hypersensitivity to any medication, or with disorders of liver function
EPERISONE
Eperisone (full name: eperisone hydrochloride) is an antispasmodic
drug, sold in Japan, India and Bangladesh under the brand name
Myonal. Eperisone acts by relaxing both skeletal muscles and vascular
smooth muscles, and demonstrates a variety of effects such as reduction
of myotonia, improvement of circulation, and suppression of the pain
reflex. The drug inhibits the vicious cycle of myotonia by decreasing
pain, ischaemia, and hypertonia in skeletal muscles, thus alleviating
stiffness and spasticity, and facilitating muscle movement. Eperisone
also improves dizziness and tinnitus associated with cerebrovascular
disorders or cervical spondylosis. Eperisone has a relatively low
incidence of sedation when compared with other anti-spasmodic drugs;
this simplifies the clinical application of the drug and makes it an
attractive choice for patients who require anti-spasmodic therapy
without a reduction in alertness. Eperisone also facilitates voluntary
movement of the upper and lower extremities without reducing muscle
power; it is therefore useful during the initial stage of rehabilitation and
as a supporting drug during subsequent rehabilitative therapy.
Indications
Spastic paralysis in conditions such as cerebrovascular disease, spastic
spinal paralysis, cervical spondylosis, post-operative sequelae (including
cerebrospinal tumour), sequelae to trauma (eg. spinal trauma, head
injury), amyotrophic lateral sclerosis, cerebral palsy, spinocerebellar
degeneration, spinal vascular diseases and other encephalomyelopathies;
improvement of muscular hypertonic ymptoms in conditions such as
cervical syndrome, periarthritis of the shoulder, lumbago.
Presentation
Eperisone hydrochloride is available as the brand name preparation
Myonal as 50 mg enteric coated tablets. An experimental form of the
drug, as a transdermal patch system, has shown promising results in
laboratory tests on rodents; however, this product is not currently
available for human use.
Dosage and administration
In adults, the usual dose of eperisone is 50-150 mg per day, in divided
doses after meals. However, the dosage is adjusted by the prescribing
clinician depending on factors such as severity of symptoms, patient age
and response.
Eperisone has not been established as definitely safe for paediatric use,
therefore its use in paediatrics cannot be recommended without further
study.
If elderly patients are treated with eperisone, it is recommended that a
reduced dose is used, and the patient closely monitored for signs of
psychological hypofunction during treatment.
Safety during pregnancy and breast-feeding
Eperisone has not been established to be safe for use by pregnant
women; therefore the drug should only be used in pregnant women, or
women who may be pregnant, if the expected therapeutic benefits will
outweigh the possible risks associated with treatment. The
manufacturers of Myonal recommend that the drug is not used during
lactation (breast-feeding). If eperisone must be used, it is recommended
that the patient stops breast-feeding for the duration of treatment. (It has
been reported that Eperisone is excreted in breast milk in an animal
study (in rats).
Pharmacology
IUPAC name: (2RS)-1-(4-Ethylphenyl)-2-methyl-3-piperidin-1-
ylpropan-1-one monohydrochloride C17H25NO·HCl- mass number=
295.85
Skeletal muscle relaxation
Relaxation of hypertonic skeletal muscles
Improves intramuscular blood flow
Suppression of spinal reflex potentials
Reduction of muscle spindle sensitivity via motor neurons
Vasodilatation and augmentation of blood flow
Analgesic action and inhibition of the pain reflex in the spinal cord
Contraindications
Eperisone is contraindicated in patients with known hypersensitivity to
the drug.
Cautions
Eperisone should be administered with care in patients with a history of
(Eperisone may aggravate hepatic dysfunction).
Weakness, light-headedness, sleepiness or other symptoms may occur. In
the event of such symptoms, the dosage should be reduced or treatment
discontinued. Patients should be cautioned against engaging in
potentially hazardous activities requiring alertness, such as operating
machinery or driving a car.
Side effects
Shock and Anaphylactoid reactions: In the event of symptoms such as
redness, itching, urticaria, oedema of the face and other parts of the
body, dyspnoea etc, treatment should be discontinued and appropriate
measues taken.
Oculo-muco-cutaneous syndrome (Stevens Johnson Syndrome) and
Toxic Epidermal Necrolysis: Serious dermatopathy such as oculo-muco-
cutaneous syndrome (Stevens-Johnson syndrome) or toxic epidermal
necrolysis may occur. Patients should be carefully observed, treatment
discontinued and appropriate measures taken, in the event of symptoms
such as fever, erythema, blistering, itching, ocular congestion or
stomatitis, etc
Other side effects: anaemia, rash, pruritus, sleepiness, insomnia,
headache, nausea ang vomiting, anorexia, abdominal pain, diarrhoea,
constipation, urinary retention or incontinence.
Drug interactions
There have been reports of disturbances in ocular accommodation
occuring after the concomitant use of tolperisone hydrochloride and
methocarbamol.
HEMARATE
Contents
Fe fumarate 320 mg (elemental Fe 105 mg), vit B1 10 mg, vit B2 10 mg,
vit B6 5 mg, vit B12 50 mcg, vit C 500 mg, vit E 30 iu, nicotinamide 30
mg
Indications
Nutritional & Fe-deficiency anemia due to pregnancy, lactation &
menstrual blood loss. Prevention & treatment of conditions associated
w/ B-complex deficiency.
Dosage
Adult 1 tab daily.
Administration
Should be taken on an empty stomach (Best taken between meals. May
be taken w/ meals to reduce GI discomfort.).
MIMS Class
Vitamins & Minerals (Pre & Post Natal) / Antianemics
ATC Classification
B03AE10 - Various combinations ; Belongs to the class of iron in other
combinations. Used in the treatment of anemia.
Poison Schedule
Non-Rx
GALVUS (vildaglipti
Main use Active ingredient Manufacturer
Type 2 diabetes Vildagliptin Novartis
How does it work?
Galvus tablets contain the active ingredient vildagliptin, which is a type
of medicine called a dipeptidyl peptidase-4 (DPP-4) inhibitor. It is used
to treat type 2 or non-insulin dependent diabetes (NIDDM).
Vildagliptin works by increasing the amount of two incretin hormones
found in the body, called glucagon-like peptide-1 (GLP-1) and glucose-
dependent insulinotropic peptide (GIP). These hormones are normally
produced naturally by the body in response to food intake. Their
function is to help control blood sugar (glucose) levels.
GLP-1 and GIP have two main actions that help to control blood
glucose.
Firstly, they stimulate the pancreas to produce insulin in response to
increasing levels of glucose in the blood. (Insulin is the main hormone
responsible for controlling sugar levels in the blood. It causes cells in the
body to remove sugar from the blood.)
GLP-1 also reduces the production of glucagon. (Glucagon is a hormone
that normally increases glucose production by the liver.)
GLP-1 and GIP are normally broken down by an enzyme in the body
called dipeptidyl peptidase-4 (DPP-4). Vildagliptin works by binding to
this enzyme and preventing it from breaking down the GLP-1 and GIP.
This increases the levels of these hormones in the body and so increases
their effect on controlling blood sugar.
What is it used for?
• Type 2 diabetes (non-insulin dependent diabetes).
Galvus is used for people with type 2 diabetes whose blood sugar is not
sufficiently controlled by other antidiabetic medicines. It can be added to
treatment with metformin; a sulphonylurea, for example gliclazide; or
another type of antidiabetic medicine known as a thiazolidinedione, for
example pioglitazone or rosiglitazone.
Warning!
• Hypoglycaemia (low blood glucose) has been commonly
reported when this medicine is used in combination with
metformin or sulphonylurea medicines, eg glimepiride.
Symptoms of hypoglycaemia usually occur suddenly and
may include cold sweats, cool pale skin, tremor, anxious
feeling, unusual tiredness or weakness, confusion, difficulty
in concentration, excessive hunger, temporary vision
changes, headache, nausea and palpitations. You should talk
to your doctor or diabetes specialist about this and make sure
you know what to do if you experience these symptoms.
• Your ability to concentrate or react may be reduced if you
have low blood sugar, and this can cause problems driving or
operating machinery. You should take precautions to avoid
low blood sugar when driving - discuss this with your doctor.
This medicine may also cause dizziness or fatigue. If affected
you should take care driving or operating machinery.
• People with diabetes have a higher risk of developing foot
ulcers and blistering of the skin. It is therefore important to
have a good foot care routine. Consult your doctor if you get
any new blisters or ulcers while taking this medicine.
• Rare cases of inflammation of the liver (hepatitis) have been
reported in people taking this medicine. For this reason, your
liver function should be checked before starting treatment,
every three months during the first year of treatment, and
regularly thereafter. You should consult your doctor if you
develop any of the following symptoms while taking this
medicine, so that your liver can be checked: unexplained
nausea, vomiting, abdominal pain, fatigue, loss of appetite,
darkened urine or yellowing of the eyes or skin (jaundice).
Use with caution in
• People over 75 years of age.
• People with mild heart failure.
• People taking ACE inhibitor medicines, eg captopril.
Not to be used in
• Type 1 diabetes.
• Diabetic ketoacidosis.
• Decreased liver function.
• Pregnancy.
• Breastfeeding.
• This medicine is not recommended for people receiving
dialysis or who have moderate to severe kidney disease.
• This medicine is not recommended for people with severe
heart failure.
• This medicine is not recommended for children and
adolescents under 18 years of age because it has not been
studied in this age group.
• This medicine contains lactose and should not be taken by
people with rare hereditary problems of galactose
intolerance, the Lapp lactase deficiency or glucose-galactose
malabsorption.
This medicine should not be used if you are allergic to one or any of its
ingredients. Please inform your doctor or pharmacist if you have
previously experienced such an allergy.
If you feel you have experienced an allergic reaction, stop using this
medicine and inform your doctor or pharmacist immediately.
Pregnancy and breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding.
However, other medicines may be safely used in pregnancy or
breastfeeding providing the benefits to the mother outweigh the risks to
the unborn baby. Always inform your doctor if you are pregnant or
planning a pregnancy, before using any medicine.
• The safety of this medicine for use during pregnancy has not
been established. It should not be used during pregnancy.
Diabetes mellitus is usually controlled using insulin during
pregnancy, because this provides a more stable control of
blood sugar. If you get pregnant while taking this medicine,
or are planning a pregnancy, you should seek medical advice
from your doctor.
• It is not known if this medicine passes into breast milk. The
manufacturer states that it should not be used by
breastfeeding mothers. Seek medical advice from your
doctor.
Side effects
Medicines and their possible side effects can affect individual people in
different ways. The following are some of the side effects that are known
to be associated with this medicine. Just because a side effect is stated
here does not mean that all people using this medicine will experience
that or any side effect.
Common (affect between 1 in 10 and 1 in 100 people)
• Tremor (when used with metformin or a sulphonylurea).
• Headache (when used with metformin or a sulphonylurea).
• Dizziness (when used with metformin or a sulphonylurea).
• Low blood sugar levels (when used with metformin or a
sulphonylurea).
• Nausea (when used with metformin).
• Feeling weak (when used with a sulphonylurea).
• Weight gain (when used with a glitazone).
• Swelling of the legs and ankles due to excess fluid retention
(when used with a glitazone).
Uncommon (affect between 1 in 100 and 1 in 1000 people)
• Fatigue (when used with metformin).
• Constipation (when used with a sulphonylurea).
• Headache (when used with a glitazone).
• Feeling weak (when used with a glitazone).
Rare (affect between 1 in 1000 and 1 in 10,000 people)
• Changes in liver function.
• Inflammation of the liver (hepatitis).
• Allergic reaction called angioedema, which may involve
swelling of the face, tongue or throat, difficulty swallowing
or breathing, rash or hives (stop taking this medicine and
consult your doctor immediately if you experience these
symptoms).
Very rare (affects less than 1 in 10,000 people)
• Inflammation of the nose and throat, causing a blocked or
runny nose and sore throat (nasopharyngitis).
The side effects listed above may not include all of the side effects
reported by the medicine's manufacturer.
For more information about any other possible risks associated with this
medicine, please read the information provided with the medicine or
consult your doctor or pharmacist.
How can this medicine affect other medicines?
It is important to tell your doctor or pharmacist what medicines you are
already taking, including those bought without a prescription and herbal
medicines, before you start treatment with this medicine. Similarly,
check with your doctor or pharmacist before taking any new medicines
while taking this one, to ensure that the combination is safe.
Medicines that increase blood sugar levels as a side effect may make this
medicine, and other antidiabetic medicines, less effective at controlling
blood sugar. Medicines that can increase blood sugar levels include the
following:
• bronchodilators (beta agonists), eg salbutamol, terbutaline,
salmeterol
• corticosteroids, eg prednisolone
• levothyroxine
• thiazide diuretics, eg bendroflumethiazide.
JANUVIA
Generic Name: sitagliptin (SI ta glip tin)
Brand Names: Januvia
What is Januvia?
Januvia is an oral diabetes medicine that helps control blood sugar
levels. It works by regulating the levels of insulin your body produces
after eating.
Januvia is for people with type 2 diabetes (non-insulin-dependent)
diabetes. It is sometimes used in combination with other diabetes
medications, but is not for treating type 1 diabetes.
Januvia may also be used for purposes other than those listed here.
Important information about Januvia
Do not use Januvia if you are allergic to sitagliptin or if you are in a state
of diabetic ketoacidosis (call your doctor for treatment with insulin).
Before taking Januvia, tell your doctor if you have kidney disease or are
on dialysis. If you have any of these conditions, you may not be able to
use sitagliptin, or you may need a dosage adjustment or special tests
during treatment.
You may take this medicine with or without food. Follow your doctor's
instructions.
Follow your doctor's instructions about any restrictions on food,
beverages, or activity while you are taking Januvia.
Januvia is only part of a complete program of treatment that also
includes diet, exercise, weight control, and possibly other medications. It
is important to use this medicine regularly to get the most benefit. Get
your prescription refilled before you run out of medicine completely.
Before taking Januvia
Do not use this medication if you are allergic to Januvia, or if you are in
a state of diabetic ketoacidosis (call your doctor for treatment with
insulin).
Before taking Januvia, tell your doctor if you have kidney disease or if
you are on dialysis. If you have any of these conditions, you may not be
able to use Januvia, or you may need a dosage adjustment or special
tests during treatment.
FDA pregnancy category B. Januvia is not expected to be harmful to an
unborn baby. Tell your doctor if you are pregnant or plan to become
pregnant during treatment. It is not known whether sitagliptin passes
into breast milk or if it could harm a nursing baby. Do not use this
medication without telling your doctor if you are breast-feeding a baby.
Januvia should not be given to a child younger than 18 years old without
a doctor's advice.
How should I take Januvia?
Take Januvia exactly as it was prescribed for you. Do not take the
medication in larger or smaller amounts, or take it for longer than
recommended by your doctor. Your doctor may occasionally change
your dose to make sure you get the best results from this medication.
You may take this medicine with or without food. Follow your doctor's
instructions.
Januvia is only part of a complete program of treatment that also
includes diet, exercise, weight control, and possibly other medications. It
is important to use this medicine regularly to get the most benefit. Get
your prescription refilled before you run out of medicine completely.
To be sure this medication is helping your condition, your blood will
need to be tested on a regular basis. Your kidney function may also need
to be tested. It is important that you not miss any scheduled visits to
your doctor.
Your medication needs may change if you become sick or injured, if you
have a serious infection, or if you have any type of surgery. Your doctor
may want you to stop taking Januvia for a short time if any of these
situations affect you.
Store Januvia at room temperature away from moisture, heat, and light.
What happens if I miss a dose?
Take the missed dose as soon as you remember (be sure to take the
medicine with food if your doctor has instructed you to). If it is almost
time for your next dose, skip the missed dose and take the medicine at
the next regularly scheduled time. Do not take extra medicine to make
up the missed dose.
What happens if I overdose?
Seek emergency medical attention if you think you have used too much
of this medicine. You may have signs of low blood sugar, such as
hunger, headache, confusion, irritability, drowsiness, weakness,
dizziness, tremors, sweating, fast heartbeat, seizure (convulsions),
fainting, or coma.
What should I avoid while taking Januvia?
Follow your doctor's instructions about any restrictions on food,
beverages, or activity while you are taking Januvia.
Januvia side effects
Get emergency medical help if you have any of these signs of an allergic
reaction: hives; difficulty breathing; swelling of your face, lips, tongue,
or throat.
Call your doctor at once if you have fever, sore throat, and headache
with a severe blistering, peeling, and red skin rash. These could be signs
of a serious side effect.
Less serious Januvia side effects may include:
• runny or stuffy nose, sore throat;
• headache; or
 • nausea, stomach pain, diarrhea.
This is not a complete list of side effects and others may occur. Call your
doctor for medical advice about side effects. You may report side effects
to FDA at1-800-FDA-1088.
What other drugs will affect Januvia?
Before you take Januvia, tell your doctor if you are also taking digoxin
(Lanoxicaps, Lanoxin). You may not be able to take this medicine, or
you may require a dosage adjustment or special monitoring.
Although Januvia is not as likely to cause hypoglycemia (low blood
sugar) as some other oral diabetes medications, tell your doctor if you
are taking any other drugs that can potentially lower blood sugar, such
as:
• probenecid (Benemid);
• nonsteroidal anti-inflammatory drugs (NSAIDs);
• aspirin or other salicylates (including Pepto-Bismol);
• sulfa drugs (Bactrim and others);
• a monoamine oxidase inhibitor (MAOI);or
• beta-blockers (Tenormin and others).
This list is not complete and there may be other drugs that can interact
with Januvia. Tell your doctor about all the prescription and over-the-
counter medications you use. This includes vitamins, minerals, herbal
products, and drugs prescribed by other doctors. Do not start using a
new medication without telling your doctor
Where can I get more information?
• Your pharmacist can provide more information about
Januvia.
What does my medication look like?
Sitagliptin is available with a prescription under the brand name Januvia.
Other brand or generic formulations may also be available. Ask your
pharmacist any questions you have about this medication, especially if it
is new to you.
• Januvia 25 mg - pink, round, film-coated tablets
• Januvia 50 mg - light beige, round, film-coated tablets
• Januvia 100 mg - beige, round, film-coated tablets
• Remember, keep this and all other medicines out of the reach
of children, never share your medicines with others, and use
this medication only for the indication prescribed.
• Every effort has been made to ensure that the information
provided by Cerner Multum, Inc. ('Multum') is accurate, up-
to-date, and complete, but no guarantee is made to that effect.
Drug information contained herein may be time sensitive.
Multum information has been compiled for use by healthcare
practitioners and consumers in the United States and
therefore Multum does not warrant that uses outside of the
United States are appropriate, unless specifically indicated
otherwise. Multum's drug information does not endorse
drugs, diagnose patients or recommend therapy. Multum's
drug information is an informational resource designed to
assist licensed healthcare practitioners in caring for their
patients and/or to serve consumers viewing this service as a
supplement to, and not a substitute for, the expertise, skill,
knowledge and judgment of healthcare practitioners. The
absence of a warning for a given drug or drug combination in
no way should be construed to indicate that the drug or drug
combination is safe, effective or appropriate for any given
patient. Multum does not assume any responsibility for any
aspect of healthcare administered with the aid of information
Multum provides. The information contained herein is not
intended to cover all possible uses, directions, precautions,
warnings, drug interactions, allergic reactions, or adverse
effects. If you have questions about the drugs you are taking,
check with your doctor, nurse or pharmacist.
Brand Name: Neobloc
Generic Name: Metropolol tartrate
Indications: Hypertension and chronic angina pectoris
Drug Classification: Anti-hypertensive drug, Beta-blocker
Mechanism of Action: A selective beta blocker that selectively blocks
beta 1 receptors, decreases cardiac output, peripheral
resistance and cardiac oxygen consumption and depresses
rennin secretion.
Dosage: Adult-initially 100mg daily, may increase at weekly interval to
max. 400mg/day/ Maintenance 100-400mg/day.
Special Precaution: Avoid abrupt withdrawal. Diabetes, anesth, 1st
trimester of pregnancy
Pregnancy Risk: C, D in 2nd and 3rd trimesters
Adverse Reaction: GI and sleep pattern disturbances headache,
dizziness, and weakness.
Contraindications: Heart block> 1st degree, AV block II and III,
cardiogenic shock, overt cardiac failure, sinus, bradycardia,
bronchospastic disease.
Form: Tablets- 100mg, 200mg. Injection-1mg/ 1 ml in 5-ml ampules,
Nursing Responsibilities:
➢ Check for the patient’s apical pulse before giving the
medication; if pulse is slower do not give the drug.
➢ In diabetic patients, monitor the glucose level closely because
the drug masks common sign and symptoms of
hypoglycemia.
➢ Monitor the BP frequently, the drug masks common signs
and symptoms of shock.
➢ Beta blockers may mask tachycardia caused by
hyperthyroidism.
➢ When teraphy is stopped, reduce dose gradually for 1-2
weeks.
➢ Instruct patient to take drug exactly as prescribed.
➢ Caution patient to avoid tasks requiring mental alertness until
response to therapy has bee established.
➢ Instruct patient not to stop drug suddenly.
➢ Drug is not advised for breastfeeding women.
Brand name: Plavix
Generic name: Clopidogrel
Drug Classification: Anticoagulant, antithrombotics & fibrinolytics
Indication: for the reduction of atherosclerotic events (MI, stroke &
vascular death) in patients w/ atherosclerosis documented by
recent stroke, MI or established peripheral arterial disease.
For the treatment of patients suffering from non- ST segment
elevation acute coronary syndrome (unstable angina or non-
Q wave MI) in combination w/ ASA.
Mechanism of Action: low dosage aspirin appear to inhibit clot
formation by blocking the synthesis of prostaglandin, which
in turn prevents formation of the platelet- aggregating
substance thromboxane A2. Clopidogrel
Dosage: 75 mg daily
Contraindication: Severe liver impairment. Peptic ulcer and
intracranial hemorrhage. Lactation.
Special Precaution: Patients who may be at risk of increased bleeding
from trauma, surgery or other pathological conditions.
Patients w/ moderate hepatic disease who may have bleeding
diatheses. Pregnancy.
Adverse Reaction:
CNS: depression, dizziness, fatigue, headache
EENT: epistaxis
RESP: cough, dyspnea
CV: Chest pain, edema, hypertension
GI: GI bleeding, abdominal pain, diarrhea, dyspepsia,
gastritis
DERM: pruritus, purpura, rash
HEMAT: bleeding, neutropenia, thrombotic
thrombocytopenic purpura
METAB: hypercholesterolemia
MS: arthralgia, back pain
MISC: fever, hypersensitivity reactions
Form: Film- coated tablet- 75mg
Pregnancy Risk Category: B
Nursing Responsibilities:
➢ Assess patient for symptoms of stroke, peripheral
vascular disease, or MI periodically during therapy.
➢ Monitor patient for signs of thrombotic thrombocytic
purpura (thrombocytopenia, microangiopathic
hemolytic anemia, neurologic findings, renal
dysfunction, fever).
➢ Monitor bleeding time during therapy.
➢ Monitor CBC with differential and platelet count
periodically during therapy.