearing as perindopril and perindoprilat, respectively; the elimination half-life of perindopril is 1.5 to 3 hours. Supply: Tab 4 mg 112 - - 113 - - demonstrated clinical signs of CHF. Preventions of MI, stroke or CV death & reduction of need for revascularization procedures in patients with an increased CV risk such as manifest coronary heart disease (with or without a history of MI), a history of stroke, or a history of peripheral vascular disease. Prevention of MI, stroke or CV death in diabetic patients. Contraindication: Hereditary angioneurotic edema. Pregnancy; lactation. Adverse effect: Nausea, dizziness & heasache, dry cough. Hypersensitivity reactions including pruritus, rash & fever. Dosage: 2.5-5 mg daily. Supply: Cap 2.5 mg Fosinopril sodium-“Monopril” (OMONO) ［ C/D ］ Indication: Hypertension, and as adjunctive management of congestive heart failure, improving survival following acute myocardial infarction, and reducing proteinuria in patients with diabetic nephropathy. Place in therapy: ACE inhibitors may be preferred initial agents in patients with heart failure complicating hypertension, or diabetic renal disease with proteinuria. The major clinically relevant differences of fosinopril among ACE inhibitors are the duration of hypotensive effect and route of elimination. Contraindication: Hypersensitivity to the drug or any other ACE inhibitor; history of angioedema; pregnancy. Adverse effect: Headache; a dry, non-productive cough; dizziness, diarrhea, fatigue, nausea/vomiting, and sexual dysfunction; hypotension in volume/salt depleted patients; Transient increases in serum potassium to 10% above normal upper limits occur in up to 2.6% of patients treated with fosinopril. Dosage: Adults: PO 5-40 mg QD, in patients of end-stage renal disease, start at PO 7.5 mg QD. Supply: Tab 10 mg Lisinopril dihydrate-“Zestril”(OZEST) “Noprisil”(ONOPR) ［ D ］ Indication: Lisinopril is effective in reducing blood pressure in patients with essential or renovascular hypertension, and is indicated as adjunctive therapy in patients with congestive heart failure. Contraindication: Hypersensitivity, history of angioedema induced by other ACE inhibitors and pregnancy. Adverse effect: Blood dyscrasias, hypotension, headache, fatigue, insomnia, hyperkalemia, nausea, diarrhea, taste disturbances, renal dysfunction, dry cough. Dosage: 5-10 mg daily; max. 80 mg/day. Supply: Tab 10 mg Perindopril-“Acertil” (ACER) Indication: Perindopril is a long-acting angiotensin converting enzyme inhibitor. It is approved for treatment of mild to moderate hypertension. Contraindication: Angioedema induced by other ACE inhibitors, hypersensitivity to this or any other ACE inhibitor, pregnancy Adverse effect: Headache, asthenia, and dizziness (as reasons for discontinuation), nausea, epigastric pain, taste disturbances, skin rash, sexual dysfunction, and proteinuria; deterioration of renal function may occur in patients with chronic renal insufficiency. Dosage: Mild-to-moderate hypertension: 4-8 mg PO QD Pharmacokinetics: Perindopril is a prodrug and is hydrolyzed in the liver and possibly other sites to its active metabolite, perindoprilat, following oral administration. Approximately 75% of an oral dose of perindopril is recovered in the urine, with up to 10% and 20% appearing as perindopril and perindoprilat, respectively; the elimination half-life of perindopril is 1.5 to 3 hours. Supply: Tab 4 mg 114 - - 115 - - Perindopril/indapamide-“Acertil Plus” (OACERP) Indication: Hypertension Contraindication: Previous history of Quincke’s edema, severe renal failure, serious liver disorder, hypokalaemia, pregnancy, and lactation. Adverse effect: Tiredness, dizziness, headache, mood swings, sleep disturbances, cramps, hypotension, allergic reactions, skin rashes, GI disorders, dry cough, dry mouth, increased risk of dehydration in the elderly & in patients suffering from heart failure. Dosage: 1 tab daily Supply: Tab perindopril 4 mg/indapamide 1.25 mg Imidapril-“Tanatril”(OTANA) Indication: Hypertension Contraindication: History of angioedema due to an ACE inhibitor, patients who undergo LDL apheresis using dextran cellulose sulfate or hemodialysis with acrylonitrile methallyl sulfonate Na membrane. Pregnancy, lactation. Adverse effect: Cough, dizziness, hypotension, headache, pharynx discomfort, rash. Rarely angioedema, thrombocytopenia, acute renal failure. Pancytopenia, pancreatitis. Dosage: 5-10 mg once daily. Supply: Tab 5 mg. 24:32.08 Angiotensin II Receptor Antagonists Candesartan - “Blopress” (OBLOP) ［ C1 st trimester, D 2 nd and 3 rd trimester ］ Indication: Hypertension Contraindication: Severe hepatic impairment, cholestasis. Pregnancy, lactation. Adverse effect: Headache, upper respiratory tract infection, back pain, dizziness, pharyngitis, rhinitis. Dosage: 8 mg once daily. May increase to 16 mg once daily. Supply: Tab 8 mg Irbesartan - “Aprovel” (OAPRO) ［ C 1 st trimester ］ ［ D 2 nd and 3 rd trimester ］ Indication: Treatment of essential hypertension. Treatment of renal disease in patients with hypertension & type 2 diabetes mellitus as part of an antihypertensive drug regimen. Contraindication: Pregnancy, lactation. Adverse effect: respiratory infection, headache, musculoskeletal pain, trauma, dizziness, fatigue, diarrhoes. Dosage: 150 mg once daily Supply: Tab 150 mg Irbesartan/hydrochlorothiazide-“Coaprovel”(OCOAP) Indication: Treatment of essential hypertension in patients who’s BP is inadequately controlled on irbessrtan or hydrochlorothiazide alone. Contraindication: 2nd & 3rd trimester of pregnancy, lactation. Severe renal & hepatic impairment, refractory hypokalemia, hypercalcaemia, biliary cirrhosis & cholestasis. Adverse effect: Headache, dizziness, fatigue, nausea, vomiting, abnormal urination. Dosage: 1 tab once daily Supply: Tab irbesartan 150 mg /hydrochlorothiazide 12.5 mg Valsartan-“Diovan” (ODIOV) ［ C/D ］ Indication: Valsartan is a nonpeptide angiotensin II receptor antagonist. It may be used alone or in combination with other antihypertensive agents in treating essential hypertension and effective in the patients with stable renal insufficiency. Place in therapy: Valsartan may be a valuable alternative for hypertensive patients unresponsive to or intolerant of angiotensin converting enzyme (ACE) inhibitors, particularly those patients with headache, cough, or excessive hypotension. Contraindication: Hypersensitivity to valsartan or other 114 - - 115 - - Perindopril/indapamide-“Acertil Plus” (OACERP) Indication: Hypertension Contraindication: Previous history of Quincke’s edema, severe renal failure, serious liver disorder, hypokalaemia, pregnancy, and lactation. Adverse effect: Tiredness, dizziness, headache, mood swings, sleep disturbances, cramps, hypotension, allergic reactions, skin rashes, GI disorders, dry cough, dry mouth, increased risk of dehydration in the elderly & in patients suffering from heart failure. Dosage: 1 tab daily Supply: Tab perindopril 4 mg/indapamide 1.25 mg Imidapril-“Tanatril”(OTANA) Indication: Hypertension Contraindication: History of angioedema due to an ACE inhibitor, patients who undergo LDL apheresis using dextran cellulose sulfate or hemodialysis with acrylonitrile methallyl sulfonate Na membrane. Pregnancy, lactation. Adverse effect: Cough, dizziness, hypotension, headache, pharynx discomfort, rash. Rarely angioedema, thrombocytopenia, acute renal failure. Pancytopenia, pancreatitis. Dosage: 5-10 mg once daily. Supply: Tab 5 mg. 24:32.08 Angiotensin II Receptor Antagonists Candesartan - “Blopress” (OBLOP) ［ C1 st trimester, D 2 nd and 3 rd trimester ］ Indication: Hypertension Contraindication: Severe hepatic impairment, cholestasis. Pregnancy, lactation. Adverse effect: Headache, upper respiratory tract infection, back pain, dizziness, pharyngitis, rhinitis. Dosage: 8 mg once daily. May increase to 16 mg once daily. Supply: Tab 8 mg Irbesartan - “Aprovel” (OAPRO) ［ C 1 st trimester ］ ［ D 2 nd and 3 rd trimester ］ Indication: Treatment of essential hypertension. Treatment of renal disease in patients with hypertension & type 2 diabetes mellitus as part of an antihypertensive drug regimen. Contraindication: Pregnancy, lactation. Adverse effect: respiratory infection, headache, musculoskeletal pain, trauma, dizziness, fatigue, diarrhoes. Dosage: 150 mg once daily Supply: Tab 150 mg Irbesartan/hydrochlorothiazide-“Coaprovel”(OCOAP) Indication: Treatment of essential hypertension in patients who’s BP is inadequately controlled on irbessrtan or hydrochlorothiazide alone. Contraindication: 2nd & 3rd trimester of pregnancy, lactation. Severe renal & hepatic impairment, refractory hypokalemia, hypercalcaemia, biliary cirrhosis & cholestasis. Adverse effect: Headache, dizziness, fatigue, nausea, vomiting, abnormal urination. Dosage: 1 tab once daily Supply: Tab irbesartan 150 mg /hydrochlorothiazide 12.5 mg Valsartan-“Diovan” (ODIOV) ［ C/D ］ Indication: Valsartan is a nonpeptide angiotensin II receptor antagonist. It may be used alone or in combination with other antihypertensive agents in treating essential hypertension and effective in the patients with stable renal insufficiency. Place in therapy: Valsartan may be a valuable alternative for hypertensive patients unresponsive to or intolerant of angiotensin converting enzyme (ACE) inhibitors, particularly those patients with headache, cough, or excessive hypotension. Contraindication: Hypersensitivity to valsartan or other 116 - - 117 - - angiotensin receptor antagonists Adverse effect: The most common adverse effects reported are headache, dizziness, viral infection, upper respiratory tract infection, cough, diarrhea, drowsiness, rhinitis, sinusitis, backache, stomachache, nausea, pharyngitis and joint pain. Dosage: Adults: 80 mg PO QD Pharmacokinetics: It has a half-life of approximately 9 hours and excreted primarily as unchanged drug in the urine (13%) and feces (83%). Supply: Tab 80 mg Valsartan/Hydrochlorothiazide – “Co-Diovan” (OCODI) Indication: Hypertension Contraindication: Severe hepatic impairment, biliary cirrhosis & cholestasis. Anuria, severe renal impairment. Refractory hypokalemia, hyponatremia, hypercalcemia & symptomatic hyperuricemia. Pregnancy & lactation. Adverse effect: Headache, dizziness, fatigue, sinusitis, pharyngitis, upper respiratory tract infection, back pain, diarrhea, viral infection, chest pain, nausea, rhinitis, dyspepsia, UTI, abdominal pain, micturition frequency, bronchitis, dyspnea, leg pain, sprains, abnormal vision, leg cramps, impotence, insomnia, rash. Dosage: 1 tab daily. Supply: Tab valsartan 80 mg/hydrochlorothiazide 12.5 mg Losartan-“Cozaar”(OCZA) Indication: Losartan is a nonpeptide angiotensin II receptor antagonist. Losartan is approved for use as monotherapy or combination therapy with a diuretic in mild to moderate hypertension. Place in therapy: Losartan may be a valuable alternative for hypertensive patients unresponsive to or intolerant of angiotensin converting enzyme (ACE) inhibitors, particularly those patients with headache, cough, or excessive hypotension. Contraindication: Hypersensitivity to losartan or other angiotensin receptor antagonists. Adverse effect: From clinical trials, the side effects with losartan are similar to that for placebo. Headache, upper respiratory infection, dizziness, cough were most common. Dosage: Adults: 25-100 mg PO QD-BID Pharmacokinetics: The drug is metabolized to an active metabolite, which accounts for the long duration of antihypertensive effects (up to 24 hours). The elimination half-life of losartan is about 2 hours, whereas a half-life of 4 to 5 hours has been reported for its metabolite E-3174. Supply: Tab 50 mg Losartan/Hydrochlorothiazide-“Hyzaar” (OHYZA) Indication: Treatment of hypertension in patients suitable in whom combination therapy is appropriate. Contraindication: Hypersensitivity to other sulfonamide-derived drugs. Patients with anuria, intravascular vol depletion, severe renal impairment, and hepatic impairment Adverse effect: Dizziness. Rarely, angioedema, hepatitis, diarrhoea. Dosage: 1 tab once daily. May be increased to 2 tab once daily. Supply: Tab losartan 50 mg/ hydrochlorothizide 12.5 mg Telmisartan-“Micardis”(OMICA) ［ C/D ］ Indication: Management of hypertension Pharmacology: Telmisartan is a specific angiotensin II receptor (type AT1) antagonist. Pharmacokinetics: Onset of action: 1-2 hours; duration: up to 24 hours; protein binding: >99.5%; metabolism: hepatic via conjugation to inactive metabolites; not metabolized via CYP; bioavailability (dose dependent): 42% to 58%; elimination half-life: 24hr Contraindication: Hypersensitivity to telmisartan or to any component of the product, bilateral renal artery stenosis, pregnancy (2nd and 3rd trimesters) Adverse effect: Hypotension, anemia, dizziness, 116 - - 117 - - angiotensin receptor antagonists Adverse effect: The most common adverse effects reported are headache, dizziness, viral infection, upper respiratory tract infection, cough, diarrhea, drowsiness, rhinitis, sinusitis, backache, stomachache, nausea, pharyngitis and joint pain. Dosage: Adults: 80 mg PO QD Pharmacokinetics: It has a half-life of approximately 9 hours and excreted primarily as unchanged drug in the urine (13%) and feces (83%). Supply: Tab 80 mg Valsartan/Hydrochlorothiazide – “Co-Diovan” (OCODI) Indication: Hypertension Contraindication: Severe hepatic impairment, biliary cirrhosis & cholestasis. Anuria, severe renal impairment. Refractory hypokalemia, hyponatremia, hypercalcemia & symptomatic hyperuricemia. Pregnancy & lactation. Adverse effect: Headache, dizziness, fatigue, sinusitis, pharyngitis, upper respiratory tract infection, back pain, diarrhea, viral infection, chest pain, nausea, rhinitis, dyspepsia, UTI, abdominal pain, micturition frequency, bronchitis, dyspnea, leg pain, sprains, abnormal vision, leg cramps, impotence, insomnia, rash. Dosage: 1 tab daily. Supply: Tab valsartan 80 mg/hydrochlorothiazide 12.5 mg Losartan-“Cozaar”(OCZA) Indication: Losartan is a nonpeptide angiotensin II receptor antagonist. Losartan is approved for use as monotherapy or combination therapy with a diuretic in mild to moderate hypertension. Place in therapy: Losartan may be a valuable alternative for hypertensive patients unresponsive to or intolerant of angiotensin converting enzyme (ACE) inhibitors, particularly those patients with headache, cough, or excessive hypotension. Contraindication: Hypersensitivity to losartan or other angiotensin receptor antagonists. Adverse effect: From clinical trials, the side effects with losartan are similar to that for placebo. Headache, upper respiratory infection, dizziness, cough were most common. Dosage: Adults: 25-100 mg PO QD-BID Pharmacokinetics: The drug is metabolized to an active metabolite, which accounts for the long duration of antihypertensive effects (up to 24 hours). The elimination half-life of losartan is about 2 hours, whereas a half-life of 4 to 5 hours has been reported for its metabolite E-3174. Supply: Tab 50 mg Losartan/Hydrochlorothiazide-“Hyzaar” (OHYZA) Indication: Treatment of hypertension in patients suitable in whom combination therapy is appropriate. Contraindication: Hypersensitivity to other sulfonamide-derived drugs. Patients with anuria, intravascular vol depletion, severe renal impairment, and hepatic impairment Adverse effect: Dizziness. Rarely, angioedema, hepatitis, diarrhoea. Dosage: 1 tab once daily. May be increased to 2 tab once daily. Supply: Tab losartan 50 mg/ hydrochlorothizide 12.5 mg Telmisartan-“Micardis”(OMICA) ［ C/D ］ Indication: Management of hypertension Pharmacology: Telmisartan is a specific angiotensin II receptor (type AT1) antagonist. Pharmacokinetics: Onset of action: 1-2 hours; duration: up to 24 hours; protein binding: >99.5%; metabolism: hepatic via conjugation to inactive metabolites; not metabolized via CYP; bioavailability (dose dependent): 42% to 58%; elimination half-life: 24hr Contraindication: Hypersensitivity to telmisartan or to any component of the product, bilateral renal artery stenosis, pregnancy (2nd and 3rd trimesters) Adverse effect: Hypotension, anemia, dizziness, 118 - - 119 - - headache, fatigue, cough, upper respiratory infection, angioedema. Dosage: Initial, 40 mg ORALLY once daily; usual maintenance dose range: 20-80 mg/day. Patients with volume depletion should be initiated on the lower dosage with close supervision. May take with or without food Supply: Tab 40 mg Telmisartan/Hydrochlorothiazide- “Micardis Plus”(OMICAP) ［ C/D ］ Indication: Treatment of essential hypertension in patients whose BP is not adequately controlled on telmisartan or hydrochlorothiazide Contraindication: cholestasis, biliary obstructive disorders, severe hepatic impairment, severe renal impairment (CrCl <30 ml/min), refractory hypokalaemia, hypercalcaemia. Pregnancy (2nd & 3rd trimesters) & lactation. Adverse effect: respiratory disorders, UTI, blood dyscrasias, precipitation of gout or latent diabets, electrolyte & fluid imbalance, metabolic & nutritional disorders, dizziness, vertigo, psychiatric & nervous system disorders, visual disturbances, CV & GI disorders, jaundice, renal disorders, arthralgia, myalgia, skin & allergic reactions. Dosage: 1 tab once daily. MAX: 160 mg/12.5-25 mg daily Supply: Tab Telmisartan 40 mg/ hydrochlorothiazide 12.5 mg Olmesartan-“Olmetec”(OOLME) ［ C/D ］ Indication: Treatment of hypertension Contraindication: Renal artery stenosis, lactation. Adverse effect: Dizziness, back pain, bronchitis, CPK increased, diarrhea, headache, hematuria, hyperglycemia, hypertiglyceridemia, flu-like syndrome, pharyngitis, rhinitis, sinusitis, and cough. Symptomatic hypotension may occur, particularly in vol- & salt-depleted patients. Dosage: 20-40 mg daily Supply: Tab 20 mg 24:32.20 Mineralocorticoid (Aldosterone) Receptor Antagonists Spironolactone-“Aldactone” (OALDA) ［ D ］ Indication: Hypertension, edema due to congestive heart failure, hepatic cirrhosis, or nephrotic syndrome. Contraindication: Anuria, acute renal insufficiency, hyperkalemia. Adverse effect: Hyperkalemia, hyponatremia, dehydration, GI syndrome, cramping, ataxia, skin rash, headache, and drowsiness. Dosage: Adults: 25-200 mg/day, divided into 2-4 doses. Children: 3.3 mg/kg/day Supply: Tab 25 mg 28:00 Central Nervous System Agents 28:04 General Anesthetics 28:04.04 Barbiturates Thiopental sodium – “Pentothal” (IPENT)( 特 ) ［ C ］ Indication: Anaesth for brief surgical procedures, induction of anaesth prior to administration of other anaesth agents, control of convulsive states, supplement to regional anaesth or low potency agents, aid in diagnosis & treatment of psychiatric disorders. Place in therapy: Thiopental is an ultra-short-acting intravenous (IV) anesthetic which produces loss of consciousness within 30 to 60 seconds following IV administration. Since the duration of action is short, it is not utilized as the sole anesthetic for surgical procedures lasting longer than 15 minutes. Concomitant narcotics, analgesics, and neuromuscular blocking agents may be required. 118 - - 119 - - headache, fatigue, cough, upper respiratory infection, angioedema. Dosage: Initial, 40 mg ORALLY once daily; usual maintenance dose range: 20-80 mg/day. Patients with volume depletion should be initiated on the lower dosage with close supervision. May take with or without food Supply: Tab 40 mg Telmisartan/Hydrochlorothiazide- “Micardis Plus”(OMICAP) ［ C/D ］ Indication: Treatment of essential hypertension in patients whose BP is not adequately controlled on telmisartan or hydrochlorothiazide Contraindication: cholestasis, biliary obstructive disorders, severe hepatic impairment, severe renal impairment (CrCl <30 ml/min), refractory hypokalaemia, hypercalcaemia. Pregnancy (2nd & 3rd trimesters) & lactation. Adverse effect: respiratory disorders, UTI, blood dyscrasias, precipitation of gout or latent diabets, electrolyte & fluid imbalance, metabolic & nutritional disorders, dizziness, vertigo, psychiatric & nervous system disorders, visual disturbances, CV & GI disorders, jaundice, renal disorders, arthralgia, myalgia, skin & allergic reactions. Dosage: 1 tab once daily. MAX: 160 mg/12.5-25 mg daily Supply: Tab Telmisartan 40 mg/ hydrochlorothiazide 12.5 mg Olmesartan-“Olmetec”(OOLME) ［ C/D ］ Indication: Treatment of hypertension Contraindication: Renal artery stenosis, lactation. Adverse effect: Dizziness, back pain, bronchitis, CPK increased, diarrhea, headache, hematuria, hyperglycemia, hypertiglyceridemia, flu-like syndrome, pharyngitis, rhinitis, sinusitis, and cough. Symptomatic hypotension may occur, particularly in vol- & salt-depleted patients. Dosage: 20-40 mg daily Supply: Tab 20 mg 24:32.20 Mineralocorticoid (Aldosterone) Receptor Antagonists Spironolactone-“Aldactone” (OALDA) ［ D ］ Indication: Hypertension, edema due to congestive heart failure, hepatic cirrhosis, or nephrotic syndrome. Contraindication: Anuria, acute renal insufficiency, hyperkalemia. Adverse effect: Hyperkalemia, hyponatremia, dehydration, GI syndrome, cramping, ataxia, skin rash, headache, and drowsiness. Dosage: Adults: 25-200 mg/day, divided into 2-4 doses. Children: 3.3 mg/kg/day Supply: Tab 25 mg 28:00 Central Nervous System Agents 28:04 General Anesthetics 28:04.04 Barbiturates Thiopental sodium – “Pentothal” (IPENT)( 特 ) ［ C ］ Indication: Anaesth for brief surgical procedures, induction of anaesth prior to administration of other anaesth agents, control of convulsive states, supplement to regional anaesth or low potency agents, aid in diagnosis & treatment of psychiatric disorders. Place in therapy: Thiopental is an ultra-short-acting intravenous (IV) anesthetic which produces loss of consciousness within 30 to 60 seconds following IV administration. Since the duration of action is short, it is not utilized as the sole anesthetic for surgical procedures lasting longer than 15 minutes. Concomitant narcotics, analgesics, and neuromuscular blocking agents may be required. 120 - - 121 - - Contraindication: Absence of suitable veins; status asthmaticus; porphyria. Adverse effect: Drowsiness; tolerance, dependence, withdrawal effects including seizures. Dosage: Induction of anesthesia & induce hypnosis: adult—test dose 25-78 mg, then 50-75 mg at 20-40 sec intervals IV; children IV 3-5 mg/kg initially, followed by 1 mg/kg if needed. Convulsions: adult IV 75-125 mg. Narcoanalysis: IV 100 mg/min until confusion occurs. Supply: Inj 2.5 g/vial 28:04.92 General Anesthetics, Miscellaneous Etomidate-“Etomidate Lipuro”(IETOM)( 特 ) Indication: Induction of anaesth. Contraindication: Hypersensitivity to etomidate or fat emulsions. Adverse effect: Nausea & vomiting, shivering, coughing, tracsient apnoea, laryngospasm. Dosage: Slow IV 0.3 mg/kg Supply: Inj 20 mg/10ml /amp Propofol-“Recofol” (IPROP) “Propofol-Lipuro” (IPROPO) ［ B ］ Indication: Inducing and/or maintaining general anesthesia, either in combination with other anesthetics or as the sole hypnotic agent. Contraindication: Hypersensitivity to propofol or its inactive ingredients: soy bean oil and egg Adverse effect: Pain on injection, apnea, dose-related hypotension, headache, dizziness, twiching, bucking, jerking, throshing, seizure, heart block, temporary reduction in serum cortisol, porphyria, urine discoloration (green urine). Dosage: For anesthesia: Initial: 2-2.5mg/kg anesthesia, maintenance: 9-12 mg/kg/hr; monitored anesthesia care (conscious sedation): infusion 6-9 mg/kg/hr, with maintenance rates of 0.3-3 mg/kg/hr or higher may be required for ICU sedation Supply: Inj 10 mg/ml, 20 ml/amp Ketamine HCI-“Ketalar” (IKETA) ［ A ］ Indication: Sole anesthetic agent for diagnostic and surgical procedures, best suited for short procedures. Induction of anesthesia; to supplement low potency agents (e.g. N2O). Contraindication: Hypertension, eclampsia or preeclampsia, glaucoma. Adverse effect: Adverse effects associated with ketamine include emergence phenomena (vivid dreams, hallucinations, delirium), cardiovascular stimulation (tachycardia, hypertension), hypersalivation, elevation of intracranial and intraocular pressures, nausea, vomiting, skeletal muscle hyperactivity, nystagmus, and skin rash; respiratory depression is observed. Following rapid IV of high doses. Dosage and administration: Surgical anesthesia: IV 2mg/ kg, I M 9-13 mg/ kg. I nduct i on anest hesi a: I V 1.0-4.5mg/kg, or IM 6.5-13mg/kg; administered slowly (over a period of 60 seconds) Barbiturates and ketalar being chemically incompatible because of precipitate formation, should not be injected from the same syringe. Supply: Inj 50mg/ml, 10 ml/vial Sevoflurane-“Ultane”(ISEVO) ( 特 ) ［ B ］ Indication: Sevoflurane is an inhalational anesthetic. Place in therapy: Sevoflurane produces smooth and rapid induction of anesthesia, and is preferable to desflurane or isoflurane for this purpose due to its lack of pungency. Contraindication: Hypersensitivity to sevoflurane or other halogenated anesthetic agents; known or suspected susceptibility to malignant hyperthermia Adverse effect: The adverse effects of sevoflurane are dose-related cardiovascular, respiratory depression, excitatory movements on induction, and postoperative 120 - - 121 - - Contraindication: Absence of suitable veins; status asthmaticus; porphyria. Adverse effect: Drowsiness; tolerance, dependence, withdrawal effects including seizures. Dosage: Induction of anesthesia & induce hypnosis: adult—test dose 25-78 mg, then 50-75 mg at 20-40 sec intervals IV; children IV 3-5 mg/kg initially, followed by 1 mg/kg if needed. Convulsions: adult IV 75-125 mg. Narcoanalysis: IV 100 mg/min until confusion occurs. Supply: Inj 2.5 g/vial 28:04.92 General Anesthetics, Miscellaneous Etomidate-“Etomidate Lipuro”(IETOM)( 特 ) Indication: Induction of anaesth. Contraindication: Hypersensitivity to etomidate or fat emulsions. Adverse effect: Nausea & vomiting, shivering, coughing, tracsient apnoea, laryngospasm. Dosage: Slow IV 0.3 mg/kg Supply: Inj 20 mg/10ml /amp Propofol-“Recofol” (IPROP) “Propofol-Lipuro” (IPROPO) ［ B ］ Indication: Inducing and/or maintaining general anesthesia, either in combination with other anesthetics or as the sole hypnotic agent. Contraindication: Hypersensitivity to propofol or its inactive ingredients: soy bean oil and egg Adverse effect: Pain on injection, apnea, dose-related hypotension, headache, dizziness, twiching, bucking, jerking, throshing, seizure, heart block, temporary reduction in serum cortisol, porphyria, urine discoloration (green urine). Dosage: For anesthesia: Initial: 2-2.5mg/kg anesthesia, maintenance: 9-12 mg/kg/hr; monitored anesthesia care (conscious sedation): infusion 6-9 mg/kg/hr, with maintenance rates of 0.3-3 mg/kg/hr or higher may be required for ICU sedation Supply: Inj 10 mg/ml, 20 ml/amp Ketamine HCI-“Ketalar” (IKETA) ［ A ］ Indication: Sole anesthetic agent for diagnostic and surgical procedures, best suited for short procedures. Induction of anesthesia; to supplement low potency agents (e.g. N2O). Contraindication: Hypertension, eclampsia or preeclampsia, glaucoma. Adverse effect: Adverse effects associated with ketamine include emergence phenomena (vivid dreams, hallucinations, delirium), cardiovascular stimulation (tachycardia, hypertension), hypersalivation, elevation of intracranial and intraocular pressures, nausea, vomiting, skeletal muscle hyperactivity, nystagmus, and skin rash; respiratory depression is observed. Following rapid IV of high doses. Dosage and administration: Surgical anesthesia: IV 2mg/ kg, I M 9-13 mg/ kg. I nduct i on anest hesi a: I V 1.0-4.5mg/kg, or IM 6.5-13mg/kg; administered slowly (over a period of 60 seconds) Barbiturates and ketalar being chemically incompatible because of precipitate formation, should not be injected from the same syringe. Supply: Inj 50mg/ml, 10 ml/vial Sevoflurane-“Ultane”(ISEVO) ( 特 ) ［ B ］ Indication: Sevoflurane is an inhalational anesthetic. Place in therapy: Sevoflurane produces smooth and rapid induction of anesthesia, and is preferable to desflurane or isoflurane for this purpose due to its lack of pungency. Contraindication: Hypersensitivity to sevoflurane or other halogenated anesthetic agents; known or suspected susceptibility to malignant hyperthermia Adverse effect: The adverse effects of sevoflurane are dose-related cardiovascular, respiratory depression, excitatory movements on induction, and postoperative 122 - - 123 - - nausea and vomiting; nephrotoxicity has not been reported despite relatively high serum concentrations of inorganic fluoride. Seizures and malignant hyperthermia have been attributed to sevoflurane anesthesia. Dosage: Adults anesthesia induction: 1.8%-5% in nitrous oxide/oxygen; anesthesia maintenance: 0.5%-3%. Children: 0.5%-3% for surgical levels of anesthesia with or without concomitant nitrous oxide Pharmacokinetics: Sevoflurane has a low blood/gas partition coefficient, which is predictive of rapid anesthesia induction and recovery. It is metabolized in the liver to inorganic fluoride, hexafluoroisopropanol, and hexafluoroisopropanol glucuronide. Stability: It should be stored at 15-30 ℃ . Supply: Soln 250ml Isoflurane-“Aerrane (Forane)”(IFORA)( 特 ) Indication: Inhalation anaesth for induction & maintenance of general anaesth. Contraindication: Hypersensitivity to isoflurane or other halogenated agents, malignant hyperthermia, known or suspected genetic susceptibility. Adverse effect: Dose-dependent respiratory depression, hypotension, arrhythmias; transient rise in CSF pressure; jaundice; malignant hyperthermia. Hepatic injury. Post-op shivering, GI upset, and ileums. Dosage: General anesthesia: induction-1.5-3% isoflurane with oxygen or oxygen-nitrous oxide mixture; maintenance-1-2.5%with nitrous oxide, additional 0.5-1% with oxygen alone. Supply: Liq 100 ml 28:08 Analgesics and Antipyretics 28:08.04 Nonsteroidal Anti-inflammatory Agents 28:08.04.08 Cyclooxygenase-2 (COX-2) Inhibitors Celecoxib- “Celebrex”(OCEL2) ［ C ］ Indication: Celecoxib is a NSAID with selective inhibition the enzyme, cyclo-oxygenase-2 (COX-2). Celecoxib is indicated for the treatment of osteoarthritis, rheumatoid arthritis, acute pain including primary dysmenorrhea, and is also indicated for reducing the number of colon and rectal polyps in familial adenomatous polyposis (FAP). Place in therapy: Some limited short-term studies in healthy subjects suggest improved gastrointestinal tolerability and lack of platelet effects with celecoxib. Contraindication: Hypersensitivity to celecoxib; patients with documented allergic-type reaction to sulfonamides; urticaria, asthma, or allergic reactions to aspirin or other nonsteroidal anti-inflammatory agents Adverse effect: Common adverse effects include dyspepsia, diarrhea, and abdominal pain. Although the risk for ulcers and other serious gastrointestinal adverse effects is lower than for other NSAIDs, product labeling still includes warnings about the risk of ulceration, bleeding and perforation. Dosage: Adults: osteoarthritis: 200 mg PO QD or 100 mg PO BID; rheumatoid arthritis: 100-200 mg PO BID; acute pain and primary dysmenorrhea: 400 mg initially PO, addition 200 mg PRN Pharmacokinetics: Celecoxib is 97% bound to plasma protein; elimination is via the kidney (27%) and feces (57%). The half-life is 11 hours. Supply: Cap 200mg Etoricoxib-“Arcoxia”(OARCO) Indication: Acute & chronic treatment of the signs & symptoms of OA & RA, acute gouty atthritis, and primary dysmenorrhea. Contraindication: CHF (NYHA II-IV), established ischemic heart disease &/or cerebrovascular disease (including those who have recently undergone coronary artery bypass graft surgery or angioplasty) Adverse effect: Asthenia/fatigue, dizziness, lower 122 - - 123 - - nausea and vomiting; nephrotoxicity has not been reported despite relatively high serum concentrations of inorganic fluoride. Seizures and malignant hyperthermia have been attributed to sevoflurane anesthesia. Dosage: Adults anesthesia induction: 1.8%-5% in nitrous oxide/oxygen; anesthesia maintenance: 0.5%-3%. Children: 0.5%-3% for surgical levels of anesthesia with or without concomitant nitrous oxide Pharmacokinetics: Sevoflurane has a low blood/gas partition coefficient, which is predictive of rapid anesthesia induction and recovery. It is metabolized in the liver to inorganic fluoride, hexafluoroisopropanol, and hexafluoroisopropanol glucuronide. Stability: It should be stored at 15-30 ℃ . Supply: Soln 250ml Isoflurane-“Aerrane (Forane)”(IFORA)( 特 ) Indication: Inhalation anaesth for induction & maintenance of general anaesth. Contraindication: Hypersensitivity to isoflurane or other halogenated agents, malignant hyperthermia, known or suspected genetic susceptibility. Adverse effect: Dose-dependent respiratory depression, hypotension, arrhythmias; transient rise in CSF pressure; jaundice; malignant hyperthermia. Hepatic injury. Post-op shivering, GI upset, and ileums. Dosage: General anesthesia: induction-1.5-3% isoflurane with oxygen or oxygen-nitrous oxide mixture; maintenance-1-2.5%with nitrous oxide, additional 0.5-1% with oxygen alone. Supply: Liq 100 ml 28:08 Analgesics and Antipyretics 28:08.04 Nonsteroidal Anti-inflammatory Agents 28:08.04.08 Cyclooxygenase-2 (COX-2) Inhibitors Celecoxib- “Celebrex”(OCEL2) ［ C ］ Indication: Celecoxib is a NSAID with selective inhibition the enzyme, cyclo-oxygenase-2 (COX-2). Celecoxib is indicated for the treatment of osteoarthritis, rheumatoid arthritis, acute pain including primary dysmenorrhea, and is also indicated for reducing the number of colon and rectal polyps in familial adenomatous polyposis (FAP). Place in therapy: Some limited short-term studies in healthy subjects suggest improved gastrointestinal tolerability and lack of platelet effects with celecoxib. Contraindication: Hypersensitivity to celecoxib; patients with documented allergic-type reaction to sulfonamides; urticaria, asthma, or allergic reactions to aspirin or other nonsteroidal anti-inflammatory agents Adverse effect: Common adverse effects include dyspepsia, diarrhea, and abdominal pain. Although the risk for ulcers and other serious gastrointestinal adverse effects is lower than for other NSAIDs, product labeling still includes warnings about the risk of ulceration, bleeding and perforation. Dosage: Adults: osteoarthritis: 200 mg PO QD or 100 mg PO BID; rheumatoid arthritis: 100-200 mg PO BID; acute pain and primary dysmenorrhea: 400 mg initially PO, addition 200 mg PRN Pharmacokinetics: Celecoxib is 97% bound to plasma protein; elimination is via the kidney (27%) and feces (57%). The half-life is 11 hours. Supply: Cap 200mg Etoricoxib-“Arcoxia”(OARCO) Indication: Acute & chronic treatment of the signs & symptoms of OA & RA, acute gouty atthritis, and primary dysmenorrhea. Contraindication: CHF (NYHA II-IV), established ischemic heart disease &/or cerebrovascular disease (including those who have recently undergone coronary artery bypass graft surgery or angioplasty) Adverse effect: Asthenia/fatigue, dizziness, lower 124 - - 125 - - extremity edema, hypertension, dyspepsia, heartburn, nausea, headache, increased ALT & AST levels. Also, hypersensitivity reactions, dysgeusia, CHF, abdominal pain, peptic ulceration & bleeding vomiting, angioedema, pruritus, rash, urticaria, renal insufficiency. Dosage: OA 60 mg once daily; RA 90 mg once daily; acute gout arthritis, dysemorrhea 120 mg once daily, use only for the acute symptomatic period, max 8 days treatment. Supply: Tab 60 mg 28:08.04.24 Salicylates Aspirin(Acetylsalicylic acid)-“Bokey”(OBOKE) “Tapal”(OTAPA) ［ C/D ］ Indication: Muscular and vascular pains, headache, dentalgia, arthritis, bursitis, rheumatoid arthritis, rheumatic fever, inflammatory joints condition. Fever and discomfort of cold, and as an anticoagulant (anti-thrombotic action). Contraindication: Hypersensitivity to salicylate, active peptic ulceration, hemophilia, severe hepatic damage and pregnancy women. Adverse effect: Gastric ulceration, dyspepsia, heartburn, hemorrhage, skin eruptions, tinnus, decreased hearing and vertigo. Dosage: Adults: PO for analgesia or fever: 325-1000 mg Q4-6H, to MAX 4 gm/day; PO for prevention of TIAs or stroke: 81-325 mg/day; PO for myocardial infarction risk reduction: 81-325 mg/day; PO for prevention of CABG occlusion 325 mg/day started 6 hr postoperatively and continued for 1 yr. Children: PO as an analgesic/antipyretic 10-15 mg/kg/dose Q4H, to a maximum of 60-80 mg/kg/day. PO for Kawasaki disease 80-120 mg/kg/day; decrease to 10 mg/kg/day after fever resolved. Supply: Cap 100 mg (Bokey); Tab 100 mg (Tapal) 28:08.04.92 Other Nonsteroidal Anti- inflammatory Agents Diclofenac Potassium-“Cataflam” (OCATA) “Peiflam”(OPEIF) ［ B ］ Indication: An analgesic, antipyretic, anti-inflammatory agent used in rheumatoid arthritis and related disorders. Contraindication: Peptic ulcer and hypersensitivity to diclofenac. Adverse effect: Diarrhea, indigestion, nausea, constipation, and flatulence. Headache, dizziness, vertigo, insomnia, drowsiness, agitation, depression, irritability, and anxiety have been reported in less than 1% Dosage: Adults: PO 100-125 mg/daily, TID or QID. Children age 1 year or over should be given PO 0.5-3 mg/kg/day in 2-3 doses. Supply: Tab 25mg (Cataflam), 50 mg (Peiflam) Diclofenac sodium-“Voren” (OVOREE) “Meitifen”(OMEIT) “Diclofen”(EVOLT) Indication: Relief of pain & inflammation in RA, osteoarthritis, ankylosing spondylitis, low back pain, peri-articular disorders. Contraindication: Peptic ulcer and hypersensitivity to diclofenac. Adverse effect: GI disorders; headache, dizziness; vertigo; rashes; elevated serum transamineases. Rarely, gastric or duodenal ulcer, GI bleeding, edema, hepatitis; hypersensitivity reactions, blood dyscrasias, and severe skin reactions. Dosage: Adult: initially 100-150 mg/day, milder cases or prol onged therapy, 75-100 mg/day. Chi l dren: 0.5-3 mg/kg/day. Supply: Cap 50 mg (Voren); Tab 75 mg (Meitifen); Supp 12.5 mg (Diclofen) Indomethacin-“Indalgin”(OINDO) ［ B/D ］ Indication: Rheumatoid arthritis, osteoarthritis of the hip, 124 - - 125 - - extremity edema, hypertension, dyspepsia, heartburn, nausea, headache, increased ALT & AST levels. Also, hypersensitivity reactions, dysgeusia, CHF, abdominal pain, peptic ulceration & bleeding vomiting, angioedema, pruritus, rash, urticaria, renal insufficiency. Dosage: OA 60 mg once daily; RA 90 mg once daily; acute gout arthritis, dysemorrhea 120 mg once daily, use only for the acute symptomatic period, max 8 days treatment. Supply: Tab 60 mg 28:08.04.24 Salicylates Aspirin(Acetylsalicylic acid)-“Bokey”(OBOKE) “Tapal”(OTAPA) ［ C/D ］ Indication: Muscular and vascular pains, headache, dentalgia, arthritis, bursitis, rheumatoid arthritis, rheumatic fever, inflammatory joints condition. Fever and discomfort of cold, and as an anticoagulant (anti-thrombotic action). Contraindication: Hypersensitivity to salicylate, active peptic ulceration, hemophilia, severe hepatic damage and pregnancy women. Adverse effect: Gastric ulceration, dyspepsia, heartburn, hemorrhage, skin eruptions, tinnus, decreased hearing and vertigo. Dosage: Adults: PO for analgesia or fever: 325-1000 mg Q4-6H, to MAX 4 gm/day; PO for prevention of TIAs or stroke: 81-325 mg/day; PO for myocardial infarction risk reduction: 81-325 mg/day; PO for prevention of CABG occlusion 325 mg/day started 6 hr postoperatively and continued for 1 yr. Children: PO as an analgesic/antipyretic 10-15 mg/kg/dose Q4H, to a maximum of 60-80 mg/kg/day. PO for Kawasaki disease 80-120 mg/kg/day; decrease to 10 mg/kg/day after fever resolved. Supply: Cap 100 mg (Bokey); Tab 100 mg (Tapal) 28:08.04.92 Other Nonsteroidal Anti- inflammatory Agents Diclofenac Potassium-“Cataflam” (OCATA) “Peiflam”(OPEIF) ［ B ］ Indication: An analgesic, antipyretic, anti-inflammatory agent used in rheumatoid arthritis and related disorders. Contraindication: Peptic ulcer and hypersensitivity to diclofenac. Adverse effect: Diarrhea, indigestion, nausea, constipation, and flatulence. Headache, dizziness, vertigo, insomnia, drowsiness, agitation, depression, irritability, and anxiety have been reported in less than 1% Dosage: Adults: PO 100-125 mg/daily, TID or QID. Children age 1 year or over should be given PO 0.5-3 mg/kg/day in 2-3 doses. Supply: Tab 25mg (Cataflam), 50 mg (Peiflam) Diclofenac sodium-“Voren” (OVOREE) “Meitifen”(OMEIT) “Diclofen”(EVOLT) Indication: Relief of pain & inflammation in RA, osteoarthritis, ankylosing spondylitis, low back pain, peri-articular disorders. Contraindication: Peptic ulcer and hypersensitivity to diclofenac. Adverse effect: GI disorders; headache, dizziness; vertigo; rashes; elevated serum transamineases. Rarely, gastric or duodenal ulcer, GI bleeding, edema, hepatitis; hypersensitivity reactions, blood dyscrasias, and severe skin reactions. Dosage: Adult: initially 100-150 mg/day, milder cases or prol onged therapy, 75-100 mg/day. Chi l dren: 0.5-3 mg/kg/day. Supply: Cap 50 mg (Voren); Tab 75 mg (Meitifen); Supp 12.5 mg (Diclofen) Indomethacin-“Indalgin”(OINDO) ［ B/D ］ Indication: Rheumatoid arthritis, osteoarthritis of the hip, 126 - - 127 - - acute gout. Contraindication: Patient with nasal polyps or angioedema, asthma, pregnancy women, child, peptic disease, psychiatric disorders. Adverse effect: GI disturbance (abdominal pain, diarrhea, gastrointestinal hemorrhage & pancreatitis), headache with dizziness, confusion and depression, psychosis with hallucinations, thrombocytopenia and aplastic anemia, coronary vasoconstriction Dosage: 25-50 mg 2-3 times/day, Max 200 mg/day Supply: Cap 25 mg Ketorolac tromethamine-“Keto”(OKET1)(IKET3) “Killpain” (IKILL) ［ C ］ Indication: Ketorolac is a non-steroidal anti-inflammatory agent with potent analgesic properties. Place in therapy: The predominant effect exhibited by ketorolac is analgesia rather than the anti-inflammatory effect exhibited by other NSAIDS. Ketorolac in equipotent doses provides comparable analgesia to morphine, meperidine and other narcotic analgesics in the treatment of mild to moderate postoperative and postpartum pain. Contraindication: Hypersensitivity; allergy to aspirin or other anti-inflammatory agents; History of or active peptic ulcer disease; Advanced renal impairment; Labor/delivery; Nursing women; Preoperatively or intraoperatively for analgesia; Patients receiving aspirin or other nonsteroidal anti-inflammatory agents; Epidural or intrathecal route of administration; Concurrent use with probenecid; Suspected or confirmed cerebrovascular bleeding, hemorrhagic diathesis, incomplete hemostasis, and patients at high risk of bleeding; Total duration of parenteral and oral therapy should not exceed 5 days; Oral doses greater than 40 mg/day Adverse effect: The adverse effects are predominantly central nervous system and gastrointestinal adverse effects including somnolence, headache, dizziness, paresthesias, dry mouth, nausea, vomiting, abdominal pain, and dyspepsia. The intramuscular injections occasionally cause local pain and the ophthalmic preparations have caused minor burning and stinging. Dosage: Adults: The combined duration of use of parenteral and oral ketorolac should not exceed 5 days. For single-dose treatment, IM 30 mg or 60 mg; IV 15 mg or 30 mg. For multiple dose treatment, IM, or IV 15 mg or 30 mg PO Q6H to a maximum daily dose of 40 mg; Children: aged 1-18 years 1 mg/kg as a loading dose (maximum 60 mg) followed by 0.5 mg/kg (maximum 30 mg) Q6H for 48-72 hours; Pharmacokinetics: The half-life is 5-6 h; hepatic metabolism to inactive metabolites is followed by renal excretion of 61% of a dose as unchanged drug. Stability: Store at controlled room temperature 15 to 30 degrees C (59 to 86 degrees F) with protection from light Supply: Tab 10 mg; Inj 30 mg/ml/amp Meloxicam-“Mobic” (OMOB1) “Melicam” (OMELIC) Indication: Meloxicam has been effective in the treatment of rheumatoid arthritis and osteoarthritis, comparing well with several other nonsteroidal anti-inflammatory drugs Place in therapy: Meloxicam has generally shown comparable efficacy and an improved gastrointestinal tolerability profile when compared to some other nonsteroidal antiinflammatory drugs (ie, diclofenac, piroxicam, naproxen). Contraindication: Meloxicam is contraindicated in patient with acute peptic ulcer disease, hypersensitivity, and rhinitis, urticaria/angioedema, asthma, or allergic reactions to aspirin or other anti-inflammatory agents. Adverse effect: The adverse effect profile of meloxicam resembles that of other nonsteroidal anti-inflammatory agents but with less gastrointestinal toxicity compared to piroxicam, diclofenac, and naproxen. 126 - - 127 - - acute gout. Contraindication: Patient with nasal polyps or angioedema, asthma, pregnancy women, child, peptic disease, psychiatric disorders. Adverse effect: GI disturbance (abdominal pain, diarrhea, gastrointestinal hemorrhage & pancreatitis), headache with dizziness, confusion and depression, psychosis with hallucinations, thrombocytopenia and aplastic anemia, coronary vasoconstriction Dosage: 25-50 mg 2-3 times/day, Max 200 mg/day Supply: Cap 25 mg Ketorolac tromethamine-“Keto”(OKET1)(IKET3) “Killpain” (IKILL) ［ C ］ Indication: Ketorolac is a non-steroidal anti-inflammatory agent with potent analgesic properties. Place in therapy: The predominant effect exhibited by ketorolac is analgesia rather than the anti-inflammatory effect exhibited by other NSAIDS. Ketorolac in equipotent doses provides comparable analgesia to morphine, meperidine and other narcotic analgesics in the treatment of mild to moderate postoperative and postpartum pain. Contraindication: Hypersensitivity; allergy to aspirin or other anti-inflammatory agents; History of or active peptic ulcer disease; Advanced renal impairment; Labor/delivery; Nursing women; Preoperatively or intraoperatively for analgesia; Patients receiving aspirin or other nonsteroidal anti-inflammatory agents; Epidural or intrathecal route of administration; Concurrent use with probenecid; Suspected or confirmed cerebrovascular bleeding, hemorrhagic diathesis, incomplete hemostasis, and patients at high risk of bleeding; Total duration of parenteral and oral therapy should not exceed 5 days; Oral doses greater than 40 mg/day Adverse effect: The adverse effects are predominantly central nervous system and gastrointestinal adverse effects including somnolence, headache, dizziness, paresthesias, dry mouth, nausea, vomiting, abdominal pain, and dyspepsia. The intramuscular injections occasionally cause local pain and the ophthalmic preparations have caused minor burning and stinging. Dosage: Adults: The combined duration of use of parenteral and oral ketorolac should not exceed 5 days. For single-dose treatment, IM 30 mg or 60 mg; IV 15 mg or 30 mg. For multiple dose treatment, IM, or IV 15 mg or 30 mg PO Q6H to a maximum daily dose of 40 mg; Children: aged 1-18 years 1 mg/kg as a loading dose (maximum 60 mg) followed by 0.5 mg/kg (maximum 30 mg) Q6H for 48-72 hours; Pharmacokinetics: The half-life is 5-6 h; hepatic metabolism to inactive metabolites is followed by renal excretion of 61% of a dose as unchanged drug. Stability: Store at controlled room temperature 15 to 30 degrees C (59 to 86 degrees F) with protection from light Supply: Tab 10 mg; Inj 30 mg/ml/amp Meloxicam-“Mobic” (OMOB1) “Melicam” (OMELIC) Indication: Meloxicam has been effective in the treatment of rheumatoid arthritis and osteoarthritis, comparing well with several other nonsteroidal anti-inflammatory drugs Place in therapy: Meloxicam has generally shown comparable efficacy and an improved gastrointestinal tolerability profile when compared to some other nonsteroidal antiinflammatory drugs (ie, diclofenac, piroxicam, naproxen). Contraindication: Meloxicam is contraindicated in patient with acute peptic ulcer disease, hypersensitivity, and rhinitis, urticaria/angioedema, asthma, or allergic reactions to aspirin or other anti-inflammatory agents. Adverse effect: The adverse effect profile of meloxicam resembles that of other nonsteroidal anti-inflammatory agents but with less gastrointestinal toxicity compared to piroxicam, diclofenac, and naproxen. 128 - - 129 - - Dosage: Rheumatoid arthritis or osteoarthritis: 7.5-15 mg PO QD, Maximal recommanded daily dose: 15 mg, No pediatric use dose suggested Pharmacokinetics: The oral bioavailability of meloxicam is 89%, and peak serum levels at steady state occur 5 to 6 hours after administration. Meloxicam is metabolized extensively in the liver; metabolites are excreted in urine and bile. The elimination half-life of meloxicam is about 20 hours after oral doses. Supply: Tab 15 mg (Mobic), 7.5 mg (Melicam) Naproxen (ONAPR) Indication: Mild to moderate pain, rheumatoid arthritis, osteoarthritis, dysmenorrhea, and acute gout. Contraindication: Hypersensitivity, pregnancy women. Adverse effect: GI upset, dizziness, headache, tinnitus, constipation, liver function impairment, jaundice, platelet dysfunction, renal function impairment. Dosage: Adults: initial dose 250 mg BID then 500 mg-1gm/day BID; maximum dose 1.25 g/day; acute gout: initial dose 750 mg then 250mg Q8H. Children (over 5 yrs): 10 mg/kg/day BID. Supply: Tab 250 mg Nimesulide-“Nimed” (ONIME) Indication: Nimesulide has demonstrated efficacy in the treatment of rheumatoid arthritis, osteoarthritis, fever, dysmenorrhea, postoperative pain, and a variety of inflammatory conditions. Contraindication: Hypersensitivity to nimesulide; Rhinitis, urticaria, asthma, or allergic reactions to aspirin or other anti-inflammatory agents Adverse effect: Heartburn, epigastric pain, nausea, skin rash Dosage: Adults: 100-200 mg PO BID; Children (6 months to 8 y/o): 5mg/kg/day for fever Pharmacokinetics: Nimesulide is highly protein-bound and is metabolized in the liver; an elimination half-life of approximately 3 hours has been reported. Supply: Tab 100 mg Sulindac-“Suloril” (OSULO) ［ B ］ Indication: Symptomatic treatment of acute and chronic rheumatoid arthritis, osteoarthritis and ankylosing spondylitis, acute gouty arthritis. Contraindication: Hypersensitivity to sulindac; patients who have experienced asthma, urticaria or allergic-type reactions after taking aspirin or other NSAIDs; severe, even fatal anaphylactic-like reactions have been reported. Adverse effect: GI pain, dyspepsia, nausea, vomiting, diarrhea and constipation, dizziness, headache, pruritus, sore or dry mucous membrane. Dosage: 150-200 mg PO BID Supply: Tab 200 mg Ketoprofen- “Ketoprofen” (OKET5)(IKETO) ［ B ］ Indication: RA, ankylosing spondylitis, osteoarthritis, bursitis, tendinitis, acute gout. Contraindication: Severe renal or hepatic impairment, heart failure, bleeding disorders, acute peptic ulceration, and hypersensitivity to aspirin or other NSAIDs. Adverse effect: GI disturbances, ulceration & bleeding, vertigo, dizziness, nervousness, tinnitus, depression, drowsiness, insomnia, hypersensitivity reactions, hematological reactions. Dosage: 50 mg TID; Max 100 mg TID Supply: Cap 50 mg; Inj 50 mg/2 ml/amp Flurbiprofen-“Lefenine”(OLEFE) Indication: RA, ankylosing spondylitis, osteoarthritis, dysmenorrhoea. Contraindication: Severe renal, hepatic or cardiac impairment, active peptic ulceration; patients in whom aspirin or other NSAIDs induce asthma, urticaria or other allergic-type reactions. Adverse effect: Dyspepsia, diarrhea, abdominal pain, 128 - - 129 - - Dosage: Rheumatoid arthritis or osteoarthritis: 7.5-15 mg PO QD, Maximal recommanded daily dose: 15 mg, No pediatric use dose suggested Pharmacokinetics: The oral bioavailability of meloxicam is 89%, and peak serum levels at steady state occur 5 to 6 hours after administration. Meloxicam is metabolized extensively in the liver; metabolites are excreted in urine and bile. The elimination half-life of meloxicam is about 20 hours after oral doses. Supply: Tab 15 mg (Mobic), 7.5 mg (Melicam) Naproxen (ONAPR) Indication: Mild to moderate pain, rheumatoid arthritis, osteoarthritis, dysmenorrhea, and acute gout. Contraindication: Hypersensitivity, pregnancy women. Adverse effect: GI upset, dizziness, headache, tinnitus, constipation, liver function impairment, jaundice, platelet dysfunction, renal function impairment. Dosage: Adults: initial dose 250 mg BID then 500 mg-1gm/day BID; maximum dose 1.25 g/day; acute gout: initial dose 750 mg then 250mg Q8H. Children (over 5 yrs): 10 mg/kg/day BID. Supply: Tab 250 mg Nimesulide-“Nimed” (ONIME) Indication: Nimesulide has demonstrated efficacy in the treatment of rheumatoid arthritis, osteoarthritis, fever, dysmenorrhea, postoperative pain, and a variety of inflammatory conditions. Contraindication: Hypersensitivity to nimesulide; Rhinitis, urticaria, asthma, or allergic reactions to aspirin or other anti-inflammatory agents Adverse effect: Heartburn, epigastric pain, nausea, skin rash Dosage: Adults: 100-200 mg PO BID; Children (6 months to 8 y/o): 5mg/kg/day for fever Pharmacokinetics: Nimesulide is highly protein-bound and is metabolized in the liver; an elimination half-life of approximately 3 hours has been reported. Supply: Tab 100 mg Sulindac-“Suloril” (OSULO) ［ B ］ Indication: Symptomatic treatment of acute and chronic rheumatoid arthritis, osteoarthritis and ankylosing spondylitis, acute gouty arthritis. Contraindication: Hypersensitivity to sulindac; patients who have experienced asthma, urticaria or allergic-type reactions after taking aspirin or other NSAIDs; severe, even fatal anaphylactic-like reactions have been reported. Adverse effect: GI pain, dyspepsia, nausea, vomiting, diarrhea and constipation, dizziness, headache, pruritus, sore or dry mucous membrane. Dosage: 150-200 mg PO BID Supply: Tab 200 mg Ketoprofen- “Ketoprofen” (OKET5)(IKETO) ［ B ］ Indication: RA, ankylosing spondylitis, osteoarthritis, bursitis, tendinitis, acute gout. Contraindication: Severe renal or hepatic impairment, heart failure, bleeding disorders, acute peptic ulceration, and hypersensitivity to aspirin or other NSAIDs. Adverse effect: GI disturbances, ulceration & bleeding, vertigo, dizziness, nervousness, tinnitus, depression, drowsiness, insomnia, hypersensitivity reactions, hematological reactions. Dosage: 50 mg TID; Max 100 mg TID Supply: Cap 50 mg; Inj 50 mg/2 ml/amp Flurbiprofen-“Lefenine”(OLEFE) Indication: RA, ankylosing spondylitis, osteoarthritis, dysmenorrhoea. Contraindication: Severe renal, hepatic or cardiac impairment, active peptic ulceration; patients in whom aspirin or other NSAIDs induce asthma, urticaria or other allergic-type reactions. Adverse effect: Dyspepsia, diarrhea, abdominal pain, 130 - - 131 - - nausea, GI bleeding & ulceration. Rarely, prolonged bleeding time, visual disturbances, fluid retention & edema, renal impairment. Dosage: 100 mg QD-BID. Max 300 mg daily in divided doses. Supply: Tab 100 mg Tenoxicam-“Tencam” (ITENC) ［ C ］ Indication: RA, degenerative joint disease, tendonitis, bursitis, sprain, acute gout. Contraindication: Hypersensitivity. Patients in whom salicylates or other NSAIDs induce symptom of asthma, rhinitis or urticaria. Severe upper GIT diseases, patients undergoing anesth or surgery. Adverse effect: GI upsets; dizziness, headache; rash, urticaria Dosage: 20 mg daily by IM or IV. Supply: Inj 20 mg/vial Etodolac-“Eric” (OERIC) “Lacoxa”(OLACO) ［ C ］ Indication: RA & osteoarthritis. Contraindication: Patients in whom aspirin & other NSAIDs precipitate attacks of asthme, angioedema, urticaria or rhinitis; active peptic ulceration. Adverse effect: GI discomfort, hypersensitivity reactions, bronchospasm, headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, hearing disturbances, photosensitivity, haematuria. Dosage: 600-1000 mg daily in divided doses. Max 1200 mg daily Supply: Tab 600 mg (Eric), 400 mg (Lacoxa) Nabumetone-“Labuton”(ONABU) ［ C ］ Indication: Treatment of pain & inflammation in degenerative arthritis & RA. Contraindication: Active peptic ulceration, severe hepatic impairment. Patients in whom attacks of asthma, urticaria or acute rhinitis are precipitated by aspirin or other NSAIDs. Adverse effect: Diarrhoea, dyspepsia, nausea, constipation, abdominal pain, flatulence, headache, dizziness, pruritus, rash, sedation. Dosage: 1 g at night. The dosage may be increased to 1.5-2 g daily in severe cases. Supply: Tab 500 mg Tiaprofenic Acid-“Surgam”(OSURG) Indication: Rheumatic disorders, spasms, fractures, various injuries, surgical sequelae, superficial phlebitis, phlebosclerosis, tonsillitis, pharyngitis, laryngitis, sinusitis, otitis, proctology. Contraindication: Known hypersensitivity to tiaprofenic acid. Gastroduodenal ulcer. Severe renal or hepatic insufficiency. History of asthma. 3rd trimester of pregnancy, children <3 years. Adverse effect: Allergic-type reactions, GI disorders. Rarely, dysuria, cystitis, hematuria. Dizziness, vertigo, buzzing. Na & water retention, reversible renal impairment. Liver test impairment. Dosage: 1 tab TID. Supply: Tab 200 mg Nefopam-“Panagesic”(OPANA) Indication: Acute & chronic pain including post-op, dental, musculoskeletal, acute traumatic & cancer pain. Contraindication: History of convulsive disorders of those taking MAOI. Pregnancy. Adverse effect: Nausea, vomiting, nervousness, dry mouth & light-headedness, blurred vision, drowsiness, sweating, insomnia, headache, tachycardia. Dosage: Adult 1 tab tid-qid. In severe pain, single dose can be increased up to 90 mg. Max recommended dose in 24 hr: 300 mg. Supply: Tab 30 mg 130 - - 131 - - nausea, GI bleeding & ulceration. Rarely, prolonged bleeding time, visual disturbances, fluid retention & edema, renal impairment. Dosage: 100 mg QD-BID. Max 300 mg daily in divided doses. Supply: Tab 100 mg Tenoxicam-“Tencam” (ITENC) ［ C ］ Indication: RA, degenerative joint disease, tendonitis, bursitis, sprain, acute gout. Contraindication: Hypersensitivity. Patients in whom salicylates or other NSAIDs induce symptom of asthma, rhinitis or urticaria. Severe upper GIT diseases, patients undergoing anesth or surgery. Adverse effect: GI upsets; dizziness, headache; rash, urticaria Dosage: 20 mg daily by IM or IV. Supply: Inj 20 mg/vial Etodolac-“Eric” (OERIC) “Lacoxa”(OLACO) ［ C ］ Indication: RA & osteoarthritis. Contraindication: Patients in whom aspirin & other NSAIDs precipitate attacks of asthme, angioedema, urticaria or rhinitis; active peptic ulceration. Adverse effect: GI discomfort, hypersensitivity reactions, bronchospasm, headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, hearing disturbances, photosensitivity, haematuria. Dosage: 600-1000 mg daily in divided doses. Max 1200 mg daily Supply: Tab 600 mg (Eric), 400 mg (Lacoxa) Nabumetone-“Labuton”(ONABU) ［ C ］ Indication: Treatment of pain & inflammation in degenerative arthritis & RA. Contraindication: Active peptic ulceration, severe hepatic impairment. Patients in whom attacks of asthma, urticaria or acute rhinitis are precipitated by aspirin or other NSAIDs. Adverse effect: Diarrhoea, dyspepsia, nausea, constipation, abdominal pain, flatulence, headache, dizziness, pruritus, rash, sedation. Dosage: 1 g at night. The dosage may be increased to 1.5-2 g daily in severe cases. Supply: Tab 500 mg Tiaprofenic Acid-“Surgam”(OSURG) Indication: Rheumatic disorders, spasms, fractures, various injuries, surgical sequelae, superficial phlebitis, phlebosclerosis, tonsillitis, pharyngitis, laryngitis, sinusitis, otitis, proctology. Contraindication: Known hypersensitivity to tiaprofenic acid. Gastroduodenal ulcer. Severe renal or hepatic insufficiency. History of asthma. 3rd trimester of pregnancy, children <3 years. Adverse effect: Allergic-type reactions, GI disorders. Rarely, dysuria, cystitis, hematuria. Dizziness, vertigo, buzzing. Na & water retention, reversible renal impairment. Liver test impairment. Dosage: 1 tab TID. Supply: Tab 200 mg Nefopam-“Panagesic”(OPANA) Indication: Acute & chronic pain including post-op, dental, musculoskeletal, acute traumatic & cancer pain. Contraindication: History of convulsive disorders of those taking MAOI. Pregnancy. Adverse effect: Nausea, vomiting, nervousness, dry mouth & light-headedness, blurred vision, drowsiness, sweating, insomnia, headache, tachycardia. Dosage: Adult 1 tab tid-qid. In severe pain, single dose can be increased up to 90 mg. Max recommended dose in 24 hr: 300 mg. Supply: Tab 30 mg 132 - - 133 - - Etofenamate Gel- “Teiria Gel” (ETEIR) “Sporton” (ESPOR) Indication: Anti-inflammatory effect and analgesic action of soft tissue in the articulating system, rheumatic and muscular pain. Precaution: It should not be applied to openly injured or eczematously inflammed skin. Limited clinical studies have reported the efficacy of topical etofenamate in the treatment of soft tissue rheumatism, ankle sprain, and other musculoskeletal and rheumatic conditions Adverse effect: Pruritus, erythema, local irritation, nonspecific cutaneous allergy, and contact dermatitis/urticaria; systemic adverse effects have not be reported in studies to date but should be considered possible. Dosage: Topical BID to TID Pharmacokinetics: Etofenamate is absorbed following cutaneous application, with a reported bioavailability of 21%; peak serum levels occur 2 hours after topical use, and the drug accumulates in synovial fluid. Etofenamate is metabolized in the liver. Supply: Gel 50 mg/g, 40 g/tube (Teiria); 100 mg/g, 40 g/tube (Sporton). Piroxicam Gel- “Focus”(EFOCU) Indication: Piroxicam cream is used in osteoarthritis, ankylosing spondylitis, and other inflammatory conditions. Contraindication: Patient with hypersensitivity to this drug Adverse effect: The adverse effects of this topical preparation include local irritation, hypersensitivity. Dosage: Topical use BID-TID. Supply: Gel 10 mg/g, 40 g/tub Flurbiprofen-“Flur Di Fen”(EFLUR) ［ C ］ Indication: Symptomatic treatment of arthritis deformans, humero-scapular periarthritis, tendonitis, peritendinitis, sore muscle, swelling, pain due to trauma. Contraindication: Patients with aspirin induced asthma or history of it. Adverse effect: Occasionally redness, rashes, pruritus, dryness, irritation, swelling, photosensitivity. Dosage: Apply 1 sheet to the affected area bid. Supply: Patch 3.33 mg/g 28:08.08 Opiate Agonists Alfentanil HCI -“Rapifen”(IRAPI)( 特 ) ［ C ］ Indication: Narcotic analgesic & anesth induction agent Contraindication: Intolerance to drug or to morphinomimetics. Adverse effect: Respiratory depression, apnoea, muscular rigidity, bradycardia; transient hypotension, dizziness & post-op nausea & emesis. Dosage: Short duration procedures & outpatients 7-15 mcg/kg IV, repeat every 10-15 mins; medium duration procedure 20-150 mcg/kg IV, 15 mcg/kg every 10-15 mins if required; long procedure IV dose adjusted as required. Induction of asesth >120 mcg/kg IV. Supply: Inj 0.5 mg/ml, 2 ml/amp. Codeine phosphate(OCODE) ［ C ］ Indication: Relief of mild to moderate pain and cough. Contraindication: Respiratory depression, convulsive disorders. Adverse effect: Dizziness, euphoria, dysphoria, nausea, vomiting, constipation, pruritus. Dosage: Adults: analgesic: 15-60 mg Q4H, antitussive: 10-20 g Q4-6H, do not exceed 120 mg in 24 hours. Children: analgesic: 3 mg/kg/day in 6 divided doses, antitussive: 2.5-10 mg Q4-6H, do not exceed 60 mg in 24 hours. Supply: Tab 30 mg Fentanyl citrate-“Fentanyl”(IFANT)( 特 ) “Durogesic”(EDUR2)( 特 )(EDUR5)( 特 ) ［ C ］ Indication: Management of moderate to severe chronic pain (Transdermal); injection for sedation, relief pain, 132 - - 133 - - Etofenamate Gel- “Teiria Gel” (ETEIR) “Sporton” (ESPOR) Indication: Anti-inflammatory effect and analgesic action of soft tissue in the articulating system, rheumatic and muscular pain. Precaution: It should not be applied to openly injured or eczematously inflammed skin. Limited clinical studies have reported the efficacy of topical etofenamate in the treatment of soft tissue rheumatism, ankle sprain, and other musculoskeletal and rheumatic conditions Adverse effect: Pruritus, erythema, local irritation, nonspecific cutaneous allergy, and contact dermatitis/urticaria; systemic adverse effects have not be reported in studies to date but should be considered possible. Dosage: Topical BID to TID Pharmacokinetics: Etofenamate is absorbed following cutaneous application, with a reported bioavailability of 21%; peak serum levels occur 2 hours after topical use, and the drug accumulates in synovial fluid. Etofenamate is metabolized in the liver. Supply: Gel 50 mg/g, 40 g/tube (Teiria); 100 mg/g, 40 g/tube (Sporton). Piroxicam Gel- “Focus”(EFOCU) Indication: Piroxicam cream is used in osteoarthritis, ankylosing spondylitis, and other inflammatory conditions. Contraindication: Patient with hypersensitivity to this drug Adverse effect: The adverse effects of this topical preparation include local irritation, hypersensitivity. Dosage: Topical use BID-TID. Supply: Gel 10 mg/g, 40 g/tub Flurbiprofen-“Flur Di Fen”(EFLUR) ［ C ］ Indication: Symptomatic treatment of arthritis deformans, humero-scapular periarthritis, tendonitis, peritendinitis, sore muscle, swelling, pain due to trauma. Contraindication: Patients with aspirin induced asthma or history of it. Adverse effect: Occasionally redness, rashes, pruritus, dryness, irritation, swelling, photosensitivity. Dosage: Apply 1 sheet to the affected area bid. Supply: Patch 3.33 mg/g 28:08.08 Opiate Agonists Alfentanil HCI -“Rapifen”(IRAPI)( 特 ) ［ C ］ Indication: Narcotic analgesic & anesth induction agent Contraindication: Intolerance to drug or to morphinomimetics. Adverse effect: Respiratory depression, apnoea, muscular rigidity, bradycardia; transient hypotension, dizziness & post-op nausea & emesis. Dosage: Short duration procedures & outpatients 7-15 mcg/kg IV, repeat every 10-15 mins; medium duration procedure 20-150 mcg/kg IV, 15 mcg/kg every 10-15 mins if required; long procedure IV dose adjusted as required. Induction of asesth >120 mcg/kg IV. Supply: Inj 0.5 mg/ml, 2 ml/amp. Codeine phosphate(OCODE) ［ C ］ Indication: Relief of mild to moderate pain and cough. Contraindication: Respiratory depression, convulsive disorders. Adverse effect: Dizziness, euphoria, dysphoria, nausea, vomiting, constipation, pruritus. Dosage: Adults: analgesic: 15-60 mg Q4H, antitussive: 10-20 g Q4-6H, do not exceed 120 mg in 24 hours. Children: analgesic: 3 mg/kg/day in 6 divided doses, antitussive: 2.5-10 mg Q4-6H, do not exceed 60 mg in 24 hours. Supply: Tab 30 mg Fentanyl citrate-“Fentanyl”(IFANT)( 特 ) “Durogesic”(EDUR2)( 特 )(EDUR5)( 特 ) ［ C ］ Indication: Management of moderate to severe chronic pain (Transdermal); injection for sedation, relief pain, 134 - - 135 - - pre-operative medications, and adjunct to general or regional anesthesia. Contraindication: Patient with known intolerance to the fentanyl and patient with asthma or myasthenia gravis. In patients who have received MAO inhibitors within 14 days is not recommended. Adverse effect: Respiratory depression, apnea, muscular rigidity, bradycardia, hypotension, dizziness, blurred vision. Dosage: Pre-medication: 0.05-0.1 mg IM. Induction: 0.05-0.1 mg IV. Maintenance: 0.025-0.05 mg IV or IM. Postoperative: 0.05-0.1 mg IM. Supply: Inj 0.05 mg/ml, 10 ml/amp; Patch TTS 25 mcg/h, 50 mcg/h Meperidine HCI (Pethidine)-“Demeral” (IDEME) ( 特 ) ［ B/D ］ Indication: Management of moderate to severe pain, adjunct to anesthesia and preoperative sedation. Contraindication: Hypersensitivity to meperidine, patients who have received MAO inhibitors within 14 days, increased intra-cranial pressure. Adverse effect: Dizziness, sedation, euphoria, dysphoria, dry mouth, respiratory depression, weakness. Dosage: Relief of pain: Adults: 50-150 mg IM Q3-4H. Children: 1.1-1.8 mg/kg IM or SC up to adult dose Q3-4H. Preoperative medication: Adults: 50-100 mg IM 30-90 min before anesthesia. Children: 0.5-1mg/lb IM up to adult dose, 30-90 min before anesthesia. Supply: Inj 50 mg/1 ml/amp Morphine HCI (IMORP)( 特 )(OMORP) ［ C ］ Indication: Relief of visceral pain, preanesthetic medication. Contraindication: Respiratory depression, biliary colic, acute pancreatitis, asthma and increased intracranial pressure. Adverse effect: Dizziness, sedation, euphoria, dysphoria, dry mouth, respiratory depression, weakness. Dosage: Adults: SC: 5-15 mg Q 4hr; IV: 4-10 mg, dilute and inject slowly over a 2-3 min period. IV infusion 1-10 mg/hr, some patients with chronic pain may require a higher dosage. IM is painful and is not recommended. Children: PO: 0.3 mg/kg Q3-4 hr; IV: 0.05-0.2 mg/kg Q4hr; IV infusion 0.01-0.04 mg/kg/hr. Supply: Inj 10 mg/ml/amp; Tab 10 mg Tramadol HCI-“Tramal SR” (ITRAM)(OTRAMS) ［ C ］ Indication: Relief of moderate to moderately severe pain Pharmacology: Binds to μ-opiate receptors in the CNS causing inhibition of ascending pain pathways, altering the perception of and response to pain Pharmacokinetics: Absorption: rapid and complete; Onset: about 1 hr; Time to peak: 2 hrs; Duration: 9 hrs; Plasma protein binding: 20%; Extensively metabolized in liver, has pharmacologically active metabolites. Elimination half-life: about 6 hrs, active metabolites: 7 hrs; prolonged in elderly, hepatic or renal impairment. Contraindication: Hypersensitivity. Adverse effect: Same as morphine but less respiratory depression, sedation. Dosage: IV 50-100 mg every 4-6 hours, maximum daliy doses 400 mg. In elderly: Oral: >75 years: 50-100 mg every 4-6 hours not to exceed 300 mg/day. Renal impairment, ClCr <30 mL/min: Administer 50-100 mg dose every 12 hours; maximum: 200 mg/day. Cirrhosis: Recommended dose is 50 mg every 12 hours. Supply: Inj 100 mg/2 ml/amp; Tab 100 mg 28:08.12 Opiate Partial Agonists Butorphanol Tartrate-“Butaro Nasal Spray” ( 專 ) Indication: Butorphanol tartrate is indicated for the management of pain when the use of an opioid analgesic is appropriate. Pharmacology: Butorphanol is a mixed narcotic agonist-antagonist with low intrinsic activity at the 134 - - 135 - - pre-operative medications, and adjunct to general or regional anesthesia. Contraindication: Patient with known intolerance to the fentanyl and patient with asthma or myasthenia gravis. In patients who have received MAO inhibitors within 14 days is not recommended. Adverse effect: Respiratory depression, apnea, muscular rigidity, bradycardia, hypotension, dizziness, blurred vision. Dosage: Pre-medication: 0.05-0.1 mg IM. Induction: 0.05-0.1 mg IV. Maintenance: 0.025-0.05 mg IV or IM. Postoperative: 0.05-0.1 mg IM. Supply: Inj 0.05 mg/ml, 10 ml/amp; Patch TTS 25 mcg/h, 50 mcg/h Meperidine HCI (Pethidine)-“Demeral” (IDEME) ( 特 ) ［ B/D ］ Indication: Management of moderate to severe pain, adjunct to anesthesia and preoperative sedation. Contraindication: Hypersensitivity to meperidine, patients who have received MAO inhibitors within 14 days, increased intra-cranial pressure. Adverse effect: Dizziness, sedation, euphoria, dysphoria, dry mouth, respiratory depression, weakness. Dosage: Relief of pain: Adults: 50-150 mg IM Q3-4H. Children: 1.1-1.8 mg/kg IM or SC up to adult dose Q3-4H. Preoperative medication: Adults: 50-100 mg IM 30-90 min before anesthesia. Children: 0.5-1mg/lb IM up to adult dose, 30-90 min before anesthesia. Supply: Inj 50 mg/1 ml/amp Morphine HCI (IMORP)( 特 )(OMORP) ［ C ］ Indication: Relief of visceral pain, preanesthetic medication. Contraindication: Respiratory depression, biliary colic, acute pancreatitis, asthma and increased intracranial pressure. Adverse effect: Dizziness, sedation, euphoria, dysphoria, dry mouth, respiratory depression, weakness. Dosage: Adults: SC: 5-15 mg Q 4hr; IV: 4-10 mg, dilute and inject slowly over a 2-3 min period. IV infusion 1-10 mg/hr, some patients with chronic pain may require a higher dosage. IM is painful and is not recommended. Children: PO: 0.3 mg/kg Q3-4 hr; IV: 0.05-0.2 mg/kg Q4hr; IV infusion 0.01-0.04 mg/kg/hr. Supply: Inj 10 mg/ml/amp; Tab 10 mg Tramadol HCI-“Tramal SR” (ITRAM)(OTRAMS) ［ C ］ Indication: Relief of moderate to moderately severe pain Pharmacology: Binds to μ-opiate receptors in the CNS causing inhibition of ascending pain pathways, altering the perception of and response to pain Pharmacokinetics: Absorption: rapid and complete; Onset: about 1 hr; Time to peak: 2 hrs; Duration: 9 hrs; Plasma protein binding: 20%; Extensively metabolized in liver, has pharmacologically active metabolites. Elimination half-life: about 6 hrs, active metabolites: 7 hrs; prolonged in elderly, hepatic or renal impairment. Contraindication: Hypersensitivity. Adverse effect: Same as morphine but less respiratory depression, sedation. Dosage: IV 50-100 mg every 4-6 hours, maximum daliy doses 400 mg. In elderly: Oral: >75 years: 50-100 mg every 4-6 hours not to exceed 300 mg/day. Renal impairment, ClCr <30 mL/min: Administer 50-100 mg dose every 12 hours; maximum: 200 mg/day. Cirrhosis: Recommended dose is 50 mg every 12 hours. Supply: Inj 100 mg/2 ml/amp; Tab 100 mg 28:08.12 Opiate Partial Agonists Butorphanol Tartrate-“Butaro Nasal Spray” ( 專 ) Indication: Butorphanol tartrate is indicated for the management of pain when the use of an opioid analgesic is appropriate. Pharmacology: Butorphanol is a mixed narcotic agonist-antagonist with low intrinsic activity at the 136 - - 137 - - Mu-opioid type receptors (morphine-like). It is an agonist at kappa-opioid receptors. Its interactions with these receptors in the central nervous system apparently mediate most of its pharmacologic effects, including analgesia. Pharmacokinetics: Onset of action is within 15 min; mean peak blood levels occur at 30-60 minutes after a 1 mg dose; Duration of analgesic 4-5 hrs; nasal bioavailability 60% - 70% .The elimination half- life 4.7-6.6 hrs. Contraindication: Hypersensitive to butorphanol tartrate or benzenthonium chloride in Butaro Nasal Spray Adverse effect: Somnolence, dizziness, nausea and/or vomiting Dosage: 1 mg intranasally (one spray in one nostril), followed by 2nd dose in 60-90 min as needed, repeat every 3-4 hr as needed. Dosage reduction is needed in severe liver disease. In moderate renal failure (GFR 10-50 ml/min), 75% of usual dose; severe renal failure (GFR ＜ 10 ml/min), 50% of usual dose. Supply: Nasal Spray 10 mg/ ml (1 mg/spray), 2.5 ml/bottle 28:08.92 Analgesics and Antipyretics, Miscellaneous Acetaminophen-“Depyretin” (Scanol) (OSCAN) “Anti-Phen”(BANTI) ［ B ］ Indication: Analgesic and antipyretic actions similar to aspirin, no anti-inflammatory properties. Contraindicaton: Hypersensitivity to acetaminophen, glucose-6-phosphate dehydrogenase deficiency, continued use in patients with anemia, or with cardiac, pulmonary, renal, or hepatic disease. Adverse effect: Erythematous or urticarial skin reaction, drowsiness, agranulocytosis, liver damage, renal tubural necrosis, methemoglobinemia. Dosage: Adults: 300-650 mg Q4H, up to 1000 mg QID, short-term therapy and long-term therapy up to 4 g/day. Children: (7-12 yrs): 150-325 mg TID or QID, don’t exceed 1.3 g in 24 hours; (under 6 yrs): 120-200 mg TID or QID, don’t exceed 480 mg in 24 hours. Supply: Tab 500 mg; Elixir 24 mg/ml, 60 ml/bot (contains 6.65% alcohol, and color agent yellow No.5 may caused allergy) Rhin (ORHIN) Indication: Relief of cold symptoms such as headache, fever, nasal congestion and sneezing. Contraindication: Impaired kidney or liver function, hypersensitivity. Adverse effect: Drowsiness, liver damage, and dizziness. Dosage: 1 Tab PO TID. Supply: Tab acetaminophen 300 mg/ phenylephrine 5 mg/chlorpheniramine maleate 1 mg/caffeine anhydrous 30 mg 28:10 Opiate Antagonists Naloxone HCI – “Narcan”(INALO)( 專 ) ［ B ］ Indication: Overdose of opiate Contraindication: Hypersensitivity to naloxone Adverse effect: Cardiac dysrhythmia, hypertension, hypotension, ventricular fibrillation; hepatotoxicity; pulmonary edema; opioid withdrawal Dosage: For narcotic analgesic overdose: IV 0.2-2 mg every 2-3 min as needed, if no response is observed after 10 mg, question the diagnosis For postoperation narcotic depression: IV, 0.1-0.2 mg, may repeat every 2-3 min as needed Supply: Inj 0.4 mg/1 ml/amp 28:12 Anticonvulsants 28:12.04 Barbiturates Phenobarbital (OPHENO) ［ D ］ Indication: Insomnia, anxiety, cardiac and gastric 136 - - 137 - - Mu-opioid type receptors (morphine-like). It is an agonist at kappa-opioid receptors. Its interactions with these receptors in the central nervous system apparently mediate most of its pharmacologic effects, including analgesia. Pharmacokinetics: Onset of action is within 15 min; mean peak blood levels occur at 30-60 minutes after a 1 mg dose; Duration of analgesic 4-5 hrs; nasal bioavailability 60% - 70% .The elimination half- life 4.7-6.6 hrs. Contraindication: Hypersensitive to butorphanol tartrate or benzenthonium chloride in Butaro Nasal Spray Adverse effect: Somnolence, dizziness, nausea and/or vomiting Dosage: 1 mg intranasally (one spray in one nostril), followed by 2nd dose in 60-90 min as needed, repeat every 3-4 hr as needed. Dosage reduction is needed in severe liver disease. In moderate renal failure (GFR 10-50 ml/min), 75% of usual dose; severe renal failure (GFR ＜ 10 ml/min), 50% of usual dose. Supply: Nasal Spray 10 mg/ ml (1 mg/spray), 2.5 ml/bottle 28:08.92 Analgesics and Antipyretics, Miscellaneous Acetaminophen-“Depyretin” (Scanol) (OSCAN) “Anti-Phen”(BANTI) ［ B ］ Indication: Analgesic and antipyretic actions similar to aspirin, no anti-inflammatory properties. Contraindicaton: Hypersensitivity to acetaminophen, glucose-6-phosphate dehydrogenase deficiency, continued use in patients with anemia, or with cardiac, pulmonary, renal, or hepatic disease. Adverse effect: Erythematous or urticarial skin reaction, drowsiness, agranulocytosis, liver damage, renal tubural necrosis, methemoglobinemia. Dosage: Adults: 300-650 mg Q4H, up to 1000 mg QID, short-term therapy and long-term therapy up to 4 g/day. Children: (7-12 yrs): 150-325 mg TID or QID, don’t exceed 1.3 g in 24 hours; (under 6 yrs): 120-200 mg TID or QID, don’t exceed 480 mg in 24 hours. Supply: Tab 500 mg; Elixir 24 mg/ml, 60 ml/bot (contains 6.65% alcohol, and color agent yellow No.5 may caused allergy) Rhin (ORHIN) Indication: Relief of cold symptoms such as headache, fever, nasal congestion and sneezing. Contraindication: Impaired kidney or liver function, hypersensitivity. Adverse effect: Drowsiness, liver damage, and dizziness. Dosage: 1 Tab PO TID. Supply: Tab acetaminophen 300 mg/ phenylephrine 5 mg/chlorpheniramine maleate 1 mg/caffeine anhydrous 30 mg 28:10 Opiate Antagonists Naloxone HCI – “Narcan”(INALO)( 專 ) ［ B ］ Indication: Overdose of opiate Contraindication: Hypersensitivity to naloxone Adverse effect: Cardiac dysrhythmia, hypertension, hypotension, ventricular fibrillation; hepatotoxicity; pulmonary edema; opioid withdrawal Dosage: For narcotic analgesic overdose: IV 0.2-2 mg every 2-3 min as needed, if no response is observed after 10 mg, question the diagnosis For postoperation narcotic depression: IV, 0.1-0.2 mg, may repeat every 2-3 min as needed Supply: Inj 0.4 mg/1 ml/amp 28:12 Anticonvulsants 28:12.04 Barbiturates Phenobarbital (OPHENO) ［ D ］ Indication: Insomnia, anxiety, cardiac and gastric 138 - - 139 - - neurosis, excitement, epilepsy, tetanus, preanesthetic medication. Contraindication: Hypersensitive to barbiturates, respiratory or cardiac disease, uncontrolled pain, history of porphyria, hepatic impairment. Adverse effect: Residual sedation, drowsiness, vertigo, ataxia, depression, nausea, vomiting, circulatory collapse. Dosage: Adults: PO, 50-100 mg BID or TID. Children: PO 3-6 mg/kg/day in divided doses Supply: Tab 32 mg 28:12.08 Benzodiazepines Clonazepam-“Rivotril” (ORIVO) (ORIV2) ［ C ］ Indication: Lennox-gastaut syndrome, akinetic and myoclonic seizure, absence (petit mal) seizure. Contraindication: Hypersensitivity to benzodiazepines, patient with significant liver disease, acute narrow angle glaucoma. Adverse effect: Drowsiness, aphonia, confusion, depression, ataxia, increased salivation, constipation, diarrhea, nausea, dry mouth, respiratory depression, thrombocytopenia. Dosage: Adults: initial dose 1.5 mg/day divided into 3 doses, followed by increased of 0.5-1.0 mg/day every 3 day until seizures control is achieved, maintenance dosage should not exceed 20 mg daily, maximum dose: 20 mg/day. Children: initial dose 0.05 mg/kg/day divided into 2-3 doses, may be increased of 0.5 mg every 3 day, maintenance dosage should not exceeded 0.2 mg/kg/day Supply: Tab 0.5 mg, 2 mg 28:12.12 Hydantoins Phenytion sodium –“Dilantin” (ODILAN) “Aleviatin”(IDILA) ［ D ］ Indication: Grand mal seizures and psychomotor seizures; ventricular tachycardia, paroxysmal atrial tachycardia; digitalis intoxication induced arrhythmias. Contraindication: Hypersensitivity to hydantoins, hemopoietic disorders, hepatic disease. Adverse effect: Drowsiness, ataxia, diplopia, GI disturbance, gingival hyperplasia, thrombocytopenia, agranulocytosis, osteomalacia. Dosage: Grand mal and psychomotor seizure: Adults: PO, initial dose 100 mg TID, increase dosage to a maximum of 600 mg/day, usual maintenance dose: 300-400 mg daily. IV, initial dose 150-200 mg given at a rate not exceeding 50 mg/min. Children: PO, initial dose 5 mg/kg/day in 2-3 divided dose, maintenance dose 4-8 mg/kg/day; IV, may be given 15-20 mg/kg, at a rate not exceeding 1-3 mg/kg/min. Cardiac arrhythmias: IV, usual dose 3.5-5 mg/kg, given at a rate not more than 50 mg/min, electrocardiographic monitoring is recommended. Stability: D5W or NS with 1, 1.5, 2, 4, or 10 g/L phenytoin is visually compatible for 4 days at 25 ℃ . NS with 100 mg/L phenytoin has no visible precipitation reported in 24 hours at 25 ℃ in an administration system that was closed to the air. Supply: Tab 100 mg; Inj 50 mg/ml, 5 ml/amp 28:12.92 Anticonvulsants, Miscellaneous Carbamazepine-“Tegretol (CR)” (OTEGR) (OTEFCR) Indication: For relief of pain associated with trigeminal neuralgia and use to control grand mal and psychomotor or partial seizure. Contraindication: Patients with previous bone marrow depression, hypersensitivity to carbamazepine and with a history of cardiac, hepatic, or renal disease. Adverse effect: Dizziness, ataxia, drowsiness, nausea, vomiting, agitation, and tremor. Dosage: Epilepsy: initial dose 100-200 mg, 1-2 times daily, gradually increased of 200 mg/day to a usual maintenance dose of 0.8 to 1.2 g daily in 2-4 divided 138 - - 139 - - neurosis, excitement, epilepsy, tetanus, preanesthetic medication. Contraindication: Hypersensitive to barbiturates, respiratory or cardiac disease, uncontrolled pain, history of porphyria, hepatic impairment. Adverse effect: Residual sedation, drowsiness, vertigo, ataxia, depression, nausea, vomiting, circulatory collapse. Dosage: Adults: PO, 50-100 mg BID or TID. Children: PO 3-6 mg/kg/day in divided doses Supply: Tab 32 mg 28:12.08 Benzodiazepines Clonazepam-“Rivotril” (ORIVO) (ORIV2) ［ C ］ Indication: Lennox-gastaut syndrome, akinetic and myoclonic seizure, absence (petit mal) seizure. Contraindication: Hypersensitivity to benzodiazepines, patient with significant liver disease, acute narrow angle glaucoma. Adverse effect: Drowsiness, aphonia, confusion, depression, ataxia, increased salivation, constipation, diarrhea, nausea, dry mouth, respiratory depression, thrombocytopenia. Dosage: Adults: initial dose 1.5 mg/day divided into 3 doses, followed by increased of 0.5-1.0 mg/day every 3 day until seizures control is achieved, maintenance dosage should not exceed 20 mg daily, maximum dose: 20 mg/day. Children: initial dose 0.05 mg/kg/day divided into 2-3 doses, may be increased of 0.5 mg every 3 day, maintenance dosage should not exceeded 0.2 mg/kg/day Supply: Tab 0.5 mg, 2 mg 28:12.12 Hydantoins Phenytion sodium –“Dilantin” (ODILAN) “Aleviatin”(IDILA) ［ D ］ Indication: Grand mal seizures and psychomotor seizures; ventricular tachycardia, paroxysmal atrial tachycardia; digitalis intoxication induced arrhythmias. Contraindication: Hypersensitivity to hydantoins, hemopoietic disorders, hepatic disease. Adverse effect: Drowsiness, ataxia, diplopia, GI disturbance, gingival hyperplasia, thrombocytopenia, agranulocytosis, osteomalacia. Dosage: Grand mal and psychomotor seizure: Adults: PO, initial dose 100 mg TID, increase dosage to a maximum of 600 mg/day, usual maintenance dose: 300-400 mg daily. IV, initial dose 150-200 mg given at a rate not exceeding 50 mg/min. Children: PO, initial dose 5 mg/kg/day in 2-3 divided dose, maintenance dose 4-8 mg/kg/day; IV, may be given 15-20 mg/kg, at a rate not exceeding 1-3 mg/kg/min. Cardiac arrhythmias: IV, usual dose 3.5-5 mg/kg, given at a rate not more than 50 mg/min, electrocardiographic monitoring is recommended. Stability: D5W or NS with 1, 1.5, 2, 4, or 10 g/L phenytoin is visually compatible for 4 days at 25 ℃ . NS with 100 mg/L phenytoin has no visible precipitation reported in 24 hours at 25 ℃ in an administration system that was closed to the air. Supply: Tab 100 mg; Inj 50 mg/ml, 5 ml/amp 28:12.92 Anticonvulsants, Miscellaneous Carbamazepine-“Tegretol (CR)” (OTEGR) (OTEFCR) Indication: For relief of pain associated with trigeminal neuralgia and use to control grand mal and psychomotor or partial seizure. Contraindication: Patients with previous bone marrow depression, hypersensitivity to carbamazepine and with a history of cardiac, hepatic, or renal disease. Adverse effect: Dizziness, ataxia, drowsiness, nausea, vomiting, agitation, and tremor. Dosage: Epilepsy: initial dose 100-200 mg, 1-2 times daily, gradually increased of 200 mg/day to a usual maintenance dose of 0.8 to 1.2 g daily in 2-4 divided 140 - - 141 - - doses up to 1.6 g/day. Trigeminal neuralgia: initial dose 100 mg BID, increased by 200 mg daily up to 1.2 g daily, usual maintenance dose 400-800 mg daily in 2-4 divided doses. Tegretol controlled release Tab can be divided into two parts butcould not be crashed. For shifting from conventional tablet to controlled release form, increasing of 10-20% dose is recommended. Supply: Tab 200 mg (Tegretol), control- released form 200 mg (Tegretol CR) Oxcarbazepine-“Trileptal” (OTRIL) ［ C ］ Indication: Monotherapy & adjunctive treatment of partial seizures in adult. Adjunctive treatment of partial seizure in children < 1 month. Precaution: Monitor plasma sodium levels in patients with pre-existing renal conditions associated with low sodium or in patients treated concomitantly with sodium-lowering drugs. Cardiac insufficiency & secondary heart failure (monitor body-weight). May affect ability to drive or operate machinery. Adverse effect: Frequent: fatigue, dizziness, headache, somnolence, nausea, vomiting, diplopia. Common: asthenia, agitation, amnesia, apathy, ataxia, impaired concentration, confusion, depression, emotional lability, nystagmus, tremor, constipation, diarrhea, abdominal pain, asymptomatic hyponatremia, acne, alopecia, rash, vertigo, vision disorders. Dosage: Adult-600-2400 mg/day in 2 divided doses. Children-initially 8-10 mg/kg/day in 2 divided doses. Dosage may be increased according to response in steps of up to 10 mg/kg daily at weekly intervals. MAX 46 mg/kg daily in divided doses. Supply: Tab 300 mg Gabapentin-“Gaty”(OGATY) ［ C ］ Indication: Gabapentin is indicated as adjunctive therapy in the treatment of partial seizures with and without secondary generalization. Place in therapy: The potential advantage of gabapentin over other antiepileptic agents is its apparent low order of toxicity. Contraindication: Hypersensitivity to Gabapentin; pancreatitis Adverse effect: Peripheral edema, myalgia, somnolence, fatigue, dizziness, ataxia, nystagmus, weight gain, skin rash, blurred vision, diplopia, mood changes, tremor, hyperactive behavior, No interactions with other anticonvulsants have been reported. Dosage: Partial seizure: Adults and children ＞ 12 yrs: 300 mg PO TID; may increase up to 1800 mg/day (divided into 3 doses); Children(3-12 yrs): initial, 10-15 mg/ kg/day in 3 divided doses. Diabetic peripheral neuropathy: 900-3600 mg/day in 3 divided doses. Post-herpetic neuralgia: 300 mg on Day 1, 300 mg BID on Day2, 300 mg TID on Day 3; may increase to 1800 mg/day (divided into 3 doses) Pharmacokinetics: The drug is not protein bound and does not appear to be metabolized; all of a dose is excreted unchanged in the urine. The terminal elimination half-life is 5 to 7 hours. Supply: Tab 600 mg Lamotrigine-“Lamictal”(OLAMI)“Lamta” (OLAMT) ［ C ］ Indication: It is used in combination with other anticonvulsant agents in the management of partial seizures. Place in therapy: The major role of lamotrigine appears to be in the treatment of simple and complex partial seizures and secondarily generalized tonic-clonic seizures resistant to multiple-drug therapy. Contraindication: It is contraindicated in patients with known hypersensitivity to the drug or any ingredient in the formulation. Adverse effect: In general, lamotrigine is well tolerated, but Stevens Johnson syndrome or rare deaths due to toxic epidermal necrolysis have been reported. The drug 140 - - 141 - - doses up to 1.6 g/day. Trigeminal neuralgia: initial dose 100 mg BID, increased by 200 mg daily up to 1.2 g daily, usual maintenance dose 400-800 mg daily in 2-4 divided doses. Tegretol controlled release Tab can be divided into two parts butcould not be crashed. For shifting from conventional tablet to controlled release form, increasing of 10-20% dose is recommended. Supply: Tab 200 mg (Tegretol), control- released form 200 mg (Tegretol CR) Oxcarbazepine-“Trileptal” (OTRIL) ［ C ］ Indication: Monotherapy & adjunctive treatment of partial seizures in adult. Adjunctive treatment of partial seizure in children < 1 month. Precaution: Monitor plasma sodium levels in patients with pre-existing renal conditions associated with low sodium or in patients treated concomitantly with sodium-lowering drugs. Cardiac insufficiency & secondary heart failure (monitor body-weight). May affect ability to drive or operate machinery. Adverse effect: Frequent: fatigue, dizziness, headache, somnolence, nausea, vomiting, diplopia. Common: asthenia, agitation, amnesia, apathy, ataxia, impaired concentration, confusion, depression, emotional lability, nystagmus, tremor, constipation, diarrhea, abdominal pain, asymptomatic hyponatremia, acne, alopecia, rash, vertigo, vision disorders. Dosage: Adult-600-2400 mg/day in 2 divided doses. Children-initially 8-10 mg/kg/day in 2 divided doses. Dosage may be increased according to response in steps of up to 10 mg/kg daily at weekly intervals. MAX 46 mg/kg daily in divided doses. Supply: Tab 300 mg Gabapentin-“Gaty”(OGATY) ［ C ］ Indication: Gabapentin is indicated as adjunctive therapy in the treatment of partial seizures with and without secondary generalization. Place in therapy: The potential advantage of gabapentin over other antiepileptic agents is its apparent low order of toxicity. Contraindication: Hypersensitivity to Gabapentin; pancreatitis Adverse effect: Peripheral edema, myalgia, somnolence, fatigue, dizziness, ataxia, nystagmus, weight gain, skin rash, blurred vision, diplopia, mood changes, tremor, hyperactive behavior, No interactions with other anticonvulsants have been reported. Dosage: Partial seizure: Adults and children ＞ 12 yrs: 300 mg PO TID; may increase up to 1800 mg/day (divided into 3 doses); Children(3-12 yrs): initial, 10-15 mg/ kg/day in 3 divided doses. Diabetic peripheral neuropathy: 900-3600 mg/day in 3 divided doses. Post-herpetic neuralgia: 300 mg on Day 1, 300 mg BID on Day2, 300 mg TID on Day 3; may increase to 1800 mg/day (divided into 3 doses) Pharmacokinetics: The drug is not protein bound and does not appear to be metabolized; all of a dose is excreted unchanged in the urine. The terminal elimination half-life is 5 to 7 hours. Supply: Tab 600 mg Lamotrigine-“Lamictal”(OLAMI)“Lamta” (OLAMT) ［ C ］ Indication: It is used in combination with other anticonvulsant agents in the management of partial seizures. Place in therapy: The major role of lamotrigine appears to be in the treatment of simple and complex partial seizures and secondarily generalized tonic-clonic seizures resistant to multiple-drug therapy. Contraindication: It is contraindicated in patients with known hypersensitivity to the drug or any ingredient in the formulation. Adverse effect: In general, lamotrigine is well tolerated, but Stevens Johnson syndrome or rare deaths due to toxic epidermal necrolysis have been reported. The drug 142 - - 143 - - is not approved for use in patients below 16 of age, due to higher incidence of severe life-threatening skin rash than in adult. Other effects include: dizziness, headache, ataxia, nausea, vomiting, rhinitis, pharyngitis, diplopia, and blurred vision. Dosage: Adults and children (>16 yrs) receiving 200-500 mg/day in two divided doses, up to 700 mg/day have been used in some cases. 100-150 mg/day are used with concomitant valproic acid. Supply: Tab 50 mg Magnesium Sulfate-“MgSO4”(IMGSO) ［ B ］ Indication: Prevention or control seizures in severe pre-eclampsia or eclampsia and in convulsions associated with epilepsy, glomerulonephritis and hypothyroidism; used to prevent or correct magnesium deficiency in TPN. Contraindication: Heart block, myocardial damage, serious renal impairment. Adverse effect: Flushing, sweating, depressed reflexes, hypotension, circulatory collapse, cardiac and CNS depression. Dosage: Initial dose: 1-4 g in 250 ml of 5% dextrose, the rate of injection not exceed 150 mg/min. Supply: Inj 10% 20 ml/amp, 16.2 mEq of Mg/amp Valproate sodium – “Depakine” (ODEPA) (ODEP5)(BDEPA)“Convulex” (OCONV) ［ D ］ Indication: Simple or complex absence seizures, complex partial epileptic seizures, acute mania Contraindication: Hypersensitivity to valproic acid, hepatic or renal function impairment, blood dyscrasias. Adverse effect: Nausea, vomiting, GI irritation, drowsiness, ataxia, transient alopecia, liver dysfunction. Dosage: Adult: Initial dose: 10-15 mg/kg/day, increased by 5-10 mg/kg daily at one week intervals until seizures are controlled, maximum recommended dosage is 60 mg/kg/day. Children: 25-30 mg/kg/day of Depakin chron; Switch from Depakin to Deparkin chrono: in a three-day base from 1500 mg Deparkin to Chrono form, day 0: 500 mg QD of Deparkin, day 1: conventional form 1 Tab QD and chrono 1 Tab TID, day 2: chrono 1 Tab QD and 2 Tabs QN, day 3: chrono 3 Tab QD or QN. Supply: Tab 200 mg (Depakine); Slow released tab 500 mg (Depakine Chrono); Cap 500 mg (Convulex); Sol 200 mg/ml, 40 ml/bot Topiramate –“Topamax” (OTOPA)(OTOPA1) Indication: Topiramate is a sulfamate-substituted monosaccharide, antiepileptic drug. Topiramate is indicated as adjunctive therapy for the treatment of patients with partial onset seizures or generalized tonic-clonic seizures. The use of topiramate in children is not reimbursed by insurance. Place in therapy: Potential advantages of topiramate are its lack of effect conventional antiepileptic agents (although phenytoin and carbamazepine can decrease topiramate serum concentrations), relatively long elimination half-life, and overall better tolerability compared to conventional agents; hematotoxicity or hepatotoxicity has not been reported in available trials. One disadvantage is its propensity to induce cognitive disturbances. Contraindication: Hypersensitivity to topiramate; precaution in the following condition: Behavioral disorders or cognitive deficits, urolithiasis, paresthesia, renal impairment or hepatic impairment, topiramate and other antiepileptic drugs should be gradually withdrawn Adverse effect: Adverse effects of topiramate include cognitive dysfunction, paresthesias, sedation, dizziness, fatigue, weight loss, diarrhea, and urolithiasis. The drug appears better tolerated in regard to hematotoxicity and hepatic dysfunction. Dosage: Adults: partial seizures or generalized tonic-clonic seizures: 400 mg/day PO BID. Children: the initial dose is topiramate 25 mg or less (1 to 3 mg/kg/day) 142 - - 143 - - is not approved for use in patients below 16 of age, due to higher incidence of severe life-threatening skin rash than in adult. Other effects include: dizziness, headache, ataxia, nausea, vomiting, rhinitis, pharyngitis, diplopia, and blurred vision. Dosage: Adults and children (>16 yrs) receiving 200-500 mg/day in two divided doses, up to 700 mg/day have been used in some cases. 100-150 mg/day are used with concomitant valproic acid. Supply: Tab 50 mg Magnesium Sulfate-“MgSO4”(IMGSO) ［ B ］ Indication: Prevention or control seizures in severe pre-eclampsia or eclampsia and in convulsions associated with epilepsy, glomerulonephritis and hypothyroidism; used to prevent or correct magnesium deficiency in TPN. Contraindication: Heart block, myocardial damage, serious renal impairment. Adverse effect: Flushing, sweating, depressed reflexes, hypotension, circulatory collapse, cardiac and CNS depression. Dosage: Initial dose: 1-4 g in 250 ml of 5% dextrose, the rate of injection not exceed 150 mg/min. Supply: Inj 10% 20 ml/amp, 16.2 mEq of Mg/amp Valproate sodium – “Depakine” (ODEPA) (ODEP5)(BDEPA)“Convulex” (OCONV) ［ D ］ Indication: Simple or complex absence seizures, complex partial epileptic seizures, acute mania Contraindication: Hypersensitivity to valproic acid, hepatic or renal function impairment, blood dyscrasias. Adverse effect: Nausea, vomiting, GI irritation, drowsiness, ataxia, transient alopecia, liver dysfunction. Dosage: Adult: Initial dose: 10-15 mg/kg/day, increased by 5-10 mg/kg daily at one week intervals until seizures are controlled, maximum recommended dosage is 60 mg/kg/day. Children: 25-30 mg/kg/day of Depakin chron; Switch from Depakin to Deparkin chrono: in a three-day base from 1500 mg Deparkin to Chrono form, day 0: 500 mg QD of Deparkin, day 1: conventional form 1 Tab QD and chrono 1 Tab TID, day 2: chrono 1 Tab QD and 2 Tabs QN, day 3: chrono 3 Tab QD or QN. Supply: Tab 200 mg (Depakine); Slow released tab 500 mg (Depakine Chrono); Cap 500 mg (Convulex); Sol 200 mg/ml, 40 ml/bot Topiramate –“Topamax” (OTOPA)(OTOPA1) Indication: Topiramate is a sulfamate-substituted monosaccharide, antiepileptic drug. Topiramate is indicated as adjunctive therapy for the treatment of patients with partial onset seizures or generalized tonic-clonic seizures. The use of topiramate in children is not reimbursed by insurance. Place in therapy: Potential advantages of topiramate are its lack of effect conventional antiepileptic agents (although phenytoin and carbamazepine can decrease topiramate serum concentrations), relatively long elimination half-life, and overall better tolerability compared to conventional agents; hematotoxicity or hepatotoxicity has not been reported in available trials. One disadvantage is its propensity to induce cognitive disturbances. Contraindication: Hypersensitivity to topiramate; precaution in the following condition: Behavioral disorders or cognitive deficits, urolithiasis, paresthesia, renal impairment or hepatic impairment, topiramate and other antiepileptic drugs should be gradually withdrawn Adverse effect: Adverse effects of topiramate include cognitive dysfunction, paresthesias, sedation, dizziness, fatigue, weight loss, diarrhea, and urolithiasis. The drug appears better tolerated in regard to hematotoxicity and hepatic dysfunction. Dosage: Adults: partial seizures or generalized tonic-clonic seizures: 400 mg/day PO BID. Children: the initial dose is topiramate 25 mg or less (1 to 3 mg/kg/day) 144 - - 145 - - nightly for 1 week. The dosage should then be increased by increments of 1-3 mg/kg/day administered in 2 divided doses at 1- to 2-week intervals. Pharmacokinetics: Topiramate is well absorbed after oral doses; peak serum concentrations occur in 2 to 4 hours. Food alters the rate of absorption but not the extent. The plasma protein binding of topiramate is minimal (9% to 17%); its volume of distribution is 0.7 L/kg. Most of an oral dose is excreted unchanged in the urine. The elimination half-life of topiramate is 18 to 24 hours. Supply: Tab 25 mg, 100 mg Vigabatrin – “Sabril”(OSABR) Indication: Vigabatrin is a derivative of gamma-aminobutyric acid that is used as an anticonvulsant. It is an effective adjunctive anticonvulsant for the treatment of multidrug-refractory complex partial seizures in adults. It is also effective in resistant partial seizures and infantile spasms in children and adolescents. Contraindication: Hypersensitivity to vigabatrin. Adverse effect: Headache, ataxia, irritablility, behavior changes, anxiety, gastrointestinal disturbance, weight gain, and acute psychosis; psychosis has occurred upon abrupt withdrawal of vigabatrin. Dosage: Adults: for add-on therapy 2-3 g/day, increase to 4 g daily if necessary Children: 1-2 g/day. Supply: Tab 500 mg 28:16 Psychotherapeutic Agents 28:16.04 Antidepressants 28:16.04.16 Selective Serotonin- and Norepinephrine-reuptake Inhibitors Venlafaxine –“Efexor XR” (OEFEX)(OEFEXX) ［ C ］ Indication: Major depressive disorder; generalized anxiety disorder and social anxiety disorder. Contraindication: Concomitant or within 14 days of MAOIs. Efexor XR must be discontinued for at least 7 days before starting treatment with MAOI. Severe renal or hepatic impairment. Pregnancy & lactation. Children <18 years. Adverse effect: Dizziness, sedation, dry mouth, insomnia, nervousness, tremor, somnolence, anorexia, constipation, nausea, vomiting, abnormal ejaculation/orgasm (males), erectile dysfunction, urinary hesitancy, sweating, asthenia, hypertension, hot flushes, ecchymosis, mucous membrane bleeding, thrombocytopenia, hypercholesterolaemia, yawning, fatigue, nausea, appetite & weight loss, decreased libido, sweating, anorexia, visual disturbances. Dosage: 75-150 mg/day Supply: Cap 37.5 mg, 75 mg Duloxetine HCl–“Cymbalta” (OCYMB) ［ C ］ Indication: Major depressive disorder Contraindication: Concomitant or within 14 days of MAOIs. Uncontrolled narrow-angle glaucoma Adverse effect: Nausea, dry mouth, constipation, diarrhea, vomiting, decreaed appetite, wt loss, fatigue, dizziness, somnolence, tremor, increased sweating, hot flushes, blurred vision, insomnia, anxiety, sexual dysfunction. Rarely, urinary hesitancy. Dosage: 40-60 mg/day in divided doses (i.e. 20 or 30 mg bid), or as a single daily dose of 60 mg Supply: Cap 30 mg 28:16.04.20 Selective Serotonin-reuptake Inhibitors Paroxetine-“Setine” (OSETI) “Seroxat” (OSERX) ［ D ］ Indication: Paroxetine is an antidepressant agent, which selectively inhibits serotonin uptake. Paroxetine is effective in the treatment of major depressive disorder, being comparable in efficacy to amitriptyline and mianserin; paroxetine is also effective for obsessive- 144 - - 145 - - nightly for 1 week. The dosage should then be increased by increments of 1-3 mg/kg/day administered in 2 divided doses at 1- to 2-week intervals. Pharmacokinetics: Topiramate is well absorbed after oral doses; peak serum concentrations occur in 2 to 4 hours. Food alters the rate of absorption but not the extent. The plasma protein binding of topiramate is minimal (9% to 17%); its volume of distribution is 0.7 L/kg. Most of an oral dose is excreted unchanged in the urine. The elimination half-life of topiramate is 18 to 24 hours. Supply: Tab 25 mg, 100 mg Vigabatrin – “Sabril”(OSABR) Indication: Vigabatrin is a derivative of gamma-aminobutyric acid that is used as an anticonvulsant. It is an effective adjunctive anticonvulsant for the treatment of multidrug-refractory complex partial seizures in adults. It is also effective in resistant partial seizures and infantile spasms in children and adolescents. Contraindication: Hypersensitivity to vigabatrin. Adverse effect: Headache, ataxia, irritablility, behavior changes, anxiety, gastrointestinal disturbance, weight gain, and acute psychosis; psychosis has occurred upon abrupt withdrawal of vigabatrin. Dosage: Adults: for add-on therapy 2-3 g/day, increase to 4 g daily if necessary Children: 1-2 g/day. Supply: Tab 500 mg 28:16 Psychotherapeutic Agents 28:16.04 Antidepressants 28:16.04.16 Selective Serotonin- and Norepinephrine-reuptake Inhibitors Venlafaxine –“Efexor XR” (OEFEX)(OEFEXX) ［ C ］ Indication: Major depressive disorder; generalized anxiety disorder and social anxiety disorder. Contraindication: Concomitant or within 14 days of MAOIs. Efexor XR must be discontinued for at least 7 days before starting treatment with MAOI. Severe renal or hepatic impairment. Pregnancy & lactation. Children <18 years. Adverse effect: Dizziness, sedation, dry mouth, insomnia, nervousness, tremor, somnolence, anorexia, constipation, nausea, vomiting, abnormal ejaculation/orgasm (males), erectile dysfunction, urinary hesitancy, sweating, asthenia, hypertension, hot flushes, ecchymosis, mucous membrane bleeding, thrombocytopenia, hypercholesterolaemia, yawning, fatigue, nausea, appetite & weight loss, decreased libido, sweating, anorexia, visual disturbances. Dosage: 75-150 mg/day Supply: Cap 37.5 mg, 75 mg Duloxetine HCl–“Cymbalta” (OCYMB) ［ C ］ Indication: Major depressive disorder Contraindication: Concomitant or within 14 days of MAOIs. Uncontrolled narrow-angle glaucoma Adverse effect: Nausea, dry mouth, constipation, diarrhea, vomiting, decreaed appetite, wt loss, fatigue, dizziness, somnolence, tremor, increased sweating, hot flushes, blurred vision, insomnia, anxiety, sexual dysfunction. Rarely, urinary hesitancy. Dosage: 40-60 mg/day in divided doses (i.e. 20 or 30 mg bid), or as a single daily dose of 60 mg Supply: Cap 30 mg 28:16.04.20 Selective Serotonin-reuptake Inhibitors Paroxetine-“Setine” (OSETI) “Seroxat” (OSERX) ［ D ］ Indication: Paroxetine is an antidepressant agent, which selectively inhibits serotonin uptake. Paroxetine is effective in the treatment of major depressive disorder, being comparable in efficacy to amitriptyline and mianserin; paroxetine is also effective for obsessive- 146 - - 147 - - compulsive disorder and panic disorder. Place in therapy: A more favorable adverse effect profile as compared to tricyclic antidepressants has been observed in several studies. Paroxetine may have a faster onset of action than fluoxetine; however, both agents are equal in efficacy after six weeks of therapy. No difference between response rates of the different drugs was noted. Contraindication: Concurrent use of monoamine oxidase inhibitor (MAOI) drugs. Adverse effect: The adverse effects of paroxetine are nausea, sedation, headache, dry mouth, dizziness, insomnia, diaphoresis, and constipation; cardiovascular effects have been minimal, and less than those observed with tricyclic antidepressants in most reports. Dosage: Major depression: 20-50 mg PO QD; initial doses of 10 mg, with a daily maximum of 40 mg are recommended in severe renal insufficiency, liver disease, and in the elderly or debilitated; obsessive compulsive disorder or panic disorder: 40 mg once daily. Pharmacokinetics: The elimination half-life is approximately 20 hours. Supply: Tab 20 mg Sertraline – “Zoloft” (OZOLO)“You-Jet” (OYOUJ) ［ C ］ Indication: Sertraline is an antidepressant with selective inhibitory effects on presynaptic serotonin (5-HT) reuptake. It is effective in the treatment of depression, obsessive-compulsive disorder (OCD), and panic disorder. Place in therapy: Sertraline is unique among the antidepressants because it seems to cause less of the sedating, anticholinergic, and cardiovascular adverse effects common to other agents, possibly due to its high specificity for the serotonin receptor. Contraindication: Concurrent use of monoamine oxidase inhibitor (MAOI) drugs. At least 2 weeks are required after ceasing a MAO inhibitor and then begin the drug, and vis versa. Adverse effect: Nausea, vomiting, diarrhea and dry mouth. Dosage: Initial doses: 50 mg PO QD; maximum doses 200 mg PO QD Supply: Tab 50 mg Fluoxetine HCI –“U-Zet” (OUZET)“Fluxen” (OFLUX)( 專 ) ［ C ］ Indication: It is an antidepressant that is a specific inhibitor of serotonin reuptake. It is as effective in the treatment of depression as amitriptyline, imipramine and doxepin but with lower degree of toxicity. Contraindication: Use with cautions in patients with renal or hepatic disease. The washout period between use of fluoxetine and MAOI is 5 weeks. Adverse effect: Nausea, hypotension, headache, anxiety, nervousness, insomnia, dry mouth, anorexia and visual disturbances, weight loss. Dosage: 20 to 80 mg/day, range from 5-60 mg/day has been suggested. Supply: Tab 20 mg Fluvoxamine-“Lote” (OLOTE5) (OLOTE) “Fluvoxin”(OFLUV) ( 專 ) ［ C ］ Indication: Treatment of symptoms of depressive illness. Contraindication: Concomitant or within 2 weeks of MAOI therapy Adverse effect: Nausea, vomiting, asthenia, headache, malaise, palpitations, tachycardia, raised hepatic enzyme levels, dry mouth, GI & nervous system disturbances, dizziness, sweating, and hyponatremia. Dosage: 100-200 mg daily. Max 300 mg. Supply: Tab 50 mg (Lote; Fluvoxin), 100 mg (Lote) Escitalopram-“Lexapro”(OLEXA) ［ C ］ Indication: Treatment of major depressive episodes. Treatment of panic disorder with or without agoraphobia; social anxiety disorder (social phobia); generalized anxiety disorder. 146 - - 147 - - compulsive disorder and panic disorder. Place in therapy: A more favorable adverse effect profile as compared to tricyclic antidepressants has been observed in several studies. Paroxetine may have a faster onset of action than fluoxetine; however, both agents are equal in efficacy after six weeks of therapy. No difference between response rates of the different drugs was noted. Contraindication: Concurrent use of monoamine oxidase inhibitor (MAOI) drugs. Adverse effect: The adverse effects of paroxetine are nausea, sedation, headache, dry mouth, dizziness, insomnia, diaphoresis, and constipation; cardiovascular effects have been minimal, and less than those observed with tricyclic antidepressants in most reports. Dosage: Major depression: 20-50 mg PO QD; initial doses of 10 mg, with a daily maximum of 40 mg are recommended in severe renal insufficiency, liver disease, and in the elderly or debilitated; obsessive compulsive disorder or panic disorder: 40 mg once daily. Pharmacokinetics: The elimination half-life is approximately 20 hours. Supply: Tab 20 mg Sertraline – “Zoloft” (OZOLO)“You-Jet” (OYOUJ) ［ C ］ Indication: Sertraline is an antidepressant with selective inhibitory effects on presynaptic serotonin (5-HT) reuptake. It is effective in the treatment of depression, obsessive-compulsive disorder (OCD), and panic disorder. Place in therapy: Sertraline is unique among the antidepressants because it seems to cause less of the sedating, anticholinergic, and cardiovascular adverse effects common to other agents, possibly due to its high specificity for the serotonin receptor. Contraindication: Concurrent use of monoamine oxidase inhibitor (MAOI) drugs. At least 2 weeks are required after ceasing a MAO inhibitor and then begin the drug, and vis versa. Adverse effect: Nausea, vomiting, diarrhea and dry mouth. Dosage: Initial doses: 50 mg PO QD; maximum doses 200 mg PO QD Supply: Tab 50 mg Fluoxetine HCI –“U-Zet” (OUZET)“Fluxen” (OFLUX)( 專 ) ［ C ］ Indication: It is an antidepressant that is a specific inhibitor of serotonin reuptake. It is as effective in the treatment of depression as amitriptyline, imipramine and doxepin but with lower degree of toxicity. Contraindication: Use with cautions in patients with renal or hepatic disease. The washout period between use of fluoxetine and MAOI is 5 weeks. Adverse effect: Nausea, hypotension, headache, anxiety, nervousness, insomnia, dry mouth, anorexia and visual disturbances, weight loss. Dosage: 20 to 80 mg/day, range from 5-60 mg/day has been suggested. Supply: Tab 20 mg Fluvoxamine-“Lote” (OLOTE5) (OLOTE) “Fluvoxin”(OFLUV) ( 專 ) ［ C ］ Indication: Treatment of symptoms of depressive illness. Contraindication: Concomitant or within 2 weeks of MAOI therapy Adverse effect: Nausea, vomiting, asthenia, headache, malaise, palpitations, tachycardia, raised hepatic enzyme levels, dry mouth, GI & nervous system disturbances, dizziness, sweating, and hyponatremia. Dosage: 100-200 mg daily. Max 300 mg. Supply: Tab 50 mg (Lote; Fluvoxin), 100 mg (Lote) Escitalopram-“Lexapro”(OLEXA) ［ C ］ Indication: Treatment of major depressive episodes. Treatment of panic disorder with or without agoraphobia; social anxiety disorder (social phobia); generalized anxiety disorder. 148 - - 149 - - Contraindication: Concomitant treatment with nonselective, irreversible MAOIs. Adverse effect: Appetite decreased, libido decreased, anorgasmia (female), insomnia, somnolence, dizziness, sinusitis, yawning, nausea, diarrhea, constipation, sweating increased, ejaculation disorder, impotence, fatigue, pyrexia. Dosage: 10 mg once daily. Max 20 mg daily. Supply: Tab 10 mg Citalopram – “Ultidep”(OULTI) “Kitapram” (OKITA) Indication: Depressive illness, panic disorder. Adverse effect: Hypersensitivity reactions including rash, anxiety, nervousness, insomnia, anorexia with weight loss or increased appetite with weight gain, asthenia, GI disturbances, somnolence, tremor, pharyngitis, sweating, impotence, abnormal ejaculation, mania or hypomania. Dosage: Adult—initially 20 mg once daily; dosage may be gradually increased if necessary to max 60 mg daily. Elderly—Max 40 mg daily. Supply: Tab 20 mg 28:16.04.24 Serotonin Modulators Trazodone HCI-“Trazo” (OTRAZ5)(OTRAZ) “Mesyrel”(OMESY) ［ C ］ Indication: Trazodone is used primarily in the treatment of mental depression or depression/anxiety disorder. Place in therapy: Trazodone may be safely combined with MAOIs for refractory depression. Disadvantages of trazodone include a high incidence of priapism, orthostatic hypotension, and induction or exacerbation of atrial and ventricular arrhythmias. However, compared with the TCAs, trazodone is still considered less cardiotoxic. Contraindication: Hypersensitivity to trazodone; carcinoid syndrome. Trazodone is not recommended for use during initial recovery phase of myocardial infarction. Adverse effect: Trazodone has a low incidence of anticholinergic effects and cardiovascular effects. Adverse effects include ventricular arrhythmias, hypotension, heart block, drowsinness, weight gain, blurred vision, dizziness, and priapism. Dosage: 50-600 mg daily, usually response range between 100-300 mg daily in single or divided dose. Supply: Tab 50 mg (Trazo, Mesyrel), 100 mg (Trazo) 28:16.04.28 Tricyclics and Other Norepinephrine-reuptake Inhibitors Imipramine HCI –“Tofranil” (OTOFR) ［ C ］ Indication: Depression, especially endogenous depression and childhood enuresis. Contraindication: Hypersensitivity to imipramine or other benzodiazepines; wait at least 14 days after discontinuing MAO inhibitors before initiating imipramine therapy, myocardial infarction during acute recovery phase. Adverse effect: Drowsiness, tachycardia, congestive heart failure, mydriasis, convulsion, hypotension, confusion, dry mouth, bone marrow depression, nausea, vomiting. Dosage: Adults: PO 75mg/day to start, followed by up to 200mg/day if needed, usual maintenance dose: 50-150mg/day. Supply: Tab 10 mg Maprotiline HCI –“Ludiomil” (OLUDI) ［ B ］ Indication: Maprotiline is a tetracyclic antidepressant. It is used in the treatment of depressive affective (mood) disorder including dysthymic disorder (depressive neurosis) and major depression. It is also used for the depressive phase of bipolar disorder. Adverse effect: Drowsiness, sedation, vertigo, blurred vision, and urinary retention. Other adverse reactions have included skin rashes, seizures, myoclonus, mania, and hallucinations. 148 - - 149 - - Contraindication: Concomitant treatment with nonselective, irreversible MAOIs. Adverse effect: Appetite decreased, libido decreased, anorgasmia (female), insomnia, somnolence, dizziness, sinusitis, yawning, nausea, diarrhea, constipation, sweating increased, ejaculation disorder, impotence, fatigue, pyrexia. Dosage: 10 mg once daily. Max 20 mg daily. Supply: Tab 10 mg Citalopram – “Ultidep”(OULTI) “Kitapram” (OKITA) Indication: Depressive illness, panic disorder. Adverse effect: Hypersensitivity reactions including rash, anxiety, nervousness, insomnia, anorexia with weight loss or increased appetite with weight gain, asthenia, GI disturbances, somnolence, tremor, pharyngitis, sweating, impotence, abnormal ejaculation, mania or hypomania. Dosage: Adult—initially 20 mg once daily; dosage may be gradually increased if necessary to max 60 mg daily. Elderly—Max 40 mg daily. Supply: Tab 20 mg 28:16.04.24 Serotonin Modulators Trazodone HCI-“Trazo” (OTRAZ5)(OTRAZ) “Mesyrel”(OMESY) ［ C ］ Indication: Trazodone is used primarily in the treatment of mental depression or depression/anxiety disorder. Place in therapy: Trazodone may be safely combined with MAOIs for refractory depression. Disadvantages of trazodone include a high incidence of priapism, orthostatic hypotension, and induction or exacerbation of atrial and ventricular arrhythmias. However, compared with the TCAs, trazodone is still considered less cardiotoxic. Contraindication: Hypersensitivity to trazodone; carcinoid syndrome. Trazodone is not recommended for use during initial recovery phase of myocardial infarction. Adverse effect: Trazodone has a low incidence of anticholinergic effects and cardiovascular effects. Adverse effects include ventricular arrhythmias, hypotension, heart block, drowsinness, weight gain, blurred vision, dizziness, and priapism. Dosage: 50-600 mg daily, usually response range between 100-300 mg daily in single or divided dose. Supply: Tab 50 mg (Trazo, Mesyrel), 100 mg (Trazo) 28:16.04.28 Tricyclics and Other Norepinephrine-reuptake Inhibitors Imipramine HCI –“Tofranil” (OTOFR) ［ C ］ Indication: Depression, especially endogenous depression and childhood enuresis. Contraindication: Hypersensitivity to imipramine or other benzodiazepines; wait at least 14 days after discontinuing MAO inhibitors before initiating imipramine therapy, myocardial infarction during acute recovery phase. Adverse effect: Drowsiness, tachycardia, congestive heart failure, mydriasis, convulsion, hypotension, confusion, dry mouth, bone marrow depression, nausea, vomiting. Dosage: Adults: PO 75mg/day to start, followed by up to 200mg/day if needed, usual maintenance dose: 50-150mg/day. Supply: Tab 10 mg Maprotiline HCI –“Ludiomil” (OLUDI) ［ B ］ Indication: Maprotiline is a tetracyclic antidepressant. It is used in the treatment of depressive affective (mood) disorder including dysthymic disorder (depressive neurosis) and major depression. It is also used for the depressive phase of bipolar disorder. Adverse effect: Drowsiness, sedation, vertigo, blurred vision, and urinary retention. Other adverse reactions have included skin rashes, seizures, myoclonus, mania, and hallucinations. 150 - - 151 - - Dosage: Adults: PO 25-50 mg TID, doses above 300 mg/day are not recommended. Children (6-14 years old): 10 mg/day increased to maximum of 75 mg. Supply: Tab 25 mg Doxepin Hydrochloride-“Sinequan” (OSINE)( 專 ) Indication: Depression, anxiety in psychoneurotic patients, associated with alcoholism, organic disease. Contraindication: Hypersensitivity, glaucoma, urinary retention. Adverse effect: Hypotension, tachycardia, drowsiness, confusion, disorientation, hallucination, dry mouth, urinary retension, bone marrow depression, nausea, vomiting, skin rash. Dosage: Adult dose: 75 mg QN, adjust dosage until optimal response is achieved, usual maintenance dosage: 75-150 mg/day. Supply: Cap 25 mg 28:16.04.92 Antidepressants, Miscellaneous Bupropion-“Wellbutrin SR”(OWELL) “Zyban SR” (OZYBA)( 專 ) ［ C ］ Indication: Depression, Smoking cessation assistance. Pharmacology: Bupropion is a selective inhibitor of the neuronal re-uptake of catecholamines (noradrenaline and dopamine) with minimal effect on the re- uptake of indolamines (serotonin), and does not inhibit monoamine oxidase. Pharmacokinetics: The absorption of bupropion is rapid. Volume of distribution 19-21 L/kg; extensively metabolized via liver to 3 active metabolites; protein binding 82-88%; elimination half-life 21±9 hrs. Contraindication: Hypersensitivity to bupropion products, patients with a seizure disorder, patients undergoing abrupt discontinuation of alcohol or sedatives (including benzodiazepines), prior or current diagnosis of bulimia or anorexia, concomitant MAO inhibitor, concomitant use of other bupropion products. Adverse effect: Headache, xerostomia, nausea, insomnia, tremor, dizziness, pharyngitis, agitation, anxiety, nausea and vomiting, constipation. Dosage: Depression: initial, Wellbutrin ® SR 150mg taken as a single daily dose. MAX 300mg/day. The maximum single dose should not exceed 150 mg. Doses greater than 150 mg/day should be taken as a twice daily with an interval of at least 8 hours between successive doses. Smoking cessation assistance: initial, Zyban ® 150 mg orally in the morning for 3 days, increasing to 150 mg twice daily. Zyban ® should be swallowed whole; do not crush, chew, or divide. Wellbutrin ® SR may be divided, but not crushed or chewed. Supply: Tab 150 mg Mirtazapine-“Remeron”(OREME) ［ C ］ Indication: Episode of major depression Precaution: Epilepsy, organic brain syndrome, hepatic or renal insufficiency, cardiac disease, low BP, micturition disturbances, acute narrow-angle glaucoma, increased intraocular pressure, diabetes mellitus; pregnancy, lactation. Patients with schizophrenia or other psychotic disturbances. Avoid abrupt withdrawal. Elderly. May impair ability to drive or operate machinery. Adverse effect: Increased appetite, weight gain; drowsiness, rarely orthostatic hypotension, mania, convulsions, tremor, myoclonus, oedema, acute bone marrow depression, exanthema, elevated transaminase levels. Dosage: 15 or 30 mg daily at bedtime. Usual dose range 15-45 mg daily. Supply: Tab 30 mg 150 - - 151 - - Dosage: Adults: PO 25-50 mg TID, doses above 300 mg/day are not recommended. Children (6-14 years old): 10 mg/day increased to maximum of 75 mg. Supply: Tab 25 mg Doxepin Hydrochloride-“Sinequan” (OSINE)( 專 ) Indication: Depression, anxiety in psychoneurotic patients, associated with alcoholism, organic disease. Contraindication: Hypersensitivity, glaucoma, urinary retention. Adverse effect: Hypotension, tachycardia, drowsiness, confusion, disorientation, hallucination, dry mouth, urinary retension, bone marrow depression, nausea, vomiting, skin rash. Dosage: Adult dose: 75 mg QN, adjust dosage until optimal response is achieved, usual maintenance dosage: 75-150 mg/day. Supply: Cap 25 mg 28:16.04.92 Antidepressants, Miscellaneous Bupropion-“Wellbutrin SR”(OWELL) “Zyban SR” (OZYBA)( 專 ) ［ C ］ Indication: Depression, Smoking cessation assistance. Pharmacology: Bupropion is a selective inhibitor of the neuronal re-uptake of catecholamines (noradrenaline and dopamine) with minimal effect on the re- uptake of indolamines (serotonin), and does not inhibit monoamine oxidase. Pharmacokinetics: The absorption of bupropion is rapid. Volume of distribution 19-21 L/kg; extensively metabolized via liver to 3 active metabolites; protein binding 82-88%; elimination half-life 21±9 hrs. Contraindication: Hypersensitivity to bupropion products, patients with a seizure disorder, patients undergoing abrupt discontinuation of alcohol or sedatives (including benzodiazepines), prior or current diagnosis of bulimia or anorexia, concomitant MAO inhibitor, concomitant use of other bupropion products. Adverse effect: Headache, xerostomia, nausea, insomnia, tremor, dizziness, pharyngitis, agitation, anxiety, nausea and vomiting, constipation. Dosage: Depression: initial, Wellbutrin ® SR 150mg taken as a single daily dose. MAX 300mg/day. The maximum single dose should not exceed 150 mg. Doses greater than 150 mg/day should be taken as a twice daily with an interval of at least 8 hours between successive doses. Smoking cessation assistance: initial, Zyban ® 150 mg orally in the morning for 3 days, increasing to 150 mg twice daily. Zyban ® should be swallowed whole; do not crush, chew, or divide. Wellbutrin ® SR may be divided, but not crushed or chewed. Supply: Tab 150 mg Mirtazapine-“Remeron”(OREME) ［ C ］ Indication: Episode of major depression Precaution: Epilepsy, organic brain syndrome, hepatic or renal insufficiency, cardiac disease, low BP, micturition disturbances, acute narrow-angle glaucoma, increased intraocular pressure, diabetes mellitus; pregnancy, lactation. Patients with schizophrenia or other psychotic disturbances. Avoid abrupt withdrawal. Elderly. May impair ability to drive or operate machinery. Adverse effect: Increased appetite, weight gain; drowsiness, rarely orthostatic hypotension, mania, convulsions, tremor, myoclonus, oedema, acute bone marrow depression, exanthema, elevated transaminase levels. Dosage: 15 or 30 mg daily at bedtime. Usual dose range 15-45 mg daily. Supply: Tab 30 mg 152 - - 153 - - 28:16.08 Antipsychotics 28:16.08.04 Atypical Antipsychotics Clozapine – “Clopine” (OCLOZ1) “Uspen”(OUSPE) “Clozaril” (OCLOZ) ［ B ］ Indication: Clozapine is an atypical antipsychotic agent and a tricyclic dibenzodiazepine derivative. Place in therapy: The drug has demonstrated efficacy in the therapy of treatment-resistant schizophrenic patients. Because of the higher risk of agranulocytosis, clozapine should be reserved for those treatment-resistant patients who have not responded to adequate trials of other antipsychotic agents. Contraindication: Myeloproliferative disorders, uncontrolled epilepsy, central nervous system depression, comatose state, and a history of clozapine-induced agranulocytosis Adverse effect: Common adverse effects include sedation, dry mouth, nausea, constipation, and sialorrhea. Agranulocytosis is a serious adverse effect of clozapine; white blood cell counts should be monitored weekly for 6 months and every other week thereafter. Dosage: Adults: 300-600 mg/day; 50-900 mg/day have also been effective; Withdrawal schedule: Gradually reduce the dose over a 1-2 week period. Children: Safety and effectiveness for use in children has not been established. But for 12-17 y/o as an initial dose of 12.5 -25 mg/day and increased every 4 days by one or two times the starting dose has been reported. Pharmacokinetics: Schizophrenia, Oral: 3 months Supply: Tab 25 mg (Clozaril), 100 mg (Clopine, Uspen) Risperidone – “Risperdal” (ORIS1)(ORIS2) (BRISP) (IRISP) “Risdon” (ORISD) ［ C ］ Indication: Risperidone is indicated for the management of the manifestations of psychotic disorders. Place in therapy: In contrast to conventional neuroleptics, risperidone acts mainly as dopamine antagonists, and blocks both 5-HT2 and dopamine D2 receptors. It may be less likely to cause extrapyramidal symptoms and tardive dyskinesias than other antipsychotics. Contraindication: Hypersensitivity to risperidone hyperpro-lactinemia, children and adolescents Adverse effect: Sedation is the most prominent adverse effect; other infrequent effects include headache, dry mouth, constipation, blurred vision, and urinary retention. Palpitations, nervousness, and lumbalgia have also been reported. Dosage: Psychotic disorders: 4-8 mg/day PO beginning with 1 mg BID initially, with increases in increments of 1 mg BID on the second and third day, as tolerated, to a target dose of 3 mg BID by the third day. 25 mg IM every 2 weeks. Some patients may benefit from higher doses of 37.5 mg or 50 mg. Pharmacokinetics: It has peak plasma concentration of 1-2 hours after administration. Supply: Tab 1 mg (Risperdal), 2 mg (Risperdal, Risdon); Soln 1 mg/ml (Risperdal), 30 ml/bot; Inj 25 mg/vial (Risperdal) Paliperidone – “Invega”(OINVE3) ［ C ］ Indication: Acute and maintenance treatment of sckizophrenia Place in therapy: Paliperidone is also active as an antagonist at alpha-1 and –2 adrenergic receptors and H1 histaminergic receptors, which may explain some of the other effects of the drug. Contraindication: Hypersensitivity to paliperidone, risperidone or any compents in Invega formulation hyperpro-lactinemia, children and adolescents Adverse effect: Somnolence, orthostatic hypotension, salivary hypersecretion, akathisia, systonia, systonia, extrapyramidal disorder, hypertonis and Pakinsonism. Dosage: 6 mg/day with increases of 3 mg/day at 152 - - 153 - - 28:16.08 Antipsychotics 28:16.08.04 Atypical Antipsychotics Clozapine – “Clopine” (OCLOZ1) “Uspen”(OUSPE) “Clozaril” (OCLOZ) ［ B ］ Indication: Clozapine is an atypical antipsychotic agent and a tricyclic dibenzodiazepine derivative. Place in therapy: The drug has demonstrated efficacy in the therapy of treatment-resistant schizophrenic patients. Because of the higher risk of agranulocytosis, clozapine should be reserved for those treatment-resistant patients who have not responded to adequate trials of other antipsychotic agents. Contraindication: Myeloproliferative disorders, uncontrolled epilepsy, central nervous system depression, comatose state, and a history of clozapine-induced agranulocytosis Adverse effect: Common adverse effects include sedation, dry mouth, nausea, constipation, and sialorrhea. Agranulocytosis is a serious adverse effect of clozapine; white blood cell counts should be monitored weekly for 6 months and every other week thereafter. Dosage: Adults: 300-600 mg/day; 50-900 mg/day have also been effective; Withdrawal schedule: Gradually reduce the dose over a 1-2 week period. Children: Safety and effectiveness for use in children has not been established. But for 12-17 y/o as an initial dose of 12.5 -25 mg/day and increased every 4 days by one or two times the starting dose has been reported. Pharmacokinetics: Schizophrenia, Oral: 3 months Supply: Tab 25 mg (Clozaril), 100 mg (Clopine, Uspen) Risperidone – “Risperdal” (ORIS1)(ORIS2) (BRISP) (IRISP) “Risdon” (ORISD) ［ C ］ Indication: Risperidone is indicated for the management of the manifestations of psychotic disorders. Place in therapy: In contrast to conventional neuroleptics, risperidone acts mainly as dopamine antagonists, and blocks both 5-HT2 and dopamine D2 receptors. It may be less likely to cause extrapyramidal symptoms and tardive dyskinesias than other antipsychotics. Contraindication: Hypersensitivity to risperidone hyperpro-lactinemia, children and adolescents Adverse effect: Sedation is the most prominent adverse effect; other infrequent effects include headache, dry mouth, constipation, blurred vision, and urinary retention. Palpitations, nervousness, and lumbalgia have also been reported. Dosage: Psychotic disorders: 4-8 mg/day PO beginning with 1 mg BID initially, with increases in increments of 1 mg BID on the second and third day, as tolerated, to a target dose of 3 mg BID by the third day. 25 mg IM every 2 weeks. Some patients may benefit from higher doses of 37.5 mg or 50 mg. Pharmacokinetics: It has peak plasma concentration of 1-2 hours after administration. Supply: Tab 1 mg (Risperdal), 2 mg (Risperdal, Risdon); Soln 1 mg/ml (Risperdal), 30 ml/bot; Inj 25 mg/vial (Risperdal) Paliperidone – “Invega”(OINVE3) ［ C ］ Indication: Acute and maintenance treatment of sckizophrenia Place in therapy: Paliperidone is also active as an antagonist at alpha-1 and –2 adrenergic receptors and H1 histaminergic receptors, which may explain some of the other effects of the drug. Contraindication: Hypersensitivity to paliperidone, risperidone or any compents in Invega formulation hyperpro-lactinemia, children and adolescents Adverse effect: Somnolence, orthostatic hypotension, salivary hypersecretion, akathisia, systonia, systonia, extrapyramidal disorder, hypertonis and Pakinsonism. Dosage: 6 mg/day with increases of 3 mg/day at 154 - - 155 - - intervals of at least 5 days, to a maximum of 12 mg/day. Pharmacokinetics: The pharmacokinetics are dose-proportional within the recommended clinical dose range (3-12 mg). The plasma conc. of paliperidone gradually rise to reach peak plasma conc (Cmax) approximately 24 hr after dosing. The terminal elimination half-life of paliperidone is approximately 23 hr. Supply: Tab 3 mg Zotepine – “Lodopin” (OLODO) Indication: Schizophrenia Pharmacology: Zotepine is thought to act by blocking both dopamine D1 and D2 receptor sub-types. It also blocks four serotonin receptor sub-types, histamine-H1 receptors and is a potent inhibitor of nor-adrenaline reuptake. Pharmacokinetics: Oral bioavilability: 7-13%, it undergoes extensive firs-pass metabolism. One major metabolite, norzotepine, has some pharmacological activity. Both zotepine and its metabolites are excreted via the bile and feces. Protein binding: 97%, the elimination half-life is about 15 hours. Contraindication: Hypersensitivity to zotepine, phenothiazines, or thioxanthenes; acute alcohol, opiate, sedative-hypnotic, or psychotropic drug intoxication; patient with coma or circulatory collapse, impaired hematopoiesis, children, pregnancy, breastfeeding. Zotepine can prolong the QT interval and patients with pre-existing prolongation of the QT interval should not be given the drug. Adverse effect: Sleepiness, weak-ness/malaise, insomnia, headache, oral dryness, constipation, dizziness, weight gain. Dosage: Initial: 25 mg three times daily, MAX 450 mg/day. Doses should also be reduced in patients with hepatic or renal impairment. Supply: Tab 50 mg Quetiapine –“Seroquel” (OSERQ)(OSER2) “Utapine”(OUTAP) ［ C ］ Indication: Schizophrenia, manic episodes associated with bipolar disorder. Contraindication: Hypersensitivity to quetiapine fumarate or any component of the product Adverse effect: Headache, asthenia, abdominal pain, back pain, fever, chest pain, postural hypotension, tachycardia, hypertension, constipation, dry mouth, dyspepsia, diarrhoea, weight gain. Dosage: Schizophrenia: total daily dose—50 mg (Day 1), 100 mg (Day 2), 200 mg (Day 3), 300 mg (Day 4). From Day 4 onwards, dose titrated to dose range of 300-450 mg/day. Dose may be adjusted within the range 150-750 mg/day. Mainic episodes associated bipolar disorder: as monotherapy of as adjunct therapy to mood stabilizers, total daily dose: 100 mg (Day 1), 200 mg (Day 2), 300 mg (Day 3), 400 mg (Day 4). Further dosage adjustments up to 800 mg/day by Day 6 should be in increments of no >200 mg/day. Supply: Tab 100 mg (Seroquel), 200 mg (Seroquel, Utapine) Olanzapine-“Zyprexa”(OZYPR) ［ C ］ Indication: Olanzapine is indicated for the treatment of schizophrenia. Olanzapine is effective in maintaining the clinical improvement during continuation therapy in patients who have shown an initial treatment response. Olanzapine is indicated for the treatment of moderate to severe manic episode. In patients whose manic episode has responded to olanzapine treatment, olanzapine is indicated for the prevention of recurrence in patients with bipolar disorder. Contraindication: Narrow-angle glaucoma. Adverse effect: Somnolence, weight gain, dizziness, akathisia, Parkinsonism, dyskinesia, increased appetite, elevated glucose & triglyceride levels, asthenia, edema, orthostatic hypotension, dry mouth, constipation, eosinophilia, elevated prolactin levels (but clinical 154 - - 155 - - intervals of at least 5 days, to a maximum of 12 mg/day. Pharmacokinetics: The pharmacokinetics are dose-proportional within the recommended clinical dose range (3-12 mg). The plasma conc. of paliperidone gradually rise to reach peak plasma conc (Cmax) approximately 24 hr after dosing. The terminal elimination half-life of paliperidone is approximately 23 hr. Supply: Tab 3 mg Zotepine – “Lodopin” (OLODO) Indication: Schizophrenia Pharmacology: Zotepine is thought to act by blocking both dopamine D1 and D2 receptor sub-types. It also blocks four serotonin receptor sub-types, histamine-H1 receptors and is a potent inhibitor of nor-adrenaline reuptake. Pharmacokinetics: Oral bioavilability: 7-13%, it undergoes extensive firs-pass metabolism. One major metabolite, norzotepine, has some pharmacological activity. Both zotepine and its metabolites are excreted via the bile and feces. Protein binding: 97%, the elimination half-life is about 15 hours. Contraindication: Hypersensitivity to zotepine, phenothiazines, or thioxanthenes; acute alcohol, opiate, sedative-hypnotic, or psychotropic drug intoxication; patient with coma or circulatory collapse, impaired hematopoiesis, children, pregnancy, breastfeeding. Zotepine can prolong the QT interval and patients with pre-existing prolongation of the QT interval should not be given the drug. Adverse effect: Sleepiness, weak-ness/malaise, insomnia, headache, oral dryness, constipation, dizziness, weight gain. Dosage: Initial: 25 mg three times daily, MAX 450 mg/day. Doses should also be reduced in patients with hepatic or renal impairment. Supply: Tab 50 mg Quetiapine –“Seroquel” (OSERQ)(OSER2) “Utapine”(OUTAP) ［ C ］ Indication: Schizophrenia, manic episodes associated with bipolar disorder. Contraindication: Hypersensitivity to quetiapine fumarate or any component of the product Adverse effect: Headache, asthenia, abdominal pain, back pain, fever, chest pain, postural hypotension, tachycardia, hypertension, constipation, dry mouth, dyspepsia, diarrhoea, weight gain. Dosage: Schizophrenia: total daily dose—50 mg (Day 1), 100 mg (Day 2), 200 mg (Day 3), 300 mg (Day 4). From Day 4 onwards, dose titrated to dose range of 300-450 mg/day. Dose may be adjusted within the range 150-750 mg/day. Mainic episodes associated bipolar disorder: as monotherapy of as adjunct therapy to mood stabilizers, total daily dose: 100 mg (Day 1), 200 mg (Day 2), 300 mg (Day 3), 400 mg (Day 4). Further dosage adjustments up to 800 mg/day by Day 6 should be in increments of no >200 mg/day. Supply: Tab 100 mg (Seroquel), 200 mg (Seroquel, Utapine) Olanzapine-“Zyprexa”(OZYPR) ［ C ］ Indication: Olanzapine is indicated for the treatment of schizophrenia. Olanzapine is effective in maintaining the clinical improvement during continuation therapy in patients who have shown an initial treatment response. Olanzapine is indicated for the treatment of moderate to severe manic episode. In patients whose manic episode has responded to olanzapine treatment, olanzapine is indicated for the prevention of recurrence in patients with bipolar disorder. Contraindication: Narrow-angle glaucoma. Adverse effect: Somnolence, weight gain, dizziness, akathisia, Parkinsonism, dyskinesia, increased appetite, elevated glucose & triglyceride levels, asthenia, edema, orthostatic hypotension, dry mouth, constipation, eosinophilia, elevated prolactin levels (but clinical 156 - - 157 - - manifestations rare). May affect ability to operate machinery or drive motor vehicles. Dosage: 5-20 mg daily. Supply: Tab 10 mg Ziprasidone-“Geodon”(OGEO6) ［ C ］ Indication: Management of schizophrenia and acute bipolar mania. Contraindication: QT-interval prolongation, acute MI, uncompensated heart failure, cardiac arrhythmias requiring treatment with Class I & II antiarrhythmic drugs. Adverse effect: Asthenia, extrapyramidal syndrome, nausea, somnolence, respiratory disorder. Dosage: 40 mg BID. Max 80 mg BID. Supply: Cap 60 mg Aripiprazole-“Otsuka”(OABIL)( 專 ) ［ C ］ Indication: Schizophrenia; acute manic & mixed episodes associated with bipolar disorder. Adverse effect: Headache, asthenia, accidental injury, peripheral edema, hypertension, GI disturbances, myalgia, agitation, anxiety, insomnia, lightheadedness, somnolence, akathisia, extrapyramidal syndrome, tremor, increased salivation, rhinitis, pharyngitis, coughing, blurred vision. Dosage: 10-30 mg/day. Supply: Tab 10 mg Amisulpride-“Solian”(OSOLI) Indication: Treatment of acute & chronic schizophrenia. Contraindication: Phaeochromocytoma, concomitant prolactin-dependent tumours, children < 15 years, lactation. Adverse effect: Sedation or somnolence at high doses, elderly dyskinesia, extrapyramidal symptom, tardive dyskinesia, change in libido, amenorrhoea, galactorrhoea, gynaecomastia, hyperprolactinaemia, weitht gain. Rarely, postural hypotensin at high doses. Dosage: 400-800 mg/day in divided doses, adjusted according to response. Max 1200 mg/day. Supply: Tab 200 mg 28:16.08.08 Butyrophenones Haloperidol-“Haldol”(IBINI)(OHAL5)“U-Dolan” (IUDOL) ［ C ］ Indication: Antidyskinetic (in Gilles de la Tourette’s disease), antipsychotic. Depot injection is for the maintenance treatment of psychosis. Contraindication: Patient with severe toxic CNS depression or comatose states; Parkinsom’s disease; hypersensitivity to haloperidol Adverse effect: Extrapyramidal reaction, tachycardia, hypotension, leukopenia, maculopapular and acne form skin reactions, anorexia, constipation. Dosage: Adults: PO 0.5-2 mg BID or TID; for severe symptoms 3-5 mg BID or TID, up to a maximum of 100 mg/day; for prompt control of moderate to severe symptoms, IM 2-5 mg Q1-8H. For Depot injection: IM 50-100 mg and 150-200 mg every 4 weeks is sufficient for mild and moderate conditions, higher dose 250-300 mg for severe case is required. Supply: Inj 5 mg/ml/amp, 50 mg/ml/amp; Tab 5 mg 28:16.08.24 Phenothiazines Chlorpromazine HCI-“Wintermin” (OWIN1) ［ C ］ Indication: Treatment of Schizophrenia, acute psychoses and to control the manifestations of acute mania, moderate to severe agitation, hyperactivity or aggressiveness in disturbed children, pre-operative medication, intractable hiccups. Contraindication: Patient with comatose states, bone marrow depression, hypersensitivity to phenothiazines, jaundice, hepatic damage. Adverse effect: CNS depression, somnolence, hypotension, extrapyramidal symptoms, agitation, restlessness, convulsion, fever, dry mouth. 156 - - 157 - - manifestations rare). May affect ability to operate machinery or drive motor vehicles. Dosage: 5-20 mg daily. Supply: Tab 10 mg Ziprasidone-“Geodon”(OGEO6) ［ C ］ Indication: Management of schizophrenia and acute bipolar mania. Contraindication: QT-interval prolongation, acute MI, uncompensated heart failure, cardiac arrhythmias requiring treatment with Class I & II antiarrhythmic drugs. Adverse effect: Asthenia, extrapyramidal syndrome, nausea, somnolence, respiratory disorder. Dosage: 40 mg BID. Max 80 mg BID. Supply: Cap 60 mg Aripiprazole-“Otsuka”(OABIL)( 專 ) ［ C ］ Indication: Schizophrenia; acute manic & mixed episodes associated with bipolar disorder. Adverse effect: Headache, asthenia, accidental injury, peripheral edema, hypertension, GI disturbances, myalgia, agitation, anxiety, insomnia, lightheadedness, somnolence, akathisia, extrapyramidal syndrome, tremor, increased salivation, rhinitis, pharyngitis, coughing, blurred vision. Dosage: 10-30 mg/day. Supply: Tab 10 mg Amisulpride-“Solian”(OSOLI) Indication: Treatment of acute & chronic schizophrenia. Contraindication: Phaeochromocytoma, concomitant prolactin-dependent tumours, children < 15 years, lactation. Adverse effect: Sedation or somnolence at high doses, elderly dyskinesia, extrapyramidal symptom, tardive dyskinesia, change in libido, amenorrhoea, galactorrhoea, gynaecomastia, hyperprolactinaemia, weitht gain. Rarely, postural hypotensin at high doses. Dosage: 400-800 mg/day in divided doses, adjusted according to response. Max 1200 mg/day. Supply: Tab 200 mg 28:16.08.08 Butyrophenones Haloperidol-“Haldol”(IBINI)(OHAL5)“U-Dolan” (IUDOL) ［ C ］ Indication: Antidyskinetic (in Gilles de la Tourette’s disease), antipsychotic. Depot injection is for the maintenance treatment of psychosis. Contraindication: Patient with severe toxic CNS depression or comatose states; Parkinsom’s disease; hypersensitivity to haloperidol Adverse effect: Extrapyramidal reaction, tachycardia, hypotension, leukopenia, maculopapular and acne form skin reactions, anorexia, constipation. Dosage: Adults: PO 0.5-2 mg BID or TID; for severe symptoms 3-5 mg BID or TID, up to a maximum of 100 mg/day; for prompt control of moderate to severe symptoms, IM 2-5 mg Q1-8H. For Depot injection: IM 50-100 mg and 150-200 mg every 4 weeks is sufficient for mild and moderate conditions, higher dose 250-300 mg for severe case is required. Supply: Inj 5 mg/ml/amp, 50 mg/ml/amp; Tab 5 mg 28:16.08.24 Phenothiazines Chlorpromazine HCI-“Wintermin” (OWIN1) ［ C ］ Indication: Treatment of Schizophrenia, acute psychoses and to control the manifestations of acute mania, moderate to severe agitation, hyperactivity or aggressiveness in disturbed children, pre-operative medication, intractable hiccups. Contraindication: Patient with comatose states, bone marrow depression, hypersensitivity to phenothiazines, jaundice, hepatic damage. Adverse effect: CNS depression, somnolence, hypotension, extrapyramidal symptoms, agitation, restlessness, convulsion, fever, dry mouth. 158 - - 159 - - Dosage: Adults: PO 10 mg TID-QID, or 25 mg BID or TID. Children: PO 0.5 mg/kg Q4-6H as needed; maximum dose: 1 g/day Supply: Tab 100 mg 28:16.08.92 Antipsychotics, Miscellaneous Flupenthixol -“Fluanxol” (OFLUA)(IFLUA) ［ C ］ Indication: Anxiety, behavior disorders, schizophrenia. Contraindication: Comatose patients, particularly those under the influence of alcohol, barbiturate, narcotics or other CNS depression, and in patients with bone marrow depression. Adverse effect: Extrapyramidal symptom, restlessness, insomnia, depressive reaction, urinary incontinence, weight gain. Dosage: Adults: PO 0.5-2 mg/day for depression, 16-224 mg/day for acute psychosis; IM 10 mg/month to 100 mg/week. Children: PO 0.4-2 mg/day for 6 months has been used in psychotic/aggressive children Supply: Tab 3 mg; Inj 20 mg/ml/amp Clothiapine – “Etumine”(OETUM) Indication: Acute schizophrenia or exacerbations of chronic schizophrenia; Manic-depressive psychosis, endogeneous and reactive manic phase of manic-depressive illness; sleep disorders. Contraindication: Hypersensitivity to phenothiazines; comatose states; concomitant use of large quantities of central nervous system depressants; epilepsy; pregnancy; breastfeeding Adverse effect: Common adverse effects include fatigue, drowsiness, tremor, constipation, tardive dyskinesia, extrapyramidal effects and neuroleptic malignant syndrome. Pharmacokinetics: Clothiapine is extensively metabolized and a major portion is excreted in the urine. Dosage: Psychosis: 120-200 mg (initial), 20-160 mg QD or TID (maintenance). Neurosis: 20-120 mg QD or TID. Sleep disorders: 20-40 mg before retiring. Supply: Tab 40mg Sulpiride- “Sulmatyl”(OSULM) “Betamac” (OSUL2) Indication: Sulpiride is a selective dopamine D2 antagonist with antipsychotic and antidepressant activity. It is used for tranquillization, antipsychotic, mood elevating, antiemetic, anti-gastrin secretion. Contraindication: Hypersensitivity, phaeochromocytoma, hypertension Adverse effect: Predominant adverse effects have been extra-pyramidal reactions and sedation. Tardive dyskinesia has been reported; similar to other neuroleptics, sulpiride has been associated with neuroleptic malignant syndrome and cholestatic jaundice. Other adverse effects are sleep disturbances, over-stimulation, and agitation. Dosage: Schizophrenia: PO, initial: 200-400 mg BID, ranging from 200-3200 mg daily. Children: 3-5mg/kg Gastric and duodenal ulcers: 150-300mg daily Supply: Tab 50mg (Sulmatyl), 200mg (Betamac) 28:20 Anorexigenic Agents and Respiratory and Cerebral Stimulants 28:20.92 Anorexigenic Agents and Respiratory and Cerebral Stimulants, Miscellaneous Methylphenidate HCI-“Concerta”(OCON18) (OCON3) ［ C ］ Indication: Treatment of attention deficit hyperactivity disorder. Contraindication: Patients with marked anxiety, tension & agitation, glaucoma, Tourette’s syndrome, & patients on MAOI therapy. Adverse effect: Headache, stomach ache, loss of appetite, insomnia, aggravation reaction, asthenia, hypertension, nausea &/or vomiting, dyspepsia, weight 158 - - 159 - - Dosage: Adults: PO 10 mg TID-QID, or 25 mg BID or TID. Children: PO 0.5 mg/kg Q4-6H as needed; maximum dose: 1 g/day Supply: Tab 100 mg 28:16.08.92 Antipsychotics, Miscellaneous Flupenthixol -“Fluanxol” (OFLUA)(IFLUA) ［ C ］ Indication: Anxiety, behavior disorders, schizophrenia. Contraindication: Comatose patients, particularly those under the influence of alcohol, barbiturate, narcotics or other CNS depression, and in patients with bone marrow depression. Adverse effect: Extrapyramidal symptom, restlessness, insomnia, depressive reaction, urinary incontinence, weight gain. Dosage: Adults: PO 0.5-2 mg/day for depression, 16-224 mg/day for acute psychosis; IM 10 mg/month to 100 mg/week. Children: PO 0.4-2 mg/day for 6 months has been used in psychotic/aggressive children Supply: Tab 3 mg; Inj 20 mg/ml/amp Clothiapine – “Etumine”(OETUM) Indication: Acute schizophrenia or exacerbations of chronic schizophrenia; Manic-depressive psychosis, endogeneous and reactive manic phase of manic-depressive illness; sleep disorders. Contraindication: Hypersensitivity to phenothiazines; comatose states; concomitant use of large quantities of central nervous system depressants; epilepsy; pregnancy; breastfeeding Adverse effect: Common adverse effects include fatigue, drowsiness, tremor, constipation, tardive dyskinesia, extrapyramidal effects and neuroleptic malignant syndrome. Pharmacokinetics: Clothiapine is extensively metabolized and a major portion is excreted in the urine. Dosage: Psychosis: 120-200 mg (initial), 20-160 mg QD or TID (maintenance). Neurosis: 20-120 mg QD or TID. Sleep disorders: 20-40 mg before retiring. Supply: Tab 40mg Sulpiride- “Sulmatyl”(OSULM) “Betamac” (OSUL2) Indication: Sulpiride is a selective dopamine D2 antagonist with antipsychotic and antidepressant activity. It is used for tranquillization, antipsychotic, mood elevating, antiemetic, anti-gastrin secretion. Contraindication: Hypersensitivity, phaeochromocytoma, hypertension Adverse effect: Predominant adverse effects have been extra-pyramidal reactions and sedation. Tardive dyskinesia has been reported; similar to other neuroleptics, sulpiride has been associated with neuroleptic malignant syndrome and cholestatic jaundice. Other adverse effects are sleep disturbances, over-stimulation, and agitation. Dosage: Schizophrenia: PO, initial: 200-400 mg BID, ranging from 200-3200 mg daily. Children: 3-5mg/kg Gastric and duodenal ulcers: 150-300mg daily Supply: Tab 50mg (Sulmatyl), 200mg (Betamac) 28:20 Anorexigenic Agents and Respiratory and Cerebral Stimulants 28:20.92 Anorexigenic Agents and Respiratory and Cerebral Stimulants, Miscellaneous Methylphenidate HCI-“Concerta”(OCON18) (OCON3) ［ C ］ Indication: Treatment of attention deficit hyperactivity disorder. Contraindication: Patients with marked anxiety, tension & agitation, glaucoma, Tourette’s syndrome, & patients on MAOI therapy. Adverse effect: Headache, stomach ache, loss of appetite, insomnia, aggravation reaction, asthenia, hypertension, nausea &/or vomiting, dyspepsia, weight 160 - - 161 - - loss, twitchingdizziness, emotional lability, somnolence, anxiety, depression, nervousness, hostility, rash. Dosage: 1 tab once daily in the morning. Supply: Tab18 mg, 36 mg. Sibutramine – “Reductil”(OREDU)( 專 ) ［ C ］ Indication: Supportive treatment within a weight management program of patients with alimentary obesity & a body mass index (BMI) >30 kg/m2, patients with alimentary excess weitht & a BMI >27 kg/m2 or above who have obesity-related risk factors like type 2 diabetes or dyslipidaemia. Contraindication: Obesity caused by organic dysfunction, eating disorders such as anorexia nervosa or bulimia nervosa, mental illness, Gilles de la Tourette’s syndrome, coronary artery disease, CHF, tachycardia, occlusive artery disease, heart rhythm disorder, cerebrovascular disease, inadequately controlled high BP, hyperthyroidism, severely impaired liver or kidney function, benign prostatic hyperplasia, phaeochromocytoma, narrow angle glaucoma, pregnancy, lactation, children <18, elderly >65. Cocomitant use of MAOIs or other CNS active drugs for the treatment of mental disorders (such as antidepressants or antipsychotics), for sleep disorders or for weight reduction. Misuse of drugs, medicines or alcohol. Adverse effect: Loss of appetite, constipation; dru mouth, insomnia; tachycardia, palpitations, hypertension; dizziness, paresthesia, headache, anxiety; sweating; taste disturbances. Dosage: 1 cap daily in the morning. Supply: Cap 10 mg 28:24 Anxiolytics, Sedatives, and Hypnotics 28:24.08 Benzodiazepines Alprazolam-“Xanax” (OXANA)“Gendergin” (OGEND1) ［ D ］ Indication: Used for the management of anxiety disorder or for the short-term relief of symptoms of anxiety. Long- term use (more than 4 months) has not been evaluated. Contraindication: Hypersensitivity, narrow angle glaucoma. Adverse effect: Headache, insomnia, dizziness, sleepiness, nervousness, tremor, syncope, confusion, depression, nausea, vomiting, diarrhea, constipation, seizure, delirium and withdrawal symptoms have occured in some patients following rapid dosage reduction or abrupt discontinuance of alprazolam. Dosage: PO 0.5-4 mg daily BID or TID Supply: Tab 0.5 mg (Xanax), 1 mg (Gendergin) Bromazepam-“Lexotan” (OLEX1) ［ C ］ Indication: Symptomatic treatment of anxiety Contraindication: Hypersensitivity, myasthenia gravis, narrow-angle glaucoma Adverse effect: Adverse effects are sedation, drowsiness, hypotension, nausea and vomiting. Dosage: 1.5-3 mg TID for outpatient therapy; 6-12 mg BID to TID for severe cases. Supply: Tab 1.5 mg Clobazam-“Frisium” (OFRIS) Indication: Anxiety, psychosis. Place in therapy: Clobazam is as effective as diazepam in the treatment of anxiety neurosis; the drug has also been effective in uncontrolled or refractory epilepsy, catamenial epilepsy, and alcohol withdrawal syndrome; tolerance to the antiepileptic effect appears to be a problem. Contraindication: Myasthenia gravis, hypersensitive to the 1.4-benzodiazepine. Adverse effect: Sedation, drowsiness and hangover effects; psychomotor performance impairment; Orthostatic hypotension and syncope, toxic confusional state, headache, mood changes and speech 160 - - 161 - - loss, twitchingdizziness, emotional lability, somnolence, anxiety, depression, nervousness, hostility, rash. Dosage: 1 tab once daily in the morning. Supply: Tab18 mg, 36 mg. Sibutramine – “Reductil”(OREDU)( 專 ) ［ C ］ Indication: Supportive treatment within a weight management program of patients with alimentary obesity & a body mass index (BMI) >30 kg/m2, patients with alimentary excess weitht & a BMI >27 kg/m2 or above who have obesity-related risk factors like type 2 diabetes or dyslipidaemia. Contraindication: Obesity caused by organic dysfunction, eating disorders such as anorexia nervosa or bulimia nervosa, mental illness, Gilles de la Tourette’s syndrome, coronary artery disease, CHF, tachycardia, occlusive artery disease, heart rhythm disorder, cerebrovascular disease, inadequately controlled high BP, hyperthyroidism, severely impaired liver or kidney function, benign prostatic hyperplasia, phaeochromocytoma, narrow angle glaucoma, pregnancy, lactation, children <18, elderly >65. Cocomitant use of MAOIs or other CNS active drugs for the treatment of mental disorders (such as antidepressants or antipsychotics), for sleep disorders or for weight reduction. Misuse of drugs, medicines or alcohol. Adverse effect: Loss of appetite, constipation; dru mouth, insomnia; tachycardia, palpitations, hypertension; dizziness, paresthesia, headache, anxiety; sweating; taste disturbances. Dosage: 1 cap daily in the morning. Supply: Cap 10 mg 28:24 Anxiolytics, Sedatives, and Hypnotics 28:24.08 Benzodiazepines Alprazolam-“Xanax” (OXANA)“Gendergin” (OGEND1) ［ D ］ Indication: Used for the management of anxiety disorder or for the short-term relief of symptoms of anxiety. Long- term use (more than 4 months) has not been evaluated. Contraindication: Hypersensitivity, narrow angle glaucoma. Adverse effect: Headache, insomnia, dizziness, sleepiness, nervousness, tremor, syncope, confusion, depression, nausea, vomiting, diarrhea, constipation, seizure, delirium and withdrawal symptoms have occured in some patients following rapid dosage reduction or abrupt discontinuance of alprazolam. Dosage: PO 0.5-4 mg daily BID or TID Supply: Tab 0.5 mg (Xanax), 1 mg (Gendergin) Bromazepam-“Lexotan” (OLEX1) ［ C ］ Indication: Symptomatic treatment of anxiety Contraindication: Hypersensitivity, myasthenia gravis, narrow-angle glaucoma Adverse effect: Adverse effects are sedation, drowsiness, hypotension, nausea and vomiting. Dosage: 1.5-3 mg TID for outpatient therapy; 6-12 mg BID to TID for severe cases. Supply: Tab 1.5 mg Clobazam-“Frisium” (OFRIS) Indication: Anxiety, psychosis. Place in therapy: Clobazam is as effective as diazepam in the treatment of anxiety neurosis; the drug has also been effective in uncontrolled or refractory epilepsy, catamenial epilepsy, and alcohol withdrawal syndrome; tolerance to the antiepileptic effect appears to be a problem. Contraindication: Myasthenia gravis, hypersensitive to the 1.4-benzodiazepine. Adverse effect: Sedation, drowsiness and hangover effects; psychomotor performance impairment; Orthostatic hypotension and syncope, toxic confusional state, headache, mood changes and speech 162 - - 163 - - disturbances; dry mouth, nausea, vomiting, weight gain and galactorrhea; withdrawal reactions have been reported. Dosage: 20-30 mg daily, maintenance dose: 10 mg BID. Supply: Tab 10 mg Diazepam-“Valium” (IVALI) ［ D ］ Indication: Tension, anxiety, moderate to severe psycho-neurotic state, acute alcohol withdrawal syndrome, tetanus, convulsive disorders, preoperative medication. Contraindication: Hypersensitive to diazepam, acute narrow angle glaucoma, psychosis, shock, coma, alcohol intoxication. Adverse effect: Drowsiness, depression, confusion, fatigue, ataxia, hypoactivity, bradycardia, cardiovascular collapse. Dosage: Adults: 2-10 mg IM or IV, may repeat in 3-4 hrs if need. Children: 0.04-0.3 mg/kg/dose IM or IV Q2-4H to a MAX of 0.6 mg/kg within an 8-hr period if needed. Not for use in children under 6 months of age. Administration: Do not mix IV product with other medications. To administer directly IV, inject slowly through infusion tubing as close as possible to the vein insertion. Because of the possibility of precipitation of diazepam in IV fluids and the instability of the drug in plastic (PVC) bags and infusion tubing, IV infusion of diazepam is not recommended. Supply: Inj 5 mg/ml, 2 ml/amp Estazolam-“Eurodin”(OEURO)“Eszo” (OESZO) ［ X ］ Indication: Estazolam is used in the short-term treatment of insomnia. Contraindication: Contraindicated for use during pregnancy. Adverse effect: Leukopenia, agranulocytosis, palpitation, arrhythmias, syncope, dizziness, headache, impaired coordination, constipation, vomiting, arthritis, myalgia, muscle spasm, anorexia Dosage: Insomnia: a signle dose of 1-4 mg at bedtime. Premedication: Preoperative night: a single dose of 1-2 mg at bedtime. Preoperation: a single dose of 2-4 mg. Smaller or older, debilitated patients: 0.5 mg initially. Maximum dose: a single dose of 6 mg and daily dose of 8 mg. Supply: Tab 2 mg Fludiazepam-“Erispan”(OERIS) Indication: Fludiazepam is a short acting benzodiazepine with general properties similar to those of diazepam. It is used to treat anxiety disorder. Contraindication: Patients with narrow angle glaucoma, myasthenia gravis. Adverse effect: The adverse effects similar to those of benzodiazepines: drowsiness, dizziness, and tiredness. Other side effects include: GI symptoms, difficult in urine voiding. Dosage: 1 Tab PO TID Supply: Tab 0.25 mg Flunitrazepam-“Rohypnol” (OROH1) ［ D ］ Indication: Flunitrazepam has been effective for induction of general anesthesia, as an oral premedicant, and in the treatment of insomnia; it may be useful for anesthesia induction in patients with cardiac disease. Place in therapy: Flunitrazepam should probably be reserved as alternative for patients with moderate-to-severe insomnia who do not respond to other benzodiazepines. In these patients, higher doses may be needed and residual effects tolerated. Contraindication: Hypersensitivity to flunitrazepam or nitrazepam; use with caution in patient with myasthenia gravis, pregnancy or the breast feeding period, severe cardiovascular disease, elderly, hepatic or renal insufficiency, Adverse effect: Residual sedation/psychomotor impairment; headache, dizziness, and gastrointestinal 162 - - 163 - - disturbances; dry mouth, nausea, vomiting, weight gain and galactorrhea; withdrawal reactions have been reported. Dosage: 20-30 mg daily, maintenance dose: 10 mg BID. Supply: Tab 10 mg Diazepam-“Valium” (IVALI) ［ D ］ Indication: Tension, anxiety, moderate to severe psycho-neurotic state, acute alcohol withdrawal syndrome, tetanus, convulsive disorders, preoperative medication. Contraindication: Hypersensitive to diazepam, acute narrow angle glaucoma, psychosis, shock, coma, alcohol intoxication. Adverse effect: Drowsiness, depression, confusion, fatigue, ataxia, hypoactivity, bradycardia, cardiovascular collapse. Dosage: Adults: 2-10 mg IM or IV, may repeat in 3-4 hrs if need. Children: 0.04-0.3 mg/kg/dose IM or IV Q2-4H to a MAX of 0.6 mg/kg within an 8-hr period if needed. Not for use in children under 6 months of age. Administration: Do not mix IV product with other medications. To administer directly IV, inject slowly through infusion tubing as close as possible to the vein insertion. Because of the possibility of precipitation of diazepam in IV fluids and the instability of the drug in plastic (PVC) bags and infusion tubing, IV infusion of diazepam is not recommended. Supply: Inj 5 mg/ml, 2 ml/amp Estazolam-“Eurodin”(OEURO)“Eszo” (OESZO) ［ X ］ Indication: Estazolam is used in the short-term treatment of insomnia. Contraindication: Contraindicated for use during pregnancy. Adverse effect: Leukopenia, agranulocytosis, palpitation, arrhythmias, syncope, dizziness, headache, impaired coordination, constipation, vomiting, arthritis, myalgia, muscle spasm, anorexia Dosage: Insomnia: a signle dose of 1-4 mg at bedtime. Premedication: Preoperative night: a single dose of 1-2 mg at bedtime. Preoperation: a single dose of 2-4 mg. Smaller or older, debilitated patients: 0.5 mg initially. Maximum dose: a single dose of 6 mg and daily dose of 8 mg. Supply: Tab 2 mg Fludiazepam-“Erispan”(OERIS) Indication: Fludiazepam is a short acting benzodiazepine with general properties similar to those of diazepam. It is used to treat anxiety disorder. Contraindication: Patients with narrow angle glaucoma, myasthenia gravis. Adverse effect: The adverse effects similar to those of benzodiazepines: drowsiness, dizziness, and tiredness. Other side effects include: GI symptoms, difficult in urine voiding. Dosage: 1 Tab PO TID Supply: Tab 0.25 mg Flunitrazepam-“Rohypnol” (OROH1) ［ D ］ Indication: Flunitrazepam has been effective for induction of general anesthesia, as an oral premedicant, and in the treatment of insomnia; it may be useful for anesthesia induction in patients with cardiac disease. Place in therapy: Flunitrazepam should probably be reserved as alternative for patients with moderate-to-severe insomnia who do not respond to other benzodiazepines. In these patients, higher doses may be needed and residual effects tolerated. Contraindication: Hypersensitivity to flunitrazepam or nitrazepam; use with caution in patient with myasthenia gravis, pregnancy or the breast feeding period, severe cardiovascular disease, elderly, hepatic or renal insufficiency, Adverse effect: Residual sedation/psychomotor impairment; headache, dizziness, and gastrointestinal 164 - - 165 - - disturbances, psychological and physical dependence may occur with prolonged use of flunitrazepam Dosage: Adults: For anesthesia induction, 0.02-0.03 mg/k IV over 30-60 sec; pre-medication 1-2 mg PO; insomnia 0.5 mg. Children: Anesthesia induction: IV 0.03-0.04mg/kg, over 20-30 sec Supply: Tab 1 mg Lorazepam-“Anxiedin (Ativan)”(OATIV1) “Neuropam”(INEUR) ［ D ］ Indication: Anxiety, tension, agitation, irritability, insomnia with anxiety, neurosis or transient situational disturbances. Contraindication: Hypersensitive to the benzodiazepines, acute narrow angle glaucoma, psychotic reactions, primary depression disorders. Adverse effect: Sedation, dizziness, weakness, unsteadiness, confusion, headache, sleep disturbance, slight hypotension. Dosage: Anxiety and sedation: Adults: usual dose: 2-6 mg/day in divided dose, up to 10 mg/day. Children: oral, IV: 0.05 mg/kg/dose (range: 0.02-0.09 mg/kg) Q4-8 hr. Insomnia: 2-4 mg HS. Stability: Intact injection solution should be refrigerated, protect from light. Stability of parenteral admixture at 25 ℃ : 4 hrs. Supply: Tab 1 mg; Inj 2 mg/ml/amp Midazolam-“Dormicum”(IDORM5)(IDORMI) ( 麻科用 )(ODORM) ［ D ］ Indication: Midazolam is effective for anesthesia induction, as a preanesthetic medication, a hypnotic prior to short surgical procedures and in the treatment of insomnia. Place in therapy: Midazolam produces a more rapid onset and less venous irritation of anesthesia induction than diazepam. It also can be considered as an alternative to thiopental although it has a slower onset of action. Midazolam appears to offer no advantage over triazolam as hypnotics for insomnia. Contraindication: Hypersensitivity to midazolam or other benzodiazepines; Patients with narrow angle glancoma. Adverse effect: Respiratory depression, apnea, injection site pain and phlebitis （ less than diazepam ） . Dosage: PO 7.5-15 mg at night. For anesthesia: 0.15 to 0.3 mg/kg IV; doses of 0.1 mg/kg IM have been effective for anesthetic premedication. For conscious sedation: 0.05-0.1 mg/kg IV, maintenance of sedation in increament of 25% of initial dose may be given by slow titration; 1 mg/ml is recommended for titration, no more than 2.5 mg should be given over at least 2 minutes. Maximal dose: some cases showed 0.3-0.85 mg/kg (20-55 mg/hr) without respiratory depression or hypnotic. Stability: Midazolam 2 mg/ml in NS was stable in polypropylene infusion pump syringe at 30 ℃ for 10 days. Supply: Inj 5 mg/ml/amp; Tab 7.5 mg Oxazolam-“Serenal”(OSER) Indication: Anxiety, tension, agitation, irritability, preanesthetic medication. Contraindication: Glaucoma, myasthenia gravis, renal or hepatic impairment. Adverse effect: Drowsiness, dizziness, vertigo, headache, mild paradoxical reaction, skin rash. Dosage: 10-20 mg TID. Supply: Tab 10 mg Triazolam-“Halcion” (OHALC) ［ X ］ Indication: Transient & short-term insomnia, short-term adjunctive treatment in long-term insomnia. Contraindication: Concomitant use with itraconazole or ketoconazole; hypersensitivity to triazolam or other benzodiazepines; pregnancy. Adverse effect: Drowsiness, dizziness, lightheasedness, impaired coordination. Occasionally, anterograde 164 - - 165 - - disturbances, psychological and physical dependence may occur with prolonged use of flunitrazepam Dosage: Adults: For anesthesia induction, 0.02-0.03 mg/k IV over 30-60 sec; pre-medication 1-2 mg PO; insomnia 0.5 mg. Children: Anesthesia induction: IV 0.03-0.04mg/kg, over 20-30 sec Supply: Tab 1 mg Lorazepam-“Anxiedin (Ativan)”(OATIV1) “Neuropam”(INEUR) ［ D ］ Indication: Anxiety, tension, agitation, irritability, insomnia with anxiety, neurosis or transient situational disturbances. Contraindication: Hypersensitive to the benzodiazepines, acute narrow angle glaucoma, psychotic reactions, primary depression disorders. Adverse effect: Sedation, dizziness, weakness, unsteadiness, confusion, headache, sleep disturbance, slight hypotension. Dosage: Anxiety and sedation: Adults: usual dose: 2-6 mg/day in divided dose, up to 10 mg/day. Children: oral, IV: 0.05 mg/kg/dose (range: 0.02-0.09 mg/kg) Q4-8 hr. Insomnia: 2-4 mg HS. Stability: Intact injection solution should be refrigerated, protect from light. Stability of parenteral admixture at 25 ℃ : 4 hrs. Supply: Tab 1 mg; Inj 2 mg/ml/amp Midazolam-“Dormicum”(IDORM5)(IDORMI) ( 麻科用 )(ODORM) ［ D ］ Indication: Midazolam is effective for anesthesia induction, as a preanesthetic medication, a hypnotic prior to short surgical procedures and in the treatment of insomnia. Place in therapy: Midazolam produces a more rapid onset and less venous irritation of anesthesia induction than diazepam. It also can be considered as an alternative to thiopental although it has a slower onset of action. Midazolam appears to offer no advantage over triazolam as hypnotics for insomnia. Contraindication: Hypersensitivity to midazolam or other benzodiazepines; Patients with narrow angle glancoma. Adverse effect: Respiratory depression, apnea, injection site pain and phlebitis （ less than diazepam ） . Dosage: PO 7.5-15 mg at night. For anesthesia: 0.15 to 0.3 mg/kg IV; doses of 0.1 mg/kg IM have been effective for anesthetic premedication. For conscious sedation: 0.05-0.1 mg/kg IV, maintenance of sedation in increament of 25% of initial dose may be given by slow titration; 1 mg/ml is recommended for titration, no more than 2.5 mg should be given over at least 2 minutes. Maximal dose: some cases showed 0.3-0.85 mg/kg (20-55 mg/hr) without respiratory depression or hypnotic. Stability: Midazolam 2 mg/ml in NS was stable in polypropylene infusion pump syringe at 30 ℃ for 10 days. Supply: Inj 5 mg/ml/amp; Tab 7.5 mg Oxazolam-“Serenal”(OSER) Indication: Anxiety, tension, agitation, irritability, preanesthetic medication. Contraindication: Glaucoma, myasthenia gravis, renal or hepatic impairment. Adverse effect: Drowsiness, dizziness, vertigo, headache, mild paradoxical reaction, skin rash. Dosage: 10-20 mg TID. Supply: Tab 10 mg Triazolam-“Halcion” (OHALC) ［ X ］ Indication: Transient & short-term insomnia, short-term adjunctive treatment in long-term insomnia. Contraindication: Concomitant use with itraconazole or ketoconazole; hypersensitivity to triazolam or other benzodiazepines; pregnancy. Adverse effect: Drowsiness, dizziness, lightheasedness, impaired coordination. Occasionally, anterograde 166 - - 167 - - amnesia, confusion, and agitation. Dosage: Adult 0.25 mg before retiring; elderly &/or debilitated patient 0.125-0.25 mg (therapy initiated at 0.125 mg) before retiring. Supply: Tab 0.25 mg Oxazepam-“Alepam”(OALEP) ［ D ］ Indication: Anxiety, tension, irritability, agitation, psychoneurosis. Contraindication: Psychoses; myasthenia gravis, acute narrow angle glaucoma, shock, coma or alcohol intoxication. Adverse effect: Transient mild drowsiness. Idiosyncratic, allergic or hypersensitivity reactions; rarely leucopenia & hepatic dysfunction. Dosage: Adult: 15-30 mg 3-4 times daily. Geriatric patients: 7.5-15 mg 2-3 times daily. Children >6 years: 0.5 mg/kg daily. Supply: Tab 15 mg Brotizolam-“Lendormin”(OLEND) Indication: Insomnia Contraindication: Myasthenia gravis. Adverse effect: fatigue & reduced ability to concentrate after waking in patients sensitive to diazepines & following high doses. GI disorders; headache, dizziness; dryness of mouth; drop in BP in hypertensive patients. Tolerance & loss of memory. Dosage: 1 tab at bedtime. Elderly & those with decreased clearance 1/2 tab at bedtime. In isolated cases, dose may be increased to 2 tab. Supply: Tab 250 mcg 28:24.92 Anxiolytics, Sedatives, and Hypnotics; Miscellaneous Chloral hydrate (BCHLO)( 專 ) ［ C ］ Indication: As sedative and hypnotic agent Contraindication: patients with mark hepatic or renal impairment and in patients who have hypersensitivity or idiosyncratic reaction to the drug. Oral administered should be avoided in patients with esophagitis, gastritis or peptic ulcer disease. Adverse effect: Arrhythmias, alterations in sleep patterns, respiratory arrest, and cutaneous reaction. Dosage: Adults: For sedative: oral or rectal 250mg TID, maximum 2 g/day. For hypnotic: PO 500-1000 mg at bedtime. Pediatric: oral or rectal 25-50 mg/kg/day, maximum 1g/day Supply: Solution 10% 100 ml Zolpidem – “Stilnox”(OSTIL) “Semi-Nax” (OSEMI) “Zolman”( 專 )(OZOLM) ( 專 ) ［ B ］ Indication: Zolpidem is an imidazopyridine sedative-hypnotic that is structurally unrelated to the barbiturates and benzodiazepines. Zolpidem has been f ound to be effective for the short-term treatment of insomnia. Other applications have been investigated (e.g., preoperative sedation), but further study is needed. Place in therapy: A significant therapeutic advantage over the benzodiazepines due to its low incidence of adverse effects such as daytime sedation, amnesia, tolerance, dependence, and rebound insomnia upon withdrawal after therapeutic doses. Patients whose insomnia does not resolve after 7 to 10 days should be evaluated for other causes of sleep disturbance. Zolpidem has no anxiolytic properties, thus overuse is possible when used in anxious patients for sleep induction. Contraindication: Use with caution in elderly or debilitated patients, patient with respiratory impairment, patient with hepatic impairment. Adverse effect: Adverse effects have been infrequent; anxiety, dizziness, drowsiness, fatigue, headache, irritability, diplopia, and muscle tremors have been reported. Dosage: Adults: 10-20 mg PO QN immediate before 166 - - 167 - - amnesia, confusion, and agitation. Dosage: Adult 0.25 mg before retiring; elderly &/or debilitated patient 0.125-0.25 mg (therapy initiated at 0.125 mg) before retiring. Supply: Tab 0.25 mg Oxazepam-“Alepam”(OALEP) ［ D ］ Indication: Anxiety, tension, irritability, agitation, psychoneurosis. Contraindication: Psychoses; myasthenia gravis, acute narrow angle glaucoma, shock, coma or alcohol intoxication. Adverse effect: Transient mild drowsiness. Idiosyncratic, allergic or hypersensitivity reactions; rarely leucopenia & hepatic dysfunction. Dosage: Adult: 15-30 mg 3-4 times daily. Geriatric patients: 7.5-15 mg 2-3 times daily. Children >6 years: 0.5 mg/kg daily. Supply: Tab 15 mg Brotizolam-“Lendormin”(OLEND) Indication: Insomnia Contraindication: Myasthenia gravis. Adverse effect: fatigue & reduced ability to concentrate after waking in patients sensitive to diazepines & following high doses. GI disorders; headache, dizziness; dryness of mouth; drop in BP in hypertensive patients. Tolerance & loss of memory. Dosage: 1 tab at bedtime. Elderly & those with decreased clearance 1/2 tab at bedtime. In isolated cases, dose may be increased to 2 tab. Supply: Tab 250 mcg 28:24.92 Anxiolytics, Sedatives, and Hypnotics; Miscellaneous Chloral hydrate (BCHLO)( 專 ) ［ C ］ Indication: As sedative and hypnotic agent Contraindication: patients with mark hepatic or renal impairment and in patients who have hypersensitivity or idiosyncratic reaction to the drug. Oral administered should be avoided in patients with esophagitis, gastritis or peptic ulcer disease. Adverse effect: Arrhythmias, alterations in sleep patterns, respiratory arrest, and cutaneous reaction. Dosage: Adults: For sedative: oral or rectal 250mg TID, maximum 2 g/day. For hypnotic: PO 500-1000 mg at bedtime. Pediatric: oral or rectal 25-50 mg/kg/day, maximum 1g/day Supply: Solution 10% 100 ml Zolpidem – “Stilnox”(OSTIL) “Semi-Nax” (OSEMI) “Zolman”( 專 )(OZOLM) ( 專 ) ［ B ］ Indication: Zolpidem is an imidazopyridine sedative-hypnotic that is structurally unrelated to the barbiturates and benzodiazepines. Zolpidem has been f ound to be effective for the short-term treatment of insomnia. Other applications have been investigated (e.g., preoperative sedation), but further study is needed. Place in therapy: A significant therapeutic advantage over the benzodiazepines due to its low incidence of adverse effects such as daytime sedation, amnesia, tolerance, dependence, and rebound insomnia upon withdrawal after therapeutic doses. Patients whose insomnia does not resolve after 7 to 10 days should be evaluated for other causes of sleep disturbance. Zolpidem has no anxiolytic properties, thus overuse is possible when used in anxious patients for sleep induction. Contraindication: Use with caution in elderly or debilitated patients, patient with respiratory impairment, patient with hepatic impairment. Adverse effect: Adverse effects have been infrequent; anxiety, dizziness, drowsiness, fatigue, headache, irritability, diplopia, and muscle tremors have been reported. Dosage: Adults: 10-20 mg PO QN immediate before 168 - - 169 - - sleep; elderly patients and patients with hepatic impairment should be given an initial dose of 5 mg. Pharmacokinetics: Zolpidem is rapidly absorbed, extensively protein-bound, and rapidly eliminated with a plasma half-life of 2.5 to 5 hours. Supply: Tab 10 mg Zopiclone-“Imovane”(OIMOV) “Genclone” (OGENC) “Insopin” (OINSO) Indication: Zopiclone is a short-acting non-benzodiazepine hypnotic agent. It is effective in the treatment of insomnia. Place in therapy: In comparison with rapid eliminated benzodiazepines, it offers little or no advantage with regard to residual effects. Rebound insomnia has been reported. Contraindication: Hypersensitivity to Zopiclone; caution in patient with severe liver disease and elderly with moderate-to-severe liver disease. The drug should not be prescribed for longer than 28 days. Adverse effect: dryness of the mouth and bitter taste, residual sedation/psychomotor impairment, and rebound insomnia. Physical dependence, psychiatric reaction, and hallucinations have been reported. Dosage: 7.5 mg PO HS, prolong use should be avoided Pharmacokinetics: Peak serum level occurs 1 hour after oral administration. Elimination half-life is 5 hours. Supply: Tab 7.5 mg 28:28 Antimanic Agents Lithium carbonate-“Lidin”(OLIDI) ［ D ］ Indication: Manic episodes, bipolar disorder Contraindication: Patient with renal impairment or cardiac disease. Adverse effect: Diarrhea, vomiting, drowsiness, arrhythmia, muscular weakness, hypotension, blurred vision, dry mouth. Dosage: Adults: For acute episode, 600mg TID; for maintenance 300mg TID or QID; maximum dose: 2.4 g/day Supply: Tab 300mg 28:36 Antiparkinsonian Agents 28:36.04 Adamantanes Amantadine – “Amanda”(OAMAND) ［ C ］ Indication: Amantadine is an antiviral agent. In addition, amantadine may be useful in the treatment of Parkinsonism, in the management of multiple sclerosis symptoms, and in combination with interferon for chronic hepatitis C. Place in therapy: Amantadine alone or with levodopa is useful in alleviating parkinsonian symptoms; however, when used alone it does not appear to be as effective as levodopa or trihexyphenidyl. Contraindication: Hypersensitivity to amantadine; In Parkinson’s disease patients, abrupt discontinuation may result in Parkinsonian crisis. Adverse effect: Adverse effects include anticholinergic effects, confusion, disorientation, depression, nervousness, insomnia, and dermatologic reactions. Dosage: Adults: Extrapyramidal Reactions: 200-300 mg/day in divided doses for controlling drug-induced extrapyramidal reactions. Influenza A: 200 mg PO QD. Children: 1 to 9 years: 4.4 to 8.8 mg/kg/day to a maximum of 150 mg/day QD or BID. 10 years and older: 100 mg BID; however, for children weighing less than 40 kg, prescribing 5 milligrams/kilogram/day, regardless of age, is advisable Supply: Tab 100 mg 28:36.08 Anticholinergic Agents Biperiden HCI-“Bipiden (Akineton)”(OAKIN) (IAKIN) “Biperin”(OBIPE) ［ C ］ 168 - - 169 - - sleep; elderly patients and patients with hepatic impairment should be given an initial dose of 5 mg. Pharmacokinetics: Zolpidem is rapidly absorbed, extensively protein-bound, and rapidly eliminated with a plasma half-life of 2.5 to 5 hours. Supply: Tab 10 mg Zopiclone-“Imovane”(OIMOV) “Genclone” (OGENC) “Insopin” (OINSO) Indication: Zopiclone is a short-acting non-benzodiazepine hypnotic agent. It is effective in the treatment of insomnia. Place in therapy: In comparison with rapid eliminated benzodiazepines, it offers little or no advantage with regard to residual effects. Rebound insomnia has been reported. Contraindication: Hypersensitivity to Zopiclone; caution in patient with severe liver disease and elderly with moderate-to-severe liver disease. The drug should not be prescribed for longer than 28 days. Adverse effect: dryness of the mouth and bitter taste, residual sedation/psychomotor impairment, and rebound insomnia. Physical dependence, psychiatric reaction, and hallucinations have been reported. Dosage: 7.5 mg PO HS, prolong use should be avoided Pharmacokinetics: Peak serum level occurs 1 hour after oral administration. Elimination half-life is 5 hours. Supply: Tab 7.5 mg 28:28 Antimanic Agents Lithium carbonate-“Lidin”(OLIDI) ［ D ］ Indication: Manic episodes, bipolar disorder Contraindication: Patient with renal impairment or cardiac disease. Adverse effect: Diarrhea, vomiting, drowsiness, arrhythmia, muscular weakness, hypotension, blurred vision, dry mouth. Dosage: Adults: For acute episode, 600mg TID; for maintenance 300mg TID or QID; maximum dose: 2.4 g/day Supply: Tab 300mg 28:36 Antiparkinsonian Agents 28:36.04 Adamantanes Amantadine – “Amanda”(OAMAND) ［ C ］ Indication: Amantadine is an antiviral agent. In addition, amantadine may be useful in the treatment of Parkinsonism, in the management of multiple sclerosis symptoms, and in combination with interferon for chronic hepatitis C. Place in therapy: Amantadine alone or with levodopa is useful in alleviating parkinsonian symptoms; however, when used alone it does not appear to be as effective as levodopa or trihexyphenidyl. Contraindication: Hypersensitivity to amantadine; In Parkinson’s disease patients, abrupt discontinuation may result in Parkinsonian crisis. Adverse effect: Adverse effects include anticholinergic effects, confusion, disorientation, depression, nervousness, insomnia, and dermatologic reactions. Dosage: Adults: Extrapyramidal Reactions: 200-300 mg/day in divided doses for controlling drug-induced extrapyramidal reactions. Influenza A: 200 mg PO QD. Children: 1 to 9 years: 4.4 to 8.8 mg/kg/day to a maximum of 150 mg/day QD or BID. 10 years and older: 100 mg BID; however, for children weighing less than 40 kg, prescribing 5 milligrams/kilogram/day, regardless of age, is advisable Supply: Tab 100 mg 28:36.08 Anticholinergic Agents Biperiden HCI-“Bipiden (Akineton)”(OAKIN) (IAKIN) “Biperin”(OBIPE) ［ C ］ 170 - - 171 - - Indication: Arteriosclerotic, idiopathic postencephalitic parkin-sonism, drug-induced extrapyramidal syndrome. Contraindication: Closed angle glaucoma, mechanic stenosis of the GI tract, hypersensitivity. Adverse effect: Dry mouth, dizziness, fatigue, vertigo, gastric upset, mental confusion, and transient postural hypotension. Dosage: PO 2 mg TID or QID, PC. IM 2 mg repeated every 30 minutes if needed or 5 mg slow IV, up to 20 mg/day. Supply: Tab 2 mg, Inj 5 mg/amp Trihexyphenidyl HCI-“Artane” (OARTA) ［ C ］ Indication: Parkinsonism, extrapyramidal disorders due to reserpine and phenothiazine, muscle rigidity. Contraindication: Closed angle galucoma, paralytic ileus or pyloric stenosis, prostatic enlargement. Adverse effect: Dry mouth, fatigue, vertigo, gastric upset, and psychotic disturbance. Dosage: Usual dose 2 mg TID or QID. Maximum dose: 15 mg/day Supply: Tab 2 mg 28:36.12 Catechol-O-Methyltransferase (COMT) Inhibitors Entacapone-“Comtan”(OCOMT) Indication: Adjunct to levodopa/benserazide or levodopa/carbidopa for use in patients with Parkinson’s disease. Pharmacology: Entacapone is a reversible, specific, and mainly peripherally acting catechol-O- methyltransferase (COMT) inhibitor designed for concomitant administration with levodopa preparations. This leads to an increase in the bioavailability of levodopa and an increased amount of levodopa available to the brain. Entacapone thus prolongs the clinical response to levodopa. Pharmacokinetic: Oral bioavailability 35%. Plasma protein binding is 98%, mainly to serum albumin. Entacapone is metabolized by almost completely before elimination; metabolites are eliminated primarily by biliary excretion, with 90% of the metabolites found in feces and 10% in urine. Contraindication: Hypersensitivity to entacapone products, Concomitant use with non-selective MAO inhibitors but it can be taken with a selective MAO-B inhibitor (e.g., selegiline). Adverse effect: Common: abdominal pain, constipation, diarrhea, nausea, vomiting; urine discoloration; dizziness, fatigue. Serious: dyskinesia, hyperactive behavior; insomnia; hallucinations. Dosage: One 200 mg tab with each levodopa/dopa decarboxylase inhibitor dose to a MAX 1600 mg /day. May be taken with or without food, Use caution in patients with biliary obstruction. Supply: Tab 200 mg 28:36.16 Dopamine Precursors Madopar (OMAD1) (OMADH) (OMAD2) Indication: Symptomatic (postencephalitic, toxic or arterio-sclerotic) Parkinsonism, except drug-induced Parkinsonism, Parkinson’s disease. Contraindication: Severely de-compensated endocrine, renal, hepatic, cardiac disorders; psychosis and severe psychoneurosis; patient under 25 years old (due to possibility of skeletal abnormalities from benserazide); pregnant women; use of MAO inhibitors within prior 14 days; narrow-angle glaucoma or closed-angle glaucoma. Adverse effect: Anorexia, nausea, and vomiting, psychic disturbance. The effects of levodopa are reduced or abolished by the concurrent use of vitamin B6 but no interaction occurred with levodopa-carbidopa or levodopa-benserazide preperations. Dosage: Initial dose: 125 mg TID then increased by 125 mg weekly until the individual therapeutic dosage is 170 - - 171 - - Indication: Arteriosclerotic, idiopathic postencephalitic parkin-sonism, drug-induced extrapyramidal syndrome. Contraindication: Closed angle glaucoma, mechanic stenosis of the GI tract, hypersensitivity. Adverse effect: Dry mouth, dizziness, fatigue, vertigo, gastric upset, mental confusion, and transient postural hypotension. Dosage: PO 2 mg TID or QID, PC. IM 2 mg repeated every 30 minutes if needed or 5 mg slow IV, up to 20 mg/day. Supply: Tab 2 mg, Inj 5 mg/amp Trihexyphenidyl HCI-“Artane” (OARTA) ［ C ］ Indication: Parkinsonism, extrapyramidal disorders due to reserpine and phenothiazine, muscle rigidity. Contraindication: Closed angle galucoma, paralytic ileus or pyloric stenosis, prostatic enlargement. Adverse effect: Dry mouth, fatigue, vertigo, gastric upset, and psychotic disturbance. Dosage: Usual dose 2 mg TID or QID. Maximum dose: 15 mg/day Supply: Tab 2 mg 28:36.12 Catechol-O-Methyltransferase (COMT) Inhibitors Entacapone-“Comtan”(OCOMT) Indication: Adjunct to levodopa/benserazide or levodopa/carbidopa for use in patients with Parkinson’s disease. Pharmacology: Entacapone is a reversible, specific, and mainly peripherally acting catechol-O- methyltransferase (COMT) inhibitor designed for concomitant administration with levodopa preparations. This leads to an increase in the bioavailability of levodopa and an increased amount of levodopa available to the brain. Entacapone thus prolongs the clinical response to levodopa. Pharmacokinetic: Oral bioavailability 35%. Plasma protein binding is 98%, mainly to serum albumin. Entacapone is metabolized by almost completely before elimination; metabolites are eliminated primarily by biliary excretion, with 90% of the metabolites found in feces and 10% in urine. Contraindication: Hypersensitivity to entacapone products, Concomitant use with non-selective MAO inhibitors but it can be taken with a selective MAO-B inhibitor (e.g., selegiline). Adverse effect: Common: abdominal pain, constipation, diarrhea, nausea, vomiting; urine discoloration; dizziness, fatigue. Serious: dyskinesia, hyperactive behavior; insomnia; hallucinations. Dosage: One 200 mg tab with each levodopa/dopa decarboxylase inhibitor dose to a MAX 1600 mg /day. May be taken with or without food, Use caution in patients with biliary obstruction. Supply: Tab 200 mg 28:36.16 Dopamine Precursors Madopar (OMAD1) (OMADH) (OMAD2) Indication: Symptomatic (postencephalitic, toxic or arterio-sclerotic) Parkinsonism, except drug-induced Parkinsonism, Parkinson’s disease. Contraindication: Severely de-compensated endocrine, renal, hepatic, cardiac disorders; psychosis and severe psychoneurosis; patient under 25 years old (due to possibility of skeletal abnormalities from benserazide); pregnant women; use of MAO inhibitors within prior 14 days; narrow-angle glaucoma or closed-angle glaucoma. Adverse effect: Anorexia, nausea, and vomiting, psychic disturbance. The effects of levodopa are reduced or abolished by the concurrent use of vitamin B6 but no interaction occurred with levodopa-carbidopa or levodopa-benserazide preperations. Dosage: Initial dose: 125 mg TID then increased by 125 mg weekly until the individual therapeutic dosage is 172 - - 173 - - reached up to 1000 mg/day QID. Pharmacokinetics: The bioavailablilty of Madopar HBS is 60%. After ingestion of HBS form need 3 hours to achieve serum peak concentration. Administration: Capsules should be swallowed whole; Do Not crush, chew, open, or dissolve in liquid. Supply: Cap 125 mg Madopar Hydrodynamic Balance System (HBS, 100 mg L-dopa + 25 mg benserazide), Tab 250 mg (200 mg L-dopa + 50 mg benserazide). 28:36.20 Dopamine Receptor Agonists 28:36.20.04 Ergot-derivative Dopamine Receptor Agonists Bromocriptine – “Syntocriptine”(OBROM) ［ C ］ Indication: A dopaminergic agonists, for treatment of galactorrhea, amenorrhea, infertility, acromegaly, Parkinsonism. Contraindication: Patients who are sensitive to any ergot alkaloid. Adverse effect: Postural hypotension, syncope, nausea, constipation, peptic ulcer, hallucination. Dosage: For the prevention of puerperal lactation: initially 1.25 mg a day, then 2.5 mg BID for 4-14 days. For galactorrhea, amenorrhea infertility & acromegaly: initially 1.25 mg (at night with food) increased by 1.25 mg every third day, as necessary, up to 15 mg a day (but up to 30 mg daily may be required), usually in three divided doses with meals. For Parkinsonism: up to 100 mg a day (but up to 300 mg daily has been used) in divided doses. Supply: Tab 2.5 mg Pergolide mesylate - “Celance”(OCELA) ［ B ］ Indication: Adjunctive therapy with levodopa/carbidopa in long-term parkinsonian patients with clinical fluctuations. It is also effective in the treatment of hyperprolactinemia and acromegaly. Contraindication: Displayed hypersensitivity or idiosyncratic reactions to this drug or other ergot derivatives. Adverse effect: Dyskinesias, dystonias, orthostatic hypotension, dizziness, confusion, somnolance, insomnia, nausea, constipation; CNS complain is most commonly hallucinations and confusion are the primary cause for drug withdrawal. Dosage: In hyperprolactinemic and acromegalic patients: 0.025 to 0.5 mg/day, PO. In Parkinson’s disease: 2 to 3 mg, up to 10 mg/day in divided doses. Supply: Tab 0.25 mg 28:36.20.08 Nonergot-derivative Dopamine Receptor Agonists Pramipexole-“Mirapex”(OMIRA) ［ C ］ Indication: Treatment of the signs & symptoms of idiopathic Parkinson’s disease. Contraindication: Hypersensitivity to pramipexole products Adverse effect: Nausea, dizziness, somnolence (including sudden onset of sleep), insomnia, constipation, asthenia, hallucinations, orthostatic hypotension, dyskinesia (reduce Levodopa dose), extrapyramidal syndrome, confusion, dystonia, gait abnormality, hypertonia, dry mouth, amnesia, urinary frequency. Dosage: Initially, 0.375 mg/day in 3 divided doses increased to 0.25 mg tid in weeks 2 & then to 0.5 tid in weeks 3 according to response. Thereafter the daily dose may be increased by 0.25 mg at weekly intervals to a max 4.5 mg daily. Maintenance: 1.5-4.5 mg/day in 3 divided doses with or without concomitant L-dopa. Supply: Tab 1 mg 28:36.32 Monoamine Oxidase B Inhibitors Selegiline HCI-“Parkryl” (OPARK) ［ C ］ 172 - - 173 - - reached up to 1000 mg/day QID. Pharmacokinetics: The bioavailablilty of Madopar HBS is 60%. After ingestion of HBS form need 3 hours to achieve serum peak concentration. Administration: Capsules should be swallowed whole; Do Not crush, chew, open, or dissolve in liquid. Supply: Cap 125 mg Madopar Hydrodynamic Balance System (HBS, 100 mg L-dopa + 25 mg benserazide), Tab 250 mg (200 mg L-dopa + 50 mg benserazide). 28:36.20 Dopamine Receptor Agonists 28:36.20.04 Ergot-derivative Dopamine Receptor Agonists Bromocriptine – “Syntocriptine”(OBROM) ［ C ］ Indication: A dopaminergic agonists, for treatment of galactorrhea, amenorrhea, infertility, acromegaly, Parkinsonism. Contraindication: Patients who are sensitive to any ergot alkaloid. Adverse effect: Postural hypotension, syncope, nausea, constipation, peptic ulcer, hallucination. Dosage: For the prevention of puerperal lactation: initially 1.25 mg a day, then 2.5 mg BID for 4-14 days. For galactorrhea, amenorrhea infertility & acromegaly: initially 1.25 mg (at night with food) increased by 1.25 mg every third day, as necessary, up to 15 mg a day (but up to 30 mg daily may be required), usually in three divided doses with meals. For Parkinsonism: up to 100 mg a day (but up to 300 mg daily has been used) in divided doses. Supply: Tab 2.5 mg Pergolide mesylate - “Celance”(OCELA) ［ B ］ Indication: Adjunctive therapy with levodopa/carbidopa in long-term parkinsonian patients with clinical fluctuations. It is also effective in the treatment of hyperprolactinemia and acromegaly. Contraindication: Displayed hypersensitivity or idiosyncratic reactions to this drug or other ergot derivatives. Adverse effect: Dyskinesias, dystonias, orthostatic hypotension, dizziness, confusion, somnolance, insomnia, nausea, constipation; CNS complain is most commonly hallucinations and confusion are the primary cause for drug withdrawal. Dosage: In hyperprolactinemic and acromegalic patients: 0.025 to 0.5 mg/day, PO. In Parkinson’s disease: 2 to 3 mg, up to 10 mg/day in divided doses. Supply: Tab 0.25 mg 28:36.20.08 Nonergot-derivative Dopamine Receptor Agonists Pramipexole-“Mirapex”(OMIRA) ［ C ］ Indication: Treatment of the signs & symptoms of idiopathic Parkinson’s disease. Contraindication: Hypersensitivity to pramipexole products Adverse effect: Nausea, dizziness, somnolence (including sudden onset of sleep), insomnia, constipation, asthenia, hallucinations, orthostatic hypotension, dyskinesia (reduce Levodopa dose), extrapyramidal syndrome, confusion, dystonia, gait abnormality, hypertonia, dry mouth, amnesia, urinary frequency. Dosage: Initially, 0.375 mg/day in 3 divided doses increased to 0.25 mg tid in weeks 2 & then to 0.5 tid in weeks 3 according to response. Thereafter the daily dose may be increased by 0.25 mg at weekly intervals to a max 4.5 mg daily. Maintenance: 1.5-4.5 mg/day in 3 divided doses with or without concomitant L-dopa. Supply: Tab 1 mg 28:36.32 Monoamine Oxidase B Inhibitors Selegiline HCI-“Parkryl” (OPARK) ［ C ］ 174 - - 175 - - Indication: Selegiline is a monoamine oxidase (MAO) inhibitor that is specific for the MAO-B isozyme. It is effective in treating parkinsonian patients who develop fluctuations in response to chronic levodopa therapy and require maximum doses of the drug. Contraindication: Use with meperidine and patient with hypersensitivity to the drug. Adverse effect: Sleep disturbances, psychosis, agitation, confusion, and dyskinesias, hypotension, anorexia, and increased libido; the adverse effects of agitation, confusion, and insomnia may occur more frequently in the elderly. Dosage: Parkinsonism: PO 5-10 mg QD; Depression: PO 5-30 mg, QD. The doses should not exceed 10 mg/day because of the risks associated with non-selective inhibition of monoamine oxidase Supply: Tab 5 mg 28:92 Central Nervous System Agents, Miscellaneous Flumazenil—“Anexate”(IANEX) ［ C ］ Indication: Flumazenil is a benzodiazepine antagonist. It is indicated for reversal of the centrally sedative effects of benzodiazepines. Contraindication: Hypersensitivity to flumazenil or the benzodi azepi nes, pati ents who have been gi ven a benzodiazepine for potentially life-threatening condition and who exhibit signs and symptoms of serious cyclic antidepressant overdose. Adverse effect: Cardiac arrhythmias and bradycardia are reported rarely. Dizziness (1.07%) is a common CNS adverse effect. Nausea and vomiting (6%) are the most common adverse effects with flumazenil. Seizures may occur with flumazenil use, especially in cases of cyclic antidepressant or other mixed drug overdose. Dosage: Anesthesia reversal: 0.2 mg, followed by 0.2 mg every 30-60 seconds until the patient awakens or until a total dose of 1 mg. Benzodiazepine overdose: 0.3 mg up to a total of 1.5 to 10 mg Supply: Inj 0.5 mg/5 ml/amp Memantine-“Ebixa”(OEBIX) ［ B ］ Indication: Treatment of patients with moderately severe to severe Alzeimer’s disease Contraindication: Hypersensitivity to memantine hydrochloride Adverse effect: Agitation, inflicted injury, urinary incontinence, diarrhea, insomnia, dizziness, headache, hallucinations, fall, constipation, coughing, tiredness. Dosage: Initially 5 mg daily for the 1st week; this should be increased in weekly increments of 5 mg to the recommended maintenance dose of 10 mg bid. Supply: Tab 10 mg 40:00 Electrolytic, Caloric, and Water Balance 40:08 Alkalinizing Agents Sodium bicarbonate - (NaHCO3) (INAHC) (ONAHC) ［ C ］ Indication: Antacid, systemic & urinary alkalinizer. Contraindication: Alkalosis, edematous sodium retaining states, congestive heart failure, renal impairment. Dosage: PO, 0.3-2g QD up to QID, Maximum daily dose in patients less than 60 years is 16 gmand greater than 60 years is 8 gm. Less urgent forms of metabolic acidosis: 2-5 mEq/kg IV infusion over 4-8 hr as needed. Stability: NS or D5W with sodium bicarbonate 3.75 g/L is physically compatible. Supply: Inj 7% 20 ml/Amp (0.83mEq/ml, 16.66mEq/Amp); Tab 300 mg U-Citra Granules (OUCIT) Indication: Citrate and citric acid solutions are systemic and urinary alkalinizing agents. Used to correct the acidosis of certain renal tubular disorders, to treat metabolic acidosis, for long-term urine alkalinization, for 174 - - 175 - - Indication: Selegiline is a monoamine oxidase (MAO) inhibitor that is specific for the MAO-B isozyme. It is effective in treating parkinsonian patients who develop fluctuations in response to chronic levodopa therapy and require maximum doses of the drug. Contraindication: Use with meperidine and patient with hypersensitivity to the drug. Adverse effect: Sleep disturbances, psychosis, agitation, confusion, and dyskinesias, hypotension, anorexia, and increased libido; the adverse effects of agitation, confusion, and insomnia may occur more frequently in the elderly. Dosage: Parkinsonism: PO 5-10 mg QD; Depression: PO 5-30 mg, QD. The doses should not exceed 10 mg/day because of the risks associated with non-selective inhibition of monoamine oxidase Supply: Tab 5 mg 28:92 Central Nervous System Agents, Miscellaneous Flumazenil—“Anexate”(IANEX) ［ C ］ Indication: Flumazenil is a benzodiazepine antagonist. It is indicated for reversal of the centrally sedative effects of benzodiazepines. Contraindication: Hypersensitivity to flumazenil or the benzodi azepi nes, pati ents who have been gi ven a benzodiazepine for potentially life-threatening condition and who exhibit signs and symptoms of serious cyclic antidepressant overdose. Adverse effect: Cardiac arrhythmias and bradycardia are reported rarely. Dizziness (1.07%) is a common CNS adverse effect. Nausea and vomiting (6%) are the most common adverse effects with flumazenil. Seizures may occur with flumazenil use, especially in cases of cyclic antidepressant or other mixed drug overdose. Dosage: Anesthesia reversal: 0.2 mg, followed by 0.2 mg every 30-60 seconds until the patient awakens or until a total dose of 1 mg. Benzodiazepine overdose: 0.3 mg up to a total of 1.5 to 10 mg Supply: Inj 0.5 mg/5 ml/amp Memantine-“Ebixa”(OEBIX) ［ B ］ Indication: Treatment of patients with moderately severe to severe Alzeimer’s disease Contraindication: Hypersensitivity to memantine hydrochloride Adverse effect: Agitation, inflicted injury, urinary incontinence, diarrhea, insomnia, dizziness, headache, hallucinations, fall, constipation, coughing, tiredness. Dosage: Initially 5 mg daily for the 1st week; this should be increased in weekly increments of 5 mg to the recommended maintenance dose of 10 mg bid. Supply: Tab 10 mg 40:00 Electrolytic, Caloric, and Water Balance 40:08 Alkalinizing Agents Sodium bicarbonate - (NaHCO3) (INAHC) (ONAHC) ［ C ］ Indication: Antacid, systemic & urinary alkalinizer. Contraindication: Alkalosis, edematous sodium retaining states, congestive heart failure, renal impairment. Dosage: PO, 0.3-2g QD up to QID, Maximum daily dose in patients less than 60 years is 16 gmand greater than 60 years is 8 gm. Less urgent forms of metabolic acidosis: 2-5 mEq/kg IV infusion over 4-8 hr as needed. Stability: NS or D5W with sodium bicarbonate 3.75 g/L is physically compatible. Supply: Inj 7% 20 ml/Amp (0.83mEq/ml, 16.66mEq/Amp); Tab 300 mg U-Citra Granules (OUCIT) Indication: Citrate and citric acid solutions are systemic and urinary alkalinizing agents. Used to correct the acidosis of certain renal tubular disorders, to treat metabolic acidosis, for long-term urine alkalinization, for 176 - - 177 - - prevention and treatment of uric acid and calcium kidney stones, and as non-particulate neutralizing buffers. Contraindication: Severe renal impairment with oliguria, azotemia, or anuria; Addison’s disease; adynamic episodica hereditaria; acute dehydration; heat cramps; severe myocardial damage; hyperkalemia. Caution should be used in patients with low urinary output or reduced glomerular filtration rates. Adverse effect: Excess amount or patient with renal dysfuction may induce metabolic alkalosis or hyperkalemia. Dosage: For urine alkalization: 15 to 30 mL, children: 5 to 15 mL, diluted with water, PC and HS. For treatment of calcium and uric acid stones: potassium citrate 30-60 mEq/day PO in 3 or 4 doses with meals or within 30 minutes after meals. Supply: Each package contains: Potassium citrate monohydrate 3300 mg, Citratic acid monohydrate 1002 mg (Citrate content: 43.92 mEq/package Potassium content: 30.51 mEq/package) 40:10 Ammonia Detoxicants Lactulose-“Lactul” (BLACT) ［ B ］ Indication: Lactulose is a synthetic disaccharide sugar used in constipation and hepatic encephalopathy. Place in therapy: Since lactulose does not alter the underlying disease, its use does not preclude treatment of the underlying liver disease. It is not useful for non-nitrogenous types of encephalopathy. Contraindication: Patients with intestinal obstruction, abdominal pain, nausea, or vomiting or on a galactose-free diet. Adverse effect: Adverse effects include diarrhea, abdominal distention, flatulence, abdominal cramping, epigastric pain, anorexia, hypernatremia, and lactic acidosis. Dosage: Constipation: Adult, 15 ml BID, Children (5-10 yr.), 10 ml BID; Children (less than 5 yr.), 5ml BID; Infant, 2.5 ml BID. Hepatic encephalopathy: 30-50 ml TID; Retention enema: 300 ml of lactulose with 700 ml water, retained for 30-60 min can be repeated for 3 times Pharmacokinetics: Minimal amounts of LACTULOSE are absorbed orally and the onset of effect on constipation may require 48 hours; the drug is metabolized by colonic bacteria to lactic, formic, and acetic acid and 3% or less is excreted unchanged in the urine, with small amounts in the bile and feces. Supply: Sol 333 gm/500 ml/bot 40:12 Replacement Preparations Calcium Salts—“Calglon”(ICALG) ( 專 )“CaCO3” (OCALC) “Procal”(OPROC) “Calbo”(OCALB) “Jia-Cal” (OJIAC) Indication: Low calcium tetany, hypoparathyroidism senile, osteoporosis, rickets and osteomalacia. Contraindication: Patient receiving digitalis glycosides, or patients with ventricullar fibrillation or hypercalcemia. Adverse effect: Soft-tissue calcification, venous thrombosis, arrhythmias, hypercalcemia may result in nephrolithiasis, anorexia, nausea, vomiting, and ocular toxicity. Dosage: Recommended daily allowance of calcium: adults 1g, children 800mg, infant 600 mg, MAX dose: 15g (1.42g of calcium). Hypocalcemia: initial, 10% 20ml IV, followed by 0.3-0.8% solution infusion over 3-12 hours. Supply: Inj 10%, 10 ml/amp (0.45-0.48 mEq of Ca/ml, 89.2 mg of Ca/amp); Tab CaCO3 500mg (calcium carbonate 10 mEq/tab, 200 mg Ca/tab), Procal 667 mg (calcium acetate 8.47 mEq/tab, 168.8 mg Ca/tab), Calbo 950 mg (calcium citrate 10.07 mEq/tab, 200.5 mg of Ca/tab), 200.5 mg of Ca/tab Potassium chloride- “Slow-K” (OSLOW) “KCI”(IKCL5) ［ C ］ Indication: Potassium depletion, corticosteroid therapy, hypokalemia in digitalis intoxication. Contraindication: Addison’s disease, acute dehydration, 176 - - 177 - - prevention and treatment of uric acid and calcium kidney stones, and as non-particulate neutralizing buffers. Contraindication: Severe renal impairment with oliguria, azotemia, or anuria; Addison’s disease; adynamic episodica hereditaria; acute dehydration; heat cramps; severe myocardial damage; hyperkalemia. Caution should be used in patients with low urinary output or reduced glomerular filtration rates. Adverse effect: Excess amount or patient with renal dysfuction may induce metabolic alkalosis or hyperkalemia. Dosage: For urine alkalization: 15 to 30 mL, children: 5 to 15 mL, diluted with water, PC and HS. For treatment of calcium and uric acid stones: potassium citrate 30-60 mEq/day PO in 3 or 4 doses with meals or within 30 minutes after meals. Supply: Each package contains: Potassium citrate monohydrate 3300 mg, Citratic acid monohydrate 1002 mg (Citrate content: 43.92 mEq/package Potassium content: 30.51 mEq/package) 40:10 Ammonia Detoxicants Lactulose-“Lactul” (BLACT) ［ B ］ Indication: Lactulose is a synthetic disaccharide sugar used in constipation and hepatic encephalopathy. Place in therapy: Since lactulose does not alter the underlying disease, its use does not preclude treatment of the underlying liver disease. It is not useful for non-nitrogenous types of encephalopathy. Contraindication: Patients with intestinal obstruction, abdominal pain, nausea, or vomiting or on a galactose-free diet. Adverse effect: Adverse effects include diarrhea, abdominal distention, flatulence, abdominal cramping, epigastric pain, anorexia, hypernatremia, and lactic acidosis. Dosage: Constipation: Adult, 15 ml BID, Children (5-10 yr.), 10 ml BID; Children (less than 5 yr.), 5ml BID; Infant, 2.5 ml BID. Hepatic encephalopathy: 30-50 ml TID; Retention enema: 300 ml of lactulose with 700 ml water, retained for 30-60 min can be repeated for 3 times Pharmacokinetics: Minimal amounts of LACTULOSE are absorbed orally and the onset of effect on constipation may require 48 hours; the drug is metabolized by colonic bacteria to lactic, formic, and acetic acid and 3% or less is excreted unchanged in the urine, with small amounts in the bile and feces. Supply: Sol 333 gm/500 ml/bot 40:12 Replacement Preparations Calcium Salts—“Calglon”(ICALG) ( 專 )“CaCO3” (OCALC) “Procal”(OPROC) “Calbo”(OCALB) “Jia-Cal” (OJIAC) Indication: Low calcium tetany, hypoparathyroidism senile, osteoporosis, rickets and osteomalacia. Contraindication: Patient receiving digitalis glycosides, or patients with ventricullar fibrillation or hypercalcemia. Adverse effect: Soft-tissue calcification, venous thrombosis, arrhythmias, hypercalcemia may result in nephrolithiasis, anorexia, nausea, vomiting, and ocular toxicity. Dosage: Recommended daily allowance of calcium: adults 1g, children 800mg, infant 600 mg, MAX dose: 15g (1.42g of calcium). Hypocalcemia: initial, 10% 20ml IV, followed by 0.3-0.8% solution infusion over 3-12 hours. Supply: Inj 10%, 10 ml/amp (0.45-0.48 mEq of Ca/ml, 89.2 mg of Ca/amp); Tab CaCO3 500mg (calcium carbonate 10 mEq/tab, 200 mg Ca/tab), Procal 667 mg (calcium acetate 8.47 mEq/tab, 168.8 mg Ca/tab), Calbo 950 mg (calcium citrate 10.07 mEq/tab, 200.5 mg of Ca/tab), 200.5 mg of Ca/tab Potassium chloride- “Slow-K” (OSLOW) “KCI”(IKCL5) ［ C ］ Indication: Potassium depletion, corticosteroid therapy, hypokalemia in digitalis intoxication. Contraindication: Addison’s disease, acute dehydration, 178 - - 179 - - acute or chronic renal disease, hyperkalemia, severe renal impairment with azotemia or oligouria. Adverse effect: Hyperkalemia, flaccid paralysis, mental confusion, cardiac depression, cardiac arrhythmias. Administration: Prevention of hypokalemia (20mEq/day) Potassium depletion (40-100mEq/day). Supply: Tab 600 mg (8 mEq of K/tab); Inj 15%, 5 ml/amp (2 mEq of K/ml) Sodium chloride (I45NS) (INS45) (INSB) (INS1) (INS2) (INS3) ［ C ］ Indication: Hypotonic sodium chloride solution (0.45%): fluid replacement when fluid losses exceed electrolyte depletion. Isotonic solution (0.9%): water and sodium retention. Hypertonic solution (3%): hyponatremia, hypochloremia. Contraindication: Congestive heart failure, severe renal impairment, edema with sodium retention. Administration: Dose dependent on age, weight and clinical condition of patients: 6-10 g/day. Supply: 0.45% 20 ml, 500 ml/bot; 0.9% 500 ml, 1000 ml, 2000 ml/Bot; 3% 500 ml/bot Lactated Ringer’s (ILRB) Indication: Increase circulating fluid volume, acidosis, and dehydration. Contraindication: Severe liver damage, edema, circulatory overload, lactic acidosis. Dosage: 20-30ml/kg (slowly IV). Supply: Solu 0.02% CaCl 2 +0.03% KCl+0.6% NaCl +0.3% Sodium lactate/500 ml/bot 2. Electrolyte content given in meq/L Na K Ca Cl Lactate 124-137 3.6-4.4 1.22-1.5 104-115 26-29 Trace element (ITRAE) Indication: Treatment of trace element deficient patients on long-term of total parenteral nutrition. Administration: 1 ml of the trace elements given twice weekly. Supply: Inj Zn 1.5 mg+Cu 0.5 mg+Mn 0.2 mg+I 0.028 mg+Cr 0.005 mg/ml, 10 ml/vial Pentastarch – “Haes-steril”(IHAES) ［ C ］ Indication: Pentastarch (weight average molecular weight 200000) used as an expanding plasma agent in major either elective or emergency surgery. Ten percent of medium-molecular-weight pentastarch is a hyperoncotic solution that produces an expansion of plasma volume of about 1.5 times the infused volume. Place in therapy: Pentastarch may be a safe alternative to albumin as a replacement fluid administered during therapeutic plasma exchange. Contraindication: Hypersensitivity Adverse effect: Hypersensitivity, coagulopathy and haemorrhage have been reported. Dosage: Adults: Hypovolemia shock: 20 ml/kg/day; blood transfusion shock: 20 ml/kg/hr; Children (<10 y/o): less than 15 ml/kg/hr Supply: Inj 10% 500ml/bag; each ml contain: Pentastarch 100 mg Sodium chlorise 9. 0mg Succinylated gelatin – “Gelofusine” (IGELO) ［ C ］ Indication: Treatment and prevention of hypovalemia including absolute hypovolemia hemorrhage. It is also employed as a plasma volume expander. Pharmacology: Succinylation of the gelatin molecule results in a negatively charged molecule, as a colloidal plasma volume substitute. Parmacokinetics: Gelofusine has a volume effect lasting about 3-4 hours. About 1% of the infused drug is metabolized; 75% of the dose is excreted in the urine in 24 hours. The half-life is about 4 hrs. Contraindication: Known hypersensitivity to gelatin, hypervolaemia or hyperhydration, severe cardiac 178 - - 179 - - acute or chronic renal disease, hyperkalemia, severe renal impairment with azotemia or oligouria. Adverse effect: Hyperkalemia, flaccid paralysis, mental confusion, cardiac depression, cardiac arrhythmias. Administration: Prevention of hypokalemia (20mEq/day) Potassium depletion (40-100mEq/day). Supply: Tab 600 mg (8 mEq of K/tab); Inj 15%, 5 ml/amp (2 mEq of K/ml) Sodium chloride (I45NS) (INS45) (INSB) (INS1) (INS2) (INS3) ［ C ］ Indication: Hypotonic sodium chloride solution (0.45%): fluid replacement when fluid losses exceed electrolyte depletion. Isotonic solution (0.9%): water and sodium retention. Hypertonic solution (3%): hyponatremia, hypochloremia. Contraindication: Congestive heart failure, severe renal impairment, edema with sodium retention. Administration: Dose dependent on age, weight and clinical condition of patients: 6-10 g/day. Supply: 0.45% 20 ml, 500 ml/bot; 0.9% 500 ml, 1000 ml, 2000 ml/Bot; 3% 500 ml/bot Lactated Ringer’s (ILRB) Indication: Increase circulating fluid volume, acidosis, and dehydration. Contraindication: Severe liver damage, edema, circulatory overload, lactic acidosis. Dosage: 20-30ml/kg (slowly IV). Supply: Solu 0.02% CaCl 2 +0.03% KCl+0.6% NaCl +0.3% Sodium lactate/500 ml/bot 2. Electrolyte content given in meq/L Na K Ca Cl Lactate 124-137 3.6-4.4 1.22-1.5 104-115 26-29 Trace element (ITRAE) Indication: Treatment of trace element deficient patients on long-term of total parenteral nutrition. Administration: 1 ml of the trace elements given twice weekly. Supply: Inj Zn 1.5 mg+Cu 0.5 mg+Mn 0.2 mg+I 0.028 mg+Cr 0.005 mg/ml, 10 ml/vial Pentastarch – “Haes-steril”(IHAES) ［ C ］ Indication: Pentastarch (weight average molecular weight 200000) used as an expanding plasma agent in major either elective or emergency surgery. Ten percent of medium-molecular-weight pentastarch is a hyperoncotic solution that produces an expansion of plasma volume of about 1.5 times the infused volume. Place in therapy: Pentastarch may be a safe alternative to albumin as a replacement fluid administered during therapeutic plasma exchange. Contraindication: Hypersensitivity Adverse effect: Hypersensitivity, coagulopathy and haemorrhage have been reported. Dosage: Adults: Hypovolemia shock: 20 ml/kg/day; blood transfusion shock: 20 ml/kg/hr; Children (<10 y/o): less than 15 ml/kg/hr Supply: Inj 10% 500ml/bag; each ml contain: Pentastarch 100 mg Sodium chlorise 9. 0mg Succinylated gelatin – “Gelofusine” (IGELO) ［ C ］ Indication: Treatment and prevention of hypovalemia including absolute hypovolemia hemorrhage. It is also employed as a plasma volume expander. Pharmacology: Succinylation of the gelatin molecule results in a negatively charged molecule, as a colloidal plasma volume substitute. Parmacokinetics: Gelofusine has a volume effect lasting about 3-4 hours. About 1% of the infused drug is metabolized; 75% of the dose is excreted in the urine in 24 hours. The half-life is about 4 hrs. Contraindication: Known hypersensitivity to gelatin, hypervolaemia or hyperhydration, severe cardiac 180 - - 181 - - insufficiency, severe blood clotting disorders. Adverse effect: Hypersensitivity reaction including anaphylactaoid/anaphylactic reactions. Dosage: A 4% solution of Gelofusine has been infused in doses of 500 to 1000 ml; the first 20-30 ml should be infused slowly, MAX 20 ml/kg/day. Each 1000 ml Gelofusine contains succinylated gelatin 40gm, NaCl 7.01gm, and sodium hydroxide 1.36 gm. The sodium concentration is 154 mmol/L. Supply: Inj. Succinylated gelatin 40 g/L+Na 145 mmol/L+Cl 120 mmol/L, 500ml /bottle Dextran 40-“Rheomacrodex” (IRHEO) ［ C ］ Indication: Acute blood loss due to external wounds, internal bleeding or during operation. Contraindication: Hypotonic dehydration, severe cardiac insufficiency. Adverse effect: Hypersensitivity reaction, anaphylactic shock, acute renal insufficiency. Rarely: nausea, vomiting, skin rashes. Dosage: Adult: initially 20 ml/kg IV; prophylaxis & treatment of thromoboembolism 10 ml/kg daily, not > 5 days; extracorporeal circulation 10-20 ml/kg. Supply: Inj 10% dextran 50g+glucose 25 g/500 ml/bot 40:18 Ion-removing Agents 40:18.18 Potassium-removing Agents Sodium polystyrene sulfonate -“Resonium-A” (“Kayexalate”) (OKAYE) ［ C ］ Indication: Treatment of hyperkalemia. Contraindication: To be caution in patients with renal failure, severe hypertension, congestive heart failure, receiving digitalis preparations. Adverse effect: Electrolyte disturbance, constipation, fecal impaction, anorexia, vomiting, diarrhea. Dosage: Oral, adults: 15g TID-QID, children: up to 1g/kg/day in divided doses, maintain dose 500mg/kg. Enema, 30g in aqueous vehicle containing sorbitol or 1% methylcellulose. Supply: powder 1 lb (453.6 g)/Bot Note 1.1g of resin binds about 1mEq of potassium 2.The powder should not be mixed with foods or liquids that contain a large amount of potassium such as bananas or orange juice. 40:20 Caloric Agents 3% Amino acid ＋ 3% Glycerin ＋ Electrolytes- “Glycal-Amin” (IGLYA) ( 專 ) Indication: Peripheral administration in adults to preserve body protein and improve nitrogen balance in patients who require short-term parenteral nutrition. Contraindication: Renal failure, severe liver disease and hepatic coma, metabolic disorders associated with impaired nitrogen utilization, hypersensitivity to one or more amino acids. Adverse effect: Local reaction (a warm sensation, erythema, phlebitis and thrombosis), flushing, fever, nausea. Dosage: Approximately 3 L/day will provide a total of 90 g of amino acids, 390 non-protein calories and the recommended daily electrolytes requirements for the stable patient. Supply: Inj. 500 ml/Bot. Each 100 ml contain Glycerine 3.0 gm and following amino acids: L-Isoleucine 210 mg L-Alanine 210 mg L-Leucine 270 mg L-Arginine 290 mg L-Lysine acetate 310 mg L-Histidine 85 mg L-Methionine 160 mg L-Proline 340 mg L-Phenylalanine 170 mg L-Serine 180 mg L-Threonine 120 mg Cysteine HCl H 2 O 20 mg L-Tryptophan 46 mg Glycine 420 mg L-Valine 200 mg 180 - - 181 - - insufficiency, severe blood clotting disorders. Adverse effect: Hypersensitivity reaction including anaphylactaoid/anaphylactic reactions. Dosage: A 4% solution of Gelofusine has been infused in doses of 500 to 1000 ml; the first 20-30 ml should be infused slowly, MAX 20 ml/kg/day. Each 1000 ml Gelofusine contains succinylated gelatin 40gm, NaCl 7.01gm, and sodium hydroxide 1.36 gm. The sodium concentration is 154 mmol/L. Supply: Inj. Succinylated gelatin 40 g/L+Na 145 mmol/L+Cl 120 mmol/L, 500ml /bottle Dextran 40-“Rheomacrodex” (IRHEO) ［ C ］ Indication: Acute blood loss due to external wounds, internal bleeding or during operation. Contraindication: Hypotonic dehydration, severe cardiac insufficiency. Adverse effect: Hypersensitivity reaction, anaphylactic shock, acute renal insufficiency. Rarely: nausea, vomiting, skin rashes. Dosage: Adult: initially 20 ml/kg IV; prophylaxis & treatment of thromoboembolism 10 ml/kg daily, not > 5 days; extracorporeal circulation 10-20 ml/kg. Supply: Inj 10% dextran 50g+glucose 25 g/500 ml/bot 40:18 Ion-removing Agents 40:18.18 Potassium-removing Agents Sodium polystyrene sulfonate -“Resonium-A” (“Kayexalate”) (OKAYE) ［ C ］ Indication: Treatment of hyperkalemia. Contraindication: To be caution in patients with renal failure, severe hypertension, congestive heart failure, receiving digitalis preparations. Adverse effect: Electrolyte disturbance, constipation, fecal impaction, anorexia, vomiting, diarrhea. Dosage: Oral, adults: 15g TID-QID, children: up to 1g/kg/day in divided doses, maintain dose 500mg/kg. Enema, 30g in aqueous vehicle containing sorbitol or 1% methylcellulose. Supply: powder 1 lb (453.6 g)/Bot Note 1.1g of resin binds about 1mEq of potassium 2.The powder should not be mixed with foods or liquids that contain a large amount of potassium such as bananas or orange juice. 40:20 Caloric Agents 3% Amino acid ＋ 3% Glycerin ＋ Electrolytes- “Glycal-Amin” (IGLYA) ( 專 ) Indication: Peripheral administration in adults to preserve body protein and improve nitrogen balance in patients who require short-term parenteral nutrition. Contraindication: Renal failure, severe liver disease and hepatic coma, metabolic disorders associated with impaired nitrogen utilization, hypersensitivity to one or more amino acids. Adverse effect: Local reaction (a warm sensation, erythema, phlebitis and thrombosis), flushing, fever, nausea. Dosage: Approximately 3 L/day will provide a total of 90 g of amino acids, 390 non-protein calories and the recommended daily electrolytes requirements for the stable patient. Supply: Inj. 500 ml/Bot. Each 100 ml contain Glycerine 3.0 gm and following amino acids: L-Isoleucine 210 mg L-Alanine 210 mg L-Leucine 270 mg L-Arginine 290 mg L-Lysine acetate 310 mg L-Histidine 85 mg L-Methionine 160 mg L-Proline 340 mg L-Phenylalanine 170 mg L-Serine 180 mg L-Threonine 120 mg Cysteine HCl H 2 O 20 mg L-Tryptophan 46 mg Glycine 420 mg L-Valine 200 mg 182 - - 183 - - Concentration of electrolytes (mEq/L) ： Sodium 35; Potassium 24; Magnesium 5; Calcium 3; Chloride 41 ; Phosphate 7; Acetate 47 . Lipovenos 20%(ILIP2) ［ C ］ Indication: Fat emulsion for parenteral nutrition. Contraindication: Collapse and shock states, hyperlipoprotein-aemia, impaired lipid metabolism, fat embolism, hemorrhagic diathesis, thrombosis, acute hepatitis, existing arteriosclerosis, pregnancy, acute pancreatitis, florid infections, sepsis. Adverse effect: Hot flushes, chills, anorexia, nausea, vomiting, dyspnoea, headache, myelalgia, ostalgia, anaemia, leucopenia, thrombocytopenia, hemorrhagic diathesis, pathological liver findings. Dosage: Not more than 2g fat/kg/day ( ～ 10ml/kg/day); infusion rate: initial 0.05g fat/kg/hr, maintained by < 0.1g fat/kg/hr Supply: Inj 20%, 250 ml/bot Each ml contains: Glycerol 25.0 mg Egg lecithin 12.0 mg Soybean oil 200.0 mg Sodium oleate 0.3 mg Sodium hydroxide (1N) q.s. 0-0.001 ml Total energy ～2000 kcal/L Theoretical osmolarity 273 mOsm/kg PH value 6.5-8.7 Moriamin-SN (IMORI) Indication: Adjust in offsetting nitrogen loss or in the treatment of negative nitrogen balance in patients. Contraindication: Hypersensitivity to one or more amino acids, severer liver disease or hepatic coma. Adverse effect: Mild thrombophlebitis, flushing, fever, nausea, palpitation, rarely acidosis, liver & kidney function impaired in large doses. Dosage: Infusion rate: peripheral 200ml/2hrs, 200-400ml/day; central venous 400-800ml/day. Supply: Inj 200 ml/Bot Each 200 ml contains: W/V % mg/200 ml L-Isoleucine 0.560 1,120 L-Leucine 1.250 2,500 Lysine 1.240 2,480 L-Methionine 0.350 700 L-Phenylalanine 0.935 1,870 L-Threonine 0.650 1,300 L-Tryptophan 0.130 260 L-Valine 0.450 900 L-Alanine 0.620 1,240 L-Arginine 0.790 1,580 L-Aspartic acid 0.380 760 L-Cysteine 0.100 200 L-Glutamic acid 0.650 1,300 L-Histidine 0.600 1,200 L-Proline 0.330 660 L-Serine 0.220 440 L-Tyrosine 0.035 70 Aminoacetic acid 1.070 2,140 Total nitrogen=15.2mg/ml, Free amino acid conc= 10% W/V, pH: 5.5-6.5; Osmotic ratio: about 3; Electrolyte (meq/200 ml) Cl - : 0, Na + : 1, CH3COO - : about 12. Kabiven/Kabiven Peripheral (IKABI)(IKABP) Indication: Parenteral nutrition for adult & children > 2 years. Contraindication: hypersensitivity to egg or soy protein; severe hyperlipaemia; severe liver insufficiency; severe blood coagulation disorders; inborn errors of amino acid metabolism; renal insufficiency without hemofiltration or dialysis; acute shock; hyperglycemia requiring > 6 units insulin/hr; pathologically elevated serum electrolyte levels; hemophagocytotic syndrome; unstable conditions; infants < 2 years. Adverse effect: fat overload syndrome, rise in body temperature, shivering, chills & nausea, vomiting, transient increases in liver enzymes. Thrombophlebitis. Dosage: Kabiven—adult & children >10 years: 19-38 mL/kg body weight/day; children 2-10 years: initially 182 - - 183 - - Concentration of electrolytes (mEq/L) ： Sodium 35; Potassium 24; Magnesium 5; Calcium 3; Chloride 41 ; Phosphate 7; Acetate 47 . Lipovenos 20%(ILIP2) ［ C ］ Indication: Fat emulsion for parenteral nutrition. Contraindication: Collapse and shock states, hyperlipoprotein-aemia, impaired lipid metabolism, fat embolism, hemorrhagic diathesis, thrombosis, acute hepatitis, existing arteriosclerosis, pregnancy, acute pancreatitis, florid infections, sepsis. Adverse effect: Hot flushes, chills, anorexia, nausea, vomiting, dyspnoea, headache, myelalgia, ostalgia, anaemia, leucopenia, thrombocytopenia, hemorrhagic diathesis, pathological liver findings. Dosage: Not more than 2g fat/kg/day ( ～ 10ml/kg/day); infusion rate: initial 0.05g fat/kg/hr, maintained by < 0.1g fat/kg/hr Supply: Inj 20%, 250 ml/bot Each ml contains: Glycerol 25.0 mg Egg lecithin 12.0 mg Soybean oil 200.0 mg Sodium oleate 0.3 mg Sodium hydroxide (1N) q.s. 0-0.001 ml Total energy ～2000 kcal/L Theoretical osmolarity 273 mOsm/kg PH value 6.5-8.7 Moriamin-SN (IMORI) Indication: Adjust in offsetting nitrogen loss or in the treatment of negative nitrogen balance in patients. Contraindication: Hypersensitivity to one or more amino acids, severer liver disease or hepatic coma. Adverse effect: Mild thrombophlebitis, flushing, fever, nausea, palpitation, rarely acidosis, liver & kidney function impaired in large doses. Dosage: Infusion rate: peripheral 200ml/2hrs, 200-400ml/day; central venous 400-800ml/day. Supply: Inj 200 ml/Bot Each 200 ml contains: W/V % mg/200 ml L-Isoleucine 0.560 1,120 L-Leucine 1.250 2,500 Lysine 1.240 2,480 L-Methionine 0.350 700 L-Phenylalanine 0.935 1,870 L-Threonine 0.650 1,300 L-Tryptophan 0.130 260 L-Valine 0.450 900 L-Alanine 0.620 1,240 L-Arginine 0.790 1,580 L-Aspartic acid 0.380 760 L-Cysteine 0.100 200 L-Glutamic acid 0.650 1,300 L-Histidine 0.600 1,200 L-Proline 0.330 660 L-Serine 0.220 440 L-Tyrosine 0.035 70 Aminoacetic acid 1.070 2,140 Total nitrogen=15.2mg/ml, Free amino acid conc= 10% W/V, pH: 5.5-6.5; Osmotic ratio: about 3; Electrolyte (meq/200 ml) Cl - : 0, Na + : 1, CH3COO - : about 12. Kabiven/Kabiven Peripheral (IKABI)(IKABP) Indication: Parenteral nutrition for adult & children > 2 years. Contraindication: hypersensitivity to egg or soy protein; severe hyperlipaemia; severe liver insufficiency; severe blood coagulation disorders; inborn errors of amino acid metabolism; renal insufficiency without hemofiltration or dialysis; acute shock; hyperglycemia requiring > 6 units insulin/hr; pathologically elevated serum electrolyte levels; hemophagocytotic syndrome; unstable conditions; infants < 2 years. Adverse effect: fat overload syndrome, rise in body temperature, shivering, chills & nausea, vomiting, transient increases in liver enzymes. Thrombophlebitis. Dosage: Kabiven—adult & children >10 years: 19-38 mL/kg body weight/day; children 2-10 years: initially 184 - - 185 - - 12.5-25 mL/kg/day & increased by 10-15 mL/kg/day up to a max of 40 mL/kg/day; Kabiven is recommended to be infused only into a central vein. Kabiven Periphral—adult & children >10 years: 27-40 mL/kg body weight/day; children 2-10 years: initially 14-28 mL/kg/day & increased by 10-15 mL/kg/day up to a max of 40 mL/kg/day; by IV infusion into a peripheral or central vein. Supply: each 1 L contains: Kabiven Peripheral Kabiven Amino acid (g) 33 24 Nitrogen (g) 5.3 3.5 Fat (g) 39 35 Glucose (Dextrose) (g) 97 68 Na (mmol) 31 22 K (mmol) 23 17 Mg (mmol) 4 2.8 Ca (mmol) 2 1.4 Phosopate (mmol) 9.7 7.5 Sulphate (mmol) 4 2.8 Cl (mmol) 45 32 Acetate (mmol) 38 27 Energy (kCal) 910 910 Kabiven 1540 ml/bot; Kabiven Peripheral 1440 ml/bot Aminopoly-H (IAMIH) Dosage: IV infusion, 1bot/day as needed Supply: Each 100ml contains: (500 ml/bot) L-Isoleucine 920 mg L-Leucine 945 mg L-Lysine Acetate 395 mg L-Methionine 65 mg L-Phenylalanine 30 mg L-Threonine 300 mg L-Tryptophane 70 mg L-Valine 890 mg L-Alanine 840 mg L-Arginine 920 mg L-Histidine 310 mg L-Proline 530 mg L-Serine 260 mg Amino Acetic Acid 540 mg L-Aspartic Acid 20 mg L-Tyrosine 60 mg L-Cysteine 20 mg Aminol-V (IAMIV) Dosage: IV infusion, 1bot/day as needed Supply: Each 100ml contains: (500 ml/bot) L-Isoleucine 140 mg L-Leucine 220 mg L-Methionine 220 mg L-Phenylalanine 220 mg L-Treonine 100 mg L-Trytophan 50 mg L-Histidine 120 mg L-Valine 160 mg L-Arginine 500 mg Glycine 1000 mg L-Alanine 1710 mg L-Poline 350 mg L-Lysine 160 mg L-Ornithine-L-Aspartate 50 mg L-Malic Acid 350 mg Nicotinamide 1.5mg Riboflavin-5”-Phosphate-Sodium 0.2mg Panthenol 1 mg Pyridoxine HCl 0.2mg Rutin 24mg Sorbitol 5000mg Sodium Chloride 175.3mg Potassium Chlorise 186.4mg/ml Total Nitrogen 839.7mg/ml Amiparen (IAMIP) ( 專 ) Indication: Nutritional support for patients with 184 - - 185 - - 12.5-25 mL/kg/day & increased by 10-15 mL/kg/day up to a max of 40 mL/kg/day; Kabiven is recommended to be infused only into a central vein. Kabiven Periphral—adult & children >10 years: 27-40 mL/kg body weight/day; children 2-10 years: initially 14-28 mL/kg/day & increased by 10-15 mL/kg/day up to a max of 40 mL/kg/day; by IV infusion into a peripheral or central vein. Supply: each 1 L contains: Kabiven Peripheral Kabiven Amino acid (g) 33 24 Nitrogen (g) 5.3 3.5 Fat (g) 39 35 Glucose (Dextrose) (g) 97 68 Na (mmol) 31 22 K (mmol) 23 17 Mg (mmol) 4 2.8 Ca (mmol) 2 1.4 Phosopate (mmol) 9.7 7.5 Sulphate (mmol) 4 2.8 Cl (mmol) 45 32 Acetate (mmol) 38 27 Energy (kCal) 910 910 Kabiven 1540 ml/bot; Kabiven Peripheral 1440 ml/bot Aminopoly-H (IAMIH) Dosage: IV infusion, 1bot/day as needed Supply: Each 100ml contains: (500 ml/bot) L-Isoleucine 920 mg L-Leucine 945 mg L-Lysine Acetate 395 mg L-Methionine 65 mg L-Phenylalanine 30 mg L-Threonine 300 mg L-Tryptophane 70 mg L-Valine 890 mg L-Alanine 840 mg L-Arginine 920 mg L-Histidine 310 mg L-Proline 530 mg L-Serine 260 mg Amino Acetic Acid 540 mg L-Aspartic Acid 20 mg L-Tyrosine 60 mg L-Cysteine 20 mg Aminol-V (IAMIV) Dosage: IV infusion, 1bot/day as needed Supply: Each 100ml contains: (500 ml/bot) L-Isoleucine 140 mg L-Leucine 220 mg L-Methionine 220 mg L-Phenylalanine 220 mg L-Treonine 100 mg L-Trytophan 50 mg L-Histidine 120 mg L-Valine 160 mg L-Arginine 500 mg Glycine 1000 mg L-Alanine 1710 mg L-Poline 350 mg L-Lysine 160 mg L-Ornithine-L-Aspartate 50 mg L-Malic Acid 350 mg Nicotinamide 1.5mg Riboflavin-5”-Phosphate-Sodium 0.2mg Panthenol 1 mg Pyridoxine HCl 0.2mg Rutin 24mg Sorbitol 5000mg Sodium Chloride 175.3mg Potassium Chlorise 186.4mg/ml Total Nitrogen 839.7mg/ml Amiparen (IAMIP) ( 專 ) Indication: Nutritional support for patients with 186 - - 187 - - hypoproteinemia, malnutrition. Contraindication: Hepatic coma, severly impaired renal function, abnormal amino acid metabolism. Adverse effect: Hypersensitivity, GI upsets, chest discomfort, palpitations, occasional chills, hot flushes, fever, headache, increase of GOT, GPT & BUN level. Dosage: Adult 400-800 ml/TPN, 200-400 ml/IV infusion (amino acid 10 g/60 min) Supply: Amino acids 10%, total nitrogen 15.7 g/L, branched amino acids 30%, Na 2 meq/L, acetate 120 meq/L; 400 ml/bot. Arginine oxoglurate-“Eucol”(IEUCO)( 專 ) Indication: Liver dysfunction; general physical & mental apathy; hepatic encephalopathy due to chronic alcohol abuse. Dosage: 1-2 vial (2.5-5 g) daily IV Supply: Inj 2.5 g/vial Dextrose (glucose) Injection (IG5%) (IVITA)( 專 )(IG10%)(I50GW) ( 專 )(IGW50)( 專 ) ［ C ］ Indication: Sodium depletion, hypertonic used for shock, anti-ketogenic action used for acidosis, provide calories (5%, 10%, 20%, 50% infusion), 50 % dextrose for insulin hypoglycemia. Contraindication: Intracranial or intraspinal hemorrhage, diabetic coma, glucose-galactose malabsorption syndrome. Adverse effect: Thrombophlebitis, hyperglycemia, glycosuria. Dosage: depend on the age, weight and clinical condition. The maximum rate is 0.5g/kg/hr. Supply: Inj 5%, 500 ml/bot, 250 ml/bot; Inj 10% 500 ml/bot; Inj 50%, 500 ml/bot, 50%, 20 ml/amp Dextrose (glucose) and Sodium chloride (I509)(ID509) (I5033)(I5045)(I5022)( 專 ) Indication: Maintenance fluid therapy, sodium depletion. Contraindication: Edema, circulatory overload. Supply: 5% G/W + 0.9% N/S 500 ml, 1000 ml; 5% G/W + 0.33% N/S 500 ml; 5% G/W + 0.45 N/S 500 ml; 5% G/W + 0.225% N/S 500 ml 40:28 Diuretics 40:28.08 Loop Diuretics Furosemide-“Lasix”(OLASI)(ILASI) Indication: Hypertension, acute pulmonary edema, edema due to congestive heart failure, hepatic cirrhosis and renal disease. Contraindication: Anuria, hypersensitive to furosemide. Adverse effect: Dehydration, hypokalemia, glucose intolerance, hypochloremic alkalosis, hyperuricemia. Dosage: 40-500 mg/day, maximum daily dose: 600 mg. Stability: NS or D5W with furosemide 600 mg/L is physically compatible for 24 hours. Supply: Tab 40 mg; Inj 20 mg/2 ml/amp 40:28.12 Osmotic Diuretics Mannitol (IMAN5) ［ C ］ Indication: Glaucoma, cerebral edema, measurement of glomerular filtration rate. Contraindication: Pulmonary congestion or pulmonary edema, congestive heart failure, severe dehydration. Adverse effect: Fluid and electrolyte imbalance, hypersensitivity, diarrhea, nausea, vomiting, headache (when given by mouth). Dosage: IV infusion, 50-200 g/day, maximum dose: 6 g/kg. Stability: Mannitol solution may be crystallization at low temperature. It can be resolubilized by heating to 70-80 ℃ in a water bath. Allow the solution to cool to room temperature before reinspection for crystals. The solution is incompatible with potassium chloride or sodium chloride for the latter will be salt out. Supply: Inj 20% 500 ml/bot 186 - - 187 - - hypoproteinemia, malnutrition. Contraindication: Hepatic coma, severly impaired renal function, abnormal amino acid metabolism. Adverse effect: Hypersensitivity, GI upsets, chest discomfort, palpitations, occasional chills, hot flushes, fever, headache, increase of GOT, GPT & BUN level. Dosage: Adult 400-800 ml/TPN, 200-400 ml/IV infusion (amino acid 10 g/60 min) Supply: Amino acids 10%, total nitrogen 15.7 g/L, branched amino acids 30%, Na 2 meq/L, acetate 120 meq/L; 400 ml/bot. Arginine oxoglurate-“Eucol”(IEUCO)( 專 ) Indication: Liver dysfunction; general physical & mental apathy; hepatic encephalopathy due to chronic alcohol abuse. Dosage: 1-2 vial (2.5-5 g) daily IV Supply: Inj 2.5 g/vial Dextrose (glucose) Injection (IG5%) (IVITA)( 專 )(IG10%)(I50GW) ( 專 )(IGW50)( 專 ) ［ C ］ Indication: Sodium depletion, hypertonic used for shock, anti-ketogenic action used for acidosis, provide calories (5%, 10%, 20%, 50% infusion), 50 % dextrose for insulin hypoglycemia. Contraindication: Intracranial or intraspinal hemorrhage, diabetic coma, glucose-galactose malabsorption syndrome. Adverse effect: Thrombophlebitis, hyperglycemia, glycosuria. Dosage: depend on the age, weight and clinical condition. The maximum rate is 0.5g/kg/hr. Supply: Inj 5%, 500 ml/bot, 250 ml/bot; Inj 10% 500 ml/bot; Inj 50%, 500 ml/bot, 50%, 20 ml/amp Dextrose (glucose) and Sodium chloride (I509)(ID509) (I5033)(I5045)(I5022)( 專 ) Indication: Maintenance fluid therapy, sodium depletion. Contraindication: Edema, circulatory overload. Supply: 5% G/W + 0.9% N/S 500 ml, 1000 ml; 5% G/W + 0.33% N/S 500 ml; 5% G/W + 0.45 N/S 500 ml; 5% G/W + 0.225% N/S 500 ml 40:28 Diuretics 40:28.08 Loop Diuretics Furosemide-“Lasix”(OLASI)(ILASI) Indication: Hypertension, acute pulmonary edema, edema due to congestive heart failure, hepatic cirrhosis and renal disease. Contraindication: Anuria, hypersensitive to furosemide. Adverse effect: Dehydration, hypokalemia, glucose intolerance, hypochloremic alkalosis, hyperuricemia. Dosage: 40-500 mg/day, maximum daily dose: 600 mg. Stability: NS or D5W with furosemide 600 mg/L is physically compatible for 24 hours. Supply: Tab 40 mg; Inj 20 mg/2 ml/amp 40:28.12 Osmotic Diuretics Mannitol (IMAN5) ［ C ］ Indication: Glaucoma, cerebral edema, measurement of glomerular filtration rate. Contraindication: Pulmonary congestion or pulmonary edema, congestive heart failure, severe dehydration. Adverse effect: Fluid and electrolyte imbalance, hypersensitivity, diarrhea, nausea, vomiting, headache (when given by mouth). Dosage: IV infusion, 50-200 g/day, maximum dose: 6 g/kg. Stability: Mannitol solution may be crystallization at low temperature. It can be resolubilized by heating to 70-80 ℃ in a water bath. Allow the solution to cool to room temperature before reinspection for crystals. The solution is incompatible with potassium chloride or sodium chloride for the latter will be salt out. Supply: Inj 20% 500 ml/bot 188 - - 189 - - Glycetose (IGLYC) Indication: Treatment of intracranial edema, and increased intracranial pressure, reduction of brain or eyeball volume during brain or eye surgery. Contraindication: Patients with hereditary fructose intolerance. Adverse effect: Occult blood in urine, hemoglobinuria, headache. Dosage: Usual adult dose: 200-500mg QD or Q12H IV infusion for 2-3 hours, duration of administration: 1-2 weeks. Supply: Inj 10%, 300 ml/bot 40:28.20 Thiazide Diuretics Trichlormethiazide-“Fluitran” (OFLUI) ［ D ］ Indication: Hypertension, edema due to congestive heart failure, hepatic cirrhosis, chronic renal disease and corticosteroid therapy. Contraindication: Anuria, hypersensitivity to trichlormethiazide. Adverse effect: Nausea, flushing of face, hypokalemia, hyponatremia, hypochloremic alkalosis. Dosage: 2-4 mg/day. Supply: Tab 2 mg 40:28.24 Thiazide-like Diuretics Metolazone-“Mykrox”(OMYKR) ［ B ］ Indication: Metolazone is an effective diuretic for edema and essential hypertension. It has been used in patients with renal failure and nephrotic syndrome. Place in therapy: The only apparent advantage over other thiazides is its usefulness in patients with a decreased glomerular filtration rate. Contraindication: Thiazide diuretics are contraindicated in patients with anuria, hypersensitivity to other thiazide diuretics, or sulfonamides and in use in pregnant women. Adverse effect: Anemia, orthostatic hypotension, hypokalemia, hyperuricemia, and hyponatremia. Dosage: Adults: Initial oral dose 0.5 mg/day, increase to 1 mg/day. Children: 0.2-0.4 mg/kg/day; safety and efficacy of metolazone have not been established in pediatric patients and manufacturer is not recommended its use in children. Supply: Tab 0.5 mg Indapamide–“NatrilixSR” (ONAT1) “Indax SR” (OINDA) ［ B ］ Indication: Hypertension Contraindication: Hypersensitivity to sulfonamides; severe hepatic or renal failure, hypokalemia. Adverse effect: Fatigue, orthostatic hypotension, hypokalaemia, allergic manifestations. Dosage: 1.25-5 mg daily. Supply: Tab 1.5 mg (Natrilix, Indax) 40:36 Irrigating Solutions Ringer’s Solution (IRSB) Dosage IV infusion, 500-1000 ml Supply: 500 ml/bot; Each bot contains : Sodium chloride 0.86%, Potassium chloride 0.03% & Calcium chloride 0.033% Bss (Balanced Salt Solution) (IBSS) Indication: Irrigation during various surgical procedures of eyes, ears, and/or throat. Precautions: Diabetic patients undergoing vitrectomy. Adverse effect: Postoperative inflammatory reaction; corneal edema and decompensation; bullous keratopathy. Supply: Soln each ml contains: Sodium chloride 0.64%, Potassium chloride 0.075%, Calcium chloride dihydrate 0.048%, Magnesium chloride hexahydrate 0.03%, Sodium acetate trihydrate 0.39%, Sodium citrate dihydrate 0.17%, Sodium hydroxide and/or Hydrochloric 188 - - 189 - - Glycetose (IGLYC) Indication: Treatment of intracranial edema, and increased intracranial pressure, reduction of brain or eyeball volume during brain or eye surgery. Contraindication: Patients with hereditary fructose intolerance. Adverse effect: Occult blood in urine, hemoglobinuria, headache. Dosage: Usual adult dose: 200-500mg QD or Q12H IV infusion for 2-3 hours, duration of administration: 1-2 weeks. Supply: Inj 10%, 300 ml/bot 40:28.20 Thiazide Diuretics Trichlormethiazide-“Fluitran” (OFLUI) ［ D ］ Indication: Hypertension, edema due to congestive heart failure, hepatic cirrhosis, chronic renal disease and corticosteroid therapy. Contraindication: Anuria, hypersensitivity to trichlormethiazide. Adverse effect: Nausea, flushing of face, hypokalemia, hyponatremia, hypochloremic alkalosis. Dosage: 2-4 mg/day. Supply: Tab 2 mg 40:28.24 Thiazide-like Diuretics Metolazone-“Mykrox”(OMYKR) ［ B ］ Indication: Metolazone is an effective diuretic for edema and essential hypertension. It has been used in patients with renal failure and nephrotic syndrome. Place in therapy: The only apparent advantage over other thiazides is its usefulness in patients with a decreased glomerular filtration rate. Contraindication: Thiazide diuretics are contraindicated in patients with anuria, hypersensitivity to other thiazide diuretics, or sulfonamides and in use in pregnant women. Adverse effect: Anemia, orthostatic hypotension, hypokalemia, hyperuricemia, and hyponatremia. Dosage: Adults: Initial oral dose 0.5 mg/day, increase to 1 mg/day. Children: 0.2-0.4 mg/kg/day; safety and efficacy of metolazone have not been established in pediatric patients and manufacturer is not recommended its use in children. Supply: Tab 0.5 mg Indapamide–“NatrilixSR” (ONAT1) “Indax SR” (OINDA) ［ B ］ Indication: Hypertension Contraindication: Hypersensitivity to sulfonamides; severe hepatic or renal failure, hypokalemia. Adverse effect: Fatigue, orthostatic hypotension, hypokalaemia, allergic manifestations. Dosage: 1.25-5 mg daily. Supply: Tab 1.5 mg (Natrilix, Indax) 40:36 Irrigating Solutions Ringer’s Solution (IRSB) Dosage IV infusion, 500-1000 ml Supply: 500 ml/bot; Each bot contains : Sodium chloride 0.86%, Potassium chloride 0.03% & Calcium chloride 0.033% Bss (Balanced Salt Solution) (IBSS) Indication: Irrigation during various surgical procedures of eyes, ears, and/or throat. Precautions: Diabetic patients undergoing vitrectomy. Adverse effect: Postoperative inflammatory reaction; corneal edema and decompensation; bullous keratopathy. Supply: Soln each ml contains: Sodium chloride 0.64%, Potassium chloride 0.075%, Calcium chloride dihydrate 0.048%, Magnesium chloride hexahydrate 0.03%, Sodium acetate trihydrate 0.39%, Sodium citrate dihydrate 0.17%, Sodium hydroxide and/or Hydrochloric 190 - - 191 - - acid to adjust pH and water for injection; 250 ml/bot. 40:40 Uricosuric Agents Benzbromarone-“Deuron”(ODEUR) ［ D ］ Indication: Benzbromarone is a uricosuric used to treat asymptomatic and symptomatic hyperuricemia, gout. Contraindication: Renal dysfunction, glomerular filtration rate is less than 20 ml/minute; Benzbromarone therapy should not be initiated during an acute attack of gout. Adverse effect: Diarrhea, rash; benzbromarone may precipitate an acute attack of gout and/or uric acid nephropathy. Ensure adequate fluid intake and maintenance of a relatively high urine pH to reduce the risk of nephrolithiasis. Dosage: 50-200 mg QD Supply: Tab 50 mg Sulfinpyrazone (OSULF) Indication: Treatment of hyperuricaemia associated with chronic gout. Contraindication: Peptic ulceration, nephrolithiasis, blood dyscrasias, severe kidney or liver damage. Adverse effect: GI disturbances, allergic skin reactions. Rarely, anaemia, raised hepatic enzyme levels, jaundice. Dosage: Initially 100-200 mg bid, gradually increased to a max dose of 800 mg daily. Supply: Tab 100 mg 44:00 Enzymes Serratiopeptidase – “Danzen”(ODANZ) Indication: Used in the treatment of inflammatory disorders. Contraindication: Patients with reduced plasminogen or fibrinogen levels, acute cellulitis with suppuration, bronchopleural fistulas. Pregnancy risk category: No data available. Adverse effect: GI disturbance, skin rash. Dosage: Usual dose 1-2 of enteric coated tabs, TID, to be swallowed whole with warm drinking water. Supply: Tab 5 mg (10,000 U). Bromelain/L-Cysteine – “Broen-C”(OBROE) Indication: Adjunct in the treatment of inflammatory & edema associated with trauma or surgery. Place in therapy: Bromelain are sulfhydryl proteolytic wnzymes that are obtained from the pineapple plant and used as an enzyme to aid in digestion. Bromelain acts primarily to help maintain hemeostasis in inflammatoty processes. Contraindication: Coagulation disorders, dialysis, hyperssnitive to bromelain or pineapply, and severe liver or kidney impairment Adverse effect: Bronchial asthma, erythema and pruritus, increase in heart rate, palpitations, stomach ache, diarrhea Dosage: Initially 2 tab qid, maintenance 1 tab qid Supply: Tab Bromelain 20000 units/L-Cysteine 20 mg 48:00 Respiratory Tract Agents 48:08 Antitussives Codeine (OCODE) ［ C ］ Indication: Relief of mild to moderate pain and cough. Contraindication: Respiratory depression, convulsive disorders. Adverse effect: Dizziness, euphoria, dysphoria, nausea, vomiting, constipation, pruritus. Dosage: Adults: analgesic: 15-60 mg Q4H, antitussive: 10-20 g Q4-6H, do not exceed 120 mg in 24 hours. Children: analgesic: 3 mg/kg/day in 6 divided doses, antitussive: 2.5-10 mg Q4-6H, do not exceed 60 mg in 24 hours. 190 - - 191 - - acid to adjust pH and water for injection; 250 ml/bot. 40:40 Uricosuric Agents Benzbromarone-“Deuron”(ODEUR) ［ D ］ Indication: Benzbromarone is a uricosuric used to treat asymptomatic and symptomatic hyperuricemia, gout. Contraindication: Renal dysfunction, glomerular filtration rate is less than 20 ml/minute; Benzbromarone therapy should not be initiated during an acute attack of gout. Adverse effect: Diarrhea, rash; benzbromarone may precipitate an acute attack of gout and/or uric acid nephropathy. Ensure adequate fluid intake and maintenance of a relatively high urine pH to reduce the risk of nephrolithiasis. Dosage: 50-200 mg QD Supply: Tab 50 mg Sulfinpyrazone (OSULF) Indication: Treatment of hyperuricaemia associated with chronic gout. Contraindication: Peptic ulceration, nephrolithiasis, blood dyscrasias, severe kidney or liver damage. Adverse effect: GI disturbances, allergic skin reactions. Rarely, anaemia, raised hepatic enzyme levels, jaundice. Dosage: Initially 100-200 mg bid, gradually increased to a max dose of 800 mg daily. Supply: Tab 100 mg 44:00 Enzymes Serratiopeptidase – “Danzen”(ODANZ) Indication: Used in the treatment of inflammatory disorders. Contraindication: Patients with reduced plasminogen or fibrinogen levels, acute cellulitis with suppuration, bronchopleural fistulas. Pregnancy risk category: No data available. Adverse effect: GI disturbance, skin rash. Dosage: Usual dose 1-2 of enteric coated tabs, TID, to be swallowed whole with warm drinking water. Supply: Tab 5 mg (10,000 U). Bromelain/L-Cysteine – “Broen-C”(OBROE) Indication: Adjunct in the treatment of inflammatory & edema associated with trauma or surgery. Place in therapy: Bromelain are sulfhydryl proteolytic wnzymes that are obtained from the pineapple plant and used as an enzyme to aid in digestion. Bromelain acts primarily to help maintain hemeostasis in inflammatoty processes. Contraindication: Coagulation disorders, dialysis, hyperssnitive to bromelain or pineapply, and severe liver or kidney impairment Adverse effect: Bronchial asthma, erythema and pruritus, increase in heart rate, palpitations, stomach ache, diarrhea Dosage: Initially 2 tab qid, maintenance 1 tab qid Supply: Tab Bromelain 20000 units/L-Cysteine 20 mg 48:00 Respiratory Tract Agents 48:08 Antitussives Codeine (OCODE) ［ C ］ Indication: Relief of mild to moderate pain and cough. Contraindication: Respiratory depression, convulsive disorders. Adverse effect: Dizziness, euphoria, dysphoria, nausea, vomiting, constipation, pruritus. Dosage: Adults: analgesic: 15-60 mg Q4H, antitussive: 10-20 g Q4-6H, do not exceed 120 mg in 24 hours. Children: analgesic: 3 mg/kg/day in 6 divided doses, antitussive: 2.5-10 mg Q4-6H, do not exceed 60 mg in 24 hours. 192 - - 193 - - Supply: Tab 30 mg Dextromethorphan-“Delcopan SR” (ODELC) ［ C ］ Indication: Relief acute or chronic cough syndrome Pharmacology:Dextromethorphan is the D-isomer of the codeine analog of levorphanol, but has little analgesic or addictive properties. However, it does act on the cough center in the medulla oblongata by elevating the threshold for coughing. Pharmacokinetics: Onset 1-2hr; duration 12 hr. Extensively metabolized, including appreciable first-pass effect, mainly to the active metabolite dextrophan. The rate of metabolism varies between individuals according to phenotype (extensive vs poor metabolizers). Contraindication: Hypersensitivity to dextromethorphan, co-administration with monoamine oxidase inhibitors Adverse effect: Dizziness (mild), somnolence (mild), fatigue (mild). Intoxication, bizarre behavior, CNS depression, and respiratory depression can occur with extremely high dosages. Dosage: 60 mg orally twice daily, MAX dose 120 mg/day Supply: Tab 60 mg Fucou (OFUCO) Indication: Cough Dosage: 1 cap TID Supply: Cap dextromethorphan 20 mg, potassium cresolsulfonate 90 mg, lysozyme chloride 20 mg Benzonatate-“Bansau”(OBENS) Indication: Benzonatate is an antitussive agent with local anesthetic properties. Benzonatate is utilized for the symptomatic relief of cough. Place in therapy: Benzonatate is an effective antitussive and an alternative to opioid antitussives, such as codeine. It appears to have a more sustained cough-suppressing effect than many other antitussives. Contraindication: Benzonatate is contraindicated in patients with hypersensitivity to the drug. Use with caution in children less than 10 years of age. Adverse effect: Numbness of the mouth, headache, and drowsiness Dosage: Adults: 100 mg PO TID; Benzonatate perles should be swallowed without chewing since they can produce temporary anesthesia of the mouth and pharynx Pharmacokinetics: The onset of therapeutic effect is within 15 to 20 minutes; the duration of antitussive effect is 3 to 8 hours. Supply: Cap 100 mg Dimemorfan Phosphate-“Astomin”(OASTO) Indication: Symptomatic control of cough Precautions: Diabetes mellitus Adverse effect: Infrequently, change in glucose tolerance; dizziness, drowsiness; dry mouth, nausea, vomiting. Rarely, malaise, tachycardia, palpitations, hot flushes. Dosage: Adult 1-2 tab tid. Children 1 tab tid Supply: Tab 10 mg Sodium Dibunate - “Becantex”(OBECA) Indication: Cough suppressant in non-productive cough Pharmacology: Becantex is a non-narcotic antitussive agent. It is claimed to have central and peripheral actions on the cough reflex. Pharmacokinetics: Onset of action: 15 ~30 minutes; Duration: 7~12 hr Dosage: Adulst: Usual dose: 1 tab PO TID~QID; in severe case: 2 tab TID-QID or 1 tab 5-6 times/day Children: 4~8 mg/kg/day Supply: Tab 30 mg Oxeladin-“Pacomin”(OPACO) Indication: Non-productive cough Adverse effect: GI disturbances. Dosage: Adult 60 mg; children (>8 years) 30 mg, (5-8 192 - - 193 - - Supply: Tab 30 mg Dextromethorphan-“Delcopan SR” (ODELC) ［ C ］ Indication: Relief acute or chronic cough syndrome Pharmacology:Dextromethorphan is the D-isomer of the codeine analog of levorphanol, but has little analgesic or addictive properties. However, it does act on the cough center in the medulla oblongata by elevating the threshold for coughing. Pharmacokinetics: Onset 1-2hr; duration 12 hr. Extensively metabolized, including appreciable first-pass effect, mainly to the active metabolite dextrophan. The rate of metabolism varies between individuals according to phenotype (extensive vs poor metabolizers). Contraindication: Hypersensitivity to dextromethorphan, co-administration with monoamine oxidase inhibitors Adverse effect: Dizziness (mild), somnolence (mild), fatigue (mild). Intoxication, bizarre behavior, CNS depression, and respiratory depression can occur with extremely high dosages. Dosage: 60 mg orally twice daily, MAX dose 120 mg/day Supply: Tab 60 mg Fucou (OFUCO) Indication: Cough Dosage: 1 cap TID Supply: Cap dextromethorphan 20 mg, potassium cresolsulfonate 90 mg, lysozyme chloride 20 mg Benzonatate-“Bansau”(OBENS) Indication: Benzonatate is an antitussive agent with local anesthetic properties. Benzonatate is utilized for the symptomatic relief of cough. Place in therapy: Benzonatate is an effective antitussive and an alternative to opioid antitussives, such as codeine. It appears to have a more sustained cough-suppressing effect than many other antitussives. Contraindication: Benzonatate is contraindicated in patients with hypersensitivity to the drug. Use with caution in children less than 10 years of age. Adverse effect: Numbness of the mouth, headache, and drowsiness Dosage: Adults: 100 mg PO TID; Benzonatate perles should be swallowed without chewing since they can produce temporary anesthesia of the mouth and pharynx Pharmacokinetics: The onset of therapeutic effect is within 15 to 20 minutes; the duration of antitussive effect is 3 to 8 hours. Supply: Cap 100 mg Dimemorfan Phosphate-“Astomin”(OASTO) Indication: Symptomatic control of cough Precautions: Diabetes mellitus Adverse effect: Infrequently, change in glucose tolerance; dizziness, drowsiness; dry mouth, nausea, vomiting. Rarely, malaise, tachycardia, palpitations, hot flushes. Dosage: Adult 1-2 tab tid. Children 1 tab tid Supply: Tab 10 mg Sodium Dibunate - “Becantex”(OBECA) Indication: Cough suppressant in non-productive cough Pharmacology: Becantex is a non-narcotic antitussive agent. It is claimed to have central and peripheral actions on the cough reflex. Pharmacokinetics: Onset of action: 15 ~30 minutes; Duration: 7~12 hr Dosage: Adulst: Usual dose: 1 tab PO TID~QID; in severe case: 2 tab TID-QID or 1 tab 5-6 times/day Children: 4~8 mg/kg/day Supply: Tab 30 mg Oxeladin-“Pacomin”(OPACO) Indication: Non-productive cough Adverse effect: GI disturbances. Dosage: Adult 60 mg; children (>8 years) 30 mg, (5-8 194 - - 195 - - years) 20 mg. To be taken tid. Supply: Tab 20 mg Nocough Syrup (BNOCO) Dosage: Adults: 10-15 ml every 3-4 hours Children: 6-12 yo, 5 ml 4-5 times/day; 3-6 yo, 2.5-5 ml 2-3 times/day; 1-3yo, 2.5 ml 2-3 times/day Supply: Soln 120 ml/bot, each mL contain: Dextromethorphan HBr 1 mg Glyceryl Guaiaolate 5 mg Phenylephrine HCI 1 mg Chlorpheniramine maleate 0.2 mg Fusoco Syrup (BFUSO) Dosage: Adults 20 ml TID Children 4-2 yo 4 ml 7-5 yo 7 ml 15-8 yo 10 ml TID Supply: Soln 120 ml/bot, each ml contain: Dextromethorphan HBr 0.5 mg Chlorpheniramine maleate 0.15 mg dl – Methylephedrine Hcl 0.4 mg Potassium Guaiacol Sulfonate 6 mg Ammonium Chloride 2 mg Liquid Brown Mixture (BBML) Dosage: Adult 5 ml TID-QID Supply: Soln 200 ml/bot, each ml contain glycyrrhiza fluid extract 0.12 ml, opium tincture 0.012 ml, antimony potassium tartrate 0.24 mg, ethyl nitrite spirit 0.03 ml 48:10 Anti-inflammatory Agents 48:10.24 Leukotriene Modifiers Montelukast-“Singulair”(OSING) ［ B ］ Indication: Prophylaxis & chronic treatment of asthma and for the relief symptoms of seasonal allerfic rhinitis. Precautions: Should not be used for treatment of acute asthma attacks. Should not be abruptly substituted for inhaled or oral corticosteroids. Pregnancy & lactation. Children < 6 months. Adverse effect: abdominal pain, headache, thirst, diarrhea, hyperkinesias, asthma, eczematous dermatitis, and rash. Dosage: Asthma &/ or seasonal allergic rhinitis—adult >15 years 10 mg daily. For asthma, the dose should be taken in evening. For seasonal allergic rhinitis, the time of administration may be individualized to suit patient needs. Supply: Tab 10 mg 48:16 Expectorants Bromhexine HCl-“Bisolvon” (OBISO)(BBISO) ［ A ］ Indication: To change the structure of bronchial secretions and to reduce the viscosity of sputum, and used as an expectorant. Contraindication: Use with caution to patients with gastric ulceration. Adverse effect: Nausea, GI disturbance. Dosage: Adults: 8-16 mg TID or QID. Children: 5-10 yrs, 4 mg QID; 5 yrs, 4 mg BID. Babies: 5 drops TID Supply: Tab 8 mg; Soln 2 mg/ml, 50ml/bot Ambroxol HCl-“Mucosolvan” (OMUSC) “Loxol SR”(OLOXO) Indication: Ambroxol is used as an expectorant and mucolytic in the treatment of pulmonary disorders such as bronchitis and pulmonary infections to facilitate the removal of secretions from the lungs. Place in therapy: Ambroxol is used in the treatment of bronchitis and pulmonary infections to facilitate the removal of secretions from the respiratory tract. Adverse effect: Adverse effects include fatigue, dry mouth, rhinorrhea, constipation, dysuria, and contact dermatitis. Dosage: Adults: 60-180 mg/day in 2 or 3 divided doses; Children: up to 2 years: 15 mg/day; 2-5 yrs: 15-30 mg/day; 194 - - 195 - - years) 20 mg. To be taken tid. Supply: Tab 20 mg Nocough Syrup (BNOCO) Dosage: Adults: 10-15 ml every 3-4 hours Children: 6-12 yo, 5 ml 4-5 times/day; 3-6 yo, 2.5-5 ml 2-3 times/day; 1-3yo, 2.5 ml 2-3 times/day Supply: Soln 120 ml/bot, each mL contain: Dextromethorphan HBr 1 mg Glyceryl Guaiaolate 5 mg Phenylephrine HCI 1 mg Chlorpheniramine maleate 0.2 mg Fusoco Syrup (BFUSO) Dosage: Adults 20 ml TID Children 4-2 yo 4 ml 7-5 yo 7 ml 15-8 yo 10 ml TID Supply: Soln 120 ml/bot, each ml contain: Dextromethorphan HBr 0.5 mg Chlorpheniramine maleate 0.15 mg dl – Methylephedrine Hcl 0.4 mg Potassium Guaiacol Sulfonate 6 mg Ammonium Chloride 2 mg Liquid Brown Mixture (BBML) Dosage: Adult 5 ml TID-QID Supply: Soln 200 ml/bot, each ml contain glycyrrhiza fluid extract 0.12 ml, opium tincture 0.012 ml, antimony potassium tartrate 0.24 mg, ethyl nitrite spirit 0.03 ml 48:10 Anti-inflammatory Agents 48:10.24 Leukotriene Modifiers Montelukast-“Singulair”(OSING) ［ B ］ Indication: Prophylaxis & chronic treatment of asthma and for the relief symptoms of seasonal allerfic rhinitis. Precautions: Should not be used for treatment of acute asthma attacks. Should not be abruptly substituted for inhaled or oral corticosteroids. Pregnancy & lactation. Children < 6 months. Adverse effect: abdominal pain, headache, thirst, diarrhea, hyperkinesias, asthma, eczematous dermatitis, and rash. Dosage: Asthma &/ or seasonal allergic rhinitis—adult >15 years 10 mg daily. For asthma, the dose should be taken in evening. For seasonal allergic rhinitis, the time of administration may be individualized to suit patient needs. Supply: Tab 10 mg 48:16 Expectorants Bromhexine HCl-“Bisolvon” (OBISO)(BBISO) ［ A ］ Indication: To change the structure of bronchial secretions and to reduce the viscosity of sputum, and used as an expectorant. Contraindication: Use with caution to patients with gastric ulceration. Adverse effect: Nausea, GI disturbance. Dosage: Adults: 8-16 mg TID or QID. Children: 5-10 yrs, 4 mg QID; 5 yrs, 4 mg BID. Babies: 5 drops TID Supply: Tab 8 mg; Soln 2 mg/ml, 50ml/bot Ambroxol HCl-“Mucosolvan” (OMUSC) “Loxol SR”(OLOXO) Indication: Ambroxol is used as an expectorant and mucolytic in the treatment of pulmonary disorders such as bronchitis and pulmonary infections to facilitate the removal of secretions from the lungs. Place in therapy: Ambroxol is used in the treatment of bronchitis and pulmonary infections to facilitate the removal of secretions from the respiratory tract. Adverse effect: Adverse effects include fatigue, dry mouth, rhinorrhea, constipation, dysuria, and contact dermatitis. Dosage: Adults: 60-180 mg/day in 2 or 3 divided doses; Children: up to 2 years: 15 mg/day; 2-5 yrs: 15-30 mg/day; 196 - - 197 - - 5-12 yrs: 30-45 mg/day, 12 years and older: 60-90 mg/day Pharmacokinetics: About 5-6% of a dose is excreted unchanged in the urine. Alpha half-life: 1.3 hrs and beta half-life: of 8.8 hrs. Supply: Tab 30 mg (Mucosolvan), 75 mg (Loxol) 52:00 Eye, Ear, Nose, and Throat (EENT) Preparations 52:02 Antiallergic Agents Azelastine-“Azela”(EAZEL) ［ C ］ Indication: Allergic rhinitis. Adverse effect: Rarely, irritation of inflamed nasal mucosa on spraying. Improper administration may produce a taste disturbance. Dosage: Adult & children >6 years 1 puff into each nostril bid. Supply: Nasal spray 0.1 % 100 puff/bot. Kasulo Nasal Spray (EKASU) Indication: Naphazoline is an imidazoline alpha-adrenergic agonist used as a nasal and ocular decongestant. Chlorpheniramine is an antihistamine of the propylamine class. Kasulo nasal spray can be used for sneezing, running nose, and other initial symptoms of common cold. Contraindication: Kasulo is contraindicated in patients who have hypersensitivity to these components and children younger than 2 years old. Naphazoline should be used with caution in patients with a history of cardiovascular disease, thyroid disease, hypertension, and diabetes Adverse effect: Systemic adverse effects of chlorphiramine include agranulocytosis, aplastic anemia, thrombocytopenia, arrhythmias, dyskinesias, psychotic reactions, and cutaneous reactions. Topical use of Naphazoline can cause burning, stinging, nasal dryness, headaches, insomnia, dizziness, tremors, palpitations, rebound congestion, and rhinitis medicamentosa with prolonged use; excessive absorption (or overdose) may result in arrhythmias, hypertension, hypotension, bradycardia, and central nervous system depression. Dosage: Nasal spray 2-3 puffs QID Pharmacokinetics: Naphazoline has a rapid onset of action when used topically, usually within 5 minutes with duration of action of approximately 2 to 6 hours. Supply: Nasal spray 15 ml/bot, each ml contain naphazoline 0.5 mg and chlorpheniramine 4 mg Spersallerg eye drops (ESPEG) ［ C ］ Indication: Irritant conjunctivitis, allergic inflammatory conditions of the conjunctiva, particularly hay fever conjunctivitis & vernal conjunctivitis. Contraindication: Narrow-angle glaucoma. Adverse effect: Mild burning sensation; headache, sleepiness, tachycardia. Dosage: Acute stage: 1 drop 3 hrly. Continuous use: 1 drop 2-3 times daily. Severe cases: use hrly. Infant—Max 1-2 drop daily. Supply: Soln 10 ml/bot, each ml contain: antazoline HCl 0.5 mg+tetrahydrozoline HCl 0.4 mg 52:04 Anti-infectives 52:04.04 Antibacterials Sulfamethoxazole Oph Solution-“Kingmin (Sinomin)” (ESINO) ［ C ］ Indication: Treatment of local infections of eye due to susceptible microorganism. Contraindication: Sulfonamides ophthalmic products should not be used with silver preparations. Dosage: 1 drop TID-QID Supply: Soln 4%, 10 ml/bot. 196 - - 197 - - 5-12 yrs: 30-45 mg/day, 12 years and older: 60-90 mg/day Pharmacokinetics: About 5-6% of a dose is excreted unchanged in the urine. Alpha half-life: 1.3 hrs and beta half-life: of 8.8 hrs. Supply: Tab 30 mg (Mucosolvan), 75 mg (Loxol) 52:00 Eye, Ear, Nose, and Throat (EENT) Preparations 52:02 Antiallergic Agents Azelastine-“Azela”(EAZEL) ［ C ］ Indication: Allergic rhinitis. Adverse effect: Rarely, irritation of inflamed nasal mucosa on spraying. Improper administration may produce a taste disturbance. Dosage: Adult & children >6 years 1 puff into each nostril bid. Supply: Nasal spray 0.1 % 100 puff/bot. Kasulo Nasal Spray (EKASU) Indication: Naphazoline is an imidazoline alpha-adrenergic agonist used as a nasal and ocular decongestant. Chlorpheniramine is an antihistamine of the propylamine class. Kasulo nasal spray can be used for sneezing, running nose, and other initial symptoms of common cold. Contraindication: Kasulo is contraindicated in patients who have hypersensitivity to these components and children younger than 2 years old. Naphazoline should be used with caution in patients with a history of cardiovascular disease, thyroid disease, hypertension, and diabetes Adverse effect: Systemic adverse effects of chlorphiramine include agranulocytosis, aplastic anemia, thrombocytopenia, arrhythmias, dyskinesias, psychotic reactions, and cutaneous reactions. Topical use of Naphazoline can cause burning, stinging, nasal dryness, headaches, insomnia, dizziness, tremors, palpitations, rebound congestion, and rhinitis medicamentosa with prolonged use; excessive absorption (or overdose) may result in arrhythmias, hypertension, hypotension, bradycardia, and central nervous system depression. Dosage: Nasal spray 2-3 puffs QID Pharmacokinetics: Naphazoline has a rapid onset of action when used topically, usually within 5 minutes with duration of action of approximately 2 to 6 hours. Supply: Nasal spray 15 ml/bot, each ml contain naphazoline 0.5 mg and chlorpheniramine 4 mg Spersallerg eye drops (ESPEG) ［ C ］ Indication: Irritant conjunctivitis, allergic inflammatory conditions of the conjunctiva, particularly hay fever conjunctivitis & vernal conjunctivitis. Contraindication: Narrow-angle glaucoma. Adverse effect: Mild burning sensation; headache, sleepiness, tachycardia. Dosage: Acute stage: 1 drop 3 hrly. Continuous use: 1 drop 2-3 times daily. Severe cases: use hrly. Infant—Max 1-2 drop daily. Supply: Soln 10 ml/bot, each ml contain: antazoline HCl 0.5 mg+tetrahydrozoline HCl 0.4 mg 52:04 Anti-infectives 52:04.04 Antibacterials Sulfamethoxazole Oph Solution-“Kingmin (Sinomin)” (ESINO) ［ C ］ Indication: Treatment of local infections of eye due to susceptible microorganism. Contraindication: Sulfonamides ophthalmic products should not be used with silver preparations. Dosage: 1 drop TID-QID Supply: Soln 4%, 10 ml/bot. 198 - - 199 - - Chloramphenicol Oph Soln – “CM”(ECM) ［ C ］ Indication: Treatment of local infections of the eye due to suscepctible microorgansim. Adverse effect: Bone marrow hypoplasia. Dosage: 1 drop TID-QID Supply: Soln 0.25%, 10ml/bot Erythromycin oph oint – “Ilotycin” (EILOT) ［ B ］ Indication: Treatment of bacterial infections of the eye involving the conjunctiva &/or cornea caused by susceptible organisms. Contraindication: Hypersensitivity. Adverse effect: Rarely, hypersensitivity reactions, ocular irritation or redness. Dosage: Apply up to 6 times daily. Supply: Oph onit 0.5% 3.5 g/tube Gentamicin oph solu-“Gentamycin” ( 專 )(EGM) ［ C ］ Indication: Superifical bacterial infection of the eye & its adnexa. Adverse effect: Discontinue if irritation or sensitization occurs. Dosage: 2 drop TID-QID Supply: Soln 0.3% 5 ml/bot Tetracycline oph oint-“Tetracycline” (ETETR) ［ D ］ Indication: Ophthalmia neonatorum (prophylaxis); trachoma Dosage: Ocular infections: a thin strip of oint q2-4h or more frequently; ophthalmia neonatorum: a thin strip of oint as a single dose. Supply: Oph oint 10 mg/g, 5 g/tube Otozambon Ear Drop (EOTOZ) Indication: Otitis externa & media, furunculosis of auricular tube, allergic dermatoses of exudative, seborrheic & eczematous type, suppurative complications following ear & mastoid surgery, otalgia. Contraindication: Infected TB lesions of ear; chickenpox; live vaccine; herpes simplex. Precautions: Perforations of tympanic membrane. Dosage: 4-5 drop BID-QID Supply: Soln 8 ml/bot, each ml contains: Polymyxin B Sulphate 10,000 IU, neomycin sulphate 5mg, lidocaine hydrochloride 40mg Ofloxacin – “Tarivid OTIC”(ETARI) ［ C ］ Indication: The otic solution of ofloxacin is indicated for the treatment of otitis externa and acute otitis media in pediatric patients 1 year and older with tympanostomy tubes, and chronic, suppurative otitis media with perforated tympanic membranes in patients 12 years of age and older. Contraindication: Hypersensitivity to ofloxacin or to other fluoroquinolones; otic solution is not for ophthalmic use or for injection Adverse effect: The adverse effects include: hypersensitivity, ear pain, replacement the rehabitated external normal flora Dosage: Adults: otitis externa 5 to 10 drops twice a day for 10 days (patients 12 years and older); Children: otitis externa; 5 drops twice a day for 10 days (1 to 12 years of age) Supply: Otic soln 3 mg/ml, 5 ml/bot 52:04.20 Antivirals Acyclovir – “Zovirax Oph Oint”(EZOVIR) ［ B ］ Indication: Treatment of herpes simplex infections in immuno-compromised patients. Contraindication: Hypersensitivity, use with caution in patients with abnormal renal function. Adverse effect: Severe inflammation sometimes leading to ulceration has resulted from accidental infusion into the tissue extravascularly. Dosage: Slow IV infusion 5mg/kg over 1 hour Q8H, 198 - - 199 - - Chloramphenicol Oph Soln – “CM”(ECM) ［ C ］ Indication: Treatment of local infections of the eye due to suscepctible microorgansim. Adverse effect: Bone marrow hypoplasia. Dosage: 1 drop TID-QID Supply: Soln 0.25%, 10ml/bot Erythromycin oph oint – “Ilotycin” (EILOT) ［ B ］ Indication: Treatment of bacterial infections of the eye involving the conjunctiva &/or cornea caused by susceptible organisms. Contraindication: Hypersensitivity. Adverse effect: Rarely, hypersensitivity reactions, ocular irritation or redness. Dosage: Apply up to 6 times daily. Supply: Oph onit 0.5% 3.5 g/tube Gentamicin oph solu-“Gentamycin” ( 專 )(EGM) ［ C ］ Indication: Superifical bacterial infection of the eye & its adnexa. Adverse effect: Discontinue if irritation or sensitization occurs. Dosage: 2 drop TID-QID Supply: Soln 0.3% 5 ml/bot Tetracycline oph oint-“Tetracycline” (ETETR) ［ D ］ Indication: Ophthalmia neonatorum (prophylaxis); trachoma Dosage: Ocular infections: a thin strip of oint q2-4h or more frequently; ophthalmia neonatorum: a thin strip of oint as a single dose. Supply: Oph oint 10 mg/g, 5 g/tube Otozambon Ear Drop (EOTOZ) Indication: Otitis externa & media, furunculosis of auricular tube, allergic dermatoses of exudative, seborrheic & eczematous type, suppurative complications following ear & mastoid surgery, otalgia. Contraindication: Infected TB lesions of ear; chickenpox; live vaccine; herpes simplex. Precautions: Perforations of tympanic membrane. Dosage: 4-5 drop BID-QID Supply: Soln 8 ml/bot, each ml contains: Polymyxin B Sulphate 10,000 IU, neomycin sulphate 5mg, lidocaine hydrochloride 40mg Ofloxacin – “Tarivid OTIC”(ETARI) ［ C ］ Indication: The otic solution of ofloxacin is indicated for the treatment of otitis externa and acute otitis media in pediatric patients 1 year and older with tympanostomy tubes, and chronic, suppurative otitis media with perforated tympanic membranes in patients 12 years of age and older. Contraindication: Hypersensitivity to ofloxacin or to other fluoroquinolones; otic solution is not for ophthalmic use or for injection Adverse effect: The adverse effects include: hypersensitivity, ear pain, replacement the rehabitated external normal flora Dosage: Adults: otitis externa 5 to 10 drops twice a day for 10 days (patients 12 years and older); Children: otitis externa; 5 drops twice a day for 10 days (1 to 12 years of age) Supply: Otic soln 3 mg/ml, 5 ml/bot 52:04.20 Antivirals Acyclovir – “Zovirax Oph Oint”(EZOVIR) ［ B ］ Indication: Treatment of herpes simplex infections in immuno-compromised patients. Contraindication: Hypersensitivity, use with caution in patients with abnormal renal function. Adverse effect: Severe inflammation sometimes leading to ulceration has resulted from accidental infusion into the tissue extravascularly. Dosage: Slow IV infusion 5mg/kg over 1 hour Q8H, 200 - - 201 - - maximum daily dose: 30 mg/kg or 1.5 g/m2. Cream: apply 5 times daily at approximately 4 hr interval for 5-10 days. Oph oint: apply 10 mm 5 times daily approximately 4 hrly, continue for 3 days after healing. Supply: Oph oint 3% 4.5 g/tube 52:08 Anti-inflammatory Agents 52:08.08 Corticosteroids Rinderon A Oph Oint/Soln (ERIND) (ERINDE) Indication: Anti-inflammation of conjunctiva, cornea, sclera, choroid. Contraindication: Hypersensitivity to betamethasone products or other corticosteroids Adverse effect: Induce intraocular pressure elevation, glaucoma. Dosage: Soln—1 drop TID-QID; Oint—one to several times/day Supply: Oint 3 gm/tub; Soln 5 ml/bot, each g (ml) contains: betamethasone 0.1% & fradiomycin 0.35% Prednisolone acetate – “Pred forte Oph Susp” (EPRED) ［ C ］ Indication: Treatment of palpebral and bulbar conjunctivitis, corneal injury from chemical, radiation, thermal burns, or foreign body penetration. Contraindication: Acute untreated purulent ocular infections, acute superficial herpes simplex (dendritic keratitis), vaccinia, varicella and most other viral disease of the cornea and conjunctiva, ocular tuberculosis and fungal diseases of the eye. Adverse effect: Increased intraocular pressure, optic nerve damage, defects in the visual fields. Dosage and Administration: 1 to 2 drops instilled into the conjunctival sac 2 to 4 times daily. During the initial 24 to 48 hours the dosage may be safely increased to 2 drops every hour. Supply: Susp 1%, 5 ml/bot Fluorometholone (FML) – “Flumetholon Oph Susp” (EFLU2) ［ C ］ Indication: Fluorometholone is a topical corticosteroid used as an ophthalmic antiinflammatory agent. It is indicated in inflammation of the palpebral and bulbar conjunctiva, cornea, and anterior segment of the globe. Place in therapy: Fluorometholone may be of particular value in treating the indicated ocular conditions in those patients susceptible to elevation of intraocular pressure associated with corticosteroid therapy. Contraindication: Epithelial herpes simplex keratitis; Fungal diseases of the ocular structures; hypersensitivity to any of the components of the preparation; mycobacterial infection of the eye; vaccinia; varicella and other viral diseases of the cornea and conjunctiva. Adverse effect: Ophthalmic corticosteroids have caused elevation of intraocular pressure (IOP) with possible development of glaucoma, subcapsular cataracts, and delayed wound healing. Ocular infections especially fungal and viral infections have also been reported. Dosage: 1 drop to eye BID to QID Stability: Protect from light. Supply: Oph susp 0.02%, 5 ml/bot Triamcinolone acetonide – “Nasacort AQ” (ENASA) ［ C ］ Indication: Seasonal and perennial allergic rhinitis symptoms. Contraindication: Hypersensitivity to triamcinolone, systemic fungal infections Adverse effect: Rhinitis, headache, pharingitis, epistaxis, nasal irritation, dry mucous membrane, nasal congestion and sneezing. Dosage: For adults and children over 12 years old, the initial dose is 2 metered sprays (55 mcg/spray) in each nostril once a day (220 mcg/day); maintenance, 1 metered 200 - - 201 - - maximum daily dose: 30 mg/kg or 1.5 g/m2. Cream: apply 5 times daily at approximately 4 hr interval for 5-10 days. Oph oint: apply 10 mm 5 times daily approximately 4 hrly, continue for 3 days after healing. Supply: Oph oint 3% 4.5 g/tube 52:08 Anti-inflammatory Agents 52:08.08 Corticosteroids Rinderon A Oph Oint/Soln (ERIND) (ERINDE) Indication: Anti-inflammation of conjunctiva, cornea, sclera, choroid. Contraindication: Hypersensitivity to betamethasone products or other corticosteroids Adverse effect: Induce intraocular pressure elevation, glaucoma. Dosage: Soln—1 drop TID-QID; Oint—one to several times/day Supply: Oint 3 gm/tub; Soln 5 ml/bot, each g (ml) contains: betamethasone 0.1% & fradiomycin 0.35% Prednisolone acetate – “Pred forte Oph Susp” (EPRED) ［ C ］ Indication: Treatment of palpebral and bulbar conjunctivitis, corneal injury from chemical, radiation, thermal burns, or foreign body penetration. Contraindication: Acute untreated purulent ocular infections, acute superficial herpes simplex (dendritic keratitis), vaccinia, varicella and most other viral disease of the cornea and conjunctiva, ocular tuberculosis and fungal diseases of the eye. Adverse effect: Increased intraocular pressure, optic nerve damage, defects in the visual fields. Dosage and Administration: 1 to 2 drops instilled into the conjunctival sac 2 to 4 times daily. During the initial 24 to 48 hours the dosage may be safely increased to 2 drops every hour. Supply: Susp 1%, 5 ml/bot Fluorometholone (FML) – “Flumetholon Oph Susp” (EFLU2) ［ C ］ Indication: Fluorometholone is a topical corticosteroid used as an ophthalmic antiinflammatory agent. It is indicated in inflammation of the palpebral and bulbar conjunctiva, cornea, and anterior segment of the globe. Place in therapy: Fluorometholone may be of particular value in treating the indicated ocular conditions in those patients susceptible to elevation of intraocular pressure associated with corticosteroid therapy. Contraindication: Epithelial herpes simplex keratitis; Fungal diseases of the ocular structures; hypersensitivity to any of the components of the preparation; mycobacterial infection of the eye; vaccinia; varicella and other viral diseases of the cornea and conjunctiva. Adverse effect: Ophthalmic corticosteroids have caused elevation of intraocular pressure (IOP) with possible development of glaucoma, subcapsular cataracts, and delayed wound healing. Ocular infections especially fungal and viral infections have also been reported. Dosage: 1 drop to eye BID to QID Stability: Protect from light. Supply: Oph susp 0.02%, 5 ml/bot Triamcinolone acetonide – “Nasacort AQ” (ENASA) ［ C ］ Indication: Seasonal and perennial allergic rhinitis symptoms. Contraindication: Hypersensitivity to triamcinolone, systemic fungal infections Adverse effect: Rhinitis, headache, pharingitis, epistaxis, nasal irritation, dry mucous membrane, nasal congestion and sneezing. Dosage: For adults and children over 12 years old, the initial dose is 2 metered sprays (55 mcg/spray) in each nostril once a day (220 mcg/day); maintenance, 1 metered 202 - - 203 - - spray in each nostril once a day (110 mcg/day). For children 6 to 12 years old, the initial dosage is 110 mcg once daily, 1 spray in each nostril. Age < 6 yr, dosage not established. Supply: Nasal spray 55mcg/dose, 120 sprays/bot Mometasone furoate-“Nasonex” (ENASO) ［ C ］ Indication: Treatment of seasonal or perennial rhinitis & associated symptoms in adults, adolescents & children > 3 years. Treatment of mild to severe nasal polyps & associated symptoms in adults > 18 years. Precautions: Presence of untreated localized infection involving the nasal mucosa. Recent nasal surgery or trauma. Active or quiescent tuberculous infections of resp tract, or in untreated fungal, bacterial, systemic viral infections or ocular herpes simplex. Pregnancy, lactation. Adverse effect: Headache, epistaxis, pharyngitis, nasal burning, nasal irritation & nasal ulceration. Dosage: Prophylaxis & treatment of seasonal allergic or perennial rhinitis: adult & adolescent 2 sprays into each nostril once daily; children 3-11 years 1 spray into each nostril once daily. Treatment of nasal polyps: adult >18 yr 2 sprays in each nostril BID; may be reduced to 2 sprays in each nostril once daily once symptoms are adequately controlled. Supply: Nasal spray 50 mcg/actuation, 140 metered doses/bot Fluticasone propionate – “Flixonase”(EFLIX) “Flixotide”(EFLI2)( 專 ) Indication: Fluticasone is a medium-potency topical corticosteroid. It is also available as an inhalation product for the treatment of asthma. Place in therapy: Inhaled fluticasone has an oral bioavailability of less than 1%. It has a high affinity for the glucocorticoid receptor in the lungs. Fluticasone is also more lipophilic than its precursors and concentrates in the lungs to a higher extent, thus stronger antiinflammatory action and better therapeutic efficacy can be expected. Contraindication: Fluticasone is contraindicated in patients with hypersensitivity, status asthmaticus or other acute episodes of asthma. And use with cautions the inhaler should not be stopped abruptly or when transferring a patient from systemic corticosteroids to fluticasone inhaler. Caution is necessary especially during periods of stress. Weaning of systemic corticosteroids should be done slowly (eg, 2.5 mg per week of prednisone) when transferring to fluticasone inhaler. Adverse effect: Adverse effects associated with inhaled fluticasone include headache, pharyngitis, nasal congestion, dysphonia, and oral candidiasis. Dosage: Adults and children age over 12: 100 μg-1000 μg BID inhalation; for aqueous spray 2 puffs each nostril QD, maximal 4 puffs each nostril daily. Children: >4 yr 50-100 μg BID inhalation; age <12 y/o for aqueous nasal spray 1 puff each nostril QD, maximum 2 puffs each nosdril QD Pharmacokinetics: The plasma half-life of fluticasone is approximately 3 hours. Supply: Nasal spray 50 μg/metered spray, 120 doses/bot; Accuhaler 250 μg/dose, 60 doses/box. Salmeterol/fluticasone-“Seretide”(ESERT) ［ C ］ Indication: Chronic obstructive pulmonary disease, asthma. Pharmacology: Salmeterol is a selective long-acting β 2 agonist and offer effective protection against histamine-induced broncho-constriction and produce a longer duration of broncho-dilation, lasting for at least 12 hours. Fluticasone propionate has a potent glucocorticoid anti-inflammatory action within the lung, resulting in reduced symptom and exacerbations of asthma. Contraindication: Hypersensitivity to fluticasone, salmeterol, or any component of the formulation; status asthmaticus; acute episodes of asthma 202 - - 203 - - spray in each nostril once a day (110 mcg/day). For children 6 to 12 years old, the initial dosage is 110 mcg once daily, 1 spray in each nostril. Age < 6 yr, dosage not established. Supply: Nasal spray 55mcg/dose, 120 sprays/bot Mometasone furoate-“Nasonex” (ENASO) ［ C ］ Indication: Treatment of seasonal or perennial rhinitis & associated symptoms in adults, adolescents & children > 3 years. Treatment of mild to severe nasal polyps & associated symptoms in adults > 18 years. Precautions: Presence of untreated localized infection involving the nasal mucosa. Recent nasal surgery or trauma. Active or quiescent tuberculous infections of resp tract, or in untreated fungal, bacterial, systemic viral infections or ocular herpes simplex. Pregnancy, lactation. Adverse effect: Headache, epistaxis, pharyngitis, nasal burning, nasal irritation & nasal ulceration. Dosage: Prophylaxis & treatment of seasonal allergic or perennial rhinitis: adult & adolescent 2 sprays into each nostril once daily; children 3-11 years 1 spray into each nostril once daily. Treatment of nasal polyps: adult >18 yr 2 sprays in each nostril BID; may be reduced to 2 sprays in each nostril once daily once symptoms are adequately controlled. Supply: Nasal spray 50 mcg/actuation, 140 metered doses/bot Fluticasone propionate – “Flixonase”(EFLIX) “Flixotide”(EFLI2)( 專 ) Indication: Fluticasone is a medium-potency topical corticosteroid. It is also available as an inhalation product for the treatment of asthma. Place in therapy: Inhaled fluticasone has an oral bioavailability of less than 1%. It has a high affinity for the glucocorticoid receptor in the lungs. Fluticasone is also more lipophilic than its precursors and concentrates in the lungs to a higher extent, thus stronger antiinflammatory action and better therapeutic efficacy can be expected. Contraindication: Fluticasone is contraindicated in patients with hypersensitivity, status asthmaticus or other acute episodes of asthma. And use with cautions the inhaler should not be stopped abruptly or when transferring a patient from systemic corticosteroids to fluticasone inhaler. Caution is necessary especially during periods of stress. Weaning of systemic corticosteroids should be done slowly (eg, 2.5 mg per week of prednisone) when transferring to fluticasone inhaler. Adverse effect: Adverse effects associated with inhaled fluticasone include headache, pharyngitis, nasal congestion, dysphonia, and oral candidiasis. Dosage: Adults and children age over 12: 100 μg-1000 μg BID inhalation; for aqueous spray 2 puffs each nostril QD, maximal 4 puffs each nostril daily. Children: >4 yr 50-100 μg BID inhalation; age <12 y/o for aqueous nasal spray 1 puff each nostril QD, maximum 2 puffs each nosdril QD Pharmacokinetics: The plasma half-life of fluticasone is approximately 3 hours. Supply: Nasal spray 50 μg/metered spray, 120 doses/bot; Accuhaler 250 μg/dose, 60 doses/box. Salmeterol/fluticasone-“Seretide”(ESERT) ［ C ］ Indication: Chronic obstructive pulmonary disease, asthma. Pharmacology: Salmeterol is a selective long-acting β 2 agonist and offer effective protection against histamine-induced broncho-constriction and produce a longer duration of broncho-dilation, lasting for at least 12 hours. Fluticasone propionate has a potent glucocorticoid anti-inflammatory action within the lung, resulting in reduced symptom and exacerbations of asthma. Contraindication: Hypersensitivity to fluticasone, salmeterol, or any component of the formulation; status asthmaticus; acute episodes of asthma 204 - - 205 - - Adverse effect: Upper respiratory tract infection, headache, serum glucose increased, serum potassium decreased, hoarseness/dysphonia, oral candidiasis Dosage: Adults (COPD): Seretide-250 Accuhaler one inhalation twice daily, 12 hours apart. Supply: Accuhaler 60 inhalations/bot, each single provides 50 mcg salmeterol and 250 mcg fluticasone Formoterol/budesonide-“Symbicort” (ESYMB) Indication: Combined formoterol/budesonide is indicated in asthmatic patients experiencing persistent symptoms on inhaled glucocorticoids alone. Place in therapy: Combined formoterol/ budesonide (fixed-dose combination or separate agents) appears useful in this setting; the fixed combination offers improved compliance and greater patient convenience, although separate administration of these agents may be indicated for optimal symptom control. Contraindication: Prior hypersensitivity to budesonide or formoterol Adverse effect: Adverse effects are tremor, insomnia, restlessness, headache, hypokalemia, nausea, and dry mouth; cardiovascular effects are minimal with therapeutic doses. Headache, insomnia, dyspepsia, dry mouth, abdominal pain, oral candidiasis, dysphonia, and respiratory infection have been observed with budesonide inhalation. Adrenal suppression is uncommon with inhaled budesonide in daily doses of less than 800μg. Dosage: Adults: Inhalation 1-2 doses BID Pharmacokinetics: Both agents are metabolized in the liver; urinary excretion is about 25% for formoterol (unchanged) and 60% for budesonide (as metabolites). Budesonide has an elimination half-life of 2 to 3 hours. Supply: Inhalation 160 mcg budesonide/4.5 mcg formoterol in each dose, 120 doses/device Triamcinolone acetonide- “Nincort”(ENINC) Indication: Acute and chronic oral lesions. Contraindication: Same as hydrocortisone. Administration: Apply a small dab (about 1/4 inch) to the lesion at bed time, or 2-3 times a day after meals. Supply: Oral gel 3.5 g/tube, each gm contains triamcinolone 1 mg. 52:16 Local Anesthetics Proparacaine HCl – “Alcaine Oph Solution” (EALCA)( 特 ) Indication: Short-term local anesthesia in the eye. Adverse effect: Mild transient corneal edema may occur but is unusual. Adminstration: For simple surgical procedure use 1-2 drops topically. For cataract extraction, 1 drop is instilled every 5-10 mins to a total of 5-7 application (onset: 20 secs; duration: 15 mins). Supply: Soln 0.5%, 15 ml/bot. 52:24 Mydriatics Atropine Eye Soln (EATR1) Indication: Mydriatic and cyclopegic agent, uveitis, amblyopia Contraindication: Patient with glaucoma. Adverse effect: Contact dermatitis involving the lids and conjunctiva is frequently seen after the topical use, and acceleration of the heart rate may occur after topical application. Dosage: 1 or 2 drops of solution or ointment instilled into the eye one to three times a day. Each drops of 0.5% solution of atropine contains 0.25 mg of atropine. Supply: Soln 0.5% 10ml/bot Tropicamide – “Mydriacyl Oph Solution” (EMYDR)( 特 ) Indication: Mydriasis & cycloplegia for diagnostic 204 - - 205 - - Adverse effect: Upper respiratory tract infection, headache, serum glucose increased, serum potassium decreased, hoarseness/dysphonia, oral candidiasis Dosage: Adults (COPD): Seretide-250 Accuhaler one inhalation twice daily, 12 hours apart. Supply: Accuhaler 60 inhalations/bot, each single provides 50 mcg salmeterol and 250 mcg fluticasone Formoterol/budesonide-“Symbicort” (ESYMB) Indication: Combined formoterol/budesonide is indicated in asthmatic patients experiencing persistent symptoms on inhaled glucocorticoids alone. Place in therapy: Combined formoterol/ budesonide (fixed-dose combination or separate agents) appears useful in this setting; the fixed combination offers improved compliance and greater patient convenience, although separate administration of these agents may be indicated for optimal symptom control. Contraindication: Prior hypersensitivity to budesonide or formoterol Adverse effect: Adverse effects are tremor, insomnia, restlessness, headache, hypokalemia, nausea, and dry mouth; cardiovascular effects are minimal with therapeutic doses. Headache, insomnia, dyspepsia, dry mouth, abdominal pain, oral candidiasis, dysphonia, and respiratory infection have been observed with budesonide inhalation. Adrenal suppression is uncommon with inhaled budesonide in daily doses of less than 800μg. Dosage: Adults: Inhalation 1-2 doses BID Pharmacokinetics: Both agents are metabolized in the liver; urinary excretion is about 25% for formoterol (unchanged) and 60% for budesonide (as metabolites). Budesonide has an elimination half-life of 2 to 3 hours. Supply: Inhalation 160 mcg budesonide/4.5 mcg formoterol in each dose, 120 doses/device Triamcinolone acetonide- “Nincort”(ENINC) Indication: Acute and chronic oral lesions. Contraindication: Same as hydrocortisone. Administration: Apply a small dab (about 1/4 inch) to the lesion at bed time, or 2-3 times a day after meals. Supply: Oral gel 3.5 g/tube, each gm contains triamcinolone 1 mg. 52:16 Local Anesthetics Proparacaine HCl – “Alcaine Oph Solution” (EALCA)( 特 ) Indication: Short-term local anesthesia in the eye. Adverse effect: Mild transient corneal edema may occur but is unusual. Adminstration: For simple surgical procedure use 1-2 drops topically. For cataract extraction, 1 drop is instilled every 5-10 mins to a total of 5-7 application (onset: 20 secs; duration: 15 mins). Supply: Soln 0.5%, 15 ml/bot. 52:24 Mydriatics Atropine Eye Soln (EATR1) Indication: Mydriatic and cyclopegic agent, uveitis, amblyopia Contraindication: Patient with glaucoma. Adverse effect: Contact dermatitis involving the lids and conjunctiva is frequently seen after the topical use, and acceleration of the heart rate may occur after topical application. Dosage: 1 or 2 drops of solution or ointment instilled into the eye one to three times a day. Each drops of 0.5% solution of atropine contains 0.25 mg of atropine. Supply: Soln 0.5% 10ml/bot Tropicamide – “Mydriacyl Oph Solution” (EMYDR)( 特 ) Indication: Mydriasis & cycloplegia for diagnostic 206 - - 207 - - procedures. Contraindication: Primary glaucoma or a tendency toward glaucoma. Adverse effect: Increased intraocular pressure. Psychotic reactions, behavioral disturbances, cardioresp collapse in children & some adults; transient stinging, dru mouth, blurred vision, photophobia with or without corneal staining, tachycardia, headache, parasympathetic stimulation, allergic reactions. Dosage: Refraction 1-2 drop repeated in 5 mins. Fundus exam 1-2 drop. 15-20 mins prior to exam. Supply: Oph soln 1 % 5 ml/bot Cyclopentolate HCl -”Cyclogyl Oph Solution” (ECYCL) ［ C ］ Indication: Mydriasis & cycloplegia. Contraindication: Narrow-angle glaucoma. Adverse effect: Increased intraocular pressure, burning, photophobia, blurred vision, irritation, hyperemia, conjunctivitis, blepharoconjunctivitis, punctuate keratitis, synechiae. Dosage: Adult & children 1 or 2 drop which may be repeated in 5-10 mins if necessary. Small infant 1 drop in each eye. Supply: Eye soln 1 % 5 ml/bot. 52:28 Mouthwashes and Gargles Chlorhexidine Gluconate- “Parmason”(EPARM) Indication: Chlorhexidine is an antiseptic antimicrobial which is active against gram-positive and gram-negative bacteria, facultative anaerobes and aerobes, and yeast. Chlorhexidine is indicated for topical use in preoperative skin preparation, skin wound and general skin cleansing, and as a surgical hand scrub for health care professionals. Orally, chlorhexidine is indicated as a mouth rinse for treating gingivitis between dental visits. Place in therapy: Oral chlorhexidine mouth rinses have been effective in decreasing plaque formation and in controlling gingivitis. The formulation should be considered as an adjunct to mechanical toothbrushing and professional dental prophylaxis rather than as a substitute. Chlorhexidine mouthrinse may be used as a short-term substitute for toothbrushing in situations where the patient is unable to tolerate mechanical stimulation of the gums, such as after oral surgery. Adverse effect: The primary adverse effect with topical chlorhexidine is skin irritation. Deafness has been reported when chlorhexidine is instilled into the middle ear through a perforated eardrum. With oral rinsing, the most common adverse effect of chlorhexidine is tooth staining. This staining is a cosmetic problem and may be removed with professional dental cleaning. Transient alterations in taste perception have also been reported with oral chlorhexidine. Contraindication: Hypersensitivity to chlorhexidine Dosage: As an oral rinse, about 15 ml of chlorhexidine mouth rinse should be used for 30 seconds twice daily after toothbrushing. Oral mouth rinse should be expectorated, not swallowed. Supply: Gargle soln 0.2% 200 ml/bot 52:32 Vasoconstrictors Phenylephrine (EPHEN) Indication: Mydriasis. Contraindication: Narrow-angle glaucoma. Adverse effect: Eye irritation & pain, blurred vision, photophobia. May also cause systemic effects like arrhythmias, hypertension, coronary artery spasm. Dosage: 1 drop as required. Supply: Eye drops 100 mg/ml, 5 ml/bot 206 - - 207 - - procedures. Contraindication: Primary glaucoma or a tendency toward glaucoma. Adverse effect: Increased intraocular pressure. Psychotic reactions, behavioral disturbances, cardioresp collapse in children & some adults; transient stinging, dru mouth, blurred vision, photophobia with or without corneal staining, tachycardia, headache, parasympathetic stimulation, allergic reactions. Dosage: Refraction 1-2 drop repeated in 5 mins. Fundus exam 1-2 drop. 15-20 mins prior to exam. Supply: Oph soln 1 % 5 ml/bot Cyclopentolate HCl -”Cyclogyl Oph Solution” (ECYCL) ［ C ］ Indication: Mydriasis & cycloplegia. Contraindication: Narrow-angle glaucoma. Adverse effect: Increased intraocular pressure, burning, photophobia, blurred vision, irritation, hyperemia, conjunctivitis, blepharoconjunctivitis, punctuate keratitis, synechiae. Dosage: Adult & children 1 or 2 drop which may be repeated in 5-10 mins if necessary. Small infant 1 drop in each eye. Supply: Eye soln 1 % 5 ml/bot. 52:28 Mouthwashes and Gargles Chlorhexidine Gluconate- “Parmason”(EPARM) Indication: Chlorhexidine is an antiseptic antimicrobial which is active against gram-positive and gram-negative bacteria, facultative anaerobes and aerobes, and yeast. Chlorhexidine is indicated for topical use in preoperative skin preparation, skin wound and general skin cleansing, and as a surgical hand scrub for health care professionals. Orally, chlorhexidine is indicated as a mouth rinse for treating gingivitis between dental visits. Place in therapy: Oral chlorhexidine mouth rinses have been effective in decreasing plaque formation and in controlling gingivitis. The formulation should be considered as an adjunct to mechanical toothbrushing and professional dental prophylaxis rather than as a substitute. Chlorhexidine mouthrinse may be used as a short-term substitute for toothbrushing in situations where the patient is unable to tolerate mechanical stimulation of the gums, such as after oral surgery. Adverse effect: The primary adverse effect with topical chlorhexidine is skin irritation. Deafness has been reported when chlorhexidine is instilled into the middle ear through a perforated eardrum. With oral rinsing, the most common adverse effect of chlorhexidine is tooth staining. This staining is a cosmetic problem and may be removed with professional dental cleaning. Transient alterations in taste perception have also been reported with oral chlorhexidine. Contraindication: Hypersensitivity to chlorhexidine Dosage: As an oral rinse, about 15 ml of chlorhexidine mouth rinse should be used for 30 seconds twice daily after toothbrushing. Oral mouth rinse should be expectorated, not swallowed. Supply: Gargle soln 0.2% 200 ml/bot 52:32 Vasoconstrictors Phenylephrine (EPHEN) Indication: Mydriasis. Contraindication: Narrow-angle glaucoma. Adverse effect: Eye irritation & pain, blurred vision, photophobia. May also cause systemic effects like arrhythmias, hypertension, coronary artery spasm. Dosage: 1 drop as required. Supply: Eye drops 100 mg/ml, 5 ml/bot 208 - - 209 - - 52:40 Antiglaucoma Agents 52:40.08 β -Adrenergic Blocking Agents Carteolol HCl –“Arteoptic Oph Solution”(EARTE) ［ C ］ Indication: Carteolol is a long-acting nonselective beta-adrenergic blocking agent with moderate intrinsic sympathomimetic activity, no membrane stabilizing activity and low lipid solubility. Carteolol ophthalmic solution is indicated, alone or in combination with other intraocular pressure lowering agents, for the treatment of chronic open angle glaucoma and ocular hypertension. Place in therapy: Carteolol appears to be comparable in efficacy to betaxolol and timolol, but offers no clear advantages over either agent. Contraindication: Ocular administration can result in some systemic absorption; the precautionary statements r egarding oral and ocular administration are the same. It is contraindicated in patient with bronchial asthma or chronic obstructive pulmonary disease, cardiogenic shock, hypersensitivity to carteolol, overt cardiac failure, severe sinus bradycardia. Adverse effect: Transient eye irritation, burning, tearing, conjunctival hyperemia, and edema have been reported in approximately 25% of patients following ocular administration of carteolol. Other effects reported include blurred or cloudy vision, light sensitivity, decreased night vision, ptosis, redness, abnormal corneal staining, blepharoconjunctivitis, and corneal sensitivity. Dosage: Adults: glaucoma: one drop BID Pharmacokinetics: Peak response of ophthalmic soln: 2 to 3 hours Stability: Store at 15 to 25 ℃ and protect from light Supply: Ophth soln 2% 5 ml/bot Timolol maleate – “Timoptol XE Oph Solution” (ETIM5) ［ C ］ Indication: Treatment of chronic open-angle glaucoma. Contraindication: Patient with bronchospasm, severe chronic obstructive pulmonary disease, or uncontrolled cardiac failure. Adverse effect: Bradycardia, palpitation, hypotension, syncope, congestive heart failure, exacerbation of intrinsic bronchial asthma, psychic disorientation, and confusion. It is advisable to monitor pulse rate and blood pressure in patients receiving timolol. Dosage: 1 drop QD Supply: Oph soln 0.5%, 2.5 ml/bot. 52:40.12 Carbonic Anhydrase Inhibitors Acetazolamide- “Diamox” (ODIAMO) ［ C ］ Indication: Acetazolamide is a useful adjunct to the therapy of open angle glaucoma, seizure, edema, and CHF. It has been used to prevent acute mountain sickness. Contraindication: Patients with hyperkalemia or progressive renal failure; concomitant with potassium-sparing diuretics and potassium salt. Adverse effect: Nausea, vomiting, abdominal pain, diarrhea or constipation, thirst, dizziness, hyperkalemia. Dosage: Antiglaucoma: 0.25-1.5g/day in divided doses. Anticonvulsion: 8-30 mg/kg/day in divided doses; maximum daily dose: 1.5 g. Prophylaxis of mountain sickness: 250mg BID-TID prior to ascent. Diuresis: 250-375 mg QD. Rapid tolerance to acetazolamide diuresis develops when used on daily basis. To obtain maximal diuretic effect, an alternate day dosing is recommended Supply: Tab 250 mg Dorzolamide – “Trusopt”(ETRUS) Indication: Dorzolamide is a carbonic anhydrase inhibitor for topical application. Dorzolamide 2% ophthalmic solution given 2 to 3 times daily has been demonstrated to be effective in lowering intraocular pressure in patients with open-angle glaucoma or ocular hypertension, with an approved dosing regimen of 3 times daily 208 - - 209 - - 52:40 Antiglaucoma Agents 52:40.08 β -Adrenergic Blocking Agents Carteolol HCl –“Arteoptic Oph Solution”(EARTE) ［ C ］ Indication: Carteolol is a long-acting nonselective beta-adrenergic blocking agent with moderate intrinsic sympathomimetic activity, no membrane stabilizing activity and low lipid solubility. Carteolol ophthalmic solution is indicated, alone or in combination with other intraocular pressure lowering agents, for the treatment of chronic open angle glaucoma and ocular hypertension. Place in therapy: Carteolol appears to be comparable in efficacy to betaxolol and timolol, but offers no clear advantages over either agent. Contraindication: Ocular administration can result in some systemic absorption; the precautionary statements r egarding oral and ocular administration are the same. It is contraindicated in patient with bronchial asthma or chronic obstructive pulmonary disease, cardiogenic shock, hypersensitivity to carteolol, overt cardiac failure, severe sinus bradycardia. Adverse effect: Transient eye irritation, burning, tearing, conjunctival hyperemia, and edema have been reported in approximately 25% of patients following ocular administration of carteolol. Other effects reported include blurred or cloudy vision, light sensitivity, decreased night vision, ptosis, redness, abnormal corneal staining, blepharoconjunctivitis, and corneal sensitivity. Dosage: Adults: glaucoma: one drop BID Pharmacokinetics: Peak response of ophthalmic soln: 2 to 3 hours Stability: Store at 15 to 25 ℃ and protect from light Supply: Ophth soln 2% 5 ml/bot Timolol maleate – “Timoptol XE Oph Solution” (ETIM5) ［ C ］ Indication: Treatment of chronic open-angle glaucoma. Contraindication: Patient with bronchospasm, severe chronic obstructive pulmonary disease, or uncontrolled cardiac failure. Adverse effect: Bradycardia, palpitation, hypotension, syncope, congestive heart failure, exacerbation of intrinsic bronchial asthma, psychic disorientation, and confusion. It is advisable to monitor pulse rate and blood pressure in patients receiving timolol. Dosage: 1 drop QD Supply: Oph soln 0.5%, 2.5 ml/bot. 52:40.12 Carbonic Anhydrase Inhibitors Acetazolamide- “Diamox” (ODIAMO) ［ C ］ Indication: Acetazolamide is a useful adjunct to the therapy of open angle glaucoma, seizure, edema, and CHF. It has been used to prevent acute mountain sickness. Contraindication: Patients with hyperkalemia or progressive renal failure; concomitant with potassium-sparing diuretics and potassium salt. Adverse effect: Nausea, vomiting, abdominal pain, diarrhea or constipation, thirst, dizziness, hyperkalemia. Dosage: Antiglaucoma: 0.25-1.5g/day in divided doses. Anticonvulsion: 8-30 mg/kg/day in divided doses; maximum daily dose: 1.5 g. Prophylaxis of mountain sickness: 250mg BID-TID prior to ascent. Diuresis: 250-375 mg QD. Rapid tolerance to acetazolamide diuresis develops when used on daily basis. To obtain maximal diuretic effect, an alternate day dosing is recommended Supply: Tab 250 mg Dorzolamide – “Trusopt”(ETRUS) Indication: Dorzolamide is a carbonic anhydrase inhibitor for topical application. Dorzolamide 2% ophthalmic solution given 2 to 3 times daily has been demonstrated to be effective in lowering intraocular pressure in patients with open-angle glaucoma or ocular hypertension, with an approved dosing regimen of 3 times daily 210 - - 211 - - Place in therapy: The most obvious advantage over systemic carbonic anhydrase inhibitor therapy is the smaller dose administered and minimal adverse effects. It is especially useful in patients for whom beta-blockers are contraindicated. Dorzolamide also be used in combination with a beta-blocker where it provides further reduction in intraocular pressures. Contraindication: Cardiogenic shock, current or history of bronchial asthma, hypersensitivity, Overt cardiac failure, second or third degree atrioventricular block, severe chronic obstructive pulmonary disease, sinus bradycardia; The preservative Benzalkonium chloide may be absorbed by contact lens, should a 15-min lag before putting on contact lens. Adverse effect: Major local adverse effects in clinical studies have included burning, stinging discomfort upon instillation, superficial punctate keratitis, ocular allergic reaction, blurred vision, tearing, dryness, and photophobia; systemic reactions include bitter taste, headache, nausea, and asthenia/fatigue. Occular reactions, headache or vertigo are the most common reasons for drug withdrawal. Dosage: Adults: glaucoma or ocular hypertension: 1 drop Q8H-Q12H. Children: The safety and efficacy in children has not been determined Supply: Ophth soln 2%, 5 ml/bot Dorzolamide/Timolol-“Cosopt” (ECOSO) ［ C/D ］ Indication: Reduction of elevated intraocular pressure in patients with open-angle glaucoma or ocular hypertension who are insufficiently responsive to b-blokcers. Contraindication: Bronchial asthma or a history of bronchial asthma, or severe COPD, sinus bradycardia, 2nd or 3rd degree AV block, overt cardiac failure, cardiogenic shock. Adverse effect: Taste perversion, ocular burning &/or stinging, conjunctival hyperemia, blurred vision, superficial punctate keratitis or eye itching. Dosage: 1 drop into the affected eyes bid. Supply: Ophth soln 2% dorzolamide, 0.5% timolol, 5 ml/bot. 52:40.20 Miotics Pilocarpine nitrate Oph Solution - “OPD”(EOPD2) ［ C ］ Indication: As a miotic; to reduce elevated intraocular pressure in glaucoma; alternated with mydriatics to break up adhesions between the iris and lens. Adverse effect: Common adverse effects associated with the ophthalmic preparations include burning, itching or smarting of the eyes, blurred vision, difficult with night vision, red eyes, headaches, and nervousness. Dose: Glaucoma: 1 drop in the eyes of a 1% or 2% solution Q6-8H Pharmacokinetics: Miosis usually occurs within 10 to 30 minutes of instillation; maximal decrease in intraocular pressure occurs at 2 to 4 hours. Supply: Soln 2%, 10 ml/bot. Carbachol-“Miostat”(IMIOS)( 特 ) ［ C ］ Indication: Intraocular use for miosis during surgery. Precautions: Patients with acute cardiac failure, bronchial asthma, peptic ulcer, hyperthyroidism, GI spasm, urinary tract obstruction & Parkinson’s disease. Adverse effect: Corneal clouding, bullous keratopathy, post-op iritis. Dosage: Instill no more than 1/2 ml into the anterior chamber. Supply: Vial 0.01% 1.5 ml Neostigmine-“O.N.S.D.”(EONSD) ［ C ］ Indication: Relief of fatigue of ocular muscle. Dosage: 1-2 drop 3-5 times daily. Supply: Eye Soln 0.01 % 10 ml/bot. 210 - - 211 - - Place in therapy: The most obvious advantage over systemic carbonic anhydrase inhibitor therapy is the smaller dose administered and minimal adverse effects. It is especially useful in patients for whom beta-blockers are contraindicated. Dorzolamide also be used in combination with a beta-blocker where it provides further reduction in intraocular pressures. Contraindication: Cardiogenic shock, current or history of bronchial asthma, hypersensitivity, Overt cardiac failure, second or third degree atrioventricular block, severe chronic obstructive pulmonary disease, sinus bradycardia; The preservative Benzalkonium chloide may be absorbed by contact lens, should a 15-min lag before putting on contact lens. Adverse effect: Major local adverse effects in clinical studies have included burning, stinging discomfort upon instillation, superficial punctate keratitis, ocular allergic reaction, blurred vision, tearing, dryness, and photophobia; systemic reactions include bitter taste, headache, nausea, and asthenia/fatigue. Occular reactions, headache or vertigo are the most common reasons for drug withdrawal. Dosage: Adults: glaucoma or ocular hypertension: 1 drop Q8H-Q12H. Children: The safety and efficacy in children has not been determined Supply: Ophth soln 2%, 5 ml/bot Dorzolamide/Timolol-“Cosopt” (ECOSO) ［ C/D ］ Indication: Reduction of elevated intraocular pressure in patients with open-angle glaucoma or ocular hypertension who are insufficiently responsive to b-blokcers. Contraindication: Bronchial asthma or a history of bronchial asthma, or severe COPD, sinus bradycardia, 2nd or 3rd degree AV block, overt cardiac failure, cardiogenic shock. Adverse effect: Taste perversion, ocular burning &/or stinging, conjunctival hyperemia, blurred vision, superficial punctate keratitis or eye itching. Dosage: 1 drop into the affected eyes bid. Supply: Ophth soln 2% dorzolamide, 0.5% timolol, 5 ml/bot. 52:40.20 Miotics Pilocarpine nitrate Oph Solution - “OPD”(EOPD2) ［ C ］ Indication: As a miotic; to reduce elevated intraocular pressure in glaucoma; alternated with mydriatics to break up adhesions between the iris and lens. Adverse effect: Common adverse effects associated with the ophthalmic preparations include burning, itching or smarting of the eyes, blurred vision, difficult with night vision, red eyes, headaches, and nervousness. Dose: Glaucoma: 1 drop in the eyes of a 1% or 2% solution Q6-8H Pharmacokinetics: Miosis usually occurs within 10 to 30 minutes of instillation; maximal decrease in intraocular pressure occurs at 2 to 4 hours. Supply: Soln 2%, 10 ml/bot. Carbachol-“Miostat”(IMIOS)( 特 ) ［ C ］ Indication: Intraocular use for miosis during surgery. Precautions: Patients with acute cardiac failure, bronchial asthma, peptic ulcer, hyperthyroidism, GI spasm, urinary tract obstruction & Parkinson’s disease. Adverse effect: Corneal clouding, bullous keratopathy, post-op iritis. Dosage: Instill no more than 1/2 ml into the anterior chamber. Supply: Vial 0.01% 1.5 ml Neostigmine-“O.N.S.D.”(EONSD) ［ C ］ Indication: Relief of fatigue of ocular muscle. Dosage: 1-2 drop 3-5 times daily. Supply: Eye Soln 0.01 % 10 ml/bot. 212 - - 213 - - 52:40.28 Prostaglandin Analogs Travoprost – “Travatan”(ETRAV) ［ C ］ Indication: Open-angle glaucoma, ocular hypertension Pharmacology: Travoprost is an isopropyl ester prodrug, and is rapidly hydrolyzed to active free acid form following ocular instillation. Travoprost free acid appears to facilitate a reduction in intra-ocular pressure by increasing uveoscleral outflow. Pharmakinetics: Onset of action: ~2 hours, Peak effect: 12 hours Contraindications: Hypersensitivity to travoprost or any component of the formulation; pregnancy Adverse effect: Common: ocular hyperemia, foreign body sensation, blepharitis, blurred vision, itching of eye, pain in eye, reduced visual acuity, iris pigmentation. Pigmentation of periorbital tissue (eyelid) and eyelash changes (eg, increased length, thickness, number and/or pigmentation), cataract. Serious: Angina pectoris, bradycardia, chest pain, hypertension, and hypotension Dosage: Adults: instill 1 drop into affected eye(s) once daily in the evening; Do not exceed once-daily dosing (may decrease IOP-lowering effect). Supply: Ophth soln 0.004%, 2.5 ml/bot Latanoprost – “Xalatan”(EXALA) Indication: Latanoprost is a phenyl-substituted prostaglandin F2-alpha analogue indicated for the treatment of ocular hypertension and glaucoma. Place in therapy: Its concomitant use with timolol monotherapy and timolol/dorzolamide combined therapy has significantly reduced intraocular pressure in unresponsive patients, until further data regarding iris pigmentation are available, the drug is recommended only as second-line therapy in patients with persistent increases in intraocular pressure despite optimal doses of other antiglaucoma agents. Contraindication: Hypersensitivity to latanoprost or benzalkonium chloride; use with caution in patient with acute angle-closure, active ocular infection or inflammation, concomitant use in patients with contact lenses; lenses may be reinserted 15 minutes after latanoprost instillation Adverse effect: Mild conjunctival hyperemia and local irritation, which have been clinically acceptable. Iris pigmentation has been problematic with its long-term use. Dosage: Adults: One drop of a 0.005% ophthalmic solution QD Pharmacokinetics: Latanoprost is a prodrug, and is rapidly hydrolyzed to hydrophilic free acids following ocular instillation. Stability: Store opened bottle at room temperature up to 25 ℃ for six weeks. Supply: Eye drop 0.005%, 2.5ml/bot Latanoprost/Timolol-“Xalacom”(ELATA) Indication: Reduction of intraocular pressure in patients with open angle glaucoma & ocular hypertension who are insufficiently responsive to topical b-blockers. Contraindication: Hypersensitivity, reactive airway disease including bronchial asthma or a history of bronchial asthma, severe COPD. Sinus bradycardia, 2nd or 3 rd degree AV block, overt cardiac failure, cardiogenic shock. Adverse effect: Eye irritation, eye hyperemia, corneal disorders, conjunctivitis, blepharitis, eye pain, headache, skin rash. Dosage: 1 drop in the affected eyes once daily in the morning. Supply: Ophth soln latanoprost 0.005%, timolol 0.5%; 2.5 ml/bot. 52:92 EENT Drugs, Miscellaneous Quinax Oph Solution (EQUIN)(EQUI1) 212 - - 213 - - 52:40.28 Prostaglandin Analogs Travoprost – “Travatan”(ETRAV) ［ C ］ Indication: Open-angle glaucoma, ocular hypertension Pharmacology: Travoprost is an isopropyl ester prodrug, and is rapidly hydrolyzed to active free acid form following ocular instillation. Travoprost free acid appears to facilitate a reduction in intra-ocular pressure by increasing uveoscleral outflow. Pharmakinetics: Onset of action: ~2 hours, Peak effect: 12 hours Contraindications: Hypersensitivity to travoprost or any component of the formulation; pregnancy Adverse effect: Common: ocular hyperemia, foreign body sensation, blepharitis, blurred vision, itching of eye, pain in eye, reduced visual acuity, iris pigmentation. Pigmentation of periorbital tissue (eyelid) and eyelash changes (eg, increased length, thickness, number and/or pigmentation), cataract. Serious: Angina pectoris, bradycardia, chest pain, hypertension, and hypotension Dosage: Adults: instill 1 drop into affected eye(s) once daily in the evening; Do not exceed once-daily dosing (may decrease IOP-lowering effect). Supply: Ophth soln 0.004%, 2.5 ml/bot Latanoprost – “Xalatan”(EXALA) Indication: Latanoprost is a phenyl-substituted prostaglandin F2-alpha analogue indicated for the treatment of ocular hypertension and glaucoma. Place in therapy: Its concomitant use with timolol monotherapy and timolol/dorzolamide combined therapy has significantly reduced intraocular pressure in unresponsive patients, until further data regarding iris pigmentation are available, the drug is recommended only as second-line therapy in patients with persistent increases in intraocular pressure despite optimal doses of other antiglaucoma agents. Contraindication: Hypersensitivity to latanoprost or benzalkonium chloride; use with caution in patient with acute angle-closure, active ocular infection or inflammation, concomitant use in patients with contact lenses; lenses may be reinserted 15 minutes after latanoprost instillation Adverse effect: Mild conjunctival hyperemia and local irritation, which have been clinically acceptable. Iris pigmentation has been problematic with its long-term use. Dosage: Adults: One drop of a 0.005% ophthalmic solution QD Pharmacokinetics: Latanoprost is a prodrug, and is rapidly hydrolyzed to hydrophilic free acids following ocular instillation. Stability: Store opened bottle at room temperature up to 25 ℃ for six weeks. Supply: Eye drop 0.005%, 2.5ml/bot Latanoprost/Timolol-“Xalacom”(ELATA) Indication: Reduction of intraocular pressure in patients with open angle glaucoma & ocular hypertension who are insufficiently responsive to topical b-blockers. Contraindication: Hypersensitivity, reactive airway disease including bronchial asthma or a history of bronchial asthma, severe COPD. Sinus bradycardia, 2nd or 3 rd degree AV block, overt cardiac failure, cardiogenic shock. Adverse effect: Eye irritation, eye hyperemia, corneal disorders, conjunctivitis, blepharitis, eye pain, headache, skin rash. Dosage: 1 drop in the affected eyes once daily in the morning. Supply: Ophth soln latanoprost 0.005%, timolol 0.5%; 2.5 ml/bot. 52:92 EENT Drugs, Miscellaneous Quinax Oph Solution (EQUIN)(EQUI1) 214 - - 215 - - Indication: Quinax have been used in senile cataract, traumatic cataract, congenital cataract and secondary cataract. Place in therapy: Quinax has been suggested to prevent radical oxidation of SH group in soluble protein contained in the lens. Contraindication: Patient has hypersensitivity to any components of the preparation. Adverse effect: No data available. Dosage: Topically instill 2 drops 3-5 times daily. Stability: Discard one month after opening. Supply: Ophth soln 5 ml/bot, 15 ml/bot, each ml contain: sodium dihydroazapentacene polysulfonate 0.15 mg, boric acid 6.3 mg and sodium borate 0.3 mg Artelac Oph Solution (EARTEL) Indication: Artelac is a supplementary of lacrimae that can be used in laceimal gland defect. Dosage: 1 drop if necessary Supply: Oph soln 10 ml/bot, each ml contain: Hydroxypropylmethylcellulose (HPMC) 3.20 mg Cetrimide 0.10 mg Disodium phosphate Dodecahydrate q.s. Sod Dihydrogen phosphate Dihydrate q.s. Disodium edetate q.s. Sorbitol 45.00 mg Water for injection q.s. Carbomer Gel-“Vidisic”(EVIDI) Indication: High molecular weight polymers of acrylic acid cross-linked with polyalkenyl ethers of sugars or polyalcohols. Topically 0.2 or 0.3%, are used topically as tear substitutes in the management of dry eye. Contraindication: Hypersensitivity to cetrimide Adverse effect: Temperory blurrd vision after application. Dosage: Topically use 4-5 times daily Stability: After open the original bottle, it can be stroed at 25 ℃ for one month. Supply: Oph gel 2 mg/g, 10 g/tube. 56:00 Gastrointestinal Drugs 56:04 Antacids and Adsorbents Lederscon (OLEDE) Indication: Peptic ulcer, gastritis, gastroxia. Pregnancy risk category: B Adverse effect: Same as Aluminum and Magnesium salt. Dosage: 1-2 Tabs TID PC & HS, chewable. Supply: Tab aluminium hydroxide gel 334mg, MgO 166mg, antifoam AF emulsion 36.7 mg Antasil-B (BANTB) Indication: Peptic ulcer, gastroxia, gastralgia. Adverse effect: Phosphate depletion, hypermagnesiemia in renal failure. Dosage: 7.5-10 ml tid-qid. Supply: Susp 500 ml/bot, each gm contain: aluminum hydroxide gel 240mg, Mag. hydroxide paste 133.2mg Alugel (OALUG) Indication: Peptic ulcer, peptic esophagitis, gastroxia, gastritis. Contraindication: Gastric outlet obstruction. Adverse effect: Constipation, intestinal obstruction, hypophos-phatemia for prolonged use. Dosage: 1-3 Tabs TID or QID between meals & HS. Supply: Tab 300mg Magnesium oxide (OMGO) Indication: Gastroxia, peptic ulcer, constipation. Contraindication: Moderate or severe renal impairment. Adverse effect: Diarrhea, hypermagnesiemia in renal failure. Dosage: Antacid 250-500 mg daily; laxative 2-4 g daily. 214 - - 215 - - Indication: Quinax have been used in senile cataract, traumatic cataract, congenital cataract and secondary cataract. Place in therapy: Quinax has been suggested to prevent radical oxidation of SH group in soluble protein contained in the lens. Contraindication: Patient has hypersensitivity to any components of the preparation. Adverse effect: No data available. Dosage: Topically instill 2 drops 3-5 times daily. Stability: Discard one month after opening. Supply: Ophth soln 5 ml/bot, 15 ml/bot, each ml contain: sodium dihydroazapentacene polysulfonate 0.15 mg, boric acid 6.3 mg and sodium borate 0.3 mg Artelac Oph Solution (EARTEL) Indication: Artelac is a supplementary of lacrimae that can be used in laceimal gland defect. Dosage: 1 drop if necessary Supply: Oph soln 10 ml/bot, each ml contain: Hydroxypropylmethylcellulose (HPMC) 3.20 mg Cetrimide 0.10 mg Disodium phosphate Dodecahydrate q.s. Sod Dihydrogen phosphate Dihydrate q.s. Disodium edetate q.s. Sorbitol 45.00 mg Water for injection q.s. Carbomer Gel-“Vidisic”(EVIDI) Indication: High molecular weight polymers of acrylic acid cross-linked with polyalkenyl ethers of sugars or polyalcohols. Topically 0.2 or 0.3%, are used topically as tear substitutes in the management of dry eye. Contraindication: Hypersensitivity to cetrimide Adverse effect: Temperory blurrd vision after application. Dosage: Topically use 4-5 times daily Stability: After open the original bottle, it can be stroed at 25 ℃ for one month. Supply: Oph gel 2 mg/g, 10 g/tube. 56:00 Gastrointestinal Drugs 56:04 Antacids and Adsorbents Lederscon (OLEDE) Indication: Peptic ulcer, gastritis, gastroxia. Pregnancy risk category: B Adverse effect: Same as Aluminum and Magnesium salt. Dosage: 1-2 Tabs TID PC & HS, chewable. Supply: Tab aluminium hydroxide gel 334mg, MgO 166mg, antifoam AF emulsion 36.7 mg Antasil-B (BANTB) Indication: Peptic ulcer, gastroxia, gastralgia. Adverse effect: Phosphate depletion, hypermagnesiemia in renal failure. Dosage: 7.5-10 ml tid-qid. Supply: Susp 500 ml/bot, each gm contain: aluminum hydroxide gel 240mg, Mag. hydroxide paste 133.2mg Alugel (OALUG) Indication: Peptic ulcer, peptic esophagitis, gastroxia, gastritis. Contraindication: Gastric outlet obstruction. Adverse effect: Constipation, intestinal obstruction, hypophos-phatemia for prolonged use. Dosage: 1-3 Tabs TID or QID between meals & HS. Supply: Tab 300mg Magnesium oxide (OMGO) Indication: Gastroxia, peptic ulcer, constipation. Contraindication: Moderate or severe renal impairment. Adverse effect: Diarrhea, hypermagnesiemia in renal failure. Dosage: Antacid 250-500 mg daily; laxative 2-4 g daily. 216 - - 217 - - Supply: Tab 250 mg Mucaine (OMUCA) Indication: Symptomatic relief of peptic ulcer, gastritis, esophagitis. Contraindication: Hypophosphatemia; severe renal impairment; symptoms of appendicitis. Adverse effect: Hypersensitivity reactions, dermatitis, urticaria, pruritus, glossitis, angioedema & collapse. In large doses, dizziness, faintness or drowsiness. Diarrhea, constipation. Dosage: 2-4 tab QID. Supply: Tab aluminium hydroxide 126 mg, magnesium oxide 35 mg & oxethazaine 5mg Aciden (OACID) Indication: Hyperacidity 、 gastritis 、 duodenitis 、 spasm and pain due to the gastric ulcer or duodenal ulcer Contraindication: Hypersensitivity to any composement of the drug Adverse effect: Constipation, nausea, vomit, abdominal distention, hiccup. Dosage: 1 tablet each time, 3 times a day. Supply: Tab butinolin phosphate 2 mg, calcium carbonate 300 mg, dried aluminum hydroxide gel 200 mg Activated charcoal—“Carbomix”(OCARB) Indication: GI adsorbent for known or suspected toxic ingestion. Adverse effect: Vomiting. Dosage: PO 30-100g (1-2g/kg) then 0.5g/kg Q4H; Q4H until charcoal stool is passed. Supply: Granules 61.5 g/bot 56:08 Antidiarrhea Agents Kaolin-Pectin-“Kaopectin” (BKAOP) ［ C ］ Indication: Simple diarrhea, functional bowel frequency, enteritis and dysentery. Contraindication: Intestinal obstruction. Adverse effect: Large dose may increase flatulence, distension, and intestinal obstruction. If diarrhea is not controlled in 48 hours and/or fever develops, the patient should consult a physician. Constipation may occur in children and in the elderly. Dosage: 15-30 ml TID or QID. Supply: Soln 4000 ml/bot, each 100 ml contains: kaolin 20 gm and pectin 1 gm Loperamide HCl-“Ufunin” (OUFUN) ［ B ］ Indication: Acute nonspecific diarrhea, chronic diarrhea, reduced volume of discharge after ilestomy. Contraindication: Hypersensitivity to loperamide, constipation, infectious diarrhea, pseudomembranous colitis caused by broad-spectrum antibiotics. Adverse effect: Adverse effects include fatigue, dizziness, nausea, vomiting, dry mouth, abdominal cramps, anorexia, paralytic ileus, urinary retention, and rash. Dosage: 4 mg initial then 2mg prn, up to 16 mg/day, dosage should not exceed 16 mg/day. In acute diarrhea, loperamide should be discontinued if there is no improvement after 48 hours of therapy. Supply: Tab 2mg Vioment (Biofermin) (OBIOF) Indication: Functional intestinal disorder and nutritional disturbance in children; Nonspecific ingestion and nonspecific enteritis with diarrhea Adverse effect: Metabolic acidosis has occurred following use of tablets containing Lactobacillus acidophilus. Dosage: 1-3 Tabs TID with meal. Supply: Tab Lactobacteria 3mg Glycobacteria 2mg 216 - - 217 - - Supply: Tab 250 mg Mucaine (OMUCA) Indication: Symptomatic relief of peptic ulcer, gastritis, esophagitis. Contraindication: Hypophosphatemia; severe renal impairment; symptoms of appendicitis. Adverse effect: Hypersensitivity reactions, dermatitis, urticaria, pruritus, glossitis, angioedema & collapse. In large doses, dizziness, faintness or drowsiness. Diarrhea, constipation. Dosage: 2-4 tab QID. Supply: Tab aluminium hydroxide 126 mg, magnesium oxide 35 mg & oxethazaine 5mg Aciden (OACID) Indication: Hyperacidity 、 gastritis 、 duodenitis 、 spasm and pain due to the gastric ulcer or duodenal ulcer Contraindication: Hypersensitivity to any composement of the drug Adverse effect: Constipation, nausea, vomit, abdominal distention, hiccup. Dosage: 1 tablet each time, 3 times a day. Supply: Tab butinolin phosphate 2 mg, calcium carbonate 300 mg, dried aluminum hydroxide gel 200 mg Activated charcoal—“Carbomix”(OCARB) Indication: GI adsorbent for known or suspected toxic ingestion. Adverse effect: Vomiting. Dosage: PO 30-100g (1-2g/kg) then 0.5g/kg Q4H; Q4H until charcoal stool is passed. Supply: Granules 61.5 g/bot 56:08 Antidiarrhea Agents Kaolin-Pectin-“Kaopectin” (BKAOP) ［ C ］ Indication: Simple diarrhea, functional bowel frequency, enteritis and dysentery. Contraindication: Intestinal obstruction. Adverse effect: Large dose may increase flatulence, distension, and intestinal obstruction. If diarrhea is not controlled in 48 hours and/or fever develops, the patient should consult a physician. Constipation may occur in children and in the elderly. Dosage: 15-30 ml TID or QID. Supply: Soln 4000 ml/bot, each 100 ml contains: kaolin 20 gm and pectin 1 gm Loperamide HCl-“Ufunin” (OUFUN) ［ B ］ Indication: Acute nonspecific diarrhea, chronic diarrhea, reduced volume of discharge after ilestomy. Contraindication: Hypersensitivity to loperamide, constipation, infectious diarrhea, pseudomembranous colitis caused by broad-spectrum antibiotics. Adverse effect: Adverse effects include fatigue, dizziness, nausea, vomiting, dry mouth, abdominal cramps, anorexia, paralytic ileus, urinary retention, and rash. Dosage: 4 mg initial then 2mg prn, up to 16 mg/day, dosage should not exceed 16 mg/day. In acute diarrhea, loperamide should be discontinued if there is no improvement after 48 hours of therapy. Supply: Tab 2mg Vioment (Biofermin) (OBIOF) Indication: Functional intestinal disorder and nutritional disturbance in children; Nonspecific ingestion and nonspecific enteritis with diarrhea Adverse effect: Metabolic acidosis has occurred following use of tablets containing Lactobacillus acidophilus. Dosage: 1-3 Tabs TID with meal. Supply: Tab Lactobacteria 3mg Glycobacteria 2mg 218 - - 219 - - Lactobacillus casei –“Antibiophilus” (OLACT) Indication: Prevention of antibiotic induced diarrhea; symptomatic treatment of diarrhea of a non-organic orign in infant < 2 years: as a complement to rehydration, >2 years: treatment dose not exempt from rehydration if necessary. Dosage: Preventive treatment 2 cap/day. Intestinal transit disorders 4-8 cap/day. Supply: Cap lactobacillus casei variety rhamnosus 2.0*108 56:10 Antiflatulents Dimethicone-“Gascon” (OGASC) ［ C ］ Indication: Antiflatulent, relief GI gas pain. Contraindication: Hypersensitivity to simethicone or other product components Adverse effect: None. Dosage: Adults and Children ( ＞ 12yrs) : 40-120 mg PO 4 times a day (after meal and at bedtime); Drops: 2 ml after meal and at bedtime, shake well before using; Children( ＜ 12 yrs): 40 mg 4 times a day. Infants: 20 mg 4 times a day. Supply: Tab 40mg 56:12 Cathartics and Laxatives Bisacodyl (OBISA) ［ B ］ Indication: All type of functional constipation, preparation for surgery and some intestinal examination. Contraindication: Acute abdominal pain or cramps, intestinal obstruction. Adverse effect: Severe abdominal cramps, irritation, excessive purgation. Dosage: PO 2-3 Tabs HS. Supply: Tab 5 mg Sennosides-“Senokot” (OSENO)“Through” (OTHRO) ［ C ］ Indication: Anthraquinones laxatives are colonic-specific stimulant laxatives made from the plant-derived compounds senna; all types of functional constipation. Contraindication: Acute surgical abdomen, bowel obstruction, fecal impaction, hypersensitivity to anthraquinone laxatives or to any of the ingredients, patients with nausea, vomiting, or other symptoms of appendicitis, undiagnosed abdominal pain Adverse effect: Long standing use may cause motility, GI disturbance. Dosage: 15-30 mg hs Supply: Tab 7.5 mg (Senokot), 12 mg (Through) Sterculia-“Normacol”(ONORM) Indication: Treatment of constipation, particularly hypotonic or slow transit constipation resistant to bulk alone .The initiation and maintenance of bowel action after rectal surgery and after haemorrhoidectomy Place in therapy: Bulk-forming laxatives have been used in patients with anorectal conditions, constipation, diarrhea, gastrointestinal disorders, hypercholesterolemia, in pregnant and geriatric patients, and to regulate colostomies. Contraindications: Intestinal obstruction, fecal impaction, and total atony of the colon. Adverse effect: Abdominal distention. Intestinal obstruction is possible if the product is taken in overdosage or is not adequately washed down with fluid. Dosage: Adults: 1 or 2 sachets once or twice daily after meals. Children (6-12 years): a reduced amount may be given at the discretion of the physician. Supply: Granule 62% sterculia and 8% frangula, 7 g/sachet Castor oil liquid (BCAST) ( 專 ) Indication: Constipation, preparation of surgery and intestinal examination. Contraindication: Used cautiously during menstruation or pregnancy. 218 - - 219 - - Lactobacillus casei –“Antibiophilus” (OLACT) Indication: Prevention of antibiotic induced diarrhea; symptomatic treatment of diarrhea of a non-organic orign in infant < 2 years: as a complement to rehydration, >2 years: treatment dose not exempt from rehydration if necessary. Dosage: Preventive treatment 2 cap/day. Intestinal transit disorders 4-8 cap/day. Supply: Cap lactobacillus casei variety rhamnosus 2.0*108 56:10 Antiflatulents Dimethicone-“Gascon” (OGASC) ［ C ］ Indication: Antiflatulent, relief GI gas pain. Contraindication: Hypersensitivity to simethicone or other product components Adverse effect: None. Dosage: Adults and Children ( ＞ 12yrs) : 40-120 mg PO 4 times a day (after meal and at bedtime); Drops: 2 ml after meal and at bedtime, shake well before using; Children( ＜ 12 yrs): 40 mg 4 times a day. Infants: 20 mg 4 times a day. Supply: Tab 40mg 56:12 Cathartics and Laxatives Bisacodyl (OBISA) ［ B ］ Indication: All type of functional constipation, preparation for surgery and some intestinal examination. Contraindication: Acute abdominal pain or cramps, intestinal obstruction. Adverse effect: Severe abdominal cramps, irritation, excessive purgation. Dosage: PO 2-3 Tabs HS. Supply: Tab 5 mg Sennosides-“Senokot” (OSENO)“Through” (OTHRO) ［ C ］ Indication: Anthraquinones laxatives are colonic-specific stimulant laxatives made from the plant-derived compounds senna; all types of functional constipation. Contraindication: Acute surgical abdomen, bowel obstruction, fecal impaction, hypersensitivity to anthraquinone laxatives or to any of the ingredients, patients with nausea, vomiting, or other symptoms of appendicitis, undiagnosed abdominal pain Adverse effect: Long standing use may cause motility, GI disturbance. Dosage: 15-30 mg hs Supply: Tab 7.5 mg (Senokot), 12 mg (Through) Sterculia-“Normacol”(ONORM) Indication: Treatment of constipation, particularly hypotonic or slow transit constipation resistant to bulk alone .The initiation and maintenance of bowel action after rectal surgery and after haemorrhoidectomy Place in therapy: Bulk-forming laxatives have been used in patients with anorectal conditions, constipation, diarrhea, gastrointestinal disorders, hypercholesterolemia, in pregnant and geriatric patients, and to regulate colostomies. Contraindications: Intestinal obstruction, fecal impaction, and total atony of the colon. Adverse effect: Abdominal distention. Intestinal obstruction is possible if the product is taken in overdosage or is not adequately washed down with fluid. Dosage: Adults: 1 or 2 sachets once or twice daily after meals. Children (6-12 years): a reduced amount may be given at the discretion of the physician. Supply: Granule 62% sterculia and 8% frangula, 7 g/sachet Castor oil liquid (BCAST) ( 專 ) Indication: Constipation, preparation of surgery and intestinal examination. Contraindication: Used cautiously during menstruation or pregnancy. 220 - - 221 - - Adverse effect: Large dose or long standing usage may cause intestinal irritation. Dosage: 15-30 ml once, maxinum dose 60 ml. Supply: Soln 500 ml/bot Monosodium phosphate/disodium phosphate -“Evac Enema” (EEVAC) Indication: Sodium phosphate and sodium biphosphate enema is used as an electrolytes laxative. Place in therapy: Saline laxatives should be used only for acute evacuation of the bowel or infrequently for the treatment of acute constipation Contraindication: Hypersensitivity to the components of the laxative products, patients with impaired renal function, laxatives should not be taken if abdominal pain, nausea, vomiting, change in bowel habits, the phosphate salts may provide excessive sodium to patients who must restrict sodium intake (congestive heart failure, edema); they may also result in hypocalcemia if used in children under 2 years of age Adverse effect: Caution must be used in patients with any degree of renal impairment, hepatic cirrhosis, or heart failure. The most common toxic effect of phosphate is hypocalcemia, which can occur with any route of phosphate administration. Dosage: Adults: 1 bot enema use Children: 2-12 years old 0.5 bot enema use Supply: Each ml contain monosodium phosphate anhydrous 139.1 mg disodium phosphate anhydrous 31.8 mg (118 ml/Bot) Klean-Prep powder (OKLEA)( 專 ) Indication: Used before operation to decrease gastrointestinal content. Contraindication: GI tract occlusion, perforation, acute GI tract ulcer, megacolon Adverse effect: Nausea, vomiting, abdominal pain, abdominal distension. Dosage: Adults: One-liter water for one package of powder, PO 250 ml in 10-15 min interval, total 4 sachet can be used Supply: Each sachet contain: Polyethylene glycol 59 g Sodium sulfate, anhydrate 5.685 g Sodium bicarbonate 1.685 g Sodium chloride 1.465 g Potassium chloride 0.7425 g Aspartame 0.0494 g 56:16 Digestants Stazyme (OSTAZ) Indication: Indigestion Dosage: 1-2 tab tid. Supply: Tab biodiastase 8000 U, cellulase 300 U, lipase 900 U, prozyme 300 U. Biogen (OBIOG) Indication: Indigestion Dosage: 2-3 tab tid. Supply: Tab biodiastase 110 mg, cellulase 5 mg, biodiasmine 25 mg, thiamine mononitrate 1 mg, riboflavin 0.1 mg Protease (OPROT) Indication: Chronic pancreatitis, cystic fibrosis, pancreatic insutficiency Contraindication: Hypersensitivity. Adverse effect: Hyperuricemia; bloating symptom, 220 - - 221 - - Adverse effect: Large dose or long standing usage may cause intestinal irritation. Dosage: 15-30 ml once, maxinum dose 60 ml. Supply: Soln 500 ml/bot Monosodium phosphate/disodium phosphate -“Evac Enema” (EEVAC) Indication: Sodium phosphate and sodium biphosphate enema is used as an electrolytes laxative. Place in therapy: Saline laxatives should be used only for acute evacuation of the bowel or infrequently for the treatment of acute constipation Contraindication: Hypersensitivity to the components of the laxative products, patients with impaired renal function, laxatives should not be taken if abdominal pain, nausea, vomiting, change in bowel habits, the phosphate salts may provide excessive sodium to patients who must restrict sodium intake (congestive heart failure, edema); they may also result in hypocalcemia if used in children under 2 years of age Adverse effect: Caution must be used in patients with any degree of renal impairment, hepatic cirrhosis, or heart failure. The most common toxic effect of phosphate is hypocalcemia, which can occur with any route of phosphate administration. Dosage: Adults: 1 bot enema use Children: 2-12 years old 0.5 bot enema use Supply: Each ml contain monosodium phosphate anhydrous 139.1 mg disodium phosphate anhydrous 31.8 mg (118 ml/Bot) Klean-Prep powder (OKLEA)( 專 ) Indication: Used before operation to decrease gastrointestinal content. Contraindication: GI tract occlusion, perforation, acute GI tract ulcer, megacolon Adverse effect: Nausea, vomiting, abdominal pain, abdominal distension. Dosage: Adults: One-liter water for one package of powder, PO 250 ml in 10-15 min interval, total 4 sachet can be used Supply: Each sachet contain: Polyethylene glycol 59 g Sodium sulfate, anhydrate 5.685 g Sodium bicarbonate 1.685 g Sodium chloride 1.465 g Potassium chloride 0.7425 g Aspartame 0.0494 g 56:16 Digestants Stazyme (OSTAZ) Indication: Indigestion Dosage: 1-2 tab tid. Supply: Tab biodiastase 8000 U, cellulase 300 U, lipase 900 U, prozyme 300 U. Biogen (OBIOG) Indication: Indigestion Dosage: 2-3 tab tid. Supply: Tab biodiastase 110 mg, cellulase 5 mg, biodiasmine 25 mg, thiamine mononitrate 1 mg, riboflavin 0.1 mg Protease (OPROT) Indication: Chronic pancreatitis, cystic fibrosis, pancreatic insutficiency Contraindication: Hypersensitivity. Adverse effect: Hyperuricemia; bloating symptom, 222 - - 223 - - nausea, vomiting; cramp; increased uric acid level Dosage: 8000-32000 lipase USP U taken per or snack Supply: Cap pancrelipase 280 mg (lipase 20000 USP U, protease 75000 USP U, amylase 66400 USP U) 56:22 Antiemetics 56:22.08 Antihistamines Prochlorperazine-“Novamin” (INOVA) (ONOVA) ［ C ］ Indication: Nausea, vomiting, excessive anxiety, relatively mild psychiatric conditions & moderate to severe psychiatric conditions. Contraindication: Coma, drug-induced CNS depression, bone marrow depression. Adverse effect: Extrapyramidal symptoms, CNS depression, deep sleep, coma, agitation, convulsions, hypotension, restlessness. Dosage: Adults: PO 5-10 mg TID or QID, IM 5-10 mg to start, repeated Q3-4H as needed, up to 40 mg/day. Children: 2.5 mg PO QD, BID or TID, IM 0.13 mg/kg. Supply: Inj 5 mg/1 ml/amp; Tab 5 mg 56:22.20 5-HT3 Receptor Antagonists Ondansetron-“Zofran”(IONDA)( 專 ) ［ B ］ Indication: A selective serotonin 5-HT3-type receptor antagonist. Ondansetron is highly effective in controlling emesis occurring after cisplatin and non-cisplatin chemotherapeutic regimens in cancer patients; efficacy has also been demonstrated in radiation-induced emesis. Contraindication: Patient hypersensitivity to ondansetron. Adverse effect: Headache, constipation or diarrhea, and elevation of liver enzymes. Dosage: IV for chemotherapy-induced nausea or vomiting: Adults and Children (2-18 yrs): 0.15 mg/kg for 3 dose (30 min before chemotherapy an then 4 and 8 hr after) or 0.45 mg/kg, to a MAX of 32 mg as a single dose or 8 mg IV as a single dose for cisplatin doses ＜ 100 mg /m 2 . Infuse slowly over 15 min in 50 ml D5W or NS. Supply: Inj 8 mg/4 ml/amp 56:22.92 Antiemetics, Miscellaneous Diphenidol –“Cedol” (OCEDO) Indication: Diphenidol is an antiemetic agent. It may be used to treat nausea and vomiting or vertigo. Contraindication: Patient who has hypersensitivity to the drug. Use with caution to those patient with glaucoma, GI obstruction, or GU disease. Adverse effect: The most serious side effects are hallucinations, confusion, and disorientation. Diphenidol should only be administered to patients in the institutional setting. Dosage: 25-50 mg PO Q4H, diphenidol should Not be used in children weighing less than 23 kg. Supply: Tab 25 mg 56:28 Antiulcer Agents and Acid Suppressants 56:28.12 Histamine H 2 -Antagonists Cimetidine- “Cimewell”(OCIMEW) “Defense” (ODEFE) “Gastrodin”(OGAST2) ［ B ］ Indication: Gatric and duodenal ulcer, gastroesophageal reflux, pathological hypersecretory conditions (eg. Zollinger-Ellison syndrome), stress related mucosal damage. Adverse effect: Dizziness, headache, confusional states, diarrhea, rash, gynecomastia, impotence, thrombocytopenia, muscular pain, cardiac arrhythmia. Dosage: Adults: 300 mg IV/ IM Q6-8H; 300 mg PO QID, 400 mg BID, or 800 mg at bedtime and treated continuously for 4-6 weeks. In hyper-secretory condition, 300 mg QID with meals and at bedtime, MAX doses: 2.4 gm/day, 12 gm/day. For prophylaxis of recurrent ulcer: 222 - - 223 - - nausea, vomiting; cramp; increased uric acid level Dosage: 8000-32000 lipase USP U taken per or snack Supply: Cap pancrelipase 280 mg (lipase 20000 USP U, protease 75000 USP U, amylase 66400 USP U) 56:22 Antiemetics 56:22.08 Antihistamines Prochlorperazine-“Novamin” (INOVA) (ONOVA) ［ C ］ Indication: Nausea, vomiting, excessive anxiety, relatively mild psychiatric conditions & moderate to severe psychiatric conditions. Contraindication: Coma, drug-induced CNS depression, bone marrow depression. Adverse effect: Extrapyramidal symptoms, CNS depression, deep sleep, coma, agitation, convulsions, hypotension, restlessness. Dosage: Adults: PO 5-10 mg TID or QID, IM 5-10 mg to start, repeated Q3-4H as needed, up to 40 mg/day. Children: 2.5 mg PO QD, BID or TID, IM 0.13 mg/kg. Supply: Inj 5 mg/1 ml/amp; Tab 5 mg 56:22.20 5-HT3 Receptor Antagonists Ondansetron-“Zofran”(IONDA)( 專 ) ［ B ］ Indication: A selective serotonin 5-HT3-type receptor antagonist. Ondansetron is highly effective in controlling emesis occurring after cisplatin and non-cisplatin chemotherapeutic regimens in cancer patients; efficacy has also been demonstrated in radiation-induced emesis. Contraindication: Patient hypersensitivity to ondansetron. Adverse effect: Headache, constipation or diarrhea, and elevation of liver enzymes. Dosage: IV for chemotherapy-induced nausea or vomiting: Adults and Children (2-18 yrs): 0.15 mg/kg for 3 dose (30 min before chemotherapy an then 4 and 8 hr after) or 0.45 mg/kg, to a MAX of 32 mg as a single dose or 8 mg IV as a single dose for cisplatin doses ＜ 100 mg /m 2 . Infuse slowly over 15 min in 50 ml D5W or NS. Supply: Inj 8 mg/4 ml/amp 56:22.92 Antiemetics, Miscellaneous Diphenidol –“Cedol” (OCEDO) Indication: Diphenidol is an antiemetic agent. It may be used to treat nausea and vomiting or vertigo. Contraindication: Patient who has hypersensitivity to the drug. Use with caution to those patient with glaucoma, GI obstruction, or GU disease. Adverse effect: The most serious side effects are hallucinations, confusion, and disorientation. Diphenidol should only be administered to patients in the institutional setting. Dosage: 25-50 mg PO Q4H, diphenidol should Not be used in children weighing less than 23 kg. Supply: Tab 25 mg 56:28 Antiulcer Agents and Acid Suppressants 56:28.12 Histamine H 2 -Antagonists Cimetidine- “Cimewell”(OCIMEW) “Defense” (ODEFE) “Gastrodin”(OGAST2) ［ B ］ Indication: Gatric and duodenal ulcer, gastroesophageal reflux, pathological hypersecretory conditions (eg. Zollinger-Ellison syndrome), stress related mucosal damage. Adverse effect: Dizziness, headache, confusional states, diarrhea, rash, gynecomastia, impotence, thrombocytopenia, muscular pain, cardiac arrhythmia. Dosage: Adults: 300 mg IV/ IM Q6-8H; 300 mg PO QID, 400 mg BID, or 800 mg at bedtime and treated continuously for 4-6 weeks. In hyper-secretory condition, 300 mg QID with meals and at bedtime, MAX doses: 2.4 gm/day, 12 gm/day. For prophylaxis of recurrent ulcer: 224 - - 225 - - 400 mg PO HS. Children: 20-40 mg/kg/day (Tab, Inj) in divided doses, four times a day. Supply: Tab 400 mg (Cimewell), 300 mg (Defense), and 200 mg (Gastrodin) Famotidine-“Ulstop” (OFAMO) ［ B ］ Indication: Similar to cimetidine. Adverse effect: Headache, dizziness, diarrhea, constipation, arthralgia, somnolence, rash. Dosage: Adults: 20 mg PO BID or 40 mg HS for treatment of duodenal or benign gastric ulcer. 20-40mg PO BID for treatment of GERD. For prophylaxis of recurrent ulcer: 20 mg PO HS. Children (1-16 yrs): 0.5-1 mg/kg/day orally in two divided doses, up to 40 mg BID. Supply: Tab 20 mg Ranitidine-“Zantac” (IZANT)“Weidos” (OWEID) ［ B ］ Indication: Similar to cimetidine. Adverse effect: Dizziness, insomnia, rash, arthragia. Dosage: Adults: IV, IM: 50 mg Q6-8H; PO: 150 mg BID or 300 mg HS for treatment of duodenal or gastric ulcer; maximum dose: IV 400mg/day, PO 6 gm/day; PO 150 mg HS for prophylaxis of recurrent ulcer. Children: Oral, 2-4 mg/kg, two times a day up to a maximam dose of 300 mg/day. IV: 2-4 mg/kg/day, in divided doses. Supply: Inj 50 mg/2 ml/amp (Zantac); Tab 300 mg (Weidos) 56:28.28 Prostaglandins Misoprostol-“Cytotec” (OCYTOT) ［ X ］ Indication: Misoprostol is a prostaglandin E1 analog, used in prevention of NSAID-induced ulcers, duodenal ulcer, and gastric ulcer. Contraindication: pregnant women, known hypersensitivity to prostaglandins Adverse effect: Diarrhea (in 800 μg/day), abdominal pain, and uterine bleeding. An abortion rate of 11-15% has been noted when it is used during the first trimester; dyspepsia, headache, nausea. Dosage: Preventing NSAID-induced gastric ulcer: 200 μg PO QID; duodenal and/or gastic ulcer: 200 μg PO QID for 4 weeks. Supply: Tab 200 μg 56:28.32 Protectants Sucralfate-“Sucral” (OSUCR) ［ B 2 ］ Indication: Sucralfate is indicated for the treatment of active duodenal ulcers, and for maintenance therapy. It has also been used to treat gastric ulcers, for stress ulcer prophylaxis, and gastroesophageal reflux disease. Adverse effect: Dizziness, dry mouth, constipation may occur after prolong use. Pharmacokinetics: Sucralfate forms a protective barrier over the ulcer site, thus promoting ulcer healing. The onset of action typically occurs within 1 hour and binding of drug to the ulcer may last up to 6 hours. Dosage: Duodenal ulcers 1 g QID or 2 g BID; maintenance therapy 1 g BID Supply: Tab 500 mg Sulcain, polymagal – “Stacaine”(OSTAC) Indication: Acute and chronic gastritis, stomachache, heart-burn, gastric hyperacidity, discomfort as stomach Dosage: 2 tab 3-4 times daily. Supply: Tab sulcain 100 mg, polymagal 100 mg 56:28.36 Proton-pump Inhibitors Lansoprazole-“Lanpo” (OLANS)“Rich” (ORICH) “Takepron OD”(OTAKEO) ［ B ］ Indication: Lansoprazole is a proton-pump inhibitor similar to omeprazole. It is primarily used in gastric ulcer, duodenal ulcer, reflex esophagitis, and Zollinger-Ellison syndrome. 224 - - 225 - - 400 mg PO HS. Children: 20-40 mg/kg/day (Tab, Inj) in divided doses, four times a day. Supply: Tab 400 mg (Cimewell), 300 mg (Defense), and 200 mg (Gastrodin) Famotidine-“Ulstop” (OFAMO) ［ B ］ Indication: Similar to cimetidine. Adverse effect: Headache, dizziness, diarrhea, constipation, arthralgia, somnolence, rash. Dosage: Adults: 20 mg PO BID or 40 mg HS for treatment of duodenal or benign gastric ulcer. 20-40mg PO BID for treatment of GERD. For prophylaxis of recurrent ulcer: 20 mg PO HS. Children (1-16 yrs): 0.5-1 mg/kg/day orally in two divided doses, up to 40 mg BID. Supply: Tab 20 mg Ranitidine-“Zantac” (IZANT)“Weidos” (OWEID) ［ B ］ Indication: Similar to cimetidine. Adverse effect: Dizziness, insomnia, rash, arthragia. Dosage: Adults: IV, IM: 50 mg Q6-8H; PO: 150 mg BID or 300 mg HS for treatment of duodenal or gastric ulcer; maximum dose: IV 400mg/day, PO 6 gm/day; PO 150 mg HS for prophylaxis of recurrent ulcer. Children: Oral, 2-4 mg/kg, two times a day up to a maximam dose of 300 mg/day. IV: 2-4 mg/kg/day, in divided doses. Supply: Inj 50 mg/2 ml/amp (Zantac); Tab 300 mg (Weidos) 56:28.28 Prostaglandins Misoprostol-“Cytotec” (OCYTOT) ［ X ］ Indication: Misoprostol is a prostaglandin E1 analog, used in prevention of NSAID-induced ulcers, duodenal ulcer, and gastric ulcer. Contraindication: pregnant women, known hypersensitivity to prostaglandins Adverse effect: Diarrhea (in 800 μg/day), abdominal pain, and uterine bleeding. An abortion rate of 11-15% has been noted when it is used during the first trimester; dyspepsia, headache, nausea. Dosage: Preventing NSAID-induced gastric ulcer: 200 μg PO QID; duodenal and/or gastic ulcer: 200 μg PO QID for 4 weeks. Supply: Tab 200 μg 56:28.32 Protectants Sucralfate-“Sucral” (OSUCR) ［ B 2 ］ Indication: Sucralfate is indicated for the treatment of active duodenal ulcers, and for maintenance therapy. It has also been used to treat gastric ulcers, for stress ulcer prophylaxis, and gastroesophageal reflux disease. Adverse effect: Dizziness, dry mouth, constipation may occur after prolong use. Pharmacokinetics: Sucralfate forms a protective barrier over the ulcer site, thus promoting ulcer healing. The onset of action typically occurs within 1 hour and binding of drug to the ulcer may last up to 6 hours. Dosage: Duodenal ulcers 1 g QID or 2 g BID; maintenance therapy 1 g BID Supply: Tab 500 mg Sulcain, polymagal – “Stacaine”(OSTAC) Indication: Acute and chronic gastritis, stomachache, heart-burn, gastric hyperacidity, discomfort as stomach Dosage: 2 tab 3-4 times daily. Supply: Tab sulcain 100 mg, polymagal 100 mg 56:28.36 Proton-pump Inhibitors Lansoprazole-“Lanpo” (OLANS)“Rich” (ORICH) “Takepron OD”(OTAKEO) ［ B ］ Indication: Lansoprazole is a proton-pump inhibitor similar to omeprazole. It is primarily used in gastric ulcer, duodenal ulcer, reflex esophagitis, and Zollinger-Ellison syndrome. 226 - - 227 - - Place in therapy: Besides therapeutic effects, the adverse effect associated with lansoprazole therapy is also similar to that of omeprazole with no clear differences. It can be consider as an alternative of omeprazole. Contraindication: Previous hypersensitivity to lansoprazole. Adverse effect: Nausea, diarrhea, anorexia, skin rash, fatigue, dizzness, headache, hypergastrinemia. Dosage: Duodenal ulcer: 30 mg PO QD for 4 weeks, or for 8 weeks in gastric ulcer and reflex esophagitis. Supply: Cap 30 mg (Lanpo, Rich); Tab 30 mg (Takepron OD) Pantoprazole – “Pantoloc”(OPANTO) (IPANT) “Pozola”(OPOZO) “Gastroloc”(OGASTR) Indication: Gastric and duodenal ulcers, moderate and severe reflux esophagitis; pathological gastric hyper-secretion Place in therapy: Pantoprazole is a potent inhibitor of gastric acid secretion. Animal and in vitro studies have demonstrated it to be comparable to or more potent than omeprazole, with less potential for interactions with P450 cytochromes and better acid stability. Contraindication: Hypersensitivity to pantoprazole; severe hepatic insufficiency; Cirrhosis Adverse effect: Headache, diarrhea, dizziness, pruritis, and asthenia Dosage: Adults: gastric ulcer, duodenal ulcer and reflux esophagitis: 40-80 mg PO QD; or 40mg IV QD for 7-10 days; pathological gastric hyper-secretion: 40 mg PO BID; MAX 240 mg daily; 80 mg IV Q12H, may increase to Q8H, MAX 240 mg/day. Dosage reductions are not necessary for patients with renal insufficiency or on dialysis, the maximum daily dose 40 mg Supply: Tab 40 mg; Inj 40 mg/vial Omeprazole-“Omezol” (IOMEZ) (OOMEZ) “Losec” (ILOSE) ［ C ］ Indication: Gastric and duodenal ulcers, moderate and severe reflux esophagitis; pathological gastric hypersecretion Pharmacology: Omeprazole suppresses gastric acid secretion by binding to the proton pump of the parietal cell. Contraindication: Hypersensitivity; symptomatic response to omeprazole therapy does not preclude the presence of gastric malignancy. Adverse effect: It is well tolerated but elevations of liver enzymes have been reported in patients with pre-existing liver disease. Long-term safety has not been established. In most cases drug therapy should be limited to short-term (less than 8 weeks) treatment. Dosage: Duodenal, gastric, jejunal or esophageal ulcers: 20mg QD, 2-4 weeks for duodenal ulcers, 4-8 weeks for gastric ulcers or duodenal ulcer patients who smoke. Stability: Omezol (lyophilized injection) should be used up within 4 hrs after reconstitution. Supply: Inj 40 mg/vial; Cap 20 mg Esomeprazole-“Nexium” (ONEXI) Indication: Duodenal ulcer disease, erosive esophagitis, gastric ulcer; prophylaxis for NSAID-associated gastropathy, gastroesophageal reflux disease. Pharmacology: Esomeprazole is a proton-pump inhibitor, acting to suppress gastric acid secretion by specific inhibition of H+/K+ - ATPase within the gastric parietal cell. As the S-enantiomer of omeprazole, it appears to offer pharmacokinetic advantages over the racemic compound, including less first-pass hepatic metabolism and a lower plasma clearance; the greater oral bioavailability of esomeprazole is claimed to enable more effective management of acid-related disorders. Pharmacokinetics: Initial response is 1 to 2 hours, duration of multiple dose are 17 hours; oral bioavailability 89% to 90%; AUC was decreased by 33% to 53% after food intake compared to fasting; protein binding 97%, The major metabolic pathway is via the hepatic cytochrome P450- 2C19 isoenzyme, to form the hydroxy 226 - - 227 - - Place in therapy: Besides therapeutic effects, the adverse effect associated with lansoprazole therapy is also similar to that of omeprazole with no clear differences. It can be consider as an alternative of omeprazole. Contraindication: Previous hypersensitivity to lansoprazole. Adverse effect: Nausea, diarrhea, anorexia, skin rash, fatigue, dizzness, headache, hypergastrinemia. Dosage: Duodenal ulcer: 30 mg PO QD for 4 weeks, or for 8 weeks in gastric ulcer and reflex esophagitis. Supply: Cap 30 mg (Lanpo, Rich); Tab 30 mg (Takepron OD) Pantoprazole – “Pantoloc”(OPANTO) (IPANT) “Pozola”(OPOZO) “Gastroloc”(OGASTR) Indication: Gastric and duodenal ulcers, moderate and severe reflux esophagitis; pathological gastric hyper-secretion Place in therapy: Pantoprazole is a potent inhibitor of gastric acid secretion. Animal and in vitro studies have demonstrated it to be comparable to or more potent than omeprazole, with less potential for interactions with P450 cytochromes and better acid stability. Contraindication: Hypersensitivity to pantoprazole; severe hepatic insufficiency; Cirrhosis Adverse effect: Headache, diarrhea, dizziness, pruritis, and asthenia Dosage: Adults: gastric ulcer, duodenal ulcer and reflux esophagitis: 40-80 mg PO QD; or 40mg IV QD for 7-10 days; pathological gastric hyper-secretion: 40 mg PO BID; MAX 240 mg daily; 80 mg IV Q12H, may increase to Q8H, MAX 240 mg/day. Dosage reductions are not necessary for patients with renal insufficiency or on dialysis, the maximum daily dose 40 mg Supply: Tab 40 mg; Inj 40 mg/vial Omeprazole-“Omezol” (IOMEZ) (OOMEZ) “Losec” (ILOSE) ［ C ］ Indication: Gastric and duodenal ulcers, moderate and severe reflux esophagitis; pathological gastric hypersecretion Pharmacology: Omeprazole suppresses gastric acid secretion by binding to the proton pump of the parietal cell. Contraindication: Hypersensitivity; symptomatic response to omeprazole therapy does not preclude the presence of gastric malignancy. Adverse effect: It is well tolerated but elevations of liver enzymes have been reported in patients with pre-existing liver disease. Long-term safety has not been established. In most cases drug therapy should be limited to short-term (less than 8 weeks) treatment. Dosage: Duodenal, gastric, jejunal or esophageal ulcers: 20mg QD, 2-4 weeks for duodenal ulcers, 4-8 weeks for gastric ulcers or duodenal ulcer patients who smoke. Stability: Omezol (lyophilized injection) should be used up within 4 hrs after reconstitution. Supply: Inj 40 mg/vial; Cap 20 mg Esomeprazole-“Nexium” (ONEXI) Indication: Duodenal ulcer disease, erosive esophagitis, gastric ulcer; prophylaxis for NSAID-associated gastropathy, gastroesophageal reflux disease. Pharmacology: Esomeprazole is a proton-pump inhibitor, acting to suppress gastric acid secretion by specific inhibition of H+/K+ - ATPase within the gastric parietal cell. As the S-enantiomer of omeprazole, it appears to offer pharmacokinetic advantages over the racemic compound, including less first-pass hepatic metabolism and a lower plasma clearance; the greater oral bioavailability of esomeprazole is claimed to enable more effective management of acid-related disorders. Pharmacokinetics: Initial response is 1 to 2 hours, duration of multiple dose are 17 hours; oral bioavailability 89% to 90%; AUC was decreased by 33% to 53% after food intake compared to fasting; protein binding 97%, The major metabolic pathway is via the hepatic cytochrome P450- 2C19 isoenzyme, to form the hydroxy 228 - - 229 - - and desmethyl metabolites. Excretion: Urine (80%, as inactive metabolites), feces (20%). Elimination half-life is 1.2 to 1.5 hours. Contraindication: Hypersensitivity to esomeprazole or benzimidazoles. Adverse effect: Abdominal pain, constipation, diarrhea, , flatulence, nausea, dizziness, headache, respiratory infection and sinusitis. Dosage: 20 － 40 mg once daily ; take at least 1 hour before meals, do not chew or crush tablet. Supply: Tab 40 mg 56:32 Prokinetic Agents Domperidone- “D.M.P (Motilium)” (OMOTI) Indication: Domperidone is a peripheral dopamine antagonist. It has been used in delayed gastric emptying, nausea and vomiting, gastroesopageal reflux disease, and miscellaneous indications. Contraindication: Hypersensitivity. Adverse effect: Galactorrhea, seizures, and cardiac arrhythmias have been reported. Dosage: Nausea and vomiting 20-30 mg PO TID - QID. Postprandial dyspepsia 10 mg PO TID (15 to 30 minutes before meals). Supply: Tab 10 mg Metoclopramide HCl-“Primperan” (IPRIM) (OPRIMP) “Gastro-T” (OGAST) ［ B ］ Indication: Stimulate gastric emptying, significant relief of nausea, vomiting, anorexia & abdominal fullness, prevention of cancer chemotherapy-induced emesis. Contraindication: GI hemorrhage, mechanical obstruction or perforation, pheochromocytoma, current use of MAO inhibitors, tricyclic antidepressants or sympathomimetic drug cause extrapyramidal reaction. Use cautiously in patients with asthma, glaucoma, or prostate gland enlargement. Adverse effect: Constipation, diarrhea, drowsiness, lassitude, extrapyramidal reaction, galactorrhea, dizziness, anxiety, periorbital oedema and skin rash Dosage: PO 5-10 mg TID-QID AC, maximum dose: 0.5 mg/kg. For the prevention of cancer chemotherapy-induced emesis, IV infusion 2 mg/kg is given initially 30 minutes before administration of a highly emetogenic drug and repeated twice at 2 hour intervals following the initial dose. Supply: Inj 10 mg/2 ml/amp; Tab 5 mg (Primperan); Cap 30 mg (Gastro-T) 64:00 Heavy Metal Antagonists Deferoxamine methanesulfonate-“Desferal” (IDESF) ［ C ］ Indication: Treatment of acute iron intoxication, to promote iron excretion in patients who have secondary iron overload from the multiple transfusions frequently used in the treatment of thalassemia or other chronic anemia. Contraindication: Patients with severe renal disease or anuria. Adverse effect: Allergic skin reactions, hypotension, shock, dizziness, blurred vision, abdominal discomfort, diarrhea. Dosage: For acute iron intoxication: IM, Slow IV infusion, 1 g; to be followed by 0.5 g q4h for 2 doses then 0.5 g q4-12h as needed; Max 6 g/day For chronic iron overload: IM 0.5-1 g/day; SC infusion, 1-2 g/day; Slow IV infusion, 2 g for 1unit of blood transfusion Supply: Inj 500 mg/vial 68:00 Hormones and Synthetic Substitutes 68:04 Adrenals 228 - - 229 - - and desmethyl metabolites. Excretion: Urine (80%, as inactive metabolites), feces (20%). Elimination half-life is 1.2 to 1.5 hours. Contraindication: Hypersensitivity to esomeprazole or benzimidazoles. Adverse effect: Abdominal pain, constipation, diarrhea, , flatulence, nausea, dizziness, headache, respiratory infection and sinusitis. Dosage: 20 － 40 mg once daily ; take at least 1 hour before meals, do not chew or crush tablet. Supply: Tab 40 mg 56:32 Prokinetic Agents Domperidone- “D.M.P (Motilium)” (OMOTI) Indication: Domperidone is a peripheral dopamine antagonist. It has been used in delayed gastric emptying, nausea and vomiting, gastroesopageal reflux disease, and miscellaneous indications. Contraindication: Hypersensitivity. Adverse effect: Galactorrhea, seizures, and cardiac arrhythmias have been reported. Dosage: Nausea and vomiting 20-30 mg PO TID - QID. Postprandial dyspepsia 10 mg PO TID (15 to 30 minutes before meals). Supply: Tab 10 mg Metoclopramide HCl-“Primperan” (IPRIM) (OPRIMP) “Gastro-T” (OGAST) ［ B ］ Indication: Stimulate gastric emptying, significant relief of nausea, vomiting, anorexia & abdominal fullness, prevention of cancer chemotherapy-induced emesis. Contraindication: GI hemorrhage, mechanical obstruction or perforation, pheochromocytoma, current use of MAO inhibitors, tricyclic antidepressants or sympathomimetic drug cause extrapyramidal reaction. Use cautiously in patients with asthma, glaucoma, or prostate gland enlargement. Adverse effect: Constipation, diarrhea, drowsiness, lassitude, extrapyramidal reaction, galactorrhea, dizziness, anxiety, periorbital oedema and skin rash Dosage: PO 5-10 mg TID-QID AC, maximum dose: 0.5 mg/kg. For the prevention of cancer chemotherapy-induced emesis, IV infusion 2 mg/kg is given initially 30 minutes before administration of a highly emetogenic drug and repeated twice at 2 hour intervals following the initial dose. Supply: Inj 10 mg/2 ml/amp; Tab 5 mg (Primperan); Cap 30 mg (Gastro-T) 64:00 Heavy Metal Antagonists Deferoxamine methanesulfonate-“Desferal” (IDESF) ［ C ］ Indication: Treatment of acute iron intoxication, to promote iron excretion in patients who have secondary iron overload from the multiple transfusions frequently used in the treatment of thalassemia or other chronic anemia. Contraindication: Patients with severe renal disease or anuria. Adverse effect: Allergic skin reactions, hypotension, shock, dizziness, blurred vision, abdominal discomfort, diarrhea. Dosage: For acute iron intoxication: IM, Slow IV infusion, 1 g; to be followed by 0.5 g q4h for 2 doses then 0.5 g q4-12h as needed; Max 6 g/day For chronic iron overload: IM 0.5-1 g/day; SC infusion, 1-2 g/day; Slow IV infusion, 2 g for 1unit of blood transfusion Supply: Inj 500 mg/vial 68:00 Hormones and Synthetic Substitutes 68:04 Adrenals 230 - - 231 - - Prednisolone (OPRED) ［ C ］ Indication: Endocrine and rheumatic disorders; collagen, dermatological, ophthalmic, respiratory and GI disease, exacerbation of multiple sclerosis, trichinosis associated with neurological or myocardial involvement. Contraindication: Hypersensitivity; ophthalmic products should not be used for epithelial herpes simplex keratitis, acute viral infections of the cornea or conjunctiva, fungal eye infections, mycobacterial infections of the eye; systemic fungal infection. Adverse effect: Anemia, eosinopenia, leukocytosis, lymphopenia, thrombocytopenia, leukocytosis, hypertensive crisis, hypertension, psychosis, schizophrenic psychosis, extrapyramidal effects, pseudotumor cerebri, hyperglycemia, hyperuricemia, hypercalcemia, adrenal suppression, Cushing’s syndrome, porphyria, lipid abnormalities, hypokalemia, peptic ulcers, pancreatitis, abdominal pain, nephrotoxicity, proteinuria, cataracts, papilledema, acne, osteonecrosis, osteoporosis, myopathy, and superinfections. Dosage: 5-60 mg/day, maximum dose 250 mg/day. Supply: Tab 5mg Methylprednisolone-“Mednin”(OMEDN) ［ A ］ Indication: RA, acute & subacute bursitis, exfoliative dermatitis, allergic rhinitis, bronchial asthma, contact dermatitis & allergic conjunctivitis. Contraindication: Systemic fungal infection; immunization. Lactation. Adverse effect: Fluis & electrolyte disturbances; muscle weakness, aseptic osteonecrosis, osteoporosis; peptic ulcer with perforation, hemorrhage, abdominal distention, impaired wound healing; increased intraocular pressure; Cushingoid state, grow suppression, menstrual irregularities, posterior subcapsular cataracts. Dosage: 4-48 mg QD-QID Supply: Tab 4 mg Hydrocortisone sodium succinate-“Solu-Cortef” (ISOLU) ［ A ］ Indication: Same as cortisone. Contraindication: Hypersensitivity, during the immediate and early post-operative period after ileocolostomy; systemic fungal infection. Adverse effect: Adverse effects associated with long-term systemic use include fluid retention, hypertension, euphoria, depression, adrenal suppression, hyperglycemia, growth suppression, gastrointestinal upset, cataracts, glaucoma, osteoporosis, and infection. Topical products may cause burning, itching, or irritation. Dosage: 15-240 mg/day, IM or IV or SC. Stability: Hydrocortisone sodium succinate 250 mg/L is physically compatible with D5W. Supply: Inj 100 mg/vial Methylprednisolone sodium succinate “Solu-Medrol” (ISOLM) ［ A ］ Indication: Endocrine disorders, severe shock, collagen disease, bronchial asthma and dermatologic disease. Contraindication: Hypersensitivity, during the immediate and early post-operative period after ileocolostomy, systemic fungal infection. Adverse effect: High-dose pulse therapy of methylprednisolone has been associated with arrhythmias, cardiac arrest, and myocardial infarction. Central nervous system effects include hemiplegia, seizures, papilledema, headache, psychosis, visual hallucinations, and meningitis. Dosage: Usual dose 4-48 mg/day IV over one to several minutes; high dose therapy, 30 mg/kg IV over 10-20 minutes, may be repeated Q4H or Q6H for 48 hours. Supply: Inj 125 mg/vial Triamcinolone – “Kenacort - A”(IKENA) ［ C ］ Indication: Endocrine disorders, adrenocortical insufficiency, rheumatic disorders, collagen and dermatological disease, bronchial asthma, serum 230 - - 231 - - Prednisolone (OPRED) ［ C ］ Indication: Endocrine and rheumatic disorders; collagen, dermatological, ophthalmic, respiratory and GI disease, exacerbation of multiple sclerosis, trichinosis associated with neurological or myocardial involvement. Contraindication: Hypersensitivity; ophthalmic products should not be used for epithelial herpes simplex keratitis, acute viral infections of the cornea or conjunctiva, fungal eye infections, mycobacterial infections of the eye; systemic fungal infection. Adverse effect: Anemia, eosinopenia, leukocytosis, lymphopenia, thrombocytopenia, leukocytosis, hypertensive crisis, hypertension, psychosis, schizophrenic psychosis, extrapyramidal effects, pseudotumor cerebri, hyperglycemia, hyperuricemia, hypercalcemia, adrenal suppression, Cushing’s syndrome, porphyria, lipid abnormalities, hypokalemia, peptic ulcers, pancreatitis, abdominal pain, nephrotoxicity, proteinuria, cataracts, papilledema, acne, osteonecrosis, osteoporosis, myopathy, and superinfections. Dosage: 5-60 mg/day, maximum dose 250 mg/day. Supply: Tab 5mg Methylprednisolone-“Mednin”(OMEDN) ［ A ］ Indication: RA, acute & subacute bursitis, exfoliative dermatitis, allergic rhinitis, bronchial asthma, contact dermatitis & allergic conjunctivitis. Contraindication: Systemic fungal infection; immunization. Lactation. Adverse effect: Fluis & electrolyte disturbances; muscle weakness, aseptic osteonecrosis, osteoporosis; peptic ulcer with perforation, hemorrhage, abdominal distention, impaired wound healing; increased intraocular pressure; Cushingoid state, grow suppression, menstrual irregularities, posterior subcapsular cataracts. Dosage: 4-48 mg QD-QID Supply: Tab 4 mg Hydrocortisone sodium succinate-“Solu-Cortef” (ISOLU) ［ A ］ Indication: Same as cortisone. Contraindication: Hypersensitivity, during the immediate and early post-operative period after ileocolostomy; systemic fungal infection. Adverse effect: Adverse effects associated with long-term systemic use include fluid retention, hypertension, euphoria, depression, adrenal suppression, hyperglycemia, growth suppression, gastrointestinal upset, cataracts, glaucoma, osteoporosis, and infection. Topical products may cause burning, itching, or irritation. Dosage: 15-240 mg/day, IM or IV or SC. Stability: Hydrocortisone sodium succinate 250 mg/L is physically compatible with D5W. Supply: Inj 100 mg/vial Methylprednisolone sodium succinate “Solu-Medrol” (ISOLM) ［ A ］ Indication: Endocrine disorders, severe shock, collagen disease, bronchial asthma and dermatologic disease. Contraindication: Hypersensitivity, during the immediate and early post-operative period after ileocolostomy, systemic fungal infection. Adverse effect: High-dose pulse therapy of methylprednisolone has been associated with arrhythmias, cardiac arrest, and myocardial infarction. Central nervous system effects include hemiplegia, seizures, papilledema, headache, psychosis, visual hallucinations, and meningitis. Dosage: Usual dose 4-48 mg/day IV over one to several minutes; high dose therapy, 30 mg/kg IV over 10-20 minutes, may be repeated Q4H or Q6H for 48 hours. Supply: Inj 125 mg/vial Triamcinolone – “Kenacort - A”(IKENA) ［ C ］ Indication: Endocrine disorders, adrenocortical insufficiency, rheumatic disorders, collagen and dermatological disease, bronchial asthma, serum 232 - - 233 - - sickness, ophthalmic disease, respiratory disease, hematological disease. Contraindication: Hypersensitivity; dental paste - fungal, viral, or bacterial infections of the mouth or throat; inhaler - status asthmaticus or other acute episodes of asthma; intramuscular - idiopathic thrombocytopenia purpura; systemic fungal infection. Adverse effect: Sodium retention, muscle weakness, osteoporosis, pancreatitis, ulcerative esophagitis, vertigo, headache, convulsion and negative nitrogen balance. Dosage: Intraarticular or intrabursal, 2.5-40 mg; intradermal, 1 mg at each site repeated one or more times weekly; IM, 60 mg. Supply: Inj 10 mg/ml/vial Dexamethasone-“Decadron (Methason)”(IDECA) ［ A ］ Indication: Conditions where the anti-inflammatory & immunosuppressive effects of the corticosteroids are desirable, especially for intensive treatment during shorter periods. Contraindication: Systemic fungal infection, hypersensitivity. Administration of live virus vaccine. Unstable or infected joints, diagnosed sepsis. Adverse effect: Fluid & electrolyte disturbances, CV, musculoskeletal, GI, dermatologic, neurologic, endocrine, ophth & metabolic effects. Thromboembolism. Psychic disturbances. Joint tissue damage (frequent IA inj). Dosage: Depending on the conditions of the patient & the disease being treated, 0.75-15 mg/day. Supply: Inj 5 mg/ml/amp 68:08 Androgens Danazol-“Ectopal” (OECTO)( 專 ) ［ X ］ Indication: Endometriosis, fibrocystic breast disease, menorrhagia. Contraindication: Abnormal genital bleeding; impaired hepatic, renal or cardiac function; pregnancy and breast- feeding. Adverse effect: Acne, edema, mild hirsutism, decrease in breast size, weight gain and testicular atrophy. Dosage: Endometriosis: make sure the patient is not pregnant; administer 800 mg/day BID for 3-6 months, up to 9 months. Fibrocystic breast disease: 100-400 mg BID. Supply: Cap 200 mg 68:16 Estrogens and Estrogen Agonists- Antagonists 68:16.04 Estrogens Conjugated Estrogens-“ Estromon” (OESTR) “Premarin”(EPREM) (IPREM) ［ X ］ Indication: Severe vasomotor symptoms associated with the menopause; primary ovarian failure; atrophic vaginitis. Contraindication: Breast cancer; estrogen dependent neoplasia, pregnancy, active thrombophlebitis, or thromboembolic disorders, abnormal vaginal bleeding. Adverse effect: Breast tenderness, enlargement and secretion, melasma, erythema multiforme erythema nodosum, migraine, dizziness, mental depression and chorea. Dosage: Oral menopausal symptom 0.3-1.25 mg/day cyclically, female hypogonadism 2.5-7.5mg/day in div, doses for 20 days/cycle, female castration or primary ovarian failure 1.25mg/day, dysfunctional uterine bleeding 2.5mg/day in div doses for 7 days, osteoporsis 0.625 mg/day, breast carcinoma in postmenopausal women 10 mg tid for at least 3 mons, prostatic carcinoma 1.25-2.5mg tid; IM, slow IV emergency treatment of dysfunctional bleeding 25mg repeat in 6-12hrs if necessary Supply: Tab 0.625 mg; Vaginal cream 0.625 mg/gm, 42.5 gm/tube; Inj 25 mg/vial. Estradiol-“Oestrogel” (EOES3) ［ X ］ Indication: Natural or surgical menopause, estrogen 232 - - 233 - - sickness, ophthalmic disease, respiratory disease, hematological disease. Contraindication: Hypersensitivity; dental paste - fungal, viral, or bacterial infections of the mouth or throat; inhaler - status asthmaticus or other acute episodes of asthma; intramuscular - idiopathic thrombocytopenia purpura; systemic fungal infection. Adverse effect: Sodium retention, muscle weakness, osteoporosis, pancreatitis, ulcerative esophagitis, vertigo, headache, convulsion and negative nitrogen balance. Dosage: Intraarticular or intrabursal, 2.5-40 mg; intradermal, 1 mg at each site repeated one or more times weekly; IM, 60 mg. Supply: Inj 10 mg/ml/vial Dexamethasone-“Decadron (Methason)”(IDECA) ［ A ］ Indication: Conditions where the anti-inflammatory & immunosuppressive effects of the corticosteroids are desirable, especially for intensive treatment during shorter periods. Contraindication: Systemic fungal infection, hypersensitivity. Administration of live virus vaccine. Unstable or infected joints, diagnosed sepsis. Adverse effect: Fluid & electrolyte disturbances, CV, musculoskeletal, GI, dermatologic, neurologic, endocrine, ophth & metabolic effects. Thromboembolism. Psychic disturbances. Joint tissue damage (frequent IA inj). Dosage: Depending on the conditions of the patient & the disease being treated, 0.75-15 mg/day. Supply: Inj 5 mg/ml/amp 68:08 Androgens Danazol-“Ectopal” (OECTO)( 專 ) ［ X ］ Indication: Endometriosis, fibrocystic breast disease, menorrhagia. Contraindication: Abnormal genital bleeding; impaired hepatic, renal or cardiac function; pregnancy and breast- feeding. Adverse effect: Acne, edema, mild hirsutism, decrease in breast size, weight gain and testicular atrophy. Dosage: Endometriosis: make sure the patient is not pregnant; administer 800 mg/day BID for 3-6 months, up to 9 months. Fibrocystic breast disease: 100-400 mg BID. Supply: Cap 200 mg 68:16 Estrogens and Estrogen Agonists- Antagonists 68:16.04 Estrogens Conjugated Estrogens-“ Estromon” (OESTR) “Premarin”(EPREM) (IPREM) ［ X ］ Indication: Severe vasomotor symptoms associated with the menopause; primary ovarian failure; atrophic vaginitis. Contraindication: Breast cancer; estrogen dependent neoplasia, pregnancy, active thrombophlebitis, or thromboembolic disorders, abnormal vaginal bleeding. Adverse effect: Breast tenderness, enlargement and secretion, melasma, erythema multiforme erythema nodosum, migraine, dizziness, mental depression and chorea. Dosage: Oral menopausal symptom 0.3-1.25 mg/day cyclically, female hypogonadism 2.5-7.5mg/day in div, doses for 20 days/cycle, female castration or primary ovarian failure 1.25mg/day, dysfunctional uterine bleeding 2.5mg/day in div doses for 7 days, osteoporsis 0.625 mg/day, breast carcinoma in postmenopausal women 10 mg tid for at least 3 mons, prostatic carcinoma 1.25-2.5mg tid; IM, slow IV emergency treatment of dysfunctional bleeding 25mg repeat in 6-12hrs if necessary Supply: Tab 0.625 mg; Vaginal cream 0.625 mg/gm, 42.5 gm/tube; Inj 25 mg/vial. Estradiol-“Oestrogel” (EOES3) ［ X ］ Indication: Natural or surgical menopause, estrogen 234 - - 235 - - deficiencies; vasomotor disorders associated with menopause; tropic disorders caused by disturbances in ovarian secretions as in vag atrophy, kraurosis vulvae, female hypogonadism, castration in women, primary ovarian deficiency. Precautions: Migraine, oestrogen-sensitive gynaeocological disorders eg uterine fibromyomata, endometriosis. Dosage: Apply 2.5 g daily (preferably on the abdomen) for 24 successive days, stop for 1 week (25 th -end of the months), then combine therapy with an oral progesterone from 13 th -24 th day of the cycle. A depletion in bleeding is generally seen during the weeks of interruption. Supply: Gel 0.06% 30 g/tube 68:16.12 Estrogen Agonists-Antagonists Clomiphene citrate (OCLOM) ［ X ］ Indication: It is used in anovulatory infertility; the drug has also been used to treat male infertility. Contraindication: During pregnancy; liver dysfunction; abnormal uterine bleeding; organic intracranial lesion such as a pituitary tumor; uncontrolled thyroid or adrenal dysfunction; hypersensitivity to clomiphene Adverse effect: Hot flushes, abdominal discomfort, ovarian enlargement, blurred vision; isolated cases of cancer (testicular, hepatic, breast) have been reported. Dosage: 50mg/day for 5 days should be started in the fifth day of the cycle; if no effect, next course 100mg/day for 5 days. Supply: Tab 50 mg Tibolone – “Livial” (OLIVI) Indication: Tibolone is a synthetic steroidal agent with estrogenic, progestogenic, and androgenic activity. Tibolone has demonstrated efficacy in the treatment of menopausal symptoms and has prevented bone loss in postmenopausal patients. Contraindication: Hypersensitivity, breast cancer, estrogen-dependent neoplasms, cerebrovascular disease, coronary artery disease, thromboembolic disorders, history of cholestatic jaundice, hepatic tumors, abnormal vaginal bleeding Adverse effect: Headache, dizziness, edema and weight gain, and gastrointestinal disturbances. Vaginal bleeding is more common when the drug is given during the first year of menopause; potentially deleterious decreases in high-density lipoprotein (HDL) cholesterol and apolipoprotein A1 levels have been observed with tibolone. No coagulation effects were associated. Dosage: Menopausal symptoms and prevention and treatment of postmenopausal osteoporosis: 2.5 mg PO QD Supply: Tab 2.5 mg 68:18 Gonadotropins Human Chorionic Gonadotropin – “Pregnyl” (HCG)(IHCG)( 專 ) ［ X ］ Indication: Amenorrhea, oligomenorrhea, abortion, ovulation induction; for male: hypogonadotropic eunuchoidism, azoospermia, impotency, obesity, asthenospermia, cryptorchidism. Contraindication: Pregnancy, pituitary tumor, hypersensitivity, premature menopause, prostate cancer. Adverse effect: Ovarian enlargement, rupture of ovarian cysts, multiple births. Dosage: For induction of ovulation and pregnancy: IM 5000-10000 IU given 1 day following the last dose of menotropins. For prepubertal cryptorchidism: IM, 5000 IU qod for 4 doses or 500-1000 IU for 15 doses over 6wks. For hypogonadotropic hypogonadism: IM, 500-1000 IU 3 times/wk for 3 wks, followed by the same dose 3 times/wk foe 3 wks Stability: Human chorionic gonadotropin 10,000 units with a solvent of Sodium Chloride 0.72% and phenol 0.45% 10mL to provide 1000 units/mL, stable for 1 week 234 - - 235 - - deficiencies; vasomotor disorders associated with menopause; tropic disorders caused by disturbances in ovarian secretions as in vag atrophy, kraurosis vulvae, female hypogonadism, castration in women, primary ovarian deficiency. Precautions: Migraine, oestrogen-sensitive gynaeocological disorders eg uterine fibromyomata, endometriosis. Dosage: Apply 2.5 g daily (preferably on the abdomen) for 24 successive days, stop for 1 week (25 th -end of the months), then combine therapy with an oral progesterone from 13 th -24 th day of the cycle. A depletion in bleeding is generally seen during the weeks of interruption. Supply: Gel 0.06% 30 g/tube 68:16.12 Estrogen Agonists-Antagonists Clomiphene citrate (OCLOM) ［ X ］ Indication: It is used in anovulatory infertility; the drug has also been used to treat male infertility. Contraindication: During pregnancy; liver dysfunction; abnormal uterine bleeding; organic intracranial lesion such as a pituitary tumor; uncontrolled thyroid or adrenal dysfunction; hypersensitivity to clomiphene Adverse effect: Hot flushes, abdominal discomfort, ovarian enlargement, blurred vision; isolated cases of cancer (testicular, hepatic, breast) have been reported. Dosage: 50mg/day for 5 days should be started in the fifth day of the cycle; if no effect, next course 100mg/day for 5 days. Supply: Tab 50 mg Tibolone – “Livial” (OLIVI) Indication: Tibolone is a synthetic steroidal agent with estrogenic, progestogenic, and androgenic activity. Tibolone has demonstrated efficacy in the treatment of menopausal symptoms and has prevented bone loss in postmenopausal patients. Contraindication: Hypersensitivity, breast cancer, estrogen-dependent neoplasms, cerebrovascular disease, coronary artery disease, thromboembolic disorders, history of cholestatic jaundice, hepatic tumors, abnormal vaginal bleeding Adverse effect: Headache, dizziness, edema and weight gain, and gastrointestinal disturbances. Vaginal bleeding is more common when the drug is given during the first year of menopause; potentially deleterious decreases in high-density lipoprotein (HDL) cholesterol and apolipoprotein A1 levels have been observed with tibolone. No coagulation effects were associated. Dosage: Menopausal symptoms and prevention and treatment of postmenopausal osteoporosis: 2.5 mg PO QD Supply: Tab 2.5 mg 68:18 Gonadotropins Human Chorionic Gonadotropin – “Pregnyl” (HCG)(IHCG)( 專 ) ［ X ］ Indication: Amenorrhea, oligomenorrhea, abortion, ovulation induction; for male: hypogonadotropic eunuchoidism, azoospermia, impotency, obesity, asthenospermia, cryptorchidism. Contraindication: Pregnancy, pituitary tumor, hypersensitivity, premature menopause, prostate cancer. Adverse effect: Ovarian enlargement, rupture of ovarian cysts, multiple births. Dosage: For induction of ovulation and pregnancy: IM 5000-10000 IU given 1 day following the last dose of menotropins. For prepubertal cryptorchidism: IM, 5000 IU qod for 4 doses or 500-1000 IU for 15 doses over 6wks. For hypogonadotropic hypogonadism: IM, 500-1000 IU 3 times/wk for 3 wks, followed by the same dose 3 times/wk foe 3 wks Stability: Human chorionic gonadotropin 10,000 units with a solvent of Sodium Chloride 0.72% and phenol 0.45% 10mL to provide 1000 units/mL, stable for 1 week 236 - - 237 - - at room temperature and 3 months refrigerated. Supply: Inj 5000 IU/amp Follitropin-beta (FSH)-“Puregon” (IPURE) ［ X ］ Indication: In female infertility ： anovulation in women who have been unresponsive to treatment with clomiphene, controlled ovarian hyperstimulation to induce the development of multiple follicles in medically assisted reproduction programs. In male ： deficient spermatogenesis due to hypogonadotrophic hypogonadism. Pharmacology: Follitropin beta is a preparation of human-follicle stimulating hormone (FSH) derived by recombinant DNA technology. Thus it can be used to stimulate follicular growth and maturation, and gonadal steroid production. Pharmacokinetics: Puregon for IM or SC administration were equivalent with respect to the extent of absorption; The time to maximal concentration is within about 12 hours, Vd: 8 liter, elimination half-life 27-44 hours. Contraindication: Abnormal vaginal bleeding of undetermined origin, high circulating FSH level indicating primary ovarian failure, hypersensitivity to recombinant human FSH products, ovarian cysts/enlargement not due to polycystic ovary syndrome, pregnancy, tumor of the ovary, breast, uterus, hypothalamus, or pituitary gland, uncontrolled thyroid or adrenal dysfunction. Adverse effect: Headache (up to 27%), abdominal pain (up to 23%), dizziness, fever, ovarian hyper-stimulation syndrome, ectopic pregnancy, hypertrophy of ovary, spontaneous abortion. Dosage: Anovulation: initial, 75 IU SC/IM daily for up to 14 days; max 300 IU/day; administer hCG 1 day after last dose. In medically assisted reproduction programs: initial, 150-225 IU SC/IM daily for at least 4 days, then 75-300 IU daily for 6-12 days; max 600 IU/day; administer hCG once follicular development is evident. Storage: Store at 2 ℃ -8 ℃ ( in a refrigerator). Do not freeze. Supply: Cartridge 300 IU/0.36 ml 68:20 Antidiabetic Agents 68:20.02 α -Glucosidase Inhibitors Acarbose-“Glucobay” (OGLUCB) Indication: Type 2 diabetes mellitus. Place in therapy: Acarbose is an inhibitor of intestinal α -glucosidases. It acts via competitive inhibition of α -glucosidases, which delays absorption of monosaccharides and reduces post-prandial blood glucose. Contraindication: Hypersensitivity to acarbose, Diabetic ketoacidosis, Cirrhosis, Digestive diseases associated with marked problems in absorption or digestion; Conditions which may worsen with increased intestinal gas, Partial bowel obstruction or predisposition to bowel obstruction, Inflammatory bowel disease, Colon ulcerations. Adverse effect: Flatulence, meteorism, abdominal pain and distention, diarrhea, and borborygmi are the main adverse effects. Isolated cases of elevated liver enzymes have been reported. Dosage: Initial 25 mg TID with meal, maintenance dose 50-100 mg TID Pharmacokinetics: Approximately 0.7 to 2% is absorbed from GI tract. Acarbose is not metabolized systemically, but it may be degraded by the influence of intestinal bacteria and the degradation products are absorbed. Supply: Tab 50 mg 68:20.04 Biguanides Metformin-“Glucophage” (OGLUC) “Metformin”(OMETF) “C.T.L. XR” (OCTL) “Glucomin XR” (OGLU5) “Antigluco”(OMET8) “Anxoken”(OANXO) ［ B ］ Indication: Metformin is a biguanide indicated as an adjunct to diet for lowering blood glucose levels in patients with type II diabetes mellitus. Place in therapy: It has also been used in combination 236 - - 237 - - at room temperature and 3 months refrigerated. Supply: Inj 5000 IU/amp Follitropin-beta (FSH)-“Puregon” (IPURE) ［ X ］ Indication: In female infertility ： anovulation in women who have been unresponsive to treatment with clomiphene, controlled ovarian hyperstimulation to induce the development of multiple follicles in medically assisted reproduction programs. In male ： deficient spermatogenesis due to hypogonadotrophic hypogonadism. Pharmacology: Follitropin beta is a preparation of human-follicle stimulating hormone (FSH) derived by recombinant DNA technology. Thus it can be used to stimulate follicular growth and maturation, and gonadal steroid production. Pharmacokinetics: Puregon for IM or SC administration were equivalent with respect to the extent of absorption; The time to maximal concentration is within about 12 hours, Vd: 8 liter, elimination half-life 27-44 hours. Contraindication: Abnormal vaginal bleeding of undetermined origin, high circulating FSH level indicating primary ovarian failure, hypersensitivity to recombinant human FSH products, ovarian cysts/enlargement not due to polycystic ovary syndrome, pregnancy, tumor of the ovary, breast, uterus, hypothalamus, or pituitary gland, uncontrolled thyroid or adrenal dysfunction. Adverse effect: Headache (up to 27%), abdominal pain (up to 23%), dizziness, fever, ovarian hyper-stimulation syndrome, ectopic pregnancy, hypertrophy of ovary, spontaneous abortion. Dosage: Anovulation: initial, 75 IU SC/IM daily for up to 14 days; max 300 IU/day; administer hCG 1 day after last dose. In medically assisted reproduction programs: initial, 150-225 IU SC/IM daily for at least 4 days, then 75-300 IU daily for 6-12 days; max 600 IU/day; administer hCG once follicular development is evident. Storage: Store at 2 ℃ -8 ℃ ( in a refrigerator). Do not freeze. Supply: Cartridge 300 IU/0.36 ml 68:20 Antidiabetic Agents 68:20.02 α -Glucosidase Inhibitors Acarbose-“Glucobay” (OGLUCB) Indication: Type 2 diabetes mellitus. Place in therapy: Acarbose is an inhibitor of intestinal α -glucosidases. It acts via competitive inhibition of α -glucosidases, which delays absorption of monosaccharides and reduces post-prandial blood glucose. Contraindication: Hypersensitivity to acarbose, Diabetic ketoacidosis, Cirrhosis, Digestive diseases associated with marked problems in absorption or digestion; Conditions which may worsen with increased intestinal gas, Partial bowel obstruction or predisposition to bowel obstruction, Inflammatory bowel disease, Colon ulcerations. Adverse effect: Flatulence, meteorism, abdominal pain and distention, diarrhea, and borborygmi are the main adverse effects. Isolated cases of elevated liver enzymes have been reported. Dosage: Initial 25 mg TID with meal, maintenance dose 50-100 mg TID Pharmacokinetics: Approximately 0.7 to 2% is absorbed from GI tract. Acarbose is not metabolized systemically, but it may be degraded by the influence of intestinal bacteria and the degradation products are absorbed. Supply: Tab 50 mg 68:20.04 Biguanides Metformin-“Glucophage” (OGLUC) “Metformin”(OMETF) “C.T.L. XR” (OCTL) “Glucomin XR” (OGLU5) “Antigluco”(OMET8) “Anxoken”(OANXO) ［ B ］ Indication: Metformin is a biguanide indicated as an adjunct to diet for lowering blood glucose levels in patients with type II diabetes mellitus. Place in therapy: It has also been used in combination 238 - - 239 - - with sulfonylureas and insulin. The mechanism of action and side effect profile differ from sulfonylureas and offer advantages particularly for obese patients with type II diabetes mellitus. Contraindication: Diabetic coma and ketoacidosis. Adverse effect: GI disturbances, skin rash, and lactacidosis. Dosage: 0.75-1.5g daily. Supply: Tab 500 mg (Glucophage, Metformin, C.T.L.XR, Glucomin XR), 850 mg (Antigluco), 1000 mg (Anxoken) Glyburide/Metformin-“Glucomet” (OGLUM) ［ B ］ Indication: Type 2 Diabetes Contraindication: Hypersensitivity to metformin or glyburide, renal disease or renal dysfunction (serum creatinine 1.5 mg/dL in males or 1.4 mg/dL in females); congestive heart failure requiring pharmacologic treatment; acute or chronic metabolic acidosis, including diabetic ketoacidosis, with or without coma. Adverse effect: Hypoglycemia, gastrointestinal reactions, lactic asidosis (less than 3 cases in every 100,000 cases). Dosage: Initial: 2.5 mg/500 mg or 5 mg/500 mg twice daily, MAX: 20 mg/200 mg/day Supply: Tab Glyburide 5 mg/Metformin 500 mg 68:20.05 Dipeptidyl Peptidase IV (DPP-4) Inhibitors Sitagliptin phosphate-“Januvia” (OJANU) ［ B ］ Indication: Type 2 Diabetes Contraindication: Serious hypersensitivity reaction (eg, angioedema, anaphylaxis) to sitagliptin Adverse effect: Hypoglycemia, headache, nasopharyngitis and upper respiratory infection. Dosage: 100 mg orally once daily with or without food; when administered with sulfonylurea, a lower dose of sulfonylurea may be required. Supply: Tab Sitagliptin 100 mg 68:20.08 Insulins Isophane Insulin (NPH Insulin), Human -“Insulatard HM”(IHUN)(IHUNU) Indication: Insulin-requiring diabetes mellitus. Contraindication: Hypoglycaemia, insulinoma. Adverse effect: Rare incidence of allergy & lipoatrophy. Dosage: Administer once or twice daily by SC inj. Supply: Inj 100 IU/ml, 10 ml/vial Regular Insulin, Human -“Actrapid HM” (IHUR) (IHURU) Indication: Insulin-requiring diabetes mellitus. Contraindication: Hypoglycaemia, insulinoma. Adverse effect: Rarely incidence of allergy & lipoatrophy. Dosage: Usually given 3 or more times daily (when used alone) by SC, IM or IV inj. Supply: Inj 100 IU/ml, 10 ml/vial Insulin aspart/Insulin aspart protamine- “Novomix 30” (IHUMP) ［ C ］ Indication: Treatment of patients with diabetes mellitus Pharmacology: NovoMix 30 Penfill contain insulin aspart and insulin aspart protamine. The blood glucose lowering effect of insulin aspart occurs when molecules facilitate the uptake of glucose by binding to insulin receptors on muscle and fat cells and simultaneously inhibit glucose release from the liver. Pharmacokinetics: NovoMix onset: 10-20 min, peak effect: 1-4 hours, duration: 24 hours.. Contraindication: Hypoglycaemia; hypersensitivity to insulin aspart or any of the excipients. Adverse effect: Hypoglycaemia Dosage: Usual initial dose: 0.5-1 unit/kg/day in divided doses; SC within 5-10 min before a meal. Supply: Inj insulin aspart 30%, insulin aspart protamine 70%, 100 U/ml, 3 ml/cartridge. 238 - - 239 - - with sulfonylureas and insulin. The mechanism of action and side effect profile differ from sulfonylureas and offer advantages particularly for obese patients with type II diabetes mellitus. Contraindication: Diabetic coma and ketoacidosis. Adverse effect: GI disturbances, skin rash, and lactacidosis. Dosage: 0.75-1.5g daily. Supply: Tab 500 mg (Glucophage, Metformin, C.T.L.XR, Glucomin XR), 850 mg (Antigluco), 1000 mg (Anxoken) Glyburide/Metformin-“Glucomet” (OGLUM) ［ B ］ Indication: Type 2 Diabetes Contraindication: Hypersensitivity to metformin or glyburide, renal disease or renal dysfunction (serum creatinine 1.5 mg/dL in males or 1.4 mg/dL in females); congestive heart failure requiring pharmacologic treatment; acute or chronic metabolic acidosis, including diabetic ketoacidosis, with or without coma. Adverse effect: Hypoglycemia, gastrointestinal reactions, lactic asidosis (less than 3 cases in every 100,000 cases). Dosage: Initial: 2.5 mg/500 mg or 5 mg/500 mg twice daily, MAX: 20 mg/200 mg/day Supply: Tab Glyburide 5 mg/Metformin 500 mg 68:20.05 Dipeptidyl Peptidase IV (DPP-4) Inhibitors Sitagliptin phosphate-“Januvia” (OJANU) ［ B ］ Indication: Type 2 Diabetes Contraindication: Serious hypersensitivity reaction (eg, angioedema, anaphylaxis) to sitagliptin Adverse effect: Hypoglycemia, headache, nasopharyngitis and upper respiratory infection. Dosage: 100 mg orally once daily with or without food; when administered with sulfonylurea, a lower dose of sulfonylurea may be required. Supply: Tab Sitagliptin 100 mg 68:20.08 Insulins Isophane Insulin (NPH Insulin), Human -“Insulatard HM”(IHUN)(IHUNU) Indication: Insulin-requiring diabetes mellitus. Contraindication: Hypoglycaemia, insulinoma. Adverse effect: Rare incidence of allergy & lipoatrophy. Dosage: Administer once or twice daily by SC inj. Supply: Inj 100 IU/ml, 10 ml/vial Regular Insulin, Human -“Actrapid HM” (IHUR) (IHURU) Indication: Insulin-requiring diabetes mellitus. Contraindication: Hypoglycaemia, insulinoma. Adverse effect: Rarely incidence of allergy & lipoatrophy. Dosage: Usually given 3 or more times daily (when used alone) by SC, IM or IV inj. Supply: Inj 100 IU/ml, 10 ml/vial Insulin aspart/Insulin aspart protamine- “Novomix 30” (IHUMP) ［ C ］ Indication: Treatment of patients with diabetes mellitus Pharmacology: NovoMix 30 Penfill contain insulin aspart and insulin aspart protamine. The blood glucose lowering effect of insulin aspart occurs when molecules facilitate the uptake of glucose by binding to insulin receptors on muscle and fat cells and simultaneously inhibit glucose release from the liver. Pharmacokinetics: NovoMix onset: 10-20 min, peak effect: 1-4 hours, duration: 24 hours.. Contraindication: Hypoglycaemia; hypersensitivity to insulin aspart or any of the excipients. Adverse effect: Hypoglycaemia Dosage: Usual initial dose: 0.5-1 unit/kg/day in divided doses; SC within 5-10 min before a meal. Supply: Inj insulin aspart 30%, insulin aspart protamine 70%, 100 U/ml, 3 ml/cartridge. 240 - - 241 - - Insulin glargine-“Lantus” (ILANT) Indication: Lantus is indicated for once-daily subcutaneous administration for the treatment of adult and pediatric patients with type 1 diabetes mellitus, or adult patients with type 2 diabetes mellitus requiring basal (long-acting) insulin for the control of hyperglycemia. Pharmacology: Insulin glargine is a recombinant human insulin analog that is a long-acting (up to 24-hour duration of action), parenteral blood-glucose-lowering agent. Pharmacokinetics: After subcutaneous injection of insulin glargine in healthy subjects and in patients with diabetes, the insulin serum concentrations indicated a slower, more prolonged absorption and a relatively constant concentration/time profile over 24 hours with no pronounced peak in comparison to NPH human insulin. Contraindication: Hypoglycemia, hypersensitivity to insulin glargine or any of the excipients. Adverse effect: Hypoglycaemia, injection site pain, rash. Dosage: Usual initial dose: 0.15-0.4 unit/kg/day. Lantus should be administered SC once a day at the same time every day. Do NOT be administered intravenously. Do NOT dilute; Do NOT mix with any other insulin product or solution. The solution should be clear and colorless with no particles visible. Storage: Should be stored at 2-8 ℃ , the opened vials or cartridges should be used within 28 days. Supply: Inj 100U/ml, 3ml/pen. Insulin detemir-“Levemir”(ILEVE) ［ C ］ Indication: Treatment of diabetes mellitus. Precautions: Psychic stress, infection or other diseases that may increase insulin requirement. Pregnancy. Adverse effect: Hypoglycemia, inj site reactions. Rarely, lipodystrophy, allergic reactions. Dosage: Administer SC once or bid. Duration of action: up to 24 hr depending on dose. Supply: Flex pen 100 U/ml, 3 ml/pen. 68:20.16 Meglitinides Repaglinide – “Novonorm”(ONOVO) “Supernide”(OREPA) ［ C ］ Indication: Repaglinide is an oral agent of the meglitinide class used for treating noninsulin dependent diabetes mellitus. Place in therapy: Repaglinide has significantly reduced postprandial blood glucose in type 2 diabetes; minimal effects on fasting blood glucose were observed. Contraindication: Hypersensitivity to repaglinide; insulin dependent diabetes mellitus; ketoacidosis Adverse effect: Hypoglycemia is the major adverse effect; nausea, diarrhea, constipation, vomiting, and dyspepsia were reported at a similar incidence to placebo and sulfonylureas. Dosage: 0.5-4 mg PO AC; the maximum total daily dose should not exceed 16 mg Pharmacokinetics: Rapidly absorbed following oral administration. Extensively metabolized in the liver and excreted predominantly via the feces; Elimination half-life: less than one hour. Supply: Tab 1 mg 68:20.20 Sulfonylureas Glibenclamide-“Euglucon”(OEUGL) ［ B ］ Indication: Mild or moderately severe uncomplicated non-insulin dependent diabetes mellitus. Contraindication: Patients complicated by fever, trauma or gangrene, and with impaired renal or hepatic functions or serious impairment of thyroid or adrenal function, insulin-dependent diabetes mellitus. Adverse effect: GI disturbances, dizziness, jaundice, skin rashes and blood disorders. Dosage: Initial dose 5 mg/day, may be gradually increased if necessary, up to 20 mg daily. Supply: Tab 5 mg 240 - - 241 - - Insulin glargine-“Lantus” (ILANT) Indication: Lantus is indicated for once-daily subcutaneous administration for the treatment of adult and pediatric patients with type 1 diabetes mellitus, or adult patients with type 2 diabetes mellitus requiring basal (long-acting) insulin for the control of hyperglycemia. Pharmacology: Insulin glargine is a recombinant human insulin analog that is a long-acting (up to 24-hour duration of action), parenteral blood-glucose-lowering agent. Pharmacokinetics: After subcutaneous injection of insulin glargine in healthy subjects and in patients with diabetes, the insulin serum concentrations indicated a slower, more prolonged absorption and a relatively constant concentration/time profile over 24 hours with no pronounced peak in comparison to NPH human insulin. Contraindication: Hypoglycemia, hypersensitivity to insulin glargine or any of the excipients. Adverse effect: Hypoglycaemia, injection site pain, rash. Dosage: Usual initial dose: 0.15-0.4 unit/kg/day. Lantus should be administered SC once a day at the same time every day. Do NOT be administered intravenously. Do NOT dilute; Do NOT mix with any other insulin product or solution. The solution should be clear and colorless with no particles visible. Storage: Should be stored at 2-8 ℃ , the opened vials or cartridges should be used within 28 days. Supply: Inj 100U/ml, 3ml/pen. Insulin detemir-“Levemir”(ILEVE) ［ C ］ Indication: Treatment of diabetes mellitus. Precautions: Psychic stress, infection or other diseases that may increase insulin requirement. Pregnancy. Adverse effect: Hypoglycemia, inj site reactions. Rarely, lipodystrophy, allergic reactions. Dosage: Administer SC once or bid. Duration of action: up to 24 hr depending on dose. Supply: Flex pen 100 U/ml, 3 ml/pen. 68:20.16 Meglitinides Repaglinide – “Novonorm”(ONOVO) “Supernide”(OREPA) ［ C ］ Indication: Repaglinide is an oral agent of the meglitinide class used for treating noninsulin dependent diabetes mellitus. Place in therapy: Repaglinide has significantly reduced postprandial blood glucose in type 2 diabetes; minimal effects on fasting blood glucose were observed. Contraindication: Hypersensitivity to repaglinide; insulin dependent diabetes mellitus; ketoacidosis Adverse effect: Hypoglycemia is the major adverse effect; nausea, diarrhea, constipation, vomiting, and dyspepsia were reported at a similar incidence to placebo and sulfonylureas. Dosage: 0.5-4 mg PO AC; the maximum total daily dose should not exceed 16 mg Pharmacokinetics: Rapidly absorbed following oral administration. Extensively metabolized in the liver and excreted predominantly via the feces; Elimination half-life: less than one hour. Supply: Tab 1 mg 68:20.20 Sulfonylureas Glibenclamide-“Euglucon”(OEUGL) ［ B ］ Indication: Mild or moderately severe uncomplicated non-insulin dependent diabetes mellitus. Contraindication: Patients complicated by fever, trauma or gangrene, and with impaired renal or hepatic functions or serious impairment of thyroid or adrenal function, insulin-dependent diabetes mellitus. Adverse effect: GI disturbances, dizziness, jaundice, skin rashes and blood disorders. Dosage: Initial dose 5 mg/day, may be gradually increased if necessary, up to 20 mg daily. Supply: Tab 5 mg 242 - - 243 - - Gliclazide-“Diamicron MR” (ODIAMM) “Diamin MR”(ODIAM) “Kludone”(OKLUD) “Dail”(OGLIC) ［ C ］ Indication: All types of maturity onset diabetes. Contraindication: Same as glibenclamide. Adverse effect: Skin reaction, headache, GI disturbances. Dosage: Initial doses 30 mg/day, gradually increased if necessary up to 120 mg/day. Supply: Tab 30 mg (Diamicron MR, Diamin MR, Kludone), 80 mg (Dial). Glipizide-“Minidiab”(OMINI) “Diabetrol SR” (ODIAB) Indication: Non-insulin dependent diabetes mellitus (Type II) pati ents whose hypergl ycemi a cannot be controlled by diet alone. Contraindication: Hypersensitivity; diabetic ketoacidosis; insulin should be used Adverse effect: Hypoglycemia, Nausea, anorexia, vomiting, pyrosis, gastralgia, diarrhea, constipation, allergic skin reaction, dizziness, drowsiness, headache. Dosage: PO 2.5 mg to 20 mg QD, administered approximately 30 minutes before meals; maximum dose: 40 mg/day (Minidiab), 20 mg/day (Diabetrol SR). If doses exceed 15 mg, divided into at least 2 doses. Pharmacokinetics: Maximum decreases in blood glucose occur 2 to 3 after administration. It is extensively metabolized in the liver. About 10% of a dose is eliminated as unchanged drug in the urine and feces. Supply: Tab 5 mg (Minidiab), 10 mg (Diabetrol SR) Glimepiride-“Amaryl”(OAMAR) “Glimaryl” (OGLIMA) ［ C ］ Indication: Glimepiride is a second-generation sulfonylurea. Place in therapy: Glimepiride monotherapy is indicated as an adjunct to diet and exercise for non-insulin dependent diabetes mellitus. It is also indicated for use in combination with insulin in patients with secondary failure. Glimepiride may also be used with metformin if glimepiride monotherapy does not achieve adequate lowering of blood glucose. Contraindication: Diabetic ketoacidosis, hypersensitivity Adverse effect: Adverse effects of glimepiride resemble those of other sulfonylureas, and include hypoglycemia, gastrointestinal symptoms, dizziness, headache, skin reactions, hyponatremia, and transaminase elevations. Dosage: Adults: non-insulin-dependent (type II) diabetes mellitus: 1-2 mg PO QD, followed by gradual increases to a maximum of 8 mg PO QD Pharmacokinetics: Glimepiride is completely and rapidly absorbed after oral doses. Metabolism occurs in the liver. Supply: Tab 2 mg 68:20.28 Thiazolidinediones Pioglitazone – “Actos”(OACTO) “Diazone” (ODIAZ) ［ C ］ Indication: Pioglitazone is a thiazolidinedione antidiabetic agent. Pioglitazone is indicated for type II diabetes mellitus alone or in combination with sulfonylureas, metformin, or insulin. Contraindication: Type I diabetes mellitus; diabetic ketoacidosis; pioglitazone should not be started in patients with clinical evidence of active liver disease or in patients with an alanine aminotransferase greater than 2.5 times the upper limit of normal Adverse effect: The primary adverse effect is edema. Other adverse effects include headache, myalgia, and upper respiratory infection. Although the incidence of liver enzyme elevations was similar for pioglitazone and placebo, and no symptoms of hepatotoxicity were reported, frequent monitoring of liver enzymes is recommended during pioglitazone therapy. Dosage: initial dosage 15-30 mg PO QD without regard to meals; the maximum recommended dosage is 45 mg PO QD Pharmacokinetics: Total protein binding is greater than 99%; pioglitazone is bound primarily to serum albumin. 242 - - 243 - - Gliclazide-“Diamicron MR” (ODIAMM) “Diamin MR”(ODIAM) “Kludone”(OKLUD) “Dail”(OGLIC) ［ C ］ Indication: All types of maturity onset diabetes. Contraindication: Same as glibenclamide. Adverse effect: Skin reaction, headache, GI disturbances. Dosage: Initial doses 30 mg/day, gradually increased if necessary up to 120 mg/day. Supply: Tab 30 mg (Diamicron MR, Diamin MR, Kludone), 80 mg (Dial). Glipizide-“Minidiab”(OMINI) “Diabetrol SR” (ODIAB) Indication: Non-insulin dependent diabetes mellitus (Type II) pati ents whose hypergl ycemi a cannot be controlled by diet alone. Contraindication: Hypersensitivity; diabetic ketoacidosis; insulin should be used Adverse effect: Hypoglycemia, Nausea, anorexia, vomiting, pyrosis, gastralgia, diarrhea, constipation, allergic skin reaction, dizziness, drowsiness, headache. Dosage: PO 2.5 mg to 20 mg QD, administered approximately 30 minutes before meals; maximum dose: 40 mg/day (Minidiab), 20 mg/day (Diabetrol SR). If doses exceed 15 mg, divided into at least 2 doses. Pharmacokinetics: Maximum decreases in blood glucose occur 2 to 3 after administration. It is extensively metabolized in the liver. About 10% of a dose is eliminated as unchanged drug in the urine and feces. Supply: Tab 5 mg (Minidiab), 10 mg (Diabetrol SR) Glimepiride-“Amaryl”(OAMAR) “Glimaryl” (OGLIMA) ［ C ］ Indication: Glimepiride is a second-generation sulfonylurea. Place in therapy: Glimepiride monotherapy is indicated as an adjunct to diet and exercise for non-insulin dependent diabetes mellitus. It is also indicated for use in combination with insulin in patients with secondary failure. Glimepiride may also be used with metformin if glimepiride monotherapy does not achieve adequate lowering of blood glucose. Contraindication: Diabetic ketoacidosis, hypersensitivity Adverse effect: Adverse effects of glimepiride resemble those of other sulfonylureas, and include hypoglycemia, gastrointestinal symptoms, dizziness, headache, skin reactions, hyponatremia, and transaminase elevations. Dosage: Adults: non-insulin-dependent (type II) diabetes mellitus: 1-2 mg PO QD, followed by gradual increases to a maximum of 8 mg PO QD Pharmacokinetics: Glimepiride is completely and rapidly absorbed after oral doses. Metabolism occurs in the liver. Supply: Tab 2 mg 68:20.28 Thiazolidinediones Pioglitazone – “Actos”(OACTO) “Diazone” (ODIAZ) ［ C ］ Indication: Pioglitazone is a thiazolidinedione antidiabetic agent. Pioglitazone is indicated for type II diabetes mellitus alone or in combination with sulfonylureas, metformin, or insulin. Contraindication: Type I diabetes mellitus; diabetic ketoacidosis; pioglitazone should not be started in patients with clinical evidence of active liver disease or in patients with an alanine aminotransferase greater than 2.5 times the upper limit of normal Adverse effect: The primary adverse effect is edema. Other adverse effects include headache, myalgia, and upper respiratory infection. Although the incidence of liver enzyme elevations was similar for pioglitazone and placebo, and no symptoms of hepatotoxicity were reported, frequent monitoring of liver enzymes is recommended during pioglitazone therapy. Dosage: initial dosage 15-30 mg PO QD without regard to meals; the maximum recommended dosage is 45 mg PO QD Pharmacokinetics: Total protein binding is greater than 99%; pioglitazone is bound primarily to serum albumin. 244 - - 245 - - Pioglitazone is metabolized extensively in the liver to active and inactive metabolites. Supply: Tab 30 mg (Actos), 15 mg (Diazone) Rosiglitazone-“Avandia”(OAVAN) ［ C ］ Indication: Rosiglitazone is effective as monotherapy or in combination with metformin or a sulfonylurea for treating type II diabetes mellitus. Contraindication: Hypersensitivity to rosiglitazone Adverse effect: Headache and upper respiratory infection were reported. The elevation of serum transaminases was reported in clinical trials with incidence of 0.2%. Dosage: Adults: initially 4 mg PO QD or dose divided to BID, may be increased to 8 mg QD after 8-12 weeks Pharmacokinetics: It is almost completely metabolized in the liver to inactive metabolites. Elimination is via the kidney (64%) and feces (23%); the elimination half-life is 3 to 4 hours. Supply: Tab 4 mg 68:24 Parathyroid Salmon Calcitonin-“Miacalcic (N.S.)”(IMIAC) “Caspray N.S.” (ECASP) ［ C ］ Indication: Calcitonins are used to treat severe hypercalcemia of various origins, Paget’s disease, osteoporosis of various origins, and intractable cancer pain in patients with malignant bone metastases. Place in therapy: It is often the first drug of choice in patients who are moderately or severely symptomatic and who are not controlled with general measures (re-hydration and furosemide-induced diuresis). Contraindication: Hypersensitivity. Adverse effect: Nausea, facial flushing, and increased urinary frequency are the most common adverse effects of calcitonins. The adverse effects are dose-related, which can generally be controlled by decreasing the dose, administering at bedtime, using antiemetics, or possibly by giving an antiserotonin agent. Dosage: Hypercalcemia: 4 IU/kg of salmon calcitonin Q12H IM or SC, increasing every 1-2 day to a MAX of 8 IU/kg Q12H if necessary. Postmenopausal osteoporosis: 100 IU of salmon calcitonin daily or every other day IM or SC. Paget’s disease: 50 to 100 IU of salmon calcitonin once to 7 times weekly IM or SC. Intractable pain from bone metastases: 100 IU/day of salmon calcitonin SC. Stability: Calcitonin is stable at 25 ℃ for up to 2 weeks but manufacturer recommend the product be stored under 2-8 ℃ . Supply: Inj 50 I.U./1ml/amp (Miacalcic); Nasal spray 200 IU/puff, 14 puffs/bot (Caspray) 68:28 Pituitary Vasopressin-“Pitressin” (IPITR) ［ B ］ Indication: Postoperative abdominal distension and in diabetes insipidus. Contraindication: Anaphylaxis or hypersensitivity to the components. Adverse effect: Vasopressin may cause a marked decrease in cardiac function due to coronary artery constriction; the drug should be used with caution and appropriate monitoring in critically ill patients. Other adverse effects reported include tremor, sweating, vertigo, water intoxication, hyponatremia, metabolic acidosis, abdominal cramps, nausea, vomiting, urticaria, and anaphylaxis. Administration: 10 units (0.5 ml) will usually elicit full physiologic response. In adult, pitressin should be given IM at 3 or 4 hours intervals as needed. Stability: D5W or NS has been used for the dilution of vasopressin injection to a concentration of 100 to 1000 U/L. Supply: Inj 20 units/ml/amp (aqueous solution) 244 - - 245 - - Pioglitazone is metabolized extensively in the liver to active and inactive metabolites. Supply: Tab 30 mg (Actos), 15 mg (Diazone) Rosiglitazone-“Avandia”(OAVAN) ［ C ］ Indication: Rosiglitazone is effective as monotherapy or in combination with metformin or a sulfonylurea for treating type II diabetes mellitus. Contraindication: Hypersensitivity to rosiglitazone Adverse effect: Headache and upper respiratory infection were reported. The elevation of serum transaminases was reported in clinical trials with incidence of 0.2%. Dosage: Adults: initially 4 mg PO QD or dose divided to BID, may be increased to 8 mg QD after 8-12 weeks Pharmacokinetics: It is almost completely metabolized in the liver to inactive metabolites. Elimination is via the kidney (64%) and feces (23%); the elimination half-life is 3 to 4 hours. Supply: Tab 4 mg 68:24 Parathyroid Salmon Calcitonin-“Miacalcic (N.S.)”(IMIAC) “Caspray N.S.” (ECASP) ［ C ］ Indication: Calcitonins are used to treat severe hypercalcemia of various origins, Paget’s disease, osteoporosis of various origins, and intractable cancer pain in patients with malignant bone metastases. Place in therapy: It is often the first drug of choice in patients who are moderately or severely symptomatic and who are not controlled with general measures (re-hydration and furosemide-induced diuresis). Contraindication: Hypersensitivity. Adverse effect: Nausea, facial flushing, and increased urinary frequency are the most common adverse effects of calcitonins. The adverse effects are dose-related, which can generally be controlled by decreasing the dose, administering at bedtime, using antiemetics, or possibly by giving an antiserotonin agent. Dosage: Hypercalcemia: 4 IU/kg of salmon calcitonin Q12H IM or SC, increasing every 1-2 day to a MAX of 8 IU/kg Q12H if necessary. Postmenopausal osteoporosis: 100 IU of salmon calcitonin daily or every other day IM or SC. Paget’s disease: 50 to 100 IU of salmon calcitonin once to 7 times weekly IM or SC. Intractable pain from bone metastases: 100 IU/day of salmon calcitonin SC. Stability: Calcitonin is stable at 25 ℃ for up to 2 weeks but manufacturer recommend the product be stored under 2-8 ℃ . Supply: Inj 50 I.U./1ml/amp (Miacalcic); Nasal spray 200 IU/puff, 14 puffs/bot (Caspray) 68:28 Pituitary Vasopressin-“Pitressin” (IPITR) ［ B ］ Indication: Postoperative abdominal distension and in diabetes insipidus. Contraindication: Anaphylaxis or hypersensitivity to the components. Adverse effect: Vasopressin may cause a marked decrease in cardiac function due to coronary artery constriction; the drug should be used with caution and appropriate monitoring in critically ill patients. Other adverse effects reported include tremor, sweating, vertigo, water intoxication, hyponatremia, metabolic acidosis, abdominal cramps, nausea, vomiting, urticaria, and anaphylaxis. Administration: 10 units (0.5 ml) will usually elicit full physiologic response. In adult, pitressin should be given IM at 3 or 4 hours intervals as needed. Stability: D5W or NS has been used for the dilution of vasopressin injection to a concentration of 100 to 1000 U/L. Supply: Inj 20 units/ml/amp (aqueous solution) 246 - - 247 - - Desmopressin-“Minirin”(OMINIR) ［ B ］ Indication: Central (neurogenic) diabetes insipidus, for urine concentration test. In addition, desmopressin may be useful in increasing plasma levels of factor VIII activity in patients with hemophilia A or von Willebrand’s disease. Contraindication: Hypersensitivity to desmopressin; children under 3 months of age (IV administration); patients with Type IIB von Willebrand’s diseasepatients Adverse effect: Hypotension, headache, psychosis, seizures, water retention and hyponatremia, abdominal cramps, vulval pain, nasal congestion, rhinitis, flushing, local dermatologic effects following injection, and hypersensitivity reactions. Dosage: For diabetes insipidus: intranasal, adult: 10-40 μg a day in 1-3 divided doses, children: 5-30 μg/day. For urine concentration test: intranasal, 40 μg. The initial oral dose is 0.05 mg twice daily titrated to clinical response; the usual range is 0.1 to 0.8 mg daily. Supply: Tab 0.1 mg 68:32 Progestins Medroxyprogesterone-“Provera” (OPROV) ［ X ］ Indication: Treatment of secondary amenorrhea and abnormal uterine bleeding caused by hormonal imbalance in patients without underlying organic pathology such as fibrosis or uterine cancer. Contraindication: Pregnancy, malignancy of breast or genital organ, Patients with thrombophlebitis, thromboembolic disorders, cerebral apoplexy, undiagnosed vaginal bleeding, missed abortion. Adverse effect: Changes in menstrual flow, spotting, amenorrhea, changes in cervical erosion and secretions, edema, weight gain or loss, cholestatic jaundice, breast tenderness, gastrointestinal disturbances, galactorrhea, and dermatologic effects. Dosage: Treatment of secondary amenorrhea and abnormal uterine bleeding, usual oral dosage is 5-10 mg daily for 5-10 days. Mammary carcinoma, prostate carcinoma, or renal carcinoma: 100-1000 mg/day in 2-3 divided doses, may be combined with other antineoplastic agents. Supply: Tab 5 mg Norethisterone acetate-“Primolut-Nor” (OPRIMO) ［ X ］ Indication: Primary or secondary amenorrhea, dysfunctional uterinebleeding, contraception, endometriosis Contraindication: Pregnancy, severe liver disease, Dubin-Johnson syndrome, Rotor syndrome. Adverse effect: Cholestatic liver changes (in high dose). Dosage: 10-20 mg/day. Supply: Tab 5 mg Progesterone-“Progesterone” (IPROG)( 專 ) “Utrogestan”(OUTRO) ［ B ］ Indication: Habitual abortion, premature labor, uterine bleeding, dysmenorrhoea and female hypogonadism. Contraindication: Severe hepatic and renal disease, missed and incomplete abortion. Adverse effect: Skin rash, edema, weight gain, GI disorders and headache. Dosage: In habitual abortion: 5-20 mg 3 times/week. In threatened labor: 25-50 mg/day. In functional uterine bleeding: 5-10 mg/day. In premature labor: 25-50 mg/day. In progesterone insufficiency: 1 cap in the morning, 2 caps at night, during 10 days per month, from 17th-26th day of the cycle. Vary from 1 to 4 caps per day Supply: Inj 25 mg/1 ml/amp; Cap (micronized) 100 mg Estradiol, norethisterone - “Trisequens” (OTRIS) ［ X ］ Indication: Conjugated estrogens and estradiol are primarily used as estrogen replacement therapy in postmenopausal and castrate women; the benefits of estrogen replacement therapy include relief of vasomotor symptoms and atrophic changes, as well as prevention of osteoporosis. 246 - - 247 - - Desmopressin-“Minirin”(OMINIR) ［ B ］ Indication: Central (neurogenic) diabetes insipidus, for urine concentration test. In addition, desmopressin may be useful in increasing plasma levels of factor VIII activity in patients with hemophilia A or von Willebrand’s disease. Contraindication: Hypersensitivity to desmopressin; children under 3 months of age (IV administration); patients with Type IIB von Willebrand’s diseasepatients Adverse effect: Hypotension, headache, psychosis, seizures, water retention and hyponatremia, abdominal cramps, vulval pain, nasal congestion, rhinitis, flushing, local dermatologic effects following injection, and hypersensitivity reactions. Dosage: For diabetes insipidus: intranasal, adult: 10-40 μg a day in 1-3 divided doses, children: 5-30 μg/day. For urine concentration test: intranasal, 40 μg. The initial oral dose is 0.05 mg twice daily titrated to clinical response; the usual range is 0.1 to 0.8 mg daily. Supply: Tab 0.1 mg 68:32 Progestins Medroxyprogesterone-“Provera” (OPROV) ［ X ］ Indication: Treatment of secondary amenorrhea and abnormal uterine bleeding caused by hormonal imbalance in patients without underlying organic pathology such as fibrosis or uterine cancer. Contraindication: Pregnancy, malignancy of breast or genital organ, Patients with thrombophlebitis, thromboembolic disorders, cerebral apoplexy, undiagnosed vaginal bleeding, missed abortion. Adverse effect: Changes in menstrual flow, spotting, amenorrhea, changes in cervical erosion and secretions, edema, weight gain or loss, cholestatic jaundice, breast tenderness, gastrointestinal disturbances, galactorrhea, and dermatologic effects. Dosage: Treatment of secondary amenorrhea and abnormal uterine bleeding, usual oral dosage is 5-10 mg daily for 5-10 days. Mammary carcinoma, prostate carcinoma, or renal carcinoma: 100-1000 mg/day in 2-3 divided doses, may be combined with other antineoplastic agents. Supply: Tab 5 mg Norethisterone acetate-“Primolut-Nor” (OPRIMO) ［ X ］ Indication: Primary or secondary amenorrhea, dysfunctional uterinebleeding, contraception, endometriosis Contraindication: Pregnancy, severe liver disease, Dubin-Johnson syndrome, Rotor syndrome. Adverse effect: Cholestatic liver changes (in high dose). Dosage: 10-20 mg/day. Supply: Tab 5 mg Progesterone-“Progesterone” (IPROG)( 專 ) “Utrogestan”(OUTRO) ［ B ］ Indication: Habitual abortion, premature labor, uterine bleeding, dysmenorrhoea and female hypogonadism. Contraindication: Severe hepatic and renal disease, missed and incomplete abortion. Adverse effect: Skin rash, edema, weight gain, GI disorders and headache. Dosage: In habitual abortion: 5-20 mg 3 times/week. In threatened labor: 25-50 mg/day. In functional uterine bleeding: 5-10 mg/day. In premature labor: 25-50 mg/day. In progesterone insufficiency: 1 cap in the morning, 2 caps at night, during 10 days per month, from 17th-26th day of the cycle. Vary from 1 to 4 caps per day Supply: Inj 25 mg/1 ml/amp; Cap (micronized) 100 mg Estradiol, norethisterone - “Trisequens” (OTRIS) ［ X ］ Indication: Conjugated estrogens and estradiol are primarily used as estrogen replacement therapy in postmenopausal and castrate women; the benefits of estrogen replacement therapy include relief of vasomotor symptoms and atrophic changes, as well as prevention of osteoporosis. 248 - - 249 - - Contraindication: Hypersensitivity to medroxyprogesterone, conjugated estrogens, estradiol, norethindrone, norgestimate; known or suspected breast cancer; Adverse effect: Back pain, headache, dizziness, nausea, vomiting, abdominal pain, breast pain, dysmenorrhea, and leukorrhea. Dosage: 1 Tab PO QD Supply: Havina package 28 tabs/box, each tab contains--blue tab: estradiol 2 mg, white tab: estradiol 2 mg + norethisterone 1 mg, red tab: estradiol 1 mg Indivina (OINDI) ［ X ］ Indication: Hormone replacement therapy (HRT) for estrogen deficiency symptoms & prophylaxis of osteoporosis in women with an intact uterus. Contraindication: Pregnancy & lactation. Known, suspected or past history of breast cancer or estrogen-dependent tumour, undiagnosed vag bleeding, confirmed active venous thromboembolism (VTE) within the last 2 years. History of recurrent VTE or known thrombophilic disease in patients not on anticoagulant, acute or chronic liver diseases or a history of liver disease. Adverse effect: Breast tenderness & enlargement, uterine bleeding, increase in size of uterine fibroids, headache, GI discomfort, weight changes, edema, mood changes including anxiety & depressive mood, changes in libido. Dosage: 1 tab daily. Supply: Tab estradiol valerate 1 mg, medroxy- progesterone acetate 2.5 mg Progyluton (OPROG) Indication: Pre-& postmenopausal symptoms, primary & secondary amenorrhea; menstrual irregularities; deficiency symptoms after oophorectomy or radiological castration for non-carcinomatous diseases. Contraindication: Pregnancy; severe liver dysfunction; jaundice or severe pruritus during a previous pregnancy; previous or existing thromboembolic processes; endometriosis; disturbances of lipometabolism, a history of herpes gestationis, otosclerosis with deterioration during previous pregnancies, Dubin-Johnson syndrome, Rotor syndrome, sickle-cell anemia. Adverse effect: Rarely, breast tension, gastric upsets, nausea, headache, influence on body weight & libido, unscheduled bleeding. Dosage: 1 tab daily for 21 days beginning on the 5th day of the cycle, pause for 7 days. Supply: Tab 11 white estradiol valerate 2 mg, 10 light brown estradiol valerate 2 mg+ norgestrel 0.5 mg Gestrinone-“Dimetriose”(ODIME) ［ X ］ Indication: Endometriosis Contraindication: Pregnancy, lactation; severe cardiac, renal or hepatic insufficiency; metabolic &/or vasculsr disorders during previous oestrogen &/or progestogen therapy. Adverse effect: Spotting, mild acne, oily skin, fluid retention, weight gain; hirsutism, voice change. Transient increases in liver transaminases, headache, GI disturbances, libido changes, hot flushed, breast size reduction, nervousness & depression, cramp & appetite changes, arthralgia & isolated cases of benign intra-cranial hypertension. Dosage: 2 cap/wk. Initial dose must be taken on day 1 of the menstrual cycle, 2nd dose on day 4, continue treatment for 6 months. Supply: Cap 2.5 mg 68:36 Thyroid and Antithyroid Agents 68:36.04 Thyroid Agents Levothyroxine sodium (T4)-“Eltroxin” (OELTR) ［ A ］ Indication: Hypothyroidism. 248 - - 249 - - Contraindication: Hypersensitivity to medroxyprogesterone, conjugated estrogens, estradiol, norethindrone, norgestimate; known or suspected breast cancer; Adverse effect: Back pain, headache, dizziness, nausea, vomiting, abdominal pain, breast pain, dysmenorrhea, and leukorrhea. Dosage: 1 Tab PO QD Supply: Havina package 28 tabs/box, each tab contains--blue tab: estradiol 2 mg, white tab: estradiol 2 mg + norethisterone 1 mg, red tab: estradiol 1 mg Indivina (OINDI) ［ X ］ Indication: Hormone replacement therapy (HRT) for estrogen deficiency symptoms & prophylaxis of osteoporosis in women with an intact uterus. Contraindication: Pregnancy & lactation. Known, suspected or past history of breast cancer or estrogen-dependent tumour, undiagnosed vag bleeding, confirmed active venous thromboembolism (VTE) within the last 2 years. History of recurrent VTE or known thrombophilic disease in patients not on anticoagulant, acute or chronic liver diseases or a history of liver disease. Adverse effect: Breast tenderness & enlargement, uterine bleeding, increase in size of uterine fibroids, headache, GI discomfort, weight changes, edema, mood changes including anxiety & depressive mood, changes in libido. Dosage: 1 tab daily. Supply: Tab estradiol valerate 1 mg, medroxy- progesterone acetate 2.5 mg Progyluton (OPROG) Indication: Pre-& postmenopausal symptoms, primary & secondary amenorrhea; menstrual irregularities; deficiency symptoms after oophorectomy or radiological castration for non-carcinomatous diseases. Contraindication: Pregnancy; severe liver dysfunction; jaundice or severe pruritus during a previous pregnancy; previous or existing thromboembolic processes; endometriosis; disturbances of lipometabolism, a history of herpes gestationis, otosclerosis with deterioration during previous pregnancies, Dubin-Johnson syndrome, Rotor syndrome, sickle-cell anemia. Adverse effect: Rarely, breast tension, gastric upsets, nausea, headache, influence on body weight & libido, unscheduled bleeding. Dosage: 1 tab daily for 21 days beginning on the 5th day of the cycle, pause for 7 days. Supply: Tab 11 white estradiol valerate 2 mg, 10 light brown estradiol valerate 2 mg+ norgestrel 0.5 mg Gestrinone-“Dimetriose”(ODIME) ［ X ］ Indication: Endometriosis Contraindication: Pregnancy, lactation; severe cardiac, renal or hepatic insufficiency; metabolic &/or vasculsr disorders during previous oestrogen &/or progestogen therapy. Adverse effect: Spotting, mild acne, oily skin, fluid retention, weight gain; hirsutism, voice change. Transient increases in liver transaminases, headache, GI disturbances, libido changes, hot flushed, breast size reduction, nervousness & depression, cramp & appetite changes, arthralgia & isolated cases of benign intra-cranial hypertension. Dosage: 2 cap/wk. Initial dose must be taken on day 1 of the menstrual cycle, 2nd dose on day 4, continue treatment for 6 months. Supply: Cap 2.5 mg 68:36 Thyroid and Antithyroid Agents 68:36.04 Thyroid Agents Levothyroxine sodium (T4)-“Eltroxin” (OELTR) ［ A ］ Indication: Hypothyroidism. 250 - - 251 - - Place in therapy: Levothyroxine is the drug of choice for thyroid replacement and is commonly used for hypothyroidism, simple non-endemic goiter, chronic lymphocytic thyroiditis, and thyrotropin-dependent carcinoma of the thyroid. The drug has also been used to prevent the goitrogenic effects of agents such as lithium and aminosalicylic acid. Contraindication: Hypersensitivity to thyroid hormone; the treatment of obesity thyrotoxicosis; uncorrected adrenal cortical insufficiency, angina, hypertension, myocardial infarction, thyrotoxicosis Adverse effect: Adverse effects include coronary vasospasm, cardiac arrest, pseudotumor cerebri, hypothyroidism, hyperthyroidism, pituitary suppression, porphyria, and osteomalacia. Dosage: 50-300 mcg/day Supply: Tab 0.1 mg 68:36.08 Antithyroid Agents Methimazole-“Hontan”(OMETH) ［ D ］ Indication: Management of hyperthyroidism. Contraindication: Pregnancy, lactation. Adverse effect: GI disturbances, headache, arthralgia, skin rashes & pruritus, alopecia, bone marrow depression & mild leucopenia. Dosage: Adult—1-2 tab tid; maintenance 1-2 tab daily; children 10-15 years—2/3 adult dose; 5-10 years—1/3-1/2 adult dose. Supply: Tab 5 mg Propylthiouracil-“Procil” (OPROCI) ［ D ］ Indication: Hyperthyroidism. Contraindication: Hypersensitive to the drug. Adverse effect: Adverse effects include agranulocytosis, leukopenia, hemolytic anemia, aplastic anemia, leukemia, disseminated intravascular coagulation, galactorrhea, porphyria, sexual dysfunction, hepatotoxicity, interstitial pneumonitis, rheumatoid arthritis, systemic lupus erythematosus, serum sickness, and ototoxicity. Dosage: Initial 50-100mg TID, maintenance 100-150mg TID. Pharmacokinetics: Clinical improvement of hyperthyroidism begins within 24 to 36 h and remissions occur in 4 months; the duration of effect from a single 100-mg dose was 2 to 3 h; elimination half-life ranges from 1.6 to 25 h. Supply: Tab 50 mg 72:00 Local Anesthetics Bupivacaine HCl – “Marcaine” (IMARC)( 特 ) ［ C ］ Indication: Peripheral nerve block, infiltration, sympathetic block, caudal or epidural block. Contraindication: Hypersensitivity to marcaine. Adverse effect: During prolonged epidural block, venous stasis and pressure sores may develop. Foetal bradycardia has been reported following paracervical block during labor and may require the administration of atropine sulfate intravenously. Administration: 1. Local infiltration: 0.25% solution 2. Epidural block: 0.25% 0r 0.5% solution. 3. Caudal block: 0.25% or 0.5% solution 4. Peripheral nerve block: 0.25% or 0.5% solution. 5. Sympathetic block: 0.25% solution. The maximum dose is 2 mg/kg in any 4 hours period equivalent to 25-30 ml of 0.5% solution. Supply: Inj 0.5% 20 ml/vial Bupivacaine HCl – “Marcaine spinal heavy” (IMARCA) ( 特 ) ［ C ］ Indication: Spinal anesthesia for surgery Contraindication: Same as marcaine. Adverse effect: Drowsiness, hypotension, myocardial depression, bradycardia, numbness of the tongue, 250 - - 251 - - Place in therapy: Levothyroxine is the drug of choice for thyroid replacement and is commonly used for hypothyroidism, simple non-endemic goiter, chronic lymphocytic thyroiditis, and thyrotropin-dependent carcinoma of the thyroid. The drug has also been used to prevent the goitrogenic effects of agents such as lithium and aminosalicylic acid. Contraindication: Hypersensitivity to thyroid hormone; the treatment of obesity thyrotoxicosis; uncorrected adrenal cortical insufficiency, angina, hypertension, myocardial infarction, thyrotoxicosis Adverse effect: Adverse effects include coronary vasospasm, cardiac arrest, pseudotumor cerebri, hypothyroidism, hyperthyroidism, pituitary suppression, porphyria, and osteomalacia. Dosage: 50-300 mcg/day Supply: Tab 0.1 mg 68:36.08 Antithyroid Agents Methimazole-“Hontan”(OMETH) ［ D ］ Indication: Management of hyperthyroidism. Contraindication: Pregnancy, lactation. Adverse effect: GI disturbances, headache, arthralgia, skin rashes & pruritus, alopecia, bone marrow depression & mild leucopenia. Dosage: Adult—1-2 tab tid; maintenance 1-2 tab daily; children 10-15 years—2/3 adult dose; 5-10 years—1/3-1/2 adult dose. Supply: Tab 5 mg Propylthiouracil-“Procil” (OPROCI) ［ D ］ Indication: Hyperthyroidism. Contraindication: Hypersensitive to the drug. Adverse effect: Adverse effects include agranulocytosis, leukopenia, hemolytic anemia, aplastic anemia, leukemia, disseminated intravascular coagulation, galactorrhea, porphyria, sexual dysfunction, hepatotoxicity, interstitial pneumonitis, rheumatoid arthritis, systemic lupus erythematosus, serum sickness, and ototoxicity. Dosage: Initial 50-100mg TID, maintenance 100-150mg TID. Pharmacokinetics: Clinical improvement of hyperthyroidism begins within 24 to 36 h and remissions occur in 4 months; the duration of effect from a single 100-mg dose was 2 to 3 h; elimination half-life ranges from 1.6 to 25 h. Supply: Tab 50 mg 72:00 Local Anesthetics Bupivacaine HCl – “Marcaine” (IMARC)( 特 ) ［ C ］ Indication: Peripheral nerve block, infiltration, sympathetic block, caudal or epidural block. Contraindication: Hypersensitivity to marcaine. Adverse effect: During prolonged epidural block, venous stasis and pressure sores may develop. Foetal bradycardia has been reported following paracervical block during labor and may require the administration of atropine sulfate intravenously. Administration: 1. Local infiltration: 0.25% solution 2. Epidural block: 0.25% 0r 0.5% solution. 3. Caudal block: 0.25% or 0.5% solution 4. Peripheral nerve block: 0.25% or 0.5% solution. 5. Sympathetic block: 0.25% solution. The maximum dose is 2 mg/kg in any 4 hours period equivalent to 25-30 ml of 0.5% solution. Supply: Inj 0.5% 20 ml/vial Bupivacaine HCl – “Marcaine spinal heavy” (IMARCA) ( 特 ) ［ C ］ Indication: Spinal anesthesia for surgery Contraindication: Same as marcaine. Adverse effect: Drowsiness, hypotension, myocardial depression, bradycardia, numbness of the tongue, 252 - - 253 - - lightheadedness, dizziness, tremor. Dosage: 3-4 ml to be administered according to the requirements of the procedure. Supply: Inj bupivacaine HCl 0.5% w/ glucose 8 %, 4 ml/amp Bupivacaine HCl – “Marcaine spinal ” (IMARS)( 特 ) ［ C ］ Indication: Spinal anesthesia for surgery Contraindication: Same as marcaine Adverse effect: Drowsiness, hypotension, myocardial depression, bradycardia, numbness of the tongue, light headedness, dizziness, tremor. Dosage: Individualized dosage. Supply: Inj bupivacaine HCl 0.5% w/ NaCl 0.8%, 4 ml/amp Lidocaine HCl – “Xylocaine”(IXYL2) (IXYLE)( 特 ) (IORA)(EXY10)(ISYLI)(IXYL4)( 特 ) (EXYLJ)( 特 ) ［ B ］ Indication: Local anesthesia, acute management of cardiac arrhythmia. Contraindication: Hypersensitivity to local anesthetics of the amide type, Adam’s-stokes syndrome, sinoatrial, atrioventricular or intraventricular heart block, hypovolemia. Adverse effect: Less tolerant to local anesthetics, excitation of the CNS, arrhythmias and cardiac arrest may occur. Dosage: Direct IV, adults: 50-100 mg, rate 25-50 mg/min, repeat if necessary, in one hour period 200-300 mg. IV infusion, adults: 20-50 mcg/kg/min, ECG monitoring. Usual initial adult dose: without epinephrine not exceed 300 mg, with epinephrine not exceed 500 mg. Children, use of 0.5 or 1% solution. Supply: 1) Local anesthesics (Local use): Inj 2% 20 ml/vial 2) 2% with epinephrine (1: 80,000) 20 ml/vial 3) 2% with epinephrine (1:73000) 1.8 ml/cartridge. 4) Spray: 10% 50 ml/bot 5) Antiarrythmics (Inj for IV): 2% 5 ml 6) 4% 30 ml/vial 7) Jelly 2%, 30 g Tetracaine-“Tetocaine” (ITETO)( 特 ) ［ C ］ Indication: Intraspinal anaesth of surgery; extradural, infiltrative & conductive anaesth. Dosage: Individualized dosage. Supply: Inj 10 ml 76:00 Oxytocics Ergonovine (OERGO) Indication: For treatment of postpartum bleeding. Contraindication: Peripheral vascular disease, pregnancy. Adverse effect: Nausea, vomiting, hypertension, artherosclerosis, cramping, palpitation, dyspnea, thrombophlebitis; Raynaund’s or Ruerger’s syndrome. Dosage: 0.2-0.4 mg PO BID-QID for 2 days postpartum, but longer if necessary. Supply: Tab 0.2 mg Methylergonovine (IERGO)( 專 ) ［ C ］ Indication: Postpartum hemorrhage, associated with uterine atony or subinvolution Contraindication: Hypersensitivity to methylergonovine productions; concomitant use with potent CYP3A4 inhibitors; pregnancy; toxemia; uncontrolled hypertension. Adverse effect: Nausea, vomiting, hypertension, sweating symptom, dizziness, headache, tinnitus. Dosage: 0.2 mg IM/IV (may be repeated at 2 to 4 h intervals up to 5 doses) then 0.2 mg orally 3 to 4 times daily as needed. Supply: Inj 0.2 mg/ml/amp Oxytocin (IOXYT)( 專 ) ［ A ］ Indication: Induction of labor, uterine inertia, and postpartum bleeding. Contraindication: Toxemia abruption placenta, undilated cervix over distended uterus, abnormal presentation, and cardiovascular or renal disease. Adverse effect: Nausea, vomiting, cardiac arrhythmia, 252 - - 253 - - lightheadedness, dizziness, tremor. Dosage: 3-4 ml to be administered according to the requirements of the procedure. Supply: Inj bupivacaine HCl 0.5% w/ glucose 8 %, 4 ml/amp Bupivacaine HCl – “Marcaine spinal ” (IMARS)( 特 ) ［ C ］ Indication: Spinal anesthesia for surgery Contraindication: Same as marcaine Adverse effect: Drowsiness, hypotension, myocardial depression, bradycardia, numbness of the tongue, light headedness, dizziness, tremor. Dosage: Individualized dosage. Supply: Inj bupivacaine HCl 0.5% w/ NaCl 0.8%, 4 ml/amp Lidocaine HCl – “Xylocaine”(IXYL2) (IXYLE)( 特 ) (IORA)(EXY10)(ISYLI)(IXYL4)( 特 ) (EXYLJ)( 特 ) ［ B ］ Indication: Local anesthesia, acute management of cardiac arrhythmia. Contraindication: Hypersensitivity to local anesthetics of the amide type, Adam’s-stokes syndrome, sinoatrial, atrioventricular or intraventricular heart block, hypovolemia. Adverse effect: Less tolerant to local anesthetics, excitation of the CNS, arrhythmias and cardiac arrest may occur. Dosage: Direct IV, adults: 50-100 mg, rate 25-50 mg/min, repeat if necessary, in one hour period 200-300 mg. IV infusion, adults: 20-50 mcg/kg/min, ECG monitoring. Usual initial adult dose: without epinephrine not exceed 300 mg, with epinephrine not exceed 500 mg. Children, use of 0.5 or 1% solution. Supply: 1) Local anesthesics (Local use): Inj 2% 20 ml/vial 2) 2% with epinephrine (1: 80,000) 20 ml/vial 3) 2% with epinephrine (1:73000) 1.8 ml/cartridge. 4) Spray: 10% 50 ml/bot 5) Antiarrythmics (Inj for IV): 2% 5 ml 6) 4% 30 ml/vial 7) Jelly 2%, 30 g Tetracaine-“Tetocaine” (ITETO)( 特 ) ［ C ］ Indication: Intraspinal anaesth of surgery; extradural, infiltrative & conductive anaesth. Dosage: Individualized dosage. Supply: Inj 10 ml 76:00 Oxytocics Ergonovine (OERGO) Indication: For treatment of postpartum bleeding. Contraindication: Peripheral vascular disease, pregnancy. Adverse effect: Nausea, vomiting, hypertension, artherosclerosis, cramping, palpitation, dyspnea, thrombophlebitis; Raynaund’s or Ruerger’s syndrome. Dosage: 0.2-0.4 mg PO BID-QID for 2 days postpartum, but longer if necessary. Supply: Tab 0.2 mg Methylergonovine (IERGO)( 專 ) ［ C ］ Indication: Postpartum hemorrhage, associated with uterine atony or subinvolution Contraindication: Hypersensitivity to methylergonovine productions; concomitant use with potent CYP3A4 inhibitors; pregnancy; toxemia; uncontrolled hypertension. Adverse effect: Nausea, vomiting, hypertension, sweating symptom, dizziness, headache, tinnitus. Dosage: 0.2 mg IM/IV (may be repeated at 2 to 4 h intervals up to 5 doses) then 0.2 mg orally 3 to 4 times daily as needed. Supply: Inj 0.2 mg/ml/amp Oxytocin (IOXYT)( 專 ) ［ A ］ Indication: Induction of labor, uterine inertia, and postpartum bleeding. Contraindication: Toxemia abruption placenta, undilated cervix over distended uterus, abnormal presentation, and cardiovascular or renal disease. Adverse effect: Nausea, vomiting, cardiac arrhythmia, 254 - - 255 - - fetal bradycardia, postpartum hemorrhage, afibrinogenemia, pelvic hematoma, water intoxication. Dosage: Dosage is determined by uterine response: 1.Induction of labor: IV infusion: 10 units diluted with 1000ml isotonic saline or dextrose and staring at 0.01 units per minute. The dosage can be doubled every 30-45 minutes. IM: initial dose 0.1 unit increasing to 0.2, 0.4, 0.8 unit etc every 30 minutes intervals. 2.Control postpartum bleeding: 20-40 units diluted with 1000ml isotonic saline or dextrose IV infusion. Stability: Oxytocin 5 unit/L with either D5W or NS is physically compatible. Supply: Inj 10 unit/ml/amp Mifepristone-“ Apano”(OAPAN)( 專 ) ［ X ］ Indication: Mifepristone is a progesterone receptor antagonist, which may be used to induce abortions during early pregnancy. Contraindication: Hypersensitivity; confirmed or suspected ectopic pregnancy or undiagnosed adnexal mass; IUD in place; chronic adrenal failure; concurrent long-term corticosteroid therapy; hemorrhagic disorders or concurrent anticoagulant therapy; inherited porphyrias Adverse effect: Excessive uterine bleeding and failed abortions are the major problems seen with mifepristone. Dosage: For inducing abortions: Single doses of 600 mg and check with physician after 36-48 h or multi-doses of 25 to 100 mg/day for 5-7 days; Cushing’s syndrome: up to 20 mg/kg/day Pharmacokinetics: The elimination half-life of 20 to 54 hours. Supply: Tab 200 mg 80:00 Serums, Toxoids, and Vaccines 80:04 Serums Antivenin- Hemorrhagic (IANTH)( 專 ) Indication: Treatment of crotalus snake- bite Contraindication: Patients with a history of allergy or sensitivity to equine serum. Pregnancy risk category: No data available. Adverse effect: Anaphylactic shock, urticaria, edema of face & throat, cyanosis, collapse. Dosage: 1 dose; a small portion SC around the wound, all the left IV at rate < 1 ml/min, repeated every 0.5-2 hrs as needed Supply: Inj 10 ml single dose package Note 1.Each 10ml contains-Antivenin Tr. Mucrosquamatus & Tr. Gramineus: 1000 or more Tannaka units 2.Should be used within 2hrs after reconstitution Antivenin – Neurotropic (IANTN)( 專 ) Indication: Treatment of crotalus snake- bite Contraindication: Patients with a history of allergy or sensitivity to equine serum. Adverse effect: Anaphylactic shock, urticaria, edema of face & throat, cyanosis, collapse. Dosage: 1 dose; a small portion SC around the wound, all the left IV at rate < 1ml/min, repeated every 0.5-2 hrs as needed Supply: Inj 10ml single dose package Note 1.Each 10 ml contains-Antivenin of B. multicintus & N. naja atra: 1000 or more Tannaka units 2. Should be used within 2hrs after reconstitution Human Immunoglobulin (IIVIG) ( 專 ) ［ C ］ Indication: Primary humoral immunodeficiency, idiopathic thrombocytopenic purpura, BMT, Contraindication: Anaphylactic or severe systemic response to human Ig. Selective IgA deficiencies who have known antibody vs IgA. Adverse effect: Local reactions, eg pain & tenderness at inj site, allergic reactions, malaise, fever, chills, headache, 254 - - 255 - - fetal bradycardia, postpartum hemorrhage, afibrinogenemia, pelvic hematoma, water intoxication. Dosage: Dosage is determined by uterine response: 1.Induction of labor: IV infusion: 10 units diluted with 1000ml isotonic saline or dextrose and staring at 0.01 units per minute. The dosage can be doubled every 30-45 minutes. IM: initial dose 0.1 unit increasing to 0.2, 0.4, 0.8 unit etc every 30 minutes intervals. 2.Control postpartum bleeding: 20-40 units diluted with 1000ml isotonic saline or dextrose IV infusion. Stability: Oxytocin 5 unit/L with either D5W or NS is physically compatible. Supply: Inj 10 unit/ml/amp Mifepristone-“ Apano”(OAPAN)( 專 ) ［ X ］ Indication: Mifepristone is a progesterone receptor antagonist, which may be used to induce abortions during early pregnancy. Contraindication: Hypersensitivity; confirmed or suspected ectopic pregnancy or undiagnosed adnexal mass; IUD in place; chronic adrenal failure; concurrent long-term corticosteroid therapy; hemorrhagic disorders or concurrent anticoagulant therapy; inherited porphyrias Adverse effect: Excessive uterine bleeding and failed abortions are the major problems seen with mifepristone. Dosage: For inducing abortions: Single doses of 600 mg and check with physician after 36-48 h or multi-doses of 25 to 100 mg/day for 5-7 days; Cushing’s syndrome: up to 20 mg/kg/day Pharmacokinetics: The elimination half-life of 20 to 54 hours. Supply: Tab 200 mg 80:00 Serums, Toxoids, and Vaccines 80:04 Serums Antivenin- Hemorrhagic (IANTH)( 專 ) Indication: Treatment of crotalus snake- bite Contraindication: Patients with a history of allergy or sensitivity to equine serum. Pregnancy risk category: No data available. Adverse effect: Anaphylactic shock, urticaria, edema of face & throat, cyanosis, collapse. Dosage: 1 dose; a small portion SC around the wound, all the left IV at rate < 1 ml/min, repeated every 0.5-2 hrs as needed Supply: Inj 10 ml single dose package Note 1.Each 10ml contains-Antivenin Tr. Mucrosquamatus & Tr. Gramineus: 1000 or more Tannaka units 2.Should be used within 2hrs after reconstitution Antivenin – Neurotropic (IANTN)( 專 ) Indication: Treatment of crotalus snake- bite Contraindication: Patients with a history of allergy or sensitivity to equine serum. Adverse effect: Anaphylactic shock, urticaria, edema of face & throat, cyanosis, collapse. Dosage: 1 dose; a small portion SC around the wound, all the left IV at rate < 1ml/min, repeated every 0.5-2 hrs as needed Supply: Inj 10ml single dose package Note 1.Each 10 ml contains-Antivenin of B. multicintus & N. naja atra: 1000 or more Tannaka units 2. Should be used within 2hrs after reconstitution Human Immunoglobulin (IIVIG) ( 專 ) ［ C ］ Indication: Primary humoral immunodeficiency, idiopathic thrombocytopenic purpura, BMT, Contraindication: Anaphylactic or severe systemic response to human Ig. Selective IgA deficiencies who have known antibody vs IgA. Adverse effect: Local reactions, eg pain & tenderness at inj site, allergic reactions, malaise, fever, chills, headache, 256 - - 257 - - nausea & vomiting, chest tightness, dyspnea, chest/back pain. Dosage: 2-4 ml/kg once a month, IV infusion rate 0.01-0.02 ml/kg/min for 30 mins, if well-tolerated may be gradually increased to a max 0.08 ml/kg/min Supply: Inj 6% 50 ml/bot Biseko (IBISE)( 專 ) Indication: Hypoproteinemia; hypo gammaglobulinemia; hypoalbuminemia. Prophylaxis against infections diseases in patients with antibody deficiency syndrome. Dystrophies. Diseases related to burns. Hemodilution. Shock. Vol therapy. Adverse effect: Rise in temp; backache, skin reactions or general intolerance phenomena, in rare cases leading to shock. Dosage: By IV inj or infusion. At the beginning of the infusion, infuse at 1 ml/min. After infusion of 10 mins, rate may be increased to 3-4 ml/min. Adult—up to 2 L IV daily; children—15-20 ml/kg body weight/day. Supply: Inj 5% human serum protein 50 ml/bot. Hepatitis B Immunoglobulin (IHEBS)( 專 ) Indication: Prophylaxis of hepatitis B infection. Contraindication: Anaphylactic or severe systemic reactions to parenteral human globulins Adverse effect: Backache, nausea, flush, urticaria, tachycardia, hypotension, dyspnoea, shock, cardiac or respiratory arrest. Dosage: IM, 0.06 ml/kg administer within 7 days after exposure and repeat 28-30 days later. Hepatect CP is used for IV infusion: initial, 0.1 ml/kg/hr for 10 min, if well tolerated; then gradually increase rate to MAX 1ml/ kg/hr. Stability: Should be stored at 2-8 ℃ Rho (D) immune globulin (IRHOD)( 專 ) ［ C ］ Indication: Sensitization of Rho(D)(-) females to Rho(D)(+) blood (prophylaxis); Rh hemolytic disease of the newborn (prophylaxis) Precautions: Selective IgA deficiencies in patients who have known antibody to IgA. Adverse effect: Fever, soreness at the place of inj. Dosage: Postpartum prophylaxis—300 mcg, preferably within 72 hrs of delivery; antepartum prophylaxis—300 mcg at 26-28 wks gestation and 300 mcg within 72 hrs after Rh-incompatible delivery to prevent Rhisoimmunization during pregnancy; following amniocentesis, miscarriage, abortion or ectopic pregnancy at or beyond 13wks’ gestation—300 mcg; transusion accidents—the number of vials to be asministered depends on the volume of packed red cells or whole blood transfused. Supply: Inj 300 mcg/vial 80:08 Toxoids Tetanus Toxoid (ITT1)( 專 ) ［ C ］ Indication: Active immunization against tetanus. Contraindication: Postpone vaccination in acute febrile illness. Adverse effect: Swelling, redness & pain at inj site. Rarely, rash, arthralgia, lymphadenopathy, faintness, nausea, headache, lethargy, malaise, myalgia, pyrexia, serum sickness, peripheral neuropathy. Persistent nodules at the site of inj may occur. Dosage: Primary immunization schedule: 2 doses of 0.5 ml at intervals of 4-8 weeks deep SC/IM. A booster dose may be given 6-12 months after the primary immunization or following a tetanus-prone wound. Supply: Inj 1ml/vial 80:12 Vaccines Hepatitis B Vaccine- “Engerix-B”(IENGEB) ［ C ］ Indication: Prevention of hepatitis B in healthy individuals exposed to the risk of contamination. 256 - - 257 - - nausea & vomiting, chest tightness, dyspnea, chest/back pain. Dosage: 2-4 ml/kg once a month, IV infusion rate 0.01-0.02 ml/kg/min for 30 mins, if well-tolerated may be gradually increased to a max 0.08 ml/kg/min Supply: Inj 6% 50 ml/bot Biseko (IBISE)( 專 ) Indication: Hypoproteinemia; hypo gammaglobulinemia; hypoalbuminemia. Prophylaxis against infections diseases in patients with antibody deficiency syndrome. Dystrophies. Diseases related to burns. Hemodilution. Shock. Vol therapy. Adverse effect: Rise in temp; backache, skin reactions or general intolerance phenomena, in rare cases leading to shock. Dosage: By IV inj or infusion. At the beginning of the infusion, infuse at 1 ml/min. After infusion of 10 mins, rate may be increased to 3-4 ml/min. Adult—up to 2 L IV daily; children—15-20 ml/kg body weight/day. Supply: Inj 5% human serum protein 50 ml/bot. Hepatitis B Immunoglobulin (IHEBS)( 專 ) Indication: Prophylaxis of hepatitis B infection. Contraindication: Anaphylactic or severe systemic reactions to parenteral human globulins Adverse effect: Backache, nausea, flush, urticaria, tachycardia, hypotension, dyspnoea, shock, cardiac or respiratory arrest. Dosage: IM, 0.06 ml/kg administer within 7 days after exposure and repeat 28-30 days later. Hepatect CP is used for IV infusion: initial, 0.1 ml/kg/hr for 10 min, if well tolerated; then gradually increase rate to MAX 1ml/ kg/hr. Stability: Should be stored at 2-8 ℃ Rho (D) immune globulin (IRHOD)( 專 ) ［ C ］ Indication: Sensitization of Rho(D)(-) females to Rho(D)(+) blood (prophylaxis); Rh hemolytic disease of the newborn (prophylaxis) Precautions: Selective IgA deficiencies in patients who have known antibody to IgA. Adverse effect: Fever, soreness at the place of inj. Dosage: Postpartum prophylaxis—300 mcg, preferably within 72 hrs of delivery; antepartum prophylaxis—300 mcg at 26-28 wks gestation and 300 mcg within 72 hrs after Rh-incompatible delivery to prevent Rhisoimmunization during pregnancy; following amniocentesis, miscarriage, abortion or ectopic pregnancy at or beyond 13wks’ gestation—300 mcg; transusion accidents—the number of vials to be asministered depends on the volume of packed red cells or whole blood transfused. Supply: Inj 300 mcg/vial 80:08 Toxoids Tetanus Toxoid (ITT1)( 專 ) ［ C ］ Indication: Active immunization against tetanus. Contraindication: Postpone vaccination in acute febrile illness. Adverse effect: Swelling, redness & pain at inj site. Rarely, rash, arthralgia, lymphadenopathy, faintness, nausea, headache, lethargy, malaise, myalgia, pyrexia, serum sickness, peripheral neuropathy. Persistent nodules at the site of inj may occur. Dosage: Primary immunization schedule: 2 doses of 0.5 ml at intervals of 4-8 weeks deep SC/IM. A booster dose may be given 6-12 months after the primary immunization or following a tetanus-prone wound. Supply: Inj 1ml/vial 80:12 Vaccines Hepatitis B Vaccine- “Engerix-B”(IENGEB) ［ C ］ Indication: Prevention of hepatitis B in healthy individuals exposed to the risk of contamination. 258 - - 259 - - Contraindication: Hypersensitivity to hepatitis B vaccine, yeast, or any component of the product. Dosage: Adults: IM, regimen consists of 3 doses (at 0, 1, and 6 month). Booster dose: one year after the first injection, then every five years. Supply: Inj 20 mcg/ml/vial. Pneumococcal vaccine-“Pneumovax” (IPNEU)( 專 ) ［ C ］ Indication: Pneumococcal vaccines are indicated for the prevention of serious pneumococcal infections in patients at high risk for pneumococcal disease such as patients with splenectomy, sickle-cell anemia, nephrotic syndrome, and chronic illnesses such as cardiovascular or chronic obstructive pulmonary disease, and patients 50 years of age or older. Contraindication: Hypersensitivity to any component of the vaccine. Adverse effect: Adverse effects include thrombocytopenia, hyperpyrexia, hypersensitivity, and injection-site reactions, such as soreness, induration, erythema, and tenderness. Dosage: Adults: 0.5 ml IM or SC for adults and children age 2 and older; a single dose is effective. Do not administer intravenously or intradermally. Children: 0.5 ml of the polyvalent vaccine SC or IM for pneumococcal prophylaxis; pneumococcal vaccine may be administered at the same time as influenza vaccine (by separate injection in the other arm) Pharmacokinetics: The onset of antibody titers occurs within 2 to 3 weeks, with duration of 5 to 8 years Stability: Vials left at room temperature inadvertently can be refrigerated again without loss of potency if the period of time at room temperature does not exceed 72 hours. A one-time exposure to freezing temperatures does not alter the antigenicity of the vaccine. Supply: Inj 0.5 ml/vial Pneumococcal Polysaccharide Conjugated Vaccine- “Prevenar” (IPREV) ［ C ］ Indication: Active immunization against invasive disease (including sepsis, meningitis, bacteraemic pneumonia, bacteraemia) caused by Streptococcus pneumoniae serotypes 4, 6B, 9V, 14, 18C, 19F and 23F in infants and young children from 2 months to 2 years of age, or previously unvaccinated children aged 2 to 5 years (for high-risk subjects). Contraindication: Hypersensitivity to the active substances, any component of the product, or diphtheria toxoid. Adverse effects: Injection site reactions (e.g. erythema, induration/swelling, pain/tenderness); fever ＞ 38 °C, irritability, drowsiness, restless sleep; decreased appetite, vomiting, diarrhea. Dosage: The vaccine should be given by intra-muscular injection. Infants aged 2 - 6 months: three single doses of 0.5 ml at interval of 1 month, starting at 2 months of age and with a fourth dose given in 12-15 months of age. Previously unvaccinated older infants and children: Infants aged 7 - 11 months: two doses, each of 0.5 ml, with an interval of at least 1 month between doses. A third dose is recommended in 12-15 months of age. Children aged 12 - 23 months: two doses, each of 0.5 ml, with an interval of at least 2 months between doses. Children aged 24 months- 5 years: one single dose. Warning: This vaccine should not be given to infants or children with thrombocytopenia or any coagulation disorder that would contraindicate intra-muscular injection unless the potential benefit clearly outweighs the risk of administration. When Prevnar is co-administered with hexavalent vaccines DTaP/Hib (PRP-T)/IPV/HepB), the rate of febrile reactions was higher compared to that occurring following the administration of hexavalent vaccines alone. These reactions were mostly moderate (≤ 39 °C) and transient. Storage: Store at 2 – 8 ℃ and Do not freeze. 258 - - 259 - - Contraindication: Hypersensitivity to hepatitis B vaccine, yeast, or any component of the product. Dosage: Adults: IM, regimen consists of 3 doses (at 0, 1, and 6 month). Booster dose: one year after the first injection, then every five years. Supply: Inj 20 mcg/ml/vial. Pneumococcal vaccine-“Pneumovax” (IPNEU)( 專 ) ［ C ］ Indication: Pneumococcal vaccines are indicated for the prevention of serious pneumococcal infections in patients at high risk for pneumococcal disease such as patients with splenectomy, sickle-cell anemia, nephrotic syndrome, and chronic illnesses such as cardiovascular or chronic obstructive pulmonary disease, and patients 50 years of age or older. Contraindication: Hypersensitivity to any component of the vaccine. Adverse effect: Adverse effects include thrombocytopenia, hyperpyrexia, hypersensitivity, and injection-site reactions, such as soreness, induration, erythema, and tenderness. Dosage: Adults: 0.5 ml IM or SC for adults and children age 2 and older; a single dose is effective. Do not administer intravenously or intradermally. Children: 0.5 ml of the polyvalent vaccine SC or IM for pneumococcal prophylaxis; pneumococcal vaccine may be administered at the same time as influenza vaccine (by separate injection in the other arm) Pharmacokinetics: The onset of antibody titers occurs within 2 to 3 weeks, with duration of 5 to 8 years Stability: Vials left at room temperature inadvertently can be refrigerated again without loss of potency if the period of time at room temperature does not exceed 72 hours. A one-time exposure to freezing temperatures does not alter the antigenicity of the vaccine. Supply: Inj 0.5 ml/vial Pneumococcal Polysaccharide Conjugated Vaccine- “Prevenar” (IPREV) ［ C ］ Indication: Active immunization against invasive disease (including sepsis, meningitis, bacteraemic pneumonia, bacteraemia) caused by Streptococcus pneumoniae serotypes 4, 6B, 9V, 14, 18C, 19F and 23F in infants and young children from 2 months to 2 years of age, or previously unvaccinated children aged 2 to 5 years (for high-risk subjects). Contraindication: Hypersensitivity to the active substances, any component of the product, or diphtheria toxoid. Adverse effects: Injection site reactions (e.g. erythema, induration/swelling, pain/tenderness); fever ＞ 38 °C, irritability, drowsiness, restless sleep; decreased appetite, vomiting, diarrhea. Dosage: The vaccine should be given by intra-muscular injection. Infants aged 2 - 6 months: three single doses of 0.5 ml at interval of 1 month, starting at 2 months of age and with a fourth dose given in 12-15 months of age. Previously unvaccinated older infants and children: Infants aged 7 - 11 months: two doses, each of 0.5 ml, with an interval of at least 1 month between doses. A third dose is recommended in 12-15 months of age. Children aged 12 - 23 months: two doses, each of 0.5 ml, with an interval of at least 2 months between doses. Children aged 24 months- 5 years: one single dose. Warning: This vaccine should not be given to infants or children with thrombocytopenia or any coagulation disorder that would contraindicate intra-muscular injection unless the potential benefit clearly outweighs the risk of administration. When Prevnar is co-administered with hexavalent vaccines DTaP/Hib (PRP-T)/IPV/HepB), the rate of febrile reactions was higher compared to that occurring following the administration of hexavalent vaccines alone. These reactions were mostly moderate (≤ 39 °C) and transient. Storage: Store at 2 – 8 ℃ and Do not freeze. 260 - - 261 - - Supply: Inj 0.5 ml/syringe Quadrivalent human papillomavirus (type 6, 11, 16, 18) recombinanrt vaccine -“Gardasil”(IHPV) ( 專 ) ［ B ］ Indication: Prevention of cervical cancer, genital warts & precancerous or dysplastic lesions eg, cervical adenocarcinoma in situ, cervical intraepithelial neoplasia (CIN) grandes 2 & 3, vulvar intraepithelial neoplasia (VIN) grades 2 & 3 (VaIN), cervical intraepithelial neoplasia grade 1 in girls & women 9-26 yr. Contraindication: Hypersensitivity Adverse effect: Injection site reactions, fever, nausea, dizziness. Dosage: 0.5 ml IM in the deltoid region of the upper arm or in the higher anterolateral area of the thigh, according to the following schedule: 1st dose—at elected date; 2nd dose—2month after the 1st dose; 3rd dose—6 month after the 1st dose. Supply: Inj 0.5 ml/syringe Influenza vaccine-“Fluvirin”(IINV 自費 )( 專 ) Indication: Prophylaxis of influenza Contraindication: Hypersensitivity to eggs, chicken proteins, aminoglycosides. Postpone immunization in patients with febrile illness or acute infection. Adverse effect: Redness, swelling, pain, ecchymosis or induration at inj site; fever, malaise, shivering, fatigue, headache, sweating, myalgia, and arthralgia. Dosage: IM or deep SC inj. Adult & children >36 months—0.5 ml; children 6-35 months—0.25-0.5 ml. Administer a 2nd dose after at least 4 weeks in children who have not been previously vaccinated. Supply: Inj 0.5 ml/syringe Pediacel (DtaP-IPV-Hib)(IPEDI)( 專 ) ［ C ］ Indication: Active immunization of children from 2 months of age to 7 years agonist diphtheria, tetanus, pertussis, poliomyelitis & invasive Haemophilus influenzae type b disease. Contraindication: Hypersensitivity to neomycin, streptomycin or polymyxin B. postpone vaccination in acute febrile illness. Children >7 yr, adults. Adverse effect: Redness, tenderness & swelling at inj site; fever, crying, drowsiness; decreased feeding, vomiting, irritability. Dosage: Primary immunization schedule: one 0.5 ml dose IM at 2, 4, 6 & 18 months of age. Supply: Inj 0.5 ml/vial BCG live-“ImmuCyst” (EBCG)( 專 ) ［ C ］ Indication: BCG is an attenuated strain of Bacillus Calmette-Guerin used as a biological response modifier. The primary application of BCG live is the treatment of carcinoma in situ of the urinary bladder and should not be used for tuberculosis immunization. Place in therapy: BCG live (intravesical) demonstrates a complete remission rate of better than 70% in patients with bladder carcinoma. BCG Vaccine has been used in the treatment of a variety of cancers such as malignant melanoma, malignant lymphoma, metastatic breast cancer, ovarian cancer, bladder cancer, gastric cancer, Hodgkin’s disease, lung cancer, leukemia, and prostate cancer. Contraindication: BCG is contraindicated in following conditons: 1.Active tuberculosis 2.Burn patients 3.Recent smallpox vaccinations. 4.Acquired immunodeficiency syndrome. 5. Impaired immunologic responses. 6.Suppressed immunologic responses by drugs. 7.Fever. 8.Urinary tract infections. Adverse effect: thrombocytopenia, eosinophilia, polyneuritis, fever, malaise, vomiting, osteomyelitis, dermatologic effects, and anaphylaxis. Dosage: 1 vial in 53 ml NS for bladder instillation every week for 6 times in patients with bladder carcinoma. Stability: The reconstitution solution is stable at 2-8 ℃ for 8 hrs. 260 - - 261 - - Supply: Inj 0.5 ml/syringe Quadrivalent human papillomavirus (type 6, 11, 16, 18) recombinanrt vaccine -“Gardasil”(IHPV) ( 專 ) ［ B ］ Indication: Prevention of cervical cancer, genital warts & precancerous or dysplastic lesions eg, cervical adenocarcinoma in situ, cervical intraepithelial neoplasia (CIN) grandes 2 & 3, vulvar intraepithelial neoplasia (VIN) grades 2 & 3 (VaIN), cervical intraepithelial neoplasia grade 1 in girls & women 9-26 yr. Contraindication: Hypersensitivity Adverse effect: Injection site reactions, fever, nausea, dizziness. Dosage: 0.5 ml IM in the deltoid region of the upper arm or in the higher anterolateral area of the thigh, according to the following schedule: 1st dose—at elected date; 2nd dose—2month after the 1st dose; 3rd dose—6 month after the 1st dose. Supply: Inj 0.5 ml/syringe Influenza vaccine-“Fluvirin”(IINV 自費 )( 專 ) Indication: Prophylaxis of influenza Contraindication: Hypersensitivity to eggs, chicken proteins, aminoglycosides. Postpone immunization in patients with febrile illness or acute infection. Adverse effect: Redness, swelling, pain, ecchymosis or induration at inj site; fever, malaise, shivering, fatigue, headache, sweating, myalgia, and arthralgia. Dosage: IM or deep SC inj. Adult & children >36 months—0.5 ml; children 6-35 months—0.25-0.5 ml. Administer a 2nd dose after at least 4 weeks in children who have not been previously vaccinated. Supply: Inj 0.5 ml/syringe Pediacel (DtaP-IPV-Hib)(IPEDI)( 專 ) ［ C ］ Indication: Active immunization of children from 2 months of age to 7 years agonist diphtheria, tetanus, pertussis, poliomyelitis & invasive Haemophilus influenzae type b disease. Contraindication: Hypersensitivity to neomycin, streptomycin or polymyxin B. postpone vaccination in acute febrile illness. Children >7 yr, adults. Adverse effect: Redness, tenderness & swelling at inj site; fever, crying, drowsiness; decreased feeding, vomiting, irritability. Dosage: Primary immunization schedule: one 0.5 ml dose IM at 2, 4, 6 & 18 months of age. Supply: Inj 0.5 ml/vial BCG live-“ImmuCyst” (EBCG)( 專 ) ［ C ］ Indication: BCG is an attenuated strain of Bacillus Calmette-Guerin used as a biological response modifier. The primary application of BCG live is the treatment of carcinoma in situ of the urinary bladder and should not be used for tuberculosis immunization. Place in therapy: BCG live (intravesical) demonstrates a complete remission rate of better than 70% in patients with bladder carcinoma. BCG Vaccine has been used in the treatment of a variety of cancers such as malignant melanoma, malignant lymphoma, metastatic breast cancer, ovarian cancer, bladder cancer, gastric cancer, Hodgkin’s disease, lung cancer, leukemia, and prostate cancer. Contraindication: BCG is contraindicated in following conditons: 1.Active tuberculosis 2.Burn patients 3.Recent smallpox vaccinations. 4.Acquired immunodeficiency syndrome. 5. Impaired immunologic responses. 6.Suppressed immunologic responses by drugs. 7.Fever. 8.Urinary tract infections. Adverse effect: thrombocytopenia, eosinophilia, polyneuritis, fever, malaise, vomiting, osteomyelitis, dermatologic effects, and anaphylaxis. Dosage: 1 vial in 53 ml NS for bladder instillation every week for 6 times in patients with bladder carcinoma. Stability: The reconstitution solution is stable at 2-8 ℃ for 8 hrs. 262 - - 263 - - Supply: Vaccine 81 mg/10.5 + 8.7 x 10 8 CFU/Vial with 3 ml diluent 84:00 Skin and Mucous Membrane Agents 84:04 Anti-infectives 84:04.04 Antibacterials Clindamycin phosphate Solution -”Cleocin Topical Solution”(ECLEO) ［ B ］ Indication: It is indicated in the treatment of acne vulgaris. Contraindication: Hypersensitivity to clindamycin and lincomycin Adverse effect: Skin dryness, is a common side effect. Other side effects include abdominal pain, contact dermatitis, irritation, gram-negative bacterial foliculitis, and GI disturbance. Diarrhea and pseudomembrane colitis have been reported in case of topical application. Dosage: Topical application BID Supply: Soln 10 mg/ml, 30 ml/bot Neomycin sulfate (ENEOM) ［ D ］ Indication: Local treatment or prevention of susceptible infections of the skin, including pyogenic or secondary infected stasis dermatoses, wound, impetigo, burns, ulcers, blepharitis and stye. Contraindication: Do not use in eyes or external ear canal, if the ear dram is perforated. Supply: Oint 0.5% 28 g/tube Neomycin sulfate/bacitracin zinc – “Bacitracin” (EBACI) ［ C ］ Indication: infections caused by neomycin &/or bacitracin-susceptible organisms. Precautions: pregnancy & lactation. Children. Adverse effect: allergic reactions like reddening & dryness of skin, skin rashes & pruritus. Dosage: apply bid-qid. Supply: Oint each g contain: neomycin sulfate 5 mg, bacitracin zinc 12.5 mg; 30 g/tube. Na fusidate-“Conlifu”(ECONL) ［ C ］ Indication: Skin infections caused by Staph, Strep & other Fucidin-sensitive organisms. Precautions: Avoid contact with eyes. Adverse effect: Hypersensitivity Dosage: Apply bid-tid. Supply: Oint 2% 5 g/tube. 84:04.06 Antivirals Acyclovir-“Zovirax” (EZOV2) ［ B ］ Indication: Herpes simplex virus infection of the skin including initial & recurrent genital herpes & herpes labialis. Precautions: Application to mucous membranes. Adverse effect: Transient burning or stinging. Mild during & flaking. erythema & itching. Dosage: apply 5 times daily at approximately 4 hr interval for 5 days. Omit night-time dose. Supply: Cream 5% 2 g/tube. 84:04.08 Antifungals Econazole-“Econol” (EECON) “Gyno-pevaryl” (EGYNO) ［ C ］ Indication: Dermatomycoses caused by dermatophytes, yeasts, moulds; vulvovag mycoses, vulvo-vaginal mycoses, mycotic balanitis. Adverse effect: Infrequently, local irritation; burning sensation. Dosage: Creame-apply morning & evening, local irritation; ovule-1 ovule nigtly for 3 days Supply: Creame 1% 5 g; Ovule 150 mg Ciclopiroxolamine-“Brumixol”(EBRUM) ［ B ］ Indication: Fungal infections of the skin Precautions: Infants, children<6 years; pregnancy. 262 - - 263 - - Supply: Vaccine 81 mg/10.5 + 8.7 x 10 8 CFU/Vial with 3 ml diluent 84:00 Skin and Mucous Membrane Agents 84:04 Anti-infectives 84:04.04 Antibacterials Clindamycin phosphate Solution -”Cleocin Topical Solution”(ECLEO) ［ B ］ Indication: It is indicated in the treatment of acne vulgaris. Contraindication: Hypersensitivity to clindamycin and lincomycin Adverse effect: Skin dryness, is a common side effect. Other side effects include abdominal pain, contact dermatitis, irritation, gram-negative bacterial foliculitis, and GI disturbance. Diarrhea and pseudomembrane colitis have been reported in case of topical application. Dosage: Topical application BID Supply: Soln 10 mg/ml, 30 ml/bot Neomycin sulfate (ENEOM) ［ D ］ Indication: Local treatment or prevention of susceptible infections of the skin, including pyogenic or secondary infected stasis dermatoses, wound, impetigo, burns, ulcers, blepharitis and stye. Contraindication: Do not use in eyes or external ear canal, if the ear dram is perforated. Supply: Oint 0.5% 28 g/tube Neomycin sulfate/bacitracin zinc – “Bacitracin” (EBACI) ［ C ］ Indication: infections caused by neomycin &/or bacitracin-susceptible organisms. Precautions: pregnancy & lactation. Children. Adverse effect: allergic reactions like reddening & dryness of skin, skin rashes & pruritus. Dosage: apply bid-qid. Supply: Oint each g contain: neomycin sulfate 5 mg, bacitracin zinc 12.5 mg; 30 g/tube. Na fusidate-“Conlifu”(ECONL) ［ C ］ Indication: Skin infections caused by Staph, Strep & other Fucidin-sensitive organisms. Precautions: Avoid contact with eyes. Adverse effect: Hypersensitivity Dosage: Apply bid-tid. Supply: Oint 2% 5 g/tube. 84:04.06 Antivirals Acyclovir-“Zovirax” (EZOV2) ［ B ］ Indication: Herpes simplex virus infection of the skin including initial & recurrent genital herpes & herpes labialis. Precautions: Application to mucous membranes. Adverse effect: Transient burning or stinging. Mild during & flaking. erythema & itching. Dosage: apply 5 times daily at approximately 4 hr interval for 5 days. Omit night-time dose. Supply: Cream 5% 2 g/tube. 84:04.08 Antifungals Econazole-“Econol” (EECON) “Gyno-pevaryl” (EGYNO) ［ C ］ Indication: Dermatomycoses caused by dermatophytes, yeasts, moulds; vulvovag mycoses, vulvo-vaginal mycoses, mycotic balanitis. Adverse effect: Infrequently, local irritation; burning sensation. Dosage: Creame-apply morning & evening, local irritation; ovule-1 ovule nigtly for 3 days Supply: Creame 1% 5 g; Ovule 150 mg Ciclopiroxolamine-“Brumixol”(EBRUM) ［ B ］ Indication: Fungal infections of the skin Precautions: Infants, children<6 years; pregnancy. 264 - - 265 - - Avoid contact with eyes. Adverse effect: Pruritus, burning sensation. Dosage: Apply bid. Continue treatment for about 1-2 weeks after disappearance of signs of infection to prevent recurrence. Supply: Cream 10 mg/g, 10 g/tube. Naftifine-“Jia Mei”(EJIAM) ［ B ］ Indication: Mycotic infections of skin & skin folds; onychomycosis; candida infections of the skin; pityriasis versicolor; dermatomycosis (with or without pruritus) Precautions: Avoid contact with eyes. Not to be applied to open wounds. Adverse effect: Burning, stinging, dryness, redness. Dosage: 1% applied topically once or bid. Continue for at least 2 weeks after clinical healing. Supply: Cream 1% 10 g/tube Sulconazole Nitrate Solution-“Exelderm” (EEXEL) ［ C ］ Indication: Cutaneous fungal or yeast infections. Contraindication: Hypersensitivity, avoid contact with eyes. Adverse effect: Mild and transient burning, irritation, itching, redness, allergies to sulconazole or its vehicle have been reported. Dosage: Topical 1 or 2 applications a day to affected area for 3-4 weeks. Supply: Soln 1% 10 ml Undecylenic Acid Compound Ointment- “Undacid”(EUUO) Indication: Fungistatic agents for athlete’s foot tinea coporis, ringworm, tinea capitis, tinea cruris and tinea barbae. Contraindication: Do not use if skin is pustular or severely broken. Supply: Oint 10z/tube, each gm contains: undecylenic acid 50mg, Zinc undecylenate 200mg Metronidazole-“Sutrol Gel-Vaginal”(ESUTR) “Metrozole”(EMETR)( 專 ) ［ B ］ Indication: Treatment of bacterial vaginosis. Contraindication: Hypersensitivity to metronidazole Adverse effect: Transient redness, mild dryness, burning & skin irritation. Watery (tearing) eyes if applied too near the eyes. Dosage: Gel-apply bid; vag tab-1 tab once daily for 10-20 days. Supply: Gel-vaginal each gm contains metronidazole 7.5 mg, 25 gm/tube; Vag tab 250 mg. Nystatin-“Mycostatin” (EMYCO) (BMYCO) ［ C ］ Indication: Fungistatic and fungicidal antibiotic against Candida spp, Coccidioides immitis, Cryptococcus neoformans, Histoplasma capsulatum, Blastomyces dermatiditis. Contraindication: Hypersensitivity to nystatin. Adverse effect: Nausea, vomiting and diarrhea. Dosage: Vag 1 tab qd-bid for 2 wks; Powder, apply qid to affected area of mouth, retaining the drug as long as possible before swallowing Supply: Vag Tab 100,000 U; Susp 100,000 U/ml, 24 ml/bot 84:04.12 Scabicides and Pediculicides Benzyl benzoate-“Jaline Lotion”(EJALI) Indication: Treatment of scabies, head lice. Precautions: Avoid contact with eyes & mucous membranes; do not use on bronken or secondarily infected skin. Adverse effect: Skin irritation, burning sensation. Dosage: Scabies—apply over the whole body; repeat without bathing on the following day & wash off 24 hr later. A repeat application may be required in some cases. Head lice—apply 10 ml to the affected area & repeat as often as necessary. Supply: Lotion 25% 150 ml/bot 264 - - 265 - - Avoid contact with eyes. Adverse effect: Pruritus, burning sensation. Dosage: Apply bid. Continue treatment for about 1-2 weeks after disappearance of signs of infection to prevent recurrence. Supply: Cream 10 mg/g, 10 g/tube. Naftifine-“Jia Mei”(EJIAM) ［ B ］ Indication: Mycotic infections of skin & skin folds; onychomycosis; candida infections of the skin; pityriasis versicolor; dermatomycosis (with or without pruritus) Precautions: Avoid contact with eyes. Not to be applied to open wounds. Adverse effect: Burning, stinging, dryness, redness. Dosage: 1% applied topically once or bid. Continue for at least 2 weeks after clinical healing. Supply: Cream 1% 10 g/tube Sulconazole Nitrate Solution-“Exelderm” (EEXEL) ［ C ］ Indication: Cutaneous fungal or yeast infections. Contraindication: Hypersensitivity, avoid contact with eyes. Adverse effect: Mild and transient burning, irritation, itching, redness, allergies to sulconazole or its vehicle have been reported. Dosage: Topical 1 or 2 applications a day to affected area for 3-4 weeks. Supply: Soln 1% 10 ml Undecylenic Acid Compound Ointment- “Undacid”(EUUO) Indication: Fungistatic agents for athlete’s foot tinea coporis, ringworm, tinea capitis, tinea cruris and tinea barbae. Contraindication: Do not use if skin is pustular or severely broken. Supply: Oint 10z/tube, each gm contains: undecylenic acid 50mg, Zinc undecylenate 200mg Metronidazole-“Sutrol Gel-Vaginal”(ESUTR) “Metrozole”(EMETR)( 專 ) ［ B ］ Indication: Treatment of bacterial vaginosis. Contraindication: Hypersensitivity to metronidazole Adverse effect: Transient redness, mild dryness, burning & skin irritation. Watery (tearing) eyes if applied too near the eyes. Dosage: Gel-apply bid; vag tab-1 tab once daily for 10-20 days. Supply: Gel-vaginal each gm contains metronidazole 7.5 mg, 25 gm/tube; Vag tab 250 mg. Nystatin-“Mycostatin” (EMYCO) (BMYCO) ［ C ］ Indication: Fungistatic and fungicidal antibiotic against Candida spp, Coccidioides immitis, Cryptococcus neoformans, Histoplasma capsulatum, Blastomyces dermatiditis. Contraindication: Hypersensitivity to nystatin. Adverse effect: Nausea, vomiting and diarrhea. Dosage: Vag 1 tab qd-bid for 2 wks; Powder, apply qid to affected area of mouth, retaining the drug as long as possible before swallowing Supply: Vag Tab 100,000 U; Susp 100,000 U/ml, 24 ml/bot 84:04.12 Scabicides and Pediculicides Benzyl benzoate-“Jaline Lotion”(EJALI) Indication: Treatment of scabies, head lice. Precautions: Avoid contact with eyes & mucous membranes; do not use on bronken or secondarily infected skin. Adverse effect: Skin irritation, burning sensation. Dosage: Scabies—apply over the whole body; repeat without bathing on the following day & wash off 24 hr later. A repeat application may be required in some cases. Head lice—apply 10 ml to the affected area & repeat as often as necessary. Supply: Lotion 25% 150 ml/bot 266 - - 267 - - Gamma benzene hexachloride-“Scabi” (ESCAB) ［ C ］ Indication: Gamma benzene hexachloride is a chlorinated insecticide. It can be used in treatment of scabies and pediculosis Contraindication: Hypersensitivity to BHC Adverse effect: Seizures have been reported following the topical use of lindane. Isolated reports of adverse effects associated with lindane include disseminated intravascular coagulation and subsequent death after oral ingestion and aplastic anaemia after prolonged topical exposure (twice daily application for three weeks). Dosage: Local application for 8-12 hs then wash the cream out, use once is enough for therapy Supply: Cream 10 g/tub, each gram contain Gamma benzene hexachloride 10 mg 84:04.92 Local Anti-infectives, Miscellaneous Silver sulfadiazine-“Sulfasil”(ESUL2) ［ B ］ Indication: Prevention and treatment of infection particularly by Pseudomonas aeruginosa; severe burns. Contraindication: Because sulfonamide therapy is known to increase the possibility of kernicterus, do not used in pregnancy women near term or in newborn infants. Do not use in Glucose-6-phosphate dehydrogenase deficient individual. Also should not be used with proteolytic enzymes. Administration: The burn wounds are cleaned and debrided and silver sulfadiazine is applied to a thickness of 3 to 5 mm with a sterile gloved hand, once to twice daily. Supply: Cream 1% 25 g/tube Better-Iodine -“Polvidine (B-I)”(EBETI) Indication: Topical antiseptic agent. Supply: Aq. soln 10% better-iodine 84:06 Anti-inflammatory Agents Mometasone–“Elomet” (EELOM) ［ C ］ Indication: Mometasone is a medium-potency topical corticosteroid. Place in therapy: Once-daily application has been shown to be as effective as twice-daily administration of other corticosteroids. Mometasone-induced atrophy have been reported after approximately 6 weeks of therapy which is compared to 3 weeks before atrophy induced by other corticosteroids. Contraindication: Hypersensitivity to mometasone Adverse effect: Dermal atrophy has occurred with topical corticosteroids. Other adverse reactions may include burning, itching, or stinging. Dosage: Topical application QD Supply: Cream 0.1% 5 g/tube Betamethasone-“Rinderon V”(ERINVC) ［ C ］ Indication: Inflammatory dermatoses. Contraindication: Rosacea, acne & perioral dermatitis; viral, fungal or bacteria infection; infant <1 years. Precautions: Eyes; face, co-existing infection; psoriasis; children <4 years (max 3 weeks treatmnet); pregnancy. Adverse effect: Atrophy; rarely, hypersensitivity. Dosage: Apply once daily until improvement occurs. Supply: Cream 0.06% 5 g/tube Clobetasol propionate-“Clobesol” (ECLOB) ［ C ］ Indication: The most potent topical corticosteroid, psoriasis, eczema, vitiligo. Contraindication: Hypersensitivity, tuberculosis, viral infection of the eye or skin. Adverse effect: Adrenal suppression. Dosage: Topical, BID. Supply: Cream 0.05%, 5 g/tub 266 - - 267 - - Gamma benzene hexachloride-“Scabi” (ESCAB) ［ C ］ Indication: Gamma benzene hexachloride is a chlorinated insecticide. It can be used in treatment of scabies and pediculosis Contraindication: Hypersensitivity to BHC Adverse effect: Seizures have been reported following the topical use of lindane. Isolated reports of adverse effects associated with lindane include disseminated intravascular coagulation and subsequent death after oral ingestion and aplastic anaemia after prolonged topical exposure (twice daily application for three weeks). Dosage: Local application for 8-12 hs then wash the cream out, use once is enough for therapy Supply: Cream 10 g/tub, each gram contain Gamma benzene hexachloride 10 mg 84:04.92 Local Anti-infectives, Miscellaneous Silver sulfadiazine-“Sulfasil”(ESUL2) ［ B ］ Indication: Prevention and treatment of infection particularly by Pseudomonas aeruginosa; severe burns. Contraindication: Because sulfonamide therapy is known to increase the possibility of kernicterus, do not used in pregnancy women near term or in newborn infants. Do not use in Glucose-6-phosphate dehydrogenase deficient individual. Also should not be used with proteolytic enzymes. Administration: The burn wounds are cleaned and debrided and silver sulfadiazine is applied to a thickness of 3 to 5 mm with a sterile gloved hand, once to twice daily. Supply: Cream 1% 25 g/tube Better-Iodine -“Polvidine (B-I)”(EBETI) Indication: Topical antiseptic agent. Supply: Aq. soln 10% better-iodine 84:06 Anti-inflammatory Agents Mometasone–“Elomet” (EELOM) ［ C ］ Indication: Mometasone is a medium-potency topical corticosteroid. Place in therapy: Once-daily application has been shown to be as effective as twice-daily administration of other corticosteroids. Mometasone-induced atrophy have been reported after approximately 6 weeks of therapy which is compared to 3 weeks before atrophy induced by other corticosteroids. Contraindication: Hypersensitivity to mometasone Adverse effect: Dermal atrophy has occurred with topical corticosteroids. Other adverse reactions may include burning, itching, or stinging. Dosage: Topical application QD Supply: Cream 0.1% 5 g/tube Betamethasone-“Rinderon V”(ERINVC) ［ C ］ Indication: Inflammatory dermatoses. Contraindication: Rosacea, acne & perioral dermatitis; viral, fungal or bacteria infection; infant <1 years. Precautions: Eyes; face, co-existing infection; psoriasis; children <4 years (max 3 weeks treatmnet); pregnancy. Adverse effect: Atrophy; rarely, hypersensitivity. Dosage: Apply once daily until improvement occurs. Supply: Cream 0.06% 5 g/tube Clobetasol propionate-“Clobesol” (ECLOB) ［ C ］ Indication: The most potent topical corticosteroid, psoriasis, eczema, vitiligo. Contraindication: Hypersensitivity, tuberculosis, viral infection of the eye or skin. Adverse effect: Adrenal suppression. Dosage: Topical, BID. Supply: Cream 0.05%, 5 g/tub 268 - - 269 - - Fluclorolone-“Topicon” (ETOPI) ［ C ］ Indication: Steroid-responsive dermatosis, eczema, acute exacerbation of atopic, seborrhoeic, contact dermatitis. Precautions: Infected skin; atrophy of skin & SC tissue may occur with prolonged use. When used on face atrophy may occur with short-term use. HPA axis suppression may occur if large quantities are used for prolonged period. Dosage: Apply qid. Supply: Cream 0.025% 5 g/tube Fluocinonide – “Topysm”(ETOPS) ［ C ］ Indication: Fluocinonide is indicated for use topically in the relief of inflammatory and pruritic manifestations of corticosteroid responsive dermatoses. Place in therapy: Fluocinonide is a potent fluorinated topical corticosteroid with comparable efficacy to amcinonide, desoximetasone, diflorasone diacetate, betamethasone dipropionate, and halcinonide. Contraindication: Hypersensitivity Adverse effect: Adverse effects are limited primarily to local reactions such as burning, itching, irritation, dryness, hypopigmentation, and allergic contact dermatitis. Systemic absorption of topical corticosteroids may produce reversible HPA axis suppression and Cushing’s syndrome. Dosage: Adults: topical use BID to QID; children: administration of topical corticosteroids should be limited in children to the smallest amount that will be clinically effective. Supply: Lotion 0.5 mg/g, 10 g/bot Flumethasone pivalate-“Locacorten oint” (ELOCA) Indication: Non-infectious inflammatory skin disease responsive to topical corticosteroid therapy Contraindication: Bacterial & viral affections of the skin. Not for ophth use. Adverse effect: Rarely, burning sensation, itching, skin rash; in isolated cases, mild skin atrophy, changes in skin pigmentation; telangiectasia, purpura, steroid acne, especially after prolonged application. Dosage: Apply bid-tid. Supply: Oint 0.02% 5 g/tube 84:08 Antipruritics and Local Anesthetics Lidocaine Jelly-“Xylocaine Jelly”(EXYLJ)( 特 ) Indication: Surface anaesth Precautions: Should not be used as ophth drug. Presence of sepsis or severely traumatized mucosa in area of application. When used for endotracheal tube lubrication, avoid introducing into the lumen of the tube. Adverse effect: Intoxication, cutaneous & hypersensitivity symptoms. Drowsiness, anxiety, excitement, blurred vision, nausea, dizziness & vomiting. Dosage: Several times daily. Supply: Jelly 2% 30 g/tube Menphencala Lotion (ECALAM) Indication: Urticaria, miliaria, mild sunburn, insect bites, diaper & allergic rash, napkin rash & prickly heat in infants. Precautions: Avoid occlusive dressing & contact with open wounds. Acne preparations. Dosage: Apply once-bid daily. Supply: Lotion calamine 8 g, Zn oxide 8 g; 100 ml/bot. Doxepin HCI – “Ichderm” (EICHD) ［ C ］ Indication: Temporary relief of moderate itch associated with eczematous dermatitis. Precautions: Pregnancy, lactation, children. Adverse effect: Local skin irritation. Dosage: Apply qid Supply: Cream 50 mg/g, 15 g/tube. 268 - - 269 - - Fluclorolone-“Topicon” (ETOPI) ［ C ］ Indication: Steroid-responsive dermatosis, eczema, acute exacerbation of atopic, seborrhoeic, contact dermatitis. Precautions: Infected skin; atrophy of skin & SC tissue may occur with prolonged use. When used on face atrophy may occur with short-term use. HPA axis suppression may occur if large quantities are used for prolonged period. Dosage: Apply qid. Supply: Cream 0.025% 5 g/tube Fluocinonide – “Topysm”(ETOPS) ［ C ］ Indication: Fluocinonide is indicated for use topically in the relief of inflammatory and pruritic manifestations of corticosteroid responsive dermatoses. Place in therapy: Fluocinonide is a potent fluorinated topical corticosteroid with comparable efficacy to amcinonide, desoximetasone, diflorasone diacetate, betamethasone dipropionate, and halcinonide. Contraindication: Hypersensitivity Adverse effect: Adverse effects are limited primarily to local reactions such as burning, itching, irritation, dryness, hypopigmentation, and allergic contact dermatitis. Systemic absorption of topical corticosteroids may produce reversible HPA axis suppression and Cushing’s syndrome. Dosage: Adults: topical use BID to QID; children: administration of topical corticosteroids should be limited in children to the smallest amount that will be clinically effective. Supply: Lotion 0.5 mg/g, 10 g/bot Flumethasone pivalate-“Locacorten oint” (ELOCA) Indication: Non-infectious inflammatory skin disease responsive to topical corticosteroid therapy Contraindication: Bacterial & viral affections of the skin. Not for ophth use. Adverse effect: Rarely, burning sensation, itching, skin rash; in isolated cases, mild skin atrophy, changes in skin pigmentation; telangiectasia, purpura, steroid acne, especially after prolonged application. Dosage: Apply bid-tid. Supply: Oint 0.02% 5 g/tube 84:08 Antipruritics and Local Anesthetics Lidocaine Jelly-“Xylocaine Jelly”(EXYLJ)( 特 ) Indication: Surface anaesth Precautions: Should not be used as ophth drug. Presence of sepsis or severely traumatized mucosa in area of application. When used for endotracheal tube lubrication, avoid introducing into the lumen of the tube. Adverse effect: Intoxication, cutaneous & hypersensitivity symptoms. Drowsiness, anxiety, excitement, blurred vision, nausea, dizziness & vomiting. Dosage: Several times daily. Supply: Jelly 2% 30 g/tube Menphencala Lotion (ECALAM) Indication: Urticaria, miliaria, mild sunburn, insect bites, diaper & allergic rash, napkin rash & prickly heat in infants. Precautions: Avoid occlusive dressing & contact with open wounds. Acne preparations. Dosage: Apply once-bid daily. Supply: Lotion calamine 8 g, Zn oxide 8 g; 100 ml/bot. Doxepin HCI – “Ichderm” (EICHD) ［ C ］ Indication: Temporary relief of moderate itch associated with eczematous dermatitis. Precautions: Pregnancy, lactation, children. Adverse effect: Local skin irritation. Dosage: Apply qid Supply: Cream 50 mg/g, 15 g/tube. 270 - - 271 - - Emla cream (EEMLA) Indication: Topical anesth of the skin in connection with insertion of IV catheters, blood sampling & superficial surgical procedures. Preautions: Eyes; infants. Adverse effect: Rarely, mild local reactions eg edema, itching, erythema; corneal irritation, methemoglobinemia (rare) Dosage: Apply a thick layer to the skin & cover with an occlusive dressing. For venipuncture, about 2 g is recommended. Apply at least 1 hr prior start of the procedure. Supply: Cream each g contains lidocaine 25 mg, prilocaine 25 mg, 5% 5 g 84:16 Cell Stimulants and Proliferants Tretinoin-“May White Oint (1)” (EMW1) ［ D ］ Indication: Acne vulgaris Contraindication: Hypersensitivity Precautions: Expose to sunlight including sunlamp should be minimized. Avoid contact with eyes, mouth, angle of the nose & mucous membrane. Eczema; sunburn; pregnancy & lactation. Adverse effect: Erythema, edema, blistering; hypo-or hyperpigmentation, photosensitivity. Dosage: Apply once daily before bedtime. Supply: Oint 0.05% 5 g 84:24 Emollients, Demulcents, and Protectants Calcipotriol-“Daivonex” (EDAIV) ［ C ］ Indication: Preparations of calcipotriol are indicated for the treatment of moderate plaque psoriasis. Other therapeutic uses include congenital ichthyosis, hereditary epidermolytic palmoplantar keratoderma, pityriasis rubra, and pustular psoriasis. Place in therapy: The effectiveness of topical calcipotriol in the treatment of psoriasis results mainly from inhibition of epidermal proliferation and stimulation of differentiation of epidermal cells. Although calcipotriol appears to exert a significantly lesser effect on calcium metabolism than does calcitriol, some investigators feel there is no advantage in using topical calcipotriol over topical calcitriol in psoriasis patients. Contraindication: Vitamin D toxicity. Hypercalcemia. Do not apply to the face. Hypersensitivity to calcipotriol or any ingredient Adverse effect: Transient, rapidly reversible elevation of serum calcium has occurred with the use of calcipotriol. The use of calcipotriol may cause burning, stinging, erythema, and a facial dermatitis. Dosage: Topical application BID, discontinued if serum calcium is above normal range. Do not exceed maximum dose of 100-g ointment per week. Children: Maximum dose: age over 12 yrs 75 g/week, 6-12 yrs 50 g/week, under 6 yrs no maximum safe dose known, but 25 g/week is consider appropriate. Pregnant women: started with QD combined with a group III corticosteroid also QD topically. The maximum dose is 25 g/week. Supply: Oint 50 μg/g, 30 g/Tube 84:28 Keratolytic Agents Urea-“Sinpharderm” (ESINP) Indication: Ichthyosis & hyperkeratotic skin disorders. Adverse effect: Irritant to sensitive skin. Dosage: Apply once-bid. Supply: Cream 100 mg/g, 30 g/tube 84:32 Keratoplastic Agents Polytar Emollient (EPOLE)( 專 ) Indication: Psoriasis, eczema, atopic & pruritic dermatoses. Precautions: Avoid contact with eyes. 270 - - 271 - - Emla cream (EEMLA) Indication: Topical anesth of the skin in connection with insertion of IV catheters, blood sampling & superficial surgical procedures. Preautions: Eyes; infants. Adverse effect: Rarely, mild local reactions eg edema, itching, erythema; corneal irritation, methemoglobinemia (rare) Dosage: Apply a thick layer to the skin & cover with an occlusive dressing. For venipuncture, about 2 g is recommended. Apply at least 1 hr prior start of the procedure. Supply: Cream each g contains lidocaine 25 mg, prilocaine 25 mg, 5% 5 g 84:16 Cell Stimulants and Proliferants Tretinoin-“May White Oint (1)” (EMW1) ［ D ］ Indication: Acne vulgaris Contraindication: Hypersensitivity Precautions: Expose to sunlight including sunlamp should be minimized. Avoid contact with eyes, mouth, angle of the nose & mucous membrane. Eczema; sunburn; pregnancy & lactation. Adverse effect: Erythema, edema, blistering; hypo-or hyperpigmentation, photosensitivity. Dosage: Apply once daily before bedtime. Supply: Oint 0.05% 5 g 84:24 Emollients, Demulcents, and Protectants Calcipotriol-“Daivonex” (EDAIV) ［ C ］ Indication: Preparations of calcipotriol are indicated for the treatment of moderate plaque psoriasis. Other therapeutic uses include congenital ichthyosis, hereditary epidermolytic palmoplantar keratoderma, pityriasis rubra, and pustular psoriasis. Place in therapy: The effectiveness of topical calcipotriol in the treatment of psoriasis results mainly from inhibition of epidermal proliferation and stimulation of differentiation of epidermal cells. Although calcipotriol appears to exert a significantly lesser effect on calcium metabolism than does calcitriol, some investigators feel there is no advantage in using topical calcipotriol over topical calcitriol in psoriasis patients. Contraindication: Vitamin D toxicity. Hypercalcemia. Do not apply to the face. Hypersensitivity to calcipotriol or any ingredient Adverse effect: Transient, rapidly reversible elevation of serum calcium has occurred with the use of calcipotriol. The use of calcipotriol may cause burning, stinging, erythema, and a facial dermatitis. Dosage: Topical application BID, discontinued if serum calcium is above normal range. Do not exceed maximum dose of 100-g ointment per week. Children: Maximum dose: age over 12 yrs 75 g/week, 6-12 yrs 50 g/week, under 6 yrs no maximum safe dose known, but 25 g/week is consider appropriate. Pregnant women: started with QD combined with a group III corticosteroid also QD topically. The maximum dose is 25 g/week. Supply: Oint 50 μg/g, 30 g/Tube 84:28 Keratolytic Agents Urea-“Sinpharderm” (ESINP) Indication: Ichthyosis & hyperkeratotic skin disorders. Adverse effect: Irritant to sensitive skin. Dosage: Apply once-bid. Supply: Cream 100 mg/g, 30 g/tube 84:32 Keratoplastic Agents Polytar Emollient (EPOLE)( 專 ) Indication: Psoriasis, eczema, atopic & pruritic dermatoses. Precautions: Avoid contact with eyes. 272 - - 273 - - Dosage: 2-4 capful to an 8 inch bath. Soak for 20 mins. Pat skin dry. Supply: Liqd Tar 7.5%, cade oil 7.5%, coal tar soln 2.5%, arachis oil extr of crude coal tar 7.5%, liqd paraffin 35%, 350 ml/bot. 84:50 Depigmenting and Pigmenting Agents 84:50.04 Depigmenting Agents Hydroquinone-“May White Oint (2)” (EMW2) ［ C ］ Indication: Chloasma, melasma, freckles, senile lentigines, & other unwanted areas of melanin hyperpigmentation. Adverse effect: Hypersensitivity. Dosage: Apply to the affected area bid. Supply: Oint 4% 10 gm 84:92 Skin and Mucous Membrane Agents, Miscellaneous Benzoyl peroxide – “PanOxyl” (EDIFF) ［ C ］ Indication: Acne vulgaris. Precautions: Avoid contact with eyes, mouth & other mucous membranes. May bleach dyed clothing & fabrics. Dosage: Apply once daily initially. Increase strength as required. Supply: Gel 5% 6 g/tube Hirudoid Cream (EHIR4) Indication: Superficial phlebitis and thrombosis, inflammed varicose veins, leg ulcers, lymphadentitis, exudates, edema, haematoma, softening of hand scars, to improve scars of injuries burn, surgical operations. Precautions: Avoid open wounds or mucous membranes. Dosage: Apply gently or massage severeal times daily. Supply: Cream each 100 g contains 25,000 IU mucopolysaccharide polysulfate (organo-heparinoid “Luitpold”), 40 g/tube. Alcos-Anal (EALC2) Indication: Hemorrhoids; pruritus ani. Adverse effect: Local irritation. Dosage: Apply twice daily. Supply: Oint each g contains Na oleate 100 mg, polidocanol 20 mg, chlorocarvacol 1 mg, 20 g/tube. Sokerz (ESOKE)( 專 ) Indication: Internal & external hemorrhoids Precautions: Infants or pregnancy, avoid prolonged use. Dosage: 1 supp morning & night after each bowel evacuation. Supply: Supp policresulen 100 mg, cinchocaine HCl 2.5 mg Zinc oxide – “Zinc oxide”(EZINC) ［ A ］ Indication: Subacute and chronic dermatitis, diape rash, minor cuts and abrasions, heat rash, and symptomatic relief of eczema, sunburn and superficial burns. Contraindication: Oozing eruption. Supply: Oint 200 mg/g, 28.4 g/tube. 86:00 Smooth Muscle Relaxants 86:12 Genitourinary Smooth Muscle Relaxants Propiverine-“Urotrol”(OUROT) Indication: Management of urinary frequency, urgency & incontinence in idiopathic detrusor instability or neurogenic bladder disorders due to spinal cord lesions. Contraindication: GI obstruction or intestinal atony, significant bladder outflow obstruction, myasthenia gravis, severe ulcerative colitis, toxic megacolon, glaucoma, tachyarrhythmia. Pregnancy & lactation. Adverse effect: dry, mouth, blurred vision, GI disturbances, mydriasis with cycloplegia & photophobia, 272 - - 273 - - Dosage: 2-4 capful to an 8 inch bath. Soak for 20 mins. Pat skin dry. Supply: Liqd Tar 7.5%, cade oil 7.5%, coal tar soln 2.5%, arachis oil extr of crude coal tar 7.5%, liqd paraffin 35%, 350 ml/bot. 84:50 Depigmenting and Pigmenting Agents 84:50.04 Depigmenting Agents Hydroquinone-“May White Oint (2)” (EMW2) ［ C ］ Indication: Chloasma, melasma, freckles, senile lentigines, & other unwanted areas of melanin hyperpigmentation. Adverse effect: Hypersensitivity. Dosage: Apply to the affected area bid. Supply: Oint 4% 10 gm 84:92 Skin and Mucous Membrane Agents, Miscellaneous Benzoyl peroxide – “PanOxyl” (EDIFF) ［ C ］ Indication: Acne vulgaris. Precautions: Avoid contact with eyes, mouth & other mucous membranes. May bleach dyed clothing & fabrics. Dosage: Apply once daily initially. Increase strength as required. Supply: Gel 5% 6 g/tube Hirudoid Cream (EHIR4) Indication: Superficial phlebitis and thrombosis, inflammed varicose veins, leg ulcers, lymphadentitis, exudates, edema, haematoma, softening of hand scars, to improve scars of injuries burn, surgical operations. Precautions: Avoid open wounds or mucous membranes. Dosage: Apply gently or massage severeal times daily. Supply: Cream each 100 g contains 25,000 IU mucopolysaccharide polysulfate (organo-heparinoid “Luitpold”), 40 g/tube. Alcos-Anal (EALC2) Indication: Hemorrhoids; pruritus ani. Adverse effect: Local irritation. Dosage: Apply twice daily. Supply: Oint each g contains Na oleate 100 mg, polidocanol 20 mg, chlorocarvacol 1 mg, 20 g/tube. Sokerz (ESOKE)( 專 ) Indication: Internal & external hemorrhoids Precautions: Infants or pregnancy, avoid prolonged use. Dosage: 1 supp morning & night after each bowel evacuation. Supply: Supp policresulen 100 mg, cinchocaine HCl 2.5 mg Zinc oxide – “Zinc oxide”(EZINC) ［ A ］ Indication: Subacute and chronic dermatitis, diape rash, minor cuts and abrasions, heat rash, and symptomatic relief of eczema, sunburn and superficial burns. Contraindication: Oozing eruption. Supply: Oint 200 mg/g, 28.4 g/tube. 86:00 Smooth Muscle Relaxants 86:12 Genitourinary Smooth Muscle Relaxants Propiverine-“Urotrol”(OUROT) Indication: Management of urinary frequency, urgency & incontinence in idiopathic detrusor instability or neurogenic bladder disorders due to spinal cord lesions. Contraindication: GI obstruction or intestinal atony, significant bladder outflow obstruction, myasthenia gravis, severe ulcerative colitis, toxic megacolon, glaucoma, tachyarrhythmia. Pregnancy & lactation. Adverse effect: dry, mouth, blurred vision, GI disturbances, mydriasis with cycloplegia & photophobia, 274 - - 275 - - transient bradycardia followed by tachycardia, palpitations & arrhythmias, difficulty in micturition. Dosage: 15 mg bid-tid, increased to qid if required. Supply: Tab 15 mg Oxybutynin-“Ditropan”(ODIT2) ［ B ］ Indication: Used as an antispasmodic in patients with uninhibited neurogenic or reflex neurogenic bladder for the relief of symptoms associated with voiding, such as urgency, urge incontinence, frequency, nocturia and incontinence. Contraindication: Patients with glaucoma, myasthenia gravis, partial or complete obstruction of the GI tract, adynamic ileus, megacolon, severe colitis or ulcerative colitis when megacolon is present. Adverse effect: Dry mouth, decreased sweating, urinary hesitancy and/or retention, hot flushes, fever, tachycardia, palpitation, transient blurred vision, mydriasis, cycloplegia or increased ocular tension. Dosage: The usual adult dosage is 5 mg 2 or 3 times daily with a maximum of 5 mg 4 times daily. Children ( ＞ 5 years): 5 mg twice daily with a maximum of 5 mg 3 times daily. Supply: Tab 2.5 mg Tolterodine - “Detrusitol”(ODETR) “Uridin” (OURID) ［ C ］ Indication: Tolterodine is a muscarinic receptor antagonist. It is effective in treating urge incontinence and urinary urgency or frequency. Place in therapy: Tolterodine is a safer and more selective alternative to conventional anticholinergic agents than propantheline, oxybutynin, and tricyclic antidepressants. Contraindication: Gastric retention, hypersensitivity to tolterodine, uncontrolled narrow angle glaucoma, urinary retention Adverse effect: Tolterodine has produced adverse effects characteristic of other anticholinergic agents in clinical studies, such as blurred vision, constipation, and dry mouth and throat. Dosage: Adults: 2 mg PO BID then 1mg PO BID to avoid the side effects of anticholinergics. Children: detrusor hyperreflexia: 0.1 mg/kg Pharmacokinetics: Peak serum concentrations of tolterodine occur within 1 hour of oral doses. Supply: Tab 2 mg Flavoxate HCl-“Genurin” (OGENU)“Uroxate” (OUROX) ［ B ］ Indication: Used as an antispasmodic to provide symptomatic relief of dysuria, urgency, nocturia, suprapubic pain, frequency and incontinence that may occur in patients with cystitis, prostatitis, urethritis, urethrocystitis, or urethro-trigonitis. Contraindication: Patients with pyloric or duodenal obstruction, obstructive intestinal lesions or ileus, achalasia, GI hemorrhage, or obstructive uropathies of the lower urinary tract. Adverse effect: Nausea, vomiting, dry mouth and throat, nervousness, vertigo, headache, drowsiness, blurred vision, increased ocular tension, urticaria, mental confusion, dysuria, tachycarida, palpitation, hyperpyrexia and eosinophilia. Dosage: PO 100-200 mg, 3 or 4 times daily. Supply: Tab 200 mg 86:16 Respiratory Smooth Muscle Relaxants Aminophylline-“Aminophylline” (IAMIN) “Antiasth”(OANTI) ［ C ］ Indication: Treatment of bronchial or cardiac asthma, chronic bronchitis emphysema. Contraindication: Hypersensitivity to any xanthine, severe cardiac disease, peptic ulcer, severe renal and liver impairment. Adverse effect: Anorexia, nausea, vomiting, abdominal 274 - - 275 - - transient bradycardia followed by tachycardia, palpitations & arrhythmias, difficulty in micturition. Dosage: 15 mg bid-tid, increased to qid if required. Supply: Tab 15 mg Oxybutynin-“Ditropan”(ODIT2) ［ B ］ Indication: Used as an antispasmodic in patients with uninhibited neurogenic or reflex neurogenic bladder for the relief of symptoms associated with voiding, such as urgency, urge incontinence, frequency, nocturia and incontinence. Contraindication: Patients with glaucoma, myasthenia gravis, partial or complete obstruction of the GI tract, adynamic ileus, megacolon, severe colitis or ulcerative colitis when megacolon is present. Adverse effect: Dry mouth, decreased sweating, urinary hesitancy and/or retention, hot flushes, fever, tachycardia, palpitation, transient blurred vision, mydriasis, cycloplegia or increased ocular tension. Dosage: The usual adult dosage is 5 mg 2 or 3 times daily with a maximum of 5 mg 4 times daily. Children ( ＞ 5 years): 5 mg twice daily with a maximum of 5 mg 3 times daily. Supply: Tab 2.5 mg Tolterodine - “Detrusitol”(ODETR) “Uridin” (OURID) ［ C ］ Indication: Tolterodine is a muscarinic receptor antagonist. It is effective in treating urge incontinence and urinary urgency or frequency. Place in therapy: Tolterodine is a safer and more selective alternative to conventional anticholinergic agents than propantheline, oxybutynin, and tricyclic antidepressants. Contraindication: Gastric retention, hypersensitivity to tolterodine, uncontrolled narrow angle glaucoma, urinary retention Adverse effect: Tolterodine has produced adverse effects characteristic of other anticholinergic agents in clinical studies, such as blurred vision, constipation, and dry mouth and throat. Dosage: Adults: 2 mg PO BID then 1mg PO BID to avoid the side effects of anticholinergics. Children: detrusor hyperreflexia: 0.1 mg/kg Pharmacokinetics: Peak serum concentrations of tolterodine occur within 1 hour of oral doses. Supply: Tab 2 mg Flavoxate HCl-“Genurin” (OGENU)“Uroxate” (OUROX) ［ B ］ Indication: Used as an antispasmodic to provide symptomatic relief of dysuria, urgency, nocturia, suprapubic pain, frequency and incontinence that may occur in patients with cystitis, prostatitis, urethritis, urethrocystitis, or urethro-trigonitis. Contraindication: Patients with pyloric or duodenal obstruction, obstructive intestinal lesions or ileus, achalasia, GI hemorrhage, or obstructive uropathies of the lower urinary tract. Adverse effect: Nausea, vomiting, dry mouth and throat, nervousness, vertigo, headache, drowsiness, blurred vision, increased ocular tension, urticaria, mental confusion, dysuria, tachycarida, palpitation, hyperpyrexia and eosinophilia. Dosage: PO 100-200 mg, 3 or 4 times daily. Supply: Tab 200 mg 86:16 Respiratory Smooth Muscle Relaxants Aminophylline-“Aminophylline” (IAMIN) “Antiasth”(OANTI) ［ C ］ Indication: Treatment of bronchial or cardiac asthma, chronic bronchitis emphysema. Contraindication: Hypersensitivity to any xanthine, severe cardiac disease, peptic ulcer, severe renal and liver impairment. Adverse effect: Anorexia, nausea, vomiting, abdominal 276 - - 277 - - discomfort, nervousness, irritability, insomnia, headache, serious arrhythmia and convulsion. For sustained release tablet epigastric distress, nausea, vomiting, and palpitation have been reported. Dosage: Usual adult IV Dosage: 250-500 mg up to 1.5 gm daily; Sustained release tablet: 1-2 Tabs BID or Q12H. Children: IV loading: 6 mg/kg over 20 min Supply: Inj 250 mg/10 ml/amp; Tab 225 mg Theophylline–“Xanthium” (OXANT) “Thoin”(OTHOI) ［ C ］ Indication: Bronchial asthma, bronchospasm. Contraindication: Same as aminophylline. Adverse effect: Tachycardia, seizures, hypokalemia, ulceration, reflux, nausea, vomiting, rash, hepatotoxicity. Dosage: Adults: initial 400 mg QD, maintenance: 400-600 mg QD; children: 200-400 mg QD Supply: Cap 400 mg (Xanthium), 250 mg (Thoin) 88:00 Vitamins 88:08 Vitamin B Complex Folic acid (OFOLI) ［ A ］ Indication: Megaloblastic anemia, anemia of nutritional origin, pregnancy, infancy or childhood. Contraindication: It is an incomplete therapy for pernicious anemia, it should not be employed because of the menace of neurological complications various types of leukemia. Adverse effect: Allergic sensitization. Dosage: Folic acid deficiency: up to 1 mg/day IM, IV, oral, SC; maintenance: 0.4 mg/day IM, IV, oral, SC. Supply: Tab 5 mg Mecobalamin-“Hitocobamin M”(OHITO) Indication: Peripheral neuropathy, megaloblastic anemia due to vit B12 deficiency. Precautions: Discontinue if there is no response after oral intake for several months. Adverse effect: Anorexia, nausea, diarrhea & other GI symptoms. Dosage: 1 cap TID Supply: Cap 500 mcg Cyanocobalamin - Vitamin B12 (ICYA1) ［ C ］ Indication: Pernicious anemia and related macrocytic anemias. Contraindication: Hypersensitivity to cyanocobalamine. Adverse effect: Anaphylactic shock, itching, peripheral vascular thrombosis, polycythemia vera, etc. Dosage: Vitamin B12 deficiency: normal absorption, 1000 μg QD orally; mal-absorption, 100 μg/day IM or deep SC for 6-7 days, if clinical improvement, give 100 μg Q2D for 7 doses, then every 3-4 days for another 2-3 weeks, then 100 μg monthly. Supply: Inj 1000 μg/ml Felinamin (IFELI) Indication: Treatment of vit B deficiency states, particularly in psychiatric states, after acute infections, post-op & in macrocytic anaemias associated with vitamin B12 deficiency. Contraindication: Hypersensitivity Adverse effect: Symptom like emesis and are occasionally accompany with injections. Dosage: IV slowly 10-20 ml/day Supply: Inj thiamine disulfide 50 mg, pyridoxine hydrochloride 100 mg, hydroxocobalamin 1000 mcg; 10 ml/amp. Vitamin B complex (IVITB) (OVITB) Indication: Vit B deficiency Adverse effect: Allergic hypersensitivity reactions; severe peripheral neuropathies. Dosage: Orally 1-2 tab tid; inj 1-2 ml qd-bid. Supply: Inj 1 ml/amp, each ml contains thiamine HCl 100 276 - - 277 - - discomfort, nervousness, irritability, insomnia, headache, serious arrhythmia and convulsion. For sustained release tablet epigastric distress, nausea, vomiting, and palpitation have been reported. Dosage: Usual adult IV Dosage: 250-500 mg up to 1.5 gm daily; Sustained release tablet: 1-2 Tabs BID or Q12H. Children: IV loading: 6 mg/kg over 20 min Supply: Inj 250 mg/10 ml/amp; Tab 225 mg Theophylline–“Xanthium” (OXANT) “Thoin”(OTHOI) ［ C ］ Indication: Bronchial asthma, bronchospasm. Contraindication: Same as aminophylline. Adverse effect: Tachycardia, seizures, hypokalemia, ulceration, reflux, nausea, vomiting, rash, hepatotoxicity. Dosage: Adults: initial 400 mg QD, maintenance: 400-600 mg QD; children: 200-400 mg QD Supply: Cap 400 mg (Xanthium), 250 mg (Thoin) 88:00 Vitamins 88:08 Vitamin B Complex Folic acid (OFOLI) ［ A ］ Indication: Megaloblastic anemia, anemia of nutritional origin, pregnancy, infancy or childhood. Contraindication: It is an incomplete therapy for pernicious anemia, it should not be employed because of the menace of neurological complications various types of leukemia. Adverse effect: Allergic sensitization. Dosage: Folic acid deficiency: up to 1 mg/day IM, IV, oral, SC; maintenance: 0.4 mg/day IM, IV, oral, SC. Supply: Tab 5 mg Mecobalamin-“Hitocobamin M”(OHITO) Indication: Peripheral neuropathy, megaloblastic anemia due to vit B12 deficiency. Precautions: Discontinue if there is no response after oral intake for several months. Adverse effect: Anorexia, nausea, diarrhea & other GI symptoms. Dosage: 1 cap TID Supply: Cap 500 mcg Cyanocobalamin - Vitamin B12 (ICYA1) ［ C ］ Indication: Pernicious anemia and related macrocytic anemias. Contraindication: Hypersensitivity to cyanocobalamine. Adverse effect: Anaphylactic shock, itching, peripheral vascular thrombosis, polycythemia vera, etc. Dosage: Vitamin B12 deficiency: normal absorption, 1000 μg QD orally; mal-absorption, 100 μg/day IM or deep SC for 6-7 days, if clinical improvement, give 100 μg Q2D for 7 doses, then every 3-4 days for another 2-3 weeks, then 100 μg monthly. Supply: Inj 1000 μg/ml Felinamin (IFELI) Indication: Treatment of vit B deficiency states, particularly in psychiatric states, after acute infections, post-op & in macrocytic anaemias associated with vitamin B12 deficiency. Contraindication: Hypersensitivity Adverse effect: Symptom like emesis and are occasionally accompany with injections. Dosage: IV slowly 10-20 ml/day Supply: Inj thiamine disulfide 50 mg, pyridoxine hydrochloride 100 mg, hydroxocobalamin 1000 mcg; 10 ml/amp. Vitamin B complex (IVITB) (OVITB) Indication: Vit B deficiency Adverse effect: Allergic hypersensitivity reactions; severe peripheral neuropathies. Dosage: Orally 1-2 tab tid; inj 1-2 ml qd-bid. Supply: Inj 1 ml/amp, each ml contains thiamine HCl 100 278 - - 279 - - mg, riboflavin sodium 5 mg, pyridoxine HCl 5 mg, pantothenate 5 mg, nicotinamide 50 mg; Tab thiamine HCl 5 mg, riboflavin 3 mg, nicotinamide 20 mg, pyridoxine HCl 0.5 mg, cyanocobalamin 1 mcg, Cal pantothenate 3 mg. Pyridoxine HCl (Vitamin B6)-“Beesix”(OVIT6) ［ A/C ］ Indication: For pyridoxine deficiency, treatment of irradiation sickness, and nausea/ vomiting of pregnancy. Contraindication: Sensitivity to pyridoxine. Adverse effect: Paresthesia, somnolence and low serum folic acid level. Dosage: Deficiency: 5-25 mg/day PO for 3 weeks, followed by 1.5-2.5 mg/day in a multivitamin preparation QD. Drug-induced vitamin B6 Deficiency: 100 mg/day for 3 weeks, followed by 30 mg/day for maintenance. Supply: Tab 50 mg Thiamine HCI (Vitamin B1) (OVIT1) ［ A/C ］ Indication: Thiamine deficiency, beriberi disease. Contraindication: Hypersensitivity to thiamine. Adverse effect: Analphylactic shock after injection of large dose. Dosage: Thiamine deficiency: 10-30 mg PO QD Supply: Tab 50 mg 88:12 Vitamin C Ascorbic acid (Vitamin C)-“Cilnin” (IVITC) “Astar”(OVITC) ［ C ］ Indication: For vitamin C deficiency, adjunct in iron supplement, scurvy, deep burns, and wound healing. Contraindication: Too rapid IV injection should be avoided. Adverse effect: Large dose may cause diarrhea, renal stone, too rapid IV administration may cause temporary faintness or dizziness. Dosage: 100-500 mg/day, this dosage can be given PO, IV, or IM Supply: Inj 100 mg/2 ml/amp; Tab 50 mg 88:16 Vitamin D Alfacalcidol (1 α - hydroxyvitamin D3)- “Alfarol” (OALFA) Indication: 1 α -hydroxyvitamin D3 is and analog of vitamin D. It can be used in familial hypophosphatemia, hypoparathyroidism, and vitamin D resistant rickets. It is also effective in chronic renal failure patients. Contraindication: Hypersensitivity, evidence of vitamin D toxicity or hypercalcemia. Pregnancy risk category: No data available. Adverse effect: Execessive doses will result in hypercalcemia or hypercalciuria. Dosage: Usual dose: 0.5 to 1.0 μg/day. Supply: Tab 0.25 μg 88:24 Vitamin K Activity Phytonadione (Vitamin K1 ) (IK1) ［ C ］ Indication: Hypoprothrombinaemia due to oral anticoagulants, antibacterials and salicylates; hemorrhagic disease of the newborn. Adverse effect: Severe reactions (flushing, dyspnea, chest pain) and occasionally deaths have occurred after IV, possibly due to emulsifier; inject site allergy. Dosage: IM, SC is preffered; in emergency, direct IV push not exceeding 1 mg/min, or IV infusion. Dose, route, duration of therapy are dependent on patient’s requirements and regulated by repeated determinations of prothrombin time. Newborns: 0.5-1.0 mg IM or SC, to correct excessively long prothrombin time. In adults: 2.5-25 mg or up to 50mg given initially, subsequent doses be individualized on the basis of response. Supply: Inj 10 mg/1 ml/amp 278 - - 279 - - mg, riboflavin sodium 5 mg, pyridoxine HCl 5 mg, pantothenate 5 mg, nicotinamide 50 mg; Tab thiamine HCl 5 mg, riboflavin 3 mg, nicotinamide 20 mg, pyridoxine HCl 0.5 mg, cyanocobalamin 1 mcg, Cal pantothenate 3 mg. Pyridoxine HCl (Vitamin B6)-“Beesix”(OVIT6) ［ A/C ］ Indication: For pyridoxine deficiency, treatment of irradiation sickness, and nausea/ vomiting of pregnancy. Contraindication: Sensitivity to pyridoxine. Adverse effect: Paresthesia, somnolence and low serum folic acid level. Dosage: Deficiency: 5-25 mg/day PO for 3 weeks, followed by 1.5-2.5 mg/day in a multivitamin preparation QD. Drug-induced vitamin B6 Deficiency: 100 mg/day for 3 weeks, followed by 30 mg/day for maintenance. Supply: Tab 50 mg Thiamine HCI (Vitamin B1) (OVIT1) ［ A/C ］ Indication: Thiamine deficiency, beriberi disease. Contraindication: Hypersensitivity to thiamine. Adverse effect: Analphylactic shock after injection of large dose. Dosage: Thiamine deficiency: 10-30 mg PO QD Supply: Tab 50 mg 88:12 Vitamin C Ascorbic acid (Vitamin C)-“Cilnin” (IVITC) “Astar”(OVITC) ［ C ］ Indication: For vitamin C deficiency, adjunct in iron supplement, scurvy, deep burns, and wound healing. Contraindication: Too rapid IV injection should be avoided. Adverse effect: Large dose may cause diarrhea, renal stone, too rapid IV administration may cause temporary faintness or dizziness. Dosage: 100-500 mg/day, this dosage can be given PO, IV, or IM Supply: Inj 100 mg/2 ml/amp; Tab 50 mg 88:16 Vitamin D Alfacalcidol (1 α - hydroxyvitamin D3)- “Alfarol” (OALFA) Indication: 1 α -hydroxyvitamin D3 is and analog of vitamin D. It can be used in familial hypophosphatemia, hypoparathyroidism, and vitamin D resistant rickets. It is also effective in chronic renal failure patients. Contraindication: Hypersensitivity, evidence of vitamin D toxicity or hypercalcemia. Pregnancy risk category: No data available. Adverse effect: Execessive doses will result in hypercalcemia or hypercalciuria. Dosage: Usual dose: 0.5 to 1.0 μg/day. Supply: Tab 0.25 μg 88:24 Vitamin K Activity Phytonadione (Vitamin K1 ) (IK1) ［ C ］ Indication: Hypoprothrombinaemia due to oral anticoagulants, antibacterials and salicylates; hemorrhagic disease of the newborn. Adverse effect: Severe reactions (flushing, dyspnea, chest pain) and occasionally deaths have occurred after IV, possibly due to emulsifier; inject site allergy. Dosage: IM, SC is preffered; in emergency, direct IV push not exceeding 1 mg/min, or IV infusion. Dose, route, duration of therapy are dependent on patient’s requirements and regulated by repeated determinations of prothrombin time. Newborns: 0.5-1.0 mg IM or SC, to correct excessively long prothrombin time. In adults: 2.5-25 mg or up to 50mg given initially, subsequent doses be individualized on the basis of response. Supply: Inj 10 mg/1 ml/amp 280 - - 281 - - 88:28 Multivitamin Preparations Multivitamin- “Undeca” (OMV) Indication: Multivit supplement. Dosage: 1-2 tabs BID-TID Supply: Tab Vit A 4000 unit, Vit D 400 unit, Vit C 70 mg, Cal. Pantothenate 10 mg, cyanocobalamin 1 mcg, folic acid 50 mcg, nicotinamide 20 mg, pyrdoxine HCl 2 mg, riboflavine 2 mg, thiamine mononitrate 2 mg, Vit E 11 mg Lyopovigen (ILYOP) Indication: Vitamin deficiency. Contraindication: Patients with allergy to thiamine. Pregnancy risk category: No data available. Adverse effect: Dizziness, faintness Dosage: Added into 500-1000 ml dextrose, or saline fluid IV infusion. Supply: Inj 5 ml/vial Each vial provides: Vit A palmitate 10,000 IU Vit D (ergocalciferol) 1,000 IU Vit E 5 IU Ascorbic acid 500 mg Thiamine HCl 50 mg Riboflavine 10 mg Niacinamide 100 mg Pyridoxine HCl 15 mg d-Panthenol 25 mg pH: 2.5-4.0 after dilution. 92:00 Miscellaneous Therapeutic Agents 5- α -Reductase Inhibitors Finasteride – “Proscar”(OPROSC)“Finta”(OFINT) ［ X ］ Indication: Benign prostatic hyperplasia. Finasteride causes a decrease in serum prostate-specific antigen, a marker commonly used for the detection of prostatic carcinoma. Patients should be screened for prostatic carcinoma by other methods (digital rectal exam) prior to and during finasteride therapy. Place in therapy: Finasteride is a 5- α -reductase inhibitor; it inhibits the conversion of testosterone to dihydrotestosterone. But several weeks of therapy are often required before any benefit noted by the patient. Combination therapy with finasteride and an alpha-blocker may provide optimal medical management. Contraindication: Hypersensitivity to finasteride and pregnancy; It is not indicated for use in women or children. Adverse effect: Rash, breast tenderness, erectile dysfunction, reduced libido Dosage: 5 mg PO QD; urinary excretion of metabolites are decreased in patients with chronic renal insufficiency. However, an increased fecal excretion occurs in these patients. No dosage adjustment is necessary in patients with chronic renal insufficiency; male pattern hair loss in men only: 1 mg PO QD with or without meals for 3 months or more Supply: Tab 5 mg Dutasteride-“Avodart” (OAVOD) ［ X ］ Indication: Benign prostatic hyperplasia in men with an enlarged prostate Pharmacology: Dutasteride inhibits the conversion of testosterone to 5 α -dihydrotesterone (DHT). Testosterone is converted to DHT by the enzyme 5- α -reductase, which exists as isoforms, type1 and type2. Dutasteride is an irreversible competitive inhibitor of 5- α -reductase type1 and type2. Pharmacokinetics: Bioavailability is approximately 61%. Dutasteride is highly bound to plasma albumin (99%) and al pha-1 aci d gl ycoprot i en (99. 6%). Dut ast eri de i s extensively metabolized in liver via CYP3A4 isozymes, and its metabolites were excreted mainly in feces. The terminal elimination half- life is approximately 5 weeks at steady state. Dutasteride is absorbed via skin when 280 - - 281 - - 88:28 Multivitamin Preparations Multivitamin- “Undeca” (OMV) Indication: Multivit supplement. Dosage: 1-2 tabs BID-TID Supply: Tab Vit A 4000 unit, Vit D 400 unit, Vit C 70 mg, Cal. Pantothenate 10 mg, cyanocobalamin 1 mcg, folic acid 50 mcg, nicotinamide 20 mg, pyrdoxine HCl 2 mg, riboflavine 2 mg, thiamine mononitrate 2 mg, Vit E 11 mg Lyopovigen (ILYOP) Indication: Vitamin deficiency. Contraindication: Patients with allergy to thiamine. Pregnancy risk category: No data available. Adverse effect: Dizziness, faintness Dosage: Added into 500-1000 ml dextrose, or saline fluid IV infusion. Supply: Inj 5 ml/vial Each vial provides: Vit A palmitate 10,000 IU Vit D (ergocalciferol) 1,000 IU Vit E 5 IU Ascorbic acid 500 mg Thiamine HCl 50 mg Riboflavine 10 mg Niacinamide 100 mg Pyridoxine HCl 15 mg d-Panthenol 25 mg pH: 2.5-4.0 after dilution. 92:00 Miscellaneous Therapeutic Agents 5- α -Reductase Inhibitors Finasteride – “Proscar”(OPROSC)“Finta”(OFINT) ［ X ］ Indication: Benign prostatic hyperplasia. Finasteride causes a decrease in serum prostate-specific antigen, a marker commonly used for the detection of prostatic carcinoma. Patients should be screened for prostatic carcinoma by other methods (digital rectal exam) prior to and during finasteride therapy. Place in therapy: Finasteride is a 5- α -reductase inhibitor; it inhibits the conversion of testosterone to dihydrotestosterone. But several weeks of therapy are often required before any benefit noted by the patient. Combination therapy with finasteride and an alpha-blocker may provide optimal medical management. Contraindication: Hypersensitivity to finasteride and pregnancy; It is not indicated for use in women or children. Adverse effect: Rash, breast tenderness, erectile dysfunction, reduced libido Dosage: 5 mg PO QD; urinary excretion of metabolites are decreased in patients with chronic renal insufficiency. However, an increased fecal excretion occurs in these patients. No dosage adjustment is necessary in patients with chronic renal insufficiency; male pattern hair loss in men only: 1 mg PO QD with or without meals for 3 months or more Supply: Tab 5 mg Dutasteride-“Avodart” (OAVOD) ［ X ］ Indication: Benign prostatic hyperplasia in men with an enlarged prostate Pharmacology: Dutasteride inhibits the conversion of testosterone to 5 α -dihydrotesterone (DHT). Testosterone is converted to DHT by the enzyme 5- α -reductase, which exists as isoforms, type1 and type2. Dutasteride is an irreversible competitive inhibitor of 5- α -reductase type1 and type2. Pharmacokinetics: Bioavailability is approximately 61%. Dutasteride is highly bound to plasma albumin (99%) and al pha-1 aci d gl ycoprot i en (99. 6%). Dut ast eri de i s extensively metabolized in liver via CYP3A4 isozymes, and its metabolites were excreted mainly in feces. The terminal elimination half- life is approximately 5 weeks at steady state. Dutasteride is absorbed via skin when 282 - - 283 - - handling capsules. Contraindication: Use in women and children, hypersensitivity to dutasteride, or other 5- α -reductase inhibitors, or any component of the preparation. Adverse effect: Serum testosterone increased, thyroi d-sti mul ati ng hormone i ncreased, i mpotence, decreased libido, ejaculation disorder, breast tenderness and breast enlargement. Dosage: 0.5 mg taken orally once a day. The capsules should be swallowed whole. May be administered with or without food. Supply: Cap 0.5 mg Antidotes Acetylcysteine – “Acetin”(OACET) ［ B ］ Indication: It is a mucolytic agent that possesses marginal efficacy in the treatment of pulmonary diseases. The drug is very effective in reversing the hepatotoxicity induced by acetaminophen poisoning. Contraindication: Hypersensitivity. Adverse effect: Bronchoconstriction, bronchospasm, and allergic reactions. Dosage: For acetaminophen overdose: oral, initial 140 mg/kg followed with 70 mg/kg Q4H for 17 additional doses starting 4 hr after loading dose. For mucolytic: adult—200 mg tid; children 100 mg bid-qid. Supply: Granule 66.67 mg/gm, 1.5 gm/package Calcium folinate-“Leucovorin Calcium”(ILEU5) ［ C ］ Indication: Cellular rescue from the adverse effects of high-dose methotrexate therapy. Contraindication: Pernicious anemia and other megaloblastic anemia secondary to lack of Vitamin B12, Adverse effect: Allergic sensitization. Dosage: Rescue of methotrexate adverse reaction: 10-15 mg/m2 IV, IM or PO every 6 hours for 10 doses starting 24hrs after beginning of MTX infusion, continue until methotrexate serum levels below 0.01 μmole/L. Stability: D5W with leucovorin 910 mg/L, less than 10% leucovorin decomposition in 24 hours at room temperature in glass or polyvinylchloride containers Supply:Inj 50 mg/5 ml/vial Pralidoxime-“PAMCI”(IPAM) ［ C ］ Indication: Poisoning by certain cholinesterase inhibitors and some organophorous insecticides and miotics. Contraindication: Impaired renal function. Adverse effect: Drowsiness, dizziness, disturbances of vision, nausea, tachycardia, headache, hypertension, and muscle weakness; large dose may cause transient neuromuscular blockade. Dosage: Organophosphate poisoning: Adults: initial 1-2 g (15-30 mg/kg) in 100 ml normal saline IV infused over 15-30 min, repeat 1-2 gm in 1 hr if muscle weakness persists. Children: 25-50 mg/kg IV; repeat in 1-2 hrs, then at 10-12 hr interval if necessary. Supply: Inj 50 mg/ml, 10 ml/amp. Antigout Agents Allopurinol (OALLO) ［ C ］ Indication: Primary hyperuricemia of gout, secondary hyper-uricemia due to hematological disorders or antineoplastic therapy, and renal urate stone. Contraindication: Hypersensitivity to allopurinol, idiopathic hemochromatosis, nursing mothers and children. Adverse effect: Rash, exfoliative, urticarial or purpuric lesions, nausea, vomiting, agranulocytosis, anemia, peripheral neuritis, diarrhea, headache. Dosage: Adults: initial dose: 100 mg/day PC, then increased by 100 mg at weekly interval until serum uric level < 6 mg/dl. Maximum dose: 300 mg/dose, 800 mg/day. Supply: Tab 100 mg 282 - - 283 - - handling capsules. Contraindication: Use in women and children, hypersensitivity to dutasteride, or other 5- α -reductase inhibitors, or any component of the preparation. Adverse effect: Serum testosterone increased, thyroi d-sti mul ati ng hormone i ncreased, i mpotence, decreased libido, ejaculation disorder, breast tenderness and breast enlargement. Dosage: 0.5 mg taken orally once a day. The capsules should be swallowed whole. May be administered with or without food. Supply: Cap 0.5 mg Antidotes Acetylcysteine – “Acetin”(OACET) ［ B ］ Indication: It is a mucolytic agent that possesses marginal efficacy in the treatment of pulmonary diseases. The drug is very effective in reversing the hepatotoxicity induced by acetaminophen poisoning. Contraindication: Hypersensitivity. Adverse effect: Bronchoconstriction, bronchospasm, and allergic reactions. Dosage: For acetaminophen overdose: oral, initial 140 mg/kg followed with 70 mg/kg Q4H for 17 additional doses starting 4 hr after loading dose. For mucolytic: adult—200 mg tid; children 100 mg bid-qid. Supply: Granule 66.67 mg/gm, 1.5 gm/package Calcium folinate-“Leucovorin Calcium”(ILEU5) ［ C ］ Indication: Cellular rescue from the adverse effects of high-dose methotrexate therapy. Contraindication: Pernicious anemia and other megaloblastic anemia secondary to lack of Vitamin B12, Adverse effect: Allergic sensitization. Dosage: Rescue of methotrexate adverse reaction: 10-15 mg/m2 IV, IM or PO every 6 hours for 10 doses starting 24hrs after beginning of MTX infusion, continue until methotrexate serum levels below 0.01 μmole/L. Stability: D5W with leucovorin 910 mg/L, less than 10% leucovorin decomposition in 24 hours at room temperature in glass or polyvinylchloride containers Supply:Inj 50 mg/5 ml/vial Pralidoxime-“PAMCI”(IPAM) ［ C ］ Indication: Poisoning by certain cholinesterase inhibitors and some organophorous insecticides and miotics. Contraindication: Impaired renal function. Adverse effect: Drowsiness, dizziness, disturbances of vision, nausea, tachycardia, headache, hypertension, and muscle weakness; large dose may cause transient neuromuscular blockade. Dosage: Organophosphate poisoning: Adults: initial 1-2 g (15-30 mg/kg) in 100 ml normal saline IV infused over 15-30 min, repeat 1-2 gm in 1 hr if muscle weakness persists. Children: 25-50 mg/kg IV; repeat in 1-2 hrs, then at 10-12 hr interval if necessary. Supply: Inj 50 mg/ml, 10 ml/amp. Antigout Agents Allopurinol (OALLO) ［ C ］ Indication: Primary hyperuricemia of gout, secondary hyper-uricemia due to hematological disorders or antineoplastic therapy, and renal urate stone. Contraindication: Hypersensitivity to allopurinol, idiopathic hemochromatosis, nursing mothers and children. Adverse effect: Rash, exfoliative, urticarial or purpuric lesions, nausea, vomiting, agranulocytosis, anemia, peripheral neuritis, diarrhea, headache. Dosage: Adults: initial dose: 100 mg/day PC, then increased by 100 mg at weekly interval until serum uric level < 6 mg/dl. Maximum dose: 300 mg/dose, 800 mg/day. Supply: Tab 100 mg 284 - - 285 - - Colchicine (OCOLC) ［ D ］ Indication: Acute gouty arthritis, chronic sarcoid arthritis. Contraindication: Pregnancy, old or feeble patient with cardiac, renal, hepatic & GI disease. Adverse effect: Nausea, vomiting, abdominal pain, hairless, bone marrow depression, myopathy, peripheral neuritis, burning threat pain, bloody diarrhea, shock, hematuria, oligouria. Dosage: Prophylactic dose: 0.5 mg QD-TID. Acute attack of gout: initial dose: 1-1.2 mg then 0.5 mg Q2H until pain is relieved or nausea, diarrhea appeared, to a MAX total dose of 4-8 mg. Supply: Tab 0.5 mg Bone Resorption Inhibitors Alendronate/colecalciferol – “Fosamax Plus”(OFOSP) Indication: Treatment of osteoporosis in post-menopausal women to prevent fractures, including those of the hip & spine (vertebral compression fractures). Treatment of osteoporosis in men to prevent fractures. Contraindication: Abnormalities of the esophagus (eg stricture or achalasia), inability to stand or sit upright for at least 30 mins, hypocalcemia. Adverse effect: Hypersensitivity reactions including urticaria & rarely angioedema. Transient symptoms of myalgia, malaise, asthenia & symptoms of myalgia, malaise, asthenia & rarely fever. Esophagitis, esophageal erosions, esophageal ulcers, rarely esophageal stricutre or perforation, & oropharyngeal ulceration. Rarely, localized osteonecrosis of the jaw generally associated with tooth extraction &/or local infection, often with delayed healing. Joint swelling, dizziness & vertigo, rash (occasionally with photosensitivity), pruritus. Dosage: 1 tab once weekly. Supply: Tab Alendronate Na 70 mg, colecalciferol 2800 IU Pamidronate-“Aredia”(IARED)( 專 ) ［ D ］ Indication: Pamidronate is a bisphosphonate bone-resorption inhibitor. It is effective in moderate or severe hypercalcemia of malignancy. Place in therapy: The drug represents a useful alternative to etidronate, and may replace etidronate if further studies confirm its efficacy and lack of effects on bone mineralization. Pamidronate is effective for treating osteolytic bone lesions of multiple myeloma and may be effective in treating bone pain associated with other tumor types (eg, breast cancer, prostate cancer). Pamidronate is also effective for treating Paget’s disease of bone. Contraindication: Hypersensitivity to pamidronate or other bisphosphonates. Monitor renal function tests as nephropathy may occur. Monitor serum calcium, phosphate, magnesium, and potassium. If pre-existing anemia, leukopenia, or thrombocytopenia is present, follow complete blood count during the first 2 weeks of treatment. Adverse effect: The primary adverse effects of intravenous pamidronate are fever and malaise; gastrointestinal symptoms have occurred with oral therapy. Dosage: Adults: 60-90 mg initially, single-dose IV infusion over 4 hours (60 mg) or 24 hours (90 mg) for moderate to severe hypercalcemia of malignancy; 90 mg monthly as a 4-hour infusion for the treatment of osteolytic bone lesions of multiple myeloma; 30 mg qd for 3 days as a 4-hour infusion for the treatment of Paget’s disease. Pharmacokinetics: In cancer patients, a mean of 51% of pamidronate was excreted unchanged in the urine within 72 hours. The urinary-excretion-rate profile of pamidronate was biphasic (60 milligrams); alpha half-life, 2.1 hours, beta half-life, 28 hours. Stability: After reconstitution of pamidronate lyophilized powder, the solution is stable for up to 24 hours when refrigerated (2 to 8 C). When pamidronate is prepared in 284 - - 285 - - Colchicine (OCOLC) ［ D ］ Indication: Acute gouty arthritis, chronic sarcoid arthritis. Contraindication: Pregnancy, old or feeble patient with cardiac, renal, hepatic & GI disease. Adverse effect: Nausea, vomiting, abdominal pain, hairless, bone marrow depression, myopathy, peripheral neuritis, burning threat pain, bloody diarrhea, shock, hematuria, oligouria. Dosage: Prophylactic dose: 0.5 mg QD-TID. Acute attack of gout: initial dose: 1-1.2 mg then 0.5 mg Q2H until pain is relieved or nausea, diarrhea appeared, to a MAX total dose of 4-8 mg. Supply: Tab 0.5 mg Bone Resorption Inhibitors Alendronate/colecalciferol – “Fosamax Plus”(OFOSP) Indication: Treatment of osteoporosis in post-menopausal women to prevent fractures, including those of the hip & spine (vertebral compression fractures). Treatment of osteoporosis in men to prevent fractures. Contraindication: Abnormalities of the esophagus (eg stricture or achalasia), inability to stand or sit upright for at least 30 mins, hypocalcemia. Adverse effect: Hypersensitivity reactions including urticaria & rarely angioedema. Transient symptoms of myalgia, malaise, asthenia & symptoms of myalgia, malaise, asthenia & rarely fever. Esophagitis, esophageal erosions, esophageal ulcers, rarely esophageal stricutre or perforation, & oropharyngeal ulceration. Rarely, localized osteonecrosis of the jaw generally associated with tooth extraction &/or local infection, often with delayed healing. Joint swelling, dizziness & vertigo, rash (occasionally with photosensitivity), pruritus. Dosage: 1 tab once weekly. Supply: Tab Alendronate Na 70 mg, colecalciferol 2800 IU Pamidronate-“Aredia”(IARED)( 專 ) ［ D ］ Indication: Pamidronate is a bisphosphonate bone-resorption inhibitor. It is effective in moderate or severe hypercalcemia of malignancy. Place in therapy: The drug represents a useful alternative to etidronate, and may replace etidronate if further studies confirm its efficacy and lack of effects on bone mineralization. Pamidronate is effective for treating osteolytic bone lesions of multiple myeloma and may be effective in treating bone pain associated with other tumor types (eg, breast cancer, prostate cancer). Pamidronate is also effective for treating Paget’s disease of bone. Contraindication: Hypersensitivity to pamidronate or other bisphosphonates. Monitor renal function tests as nephropathy may occur. Monitor serum calcium, phosphate, magnesium, and potassium. If pre-existing anemia, leukopenia, or thrombocytopenia is present, follow complete blood count during the first 2 weeks of treatment. Adverse effect: The primary adverse effects of intravenous pamidronate are fever and malaise; gastrointestinal symptoms have occurred with oral therapy. Dosage: Adults: 60-90 mg initially, single-dose IV infusion over 4 hours (60 mg) or 24 hours (90 mg) for moderate to severe hypercalcemia of malignancy; 90 mg monthly as a 4-hour infusion for the treatment of osteolytic bone lesions of multiple myeloma; 30 mg qd for 3 days as a 4-hour infusion for the treatment of Paget’s disease. Pharmacokinetics: In cancer patients, a mean of 51% of pamidronate was excreted unchanged in the urine within 72 hours. The urinary-excretion-rate profile of pamidronate was biphasic (60 milligrams); alpha half-life, 2.1 hours, beta half-life, 28 hours. Stability: After reconstitution of pamidronate lyophilized powder, the solution is stable for up to 24 hours when refrigerated (2 to 8 C). When pamidronate is prepared in 286 - - 287 - - 500 ml or 1000 ml of dextrose 5%, sodium chloride 0.45%, or sodium chloride 0.9%, the infusion solution is stable for 24 hours at room temperature. Pamidronate should not be mixed in a calcium-containing infusion solution (eg, Ringer’s solution). Supply: Inj 15 mg/ml/vial Disease-modifying Antirheumatic Drugs Etanercept-“Enbrel” (IENBR)( 專 ) ［ B ］ Indication: Rheumatoid arthritis, ankylosing spondylitis, moderately to severely active polyarticular-course JRA, severely active arthritis in patient with psoriatic arthritis. Pharmacology: Etanercept binds tumor necrosis factor (TNF) and blocks its interaction with cell surface receptors. Pharmacokinetics: Onset of action : 2~ 3 weeks; bioavailability with SC injection is 58%, with peak plasma concentrations achieved within 48~96 hrs ; Elimination half-life:115 hrs. Contraindication: Sepsis, hypersensitivity to etanercept or components Adverse effect: Injection site reaction (37%, erythema, itching, pain, swelling), Upper respiratory infection, headache, rhinitis, dizziness, pharyngitis, and cough occur frequently. Dosage: Ankylosing spondylitis, Psoriasis with arthropathy, Rheumatoid arthritis, Adult : 50 mg per week SC as one dose, or 25 mg twice weekly (should be separated by 72-96 hrs). Administratuion: Reconstitute 25 mg vial with 1 mL of bacteriostatic sterile water (included), add slowly and without shaking or agitation to minimize foaming. Swirl gently; dissolution requires about 10 minutes. Resultant solution should be clear and colorless. Administer the solution as soon as possible after reconstitution. Storage: Etanercept sterile powder must be refrigerated at 2-8 ℃ Supply: Inj 25 mg/vial Immunosuppressive Agents Azathioprine-“Imuran” (OIMUR) ［ D ］ Indication: Renal transplantation (organ and tissue transplantation), multiple myeloma. Contraindication: Liver damage, liver disease, pregnancy, and hypersensitivity to the drug. Adverse effect: Hematological toxicity (leukopenia, anemia, and thrombocytopenia), bone marrow suppression, diarrhea, rash, fever. Dosage: PO 300 mg/day. Supply: Tab 50 mg Cyclosporine-“Sandimmun” (OSAN2)(OSAN1) ［ C ］ Indication: To prevent the rejection of transplanted kidney, heart, liver and bone marrow. Pharmacology: Inhibition of production and release of IL-2 and inhibits IL-2-induced activation of resting T-lymphocytes Pharmacokinetics: Oral absorption is erratic and incomplete, about 30%, dependent on presence of food, bile acid, and GI motility. Distribution: widely in tissues and body fluids including the liver, pancreas, and lung; across placenta, enters breast milk. Protein binding: 90-98% to lipoproteins. Extensively metabolized in liver via CYP450 3A4 enzyme. Elimination half-life: 10.5-15 hr in adults, 7.5 hr in children, prolonged in the elderly and in patients with liver dysfunction. Excretion: primarily feces; urine (6%, 0.1% as unchanged drug and metabolites) Contraindication: Hypersensitivity to cyclosporine Adverse effect: Nephrotoxicity (30%), hyperkalemia, hypertension, hirsutism, hyperuricemia and gout, tremor, cramps, headache, gum hypertrophy, lymphomas, GI disturbances, and transient hepatoxicity. Dosage: Renal transplant: 9± 3 mg/kg/day; liver transplant: 8± 4 mg/kg/day; heart transplant: 7± 3 mg/kg/day in 2 di vi ded doses; r heumat oi d ar t hr i t i s: i ni t i al 2. 5 mg/kg/day div. Into 2 doses for 6 wks, Max .4 mg/kg/day if 286 - - 287 - - 500 ml or 1000 ml of dextrose 5%, sodium chloride 0.45%, or sodium chloride 0.9%, the infusion solution is stable for 24 hours at room temperature. Pamidronate should not be mixed in a calcium-containing infusion solution (eg, Ringer’s solution). Supply: Inj 15 mg/ml/vial Disease-modifying Antirheumatic Drugs Etanercept-“Enbrel” (IENBR)( 專 ) ［ B ］ Indication: Rheumatoid arthritis, ankylosing spondylitis, moderately to severely active polyarticular-course JRA, severely active arthritis in patient with psoriatic arthritis. Pharmacology: Etanercept binds tumor necrosis factor (TNF) and blocks its interaction with cell surface receptors. Pharmacokinetics: Onset of action : 2~ 3 weeks; bioavailability with SC injection is 58%, with peak plasma concentrations achieved within 48~96 hrs ; Elimination half-life:115 hrs. Contraindication: Sepsis, hypersensitivity to etanercept or components Adverse effect: Injection site reaction (37%, erythema, itching, pain, swelling), Upper respiratory infection, headache, rhinitis, dizziness, pharyngitis, and cough occur frequently. Dosage: Ankylosing spondylitis, Psoriasis with arthropathy, Rheumatoid arthritis, Adult : 50 mg per week SC as one dose, or 25 mg twice weekly (should be separated by 72-96 hrs). Administratuion: Reconstitute 25 mg vial with 1 mL of bacteriostatic sterile water (included), add slowly and without shaking or agitation to minimize foaming. Swirl gently; dissolution requires about 10 minutes. Resultant solution should be clear and colorless. Administer the solution as soon as possible after reconstitution. Storage: Etanercept sterile powder must be refrigerated at 2-8 ℃ Supply: Inj 25 mg/vial Immunosuppressive Agents Azathioprine-“Imuran” (OIMUR) ［ D ］ Indication: Renal transplantation (organ and tissue transplantation), multiple myeloma. Contraindication: Liver damage, liver disease, pregnancy, and hypersensitivity to the drug. Adverse effect: Hematological toxicity (leukopenia, anemia, and thrombocytopenia), bone marrow suppression, diarrhea, rash, fever. Dosage: PO 300 mg/day. Supply: Tab 50 mg Cyclosporine-“Sandimmun” (OSAN2)(OSAN1) ［ C ］ Indication: To prevent the rejection of transplanted kidney, heart, liver and bone marrow. Pharmacology: Inhibition of production and release of IL-2 and inhibits IL-2-induced activation of resting T-lymphocytes Pharmacokinetics: Oral absorption is erratic and incomplete, about 30%, dependent on presence of food, bile acid, and GI motility. Distribution: widely in tissues and body fluids including the liver, pancreas, and lung; across placenta, enters breast milk. Protein binding: 90-98% to lipoproteins. Extensively metabolized in liver via CYP450 3A4 enzyme. Elimination half-life: 10.5-15 hr in adults, 7.5 hr in children, prolonged in the elderly and in patients with liver dysfunction. Excretion: primarily feces; urine (6%, 0.1% as unchanged drug and metabolites) Contraindication: Hypersensitivity to cyclosporine Adverse effect: Nephrotoxicity (30%), hyperkalemia, hypertension, hirsutism, hyperuricemia and gout, tremor, cramps, headache, gum hypertrophy, lymphomas, GI disturbances, and transient hepatoxicity. Dosage: Renal transplant: 9± 3 mg/kg/day; liver transplant: 8± 4 mg/kg/day; heart transplant: 7± 3 mg/kg/day in 2 di vi ded doses; r heumat oi d ar t hr i t i s: i ni t i al 2. 5 mg/kg/day div. Into 2 doses for 6 wks, Max .4 mg/kg/day if 288 - - 289 - - no response after 3 months. Supply: Cap 25 mg, 100 mg Other Miscellaneous Therapeutic Agents Botulinum toxin type A – “Botox” (IBOTO)( 專 ) ［ C ］ Indication: For treatment of strabismus & blepharospasm associated with dystonia, including benign essential blepharospasm or VII nerve disorders in patients >12 years. Treatment of spasmodic torticollis (cervical dystonia) in adults. Treatment of dynamic quines foot deformity due to spasticity in pediatric cerebral palsy patients >2years. Treatment of primary hyperhidrosis of the axilla. Treatment of glabellar lines associated with corrugator &/or procerus muscle activity. Management of focal spasticity, including treatment of upper limb spasticity associated with stroke in adults. Contraindication: Mysasthenia gravis or Eaton Lambert syndrome, infection at inj site. Precautions: Inflammation at inj site, excessive weakness or atrophy in target muscle, amyotrophic lateral sclerosis, disorders of peripheral neuromuscular function, angle closure glaucoma. Pregnancy, lactation. Adverse effect: Localized pain, tenderness &/ or bruising, local weakness, ptosis, vertical deviation, irritation/tearing. Rarely, skin rash (including erythema multiforme, urticaria & psoriasiform eruption), pruritus, allergic reactions, dysphagia, pneumonia. Dosage: For blepharospasm: 1.25-2.5 Units injected into orbicularis oculi muscle; 30 day cumulative MAX 200 Units; For glabellar lines: in patients 65 years of age and younger, 4 Units (0.1Ml) into each of 5 sites (2 in each corrugator muscle, 1 in procerus muscle); total dose 20 Units Supply: Inj 100U Betahistine-“Merislon” (OMERI)“Nilasen” (ONILA) Indication: Vertigo & dizziness associated with Meniere’s syndrome. Precautions: Peptic ulcer; bronchial asthma, pheochromocytoma. Adverse effect: Nausea, vomiting; skin rash. Dosage: 6-12 mg tid. Supply: Tab 12 mg (Merislon), 24 mg (Nilasen) Ginkgo Biloba Extr – “Cerenin”(OCERE) “Mylin”(OMYLI) Indication: It has been used in cerebrovascular insufficiency, peripheral circulation disorder, disturbance in skin circulation and skin ulcers. Contraindication: Hypersensitivity to components of Ginkgo. Adverse effect: Adverse effects include headaches, dizziness, palpitations, gastrointestinal disturbances, and skin hypersensi-tivity reactions. Dosage: 1 tab PO TID. Supply: Tab 40 mg Piracetam – “Nootropil”(ONOO1)(INOO6)( 專 ) Indication: Age-associated cognitive impairment, supplemental therapy in cortical myoclonus. Pharmacology: Piracetam acts on the CNS and has been described as a `nootropic’; it is said to protect the cerebral cortex against hypoxia. It is also reported to inhibit platelet aggregation and reduce blood viscosity at high doses. Pharmacokinetics: High distribution in cerebrospinal fluid; not metabolized in the body; primarily excreted unchanged in the urine; Elimination Half-life: 5 to 6 hours. Contraindication: Previous hypersensitivity to piracetam, Huntington’s chorea, cerebral hemorrhage, end stage renal disease. Adverse effect: Insomnia, somnolence, weight gain, hyperkinesia, nervousness, and depression. Dosage: Cerebrovascular insufficiencies & age-associated cognitive impairment: loading dose 4.8 g daily during initial weeks of treatment; maintenance 1.2-2.4 g daily; cortical myoclonus: initially 7.2 g daily, 288 - - 289 - - no response after 3 months. Supply: Cap 25 mg, 100 mg Other Miscellaneous Therapeutic Agents Botulinum toxin type A – “Botox” (IBOTO)( 專 ) ［ C ］ Indication: For treatment of strabismus & blepharospasm associated with dystonia, including benign essential blepharospasm or VII nerve disorders in patients >12 years. Treatment of spasmodic torticollis (cervical dystonia) in adults. Treatment of dynamic quines foot deformity due to spasticity in pediatric cerebral palsy patients >2years. Treatment of primary hyperhidrosis of the axilla. Treatment of glabellar lines associated with corrugator &/or procerus muscle activity. Management of focal spasticity, including treatment of upper limb spasticity associated with stroke in adults. Contraindication: Mysasthenia gravis or Eaton Lambert syndrome, infection at inj site. Precautions: Inflammation at inj site, excessive weakness or atrophy in target muscle, amyotrophic lateral sclerosis, disorders of peripheral neuromuscular function, angle closure glaucoma. Pregnancy, lactation. Adverse effect: Localized pain, tenderness &/ or bruising, local weakness, ptosis, vertical deviation, irritation/tearing. Rarely, skin rash (including erythema multiforme, urticaria & psoriasiform eruption), pruritus, allergic reactions, dysphagia, pneumonia. Dosage: For blepharospasm: 1.25-2.5 Units injected into orbicularis oculi muscle; 30 day cumulative MAX 200 Units; For glabellar lines: in patients 65 years of age and younger, 4 Units (0.1Ml) into each of 5 sites (2 in each corrugator muscle, 1 in procerus muscle); total dose 20 Units Supply: Inj 100U Betahistine-“Merislon” (OMERI)“Nilasen” (ONILA) Indication: Vertigo & dizziness associated with Meniere’s syndrome. Precautions: Peptic ulcer; bronchial asthma, pheochromocytoma. Adverse effect: Nausea, vomiting; skin rash. Dosage: 6-12 mg tid. Supply: Tab 12 mg (Merislon), 24 mg (Nilasen) Ginkgo Biloba Extr – “Cerenin”(OCERE) “Mylin”(OMYLI) Indication: It has been used in cerebrovascular insufficiency, peripheral circulation disorder, disturbance in skin circulation and skin ulcers. Contraindication: Hypersensitivity to components of Ginkgo. Adverse effect: Adverse effects include headaches, dizziness, palpitations, gastrointestinal disturbances, and skin hypersensi-tivity reactions. Dosage: 1 tab PO TID. Supply: Tab 40 mg Piracetam – “Nootropil”(ONOO1)(INOO6)( 專 ) Indication: Age-associated cognitive impairment, supplemental therapy in cortical myoclonus. Pharmacology: Piracetam acts on the CNS and has been described as a `nootropic’; it is said to protect the cerebral cortex against hypoxia. It is also reported to inhibit platelet aggregation and reduce blood viscosity at high doses. Pharmacokinetics: High distribution in cerebrospinal fluid; not metabolized in the body; primarily excreted unchanged in the urine; Elimination Half-life: 5 to 6 hours. Contraindication: Previous hypersensitivity to piracetam, Huntington’s chorea, cerebral hemorrhage, end stage renal disease. Adverse effect: Insomnia, somnolence, weight gain, hyperkinesia, nervousness, and depression. Dosage: Cerebrovascular insufficiencies & age-associated cognitive impairment: loading dose 4.8 g daily during initial weeks of treatment; maintenance 1.2-2.4 g daily; cortical myoclonus: initially 7.2 g daily, 290 - - 291 - - increasing by 4.8 g/day every 3-4 days to a max of 24 g/day in divided doses. Supply: Tab 1200 mg; Inj 200 mg/ml, 60 ml/vial Ubidecarenone-“Neuquinon”(ONEUQ) Indication: Supplemental therapy of CHF Adverse effect: Infrequently, gastric discomfort, anorexia, diarrhea, nausea, skin rash. Dosage: 1 tab TID Supply: Tab 10 mg Glucosamine sulfate – “Viartril - S”(OVIAR) “Glucosamine”(OGLUCS) “Cuine”(OCUIN) Indication: Osteoarthritis Pharmacology: Glucosamine is an endogenous aminomonosaccharide synthesized from glucose and utilized for biosynthesis of glycoproteins and glycosaminoglycans. Glucosamine enhances cartilage proteoglycan synthesis, thereby inhibiting deterioration of cartilage brought about by osteoarthritis and helping to maintain equilibrium between cartilage catabolic and anabolic processes. Pharmacokinetics: Onset: 2-3 weeks; oral bioavailability is low (26%) due to first-pass hepatic metabolism; not protein-bound, but rather incorporates into plasma proteins; extensively metabolized in the liver to smaller molecules and ultimately to carbon dioxide, water, and urea; elimination half-life: 70 hr. Contraindication: Hypersensitivity to glucosamine Adverse effect: Peripheral edema, tachyarrhythmia, constipation, diarrhea, dyspepsia, nausea, vomiting, headache, insomnia, somnolence Dosage: 500 mg ORALLY 3 times per day Supply: Cap 250 mg (Viartril-S contains sodium choride 64 mg) Octreotide-“Sandostatin”(ISAND) “Octide” (IOCTI) ［ B ］ Indication: Octreotide inhibits growth hormone secretion, insulin secretion and glucagon secretion. The drug has been useful in the treatment of acromegaly, Zollinger-Ellison syndrome, VIPoma syndrome, GI endocrine tumors, secretory diarrhea, carcinoid syndrome. Contraindication: Hypersensitivity to octreotide. Octreotide should be used with caution in patients who are diabetic. Patients on prolonged therapy should be monitored periodically for the presence of gallstones since octreotide can produce bile stasis. Octreotide can alter absorption of dietary fats, therefore, patients should be monitored periodically for evidence of fat malabsorption (quantitative 72-hour fecal fat and serum carotene) during extended therapy Adverse effect: Nausea is the most frequent side effect. Other side effects include diarrhea, transient dizziness, steatorrhea, rebound hypergastrinemia. Dosage: 50-100 μg SC BID or TID. Repeated injections at the same site in short periods of time should be avoided. Supply: Inj 0.1 mg/ml/amp Ursodeoxycholic acid-“Ursolic” (OURSO) ［ B ］ Indication: Ursodesoxycholic acid is a bile acid that is used in the dissolution of cholesterol gallstones. Contraindication: Calcified cholesterol stones, radiopaque stones, or radiolucent bile pigment stones, allergy to bile acids. Ursodeoxycholic acid should not be administered to patients with chronic liver disease, peptic ulcers, or inflammatory bowel disease. Adverse effect: Ursodeoxycholic acid may cause nausea, vomiting, and other gastrointestinal disturbances but diarrhoea is reported to occur less frequently than with chenodeoxycholic acid. Increased liver enzyme values are also less likely. Pruritus may occur. Dosage: 8 to 13 mg/kg/day Supply: Tab 100 mg Silymarin-“Sirin” (OSIL3)“Silygen-H”(OSILY) Indication: Chronic persistent & chronic active hepatitis, 290 - - 291 - - increasing by 4.8 g/day every 3-4 days to a max of 24 g/day in divided doses. Supply: Tab 1200 mg; Inj 200 mg/ml, 60 ml/vial Ubidecarenone-“Neuquinon”(ONEUQ) Indication: Supplemental therapy of CHF Adverse effect: Infrequently, gastric discomfort, anorexia, diarrhea, nausea, skin rash. Dosage: 1 tab TID Supply: Tab 10 mg Glucosamine sulfate – “Viartril - S”(OVIAR) “Glucosamine”(OGLUCS) “Cuine”(OCUIN) Indication: Osteoarthritis Pharmacology: Glucosamine is an endogenous aminomonosaccharide synthesized from glucose and utilized for biosynthesis of glycoproteins and glycosaminoglycans. Glucosamine enhances cartilage proteoglycan synthesis, thereby inhibiting deterioration of cartilage brought about by osteoarthritis and helping to maintain equilibrium between cartilage catabolic and anabolic processes. Pharmacokinetics: Onset: 2-3 weeks; oral bioavailability is low (26%) due to first-pass hepatic metabolism; not protein-bound, but rather incorporates into plasma proteins; extensively metabolized in the liver to smaller molecules and ultimately to carbon dioxide, water, and urea; elimination half-life: 70 hr. Contraindication: Hypersensitivity to glucosamine Adverse effect: Peripheral edema, tachyarrhythmia, constipation, diarrhea, dyspepsia, nausea, vomiting, headache, insomnia, somnolence Dosage: 500 mg ORALLY 3 times per day Supply: Cap 250 mg (Viartril-S contains sodium choride 64 mg) Octreotide-“Sandostatin”(ISAND) “Octide” (IOCTI) ［ B ］ Indication: Octreotide inhibits growth hormone secretion, insulin secretion and glucagon secretion. The drug has been useful in the treatment of acromegaly, Zollinger-Ellison syndrome, VIPoma syndrome, GI endocrine tumors, secretory diarrhea, carcinoid syndrome. Contraindication: Hypersensitivity to octreotide. Octreotide should be used with caution in patients who are diabetic. Patients on prolonged therapy should be monitored periodically for the presence of gallstones since octreotide can produce bile stasis. Octreotide can alter absorption of dietary fats, therefore, patients should be monitored periodically for evidence of fat malabsorption (quantitative 72-hour fecal fat and serum carotene) during extended therapy Adverse effect: Nausea is the most frequent side effect. Other side effects include diarrhea, transient dizziness, steatorrhea, rebound hypergastrinemia. Dosage: 50-100 μg SC BID or TID. Repeated injections at the same site in short periods of time should be avoided. Supply: Inj 0.1 mg/ml/amp Ursodeoxycholic acid-“Ursolic” (OURSO) ［ B ］ Indication: Ursodesoxycholic acid is a bile acid that is used in the dissolution of cholesterol gallstones. Contraindication: Calcified cholesterol stones, radiopaque stones, or radiolucent bile pigment stones, allergy to bile acids. Ursodeoxycholic acid should not be administered to patients with chronic liver disease, peptic ulcers, or inflammatory bowel disease. Adverse effect: Ursodeoxycholic acid may cause nausea, vomiting, and other gastrointestinal disturbances but diarrhoea is reported to occur less frequently than with chenodeoxycholic acid. Increased liver enzyme values are also less likely. Pruritus may occur. Dosage: 8 to 13 mg/kg/day Supply: Tab 100 mg Silymarin-“Sirin” (OSIL3)“Silygen-H”(OSILY) Indication: Chronic persistent & chronic active hepatitis, 292 - - 293 - - hepatic cirrhosis, toxic-metabolic liver damage. Contraindication: No contraindications have been noted. Adverse effect: Non-toxic & dose not cause any adverse effects even on long- term administration. Dosage: 70-140 mg TID Supply: Tab 35 mg (Sirin); Cap 150 mg (Silygen-H) 299 ¡,- ¡,- ¡,- ¡,- ¸¡¸¸¸¦÷Z¸¸¡¼,¸j,_ ¸¡¸¸¸¦÷Z¸¸¡¼,¸j,_ ¸¡¸¸¸¦÷Z¸¸¡¼,¸j,_ ¸¡¸¸¸¦÷Z¸¸¡¼,¸j,_ ¯}±¸-_+g¸)¸¸j¡/¸_)){,¸¸Z¸¸¼¸¡¦_)¦ ¯ ), ¡_¦¦_j¸¦ (;,);nd;d ;;¦;u;;;¡¦¸¸,[¸¦[¸¡¸[)¸ ,[¸¦¸_¸¯¦¡j¸Z¸±¶¸¸ 2, ¸,{¸[{¸_j¸¦ (;n);;¦c cou);d;¡¦_¸¸¿_¸¦_¸jj ¸¸¸j¸¸¸¿j¸¿| ,, ¸¯¸_ (;ul¦¦nguu¦; 4, ¡¦_¸¸¸¸¸¿+¿{[j¸¦ o, ¡¦_§_¸ (¦,j;¸¸¸¸¸j¸¦ b, {|¸¸_¸¸¸_{¸,¦¡j¸¦ 7, }¸[¸¸[_jj¸¦¿¿¿¸¸j¡j¸±_'¸¸¿) ¸¦,,¿ ¸¦,,¿ ¸¦,,¿ ¸¦,,¿ ¸¦¸¿ ¸¦¸¿ ¸¦¸¿ ¸¦¸¿ _) _) _) _) ( (( (¦± ¦± ¦± ¦± ¸ ¸¸ ¸; ;; ; I_g¸¸¸ I_g¸¸¸ I_g¸¸¸ I_g¸¸¸ ¿_¸¡¸, ¿_¸¡¸, ¿_¸¡¸, ¿_¸¡¸, }du¦u) OkOS \¦f;d¦p¦n; OkOS ,0mg ) _[(gZ¸¸ ¸·{={¡¦ }mu;y¦ O¦¦m;p¦;¦d; 2mg ¡,¿ _ _|(g }¦fu;o¦ }¦fucu¦c¦do¦ 0,2omcg b _[(g }n)¦u;)¦ }m¦nop¦y¦¦¦n; 22omg ) _[(gZ¸¸ ¸·{={¡¦ }n,o¦;n ý;)fo;m¦n )000 mg ¡,¿ __[ (g _((gZ¸¸¸ }ugm;n)¦n }mo,¦c¦¦¦¦n 2o0mg + |¦uvu¦un¦c uc¦d )2omg o _[(gZ¸¡¦ }v;¦o, ýo,¦f¦o,uc¦n 400mg ¡,¿ __[ (g {±_[(g - 293 - 300 ¸¦,,¿ ¸¦,,¿ ¸¦,,¿ ¸¦,,¿ ¸¦¸¿ ¸¦¸¿ ¸¦¸¿ ¸¦¸¿ _) _) _) _) ( (( (¦ ¦¦ ¦ ±¸ ±¸ ±¸ ±¸; ;; ; I_g¸¸¸ I_g¸¸¸ I_g¸¸¸ I_g¸¸¸ ¿_¸¡¸, ¿_¸¡¸, ¿_¸¡¸, ¿_¸¡¸, }vodu;) lu)u;);;¦d; 0,omg b bb b _[(gZ¸¸ ¼ h;n;uu h;n,onu)u); )00mg b _[(gZ¸¸ ¸ h¦;ucody¦ h¦;ucody¦ omg 2 _[(gZ¸¸ ¸·{={¡¦ S;no¦o) h¦;o l,| h¦;op;o¦o¦ o mg ¡,¿_ _[(g _[[{((g ho¦;y };p¦;¦n )00mg 2 _[(g¸¡¡ |¸j¸[¿¡ (¸ |,T,|,\k ý;)fo;m¦n o00 mg ) Z¸¡¼¸¸¸ |u;d¦,;m uno)u;d l¦¦)¦u,;m )80mg ) _[(gZ¸¸ ¸·{={¡¦ h;;l;;;;; |;¦¦c;p) ýycop¦;no¦u); 2o0mg 7 _[(g¿¿¸ ¸¸{[¡j} |¸)¦¸ |;;;)u¦ P;n)o,yfy¦¦¦n 400 mg ) _[(g |¦p;o,¦n |¦p;of¦o,uc¦n 2o0mg 4 _[(g |¦u;¦nu;; |o;u)ud¦n; omg + p;;udo;p¦;d;¦n; )20mg ¡/_¸ ( _[(gZ¸¸ ¸·{={¡¦ |onc;;)u ý;)¦y¦p¦;n¦du); )8mg, ,b mg ) ¸¦,¦Z¸¸ ¸{¡¸_¼ |onco; h¦;op;o¦o¦ omg, ),2o mg ¡,¿_ _[(g _[(g |onvu¦;, \u¦p;o¦c uc¦d o00mg b _[(gZ¸¸ ¼ |o;uc);n \¦f;d¦p¦n; 20mg ) _[(g¸¡¡ |¸j¸[¿¡ (¸ |o,uu; |o;u;)un o0 mg ¡,¿_ _[(g¸{= - 294 - 301 ¸¦,,¿ ¸¦,,¿ ¸¦,,¿ ¸¦,,¿ ¸¦¸¿ ¸¦¸¿ ¸¦¸¿ ¸¦¸¿ _) _) _) _) ( (( (¦ ¦¦ ¦ ±¸ ±¸ ±¸ ±¸; ;; ; I_g¸¸¸ I_g¸¸¸ I_g¸¸¸ I_g¸¸¸ ¿_¸¡¸, ¿_¸¡¸, ¿_¸¡¸, ¿_¸¡¸, |;uv¦) |;vof¦o,uc¦n l| o00mg ¡,¿_ Z¸H¡¸{= lun,;n S;;;u)¦op;p)¦du ;; omg 2 _[(gZ¸¸ ¸·{={¡¦ l;¦copun Sk l;,);om;)¦o;p¦u n b0 mg ) _,¸¸¸¡¦ l;¦¦l; P¦nuv;;¦um h;, o0mg ¡,¿_ Z¸+_¸Z¸ ¸¼ l;pu¦¦n; Sod¦um vu¦p;ou); 200mg 2 _[(gZ¸¸ ¸·{={¡¦ l;pu¦¦n; c¦;ono Sod¦um vu¦p;ou); o00mg ) _[(gZ¸¸ ¸¸¡¦)¸{ = l¦um¦c;on ýk O¦¦c¦u,¦d; ,0mg ) _[(gZ¸¸ ¸·{={¡¦ l¦um¦n ýk O¦¦c¦u,¦d; ,0mg ) _[(gZ¸¸ ¸·{={¡¦ lo,ul;n \| lo,u,o;¦n 4mg ) _[(gZ¸¸ ¸·{=¸¡¦ lo,ul;n 2mg lo;ul;n 2mg lynuc¦;c ¦;;ud¦p¦n omg ) ¸¦|¸_[( g |f;,o; \k \;n¦ufu,¦n; Sk ,7,omg, 7o mg ) _[(gZ¸¸ ¸¸¡¦)¸{ = |ýh |)¦umlu)o¦ 400mg o _[(gZ¸¡ ¦ |ndo,un |yc¦op¦o;p¦um¦d ; o0mg 7 _[(g¿¿¸ ¸¡j |;¦c Sk |)odo¦uc b00mg ) _[(gZ¸¸ ¸·¡¦ |;p¦n |,ý };p¦;¦n )00mg 2 _[(g¸¡¡ |¸j¸[¿¡ (¸ |,;¦on k¦vu;)¦gm¦n; ),o mg ¡,¿_ _[(gZ¸¡ ¡¸_¼ - 295 - 302 ¸¦,,¿ ¸¦,,¿ ¸¦,,¿ ¸¦,,¿ ¸¦¸¿ ¸¦¸¿ ¸¦¸¿ ¸¦¸¿ _) _) _) _) ( (( (¦ ¦¦ ¦ ±¸ ±¸ ±¸ ±¸; ;; ; I_g¸¸¸ I_g¸¸¸ I_g¸¸¸ I_g¸¸¸ ¿_¸¡¸, ¿_¸¡¸, ¿_¸¡¸, ¿_¸¡¸, l;¦op¦n; Sk l;¦od¦p¦n; )0mg ) _[(gZ¸¸ ¸·{={¡¦ l;nof¦l;u); l;nof¦l;u); )00mg ¡,¿_ _[(g _[(g|¸Z ¸¡¡ l¦n)u l¦nu;);;¦d; omg 7 _[(g¿¿¸ ¸¡j lo;umu, }¦;nd;onu); 70mg 2 _[(gZ¸¸ ¸·{={¡¦ ly¦¦n P;n)o,yfy¦¦¦n; Sk 400mg ) _[(gZ¸¸ ¸·{={¡¦ Ou;);o¦oc Pun)op;u,o¦; 40mg 2 _[(g Ou;);o¬)¦m;¦;); ý;)oc¦op;um¦d; ,0mg ) _[(gZ¸¸ ¸ P;¦mp;;un O;nd;;g¦n }¦p;u,o¦um )mg ) _[(g \unu, O¦¦mu;y¦ O¦¦m;p¦;¦d; 2mg ¡,¿_ Z¸¸¼ O¦ucom¦n \,k, ý;)fo;m¦n o00 mg ) _|(gZ¸¸ ¸¸H¡ O¦ucop¦ug; ý;)fo;m¦n o00 mg ¡,¿_ _[(gZ¸¸ ¸ hunu,¦d; O¦¦c¦u,¦d; ,0mg ) _[(g hu;nu¦¦dg; l Tum;u¦o;¦n 0,2mg ) +,(_¸¸¦ |[,¸¼ ¦ndu, Sk ¦ndupum¦d; ),omg ) Z¸¸¼ ¦;mo¬20 ¦;o;o;l¦d;¬o¬mo non¦);u); ¡,¿_ Z¸¸¼ |¦n;cu; l,|, l¦nu;);;¦d; omg 7 _[(g¿¿¸ ¸¡j |¬myc¦n |¦u;¦)¦;omyc¦n 2o0mg 4 _[(g |¦udon; ýk O¦¦c¦u,¦d; ,0mg ) _[(gZ¸¸ ¸·{={¡¦ |ulu)on \ulum;)on; o00mg 2 _[(gZ¸¸ ¸ ¸}co,¬2 \S}¦l; |uco,u |)odo¦uc 400 mg ) _[(g ¸}co,¬2 \S}¦l; - 296 - 303 ¸¦,,¿ ¸¦,,¿ ¸¦,,¿ ¸¦,,¿ ¸¦¸¿ ¸¦¸¿ ¸¦¸¿ ¸¦¸¿ _) _) _) _) ( (( (¦ ¦¦ ¦ ±¸ ±¸ ±¸ ±¸; ;; ; I_g¸¸¸ I_g¸¸¸ I_g¸¸¸ I_g¸¸¸ ¿_¸¡¸, ¿_¸¡¸, ¿_¸¡¸, ¿_¸¡¸, |unpo |un;op;u,o¦; ,0mg 2 _[(g¸¡¡ |¸j¸[¿¡ (¸ |¦p¦)o; });ovu;)u)¦n 40mg 2 Z¸¡¦ |¦pun)¦y¦ l;nof¦l;u); 200mg ¡,¿_ _[(g _[(g|¸Z ¸¡¡ |¦v¦u¦ T¦lo¦on; ¡,¿_ _[(g _[(gZ¸¸ ¼ |o); l¦uvo,um¦n; mu¦;u); )00mg, o0 mg 2 Z¸¸¼ |o,o¦ Sk }ml;o,o¦ ¦yd;oc¦¦o;¦d; 7omg ) _[(gZ¸¸ ¸ |ud¦om¦¦ ýup;o)¦¦¦n; 2o mg ¡,¿_ _[(g ýudopu; hhS |¬dopu + h;n;;;u,¦d; ) _[(g|¸Z ¸¡¡ ýudopu; )2omg ý;¦)¦f;n Sk l¦c¦of;nuc ;od 7omg ) _[(gZ¸¸ ¸·{={¡¦ ý;)fo;m¦n (¬¸; ý;)fo;m¦n o00 mg ) _[(gjZ¸ ¡¼¸¸( ýT\ ý;)¦o);;,u); 2,omg 7 _[(g¿¿¸ ¸¡j ý;)o ý;)fo;m¦n o00 mg ¡,¿_ _[(g_,¸ ¸ ý;,¦)¦¦ ý;,¦¦;)¦n; ¡,¿_ _[(g ýucu¦n; O,;)¦u,¦n; omg + }¦ ¦yd;o,¦d; + ýg cu;lonu); 4 _[(gZ¸¸ ¸ \u);¦¦¦, Sk ¦ndupum¦d; ),omg ) _[(gZ¸¸ ¸¸¡¦)¸{ = - 297 - 304 ¸¦,,¿ ¸¦,,¿ ¸¦,,¿ ¸¦,,¿ ¸¦¸¿ ¸¦¸¿ ¸¦¸¿ ¸¦¸¿ _) _) _) _) ( (( (¦ ¦¦ ¦ ±¸ ±¸ ±¸ ±¸; ;; ; I_g¸¸¸ I_g¸¸¸ I_g¸¸¸ I_g¸¸¸ ¿_¸¡¸, ¿_¸¡¸, ¿_¸¡¸, ¿_¸¡¸, \;,¦um |;om;p;u,o¦; 40mg ¡,¿_ _[(g _[(g,¸¼ ¸_¼¸j¸( ,¦±÷(¸ \¦);o;)u) \¦);og¦yc;;¦n 0,bmg , ¦¦¸¯,jZ ¸¸¸¸(g \o;muco¦ p¦u; S);;cu¦¦u f;ungu¦u o |[_¦¸±, ¸¼¸_¼µ¡ ±,(g Pun)o¦oc Pun)op;u,o¦; 40mg 2 _[(gZ¸¸ ¸·{={¡¦ P;¦f¦um l¦c¦of;nuc po)u;;¦um o0mg ¡,¿_ _[(g P¦;nd¦¦ l;¦od¦p¦n; )0mg ) _[(gZ¸¸ ¸·{={¡¦ Po,o¦u l,|, Pun)op;u,o¦; 40mg 2 Z¸¡{=¸¸ ¼ P;¦mo¦u)¬\o; \o;;)¦¦;);;on; uc;)u); ¡,¿_ _[(g P;o;cu; l¦nu;);;¦d; omg 7 _[(g¿¿¸ ¸¡j P;o);u;; Punc;;¦¦pu;; 280mg 2 |¸)j¦Z¸ ¸¸¸_¼ Qu;;);un |¦o¦;;)y;um¦n; 4g \} §¸¡¸}¸, ¸¡¸}¸,, ¡¡¦ ky)mono;m P;opuf;non; )o0mg 4 _[(g Su¦u,opy;¦n Su¦fu;u¦u,¦n; o00mg 2 _[(gZ¸¸ ¸·{={¡¦ Sund¦mmun |yc¦o;po;¦n; 2omg, )00mg b _[(g S;g¦o; ;;)u;d l¦¦yd;o;;go)um¦ n; omg ) _[(gZ¸¸ ¸·{={¡¦ S;;o,u) Pu;o,;)¦n; 20mg ¡,¿_ ¿¡(g_,¸ ¸ - 298 - 305 ¸¦,,¿ ¸¦,,¿ ¸¦,,¿ ¸¦,,¿ ¸¦¸¿ ¸¦¸¿ ¸¦¸¿ ¸¦¸¿ _) _) _) _) ( (( (¦ ¦¦ ¦ ±¸ ±¸ ±¸ ±¸; ;; ; I_g¸¸¸ I_g¸¸¸ I_g¸¸¸ I_g¸¸¸ ¿_¸¡¸, ¿_¸¡¸, ¿_¸¡¸, ¿_¸¡¸, S;)¦n; l,|, Pu;o,;)¦n; 20mg ¡,¿_ ¿¡(g_,¸ ¸ S¦ow¬| Po)u;;¦um c¦¦o;¦d; b00mg ) _[(gZ¸¸ ¸·{={¡¦ Spu;mo¬|uv;;n¦¦ Su¦fucu;lum¦d; o00 mg.P¦;nu,opy;¦d ¦n; o0 mg ¡,¿_ _¦[{(( ¸Z¸¸¸ Spo;uno, ¦);uconu,o¦; )00mg ¡,¿_ _[(g _[(g S)uccu¦n; Su¦cu¦n; )00mg + po¦ymugu¦ )00mg 4 _[(gZ¸¸ ¸ Sup;;oc¦n |¦p;of¦o,uc¦n 2o0mg 4 _[(g Tu¦;p;on Ol |un;op;u,o¦; ,0mg ¡,¿_ +,((¸±; (¸j¸,¦± ÷()o mg ¦ 4m¦;,0 mg ¦)0 m¦; Tum;o Sk Tum;u¦o;¦n 0,2mg ) _[(gZ¸¸ ¸|¸¸¡¡) Z¸¡¦ Tupu¦ };p¦;¦n )00mg o _[(gZ¸¡ ¦)¸{= T;g;;)o¦ |k |u;lumu,;p¦n; 200mg ) _[(gZ¸¸ ¸¸¡¦)¸{ = T¦o¦n T¦;op¦y¦¦¦n; 2o0mg ) _[(gZ¸¸ ¸|¸¸¡¡) Z¸¡¦ T¦;oug¦ S;nno;¦d; 20mg 2 _[(gZ¸¸ ¸·{={¡¦ S;no¦o) Topumu, Top¦;umu); 2omg, )00mg ¡,¿_ _[(g _[(gZ¸{ ¡ - 299 - 306 ¸¦,,¿ ¸¦,,¿ ¸¦,,¿ ¸¦,,¿ ¸¦¸¿ ¸¦¸¿ ¸¦¸¿ ¸¦¸¿ _) _) _) _) ( (( (¦ ¦¦ ¦ ±¸ ±¸ ±¸ ±¸; ;; ; I_g¸¸¸ I_g¸¸¸ I_g¸¸¸ I_g¸¸¸ ¿_¸¡¸, ¿_¸¡¸, ¿_¸¡¸, ¿_¸¡¸, T;umu¦ Sk T;umudo¦ )00mg ) _[(gZ¸¸ ¸¸¡¦)¸{ = T;;n)u¦ P;n)o,yfy¦¦¦n; Sk 400mg ) _[(gZ¸¸ ¸·{={¡¦ lfu; l;uc¦¦ 224mg + );gufu; )000mg 7 _[(g l);og;;)un P;og;;);;on; )00mg b _[(g \;;;¦un \;;upum¦¦ Sk )20mg ) _[(g¸¡¡ |¸j¸[¿¡ (¸ \o;;n |ý| l¦c¦of;nuc ;od¦um o0mg 2 _[(g¸¡¡ |¸j¸[¿¡ (¸ W;¦¦lu);¦n Sk hup;op¦on )o0mg ) _[(gZ¸¸ ¸·{={¡¦ \un)¦¦um T¦;op¦y¦¦¦n; 400mg ) _[(gZ¸¸ ¸|¸¸¡¡) Z¸¡¦ \u);u¦ \| }¦fu,o;¦n )0mg ) _[(gZ¸¸ ¸·{={¡¦ /oco; S¦mvu;)u)¦n 40 mg ¡,¿_ Z¸H¡(¸ÿ ¸:)0 m¦ ¸¡¸ ¸_,¸ S¦mvu)¦n 20mg /ylun Sk hup;op¦on )o0mg ) _[(gZ¸¸ ¸·{={¡¦ Sou;c;;· ), Tu¦;)omo, P;d¦u);¦c lo;ug; hundloo¦ o )¦ ;d 2, ý¦c;om;d;, h;u¦)¦cu;; S;;¦;; ,, ¡,¸[ - 300 - 307 ¡,. ¡,. ¡,. ¡,. ¿j¸,,_ ¿j¸,,_ ¿j¸,,_ ¿j¸,,_ s/N ,¿¿| ,¿¿| ,¿¿| ,¿¿| ,¸,,$ ,¸,,$ ,¸,,$ ,¸,,$( (( (_¬¡ _¬¡ _¬¡ _¬¡ ± ±± ±· ·· ·¸» ¸» ¸» ¸»; ;; ; ¸ÿ ¸ÿ ¸ÿ ¸ÿ. .. . ¸± ¸± ¸± ¸± ¸¸ ¸¸ ¸¸ ¸¸ ( (( (_¬_» _¬_» _¬_» _¬_»; ;; ; ¸(¸_ ¸(¸_ ¸(¸_ ¸(¸_ j(¸ j(¸ j(¸ j(¸ A. Adrenergic agonist 1 Adrenalin 1mg/1mL/amp (Epinephrine) _[___|j_ ex. Sodium bicarbonatenitrates 2 Dobuject 250mg/5mL/ amp (Dobutamine) ¸IVAC __[IV ¡_ _IVF ¡¸ 2-20 mcg/kg/min __ 2-7.7mcg/kg/min ¡____¸_,_j _ __¸¸____j_ __)_]¯_ 3 Dopamine 200mg/5mL/ amp ¸IVAC __[IV ¡_ _IVF ¡¸ Shock 2-20mcg/kg/min Max.50mcg/kg/min Refractory CHF 0.5-2 mcg/kg/min, Max.3mcg/kg/min Ch. 0.3-25 mcg/kg/min __¸¸______ )_]¯___¡_ ¸ 4 Ephedrine 25mg/1mL/ amp IV: 5-10min (10-25mg) Max dose: 150mg/day 5 Levophed 4mg/4mL/amp (Norepinephrine) ¸¸___j_·¸ ¸¸__¸¸ _¸_¸. ¡¸: initial 8-12mcg/min, maintain 2-4 mcg/min. Max.68mg/day prn. __: initial 0.1mcg/kg/min or 2mcg/min - 301 - 308 s/N ,¿¿| ,¿¿| ,¿¿| ,¿¿| ,¸,,$ ,¸,,$ ,¸,,$ ,¸,,$( (( (_ __ _ ¬¡± ¬¡± ¬¡± ¬¡±· ·· ·¸» ¸» ¸» ¸»; ;; ; ¸ÿ ¸ÿ ¸ÿ ¸ÿ. .. . ¸± ¸± ¸± ¸± ¸¸ ¸¸ ¸¸ ¸¸ ( (( (_¬_» _¬_» _¬_» _¬_»; ;; ; ¸(¸_ ¸(¸_ ¸(¸_ ¸(¸_ j(¸ j(¸ j(¸ j(¸ A. Adrenergic agonist cont’d 6 Yutopar 50mg/5mL/amp (Ritodrine) _¸¸ controlled infusion device ___¸¸¸_]¸ 12hr _¡___¿_ __¡ ¸___]__[_ _¸¸¸¸¸¸¿¸ D5Wj] Initially 50-100 mcg/min, increased by 50mcg/min q10min, the effective dosage is usually 15-350mcg/ min. IV infusion rate should not exceed 350mcg/min. 7 Proternol-L 2mg/mL (Isoproterenol) _[___|j __¡___ ___¸ _¸¸__¸__j _¡_]¯_¸¸ Initially0.1mcg/kg/min , increased by 0.05mcg/kg/min q15-20min the effective dosage is usually 0.1-1mcg/kg/ min . IV infusion rate should not exceed 0.08-1.7mcg/min. B. Adrenergic antagonist 8 Brevibloc 100mg/10mL/vial (Esmolol) ¡______ ¸ ¦V[ [¸ ;¡[(,;z¡ p(qp; __¸¸__¡__ ___¸_¡¡_ _____¡_ _____ Loading : 0.5mg/kg/min for 1min or 1mg /kg over 30 sec Maintenance : 0.05-0.3mg/kg/min Atropine, Iso- proterenol , glucagon 9 Trandate 25mg/5mL (Labetalol) IV push or IV infusion ¡_ ¸¿_¸__¸_¡ __ Hypertensive encephalopathy: slow continuous infusion, 50-200 mg at 2 mg/ min; MAX total dose, 300 mg IV C. NSAID ¡_¡ ¡_¡ ¡_¡ ¡_¡ 10 Kallpain j[_¸_]¸ ¸¸_____¡_ _¸¸_¸¸¸_¸ __ 120mg/day ¡__¸,¸__¸ _,¯__¸¸ Epineph- rine; methyl- prednisolo ne; anti- histamine - 302 - 309 s/N ,¿¿| ,¿¿| ,¿¿| ,¿¿| ,¸,,$ ,¸,,$ ,¸,,$ ,¸,,$( (( (_ __ _ ¬¡± ¬¡± ¬¡± ¬¡±· ·· ·¸» ¸» ¸» ¸»; ;; ; ¸ÿ ¸ÿ ¸ÿ ¸ÿ. .. . ¸± ¸± ¸± ¸± ¸¸ ¸¸ ¸¸ ¸¸ ( (( (_¬_» _¬_» _¬_» _¬_»; ;; ; ¸(¸_ ¸(¸_ ¸(¸_ ¸(¸_ j(¸ j(¸ j(¸ j(¸ 11 Keto 30mg/mL/amp (Ketorolac) j[_¸_]¸ ¸¸_____¡_ _¸¸_¸¸¸_¸ __ 120mg/day ¡__¸,¸__¸ _,¯__¸¸ Epineph- rine; methyl- prednisolo ne; anti- histamine D. Narcotics/opiates ¡_¡_,__ ¡_¡_,__ ¡_¡_,__ ¡_¡_,__ 12 Codeine phosphate 30mg/tab ¡___j] __¸¸_¸¡_ ¡¸5q_/|_,z,z; __¦q_/|_/,z,z ¸_¸¸¸___j ] Naloxone 13 Demeral 50mg/mL/amp (Meperidine) ¡___j] ¯_¸¸¡_¸¸¸ ¸_¡_]____ ¸¯__IV ¡_ __9q_/|_/, ; ¡¸¦50 q_/,z,z ¸_¸¸¸___j ] Naloxone 14 Fentanyl 0.1mg/2mL/ amp ¡___j] over 1-2min __¸ qz_/|_/,z,z ; ¡¸¦ qz_/|_/,z,z ¸_¸¸¸___ j] Naloxone 15 Morphine 10mg/mL/amp ¡___j] 1.¸_¸¸¸___ j] 2.ICP _) ¡¸,¸0q_/,z,z __,¦5q_/,z,z Naloxone 16 Morphine 10mg/tab ¡___j] ¸_¸¸¸___j ] 180mg/day Naloxone E. Sedatives ¡_¡ ¡_¡ ¡_¡ ¡_¡ 17 Dormicum 5mg/1mL/amp (Midazolam) ¡__¡¸__ ¸ IV 5mg/dose ___2 ¸_ ¡¸ 5mg/dose __ 18mcg/kg/min Flumazenil 18 Diazepam 10mg/2mL (Diazepam) 1. _[[_¡__ j_¸KCL 2. _¸¸_¸¡¸ _¦__¸_ Do not administer IV diazepam at rates exceeding 5 mg/min. Flumazenil 19 Neuropam 2mg/mL/amp (Lorazepam) ¡_¸j[IV ¡_ _IM; IV IV rate ¯¸__ 2mg/min ¡¸4mg/dose __0.3mg Flumazenil - 303 - 310 s/N ,¿¿| ,¿¿| ,¿¿| ,¿¿| ,¸,,$ ,¸,,$ ,¸,,$ ,¸,,$( (( (_ __ _ ¬¡± ¬¡± ¬¡± ¬¡±· ·· ·¸» ¸» ¸» ¸»; ;; ; ¸ÿ ¸ÿ ¸ÿ ¸ÿ. .. . ¸± ¸± ¸± ¸± ¸¸ ¸¸ ¸¸ ¸¸ ( (( (_¬_» _¬_» _¬_» _¬_»; ;; ; ¸(¸_ ¸(¸_ ¸(¸_ ¸(¸_ j(¸ j(¸ j(¸ j(¸ F. ¸¸¸¡_¡ ¸¸¸¡_¡ ¸¸¸¡_¡ ¸¸¸¡_¡ 20 Calglon 100mg/10mL/ Amp (Calcium gluconate) ¡__]_¸ _IV, IVF ¯¸_¡__¯¡ _IV ¡_¸¸¸3-5 ¸_IVF ¯__ 0.7-1.5mEq/min ¸__, ;00q_/|_/,; ¸___ _,500q_/|_/,; ¡¸,¦5000q_/, 21 KCL 15% 5mL/amp (Potassium chloride) _IVF _IVF _j]__¸¡_, ¸¸____40q[¸/[ ¸¸¡___ 40mEq/hr G. ____¡_¡ ____¡_¡ ____¡_¡ ____¡_¡ 22 Aminophylline 250mg/10mL/ amp ¸IVAC __ _IV, IVF __¸___]¸_ _¿_¯¸ IVF rate: 25mg/min H. Neuromuscular blocking agents _¡__¡ _¡__¡ _¡__¡ _¡__¡¸ ¸¸ ¸¡_¡ ¡_¡ ¡_¡ ¡_¡¸ ¸¸ ¸ 23 Tracrium 25mg/2.5mL/ amp (Atracurium) ¸¸¸___ ¯¸IM ___¸¡_ 0,4-0,5q_/|_¦V,_¡_ ¦5-¸5 ¸_¸_[ 0,0;-0,¦q_/|_,¸__ _¡_¸____¸ ,, ¸¸___ 0.5mg/kg/dose Neo- stigmine 24 Pavulon 4mg/2mL/amp (Pancuronium) ¸¸¸___ ¯¸IM ___¸¡_ 0.04-0.1mg/kgIV,_¡ _25-60 ¸_¸_[ 0.01mg/kg,¸___¡ _¸____¸,, ¸¸___ 0.1mg/kg/dose Neo- stigmine 25 Relaxin 500mg/25mL/ vial (Succinyl- choline) ______[ _¸ ¸__ _¯¸ IVF 1. IM total dose ¯_ _150 mg 2._____¡__ ___ 150mg/dose Atropine - 304 - 311 s/N ,¿¿| ,¿¿| ,¿¿| ,¿¿| ,¸,,$ ,¸,,$ ,¸,,$ ,¸,,$( (( (_ __ _ ¬¡± ¬¡± ¬¡± ¬¡±· ·· ·¸» ¸» ¸» ¸»; ;; ; ¸ÿ ¸ÿ ¸ÿ ¸ÿ. .. . ¸± ¸± ¸± ¸± ¸¸ ¸¸ ¸¸ ¸¸ ( (( (_¬_» _¬_» _¬_» _¬_»; ;; ; ¸(¸_ ¸(¸_ ¸(¸_ ¸(¸_ j(¸ j(¸ j(¸ j(¸ I. ¸q¡ ¸q¡ ¸q¡ ¸q¡¸ ¸¸ ¸¡___¸ ¡___¸ ¡___¸ ¡___¸¸ ¸¸ ¸ 26 Recofol 200mg/20mL/amp (Propofol) j]___[¸ ¸ jY__]_j _¸¸D5W, NS ICU sedation: 5mcg/kg/min× 5min; ¸ then0.3-3mg/kg/hr or higher General anesthesia 4ml(40mg)/10sec; then 6-12mg/kg/hr ¸¿¸_ hypotension & apnea severe cardiacrespiratory disease and seizure _¸ ¸___¸¸ 27 Propofol-Lipuro 200mg/20mL/amp (Propofol) j]___[¸ ¸ jY__]_j _¸¸D5W, NS ICU sedation: 5mcg/kg/min× 5min; ¸ then0.3-3mg/kg/hr or higher General anesthesia 4ml(40mg)/10sec; then 6-12mg/kg/hr ¸¿¸_ hypotension & apnea severe cardiacrespiratory disease and seizure _¸ ¸___¸¸ 28 Marcaine 0.5% 30mL/vial (Bupivacaine) 1.6mg/kg/dose 29 Marcaine spinal heavy 0.5% 4mL/amp 1.6mg/kg/dose 30 Marcaine spinal 0.5% 4mL/amp 1.¸¸_j_¸q ___[__2.¸ ¸____ 1.6mg/kg/dose 31 Sevoflurane inha. 250mL/bot - 305 - 312 s/N ,¿¿| ,¿¿| ,¿¿| ,¿¿| ,¸,,$ ,¸,,$ ,¸,,$ ,¸,,$( (( (_ __ _ ¬¡± ¬¡± ¬¡± ¬¡±· ·· ·¸» ¸» ¸» ¸»; ;; ; ¸ÿ ¸ÿ ¸ÿ ¸ÿ. .. . ¸± ¸± ¸± ¸± ¸¸ ¸¸ ¸¸ ¸¸ ( (( (_¬_» _¬_» _¬_» _¬_»; ;; ; ¸(¸_ ¸(¸_ ¸(¸_ ¸(¸_ j(¸ j(¸ j(¸ j(¸ J. Penicillin _¡_¡ _¡_¡ _¡_¡ _¡_¡ 32 Ampolin 500mg/vial (Ampicillin) 33 Ansullina 1500mg/vial (Ampicillin/ Sulbactam) __ 100-200mg/kg/ day 34 Augcin 1.2g/vial (Amoxicillin/ Clavulanic acid) 35 Amoclavunin 0.6g/vial (Amoxicillin/ Clavulanic acid) 36 Penicillin 3MU/vial 37 Pitamycin 2g/vial (Piperacillin) 38 Prostaphlin 500mg/vial (Oxacillin) 39 Retarpen 2.4MU/vial (Benzathine penicillin) 40 Subacillin 1500mg/vial (Ampicillin/ Sulbactam) 41 Tapimycin 2.25g/vial (Piperacillin/Tazobactam) 42 Unasyn 1500mg/vial (Ampicillin/ Sulbactam) j[_¸_]¸ 1.¸¸___|¸_ ¸____|_¸¸ _ 2.__]Penicillin skin test(____¸¸ ¸|__|,__¸] _¸_¸) 3._¸_¸__¸ _¸¡_[,¸¸__ ____¸¸¸_¸, j__¸_]¸[j j__ Epine- phrine, 100% oxygen, MTP K. Hypoglycemics 43 Insulin, regular HM 100U/mL, 10mL/vial ¡_¡___] 44 Insulin, isophane HM 100U/mL, 10mL/vial 45 Insulin Detemir Flexpen (Levemir FlexPen) 100 U/ml, 3 ml/pen 46 Insulin glargine (Lantus ) 100 U/ml, 3 ml/pen 1.¸[¸¡___]¸_ ¸¸·_j·_j·_¸· ¡_·__·¸]·__j j·_ _·__·__ 2.¸¡___][___ _¸_j_¸ 2-3 ¡¸_ ¸__¡| 3. ¸_¸__¸j__ _¸__¸[__¸j 100 units/day - 306 - 313 47 Novomix 30 penfill, 100U/mL, 3mL/vial _2-3 ¡¸_ 4. j 15 ¸__¸j__ _¸__¸[_¸j_ 2-3 ¡¸_]_¸__. 48 Amaryl 2mg/tab (Glimepiride) 8mg/day (4 _) 49 Glimaryl 2 mg/tab (Glimepiride) 8mg/day (4 _) 50 Kludone MR 30mg/tab (Gliclazide) 320mg/ day (10.66 _) 51 Diamicron MR 30 mg/tab (Gliclazide) 320mg/ day (10.66 _) 52 Diamin MR 30 mg/tab (Gliclazide) 320mg/ day (10.66 _) 53 Diabitin 5mg/tab (Glibenclamide) 20mg/day (4 _) 54 Minidiab 5mg/tab (Glipizide) 40mg/day (8 _) 55 Diabetrol SR 10mg/tab (Glipizide) 20mg/day(2 _) 56 Novonorm 1mg/tab (Repaglinide) 16mg/day 57 Supernide 1mg/tab (Repaglinide) ¡_¡___] 1.¸[¸¡___]¸_ ¸¸·_j·_j·_¸· ¡_·__·¸]·__j j·_ _·__·__ 2.¸¡___][___ _¸_j_¸2-3 ¡¸_ ¸__¡| 3. ¸_¸__¸j__ _¸__¸[__¸j _2-3 ¡¸_ 4.j15 ¸__¸j__ _¸__¸[_¸j_ 2-3 ¡¸_]_¸__. 16mg/day 58 Glucobay 50mg/tab (Acarbose) ¡_¡___] ¡__[___¸¸_¸ (_¡¸_¡|);¸¦ insulin ¸,_j___¡ ¸_¯¸__6 _ 300mg/day 59 Antigluco 850mg/tab (Metformin) ¸¦ insulin ¸,_j__ _¡¸_¯¸__3,5 _ 2550mg/day 60 Anxoken 1000mg/tab (Metformin) ¡_¡___] 2500mg/day - 307 - 314 s/N ,¿¿| ,¿¿| ,¿¿| ,¿¿| ,¸,,$ ,¸,,$ ,¸,,$ ,¸,,$( (( (_ __ _ ¬¡± ¬¡± ¬¡± ¬¡±· ·· ·¸» ¸» ¸» ¸»; ;; ; ¸ÿ ¸ÿ ¸ÿ ¸ÿ. .. . ¸± ¸± ¸± ¸± ¸¸ ¸¸ ¸¸ ¸¸ ( (( (_¬_» _¬_» _¬_» _¬_»; ;; ; ¸(¸_ ¸(¸_ ¸(¸_ ¸(¸_ j(¸ j(¸ j(¸ j(¸ K. Hypoglycemics cont’d 61 Glucophage 500mg/tab (Metformin) 2550mg/day 62 Glucomin XR 500mg/tab (Metformin) 2000mg/day 63 C.T.L XR 500mg/tab (Metformin) 2000mg/day 64 Metformin 500mg/tab (Metformin) ¡_¡___] ¸¦insulin ¸,_j__ _¡¸_¯¸__( _ 2000mg/day 65 GlucoMet F.C. (Metformin HCI 500mg+Glyburide 5mg) ¡_¡___] MAX:4 tab 66 Actos 30mg/tab (Pioglitazone) 45mg/day 67 Diazone 15mg/tab (Pioglitazone) ¡_¡___] 1.¸¦insulin ¸,_j_ __¡¸_¯¸__2 _ 2.¸¸¿¸¸·__¸·_ _¸¸¯__¸¸ 3.¸¸¿¸¸_¸_2.5 ¡·__¸ functional class III·IV ¸¸_¸¸¸ 45mg/day 68 Avandia 4mg/tab (Rosiglitazone) ¡_¡___ ¸¦insulin ¸,_j__ _¡¸_¯¸__2 _ 8mg/day L. Chemotherapeutic agents 69 Androcur 50mg/tab (Cyproterone Acetate) _¸¸ _¸¸ ¸ __¸_¸¸¿·¡__ _¸¸¿___]_ 70 Bleocin 5mg/amp (Bleomycin) j[IV ¡_ ¡_4-5_[¸¿_¸_ _¸_ 71 Casodex 50mg/tab (Bicalutamide) _¸¸ ¸__ __ ¸_¸__¸¸¿¸¿ __j¸¸ 72 Endoxan-Asta 200mg/vial (Cyclophosphamide) j[IV ¡_ _¸¸_ ____[¸_ 40-50mg/kg/ day 73 Endoxan 50mg/tab (Cyclophosphamide) 1-5mg/kg/day - 308 - 315 s/N ,¿¿| ,¿¿| ,¿¿| ,¿¿| ,¸,,$ ,¸,,$ ,¸,,$ ,¸,,$( (( (_ __ _ ¬¡± ¬¡± ¬¡± ¬¡±· ·· ·¸» ¸» ¸» ¸»; ;; ; ¸ÿ ¸ÿ ¸ÿ ¸ÿ. .. . ¸± ¸± ¸± ¸± ¸¸ ¸¸ ¸¸ ¸¸ ( (( (_¬_» _¬_» _¬_» _¬_»; ;; ; ¸(¸_ ¸(¸_ ¸(¸_ ¸(¸_ j(¸ j(¸ j(¸ j(¸ L. Chemotherapeutic agents cont’d 74 Epirubicin 10mg/vial (Pharmorubicin) j[IV ¡_ 75 Fuprostate 250mg/tab (Flutamide) ¯__ ¸¸¸ ¸ ____¸_¸_¸¸ _ 76 5-Fluorouracil 1g/vial j[IV ¡_ j]_¸8 _[ ¡¸_ MAX:1g/ day 77 Gemzar 200mg/vial (Gemcitabine) j[IV ¡_ ___¸__¸ 15-30(¡¸. 24hr ¡¸_ 1. ___40mg/ml j ___¸_ 2. infusion time ¸__60 ¸_.¡ __,¸¸¸¡_¸ j_]_¸_ 1000mg/m 2 over 30 min IVF 78 Irino 100mg/vial (Irinotecan) j[IV ¡_,j ]__¸12 _ [¡¸¸ ¸·¡¸¿¯_¸¸__ _¸¸ 79 Methotrexate 50mg/2mL/vial j[IV ¡_ ¡¸¿¯__¸¡¡_ 50mg/m 2 Hydration, Leuco- vorin 80 Mitomycin-C Kyowa 10mg/vial j[IV ¡_ 20mg/ m 2 81 Oxalip 50mg/vial (Oxaliplatin) j[IV ¡_ ¯¸[N/S ¸_ ¸_¡__j_ 82 Platinex 50mg/vial (Cisplatin) j[IV ¡_ Adequate hydration before and for 24hrs after therapy 300mg/m 2 83 Tamoplex 10mg/tab (Tamoxifen) ¸¸¯_¸__ ____[]_ 84 Ufur cap (Tegafur 100mg + uracil 224mg) _¸___¸__¸_ ¿_¸¸__¸¿_ __¸_¸¸¿ M. Dextrose, hypertonic 20% or greater 85 Dextrose 50% 20mL/amp Use at a rate of 3mL/min - 309 - 316 s/N ,¿¿| ,¿¿| ,¿¿| ,¿¿| ,¸,,$ ,¸,,$ ,¸,,$ ,¸,,$( (( (_ __ _ ¬¡± ¬¡± ¬¡± ¬¡±· ·· ·¸» ¸» ¸» ¸»; ;; ; ¸ÿ ¸ÿ ¸ÿ ¸ÿ. .. . ¸± ¸± ¸± ¸± ¸¸ ¸¸ ¸¸ ¸¸ ( (( (_¬_» _¬_» _¬_» _¬_»; ;; ; ¸(¸_ ¸(¸_ ¸(¸_ ¸(¸_ j(¸ j(¸ j(¸ j(¸ N. Glycoprotein IIb/IIIa inhibitors 86 Aggrastat 12.5mg/50mL/vial (Tirofiban) ¡_platelet count Initial: 0.4mcg/kg/min for 30 mins Maintenance: 0.1mcg/kg/min for 12-24 hrs O. Inotropic agents ¡_¡ ¡_¡ ¡_¡ ¡_¡ 87 Cordarone 150mg/3mL/amp (Amiodarone) ¡_[_15 ¸ ___¸¡_ _¡ ¸¿¸ D5Wj ] 2g/day, MAX IV rate 30mg/min _¸¸_¡_ ]¸·3 _j ¯¡__·¸ ¸__¡¸ 88 Lanoxin 0.5mg/2mL/amp (Digoxin) ¡¸¡_¸[_ 6 _[ IM: ]¸¸[]¯¿ IV¯_¸___ rate ¸1-5min 0.5mg/dose __¸¸__ ¡____ __¸_ ¡_¸-__ ¡¸[p 89 Lanoxin 0.25mg (Digoxin) ,__ _¸¸______j ¸__¸ 90 Primacor 10mg/10mL/amp (Milrinone) Loading dose: 50mcg/kg over 10 min Maintenance dose:0.375-0.75mcg/kg/ min P. Thrombolytic agent 91 Actilyse 50mg/50mL/vial (r-Tissue Plasminogen Activator) AMI(100mg/3hr)60mg x 1hr(of which 6-10mg over 1-2 min); then 20mg/hr x 2 hrs If BW<65kg (1.25mg/kg/3hr) 0.75mg/kg x 1hr (of which 0.045-0.075mg/kg over 1-2min) then 0.25mg/kg/hr x 2hrs. __¯j >0,5q_/q}_ __¸¸_ The total dose should not exceed 100mg - 310 - 317 s/N ,¿¿| ,¿¿| ,¿¿| ,¿¿| ,¸,,$ ,¸,,$ ,¸,,$ ,¸,,$( (( (_ __ _ ¬¡± ¬¡± ¬¡± ¬¡±· ·· ·¸» ¸» ¸» ¸»; ;; ; ¸ÿ ¸ÿ ¸ÿ ¸ÿ. .. . ¸± ¸± ¸± ¸± ¸¸ ¸¸ ¸¸ ¸¸ ( (( (_¬_» _¬_» _¬_» _¬_»; ;; ; ¸(¸_ ¸(¸_ ¸(¸_ ¸(¸_ j(¸ j(¸ j(¸ j(¸ P. Thrombolytic agent cont’d 92 Urokinase inj 6,000IU For IVF only j]¸¡¡_¸ _¯¸_[_¡ ¸¸__j] ¸¸_¸j__ _ 6000 IU/min x 2hr ¸ 93 Urokinase inj 60,000IU For IVF only j]¸¡¡_¸ _¯¸_[_¡ ¸¸__j] ¸¸_¸j__ _ 6000 IU/min x 2hr ¸ Q. Specific medications 94 Clexane 2000anti-Xa IU/0.2mL/amp (Enoxaparin) _SC ¡_¯ ¸IM 95 Millisrol 5 mg/10 ml/amp (Glyceryl trinitrate) IV infusion Stability after reconstitution: 2days at RT, 7days under refrigeration. ¸¿_¸_¡__ ¡¸: 5mcg/min increase by 5mcg/min q3-5min, upto 20mcg/min. If no responses, increase 10-20mcg/min to desired effect or appearance of headache or nausea. Max. 100mcg/min. __: 0.25-0.5 mcg/kg/min or 5mcg/min, whichever is less. Max. 5mcg/kg/min not to exceed adult dose. 96 Heparin 5000U/mL, 5mL/vial ¯¸IM¡_ Anticoagulant therapy: 100U/kg q4h Prota- mine sulphate - 311 - 318 s/N ,¿¿| ,¿¿| ,¿¿| ,¿¿| ,¸,,$ ,¸,,$ ,¸,,$ ,¸,,$( (( (_ __ _ ¬¡± ¬¡± ¬¡± ¬¡±· ·· ·¸» ¸» ¸» ¸»; ;; ; ¸ÿ ¸ÿ ¸ÿ ¸ÿ. .. . ¸± ¸± ¸± ¸± ¸¸ ¸¸ ¸¸ ¸¸ ( (( (_¬_» _¬_» _¬_» _¬_»; ;; ; ¸(¸_ ¸(¸_ ¸(¸_ ¸(¸_ j(¸ j(¸ j(¸ j(¸ Q. Specific medications cont’d 97 Isoket 10mg/10mL/amp (Isosorbide) IV infusion ¡_ 1. ¯¸¸¸¸_¡_ _¡_¸ 2. _¸¸¸_¡__ _¸ rate 1-10mg/hr 98 Magnesium sulfate inj 10% 20mL/amp IV rate should not exceed 150mg/min (¸___[ ¸) 99 Methotrexate 2.5mg/tab 50mg/day Leuco- vorin 100 Nipride 50mg/vial (Nitroprusside) To avoid thiocyanate toxicity, not to exceed 3mcg/kg/min in normal renal function, or 1 mcg / kg /min in anuric patients, and avoid prolonged therapy (>48hr). Monitor serum thiocyanate level qd, not to > 60mg/L (1mmole/L). Protect from light during infusion and discard solution after 24hr or if the color changed. Initial 0.25-0.3 mcg/kg/min, increase to an average of 3mcg/kg/min, Range 0.5-10 mcg/kg/min. Max. 10mcg/kg/min for 10min ¸ MAX 10mcg/kg/min for maximum of 10mins - 312 - 319 s/N ,¿¿| ,¿¿| ,¿¿| ,¿¿| ,¸,,$ ,¸,,$ ,¸,,$ ,¸,,$( (( (_ __ _ ¬¡± ¬¡± ¬¡± ¬¡±· ·· ·¸» ¸» ¸» ¸»; ;; ; ¸ÿ ¸ÿ ¸ÿ ¸ÿ. .. . ¸± ¸± ¸± ¸± ¸¸ ¸¸ ¸¸ ¸¸ ( (( (_¬_» _¬_» _¬_» _¬_»; ;; ; ¸(¸_ ¸(¸_ ¸(¸_ ¸(¸_ j(¸ j(¸ j(¸ j(¸ Q. Specific medications cont’d 101 Nitrostat 0.6mg (Nitroglycerin) _¯_ NTG _|¸_¡_¡_ ]¿____¸¸¸¿ ¸¸¸ 102 Orfarin 5mg (Coumadin) 1. Monitor international normalized ratio (INR) or prothrombin time (PT). 2. Monitor hemoglobin and hematocrit if bleeding occurs. 103 Sodium bicarbonate 70mg/mL _IV_[ Dobutamine j _ ¡___flush iv line ¸_¸_¸_¸][ ¡]¸__¯_¸_ _¸¸ hypertonic: _¸W¸ D5Wj]_1.5% (isotonic) rate over 1-2min 104 Sodium chloride 3% 500mL/bag Hypertonic soln Sources: Institute for Safe Medication Practices JCAHO (Joint Commission on Accreditation of Healthcare Organization) Package insert - 313 - 320 ¸_|})(}¿j¡,_ ¸_|})(}¿j¡,_ ¸_|})(}¿j¡,_ ¸_|})(}¿j¡,_ s/N _¸¸j _¸¸j _¸¸j _¸¸j __¡_ __¡_ __¡_ __¡_ 1 Acetaminophen 500mg/tab 6-12 yr: 2.6 g/day 3-6 yr: 720 mg/day 2 Acetaminophen syrup 24mg/mL, 60mL/bot 6-12 yr: 2.6 g/day 3-6 yr: 720 mg/day 3 Acetaminophen+Phenylpropanolamine+Phenyltoloxamine 300 mg+25 mg+22 mg/tab(Rhin) Phenylpropanolamine 75 mg/day 4 Carbinoxamine 4 mg+Pseudoephedrine 60 mg/tab (Rotec) Pseudoephedrine—2-5 yr: 60 mg/day 6-12 yr: 120 mg/day 5 Lactul liquid 333gm/500ml/bot (Lactulose) ¸_ (2mth – 1yr): 10mL/day; __ (1-12 yr): 90mL/day 6 Procaterol liquid 5mcg/mL, 60mL/bot (Meptin) 0.25mL/kg/day 7 Nystatin susp 100,000U/mL, 24mL/bot (Mycostatin) 8mL/day 8 Cyproheptadine 0.4mg/mL, 60mL/bot (Periactin) 1mL/kg/day 9 Aspirin 100 mg/tab (Tapal) 60-80 mg/kg/day 10 Cetirizine 10 mg/tab (Cetimin), 0.1% 60ml/bot (Zyrtec) 10 mg/d 11 Loratadine 10 mg/ta (Genadine) 2-6yr:5mg/d 12 Cyproheptadine 4mg/tab (Periactin) 0.4mg/kg/day 13 Metoclopramide 5mg (Primperan) 0.5mg/kg/day 14 Procaterol 25 mcg/tab (Meptin) 1.25 mcg/kg/d 15 Xanthium 400mg (Theophylline) <1yr: (0.3 x age in weeks) + 8 mg/kg/day <45kg: 12-24mg/kg/day MAX 600mg/day - 314 - 321 [_¸ [_¸ [_¸ [_¸ ¸____¸ ¸____¸ ¸____¸ ¸____¸ _ __ _ _ __ _ _ ¸ ¸ j _ ¸ ¸ j _ ¸ ¸ j _ ¸ ¸ j ¡ ¸ ¡ ¸ ¡ ¸ ¡ ¸ ¯_ ¯_ ¯_ ¯_ j¸¡] j¸¡] j¸¡] j¸¡] 1 Engerix-B 20mcg/mL Adsorbed purified surface antigen protein of Hepatitis B virus Vial 2˚C - 8˚C 2 Infanrix-IPV+HIB 0.5mL Diphtheria toxoid, tetanus toxoid, pertussis toxoid, inactivated polio virus, purified capsular polysaccharide of Haemophilus influenzae B Syr 2˚C - 8˚C 3 Pneumovax 23 25mcg/0.5mL Capsular polysaccharides from the 23 most prevalent of invasive pneumococcal types Vial 2˚C - 8˚C 4 Prevenar 0.5mL Pneumococcal saccharide conjugated vaccine Syr 2˚C - 8˚C 5 Tetanus Toxoid Alum Precipitated 10Lf/mL, 1mL Tetanus Toxoid Vial 2˚C - 8˚C 6 Garadasil 0.5ml Quadrivalent Human Papillomavirus (types 6, 11, 16, 18) Syr 2˚C - 8˚C 7 Fluvirin Influenza Vaccine Syr 2˚C - 8˚C 8 Pediacel Diptheria and Tetanus Toxoids and Acellular Pertussis Vaccine Adsorbed Combined with Inactivated Poliomyelitis Vaccine and Haemophilus b Conjugate Vaccine Vial 2˚C - 8˚C - 315 - 322 ¡,v ¡,v ¡,v ¡,v ¸¡y¿});¸¸¸)¡[¦¸¡¿¿,{¡¸¦ ¸¡y¿});¸¸¸)¡[¦¸¡¿¿,{¡¸¦ ¸¡y¿});¸¸¸)¡[¦¸¡¿¿,{¡¸¦ ¸¡y¿});¸¸¸)¡[¦¸¡¿¿,{¡¸¦ _ _ ¸ ¦ ¿¿,{¡¸¦ ¿_¸,{¡,¸ 1 Acyclovir (Zovirax 250mg) Dobutamine, dopamine, aztreonam, cefepime, morphine, ondansetron, piperacillin sod-tazobactam sod D5W, NaCl 0.9% 2 Adenosine (Adenocor 6mg/2mL) ¸¸[ D5RL, D5W, RL, NaCl 0.9% 3 25%Albumin 50mL Midazolam, vancomycin NaCl 0.45&0.9%, R, RL, D5W, D10W 4 Amikacin (Aminfec250mg/2mL) Amphotericin B, ampicillin, cefazolin, heparin, hetastarch, phenytoin, propofol, vitamin B complex with C D5W, D10W, D5NaCl 0.2 & 0.9%, NaCl 0.45 & 0.9%, D5R, D5RL, R, RL 5 Aminophylline 250mg/10mL Ascorbic acid, atracurium, amiodarone, cefepime, ceftazidime, ceftriaxone, ciprofloxacin, clindamycin, dobutamine, epinephrine, hydralazine, isoproterenol, meperidine, morphine, norepinephrine, ondansetron, prochlorperazine, RI D5W, D5NaCl 0.2 & 0.9%, NaCl 0.45 & 0.9%, R, RL, D5RL 6 Amiodarone (Cordarone150mg/3mL) Aminophylline, heparin, NaHCO3 D5W 7 Amphotericin B (Fungizone 50mg) Amikacin, aztreonam, Ca. gluconate, cefepime, cefpirome, cimetidine, diphenhydramine, dopamine, filgrastime, gentamicin, lidocaine, MgSO4, meropenem, penicillin G sodium, piperacillin sod-tazobactam sod, KCL, prochlorperazine, propofol, ranitidine D5W, D10W, D5NaCl 0.2% 8 Ampicillin sod 1000mg-Sulbactam 500mg (Unasyn 1.5g; Ansullina 1.5g; Subacillin¸ Ciproxin, ondansetron NaCl 0.9% 9. Ascorbic acid 100mg/2mL Sod. Bicarbonate, theophylline, cefazolin D5NaCl 0.45%, D5W, D10W, R, RL, NaCl 10 Ampicillin 500mg Amikacin, dopamine, epinephrine, erythromycin lactobionate, fluconazole, gentamicin, hydralazine, metoclopramide, midazolam, ondansetron, prochlorperazine NaCl 0.9% - 316 - 323 _ _ ¸ ¦ ¿¿,{¡¸¦ ¿_¸,{¡,¸ 11 Atracurium (Tracrium25mg/2.5mL) Aminophylline, cefazolin, diazepam, heparin, nitroprusside, propofol, ranitidine D5W, D5NaCl 0.9%, NaCl 0.9% 12 10% Calcium gluconate AmphotericinB, dobutamine, fluconazole, indomethacin, methylprednisolone, metoclopramide D5RL, D5NaCl 0.9%, D5W, D10W, RL, NaCl 0.9% 13 Cefazolin (Veterin 500mg Winzolin 1000mg) Amikacin, ascorbic acid, atracurium, cimetidine, lidocaine, ranitidine, vitamin B complex with C D5RL, D5NaCl 0.20.45 & 0.9%, D5W, R, RL, NaCl 0.9% 14 Cefepime HCL (Maxipime500mg, Antifect 1000mg) Acyclovir, aminophylline, amphotericin B, cimetidine, ciprofloxacin, diazepam, diphenhydramine, dobutamine, dopamine, famotidine, filgrastim, ganciclovir, gentamicin, haloperidol, MgSO4, mannitol, meperidine, metoclopramide, morphine, netilmicin, ondansetron, prochlorperazine, tobramycin D5RL, D5NaCl 0.9%, D5W, D10W, NaCl 0.9% 15 Cefoxitin (Lofatin1gm) Filgrastim, hetastarch, ranitidine D5W, D10W, D5NaCl 0.2 ,0.45& 0.9%, NaCl 0.9%, R, RL, D5RL 16 Ceftazidime (Sintum 1gm) Aminophylline, fluconazole, midazolam, ranitidine, warfarin D5NaCl 0.2 0.45&0.9%, D5W, D10W, R, RL, NaCl 0.9% 17 Ceftriaxone (Rocephin 500mg; Sintrix 1gm) Aminophylline, clidamycin, filgrastim, fluconazole, labetalol, vancomycin D5W, D10W, RL, NaCl 0.9% 18 Cefuroxime (Cefuroxime 750mg) Gentamicinsulfate, RanitidineHCl , DoxapramHCl ,Cisatracuriumbesylate, Clarithromycin ,Filgrastin , Fluconazole , Midazolam HCl , Vancomycin HCl , Vinorelbine tartrate D5W,NaCl 0.9% 19 Chloramphenicol(Chlora mphenicol 1000mg) Chlorpromazine,Hydroxyzine, PolymyxinB,Prochlorperazine , Prochlorperazine ,Promethazine, Vancomycin,Glycopyrrole, Metoclopramide,Fluconazole, D5RL,D5NaCl0.9%,D5W, D10W,R,RL,NaCl0.45%, NaCl 0.9% - 317 - 324 _ _ ¸ ¦ ¿¿,{¡¸¦ ¿_¸,{¡,¸ 20 Ciprofloxacin (Ciproxin 200mg/100mL; Cinolone 200mg/100mL) Aminophylline, ampicillin-sulbactam, amoxicillin, cefepime, clindamycin, dexamethasone, furosemide, heparin, hydrocortisone, methylprednisolone, phenytoin, propofol, warfarin D5NaCl 0.2& 0.45 %, D5W, D10W, NaCl 0.9%, R, RL 21 Clindamycin (Clincin 300mg/2mL) Aminophylline, barbiturates, calcium gluconate, ceftriaxone, ciprofloxacin, filgrastim, phenytoin D5R, D5W, D10W, D5NaCl 0.45 & 0.9%, NaCl 0.9%, RL 22 Cyanocobalamin 1mg/1mL ¸¸[ D5W, D10W, R, RL, NaCl 0.45 & 0.9% 23 Diltiazem( Herbesser 50mg) Acetazolamide,Acyclovir,Aminophylline, Ampicillin,Cefamandole,Cefoperazone, Diazepam,Furosemide,Heparin,Insulin, Methylprednisolone,Nafcillin,Phenytoin, Rifampin,Sodium bicarbonate,Thiopental D5W,D5NaCl 0.9%, NaCl 0.9% 24 Fentanyl ¸¸[ D5W,NaCL0.9% 25 Fluconazole (Diflucan) 100mg Amphotericin B, ampicillin, Ca.gluconate, ceftriaxone, clindamycin, diazepam, digoxin, dobutamine, erythromycin, lactobionate, furosemide, gentamicin, haloperidol,imipenem-cilastatin,meperid ine, netilmicin, piperacillin, ticarcillin, trimethoprim+sulfamethoxazole D5W,D10W,RL 26 Furosemide(Lasix20mg/2 mL) Ciprofloxacin, diazepam, diltiazem, esmolol, filgrastim, fluconazole, hydralazine, isoproterenol, metoclopramide, midazolam, netilmicin, nicardipine, ondansetron, prochlorperazine, vecuronium D5RL,D5NaCL 0.9%,D5W,RL, NaCL0.9% 27 Gentamicin 80mg/2mL Amphotericin B,ampicillin,cefepime, furosemide, heparin, hetastarch,indomethacin, propofol, ticarcillin, warfarin D5W, D10W,R,RL, NaCL 0.9% - 318 - 325 _ _ ¸ ¦ ¿¿,{¡¸¦ ¿_¸,{¡,¸ 28 Haloperidol (Binin-U 5mg/mL) Cefepime, diphenhydramine, NS,fluconazole, heparin, ketorolac,morphine, piperacillin-tazobactam, Sod.nitroprusside D5W 29 Heparin (Agglutex 5000IU/ml) Amiodarone, amikacin, atracurium, ciprofloxacin, diazepam, erythromycin, lactobinate, filgrastim, gentamicin, haloperidol, meperidine, morphine, netilmicin, nicardipine, phenytoin, tobramycin, vancomycin, warfarin D5NaCl 0.45&0.9%, D5W, NaCl 0.45&0.9%, D5RL, R 30 Hydrocortisone sod.succinate (Solu-cortef 100mg) Ciprofloxacin, diazepam, midazolam, Phenobarbital, phenytoin, prochlorperazine D5R, D5RL, D5NaCL2,0.45&0.9%,R,RL, NaCL0.45%&0.9% 31 Imipenem500mg Cilastatin500mg (Tienam) Fluconazole, lorazepam, meperidine, midazolam, Sod.Bicarbonate D5NaCL0.2, 0.45&0.9%, RL,D5W,NaCL0.9% 32 Insulin Aminophylline, dopamine, dobutamine, norepinephrine, henobarbital,phenytoin, ranitidine NaCL 0.9% 33 Isoproterenol (Proternol-L 0.2mg/mL) Aminophylline,barbiturates,furosemide, Lidocaine, Sod.Bicarbonate D5RL,D5NaCL 0.9%, D5W, RL, NaCL0.45&0.9% 34 Ketorolac (Keto 30mg/mL; Killpain 30mg/mL¸ Haloperidol, prochlorperazine D5NaCl 0.9%, D5W, R, RL, NaCl 0.9% 35 Labetalol¸Trandate 25mg/5mL¸ Cefoperazone, ceftriaxone, warfarin D5R, D5RL, D5NaCl 0.2, 0.33&0.9%, D5W, R, RL, NaCl 0.9% 36 Lidocaine¸xylocaine 2%¸Cefazolin, epinephrine, isoproterenol, norepinephrine, phenytoin D5RL,D5NaCl 0.45%&0.9%,D5W,RL, NaCl 0.45%&0.9% 37 Lorazepam ¸Neuropam 2mg/mL¸ Aztreonam,mipenem-cilastatin, omeprazole, ondansetron D5W 38 Magnesium sulfate MgSO 4 Amphotericin B, cefepime, cyclosporine, Sod.bicarbonate D5W, RL, NaCl 0.9% - 319 - 326 _ _ ¸ ¦ ¿¿,{¡¸¦ ¿_¸,{¡,¸ 39 Mannitol 500mL Imipenem-cilastatin, cefepime,meropenem ¸ 40 Meperidine ¸Demerol¸ Aminophylline, cefepime, cefoperazone, furosemide, imipenem-cilastatin, heparin, morphine, phenytoin, phenobarbital D5R, D5RL, D5NaCl 0.2, 0.45&0.9%, D5W, R, RL, NaCl 0.45&0.9% 41 Meropenem ¸Mepem250mg¸ Amphotericin B, diazepam, metronidazole, multivitamins NaCl 0.9%, R, RL, D5W 42 Methylprednisolone ¸Solu-medrol 125mg¸ Ca. Gluconate, ciprofloxacin, filgrastim, RI,ondansetron, penicillin G Na , propofol D5NaCl 0.9%, D5W, NaCl 0.9% 43 Metoclopramide ¸primperan 10mg/2mL¸ Ampicillin, Ca.Gluconate, cefepime, erythromycin lactobionate, furosemide, propofol, Sod.bicarbonate D5NaCl 0.45%, D5W, R, RL, NaCl 0.9% 44 Metronidazole¸Medazole 500mg/100mL¸ Aztreonam, dopamine, filgrastim, meropenem, warfarin D5W, RL, NaCl 0.9% 45 Mirosin(Minocycline 100mg) Rifampin,Allopurinol,Amifostine, Hydromorphone,Meperidine,Morphine, Piperacillin-tazobactam,Propofol,Thiotep a D5W,NaCl 0.9%, 46 Midazolam¸Dormicum 5mg/1mL¸ Albumin, ampicillin, ceftazidime, dexamethasone, furosemide, hydrocortisone, imipenem-cilastatin, omeprazole, prochlorperazine, ranitidine, sod. Bicarbonate, trimethoprim-sulfamethoxazole D5NaCl 0.9%, D5W, NaCl 0.9% 47 Morphine 10mg/1ml Aminophylline, cefepime, haloperidol, heparin, meperidine, Phenobarbital, phenytoin, sod.bicarbonate D5R, D5RL, D5NaCl 0.2 , 0.45&0.9% , D5W, R, RL, NaCl 0.45&0.9% 48 Glyceryl trinitrate 50mg/10mL Hydralazine, phenytoin D5RL, D5NaCl 0.45&0.9% , D5W, RL , NaCl 0.45&0.9% 49 Norepinephrine ¸Levophed 4mg/4mL¸ Aminophylline, RI, lidocaine, Phenobarbital, phenytoin, sod.Bicarbonate, whole blood D5NaCl 0.9% , D5W, RL, NaCl 0.9% 50 Octreotide¸Sandostatin¸ 0.1mg/1mL ¸¸[ NaCl 0.9% - 320 - 327 _ _ ¸ ¦ ¿¿,{¡¸¦ ¿_¸,{¡,¸ 51 Ondansetron¸Zofran 8mg/4mL¸ Acyclovir, aminophylline, amphotericin B, ampicillin, ampicillin sod.-sulbactam sod , cefepime, cefoperazone, furosemide, ganciclovir , lorazepam , methylprdnisolone, piperacillin, sod. Bicarbonate D5NaCl 0.45&0.9% , D5W, R, NaCl 0.9%, RL 52 Oxacillin¸Prostaphlin 500mg¸ Sodium bicarbonate D5NaCl 0.9%, D5W, RL, NaCl 0.9%, D5RL 53 Pancuronium¸Pavulon 4mg/2mL¸ Diazepam D5NaCl 0.9%, D5W, RL, NaCl 0.9% 54 Penicillin G sod. 3MIU Amphotericin B, methylprednisolone, prochlorperazine, vancomycin NaCl 0.9% 55 Phenytoin (Aleviatin 250mg/5mL) Amikacin,aminophylline, ciprofloxacin, diltiazem, dobutamine, gentamicin, heparin, RI, lidocaine, meperidine, morphine, nitroglycerin, norepinephrine, KCl, prochlorperazine, propofol, theophylline, vancomycin, vitamin B complex with C NaCl 0.9% 56 Phytonadione (Vitamin Kl 10mg/1mL) Dobutamine, ranitidine D5W, D10W, R, RL, NaCl 0.45&0.9% 57 Piperacillin¸Pitamycin 2gm¸ Aminoglycosides, filgrastim, fluconazole, ondansetron, vancomycin D5NaCl 0.9% , D5W, RL, NaCl 0.9% 58 Piperacillin sod. 2g Tazobactam sod. 250mg ¸Tapimycin2.25gm¸ Acyclovir, amphotericin B, dobutamine, famotidine, ganciclovir, haloperidol, prochlorperazine, vancomycin D5W, NaCl 0.9% 59 Potassium chloride ¸KCl 15% 5mL¸ Amphtericin B, diazepam, phenytoin D5R, D5RL, D5NaCl 0.2,0.45&0.9%, D5W, D10W, R, RL, NaCl 0.45&0.9% 60 Procholrperazine ¸Novamin 5mg/1mL¸ Aminophylline, amphotericin B , ampicillin, aztreonam, cefepime, filgrastim, furosemide, hydrocortisone, ketorolac, midazolam, penicillin G sodium, Phenobarbital, piperacillin sod.-tazobactam sod D5R, D5RL, D5NaCl 0.2, 0.45&0.9%, D5W, R, RL, NaCl 0.45&0.9% - 321 - 328 _ _ ¸ ¦ ¿¿,{¡¸¦ ¿_¸,{¡,¸ 61 Propofol¸Recofol 10mg/ml, 20mL¸ Amikacin, amphotericin B, atracurium, ciprofloxacin, diazepam, digoxin, gentamicin, methotrexate, methylprdnisolone, metoclopramide, netilmicin, phenytoin, tobramycin D5RL, D5NaCl 0.2&0.45%, D5W, RL 62 Ranitidine ¸Zantac50mg/2mL¸ Amphotericin B , atracuonrium, cefazolin, cefoxitin, ceftazidime, clindamycin, hetastarch, midazolam, Phenobarbital, phytonadione D5NaCl 0.45%, D5W, D10W, RL, NaCl 0.9% 63 Sod. Bicarbonate NaHCO 3 7% 20mL Amiodarone,Vit C, dobutamine, dopamine, epinephrine, imipenem-cilastatin, isoproterenol, labetalol, midazolam, MgSO 4 , morphine, metoclopramide, meropenem, norepinephrine, ondansetron, succinylcholine, ticarcillin disod clavulanate pot. D5R, D5NaCl 0.2, 0.45&0.9%, D5W, NaCl 0.45&0.9% 64 Vasopressin¸Pitressin 200mg/1mL¸ ¸¸[ D5W, NaCl 0.9% 65 Vancomycin¸Vanco 500mg; U-Vanco 1gm¸ Albumin, cefepime, ceftazidime, dexamethasone, heparin, omeprazole, Phenobarbital, phenytoin, piperacillin sod.-tazobactam sod. ,ticarcillin disod. clavulanate pot., vitamin B complex with C D5RL, D5NaCl 0.9%, D5W, RL, NaCl 0.9% 66 Dexamethasone (Decadron 5mg/1mL) Ciprofloxacin, midazolam, vancomycin D5W, NaCl 0.9% 67 Diazepam¸Valium¸ Atracurium, cefepime, diltiazem, furosemide, fluconazole, heparin, meropenem, pancuronium bromide, KClpropofolvecuronium bromide vitamin B complex with C ¸)¯j,¸¦¸_¡¸ ¯¸¸)D5W, R, NaCl 0.9% 68 Digoxin 0.5mg/2mL Dobutamine, fluconazole, propofol D5W, RL, NaCl 0.45&0.9% - 322 - 329 _ _ ¸ ¦ ¿¿,{¡¸¦ ¿_¸,{¡,¸ 69 Diphenhydramine¸Bena 30mg/1mL¸ Amphotericin B, cefepime, haloperidol, Phenobarbital, phenytoin D5R,D5RL, D5NaCl 0.2, 0.45&0.9%, NaCl 0.45&0.9%, D5W, D10W, R, RL 70 Dobutamine¸Dobuject 250mg/5mL¸ Acyclovir, aminophylline, cefepime, calcium gluconate, diazepam, digoxin, furosemide, MgSO 4 , phenytoin, phytonadione, piperacillin sod.-tazobactam sod., potassium phosphates, RI, Sod. Bicarbonate, warfarin D5RL, D5NaCl 0.45&0.9%, D5W, RL, NaCl 0.45&0.9% 71 Dopamine 200mg/5mL Acyclovir, amphotericin B, ampicillin, cefepime, RI D5RL, D5NaCl 0.45&0.9%, D5W, D10W, RL, NaCl 0.9% 72 Epinephrine¸Adrenalin 1mg/1mL¸ Aminophylline, ampicillin, lidocaine, sod. bicarbonate D5R, D5RL, D5NaCl 0.9%, D5W, R, RL, NaCl 0.9% `1 D5RDextrose 5% in Ringer’s injection; D5RLDextrose 5% in Ringer’s injection , lactated; D5NaCl 0.2, 0.45±0.9%Dextrose 5% in sodium chloride 0.2, 0.45±0.9% ; D5¸10¸WDextrose 5¸10¸% in water; RRinger’s injection; RLRinger’s injection, lactated; NaCl 0.45±0.9%Sodium chloride 0.45±0.9%. `2 ¿¿,{¡¸¦[]Incompatible ¡¸,¸_additive compatibility, drugs in syringe compatibility , Y-site injection compatibility¸. - 323 - 330 ¡,( ¡,( ¡,( ¡,( ¸¡y¿});¸¦µ_j¸¸| ¸¡y¿});¸¦µ_j¸¸| ¸¡y¿});¸¦µ_j¸¸| ¸¡y¿});¸¦µ_j¸¸| _ __ _ _ __ _ ¸ ¸¸ ¸ ¦ ¦¦ ¦ Room temp (_¸ _¸ _¸ _¸) 25° °° °C Refrigerated (,¸ ,¸ ,¸ ,¸) 2° °° °C ~8° °° °C 1 Abitrexate(MTX)50 mg/2 mL(_)(¡) 24 hrs 2 Actilyse 50 mg/50mL 8 hrs 3 Adenocor® (Adenosine 6mg/2mL) 7 days 4 Adrenalin® (Epinephrine 1mg/1mL)* 48 hrs (diluted) 5 Agglutex® (Heparin 5000IU/mL) 24 hrs __¸¸+¸:Z¸¸ 10 _¸_¿_¸¸¦ 15 ¸)¸) 6 Albumin ¡)_4 ¸ÿ)¸)_( 7 Aleviatin® (Phenytoin 250mg/5mL) Immediately 8 Aminfec 125mg/ml 2mL 24 hrs 7 days 9 Aminophylline 250mg/10mL 5 hrs 10 Amoclavunin 0.6gm 4 hrs 8 hrs 11 Ampolin® (Ampicillin 500mg) 4 hrs (in D5W); 8 hrs (in N/S) 12 Anexate 0.5 mg/5 mL 24 hrs 13 Ansullina® (Ampicillin sod 1000mg-Sulbactam 500mg) 8 hrs (in N/S), 2 hrs (in D5W) 48 hrs (in N/S); 4 hrs(in D5W) 14 Antifect 1gm 24 hrs 7 days 15 Antivenin, hemorrhagic* 2 hrs 16 Antivenin, neurotropic* 2hrs 17 Aredia 15mg/ml(_) 24 hrs 18 Augcin® (Amoxicillin 1g + Clavulanic acid 0.2g) 4 hrs 19 Avelox 400mg/250ml 24 hrs 20 Bena® (Diphenhydramine 30mg/1mL) Immediately 21 Binin-U® (Haloperidol 5mg/mL) Immediately 22 Buscopan® (Hyoscine-N- butylbromide 10mg) 24 hrs 23 Calglon® (10% Calcium gluconate) 24 hrs 24 Cefadin® (Cephradine 1g) 2 hrs 24 hrs 25 Cefuroxime® (Cefuroxime 750g) 24 hrs 48 hrs 26 Cephalexin 1gm 24 hrs 5 days 27 Cilnin® (Ascorbic acid 100mg/2mL) Immediately - 324 - 331 _ __ _ _ __ _ ¸ ¸¸ ¸ ¦ ¦¦ ¦ Room temp (_ __ _¸ ¸¸ ¸) 25° °° °C Refrigerated (,¸ ,¸ ,¸ ,¸) 2° °° °C ~8° °° °C 28 Ciproxin® (Ciprofloxacin 200mg/100mL) 3 days 29 Clincin® (Clindamycin 300mg/2mL) 24 hrs 30 Cordarone® (Amiodarone 150mg/3mL) 24 hrs 31 Cyanocobalamin 1mg/1mL* ¡)_\³¸)_( 32 Demeral (Meperidine 50mg/1mL) 24 hrs 33 Diazepam 10mg/2mL Immediately 34 Dobuject ® (Dobutamine 250mg/5mL) 12 hrs 24 hrs 35 Dopamine 200mg/5mL* 24 hrs 36 Dormicum® (Midazolam 5mg/1mL) 24 hrs 3 days 37 Endoxan-Asta (Syklofosfamid) 200 mg(±¸¸¸)(_) 24 hrs 38 Fentanyl 0.5mg/mL Immediately 39 Flumarin 500 mg 6 hrs 24 hrs 40 Fungizone 50 mg(_)(¡) 24 hrs 7 days 41 Gemzar 200 mg(±¸¸¸)(_) 24 hrs 42 Gentamicin 80mg/2mL(¸¸·¸¿) 24 hrs 7 days 43 Glyceryl trinitrate 50mg/10mL* 48 hrs (diluted) 7 days 44 Herbesser(Diltiazem 50mg/Amp) 24hrs Do not refrigerate 45 Insulin 1 month 46 Invanz (Ertapenem1g) 6 hrs 24 hrs 47 Isoket (Isosorbide dinitrate10 mg/10 Ml) 24 hrs 48 Ketalar (Ketamine50 mg/mL 10 Ml) 24 hrs 49 Kenacort-A (Shincort®) (Triamcinolone acetonide10 mg/1mL) ¡)_3 ¸))( 50 Keto® (Ketorolac 30mg/mL) 48 hrs 51 Lanoxin® (Digoxin 0.5mg/2mL) 48 hrs 52 Lasix® (Furosemide 20mg/2mL)* 24 hrs 53 Levophed® (Norepinephrine 4mg/4mL)* 24 hrs 54 Lofatin® (Cefoxitin 1gm) 24 hrs 5 days 55 Losec® (Omeprazole 40mg) 12 hrs (in N/S); 6 hrs (in D5W) 56 Magnesium sulfate 10% MgSO 4 30 days 57 Maxipime® (Cefepime HCL 500mg) 24 hrs 7 days - 325 - 332 _ __ _ _ __ _ ¸ ¸¸ ¸ ¦ ¦¦ ¦ Room temp (_¸ _¸ _¸ _¸) 25° °° °C Refrigerated (,¸ ,¸ ,¸ ,¸) 2° °° °C ~8° °° °C 58 Medazole® (Metronidazole 500mg/100mL) 24 hrs 59 Mepem® (Meropenem 250mg) 6 hrs (in NaCl 0.9%) 1 hr (in D5W) 24 hrs (in NaCl 0.9%) 4 hrs (in D5W) 60 Methason® (Dexamethasone 5mg/1mL) 24 hrs 61 Miacalcic® (Calcitonin 50IU/1mL) 2 weeks 62 Minocycline(Mirosin 100mg) 24 hrs 63 Morphine 10mg/1mL 24 hrs 64 Narcan (Naloxone) 0.4 mg/1 mL(_)(¡) 24 hrs 65 Neuropam® (Lorazepam 2mg/mL) Immediately 66 Nimotop® (Nimodipine 0.02% 50mL)* 10 hrs 67 Novamin® (Procholrperazine 5mg/1mL) Immediately 68 Octide (Octreotide.1 mg/1 mL) 24 hrs 69 Omezol® (Omeprazole 40mg) 4 hrs 70 Pantoloc (Pantoprazole 40mg) 12 hrs 71 Pavulon (Pancuronium 4 mg/2 mL) 48 hrs 72 Penicillin G sod. 3MIU 24 hrs 7days 73 Perdipine® (Nicardipine 1mg/1mL) 24 hrs 74 Piton-S® (Oxytocin 10IU/1mL) 48 hrs 75 Potassium chloride (KCl 15% 5mL) 24 hrs 76 Primperan® (Metoclopramide10mg/2mL) 24 hrs 77 Promostan® (Alprostadil 20mcg)* 24 hrs 78 Prostaphlin® (Oxacillin 500mg) 3 days 7 days 79 Protamine sulfate 10mg/mL Immediately 80 Proternol-L® (Isoproterenol-L 0.2mg/mL)* 24 hrs (in D5W) 81 Recofol 10 mg/mL, 20mL 6 hrs 82 Relaxin® (Succinylcholine 500mg/25mL) 24hrs 83 Retarpen® (Penicillin G Benzathine) 7 days 21 days 84 Rocephin® (Ceftriaxone 500mg) 6 hrs 24 hrs 85 Sandostatin® (Octreotide 0.1mg/1mL) 24 hrs 86 Sintrix® (Ceftriaxone 1g) Immediately - 326 - 333 _ __ _ _ __ _ ¸ ¸¸ ¸ ¦ ¦¦ ¦ Room temp (_¸ _¸ _¸ _¸) 25° °° °C Refrigerated (,¸ ,¸ ,¸ ,¸) 2° °° °C ~8° °° °C 87 Sintum (Ceftazidime 1gm) 24 hrs 7 days 88 Sodium Bicarbonate (NaHCO 3 7% 20mL) 24 hrs 89 Solu-cortef® (Hydrocortisone sod.succinate100mg)* 3 days 90 Solu-medrol® (Methylprednisolone 125mg) 48 hrs 91 Subacillin (Amipicillin1gm +Sulbactaum 500mg) 8 hrs 48 hrs 92 Tapimycin (Piperacillin 2 g/Tazobactam 250 mg) 24 hrs 48 hrs 93 Targocid® (Teicoplanin)* 24 hrs 94 Tienam® (Imipenem500mg Cilastatin500mg) 4 hrs 24 hrs 95 Tracrium® (Atracurium 25mg/2.5mL) 24 hrs 96 Trandate® (Labetalol 25mg/5mL)* 24 hrs 97 Tygacil (Tigecycline50mg) 24 hrs 45 hrs 98 Unasyn® (Ampicillin sod 1000mg-Sulbactam 500mg) 8 hrs 48 hrs 99 Urokinase 6,000 IU; 60,000IU 24 hrs 24 hrs 100 Vanco 500mg; U-Vanco 1gm 24 hrs 4 days 101 Veterin® (Cefazolin 500mg) 24 hrs 4 days 102 Vitamin Kl (Phytonadione 10mg/1mL)* Immediately 103 Winzolin(Cefazolin 1000mg)* 24 hrs 4 days 104 Xylocaine® (Lidocaine 2% 20mL) ¡)_3 ¸)¸)_( 105 2% Xylocaine 5ml(¸,) 24 hrs 106 Zantac® (Ranitidine 50mg/2mL) 48 hrs 107 Zofran® (Ondansetron 8mg/4mL) 24 hrs 108 Zovirax® (Acyclovir 250mg) 12 hrs Do not refrigerate *Protect from light ¿_ Sources: 1. Trissel. Handbook on Injectable Drugs 11 th ed 2. Micromedex Healthcare Series 3. ¡,¸[ - 327 - 3 3 4 [ _ ¸ [ _ ¸ [ _ ¸ [ _ ¸ ¸ _ _ ¸ ¸ ¸ ¡ _ _ ¸ ¸ _ _ ¸ ¸ ¸ ¡ _ _ ¸ ¸ _ _ ¸ ¸ ¸ ¡ _ _ ¸ ¸ _ _ ¸ ¸ ¸ ¡ _ _ ¸ ¡ _ ¸ ¡ _ ¸ ¡ _ ¸ ¡ _ ¸ ¡ ¸ ¸ _ _ _ ¡ ¸ ¸ _ _ _ ¡ ¸ ¸ _ _ _ ¡ ¸ ¸ _ _ _ ¸¸¸ ¸ ___ _ ¡¡¡ ¡ ___ _ ___ _ ___ _ ___ _ ___ _ ¯ _ ¸ _ ¯ _ ¸ _ ¯ _ ¸ _ ¯ _ ¸ _ ___ _ ___ _ ___ _ ___ _ , z z | ; ¡ _ ; ¡ ¡ ( } z ¦ - ¡ z z | y } z y , | z ; ¡ z ( ; ¡ ¡ ( } z ¦ 0 0 q _ / p | ( ( , ( 7 q _ / _ q / ¦ , 5 _ q , z z | ¡ q ; ¡ z p j z ¡ ¸ ¸ ¦ 4 0 q _ / | _ ¬ | j z ¡ 7 0 q _ / | _ ¸ 4 j , , ¦ 7 , z , z , [ ( _ ¸ _ ¸ ¸ _ ¸ _ _ ¸ ¸ _ _ ¡ _ _ ] _ ] / _ _ _ ¸ _ _ _ ] ¡ _ ¸ ¸ ¿ _ _ _ ¸ ¡ z z | ¡ q ; ¡ z p j ¡ ¡ ¸ ¸ _ ; - ¦ 0 j ; ¡ ¡ _ ¸ ¸ _ | [ ( ¦ ( | , ; , z z ¡ | ; ¡ ( z ¦ , , | j z ; ¡ p y ; [ | j z ; ¡ ; | ; ¡ } } z v z } ; , ¡ | z v z | j z | ; z ¡ | q z ¡ | } ; ¡ z ¡ ¡ , , ( | , z ¸ ( z ¡ | } z v z } , [ ¡ } } | z } z w | j z | ; z ¡ | q z ¡ | } ; ¡ z , , ¡ z ¡ ¡ | z ; ¡ ] , [ } ( q ¡ , z ¡ ; } 0 , 5 q _ / 5 q } / ¡ q p _ ¸ | z ¡ , z , ; ¡ , z p ; ¡ z _ _ | ¸ ¸ ¡ ¸ _ _ ¡ _ 0 , ¸ - 0 , 3 q _ , ¸ _ ¸ _ _ ( 0 ] ¡ ¸ ¸ _ , ¸ j ¡ _ ¸ ¡ _ _ _ _ ¸ ¸ _ ¸ _ ¸ ¡ _ ¸ q _ _ _ _ _ ¡ _ 0 , 0 0 5 - 0 , 0 ¦ q _ / | _ , _ ¯ ¸ ¦ V ; ¡ [ ( , ; z ¡ 0 , 0 0 5 - 0 , 0 ¦ q _ / | _ / j ; , ¸ ¡ _ ¦ q _ ¦ V _ ¸ _ ¸ ¸ _ ¸ ¸ z y z } ; z ¡ ¡ | ; , z p ; z , , ¡ ¡ | _ _ ¸ ¿ _ ¯ ¸ · _ _ · _ ¸ · j ¸ ¯ _ ¡ _ ¸ _ ¸ ¿ _ _ _ _ ¸ ¸ ¸ _ ¸ ] _ _ _ ¡ _ _ ¸ ¸ ¿ ¸ _ _ _ ¸ _ ] ¯ _ ¸ ¿ ¸ ; z - , z , ¡ | ; z ¡ ¸ _ ¸ _ ¦ V ; ¡ [ ( , ; z ¡ 0 , ¦ - 0 , 4 q _ / j ; _ _ _ ¸ _ _ _ / _ _ ] _ ¸ _ ¸ _ _ ¸ ¸ | ¸ [ , ¸ ¿ _ ¸ _ _ _ p _ ] , ¸ ¦ V , ; ¡ , z p ¡ q 5 q _ ¸ _ ¸ _ _ ¸ ¸ | ¸ [ ¡ _ ¡ ¡ z ¡ ¡ | z [ ¸ ¿ _ ¸ _ _ _ ( , z ; , ( ; z ) _ ¸ _ ¸ ¸ _ _ _ ¸ _ _ _ ¸ ¸ ¸ j ¸ _ | ¡ _ ( _ j _ ) ¸ , ¸ ¸ ¸ ¸ _ ¸ _ _ _ ¸ ¸ _ ¡ ¸ ¸ ¸ ¸ _ ¦ , _ ¸ ¸ q ¸ ¡ ¸ , | ¸ [ _ _ | ¸ ¸ _ _ _ ¸ p [ _ ¸ - 328 - 3 3 5 ¡ _ ¸ ¡ _ ¸ ¡ _ ¸ ¡ _ ¸ ¡ ¸ ¸ _ _ _ ¡ ¸ ¸ _ _ _ ¡ ¸ ¸ _ _ _ ¡ ¸ ¸ _ _ _ ¸¸¸ ¸ ___ _ ¡¡¡ ¡ ___ _ ___ _ ___ _ ___ _ ___ _ ¯ _ ¸ _ ¯ _ ¸ _ ¯ _ ¸ _ ¯ _ ¸ _ ___ _ ___ _ ___ _ ___ _ _ ¸ _ _ ¡ ¸ ¸ ¸ ¡ _ | ¸ _ ¡ _ _ _ _ ¡ ¸ _ _ ¡ _ ¦ - ¸ q _ , _ ¯ ¸ ¡ 5 - ¦ 0 ¸ _ ¡ _ ¸ q _ _ _ _ _ ¡ _ ¦ q _ , _ ¯ ¸ ¡ 5 - ¦ 0 ¸ _ ¡ _ 0 , 5 - ¦ q _ ¦ V ¦ ¡ , | ; z p ; ¡ z ¦ ¡ ] , | ; z p ; ¡ z ¦ q _ / ¦ q } / ¡ q p _ ¸ ¸ ¸ [ _ _ ¡ ¸ ¸ ¡ _ ¦ - ¸ q _ , ¡ 3 - ; ¸ _ ¡ _ ¡ _ _ _ _ ] _ j _ ] ¦ V ¦ ¡ _ ¸ _ ¡ ¸ _ _ ¡ _ [ _ _ _ _ _ ¸ _ ¸ _ ¸ ¸ ¸ _ _ j , ¸ ¸ _ ¡ ¸ ¸ ¿ _ [ p ¸ ¡ _ ¡ ¡ ¸ ¡ ¸ _ _ ¡ _ ¸ ¸ _ _ _ _ ¡ ] / _ j _ ¸ _ ¸ _ _ _ _ ( [ ; ; ¡ z z ( | p ( | ) _ _ ¸ ¸ ] ¸ ( ¡ ( z z ( , q z q | ; ¡ ¡ z ) ¸ ¡ ¸ _ ¸ _ _ _ ¸ _ ( ¸ _ ] _ _ ¸ ¸ , ¸ _ _ , _ _ _ _ , _ _ _ _ ¸ _ j ) , _ { ] _ ¸ _ ¸ _ _ _ ¸ ¸ , ¡ ; | z q ; ¡ _ ; ¡ ¡ ( } z , z | ; v ¡ | z , z j ¡ ; z z ¡ } 5 0 _ q / | | } _ _ | / ¸ ¸ ¸ ¸ ¦ _ q / | _ [ ( _ ¡ _ [ _ ¿ _ _ [ ¸ _ _ ¸ _ _ _ _ _ ¸ _ ¸ ¡ _ [ ¸ ¡ _ _ _ _ ¸ ( ¸ 5 0 _ q _ ¡ z | ; v ¡ | z , z j ¡ ; z z ¡ } _ _ _ ¡ _ 4 0 0 q } _ _ ¸ ) ¸ ¡ ¸ ¸ _ | , ¸ ¡ _ _ ¸ _ ¡ _ { j , ¿ j , _ [ _ ¡ ¯ _ _ _ [ ¸ ¿ _ ¸ ¸ ¸ _ _ _ ¸ ¸ _ _ ¡ ¸ ¸ ¸ ¸ _ _ | ¸ ¸ _ _ ¸ ¸ - 329 - 3 3 6 ¡ _ ¸ ¡ _ ¸ ¡ _ ¸ ¡ _ ¸ ¡ ¸ ¸ _ _ _ ¡ ¸ ¸ _ _ _ ¡ ¸ ¸ _ _ _ ¡ ¸ ¸ _ _ _ ¸¸¸ ¸ ___ _ ¡¡¡ ¡ ___ _ ___ _ ___ _ ___ _ ___ _ ¯ _ ¸ _ ¯ _ ¸ _ ¯ _ ¸ _ ¯ _ ¸ _ ___ _ ___ _ ___ _ ___ _ [ z , [ z ; ¡ } ; ¡ ] , [ z [ z ; z ¡ ¡ q ; ¡ z q z | j ¡ ¡ , ( } [ z ¡ ; z 5 0 0 q _ / v ; ¡ } _ _ ¸ _ _ _ ¸ ¸ _ _ _ ¸ ¸ ¡ ¸ 0 , 5 - ¦ _ q / , ¡ y ¦ ¡ ¸ ¦ - ¸ _ q / , ¡ y $ , z v z ; ; - ¦ ¸ j ; _ _ ¦ 5 q _ / | _ / j ; ¦ V ¸ ¸ 0 - 4 0 q _ / | _ / , ¡ y $ , z v z ; ; - ¦ ¸ j ; _ _ _ ¸ ¸ ¡ ¸ _ _ ¡ _ ¦ _ q ¦ ¡ ¸ ¦ V , _ ¸ ¡ _ ¡ _ 5 0 0 _ q ¸ 4 j ¡ ¸ , j 5 0 0 _ q ¸ 4 - ¦ ¸ j , ¸ ¸ ¡ _ ( _ q / , ¡ y _ _ 9 0 q _ / | _ ¸ ; j ¸ ¦ 5 q _ / | _ / j ; , ¸ ¸ ¡ _ ( _ q / , ¡ y ¦ ¡ ¦ V _ ¸ _ ¸ ¸ ¡ _ ¸ ¸ _ ¸ ¸ ¸ _ _ ¡ ¡ _ ¸ _ ¡ _ , _ j ¸ ¿ _ ¡ _ ¸ ¸ _ ¸ ¡ _ _ , _ ¡ _ , ¸ _ _ ¦ 5 q _ / | _ / j ; , ¸ _ _ _ ¡ , ¸ ¸ ¸ _ ¡ ¡ _ _ _ ¡ _ , ¡ _ | _ ¸ z ; ; ¡ | ; z _ _ , z ; ( q ; ; z ¡ _ _ ¸ ¸ _ _ _ ¸ _ _ ¸ [ ¿ ¸ _ _ _ _ _ _ ¸ _ _ ¸ _ _ _ _ _ _ ¡ _ ¸ ¸ ¡ _ ¸ _ ¦ ( _ q / , ¡ y ¸ ¿ _ ¸ ¸ _ _ ¸ _ _ ¸ ¸ ¡ ¸ ( ; - ¦ 5 ( ) - 330 - 3 3 7 ¡ _ ¸ ¡ _ ¸ ¡ _ ¸ ¡ _ ¸ ¡ ¸ ¸ _ _ _ ¡ ¸ ¸ _ _ _ ¡ ¸ ¸ _ _ _ ¡ ¸ ¸ _ _ _ ¸¸¸ ¸ ___ _ ¡¡¡ ¡ ___ _ ___ _ ___ _ ___ _ ___ _ ¯ _ ¸ _ ¯ _ ¸ _ ¯ _ ¸ _ ¯ _ ¸ _ ___ _ ___ _ ___ _ ___ _ [ z , z ( v z } ; ¡ , ¡ } z ; ( q [ z } ; ¡ ¡ | z 5 0 q _ / v ; ¡ } _ ¸ [ z } ; z ¡ z ; , ¡ ¡ | ¡ _ z ¡ ; , | _ ¸ ¸ _ _ [ ¸ ¸ _ _ | ¸ , ¸ ¸ _ | ¸ ¦ , q z | j z | ; z ¡ ¡ | z , ¦ 5 q _ ¸ ( j j _ ¡ _ 5 - 7 ¸ ¸ , | ; ; q z | j z p ; ; q , , _ ¦ 5 q _ ¸ ¸ 4 j j _ ¡ _ 5 - 7 ¸ 3 , q z | j ¡ ¡ z } , _ _ ¡ _ 3 0 q _ ¸ ( j j _ ¸ ¸ ¦ ¡ ] z z | ; z ¡ _ ¸ _ ¸ ¸ _ ¸ _ _ _ _ ¸ ¡ _ ¡ , | , ¡ ¸ ¸ _ _ ¡ } z ( z z v z ; ; ¡ ; z , z ( z , _ , z ; ( q z ; z ¡ | ; ¡ ; ¡ z } z v z } ¸ ¸ ¸ _ | _ _ _ _ _ ( , z ; ( q } z v z } ) _ _ _ ¸ _ _ ¸ ¸ ¸ _ _ _ _ _ ] ¡ _ _ ¸ _ [ _ _ ¸ ¸ [ _ _ ¸ [ ¸ , ¸ ¿ ¿ ¸ ¦ j ; ¡ ¡ _ ¸ ¸ ¡ } z ( z z v z ; ; ¡ , ¸ ¸ ¸ _ _ _ ¸ 4 j ; _ } z ( z z v z ; ; ¡ _ ¸ - 331 - 3 3 8 ¡ _ ¸ ¡ _ ¸ ¡ _ ¸ ¡ _ ¸ ¡ ¸ ¸ _ _ _ ¡ ¸ ¸ _ _ _ ¡ ¸ ¸ _ _ _ ¡ ¸ ¸ _ _ _ ¸¸¸ ¸ ___ _ ¡¡¡ ¡ ___ _ ___ _ ___ _ ___ _ ___ _ ¯ _ ¸ _ ¯ _ ¸ _ ¯ _ ¸ _ ¯ _ ¸ _ ___ _ ___ _ ___ _ ___ _ ¦ ¡ ; z ¡ ¡ ; ¡ ] ¦ ¡ } z ¡ z ¡ z 0 , 4 q _ / q [ _ ¸ ¸ q _ _ _ _ ¡ ¸ 0 , 4 - ¸ q _ ¦ V / ¦ ¡ / $ , , ; z p z ¡ | z v z ; y ¸ - 3 q ; ¡ ¡ , ¡ z z , z , ; ; [ ¡ z ; z , p z ¡ , z ¡ [ | z ; ¦ 0 q _ , ; z z z ¡ , ; , z ; , ; ¡ _ ¡ z , ; , z [ z p ; z ; , | z ¡ ; z ; | y _ _ 0 . 0 1 m g / k g I V , t h e n 0 . 1 m g / k g i f n e e d e d ; m a y g i v e I M / S C i n d i v i d e d d o s e s i f I V r o u t e n o t a v a i l a b l e ¦ V ¦ ¡ $ , _ ¸ _ ¸ ¸ C a r d i o v a s c u l a r : C a r d i a c d y s r h y t h m i a , H y p e r t e n s i o n , H y p o t e n s i o n , V e n t r i c u l a r f i b r i l l a t i o n H e p a t i c : H e p a t o t o x i c i t y [ z , p ; ; ¡ | z ; y , [ ( } q z ¡ ¡ ; y z , z q ¡ P r e c a u t i o n s k n o w n o r s u s p e c t e d p h y s i c a l d e p e n d e n c e o n o p i o i d s ; n a l o x o n e m a y p r e c i p i t a t e w i t h d r a w a l s y m p t o m s r e v e r s a l o f b u p r e n o r p h i n e - i n d u c e d r e s p i r a t o r y d e p r e s s i o n m a y b e i n c o m p l e t e c o n c u r r e n t c a r d i o t o x i c d r u g s i n t r a m u s c u l a r o r s u b c u t a n e o u s i n j e c t i o n s i n p a t i e n t s w h o a r e h y p o t e n s i v e o r h a v e i m p a i r e d p e r i p h e r a l c i r c u l a t i o n n e o n a t e s p r e - e x i s t i n g c a r d i a c d i s e a s e - 332 - 3 3 9 ¡ _ ¸ ¡ _ ¸ ¡ _ ¸ ¡ _ ¸ ¡ ¸ ¸ _ _ _ ¡ ¸ ¸ _ _ _ ¡ ¸ ¸ _ _ _ ¡ ¸ ¸ _ _ _ ¸¸¸ ¸ ___ _ ¡¡¡ ¡ ___ _ ___ _ ___ _ ___ _ ___ _ ¯ _ ¸ _ ¯ _ ¸ _ ¯ _ ¸ _ ¯ _ ¸ _ ___ _ ___ _ ___ _ ___ _ _ ¸ ¸ ¸ [ _ _ ¡ ¸ ¸ ¡ ¸ O r g a n o p h o s p h a t e p o i s o n i n g : i n i t i a l , 1 - 2 g i n 1 0 0 m L N S I V i n f u s e d o v e r 1 5 - 3 0 m i n o r 5 % s o l u t i o n i n S W F I o v e r n o t l e s s t h a n 5 m i n ; r e p e a t , 1 - 2 g i n 1 h o u r i f m u s c l e w e a k n e s s p e r s i s t s _ _ O r g a n o p h o s p h a t e p o i s o n i n g ( M o d e r a t e t o S e v e r e ) : i n t e r m i t t e n t , 2 5 - 5 0 m g / k g I V ; m a y r e p e a t i n 1 - 2 h r s , t h e n a t 1 0 - 1 2 h r i n t e r v a l s i f n e c e s s a r y ( ; _ ¡ ¡ z p j z , p j ¡ | z p z ; , z ¡ ; ¡ _ ( ¡ z , z ; ¡ | z | z $ z v z ; z ) , z z ¡ | ; ¡ ( z ( , , ¸ 5 q _ / | _ ¦ V ¡ , , ; ¡ _ } z , z , z , | j z ¡ | z _ ; ¡ ; ¡ [ ( , ; z ¡ ¡ | ¦ 0 - ¸ 0 q _ / | _ / j ; ¦ V [ , ¡ , } ; ¡ ] [ ; ¡ } ; , z ¡ ; q z 5 0 0 q _ / ¦ 0 q [ _ ¸ , ¡ | ; z j z } ; ¡ z , | z ; ¡ , z z v z ; , z , z ¡ ¸ , ¡ | ; z j z } ; ¡ z , | z ; ¡ , z z v z ; , z , z , ; ¡ ; | ; ¡ } , ¦ - ¸ _ ¦ V ; q ¡ ; ¡ | z ¡ ¡ ¡ z z , ¸ 5 0 q _ ¦ V z v z ; y [ ; v z q ; ¡ ( | z , ¦ V _ ¸ _ ¸ ¸ G a s t r o i n t e s t i n a l : N a u s e a N e u r o l o g i c : D i z z i n e s s , H e a d a c h e O p h t h a l m i c : B l u r r e d v i s i o n R e s p i r a t o r y : H y p e r v e n t i l a t i o n , L a r y n g e a l s p a s m m y a s t h e n i a g r a v i s ( m a y p r e c i p i t a t e m y a s t h e n i c c r i s i s ) n o t e f f e c t i v e i n p o i s o n i n g s d u e t o o r g a n o p h o s p h a t e s w i t h o u t a n t i c h o l i n e s t e r a s e a c t i v i t y n o t e f f e c t i v e i n p o i s o n i n g s d u e t o p h o s p h o r u s / i n o r g a n i c p h o s p h a t e s r e n a l i m p a i r m e n t s l o w I V i n f u s i o n p r e v e n t s t a c h y c a r d i a , l a r y n g o s p a s m , m u s c l e r i g i d i t y - 333 - 3 4 0 ¡ _ ¸ ¡ _ ¸ ¡ _ ¸ ¡ _ ¸ ¡ ¸ ¸ _ _ _ ¡ ¸ ¸ _ _ _ ¡ ¸ ¸ _ _ _ ¡ ¸ ¸ _ _ _ ¸¸¸ ¸ ___ _ ¡¡¡ ¡ ___ _ ___ _ ___ _ ___ _ ___ _ ¯ _ ¸ _ ¯ _ ¸ _ ¯ _ ¸ _ ¯ _ ¸ _ ___ _ ___ _ ___ _ ___ _ [ j y | z ¡ ¡ , ; z ¡ z ; ¡ ] V ; | ¡ q ; ¡ [ ¦ ¦ 0 q _ / ¦ q [ _ ¸ W , ) ¦ , ) , µ [ _ j [ _ _ ¸ ¸ ¸ , 5 - ¸ 5 q _ $ , / ¦ ¡ / ¦ V $ , ¦ ¡ ¦ V _ ¸ _ ¸ ¸ [ z ; q ¡ | z } z _ ; z , $ | ; ¡ ; z ¡ z | ; z ¡ l i v e r d i s e a s e , z v z ; z ; z ¡ z | ; z ¡ , , ; ¡ z } ( , ; ¡ _ [ ¡ | ¡ } ; | ; z , , j ¡ v z z z z ( ; ; z , w ; | j ¦ V ¡ ¡ , ¦ ¡ ¡ , q ; ¡ ; , | ; ¡ | ; z ¡ [ ; z | ¡ q ; ¡ z ; ¡ ] [ ; z | ¡ q ; ¡ z , ( } [ ¡ | z 5 0 q _ / 5 q [ _ ¸ µ , p , ) , µ ¸ ¸ H e p a r i n o v e r d o s e : 1 m g I V f o r e v e r y 1 0 0 u n i t s o f h e p a r i n r e m a i n i n g i n p a t i e n t ; i f 3 0 m i n u t e s h a v e e l a p s e d s i n c e t h e i n j e c t i o n o f h e p a r i n o n e - h a l f t h e d o s e m a y b e s u f f i c i e n t ; m a x i m u m 5 0 m g g i v e n o v e r 1 0 m i n u t e s H e p a r i n o v e r d o s e : t h e d o s e c a n b e g i v e n a s a l o a d i n g d o s e o f 2 5 t o 5 0 m g b y s l o w I V i n j e c t i o n , w i t h t h e r e s t o f t h e c a l c u l a t e d d o s e o v e r 8 t o 1 6 h o u r s b y i n t r a v e n o u s i n f u s i o n ¦ V _ ¸ _ ¸ ¸ D e r m a t o l o g i c : F l u s h i n g G a s t r o i n t e s t i n a l : N a u s e a , V o m i t i n g R e s p i r a t o r y : D y s p n e a t o o - r a p i d a d m i n i s t r a t i o n m a y c a u s e s e v e r e h y p o t e n s i v e a n d a n a p h y l a c t o i d r e a c t i o n s h y p e r s e n s i t i v i t y t o f i s h ( i n c r e a s e d r i s k o f h y p e r s e n s i t i v i t y ) i n f e r t i l e o r v a s e c t o m i z e d m e n ( i n c r e a s e d r i s k o f h y p e r s e n s i t i v i t y ) p r e v i o u s e x p o s u r e t o p r o t a m i n e ( i n c r e a s e d r i s k o f h y p e r s e n s i t i v i t y ) j z p ¡ ; ; ¡ ; z | z ( ¡ , z ; | } z z , ; ¡ _ j ¡ , | z z ¡ ; z p z ; | z , ; ¡ z ¡ ; , ; ¡ z , ( ; _ z ; y p ¡ | ; z ¡ | , , z , p ; | z ¡ , z ¸ ( ¡ | z ¡ z ( | ; ¡ } ; , ¡ | ; z ¡ z [ j z p ¡ ; ; ¡ w ; | j p ; z | ¡ q ; ¡ z S o u r c e s : 1 . M i c r o m e d e x H e a l t h c a r e S e r i e s - 334 - 341 ¡,¬ ¡,¬ ¡,¬ ¡,¬ ;¸¸¦¸_¦_ ;¸¸¦¸_¦_ ;¸¸¦¸_¦_ ;¸¸¦¸_¦_ 1 5-Fluorouracil If bilirubin > 5, the dose should be omitted. 2 Aggrastat 12.5 mg/50 mL CrCl <30 mL/min: give half the usual dose 3 Aminophylline 250 mg/10 mL 1. Dialysis: theophylline is dialyzable; dosage may have to be increased 2. Geriatric: maintenance rate theophylline 0.2 mg/kg/hr (aminophylline 0.25 mg/kg/hr) 3. Liver disease: reduce dose as necessary; IV maintenance rate theophylline 0.2 mg/kg/hr (aminophylline 0.25 mg/kg/hr); monitor serum levels 4. Smokers, young adults: IV, maintenance rate theophylline 0.7 mg/kg/hr (aminophylline 0.875 mg/kg/hr) GFR (ml/min) > 50 10-50 10-50 <10 4 Aminfec 125mg/ml 2mL Dose 60%-90% Q12H 30%-70% Q12-18H 20% to 30% Q24-48H CrCl (ml/min) 10-30 <10 Dose Q12H Q24H 5 Amoclavunin 0.6gm Hemodialysis Q24H, and during and after each hemodialysis session 6 Ampolin inj. 500mg CrCl 10-50 mL/min, Q6-12H; <10 mL/min, Q12H 7 Anexate 0.5 mg/5 mL Liver disease: initial dose is unchanged, but repeat doses of the drug should be reduced in size or frequency 8 Ansullina 1.5Gm CrCl 15-29 mL/min, Q12H; <5-14 mL/min, Q24H 9 Antivenin Most effective when administered within 4 hours of the bite; but recommended up to 24 hours post-bite CrCL (ml/min) >30 10-30 <10 10 Antifect 1gm Dose 1 g Q12H 500 mg QD 250 mg QD 11 Aramin Hepatic insufficiency: cautious use is recommended CrCl (ml/min) 10-30 <10 Dose Q12H Q24H 12 Augcin inj 1.2gm Hemodialysis Q24H, and during and after each hemodialysis session - 335 - 342 13 Binin-U 5 mg/1 mL Geriatrics: 1-6 mg/day in 2-3 divided doses; may gradually increase dosage in 0.5 mg/day increments GFR (ml/min) 10-50 <10 14 Bleocin 5mg Dose 75% 50% 15 Caverject 20 mcg Respiratory status should be monitored throughout treatment CrCl (ml/min) 10-20 <10 Dose 750 mg Q12H 750 mg Q24H 16 Cefuroxime 750 mg Hemodialysis Supplemental dose should be given CrCl 35-54 11-34 <10 17 Cefacin 500mg (Veterin) Dose 100% Q8H 50% Q12H 50% Q18-24H 18 Cephalexin 1gm CrCl < 50 mL/min, Q12H 19 Chloramphenicol 1g Renal and hepatic impairment: serum drug concentration monitoring is recommended 20 Cinolone 200mg/100mL CrCl 5-29 mL/min, 200-400 mg Q18-24H 21 Ciproxin inj 200 mg/100 mL CrCl 5-29 mL/min, 200-400 mg Q18-24H 22 Cisplatin (Platinex) 50 mg Call physician if dose is greater than 100 mg/m 2 /cycle GFR 10 to 50 mL/min, 75%; GFR < 10 mL/min, 50% 23 Cordarone 150 mg/3 mL Pulmonary toxicity (hypersensitivity pneumonitis or interstitial/alveolar pneumonitis) CrCl 20-49 10-19 Hemodialysis/CA PD 24 Cravit 500mg/100 mL 1. Inhalational anthrax (postexposure prophylaxis) 2. Chronic bronchitis 3. Chronic prostatitis 4. CAP (7- to 14-day regimen) 5. Sinusitis (10- to 14-day regimen) 6. Uncomplicated skin infections 500 mg (initially) 250 mg Q24H 500 mg (initially) 250 mg Q48H 500 mg (initially) 250 mg Q48H - 336 - 343 1. Nosocomial pneumonia 2. CAP (5-day regimen) 3. Complicated skin infections 4. Sinusitis (5-day regimen) 5. UTI (5-day regimen) 6. Pyelonephritis (5-day regimen) 750 mg Q48H 750 mg (initially) 500 mg Q48H 750 mg (initially) 500 mg Q48H 1. Complicated UTI 2. Pyelonephritis (10-day regimen) NO adjustment 250 mg Q48H 25 Demeral Hcl 50mg/1cc GFR 10-50 mL/min: 75%; <10 mL/min: 50% 26 Dilantin (Aleviatin) 250 mg/5 mL Geriatrics: initially 3 mg/kg/day 27 Diflucan 100 mg <50 mL/min: 50%; replace entire dose after each dialysis session 28 Diphenhydramini 30mg/1mL MAX: 400 mg/day GFR >50 mL/min: Q6H; 10-50 ml/min: Q6-12H; <10 ml/min: Q12-18H 29 Dormicum 5 mg/1 mL CrCL <10 mL/min: decrease dose by 50% 30 Dobuject 250 mg/5 mL MAX dose, 40 mcg/kg/min IV 31 Dopamin 200 mg/ 5 mL MAX 50 mcg/kg/min IV 32 Dormicum 5 mg/1 mL Renal failure (CrCL < 10 mL/min) and liver disease: 50% 33 Methylergonovine 0.2 mg/1 mL MAX duration: 7 days 34 Fluanxol inj 20 mg/1 mL Hepatic dysfunction: caution 35 Flumarin 500 mg Dosage reduction may be required in patients with renal impairment 36 Fungizone 50 mg GFR<10 mL/min, Q24-46H 37 Gelofusine MAX 20 ml/kg/day 38 Gentamycin 80mg/2mL ( ) 1. Once-daily dosing: CrCl 40-60 mL/min, Q36H; CrCl 20-40 mL/min, Q48H 2. Traditional dosing: GFR >50 mL/min, 60% to 90% of usual dose Q8-12H or 100% of usual dose Q12H-24H; 10 to 50 mL/min, 30% to 70% of usual dose Q12H or 100% of usual dose Q24-48H; <10 mL/min, 20% to 30% of usual dose Q24H-48H or 100% of usual dose Q48-72H 39 Haes-Steril 10% 500ml 1. Total doses should not exceed 2000 mL daily or 28 mL/kilogram (kg) 2. Avoidance in patients with renal disease with oliguria and anuria unrelated to hypovolemia - 337 - 344 40 Heparin Age greater than 60 years: lower dosage 41 Herbesser 50 mg Liver disease: dose reduction 42 Invanz 1g CrCl<30 mL/min: 500 mg QDI Hemodialysis: 500 mg QDI; supplemental dose of 150 mg after dialysis if last 500 mg dose given within 6 hr prior to dialysis, no supplemental dose necessary if last 500 mg dose given at least 6 hr prior to dialysis 43 Isoket 10 mg/10 mL Hemodialysis: a supplemental dose of 10-20 mg after dialysis has been recommended 44 Isoptin (Verapamil) 5 mg/2 mL 1. Liver disease: 20% to 50% of normal dose 2. Geriatrics: give IV at slower rate 45 Keto inj 30 mg/mL Killpain 30 mg/mL 1. >65 y/o: IM 30 mg (IV 15mg) for 1 dose or 15 mg Q6H 2. <50 kg: IM 30 mg (IV 15 mg) for 1 dose or 15 mg Q6H 3. Renal impairment: IM 30 mg (IV 15 mg) for 1 dose or 15 mg Q6H, MAX 60 mg/day 46 Ketalar 50 mg/mL 10 mL Liver disease: dose reductions with hepatic impairment due to prolonged duration of action 47 Lasix 20 mg/2 mL 1. Renal impairment: 4 mg/min; if serum creatinine > 5 mg/dL, MAX 2.5 mg/min; MAX 1500 to 2000 mg IV/day 2. Liver disease: cirrhotic patients have a diminished diuretic effect and may require a higher than usual dose (specific guidelines unavailable) CrCl (ml/min) 30-50 10-29 5-9 <5 48 Lofatin 1gm Dose 1-2 g Q8-12H 1-2 g Q12-24H 0.5-1 g Q12-24H 0.5-1 g Q24-48H 49 Losec 40 mg Hepatic impairment: dose adjustment is recommended 50 Medazole 500 mg/100 mL GFR<10 mL/min: 50% of normal dose Clcr >60 30-60 11-29 <11 500 mg Q12H 500 mg Q24H 500 mg Q24H 250 mg Q24H 1 g Q12H 1g Q24H 500 mg Q24H 250 mg Q24H 2 g Q12H 2g Q24H 1g Q24H 500 mg Q24H 51 Maxipime 500 mg 2 g Q8H 2g Q12H 2g Q24H 1g Q24H 52 Mepem 250 mg CrCl 26-50 mL/min, usual doseQ12H CrCl 10-25 mL/min, one-half usual dose Q12H CrCl < 10 mL/min, one-half usual dose Q24H 53 MgSO4 Renal insufficiency (severe): MAX 20 g/48 hours; frequent - 338 - 345 serum magnesium monitoring recommended 54 Mitomycin-C Kyowa 10 mg Renal impairment: do not give to patients with a SCr>1.7 mg/dL; GFR<10 mL/min administer 75% of the usual dose 55 Morphine Hcl 10mg/1ml GFR 10-50 mL/min: 75% of normal dose GFR < 10 mL/min: 50% of normal dose Liver impairment: alter dose in cirrhotic patients 56 Octide 0.1 mg/1 mL Renal impairment: dosage adjustments may be necessary in patients with severe renal failure requiring dialysis since the half-life of the drug can be increased 57 Omezol inj 40 mg Hepatic impairment: dose adjustment is recommended 58 Penicillin G 3 MIU CrCl 10-50 mL/min: 75%; CrCl < 10 mL/min: 20-50% 59 Perdipine 1mg/ml Hypotension or tachycardia: IV, discontinue infusion; restart at 3 to 5 mg/hr when blood pressure and heart rate stabilize 60 Pharmorubicin 10 mg Bilirubin 1.2-3 mg/dL or AST 2 to 4 times upper limit of normal: 50% of starting dose Bilirubin > 3 mg/dL or AST > 4 times upper limit of normal: 25% of starting dose Renal impairment: lower doses should be considered in severe renal impairment (serum creatinine > 5 mg/dL) CrCl 20-40 <20 Hemodialysis Complicated UTI 3 g Q8H 3 g Q12H 61 Pitamycin 2gm Serious infection 4g Q8H 4 g Q12H MAX 2 g Q8H; 1 g after each dialysis session 62 Primperan inj 10 mg/2 mL CrCl l< 40 mL/min: initiate at 50% of recommended dose Geriatric: initiate at 50% of recommended dose 63 Primacor 10mg/10ml Renal impairment: titrate to effect without exceeding a dose of 1.13 mg/kg/day IV 64 Retarpen 2.4 MIU CrCl 10-50 mL/min: 75%; CrCl < 10 mL/min: 20-50% 65 Risperdal inj. 25mg Geriatric: 25 mg IM every 2 weeks Hepatic and renal impairment: administer titrated doses of ORAL risperidone prior to starting IM therapy in these patients; 0.5 mg ORALLY twice daily for one week 1 mg twice daily ( or 2 mg once daily) in the second week12.5 mg or 25 mg of the long-acting injection may be given IM every 2 weeks 66 Rocephin 500 mg Combined renal and hepatic impairment: NOT exceed 2 g/day 67 S-60 (Cephradine) 1 g CrCl 10-50 mL/min: 50%; CrCl < 10 mL/min: 25% 68 Sandostatin 0.1 mg/1 mL Renal impairment: dosage adjustments may be necessary in - 339 - 346 patients with severe renal failure requiring dialysis since the half-life of the drug can be increased 69 Sevatrim 80/400mg 5ml CrCl 15 to 30 mL/min: give one-half the usual dose CrCl <15 mL/min: not recommended 70 Sintrix Inj. 1gm Combined renal and hepatic impairment: NOT exceed 2 g/day CrCl 31 to 50 16-30 6-15 <5 1 g Q12H 1 g Q24H 0.5 g Q24H 0.5 g Q48H Hemodialysis: give initial 1 g loading dose followed by 1 g after each hemodialysis period 71 Sintum 1gm Peritoneal dialysis: give initial 1 g IV loading dose followed by 0.5 g IV every 24 hr or add 250 mg to 2 L of dialysis fluid CrCl >50 mL/min 10-50 <10 Q24H Q24-72H Q72-96H Geriatrics (>60 y/o): reduced doses 72 Streptomycin 1 g Hemodialysis: one-half normal dose recommended as supplement after dialysis 73 Subacillin 1.5Gm CrCl 15-29 mL/min, Q12H; <5-14 mL/min, Q24H CrCl >40 20-40 <20 hemodialysis CAPD All indications 3.375 g Q6H 2.25 g Q6H 2.25 g Q8H 2.25 g Q12H; 0.75 g after each dialysis 2.25 g Q12H 74 Tapimycin 2.25gm Nosocomial pneumonia 4.5 g Q6H 3.375 Q6H 2.25 g Q6H 2.25 g Q8H; 0.75 g after each dialysis 2.25 g Q8H CrCl >80 30-80 <10 Constant interval 400 mg Q24H 200 mg Q24H 133 mg Q24H 75 Targocid 200 mg Constant dose 400 mg Q24H 400 mg Q48H 400 mg Q72H CrCl 30-70 20-30 6-20 <5 Dose (IV) 50% Q6-8H 37% Q8-12H 25% Q12H NOT recommended IM NOT recommended with CrCl < 20 76 Tienam 500mg Hemodialysis 25% Q12H; give dose after dialysis then every 12 hr - 340 - 347 CrCl >60 40-60 20-40 Once-daily dosing Q24H Q36H Q48H Tranditional dosing Give initial dose, draw at least 2 serum drug levels Cystic fibrosis Initiating dosing at 3 mg/kg IV every 8 hr 77 Tobra 80mg/2ml Obese P’t Based on ideal body weight Dosing weight = ideal body weight + 0.4 (total body weight - ideal body weight) 78 Trandate inj 25mg/5ml Liver disease: dosage adjustments may be required 79 Tracrium 25 mg/2.5 mL Initial, 0.4 to 0.5 mg/kg IV bolus; in ICU, 11 to 13 mcg/kg/min (range 4.5 to 29.5 mcg/kg/min) continuous IV infusion 80 Tygacil 50mg Hepatic impairment: severe (Child Pugh C), initial dose is 100 mg IV followed by 25 mg IV every 12 hours 81 Unasyn 1500mg CrCl 15-29 mL/min, Q12H; <5-14 mL/min, Q24H 82 U-Vanco 1gm Vanco 500 mg 1. Renal impairment: 15 mg/kg as initial dose then optimal dose and interval based on serum conc. 2. Anuric patients (adults): 1 g every 7 to 10 days 3. Obesity: use actual body weight to calculate initial dosage, with subsequent dose adjustments based on serum conc. 83 Valium (Diazepam) 10mg/2mL Liver disease: decrease usual dose by 50% CrCl 35-54 11-34 <10 84 Winzolin 1gm Dose 100% Q8H 50% Q12H 50% Q18-24H 85 Zantac inj 50 mg/2 mL CrCl < 50 mL/min, 50 mg IV every 18-24 hours 86 Zofran 8 mg/4 mL Severe hepatic impairment (Child-Pugh score 10 or greater): NOT exceed 8 mg/day CrCl 25-50 10-25 <10 Dose 100% Q12H 100% Q24H 50% Q24H Hemodialysis An additional dose after each dialysis Peritoneal dialysis NO supplemental dose 87 Zovirax 250 mg Obese patients IV infusion, dose at recommended adult dose using ideal body weight - 341 - 1 Antigluco( ) Contraindicated 2 Acerine 5mg lower dose 3 Acertil 4 mg ClCr>60 ml/min--4 mg/day ClCr 30-60 ml/min--2 mg/day ClCr 15-30 ml/min--2 mg/QOD ClCr <15 ml/min--2 mg on dailysis day 4 Allopurinol 100 mg 10-20 ml/min: 200 mg <10 ml/min: 100 mg <3 mg/min: 100 mg at extended intervals 5 Amanda F.C. 100 mg 30-50 ml/min: 100 mg QD 15-29 ml/min: 100 mg QOD <15 ml/min: 200 mg Q1W 6 Amaryl 2mg( ) 1 mg QD 7 Ampicillin 500 mg ClCr >50 ml/min--Q6H ClCr 10-50 ml/min--Q6H to Q12H ClCr <10 ml/min--Q12H to Q16H 8 Anxoken 1000mg( ) Contraindicated 9 Apresoline 50 mg >10 ml/min Q8H <10 ml/min-- in fast acetylators Q8-16H in slow acetylators Q12-24H 10 Augmetin 375mg 10-30 ml/min Q12H <10 ml/min Q24H 11 Bacide (Baktar) 400 mg 15-30 ml/min: 1/2 standard regimen <15 ml/min: not recommended 12 Baclon 10 mg lower dose 13 Baraclude 0.5mg( ) ClCr 30-50: 0.25 mg QD or 0.5 mg QOD (treatment-naive) 0.5 mg QD or 1 mg QOD (lamivudine-refractory) ClCr 10-30: 0.15 mg QD or 0.5 mg Q72H (treatment-naive) 0.3 mg QD or 1 mg Q72H (lamivudine-refractory) ClCr <10: 0.05 mg QD or 0.5 Q7D (treatment-naive) - 342 - 349 0.1 mg QD or 1 mg Q7D (lamivudine-refractory) 14 Benamine 50 mg 10-50 ml/min Q6-12H; <10 ml/min Q12-18H 15 Bexolo 20 mg(_¸) MAX 20 mg/day 16 Biso F.C. 5mg(_¸_¸) MAX: 10 mg/day 17 C.T.L. XR 500mg(_¦) contraindicated 18 Calbo 950mg Clcr<25 ml/min:dosage adjustments may be necessary dependent on serum calcium levels 19 Calcium Carbonate 500mg Clcr<25 ml/min:dosage adjustments may be necessary dependent on serum calcium levels 20 Capoten 25 mg >50 ml/min Q8-12H 10-50 ml/min 75% dose Q12-18H <10 ml/min 50% dose QD 21 Cefadroxil 500 mg >50 ml/min Q12H 10-50 ml/min Q12-24H <10 ml/minQ24-48H 22 Ceflexin 500 mg <50 ml/min 250-500 mg Q12H 23 Cetimin 10mg(_¦) 5 mg QD 24 Cetipo E.R.F.C. 1# QD in moderate renal impairment and in patients on hemodialysis (ClCr< 30 mL/min) 25 Cimewell 400 mg(__) 10-50 ml/min 75% of the usual dose <10 ml/min 50 % of usual dose 26 Ciproxin 250 mg 30-50 ml/min 250-500 mg Q12H 5-29 ml/min 250-500 mg Q19H 27 Clarinase <30 ml/min 1 tab QD 28 Codeine 30mg(_2) 10-50 ml/min 75%; <10 ml/min 50% of the usual dose 29 Colchicine 0.5 mg 10-50 ml/min <0.6 mg/day to every other day <10 ml/min contraindicated 30 Concor 1.25mg** MAX: 10 mg/day 31 Concor 5mg MAX: 10 mg/day 32 Crestor 10mg ClCr<30 ml/min not on hemodialysis: starting dose should be 5 milligrams (mg) once daily with titration not to exceed 10 mg once daily 33 Cymbalta 30 mg lower dose and then increased gradually; not recommended for patients with end-stage renal disease (requiring dialysis) or severe renal impairment (ClCr<30 ml/min) - 343 - 350 ¸¸_| ___¸ 34 Defense F.C 300 mg(__) GFR 10 to 50 ml/min: 75% of the usual dose GFR <10 ml/min: 50% of the usual dose 35 Detrusitol 2mg Clcr 10 to 30 ml/min 2 mg/day 36 Deuron 50 mg(__) NOT recommended if GFR<20 ml/min 37 Diabitin (Euglucon) 5 mg NOT recommended in ClCr<50 ml/min 38 Diamox 250 mg GFR >50 ml/min Q6H; 10-50 ml/min Q12H; <10 ml/min not receive 39 Diflucan 50 mg Clcr<50 ml/min 50 % 40 Dormicum 7.5 mg(_4) Clcr <10 ml/min 50 % 41 Ebixa 10mg Clcr 5-29 ml/min: 5 mg ORALLY twice daily 42 Ebutol (E.M.B 400mg) GFR 10 to 50 ml/min: Q24-36H; <10 ml/min Q48H 43 Efexor XR 37.5(¸)(_) GFR 10-70 ml/min: 75%; hemodialysis: 50% 44 Efexor XR 75 mg GFR 10-70 ml/min: 75%; hemodialysis: 50% 45 Erymycin 250 mg MAX 2 g/day; GFR<10 ml/min 50 to 75% 46 Fenofibrate 100mg(¸_) Initial dose should be 50 mg QD in renal impairment 47 Fenolip 200 mg(_¦) Initial dose should be 50 mg QD in renal impairment 48 Fluitran 2 mg Thiazides should not be used in patients with a serum creatinine or urea nitrogen level greater than 2.5 mg/Dl 49 Fonitec 20mg Clcr<30 ml/min: 2.5 mg/day 50 Gastrodin 200mg 10-50 ml/min 75% of the usual dose <10 ml/min 50 % of usual dose 51 Gastro-T 30 mg GFR <10 ml/min: 50%; 10-50 ml/min: 75% 52 Genadine 10mg Clcr<30 ml/min: 10 mg QOD 53 Glimaryl 2mg(_¸¸) 1 mg QD 54 GlucoMet F.C. NOT be used in renal insufficiency 55 Glucomin X.R. 500mg contraindicated 56 Glucophage 500 mg contraindicated 57 I N A H 100 mg Clcr<10 ml/min: 50% 58 Imuran 50 mg GFR 10 to 50 ml/mi: 75% ; <10 ml/min 50% 59 Invega 3mg ClCr 50-80 mL/min: MAX 6 mg once daily 10-50 mL/min, MAX 3 mg once daily 60 Januvia 100 mg 30-50 ml/min: 50mg QD; <30: 25mg QD 61 Jia-Cal 950mg Clcr<25 ml/min:dosage adjustments may be necessary dependent on serum calcium levels 62 Keto 10 mg Contraindicated in advanced renal impairment 63 Ketoprofen 50mg Adjustment for patients with a ClCr< 20 mL/minute - 344 - 351 ¸¸_| ___¸ 64 K-mycin 250mg <30 ml/min halved or the dosing interval doubled 65 Lamictal 50 mg Low dose 66 Lamisil 250 mg NOT recommended in CrCl <50 ml/min 67 Lamta 50mg Low dose 68 Lanoxin (Digoxin) 0.25 mg Low dose 69 Lefenine 100 mg Low dose 70 Licodin 100 mg Low dose 71 Lidin 300 mg GFR 10 to 50 ml/min: 50 to 75%; <10 ml/min: 25 to 50% 72 Lipanthyl 200mg Initial dose should be 50 mg QD in renal impairment 73 Lipdown 300 mg GFR 10 to 50 ml/min: 50%; <10 ml/min: 25% 74 Lipolin 100mg Initial dose should be 50 mg QD in renal impairment 75 Lote 100mg Low starting dosage 76 Melicam 7.5mg 7.5 mg daily 77 Metformin 500mg(¸_) Contraindicated 78 Methotrexate 2.5 mg GFR10-50 ml/min: 50%; <10 ml/min: avoided 79 Metrozole 250mg GFR <10 ml/min 50% 80 Mobic 15mg The lower dose of 7.5 milligrams daily has been suggested 81 Monopril 10 mg GFR<10 ml/min: 75%-100% 82 Morphine 10 mg GFR10-50 ml/min: 75%; <10 ml/min: 50% 83 Naproxen 250 mg A reduction in daily dosage should be considered (Clcr<20 ml/min) 84 Nasaga 60mg A reduction in daily dosage should be considered (Clcr<20 ml/min) 85 Neomycin 250 mg GFR> 50 ml/min: Q6H; 10 to 50 ml/min: Q12-18H; severe: Q18-24H 86 Nootropil 1.2gm Potential need for dose adjustments in renal insufficiency 87 Noprisil 10mg Clcr 10 to 30 mL/min: 5 mg/day; < 10 mL/min: 2.5mg/day 88 NovoNorm 1 mg CrCl 20 to 40 ml/min: starting dose 0.5 mg 89 Phenobarbital 32 mg GFR<10 ml/min:Q12-16H 90 Preterax Scored ClCr>60 ml/min--4 mg/day; 30-60 ml/min--2 mg/day; 15-30 ml/min--2 mg/QOD; <15 ml/min--2 mg on dailysis day 91 Primperan 5 mg GFR <10 ml/min: 50%; 10-50 ml/min: 75% 92 Procal 667 mg Clcr<25 ml/min:dosage adjustments may be necessary dependent on serum calcium levels - 345 - 352 93 Ramitace 2.5mg < 40 ml/min (>2.5 mg/dL), oral dosing should be reduced to approximately 25% of usual doses 94 Reminyl 8mg Moderate: < 16 mg/day; severe (creatinine clearance < 9 ml/min): not recommended 95 Renitec 20mg5 mg Clcr<30 ml/min: 2.5 mg/day 96 Rifinah INAH--Clcr<10 ml/min:50% 97 Risdon 2mg A maximum dose of 2 mg twice daily 98 Risperdal 1 mg2 mg A maximum dose of 2 mg twice daily 99 Rohypnol 1 mg Lower doses 100 Rosis (Lasix) 40 mg Patients in renal failure may require higher than usual doses to induce diuresis 101 Sabril 500 mg Clcr<60 ml/min: Dose reductions 102 Salazopyrin 500mg Dosage of sulfonamides be adjusted in patients with impaired renal function 103 Sandimmun 100 mg25 mg Serum creatinine is recommended to be maintained less than or equal to 30% of baseline values 104 Sebivo 600 mg ClCr 30 to 49 mL/min: 600 mg QOD; <30 mL/min: 600 mg Q72H; ESRD requiring hemodialysis: 600 mg Q96H, to be given after hemodialysis. 105 Sectral 400 mg Clcr<50 ml/min: 50%; Clcr<25 ml/min: 25% 106 Seromin 10mg Reduced 107 Seroxat 20mg MAX 40 mg/day 108 Setine F.C. 20mg MAX 40 mg/day 109 Simvatin 20mg Starting dose is 5 milligrams 110 Spirotone (Aldacton) 25 mg > 50 mL/min Q6-12H; 10 to 50 mL/min Q12-24; <10 ml/min avoidable 111 Supernide(Repaglinide)1mg CrCl 20 to 40 ml/min: starting dose 0.5 mg 112 Superocin(Ciprofloxacin)250 mg 30-50 ml/min 250-500 mg Q12H; 5-29 ml/min 250-500 mg Q18H 113 Surgam 200 mg Slight reduction in the normal dose or by increasing the dosing interval 114 Tamiflu 75mg Clcr10-30 ml/min:treatment--75 mg/day; prophylaxis--75 mg QOD or 30 mgQD 115 Tenolol (Ateol) 100 mg Dose reductions are necessary 116 Tenormin 100 mg Dose reductions are necessary - 346 - 353 117 Tetracycline (Achromycin) 250mg > 50 ml/min Q8-12H; 10 to 50 ml/min Q12-24H; < 10 ml/min Q24H, but is best avoided in these patients 118 Topamax 100mg25mg One half of the usual adult dose is recommended 119 Tramal SR 100 mg Do not use extended-release tramadol in patients with severe renal impairment (creatinine clearance less than 30 mL/min). 120 Trileptal 300mg < 30 ml/min: initiated at 300mg/day, one-half the usual starting dose, and increased at a slower rate than usual based on clinical response 121 Ulstop (Famotidine) 20 mg Clcr<50 ml/min: 50% or Q36-48H 122 Uridin F.C. 2mg Clcr 10 to 30 ml/min 2 mg/day 123 Viagra 100 mg50 mg Clcr<30 ml/min: 25 mg (starting dose) 124 Weidos 300mg Clcr<50 ml/min: 150 mg/day 125 Winlex(Cephalxin 500 mg) <50 ml/min 250-500 mg Q12H 126 Zestril 10 mg Clcr 10 to 30 mL/min: 5 mg/day; < 10 mL/min: 2.5mg/day 127 Zocor 40mg Starting dose is 5 mg - 347 - 3 5 4 ¡ , ¸ ¡ , ¸ ¡ , ¸ ¡ , ¸ [ [ ¸ ¡ _ ¡ [ [ ¸ ¡ _ ¡ [ [ ¸ ¡ _ ¡ [ [ ¸ ¡ _ ¡ ))) ) jjj j _ ¸ [ ) ¸ , @ = ( _ ¸ [ ) ¸ , @ = ( _ ¸ [ ) ¸ , @ = ( _ ¸ [ ) ¸ , @ = ( ¸ , ¸ , ¸ , ¸ , 1 ¸ , ¸ , ¸ , ¸ , 2 _ ¸ [ ) ; ¶ _ ¸ [ ) ; ¶ _ ¸ [ ) ; ¶ _ ¸ [ ) ; ¶ A c t i l y s e 5 0 m g / 5 0 m L M i l l i s r o l 5 m g / 1 0 m l , N i t r o s t a t ( N . T . G . ) 0 . 6 m g I m p a i r m e n t o f t h e t h r o m b o l y t i c e f f e c t A d r e n a l i n ( E p i n e p h r i n e ) 1 m g / 1 m L I n d e r a l 1 0 m g , 4 0 m g ( C a r d o l o l ) R e f l e x b r a d y c a r d i a A m i n o g l y c o s i d e s ( T o b r a 8 0 m g / 2 m l , S t r e p t o m y c i n 1 g , G e n t a m y c i n , A m i n f e c 1 2 5 m g / m l 2 m L ) L a s i x A u d i t o r y t o x i c i t y B i n i n - U ( H a l d o l ) 5 m g , 5 m g / 1 m L , U - D o l a n 5 0 m g / m L L i d i n 3 0 0 m g E x t r a p y r a m i d a l e f f e c t s i n c r e a s e d C o l c h i c i n e 0 . 5 m g K - m y c i n 2 5 0 m g , E r y m y c i n 2 5 0 m g C o l c h i c i n e t o x i c i t y m a y o c c u r C o r d a r o n e A v e l o x , C r a v i t P r o l o n g Q T c i n t e r v a l C o r d a r o n e F e n t a n y l 0 . 0 5 m g / m L 2 m L B r a d y c a r d i a , s i n u s a r r e s t , h y p o t e n s i o n C o r t i c o s t e r o i d s ( M e d n i n 4 m g , M e t h a s o n ( D e c a d r o n ) 5 m g / 1 m L , S h i n c o r t 1 0 m g / 1 m L , M e t h y l p r e d n i s o l o n e 4 0 m g , S o l u - M e d r o l 1 2 5 m g , S o l u - C o r t e f 1 0 0 m g , P r e d n i s o l o n e 5 m g ) R i f a m p i n , R i f i n a h C o r t i c o s t e r o i d s e f f e c t s m a y b e d e c r e a s e d D e m e r a l H c l 5 0 m g / 1 c c ( ((( ( 2 ) ( ¡¡¡ ¡ ) P a r k r y l 5 m g W i t h d r a w a l o f M A O I m a y o c c u r - 348 - 3 5 5 ¸ , ¸ , ¸ , ¸ , 1 ¸ , ¸ , ¸ , ¸ , 2 _ ¸ [ ) ; ¶ _ ¸ [ ) ; ¶ _ ¸ [ ) ; ¶ _ ¸ [ ) ; ¶ D o p a m i n 2 0 0 m g / 5 m L D i l a n t i n H y p o t e n s i o n , c a r d i a c a r r e s t m a y o c c u r E r g o t a l k a l o i d s ( E l m e s a t t 2 m g , H o d r i n 1 . 5 m g , S e g l o r R e t a r d 5 m g ) E r y m y c i n 2 5 0 m g , K - m y c i n 2 5 0 m g P e r i p h e r a l i s c h e m i a E r y m y c i n 2 5 0 m g A v e l o x R i s k o f c a r d i a c a r r h y t h m i a s m a y b e i n c r e a s e d G e o d o n 6 0 m g A v e l o x , C r a v i t P r o l o n g Q T c i n t e r v a l G e o d o n 6 0 m g C o r d a r o n e P r o l o n g Q T c i n t e r v a l G e o d o n 6 0 m g Q u i n i d i n e 2 0 0 m g P r o l o n g Q T c i n t e r v a l G e o d o n 6 0 m g M o r e f i n e ( W i n t e r m i n ) 1 0 0 m g P r o l o n g Q T c i n t e r v a l H M G - C o A R e d u c t a s e ( C a d u e t 5 m g / 1 0 m g , C r e s t o r 1 0 m g , L e s c o l 4 0 m g , L i p i t o r 4 0 m g , L o v a s t a 2 0 m g , S i m v a t i n 2 0 m g , Z o c o r 4 0 m g ) K - m y c i n 2 5 0 m g , E r y m y c i n 2 5 0 m g , Z i t h r o m a x 2 5 0 m g S e v e r e m y o p a t h y m a y o c c u r H M G - C o A R e d u c t a s e ( C a d u e t 5 m g / 1 0 m g , C r e s t o r 1 0 m g , L e s c o l 4 0 m g , L i p i t o r 4 0 m g , L o v a s t a 2 0 m g , S i m v a t i n 2 0 m g , Z o c o r 4 0 m g ) F e n o f i b r a t e 1 0 0 m g , F e n o l i p 2 0 0 m g , L i p a n t h y l 2 0 0 m g , L i p d o w n 3 0 0 m g , L i p o l i n 1 0 0 m g S e v e r e m y o p a t h y m a y o c c u r H M G - C o A R e d u c t a s e ( C a d u e t 5 m g / 1 0 m g , C r e s t o r 1 0 m g , L e s c o l 4 0 m g , L i p i t o r 4 0 m g , L o v a s t a 2 0 m g , S i m v a t i n 2 0 m g , Z o c o r 4 0 m g ) S a n d i m m u n 1 0 0 m g , 2 5 m g I n c r e a s e d s i d e e f f e c t s ( r h a b d o m y o l y s i s ) I N A H 1 0 0 m g R i f a m p i n 3 0 0 m g , 4 5 0 m g H e p a t o x i c i t y m a y o c c u r - 349 - 3 5 6 ¸ , ¸ , ¸ , ¸ , 1 ¸ , ¸ , ¸ , ¸ , 2 _ ¸ [ ) ; ¶ _ ¸ [ ) ; ¶ _ ¸ [ ) ; ¶ _ ¸ [ ) ; ¶ I m u r a n 5 0 m g A l l o p u r i n o l 1 0 0 m g T o x i c e f f e c t s o f t h i o p u r i n e s m a y o c c u r I n d e r a l 1 0 m g ( C a r d o l o l ) M o r e f i n e ( W i n t e r m i n ) 1 0 0 m g B o t h d r u g s m a y i n c r e a s e d e f f e c t s K C L 1 5 % 5 m L , S l o w - k 6 0 0 m g S p i r o t o n e ( A l d a c t o n ) 2 5 m g S e v e r e h y p e r k a l e m i a K e t o , K i l l p a i n 3 0 m g / m L B o k e y 1 0 0 m g , T a p a l 1 0 0 m g I n c r e a s e d r i s k o f s i d e e f f e c t s L a n o x i n ( D i g o x i n ) 0 . 2 5 m g ( ¸ ¡ ¸ ¸ ¡ ¸ ¸ ¡ ¸ ¸ ¡ ¸ ) C o r d a r o n e , Q u i n i d i n e 2 0 0 m g , R y t m o n o r m 1 5 0 m g D i g o x i n c o n c . m a y b e i n c r e a s e d L a n o x i n ( D i g o x i n ) 0 . 2 5 m g ( ¸ ¡ ¸ ¸ ¡ ¸ ¸ ¡ ¸ ¸ ¡ ¸ ) V e r a p a m i l ( I s o p t i n ) 5 m g / 2 m L , V e r e l a n 1 2 0 m g D i g o x i n c o n c . m a y b e i n c r e a s e d L a n o x i n ( D i g o x i n ) 0 . 2 5 m g ( ¸ ¡ ¸ ¸ ¡ ¸ ¸ ¡ ¸ ¸ ¡ ¸ ) L a s i x I n d u c e d a r r h y t h m i a s L a n o x i n ( D i g o x i n ) 0 . 2 5 m g ( ¸ ¡ ¸ ¸ ¡ ¸ ¸ ¡ ¸ ¸ ¡ ¸ ) T h i a z i d e d i u r e t i c s ( P l u s A c e r t i l 4 m g / 1 . 2 5 m g , C o a p r o v e l 1 5 0 / 1 2 . 5 m g , C o - D i o v a n 8 0 / 1 2 . 5 , E s i d r i , F l u i t r a n 2 m g , H y z a a r , I n d a x S R 1 . 5 m g , M I C A R D I S P L U S 4 0 / 1 2 . 5 m g , M y k r o x 0 . 5 m g , N a t r i l i x S R 1 . 5 m g ) I n d u c e d a r r h y t h m i a s L a n o x i n ( D i g o x i n ) 0 . 2 5 m g ( ¸ ¡ ¸ ¸ ¡ ¸ ¸ ¡ ¸ ¸ ¡ ¸ ) T e t r a c y c l i n e ( A c h r o m y c i n ) 2 5 0 m g , D o x y m y c i n 1 0 0 m g , M i n o c y c l i n e D i g o x i n c o n c . m a y b e i n c r e a s e d L a n o x i n ( D i g o x i n ) 0 . 2 5 m g ( ¸ ¡ ¸ ¸ ¡ ¸ ¸ ¡ ¸ ¸ ¡ ¸ ) E r y m y c i n ( E r y t h r o m y c i n ) 2 5 0 m g , K - m y c i n 2 5 0 m g D i g o x i n c o n c . m a y b e i n c r e a s e d L a n o x i n ( D i g o x i n ) 0 . 2 5 m g ( ¸ ¡ ¸ ¸ ¡ ¸ ¸ ¡ ¸ ¸ ¡ ¸ ) S a n d i m m u n 1 0 0 m g , 2 5 m g D i g o x i n c o n c . m a y b e i n c r e a s e d L a n o x i n ( D i g o x i n ) 0 . 2 5 m g ( ¸ ¡ ¸ ¸ ¡ ¸ ¸ ¡ ¸ ¸ ¡ ¸ ) S e t i n e , S e r o x a t D i g o x i n c o n c . m a y b e i n c r e a s e d - 350 - 3 5 7 ¸ , ¸ , ¸ , ¸ , 1 ¸ , ¸ , ¸ , ¸ , 2 _ ¸ [ ) ; ¶ _ ¸ [ ) ; ¶ _ ¸ [ ) ; ¶ _ ¸ [ ) ; ¶ M e s t i n o n 6 0 m g C o r t i c o s t e r o i d s ( M e d n i n 4 m g , M e t h a s o n 5 m g / 1 m L , S h i n c o r t 1 0 m g / 1 m L , M e t h y l p r e d n i s o l o n e 4 0 m g , S o l u - M e d r o l 1 2 5 m g , S o l u - C o r t e f 1 0 0 m g , P r e d n i s o l o n e 5 m g ) A n t a g o n i z e t h e e f f e c t s o f a n t i c h o l i n e s t e r a s e s M e t h o t r e x a t e P e n i c i l l i n s ( A u g m e n t i n , A m o c l a v u n i n 0 . 6 g m , A u g c i n i n j 1 . 2 g m , A m p o l i n i n j . 5 0 0 m g , P e n i c i l l i n G 3 M I U , P i t a m y c i n 2 g m , P r o s t a p h l i n 5 0 0 m g , U n a s y n 1 5 0 0 m g , S u b a c i l l i n 1 5 0 0 m g , A m p i c i l l i n 5 0 0 m g , C l o x a c i l l i n 2 5 0 m g , S u p e r c i l l i n 2 5 0 m g ) I n c r e a s e d M T X t o x i c i t y M e t h o t r e x a t e N S A I D ( K e t o , K e t o p r o f e n , K i l l p a i n 3 0 m g / m L , C a t a f l a m 2 5 m g , E r i c S R 6 0 0 m g , I n d a l g i n ( I n d o m e t h a c i n ) 2 5 m g , M e i t i f e n S . R . F . C 7 5 m g , L a c o x a 4 0 0 m g , L a b u t o n F . C 5 0 0 m g , N a p o s i n 2 5 0 m g , P e i f l a m 5 0 m g , S u l o r i l 2 0 0 m g , V o r e n E . M . C . 5 0 m g ) I n c r e a s e d M T X t o x i c i t y - 351 - 3 5 8 ¸ , ¸ , ¸ , ¸ , 1 ¸ , ¸ , ¸ , ¸ , 2 _ ¸ [ ) ; ¶ _ ¸ [ ) ; ¶ _ ¸ [ ) ; ¶ _ ¸ [ ) ; ¶ M e t h o t r e x a t e B a c i d e ( B a k t a r ) 4 0 0 m g I n c r e a s e d M T X t o x i c i t y M e t h o t r e x a t e S a l i c y l a t e s ( B o k e y 1 0 0 m g , T a p a l 1 0 0 m g ) I n c r e a s e d M T X t o x i c i t y M e t h o t r e x a t e S a l a z o p y r i n 5 0 0 m g I n c r e a s e d M T X t o x i c i t y N i t r a t e s ( I s m o - 2 0 2 0 m g , I s o k e t 1 0 m g / 1 0 m L , N i t r o g l y c e r i n ) C i a l i s 2 0 m g , L e v i t r a 2 0 m g , V i a g r a 5 0 m g , 1 0 0 m g S e v e r e h y p o t e n s i o n m a y o c c u r N o n d e p o l . m u s c l e r e l a x a n t s ( T r a c r i u m 2 5 m g / 2 . 5 m L , P a v u l o n 4 m g / 2 m L , E s m e r o n ) A m i n o g l y c o s i d e s ( T o b r a 8 0 m g / 2 m l , S t r e p t o m y c i n 1 g , G e n t a m y c i n , A m i n f e c 1 2 5 m g / m l 2 m L , N e o m y c i n 2 5 0 m g P O ) R e s i r a t o r y d e p r e s s i o n O r f a r i n ( C o u m a d i n ) 5 m g ( ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ) S a l i c y l a t e s ( B o k e y 1 0 0 m g , T a p a l 1 0 0 m g ) A n t i c o a g u l a n t a c t i v i t y m a y b e e n h a n c e d O r f a r i n ( C o u m a d i n ) 5 m g ( ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ) N S A I D ( K e t o , K e t o p r o f e n , K i l l p a i n , C a t a f l a m 2 5 m g , E r i c S R 6 0 0 m g , L a c o x a 4 0 0 m g , I n d a l g i n 2 5 m g , L e f e n i n e 1 0 0 m g , M e i t i f e n S . R . F . C 7 5 m g , L a b u t o n F . C 5 0 0 m g , N a p o s i n 2 5 0 m g , P e i f l a m 5 0 m g , S u l o r i l 2 0 0 m g , V o r e n E . M . C . 5 0 m g ) I n c r e a s e d a n t i c o a g u l a n t a c t i v i t y O r f a r i n ( C o u m a d i n ) 5 m g ( ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ) C O X - 2 s e l e c t i v e ( C e l e b r e x 2 0 0 m g ) I n c r e a s e d a n t i c o a g u l a n t a c t i v i t y - 352 - 3 5 9 ¸ , ¸ , ¸ , ¸ , 1 ¸ , ¸ , ¸ , ¸ , 2 _ ¸ [ ) ; ¶ _ ¸ [ ) ; ¶ _ ¸ [ ) ; ¶ _ ¸ [ ) ; ¶ O r f a r i n ( C o u m a d i n ) 5 m g ( ¸ ¸ ¬ ¸ ¸ ¬ ¸ ¸ ¬ ¸ ¸ ¬ ¸¸¸ ¸ ) A n t i n e o p l a s t i c a g e n t s ( 5 - F l u o r o u r a c i l 1 0 0 0 m g , G e m z a r 2 0 0 m g , E n d o x a n - A s t a ) A n t i c o a g u l a n t e f f e c t m a y b e i n c r e a s e d O r f a r i n ( C o u m a d i n ) 5 m g ( ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ) P h e n o b a r b i t a l 3 2 m g ( ((( ( 4 ) R e d u c e t h e e f f e c t s o f a n t i c o a g u l a n t s O r f a r i n ( C o u m a d i n ) 5 m g ( ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ) C o r d a r o n e H y p o p r o t h r o m b i n e m i c e f f e c t O r f a r i n ( C o u m a d i n ) 5 m g ( ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ) Q u i n i d i n e 2 0 0 m g H e m o r r h a g e c o u l d o c c u r O r f a r i n ( C o u m a d i n ) 5 m g ( ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ) A z o l e a n t i f u n g a l a g e n t s ( D i f l u c a n , K e t a z o l e 2 0 0 m g ) A n t i c o a g u l a n t e f f e c t m a y b e i n c r e a s e d O r f a r i n ( C o u m a d i n ) 5 m g ( ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ) Q u i n o l o n e s ( C i p r o x i n , S u p e r o c i n , C i n o l o n e , C r a v i t , A v e l o x ) A n t i c o a g u l a n t e f f e c t m a y b e i n c r e a s e d O r f a r i n ( C o u m a d i n ) 5 m g ( ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ) T e t r a c y c l i n e s ( T e t r a c y c l i n e 2 5 0 m g , D o x y m y c i n 1 0 0 m g , M i n o c y c l i n e ) A n t i c o a g u l a n t e f f e c t m a y b e i n c r e a s e d O r f a r i n ( C o u m a d i n ) 5 m g ( ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ) M a c r o l i d e a n t i b i o t i c s ( K - m y c i n 2 5 0 m g , E r y m y c i n 2 5 0 m g , Z i t h r o m a x 2 5 0 m g ) A n t i c o a g u l a n t e f f e c t m a y b e i n c r e a s e d O r f a r i n ( C o u m a d i n ) 5 m g ( ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ) S u l f o n a m i d e s ( B a c i d e 4 0 0 m g , S e v a t r i m ) A n t i c o a g u l a n t e f f e c t m a y b e e n h a n c e d O r f a r i n ( C o u m a d i n ) 5 m g ( ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ) C i m e t i d i n e ( C i m e w e l l 4 0 0 m g , D e f e n s e F . C 3 0 0 m g , G a s t r o d i n ) P o s s i b l e h e m o r r h a g e - 353 - 3 6 0 ¸ , ¸ , ¸ , ¸ , 1 ¸ , ¸ , ¸ , ¸ , 2 _ ¸ [ ) ; ¶ _ ¸ [ ) ; ¶ _ ¸ [ ) ; ¶ _ ¸ [ ) ; ¶ O r f a r i n ( C o u m a d i n ) 5 m g ( ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ) F i b r i c a c i d s ( F e n o f i b r a t e 1 0 0 m g , F e n o l i p 2 0 0 m g , L i p a n t h y l 2 0 0 m g , L i p d o w n 3 0 0 m g , L i p o l i n 1 0 0 m g ) M a y i n c r e a s e t h e h y p o p r o t h r o m b i n e m i c e f f e c t s O r f a r i n ( C o u m a d i n ) 5 m g ( ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ) E l t r o x i n 1 0 0 m c g A n t i c o a g u l a n t a c t i o n m a y b e c h a n g e d O r f a r i n ( C o u m a d i n ) 5 m g ( ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ) T h i o a m i n e s ( H o n t a n , P r o c i l 5 0 m g ) A n t i c o a g u l a n t a c t i o n m a y b e c h a n g e d O r f a r i n ( C o u m a d i n ) 5 m g ( ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ) M e t r o z o l e 2 5 0 m g ( ___ _ ) ( ¡¡¡ ¡ ) A n t i c o a g u l a n t e f f e c t m a y b e i n c r e a s e d O r f a r i n ( C o u m a d i n ) 5 m g ( ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ) S a l a z o p y r i n 5 0 0 m g A n t i c o a g u l a n t e f f e c t m a y b e e n h a n c e d O r f a r i n ( C o u m a d i n ) 5 m g ( ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ¸ ¸ ¬ ¸ ) S u l f i n p y r a z o n e 1 0 0 m g H e m o r r h a g e c o u l d o c c u r P e n i c i l l i n s ( A m o c l a v u n i n 0 . 6 g m , A m p i c i l l i n 5 0 0 m g , A m p o l i n i n j . 5 0 0 m g , A n s u l l i n a 1 . 5 G m , A u g c i n i n j 1 . 2 g m , A u g m e n t i n , C l o x a c i l l i n 2 5 0 m g , P e n i c i l l i n G 3 M I U , P i t a m y c i n 2 g m , P r o s t a p h l i n , S u b a c i l l i n , S u p e r c i l l i n 2 5 0 m g , U n a s y n 1 5 0 0 m g ) T e t r a c y c l i n e ( A c h r o m y c i n ) 2 5 0 m g , D o x y m y c i n 1 0 0 m g , M i n o c y c l i n e ) A c t i o n o f p e n i c i l l i n s c o u l d b e r e d u c e d P l a v i x 7 5 m g B o k e y 1 0 0 m g , T a p a l 1 0 0 m g I n c r e a s e d r i s k o f s i d e e f f e c t s P r o g e s t i n s ( U t r o g e s t a n 1 0 0 m g , P r i m o l u t - N o r 5 m g , P r o v e r a 5 m g , P r o g y l u t o n , T r i s e q u e n s , I n d i v i n a ) R i f a m p i n , R i f i n a h P r o g e s t i n e f f e c t s m a y b e d e c r e a s e d Q u i n i d i n e 2 0 0 m g A v e l o x , C r a v i t P r o l o n g Q T c i n t e r v a l Q u i n i d i n e 2 0 0 m g C o r d a r o n e Q u i n i d i n e c o n c . m a y b e i n c r e a s e d - 354 - 3 6 1 ¸ , ¸ , ¸ , ¸ , 1 ¸ , ¸ , ¸ , ¸ , 2 _ ¸ [ ) ; ¶ _ ¸ [ ) ; ¶ _ ¸ [ ) ; ¶ _ ¸ [ ) ; ¶ Q u i n i d i n e 2 0 0 m g V e r a p a m i l , V e r e l a n 1 2 0 m g * * H y p o t e n s i o n , b r a d y c a r d i a , A V b l o c k m a y o c c u r R e d u c t i l 1 0 m g ( ___ _ ) D e m e r a l H c l 5 0 m g / 1 c c S e r o t o n i n s y n d r o m e m a y o c c u r R e d u c t i l 1 0 m g ( ___ _ ) S e r o t o n i n r e u p t a k e i n h i b i t o r s ( E f e x o r X R , Y o u - J e t 5 0 m g , U - Z e t 2 0 m g , Z o l o f t 5 0 m g ) S e r o t o n i n s y n d r o m e m a y o c c u r R e d u c t i l 1 0 m g ( ___ _ ) E r g o t a l k a l o i d s ( E l m e s a t t 2 m g , H o d r i n 1 . 5 m g , S e g l o r R e t a r d 5 m g ) S e r o t o n i n s y n d r o m e m a y o c c u r R e d u c t i l 1 0 m g ( ___ _ ) F u c o u , D e l c o p a n S e r o t o n i n s y n d r o m e m a y o c c u r R e d u c t i l 1 0 m g ( ___ _ ) L i d i n 3 0 0 m g S e r o t o n i n s y n d r o m e m a y o c c u r R i s d o n 2 m g , R i s p e r d a l S e r o x a t 2 0 m g , S e t i n e F . C . 2 0 m g R i s p e r i d o n e c o n c . m a y b e i n c r e a s e d R o c e p h i n 5 0 0 m g , S i n t r i x I n j . 1 g m 1 0 % C a l g l o n ( C a l G l u c o n a t e ) , L - R i n g e r 5 0 0 m L , R i n g e r 5 0 0 m L , ) ÿ ( _ ¸ , , { + [ ¸ } [ , ) ÿ ( _ ¸ , , { + [ ¸ } [ , ) ÿ ( _ ¸ , , { + [ ¸ } [ , ) ÿ ( _ ¸ , , { + [ ¸ } [ S a n d i m m u n D i l a n t i n C y c l o s p o r i n e c o n c . m a y b e d e c r e a s e d S a n d i m m u n R i f a m p i n , R i f i n a h C y c l o s p o r i n e c o n c . m a y b e d e c r e a s e d S e r o t o n i n r e u p t a k e i n h i b i t o r s ( K i t a p r a m 2 0 m g , L e x a p r o 1 0 m g , L o t e , S e t i n e F . C . 2 0 m g , S e r o x a t 2 0 m g , Z o l o f t 5 0 m g , Y o u - J e t 5 0 m g , U - Z e t 2 0 m g , U l t i d e p 2 0 m g , E f e x o r X R ) T r a m a l S e r o t o n i n s y n d r o m e m a y o c c u r - 355 - 3 6 2 ¸ , ¸ , ¸ , ¸ , 1 ¸ , ¸ , ¸ , ¸ , 2 _ ¸ [ ) ; ¶ _ ¸ [ ) ; ¶ _ ¸ [ ) ; ¶ _ ¸ [ ) ; ¶ S e r o t o n i n r e u p t a k e i n h i b i t o r s ( K i t a p r a m 2 0 m g , L e x a p r o 1 0 m g , L o t e , S e t i n e F . C . 2 0 m g , S e r o x a t 2 0 m g , Z o l o f t 5 0 m g , Y o u - J e t 5 0 m g , U - Z e t 2 0 m g , U l t i d e p 2 0 m g , E f e x o r X R ) Z y v o x 6 0 0 m g / 3 0 0 m L ( ___ _ ) S e r o t o n i n s y n d r o m e m a y o c c u r S e r o t o n i n r e u p t a k e i n h i b i t o r s ( K i t a p r a m 2 0 m g , L e x a p r o 1 0 m g , L o t e , S e t i n e F . C . 2 0 m g , S e r o x a t 2 0 m g , Z o l o f t 5 0 m g , Y o u - J e t 5 0 m g , U - Z e t 2 0 m g , U l t i d e p 2 0 m g , E f e x o r X R , C y m b a l t a 3 0 m g ) P a r k r y l 5 m g S e r o t o n i n s y n d r o m e m a y o c c u r S p i r o t o n e ( A l d a c t o n ) 2 5 m g A C E I n h i b i t o r s ( A c e r t i l 4 m g , P l u s A c e r t i l 4 m g / 1 . 2 5 m g , C a p o t e n 2 5 m g , F o n i t e c 2 0 m g , M o n o p r i l 1 0 m g , N o p r i s i l 1 0 m g , R a m i t a c e 2 . 5 m g , R e n i t e c , T a n a t r i l 5 m g , Z e s t r i l 1 0 m g ) S e v e r e h y p e r k a l e m i a S p i r o t o n e ( A l d a c t o n ) 2 5 m g A R B ( B l o p r e s s , A p r o v e l , C o a p r o v e l , D i o v a n , C o - d i o v a n , C o z a a r , H y z a a r , M i c a r d i s ( P l u s ) , O l m e t i c ) S e r u m p o t a s s i u m T e g r e t o l 2 0 0 m g , T r i l e p t a l 3 0 0 m g K - m y c i n 2 5 0 m g C a r b a m a z e p i n e t o x i c i t y m a y b e i n c r e a s e d T e g r e t o l 2 0 0 m g , T r i l e p t a l 3 0 0 m g E r y m y c i n ( E r y t h r o m y c i n ) 2 5 0 m g C a r b a m a z e p i n e t o x i c i t y m a y b e i n c r e a s e d - 356 - 3 6 3 ¸ , ¸ , ¸ , ¸ , 1 ¸ , ¸ , ¸ , ¸ , 2 _ ¸ [ ) ; ¶ _ ¸ [ ) ; ¶ _ ¸ [ ) ; ¶ _ ¸ [ ) ; ¶ - a d r e n e r g i c b l o c k e r s ( T e z o p i n 2 m g , T a m s o S R 0 . 2 m g , W e s o n 2 m g , H a r n a l i d g e D 0 . 2 m g , D o s a b i n 2 m g , D o x a b e n 2 m g , D o x a b e n X L , X a t r a l X L ) C i a l i s 2 0 m g ( ___ _ ) B P - l o w e r i n g e f f e c t m a y b e i n c r e a s e d - b l o c e r s ( T e n o l o l 1 0 0 m g , T e n o r m i n 1 0 0 m g , S e c t r a l 4 0 0 m g , I n d e r a l 1 0 m g , 4 0 m g , B e x o l o 2 0 m g ) V e r a p a m i l ( I s o p t i n ) 5 m g / 2 m L , V e r e l a n 1 2 0 m g B o t h d r u g s m a y i n c r e a s e d e f f e c t s F r o m D r u g I n t e r a c t i o n F a c t s 2 0 0 8 - 357 - 364 ¡,¬ ¡,¬ ¡,¬ ¡,¬ ¸¦,¸_,¦¬ÿ]¸,___ ¸¦,¸_,¦¬ÿ]¸,___ ¸¦,¸_,¦¬ÿ]¸,___ ¸¦,¸_,¦¬ÿ]¸,___ ¸¦ ¸¦ ¸¦ ¸¦ ¸¸,¸¸¸¸¸ ¸¸,¸¸¸¸¸ ¸¸,¸¸¸¸¸ ¸¸,¸¸¸¸¸ ¸¸¦¬ÿ] ¸¸¦¬ÿ] ¸¸¦¬ÿ] ¸¸¦¬ÿ] ¡¦¬ÿ] ¡¦¬ÿ] ¡¦¬ÿ] ¡¦¬ÿ] ,___ ,___ ,___ ,___ Amikacin Peak 20-30µg/mL Trough 5-10µg/mL Peak 30 ,¸¸|¡,;±_¡¸30 , ¸¦¬¸³¸|¡,¡¦_-¸ÿ¦¬¸ Trough ,¸¸10 ,¸ 1-2 days ¿¿¡¸¸¸ penicillins (¦ carbenicillin) ,) Gentamicin Tobramycin Peak 4-8µg/mL Trough 0.5-2µg/mL Peak 30 ,¸¸|¡,;±_¡¸30 ,¸¦¬¸³¸|¡,¡¦_-¸ÿ¦¬¸ Trough ,¸¸30 ,¸ 1-2 days Vancomycin Peak 20-30µg/mL Trough 5-15µg/mL Peak ¸|¡,;±_2 ¸ÿ¦¬ Trough ,¸¸ 1-2 days Phenytoin (Dilantin) 10-20µg/mL 6-14µg/mL (<3 ¦}¸_¸ Steady state ¡_,¸¸¸_,__¸¸ -¸_ Peak +g_1.5-3 ¸ÿ¦¬ Trough ,¸¸ ¸¸-¸ <1yr: 5days )+g¸{¸¸ ¸¿__,trough ¸¸³¸ Phenobarbital (Luminal) 15-40µg/mL Steady state ¡_,¸¸¸_,__¸¸ 10 ¸_ Peak +g_6-18 ¸ÿ¦¬ Trough ,¸¸ ¸¸10 ¸ )+g¸{¸¸ ¸¿__,trough ¸¸³¸ Carbamaze- pine (Tegretol) 4-10µg/mL Steady state ¡_,¸¸¸_,__¸¸ 2-6 ¸_ Trough ,¸¸ 2-6 days )+g¸{¸¸ ¸¿__,trough ¸¸³¸ Valproic acid (Depakine) 50-100µg/mL Steady state ¡_,¸¸¸_,__¸¸ 2-4 ¸_ Trough ,¸¸ 2-4 days )+g¸{¸¸ ¸¿__,trough ¸¸³¸ Digoxin (Lanoxin) 0.9-2.2ng/mL Steady state ¡_,¸¸¸_,__¸¸ 5-7 ¸_ Trough ,¸¸ ¸}ÿ¡+g_6 - 8 ¸ÿ·¸,_4 - 6 ¸ÿ 5-7 days )+g¸{¸¸ ¸¿__,trough ¸¸³¸ Lithium (Lidin) 0.4-1.5 mEq/L Steady state ¡_,¸¸¸_,__¸¸ 3-5 ¸_ Trough ,¸¸ 3-5 days )+g¸{¸¸ ¸¿__,trough ¸¸³¸ Theophylline 5-15µg/mL 6-11µg/mL (]¸_¸ Steady state ¡_,¸¸¸_,__¸¸ 2 ¸_<1 ¸(5 days Peak ¡¡¸_¬+g_2 ¸ÿ¦¬¸¦ ¸_¬+g_4 ¸ÿ¦¬¸¸,}±_\ }¦¬ Trough ,¸¸ 2-5 days )+g¸{¸¸ ¸¿__,trough ¸¸³¸ - 358 - 366 Creatinine clearance formulas Formulas for estimating creatinine clearance in patients with stable renal function Adults [age 18 years and older] (140-Age)(Weight) Cl cr (Females)0.85 Above value Where Cl cr =creatinine clearance in ml/min Crs=serum creatinine in mg/dl Age is in years Weight is in kg Children [age 1-18years] 0.48(Height)(BSA) Where BSA=body surface area in m 2 Cl cr =creatinine clearance in ml/min Crs=serum creatinine in mg/dl Height is in cm Formula for estimating creatinine clearance from a measured urine collection Where Uconcentration of creatinine in a urine specimen (in same units as P) Vvolume of urine in ml Pconcentration of creatinine in serum at the midpoint of the urine collection period (in same units as U) ttime of the urine collection period in minutes Cl cr (Males) Cr s 72 Clcr (Males) Crs 1.73 CLcr (ml/min) U V P t - 359 - 367 Ideal body weight IBW is the weight expected for a nonobese person of a given height. The IBW formulas below and various life insurance tables can be used to estimate IBW. Most dosing methods described in the literature use IBW as a method in dosing obese patients. Adults [age 18 years and older] IBW (Males)=50(2.3height in inches over 5 feet) IBW (Females)45.5(2.3height in inches over 5 feet) Where IBW is in kg. Children [age 1-18 years] Under 5 feet tall: IBW Where IBW is in kg; Height is in cm. 5 feet or taller: IBW (males)39(2.27height in inches over 5 feet) IBW (females)42.2(2.27height in inches over 5 feet) Where IBW is in kg (Height 2 1.65) 1000 - 360 - ¡,¬. ¡,¬. ¡,¬. ¡,¬. z)¡¸¸ z)¡¸¸ z)¡¸¸ z)¡¸¸ Laboratory Test Reference Range for Adults Acid phosphatase 0-8 IU/L Acrivated partial thromboplastin time (aPTT) 25-40 sec Adrenocorticotropic hormone (ACTH) 15-80 pg/mL Alanine aminotransferase (ALT) 5-35 IU/L Albumin 3.5-5.0 g/dL Alkaline phosphatase 30-120 IU/L Alpha-fetoprotin (AFP) 0-20 ng/mL Ammonia 15-45 mg/dL Amylase 0-130 IU/L Anion gap 8-16 mEq/L Antidouble-stranded DNA (anti-ds DNA) Negative Anti-HAV Negative Anti-HBc Negative Anti-HBs Negative Anti-HCV Negative Anti-Sm antibody Negative Antinuclear antibody (ANA) Negative at 1:20 dilution Aspartate aminotransferase (AST) 5-40 IU/L 2 -microglobulin 0.6-2.0 mg/dL Bilirubin, direct 0.1-0.3 mg/dL Bilirubin , indirect 0.1-1.0 mg/dL Bilirubin , total 0.1-1.2 mg/dL Bleeding time 3-7 min Blood gases, arterial (ABG) PH 7.35-7.45 pC 2 35-45 mm Hg pO 2 80-100 mm Hg HCO 3 22-26 mEq/L O 2 saturation (Sao 2 ) 95% Blood urea nitrogen (BUN) 5-25 mg/dL - 361 - 369 Laboratory Test Reference Range for Adults BUN-to-creatinine ratio 10:1-20:1 C-reactive protein 0.0-0.8 mg/dL CA-125 35 IU/mL CA 15-3 22 U/mL CA 27.29 38 U/mL Calcium, ionized 4.4-5.9 mg/dL; 2.2-2.5 mEq/L Calcium, total 9-11 mg/dL; 4.5-5.5 mEq/L Carboxyhemoglobin 3% Carcinoembryonic antigen (CEA) 3 ng/mL non-smokers; 0-6 ng/mL non-smokers CD4 lymphocyte count 31-61% of total lymphocytes CD8 lymphocyte count 18-39% of total lymphocytes Cerebrospinal fluid (CSF) Pressure 75-175 mm H 2 O Glucose 30-80 mg/dL Protein 15-45 mg/dL WBC 10/mm 3 Chloride 95-105 mEq/L Cholesterol, HDL 40 mg/dL (low) 60 mg/dL (high) Cholesterol, LDL 100 mg/dL (optimal), 100-129 mg/dL (near or above optimal), 130-159 mg/dL (borderline high) 160-189 mg/dL(high) 190 mg/dL (very high) Cholesterol, total 200 mg/dL(desirable) 200-239 mg/dL (borderline high) 240 mg/dL( high) CO 2 content 22-30 mEq/L Complement complement 3 (C3) 70-160 mg/dL Complement complement 4 (C4) 20-40 mg/dL Copper 70-150 µg/dL Cortisol (serum) 8:00 AM to 10:00 AM 5-23 µg/dL 4:00 PM to 6:00 PM 3-13 µg/dL Cortisol, free (urine) 10-110 µg/24h - 362 - 3 Laboratory Test Reference Range for Adults Creatine phosphokinase (CPK, CK) 30-180 IU/L CK-MB 5% in myocardial infarction Creatine clearance (CLCr, urine) 85-135 mL/ mim Creatine, serum 0.5-1.5 mg/dL Cryptococcal antigen 1:8 D-dimers 200 ng/mL Dexamethasone suppression test cortisol 10 µg/dL (8:00 AM) DHEAS 1-12 µmol/L Digoxin,therapeutic 0.8 ng/mL Erythrocyte sedimentation rate (ESR) Westergren 0-20 mm/h (men); 0-30 mm/h (women) Wintrobe 0-9 mm/h(men); 0-15 mm/h (women) Erythropoietin 2-25 IU/L; 2-25 mIU/mL Ethanol, legal intoxication 50-100 mg/dL; 0.05-0.1 % Ethosuccimide, therapeutic 40-100 mg/L Ferritin 2-20 µg/dL; 20-200 ng/mL Fibrin degredation products (FDP) 2-10 mg/L Fibrinogen 200-400 mg/ dL Folic acid 0.2-1.0 µg/dL; 2-10 ng/mL Folic acid (RBC) 165-760 ng/mL Follicle-stimulating hormone (FSH) 30-100 mlU/mL (postmenopausal women) 5-22 mlU/mL (women,midcycle) Free thyroixin index (FT 4 I) 6.5-12.5 Gamma glutamyl transferase (GGT) 0-30 lU/L Globulin 2.3-3.5 g/dL Glucose,fasting (FBG) 70-110 mg/dL Glucose, two-hour postprandial blood (PPBG) 140 mg/dL Haptoglobin 60-270 mg/dL HbeAg Negative HbsAg Negative - 363 - 371 Laboratory Test Reference Range for Adults HBV DNA Negative Hematocrit 40-50 % men 36-46 % women Hemoglobin 13.5-17.5 g/dL men 12 - 16 g/dL women Hemoglobin A 1c (HbA 1c ) 3.8-6.4% Homocysteine 3.3-10.4 µmoI/L Internation normalized ration (INR), therapeutic 2.0-3.0 (2.5-3.5 for some indication) Iron, serum 50-160 µg/dL men 40-150 µg/dL women Lactate 0.5-1.5 mEq/L Lactate dehydrogenase (LDH) 100-190 IU/L Lidocaine , therapeutic 1.5-6.0 mg/L Lipase 20-180 IU/L Lithium,therapeutic 0.5-1.25 mEq/L Luteinizing hormone (LH) 24-105 mIU/mL (midcycle peak) Magnesium 1.8-3.0 mg/dL; 1.5-2.5 mEq/L Mean corpuscular hemoglobin (MCH) 26-34 pg Mean corpuscular hemoglobin concentration (MCHC) 31-37 g/dL Mean corpuscular volume (MCV) 80-100 µ m Osmolality (serum) 280-300 mOsm/kg Osmolality (ueine) 200-800 mOsm/kg Parathyroid hormone (PTH), Intact 10-65 pg/mL Parathyroid hormone (PTH), N-terminal 8-24 pg/mL Parathyroid hormone (PTH), C-terminal 50-300 pg/mL Phosphorus 2.5-4.5 mg/dL; 1.7-2.6 mEq/L Platelet count 150-400 × 10/mm Potassium 3.5-5.0 mEq/L Prealbumin (transthyretin) 10-40 mg/dL Prolactin 20 ng/mL or mg/L - 364 - 32 Laboratory Test Reference Range for Adults Prostate-specific antigen (PSA) 0-4 ng/mL Protein, total 6.0-8.0 g/dL Prothrombin time (PT) 10-12 sec Radioactive iodine uptake (RAIU) 6% in 2 hours Red blood cell (RBC) count, 4.6-6.0 ×10 6 /mm 3 (men) 4.0to 5.0 ×10 6 /mm 3 (women) Red blood cell (RBC) folic acid 165-760 ng/mL Red cell distribution width (RDW) 11.5-14.5% Retinculocyte count 0.5-1.5% of total RBC count Retinal-binding protein (RBP) 2.7-7.6 mg/dL Rheumatoid factor (RF) titer 1:20 Sodium 135-145 mEq/L Testosterone, total 3-1.0 ng/mL men 00.3-1.0 ng/mL Testosterone, free 40 pmol/L(men) 22.4-12.5 pmol/L (women) Thrombin time 20-24 sec Thyroid-stmulating hormone (THS) 0.3-0.5 mIU/L Thyroid-binding globulin (TBG) 10-26 µg/dL Thyroxine(T 4 ),free 0.8-2.8 ng/dL Thyroxine(T 4 ),total 4.5-11.5 µg/dL Thyroxine-binding prealbumin (transthyretin) 10-40 mg/dL Thyroxine index, free (FT 4 I) 6.5-12.5 Total iron-binding capacity (TIBC) 250-450 µg/dL Transferrin 200-430 mg/dL Transferrin saturaton 30 to 50% Transthyretin (thyroxine-binding preadlbumin) 10-40 mg/dL Triglycerides <150 mg/dL (normal) 150-199 mg/dL (borderline high) 200-499 mg/dL (high) 500mg/dL (very high) Triiodothyronine (T 3 ) 75-200 ng/dL Triiodothyyronine(T 3 ) resin uptake 25-35% Tropoin-I (cardiac) <1.5 ng/mL TSH receptor antibodies (TSH Rab) 0-1 U/mL Uric acid 3.5-8.0 mg/dL - 365 - 373 Laboratory Test Reference Range for Adults Urindlysis (urine) PH Specific gravity Protein Glucose Ketones RBC WBC Casts 4.5-8.0 1.005-1.030 Negative Negative Negative 1-2 per low-power field 3-4 per low –power field Occasional hyaline Urobilinogen (urine) 0.5-4.0 Ehrlich Units/24h Vitamin A (retinal) 30-95 µg/dL Vitamin B 12 200-900 pg/mL Vitamin D 3 , 1,25-dihydroxy 20-76 pg/mL Vitamin E (alpha tocopherol) 5-20 pg/L White blood cell (WBC) count, 4.5-10.0 ×10 3 /mm 3 WBC differential (peripheral blood) Polymorphnuclear neutrophils 50-65 % Bands 0-5 % Eosinophils 0-3 % Basophils 1-3 % Lymphocytes 25-35 % Monocytes 2-6 % WBC differential (bone marrow) Polymorphnuclear neutrophils 3-11 % Bands 9-15 % Metamyelocytes 9-25 % Myelocytes 8-16 % Promyelocytes 1-8 % Myeloblasts 0-5 % Eosinophils 1-5 % Basophils 0-1 % Lymphocytes 11-23 % Monocytes 0-1 % Zn 60-150 µg/dL - 366 -