Find Medicines

Anti-emetic drugs, Miscellaneous sedatives & hypnotics, Sedating Anti-histamine

Promethazine is a phenothiazine derivative which blocks postsynaptic mesolimbic dopaminergic receptors in the brain. It exhibits strong α-adrenergic blocking effect and depresses the release of hypothalamic and hypophyseal hormones. It competes with histamine for the H1-receptor; muscarinic blocking effect may be responsible for antiemetic activity. It also reduces stimuli to the brainstem reticular system.

Promethazine is well absorbed from the gastrointestinal tract. Clinical effects are apparent within 20 minutes after oral administration and generally last four to six hours, although they may persist as long as 12 hours. Promethazine is metabolized by the liver to a variety of compounds; the sulfoxides of promethazine and N-demethylpromethazine are the predominant metabolites appearing in the urine.

Adults: Initial dose one 25 mg tablet at night; may be increased to two or three 25 mg tablets at night if necessary. In allergic conditions more frequently administration, twice or three times daily, may be necessary, starting with one or two 10 mg tablets and increasing as required.

Elderly: No specific dosage recommendations.

Children: They may be treated more conveniently by the elixir containing 5 mg/5 ml.

As an antihistamine in allergy:

• Children of 2-5 years: 5-15 mg
• Children of 5-10 years: 10-25 mg
• In the case where two doses in 24 hours are required, the lower dose stated should be given.

As a sedative:

• Children of 2-5 years: 15-20 mg
• Children of 5-10 years: 20-25 mg
• Given as a single night-time dose

• Nervous system disorders: Frequency Unknown: Neuroleptic Malignant Syndrome the elderly are particularly susceptible to the anticholinergic efects and confusion due to Promethazine, somnolence, dizziness, headaches, extrapyramidal efects including muscle spasm, tic-like movements of the head and face. A very serious and sometimes deadly health problem called neuroleptic malignant syndrome (NMS) may happen. Stop treatment and call your doctor right away if you have high fever, muscle cramps or stifness, dizziness, very bad headache, fast heartbeat, confusion, agitation, hallucinations, or are sweating a lot.
• Immune System Disorders- Frequency unknown: Allergic reactions, including urticaria, rash, pruritus, and anaphylaxis, have been reported.
• Skin and Subcutaneous Tissue Disorders- Frequency unknown: Photosensitivity reaction
• Metabolism and Nutrition Disorders- Frequency unknown: Anorexia
• Gastrointestinal Disorders- Frequency unknown: Epigastric discomfort, dry mouth
• Eye Disorders- Frequency unknown: Blurred vision
• Blood and Lymphatic System Disorders- Frequency unknown: Blood dyscrasias including hemolytic anemia, agranulocytosis
• Renal and Urinary Disorders- Frequency unknown: Urinary retention
• Psychiatric Disorders- Frequency unknown: Infants, newborns and premature are susceptible to the anticholinergic efects of promethazine, while other children may display paradoxical hyperexcitability, restlessness, nightmares, disorientation
• Cardiac Disorders- Frequency unknown: Palpitations, arrhythmias
• Vascular disorders- Frequency unknown: Hypotension
• Hepatobiliary disorders- Frequency unknown: Jaundice
• General Disorders and Administration Site Conditions- Frequency unknown: Tiredness

Use this drug only as recommended. Do not exceed the recommended dose. There have been case reports of promethazine abuse. Do not take for longer than 10 days.

There is epidemiological evidence for the safety of promethazine in pregnancy and animal studies have shown no hazard, nevertheless, it should not be used in pregnancy unless the physician considers it essential. The use of Phenergan is not recommended in the two weeks prior to delivery in view of the risk of irritability and excitement in the neonate. When promethazine has been given in high doses during late pregnancy, promethazine has caused prolonged neurological disturbances in the infant. Promethazine should be used in pregnancy only if the potential benefts to the patient are weighed against the possible risk to the fetus. Promethazine is excreted in breastmilk. There are risks of neonatal irritability and excitement.

Symptoms of severe over dosage are variable. They are characterised in children by various combinations of excitation, ataxia, incoordination, athetosis and hallucinations, while adults may become drowsy and lapse into coma. Convulsions may occur in both adults and children; coma or excitement may precede their occurrence. Tachycardia may develop. Cardiorespiratory depression is uncommon. If the patient is seen soon enough after ingestion, it should be possible to induce vomiting with ipecacuanha despite the antiemetic efect of promethazine; alternatively, gastric lavage may be used. Treatment is otherwise supportive with attention to maintenance of adequate respiratory and circulatory status. Convulsions should be treated with diazepam or other suitable anticonvulsant.

Protect from light. Do not use later than the date of expiry. Keep all medicines out of the reach of children. To be dispensed only on the prescription of a registered physician

Anti-emetic drugs, Miscellaneous sedatives & hypnotics, Sedating Anti-histamine

Promethazine is a phenothiazine derivative which blocks postsynaptic mesolimbic dopaminergic receptors in the brain. It exhibits strong α-adrenergic blocking effect and depresses the release of hypothalamic and hypophyseal hormones. It competes with histamine for the H1-receptor; muscarinic blocking effect may be responsible for antiemetic activity. It also reduces stimuli to the brainstem reticular system.

Promethazine is well absorbed from the gastrointestinal tract. Clinical effects are apparent within 20 minutes after oral administration and generally last four to six hours, although they may persist as long as 12 hours. Promethazine is metabolized by the liver to a variety of compounds; the sulfoxides of promethazine and N-demethylpromethazine are the predominant metabolites appearing in the urine.

Adults: Initial dose one 25 mg tablet at night; may be increased to two or three 25 mg tablets at night if necessary. In allergic conditions more frequently administration, twice or three times daily, may be necessary, starting with one or two 10 mg tablets and increasing as required.

Elderly: No specific dosage recommendations.

Children: They may be treated more conveniently by the elixir containing 5 mg/5 ml.

As an antihistamine in allergy:

• Children of 2-5 years: 5-15 mg
• Children of 5-10 years: 10-25 mg
• In the case where two doses in 24 hours are required, the lower dose stated should be given.

As a sedative:

• Children of 2-5 years: 15-20 mg
• Children of 5-10 years: 20-25 mg
• Given as a single night-time dose

• Nervous system disorders: Frequency Unknown: Neuroleptic Malignant Syndrome the elderly are particularly susceptible to the anticholinergic efects and confusion due to Promethazine, somnolence, dizziness, headaches, extrapyramidal efects including muscle spasm, tic-like movements of the head and face. A very serious and sometimes deadly health problem called neuroleptic malignant syndrome (NMS) may happen. Stop treatment and call your doctor right away if you have high fever, muscle cramps or stifness, dizziness, very bad headache, fast heartbeat, confusion, agitation, hallucinations, or are sweating a lot.
• Immune System Disorders- Frequency unknown: Allergic reactions, including urticaria, rash, pruritus, and anaphylaxis, have been reported.
• Skin and Subcutaneous Tissue Disorders- Frequency unknown: Photosensitivity reaction
• Metabolism and Nutrition Disorders- Frequency unknown: Anorexia
• Gastrointestinal Disorders- Frequency unknown: Epigastric discomfort, dry mouth
• Eye Disorders- Frequency unknown: Blurred vision
• Blood and Lymphatic System Disorders- Frequency unknown: Blood dyscrasias including hemolytic anemia, agranulocytosis
• Renal and Urinary Disorders- Frequency unknown: Urinary retention
• Psychiatric Disorders- Frequency unknown: Infants, newborns and premature are susceptible to the anticholinergic efects of promethazine, while other children may display paradoxical hyperexcitability, restlessness, nightmares, disorientation
• Cardiac Disorders- Frequency unknown: Palpitations, arrhythmias
• Vascular disorders- Frequency unknown: Hypotension
• Hepatobiliary disorders- Frequency unknown: Jaundice
• General Disorders and Administration Site Conditions- Frequency unknown: Tiredness

Use this drug only as recommended. Do not exceed the recommended dose. There have been case reports of promethazine abuse. Do not take for longer than 10 days.

There is epidemiological evidence for the safety of promethazine in pregnancy and animal studies have shown no hazard, nevertheless, it should not be used in pregnancy unless the physician considers it essential. The use of Phenergan is not recommended in the two weeks prior to delivery in view of the risk of irritability and excitement in the neonate. When promethazine has been given in high doses during late pregnancy, promethazine has caused prolonged neurological disturbances in the infant. Promethazine should be used in pregnancy only if the potential benefts to the patient are weighed against the possible risk to the fetus. Promethazine is excreted in breastmilk. There are risks of neonatal irritability and excitement.

Symptoms of severe over dosage are variable. They are characterised in children by various combinations of excitation, ataxia, incoordination, athetosis and hallucinations, while adults may become drowsy and lapse into coma. Convulsions may occur in both adults and children; coma or excitement may precede their occurrence. Tachycardia may develop. Cardiorespiratory depression is uncommon. If the patient is seen soon enough after ingestion, it should be possible to induce vomiting with ipecacuanha despite the antiemetic efect of promethazine; alternatively, gastric lavage may be used. Treatment is otherwise supportive with attention to maintenance of adequate respiratory and circulatory status. Convulsions should be treated with diazepam or other suitable anticonvulsant.

Protect from light. Do not use later than the date of expiry. Keep all medicines out of the reach of children. To be dispensed only on the prescription of a registered physician

Hydrocortisone, Neomycin Sulphate & Polymixin B ear drops are indicated for the treatment of bacterial ear infections. It will not work for other types of ear infections. Unnecessary use or overuse of any antibiotic can lead to its decreased effectiveness.

Ophthalmic steroid - antibiotic combined preparations, Ophthalmic Steroid preparations

Polymyxin B sulphate and neomycin sulphate belong to a group of medicines called antibiotics. They kill the germs that can cause ear infections. The anti-infective components in the combination are included to provide action against specific organisms susceptible to them. Neomycin sulfate and polymyxin B sulfate together are considered active against the following microorganisms: Staphylococcus aureus, Escherichia coli, Haemophilus influenzae, Klebsiella-Enterobacter species, Neisseria species, and Pseudomonas aeruginosa. This product does not provide adequate coverage against Serratia marcescens and streptococci, including Streptococcus pneumoniae.

Hydrocortisone belongs to a group of medicines called steroids. It helps to reduce the swelling and irritation caused by the infection. Hydrocortisone suppress the inflammatory response to a variety of agents and they may delay healing. Since Hydrocortisone may inhibit the body’s defense mechanism against infection, a concomitant antimicrobial drug may be used when this inhibition is considered to be clinically significant in a particular case.

Adults and children over 3 years old: Apply 3 drops into the affected ear up to four times a day, for up to 7 days. Make sure you finish the course of this drop which your doctor has prescribed.

The following side effects rarely may happen with this medicine: seem to get worse instead of better, become red, scaly and itchy.

Contraindicated-

• if you are allergic (hypersensitive) to polymyxin B sulphate, neomycin sulphate, hydrocortisone or any of the other ingredients of this preparation.
• if you are allergic (hypersensitive) to aminoglycoside antibiotics such as framycetin, kanamycin or gentamicin
• if you have a perforated ear drum
• if you have either a viral, fungal or tubercular (TB) infection
• for a child under 3 years old.

Caution should be taken if you have kidney problems. If you have a long-standing infection of your outer ear.

Additive toxicity with neurotoxic, ototoxic or nephrotoxic drugs. Increased neuromuscular blockade and possibly respiratory depression with neuromuscular blocking agents if significant amounts of neomycin absorbed significantly.

Do not use this preparation if you are pregnant or plan to get pregnant. Do not breast-feed while using this.

Keep out of the reach and sight of children. Do not store above 25°C. Should be stored in the carton to protect it from light.

লাইনেসট্রেনল ও ইথিনাইল এস্ট্রাডিয়েল একটি কম্বাইন্ড গর্ভনিরোধক পিল যা খাওয়ার গর্ভনিরোধক হিসাবে নির্দেশিত।

Oral Contraceptive preparations

প্রতিদিন যথাসম্ভব একই সময়ে নির্দেশ অনুযায়ী পিল খেতে হবে। আপনার মাসিক শুরুর প্রথম দিনই পিল খেতে শুরু করবেন। মাসিকের ২-৫ দিনের ভিতরে যে কোন দিন পিল খাওয়া শুরু করা যায় , কিন্তু সেইক্ষেত্রে প্রথম মাসে পিল খাওয়াকালীন প্রথম সাত দিন কনডম ব্যবহার করা উচিত। প্রতিদিন ১ টি করে , পর পর ২২ দিন পিল খাবেন। ৬ দিনের পিল মুক্ত সময়ের পর পরবর্তী নতুন প্যাকেট থেকে পিল খাওয়া শুরু করবেন ।

এই ৬ দিনের ভিতরেই আপনার মাসিক হবে যা কখনো কখনো পরবর্তী প্যাকেট শুরুর আগে পর্যন্ত চলতে পারে। মাসিক চলতে থাকলেও এই পিল এর পরবর্তী প্যাকেট সপ্তম দিনে আরম্ভ করুন। আপনি যত দিন সন্তান না চাইবেন , ততদিন এই নিয়মে পিল খাওয়া চালিয়ে যাবেন।

প্রাথমিক পর্যায়ে কারও কারও সাময়িক কিছু পার্শ্ব প্রতিক্রিয়া যেমন মাথা ব্যাথা, মাথা ঘোরা, বমি বমি ভাব অথবা পিল খাওয়াকালীন সময়ে সামান্য ফোটা ফোঁটা আকারে মাসিক হতে পারে। কিন্তু নিয়মিত পিল খেতে থাকলে স্বাভাবিকভাবেই এই সমস্ত উপসর্গ দুই থেকে তিন মাসের মধ্যে দূরীভূত হয়ে যাবে। এই সকল উপসর্গের জন্য অতিরিক্ত চিন্তিত হবার কোন কারণ নাই। তবে পার্শ্ব প্রতিক্রিয়া যদি আরও বেশি দিন চলতে থাকে তখন অবশ্যই ডাক্তারের পরামর্শ নিতে হবে।

যে সব ক্ষেত্রে আপনি কম্বাইন্ড গর্ভনিরোধক ব্যবহার করতে পারবেন না-

• ভেনাস থ্রম্বসিস বর্তমানে উপস্থিত অথবা পূর্বে ছিল
• কার্ডিওভাসকুলার অ্যাক্সিডেন্ট ও মায়োকার্ডিয়াল ইনফারকশন অথবা ব্যাধির পূর্ব লক্ষণ
• ডায়াবেটিস মেলিটাসের সঙ্গে সংবহণ নালী সংক্রান্ত লক্ষণ থাকলে
• মারাত্মক রকমের উচ্চ রক্তচাপ
• সিভিয়ার ডিসলিপোপ্রোটিনেমিয়া
• জন্মগত অথবা অন্য কোন ভাবে ভেনাস অথবা আর্টারিয়াল থ্রম্বসিসের প্রবণতা থাকলে
• জনন অঙ্গসমূহ, স্তন অথবা লিভারে ম্যালিগন্যান্ট অবস্থার কথা জানা থাকলে অথবা সন্দেহ করলে
• লিভারের জটিল রোগ থাকলে এমনকি লিভার ফাংশন স্বাভাবিক অবস্থায় ফিরে আসতে ব্যর্থ হওয়ার পূর্ব বিবরন থাকলে
• অজ্ঞাত কারণে ভ্যাজাইনাল ব্লিডিং হলে
• এই পিলের যে কোন উপাদানে অতি সংবেদনশীলতা থাকলে

যদি নির্দিষ্ট সময়ে পিল না খাওয়া হয় এবং যদি ১২ ঘন্টা অতিক্রম না করে তা হলে পিলের কার্যক্ষমতা বজায় থাকে। এক্ষেত্রে যখনই মনে পড়বে তখনই পিলটি খেয়ে নিন এবং পরের পিল গুলি সঠিক সময়ে খাবেন।

যদি ১২ ঘন্টার বেশী সময় পার হয় তবে পিলের কার্যক্ষমতা কমে যায়। তখন আপনাকে নিম্নলিখিত নিয়ম পালন করতে হবে। মনে রাখবেন ১ম ও ৩য় সপ্তাহে যে কোন দিন পিল খেতে ভুলে গেলে বিশেষ সতর্কতার প্রয়োজন। অন্যথায় গর্ভধারনের ঝুঁকি বেশি হতে পারে।

প্রথম সপ্তাহে পিল খেতে ভুলে গেলে এবং ভুলে যাওয়ার আগে ঐ সন্তাহে যৌন মিলন করে থাকলে  ডাক্তারের পরামর্শ নিন । যদি যৌন মিলন না করে থাকেন তাহলেঃ

• ভুলে যাওয়া ট্যাবলেটটি খান
• সাতদিন অতিরিক্ত সাবধানতা গ্রহন করুন
• প্যাক শেষ করুন

দ্বিতীয় সপ্তাহে পিল খেতে ভুলে গেলেঃ

• ভুলে যাওয়া ট্যাবলেটটি খান
• প্যাক শেষ করুন

তৃতীয় সপ্তাহে পিল খেতে ভুলে গেলেঃ

• ভুলে যাওয়া ট্যাবলেটটি খান
• প্যাক শেষ করুন
• ট্যাবলেটহীন বিরতি বাদ দিন
• পরবর্তী প্যাক শুরু করুন

অথবা

• বর্তমান প্যাক বন্ধ করুন
• ট্যাবলেটহীন বিরতি পালন করুন
• ভুলে যাওয়া ট্যাবলেটের দিনসহ ৬ দিনের বেশি নয়
• পরবর্তী প্যাক শুরু করুন

প্যাকের একাধিক পিল ভুলে গেলে অবশ্যই ডাক্তারের পরামর্শ নিতে হবে। আপনি যদি প্যাকের পিল খেতে ভুলে যান এবং প্রথম পিল মুক্ত দিনে আপনার মাসিক না হয় তবে আপনি গর্ভবতী হতে পারেন। পরবর্তী প্যাক আরম্ভের আগে ডাক্তারের পরামর্শ নিন।

সতর্কতাঃ

অন্যান্য শারীরিক অবস্থা, যার জন্য সংবহনগত সমস্যা দেখা দিতে পারে, কিন্তু কম্বাইন্ড গর্ভনিরোধক ব্যবহারের সঙ্গে কোন সম্পর্ক নাই এই সকল ক্ষেত্রে অবশ্যই সতর্কতার প্রয়োজন। যেমন- ডায়াবেটিস মেলিটাস, সিষ্টেমিক লুপাস এরিথমেটোসাস, হিমোলাইটিক ইউরেমিক সিনড্রোম, পেটের নাড়িতে দীর্ঘস্থায়ী প্রদাহ ইত্যাদি এই সকল ক্ষেত্রে অবশ্যই সতর্কতার প্রয়োজন আছে। ঘন ঘন মাইগ্রেন দেখা দেওয়া, টিউমার, লিভারের কার্যকারিতার দীর্ঘদিনের সমস্যা এই সকল ক্ষেত্রেও সতর্কতার প্রয়োজন। বাচ্চাকে বুকের দুধ দিচ্ছেন এমন মহিলাদেরও সতর্কতার প্রয়োজন কারণ কম্বাইন্ড গর্ভনিরোধক পিল বুকের দুধের পরিমান এবং গুনগতমানের পরিবর্তন করতে পারে। ডায়াবেটিক আছে এমন মহিলারা খাওয়ার কম্বাইন্ড গর্ভনিরোধক ব্যবহারকালে বিশেষ করে যখন খাওয়া শুরু করবেন, তখন সতর্কতার প্রয়োজন। যে সব মহিলার ক্ষেত্রে ক্লোয়েসমা গ্রাভিডেরামের পূর্ব বিবরণ রয়েছে তারা চড়া রোদ উপেক্ষা করবেন।

কম্বাইন্ড গর্ভনিরোধক পিল ব্যবহারকারীদের নিম্নলিখিত অনাকাঙ্খিত সমস্যাসমূহ, যেমন স্তনের স্পর্শকাতরতা, মাথাধরা, মাইগ্রেন, কন্টাক্টলেন্সে অস্বস্তিবোধ হওয়া, ত্বকের বিভিন্ন সমস্যা, ইডিমা, শারীরিক ওজনের পরিবর্তন ইত্যাদি দেখা দিলে ডাক্তারের পরামর্শ নিন।

অ্যাম্পিসিলিন, টেট্রাসাইক্লিন, বারবিচুরেটস, হাইড্যান্টয়েনস, প্রিমিডন, কার্বামাজেপিন ও রিফামপিসিন এই জাতীয় কিছু কিছু ঔষধ পিলের কার্যকারিতা কমিয়ে দিতে পারে। পিল খাওয়াকালীন সময়ে যদি আরও কোন ঔষধ কোন কারনে খাওয়ার প্রয়োজন পড়ে তাহলে অবশ্যই ডাক্তারের সাথে পরামর্শ করুন।

গর্ভধারণ করলে অথবা এ ব্যাপারে সন্দেহ দেখা দিলে কম্বাইন্ড গর্ভনিরোধক ব্যবহার করতে পারবেন না।

আলো থেকে দূরে, ২°C-২৫°C তাপমাত্রায় শুষ্ক স্থানে রাখুন। শিশুদের নাগালের বাইরে রাখুন।

Anthelmintic

Levamisole is the active laevo-isomer of tetramisole. It works by paralysing susceptible intestinal worms which are then excreted from the intestines. Levamisole also enhances cellular immune responses in humans.

The following doses of Levamisole are given as a single administration, preferably after a light meal.

• Age 1-4 year: 1 Tablets or 5 ml Syrup
• Age 5-15 year: 2 Tablets or 10 ml Syrup
• Age 16 year and over: 3 Tablets or 15 ml Syrup

In cases of severe hookworm infection it is suggested that a second standard dose be given one or seven days after the first, whichever timing is feasible.

Side-effects are infrequent. They are usually mild and transient and include nausea, vomiting, abdominal pain, giddiness(dizziness) and headache. An encephalopathylike syndrome has been reported to have occurred in a few patients two or three weeks after treatment.

There is no absolute contra-indication to the use of Levamisole

Effect on ability to drive or operate machinery: There is no evidence to suggest that Levamisole , used for anthelmintic purpose, will produce sedation. Mild and transient giddiness is an infrequent side-effect of treatment. No precautions are suggested concerning the ability to drive or operate machinery.

In case of concurrent microfilaraemia transient fever may occur.

May increase toxicity of phenytoin. Increases bioavailability of ivermectin; decreases bioavailability of albendazole. Alcohol causes disulfiram-like reaction.

Although studies in animals have shown that Levamisole produces no teratogenic effects, current medical practice requires that the benefits of any drug used during pregnancy should be weighed against the possible dangers.

Counter possible anticholinesterase activity with e.g. atropine. Control blood pressure and respiration . Do not use sedatives.

Tablet: Store in room temperature and protect from moisture.
Syrup: Store in room temperature and protect from light.

Niraparib is indicated for the maintenance treatment of adult patients with recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer who are in a complete or partial response to platinum-based chemotherapy.

Cytotoxic Chemotherapy

Niraparib is an inhibitor of poly (ADP-ribose) polymerase (PARP) enzymes, PARP-1 and PARP-2, which play a role in DNA repair. In vitro studies have shown that niraparib induced cytotoxicity may involve inhibition of PARP enzymatic activity and increased formation of PARP-DNA complexes resulting in DNA damage, apoptosis and cell death. Increased Niraparib-induced cytotoxicity was observed in tumor cell lines with or without deficiencies in BRCA1/2. Niraparib decreased tumor growth in mouse xenograft models of human cancer cell lines with deficiencies in BRCA1/2 and in human patient-derived xenograft tumor models with homologous recombination deficiency that had either mutated or wild type BRCA1/2.

Absorption: The absolute bioavailability of niraparib is approximately 73%. Following oral administration of Niraparib, peak plasma concentration, Cmax, is reached within 3 hours. Concomitant administration of a high fat meal (800-1,000 calories with approximately 50% of total caloric content of the meal from fat) did not significantly affect the pharmacokinetics of Niraparib.

Distribution: Niraparib is 83.0% bound to human plasma proteins. The average (±SD) apparent volume of distribution (Vd/F) was 1220 (±1114) L. In a population pharmacokinetic analysis, the Vd/F of Niraparib was 1074 L in cancer patients.

Elimination: Following multiple daily doses of 300 mg Niraparib, the mean half-life (t1/2) is 36 hours. In a population pharmacokinetic analysis, the apparent total clearance (CL/F) of niraparib was 16.2 L/h in cancer patients.

Metabolism: Niraparib is metabolized primarily by carboxylesterases (CEs) to form a major inactive metabolite, which subsequently undergoes glucuronidation.

Excretion: Following administration of a single oral 300 mg dose of radio-labeled Niraparib, the average percent recovery of the administered dose over 21 days was 47.5% (range 33.4% to 60.2%) in urine and 38.8% (range 28.3% to 47.0%) in feces. In pooled samples collected over 6 days, unchanged Niraparib accounted for 11% and 19% of the administered dose recovered in urine and feces, respectively

The recommended dose of Niraparib as monotherapy is 300 mg (three 100 mg capsules) taken orally once daily. Instruct patients to take their dose of Niraparib at approximately the same time each day. Each capsule should be swallowed whole. Niraparib may be taken with or without food. Bedtime administration may be a potential method for managing nausea. Patients should start treatment with Niraparib no later than 8 weeks after their most recent platinum-containing regimen. Niraparib treatment should be continued until disease progression or unacceptable toxicity. In the case of a missed dose of Niraparib, instruct patients to take their next dose at its regularly scheduled time. If a patient vomits or misses a dose of Niraparib, an additional dose should not be taken.

Niraparib is for oral use. The capsules should be swallowed whole with water. The capsules should not be chewed or crushed. Niraparib can be taken without regard to meals.

In the pivotal ENGOT-OV16 study, adverse reactions (ADRs) occurring > 10% of patients receiving Niraparib monotherapy were nausea, thrombocytopenia, fatigue/asthenia, anaemia, constipation, vomiting, abdominal pain, neutropenia, insomnia, headache, decreased appetite, nasopharyngitis, diarrhoea, dyspnea, hypertension, dyspepsia, back pain, dizziness, cough, urinary tract infection, arthralgia, palpitations, and dysgeusia. The most common serious adverse reactions >1% (treatment-emergent frequencies) were thrombocytopenia and anaemia.

Hypersensitivity to the active substance or to any of the excipients & breast-feeding.

Myelodysplastic syndrome/acute myeloid leukaemia: Myelodysplastic syndrome/acute myeloid leukaemia (MDS/AML), including cases with fatal outcome, have been reported in a small number of patients who received Niraparib or placebo. In the pivotal Phase 3 international trial (ENGOT-OV16), the incidence of MDS/AML in patients who received niraparib (1.4%) was similar to that in patients who received placebo (1.1%). Overall, MDS/AML has been reported in 7 out of 751 (0.9%) patients treated with Niraparib in clinical studies. The duration of Niraparib treatment in patients prior to developing MDS/AML varied from 1 month to > 2 years. The cases were typical of secondary, cancer therapy-related MDS/AML. All patients had received multiple platinum-containing chemotherapy regimens and many had also received other DNA damaging agents and radiotherapy. Some of the patients had a history of bone marrow dysplasia. If MDS and/or AML are confirmed while on treatment with Niraparib, treatment should be discontinued and the patient treated appropriately.

Hypertension including hypertensive crisis: Hypertension, including hypertensive crisis, has been reported with the use of Niraparib. Pre-existing hypertension should be adequately controlled before starting Niraparib treatment. Blood pressure should be monitored monthly for the first year and periodically thereafter during treatment with Niraparib. Hypertension should be medically managed with antihypertensive medicinal products as well as adjustment of the Niraparib dose, if necessary. In the clinical programme, blood pressure measurements were obtained on Day 1 of each 28-day cycle while the patient remained on Niraparib. In most cases, hypertension was controlled adequately using standard antihypertensive treatment with or without Niraparib dose adjustment. Niraparib should be discontinued in case of hypertensive crisis or if medically significant hypertension cannot be adequately controlled with antihypertensive therapy.

Pregnancy/contraception: Niraparib should not be used during pregnancy or in women of childbearing potential not willing to use reliable contraception during therapy and for 1 month after receiving the last dose of Niraparib. A pregnancy test should be performed on all women of childbearing potential prior to treatment.

Lactose: Niraparib hard capsules contain lactose monohydrate. Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose galactose malabsorption should not take this medicine.

Tartrazine (E102): This medicinal product contains tartrazine (E 102), which may cause allergic reactions.

Inhibition of CYPs (CYP1A2, CYP2B6, CYP2C8, CYP2C9, CYP2C19, CYP2D6, and CYP3A4). Neither Niraparib nor M1 is an inhibitor of any active ubstance-metabolising CYP enzymes, namely CYP1A1/2, CYP2B6, CYP2C8, CYP2C9, CYP2C19, CYP2D6 and CYP3A4/5. Even though inhibition of CYP3A4 in the liver is not expected, the potential to inhibit CYP3A4 at the intestinal level has not been established at relevant Niraparib concentrations. Therefore, caution is recommended when Niraparib is combined with active substances the metabolism of which is CYP3A4-dependent and, notably, those having a narrow therapeutic range (e.g. ciclosporin, tacrolimus, alfentanil, ergotamine, pimozide, quetiapine and halofantrine).

Induction of CYPs (CYP1A2 and CYP3A4): Neither Niraparib nor M1 is a CYP3A4 inducer in vitro. In vitro, Niraparib weakly induces CYP1A2 at high concentrations and the clinical relevance of this effect would not be completely ruled out. M1 is not a CYP1A2 inducer. Therefore, caution is recommended when niraparib is combined with active substances the metabolism of which is CYP1A2-dependent and, notably, those having a narrow therapeutic range (e.g. clozapine, theophylline and ropinirole).

Women of childbearing potential/contraception in females Women of childbearing potential should not become pregnant while on treatment and should not be pregnant at the beginning of treatment. A pregnancy test should be performed on all women of childbearing potential prior to treatment. Women of childbearing potential must use effective contraception during therapy and for 1 month after receiving the last dose of Niraparib.

Pregnancy: There are no or limited amount of data from the use of Niraparib in pregnant women. Animal reproductive and developmental toxicity studies have not been conducted. However, based on its mechanism of action, niraparib could cause embryonic or foetal harm, including embryo-lethal and teratogenic effects, when administered to a pregnant woman. Niraparib should not be used during pregnancy.

Breast-feeding: It is unknown whether niraparib or its metabolites are excreted in human milk. Breast-feeding is contraindicated during administration of Niraparib and for 1 month after receiving the last dose.

Fertility: There are no clinical data on fertility. A reversible reduction of spermatogenesis was observed in rats and dogs.

Elderly: No dose adjustment is necessary for elderly patients (> 65 years). There are limited clinical data in patients aged 75 or over.

Paediatric population: The safety and efficacy of niraparib in children and adolescents below 18 years of age have not yet been established. No data are available.

Renal impairment: No dose adjustment is necessary for patients with mild to moderate renal impairment. There are no data in patients with severe renal impairment or end-stage renal disease undergoing hemodialysis; use with caution in these patients.

Hepatic impairment: No dose adjustment is needed in patients with mild to moderate hepatic impairment. There are no data in patients with severe hepatic impairment; use with caution in these patients.

There is no specific treatment in the event of Niraparib overdose, and symptoms of overdose are not established. In the event of an overdose, physicians should follow general supportive measures and should treat symptomatically.

Store in a cool and dry place. Do not store above 30°C. Do not take Niraparib if it is suspected of having been exposed to temperatures greater than 40°C or 104°F. Keep Niraparib out of the reach and sight of children.

Letrozole is indicated for the first-line treatment of advanced/metastatic breast cancer (hormone receptor positive or receptor status unknown) in post-menopausal women.

Hormonal Chemotherapy

Mechanism of Action: Letrozole is a potent and highly specific nonsteroidal aromatase inhibitor. It inhibits the aromatase enzyme by competitively binding to the haem of the cytochrome P450 subunit of the enzyme, resulting in a reduction of estrogen biosynthesis in all tissues. Letrozole exerts its antitumor effect by depriving estrogen-dependent breast cancer cells of their growth stimulus. In postmenopausal women, estrogens are derived mainly from the action of the aromatase enzyme, which coverts adrenal androgens primarily androstenedione and testosterone-to oestrone (E1) and oestradiol (E2). The suppression of estrogen biosynthesis in the peripheral tissues and the malignant tissues can be achieved by specifically inhibiting the aromatase enzyme.

In healthy postmenopausal women, single doses of 0.1, 0.5 and 2.5mg letrozole suppress serum oestrone and oestradiol by 75-78% and 78% from baseline respectively. Maximum suppression is achieved in 48-78 hours. In post-menopausal patients, with advanced breast cancer, daily doses of 0.1 to 5mg suppress plasma concentration of oestradiol, oestrone, and oestrone sulphate by 78-95% from baseline in all patients treated. Letrozole had no effect on plasma androgen concentrations (androstenedione and testosterone) among healthy postmenopausal women after single doses of 0.1, 0.5 and 2.5mg indicating that the blockade of estrogen biosynthesis does not lead to accumulation of androgenic precursors. Impairment of adrenal steroidogenesis has not been observed.

Pharmacokinetics: Letrozole is rapidly and completely absorbed from the gastrointestinal tract (absolute bioavailability 99.9%). Food slightly decreases the rate of absorption, but the extent of absorption remains unchanged. The minor effect of the absorption rate is not considered to be of clinical relevance and therefore letrozole may be taken after, with or before food. Plasma protein binding of letrozole is approximately 60%, mainly to albumin (55%). The concentration of letrozole in erythrocytes is about 80% of that in plasma. Metabolic clearance to a pharmacologically inactive carbinol metabolite is the major elimination pathway of letrozole but is relatively slow when compared to hepatic blood flow. The cytochrome P450 isoenzymes 3A4 and 2A6 were found to be capable of converting letrozole to this metabolite in vitro but their individual contributions to letrozole metabolism in vivo have not been established. The apparent terminal elimination half-life in plasma is about 2 days. After daily administration of 2.5mg of letrozole, steady-state levels are reached within 2 to 6 weeks.

The recommended dose of Letrozole is 2.5 mg once daily. Treatment with Letrozole should continue as long as tumor response is seen. The drug should be discontinued if tumor stops responding as judged by tumor progression. For elderly patients, no modification of the normal adult dosage regimen is necessary. No dosage adjustment is required for patients with mild to moderate hepatic impairment or renal impairment.

Adverse events associated with letrozole are generally mild to moderate and rarely severe enough to require discontinuation. Many can be attributed to either the underlying disease or the normal pharmacological consequence of oestrogen deprivation (hot flushes, hair thinning). The most frequently reported adverse events are musculoskeletal pain, arthralgia, headache, fatigue, nausea, dyspnoea, peripheral oedema, coughing, constipation, vomiting, chest pain, viral infection, diarrhoea, rash, abdominal pain, dyspepsia and anorexia. Dizziness, weight increase and pruritus are less commonly seen.

Letrozole is contraindicated in known or suspected hypersensitivity to letrozole, other aromatase inhibitors, or to any of their ingredients. It is contraindicated during pregnancy, lactation and in pre-menopausal women. It is also contraindicated in severe hepatic dysfunction.

In breast cancer patients with moderate hepatic dysfunction, no dosage adjustment is necessary, but caution is recommended since letrozole elimination depends mainly on intrinsic metabolic clearance. Renal impairment (calculated creatinine clearance: 20 to 50 ml/min) did not affect steady-state plasma letrozole concentration at a dose of 2.5 mg or 5 mg. Hence, no dose adjustment is necessary for such renal function impairment. It is anticipated that letrozole could be removed from blood by dialysis since it is weakly bound to plasma proteins. The potential risks and benefits to such patients should be considered carefully before prescribing letrozole. In some cases, fatigue and dizziness have been observed with the use of letrozole. Patients should therefore, be advised that their physical and/or mental abilities required for operating machinery or driving a car may be impaired.

Clinical interaction studies with cimetidine and warfarin indicated that the co-administration of letrozole with these drugs does not result in clinically significant drug reactions, even through cimetidine is a known inhibitor of one of the cytochrome P450 isoenzymes capable of metabolising letrozole in vitro.

Oral administration of letrozole in pregnant rats resulted in teratogenicity and maternal toxicity at 0.03 mg/kg. Embryotoxicity and foetotoxicity were seen at doses >0.003 mg/kg and there was an increase in the incidence of foetal malformation among the animals treated. However, there are no adequate and well-controlled studies of letrozole in pregnant women and its use in these patients is not recommended. It is not known whether letrozole is excreted in human milk. Because many drugs are excreted in human milk, letrozole should not be administered to a nursing woman.

There is no clinical experience of overdosage. There is no specific antidote to letrozole. Since letrozole is not highly protein-bound, dialysis may be helpful. Emesis may be induced if the patient is alert. In general, supportive care and frequent monitoring of vital signs is appropriate.

Keep below 30°C temperature, away from light & moisture. Keep out of the reach of children.

4-Quinolone preparations

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.

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.

1.5% eye drop: Adults and children 6 years of age and older:

• 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.

Children <1 year: Safety and effectiveness of Levofloxacin below 1 year of age have not been established.

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.

It is contraindicated in patients with a history of hypersensitivity to Levofloxacin, to other quinolones or to any of the components of this medication

Prolonged use may result in the overgrowth of non-susceptible organisms, including fungi. If superinfection occurs, discontinue use and institute alternative therapy.

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 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.

Eye drops should be protected from light, store in a cool (15°-25° C) and dry place & keep out of reach of children.

4-Quinolone preparations

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.

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:

• 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:

• Children 6 months to <5 years: 10 mg/kg every 12 hours.
• Children >5 years: 10 mg/kg every 24 hours

In each case, sequential therapy (intravenous to oral) may be instituted at the discretion of the physician.

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.

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.

Levofloxacin is contraindicated in patients with a history of hypersensitivity to levofloxacin, quinolone antimicrobial agents, or any other components of this product.

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.

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.

Levofloxacin is not recommended for use during pregnancy or nursing, as the effects on the unborn child or nursing infant are unknown.

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.

Keep below 30°C temperature, away from light & moisture. Keep out of the reach of children.

4-Quinolone preparations

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.

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.

1.5% eye drop: Adults and children 6 years of age and older:

• 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.

Children <1 year: Safety and effectiveness of Levofloxacin below 1 year of age have not been established.

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.

It is contraindicated in patients with a history of hypersensitivity to Levofloxacin, to other quinolones or to any of the components of this medication

Prolonged use may result in the overgrowth of non-susceptible organisms, including fungi. If superinfection occurs, discontinue use and institute alternative therapy.

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 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.

Eye drops should be protected from light, store in a cool (15°-25° C) and dry place & keep out of reach of children.

Drugs for Infertility, Drugs for menopausal symptoms: Hormone replacement therapy, Female Sex hormones

Estriol Cream is a Hormone Replacement Therapy (HRT). It contains the female hormone estriol (an estrogen). During menopause Estriol is used in vagina which is slowly released and absorbed into the surrounding area and into the bloodstream.

Estriol induces the normalization of the vaginal epithelium and thus helps to restore the normal microflora and the physiological pH in the vagina. As a result, it increases the resistance of the vaginal epithelial cells to infection and inflammation. In comparison to other estrogens, estriol is short acting. In the years just before and after the menopause (which can be natural or surgically induced) estriol can be used in the treatment of symptoms and complaints related to estrogen deficiency. Estriol is particularly used in the treatment of urogenital symptoms.

Estriol cream should be used as per physician's advice. Each dose of cream contains 0.5 mg estriol.

• For vulvo-vaginal complaints associated with menopause: Initially one dose of cream per day for 3 weeks. Later you may only need one dose of cream twice a week.
• Before surgery: One dose of cream daily 2 weeks before the operation. When having a Pap smear your doctor may recommend a daily application of cream for 7 days.

How to apply the cream:

• Remove cap from the tube, invert it, and use the sharp point to open the tube.
• Pull the plunger up to the ring. Now attach it to the opening of the tube.
• Squeeze the tube slowly to fill the applicator to the ring-mark (where the plunger stops).
• Remove the tube.
• To apply the cream, lie down; insert the applicator deep into the vagina.
• Slowly push the plunger all the way in until the applicator is empty
• After use, pull the plunger out of the barrel beyond the point of resistance and wash both parts in warm, soapy water. Do not use detergents. Rinse well and dry afterwards. Do not put the applicator in hot or boiling water.
• The applicator can be re-assembled by fully inserting the plunger into the barrel beyond the point where resistance is felt.
• Discard the applicator once the tube is empty. Take Estriol cream before taking rest or going to sleep.If you forget a dose, use it as soon as you remember. But if you remember your missed dose at the time of your next dose, do not use an extra dose. Do not use a double dose to make up for the missed dose. This may increase the chance of you getting an unwanted side effect.

Do not use Estriol cream if:

• You have or have ever had breast cancer, or if you are suspected of having it, ovarian cancer, heart attack, stroke, angina, liver disease , thrombosis, pulmonary embolism, vaginal cancer.
• You are pregnant or think you may be pregnant
• You have any unexplained vaginal bleeding, blood clotting disorder, endometrial hyperplasia, porphyria, and various kind of allergic reaction.
• Jaundice, migraine pain, high blood pressure & breathing problem
• You have had an allergic reaction to estriol, or any of the other ingredients of estriol

Patients should keep under doctor’s observation for any Hormone Replacement Therapy (HRT). Same role is applicable for the application of Estriol cream. Doctor will give continuous advice regarding risks & benefts of the drug. But in case of jaundice, sudden high blood pressure, migraine, severe headache or pregnancy, the use of Estriol cream will be stopped immediately. Children’s are not allowed to use Estriol cream.

Interaction is found with Anticoagulants,corticosteroid hormones, succinylcholine, theophyllines, and medicines for epilepsy, medicines for fungal or bacterial infections, viral infections, and herbal preparations containing St John's Wort. As a result irregular bleeding may occur.

This medicine is contraindicated during pregnancy & lactation.

Store below 25°C. Protect from light and moisture. Keep out of reach of children.

Drugs for Infertility, Drugs for menopausal symptoms: Hormone replacement therapy, Female Sex hormones

Estriol induces the normalization of the vaginal epithelium and thus helps to restore the normal microflora and the physiological pH in the vagina. As a result, it increases the resistance of the vaginal epithelial cells to infection and inflammation. In comparison to other estrogens, estriol is short acting. In the years just before and after the menopause (which can be natural or surgically induced) estriol can be used in the treatment of symptoms and complaints related to estrogen deficiency. Estriol is particularly used in the treatment of urogenital symptoms.

After oral administration, estriol is rapidly and almost completely absorbed from the gastrointestinal tract. Peak plasma levels of unconjugated estriol are reached within 1 hr of administration. Nearly all (90%) estriol is bound to albumin in the plasma and unlike other estrogens; estriol is hardly bound to sex hormone-binding globulin. The metabolism of estriol consists mainly of conjugation and deconjugation during enterohepatic circulation. Estriol, a metabolic end product, is mainly excreted via the urine in the conjugated form. Only a small fraction is excreted via the feces, mainly as unconjugated estriol.

It is important that the total daily dose is taken at one time. It may be taken with or without food.

• Atropy of the lower urogenital tract: 4-8 mg/day for the first weeks, followed by a gradual reduction, based on relief of symptoms, until a maintenance dosage (e.g. 1-2 mg/day) is reached.
• Pre and postoperative therapy in postmenopausal women undergoing vaginal surgery: 4-8 mg/day in the 2 weeks before surgery; 1-2 mg/day in the 2 weeks after surgery.
• Climacteric complaints such as hot flushes and night sweating: 4-8 mg/day during the first weeks, followed by a gradual reduction. For maintenance therapy the lowest effective dosage should be used.
• A diagnostic aid in case of a doubtful atrophic cervical smear: 2-4 mg/day for 7 days before taking the next smear.
• Infertility due to cervical hostility: In general 1-2 mg/day on days 6-15 of the menstrual cycle. However, for some patients dosages as low as 1 mg/day are sufficient, whereas others may need up to 8 mg/day. Therefore, the dosage should be increased each month until an optimal effect on the cervical mucus is obtained.

Breast tension or pain, nausea, spotting, fluid retention and cervical hypersecretion may occasionally occur and be indicative of too high dosage. Headache, hypertension, leg cramps and vision disturbances are seldom observed. In general, most of these adverse reactions disappear after the 1 st week of treatment.

Breast enlargement, vaginal candidiasis, change in vaginal bleeding pattern, vomiting, stomach cramps, cholestatic jaundice, chloasma or melasma, erythema multiforme, erythema nodosum, hemorrhagic eruption, mental depression, chorea, increasing or decreasing body weight, edema, changes in libido.

Contraindicated in pregnancy, known or suspected estrogen-dependent tumours, undiagnosed vaginal bleeding, untreated endometrial hyperplasia, known or suspected breast cancer.

During prolonged treatment with estrogens, periodic medical examinations are advisable. With vaginal infections, a concomitant specific treatment is recommended. In order to prevent endometrial stimulation, the daily dose should not exceed 8 mg nor should this maximum dose be used for longer than several weeks. Patients with any of the following conditions should be monitored: A history of latent or overt cardiac failure, fluid retention due to renal dysfunction, hypertension, epilepsy or migraine (or a history of these conditions), severe liver disorders, endometriosis, fibrocystic mastopathy, porphyria, hyperlipoproteinaemia, a history during pregnancy or previous use of steroids of severe pruritus, cholestatic jaundice or herpes gestationis. Estrogen is reported to increase the risk of endometrial carcinoma in postmenopausal women. Use with precaution in gallbladder disorders, hypercalcemia, additional progestin, hypercoagulability, urethral bleeding and mastodynia.

There are strong indications that estrogens, estriol included, can increase the pharmacologic effects of certain corticosteroids. If necessary, the dosage of the corticosteroid should be reduced. There are also some indications, mainly obtained with other estrogens or oral contraceptives, that concurrent use of estriol with activated charcoal, barbiturates, hydantoins and rifampicin may possibly decrease the effectiveness of estriol.

Estriol is contraindicated during pregnancy. Use Estriol in breastfeeding women only if really needed, as estriol is excreted in the milk and it may decrease the quality and quantity of the milk production.

Symptoms that may occur in the case of an acute overdosage are nausea, vomiting and possibly withdrawal bleeding in females. No specific antidote is known. If necessary, a symptomatic treatment should be instituted.

Keep below 30°C temperature, away from light & moisture. Keep out of the reach of children.

Female Sex hormones

The physicochemical, immunological, and biological activities of recombinant hCG are comparable to those of placental and human pregnancy urine-derived hCG. Choriogonadotropin alfa stimulates late follicular maturation and resumption of oocyte meiosis, and initiates rupture of the pre-ovulatory ovarian follicle. Choriogonadotropin alfa, the active component of Choriogonadotropin Alpha PreFilled Syringe, is an analogue of Luteinizing Hormone (LH) and binds to the LH/hCG receptor of the granulosa and theca cells of the ovary to effect these changes in the absence of an endogenous LH surge. In pregnancy, hCG, secreted by the placenta, maintains the viability of the corpus luteum to provide the continued secretion of estrogen and progesterone necessary to support the first trimester of pregnancy. Choriogonadotropin Alpha PreFilled Syringe is administered when monitoring of the patient indicates that sufficient follicular development has occurred in response to FSH treatment for ovulation induction.

Infertile Women Undergoing Assisted Reproductive Technologies (ART): Choriogonadotropin Alfa PreFilled Syringe 250 μg should be administered one day following the last dose of the follicle stimulating agent. Choriogonadotropin Alfa PreFilled Syringe should not be administered until adequate follicular development is indicated by serum estradioland vaginal ultrasonography. Administration should be withheld in situations where there is an excessive ovarian response, as evidenced by clinically significant ovarian enlargement or excessive estradiol production.

Infertile Women Undergoing Ovulation Induction (OI): Choriogonadotropin Alfa PreFilled Syringe should not be administered until adequate follicular development is indicated by serum estradiol and vaginal ultrasonography. Choriogonadotropin Alfa PreFilled Syringe 250 μg should be administered one day following the last dose of the follicle stimulating agent. Choriogonadotropin Alfa PreFilled Syringe administration should be withheld in situations where there is an excessive ovarian response, as evidenced by multiple follicular development, clinically significant ovarian enlargement or excessive estradiol production.

For Subcutaneous Use Only. Directions For Administration Of Choriogonadotropin Alfa Prefilled Syringe is intended for a single subcutaneous injection. Any unused material should be discarded. Choriogonadotropin Alfa PreFilled Syringe may be self-administered by the patient. Follow the directions below for injecting Choriogonadotropin Alfa PreFilled Syringe.

Step 1: Wash your hands thoroughly with soap and water.

Step 2: Carefully clean the injection site: Make yourself comfortable by sitting or lying down. Carefully clean the injection site on the stomach with an alcohol wipe and allow it to air-dry.

Step 3: Administer your injection: Carefully remove the needle cap from the syringe. Do not touch the needle or allow the needle to touch any surface. Inject the prescribed dose as directed by your doctor, nurse or pharmacist.
 
Step 4: Gently withdraw the needle: Discard the needle and syringe into your safety container. Place gauze over the injection site. If any bleeding occurs, apply gentle pressure. If bleeding does not stop within a few minutes, place a clean piece of gauze over the injection site and cover it with an adhesive bandage.

Step 5: Storage and clean up: Remember that your injection materials must be kept sterile and cannot be reused.

Injection site inflammation and reaction, flatulence, diarrhea, hiccup, ectopic pregnancy, breast pain, intermenstrual bleeding, vaginal hemorrhage, cervical lesion, leukorrhea, ovarian hyperstimulation, uterine disorders, vaginitis, vaginal discomfort, body pain, back pain, fever, dizziness, headache, hot flashes, malaise, paraesthesias, rash, emotional lability, insomnia, upper respiratory tract infection, cough, dysuria, urinary tract infection, urinary incontinence, albuminuria, cardiac arrhythmia, genital moniliasis, genital herpes, leukocytosis, heart murmurand cervical carcinoma.

Choriogonadotropin Alpha PreFilled Syringe is contraindicated in women who exhibit:

• Prior hypersensitivity to hCG preparations or one of their excipients.
• Primary ovarian failure.
• Uncontrolled thyroid or adrenal dysfunction.
• An uncontrolled organic intracranial lesion such as a pituitary tumor.
• Abnormal uterine bleeding of undetermined origin 
• Ovarian cyst or enlargement of undetermined origin
• Sex hormone dependent tumors of the reproductive tract and accessoryorgans.
• Pregnancy.

Gonadotropins, including Choriogonadotropin Alpha PreFilled Syringe (choriogonado-tropin alfa injection), should only be used by physicians who are thoroughly familiar with infertility problems and their management. Like other hCG products, Choriogonadotropin Alpha PreFilled Syringe is a potent gonadotropic substance capable of causing OvarianHyperstimulation Syndrome (OHSS) in women with or without pulmonary or vascularcomplications. The risks of gonadoptropin treatment should be considered for women with risk factors of thromboembolic events such as prior medical or family history. Gonadotropin therapy requires a certain time commitment by physicians and supportive health professionals, and requires the availability of appropriate monitoring facilities. Safe and effective induction of ovulation and use of Choriogonadotropin Alpha PreFilled Syringe in women requires monitoring of ovarian response with serum estradiol and transvaginal ultrasound on a regular basis.

Drng & other interactions: No clinically significant drug interactions have been reported during hCG therapy. Following administration, Ovidrel (choriogonadotrophin alfa) may interfere for up to ten days with the immunological determination of serum/urinary hCG, leading to a false positive pregnancy test. During Ovidrel therapy, a minor thyroid stimulation is possible of which the clinical relevance is unknown.

Pregnancy Category X. Intrauterine death and impaired parturition were observed in pregnant rats given a dose of urinary-hCG (500 IU) equivalent to three times the maximum human dose of 10,000, based on body surface area.

Nursing Mothers: It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised if hCG is administered to a nursing woman.

Pediatric Patients: Safety and effectiveness in pediatric patients has not been established.

Geriatric Patients: Safety and effectiveness in geriatric patients has not been established.

The Choriogonadotropin Alfa PreFilled Syringe must be stored refrigerated between 2-8° C before being dispensed to the patient. Patients should store the pre-filled syringe refrigerated to allow the product to be used until the expiry date shown on the syringe or carton. The Choriogonadotropin Alfa PreFilled Syringe may be stored by the patient for no more than 30 days at room temperature up to 25° C but must be used within those 30 days. Protect from light. Store in original package. Discard unused material.

Vitamin-A preparations

Beta-carotene, retinol, and retinal have effective and reliable vitamin A activity. Retinal and retinol are in chemical equilibrium in the body and have equivalent antixerophthalmic activity. Retinal combines with the rod pigment, opsin, in the retina to form rhodopsin, necessary for visual dark adaptation.

Vitamin A prevents retardation of growth and preserves the epithe-lial cells' integrity. Normal adult liver storage is sufficient to satisfy two years'requirements of vitamin A. Vitamin A is readily absorbed from the gastrointestinal tract, where the biosynthesis of vitamin A from beta-carotene takes place. Vitamin A absorption requires bile salts, pancreatic lipase, and dietary fat. It is transported in the blood to the liver by the chy lomicron fraction of the lymph. Vitamin Ais stored in Kupffer cells of the liver mainly as the palmitate. Normal serum vitamin A is 80-300 Units per 100 mL (plasma range is 30-70 mcg per dl) and for carotenoids 270-753 Units per 100 mL.The normal adult liver contains approximately 100 to 300 micrograms per gram, mostly as retinol palmitate.

For Adults: 50000 IU-100000 IU daily up to 200000 IU if necessary.

Children (Above 1 year):

• Night blindness, Bitot's spots, Xerophthalmia: 200000 IU 1st day, 2nd day, 14th day
• Measles: 200000 IU 1st day, 2nd day
• Diarrhoea, Respiratory tract infection: 200000 IU every time after disease
• Severe malnutrition: 200000 IU single-dose or as directed by the registered physician.

Vitamin A intoxication includes irritability, vomiting, loss of appetite, headache, dry and pruritic skin, skin desquamation, fatique, pain in ankles and feet, myalgia, loss of body hair, papilledema, nystagmus, liver sclerosis and cirrhosis.

Hypervitaminosis of vitamin A. Sensitivity to any of the ingredients in this preparation.

Ensure Vitamin A free interval after long term therapy with vitamin A. No daily dose over 5000 IU during pregnancy. Vitamin A doses over 50000 IU under medical supervision only.

Safety of amounts exceeding 6,000 Units of vitamin A daily during pregnancy has not been established at this time. The use of vitamin A in excess of the recommended dietary allowance may cause fetal harm when administered to a pregnant woman. Animal reproduction studies have shown fetal abnormalities associated with over-dosage in several species. Malformations of the central nervous system, the eye, the palate, and the urogenital tract are recorded. Vitamin Ain excess of the recommended dietary allowance is contraindicated in women who are or may become pregnant. If vitamin Ais used during pregnancy, or if the patient becomes pregnant while taking vitamin A, the patient should be apprised of the potential hazard to the fetus. 

The U.S. Recommended Daily Allowance (RDA) of vitamin A (5,000 Units) is recommended for nursing mothers.

Keep below 25°C temperature, away from light & moisture. Keep out of the reach of children.

Vitamin-A preparations

Beta-carotene, retinol, and retinal have effective and reliable vitamin A activity. Retinal and retinol are in chemical equilibrium in the body and have equivalent antixerophthalmic activity. Retinal combines with the rod pigment, opsin, in the retina to form rhodopsin, necessary for visual dark adaptation.

Vitamin A prevents retardation of growth and preserves the epithe-lial cells' integrity. Normal adult liver storage is sufficient to satisfy two years'requirements of vitamin A. Vitamin A is readily absorbed from the gastrointestinal tract, where the biosynthesis of vitamin A from beta-carotene takes place. Vitamin A absorption requires bile salts, pancreatic lipase, and dietary fat. It is transported in the blood to the liver by the chy lomicron fraction of the lymph. Vitamin Ais stored in Kupffer cells of the liver mainly as the palmitate. Normal serum vitamin A is 80-300 Units per 100 mL (plasma range is 30-70 mcg per dl) and for carotenoids 270-753 Units per 100 mL.The normal adult liver contains approximately 100 to 300 micrograms per gram, mostly as retinol palmitate.

For Adults: 50000 IU-100000 IU daily up to 200000 IU if necessary.

Children (Above 1 year):

• Night blindness, Bitot's spots, Xerophthalmia: 200000 IU 1st day, 2nd day, 14th day
• Measles: 200000 IU 1st day, 2nd day
• Diarrhoea, Respiratory tract infection: 200000 IU every time after disease
• Severe malnutrition: 200000 IU single-dose or as directed by the registered physician.

Vitamin A intoxication includes irritability, vomiting, loss of appetite, headache, dry and pruritic skin, skin desquamation, fatique, pain in ankles and feet, myalgia, loss of body hair, papilledema, nystagmus, liver sclerosis and cirrhosis.

Hypervitaminosis of vitamin A. Sensitivity to any of the ingredients in this preparation.

Ensure Vitamin A free interval after long term therapy with vitamin A. No daily dose over 5000 IU during pregnancy. Vitamin A doses over 50000 IU under medical supervision only.

Safety of amounts exceeding 6,000 Units of vitamin A daily during pregnancy has not been established at this time. The use of vitamin A in excess of the recommended dietary allowance may cause fetal harm when administered to a pregnant woman. Animal reproduction studies have shown fetal abnormalities associated with over-dosage in several species. Malformations of the central nervous system, the eye, the palate, and the urogenital tract are recorded. Vitamin Ain excess of the recommended dietary allowance is contraindicated in women who are or may become pregnant. If vitamin Ais used during pregnancy, or if the patient becomes pregnant while taking vitamin A, the patient should be apprised of the potential hazard to the fetus. 

The U.S. Recommended Daily Allowance (RDA) of vitamin A (5,000 Units) is recommended for nursing mothers.

Keep below 25°C temperature, away from light & moisture. Keep out of the reach of children.

Herbal and Nutraceuticals, Vitamin-E Preparations

Vitamin E acts as an antioxidant in the body. Vitamin E protects polyunsaturated fatty acids (which are components of cellular membrane) and other oxygen-sensitive substances such as vitamin A & vitamin C from oxidation. In premature neonates irritability, edema, thrombosis and hemolytic anemia may be caused due to vitamin E deficiency. Creatinuria, ceroid deposition, muscle weakness, decreased erythrocyte survival or increased in vitro hemolysis by oxidizing agents have been identified in adults and children with low serum tocopherol concentrations.

Betterment of cardiovascular health: 400 IU-800 IU per day
Deficiency syndrome in adults: 200 IU-400 IU per day
Deficiency syndrome in children: 200 IU per day
Thalassemia: 800 IU per day
Sickle-cell anemia: 400 IU per day
Betterment of skin & hair: 200 IU-400 IU per day (Topical use is also established for beautification)
Chronic cold in adults: 200 IU per day

Overdosage (>1 gm) have been associated with minor side effects, including hypertension, fatigue, diarrhea and myopathy.

No known contraindications found.

It may increase the risk of thrombosis in some patients, such as those taking estrogens.

Vitamin E may impair the absorption of Vitamin A & function of Vitamin K and potentiates the effect of Warfarin.

Vitamin E is safe in pregnancy and lactation, when used as recommended doses. Higher doses are not established.

Vitamin E is safe for children.

Keep in a dry place away from light and heat. Keep out of the reach of children.

Herbal and Nutraceuticals, Vitamin-E Preparations

Vitamin E acts as an antioxidant in the body. Vitamin E protects polyunsaturated fatty acids (which are components of cellular membrane) and other oxygen-sensitive substances such as vitamin A & vitamin C from oxidation. In premature neonates irritability, edema, thrombosis and hemolytic anemia may be caused due to vitamin E deficiency. Creatinuria, ceroid deposition, muscle weakness, decreased erythrocyte survival or increased in vitro hemolysis by oxidizing agents have been identified in adults and children with low serum tocopherol concentrations.

Betterment of cardiovascular health: 400 IU-800 IU per day
Deficiency syndrome in adults: 200 IU-400 IU per day
Deficiency syndrome in children: 200 IU per day
Thalassemia: 800 IU per day
Sickle-cell anemia: 400 IU per day
Betterment of skin & hair: 200 IU-400 IU per day (Topical use is also established for beautification)
Chronic cold in adults: 200 IU per day

Overdosage (>1 gm) have been associated with minor side effects, including hypertension, fatigue, diarrhea and myopathy.

No known contraindications found.

It may increase the risk of thrombosis in some patients, such as those taking estrogens.

Vitamin E may impair the absorption of Vitamin A & function of Vitamin K and potentiates the effect of Warfarin.

Vitamin E is safe in pregnancy and lactation, when used as recommended doses. Higher doses are not established.

Vitamin E is safe for children.

Keep in a dry place away from light and heat. Keep out of the reach of children.

Specific mineral & vitamin combined preparations

Calcium plays a very important role in the body. It is necessary for normal functioning of bone, nerve cells, muscle, and other vital organs and the regulatory system of the body. If there is not enough calcium in the blood, then the body will take Calcium from bones, thereby weakening bones and triggers different types of bone disorder. Vitamin D3 helps the body to absorb Calcium. Having the right amounts of Calcium and Vitamin D3 is important for building and keeping strong bones and healthy muscles.

Route of Administration: Oral. One tablet in the morning and one tablet at night or as directed by the physician. Use in children and adolescents should be directed by the physician.

Common Side Effects: Generally orally administered Calcium Carbonate may be irritating to the Gl tract and it may also cause constipation but eggshell Calcium is safe for long-term use without causing any Gl discomfort or constipation. Rare Side Effects: Kidney stone, hypercalcemia, alkalosis, loss of appetite.

When hypercalcemia occurs, discontinuation of the drug is required. Patients with a history of kidney stone formation should also be recommended to increase their fluid intake.

With Medicine: It has possible interaction with digoxin, antacids containing Calcium, aluminum or magnesium, other Calcium supplements, calcitriol, tetracycline, doxycycline, aminocycline or oxytetracycline etc. So while taking Calcium tablet with any of these drugs consultations of the physicians is needed.

With food & others: The intestinal uptake of Calcium may be reduced by concomitant ingestion of certain foods (e.g. spinach, milk and milk products).

It should be used as directed by the physician during Pregnancy and Lactation.

Symptoms of overdose may include nausea and vomiting, dry mouth, loss of appetite, metallic taste, diarrhea, weakness, headache, irritability or dizziness etc.

Store in a cool (below 30°C) and dry place, away from light. Keep out of the reach of children.

Specific mineral & vitamin combined preparations

Calcium plays a very important role in the body. It is necessary for normal functioning of bone, nerve cells, muscle, and other vital organs and the regulatory system of the body. If there is not enough calcium in the blood, then the body will take Calcium from bones, thereby weakening bones and triggers different types of bone disorder. Vitamin D3 helps the body to absorb Calcium. Having the right amounts of Calcium and Vitamin D3 is important for building and keeping strong bones and healthy muscles.

Route of Administration: Oral. One tablet in the morning and one tablet at night or as directed by the physician. Use in children and adolescents should be directed by the physician.

Common Side Effects: Generally orally administered Calcium Carbonate may be irritating to the Gl tract and it may also cause constipation but eggshell Calcium is safe for long-term use without causing any Gl discomfort or constipation. Rare Side Effects: Kidney stone, hypercalcemia, alkalosis, loss of appetite.

When hypercalcemia occurs, discontinuation of the drug is required. Patients with a history of kidney stone formation should also be recommended to increase their fluid intake.

With Medicine: It has possible interaction with digoxin, antacids containing Calcium, aluminum or magnesium, other Calcium supplements, calcitriol, tetracycline, doxycycline, aminocycline or oxytetracycline etc. So while taking Calcium tablet with any of these drugs consultations of the physicians is needed.

With food & others: The intestinal uptake of Calcium may be reduced by concomitant ingestion of certain foods (e.g. spinach, milk and milk products).

It should be used as directed by the physician during Pregnancy and Lactation.

Symptoms of overdose may include nausea and vomiting, dry mouth, loss of appetite, metallic taste, diarrhea, weakness, headache, irritability or dizziness etc.

Store in a cool (below 30°C) and dry place, away from light. Keep out of the reach of children.

লাইনেসট্রেনল ও ইথিনাইল এস্ট্রাডিয়েল একটি কম্বাইন্ড গর্ভনিরোধক পিল যা খাওয়ার গর্ভনিরোধক হিসাবে নির্দেশিত।

Oral Contraceptive preparations

প্রতিদিন যথাসম্ভব একই সময়ে নির্দেশ অনুযায়ী পিল খেতে হবে। আপনার মাসিক শুরুর প্রথম দিনই পিল খেতে শুরু করবেন। মাসিকের ২-৫ দিনের ভিতরে যে কোন দিন পিল খাওয়া শুরু করা যায় , কিন্তু সেইক্ষেত্রে প্রথম মাসে পিল খাওয়াকালীন প্রথম সাত দিন কনডম ব্যবহার করা উচিত। প্রতিদিন ১ টি করে , পর পর ২২ দিন পিল খাবেন। ৬ দিনের পিল মুক্ত সময়ের পর পরবর্তী নতুন প্যাকেট থেকে পিল খাওয়া শুরু করবেন ।

এই ৬ দিনের ভিতরেই আপনার মাসিক হবে যা কখনো কখনো পরবর্তী প্যাকেট শুরুর আগে পর্যন্ত চলতে পারে। মাসিক চলতে থাকলেও এই পিল এর পরবর্তী প্যাকেট সপ্তম দিনে আরম্ভ করুন। আপনি যত দিন সন্তান না চাইবেন , ততদিন এই নিয়মে পিল খাওয়া চালিয়ে যাবেন।

প্রাথমিক পর্যায়ে কারও কারও সাময়িক কিছু পার্শ্ব প্রতিক্রিয়া যেমন মাথা ব্যাথা, মাথা ঘোরা, বমি বমি ভাব অথবা পিল খাওয়াকালীন সময়ে সামান্য ফোটা ফোঁটা আকারে মাসিক হতে পারে। কিন্তু নিয়মিত পিল খেতে থাকলে স্বাভাবিকভাবেই এই সমস্ত উপসর্গ দুই থেকে তিন মাসের মধ্যে দূরীভূত হয়ে যাবে। এই সকল উপসর্গের জন্য অতিরিক্ত চিন্তিত হবার কোন কারণ নাই। তবে পার্শ্ব প্রতিক্রিয়া যদি আরও বেশি দিন চলতে থাকে তখন অবশ্যই ডাক্তারের পরামর্শ নিতে হবে।

যে সব ক্ষেত্রে আপনি কম্বাইন্ড গর্ভনিরোধক ব্যবহার করতে পারবেন না-

• ভেনাস থ্রম্বসিস বর্তমানে উপস্থিত অথবা পূর্বে ছিল
• কার্ডিওভাসকুলার অ্যাক্সিডেন্ট ও মায়োকার্ডিয়াল ইনফারকশন অথবা ব্যাধির পূর্ব লক্ষণ
• ডায়াবেটিস মেলিটাসের সঙ্গে সংবহণ নালী সংক্রান্ত লক্ষণ থাকলে
• মারাত্মক রকমের উচ্চ রক্তচাপ
• সিভিয়ার ডিসলিপোপ্রোটিনেমিয়া
• জন্মগত অথবা অন্য কোন ভাবে ভেনাস অথবা আর্টারিয়াল থ্রম্বসিসের প্রবণতা থাকলে
• জনন অঙ্গসমূহ, স্তন অথবা লিভারে ম্যালিগন্যান্ট অবস্থার কথা জানা থাকলে অথবা সন্দেহ করলে
• লিভারের জটিল রোগ থাকলে এমনকি লিভার ফাংশন স্বাভাবিক অবস্থায় ফিরে আসতে ব্যর্থ হওয়ার পূর্ব বিবরন থাকলে
• অজ্ঞাত কারণে ভ্যাজাইনাল ব্লিডিং হলে
• এই পিলের যে কোন উপাদানে অতি সংবেদনশীলতা থাকলে

যদি নির্দিষ্ট সময়ে পিল না খাওয়া হয় এবং যদি ১২ ঘন্টা অতিক্রম না করে তা হলে পিলের কার্যক্ষমতা বজায় থাকে। এক্ষেত্রে যখনই মনে পড়বে তখনই পিলটি খেয়ে নিন এবং পরের পিল গুলি সঠিক সময়ে খাবেন।

যদি ১২ ঘন্টার বেশী সময় পার হয় তবে পিলের কার্যক্ষমতা কমে যায়। তখন আপনাকে নিম্নলিখিত নিয়ম পালন করতে হবে। মনে রাখবেন ১ম ও ৩য় সপ্তাহে যে কোন দিন পিল খেতে ভুলে গেলে বিশেষ সতর্কতার প্রয়োজন। অন্যথায় গর্ভধারনের ঝুঁকি বেশি হতে পারে।

প্রথম সপ্তাহে পিল খেতে ভুলে গেলে এবং ভুলে যাওয়ার আগে ঐ সন্তাহে যৌন মিলন করে থাকলে  ডাক্তারের পরামর্শ নিন । যদি যৌন মিলন না করে থাকেন তাহলেঃ

• ভুলে যাওয়া ট্যাবলেটটি খান
• সাতদিন অতিরিক্ত সাবধানতা গ্রহন করুন
• প্যাক শেষ করুন

দ্বিতীয় সপ্তাহে পিল খেতে ভুলে গেলেঃ

• ভুলে যাওয়া ট্যাবলেটটি খান
• প্যাক শেষ করুন

তৃতীয় সপ্তাহে পিল খেতে ভুলে গেলেঃ

• ভুলে যাওয়া ট্যাবলেটটি খান
• প্যাক শেষ করুন
• ট্যাবলেটহীন বিরতি বাদ দিন
• পরবর্তী প্যাক শুরু করুন

অথবা

• বর্তমান প্যাক বন্ধ করুন
• ট্যাবলেটহীন বিরতি পালন করুন
• ভুলে যাওয়া ট্যাবলেটের দিনসহ ৬ দিনের বেশি নয়
• পরবর্তী প্যাক শুরু করুন

প্যাকের একাধিক পিল ভুলে গেলে অবশ্যই ডাক্তারের পরামর্শ নিতে হবে। আপনি যদি প্যাকের পিল খেতে ভুলে যান এবং প্রথম পিল মুক্ত দিনে আপনার মাসিক না হয় তবে আপনি গর্ভবতী হতে পারেন। পরবর্তী প্যাক আরম্ভের আগে ডাক্তারের পরামর্শ নিন।

সতর্কতাঃ

অন্যান্য শারীরিক অবস্থা, যার জন্য সংবহনগত সমস্যা দেখা দিতে পারে, কিন্তু কম্বাইন্ড গর্ভনিরোধক ব্যবহারের সঙ্গে কোন সম্পর্ক নাই এই সকল ক্ষেত্রে অবশ্যই সতর্কতার প্রয়োজন। যেমন- ডায়াবেটিস মেলিটাস, সিষ্টেমিক লুপাস এরিথমেটোসাস, হিমোলাইটিক ইউরেমিক সিনড্রোম, পেটের নাড়িতে দীর্ঘস্থায়ী প্রদাহ ইত্যাদি এই সকল ক্ষেত্রে অবশ্যই সতর্কতার প্রয়োজন আছে। ঘন ঘন মাইগ্রেন দেখা দেওয়া, টিউমার, লিভারের কার্যকারিতার দীর্ঘদিনের সমস্যা এই সকল ক্ষেত্রেও সতর্কতার প্রয়োজন। বাচ্চাকে বুকের দুধ দিচ্ছেন এমন মহিলাদেরও সতর্কতার প্রয়োজন কারণ কম্বাইন্ড গর্ভনিরোধক পিল বুকের দুধের পরিমান এবং গুনগতমানের পরিবর্তন করতে পারে। ডায়াবেটিক আছে এমন মহিলারা খাওয়ার কম্বাইন্ড গর্ভনিরোধক ব্যবহারকালে বিশেষ করে যখন খাওয়া শুরু করবেন, তখন সতর্কতার প্রয়োজন। যে সব মহিলার ক্ষেত্রে ক্লোয়েসমা গ্রাভিডেরামের পূর্ব বিবরণ রয়েছে তারা চড়া রোদ উপেক্ষা করবেন।

কম্বাইন্ড গর্ভনিরোধক পিল ব্যবহারকারীদের নিম্নলিখিত অনাকাঙ্খিত সমস্যাসমূহ, যেমন স্তনের স্পর্শকাতরতা, মাথাধরা, মাইগ্রেন, কন্টাক্টলেন্সে অস্বস্তিবোধ হওয়া, ত্বকের বিভিন্ন সমস্যা, ইডিমা, শারীরিক ওজনের পরিবর্তন ইত্যাদি দেখা দিলে ডাক্তারের পরামর্শ নিন।

অ্যাম্পিসিলিন, টেট্রাসাইক্লিন, বারবিচুরেটস, হাইড্যান্টয়েনস, প্রিমিডন, কার্বামাজেপিন ও রিফামপিসিন এই জাতীয় কিছু কিছু ঔষধ পিলের কার্যকারিতা কমিয়ে দিতে পারে। পিল খাওয়াকালীন সময়ে যদি আরও কোন ঔষধ কোন কারনে খাওয়ার প্রয়োজন পড়ে তাহলে অবশ্যই ডাক্তারের সাথে পরামর্শ করুন।

গর্ভধারণ করলে অথবা এ ব্যাপারে সন্দেহ দেখা দিলে কম্বাইন্ড গর্ভনিরোধক ব্যবহার করতে পারবেন না।

আলো থেকে দূরে, ২°C-২৫°C তাপমাত্রায় শুষ্ক স্থানে রাখুন। শিশুদের নাগালের বাইরে রাখুন।