Medicines & You

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

Genito-Urinary System

a) Preparations for Vaginal Conditions

Policresulen condensation product of metacresolsulfonic acid & methanal.
Local treatment of vag & cervical inflammation & tissue damage eg discharge due to bacterial, trichomonal & fungal infections; pressure sores from pessaries, condylomata acuminate. Protuberance of cervical mucosa. Hemostasis following biopsy or excision of uterine polyps. Local treatment of skin damage in order to accelerate the sloughing of necrotic tissue, for cleaning & stimulation of oozing hemorrhages. Local treatment of inflammation of the oral mucosa & gingival, aphthae. Hemostasis after tonsillectomy & in epistaxis.
Concomitant use of other topical agents in treating the affected areas.
1st trimester of pregnancy. Avoid deep intracervical application of the concentrate.
occasionally, mild local discomfort at beginning of treatment which disappears on discontinuation.

Clotrimazole.
Infectious leucorrhoea, vaginitis caused by fungi. Superinfection w/ Canesten-sensitive bacteria.
One 100mg vag tab in the evening for 6 consecutive days; or two 100 mg vag tab for 3 consecutive days; or single dose of 500 mg vag tab.
Skin reactions (rare).

Clindamycin phosphate.
Bacterial vaginosis.
History of hypersensitivity to clindamycin or lincomycin, regional enteritis, ulcerative colitis, antibiotic-associated colitis.
Cervicitis/vaginitis, vulvar irritation, superinfection. Dizziness, headache vertigo. Heart-burn, nausea, vomiting, diarrhea, constipation, abdominal pain. Urticaria.
May enhance the action of the neuromuscular blocking agents.

Tinidazole.
Treatment of urogenital trichomoniasis.
History of blood dyscrasias. Patients w/ active organic neurological disorders. 1st trimester of pregnancy & lactation.
IF abnormal neurological signs develop, discontinue therapy.
Neurological disturbances Gl disturbances, anorexia & metallic taste; hypersensitivity; rarely leucopenia, headache, tiredness, furry tongue, dark urine.
May cause alcohol intolerance.

Metronidazole.
Trichomonas infection of GUT.
If administered for >10 days, haematological tests are recommended.
Unpleasant taste in mouth, furry tongue, GIT disturbances. Urticaria, angioedema. Drowsiness, dizziness, headache, ataxia, skin rashes, pruritus, darkening of urine. Peripheral neuropathy or transient epileptiform seizures (prolonged therapy). Leucopenia. Anaphylaxis (rare).
Alcohol may cause disulfiram-like reaction. Potentiates the anticoagulant effect of warfarin type oral anticoagulants. Phenobarb increases the metabolism of metronidazole.

Tioconazole.
Vag yeast infection.
1st trimester of pregnancy.
Local reactions (transient).

Lactoserum lactic acid.
Caily feminine hygience. Post-partum care. Vaginitis, leucorrhea, vulvitis, vulval pruritus.
Douching is not recommended during pregnancy & menstruation.
Repeated use.
Local irritation.
Simultaneous or successive use of other antiseptics.

Per g – Natural conjugated destrogens in non-liquefying cream base 0.625 mg.
Atrophic vaginitis, postmenopausal atrophic urethritis.
Known or suspected breast cancer, estrogen-dependent neoplasia, active thromboembolic disease, undiagnosed abnormal genital bleeding. Known or suspected pregnancy.
Systemic absorption may occur. Warnings & precautions associated w/ oral Premarin should be considered.
Rarely nausea, vomiting. Breakthrough bleeding, spotting, change in menstrual flow, amenorrhea. Breast tenderness, enlargement, secretion. Gl effects, cholestatic jaundice. Chloasma or melasma. Steepening of the corneal curvature; intolerance to contact lenses. Headache, migraine, dizziness; chorea. Wt changes; edema; changes in libido.

b) Urinary Antiseptics

Pipemidic acid.
Acute, painful infection of the GUT caused by susceptible gm+ve, gm-ve bacterial & pseudomonas. Adjuvant therapy in prostaticadenoma, urinary incontinence, permanent catheters.
Childn = 12 yr.
Impaired renal & hepatic function. CNS damage, convulsions. Exposure to strong sunlight.
Nausea, abdominal pain. Exanthematous or urticarial skin rashes. CNS effects. Muscular weakness, myalgia. Intracranial hypertension.
Protein-bound drugs, antacids.

c) Drugs Acting on Uterus

Methylergometrine hydrogen maleate.
Active management of 3rd stage of labour, uterine atony/haemorrhage, subinvolution, lochiometra, puerperal bleeding.
Pregnancy; 1st & 2nd stage of labour & before crowning of the head; severe hypertension, hypertensive toxemia; occlusive vascular disease; sepsis.
Should not be given in abnormal presentations, before delivery of the child is completed & in multiple birth not before the last child has been delivered; active management of the 3rd stage of labor requires obstetric supervision; IV inj must be given slowly, over 60 seconds. Hypertension; impaired kidney or liver function; lactation.
Abdominal pain, Gl upsets, sweating, dizziness, headache, skin eruptions. Rarely hypertension, bradycardia or tachycardia, chest pain, peripheral vasospastic reaction. Very rarely anaphylactic reaction.
Enhances vasoconstrictor effects of sympathomimetics or ergotamine.

Dinoprostone.
To induce cervical softening & dilatation before labour is induced by conventional means.
History of Caesarean section or major uterine surgery, major degrees of cephalopelvic disproportion, a history of difficult labor &/or traumatic delivery, grand multiparae w/ 6 or more previous term pregnancies. Ruptured chorioamniotic membranes, non-vertex presentations or unexplained vag bleeding during pregnancy.
History of hypertonic or titanic uterine contractions. Women w/ asthma or history of asthma, glaucoma or raised intraocular pressure. Do not administer above the level of the internal os. Severe renal &/or hepatic disease w/ metabolic aberrations.
Intrapartum fetal heart rate changes & unclassified fetal distress during or after treatment. Uterine contractile abnormalities w/ or w/o fetal heart rate changes. Vomiting &/or diarrhea. Depressed neonates at birth.
Potentiates effects of oxytocin on the uterus.

Dinoprostone.
Induction of labour.
History of cesarean section or major uterine surgery; cephalopelvic disproportion, preexisting fetal distress, history of difficult labour &/or traumatic delivery; grand multiparae w/ =6 previous term pregnancies. Patients in whom oxytocin drugs are contraindicated. Presence of ruptured membranes. Conditions when prolonged contractions of uterus are inappropriate. Patients w/ pelvic inflammatory disease.
Glaucoma, elevated intraocular pressure, asthma or a history of asthma. Cephalopelvic relationships should be carefully evaluated before use. During use, uterine activity, fetal status & the progression of cervical dilatation should be evaluated at frequent interval. In patients w/ history of hypertonic uterine contractility or titanic contractions, it is recommended that uterine activity & state of the foetus be continue monitored throughout the labour. Possible uterine rupture where high-tone myometrial contractions are sustained.
Gl upsets, uterine hypercontractility w/ or w/o fetal bradycardia, rapid cervical dilatation w/ low Apgar score; headache.
May potentiate effects of oxytocin.

Synthetic oxytocin.
Primary & secondary uterine inertia. Postpartum haemorrhage & uterine atony. Induction or enhancement of labour. Caesarean section.
Significant cephalopelvic disproportion, foetal malpresentation; placenta praevia, placental abruption, grand multiparity, history of major uterine surgery including caesarean section; severe toxemia, severe CV disorders.
For induction or enhancement of labor use Syntocinon only as IV infusion; careful monitoring of foetal heart rate & uterine contractions are required.
Rarely, Gl upsets, water intoxication resulting from large amounts of soln or too rapid infusion. Cardiac arrhythmias.
prostaglandins, inhalation anesth, vasoconstrictor agents.

Per ML Synthetic oxytocin 5 iu, ergometrine maleate 0.5 mg.
Active management of the 3rd stage of labour, prevention & treatment of post-partum haemorrhage.
Pregnancy, labor (except 2nd stage following delivery of the anterior shoulder); severe hypertension, pre-eclampsia, eclampsia; severe disorders of cardiac, hepatic, or renal function; occlusive vascular disease; sepsis.
Hypertension, cardiac, hepatic or renal disease. Syntometrine should not be given until after delivery of child & in multiple births not until the last child has been delivered.

Ritodrine HCI
Pre-term labour: Initial treatment (parenteral) IV infusion, IM inj, maintenance treatment (oral), acute foetal distress/Prevention of pre-term labour after operation.
Antepartum haemorrhage due to any cause but particularly placenta previa & abruption placentae. Eclampsia & severe pre-eclampsia. Intra-uterine foetal death. Chorioamnionitis. Maternal cardiac disorder. Hyperthyroidism. Uncontrolled hypertension. Any other condition which can endanger the cardiac function.
Patients w/ potential cardiac risks & cardiac abnormalities. Careful monitoring of patients w/ suspected cardiac disorders. Occult cardiac disease may be unmasked. Diabetic patients or those receiving K-depleting diuretics, Monitor patient’s state of hydration, avoid fluid overload. IV treatment for = 2-3 wk may lead to leucopenia &/or agranulocytosis w/ complete recovery after discontinuation of treatment.
Pulmoney oedema (several cases reported w/ fatal results). Maternal & foetal heart rate can increase. Frequently: Tremor, nausea, vomiting, headache or erythema, nervousness, restlessness, jitteriness, emotional upset, anxiety or malaise. Infrequently cardiac symptoms, eg chest pain or tightness w/ or w/o ECG abnormalities & cardiac arrhythmias. Impaired liver function.
Corticosteroids, general anesth. Other sympathomimetic amines, ß-adrenergic blocking drugs, anaesth used in surgery.

d) Other Drugs Acting on Genito-Urinary System

Alprostadil.
Erectile dysfunction of neurogenic etiology, erectile dysfunction of vasculogenic, psychogenic or mixed etiology, diagnosis of erectile dysfunction.
Predisposition to priapism eg sickle cell anemia or trait, multiple myeloma or leukaemia. Anatomical deformation of the penis eg angulation, cavernosal fibrosis or peyronie’s disease. Patients w/ penile implants, men for whom sexual activity is inadvisable or contraindicated.
Regular follow-up to detect signs of penile fibrosis. Patients on anticoagulants.
Penile pain, haematoma at the site of inj, prolonged erection, priapism, ecchymosis, penile rash, itching, penile oedema & penile fibrosis.

Terazosin HCI
Symptomatic benign prostatic hyperplasia (BPH). Hypertension.
Pregnancy.
May impair ability to drive or operate machinery. Lactation.
Dizziness, nasal congestion, drowsiness, nausea, peripheral edema, asthenia, postural hypotension.

Finasteride.
Treatment & control of benign prostatic hyperplasia to cause regression of enlarged prostate. Improve urinary flow & symptoms associated w/ BPH.
Women & paed patients.
Large residual urine vol &/or severely diminished urinary flow (monitor for obstructive uropathy); exclude prostate cancer (initial & periodic digital rectal exam). Generally a baseline PSA > 10 ng/mL (Hybritech) prompts further evaluation & consideration of biopsy: For PSA levels btw 4 & 10 ng/mL, further evaluation is advisable. The physician should be aware that baseline PSA < 4 ng/mL does not exclude prostate cancer. Finasteride causes decrease in serum PSA concentration even in the presence of prostate cancer. BPH patients treated w/ Proscar w/ reduction of serum PSA levels does not rule out concomitant prostate cancer. Careful evaluation needed if any sustained increase in PSA levels occur in patients treated w/ Proscar. Exposure to finasteride: Crushed or broken tablets Proscar should not be handled by women when they are/may potentially be pregnant because of possibility of absorption of finasteride.
Impotence, decreased libido & vol of ejaculate.

Pinene 31 mg, camphene 15 mg, fenchone 4mg, borneol 10 mg, anethol 4 mg, cineol 3 mg, olive oil 33 mg.
Urolithiasis, nephrolithiasis, cystitis & UTI.
1st trimester of pregnancy.
Lactation. Increase liqd intake during therapy.

Sildenafil citrate.
Treatment of erectile dysfunction.
Men for whom sexual activity is inadvisable (patients w/ severe CV disorders eg unstable angina or severe cardiac failure). Severe hepatic impairment, hypotension (< 90/50 mmHg), recent history of stroke or MI, known hereditary degenerative retinal disorders such as retinitis pigmentosa. Coadministration w/ nitric oxide donors (eg amyl nitrite) or nitrates in any form. Hypersensitivity to sildenafil.
A medical history & physical examination should be undertaken to diagnose erectile dysfunction & determine potential underlying causes, before Viagra is considered. Anatomical deformation of the penis (angulation, cavernosal fibrosis or Peyronie’s disease), conditions which may predispose to priapism (sickle cell anaemia, multiple myeloma or leukaemia). Patients w/ bleeding disorders, active peptic ulceration, or untreated proliferative diabetic retinopathy.
Headache, flushing, dizziness, dyspepsia, nasal congestion, altered vision.
Organic nitrates, nitric oxide donors (amyi nitrite), ketoconazole, erythromycin, cimetidine.

Alfuzosin HCI.
Treatment of certain functional symptoms of benign prostatic hypertrophy (prostate vol increase).
History of orthostatic hypotension.
Renal or hepatic impairment. Hypertension; monitor BP regularly. Coronary insufficiency; discontinue if angina re-appears or worsens.
More frequently: GI disturbances, lipothymic events & headache. Less frequently: dry mouth, tachycardia, chest pain, asthenia, drowsiness, rash, pruritus & flushes. Palpitation, orthostatic hypotension & edema.
Avoid combination w/ other 81-blockers or Ca antagonists. Monitor carefully when used w/ general anesth. Antihypertensives.