Description of drug Mebeverine is a musculotropic antispasmodic drug, mainly used to treat irritable bowel syndrome (IBS) and the associated abdominal cramping. It works by relaxing the muscles in and around the gut. Dose & overdose Adult dose: 400mg/ day Overdose: > 405mg/day Child dose: Not recommended Indications/ Disease 1. For symptomatic treatment of irritable bowel syndrome 2. Chronic irritable colon 3. Spastic constipation 4. Mucous colitis 5. Colicky abdominal pain 6. Persistent non-specific diarrhea Side effects & Adverse effects 1. Allergic reactions 2. Hypersensitivity 3. Urticaria 4. Angioedema 5. Face oedema 6. Exanthema Contraindication If you are allergic to mebeverine hydrochloride or any of the excipients.
Warning DO NOT TAKE MEBEVERINE IF: 1. You have liver or kidney problems 2. You are over 40 years 3. Have passed blood form the bowel 4. You are feeling sick or vomiting 5. You are looking pale and feeling tired 6. You are suffering from severe constipation 7. You have a fever 8. You have recently travelled abroad 9. You are or may be pregnant 10. You have abnormal vaginal bleeding or discharge 11. You have difficulty or pain passing urine Clinical experience Mebeverine should not given to children and adolescents Group Synthetic anticholinergics, esters with tertiary amino group, musculotropic antispasmodic
Advice to patient 1. If you forget a single dose do not take a consequent double dose to make up for it. 2. Keep away from children 3. Keep in original packaging 4. Do not store above 30C Reference Medicines.org.uk Brand name Manufacturer Dosage form Dose Price Pack EVARIN Delta Pharma Limited Tablet 135mg 299.98 MRP 50s IRBAN Incepta Pharmaceuticals Ltd Tablet 135mg 300.00 MRP 50s MANIL Gaco Phamaceutical Ltd Tablet 135mg 303.43 MRP 50s MAVE Opsonin Pharma Ltd Tablet 135mg 300.00 MRP 50s MESPA Ambee Pharmaceuticals Ltd Tablet 135mg 300.00 MRP 50s MEVERINE Drug International Ltd Tablet 135mg 300.00 MRP 50s ROSTIL Beximco Tablet 135mg 300.00 50s
2. Generic name: Meclizine
Description Meclizine is a piperazine-derivative antihistamine that is used as an antiemetic. It has antiemetic, anticholinergic and antihistaminic properties. It reduces the sensitivity of the labyrinthine apparatus. The action may be mediated through nerve pathways to the vomiting center (VC) from the chemoreceptor trigger zone (CTZ), peripheral nerve pathways, the VC or other CNS centers. Dose & overdose Adult dose for: Motion sickness: Take an initial dose of 25-50 mg, 1 hour prior to travel. May repeat the dose every 24 hours for the duration of the journey. Radiation sickness: 50 mg administered 2-12 hours prior to radiation treatment. Vertigo: 25-100 mg daily in divided doses. Emergency contraception: 25-50 mg, 1 hour before first ECP dose; repeat if needed in 24 hours. Children <12 dose: Not established Overdose: >100mg Indications/ Disease 1. Nausea 2. Vomiting 3. Dizziness 4. Motion sickness 5. Vertigo associated with diseases of vestibular system. Side effects & Adverse effects 1. Drowsiness 2. Dry mouth 3. Blurred vision 4. Constipation Pharmaceuticals Ltd MRP VERON Eskayef Bangladesh Ltd Tablet 135mg 304.00 MRP 50s Contraindications Contraindicated in patients who have hypersensitivity to Meclizine and those who are breastfeeding Warning 1. Patients should be warned that Meclizine may impair their ability to perform hazardous activities requiring mental alertness or physical coordination (e.g., operating machinery, driving a motor vehicle). 2. Patients should avoid alcoholic beverages while taking this drug. Due to its potential anticholinergic action, this drug should be used with caution in patients with asthma, glaucoma, or enlargement of the prostate gland. Clinical experience 1. Shouldnt be used in children under 12. Group Antiemetic;Histamine H1 Antagonist;Histamine H1 Antagonist, First Generation;Piperazine Derivative Advice to patient 1. Dry mouth may cause an increase in cavities. Take good care of your teeth. See a dentist regularly. 2. Do not take double or extra doses. 3. Do not share your medicine with others and do not take anyone else's medicine. 4. Keep all medicine out of the reach of children and pets. Reference http://www.gthrifty.com
3. Generic name: Metformin Description of drug Metformin is a biguanide type oral antihyperglycemic drug used in the management of type 2 diabetes. It lowers both basal and postprandial plasma glucose. Its mechanism of action is different from those of sulfonylureas and it does not produce hypoglycemia. Nobesit decreases hepatic glucose production, decreases intestinal absorption of glucose and improves insulin sensitivity by an increase in peripheral glucose uptake and utilization. Dose & overdose Adult tablet dose: 500mg twice a dat Adult extended release dose: 500mg once a day Overdose: > 2550mg Children over 10: 500mg twice a day Indications/ Disease 1. To improve glycemic control in type 2 diabetes 2. To help hormone balance 3. Lowers blood sugar & helps insulin work better Side effects & Adverse effects 1. Anorexia 2. Flatulence 3. Loss of appetite 4. Diarrhea 5. Nausea 6. Vomiting Contraindication Metformin is contraindicated in patients with: 1. Renal dysfunction 2. Cardiovascular collapse 3. Acute myocardial infarction 4. Diabetic ketoacidosis 5. Hypersensitivity to Metformin Warning Metformin is known to be substantially excreted by the kidney and the risk of Metformin accumulation and lactic acidosis increases with the degree of impairment of renal function. Thus, patients with serum creatinine levels above the upper limit of normal for their age should not receive Metformin. Clinical experience Rarely lactic acidosis (approximately 0.03 cases/1000 patient-year) can occur due to Metformin accumulation during treatment with Metformin. Group Antidiabetic Agent, Biguanide Advice to patient 1. Keep out of reach of children 2. Store away from water and light 3. Do not take double doses 4. Consult doctor in case of pregnancy Reference www.gthrifty.com, www.inceptapharma.com
HI-MET Hudson Pharmaceuticals Ltd. Tablet Metformin hydrochloride 850mg/tablet 850mg x 100s pack: 300.00 IP
INFO Bristol Pharma Limited Tablet Metformin hydrochloride 500mg & 850mg/tablet 500mg x 50s pack: 100.00 MRP; 850mg x 50s pack: 150.00 MRP
INFORMET Beximco Pharmaceuticals Ltd.
Tablet Metformin hydrochloride 500mg & 850mg/tablet 500mg x 100s pack: 300.00 IP; 850mg x 60s pack: 270.00 IP
INFORMET LA Beximco Pharmaceuticals Ltd.
Tablet(Long Acting) Metformin hydrochloride 500mg/tablet 500mg x 100s pack: 500.00 IP
INSIMET IBN SINA Pharmaceutical Industry Ltd. Tablet Metformin hydrochloride 500mg & 850mg/tablet 500mg x 100s pack: 250.00 MRP; 850mg x 50s pack: 175.00 MRP
KEMIN Kemiko Pharmaceuticals Ltd. Tablet Metformin hydrochloride 500mg & 850mg/tablet 500mg x 50s pack: 100.00 MRP; 850mg x 50s pack: 150.00 MRP
MEFOREX Jayson Pharmaceuticals Ltd. Tablet Metformin hydrochloride 500mg & 850mg/tablet 500mg x 50s pack: 55.00 IP; 850mg x 30s pack: 75.00 IP
MEFORIN XR RAK Pharmaceuticals Pvt. Ltd. Tablet(Extended Release) Metformin hydrochloride 500mg/tablet 500mg x 30s pack: 150.00 MRP
MEFORIN 850 RAK Pharmaceuticals Pvt. Ltd. Tablet Metformin hydrochloride 850mg/tablet 850mg x 50s pack: 200.00 MRP
MEGLU Unimed & Unihealth Manufacturers Ltd.
Tablet Metformin hydrochloride 500mg & 850mg/tablet 500mg x 30s pack: 60.00 MRP; 850mg x 30s pack: 90.00 MRP
MEGLU ER 500 Unimed & Unihealth Manufacturers Ltd.
SUGAMET General Pharmaceuticals Ltd. Tablet Metformin hydrochloride 500mg & 850mg/tablet 500mg x 100s pack: 200.00 MRP; 850mg x 40s pack: 120.00 MRP
4. Generic name: Metoprolol
De Description of drug Metoprolol tartrate BP, is a selective 1- adrenoreceptor blocking agent. Metoprolol tartrate is ()-1- (isopropylamino)-3-[p-(2- methoxyethyl)phenoxy]-2-propanol L-(+)-tartrate (2:1) salt. It is a white, practically odorless, crystalline powder with a molecular weight of 684.82. It is very soluble in water;freely soluble in methylene chloride, in chloroform, and in alcohol, slightly soluble in acetone; and insoluble in ether. Dose & overdose Adult dose: 1. Hypertension: initially 100mg daily, maintenance 100-200mg daily in 1-2 divided doses 2. Angina Pectoris: 50-100mg 2-3 times daily. 3. Myocardial Infarction: After early intravenous treatment for 48 hours, patients should receive a maintenance dose of 100mg twice daily. 4. Arrhythmias: usually 50mg 2-3 times daily; up to 300mg daily in divided doses if necessary. 5. Hyperthyroidism: (adjunct), 50mg 4 times daily 6. Migraine Prophylaxis: 100-200mg daily in divided doses.
Indications/ Disease 1. Hypertension 2. Angina Pectoris 3. Myocardial infarction 4. Arrythmias 5. Hyperthyroidism 6. Migraine prophylaxis Side effects & Adverse effects 1. Bradycardia 2. Heart failure 3. Hypotension 4. Conduction disorder 5. Bronchospasm 6. Peripheral vasoconstriction 7. Gastrointestinal disturbances 8. Fatigue 9. Sleep disturbances 10. Rash 11. Dry eye 12. Sexual dysfunction 13. Exacerbation of psoriasis Contraindication Hypertension and Angina: Metoprolol is contraindicated in sinus bradycardia, heart block greater than first degree, cardiogenic shock, and overt cardiac failure.
Myocardial Infarction: Metoprolol is contraindicated in patients with a heart rate<45 beats/min; second and third-degree heart block; significant first-degree heart block; systolic blood pressure <100 mmHg; or moderate-to-severe cardiac failure. Warning Metoprolol should be used with caution in patients with impaired hepatic function. Clinical experience Metoprolol should not be used in women more than 12 weeks pregnant and those with Raynauds disease. Group Beta Blocker, Beta-1 Selective Advice to patient Patients should be advised to take Metoprolol regularly and continuously, as directed, with or immediately following meals. If a dose missed, the patient should take only the next scheduled dose (without doubling it). Patient should not discontinue Metoprolol without consulting the physician. Patients should be advised to avoid operating automobiles and machinery or engaging in other tasks requiring alertness until the patient's response to therapy with Metoprolol has been determined. contact the physician if any difficulty in breathing occurs. inform the physician or dentist before any type of surgery that he or she is taking Metoprolol. Reference www.gthrifty.com, www.inceptapharma.com
5. Generic name: Metronidazole
Description of drug Metronidazole is a member of the imidazole class of antibacterial agents and is classified therapeutically as an antiprotozoal and antibacterial agent. The intracellular targets of action of metronidazole on anaerobes are largely unknown. The 5-nitro group of metronidazole is reduced by metabolically active anaerobes, and studies have demonstrated that the reduced form of the drug interacts with bacterial DNA. However, it is not clear whether interaction with DNA alone is an important component in the bactericidal action of metronidazole on anaerobic organisms. Dose & overdose Adult Dosing 1. Trichomonasis: 2g one day 2. Amebiasis: 750mg three times a day 3. Anerobic bacterial infection: 7.5mg/kg every 6 hours
Overdose: >4g/day Indications/ Disease 1. The prevention of post-operative infections due to anaerobic bacteria, particularly species of bacteroides and anaerobic streptococci. 2. The treatment of septicaemia, bacteraemia, peritonitis, brain abscess, necrotising pneumonia, osteomyelitis, puerperal sepsis, pelvic abscess, pelvic cellulitis and post-operative wound infections from which pathogenic anaerobes have been isolated. 3. Urogenital trichomoniasis in the female (trichomonal vaginitis) and in the male. 4. Bacterial vaginosis (also known as non-specific vaginitis, anaerobic vaginosis or Gardnerella vaginitis). 5. All forms of amoebiasis (intestinal and extra-intestinal disease and that of symptomless cyst passers). 6. Giardiasis. 7. Acute ulcerative gingivitis. 8. Anaerobically-infected leg ulcers and pressure sores. 9. Acute dental infections due to anaerobic organisms (eg. acute pericoronitis and acute apical infections). 10. H. pylori infection 11. Antibiotic Associated Pseudomembranus colitis Side effects & Adverse effects 1. Pain 2. Tenderness 3. Redness or swelling over vein in which medicine is given 4. Unsteadiness 5. Fever 6. Sore throat 7. Chills 8. Headache 9. Numbness 10.Weakness in hands & feet 11. Skin itching 12. Vaginal irritation 13. Seizures 14. Unusual tiredness Contraindication Metronidazole is contraindicated in patients with a history of hypersensitivity to Metronidazole or other Nitroimidazole derivatives. Warning Metronidazole should be given with caution in the following conditions- anaemia or other blood disorders, liver disease, disease of the nervous system, seizures etc. Clinical experience Nil Group Antiiprotozoal Advice to patient 1.Nursing mothers shouldnt take metronidazole 2. Keep away from reach of children Reference www.inceptapharma.com
6. Generic name: Midazolam
Description of drug Midazolam is a sleep inducing agent characterized by a rapid onset and short duration of action. It also exerts an anxiolytic, anticonvulsant and muscle-relaxant effect. Dose & overdose Oral dosage: For adults 7.5-15 mg daily. In elderly and debilitated patients, the recommended dose is 7.5 mg. In premedication, 15 mg of Midazolam should be given 30-60 minutes before the procedure.
Intravenous administration: Endoscopic or Cardiovascular Procedures In healthy adults the initial dose is approximately 2.5 mg. In cases of severe illness and in elderly patients, the initial dose must be reduced to 1 to 1.5 mg.
Induction of Anesthesia The dose is 10-15 mg I. V.
Intramuscular administration: Adult: 0.07-0.1 mg/kg bodyweight i. m. Usual dose is about 5 mg. Children: 0.15-0.20 mg/kg. Elderly and debilitated patients: 0.025-0.05 mg/kg
Rectal administration in children: For preoperative sedation, rectal administration of the ampoule solution (0.35-0.45 mg/kg) 20-30 min before induction of general anesthesia. Overdose: >30mg in 24 hours Indications/ Disease 1. Short term treatment of insomnia 2. Sedation in premedication before surgical or diagnostic procedures. Side effects & Adverse effects 1. Drowsiness 2. Confusion 3. Fatigue 4. Headache 5. Muscle weakness In IV or IM admisntration there can be respiratory depression, apnoea, variations in blood pressure and pulse rate. Contraindication Midazolam must not be given to patients with severe respiratory insufficiency, severe hepatic insufficiency, myasthenia gravis, sleep apnea syndrome and with known hypersensitivity to benzodiazepines or to any component of the product. Warning Midazolam should be used with caution in: patients over 60 years of age, patients routinely short of breath, myasthenia gravis (a disease causing muscle weakness), a kidney, liver or heart condition, a history of alcohol or drug abuse, coma, patients taking any other medicines including those not prescribed by your doctor (make sure that your doctor knows what other medicines you are taking, including ones you may have bought without a prescription), heart problems, pregnancy, personality disorder, in babies or children. Let your doctor know if your child has a heart condition.
It should not be used in: allergies to midazolam, any other benzodiazepines or any of the other ingredients; severe difficulty in breathing or those who are very short of breath and are to undergo conscious sedation (a state of calm or drowsiness where you remain awake); unstable myasthenia gravis (a condition causing muscle weakness); sleep apnoea (a condition causing frequent interrupted breathing during sleep); severe liver problems. Clinical experience Midazolam IV should be administered very slowly Group Anesthetic. Sedative Hypnotic, Benzodiazepines Advice to patient 1. Before using this medication, tell your doctor or pharmacist your medical history 2. Avoid drinking alcohol as it may increase the sedative effect and may cause problems with your breathing. Reference www.drugs.webmd.boots.com, www.inceptapharma.com
7. Generic name: Minoxidil
Description of drug Minoxidil can reverse the hair loss process of androgenetic alopecia by the following means: increase the diameter of hair shaft; stimulate anagen growth; prolong the anagen phase; stimulate anagen recovery from telogen phase.
As a peripheral vasodilator Minoxidil enhances microcirculation of hair follicles. The Vascular Endothelial growth factor (VEGF) is stimulated by Minoxidil and VEGF is presumably responsible for the increased capillary fenestration, indicative of a metabolic activity observed during the anagen phase. Dose & overdose Adults Male: Apply 1 mL of 2% or 5% solution to affected areas of scalp BID (qAM & qHS); no more than 2 ml in 24 hours Female: Apply 1 mL of 2% solution to affected areas of scalp BID (qAM & qHS) Pediatric Not for children under 18 Indications/ Disease Minoxidil indicated for the treatment of alopecia androgenetica in men and women aged between 18 and 65. Side effects & Adverse effects 1. Hypertrichosis 2. Local erythema 3. Scalp flaking 4. Exacerbation of hairloss Contraindication inoxidil topical solution is contraindicated in patients with a history of hypersensitivity to Minoxidil or any of the other ingredients in the formulation such as propylene glycol or ethanol. Warning Before using Minoxidil, the user should determine that the scalp is normal and healthy. Patients with known cardiovascular disease or cardiac arrhythmia should contact a physician before using Minoxidil. Minoxidil contains alcohol, which will cause burning and irritation of the eye. In the event of accidental contact with sensitive surfaces (eye, abraded skin and mucous membranes) the area should be bathed with large amount of cool tap water. Clinical experience Do not use on sunburnt or irritated scalp. Avoid guanethidine (hospitalize until stable if used) Group Vasodilator, Advice to patient Not recommended for lactating mothers Reference www.empr.com, www.inceptapharma.com,
8. Generic name: Montelukast
Description of drug Montelukast is a selective and orally active leukotriene receptor antagonist that inhibits the cysteinyl leukotriene CysLT1 receptor. Cysteinyl leukotrienes and leukotriene receptor occupation have been correlated with the pathophysiology of asthma ( such as, airway edema, smooth muscle contraction and altered cellular activity associated with the inflammatory process, which contribute to the signs and symptoms of asthma). Dose & overdose Adults (15 years of age or over): 10 mg daily to be taken in the evening. Children (6-14 years of age): 5 mg daily to be taken in the evening. Children (6 months-5 years of age): 4 mg daily to be taken in the evening. Indications/ Disease Montelukast is indicated for the prophylaxis and chronic treatment of asthma in adults and pediatric patients from 6 months of age and older. Side effects & Adverse effects 1. Dizziness 2. Headache 3. Restlessness 4. Abdominal pain 5. Cough 6. Fever 7. Asthenia 8. Rash 9. Upper respiratory tract infection Contraindication Montelukast is contraindicated to patients with hypersensitivity to any component of this product. Warning Patients with known aspirin sensitivity should continue avoidance of aspirin or other NSAID, while taking Montelukast. In rare cases, patients on therapy with Montelukast may present with systemic eosinophilia, sometimes presenting with clinical features of vasculitis consistent with churg-strauss syndrome, a condition which is often treated with systemic corticosteroid therapy. Physician should be alert to eosinophilia, vasculitic rash, worsening pulmonary symptoms, cardiac complications, and/or neuropathy presenting in their patients. A causal association between Montelukast and these underlying conditions has not been established. Clinical experience The safety and efficacy of Montelukast was demonstrated in clinical trials where it was administered in the evening without regard to the time of food ingestion. Group Anti Asthmatics, Leukotriene Receptor Antagonist Advice to patient Keep away from reach of children Reference www.inceptapharma.com
9. Generic name: Morphine
Description of drug Morphine is the most important alkaloid of opium and is a phenanthrene derivative. It is available as the sulfate salt. Dose & overdose Adults: 2-10mg/70kg <18: No available information Overdose: 5mg/day Indications/ Disease 1.Management of pain 2. Shortness of breath 3. Intractable pain 4. Sedative 5. Cancer pain 6. Severe neuralgia 7. Acute pulmonary edema 8. FRactures Side effects & Adverse effects 1. Constipation 2. Headache 3. Itchy skin 4. Dizziness 5. Nausea Contraindication Morphine is contraindicated in: 1. Respiratory depression 2. Hypersensitivity 3. Paralytic ileus 4. Delayed gastric emptying 5. Obstructive airway disease 6. Acute hepatic disease 7. MAO Inhibitor 8. Pregnancy 9. Lactation and in children. Warning Some of the adverse effects of morphine can be dangerous in CNS disease, head injury, Emphysema, asthma, chronic lung disease, enlarged prostate and in micturition difficulties. The chance of adverse effects may be increased in Colitis, cardiac disease, renal disease and in Hepatic disease. Clinical experience Morphine will not be effective in people taking naltrexone. It can increase the sedative effect of alcohol, increase the risk of respiratory depression when used with MAO inhibitors and Cimetidine. It antagonises the effects of diuretics. Group Opioid Analgesic Advice to patient Use as indicated by prescriber Keep away from children Reference www.webhealthcarecentre.com
10. Generic name: Moxifloxacin
Description of drug Moxifloxacin hydrochloride is a synthetic broad spectrum antibacterial agent. Dose & overdose Adult Dose 18yrs: 400mg once daily. Sinusitis: treat for 10 days. Bronchitis: treat for 5 days. Pneumonia: treat for 714 days. Skin and skin structure: treat for 7 days, if complicated: 721 days. Intra-abdominal: treat for 514 days; use IV form first. IV form: infuse over 60mins. Childrens Dose: not established Indications/ Disease 1. Sinus infection 2. Urinary tract infection 3. Gonorrhea 4. Acute bronchitis 5. Bacterial infection of the kidney 6. Diverticulitis 7. Bladder inflammation 8. Staphylococcus bacteria infection 9. Bacterial pneumonia 10. Salmonella infections 11. Pseudomonas infection 12. Streptococcus bacteria infection 13. Bacteroides infections 14. Proteus Infections 15. Klebsiella infection 16. E coli infection 17. Hemophilus infection Side effects & Adverse effects 1. Nausea 2. Diarrhea 3. Dizziness 4. Headache 5. Hypersensitivity reactions 6. Burning of eye 7. Dry eyes 8. Mild blurred vision 9. Skin rash 10. Numbness 11. Seizures 12. Yellow skin 13. Taste perversion Contraindication Moxifloxacin is contraindicated with NSAIDs and for people with a history of hypersensitivity to moxifloxacin. It is alsi contraindicated in pregnancy and pediatric populations. Warning History of myasthenia gravis; avoid. Increased risk of tendinitis and tendon rupture esp. in patients >60yrs, or those with kidney, heart or lung transplants. CNS disorders (eg, seizures). Discontinue if tendon pain, inflammation, or rupture occurs; or if allergic reaction or CNS events occur. Severe hepatic impairment. History of QT prolongation or proarrhythmic conditions (eg, hypokalemia, bradycardia, acute myocardial ischemia). Clinical experience Concomitant NSAIDs may increase risk of seizure. Increased risk of tendonitis & tendon rupture with corticosteroids Group Quinolone antibiotic Advice to patient Do not exceed recommended dose or infusion rate; may increase QT prolongation. Discontinue immediately if symptoms of peripheral neuropathy occur. Maintain adequate hydration. Avoid excessive sun or UV light. Elderly. Pregnancy (Cat.C), nursing mothers: not recommended. Reference www.empr.com