Medicines & You

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

Eye

a) Eye anti-infectives & Antiseptics

Norfloxacin.
Superficial infections of the eye & its adnexae.
Hypersensitivity to quinolones.
Pregnancy, lactation, childn < 1 yr.
Local burning or smarting. Rarely, conjunctival hyperemia, chemosis, photophobia & a bitter taste following instillation.

Ciprofloxacin HCI.
Treatment of bacterial infections caused by susceptible strains of the designated micro-organisms in corneal ulcers & conjunctivitis.
History of hypersensitivity to ciprofloxacin or other quinolones.
Prolonged use may result in overgrowth of nonsusceptible organisms. Discontinue use at 1st appearance of skin rash or other sign of hypersensitivity reactions. Childn < 1 yr.
Local burning or discomfort, itching, lid edema, tearing, white crystalline precipitates which resolve.

Fusidic acid.
Bacterial eye infection. Prophylaxis in ophth surgery, removal of foreign bodies.
Allergy
Do not apply to eyes w/ contact lenses.
transient stinging.

Gentamicin sulfate.
Conjunctivitis, blepharitis, blepharo-conjunctivitis, keratitis, keratoconjunctivitis, episcleritis, dacrocystitis, corneal ulcers, styes & infected eye sockets.
Garamycin soln should never be injected subconjunctivally, nor directly introduced into the anterior chamber of the eye.
Discontinue if irritation or sensitization occurs.

Per g Oxytetracycline 5 mg, polymyxin B sulfate 1 mg.
Conjuctivitis, dacryocystitis, blepharoconjunctivitis, keratitis, trachoma, blepharitis; pre-opprophylaxis against infection.
Allergic reactions.

Tobramycin
Treatment of external infection of eye & its adnexa caused by susceptible bacterial.
Hypersensitivity
Prolonged use, superinfection. May retard corneal wound healing. Concomitant administration w/ aminoglycoside.
Localised ocular toxicity & hypersensitivity including itching & swelling & conjuctival erythema.

Acyclovir.
Herpes simplex keratitis.
Transient mild stinging; superficial punctuate keratopathy; local irritation & inflammation.

b) Eye Corticosteroids

Betamethasone disodium phosphate.
Blepharitis; spastic entropion due to local irritation; conjunctivitis; phlyctenular; interstitial keratitis; herpes zoster ophthalmicus; phlyctenular keratoconjuctivitis; neovascularization; scleritis; episcleritis; acute, chronic & traumatic irritis; iridocyclitis.
Herpes simplex cornea, dendritic corneal ulcer; viral & fungal disease of the ocular structures; TB of the eye.
Rise in intraocular pressure, esp those w/ glaucoma or latent glaucoma. Thinning of cornea (possible perforation).

Fluorometholone.
Acute & chronic iritis, iridocyclitis, scleritis, episcleritis, conjunctivitis, keratitis, resistant ocular allergy & inflammation following surgery.
Acute superficial herpes simplex keratitis, fungal diseases of ocular structure; vaccinia, varicella & other viral disease of the cornea & conjunctive, eye TB.
Glaucoma, disease causing thinning of cornea or sclera, history of herpes simplex, acute purulent conditions.
Glaucoma w/ optic nerve damage, visual acuity or field defects, raised intraocular pressure, secondary infection (persistent corneal ulceration, possibly fungal invasion), perforation of globe, posterior subcapsular cataract formation.

Desamethasone.
Treatment of allergic & other steroid-responsive inflammatory conditions of the palpebral & bulbar conjunctiva, cornea & anterior segment of the eye.
Epithelial herpes simplex, vaccinia, varicella, most other viral diseases of cornea & conjunctiva. TB of eye, fungal disease of ocular structures. After uncomplicated removal of a corneal foreign body.
Prolonged use. Acute purulent eye infection, diseases causing thinning of cornea or sclera.
Glaucoma w/ optic nerve damage, visual acuity & field defects; secondary infection following suppression of host response, perforation of globe.

Prednisolone acetate 0.12% (1% for Forte), methylcellulose 0.12%.
Mild allergies, inflammatory disorders, chemical & thermal burns. Forte- Severe inflammation, iritis, iridocyclitis, scleritis, episcleritis, uveitis.
Acute untreated purulent ocular infections, acute superficial herpes simplex (dendritic keratitis), vaccinia, varicella & most other viral diseases of the cornea & conjunctiva, ocular TB & fungal diseases of the eye.
History of herpes simplex keratitis.
Increased intraocular pressure w/ optic nerve damage, visual field defects. Posterior subcapsular cataract formation (heavy or protracted use), secomdary ocular infection from fungi or viruses liberated from ocular tissues & perforation of the globe when there is thinning of the cornea or sclera. Systemic side effects may occur w/ extensive use of steroids.

c) Eye Antiseptics with Corticosteroids

Betnesol Betamethasone Na phosphate 0.1%. Betnesol-N Betamethasone Na phosphate 0.1% neomycin sulfate 0.5%.
Steroid responsive inflammatory conditions of the eye, ear & nose. Betnesol-N prep should be used if bacterial infection is present or suspected.
Viral, fungal, TB, purulent eye infection, glaucoma, herpetic keratitis.
Pregnancy. Posterior subcapsular cataract formation & glaucoma w/ optic nerve damage on prolonged use: perforation, thinning of cornea.
Rise in intraocular pressure, corneal ulcers. Acute sensitization to neomycin.

Na sulfacetamide 10%, prednisolone acetate 0.2%, phenylephrine HCI 0.12%, polyvinyl alcohol 1.4%.
Non-purulent blepharitis, blepharo-conjunctivitis, non-purulent conjunctivitis (allergic & bacterial).
Acute herpes simplex, purulent untreated infection, vaccinia, varicella, viral & fungal eye diseases, ocular TB.
Increased intraocular pressure, thinning of cornea, perforation, sensitivity to sulfonamides, narrow-angle glaucoma, posterior, subcapsular cataract & overgrowth of non-susceptible organisms on prolonged use. Infants.

Gentamicin sulfate 0.3%, betamethasone disodium phosphate 0.1%.
Inflammatory & allergic conditions involving superficial eye structures & when bacterial infection is present, suspected or anticipated: Conjunctivitis, blepharitis, keratitis, episcleritis, dacryocystitis, hordeolum, meibomianitis, injuries involving anterior segment of the eye.
Epithelial herpes simplex keratotis, dendritic keratitis; viral diseases of the cornea & conjuctiva; mycobacterial or fungal infection.
When applied for = 10 days, tonometry & slit lamp exam are advisable.
Increased intraocular pressure; glaucoma; optic nerve damage; cataract; acute anterior uveitis; perforation of the globe.

d) Mydriatics Drugs

Cyclopentolate HCI 0.2%, phenylephrine HCI 1%.
For the production of mydriasis.
Narrow-angle glaucoma.
May impair ability to drive or operate machinery.
Increased intraocular pressure. Psychotic reactions & behavioral disturbances in childn.

Atropine sulfate.
Mydriasis &/or cycloplegia, cycloplegic refraction for papillary dilation desired in acute inflammatory conditions of the iris & uveal tract.
Primary glaucoma or a tendency toward glaucoma. Hypersensitivity.
To avoid inducing angle-closure glaucoma, an estimate of the depth of the angle of anterior chamber should be made. Childn.
prolonged use may produce local irritation.

Homatropine HBr.
For cycloplegic refraction & in the treatment of inflammatory conditions of the uveal tract. For pre- & post-op states when mydriasis is required. Used as an optical aid in some cases of axial lens opacities.
Primary glaucoma, narrow anterior chamber angle.
Infants & small childn.
Transient stinging. Local irritation (prolonged use).

Phenylephrine HCI.
For papillary dilation in uveitis, for refraction w/o cycloplegic. For fundascopy & other diagnostic procedures.
Narrow-angle glaucoma. Infant, elderly w/ severe arteriosclerotic, CV or cerebrovascular disease. During intraocular operative procedures when corneal epithelial barrier is disturbed.
Caution if administered w/ or up to 3 wk after MAOI therapy. Infant w/ cardiac anomalies.
Marked increase in BP in low-wt neonates, infant & adult w/ idiopathic hypotension. CV reactions in the elderly.
Tricyclic antidepressants. Propranolol.

Tropicamide.
For mydriasis & cycloplegia for diagnostic procedures.
Primary glaucoma or a tendency toward glaucoma.
caution when intraocular pressure is high or unknown or when anterior chamber is shallow.
Increased intraocular pressure, psychotic reactions. Transient stinging, dry mouth, allergic reactions may occur.

e) Miotics Drugs

Pilocarpine HCI.
To control intraocular pressure.
Where constriction is undesirable eg in acute iritis, papillary block glaucoma.
Night driving & other hazardous occupations in poor light.
Slight ciliary spasm, conjunctival vascular congestion, temporal or supraorbital headache, myopia.

Carbachol.
Intraocular use for mjosis during surgery.
Patients w/ acute cardiac failure, bronchial asthma, peptic ulcer, hyperthyroidism, Gl spasm, urinary tract obstruction & Parkinson’s disease.
Corneal clouding, bullous keratopathy, post-op iritis.

Per Timpilo 2- Timolol maleate 0.5%, pilocarpine HCI 2%. Per Timpilo 4 Timolol maleate 0.5%, pilocarpine HCI 4%.
Reduction of elevated intraocular pressure in patients whose IOP is not adequately controlled on monotherapy w/ a ß-blocker or pilocarpine or when concomitant therapy is appropriate.
Bronchospasm, including bronchial asthma, or a history of these conditions, or COPD. Sinus bradycardia, 2nd or 3rd degree AV block, overt congestive cardiac failure, cardiogenic shock. Conditions in which miosis is undesirable.
Cardiac failure should be controlled before beginning therapy. Patients w/ history of cardiac disease. Patient w/ asthma. Caution in night driving & other hazardous activities in poor illumination. Patients w/ history of atopy or a history of severe anaphylactic reactions. Lactation. Pregnancy. Not used while wearing soft contact lenses. Lenses should not be inserted earlier than 15 mins after use.
Severe resp reactions & cardiac reactions. Blurring in vision, difficulty in dark adaptation, headache/brow-ache & ocular irritation. Bradycardia, arrhythmia, hypotension, syncope, heart block, CVA, cerebral ischemia. CHF, palpitation, cardiac arrest. Bronchospasm, resp failure, dyspnea. Headache, asthenia, fatigue,, chest pain. Hypersensitivity reactions including localized & generalized rash & urticaria; alopecia. Dizziness, depression, increased in signs & symptoms of myasthenia gravis. Nausea. Ciliary spasm. Conjunctival vascular congestion. Lactrimation, temporal or supra-orbital headache, induced myopia, reduced visual acuity in poor illumination, retinal detachment. Lens opacity (prolonged use).
Additive effect w/ other topical ophth ß-blockers, Ca-blockers, catecholamine-depleting drugs may produce additive effects. IV Ca-blockers (caution w/ ß-blockers).

f) Glaucoma Preparations

Levobunolol HCI.
Chronic open-angle glaucoma, ocular hypertension.
Severe COPD; bronchospasm, bronchial asthma & uncontrolled CHF.
Abnormally low heart rate & severe heart block; CHF should be adequately controlled before therapy; history of cardiac disease (monitor pulse rates); diminished pulmonary function.
Transient ocular burning, stinging, itching; dizziness, headache; rarely, urticaria; blepharoconjunctivitis & decrease in heart rate & BP.
Additive effects w/ systemic antihypertensives; systemic ß-blockers may potentiate ocular hypotensive effects; adrenaline may cause mydriasis.

Betaxolol.
Chronic open-angle glaucoma, ocular hypertension. In clinical studies, it safely controlled the intraocular pressure of glaucoma patients w/ reactive airway disease. However caution in treating patients w/ severe reactive airway disease or a history of asthma.
Sinus bradycardia, = 1st degree AV block, cardiogenic shock, overt cardiac failure.
Diabetes, thyrotoxicosis, patients w/ excessive restriction of pulmonary function, pregnancy.
rare instances of decreased corneal sensitivity, erythema, itching, corneal punctuate staining, keratitis, anisocoria, photophobia, dryness, tearing, discomfort.
Epinephrine, catecholamine-depleting drugs, adrenergic psychotropic drugs (caution), oral ß-blockers.

Timolol maleate.
Reduction of elevated intraocular pressure.
Bronchial asthma or a history of bronchial asthma, severe COPD. Sinus bradycardia, 2nd & 3rd degree AV block, overt cardiac failure, cardiogenic shock.
Severe resp & cardiac reactions. History of atopy or a history of severe anaphylactic reaction to a variety of allergens. Lactation (discontinue). Remove soft contact lenses prior to administration, reinsert after 15 mins. Cardiac failure should be controlled before beginning therapy. Patients w/ asthma & history of cardiac disease. Use w/ a miotic in treatment of angle-closure glaucoma.
Ocular irritation, visual disturbances, bradycardia, arrhythmia, hypotension, syncope, heart block, CVA, cerebral ischemia, CHF; palpitation, cardiac arrest, bronchospasm in patients w/ pre-existing bronchospastic disease; resp failure, dyspnea, hypersensitivity reactions.
ß-blockers, oral Ca-entry blocker, catecholamine-depleting drugs, quinidine.

Dorzolamide HCI.
Treatment of elevated intraocular pressure in patients w/ ocular hypertension, open-angle glaucoma, pseudoexfoliative glaucoma & other secondary open-angle glaucomas.
Patients w/ severe renal (CrCL < 30 mL/min_ or hepatic impairment. Pregnancy & lactation. Children. Remove soft contact lens prior to administration & do not reinsert < 15 mins after use. Acute angle glaucoma, sensitivity to sulfonamide. Discontinue if signs of serious reaction/hypersensitivity occurs.
Burning, stinging, conjunctivitis, eyelid inflammation, eye itching, eyelid irritations. Headache, bitter taste, nausea, itching, fatigue/asthenia. Blurred vision, tearing. Rarely, iridocyclitis & rash. Angioedema, bronchospasm, urticaria, pruritus, dizziness, paraesthesia, transient myopia (resolve upon discontinuation) & suoerficial punctuate keratitis have also been reported.
High dose of salicylate therapy. Potential additive effect w/ oral carbonic anhydrase inhibitors.

g) Other Eye Preparations

Pirenoxine Na.
Senile cataract.

Lodoxamide tromethamine.
Allergic/ atopic conjunctivitis, vernal conjunctivitis & giant papillary conjunctivitis.
Soft lenses.
Pregnancy, Lactation
Burning, stinging, itching or vision disorders.

Phenylephrine HCI.
Relieves redness of the eye due to minor irritation that are not caused by infection. Protects against further irritation. Relieves dryness & reduce congestion of the eye.
Narrow-angle glaucoma.
Eye redness on overuse.

White petrolatum 55%, mineral oil 42.5%, nonionic lanolin derivatives 2%.
Lubrication of eyes for protection in conditions such as exposure keratitis, decreased corneal erosions, recurrent corneal erosions, keratitis sicca.

Murine NTF Polyvinyl alcohol 0.5%, povidone 0.6%. Murine Plus Polyvinyl alcohol 0.5%, povidone 0.6%, tetrahydrozoline HCI 0.05%.
Relief of dry eyes syndrome, irritation, burning, itching, excessive lacrimation & redness due to conjunctival hyperemia.

Tetrahydrozoline HCI.
Relief of burning, itching, excessive lacrimation & redness due to conjunctival hyperemia.
Glaucoma.
Use only for minor eye irritations.
Ocular stinging, burning & reactive hyperemia (w/ excessive use).

Ear

a) Ear Anti-infectives & Antiseptics

Per mL – Polymyxin B sulfate 10,000 u, lignocaine HCI 50 mg.
Treatment of bacterial infection & inflammation of external auditory meatus particularly when pain & itch are present.
Perforated eardrum.
Prolonged use.

b) Ear Antiseptics with Corticosteroids

Per mL- Polymyxin B sulfate 10,000 u, neomycin sulfate 3,400 u, hydrocortisone 10 mg.
Bacterial infection & inflammation of the external auditory meatus.
Perforation of eardrum.
Prolonged use.

Dexamethasone 0.05%, framycetin sulfate 0.5%, gramicidin 0.005%.
Eye: Treatment of steroid responsive conditions. Ear: Otitis externa.
herpes simplex infection; viral diseases of cornea & conjunctiva; TB & fungal disease of eyes.
Glaucoma; pregnancy; prolonged use in infants.
Sensitivity reactions.

Mouth & Throat

a) Mouth / Throat Preparations

Hexetidine.
symptomatic relief of mouth & throat infections including mouth ulcers caused by susceptible bacterial & fungi.
Not to be taken internally.

Cetalkonium Cl 0.01%, choline salicylate 8.7%.
Oral ulcers, cold sores, denture discomfort, infant teething.
Infants < 4 mth.

Miconazole nitrate.
Curative & prophylactic treatment of candidiasis of the buccopharyngeal cavity & GIT. Alone or combined w/ Daktarin IV as a therapeutic or prophylactic measure against other digestive mycoses or systemic mycoses.
occasional itching, burning, skin irritation.

Benzydamine HCI.
Painful & inflammatory mouth & throat conditions including tonsillitis, sore throat, radiation mucositis, aphthous ulcer, post-orosurgical & post-periodontal procedures.
Do not swallow soln. hepatic or renal impairment. Pregnancy, childn < 6 yr. In bacterial infection, appropriate antibacterial therapy should be used in addition to product.
Oral numbness; dryness or thirst, tingling, warm feeling in mouth, altered sense of taste.

Chlorhexidine gluconate.
Prevention of plaque formation, gingivitis. Promotes healing of mouth ulcers.
May cause staining of tongue & teeth, temporary alteration in taste perception.

Dichlorobenzyl alcohol 1.2 mg, amylmetacresol 0.6 mg.
Minor mouth & throat infections.
Rarely, diarrhea, stomach upset & sore tongue.

Amylmetacresol 0.6mg, 2,4-dichlorobenzyl alcohol 1.2mg, lignocaine HCI 10mg.
For symptomatic relief of mouth & throat infections including severe sore throat.
Pregnancy & lactation. Childn < 12 yr.
Taste perversion & burning sensation of throat.