Medicines & You

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

Other Chemotherapeutics

a) Antituberculous Agents

Pyrazinamide.
All forms of TB.
Porphyria, severe liver damage, acute liver disease, pregnancy, lactation.
Slightly impaired liver function, hyperuricaemia, arthralgia, renal insufficiency, diabetes mellitus.
Liver toxicity depending on treatment duration & concomitant therapy. Transient increase inserum transminase levels, acute yellow atrophy of the liver. Nausea, vomiting, anorexia, diarrhea, abdominal pain. Hyperuricaemia may occur w/ dosages > 2g/day. Occasionally & reversible arthralgia, gout attacks. Rarely, sideroblastic anaemia, thrombocytopenia, porphyric attacks. Mild fever, malaise. Urticaria, rash, flushing, pruritus, burning skin, photosensitization.

Rifampicin, INH.
Pulmonary & extrapulmonary TB.
Hypersensitivity, history of drug-induced hepatitis; acute liver diseases, peripheral neuritis.
Avoid irregular intake & resumption of fixed combination after interruption of therapy. Liver disease, undernourishment, alcoholism, porphyria, epilepsy, pregnancy, lactation. Stop treatment in the event of thrombocytopenia, purpura, haemolytic anaemia, dyspnoea, shock, renal failure.
Increase in liver enzymes, hepatitis, jaundice, leucopenia, eosinophilia, thrombocytopenia, agranulocytosis, anaemia, “flu-syndrome’ & complications (thrombocytopenia, purpura, haemolytic anaemia, dysponoea, asthma-like attacks, shock, renal failure) when resuming treatment after temporary interruption, erosive gastritis, exfoliative dermatitis, Lyell’s syndrome, pemphigoid reactions. Peripheral neuropathy, convulsions, psychosis, toxic encephalopathy, rheumatic syndrome, lupus erythematosus-like symptoms, pellagra.
Oral anticoagulants, oral antidiabetics, digitalis, antiarrhythmic agents, cyclosporine, antiepileptic drugs, disulfiram, hydantoins, Ca-channel blockers, OCs.

Streptomycin sulfate.
Pulmonary & other TB, bacterial endocarditis, tularemia, Weil’s disease.
Hypersensitivity to other aminoglycosides.
Renal & hepatic impairment. Elderly, poor oral & parenteral nutrition. Pregnancy & lactation.
Ototoxicity, nephrotoxicity, shock, vit K & vit B deficiency, Steven-Johnson syndrome.
Used w/blood substitutes &diuretics intensify nephrotoxicity &ototoxicity. Possible inhibition of respiration w/anaesth or muscle relaxants.

b) Antiamoebics

Tinidazole.
Giardiasis, Amoebiasis.
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, rarely, leucopenia, headache, tiredness, furry tongue, dark urine.
May cause alcohol intolerance.

Metronidazole.
Tab Amoebiasis – invasive intestinal disease in susceptible subjects, amoebiasis- intestinal disease in less susceptible subjects & chronic amoebic hepatitis. Amoebiasis – symptomless cyst passers, giardiasis.
If administered for > 10 days, haematological tests are recommended. Re-administer immediately after haemodialysis. Caution in patient w/ active disease of CNS except for brain abscess or hepatic encephalopathy. Pregnancy & lactation.
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. Rarely, anaphylaxis.
Alcohol may cause disulfiram-like reaction. Potentiates anticoagulant effect of warfarin-type oral anticoagulants. Phenobarb increases the metabolism of metronidazole. Plasma levels of lithium may be increased.

c) Anthelmintics

Mebendazole.
Infections w/ 1 or several of the following worms: Pinworm, whipworm, roundworm, hookworm & threadworm.
Childn < 2 yr. Cholestasis. Impaired hepatic drug metabolizing capacity. Pregnancy.
Gl disturbances.

Albendazole.
Infestations of Ascaris lumbricoides, Ancylostoma duodenale, Necator americanus, Trichuris trichiura, Enterobius vermicularis, Strongyloides stercoralis.
Pregnancy.
Gl discomfort, dizziness, headache.

d) Antileprotics

Clofazimine.
All forms of multibacillary leprosy in combination therapy.
Avoid treatment if possible in patients w/ abdominal pains, diarrhea, liver or kidney damage. Treatment w/ daily doses > 100 mg; not to be used for > 3 mth. Persistent diarrhea or vomiting; patients should be hospitalized. Pregnancy, lactation.
Reversible reddish to dark brown discoloration, non-specific skin reactions, Gl effects including eosinophilic enteropathy.

e) Antivirals

Lamivudine 150 mg, zidovudine 300 mg.
Treatment of HIV infected adult & childn > 12 yr w/ progressive immunodeficiency (CD4† count = 500 cells/mm³).
Hypersensitivity. Patients w/ adnormally low neutrophil counts ( < 0.75 x 10x9/L), or abnormally low haemoglobin levels ( < 7.5 g/dL or 4.65 mmol/L).
Advanced cirrhotic liver disease due to chronic hepatitis B infection. Severe hepatic or renal impairment. Monitor haematological parameters.
Headache, malaise, fatigue, Gl effects, upper abdominal pain, fever & rash. Pancreatitis & peripheral neuropathy. Leucopenia, neutropenia, anaemia, thrombocytopenia.
Trimethoprim, phenytoin, paracetamol, aspirin, codeine, morphine, indomethacin, ketoprofen, naproxen, oxazepam, lorazepam, cimetidine, clofibrate, dapsone & Isoprinosine, potentially nephrotoxic or myelosuppresive drugs, ribavirin.

Indinavir sulfate.
Treatment of adults w/ HIV-1 infection.
If signs & symptoms of nephrolithiasis including flank pain w/ or w/o haematuria, temporary interruption of therapy may be considered. Ensure adequate hydration. Hepatic insufficiency due to cirrhosis, dose should be lowered. Pregnancy. Lactation. Pediatric use. Acute haemolytic anaemia has been reported. Once diagnosis apparent, institute appropriate treatment & may discontinue Crixivan. New onset diabetes mellitus or hyperglycaemia or exacerbation of pre-existing diabetes mellitus have been reported in patients receiving protease inhibitors. Diabetic ketoacidosis occurred in some cases. Causal relationship not established. Spontaneous bleeding in patients with haemophilia A & B treated with protease inhibitors have been reported. Causal relationship not established. Caution use w/ Phenobarbital, phenytoin, carbamazepine & dexamethasone.
Asthenia/ fatigue, abdominal pain, acid regurgitation, diarrhea, dry mouth, dyspepsia, flatulence, nausea, vomiting, lymphadenopathy, dizziness, headache, hypesthesia, insomnia, dry skin, pruritus, rash, and taste perversion. Nephrolithiasis, including flank pain w/ or w/o haematuria. Abdominal distension, liver function abnormalities, hepatitis, spontaneous bleeding in patients w/ haemophilia, acute hemolytic anemia, new onset diabetes mellitus or hyperglycaemia or exacerbation of pre-existing diabetes mellitus, hyperpigmentation, alopecia, urticaria.
Rifabutin, ketoconazole, rifampin, terfenadine, astemizole, cisapride. Administer Crixivan & didanosine at least 1 hr apart on an empty stomach. Trizolam, midazolam.

Zidovudine.
Management of patients w/ asymptomatic & symptomatic (early or advanced) HIV infection. Reduction of rate of maternal-foetal transmission of HIV.
Abnormally low neutrophil cell count (<0.75 10x9/L) or abnormally low Hb levels (<7.5g/dL).
Monitor carefully haematological parameters. If severe anaemia or myelosuppression occurs dose adjustments are suggested. Patients w/ pre-existing bone marrow compromise. Pregnancy & lactation.
Anemia, neutropenia. Others: nausea, headache, rash, abdominal pain, fever, myalgia, paraesthesia, vomiting, insomnia & anorexia. Less commonly: asthenia, malaise, somnolence, diarrhea, dizziness, sweating, dyspnoea, dyspepsia, flatulence, bad taste, chest pain, loss of mental acuity, anxiety, urinary frequency, depression, generalized pain, chills, cough, urticaria, pruritus & flu-like syndrome.
Chronic paracetamol use, potentially nephrotoxic or myelosuppressive drugs, probenecid.

Valaciclovir.
Treatment of herpes zoster. Treatment of herpes simplex infections of the skin & mucous membranes, including initial & recurrent genital herpes. Accelerates the resolution of pain by reducing the duration of & proportion of patients w/ zoster-associated pain, which includes acute & post-herpetic neuralgia..
Hypersensitivity to acyclovir.
Significant renal impairment. Naintain adequate hydration.
Mild headache & nausea. Renal insufficiency, microangiopathic hemolytic anaemia & thrombocytopenia in severely immunocompromised patients w/ high doses & prolonged periods but these have also been observed in patients not on valaciclovir having the same underlying conditions.

Lamivudine.
Treatment of patients =16 yr w/ chronic hepatitis B & evidence of hepatitis B virus replication.
Patients should be monitored regularly during treatment. Moderate to severe renal impairment. Pregnancy, lactation.
Malaise & fatigue, resp tract infections, headache, abdominal discomfort & pain, nausea, vomiting & diarrhea.
Zidovudine, co-trimoxazole.

Acyclovir.
Oral Herpes simplex Infection of skin & mucous membranes, prophylaxis in immunocompromised patients, treatment of varicella & herpes zoster in adult, treatment of varicella in childn, IV Herpes simplex infection, herpes zoster & herpes encephalitis.
In patients receiving Zovirax IV at higher doses, specific care regarding renal function should be taken, particularly when patients are dehydrated or have any renal impairment.
Skin rashes; Gl effects. Rare: neurological reactions (IV infusion).
Increased mean ½-life & plasma conc w/ probenecid.

f) Antineoplastics

Fluorouracil.
Cancers of the stomach, colon, rectum, breast.
Patients receiving sorivudine.
Bone marrow depression, hepatic & renal disorders, serious enteritis, infectious disease, bleeding tendency, hematologic disturbance.
Dehydration, enteritis, bone marrow suppression, leukoencephalopathy, angina at rest, stomatitis, gastrointestinal ulcer, intestinal pneumonia, anosmia, etc.

Anastrozole.
Treatment of advanced breast cancer in post-menopausal women whose disease progressed following treatment w/ tamoxifen or other anti-oestrogens.
Pre-menopausal women, severe renal impairment, moderate or severe hepatic disease, childn. Pregnancy, lactation.
Oestrogen-containing therapies.
Vag dryness & hair thinning, vag bleeding, hot flushes, Gl disturbances (anorexia, nausea, vomiting & diarrhea), asthenia, somnolence, headache or rash.
Oestrogens.

Disodium clodronate.
Management of increased bone resorption due to malignancy & hypercalcaemia of malignancy.
Renal dysfunction. Pregnancy, lactation.
Mild Gl irritation.
Cap: Food, antacids & drugs containing Fe, Mg or manganese.

Doxorubicin HCI.
AIDS-related Kaposi’s sarcoma, in patients w/ low CD4 counts (<200 CD4 lymphocytes/mm³) & extensive mucocutaneous or visceral disease.
Pregnancy & lactation. AIDS-KS that may be effectively treated w/ local therapy or systemic 8-interferon.
History of CV disease, impaired cardiac function, patients who have received other anthracyclines, myelosuppression. Impaired hepatic function.
Leukopenia, anemia, thrombocytopenia, nausea, asthenia, alopecia, fever, diarrhea, in fusion associated acute reactions, stomatitis flushing, shortness of breath, facial edema, headache, chills, back pain, tightness in the chest & throat &/or hypotension.
Cyclophosphamide, 6-mercaptopurine.

Carboplatin.
Treatment of advanced stage ovarian cancer of epithelial origin.
Severe myelosuppression. Pre-existing severe renal impairment. History of severe hypersensitivity to carboplatin, or other platinum containing compd. Mannitol. Pregnancy. Lactation.
Monitor peripheral blood counts & renal function. Perform neurological evaluation & assessment of hearing regularly.
Severe nausea & vomiting, serious toxic effects to kidneys, bone marrow & ears, electrolyte disturbances, hyperuricaemia, bone marrow depression, ototoxicity & other neurological effects, anaphylactic reactions, cardiac abnormalities.
Nephrotoxic & ototoxic drugs.

Bicalutamide.
Treatment of advanced prostate cancer in combination w/ LHRH analogue therapy or surgical castration.
Females, childn. Pregnancy & lactation.
Moderate to severe hepatic impairment.
Hot flushes, pruritus, breast tenderness, gynaecomastia, diarrhea, nausea, vomiting, asthenia, dry skin, jaundice, heart failure, anorexia, dry mouth, dyspepsia, constipation, flatulence, dizziness, insomnia, somnolence, decreased libido, dyspnose, impotence, nocturia, anaemia, alopecia, rash, sweating, hirsutism, diabetes mellitus, hyperglycaemia, oedema, wt gain or wt loss, abdominal pain, chest pain, headache, pain, pelvic pain, chills.
Coumarin anticoagulants.

Doxorubicin HCI.
Acute leukemia, Wilm’s tumour, neuroblastoma, breast cancer, bronchogenic carcinoma, ovarian cancer, acute leukemia, soft tissue & bone sarcomas, lymphomas of both Hodgkin;s & non-Hodgkin type.
Marked myelosuppression, impaired cardiac function, patients who received previously a full cumulative dose of doxorubicin & daunorubicin; pregnancy, lactation.
Blood count & liver function tests done prior to each treatment.
Cardiotoxicity, dermatological eggects, Gl effects, flushing, myelosuppression, leucopenia, mucositis.
Concurrent cyclophosphamide treatment may sensitise the heart to the cardiotoxic effects of doxorubicin. Increased cardiotoxicity when used w/ propranolol.

Oxaliplatin.
Treatment of metastatic colorectal cancer following failure of fluoropyrimidine-based therapy, alone or combined w/ fluoropyrimidine.
Known allergy to platinum derivatives. Pregnancy, lactation.
Event of hematological involvement (leukocytes < 2,000/mm³).
Anaemia, leucopenia, agranulocytosis, thrombocytopenia, nausea, vomiting & diarrhea. Peripheral sensory neuropathies, characterized by paresthesia of the extremities, cramps, dysesthesia of the perioral region & the upper resp & digestive tracts. Exceptional cases of fever, skin rash, malaise at inj site.
Drugs w/ potential neurological toxicity.

Cyclophosphamide.
Chemotherapy of malignant tumours & leukemia.
Acute infection, severe bone marrow depression, acute UTI. Severe impairment of liver function. Pregnancy.
Patients of reproductive age should use contraceptives throughout therapy & for not < 6 mth afterwards. Diabetes mellitus; elderly & debilitated patients; renal & hepatic failure.
Gl upsets; alopecia; reticulo-endothelial system depression; hematuria; reversible amenorrhea & azoospermia; myocardial damage w/ very high doses; pigmentation, macrocytosis, water retention; induction of hyperglycemia or hypoglycemia; risk of secondary malignancies.
May potentiate hypoglycemic effect of sulfonylureas. Allopurinal (increased incidence of bone marrow depression). Suxamethonium (prolongation of apnoea).

Crisantaspase.
In combination w/ other neoplastic agents to treat acute lymphoblastic leukaemia.
Test patient for hypersensitivity prior to the start of treatment.
Neurotoxicity, life-threatening sepsis & severe hypersensitivity. Fever, nausea, vomiting, CNS depression, hypersensitivity & plasma biochemical changes.

Fludarabine phosphate.
Treatment of patients w/ B-cell chronic lymphocytic leukaemia who have not responded to or whose disease has progressed during or after treatment w/ at least 1 standard alkylating-agent containing regimen.
Renally impaired patients w/ creatinine clearance < 30 mL/min. Pregnancy & lactation.
Severe bone marrow suppression (notably anaemia, thrombocytopenia & neutropenia) or myelosuppression may occur. Closely observe patients for signs of haematologic & non-haematologic toxicity. Periodic assessment of peripheral blood counts recommended to detect development of anaemia, neutropenia & thrombocytopenia. Monitor for signs of autoimmune haemolytic anaemia. Measure creatinine clearance for renal-impaired patients & those over 70 yr. Caution in use in the elderly. Females of childbearing potential or males should take contraceptive measures for at least 6 mth after stopping therapy. Avoid live vaccines during & after treatment.
Commonly, myelosuppression, fever, chills, infection, malaise, fatigue, anorexia, nausea, vomiting & weakness.
Concomitant use w/ pentostatin not recommended. Effectiveness may be reduced by dipyridamole & other inhibitors of adenosine uptake.

Amifostine.
Reduction of renal intoxication associated w/ cisplatin use in patients w/ ovarian or non-small cell lung cancer.
Hypotensive or dehydrated patients. Renal or hepatic impairment. Childn & patients > 70 yr.
hydrate patient adequately prior to infusion, keep in supine position & monitor BP. Monitor Ca serum levels in patients at risk of hypocalcaemia eg those w/ nephritic syndrome.
Hypotension, nausea, vomiting, flushing/ feeling of warmth, chills/feeling of coldness, dizziness, somnolence, hiccups & sneezing.
May potentiate hypotension w/ antihypertensives.

Ifosfamide.
Lung cancer, testicular tumors, soft tissue sarcomas, ovarian carcinoma, malignant lymphomas, breast cancer, carcinoma of the cervix, endometrial carcinoma, hypernephroma & others.
Severe bone marrow depression; impaired renal function; bilateral urinary obstruction, acute infections, acute hemorrhagic cystitis. Pregnancy.
Patients of reproductive age should use contraceptives during therapy & for the following 6 mth. Unilateral nephrectomies; brain metastases, infection, electrolyte imbalance.
Gl upsets; alopecia; reduction in blood count; cystitis; reversible encephalopathy. Immunosuppression. Occasionally, renal, hepatic & cardiac dysfunction in rare cases. Risk of secondary malignancies.
Neurotoxicity, hematotoxicity & nephrotoxicity may be increased by cisplatin therapy. Increased hypoglycemic effects w/ sulfonylureas. Increased bone marrow depression w/ allopurinol. Disturbances of anticoagulant control of warfarin.

Fosfestrol tetrasodium.
Metastatic prostatic carcinoma.
Thromboembolic disease in anamnesia.
Existing heart failure or fluid retention. Hepatic function disorders.
Gl upsets, dizziness, loss of appetite, pyrexia, shivering. Burning sensations, itching or pain in anal or genital regions during inj.

Thioguanine.
Acute myelogenous leukaemia, acute lymphoblastic & chronic granulocytic leukaemia, polycythaenia rubra vera.
Lactation.
Full blood counts must be taken frequently during remission induction. Pregnancy.
Bone marrow suppression, Gl intolerance, stomatitis; liver function abnormalities, jaundice.

L-asparaginase.
Acute leukemia (including chronic leukemia that turned acute), malignant lymphoma.
Pancreatitis.
Bone marrow depression. Infectious disease. Varicella. Liver or kidney dysfunction.
Shock, liver & pancreas dysfunction, coma.

Methotrexate Na.
Gestational choriocarcinoma, chorioadenoma destruens & hydatidiform mole. In ALL, as prophylaxis of meningeal leukemia & as maintenance therapy in combination. Alone or in combination- breast cancer, epidermoid cancers of the head & neck; advanced mycosis fungoides & lung CA; advanced stage of non-Hodgkin’s lymphoma; in high doses followed by leucovorin rescue & in combination – may prolong relapse-free survival of patients w/ non-metastatic osteosarcoma after surgical resection or amputation of primary tumor. Psoriasis. RA.
Pregnancy & lactation. Patients w/ psoriasis or RA w/ alcoholism, alcoholic liver disease or other chronic liver disease; Immunodeficiency syndromes, pre-existing blood dyscrasias.
Peptic ulcer disease, ulcerative colitis, malignancy & pre-existing hematopoietic impairment. Granulocytopenia, fever, pre-existing liver damage, impaired hepatic function, infection or immunologic states, craniospinal irradiation. Renal impairment. Debility, in extreme youth & old age.
Ulcerative stomatitis, leucopenia, nausea, abdominal distress, frequently reported malaise, undue fatigue, chills & fever, dizziness & decreased resistance to infection.
NSAIDs, salicylates, phenylbutazone, phenytoin, sulphonamides, probenecid, nephrotoxic chemotherapeutic agents. Tetracycline, spectrum antibiotics. Penicillins, retinoids, theophylline, folic acid.

Mitomycin C.
Gl, lung, breast, liver, bladder, cervical & uterine cancer.
Pregnancy & lactation. Renal disorders. Bleeding tendencies. Infection.
Bone marrow suppression. Hepatic disorders. Varicella.
Leukocytopenia, thrombocytopenia; hemorrhage; microangiopathic hemolytic anemia. Also see lit

Busulphan.
Chronic granulocytic leukaemia.
Lactation.
Monitor blood counts; should not be given to patients who have recently received radio- or cytotoxic drug therapies. Pregnancy.
Bone marrow depression. Gl effects (rare). Hyperpigmentation. Rare: Diffuse pulmonary fibrosis w/ progressive dyspnoea & persistent non-productive cough. Others: Urticaria, erythema multiforme, erythema nodosum, alopecia, porphyria cutanea tarda, excessive dryness & fragility of the skin w/ complete anhydrosis, dryness of the oral mucous membranes & cheilosis, gynaecomastia, cholestatic jaundice, endocardial fibrosis & myasthenia gravis.
Thioguanine, cytotoxics producing pulmonary toxicity.

Tamoxifen citrate.
Breast cancer.
Pregnancy.
Menstruation suppressed in some pre-menopausal patients; lactation. Report abnormal vag bleeding.
Hot flushes, vag bleeding & pruritus vulvae; Gl intolerance, tumour flare, lightheadedness; occasionally fluid retention, skin rash, vag discharge. Visual disturbance including corneal changes, cataracts & retinopathy. Thromboembolic events (rare). Cystic ovarian swellings occasionally in pre-menopausal women. Rarely, endometrial hyperplasia, polyps & carcinoma may develop. Transient fall in platelet count.
May potentiate effect of coumarin-type anti-coagulants.

Mitoxantrone HCI.
Treatment of advanced breast cancer, non-Hodgkin’s lymphoma & adult non-lymphocytic leukemia. As palliation of non-resectable primary hepatocellular carcinoma; in combination w/ low-dose oral cortisone, as initial chemotherapy for the treatment of patients w/ pain related to advanced hormone-refractory prostate cancer.
Myelosuppression or poor general condition; in cases w/ functional cardiac changes including CHF & decrease in left ventricular ejection fraction; cardiac monitoring in doses exceeding 160 mg/m²; Hepatic insufficiency; May impart bluish discoloration of the sclera & blue-green color to the urine 24 hrs after administration. Childn. Pregnancy & lactation.
Transient leucopenia; thrombocytopenia & anaemia are rare. Alopecia, fatigue & weakness, Gl disturbances. CV effects.

Aminoglutethimide.
Postmenopausal advanced carcinoma of breast. Metastasising carcinoma of prostate (palliative treatment). Cushing’s syndrome.
Porphyria. Pregnancy.
Monitoring of BP, adrenal & thyroid function. Periodic complete blood counts. Road/machinery users.
Frequent: Drowsiness, lethargy, rash (sometimes w/ fever). Rare: Agranulocytosis, leucopenia, thrombocytopenia, adrenal insufficiency. Isolated cases: Exfoliative dermatitis. Steven-Johnson syndrome, hepatitis, jaundice, renal function abnormalities, pancytopenia, anaemia, allergic/anaphylactic reactions, allergic alveolitis, hypothyroidism.
Increased metabolism of synthetic glucocorticoids, warfarin & other oral anticoagulants, digitoxin, theophylline, medroxyprogesterone & oral antidiabetics.

Epirubicin HCI.
Breast carcinoma, ovarian carcinoma; lung carcinoma, gastric, hepatic, pancreatic & sigmo-rectal carcinomas; head & neck carcinomas; non-Hodgkin’s lymphoma & Hodgkin’s disease; soft tissue & bone sarcomas; acute leukaemias & multiple myeloma. Transitional cell carcinoma of the bladder.
Myelosuppression. Cardiac impairment. Previous full cumulative doses of anthracyclines. Pregnancy. Lactation.
Liver impairment. Previous extensive radio-therapy. Bone infiltration by tumor.
Myelosuppression, cardiotoxicity, alopecia, mucositis, Gl disturbances, hyperpyrexia.
Should not be mixd w/ heparin.

Cisplatin.
Metastatic testicular or ovarian tumours, squamous cell & bladder carcinoma.
History of allergy to cisplatin, pregnancy, lactation, renal dysfunction, hearing impairment, bone marrow hypoplasia, leucopenia, thrombocytopenia & anemia.
Cumulative nephrotoxicity, monitoring of peripheral blood counts & liver function.
Nephrotoxicity, Gl upsets, ototoxicity, loss of visual power, myelosuppression, peripheral neuropathies, hyperuricaemia.
Hepatotoxic or nephrotoxic drugs.

Mercaptopurine.
Acute lymphoblastic leukaemia, acute myelogenous leukaemia, chronic granulocytic leukaemia.
Lactation.
Full blood counts daily during remission induction. Monitor liver-function tests wkly during treatment. Pregnancy.
Bone marrow suppression. Hepatotoxicity. Occasionally: anorexia, nausea & vomiting. Rarely: intestinal ulceration.
Allopurinol reduces rate of catabolism of mercaptopurine. Possible inhibition of anticoagulant effect of warfarin.

Buserelin.
Prostatic carcinoma.
Hypersensitivity to buserelin, benzyl alcohol. Post-orchiectomy condition. Known hormone insensitivity.
Hypertension, diabetes, depression.
Loss of potency or libido, hot flushes, breast enlargement, depressive moods, bone pain, obstructed micturition, muscular weakness, lymphostasis, headache, thrombosis w/ pulmonary embolism, skin reddening, urticaria, exanthema, dyspnea, shock, nausea, vomiting, diarrhea, dizziness.

Medroxyprogesterone acetate.
Breast carcinoma, endometrial carcinoma.
Asthma, migraine, cardiac insufficiency, renal dysfunction, seizure disorders, history of mental depression, diabetes mellitus, thyroid dysfunction, thromboembolic complications, persistent vaginal bleeding. Pregnancy & lactation.
Fluid retention, wt pain, hypertension, change in menstrual flow, breakthrough bleeding, amenorrhoea, nausea, galactorrhoea, breast tenderness, insomnia, nervousness, dizziness, irritability, thrombosis, thromboembolism, loss of vision, bulging eyes, double vision, hepatitis, gallbladder obstruction, fever, hirsutism, acne.

Vincristine sulfate.
Acute leukemia, Hodgkin’s disease, non-Hodgkin lymphomas, rhabdomyosarcoma & other sarcomas, neuroblastoma, Wilm’s tumour, breast & small cell lung cancer.
Pregnancy.
Neuromuscular disease. Decreased liver function.
Leukopenia, temporary thrombocytosis, neurotoxicity, constipation, Gl effects, alopecia, phlebitis, acute uric acid nephropathy.
INH, L-asparaginase, doxorubicin.

Idarubicin HCI.
Acute non-lymphocytic leukemia (ANLL) in adults & acute lymphocytic leukemia (ALL) as 2nd line treatment in adults & childn.
Myelosuppression, uncontrolled infection, renal & liver impairment, cardiac impairment, previous full cumulative doses of anthracyclines; pregnancy, lactation.
Elderly. Hyperuricemia. Systemic infections.
Severe myelosuppression, cardiac toxicity; reversible alopecia; acute nausea & vomiting, mucositis, oesophagitis, diarrhea; fever; tremors; chills; skin rash; elevation of liver enzymes & bilirubin. Severe & sometimes fatal infections. Red urine discoloration. Cap: severe enterocolitis w/ perforation, Gl ulceration &/or bleeding.
Other myelosuppressants.

Goserelin acetate.
management of prostate cancer suitable for hormonal manipulation.
Not for use in females & childn.
Men at particular risk of developing ureteric obstruction or spinal cord compression.
Hypersensitivity reactions, anaphylaxis, hot flushes, decrease in potency. Breast swelling & tenderness, temporary increase in bone pain. Isolated cases of ureteric obstruction. Changes in BP (hypo-& hypertension).

g) Antimalarials

Hydroxychloroquine sulfate.
Malaria, radical cure of vivax & malariae malaria, lupus erythematosus, RA.
Retinal or visual field changes. Long-term therapy in childn.
hepatic disease, alcoholism or concomitant use w/ hepatotoxic drugs. G6PD deficiency. Severe blood disorder. Psoriasis. Porphyria. Carry out periodic ophth exam.
Headache, Gl complaints; skin reactions; psychic stimulation, bleaching of hair, alopecia, blurred vision, difficulty in focusing or accommodation, corneal changes, retinal changes; blood dyscrasias.
Increases plasma digoxin levels.

Proguanil HCI
Prevention & suppression of malaria.
Severe renal failure. Pregnancy & lactation.
Mild gastric intolerance. Mouth ulceration, stomatitis, skin reactions, reversible hair loss.