Medicines and You

= Chemical Compound
= Indications
= Dosage
= Contraindication
= Special Precautions
= Adverse Reactions
= Drug-Drug Interaction

Allergy & Immune System

a) Antihistamines & Antiallergics

Hydroxyzine.
Pruritus. Symptomatic relief of anxiety & tension. Generalised Anxiety Disorders (GAD). Pre-medication.
Previous hypersensitivity.
Early pregnancy. Avoid operating vehicles or machinery.
Sedation.
Alcohol, CNS depressants

Loratadine
Relief of symptoms associated w/ allergic rhinitis eg sneezing, nasal discharge & itching, as well as ocular itching & burning. Chronic urticaria & other allergic dermatologic disorders.
Pregnancy & lactation.

Buclizine diHCI.
Motion sickness, hay fever, urticaria, pruritus, perennial rhinitis.
Acute attack of asthma. Premature infants.
Narrow-angle glaucoma, pregnancy. Large dose may precipitate fits. Urinary retention, prostatic hypertrophy. Avoid operating vehicles & machinery. Cross-sensitivity to related drugs.
Drowsiness, dizziness, dry mouth. Gl disturbances.
CNS depressants. Anticholinergics, MAOIs, alcohol.

Chlorpheniramine maleate.
Allergic conditions responsive to antihistamine.
Avoid operating vehicles or machinery. Pregnancy.
Drowsiness, dizziness, stinging, burning sensation at inj site. Hypotension, CNS stimulation.
Alcohol, CNS depressants, MAOIs, anticholinergic drugs.

Dexchlorpheniramine maleate.
Allergic conditions.
Newborn & premature infants. MAOI therapy.
Narrow-angle glaucoma; stenosing peptic ulcer; pyloroduodenal obstruction; prostatic hypertrophy or bladder neck obstruction; CV disease; increased intraocular pressure; hyperthyroidism. Avoid driving & operating machinery.
Drowsiness, urticaria, drug rash, anaphylactic shock, photosensitivity, excessive perspiration; chills; dry mouth, nose & throat. Severe hypotension. CV, hematalogic, neurologic, Gl, GUT & resp reactions.
Effects prolonged & intensified by MAOIs. Sedative effects potentiated by alcohol, tricyclic antidepressants, barbiturates or other CNS depressants.

Azatadine maleate.
Allergic skin conditions; allergic minitis, hay fever, vasomotor rhinitis.
Newborn & premature infants. Patients receiving MAOI. Known hypersensitivity. Acute attack of asthma.
Narrow-angle glaucoma, prostatic hypertrophy or bladder neck obstruction; pyloroduodenal obstruction; CV disease; hyperthyroidism; increased intraocular pressure. Childn , 1 yr. Patients w/ focal lesions of the cerebral cortex. Cross-sensitivity to related drugs. Avoid operating vehicles or machinery. Pregnancy & lactation.
Drowsiness, CV & CNS effects. Blood disorders. GIT disturbances. Photosensitivity. Allergic reactions. Antimuscarinic effects. Muscular weakness.
MAOIs prolong action & intensity of antihistamine. Alcohol, tricyclic antidepressants, barbiturates or other CNS depressants may potentiate sedative effect. Effects of oral anticoagulant may be inhibited.

Cetirizine diHCI.
Perennial rhinitis, seasonal allergic rhinitis, acute & chronic urticaria & other allergic dermatological disorders, allergic conjunctivitis.
Pregnancy, lactation.
Occasionally, symptoms of hypersensitivity.

b) Vaccines, natisera & immunologicals

Haemophilus influenzae type b polysaccharide conjugated to tetanus protein.
Routine immunization against invasive disease caused by Haemophilus influenzae type b in infant from 2 mth.
Presence of fever or acute infection.

Type I, II & III attenuated polio viruses.
Oral, active immunization against poliomyelitis.
Suppressed immune response & primary immunodeficiencies. Persistent vomiting & diarrhea. Acute febrile illness. Debilitated states.
Pregnancy. Do not administer parenterally.
Rarely, vaccine-acquired poliomyelitis.
TB, lg & blood products, immunosuppressives, live vaccines.

Human standard ?-globulin.
Prophylaxis & treatment of viral diseases; supportive treatment in septic bacterial infection; treatment of antibody deficiency.
Selective lg A deficiency.
Severe thrombocytopenia, bleeding disorders.
Local reaction w/ pain & tenderness. Headache, malaise, fever, arthralgia, nephritic syndrome. Allergic reactions. Rarely, anaphylaxis.
Live attenuated vaccines.
Hepatitis B surface antigen.
Immunization against infections caused by all known subtypes of hepatitis B virus.
Hypersensitivity.
pregnancy. Delay use in serious infection. Person w/ immuno deficiency or those receiving immunosuppression therapy require larger doses & respond less well. Severely compromised cardiopulmonary status. Patient whom a febrile or systemic reaction could pose a risk.
Fatigue, malaise, fever, nausea, diarrhea, headache, reactions at inj site, including local pain, soreness & tenderness, pruritus, erythema, ecchymoses, swelling, warmth & nodule formation; pharyngitis, upper resp infection.

Interferon 8-2b.
Hairy cell leukaemia, condylomata acuminate (vial only), chronic myelogenous leukaemia, AIDS-related Kaposi’s sarcoma, chronic hepatitis C/non-A non-B, chronic hepatitis B, multiple myeloma, Non-Hodgkin’s lymphoma, Metastatic renal cell carcinoma, malignant melanoma (vial only).
History of hypersensitivity.
Hypotension. History of MI &/or previous or current arrhythmic disorders.
Fever, fatigue, headache, myalgia, rigor, anorexia, nausea, thrombocytopenia, granulocytopenia & Gl disturbances.

Inactivated virions of Japanese encephalitis virus.
prevention of Japanese encephalitis.
Fever or severe malnutrition. CV, renal or hepatic diseases in acute, exacerbating or active phases, history of abnormal edverse reactions caused by this vaccine, history of spasmodic symptoms w/in 1 yr, pregnancy.
Local reactions eg redness, swelling, tenderness or systemic reactions eg fever, chill, headache, lassitude.

Live measles, mumps & rubella virus vaccine.
Immunisation against measles, mumps & rubella in childn =15 mth, nonpregnant adolescents, adult female & postpartum women. A 2nd dose of MMR II or measles vaccine recommended. If vaccinating childn = 12 mth, revaccinate after reaching 15 nth. Infants immunized at < 1 yr old may not develop sustained antibody levels when later reimmunized.
Pregnancy. Any febrile infection or febrile resp illness. Active untreated TB, blood dyscrasias, leukemia, lymphomas of any type, malignant neoplasms affecting the bone marrow or lymphatic system. Patients receiving immunosuppressive therapy except patients receiving corticosteroids as replacement therapy, eg Addison’s Disease. Primary & acquired immunodeficiency states, or family history of immunodeficiency. Hypersensitivity to neomycin or eggs.
Avoid pregnancy for 3 mth following vaccination. Provide adequate treatment should an anaphylactic reaction occurs. Individual or family history of convulsions, history of cerebral injury or conditions in which stress due to fever should be avoided. Temp elevation may occur. Defer vaccination for at least 3 mth following transfusions or administration of human lg. Lactation. May cause temporary depression of tuberculin skin sensitivity. HIV-infected individuals w/o overt signs of immunosuppression may be vaccinated but immunization may be less effective.
Common: Burning, stinging at inj site. Occasional: Fever, rash. Rare: Headache, fever, sore throat, nausea, vomiting, diarrhea, rash, arthralgia &/or arthritis, parotitis, nerve deafness, optic neuritis. Lymphadenopathy, febrile convulsions, ataxia, Guillain-Barre syndrome, thrombocytopenia, purpura, dizziness, paraesthesias.
Affected by lg.

Haemophilus b conjugate vaccine (meningococcal protein conjugate).
Immunization against invasive disease caused by Haemophilus influenza type b in infant & childn 2-71 mth.
Pregnancy. Persons w/ malignancies, or those receiving immunosuppressive therapy or are immunocompromised, expected immuneresponse may not be obtained. Provide adequate treatment should an anaphylactic reaction ossur. Acute infection or febrile illness.
Swelling/induration, pain/soreness, erythema, rash, fever, urticaria.

Purified capsular polysaccharides from the 23 most prevalent invasive pneumococcal types.
Immunisation against pneumococcal disease caused by these pneumococcal types included in the vaccine. For use in selected individuals > 2 yr: Patients who have anatomical asplenia or who have splenic dysfunction due to sickle cell disease or other causes; persons w/ chronic illnesses in which there is an increased risk of pneumococcal disease (such as functional impairment of cardio-resp, hepatic & renal systems); persons =50 yr; patients w/ other chronic illness who may be at greater risk of developing pneumococcal infection or experiencing more severe pneumococcal illness as a result of alcohol abuse or co-existing diseases including diabetes mellitus, chronic CSF leakage or conditions associated w/ immunosuppression; patients w/ Hodgkin’s disease if immunization can be given at least 10 days 914 days for max antibody response) prior to treatment. For use in communities in persons > 2yr. Closed groups such as those in residential schools, nursing homes & other institutions; groups epidemiologically at risk in the community when there is a generalized outbreak in the population due to a single pneumococcal type included in the vaccine; patients at high risk of flu complications, particularly pneumonia. Revaccination after 3-5 yr recommended for childn at highest risk for pneumococcal infection if aged = 10 yr old at revaccination.
Hypersensitivity. Revaccination of adults w/ Pneumovax 23 is contraindicated except for those at highest risk of pneumococcal infections. Patients w/ Hodgkin’s disease immunized < 7 to 10 days prior to or during immunosuppressive therapy & patients w/ hodgkin’s disease who have received extensive chemotherapy &/or nodal irradiation.
In persons receiving immunosuppressive therapy, expected serum antibody response may not be obtained. Avoid intradermal administration. Severely compromised cardiac &/or pulmonary function. Delay usage in febrile resp illness or other active infection. In patients who require antibiotic prophylaxis against pneumococcal infection, such prophylaxis should not be discontinued after vaccination w/ Pneumovax 23. Pregnancy & lactation. Childn < 2 yr. Patients w/ severe renal & hepatic impairment.
Local inj-site soreness, warmth, erythema & swelling. Fever, headache, malaise, rash, urticaria, arthritis, arthralgia.

Inactivated whole virus vaccine which induces antibody to hepatitis A virus protein.
Vaccination against infecton caused by hepatitis A virus.
Patients w/ malignancies or those receiving immunosuppressive therapy or those who are immunocompromised. Acute infections or febrile illness. Pregnancy, lactation.
Pain, tenderness & swelling at inj site. Warrmth, erythema, ecchymosis, abdominal pain, diarrhea, vomiting, headache, pharyngitis.

Live varicella virus vaccine.
Vaccination against varicella in persons = 12 mth.
Hypersensitivity to any component including gelatin. Blood dyscrasias, leukaemia, lymphoma, malignant neoplasms affecting bone marrow or lymphatic system. Immunodeficiency, active untreated TB, febrile resp illness or other active infections. History of anaphylactoid reaction to neomycin. Individuals receiving immunosuppressive therapy.
Avoid salicylates for 6 wk & avoid pregnancy for 3 mth after vaccination. Defer vaccination for = 5 mth following blood/plasma transfusion/administration of lg/Varicella Zoster immune globulin (VZIG)> Following administration of Varivax, any lg including VZIG should not be given for 2 mth thereafter unless its use out-weights thebenefits of vaccination. Avoid close association w/ susceptibe high risk individuals.
Redness & pain at inj site, upper & lower resp illness, cough, irritability/nervousness, fatigue, disturbed sleep, vomiting, otitis, diaper rash, contact rash, headache, mild Gl upset, myalgia, arthralgia, lymhadenopathy.
Generally regarding administration of lg, salicylates & transfusion.

c) Immunosuppressants

Lymphocyte lg, anti-thymocyte globulin (equine).
Delaying onset of renal allograft rejection, treatment of rejection, aplastic anaemia.
Known hypersensitivity.
Monitor for signs of leucopenia, thrombocytopenia or concurrent infection. Perform skin testing.
Fever, shivering, nausea, tachycardia & hypotension; allergic reactions, anaphylaxis. Lymphocytopenia patients may experience leucopenia & thrombocytopenia. Thrombophlebitis.

Azathioprine.
Organ transplants, chronic active hepatitis, severe RA, SLE, idiopathic thrombocytopenic purpura, acquired haemolytic anaemia, pemphigus vulgaris.
Initial careful monitoring required in severe hepatic or renal impairment. Pregnancy. Elderly (monitor white cell count).
Bone marrow depression, haematopoiesis, macrocytosis. Nausea, occasional vomiting. Occasionally, allergic reactions, cholestatic jaundice.
Metabolism inhibited by allopurinol. Reduces the neuromuscular blockade of curare, tubocurarine but potentiates that of succinylcholine.

Ciclosporin.
Prevention of rejection of organ transplantation. Treatment of transplant rejection in patients previously receiving other immunosuppressive agents. Bone marrow transplantation: prevention of graft rejection. Prevention & treatment of graft-versus-host disease. Severe psoriasis cases in which alternative are ineffective or inappropriate. Severe RA cases in which standard treatment are ineffective or inappropriate.
Hypersensitivity to ciclosporin, kidney failure except in patients w/ nephritic syndrome. Uncontrolled infection, history of known or diagnosed malignancy of any kind except premalignant or malignant skin changes. Lactation.
Long-term use, severe renal dysfunction. Pregnancy.
Impaired kidney function, hypertension, tremor hypertrichosis, Gl disturbances, gingival hypertrophy, liver failure, infection, fatigue, headache, paraesthesias. Less frequently acne, rash, hyperhlycaemia, hyperuricaemia, hyperkalaemia, hypomagnesaemia; anaemia; peptic ulcer, oedema, wt gain, convulsions; reversible dysmenorrhoea or amenorrhoea. Rarely, muscle cramps.
Other immunosuppressive agents except corticosteroids, dietary K intake & K-containing drugs or K-sparing diuretics. ß-blockers, diuretics, live vaccines. Acyclovir, aminoglycosides, amphotericin B, ciprofloxacin, furosemide, mannitol, melphalan, trimethoprim (+ sulfamethoxazole), vancomycin, NSAIDs. Barbiturates, carbamazepine, phenytoin, nafcillin, sulfadimidine, rifampicin, octreotide, probucol, trimethoprim. Chloroquine, macrolide antibiotics, ketoconazole, diltiazem, nicardipine, verapamil, metoclopramide, OCs allopurinol, amiodarone, cholic acid & derivatives, doxycycline, propafenone, nifedipine.