Medicines & You

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

Neuro-Muscular System

a) Anti-Inflammatory Enzymes

Serratiopeptidase.
Inflammatory after operation & traumatic injury. Inflammatory in the following diseases & symptoms: Otorhinolaryngology, gynaecology, urology, dentistry & oral surgery. Inadequate expectoration of sputum in resp tract diseases or after anesth.
Blood coagulation abnormalities; severe hepatic & renal disturbances.
occasionally, GI disturbances

Lysozyme CI.
Chronis sinusitis, difficulty in expectoration of sputum associated w/ resp diseases & bleeding during or after minor dental or urological surgery, mitigation of inflammatory signs & symptoms associated w/ alveolar pyorrhea.
Self-or family history of allergies.
Shock; skin rash or redness; anorexia, GI disturbances. Rarely, stomatitis.

b) Analgesics & Antipyretics

Aspirin.
Relieves headaches, toothache, neuralgia, muscular pains, colds, influenza & feversish complaints.
Gastric & duodenal ulcers. Haemorrhagic diathesis. Childn <16 yr.
Renal disorders, G6PD deficiency. Pregnant women close to delivery, patients w/ flu, chickenpox or haemorrhagic fever, GI ulceration or asthma. Onset of persistent vomiting may be a sign of Reye’s syndrome (immediate treatment).
Gastric haemorrhage, hypersensitivity, thrombocytopenia.
Anticoagulants, corticosteroids, antirheumatics, sulfonylureas, methotrexate, spironolactone, furosemide, antigout agents.

Ibuprofen.
Symptomatic refief of pain & fever associated w/ colds, flu, toothache, bronchitis & other bacterial & viral infection.
Known hypersensitivity to ibuprofen, aspirin or other NSAIDs; active GI bleeding.
Patients w/ active or severe peptic ulceration; pregnancy. History of bronchial asthma.
GI disturbances, peptic ulceration, GI bleeding. Others include headache, dizziness, nervousness; skin rash, pruritus, tinnitus, edema, depression, drowsiness, insomnia, blurred vision, hypersensitivity, impairment of renal function, thrombocytopenia.

Paracetamol.
Pain, fever.
Severe hepatic or renal dysfunction.
Rare: skin rash & other allergic reactions. Isolated cases: thrombocytopenic purpura, haemolytic anemia & agranulocytosis.
Barbiturates, tricyclic antidepressants & alcohol. Liver enzyme inducers.

Dihydrocodeine tartrate.
Painful conditions.
Resp depression, obstructive airway disease, acute alcoholism, acute asthmatic attack.
Hypothyroidism, chronic hepatic or adrenocortical disease, renal insufficiency, elderly.
GI disturbance, headache, vertigo. Dependence. Resp depression.
MAOIs, phenothiazines, CNS depressants, cimetidine.

Morphine sulfate.
Prolonged relief of severe pain.
Resp depression, obstructive airways disease, liver dysfunction, paralytic ileus, morphine sensitivity, MAOIs, pregnancy, nursing period, paediatric use.
Dose reduction advisable: elderly, hypothyroidism, renal & chronic hepatic disease.
Tolerance, dependence, constipation, nausea, vomiting.
MAOIs, CNS depressants.

Nalbuphine HCI.
Moderate to severe pain, pre-op & post-op analgesia, supplement to surgical anesth & for obstetrical analgesia during labour.
Impaired renal or hepatic function, billiary tract surgery, impaired respiration, MI. Labour & delivery.
Sedation. Infrequently sweating, GI upsets, vertigo, dizziness; dry mouth; headache, allergic reactions.
Phenothiazines; alcohol, CNS depressants.

Paracetamol 500mg, codeine phosphate 8mg.
Headache, dysmenorrheal, musculoskeletal pain, myalgias, neuralgias, after dental work or tooth extraction. Conditions accompanied by discomfort & fever, as in common cold & viral infection.
Severe resp depression, head injuries.
Acute abdominal conditions, head injuries. Increased intracranial pressure or w/ Addison’s disease.
Allergic reactions, GI upsets, constipation, CNS disturbances, dry mouth.
Alcohol, barbiturates, phenothiazines, CNS depressants.

Paracetamol 500mg, pamabrom 25mg.
Relief of bloating, water-wt gain, headache, fever, backache & muscular aches & pains associated w/ pre-menstrual & menstrual pain & discomfort.
Hepatic dysfunction.
Hypersensitivity (discontinue therapy).
Hypersensitivity reactions (urticaria, erythema or fixed drug eruption.

Mefenamic acid.
Bursitis, muscular aches & sprains, traumatic pain & post-extraction pain, dysmenorrhoea & menorrhagia, earache, toothache, cold, common resp infection, fever, minor injuries.
GI ulceration or inflammatory bowel disease. Renal or hepatic impairment.
Renal impairment; asthmatics sensitive to NSAIDs or salicylates. Pregnancy.
Drowsiness. Hypersensitivity. Diarrhea.

Tramadol HCI
Moderate to severe acute & chronic pain, painful diagnostic measures & surgical pain.
Acute intoxication w/ alcohol, hypnotics, analgesics or psychotropics. Narcotic w/drawal treatment. Hypersensitivity.
Opioid dependence, reduced level of consciousness of unclear origin, resp disorders, increased intracranial pressure. Patients known to suffer from convulsions. Pregnancy & lactation. Capacity to drive or operate machines may be impaired, esp if taken w/ alcohol.
Sweating, dizziness, muzziness, vomiting, dry mouth. In rare cases, influence on CVS regulation, esp after IV administration, headache, retching, vomiting, constipation, GI irritation, skin reactions. In very rare cases, motorial weakness, appetite changes, micturition disorders, psychic side effects, eg mood, perception & activity changes. In isolated cases, cerebral convulsions esp on co-medication w/ neuroleptics. Allergic reactions & shock cannot definitely be ruled out. If recommended dosage is exceeded considerably, possibility of resp depression cannot be excluded.
Sedative effects of some CNS drugs may be enhanced. Avoid concurrent administration of MAOIs.

c) Antirheumatic, Anti-inflammatory Analgesics

Piroxicam
RA, osteoarthritis & ankylosing spondylitis, Acute musculoskeletal disorders, Acute gout, primary dysmenorrhoea, post-op & post-traumatic pain, Upper resp tract inflammation, Juvenile RA.
Active peptic ulceration. Hypersensitivity to aspirin & NSAIDs.
Upper GI disease. Compromised cardiac function. Hypertension. Liver cirrhosis, nephritic syndrome & overt renal disease.
GI symptoms. Ankle edema (occasional). CNS effects (rare). Swollen eyes, blurred vision & eye irritations. Malaise & tinnitus. Skin rash & pruritus. Anemia. Rarely, severe hepatic reactions.
Interferes w/ natriuretic action of diuretic agents.

Ketoprofen.
Acute articular & periarticular disorders; bursitis, tendonitis, synovitis, tenosynovitis, shoulder capsulitis, painful musculoskeletal conditions, low back pain (strain, lumbago, sciatica, fibrositis), acute exacerbation of osteoarthritis, gout, post-op & inflammatory pain.
Active peptic ulceration, history of recurrent peptic ulcer or chronic dyspepsia. Asthma or allergy provoked by aspirin or NSAIDs.
Renal impairment.
GI disorders, headache, drowsiness, dizziness, oedema.
Highly protein-bound drugs (eg anticoagulants, sulfonamides, hydantoins). NSAIDs, methotrexate.

Crystalline glucosamine sulfate.
Degenerative joint diseases, osteoarthrosis, lumbarthrosis, osteoarticular dystrophies, chronic & subacute arthritis, HIP arthrosis.

Standardized zingiber officinale roscoe extract (HMP-33).
Relief of arthritic/rtheumatic pain & inflammation. Relief of other musculoskeletal conditions associated with pain & inflammation.

Diclofenac Na.
Inflammatory, degenerative & non-articular forms of rheumatism. Acute musculoskeletal disorders. Acute gout. Post-traumatic & post-op inflammatory & swelling. Painful &/ or inflammatory conditions in gynaecology. Renal & biliary colic. Adjuvant in severe painful inflammatory infection of the ENT. Dysmenorrhoea. IV infusion Treatment or prevention of post-op pain in hospital setting.
Peptic or intestinal ulcer. Hypersensitivity to diclofenac or other NSAIDs. Proctitis (supp).
Symptoms/history of GI disease. Asthma. Impaired hepatic, cardiac or renal function. Elderly. Patients on diuretics. During prolonged use, periodic monitoring of liver function & blood counts are recommended. Pregnancy, lactation. Porphyria. Extracellular vol depletion. Ability to drive & use machines may be affected.
Occasional: GI disorders; headache, dizziness, vertigo; rash; elevation of serum transaminases. Local reactions after IM inj. Rarely: gastric or intestinal ulcer, GI bleeding; abnormalities of renal function; hypersensitivity reactions; hepatitis. Isolated cases: disturbances of sensation or vision, erythema multiforme; blood dyscrasias, purpura, erythroderma, Lyell’s syndrome, Stevens-Johnson syndrome, CV disturbances, pancreatitis, diaphragm-like intestinal strictures, aseptic meningitis.
Lithium, methotrevate, digoxin, cyclosporine, diuretics anticoagulants, oral antidiabetics, quinolones.

d) Gout Preparations

Allopurinol.
Gout, hyperuricemia & uric acid lithiasis. Treatment of Ca oxalate/phosphate renal stones in the presence of hyperuricemia &/or hyperuricosuria.
Pregnancy. As treatment for the acute attack of gout.
Acute attack of gouty arthritis in early stages of therapy. Skin reactions (discontinue use). Very rarely, granulomatous hepatitis. Occasionally; thrombocytopenia, agranulocytosis, & aplastic anaemia in patients w/ impaired renal function.
Use only ¼ of the usual dose of 6-mercaptopurine or azathioprine when given concurrently. Increases plasma ½-life of adenine arabinoside. Effects decreased by uricosurics & large doses of salicylates.

e) Minor Tranquillisers

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

Lorazepam.
Management of anxiety disorders or anxiety associated w/ depressive symptoms; anxiety component in psychotic states; pre-surgical medication; adjunct to antiemetic drugs for nausea & vomiting associated w/ cancer chemotherapy.
Hypersensitivity; sleep apnea; severe resp insufficiency. Pregnancy, lactation.
History of alcoholism or drug abuse or in patients w/ significant personality disorders. Pre-existing seizure disorders. Acute narrow-angle glaucoma, myasthenia gravis. Impaired renal or hepatic function. Elderly or debilitated patients. Chronic resp insufficiency. Severe hepatic insufficiency.
Daytime drowsiness; dizziness; muscle weakness; ataxia; confusion; depression; change in appetite; headache; sleep disturbance; agitation; dermatological symptoms; change in libido; decreased alertness; numbed emotions; eye function disturbance; GI symptoms; blood dyscrasias; elevated liver enzymes. Paradoxical reactions eg stimulation & rage (rare). Hypotension.
Additive effects w/ other CNS depressants including alcohol, barbiturates.

Clobazam.
Anxiety states w/ mental & somatic symptoms (organic causes must be excluded). Adjuvant in treatment of epilepsy.
Myasthenia gravis.
Pregnancy & lactation; acute resp failure; investigate possible organic cause in psychovegetative & psychosomatic disorders. May impair ability to drive or operated machinery; habituation & dependence.
Tiredness. Rarely, dry mouth, constipation, loss of appetite, nausea, dizziness or fine tremor of fingers. Occasionally, restlessness, irritability & muscle weakness.
Mutual potentiation w/ CNS depressants or alcohol. Anticonvulsants.

Alprazolam.
Management of anxiety disorders & anxiety associated w/ depression symptoms.
Known hypersensitivity to benzodiazepines. Acute narrow angle glaucoma.
Avoid operating vehicles or machinery; abuse-prone individuals; pregnancy; lactation; renal or hepatic dysfunction. Patients whose primary diagnosis is schizophrenia. Avoid abrupt discontinuation. Childn <18 yr. Depressed or suicidal patients.
Drowsiness. Less commonly lightheadedness, blurred vision, co-ordination disorders; GI effects; autonomic effects; dependence, w/drawal syndrome. Rarely, paradoxical agitation, confusion.
Effects enhanced by CNS depressants, alcohol, barbiturates. Cimetidine may delay clearance.

f) Major Tranquillisers

Risperidone.
treatment of acute & chronic schizophrenic psychoses & other psychotic conditions. Alleviates affective symptoms associated w/ schizophrenia.
Known CV disease, dosage should be gradually titrated as recommended, a dose reduction should be considered when hypotension occurs. Renal or liver insufficiency. Elderly. Parkinsonism. Epilepsy. Monitor for signs of tardive dyskinesia. Driving/operating machinery. Pregnancy, lactation.
Insomnia, agitation, anxiety, headache, somnolence, fatigue. Occasionally orthostatic hypotension, reflex tachycardia or hypertension. Extrapyramidal symptoms, wt gain.
Levodopa & other dopamine agonists. Centrally-acting drugs (caution).

Quetiapine fumarate.
Treatment of schizophrenia.
CV disease, cerebrovascular disease, or other conditions predisposing to hypotension. Renal & hepatic impairment. Seizures. Neuroleptic malignant syndrome. Pregnancy & lactation. May affect ability to drive or operate machinery.
Headache, asthenia, abdominal pain, back pain, fever, chest pain, postural hypotension, tachycardia, hypertension, constipation, dry mouth, dyspepsia, diarrhoea, wt gain.
Other centrally-acting drugs, alcohol, hepatic enzyme inducers eg phenytoin, thioridazine, ketoconazole, erythromycin.

Olanzapine.
Acute & maintenance treatment of schizophrenia & other psychoses.
Lactation.
Elevated ALT &/or AST, hepatic impairment; seizures; low leukocyte/neutrophil counts; history of drug-induced bone marrow depression; hypereosinophilic conditiond; myeloproliferative disease; CV disease, cerebrovascular disease & conditions that predispose to hypotension; prostatic hypertrophy, paralytic ileus, narrow angle glaucoma. Pregnancy.
Somnolence, wt gain, dizziness, akathisia, increased appetite, peripheral edema, orthostatic hypotension, dry mouth, constipation. May effect ability to operate machinery or drive motor vehicles.
May antagonize the effects of levodopa & dopamine agonist. Clearance is increased by smoking or carbamazepine administration. Other centrally-acting drugs including alcohol.

g) Hypnotics & Sedatives

Triazolam.
Insomnia.
Acute pulmonary insufficiency.
Pregnancy, lactation.
Drowsiness, dizziness, amnesia, confusion, agitation.
Alcohol, CNS depressants. Plasma conc increased by cimetidine.

Zolpidem hemitartrate.
Insomnia.
Childn < 15yr; pregnancy & lactation.
Resp insufficiency, myasthenia gravis, hepatic & renal insufficiency.
Occasional dizziness, drowsiness, nausea & headache.


h) Anticonvulsants

Phenytoin (susp: base, Cap: Na).
Epilepsy & psychomotor seizures. Migraine & trigeminal neuralgia.
Severe myocardial insufficiency. Impaired hepatic function. Abrupt w/ drawal. Pregnancy.
GI disturbances; ataxia, slurred speech; diplopia, nystagmus & mental confusion w/ headache, dizziness, gingival hyperplasia, hirsutism.
Rate of metabolism increased by phenobarb & cardamazepine. Dicoumarol, disulfiram, INH, chloramphenicol & cimeridine inhibit the metabolism of phenytoin.

Na valproate.
Generalised, focal or other epilepsy.
Active liver disease.
Tiredness; loss of appetite; vomiting. Pregnancy.
Liver dysfunction, GI disorders, wt gain.
Potentiate effects of MAOIs.

Lamotrigine.
Partial seizures & generalized tonic clonic seizures not satisfactorily controlled w/ other antiepileptic drugs. Lennox-Gastaut syndrome.
Avoid abrupt w/drawal (reduce dosage stepwise over a period of 2 wk). Significant hepatic or renal impairment. Pregnancy. Lactation.
Skin rashes, diplopia, blurred vision, dizziness, drowsiness, headache, unsteadiness, tiredness, GI disturbances, irritability, aggression.
Phenytoin, carbamazepine, phenobarb, primidone enhances the metabolism of lamotrigine. Na valproate reduces the metabolism of lamotrigine.

Primidone.
Grand mal & psychomotor epilepsy, focal seizures, myoclonic jerks & akinetic attacks.
Hypersensitivity; acute intermittent porphyria.
Childn, elderly, debilitated patients. Impaired renal, hepatic or resp function. Abrupt w/drawal after prolonged use. Ability to drive or operated machinery may be affected. Pregnancy & lactation. Decrease in serum folate. Potent CNS depressant, potential for tolerance, dependence & w/drawal reaction on abrupt cessation.
Drowsiness, listlessness. May impair reaction time. Symptoms of neurotoxicity are visual disturbances, nausea, vomiting, headache, nystagmus & ataxia. Dermatological reactions incl severe skin eruptions, idiosyncratic reaction. Rarely , SLE, arthralgia, personality changes including psychotic reactions. Megaloblastic anemia, blood dyscrasias are rare.
Enhances effects of other CNS depressants. Reduces efficacy of other anticonvulsants, oral anticoagulants, OC, phenytoin.

Carbamazepine.
Epilepsy. Trigeminal neuralgia. Mania & manic-depressive prophylaxis. Alcohol w/drawal syndrome.
AV block. History of bone marrow depression or acute intermittent porphyria.
pregnancy, lactation. Initial & periodic complete blood counts, liver function tests & urinalysis. Monitoring of plasma levels. History of cardiac, hepatic or renal damage & adverse haematological reactions. Road/machinery users. Intraocular pressure, latent psychosis, confusion, agitation. Mixed seizure disorders. Elderly patients. Abrupt discontinuation of treatment.
Frequent: Dizziness, ataxia, mild allergic skin reactions, mild leucopenia. Occasionally: Diplopia, liver enzyme elevations, vomiting, thrombocytopenia, hyponatremia, accommodation disorders. Rare: Exfoliative dermatitis, Stevens-Johnson syndrome, jaundice, hepatitis, delayed multi-organ hypersensitivity disorders, SLE-like syndrome. Isolated cases: Neuritis, hallucinations, agitation, depression, Lyell’s syndrome, blood dyscrasias, anaphylactic reaction, AV-block, CHF, thromboembolism, osteomalacia, renal dysfunction, interstitial nephritis, sexual disturbances.
Carbamazepine is a powerful enzyme inducer. Clinically important interactions w/ other drugs/ substances (including OCs & alcohol) are common.

Topiramate.
Adjunctive therapy in adult patients w/ partial onset seizures w/ or w/o secondarily generalized seizures.
Childn <18 yr old.
Gradual w/drawal. Renal impairment. Pregnancy , lactation. May impair ability to drive or operate machinery.
Ataxia, impaired conc, confusion, dixxiness, fatigue, paresthesia, somnolence, abnormal thinking. Less commonly, agitation, amnesia, anorexia, aphasia, depression, diplopia, emotional lability, nausea, nystagmus, speech disorder, taste perversion, abnormal vision & wt decrease. Nephrolithiasis (rare).
Plasma conc decreased by phenytoin & carbamazepine.

i) Antidepressants

Venlafaxine HCI
Treatment of depression, including depression associated w/ anxiety, in both hospitalized patients & outpatients.
Concomitant use in patient taking MAOIs. Pregnancy, lactation. Childn<18yr.
Routine BP monitoring is advisable at doses >200 mg/day. History of mania. Elderly patients taking diuretics or vol-depleted patients. History of seizure disorder. History of drug abuse.
Dizziness, dry mouth, insomnia, nervousness, somnolence, anorexia, constipation, nausea, abnormal ejaculation/orgasm, sweating, asthenia.
MAOIs, other CNS active drugs.

Fluvoxamine maleate.
treatment of depressive illness & symptoms of depressive disorder.
Not to be used w/or w/in 2 wk of terminating MAOIs treatment; hepatic insufficiency; not recommended in childn & epileptics; pregnancy & lactation.
patients w/ affective disorders often display vegetative symptoms eg blurred vision, dry mouth. Tremor, GI disturbances, somnolence, constipation, agitation, anorexia.
Warfarin, phenytoin, theophylline, propranolol, lithium.

Fluoxetine HCI.
Depression w/ or w/o anxiety, obsessive compulsive disorder.
Concomitant use w/ MAOIs.
History of seizures. Elderly. Vol-depletion. Diabetes. Pregnancy, lactation. May impair alertness.
Autonomic symptoms eg dry mouth, sweating; hypersensitivity; serotonin syndrome; GI disorders; inappropriate secretion of ADH; nervous system disorders eg dizziness, fatigue; alopecia; urogenital system disorders.
Drugs metabolized by cytochrome P450IID6 eg flecainide, vinblastine, carbamazepine, tricyclic antidepressants. CNS active drugs eg diazepam, imipramine, phenytoin, haloperidol. Drugs highly bound to plasma protein. Warfarin. Alcohol.

Paroxetine HCI.
depression of all types, including reactive & severe depression & depression accompanied by anxiety. Obsessive compulsive disorder (OCD)/ panic disorder w/ or w/o agoraphobia.
History of mania, cardiac conditions, epilepsy, seizures (discontinue use). Patients on anticoagulant therapy. Pregnancy, lactation.
Nausea, somnolence, sweating, tremor, asthenia, dry mouth, insomnia, sexual dysfunction, dizziness, rash; infrequently, extrapyramidal reactions, dystonia; rarely, abnormalities of liver function tests, hyponatremia.
Tryptophan, oral anticoagulants, drug-metabolizing enzyme inhibitors/inducers, alcohol, MAOIs, lithium, phenytoin, anticonvulsants, drugs metabolized by cytochrome P450.

Imipramine HCI.
Depression. Panic attacks. Chronic painful conditions. Nocturnal enuresis.
Acute stage of MI. Mania.
Concomitant administration w/ MAOIs. CV disturbances. AV block (grades i-iii), arrhythmias, hypotension. Narrow-angle glaucoma, disturbances of micturition, lowered convulsion threshold. Road users. Pregnancy, lactation.
Anticholinergic effects are frequent. Rarely, liver disorders, CV effects.
Antihypertensives, sympathomimetics, alcohol. CNS depressants potentiate its effects. Methylphenidate increases plasma level.

Sertraline HCI.
Treatment of symptoms of depression including depression accompanied by symptoms of anxiety in patients w/ or w/o a history of mania. Obssessive compulsive disorders. Panic disorder, w/ or w/o agoraphobia.
hepatic insufficiency; electroconvulsive therapy, unstable epilepsy; may impair ability to drive or operate machinery; pregnancy, lactation; childn.
Nausea, diarrhoea/loose stools, anorexia, dyspepsia; male sexual dysfunction (ejaculatory delay); tremor; dry mouth; increased sweating. Rarely pancreatitis & serious liver events.
MAOIs, other serotonergic drugs.

j) CNS Stimulants

Methylphenidate HCI.
Attention-deficit hyperactivity disorders (ADHD), narcolepsy.
Anxiety & tension states, agitation, tics, tics in siblings, familial history or diagnosis of Tourette’s syndrome. Glaucoma. Hyperthroidism. Cardiac arrthmias, severe angina pectoris.
May exacerbate behavioural disturbance & thought disorder in psychotic patients. Not for severe depression. Chronic abuse can lead to marked tolerance & psychic dependence. Epilepsy & hypertension. Monitor blood count during long-term treatment. Careful supervision during drug w/ drawal. Childn <6 yr. Pregnancy & lactation. Caution in road/machinery users
Frequent: Nervousness, insomnia, decreased appetite. Occassional: headache, drowsiness, dizziness, dry mouth, tachycardia, palpitations, arrhythmias, changes in BP & heart rate. GI disturbances, skin reactions, fever, arthralgia. Rare: blurred vision, moderately reduced wt gain & minor growth retardation in childn.
Pressor agents, MAOIs, anticoagulants, anticonvulsants, tricyclic antidepressants, phenylbutazone, guanethidine.

k) Nootropics & Neurotonics

Sulbutiamine.
Symptomatic treatment of all forms of functional asthenia.
Occasionally: mild agitation in the elderly. Allergic skin reactions are rare, but have been reported.

Mecobalamin.
Peripheral neuropathies.
Discontinue if there is no response after taking orally for several mth.
Infrequently: Anorexia, nausea, diarrhea, pain & induration at IM inj site. Rarely: Skin rash, headache, sweating or hot sensation.

Nimodipine.
prophylaxis & treatment of ischaemic neurological deficits caused by cerebral vasospasm following subarachnoid haemorrhage.
Generalized cerebral edema or severely raised intracranial pressure; renal or liver impairment; pregnancy.
Severe BP lowering. GI disturbances. In addition for infusion: deterioration of renal function, disturbances of heart rhythm, phlebitis, increase of liver enzymes.
Potentiates effects of antihypertensives. IV ß-blockers (avoid). Possible increase of nimodipine blood conc w/ cimetidine. Possible decrease of nimodipine efficacy w/ rifampicin. Infusion: Ca-antagonists, methyldopa. Nephrotoxic drugs, monitor renal function.

Piracetam.
Involutional syndrome related to ageing: memory deficits, asthenia, adaptation disorders, disturbed psychomotor reactions. CVA & cerebral circulatory insufficiency: ischemic or even hemorrhagic acute accidents; chronic manifestations of the above accidents or of cerebral atherosclerosis. Chronic alcoholism & addiction. Post-traumatic syndrome: cerebral dysfunction related to post-traumatic sequelae (headache, vertigo, agitation, memory, asthenia). Severe obnubilation & vascular coma of a traumatic or toxic origin: rapid recovery of consciousness. Ped therapy: Dyslexia, learning difficulties.
Severe renal insufficiency.
Renal insufficiency. Creatinine clearance <60mL/minute or serum creatinine > 1.25 mg/100mL.
Nervousness, agitation, irritability, anxiety & sleep disturbances. Fatigue or drowsiness. GI disturbances.

l) Antiemetics & Antivertigo Drugs

Betahistine diHCI.
Vertigo, tinnitus &/or progressive hearing loss associated w/ Meniere’s disease & Meniere-like syndrome. Symptomatic treatment of vestibular vertigo.
Phaeochromocytoma or bronchial asthma; history of peptic ulcer.
Mild gastric complaints.

Granisetron HCI.
Oral Prevention of nausea & vomiting induced by cytostatic therapy. Infusion Prevention & treatment of nausea & vomiting induced by cytostatic therapy.
Subacute intestinal obstruction. Pregnancy, lactation.
Headache, constipation


Betahistine mesylate.
vertigo & dizziness associated w/ Meniere’s disease, Meniere’s syndrome & peripheral vertigo.
Peptic ulcer, bronchial asthma, pheochromocytoma.
Nausea, vomiting; skin rash.

Domperidone.
Nausea & vomiting, hiccups.
Babies <1 yr; pregnancy.
Rarely, mild abdominal cramps. Raised serum prolactin levels
Abtagonized by anticholinergic drugs. Anticids or antisecretory agents should be taken after meals when used concomitantly.

Meclizine diHCI 25mg, pyridoxine HCI 50mg.
Nausea & vomiting of pregnancy.
Acute asthmatic attack, premature infants.
Avoid driving & operating machinery.
Drowsiness, dizziness, dry mouth.
Alcohol, CNS depressants, anticholinergic-like drugs, MAOIs.

Prochlorperazine.
Vertigo due to Meniere’s Syndrome, labyrinthitis & other causes, nausea & vomiting, migraine.
CV collapse, CNS depression, bone marrow depression.
Hypotension, epilepsy, acute narrow-angle glaucoma, liver disease. Pregnancy, lactation.
Constipation, dry mouth, hypotension, urinary retention, liver damage, insomnia.
Alcohol, CNS depressants, phenothiazines.

Cinnarizine diHCI.
Travel & motion sickness. Dizziness & vertigo.
Pregnancy.
rarely, somnolence & GI disturbances. Aggravation or appearance of extrapyramidal symptoms (prolonged use in elderly).

Ondansetron HCI dehydrate.
Nausea & vomiting induced by cytotoxic chemotherapy & radiotherapy. Prevention & treatment of post-operative nausea & vomiting.
pregnancy & lactation.
Headache, sensation of flushing or warmth in the head & egipastrium, occasional transient, asymptomatic increases in aminotrasferases, constipations w/ severe anaphylaxis, visual disturbances, dizziness during rapid IV administration, involuntary movement disorders & seizures.

m) Neurodegenerative Disease Drugs

Donepezil HCI.
Treatment of mild to moderate dementia in Alzheimer’s disease.
Sick sinus syndrome, supraventricular cardiac conduction conditions, history of ulcer disease, history of asthma or obstructive pulmonary disease. Pregnancy & lactation.
Diarrhoea, mucle cramps, fatigue, nausea, vomiting, insomnia, dizziness, psychiatric disturbances.
Anaesth, medications w/ anticholinergic activity, succinylcholine, other neuromuscular blocking agents or cholinergic agonists.

Rivastigmine hydrogen tartrate.
Mild to moderately severe dementia of the Alzheimer type.
Hypersensitivity to rivastigmine, other carbamate derivatives.
Sick-sinus syndrome, severe cardiac arrhythmias, gastroduodenal ulcerative conditions in predisposed patients, resp disease, urinary obstruction, seizure, pregnancy & lactation.
Nausea, vomiting, diarrhoea, abdominal pain, loss of appetite, dyspepsia, dizziness, headache.
Cholinomimetic drugs, anticholinergic medications.

n) Antiparkinsonism Preparations

Pergolide mesylate.
Adjunct to levodopa/carbidopa in the management of the signs & symptoms of Parkinson’s disease.
Patients prone to cardiac dysrhythmias or significant underlying cardiac disease. Avoid abrupt w/drawal of the drug. Administration to patients receiving levodopa may exacerbate pre-existing dyskinesia. Pregnancy, lactation.
Body pain, abdominal pain; nausea, dyspepsia; dyskinesia, hallucinations, somnolence; rhinitis, dyspnoea; diplopia; insomnia, confusion, caonstipation, diarrhoea, hypotension, atrial premature contractions, sinus tachycardia.
Effectiveness diminished by neuroleptics or metoclopramide. Risk of postural &/or sustained hypotension when used w/ antihypertensives. Protein-bound drugs.

Benztropine mesylate.
Idiopathic & post-encephalitic parkinsonism, Drug-induced parkinsonism
Childn <3 yr; tardive dyskinesia.
Do not terminate other antiparkinsonian agents abruptly when cogentin is started. Patients w/ tachycardia, prostatic hypertrophy, mental disorders (may be intensified), narrow-angle glaucoma. Pregnancy. Older childn.
Tachycardia, constipation, dry mouth, nausea, vomiting. Allergic reactions & CNS effects. Impairment of mental &/or physical abilities, muscle weakness, may aggravate tardive dyskinesia & anhidrosis may occur.
Combination w/ phenothiazines, tricyclic antidepressants & other anticholinergics (caution), haloperidol.

Bromocriptine mesylate.
Idiopathic & post-encephalitic Parkinson’s disease, as monotherapy or in combination w/ other antiparkinsonian drugs.
Toxemia of pregnancy, hypertension postpartum & during puerperium.
Postpartum & puerperal women w/ high BP, coronary artery disease, or psychic disorders; concomitant use of other ergot alkaloid. Fertility may be restored (contraception needed if conception is not desired); luteal function impairment at high doses in normoprolactinemic women; malignancy must be excluded before usage for benign breast disease; hypotensive reactions may occur (care to be exercised when driving vehicles or operating machinery); alcohol reduces tolerability; history of psychotic disorders or severe CV disease, & in acromegalic patients w/ a history or evidence of peptic ulceration.
Slight nausea, vomiting, fatigue, dizziness & orthostatic hypotension. Additionally, constipation, drowsiness, headache, confusion, dyskinesia, dryness of the mouth, leg cramps & allergic skin reactions habe been reported. On prolonged treatment, reversible pallor of fingers & toes have been reported.
Bromocriptine plasma levels may be increased by erythromycin or josamycin. Alcohol.

Per Sinemet 25/100 tab- Carbidopa 25 mg, levodopa 100mg. Per Sinemet 25/250 tab- Carbidopa 25mg, levodopa 250mg. Per Sinemet CR tab- Carbidopa 50 mg, levodopa 200 mg.
treatment of Parkinson’s disease & syndrome.
Narrow-angle glaucoma. Undiagnosed skin lesions or history of melanoma. MAOIs (except low doses of selective MAO-B inhibitors). Discontinue inhibitors at least 2 wk before starting Sinemet. Hypersensitivity to any component of this product.
Severe CV disease including history of MI or arrhythmias or pulmonary disease, bronchial asthma, renal, hepatic or endocrine disease, history of psychoses or convulsions, or chronic wide-angle glaucoma. History of peptic ulcer. Absorption of l-dopa may be impaired in some patients on a high protein diet. Not recommended for childn < 18 yr & in drug-induced extrapyramidal reactions. Patients already on I-dopa alone. Abrupt w/ drawal. Pregnancy, lactation.
Dyskinesia including choreiform, dystonic & other involuntary movements. Muscle twitching & blepharospasm may be early signs for dose reduction. Mental changes including paranoid ideation & psychotic episodes; depression w/ or w/o development of suicidal tendencies; dementia; & GI disturbances.
Tricyclic antidepressants, antihypertensives, phenothiazines, butyrophenones, phenytoin, papavarine.

Amantadine HCI.
Parkinson’s disease. Prevention & treatment of type A virus influenza.
Pregnancy.
Seizure disorders; psychiatric disorders; history of heart failure; recurrent eczema; gastric ulceration; orthostatic hypotension; CV disorders; cerebral atherosclerosis; liver & renal disorders. Lactation. Abrupt w/ drawal.
Frequent: Oedema of ankles, livedo reticularis. Occasional: depression & hallucinations. Rare: convulsions, urinary retention.
Sympathomimetics, appetite suppressants, anticholinergics, L-dopa. Alcohol.

o) Muscle Relaxants

Clostridium botulinum toxin type A.
Strabismus & blepharospasm associated w/ dystonia.
Anaphylaxis, corneal exposure.
Skin rash, local swelling of the eyelid. Spatial disorientation, double vision, past-pointing, ptosis, vertical deviation, irritation, ecchymosis. Also see lit.
Effects potentiated bu aminoglycosides or other drugs that interfere w/ neuromuscular transmission.

Rocuronium Br.
Adjunct to general anaesth to facilitate endotracheal intubation & to provide skeletal muscle relaxation during surgery.
Hepatic & biliary tract & renal diseases, conditions associated w/ prolonged circulation time, neuromuscular disease, hypothermic conditions, obesity. Hypokalaemia, hypermagnesaemia, hypocalcaemia, hypo-proteinaemia, dehydration, acidosis, hypercapnia, cachexia increases effects. Not recommended to drive or operate machinery w/in 24 hr after full recovery.
Anaphylactic reactions. Itching & erythematous reactions at the site of inj &/or generalized histaminoid reactions such as bronchospasm & CV changes.
Increased effects w/ anaesth, other non-depolarizing neuromuscular blocking agents, prior administration of suxamethonium. Decreased effects w/ neostigmine, edrophonium, pyridostigmine, aminopyridine derivatives, prior chronic administration of corticosteroids, phenytoin or carbamazepine. Norepinephrine, azathioprine, theophylline, CaCi2.

Baclofen.
Skeletal-muscle spasticity of spinal & cerebral origin.
Pregnancy. Epilepsy, psychiatric disorders, CV or resp insufficiency. CNS depressants, antihypertensives, levodopa. Caution in road users. Avoid abrupt discontinuation.
Frequent: sedation, drowsiness, nausea. Occasional: resp depression, diminished CV function. Rare: urinary retention.

Mivacurium CI.
As an adjunct to general anesth to relax skeletal muscles & to facilitate tracheal intubation & mechanical ventilation.
patients known to be homozygous for the atypical plasma cholinesterase gene. Pregnancy, childn <2 yr.
Renal, hepatic or CV disease & elderly (reduce dose & frequency); neuromuscular disease eg myasthenia gravis; asthma; acid-base or electrolyte abnormalities, burn patients, lactation.
Skin flushing, erythema, urticaria, mild transient hypotension, transient tachycardia, bronchospasm.
effects increased w/ inhalational anaesth, antibiotics, anti-arrhythmics, diuretics, Mg & lithium salts, ketamine, ganglion blockers, anti-mitotics, MAOIs, ecothiopate iodide, pancuronium, organophosphates, anticholinesterases, certain hormones, bambuterol. Longer onset of block & shorter duration of block in patients on chronic phenytoin or carbamazapine therapy. Prolonged & complete block w/ suxamethonium CI which can be difficult to reverse w/ anticholinesterase drugs.

Eperisone HCI.
Treatment of spastic paralysis in cerebrovascular diseases, spastic spinal paralysis,cervical spondylosis, post-op sequelae, spinal trauma, head injury, amyotrophic lateral sclerosis, cerebral palsy, spinocerebellar degenerations, spinal vascular diseases & other encephalomyelopathies. Signs & symptoms of increased muscle tone associated w/ cervical syndrome, periarthritis of the shoulder & low back pain.
Hepatic disorders.
Weakness, dizziness, insomnia, drowsiness, numbness or trembling in the extremities, hepatic & renal dysfunction, haematological changes, rashes, GI disturbances, urinary disorders.
methocarbamol. Tolperisone HCI.

Orphenedrine citrate 35 mg, paracetamol 450 mg.
Relief of painful muscular conditions, tension headache, non-articular rheumatism, dysmenorrheal.
Glaucoma; myasthenia gravis; prostatic hypertrophy or bladder neck obstruction.
Cardiac arrhythmias, tachycardia, cardiac decompensation, coronary insufficiency. Pregnancy.
Nausea, dry mouth, blurred vision. Rarely rash, drowsiness.