Tuesday, May 27, 2014

Frusemide

FRUSEMIDE-PS

frusemide 20 mg & 40 mg tablets
Consumer Medicine Information

What is in this leaflet

This leaflet answers some common questions about FRUSEMIDE-PS. It does not contain all the available information.
It does not take the place of talking to your doctor or pharmacist.
All medicines have risks and benefits. Your doctor has weighed the risks of you taking FRUSEMIDE-PS against the benefits it is expected to have for you.
If you have any concerns about taking this medicine, ask your doctor or pharmacist.
Keep this leaflet with the medicine. You may need to read it again.

What FRUSEMIDE-PS is used for

FRUSEMIDE-PS is a water tablet (or diuretic). It may be taken alone, or together with other medicines.
One of its uses is to help reduce the amount of water in the body for people who have:
  • swelling of the ankles, feet and legs, which doctors call oedema
  • swelling of the stomach area due to liver disease.
FRUSEMIDE-PS also helps lower high blood pressure, which doctors call hypertension.
Everyone has blood pressure. This pressure helps circulate the blood around your body. Your blood pressure may be different at different times of the day, depending on how busy or worried you are. You have hypertension (high blood pressure) when your blood pressure stays higher than is needed, even when you are calm and relaxed.
There are usually no symptoms of hypertension. The only way of knowing that you have hypertension is to have your blood pressure checked on a regular basis. If high blood pressure is not treated it can lead to serious health problems. You may feel fine and have no symptoms, but eventually hypertension can cause stroke, heart disease and kidney failure. FRUSEMIDE-PS helps to lower your blood pressure.
FRUSEMIDE-PS works by making your kidneys pass more water and salt. This helps reduce high blood pressure and some forms of swelling.
Your doctor may prescribe FRUSEMIDE-PS for another reason. Ask your doctor if you have any questions about why FRUSEMIDE-PS has been prescribed for you.
There is no evidence that FRUSEMIDE-PS is addictive.

Before you start to take FRUSEMIDE-PS tablets

When you must not take it

Do not take FRUSEMIDE-PS if:
  • You have an allergy to frusemide or any of the ingredients listed at the end of this leaflet or any other sulfonamide type medication. Usual symptoms of allergy are skin rash, itching, redness or other discolouration of the skin.
  • You are pregnant, or intend to become pregnant. FRUSEMIDE-PS may affect your developing baby if you take it during pregnancy.
  • You have severe kidney disease
  • The expiry date (EXP) printed on the pack has passed. If you take this medicine after the expiry date has passed it may not work, or it may make you sick.
  • The packaging is torn or shows signs of tampering
If you are not sure whether you should start taking FRUSEMIDE-PS, talk to your doctor.

Before you start to take it

You must tell your doctor if you have any allergies to any other medicines or any other substances, such as foods, preservatives or dyes.
Tell your doctor or pharmacist if you have any of these medical conditions
  • diabetes mellitus
  • liver disease
  • heart and lung disease
  • kidney disease
  • prostrate problems
  • gout
  • any other medical conditions or if you are on salt restricted diet.
Tell your doctor or pharmacist if you are breast-feeding or intend to breast-feed. FRUSEMIDE-PS passes into breast milk. Your doctor will decide whether or not you should take FRUSEMIDE-PS.
Tell your doctor or pharmacist if you are pregnant or intend to become pregnant. Your doctor will discuss the possible risks of using FRUSEMIDE-PS during pregnancy.

Taking other medicines

Tell your doctor if you are taking any other medicines, including any that you have bought from your pharmacy, supermarket or health food shop.
Some of the medicines in common use that may interfere with FRUSEMIDE-PS include:
  • digoxin for heart conditions
  • steroids such as cortisone, prednisone, dexamethasone
  • laxatives for constipation
  • some antibiotics for treating infections
  • theophylline for respiratory diseases
  • medicines for epilepsy
  • medicines for diabetes
  • lithium for mood disorders
  • medicines for arthritis such as aspirin, NSAIDs
  • medicines for high blood pressure, especially ACE inhibitors
  • liquorice when consumed in large amounts.
These medicines may be affected by FRUSEMIDE-PS, or may affect how well it works. You may need to take different amounts of your medicine, or you may need to take different medicines. Your doctor or pharmacist has a more complete list of medicines to avoid while taking FRUSEMIDE-PS.
If you have not told your doctor about any of the above, tell them before you take any FRUSEMIDE-PS.

How to take FRUSEMIDE-PS tablets

How much to take

Take FRUSEMIDE-PS only when prescribed by your doctor. Your doctor will tell you how many tablets you need to take each day.
The number will depend on your condition and whether you are taking other medicines. Do not take more tablets than your doctor has prescribed.
Your doctor will follow your progress and adjust the dose accordingly.
If you do not understand the instructions on the label, ask your doctor or pharmacist for help.

How to take it

Swallow FRUSEMIDE-PS with a glass of water .

When to take it

Take your FRUSEMIDE-PS every day at about the same time each day, unless your doctor tells you otherwise.
Taking your tablets at the same time each day will have the best effect. It will also help you to remember when to take the tablets.
If you are taking a single dose a day, take it in the morning, for example at breakfast time.
If you are taking more than one dose a day, take the last dose no later than 6 pm, unless your doctor tells you otherwise.
FRUSEMIDE-PS will increase the amount of water (urine) you pass and also the number of times you go to the toilet. By taking the last dose no later than 6 pm there may be less chance of your sleep being disturbed.

How long to take it

If you have high blood pressure or swelling, FRUSEMIDE-PS helps to control the condition but does not cure it. Therefore, FRUSEMIDE-PS must be taken every day. Continue taking FRUSEMIDE-PS for as long as your doctor prescribes.

If you forget to take it

Take it as soon as you remember, and then go back to taking your tablets as you would normally. However, if it is almost time for your next dose, skip the dose you missed and take your next dose when you are meant to.
Do not take a double dose to make up for the dose that you missed.
If you have trouble remembering to take your tablets, ask your pharmacist for some hints.

If you take too much (overdose)

Immediately telephone your doctor or Poisons Information Centre (13 11 26), or go to casualty at your nearest hospital, if you think that you or anyone else may have taken too much FRUSEMIDE-PS. Do this even if there are no signs of discomfort or poisoning. Keep telephone numbers of these places handy.
If you take too many tablets, you will probably feel light-headed or dizzy. You may also become very thirsty, confused, have a change in the amount of urine passed or have a fast heart beat.

While you are using FRUSEMIDE-PS tablets

Things you must do

Have your blood pressure checked when your doctor says to make sure FRUSEMIDE-PS is working.
Tell your doctor and pharmacist that you are taking FRUSEMIDE-PS if you are about to be started on any new medicine.
Get up slowly when getting out of bed or standing up if you feel light-headed, dizzy or faint.
You may feel light-headed or dizzy when you begin to take FRUSEMIDE-PS. This is because your blood pressure is falling suddenly. Standing up slowly, especially when you get up from bed or chairs, will help your body get used to the change in position and blood pressure.
Tell your doctor if you have excessive vomiting and/or diarrhoea while taking FRUSEMIDE-PS, or you have any of the following symptoms:
  • dry mouth, thirst
  • weakness, tiredness, drowsiness
  • muscle pains or cramps
  • fast heart beat
  • passing less urine than normal
You may be dehydrated because you are losing too much water.
Tell your doctor or dentist that you are taking FRUSEMIDE-PS if you plan to have surgery (even at the dentist) that needs a general anaesthetic. Your blood pressure may drop suddenly.

Things you must not do

Do not stop taking FRUSEMIDE-PS or lower the dose because you are feeling better, unless advised to by your doctor.
Do not give FRUSEMIDE-PS to anyone else even if their symptoms seem similar to yours.
Do not give FRUSEMIDE-PS to a child, as there have been no studies into its effects in children.

Things to be careful of

Be careful driving or operating machinery until you know how FRUSEMIDE-PS affects you.
FRUSEMIDE-PS may cause dizziness or light-headedness in some people, especially after the first few doses. Make sure you know how you react to FRUSEMIDE-PS before you drive a car, operate machinery, or do anything else that could be dangerous if you are dizzy or light-headed. If you drink alcohol, dizziness or light-headedness may be worse.
Talk to your doctor about foods or drinks that have a high potassium content.
Long term FRUSEMIDE-PS therapy causes a fall
in potassium levels in your body. However, if you eat foods or have drinks that are high in potassium this will help maintain normal levels of potassium in your body. Too much potassium can, however, be harmful, therefore, it is important to discuss your diet with your doctor.

Things that would be helpful for your blood pressure

Some self help measures suggested below may help your blood pressure. Talk to your doctor or pharmacist about these measures and for more information.
  • Alcohol - your doctor may advise you to limit your alcohol intake.
  • Diet - eat a healthy diet that includes plenty of fresh vegetables, fruit, bread, cereals and fish. Also eat less fat and sugar.
  • Exercise - regular exercise helps to reduce blood pressure. Try regular walking, swimming, cycling or games such as tennis and golf. Before starting any exercise, ask your doctor about the best kind of program for you.
  • Salt - your doctor may advise you to watch the amount of salt in your diet. To reduce your salt intake you should avoid using salt in cooking or at the table.
  • Smoking - your doctor may advise you to stop smoking or at least cut down.
  • Weight - your doctor may suggest losing some weight to help lower your blood pressure. Some people may need a dietician’s help to lose weight.

Side Effects

Tell your doctor or pharmacist as soon as possible if you do not feel well while you are taking FRUSEMIDE-PS.
FRUSEMIDE-PS helps most people, but it may have unwanted side effects in a few people. All medicines can have side effects. Sometimes they are serious, most of the time they are not. You may need medical treatment if you get some of the side effects.
Ask your doctor or pharmacist to answer any questions you may have.
Tell your doctor if you notice any of the following and they worry you:
  • nausea
  • vomiting
  • stomach pain
  • constipation, diarrhoea
  • dizziness
  • headache
  • dry mouth
These are mild side effects of FRUSEMIDE-PS.
Tell your doctor immediately if you notice any of the following:
  • muscle cramps
  • weakness
  • skin rash, itching
  • ringing in your ears (tinnitus)
  • loss of hearing
  • chest pain or tightness
  • fever
  • blurred vision
  • changes in the way your heart beats
  • yellowing of the skin and eyes, also called jaundice
  • unusual bruising or bleeding
  • increasing frequency of infections such as fever, severe chills, sore throat or mouth ulcers
These are serious side effects. You may need urgent medical attention. Serious side effects are rare.
Other side effects not listed above may also occur in some patients. Tell your doctor if you notice anything else that is making you feel unwell.

After taking FRUSEMIDE-PS tablets

Storage

Keep your tablets in the bottle until it is time to take them. Keep the bottle tightly closed. If you take the tablets out of the bottle they may not keep well.
Keep it in a cool dry place where the temperature stays below 30C and away from light.
Do not store it or any other medicines in the bathroom or near a sink.
Do not leave it in the car or on window sills. Heat and dampness can destroy some medicines.
Keep it where young children cannot reach it. A locked cupboard at least one-and-a-half metres above the ground is a good place to store medicines.

Disposal

If your doctor tells you to stop taking the tablets, ask your pharmacist what to do with any tablets left over.

Further information

This is not all the information that is available on FRUSEMIDE-PS. If you have any more questions or are not sure about anything, ask your doctor or pharmacist.

Product description

What it looks like

  • FRUSEMIDE-PS 20mg is a white, round tablet with 20 and a breakline on one side. A bottle contains 50 tablets.
  • FRUSEMIDE-PS 40mg is a white, round tablet with FRUSEMIDE-PS on one face and a breakline on the other face. A bottle contains 100 tablets.

Ingredients

Active ingredient:
  • FRUSEMIDE-PS 20mg contains Frusemide 20mg per tablet.
  • FRUSEMIDE-PS 40mg contains Frusemide 40mg per tablet.
Inactive ingredients:
  • lactose
  • magnesium stearate
  • butyl hydroxybenzoate
  • microcrystalline cellulose
  • povidone
  • propyl hydroxybenzoate
  • silica colloidal anhydrous
  • sodium starch glycollate
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chlorpheniramine

Chlorpheniramine Maleate by Jamp


How does Chlorpheniramine Maleate by Jamp work? What will it do for me?

Chlorpheniramine belongs to a group of medications known as first-generation antihistamines. For adults and children 6 years of age and older, it is used to treat symptoms caused by allergies, including itchy and watery eyes, sneezing, runny nose, and skin rash and irritations. It is also used to manage itchy skin caused by insect bites, and other medical conditions like chicken pox or measles. Chlorpheniramine works by blocking the effects of histamine, a substance released by cells in the body that produce allergy symptoms.
Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. As well, some forms of this medication may not be used for all of the conditions discussed here. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.
Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

How should I use Chlorpheniramine Maleate by Jamp?

For allergic rhinitis, the usual dose for adults and children 12 years of age and over is 4 mg every 4 to 6 hours. For the extended-release tablets, the usual dose for adults and children 12 years of age and older is 12 mg every 12 hours. The maximum recommended dose is 24 mg within a 24-hour period.
For the prevention of seasonal allergic rhinitis, the recommended starting dose is 4 mg at bedtime, which can be increased to 8 mg 3 times a day as needed over a 2-week period.
For children between 6 and 11 years of age, the usual recommended dose is 2 mg every 4 to 6 hours. The maximum recommended dose is 12 mg within a 24-hour period. This medication is not recommended for children under 6 years of age unless recommended by a doctor.
Seniors may need lower doses of this medication.
Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.
It is important to take this medication exactly as suggested by your doctor or pharmacist. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.
Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.
Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.


What form(s) does Chlorpheniramine Maleate by Jamp come in?

This medication is available as a 4 mg tablet.

Who should NOT take Chlorpheniramine Maleate by Jamp?

Do not take this medication if you:
  • are allergic to chlorpheniramine or any ingredients of this medication
  • are taking a MAO inhibitor (e.g., phenelzine, tranylcypromine, moclobemide)
Do not give this medication to newborns or premature infants.
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Posted by Unknown at 9:22 PM 1 comments

Clomethiazole

Clomethiazole capsules


Swallow the capsules whole with a drink of water. Do not chew them.
Clomethiazole will make you sleepy. If you still feel sleepy the next day, do not drive or use tools or machines. Do not drink alcohol.
The most common side-effects are a runny or blocked nose, and headache. These should soon pass.
Type of medicine Hypnotic and sedative
Used for Insomnia, restlessness, or agitation, particularly in elderly people
Alcohol withdrawal symptoms
Available as Capsules
Insomnia, or poor sleep, is fairly common. If you have problems sleeping, it may mean that you have difficulty getting off to sleep, or you may wake up for long periods during the night, or you may wake up too early in the morning. 'Sleeping pills' like clomethiazole are considered a last resort, but are sometimes prescribed for a short period of time to help with a particularly bad spell of insomnia.
Clomethiazole is also prescribed in certain circumstances to help calm elderly people who are particularly restless or agitated. It is also used within specialist dependency units to relieve the symptoms of alcohol withdrawal.
Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking clomethiazole it is important that your doctor or pharmacist knows:
  • If you are pregnant or breast-feeding.
  • If you have a heart condition, or liver or kidney problems.
  • If you have breathing problems or sleep apnoea (a problem where you stop breathing for short periods at night).
  • If you have ever had a drug addiction, or a personality disorder.
  • If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, such as herbal and complementary medicines.
  • If you have ever had an allergic reaction to a medicine.
  • Before you start this treatment, read the manufacturer's printed information leaflet from inside your pack. The leaflet will give you more information about clomethiazole and a full list of side-effects which you may experience from taking it. The most common side-effects are listed for you in the table below.
  • Take the capsules exactly as your doctor tells you to. Your dose will be on the label of the pack to remind you.
    • If you have been prescribed clomethiazole for insomnia, your doctor may either recommend that you take one or two capsules each evening, or only on certain days of the week. Take the capsules just before you go to bed.
    • If you have been prescribed clomethiazole to help calm restlessness or agitation, your doctor is likely to recommend that you take one capsule three times daily, for a short period of time.
    • If you have been prescribed clomethiazole to help reduce alcohol withdrawal symptoms, your doctor or clinic will tell you how to take it.
  • Swallow the capsules whole with a drink of water. Do not chew them.
  • Try to keep your regular appointments with your doctor. This is so your doctor can check on your progress.
  • The capsules will make you sleepy. If you still feel sleepy the next day, do not drive or use tools or machines. Do not drink alcohol.
  • Clomethiazole is only recommended for a short period of time. This is because your body can become dependent on it after a while. This can cause problems when you then stop taking it.
Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. These usually improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following side-effects continue or become troublesome.
Common clomethiazole side-effects What can I do if I experience this?
Headache Ask your pharmacist to recommend a suitable painkiller
A runny or blocked nose, sore eyes These can occur soon after taking a dose, but usually quickly pass
If you experience any other symptoms which you think may be due to this medicine, speak with your doctor or pharmacist.
  • Keep all medicines out of the reach and sight of children.
  • Store in a cool, dry place, away from direct heat and light.
If you buy any medicines, check with a pharmacist that they are safe to take with your other medicines.
Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.
If you are having an operation or dental treatment, tell the person carrying out the treatment which medicines you are taking.
This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.
Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.
If you have any questions about this medicine ask your pharmacist.

Further reading & references

  • Manufacturer's PIL, Clomethiazole 192 mg Capsules; Intrapharm Laboratories Ltd, The electronic Medicines Compendium. Dated May 2012.
  • British National Formulary; 65th Edition (Mar 2013) British Medical Association and Royal Pharmaceutical Society of Great Britain, London
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.
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Cephalexin

Cephalexin

Why is this medication prescribed?

Cephalexin is a cephalosporin antibiotic used to treat certain infections caused by bacteria such as pneumonia and bone, ear, skin, and urinary tract infections. Antibiotics will not work for colds, flu, or other viral infections.
This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

How should this medicine be used?

Cephalexin comes as a capsule, tablet, and liquid to take by mouth. It is usually taken every 6 hours (four times a day) or every 12 hours (twice a day) for 7 to 10 days. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take cephalexin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Shake the liquid well before each use to mix the medication evenly.
The capsules and tablets should be swallowed whole and taken with a full glass of water.
Continue to take cephalexin even if you feel well. Do not stop taking cephalexin without talking to your doctor.

What special precautions should I follow?


Before taking cephalexin,

  • tell your doctor and pharmacist if you are allergic to cephalexin or any other cephalosporin antibiotic such as cefadroxil (Duricef) or cephradine (Velosef), penicillin, or any other drugs.
  • tell your doctor and pharmacist what prescription and nonprescription medications you are taking, especially other antibiotics, anticoagulants ('blood thinners') such as warfarin (Coumadin), probenecid (Benemid), and vitamins.
  • tell your doctor if you have or have ever had kidney or liver disease, colitis, or stomach problems.
  • tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking cephalexin, call your doctor.
  • if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking cephalexin.

What special dietary instructions should I follow?


Cephalexin may cause an upset stomach. Take cephalexin with food or milk.

What should I do if I forget a dose?


Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What side effects can this medication cause?

Cephalexin may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

  • upset stomach
  • diarrhea
  • vomiting
  • mild skin rash

If you experience any of the following symptoms, call your doctor immediately:

  • severe skin rash
  • itching
  • hives
  • difficulty breathing or swallowing
  • wheezing
  • unusual bleeding or bruising
  • sore throat
  • painful mouth or throat sores
  • vaginal infection
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online

What should I know about storage and disposal of this medication?


Keep this medication in the container it came in, tightly closed, and out of reach of children. Store the capsules and tablets at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Keep liquid medicine in the refrigerator, tightly closed, and throw away any unused medication after 14 days. Do not freeze. Talk to your pharmacist about the proper disposal of your medication.

What other information should I know?

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your response to cephalexin.
If you are diabetic, use Clinistix or TesTape (not Clinitest) to test your urine for sugar while taking this drug.
Do not let anyone else take your medication. Your prescription is probably not refillable. If you still have symptoms of infection after you finish the cephalexin, call your doctor.
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

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  • Keflet® Tablet
  • Keflex® Capsules
  • Keflex® Suspension
  • Keftab® Tablets
  • Panixine® Disperdose

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Amethocaine

Amethocaine

Amethocaine is a local anaesthetic. Local anaesthetics are drugs that remove feeling and pain, and numb a particular area of the skin.

(Also known as tetracaine)
Amethocaine is the active ingredient of amethocaine cream (Nappi code: 799211-028).
General information
Amethocaine is a local anaesthetic. Local anaesthetics are drugs that remove feeling and pain, and numb a particular area of the skin.
In South Africa amethocaine is registered for the numbing a localised area of the skin.
This medication does not cure the underlying condition, but simply keeps the symptoms under control. For it to be effective it has to be applied regularly.
Fast facts
Drug schedule: schedule 1
Available as: amethocaine is available as a cream
What does it do? Amethocaine is used for the numbing of a localised area of the skin, namely to desensitise the skin prior to injections or for relief of the pain/itch associated with viral infections.
Overdose risk: low
Dependence risk: low
Is amethocaine available as a generic? no
Is amethocaine available on prescription only? no
User information
Onset of effect: within 10 minutes
Duration of action: several hours
Stopping this medicine: treatment with this medication can be safely stopped when no longer needed.
Prolonged use: treatment should be limited to a few days only.
Special precautions
Consult your doctor before applying this drug to broken or inflamed skin
Pregnancy: avoid. Potential risk to the foetus has been reported. Consult your doctor before use, or if you are planning to fall pregnant.
Breastfeeding: avoid. It is unknown how this medication may affect your baby. Consult your doctor before use.
Porphyria: this medication is safe for use.
Infants and children: this medication is not intended for use in children under the age of 2 years.
The elderly: no special precautions need to be taken.
Possible side effects

Side Effect
Frequency
Consult your doctor
 
Common
Rare
Only if severe
In all cases
stinging
 
X
X
 
burning
 
X
X
 
skin rash
 
X
 
X
Interactions
Drug interactions
No known interactions
Overdose action
A small overdose is no cause for concern. In case of intentional large overdose, seek emergency medical attention.
Recommended dosage
Adults, topical: Apply sparingly as needed, usually every 3 - 4 hours to the affected area.
This material is not intended to substitute medical advice, but is for informational purposes only. Please consult a physician for specific treatment and recommendations.
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Posted by Unknown at 9:13 PM 0 comments
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Flupentixol

Disclaimer

flupentixol-oral


GENERIC NAME: FLUPENTIXOL - ORAL (flew-pen-TICK-sole)


USES: This medication is used for schizophrenia (a psychiatric disorder).

HOW TO USE: Take this medication by mouth exactly as prescribed. During the first few days your doctor may gradually increase your dose to allow your body to adjust to the medication. Do not take this more often or increase your dose without consulting your doctor. Your condition will not improve any faster but the risk of serious side effects will be increased. Do not stop taking this drug suddenly without your doctor's approval. It may take several weeks for the full benefit of this medicine to take effect.

SIDE EFFECTS: Constipation, drowsiness, vision changes or dry mouth may occur. If any of these effects persist or worsen, notify your doctor. Unlikely to occur, but report promptly: restlessness, muscle stiffness, weakness, difficulty speaking, loss of balance, mask- like facial expression, trembling or shaking, dizziness, lip smacking or other uncontrollable movements, difficulty urinating, skin rash/discoloration. Very unlikely to occur, but report promptly: sore throat, unusual bleeding or bruising, stomach pain, yellowing of eyes or skin, dark urine, hot dry skin, vomiting. Though very unlikely to occur, notify your doctor immediately if you experience any of the following effects: severe muscle stiffness, confusion, fever, seizures, irregular/fast heartbeat, increased sweating, prolonged/painful erection. In the unlikely event you have an allergic reaction to this drug, seek immediate medical attention. Symptoms of an allergic reaction include: rash, itching, swelling, dizziness, trouble breathing. If you notice other effects not listed above, contact your doctor or pharmacist.
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Posted by Unknown at 9:10 PM 0 comments
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BROMAZEPAM

GENERIC NAME: BROMAZEPAM - ORAL TABLET (bro-MAY-zeh-pam)



This medication is used to relieve anxiety, nervousness and tension.


Take this medication by mouth exactly as directed by your doctor. Do not increase your dose, use it more frequently or use it for a longer period of time than prescribed because this drug can be habit-forming. If used for an extended period, do not suddenly stop using this drug without your doctor's approval. Over time, this drug may not work as well. Consult your doctor if this medication stops working well.

Drowsiness, dizziness, or loss of coordination may occur. Dry mouth, headache or stomach upset rarely occurs. If any of these effects persist or worsen, inform your doctor. Notify your doctor if you develop: rapid/pounding or irregular heartbeat, changes in vision, slurred speech, confusion, depression, behavior changes. In the unlikely event you have an allergic reaction to this drug, seek immediate medical attention. Symptoms of an allergic reaction include: rash, itching, swelling, dizziness, trouble breathing. If you notice other effects not listed above, contact your doctor or pharmacist.
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Cefradine

SPC Cefradine 500mg Capsules




1. Name of the medicinal product

Cefradine 500mg Capsules

2. Qualitative and quantitative composition

Each capsule contains 500mg cefradine anhydrous
For excipients, see section 6.1.

3. Pharmaceutical form

Capsule, hard.

4. Clinical particulars




4.1 Therapeutic indications

Cefradine 500mg Capsules are used in the treatment of bacterial infections of the respiratory and urinary tracts and of the skin and soft tissues. These include the following:
Upper respiratory tract infections - sinusitis, pharyngitis, tonsillitis, laryngo-tracheo bronchitis and otitis media.
Lower respiratory tract infections - acute and chronic bronchitis, lobar and bronchopneumonia.
Urinary tract infections - cystitis, urethritis and pyelonephritis.
Skin and soft tissue infections - impetigo, abscess, cellulitis, furunculosis.
Cefradine 500mg Capsules are also used in the prophylaxis of postoperative infections following surgical procedures associated with a high risk of infection and for patients with a reduced host resistance to bacterial infection. Cefradine should be administered immediately prior to surgery in order to ensure sufficient local tissue concentrations at the time that contamination is likely to occur. Treatment should be continued during the post operative period.
Laboratory testing should be carried out to determine the causative agents and their sensitivity to cefradine. However, therapy may commence prior to receipt of the sensitivity test results.

4.2 Posology and method of administration

Adults
Respiratory tract infections and skin and soft tissue infections - the usual dose is 250mg or 500mg four times daily or 500mg or 1g twice daily depending on the severity and site of infection.
Urinary tract infections - the usual dose is 500mg four times daily or 1g twice daily. This may need to be increased for severe or chronic infections. Prolonged intensive therapy is needed for complications such as prostatitis and epididymitis.
Elderly
As for adults. Patients with impaired renal or hepatic function should be monitored as modifications of the dosage schedule may be required.
Children
The usual dose is 25 to 50 mg/kg/day total, given in two or four equally divided doses. For otitis media daily doses from 75 to 100mg/kg in divided doses every 6 to 12 hours are recommended. Maximum dose 4g per day.
Cefradine may be taken without regard to meals.
In the case of severe or chronic infection larger doses of up to 1g four times daily may be given. Administration should be continued for a minimum of 48-72 hours after the patient becomes asymptomatic or evidence of bacterial eradication has been obtained. For infections caused by haemolytic strains of streptococci, a minimum of 10 days treatment is recommended to guard against the risk of rheumatic fever or glomerulo-nephritis. For the treatment of chronic urinary tract infections, frequent bacteriological and clinical appraisal is necessary during therapy and may be necessary for several months afterwards. Persistent infections may require treatment for several weeks. Smaller doses than those indicated above should not be used. Doses for children should not exceed those recommended for adults. As cefradine is available in both injectable and oral forms, patients may be changed from injection to capsules at the same dosage level.
Dosage in renal impairment:
For patients not on dialysis: The following dosage schedule guideline is based on a dosage of 500mg 6 hourly and on creatinine clearance:
Creatinine ClearanceDoseTime interval
More than 20ml/min500mg6 hours
5-20ml/min250mg6 hours
Less than 5 ml/min250mg12 hours
Adjustments to the dosage schedule provided may be necessary because of the dosage selected and individual variation.
For patients on chronic, intermittent haemodialysis:
250mgAt start of haemodialysis
250mg6-12 hours after start
250mg36-48 hours after start
250mgAt start of next haemodialysis if >30 hours after previous dose.
Further modification of the dosage schedule may be required in children.

4.3 Contraindications

Use in patients with a history of hypersensitivity to the cephalosporin antibiotics or to any component of the formulation.

4.4 Special warnings and precautions for use

Following administration of cefradine, a false positive reaction for glucose in the urine may occur with Benedict's or Fehling's solution or with reagent tablets such as Clinitest. This does not occur with enzyme based tests such as Clinistix or Diastix.
Prolonged use of antibiotics may result in overgrowth of non-susceptible organisms.
There is evidence of partial allergenicity between the penicillins and the cephalosporins. Therefore, cefradine should be used with caution in those patients with known hypersensitivity to penicillins. There have been instances of patients who have had reactions to both drug classes (including anaphylaxis).
Dosage should be reduced in renal failure (see section 4.2).
Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine.


4.5 Interaction with other medicinal products and other forms of interaction

Loop diuretics may increase nephrotoxicity of cephalosporins.
Probenecid has been seen to raise serum concentrations of cefradine, by reducing renal clearance of the cephalosporins.


4.6 Pregnancy and lactation

Although animal studies have shown no teratogenic effects, safety in pregnancy has not been established. As with all medicines, use should be avoided in pregnancy especially in the first trimester, unless considered essential by the physician. Cefradine is excreted in breast milk and therefore should be used with caution in lactating mothers.

4.7 Effects on ability to drive and use machines

Since this medicine may cause dizziness, patients should be cautioned about operating hazardous machinery, including automobiles.

4.8 Undesirable effects

Undesirable effects are uncommon and mainly mild in nature. They are limited essentially to gastrointestinal disturbances and on occasion to hypersensitivity phenomena.
Infections and infestations
Rarely:Antibiotic-associated colitis
Frequency unknown:Vaginitis, candidal overgrowth, candidiasis
Blood and lymphatic system disorders
Frequency unknown:Eosinophilia, blood disorders (including thrombocytopenia, leucopenia, agranulocytosis, aplastic anaemia and haemolytic anaemia)
Immune system disorders
Frequency unknown:Fever, athralgia, serum sickness-like reactions, anaphylaxis
Psychiatric disorders
Frequency unknown:Confusion, sleep disturbances
Nervous system disorders
Frequency unknown:Hypersensitivity, hyperactivity, hypertonia, dizziness, nervousness
Rarely: Headache
Gastrointestinal disorders
Frequency unknown:Diarrhoea, nausea, glossitis, heartburn
Rarely: Vomiting, abdominal discomfort,
Hepatobiliary disorders
Frequency unknown:Liver, enzyme disturbances, transient hepatitis, cholestatic jaundice
Skin and subcutaneous tissue disorders
Frequency unknown:Rashes, toxic epidermal necrolysis, pruritis, urticaria, erythema multiforme, Stevens-Johnson syndrome
Renal and urinary disorders
Frequency unknown:Reversible interstitial nephritis
General disorders and administration site conditions
Frequency unknown:Tightness in the chest
Investigations
Frequency unknown:Elevation of blood urea nitrogen, serum creatinine, alanine aminotransferase, aspartate aminotransferase, total bilirubin, alkaline phosphates


4.9 Overdose

None known.

5. Pharmacological properties




5.1 Pharmacodynamic properties

Cefradine is an antibiotic agent with a broad spectrum of activity against both Gram-positive and Gram-negative bacteria. It is also highly active against most strains of penicillinase-producing Staphylococci.
Microbiology
The following organisms have shown in vitro sensitivity to cefradine:
Gram-positive
Staphylococci (both penicillin sensitive and resistant strains), Streptococci, Streptococcus pyogenes (beta haemolytic) and Streptococcus pneumoniae.
Gram-negative
Escherichia coli, Klebsiella spp., Proteus mirabilis, Haemophilus influenza, Shigella spp., Salmonella spp. (including Salmonella typhi) and Neisseria spp.
Because cefradine is unaffected by penicillinase, many strains of Escherichia coli and Staphylococcus aureus which produce this enzyme are susceptible to cefradine but resistant to ampicillin.


5.2 Pharmacokinetic properties

Cefradine has a high degree of stability to many beta-lactamases. It has a low degree of protein binding and a large volume of distribution. Therefore, tissue levels are generally found to be high.
Oral cefradine can be given twice or four times daily and is well absorbed. Cefradine is acid stable and is rapidly absorbed following oral administration in the fasting state. Following doses of 250mg, 500mg and 1000mg average peak serum levels of approximately 9, 16.5, and 24.2 micrograms/ml, respectively, were obtained at one hour. The presence of food in the gastrointestinal tract delays the absorption but does not affect the total amount of cefradine absorbed. Measurable serum levels are present six hours after administration. Over 90% of the drug is excreted unchanged in the urine within 6 hours. Peak urine concentrations are approximately 1600 micrograms/ml following a 250mg dose, 3200 micrograms/ml following a 500mg dose, and 4000 micrograms/ml following a 1000mg dose. After 48 hours administration of 100mg/kg/day of cefradine for the treatment of otitis media, cefradine has been measured in the middle ear exudate at an average level of 3.6 microgram/ml.

5.3 Preclinical safety data

There are no preclinical safety data of relevance to the prescriber which are additional to that already included in other sections of the SPC.

6. Pharmaceutical particulars




6.1 List of excipients

Magnesium stearate
Lactose monohydrate
The capsule shell contains:
Gelatin
Titanium dioxide (E171)
Indigo carmine (E132)

6.2 Incompatibilities

None.

6.3 Shelf life

24 months.

6.4 Special precautions for storage

Do not store above 25°C.

6.5 Nature and contents of container

PVC/PVDC blister foil, 0.25 +/- 5% mm thick with an aluminium lidding foil 0.025 mm thick containing 10, 20 or 100 capsules.

6.6 Special precautions for disposal and other handling

No special instructions.
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Methapred

Methapred

A-METHAPRED
(methylprednisolone sodium succinate) Injection, Powder, Lyophilized, for Solution
For Intravenous or Intramuscular Administration



DRUG DESCRIPTION

A-Methapred (methylprednisolone sodium succinate for injection, USP) sterile powder contains methylprednisolone sodium succinate as the active ingredient. Methylprednisolone sodium succinate, USP, occurs as a white, or nearly white, odorless hygroscopic, amorphous solid. It is very soluble in water and in alcohol; it is insoluble in chloroform and is very slightly soluble in acetone.
The chemical name for methylprednisolone sodium succinate is pregna-1,4-diene-3,20-dione,21-(3-carboxy-1-oxo-propoxy)-11,17-dihydroxy-6-methyl-monosodium salt, (6a, 11ß), and the molecular weight is 496.53.
The structural formula is represented below:
A-Methapred (methylprednisolone sodium succinate) structural formula illustration
Methylprednisolone sodium succinate is so extremely soluble in water that it may be administered in a small volume of diluent and is especially well suited for intravenous use in situations in which high blood levels of methylprednisolone are required rapidly.
A-Methapred (methylprednisolone sodium succinate) is available in several strengths and packages for intravenous or intramuscular administration.
40 mg Single-Dose Vial- Each mL (when mixed) contains methylprednisolone sodium succinate equivalent to 40 mg methylprednisolone; also 1.6 mg monobasic sodium phosphate anhydrous; 17.46 mg dibasic sodium phosphate anhydrous; 25 mg lactose anhydrous; 8.8 mg benzyl alcohol added as preservative.
125 mg Single-Dose Vial- Each 2 mL (when mixed) contains methylprednisolone sodium succinate equivalent to 125 mg methylprednisolone; also 1.6 mg monobasic sodium phosphate anhydrous; 17.4 mg dibasic sodium phosphate anhydrous; 17.6 mg benzyl alcohol added as preservative.
When necessary, the pH of each formula was adjusted with sodium hydroxide so that the pH of the reconstituted solution is within the USP specified range of 7 to 8 and the tonicities are, for the 40 mg per mL solution, 0.50 osmolar; for the 125 mg per 2 mL, 0.40 osmolar; (Isotonic saline = 0.28 osmolar).
IMPORTANT- Use only Bacteriostatic Water For Injection with Benzyl Alcohol when reconstituting A-Methapred (methylprednisolone sodium succinate) .
Use within 48 hours after mixing.
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Cetirizine

Cetirizine is a second-generation antihistamine used in the treatment of hay fever, allergies, angioedema, and urticaria. It is a major metabolite of hydroxyzine, and a racemic selective H1 receptor inverse agonist.

Availability

Cetirizine10.JPG
Formerly prescription-only in the USA and Canada, cetirizine is now available over-the-counter in both countries[2] as Zyrtec and Reactine, respectively. Zyrtec was the highest-grossing new non-food product of 2008 in the US, generating sales of $315.9 million.[3] It is also available as a generic drug. In Turkey, Australia and New Zealand, Zyrtec is available over-the-counter in pharmacies and in the UK and The Netherlands cetirizine can be sold in limited quantities off-the-shelf in any outlet and is often available in supermarkets. As of 2009, Germany made many generic drugs containing cetirizine available in pharmacies without prescription.[4] Norway, Sweden,[5] Finland, Poland and Israel also recognize Cetirizine as an over-the-counter medicine. In India, it is sold over-the-counter as brand-name "CTZ" (formerly called "Cetzine"), even though it remains classified as a Schedule H (prescription) drug.[6] India also classifies Cetirizine as an OTC drug, and uses it as an alternative to Pheniramine (Avil) which is no longer provided OTC in India.

Pharmacology

Cetirizine crosses the blood–brain barrier only slightly, reducing the sedative side-effect common with older antihistamines.[7] It has also been shown to inhibit eosinophil chemotaxis and LTB4 release. At a dosage of 20 mg, Boone et al. found that it inhibited the expression of VCAM-1 in patients with atopic dermatitis.[8] Unlike many other antihistamines, Cetirizine does not exhibit anticholinergic properties.[9]
The levorotary enantiomer of cetirizine, known as levocetirizine, is the more active form.

L-Stereoisomer, levocetirizine (top) and D-stereoisomer of cetirizine

Administration method and metabolism

Chewable, non-chewable, and syrup forms of cetirizine are similarly absorbed rapidly and effectively, with absorbed food minutely affecting the absorption rate which yields a peak serum level one hour after administration;[10] in a study of healthy volunteers prescribed 10 mg tablets, once daily for 10 days, a mean peak serum level of 311 ng/mL was observed.[11] The metabolic effects of cetirizine are long acting, remaining in the system for a maximum of 21 hours before being excreted; the average elimination half-life is 8 hours. About 70% of the drug is removed through urination, of which half is observed as unchanged cetirizine compound. Another 10% is excreted.[10][11]
Like many other antihistamine medications, cetirizine is commonly prescribed in combination with pseudoephedrine hydrochloride, a decongestant. These combinations are marketed using the same brand name as the cetirizine with a "-D" suffix (Zyrtec-D, Virlix-D, etc.)

Indications

Allergies

Cetirizine's primary indication is for hay fever and other allergies. Because the symptoms of itching and redness in these conditions are caused by histamine acting on the H1 receptor, blocking those receptors temporarily relieves those symptoms.
Cetirizine is also commonly prescribed to treat acute and (in particular cases) chronic urticaria, more efficiently than any other second-generation antihistamine. It is preferred over diphenhydramine in many countries because, while being as effective as it for treating hives-related skin diseases, cetirizine does not affect the regular functioning of the brain.

Rhinovirus infection

Interleukin 6 and interleukin 8 have been shown to be elevated in acute respiratory distress syndrome.[12] Cetirizine contains L- and D-stereoisomers. Chemically, levocetirizine is the active L-enantiomer of cetirizine. One recent study of airway epithelial cells showed that Levocetirizine may have beneficial effects on the pathophysiologic changes related to human rhinovirus (HRV) infection.[13] Airway inflammation caused from a cytokine storm secondary to acute respiratory distress syndrome could also theoretically benefit.

Kimura's disease

Cetirizine is an effective agent in treating the symptoms of Kimura's disease, which mostly occurs in young Asian men, affecting the lymph nodes and soft tissue of the head and neck in the form of tumor-like lesions. Cetirizine's properties of being effective both in the treatment of pruritus (itching) and as an anti-inflammatory agent make it suitable for the treatment of the pruritus associated with these lesions.[14] In a 2005 study, the American College of Rheumatology conducted treatments initially using prednisone, followed by steroid dosages and azathioprine, omeprazole, and calcium and vitamin D supplements over the course of two years.[14] The skin condition of the patient began to improve and the skin lesions lessened. However, there were symptoms of cushingoid and hirsutism observed before the patient was removed from the courses of steroids and placed on 10 mg/day of cetirizine to prevent skin lesions;[14] an agent suitable for the treatment of pruritus associated with such lesions.[14] Asymptomatically, the patient's skin lesions disappeared after treatment with cetirizine, blood eosinophil counts became normal,[14] corticosteroid effects were resolved,[14] and a remission began within a period of two months.[14] It is also thought that the inhibition of eosinophils may be the key to treatment of Kimura's disease due to the role of eosinophils, rather than other cells with regards to the lesions of the skin.[14]

Side effects

Dryness of the mouth, nose and throat, drowsiness, urinary retention, blurred vision, nightmares and headaches are commonly reported side effects of this drug (in over 40% of the patients). Stomach aches are usually rare, but mostly present in patients with lactose intolerance.[15] Cetirizine does not block the action of the muscarinic acetylcholine receptors, even though these side effects can occur in some patients. Also, cetirizine does not have antidopaminergic properties. In 2012, the FDA added cetirizine in Drugs to Watch List for oculogyric crisis.[16]
Patients report that going off the drug can cause intense itching and hives.[17][18]

Synthesis

The following synthesis of this compound was reported in 1985:[19]
Cetirizine synthesis.png
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Anti Histamin

Antihistamines for Allergies

Treating allergies can involve different medications, including steroids and allergy shots, but usually the first thing to try is an antihistamine.

How Antihistamines Treat Allergies

When your body comes into contact with whatever your allergic trigger is -- pollen, ragweed, pet dander, dust mites, for example -- it makes chemicals called histamines.  They cause the tissue in your nose to swell (making it stuffy), your nose and eyes to run, and your eyes to itch. Sometimes you may also get an itchy rash on your skin, called hives.  
Antihistamines reduce or block histamines, so they stop allergy symptoms.
Antihistamines work well to relieve symptoms of different types of allergies, including seasonal (hay fever), indoor, and food allergies, but they can't relieve every symptom. To treat nasal congestion, your doctor may recommend taking a decongestant. Some drugs combine an antihistamine and decongestant.

What Types of Antihistamines Are Available?

Antihistamines come in different forms, including tablets, capsules, liquids, nasal sprays, and eyedrops. Some are only available by prescription. Others you can buy over the counter (OTC) at your local pharmacy.
Examples of prescription antihistamines include:
  • Astelin, Astepro (azelastine) nasal sprays
  • Atarax, Vistaril (hydroxyzine)
  • Clarinex (desloratadine)
  • Cyproheptadine (generic only)
  • Emadine (emadastine) eyedrops
  • Livostin (levocabastine)  eyedrops
  • Optivar (azelastine) eyedrops
  • Palgic (carbinoxamine)
  • Xyzal (levocetirizine)
Examples of OTC antihistamines:
  • Allegra (fexofenadine)
  • Benadryl (diphenhydramine)
  • Dimetane (brompheniramine)
  • Claritin, Alavert (loratadine)
  • Tavist (clemastine)
  • Chlor-Trimeton (chlorpheniramine)
  • Zyrtec (certirizine)
Eyedrops likes Emadine and Livostin treat symptoms of eye allergies, including itchy, watery eyes. Some medications, like Allegra-D, Claritin-D, and Zyrtec-D, combine an antihistamine and a decongestant to relieve congestion.

Side Effects of Antihistamines

Antihistamines can cause side effects, and some cause more side effects than others. Drugs such as Benadryl, Chlor-Trimeton, and Tavist and belong to an older group known as "first-generation" antihistamines. They tend to cause more side effects, particularly drowsiness.
Newer-generation antihistamines such as Allegra, Clarinex, and Zyrtec and have fewer side effects, so they may be a better choice for some people.
Some of the main side effects of antihistamines include:
  • Dry mouth
  • Drowsiness
  • Dizziness
  • Nausea and vomiting
  • Restlessness or moodiness (in some children)
  • Trouble urinating or not being able to urinate
  • Blurred vision
  • Confusion
If you're taking an antihistamine that causes drowsiness, try to take it before bedtime. Don’t take it during the day before driving or operating heavy machinery.
Read the label before you take an allergy drug. Antihistamines may interact with other medications you are taking.
Talk to your doctor first if you have an enlarged prostate, heart disease, high blood pressure, thyroid problems, kidney or liver disease, a bladder obstruction, or glaucoma. Also check with your doctor if you are pregnant or nursing.
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Metronidazole

Metronidazole 
(AAN, BAN, INN, USAN) /mɛtrəˈnaɪdəzoʊl/ (Flagyl and others) is a nitroimidazole antibiotic medication used particularly for anaerobic bacteria and protozoa. Metronidazole is an antibacterial against anaerobic organisms, amoebicide and antiprotozoal.[3] It is the drug of choice for first episodes of mild-to-moderate Clostridium difficile infection.[4]
It is on the World Health Organization's List of Essential Medicines, a list of the most important medication needed in a basic health system.[5]

Medical uses

Metronidazole is primarily used to treat: bacterial vaginosis, pelvic inflammatory disease (along with other antibacterials like ceftriaxone), pseudomembranous colitis, aspiration pneumonia, rosacea (topical), fungating wounds (topical), intra-abdominal infections, lung abscess, gingivitis, amoebiasis, giardiasis, trichomoniasis, and infections caused by susceptible anaerobic organisms such as Bacteroides fragilis, spp, Fusobacterium spp, Clostridium spp, Peptostreptococcus spp and Prevotella spp.[6] It is also often used to eradicate Helicobacter pylori along with other drugs and to prevent infection in people recovering from surgery.[6]

Bacterial vaginosis

Drugs of choice for the treatment of bacterial vaginosis include metronidazole and clindamycin. The treatment of choice for bacterial vaginosis in non-pregnant women include metronidazole oral twice daily for seven days, or metronidazole gel intravaginally once daily for five days, or clindamycin intravaginally at bedtime for seven days. For pregnant women, the treatment of choice is metronidazole oral three times a day for seven days. Data does not report routine treatment of male sexual partners in non-pregnant or pregnant women.[7]

Trichomoniasis

The 5-nitroimidazole drugs (metronidazole and tinidazole) are the mainstay of treatment for infection with Trichomonas vaginalis. Treatment for both the infected patient and the patient's sexual partner is recommended, even if asymptomatic. Therapy other than 5-nitroimidazole drugs is also an option, but cure rates are much lower.[8]

Clostridium difficile colitis

Initial antibiotic therapy for non-severe Clostridium difficile colitis (pseudomembranous colitis) consists of oral metronidazole or oral vancomycin. Several randomized controlled trials have demonstrated equivalent efficacy of oral metronidazole and oral vancomycin in treating non-severe Clostridium difficile colitis.[9][10][11] However, it has been shown that oral vancomycin is more effective in treating patients with severe Clostridium difficile colitis.[9]

Entamoeba histolytica

Invasive colitis and extraintestinal disease including liver abscesses, pleuropulmonary infections, and brain abscesses can result from infection with Entamoeba histolytica. Metronidazole is a widely used drug in patients with invasivs colitis, liver abscesses, pleuropulmonary infection, and/or brain abscesses caused by Entamoeba histolytica.

Preterm births

Metronidazole has also been used in women to prevent preterm birth associated with bacterial vaginosis, amongst other risk factors including the presence of cervicovaginal fetal fibronectin (fFN). A randomised controlled trial demonstrated that metronidazole was ineffective in preventing preterm delivery in high-risk pregnant women (selected by history and a positive fFN test) and, conversely, the incidence of preterm delivery was found to be higher in women treated with metronidazole.[12]

Adverse effects

Common adverse drug reactions (≥1% of those treated with the drug) associated with systemic metronidazole therapy include: nausea, diarrhoea, weight loss, abdominal pain, vomiting, headache, dizziness and metallic taste in the mouth. Intravenous administration is commonly associated with thrombophlebitis. Infrequent adverse effects include: hypersensitivity reactions (rash, itch, flushing, fever), headache, dizziness, vomiting, glossitis, stomatitis, dark urine and paraesthesia.[6] High doses and/or long-term systemic treatment with metronidazole is associated with the development of leucopenia, neutropenia, increased risk of peripheral neuropathy and CNS toxicity.[6]
Common adverse drug reaction associated with topical metronidazole therapy include local redness, dryness and skin irritation; and eye watering (if applied near eyes).[6]
Metronidazole may cause mood swings. There is some evidence from studies in rats that supports the possibility of metronidazole may contribute to serotonin syndrome, although no case reports documenting this have been published to date.[13][14]

Mutagenesis and carcinogenesis

Metronidazole is listed by the US National Toxicology Program (NTP) as reasonably anticipated to be a human carcinogen.[15] Although some of the testing methods have been questioned, oral exposure has been shown to cause cancer in experimental animals and has also demonstrated some mutagenic effects in bacterial cultures.[15][16] The relationship between exposure to metronidazole and human cancer is unclear.[15][17] One study (Beard et al. 1988) found an excess in lung cancer among women (even after adjusting for smoking), while other studies (IARC 1987; Thapa et al. 1998) found either no increased risk, or a statistically insignificant risk.[15] [18] Metronidazole is listed as a possible carcinogen according to the WHO International Agency for Research on Cancer (IARC).[19] A study in those with Crohn's disease also found chromosomal abnormalities in circulating lymphocytes in people treated with metronidazole.[16]
Due to its potential carcinogenic properties, metronidazole is banned in the European Union and the USA for veterinary use in the feed of animals and is banned for use in any food animals in the USA.[20][21]

Interaction with alcohol

Consuming ethanol (alcohol) while taking metronidazole has long been thought to have a disulfiram-like reaction with effects that can include nausea, vomiting, flushing of the skin, tachycardia (accelerated heart rate), and shortness of breath.[22] It is typically advised that consumption of alcohol should be avoided by patients during systemic metronidazole therapy and for at least 48 hours after completion of treatment.[6] However there are studies calling into question the mechanism of the interaction of alcohol and metronidazole,[23] ,[24][25] and a possible central toxic serotonin reaction for the alcohol intolerance suggested.[13] Metronidazole is also generally thought to inhibit the liver metabolism of propylene glycol (found in some foods, medicines and in many electronic cigarette e-liquids), and thus propylene glycol may potentially have similar interaction effects with metronidazole.[citation needed]

Other drug interactions

It also inhibits CYP2C9 and CYP3A4 and hence may interact with medications that are metabolised by this enzyme (e.g. lomitapide, warfarin).[1]

Stevens–Johnson syndrome

Metronidazole alone rarely causes Stevens–Johnson syndrome but is reported to occur at high rates when combined with mebendazole.[26]

Mechanism of action

It inhibits nucleic acid synthesis by disrupting the DNA of microbial cells.[1] This function only occurs when metronidazole is partially reduced, and because this reduction usually happens only in anaerobic cells, it has relatively little effect upon human cells or aerobic bacteria.[27]

Synthesis

2-Methylimidazole (1) may be prepared via the Debus-Radziszewski imidazole synthesis, or from ethylenediamine and acetic acid, followed by treatment with lime, then Raney nickel. 2-Methylimidazole nitrated to give 2-methyl-4(5)-nitroimidazole (2), which is in turn alkylated with ethylene oxide or 2-chloroethanol to give metronidazole (3):[28][29][30]
Synthesis of metronidazole.png
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