Drugs Information Center(DIC)

MEDICATIONS CONTRAINDICATED IN PREGNANCY

noreply@blogger.com (Dr. Farhan Ahmad Khan) — Wed, 29 Jul 2015 09:55:00 +0000

1. Vitamin A and its derivatives (isotretinein, Accutane and etretinate)Women who are pregnant should not take regular vitamins. Too many vitamins can harm your baby. For example, very high levels of vitamin A have been linked with severe birth defects.Significant risk of spontaneous abortion [20] and risk of many significant anomalies2. ACE inhibitors (May cause fetal hypotension, kidney damage in the fetus when used in II and III trimester, decrease in the amount of amniotic fluid and deformities of face, limbs and lungs)3. Anticoagulants- warfarinDuring 1^st Trimester- defects like nasal hypoplasia and a depressed nasal bridge; termed as Fetal warfarin SyndromeDuring 2^nd and 3^rd Trimester- risk of fetal malformations
4. Anti-thyroids (Methimazole, Carbimazole) - Overactive and enlarged Thyroid gland.
5. Anticonvulsants- Carbamazepine (Risk of birth defects)
Sodium valproate (Increased risk cleft palate and abnormalities of the heart, face, skull, hands or abdominal organs)6. NSAIDs Aspirin and other Salicylates Delay in start of labor, premature closing of ductus arteriosus, jaundice, brain damage in the fetus and bleeding problems in the woman during and after delivery and in the newbornCan cause serious blood flow problems in the baby if used during the last 3 months of pregnancy7. Ciprofloxacin Possibility of joint abnormalities8. Kanamycin and Streptomycin Damage to fetus's ear resulting in deafness (risk of ototoxicity9. Oral Hypoglycemic drugs A very low level of sugar in the blood of newborn.

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Basics of Oral Anti-diabetic drugs

noreply@blogger.com (Dr. Farhan Ahmad Khan) — Thu, 22 Aug 2013 06:28:00 +0000

The sulfonylureas and meglitinides increase the secretion of insulin by the pancreas.

_ Metformin inhibits glucose production by the liver and decreases insulin resistance.

_ The alpha-glucosidase inhibitors delay absorption of glucose by the intestine.

_ The thiazolidinediones decrease insulin resistance.

_ The dipeptidyl peptidase 4 inhibitors promote the release of insulin from the pancreas after eating a meal.

It is necessary to know before starting these drugs that all the diabetes drugs have the potential to cause side effects and lifestyle changes have benefits to your health beyond controlling blood sugar, most doctors will recommend you try diet and lifestyle modifications first — before you try a drug.

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FDA Adds 8 Drugs to Watch List

noreply@blogger.com (Dr. Farhan Ahmad Khan) — Thu, 25 Oct 2012 04:12:00 +0000

1. Cetirizine HCl =========> Oculogyric crisis

2. Codeine sulfate =========> Respiratory depression or arrest resulting in death in children taking

codeine who are CYP2D6 ultra-rapid metabolizers

3. Fluoroquinolone =========> Retinal detachment

4. Olmesartan medoxomil =========>Malabsorption resulting in severe diarrhea and weight loss

5. Proton pump inhibitors =========>Pneumonia

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EFFECT OF ACETAMINOPHEN ON BLOOD PRESSURE

noreply@blogger.com (Dr. Farhan Ahmad Khan) — Sat, 06 Oct 2012 07:11:00 +0000

Acetaminophen produces its analgesic effect by inhibiting the same cyclooxygenase, prostaglandin H2 synthase, that is the target of NSAID and aspirin. However, acetaminophen blocks this enzyme at its peroxidase catalytic rather than at the cyclooxygenase catalytic site. Therefore, the acetaminophen-mediated inhibition is sensitive to changes in the tissue peroxide levels; higher concentrations of peroxide in activated leukocytes and platelets block the effect of acetaminophen on inflammation and platelet thrombosis. However, acetaminophen is able to inhibit prostaglandins in the central nervous system, thus providing relief of pain and fever. Therefore, acetaminophen is not an NSAID or anti-thrombotic agent.

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Ultram

noreply@blogger.com (Dr. Farhan Ahmad Khan) — Tue, 15 May 2012 18:55:00 +0000

Ultram is the Generic form of Ultram. ULTRAN ® (tranadol hydrochloride tablets) is a prescription medication indicated for the management of moderate to moderately severe pain. ULTRAM received U.S. Food and Drug Administration (FDA) approval in March, 1995. Ultram has been prescribed to more than 55 million patients worldwide and ULTRAM has been prescribed to more than 21 million patients in the United States alone.

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Tenecteplase versus Alteplase for Acute Ischemic Stroke

noreply@blogger.com (Dr. Farhan Ahmad Khan) — Thu, 22 Mar 2012 05:47:00 +0000

Intravenous alteplase is the only approved treatment for acute ischemic stroke. Tenecteplase, a genetically engineered mutant tissue plasminogen activator, is an alternative thrombolytic agent.
Tenecteplase was associated with significantly better reperfusion and clinical outcomes than alteplase in patients with stroke who were selected on the basis of CT perfusion imaging.

Source

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“Gatifloxacin can cause severe hyperglycemia”

noreply@blogger.com (Dr. Farhan Ahmad Khan) — Tue, 29 Nov 2011 04:24:00 +0000

A 65-year-old woman with no history of diabetes, developed hyperglycemia, after taking Gatifloxacin. She was admitted to the hospital with a one day history of abdominal cramps, nausea, and vomiting. Her blood glucose was 1,121 mg/dL (normal range 70 to 100 mg/ dL). She had a history of high BP, transient ischemic attacks, hyperlipidemia and renal failure. The patient was receiving Gatifloxacin 200 mg daily for 9 days empirically for bronchitis, which was started during a prior hospitalization. After admission, she responded well to an insulin infusion combined with subcutaneous doses of regular insulin. (Ann Pharmacother.2005; 39(7):1349–1352)

Reports of hypoglycemia with other fluoroquinolones have been documented, but only Gatifloxacin is reported to cause severe hyperglycemia

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Omeprazole+ Sodium bicarbonate

noreply@blogger.com (Dr. Farhan Ahmad Khan) — Fri, 25 Dec 2009 18:03:00 +0000

FDA Approved OTC Version Of Heartburn Drug Zegerid (omeprazole and sodium bicarbonate) on December 2, 2009.

Omeprazole is sensitive to acidic environment, so it is destroyed partly is stomach. Sodium bicarbonate saves it from destruction and increases the bioavailability by its acid neutralisation capacity.

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Dexmedetomidine

noreply@blogger.com (Dr. Farhan Ahmad Khan) — Tue, 08 Dec 2009 15:18:00 +0000

Dexmedetomidine is a sedative medication used by intensive care units and anesthesiologists. It is relatively unique in its ability to provide sedation without causing respiratory depression. Like clonidine, its mechanism of action is agonism of alpha-2 receptors in certain parts of the brain.

Dexmedetomidine has sedative, analgesic, sympatholytic, and anxiolytic effects that blunt many of the cardiovascular responses in the perioperative period. It reduces the volatile anesthetic, sedative and analgesic requirements of the patient without causing significant respiratory depression.

Recent research has suggested dexmedetomidine to be an effective treatment for the dangerous cardiovascular symptoms of cocaine intoxication and overdose. It also seemed to be superior to lorazepam for ventilated patients in the intensive care unit. Compared to midazolam, dexmedetomidine was similarly effective for sedation, but shortened the time to extubation, was associated with less delirium, and experience more bradycardia and less tachycardiaand hypertension.

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FDA Warns of Drug Interactions between Clopidogrel and Omeprazole

noreply@blogger.com (Dr. Farhan Ahmad Khan) — Thu, 19 Nov 2009 13:45:00 +0000

FDA notified healthcare professionals of new safety information concerning an interaction between clopidogrel (Plavix), an anti-clotting medication, and omeprazole (Prilosec/Prilosec OTC), a proton pump inhibitor (PPI) used to reduce stomach acid. New data show that when clopidogrel and omeprazole are taken together, the effectiveness of clopidogrel is reduced. Patients at risk for heart attacks or strokes who use clopidogrel to prevent blood clots will not get the full effect of this medicine if they are also taking omeprazole. Separating the dose of clopidogrel and omeprazole in time will not reduce this drug interaction.

Other drugs that are expected to have a similar effect and should be avoided in combination with clopidogrel include: cimetidine, fluconazole, ketoconazole, voriconazole, etravirine, felbamate, fluoxetine, fluvoxamine, and ticlopidine.

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RANOLAZINE

noreply@blogger.com (Dr. Farhan Ahmad Khan) — Tue, 17 Nov 2009 14:00:00 +0000

Dosing Information

Adult: In Angina pectoris, chronic, initial, 500 mg orally twice daily; increase to the maximum recommended dose of 1000 mg orally twice daily as needed based on clinical symptoms.

Pediatric: Safety and efficacy not established in pediatric patients.

Contraindications

• Concurrent use of potent and moderately potent CYP3A inhibitors, including diltiazem, verapamil, macrolide antibiotics, HIV protease inhibitors, ketoconazole and other azole antifungals, and grapefruit juice or grapefruit-containing products; increased ranolazine levels and QTc prolongation.

• Concurrent use of QT prolonging drugs (such as Class Ia and Class III antiarrhythmics, and certain antipsychotic).

• Hepatic impairment, Child-Pugh Classes A, B or C; QTc prolongation is increased approximately 3-fold.

• QT prolongation, pre-existing, including congenital long QT syndrome and uncorrected hypokalemia.

Precautions

• Concurrent use of CYP3A and P-glycoprotein inducers (eg, carbamazepine, phenobarbital, phenytoin, rifabutin, rifampin, rifapentin, St John’s Wort) should be avoided; decreased ranolazine concentrations.

• Doses greater than 1,000 mg twice daily should be avoided; increased risk of QTc interval prolongation.

• QTc interval prolongation; dose-related prolongation may occur, possibly leading to torsades de pointes-type arrhythmias and sudden death.

• Renal impairment, severe; increases blood pressure by approximately 15 mmHg.

• Ventricular tachycardia, history.

Adverse Effects

• Prolonged QT interval

• Serum blood urea nitrogen raised

• Syncope

Pharmacokinetics

Onset and Duration of action: Initial Response in stable angina, Oral: 2.5 hours (single doses; reflects time of efficacy measurements after dosing).

Drug Concentration Levels

A) Therapeutic Drug Concentration: In stable Angina Pectoris 500 ng/mL suggested in single-dose study.

B) Peak Concentration

1) Oral, extended-release: 2569 ng/mL.

2) Steady state peak and trough plasma concentrations for ranolazine and its metabolites were generally higher in renally impaired subjects compared to healthy subjects. Patients received a ranolazine extended-release loading dose of 875 mg orally, followed by 500 mg every 12 hours for a total of 4 maintenance doses.

C) Time to Peak Concentration: Oral, extended-release: 2 to 5 hours.

Mechanism of Action

1) Ranolazine is a piperazine derivative and the mechanism of action of its anti-anginal and anti-ischemic effect is unknown. The anti-anginal and anti-ischemic action of ranolazine is not dependent upon heart rate or blood pressure reduction and does not increase myocardial workload. At therapeutic levels, ranolazine can inhibit the inactivating component of the sodium current (I(Na)) although its relationship to angina symptoms is uncertain. It also inhibits the rapid inward rectifying current (I(Kr)), thereby prolonging the ventricular action potential.

2) Ranolazine has also been postulated to modulate myocardial metabolism by partially inhibiting fatty acid oxidation, thereby increasing glucose oxidation and generating more adenosine triphosphate (ATP) per molecule of oxygen consumed (i.e., cardiac muscle cell substrate utilization is shifted towards carbohydrates and away from fatty acids). The anti-anginal and anti-ischemic action of ranolazine is not dependent upon heart rate or blood pressure reduction and does not increase myocardial workload.

3) Action unlike beta-blockers and calcium antagonists, ranolazine lacks effects on hemodynamics, contractile/ conduction parameters.

4) Ranolazine has renal transplant preservation potential.

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Pharmacotherapy of Asthma

noreply@blogger.com (Dr. Farhan Ahmad Khan) — Tue, 17 Nov 2009 13:48:00 +0000

Asthma is a long-term illness that causes the airways of the lungs to be irritated, make mucus, and to swell. You may have some airway swelling all the time, even when you feel OK. Your airways may also become smaller causing you to have breathing problems or to wheeze. Wheezing is a loud noise you hear when you breathe in or out. An asthma attack happens when your airways narrow making it hard to breathe. Asthma attacks are also called flare-ups, exacerbations, or episodes.

Causes: The following may be possible causes of an asthma attack.

􀁺 Air pollution.

􀁺 Animals.

􀁺 Cold weather.

􀁺 Dust.

􀁺 Exercise.

Foods.

􀁺 Lung infections.

􀁺 Molds.

􀁺 Pollens.

􀁺 Smoke.

􀁺 Stress.

Signs and Symptoms:

Breathing faster than normal.
􀁺 Breathing trouble.
􀁺 Cough which may be worse at night or early morning.
􀁺 Drop in peak flow reading.
􀁺 Fast heartbeat.
􀁺 Head "stopped up."
􀁺 Itchy, scratchy, or sore throat.
􀁺 Short of breath.
􀁺 Tight feeling in the chest.
􀁺 Tired.
􀁺 Wheezing.

Grades of asthma
􀁺 Intermittent: This is the least serious level of asthma. At this level a person has asthma symptoms no more than 2 times a week. He will also not be awakened at night with asthma symptoms more than 2 times a month. An asthma attack may last from a few hours to a few days. A person at this level will not have symptoms between asthma attacks. Between asthma attacks the peak expiratory flow or "PEF" is normal. The PEF is a measure of airflow to your lungs. A peak flow meter is used to get a PEF reading. The PEF reading will vary by less than 20%.
􀁺 Mild persistent : A person at this level has asthma symptoms more than 2 times a week but not every day. He will have nightime asthma symptoms more than 2 times a month. An asthma attack may slow his daily activities. The PEF reading will vary by 20% to 30%.
􀁺 Moderate persistent: A person at this level has asthma symptoms every day. He will use a shortacting inhaled asthma medicine every day. He will have nightime asthma symptoms about once a week. Asthma attacks may happen at least 2 times a week and last for many days. At this level, asthma attacks get in the way of a person's daily activities. The PEF reading may vary by more than 30%.
􀁺 Severe persistent: This is the most serious level of asthma. A person at this level has asthma symptoms all the time. These symptoms limit a person's physical activity. Asthma attacks are common as well as nighttime symptoms. The PEF reading may vary by more than 30%.

Pharmacotherapy. Following are the 2 groups of asthma medicines.
􀁻 Long-term control medicines. These medicines are taken every day to control persistent
asthma by decreasing inflammation . Inflammation is when your airways swell and tighten. This group of medicines may also keep airway swelling from starting. Inhaled steroid medicine is used to decrease the inflammation. This medicine is put into an inhaler through which you breathe.
􀁻 Quick-relief medicines. These medicines are taken to quickly open your airways and to treat other symptoms. These symptoms may be cough, chest tightness, wheezing, or shortness of breath. Quick-relief medicines are bronchodilators . Bronchodilators relax muscles that have tightened around the airways. This opens the airways to help you breathe easier.

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MEMANTINE

noreply@blogger.com (Dr. Farhan Ahmad Khan) — Tue, 17 Nov 2009 13:11:00 +0000

Treats symptoms of Alzheimer's disease, such as problems with memory, concentration, and

judgment.

How to Use This Medicine:

Tablet

􀁺 Your doctor will tell you how much of this medicine to use and how often. Your dose may need to be changed several times in order to find out what works best for you. Do not use more medicine or use it more often than your doctor tells you to. Most people need to wait at least one week between dose changes.

􀁺 You may take this medicine with or without food.

If a dose is missed:

􀁺 If you miss a dose or forget to use your medicine, use it as soon as you can. If it is almost time for your next dose, wait until then to use the medicine and skip the missed dose. Do not use extra medicine to make up for a missed dose.

Warnings While Using This Medicine:

􀁺 Make sure your doctor knows if you are pregnant or breast feeding, or if you have epilepsy or liver disease. Tell your doctor if you have any problems with your kidneys or bladder.

􀁺 Call your doctor if you get a urinary tract infection. This includes any infection in your bladder or kidneys. Your dose of this medicine might need to be changed while you have an infection.

Possible Side Effects:

Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or
throat, chest tightness, trouble breathing.
􀁺 Chest pain.
􀁺 Dizziness, fainting.
􀁺 Severe sleepiness, restlessness, seeing or hearing things that are not there.
􀁺 Sudden or severe headache.

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FEXOFENADINE may interact with GRAPEFRUIT JUICE

noreply@blogger.com (Dr. Farhan Ahmad Khan) — Sat, 19 Sep 2009 18:57:00 +0000

Grapefruit juice can decrease the absorption of fexofenadine from the stomach into the bloodstream. This could make fexofenadine less effective. To avoid this interaction, take fexofenadine with water or liquids other than fruit juices. Do not take fexofenadine with grapefruit juice or grapefruit itself. Also avoid taking fexofenadine with apple juice and orange juice.Discuss this potential interaction with your healthcare provider at your next appointment, or sooner if you think you are having problems.

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Maraviroc, CCR5 Co- Receptor Antagonists

noreply@blogger.com (Dr. Farhan Ahmad Khan) — Sat, 19 Sep 2009 12:30:00 +0000

Clinical Use

:Ø ART experienced patients with CCR5 tropic HIV-1 virus and withdetectable viral resistance to multiple ARTs

Ø Should not be used in treatment naïve patient

Failure:• Tropism for conversion from CCR 5 to CXCR 4 or dual or mixedtropism of HIV-1

• v3 loop mutation in gp120

Recommended Maraviroc Dose:1) 150mg oral BD in combination with CYP3A inhibitors (proteaseinhibitors,azole itraconazol/ ketoconazol, clarithromycin).2) 300mg oral BD in combination with ritonavir boosted tipranavir, NRTI,enfuvirtide, nevirapine or other drugs without CYP3A effect.3) 600mg oral BD with CYP 3A inducers efavirenz, entravirin, rifampicin,st. jone`s wart.Metabolism :Primarily by liverToxicities: Diarrhoea, nausea, fatigue, headache and derangement ofliver function testVicriviroc:Plasma half life markedly increased by CYP 3A4 inhibitorsPlasma half life >24 hrsNo food effectDurable antiretroviral activity in CCR5 tropic strainUnder Phase III trialAlpraviroc: Hepatotoxic, so trial was terminated.Apretinant: neurokinin 1 receptor antagonistApproved antiemetic, downregulates CCR5 expression on macrophages invitro- under investigation.

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The First HIV Integrase Inhibitor: Raltegravir

noreply@blogger.com (Dr. Farhan Ahmad Khan) — Mon, 03 Aug 2009 16:57:00 +0000

Raltegravir is the first integraseinhibitor to be approved by the US Food and Drug Administration for use in antiretroviral treatment–experienced adult patients with viral resistance. Raltegravir blocks HIV replication by inhibitingessential strand-transfer activities of integrase. Raltegravir is rapidly absorbed, with a median Tmax of~4 hours in the fasting state. No dose adjustment is recommended in patients with moderate renal or hepaticinsufficiency, and raltegravir may be taken withoutregard to meals.

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Vaccination against Typhoid Fever

noreply@blogger.com (Dr. Farhan Ahmad Khan) — Thu, 23 Jul 2009 03:42:00 +0000

Outbreaks of chloramphenicol-resistant typhoid stimulated a search for alternative oral antibiotic therapies and accelerated efforts to develop a new generation of better-tolerated, efficacious typhoid vaccines. The efforts bore fruit when live oral S. Typhi vaccine strain Ty21a and parenteral Vi polysaccharide vaccine were licensed in the late 1980s and early 1990s. Despite extensive data documenting the safety, efficacy, and practicality of the Vi and Ty21a vaccines, these preparations have not been widely applied programmatically in developing countries. The limited use of the Vi vaccine has been partly due to doubts about the programmatic feasibility and effect of Vi vaccination in public health programs, as well as questions about whether the vaccine is protective in children between the ages of 2 and 5 years and whether it can confer herd immunity.

According to the Sur et al. report, the Vi vaccine conferred an adjusted vaccine effectiveness in preschool children of 80% after two years follow-up; but vaccine effectiveness was lower in older children and adults (56% in children between the ages of 5 and 14 years and 46% in persons 15 years of age or older). Among unvaccinated members of the Vi-vaccine clusters, the level of protection was 44%, giving an overall level of protection among all residents of Vi-vaccine clusters of 57%.

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Propylthiouracil (PTU) side effects

noreply@blogger.com (Dr. Farhan Ahmad Khan) — Tue, 16 Jun 2009 04:54:00 +0000

The FDA warned prescribers about the risk of serious liver injury associated with the use of the anti-thyroid drug propylthiouracil (PTU).
FDA’s warning highlights:
There is an increased risk of liver injury with propylthiouracil (PTU) when compared to methimazole.
Monitor for symptoms and signs of liver injury when propylthiouracil is chosen as anti-thyroid therapy. This should be emphasized during the first six months after initiating therapy.

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Injecting Insulin

noreply@blogger.com (Dr. Farhan Ahmad Khan) — Mon, 08 Jun 2009 09:52:00 +0000

Insulin is injected into the fatty tissue. The body areas that can be used for injections are shown in the picture below. Insulin absorption varies with the body area that is used. The abdomen has the fastest rate of absorption followed by the arms, legs and buttocks. Randomly changing the body areas used for injections may result in variability in blood sugar levels. It is best that injection sites be changed within one body area instead of between body areas. The body area used for each routine injection (for example, before breakfast) should be the same every day.
Abdomen - stay 2 inches away from the navel (belly button) or scars and go sideways to the hips. You can go above or below the waist if there is good tissue.
Arms - measure one hand width down from the shoulder and one hand width up from the elbow. Use the fleshy outer surface.
Legs - measure one hand width down from the groin and one hand width up from the knee. Use the top and outer part of the leg staying away from the inner part of the thigh.
Buttocks - use the upper outer area. * Do Not Inject In The Same Place. Keep Changing Your Injection Sites In A Body Area.
Injecting
Wipe the injection site with alcohol or clean with soap and water.
Gently pinch up the skin at the injection site with your free hand to pull the fat away from the muscle.
Holding the syringe like a pencil, quickly push the needle into the injection site. The needle can be inserted at an angle of 45° or 90°. Be sure the needle is all the way in.
Push the plunger in at a steady rate all the way down.
Pull the needle straight out quickly. Hold the alcohol wipe over the injection site for a few seconds. Do not rub the area. Disposal of Needles and Syringes Dispose of the needles and syringes properly. It is recommended that they be disposed of in a container that is used only for that purpose. A coffee can or hard plastic bottle, such as an empty bleach or liquid detergent bottle, can be used. Do not use a container that will be returned to a store or recycled. Do not use glass or clear plastic containers. When the container is full, seal the lid with heavy-duty tape. Check with your local community waste disposal agency for the proper way to dispose of the container. Make sure that sharps are kept out of the reach of children.
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DANGEROUS DRUGS THAT HAVE BEEN GLOBALLY DISCARDED

noreply@blogger.com (Dr. Farhan Ahmad Khan) — Fri, 05 Jun 2009 21:36:00 +0000

India has become a dumping ground for banned drugs; also the business for production of banned drugs is booming. Plz make sure that u buy drugs, only if prescribed by a doctor (Also, ask which company manufactures it, this would help to ensure that u get what is prescribed at the Drug Store) and that also from a reputed drug store. Not many people know about these banned drugs and consume them causing a lot of damage to themselves.
1. PHENYLPROPANOLAMINE: cold and cough. Reason for ban : stroke.
Brand name : Vicks A
2. ANALGIN: This is a pain-killer. Reason for ban: Bone marrow depression.
Brand name: Novalgin
3. CISAPRIDE: Acidity, constipation. Reason for ban : irregular heartbeat
Brand name : Ciza, Syspride
4. DROPERIDOL: Anti-depressant. Reason for ban : Irregular heartbeat.
Brand name : Droperol
5. FURAZOLIDONE: Antidiarrhoeal. Reason for ban : Cancer.
Brand name : Furoxone, Lomofen
6. NIMESULIDE: Painkiller, fever. Reason for ban : Liver failure.
Brand name : Nise, Nimulid
7. NITROFURAZONE: Antibacterial cream. Reason for ban : Cancer.
Brand name : Furacin
8. PHENOLPHTHALEIN: Laxative.. Reason for ban : Cancer.
Brand name : Agarol
9. OXYPHENBUTAZONE: Non-steroidal anti-inflammatory drug.
Reason for ban : Bone marrow depression.
Brand name : Sioril
10. PIPERAZINE: Anti-worms. Reason for ban : Nerve damage.
Brand name : Piperazine
11. QUINIODOCHLOR: Anti-diarrhoeal. Reason for ban : Damage to sight.
Brand name: Enteroquinol

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Treatment Guidelines for Malaria Contd...

noreply@blogger.com (Dr. Farhan Ahmad Khan) — Mon, 16 Mar 2009 05:54:00 +0000

Treatment regimens for uncomplicated malaria in adults

_ Oral quinine sulphate 600 mg/8 h for 5e7 days plus doxycycline 200 mg daily (or clindamycin 450 mg/8 h for pregnant women) for 7 days

_ Atovaquoneeproguanil (Malarone_): 4 ‘standard’ tablets daily for 3 days or

_ Co-artem ((artemetherelumefantrine_): if weight > 35 kg, 4 tablets then 4 tablets at 8, 24, 36, 48 and 60 h

Child Initial dose 10 mg/kg/base then 5 mg/kg base 6e8 h later and on days 2 and 3

However, both of these newer regimens need to be taken for only 3 days. In contrast, quinine needs to be taken for 5e7 days and is often associated with ‘‘cinchonism’’ (nausea, deafness and ringing in the ears), which often results in poor adherence. Although international recommendations suggest that quinine should be taken for 7 days in endemic areas,2 UK experience suggests that 5 days treatment is adequate for the vast majority of cases. Quinine should be combined with a second drug (doxycycline for adults or clindamycin in pregnant women and young children) to ensure complete eradication of parasites.

Drug treatment of severe or complicated malaria

_ Quinine: loading dose of 20 mg/kg quinine dihydrochloride in 5% dextrose or dextrose saline over 4 h. Followed by 10 mg/kg every 8 h for first 48 h (or until patient can swallow). Frequency of dosing should be reduced to 12 hourly if intravenous quinine continues for more than 48 h.

_ Alternative rapid quinine loading regimen (adults only) 7 mg/kg quinine dihydrochloride over 30 min using an infusion pump followed by 10 mg/kg over 4 h.

_ Parenteral quinine therapy should be continued until the patient can take oral therapy when quinine sulphate 600 mg should be given 3 times a day to complete 5e7 days of quinine in total.

_ Quinine treatment should always be accompanied by a second drug: doxycycline 200 mg (or clindamycin 450 mg 3 times a day for pregnant women, 7e13 mg/kg 3 times a day for children), given orally for total of 7 days from when the patient can swallow.

_ Artesunate regimen: appropriate for adults only on expert advice. 2.4 mg/kg given as an intravenous injection at 0, 12 and 24 h then daily thereafter. A 7-day course of doxycycline should also be given.

Intensive care management of severe or complicated malaria

_ Careful management of fluid balance to optimise oxygen delivery and reduce acidosis

_ Monitoring of central venous pressure to keep right atrial pressure <>

_ Regular monitoring for hypoglycaemia

_ Consider broad spectrum antibiotics if evidence of shock or secondary bacterial infection

_ Haemofiltration for renal failure or control of acidosis or fluid/electrolyte imbalance

_ Consider medication to control seizures

_ Consideration of exchange transfusion in patients with hyperparasitaemia

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Treatment Guidelines for Malaria Contd...

noreply@blogger.com (Dr. Farhan Ahmad Khan) — Mon, 16 Mar 2009 05:54:00 +0000

Treatment regimens for uncomplicated malaria in adults

_ Oral quinine sulphate 600 mg/8 h for 5e7 days plus doxycycline 200 mg daily (or clindamycin 450 mg/8 h for pregnant women) for 7 days

_ Atovaquoneeproguanil (Malarone_): 4 ‘standard’ tablets daily for 3 days or

_ Co-artem ((artemetherelumefantrine_): if weight > 35 kg, 4 tablets then 4 tablets at 8, 24, 36, 48 and 60 h

Child Initial dose 10 mg/kg/base then 5 mg/kg base 6e8 h later and on days 2 and 3

Drug treatment of severe or complicated malaria

_ Alternative rapid quinine loading regimen (adults only) 7 mg/kg quinine dihydrochloride over 30 min using an infusion pump followed by 10 mg/kg over 4 h.

_ Parenteral quinine therapy should be continued until the patient can take oral therapy when quinine sulphate 600 mg should be given 3 times a day to complete 5e7 days of quinine in total.

Intensive care management of severe or complicated malaria

_ Careful management of fluid balance to optimise oxygen delivery and reduce acidosis

_ Monitoring of central venous pressure to keep right atrial pressure <>

_ Regular monitoring for hypoglycaemia

_ Consider broad spectrum antibiotics if evidence of shock or secondary bacterial infection

_ Haemofiltration for renal failure or control of acidosis or fluid/electrolyte imbalance

_ Consider medication to control seizures

_ Consideration of exchange transfusion in patients with hyperparasitaemia

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Treatment Guidelines for Malaria

noreply@blogger.com (Dr. Farhan Ahmad Khan) — Mon, 16 Mar 2009 05:54:00 +0000

The treatment of choice for non-falciparum malaria is a 3-day course of oral chloroquine, to which only a limited proportion of P. vivax strains have gained resistance. Dormant parasites (hypnozoites) persist in the liver after treatment of P. vivax or P. ovale infection: the only currently effective drug for eradication of hypnozoites is primaquine. This must be avoided or given with caution under expert supervision in patients with glucose-6-phosphate dehydrogenase deficiency (G6PD), in whom it may cause severe haemolysis. Uncomplicated P. falciparum malaria can be treated orally with quinine, atovaquone plus proguanil (Malarone _) or co-artemether (Riamet_); quinine is highly effective but poorly tolerated in prolonged dosage and is always supplemented by additional treatment, usually with oral doxycycline.

ALL patients treated for P. falciparum malaria should be admitted to hospital for at least 24 h, since patients can deteriorate suddenly, especially early in the course of treatment. Intravenous artesunate reduces high parasite loads more rapidly than quinine and is more effective in treating severe malaria in selected situations.

Falciparum malaria in pregnancy is more likely to be severe and complicated: the placenta contains high levels of parasites. Stillbirth or early delivery may occur and diagnosis can be difficult if parasites are concentrated in the placenta and scanty in the blood. The treatment of choice for falciparum malaria in pregnancy is quinine; doxycycline is contraindicated in pregnancy but clindamycin can be substituted for it, and is equally effective. Primaquine (for eradication of P. vivax or P. ovale hypnozoites) is contraindicated in pregnancy; after treatment for these infections a pregnant woman should take weekly chloroquine prophylaxis until after delivery when hypnozoite eradication can be considered.

There are no specific symptoms of malaria: most patients complain of fever, headache and general malaise.6 Gastrointestinal disturbances, jaundice or respiratory symptoms occasionally occur and are often responsible for misdiagnosis. Most missed malaria infections are erroneously diagnosed as non-specific viral infections, influenza, gastroenteritis or hepatitis.

If there is clinical suspicion of malaria, but initial blood films are negative, repeat films should be examined after 12e24 h and again after a further 24 h. Thrombocytopenia, in particular, is highly suggestive of malaria in non-immune adults and children, both in falciparum and non-falciparum malaria.

Major features of severe or complicated falciparum malaria in adults

Impaired consciousness or seizures
Renal impairment (oliguria <> 265mmol/l)
Acidosis (pH <>
Hypoglycaemia (<2.2>
Pulmonary oedema or acute respiratory distress syndrome (ARDS)
Haemoglobin _ 8 g/dL
Spontaneous bleeding/disseminated intravascular coagulation
Shock (algid malaria e BP <>
Haemoglobinuria (without G6PD deficiency)

Assessment of the patient should include careful clinical evaluation and review of investigations for the features of severe malaria detailed below. A full blood count, urea and electrolytes, liver function tests and blood glucose should be done routinely. In ill patients, blood gases, blood culture, lactate and clotting studies should also be performed. Urine dipstick and culture, stool culture and chest X-ray may be appropriate. Lumbar puncture to exclude meningitis should be considered in febrile patients with impaired consciousness or repeated seizures.

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DARPins (designed ankyrin repeat proteins)

noreply@blogger.com (Dr. Farhan Ahmad Khan) — Thu, 19 Feb 2009 05:44:00 +0000

DARPins (designed ankyrin repeat proteins) are a novel class of binding molecules with the potential to overcome limitations of monoclonal antibodies, hence allowing novel therapeutic approaches. DARPins are small, single domain proteins (14 kDa) which can be selected to bind any given target protein with high affinity and specificity. These characteristics make them ideal agonistic, antagonistic or inhibitory drug candidates. Furthermore, DARPins can be engineered to carry various effector functions or combine multiple binding specificities, enabling completely new drug formats. Taken together, DARPins are a prominent member of the next generation of protein therapeutics with the potential to surpass existing antibody drugs.

For details visit http://www.drugdiscoverytoday.com/echoice/feb2009/Stumpp.pdf

Cortesy

Dr. Tariq Salman

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Clopidogrel bisulfate

noreply@blogger.com (Dr. Farhan Ahmad Khan) — Fri, 30 Jan 2009 05:19:00 +0000

Cardiovascular healthcare professionals, Pharmacists agreed to work with FDA to conduct studies to obtain additional information that will allow a better understanding and characterization of the effects of genetic factors and other drugs (especially the proton pump inhibitors (PPIs)) on the effectiveness of clopidogrel. FDA is aware of published reports that clopidogrel (marketed as Plavix) is less effective in some patients than it is in others. Differences in effectiveness may be due to genetic differences in the way the body metabolizes clopidogrel or that using certain other drugs with clopidogrel can interfere with how the body metabolizes clopidogrel. These studies should lead to a better understanding about how to optimize the use of clopidogrel. Until further information is available FDA recommends the following:

Healthcare providers should continue to prescribe and patients should continue to take clopidogrel as directed, because clopidogrel has demonstrated benefits in preventing blood clots that could lead to a heart attack or stroke.
Healthcare providers should re-evaluate the need for starting or continuing treatment with a PPI, including Prilosec OTC, in patients taking clopidogrel.
Patients taking clopidogrel should consult with their healthcare provider if they are currently taking or considering taking a PPI, including Prilosec OTC.

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