Medicines
Find Medicines
Search 21,000+ medicines by brand, generic, indication, or drug class
Livcare
Obeticholic Acid
Livcare
Obeticholic Acid
Indications
Primary biliary cholangitis (PBC)
Indication detailsView
Obeticholic Acid is indicated for the treatment of primary biliary cholangitis (PBC) in combination with Ursodeoxycholic Acid (UDCA) in adults with an inadequate response to UDCA, or as monotherapy in adults unable to tolerate UDCA, cholestatic liver disease & non-alcoholic fatty liver disease (NAFLD) including non-alcoholic steatohepatitis (NASH).
Therapeutic classView
Farnesoid X Receptor Agonists
PharmacologyView
Obeticholic Acid is an agonist for FXR, a nuclear receptor expressed in the liver and intestine. FXR is a key regulator of bile acid, inflammatory, fibrotic, and metabolic pathways. FXR activation decreases the intracellular hepatocyte concentrations of bile acids by suppressing de novo synthesis from cholesterol as well as by increased transport of bile acids out of the hepatocytes. These mechanisms limit the overall size of the circulating bile acid pool while promoting choleresis, thus reducing hepatic exposure to bile acids.
DosageView
Starting Dosage: The recommended starting dosage of Obeticholic Acid is 5 mg orally once daily in adult patients who have not achieved an adequate biochemical response to an appropriate dosage of Ursodeoxycholic Acid (UDCA) for at least 1 year or are intolerant to UDCA.
Dosage Titration: If an adequate reduction in alkaline phosphatase (ALP) and/or total bilirubin has not been achieved after 3 months of Obeticholic Acid 5 mg once daily, and the patient is tolerating Obeticholic Acid, increase the dosage of Obeticholic Acid to 10 mg once daily.
Maximum Dosage: The maximum recommended dosage of Obeticholic Acid is 10 mg once daily.
Management of Patients with Intolerable Pruritus on Obeticholic Acid: For patients with intolerable pruritus on Obeticholic Acid, consider one or more of the following:
Add an antihistamine or bile acid binding resin. Reduce the dosage of Obeticholic Acid to:
Increase the dosage of Obeticholic Acid to 10 mg once daily, as tolerated, to achieve optimal response. Consider discontinuing Obeticholic Acid treatment in patients who continue to experience persistent, intolerable pruritus.
Dosage Titration: If an adequate reduction in alkaline phosphatase (ALP) and/or total bilirubin has not been achieved after 3 months of Obeticholic Acid 5 mg once daily, and the patient is tolerating Obeticholic Acid, increase the dosage of Obeticholic Acid to 10 mg once daily.
Maximum Dosage: The maximum recommended dosage of Obeticholic Acid is 10 mg once daily.
Management of Patients with Intolerable Pruritus on Obeticholic Acid: For patients with intolerable pruritus on Obeticholic Acid, consider one or more of the following:
Add an antihistamine or bile acid binding resin. Reduce the dosage of Obeticholic Acid to:
- 5 mg every other day, for patients intolerant to 5 mg once daily
- 5 mg once daily, for patients intolerant to 10 mg once daily
Increase the dosage of Obeticholic Acid to 10 mg once daily, as tolerated, to achieve optimal response. Consider discontinuing Obeticholic Acid treatment in patients who continue to experience persistent, intolerable pruritus.
Side effectsView
The most common side effects of Obeticholic Acid include: Pruritus, Fatigue & Stomach pain and discomfort. Other common side effects include rash, arthralgia (joint pain), oropharyngeal pain (pain in the middle part of the throat), dizziness, constipation, abnormal thyroid function, and eczema (inflammation of the skin).
ContraindicationsView
Contraindicated in patients known to have hypersensitivity to the drug or any of its components & in patients with complete biliary obstruction.
PrecautionsView
The following clinically significant reactions are described:
- Liver-Related Adverse Reactions
- Severe Pruritus
- Reduction in high density lipoprotein-cholesterol (HDL-C)
InteractionsView
Bile Acid Binding Resins: Bile acid binding resins such as cholestyramine, colestipol, or colesevelam adsorb and reduce bile acid absorption and may reduce the absorption, systemic exposure, and efficacy of Obeticholic Acid. If taking a bile acid binding resin, take Obeticholic Acid at least 4 hours before or 4 hours after taking the bile acid binding resin, or at as great an interval as possible.
Warfarin: The International Normalized Ratio (INR) decreased following co-administration of warfarin and Obeticholic Acid. Monitor INR and adjust the dosage of warfarin, as needed, to maintain the target INR range when co-administering Obeticholic Acid and warfarin.
CYP1A2 Substrates with Narrow Therapeutic Index: Obeticholic Acid may increase the exposure to concomitant drugs that are CYP1A2 substrates. Therapeutic monitoring of CYP1A2 substrates with a narrow therapeutic index.
Warfarin: The International Normalized Ratio (INR) decreased following co-administration of warfarin and Obeticholic Acid. Monitor INR and adjust the dosage of warfarin, as needed, to maintain the target INR range when co-administering Obeticholic Acid and warfarin.
CYP1A2 Substrates with Narrow Therapeutic Index: Obeticholic Acid may increase the exposure to concomitant drugs that are CYP1A2 substrates. Therapeutic monitoring of CYP1A2 substrates with a narrow therapeutic index.
Pregnancy & lactationView
The limited available human data on the use of Obeticholic Acid during pregnancy are not sufficient to inform a drug-associated risk.There is no information on the presence of Obeticholic Acid in human milk, the effects on the breast-fed infant or the effects on milk production.
Pediatric usageView
Geriatric Use: No dosage adjustment is recommended in elderly patientless than 65 years of age.
Pediatric Use: Safety and efficacy have not been established in patients younger than 18 years.
Use in Patients with Impaired Renal Function: Obeticholic Acid has not been studied in patients with moderate and severe renal impairment (estimated glomerular filtration rate [eGFR] less than 60 ml/min/1.73 m2). In the population pharmacokinetic analysis, an eGFR greater than 50 ml/min/1.73 m2 did not have a meaningful effect on the pharmacokinetics of Obeticholic Acid and its conjugated metabolites.
Use in Patients with Impaired Hepatic Function: Obeticholic Acid is metabolized in the liver. Plasma exposure to Obeticholic Acid and its active conjugates, increases significantly in patients with moderate to severe hepatic impairment (Child-Pugh Classes B and C).The recommended starting dosage of Obeticholic Acid for moderate (Child-Pugh Class B) and severe (Child-Pugh Class C) hepatic impairment is 5 mg once weekly. If an adequate reduction in ALP and/or total bilirubin has not been achieved after 3 months of Obeticholic Acid 5 mg once weekly, and the patient is tolerating the drug, increase the dosage of Obeticholic Acid to 5 mg twice weekly (at least three days apart) and subsequently to 10 mg twice weekly (at least three days apart) depending on response and tolerability.
Pediatric Use: Safety and efficacy have not been established in patients younger than 18 years.
Use in Patients with Impaired Renal Function: Obeticholic Acid has not been studied in patients with moderate and severe renal impairment (estimated glomerular filtration rate [eGFR] less than 60 ml/min/1.73 m2). In the population pharmacokinetic analysis, an eGFR greater than 50 ml/min/1.73 m2 did not have a meaningful effect on the pharmacokinetics of Obeticholic Acid and its conjugated metabolites.
Use in Patients with Impaired Hepatic Function: Obeticholic Acid is metabolized in the liver. Plasma exposure to Obeticholic Acid and its active conjugates, increases significantly in patients with moderate to severe hepatic impairment (Child-Pugh Classes B and C).The recommended starting dosage of Obeticholic Acid for moderate (Child-Pugh Class B) and severe (Child-Pugh Class C) hepatic impairment is 5 mg once weekly. If an adequate reduction in ALP and/or total bilirubin has not been achieved after 3 months of Obeticholic Acid 5 mg once weekly, and the patient is tolerating the drug, increase the dosage of Obeticholic Acid to 5 mg twice weekly (at least three days apart) and subsequently to 10 mg twice weekly (at least three days apart) depending on response and tolerability.
Overdose effectsView
In PBC patients who received Obeticholic Acid 25 mg once daily (2.5 times the highestrecommended dosage) or 50 mg once daily (5 times the highest recommended dosage), a dose-dependent increase in the incidence of liver-related adverse reactions, including elevations in liver biochemical tests, ascites, jaundice, portal hypertension, and primary biliary cholangitis flare, was reported. In the case of over dosage, patients should be carefully observed and supportive care administered, as appropriate.
StorageView
Store at 15°C to 30°C in a dry place protected from light. Keep out of reach of children
Livec
Silymarin [Milk thistle]
Livec
Silymarin [Milk thistle]
Indications
Jaundice
Indication detailsView
Silymarin (Milk thistle) is indicated for the treatment and prevention of-
- Liver disease, (non-alcoholic & alcoholic)
- Liver cirrhosis, (non-alcoholic & alcoholic)
- Infectious hepatitis
- Drug-induced hepatitis
- Liver disease secondary to diabetes mellitus
- Toxicity of narcotics
- Fatty liver
- Jaundice
Therapeutic classView
Cholagogues, Cholelitholytics & Hepatic Protectors, Herbal and Nutraceuticals
PharmacologyView
Silymarin, a flavonoid complex of Silybum marianum or Milk thistle, is the biologically active component. It provides hepatocellular protection through toxin blockade at the membrane level, enhances protein synthesis, antioxidant activity, anti-fibrotic activity and possible anti-inflammatory or immunomodulating effects.
DosageView
1 capsule 2 to 3 times daily or as directed by a physician.
Side effectsView
Well tolerated in the recommended dose. Occasionally a mild laxative effect may observe.
ContraindicationsView
Contraindicated in patient with a known hypersensitivity to silymarin.
InteractionsView
Concomitant use of silymarin and butyrophenones or phenothiazines has resulted in the reduction of lipid peroxidation.
Pregnancy & lactationView
No experience is available about the use of Silymarin 70 mg or 140 mg during pregnancy and lactation. Therefore, if needed Silymarin 70 mg or 140 mg should be taken with caution according to the physician’s advice.
StorageView
Store in a cool & dry place, away from light & moisture. Keep out of reach of children.
Liveric
Ursodeoxycholic Acid
Liveric
Ursodeoxycholic Acid
Indications
Primary biliary cirrhosis
Indication detailsView
Ursodeoxycholic Acid is indicated for the treatment of
- Cholestasis (Jaundice)
- Viral Hepatitis
- Alcoholic Fatty Liver
- Primary Billiary Cirrhosis (PBC)
- Primary Sclerosing Cholangitis (PSC)
- Dissolution of Gallstones and Non-Alcoholic Steato Hepatitis (NASH).
Therapeutic classView
Anti-gallstones drugs: Bile Acids
PharmacologyView
Ursodeoxycholic Acid is a naturally occurring bile acid used to treat different hepatobilliary disorders. The activity of Ursodeoxycholic Acid is achieved through a decrease in secretion of cholesterol in bile. Ursodeoxycholic Acid achieves this through a few mechanisms: it reduces cholesterol absorption, suppresses liver cholesterol synthesis and it does not inhibit bile acid synthesis.
Therefore, alters bile composition from supersaturated to unsaturated. Ursodeoxycholic Acid also promotes the formation of liquid cholesterol crystal complexes which enhance removal of the cholesterol from the gallbladder into the intestine to be expelled. Ursodeoxycholic Acid improves cholestatic liver diseases by-
Therefore, alters bile composition from supersaturated to unsaturated. Ursodeoxycholic Acid also promotes the formation of liquid cholesterol crystal complexes which enhance removal of the cholesterol from the gallbladder into the intestine to be expelled. Ursodeoxycholic Acid improves cholestatic liver diseases by-
- Protecting cholangiocytes against cytotoxicity of hydrophobic bile acids
- Stimulating hepatobilliary secretion
- Protecting hepatocytes against bile acid-induced apoptosis
DosageView
Dissolution of Gall stones: 8-12 mg/kg/day either as single night time dose or in divided doses.
Primary Billiary Cirrhosis: 10-15 mg/kg/day in 2-4 divided doses.
Acute Viral Hepatitis: 600 mg/day.
Alcoholic Fatty Liver: 300 mg/day.
Primary Sclerosing Cholangitis: 25-30 mg/kg/day.
Dissolution of Gallstones and Non-Alcoholic Steato Hepatitis: 13-15 mg/kg/day.
Primary Billiary Cirrhosis: 10-15 mg/kg/day in 2-4 divided doses.
Acute Viral Hepatitis: 600 mg/day.
Alcoholic Fatty Liver: 300 mg/day.
Primary Sclerosing Cholangitis: 25-30 mg/kg/day.
Dissolution of Gallstones and Non-Alcoholic Steato Hepatitis: 13-15 mg/kg/day.
Side effectsView
Commonly reported side effects are nausea, vomiting, diarrhoea, gallstone opacilication, pruritus.
ContraindicationsView
Non-functioning gall-bladder calcified and pigmented gallstones, inflammatory bowel disease.
PrecautionsView
It should be used cautiously in those with liver disease.
InteractionsView
Ursodeoxycholic Acid should not be used with drugs, such as oestrogenic hormones, that increase bile cholesterol. Concomitant administration with bile-acid binding drugs including antacids, charcoal and cholestyramine should be avoided, since this may reduce the effectiveness of therapy with Ursodeoxycholic acid.
Pregnancy & lactationView
Pregnancy category B. No evidence of harm has been reported in pregnancy. It has been effectively used for the treatment of cholestasis of pregnancy during the last trimester without any side effects. Problems have not been documented in humans regarding breast feeding.
StorageView
Store below 25° C. Protected from light and moisture. Keep the medicine out of the reach of children.
Liveric
Ursodeoxycholic Acid
Liveric
Ursodeoxycholic Acid
Indications
Primary biliary cirrhosis
Indication detailsView
Ursodeoxycholic Acid is indicated for the treatment of
- Cholestasis (Jaundice)
- Viral Hepatitis
- Alcoholic Fatty Liver
- Primary Billiary Cirrhosis (PBC)
- Primary Sclerosing Cholangitis (PSC)
- Dissolution of Gallstones and Non-Alcoholic Steato Hepatitis (NASH).
Therapeutic classView
Anti-gallstones drugs: Bile Acids
PharmacologyView
Ursodeoxycholic Acid is a naturally occurring bile acid used to treat different hepatobilliary disorders. The activity of Ursodeoxycholic Acid is achieved through a decrease in secretion of cholesterol in bile. Ursodeoxycholic Acid achieves this through a few mechanisms: it reduces cholesterol absorption, suppresses liver cholesterol synthesis and it does not inhibit bile acid synthesis.
Therefore, alters bile composition from supersaturated to unsaturated. Ursodeoxycholic Acid also promotes the formation of liquid cholesterol crystal complexes which enhance removal of the cholesterol from the gallbladder into the intestine to be expelled. Ursodeoxycholic Acid improves cholestatic liver diseases by-
Therefore, alters bile composition from supersaturated to unsaturated. Ursodeoxycholic Acid also promotes the formation of liquid cholesterol crystal complexes which enhance removal of the cholesterol from the gallbladder into the intestine to be expelled. Ursodeoxycholic Acid improves cholestatic liver diseases by-
- Protecting cholangiocytes against cytotoxicity of hydrophobic bile acids
- Stimulating hepatobilliary secretion
- Protecting hepatocytes against bile acid-induced apoptosis
DosageView
Dissolution of Gall stones: 8-12 mg/kg/day either as single night time dose or in divided doses.
Primary Billiary Cirrhosis: 10-15 mg/kg/day in 2-4 divided doses.
Acute Viral Hepatitis: 600 mg/day.
Alcoholic Fatty Liver: 300 mg/day.
Primary Sclerosing Cholangitis: 25-30 mg/kg/day.
Dissolution of Gallstones and Non-Alcoholic Steato Hepatitis: 13-15 mg/kg/day.
Primary Billiary Cirrhosis: 10-15 mg/kg/day in 2-4 divided doses.
Acute Viral Hepatitis: 600 mg/day.
Alcoholic Fatty Liver: 300 mg/day.
Primary Sclerosing Cholangitis: 25-30 mg/kg/day.
Dissolution of Gallstones and Non-Alcoholic Steato Hepatitis: 13-15 mg/kg/day.
Side effectsView
Commonly reported side effects are nausea, vomiting, diarrhoea, gallstone opacilication, pruritus.
ContraindicationsView
Non-functioning gall-bladder calcified and pigmented gallstones, inflammatory bowel disease.
PrecautionsView
It should be used cautiously in those with liver disease.
InteractionsView
Ursodeoxycholic Acid should not be used with drugs, such as oestrogenic hormones, that increase bile cholesterol. Concomitant administration with bile-acid binding drugs including antacids, charcoal and cholestyramine should be avoided, since this may reduce the effectiveness of therapy with Ursodeoxycholic acid.
Pregnancy & lactationView
Pregnancy category B. No evidence of harm has been reported in pregnancy. It has been effectively used for the treatment of cholestasis of pregnancy during the last trimester without any side effects. Problems have not been documented in humans regarding breast feeding.
StorageView
Store below 25° C. Protected from light and moisture. Keep the medicine out of the reach of children.
Livita
Iron Polymaltose Complex + Vitamin B Complex + Zinc
Livita
Iron Polymaltose Complex + Vitamin B Complex + Zinc
Indications
Vitamin deficiency
Indication detailsView
This syrup is indicated for the treatment and prevention of Iron, Vitamin B complex and Zinc deficiencies, specially during pregnancy and lactation.
Therapeutic classView
Iron & Vitamin Combined preparations
PharmacologyView
This syrup is the preparation of Iron, Vitamin B complex and Zinc. In this preparation, Iron is present as Iron (III) Hydroxide Polymaltose Complex. Iron (III) Hydroxide Polymaltose Complex facilitates a controlled absorption of the iron when it comes in contact with the mucosal cell surface. Due to non-ionic nature, this Iron (III) Hydroxide Polymaltose Complex is more stable than conventional Iron form.
DosageView
Adults: 5 ml-10 ml (1-2 teaspoonful) 3 times daily or as recommended by the physician.
Children: 5 ml (1 teaspoonful) 3 times daily or as recommended by the physician.
Infants: 0.33 ml/kg body weight daily or as recommended by the physician.
Children: 5 ml (1 teaspoonful) 3 times daily or as recommended by the physician.
Infants: 0.33 ml/kg body weight daily or as recommended by the physician.
Side effectsView
This syrup is generally well tolerated. However, a few side effects of oral Iron preparations, including nausea, vomiting, constipation or diarrhoea may occur.
ContraindicationsView
It is contraindicated in patients with a known hypersensitivity to any of the ingredients of this product.
PrecautionsView
Caution should be taken in the conditions where there is a risk of Iron overload, such as hemochromatosis, thalassemia, hemosiderosis or hemolytic anemia.
InteractionsView
Since Iron is complex bound, ionic interaction with foodstuff components (phytates, oxalates, tannin etc.) and concomitant administrations of medicaments (tetracyclines, antacids) are unlikely to occur.
Pregnancy & lactationView
Recommended in pregnancy & lactation
Pediatric usageView
Recommended in children
Overdose effectsView
In case of overdose, epigastric pain, diarrhoea, vomiting, metabolic acidosis and convulsion may occur. Should seek emergency medical attention in case of overdose. Initially an emetic should be given and then gastric lavage & general supportive measures should be employed.
StorageView
Keep in a dry place away from light and heat. Keep out of the reach of children.
Livocard
Clopidogrel Bisulphate
Livocard
Clopidogrel Bisulphate
Indications
Unstable angina
Indication detailsView
Acute Coronary Syndrome (ACS): It is indicated to reduce the rate of myocardial infarction (MI) and stroke in patients with non-ST-segment elevation ACS [unstable angina (UA)/non-ST-elevation myocardial infarction (NSTEMI)]. It is indicated to reduce the rate of myocardial infarction and stroke in patients with acute ST-elevation myocardial infarction (STEMI).
Recent MI, recent Stroke, or established Peripheral Arterial Disease: In patients with established peripheral arterial disease or with a history of recent myocardial infarction (MI) or recent stroke it is indicated to reduce the rate of MI and stroke.
Recent MI, recent Stroke, or established Peripheral Arterial Disease: In patients with established peripheral arterial disease or with a history of recent myocardial infarction (MI) or recent stroke it is indicated to reduce the rate of MI and stroke.
Therapeutic classView
Anti-platelet drugs
PharmacologyView
Clopidogrel is a prodrug. It inhibits platelet activation and aggregation through the irreversible binding of its active metabolite to the P2Y12 class of ADP receptors on platelets. Dose-dependent inhibition of platelet aggregation can be seen 2 hours after single oral doses. Repeated doses of 75 mg per day inhibit ADP-induced platelet aggregation on the first day, and inhibition reaches steady state between Day 3 and Day 7.
DosageView
Acute Coronary Syndrome: In patients who need an antiplatelet effect within hours, initiate clopidogrel with a single 300 mg (4 tablets) oral loading dose and then continue at 75 mg once daily. Initiating it without a loading dose will delay establishment of an antiplatelet effect by several days.
Recent MI, Recent Stroke, or Established Peripheral Arterial Disease: 75 mg once daily orally without a loading dose.
It is given orally with or without food.
Recent MI, Recent Stroke, or Established Peripheral Arterial Disease: 75 mg once daily orally without a loading dose.
It is given orally with or without food.
Side effectsView
Clopidogrel is generally well tolerated drug.
- Common side effects: Bleeding, Diarrhoea, gastrointestinal discomfort, haemorrhage, Skin reactions.
- Rare side effects: Acquired haemophilia, anaemia, angioedema, arthralgia, arthritis, bone marrow disorders.
ContraindicationsView
Clopidogrel is contraindicated in the following conditions: Hypersensitivity to the drug substance or any component of the product. Active pathological bleeding such as peptic ulcer or intracranial hemorrhage.
PrecautionsView
- As it is a prodrug, so metabolism to its active metabolite is impaired by genetic variations in CYP2C19 (poor metabolizer) and by the drugs that inhibit CYP2C19 such as Omeprazole and Esomeprazole. Concomitant use with these drugs and in CYP2C19 poor metaboliser may reduce the antiplatelet activity of Clopidogrel.
- As it inhibits platelet aggregation for the lifetime of the platelet (7-10 days), risk of bleeding may increase. To restore hemostasis, platelet transfusions within 4 hours of the loading dose or 2 hours of the maintenance dose may be less effective.
- Discontinuation of Clopidogrel increases the risk of cardiovascular events. Discontinue 5 days prior to elective surgery that has a major risk of bleeding. Resume Clopidogrel as soon as hemostasis is achieved.
- Thrombotic Thrombocytopenic Purpura (TTP) has been reported that requires urgent treatment including plasmapheresis (plasma exchange).
- Hypersensitivity including rash, angioedema or hematologic reaction has been reported in patients receiving clopidogrel or history of hypersensitivity to other thienopyridines.
InteractionsView
- NSAIDs, warfarin, selective serotonin and serotonin norepinephrine reuptake inhibitors (SSRIs, SNRIs): Increases risk of bleeding
- CYP2C19 inhibitors (omeprazole or esomeprazole): Avoid concomitant use of omeprazole or esomeprazole
- Repaglinide (CYP2C8 substrates): Avoid concomitant use of Clopidogrel with Repaglinide as it increases plasma concentrations of Repaglinide
Pregnancy & lactationView
There are no adequate and well-controlled studies in pregnant women. It should be used during pregnancy only if clearly needed. It is unknown whether clopidogrel is excreted in human breast milk. A decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
Pediatric usageView
Safety and effectiveness in pediatric populations have not been established. No dosage adjustment is necessary in elderly patients.
Overdose effectsView
Overdose following clopidogrel administration may lead to bleeding complications. Based on biological plausibility, platelet transfusion may restore clotting ability.
StorageView
Keep below 30°C temperature in a dry place. Protected from light. Do not freeze. Keep out of the reach of children.
Livocard Plus
Clopidogrel + Aspirin
Livocard Plus
Clopidogrel + Aspirin
Indications
Transient ischemic attack
Indication detailsView
Acute Coronary Syndrome (ACS): It is indicated to reduce the rate of Myocardial Infarction (MI) and Stroke in patients with non-ST-segment elevation ACS [unstable angina (UA)/non-ST-elevation Myocardial Infarction (NSTEMI)] and acute ST-segment elevation ACS [ST-elevation Myocardial Infarction (STEMI)].
Recent MI, recent Stroke, or established Peripheral Arterial Disease: In patients with established peripheral arterial disease or with a history of recent Myocardial Infarction (MI) or recent Stroke it is indicated to reduce the rate of MI and Stroke.
Recent MI, recent Stroke, or established Peripheral Arterial Disease: In patients with established peripheral arterial disease or with a history of recent Myocardial Infarction (MI) or recent Stroke it is indicated to reduce the rate of MI and Stroke.
Therapeutic classView
Anti-platelet drugs
PharmacologyView
Clopidogrel is a prodrug. It inhibits platelet activation and aggregation through the irreversible binding of its active metabolite to the P2Y12 class of ADP receptors on platelets. Dose-dependent inhibition of platelet aggregation can be seen at 2 hours after single oral doses. Repeated doses of 75 mg per day inhibit ADP-induced platelet aggregation on the first day, and inhibition reaches steady state between Day 3 and Day 7.
Aspirin inhibits platelet aggregation by irreversible inhibition of platelet cyclooxygenase and thus inhibiting the generation of thromboxane A2 a powerful inducer of platelet aggregation and vasoconstriction.
Aspirin inhibits platelet aggregation by irreversible inhibition of platelet cyclooxygenase and thus inhibiting the generation of thromboxane A2 a powerful inducer of platelet aggregation and vasoconstriction.
DosageView
The recommended oral dose is one tablet daily.
Side effectsView
This combination is generally well tolerated.
ContraindicationsView
This combination is contraindicated in the following conditions: Hypersensitivity to the drug substance or any component of the product. Active pathological bleeding such as peptic ulcer or intracranial hemorrhage.
PrecautionsView
- This combination may prolongs the bleeding time.
- Thrombotic thrombocytopenic purpura (TTP): TTP has been reported rarely following use of this combination.
- Reye's syndrome: Reye's syndrome may develop in individuals who have chicken pox, influenza or flu symptoms. Hypersensitivity including rash, angioedema or hematologic reaction has been reported in patients receiving this combination or history of hypersensitivity to other thienopyridines
InteractionsView
Oral anticoagulants, NSAIDs, Metamizole, SSRIs, CYP2C19 inhibitors increase the risk of bleeding. It shows interaction with Tonofovir, Valproic acid, Varicella vaccine, Acetazolamide and Nicorandil.
Pregnancy & lactationView
There are no adequate and well-controlled studies in pregnant women. It should be used during first and second trimesters of pregnancy only if clearly needed. It is contraindicated during the third trimester of pregnancy. It is unknown whether Clopidogrel is excreted in human breast milk but Aspirin is known to be excreted in human milk. This Drug should be discontinued during the breast feeding.
Pediatric usageView
It should not be given to children, particularly those under 12 years, unless the expected benefits outweight the possible risks. Aspirin may be a contributory factor in the causation of Reye’s syndrome in some children.
Overdose effectsView
Clopidogrel overdose may lead to bleeding complications. Based on biological plausibility, platelet transfusion may restore clotting ability. In moderate aspirin intoxication dizziness, headache, tinnitus, confusion, and gastrointestinal symptoms may occur which can be treated by inducing vomiting followed by gastric lavage if needed. In severe Aspirin intoxication respiratory alkalosis respiratory acidosis, metabolic acidosis, hyperthermia, perspiration, dehydration can occur. It can be treated with haemodialysis and other symptomatic treatment.
StorageView
Keep in a cool & dry place (below 30o C), protected from light & moisture. Keep out of the reach of children.
Livodel
Levosalbutamol (Oral)
Livodel
Levosalbutamol (Oral)
Indications
COPD
Indication detailsView
Levosalbutamol is indicated for the treatment or prevention of bronchospasm in adults, adolescents and children 6 years of age and older with reversible obstructive airway disease.
Therapeutic classView
Short-acting selective & β2-adrenoceptor stimulants
PharmacologyView
Levosalbutamol is a single isomer beta 2-agonist that differs from racemic salbutamol by elimination of (S)-salbutamol. Levosalbutamol is an effective bronchodilator whose primary mechanism of action is unimpeded by (S)-salbutamol. Thus, when compared with racemic salbutamol, clinically comparable bronchodilation can be achieved with doses that substantially lessen beta-mediated side effects.
DosageView
Tablet-
- Adults and adolescents above 12 years: 1-2 mg three times daily.
- Children (6 -11 years): 1 mg three times daily.
- Adults : 5-10 ml three times daily.
- Childrn (6-11 years): 5 ml three times daily.
Side effectsView
Hypocalcaemia, palpitation, fine tremors of the skeletal muscle and muscle cramps may occur. The other likely side effects are nausea, vomiting, burning substernal or epigastric pain and diarrhoea.
ContraindicationsView
Levosalbutamol is contraindicated in patients with a history of hypersensitivity to levosalbutamol or any of its components.
PrecautionsView
Particular caution is advised in acute severe asthma as this effect may be potentiated by hypoxia and by concomitant treatment with xanthine derivatives, steroids and diuretics. Serum potassium levels should be monitored in such situations.
InteractionsView
Other short acting sympathomimetic bronchodilators or epinephrine should be used with caution with Levosalbutamol. If additional adrenergic drugs are to be administered by any route, they will be used with caution to avoid deleterious cardiovascular effects.
Pregnancy & lactationView
The drug should be used during pregnancy only if the potential benefit justifies the potential risk of the fetus. It is not known whether Levosalbutamol is excreted in human milk. Caution should be exercised when oral Levosalbutamol is administered to a nursing woman.
Overdose effectsView
The expected symptoms with over dosage are those of excessive beta-adrenergic stimulation and the symptoms listed under side effects. In the event of serious poisoning, the stomach should be emptied and, if necessary, a beta-blocker administered with caution in patients with a history of bronchospasm.
StorageView
Keep all medicines out of reach of children. Store in a cool and dry place, protected from light.
Livolite
Andrographis paniculata
Livolite
Andrographis paniculata
Indications
Sinusitis
Indication detailsView
Andrographis paniculata is indicated in-
- Viral fever
- Flu
- Common cold
- Sinusitis
- Upper respiratory tract infection
- Viral hepatitis.
Therapeutic classView
Herbal and Nutraceuticals
PharmacologyView
Andrographis compounds have shown antiviral properties which appear to inhibit glycoproteins in the virus. This impedes the ability of viruses to invade cells and replicate. It also has a major effect activating the general defense functions of the immune system by stimulating the production of antibodies as well as non-specific immune responses such as increased macrophage phagocytosis, rather than by any direct antimicrobial activity. Andrographis has flavonoids, which always have an anti-inflammatory effect. In vitro studies have shown that the flavonoid activities suppressed the genetic expression of neutrophils. Similarly, studies have indicated that a variety of inflammatory proteins, including COX-2, are reduced by the presence of Andrographoloid.
The aerial parts and their constituent andrographolides have antihepato-toxic activity in vitro and in vivo. In vitro studies have shown that intraperitoneal administration of a methanol extract of the aerial parts to mice reduced hepatotoxicity induced by carbon tetrachloride CCl4, and reversed CCl4 induced histopathological changes in the liver. Intraperitoneal administration of andrographolide to mice inhibited the CCl4 induced increase in the activity of serum glutamate oxaloacetate transaminase, serum glutamate pyruvate transaminase, alkaline phosphatase, bilirubin and hepatic triglycerides. Andrographolide, the major antihepatotoxic component of the plant, exerted a pronounced protective effect in rats against hepato-toxicity induced by CCl4, Dgalactosamine, paracetamol and ethanol.
Moreover, andrographolide and related diterpenes are choleretic, antidiarrheal, immunostimulant, antimalarial, antipyretic and active in urinary tract infections.
The aerial parts and their constituent andrographolides have antihepato-toxic activity in vitro and in vivo. In vitro studies have shown that intraperitoneal administration of a methanol extract of the aerial parts to mice reduced hepatotoxicity induced by carbon tetrachloride CCl4, and reversed CCl4 induced histopathological changes in the liver. Intraperitoneal administration of andrographolide to mice inhibited the CCl4 induced increase in the activity of serum glutamate oxaloacetate transaminase, serum glutamate pyruvate transaminase, alkaline phosphatase, bilirubin and hepatic triglycerides. Andrographolide, the major antihepatotoxic component of the plant, exerted a pronounced protective effect in rats against hepato-toxicity induced by CCl4, Dgalactosamine, paracetamol and ethanol.
Moreover, andrographolide and related diterpenes are choleretic, antidiarrheal, immunostimulant, antimalarial, antipyretic and active in urinary tract infections.
DosageView
Age 18 and above: 1 capsule 3 times daily after meal for 5 to 10 days.
12 to 17 years: 1 capsule 2 times daily after meal for 5 to 10 days.
4 to 11 years: 1 capsule daily after meal for 5 to 10 days or as directed by the physician.
12 to 17 years: 1 capsule 2 times daily after meal for 5 to 10 days.
4 to 11 years: 1 capsule daily after meal for 5 to 10 days or as directed by the physician.
Side effectsView
Large oral doses may cause gastric discomfort, vomiting and loss of appetite. These side-effects appear to be due to the bitter taste of andrographolide.
ContraindicationsView
Andrographis is contraindicated in cases of known allergy to plants of the acanthaceae family
InteractionsView
May have a synergistic effect with isoniazid.
Pregnancy & lactationView
Andrographis should not be used during pregnancy or lactation.
StorageView
Keep below 30°C temperature, away from light & moisture. Keep out of the reach of children.
Livoton
Lactulose
Livoton
Lactulose
Indications
Osmotic laxative
Indication detailsView
Constipation (Chronic Constipation): In every case of chronic constipation, initial treatment should consist of a diet rich in fiber (vegetables, salads, fruits etc.) a generous amount of liquids and much physical exercise. Lactulose is only to be taken when these measures prove insufficient.
Intestinal flora disturbances:
Intestinal flora disturbances:
- In damaged to intestinal flora (e.g. following long-term antibiotic treatment)
- gall bladder diseases
- intestinal diseases ( Colitis, Diverticulosis, Megacolon)
Therapeutic classView
Osmotic purgatives
PharmacologyView
Lactulose is a synthetic disaccharide. Lactulose is metabolized in the colon by the saccharolytic bacteria, producing low molecular weight organic acids (mainly lactic acid), which lowers the pH of the colon contents, promote the retention of water by an osmotic effect; thus increasing peristaltic activity. Lactulose is minimally absorbed; therefore, the pharmacokinetics of the absorbed material are not relevant to the principal therapeutic action.
DosageView
In constipation ( chronic constipation):
- Adults: Initially 3-6 tea-spoons daily, In long-term therapy 1½-6 tea-spoons daily
- Children up to 14 years: Initially 3 tea-spoons daily, In long-term therapy 1-2 tea-spoons daily
- Infants and toddlers: Initially 1-2 tea-spoons daily, In long-term therapy 1 tea-spoon daily
- Adults: 1-2 tea-spoons daily
- Children: 1 tea-spoon daily
- Hyper-ammoniemia in hepatopathy: a maximum of 18-30 tea-spoons daily.
- In portal systemic encephalopathy: hourly doses of 6-9 tea-spoons of Lactulose solution may be used to induce the rapid laxation. When the laxative effect has been achieved, the dose may then be reduced.
Side effectsView
Occasionally flatulence, cramp and abdominal discomfort can occur at the beginning of treatment; this is rapidly eliminated by reducing the dose. Overdose can result in diarrhoea. In abuse, loss of electrolytes (primarily potassium).
ContraindicationsView
Hypersensitivity to either galactose and or lactose; galactose-free diet, gastro-cardial symptom complex, suspected intestinal obstruction.
PrecautionsView
Lactulose should be administered with care to patients who are intolerant to lactulose. The dose used in the treatment of (pre) coma hepaticum is usually much higher and may need to be taken into consideration for diabetics.
InteractionsView
There is no significant drug interactions with lactulose. The glycosidic effect of cardiac glycosides can be intensified by potassium deficiency in abuse.
Pregnancy & lactationView
US FDA Pregnancy Category of Lactulose is B. Studies show that Lactulose has no adverse effects. Decisions regarding use during pregnancy and lactation must be made by registered physician.
Overdose effectsView
There have been no reports of accidental overdosage. In the event of acute overdosage it is expected that diarrhoea and abdominal cramps would be the major symptoms.
StorageView
Keep in a dry place away from light and heat. Keep out of the reach of children.
Livwel
Multivitamin & Multimineral [A-Z syrup preparation]
Livwel
Multivitamin & Multimineral [A-Z syrup preparation]
Indications
Vitamin deficiency
Indication detailsView
This Syrup is indicated in multivitamin & multimineral deficiencies in:
- Adults (especially who cannot intake supplements in solid dosage forms e.g. tablet and who suffer gastrointestinal side effects after taking solid dosage forms).
- Children of all ages & infants.
Therapeutic classView
Multi-vitamin & Multi-mineral combined preparations
PharmacologyView
This Syrup is a well balanced supplement containing 24 nutritional elements which include vitamins, minerals & trace elements for the adults & for the all ages of children. This Syrup keeps oneself sharp and physically and mentally active. Stresses and strains of today's life are causing hypertension, diabetes, heart disorders, depression, memory loss and arthritis to the elderly. Some of the declines seniors experience may not be totally age related, but may be caused by poor nutrition, unhealthy eating habits. Research has shown that many times adults fail to get the balanced nutrition that is necessary for proper and healthy bodily functions. As a result, the vital organs of the body begin to break down and illnesses are the result. This Syrup provides optimum nutrition to the senior citizens who cannot intake or tolerate supplements in solid dosage forms like tablet or capsule. Moreover, This Syrup provides the optimal dosage of the essential vitamins and minerals with trace elements for infants and children of all ages. Its essential nutrients support healthy developments, strong immune function and emotional and mental vitality of children. This Syrup contains the primary antioxidant vitamins-C, E & A and minerals - Zn, Se & Mn. All of these elements support immune function, and protect the body from harmful free radicals by neutralizing toxins, helping the body detoxify and eliminating these chemicals; thereby allowing the immune system be more effective and vital on other fonts. The B vitamins are all actively involved helping nervous system functions (learning, memory, managing stress) correctly. Folic acid helps the body digest, assimilate protein and produce RBCs and DNA. Biotin is also involved in DNA/RNA production and fats and oils metabolism which is why it can affect the hair and skin so well. PABA is used to improve the protein used in the body, it relates to red blood cell formation as well as it assists the manufacture of folic acid in the intestines. PABA is an antioxidant nutrient that inhibits the formation of the damaging free radicals. Choline is an essential component of acetylcholine, a neurotransmitter that is involved in regulating sleep, muscle movement, learning and memory.
DosageView
For adults: 3-4 teaspoonfuls daily
For children of 4-12 years: 2 - 3 teaspoonfuls daily
For children of 1-4 years: 1-2 teaspoonfuls daily
For infants up to 1 year: 1 teaspoonful daily, or as directed by the physician.
For children of 4-12 years: 2 - 3 teaspoonfuls daily
For children of 1-4 years: 1-2 teaspoonfuls daily
For infants up to 1 year: 1 teaspoonful daily, or as directed by the physician.
Side effectsView
Generally the product is well tolerated.
ContraindicationsView
The product is contraindicated in patients with a known hypersensitivity to any of the ingredients of this product.
PrecautionsView
Supplement should not be used in over dosage or should not be used long time without the recommendation by a physician.
InteractionsView
Generally no interactions have been observed.
Pregnancy & lactationView
The specific information is not available in this respect.
StorageView
Keep below 30°C temperature, away from light & moisture. Keep out of the reach of children.
Lixidol
Ketorolac Tromethamine
Lixidol
Ketorolac Tromethamine
Indications
Soft tissue inflammation
Indication detailsView
Ketorolac Tromethamine is indicated for the short-term management of moderate to severe acute post-operative pain.
Therapeutic classView
Drugs used for Rheumatoid Arthritis, Non-Opioid Analgesics
PharmacologyView
Ketorolac Tromethamine is a potent analgesic of the non-steroidal anti-inflammatory drugs (NSAIDs). It acts by inhibiting the cyclooxygenase enzyme system and hence inhibits the prostaglandin synthesis. It demonstrates a minimal anti-inflammatory effect at its analgesic dose.
DosageView
Tablet-
Recommended dose is 10 mg every 4-6 hours. It should be used short-term only (up to 7 days) and are not recommended for chronic use. Doses exceeding 40 mg/day is not recommended.Injection-
Ketorolac injection may be used as a single or multiple doses, on a regular or when necessary schedule for the management of moderately severe, acute pain that requires analgesia at the opioid level, usually in a postoperative setting. When administering Ketorolac injection, the IV bolus must be given over no less than 15 seconds. The IM administration should be given slowly and deeply into the muscle. The analgesic effect begins within 30 minutes with maximum effect in 1 to 2 hours after dosing IV or IM. Duration of analgesic effect is usually 4 to 6 hours.Single-Dose Treatment-
IM Dosing (Adult):
- Patients <65 years of age: One dose of 60 mg.
- Patients >65 years of age, renally impaired and/or less than 50 kg of body weight: One dose of 30 mg.
- Patients <65 years of age: One dose of 30 mg.
- Patients >65 years of age, renally impaired and/or less than 50 kg of body weight: One dose of 15 mg.
- IM Dosing: One dose of 1 mg/kg up to a maximum of 30 mg.
- IV Dosing: One dose of 0.5 mg/kg up to a maximum of 15 mg.
- Patients <65 years of age: The recommended dose is 30 mg Ketorolac injection every 6 hours. The maximum daily dose should not exceed 120 mg. Patients >65 years of age, renally impaired patients and patients less than 50 kg: The recommended dose is 15 mg Ketorolac injection every 6 hours. The maximum daily dose for these populations should not exceed 60 mg. For breakthrough pain, do not increase the dose or the frequency of Ketorolac Tromethamine.
- Conversion from Parenteral to Oral Therapy: Ketorolac tablets may be used either as monotherapy or as follow-on therapy to parenteral Ketorolac. When Ketorolac tablets are used as a follow-on therapy to parenteral Ketorolac, the total combined daily dose of ketorolac (oral + parenteral) should not exceed 120 mg in younger adult patients or 60 mg in elderly patients on the day the change of formulation is made. On subsequent days, oral dosing should not exceed the recommended daily maximum of 40 mg. Ketorolac IM should be replaced by Ketorolac tablet as soon as feasible. The total duration of combined parenteral and oral treatment should not exceed 5 days.
Side effectsView
Commonly occurring side effects are nausea, vomiting, gastro-intestinal bleeding, melana, peptic ulcer, pancreatitis, anxiety, drowsiness, headache, excessive thirst, fatigue, bradycardia, hypertension, palpitation, chest pain, infertility in female and pulmonary edema.
ContraindicationsView
Ketorolac is contraindicated in patients having hypersensitivity to this drug or other NSAIDs. It should not be used in children under 16 years of age. lt is also contraindicated as prophylactic analgesic before surgery.
PrecautionsView
Caution should be exercised in patients over the age of 65 years. Caution should also be taken in patients with active or suspected peptic ulcer or gastrointestinal bleeding or asthma and liver dysfunction.
InteractionsView
Other NSAIDs or aspirin: Increase the side effects of ketorolac Tromethamine.
Anti-coagulants: Enhance anti-coagulant effect.
Beta Blocker: Reduce the anti-hypertensive effect .
ACE Inhibitors: Increase the risk of renal impairment.
Methotrexate: Enhance the toxicity of methotrexate.
Anti-coagulants: Enhance anti-coagulant effect.
Beta Blocker: Reduce the anti-hypertensive effect .
ACE Inhibitors: Increase the risk of renal impairment.
Methotrexate: Enhance the toxicity of methotrexate.
Pregnancy & lactationView
US FDA Pregnancy category of Ketorolac Tromethamine is C. So, Ketorolac Tromethamine should be avoided in pregnancy and lactation unless the potential benefits to the other outweigh the possible risks to the fetus.
StorageView
Keep in a dry place away from light and heat. Keep out of the reach of children.
Lizen
Linezolid
Lizen
Linezolid
Indications
Uncomplicated pneumococcal pneumonia
Indication detailsView
Vancomycin-Resistant Enterococcus faecium infections including cases with concurrent bacteremia.
Nosocomial pneumonia caused by Staphylococcus aureus (methicillin-susceptible and -resistant strains) or Streptococcus pneumoniae (including multi-drug resistant strains). Combination therapy may be clinically indicated if the documented or presumptive pathogens include Gram-negative organism.
Complicated skin and skin structure infections, including diabetic foot infections (without concomitant osteomyelitis) caused by Staphylococcus aureus (methicillin-susceptible and methicillin-resistant strains), Streptococcus pyogenes or Streptococcus agalactiae.
Uncomplicated skin and skin structure infections caused by Staphylococcus aureus (methicillin-susceptible only) or Streptococcus pyogenes.
Community-acquired pneumonia caused by Streptococcus pneumoniae (including multi-drug resistant strains) including cases with concurrent bacteremia or Staphylococcus aureus (methicillin-susceptible strains only).
Nosocomial pneumonia caused by Staphylococcus aureus (methicillin-susceptible and -resistant strains) or Streptococcus pneumoniae (including multi-drug resistant strains). Combination therapy may be clinically indicated if the documented or presumptive pathogens include Gram-negative organism.
Complicated skin and skin structure infections, including diabetic foot infections (without concomitant osteomyelitis) caused by Staphylococcus aureus (methicillin-susceptible and methicillin-resistant strains), Streptococcus pyogenes or Streptococcus agalactiae.
Uncomplicated skin and skin structure infections caused by Staphylococcus aureus (methicillin-susceptible only) or Streptococcus pyogenes.
Community-acquired pneumonia caused by Streptococcus pneumoniae (including multi-drug resistant strains) including cases with concurrent bacteremia or Staphylococcus aureus (methicillin-susceptible strains only).
Therapeutic classView
Macrolides
PharmacologyView
Linezolid is a synthetic, antibacterial agent belonging to a new class of antibiotics, the oxazolidinones, with in vitro activity against Gram positive aerobic bacteria, some Gram positive anaerobic bacteria and certain Gram negative bacteria. It selectively inhibits bacterial protein synthesis via a mechanism of action different from that of other antibacterial agents. Linezolid binds to the 23S ribosomal RNA of the 50S subunit of the bacterial ribosome and prevents the formation of a functional 70S initiation complex which is an essential component of the bacterial translation process. The results of time-kill studies have shown Linezolid to be bacteriostatic against enterococci and staphylococci. For streptococci, Linezolid was found to be bactericidal for the majority of strains.
DosageView
Patients who commence treatment on the parenteral formulation may be switched to oral presentation when clinically indicated. In such circumstances, no dose adjustment is required as Linezolid has an oral bioavailability of approximately 100%. The injection should be administered over a period of 30 to 120 minutes. The film-coated tablets or oral suspension may be taken with or without food.
Complicated skin and skin structure infections, Community-acquired pneumonia, including concurrent bacteremia-
Complicated skin and skin structure infections, Community-acquired pneumonia, including concurrent bacteremia-
- Pediatric Patients (Birth through 11 Years of Age): 10 mg/kg IV or oral t.i.d.
- Adults and Adolescents (12 Years and Older): 600 mg IV or oral b.i.d.
- Recommended Duration of Treatment (consecutive days): 10 to 14
- Pediatric Patients (Birth through 11 Years of Age): 10 mg/kg IV or oral t.i.d.
- Adults and Adolescents (12 Years and Older): 600 mg IV or oral b.i.d.
- Recommended Duration of Treatment (consecutive days): 14 to 28
- Pediatric Patients (Birth through 11 Years of Age): <5 yrs: 10 mg/kg oral t.i.d. 5-11 yrs: 10 mg/kg oral b.i.d
- Adults and Adolescents (12 Years and Older): Adults: 400 mg oral b.i.d. Adolescents: 600 mg oral b.i.d
- Recommended Duration of Treatment (consecutive days): 10 to 14
AdministrationView
Reconstitution of Oral Suspension: Shake the bottle to loosen powder. Add 75 ml (with the help of given cup) of boiled and cooled water to the dry mixture in the bottle. For the ease of preparation, add water to the bottle in two portions. Shake well after each addition until all the powder is in suspension.
Note: Shake the suspension well before each use. Keep the bottle tightly closed. The reconstituted suspension should be stored in a cool and dry place. Use within 21 days after constitution.
Intravenous Administration: Linezolid IV Injection is supplied in single-use, ready-to-use infusion bottles. Linezolid IV Injection should be administered by intravenous infusion over a period of 30 to 120 minutes. The intravenous infusion bottles should not be used in series connections. Additives should not be introduced into this solution. The infusion bottles should be stored at room temperature and protected from freezing. Linezolid IV Injection may exhibit a yellow color that can intensify over time without adversely affecting potency.
Note: Shake the suspension well before each use. Keep the bottle tightly closed. The reconstituted suspension should be stored in a cool and dry place. Use within 21 days after constitution.
Intravenous Administration: Linezolid IV Injection is supplied in single-use, ready-to-use infusion bottles. Linezolid IV Injection should be administered by intravenous infusion over a period of 30 to 120 minutes. The intravenous infusion bottles should not be used in series connections. Additives should not be introduced into this solution. The infusion bottles should be stored at room temperature and protected from freezing. Linezolid IV Injection may exhibit a yellow color that can intensify over time without adversely affecting potency.
Side effectsView
Most of the adverse events reported with Linezolid were mild to moderate in intensity. The most common adverse events in patients treated with Linezolid were diarrhea, headache and nausea. Other adverse events includes oral moniliasis, vaginal moniliasis, hypertension, dyspepsia, localized abdominal pain, pruritus, and tongue discoloration.
ContraindicationsView
Linezolid formulations are contraindicated for using in patients who have known hypersensitivity to Linezolid or any of the other product components. Linezolid should not be used in patients taking any medicinal product which inhibits monoamine oxidases A or B (e.g. Phenelzine, Isocarboxazid) or within two weeks of taking any such medicinal product. Linezolid should not be administered to patients with uncontrolled hypertension, pheochromocytoma, thyrotoxicosis, carcinoid syndrome and/or patients taking directly and indirectly acting sympathomimetic agents (e.g. Pseudoephedrine), vasopressive agents (e.g. Epinephrine, Norepinephrine), dopaminergic agents (e.g. Dopamine, Dobutamine), serotonin re-uptake inhibitors, tricyclic antidepressants, serotonin 5-HT1 receptor agonists (triptans), meperidine or buspirone.
PrecautionsView
Patients who develop recurrent nausea or vomiting, unexplained acidosis or low bicarbonate level while receiving Linezolid should receive immediate medical evaluation. Where administration of Linezolid and concomitant serotonergic agents are clinically appropriate, patients should be closely observed for signs and symptoms of serotonin syndrome such as cognitive dysfunction, hyperpyrexia, hyperreflexia and incoordination. If signs or symptoms occur, physicians should consider discontinuation of either one or both agents. If the concomitant serotonergic agent is withdrawn, discontinuation symptoms can be observed. If patients experience symptoms of visual impairment, such as changes in visual acuity, changes in color vision, blurred vision or visual field defect, prompt ophthalmic evaluation is recommended. Convulsions have been reported in patients when treated with Linezolid. In some of these cases, a history of seizures or risk factors for seizures was reported.
InteractionsView
Monoamine Oxidase Inhibition: Linezolid is a reversible and nonselective inhibitor of monoamine oxidase. Therefore, Linezolid has the potential for interaction with adrenergic and serotonergic agents.
Adrenergic Agents: Some individuals receiving Linezolid may experience a reversible enhancement of the pressor response to indirect-acting sympathomimetic agents, vasopressor or dopaminergic agents. Initial doses of adrenergic agents such as dopamine or epinephrine should be reduced and titrated to achieve the desired response.
Serotonergic Agents: Physicians should be alert to the possible signs and symptoms of serotonergic syndrome in patients receiving concomitant Linezolid and serotonergic agents.
Adrenergic Agents: Some individuals receiving Linezolid may experience a reversible enhancement of the pressor response to indirect-acting sympathomimetic agents, vasopressor or dopaminergic agents. Initial doses of adrenergic agents such as dopamine or epinephrine should be reduced and titrated to achieve the desired response.
Serotonergic Agents: Physicians should be alert to the possible signs and symptoms of serotonergic syndrome in patients receiving concomitant Linezolid and serotonergic agents.
Pregnancy & lactationView
Pregnancy Category C. There are no adequate and well-controlled studies in pregnant women. Linezolid should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is not known whether Linezolid is excreted in human milk. Because many drugs are excreted in human milk. Caution should be exercised when Linezolid is administered to a nursing woman.
Overdose effectsView
No cases of overdose have been reported. Symptomatic and supportive care is advised together with maintenance of glomerular filtration. Approximately 30% of a Linezolid dose is removed during 3 hours of haemodialysis. No data are available for the removal of Linezolid by peritoneal dialysis or haemoperfusion.
StorageView
Linezolid formulations should be stored at room temperature (15°C-30°C), away from light and moisture. All medicines should be kept away from children.
Lizen
Linezolid
Lizen
Linezolid
Indications
Uncomplicated pneumococcal pneumonia
Indication detailsView
Vancomycin-Resistant Enterococcus faecium infections including cases with concurrent bacteremia.
Nosocomial pneumonia caused by Staphylococcus aureus (methicillin-susceptible and -resistant strains) or Streptococcus pneumoniae (including multi-drug resistant strains). Combination therapy may be clinically indicated if the documented or presumptive pathogens include Gram-negative organism.
Complicated skin and skin structure infections, including diabetic foot infections (without concomitant osteomyelitis) caused by Staphylococcus aureus (methicillin-susceptible and methicillin-resistant strains), Streptococcus pyogenes or Streptococcus agalactiae.
Uncomplicated skin and skin structure infections caused by Staphylococcus aureus (methicillin-susceptible only) or Streptococcus pyogenes.
Community-acquired pneumonia caused by Streptococcus pneumoniae (including multi-drug resistant strains) including cases with concurrent bacteremia or Staphylococcus aureus (methicillin-susceptible strains only).
Nosocomial pneumonia caused by Staphylococcus aureus (methicillin-susceptible and -resistant strains) or Streptococcus pneumoniae (including multi-drug resistant strains). Combination therapy may be clinically indicated if the documented or presumptive pathogens include Gram-negative organism.
Complicated skin and skin structure infections, including diabetic foot infections (without concomitant osteomyelitis) caused by Staphylococcus aureus (methicillin-susceptible and methicillin-resistant strains), Streptococcus pyogenes or Streptococcus agalactiae.
Uncomplicated skin and skin structure infections caused by Staphylococcus aureus (methicillin-susceptible only) or Streptococcus pyogenes.
Community-acquired pneumonia caused by Streptococcus pneumoniae (including multi-drug resistant strains) including cases with concurrent bacteremia or Staphylococcus aureus (methicillin-susceptible strains only).
Therapeutic classView
Macrolides
PharmacologyView
Linezolid is a synthetic, antibacterial agent belonging to a new class of antibiotics, the oxazolidinones, with in vitro activity against Gram positive aerobic bacteria, some Gram positive anaerobic bacteria and certain Gram negative bacteria. It selectively inhibits bacterial protein synthesis via a mechanism of action different from that of other antibacterial agents. Linezolid binds to the 23S ribosomal RNA of the 50S subunit of the bacterial ribosome and prevents the formation of a functional 70S initiation complex which is an essential component of the bacterial translation process. The results of time-kill studies have shown Linezolid to be bacteriostatic against enterococci and staphylococci. For streptococci, Linezolid was found to be bactericidal for the majority of strains.
DosageView
Patients who commence treatment on the parenteral formulation may be switched to oral presentation when clinically indicated. In such circumstances, no dose adjustment is required as Linezolid has an oral bioavailability of approximately 100%. The injection should be administered over a period of 30 to 120 minutes. The film-coated tablets or oral suspension may be taken with or without food.
Complicated skin and skin structure infections, Community-acquired pneumonia, including concurrent bacteremia-
Complicated skin and skin structure infections, Community-acquired pneumonia, including concurrent bacteremia-
- Pediatric Patients (Birth through 11 Years of Age): 10 mg/kg IV or oral t.i.d.
- Adults and Adolescents (12 Years and Older): 600 mg IV or oral b.i.d.
- Recommended Duration of Treatment (consecutive days): 10 to 14
- Pediatric Patients (Birth through 11 Years of Age): 10 mg/kg IV or oral t.i.d.
- Adults and Adolescents (12 Years and Older): 600 mg IV or oral b.i.d.
- Recommended Duration of Treatment (consecutive days): 14 to 28
- Pediatric Patients (Birth through 11 Years of Age): <5 yrs: 10 mg/kg oral t.i.d. 5-11 yrs: 10 mg/kg oral b.i.d
- Adults and Adolescents (12 Years and Older): Adults: 400 mg oral b.i.d. Adolescents: 600 mg oral b.i.d
- Recommended Duration of Treatment (consecutive days): 10 to 14
AdministrationView
Reconstitution of Oral Suspension: Shake the bottle to loosen powder. Add 75 ml (with the help of given cup) of boiled and cooled water to the dry mixture in the bottle. For the ease of preparation, add water to the bottle in two portions. Shake well after each addition until all the powder is in suspension.
Note: Shake the suspension well before each use. Keep the bottle tightly closed. The reconstituted suspension should be stored in a cool and dry place. Use within 21 days after constitution.
Intravenous Administration: Linezolid IV Injection is supplied in single-use, ready-to-use infusion bottles. Linezolid IV Injection should be administered by intravenous infusion over a period of 30 to 120 minutes. The intravenous infusion bottles should not be used in series connections. Additives should not be introduced into this solution. The infusion bottles should be stored at room temperature and protected from freezing. Linezolid IV Injection may exhibit a yellow color that can intensify over time without adversely affecting potency.
Note: Shake the suspension well before each use. Keep the bottle tightly closed. The reconstituted suspension should be stored in a cool and dry place. Use within 21 days after constitution.
Intravenous Administration: Linezolid IV Injection is supplied in single-use, ready-to-use infusion bottles. Linezolid IV Injection should be administered by intravenous infusion over a period of 30 to 120 minutes. The intravenous infusion bottles should not be used in series connections. Additives should not be introduced into this solution. The infusion bottles should be stored at room temperature and protected from freezing. Linezolid IV Injection may exhibit a yellow color that can intensify over time without adversely affecting potency.
Side effectsView
Most of the adverse events reported with Linezolid were mild to moderate in intensity. The most common adverse events in patients treated with Linezolid were diarrhea, headache and nausea. Other adverse events includes oral moniliasis, vaginal moniliasis, hypertension, dyspepsia, localized abdominal pain, pruritus, and tongue discoloration.
ContraindicationsView
Linezolid formulations are contraindicated for using in patients who have known hypersensitivity to Linezolid or any of the other product components. Linezolid should not be used in patients taking any medicinal product which inhibits monoamine oxidases A or B (e.g. Phenelzine, Isocarboxazid) or within two weeks of taking any such medicinal product. Linezolid should not be administered to patients with uncontrolled hypertension, pheochromocytoma, thyrotoxicosis, carcinoid syndrome and/or patients taking directly and indirectly acting sympathomimetic agents (e.g. Pseudoephedrine), vasopressive agents (e.g. Epinephrine, Norepinephrine), dopaminergic agents (e.g. Dopamine, Dobutamine), serotonin re-uptake inhibitors, tricyclic antidepressants, serotonin 5-HT1 receptor agonists (triptans), meperidine or buspirone.
PrecautionsView
Patients who develop recurrent nausea or vomiting, unexplained acidosis or low bicarbonate level while receiving Linezolid should receive immediate medical evaluation. Where administration of Linezolid and concomitant serotonergic agents are clinically appropriate, patients should be closely observed for signs and symptoms of serotonin syndrome such as cognitive dysfunction, hyperpyrexia, hyperreflexia and incoordination. If signs or symptoms occur, physicians should consider discontinuation of either one or both agents. If the concomitant serotonergic agent is withdrawn, discontinuation symptoms can be observed. If patients experience symptoms of visual impairment, such as changes in visual acuity, changes in color vision, blurred vision or visual field defect, prompt ophthalmic evaluation is recommended. Convulsions have been reported in patients when treated with Linezolid. In some of these cases, a history of seizures or risk factors for seizures was reported.
InteractionsView
Monoamine Oxidase Inhibition: Linezolid is a reversible and nonselective inhibitor of monoamine oxidase. Therefore, Linezolid has the potential for interaction with adrenergic and serotonergic agents.
Adrenergic Agents: Some individuals receiving Linezolid may experience a reversible enhancement of the pressor response to indirect-acting sympathomimetic agents, vasopressor or dopaminergic agents. Initial doses of adrenergic agents such as dopamine or epinephrine should be reduced and titrated to achieve the desired response.
Serotonergic Agents: Physicians should be alert to the possible signs and symptoms of serotonergic syndrome in patients receiving concomitant Linezolid and serotonergic agents.
Adrenergic Agents: Some individuals receiving Linezolid may experience a reversible enhancement of the pressor response to indirect-acting sympathomimetic agents, vasopressor or dopaminergic agents. Initial doses of adrenergic agents such as dopamine or epinephrine should be reduced and titrated to achieve the desired response.
Serotonergic Agents: Physicians should be alert to the possible signs and symptoms of serotonergic syndrome in patients receiving concomitant Linezolid and serotonergic agents.
Pregnancy & lactationView
Pregnancy Category C. There are no adequate and well-controlled studies in pregnant women. Linezolid should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is not known whether Linezolid is excreted in human milk. Because many drugs are excreted in human milk. Caution should be exercised when Linezolid is administered to a nursing woman.
Overdose effectsView
No cases of overdose have been reported. Symptomatic and supportive care is advised together with maintenance of glomerular filtration. Approximately 30% of a Linezolid dose is removed during 3 hours of haemodialysis. No data are available for the removal of Linezolid by peritoneal dialysis or haemoperfusion.
StorageView
Linezolid formulations should be stored at room temperature (15°C-30°C), away from light and moisture. All medicines should be kept away from children.
Locaine
Lidocaine Hydrochloride (Injection)
Locaine
Lidocaine Hydrochloride (Injection)
Indications
Local pain relief
Indication detailsView
Lidocaine Injection is indicated-
- As a local anaesthetic for use in infiltration blockade and intravenous regional analgesia.
- For the prevention and treatment of ventricular tachyarrhythmias
Therapeutic classView
Local & Surface anesthesia
PharmacologyView
Lidocaine acts mainly by inhibiting sodium influx through sodium specific ion channels in the neuronal cell membrane, in particular the so called voltage-gated sodium channels. When the influx of sodium is interrupted, an action potential cannot arise and signal conduction is inhibited. The receptor site is thought to be located at the cytoplasmic (inner) portion of the sodium channel. Lidocaine binds more readily to sodium channels in activated state, thus onset of neuronal blockade is faster in neurons that are rapidly firing. This is referred to as state dependent blockade.
DosageView
The dosage is adjusted according to the response of the patient and site of administration.
Adult: For healthy adults, the maximum individual dose should not exceed 4.5mg/kg of body weight and in general it is recommended that the maximum total dose does not exceed 300 mg. Recommended doses given in the below serve only as a guide to the amount of anaesthetic required for most routine procedures.
Infiltration-
Adult: For healthy adults, the maximum individual dose should not exceed 4.5mg/kg of body weight and in general it is recommended that the maximum total dose does not exceed 300 mg. Recommended doses given in the below serve only as a guide to the amount of anaesthetic required for most routine procedures.
Infiltration-
- Percutaneous: Total dose 5-300 mg
- Intravenous regional: Total dose 50-300 mg
- Brachial: Total dose 225-300 mg
- Dental: Total dose 20-100 mg
- Intercostal: Total dose 30 mg
- Paravertebral: Total dose 30-50 mg
- Paracervical Obstetrical analgesia: Total dose 100 mg
- Cervical: Total dose 50 mg
- Lumbar: Total dose 50-100 mg
- Epidural: Total dose 200-300 mg [Dose determined by number of dermatomes to be anesthetized (2-3 mL/dermatome) periodically.]
- Thoracic: Total dose 200-300 mg
- Analgesia: Total dose 250-300 mg
- Anesthesia: Total dose 200-300 mg
- Obstetrical analgesia: Total dose 200-300 mg
- Surgical anesthesia: Total dose 225-300 mg.
AdministrationView
Antiarrhythmic treatment: An intravenous dose of 1 mg.kg-1 may be given over 2 min and repeated after 5 min, but giving an infusion of 2-4 mg.min-1 to produce a plasma level of 2-4 mg. l-1 is a more satisfactory technique. To avoid a long delay in achieving a steady state, a loading dose of approximately 1 mg.kg-1 is usually given intravenously over 2 min at the outset.
Side effectsView
In common with other local anaesthetics, adverse reactions to lidocaine are rare and are usually the result of excessively high blood concentrations due to inadvertent intravascular injection, excessive dosage, rapid absorption or occasionally to hypersensitivity, idiosyncracy or diminished tolerance on the part of the patient. In such circumstances systemic effects occur involving the central nervous system and/or the cardiovascular system. CNS reactions are excitatory and/or depressant and may be characterized by nervousness, dizziness, blurred vision and tremors, followed by drowsiness, convulsions, unconsciousness and possibly respiratory arrest. Cardiovascular reactions are hypotension, myocardial depression, bradycardia and possibly cardiac arrest. Allergic reactions are extremely rare. They may be characterized by cutaneous lesions, urticaria, oedema or anaphylactoid reactions.
ContraindicationsView
Known hypersensitivity to anaesthetics of the amide type.
PrecautionsView
Lidocaine for infiltration and nerve block should be employed only by clinicians who are well versed in diagnosis and management of dose-related toxicity. The safety and effectiveness of lidocaine depend on proper dosage, correct technique, adequate precautions, and readiness for emergencies. Standard text books should be consulted for specific techniques and precautions for various regional anaesthetic procedures. Resuscitative equipment, oxygen and other resuscitative drugs should be available for immediate use.
It should be used cautiously in patients with epilepsy, impaired cardiac conduction, bradycardia, impaired respiratory function and in patients with impaired hepatic function, if the dose or site of administration is likely to result in high blood levels. The effect of local anaesthetics may be reduced if an injection is made into an inflamed or infected area. Repeated doses of lidocaine may cause significant increases in blood levels with each repeated dose because of slow accumulation of the drug or its metabolites. Tolerance to elevated blood levels varies with the status of the patient. Careful and constant monitoring of cardiovascular and respiratory vital signs and the patient's state of consciousness should be accomplished after each local anaesthetic injection.
It should be used cautiously in patients with epilepsy, impaired cardiac conduction, bradycardia, impaired respiratory function and in patients with impaired hepatic function, if the dose or site of administration is likely to result in high blood levels. The effect of local anaesthetics may be reduced if an injection is made into an inflamed or infected area. Repeated doses of lidocaine may cause significant increases in blood levels with each repeated dose because of slow accumulation of the drug or its metabolites. Tolerance to elevated blood levels varies with the status of the patient. Careful and constant monitoring of cardiovascular and respiratory vital signs and the patient's state of consciousness should be accomplished after each local anaesthetic injection.
InteractionsView
Cimetidine can impair the metabolism of lidocaine absorbed into the circulation. Elimination will be delayed and the risk of adverse reactions increased. Significant increases in plasma lidocaine concentrations have occurred during concomitant therapy with beta blockers such as propranolol, metoprolol or nadolol. It prolongs the duration of action of suxamethonium.
Pregnancy & lactationView
Although there is no evidence from animal studies of harm to the foetus, as with all drugs, it should not be given during early pregnancy unless the benefits are considered to outweigh the risks. Caution should be exercised when it is administered to a nursing woman.
Pediatric usageView
Dosages in children should be reduced, commensurate with age, body-weight and physical condition. Elderly patients may be more sensitive to systemic effects and may require dose reductions.
StorageView
Keep below 25°C temperature, away from light & moisture. Keep out of the reach of children.
Locard
Amlodipine Besilate
Locard
Amlodipine Besilate
Indications
Stroke
Indication detailsView
Essential hypertension: Amlodipine is efficacious as monotherapy in the treatment of hypertension. It may be used in combination with other antihypertensive agents.
Angina pectoris: Amlodipine is indicated for the treatment of chronic stable angina pectoris and is efficacious as monotherapy. It may be used in combination with other antianginal agents.
Vasospastic angina: Amlodipine is indicated for the treatment of confirmed or suspected vasospastic angina. It may be used as monotherapy or in combination with other antianginal drugs.
Angina pectoris: Amlodipine is indicated for the treatment of chronic stable angina pectoris and is efficacious as monotherapy. It may be used in combination with other antianginal agents.
Vasospastic angina: Amlodipine is indicated for the treatment of confirmed or suspected vasospastic angina. It may be used as monotherapy or in combination with other antianginal drugs.
Therapeutic classView
Calcium-channel blockers
PharmacologyView
Amlodipine is a dihydropyridine calcium-channel blocker, with a long duration of action, used for the treatment of hypertension and angina pectoris. Amlodipine influences the myocardial cells, the cells within the specialized conducting system of the heart, and the cells of vascular smooth muscle. Administration of Amlodipine results primarily in vasodilation, with reduced peripheral resistance, blood pressure and afterload, increased coronary blood flow and a reflex increase in coronary heart rate. This in turn results in an increase in myocardial oxygen supply and cardiac output.
DosageView
Hypertension: Usual dose is 5 mg once daily. The maximum dose is 10 mg once daily. Elderly patients with hepatic insufficiency may be started on 2.5 mg once daily; this dose may also be used when adding Amlodipine to other antihypertensive therapy.
Angina (Chronic stable or Vasospastic): 5 to 10 mg, using the lower dose for elderly and in patients with hepatic insufficiency. Most patients require 10 mg.
Administrations: May be taken without regard to meals.
Angina (Chronic stable or Vasospastic): 5 to 10 mg, using the lower dose for elderly and in patients with hepatic insufficiency. Most patients require 10 mg.
Administrations: May be taken without regard to meals.
Side effectsView
The most common adverse effects of amlodipine are associated with vasodilatory action, such as dizziness, flushing, headache, hypotension and peripheral edema. Gastrointestinal disturbances, increased micturition frequency, lethargy, eye pain and mental depression may also occur. A paradoxical increase in ischaemic chest pain may occur at the start of the treatment and in a few patients excessive fall in blood pressure has led to cerebral or myocardial ischaemia or transient blindness. Rashes, fever and abnormalities in liver function due to hypersensitivity reaction of Amlodipine may occur.
ContraindicationsView
Hypersensitivity to dihydropyridine derivatives. Pregnant woman.
PrecautionsView
Precaution should be taken in patients with hepatic impairment and during pregnancy and breast feeding.
InteractionsView
Drug Interactions-
- Potentially hazardous interactions: Little or no data are available in patients with markedly impaired cardiac left ventricular function; however, as with other calcium antagonist drugs, the combination of Amlodipine and p-blockers should be avoided in such patients.
- Digoxin: Absence of any interaction between Amlodipine and Digoxin in healthy volunteers has been documented in a controlled clinical study.
- Cimetidine: An unpublished clinical study indicated no interaction between, Amlodipine and Cimetidine in healthy volunteers.
- Warfarin: An unpublished clinical study in healthy volunteers indicates that Amlodipine did not significantly alter the effect of Warfarin on prothrombin time.
- Food: Food does not alter the rate or extent of absorption of Amlodipine.
Pregnancy & lactationView
Pregnancy Category C. There are no adequate and well-controlled studies of Amlodipine in pregnant women. Amlodipine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is not known whether Amlodipine is excreted in human milk. In the absence of this information, it is recommended that nursing be discontinued while Amlodipine is administered.
Pediatric usageView
Children with hypertension from 6 years to 17 years of age: 2.5 mg once daily as a starting dose, up-titrated to 5 mg once daily if blood pressure goal is not achieved after 4 weeks. Doses in excess of 5 mg daily have not been studied in pediatric patients.
Children under 6 years old: The effect of amlodipine on blood pressure in patients less than 6 years of age is not known.
Elderly: Amlodipine used at similar doses in elderly or younger patients is equally well tolerated. Normal dosage regimens are recommended in the elderly, but increase of the dosage should take place with care.
Renal impairment: Changes in amlodipine plasma concentrations are not correlated with degree of renal impairment, therefore the normal dosage is recommended. Amlodipine is not dialysable.
Hepatic impairment: Dosage recommendations have not been established in patients with mild to moderate hepatic impairment; therefore dose selection should be cautions and should start at the lower end of the dosing range. The pharmacokinetics of Amlodipine have not been studied in severe hepatic impairment. Amlodipine should be initiated at the lowest dose (2.5 mg once daily) and titrated slowly in patients with severe hepatic impairment.
Children under 6 years old: The effect of amlodipine on blood pressure in patients less than 6 years of age is not known.
Elderly: Amlodipine used at similar doses in elderly or younger patients is equally well tolerated. Normal dosage regimens are recommended in the elderly, but increase of the dosage should take place with care.
Renal impairment: Changes in amlodipine plasma concentrations are not correlated with degree of renal impairment, therefore the normal dosage is recommended. Amlodipine is not dialysable.
Hepatic impairment: Dosage recommendations have not been established in patients with mild to moderate hepatic impairment; therefore dose selection should be cautions and should start at the lower end of the dosing range. The pharmacokinetics of Amlodipine have not been studied in severe hepatic impairment. Amlodipine should be initiated at the lowest dose (2.5 mg once daily) and titrated slowly in patients with severe hepatic impairment.
Overdose effectsView
Symptoms: Available data suggest that large overdosage could result in excessive peripheral vasodilatation and possibly reflex tachycardia. Marked and probably prolonged systemic hypotension up to and including shock with fatal outcome have been reported.
Management: Clinically significant hypotension due to amlodipine overdosage calls for active cardiovascular support including frequent monitoring of cardiac and respiratory function, elevation of extremities, and attention to circulating fluid volume and urine output.
A vasoconstrictor may be helpful in restoring vascular tone and blood pressure, provided that there is no contraindication to its use. Intravenous calcium gluconate may be beneficial in reversing the effects of calcium channel blockade. Gastric lavage may be worthwhile in some cases. In healthy volunteers the use of charcoal up to 2 hours after administration of amlodipine 10 mg has been shown to reduce the absorption rate of amlodipine. Since amlodipine is highly protein-bound, dialysis is not likely to be of benefit.
Management: Clinically significant hypotension due to amlodipine overdosage calls for active cardiovascular support including frequent monitoring of cardiac and respiratory function, elevation of extremities, and attention to circulating fluid volume and urine output.
A vasoconstrictor may be helpful in restoring vascular tone and blood pressure, provided that there is no contraindication to its use. Intravenous calcium gluconate may be beneficial in reversing the effects of calcium channel blockade. Gastric lavage may be worthwhile in some cases. In healthy volunteers the use of charcoal up to 2 hours after administration of amlodipine 10 mg has been shown to reduce the absorption rate of amlodipine. Since amlodipine is highly protein-bound, dialysis is not likely to be of benefit.
StorageView
Keep all medicines out of reach of children. Store in a cool & dry place, protected from light.
Locard Plus
Amlodipine Besilate + Atenolol
Locard Plus
Amlodipine Besilate + Atenolol
Indications
Refractory angina pectoris where nitrate therapy has failed
Indication detailsView
This is indicated in-
- Patients with essential hypertension
- Patients with angina pectoris & hypertension as co-existing diseases
- ln post Ml patients
- ln patients with refractory angina pectoris where nitrate therapy has failed.
Therapeutic classView
Combined antihypertensive preparations
PharmacologyView
This is a fixed-dose combination of Amlodipine and Atenolol. Amlodipine is a dihydropyridine calcium antagonist that inhibits the transmembrane influx of calcium ions into vascular smooth muscle and cardiac muscle; it has a greater effect on vascular smooth muscle than on cardiac muscle. Amlodipine is a peripheral vasodilator that acts directly on vascular smooth muscle to cause a reduction in peripheral vascular resistance and reduction in blood pressure. Amlodipine reduces tone, decreases coronary vasoreactivity and lowers cardiac demand by reducing afterload.
Atenolol is a cardioselective beta-blocker. The cardio-selectivity is dose-related. Atenolol causes a reduction in blood pressure by lowering cardiac output, decreasing the plasma renin activity and sympathetic outflow from CNS. Atenolol also causes a reduction in myocardial oxygen demand by virtue of its negative inotropic and negative chronotropic effects.
Atenolol is a cardioselective beta-blocker. The cardio-selectivity is dose-related. Atenolol causes a reduction in blood pressure by lowering cardiac output, decreasing the plasma renin activity and sympathetic outflow from CNS. Atenolol also causes a reduction in myocardial oxygen demand by virtue of its negative inotropic and negative chronotropic effects.
DosageView
The recommended dosage is Amlodipine and Atenolol 5/25 mg tablet once daily. If necessary, the dosage may be increased to 5/25 mg two tablets daily or as advised by the physicians. The dosage however should be individualized.
Side effectsView
The combination of Amlodipine and Atenolol is well tolerated. Overall side-effects include
fatigue, headache, edema, nausea, drowsiness, anxiety and depression.
fatigue, headache, edema, nausea, drowsiness, anxiety and depression.
ContraindicationsView
Hypersensitivity to either component, sinus bradycardia, second and higher degrees of heart block, cardiogenic shock, hypotension, congestive heart failure, poor left ventricular function.
PrecautionsView
Bronchospasm: The combination should be used with caution in patients with airway obstruction.
Renal impairment: The combination can be used in patients with renal impairment. However, caution may be necessary if the creatinine clearance is less than 30 ml/min because of possible reduction in the excretion of unchanged Atenolol.
Hepatic impairment: Caution may be necessary in the use of the combination in patients with severe liver damage because of prolongation of the elimination half-life of Amlodipine.
Drug withdrawal: Since coronary heart disease may exist without being recognized, patients should be warned against stopping the drug suddenly. Any discontinuation should be gradual and under observation.
Renal impairment: The combination can be used in patients with renal impairment. However, caution may be necessary if the creatinine clearance is less than 30 ml/min because of possible reduction in the excretion of unchanged Atenolol.
Hepatic impairment: Caution may be necessary in the use of the combination in patients with severe liver damage because of prolongation of the elimination half-life of Amlodipine.
Drug withdrawal: Since coronary heart disease may exist without being recognized, patients should be warned against stopping the drug suddenly. Any discontinuation should be gradual and under observation.
InteractionsView
Disopyramide: Atenolol reduces the clearance of disopyramide by 20%. Additive negative inotropic effects on the heart may be produced.
Ampicillin: at doses of 1 gm and above may reduce Atenolol levels.
Oral antidiabetics and insulin: Beta-blockers may decrease tissue sensitivity to insulin and inhibit insulin secretion e.g. in response to oral antidiabetics. Atenolol has less potential for these actions.
Ampicillin: at doses of 1 gm and above may reduce Atenolol levels.
Oral antidiabetics and insulin: Beta-blockers may decrease tissue sensitivity to insulin and inhibit insulin secretion e.g. in response to oral antidiabetics. Atenolol has less potential for these actions.
Pregnancy & lactationView
The combination should be used during pregnancy only if the expected benefit outweighs the potential fetal risk. The combination should not be used by nursing mothers. If its use is considered necessary, breast-feeding should be stopped.
Overdose effectsView
Though not documented, hypotension and less frequently congestive cardiac failure may occur in cases of overdosage. Unabsorbed drugs may be removed by gastric lavage or administration of activated charcoal. Symptomatic treatment is suggested.
StorageView
Keep below 30°C temperature, away from light & moisture. Keep out of the reach of children.
Locin
Levofloxacin Hemihydrate
Locin
Levofloxacin Hemihydrate
Indications
Urinary tract infection
Indication detailsView
Levofloxacin is indicated for the treatment of mild, moderate and severe infections caused by susceptible strains of the designated micro-organisms in the condition listed below:
- Acute maxillary sinusitis due to Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis.
- Acute bacterial exacerbation of chronic bronchitis due to Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis.
- Community-acquired pneumonia due to Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Klebsiella pneumoniae, Moraxella catarrhalis, Chlamydia pneumoniae, Legionella pneumophila, or Mycoplasma pneumoniae.
- Uncomplicated & complicated urinary tract infections due to Escherichia coli, Klebsiella pneumoniae, or Staphylococcus saprophyticus.
- Acute pyelonephritis caused by Escherichia coli.
- Uncomplicated & complicated skin and soft tissue infections including abscesses, cellulitis, furuncles, impetigo, pyoderma, wound infections, due to Staphylococcus aureus, Streptococcus pyogenes, Proteus mirabilis or Enterococcus faecalis.
- Enteric infections caused by Enterobacter sp., Escherichia coli, Campylobacter sp., Vibrio cholerae, Shigella sp., Salmonella sp.
Therapeutic classView
4-Quinolone preparations
PharmacologyView
Levofloxacin is a synthetic, broad-spectrum, third generation fluoroquinolone antibiotic. Chemically, Levofloxacin is a chiral fluorinated carboxyquinolone. Levofloxacin exerts antibacterial action by inhibiting bacterial topoisomerase IV and DNA gyrase, the enzymes required for DNA replication, transcription repair and recombination. It has in vitro activity against a wide range of gm-ve and gm+ve microorganisms.
DosageView
The usual dose of Levofloxacin Tablets is 250 mg or 500 mg or 750 mg administered orally every 24 hours. Levofloxacin tablets can be administered without regard to food. Levofloxacin oral solution should be taken 1 hour before, or 2 hours after eating.
Levofloxacin injection should only be administered by intravenous infusion. It is not for intramuscular, intrathecal, intraperitoneal, or subcutaneous administration. The usual dose of Levofloxacin injection is 250 mg or 500 mg administered by slow infusion over 60 minutes every 24 hours or 750 mg administered by slow infusion over 90 minutes every 24 hours. Since the Levofloxacin injections are for single-use only, any unused portion should be discarded. Additives or other medications should not be added to Levofloxacin Injection or infused simultaneously through the same intravenous line.
Adults:
Levofloxacin injection should only be administered by intravenous infusion. It is not for intramuscular, intrathecal, intraperitoneal, or subcutaneous administration. The usual dose of Levofloxacin injection is 250 mg or 500 mg administered by slow infusion over 60 minutes every 24 hours or 750 mg administered by slow infusion over 90 minutes every 24 hours. Since the Levofloxacin injections are for single-use only, any unused portion should be discarded. Additives or other medications should not be added to Levofloxacin Injection or infused simultaneously through the same intravenous line.
Adults:
- Acute sinusitis: 500 mg once daily for 10-14 days, or 750 mg once daily for 5 days
- Exacerbation of chronic bronchitis: 500 mg once daily for 7 days, or 750 mg once daily for 3 days (Uncomplicated), 750 mg once daily for 5 days (Complicated)
- Community-acquired pneumonia: 500 mg once daily for 7-14 days, or 750 mg once daily for 5 days
- Uncomplicated urinary-tract infections: 250 mg once daily for 3 days
- Complicated urinary-tract infections and acute pyelonephritis: 250 mg once daily for 7-10 days
- Uncomplicated skin and soft-tissue infections: 500 mg once daily for 7-10 days.
- Complicated skin and soft-tissue infections: 750 mg once daily for 7-14 days.
- Enteric fever: 500 mg once daily for 7-14 days.
- Diarrhea, cholera, shigellosis & enteritis: Mild to moderate case: 500 mg (single dose). Moderate to sever case: 500 mg once daily for 3 days
- Children 6 months to <5 years: 10 mg/kg every 12 hours.
- Children >5 years: 10 mg/kg every 24 hours
AdministrationView
Instructions for the Use of Levofloxacin Infusion-
- Check the container for minute leaks by squeezing the inner bag firmly. If leaks are found, or if the seal is not intact, discard the solution.
- Do not use if the solution is cloudy or a precipitate is present.
- Do not use flexible containers in series connections.
- Close flow control clamp of administration set.
- Remove cover from port at bottom of container.
- Insert piercing pin of administration set into port with a twisting motion until the pin is firmly seated.
- Suspend container from hanger.
- Squeeze and release drip chamber to establish proper fluid level in chamber during infusion of Levoxin Injection.
- Open flow control clamp to expel air from set. Close clamp.
- Regulate rate of administration with flow control clamp.
Side effectsView
Levofloxacin is generally well tolerated. However, a few side-effects can usually be seen. There is a risk of retinal detachment. Other side-effects include: nausea, vomiting, diarrhea, abdominal pain, flatulence and rare occurrence of phototoxicity (0.1%). Side-effects that may be seen very rarely include tremors, depression, anxiety, confusion etc.
ContraindicationsView
Levofloxacin is contraindicated in patients with a history of hypersensitivity to levofloxacin, quinolone antimicrobial agents, or any other components of this product.
PrecautionsView
The following measures should be taken during administration of Levofloxacin:
- Levofloxacin Injection should only be administered by slow intravenous infusion over a period of 60 or 90 minutes depending on the dosage.
- While administrating Levofloxacin, adequate amount of water should be taken to avoid concentrated form of urine.
- Dose adjustment should be exercised during Levofloxacin administration in presence of renal insufficiency.
InteractionsView
No quinolone should be co-administered with any solution containing multivalent cations, e.g., magnesium, through the same intravenous line. Antacids, Iron and Adsorbents reduce absorption of Levofloxacin. NSAID may increase the risk of CNS stimulation. Warfarin may increase the risk of bleeding.
Pregnancy & lactationView
Levofloxacin is not recommended for use during pregnancy or nursing, as the effects on the unborn child or nursing infant are unknown.
Overdose effectsView
Levofloxacin exhibits a low potential for acute toxicity. However, in the events of an acute overdosage, the stomach should be emptied. The patients should be kept under observation and appropriate hydration should be maintained.
StorageView
Keep below 30°C temperature, away from light & moisture. Keep out of the reach of children.
Locin
Levofloxacin Hemihydrate
Locin
Levofloxacin Hemihydrate
Indications
Urinary tract infection
Indication detailsView
Levofloxacin is indicated for the treatment of mild, moderate and severe infections caused by susceptible strains of the designated micro-organisms in the condition listed below:
- Acute maxillary sinusitis due to Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis.
- Acute bacterial exacerbation of chronic bronchitis due to Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis.
- Community-acquired pneumonia due to Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Klebsiella pneumoniae, Moraxella catarrhalis, Chlamydia pneumoniae, Legionella pneumophila, or Mycoplasma pneumoniae.
- Uncomplicated & complicated urinary tract infections due to Escherichia coli, Klebsiella pneumoniae, or Staphylococcus saprophyticus.
- Acute pyelonephritis caused by Escherichia coli.
- Uncomplicated & complicated skin and soft tissue infections including abscesses, cellulitis, furuncles, impetigo, pyoderma, wound infections, due to Staphylococcus aureus, Streptococcus pyogenes, Proteus mirabilis or Enterococcus faecalis.
- Enteric infections caused by Enterobacter sp., Escherichia coli, Campylobacter sp., Vibrio cholerae, Shigella sp., Salmonella sp.
Therapeutic classView
4-Quinolone preparations
PharmacologyView
Levofloxacin is a synthetic, broad-spectrum, third generation fluoroquinolone antibiotic. Chemically, Levofloxacin is a chiral fluorinated carboxyquinolone. Levofloxacin exerts antibacterial action by inhibiting bacterial topoisomerase IV and DNA gyrase, the enzymes required for DNA replication, transcription repair and recombination. It has in vitro activity against a wide range of gm-ve and gm+ve microorganisms.
DosageView
The usual dose of Levofloxacin Tablets is 250 mg or 500 mg or 750 mg administered orally every 24 hours. Levofloxacin tablets can be administered without regard to food. Levofloxacin oral solution should be taken 1 hour before, or 2 hours after eating.
Levofloxacin injection should only be administered by intravenous infusion. It is not for intramuscular, intrathecal, intraperitoneal, or subcutaneous administration. The usual dose of Levofloxacin injection is 250 mg or 500 mg administered by slow infusion over 60 minutes every 24 hours or 750 mg administered by slow infusion over 90 minutes every 24 hours. Since the Levofloxacin injections are for single-use only, any unused portion should be discarded. Additives or other medications should not be added to Levofloxacin Injection or infused simultaneously through the same intravenous line.
Adults:
Levofloxacin injection should only be administered by intravenous infusion. It is not for intramuscular, intrathecal, intraperitoneal, or subcutaneous administration. The usual dose of Levofloxacin injection is 250 mg or 500 mg administered by slow infusion over 60 minutes every 24 hours or 750 mg administered by slow infusion over 90 minutes every 24 hours. Since the Levofloxacin injections are for single-use only, any unused portion should be discarded. Additives or other medications should not be added to Levofloxacin Injection or infused simultaneously through the same intravenous line.
Adults:
- Acute sinusitis: 500 mg once daily for 10-14 days, or 750 mg once daily for 5 days
- Exacerbation of chronic bronchitis: 500 mg once daily for 7 days, or 750 mg once daily for 3 days (Uncomplicated), 750 mg once daily for 5 days (Complicated)
- Community-acquired pneumonia: 500 mg once daily for 7-14 days, or 750 mg once daily for 5 days
- Uncomplicated urinary-tract infections: 250 mg once daily for 3 days
- Complicated urinary-tract infections and acute pyelonephritis: 250 mg once daily for 7-10 days
- Uncomplicated skin and soft-tissue infections: 500 mg once daily for 7-10 days.
- Complicated skin and soft-tissue infections: 750 mg once daily for 7-14 days.
- Enteric fever: 500 mg once daily for 7-14 days.
- Diarrhea, cholera, shigellosis & enteritis: Mild to moderate case: 500 mg (single dose). Moderate to sever case: 500 mg once daily for 3 days
- Children 6 months to <5 years: 10 mg/kg every 12 hours.
- Children >5 years: 10 mg/kg every 24 hours
AdministrationView
Instructions for the Use of Levofloxacin Infusion-
- Check the container for minute leaks by squeezing the inner bag firmly. If leaks are found, or if the seal is not intact, discard the solution.
- Do not use if the solution is cloudy or a precipitate is present.
- Do not use flexible containers in series connections.
- Close flow control clamp of administration set.
- Remove cover from port at bottom of container.
- Insert piercing pin of administration set into port with a twisting motion until the pin is firmly seated.
- Suspend container from hanger.
- Squeeze and release drip chamber to establish proper fluid level in chamber during infusion of Levoxin Injection.
- Open flow control clamp to expel air from set. Close clamp.
- Regulate rate of administration with flow control clamp.
Side effectsView
Levofloxacin is generally well tolerated. However, a few side-effects can usually be seen. There is a risk of retinal detachment. Other side-effects include: nausea, vomiting, diarrhea, abdominal pain, flatulence and rare occurrence of phototoxicity (0.1%). Side-effects that may be seen very rarely include tremors, depression, anxiety, confusion etc.
ContraindicationsView
Levofloxacin is contraindicated in patients with a history of hypersensitivity to levofloxacin, quinolone antimicrobial agents, or any other components of this product.
PrecautionsView
The following measures should be taken during administration of Levofloxacin:
- Levofloxacin Injection should only be administered by slow intravenous infusion over a period of 60 or 90 minutes depending on the dosage.
- While administrating Levofloxacin, adequate amount of water should be taken to avoid concentrated form of urine.
- Dose adjustment should be exercised during Levofloxacin administration in presence of renal insufficiency.
InteractionsView
No quinolone should be co-administered with any solution containing multivalent cations, e.g., magnesium, through the same intravenous line. Antacids, Iron and Adsorbents reduce absorption of Levofloxacin. NSAID may increase the risk of CNS stimulation. Warfarin may increase the risk of bleeding.
Pregnancy & lactationView
Levofloxacin is not recommended for use during pregnancy or nursing, as the effects on the unborn child or nursing infant are unknown.
Overdose effectsView
Levofloxacin exhibits a low potential for acute toxicity. However, in the events of an acute overdosage, the stomach should be emptied. The patients should be kept under observation and appropriate hydration should be maintained.
StorageView
Keep below 30°C temperature, away from light & moisture. Keep out of the reach of children.
Locin
Levofloxacin (Ophthalmic)
Locin
Levofloxacin (Ophthalmic)
Indications
Corneal ulcer
Indication detailsView
Levofloxacin eye drops is indicated for the treatment of bacterial conjunctivitis caused by susceptible strains of the following bacteria:
Aerobic Gram-Positive bacteria-
Aerobic Gram-Positive bacteria-
- Corynebacterium species
- Staphylococcus oureus
- Staphylococcus epidermidis
- Streptococcus pneumoniae
- Streptococcus (Groups C/F)
- Streptococcus (Group G)
- Streptococcus viridons group
- Acinetobocter Iwoffii
- Haemophilus influenzae
- Serrotia morcescens
Therapeutic classView
4-Quinolone preparations
PharmacologyView
Levofloxacin eye drops is a sterile topical ophthalmic solution. It is a synthetic, broad spectrum, third generation fluoroquinolone bactericidal antibiotic, which active against a broad spectrum of Gram-positive & Gram-negative ocular pathogens. It functions by inhibiting bacterial topoisomerase IV and DNA gyrase enzymes required for DNA replication, transcription, repair and recombination.
DosageView
0.5% eye drop: Adults and children 1 year of age and older:
- Days 1 and 2: Instill 1-2 drops in the affected eye(s) every 2 hours while awake, up to 8 times per day.
- Days 3 through 7: Instill 1-2 drops in the affected eye(s) every 4 hours while awake, up to 4 times per day.
- Days 1 through 3: Instill one to two drops in the affected eye(s) every 30 minutes to 2 hours while awake and approximately 4 and 6 hours after retiring.
- Day 4 through treatment completion: Instill one to two drops in the affected eye(s) every 1 to 4 hours while awake.
Side effectsView
Side effects occurred only approximately 1-3% of patients that may include transient blurred vision, fever, foreign body sensation, headache, transient ocular burning, ocular pain or discomfort, pharyngitis and photophobia. In less than 1% of patients included allergic reactions, lid edema, ocular dryness and ocular itching.
ContraindicationsView
It is contraindicated in patients with a history of hypersensitivity to Levofloxacin, to other quinolones or to any of the components of this medication
PrecautionsView
Prolonged use may result in the overgrowth of non-susceptible organisms, including fungi. If superinfection occurs, discontinue use and institute alternative therapy.
InteractionsView
Specific drug interaction studies have not been conducted with levofloxacin eye drops. But the systemic administration of some quinolones has been shown to elevate plasma concentrations of theophylline, interfere with the metabolism of caffeine and enhance the effects of the oral anticoagulant warfarin and its derivatives.
Pregnancy & lactationView
Pregnancy Category C. Levofloxacin should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Levofloxacin has not been measured in human milk. Caution should be exercised when Levofloxacin eye drops is administered to a nursing mother.
StorageView
Eye drops should be protected from light, store in a cool (15°-25° C) and dry place & keep out of reach of children.